OCT in Lamellar Corneal Transplantation

Anterior segment optical coherence tomography (AS-OCT) is a valuable tool in corneal transplantation surgery. In deep anterior lamellar keratoplasty (DALK), AS-OCT gives valuable information on preoperative decision process. AS-OCT image of the recipient cornea helps the surgeon to decide whether to proceed with a big bubble DALK or a manual dissection. Preoperative AS-OCT imaging of recipient stroma can also predict Descemet membrane perforation during big bubble induction. Intraoperative AS-OCT assures reaching the proper depth in order, and postoperatively, a surgeon can objectively assess the Descemet membrane and donor association and define complications such as a double anterior chamber. Before deciding for a Descemet membrane endothelial keratoplasty (DMEK), preoperative stromal scars can be identified with an AS-OCT and might affect the decision of the surgical procedure (DMEK or penetrating keratoplasty). After DMEK, graft detachment can be visualized by AS-OCT and treated accordingly

Bilateral Anterior Uveitis Revealing Relapsing Polychondritis

Relapsing polychondritis is a potentially lethal but rare systemic autoimmune disease. The major site of inflammation is the connective tissue, usually involving the ears, nose, larynx, tracheobronchial tree, and cardiovascular system. Although scleritis and episcleritis are known to be the most probable ocular manifestation, it may also present with uveitis. We present the case of a 22-year-old young lady who initially referred with bilateral red and painful eyes caused by anterior uveitis. Her right ear was also red and painful, consistent with cartilaginous inflammation. She was diagnosed with relapsing polychondritis with bilateral anterior uveitis and chondritis of the ear in conjunction with the rheumatology department. Bilateral anterior uveitis should evaluated and monitored carefully in patients with relapsing polychondritis

Comparison of voriconazole and corneal collagen cross-linking treatments in A model of fungal keratitis

Amaç: Tavşan kornealarında deneysel oluşturulmuş Fusarium solani ve Candida albicans keratit modellerinde %0.25 riboflavin konsantrasyonu kullanılan PACK-CXL ile topikal antifungal tedavinin etkinliklerinin kontrol grubuyla ve kendi aralarında klinik, mikrobiyolojik ve patolojik incelemelerle karşılaştırılmasıdır. Gereç ve Yöntem: Çalışmaya, etik kurul onayı alındıktan sonra, 28 adet Yeni Zelanda tavşanının her iki gözü dâhil edilmiştir. Keratitli vakalardan elde edilen, Fusarium solani (FS) ve Candida albicans (CA) suşlarından 10⁵ CFU/ml konsantrasyonda mantar süspansiyonları 0.1 ml dozda intrastromal enjekte edilerek 3. günde keratit oluştuğu gözlenmiştir. FS grubu kontrol (Grup 1A), PACK-CXL (Grup 1B), Vorikonazol (Grup 1C) ve PACK-CXL ile kombine vorikonazol (Grup 1D) grupları olarak 4 gruba ayrılmıştır. CA grubunda da aynı sırayla grup 2A, 2B, 2C ve 2D olarak grupları oluşturulmuştur. PACK-CXL hızlandırılmış Dresden protokolünde (toplam UV-A dozu 5,4 J/cm²) %0.25 riboflavin kullanılarak uygulanmıştır. Vorikonazol, %1 (10 mg/ml) dozda, 3.günden itibaren topikal 7x1 olarak uygulanmıştır. 10. gün korneal butonlar eksize edilerek her alt grupta 7 korneal butonun 6'sı kültür ekimi ile koloni sayımı yapılmıştır. Kalan korneal butona patolojik inceleme yapılmıştır. Bulgular: Grup 1B, 1C ve 1D'de grup 1A'ya göre daha az mantar üremiştir (p0.05). İncelenen patolojik kesitlerde Grup 1B, 1D, 2B ve 2D'de daha az hif ve nonspesifik stromal değişiklikler görülmüştür. Sonuç: %0.25 riboflavin ile yapılmış PACK-CXL tedavisinin gerek tek başına gerekse antifungal ilaçlarla kombine tedavi ile fungal keratitlerde medikal antifungal tedaviye göre başarılı fungal öldürme oranlarına sahiptir. PACK-CXL tedavisinin, özellikle antifungal ilaçlar ile kombine edilerek erken dönemde uygulanması şeklinde, fungal keratit tedavi algoritmasının içine girmesinin uygun olduğu düşünülmüştür.Purpose: We aim to compare the antifungal efficacy of PACK-CXL with 0.25% riboflavin concentration and voriconasole with clinical, microbiological and pathological examinations, and investigate MMP-9 and MMP-13 levels in all experimental groups in the rabbit model of Fusarium and Candida keratitis. Methods: 32 rabbits included to the study after approval of ethical commitee. 0.1 cc suspension prepared from 10⁵ CFU/ml concentration of Fusarium solani (FS) and Candida albicans (CA) strains which obtained from clinical keratitis cases, injected intrastromal. Keratitis has been observed at third day. FS group divided into four subgroups. Group 1A was control group and left untreated, group 1B was treated with PACK-CXL, group 1C was treated with voriconazole, group 1D was treated with PACK-CXL and voriconazole. CA group was divided into four subgroups same as FS (Group 2A, 2B, 2C and 2D). PACK-CXL was applied with 0.25% riboflavin in accelerated Dresden protocol (total UV dose was 5,4 J / cm²). 0,1% voriconazole (10 mg/ml) drops was administered as topical 7x1. All corneal buttons excised at 10th day after ophthalmological examination. 6 of 7 corneal buttons were cultivated for microbiological examination. Remaining corneal button was prepared for pathological examination. Results: Fungal cell counts were determined in all groups. CFU counts were statistically significant lower at group 1B, 1C and 1D compared to group 1A (p0,05). At pathological fewer Fusarium hyphae and nonspecific stromal changes were observed in group 1B, 1D, 2B and 2D Conclusion: PACK-CXL with 0,25% riboflavin either alone or combined with antifungal drops has better fungal killing rate compared to medical antifungal treatment It is appropriate to add PACK-CXL treatment, especially combined with antifungal drops, into fungal keratitis algorithm at the early stage of the disease