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Purpose: We aimed to compare the neuroprotective effects of brimonidine tartrate (BRT) and melatonin (MEL) on retinal ganglion cells (RGCs) in a rat glaucoma model. Methods: Thirty-six adult Wistar albino rats were allocated into six groups: control (C), glaucoma (G), BRT, MEL, G + BRT and G + MEL. After establishing the glaucoma model, intraocular pressure (IOP) of all animals measured at day 4 and day 30 was compared statistically with day 0 and day 4, respectively. Prior to sacrification at day 30 for histological evaluation and TUNEL analysis, retrograde labeling of non-apoptotic RGCs with 3% Fluorogold was performed and RGCs were evaluated under fluorescein microscope. Results: IOP measurements at day 4 were significantly higher than basal measurements in all glaucoma groups. BRT alone induced a time-dependent decrease in IOP (p

¦ BACKGROUND AND OBJECTIVE: To examine the exact position of implanted Keraring (Mediphacos, Belo Horizonte, Brazil) segments by high-resolution anterior segment optical coherence tomography (AS-OCT). ¦ PATIENTS AND METHODS: This study included 17 eyes of 13 patients with keratoconus who underwent uneventful intracorneal ring segment implantation with the aid of femtosecond laser. Eyes were evaluated by AS-OCT at the third postoperative month. Distance from the apex of the triangular crosssection of the ring segment to the anterior corneal surface and distances from two basal corners to the posterior corneal surface were measured. ¦ RESULTS: Distance from apex to anterior corneal surface (263.1 ± 42.9 µm) was significantly smaller than target depth calculated intraoperatively (356.9 ± 35.7 µm, P < .001). Distance between outer basal corner and posterior corneal surface was significantly greater than distance between inner basal corner and posterior corneal surface. ¦ CONCLUSION: High-resolution AS-OCT is a rapid, convenient, and valuable technique in the follow-up of patients with implanted Keraring segments that may be helpful in predicting ring-related complications. Copyright © SLACK Incorporated.

Purpose: To analyze the visual and refractive outcomes of laser in situ keratomileusis (LASIK) after deep anterior lamellar keratoplasty (DALK) for keratoconus. Setting: Haydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey. Design: Cohort study. Methods: Patients with compound myopic astigmatism after DALK and a spherical equivalent (SE) between -2.50 diopters (D) and -8.00 D had LASIK as a single-step procedure, correcting the manifest refraction error. The visual and refractive results at 1 month, 3 months, and the last follow-up were compared with preoperative values. Results: The mean follow-up was 11.17 months ± 3.61 (SD). The mean manifest refraction SE (MRSE) and autorefractometer measurements and the autokeratorefractometer and corneal topography keratometry readings decreased significantly from preoperatively to 1 month postoperatively (P.05). Preoperatively, the mean uncorrected (UDVA) and corrected (CDVA) distance visual acuities were 0.21 ± 0.08 and 0.73 ± 0.08, respectively; postoperatively, the means were 0.73 ± 0.10 and 0.98 ± 0.05, respectively. All eyes achieved a postoperative UDVA better than 0.5. No eye lost CDVA lines. The safety index was 1.34. The mean MRSE was -5.18 ± 1.74 D preoperatively and -1.05 ± 0.64 D postoperatively (P

