R Asoklis

Age-related changes in corneal thickness and endothelial characteristics

Purpose To determine the influence of age on central corneal thickness (CCT), endothelial cell density (ECD), average cell size, coefficient of variation in cell size, and percentage of regular hexagonal cells; and to estimate the average ECD and CCT in seven age groups. Materials and methods After obtaining informed consent, 211 Caucasian patients (358 eyes) were examined using a noncontact specular microscope at the Center of Eye Diseases in Vilnius University Hospital Santariskiu Clinic. The main corneal parameters were: ECD, average cell size, coefficient of variation in cell size, percentage of regular hexagonal cells, and CCT. Subjects (20–89 years) were stratified by age into seven groups. Correlations between CCT, endothelial parameters (ECD, percentage of regular hexagonal cells, average, coefficient of variation), and age were found. Student’s t-test and Pearson’s correlation coefficient (r) values were calculated. Results A total of 114 (54.03%) women and 97 (45.97%) men participated in the study. Average ECD (cell/mm2) ranged from 2,931 (±371) in 20–29 year olds to 2,222 (±182) in 80–89 year olds; CCT (μm) ranged from 563 (±44) in 20–29 year olds to 540 (±35) in 80–89 year olds. A strong inverse correlation was observed between age and corneal ECD (r=−0.650, P<0.01) and a weak inverse correlation was observed between age and CCT (r=−0.156, P<0.01). ECD and CCT correlated directly (r=0.232, P<0.01). The average size of corneal endothelial cells directly correlated with age (r=0.586, P<0.01). There was no correlation between age and the coefficient of variation in cell size nor the percentage of regular hexagonal cells (P>0.05). Conclusion Young people have higher ECD. CCT also decreases, but its dependence on age is weaker. A lower cell density indicates a thinner cornea. The variation in cell size and percentage of regular hexagonal cells are not dependent on age.

Changes in choroidal thickness after intraocular pressure reduction following trabeculectomy

To evaluate the changes of peripapillary and subfoveal choroidal thickness (CT) after trabeculectomy.

Changes in choroidal thickness and corneal parameters in diabetic eyes.

Purpose To evaluate the effect of diabetes mellitus (DM) on central corneal thickness (CCT), corneal endothelial parameters (endothelial cell density [ECD], average size [AVE], hexagonality [A6], polymegathism [SD]), and subfoveal choroidal thickness (SFCT), and to determine whether these parameters depend on the duration of DM and hemoglobin A1c (HbA1c) level. Methods A total of 62 patients with type 2 DM and 65 healthy subjects were examined using a noncontact specular microscope, A-scan ultrasound, and spectral-domain optical coherence tomography. The study parameters included medical history, age, eye axial length, CCT, ECD, AVE, A6, SD, and SFCT. The duration of DM and HbA1c level of the 2 latest tests were noted. Results The SFCT (258.0 ± 74.4 µm) and ECD (2721.8 ± 264.1 cells/mm2) were significantly lower, and the CCT (566.7 ± 35.7 µm) higher, in diabetic patients than in the control group (313.1 ± 88.5 µm, 2967.3 ± 220.6 cells/mm2, 550.0 ± 56.4 µm, respectively) (p<0.05). There were no differences in age, sex, or axial length between the diabetic and control groups (p>0.05). Diabetic retinopathy and macular edema did not influence SFCT significantly (p>0.05). No differences in endothelial parameters between groups and no correlations among HbA1c, duration of DM, and any of the examined parameters were found (p>0.05). Conclusions Diabetic patients have thicker corneas, lower ECD, and thinner subfoveal choroid than healthy subjects.

Ocular surface reconstruction using amniotic membrane following excision of conjunctival and limbal tumors.

