Ocular findings in patients with vitiligo: A single-center experience.

PURPOSE: We sought to evaluate ocular abnormalities in patients with nonsegmental vitiligo. METHODS: This was a case-control study in which patients with vitiligo were evaluated in terms of ocular findings. Vitiligo patients were classified into acrofacial and generalized groups. Duration and periocular involvement of the vitiligo were recorded. Vitiligo Area Scoring Index (VASI) and Vitiligo Disease Activity Score (VIDA) were calculated. All patients and control subjects underwent uncorrected and corrected visual acuity, keratometry, central corneal thickness, Schirmer's testing, tear film break-up time (TBUT), intraocular pressure, biomicroscopic examination, and anterior segment tomography. RESULTS: A total of 244 subjects (130 vitiligo and 114 controls) were included in the study. Most of the vitiligo patients (87.7%) had vitiligo vulgaris. One-third of all vitiligo patients had periocular involvement. Fundus hypopigmentation was found in 42.6% of the vitiligo patients. Thirty-five vitiligo patients (27.3%) and 23 vitiligo patients (18%) had moderately severe and very severe dry eyes, respectively. Based on TBUT, 48 vitiligo patients (44.4%) had a poor tear film. Median scores on Schirmer's testing were 5mm in vitiligo patients with periocular involvement and 11mm in vitiligo patients without periocular involvement (P<0.001). Mean intraocular pressure was 14.4±3.2mmHg in vitiligo patients and was no different from that of the control subjects. Six patients (4.6%) had increased IOP. None of the control subjects had increased IOP. Corneal keratometry showed a significantly higher vertical measurement in vitiligo patients. Astigmatism was significantly higher and peripheral iris atrophy was significantly more frequent in vitiligo patients compared to controls. CONCLUSION: Periocular involvement was associated with an increased risk of dry eye in vitiligo patients.

Evaluation of augmentation index and pulse wave velocity measurements in central retinal vein occlusion patients with and without hypertension.

PURPOSE: To evaluate arterial stiffness using the pulse wave velocity (PWV) and augmentation index (AI) in central retinal vein occlusion (CRVO) patients. METHODS: Forty-two CRVO patients (i.e., CRVO group) and 54 healthy controls (i.e., control group) were included in this comparative and cross-sectional study. The PWV, AI and augmentation pressure were measured with a noninvasive, oscillometric method. RESULTS: The mean PWV, AI and augmentation pressure values were significantly higher in CRVO patients than in controls (p = 0.024, p < 0.001 and p = 0.001, respectively). The mean augmentation pressure, AI and PWV measurements were not statistically significant between CRVO patients with and without hypertension (p = 0.856 and p < 0.526, p = 0.432, respectively). Age, presence of hypertension, AI and PWV were found to be as independent risk factors of CRVO development (OR = 2.21, 95% CI [1.44, 3.38] and OR = 2.40, 95% CI [1.50, 3.86], OR = 3.2, 95% CI [1.70, 5.60] and OR = 5.70, 95% CI [2.00, 18.50], respectively). CONCLUSION: The AI and PWV values were significantly higher in CRVO patients than in controls. These results indicate that similar abnormalities in the arterial wall structure may play an important role in the pathogenesis of the CRVO and cardiovascular diseases. In addition, our findings show that each patient with RVO should be examined in terms of systemic vascular pathologies.

A new potential risk factor for central serous chorioretinopathy: blood pressure variability.

BACKGROUND/OBJECTIVES: The choroid, mostly composed of vascular structures, can be directly affected by systemic hemodynamic changes. Blood pressure variability (BPV) may factor into choroidal dysfunction, which can be associated with the pathogenesis of central serous chorioretinopathy (CSCR). The aim of our study was to investigate short-term BPV over 24 h in patients with acute CSCR versus healthy controls. SUBJECTS/METHODS: Our cross-sectional comparative study included 50 patients with CSCR (i.e., patient group) and 60 healthy individuals (i.e., control group). In all participants, 24-h ambulatory blood pressure was monitored every 15 min during the day and every 30 min at night. Mean variability index (VI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) during the day, at night, and across the 24-h period were subjected to statistical analyses. RESULTS: Mean 24-h, daytime, and night-time SBP and DBP did not significantly differ between the groups. The mean 24-h and daytime VI values for SBP and DBP were significantly higher in the patient group than in the control group, whereas the mean night-time VI values for SBP and DBP between the groups were similar. Multivariate logistic regression models revealed that the VI values for 24-h and daytime SBP and DBP emerged as independent risk factors for developing CSCR. CONCLUSION: Our study revealed that variabilities in 24-h, daytime SBP and DBP were significantly higher in patients with CSCR than in controls. Our results thus suggest that increased BPV may be a new risk factor for the development of CSCR.

