Evaluation of Long-Term Corneal Morphology After Photorefractive Keratectomy by In Vivo Confocal Microscopy and Specular Microscopy; 20-Year Follow-Up.

PURPOSE: To evaluate long-term corneal morphological changes after photorefractive keratectomy (PRK) using in vivo confocal microscopy (IVCM) and specular microscopy. METHODS: This comparative case-control study included 16 eyes of 8 patients who underwent PRK for mild to moderate myopia 20 years ago and 30 eyes of 15 sex- and age-matched healthy controls. Corneal epithelial cells, sub-basal nerves, keratocytes (anterior, midstromal, and posterior), and endothelial cells were evaluated in both groups 10 and 20 years after surgery. Long-term visual outcomes were also recorded. RESULTS: In vivo confocal microscopy examination revealed similar epithelial morphology, sub-basal nerve fiber morphology/density, mid/posterior stromal keratocyte density, and endothelial cell density between PRK patients and controls at their 10th and 20th year follow-up. Anterior stromal keratocyte density was lower at 10th year; however, it reached to control group value at 20th year follow-up. Extracellular matrix reflectivity was slightly higher, and there was a trace subepithelial corneal haze in PRK group (milder in 20th year than 10th year) compared with controls. At the 20th year, uncorrected distance visual acuity was 20/20 or more in 6 eyes (37.5%), 20/40 or more in 16 eyes (100%), and all eyes had corrected distance visual acuity of 20/20 or better (spherical equivalent -0.31±0.37 D). CONCLUSIONS: Photorefractive keratectomy in low to moderate myopia seems to be safe and effective method in the long term with preserving corneal morphology (including anterior stromal keratocyte and sub-basal nerve fiber density) and refractive outcomes as shown in this study. In appropriate patients, this method can be considered confidently.

Conventional Corneal Collagen Cross-Linking Versus Transepithelial Diluted Alcohol and Iontophoresis-Assisted Corneal Cross-Linking in Progressive Keratoconus.

PURPOSE: To compare clinical outcomes of conventional corneal cross-linking (C-CXL) and diluted alcohol and iontophoresis-assisted corneal cross-linking (DAI-CXL) for the treatment of progressive keratoconus (KC). METHODS: Ninety-three eyes of 80 patients with KC were treated by C-CXL (n = 47) or DAI-CXL (n = 46). Visual acuity, keratometry, KC indexes, pachymetry, and aberrations were recorded before treatment and 1, 3, 6, and 12 months after treatment. The demarcation line was assessed 1 month after treatment. RESULTS: A significant improvement in visual acuity was observed at month 3 and month 6 after DAI-CXL and C-CXL, respectively. A significant decrease in maximum keratometry was observed in both groups at month 6. The front symmetry index significantly improved in both groups after 6 months, whereas the Baiocchi Calossi Versaci index significantly improved only after DAI-CXL at month 12 (P = 0.01). Average keratometry and other KC indexes were stable during 12 months of follow-up. Central corneal thickness decreased by 28.6 and 40.2 µm after DAI-CXL and C-CXL at month 1, respectively (P < 0.01), and it reached baseline at the 12th month (P = 0.14) only in the DAI-CXL group. Higher-order aberrations, coma, and spherical aberration significantly worsened at month 1 (P < 0.01) only after C-CXL; however, they improved significantly at month 12 compared with baseline (P < 0.05) in both groups. The demarcation line was visible in all cases at month 1 at a mean depth of 302 ± 56 µm and 311 ± 57 µm after DAI-CXL and C-CXL, respectively (P = 0.7). CONCLUSIONS: The DAI-CXL protocol seems as effective as the C-CXL protocol in halting KC progression after 1 year of follow-up.

The outcome of penetrating keratoplasty for corneal scarring due to herpes simplex keratitis.

