Corneal Endothelial Cell Density and Morphology in Healthy Turkish Eyes

Purpose. To describe the normative values of corneal endothelial cell density, morphology, and central corneal thickness in healthy Turkish eyes. Methods. Specular microscopy was performed in 252 eyes of 126 healthy volunteers (M : F, 42 : 84). Parameters studied included mean endothelial cell density (MCD), mean cell area (MCA), coefficient of variation (CV) in cell size, percentage of hexagonal cells, and central corneal thickness (CCT). Results. The mean age of volunteers was 44.3±13.5 (range, 20 to 70) years. There was a statistically significant decrease in MCD (P<0.001; correlation, −0.388) and percentage of hexagonal cells, (P<0.001; correlation, −0.199) with age. There was also a statistically significant increase in MCA (P<0.001; correlation, 0.363) with increasing age. There was no statistically significant difference in MCD, MCA, CV in cell size, percentage of hexagonal cells, and CCT between genders and there was also no significant difference in these parameters between fellow eyes of subjects. Conclusions. Normotive data for the endothelium in the Turkish population are reported. Endothelial cell density in the Turkish eyes is less than that described in the Japanese, American, Chinese, and Filipino eyes and higher than that described in Indian, Thai, and Iranian eyes

Use of Botulinum Neurotoxin in Ophthalmology

Botulinum neurotoxin (BoNT) is the first biological toxin used in the treatment of ophthalmic diseases and to decrease skin wrinkles as an aesthetic agent. When used appropriately, it weakens the force of muscular contraction and/or inhibits glandular secretion. The most common areas for botulinum toxin treatment are the upper face, including the glabella, forehead, brows, and lateral canthal lines or crow’s feet. By relaxing the muscles causing wrinkles, non-permanent results may be achieved with its use. BoNT has gained widespread use in a variety of ophthalmic diseases. The effect of BoNT is temporary, but the therapeutic benefit is usually maintained even after repeated injections. Treatment is usually well tolerated. Complications and side effects associated with the treatment are rare and temporary. Complications occur due to weakness (chemodenervation) of adjacent muscle groups, immunological mechanisms and injection technique. Current therapeutic indications, doses, complications and contraindications of BoNT use in the following disorders related to ophthalmology were investigated: aesthetic use, strabismus, blepharospasm, hemifacial spasm, eyelid retraction, entropion, lacrimal hypersecretion syndrome, and facial paralysis

Use of Botulinum Neurotoxin in Ophthalmology

Botulinum neurotoxin (BoNT) is the first biological toxin used in the treatment of ophthalmic diseases and to decrease skin wrinkles as an aesthetic agent. When used appropriately, it weakens the force of muscular contraction and/or inhibits glandular secretion. The most common areas for botulinum toxin treatment are the upper face, including the glabella, forehead, brows, and lateral canthal lines or crow’s feet. By relaxing the muscles causing wrinkles, non-permanent results may be achieved with its use. BoNT has gained widespread use in a variety of ophthalmic diseases. The effect of BoNT is temporary, but the therapeutic benefit is usually maintained even after repeated injections. Treatment is usually well tolerated. Complications and side effects associated with the treatment are rare and temporary. Complications occur due to weakness (chemodenervation) of adjacent muscle groups, immunological mechanisms and injection technique. Current therapeutic indications, doses, complications and contraindications of BoNT use in the following disorders related to ophthalmology were investigated: aesthetic use, strabismus, blepharospasm, hemifacial spasm, eyelid retraction, entropion, lacrimal hypersecretion syndrome, and facial paralysis

Yüksek doz oral fluoksetin alımı sonrası gelişen oküler herpes simpleks virus aktivasyonu

