Galectin-3, IL-1A, IL-6, and EGF Levels in Corneal Epithelium of Patients With Recurrent Corneal Erosion Syndrome.

PURPOSE: To determine the galectin-3 (Gal3), interleukin-1 (IL-1), interleukin-6 (IL-6), and epidermal growth factor (EGF) levels in corneal epithelium of patients with recurrent corneal erosion (RCE) syndrome and compare them with healthy controls. METHODS: In this prospective interventional case control study, 32 eyes of 32 patients with RCE syndrome who had corneal epithelial erosions and 28 eyes of 28 healthy participants scheduled for photorefractive keratectomy (control group) were included. Exclusion criteria included corneal dystrophies, ectasia, dry eye, previous ocular surgery or topical medications, and systemic diseases. Epithelial samples were obtained during epithelial debridement in the study group and mechanical epithelial keratectomy in the control group. Galectin-3 levels were studied by the chemiluminescent microparticle immunoassay method. IL-1, IL-6, and EGF levels were determined using corresponding ELISA kits. RESULTS: The median Gal3 levels were 132.25 ng/mL in the study group and 106.50 ng/mL in the control group. The median IL-1 and IL-6 levels were 6.24 pg/mL and 10.16 pg/mL, respectively, in the study group which were higher than that in the control group. The median EGF level in the study group was lower than that the control group with 1.30 pg/mL versus 2.67 pg/mL. In the control group, there was a significant positive correlation between EGF and IL-6 (r = 0.554; P = 0.040). A similar correlation was not observed in patients with RCE (r = -0.071; P = 0.794). CONCLUSIONS: The lack of increased EGF expression and the imbalance between growth factors, adhesion molecules, and interleukins may be the reason for the impaired wound healing response in RCE syndrome.

Descemet Membrane Endothelial Keratoplasty: Outcomes in the First Year of Experience.

OBJECTIVES: We aimed to report the clinical outcomes of Descemet membrane endothelial keratoplasty in our first year of experience. MATERIALS AND METHODS: Patients who underwent Descemet membrane endothelial keratoplasty at the Baskent University Faculty of Medicine, Department of Ophthalmology, between 2015 and 2016 were included in the study. Patient demographics, cause of endothelial dysfunction, best-corrected visual acuity, central corneal thickness, graft survival, follow-up duration, and intraoperative and postoperative complications were recorded. RESULTS: Five eyes of 5 patients (4 female, 1 male) with a mean age of 53.4 ± 12.7 years were included. Cause of endothelial dysfunction included corneal endothelial dystrophy in 3 patients, pseudophakic bullous keratopathy in 1 patient, and endothelial graft failure after previous penetrating keratoplasty in 1 patient. Pre-stripped Descemet membranes obtained from the Ankara State Hospital Eye Bank were used. Mean duration of postoperative follow-up was 7.4 ± 3.7 months. Mean preoperative Snellen best-corrected visual acuity and central corneal thickness were 0.24 ± 0.15 and 625.5 ± 97.4 µm. Mean best-corrected visual acuity increased to 0.67 ± 0.26 (P = .02) in the first month and to 0.84 ± 0.11 (P < .01) at the end of follow-up. Mean central corneal thickness decreased to 546.6 ± 28.4 µm (P = .03). Graft detachment was observed in 1 patient on the first postoperative day, and it was reattached successfully by injection of air into the anterior chamber. There were no intraoperative complications. All corneas were clear at the end of follow-up. CONCLUSIONS: Descemet membrane endothelial keratoplasty provides a new and exciting option for endothelial transplant and has the potential to become the primary procedure for surgical management of Fuchs endothelial dystrophy and corneal endothelial disease. Rapid visual rehabilitation with few and manageable complications and good visual outcomes are the major advantages of this procedure.

Effect of dry eye on Scheimpflug imaging of the cornea and elevation data.

OBJECTIVE: To evaluate the effect of dry eye on Scheimpflug imaging of the cornea and elevation data. DESIGN: Prospective observational study. PARTICIPANTS: Scheimpflug images of 50 patients with dry eye who were being tested for eligibility for corneal refractive surgery were screened. Twelve eyes of 12 patients with abnormal Belin/Ambrosio enhanced ectasia display (BAD) anterior elevation difference were included in the study. The patients had no history of contact lens wear or any other sign of ectasia. METHODS: Peak central corneal densitometry value, corneal volume, pachymetry at the thinnest point, and BAD anterior elevation difference value at the centre of the 9 mm zone were recorded before and after 4 weeks of dry eye treatment. Measurements were compared with the Wilcoxon signed rank test. RESULTS: The mean corneal peak densitometry and volume were similar before and after therapy (p = 0.465 and p = 0.441, respectively). The mean anterior elevation difference value at the centre of the 9 mm zone before treatment (6.67 ± 1.72 µm) was significantly higher than the mean post-treatment value (4.00 ± 1.48 µm) (p = 0.002). The mean pachymetry at the thinnest location after treatment (548 ± 11.0) was significantly higher than the pretreatment value (538 ± 8.5) (p = 0.027). CONCLUSIONS: BAD anterior elevation differences and pachymetric measurements may be affected by ocular surface or tear film abnormalities associated with dry eye disease. Repeated evaluations after treatment may reveal normal results.

