Corneal parameters, ocular biometers, and retinal and choroidal thickness in acromegaly patients.

BACKGROUND: To compare ocular findings of acromegaly patients with healthy individuals and investigate the relation of serum levels of insulin-like growth factor (IGF-1) along with growth hormone (GH) and pituitary tumor (adenoma) dimensions (TD) with specific ocular parameters. METHODS: The ocular parameters of acromegaly patients (n = 38) were compared with those of healthy subjects (n = 36). These parameters were intraocular pressure, keratometric (K1-K2) values, central corneal thickness (CCT), total axial length along with anterior chamber-lens-vitreous length, retinal nerve fiber layer (RNFL) thickness, central foveal thickness (CFT), choroidal thickness (CT), ganglion cell layer thickness (GCLT), and inner plexiform layer thickness (IPLT). Also investigated was whether there was a correlation between disease duration, TD, GH, IGF-I, CCT, RNFL, CFT, GCLT, IPLT, and CT. RESULTS: The lens length of the acromegaly group was increased (p = 0.014). GH and IGF-1 levels were positively correlated with CT and CCT, respectively (p = 0.041, r = 0.343) (p = 0.03, r = 0.347). Analysis of TD also found a highly negative correlation with the mean RNFL thickness of the acromegaly patients (p < 0.01, r = -0.603). The mean value of the inner parts of GCLT and IPLT was negatively correlated with TD (p = 0.041, r = -0.343 and p = 0.025, r = -0.379, respectively). CONCLUSION: Serum IGF-1 and GH levels might be determinant factors in CCT and CT, respectively. The pituitary adenoma size increasing may be prone to lead RNFL, ganglion cell layer, inner plexiform layer thinning. Increased lens thickness was found in the acromegaly group.

The role of anterior segment optical coherence tomography in the evaluation of the pterygium.

BACKGROUND: To evaluate the ability of anterior segment optical coherence tomography (AS-OCT) to visualize the anatomic features of the pterygium and its invasion of the corneal layers. METHODS: Seventy-five eyes of 54 patients diagnosed with pterygium were included. All subjects underwent complete ophthalmologic examinations, including AS-OCT. The limbus-apex distance, vertical height at the limbus, invasion of the Bowman's and stromal layers, and other morphologic structures of the pterygium tissue were analyzed. RESULTS: The mean age of the patients was 49.67 ± 16.49 (20-85) years. The mean apex-limbus distance was 2548.37 ± 1026.32 (933-4597) µm, and the mean vertical height at the limbus was 4843.89 ± 1374.10 (1740-7784) µm. A space was observed beneath the pterygium tissue in 44 (58.67%) eyes. The mean width and height of this space were 1756.33 ± 560.22 (1009-3095) µm and 231.70 ± 85.88 (109-465) µm, respectively. Invasion of the Bowman's layer was apparent in 74 (98.67%) eyes, and invasion of the stromal layer was detected in 33 (44%) eyes. A hyperreflective layer was observed beneath the epithelial layer at the edge of the pterygium apex in 31 (41.33%) eyes. In 24 (92.31%) of the 26 advanced pterygium cases and 20 (40.82%) of the 49 early pterygium cases, a subpterygium space was found beneath the lesion (p = 0.0001). CONCLUSION: AS-OCT enables measurement of the actual size and thickness of pterygia, assessment of invasion of the Bowman's and stromal layers of the cornea, and evaluation of the pterygium structure. Over half of the eyes exhibited space beneath the pterygium.

Assessment of serum catalase, reduced glutathione, and superoxide dismutase activities and malondialdehyde levels in keratoconus patients.