A 51-year-old man with high intraocular pressure on the left eye was referred to our clinic. A laser iridotomy was performed with full anti-glaucoma medication prior to the referral. There was a fixed dilated irregular pupil of the left eye, accompanied with mild corneal edema, a paracentral stromal corneal haze, patchy iris atrophy, fine keratic precipitates, trace amounts of cells and pigments in the anterior chamber and a patent iridotomy. Medical history was revealed a previous herpetic episode 7 years ago and fluoxetine use for major depression for 2 years which he overdosed 5 days before his ocular symptoms have started. Ocular herpes simplex virus activation associated with high dose fluoxetine was suspected. Fluoxetine was discontinued. Oral acyclovir, topical steroids and anti-glaucoma medication has been prescribed. A week later, on his control visit, the intraocular pressure was normalized and clinical findings have subsided. Fluoxetine, a selective serotonin re-uptake inhibitor, and some other anti-depressants, has been proved to suppress cellular immunity. Herpes simplex virus activation after surreptitious self-administration of high dose fluoxetine in this case is much more probable than coincidence. This is the first reported case of ocular herpes activation related to fluoxetine use.Yüksek Doz Oral Fluoksetin Alımı Sonrası Gelişen Oküler Herpes Simpleks Virus AktivasyonuElli bir yaşında erkek hasta, kliniğimize yüksek göz içi basıncı nedeniyle refere edilmiş. Öncesinde hastaya tam antiglokomatöz tedavi ve lazer iridotomi uygulanmış. Hastanın sol gözünde fikse dilate düzensiz pupilla ve eşlik eden hafif kornea ödemi, parasantral stromal korneal bulanıklık, yama şeklinde iris atrofisi, keratik presipitatlar, ön kamarada eser miktarda hücre ve pigment kümeleri ve açık iridotomi izlendi. Medikal öyküsünde 7 yıl önce geçirilmiş herpetik atak öyküsü belirlendi ve major depresyon nedeniyle 2 yıldır fluoksetin kullanan hastanın göz yakınmalarının başlamasından 5 gün öncesinde ilacı yüksek dozda aldığı belirlendi. Oküler herpes simpleks virus aktivasyonunun yüksek doz fluoksetin alımından olabileceğinden şüphelenildi. Fluoksetin kesildi. Oral asiklovir, topikal steroid ve anti-glokomatöz tedavi başlandı. Bir hafta sonra, hastanın kontrol muayenesinde göz içi basıncının normale geldiği ve klinik bulguların yatışmış olduğu izlendi. Fluoksetin, selektif serotonin geri alım inhibitörü olup, bazı diğer antidepresan ilaçlar gibi, hücresel immüniteyi baskıladığı kanıtlanmıştır. Bu olguda olduğu gibi hastanın gizlice yüksek doz fluoksetin alımı sonrası gelişen herpes simpleks virus aktivasyonu tesadüf olmasından daha olasıdır. Fluoksetin kullanımıyla ilişkili oküler herpes aktivasyonu olgusu ilk kez rapor edilmektedir

Effect of hemifacial spasm intraocular pressure measurement

WOS: 000425412900001PubMed ID: 29545951Purpose. To evaluate the effect of hemifacial spasm (HFS) on intraocular pressure (IOP) measurement. Methods. Twenty-four consecutive patients with HFS and 25 age-and gender-matched randomly selected eyes of healthy volunteers underwent corneal pachymetry and IOP measurements using Goldmann applanation tonometer (GAT) and noncontact tonometer (NCT). IOP measurements were performed before (during HFS) and 2 weeks after Botox injections in HFS patients and in healthy volunteers without Botox injections. Results. There was no statistical difference between involved eye side and uninvolved eye side of HFS patients in measured central corneal thickness. Similarly, no difference was found between involved eye side of HFS patients and controls. There were no statistically significant differences comparing IOP values before treatment and levels measured at 2 weeks of Botox injections, either with GAT (p = 0 33, 0.11) or NCT (p = 0 80, 0.43) devices in the involved eyes and uninvolved eyes of patients with HFS, respectively. There were also no significant differences in these parameters (GAT (p = 0 63) and NCT (p = 0 54)) in controls. Conclusions. Contractions in facial muscles may not lead to significant increase in IOP in HFS patients. This result may help clinical decision making in the treatment of glaucoma patients with HFS. This trial is registered with NCT03390803

Miyopik lasık cerrahi öyküsü olan travmatik afakik gözde göziçi lens gücünün hesaplanması: Olgu sunumu

A fi fty years old female patient with the history of Laser in situ keratomileusis (LASIK) presented at emergency room complaining of insertion of a hair clip piece into her left eye. On slit-lamp examination, there was a foreign body impacted in inferotemporal paracentral cornea extending into the lens via penetrating iris. Two and a half months after the corneal fi xation and traumatic cataract extraction, iridoplasty and secondary intraocular lens (IOL) implantation were applied. The stable refraction was – 0.50 – 0.75/160 degrees at the fi rst year of trauma. In traumatic aphakic eyes with the history of refractive surgery choosing appropriate IOL calculation formula may become more diffi cult because routinely used methods to calculate IOL power do not guarantee the same accuracy compared with naive eyes. Haigis-L formula might be a preferable method to calculate IOL power for these eyes.Geçirilmiş Laser in situ keratomileusis (LASIK) öyküsü olan 50 yaşında kadın hasta sol gözüne saç tokası parçası gelme şikayeti ile acil servise başvurdu. Biyomikroskopik incelemesinde alt temporal parasantral korneadan irisi penetre ederek lense uzanan yabancı cisim izlenmekteydi. Korneal sütürasyon ve travmatik katarakt ekstraksiyonundan 2,5 ay sonra hastaya iridoplasti ve sekonder göziçi lens implantasyonu uygulandı. Travmanın birinci yılında stabil refraksiyon -0.50 -0.75/160 derece düzeyinde idi. Refraktif cerrahi öyküsü olan travmatik afakik hastalarda uygun göziçi lens formülasyonunun seçilmesi rutinde kullanılan diğer yöntemlerin naif gözlerdeki doğruluğu garanti etmemesi nedeniyle zordur. Haigis-L formülünün bu gözler için tercih edilebilir bir yöntem olabileceği düşünülmektedir

