Search

Purpose: To investigate the effect of intensive glycemic control on hyperglycemia- induced changes in refraction, corneal topography, lenticular and corneal thickness in diabetic patients., Methods: Eighteen diabetic patients with plasma glucose >300 mg/dl were enrolled in the study consecutively. Autorefraction, C-Scan corneal topography, Javal keratometry, corneal pachymetry and ultrasonic biometric measurements were carried out at presentation and after metabolic control of blood sugar (plasma glucose profile <200 mg/dl). One eye of each patient was selected randomly for statistical analysis., Results: Mean plasma glucose levels were 356.00 mg/dl before and 133.78 mg/dl after treatment. The median values of the autorefractometric measurements were - 0.125 D on admission and + 0.375 D at the second examination. The difference in the refraction was statistically significant (P = 0.022). Nine of 18 patients became hyperopic, 2 became myopic and 7 showed no change after treatment. There was a significant change in the corneal topographic keratometric measurements at the flattest corneal meridian after treatment (P = 0.037). After treatment no statistically significant changes were observed in the pachymetric corneal thickness, anterior chamber depth, biometric dioptric lens calculations and Javal keratometric data., Conclusions: Hyperglycemia is the major cause of the transient refractive changes in diabetic patients. Following intensive medical treatment, a considerable number of patients tend to become more hyperopic compared with the hyperglycemic state. During the treatment period, changes in the corneal topographic parameters might be a potential source of error for keratorefractive and cataract surgery.

Introduction: Permeability changes in the blood-brain barrier (BBB) and their possible contribution to brain edema formation have a crucial role in the pathophysiology of septic encephalopathy. Magnesium sulfate has been shown to have a protective effect on BBB integrity in multiple experimental models. In this study we determine whether magnesium sulfate administration could have any protective effects on BBB derangement in a rat model of sepsis., Methods: This randomized controlled experimental study was performed on adult male Sprague-Dawley rats. Intraperitoneal sepsis was induced by using the infected fibrin-thrombin clot model. To examine the effect of magnesium in septic and sham-operated rats, a dose of 750 micromol/kg magnesium sulfate was given intramuscularly immediately after surgery. Control groups for both infected and sham-operated rats were injected with equal volume of saline. Those rats surviving for 24 hours were anesthetized and decapitated for the investigation of brain tissue specific gravity and BBB integrity by the spectrophotometric assay of Evans blue dye extravasations. Another set of experiments was performed for hemodynamic measurements and plasma magnesium level analysis. Rats were allocated into four parallel groups undergoing identical procedures., Results: Sepsis significantly increased BBB permeability to Evans blue. The dye content of each hemisphere was significantly lower in the magnesium-treated septic rats (left hemisphere, 0.00218 +/- 0.0005; right hemisphere, 0.00199 +/- 0.0007 [all results are means +/- standard deviation]) than in control septic animals (left hemisphere, 0.00466 +/- 0.0002; right hemisphere, 0.00641 +/- 0.0003). In septic animals treated with magnesium sulfate, specific gravity was higher (left hemisphere, 1.0438 +/- 0.0007; right hemisphere, 1.0439 +/- 0.0004) than in the untreated septic animals (left hemisphere, 1.0429 +/- 0.0009; right hemisphere, 1.0424 +/- 0.0012), indicating less edema formation with the administration of magnesium. A significant decrease in plasma magnesium levels was observed 24 hours after the induction of sepsis. The dose of magnesium that we used maintained the baseline plasma magnesium levels in magnesium-treated septic rats., Conclusions: Magnesium administration attenuated the increased BBB permeability defect and caused a reduction in brain edema formation in our rat model of intraperitoneal sepsis.

Objectives: The purpose of this study was to investigate the effects of PEEP on oxygenation and airway pressures during PCV-OLV., Design: Randomized, crossover, clinical study., Setting: University hospital., Participants: Twenty-five patients undergoing thoracotomy., Interventions: During the first 5 minutes of OLV, all patients were ventilated with VCV (PEEP: 0) (VCV-ZEEP). Afterward, ventilation was changed to PCV with PEEP: 0 (PCV-ZEEP) or PEEP: 4 cmH2O (PCV-PEEP) for 20 minutes. In the following 20 minutes, PCV-PEEP and PCV-ZEEP were applied in reverse sequence., Measurements and Main Results: At the end of VCV-ZEEP airway pressures (peak airway pressure, plateau airway pressure, mean airway pressure, and pause airway pressure) were recorded. At the end of PCV-PEEP and PCV-ZEEP airway pressures, PaO2 and Qs/Qt were recorded. Ppeak and Pplat were significantly lower with PCV-PEEP compared with VCV-ZEEP (eg, Ppeak: 33.4+/-4.2, 28.3+/-4.1, and 28.9+/-3.7 cmH2O in VCV-ZEEP, PCV-ZEEP, and PCV-PEEP, respectively; p<0.05 for PCV-ZEEP v VCV-ZEEP and PCV-PEEP v VCV-ZEEP). PCV-PEEP was associated with an increased PaO2 (230.3+/-69.8 v 189.0+/-54.8 mmHg, p<0.05) and decreased Qs/Qt (33.4%+/-7.3% v 38.4%+/-5.7%, p<0.05) compared with PCV-ZEEP (mean+/-SD). Eighty-eight percent of the patients have benefited from PEEP., Conclusion: During OLV, PCV with a low level of PEEP leads to improved oxygenation with lower airway pressures.

