Necati Duru

Thinning of Choroidal Thickness in Patients with Rheumatoid Arthritis Unrelated to Disease Activity

Abstract Purpose: To investigate subfoveal and perifoveal choroidal thickness (CT) in patients with rheumatoid arthritis (RA). Methods: A study group of 117 patients with RA and a control group of 46 age-matched healthy individuals were enrolled in the study. Subfoveal and perifoveal CTs were measured using enhanced depth imaging optical coherence tomography (EDI-OCT). Perifoveal CT was measured 1,500 µm nasally and 1,500 µm temporally apart from the foveal center. Relationship between the disease activity score 28 (DAS-28) and subfoveal CT was also evaluated. Results: The mean subfoveal CT values in the study and control groups were 226.90 ± 43.61 μm and 299.74 ± 48.06 μm, respectively, which made for a statistically significant difference (p < 0.001). Likewise, perifoveal CT values were significantly thinner in the study group when compared with control group. DAS-28 wasn’t correlated with subfoveal CT in the study group. Conclusions: CT was significantly thinner in patients with RA when compared with healthy controls.

Accelerated corneal crosslinking for treatment of progressive keratoconus in pediatric patients

Purpose To evaluate the safety and efficacy of accelerated corneal crosslinking (CXL) in patients with progressive keratoconus aged 18 years or less. Methods A total of 28 eyes from 19 patients with progressive keratoconus aged 18 years or less were enrolled. We divided participants into 2 groups according to corneal thickness (CT). Group 1 included 13 eyes of 8 patients with CT ≥450 µm; group 2 included 15 eyes of 11 patients with CT <450 µm. Each participant underwent accelerated CXL using 10-minute ultraviolet A irradiance at 9 mW/cm2 for a total energy dose of 5.4 J/cm2. The efficacy and safety of the procedure were assessed postoperatively at 1, 3, 6, and 12 months with Pentacam and visual acuity. Results In uncorrected visual acuity, group 1 showed a statistically significant +0.12 logMAR improvement at 3 months postoperatively (p = 0.003), and in group 2, there was a statistically significant +0.3 logMAR improvement at 1 month postoperatively (p = 0.005). In best-corrected visual acuity, there was a +0.15 logMAR (p<0.001) and +0.22 logMAR (p = 0.005) improvement in group 1 and group 2, respectively, at 12 months postoperatively. All mean keratometric values including K1 and K2 dropped by at least 1 D or remained stable (< ± 1 D) in both groups after accelerated CXL treatment. Conclusions The findings showed that accelerated CXL treatment seems to be effective in slowing or halting the progression of keratoconus and that no permanent apparent complications are noted 6 months after accelerated CXL.

Choroidal Thickness in Patients with Systemic Lupus Erythematosus Analyzed by Spectral-domain Optical Coherence Tomography

Abstract Purpose: The aim of this study is to investigate the effect of systemic lupus erythematosus (SLE) on choroidal thickness (CT) in the subfoveal and perifoveal area as measured by enhanced depth imaging optical coherence tomography (EDI-OCT) in patients with SLE. Materials and methods: Fifty-eight patients with SLE (study group) and 58 healthy individuals (control group) were enrolled in the study. The subfoveal and perifoveal CT were measured by EDI-OCT. Results: The mean CT (μm) subfoveal, nasal, and temporal was 231.2 ± 57.6, 190.56 ± 30.64, and 222.65 ± 37.45 in the study group and 297.5 ± 45.1, 248.34 ± 39.67, and 286.54 ± 49.65 in the control group, respectively (p < 0.001, for all). Conclusion: The mean subfoveal, nasal, and temporal CT values were statistically significantly lower in patients with SLE when compared with healthy controls.

Measurement of choroidal thickness and macular thickness during and after pregnancy

AIM To investigate the effect of pregnancy on subfoveal choroidal thickness (SFCT) and macular thickness in both pregnant and not pregnant healthy women. METHODS Twenty-nine healthy pregnant women in their third trimester and 36 age-matched healthy women were enrolled in a prospective, cross-sectional study. Foveal and parafoveal thickness in the four quadrants and SFCT were measured by optical coherence tomography (OCT) in the healthy pregnant women (i.e. study group) and healthy women (i.e. control group). OCT measurements were again measured 3mo after delivery in the study group. RESULTS Mean SFCT measurements in the control group, pregnant women of the study group, and after delivery of the study group were 320.86±59.18 µm, 387.97±59.91 µm, and 332.40±26.03 µm, respectively. There was a statistically significant difference in the mean SFCT values between pregnant women of the study group and the control group (P=0.000). Foveal and parafoveal thickness values were not statistically significant in either the study or control group. CONCLUSION SFCT increases during pregnancy and returns to normal range in the three months after delivery. Macular thickness does not show any change during pregnancy.

