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BACKGROUND: To evaluate the effect of brimonidine tartrate 0.15% ophthalmic solution on pupil size under scotopic condition and upper eyelid position. METHODS: This study comprised 72 eyes of 36 healthy subjects. A single drop of brimonidine tartrate 0.15% ophthalmic solution was instilled in the right eye and artificial tear was instilled in the left eye. Pupil size was measured using an infra-red pupillometer under scotopic condition before and at 30 min, 2, 4, 6, 8 and 10 h after instillation. Measurement of margin reflex distance 1 (MRD1) was performed using a millimetre ruler before and after at 10 min after instillation. RESULTS: The mean age of the subjects was 32.19 ± 11.43 years (range 10–52 years), 17 were female and 19 were male. Before brimonidine instillation, the mean pupil size was 6.09 ± 1.03 mm in the brimonidine eyes and 6.06 ± 1.04 mm in the control eyes. There was a significant decrease in mean pupil size at 30 min (4.45 ± 1.04), 2 h (4.49 ± 1.06), 4 h (4.59 ± 1.06), 6 h (4.89 ± 1.06) and 8 h (5.38 ± 1.02) after instillation compared to before in brimonidine eyes (p

Arslan, Osman Sevki/0000-0001-6359-4799; DOGAN, CEZMI/0000-0002-6305-8176; Mergen, Burak/0000-0002-8132-495X WOS:000493117400001 PubMed ID: 31650789 Objectives: To evaluate the 6-month outcomes of Descemet membrane endothelial keraroplasty (DMEK) in patients with pseudophakic bullous keratopathy (PBK) and Fuchs' endothelial dystrophy (FED) in a single center in Turkey. Materials and Methods: The medical records of patients who underwent DMEK were reviewed retrospectively. Best corrected visual acuity (BCVA), donor corneal endothelial cell density (ECD), donor age, duration in solution after obtaining the donor tissue, and duration after exitus of the donor were evaluated preoperatively and BCVA, ECD, and ECD loss (%) at postoperative 6 months were evaluated postoperatively. Graft detachment, graft failure, and pupillary block were recorded as surgical complications. Patients with cataract and FED underwent combined or staged procedures. Two different graft preparation techniques were utilized: 8 and 9.5 mm. Results: One hundred eyes of 74 patients were included in the study. Fifty-two of the eyes had FED and the remaining 48 had PBK. Mean ECD loss in 6 months was 29.2 +/- 4.4% in the FED group and 29.7 +/- 5% in the PBK group (p = 0.415). Mean BCVA at 6 months was 0.06 +/- 0.05 in the patients with FED and 0.07 +/- 0.05 in the patients with PBK (p=0.378). Mean ECD loss in 6 months was 28.3 +/- 5.3% in the 8 mm group vs. 29.7 +/- 4.5% in the 9.5 mm group (p=0.255), and 28.5 +/- 5.6% in the combined group vs. 29.8 +/- 2.9% in the staged grout (p = 0 .279). Conclusion: Different graft preparation techniques can be utilized with similar efficiency for DMEK surgery. A staged or combined approach can be used efficiently in the management of patients with FED and cataract. Our results are promising both for PBK and FED patients.

Objective: Investigation of the effect of the globe injury site and the globe injury type on the postoperative results in the patients with a relatively softer open globe injury (OGI) was aimed. Methods: Medical records of the patients with OGI due to blunt or penetrating trauma were analyzed retrospectively. The patient cohort was divided into laceration and rupture groups. The location of injury was evaluated in zones (I-II-III). Presence and type of the complication (cataract, retinal detachment, etc.) were evaluated. Final best-corrected visual acuity (BCVA) was evaluated as the primary outcome measure. Results: Seventy eyes of 70 patients with OGI were included in the study. While 58 eyes (82.9%) had lacerations, 12 eyes (17.1%) had ruptures. Among the 52 patients with lacerations for whom there was an available BCVA data, 13 (25%) patients showed no change, 32 (61.5%) showed an increase, and 7 (13.5%) showed a decrease in BCVA. Among the 11 patients with ruptures, 2 (18.2%) patients showed no change and 9 (81.8%) showed an increase in BCVA. A complication was observed in 23 (44.2%) patients with laceration and 4 (33.3%) patients with rupture (p: 0.474). No difference was detected in terms of the complication rate between the patients having a different zone of injury. However, final BCVA was lower in those with Zone III injury in comparison to those with Zone II injury (p: 0.028). Conclusion: Although the injury type was thought to have an effect on the final BCVA of the patients with OGI, no difference was detected between the patients with laceration and rupture. Zone III injuries resulted in lower preoperative BCVA values. However, despite a significant difference between Zone II and III injuries, no significant difference was observed in terms of the final BCVA between the patients with Zone I and those with Zone III injuries.