Purpose: To assess the corneal biomechanical properties of patients with pseudoexfoliation syndrome (PEX syndrome). Methods: Fifty-two eyes of 52 patients (27 unilateral and 25 bilateral) and 42 eyes of 42 age-matched control subjects were enrolled in the study. Metrics of corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with the ocular response analyzer (ORA). The ORA also determined the values of Goldmann-correlated intraocular pressure and corneal-compensated intraocular pressure. Central corneal thickness (CCT) was measured by the ORA integrated handheld ultrasonic pachymeter. The values recorded by the ORA were compared between eyes with PEX syndrome and those without PEX syndrome. Eyes with unilateral PEX syndrome and fellow eyes without PEX syndrome were also compared. Results: The mean CH and CRF of all eyes with PEX syndrome were significantly lower than those of control eyes (P < 0.05). Neither corneal-compensated intraocular pressure nor Goldmann-correlated intraocular pressure showed a statistically significant difference in both the groups. Mean CCT values also did not show significant difference. Comparison of the unilateral eyes with PEX syndrome with the apparently normal fellow eyes revealed no significant difference between the mean CCT, mean CH, and mean CRF values (P > 0.05). However, the mean corneal-compensated intraocular pressure and Goldmann-correlated intraocular pressure were relatively higher in the PEX syndrome eye (P < 0.05). There was no significant difference between the mean CCT values of these groups (P > 0.05). Conclusions: The CH and CRF decrease in both unilateral and bilateral PEX syndrome suggested that PEX syndrome has a weakening effect on corneal biomechanical properties. Moreover, in subjects with clinically unilateral PEX syndrome, these properties were closer to eyes with PEX syndrome than to normal control eyes. Copyright © 2011 by Lippincott Williams & Wilkins.

¦ BACKGROUND AND OBJECTIVE: This study examined the repeatability of and agreements between central corneal thickness measurements obtained by four different non-contact pachymetry devices. ¦ PATIENTS AND METHODS: Seventy-eight eyes of 39 subjects were included. Central corneal thickness of each eye was measured by Visante optical coherence tomography (OCT) (Carl Zeiss Meditec Inc., Dublin, CA), Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany), Orbscan IIz topography (Bausch & Lomb Surgical Inc., San Dimas, CA), and slit-lamp OCT (SL-OCT) (Heidelberg Engineering GmbH, Heidelberg, Germany). Inter-device agreements and correlations and repeatability of each device were examined. ¦ RESULTS: All measurement methods correlated well with each other with a correlation coefficient greater than 0.90 and P value of less than .001 for all comparisons. However, Pentacam overestimated central corneal thickness: 546.7 ± 38.2, 535.5 ± 42.7, 531.7 ±37.6, and 531.2 ± 36.0 µ m for Pentacam, Orbscan IIz, Visante OCT, and SL-OCT, respectively (P < .001 for all comparisons versus Pentacam). Despite good correlation, magnitude of differences was high and this bias was proportional (ie, not constant across a range of corneal thickness values) for the following pairs: Orbscan versus Visante OCT, Orbscan versus SL-OCT, and Orbscan versus Pentacam (P < .001 for all comparisons). ¦ CONCLUSION: Although measurements obtained by various non-contact methods correlate well, numerical agreement of the results may not be sufficient for their interchangeable use in clinical practice. Copyright © SLACK Incorporated.

Purpose: To compare phacoemulsification-related endothelial cell loss in eyes with previous penetrating keratoplasty (PKP), previous deep anterior lamellar keratoplasty (DALK), or no previous corneal surgery. Setting: Ophthalmology Clinic, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey. Design: Comparative case series. Methods: Eyes with previous PKP (Group 1), previous DALK (Group 2), or no previous ocular surgery (Group 3) had extracapsular cataract extraction by phacoemulsification. The endothelial cell count was evaluated 1, 3, 6, and 12 months after cataract surgery. Results: Group 1 comprised 16 eyes and Group 2 and Group 3, 20 eyes each. The endothelial cell density (ECD) decreased progressively throughout the follow-up in all groups (P.05). Conclusions: Eyes with previous PKP had significantly greater endothelial cell loss than eyes with previous DALK or no previous surgery. Preservation of the patient's endothelium seems to be an advantage of DALK in terms of increasing corneal safety in future intraocular surgery. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2011 ASCRS and ESCRS.

