We aimed to evaluate the morphological changes in meibomian glands in keratoconus patients using scleral contact lenses and compare them with keratoconus and healthy controls. The study included 34 eyes of 20 patients who were wearing scleral contact lenses due to keratoconus, as well as 31 age- and sex-matched keratoconus controls and 31 healthy controls. Slit-lamp biomicroscopy, non-invasive tear film break-up time assessment, Schirmer I test, meibography, and corneal staining with fluorescein were performed. Subjective symptoms were assessed using the Ocular Surface Disease Index. In this study, the lower and upper percentage meibomian gland loss was statistically higher in the scleral contact lens group than in the keratoconus and healthy control groups (p < 0.001 and p = 0.013, respectively). There was a positive correlation between scleral contact lens wear duration and the lower eyelid percentage meibomian gland loss and upper eyelid gland curling scores (rho: 0.396; p = 0.021 and rho: 0.344; p = 0.047, respectively). The lower and upper eyelid percentage meibomian gland loss, and upper eyelid gland curling values were higher, and the Schirmer 1 values were found to be lower in patients who used scleral contact lenses for more than three years than those who wore them less than three years. In patients using scleral contact lenses for more than three years, meibomian gland curling values and percentages of meibomian gland loss in both eyelids are higher.

Objectives:The aim of the study was to determine the prevalence of positive corneoscleral donor rim cultures and to report keratitis and endophthalmitis after keratoplasty.Methods:Eye bank records and medical records of patients who underwent keratoplasty between September 1, 2015, and December 31, 2019, were retrospectively reviewed. Patients who had routine donor-rim culture taken during surgery and followed up for at least 1 year in the post-operative period were included in the study.Results:A total of 826 keratoplasty procedures were performed. A total of 120 (14.5%) cases had a positive donor corneoscleral rim culture. Positive bacterial cultures were obtained from 108 (13.7%) of the donors. Bacterial keratitis was observed in one patient (0.83% of recipients) who had a positive bacterial culture. Positive fungal cultures were obtained from 12 (1.45%) donors, of whom one (8.33% of recipients) developed fungal keratitis. Endophthalmitis was observed in one patient whose culture result was negative. Both bacterial and fungal culture results were similar in penetrating and lamellar surgical procedures.Conclusion:Although the donor corneoscleral rims have a high positive culture result, the rate of bacterial keratitis and endophthalmitis is low, the risk of infection is high in patients with a fungal positive donor rim. Closer follow-up of patients with fungal positive donor corneo-scleral rim result and initiation of aggressive antifungal treatment when infection occurs will be beneficial.

Objectives: The objective of the study is to evaluate the agreement between Goldmann applanation tonometer (GAT) and Easyton transpalpebral tonometer, Tonopen, and Icare in patients with Keratoconus. Methods: This cross-sectional study included 46 eyes of 26 patients with keratoconus. Intraocular pressure (IOP) is measured using easyton, icare, tonopen, and GAT. Measurements were compared and the influences of corneal topographic variables on IOP measurement were evaluated. Bland–Altman plots were used for assessing agreement between different tonometers. Results: The mean age of the participants was 24.08±6.76 (range, 18–47) years (15 males and 11 females). The highest of the mean IOP values measured with different tonometers was obtained with Easyton (12.33±1.65), followed by Tonopen (11.59±2.17), GAT (10.67±1.52), and Icare (10.04±2.33). The mean IOP value measured with Easyton was significantly higher than that measured with GAT (p<0.001). There was no significant difference between GAT and either Tonopen (p=0.154) or Icare measurements (p=0.732). There was no significant difference between Tonopen and Easyton measurements (p=0.421). Icare measurements were correlated with central corneal thickness and keratometric values. GAT measurements were correlated with only Kmax. Thirty-eight (82.6%) of the differences were within the agreement limits (assumed clinically important deviation of up to ±2 mmHg) of GAT and Tonopen, 73.9% (n=34) were within the agreement limits of GAT and Icare, and 78.3% (n=36) were within the agreement limits of GAT and Easyton. Conclusion: Compared with GAT, the gold standard method, Easyton IOP readings were higher, while both Tonopen and Icare readings were similar to GAT. All three tonometers showed acceptable agreement with the GAT, however, Tonopen showed the greatest agreement.