PURPOSE:: To determine the outcomes of penetrating keratoplasty (PK) for treatment of corneal scarring caused by Herpes simplex virus (HSV) keratitis, and whether the corneal scar type affects treatment outcome. METHODS:: A retrospective analysis of patients who underwent PK for HSV-related corneal scarring between January 2008 and July 2011 was performed. The patients were categorized into two groups. Group 1 consisted of patients with a quiescent herpetic corneal scar and group 2 consisted of patients who developed a corneal descemetocele or perforation secondary to persistent epithelial defects with no active stromal inflammation. The mean follow-up was 21.30 ± 14.59 months. The main parameters evaluated were recurrence of herpetic keratitis, graft rejection, graft failure, visual acuity, and graft survival rate. RESULTS:: There were 42 patients in group 1 and 13 in group 2. Preoperative BCVA varied from hand movements to 0.7 logMAR. Postoperatively, 34 patients (61.8%) achieved visual acuity of 0.6 logMAR or more. Recurrence of HSV keratitis was noted in 12 (28.57%) eyes in group 1 and 4 (30.76%) eyes in group 2 (p=0.40). Graft rejection occurred in 4 eyes (9.52%) in group 1 and in 3 (23.07%) eyes in group 2 (p=0.58). The 1-, 2-, and 3-year graft survival rates were 91.9%, 76.0%, and 65.1% in group 1, and 89.5%, 76.0%, and 63.6% in group 2 (p=0.91), respectively. CONCLUSIONS:: Although there were different recurrence and graft rejection rates for two groups, the graft survival rates at 3 years were similar. According to our results, without inflammation, corneal herpetic scarring with a descemetocele or perforation achieved similar graft survival rates with quiescent herpetic corneal scars.

The outcome of penetrating keratoplasty for corneal scarring due to herpes simplex keratitis / O resultado da ceratoplastia penetrante para cicatriz de córnea consequente à ceratite por herpes simplex

ABSTRACT Purpose: To determine the outcomes of penetrating keratoplasty (PK) for treatment of corneal scarring caused by Herpes simplex virus (HSV) keratitis, and whether the corneal scar type affects treatment outcome. Methods: A retrospective analysis of patients who underwent PK for HSV-related corneal scarring between January 2008 and July 2011 was performed. The patients were categorized into two groups. Group 1 consisted of patients with a quiescent herpetic corneal scar and group 2 consisted of patients who developed a corneal descemetocele or perforation secondary to persistent epithelial defects with no active stromal inflammation. The mean follow-up was 21.30 ± 14.59 months. The main parameters evaluated were recurrence of herpetic keratitis, graft rejection, graft failure, visual acuity, and graft survival rate. Results: There were 42 patients in group 1 and 13 in group 2. Preoperative BCVA varied from hand movements to 0.7 logMAR. Postoperatively, 34 patients (61.8%) achieved visual acuity of 0.6 logMAR or more. Recurrence of HSV keratitis was noted in 12 (28.57%) eyes in group 1 and 4 (30.76%) eyes in group 2 (p=0.40). Graft rejection occurred in 4 eyes (9.52%) in group 1 and in 3 (23.07%) eyes in group 2 (p=0.58). The 1-, 2-, and 3-year graft survival rates were 91.9%, 76.0%, and 65.1% in group 1, and 89.5%, 76.0%, and 63.6% in group 2 (p=0.91), respectively. Conclusions: Although there were different recurrence and graft rejection rates for two groups, the graft survival rates at 3 years were similar. According to our results, without inflammation, corneal herpetic scarring with a descemetocele or perforation achieved similar graft survival rates with quiescent herpetic corneal scars.

RESUMO Objetivo: Determinar os resultados da ceratoplastia penetrante (PK) para o tratamento da cicatriz da córnea consequente à ceratite por Herpes simplex vírus (HSV), e se o tipo de cicatriz na córnea afeta o resultado cirúrgico. Métodos: Foi realizada análise retrospectiva dos pacientes, submetidos à PK para a cicatriz da córnea relacionados com o HSV entre janeiro de 2008 e julho de 2011. Os pacientes foram divididos em dois grupos. Grupo 1 consistiu de pacientes que tiveram cicatriz corneana herpética quiescente e grupo 2 consistiu de pacientes que desenvolveram descemetocele ou perfuração córnea secundária a defeitos epiteliais persistentes sem inflamação estromal ativa. O seguimento médio foi de 21,30 ± 14,59 meses. Os principais parâmetros avaliados foram recorrência de ceratite herpética, rejeição de enxerto, falência do enxerto, acuidade visual e taxa de sobrevida do enxerto. Resultados: Foram avaliados 42 pacientes do grupo 1 e 13 doentes do grupo 2. Acuidade visual pré-operatória variou de movimentos das mãos (HM) para 0,7 logMAR. No pós-operatório, 34 pacientes (61,8%) atingiram acuidade visual de 0,6 logMAR ou melhor. Doze olhos (28,57%) tiveram recorrência de HSV ceratite no grupo 1, e quatro olhos (30,76%) tiveram recorrência no grupo 2 (p=0,40). A rejeição do enxerto ocorreu em 4 olhos (9,52%) no grupo 1, e em 3 olhos do grupo 2 (23,07%; p=0,58), taxa de sobrevivência do enxerto foi de 91,9% a 1 ano, 76,0% aos 2 anos e 65,1% aos 3 anos no grupo 1, e 89,5% a 1 ano, 76,0% aos 2 anos e 63,6% aos 3 anos no grupo 2 (p=0,91). Conclusões: Embora diferentes taxas de recorrência e de rejeição do enxerto foram encontradas nos dois grupos, a taxa de sobrevida do enxerto em 3 anos foi semelhantes nos dois grupos. De acordo com nossos resultados, em casos sem inflamação, a cicatriz herpética da córnea com descemetocele ou perfuração demonstra as taxas de sobrevivência do enxerto semelhantes às da cicatriz corneana herpética quiescente.