In 1985, Frydman et al. [1985: Clin Genet 27:414-419] described a syndrome characterized by growth failure, microcephaly, persistent hyperplastic primary vitreous (PHPV) with microphthalmia, cleft palate, connective tissue abnormality, mental retardation, and spastic quadriplegia. The syndrome was termed as oculo-palato-cerebral dwarfism. The first patients described were offsprings of a consanguineous couple of Moroccan Jewish descent, suggesting autosomal recessive inheritance. An additional case was reported by Pellegrino et al. [2001: Am J Med Genet 99:200-203] in 2001. The clinical features were milder than the original cases, and there was no consanguinity. We report a third patient with oculo-palato-cerebral syndrome, supporting autosomal recessive inheritance, and a detailed comparison with the previous cases. This article contains supplementary material, which may be viewed at the American Journal of Medical Genetics website at http://www.interscience.wiley.com/jpages/0148-7299/suppmat/index.html., (Copyright 2004 Wiley-Liss, Inc.)

Purpose: To determine the effect of scan repetition during a single visit for improved reproducibility of optic nerve head topographic measurements., Methods: One randomly selected eye of 20 healthy subjects with no systemic or ocular disease was evaluated. Half of the subjects were under 30 years of age and the other half were older than 60 years. Five independent image series, each consisting of 10 newly recorded consecutive images, were obtained for each subject over a period of 10 weeks with a confocal scanning laser ophthalmoscope, the Top SS. Subjects were divided into two groups according to disc area being either smaller or larger than 2 mm2. Reproducibility of the measurements in three parameters (volume below, half depth area and the average depth) were calculated for each set of scans. The coefficient of variation (standard deviation divided by the mean) was taken as the measure of reproducibility. Repeated measures of analysis of variation and independent sample t-test were used for statistical analysis. Statistical significance was set as P < 0.05., Results: Both age groups were found to be equally distributed with respect to sex. There were no significant intergroup differences in keratometry, pupil diameter or refractive error. Increasing the scan repetition per visit up to five improved the reproducibility of the measurements. Further increases in scans per visit reduced the reproducibility. Subjects with larger discs and older age were found to have lower coefficients of variation for topographic measurements., Conclusions: Normal subjects should be examined at least three to four times per visit to have significantly improved reliability of measurements of optic nerve head topography. Factors associated with decreased reproducibility included older age, smaller discs, and more than five scans per visit. Sex, refraction and pupil diameter were shown to have no effect on the reproducibility.

Background: To investigate the effects of topical antiglaucoma drugs on apoptosis rates of conjunctival epithelial cells in vivo., Methods: Specimens were obtained from the bulbar conjunctiva of 30 patients who underwent either cataract or glaucoma surgery. Of these 30 patients, 14 had glaucoma and received topical antiglaucoma drugs. The 16 patients in the control group had neither systemic nor ocular disease except cataract and they did not receive any medications. TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling) method was used to show the apoptosis of the conjunctival epithelial cells., Results: Increased apoptosis rates were detected in specimens of patients who were on topical antiglaucoma therapy (mean +/- SD 0.208 +/- 0.154) when compared with the healthy subjects (mean +/- SD 0.083 +/- 0.102; P = 0.013). The apoptosis rates did not differ according to type, number or duration of drugs., Conclusions: The apoptosis observed in the conjunctival epithelial cells might be due to the preservative benzalkonium chloride in the antiglaucoma medications because the apoptosis rates did not differ in patients using different types of medications.

Aim: To determine the factors affecting the topographic characteristics of the optic nerve head in a normal Turkish population., Methods: A cross-sectional study was performed on the optic nerve head of the right eyes of 613 healthy subjects of both sexes aged 11-77 years using a confocal scanning laser ophthalmoscope. The study population was divided into three groups (<20 years, 20-50 years, and>50 years) to evaluate age-related changes in the optic nerve head topography. A total of 15 variables were determined. Statistical analysis was performed using Student's t-test, anova, Tukey HSD test, linear regression analysis and Pearson's correlation coefficient., Results: Four eyes were excluded from the study due to poor image quality. There were 307 female subjects and 302 male subjects. The mean age of the subjects was 42.1 +/- 15.1 years. The mean optic disc areas were 1.99 +/- 0.45 mm2 and 1.97 +/- 0.41 mm2 for male and female subjects, respectively. The disc area of the subjects ranged between 1.01 and 4.19 mm2. Disc area was found to be associated with all of the optic nerve head variables studied, and was also found to be significantly increased with advancing age (P < 0.05). The only variable that showed a sex-related difference was neuroretinal rim volume, which was found to be higher in female subjects in all cases., Conclusion: Optic disc area was found to be the main determinant of the optic nerve head topography in a normal population. Optic disc area was found to be significantly increased with ageing in a normal population. These acquired changes to the optic disc could suggest stretching of the scleral ring, which may highlight the role of advancing age on the pathogenesis of glaucomatous optic neuropathy.

