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Objectives We aimed to compare the results of biomicroscopic examination and light microscopy in the diagnosis of Demodex infestation in chronic blepharitis cases. Methods The study was performed with retrospective data and included patients with chronic blepharitis and who were admitted to the Medipol University Ophthalmology Outpatient Clinic. Biomicroscopic evaluation was performed intentionally under 40x magnification to investigate the presence of Demodex ectoparasites. Three or four pieces of eyelashes were obtained from all cases with epilation technique, and Demodex parasites were examined under ×100 and ×400 magnifications with light microscopy. The presence of one or more Demodex parasites in the examined area under light microscopy was considered to be positive for infestation. We calculated sensitivity, specificity, false-positive rate, false-negative rate, and positive and negative predictive values of biomicroscopic examination compared with those of positive light microscopy. Results Of the 255 subjects included in the study, 134 (52.5%) were men and 121 (47.5%) were women. The mean age was 43.9±11.9 years. Of the 255 chronic blepharitis cases, 130 (51%) presented Demodex infestation on light microscopy. We calculated the sensitivity, specificity, false-positive rate, false-negative rate, positive predictive value, and negative predictive value and were found to be 83.07%, 90.4%, 9.6%, 16.9%, 90%, and 83.7%, respectively, for the biomicroscopic examination. Conclusions Careful biomicroscopic examination can be time-efficient and cost-effective, and the need for more advanced and invasive procedures for the identification of Demodex in patients with chronic blepharitis can be reduced.

Objective Demodex acari is an obligate ectoparasite, and it is usually located in the human hair follicles, eyelash roots, and sebaceous glands. The aim of this study was to investigate the presence of Demodex infestation in chronic blepharitis cases that are resistant to therapy. Methods Patients who were admitted at the Istanbul Medipol University School of Medicine Hospital with a diagnosis of chronic blepharitis were included. All cases received conventional therapy at least three times. Three or four eyelash samples from patients with blepharitis were collected and examined under light microscopy. For the diagnosis, the presence of one or more Demodex parasites at 10× and 40× magnification by a light microscope was considered as positive for infestation. Results Overall, 153 cases were included in the study. Of the cases, 79 (51.6%) were males and 74 (48.4%) were females. The mean age was 43.1±9.7 years. The presence of D. acari in the follicles of the eyelashes in patients with chronic blepharitis was found in 69 (45.1%) cases. Conclusion D. acari should be considered in patients with chronic blepharitis, especially in treatment-resistant cases. We believe that it would be useful to search for the parasite in patients with blepharitis prior to treatment on a routine basis.

WOS: 000457837000011 PubMed ID: 27660921 Objectives: The aim of this study was to evaluate tear film function in patients with vitamin D deficiency. Methods: In a single center, 60 eyes of 30 patients with vitamin D deficiency (group 1), and 60 eyes of 30 healthy individuals (group 2) were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear break-up time (TBUT), scoring of ocular surface fluorescein staining using a modified Oxford scale, and tear osmolarity. Results: Tear osmolarity values, OSDI, and Oxford scale scores were significantly higher in group 1 (309 +/- 9 mOsm/L, 35.78 +/- 21.44 and 1.3 +/- 0.9, respectively) compared with group 2 (295610 mOsm/L, 18.69 +/- 17.21 and 0.4 +/- 0.8, respectively) (P

WOS: 000444817100007 PubMed ID: 29509052 Background: To determine the agreement of central corneal thickness (CCT) measurements taken with ultrasonic pachymetry (USP), spectral domain optical coherence tomography (SD-OCT) and noncontact specular microscopy (NSM). Methods: A prospective, observational, cross-sectional study was performed in the outpatient ophthalmology clinic. CCT was measured in a total of 147 eyes of 147 consecutive healthy patients with USP, NSM, and SD-OCT. Same examiner performed all examinations. Bland-Altman plots were used to evaluate the agreement between instruments. Results: The average CCT values obtained by USP, NSM, and SD-OCT were 555 +/- 37 mu m, 554 +/- 34 mu m, and 546 +/- 34 mu m, respectively. There was a strong correlation between instruments: USP with SD-OCT (r = 0.937, p