Purpose To report the clinical results of patients treated by preserved human amniotic membrane transplantation (AMT) following the removal of conjunctival and limbal tumors. Methods Retrospective noncomparative interventional case series of 9 patients (9 eyes) who underwent AMT after removal of conjunctival and limbal tumors with lesion-free margins and perilesional cryotherapy. Results The excised tumors were histopathologically examined and included 2 squamous cell carcinomas, 2 papillomas, and 5 nevi. Bulbar conjunctiva was involved in all of the eyes, limbus and cornea in 7 and 3 eyes, respectively. The mean extent of the limbal involvement was 4 clock hours (range 2–9, SD 2.4); the average diameter of the base of the tumor was 12.8 mm (range 10–20, SD 4.4). The mean follow-up time was 38 months (range 13–60, SD 15). No surgical or early postoperative complications were observed. In all eyes, complete healing of the tissue defect occurred, resulting in a stable, wet, and noninflamed epithelium. All eyes demonstrated a smooth ocular surface except one with a clinically insignificant Symblepharon after the excision of a squamous cell carcinoma. Superficial peripheral corneal vascularization and opacification as a sign of partial limbal stem cell deficiency developed in 2 eyes. In one case, a recurrence of conjunctival papilloma was diagnosed after a 3-year follow-up. Conclusions Amniotic membrane transplantation is an effective method of reconstruction following a conjunctival and limbal tumor excision and cryotherapy of surgical wound margins. In most cases, complete healing of an ocular surface can be achieved without any clinically significant complications.

Comparison of intraocular pressure measurements with different contact tonometers in young healthy persons.

AIM To analyze the correlation of Goldmann applanation tonometer (GAT), I-Care tonometer and Tono-Pen tonometer results in young healthy persons, and to investigate the influence of central corneal thickness (CCT) on intraocular pressure (IOP) measurements recorded with these tonometers. METHODS We conducted a pilot clinical study in 78 eyes of 78 subjects aged 22-28 years old (44 women and 34 men; mean age 23.8±1.19y). IOP was measured using GAT, I-Care and Tono-Pen tonometers, followed by measurements of CCT. Statistical analysis was performed using SPSS 20.0. RESULTS The mean IOPs and standard deviation (±SD) for GAT, I-Care and Tono-Pen were 15.62±2.281 mm Hg, 16.29±2.726 mm Hg and 16.32±2.393 mm Hg, respectively. The mean CCT was 555.15±29.648 µm. Clear positive correlations between GAT and I-Care, GAT and Tono-Pen, and I-Care and Tono-Pen tonometers were found (r=0.867, P<0.001; r=0.861, P<0.001; r=0.915, P<0.001, respectively). In comparison between devices, Bland-Altman analysis showed a significant mean difference (MD) in the measurements by GAT and I-Care of -0.679 mm Hg and by GAT and Tono-Pen of -0.705 mm Hg ( P<0.001), but there was no significant difference between I-Care and Tono-Pen ( P>0.05). Both non-gold standard tonometers were affected by CCT; that is, both I-Care and Tono-Pen tonometer values were significantly higher with higher CCT means (>555 µm; MD=-1.282, P<0.001; MD=-0.949, P<0.001, respectively) compared with GAT. CONCLUSION Both I-Care and Tono-Pen tonometers overestimated IOP compared with the GAT values. Either the I-Care or Tono-Pen tonometer could be used instead of GAT because there was no significant difference between their results. Higher CCT values (>555 µm) were associated with overestimated IOP values.

Late ocular changes after closantel poisoning in five women

In 1993, donated closantel (Fukiver) was mistakenly administered by a gynecologist to eleven female patients in Lithuania, for use as a treatment for endometritis [1]. Closantel is a salicylanilide-derived compound commonly used as an anthelmintic in veterinary practice [2]. In literature we found only few cases of closantel poisoning in humans, but no cases of late ocular changes were found [3–5]. Therefore, the aim of this article is to assess late ocular changes after closantel poisoning in humans.