Evaluation of anterior segment parameters during and after pregnancy.

PURPOSE To compare the anterior segment parameters during pregnancy and post-pregnancy. MATERIALS AND METHODS Fifty-four healthy pregnant women in their third trimester with ages ranging from 18 to 38 years were included in the study. All of the patients underwent comprehensive ophthalmologic examinations, including refraction, anterior segment, and fundus examinations, intraocular pressure, and axial length measurements. In addition, anterior chamber angle, anterior chamber depth, anterior chamber volume, corneal volume, central corneal thickness, and keratometry values were measured by Pentacam Scheimpflug camera. All measurements were measured again 3 months after delivery. RESULTS The mean intraocular pressure, anterior chamber angle, anterior chamber depth, anterior chamber volume, corneal volume, central corneal thickness, and keratometry measurements were significantly different during pregnancy and post-pregnancy (p<0.05 for all); however, the mean spherical refraction, cylindrical refraction, and axial length were not statistically significantly different during pregnancy and post-pregnancy (p>0.05 for all). CONCLUSIONS We found that there is an increase in the anterior chamber parameters, corneal volume, corneal thickness, and corneal curvature and a decrease in intraocular pressure in the third trimester.

Topographic and biomechanical evaluation of cornea in patients with acromegaly.

Purpose: The aim of this study was to compare topographic and biomechanical properties of corneas in patients with acromegaly with those of healthy individuals. Methods: Thirty-five patients with acromegaly (study group) and 35 healthy individuals (control group) were enrolled in this prospective study. Topographic measurements, including central corneal thickness (CCT), mean keratometry (K) value, K1, K2, surface asymmetry index, corneal volume (CV), and anterior chamber depth in the right eye of each participant were obtained using a Scheimpflug camera with a Placido disc topographer (Sirius; Costruzione Strumenti Oftalmici). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOP), and Goldmann-corelated intraocular pressure (IOPg) were measured using Reichert Ocular Response Analyzer (Reichert Ophthalmic Instruments). Results: Mean CCT, CV, CH, CRF, and IOPg values were higher in acromegalic eyes (549.3 ± 30.2 &mgr;m, 59.1 ± 3.1 &mgr;m, 11.3 ± 1.2 mm Hg, 11.3 ± 1.2 mm Hg, and 17.5 ± 2.9 mm Hg, respectively) than in healthy eyes (531.4 ± 33.6 &mgr;m, 57.4 ± 2.7 &mgr;m, 10.4 ± 1.2 mm Hg, 10.2 ± 1.6 mm Hg, and 14.8 ± 3.1 mm Hg, respectively; CCT, P = 0.042; CV, P = 0.032; CH, P = 0.044; CRF, P = 0.035; IOPg, P < 0.001). Conclusions: CCT, CV, CH, CRF, IOPg, and IOP with Goldmann applanation tonometry were significantly higher in acromegalic eyes. These corneal topographic and biomechanical properties, disease duration, and disease status should be considered when planning corneal refractive surgery and determining accurate intraocular pressure in patients with acromegaly.

Evaluation of Retinal Nerve Fiber Layer Thickness in Acromegalic Patients Using Spectral-Domain Optical Coherence Tomography

ABSTRACT Purpose: To evaluate retinal nerve fiber layer (RNFL) thickness in acromegalic patients. Methods: A study group of 29 patients with acromegaly and a control group of 38 age-matched healthy individuals were enrolled in a cross-sectional study. The study group was further divided by tumor size into two subgroups, a macroadenoma group and a microadenoma group. Serum growth hormone (GH) and insulin-like growth factor-1 (IGF-I) levels were detected at the time of ophthalmological examination in the study group. In both the study and control group, the RNFL thickness in the four quadrants was measured by optical coherence tomography. The relationship between GH and IGF-I levels and RNLF thickness was also evaluated. Results: The difference in mean RNLF thickness in all quadrants between the study and control groups was not statistically significant. In acromegalic patients with macroadenoma, the mean RNLF thickness of the inferior quadrant decreased significantly compared to both patients with microadenoma and healthy individuals (p = 0,032 and p = 0,046). GH and IGF-1 levels were not significantly correlated with the RNLF thickness in the study group. Conclusions: Excessive GH and IGF-1 levels do not affect the optic nerve or RNLF thickness, whereas the RNLF becomes thinner in the inferior quadrant in acromegalic patients with macroadenoma as a result of the chiasmal compression.