WOS: 000350136600012 PubMed ID: 25503914 Purpose: The aim of this study was to evaluate changes in ocular surface and tear function parameters in chronic hepatitis C at initial stages of hepatic fibrosis. Methods: Thirty-one patients with biopsy-proven chronic hepatitis C and 31 age-and sex-matched healthy control subjects without systemic hepatitis C infection were examined with the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I, tear film break-up time, and scoring of ocular surface fluorescein and Rose Bengal staining using modified Oxford and van Bijsterveld scoring systems, respectively. Results: All ocular surface parameters, except OSDI and corneal staining scores, were significantly worse in hepatitis C group. The control group had greater OSDI scores than the hepatitis C group, but there was no statistically important difference. In subgroup analysis, progression of hepatic fibrosis was found to be correlated strongly with decreased Schirmer test I, increased OSDI, lid parallel conjunctival folds, conjunctival, and corneal staining scores. Conclusion: Patients with chronic hepatitis C were more likely to exhibit severe ocular surface damage and signs of dry eye.

WOS: 000349405000011 PubMed ID: 25630007 Objectives: To compare epithelial healing time following laser epithelial keratomileusis (LASEK) and photorefractive keratectomy (PRK) with anterior segment optic coherence tomography (AS-OCT). Methods: This prospective interventional case series study comprised 56 eyes of 28 patients that underwent laser refractive surgery in the Department of Ophthalmology, Medipol University Medical Faculty, Istanbul, Turkey, between March 2014 and May 2014. Each patient was randomized to have one eye operated on with PRK, and the other with LASEK. Patients were examined daily for 5 days, and epithelial healing time was assessed by using AS-OCT without removing therapeutic contact lens (TCL). Average discomfort scores were calculated from ratings obtained from questions regarding pain, photophobia, and lacrimation according to a scale of 0 (none) to 5. Results: The mean re-epithelialization time assessed with AS-OCT was 3.07 +/- 0.64 days in the PRK group, 3.55 +/- 0.54 days in the LASEK group, and the difference was statistically significant (p=0.03). Mean subjective discomfort score was 4.42 +/- 0.50 in the PRK eyes, and 2.85 +/- 0.44 in the LASEK eyes on the first exam day (p=0.001). The score obtained on the second (p=0.024), and third day (p=0.03) were also statistically significant. The fourth (p=0.069), and fifth days scores (p=0.1) showed no statistically significant difference between groups. Conclusion: The PRK showed a statistically significant shorter epithelial healing time, but had a statistically significant higher discomfort score until the postoperative fourth day compared with LASEK. الطريقة: هذه الدراسة التداخلية املرتقبة للحاالت املسلسلة تتضمن 56 ً عينا من 28 ً مريضا الذين تلقوا جراحة الليزر االنكسارية في قسم أمراض العيون في مستشفى كلية الطب جامعة ميدي بول، اسطنبول، تركيا، في الفترة ما بني مارس 2014م مايو 2014م. كل مريض خضع للعملية ألحدى عينيه بطريقة )الالزيك( والعني االخرى بطريقة )بي آر كي(. مت االختيار بني العينني بطريقة عشوائية. مت فحص كل مريض بعد العملية بشكل دوري وملدة خمسة أيام، ومت حساب الزمن املستغرق لشفاء الغشاء الظهاري للقرنية باستخدام الـ ) أي اس- أو سي تي( بدون ازالة العدسات الالصقة املداوية. مت حساب معدل درجات االنزعاج عن طريق سؤال املريض عن األلم، رهاب الضوء و تدمع العني بنقاط من الصفر )مبعنى ال يوجد( الى 5. النتائج: املتوسط الزمني لعودة التظهرن املقاس بطريقة الـ ) أي اس- أو سي تي( كانت: 64.0±07.3 يوم في مجموعة الـ)بي آر كي( و 54.0±55.3 في مجموعة الـ )الالزيك( والفرق بني املجموعتني كان ً واضحا ً إحصائيا )بي= 03.0 .)املتوسط االنزعاجي الغير املوضوعي كان 50.0±42.4 في العيون التي خضعت للـ )بي آر كي( و 44.0±85.2 في العيون التي خضعت للـ )الالزيك( في اليوم األول للفحص. املعدالت التي مت احلصول عليها لدرجة االنزعاج في اليومني الثاني والثالث كانت ً أيضا ً واضحة احصائيا، )بي= 024.0 و بي=03.0 على التوالي(. ً اليومني الرابع واخلامس لم يظهر درجات واضحة احصائيا بني املجموعتني )بي=069.0 و بي=1.0 )على التوالي. اخلامتة: أظهرت طريقة الـ )بي آر كي( زمنا أقصر اللتئام الغشاء الظهاري ً الذي كان واضحا ً إحصائيا ولكنه في الوقت نفسه أظهرت درجة انزعاج أكثر حتى اليوم الثالث بعد العملية.