SIGNIFICANCE Visual acuity may be limited after endothelial keratoplasty in Fuchs’ endothelial corneal dystrophy. This may be due to increased anterior high-order aberrations that persist after endothelial keratoplasty. It is not clear at what stage these aberrations begin. We aimed to evaluate how subclinical corneal edema affects anterior corneal high-order aberrations. PURPOSE We aimed to evaluate anterior corneal high-order aberrations according to the presence of subclinical corneal edema in Fuchs’ endothelial corneal dystrophy using Scheimpflug topography. METHODS All the patients underwent corneal topography (Sirius Scheimpflug-Placido disc camera; CSO Ophthalmic, Scandicci, Italy). Fifty-two eyes of 31 patients with Fuchs’ endothelial corneal dystrophy and 52 eyes of 35 patients without corneal problems were included. In addition, patients with Fuchs’ endothelial corneal dystrophy were divided into two groups according to subclinical corneal edema as with Fuchs’ endothelial corneal dystrophy-edema and Fuchs’ endothelial corneal dystrophy-nonedema. Subclinical corneal edema was defined based on the presence of at least two of three findings of the loss of regular isopachs, displacement of the thinnest point of the cornea, and posterior depression. High-order aberrations were expressed as Zernike polynomials in the 4- and 6-mm optical zone. RESULTS We found that subclinical corneal edema in Fuchs’ endothelial corneal dystrophy caused a larger 4-mm trefoil II and a smaller 6-mm spherical aberration II measurements than the nonedema group. The 6-mm total high-order aberrations, 6-mm coma aberration, and 4- and 6-mm trefoil II aberration measurements were larger, and the 6-mm spherical aberration II was smaller in Fuchs’ endothelial corneal dystrophy patients with edema compared with the healthy eyes. CONCLUSIONS The presence of subclinical corneal edema in Fuchs’ endothelial corneal dystrophy results in larger 4-mm trefoil II and smaller 6-mm spherical aberration II measurements. More patients with intermediate values are needed to evaluate the effect of these aberrations on visual acuity.

OBJECTIVES:In this study, we aimed to evaluate Schlemm canal parameters using anterior segment swept-source optical coherence tomography in eyes that underwent keratoplasty and compare them with keratoconus and healthy control groups.METHODS:The study included 32 patients who underwent penetrating keratoplasty or deep anterior lamellar keratoplasty once due to keratoconus and age-matched and sex-matched 20 keratoconus patients and 30 healthy controls. In all the patients, a single horizontal image centered on the central cornea was obtained from the nasal and temporal quadrants with low-intensity scanning to visualize Schlemm canal.RESULTS:There was no statistically significant difference between the groups for age and gender ( P ˃0.05). In the keratoplasty group, the area and diameter of Schlemm canal were 2.266±1.141μm 2 and 160.77±65.08 μm, respectively, in the nasal quadrant and 2.623±1.277 μm 2 and 158.81±68.05 μm, respectively in the temporal quadrant, which were statistically significantly lower compared with other groups ( P <0.001 for all). There was no significant difference between the penetrating and deep anterior lamellar keratoplasty subgroups for Schlemm canal parameters.CONCLUSION:This is the first study to report anterior segment optical coherence tomography after surgery shows SC parameters that are, on average, less than age-matched and keratoconus controls.

