Gamze Dereli Can

Mechanical epithelial removal followed by corneal collagen crosslinking in progressive keratoconus: Short-term complications

Purpose To compare the complications occurring within the first 3 months of corneal collagen crosslinking (CXL) performed with mechanical or transepithelial phototherapeutic keratectomy (PTK) epithelial removal in keratoconus patients. Setting Yildirim Beyazit University Ataturk Training and Research Hospital, Ankara, Turkey. Design Nonrandomized retrospective clinical study. Methods Eyes of consecutive progressive keratoconus patients who had PTK or mechanical epithelial removal followed by CXL were included. All patients were examined regularly until epithelial healing. Detailed ophthalmologic examinations were performed preoperatively and 1 and 3 months postoperatively. Results The study comprised 499 eyes (302 patients) that had transepithelial PTK (Group 1, 153 eyes) or mechanical epithelial removal (Group 2, 256 eyes) followed by CXL. Delayed epithelial healing occurred in 15.0% of eyes in Group 1 and 3.5% of eyes in Group 2 (P = .001). Epithelial hypertrophy occurred in 24.8% of eyes and 3.5% of eyes, respectively (P = .001). Salzmann‐like epithelial nodules (2.6%), epithelial herpetic keratitis (1.9%), anterior uveitis (1.9%), and elevated intraocular pressure (1.9%) occurred in Group 1 only and infective keratitis (0.8%) in Group 2 only. Marked stromal edema and peripheral sterile infiltrates occurred at similar rates in both groups (P = .567 and P = .479, respectively). Grade 1+ corneal haze was significantly high in Group 2. Grade 2+ and 3+ haze was significantly high in Group 1 (P = .001). Conclusions Ocular surface healing disorders were the most common early complications of CXL. Short‐term complications were higher with the transepithelial PTK epithelial removal technique than with mechanical epithelial removal. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Corneal Biomechanical Properties in Rheumatoid Arthritis.

Purpose: To investigate the variations in biomechanical properties of the cornea in rheumatoid arthritis (RA) patients. Methods: A total of 53 RA patients, and 25 healthy individuals (control group) were enrolled. Rheumatoid arthritis patients were classified as in active phase (group 1; n=24) or in remission phase (group 2; n=29). Corneal biomechanical parameters including corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with the Reichert Ocular Response Analyzer. Topographical measurements, including central corneal thickness (CCT), anterior chamber depth, iridocorneal angle, and corneal volume were measured using a Sirius corneal topographer. Results: The mean CH was 9.43±1.17 mm Hg in group 1, 9.42±1.84 mm Hg in group 2, and 10.47±1.68 mm Hg in the control group (P=0.03). The mean IOPcc was 17.85±3.2 mm Hg in group 1, 17.95±3.49 mm Hg in group 2, and 15.36±3.11 mm Hg in the control group (P=0.008). The CH showed a significant positive correlation with CRF (P=0.000, r=0.809) and CCT (P=0.000, r=0.461), and a significant negative correlation with IOPcc (P=0.000, r=−0.469). Conclusions: Decrease in the mean CH measurements indicates that ultrastructural changes in the cornea may occur in the active phase, and these changes persist in the remission period. In addition, IOPcc is significantly affected by the corneal biomechanical properties. In RA patients, it is important to control the corneal parameters and IOP measurements against the irreversible changes on the optic nerve.

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.

Choroidal Thickness in Childhood Obesity

BACKGROUND AND OBJECTIVE To evaluate the effects of obesity on choroidal thickness (CT) in childhood. PATIENTS AND METHODS Forty-four patients with obesity (study group) and 42 healthy children (control group) were enrolled in the study. Subjects underwent a complete ocular examination. The mean CT was measured by enhanced depth imaging optical coherence tomography (EDI-OCT). Body mass index (BMI) was calculated. RESULTS Mean BMI value was 31.8 ± 1.9 in the study group and 19.8 ± 4.4 in the control group. The mean subfoveal CT value 385.77 µm ± 6.09 µm in the study group and 348.43 µm ± 73.21 µm in the control group. There was a significant difference between the study and control groups with regard to subfoveal CT (P = .017). Subfoveal CT and BMI were positively correlated (r = 0.288; P = .004). CONCLUSIONS CT increases in childhood obesity. Findings revealed that adiposity causes a significant increase in CT, and it may be related to ocular complications. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:10-17.].

A Novel Technique for Conjunctivoplasty in a Rabbit Model: Platelet-Rich Fibrin Membrane Grafting

Purpose. To investigate the effect of platelet-rich fibrin (PRF) membrane on wound healing. Methods. Twenty-four right eyes of 24 New Zealand rabbits equally divided into 2 groups for the study design. After the creation of 5 × 5 mm conjunctival damage, it was secured with PRF membrane, which was generated from the rabbits whole blood samples in PRF membrane group, whereas damage was left unsutured in the control group. Three animals were sacrificed in each group on the 1st, 3rd, 7th, and 28th postoperative days. Immunohistochemical (IHC) stainings and biomicroscopic evaluation were performed and compared between groups. Results. PRF membrane generated significant expressions of vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-β), and platelet-derived growth factor (PDGF) in the early postoperative period. However, the IHC evaluation allowed showing the excessive staining at day 28, in control group. Biomicroscopic evaluation revealed complete epithelialization in PRF membrane group, but none of the cases showed complete healing in the control group. Conclusions. This experimental study showed us the beneficial effects of the PRF membrane on conjunctival healing. Besides its chemical effects, it provides mechanical support as a scaffold for the migrating cells that are important for ocular surface regeneration. These overall results encourage us to apply autologous PRF membrane as a growth factor-enriched endogenous scaffold for ocular surface reconstruction.

Successful Treatment of Corneal and Conjunctival Intraepithelial Neoplasia with Topical Interferon Alfa-2b: Case Report

46 orneal and conjunctival intraepithelial neoplasia (CCIN) is a premalignant lesion of the corneal epithelium and limbus and the most common tumor of the ocular surface.1 Generally it occurs in the interpalpebral fissure, usually at the region of the limbus, although it may be found elsewhere.2 The etiology of this disease is most likely multifactorial, involving such factors as age, ultraviolet light exposure, human papillomavirus, and human immunodeficiency virus. Management of these lesions includes wide local excision followed by supplemental cryotherapy, and topical chemotherapy with antineoplastic drugs. CCIN has been known to have a high recurrence rate after excision alone. Cryotherapy, radiation, Successful Treatment of Corneal and Conjunctival Intraepithelial Neoplasia with Topical Interferon Alfa-2b: Case Report