Long-term ocular surface stability in conjunctivolimbal autograft and ocular surface safety in the donor eyes.

PURPOSE: The current study is aimed to present the long-term results of the patients who underwent conjunctivolimbal autograft (CLAU) as the primary operation in unilateral limbal stem cell deficiency and the ocular surface safety of the donor eyes. The patients were followed up for five years or longer. METHODS: The records of all patients who underwent CLAU as the primary operation were retrospectively analyzed. Additional ocular surface operations, ocular surface stability, best-corrected visual acuity (BCVA), and ocular surface status of the donor eyes were investigated. RESULTS: The mean age of the patients at the time of transplantation was 35.07 ± 12.9 (12-60). Twenty-nine eyes of 29 patients were followed up for an average of 97.82 ± 34.45 (60-186) months. Additional ocular surface operation was required in 27.58% (8/29) of the eyes in order to achieve a stable ocular surface. Ocular surface stability was achieved in 82.75% (24/29) of the eyes at the end of the follow-up period. BCVA increased from 1.78 ± 0.82 to 0.91 ± 0.92 logMAR at the last visit (p < 0.001). Corneal ectasia and vascularization developed in one donor eye in the fifth postoperative year. CONCLUSIONS: CLAU tissues provide ocular surface stability with a successful vision result in the long term. CLAU theoretically carries risks including limbal stem cell deficiency in the donor eye. In the long-term follow-up of donor eyes after CLAU, ectasia and limbal stem cell deficiency were observed in one eye.

Treatment of persistent epithelial defects with single-dose autologous serum eye drops.

PURPOSE: We aimed to investigate the efficacy and safety of single-dose autologous serum eye drops (ASEDs) for treatment of persistent corneal epithelial defects (PEDs). METHODS: About 34 eyes of 26 patients treated from March 2016 to May 2020 with a single dose of ASEDs for PEDs that did not respond to conventional treatment were retrospectively evaluated. Patient demographics, predisposing factors, size, and duration of the PED, duration of treatment, and dosage of ASEDs, PED healing time, success rate of the ASED treatment, and follow-up time after the onset of ASED treatment were recorded. Autologous serum eye drops (20%) were prepared by diluting the serum with preservative-free artificial tears in single-dose vials. Vials were stored at -20°C and used daily after dissolving. RESULTS: The mean patient age was 47.0 ± 18.5 years, and 13 (50%) of the patients were male. The most common indication for ASEDs was PED after keratoplasty. The mean duration of ASED treatment was 8.5 ± 6.3 months, and mean follow-up time was 22.8 ± 12.2 months. Autologous serum eye drop treatment was effective in 25 (73.5%) eyes and partially effective in 5 (14.7%) eyes. None of the eyes displayed complications related to the treatment. CONCLUSION: In patients with PED for whom conservative treatment is insufficient, ASEDs prepared by dilution with preservative-free artificial tears in single-dose vials and administered based on the daily use principle appear to be effective and safe.

Donor Cornea Use in Scleral Surface Reconstruction

Objectives: To investigate the indications for and results of treating scleral surface problems with donor corneal grafts that are not used in keratoplasty surgery or are left over from keratoplasty. Materials and Methods: The records of 16 patients in whom corneal tissue was used to repair a scleral tissue defect or cover an exposed glaucoma drainage implant were evaluated retrospectively. Partial-thickness grafts were prepared using a combined microkeratome system with artificial anterior chamber in 10 eyes and by manual dissection in 3 eyes. Full-thickness grafts were used in 3 eyes. Results: There were 8 female and 8 male patients aged 5-79 years (mean: 39.37±24.68). Indications for the use of corneal tissue on the scleral surface were limbal dermoid excision (n=2), pterygium surgery (n=1), intraocular lens removal and scleral fixation intraocular lens (SFIOL) implantation (n=1), exposed SFIOL suture coverage (n=1), trauma (n=2), scleral tissue loss due to repeated glaucoma surgeries (n=5), and exposed glaucoma drainage implant (n=4). The patients were followed for 6-42 months (mean: 14.37±9.14). None of the patients had graft infection, thinning, immunological graft rejection, or vision loss during follow-up. Tectonic lamellar grafts did not adversely affect final visual acuity in any case. At final examination, a good combination of graft and recipient tissue, a smooth ocular surface, and a cosmetic appearance were achieved in all eyes. Conclusion: Donor corneas that are not suitable for corneal transplantation or left over from the cornea transplant can be used in patients with scleral tissue loss due to various pathologies and in the treatment of glaucoma drainage implant erosion. In these cases, the use of corneal grafts provides a good ocular surface restoration and cosmetic appearance. The effectiveness and safety of this method should be investigated with large patient series and long follow-up times.