¦ BACKGROUND AND OBJECTIVE: To investigate the efficacy of anterior segment optical coherence tomography (AS-OCT) for calculating flap thickness in femtosecond laser-assisted laser in situ keratomileusis. ¦ PATIENTS AND METHODS: Fifty-one eyes of 26 patients with myopia and myopic astigmatism were included in this prospective study. High-resolution corneal images were evaluated at 1 week and 1 month postoperatively. Images along the horizontal meridian were measured with the flap tool at seven points. ¦ RESULT: Measurements at vertex and at 1 mm nasally and temporally from the vertex were indistinct but easily defined. Although statistically not significant, flaps were found to be thinner in the central cornea and thicker in the periphery (P > .05). ¦ CONCLUSION: AS-OCT provides detailed high-resolution images for quantitative evaluation of the flap-stroma relationship, but it may not be precise in the central 2-mm area of the cornea. Despite this, AS-OCT is an imaging tool with significant utility. Copyright © SLACK Incorporated.

Pulmonary department of a medical academy in Ankara, Turkey.Neopterin is a marker of cell-mediated immunity, and it has been demonstrated that neopterin levels of various body fluids could be elevated in tuberculosis. We aimed to investigate diagnostic values of serum, pleural fluid and urine neopterin measurements in tuberculous pleurisy (TP).Serum, pleural fluid and urine neopterin levels were measured in 34 patients with TP and in 29 patients with pleural effusion of non-tuberculous origin as controls.Neopterin levels in serum, pleural fluid and urine (38.28 +/- 14.18 nmol/l, 38.97 +/- 14.18 nmol/l and 759.15 +/- 622.74 micromol/mol, respectively) were significantly higher in patients with TP than those with non-tuberculous pleural effusion (22.57 +/- 6.02 nmol/l, 21.88 +/- 6.90 nmol/l and 343.10 +/- 233.65 micromol/mol, respectively). Pleural fluid neopterinor =30 mol/l gave the best diagnostic yield, with 85% sensitivity, 93% specificity, 94% positive predictive value, 84% negative predictive value and 89% diagnostic accuracy, although it is not superior to pleural fluid adenosine deaminase determination.We have suggested that elevated serum, pleural fluid and urinary neopterin levels in TP with respect to pleural effusions of non-tuberculous origin may reflect activation of cell-mediated immunity and that pleural fluid neopterin measurement may be of value in the differential diagnosis of TP.

UNLABELLED To assess the visual and refractive results of excimer laser photorefractive keratectomy (PRK) in myopic astigmatism. METHODS Excimer laser PRK was performed using an Aesculap Meditec MEL 60 laser in 46 myopic astigmatic eyes. Preoperative corneal astigmatism was -1.50 D. (+/- 0.50) in 7 eyes (15.2%); -2.50 D. (+/- 0.50 in 14 eyes (30.5%); -3.50 D. (+/- 0.50) in 13 eyes (28.3%); -4.50 D. (+/- 0.50) in 8 eyes (17.4%); and -5.50 D. (+/- 0.50) in 4 eyes (8.6%). Mean preoperative cylinder was -3.50 D. (+/- 2.50). Mean preoperative sphere was -4.50 D. (+/- 2.25). Pre and post-operative visual acuity, refraction, keratometer readings, corneal topography, intraocular pressure, and slit lamp findings were recorded. RESULTS By one year of follow-up, postoperative cylinder was between +0.50 and -0.50 D. in 31 eyes (67.4%); between -0.50 and -1.50 D. in 11 eyes (23.9%); between -1.50 and -2.50 D. in 4 eyes (8.7%). Mean post-operative cylinder was -1.21 D. (+/- 1.70). Mean postoperative sphere was -1.09 D. (+/- 1.25). Myopic and astigmatic improvement was achieved in each patient (100%). Topography analysis showed 69.4% were within 0.5 mm, 96.8% within 1 mm, 97.8% within 1.5 mm of centration; 55% of the patients achieved uncorrected visual acuity of 10/10 (Snellen). One patient (2.2%) lost one line of best corrected vision due to decentration and change of axis. CONCLUSION These preliminary results of myopic astigmatic excimer laser PRK procedures compare favorably in efficiency and safety with reports of PRK for myopia.

