Erdem Yuksel

Neutrophil-to-lymphocyte ratio may predict progression in patients with keratoconus.

Purpose: Neutrophil-to-lymphocyte ratio (NLR) is a new potential predictor of systemic inflammation in several diseases. In this study, we aimed to evaluate NLR in patients with keratoconus. Methods: This cross-sectional observational study included 54 patients with keratoconus and 25 age- and sex-matched control subjects. All participants underwent a detailed ophthalmological examination and corneal topography. The patients were divided into progressive and nonprogressive keratoconus groups on the basis of topographic parameters. Serum samples were obtained from all subjects, and the NLR was calculated. Results: The NLR was 3.27 ± 1.37 in the progressive keratoconus group versus 1.87 ± 0.39 and 1.87 ± 0.52 in the nonprogressive and control groups, respectively (P < 0.01). There was a positive correlation between NLR and progression (P < 0.05). In the receiver-operating characteristic analysis, an NLR ≥ 2.24 predicted the presence of progression with 79% sensitivity and 81% specificity. Conclusions: The NLR is a simple and inexpensive marker of systemic inflammation. The NLR was found to be higher in patients with progressive keratoconus than in the nonprogressive group and controls.

Long term results of Epi-LASIK and LASEK for myopia

PURPOSE To evaluate the long term clinical and confocal results of mechanical (Epi-LASIK) versus alcohol-assisted laser epithelial keratomileusis (LASEK) for correction of myopia. SETTING Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey. DESIGN Retrospective study. METHODS Twenty-two eyes treated with LASEK and twenty eyes treated with Epi-LASIK were evaluated with a mean follow-up duration of 45 months. Mechanical separation of the epithelium was performed with Lasitome epithelial separator, and alcohol-assisted separation with 25s application of 18% alcohol. Laser ablation was performed with the ESIRIS laser. All patients were examined daily until epithelial closure; at 1, 3, 6, and 12 months; and every year subsequently. Main outcome measures were uncorrected visual acuity (UCVA), manifest refraction, haze, and gray scale value in confocal microscopy, efficacy and safety indexes. RESULTS Preoperative myopic spherical equivalent refraction was -4.65 ± 1.74 D in the LASEK and -3.87 ± 1.30 D in the Epi-LASIK-treated eyes (p=0.36). Of both LASEK and Epi-LASIK-treated eyes, 95% achieved 20/25 or better final UCVA. The grade of haze and mean gray scale value in confocal microscopy were similar in LASEK and Epi-LASIK-treated eyes at all postoperative periods. The efficacy index was 0.94 in LASEK group and 0.96 in Epi-LASIK group (p=0.44). The safety index was 1.01 in LASEK group and 1.02 in Epi-LASIK group (p=0.42). CONCLUSIONS Both LASEK and Epi-LASIK offer safe and effective correction of myopia in the long term.

Comparison of Wide Conjunctival Flap and Conjunctival Autografting Techniques in Pterygium Surgery

Pterygium is an abnormal fibrovascular tissue extending on the cornea which is a degenerative and hyperplastic disorder. A stromal overgrowth of fibroblast and blood vessels is accompanied by an inflammatory cell infiltrate and abnormal extracellular matrix accumulation. The surgical excision is the main treatment method of pterygium, but recurrence is the most common postoperative complication. In the present study, we aimed to compare the wide conjunctival flap and the conjunctival autografting techniques in pterygium surgery according to time of operation, safety, and effectiveness. Results showed that the effect of wide conjunctival flap techniques on primary pterygium surgery was found close to the conjunctival autograft techniques. In addition, the flap technique has a shorter surgical time, the surgery does not require extreme experience, feeding of the flap is provided with own vessels since the vascular structure is protected on the upper temporal conjunctival area, reverse placement of the flap is not seen, it needs fewer sutures, so that suture disturbances may reduce, and it is less traumatic than autograft technique during conjunctival transport. Therefore, this technique may be preferred in suitable cases.

