Ferda Ciftci

Tear Osmolarity Measurements in Dry Eye Related to Primary Sjögren’s Syndrome

Background: To evaluate the tear osmolarity in patients with dry eye syndrome related to primary Sjögren’s Syndrome (SS). Materials and Methods: Twenty eyes of 10 patients with dry eye and primary SS (Group 1) and 20 eyes of 20 subjects who do not have dry eye syndrome (Group 2) were included in this cross-sectional study. In all eyes, ophthalmic examination was performed in the same order: International Ocular Surface Disease Index survey, visual acuity assessment, conjunctival hyperemia scoring, tear osmolarity measurement with TearLab™ Osmolarity System, tear film break-up time assessment, corneal fluorescein staining scoring, ocular surface Lissamine Green staining scoring, anesthetized Schirmer test. Dry eye severity was graded according to Dry Eye Workshop (DEWS) classification system. Results: Four eyes with grade 1, four eyes with grade 2, seven eyes with grade 3, and five eyes with grade 4 dryness, according to DEWS system, were included. The mean tear osmolarity value was 301.9u2009±u200911.40 mOsm/L (range: 290–328) in Group 1, and 294.85u2009±u20098.33 mOsm/L (range: 283–311) in Group 2 (pu2009=u20090.03). In Group 1, tear osmolarity values were positively correlated with OSDI scores (r(18)u2009=u20090.55, r2u2009=u20090.31, pu2009=u20090.01), DEWS classification grades (r(18)u2009=u20090.73, r2u2009=u20090.54, pu2009<u20090.01), temporal and total corneal staining scores (r(18)u2009=u20090.67, r2u2009=u20090.44, pu2009<u20090.01, and r(18)u2009=u20090.51, r2u2009=u20090.26, pu2009=u20090.02, respectively), temporal conjunctival staining scores (r(18)u2009=u200958, r2u2009=u20090.34, pu2009<u20090.01); and negatively correlated with anesthetized Schirmer test results (r(18)u2009=u2009-0.62, r2u2009=u20090.38, pu2009<u20090.01) and TFBUT (r(18)u2009=u2009-0.50, r2u2009=u20090.25, pu2009=u20090.02). Conclusions: Tear osmolarity values were found to be greater in patients with dry eye syndrome related to primary SS compared to control subjects, and positively correlated with the severity of dry eye.

Fundus autofluorescence in acute and chronic central serous chorioretinopathy

Background:u2002 A prospective evaluation of the pattern of fundus autofluorescence in cases of acute versus chronic central serous chorioretinopathy (CSR).

Endothelial cell loss after phacoemulsification in eyes with previous penetrating keratoplasty, previous deep anterior lamellar keratoplasty, or no previous surgery

PURPOSE: To compare phacoemulsification‐related endothelial cell loss in eyes with previous penetrating keratoplasty (PKP), previous deep anterior lamellar keratoplasty (DALK), or no previous corneal surgery. SETTING: Ophthalmology Clinic, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey. DESIGN: Comparative case series. METHODS: Eyes with previous PKP (Group 1), previous DALK (Group 2), or no previous ocular surgery (Group 3) had extracapsular cataract extraction by phacoemulsification. The endothelial cell count was evaluated 1, 3, 6, and 12 months after cataract surgery. RESULTS: Group 1 comprised 16 eyes and Group 2 and Group 3, 20 eyes each. The endothelial cell density (ECD) decreased progressively throughout the follow‐up in all groups (P<.01). The amount of change in ECD was significantly greater in Group 1 than in Group 2 and Group 3 from preoperatively to 1 month postoperatively, from 1 to 3 months postoperatively, from 3 to 6 months postoperatively, and from 6 to 12 months postoperatively (all P<.01). The changes were similar in Group 2 and Group 3 at all time points (P>.05). CONCLUSIONS: Eyes with previous PKP had significantly greater endothelial cell loss than eyes with previous DALK or no previous surgery. Preservation of the patients endothelium seems to be an advantage of DALK in terms of increasing corneal safety in future intraocular surgery. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Laser in situ keratomileusis to manage refractive errors after deep anterior lamellar keratoplasty.