Amaç: Monovizyon presbiyopik tedavi uygulamalarında oküler dominansın klinik önemi artmıştır. Dominant ve dominant olmayan gözde akomodatif fonksiyonu araştıran az sayıda çalışmada çelişkili sonuçlar bildirilmiştir. Çalışmamızda oküler dominans ve lateralitenin akomodasyon üzerindeki etkisini değerlendirmek amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya otuz beş sağlıklı, genç izometropik katılımcı dahil edildi. Oküler dominans, kart içinde delik testi kullanılarak belirlendi. Monoküler görüş koşulları altında Hartmann- Shack aberometresi kullanılarak, 0,5 diyoptrilik artışlarla 0,5 ila 5 diyoptri arasında artan akomodatif uyarana verilen akomodatif yanıtlar ölçüldü. Bulgular: Katılımcıların yaş ortalaması 31,49 ± 4,22 (24-38) idi. Yirmi ikisi (%62,9) kadın, 13’ü (%37,1) erkekti. Yirmi yedi (%77,1) olguda sağ göz, 8 olguda (%22,9) sol göz dominant idi. Dominant ve dominant olmayan gözler arasında kırma kusuru (sferik, silindirik ve sferik eşdeğer) açısından anlamlı bir fark yoktu (p>0,05). Dominant ve dominant olmayan gözler arasında 0,5 ila 5 diyoptrilik akomodatif uyarana verilen akomodatif yanıtlarda anlamlı fark yoktu (p>0,05). Ayrıca, sağ ve sol gözlerin akomodatif yanıtları benzerdi (p>0,05). Sonuç: Çalışmamızda sağlıklı genç izometropik katılımcıların dominant ve dominant olmayan gözlerinin farklı akomodatif uyaranlara akomodatif yanıtları benzer bulundu. Sağ ve sol göz arasında da fark yoktu. Akomodasyonda oküler dominans ve lateralitenin rolünü anlamak için daha fazla çalışmaya ihtiyaç vardır.

Objective: The present study aimed to compare the Nidek CEM-530 (Nidek Co., Japan), Konan CellChek XL (Konan Medical, Hyogo, Japan), and Topcon SP-3000P (Topcon Corporation, Tokyo, Japan) noncontact specular microscopes (NCSM) in terms of endothelial cell density (ECD), morphological endothelial cell parameters, and central corneal thickness (CCT), in healthy subjects. Material and Methods: Right eyes of 49 patients were included in this study. ECD, CCT, average cell area, coefficient of variation, Standard deviation of cell area, cell hexagonality ratio were evaluated with Nidek CEM-530, Topcon SP-3000P and The CellChek XL NCSMs. Results: The mean age was 36.2±9.6 years. The mean ECD was 2809±24.1, 2626±50.4, and 2588±32.1 in measurements with Konan CellCheck XL, Topcon SP-3000P, and Nidek CEM-530 NCSMs, respectively. The difference was statistically significant between Konan CellCheck XL with Nidek CEM-530 and Topcon SP-3000P (p<0.001 for both). The hexagonality ratio results between these 3 devices were statistically significant in all paired comparisons (p<0.001, for all). The mean CCT was 534.4±5.0, 553.9±5.6, 567.5±5.3 in measurements with Nidek CEM-530, Konan CellCheck XL, and Topcon SP-3000P, respectively. CCT values obtained with Topcon SP-3000P were found to be higher than with other devices (p<0.001, for both). Conclusion: Among the 3 devices, the highest ECD values were obtained with Konan CellCheck XL and the highest CCT values were obtained with Topcon SP-3000P. On account of the discrepancies in endothelial parameters tested in our study, we do not advise using these devices interchangeably.

Purpose: To evaluate clinical and in vivo confocal microscopy (IVCM) findings of a patient who developed multiple unilateral subepithelial stromal opacities following conjunctivitis that developed during a COVID-19 infection. Methods: A 22-year-old female presented to our clinic with blurred right vision. The history revealed that she had experienced a COVID-19 infection one month ago. Redness and stinging of the right eye had started at the same time and she had been prescribed topical antibiotic drops and ointments. The redness in the right eye had decreased but blurred vision had then developed. Results: Slit lamp examination revealed a normal left eye. Several tiny subepithelial infiltrates without fluorescein staining of the cornea were present in the right eye. The anterior chamber, lens and fundus were bilaterally normal. IVCM revealed irregular corneal epithelial cells with bright borders in addition to scattered inflammatory cells and cell debris in the right eye. There were activated dendritic cells in the subbasal epithelial area with a significant decrease in the subbasal corneal nerve plexus. Clusters of highly reflective cells with an irregular shape were seen in the anterior corneal stroma together with foci of activated keratocytes. The corneal endothelial cell layer was normal. The left eye IVCM findings were all within normal limits. The right eye also showed decreased corneal sensitivity compared to the left. Conclusions: The possible role of corneal infiltrates as a trigger for COVID-19 could be explained with an immune-mediated mechanism. SARS-CoV-2 can result in decreased corneal sensitivity through corneal nerve involvement. The clinical results of this effect need to be evaluated in larger series.

