Ocular surface and dry eye in Graves' disease.

PURPOSE: To evaluate the tear function tests and the ocular surface damage in Graves' disease (GD) patients either with or without thyroid associated orbitopathy (TAO). METHODS: Forty-two eyes of 21 randomly selected patients with GD, and 30 eyes of 15 healthy subjects were included in this prospective study. The presence of TAO was evaluated clinically. The palpebral fissure height, degree of proptosis, ocular surface disease index (OSDI), Schirmer tear test, tear break-up time (TBUT), and conjunctival impression cytology were assessed. The results were first compared between the patient and the control groups. Results were then compared between the patients with TAO (group I) and without TAO (group II). RESULTS: The mean OSDI score in the patient group was 44.79 ± 11.83 and it was 21.17 ± 9.89 in the control group (p = 0.001). The mean Schirmer tear test score was 14.4 ± 8.32 mm and 24.9 ± 3.57 mm in the patient and control group, respectively (p = 0.001). The mean TBUT in the patient group was 7.1 sec. In the control group it was significantly increased to 10 sec (p = 0.003). The mean proptosis and interpalpebral distance did not show any difference between the GD patients and controls (p > 0.05). The patients with GD showed significant ocular surface damage in which 75.71% had grade 2-3 squamous metaplasia in temporal interpalpebral conjunctiva. Twenty-four (57%) eyes composed group I. There were no differences in the mean OSDI score, Schirmer tear test score, TBUT, and the amount of ocular surface damage between group I and group II (p > 0.05). CONCLUSIONS: Dry eye findings and the ocular surface damage in GD were most likely associated with the ocular surface inflammation. Before the development of the classic findings of TAO, ocular surface inflammation can be the only presenting clinical sign in GD.

Incidence, etiology and risk factors associated with mortality of nosocomial candidemia in a tertiary care hospital in Istanbul, Turkey.

OBJECTIVE: The aim of this study was to determine the incidence, etiology and risk factors for mortality of patients with nosocomial candidemia. SUBJECTS AND METHODS: This observational study was performed at Haydarpasa Numune Training and Research Hospital, a tertiary care hospital with 750 beds, between the years 2004 and 2007. Fifty defined cases with a nosocomial bloodstream infection caused by Candida species were included in the study. All demographic, microbiological and clinical records for each patient were collected using a standardized form. Blood culture was performed by automated blood culture system, and those samples positive for yeast were subcultured on Sabouraud agar. RESULTS: The mean incidence density of nosocomial candidemia was 0.58/10,000 patient-days/year (range 0.17-1.4). Candidemia episodes increased from 0.17/10,000 to 1.4/10,000 patient-days/year (p < 0.0001). Candida albicans and non-albicans Candida accounted for 15 (30%) and 35 (70%) cases, respectively. The overall mortality was 56% and was significantly associated with stayingin the intensive care unit (odds ratio: 3.667, 95% confidence interval: 1.07-12.54, p = 0.034). CONCLUSION: This study showed that there was a significantly increased trend in the incidence of candidemia with high mortality during the study period.

Topical cyclosporine in thyroid orbitopathy-related dry eye: clinical findings, conjunctival epithelial apoptosis, and MMP-9 expression.

OBJECTIVES: To evaluate the effects of topical cyclosporine A (CsA) 0.05% (Restasis) on the signs and symptoms of dry eye, on apoptosis, and on MMP-9 expression in conjunctiva epithelial cells in thyroid orbitopathy (TO)-related dry eye patients. METHODS: Prospective, clinical study. Twenty-four eyes of 12 consecutive TO patients with dry eye findings instilled CsA twice daily for 2 months. Ocular surface disease index, Schirmer tear test, tear breakup time (TBUT), conjunctival apoptosis index, and conjunctival MMP-9 expression were evaluated before and after 2 months treatment. Conjunctival biopsies were harvested from all eyes at baseline and after 2 months treatment. Apoptosis was detected by the terminal deoxynucleotidyl transferase-mediated dUTP-nick end labeling (TUNEL) assay. MMP-9 expression was determined by immunohistochemistry. RESULTS: After 2 months of topical CsA treatment, the mean OSDI score was significantly decreased from 58.08 +/- 6.28 to 36.41 +/- 11.75 (P = 0.001). At baseline, the mean Schirmer tear test score was 8.92 +/- 5.52 mm. It was increased to 11.25 +/- 4.71 mm after treatment (P > 0.05). The mean TBUT increased significantly from 3.92 +/- 2.18 sec to 9.16 +/- 3.34 sec (P = 0.001). The mean percentage of apoptosis index at baseline was 72.10 +/- 35.82%. This was significantly decreased to 53.29 +/- 34.46% after treatment (P = 0.008). The mean percentage of MMP-9 expression of the conjunctival epithelial cells was significantly decreased from 48.12 +/- 28.58% to 26.66 +/- 25.13% following treatment (P = 0.005). CONCLUSIONS: Topical CsA treatment appears to improve the signs and symptoms of dry eye and inhibits apoptosis and MMP-9 expression in conjunctival epithelial cells in TO-related dry eye patients after 2 months of treatment.

