Aims/Purpose: Corneal collagen cross‐linking (CXL) treatment is widely applied to halt the progression of ectatic diseases such as keratoconus. Unfortunately, the standard CXL procedure based on ...riboflavin and UV‐A light can only be applied to cornea thicker than 400 μm and results in frequent complications, such as corneal haze and endothelial damage 1. This study investigates a new CXL procedure based on ruthenium, which is a water‐soluble photoinitiator and visible light (430 nm) in vivo.
Methods: For the CXL procedure, tris(bipyridine)ruthenium(II) (Ru(bpy)32+), an SPS solution was applied to the rat's cornea and exposed to blue light. After the crosslinking procedure, observations were made for corneal opacity, corneal neovascularization, limbal neovascularization and corneal epithelial damage. Furthermore, the corneas were isolated for histopathological examination, cell viability and SEM analysis, and the results were compared with the conventional riboflavin/UV‐A crosslinking approach.
Results: Crosslinked corneas with ruthenium‐based CXL approach showed significantly improved scoring in corneal opacity, corneal neovascularization, limbal neovascularization and corneal wound healing as compared to the standard riboflavin and UVA‐based CXL procedure. Histopathological analysis and cell viability revealed ruthenium to be nontoxic and create more bonds between collagen fibrils when observed under scanning electron microscopy.
Conclusions: In this in vivo study, the ruthenium and visible light‐based crosslinking approach proved to be non‐toxic and a faster alternative to the conventional riboflavin and UVA‐based CXL method. We foresee that ruthenium visible light‐based crosslinking treatment could potentially change the treatment modality in keratoconus patients in a clinical setting.
Funding Information: This work is supported by the Scientific and Technological Research Council of Turkey (TÜBİTAK) under GrantARDEB‐219S349.
References:
1. Gulzar, A., et al., Ruthenium‐induced corneal collagen crosslinking under visible light. Acta Biomater, 2022. 147: p. 198–208.
The pine processionary caterpillar is an insect that has multiple small, thin hairs around its body as a defense mechanism. These hairs have a hazardous effect on ocular structures and cause a broad ...range of reactions from conjunctivitis to endophthalmitis, referred to as ophthalmia nodosa. The diagnosis of the disease is based on the patient's history and the detection of the hairs on ocular structures. In this report, we present a patient with ophthalmia nodosa misdiagnosed as fungal keratitis, and the actual diagnosis was made by
confocal microscopy. We also would like to increase awareness among ophthalmologists about the disease which has a growing distribution area due to climate change.
Objectives: To investigate the effect of the novel coronavirus disease 2019 (COVID-19) pandemic on the clinical practice of ophthalmologists in our country. Materials and Methods: A questionnaire ...consisting of 22 questions was delivered to 250 ophthalmologists via e-mail and a smartphone messaging application. A total of 113 ophthalmologists completed the survey. The questions included the participants' demographic data (age, years in practice, institution, and city), changes in their working conditions and institutional preventive measures implemented during the pandemic, their personal COVID-19 experiences, the prevalence of telemedicine applications, and their attitudes toward these practices. Results: Nearly half (47.8%) of the 113 ophthalmologists were 36 to 45 years old. In terms of years in practice, the largest proportion of respondents (28.3%) had 6-10 years of experience. Most of the participants worked in private/foundation universities (37.2%), while 22.1% worked in education and research clinics. Participants working at public universities most often reported that they or a close contact had to work in COVID wards (89.5%). Triage was performed in 51.5% of ophthalmology outpatient clinics, with 88.0% of these participants reporting that patients with fever, cough, or dyspnea were directed to the pandemic clinic without ophthalmological examination. All participants working in public hospitals, education and research clinics, and public university hospitals had postponed elective surgeries, whereas 12.5% of those working in private practice and 20.5% of those working in private/foundation universities reported that they continued elective surgeries. While 80.8% of the participants did not conduct online interviews or examinations, 40.4% stated that they considered telemedicine applications beneficial. Seventy-seven percent of participants expressed concern about a decrease in their income during the pandemic, with this being especially common among participants working in private practice (87.5%) and private/foundation university hospitals (85.7%). Conclusion: Ophthalmologists across our country have been affected by this pandemic at a level that will change their clinical approach. We think that ophthalmologists impacted by the difficulty of providing personal protective equipment and economic concerns should be supported more during the pandemic. Keywords: COVID-19 pandemic, ophthalmology clinical practice, survey
This study is an analysis of the cosmetic and functional results of patients who underwent keratopigmentation (KTP).