Evaluation of Antifungal Efficacy of 0.1% and 0.25% Riboflavin with UVA: A Comparative In Vitro Study

ABSTRACT Purpose: Antifungal efficacy of photochemical cross-linking (PACK-CXL) with 0.1% and 0.25% riboflavin was evaluated with a comparative in vitro study. Methods: Candida albicans and Aspergillus fumigatus ATCC reference strains, Candida parapsilosis, Aspergillus fumigatus, Fusarium solani, Scedosporium apiospermum, and Alternaria alternata strains isolated from keratitis cases were chosen as targeted microorganisms. Unique “black plate method” was developed in polystyrene microplates. Riboflavin suspensions in 0.1% and 0.25% were separately added into inoculated wells. Non-inoculated wells were filled by black colored dye in order to protect treated wells from reflection of UV treatment. After ultraviolet A (UVA) treatment, each well was evaluated by microbiological culture in order to count viable fungal colonies. Fungal killing rate was calculated by comparing fungal counts (CFU/mL) before and after UVA application of riboflavin-added wells. Results: Four different fungal inoculum concentrations of targeted microorganisms, including 104, 103, 102, and 101 CFU/mL, were assayed. PACK-CXL with 0.25% riboflavin was found to be highly effective on fungal cells even in 104 CFU/mL of concentration. Conclusions: PACK-CXL appears as a promising treatment option for difficult-to-treat cases of fungal keratitis and 0.25% riboflavin concentration increases fungicidal effect of the procedure dramatically.

Evaluation of anterior segment parameters using the Pentacam in hyperopic anisometropic amblyopic and normal eyes

PURPOSE To evaluate differences in anterior segment parameters using the Pentacam between hyperopic anisometropic amblyopic eyes and normal eyes. METHODS The amblyopic and fellow eyes of children with hyperopic anisometropic amblyopia and the right eyes of normal control subjects were prospectively evaluated using the Pentacam under photopic, scotopic, and cycloplegic conditions. Hyperopic anisometropic amblyopia was defined as hyperopia of ≥1.5 D, an interocular difference of at least 1.5 D in spherical equivalent, and a visual acuity difference between the amblyopic and normal eyes of at least 2 lines on the Snellen chart. RESULTS A total of 34 amblyopic subjects and 36 controls were included. There were no significant differences in the anterior corneal curvature, posterior corneal curvature, central corneal thickness, corneal volume, anterior chamber depth, anterior chamber volume, and pupil diameter between amblyopic, fellow, and normal eyes (P > 0.05). CONCLUSIONS In this patient cohort the Pentacam detected no significant differences in anterior segment parameters in hyperopic anisometropic amblyopic, fellow, and normal eyes under photopic, scotopic, and cycloplegic conditions.

Corneal thickness measured by Scheimpflug imaging in children with Down syndrome.

PURPOSE To measure corneal thickness via the use of a Scheimpflug imaging system (OCULUS Optikgeräte GmbH, Wetzlar, Germany) in children with Down syndrome. METHODS This prospective, nonrandomized, clinical trial included children with Down syndrome and age- and sex-matched healthy controls. All subjects received a complete ophthalmologic examination. Corneal topography measurements were acquired by means of Scheimpflug imaging. Central corneal thickness (CCT), thinnest point of cornea (TP), and corneal volume (CV) were analyzed. RESULTS A total of 27 children with Down syndrome and 37 control subjects were included in the study. In children with Down syndrome, the mean CCT was 494.27 ± 47 μm, the mean TP was 487 ± 49 μm, and the mean CV was 56.2 ± 6. In the controls, the mean CCT was 539.3 ± 40 μm, the mean TP was 538.0 ± 40.8 μm, and the mean CV was 61.3 ± 4. For all 3 parameters, the difference was statistically significant (P < 0.001). In the Down syndrome group, the CCT was <500 μm in 16 subjects (59.2%) and <450 μm in 5 (18.5%). In the control group, the CCT was <500 μm in 14 subjects (37.8%) and <450 μm in 2 (5.4%). CONCLUSIONS In this study, corneal thickness was less in children with Down syndrome than in healthy control subjects. Decreased corneal thickness may be an early sign of a degenerative corneal disease such as keratoconus in children with Down syndrome.