Corneal Pathology and Cataract: Combined Surgery or Sequential Surgery?

Objectives: To compare our combined surgery (CS) and sequential surgery (SS) results. Materials and Methods: The files of 44 patients who underwent CS (penetrating keratoplasty [PK], cataract extraction, and intraocular lens [IOL] implantation) and 126 patients who underwent SS (cataract extraction and IOL implantation in a second session after PK) between January 2009 and December 2018 were evaluated retrospectively. One eye of the patients who were followed up for at least 1 year was included in the study. The two groups were compared in terms of indications, corrected distance visual acuity (CDVA), refractive results, complications, and graft survival. Results: In the CS and SS groups, the median age was 63 (30-79) and 43 (18-73) years (p<0.001) and the median follow-up time was 51 (13-152) and 64.5 (13-154) months (p=0.011), respectively. The most common PK indications were traumatic corneal scar (20.5%) and endothelial dystrophy (15.9%) in the CS group versus keratoconus (24.6%) and stroma dystrophy (17.5%) in the SS group. In the CS and SS groups, 50% vs 69% of patients had CDVA ≥0.4 (p=0.04); 45.5% vs 25.4% had CDVA (0.1-0.3) (p=0.04); and 54.5% vs 73% had spherical equivalent ≤±2.0 D (p=0.02). The most common postoperative complications were glaucoma (20.5% vs 15.9%, p=0.48) and allograft reaction (9.1% vs 23%, p=0.04). Graft survival rates were 95.2% vs 86.5% (p=0.10) at 1 year and 75.9% vs 68.9% (p=0.47) at 5 years, respectively. Conclusion: Over long-term follow-up, the groups were similar in terms of graft survival. For this reason, each patient must be evaluated separately whether to perform a combined or sequential surgery. Given the lower refractive error and higher expectation of final visual acuity, SS can be more advantageous especially in young patients.

Anterior Segment Surgeries Under Topical Fresh Frozen Plasma Treatment in Ligneous Conjunctivitis.

PURPOSE: To evaluate the efficacy of topical fresh frozen plasma (FFP) therapy on clinical symptoms, findings, and prognosis after anterior segment surgeries in patients with ligneous conjunctivitis (LC). METHODS: Retrospective case note review. RESULTS: Eleven eyes of 7 cases whose remission was not achieved after medical treatment such as topical corticosteroids, cyclosporine A, and heparin were included in the study. The median age of admission was 19 (1-49) years, median duration of FFP treatment was 48 (15-79) months, median follow-up period was 62 (16-114) months, and median age at symptom onset was 12 (4-252) months. Diagnosis was made according to clinical presentations, plasminogen activities, and response to treatment. Topical FFP that was prepared in our clinic was used in all cases. Surgeries (membrane excision, eyelid surgery, deep anterior lamellar keratoplasty, and cataract surgery) were performed after at least 1 month of FFP treatment. Prosthetic contact lens was applied to one eye. During the follow-up period, recurrences requiring membrane excision and side effects from topical FFP were not observed. CONCLUSIONS: LC is a rare membranous conjunctivitis that proceeds with remissions and recurrences. When it was shown that the etiology of LC is plasminogen deficiency, FFP became the only treatment option targeting the etiology. In this study, we observed that the topical FFP is an effective treatment method that prevents recurrence and ensures regression of membranes and safer anterior segment surgeries in LC.

