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Purpose: To investigate the potential associations between keratoconus and catalase rs1001179, superoxide dismutase 2 rs4880, and glutathione peroxidase 1 rs1050450 gene polymorphisms in a Turkish population. Methods: The study group included 121 unrelated keratoconus patients and 94 unrelated healthy controls. Blood samples (200 ml) were collected from all patients and controls to isolate genomic DNA. Genotyping was performed to identify rs1001179, rs4880, and rs1050450 using real-time polymerase chain reaction (PCR). Genotype and allele frequencies were calculated; their associations with keratoconus risk were assayed, and the association with keratoconus risk and demographic factors was examined. Results: Glutathione peroxidase 1 rs1050450 polymorphism was present in 41% cases compared with 29% controls (OR=1.66; 95% CI=1.11-2.50; p=0.014). No association was observed between catalase rs1001179 and SOD2 rs4880 polymorphisms and keratoconus (for all, p>0.05). Conclusions: This study evaluated possible relationships between rs1050450, rs1001179, and rs4880 polymorphisms and keratoconus susceptibility. We found a possible association between glutathione peroxidase 1 rs1050450 polymorphism and an increased risk of keratoconus. However, the genotype and allele frequencies were identical in the catalase rs1001179 and superoxide dismutase 2 rs4880 polymorphisms. Further studies are needed to analyze the effect of such variations in identifying keratoconus susceptibility. RESUMO Objetivo: Investigar as possíveis associações entre o ceratocone e os polimorfismos rs1001179 da catalase, rs4880 da superóxido-dismutase 2 e rs1050450 da glutationa-peroxidase 1 rs1050450 em uma população turca. Métodos: O grupo de estudo incluiu 121 pacientes com ceratocone não relacionados e 94 controles saudáveis também sem pa rentesco. Amostra de sangue (200 mL) foram coletadas de todos os pacientes e controle para isolar o DNA genômico. A genotipagem foi realizada para identificar rs1001179, rs4880 e rs1050450 utilizando a reação em cadeia da polimerase (PCR) em tempo real. As frequências de genótipos e alelos foram calculadas, suas associações com o risco de ceratocone foram avaliadas, e a associação com risco de ceratocone e fatores demográficos foi examinada. Resultados: O polimorfismo da glutationa-peroxidase 1 rs1050450 estava presente em 41% dos casos, comparado com 29% dos controles (OR=1,66, IC 95%=1,11-2,50; p=0,014). Não foi observada associação entre o ceratocone e os polimorfismos rs1001179 e SOD2 rs4880 da catalase (para todos, p>0,05). Conclusões: Este estudo avaliou possíveis relações entre os polimorfismos rs1001179, rs4880 e suscetibilidade a cerato cone. Encontramos uma possível associação entre po limorfis mo da glutationa-peroxidase 1 rs1050450 e um risco aumentado de ceratocone. No entanto, o genótipo e as frequências alélicas foram idênticas nos polimorfismos rs1001179 da catalase e superóxido-dismutase 2 rs4880. Mais estudos são necessários para esclarecer o efeito dessas va riações na detecção da sus cetibilidade ao ceratocone.

Deterioration of retina and death of the retinal cells due to age, diabetes, or occlusion can cause retinal degeneration which leads to loss of vision. In this study, it is aimed to design a bilayered matrix to mimic the choroid and the Bruch's membrane of the retinal tissue. As choroid, a microchanneled network resembling a fractal tree design was fabricated by photolithography over photo-cross-linkable methacrylated hyaluronic acid hydrogel. Gelatin or collagen was immobilized into the microchannels to enhance adherence of Human Umbilical Vein Endothelial Cells (HUVEC). At late culture periods (2 weeks), formation of tubular structures due to proliferation of the attached cells was observed. As Bruch's membrane, an electrospun fibroin nanofiber mat was produced to grow retinal pigment epithelium (RPE) cells on. Cellular interactions between RPE and HUVEC in the microchannels were investigated in a coculture model in a noncontact mode. It was deduced that by combining the RPE layer on the highly permeable Bruch's membrane with the choroid layer populated by HUVECs, a retinal substitute which might have a potential for use in the treatment of retinal diseases is possible. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2166-2177, 2016.

Introduction: The aim of the study was to explore the distribution of eyelid tumors in Ankara, the capital city of Turkey, from a histopathological point of view. Materials and Methods : Medical records of 1,502 patients who had eyelid surgery because of tumoral lesions were retrospectively reviewed after obtaining institutional review board approval. A total of 1,541 lesions with histopathologic diagnosis were included. Inflammatory tumoral lesions were excluded. The lesions were categorized into three groups according to the origin: epidermal, adnexal tumors and ‘others’, including melanocytic, neural and vascular lesions. Results: Of the total of 1,541, 908 lesions were epidermal in origin. Only 22 (1.5%) were malignant, and 6.0% was premalignant lesions such as actinic keratosis and Bowen’s disease. Twenty-one of 22 malignant lesions were basal cell carcinoma. There was only one patient with squamous cell carcinoma and no sebaceous cell carcinoma. Among the benign tumors (92.5%), squamous papilloma was the most frequent (21.8% of all lesions). The other frequent lesions were nevus (17.6%), seborrheic keratosis (17.3%), hydrocystomas (10.6%), xanthelasma (7.6%) and epidermal cysts (7.2%). Conclusions: The results of this study are in accordance with published literature. The absence of sebaceous cell carcinomas needs to be stressed. Keywords