Sixteen eyes of 16 patients, 7 females (43.75%) and 9 males (56.25%) were included ...in the study. Intrastromal and superficial manual KTP were performed under general anesthesia. Patients with no light perception or with only light perception but total corneal opacification, prosthetic contact lens intolerance, or unwillingness to use a contact lens were studied. The main outcomes were postoperative patient's satisfaction, cosmetic results, pigment stabilization and surgical complications. A grading system (0-5 points) was used to assess patient satisfaction and the cosmetic results.
The mean age of the patients was 30.5±12.06 years (range: 16-53 years). Black pigment was used in 10 patients (62.5%), a brownish color in 5 patients (31.25%) and a greenish, yellow, blue, and black color pigmentation was used for 1 patient (6.25%). The mean follow-up was 29.31±15.45 months (range: 8-52 months). In 2 of 16 patients, mild to moderate pigment loss was seen 12 months after the surgery and superficial KTP was repeated. Minimal pigment loss was seen in 5 patients, but the cosmetic results were satisfactory and no secondary surgical procedure was required. Pigment leakage underneath the conjunctiva was seen in only 1 patient. Otherwise, there were no complications associated with keratopigmentation. The postoperative mean patient satisfaction score was 4.18±0.75 points (range: 3-5 points).
KTP is a safe surgical procedure that is easy to learn and perform, does not require expensive materials, and avoids more extensive and invasive reconstructive ocular procedures. Corneal KTP may have a great impact on future ophthalmic surgical practice from both therapeutic and cosmetic perspectives.
To investigate the efficacy of lid wipes (LWs) containing terpinen-4-ol and sodium hyaluronate (Hy-ter
) for the treatment of seborrheic blepharitis compared to baby shampoo (BS).
This randomized, ...double-blind, active control, parallel group, multicentre clinical trial included 48 eyes of 48 patients with seborrheic blepharitis who were randomly divided into two treatment arms (1:1, n = 24) using block randomization. LWs or BS were prescribed twice a day for 8 weeks followed by a discontinuation period of 4 weeks. Change in Blepharitis Symptom measure (BLISS), Schirmer's test, tear breakup time (TBUT), noninvasive TBUT (NI-TBUT), ocular surface disease index (OSDI) score, corneal and conjunctival staining, meibography, and Demodex count at different visits (Baseline, 4th, 8th, and 12th week) were the main outcome measures.
The baseline values of both groups were similar (p > 0.05). Despite high clinical efficacy in both treatment arms, patients using LWs showed a lower BLISS score at the 8th and 12th-week visit (1.9 ± 2.2 versus 7.2 ± 6.6, p = 0.003; 4.0 ± 1.3 versus 5.8 ± 6.3, p = 0.026). NI-TBUT showed a significant increase starting from the 4th week for patients using LWs and 8th week for patients using BS. Both treatment modalities caused a reduction in the Demodex count after 4 weeks of treatment (p < 0.001). The treatment withdrawal did not cause any recurrence in both treatment arms.
BS or LWs containing Hy-ter
can be used with good efficacy for the treatment of seborrheic blepharitis. However, LWs may provide a better symptomatic relief compared to BS after 8 weeks of treatment.
