Guzin Iskeleli

Tear film osmolarity in patients with thyroid ophthalmopathy

PurposeTo compare tear film osmolarity between patients with thyroid ophthalmopathy and normal healthy subjects.MethodsThe tear film osmolarity in 15 normal subjects (15 eyes) (control group) and 21 patients (21 eyes) with thyroid ophthalmopathy was evaluated. Tear film osmolarity in milliosmole (mOsm) was determined by using an auto-osmometer. The palpebral fissure width, degree of proptosis, and tear break-up time (BUT) were also determined. The results for the two groups were compared statistically.ResultsThe mean palpebral fissure width was 9.13 ± 0.74 mm in the healthy subjects and 13.33 ± 1.55 mm in the thyroid ophthalmopathy patients. This difference was statistically significant (P = 0.0001). The mean proptosis was 15.33 ± 1.39 Hertel units in the healthy subjects and 20.71 ± 0.95 Hertel units in the patients. This difference was also statistically significant (P = 0.0001). The mean tear BUT was 6.35 ± 1.56 s in the patients and 18.27 ± 1.53 s in the healthy subjects, and this difference was also statistically significant (P = 0.0005). The mean tear film osmolarity was 290.80 ± 13.58 mOsm in the healthy subjects and 340.38 ± 18.74 mOsm in the patients. There was a statistically significant difference between the groups (P = 0.0001).ConclusionsThe significantly higher tear film osmolarity in patients with thyroid ophthalmopathy was most likely due to the increased proptosis and lid fissure width. These conditions may lead to injury of the ocular surface.

Comparison of tear-film osmolarity in different types of contact lenses.

PURPOSE To investigate the tear-film osmolarity of contact lens wearers for different types of contact lenses. METHODS Fifty six eyes of 56 cases were evaluated in four different groups according to the type of contact lens worn, with 14 eyes in each group. Groups 1 and 2 consisted of subjects who wore frequent-replacement daily wear soft contact lenses; group 1 lenses had 55% water content, and lenses in group 2 had 38% water content. Groups 3 and 4 consisted of subjects who wore rigid gas-permeable contact lenses, with a Dk value of 90 in group 3 and a Dk value of 52 in group 4. Tear-film osmolarity values in milliosmole (mosm) units were determined by auto-osmometer (Orstat 6030, Daiichi Kagacu, Kyoto, Japan) before and after contact lens wear for each group, and the results were compared statistically by ANOVA test. RESULTS Before the period of contact lens wear, the tear-film osmolarity values of group 1, 2, 3, and 4 were 283.61+/-12.83 mosm, 285.23+/-8.94 mosm, 285.57+/-11.39 mosm, and 280.15+/-12.07 mosm, respectively. After the period of contact lens wear, these values were measured at 312.15+/-16.03 mosm in group 1, 316.54+/-12.14 mosm in group 2, 313.14+/-9.66 mosm in group 3, and 316.38+/-11.60 mosm in group 4. Although the difference between the values before and after the period of contact lens wear was statistically significant for each group (F=291.45; P=0.0005), there was no statistically significant difference among the groups. CONCLUSIONS When a contact lens is placed in the eye, the lens alters the normal structure of the tear film and affects its rate of evaporation; therefore tear-film osmolarity may increase. In our study, all contact lenses produced a similar effect on tear-film osmolarity.

The effect of artificial tears on corneal surface regularity in patients with Sjögren syndrome

Purpose: To evaluate the effect of artificial tears on the topographic parameters associated with corneal surface regularity in patients with Sjögren syndrome. Methods: A total of 38 eyes of 20 patients with Sjögren syndrome were evaluated prospectively. The mean age of the patients was 50.5 ± 15.3 years (range, 28–76). Corneal topography with the Topographic Modeling System (TMS-2, Tomey) was performed before and after the instillation of artificial tears. The surface regularity index (SRI), surface asymmetry index (SAI), potential visual acuity (PVA) and mean astigmatism were compared in dry eyes before and after the instillation of artificial tears. Results: Before the instillation of artificial tears SAI, SRI, PVA and mean antigmatism values were found to be 1.37 ± 1.47, 0.74 ± 0.42, 20/30.92 ± 20/8.12 and 1.53 ± 1.47 D, respectively. In corneal topography performed after the instillation of artificial tears SAI, SRI, PVA and mean astigmatism values were 0.71 ± 0.82, 0.43 ± 0.36, 20/25.92 ± 20/5.55 and 1.08 ± 1.18, respectively. When compared statistically, the SRI, SAI, and mean astigmatism all decreased significantly and the PVA improved (p = 0.0001). Conclusion: Irregular corneal surface in dry eye patients affects optical quality. The statistically significant improvement observed in SRI and SAI values after the instillation of artificial tears also improves the PVA that is especially related to SRI.

Comparative Analysis of Tear Film Levels of Inflammatory Mediators in Contact Lens Users

ABSTRACT Purpose: To compare tear films levels of various inflammatory cytokines in asymptomatic contact lens (CL) users. CL users of rigid gas-permeable CLs (RGPCL) (group 1) or silicone hydrogel CLs (SiHCL) (group 2) were compared with non-CL-using healthy subjects (group 3). Materials and Methods: Tear samples were collected from subjects in each group after ensuring that there were no complications secondary to CL wear in the CL-wearing participants. Tear-film levels of interleukins (ILs)-1β, -6, and -8; granulocyte-macrophage colony-stimulating factor (GM-CSF) (using the Luminex method); and leukotriene B4 (LTB4) (using the ELISA method) were determined. Cytokine levels were compared among the three groups using analysis-of-variance (ANOVA) and Kruskall–Wallis tests. Results: There were significant differences in concentrations of IL-1β, GM-CSF and LTB4 among the three groups (p = 0.002, p = 0.021 and p = 0.009, respectively), as shown by the Kruskall–Wallis test comparing all three groups for the three cytokines. There were no significant differences for IL-6 and IL-8 (p = 0.079 and 0.094, respectively) when all three groups were compared. Conclusions: There were substantial statistically significant differences between RGPCL users, SiHCL users and control subjects in levels of tear film cytokines. Although CL users were asymptomatic, changes in tear-film levels of several important inflammatory mediators revealed that a chronic inflammatory process occurs during CL wear.