Anterior segment parameters in Behçet's patients with ocular involvement.

PURPOSE: To evaluate anterior segment findings in Behçet's disease patients within the ocular involvement inactive period. METHODS: One hundred twenty patients with Behçet uveitis in the inactive period (Behçet's disease group) and 121-age and sex matched healthy subjects (control group) were examined. Anterior segment parameters were assessed by Scheimpflug camera. RESULTS: In Behçet's disease group, the mean age was 39.89 ± 10.16 years, and 55.8% of patients were male; in the control group, the mean age was 38.69 ± 14.08 years, and 56.2% of control subjects were male. Pachymetric measurements of corneal apex (523.84 ± 30.36 µ vs 540.73 ± 27.85 µ, p < 0.001) thinnest point (518.70 ± 30.75 µ vs 537 ± 28.66 µ, p < 0.001), mean corneal volume (57.90 ± 3.39 mm3 vs 59.57 ± 3.37 mm3, p < 0.001) were significantly lower and anterior elevation [5.0 (1.0-34.0) vs 2.0 (1.0-7.0) diopter(D), p < 0.001], posterior elevation [11.0 (1.0-66.0) vs 4.0 (0-22.0) D, p < 0.001)] and corneal astigmatism [1.1 (0-7.1) vs 0.7 (0.1-5.7) D, p = 0.005] were significantly higher in the Behçet's disease group than in control group. No significant difference was found in other anterior segment parameters between the Behçet's disease group and control group. Concurrent keratoconus was detected in two cases (1.7%). A statistically significant correlation was found between the corneal measurements and frequency of uveitis attacks. CONCLUSION: The chronic inflammatory process associated with various proinflammatory cytokines, which play a role in the pathogenesis of keratoconus, may also contribute to a decrease in corneal thickness and corneal volume in Behçet's patients with ocular involvement.

Corneal Collagen Cross-Linking With Photoactivated Chromophore for Infectious Keratitis After Penetrating Keratoplasty.

PURPOSE: To evaluate the efficacy and safety of corneal collagen cross-linking with photoactivated chromophore (PACK-CXL) plus medical treatment in comparison with the non-CXL group in the management of graft infections after penetrating keratoplasty. METHODS: Forty eyes of 40 patients, 18 eyes in the PACK-CXL group and 22 eyes in the non-CXL group, with graft infections were retrospectively reviewed. Patients with microbial keratitis who were resistant to medical treatment for at least 1 week were treated with PACK-CXL in conjunction with medical treatment. The non-CXL group received only medical treatment. RESULTS: The median (interquartile range) size of the infiltrate was 11 (3-12.7) versus 7.5 (3.5-12.7) mm (P = 0.37), the epithelization time was 3 (2.7-5) versus 6 (3-11.2) days (P = 0.06), the complete healing time was 23.5 (17.7-33.5) versus 34 (27.7-41.2) days (P = 0.02), and the best-corrected distance visual acuity was 2.5 (0.5-3) versus 2.0 (0.9-3) logarithm of the minimum angle of resolution (P = 0.79) at presentation and 1 (0.3-3) versus 3 (1-3) logarithm of the minimum angle of resolution (P = 0.19) at the final visit for the PACK-CXL and non-CXL groups, respectively. Resolution of infiltrates was observed in 83.3% and 68.2% of cases in the PACK-CXL and non-CXL groups, respectively (P = 0.28). Graft failure was observed in 5 (27.8%) and 12 (54.5%) patients in the PACK-CXL and non-CXL groups, respectively (P = 0.08). CONCLUSIONS: PACK-CXL appears to be a promising adjuvant procedure in the management of resistant graft infections by reducing both the duration required for complete healing and rates of graft failure.

Wound dehiscence after penetrating keratoplasty.