AIM: To compare the outcomes achieved with external dacryocystorhinostomy(EX-DCR) and transcanalicular dacryocystorhinostomy(TC-DCR) using a multidiode laser in patients with bilateral nasolacrimal ...duct obstruction(NLDO).METHODS: This prospective study was conducted on38 eyes of 19 patients with bilateral NLDO. Simultaneous bilateral surgery was performed on all patients. TC-DCR(Group 1) with a diode laser was used in the right eye,and EX-DCR(Group 2) was used in the left eye. All patients were placed under general anesthesia. Routine follow-ups were scheduled at 1wk; 1, 3, 6 and 12 mo postoperative intervals. Objective(lacrimal system irrigation) and subjective tearing, irritation, pain,discharge and visual analogue scale(VAS) scoreoutcomes were evaluated.RESULTS: The overall objective success rate at 12 mo was 73.7%(14/19) in Group 1 and 89.5 %(17/19) in Group2. This difference was statistically significant. There were no significant between-group differences in the subjective results, such as tearing, pain and irritation.Only the discharge scores were found to be significantly higher in Group 1 compared to Group 2 at the 1y followup. The average VAS score was 6.8 in Group 1 and 8.7 in Group 2, with no statistically significant differences.CONCLUSION: Although TC-DCR allows surgeons to perform a minimally invasive and safe procedure, EX-DCR offers better objective and subjective outcomes than TC-DCR.
Purpose. Since quantification and communication of ocular pain is important for a healthier patient follow-up and postoperative guidance, reliable measures like the Ophthalmic Pain Assessment Survey ...(OPAS) are needed to assess the outcome and management of different operations. To address that need, we carried out the adaptation of OPAS into Turkish to reach different age groups and backgrounds, widening the use of OPAS on patients who underwent an ophthalmic operation. Methods. We used back-translation method and achieved cultural adaptation through content validity scoring by 5 independent ophthalmologists. The survey is then administered three times: preoperatively, postoperatively within 24 hours, and finally a week later in the follow-up visit. Validity is measured in comparison to Visual Analog Scale using Spearman’s correlation coefficient and reliability is measured using Cronbach’s alpha. Factor analysis is performed by principal component analysis and rotation is performed using Varimax method when necessary. Results. We reached a total of 132 patients with a mean age of 64.2 years. Most of them underwent phacoemulsification (n = 83), followed by PRK (n = 37). Overall, the T-OPAS demonstrated good reliability (mean C. alpha: 0.830) and its correlation with the VAS was especially high (S. coeff. >0.5) in the first three sections in all three surveys. Factor analysis yielded 5 subscales, allowing us to shape the final form of T-OPAS. Conclusion. Through this adaptation of OPAS into a foreign language, we present a reliable and valid tool for postoperative pain quantification, allowing objective measurement of pain in different populations such as the elderly.
Purpose
To evaluate choroidal vascular involvement in pseudoexfoliative glaucoma (PEXG) by applying the choroidal vascularity index (CVI) to optic coherence tomography (OCT) images.
Methods
...Seventy-eight eyes from 40 subjects were included the study. Group 1 included healthy eyes (
n
= 20), group 2 eyes with PEX (
n
= 16), and group 3 eyes with PEXG (
n
= 42). OCT imaging of macular and peripapillary regions and retinal nerve fiber layer (RNFL) analyses were performed. CVI was calculated using ImageJ software.
Results
The mean age was 64.89 ± 5.8, 71.2 ± 7.8, and 68.24 ± 7.4 years in groups 1, 2, and 3, respectively (
p
= 0.046). There were no significant differences between the groups in terms of sex (
p
= 0.777). In macula, mean CVI rates were 66.97 ± 1.9%, 64.23 ± 1.2%, and 64.63 ± 1.6%, and in the peripapillary areas, mean CVI rates were 67.04 ± 1.5%, 65.20 ± 1.5%, and 64.14 ± 2.1% in groups 1, 2, and 3, respectively (group 1 vs. group 2 and 3,
p
= 0.000; group 2 vs. group 3,
p
> 0.05). The decrease in average RNFL thickness was statistically significant in group 3 compared to groups 1 and 2.
Conclusion
CVI could be used to assess choroidal vascular changes in ocular diseases. CVI was found to be reduced in PEX and PEXG, indicating an ocular vascular involvement in pseudoexfoliative process.