Agreement between Corneal Thickness Measurements Using Pentacam Scheimpflug Camera, Noncontact Specular Microscopy, and Ultrasonographic Pachymetry in Diabetic Patients.

PURPOSE: To evaluate the agreement of corneal thickness (CT) measurements obtained by the Pentacam Scheimpflug camera, noncontact specular microscopy (SM), and ultrasonographic pachymetry (UP) in diabetic (DM) patients; and whether duration of diabetes and level of Hb A1c affect the agreement. MATERIALS AND METHODS: The CT was measured in 127 patients with DM, and 137 age and sex-matched healthy controls sequentially by Pentacam, SM, and UP. Also diabetic subjects were subdivided according to duration of diabetes and Hb A1c levels. Pearson correlation analysis, linear regression analysis, and Bland-Altman plots were used for examination of agreement. RESULTS: We found an excellent and statistically significant correlation of CT measurements between Pentacam-SM (R2 = 0.768; R2 = 0.855), Pentacam-UP (R2 = 0.546; R2 = 0.652), and SM-UP (R2 = 0.759; R2 = 0.797) in diabetic and control groups, respectively. We performed further comparisons of the pair of instruments using the Bland-Altman analysis, and the mean difference between pair of methods was much smaller for SM-UP pair (-4.20 ± 9.79 in diabetic, and -4.58 ± 8.08 in control group). The group having Hb A1c level less than 7.5% showed the best agreement between SM-UP pair as in the control group. Whereas Pentacam-UP showed the best agreement in the group having Hb A1c level ≥7.5%. The best agreement was between Pentacam-UP in 0-4 year group, and between Pentacam-SM in 5-9 year and ≥10 year groups. CONCLUSION: SM-UP pair showed a higher agreement in diabetic patients. According to subgroup analyses, Hb A1c level, rather than the duration of diabetes, may determine the agreement of these pachymetry devices. But the difference in CT measurements between devices can still influence clinical diagnosis and treatment. Therefore, these methods are not completely interchangeable.

Macular ganglion cell complex thickness in acute and chronic central serous chorioretinopathy.

Central serous chorioretinopathy (CSCR) is characterized by neurosensory retinal detachment. Because the retina pigment epithelium and choroidal pathology is the current mechanism in CSCR, many studies in the literature focused on the outer retinal layers. There is little information about the functional or histological structure of the detached retina. In this study, we assess the ganglion cell complex (GCC) thickness using optical coherence tomography (OCT) in patients with acute and chronic CSCR. The medical records of 16 acute and 19 chronic CSCR patients which have no other disorders that cause a serous macula detachment were analyzed. Chronic cases were also divided into two subgroups: chronic active and chronic nonactive CSCR. The eyes with extramacular involvement or cystoid degeneration and cases which developed choroidal neovascularization were excluded from the study. The mean, minimum, superior-nasal, superior, superior-temporal, inferior-nasal, inferior, and inferior-temporal GCC values obtained using OCT were used for analysis. The duration from the onset was 7.8 ± 4.5 weeks and the mean age was 45.0 ± 10.7 years in acute CSCR, and in chronic cases the values were 36.0 ± 6.2 weeks and 52.9 ± 10.5 years, respectively. There were no significant differences in sex distribution. The chronic cases were statistically significantly older than acute cases (p = 0.02). While there was no difference between the acute and chronic cases, there were statistically significant differences between the chronic CSCR and control group in all values of GCC. Additionally, there were statistically significant differences between the acute CSCR and control group in mean, minimum, and superior-temporal GCC thicknesses. Although choroid and outer retinal layers play an important role in the pathogenesis of CSCR, there is scant information about the functional or histological structure of the detached retina in CSCR. Our results showed that GCC was significantly reduced in both acute and chronic CSCR compared to healthy subjects. Analysis of ganglion cell helps us understand the etiology of the patients which healed anatomically but had limited visual improvement in CSCR.

