Mehtap Caglayan

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.

Factors Influencing Progression of Keratoconus 2 Years After Corneal Collagen Cross-Linking in Pediatric Patients

Purpose: To assess the preoperative patient characteristics that may predict outcomes of keratoconus 2 years after corneal collagen cross-linking (CXL) in pediatric patients with keratoconus. Methods: This retrospective study included 72 eyes of 52 consecutive patients with keratoconus under the age of 18 with 2-year follow-up after CXL. Subgroup analysis and cutoff values were determined as per age (<14 and ≥14 years), sex, baseline uncorrected and corrected distance visual acuities (UCVA, CDVA; <0.8 and ≥0.8 logMAR), topographic cone location (central and paracentral), maximum keratometry (K-max, <54 and ≥54 diopters), and corneal thickness at the thinnest point (thCT) (<450 and ≥450 &mgr;m) to evaluate the associations between preoperative patient characteristics and outcomes of CXL treatment in terms of K-max. Postoperative progression in K-max was defined as steepening of 1.0 diopter or more. Results: Average age of patients was 14.8 ± 2.2 (9–17) years. After 2 years, the mean UCVA significantly improved and the mean thCT significantly decreased in all patients (P = 0.023, P < 0.001, respectively). The K-max in patients with paracentral cones and/or with thCT less than 450 &mgr;m were more likely to progress (cone location: P = 0.023, odds ratio = 3.21, 95% confidence interval, 1.17–8.72; thCT: P = 0.008, odds ratio = 4.54, 95% confidence interval, 1.46–14.14). Age, sex, baseline UCVA, CDVA, and K-max did not present any significant effect on progression of CXL after treatment (P > 0.05 for all variables). Conclusions: In pediatric patients with keratoconus, cone location and the baseline thinnest corneal thickness seem to affect the success rate of CXL treatment after 2-year follow-up.

Evaluation of the shifting of the line of sight and higher order aberrations of eyes with keratoconus after corneal cross-linking

AIM To evaluate changes in the coordinates of the line of sight (LoS) and higher order aberrations (HOAs) of eyes with keratoconus, following corneal cross-linking (CXL). METHODS All patients (93 eyes) underwent detailed ophthalmologic examination and Pentacam HR measurements at baseline and at 3, 6, and 12 months after corneal CXL. LoS coordinates on the horizontal (x) and vertical (y) axes, vertical coma, vertical trefoil, spherical aberration, total root-mean square (RMS), and HOA-RMS values were recorded along with visual acuity and topographical parameters. RESULTS LoS significantly shifted to the nasal region after corneal CXL in both right and left eyes (p=0.003 and p=0.01, respectively). Horizontal axis values of both eyes significantly shifted to the temporal region at postoperative 6th months compared to the baseline measurements (p=0.02 and p=0.02, respectively) and remained the same between postoperative 6th months and 12th months (p=1.00 and p=0.97, respectively). Total-RMS, HOA-RMS, vertical coma, and spherical aberration values significantly improved after corneal CXL (p<0.001, p=0.02, p=0.04, and p<0.001, respectively). The improvements in HOAs were significant at postoperative 6th months compared to the baseline measurements (p=0.003, p=0.02, p<0.001, and p=0.003, respectively) while remained the same between postoperative 6th months and 12th months (p>0.05 for all values). The changes in horizontal-axis coordinates in left eyes were significantly correlated with anterior elevation, anterior astigmatism, total-RMS and HOA-RMS changes (r2=0.20, p=0.03; r2=0.35, p<0.01; r2=0.50, p<0.001 and r2=0.35, p=0.004; respectively). CONCLUSIONS LoS significantly shifted to the nasal region and HOAs improved after corneal CXL and these changes stabilized 6th months after corneal CXL. It would be more better to perform refractive surgery in crosslinked corneas at least 6th months after corneal CXL.

