Ocular Symptoms in Kidney, Liver, and Heart Transplant Patients.

OBJECTIVES: The purpose of this study was to report the ocular manifestations in kidney, liver, and heart transplant recipients. MATERIALS AND METHODS: We reviewed the medical records of kidney, liver, and heart transplant recipients who were examined at the ophthalmology clinic of a tertiary hospital between October 2021 and October 2022. We evaluated the ocular complaints of the patients, ophthalmological examination findings, the etiology of the underlying disease, comorbidities, posttransplant duration, and the medications used. Ocular pathologies were classified as corneal, conjunctival, lens, vitreoretinal, and optic disc pathologies for the analysis. RESULTS: Our study included 233 patients (191 kidney, 40 liver, 2 heart transplant patients). Mean age of patients was 42.94 ± 17.45 years. Among the patient group, 80.3% had at least 1 pathological ocular finding. In subgroup analysis, 12.4% of the patients had corneal pathologies, 19.3% had conjunctival pathologies, 33.0% had lens pathologies, 33.5% had vitreoretinal pathologies, and 18.9% had optic disc-related pathologies. The most common finding was dry eye, followed by cataract and vitreoretinal pathologies. The most common vitreoretinal pathology was diabetic retinopathy, followed by hypertensive retinopathy. The ocular pathology incidence in kidney and liver transplant patients was similar (P = .05). The 2 heart transplant patients did not have any ocular pathologies except refractive errors. In addition, no significant correlation was observed between posttransplant duration and ocular pathologies (P = .28). CONCLUSIONS: Ocular findings were seen in most of the kidney and liver transplant recipients. Therefore, it is required that these patients undergo routine ocular screenings in order to facilitate early diagnosis and prompt treatment when needed.

Macular and Peripapillary Vascular Densities in Non-Glaucomatous Eyes of Patients with Unilateral Glaucoma.

Objectives: Our purpose was to investigate vascular alterations in the non-glaucomatous eyes of patients with unilateral primary open angle glaucoma using optical coherence tomography angiography and to evaluate the role of vascular damage in glaucoma pathogenesis. Materials and Methods: This cross-sectional study included 60 eyes of 30 patients with unilateral glaucoma (63.4±8.8 years) and 30 eyes of 30 healthy subjects (65.6±9.1 years). Three groups were formed: group A, affected eyes of unilateral glaucoma patients; Group B, non-glaucomatous eyes of unilateral glaucoma patients; and group C, healthy controls. Results: When group A was compared with groups B and C, significant differences were detected in rim area, cup volume, mean cup/disc ratio, and retinal nerve fiber layer thickness parameters (p<0.001 for all). No significant difference was detected between groups B and C (p>0.05 for all). In peripapillary and macular vessel density (VD) comparisons, all parameters except intradisc VD were found to be lower in group A (p<0.0167 for all). No statistically significant difference was detected between groups B and C (p>0.05 for all). Conclusion: The VD values in eyes with glaucoma were found to be lower than in the other two groups. However, no difference was observed between the non-glaucomatous eyes of glaucoma patients and those of healthy individuals. Thus, the results did not support our hypothesis that VD alterations would be observed in the fellow eyes of patients with unilateral glaucoma if the vascular pathway were responsible in the pathogenesis of glaucoma.

Ophthalmologic Examination and Echocardiography Should be the Essential Components of Candidemia Bundle.