Purpose The purpose of this study was to evaluate the in vitro antifungal effects of n-butyl-2-cyanoacrylate (nB2CA; Histoacryl Blue; B. Braun, Melsungen, Germany) against a variety of different fungal species. Methods Inocula taken from suspensions prepared with Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger, Aspergillus ochraceus, Aspergillus oryzae, Fusarium solanii, Fusarium oxysporum, Trichoderma spp., Rhizomucor spp., Scedosporium apiospermum, Penicillium commune, Phoma glomerata, and Chrysosporium spp. molds and Candida albicans, Candida glabrata, Candida parapsilosis, Candida kruzei, Candida dubliniensis, Candida tropicalis, Candida kefyr, and Trichosporon asahii yeasts were spread on the surface of RPMI1640 agar media. Then, 50 μL of nB2CA was dropped on the surface of these media and they were incubated at 35°C. Observation of a clear zone of inhibition around the nB2CA was regarded as an indicator of the susceptibility of the fungi to nB2CA, and the absence of this zone was interpreted as an indicator of nonsusceptibility. The inhibition zone diameter was measured across the largest clear zone. Results A zone of inhibition was observed around nB2CA for all of the yeast and mold species except A. flavus, A. oryzae, and Chrysosporium spp. Among molds, the largest zone of inhibition was observed with P. glomerata (25.7 ± 0.6 mm), whereas among yeasts, the largest zone of inhibition was observed with C. kruzei (19.3 ± 1.5 mm). Conclusions nB2CA has shown antifungal activity against 18 different mold and yeast species, but not against A. flavus, A. oryzae, and Chrysosporium spp. molds.

DOGAN, CEZMI/0000-0002-6305-8176; Arslan, Osman Sevki/0000-0001-6359-4799 WOS:000466509800003 PubMed ID: 31055888 Objectives: To evaluate the outcomes of penetrating keratoplasty performed for therapeutic and tectonic purposes in eyes with perforated infectious corneal ulcer. Materials and Methods: This retrospective study included 43 eyes of 43 patients who developed perforated infectious corneal ulcer of various etiological causes between June 2008 and January 2018. The patients were evaluated based on age and sex, follow-up time, presence of corneal perforation, pre- and postoperative visual acuity, postoperative graft transparency, complications, and infection recurrence. Results: The mean age of the 43 patients was 52.9 +/- 13.8 years. The mean follow-up rime was 2.7 +/- 1.3 years. Preoperatively, the visual acuity of the eyes was at the level of hand motions or counting fingers; postoperative best corrected visual acuity ranged from hand motions to 0.7. Postoperative complications included hyphema in 8 patients (18.6%), elevated intraocular pressure in 14 (32.5%), posterior synechiae in 18 (41.8%), and cataract in 22 patients (51%). Therapeutic and tectonic success was achieved in 42 patients (97.6%). Postoperative graft transparency was observed in 35 patients (83.3%) within the 1-year follow-up period and in 27 patients (7 1.0%) at 2 years. Among 27 patients with graft transparency, 23 had bacterial and 4 had viral etiologies (p=0.52); 16 patients had perforations smaller than 1 mm and 11 had perforations 1-3 mm in size (p=0.2). Conclusion: Therapeutic-tectonic keratoplasty for perforated infectious corneal ulcer successfully restored globe integrity in 97.6% of cases. The rate of graft transparency was 71.0% at 2 years, with no effect of etiological agent or perforation size.

