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

Corneal nerve fibre damage precedes diabetic retinopathy in patients with type 2 diabetes mellitus

AIMS: To quantify the morphological alterations in corneal nerve fibres and cells in patients with type 2 diabetes mellitus in relation to the severity of diabetic retinopathy.METHODS: One hundred and thirty-two eyes of 132 patients with type 2 diabetes and 32 eyes of 32 healthy control subjects were evaluated with in vivo corneal confocal microscopy. Patients with diabetes were classified into three groups: patients without diabetic retinopathy, patients with non-proliferative diabetic retinopathy and patients with proliferative diabetic retinopathy. Anterior and posterior stromal keratocyte, endothelial cell and basal epithelial cell densities and sub-basal nerve fibre structure were evaluated.RESULTS: Significant reductions in basal epithelial cell, anterior stromal keratocyte and endothelial cell densities were observed only in patients with diabetic retinopathy. However, nerve fibre density, nerve branch density and nerve fibre length were reduced in patients without diabetic retinopathy and worsened progressively with increasing severity of retinopathy.CONCLUSIONS: Corneal cell pathology occurs in patients with diabetic retinopathy, but corneal nerve fibre damage seems to precede the development of diabetic retinopathy.</p

Surgical outcomes of Ex-PRESS® mini glaucoma shunt implantation [Ex-PRESS® mini glokom İmplant cerrahisi sonuçlarımız]

Objective: To evaluate intraocular pressure (IOP) lowering effect and safety of Ex-PRESS® mini glaucoma drainage implant (Alcon, Fort Worth, TX) for the surgical treatment of glaucoma. Material and Methods: The data of the subjects who underwent Ex-PRESS® mini glaucoma shunt (P-50) implantation surgery in 2011 and 2012 were retrospectively reviewed. IOP before and after the treatment, visual acuity, the number of medications and complications were analyzed. Success was defined as final IOP of 6-21 mmHg with or without antiglaucomatous medications. Results: Thirty two eyes of 32 patients were included in the study. The mean age of patients and mean follow-up time were 54.43±14.56 years (range 20-77 years) and 6.34±2.95 months (range 3-16 months), respectively. Mean pretreatment IOP was 30.71±4.72 mmHg, while it was 13.21±3.51 mmHg (p<0.001) at the first week, 14.46±4.08 mmHg (p<0.001) in the first month, 14.37±2.93 mmHg (p<0.001) in the third month, 13.78±2.98 mmHg (p<0.001) in the sixth month, and 14.53±2.27 mmHg (p<0.001) in the last visit. An IOP less than 21 mmHg was achieved in all eyes in the last visit. The median value of preoperative total antiglaucomatous medications was 4.0 (3.0-5.0), however topical medications were discontinued in 81.3% of patients in the last visit. There were no complications during the follow-up period except one case of early postoperative choroidal effusion. Conclusion: Ex-PRESS® mini glaucoma shunt implantation is supposed to be an effective and safe method for the surgical treatment of glaucoma. It also helped to reduce the number of antiglaucoma medications, thus improving both the quality of life of the patients and their compliance to therapy. © 2014 by Türkiye Klinikleri

Transscleral diode laser cyclophotocoagulation in refractory glaucoma [Dirençli glokom olgularında transskleral diod lazer siklofotokoagülasyon]

Purpose: To evaluate the safety and efficacy of transscleral diode laser cyclophotocoagulation (TSDLC) in advanced glaucoma refractory to medical or surgical treatment. Material and Method: The data of subjects who were treated with TSDLC between 2009 and 2011 were retrospectively reviewed. Intraocular pressure before and after treatment, visual acuity, the number of medications and complications were analysed. Success was defined as final IOP of 6-22 mmHg with or without antiglaucomatous medications. Results: Thirty seven eyes of 37 patients were included in the study. Mean age of patients and mean follow-up time were 61.73±17.13 years (range: 19-80 years) and 8.06±5.81 months (range: 3-22 months), respectively. Mean pretreatment IOP was 38.68±8.94 mmHg and IOP was 26.46±11.34 mmHg (p <0.01) at the second week, whereas it was 24.97±10.84 mmHg (p<0.01) at the last visit. IOP of less than 22 mmHg was achieved in 40.5% of eyes at the last visit. Mean treatment number per eye was 1.48±0.73, and more than one treatment was required in 13 (35.1%) eyes. Preoperative and postoperative mean total antiglaucomatous medications were 3.14±1.18 and 2.76±1.23, respectively. No phthisis bulbi or persistent hypotonia developed during the follow-up period. Discussion: TSDLC is an effective and safe method for the treatment of refractory glaucoma. It also served to reduce the number of antiglaucoma medications, thus improving both the quality of life of the patients and their compliance to therapy. © Galenos Yayinevi

The microbiological diagnosis of tuberculous meningitis of Haydarpasa-1 study

AbstractWe 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-γ release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, LÖwenstein 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 (Κ = −0.189); ACS and L-J culture (Κ = −0.172) (p <0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (Κ = −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