Characterization of Central and Nasal Orbital Adipose Stem Cells and their Neural Differentiation Footprints.

BACKGROUND: The unique potential of stem cells to restore vision and regenerate damaged ocular cells has led to the increased attraction of researchers and ophthalmologists to ocular regenerative medicine in recent decades. In addition, advantages such as easy access to ocular tissues, non-invasive follow-up, and ocular immunologic privilege have enhanced the desire to develop ocular regenerative medicine. OBJECTIVE: This study aimed to characterize central and nasal orbital adipose stem cells (OASCs) and their neural differentiation potential. METHODS: The central and nasal orbital adipose tissues extracted during an upper blepharoplasty surgery were explant-cultured in Dulbecco's Modified Eagle Medium (DMEM)/F12 supplemented with 10% fetal bovine serum (FBS). Cells from passage 3 were characterized morphologically by osteogenic and adipogenic differentiation potential and by flow cytometry for expression of mesenchymal (CD73, CD90, and CD105) and hematopoietic (CD34 and CD45) markers. The potential of OASCs for the expression of NGF, PI3K, and MAPK and to induce neurogenesis was assessed by real-time PCR. RESULTS: OASCs were spindle-shaped and positive for adipogenic and osteogenic induction. They were also positive for mesenchymal and negative for hematopoietic markers. They were positive for NGF expression in the absence of any significant alteration in the expression of PI3K and MAPK genes. Nasal OASCs had higher expression of CD90, higher potential for adipogenesis, a higher level of NGF expression under serum-free supplementation, and more potential for neuron-like morphology. CONCLUSION: We suggested the explant method of culture as an easy and suitable method for the expansion of OASCs. Our findings denote mesenchymal properties of both central and nasal OASCs, while mesenchymal and neural characteristics were expressed stronger in nasal OASCs when compared to central ones. These findings can be added to the literature when cell transplantation is targeted in the treatment of neuro-retinal degenerative disorders.

Serum Selenium Levels in Patients With Graves Disease With or Without Thyroid Ophthalmopathy.

BACKGROUND: Graves disease is one of the most common autoimmune thyroid diseases. Thyroid has the highest concentration of selenium (Se) in the body. Se plays a crucial role in the functioning of some thyroid enzymes; however, there are controversial results regarding the administration of serum Se levels in patients with Graves disease. METHODS: In this study, patients with Graves disease with orbitopathy (GO group) or without orbitopathy (GD group) were recruited. Healthy individuals without a history of any disease were enrolled as the control group. Serum Se and thyroid hormone levels, including T3, T4, and thyroid-stimulating hormone (TSH), were measured using atomic absorption and radioimmunoassay techniques, respectively. RESULTS: In this cross-sectional study, 60 and 56 patients and 58 healthy subjects were included in the GO, GD, and control groups. Serum Se levels in the GO, GD, and control groups were 94.53 ± 25.36 µg/dL, 96.82 ± 30.3 µg/dL, and 102.55 ± 16.53 µg/dL, respectively (P = .193). There was a reverse association between the serum Se level and thyroid hormones, including T3, T4, and TSH, in the GO group. However, serum Se levels exhibited a significant reverse association with T4 and TSH hormones but not with T3 in the GD group. CONCLUSION: Our results showed no significant differences in the serum Se levels in the GO and GD groups compared with that in the control group. In addition, we did not detect any significant difference in the serum Se levels between the GO and GD groups.

Consanguinity and Increased Risk of Congenital Ptosis: A Case-Control Study from Southern Iran.

Purpose: To assess consanguinity as a probable risk factor for congenital ptosis. Methods: In this case-control study, 97 patients with congenital ptosis and 97 participants as the control group were included. The age, sex, and residence area of the control group were matched with the cases. The inbreeding coefficient (F) was calculated for each participant, and the mean of the inbreeding coefficient (α) was calculated for each group. Results: The prevalence of consanguineous marriage in parents of cases with congenital ptosis and those of the control group was 54.6% and 30.9%, respectively (P < 0.002). The mean of the inbreeding coefficient (α) in patients with ptosis was 0.026, whereas it was 0.016 in the control group (T = 2.51, degree of freedom = 192, P = 0.0129). Conclusions: The rate of consanguineous marriage was significantly higher among the parents of patients with congenital ptosis. It implies a probable recessive pattern in the etiology of congenital ptosis.