WOS: 000387490000002 PubMed ID: 26513720 Objectives: The aim of this study was to evaluate tear osmolarity and tear film parameters in patients with ocular rosacea. Methods: In a single center, 25 eyes of 25 patients with ocular rosacea (group 1), 25 eyes of 25 patients with rosacea without ocular involvement (group 2), and 20 eyes of 20 healthy individuals (group 3) were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT), scoring of ocular surface fluorescein staining using modified Oxford scale, and tear osmolarity. Results: Tear osmolarity values, OSDI and Oxford scale scores were significantly higher in group 1 than in groups 2 and 3 (P < 0.001 for all). Schirmer I test and TBUT in group 1 were significantly lower than in groups 2 and 3 (P < 0.001 for all). There were no significant differences in OSDI, Schirmer I test, TBUT, Oxford scores, or tear osmolarity between groups 2 and 3 (P = 0.629, P = 0.175, P = 0.713, P = 865, and P = 0.388, respectively). Conclusions: This study showed that ocular rosacea is associated with tear hyperosmolarity and tear film dysfunction.

To report clinically symptomatic and angiographically documented cystoid macular edema (CME) associated with the use of latanoprost in two pseudophakic eyes after uncomplicated cataract surgery.Retrospective review of two patients who had history of latanoprost use and uncomplicated cataract surgery and described blurred vision in the first postoperative month.Ocular examination revealed CME, which was confirmed by fluorescein angiography. The visual acuities of patients improved and the CME was angiographically resolved after discontinuation of latanoprost and the initiation of nonsteroidal anti-inflammatory eyedrops and oral acetazolamide.Until a causal relationship between CME and latanoprost is proved or disproved, caution in its use in pseudophakic patients would be prudent. (Eur J Ophthalmol 2005; 15: 158-61).

WOS: 000407080800005 PubMed ID: 28328296 Purpose: The aim of this study was to evaluate tear osmolarity and tear film function and ocular surface changes in patients with metabolic syndrome.Methods: 108 eyes of 64 patients with metabolic syndrome (group 1) and 110 eyes of 55 healthy individuals (group 2) were included in this cross-sectional study. All participants were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT), and tear osmolarity. Main outcome measures were Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT), and tear osmolarity values.Results: Tear osmolarity values and OSDI scores were significantly higher in group 1 (314.4 19.1 mOsm and 38.9 +/- 1.1, respectively) compared with group 2 (295 +/- 14.3 mOsm and 18.69 +/- 17.2, respectively) (p = 0.01 for both). The Schirmer test values and TBUT in group 1 (10 +/- 3.7 mm and 14.8 +/- 3.6 sec, respectively) were significantly lower compared with group 2 (16.8 +/- 2.6 mm and 18.1 +/- 0.5 sec, respectively) (p < 0.001 for both). There was significant correlation between tear osmolarity versus waist circumference and fasting blood glucose in the study group (r = 0.364, p = 0.04; and r = 0.542, p 0.001, respectively).Conclusions: This study showed that metabolic syndrome can influence tear osmolarity and tear film function. Patients with metabolic syndrome showed tear hyperosmolarity and tear film dysfunction.

