Choroidal thickness changes in non-treated acute and ranibizumab-treated chronic central serous chorioretinopathy

To evaluate the changes in subfoveal retinal, and choroidal thicknesses (CT) in the non-treated acute and the ranibizumab-treated chronic central serous chorioretinopathy (CSCR) patients.This retrospective study included 32 eyes of 32 consecutive patients with CSCR. There were 12 patients who presented with a spontaneous resolution of CSCR (Group 1) and 20 patients who were treated with ranibizumab for persistent subretinal fluid (SRF) (Group 2). Optical coherence tomography (OCT) imaging of subfoveal retinal thickness and enhanced depth imaging OCT of CT at subfoveal; at nasal and temporal 500 μm (T500); at nasal and temporal 1500 μm (T1500) were analyzed. The Student t test and multivariate analysis were used to compare variables within and between groups, respectively and correlations were analyzed using Pearson correlation coefficient. A P value of P < .05 was accepted as significant.The mean patient age was 38.94 ± 8.41 years (range, 20-53 years). Female/male ratio was 4/28. The mean duration of follow-up was 21.6 ± 8.2 months in the chronic CSCR group. Visual acuity improved and central foveal thickness (FT) decreased significantly in both groups. CT decreased significantly only at nasal 1500 μm (N1500) in the acute group and at all measured points in the chronic group compared with baseline, except at T500 (P = .07). No significant difference in central FT was detected between the 2 groups. Compared with the acute group, baseline subfoveal CT was significantly higher in chronic patients. There was a significant difference between the groups in baseline and final CT at T500. No significant difference was found at T1500. At nasal 500 μm and N1500, the difference between the groups was significant only for final CT values.Chronic CSCR was associated with higher baseline CT values in the subfoveal region and at T500. CT significantly decreased at most of the measured points in ranibizumab-treated chronic CSCR patients, whereas it significantly decreased only at 1 point in spontaneously resolved acute CSCR patients.

Bilateral Simultaneous Rhegmatogenous Retinal Detachment following Laser in situ Keratomileusis

A 21-year-old woman developed simultaneous rhegmatogenous retinal detachment after laser in situ keratomileusis (LASIK) in both eyes. She underwent pars plana vitrectomy surgery combined with endolaser photocoagulation and silicone oil tamponade in the right eye. A week later, pneumatic retinopexy was done in the left eye. As the retinal tear did not seal, 360° scleral buckling surgery was performed and retina was attached. Bilateral simultaneous rhegmatogenous retinal detachment after LASIK for correction of myopia can be a serious complication. Patients should be informed about the possibility of this complication.

Choroidal thickness in obese women

Background

Excessive weight is a well-known risk factor for microvascular diseases. Changes in thickness in a vascular tissue, such as the choroid, can be useful to evaluate the effect of obesity on the microvascular system. The aim of this study was to evaluate the choroidal thickness (CT) changes in obese women, using optical coherence tomography (OCT).

Methods

The prospective clinical study included examination of the right eyes of 72 patients. The right eyes of 68 patients were examined and served as the controls. A complete ophthalmological examination and OCT imaging were performed for each group studied. The CT in each eye was measured using OCT.

Results

The obese group consisted of 72 female patients with a mean age of 37.27 ± 1.18 years. The control group included 68 female subjects with a mean age of 37.85 ± 7.98 years (p > 0.05). There was no statistical significant difference for the foveal retinal thickness measurements between the two groups (p > 0.5). Our study revealed significant choroidal tissue thickening subfoveally and at areas 500 μm temporal, 500 μm nasal, and 1500 μm nasal to the fovea in the obese group (all p < 0.05). There was a positive correlation between body mass index (BMI) and CT changes.

Conclusions

CT may increase in obese women and a positive correlation was found between BMI and CT.

The trial protocol was approved by the Local Ethical Committee of the Kırıkkale University, date of registration: April 27, 2015 (registration number: 10/11).

Changes in the choroidal thickness in reproductive-aged women with iron-deficiency anemia

Background

The aim of this study was to investigate the potential significance of the central macular thickness (foveal thickness-FT) and choroidal thickness (CT) in the eyes of patients with iron-deficiency anemia, the most common form of the anemia, via enhanced-depth imaging optical coherence tomography (EDI-OCT). We also investigated whether such changes might serve as an early indicator of underlying hematological disease.