Purpose: Nitrogen mustard (NM) is a devastating casualty agent in chemical warfare. There is no effective antidote to treat NM-induced ocular injury. We aimed to assess the effects of proanthocyanidin (PAC) and coenzyme Q10 (CoQ10) on NM-induced ocular injury. Methods: Eighteen male rats were divided into the following 4 groups: NM, NM + PAC, NM + CoQ10, and control. The 3 NM groups received a single dose of NM (0.02 mg/μL) on the right eye to induce ocular injury. The control group received saline only. Thirty minutes after the application of NM, the NM + PAC group received PAC (100 mg/kg) via gastric gavage, while the NM + CoQ10 group received CoQ10 (10 mg/kg) via intraperitoneal injection. PAC and CoQ10 were administered once a day for 5 consecutive days. The rats were then sacrificed. Macroscopic images of the eyes were examined and eye tissues were collected for histology. Results: The treatment groups were compared to the control group with regard to both corneal opacity and lid injury scores. The findings were not significantly different for both the NM + PAC and NM + CoQ10 groups. In both the NM + PAC and NM + CoQ10 groups, the histological changes seen in the NM group demonstrated improvement. Conclusions: Our results indicate that PAC and CoQ10 treatments have therapeutic effects on NM-induced ocular injury in a rat model. PAC and CoQ10 may be novel options in patients with NM-induced ocular injury.

Objective: Attention deficit hyperactivity disorder (ADHD) is one of the most frequently seen neurodevelopmental disorders among school-aged children. Although the main cause of ADHD is unknown, co...

Deterioration of retina and death of the retinal cells due to age, diabetes, or occlusion can cause retinal degeneration which leads to loss of vision. In this study, it is aimed to design a bilayered matrix to mimic the choroid and the Bruch's membrane of the retinal tissue. As choroid, a microchanneled network resembling a fractal tree design was fabricated by photolithography over photo-cross-linkable methacrylated hyaluronic acid hydrogel. Gelatin or collagen was immobilized into the microchannels to enhance adherence of Human Umbilical Vein Endothelial Cells (HUVEC). At late culture periods (2 weeks), formation of tubular structures due to proliferation of the attached cells was observed. As Bruch's membrane, an electrospun fibroin nanofiber mat was produced to grow retinal pigment epithelium (RPE) cells on. Cellular interactions between RPE and HUVEC in the microchannels were investigated in a coculture model in a noncontact mode. It was deduced that by combining the RPE layer on the highly permeable Bruch's membrane with the choroid layer populated by HUVECs, a retinal substitute which might have a potential for use in the treatment of retinal diseases is possible. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2166-2177, 2016.

Purpose To compare the results of two-site phacotrabeculectomy with microincision cataract surgery (MICS) and trabeculectomy. Methods Fifty-eight eyes with coexisting cataract and glaucoma were randomly assigned to have a trabeculectomy in a superior quadrant combined with phacoemulsification and intraocular lens (IOL) implantation through temporal clear corneal incision (two-site phacotrabeculectomy group), or a trabeculectomy in a superior quadrant combined with MICS followed by IOL implantation from the trabeculectomy incision (MICS + trabeculectomy group). The main outcome measures were preoperative and postoperative intraocular pressure (IOP), number of glaucoma medications, best-corrected visual acuity (BCVA), and complications. Follow-up was period was 12 months. Results Twenty-eight two-site phacotrabeculectomies and 30 MICS + trabeculectomies were performed. Mean age of the subjects was 67.4 years. Mean preoperative IOP was 24.6±5.7 mmHg in the two-site phacotrabeculectomy group and 23.7±5.5 mmHg in the MICS + trabeculectomy group (p=0.52). At 12 months postoperatively mean IOP was 14.5±3.0 and 14.3±3.4 mmHg in two-site phacotrabeculectomy and MICS + trabeculectomy groups, respectively (p=0.8). Preoperative and postoperative glaucoma medication numbers were similar and mean number of glaucoma medications decreased in both groups after the surgery (pConclusions MICS + trabeculectomy provided 1 year IOP control comparable to that with two-site phacotrabeculectomy with similar amount of complications and similar final BCVA.

Functional enuresis is defined as repeated voiding of urine into bed or clothes in children after 5 years of age following the exclusion of major somatic diseases. Autonomic nervous system dysregulation has been proposed as a pathophysiologic mechanism in the etiopathogenesis. The objective of this study was to evaluate autonomic nervous system functions with pupil diameter measurement in enuretic children. The study group consisted of 17 children with functional enuresis (ten boys, seven girls), and the control group consisted of 34 healthy children (20 boys, 14 girls). Pupil diameter measurements were performed under photopic and mesopic lighting conditions by using a pupillometer. Mean photopic pupil diameter was found to be larger in the enuretic children than in the healthy controls (4.47 +/- 0.52 mm vs. 4.03 +/- 0.75 mm; P = 0.03). Autonomic nervous system imbalance of the ocular system is considered to be part of the autonomic nervous system dysregulation in functional enuretic children.