BACKGROUND: The purpose of this study was to investigate factors affecting wound dehiscence due to blunt trauma following penetrating keratoplasty (PK) and the clinical outcomes. METHODS: The medical records of patients who experienced blunt traumatic wound dehiscence after PK between 1995 and 2015 were analyzed retrospectively. The incidence and etiology of the trauma, the time interval between PK and globe rupture, final graft clarity, best-corrected visual acuity, complications, secondary surgeries, and factors potentially affecting wound dehiscence size were recorded. RESULTS: This study included a total of 39 patients with a mean age of 42.66±16.66 years, of whom 23 patients were male and 16 patients were female. The incidence of wound dehiscence was 2.3%. The mean interval between the PK procedure and wound dehiscence was 25.91±47.24 months and the mean follow-up time was 34.43±51.02 months. The most common trauma mechanism was force with a blunt object (53.8%) and the most frequent site of wound dehiscence was the temporal quadrant (30.8%), the wound ranging from 30° to 270° in size. The patients were divided into 4 groups according to wound dehiscence size. As the size of the wound dehiscence size increased, the male ratio increased, wound dehiscence was more commonly located in the nasal and superior quadrants, lens injury and posterior segment complications were more frequent, and graft transparency was achieved at a lower rate. CONCLUSION: Traumatic wound dehiscence after PK is rare, but may lead to serious, lifelong consequences, including eye loss. Patients should be well informed about the risks and potential sequelae of wound dehiscence.

Candida parapsilosis Infection After Crescentic Lamellar Wedge Resection in Pellucid Marginal Degeneration.

Infectious keratitis after corneal lamellar surgery is a rare complication. In this report, we present unexpected complications after crescentic lamellar wedge resection (CLWR) and their treatment in a patient with pellucid marginal degeneration. A 42-year-old male patient developed fungal keratitis due to Candida parapsilosis in the late postoperative period after CLWR. Infection was controlled with medical treatment. However, recurrent intraocular infections and cataract formation occurred, probably due to capsular damage and inoculation of microorganisms into the crystalline lens during antifungal drug injection. Lensectomy was performed due to cataract progression and recurrence of the infection when treatment was discontinued. Amphotericin B was administered to the anterior chamber at the end of the operation. Four months later, an intraocular lens was implanted and corneal cross-linking treatment was performed. At the last visit, visual acuity reached 9/10. This case shows that good visual acuity can be achieved with appropriate treatment of fungal keratitis and all associated complications after CLWR.

Effect of Donor Cornea on the Surgical Outcomes of Penetrating Keratoplasty: Imported Cornea Versus Domestic Cornea.

OBJECTIVES: In this study, we compared the surgical outcomes of penetrating keratoplasty using domestic and imported donor corneas. MATERIALS AND METHODS: We retrospectively evaluated 200 eyes and 200 consecutive patients who underwent penetrating keratoplasty by using domestic and imported donor corneas between January 2013 and December 2013. The donor characteristics, preoperative clinical features, and clinical outcomes at 6, 12, 24, and 36 months were assessed. RESULTS: No significant differences existed between the 2 groups with respect to age, sex, lateralization, and penetrating keratoplasty indication (P > .05). Donor age was lower (P = .012), the death-to-preservation time and the preservation-to-surgery time were shorter, the rate of epithelial defect was lower, and the endothelial cell count was higher in the domestic group (P < .001). The 2 groups were also similar in terms of developing persistent epithelial defect, glaucoma, keratitis, and graft survival (P > .05). CONCLUSIONS: We observed no significant differences in clinical outcomes during and after penetrating keratoplasty surgery between imported and domestic donor corneas.

Outcomes of Trabeculectomy and Glaucoma Drainage Devices for Elevated Intraocular Pressure After Penetrating Keratoplasty.

