Corneal Sensitivity and Dry Eye Symptoms in Patients with Keratoconus.

PURPOSE: To investigate corneal sensitivity to selective mechanical, chemical, and thermal stimulation and to evaluate their relation to dry eye symptoms in patients with keratoconus. METHODS: Corneal sensitivity to mechanical, chemical, and thermal thresholds were determined using a gas esthesiometer in 19 patients with keratoconus (KC group) and in 20 age-matched healthy subjects (control group). Tear film dynamics was assessed by Schirmer I test and by the non-invasive tear film breakup time (NI-BUT). All eyes were examined with a rotating Scheimpflug camera to assess keratoconus severity. RESULTS: KC patients had significatly decreased tear secretion and significantly higher ocular surface disease index (OSDI) scores compared to controls (5.3+/-2.2 vs. 13.2+/-2.0 mm and 26.8+/-15.8 vs. 8.1+/-2.3; p0.05). The mean threshold for selective mechanical (KC: 139.2+/-25.8 vs. control: 109.1+/-24.0 ml/min), chemical (KC: 39.4+/-3.9 vs. control: 35.2+/-1.9%CO2), heat (KC: 0.91+/-0.32 vs. control: 0.54+/-0.26 Delta degrees C) and cold (KC: 1.28+/-0.27 vs. control: 0.98+/-0.25 Delta degrees C) stimulation in the KC patients were significantly higher than in the control subjects (p0.05), whereas in the control subjects both mechanical (r = 0.52, p = 0.02), chemical (r = 0.47, p = 0.04), heat (r = 0.26, p = 0.04) and cold threshold (r = 0.40, p = 0.03) increased with age. In the KC group, neither corneal thickness nor tear flow, NI-BUT or OSDI correlated significantly with mechanical, chemical, heat or cold thresholds (p>0.05 for all variables). CONCLUSIONS: Corneal sensitivity to different types of stimuli is decreased in patients with keratoconus independently of age and disease severity. The reduction of the sensory input from corneal nerves may contribute to the onset of unpleasant sensations in these patients and might lead to the impaired tear film dynamics

Corneal confocal microscopy detects a reduction in corneal endothelial cells and nerve fibres in patients with acute ischemic stroke

YesEndothelial dysfunction and damage underlie cerebrovascular disease and ischemic stroke. We undertook corneal confocal microscopy (CCM) to quantify corneal endothelial cell and nerve morphology in 146 patients with an acute ischemic stroke and 18 age-matched healthy control participants. Corneal endothelial cell density was lower (P<0.001) and endothelial cell area (P<0.001) and perimeter (P<0.001) were higher, whilst corneal nerve fbre density (P<0.001), corneal nerve branch density (P<0.001) and corneal nerve fbre length (P=0.001) were lower in patients with acute ischemic stroke compared to controls. Corneal endothelial cell density, cell area and cell perimeter correlated with corneal nerve fber density (P=0.033, P=0.014, P=0.011) and length (P=0.017, P=0.013, P=0.008), respectively. Multiple linear regression analysis showed a signifcant independent association between corneal endothelial cell density, area and perimeter with acute ischemic stroke and triglycerides. CCM is a rapid non-invasive ophthalmic imaging technique, which could be used to identify patients at risk of acute ischemic stroke.Qatar National Research Fund Grant BMRP2003865

Comparison of the Inferior Oblique Muscle Recession and Myectomy in the Treatment of lnferior Oblique Muscle Overaction