Half-moon supracapsular nucleofractis phacoemulsification technique.

Many nucleofractis techniques introduced to date have both advantages and disadvantages. Therefore, the search for the most effective, functional, and safest technique continues. The half-moon supracapsular phacoemulsification technique, which the authors define as a new method, is a hybrid technique derived from both chopping and supracapsular techniques. This technique allows the endonucleus to partially prolapse out of the capsulorhexis rim into the anterior chamber during hydrodissection, to be chopped under direct vision, and to continue the quadrant-removal stage endocapsularly after sending the heminuclei back into the capsular bag. The nucleus-splitting stage is performed in the anterior chamber, and the quadrant-removal stage continues in the capsular bag away from the corneal endothelium, which is again the safest place. The half-moon supracapsular phacoemulsification technique achieves the two stages of nucleus removal in the safest location with the most effective method and therefore may provide some advantages in terms of efficacy, safety, and functionality.

Ocular wavefront analysis and contrast sensitivity in eyes implanted with AcrySof IQ or AcrySof Natural intraocular lenses.

PURPOSE: This study aimed to compare ocular wavefront aberrations for pupil diameters of 4 mm and 6 mm, and contrast sensitivity, in eyes with AcrySof IQ and AcrySof Natural intraocular lenses (IOLs). METHODS: Sixty eyes of 60 patients were enrolled in this prospective randomized study. After phacoemulsification the eyes received either AcrySof IQ SN60WF or AcrySof Natural SN60AT IOLs. One month after surgery, all patients underwent complete ophthalmological examination including corneal topography, wavefront analysis for pupil diameters of 4 mm and 6 mm, and contrast sensitivity measurements with the CSV 1000E instrument under photopic and mesopic conditions with and without glare. RESULTS: There was no statistically significant difference between groups in age, sex or other preoperative ocular characteristics (p > 0.05). Patients with AcrySof IQ IOLs had higher contrast sensitivity at 6 c.p.d. under photopic conditions, at 6 c.p.d. and 18 c.p.d. under mesopic conditions, and at 6 c.p.d., 12 c.p.d. and 18 c.p.d. under mesopic conditions with glare (p < 0.05). Corneal spherical aberration was 0.273 ± 0.074 µm in the AcrySof Natural group and 0.294 ± 0.086 µm in the AcrySof IQ group (p = 0489). Ocular spherical aberration was 0.362 ± 0.141 µm and 0.069 ± 0.043 µm (p < 0.001) for 6-mm diameter pupils and 0.143 ± 0.091 µm and 0.017 ± 0.016 µm (p < 0.001) for 4-mm diameter pupils, with AcrySof Natural and AcrySof IQ IOLs, respectively. There were no significant differences in other higher-order aberrations between the groups (p > 0.05). CONCLUSIONS: Aspherical AcrySof IQ IOLs significantly reduced spherical aberration for pupil diameters of both 4 mm and 6 mm and also improved contrast sensitivity more than spherical AcrySof Natural IOLs, especially in mesopic conditions.

Half-moon supracapsular nucleofractis phacoemulsification: safety, efficacy, and functionality.

PURPOSE: To compare the safety, efficacy, and functionality of half-moon supracapsular phacoemulsification, a variation of the nucleofractis technique, with those of the stop-and-chop technique. SETTING: Atatürk Training and Research Hospital, 2nd Ophthalmology Department, Ankara, Turkey. METHODS: This prospective randomized study comprised 100 eyes having phacoemulsification with the half-moon supracapsular (Group 1, 50 eyes) or stop-and-chop (Group 2, 50 eyes) technique. The half-moon supracapsular technique is based on hydrodissection-assisted partial prolapse of the nucleus. After the prolapsed nucleus is chopped horizontally and the first wedge removed, quadrant removal is performed endocapsularly. Follow-up examinations were at 1, 7, 30, and 90 days. RESULTS: The 2 groups were similar in demographic features and surgical difficulty factors. There was no difference in the complication rate. The phaco time (mean: Group 1, 0.2 minutes +/- 0.1 (SD); Group 2, 0.4 +/- 0.4 minutes), average power (mean 11.3% +/- 6.9% and 18.3% +/- 7.3%, respectively), effective phaco time (1.7 +/- 1.8 seconds and 4.8 +/- 6.5 seconds, respectively), and total operation time (12.3 +/- 3.2 minutes and 14.3 +/- 4.3 minutes, respectively) were significantly lower in Group 1 than in Group 2. One day postoperatively, the increase in central corneal thickness increase was significantly greater in Group 1 (P = 0.011), with no significant differences thereafter. The visual acuity increase and contrast sensitivity scores at 90 days were similar in the groups. CONCLUSIONS: The half moon supracapsular technique shortened the phacoemulsification procedure and lowered phaco energy, indicating it protects surrounding intraocular tissue. There was no difference between techniques in reliability and functionality.