PURPOSE: To assess and compare the outcomes of trabeculectomy with and without antimetabolites (AMs) and glaucoma drainage devices (GDDs) in the management of elevated intraocular pressure (IOP) after penetrating keratoplasty (PK). METHODS: Data of 84 eyes of 81 patients who underwent trabeculectomy (12 eyes without an AM and 42 eyes with an AM) or GDD implantation (30 eyes) after PK were reviewed retrospectively. The main outcome measures were IOP control, corneal graft survival, and postoperative ocular complications. RESULTS: At the final visit, IOP success (<22 mm Hg) was 58.3% in trabeculectomy alone, 64.3% in trabeculectomy with an AM (TrabAM), and 86.7% in GDD groups (P = 0.047). The median time from surgery to IOP failure was 1 month after trabeculectomy alone, 13 months after TrabAM, and 20 months after GDD implantation (P = 0.042). The cumulative probability of IOP success rates at 1 and 3 years postoperatively was as follows: 66.7% and 57.1% in trabeculectomy alone, 80.6% and 64.8% in TrabAM, and 92.3% and 84.6 in GDD groups (P = 0.063). The cumulative probability of corneal graft survival rates at 1 and 3 years postoperatively was as follows: 70.0% and 60.0% in trabeculectomy alone, 76.7% and 67.7% in TrabAM, and 65.8% and 52.6% in GDD groups (P = 0.549). CONCLUSIONS: GDDs are more successful than trabeculectomy in controlling IOP in eyes that have undergone PK, but they tend to have low corneal graft survival rates. Trabeculectomy without an AM has limited success and may be considered in a limited number of patients with a low risk for bleb failure.

Ocular findings on follow-up in children who received phototherapy for neonatal jaundice.

BACKGROUND: To evaluate the ocular findings in children between 3 and 5 years of age who had received phototherapy in the neonatal period and to investigate whether they had phototherapy-related permanent ocular damage clinically. METHODS: The phototherapy group (n = 57) consisted of children who had undergone phototherapy for at least 24 h, and the control group (n = 43) comprised children who had not received phototherapy. Ophthalmic examinations consisted of assessment of visual acuity, convergence near point, ocular movements, ocular alignment, dynamic retinoscopy, cycloplegic refraction and biomicroscopic examination of anterior segment and posterior segment (using a 90 D lens in the latest). RESULTS: All children were orthophoric and had normal eye movements. A significant difference was found between the phototherapy group and control group regarding convergence near point 3.0 (2.0-5.0) vs 3.0 (2.0-5.0) (p = 0.018), right cycloplegic spherical equivalent 1.0 (0.0-3.0) vs 0.75 (0.0-4.75) (p = 0.011) and left cycloplegic spherical equivalent 1.0 (0.075-3.0) vs 0.75 (0.0-5.25) (p = 0.006).The study groups were similar according to cycloplegic spherical and cylindrical refractions. However, no significant difference was found between the groups regarding the need for eye glasses. CONCLUSION: Although there were significant differences between the phototherapy and the control groups according to the convergence near point and right and the left eye cycloplegic spherical equivalent, the similarity between the groups regarding the need for eyeglasses suggested that difference was clinically insignificant.

Ophthalmologic evaluation in geriatric patients: Assessment of consistency between patients' complaints and ocular diagnoses.

PURPOSE: This study aimed to assess the consistency between patients' complaints and their eye diseases. DESIGN: Cross-sectional study. METHODS: RESULTS: The frequencies of at least one newly diagnosed visually important ocular disease were 25.9%, 27.0%, and 45.3% in groups 1, 2, and 3, respectively (p<0.001). The same frequencies were significantly higher in patients >75 years of age compared with the younger group (59.1% vs. 22.0%, p<0.001). Although these values were statistically significant in patients ≤75 years of age (p<0.001), they were insignificant in patients >75 years of age according to type of complaints (p=0.773). Patients with diabetes mellitus exhibited significantly lower vision, higher rate of visually important ocular diseases, and higher intraocular pressure readings than patients without diabetes mellitus (p=0.009, 0.015, and 0.002, respectively). CONCLUSIONS: Visually important ocular diseases were diagnosed approximately in a quarter of patients who had no complaints about decrease in vision and in more than half of the oldest geriatric patients (>75years) irrespective of the type of complaints.