Primer ve sekonder alt oblik kas hiperfonksiyonu (AOHF) düzeltilmesinde kullanı-- lan alt oblik kas geriletmesi ve miyektomi yöntemlerinin sonuçlarının karşılaştırılmasıdır. Gereç ve Yöntemler: Ocak 2007--Aralık 2014 tarihleri arasında farklı derecelerde AOHF nedeniyle alt oblik kas zayıflatma cerrahisi uygulanan 74 hastanın 120 gözü bu retrospektif çalışmaya dahil edildi. Has-- taların demografik özellikleri, uygulanan cerrahi türü, cerrahi öncesi ve sonrası AOHF derecesi, eşlik eden horizontal kayma ve komplikasyonlar kaydedildi. Hastaların takip süresi medyan değeri 22 ay idi. Cerrahi sonrası AOHF'nin tamamen ortadan kalkmasında standart başarı kriterinin 1 dü-- zeyinde olması ise sınırlı başarı kriteri olarak belirlendi. Bulgular: Hastaların medyan yaşı 7,0 yıl (LO-32,0), medyan takip süresi 22,0 ay (LO--81,0) idi. Kırk dokuz (%62,6) hastada primer AOHF, 25 (%33,8) hastada ise sekonder AOHF mevcuttu. Altmış üç (%52,5) göze alt oblik kas miyektomisi, 57 (%47,5) göze alt oblik kas geriletmesi yapıldı. Standart başarı oranları miyektomi için %825, geri-- letme için %82,4 idi. Miyektomi yapılan gözlerin %12,7'sinde, geriletme yapılan gözlerin %10,5'inde sınırlı başarıya ulaşıldı. Hastaların cerrahi öncesi ve sonrası AOHF düzeylerindeki fark yönünden mi-- yektomi ve geriletme yöntemleri arasında anlamlı fark saptanmadı (p0,163). Cerrahi sonrası toplam 14 (sekiz göze miyektomi, alt1 göze geriletme yapılmış) gözde nüks ve (ikisine de miyektomi ya-- pılmış) gözde adezyon sendromu geliştiği gözlendi. Başka bir komplikasyon izlenmedi. Sonuç: Pri-mer ve sekonder AOHF tedavisinde uygulanan alt oblik kas miyektomi ve geriletme yöntemleri etkili ve güvenilir yöntemlerdir. Her iki yöntem de benzer başarı oranlarına sahiptir. Tekrar cerrahi ihtiyacı olan hastalarda geriletme yönteminin avantajı kasa daha kolay ulaşılmasını sağlamasıdır.To compare the results of inferior oblique muscle recession and myectomy procedures in the treatment of primary and secondary inferior oblique muscle overaction. Material and Methods: This retrospective study included 120 eyes of 74 patients with inferior oblique muscle overaction at different stages who underwent weakening procedure of the inferior oblique muscle between ]anuary 2007 and December 2014. Demographic characteristics of the subjects, type of the surgery, the degree of IOMO before and after the surgery, accompanying horizontal deviation, and complications were recorded. The median value of follow--up time was 22 months. Standard success was defined as complete resolution of IOMO, whereas limited success was defined as 1 residual IOMO. Results: The median age of the subjects was 7.0 years (range 1.0--32.0 years), the median fol-- low-up time was 22.0 months (range 1.0--81.0 months). 49 (66.2%) patients had primary IOMO, while 25 (33.8%) had secondary IOMO. Inferior oblique myectomy was performed in 63 (52.5%) eyes and inferior oblique recession was performed in 57 (47.5%) eyes. Standard success rates were 82.5% for myectomy and 82.4% for recession. Limited success was achieved in 12.7% of patients who underwent myectomy, and in 10.5% of patients who underwent recession. The difference in preoperative and postoperative IOMO was not statistically significant between myectomy and recession procedures (p0.163). total of 14 eyes (8 had undergone inferior oblique myectomy and had undergone re-- cession) had recurrence and eyes (both had undergone inferior oblique myectomy) had adhesion syndrome. No other complications were observed. Conclusion: Recession and myectomy of the inferior oblique muscle are safe and effective methods for the treatment of primary and secondary IOMO and both procedures have similar success rates. The advantage of the recession procedure is enabling easier access to the inferior oblique muscle in subjects requiring repeated surgery

The microbiological diagnosis of tuberculous meningitis: results of Haydarpasa-1 study

We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported. The Haydarpasa-1 study involved patients with microbiologically confirmed TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria and Turkey between 2000 and 2012. A positive culture, PCR or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients. A total of 506 TBM patients were included. The sensitivities of the tests were as follows: interferon- release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, Lowenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9% and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p<0.05 for both). Accordingly, CSF L-J culture was superior to CSF-PCR (p<0.05). Combination of L-J and ACS was superior to using these tests alone (p<0.05). There were poor and inverse agreements between EZNs and L-J culture (=-0.189); ACS and L-J culture (=-0.172) (p<0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (=-0.299, p<0.05). Diagnostic accuracy of TBM was increased when both ACS and L-J cultures were used together. Non-culture tests contributed to TBM diagnosis to a degree. However, due to the delays in the diagnosis with any of the cultures, combined use of non-culture tests appears to contribute early diagnosis. Hence, the diagnostic approach to TBM should be individualized according to the technical capacities of medical institutions particularly in those with poor resources