Purpose To determine the effects of intravitreally injected aspirin on normal ocular tissues. Methods Six eyes of 3 rabbits as a control group, 18 eyes of 9 albino rabbits which were injected aspirin intravitreally were studied. In the control group, the same volume of balanced salt solution (BSS) as in drug groups were injected. Clinical examination methods including biomicroscopy, indirect ophthalmoscopy, and Schiotz tonometry, electrophysiological test including ERG, and histopathological examination including light microscopy were used to evaluate the ocular effects after drug injections. All the study tests were performed before the injections and 1 week, 1 month, and 3 months after the injections as well. Results No significant toxicity was determined after injection in terms of the clinical examination methods in all eyes. Cataracts were observed in 27.7% (5/18) of the eyes in the study group. All cataracts in 5 eyes disappeared at the end of three months. In tonometry, no value out of the normal range of rabbits (17.5 ± 3.1 mmHg) was observed. No toxicity sign was observed at electrophysiological and histopathological evaluations. Conclusion After intravitreal injection of aspirin, no significant toxicity sign was observed other than a reversible cataract. Thus, intravitreal aspirin injections may be an additional or alternative treatment option for several anterior or posterior segment ocular diseases in addition to their topical utilization.

Objectives To compare the changes in the corneal endothelial cells of both the patients with keratoconus who use rigid gas-permeable (RGP) contact lens and who do not use any contact lens with healthy population. Methods Thirty-three patients with keratoconus who use RGP contact lenses (group 1), 20 patients with keratoconus who do not use any contact lens (group 2), and 40 healthy controls were included in the study. Changes in the corneal endothelial cells of all patients were evaluated using a noncontact specular microscope. Endothelial cell density (ECD), coefficient of variability (CV), hexagonal cell percentage (%HEX), and central corneal thickness (CCT) of the patients were evaluated in the study. Results In the groups 1, 2, and 3, the mean ECD was 2,420.8±247, 2,579.5±240, and 2,589.5±271 cells/mm, the mean CV was 357±9, 34±7, and 34±6, the mean %HEX was 54.3±13, 59.1±14, and 57.4±10, and the mean CCT was 508±33, 504±43, and 561±34 μm, respectively. There was no significant difference between the groups in terms of ECD, CV, and %HEX. Although significant differences between the groups 1 to 3 and groups 2 to 3 in terms of CCT were detected (P=0.001 and P=0.004, respectively), no significant difference was observed between the groups 1 and 2. Conclusions Although significant difference was found between the groups 1 to 2 and normal population in terms of CCT, no difference was detected between all the groups in terms of the other parameters. In this study, we report that long-term use of RGP contact lens in patients with keratoconus had no effect on the corneal endothelial cells.

Development of endophthalmitis during cataract surgery is one of the most severe complications and it may also result in blindness and globe loss. In this retrospective study, patients who had undergone penetrating keratoplasty and for whom phacoemulsification surgery was performed due to cataract and an intracameral ophthalmic cefuroxime solution (Aprokam®) was administered for prophylaxis were evaluated in comparison with patients with cataract without keratoplasty. There was no significant effect of the prophylactic intracameral use of ophthalmic cefuroxime solution (Aprokam®) on the endothelial cells which was used in patients with keratoplasty for whom cataract surgery was performed. Background: Development of endophthalmitis during cataract surgery is one of the most severe complications and it may also result in blindness and globe loss.Aims: To evaluate the effect of an ophthalmic cefuroxime solution (Aprokam®) that is prophylactically used in phacoemulsification surgery performed due to cataract that eventually occurs in patients with or without penetrating keratoplasty.Study Design: Case-control study.Methods: In this retrospective study, patients who had undergone penetrating keratoplasty and for whom phacoemulsification surgery was performed due to cataract and an intracameral ophthalmic cefuroxime solution (Aprokam®) was administered for prophylaxis were evaluated in comparison with patients with cataract without keratoplasty. The following parameters were evaluated: postoperative anterior chamber reaction, intraocular pressure, best corrected visual acuity, corneal endothelial cell density, and central corneal thickness alterations.Results: A total of 42 patients (18 males, 24 females) with keratoplasty and 42 patients (17 males, 25 females) without keratoplasty were included in this study. An increase in visual acuity was observed in all the patients after cataract surgery (p