Accelerated versus standard corneal collagen cross-linking in pediatric keratoconus patients: 24 months follow-up results

PURPOSE To compare the 24 month visual, refractive, topographic and aberrometric results of the accelerated and standard corneal collagen cross-linking (CXL) in pediatric keratoconus patients. METHODS 87 eyes of 64 consecutive keratoconus patients under 18 years old with 24 month follow-up period following standard or accelerated CXL were included. 38 eyes received standard CXL (3 Mw/cm2, 30 min), while 49 eyes had accelerated CXL (9 mW/cm2, 10 min). Changes in the uncorrected (UCVA) and best corrected visual acuity (BCVA), spherical equivalent (SE), manifest astigmatism (MA), corneal topographic parameters, and corneal aberrations such as spherical aberration (SA), high order aberrations (HOAs), horizontal and vertical coma were evaluated. Corneal haze was graded and progression rate was assessed. RESULTS The difference between baseline and 24 months postoperative UCVA, BCVA, SimK (keratometry)-1, SimK-2, Kmax, and the corneal aberrations were not significantly different between the two groups (p > 0.05 for all). The mean reduction in thinnest corneal pachymetry from baseline to 24 months after CXL was higher in accelerated CXL group (p = 0.007). The progression rate was 13.1% in standard and 16.3% in accelerated group (p = 0.754). There were no differences in the grade of corneal haze between the two groups (p = 0.249). No complications were observed in the both groups. CONCLUSION The 24 month results of accelerated and standard CXL revealed that, the efficacy and safety of accelerated CXL were the same with standard CXL in pediatric keratoconus patients. As being a rapid procedure, accelerated CXL appears to be more benefical for pediatric patients.

Comparison of Electrocoagulation and Conventional Medical Drops for Treatment of Conjunctivochalasis: Short-Term Results

Objectives: To compare the effectiveness of electrocoagulation and conventional medical drops for treatment of conjunctivochalasis using anterior segment-optical coherence tomography (AS-OCT). Materials and Methods: Forty eyes of 20 patients with bilateral conjunctivochalasis were included in this prospective study. Twenty eyes of 10 patients were assigned to Group 1 and underwent electrocoagulation. The other 20 eyes of 10 patients were assigned to Group 2 and received conventional medical treatment consisting of non-steroidal antiinflammatory drop (topical 0.5% ketorolac tromethamine) 4 times a day and artificial tears (0.15% sodium hyaluronate) 6 times a day for 4 weeks. Before and 4 weeks after treatment, all patients were evaluated by slit-lamp biomicroscopy, tear film break-up time (TBUT) test, and ocular surface disease index (OSDI) questionnaire. Tear meniscus height (TMH), tear meniscus area (TMA), and conjunctivochalasis area (CCA) were measured with AS-OCT. Results: In Group 1, posttreatment values of TMH, TMA, and TBUT were significantly higher (p<0.001, p=0.006, and p<0.001, respectively), while CCA and OSDI scores were significantly lower than pretreatment values (p<0.001 for both values). In Group 2, only OSDI decreased significantly between pretreatment and posttreatment values (p<0.001). The other parameters did not change significantly after treatment (p>0.05 for all values). Conclusion: Electrocoagulation is an effective modality for treatment of conjunctivochalasis

Bilateral acute depigmentation of iris: 3-year follow-up of a case

Bilateral acute depigmentation of the iris (BADI) usually affecting young women, is a newly defined clinical diagnosis with bilateral symmetrical pigment loss of iris stroma without iris transillumination defect. Herein, we want to share the results of a 3-year-long follow-up of a 23-year old female patient with BADI. She was admitted to our clinic with a complaint of discoloration of both her brown irises. An ocular evaluation of the patient revealed symmetrical pigment deposition in trabecular meshwork. No iris transillumination defect, pupillary sphincter paralysis, keratic precipitates, and inflammatory reaction in anterior chamber were seen. The depigmented iris stroma became repigmented symmetrically after 3-year follow-up period. Although it is rare, BADI should be considered in the differential diagnosis of the diseases with bilateral iris depigmentation.