Comparison of the effects of first and second generation silicone hydrogel contact lens wear on tear film osmolarity.

AIM To compare the effects of first and second generation silicone hydrogel (SiH) contact lens wear on tear film osmolarity. METHODS The healthy subjects who have never used contact lenses before were enrolled in the study. Tear film osmolarity values of 16 eyes (group 1) who wore first generation SiH contact lenses were compared with those of 18 eyes (group 2) who wore second generation SiH contact lenses after three months follow-up. RESULTS Before contact lens wear, tear film osmolarity of groups 1 and 2 were 305.02±49.08 milliosmole (mOsm) and 284.66±30.18mOsm, respectively. After three months of contact lens wear, osmolarity values were found 317.74±60.23mOsm in group 1 and 298.40±37.77mOsm in group 2. Although osmolarity values for both groups of SiH contact lens wear after three months periods were slightly higher than before the contact lens wear, the difference was not statistically significant. CONCLUSION Contact lens wear may cause evaporation from the tear film and can increase tear film osmolarity leading to symptoms of dry eye disease. In the current study, there is a tendency to increase tear film osmolarity for both groups of SiH contact lens wear, but the difference is not statistically significant.

Corneal Decompensation after Selective Laser Trabeculoplasty

A 64-year-old Caucasian man referred for decreased vision after selective laser trabeculoplasty (SLT). Slit lamp examination revealed diffuse corneal edema. Despite intensive topical treatment including steroids, corneal edema did not resolve; on the contrary, it advanced to bullous keratopathy. Corneal edema after SLT is an exceptionally rare complication and in all of the previous reports edema resolved with medical treatment. To the best of our knowledge, this is the first report presenting persistent corneal edema after SLT.

Tear Osmolarity and Tear Function Changes in Patients with Acromegaly.

Abstract Purpose: Since acromegaly is a disease with various systemic complications, it may also have ophthalmologic consequences. The aim of the current study was to compare the tear osmolarity and tear function changes in patients with acromegaly with those in healthy controls. Design: Prospective, cross-sectional study. Materials and methods: Fifty-nine consecutive patients with acromegaly and 62 age and gender matched healthy volunteers were enrolled in the study. Tear osmolarity measurement with TearLab Osmolarity System (Tearlab, San Diego, CA), tear film break-up time (TBUT) assessment, and the Schirmer test without anesthesia were performed in the same order in each group. Growth hormone (GH) and insulin like growth factor-1 (IGF1) levels were also determined in the study group. Results: The mean TBUT was lower in acromegalic patients (9.1 ± 3.6 seconds) than in healthy controls (10.7 ± 2.9 s) (p = 0.009). The difference between the two groups in tear osmolarity and Schirmer test results (p = 0.08 and p = 0.9, respectively) was not statistically different. Conclusions: Acromegaly may a cause a decrease in TBUT in the affected patient. Preservation of normal tear osmolarity and normal Schirmer test results suggests that this might be due to effects on the meibomian glands.

Treatment of plasminogen deficiency patients with fresh frozen plasma

Congenital plasminogen (Plg) deficiency leads to the development of ligneous membranes on mucosal surfaces. Here, we report our experience with local and intravenous fresh frozen plasma (FFP). We retrospectively reviewed medical files of 17 patients and their eight first‐degree relatives. Conjunctivitis was the main complaint. Thirteen patients were treated both with intravenous and conjunctival FFP. Venous thrombosis did not develop in any. Genetic evaluation revealed heterogeneous mutations as well as polymorphisms. Diagnosis and treatment of Plg deficiency is challenging; topical and intravenous FFP may be an alternative treatment.

Molten metal-related ocular thermal burn: report on two cases

We report two cases of severe thermal burns on the ocular surface and its adnexal appendages that developed secondary to exposure to molten heavy metal with a melting temperature of near-thousand degree Celsius. Despite aggressive intervention and strict monitoring, the profound inflammation caused significant damage to the ocular surface, ending up in an intractable infection with an unfavorable outcome. The heat of the molten metal at impact, the heat-retaining capacity of the heavy metal, the total area of the ocular surface exposed to the molten metal, and the duration of exposure determined the severity of the injury. The unfavorable outcome, despite an intensive treatment, in terms of visual acuity and cosmetic appearance, should be explicitly explained to the patient, and a psychiatrist consultation should be considered if necessary.

The Effect of Contact Lens Wear on the Excitability of Blink Reflex Circuit: A Prospective Controlled Study

This study determined whether the use of contact lenses constitutes a model for adaptive alterations. We included 8 volunteers using contact lenses and 11 volunteers as control group. The blink reflex (BR) recovery was measured using the paired-pulse technique. No differences were observed between groups in initial R2 recovery at 200, 400, 800 and 1000 ms intervals. The 600 ms measurements were lower in the contact lens group (P = 0.037). There was a decrease at 600 ms in the 1st week, which reached the value of the control group in the 1st month (P = 0.049). It was concluded that rigid gas-permeable contact lens use does not cause an increase in the excitability of the interneurons that affect the BR cycle.