Objective: Evaluating the clinical effects of donor cornea variables on outcomes after deep anterior lamellar keratoplasty (DALK). Material and Methods: In this retrospective study, 44 eyes of 44 patients who underwent DALK using the Anwar's big bubble technique for different corneal pathologies at the ophthalmology department of Haydarpaşa Numune Training and Research Hospital were included. Preoperative and postoperative best corrected distance visual acuity (BCDVA), slit-lamp examination and complications were recorded. Postoperative refractive error, keratometry and spherical equivalent refractive error were recorded if they could be measured. Corneal wavefront aberration analysis was evaluated in 8 eyes. Donor data including age, death-to-preservation (DP) time and preservationto- surgery (PS) time were evaluated. Results: The mean patient age was 35.06±16.48 (range 15-75) years, there was a significant increase in postoperative BCDVA (range 0-1.09 logMAR) in all eyes (p<0.001). Donor age (range 18-75 years), donor endothelial cell density (range 1,739-2,456) and DP time (range 15-1,080 minutes) were not significantly associated with postoperative best corrected visual acuity, keratometric astismatism (range 0.50-9.75), refractive error (range -9.0-7.75), spherical equivalent refractive error (range -0.38-9.38) and corneal wavefront aberration analysis. PS time (range, 1-10 days) was correlated with postoperative corneal astigmatism (r=0.417; p<0.05). Donor age and postoperative spherical refractive error were statistically correlated in the negative direction (r=-0.504; p<0.05). Conclusion: PS time was correlated with keratometric astigmatism value in the positive direction, and donor age was negatively correlated with postoperative spherical refractive error. Other factors, including DP time and graft endothelial cell count were not statistically associated with postoperative outcomes.

To evaluate ocular wavefront aberrations after vitrectomy in patients with vitreomacular interface diseases. Thirty eyes of 30 patients with vitreomacular interface diseases were included in this prospective study. A Sirius topographer (SCHWIND eye-tech-solutions, Germany) was used to measure corneal aberrations and a Hartmann Shack aberrometer (IRX-3; Imagine Eyes, Orsay, France) to measure ocular aberrations. Data were recorded at baseline and 3 months after vitrectomy. Eight patients were excluded due to the formation of cataract during the post-operation follow-up period. Data of 22 eyes (13 eyes with epiretinal membrane, two eyes with epiretinal membrane with vitreomacular traction, one eye with vitreomacular traction, and six eyes with macular hole) were analyzed for the study. The corneal aberrations such as coma, trefoil, spherical aberration, and root mean square of total higher-order aberrations did not significantly change after vitrectomy. The preoperative ocular aberrations such as coma 0.33 (0.14–0.47) µm, trefoil 0.28 (0.15–0.44) µm, root mean square of higher-order aberrations 0.51 (0.45–0.68) µm, root mean square of total aberrations 1.38 (1.16–2.60) µm were significantly reduced to 0.21 (0.14–0.29) µm, 0.20 (0.14–0.30) µm, 0.36 (0.21–0.52) µm, 0.15 (1.13–1.41) µm, respectively, after vitrectomy. The ocular higher-order aberrations were significantly reduced after vitreomacular surgery for vitreomacular interface diseases.