Atopic keratoconjunctivitis: long-term results of medical treatment and penetrating keratoplasty / Ceratoconjuntivite atópica: resultados a longo prazo do tratamento clínico e da ceratoplastia penetrante

ABSTRACT Purpose: To evaluate the long-term outcomes of medically or surgically treated patients with atopic keratoconjunctivitis (AKC). Methods: Charts of 16 patients with AKC (32 eyes) observed between 1996 and 2013 were reviewed retrospectively. Outcome measures included demographic features, follow-up duration, and biomicroscopic findings at the first and most recent visits. The corrected distance visual acuity (CDVA; in decimal units) was evaluated at the initial visit and the 1-, 6-, and 12-month follow-up visits. Results: In the medically treated group (25 eyes of 15 patients), the median follow-up duration was 3 (range, 1-9) years, and the median CDVA values were 0.01 (0.001-1.0) at the first visit and 0.01 (0.001-0.8) at the most recent visit (p=0.916). In the penetrating keratoplasty (PK) group (7 eyes of 6 patients), the median follow-up duration was 7 years (range, 1-11), and the median CDVA increased from 0.01 (0.001-0.01) to 0.2 (0.001-0.7) postoperatively (p=0.043). Conclusion: Whereas most AKC patients maintained a useful CDVA with medical treatment, PK may be required in some cases. Despite the frequent occurrence of complications, PK can significantly improve the CDVA.

RESUMO Objetivo: Avaliar os resultados a longo prazo em ceratoconjuntivite atópica (AKC) pacientes que foram tratados clinicamente ou cirurgicamente. Métodos: Os prontuários de 16 pacientes (32 olhos) com AKC, que foram acompanhados entre 1996 e 2013 foram avaliados retrospectivamente. As medidas adotadas foram as características demográficas, tempos de seguimento, e resultados biomicroscópicos da visita inicial e da visita mais recente. A acuidade visual corrigida para distância (CDVA), apresentada em unidades decimais, foi avaliada na visita inicial e nas visitas do 1º mês, 6º mês e 1º ano de seguimento. Resultados: No grupo tratado clinicamente (25 olhos de 15 pacientes), a mediana do tempo de seguimento foi de 3 anos (variação, 1-9) e a CDVA média foi de 0,01 (0,001-1,0) na visita inicial e 0,01 (0,001-0,8) na visita mais recente (p=0,916). No grupo de ceratoplastia penetrante (PK) (7 olhos de 6 pacientes), a mediana de tempo de seguimento foi de 7 anos (variação, 1-11) e a CDVA média aumentou de 0,01 (0,001-0,01) para 0,2 (0,001-0,7) (p=0,043) no pós-operatório. Conclusões: Embora a maioria dos pacientes AKC mantém a CDVA útil com o tratamento clínico, alguns necessitam de PK a fim de obter CDVA útil. Embora as complicações pós-PK ocorrem com freqüência, a CDVA pode melhorar significativamente.

Pars plana vitrectomy with silicone oil tamponade in failed scleral buckle surgery.

OBJECTIVE: This study aimed to evaluate the anatomical and functional outcomes of secondary pars plana vitrectomy (PPV) after failed scleral buckling (SB) surgery and to compare it with primary PPV for rhegmatogenous retinal detachment (RRD), including complicated proliferative vitreoretinopathy cases. DESIGN: Retrospective series in a tertiary care centre. PARTICIPANTS: One hundred and twenty consecutive patients. METHODS: The medical records of patients who underwent PPV with silicone oil tamponade for RRD were reviewed. Forty-four eyes were operated on for primary RRD (primary PPV group), and 76 eyes were operated on for failed SB surgery (secondary PPV group). The single-operation anatomical success rate, final anatomical success rate, and best-corrected visual acuity preoperatively, at 6 months, at 1 year, and at final follow-up were analyzed. RESULTS: The single-operation anatomical success rate was 74.2% in the primary PPV group and 77% in the secondary PPV group (p = 0.48). The final anatomical success rate was 90.3% in the primary PPV group and 91.8% in the secondary PPV group (p = 0.55). The number of cases with visual acuities of 3 visual categories (20/50 or better, 20/200 to 20/50, less than 20/200) was not statistically different at each time point. CONCLUSIONS: Consequent PPV with silicone oil tamponade for failed SB surgery seems not to have inferior anatomical and functional outcomes when compared with primary PPV for RRD.