PURPOSE: To analyze the visual and refractive outcomes of laser in situ keratomileusis (LASIK) after deep anterior lamellar keratoplasty (DALK) for keratoconus. SETTING: Haydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey. DESIGN: Cohort study. METHODS: Patients with compound myopic astigmatism after DALK and a spherical equivalent (SE) between −2.50 diopters (D) and −8.00 D had LASIK as a single‐step procedure, correcting the manifest refraction error. The visual and refractive results at 1 month, 3 months, and the last follow‐up were compared with preoperative values. RESULTS: The mean follow‐up was 11.17 months ± 3.61 (SD). The mean manifest refraction SE (MRSE) and autorefractometer measurements and the autokeratorefractometer and corneal topography keratometry readings decreased significantly from preoperatively to 1 month postoperatively (P<.01) but did not change significantly thereafter (P>.05). Preoperatively, the mean uncorrected (UDVA) and corrected (CDVA) distance visual acuities were 0.21 ± 0.08 and 0.73 ± 0.08, respectively; postoperatively, the means were 0.73 ± 0.10 and 0.98 ± 0.05, respectively. All eyes achieved a postoperative UDVA better than 0.5. No eye lost CDVA lines. The safety index was 1.34. The mean MRSE was −5.18 ± 1.74 D preoperatively and −1.05 ± 0.64 D postoperatively (P<.01). Postoperatively, 11 eyes (91.67%) were within ±2.00 D of the SE, 8 (6.67%) were within ±1.00 D, and 5 (41.67%) were within ±0.50 D. No complications were encountered. CONCLUSION: Treatment of post‐DALK keratoconus patients with LASIK to correct manifest refraction error seems to be a viable option. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Assessment of Intrastromal Corneal Ring Segment Position With Anterior Segment Optical Coherence Tomography

BACKGROUND AND OBJECTIVEnTo examine the exact position of implanted Keraring (Mediphacos, Belo Horizonte, Brazil) segments by high-resolution anterior segment optical coherence tomography (AS-OCT).nnnPATIENTS AND METHODSnThis study included 17 eyes of 13 patients with keratoconus who underwent uneventful intracorneal ring segment implantation with the aid of femtosecond laser. Eyes were evaluated by AS-OCT at the third postoperative month. Distance from the apex of the triangular cross-section of the ring segment to the anterior corneal surface and distances from two basal corners to the posterior corneal surface were measured.nnnRESULTSnDistance from apex to anterior corneal surface (263.1 ± 42.9 μm) was significantly smaller than target depth calculated intraoperatively (356.9 ± 35.7 μm, P < .001). Distance between outer basal corner and posterior corneal surface was significantly greater than distance between inner basal corner and posterior corneal surface.nnnCONCLUSIONnHigh-resolution AS-OCT is a rapid, convenient, and valuable technique in the follow-up of patients with implanted Keraring segments that may be helpful in predicting ring-related complications.

Corneal biomechanical properties of patients with pseudoexfoliation syndrome.

Purpose: To assess the corneal biomechanical properties of patients with pseudoexfoliation syndrome (PEX syndrome). Methods: Fifty-two eyes of 52 patients (27 unilateral and 25 bilateral) and 42 eyes of 42 age-matched control subjects were enrolled in the study. Metrics of corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with the ocular response analyzer (ORA). The ORA also determined the values of Goldmann-correlated intraocular pressure and corneal-compensated intraocular pressure. Central corneal thickness (CCT) was measured by the ORA integrated handheld ultrasonic pachymeter. The values recorded by the ORA were compared between eyes with PEX syndrome and those without PEX syndrome. Eyes with unilateral PEX syndrome and fellow eyes without PEX syndrome were also compared. Results: The mean CH and CRF of all eyes with PEX syndrome were significantly lower than those of control eyes (P < 0.05). Neither corneal-compensated intraocular pressure nor Goldmann-correlated intraocular pressure showed a statistically significant difference in both the groups. Mean CCT values also did not show significant difference. Comparison of the unilateral eyes with PEX syndrome with the apparently normal fellow eyes revealed no significant difference between the mean CCT, mean CH, and mean CRF values (P > 0.05). However, the mean corneal-compensated intraocular pressure and Goldmann-correlated intraocular pressure were relatively higher in the PEX syndrome eye (P < 0.05). There was no significant difference between the mean CCT values of these groups (P > 0.05). Conclusions: The CH and CRF decrease in both unilateral and bilateral PEX syndrome suggested that PEX syndrome has a weakening effect on corneal biomechanical properties. Moreover, in subjects with clinically unilateral PEX syndrome, these properties were closer to eyes with PEX syndrome than to normal control eyes.

Comparison of non-contact methods for the measurement of central corneal thickness