Statement of Problem: Complete dentures contribute significantly to the facial esthetics of edentulous patients. However, information as to the effect of complete dentures on the natural position of the head is limited., Purpose: The purpose of this pilot study was to evaluate the immediate and 30-day effect of wearing complete dentures on the dynamic natural head position measured during walking., Materials and Methods: The sample consisted of a volunteer group of 16 patients, 8 women and 8 men, who received new complete dentures. The ages of the subjects ranged from 45 to 64 years (mean=52 years). Dynamic measurement of head posture was carried out by a specially constructed inclinometer device. Each subject in turn was fitted with the inclinometer system and instructed to walk in a relaxed manner for 5 minutes. The data, measured as degrees, were stored in a pocket data logger. This procedure was repeated before insertion of dentures (T1), immediately after insertion of dentures (T2), and 30 days after insertion of dentures (T3). Stored dynamic head posture data were transferred to computer for analysis. The means of the measurements were statistically compared with Friedman and following Wilcoxon tests (alpha =.05)., Results: Twelve of 16 (75%) subjects showed an average of 4.6 degrees of cranial extension immediately after insertion of dentures. Six (37.5%) subjects showed an average of 6.4 degrees of cranial flexion, and 8 (50%) subjects showed an average of 5.2 degrees of cranial extension at T3 relative to the T1 measurement. Dynamic head posture measurements of the other 2 subjects remained unchanged. There were significant differences between different measurements of dynamic head posture positions (P<.025). However, only the T1 and T2 measurements were significantly different (P<.015)., Conclusion: The findings indicate that the statistically significant average extension 4.6 degrees in subjects immediately after insertion of complete dentures was not stable after a 30-day evaluation period and did not produce any statistically significant change. The overall effect of wearing dentures was an irregular flexion or extension pattern on dynamic head posture.

One of the effects of rapid maxillary expansion (RME) is a reduction in nighttime bed-wetting. The aim of this prospective study was to investigate the effects of RME on nocturnal enuresis (NE) in children who are liable to psychosocial stress conditions. Eight children (six boys and two girls) who had not responded to different conventional medical treatments were included in the study. The subjects were between eight and 11 years of age with a mean age of nine years five months, and were residents of a government orphanage. All the children wet the bed at least one time every night and previously had been subjected to unsuccessful conventional treatment modalities. Maxillary expansion was performed using a rigid acrylic RME device. Lateral and PA cephalometric films and dental casts were used in the assessment of the dentofacial and nasopharyngeal structures. Data were analyzed using a paired t-test. In seven of the eight children, remarkable improvement was observed in NE after three to six mm RME. At the end of eight months observation, the mean rate of improvement in bed-wetting in the seven successful subjects was 74.2% (57.6-87.5%). The findings also indicated significant changes in the nasomaxillary structures and nasopharyngeal airway dimensions with the use of RME. However, none of the subjects became completely dry, and the disorder is probably multicausal including psychological emotions and tensions. This study demonstrated that RME treatment could cause relief for the enuretic children. However, the long-term success rate is still questionable.

Purpose: The etiopathogenesis of pterygia is controversial. We wished to explore the effects of inflammatory cells and mediators such as T-lymphocyte subpopulations (CD4 and CD8), mast cells, intercellular adhesion molecule-1 (ICAM-1), and HLA-DR receptors on pterygium development., Methods: Immunohistochemical stainings were performed for T-lymphocyte subpopulations, mast cells, ICAM-1, and HLA-DR on sections of pterygium specimens. Nasal bulbar conjunctival specimens of patients undergoing cataract or vitrectomy operations were used for comparision. The mean number of mast cells/mm2 was calculated using an ocular grid, and the difference between the numbers derived from pterygium and from normal conjunctival sections was analyzed statistically using the Mann-Whitney U test. CD4 and CD8 lymphocytes in the epithelial and subepithelial regions, and ICAM-1 and HLA-DR expression on pterygium epithelium were compared qualitatively., Results: Increased CD4 and CD8 lymphocytic infiltration in pterygium sections was observed. Only occasional lymphocytes were detected in normal conjunctival sections. The CD4/CD8 ratio was 0.33 for pterygium epithelium and 1.34 for pterygium substantia propria. Increased HLA-DR and scattered ICAM-1 expression were also detected on pterygium epithelium, but not on the normal conjunctival epithelium. The difference in mast cell numbers between the pterygium and control groups was not statistically significant., Conclusions: The detection of T-lymphocyte infiltration and ICAM-1 and HLA-DR expression in pterygium epithelium strongly supports the suggestion that cellular immunity plays an important role in pterygium formation. Pterygium epithelium also seems to participate actively in the augmentation of this inflammatory process by expressing ICAM-1 and HLA-DR molecules. Mast cells may participate in some stages or subtypes of pterygium during its development.

Sagittal (pitch) and transversal (roll) natural head position (NHP) was measured once in 20 subjects, 18 to 24 years of age, with an inclinometer; the measurements were repeated 2 years later. The method error (reproducibility) after 2 years was 1.1 degrees for sagittal and transversal measurements. The mean change in NHP measurement was -0.3 degrees for both measurements, and the variance was 1.21 degrees (= 1.1(2)).