Atopic keratoconjunctivitis: long-term results of medical treatment and penetrating keratoplasty.

PURPOSE:: To evaluate the long-term outcomes of medically or surgically treated patients with atopic keratoconjunctivitis (AKC). METHODS:: Charts of 16 patients with AKC (32 eyes) observed between 1996 and 2013 were reviewed retrospectively. Outcome measures included demographic features, follow-up duration, and biomicroscopic findings at the first and most recent visits. The corrected distance visual acuity (CDVA; in decimal units) was evaluated at the initial visit and the 1-, 6-, and 12-month follow-up visits. RESULTS:: In the medically treated group (25 eyes of 15 patients), the median follow-up duration was 3 (range, 1-9) years, and the median CDVA values were 0.01 (0.001-1.0) at the first visit and 0.01 (0.001-0.8) at the most recent visit (p=0.916). In the penetrating keratoplasty (PK) group (7 eyes of 6 patients), the median follow-up duration was 7 years (range, 1-11), and the median CDVA increased from 0.01 (0.001-0.01) to 0.2 (0.001-0.7) postoperatively (p=0.043). CONCLUSION:: Whereas most AKC patients maintained a useful CDVA with medical treatment, PK may be required in some cases. Despite the frequent occurrence of complications, PK can significantly improve the CDVA.

Corneal topography analysis of stromal corneal dystrophies.

OBJECTIVE: The aim was to compare the corneal topography and tomography parameters of macular corneal dystrophy (MCD), granular corneal dystrophy (GCD) and lattice corneal dystrophy (LCD) patients obtained by Scheimpflug imaging system. METHODS: The charts, photographs and topography images of patients were reviewed retrospectively. This study included 73 eyes of 73 patients (28 MCD, 20 GCG and 25 LCD patients). Topography images were obtained by Pentacam (Oculus Optikgerate, Wetzlar, Germany). The densitometry readings at the corneal apex were used for the statistics. RESULTS: The female to male ratio was 13/15 in MCD group, 12/8 in GCD group and 13/12 in LCD group. The mean age median age was 32, 45 and 53 years in MCD, GCD and LCD groups respectively. The groups were similar regarding the gender (p=0.861). The MCD group was significantly younger than the other two groups (p<0.001). The median (minmum-maximum) corneal densities were 100 (100-100), 68 (17-100) and 97 (34-100) Pentacam densitometry units in MCD, GCD and LCD groups respectively. The corneal density at the corneal apex was significantly higher in MCD group than in the other groups (p<0.001). The GCD and LCD groups were statistically similar in terms of density of the corneal apex (p=0.079). In MCD group, corneal thickness at the apex and at the thinnest location was significantly thinner, than in the other groups (p=.002 for thickness at apex between MCD and LCD, and p<.001 for all the remaining comparisons). In MCD group corneal volume was significantly smaller than in the other groups (p<.001 for all comparisons). CONCLUSION: Densitometry on Scheimpflug imaging system gives information on the density of corneal opacities.

Comparison of Scheimpflug imaging analysis of pellucid marginal corneal degeneration and keratoconus.

