Efficacy of custom-made soft keratoconus lenses on corneal aberrations and photic phenomena in patients with keratoconus:a corneal topography imaging based study

AIM:To evaluate the efficacy of custom-made soft keratoconus(KC)lenses on corneal aberrations and photic phenomena in two different optical zones in patients with KC.METHODS:Sixty eyes of 42 patients with KC were examined at baseline and after fitting HydroCone(Toris K)soft silicone hydrogel lenses.Best spectacle-corrected visual acuity(BSCVA)and contact lens-corrected visual acuity(CLCVA)were recorded.Lower-and higher-order corneal aberrations(LOAs and HOAs)were measured with and without Toris K lenses and compared in central 4.5 mm and 7 mm zones.Mesopic pupil diameter and subjective photic phenomena were also assessed.RESULTS:Mean CLCVA was significantly improved compared to BSCVA(P<0.0001).Corneal curvature and refractive measurements were found to be significantly reduced by the use of Toris K lenses,except for posterior corneal curvature values.In the 4.5 mm central optical zone,all wavefront aberrations decreased significantly after lens fitting(P<0.0001).In contrast,in the 7 mm(peripheral)optical zone,values for HOAs,spherical and residual aberrations,and optical path differences were increased,while LOAs,trefoil,and quadrifoil coefficients were decreased.The rate of photic phenomena was significantly higher in participants with a pupil size>6.00 mm(85.7%).CONCLUSION:Toris K lenses provide good visual results and a significant reduction in central corneal aberrations in patients with KC but could cause an increase in peripheral aberrations.This practical and nonsurgical approach appears to be an effective method for the visual management of KC.

Comparison of intravitreal bevacizumab and triamcinolone acetonide theraphies for diffuse diabetic macular edema

AIM: To compare therapeutic effects of intravitreal triamcinolone acetonide(IVTA) versus intravitreal bevacizumab(IVB) injections for bilateral diffuse diabetic macular edema(DDME). METHODS: Forty eyes of 20 patients with bilateral DDME participated in this study. For each patient, 4 mg/0.1 m L IVTA was injected to one eye and 2.5 mg/0.1 m L IVB was injected to the other eye. The effects of injection for diabetic macular edema(DME) were evaluated using best-corrected visual acuity(BCVA), central macular thickness(CMT) by optical coherence tomography(OCT)and intraocular pressure(IOP) by applanation tonometer.Patients underwent eye examinations, including BCVA,CMT, and IOP at pre-injection, 1, 4, 8, 12 and 24 wk after injection. During the follow-up, second injections were performed to eyes which have CMT greater than 400 μm at 12 wk for salvage therapy.RESULTS: BCVA(logarithm of the minimum angle of resolution) at pre-injection, 1, 4, 8, 12 and 24 wk after injection was 0.71 ±0.19, 0.62 ±0.23, 0.63 ±0.12, 0.63 ±0.13,0.63±0.14 and 0.61±0.24 in the IVTA group and 0.68±0.25,0.61 ±0.22, 0.60 ±0.24, 0.62 ±0.25, 0.65 ±0.26 and 0.59 ±0.25 in the IVB group, respectively. CMT(μm) at pre-injection,1, 4, 8, 12 and 24 wk after injection was 544 ±125, 383±96,335 ±87, 323 ±87, 333 ±92, 335 ±61 in the IVTA group and514 ±100, 431 ±86, 428 ±107, 442 ±106, 478 ±112, 430 ±88 in the IVB group respectively. Reduction ratios of mean CMT were 29% at 1wk, 38% at 4wk, 40% at 8wk, 38% at12 wk, and 38% at 24 wk in the IVTA group. Second IVTA injections were performed to the 6 eyes(30%) at 12 wk.Reduction ratios of mean CMT were 16% at 1wk, 17% at4wk, 14% at 8wk, 7% at 12 wk, and 16% at 24 wk in the IVB group. Second IVB injections were performed to the15 eyes(75%) at 12 wk.CONCLUSION: This study showed earlier and more frequent macular edema recurrences in the eyes treated with bevacizumab compared with the ones treated with triamcinolone acetonide. Triamcinolone acetonide was found to provide more efficient and long-standing effect in terms of reducing CMT compared with the bevacizumab.