To evaluate internal refraction and its relation to other optical properties of the eye across a large range of refractive errors, which can provide useful information for the assessment and design of intraocular lenses and corneal ablation patterns.Cohort study.Three hundred ninety-four eyes of 197 healthy subjects with a mean age of 27+/-7 years (range, 18-42).All eyes underwent optical path difference scans to evaluate corneal topography, whole and internal ocular refraction (determined by the subtraction of corneal refraction from whole ocular refraction), and total and higher-order aberrations (HOAs) were assessed. After the conversion of any spherocylindrical refractive errors to vectorial data (sphere equivalent, blurring strength; cylinder, J(0) [power of Jackson cross cylinder at 90 degrees and 180 degrees] and J45 [power of Jackson cross cylinder at 45 degrees and 135 degrees]), the distribution of internal refraction among refraction groups (high myopes, low to moderate myopes, hyperopes, mixed astigmats, and emmetropes) and relationships between internal refraction, corneal refraction, and wavefront aberrations were analyzed. The compensation relation and its rate between corneal and internal astigmatism was assessed by the compensation factor (CF).Whole ocular power and astigmatism, corneal power and astigmatism, internal power and astigmatism, CF for astigmatic data, location of the highest internal refraction zone, and wavefront aberrations.The highest refraction zone was mostly (90%) located in the center in myopes, whereas it was located at the nasal side (71%) in hyperopes. There was a significant correlation between whole ocular and internal powers (P0.01), but no correlation was observed between corneal and internal powers (P0.05). Internal astigmatism was mostly against the rule. The mean CF J(0) was 0.63+/-3.78 and CF J(45) was 0.57+/-2.47. The magnitude of the internal astigmatism under the 3-mm zone was correlated with the magnitude of corneal astigmatism (P0.05). The distribution of astigmatic CF differed among refraction groups. There were significant correlations between internal power and spherical aberration (P0.05) and internal cylinder under the 5-mm zone and HOAs (P0.001).There is a remarkable tilt in internal refraction in hyperopes. Although there is a tendency of undercompensation of the corneal astigmatism by internal astigmatism in the entire group of eyes, the compensation differs among refraction groups.

PURPOSE To evaluate the location and shift of the pupil center relative to the coaxially sighted corneal reflex on horizontal and vertical planes under natural and pharmacologically dilated conditions. METHODS Ninety-four (64 myopic and 30 hyperopic) eyes of 47 patients underwent pupillometry with the NIDEK OPD-Scan under photopic and mesopic conditions before and after instillation of cyclopentolate 1%. Horizontal, vertical, and vectorial shift of the pupil center were calculated between each condition. RESULTS The pupil center was located temporally to the coaxially sighted corneal reflex a mean distance of 0.336±0.181, 0.345±0.195, and 0.339±0.170 mm under photopic, mesopic, and pharmacologically dilated conditions, respectively. The pupil center shifted primarily inferotemporally (44%), followed by inferonasally (22%), superotemporally (19%), and superonasally (15%) from photopic to pharmacologic dilation. Mean magnitude of pupil shift was 0.084±0.069 mm (range: 0.010 to 0.385 mm) from mesopic to photopic, 0.149±0.080 mm (range: 0.013 to 0.384 mm) from photopic to pharmacologic dilation, and 0.102±0.104 mm (range: 0 to 0.530 mm) from mesopic to pharmacologic dilation. Mean distance between the pupil center and the coaxially sighted corneal reflex was greater in hyperopes than in myopes (PP>.05). CONCLUSIONS The pupil center is located temporally and shifts in every direction, primarily inferotemporally, relative to the coaxially sighted corneal reflex with natural and pharmacologic dilation. The horizontal distance between the pupil center and the coaxially sighted corneal reflex was significantly higher in hyperopes than in myopes. [J Refract Surg. 2008;24:530-538.] ABOUT THE AUTHORS From the Department of Ophthalmology, Gülhane Military Medical School (Erdem, Gundogan, Sobaci, Bayer), and the Department of Ophthalmology, Ankara University School of Medicine (Muftuoglu), Ankara, Turkey. The authors have no proprietary interest in the materials presented herein. Correspondence: Uzeyir Erdem, MD, Gülhan Military Medical School, Goz AD 06018, Etlik, Ankara, Turkey. Tel: 90 312 304 3066; Fax: 90 312 304 5850; E-mail: erdemuzeyir@hotmail.com Received: October 11, 2006 Accepted: April 24, 2007 Posted online: September 15, 2007

PURPOSE: To determine changes in entrance pupil size and pupil center shift under low mesopic and photopic conditions of illumination in eyes with in-the-bag intraocular lens (IOL) implantation. METHODS: Entrance pupil size and pupil center shift were measured under low mesopic (0.06 lux) and photopic (60 lux) conditions of illumination in 55 patients with unilateral pseudophakia (study group) and 55 ageand sex-matched patients with bilateral cataracts (control group) using the NIDEK OPD-Scan. Pseudophakie eyes had an uncomplicated intraoperative and postoperative course and best spectacle-corrected visual acuity of 20/20. Cataractous eyes had no additional ocular or systemic problems affecting the pupil. Both groups were analyzed with respect to pupil size and shift in both conditions of illumination. RESULTS: Mean patient age was 64.2±6.8 and 63.6±4.3 years in the study and control groups, respectively (P=.45). In the study group, differences in pupil size under low mesopic (5.12±1.02 and 5.13±0.96 mm for pseudophakic and phakic eyes, respectively) and photopic (3.44±0.39 and 3.45±0.39 mm for pseudophakic and phakic eyes, respectively) conditions of illumination were not statistically significant (P=1.00 and P=.95 for pseudophakic and phakic eyes, respectively). Differences in pupil shift between pseudophakic (0.11±0.08 mm) and phakic (0.12±0.10 mm) eyes were not statistically significant (P=.83) in the study group. In the control group, differences in pupil size under low mesopic (P=.59) and photopic conditions of illumination (P=.60) in the right and left eyes as well as pupil shift (P=.71) were not statistically significant. CONCLUSIONS: Uncomplicated in-the-bag IOL implantation has no influence on pupil size and shift. [J Refract Surg. 2007;23:796-799.]

