Emine Kalkan Akcay

Impaired Corneal Biomechanical Properties and the Prevalence of Keratoconus in Mitral Valve Prolapse

Objective. To investigate the biomechanical characteristics of the cornea in patients with mitral valve prolapse (MVP) and the prevalence of keratoconus (KC) in MVP. Materials and Methods. Fifty-two patients with MVP, 39 patients with KC, and 45 control individuals were recruited in this study. All the participants underwent ophthalmologic examination, corneal analysis with the Sirius system (CSO), and the corneal biomechanical evaluation with Reichert ocular response analyzer (ORA). Results. KC was found in six eyes of four patients (5.7%) and suspect KC in eight eyes of five patients (7.7%) in the MVP group. KC was found in one eye of one patient (1.1%) in the control group (P = 0.035). A significant difference occurred in the mean CH and CRF between the MVP and control groups (P = 0.006 and P = 0.009, resp.). All corneal biomechanical and topographical parameters except IOPcc were significantly different between the KC-MVP groups (P < 0.05). Conclusions. KC prevalence is higher than control individuals in MVP patients and the biomechanical properties of the cornea are altered in patients with MVP. These findings should be considered when the MVP patients are evaluated before refractive surgery.

Topographic and biomechanical evaluation of cornea in patients with acromegaly.

Purpose: The aim of this study was to compare topographic and biomechanical properties of corneas in patients with acromegaly with those of healthy individuals. Methods: Thirty-five patients with acromegaly (study group) and 35 healthy individuals (control group) were enrolled in this prospective study. Topographic measurements, including central corneal thickness (CCT), mean keratometry (K) value, K1, K2, surface asymmetry index, corneal volume (CV), and anterior chamber depth in the right eye of each participant were obtained using a Scheimpflug camera with a Placido disc topographer (Sirius; Costruzione Strumenti Oftalmici). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOP), and Goldmann-corelated intraocular pressure (IOPg) were measured using Reichert Ocular Response Analyzer (Reichert Ophthalmic Instruments). Results: Mean CCT, CV, CH, CRF, and IOPg values were higher in acromegalic eyes (549.3 ± 30.2 &mgr;m, 59.1 ± 3.1 &mgr;m, 11.3 ± 1.2 mm Hg, 11.3 ± 1.2 mm Hg, and 17.5 ± 2.9 mm Hg, respectively) than in healthy eyes (531.4 ± 33.6 &mgr;m, 57.4 ± 2.7 &mgr;m, 10.4 ± 1.2 mm Hg, 10.2 ± 1.6 mm Hg, and 14.8 ± 3.1 mm Hg, respectively; CCT, P = 0.042; CV, P = 0.032; CH, P = 0.044; CRF, P = 0.035; IOPg, P < 0.001). Conclusions: CCT, CV, CH, CRF, IOPg, and IOP with Goldmann applanation tonometry were significantly higher in acromegalic eyes. These corneal topographic and biomechanical properties, disease duration, and disease status should be considered when planning corneal refractive surgery and determining accurate intraocular pressure in patients with acromegaly.

Anterior segment morphologic changes related to α-1 adrenergic receptor antagonists use.

Purpose To investigate possible changes in anterior segment parameters with the Pentacam in patients taking tamsulosin or doxazosin for benign prostatic hyperplasia. Methods This prospective, cross-sectional study was conducted at Necip Fazil City Hospital, Kahramanmaras, Turkey. Patients included in the study were grouped as follows: 29 patients treated with tamsulosin (group 1), 27 patients treated with doxazosin (group 2), and 40 untreated controls (group 3). Right eyes of each patient were included in the study. All patients underwent examination with the Pentacam under standard dim light conditions and with undilated pupils. Anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA) width, central corneal thickness (CCT), corneal volume (CV), and pupil diameter (PD) were recorded. Results Mean duration of treatments was 2.7 ± 1.2 (1–5) and 2.4 ± 0.9 (1–5) years in groups 1 and 2 (p = 0.276). The ACD, ACV, ACA width, and PD were statistically significantly decreased in groups 1 and 2 when compared to group 3 (p<0.05). There were no statistically significant differences among the groups in mean values of CCT and CV. Conclusions In this study, decreased ACD, ACV, ACA width, and PD values were detected in tamsulosin and doxazosin groups when compared to controls. These findings should be considered during anterior segment examinations and surgeries.

Bilateral anterior optic neuropathy associated with use of terbinafine.