BACKGROUND: The aim of this study was to investigate the relationship between keratoconus disease and the antioxidant activities of catalase (CAT), reduced glutathione (GSH) and superoxide dismutase (SOD) and the level of the oxidative stress marker malondialdehyde (MDA) in serum. METHODS: The study included 50 patients diagnosed with keratoconus and 53 healthy age- and sex-matched control subjects. The keratoconus patients were grouped according to the four keratoconus stages based on the modified Krumeich keratoconus classification system. The CAT, GSH and SOD activities and MDA levels in the serum samples collected from the patient and control groups were compared. RESULTS: The mean serum CAT, GSH, SOD and MDA levels in the keratoconus group were determined to be 0.075 (0.074-0.078)U/L, 0.002 (0.001-0.006) mmol/ml, 1.56 (1.51-1.62)U/L and 1.69 (1.65-1.99) mmol/L, respectively, and those in the control group were determined to be 0.024 (0.013-0.037)U/L, 0.029 (0.018-0.049) mmol/ml, 4.13 (4.01-4.17) U/L and 0.74 (0.65-0.82) mmol/L. The serum GSH levels and SOD activity were significantly lower in the keratoconus group (p < 0.001 for both) than in the control group while the CAT activity and MDA levels were significantly higher (p < 0.001 for both). CONCLUSION: The low serum GSH levels and SOD activity and the high CAT activity and MDA levels observed in this study suggest the presence of oxidative stress and inadequate antioxidant defence mechanisms in keratoconus patients. The studied parameters may offer auxiliary markers for use in the diagnosis and treatment of the keratoconus disease and in its potential therapeutic targets in the future.

The depigmentation degree of iris pigment epithelium in pseudoexfoliation syndrome.

BACKGROUND: To compare the optical density of iris pigment epithelium (ODIPE) and iris stromal thickness (IST) measurements in patients having pseudoexfoliation syndrome (PXS) and age-gender matched participants. METHODS: This is a cross-sectional study. Patients with PXS were enrolled in the study group. Age and gender-matched healthy subjects with no evidence of PXS were recruited as controls. After a comprehensive ophthalmological evaluation, the anterior segment images were acquired using anterior segment spectral-domain optical coherence tomography (AS SD-OCT). The acquired pictures were further analyzed using the ImageJ program. Two investigators measured the ODIPE and the IST of the subjects, and the repeatability and reproducibility were checked. SPSS program was used for statistical analysis. RESULTS: The PXS group was comprised of twenty-two eyes (n = 22 patients), and the control group contained twenty-six eyes of 26 age and gender-matched healthy subjects. The mean temporal ODIPE of the study group was found to be decreased significantly in comparison to the mean temporal ODIPE of the control eye (p = 0.018). Both the mean nasal (N) and temporal (T) ISTs of the PEX eyes were thinner than the control eyes (p = 0.006 and p = 0.002, respectively). The mean baseline IOP was found to significantly negatively correlate with the ODIPE in the PEX group at both N and T sides (r = -0.531, p = 0.011 and r = -0.685, p < 0.001, respectively). CONCLUSION: The pupillary margin IPE was found more depigmented, and the mean N and T IST were significantly thinner in the PEX group by comparison with the age-gender matched healthy controls. The mean baseline IOP was negatively correlated with the pupillary margin's IPE pigmentation degree in patients with PXS.

Evaluation of Successful and Failed Filtering Blebs after Trabeculectomy Using Anterior Segment Optical Coherence Tomography.

PURPOSE: To evaluate filtering bleb characteristics using anterior segment optical coherence tomography (AS-OCT) and analyze correlations between these parameters and intraocular pressure (IOP). METHODS: The study included 54 eyes of 43 patients who underwent trabeculectomy with mitomycin-C. The patients were divided into two groups based on mean postoperative IOP. The criterion for surgical success was mean unmedicated postoperative IOP ≤18 mmHg. Patients with IOP values >18 mmHg were prescribed anti-glaucoma drops and classified as a surgical failure. All patients underwent AS-OCT, and maximum bleb height, maximum bleb wall thickness, and maximum fluid-filled cavity height were measured. AS-OCT bleb parameters were compared between the successful and failed groups. RESULTS: Of the 54 eyes, 37 (68.5%) were in the successful group, and 17 (31.5%) were in the failed group. Mean preoperative IOP values in the successful and failed groups were 26.9 ± 6.5 mmHg and 22.9 ± 4.9 mmHg, preoperatively, versus postoperative values of 13.3 ± 2.1 mmHg and 22.8 ± 2.8 mmHg, respectively. Mean postoperative follow-up time was 17.4 ± 9.5 months in the successful group and 19.1 ± 10.1 months in the failed group (P = 0.22). In the successful and failed groups, mean bleb height was 1473.7 ± 150.6 µm and 1165.4 ± 217 µm (P < 0.001), bleb wall thickness was 670.5 ± 119.9 µm and 538.8 ± 144.3 µm (P = 0.001), and fluid-filled cavity height was 736.5 ± 196.8 µm versus 532.5 ± 226.2 µm (P = 0.001), respectively. CONCLUSIONS: The results of this study showed that higher AS-OCT values for bleb height, wall thickness, and fluid-filled cavity height were associated with greater functional success. These parameters may be helpful in determining bleb functionality.