Objective: Candidemia is the most common form of invasive candidiasis, and it is associated with end-organ involvement, prolonged hospitalization, increased mortality, and higher healthcare costs. Candidemia can lead to metastatic heart and ocular infections. This study aimed to define the incidence, characteristics, and mortality of candidemia episodes and compare the data with our center's previous results. Materials and Methods: In this single-center retrospective observational study, we enrolled 250 patients over 18 years diagnosed with candidemia between January 2015 and December 2020. We obtained patients' demographic, clinical, laboratory, and therapeutic data from medical records. An ophthalmologic examination and screening with echocardiography were carried out within the first week after candidemia diagnosis. Results: There were 275 candidemia episodes from 250 patients. The incidence of candidemia was 2.8/1000 admissions and 5.68/ 10,000 inpatient days, higher than our previous results (1.23/1000 and 3.29/10,000). The median age was 65 (interquartile range [IQR]=52-75) years. Malignancies were the most frequent comorbidity (50%). The most common type was Candida albicans (n=115, 41.8%). Candida glabrata (n=61, 22.2%) was common, particularly in surgical patients, patients with malignancy, and critically ill patients. There was Infectious disease consultation in 93.3% (257) episodes.The ophthalmoscopic examination was made in 145 episodes (52.7%), and ophthalmitis was detected in 16 (11.0%). Echocardiography was performed in 139 (50.5%) episodes; one case had an endocarditis diagnosis. The 30-day mortality was 44.7% (n=123). Mortality rates in C. glabrata and Candida krusei infections were higher (54.1% and 66.7). The factors related to mortality were intensive care unit requirement (p=0.0001), chronic liver disease (p=0.005), corticosteroid usage (p=0.0001), previous antibiotic usage (p=0.013), multiple antibiotic usage ( p=0.020), and CVC related candidemia (p=0.010). Conclusion: Because of the life-threatening complications such as endocarditis, increased mortality rates, and higher healthcare costs, systematic and comprehensive candidemia bundle applications would be effective strategies for providing an effective antifungal stewardship program.

Peripapillary and Macular Vessel Density Measurement With Optical Coherence Tomography Angiography in Exfoliation Syndrome.

PRECIS: Although peripapillary retinal nerve fiber layer thickness (RNFLTs) and vessel density (VD) values were similar to healthy group, eyes with exfoliation syndrome had significantly lower superficial macular VDs and minimum ganglion cell analysis values. PURPOSE: To compare peripapillary and macular perfused capillary densities with optical coherence tomography angiography (OCT-A) between patients with eyes having exfoliation syndrome (XFS) and normal age-matched healthy controls. PATIENTS AND METHODS: This cross-sectional study included patients diagnosed with XFS from December 2017 to January 2020 at the Glaucoma Department. Peripapillary and parafoveal superficial VDs were obtained using OCT-A. The RNFLTs and ganglion cell analysis values were compared. RESULTS: Thirty-nine eyes of 39 XFS patients (26 women; mean age, 69.0±8.1 y) and 39 eyes of 39 healthy patients (25 women; mean age, 68.0±8.6 y) were enrolled. There were no statistically significant differences in sex or age distribution, central corneal thickness measurements, refractive errors, or intraocular pressures between both groups (all P>0.05). There were no statistically significant differences in the peripapillary VD or peripapillary RNFLT between XFS eyes and healthy eyes (P>0.05 for all). In the macular region, most superficial VD parameters were significantly reduced in the XFS group (P=0.02 for parafoveal VD, P=0.04 for both hemifields). While the average ganglion cell and internal plexiform layer (GCL+IPL) values were similar between groups (P=0.19), the minimum GCL+IPL value was lower in the XFS group than in the healthy group (P=0.03). CONCLUSION: Although structural test results, especially peripapillary RNFLT and mean GCL+IPL, were similar between the healthy and XFS groups, macular VD values were lower in XFS eyes. Our findings implicate microvascular damage can be the mechanism underlying XFS-related changes and indicate that it precedes significant structural damage.

The Diagnostic Ability of Ganglion Cell Complex Thickness-to-Total Retinal Thickness Ratio in Glaucoma in a Caucasian Population