PURPOSE: To evaluate the effects of hormone replacement therapy (HRT) on refractive status, corneal topography, and aberrations of the eye in postmenopausal women. METHODS: Thirty-six healthy postmenopausal women (72 eyes) were included in the study. All patients received HRT that consisted of 0.625 mg/day conjugated estrogen and 5 mg/day medroxyprogesterone acetate in a continuous combined regimen. Schirmer Il test and tear film break-up time (BUT) were performed on all patients at the time of enrollment and 6 months after initiation of HRT. Refractive status, corneal topography, and wavefront aberrations were evaluated with the NIDEK Optical Path Difference-Scan before and 6 months after HRT was initiated. RESULTS: Mean patient age was 50.8+2.6 years (range: 47 to 57 years). The mean duration of menopause was 2.7+0.8 years (range: 1.4 to 3.5 years). The Schirmer Il test and tear film BUT measurements were significantly lower after HRT (P.05). CONCLUSIONS: Hormone replacement therapy in postmenopausal women does not significantly affect refractive status, corneal topography, and wavefront aberrations of the eye at 6-month follow-up. [J Refract Surg. 2007;23:567-572.]

A 21-year-old man, with bilateral posterior amorphous corneal dystrophy, was studied by biomicroscopy, corneal topography and in vivo confocal microscopy. The best-corrected visual acuity was 6/21 in the right eye and 6/6.9 in the left eye. Biomicroscopy revealed bilateral, asymmetric, sheet-like opacification at the deep posterior stromal layer. The corneal topography displayed asymmetric against-the-rule astigmatism in the right eye and prominent steepening at the inferior paracentral cornea in both eyes. In vivo confocal microscopy of the corneas demonstrated microfolds and hyper-reflective layer at the posterior stroma just adjacent to the endothelial layer. The epithelium, Bowman’s membrane, anterior stroma and the endothelial layer were normal. In vivo confocal microscopy is useful in evaluating the corneal dystrophies.

Reports of tobacco-induced electrocortical activation and decrements in ocular blood flow in the acute phase indicated that this effect is mediated via nicotine's action or neuronal systems. In this study, pattern visual evoked potentials were investigated in a group of male smokers (22 right eyes of 22 subjects) in separate real smoking and sham smoking sessions. On each session, pattern visual evoked potentials were recorded before smoking, immediately after smoking, and five minutes after smoking. Latency and amplitude values for P100 peaks were assessed and analyzed in each smoking condition for both real smoking and sham smoking sessions. Real smoking significantly decreased P100 latency values (p value related to difference between pre-smoking and immediately after smoking conditions is 0.009) and increased P100 amplitude values (p value related to difference between pre-smoking and fifth minute after smoking is 0.039). Statistically no significant difference was observed in sham smoking sessions. Our results are consistent with smoking-induced stimulant effects on pattern visual evoked potentials.

The association optic disc coloboma (the morning glory syndrome), optic nerve coloboma, and transsphenoidal meningoencephalocele is extremely rare. We describe an original case of optic disc coloboma in association with optic nerve coloboma, microphthalmos, optic nerve hypoplasia, and transsphenoidal meningoencephalocele. There were no midfacial anomalies (hypertelorism, broad nasal root, cleft lip, and cleft plate) and pituitary dysfunction. For patients who had optic disc-nerve coloboma without midfacial anomalies, neuroimaging should be prompted to look for transsphenoidal encephalocele/meningoencephalocele and other anomalies. We present demonstrative fundoscopic pictures, ultrasound and magnetic resonance imaging of this original case of a 7-year-old patient.

Aim.To evaluate the acute effects of cigarette smoking on photopic and mesopic pupil sizes and wavefront aberrations.Methods.Cigarette smoker volunteers were recruited in the study. Photopic and mesopic pupil sizes and total ocular aberrations were measured before smoking and immediately after smoking. All volunteers were asked to smoke a single cigarette containing 1.0 mg nicotine. Pupil sizes and total ocular aberrations were assessed by optical path difference scanning system (OPD-Scan II ARK-10000, NIDEK). Only the right eyes were considered for statistical analysis. The changes of pupil size and total ocular aberrations after smoking were tested for significance by Wilcoxon signed ranks test.Results.Mean photopic pupil size decreased from 3.52 ± 0.73 mm to 3.29 ± 0.58 mm(P=0.001)after smoking. Mean mesopic pupil size was also decreased from 6.42 ± 0.75 mm to 6.14 ± 0.75 mm after smoking(P=0.001). There was a decrease in all the measured components of aberrations (total wavefront aberration, higher-order aberration, total coma, total trefoil, total tetrafoil, total spherical aberration and total higher-order aberration) after smoking; however the differences were insignificant for all(P>0.05).Conclusion.Our results indicate that pupil constricts after smoking. On the other hand, smoking does not alter ocular aberrations.