WOS: 000394351800037 PubMed ID: 27664138 The objective of the study was to compare the success rate of transcanalicular laser dacryocystorhinostomy (TCL-DCR) with or without the use of adjunctive mitomycin C (MMC) in cases with primary nasolacrimal duct obstruction (NLDO). This retrospective study was comprised of 68 patients with uncomplicated primary NLDO. There were two groups in the study: the Group 1 (n = 35) patients underwent TCL-DCR surgery with MMC and the Group 2 (n = 33) patients underwent TCL-DCR surgery without MMC. All patients had bicanalicular silicone tube intubation. The main outcome measures were patent osteotomy as visualized endoscopically and patent nasolacrimal irrigation. The follow-up period was 12 months. All patients had unilateral TCL-DCR with silicone tube intubation. Six months following surgery, the silicone tubes were removed. At the final evaluation, success rates were 80 % in Group 1 and 78.8 % in Group 2. There was no statistically significant difference between the two groups (p = 0.52). No complications related to MMC usage were recorded during the study period. Intraoperative use of MMC has no beneficial effect on the success rate in TCL-DCR.

Purpose: The aim of this study was to evaluate tear osmolarity, tear film function, and ocular surface changes in patients with psoriasis. Methods: At a single center, 30 eyes of 30 patients with psoriasis (group 1) and 30 eyes of 30 healthy individuals (group 2) were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT) test, scoring of ocular surface fluorescein staining using a modified Oxford scale, and tear osmolarity measurement. Results: Tear osmolarity values, OSDI, and Oxford scale scores were significantly higher in group 1 (309.8 ± 9.4 mOsm, 38.9 ± 1.1, and 0.7 ± 1.1, respectively) than in group 2 (292.7 ± 7.7 mOsm, 4.2 ± 0.3, and 0.1 ± 0.3, respectively; p

WOS: 000341838400003 PubMed ID: 24114503 Photorefractive devices have been evaluated for their effectiveness in detecting anisometropia, hyperopia, myopia, and astigmatism. We investigated the reliability of Plusoptix S08, the newest photoscreener, and Topcon autorefractometer by comparing them with cycloplegic retinoscopy. Plusoptix S08, cycloplegic retinoscopy, and cycloplegic autorefractometer measurements for 235 eyes of 118 children (59 female, 59 male) with a mean age of 4.9 +/- 2.6 and median age of 5 years (range 1-12) were conducted. The Plusoptix S08 produced the following mean (+/- SD) results-spherical 0.27 +/- 1.64, cylindrical power -0.81 +/- 0.71, axis 89.73 +/- 61.18, and spherical equivalent -0.05 +/- 1.61. The cycloplegic retinoscopy produced the following mean (+/- SD) results-spherical 0.12 +/- 1.35, cylindrical power -0.89 +/- 0.71, axis 92.18 +/- 68.39, and spherical equivalent -0.15 +/- 1.31. The cycloplegic autorefractometer produced the following mean (+/- SD) results-spherical 0.16 +/- 1.44, cylindrical power -0.88 +/- 0.72, axis 90.86 +/- 68.21, and spherical equivalent -0.12 +/- 1.41. This study has shown that cycloplegic autorefractometer and retinoscopy results are similar and Plusoptix S08 is a very safe, easy-to-use and reliable screening method of refraction, especially for ophthalmologists unskilled in retinoscopy. Plusoptix S08 is a useful tool for estimating refraction in patients for whom conventional autorefraction is not an option.

PURPOSE: To report a case of choroidal neovascularization (CNV) in a patient with cone dystrophy (CD). METHODS: Case report.RESULTS: A 20-year-old woman presented with diminished vision in her right eye. Fundus examination showed perifoveal retinal pigment epithelial changes and retinal hemorrhage consistent with subretinal CNV in the right eye, and mild retinal pigment epithelial changes with a dull foveal reflex in the left eye. Optical coherence tomography analysis and fundus fluorescein angiography also confirmed the subfoveal CNV in the right eye. Electroretinography showed decreased amplitudes in photopic and 30-Hz. flicker tests in both eyes, which confirmed cone dystrophy. A single intravitreal ranibizumab injection resolved the edema and stabilized the CNV during the follow-up of 6 months.CONCLUSION: Cone dystrophy is an inherited ocular disorder characterized by loss of cone photoreceptors. Association of CNV has been reported in patients with fundus flavimaculatus, best dystrophy, gyrate atrophy, choroideremia, retinitis pigmentosa, adult-onset foveomacular vitelliform dystrophy, Sorsby macular dystrophy, Bietti crystalline dystrophy, and myotonic dystrophy-related macular dystrophy. We report a case of a patient with CD in whom CNV developed in one eye and responded to a single ranibizumab injection.