Objectives: To evaluate the diagnostic accuracy of the macular ganglion cell complex-to-total retinal thickness (G/T) ratio in a Caucasian population. Materials and Methods: A total of 86 patients were enrolled in this cross-sectional study. Patients were divided into 4 groups: healthy; ocular hypertension; preperimetric glaucoma; and early glaucoma. Macular ganglion cell complex (mGCC) thickness, total retinal thickness, and retinal nerve fiber layer thickness (RNFLT) in one randomly selected eye of each patient were measured with measured with Heidelberg HD spectral domain optical coherence tomography (Heidelberg Engineering, Inc., Heidelberg, Germany). G/T ratio (%) was calculated as (mGCC thickness / total retinal thickness) x100. The ability of each parameter to diagnose glaucoma was examined by area under the receiver operating characteristic curve (AUROC) analysis and sensitivity evaluation at a fixed level of specificity. Unpaired t test was used to compare the measured values between the healthy subjects and the different patient groups. Results: The study included 9 healthy individuals, 18 patients with ocular hypertension, 28 with preperimetric glaucoma, and 31 with early glaucoma. Total retinal thickness, mGCC thickness, RNFLT, and G/T ratio were highest in the healthy group and decreased progressively in patients with ocular hypertension, preperimetric glaucoma, and early glaucoma. All comparisons between the groups were significant for these parameters (p<0.001 for all). Average RNFLT, average GCC, and total retinal thickness showed consistently higher AUROC than G/T ratio in the differentiation between healthy individuals and patients with ocular hypertension, preperimetric glaucoma, and early glaucoma. Conclusion: G/T ratio does not contribute to separation of ocular hypertension, preperimetric glaucoma, and early glaucoma patients from the healthy population. Compared to the other parameters investigated, G/T had lower diagnostic value.

Evaluation of quality of life after implantation of a new trifocal intraocular lens.

PURPOSE: To evaluate the vision-related quality of life (QOL) after implantation of a new trifocal intraocular lens (IOL), by using the National Eye Institute Visual Function Questionnaire-14 (VF-14 QOL questionnaire). SETTING: Baskent University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey. DESIGN: Prospective noncomparative case series. METHODS: Consecutive patients who had a new trifocal IOL (PanOptix) bilaterally implanted were included in the study. The vision-related QOL was assessed 3 months after the surgery in the second eye. The VF-14 QOL questionnaire was used, with a grading scale of 0, no difficulty; 1, a little difficulty; 2, moderate difficulty; 3, quite difficult; 4, impossible to perform. A subgroup of 14 patients, with an interval of at least 3 months between the surgery in the first eye and the surgery in the fellow eye, were also interviewed 3 months after the monocular IOL implantation. In this subgroup, the QOL with monocular and binocular implantation was compared. RESULTS: The study comprised 48 patients. Reading small print, driving at night, and doing fine handwork were the most difficult tasks to perform, with the mean values of the VF-14 QOL questionnaire being 0.94 ± 0.81 (SD), 0.89 ± 0.68, and 0.64 ± 0.67, respectively. Binocular implantation was associated with improvement in vision-related QOL when compared with monocular implantation, with significant differences in doing fine handwork such as sewing (P = .02) and using a computer (P = .03). CONCLUSIONS: With mean values of 1.00 or lower for each question, the results of the VF-14 QOL questionnaire indicated that patients who have the new trifocal IOL bilaterally implanted have an overall high satisfaction rate and a high vision-related QOL.

Are All Retinal Nerve Fiber Layer Defects on Optic Coherence Tomography Glaucomatous?

OBJECTIVES: In this study, we investigated the patients who were referred to our clinic with a prediagnosis of glaucoma based on retinal nerve fiber layer (RNFL) defects on optic coherence tomography (OCT) but were determined to have nonglaucomatous RNLF defects upon detailed examination. MATERIALS AND METHODS: The ophthalmic examination notes, OCT images, Heidelberg retinal tomography (HRT) II and fundus photographs of 357 patients were retrospectively evaluated. Final diagnoses of these patients were investigated. RESULTS: Of the 357 patients, 216 (60.5%) were diagnosed as open angle glaucoma, 33 (9.2%) as low-tension glaucoma, 39 (10.9%) as pre-perimetric glaucoma. The ophthalmic examinations of 14 patients (3.9%) were normal and there were no RNFL defects in OCT examinations after dilatation. In 39 patients (10.9%), the ophthalmic and optic disc examinations were completely normal and no etiologic factor explaining RNFL defects was found. Twenty-two eyes of 16 patients (4.5%) were included in this study (the mean age was 53.8±11.5 years; 9 men and 7 women). After detailed questioning of the medical history and systemic and neurologic examinations, a diagnosis of ischemic optic neuropathy was made in 11 eyes (10 patients) (2.8%), optic neuritis in 3 eyes (2 patients) (0.6%), optic disc drusen in 4 eyes (2 patients) (0.6%), pseudotumor cerebri in 2 eyes (1 patient) (0.3%), and cerebral palsy in 2 eyes (1 patient) (0.3%). CONCLUSION: Decrease in RNFL thickness on OCT images alone may be misleading in glaucoma examination. In cases where optic disc cupping is not evident, diagnosis should not be based on OCT RNFL examinations alone, and the patient's medical history, detailed ophthalmic examination, OCT optic disc parameters, HRT, and visual field tests should all be carefully evaluated together.