Amaç: Biz bu çalışmada, tekrarlayan penetran keratoplasti yapılan hastaları primer endikasyon, greft yetmezliği nedenleri, sonuç görme keskinliği ve greft saydamlığı açısından değerlendirmeyi amaçladık. Gereç ve Yöntemler: Birden fazla keratoplasti yapılan hastaların kayıtları retrospektif olarak incelendi. İki defa keratoplasti yapılanlar Grup 1, 3 veya daha fazla keratoplasti yapılanlar Grup 2 olarak sınıflandırıldı. Bulgular: Sağlık Bilimleri Üniversitesi Haydarpaşa Numune Eğitim ve Araştırma Hastanesi Göz Kliniği'nde yapılan 979 keratoplastinin %12,5'i tekrarlayan penetran keratoplastiydi. Hastaların yaş ortalaması 57,76±17,59 idi. Grup 1, 95 (%78,5) hastadan, Grup 2 ise 26 (%21,5) hastadan oluşmaktaydı. Toplam ortalama takip süresi 43,6±21,7 aydı. Her iki grupta da tekrarlayan penetran keratoplasti için en sık endikasyonu büllöz keratopati oluşturmakta olup, iki grup arasında istatistiksel anlamlı fark yoktu (p=0,53). Grup 1'de geç endotelyal yetmezlik (%21,05), Grup 2'de ise allogreft rejeksiyon (%38,46) greft yetmezliğinin en sık nedenini oluşturmaktaydı. Son vizitte Grup 1'de hastaların %73,68'inde Grup 2'de ise hastaların %57,69'unda greft saydamdı. Grup 1'deki hastalarda görme keskinliği Grup 2'den istatistiksel olarak daha fazlaydı (p=0,02). Hastaların %29,75'inde görme keskinliği Snellen eşeline göre 0,05'ten yüksekti. Sonuç: Greft saydamlığı açısından iki grup arasında anlamlı fark olmamakla birlikte Grup 2'de görme keskinliği daha düşüktü. Bu nedenle tekrarlayan penetran keratoplasti hastalarında cerrahi kararı verilirken hastanın ihtiyaçları ve motivasyonu göz önünde bulundurulmalıdır.

Objectives: The aim of the study was to assess the quality and reliability of videos on Fuchs endothelial corneal dystrophy (FECD) on YouTube. Methods: A search of YouTube was performed for the term “FECD” without any changes to the website’s standard search preferences. The first 100 videos were recorded. A total of 71 videos were evaluated regarding the DISCERN score (min–max: 16–75), Journal of the American Medical Association (JAMA) score (min–max: 0–4), and Global Quality Scale (GQS) score (min–max: 0–5). Results: The mean DISCERN score was 40.1±15.6 (moderate), the mean JAMA score was 2.01±0.7 (poor), the mean GQS score was 2.5±1.3 (moderate), and the mean video power index score was 106.8±135.7. Twenty-three of the videos (32.4%) were uploaded by physicians, 25 (35.2%) by universities/private hospitals, and 21 (29.6%) by health channels. Thirty-six videos (50.7%) contained information about the disease, 24 (33.8%) discussed surgical techniques, and 11 (15.5%) were about patient experience. Conclusion: YouTube provides only moderate-quality health information on FECD. Physicians and professional organizations should be aware of and embrace this evolving technology to raise awareness about FECD.

Purpose: To evaluate the pupil size, accommodation, and ocular higher-order aberrations (HOAs) in patients with migraine during migraine attacks and compare them with interictal period and healthy controls. Methods: This prospective, case–control study included 48 eyes of 24 patients with migraine and 48 eyes of 24 age and sex-matched healthy controls. Measurements were performed using a Hartmann Shack aberrometer. Accommodative responses to accommodative stimulus ranging from 0 to 5 diopters (D) in increments of 0.5 D were recorded. Spherical, coma, trefoil aberration, and root mean square (RMS) of total HOAs were assessed. Patients with migraine were measured twice during the interictal phase and during migraine attack. Results: The mean pupil size significantly decreased during migraine attack (5.85 ± 0.19 mm) compared with the interictal phase (6.05 ± 0.19 mm) in the patients with migraine ( p = 0.012). There was a significant increase in the accommodative response to accommodative stimulus of 1.5 to 5 D during migraine attack. No significant change was observed in HOAs during migraine attack. In addition, no ictal or interictal period measurements were statistically significantly different from the controls. Comparing symptomatic and non-symptomatic sides in 17 migraine patients with unilateral headache, no significant difference was found in any of the measurements in both ictal and interictal periods. Conclusion: Our results suggest the presence of a subtle oculosympathetic hypofunction in patients with migraine during the ictal period compared to the interictal period. The accommodation status of the eye seems to be affected by this autonomic dysfunction.