[Contact lenses as a migraine trigger]. / Migren tetikleyicisi olarak kontakt lensler.

We aimed to investigate the relationship between contact lens (CL) usage and migraine attacks. Our patient who began using CL with different base curves experienced discomfort and burning of the eyes. The ocular complaints were followed by migraine attacks. The frequency of migraine attacks decreased significantly when the flatter base curve was selected. We assessed the potential causal relationship between CL and migraine.

Psychophysical assessment of koniocellular pathway in patients with schizophrenia versus healthy controls.

This study was designed to perform psychophysical assessment of koniocellular pathway in patients with schizophrenia versus healthy controls. A total of 26 patients diagnosed with schizophrenia and 15 healthy controls were included. Snellen Visual Acuity Chart scores and Short Wavelength Automated Perimetry (SWAP) visual field testing including global visual field indices [mean deviation (MD), pattern standard deviation (PSD), test time (min)], reliability parameters [false negative responses (%), false positive responses (%) and fixed losses (%)] and average threshold sensitivity [central (parafovea), peripheral area, and four quadrants] were recorded in both groups. Significantly lower MD scores, higher PSD scores and lower average threshold sensitivity at each location across the visual field were noted in schizophrenia relative to control group. In conclusion, our findings revealed a deficit in koniocellular pathway with impaired SWAP global indices and lower threshold sensitivity at each location across the visual field among chronic schizophrenic patients as compared with control subjects. Our findings emphasize potential application of SWAP outside its original intended purpose as a glaucoma test, to provide deeper understanding of the specific contribution of lateral geniculate nucleus to the visual and cognitive disturbances of schizophrenia.

Contact lenses, migraine, and allodynia.

Clinical trials and electrophysiologic studies demonstrated increased perceptual sensitivity in patients suffering from migraines. At least, one triggering factor is described in 85% of migraine patients. The aim of this report was to investigate the relationship between contact lens (CL) usage and migraine attacks in two cases. Two patients who were diagnosed with migraine reported that the frequency of migraine attacks increased after they switched to using CL with different base curves (BCs). These two patients, who began using CL with different BCs experienced discomfort and dryness of the eye. The ocular complaints were followed by migraine attacks. CL intolerance was also developed during migraine attack in one of the cases. The frequency of migraine attacks decreased and allodynia relieved significantly when flatter BCs were selected. CL related stimulus could have triggered the migraine attack. CLs should be well fitted in migraine patients with allodynia.

Methylene blue-related corneal edema and iris discoloration.

We report the case of a 70-year-old female patient who developed corneal edema and iris discoloration following the inadvertent use of 1% methylene blue instead of 0.025% trypan blue to stain the anterior capsule during cataract phacoemulsification surgery. Copious irrigation was performed upon realization of incorrect dye use. Corneal edema and iris discoloration developed during the early postoperative period and persisted at 24-months follow-up. However, keratoplasty was not required. The intracameral use of 1% methylene blue has a cytotoxic effect on the corneal endothelium and iris epithelium. Copious irrigation for at least 30 min using an anterior chamber maintainer may improve outcomes.

Methylene blue-related corneal edema and iris discoloration / Edema de córnea e descoloração de íris associados ao azul de metileno

ABSTRACT We report the case of a 70-year-old female patient who developed corneal edema and iris discoloration following the inadvertent use of 1% methylene blue instead of 0.025% trypan blue to stain the anterior capsule during cataract phacoemulsification surgery. Copious irrigation was performed upon realization of incorrect dye use. Corneal edema and iris discoloration developed during the early postoperative period and persisted at 24-months follow-up. However, keratoplasty was not required. The intracameral use of 1% methylene blue has a cytotoxic effect on the corneal endothelium and iris epithelium. Copious irrigation for at least 30 min using an anterior chamber maintainer may improve outcomes.