Purpose To describe optical coherence tomography findings in patients with late solar retinopathy and their association with visual loss. Methods Twenty-one eyes of 21 patients who had a history of watching a solar eclipse in 1999 with or without visual loss were evaluated with colored and red-free fundus photography and optical coherence tomography analysis using the macular thickness protocol. Results Ten of the eyes (47.6%) had no visual acuity loss and 11 eyes (52.4%) had visual acuities ranging from 0.3 to 0.8. There was a strong correlation between central foveal thickness and visual acuity. Empty spaces involving the full thickness of the photoreceptor layer band of the entire fovea were observed in 10 eyes and found to be associated with visual acuity loss. Signal defects in the outer and inner segments of the photoreceptors were identified in 12 and 15 eyes, respectively, and were not associated with visual acuity loss. Conclusion Decreased central foveal thickness and full-thickness empty spaces beneath the fovea in optical coherence tomography analysis can be associated with permanent visual acuity loss in patients with a history of watching a solar eclipse.

WOS: 000357806000018 PubMed ID: 26104596 Amblyopia is the most common cause of monocular decreased vision in children, with a prevalence of three to five per cent.1 Studies have demonstrated that refractive errors are the most common cause of amblyopia.2,3 Because amblyopia can be treated most effectively when treated early, screening for amblyopia is recommended by the American Academy of Pediatrics and the American Optometric Association.4 Refractive measurement of children is challenging but new technologies are helping to improve screening. Photoscreeners are gaining importance because of their portability and ease of use in examining young and disabled children (for example, those with autism).5,6 PlusoptiX S09 (Plusoptix®GmbH, Nuremberg, Germany) is a binocular, portable infrared video refractor which uses the dynamic photosciascopy method. As a digital photoscreener, it records digital video using infrared beams and analyses data in seconds using software installed on the minicomputer of the handpiece. At the beginning of a measurement, the PlusoptiX camera takes a few pictures to determine whether the refractive error is outside measurement range. If it is, a ‘measurement out of range’ error message is shown on screen. In addition, the operator will find the words ‘myopia’ or ‘hyperopia’ instead of refractive readings in the output to indicate which limitation was exceeded. The measurement is aborted in this case and the screening result is ‘refer’. The method used to detect whether the refractive error is outside the measurement range is proprietary (RJ Jacobs, personal communication). Studies suggest that non-cycloplegic photorefraction has reasonable sensitivity and specificity compared with cycloplegic retinoscopy.5,7 We present this case to show how a photoscreener can misdiagnose a patient with very high refractive error as emmetropia.

Purpose: To determine the clinical sedative effect and dosage of intranasal midazolam in refraction and fundus examination of children with strabismus. Patients and Methods: Refraction and fundus examination with (n = 28) and without (n = 24) sedation were performed in 52 children with strabismus whose ages ranged from 7 to 26 months. We delivered a 5-mg/mL solution of midazolam via a syringe for 60 seconds to provide a dose of 0.2 mg/kg. We repeated the dose to a maximum of 0.3 mg/kg if there was no clinical sedative response after 10 to 15 minutes. The ease of examination and sedation for each patient was scored by a blinded observer. The groups were evaluated for ease of examination and the time needed to complete it. Results: We obtained clinically adequate sedation at a mean (± standard deviation) of 15 minutes (± 2.69 minutes). Sedation was achieved with a mean dose of 2.64 mg/kg (± 0.66 mg/kg). Children receiving midazolam had significantly calmer examination scores. The time needed to complete the examination was statistically significantly shorter for these children than for children not receiving sedation ( P < .05). Conclusions: Intranasal midazolam is a beneficial drug and method of delivery for the sedation of anxious children with strabismus undergoing refraction and fundus examination. Sedation prior to examination is effective in reducing the anxiety and time associated with ophthalmologic examination of children with strabismus. J Pediatr Ophthalmol Strabismus 2005;42:355–359.