In this report, the case of a patient who has been treated with a different use of a tooth-borne custom-made mandibular symphyseal distraction device is presented. The difference in the application is that the distal arm of the device was sectioned during the retention phase to allow the possible relapse of displaced condyles to their original positions while the labial segment expansion is being maintained. The effect of this procedure was also evaluated on a geometrical model using measurements from the patient's cast. We conclude that symphyseal distraction is an effective and fast method of correcting orthodontic anomalies. The effect of the procedure on the condyle was only 3 degrees of distolateral rotation as calculated using the geometrical model.

Purpose: To determine the optic nerve head topographic parameters with the least variability in repeat measurements., Methods: We randomly selected and evaluated 1 eye each of 20 healthy subjects, a total of 20 eyes. We used the confocal scanning laser ophthalmoscope (CSLO) for optic nerve head analysis. The disc area and a total of 13 parameters were determined by Top SS. Each subject was examined five times, each time on a different day, during a 2-month period. We obtained a series of five 10 x 10 degrees images for each eye per visit. Three of the five images were randomly selected to create a mean image. Coefficients of variation of each of the 13 variables studied were calculated separately by using those five different optic nerve head topographic measurements., Results: The subjects were 11 women and 9 men. The mean age of the subjects was 30.5 +/- 6.9. The mean optic disc areas were 2.26 +/- 0.39 mm(2) and 1.96 +/- 0.37 mm(2) for the men and the women, respectively (P >.05). The mean coefficient of variation for measurement of the variables was found to range between 1.2% and 9.8%. The variables, cup shape, volume above, average depth, and volume below, were found to yield the best reproducible measurements., Conclusion: The CSLO with its highly reproducible measurements (<10% error) offers a highly objective, safe, and effective method for clinical use in measurements of the topography of the optic nerve head. The subtle differences in the variables, cup shape, volume above, average depth, and volume below, may be of vital importance in the follow-up of those diseases requiring longitudinal monitoring of the optic nerve head, namely ocular hypertension and glaucoma.

Purpose: To compare the retinal nerve fiber layer [RNFL] thickness of the amblyopic eye with that of the normal eye in patients with anisometropic and strabismic amblyopia., Methods: Scanning laser polarimetry was performed with the GDx Nerve Fiber Analyzer (NFA), a scanning laser ophthalmoscope that measures the thickness of the peripapillary RNFL quantitatively and objectively, in vivo, based on the birefringence of the RNFL. Eighteen anisometropic, two strabismic and four combined amblyopic (both anisometropia and strabismus) patients were enrolled in the study. There were 9 male and 15 female patients, age range 7-66 years. Using Student's t-test, 14 GDx parameters in the amblyopic eyes and sound eyes were compared., Results: The GDx parameters showed no significant differences between the two groups [p > 0.5]. The superior average and inferior average values were 79.50 microm and 80.41 microm, respectively, in the amblyopic group, and 80.75 microm and 82.75 microm, respectively, in the healthy eyes. The average thickness did not differ between amblyopic and sound eyes (65.50 microm and 66.45 microm, respectively)., Conclusion: Assessment of RNFL thickness by means of scanning laser polarimetry revealed no difference between the two eyes in patients with unilateral amblyopia.

The influence of hydroxypropyl beta-cyclodextrin (HPbetaCD) on the corneal permeation of pilocarpine nitrate was investigated by an in vitro permeability study using isolated rabbit cornea. Pupillary-response pattern to pilocarpine nitrate with and without HPbetaCD was examined in rabbit eye. Corneal permeation of pilocarpine nitrate was found to be four times higher after adding HPbetaCD into the formulation. The reduction of pupil diameter (miosis) by pilocarpine nitrate was significantly increased as a result of HPbetaCD addition into the simple aqueous solution of the active substance. The highest miotic response was obtained with the formulation prepared in a vehicle of Carbopol 940. It is suggested that ocular bioavailability of pilocarpine nitrate could be improved by the addition of HPbetaCD.

Purpose: To determine the effect of peripapillary chorioretinal atrophy in degenerative myopia on the retinal nerve fibre layer (RNFL) thickness measurements performed by scanning laser polarimetry., Methods: Polarimetric RNFL analysis was done in 41 degenerative myopic eyes of 25 patients with spherical refractive errors between -7.50 and -22.00 D (mean -12.50 D;SD 3.5). Analysis was also performed on 46 eyes of 24 age-matched healthy subjects with spherical refractive errors between -1.00 and +1.00 D (mean -0.25 D; SD 0.50) with GDx Nerve Fiber Analyzer (Version 1.0.12). All of the myopic patients had clinically evident peripapillary chorioretinal atrophy in their fundus examination., Results: In myopic patients most of the GDx parameters were statistically different from the control group (P < 0.05). Although average thickness, ellipse average, number, inferior maximum and inferior average were found to be higher than the healthy subjects,the modulation parameters and the ratio-based parameters were significantly decreased in degenerative myopic patients (P < 0.05). The TSNIT (temporal, superior, nasal, inferior, temporal) graph showed irregular high spikes with loss of the regular double hump pattern, especially in quadrants with large chorioretinal atrophy and visible sclera., Conclusion: Peripapillary chorioretinal atrophy increased retardation values, which might be explained by the high reflectivity of the bare sclera in these areas.

