Ayhan Saglik

This study aims to evaluate the visual performance of scleral contact lenses (SCLs) in patients with keratoconus based on disease stage and cone localization and provide data to inform clinical practice. This retrospective study included 95 eyes from 61 keratoconus patients (34 females and 27 males) who underwent corneal cross-linking and were regularly followed at a single center between December 2019 and December 2023. Patients were categorized according to keratoconus stage (mild, moderate, or advanced) and cone localization (central, paracentral, or inferior) based on corneal topography. Visual acuity was recorded before and after mini SCL fitting, as were corneal topography and anterior segment parameters. Statistical analyses included the Wilcoxon signed-rank test, Mann–Whitney U test, and Kruskal–Wallis test for group comparisons, with Spearman correlation analysis used to assess associations between parameters. The mean patient age was 23.7 ± 7.1 years. Among the eyes evaluated, 44% had mild, 36% moderate, and 20% advanced keratoconus; cone localization was inferior in 56%, central in 34%, and paracentral in 10%. Mean logMAR visual acuity improved significantly from 0.95 ± 0.54 before SCL fitting to 0.14 ± 0.13 after application ( P <.001), corresponding to a mean Snellen line gain of 0.59 ± 0.20 (95% CI: 0.54–0.64). Visual improvement was significantly greater in eyes with moderate-stage keratoconus and paracentral cone localization compared with other groups ( P <.05). In advanced keratoconus, the gain in corrected distance visual acuity was negatively correlated with keratometry values and anterior chamber depth. SCLs significantly enhance visual acuity in keratoconus patients, with the most substantial benefit observed in those with moderate-stage disease and paracentral cone localization. However, the small sample size in the paracentral group limits the generalizability of subgroup findings. These findings highlight the importance of considering both disease stage and cone location when planning SCL fitting, and suggest that paracentral cones may be predictive of superior visual outcomes with mini SCLs.

Amaç: Pterjiumlu gözlerde topografik keratokonus indekslerindeki değişiklikleri değerlendirmek ve pterjiumun kornea morfolojisi üzerindeki etkisini ortaya koymaktır. Materyal ve metod: Pterjium tanısı konulan 78 hastanın tek gözü çalışmaya dahil edildi. En iyi düzeltilmiş görme keskinliği ve biyomikroskopik muayene yapıldı. Hastalar pterjium evresine göre üç farklı gruba ayrıldılar. Scheimpflug tabanlı kornea topografisi kullanılarak, K1, K2, Km, Kmax, ISV, IVA, KI, CKI, IHA, IHD, Rmin, KISA% ve IS gibi parametreler kaydedildi ve istatistiksel olarak değerlendirildi. Bulgular: Hastaların yaş ortalaması 45,48 ± 14,17 yıldı. Keratokonus indekslerinin çoğu normal sınırlar içinde kaldı; ancak ISV (35,07 ± 31,85), IHA (8,49 ± 11,02) ve KISA% (22,24 ± 25,49) geniş bir aralık gösterdi. pterjium evresi arttıkça yaş ve astigmatizma (p=0.03, p<0.001) ve görme düzeyi azalmaktadır (p<0.001). Ortalama keratokmetri değerindeki değişim ve en ince kornea kalınlığındaki azalma anlamlı değildi. Evre 3 pterjiumda, ISV, IHA, IHD, Rmin, KISA, indekslerinde anlamlı artış saptanırken, IVA, IS, KI de anlamlı azalma saptandı. Sonuç: Pterjium ektatik değişikliklere neden olmasa da, belirli keratokonus endekslerinde yansıyan önemli lokal kornea yüzey düzensizliklerine yol açabilir. Kantitatif topografik analiz, pterjiumun görsel etkisinin anlaşılmasına ve cerrahi planlamaya rehberlik etmeye yardımcı olabilir.

