Alterations in Biomechanical Properties of the Cornea After Selective Laser Trabeculoplasty

Aim:To investigate changes in corneal biomechanical properties after selective laser trabeculoplasty (SLT).Methods:Patients who have received SLT and underwent evaluation of corneal biomechanical properties by ocular response analyzer (ORA) in the preoperative period, one week, and one month after SLT were analyzed. Statistical analyzes were performed by examining pre- and post-SLT examination findings and ORA measurement values from the patients’ files.Results:The mean corneal compensated intraocular pressure (IOP) values were found to be significantly reduced one week and one month after the SLT than the values before the treatment (17.14±4.06 mmHg, and 16.91±3.55 mmHg, 19.96±5.00 mmHg; respectively; p=0.004). The mean corneal hysteresis (CH) measurements one week and one month after the SLT were not different from the preoperative measurements (9.89±2.17, 10.12±1.90, and 9.81±2.46, respectively) (p=0.662). The mean corneal resistance factor (CRF) measured prior to the SLT was higher than that in the first week and first month after SLT (11.09±2.08, 10.16±2.04 and 10.39±2.13, respectively) (p=0.002).Conclusion:CH was found to be unchanged, while CRF was found to be decreased. The development of IOP reduction without statistically unaffected changes in CH and decreased CRF suggests that SLT does not have a significant side effect on the structural integrity of the cornea

Factors affecting visual acuity after accelerated crosslinking in patients with progressive keratoconus

ABSTRACT Purpose: The present study aimed to report the outcomes of patients with progressive keratoconus who were treated via accelerated crosslinking (CXL) 6 months earlier and to determine the factors that promoted improved visual acuity after treatment. Methods: This retrospective study included 35 eyes of 34 patients with progressive keratoconus who underwent CXL. Topographical measurements were obtained preoperatively and in the first, third, and sixth months postoperatively using a rotating Scheimpflug camera. The uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), flat keratometry (K) value (K1), steep K value (K2), average K value (avgK), topographic cylindrical value (Cyl), apical keratoscopy front (AKf), apical keratoscopy back (AKb), symmetry index front (SIf), symmetry index back (SIb), and thinnest point of the cornea (ThkMin) were recorded. Results: At the 6-month follow-up, the mean UCVA and BCVA values were improved, and the K values remained stable. Statistically significant decreases in AKf (p=0.04) and the thinnest point of the cornea (p=0.001) and a statistically significant increase in AKb (p=0.01) were observed. A correlation analysis revealed that the preoperative BCVA, UCVA, K1, K2, avgK, AKf, and AKb values significantly affected visual acuity at the 6-month follow-up. Conclusions: Accelerated CXL is an effective treatment for the prevention or even reversal of keratoconus progression. The preoperative K values and apexes of the anterior and posterior cornea were found to affect visual acuity at 6 months after accelerated CXL. Both AKb steepening and AKf flattening appear to be important factors in the stabilization of keratometric values and improvement of visual outcomes

The role of ocular response analyzer in differentiation of forme fruste keratoconus from corneal astigmatism

Purpose:To determine the diagnostic accuracy of corneal biomechanical factors in differentiating patients with forme fruste keratoconus (FFKC) from astigmatic and normal cases.Methods:A total of 50 eyes with FFKC, 50 with astigmatism and 50 normal eyes, were included in this study. All patients had a detailed ophthalmologic examination including slit-lamp evaluation, Goldmann tonometry, indirect fundoscopy, topography by Scheimpflug imaging biomicroscopic anterior and posterior segment examination, and corneal biomechanical and intraocular pressure evaluation with ocular response analyzer (ORA).Results:All topographic findings were statistically significant among the three groups (P>0.05). Although there was no statistically significant difference in the corneal-compensated intraocular pressure (IOPcc) among the three groups, the Goldmann-correlated intraocular pressure (IOPg), corneal hysteresis (CH), and corneal resistance factor (CRF) were statistically significantly lower in the FFKC group, compared with the other groups (P<0.001). There were no statistically significant difference in the IOPg, CH, and CRF between astigmatism and control groups (P=0.99, 0.79, and 0.86, respectively). The area under the receiver operating characteristic (AUROC) curve was greater than 0.85 for IOPg (0.80), CH (0.85), and CRF (0.90) for discriminating between FFKC and controls; whereas the AUROC was greater than 0.85 for IOPg (0.80), CH (0.79), and CRF (0.85) for discriminating between FFKC and astigmatism groups.Conclusion:Based on our study results, in differentiation of patients with FFKC from normal control cases or astigmatic patients, corneal biomechanical parameters play a role particularly in patients with suspicious results. We suggest using ORA in combination with corneal topography for better and more accurate diagnosis of FFKC