Background Pediatric cataract surgery differs substantially from adult cataract surgery. Numerous studies have focused on reducing the development of postoperative complications. Aims To compare two intraocular lens implantation techniques used in pediatric cataract surgery in terms of postoperative complications. Study design Case-control study. Methods Patients who underwent pediatric cataract surgery and intraocular lens implantation between 2008 and 2016 were evaluated in this retrospective study. Patients aged 3-15 years with unilateral or bilateral cataract and without corneal pathology were included in the study. The patients were categorized into the following two groups: those who underwent posterior capsulorhexis and anterior vitrectomy using in-the-bag intraocular lens implantation (group 1) and those who underwent posterior capsulorhexis and intraocular lens implantation with the optic fixed behind the posterior capsulorhexis (group 2). Rates of postoperative visual axis opacification and complications (glaucoma, posterior synechiae, uveitic reaction, and intraocular lens decentration) were evaluated in these groups. The implanted intraocular lenses were either monoblock (AcrySof SN60AT intraocular lens), triple-piece (AcrySof MA60BM intraocular lens) foldable hydrophobic acrylic lenses, or multifocal lenses (AcrySof IQ ReSTOR). Results This retrospective study included 52 eyes of 37 patients. Group 1 comprised 26 eyes of 20 patients and group 2 comprised 26 eyes of 17 patients. During the follow-up, visual axis opacification was observed in two patients in group 1 but no patients in group 2. Regarding postoperative complications, there was no uveitic reaction, posterior synechiae, or intraocular lens decentration in either group. There was no significant difference between the groups in terms of the postoperative complications (p>0.05). Conclusion There was no significant difference between in-the-bag intraocular lens implantation after posterior capsulorhexis and intraocular lens optic capture through posterior capsulorhexis in terms of the complications.

Aim Orbital tissue infections are common infections of childhood that can lead to severe complications. Herein, we aimed to evaluate the etiologic factors, diagnosis, follow-up, and treatment procedures in pediatric patients with orbital infections. Material and methods This study was performed retrospectively between January 2014 and December 2015 in Cerrahpasa Medical Faculty Pediatric Infectious Disease Unit. Patients were studied for age, ophthalmologic examination features, laboratory and radiology results, treatment modalities, and the response to these treatments. Results Thirty-six patients (21 males, 15 females) with an average age of 71.43±42.24 months (5-168 months) participated in the study in the two-year period. Thirty-two patients (88.9%) had preseptal cellulitis, and four (11.9%) had orbital cellulitis. All patients had eyelid hyperemia, edema, and ocular pain, with chemosis in seven and proptosis in four cases. Twenty-five patients were admitted with fever. All cases were unilateral and 44.4% occurred secondary to paranasal sinusitis. All cases were treated with intravenous cefazolin-amikacin. The mean of duration of hospitalization was 12.02±8.75 days (range, 3-28 days) and the duration of parental antibiotics was 12.83±8.18 days (range, 7-21 days). All patients recovered without any vision loss, only one patient experienced subdural empyema complicating preseptal cellulitis. Conclusions Most orbital tissue infections occur secondary to paranasal sinusitis in childhood. Orbital tissue infections can be complicated by brain abscess, cavernous sinus thrombophlebitis, and vision loss. Early diagnosis and proper antibiotic treatment are essential to prevent these life-threatening complications.

Objectives To evaluate the effect of corneal subepithelial infiltrates (SEIs) on tear film function and best-corrected visual acuity (BCVA) after persistent epidemic keratoconjunctivitis (EKC) and to compare the findings with controls. Methods In this prospective, cross-sectional study, 38 patients with EKC and 42 healthy volunteers were enrolled. While patients with SEIs after EKC made up groups 1a (first involved eye) and 1b (second involved eye), healthy controls made up group 2. Best-corrected visual acuity, corneal subepithelial infiltrate scoring (CSIS), Fantes score, tear breakup time (TBUT), Schirmer test, and ocular surface disease index (OSDI) scores were measured. The Oxford grading system was used to score corneal staining. Results The mean Fantes score was 1.8±0.8 for group 1a and 1.3±1.1 for group 1b (P=0.03). The mean CSIS was 2.9±1.3 for group 1a and 1.9±1.7 for group 1b (P=0.005). But there was no significant difference in terms of the mean BCVA, TBUT, Schirmer, OSDI, and Oxford grading (P=0.66, 0.9, 0.9, 0.9, and 1.0, respectively) between group 1a and group 1b. The mean BCVA, TBUT, Schirmer, and OSDI values were worse in group 1a and group 1b in comparison to group 2 (P=0.001). Conclusions We showed that the first involved eyes of patients with SEIs may be affected more significantly, but this difference may not have a clinical reflection on the difference in tear film functions between two eyes. However, compared with the healthy eyes, tear film function and BCVA were equally compromised in both eyes of the patients with SEIs irrelevant to the involved eye.