Effectiveness of Pulmonary Surfactant in the Treatment of Corneal Edema.

Purpose: To compare the effectiveness of topical surfactant and 3% sodium chloride (NaCl) in the treatment of corneal edema occurring after cataract surgery. Methods: Ninety eyes of 90 patients with no corneal disease who underwent cataract surgery were included in the study. Thirty eyes without corneal edema comprised group 1. Patients with corneal edema were divided into two groups: those treated with 3% NaCl (group 2, 30 eyes) and those treated with surfactant drop (group 3, 30 eyes). Results: The mean age was 70.8 ± 6.6 years, with no significant age difference between the groups. Preoperatively, there was no significant difference in mean central corneal thickness (CCT) or mean endothelial cell count (ECC) among the groups (P = 0.999). On postoperative day 1, CCT was significantly lower in group 1 (P < 0.001) but did not differ between groups 2 and 3 (P = 0.999). There was no significant difference between groups in terms of ECC (P > 0.05). At postoperative day 7 and 14, CCT differed significantly between groups 1 and 2 (P < 0.001) and between groups 2 and 3 (P = 0.001), with no significant difference between groups 1 and 3 (P = 0.474). ECC was significantly higher in group 1 (P < 0.05), whereas there was no significant difference between groups 2 and 3 (P > 0.05). Conclusion: Topical pulmonary surfactant may be a more effective treatment option than 3% hypertonic NaCl for the treatment of corneal edema that develops after cataract surgery.

In Vivo Analysis and Comparison of Anterior Segment Structures of Both Eyes in Unilateral Herpetic Anterior Uveitis.

Purpose: To compare the Schlemm's canal area (SCA) and to define iris features in patients with unilateral herpetic anterior uveitis (HAU) by using anterior segment spectral-domain optical coherence tomography (AS SD-OCT).Methods: Unilateral HAU cases that had been in complete remission for ≥ 3 months were included. Two investigators analyzed the iris features of HAU. SCA in both healthy (N), and affected eyes (HAU) were compared.Results: The mean age of the participants (n = 22) was 36.3 ± 15 (17-70) years. The mean nasal and temporal (n-t) SCA was measured as 10,844 ± 4806 µm2 and 8,772 ± 3138 µm2 in HAU in comparison with 10,200 ± 4,824 µm2 and 10,045 ± 3,889 µm2 in N, respectively (p = .47 and p = .12, respectively). The most common iris features were the sectoral iridoplegia (100%) on biomicroscopy and the disorganization of the iris layers (DIL) (77%) on AS SD-OCT images.Conclusion: SCA found similar on both sides. DIL is the most common iris feature of affected eyes.

Hemicentral Retinal Artery Occlusion: A Rare Complication of Orbital Cellulitis.

A 14-year-old boy presented with acute vision loss and swelling of the right eye. An anterior segment examination revealed a relative afferent pupillary defect, severe proptosis, and ophthalmoplegia in his right eye. The fundus examination revealed inferior hemicentral retinal artery occlusion. Although the authors proceeded with systemic medical treatment, the findings did not improve. An endoscopic orbital decompression was performed. With both medical and surgical treatment, the orbital cellulitis resolved and the patient's visual acuity improved. [J Pediatr Ophthalmol Strabismus. 2020;57:e51-e55.].

Comparison of the efficacy of accelerated corneal cross-linking therapy in different pediatric age groups having progressive keratoconus.