Purpose The Alpins vector analysis approach was used to assess astigmatic changes in eyes with forme fruste keratoconus following combination treatment with photorefractive keratectomy (PRK) and corneal collagen crosslinking (CXL). Methods This retrospective study was performed in 27 eyes from 20 patients with forme fruste keratoconus undergoing treatment with a combination of PRK, followed immediately by corneal collagen CXL. Spherical error, corneal astigmatism, and manifest astigmatism were assessed preoperatively and at 12 months postoperatively. Scheimpflug imaging was used to determine the thinnest corneal thickness, maximum keratometry (Kmax), steep keratometry (K2), and flat keratometry (K1). Alpins vector analysis was used to evaluate the corneal and refractive astigmatism vectors. Results The patients ranged in age from 18 to 35 years, with a mean of 22.00 ± 1.16 years. Unilateral surgery was performed in 7 patients, whereas 13 patients underwent bilateral surgery. After surgery, logMAR corrected distance visual acuity improved from 0.22 ± 0.04 to 0.06 ± 0.01 (p < 0.001). On examination of corneal astigmatism, the difference vector (DV) mean was 0.49 diopters (D) at axis 13°, the arithmetic mean was 0.96 D, and the correction index (CI) geometric mean was 0.64. On examination of manifest or refractive astigmatism, the DV mean was 0.10 D at axis 16°, the arithmetic mean was 0.63 D, and the geometric mean CI was 0.89. Conclusion Patients with forme fruste keratoconus with sufficient corneal thickness may benefit from a combination of surface ablation and crosslinking surgery. Astigmatic changes induced by this treatment can be examined more objectively using Alpins vector analysis.

A 63-year-old Caucasian man with metastatic lung adenocarcinoma undergoing chemotherapy and external radiotherapy was referred for routine eye examination. Although he was asymptomatic, ocular examination revealed a relatively well-circumscribed whitish retinal lesion measuring mm located along the inferotemporal vascular arcade in the right eye. Optical coherence tomography (OCT) showed a hyperreflective dome-shaped lesion occupying the inner retinal layers with few hyperreflective dots overlying the retina in the posterior vitreous consistent with tumor cells. Fluorescein angiography revealed early hyperfluorescence and late staining without leakage at the lesion site. A diagnosis of presumed retinal metastasis from lung adenocarcinoma was made. At 2 months follow-up after completion of chemotherapy, the retinal lesion was found to have regressed completely leaving minor irregularities in the inner retinal layers on OCT. To date, there have been only 41 cases of carcinoma metastasis to the retina reported in the literature including the current case. Despite its rarity, retinal metastasis should be considered in the differential diagnosis of a white-yellow retinal mass with/without overlying vitreous cells especially in patients with a history of systemic cancer.

Purpose To assess risk factors for progression following corneal collagen crosslinking (CXL) in eyes with keratoconus. Methods Charts of patients who developed progression following conventional CXL treatment (Dresden protocol) were retrospectively evaluated in two centers (Center 1 and Center 2). 871 eyes of a total of 676 patients were analyzed. Progression was defined as > 1 diopter (D) increase in maximum keratometry (Kmax) readings compared to baseline. Results Progression was noted in 20 eyes of 20 patients (progression rate 3%). The mean age of the patients was 17.65 ± 5.76 (11–34)-years-old, and the mean follow-up following CXL was 36.70 ± 25.72 (12–84)-months-old. The gender distribution was 13 (65%) females and seven (35%) males. Four eyes (20%) had mild, 13 eyes (65%) had moderate, and three eyes (15%) had severe keratoconus at baseline. Fifteen eyes (75%) had allergic conjunctivitis, and 20 eyes (100%) reported eye-rubbing. Cone location was central in 17 (85%) eyes, and peripheral in 3 (15%) eyes. A mean of 2.21 ± 1.30 D (1.00–5.30 D) steepening was determined at Kmax 6 to 82 months following CXL treatment. Conclusions Progression rate was found to be higher in the patients under the age of 17 years, female gender, allergic conjunctivitis, high preoperative Kmax (> 57 D), thin corneas (< 430 µm). The majority of progressive patients were central cone and moderate keratoconus.