Aim This study aimed to investigate the effect of scleral lens (SL) use on conjunctival microbiota. Method A total of 26 eyes of 26 patients using an SL and 25 eyes of 25 healthy controls were included in the study. The samples were obtained from the lower fornices of the eyes using sterile swabs. For the bacteriological examination, a bacterial culture was obtained by inoculating the samples on chocolate agar, blood agar, MacConkey agar, and fluid thioglycollate medium. After 24–48 h of incubation at 37 0C, the growth of different colonies of bacteria was identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (Bruker MALDI Biotyper). Results The mean age of the study group was 41.6 ± 19.1 years (18–65); the mean age of the control group was 40 ± 6 (21–62) (p = 0.69). There were 10 male patients and 16 female patients in the study group and 9 male patients and 16 female patients in the control group (p = 0.86). The mean duration of SL use was 13.7 ± 13.4 months (1–42 months). No bacterial growth was observed in 17 (65.4 %) of the 26 eyes in the SL group and 5 (20 %) of the 25 eyes in the control group (p = 0.001). The most commonly observed microorganisms were Staphylococcus epidermidis (S.epidermidis) and Staphylococcus aureus (S.aureus) in both groups. Conclusion SL users were found to have a higher rate of culture negativity in comparison to the healthy controls, suggesting that SLs have a significant effect on conjunctival microbiota.

To evaluate accumulation patterns of deposits in retinal layers of type B Niemann–Pick patients by multimodal imaging. Seven patients with type B Niemann–Pick disease were included in this study. All participants underwent a complete ophthalmologic evaluation, high-resolution digital colour imaging, spectral-domain optical coherence tomography, blue light fundus autofluorescence and optical coherence tomography angiography (OCTA). We demonstrated different accumulation patterns in the retinal ganglion cell layer, the retinal nerve fibre layer and the subfoveolar region by multimodal imaging. Local retinal capillary nonflow areas in the superficial plexus, increased vascular tortuosity and deformed foveal avascular areas were shown in OCTA scans. Multimodal imaging including OCTA is a useful technique for the identification of different types of accumulation patterns, diagnosis and follow-up of type B Niemann–Pick patients.

The purpose of this study was to investigate the efficacy and safety of the Toris K silicone hydrogel contact lens (SwissLens; Prilly, Switzerland) in keratoconus patients. A database with information on 50 keratoconus patients (64 eyes) fitted with Toris K soft contact lenses over a 2-year period was retrospectively reviewed. Demographic data, prefitting refraction, the reason for choosing the Toris K soft contact lens, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), best-corrected visual acuity with a rigid gas permeable lens (BCVA RGP), best-corrected visual acuity with the Toris K lens (BCVA Toris K), and complications were evaluated. The mean age ± standard deviation at the time of fitting was 27.92 ± 9.86 years. The mean spherical refractive power was -4.62 ± 6.53 dioptres, and the mean cylinder was -3.78 ± 2.43 dioptres. The most common reason for using Toris K soft contact lenses was an inability to fit the patient with a RGP contact lens. There was a statistically significant difference between UCVA and BCVA Toris K (p = 0.0001), as well as between BSCVA and BCVA Toris K (p = 0.0001). However, there was no statistically significant difference between BCVA Toris K and BCVA RGP (p = 0.20). Superficial punctate keratitis and giant papillary conjunctivitis were the most common complications. The Toris K contact lens is a viable alternative for the optical management of all grades of keratoconus. The Toris K soft contact lens is a promising alternative for the visual rehabilitation of keratoconus patients who cannot tolerate RGP lenses or achieve a good fit.