Long-term outcome of refractive errors in patients with congenital blepharoptosis who have undergone ptosis surgery.

CLINICAL RELEVANCE: Ptosis surgery induces some changes in pre-existing refractive errors and astigmatism. Monitoring refractive outcomes, planning of vision rehabilitation, and amblyopia treatment may be required following ptosis surgery. BACKGROUND: The few studies published on the outcomes of refractive error after ptosis surgery have been controversial. The aim of this study was to evaluate long-term outcomes of refractive error in patients with congenital blepharoptosis who had undergone ptosis surgery. METHODS: Patients with congenital blepharoptosis who had undergone ptosis surgery were enrolled in the study. Data on pre- and post-operative refractive errors, marginal reflex distance 1 (MRD1), and levator function were obtained. The data from fellow eyes were used as the control. RESULTS: The mean patient age of patients undergoing ptosis surgery was 19.8 ± 8 years. The mean follow-up time (time between the operation and post-up measurements) was 4.7 ± 2.1 years with a range of 2-10 years. There were no significant differences in mean refractive changes, being 0.53 ± 0.40D vs. 0.36 ± 0.45D in sphere (p = 0.19) and 0.48 ± 0.56 vs. 0.30 ± 0.23 in cylinder (p = 0.17) in operated and control eyes, respectively. Astigmatism change was, however, significantly higher in the operated eyes with an MRD1 change of ≥2.5 mm (0.84 ± 0.66 vs. 0.27 ± 0.39, p = 0.024). The changes in astigmatism in the operated eyes had a significantly positive correlation with the changes of MRD1 (r = 0.497, p = 0.019). Vectorial analysis showed no significant difference between the changes in astigmatism of the operated and control eyes (0.58 *48º vs. 0.45*53º, respectively). CONCLUSION: Spherical power of the eyes of patients with congenital ptosis who undergo ptosis surgery does not change. A significant change in astigmatism can be anticipated in eyes with more than 2.5 mm change in MRD1. There is an association between change in astigmatism and MRD1 following ptosis surgery.

Corneal biomechanical properties in hyperthyroidism and thyroid eye disease.

PURPOSE: The purpose of this study is to compare the corneal biomechanical properties of hyperthyroids without ophthalmopathy (HWO), thyroid eye disease (TED), and euthyroid participants. METHODS: In this prospective comparative study, one eye per patient included in the analysis and according to exclusion criteria, 38 eyes of 40 HWO patients, 31 eyes of 40 TED patients, and 150 eyes of 160 age- and sex-matched euthyroid participants were enrolled. All participants were evaluated by an endocrinologist and oculoplastic surgeon for evaluation of thyroid function and orbitopathy, respectively. Measurements of corneal biomechanical properties were performed using ocular response analyzer and Corvis ST tonometers. RESULTS: In the HWO group, applanation-1 length (A1 L), applanation-2 velocity (A2V) (P < 0.001), and corneal resistant factor (P = 0.043) were higher than the control group and corneal hysteresis (CH) was lower (P = 0.018). In the TED group, A1 L, A2V (P < 0.001), and highest concavity radius (HCR) (P = 0.027) were higher than the control group, and the CH (P = 0.007) and highest concavity deformation amplitude (HCDA) (P = 0.001) were lower. Furthermore, the level HCDA in the TED group was lower than HWO group (P = 0.011). The level of upper scleral show and palpebral fissure had a negative correlation with CH and HCDA. The amount of exophthalmos level had a positive correlation with HCR. CONCLUSION: Corneal biomechanical properties in the HWO and TED groups were different from the normal euthyroid individuals and may be taken into account in managing situation like glaucoma and refractive surgeries.

Comparison of the Effectiveness of Onion Extract, Topical Steroid, and Petrolatum Emollient in Cosmetic Appearance of Upper Blepharoplasty Scar.

