Murat Dogru

Tear function and ocular surface changes in keratoconus

PURPOSEnTo describe the ocular surface disorder in patients with keratoconus.nnnDESIGNnA prospective, case-controlled study.nnnPARTICIPANTSnSeventy-five eyes of 38 patients with keratoconus seen at Uludag University School of Medicine, Department of Ophthalmology, from March 2000 through April 2001, and 80 eyes of 40 normal control subjects were studied.nnnINTERVENTIONnThe subjects underwent routine ophthalmic examinations, corneal sensitivity measurements, Schirmer test, tear film breakup time (BUT), fluorescein and rose bengal staining of the ocular surface, and conjunctival impression cytology.nnnMAIN OUTCOME MEASURESnPatients and control subjects were compared for corneal sensitivity, tear function, ocular surface staining parameters, goblet cell density, and squamous metaplasia grade. The relation of these parameters to the severity of keratoconus progression was also investigated.nnnRESULTSnThe mean corneal sensitivity was significantly lower in keratoconus patients compared with control subjects (P < 0.001). The BUT values were also significantly lower in the keratoconus group. Patients with keratoconus had significantly higher fluorescein and rose bengal staining scores (P < 0.001). Corneal sensitivity and tear function changes seemed to get worse with advanced stages of keratoconus. Impression cytology showed goblet cell loss and conjunctival squamous metaplasia, both of which again related to the extent of progression of keratoconus.nnnCONCLUSIONSnThe ocular surface disease in keratoconus is characterized by disorder of tear quality, squamous metaplasia, and goblet cell loss, all of which seem to relate to the extent of keratoconus progression.

Tear function and ocular surface changes with topical mitomycin (MMC) treatment for primary corneal intraepithelial neoplasia

Purpose To evaluate the tear function and ocular surface alterations in patients with primary CIN before and after treatment with topical mitomycin (MMC). Patients and Methods. We describe seven patients with unilateral CIN treated with 0.04% topical MMC three times daily until full eradication of the lesion. The patients underwent tear and ocular surface examinations including Cochet-Bonnet corneal sensitivity measurements, tear film break-up time (BUT), Schirmer test, and Rose-Bengal staining before, at the time of resolution of the CIN, and at the final follow-up. Conjunctival impression cytology was performed before treatment and at the last visit. Results The mean pretreatment corneal sensitivity was 30.3 ± 7.4 mm and improved to 55 ± 5 mm at the final visit (P < 0.05). There were no aqueous-deficient eyes. The BUT values and Rose-Bengal staining scores also showed significant improvement at the last follow-up compared with the pretreatment values (P < 0.05). Initial impression cytology specimens showed goblet cell loss, higher grades of squamous metaplasia, areas of isolated keratinized, binucleated, and actively mitotic disfigured epithelial cells in all patients. The mean goblet cell density and squamous metaplasia grade were observed to improve significantly at the last visit (P < 0.05). MMC-induced cytologic changes were seen to persist long after cessation of treatment in some patients. All eyes remained free of recurrence and complications during the follow-up period. Conclusion We found 0.04% topical MMC treatment tid until full eradication to be effective in the management of CIN. The ocular surface disease of CIN was characterized by disturbance of tear film stability, goblet cell loss, and increased squamous metaplasia in all patients. Impression cytology proved useful in attaining the diagnosis of CIN, evaluating the effect of treatment, and showing MMC-related long-term changes on the ocular surface.

Transsclerally Fixated Intraocular Lenses in Children

BACKGROUND AND OBJECTIVEnTo evaluate the visual outcome and complications of transsclerally fixated intraocular lenses (IOLs) in children without sufficient capsular support.nnnPATIENTS AND METHODSnTwenty-one aphakic eyes of 18 children (13 boys and 5 girls) who underwent secondary transscleral IOL fixation were evaluated retrospectively. Ten eyes with aphakia after infantile cataract surgery, 7 aphakic eyes following traumatic cataract surgery, and 4 eyes after ectopia lentis surgery received secondary transscleral posterior chamber IOL fixation because of by insufficient posterior capsular support. Visual outcomes and postoperative complications were recorded.nnnRESULTSnAfter a mean follow up of 22.5 months (range, 12 to 36 months), visual improvement of more than 2 Snellen lines was observed in 9 eyes (42.8 %). Preoperative visual acuity could not be assessed in 7 eyes (33.3%) because of associated neurological and developmental disorders. One eye (4.7%) lost 2 Snellen lines of the best corrected visual acuity because of concurrent endophthalmitis and retinal detachment. Pupillary distortion, transient pupillary membrane, pupillary capture as well as strabismus and anterior uveitis, were the most common complications. Endophthalmitis and retinal detachment were the most severe postoperative complications.nnnCONCLUSIONnTranssclerally fixated IOL implantation may be visually rewarding in well selected pediatric cases, but the potential complications would suggest extreme caution in its consideration. Until long-term studies are published, it is difficult to recommend implantation unless it is deemed impossible to provide adequate rehabilitation by other means such as contact lenses or aphakic spectacles.