Visual Rehabilitation After Penetrating Keratoplasty.

OBJECTIVES: Here, our aim was to report our treatment strategies and their results performed for visual rehabilitation after penetrating keratoplasty. MATERIALS AND METHODS: The medical records of 98 patients (54 male/44 female), with results from 104 eyes, who underwent penetrating keratoplasty between January 2013 and January 2015 at the Baskent University Faculty of Medicine, Department of Ophthalmology were reviewed. Patient age, indication for penetrating keratoplasty, interventions performed for visual rehabilitation, follow-up duration, topographic and refractive astigmatism at the end of follow-up, and final best corrected visual acuity results were recorded. RESULTS: Mean age of patients was 54 ± 23 years. Indications for penetrating keratoplasty included keratoconus, Fuchs endothelial dystrophy, pseudophakic bullous keratopathy, and corneal scarring. The mean duration of follow-up was 23 ± 11.5 months. Topography-guided suture adjustment and selective suture removal were performed 2 to 6 weeks and after 3 months in eyes with more than 3 diopters of corneal astigmatism in patients who had continuous and interrupted sutures. Spectacle correction was administered for 86 eyes (83%), and contact lenses including rigid gas-permeable and scleral lenses were fitted in 18 eyes (17%) in patients who were unsatisfied with spectacle correction. Relaxing corneal incisions were performed in 23 eyes (22%), and toric intraocular lens implantations were performed in 34 eyes (33%) with cataracts. The mean topographic and absolute refractive astigmatism at the end of follow-up was 3.4 ± 2.6 and 3.6 ± 1.9 diopters. CONCLUSIONS: Topography-guided suture adjustment and selective suture removal are effective for minimizing early postoperative astigmatism. If significant astigmatism remains after suture removal, which cannot be corrected by optical means, then further surgical procedures including relaxing incisions and toric intraocular lens implantation can be performed.

A silicone hydrogel contact lens after 7 years of continuous wear.

PURPOSE: To report an unusual case with a bandage silicone hydrogel lens that was applied over cyanoacrylate glue application for corneal perforation. DESIGN: Retrospective, interventional case report. METHODS: A 67-year-old woman with a history of corneal trauma experienced spontaneous corneal perforation in her left eye. Upon arrival, her anterior chamber was flat and Seidel test was positive. After initial treatment with cyanoacrylate adhesive and a bandage silicone hydrogel contact lens, there was no leakage and the anterior chamber was formed at the follow-up period. She was started topical antibiotics. RESULTS: After 7 years, she came back with the complaint of permanent redness in her left eye with the same silicone hydrogel lens in her eye. CONCLUSIONS: Corneal healing may occur under cyanoacrylate adhesive glue with therapeutic contact lenses and with proper antibiotic application. Silicone hydrogel contact lenses exhibit good efficacy and safety when utilized as a continuous wear therapeutic lens with antibiotics.

Severe corneal changes following intravitreal injection of bevacizumab.

PURPOSE: To report a series of severe corneal changes following intravitreal injection of bevacizumab (Avastin) for age-related macular degeneration. DESIGN: Retrospective noncomparative case series. METHODS: The authors retrospectively reviewed the corneal changes that developed after the procedure in 1200 (460 patients) intravitreal injections of bevacizumab. RESULTS: Five significant corneal changes (1.1%) occurred in these patients within the 1st postinjection week. The severe corneal changes included corneal infiltrative keratitis (n = 2) and corneal stromal edema and descemet folds (n = 3). The findings depended on clinical examination and biomicroscopic and confocal evaluation. In terms of causality assessment, no rechallenge was possible. The appropriate treatment was applied and recovery was achieved in all patients during the follow-up period. CONCLUSIONS: Intravitreal injection of bevacizumab may cause corneal changes. The safety and effects of bevacizumab on the cornea should be evaluated in detail.

Conjunctival impression cytology, ocular surface, and tear-film changes in patients treated with systemic isotretinoin.

PURPOSE: To evaluate the ocular surface changes and tear-film functions in patients treated with systemic isotretinoin. METHODS: Fifty subjects treated with 0.8 mg/kg oral isotretinoin were enrolled in this prospective clinical trial. All patients underwent a full ophthalmoscopic examination before, during, and after treatment with isotretinoin. Ocular surface changes of the cell content of the surface conjunctival epithelium were evaluated by conjunctival impression cytology and tear-film functions using the Schirmer test, anesthetized Schirmer test, tear breakup time, and rose bengal staining. Subjective ocular complaints were scored with an Ocular Surface Disease Index questionnaire. RESULTS: There were no significant differences observed in average Schirmer test scores for patients before, during, or after isotretinoin treatment. Mean anesthetized Schirmer test scores and tear breakup time decreased significantly during treatment (P < 0.001). Mean impression cytology scores, Ocular Surface Disease Index scores, and rose bengal staining scores increased significantly during treatment (P < 0.05, P < 0.001 and P < 0.001, respectively). Blepharitis was seen in 36% of patients. All abnormal findings disappeared 1 month after the cessation of treatment. CONCLUSIONS: Conjunctival epithelial cells, tear basal secretion, and tear quality are markedly affected in patients during systemic treatment with isotretinoin (0.8 mg/kg). Ocular adverse effects of isotretinoin are generally not serious and are reversible after discontinuation.