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The effect of antihypertensive therapy on dry eye disease

Abstract Context: There is a generalization that “antihypertensive (antiHT) therapy causes Dry Eye Syndrome”, which has been claimed for years however most of the publications are epidemiological studies. We performed a clinical study to investigate the effects of antiHT agents on tear function. Objective: The aim of this article is to evaluate the effects of different classes of antiHT medications on tear osmolarity, ocular surface problems and dry eye symptoms. Materials and methods: Prospective, non-randomized a clinical study. A total of 71 patients who would be initiated antiHT medication due to elevated systemic blood pressure were included in the study. Thirty of these patients were given antiHT drugs containing diuretic (diuretic +), and 41 of them were given diuretic-free drugs (diuretic −). While the number of the patients medicated in the group that received Angiotensin Converting Enzyme inhibitors (ACE inh)/Angiotensin receptor blockers (ARB) (ACE/ARB +) was 29, the number of those medicated in the ACE/ARB-free group (ACE/ARB −) was 42. Ocular surface disease index scores, tear osmolarity, Schirmer I test, tear film break-up time (TBUT), fluorescein (FL) and rose bengal corneal staining patterns of the patients were analyzed. The patients were examined through the repetition of all the tests in the 1st and the 3rd month. Results: The participants (n = 71) comprised 38 males and 33 females with a mean age of 51.8 ± 10.4. When the first (0–1st month) and the third month (0–3rd months) control measurements between diuretics (+) and diuretics (−) groups before and after antiHT therapies were compared, a statistically significant difference was not found in any of the tests applied. When the 0–1st month measurements of ACE/ARB (+) and ACE/ARB (−) groups were compared, it was observed that staining with FL in ACE/ARB (+) group decreased in a statistically significant manner (p = 0.035) and there was a significant increase in TBUT values (p = 0.022). Discussion and conclusion: The use of antiHT drugs containing diuretic had no adverse effect on the tear function tests, but using drugs that contain ACE/ARB could have a positive impact.

Corneal biomechanics in steroid induced ocular hypertension

AIM This study aims to investigate the corneal biomechanical properties of steroid sensitive refractive surgery patients and to compare these with those patients that did not have steroid induced ocular hypertension after refractive surgery. MATERIAL AND METHODS This retrospective study in a tertiary care center involved 48 eyes with steroid induced ocular hypertension (Group I) and 61 eyes of age and sex matched refractive patients who used topical steroids for the same duration as group I without developing ocular hypertension (group II). All patients had preoperative ophthalmological examination, pachymetry and postoperative corneal hysteresis (CH) and resistance factor (CRF) measurements by ocular response analyser. The preoperative CH and CRF measurements of the two groups were compared. RESULTS The mean CH was statistically lower in group I (6.89±1.62) as compared to group II (7.80±1.30) (p=0.001). The CRF was higher in group I (7.68±2.26) as compared to group II (7.66±1.72) but the difference was not statistically significant (p=0.96). The preoperative spherical refractive error (r=0.43, p=0.00) and postoperative corneal thickness (r=0.58, p=0.001) were moderately correlated with CH. CONCLUSIONS A statistically significant decrease in CH in subjects with steroid induced ocular hypertension is found. Previous studies have revealed an association of low CH with risk of glaucomatous damage of optic nerve. This may imply risk of optic disc damage in this ocular hypertension group if not recognized and treated properly. However the results should be confirmed with larger sample sizes.

Tear Function and Ocular Surface Alterations After Accelerated Corneal Collagen Cross-Linking in Progressive Keratoconus.

Objective: To investigate the alterations in the ocular surface and tear film parameters 3 months after accelerated corneal collagen cross-linking (A-CXL) in progressive keratoconus (KC) patients. Methods: Twenty-six patients (33 eyes total) with progressive KC were enrolled in this study. All patients were subjected to ophthalmic surface examination, such as OSDI (ocular surface disease index) scoring, the osmolarity tear test, Schirmer test, tear film breakup time (TBUT) analysis, rose bengal (RB) and fluorescein (Fl) ocular surface staining, and conjunctival impression cytology (IC) analysis, respectively. These tests were performed at baseline and 3 months after A-CXL. Nelsons grading system was used to evaluate the cell morphology and goblet cell density. Results: No statistically significant differences in the levels of tear osmolarity, TBUT, Schirmer test, OSDI scoring, and Fl and RB staining between pretreatment and 3 months postoperatively were observed (all P values >0.05). A statistically significant increase in superior (P=0.005) and temporal (P=0.006) IC grading was seen at the postoperative third month compared to pretreatment. Conclusions: Only metaplastic changes and a reduction in the density of the goblet cells were seen in conjunctival IC, which is probably because of the toxicity of ultraviolet-A 3 months after A-CXL. However, these results do not lead to deterioration in TBUT. In this study, A-CXL has no adverse effect on ocular surface and tear function, which are important for visual quality.