Changes in macular thickness after trabeculectomy with or without adjunctive 5-fluorouracil

Conflict of interest. None of the authors have any conflict of interest to declare, financial or otherwise. No financial or other support was received for the study. Background. The aim of the study was to assess changes in macular thickness after trabeculectomy in respect to the use of 5-fluorouracil (5-FU) as well as to analyse possible associations between the postoperative changes in macular thickness and intraocular pressure (IOP). Materials and methods. The prospective observational study included 106 eyes (100 patients) with glaucoma who underwent trabeculectomy with or without 5-FU. Subsequently 5-FU needling was performed if failure of the filtrating bleb occurred. Macular thickness and the IOP were evaluated before, one week, and six months after the surgery. The mean and sectoral macular thickness was assessed using spectral domain optical coherence tomography. Results. The mean (±SD) IOP reduced from 27.71 (±6.88) mmHg at baseline to 18.3 (±8.1) mmHg one week (p < 0.001) and 15.1 (±7.6) mmHg six months (p < 0.001) after trabeculectomy. One week postoperatively, the mean macular thickness increased from 285.19 (±15.98) μm to 288.9 (±16.31) μm (p < 0.001); macular thickening was significant in all subfields (p < 0.001) and correlated positively with IOP reduction (rho = 0.312, p = 0.001 for central subfield). After six months, macula remained thicker only at the central and inner nasal subfields (p < 0.05). The changes in macular thickness were not affected by the use of 5-fluorouracil. Conclusions. Trabeculectomy may induce a slight macular thickening which is more pronounced in the early postoperative period. The IOP reduction plays an important role in this process and is associated with thicker postoperative macula. However, the use of adjunctive 5-FU has no influence on macular thickness after glaucoma surgery despite its potential hypotonic, inflammatory and cytotoxic effects.

Quantitative histopathological assessment of ocular surface squamous neoplasia using digital image analysis

The aim of this retrospective pilot study was to evaluate the Aperio nuclear V9 algorithm as an image analysis tool to observe the histopathological changes of ocular surface squamous neoplasia (OSSN). A histopathological assessment, including the Ki-67 proliferative index (PI) of immunohistochemically-stained tumor conjunctiva (TC) and healthy conjunctiva (HC) tissues, was performed in six cases of OSSN. The Aperio V9 algorithm was applied to digital images of the tissue specimens to count the Ki-67 PI and to measure the nuclear area indices. This digital algorithm was validated using stereological and visual analysis methods. The visual scoring of Ki-67 PI ranged from 22 to 60% (mean, 38.5%), and from 5 to 20% (mean 9.5%) in TC and HC tissue, respectively. The computer-aided analysis, using the Aperio nuclear V9 algorithm, revealed that the Ki-67 PI ranged from 21.5 to 43.5% (mean, 33.6%), and from 1.9 to 21.0% (mean, 11.8%) in the TC and HC tissue, respectively. The stereological method demonstrated that the Ki-67 PI ranged from 30.1 to 51.5% (mean, 41.0%), and from 3.2 to 30.1% (mean, 15.1%) in the TC and HC tissues, respectively. The strongest association in the collinearity of regression analysis was observed between the Aperio nuclear V9 algorithm/stereological models in the TC tissue (r2=0.7; P=0.04) and the HC tissue (r2=0.7; P=0.03), and the visual/stereological models in the TC tissue (r2=0.7; P=0.04) and the visual/Aperio nuclear V9 algorithm models in the HC tissue (r2=0.7; P=0.04). A weak and statistically insignificant association was identified between the visual/Aperio nuclear V9 algorithm analysis in the TC tissue (r2=0.4; P=0.2) and the visual/stereological models in the HC tissue (r2=0.5; P=0.13). No significant difference was observed between the nuclear area of the TC (mean, 36.5 μm2) and HC (mean, 35.7 μm2; P=0.88) tissues. It was concluded that the Aperio nuclear V9 algorithm is a useful tool for the reliable analysis of histopathological changes of OSSN. The results of this computer-aided algorithm correlate strongly with the stereological method when assessing the Ki-67 PI.

Syphilitic uveitis: Vilnius region perspetive: 6 case reports

Purpose To examine the clinical manifestations of syphilitic uveitis in Vilnius region population over four years and review trends in incidence