Optical coherence tomography findings in optic disk melanocytoma

A 49 years old male patient admitted to hospital with difficulty in reading. Distant visual acuity, anterior segment examination, and intraocular pressure measurements were normal in his both eyes. The fundus examination was normal in his right eye but in the left eye a pigmented lesion overlying and surrounding the optic disk was detected. Visual field examination (HFA II version 740 Humphrey Instruments, Inc SanLeandro, CA, Central 30-2 Threshold Test) was unremarkable in his right eye but an enlarged blind spot was detected in his left eye. Optical coherence tomography (OCT) scans showed high reflectance layer with optical shadowing behind it. OCT is a useful device in describing the actual size of melanocytoma and its follow up. OCT has a role to find out associated subretinal fluid, cystoid retinal edema, retinal traction and epiretinal membrane. We are presenting this case to emphasize the OCT findings of melanocytoma

Thyroid Hormon Levels In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Aim; The severity of airway obstruction in chronic obstructive pulmonary diseases (COPD) is associated with impairment of thyroid gland function. Methods; We evaluated thyroid abnormalities in patients with COPD and relationship between pulmonary function tests, arterial blood gases and thyroid functions. Results; There was no significant difference in mean levels of TSH, FT3 and FT4 between COPD and control group. Serum level of TSH was lower than normal limits in 20 of 62 patients with COPD. Serum level of FT3 was higher than normal limits in 2 of 20 patients with lower TSH level. In control group, TSH was lower than normal limits in 2 patients, but FT3 was normal in these patients. There was significant difference according to percentage of cases with TSH less than minimum values and FT3 higher than maximum values between COPD and control group. Conclusion; we have demonstrated that both clinic and subclinic hyperthyroidism were higher in patients with COPD exacerbations than cases without COPD

Alterations in biomechanical properties of the cornea among patients with polycystic kidney disease

WOS: 000439166500024PubMed ID: 28664236The aim of this study was to evaluate the corneal biomechanical features in polycystic kidney disease (PKD) patients and compare them with the healthy individuals. Totally 81 patients with a mean age of 48.46 +/- 14.51 years and 60 control cases with a mean age of 44.68 +/- 12.69 years were included in the study. All of the subjects underwent a complete ophthalmological examination, including visual acuity testing, biomicroscopic anterior and posterior segment examinations. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg) and corneal-compensated intraocular pressure (IOPcc) were evaluated with the ocular response analyzer, and the central corneal thickness was evaluated with Sirius(A (R)) corneal topography. PKD patients had significantly increased CH values, without any alterations in IOP or CCT values, compared with the control cases (p:0.001). Among PKD patients, 23 were having liver cysts accompanying renal cysts. There was not any statistically significant difference between PKD patients with or without liver cysts regarding biomechanical properties of the cornea. However, both patient groups had statistically significantly increased CH values compared with the control cases. Patients with PKD present with higher CH values than age-matched controls. Larger studies are warranted to elucidate the alterations in corneal biomechanical properties and their clinical relevance in PKD patients

