Simultaneous Deep Anterior Lamellar Keratoplasty and Descemet Membrane Endothelial Keratoplasty for Corneal Endothelial Failure With Stromal Scarring.

ABSTRACT: We present an alternative surgical procedure including simultaneous deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK) in a case with endothelial failure and stromal scarring. A 62-year-old woman presented with vision loss caused by pseudophakic bullous keratopathy. While waiting for a corneal transplant, the patient developed infectious keratitis, which was treated with medication. Although the keratitis healed, it left a scar. To improve the patient's vision, a corneal transplant surgery that included simultaneous DALK and DMEK was performed. Postoperatively, the corneal graft was clear, and the Descemet membrane was well attached. However, there was an interface haze because of residual stromal tissue. The patient's best-corrected visual acuity improved from hand motion to 0.2 (decimal). This combined procedure allows for lamellar keratoplasty in cases with coexistence of corneal endothelial and stromal involvement.

Cases of toxic anterior segment syndrome after primary pterygium surgery.

PURPOSE: Toxic anterior segment syndrome (TASS) is an acute, sterile, inflammatory reaction of the anterior segment after intraocular surgeries. We aimed to report an outbreak of TASS which occurred following pterygium surgeries. METHODS: A case series. RESULTS: Four eyes of four patients developed TASS associated with formaldehyde after uneventful primary pterygium surgery with conjunctival autograft. No patients reported pain; all patients demonstrated diffuse corneal edema, epithelial defects, and anterior chamber inflammation without hypopyon, fibrin formation, and vitreous involvement on the first postoperative day. TASS diagnosis was made based on clinical findings. All patients were treated with hourly topical 1% prednisolone acetate (Pred Forte, Allergan, CA), moxifloxacin 0.5% (Vigamox, Alcon, TX), and 0.24% of hyaluronic acid (Artelac complete, Bausch & Lomb). Oral steroid (prednisolone 1 mg/kg) was added on the first week and gradually tapered over weeks. None of the affected corneas improved spontaneously. Best-corrected visual acuity ranged from 20/25000 to 20/200 in the second month after surgery. Keratoplasty was scheduled for all patients. CONCLUSIONS: This is the first study to present TASS cases after pterygium surgery. Clinicians should be aware of TASS that can emerge after an extraocular surgery. In our analysis, since 2% formaldehyde was used by the operating room personnel for cleaning and sterilizing reusable ocular instruments, it was thought that formaldehyde was the most likely cause.

Simple Oral Mucosal Epithelial Transplantation in a Patient With Bilateral Limbal Stem Cell Deficiency.

PURPOSE: To present management of a patient with bilateral limbal stem cell deficiency (LSCD) by using "simple oral mucosal epithelial transplantation" (SOMET) technique. METHODS: Case report. RESULTS: A 65-year-old female diagnosed with bilateral LSCD based on clinical findings. After stabilizing the ocular surface, we performed SOMET in the right eye. At 13 months postoperatively, visual acuity improved from counting fingers to 10/100 and a stable epithelium with regressed corneal vascularization was observed. CONCLUSIONS: This report showed that SOMET seems to be an alternative technique in LSCD.

The Effect of Acute Hypovolemia on the Eye.