Irradiation of enamel with laser energy changes the physical and chemical characteristics of the enamel surface, and these alterations hold promise for the conditioning of enamel for bonding procedures. This laboratory study examined the influence of laser irradiation of enamel at 2 different power settings with an erbium, chromium: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) hydrokinetic laser system (Millennium System, Biolase Technology, Inc; San Clemente, Calif) on the shear bond strength of orthodontic appliances and compared these with that of acid-etching. The prepared surfaces of 40 noncarious, intact, extracted premolars were exposed to laser energy: 20 teeth at 2-W setting (5.6 J/cm(2)) and 20 teeth at 1-W setting (2.7 J/cm(2)) of the commercial laser unit. Twenty teeth were etched with 37% orthophosphoric acid. Brackets were bonded with an orthodontic no-mix adhesive, and shear bond strength was determined with a universal testing machine. Data were analyzed with Kruskal-Wallis and Mann-Whitney U tests. Etched and restored surfaces of an acid-etched tooth and a 2-W laser-irradiated tooth were examined with scanning electron microscopy (SEM). Laser treatment under 2 W resulted in bond strengths of 7.11 +/- 4.56 megapascals (MPa), which was not significantly different from that of acid etching (8.23 +/- 2.30 MPa). Laser irradiation at 1 W resulted in bond strengths of 5.64 +/- 3.19 MPa, which was significantly different from that of acid etching (P <.05). However, large SD and coefficient of variation values of both laser groups made reliability of this method as an enamel conditioner questionable. Scanning electron microscopy studies of the restored irradiated surfaces showed good surface characteristics, whereas the lased surface was still more irregular than the restored acid-etched sample. Although laser devices are effectively used in some other areas of dentistry, enamel conditioning with an Er,Cr:YSGG laser cannot be considered a successful alternative to the conventional methods of increasing bond strengths to enamel.

Introduction: Sympathetic ophthalmia, a diffuse bilateral granulomatous panuveitis, is a serious potential complication after penetrating eye injury. Many surgeons recommend enucleation within two weeks of trauma to prevent this condition. We retrospectively reviewed the medical records of patients with penetrating ocular injuries who had either evisceration or enucleation to determine the incidence of sympathetic ophthalmia and to evaluate the surgical interventions and their complications. Age at surgery, time after penetrating trauma, surgery technique, follow-up period, ophthalmic examination of the fellow eye, and surgical complications were evaluated., Results: In total, 217 patients were included in the study with a mean follow-up period of 10.3 +/- 6.6 years. The longest time between the trauma and time of surgery was 43 years. Postoperative uveitis was observed in only one patient (0.5%) who had primary repair after injury. Histopathological review did not reveal typical sympathetic ophthalmia. Complications after enucleation were significantly higher than after evisceration., Conclusion: There was no histopathologically supported sympathetic ophthalmia in our series. Sympathetic ophthalmia is very rare even when the injured eye is retained. With this in mind, the first choice of treatment may not be enucleation. Furthermore, evisceration may be the procedure of choice if primary repair cannot be performed or for patients who have panophthalmitis.

Purpose: To evaluate the corneal topography in patients with tilted-disc syndrome to determine the relationship between optic disc dysversion and corneal astigmatism and the pattern of astigmatism in these patients., Methods: The study included 23 eyes of the 13 tilted-disc syndrome patients with spheric refractive errors ranging between +1.00 D and -9.00 D (mean -4.00 +/- 3.4 D) and astigmatic errors ranging between -0.50 and -4.50 D (mean -1.95 +/- 0.93 D). Corneal topography was performed by computer-assisted videokeratoscope topographic modelling system 2 (TMS-2) and incidence of corneal astigmatism, corneal topographic patterns, and mean values of the topographic indices were determined., Results: Corneal topographic analysis showed corneal astigmatism in 22 out of 23 patients with tilted discs. Corneal astigmatism was symmetric bow tie pattern in 10 eyes (45.45%), asymmetric bow tie pattern in 11 eyes (50%) and irregular in 1 eye (4.5%). Among the patients with bow tie pattern group (21 eyes), 14 eyes had with-the-rule astigmatism, 1 eye had against-the-rule astigmatism, and 6 eyes had oblique astigmatism. In 18 eyes, astigmatism was corneal, whereas combined corneal and lenticular in 4 eyes and lenticular in 1 eye., Conclusion: In the majority of tilted-disc cases, ocular astigmatism is mainly corneal. Morphogenetic factors in the development of the tilted disc might possibly influence the corneal development in such a way to result in corneal astigmatism.

A 60-year-old male patient with pseudophakic bullous keratopathy in his right eye underwent corneal transplantation. Graft rejection occurred and the patient was regrafted 1 year later. The postoperative course was complicated with recurrent anterior uveitis attacks. In his right eye, he had a cilium in the posterior chamber at the five o'clock position between the intraocular lens and iris. The cilium was removed and the patient was free of any anterior uveitis or corneal rejection for 18 months. Eyes harboring corneal transplants and suffering frequent rejection, or chronic recurrent anterior uveitis should be examined carefully for the possible presence of foreign bodies.