PURPOSE: To compare the effectiveness of onion extract, topical steroid, and petrolatum emollient in the prevention of scars in cases who underwent bilateral upper eyelid blepharoplasty. METHODS: A prospective, interventional, comparative, double-blinded case series was designed on cases who underwent upper lid blepharoplasty. After suture removal (1 week following the surgery), the eyelids of participants were randomly allocated into the three groups: The first group used onion extract on the right eyelids (n = 18), and the second group used topical steroid on the right eyelids (n = 19). In the third group, the control group, petrolatum emollient was used on the left eyelids (n = 37) of the first and second group's cases. They used drugs for 2 months and were evaluated by the Manchester Scar Scale (MSS) objectively by two graders who were blinded to the type of medication. MSS evaluates five different characteristics of the scar in addition to the Visual Analog Scale (VAS). These characteristics include color, distortion, contour, texture, and transparency. VAS scores the overall scar appearance which ranged among 0-10. The sum of the scores for the five different parameters, and VAS was calculated, analyzed, and compared among the groups. RESULTS: A total of 37 cases (74 eyelids) who underwent bilateral upper blepharoplasty were included. The mean ± standard deviation (SD) of age was 51.94 ± 9.26 years, 49.40 ± 9.37 years, and 47.00 ± 9.06 years in the onion extract, topical steroid, and petrolatum emollient groups, respectively (P = 0.275). There were no statistically significant differences in the mean ± SD of the sum of the MSS scores among the three groups (P = 0.924) or between the onion extract and topical steroid groups (P = 0.951). Furthermore, the color, distortion, contour, texture, transparency, and VAS scores were not statistically significantly different among the three groups or between the onion extract and topical steroid groups (P > 0.05). CONCLUSION: There were no significant differences among these three groups of drugs regarding the appearance of the upper blepharoplasty scar.

Clinical Features of Graves' Ophthalmopathy and Impact of Enalapril on the Course of Mild Graves' Ophthalmopathy: A Pilot Study.

BACKGROUND: Inflammation, oxidative stress, and adipogenesis are associated with Graves' ophthalmopathy (GO) progression. OBJECTIVE: We conducted a pilot study to investigate the effect of Enalapril on patients with mild ophthalmopathy. METHOD: Based on the comprehensive eye examination, 12 patients with mild ophthalmopathy were selected from referred Graves' patients and treated with Enalapril (5 mg daily) for 6 months. Clinical and ophthalmological examination [IOP (Intraocular Pressure), vision, Margin reflex distance and exophthalmia measurement, CAS (clinical activity score) and VISA [V (vision); I (inflammation/ congestion); S (strabismus/motility restriction); and A (appearance/exposure] score assessment) was performed at the beginning, 3 months and 6 months of the study period. Quality of life was also evaluated using a standard questionnaire. RESULTS: Mean exophthalmia at the first visit was 18.75 ± 2.39, 3 months later 18.53 ± 2.39 and 6 months later was 17.92 ± 2.31, respectively. Mean CAS was 0.71 ± 0.82 (first visit), 0.57 ± 0.54 (3 months) and 0.14 ± 0.36 (6 months), respectively. Mean Margin reflex distance was 9.09 ± 4.36 (first visit) and 9.60 ± 4.40 (6 months), respectively. There were significant differences in the case of exophthalmia (P=0.002), CAS (P=0.006), and Margin reflex distance (P=0.029) between the first visit and 6 months after treatment. The difference between the score of quality of life in patients with GO after 6 months of follow up was statistically significant (P = 0.006). CONCLUSION: Our results showed that Enalapril treatment could ameliorate the clinical course of GO according to the ophthalmologic examinations and subjective parameters of disease progression. However, further studies should be performed to determine the efficacy of Enalapril in Graves' ophthalmopathy treatment.

Effectiveness of Topical Onion Extract Gel in the Cosmetic Appearance of Blepharoplasty Scar.

Objectives: Topical onion extract gel is commonly used in commercial anti-scar medications. The purpose of this study was to evaluate the effectiveness of topical onion extract gel on the appearance of blepharoplasty scars and to compare the results of its use to those of petroleum jelly. Design: The participants enrolled in this prospective, double-blind study were randomly treated with either topical onion extract gel or petroleum jelly. The products were applied twice daily for two months following suture removal. Patients were evaluated objectively using the Manchester Scar Scale at the end of treatment. Six months after surgery, a follow-up phone interview was conducted. Setting: The study was carried out in the Khalili and Dastghaib Hospitals in Shiraz, Iran. Participants: Out of 43 participants who had upper blepharoplasty, 26 patients completed the follow up. Measurements: The Manchester Scar Scale evaluates five different characteristics of scar: color (score: 1-4), distortion (score: 1-4), contour (score: 1-4), texture (score: 1-4), and transparency (score: 1-2). A visual analogue scale (VAS) was also used to quantify the overall scar appearance on a range of 0 to 10 (with the highest number indicating the worst appearance). The scores for the five different parameters and the VAS were calculated and compared. Results: There was no statistically significant difference in overall cosmetic appearance objectively and/or subjectively between the two sides (p value: 0.25). Conclusion: Topical onion extract gel was ineffective in improving overall blepharoplasty scar appearance when compared with a petroleum-based ointment.