Purpose: To evaluate changes in anterior chamber depth (ACD) and angle width after neodymium- yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy.Design: Prospective interventional case series.Methods: In a single institution, 43 eyes of 43 consecutive pseudophakic patients with symptomatic posterior capsule opacification (PCO) underwent Nd:YAG laser capsulotomy. Anterior chamber depth and angle width in pseudophakic eyes with posterior capsule opacification were measured with anterior segment optical coherence tomography (AS-OCT) before and 3 days after Nd:YAG laser capsulotomy. Preoperative and postoperative measurements of anterior chamber depth and angle width included the angle opening distance, measured as the perpendicular distance from the trabecular meshwork at 500 mm and 750 mm anterior to the scleral spur to the anterior iris surface (AOD500 and AOD750, respectively), and anterior chamber angle (ACA) in the nasal and temporal quadrants. Main outcome measures were the changes in ACD and angle width parameters.Results: The mean patient age was 63.4 ± 3.6 years. Before Nd:YAG laser capsulotomy, mean ACD, AOD500, AOD750, and ACA (nasal and temporal) measurementswere 3.71 ± 0.11mm, 0.61 ± 0.054mm, 0.67 ± 0.063 mm, and 34.5 ± 1.67 degrees and 34.8 ± 1.55 degrees, respectively. Three days after Nd:YAG laser capsulotomy, mean ACD, AOD500, AOD750, and ACA (nasal and temporal) measurements were 3.77 ± 0.1 mm, 0.69 ± 0.06 mm, 0.73 ± 0.06 mm, and 35.51 ± 1.64 degrees and 36.17 ± 1.51 degrees, respectively (P

To evaluate the effectiveness of an intravitreal bevacizumab injection on retinal neovascularization and diabetic macular edema (DME) refractory to laser photocoagulation therapy. Thirty-four eyes of 22 patients with proliferative diabetic retinopathy and DME refractory to laser photocoagulation therapy received an intravitreal injection of 1.25 mg/0.05 ml of bevazicumab. Changes in mean best-corrected visual acuity (BCVA), central macular thickness (CMT), regression of neovascularization over time, and correlation between BCVA and CMT were evaluated. Follow-up visits were at weeks 1, 2 and 4 and months 3 and 6. Mean BCVA was significantly better than baseline only at week 2 (P = 0.036). Mean CMT decreased significantly from baseline at weeks 1, 2, and 4 (P = 0.001). At months 3 and 6, mean CMT increased, albeit insignificantly (P = 0.804 and P = 1.0). The decrease in fluorescein leakage was moderate in all eyes at the end of week 1. At week 2, there was total resolution of fluorescein leakage in 24 (70.5%) eyes and moderate resolution in 10 (29.5%) eyes. At the end of month 3, the fluorescein leakage was fully resolved in 5 (14.7%) eyes, moderately resolved in 24 (70.5%) eyes, and was similar to baseline in 5 (14.7%) eyes. At month 6, the fluorescein leakage was fully resolved in 3 (8.8%) eyes, moderately resolved in 20 (58.8%) eyes, and was similar to baseline in 11 (32.4%) eyes. A moderate but insignificant negative correlation was found between visual acuity and CMT (P > 0.05). Persistence or recurrence of neovascular tissue after panretinal photocoagulation may be attributed to the production of vascular endothelial growth factor by the residual ischemic retina, which also results in persistent or recurrent DME despite macular grid photocoagulation.

Third-generation optical coherence tomography (StratusOCT) images of 2 female siblings with hypermetropia, microphthalmos, and papillomacular retinal fold are described. These cases suggest the possibility of genetic transmission or predisposition and show that the resulting StratusOCT images can be nearly identical.