BACKGROUND AND OBJECTIVEnThis study examined the repeatability of and agreements between central corneal thickness measurements obtained by four different non-contact pachymetry devices.nnnPATIENTS AND METHODSnSeventy-eight eyes of 39 subjects were included. Central corneal thickness of each eye was measured by Visante optical coherence tomography (OCT) (Carl Zeiss Meditec Inc., Dublin, CA), Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany), Orbscan IIz topography (Bausch & Lomb Surgical Inc., San Dimas, CA), and slit-lamp OCT (SL-OCT) (Heidelberg Engineering GmbH, Heidelberg, Germany). Inter-device agreements and correlations and repeatability of each device were examined.nnnRESULTSnAll measurement methods correlated well with each other with a correlation coefficient greater than 0.90 and P value of less than .001 for all comparisons. However, Pentacam overestimated central corneal thickness: 546.7 ± 38.2, 535.5 ± 42.7, 531.7 ± 37.6, and 531.2 ± 36.0 μm for Pentacam, Orbscan IIz, Visante OCT, and SL-OCT, respectively (P < .001 for all comparisons versus Pentacam). Despite good correlation, magnitude of differences was high and this bias was proportional (ie, not constant across a range of corneal thickness values) for the following pairs: Orbscan versus Visante OCT, Orbscan versus SL-OCT, and Orbscan versus Pentacam (P < .001 for all comparisons).nnnCONCLUSIONnAlthough measurements obtained by various non-contact methods correlate well, numerical agreement of the results may not be sufficient for their interchangeable use in clinical practice.

AS-OCT as a tool for flap thickness measurement after femtosecond-assisted LASIK.

BACKGROUND AND OBJECTIVEnto investigate the efficacy of anterior segment optical coherence tomography (AS-OCT) for calculating flap thickness in femtosecond laser-assisted laser in situ keratomileusis.nnnPATIENTS AND METHODSnfifty-one eyes of 26 patients with myopia and myopic astigmatism were included in this prospective study. High-resolution corneal images were evaluated at 1 week and 1 month postoperatively. Images along the horizontal meridian were measured with the flap tool at seven points.nnnRESULTnmeasurements at vertex and at 1 mm nasally and temporally from the vertex were indistinct but easily defined. Although statistically not significant, flaps were found to be thinner in the central cornea and thicker in the periphery (P > .05).nnnCONCLUSIONnAS-OCT provides detailed high-resolution images for quantitative evaluation of the flap-stroma relationship, but it may not be precise in the central 2-mm area of the cornea. Despite this, AS-OCT is an imaging tool with significant utility.

Macular Thickness in Highly Myopic Children Aged 3 to 7 Years.

PURPOSEnTo compare the macular thickness and volume of highly myopic children with healthy controls, using third generation optical coherence tomography (OCT).nnnMETHODSnOCT was performed on highly myopic (cycloplegic spherical equivalent refraction > -6.00 diopters [D]) children aged 3 to 7 years old and healthy controls (spherical equivalent refraction -2.00 to +4.00 D) between 2011 and 2013. OCT measurements of the average thicknesses of the fovea (central 1 mm) and inner (1 to 3 mm) and outer (3 to 6 mm) parafovea in superior, temporal, inferior, and nasal quadrants and total volume of the macular scan area were recorded. The differences between the two groups were tested with the Mann-Whitney U test.nnnRESULTSnThere were 15 patients with high myopia and 11 controls. Foveal thickness (central 1 mm) was significantly greater in the high myopia group. The parafoveal thicknesses in all quadrants of the inner and outer circles were significantly thinner in the high myopia group. The average macular volume of the highly myopic eyes was significantly smaller than the control eyes.nnnCONCLUSIONSnAnatomic changes in the retina occur even in young children with high myopia. Macular thickness characteristics of highly myopic children may influence the interpretation of data obtained with OCT.

Comparison of the neuroprotective effects of brimonidine tartrate and melatonin on retinal ganglion cells

PurposeWe aimed to compare the neuroprotective effects of brimonidine tartrate (BRT) and melatonin (MEL) on retinal ganglion cells (RGCs) in a rat glaucoma model.MethodsThirty-six adult Wistar albino rats were allocated into six groups: control (C), glaucoma (G), BRT, MEL, Gxa0+xa0BRT and Gxa0+xa0MEL. After establishing the glaucoma model, intraocular pressure (IOP) of all animals measured at day 4 and day 30 was compared statistically with day 0 and day 4, respectively. Prior to sacrification at day 30 for histological evaluation and TUNEL analysis, retrograde labeling of non-apoptotic RGCs with 3% Fluorogold was performed and RGCs were evaluated under fluorescein microscope.ResultsIOP measurements at day 4 were significantly higher than basal measurements in all glaucoma groups. BRT alone induced a time-dependent decrease in IOP (pxa0<xa00.05), while MEL alone failed to reduce IOP. However, both BRT and MEL reduced IOP in the presence of glaucoma at day 30 (pxa0<xa00.05). BRT treatment significantly reversed the reduced non-apoptotic RGC counts (pxa0<xa00.01) and increased TUNEL-positive RGCs (pxa0<xa00.001) to control group levels in the presence of glaucoma. However, no statistical significance was found between groups G and Gxa0+xa0MEL considering 3% Fluorogold-labeled cell counts and apoptotic index values.ConclusionOur study revealed that systemic administration of BRT also has an IOP reducing effect. MEL has no neuroprotective effect on RGCs; on the other hand, BRT acts as a neuroprotective agent against glaucomatous injury, when applied systemically.