Clinical value of phenylephrine testing in the upper and lower eyelids of patients with aponeurotic and congenital eyelid ptosis

·AIM:To characterize the phenylephrine test in aponeurotic and congenital eyelid ptosis,to determine the appropriate timing of the phenylephrine test,and to assess the responses of the upper and lower eyelids.·METHODS:This was a retrospective analysis of 140 eyes of 87 patients(mean age 52.29±16.45 y;22 males,65 females)with upper eyelid ptosis.Totally 88.6%had aponeurotic and 11.4%had congenital ptosis.For the evaluation of the responses of the upper and lower eyelids to topical 2.5%phenylephrine,the scleral show height,the marginal reflex distance(MRD)between the inferior margin of the upper eyelid and pupillary light reflex(MRD1),and between the central portion of the lower eyelid and pupillary light reflex(MRD2)were measured at the 2^(nd),5^(th),and15^(th)minutes.The changes of MRD1 and MRD2 with time(ΔMRD1 andΔMRD2)were evaluated.·RESULTS:The mean MRD1,MRD2.and scleral show heights increased within 5 min after testing,remaining largely stable between the 5^(th)-15^(th)minutes.The percentage of eyes with a greater response in MRD1 increased with increased severity of ptosis(P<0.05).Eyes with aponeurotic ptosis were more responsive to phenylephrine testing than congenital ptosis.The mild ptosis group had lower scleral show measurements and higherΔMRD2 values.TheΔMRD1 andΔMRD2 values were poorly correlated in all measurement times.·CONCLUSION:Performing the phenylephrine test 5 min after instilling the reagent is adequate to assess the maximum response of the upper and lower eyelids.The upper and lower eyelid responses in phenylephrine testing are poorly correlated.However,theΔMRD2 is related with baseline scleral show degree that may be a postoperative predictive factor.Further studies are necessary to determine the relationship between the responses of the lower eyelids to phenylephrine testing.

Effect of trabeculated myocardial mass on left ventricle global and regional functions in noncompaction cardiomyopathy

BACKGROUND Left ventricular(LV)noncompaction cardiomyopathy is a rare cardiomyopathic subtype that has been recognized in recent years and is being diagnosed at an increased rate.There is no consensus regarding the diagnosis of the disease,and increased trabeculation rates that meet the existing diagnostic criteria may even be present in healthy asymptomatic people.This indicates that differentiating criteria for diagnosis are needed.AIM To examine the increase in myocardial trabeculation and the change in left ventricular global and regional functions.METHODS This retrospective study included 65 patients(28 females,37 males)diagnosed with LV noncompaction cardiomyopathy who underwent cardiac magnetic resonance imaging between January 2011 and August 2016 and had a noncompacted/compacted myocardial thickness ratio of over 2.3 in more than one segment in the left ventricle.The distribution and ratios of trabeculations in apical,midventricular,and basal regions were examined in short-axis images obtained from cardiac magnetic resonance.In addition,by using short-axis cine images,regional ejection fraction(EF)and global EF were calculated using the Simpson method in the left ventricle at apical,basal,and midventricular levels.RESULTS While the number of trabeculated segments were similar at the apical(3.2±1.0)and midventricular levels,a statistically significant level of involvement was not observed at the basal level(0.4±0.9)(P>0.05).The highest noncompacted/compacted(trabeculation)ratio was observed at the apical level(3.9±1.4),while this ratio was higher at the anterior(59%-89.4%)and lateral(62%-84.8%)segments(P>0.05).Global EF was positively correlated with apical,midventricular,and basal regional EF(P<0.05).However,there was no significant correlation between regional EF and the number of trabeculated segments or trabeculation ratio in all three regions;nor was there a significant correlation between regional EF and the number of trabeculated segments or trabeculation ratio in the entire LV(P>0.05).CONCLUSION No global or regional relationship was observed between LV dysfunction and trabeculation rate or the number of trabeculated segments.This limits the usefulness of change in LV functions in the differentiation between normal and pathological trabeculation.