Purpose: To compare the inhibitory effects of dovitinib and bevacizumab for treatment of corneal neovascularization (CNV). Methods: Thirty-nine adult female Sprague Dawley rats weighing 180 to 250 g were used. CNV was induced by silver nitrate in the right eye of each rat. After the chemical burn, the animals were randomized into 5 groups. Group 1 did not receive any chemical substance. Group 2 received dimethyl sulfoxide, group 3 received bevacizumab 5 mg/mL, group 4 received dovitinib 5 mg/mL, and group 5 received bevacizumab 5 mg/mL + dovitinib 5 mg/mL topically administered twice daily for 14 days. On the 14th day, slit-lamp examination was performed, and anterior segment photographs were taken. The corneal neovascular area was measured on photographs as the percentage of the cornea's total area using computer imaging analysis. The corneal sections were stained with hematoxylin and eosin for histopathological examination. Results: A statistically significant decrease in the percentage of CNV was found in all treatment groups (group 3, group 4, and group 5) compared with the control group (group 1) (P < 0.01). A statistically significant difference in the percentage of CNV was found among group 3, group 4, and group 5 (P = 0.003). The percentage of CNV in group 4 was significantly higher than that in group 3 and group 5 (P-1 = 0.004; P-2 = 0.006). There was no statistically significant difference in the percentage of CNV between group 3 and group 5 (P = 0.228). Conclusions: Dovitinib is a newly developed multitargeted tyrosine kinase inhibitor. Topical administration of dovitinib effectively inhibited CNV, but this effect of dovitinib was found less than topical bevacizumab. WOS:000484410200025 31180924 Q2

A 28-year-old female patient was admitted to our clinic with a mass in the caruncle of her left eye. As per a slit-lamp examination, a red–pink pedicle mass was hanging out of the pigmented base. The mass size was 10 mm, and it contained lobular structures. An excisional biopsy was performed. Histopathologically, the papillary proliferation of squamous epithelia on the conjunctiva was detected, and the epitheliumshowed koilocyte-like cells. Pigmented nevoid cells were seen on the basal layer of the epidermis and subepithelial zone. Immunohistochemistry tests were performed to investigate the effect of human papilloma virus (HPV), but HPV dye staining was not observed. Lower in-situ hybridization of the HPV test was studied. It was accepted as negative because of a non-specific and weak signal monitoring. Finally, the mass was reported as conjunctival nevus and squamous papilloma within the same lesion. No recurrence was observed at a 2-year follow-up. Despite the fact that the conjunctival nevi and papilloma often separately appear, they were simultaneously seen in the same lesion in this case, which is very rare. To the best of our knowledge, this is the first case report in the literature wherein the conjunctival nevi and papilloma are simultaneously seen in the same lesion.

Background: A prospective evaluation of the pattern of fundus autofluorescence in cases of acute versus chronic central serous chorioretinopathy (CSR). Methods: A prospective, cross-sectional, single-centre investigation was performed using three diagnostic techniques, namely, fundus autofluorescence, optical coherence tomography and fundus fluorescein angiography to evaluate a sample of patients (n = 42 eyes) with both acute (n = 25 eyes) and chronic (n = 17 eyes) CSR. Results: Hypoautofluoresecence was found in 80 per cent (20 eyes) and 88.2 per cent (15 eyes) of eyes in the acute and chronic central serous chorioretinopathy groups, respectively, corresponding to the leakage points depicted by fluorescein angiography. Hypoautofluoresence corresponding to the areas of subretinal fluid accumulation was seen in 92 per cent (23 eyes) and 82.3 per cent (14 eyes) of the acute and chronic central serous chorioretinopathy groups, respectively. In two eyes (11.6 per cent) with chronic CSR, hyperautofluorescent changes were noted at the previous leakage points. In the acute CSR group, speckled hyperautofluorescence was detected in nine eyes (36 per cent) after the resolution of subretinal fluid. In the chronic CSR group, simultaneous speckled hyperautofluorescence was detected in the previous areas of subretinal fluid accumulation in 12 eyes (70.5 per cent). Conclusion: Fundus autofluorescence imaging delineates endogenous fluorescence derived mainly from lipofuscin within the retinal pigment epithelium (RPE) layer and therefore permits evaluation of functional alterations in the RPE in numerous retinal diseases. Data from fundus autofluorescence revealed distinctive findings in acute and chronic CSR. Fundus autofluorescence imaging may be used as a supplementary diagnostic tool for identifying patients with CSR and differentiation may be made between acute and chronic cases. © 2011 Optometrists Association Australia.