PURPOSE: To report a comparison analysis of accelerated corneal cross-linking (A-CXL) treatment for progressive keratoconus patients in different pediatric age groups. STUDY DESIGN: Retrospective, cross-sectional. METHODS: Patients with progressive keratoconus aged ≤ 18 were retrospectively reviewed. Forty-one eyes of 41 patients were included in the study. Patients were divided into two groups according to their age (≤ 14 years and 15-18 years). All patients underwent epithelium-off A-CXL protocol. Acquired data were compared between the two groups. RESULTS: The mean age was 14.3 ± 1.8 (10-18) years. Twenty-five (61%) of the participants were male, and 16 (39%) were female. Twenty (49%) patients were separated into group 1 (≤ 14 years of age), and 21 (51%) were in group 2 (15-18 years). Age at presentation was found to be the only factor in anticipating the progression of keratoconus at the second postoperative year visit (p < 0.001). Progression in keratometric values was detected in seven (35%) of the 20 eyes in group 1, and one (4%) of the 21 patients in group 2 (Z = - 2.44, p = 0.014). CONCLUSION: Even if proper treatment is applied, the progression of keratoconus is likely in patients younger than 14 years of age. Instead of evaluating pediatric patients as a whole, closer follow-up and early treatment may be useful in younger age groups (≤ 14 years).

Evaluation of the Initial Optical Coherence Tomography Parameters in Anticipating the Final Visual Outcome of Central Retinal Vein Occlusion.

PURPOSE: To evaluate the predictive and associated factors in determining the visual outcome in patients having central retinal vein occlusion (CRVO)-related macular edema (ME). METHODS: The charts of the patients who were treated due to CRVO-related visual disturbance were reviewed. The optical coherence tomography (OCT) images of eyes were analyzed, and disorganization of retinal inner layers (DRILs), ellipsoid zone (EZ) and external limiting membrane (ELM) disruption length, hyper-reflectivity of retinal inner layer (HRIL) existence, baseline and final visual acuity (VA), subfoveal thickness (SFT), subretinal fluid (SRF), and injection numbers were noted. The regression and correlation analyses were applied. RESULTS: Thirty eyes of thirty patients were included in the study. The mean follow-up time was 17.5 ± 11 (8-47) months. The mean baseline VA was 1.4 ± 0.7 (0.2-3.1) logMAR. A total of 87 intravitreal injections were applied for the treatment of ME during the follow-up. The initial mean central subfield thickness was 795 ± 264 (1470-398) µm. HRIL and SRF were observed in 16 and 23 eyes at the initial visit, respectively. The final mean VA was 1.2 ± 0.9 (0.1-3.1) logMAR. At the final visit, additional OCT parameters were evaluated. The mean DRIL length was 463 ± 324 µm. The mean disruption length of EZ and ELM was 367 ± 247 µm and 414 ± 327 µm, respectively. The final mean SFT was 290 ± 91 µm. SRF presence at the initial visit was found to be associated with elongated EZ and ELM disruption length at the final visit (P = 0.03 and P = 0.04, respectively). On linear regression analyses, none of the baseline features (SRF, SFT, and HRIL) except baseline poor best corrected visual acuity were found to be predictive in anticipating the final visual outcome (P = 0.04). On linear bivariate analysis, the final poor visual outcome was found to be affected by EZ disruption length of ≥500 µm at the last visit (P = 0.02). CONCLUSION: Baseline VA was the only predictive factor in anticipating the final visual outcome. At the final visit, extensive disruption length of EZ in the subfoveal area was associated with a poor visual outcome.

Choroid vascularity index as a parameter for chronicity of Fuchs' uveitis syndrome.

PURPOSE: This study aimed to compare the choroidal vascularity index (CVI) of eyes having Fuchs' uveitis syndrome (FUS) with healthy fellow eyes (N). METHODS: This prospective, cross-sectional study included unilateral FUS cases and an age- and gender-matched healthy control group. Thirty-nine participants were included in the FUS group, and 24 age- and gender-matched individuals were randomly selected for the control group. Endothelial cell density (ECD) was measured using Tomey specular microscopy. Spectral-domain optical coherence tomography was used to acquire the choroidal images, and binarization was applied to the images. Two blinded investigators analyzed the CVI in both eyes of the FUS cases and the right eyes of the healthy control group. RESULTS: CVI was found to be significantly decreased in FUS (p < 0.001). Additionally, ECD had a strong positive correlation with CVI (r = 0.383, p = 0.008). CONCLUSION: CVI may provide information about the chronicity of the disease.

Phototoxic maculopathy due to extreme usage of infrared illuminator-assembled night-vision handheld scope.