To determine the clinical outcomes in patients after type 1 Boston keratoprosthesis surgery and the significance of ultrasound biomicroscopy imaging for postoperative follow-up.PURPOSETo determine ...the clinical outcomes in patients after type 1 Boston keratoprosthesis surgery and the significance of ultrasound biomicroscopy imaging for postoperative follow-up.This retrospective analysis included 20 eyes of 19 patients who underwent corneal transplantation with type 1 Boston keratoprosthesis between April 2014 and December 2021. Data on patient demographics, preoperative diagnosis, visual acuity, and postoperative clinical findings were analyzed.METHODSThis retrospective analysis included 20 eyes of 19 patients who underwent corneal transplantation with type 1 Boston keratoprosthesis between April 2014 and December 2021. Data on patient demographics, preoperative diagnosis, visual acuity, and postoperative clinical findings were analyzed.Type 1 Boston keratoprosthesis implantation resulted in intermediate- and long-term positive outcomes. However, blindness and other serious complications such as glaucoma, retroprosthetic membrane formation, endophthalmitis, or retinal detachment also occurred. The use of ultrasound biomicroscopy imaging allowed for better evaluation of the back of the titanium plate, anterior segment structures, and the relationship of the prosthesis with surrounding tissues, which provided valuable postoperative information.RESULTSType 1 Boston keratoprosthesis implantation resulted in intermediate- and long-term positive outcomes. However, blindness and other serious complications such as glaucoma, retroprosthetic membrane formation, endophthalmitis, or retinal detachment also occurred. The use of ultrasound biomicroscopy imaging allowed for better evaluation of the back of the titanium plate, anterior segment structures, and the relationship of the prosthesis with surrounding tissues, which provided valuable postoperative information.Regular lifetime monitoring and treatment are necessary in patients who undergo Boston type 1 keratoprosthesis implantation for high-risk corneal transplantation. ultrasound biomicroscopy imaging can be a valuable imaging technique for the evaluation of patients with Boston type 1 keratoprosthesis, providing important information on anterior segment anatomy and potential complications. Further studies and consensus on postoperative follow-up protocols are required to optimize the management of patients with Boston type 1 keratoprosthesis.CONCLUSIONRegular lifetime monitoring and treatment are necessary in patients who undergo Boston type 1 keratoprosthesis implantation for high-risk corneal transplantation. ultrasound biomicroscopy imaging can be a valuable imaging technique for the evaluation of patients with Boston type 1 keratoprosthesis, providing important information on anterior segment anatomy and potential complications. Further studies and consensus on postoperative follow-up protocols are required to optimize the management of patients with Boston type 1 keratoprosthesis.
Objective: To evaluate the effect of phacoemulsification with intraocular lens (IOL) implantation on intraocular inflammation using laser flare photometer in eyes with uveitis.
Materials and Methods: ...Sixty-six eyes of 55 consecutive patients followed-up at Istanbul University, Istanbul School of Medicine, Department of Ophthalmology, Uveitis Service undergoing phacoemulsification with posterior chamber intraocular lens implantation between December 2009 and April 2013 were included in this retrospective study. Clinical records of patients were analyzed for demographic data, pre-operative and post-operative best-corrected visual acuity (BCVA), intraocular pressure, and quantitative measurement of inflammation with laser flare photometry. Baseline evaluations were performed 1 day before surgery and follow-up examinations took place at 1, 7, 30, and 90 days after surgery. Main outcome measures were BCVA and quantitative measurement of intraocular inflammation with laser flare photometry.
Results: Best-corrected visual acuity improved in 60 eyes and visual loss did not occur in any eye. Median intraocular flare value the day before surgery was 8.2 (range: 3.1-82.2) photons/ms. Postoperatively, median flare value initially increased to 16.8 (range: 0-158) photons/ms on day 1 which was a statistically significant increase compared to preoperative values. Thereafter decreased to 10.40 (range: 0-110) photons/ms on day 7, 11.25 (range: 4.4-145) photons/ms on day 30, and 8.1 (range: 0-84.6) photons/ms on day 90. There was no statistically significant difference between preoperative values and day 90.
Conclusion: In uveitic eyes with well-controlled ocular inflammation before surgery, phacoemulsification with IOL implantation appears safe and effective as assessed by changes in the BCVA and laser flare photometry, an objective method to measure intraocular inflammation.
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