Methods

This prospective clinical study compared 96 female patients with iron-deficiency anemia and 60 healthy female control subjects. The macular and choroidal thicknesses in the temporal and nasal subfoveal areas were measured using enhanced-depth imaging optical coherence tomography (EDI-OCT) at 500 and 1500 microns and in five different regions (FCT, T₁₅₀₀, T₅₀₀, N₅₀₀, and N₁₅₀₀).

Results

The mean ages of the patients and healthy controls were 34.08 ± 10.39 years and 32.29 ± 8.28 years, respectively (P =0.232). There were no significant changes in macular thickness between the groups (225.58 ± 19.76 vs. 222.45 ± 13.51, P =0.2). The choroidal thickness was significantly reduced in the patient group relative to the controls at all measured points (foveal choroidal thickness, P = 0.042; nasal–500 microns, P = 0.033; temporal–500 microns, P = 0.033; and temporal–1500 microns, P = 0.019). At some points, the choroidal thickness findings correlated with the hemoglobin values (temporal–500 microns, r = −0.287, P = 0.001; nasal–500 microns, r = −0.287, P = 0.005; nasal–1500 microns, r = −0.245, P = 0.016; and temporal–1500 microns, r = −0.280, P = 0.06).

Conclusions

Patients with iron-deficiency anemia had a significantly reduced choroidal thickness.

Comparison of the antimicrobial effect of heavy silicone oil and conventional silicone oil against endophthalmitis-causing agents

Purpose:

To conduct an in vitro experimental study comparing the effectiveness of conventional silicone oil and heavy silicone oil against endophthalmitis-causing agents.

Materials and Methods:

The antimicrobial activity of conventional silicone oil (RS OIL 5000) and heavy silicone oil (heavySil 1500) was tested. The antimicrobial effects of both silicone oils were determined by the growing capability of the microorganism.

Results:

The number of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans decreased to zero levels at the second day of inoculation in heavy silicone oil. In conventional silicone oil, the microorganisms survived longer than in heavy silicone oil.

Conclusion:

Heavy silicone oil seems to be more effective than conventional silicone oil against endophthalmitis-causing agents.

Mean platelet volume in retinal vein occlusion

OBJECTIVE

The exact pathogenic mechanism underlying the thrombotic tendency in retinal vein occlusion (RVO) is still not fully established. We investigated relationship between platelet indices including mean platelet volume (MPV) and platelet count in RVO patients compared to control group.

PATIENTS AND METHODS

Forty six patients (19 female, 27 male) diagnosed as RVO were included in the study. Forty-six subjects (26 female, 20 male) served as controls. Patients were evaluated by careful biomicroscopic examination using a fundus contact lens and fluorescein angiography. Blood samples for total blood count with MPV were obtained after overnight fasting from the antecubital vein.

RESULTS

The mean platelet volume was 8.11 ± 1.15 fl in RVO group. It was 8.68 ± 0.98 fl in controls. When compared, the mean MPV was significantly lower in RVO patients (p < 0.05). The mean platelet volume was also significantly lower in branch retinal vein occlusion group in comparison to controls (7.92 ± 1.19 fl. versus 8.68 ± 0.98 fl.) (p < 0.05).

CONCLUSIONS

MPV was significantly lower in patients with RVO than control group. MPV does not seem to be a potentially useful biomarker for prediction of RVO.

Anesthetic effectiveness of topical levobupivacaine 0.75% versus topical proparacaine 0.5% for intravitreal injections

Background and Purpose:

Today no method of topical anesthesia for intravitreal injection administration has been proven to make the patient comfortable yet. We compared the efficacy of topical levobupivacaine 0.75% and proparacaine 0.5% in patients undergoing intravitreal injections.

Materials and Methods:

A prospective, randomized study comparing two agents for topical anesthesia in intravitreal injections. Ninety-six consecutive patients were enrolled into two groups to receive either topical levobupivacaine 0.75% (n=48) or proparacaine 0.5% (n=48). Patients were asked to score their pain using a visual analog scale (VAS) immediately following the injection. The average of these scores was used as the primary outcome. The surgeon performing the procedure scored his perception of the patients’ pain using the Wong-Baker FACES scale.