Association Between Advanced Keratoconus and Serum Levels of Zinc, Calcium, Magnesium, Iron, Copper, and Selenium.

PURPOSE: To investigate the possibility of an association between serum levels of zinc (Zn), calcium (Ca), magnesium (Mg), iron (Fe), copper (Cu), and selenium (Se) and advanced keratoconus (KCN). METHODS: In this study, 50 patients with advanced KCN and 50 control subjects were included. Plasma levels of Zn, Ca, Mg, Fe, Cu, and Se were compared between the groups. RESULTS: Mean ± SD age of the patients in the case and control groups was 29.3 ± 3.5 and 28.9 ± 5.9 years, respectively (P = 0.669). Among serum parameters, there were no statistically significant differences between the 2 groups in serum levels of Ca, Mg, and Fe (P > 0.05), whereas serum levels of Zn and Cu were significantly lower in the case group than the control group [65.92 ± 7.90 vs. 87.36 ± 13.64 µg/dL and 78.48 ± 11.96 vs. 116.34 ± 20.87 µg/dL, respectively (both P < 0.001)] as well as the serum level of Se [79.76 ± 19.16 vs. 87.41 ± 15.91 µg/dL (P = 0.032)]. CONCLUSIONS: The lower serum levels of Zn, Cu, and Se in patients with advanced KCN compared with healthy controls indicate the possible role of antioxidants in the etiopathogenesis of KCN, which points to early treatment of this progressive degenerative disease with supplementation therapy, rather than keratoplasty techniques.

Bacterial Flora of the Conjunctiva One Year after Dacryocystorhinostomy.

PURPOSE: The purpose of this study was to evaluate the changes of conjunctival bacterial flora 1 year after successful dacryocystorhinostomy (DCR). METHODS: Seventy-two consecutive adult patients with successful DCR were enrolled in this study. We obtained conjunctival cultures from the operated eyes, fellow eyes, and nasal mucosa of the operated side 1 year after the operation. After the period of incubation, further evaluation was performed using standard laboratory techniques. RESULTS: In the conventional media, positive bacterial growth was detected in 48 (66.7%) of the 72 operated eyes and in 31 of the 72 normal fellow eyes (43.1%). Nasal specimens were positive for bacterial growth in 65 (90.3%) patients. Isolation rate was significantly different between the operated and the fellow (nonoperated) eyes (P = 0.0074). Colony count, type, and frequencies of bacterial isolation from the operated eyes were similar to nonoperated eyes. CONCLUSION: One year after DCR, conjunctival bacterial isolation rate increased compared with the normal fellow eyes. Remote DCR may be considered as a local risk factor for developing postoperative endophthalmitis.

The Relationship between Primary Acquired Nasolacrimal Duct Obstruction and Gastroesophageal Reflux.

Purpose/Aim of the study: To evaluate if there is any relationship or coincidence between gastroesophageal reflux disease (GERD) and primary acquired nasolacrimal duct obstruction (PANDO). MATERIAL AND METHODS: We enrolled 180 patients with PANDO, confirmed by positive regurgitation on sac squeezing or by irrigation test. In the control group, any patient with lacrimal drainage obstruction was excluded. For diagnosis of gastroesophageal reflux we used a (Gerd Q) questionnaire by R. Jones. RESULTS: According to Gerd Q, prevalence of gastroesophageal reflux in patients with PANDO was 20% (36 out of 180 patients) and in the control group, it was 10.6% (19 out of 180 patients), which was significantly higher in the presence of PANDO (p valve = 0.013). In women, 28 patients (23.5%) in the case group versus 13 patients (10.9%) in the control group has gastroesophageal reflux (p value = 0.01), which was not significant among men (p value = 0.870). When we considered age as an independent variable, results reveled significant value only for patients over 60 years old (p value = 0.008). CONCLUSION: The prevalence of gastroesophageal reflux disease was significantly higher in patients with PANDO. This statistical relationship was greater among women and patients over 60 years old. In this study, we found an association between GERD and PANDO.