Changes in tear function and the ocular surface after topical olopatadine treatment for allergic conjunctivitis: an open-label study

BACKGROUNDnOlopatadine hydrochloride 0.1% eye drops represent a new class of anti-allergic agent with combined antihistaminic and mast cell-stabilizing properties.nnnOBJECTIVEnThe purpose of this study was to describe alterations in tear function and the ocular surface in patients with allergic conjunctivitis and to analyze the effect of topical olopatadine treatment on corneal sensitivity, tear function, and impression cytology variables.nnnMETHODSnThis was a single-center, 3-visit, prospective, open-label study conducted in patients with allergic conjunctivitis. Patients received 1 drop of topical olopatadine hydrochloride 0.1% BID for 3 weeks. At each visit, patients and healthy control subjects underwent routine ophthalmic examinations and measurements of corneal sensitivity and tear function (Schirmer test of tear quantity, tear film break-up time [BUT], fluorescein staining of the cornea). All control subjects and a subgroup of patients also underwent conjunctival impression cytology for assessment of squamous metaplasia and goblet cell density. The outcomes of interest were changes in corneal sensitivity, tear function, and impression cytology variables after 3 weeks of treatment with olopatadine eye drops, both in patients with allergic conjunctivitis and between patients and controls.nnnRESULTSnAt enrollment, the study included 46 eyes of 23 patients (9 men, 14 women; age range, 20-42 years) with allergic conjunctivitis; results were calculated based on the 21 patients who completed the study. The control group consisted of 70 eyes of 35 healthy subjects (13 men, 22 women; age range, 22-39 years). Before treatment, 64.3% of the eyes of patients with allergic conjunctivitis had a fluorescein staining score of >1 point, whereas after treatment, 14.3% had a score of >1 point (P < 0.001). Patients mean (+/- SD) corneal sensitivity improved to 55.0 +/- 2.5 mm from the pretreatment value of 42.5 +/- 2.5 mm (P < 0.001). Mean BUT values before and after treatment were 8.1 +/- 3.5 and 14.0 +/- 7.0 seconds, respectively (P < 0.001). Before treatment, patients mean squamous metaplasia grade was 2.5 +/- 0.5; at the end of treatment, it had decreased to 1.0 +/- 0.5 (P < 0.001). The mean pretreatment goblet cell density of 545 +/- 85 cells/mm2 improved to 1,090 +/- 100 cells/mm2 after treatment (P < 0.001).nnnCONCLUSIONnIn the patient population studied, the disorder of tear function, squamous metaplasia, and loss of ocular surface goblet cells associated with allergic conjunctivitis improved with topical olopatadine treatment.

Primary repair and intraocular lens implantation after perforating eye injury

Purpose: To evaluate the clinical outcome after primary treatment of lens injuries with corneal or corneoscleral trauma. Methods: Ten eyes of 10 patients were retrospectively evaluated. There were no foreign bodies in any eye. After primary repair, an anterior chamber maintainer (ACM) was introduced through the inferotemporal corneal quadrant. Sodium hyaluronate 1.4% (Healon GV®) was injected, and the anterior capsule was stained with trypan blue 0.1% vital stain (Vision Blue®) under the viscoelastic substance. After a capsulorhexis was created, the lens material was aspirated. The nucleus was delivered from the scleral tunnel, which was opened from the superior/superotemporal corneal quadrant. A conventional 21.0 diopter poly(methyl methacrylate) intraocular lens (IOL) with a 5.5 mm optic and overall diameter of 12.5 mm (Dr. Schmidth®, Hannan Kibbutz) was implanted through the scleral tunnel. The scleral tunnel was not sutured, and the corneal entry sites were closed with stromal hydration. Results: The final best spectacle‐corrected visual acuity (BSCVA) was better than 20/100 in all patients, and 6 patients had a BSCVA of 20/20. The IOL was in the capsular bag in all patients at the last follow‐up. The mean follow‐up was 12.3 months (range 7 to 25 months). The main visually limiting factors were corneal scar, irregular astigmatism, and traumatic maculopathy. Conclusions: Primary IOL implantation in carefully selected patients with penetrating corneoscleral lens injury may yield visually rewarding results. The use of a vital stain to increase the visibility of the injured anterior capsule and of a closed scleral tunnel system with an ACM increased the surgical safety.

Ocular surface findings in Hallopeau-Siemens subtype of dystrophic epidermolysis bullosa: report of a case and literature review.