AIM: To determine and compare various quantitative parameters of pellucid marginal degeneration (PMD) and keratoconus with against-the-rule astigmatism (KC-ARA) obtained by elevation-based Scheimpflug imaging and to identify characteristics that can be used to discriminate PMD from KC-ARA. SETTING: Ophthalmology Clinic, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey. DESIGN: Retrospective case-control study. PATIENTS AND METHODS: Patients with ARA, a butterfly or crab claw pattern in the curvature maps, a kissing bird pattern in the elevation maps and the bell sign in the pachymetric maps were identified, and 60 eyes of 40 patients were chosen for the evaluation. The patients were divided into two groups: the PMD group (29 eyes of 18 patients) and the KC-ARA group (31 eyes of 22 patients). By moving the cursor manually, the pachymetric maps and Scheimpflug images were searched for a thinner location than the automatically identified thinnest location. The coordinates and thickness of this manually identified location were evaluated. RESULTS: In the PMD group, 7 (24.1%) eyes did not have any thinner location than the automatically identified thinnest location on the pachymetric maps and the Scheimpflug images, and in 22 (75.8%) eyes, a thinner location, which was located more peripherally, was found by manual evaluation of the pachymetric maps or Scheimpflug images. In 9 (31.0%) eyes of these 22, the manually identified thinnest locations were visible on pachymetric maps, and in 13 (44.8%) eyes the more peripheral thinnest locations were not visible on pachymetric maps but on Scheimpflug images. In the KC group, no patients had thinner locations than the automatically identified thinnest points on the pachymetric maps and the Scheimpflug images. CONCLUSION: A more peripheral thinner location than the automatically identified thinnest location exists in most of the eyes with PMD. In KC-ARA eyes, a thinner location than the automatically found thinnest point does not exist. Accordingly, a more peripheral thinner point than the identified thinnest point is a very strong indication for PMD.

Therapeutic penetrating keratoplasty for infectious and non-infectious corneal ulcers.

This study reports the outcomes of therapeutic penetrating keratoplasties, defined as keratoplasties performed to eradicate active infectious corneal diseases or to repair a structural defect of the cornea. The records of 24 eyes of 24 patients (17 female and 7 male) treated with therapeutic penetrating keratoplasty between 2002 and 2010 were evaluated retrospectively. Patients were divided into infectious keratitis group and non-infectious keratitis group. The mean age was 52.12 ± 17.91 years. The median follow-up time was 22 months (min-max: 6-96). Therapeutic success was achieved and eyes were preserved in 23 patients and one patient required evisceration for recurrent fungal infection. At the end of the follow-up period, 92.9 % (n = 13) and 77.8 % (n = 7) of grafts remained clear in the infectious and non-infectious groups, respectively (p = 0.538). Visual acuity (VA) improved at least one Snellen line in 23 patients. The mean postoperative decimal VA was 0.2 ± 0.3 and 0.1 ± 0.3 in the infectious and non-infectious groups, respectively (p = 0.12). Amniotic membrane transplantation was performed in two eyes preoperatively and in four eyes postoperatively. Therapeutic penetrating keratoplasty continues to be an effective method in the treatment process of serious perforated and non-perforated corneal infectious and non-infectious diseases resistant to medical and other surgical interventions.

Scheimpflug imaging in dermatochalasis patients before and after upper eyelid blepharoplasty.

PURPOSE: The aim of this study was to evaluate corneal parameters obtained by Scheimpflug imaging of dermatochalasis patients both preoperatively and after blepharoplasty. MATERIALS AND METHODS: Sixty eyes of 30 patients (22 female, 8 male), which were operated upon for the upper eyelid, were included in the study. Patients were divided into two groups according to preoperative upper margin reflex distance (MRD): MRD < 2.5 mm (Group 1) and MRD ≥ 2.5 mm (Group 2). Preoperative and postoperative (third-month) central corneal thickness, anterior chamber depth, steepest keratometric reading, and astigmatic power vectors were the main outcomes. RESULTS: Postoperatively, the keratometric value of the steepest meridian increased significantly in Group 1 (p = 0.018). Preoperatively and postoperatively, J0 and J45 astigmatic power vectors were similar in each group (in Group 1, for J0 p = 0.20 and for J45 p = 0.67; in Group 2, for J0 p = 0.90 and for J45 p = 0.75). The groups were similar regarding the changes in Ksteep, in astigmatic power vector J0 naJ45 (p = 0.11, p = 0.24, p = 0.55, respectively). CONCLUSIONS: The repositioning of the upper eyelid does not lead to significant changes in visual acuity, steepest keratometric reading, anterior chamber depth, central corneal thickness, or astigmatic power vector of J0 and J45. The only parameter that was significantly different from the preoperative value was the steepest keratometry reading in Group 1 patients. According to our results, blepharoplasty seems not to cause significant changes in the main corneal indices.