The purposes of this study were (1) to construct a device to record natural head position and transfer it to the cephalostat, (2) to assess its clinical use, and (3) to evaluate the reproducibility of lateral cephalograms taken with the device. The device, incorporated into a pair of eyeglass frames, included 2 tilt sensors to measure pitch and roll of the head. The natural head positions of 20 subjects were established 10 times by self balance and mirror position, recorded with the device, and reproduced in the cephalostat by using the average of these 10 measurements. Three lateral cephalograms were obtained in this manner at 30-minute intervals. The first 2 films were made with the subject wearing the device to assess the reproducibility of the recorded position in the cephalostat by the inclinometer. During exposure of the third film, the device was not worn, and this film was used to determine the stability of the established position when the inclinometer was removed. The results revealed method errors of 0.6 degrees (SD, 0.9) between the first 2 sets of radiographs with a correlation coefficient of 0.985. Method errors between the first and third and the second and third sets were 0.6 degrees (SD, 0.8) and 0.7 degrees (SD, 1), respectively, with correlation coefficients of 0.989 and 0.982. The reproducibility of the method was high, and the system was clinically practical for both recording and transferring natural head position in cephalometrics. This technique should make it possible to measure and reproduce head position accurately. Minimizing the size of the device, making it radiolucent, and integrating it into the radiographic device will make it more versatile and decrease error.

Objective: To evaluate the effect of visible optic nerve head drusen (ONHD) on retinal nerve fiber layer (RNFL) thickness retardation by using scanning laser polarimetry., Methods: Twenty-three eyes of 13 patients with visible ONHD and 26 eyes of 13 age- and sex-matched control subjects were involved in the study. Ophthalmologic examination, scanning laser polarimetry with nerve fiber analyser (NFA) type II GDX, automated Humphrey visual field testing, and red-free fundus photography were performed. Eyes with ONHD were classified from grade 0 to III according to the amount of visible drusen. Thus, grade 0 discs had no clinically visible ONHD and grade III discs represented the presence of dense drusen., Results: Measurements with NFA of RNFL thickness retardation showed significant decrease in eyes with visible ONHD compared with control eyes (P < 0.05). Although no significant difference was found between grade I and grade II discs regarding NFA measurements, grade III discs had significantly lower values, indicating the greater amount of RNFL loss with higher grade ONHD. Documentation of increased percentage of visual field defects with higher grade drusen was also in accordance with this finding., Conclusions: NFA can quantitatively detect the decrease in retardation of RNFL thickness in eyes with visible ONHD and can be used as an indicator of nerve fiber layer loss in these cases.

Purpose: The aim of this study was to compare the RNFL thickness in eyes with myelinated retinal nerve fibers (MRNF) and age, sex-matched controls using scanning laser polarimetry., Methods: Seventeen patients with MRNF underwent a comprehensive ophthalmological examination including automated visual field testing, and scanning laser polarimetry with Nerve Fiber Analyser (NFA II). Twenty eyes with MRNF from 17 patients were available for the study. Sixteen healthy, age and sex-matched subjects were taken as controls. Retinal nerve fiber thickness measurements of the four sectors (superior, inferior, nasal, temporal) and along the whole circumference of the optic disc were obtained for affected and control eyes, and compared., Results: Inferior average and inferior integral parameters of the NFA revealed significantly thinner RNFL thickness measurements in eyes with inferiorly located MRNF compared to controls., Conclusion: Retinal myelination alters the birefringent property of the RNFL, and results in diminished thickness measurements. Hence, NFA measurements in patients with MRNF may not be reliable.

This study was conducted to determine abnormalities of the GDx Glaucoma Scanning System parameters in patients with tilted discs, in order to set guidelines for the evaluation of glaucomatous damage in this situation. The objective was to determine which GDx parameters displayed the highest level of variation, and which remained unchanged in tilted disc syndrome. RNFA was polarimetrically conducted on 45 eyes from 26 subjects with tilted discs, and 43 normal eyes with Nerve Fiber Analyzer II (Laser Diagnostic Technologies). All parameters except inferior maximum, average thickness, ellipse average, and inferior average displayed a significant difference between the two groups (p < 0.05). Although NFA is useful in glaucoma diagnosis, the majority of the GDx parameters, as shown in our study, are unreliable in tilted disc syndrome in this respect.

The aim of this study was to evaluate the long-term results and the factors influencing the success in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryocystorhinostomy (DCR) and silicone tube intubation (STI). We prospectively investigated 158 patients with lacrimal obstruction in two groups, one of which comprised 108 patients treated primarily with intranasal endoscopic DCR by experienced surgeons and the other comprised 50 patients who were operated on by inexperienced surgeons. In a mean follow-up time of 49 months the surgical success was 94.4% in experienced hands and 58.0% in inexperienced hands. The endoscopic examination of six patients with failure in the first group revealed granulation tissue around the tube in four, atonic sac in one and persistence of bone that was supposed to have been excised in the nasal cavity in one. There were 21 failures out of 50 patients in the second group: granulation tissue in 2 cases, fenestration to the nasolacrimal duct instead of the sac in 6 cases, synechia between the lateral nasal wall and the middle turbinate in 2 cases, bony spicles causing obstruction in 5 cases and fenestration anterior to the sac in 2 cases. In 4 cases no reasons were found for failure, but perhaps the small fenestration and failure to remove the medial half of the membranous sac wall was the reason. DCR and STI can be performed for primary treatment in lacrimal obstruction. There is a learning curve for the operation. False localization of the lacrimal sac, granulation tissue formation around the tubes, retained bony spicles, inadequate removal of the medial wall of the sac and the synechia between the lateral wall and the middle turbinate are the most common causes of failure.

