DOI: 10.5301/ejo.5000390

Eur J Ophthalmol 2014; 24 ( 3 ): 309-313

Original Article

Increased central corneal thickness in patients with Turner syndrome Pinar Nalcacioglu-Yüksekkaya1, Emine Sen2, Asan Onder3, Semra Cetinkaya3, Tulay Tos4, Ece Kurtul1, Zehra Aycan3  epartment of Pediatric Ophthalmology, Dr. Sami Ulus Children’s Health and Disease Training and Research Hospital, D Ankara - Turkey 2 Ulucanlar Eye Research Hospital, Ankara - Turkey 3 Department of Pediatric Endocrinology, Dr. Sami Ulus Children’s Health and Disease Training and Research Hospital, Ankara - Turkey 4 Department of Genetic Disease, Dr. Sami Ulus Children’s Health and Disease Training and Research Hospital, Ankara - Turkey 1

Purpose: To evaluate central corneal thickness (CCT) values in patients with Turner syndrome (TS) and compare these values with healthy subjects. Methods: A total of 31 subjects with TS and 67 age- and sex-matched healthy subjects made up the study and control group, respectively. The CCT values were measured by an ultrasound pachymeter in this cross-sectional prospective study. The ocular findings were recorded. We also evaluated to effect of karyotype analysis, recombinant growth hormone therapy (GHT), and mean duration of treatment on the CCT parameter in patients with TS. Results: The mean CCT values were 582.0 ± 40.8 µm (490-648) in the TS and 549.1 ± 34.6 µm (494-601) in the healthy group. The mean intraocular pressure (IOP) by Goldmann applanation tonometry was 16.3 ± 3.1 mm Hg (9-22) in the TS and 15.2 ± 2.5 mm Hg (10-21) in the healthy group. The mean CCT value was significantly higher in the TS group (p0.05). There was also no significant difference for CCT regarding the karyotype, GHT use, and mean duration of treatment in patients with TS (p>0.05). Conclusions: Central corneal thickness values should be considered during measurement of IOP in individuals with TS as these values may be higher than in healthy subjects. Keywords: Central corneal thickness, Growth hormone therapy, Karyotype analysis, Pachymetry, Turner syndrome Accepted: October 14, 2013

INTRODUCTION Measurement of the central corneal thickness (CCT) is useful for diagnostic and therapeutic purposes such as assessment before refractive surgery, monitoring corneal changes after extended contact lens wear, and determining the reliability of intraocular pressure (IOP) measurements (1). Several studies have reported the CCT values in some genetic disorders. Patients with X-linked megalocornea (2) and patients with Down syndrome (3) have been reported to have

thinner than normal corneas. Turner syndrome (TS) is a sex chromosome abnormality where phenotypic females have either a missing X chromosome or a structural aberration of one X chromosome. Various ocular abnormalities including keratoconus, blue sclera, anterior segment dysgenesis, amblyopia, strabismus, blepharoptosis, epicanthus, cataract, hypertelorism, red-green color deficiency, and posterior segment abnormalities such as Coats disease (6) and rhegmatogenous retinal detachment have been described with TS (4-8). Glaucoma has also been reported (5, 9).

© 2013 Wichtig Editore - ISSN 1120-6721

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Central corneal thickness and Turner syndrome

The aim of this study was to investigate IOP, CCT values, and other ocular findings in patients with TS. This is the first report to investigate CCT values in TS.

MATERIALS AND METHODS We examined 31 subjects in a Turkish TS population who were consecutively referred to our clinic from the Endocrinology and Metabolism Clinic for the purpose of eye examinations in this prospective case-control study. Sixty-seven age-matched healthy subjects were included in this study. The healthy group had no systemic or ocular disease and had presented to the Ophthalmology Clinic for a routine ocular examination. All the control group subjects were female. Eyes with a history of dry eye, congenital glaucoma, intraocular surgery, corneal irregularity such as a corneal scar, dystrophies, microcornea, keratoconus, keratoglobus, contact lens wear, corneal injury, use of topical medication, and high spherical (>−6.0 D or >+3D) or cylindrical (>± 1.50 D) refractive errors were excluded from the study. Informed consent was obtained from the patients and their family after explaining the nature and purpose of the study. Each patient underwent full ophthalmologic examination including best-corrected Snellen visual acuity, anterior segment and fundus examination, and IOP measurement by Goldmann applanation tonometry. Refraction measurement was performed in both eyes by means of a handheld autorefractometer (Welch Allyn Sure Sight, software version 2.16 and 2.20; Welch Allyn Medical Products, Skaneateles Falls, New York, USA) and red-green color deficiency was measured by Ishihara cards. The Tomey AL-1000 ultrasonic pachymeter (Tomey Corporation, Nagoya, Japan) was used to measure CCT. After administering topical proparacaine hydrochloride 0.5% (Alcaine ophthalmic solution, Alcon, Turkey), measurements were taken with the tip of the probe targeting the center of the pupil and perpendicular to the cornea while the subject was looking at a fixed target. The probe was sterilized with alcohol after each subject was examined. At least 5 consecutive measurements were obtained and the mean value was recorded. All readings were performed by the same experienced physician (E.S.) at the same period of the day (10:00-12:00 am) Genetic analysis of our subjects with TS revealed that 17 of 31 had a 45XO karyotype, and 14 of 31 had other 310

karyotypes (mosaics having both 45X and a normal cell line or abnormalities of the X chromosome including partial deletions and ring chromosome). All subjects with TS were divided into 2 groups according to karyotype analysis: group A: 45XO; group B: others. Recombinant growth hormone (GH) therapy (GHT) was used in 25 of the 31 subjects in the TS group (number of patients treated previously or currently continuing treatment). We divided the TS group according to recombinant GHT as group 1 (with GHT) and group 2 (without GHT). The data were normally distributed (based on the result of the homogeneity of variance test, i.e., the KolmogorovSmirnov test) and the independent t test was used to compare variables between 2 independent groups. The chi-square test was used to evaluate categorical variables of parameters. The correlation between right and left eyes was evaluated by the Pearson correlation test and the difference between CCT values with or without recombinant GHT in the TS group was evaluated by the Mann-Whitney U test. The degree of association between the mean duration of recombinant GHT and CCT values was calculated by Spearman rho correlation coefficient. A p value

Increased central corneal thickness in patients with Turner syndrome.

To evaluate central corneal thickness (CCT) values in patients with Turner syndrome (TS) and compare these values with healthy subjects...
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