Comment & Response

To report a case of cilioretinal artery occlusion (CRAO) with central retinal vein occlusion (CRVO) after a journey to high altitude region and the use of late period hyperbaric oxygen (HBO) therapy successfully.A previously healthy 48-year-old lowlander woman was admitted to our department for sudden blurred vision in her right eye started at 2 weeks prior to examination. The patient had a history of 1-month exposure to high altitude that finished a day before the onset of her complaints. The best corrected visual acuity (BCVA) was 10/20 in the right eye (RE) and 10/10 in the left eye. Fundus examination of the RE revealed whitening of the retina along the distribution of cilioretinal artery, sparing fovea, flame-shaped hemorrhages, and roth spots with minimally dilated and tortuous retinal veins. Visual field analysis revealed centrocecal scotoma. The patient was treated by a daily session of 2 h of HBO at 2.5 atmosphere absolute for 11 days. BCVA rised to a level of 20/20 for the RE and the scotomas were disappeared immediately after using of the HBO treatment.CRVO related CRAO should be regarded as a rare complication of exposure to high altitude and HBO seems to be the treatment of choice of high altitude related co-occurence of CRVO and CRAO in the late period.

Objective: We evaluated the value of unusual electroretinogram (ERG) findings (negative ERG, which is selective reduction in the amplitude of the b-wave) in the differential diagnosis of night blindness in the military. Methods: We surveyed 3 years of data. Presumptive and final clinical diagnoses before and after negative ERG recordings were evaluated. Results: A total of 495 ERGs were included. The mean age was 22 ± 2.5 years (range, 20-33 years). Twenty-two patients (4.4%) had negative ERG. Final clinical diagnoses could be made for all except two patients (9%). The diagnoses were congenital stationary night blindness (CSNB) (14 patients), X-linked juvenile retinoschisis (five patients), and muscular dystrophy (one patient). Seven (50%) of 14 patients with CSNB had normal fundal appearance, symptoms of night blindness, and a presumptive clinical diagnosis of malingering before the ERG test. Conclusion: Negative ERG may prevent misdiagnosis of malingering for patients with CSNB with normal fund...

To explore amplitude and latency-check size function in multiple sclerosis (MS) patients without optic neuritis history.Thirty-six MS patients and 21 control subjects were included. Pattern visual evoked responses to ive check sizes (2°, 1°, 30', 15', and 7') were recorded.P100 amplitudes were significantly reduced in 2°, 1° and 7' checks and, P100 latencies were significantly delayed in all checks in MS patients (p0.05). Inter-ocular amplitude/ latency differences were significantly higher in MS patients than control group (p0.05). The P100 amplitudes for 2° check was somewhat higher than amplitudes for 1° check in MS and control groups. However, MS patients had latter amplitude-check size function curve in large checks. In small checks, the slope of the amplitude-check size curves were similar for MS and control groups. The flattening of amplitude-check size function curve in large checks increased in MS patients with reduced P100 amplitudes. The P100 amplitudes for 2° check was lower than P100 amplitudes for 1° check in MS patients with reduced P100 amplitudes in contrast to normal subjects and MS patients with normal P100 amplitudes. Both groups had almost parallel P100 latency-check size curves in all checks. With respect to 95% confidence limit in control subjects in each check sizes, the number of eyes with delayed latency and reduced amplitude in MS patients were higher in large checks.This study showed that P100 amplitudes are reduced in MS patients without optic neuritis history, and responses to large checks are affected more than small checks.

To investigate whether heavy habitual smoking affects microstructures and functions of the macula, 45 age- (20-39 years old) and sex-matched adult smokers (≥1 box/day for ≥5 years) and 45 nonsmokers (controls) were enrolled in this case-control study. Central macular thickness (CMT), macular autofluorescent pigment density (MAPD), macular electroretinogram (ERG), and photostress recovery time (PRT) measurements were performed. The mean age of smokers and nonsmokers was 32.9 ± 3.9 and 33.1 ± 4.1 years, respectively (p = 0.43), and smoking duration was 11 ± 5.6 years. CMT in smokers (220 ± 28 μm) and nonsmokers (217.2 ± 31 μm; p = 0.57) was similar. Smokers had lower MAPD values (124.6) than nonsmokers (138.2) (p = 0.010). Multifocal ERG parameters in the central (6°) hexagon were similar in both groups (p > 0.05 for latency and amplitudes of P1 and N1). PRT in smokers and nonsmokers was similar (7.2 ± 1.2 and 7.4 ± 1.9 min, respectively; p = 0.33); however, foveal threshold value (FTV) at the first minute after photostress was statistically higher in smokers (36.1 ± 1.04 dB) than nonsmokers (34.8 ± 1.05 dB) (p = 0.011). We conclude that decreased MAPD and altered response to photostress may be indicative of early nicotine toxicity in microstructurally sound macula of adult chronic smokers.

Purpose: To determine the effect of chronic smoking on the pupil and photostress recovery time. Methods: Macular adaptation to photostress condition, and mesopic and photopic pupillary responses were measured using automated perimetry (Humprey®), and an OPD device (Nidek), respectively. Forty heavy smokers (smoking ≥1 box/day for the past 5 years at least), and 40 age- and sex-matched nonsmokers were enrolled. All the subjects had full vision and no ocular problems. Results: The baseline foveal threshold value (FTV) before photostress was similar in both groups (p = 0.75). Although photostress recovery times (7.1 ± 1.1 and 7.4 ± 1.3 min) were similar in smokers and nonsmokers (p = 0.30), FTV measured at the first minute after photostress was statistically higher in smokers (36.05 ± 0.98 dB) than nonsmokers (34.7 ± 1.03 dB; p = 0.018). Scotopic pupil sizes in smokers (6.73 ± 0.82 mm) and nonsmokers (6.55 ± 0.62 mm) were similar (p = 0.28); however, photopic pupil size in smokers (5.36 ± 0.73 mm) was different from nonsmokers (4.73 ± 0.58 mm; p = 0.001). Conclusions: Chronic smoking may dilate the pupil, and increases macular FTV immediately after photostress.

