Banu M. Hoşal

Morphology of corneal nerves and corneal sensation in dry eye: a preliminary study

PurposeTo evaluate the corneal sensitivity and nerve morphology in dry eyes.MethodsA total of 32 eyes of 16 patients (10 Sjogrens syndrome and six non-Sjogrens syndrome) and 19 eyes of 10 age-matched controls were studied. Sensitivity of the central cornea was measured by the Cochet–Bonnet aesthesiometer. The morphology of corneal nerves was studied by in vivo confocal microscopy (ConfoScan 2.0, Fortune Technologies Srl, Vigonza (PD), Italy). Sub-basal epithelial nerve plexus, subepithelial nerve plexus, and stromal nerves were localized and evaluated for the number of nerves, thickness, reflectivity, and tortuosity for each frame.ResultsThe mean corneal sensitivity of dry eye patients (5.6 mm/grs/S) was found significantly lower than that of the control (5.0 mm/grs/S) group (P<0.01). Although the subepithelial nerves were thicker in dry eyes (mean: 6.38±1.18 μm) than control eyes (mean: 5.72±1.27 μm), this difference was not significant (P>0.05).ConclusionDecreased corneal sensitivity is not associated with morphological changes of corneal nerves in dry eyes.

Risk factors for secondary membrane formation after removal of pediatric cataract

Purpose: To evaluate the incidence of secondary membrane formation, factors that lead to its development, and the frequency of procedures to treat these membranes in children after cataract surgery. Setting: Department of Pediatric Ophthalmology, Childrens Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA. Methods: Clinical records of 152 patients (190 eyes) who had cataract extraction between January 1986 and 1996 were reviewed retrospectively. The mean follow‐up was 6 years (range 2 to 13 years). Cataract surgery was performed through a limbal incision in all cases. Twenty‐eight eyes had a primary posterior capsulectomy, and 120 eyes had posterior capsulectomy combined with an anterior vitrectomy. In 42 eyes, the posterior capsule was left intact. Nineteen eyes received a primary intraocular lens (IOL), 15 eyes received a secondary IOL, and 156 eyes were rehabilitated with spectacles or contact lenses. Results: Seventy‐two eyes (37.9%) developed secondary membrane a mean of 8.9 months postoperatively (range 3 weeks to 53 months). Membranes occurred in 78.6% of eyes with an intact posterior capsule, 42.9% with posterior capsulectomy, and 22.5% with combined posterior capsulectomy and anterior vitrectomy. Secondary membrane formation was associated with not performing a posterior capsulectomy with anterior vitrectomy (P < .001) and the presence of a primary IOL (P < .001). Younger age at surgery increased the chance of secondary membrane formation in patients who had posterior capsulectomy and anterior vitrectomy (P < .01). Conclusions: The younger the child at cataract surgery, the greater the risk of secondary membrane. Primary posterior capsulectomy combined with an anterior vitrectomy decreased but did not eliminate the incidence of secondary membrane.

The effect of topical cyclosporine A on clinical findings and cytological grade of the disease in patients with dry eye.

Purpose: To compare the clinical findings and the cytological grade of the disease before and after 6 months of topical cyclosporine A treatment in patients with dry eye. Setting: This single-center prospective study was performed at the Department of Ophthalmology, Ankara University School of Medicine, between January 2007 and June 2008. Method: Forty-five patients with dry eye (with 5 mm/5 minutes or less Schirmer test) were included in the study. Patients were treated with cyclosporine A 0.005% ophthalmic emulsion (RESTASIS) twice daily in addition to lubricant eyedrops 5 times a day. Schirmer test values, tear breakup time (BUT), and impression cytology (goblet cell density, nucleus to cytoplasmic ratio, and epithelial cell morphology) were evaluated at baseline and after 6 months. Results: Before and after 6 months of the treatment with topical cyclosporine A, the median Schirmer test scores were found as 3.00 and 4.00 mm, respectively. The median BUT score at baseline was 4.00 seconds, and after treatment, the median score was 5.00 seconds. There were statistically significant differences in the median Schirmer and BUT values between, before, and after 6 months of treatment (P < 0.05). The mean cytological grade according to Nelson grading system was 1.84 at baseline and 1.51 after treatment with topical cyclosporine A for 6 months. Statistically significant improvement in cytological grades after treatment was observed (P < 0.05). Conclusion: Treatment of patients with dry eye for 6 months with topical cyclosporine A resulted in an increase in Schirmer test results, an increase in BUT scores, and an improvement in cytological grade of the disease.

Surgical treatment of cicatricial ectropion in lamellar ichthyosis.

BACKGROUND . Lamellar ichthyosis is a skin disorder that is frequently associated with cicatricial ectropion and lagophthalmos. The authors present the surgical management of cicatricial ectropion in a case with lamellar ichthyosis. PATIENT AND METHODS . A 2-year-old male presented with bilateral cicatricial ectropion of the upper and lower eyelids. He had lagophthalmos and corneal punctuate staining. His skin was totally involved with the disease process except his prepuce. The patient was circumcised, and after the correction of horizontal eyelid laxity, the penile skin graft was sutured into the defects in all four eyelids. RESULTS . 18 months following surgery the patient had no lagophthalmos or corneal exposure, but had slight ectropion at the temporal side of the left lower eyelid. He had no complications from the circumcision. CONCLUSION . Prepuce is an alternative donor tissue in male patients with no other available donor site. To our knowledge, this is the second report of cicatricial ectropion corrected with a penile skin graft.