RESUMO Paciente do sexo feminino com 70 anos de idade desenvolveu edema da córnea e descoloração da íris após o uso inadvertido de 1% de azul de metileno em vez de 0,025% de azul tripano para corar a cápsula anterior do cristalino durante a cirurgia de catarata por facoemulsificação. Foi realizada irrigação abundante quando detectou-se que o corante incorreto tinha sido usado. Edema da córnea e descoloração íris que ocorreu no período pós-operatório precoce persistiu durante 24 meses de seguimento; no entanto, a ceratoplastia não foi necessária. O uso intracameral de 1% de azul de metileno tem efeitos citotóxicos sobre o endotélio da córnea e epitélio da íris. A irrigação abundante durante pelo menos 30 minutos, utilizando um mantenedor de câmara anterior pode resultar em um prognóstico melhor.

Assessment of corneal endothelial cell density in patients with keratoconus not using contact lenses.

PURPOSE: To assess the corneal endothelial cell density (ECD) in keratoconus patients with no history of contact lens use. SETTING: Yuzuncu Yil University, School of Medicine and Van Training and Research Hospital, Department of Ophthalmology, Van, Turkey. DESIGN: Cross-sectional controlled study. METHODS: The eyes of 65 patients with the diagnosis of keratoconus with no history of contact lens wear and the eyes of 40 healthy controls were prospectively examined using the Heidelberg Retinal Tomography Rostock Cornea Module (HRT3/RCM). The average ECD from the two groups were then compared. RESULTS: Of the cases with keratoconus, 44 (67.7%) were men and 21 (32.3%) were women. The mean age was 20.9±6.8 (range=10-41) years. Of the controls, 28 (70%) were men and 12 (30%) were women. The mean age was 23.9±5.8 (range=14-35) years. Of the 65 eyes with keratoconus, 19 (29.2%) had mild keratoconus, 21 (32.3%) had moderate keratoconus, and 25 (38.5%) had severe keratoconus. The mean ECD was 2731.6±303.2 cells/mm2 in cases with keratoconus and 2664.9±319.5 cells/mm2 in controls. There was no difference between the densities (unpaired t-test, P=0.4). No significant relationships were found between the ECD data and central corneal thickness or steepest keratometric. CONCLUSIONS: Endothelial cell density was unaltered in keratoconic patients without a history of contact lens use when compared with healthy controls. Change in ECD is independent from the central corneal thickness and the stage of keratoconus.

Assessment of keratocyte density in patients with keratoconus not using contact lenses.

PURPOSE: To assess the keratocyte density (KD) in the cornea of patients with keratoconus not using contact lenses. METHOD: In this pilot study, the eyes (n = 68) of 35 patients with the diagnosis of keratoconus, who did not use contact lenses and the eyes(n = 70) of 35 healthy controls were prospectively examined using the Heidelberg Retinal Tomography Rostock cornea module (HRT3/RCM). The cases with keratoconus and controls were compared with regard to KD in the anteroposterior stromal layers. RESULTS: Of the cases with keratoconus, 15 (42.9%) were men and 20 (57.1%) were women. The mean age was 21.1 ± 11.1 (range =14-41) years. Of the controls, 26 (73.9%) were men and 9 (26.1%)were women. The mean age was 23.9 ± 12.9 (range = 14-35) years.Of the 68 eyes with keratoconus, 22 (28.2%) had mild keratoconus, 23 (35.9%) had moderate keratoconus, and 23 (35.9%) had severe keratoconus. The mean anterior stromal KD was 651.4 ± 89 cells per square millimeter in cases with keratoconus and 879.4 ± 75 cells per square millimeter in controls (P < 0.05). The mean anterior stromal KD decreased by 25.9% in corneas with keratoconus. The mean posterior stromal KD was found to be 363.6 ± 74 cells per square millimeter in cases with keratoconus and 469.7 ± 56 cells per square millimeter in controls (P< 0.01). The mean posterior stromal KD decreased by 22.6% in corneas with keratoconus. The anterior stromal KD was higher than the posterior stromal KD (P < 0.001). No significant relationships were found between the stromal KD data and central corneal thickness or steepest keratometric. CONCLUSIONS: The KD in the anterior and posterior corneal stroma was decreased in patients with keratoconus, but without the use of contact lens, compared with healthy controls. This density difference was independent from the central corneal thickness and the stage of keratoconus.