Purpose: To determine tear lactoferrin levels in patients with chronic diffuse meibomitis associated with acne rosacea and to investigate their role in the development and perpetuation of some inflammatory ocular surface complications., Methods: In this non-randomized, controlled trial performed in a tertiary care center, eight patients with biopsy-proven acne rosacea and blepharitis, and ten patients with seborrheic blepharitis not associated with acne rosacea formed the study groups and ten normal patients were used as controls. Schirmer I test results, tear break-up time and radial immunodiffusion (Lactoplate) tests on tear samples of the three groups were compared., Results: Compared to controls, tear lactoferrin concentrations were lower in both the acne rosacea and seborrheic blepharitis groups. However, this decrease was significant in only the seborrheic blepharitis group (p = 0.026). One patient in the acne rosacea group, with the lowest measurement, developed bacterial keratitis., Conclusions: Though within the normal range, tear lactoferrin levels in patients with acne rosacea and seborrheic blepharitis were lower than controls. Low concentrations of lactoferrin may play a role in the ocular surface inflammatory components associated with these diseases.

Contact lens-associated giant papillary conjunctivitis (CL-GPC) caused by mechanical and immune mechanisms is a significant problem resulting in contact lens intolerance and discontinuation of contact lens wear. In the present study, tear fluid leukotriene C4 (LTC4) level was evaluated in soft contact lens wearers with and without CL-GPC using ELISA. Statistical analysis showed no significant difference in tear fluid LTC4 between contact lens wearers without GPC and normal controls (p>0.05), but a significant increase in tear LTC4 level in CL-GPC patients (p<0.05). On the basis of this finding, it might be possible to explain redness, conjunctival edema, increased mucoid secretion, and papillary changes by the effect of LTC4 on eye tissues. Effective treatment of CL-GPC might be possible in the future by employing inhibitors of leukotriene synthesis and action.

Purpose: We performed a prospective study to compare the surface deposits on frequent replacement soft contact lenses with deposits on conventional daily wear soft contact lenses., Methods: We fit two groups of young myopic patients with either conventional daily wear or frequent replacement soft contact lenses. Subjects in both groups wore their lenses on a daily wear basis and used a hydrogen peroxide/catalytic disk based care system. Contact lenses were obtained from patients in the frequent replacement group after 1 month of wear and from the conventional contact lens group after 12 months. Contact lenses from each group were examined with scanning electron microscopy and surface deposits were compared., Results: Frequent replacement lenses were covered with significantly fewer deposits than conventional daily wear soft contact lenses (P = 0.0003). No microorganisms were seen on frequent replacement contact lenses. Bacteria in the form of coccus on two contact lenses were seen in the other group., Conclusions: Surface deposits occur less often on frequent replacement lenses but they cannot be totally prevented. Surface deposit related contact lens complications may be expected to occur less frequently with the use of frequent replacement lenses.

The case of a 36-year-old healthy, asymptomatic man who was monitored for a slowly growing subcutaneous mass under his right inferior orbital rim for more than ten years is presented. The mass was hard, immobile, and nontender. Computed tomography (CT) documented a lytic lesion at the frontal process of the right maxilla. Four years later, magnetic resonance imaging (MRI) of the orbits revealed distinct lesions in the right zygoma, maxillary, and greater wing of the sphenoid bones. These lesions were hypointense with respect to orbital fat on T1-weighted images and hyperintense on T2-weighted series. There was moderate enhancement after contrast agent administration. These findings combined with the clinical features of the patient were suggestive of presumed multiple orbital intraosseous hemangiomas. Differential diagnosis between other osseous tumors of the orbit can be reasonably made based on imaging characteristics.

Purpose: In the etiology of pterygium abnormalities in tear functions have also been emphasized. In this study, tear function tests are evaluated in patients with pterygium., Methods: Schirmer's test 1, tear film break-up time and mucus fern patterns were evaluated in 70 eyes with pterygium and in 70 eyes of the age matched control group. Marginal tear films were also assessed., Results: Tear film break-up time was significantly reduced in the pterygium group. Mucus fern patterns and marginal tear films were found to be markedly abnormal in the eyes with pterygium, however, there was no significant difference in Schirmer's test 1., Conclusion: Tear function tests disclosed disrupted tear film stability which is more likely to be due to the altered mucin. This change may either be the primary factor inducing pterygium formation or reflect an existing pathology in the cells lining the ocular surface.