Measurement of central corneal thickness (CCT) plays an essential role in the diagnosis and treatment of many ocular diseases. In this study, we aimed to compare the CCT measurements obtained using the Scheimpflug system (Pentacam; Oculus, Inc) with a retinal optical coherence tomography device (Stratus OCT; Carl Zeiss Meditec, Inc) to examine healthy corneas.CCT measurements of 80 eyes belonging to 40 male patients (mean age: 24.48 ± 6.01 years) were evaluated with the Pentacam and the Stratus OCT. The relationship between the CCT values obtained with these 2 devices was examined with a Pearson correlation analysis, a paired t test, and a Bland-Altman analysis.The average CCT value obtained with Pentacam was 546.11 ± 34.15 μm and that obtained with Stratus OCT was 567.76 ± 35.02 μm. Although the average difference between the devices was 21.65 ± 8.59 μm (P0.0001), the measurements obtained with both devices were significantly correlated (r = 0.969, P0.0001). In Bland-Altman analysis, there was a high consistency between measurements obtained with either Pentacam or Stratus OCT devices.Corneal thickness measurements differ depending on the device used. Corneal thicknesses that have been calculated with Pentacam were lower than the values obtained with Stratus OCT. Both devices used for CCT measurement are easily applied, noninvasive, and effective. However, the devices are not interchangeable. Stratus OCT is not optimal for CCT measurement because of the important limitations of using manual measurements, but it can be used if other measurement devices designed for the purpose are not available.

Purpose To evaluate the intermediate-term safety and effectiveness of interferon alpha-2a (IFNα2a) in patients with Behcet's uveitis (BU) refractory to corticosteroids and immunosuppressive agents. Design Open, nonrandomized, uncontrolled, interventional, prospective study. Participants Fifty-three patients (106 eyes) with active, vision-threatening BU who failed to respond to conventional treatments. Intervention In 53 patients, acute inflammation was suppressed with effective prednisolone dosage (1–2 mg/kg/day, tapered to 10 mg within 4–6 weeks). The patients were treated with IFNα2a 4.5 million international units (MIU) 3 times per week for the first 3 months followed by IFNα2a 3 MIU 3 times per week for the next 3 months. Observation or other treatment methods were performed according to the decision tree developed for this study. Main Outcome Measures Remission and complete response (primary outcome measures), frequency of uveitis attacks, visual acuity (VA), and adverse effects (secondary outcome measures). Results During 2 years of follow-up (median 65 months, range 12–130 months), compliance with the therapy was excellent. At the end of 1-year follow-up, treatment response was obtained in 45 of 53 patients (84.9%). The mean attack rate of 3.6±1.1 per year (range, 2–8) decreased to 0.56±0.75 (range, 0–4) per year ( P =0.001). Visual acuity improved (≥0.2 logarithm of the minimum angle of resolution units from initial VA) in 30 eyes (28.3%) and worsened in 12 eyes (11.3%). Five patients (9.4%) did not respond to the initial treatment, and 3 patients (5.6%) developed severe adverse effects, including psoriasis, epileptic seizure, and extreme tiredness. Fifteen patients (28.3%) were off treatment for all the medications and disease free for 28±13.1 months (range, 12–50 months). Conclusions These results suggest that IFNα2a may be a valuable treatment option in BU that is refractory to corticosteroids and conventional immunosuppressive agents. The possible role of IFNα2a as a first-line agent in BU should be validated in randomized controlled clinical trials against newly described biologic agents. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Purpose: To report the treatment and follow-up of a linear epithelial keratitis with a horseshoe pattern. Methods: A 21-year-old Turkish soldier, who presented with epithelial keratitis with a horseshoe pattern that did not respond to immunosuppressive and multiple anti-microbial treatment, was studied clinically. Results: No microorganism was identified with different stains, cultures, and herpes simplex virus–polymerase chain reaction. The impression cytology revealed prominent polymorphonuclear leukocyte infiltration at the keratitis line. The keratitis did not respond to different antimicrobial treatment or local and systemic corticosteroids. After a fourth scraping was perfomed deeply with a disc-knife, the lesion healed and did not recur in six months. Conclusion: Linear epitheliitis of cornea with a horseshoe pattern was not found to be associated with any microorganism or systemic disease.