Effect of corneal cross-linking on contact lens tolerance in keratoconus

The aim was to investigate changes in corneal sensation and rigid gas‐permeable (RGP) contact lens tolerance after corneal cross‐linking (CXL) on patients with keratoconus.

Keratoconus Progression Induced by In Vitro Fertilization Treatment.

PURPOSE To evaluate patients with keratoconus who manifested progression after in vitro fertilization (IVF) treatment. METHODS Patients with keratoconus who received IVF treatment were included in this study. None of the patients became pregnant as a result of the IVF treatment. Progression of keratoconus was determined by changes in corrected distance visual acuity and/or topographic changes and subjective assessments. RESULTS Three patients with keratoconus received IVF treatment and keratoconus progression was detected in all 6 eyes of the patients. The mean age of the patients was 32.3 ± 3.6 years (range: 28 to 36 years) and the mean follow-up duration was 15.6 ± 3.2 months (range: 12 to 18 months). The mean and the maximum keratometry values increased and corrected distance visual acuity decreased after 2.3 IVF treatments. CONCLUSIONS Drugs used in IVF treatment increase estrogen levels, which may affect corneal biomechanics and induce progression of keratoconus. Corneal cross-linking treatment could be offered to minimize the risk of keratoconus progression before IVF treatment.

Measurement and clinical implications of choroidal thickness in patients with inflammatory bowel disease

PURPOSE Ocular inflammation is a frequent extraintestinal manifestation of inflammatory bowel disease (IBD) and may parallel disease activity. In this study, we evaluated the utility of a choroidal thickness measurement in assessing IBD activity. METHODS A total of 62 eyes of 31 patients with IBD [Crohns disease (CD), n=10 and ulcerative colitis (UC), n=21] and 104 eyes of 52 healthy blood donors were included in this study. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography. The Crohns disease activity index (CDAI) and the modified Truelove Witts score were used to assess disease activity in CD and UC, respectively. RESULTS No significant differences in mean subfoveal, nasal 3000 μm, or temporal 3000 μm choroidal thickness measurements (P>0.05 for all) were observed between IBD patients and healthy controls. Age, smoking, CD site of involvement (ileal and ileocolonic involvement), CDAI, CD activity, and UC endoscopic activity index were all found to be significantly correlated with choroidal thickness by univariate analysis (P<0.05). Smoking (P<0.05) and the CD site of involvement (P<0.01) were the only independent parameters associated with increased choroidal thickness at all measurement locations. CONCLUSIONS Choroidal thickness is not a useful marker of disease activity in patients with IBD but may be an indicator of ileal involvement in patients with CD.

Bacterial contamination of needles used for intravitreal injections: comparison between 27-gauge and 30-gauge needles.

Abstract Purpose: To compare the contamination rate between 27-gauge and 30-guage needles used for intravitreal injection (IVT). Methods: Patients undergoing IVT injections were enrolled prospectively. Injections were performed with 27- or 30-gauge needles. All needle tips were collected and placed in brain–heart infusion broth. The contamination rates of needles were compared. Results: A total of 109 patients participated in the study and a total of 126 IVT injections were performed. Injections were performed by 27-gauge (49%) and 30-gauge (51%) needle. No patient developed endophthalmitis. The overall contamination rate of the used needles were 13% for 27-guage and 29% for 30-guage (p = 0.022). However, this difference was nonsignificant after Bonferronis correction was applied. The most common bacteria isolated from the used needles are coagulase-negative Staphylococcus (CNS). Conclusion: The results suggest that the needle bore size seems not to be a risk factor for contamination during IVT injection.