Purpose: We compared tear leukotriene B4 (LTB4) and leukotriene C4 (LTC4) levels of vernal keratoconjunctivitis (VKC) patients with those of age-matched controls and evaluated the effects of disodium cromoglycate (DCG) 2%, lodoxamide 0.1% and fluorometholone 0.1% on the tear LTB4 and LTC4 levels of the VKC patients., Methods: Thirty VKC patients were divided into three groups and their tear LTB4 and LTC4 levels measured with an enzyme-linked immunoassay technique before and after treatment with either lodoxamide 0.1%, DCG 2% or fluorometholone 0.1%. The results were compared with the tear LTB4 and LTC4 levels of 10 healthy control subjects. During this trial period, clinical scores for signs and symptoms of VKC were also evaluated., Results: In the VKC patients median tear LTB4 and LTC4 levels were 349.0 pg/ml (range 213.3-707.7 pg/ml) and 225.2 pg/ml (range 196.1-241.1 pg/ml) respectively--significantly higher than the control group (p = 0.0065 for LTB4 and p = 0.0003 for LTC4). After treatment, LTB4 levels decreased significantly in all treatment groups when compared with baseline (for the lodoxamide group, p = 0.01; for the DCG group, p = 0.008; for the fluorometholone group, p = 0.045). LTC4 levels were also significantly reduced after treatment in all three treatment groups (for the lodoxamide group, p = 0.0209; for the DCG group, p = 0.0284; for the fluorometholone group, p = 0.0109)., Conclusions: Tear LTB4 and LTC4 levels are significantly higher in VKC patients than controls, which points to a possible role of lipoxygenase pathway products in the pathophysiology of ocular allergic disorders. Lodoxamide 0.1%, DCG 2% and fluorometholone 0.1% were all effective in reducing LTB4 and LTC4 levels in VKC.

In the treatment of the first premolar extraction cases with certain techniques, incisor retraction is realized after canine distalization. In maximum anchorage cases, retraction of anterior segments require more posterior anchorage. This treatment concept is still valid, however, the difficult anchorage control is considered a major drawback. The purpose of this study is to introduce our technique for the "en masse" retraction of maxillary anterior teeth after first premolar extraction and discuss its effects. The technique consists of the application of extraoral traction on canines, followed by banding of maxillary anterior teeth, to form them as a mass. Advantages of our mechanics are as follows: (1) Anterior headgear may have the advantage of retracting anterior teeth with minimum strain on posterior anchorage. (2) The adjustability of the outer bow in relation to the premaxilla's center of resistance, provides effective desired movements. (3) Intrusion and torque control are achieved in the course of anterior segment retraction.

Lens epithelia obtained from 37 patients who had undergone cataract surgery operation were examined by using transmission electron microscope. Their ages varied between 60-79 years and mean age was 70.2 years. Additionally, the lens epithelia of 14 patients, which were obtained in the same way were examined by using scanning electron microscope. Their ages varied between 58-78 years and mean age 70.7 years. In transmission electron microscopy, the normal appearing epithelial cells were intermingled with abnormals and the abnormal cells increased in number and in degree of abnormality with aging. The three dimensional structure of the interdigitating interlocking processes of lens cuboidal cells were visualised by using scanning electron microscope.

The Selçuk type headgear-timer (STHT) is described and tested under laboratory conditions first and then in a controlled patient study. The timing device was compared with real time measurements for 4 months. Accuracy was determined to be absolute (100%). The STHT was determined to be independent of force variables, easy to construct, rugged, and inexpensive. In the clinical test, 10 patients were instructed to wear the extraoral appliance for 16 hours a day. After a 2-month treatment period, the timing mechanisms were introduced to the patients and a subsequent 2-month treatment period was initiated. At the end of the second period, headgear wear was increased 26%. This significant improvement in patient compliance with the STHT timing device, attached to a standard breakaway type headgear, has the likelihood of enhancing treatment results. A foolproof method of assessing actual duration of wear is now available.

Background and Objective: The effectiveness of 0.04% mitomycin-C, either postoperatively for 2 weeks or intraoperatively as a single dose, as an adjunct in the surgical treatment of primary pterygium was evaluated., Patients and Methods: Mitomycin-C was used in addition to the bare sclera technique in 43 eyes with pterygia. The mean follow-up time was 18.5 months for the 24 eyes in the postoperative mitomycin-C group, 10.3 months for the 19 eyes in the intraoperative mitomycin-C group, and 17.3 months for the 17 eyes in the control group (eyes that had undergone surgical excision only)., Results: The recurrence rate was 4.2% with postoperative administration, 5.3% with intraoperative application, and 41.2% in the control group. There was a significant reduction in recurrence rates for both the postoperative and the intraoperative mitomycin-C groups compared with the control group (P = .005 and P = .01, respectively). However, recurrence rates were not statistically different according to the type of application. No serious side effect occurred during the follow-up period., Conclusion: Topical mitomycin-C, either intraoperatively or postoperatively, as an adjunct decreases the recurrence rate of primary pterygium. Intraoperative application seems advantageous because it decreases the symptomatic side effects and restricts the inappropriate use by the patient.

Disposable contact lenses have been proposed as an alternative treatment of giant papillary conjunctivitis (GPC), a common contact lens complication associated with increased tear inflammatory mediators, especially LTC(4). In this study, tear LTC(4) was determined by ELISA in tears from eight patients, fitted with disposable contact lenses for the treatment of manifest GPC. An initial decrease in tear LTC(4) in the first ten days of disposable contact lens wear was later followed by increased LTC(4) in six of eight patients (75%) at the end of the first month of disposable contact lens wear. The results of this study indicate that extended wear disposable contact lenses might have a limited place in GPC treatment, since they do not prevent pathogenic inflammatory mediator response in the long term.