The effects of hemodialysis on tear osmolarity

WOS: 000365249700001PubMed ID: 26640702Aim. To determine the effects of hemodialysis (HD) on tear osmolarity and to define the blood biochemical tests correlating with tear osmolarity among patients with end stage renal disease (ESRD). Material-Method. Tear osmolarity of ESRD patients before and after the hemodialysis program was determined as well as the blood biochemical data including glucose, sodium, potassium, calcium, urea, and creatinine levels. Results. Totally 43 eyes of 43 patients (20 females and 23 males) with a mean age of 53.98 +/- 18.06 years were included in the study. Tear osmolarity of patients was statistically significantly decreased after hemodialysis (314.06 +/- 17.77 versus 301.88 +/- 15.22mOsm/L, p = 0.0001). In correlation analysis, pre-HD tear osmolarity was negatively correlated with pre-HD blood creatinine level (r = -0.366, p = 0.016). Post-HD tear osmolarity was statistically significantly correlated with the post-HD glucose levels (r = 0.305 p = 0.047). Tear osmolarity alteration by HD was negatively correlated with creatinine alteration, body weight alteration, and ultrafiltration (r = -0.426, p = 0.004; r = -0.365, p = 0.016; and r = -0.320, p = 0.036, resp.). There was no correlation between tear osmolarity and Kt/V and URR values. Conclusion. HD effectively decreases tear osmolarity to normal values and corrects the volume and composition of the ocular fluid transiently. Tear osmolarity alteration induced by HD is correlated with body weight changes, creatinine alterations, and ultrafiltration

L’hémorragie sous-hyaloïdienne comme premier signe de présentation clinique d’un adénocarcinome gastrique

WOS: 000425546600008PubMed ID: 29310953A 43-year-old man presented to our clinic complaining of a sudden onset of reduced vision in both eyes. Full ophthalmological evaluation was performed. His visual acuity was finger counting at 1 meter in both eyes. The anterior segments were unremarkable. Fundus examination showed bilateral peripapillary and premacular subhyaloid hemorrhage, flame-shaped retinal hemorrhages and Roth’s spots (Fig. 1). A complete blood count was performed. The hematological evaluation was carried out. The patient’s platelet count was 35 × 109/L (normal range: 150—450 × 109/L); hemoglobin level was 8.8 g/dL (normal range: 13.3—17.2 g/L). Coagulation profile (prothrombin time and partial thromboplastin time) was normal. The patient was referred to a gastroenterologist. Endoscopy was performed after initial examination. He was diagnosed with gastric adenocarcinoma. Upper gastrointestinal system bleeding was controlled with medical treatment

Alterations in corneal biomechanical and topographic features after accelerated crosslinking: 1-year results

Objectives: To determine the biomechanical and topographic alterations within the first year after accelerated crosslink-ing (CXL) treatment in patients with keratoconus. Methods: In this prospective study, 52 eyes of 52 patients with progressive keratoconus underwent accelerated CXL were included. All patients had a detailed preoperative ophthalmologic examination, including slit-lamp evaluation, Gold-mann tonometry, fundoscopy, topography by Scheimpflug imaging (Sirius), and corneal biomechanical evaluation with a biomechanical waveform analysis device (ORA). Alterations in visual acuity and topographic findings were evaluated before the treatment and at 12 months follow-up. Corneal biomechanical features were obtained before the treatment, and at 1st, 3rd, 6th and 12th months. Results: Uncorrected-visual acuity and best-corrected visual acuity both statistically significantly improved at 12th month (p=0.001). There were no statistically significant differences in keratometry values, whereas maximum K (AKfront) and symmetry index front (SIfront) decreased significantly (p=0.015 and p=0.009, respectively). Corneal thinnest point and volume also decreased significantly at 12th month (p=0.001 for both). Goldmann-correlated intraocular pressure (IOPg) and corneal compensated IOP (IOPcc) values transiently increased in the first three months, while corneal hysteresis (CH) and the corneal resistance factor (CRF) transiently decreased, with the difference not statistically significant (p>0.05). However, central corneal thickness significantly decreased at the end of the 12th month (p=0.001). Conclusion: Accelerated CXL seems to be effective in stopping the progression of keratoconus. Our findings showed transient alterations in biomechanical features, which will end with the preoperative values at the end of the 12th month. Further studies are needed to demonstrate the changes in corneal biomechanics in vivo