INTRODUCTION: To investigate the effects of acute hypovolemia induced by blood donation on the eye. Methods or Study Design: This prospective, observational study included a single eye from each of 48 healthy men between 20 and 40 years of age who had donated 500 ml of blood and 28 eyes of 28 healthy, age- and gender-matched control subjects. The ocular parameters including ocular perfusion pressure (OPP), intraocular pressure (IOP), axial length (AL), central corneal thickness (CCT), choroidal and retinal thicknesses, and retinal nerve fiber layer (RNFL) were measured before blood donation and at 10 min and 1, 2, 3, and 4 h after blood donation. RESULTS: The mean OPP was significantly reduced following blood donation (baseline, 43.4 ± 4.9 vs. 40.8 ± 4.6 mmHg; p = 0.003). The mean subfoveal choroidal thickness (SFCT) was measured as 322.96 ± 76.23, 291.63 ± 77.85, 309.77 ± 75.72, 312.31 ± 75.98, 315.73 ± 75.43, and 317.75 ± 75.73 µm before blood donation, at baseline, 10 min, and 1, 2, 3, and 4 h following donation, respectively [F(2.462, 115.731) = 22.618, p < 0.001]. In the control group, the SFCT was measured as 302.04 ± 32.04, 301.43 ± 35.16, 298.07 ± 37.33, 298.96 ± 39.17, 302.54 ± 39.24, and 301.61 ± 40.41 µm at baseline, 10 min, and 1, 2, 3, and 4 h following donation, respectively [F(2.124, 57.340) = 0.592, p = 0.566]. There was no difference in AL, CCT, RNFL, retinal thicknesses, and IOP measurements performed before and after blood donation (p > 0.05). CONCLUSIONS: Acute hypovolemia caused a significant reduction in SFCT which persisted for 3 h. This study may pave way for better understanding of choroidal thickness changes in disease states.

Anterior Segment Parameters in Patients With Wilson Disease.

PURPOSE: To investigate anterior segment parameters in patients with Wilson disease (WD). METHODS: In this cross-sectional study, 22 patients with WD (study group) and 22 healthy subjects (control group) were enrolled. Each participant underwent a comprehensive ophthalmic assessment including best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, and intraocular pressure. Anterior segment parameters were measured by the Sirius anterior segment analyzer system (Costruzione Strumenti Oftalmici, Florence, Italy). RESULTS: Mean central corneal thickness was 522 ± 47 µm in the study group and 568 ± 37 µm in the control group (P < 0.001). Mean flat keratometry was 42.4 ± 1.7 diopter (D) in the study group and 41.5 ± 1.16 D in the control group (P = 0.011); mean steep keratometry was 43.4 ± 2.0 and 42.4 ± 1.4 D in the study and control groups, respectively (P = 0.025). The anterior corneal elevation value was 5.5 ± 3.2 µm in the study group and 4.08 ± 2.2 µm in the control group (P = 0.029); the mean posterior corneal elevation value was 15.1 ± 6.0 and 10.1 ± 4.1 µm in the study and control groups, respectively (P = 0.002). The mean anterior chamber depth was 2.97 ± 0.3 µm in the study group and 3.16 ± 0.3 µm in the control group (P = 0.01); the mean horizontal visible iris diameter was 11.9 ± 0.4 and 12.2 ± 0.4 µm in the study and control groups, respectively (P = 0.001). CONCLUSIONS: This study indicates that patients with WD have differences in the anterior segment parameters including central corneal thickness, keratometric values, anterior and posterior elevations, horizontal visible iris diameter, and anterior chamber depth when compared with healthy controls.

Effect of refractive status on Valsalva-induced anterior segment changes.

PURPOSE: To evaluate the effect of the Valsalva maneuver (VM) on anterior segment parameters and its association with refractive status. METHOD: In this prospective study, 120 eyes of 120 subjects were evaluated. Subjects were divided into three groups: myopic (n = 40 patients), hyperopic (n = 40 patients), and emmetropic (control group, n = 40 subjects). The anterior segment parameters, including keratometric, pachymetric, and anterior chamber parameters, were measured using the Sirius System (Costruzione Strumenti Oftalmici, Florence, Italy) before and during VM. RESULTS: There was no statistically significant difference in corneal parameters including keratometric and pachymetric values at rest or during VM in myopic, hyperopic, and control groups (p > 0.05 for all). In the myopic and control groups, anterior chamber depth, anterior chamber volume (ACV), and anterior chamber angle (ACA) were significantly decreased during VM. In the hyperopic group, only anterior chamber depth was significantly decreased during VM, while ACV and ACA did not significantly change. CONCLUSION: The Valsalva maneuver may cause significant narrowing in anterior chamber depth, anterior chamber volume, and anterior chamber angle in the myopic and emmetropic groups, whereas it may affect only anterior chamber depth in the hyperopic group.

Vitamin D level in patients with pterygium.