Isolated Triquetrum Fractures: The Importance of Proper Roentgenograms in Ulnar Sided Wrist Pain

Triquetrum fractures are the second most common carpal fractures after scaphoid. However they are seldom encountered due to their clinical symptoms and since they cause less functional disability. They can be misdiagnosed as soft-tissue injuries by considering the similar localization of pain and prolonged symptoms. The majority of triquetrum fractures can be diagnosed with direct X-ray. Obtaining three plane (anterior-posterior, lateral and oblique) X-rays is especially important in diagnosing dorsal chip fractures. Accurate diagnosis provides both controlling the symptoms with adequate immobilization, sufficient information of the patient in the acute period and preventing unnecessary diagnostic work up in the subacute period because of prolonged discomfort. In our study, fifteen patients with isolated triquetrum fractures admitted within six year period were presented with their clinical, radiological features and treatment outcomes.

Synovial Chondromatosis of the Elbow Joint in a 27-Year-Old Man:A Case Report

Introduction: Multiple intraarticular loose bodies are pathognomonic for the Synovial chondromatosis. This disorder affects a wide age range from adults to childhood with no sex dominance. Malignant transformation is rare to date, and there are approximately 34 cases in literature about the transformation of synovial chondromatosis to chondrosarcoma. Case: We present case of a 27-year-old patient who had synovial chondromatosis in his elbow. Discussion: Radiographic findings are usually pathognomonic for the diagnosis. Multiple calcified loose bodies can be seen in the joint in radiographs. Computed tomography (CT) optimally depicts the calcified intraarticular fragments and extrinsic bone erosion. However, because the radioopacity cannot be detected in 1/3 of the cases, diagnosis becomes difficult. Treatment modalities include arthroscopic or open extraction of the loose bodies and arthropasty in the presence of severe osteoarthritis. Conclusion: Synovial chondromatosis should be kept in the differential dignosis of the chronic monoarticular pain and painful limitations of the range of motions of the joints.

A New Neurological Sign Shows Severity of Carpal Tunnel Syndrome

The objective of this study was prospective comparative determination of both clinical and neurophysiological characteristics of a new pathological reflex in CTS. The authors investigated 300 patients with severe carpal tunnel syndrome undergoing surgery. The 134 patients who showed the sign were allocated as the reflex group. The remaining 166 cases with no sign were named the control group. Two blinded neurology specialists evaluated all patients prior to and after the surgery. Their clinical data, the reflex sign and the electrophysiological results were recorded. The ligament thicknesses during surgery and postoperative changes were also recorded. The reflex group showed exaggerated symptoms with worse electrophysiological results. The reflex group also had thicker median carpal ligament in operative measurements. The difference was significant. The reflex does not disappear easily after surgery and persists up to three months. In the author’s opinion, this sign may present a new pathological reflex indicating severe long-lasting nerve compression with the requirement of surgical decompression of the median nerve in CTS subjects.

Pediatric dysphagia overview:best practice recommendation study by multidisciplinary experts

Background Currently,there is no comprehensive and multidisciplinary recommendation study covering all aspects of pediatric dysphagia(PD).This study aimed to generate PD management recommendations with methods that can be used in clinical practice to fill this gap in our country and in the world,from the perspective of experienced multidisciplinary experts.Methods This recommendation paper was generated by a multidisciplinary team,using the seven-step process and a three-round modified Delphi survey via e-mail.First,ten open-ended questions were created,and then detailed recommendations including management,diagnosis,treatment,and follow-up were created with the answers from these questions.Each recommendation item was voted on by the experts as overall consensus(strong recommendation),approaching consensus(weak recommendation)and divergent consensus(not recommended).Results In the 1st Delphi round,a questionnaire of 414 items was prepared based on the experts’responses to ten open-ended questions.In the 2nd Delphi round,59.2%of these items were accepted as pre-recommendation.In the 3rd Delphi round,62.6%of 246 items were accepted for inclusion in the proposals.The final version recommendations consisted of 154 items.Conclusions This study includes comprehensive and detailed answers for every problem that could be posed in clinical practice for the management of PD,and recommendations are for all pediatric patients with both oropharyngeal and esophageal dysphagia.