Neutrophil to Platelet Ratio in Patients with Chalazia: A Novel Marker of Local Inflammation?

Aim: To evaluate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-platelet ratio (NPR) in patients with chalazia and to compare the data with those of healthy subjects. Materials & Methods: The preoperative complete blood count records of 200 patients who underwent chalazia surgery (study group) and 200 age-matched patients who underwent strabismus surgery (control group) in a tertiary care hospital were reviewed retrospectively. The NLR, PLR, and NPR were calculated and compared between the groups with an independent t-test. Results: The mean age in the study and control groups was 34.04 ± 16.04 and 33.91 ± 15.11 years, respectively (p = 0.934). There was no significant between-group difference in terms of NLR and PLR (p = 0.559 and p = 0.403, respectively). The mean NPR was significantly lower in the study group compared with the control group (p = 0.008). Conclusions: This study demonstrated that a lower NPR was associated with chalazion development. The NPR may be a predictive marker in local inflammatory diseases.

Optic Nerve Head Elastometry in Both Eyes of Patients with Unilateral Non-arteritic Anterior Ischaemic Optic Neuropathy – May It Be a Novel Aspect of the Pathogenesis?

ABSTRACT In this prospective study, the biomechanical properties of optic nerve head (ONH) and cornea in both eyes of patients with non-arteritic anterior ischaemic optic neuropathy and healthy control eyes were investigated. ONH elastometry was measured with real-time elastography, and corneal elastometry was measured with ocular response analyser. Elastometry of cornea and ONH was lower in both eyes of patients with unilateral non-arteritic ischaemic optic neuropathy than in healthy control eyes. The role of these biomechanical differences in the pathogenesis of non-arteritic ischaemic optic neuropathy should be investigated further.

Chiari 1 malformation with optic disc drusen

ABSTRACT A 32 year old female patient with CM 1 diagnosis was referred for the management of papilledema. Ophthalmologic examination revealed normal visual acuity (20/20 in both eyes), normal optic nerve function tests and normal slit-lamp biomicroscopic findings. Fundoscopy revealed bilateral irregular optic nerve heads with blurred margins. B scan ultrasonography (USG) and Spectral domain optical coherence tomography were performed and bilateral optic nerve heads were diagnosed as ODD. We concluded that the pseudopapilledema must be taken into account before making papilledema diagnosis in patients with CM 1 to protect the patients from redundant interventional procedures.

Evaluation of optic nerve head biomechanical properties in Pseudoexfoliation Glaucoma with Real-time Ultrasound Elastography

PURPOSE To investigate the biomechanical properties of the optic nerve head in patients with Pseudoexfoliation (PEX) glaucoma using Real-time Elastography (RTE) and to compare these results with those of Primary Open Angle Glaucoma (POAG) patients and healthy subjects. METHODS Twenty eyes of 20 PEX glaucoma patients (PEX group), 20 eyes of 20 POAG patients (POAG group), and 20 eyes of 20 healthy subjects (control group) were enrolled in this prospective study. The strain Ratios of Orbital Fat to Optic Nerve head (ROFON) and lateral rectus muscle to optic nerve head (RLRON) were determined. Comparisons were performed using Chi-square, Kruskal Wallis, Mann-Whitney U, and One-way ANOVA tests. RESULTS The strain ratios of orbital fat to optic nerve head were 2.34, 6.85 and 1.76 in PEX glaucoma, POAG, and control groups, respectively (p<0.001). The strain ratios of the lateral rectus muscle to the optic nerve head were 0.51, 0.82, and 0.55 in PEX glaucoma, POAG, and control groups, respectively (p=0.256). CONCLUSION The strain ratios of orbital fat to optic nerve head were different in PEX glaucoma patients than in POAG and control groups. RTE can provide biomechanical assessment of the optic nerve head in a non-invasive, quick, easily accessible, and user-friendly manner.