Aspergillus infections are being increasingly recognized as an important cause of morbidity and blindness. We report here the first cluster of Aspergillus ustus endophthalmitis cases which occurred in a large tertiary care hospital during the period October 2003 to June 2004. In three of the cases, the patients required enucleation following cataract surgery, while the fourth involved a fatal infection in a pediatric patient hospitalized for osteopetrosis. Patient charts from the four cases were reviewed retrospectively and indicated that postoperative signs of fungal endophthalmitis developed in the patients 1-11 weeks after surgery. The molecular characterization of the isolates and their epidemiological relatedness were evaluated by Random Amplification of Polymorphic DNA (RAPD). A source investigation of this mini outbreak was performed by environmental sampling, but no isolates of A. ustus were recovered from these studies. All A. ustus strains isolated from three patients with fungal endophthalmitis had the same RAPD pattern suggesting a common source. The strain from the pediatric patient differed from the ophthalmic isolates in five electrophoretic loci. The latter was included solely as an outbreak, unrelated control to evaluate the discriminatory power of the molecular typing method employed in the analysis of the ophthalmic strains. These cases illustrate the potential for uncommon species like A. ustus to cause high morbidity and mortality in some clinical settings. Aspergillus ustus endophthalmitis is a serious and devastating complication of ocular surgery. It is unknown whether ongoing hospital construction may have contributed to this cluster of cases. Random amplification of polymorphic DNA may give valuable clues about the clonality of A. ustus strains.

PURPOSE: To study the factors that correlate with improved best spectacle-corrected visual acuity (BSCVA) after LASIK. METHODS: This was a nonrandomized, prospective clinical trial of 850 eyes from 480 patients undergoing LASIK for myopia, hyperopia, and mixed astigmatism. The mean preoperative spherical equivalent refraction was -3.75±4.82 diopters (D) (range: -13.88 to 6.00 D). From this population, 72 eyes (including 22 amblyopic eyes) from 43 patients were found to have improved BSCVA 6 months after LASIK. All patients underwent LASIK with the NAVEX platform. These eyes were analyzed to evaluate factors that correlated with improved BSCVA. Pre- and postoperative BSCVA, refraction, pupil diameter, corneal topography, asphericity (Q value), total aberrations, and higher order wavefront aberrations were analyzed. All wavefront aberrations were measured using the NIDEK Optical Path Difference Scan aberrometer (OPD-Scan) preoperatively and at 6 months postoperatively. RESULTS: Postoperatively, the mean sphere was -0.44±1.30 D (range: -4.50 to +2.50 D). The mean increase in BSCVA was 0.15±0.09 logMAR. A statistically significant negative correlation was observed between the increase in BSCVA and the preoperative BSCVA (P.05). CONCLUSIONS: Decreased preoperative BSCVA, lower total spherical aberration induction, and preoperative mixed astigmatism and high myopia correlate with an increase in BSCVA after LASIK. [J Refract Surg. 2006;22: S1056-S1068.]

Dear Editor, We congratulate Eliasdottir et al. [1] for their study entitled ‘Venous oxygen saturation is reduced and variable in central retinal vein occlusion’. The authors used a non-invasive spectrophotometric retinal oximeter for measuring hemoglobin oxygen saturation in retinal vessels. They concluded that central retinal vein occlusion (CRVO) eyes are hypoxic compared to fellow eyes, and hemoglobin oxygen saturation is increased between arterioles and venules. We would like to share our reservations about the study. Fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) are widely used for evaluation of CRVO cases. The authors also shared a patient’s FFA and OCT results in figure legend 4. Retinal oximetry is a recently developed diagnostic tool. We think that assessing the patients by OCT and FFA and comparing them with retinal oximetry results can provide precious clues for the pathogenesis and management of CRVO. If available, we wonder if oximetric results of CRVO eyes with and without macular edema or CRVO eyes with or without retinal ischemia may be compared with each other. We think that its results also can be compared with FFA and OCT results in concordant and/or discordant sectors. We believe that these additional analyses will make it easy to reach reasonable inferences from the findings of the oximeter and increase the reliability of it.

Purpose To evaluate the effect of hormone replacement therapy (HRT) on dry eye in post-menopausal women. Methods Forty post-menopausal women with dry eye (20 patients, group 1) and without dry eye (20 patients, group 2), and planning to receive HRT (estrogen plus progesterone), were recruited as the study groups. Forty age-matched untreated women were enrolled as controls (group 3 with dry eye, 5 patients; group 4 without dry eye, 35 patients). Patients having at least one of the symptoms (dryness, itching, photophobia, foreign body sensation, and tearing) together with two of the tests with positive results for dry eye (tear film break-up time (BUT), fluorescein staining of the cornea, analysis of the meibomian gland, and Schirmer I test) in both eyes were considered dry eye positive. Hormonal assay for follicle stimulating hormone, luteinizing hormone, estradiol, and free testosterone was performed. Dry eye statuses in the groups were evaluated statistically. Results Four patients with incomplete follow-up data were excluded. HRT use increased estrodiol levels in the groups. Mean ages of patients (50.2 ± 4.8 and 50.7 ± 3.9 years, and 50.0 ± 4.6 and 53.0 ± 3.9 years) were similar (p = 0.67). Duration of menopause in groups 1 and 2 (3.2 ± 2.2 and 1.4 ± 1.2 years; p = 0.01), and in groups 3 and 4 (3.0 ± 1.6 and 1.7 ± 1.3 years; p = 0.014) were different. At the third month examinations, all of the patients in group 1, and 11 patients (61.1%) in group 2 had dry eye (p = 0.003). Conclusion Duration of menopause and use of HRT may increase the incidence of dry eye in post-menopausal woman.

