Aim of this study is to evaluate the differences in corneal endothelial cell morphology and corneal thickness in patients with and without type 2 diabetes related to age, disease duration, and HbA1c percentage. This retrospective cross-sectional study included 511 (1022 eyes) type 2 diabetes patients and 900 (1799 eyes) non-diabetic patients. The endothelial cell density (ECD), variation in endothelial cell size (CV), percentage of hexagonal cells, and central corneal thickness (CCT) were analyzed using a noncontact specular microscope and a Pentacam Scheimpflug camera. We also examined the correlation between the corneal parameters and the duration of diabetes. For total ages, the subjects with type 2 diabetes showed significantly lower ECD, hexagonality, higher CV, and thicker CCT than the control group. This difference was more pronounced in patients with long-standing DM (≥ 10 years) and high HbA1c (≥ 7%). When stratified by age group, from the 60 s group, corneal endothelial cell parameters showed a statistically significant difference between DM and control groups. The duration of diabetes was inversely correlated with ECD (r = − 0.167; p = 0.000). These findings suggest that diabetes affects corneal endothelial cell in older age and those with long-standing DM and higher HbA1c. Regular corneal endothelial examinations are required in diabetic patients.
Pituitary adenoma patients do not always have ocular symptoms at their first presentation, even when optic chiasm compression and visual field deficits are present. Therefore, collaboration with an ophthalmologist is important when evaluating pituitary adenoma patients.
Noninvasive methods for monitoring diabetes are being developed to eliminate the need for invasive finger-prick testing. Here, we propose the noninvasive detection of tear glucose using contact lenses that contain cerium oxide nanoparticles (CNPs). We chemically conjugated CNPs with glucose oxidase (GOx) using poly(ethylene glycol) (PEG) (CNP-PEG-GOx). GOx oxidizes glucose into hydrogen peroxide, which rapidly (∼1 min) reduces colorless Ce 3+ to yellow Ce 4+ with high sensitivity (>0.1 mM). Then, the yellow CNP-PEG-GOx can be analyzed to quantify the glucose concentration using a smartphone equipped with an image-processing algorithm. The CNP-PEG-GOx-laden contact lenses had physical properties similar to those of commercially available contact lenses and were nontoxic to human corneal cells and endothelial cells. When the CNP-PEG-GOx-laden contact lenses were placed on the eyes of diabetic rabbits, it was possible to measure the tear glucose levels. Interestingly, the lenses successfully detected glucose in human tear specimens and distinguished the diabetes status of patients. These findings suggest that the CNP-PEG-GOx-laden contact lenses could be used along with a smartphone-based image-processing algorithm to noninvasively monitor human tear glucose.
Rationale: Herpes zoster is characterized by unilateral vesicular eruption and it most often affects the trigeminal nerve. We would like to report a rare case of abducens and vagus nerves palsy caused by varicella zoster virus (VZV) without the typical vesicular rash. Patient concerns: A 71-year-old woman presented with diplopia. Three days previously, she had experienced sore throat and hoarseness. Diagnosis: At presentation, the prism cover test revealed esotropia of 10 prism diopters at primary gaze, and abduction was restricted in the right eye. No vesicular rash was observed on the patient's face, and magnetic resonance imaging of the brain showed no pathology. Flexible fiberoptic laryngoscopy revealed multiple ulcerations on the right side of the larynx—from the epiglottis to the arytenoid. After 1 day of hospitalization, a diffuse skin rash occurred on the patient's trunk, and polymerase chain reaction for VZV DNA was positive at the skin lesion. The patient was diagnosed as having herpes zoster associated with vagus and sixth nerve palsy. Intervention and outcomes: She received famciclovir at a dose of 500 mg 3 times daily for 7 days and coadministered methylprednisolone. At the 4-month follow-up, her diplopia and eye movement had resolved completely. Lessons: In patients with abducens nerve palsy without typical vesicular lesion, herpes zoster may not be detected early. In that case, systemic examination is very important for diagnosing herpes zoster.
Background Increasing interest in microincision cataract surgery has led to the use of more flexible intraocular lens (IOL). Flexible IOL may cause more IOL deformation and refractive error when capsule contraction syndrome (CCS) occurred. In this retrospective observational case series study, the aim was to report four cases of hyperopic shift caused by CCS after phacoemulsification with microincision foldable intraocular lens implantation. Case presentation All of four patients underwent phacoemulsification and in-the-bag implantation of an Akreos MI60 (Bausch and Lomb) IOL from 2010 to 2016 in our clinic. These patients had been diagnosed with CCS and had undergone Nd:YAG laser anterior capsulotomy. The mean age of the patients with CCS was 66.8 ± 6.7 years and the mean time for development of CCS after the cataract surgery was 9.3 ± 6.9 months. The mean spherical equivalent (SE) value at the time of the CCS diagnosis was 0.88 ± 0.91 D, which had shown a hyperopic shift compared to the SE value of − 0.91 ± 1.29 D after cataract surgery. The mean SE decreased by − 0.47 ± 1.14 D after Nd:YAG laser anterior capsulotomy. The mean age, axial length, anterior chamber depth, and preoperative SE were not significantly different between the patient with CCS and the patients without CCS. Conclusions In the case of IOL implantation with flexible materials in microincision cataract surgery, CCS can cause a hyperopic shift. Refractive error caused by CCS can be effectively corrected by Nd:YAG laser anterior capsulotomy.
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