Enhanced depth imaging optical coherence tomography in patients with different phases of Behcet's panuveitis.

OBJECTIVE: To evaluate the changes in choroidal thickness (CT) at 13 different points between "active," "remission," and "end-stage" phase of Behcet's panuveitis and compare this with the age, sex, and spherical equivalent matched healthy controls using enhanced depth imaging optical coherence tomography. DESIGN: Prospective study. PARTICIPANTS: Eighty-five eyes of 45 patients with Behcet's panuveitis (19 eyes with active phase, 48 eyes with remission phase, and 18 eyes with end-stage phase) and 84 eyes of 42 controls were enrolled in this study. METHODS: CT measurements were obtained beneath the fovea and at 500-µm intervals for 3 mm nasal and temporal to the centre of the fovea. Correlation analyses were calculated to assess the relationship of the CT with age and disease duration. RESULTS: At all 13 measurement points, CT was significantly thinnest in end-stage-phase eyes and thickest in active-phase eyes (p < 0.01). CT was thicker in remission-phase eyes compared with control eyes at foveal and perifoveal points, but the trend was not statistically significant. The mean CT at each of the 13 measured points showed a negative correlation with age and disease duration (p < 0.01). CONCLUSIONS: Submacular CT, as measured by enhanced depth imaging optical coherence tomography, was significantly reduced in eyes with Behcet's panuveitis in the end-stage phase and increased in those in the active phase.

Early Clinical Features of Pseudoexfoliation Syndrome in Anterior Segment and Gonioscopy Examination.

OBJECTIVES: To determine the early signs of pseudoexfoliation (PEX) in fellow eyes of cases with unilateral PEX. MATERIALS AND METHODS: Fellow eyes of 34 cases with unilateral PEX were evaluated by slit-lamp and gonioscopy. Findings associated with PEX were recorded. RESULTS: Mean age was 67.8±8.1 years (range 55-86 years). Twenty-five patients (73.5%) had pigmentation in the inferior angle and 23 patients (67.6%) had Sampaolesi's line located on the inferior angle in fellow eyes. The other most common findings were loss of peripupillary ruff in 10 patients (29.4%) and pigment dispersion following pupil dilation in 14 patients (41.1%). CONCLUSION: Pigmentation in the inferior angle and Sampaolesi's line on the inferior angle seem to be the most common early findings associated with PEX. Special attention should be paid to these findings in cases with ocular hypertension for proper management.

Corneal, Scleral, Choroidal, and Foveal Thickness in Patients with Rheumatoid Arthritis.

OBJECTIVES: To investigate corneal, scleral, choroidal, and foveal thicknesses in female patients with rheumatoid arthritis (RA) and compare them with healthy subjects. MATERIALS AND METHODS: This prospective study included consecutive female patients diagnosed with RA and healthy subjects. Corneal, scleral, choroidal, and retinal (foveal) thicknesses were obtained by using optical coherence tomography and a comparison was performed between groups for all outcome measures. RESULTS: Thirty-six eyes of 36 female patients diagnosed with RA (group 1) and 36 eyes of 36 healthy female volunteers (group 2) were included. Mean corneal, scleral, choroidal thicknesses and retinal thickness at the fovea of group 1 were 543.3±33.7 µm, 343.7±42.2 µm, 214.6±50, and 213.5±18.9 µm, respectively; in group 2, these values were 549.9±29.6 µm, 420.9±42.4 µm, 206.4±41.9 µm, and 222±15.5 µm, respectively. The comparison between group 1 and 2 with respect to corneal, choroidal, and foveal thicknesses did not reveal statistical significant differences (p>0.05). On the contrary, there was a statistically significant difference with respect to scleral thickness between the groups, with the RA patients demonstrating a thinner scleral layer (p<0.001). CONCLUSION: Female patients with RA seem to demonstrate statistically significant scleral thinning when compared with healthy subjects, while there was no difference concerning corneal, choroidal, and foveal thickness.

