Comparison of Corneal Biomechanical Properties Between the Two Eyes in Unilateral Exfoliation Syndrome Cases

Pur po se: To compare the differences in corneal biomechanical parameters between the eyes of patients with unilateral exfoliation syndrome (ES), bilateral ES and normal subjects. Ma te ri al and Met hod: Thirty patients with unilateral ES (Group A), 32 bilateral ES patients (Group B) and 49 healthy subjects (Group C) were included in this cross-sectional, non-interventional study. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc) and Goldmann-correlated IOP (IOPg) were measured using Ocular Response Analyzer (ORA). Central corneal thickness (CCT) was measured with an ultrasonic pachymeter. The differences in ORA parameters between the eyes of the study and control group participants were analyzed. Re sults: In unilateral ES patients, the mean CH values for eyes with and without exfoliation material were 8.6±2.1 mm Hg and 9.1±1.7 mm Hg, respectively (p=0.004). On the other hand, the differences in both mean CRF and CCT between the two eyes in unilateral ES cases were not statistically significant (p>0.05 for both comparisons). IOPcc was significantly higher in ES eyes than in non-ES eyes (19.3±2.9 mm Hg vs. 17.1±2.7 mm Hg) (p 0.05 for all comparisons). Dis cus si on: In unilateral ES subjects, CH was found to be significantly lower in the eyes with exfoliation. Further studies are needed to establish the relationships between exfoliation, ocular biomechanics and glaucoma. (Turk J Ophthalmol 2012; 42: 269-7

Arginine-Restricted Therapy Resistant Bilateral Macular Edema Associated with Gyrate Atrophy

Introduction. Gyrate atrophy is a rare genetical metabolic disorder affecting vision. Here, we report a 9-year-old boy with gyrate atrophy associated with bilateral macular edema at the time of diagnosis and the effect of long term metabolic control on macular edema. Case Presentation. A 9-year-old boy presented with a complaint of low visual acuity (best corrected visual acuity: 20/80 in both eyes, refractive error: −12.00 D). Dilated fundus examination revealed multiple bilateral, sharply defined, and scalloped chorioretinal atrophy areas in the midperipheral and peripheral zone. Spectral-domain optical coherence tomography revealed bilateral cystoid macular edema in both eyes. Serum ornithine level was high (622 μmol/L). An arginine-restricted diet reduced serum ornithine level (55 μmol/L). However, visual findings including macular edema remained unchanged in 2 years of follow-up. Conclusion. Arginine-restricted diet did not improve macular edema in our patient with gyrate atrophy. A more comprehensive understanding of the underlying factors for macular edema will lead to the development of effective therapies

The Effect of Contact Lens Usage on Corneal Biomechanical Parameters in Keratoconus Patients

Pur po se: To determine and compare the corneal biomechanical properties in keratoconus patients using rigid gas permeable contact lenses and keratoconus patients who do not use contact lenses. Ma te ri al and Met hod: The study consisted of 70 healthy controls (Group A), 27 ketatoconus subjects who do not use contact lens (Group B) and 36 rigid gas permeable contact lens using keratoconic patients (Group C). Corneal viscoelastic parameters were measured with an Ocular response analyzer (ORA). Central corneal thickness was measured with an ultrasonic pachymeter. The differences in ORA parameters between the groups were compared. Re sults: The mean corneal hysteresis (CH) in Groups A, B, and C were 10.3±1.5 mm Hg, 7.8±1.4 mm Hg, and 7.4±1.2 mm Hg, respectively. The differences in mean CH between Group A and the other two groups were statistically significant (p<0.01 for both comparisons), but no statistically significant difference was found between groups B and C in terms of mean CH (p=0.61). The mean corneal resistance factor (CRF) was 10.7±1.9 in Group A compared with 6.6±1.6 in Group B and 6.1±1.5 in Group C. The differences in mean CRF between Group A and the other two groups were statistically significant (p<0.01 for both comparisons). There was no significant difference in CRF between the keratoconus eyes with or without rigid gas permeable contact lens usage (p=0.57). Dis cus si on: Our results suggest that ORA-generated parameters may be different in subjects with keratoconus. Corneal biomechanical parameters did not demonstrate a clear trend of change with rigid gas permeable contact lens usage. (Turk J Ophthalmol 2012; 42: 197-201

Assessment of Spectral-Domain Optical Coherence Tomography Findings in Three Cases of X-Linked Juvenile Retinoschisis in the Same Family

X-linked juvenile retinoschisis (XLRS) is an X-linked hereditary retinal dystrophy characterized by splitting of the neurosensory retina. On fundus examination, the macula often has a spoke wheel appearance with foveal cystic lesions, and separation of the retinal layers is typical on spectral-domain optical coherence tomography (SD-OCT). Patients with XLRS can exhibit different clinical courses, stages, and SD-OCT findings, even among members of the same family. SD-OCT is an important imaging method that allows us to achieve more detailed information about XLRS. In this study, we report three patients in the same family who have different clinical features and SD-OCT findings

An overlooked effect of systemic anticholinergics: alteration on accommodation amplitude

AIM: To investigate the effect of oral solifenacin succinate, tolterodine -L -tartarate and oxybutinin hydrochloride (HCl) on accommodation amplitude

Intralenticular Sustained-Release Dexamethasone Implant: Is It Still Effective on Macular Edema

Purpose: To report the therapeutic efficacy of an accidentally injected intralenticular sustained-release dexamethasone implant in a patient with macular edema secondary to branch retinal vein occlusion and shortly discuss the management strategy of this rare complication. Methods: Complete ophthalmological examination and optical coherence tomography imaging were performed at each visit. Results: The implant accidentally caused a posterior capsular tear during the procedure and was injected into the crystalline lens because of an involuntary head movement of the patient. Since the anterior segment was normal, and the resultant cataract and implant itself did not obscure the visual axis, the decision was made to observe the patient with intralenticular implant, preserve the therapeutic effect and avoid reinjection. The macular edema resolved within time, while visual acuity did not show significant improvement due to an increase in lens opacification. The patient underwent phacoemulsification surgery at 7 months after the injection with implantation of posterior chamber IOL into the capsular bag. Conclusion: Inadvertent injection of sustained-release intravitreal dexamethasone implant into the crystalline lens is an uncommon but possible complication that is mostly caused by surgeon inexperience, improper technique and uncontrolled head movement during the procedure. Once this complication occurs, early phacoemulsification and repositioning of the implant into the vitreous is the frequently preferred management strategy. However, remarkable decrease in macular edema and visual acuity improvement can also be achieved without an immediate surgical intervention