Yazisma Adresi/Address for Correspondence: Dr. Raciha Beril Kucumen, Yeditepe Universitesi Tip Fakultesi, Goz Hastaliklari Anabilim Dali, Istanbul, Turkiye Tel.: +90 216 369 14 01 E-posta: berilkucumen@hotmail.com Gelis Tarihi/Received: 17.06.2013 Kabul Tarihi/Accepted: 08.07.2014 Amac: Kronik blefaritli hastalarda gozyasi osmolaritesini arastirmak. Ge rec ve Yon tem: Calismaya semptomatik kronik blefaritli olgular dahil edildi. Oftalmolojik muayeneyi takiben gozyasi osmolaritesi olculdu. Ayrica gozyasi kirilma zamani (GKZ), anestezili Schirmer II testi ve biyomikroskopide kornea floresein boyanmasi degerlendirildi. Gozyasi osmolarite olcumleri kontrol grubu ile karsilastirildi. Bulgular: Yas ortalamalari 47,4±14,4 yil (31-62 yil) olan 10 hastanin (6 kadin, 4 erkek) 10 gozu ve kontrol grubu 12 saglikli bireyin (10 kadin, 2 erkek) 12 gozu degerlendirildi. Hasta semptomlari yabanci cisim hissi, fotofobi, kizariklik, yanma, kasinti, pullanma, kirpik kaybi ve tekrarlayan hordeolumu icermekteydi. Kuru goze neden olabilecek sistemik ve ilave okuler patoloji bulunmamaktaydi. Ortalama osmolarite 323,8±19,91 mOsm/L (298-365 mOsm/L), ortalama GKZ 4,22±2,17 saniye (1-8 sn) ve ortalama Schirmer 7,2±3,26 mm (4-15 mm) olarak olculdu. Gozlerin %65’inde korneada floresein boyanmasi tespit edildi. Kontrol grubunda ortalama osmolarite degerleri 302,17±8,54 mOsm/L (288-316 mOsm/L) ortalama GKZ 12,5±4,52 saniye (8-23 sn), Schirmer 13,17±7,83 mm (5-30 mm) olarak olarak bulundu. Blefaritli olgular ile kontrol grubunun sirasiyla ortalama osmolarite, GKZ, Schirmer olcumleri arasinda istatistiksel olarak anlamli fark bulundu (t testi, p=0,003, p

Purpose: To compare the macular thickness and volume of highly myopic children with healthy controls, using third generation optical coherence tomography (OCT). Methods: OCT was performed on highly myopic (cycloplegic spherical equivalent refraction > −6.00 diopters [D]) children aged 3 to 7 years old and healthy controls (spherical equivalent refraction −2.00 to +4.00 D) between 2011 and 2013. OCT measurements of the average thicknesses of the fovea (central 1 mm) and inner (1 to 3 mm) and outer (3 to 6 mm) parafovea in superior, temporal, inferior, and nasal quadrants and total volume of the macular scan area were recorded. The differences between the two groups were tested with the Mann–Whitney U test. Results: There were 15 patients with high myopia and 11 controls. Foveal thickness (central 1 mm) was significantly greater in the high myopia group. The parafoveal thicknesses in all quadrants of the inner and outer circles were significantly thinner in the high myopia group. The average macular volume of the highly myopic eyes was significantly smaller than the control eyes. Conclusions: Anatomic changes in the retina occur even in young children with high myopia. Macular thickness characteristics of highly myopic children may influence the interpretation of data obtained with OCT. [ J Pediatr Ophthalmol Strabismus. 2015;52(5):282–286.]