Does Valsalva Maneuver Affect Corneal Morphology in Eyes With Keratoconus

Objectives: The aim of this study was to investigate the effect of the Valsalva maneuver on corneal morphology and anterior chamber parameters in patients with keratoconus. Methods: A total of 39 eyes from 39 patients with keratoconus and 41 eyes from 41 age-matched and gender-matched healthy individuals were included in this cross-sectional study. Measurements of corneal front keratometry values (K-flat, K-steep, and K-max), central corneal thickness, corneal apex thickness, thinnest corneal thickness, corneal volume, anterior chamber volume (ACV), anterior chamber depth (ACD), and iridocorneal angle (ICA) were performed with a Pentacam Scheimpflug camera (Oculus, Germany) before and during the Valsalva maneuver. Changes in the anterior segment parameters from baseline and during the Valsalva maneuver and the differences in parameters between the keratoconus group and the control group were analyzed. A P value less than 0.05 was accepted as statistically significant. Results: In the patients with keratoconus, the Valsalva maneuver did not have any significant influence on the corneal parameters (P>0.05). However, ACV, ACD, and ICA decreased markedly during the Valsalva maneuver (P=0.006, P=0.048, and P=0.025, respectively). Changes caused by the Valsalva maneuver were similar for all parameters when compared with those in healthy individuals (P>0.05). Conclusions: During corneal topography imaging, the Valsalva maneuver observed in patients with keratoconus does not typically cause any significant change in corneal morphology.

Tear-Film Osmolarity Changes Following Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction.

ABSTRACT Purpose: To evaluate tear osmolarity (TO) in patients with epiphora caused by primary-acquired nasolacrimal-duct obstruction (PANDO), before and after an external dacryocystorhinostomy (DCR) and to compare with healthy control subjects. Materials and Methods: Twenty eyes of 20 patients (15 women, 5 men) who suffered from epiphora for at least one year due to PANDO, and 20 eyes of 20 healthy subjects (13 women, 7 men), were included in this study. External DCR was applied to all patients with PANDO, and TO measurements were repeated during the first month follow-up visit after surgery. Results: The mean period for complaints of epiphora was 1.7 ± 0.6 years (1–3). Patients had a mean TO of 282.6 ± 10 mOsm/l (range: 269–302) prior to DCR, and this increased to 297.7 ± 7.7 mOsm/l (range: 284–310) one month after DCR (p = 0.0001). Preoperative TO values were significantly lower when compared with the healthy control subjects’ (301.7 ± 10.6 mOsm/l (range: 280–316) (p = 0.0001). No significant differences were detected between postoperative and control group TO values (p = 0.18). Conclusions: Epiphora due to PANDO causes lower TO values. One month after DCR, TO came to similar TO levels when compared to healthy subjects.

Evaluation of Intraocular Pressure by Ocular Response Analyzer in Patients Undergoing Hemodialysis.

Purpose:The aim of this study was to compare the biomechanical parameters of the cornea and intraocular pressure (IOP) before and after hemodialysis (HD) in patients with end-stage renal disease (ESRD) and also healthy subjects. Materials and Methods:Twenty-one patients with ESRD undergoing HD treatment (study group) and 21 healthy individuals (control group) were enrolled in this prospective study. Right eyes of each subjects were included. Central corneal thickness (CCT) were measured using Sirius Scheimpflug camera. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann-related IOP (IOPg) were measured using ocular response analyzer. In the study group, measurements were taken just before HD and 30 minutes after HD. Results:The mean CCT, CRF, IOPg values did not differ between pre-HD, post-HD, and controls (P>0.05). CH was found to be significantly higher in control group (10.6±1.2 mm Hg) when compared with pre-HD (8.07±1.8 mm Hg) and post-HD (8.8±1.6 mm Hg) CH values (P=0.0001). The mean IOPcc values did not differ pre-HD (18.5±3.5 mm Hg) and post-HD (17.8±3.9 mm Hg) (P=0.39). The mean IOPcc values were lower significantly in control group (15.4±2.8 mm Hg) when compared with pre-HD and post-HD values (P=0.02 and 0.02, respectively). Significant correlations were seen between post-HD CRF and post-HD CCT (r=0.6, P=0.03); and post-HD IOPg and post-HD CCT (r=0.51, P=0.01). Conclusions:ESRD may disrupt the biomechanical properties of the cornea. Changes in ocular response analyzer parameters should be kept in mind to evaluate accurate IOP measurements in patients with ESRD.