Tear-Film Osmolarity Changes Following Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction.

ABSTRACT Purpose: To evaluate tear osmolarity (TO) in patients with epiphora caused by primary-acquired nasolacrimal-duct obstruction (PANDO), before and after an external dacryocystorhinostomy (DCR) and to compare with healthy control subjects. Materials and Methods: Twenty eyes of 20 patients (15 women, 5 men) who suffered from epiphora for at least one year due to PANDO, and 20 eyes of 20 healthy subjects (13 women, 7 men), were included in this study. External DCR was applied to all patients with PANDO, and TO measurements were repeated during the first month follow-up visit after surgery. Results: The mean period for complaints of epiphora was 1.7 ± 0.6 years (1–3). Patients had a mean TO of 282.6 ± 10 mOsm/l (range: 269–302) prior to DCR, and this increased to 297.7 ± 7.7 mOsm/l (range: 284–310) one month after DCR (p = 0.0001). Preoperative TO values were significantly lower when compared with the healthy control subjects’ (301.7 ± 10.6 mOsm/l (range: 280–316) (p = 0.0001). No significant differences were detected between postoperative and control group TO values (p = 0.18). Conclusions: Epiphora due to PANDO causes lower TO values. One month after DCR, TO came to similar TO levels when compared to healthy subjects.

Effect of refractive error on temperament and character properties.

AIM To determine the effect of refractive error on temperament and character properties using Cloningers psychobiological model of personality. METHODS Using the Temperament and Character Inventory (TCI), the temperament and character profiles of 41 participants with refractive errors (17 with myopia, 12 with hyperopia, and 12 with myopic astigmatism) were compared to those of 30 healthy control participants. Here, temperament comprised the traits of novelty seeking, harm-avoidance, and reward dependence, while character comprised traits of self-directedness, cooperativeness, and self-transcendence. RESULTS Participants with refractive error showed significantly lower scores on purposefulness, cooperativeness, empathy, helpfulness, and compassion (P<0.05, P<0.01, P<0.05, P<0.05, and P<0.01, respectively). CONCLUSION Refractive error might have a negative influence on some character traits, and different types of refractive error might have different temperament and character properties. These personality traits may be implicated in the onset and/or perpetuation of refractive errors and may be a productive focus for psychotherapy.

Early retinal and retinal nerve fiber layer effects of hydroxychloroquine: a follow up study by sdOCT

Abstract Context: The antimalarial drug hydroxychloroquine (HCQ), used in the treatment of rheumatologic disease, has been associated with the development of retinopathy. The long-term incidence of HCQ retinopathy has been estimated at 0.5% when recommended dosages (≤6.5 mg/kg per day) are used. Objective: Evaluating the patients for whom HCQ treatment will be started before and after treatment prospectively with spectral domain (sd) optical coherence tomography (OCT) to observe possible early changes in the retinal and retinal nerve fiber layer thickness. Materials and methods: Thirty-six patients from rheumatology clinic who have been started HCQ therapy had clinical examination and sdOCT imaging before and 6 months after starting treatment. The baseline ophthalmological examinations and visual field analysis (on automated Humphrey visual field (HVF) 10-2 perimetry, Humphrey HFA II-i 750 i, Carl Zeiss Meditec AG, Jena, Germany) were completely normal. The sdOCT was performed with the Optovue technology according to the manufacturer’s guidelines using EMM5, retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) scans. The retinal thickness values in central foveal, inferior and superior hemispheres, temporal, superior, nasal and inferior para- and perifoveal areas and the RNFL thickness of eyes were compared before and 6 months after starting treatment by the paired t test. Results: The retinal thickness values in central parafoveal (p = 0.02), and superior hemisphere (p = 0.01) in parafoveal area, parafoveal superior (p = 0.02), temporal (p = 0.03) and nasal (p = 0.04) quadrants were significantly thicker after 6 months of treatment. The thickness of the perifoveal area and the average RNFL thickness was not significantly different in any of the quadrants before and after starting HCQ treatment. The GCC thickness also did not change significantly different in superior and inferior hemisphere after starting treatment. Discussion and conclusion: We observe increased retinal thickness in parafoveal areas in patients on HCQ therapy at short term. Its clinical significance may be apparent in longer follow up studies.