Ozlem Dikmetas

The Expression and Comparison of Healthy and Ptotic Upper Eyelid Contours Using a Polynomial Mathematical Function

Abstract Purpose: To derive a mathematical expression for the healthy upper eyelid (UE) contour and to use this expression to differentiate the normal UE curve from its abnormal configuration in the setting of blepharoptosis. Methods: The study was designed as a cross-sectional study. Fifty healthy subjects (26M/24F) and 50 patients with blepharoptosis (28M/22F) with a margin–reflex distance (MRD1) of ≤2.5 mm were recruited. A polynomial interpolation was used to approximate UE curve. The polynomial coefficients were calculated from digital eyelid images of all participants using a set of operator defined points along the UE curve. Coefficients up to the fourth-order polynomial, iris area covered by the UE, iris area covered by the lower eyelid and total iris area covered by both the upper and the lower eyelids were defined using the polynomial function and used in statistical comparisons. The t-test, Mann–Whitney U test and the Spearman’s correlation test were used for statistical comparisons. Results: The mathematical expression derived from the data of 50 healthy subjects aged 24.1 ± 2.6 years was defined as y = 22.0915 + (−1.3213)x + 0.0318x2 + (−0.0005x)3. The fifth and the consecutive coefficients were <0.00001 in all cases and were not included in the polynomial function. None of the first fourth-order coefficients of the equation were found to be significantly different in male versus female subjects. In normal subjects, the percentage of the iris area covered by upper and lower lids was 6.46 ± 5.17% and 0.66% ± 1.62%, respectively. All coefficients and mean iris area covered by the UE were significantly different between healthy and ptotic eyelids. Conclusions: The healthy and abnormal eyelid contour can be defined and differentiated using a polynomial mathematical function.

Serum C-reactive protein levels in exfoliation syndrome and exfoliative glaucoma

Sir, Exfoliation syndrome (XFS) is a systemic disorder of the extracellular matrix characterized by the accumulation of elastic microfibrils in which oxidative stress and a chronic low-grade inflammation is implicated in the pathogenesis.1, 2, 3 The purpose of this study was to evaluate the serum concentrations of CRP, a marker for systemic inflammation, in subjects with XFS and exfoliative glaucoma (XFG).

Bilateral anterior segment dysgenesis in an infant with partial trisomy 16q and partial monosomy 3p

Anterior segment dysgenesis comprises a spectrum of malformations arising from faulty neural crest cell migration. We report a newborn boy with partial trisomy 16q and partial monosomy 3p who presented with anterior segment dysgenesis with iris hypoplasia on the right and glaucoma on the left in association with systemic anomalies. The anterior segment dysgenesis features observed in this case have not been previously associated with partial trisomy 16q or partial monosomy 3p. Our findings support the hypothesis that an additional anterior segment dysgenesis gene may reside on chromosome 3p or 16q.

Posttraumatic acute choroidopathy

PurposeTo report a case of acute choroidopathy following a blunt ocular trauma.MethodsOcular examination included dilated fundus examination and optical coherence tomography enhanced depth imaging (OCT-EDI).PatientsSingle-patient case report.Case reportA 10-year-old boy was referred following a blunt trauma to the right eye. The visual acuity diminished to 20/200 and mild hemorrhage was found in the anterior chamber. The fundoscopy was unremarkable. An OCT-EDI revealed a choroidal thickening and detachment at the macula. Six month later, the choroidal morphology resolved and the visual acuity improved.ConclusionsThis study reported a case of acute choroidopathy associated with temporary thickening of the choroid and separation of the Haller’s layer from the sclera. OCT-EDI helped to detect and monitor the morphological changes in the apparently normal-looking macular choroid after ocular trauma. Further case reports with long term follow-up are needed to clarify the clinical impact of posttraumatic acute choroidopathy.

The effect of pharmacologic pupillary dilatation on anterior segment parameters in patients with exfoliation syndrome.

PURPOSE The purpose of this study was to evaluate the effect of pharmacologic pupillary dilatation on anterior chamber depth (ACD) and anterior chamber angle (ACA) in eyes with exfoliation syndrome (XFS). METHODS Thirty-six eyes of 36 patients with XFS were evaluated with slit-lamp examination, Goldmann applanation tonometry and ultrasound biomicroscopy (UBM) under standard light conditions. Primary outcome parameters were defined as the change in ACD and ACA measured before and 40 min after instillation of a single drop of either 1% cyclopentolate (Group I; n=12), 2.5% phenylephrine (Group II; n=12) or 1% tropicamide (Group III; n=12). Change in intraocular pressure (IOP) during the same time interval was included as a secondary outcome measure. RESULTS The average predilatation ACD, ACA and IOP values in the study subjects were 2.54±0.40 mm, 27.9±6.3° and 14.9±3.1 mmHg, respectively. There were no significant differences in the mean age (p=0.461), the female/male ratio (p=0.232), baseline ACD (p=0.841), ACA (p=0.761) or IOP (p=0.070) within the three groups. Differences in dilation induced changes in ACD (p=0.108), ACA (p=0.636) and IOP (p=0.160) between the three groups were not statistically significant. CONCLUSION Pupillary dilatation with a single drop of 1.0% cyclopentolate, 2.5% phenylephrine or 1% tropicamide is not associated with shallowing of the anterior chamber or narrowing of the ACA in patients with XFS who present with open angles.

Bilateral Lacrimal Gland Enlargement Associated With Isotretinoin Treatment

This report aims to raise awareness of the potential link between isotretinoin use and the development of lacrimal gland enlargement. A 23-year-old woman who was using isotretinoin 40 mg daily for acne vulgaris for 6 months presented with periocular pain and bilateral swelling of upper eyelids. She did not have any signs of inflammation. Her systemic workup including serological tests for autoimmune disorders were within normal limits. MRI of the orbits revealed bilateral enlargement of the lacrimal glands. Discontinuation of isotretinoin resulted in disappearance of her signs and symptoms and the size of the lacrimal glands reverted to normal after 2 months. Isotretinoin use may be associated with lacrimal gland enlargement, and this adverse effect seems to be transient and reversible on cessation of the drug.