PURPOSE:: To evaluate blood vitamin D level in patients with pterygium. METHODS:: This prospective study, compared 58 eyes of 58 healthy individuals (control group) with 63 eyes of 63 patients with pterygium (study group). Subjects were stratified by time spent indoors or outdoors. Participants were given comprehensive ophthalmic examinations; blood 25-hydroxyvitamin D (nmol/L) was assayed. RESULTS:: Vitamin D level was significantly higher in men with pterygium than without it (p=0.020), but the difference was not significant in women (p=0.86). In the pterygium group, vitamin D level was significantly increased in participants with outdoor activity (p=0.010). In the control group, vitamin D levels did not differ significantly with indoor and outdoor activity (p=0.126). CONCLUSION:: Vitamin D level in participants with pterygium was significantly increased only in men and in those with more outdoor activity.

Vitamin D level in patients with pterygium / Níveis de vitamina D em pacientes com pterígio

ABSTRACT Purpose: To evaluate blood vitamin D level in patients with pterygium. Methods: This prospective study, compared 58 eyes of 58 healthy individuals (control group) with 63 eyes of 63 patients with pterygium (study group). Subjects were stratified by time spent indoors or outdoors. Participants were given comprehensive ophthalmic examinations; blood 25-hydroxyvitamin D (nmol/L) was assayed. Results: Vitamin D level was significantly higher in men with pterygium than without it (p=0.020), but the difference was not significant in women (p=0.86). In the pterygium group, vitamin D level was significantly increased in participants with outdoor activity (p=0.010). In the control group, vitamin D levels did not differ significantly with indoor and outdoor activity (p=0.126). Conclusion: Vitamin D level in participants with pterygium was significantly increased only in men and in those with more outdoor activity.

RESUMO Objetivo: Avaliar os níveis sanguíneos de vitamina D em pacientes com pterígio. Métodos: Neste estudo prospectivo e comparativo, foram incluídos 58 olhos de 58 indivíduos saudáveis (grupo controle) e 63 olhos de 63 pacientes com pterígio (grupo de estudo). Os indivíduos também foram categorizados quanto ao tempo foi gasto dentro de casa ou ao ar livre. Todos os participantes foram submetidos a exames oftálmicos e avaliações de nível sanguíneo 25-hidroxivitamina D (nmol/L). Resultados: O nível de vitamina D foi significativamente maior em pacientes masculinos com pterígio do que aqueles sem pterígio (p=0,020). Não houve diferença significativa entre mulheres do grupo de estudo e controle (p=0,86). No grupo pterígio, o nível de vitamina D foi significativamente maior no subgrupo com atividade ao ar livre (p=0,010). No grupo controle, o nível de vitamina D não foi significativamente diferente entre a atividade interna e ao ar livre (p=0,126). Conclusão: Os achados deste estudo revelaram que o nível de vitamina D nos casos de pterígio foi significativamente maior apenas nos homens e nos casos com maior atividade ao ar livre.

Effects of Valsalva Maneuver on Ocular Biometric Parameters: Optical Low-Coherence Reflectometry Biometer Study.

PURPOSE: To evaluate the effects of the Valsalva Maneuver (VM) on ocular biometry and intraocular pressure (IOP). METHODS: This prospective observational study included 55 eyes of 55 healthy volunteers. Axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), corneal curvature (K-steep, K-flat and K-mean), corneal diameter (WtW), and pupil diameter (PD) were measured with a LenStar LS 900® biometer at rest and during VM. The IOP was also measured at rest and during VM measurements were compared. RESULTS: The VM did not have any significant influence on AL, WtW, K-flat, and K-mean (p > 0.05), but it decreased K-steep significantly (p < 0.001). Moreover, CCT and ACD decreased significantly during VM (p < 0.001), but VM increased IOP, PD (p < 0.001), and LT significantly (p = 0.002). CONCLUSIONS: The VM might reversibly change in IOP and ocular biometry, so it should be considered during anterior segment examinations.

Management of hypotony and flat anterior chamber associated with glaucoma filtration surgery.