Retinal Nerve Fiber Layer Thicknesses in Three Different Optic Nerve Head Size Groups Measured by Cirrus Spectral Domain Optical Coherence Tomography.

OBJECTIVES: To compare the retinal nerve fiber layer (RNFL) thicknesses in three different optic nerve head (ONH) size groups measured by Cirrus spectral domain optical coherence tomography (OCT). MATERIALS AND METHODS: Between January and March 2013, 253 eyes of 253 healthy subjects were enrolled in this study (mean age: 42.7±7.4 years [28-62 years]; 121 men and 132 women). The patients were divided into 3 groups according to ONH size: 77 patients in the "small ONH" group (ONH area <1.63 mm2), 90 patients in the "medium ONH" group (ONH area 1.63-1.97 mm2), and 86 patients in the "large ONH" group (ONH area >1.97 mm2). RESULTS: There were significant differences in superior (p=0.008), inferior (p=0.004) and average RNFL thickness (p=0.001) between the small, medium and large ONH groups. Positive correlations between ONH size and inferior/average RNFL thicknesses were significant but very weak (r=0.150, p=0.017 and r=0.157, p=0.013 respectively). CONCLUSION: RNFL thickness as measured by Cirrus OCT is positively correlated with ONH size and the differences in RNFL thickness were statistically significant between groups. This correlation and difference may be the result of a varying distance between the circular scan and the ONH margin.

Herpetic Keratouveitis and Trabeculectomy Failure during Infliximab Therapy in a Patient with Behçet's Disease.

A 51-year-old man was diagnosed with Behçet's disease in 2001. The patient was resistant to all immunosuppressive therapies. After 6 months of infliximab therapy, he presented to our clinic with pain and blurred vision in his right eye. The visual acuity was 20/200 and the intraocular pressure was 35 mmHg in the right eye. Biomicroscopic examination revealed corneal dendritic ulcers and 2+ cells in the anterior chamber in the right eye. The herpetic keratouveitis attack was controlled with antiviral therapy but the patient needed another glaucoma surgery. Trabeculectomy with mitomycin C was performed about halfway through an eight-week interval between two doses of infliximab.

Changes in Anterior Chamber Depth after Phacoemulsification in Pseudoexfoliative Eyes and their Effect on Accuracy of Intraocular Lens Power Calculation.

OBJECTIVES: To compare anterior chamber depth (ACD) changes after phacoemulsification surgery in patients with pseudoexfoliation syndrome (PEX) and normal patients using an anterior segment imaging method. Another aim of this study was to evaluate the effect of these changes on the accuracy of intraocular lens (IOL) power calculation and postoperative refraction. MATERIALS AND METHODS: Twenty-two eyes of 22 patients with PEX and 30 eyes of 30 normal patients who underwent uneventful phacoemulsification surgery and IOL implantation were included in the study. The ACD of all patients was evaluated preoperatively and at 3 months postoperatively with the ALLEGRO Oculyzer (WaveLight® Oculyzer™ II, Alcon, Novartis)-Scheimpflug imaging system. RESULTS: The postoperative mean ACD values were significantly larger than the preoperative ACD values in both groups (p<0.001 for both groups). The pre- to postoperative change in ACD was 0.46±0.3 mm in the PEX group, which was a larger change than seen in the normal patients (0.12±0.1 mm) (p=0.04). The mean absolute errors (MAE) calculated with different IOL formulas (SRK/T, Haigis, Hoffer and Holladay 1 formulas) were comparable and no statistically significant difference was observed between the two groups (p=0.21). CONCLUSION: Phacoemulsification induces more significant ACD changes in patients with PEX compared to normal patients. However, the MAE did not differ significantly between the groups.

Prevalence of Split Nerve Fiber Layer Bundles in Healthy People Imaged with Spectral Domain Optical Coherence Tomography.