Night-vision handheld scopes are of wide use in military operations at dark conditions. In some cases in the battlefield, as in our case report, if there is no light coming from any source (neither from Moon nor from Stars), infrared light-emitting diode illumination can be coupled with night-vision goggles. Reflected illumination from the target is mostly blue filtered through the night-vision goggles objective lens. Retinal damage induced by unfiltered blue light and visible light has been previously reported. We described a phototoxic maculopathy induced by night-vision handheld scope assembled with infrared light-emitting diode illuminator in two soldiers who are on duty at nights for nearly two-thirds of the last year. The phototoxic maculopathy can represent with typical optical coherence tomography findings such as intraretinal hyperreflective accumulation particularly located on the surface of outer retinal segments defect or presumably in the vicinity of the light passageway. Here, we presented a unique factor causing phototoxic maculopathy.

Effect of Insulin Therapy on Ocular Biometric Parameters in Diabetic Patients.

Purpose: To evaluate effects of insulin on ocular parameters in patients with type 2 diabetes mellitus who start insulin therapy. Methods: In this prospective study, ocular biometric parameters were obtained using optical biometer (Lenstar LS900®; Haag-Streit AG) and refraction test (ARK-510A Auto refracto-keratometer; Nidek Co. Ltd, Aichi, Japan) before and at 3 months after initiating insulin therapy. In addition, patients' fasting blood glucose (FBG), glycosylated hemoglobin (HbA1C), and blood lipid levels were measured at the same time points. Pretreatment and post-treatment results were compared. In addition, associations between ocular parameters with initial dose and type of insulin treatment regimen, HbA1C, and FBG levels were evaluated. Results: The patients' mean age was 51.2 ± 12.9 (18-73) years. Post-treatment HbA1C and FBG levels (8.5% ± 2.5% and 188.1 ± 111.2 mg/dL, respectively) were significantly lower than pretreatment values (12% ± 1.4% and 325.3 ± 95.7 mg/dL, respectively; P < 0.001 for both). There was a significant positive correlation between the change in HbA1C and the change in lens thickness (P = 0.03), and a significant negative correlation between the change in FBG and the change in the spherical equivalent refraction (P = 0.045). Insulin dose and treatment regimen type were not significantly correlated with ocular parameters (P > 0.05). Conclusion: HbA1C-lowering glycemic effect of insulin was correlated with a small decrease in lens thickness. Long-term, randomized controlled trials including larger patient numbers are needed to shed light on the long-term effects of insulin use and glycemic control on ocular parameters.

In vivo analysis and comparison of anterior segment structures of both eyes in unilateral Fuchs' uveitis syndrome.

PURPOSE: To compare corneal endothelial cell density (ECD), iris stromal thickness (IST), iris pigment epithelium optical density (IPE OD), and Schlemm's canal (SC) measurements in patients having unilateral Fuchs' uveitis syndrome (FUS). METHODS: This is a randomized, prospective study. Currently, diagnosed unilateral FUS and phakic cases were defined to be the inclusion criteria to the study. The specular microscope was used to measure ECD. Anterior segment images were acquired by using SD-OCT. The images were extracted and uploaded to the ImageJ program for further analysis. Two blinded investigators analyzed the IST, IPE OD, and SC area in both healthy (N) and affected eyes (FUS) and the comparative analysis was made by using SPSS program. RESULTS: Of twenty-one participants, 13 were female (62%). The mean age of the participants was 30 ± 9 (18-47) years. ECD was 2228 ± 365 and 2513 ± 209 cells/mm2 in the FUS and N, respectively (p < 0,001). In FUS, the mean nasal and temporal (n-t) IST was measured as 380 ± 44 and 347 ± 41 µm, compared to 393 ± 61 and 355 ± 62 µm in N, respectively (p = 0.3 and p = 0.4 respectively). The mean n-t IPE OD was measured as 1110 ± 499 and 937 ± 370 in FUS, compared to 1147 ± 528 and 1267 ± 428 in N, respectively (p = 0.008 temporal). The mean n-t SC area was measured as 5479 ± 1951 and 5624 ± 2722 µm2 in FUS, compared to 5736 ± 2574 and 5633 ± 1835 µm2 in N, respectively (p = 0.9 and p = 0.7 respectively). CONCLUSION: Decreased ECD in FUS may lead to serious complications after cataract surgery. Temporal IPE depigmentation occurs prior to the nasal side in FUS.