Comparison of Different Types of Complications in the Phacoemulsification Surgery Learning Curve According to Number of Operations Performed

Objectives: To compare the differences in intraoperative complications rates by the number of resident-performed sequential phacoemulsification surgeries. Materials and Methods: Preoperative and postoperative ophthalmological examination records and intraoperative data of 180 eyes of 140 patients who underwent cataract surgery by two residents between November 2009 and February 2012 were analyzed retrospectively. The data of 180 eyes were separated into 3 groups based on the number of operations performed: Group A (first 1-60 eyes), group B (61- 120 eyes) and group C (last 121-180 eyes). The number of direct supervisor interventions and the rates of different types of complications were compared between the three groups. Results: The number of direct supervisor interventions was 45, 35 and 19 in group A, B and C, respectively. The number of complications anterior to the iris plane was 3, 4 and 12 in group A, B and C, respectively. The difference in the rate of complications between group B and C was statistically significant (p=0.029). The number of complications posterior to the iris plane was 6, 14 and 3 in group A, B and C, respectively. The difference in the rate of complications between the groups was statistically significant (p=0.042, p=0.004). Conclusion: This study provides insight into which types of complications might arise during the phacoemulsification training period. The trends in the rates of different complication types in clinics may be analyzed, and this analysis may be used to improve and modify phacoemulsification training programmes according to the needs of residents

Four Cases of Pediatric Photokeratitis Present to the Emergency Department After Watching the Same Theater Show

We report four consecutive cases of photokeratitis that presented to the emergency department, interestingly after having watched the same theatre performance in the same school. The patients’ ages (3 male, 1 female) ranged from 9 to 13 years. All patients presented with similar complaints consisting of pain, tearing, foreign body sensation, photophobia and blurred vision in both eyes. Patients reported watching a theatre performance in the same school approximately 4 hours before symptom onset. On slit-lamp examination, conjunctival injection and corneal punctate epithelial erosions were observed in the interpalpebral zone in both eyes. On fundus examination, no pathology was observed in the vitreous, posterior pole or peripheral retina. All cases were treated with topical antibiotics and lubricant eye drops. Corneas were clear two days later in the control visit. In this case report, exposure to ultraviolet light from high-power lamps used in the theatre was proposed as a possible cause of corneal epithelial cell damage and subsequent photokeratitis. (Turk J Ophthalmol 2015; 45: 226-228

Isolated Anterior Lens Capsule Rupture Secondary to Blunt Trauma: Pathophysiology and Treatment

A 25-year-old man suffered an isolated lens anterior capsular tear and mature cataract formation following blunt injury to his right eye. One week after the trauma, best-corrected visual acuity (BCVA) in the right eye was hand motion. B-scan ultrasonography showed that the lens posterior capsule was intact; no vitreous foreign body or retinal pathology were observed. Orbital computed tomography revealed narrowed anterior chamber and increased lens material volume and lens reflectivity in the injured right eye. The globe was intact and no bone fractures were observed. The cataractous lens material was removed by phacoemulsification and a foldable, acrylic, posterior chamber intraocular lens was implanted in the bag. Postoperative BCVA in the right eye was 20/20

Repeatability and Comparison of Keratometry Values Measured with Potec PRK-6000 Autorefractometer, IOLMaster, and Pentacam

Objectives: To research the repeatability and intercompatibility of keratometry values measured with Potec PRK-6000 autorefractometer, IOL Master, and Pentacam. Materials and Methods: In this prospective study, consecutive measurements were performed in two different sessions with the mentioned three devices on 110 eyes of 55 subjects who had no additional ocular pathology except for refraction error. The consistency of flat and steep keratometry, average keratometry, and corneal astigmatism values obtained in both sessions was compared by using intraclass correlation coefficient (ICC). The measurement differences between the devices were statistically compared as well. Results: The mean age of the study subjects was 23.05±3.01 (18-30) years. ICC values of average keratometry measurements obtained in the sessions were 0.996 for Potec PRK-6000 autorefractometer, 0.997 for IOL Master, and 0.999 for Pentacam. There was high compatibility between the three devices in terms of average keratometry values in Bland-Altman analysis. However, there were statistically significant differences between the devices in terms of parameters other than corneal astigmatism. Conclusion: The repeatability of the three devices was found considerably high in keratometry measurements. However, it is not appropriate for these devices to be substituted for each other in keratometry measurements. (Turk J Ophthalmol 2014; 44: 179-83