OBJECTIVES: The presence of retinal nerve fiber layer (RNFL) split bundles was recently described in normal eyes scanned using scanning laser polarimetry and by histologic studies. Split bundles may resemble RNFL loss in healthy eyes. The aim of our study was to determine the prevalence of nerve fiber layer split bundles in healthy people. MATERIALS AND METHODS: We imaged 718 eyes of 359 healthy persons with the spectral domain optical coherence tomography in this cross-sectional study. All eyes had intraocular pressure of 21 mmHg or less, normal appearance of the optic nerve head, and normal visual fields (Humphrey Field Analyzer 24-2 full threshold program). In our study, a bundle was defined as 'split' when there is localized defect not resembling a wedge defect in the RNFL deviation map with a symmetrically divided RNFL appearance on the RNFL thickness map. The classification was performed by two independent observers who used an identical set of reference examples to standardize the classification. RESULTS: Inter-observer consensus was reached in all cases. Bilateral superior split bundles were seen in 19 cases (5.29%) and unilateral superior split was observed in 15 cases (4.16%). In 325 cases (90.52%) there was no split bundle. CONCLUSION: Split nerve fiber layer bundles, in contrast to single nerve fiber layer bundles, are not common findings in healthy eyes. In eyes with normal optic disc appearance, especially when a superior RNFL defect is observed in RNFL deviation map, the RNLF thickness map and graphs should also be examined for split nerve fiber layer bundles.

A Case of Lyme Disease Accompanied by Uveitis and White Dot Syndrome.

In this case report we aimed to present a case of Lyme disease presenting as peripheral retinal vasculitis, intermediate uveitis and multifocal white dots in the posterior pole. The patient exhibited vitritis and snowball opacities in both eyes. A diagnosis of Lyme disease was made based on clinical, angiographic and laboratory findings. Fundus fluorescein angiography revealed optic nerve and retinal venous leakage as well as multiple hyperfluorescent foci in both eyes. The patient's symptoms and ocular findings significant improved after treatment with a combination of systemic antibiotics and steroids. Ophthalmologists should bear in mind that conditions presenting with uveitis and multifocal white dots may be related to Lyme disease.

Non-Contact and Contact Tonometry in Corneal Edema.

PURPOSE: To compare the intraocular pressure (IOP) values by Goldmann applanation tonometry (GAT) and Reichert 7 CR noncontact tonometry (R7CR-NCT) in patients with postsurgical corneal edema and to examine the impact of postoperative corneal edema on these values. METHODS: Forty-six patients with grade 4 and 5 cataracts were included in this study. Intraocular pressure was measured using GAT and R7CR-NCT before and 1 day after phacoemulsification. Central corneal thickness (CCT) was determined before and after surgery to quantify postsurgical corneal edema. The R7CR-NCT provided a Goldmann-correlated IOP (IOPg) and corneal-compensated IOP (IOPcc). RESULTS: The CCT increased significantly 1 day after surgery (the mean preoperative CCT, 543.5 ± 25.4 µm; the mean postoperative CCT, 681.5 ± 19.8 µm; p < 0.001), a mean increase of 26.7%. The preoperative R7CR-NCT measurements (the mean IOPcc, 18.8 ± 5.6 mm Hg; the mean IOPg, 17.8 ± 4.5 mm Hg) were significantly higher than GAT measurements (the mean GAT-IOP, 16.0 ± 3.4 mm Hg) (p < 0.001). On postoperative day 1, the R7CR-NCT measurement (the mean IOPcc, 27.0 ± 9.8 mm Hg; the mean IOPg, 25.1 ± 8.9 mm Hg) were significantly higher than GAT measurements (the mean GAT-IOP, 18.3 ± 7.9 mm Hg) (p < 0.001). The difference between postoperative R7CR-NCT and GAT-IOP values were significantly higher than the difference between preoperative R7CR-NCT and GAT-IOP values (p < 0.001 for both IOPcc to GAT-IOP and IOPg to GAT-IOP). The difference between postoperative IOPcc and GAT-IOP was significantly correlated to the change in CCT (r = 0.526, p < 0.001). Similarly, the difference between postoperative IOPg and GAT-IOP was significantly correlated to the change in CCT (r = 0.536, p < 0.001). CONCLUSIONS: The R7CR-NCT IOP values were high in patients with postsurgical intensive corneal edema. Consequently, the difference between R7CR-NCT IOP and GAT-IOP increased in edematous corneas.