Purpose: The authors present a case of unilateral orbital myositis of new onset following COVID-19 without a severe course.Methods: The patient had been received topical treatment with a preliminary diagnosis of conjunctivitis but no recovery had been noticed. The history revealed that the ocular signs had started 1 week after the COVID-19.Results: The examination revealed sectoral hyperemia of the temporal region in the bulbar conjunctiva together with marked limitation of right inward gaze. MRI of the orbits demonstrated diffuse fusiform enhancing enlargement of the right lateral rectus and superior rectus. The results of the laboratory tests and examination findings were normal. Systemic corticosteroids were started for the orbital myositis.Conclusions: Although conjunctivitis is the more common ocular disease following COVID-19, the possibility of orbital myositis should be considered in cases with resistance to topical treatment and/or gaze limitation. The possible role of orbital myositis as a trigger for COVID-19 could be explained with an immune-mediated mechanism.

To evaluate patient satisfaction with samfilcon A contact lenses (CLs) in intensive digital device users with myopia and to compare patient satisfaction with samfilcon A lenses to prior experience with senofilcon A or lotrafilcon B CLs. This was a comparative, prospective, national study conducted at 14 centers in Turkey. Subjects were adults aged 18 and 45 years with myopia (range −0.25 D to −6.00 D) who spend a minimum of 3 hours viewing digital devices (e.g., computer, smartphone). A subgroup of patients were habitual lens wearers (senofilcon A or lotrafilcon B lens wear for at least 6 months prior to enrollment). The primary assessment was patient satisfaction with samfilcon A lenses (0–100 Likert scale). Secondary assessments included patient satisfaction with samfilcon A lenses compared to patients’ habitual lenses, investigator satisfaction with samfilcon A lenses and investigator-evaluated slit lamp examination findings. Samfilcon A lenses were given high overall ratings from both patients and investigators, with a low incidence of ocular symptoms. Overall, patients were highly satisfied with samfilcon A lenses for comfort, vision and overall performance, and stated that they would consider wearing these lenses in the future. Among habitual senofilcon A or lotrafilcon B lens wearers, samfilcon A lenses were rated significantly better than the habitual lenses in regard to comfort, vision and overall performance. Investigator assessments were also highly favorable, both at initial fit and after 4 weeks of follow-up, with no significant findings noted on slit lamp examination. Samfilcon A lenses were rated highly by investigators in regard to fit, handling and slit lamp findings, and by novice and habitual lens wearers in regard to comfort, vision and overall performance. These results support the use of samfilcon A lenses among digital device users who seek day-long comfort and good visual acuity.

Objectives: To evaluate the quality, reliability, and educational content of YouTube videos related to soft contact lenses (CL). Methods: An online YouTube search was performed for the terms contact lens and other common CL-related terms contact lens insertion and removal, contact lens wearing, and contact lens care. The first 50 videos were evaluated for each term. Videos were evaluated using three checklists (the modified DISCERN criteria, the Journal of the American Medical Association [JAMA] criteria, and Global Quality Score [GQS]). Video popularity was also evaluated using the video power index (VPI). Videos were classified into three groups according to the source of the upload; group 1: universities/occupational organizations, group 2: medical ad/profit-oriented companies, and group 3: independent users. Results: From among the 200 videos analyzed, 79 were included. The mean mDISCERN score of the videos was 2.34±1.39, the mean JAMA score was 1.20±0.99, and the mean GQS value was 3.47±1.28. There were positive correlations between the three checklists (P<0.001). Video power index was not correlated with each score. The videos in group 1 (13.9%) had the highest scores whereas videos in group 3 (41.8%) had the lowest scores. There was no significant difference between the video sources according to the VPI. Conclusion: Although some YouTube videos contain useful information for CL wearers, most videos have poor quality and reliability and contain insufficient information. Eye care providers should be aware of these sources and steer CL users to information sources that provide accurate and reliable information and do not contain misleading information.