AIM: To determine the effectiveness of pharmacological and interventional treatment of hypotony and flat anterior chamber (FAC) resulting from glaucoma filtration surgery. METHODS: We retrospectively examined the medical records of fifty-two trabeculectomy patients (52 eyes) who developed postoperative hypotony and FAC. The management and associated complications of hypotony, changing intraocular pressure (IOP) and best corrected visual acuity (BCVA) were evaluated. RESULT: Of the 52 patients with hypotony, 29 (56%) had a grade 1 FAC, 21 (40%) had a grade 2 FAC, and only 2 had a grade 3 FAC. There was no significant difference between the mean preoperative IOP and the mean IOP at three and six months after surgery. Thirteen eyes (25%) required antiglaucomatous medication three months after surgery. The mean BCVA at 6mo after surgery was significantly reduced as compared with the mean preoperative BCVA. CONCLUSION: Hypotonia and FAC following trabeculectomy are associated with troublesome complications that require pharmacological and/or surgical treatment. Thus, close follow-up is essential for affected patients.

Choroidal thickness changes after dynamic exercise as measured by spectral-domain optical coherence tomography.

PURPOSE: To measure the choroidal thickness (CT) after dynamic exercise by using enhanced depth imaging optical coherence tomography (EDI-OCT). MATERIALS AND METHODS: A total of 19 healthy participants performed 10 min of low-impact, moderate-intensity exercise (i.e., riding a bicycle ergometer) and were examined with EDI-OCT. Each participant was scanned before exercise and afterward at 5 min and 15 min. CT measurement was taken at the fovea and 1000 µ away from the fovea in the nasal, temporal, superior, and inferior regions. Retinal thickness, intraocular pressure, ocular perfusion pressure (OPP), heart rate, and mean blood pressure (mBP) were also measured. RESULTS: A significant increase occurred in OPP and mBP at 5 min and 15 min following exercise (P ˂ 0.05). The mean subfoveal CT at baseline was 344.00 ± 64.71 µm compared to 370.63 ± 66.87 µm at 5 min and 345.31 ± 63.58 µm at 15 min after exercise. CT measurements at all locations significantly increased at 5 min following exercise compared to the baseline (P ˂ 0.001), while measurements at 15 min following exercise did not significant differ compared to the baseline (P ˃ 0.05). There was no significant difference in retinal thickness at any location before and at 5 min and 15 min following exercise (P ˃ 0.05). CONCLUSION: Findings revealed that dynamic exercise causes a significant increase in CT for at least 5 min following exercise.

A Modified Glued Transscleral Intraocular Lens Implantation: Suture-Assisted Sutureless Technique.

PURPOSE: To report a modified surgical technique as an alternative procedure for sutureless fibrin glue-assisted Transscleral intraocular lens (IOL) fixation. METHODS: Description of the modified surgical technique with an accompanying video. RESULTS: In the standard glued IOL fixation technique, the leading haptic is externalized using a forceps through the sclerotomy and an assistant holds the haptic while the second IOL haptic is bimanually externalized, using the handshake technique, through the other sclerotomy site. In the author's technique, called the suture-assisted sutureless technique, IOL haptics were tied with a looped 9-0 polypropylene suture with an attached curved needle. The suture needle was fastened to the haptic, passed through the sclerotomy site, and pulled out to externalize the haptic through the sclerotomy site. CONCLUSIONS: This technique is an easy, feasible, and assistant-free procedure for glued IOL implantation in aphakic eyes.

Corneal Wavefront Aberrations After Primary and Recurrent Pterygium Surgery.