Background We hypothesized that there may be changes in sensory integration pathways in patients with dry eye. To confront this issue, we analyzed blink reflex (BR), prepulse modulation (PPM) of BR, and excitability recovery of BR to paired stimuli in 17 experimental subjects with dry eye syndrome. Method We included 17 experimental subjects, 8 with primary and 9 with secondary, dry eye syndrome. We also examined a control group of 14 age and gender matched control subjects. After clinical evaluation, we recorded BR, PPM of BR (at 50 and 100 ms intervals) and BR percentage recovery to paired stimulation (at 300 and 500 ms intervals). Results None of the patients had any spasm activity. Experimental subjects had significantly larger R2 and R2c AUCs, significantly greater excitability recovery at 300 ms interval and significantly reduced R2 and R2c prepulse inhibition, in comparison to control subjects. Experimental subjects with primary dry eye syndrome had higher number of spontaneous blinks than experimental subjects with secondary dry eye syndrome (54.0 ± 10.3 for primary dry eye and 43.5 ± 13.3 secondary dry eye). Conclusion Our results are compatible with increased excitability and abnormalities in sensorimotor integration in blink reflex circuits of patients with dry eye. This suggests the development of adaptive changes in brainstem synaptic activity, aimed at facilitation of blinking in the context of increased sensory input from corneal irritation.

Background We hypothesized that there may be adaptive changes in the central pathways in patients with dry eye. To delineate this issue, we aimed to analyze blink reflex (BR), prepulse inhibition (PPI) of BR, recovery excitability of BR (BR-RC), and somatosensory temporal discrimination threshold (STDT). Method We included 17 patients with dry eye between September 2018 and November 2018. We also formed a control group composed of 14 healthy subjects with similar age and gender. After clinical evaluation, we recorded BR, PPI of BR (with 50 and 100 ms intervals), BR-RC (300 and 500 ms intervals) and we determined STDT over second finger. Results None of the patients had any spasm activity. The disease duration was between 2 and 15 years. There was a R2-PPI deficit at each interval in the patient group compared to healthy subjects. The recovery ratios at 500 ms were higher in patients compared to healthy subjects. STDT was abnormally high in patients than healthy subjects (p = 0.000) despite the similar sensory threshold in both groups. Discussion Although the cohort in this study did not have any involuntary spasms, they exhibited inhibitory deficit, increased recovery excitability and abnormal STDT similar to that found in blepharospasm. Most of the patients in this cohort have been in follow-up for a long period and they did not develop any spasThus, we suggest patients with dry eye exhibit central adaptive changes.

Aim: To compare of the affected eyes of the patients with unilateral herpetic keratitis with their fellow eyes and the healthy controls in terms of ocular surface parameters and corneal sensation.Materials and Methods: Both eyes of the consecutive patients with a PCR-proven diagnosis of unilateral chronic herpetic epithelial keratitis and the left eyes of age- and gender-matched healthy controls were included in the study. Schirmer’s test, tear break-up time (TBUT), corneal sensation, and tear osmolarity were investigated in all of the patients. Results: Forty-two eyes of 21 patients with unilateral herpetic keratitis and twenty-one eyes of 21 healthy controls who had no ocular pathology were included in the study. While the mean tear osmolarity of the eyes with herpetic keratitis was 317.3±15.6 mOsm/L, it was 313.2±16.1 mOsm/L for the fellow eyes, and 302.6±11.9 mOsm/L for the healthy eyes (p=0.002). Both herpetic eyes and fellow eyes had significantly higher tear osmolarity and lower TBUT values in comparison to the healthy controls (osmolarity: p=0.002 and p=0.03, and TBUT: p0.001 and p=0.021, respectively). While there was no significant difference between the fellow eyes and healthy eyes in terms of central and peripheral corneal sensation (p=0.4 and p=0.09, respectively), herpetic eyes had lower central and peripheral corneal sensation in comparison to the fellow eyes and healthy controls.Conclusion: This study showed that both the affected and fellow eyes of the patients with unilateral herpetic epithelial keratitis are affected in terms of dry eye without any significant loss in the corneal sensation of the fellow eye.