OBJECTIVE To evaluate the effect of transepithelial corneal collagen cross-linking (CXL) with prolonged riboflavin application by in vivo confocal microscopy and to compare this effect with that of standard CXL with complete epithelial debridement. METHODS In eyes with progressive keratoconus, CXL procedure was performed with standard technique and transepithelial technique after prolonged riboflavin drop application for 2 hr. Patients were evaluated with in vivo confocal microscopic examination preoperatively and at postoperative months 1 and 6. RESULTS The depth of CXL effect was similar in both groups (i.e., 380.86 ± 103.23 μm in standard CXL group and 342.2 ± 68.6 μm in transepithelial CXL group) (P=0.4). The endothelial cell counts and morphological parameters (i.e., pleomorphism and polymegathism) were not significantly affected in both groups (P>0.05 for all). In the standard CXL group, in vivo confocal microscopy revealed anterior stromal acellular hyperreflective honeycomb edema with posteriorly gradually decreasing reflectivity and increasing number of keratocytes and some sheets of longitudinally aligned filamentary deposits. The keratocytes were seen to repopulate in the posterior-to-anterior direction. In transepithelial CXL group, although the depth of CXL effect was similar, less pronounced keratocyte damage, extracellular matrix hyperreflectivity, and sheets of filamentary deposits at the posterior stroma was observed. CONCLUSIONS Transepithelial CXL with prolonged peroperative riboflavin application can achieve similar depth of effect in the stroma with less pronounced confocal microscopic changes as compared with the standard CXL with complete epithelial debridement.

Background: To evaluate the tear osmolarity in patients with dry eye syndrome related to primary Sjögren's Syndrome (SS). Materials and Methods: Twenty eyes of 10 patients with dry eye and primary SS (Group 1) and 20 eyes of 20 subjects who do not have dry eye syndrome (Group 2) were included in this cross-sectional study. In all eyes, ophthalmic examination was performed in the same order: International Ocular Surface Disease Index survey, visual acuity assessment, conjunctival hyperemia scoring, tear osmolarity measurement with TearLab™ Osmolarity System, tear film break-up time assessment, corneal fluorescein staining scoring, ocular surface Lissamine Green staining scoring, anesthetized Schirmer test. Dry eye severity was graded according to Dry Eye Workshop (DEWS) classification system. Results: Four eyes with grade 1, four eyes with grade 2, seven eyes with grade 3, and five eyes with grade 4 dryness, according to DEWS system, were included. The mean tear osmolarity value was 301.9 ± 11.40 mOsm/L (range: 290328) in Group 1, and 294.85 ± 8.33 mOsm/L (range: 283311) in Group 2 (p = 0.03). In Group 1, tear osmolarity values were positively correlated with OSDI scores (r(18) = 0.55, r2 = 0.31, p = 0.01), DEWS classification grades (r(18) = 0.73, r2 = 0.54, p < 0.01), temporal and total corneal staining scores (r(18) = 0.67, r2 = 0.44, p < 0.01, and r(18) = 0.51, r2 = 0.26, p = 0.02, respectively), temporal conjunctival staining scores (r(18) = 58, r 2 = 0.34, p < 0.01); and negatively correlated with anesthetized Schirmer test results (r(18) = -0.62, r2 = 0.38, p < 0.01) and TFBUT (r(18) = -0.50, r2 = 0.25, p = 0.02). Conclusions: Tear osmolarity values were found to be greater in patients with dry eye syndrome related to primary SS compared to control subjects, and positively correlated with the severity of dry eye. © 2011 Informa Healthcare USA, Inc.