Purpose: To monitor corneal thickness during the corneal collagen cross-linking procedure in corneal ectatic diseases, by using isoosmolar riboflavin solution with 20% dextran and hypoosmolar riboflavin solution without dextran. Methods: The corneal thickness measurements were obtained at 5 different time points: after epithelial removal, after isotonic riboflavin solution application for 30 minutes, after hypotonic riboflavin solution application for 10 minutes, and after 10 and 30 minutes of isotonic riboflavin solution application. Results: A total of 9 eyes of 9 patients with progressive keratoconus (n = 8) and pellucid marginal degeneration (n = 1) were included in this study. After epithelial debridement, the thinnest pachymetric readings were between 331 and 399 μm (average, 376.11 ± 19.88 μm). The thinnest pachymetric measurements decreased significantly after the application of isoosmolar riboflavin solution for 30 minutes (by 55.22 ± 13.40 μm) and increased significantly after hypoosmolar riboflavin application for 10 minutes (by 59.56 ± 29.71 μm) (P < 0.01 for both). This artificial swelling effect was transient, and the thinnest pachymetric readings decreased significantly after 10 and 30 minutes of isoosmolar riboflavin application compared with thickness at the end of hypoosmolar riboflavin application (by 50.22 ± 29.68 μm and 65.11 ± 27.94 μm, respectively) (P < 0.01 for both). Conclusions: The iatrogenic swelling effect of the hypoosmolar riboflavin solution might be short acting and not durable throughout the UVA application in collagen cross-linking procedure.

Background: To evaluate the tear osmolarity in patients with dry eye syndrome related to primary Sjögren’s Syndrome (SS). Materials and Methods: Twenty eyes of 10 patients with dry eye and primary SS (Group 1) and 20 eyes of 20 subjects who do not have dry eye syndrome (Group 2) were included in this cross-sectional study. In all eyes, ophthalmic examination was performed in the same order: International Ocular Surface Disease Index survey, visual acuity assessment, conjunctival hyperemia scoring, tear osmolarity measurement with TearLab^™ Osmolarity System, tear film break-up time assessment, corneal fluorescein staining scoring, ocular surface Lissamine Green staining scoring, anesthetized Schirmer test. Dry eye severity was graded according to Dry Eye Workshop (DEWS) classification system. Results: Four eyes with grade 1, four eyes with grade 2, seven eyes with grade 3, and five eyes with grade 4 dryness, according to DEWS system, were included. The mean tear osmolarity value was 301.9 ± 11.40 mOsm/L (range: 290–328) in Group 1, and 294.85 ± 8.33 mOsm/L (range: 283–311) in Group 2 (p = 0.03). In Group 1, tear osmolarity values were positively correlated with OSDI scores (r(18) = 0.55, r² = 0.31, p = 0.01), DEWS classification grades (r(18) = 0.73, r² = 0.54, p < 0.01), temporal and total corneal staining scores (r(18) = 0.67, r² = 0.44, p < 0.01, and r(18) = 0.51, r² = 0.26, p = 0.02, respectively), temporal conjunctival staining scores (r(18) = 58, r² = 0.34, p < 0.01); and negatively correlated with anesthetized Schirmer test results (r(18) = -0.62, r² = 0.38, p < 0.01) and TFBUT (r(18) = -0.50, r² = 0.25, p = 0.02). Conclusions: Tear osmolarity values were found to be greater in patients with dry eye syndrome related to primary SS compared to control subjects, and positively correlated with the severity of dry eye.

Purpose: To evaluate the corneal topographic characteristics of first-degree relatives of patients with keratoconus with corneal topography to determine the incidence of clinical keratoconus and topographic abnormalities. Methods: Between February and August 2006, Orbscan II analysis was done in 144 eyes of 72 cases who were first-degree relatives of patients diagnosed with clinical keratoconus. The findings were compared with preoperative Orbscan analyses of 52 clinically normal individuals who underwent laser in situ keratomileusis surgery and did not develop corneal ectasia in 3 years of follow-up. Results: In 8 of the 72 first-degree relatives of patients with keratoconus, clinical keratoconus was diagnosed by the topographic pattern in Orbscan and clinical examination (group 1). The remaining 64 subjects (group 2) were compared with the control group (group 3). The central corneal thickness was 523.7 ± 40.4 μm in group 2, whereas it was 546.3 ± 33.1 μm in group 3 (P < 0.05). The central corneal thickness, thinnest pachymetric reading, posterior elevation value, distance between the greatest anterior/posterior elevation points, and corneal center, posterior best fit sphere (BFS) values, posterior BFS:anterior BFS ratio, and irregularity values were significantly different between group 2 and group 3 (P < 0.05). Conclusions: The keratoconus incidence was found to be 11% in first-degree relatives of patients with keratoconus as opposed to a reported incidence of keratoconus of 0.05% in the general population. In first-degree relatives of patients with keratoconus who did not have a topographic keratoconus pattern, abnormal corneal topographic values were detected. The asymptomatic relatives of patients with keratoconus should undergo a thorough preoperative analysis for subtle topographic abnormalities before any keratorefractive surgery.

To present outcomes of combined pars plana vitrectomy, silicone oil (SO) injection, and permanent keratoprosthesis (Kpro) procedure in prephthisical eyes. All 3 patients were monocular with chronic severe hypotony, aphakia, and total corneal opacity in their vital eye. Preoperative visual acuity ranged from light perception to counting fingers at 1 foot. Two patients had a history of failed corneal grafts because of SO, and one had funnel retinal detachment. Pars plana vitrectomy and long-term SO tamponade were performed, and a permanent Boston type 1 Kpro was used in lieu of a donor corneal transplantation. No unexpected intraoperative complications were encountered. Patients were followed for a period of 11-13 months. All patients had anatomic success with an attached retina and a clear visual axis. The procedures resulted in increased visual function in all patients ranging from hand motions to 20/800. No case has progressed to phthisis bulbi during the follow-up period. At the last visit, biomicroscopic examination revealed clear Kpro with an attached retina. Boston type 1 Kpro implantation, as the primary corneal procedure with pars plana vitrectomy and intraocular SO, may be a viable option in selected patients with prephthisical eyes.