Purpose: This article describes the clinical features and long-term changes in corneal sensitivity, tear function, and impression cytology findings in a patient with recessive dystrophic epidermolysis bullosa (DEB). Methods: The patient underwent best-corrected Landolt visual acuity measurements, slit-lamp examinations, anterior segment photography, Schirmer test with anesthesia, tear film break-up time, corneal fluorescein and Rose-Bengal staining, assessment of corneal sensitivity, and conjunctival impression cytology at the initial and final visits. Results: The patient had a recurrent corneal erosion in the right eye and a painful corneal blister with extensive superficial punctuate keratopathy in the left eye, which remained refractory to treatment with patching, lubricants, and antibiotic ointments for 10 weeks. The corneal disease in both eyes responded swiftly to topical fibronectin, topical nonpreserved tears, vitamin A ointment, and therapeutic soft contact lenses. Maintenance treatment was continued with preservative-free topical tear drops and vitamin A ointment. Corneal disease did not recur in the patient during the follow-up of 29 months. The mean corneal sensitivity and tear film break-up time were decreased initially in both eyes and attained normal values with treatment. Impression cytology revealed squamous metaplasia, loss of cellular cohesion, and total absence of goblet cells before treatment, all of which were observed to be normalized at the final follow-up. Conclusions: The ocular surface disease in DEB was characterized by low corneal sensitivity, disorder of tear quality, decreased cellular cohesion, squamous metaplasia of the conjunctiva, and goblet cell loss. Close follow-up for ocular complications in DEB is essential and a pathophysiology-oriented approach to the epithelial disease may not only provide rapid healing but might prevent recurrences as well.

Neurocutaneous melanosis with transposition of the great arteries and renal agenesis.

Abstract: Neurocutaneous melanosis (NCM) is rare and is characterized by the proliferation of melanocytes in the central nervous system. A 6‐day‐old infant boy was referred to our department with giant congenital melanocytic nevi and convulsions. On physical examination the patient had a giant black‐brown pigmented nevus covering his face, neck, scalp, shoulders, back, chest, and abdomen. Numerous satellite lesions were noted on the face, neck, and upper extremities. In the right bulbar conjunctiva, a brown plaque was present. Magnetic resonance imaging (MRI) showed hyperintense areas in the brain on short repetition time/short echo time sequences, compatible with intraparenchymal melanin deposits. No leptomeningeal abnormality was seen. Further investigation also revealed agenesis of the right kidney and transposition of the great arteries. Transposition of the great arteries, which has never been reported in NCM, may be an incidental finding. We present a case of NCM associated with agenesis of the right kidney and transposition of the great arteries.

Oculocardiac reflex in a nonsedated laser in situ keratomileusis patient.

A healthy 21-year-old man had laser in situ keratomileusis (LASIK) in the right eye for a refractive error of -7.0 diopters. The electrocardiogram findings and heart rate were recorded before LASIK; during eye lid speculum insertion, vacuum application, corneal flap preparation, and excimer laser keratectomy; and after the procedure. The pre-LASIK heart rate was 90 pulses/min. Severe bradycardia of 40 beats/min developed during vacuum application, and the procedure was terminated. Severe bradycardia caused by an oculocardiac reflex may occur during LASIK, and patients should be closely monitored during the procedure.

Refractive outcomes after arcuate keratotomy using the Terry astigmatome

Purpose: To investigate the refractive outcomes after arcuate keratotomy for astigmatism. Setting: Uludag University, Faculty of Medicine, Department of Ophthalmology, Bursa, Turkey. Method: Sixteen eyes of 11 patients with astigmatism had arcuate keratotomy using the Terry astigmatome. The mean age of the patients was 36 years ± 10 (SD). All patients received preoperative and postoperative ophthalmic examinations consisting of best spectacle‐corrected (BSCVA) and uncorrected (UCVA) visual acuities, corneal topography, and ultrasonic pachymetry. Surgery was performed using topical anesthesia of oxybuprocaine 0.1% eyedrops. The Terry astigmatome was selected by the mean paracentral (estimated incision area) corneal thickness. All patients received topical ofloxacin 0.3% and topical diclofenac 0.1% eyedrops postoperatively. Results: The mean corneal astigmatism was −4.0 ± 1.1 diopters (D) (range −2.2 to −6.0 D) preoperatively and –1.8 ± 0.8 D (range −0.6 to −3.0 D) postoperatively. The mean surgically induced corneal astigmatism was 2.5 ± 0.6 D. The mean UCVA (logMAR) was 0.74 ± 0.25 preoperatively and 0.18 ± 0.23 1 week postoperatively, and the mean BSCVA (logMAR) was 0.19 ± 0.24 and 0.19 ± 0.23, respectively. There were no intraoperative or postoperative complications. Conclusion: Arcuate keratotomy using the Terry astigmatome was a safe and reliable treatment for corneal astigmatism.