To evaluate the effect of the menstrual cycle and gender on right and left visual hemifields in healthy subjects.One randomly selected eye from each of 42 healthy normally menstruating women and of 37 men with no systemic and ocular problems, other than refractive error, were included in the study. Subjects underwent complete ocular examination and standard acromatic perimetric (SAP) and short-wavelength automated perimetric (SWAP) analysis in both follicular (7th to 10th day of the cycle) and luteal phases (days 3 to 7 before the menstrual bleeding) of the menstrual cycle. Visual field analysis was performed using Model 750 Humphrey Field Analyzer II (Carl Zeiss Meditec, Dublin, CA, USA) with full-threshold, central 30-2 program.The mean age of female (n = 42) and the male subjects (n = 37) were 35.2 +/- 3.1 years and 34.8 +/- 2.9 years, respectively (p = 0.58). Neither females nor males showed any statistically significant differences in the right and left hemifield tests with SAP (both p values0.05). However, using SWAP, in luteal phase of female subjects, left hemifield sensitivity was significantly less than (with a mean of 0.47 dB) right hemifield. In follicular phase, there was no significant interhemifield difference (p0.05). Male subjects did not show any significant differences between the sensitivity of the two hemifields with SWAP tests.There has been a significant difference between the mean SWAP sensitivity of right and left visual hemifields in luteal phase of the menstrual cycle. In case of a suspected hemifield difference, SAP rather than SWAP may be used to confirm suspected neurological defects as SAP is not affected by the menstrual cycle.

To assess prognostic value of the ocular trauma score (OTS) in deadly weapon-related open-globe injuries.Retrospective, interventional case series.In 82 patients (88 eyes) with deadly weapon-related open-globe injuries, certain numerical values rendered to the OTS variables (visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment, afferent pupillary defect) at presentation were summated and converted into OTS categories. The likelihood of the final visual acuities in the OTS categories were calculated and compared with those in the OTS study.The likelihood of the final visual acuities (no light perception NLP, light perception LP/hand motion HM, 1/200 to 19/200, 20/200 to 20/50, andor = 20/40) in the OTS categories (1 through 5) in this group were similar to those in the OTS study group except for LP/HM in the category-2 (53% vs 26%, P.001). No study eye was in the category-5 (the best prognosis).OTS calculated at initial examination may provide prognostic information in deadly weapon-related open-globe injuries.

Sir, We congratulate Calabresi et al . (2010) for the scientific commentary regarding retinal pathology in multiple sclerosis. The authors have excellently summarized the pathological mechanism in multiple sclerosis in the brain and retina. We would like to make a contribution to the retinal aspects of their comments. Full-field flash electroretinogram is the mass electrical activity of the retina to a flash of light. Pattern electroretinogram reflects the retinal response to a structured, contrast-reversal stimulus, mostly a checkerboard pattern. There have been many studies investigating the functional and structural retinal changes in the retinas of patients with multiple sclerosis. Mostly, optical coherence tomography has been used to explore the structural changes that show retinal nerve fibre layer thinning. This change was …

A 20-year-old male is described with craniofacial anomalies, ocular findings, pigmented nevi, camptodactyly and skeletal changes. On the basis of the clinical and radiological differences with syndromes previously described we classify the present case as a new faciothoracoskeletal syndrome. Parental consanguinity supports autosomal recessive inheritance.

Purpose: Investigation of the causes and risk factors of amblyopia which is the most important cause of legal blindness with a prevalance of 2,5% among people under 45 years old in developed countries. Material and Methods: A screening test was performed to 3-6 years old preschool children and kindergartens in Ankara. The records included age, sex, birth problems, education level of the parents, pre and postnatal problems, family history and visual acuities. Suspected cases were sent to the ophthalmologist for the examination of visual acuity, and duction and version, biomicroscopic, ophthalmoscopic and cycloplegic refractive examinations. Visual acuity of 8/10 or less without any organic cause was accepted as amblyopia. Results: Fifty six of the 202 children were sent to the ophthalmologist because of low vision. Ophthalmologic examination revealed 6 amblyopia cases. The prevalance of amblyopia was 2,97%. Conclusion: Ambliyopia was 3 times more frequent in cases with a positive family history compared with cases without a family history. But this value was statistically insignificant. The most frequent causes of amblyopia were esotropia (50%), hypermetropic amblyopia (33,3%), and deprivation amblyopia (16,6%). [TAF Prev Med Bull 2004; 3(9.000): 202-212]

Ophthalmic herpes zoster is a common ocular infection caused by the varicella-zoster virus (VZV). Viral mRNA transcripts play a major role in the replicative cycle of the virus and current antiviral agents have little effect in preventing and treating the complications. Therapeutic use of saliva for certain painful ocular diseases such as ophthalmic herpes zoster is a well-known public practice in our region. We thought that antiviral activity of saliva may stem from salivary microvesicles and we aimed to look for molecules with antiviral activity in these vesicles. As a possible candidate for antiviral activity, salivary microvesicles contain at least 20 microRNAs (miRNAs), small noncoding RNAs, which suppress the translation of target mRNAs. miRNAs not only participate in maintenance of normal cell functions, but are also involved in host–virus interactions and limit the replication of certain virus types. Thus, miRNA gene therapy by targeting mRNAs required for VZV survival may find a niche in the treatment of ophthalmic herpes zoster. But, how could salivary microvesicles reach into the corneal cells to demonstrate their antiviral activity. We suggest that human salivary microvesicles can be effective carriers of miRNA for corneal cells, because they contain a molecular machinery for vesicle trafficking and fusion allowing them to be endocytosed by target cells. After binding to the plasma membrane, microvesicles seem to enter into the corneal cells through the clathrin-mediated endocytosis. In the cytosol, human salivary miRNAs base-pair with specific viral mRNAs and inhibit their translation, thus limiting the replication of the virus.