Long-Term Results of Accelerated Corneal Cross-Linking in Adolescent Patients With Keratoconus.

PURPOSE: To report long-term results of accelerated corneal collagen cross-linking treatment in patients with progressive keratoconus in the pubertal period. METHODS: Patients with progressive keratoconus aged 14 and younger were retrospectively reviewed. Thirty-five eyes of 23 patients, who were followed for at least 4 years postoperatively, were included in the study. Demographic characteristics, uncorrected visual acuity, best-corrected visual acuity, and corneal topography data were recorded. All patients underwent an epi-off accelerated corneal collagen cross-linking protocol. RESULTS: The mean age of the participants was 13 ± 0.5 (11-14) years. Male to female ratio was 3/2. The mean pupillary center to cone apex distance was 1.6 ± 0.5 mm. At presentation, 11 eyes (31%) were classified as stage 1 keratoconus; 14 eyes (40%) were classified as stage 2 keratoconus, 8 eyes (23%) were classified as stage 3 keratoconus, and 2 eyes (6%) were classified as stage 4 keratoconus. The mean follow-up period was 56 ± 8 months. At the first year of the follow-up, central corneal thickness (CCT) and thickness of thinnest point of the cornea (TTPC) were found to be decreased significantly in comparison to preoperative values (P = 0.02 and P = 0.003, respectively). At the second year of follow-up, only TTPC was found to be decreased in comparison to preoperative value (P = 0.01). At the last follow-up visit, CCT was found to be increased significantly in comparison to preoperative CCT (P = 0.04). CONCLUSIONS: After an average follow-up of 56 months, progression was determined in 20% of the eyes despite appropriate treatment. In the last visit, progression was found to be associated with K1, K2, CCT, TTPC, and age.

Evaluation of Antiglaucomatous Drops on Conjunctival Thickness in Patients with Primary Open-Angle Glaucoma.

Purpose: To determine the effects of antiglaucomatous drops on the conjunctival thickness. Methods: Between March 2018 and May 2018, conjunctival thicknesses (epithelium + stroma) were measured with anterior segment OCT in 51 eyes of the control group and 49 eyes who had glaucoma diagnosis at the Van YYU Medical Faculty Ophthalmology Department and had been using antiglaucomatous drops for at least 6 months. At 12 o'clock direction, horizontal multisections were taken aiming at the conjunctiva 3-5 mm away from the limbus. Multiple sections were taken from limbus up to 10 mm. The average of conjunctival thicknesses was calculated. The mean conjunctival thickness between the two groups was compared. Results: The mean age of the patient group was 65.5 ± 8.01 (49-81) years; 19 (61.3%) were male and 12 (38.7%) were female. The mean age of the control group was 62.70 ± 10.03 (48-81) years; 20 (55.6%) of them were male and 16 (44.4%) were female (P = 0.2). The mean conjunctival thickness of the patient group was 182.76 ± 26.77 (130-240) µm and the mean conjunctival thickness of the control group was 235.02 ± 26.26 (185-327) µm. There was a statistically significant difference between the mean of the conjunctival thicknesses of the patient and the control group (P < 0.001). Conclusions: Antiglaucomatous drops may affect conjunctival thickness. Changes in conjunctival thickness may reduce surgical success by impairing the function and morphology of the blebs that cannot be controlled by the drip and require surgical intervention.

Evaluation of changes in axial length after congenital cataract surgery.