To evaluate systemic inflammatory parameters in patients with corneal graft rejection after low-risk penetrating keratoplasty. Patients undergoing penetrating keratoplasty with indications of keratoconus, pseudophakic bullous keratopathy, and Fuchs endothelial dystrophy were analyzed retrospectively. Patients who had an endothelial rejection attack within two years post-transplant were included in the rejection group (n = 20), whereas patients with at least two years of post-transplant follow-up without graft rejection or failure were included in the control group (n = 46). All patients’ clinical features and preoperative laboratory parameters were obtained from hospital records. The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio of the groups were calculated and compared. There was no difference between the two groups in terms of age, sex, indication, postmortem time and storage time of grafts, graft diameter, follow-up time, and common systemic diseases (p > 0.05). The NLR was found to be significantly lower in the rejection group when compared with the control group (2.04 ± 1.17, 2.66 ± 0.91, respectively, p = 0.023). There was no significant difference between the groups in terms of MLR and PLR (p = 0.243, p = 0.101, respectively). Although a high NLR value, which is an indicator of systemic inflammatory condition, is associated with many ocular diseases, NLR was found to be lower in patients with a rejection episode after transplant surgery when compared with the control group. Further studies are needed to clarify the role of these hematologic parameters in graft rejection.

Purpose To evaluate short-term retinal and choroidal vascularity changes in the healthcare professionals after four hours of use filtering facepiece respirators (FFR). Materials and Methods This prospective study included 20 healthcare professionals. Oxygen saturation, pulse rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), mean ocular perfusion pressure (MOPP), and spectral domain optical coherence tomography (OCT) imaging were evaluated at baseline and after four hours wearing of FFP3 FFRs without an exhalation valve. Superior temporal artery (STA), inferior temporal artery (ITA), superior temporal vein (STV), and inferior temporal vein (ITV) diameter were measured from OCT images. The total subfoveal choroidal area (TCA), luminal area (LA), stromal area (SA) choroidal vascularity index [(CVI), the ratio of LA to TCA] were determined after binarization of enhanced depth imaging OCT (EDI-OCT) images of the choroid. Results The mean age of the participants was 27.35 +/- 2.80 years (range, 25-34). Eight of them were female and 12 were male. After wearing the FFR for four hours, a significant decrease was observed in the mean DBP (p = 0.018), MAP (p = 0.016), and MOPP (p = 0.007) when compared to base-line values. STV diameter (p = 0.019) and ITV diameter (p = 0.046) measurements were found significantly higher than baseline measurements. A significant increase in the choroidal vascularity was observed in the LA (p = 0.004) and TCA values (p = 0.043) after wearing the FFR for four hours. Conclusion The current study shows that after four hours usage of FFR, in addition to systemic changes, retinal and choroidal vascularity might be affected significantly. With further studies, long-term effects and clinical significance of these short-term changes should be investigated on healthcare professionals.

PURPOSE:To examine the efficacy of ptosis correction with a Müller muscle-conjunctival resection with or without tarsectomy (MMCR±T), combined with bandage contact lens (BCL) use, in corneal graft patients.METHODS:Seven patients with corneal grafts who underwent MMCR±T for treatment of ptosis were evaluated retrospectively. A BCL was applied to the grafts at the end of the surgery. The collected data included preoperative and postoperative visual acuity, marginal reflex distance 1 (MRD-1), presence of Hering's dependency by the phenylephrine test, symmetry outcomes, and complications after MMCR±T.RESULTS:The average duration between the penetrating keratoplasty and MMCR±T was 14 months, with a follow-up time of 10.4 months after MMCR±T. Hering's dependency was observed in four (57.2%) patients before MMCR±T, and MRD-1 was increased in all patients based on preoperative phenylephrine tests. The mean preoperative MRD-1 was -0.14 ± 0.55 mm, and the mean postoperative MRD-1 was 2.35 ± 0.89 mm (p < 0.0001). Symmetry outcomes of perfect (<0.5 mm), good (0.5-1 mm), and fair (≥1 mm) were noted after MMCR±T in three, three, and one patients, respectively. During the follow-up, no obvious corneal epitheliopathy, keratitis, or corneal graft rejection/failure were noted in any cases. BCL use was well tolerated by all patients.CONCLUSIONS:Most patients achieved good surgical outcomes with the application of the BCL to protect the graft and with the use of the phenylephrine test and Hering's dependency to predict the final eyelid position and symmetry. MMCR±T combined with BCL may therefore represent an alternative approach for correction of ptosis in patients with corneal graft.