PURPOSE: To evaluate the effect of primary and recurrent pterygium surgery on corneal wavefront aberrations. METHODS: This prospective and interventional study included the 47 eyes of 47 patients with primary pterygium (primary group) and 41 eyes of 41 patients with recurrent pterygium (recurrent group). All patients underwent pterygium excision with conjunctival autograft transplantation. Corneal wavefront aberrations were measured using Sirius corneal topography and aberrometry system (Costruzione Strumenti Oftalmici, Florence, Italy) before surgery and at 3 and 12 months after surgery. The main outcome measures were root mean square values of total wavefront error (WFE), higher-order aberrations (HOAs), coma, trefoil, and spherical aberrations. RESULTS: Corneal wavefront aberrations were not significantly different between the primary and recurrent groups at baseline (P>0.05). Total WFE, HOA, trefoil, and coma decreased significantly in both primary and recurrent groups at postoperative 3 and 12 months compared with preoperative measurements (P<0.05). The mean spherical aberration was not significantly changed at 3 and 12 months compared with preoperative measurements (P>0.05). Total WFE, HOA, trefoil, and coma were significantly higher in the recurrent group than in the primary group at postoperative 3 and 12 months (P<0.05). CONCLUSIONS: Pterygium surgery can significantly reduce corneal wavefront aberrations, including total WFE, HOA, trefoil, and coma in eyes with primary or recurrent pterygium. However, postoperative corneal aberrations were higher in the recurrent group than in the primary group.

A quantitative evaluation of the posterior segment of the eye using spectral-domain optical coherence tomography in carotid artery stenosis: a pilot study.

BACKGROUND AND OBJECTIVE: To evaluate the posterior segment of the eye using spectral-domain optical coherence tomography (SD-OCT) in patients with internal carotid artery (ICA) stenosis. PATIENTS AND METHODS: Prospective study enrolling 25 patients with ICA stenosis (study group) and 25 age- and gender-matched healthy individuals (control group). Macular choroidal thickness (CT) was measured at the fovea; other CT measurements were taken 1,000 µm away from the fovea in the nasal, temporal, superior, and inferior regions by enhanced-depth imaging OCT (EDI-OCT). The thicknesses of the retinal nerve fiber layer (RNFL), macula, and ganglion cell complex (GCC) were measured with SD-OCT. Correlations between the CT values and the degree of ICA stenosis were also evaluated. RESULTS: Mean macular CT values in the study group were significantly thinner than those of the control groups for all quadrants (P < .05). There was no significant correlation between the degree of ICA stenosis and the CT values. Moreover, the mean thicknesses of the RNFL, macula, and GCC did not differ between the two groups. CONCLUSION: The results suggest that CT decreases in patients with ICA stenosis compared with age-matched healthy individuals, whereas the RNFL, macular, and GCC thicknesses are comparable.

Ocular complications of diabetes mellitus.

Diabetes mellitus (DM) is a important health problem that induces ernestful complications and it causes significant morbidity owing to specific microvascular complications such as, retinopathy, nephropathy and neuropathy, and macrovascular complications such as, ischaemic heart disease, and peripheral vasculopathy. It can affect children, young people and adults and is becoming more common. Ocular complications associated with DM are progressive and rapidly becoming the world's most significant cause of morbidity and are preventable with early detection and timely treatment. This review provides an overview of five main ocular complications associated with DM, diabetic retinopathy and papillopathy, cataract, glaucoma, and ocular surface diseases.

Twenty-four hour pattern of intraocular pressure and ocular perfusion pressure in night shift workers.

PURPOSE: To investigate the intraocular pressure (IOP) and ocular perfusion pressure (OPP) in night shift workers. METHODS: Seventy-one healthy individuals who work the night shift were evaluated. IOP and OPP were measured in the sitting position in each participant. Measurements were obtained at rest time (09:00, 12:00, 16:00) and night-shift time (20:00, 24:00, 04:00, 08:00). RESULTS: The mean age of the 33 females and 38 males was 35.6 ± 7.5 years (range 20-53 years). Mean IOP values were different between the measurements at 9:00 and 12:00 (p = 0.00), at 9:00 and 16:00 (p = 0.00), at 12:00 and 16:00 (p = 0.00), at 16:00 and 24:00 (p = 0.02), at 24:00 and 04:00 (p = 0.02), and at 24:00 and 08:00 (p = 0.00). Mean OPP values were significantly different only between the measurements at 9:00 and 20:00 (p = 0.01). CONCLUSION: This study revealed that IOP and OPP in night shift workers show 24-hour variations.