PURPOSE: To investigate the relationship between lens status and axial length (AL) in patients operated for unilateral and bilateral congenital cataract. SETTING: Yüzüncü Yil University, Ophthalmology Clinic, Van, Turkey. DESIGN: Retrospective study. METHODS: Records of patients who underwent surgery for unilateral or bilateral congenital cataract were analyzed. The patients were separated into three groups: bilateral aphakic, bilateral pseudophakic, and unilateral. The unilateral group was subdivided into the operated cataract eyes (unilateral aphakic and unilateral pseudophakic) and unoperated fellow phakic eyes. The patients' age at surgery, follow-up time, preoperative and postoperative AL measurements, change in AL, and monthly growth rate were evaluated. RESULTS: The bilateral aphakic group included 40 eyes of 20 patients, the bilateral pseudophakic group included 103 eyes of 54 patients, and the unilateral group included 40 eyes of 20 patients. The mean age at time of surgery in these groups was 8.17 months ± 10.65 (SD), 42.47 ± 43.81 months, and 42.47 ± 43.81 months, respectively. There were no significant differences in preoperative AL, postoperative AL, change in AL, or monthly growth rate between the aphakic and fellow phakic eyes in the unilateral group (P > .05). There were also no significant differences between unilateral pseudophakic eyes and fellow phakic eyes in the unilateral group with respect to preoperative AL or change in AL, but there were significant differences in final AL and monthly growth rate (P < .05). CONCLUSIONS: Various factors can affect axial elongation. The monthly growth rate was lower in pseudophakic eyes compared with phakic eyes. Experimental studies are required to understand the mechanism underlying this effect.

Pulmonary functions in pseudoexfoliation syndrome.

OBJECTIVES: It is well-known that pseudoexfoliative material deteriorates iris dilatation function. This material was also found in lung tissue. The aim of the study was to evaluate pulmonary function in patients with pseudoexfoliation. METHODS: This prospective study included 60 pseudoexfoliation syndrome patients without any pulmonary diseases and 52 age- and gender-matched controls without any pulmonary diseases. Patients were asked about their cigarette use and the presence of any systemic diseases such as diabetes mellitus, arterial hypertension and asthma. All cases underwent full ophthalmologic and general medical examinations including pulmonary auscultation and pulmonary posterior-anterior X-ray. Pulmonary function tests were used for evaluation of pulmonary function. FVC, FEV1 , FEV1 %, FEV1 /FVC and saturation values were recorded. RESULTS: Mean age was 67.1 ± 8.8 (44-82) years in the pseudoexfoliation group and 63.8 ± 9.4 (43-82) years in the control group (P > .05). Mean FEV1 was 1.60 ± 0.62 in the pseudoexfoliation group and 1.84 ± 0.61 in the control group (P = .036). Mean FEV1 % was 70.65 ± 23.89 in the pseudoexfoliation group and 83.46 ± 17.83 in the control group (P = .002). Mean FEV1 /FVC ratios were 0.72 ± 0.15 in the pseudoexfoliation group and 0.77 ± 0.11 in the control group (P = .043). No statistically significant differences were found between the groups for FVC, saturation or cigarette use. CONCLUSION: These results suggest that there is decline in some pulmonary functions in pseudoexfoliation syndrome.

Anterior Lens Capsule and Iris Thicknesses in Pseudoexfoliation Syndrome.

PURPOSE: The aim of this study was to evaluate anatomic properties of the lens capsule and iris by anterior segment optical coherence tomography (AS-OCT) in patients with pseudoexfoliation (PEX). METHODS: This prospective study included 62 eyes of 62 patients with PEX syndrome and 43 eyes of 43 age- and gender-matched controls. All subjects underwent full ophthalmologic examinations including AS-OCT. Pupillary diameter, midperipheral stromal iris thickness, central and temporal lens capsule thicknesses, and peripheral pseudoexfoliation material thickness on the anterior lens capsule surface were measured and recorded. RESULTS: Mean age was 66.8 ± 9.3 years in the PEX group and 65.5 ± 8.9 years in the control group (p = 0.44). The PEX group consisted of 62 patients: 38 men (61.3%) and 24 women (38.7%); the control group included 43 subjects: 25 men (58.1%) and 18 women (41.9%). Pupillary diameter after pharmacologic mydriasis was 21% smaller in the PEX group than controls. Mean midperipheral iris thickness was 36 ± 7.2 µm (7.8%) thinner in the PEX group than that of control group (p = 0.047). The central anterior capsule was a mean of 3.40 ± 0.51 µm (18%) thicker in the PEX group compared to the control group (p = 0.0001). The temporal anterior lens capsule was a mean of 0.17 ± 0.15 µm thicker in the PEX group compared to the control group (p = 0.81). CONCLUSIONS: With high-resolution OCT imaging, it has become possible to evaluate the anterior lens capsule without histologic examination and demonstrate that it is thicker than normal in PEX patients.