Optic nerve glioma with complete intraocular extension.

PURPOSE: To present a rare presentation of optic nerve glioma (ONG) with total intraocular extension. METHODS: A 44-year-old man with a history of loss of vision since childhood and recent development of progressive disfiguring proptosis was referred. RESULTS: The vision in the affected eye was no light perception, and a proptosis of about 2-3 mm was present. Computed tomography and Magnetic Resonance Imaging (MRI) of brain/orbit showed a fusiform enlargement of the left optic nerve and total filling of vitreous cavity by a mass with high signal intensity in T2-weighted MRI. There was no extension into the intracranial cavity. The patient also had no signs of neurofibromatosis. Histopathology confirmed the diagnosis of ONG of the left orbit with extension into the globe and filling vitreous cavity. CONCLUSION: ONG may extend to the vitreous cavity with no simultaneous intracranial involvement.

The use of mersilene mesh for wrapping of hydroxyapatite orbital implants: mid-term result.

PURPOSE: To report the results of Mersilene mesh wrapped hydroxyapatite orbital implantation. MATERIALS AND METHODS: Records of 63 patients operated between April 2002 and March 2006 were retrospectively reviewed. Parameters studied included sex, cause of enucleation, length of follow-up after operation, implant exposure, secondary implantation, and surgeon experience. Student's t-test and χ(2) were used for comparison group having implant exposure and those without implant exposure. RESULTS: The rate of exposure with use of Mersilene mesh was found to be 4.7%. Gender and cause of enucleation did not influence incidence of implant exposure in this study. The surgeon related factor, reported in terms of oculoplasty surgeon and non-oculoplasty surgeon, was a statistically significant factors that affected implant exposure. CONCLUSION: Mersilene showed favorable results in wrapping of hydroxyapatite orbital implants.

Does gastroesophageal reflux contribute to development of acquired nasolacrimal duct obstruction?

Primary acquired nasolacrimal duct obstruction results from inflammation of unknown cause that eventually leads to fibrosis and occlusion. The nasolacrimal duct is within the medial wall of maxillary sinus and open into the nasal cavity. It may be affected by gasteroesophageal reflux disease (GERD) by the possible direct noxious effect of the refluxate on the nasal mucosal cavity surrounding of the nasolacrimal duct opening at the inferior meatous and ascending of inflammation to the mucosa of the duct may leads to chronic inflammation and fibrosis. In addition to, the GERD may induce autonomic nervous system hyperactivity resulting in hyperemia of venous plexus surrounding nasolacrimal duct leading to secondary mucosal edema of nasolacrimal duct and dacryostenosis.

Normalization of conjunctival flora after dacryocystorhinostomy.

PURPOSE: To determine the time of normalization of conjunctival flora after successful dacryocystorhinostomy. METHODS: Forty consecutive adult patients with nasolacrimal duct obstruction and chronic dacryocystitis who had been referred for dacryocystorhinostomy were included in the study. Conjunctival cultures were obtained preoperatively from the involved and normal sides of each patient. Cultures from the lacrimal sac contents were obtained at the time of dacryocystorhinostomy. Postoperatively, conjunctival specimens were obtained from the operated side weekly until the result of the cultures was negative or the colony count was less than that of the normal side. RESULTS: The mean time of normalization was 4.5 weeks (range, 3-8 weeks). The time of normalization was significantly related to the type of organisms (p = 0.04) and the colony count (p < 0.001). The mean time of normalization was 3.5 weeks in patients with a colony count <10 and 4.93 weeks in patients with a colony count > or =10. The time of normalization was significantly related to the presence of a silicone tube (p < 0.0001). The mean time of normalization was 6.2 weeks and 3.9 weeks in patients with and without a silicone tube, respectively. CONCLUSION: A few weeks is needed for the conjunctival flora to normalize after dacryocystorhinostomy. The time of normalization is related to the type of bacteria, colony count, and presence of silicone tube.