Changes in the Macular Ganglion Cell Complex Thickness and Central Macular Thickness after Argon Laser Panretinal Photocoagulation.

PURPOSE: To evaluate the changes in the macular ganglion cell complex (GCC) thickness and central macular thickness (CMT) as measured by spectral domain optical coherence tomography (OCT) post-argon laser panretinal photocoagulation (PRP). METHODS: The medical records of 25 patients with proliferative diabetic retinopathy (PDR) who underwent PRP, 29 patients with non-proliferative diabetic retinopathy (NPDR), and 29 patients with diabetes but without diabetic retinopathy (DR) were analyzed. The patients who received PRP were followed up for one year. The follow-up measurements were evaluated at baseline, and months 1, 6, and 12 post-argon laser PRP. The baseline values of CMT and GCC thickness were compared among the groups to assess changes with PRP therapy. RESULTS: The CMT gradually increased in months 1 and 6 and then decreased; however, it was significantly higher than the baseline value at month 12 in the PDR group post-PRP. The GCC thickness also increased at months 1 and 6 in almost all segments of the macula, but at month 12 decreased to the baseline value. There was no correlation between the increasing thickness of the macula and change in the GCC thickness post-PRP period in the PDR group. In addition, no significant correlation was detected between the GCC thickness and best-corrected visual acuity during all follow-up visits. CONCLUSIONS: GCC thickness increased significantly until month 6 compared with baseline values in most of the macular segments post-PRP in the PDR group. The GCC thickness at month 12 was not different from the baseline thickness in any of the macular segments.

RETRACTED: Azithromycin 1.5% Ophthalmic Solution for Blepharitis Treatment: Comparison of 14- Versus 30-Day Treatment.

The online-ahead-of-print published article, "Azithromycin 1.5% Ophthalmic Solution for Blepharitis Treatment: Comparison of 14- Versus 30-Day Treatment," by Altay Yesim, Demirok Gulizar, Balta Ozgur, and Bolu Hulya (DOI: 10.1089/jop.2015.0099) is being officially retracted from Journal of Ocular Pharmacology and Therapeutics (JOPT) due to post-publication authorship disputes and the discovery of simultaneous submission to both JOPT and the International Journal of Ophthalmology, which is a violation of the proper protocols of peer review. Journal of Ocular Pharmacology and Therapeutics and its editorial leadership are committed to maintaining the highest levels of scientific reporting and publishing, and therefore officially retracts the article based on the infringements listed herein.

Intraoperative application of 5-fluorouracil and mitomycin C aschemoadjuvants in primary pterygium surgery.

BACKGROUND/AIM: To compare the effectiveness of intraoperative 5 fluorouracil (5-FU) and mitomycin C (MMC) application in preventing recurrence following primary pterygium excision. MATERIALS AND METHODS: This was a prospective clinical trial that included 93 patients with primary pterygia assigned to three treatment groups in which 29 patients received an intraoperative application of 25 mg/mL 5-FU for 5 min, 32 patients received an intraoperative application of 0.02% MMC for 5 min, and 32 patients underwent only surgical excision (the control group). Follow-up visits were done on postoperative days 1, 3, 7, 15, and 30, and then every month. RESULTS: After a mean follow-up of 14 months, the surgical excision recurrence rates in the 5-FU, MMC, and control groups were 27.6%, 12.5%, and 43.75%, respectively. There was a statistically significant difference in the 5-FU and MMC groups when compared with the control group (chi-square; P = 0.04); however, the difference between the 5-FU and MMC groups was not significant. No serious complications were seen in the 5-FU and MMC groups. CONCLUSION: Intraoperative application of MMC and 5-FU is effective and safe for the prevention of recurrence. Our findings suggest that MMC is more potent for the prevention of recurrence and it causes less complaints than 5-FU.

