a newly diagnosed acromegaly patient aged 45-year - old woman was referred to our clinic for an ophthalmologic examination from the endocrinology department of our hospital . serum igf-1 level was 750 ng / ml ( reference ranges of igf-1 in ages 4685 : 94166 ng / ml ) . complete ophthalmological examination including cct with ultrasonic pachymetry ( tomey corporation , nagoya , japan ) , and standard threshold perimetry with the humphrey visual field analyzer 24 - 2 program ( carl zeiss meditec , inc . , dublin , ca , usa ) were performed . after informed consent was obtained from the patient , basal tear samples were collected atraumatically from the inferior tear meniscus of both eyes using glass capillary tubes or micropipettes . tear samples were diluted in phosphate - buffered saline , placed in microtubes , and stored at 70c until further examination . tear igf-1 concentrations were measured using a commercial enzyme - linked immunosorbent assay kit ( quantikine , r and d systems , minneapolis , mn , usa ) according to the manufacturer 's instructions . tear igf-1 level was 0.63 ng / ml . best - corrected visual acuities were 1.0 in both eyes . optic disc examination revealed normal in both eyes ( cup - to - disc ratio was 0.3 in both eyes ) . cct was 615 m in the right eye and 612 m in the left eye . iop levels were 24 mm hg in the right eye and 23 mm hg in the left eye . after the patient was referred to a neurosurgery by the endocrinology clinic for an operation , he underwent transsphenoidal adenectomy for the pituitary adenoma . the patient 's serum igf-1 values had fallen to 125 ng / ml . besides tear igf-1 values were 0.32 ng / ml . cct was 585 m in the right eye and 575 m in the left eye . iop levels were 20 mm hg in the right eye and 19 mm hg in the left eye . another newly diagnosed acromegaly patient aged 55-year - old woman was referred from endocrinology clinic for an ophthalmologic examination . serum igf-1 level of the patient was 1340 ng / ml . tear igf-1 level was 0.98 ng / ml . cct was 595 m in the right eye and 590 m in the left eye . iop levels were 22 mm hg in the right eye and 21 mm hg in the left eye . optic disc examination were also normal in both eyes ( cup - to - disc ratio was 0.4 in both eyes ) . the patient also was referred to the neurosurgery department for an operation , and she also underwent pituitary surgery . three months after surgery the patient 's complete ophthalmological and visual field examination revealed normal . serum igf-1 value had fallen to 389 ng / ml . besides tear igf-1 value was 0,25 ng / ml . cct values were 565 m in the right eye and 560 m in the left eye . iop levels were 18 mm hg in the right eye and 17 mm hg in the left eye . a newly diagnosed acromegaly patient aged 45-year - old woman was referred to our clinic for an ophthalmologic examination from the endocrinology department of our hospital . serum igf-1 level was 750 ng / ml ( reference ranges of igf-1 in ages 4685 : 94166 ng / ml ) . complete ophthalmological examination including cct with ultrasonic pachymetry ( tomey corporation , nagoya , japan ) , and standard threshold perimetry with the humphrey visual field analyzer 24 - 2 program ( carl zeiss meditec , inc . , dublin , ca , usa ) were performed . after informed consent was obtained from the patient , basal tear samples were collected atraumatically from the inferior tear meniscus of both eyes using glass capillary tubes or micropipettes . tear samples were diluted in phosphate - buffered saline , placed in microtubes , and stored at 70c until further examination . tear igf-1 concentrations were measured using a commercial enzyme - linked immunosorbent assay kit ( quantikine , r and d systems , minneapolis , mn , usa ) according to the manufacturer 's instructions . tear igf-1 level was 0.63 ng / ml . best - corrected visual acuities were 1.0 in both eyes . optic disc examination revealed normal in both eyes ( cup - to - disc ratio was 0.3 in both eyes ) . cct was 615 m in the right eye and 612 m in the left eye . iop levels were 24 mm hg in the right eye and 23 mm hg in the left eye . after the patient was referred to a neurosurgery by the endocrinology clinic for an operation , he underwent transsphenoidal adenectomy for the pituitary adenoma . the patient 's serum igf-1 values had fallen to 125 ng / ml . besides tear igf-1 values were 0.32 ng / ml . cct was 585 m in the right eye and 575 m in the left eye . iop levels were 20 mm hg in the right eye and 19 mm hg in the left eye . another newly diagnosed acromegaly patient aged 55-year - old woman was referred from endocrinology clinic for an ophthalmologic examination . serum igf-1 level of the patient was 1340 ng / ml . tear igf-1 level was 0.98 ng / ml . best - corrected visual acuities were 1.0 in both eyes . cct was 595 m in the right eye and 590 m in the left eye . iop levels were 22 mm hg in the right eye and 21 mm hg in the left eye . optic disc examination were also normal in both eyes ( cup - to - disc ratio was 0.4 in both eyes ) . the patient also was referred to the neurosurgery department for an operation , and she also underwent pituitary surgery . three months after surgery the patient 's complete ophthalmological and visual field examination revealed normal . serum igf-1 value had fallen to 389 ng / ml . besides tear igf-1 value was 0,25 ng / ml . cct values were 565 m in the right eye and 560 m in the left eye . iop levels were 18 mm hg in the right eye and 17 mm hg in the left eye . in acromegaly , normalization of igf - i in serum has been used to follow - up the success of surgical and medical therapies . van setten et al . reported that the igf-1 level was elevated not only in the serum , but also in the subretinal fluid and aqueous humor in a patient with acromegaly . this study inspired us to hypothesize that the eyes might be another target organ for the effects of excess gh and igf-1 , hence in our study we measured tear igf-1 levels and evaluated the relationship with cct and iop before and after treatment in two acromegaly patients . ciresi et al . emphasized that high gh may have stimulatory effects on the cornea , as well as on other target organs . bramsen et al . divided 27 pituitary adenoma patients into two groups as those with and without acromegaly and reported higher cct values in the group with acromegaly . in contrast , polat et al . reported no statistically significant difference regarding median right and left corneal thicknesses and mean cct values between acromegaly and control groups . they divided 30 patients with acromegaly into two groups as those with active and inactive . we think that possible growth effect of tear igf-1 may have an impact on cct . we found a higher cct , iop , and tear igf-1 values in the active phase of the disease . the activity of the disease may have an impact on ocular parameters such as cct , iop , and tear igf-1 values . however , longitudinal studies including larger populations and controls are needed to confirm this relationship .
the aim of the study was to compare the central corneal thickness ( cct ) , intraocular pressure ( iop ) , and tear insulin - like growth factor-1 ( igf-1 ) levels of 2 patients with acromegaly before and after the surgical treatment of the disease . 
 ccts , iop levels , and tear igf-1 values showed a decrease after the treatment in 2 patients . as we found higher cct , iop , and tear igf-1 levels in the active phase of the disease in two acromegaly patients , detailed information about the activity of the disease may be important before the examination of these patients .