Purpose: To assess risk factors for progression following corneal collagen crosslinking (CXL) in eyes with keratoconus. Methods: Charts of patients who developed progression following conventional CXL treatment (Dresden protocol) were retrospectively evaluated in two centers (Center 1, and Center 2). 871 eyes of a total of 676 patients were analyzed. Progression was defined as >1 diopter (D) increase in maximum keratometry (Kmax) readings compared to baseline. Results: Progression was noted in 20 eyes of 20 patients (progression rate 3%). The mean age of the patients was 17.65 ± 5.76 (11–34) years and the mean follow-up following CXL was 36.70 ± 25.72 (12–84) months. The gender distribution was 13 (65%) females, and seven (35%) males. Four eyes (20%) had mild, 13 eyes (65%) had moderate, and three eyes (15%) had severe keratoconus at baseline. Fifteen eyes (75%) had allergic conjunctivitis and 20 eyes (100%) reported eye-rubbing. Cone location was central in 17 (85%) eyes and peripheral in 3 (15%) eyes. A mean of 2.21 ± 1.30 D (1.00 – 5.30 D) steepening was determined at Kmax 6 to 82 months following CXL treatment. Conclusions: Progression rate was found to be higher in the patients under the age of 17 years, female gender, allergic conjunctivitis, high preoperative Kmax (>57 D), thin corneas (<430 µm) . The majority of progressive patients were central cone and moderate keratoconus.

The aim of the present study was to measure the free carnitine and acylcarnitine levels in pterygium tissue and normal conjunctival tissue at the metabolomics level using tandem mass spectrometry. In this prospective, clinical randomized study, pterygium tissues and normal conjunctival tissues taken during pterygium excision with autograft were compared regarding their free carnitine and acylcarnitine profiles. After tissue homogenization, carnitine levels were measured using tandem mass spectrometry. The data were statistically analyzed with the Wilcoxon signed-rank test. Pterygium and normal conjunctival tissue samples from a single eye of 29 patients (16 females, 13 males; mean age, 54.75 ± 11.25 years [range, 21-78 years]) were evaluated. While the free carnitine (C0) level was significantly high in the pterygium tissue (p<0.001), acylcarnitine levels were significantly high in some esterized derivatives (C2, C5, C5:1, C5DC, C16:1, C18, methylglutarylcarnitine) (p0.05). That the carnitine levels in pterygium tissue were higher suggests that acceleration of cell metabolism developed secondary to chronic inflammation and the premalignant characteristics of pterygium tissue. High carnitine levels may also effectively suppress the apoptosis process. The data reported in our study indicate that further, more extensive studies of the carnitine profile could help clarify the pathogenesis of pterygium.

A 6-year-old female was admitted to the ophthalmology department with a preliminary diagnosis of keratoconus. An accelerated cross-linking (CXL) protocol (9 mW/cm² in 10 minutes) was performed on the right eye. On postoperative day 2, a slit-lamp examination revealed 2 corneal infiltrates with grade 3 haze. Since there was no growth in the cultivated cultures and no response to topical antibiotic treatment, the infiltrates were considered to be sterile, and topical 1% prednisolone drops were applied hourly. Despite topical steroid treatment of 1% prednisolone on postoperative day 5, no significant improvement was observed in the patient’s symptoms and slit-lamp findings. Therefore, systemic 1 mg/kg prednisolone (total dose, 15 mg) was added to the treatment on postoperative day 5. One day after initiating the systemic steroid treatment, the infiltrates had shrunk, and the patient’s complaints decreased. In patients with keratoconus who are under 10 years of age, the addition of a potent steroid regimen to the treatment may be essential in cases with suspected infiltrates after CXL treatment.

The aim of the study was to measure amino acid levels with the metabolomics analysis in pterygium tissue and normal conjunctiva tissue.

To evaluate the ABCD grading system used in follow-up of keratoconus progression after the corneal collagen cross-linking (CXL) treatment in different Kmax groups. This study included 57 eyes of 43 patients applied with CXL treatment for progressive keratoconus. All the patients were applied with the standard CXL protocol (Dresden). According to the changes in the Kmax value at the end of 12 months postoperatively (0-1D, 1-2D, >2D), the groups were separated as steepening and flattening. Scheimpflug progression parameters, such as ABCD keratoconus grading systems, were evaluated in six different groups. The Paired Samples t-test was used in the evaluation of parameters with normal distribution and the Wilcoxon test for parameters not showing normal distribution. A value of p<0.05 was accepted as statistically significant. Mean age of patients was 18.37±3.86 years (11-28 years). According to the ABCD grading system, 0.19 significant regression was determined in grade A (p=0.014) and 0.24 in grade D (p2D flattening groups. Although there is an increase in posterior elevation after CXL, despite excessive Kmax flattening, it would be inaccurate to consider this increase as an indicator of topographic progress.