Amniotic membrane transplantation in bacterial and herpetic stromal keratitis.

BACKGROUND/AIM: The aim of this study was to describe the results of amniotic membrane transplantation (AMT) in patients with bacterial and herpetic stromal keratitis. MATERIALS AND METHODS: This was a retrospective chart review study including 42 patients with herpetic keratitis (group 1) and 42 patients with bacterial keratitis (group 2). AMT was performed in addition to antimicrobial therapy. Topical steroids were administered after surgery. The outcome parameters evaluated were epithelialization time, decrease of stromal inflammation, and uncorrected visual acuity (UCVA). RESULTS: The average age of our patients was 55.85 ± 19.07 years, and average follow-up was 14.70 ± 11.75 months. The period of epithelialization was 19.23 ± 7.32 days in the herpetic group and 19.31 ± 6.30 days in the bacterial group. Descemetocele developed in 2 patients of the herpetic group. Other patients in both groups completed epithelialization after AMT procedures with varying amounts of corneal scarring. The bacterial group showed an improvement in UCVA, but the herpetic group showed no improvement in UCVA. CONCLUSION: AMT is a convenient approach for the treatment of corneal keratitis resistant to conventional treatment and allows the use of early topical steroid application. It provides patients with corneal scarring an opportunity for subsequent keratoplasty by arresting the inflammatory response.

Changing indications and techniques for corneal transplantations at a tertiary referral center in Turkey, from 1995 to 2014.

BACKGROUND: Indications for corneal transplantation in developed and developing nations differ according to the different spectrum of corneal disease in each country. OBJECTIVE: The purpose of this study is to analyze the changing indications and surgical techniques for corneal transplantation over the past 20 years at a tertiary referral center in Turkey. METHODS: We retrospectively reviewed the records of patients who underwent keratoplasty from January 1995 to December 2014 (between 1995 and 2004, period 1, and between 2005 and 2014, period 2). Patients' demographic data, indications for corneal transplantation, and the type of surgery were recorded. RESULTS: The number of keratoplasties performed ranged from 548 in period 1 to 782 in period 2. Between 1995 and 2004, the leading indications were keratoconus (34.1%), bullous keratopathy (17%), and non-herpetic corneal scar (13.3%), and between 2005 and 2014, they were keratoconus (33.8%), corneal stromal dystrophy (14.2%), and bullous keratopathy (12.7%). All the keratoplasties performed in the 1995-2004 period were penetrating keratoplasty (PKP). During the period 2005-2014, PKP accounted for 93%, automated lamellar keratoplasty 5.8%, and deep anterior lamellar keratoplasty 1.2% of all corneal transplantations. CONCLUSION: Keratoconus was the leading indication for keratoplasty in both periods. In the 2005-2014 period, corneal stromal dystrophy increased significantly. All the keratoplasties performed in period 1 and 93% of all keratoplasties performed in period 2 were PKP.

Measurements of Pupillary Diameter and Wavefront Aberrations in Pregnant Women.

Purpose. To show whether pregnancy affects the measurements of pupillary diameter and wavefront (WF) aberrations. Methods. This was a case-control study including 34 healthy pregnant women in the third trimester and age-matched 34 nonpregnant women. Only women who had no ocular abnormalities and no refractive error were included. We measured photopic and mesopic pupil diameter and WF aberrations at the third trimester and at the second postpartum month. Measurements of the right eyes were used in this study. The differences between groups were analysed by paired t-test and t-test. Results. Pregnant women's mean photopic pupil size in the third trimester was significantly higher than in postpartum period and in control group (3.74 ± 0.77, 3.45 ± 0.53, and 3.49 ± 0.15 mm, p < 0.05, resp.). Mesopic pupil size in the third trimester was also higher than in postpartum period and in control group (6.77 ± 0.52, 6.42 ± 0.55, and 6.38 ± 0.21 mm, p < 0.05, resp.). RMS-3 and RMS-5 values were higher in pregnancy but these differences were not statistically significant. Conclusion. Pregnancy increased photopic and mesopic pupil size significantly but did not increase wavefront aberrations notably. Increased pupil size may be due to increased sympathetic activity during pregnancy. And this activity can be noninvasively determined by measuring pupil size.