Results:

Mean VAS pain scores for two groups were found to be 44.77 ± 16.42 and 34.18 ± 14.83, respectively. Mean VAS pain score in the proparacaine group was significantly lower than that in the levobupivacaine group (P= 0.003). Mean Wong-Baker FACES scores for the two groups were 1.08 ± 0.49 and 1.10 ± 0.30, respectively. There was no statistically significant difference between levobupivacaine and proparacaine groups (P=0.824).

Conclusions:

Topical proparacaine 0.5% was more effective in preventing pain during intravitreal injections.

Effect of 1% brinzolamide and 0.5% timolol fixed combination on intraocular pressure after cataract surgery with phacoemulsification

AIM

To evaluate the effect of brinzolamide-timolol fixed combination on intraocular pressure (IOP) after cataract surgery.

METHODS

The study included 92 eyes of 87 patients who underwent cataract surgery and intraocular lens implantation. Patients scheduled for phacoemulsification were assigned to 1 of 2 groups. The treatment group received 1 drop of brinzolamide-timolol fixed combination immediately after surgery, and the control group received no treatment. The IOP was measured preoperatively and at 2h and 24h postoperatively.

RESULTS

The mean IOP change was lower in the treatment group than in the control group at 2h postoperatively. The difference between the mean IOP values of the two groups at 2h postoperatively was found to be statistically significant. Twenty-four hours after the surgery, the mean IOP change was still higher in the control group when compared to the treatment group.

CONCLUSION

The fixed combination brinzolamide-timolol can effectively reduce IOP after cataract surgery.

Bilateral consecutive optic neuropathy in a patient with thrombophilia

A 39-year-old man was admitted with a sudden visual loss in the left eye. Visual acuities were 10/10 on the right and 1/10 on the left. Fundus examination did not show any abnormalities. Visual acuity improved to 10/10 and visual field defect regressed in the following 2 weeks. Three years later, the patient returned with acute visual loss in the right eye. Visual acuities were 2/10 on the right and 10/10 on the left. Right optic disc had blurred margins with mild oedema. The tests revealed methylenetetrahydrofolate reductase A1298C mutation with positive lupus anticoagulant and hyperhomocysteinaemia. Enoxaparin was initialised with vitamin B12 supplementation. Complete visual recovery occurred in the following 3 weeks in both eyes. Thrombophilic screening seems to be important in the treatment and prevention of an attack in the second eye of patients with non-arteritic anterior ischaemic optic neuropathy.

Peripapillary and macular retinoschisis in a patient with pseudoexfoliation glaucoma

A 55-year-old man was admitted with a 2-year history of pseudoexfoliation glaucoma. The best-corrected visual acuities were 10/10 in both eyes. Pseudoexfoliation material was noted on the iris and the lens capsule. Fundus examination evidenced cup-to-disc ratio of 0.7 OD and 0.9 OS with peripapillary atrophy. Gonioscopy revealed open angles. Optical coherence tomography demonstrated peripapillary retinoschisis extending to the nasal macula in the left eye and optic nerve head was almost fully excavated. Coexisting retinoschisis in a patient with glaucoma may interfere with the reliability of retinal nerve fibre layer and ganglion cell complex analysis and may change the treatment plan and follow-up intervals.

Refractive astigmatism in eyes with pseudoexfoliation syndrome

PURPOSE

To determine the effect of pseudoexfoliation syndrome on ocular refractive astigmatism.

METHODS

One hundred eyes of 100 patients with pseudoexfoliation syndrome and 100 eyes of 100 age- and sex-matched control subjects were included in the study. Refractive astigmatism was measured prior to ocular examination performing cycloplegic autorefractive measures using an autorefractokeratometer (Charops, MRK3100).

RESULTS

All patients in the study and control group had myopic astigmatism. Refractive and ocular residual astigmatism were found to be significantly higher in the pseudoexfoliation syndrome group in comparison to the control group (p<0.05). The mean keratometry reading was significantly steeper in the study group than in the control eyes.

CONCLUSIONS

Significant refractive and ocular residual astigmatism were found in pseudoexfoliation syndrome.

Retinal nerve fiber layer thickness in congenital color vision deficiency

PURPOSE

To evaluate the thickness of the retinal nerve fiber layer (RNFL) in subjects with congenital red-green color vision deficiency (CVD).

METHODS

This study included 20 healthy subjects with congenital red-green CVD and 22 healthy subjects with normal color vision. After Ishihara test and examinations visual field by automated perimetry, all individuals underwent scanning laser polarimetry to measure the thickness of the RNFL.

RESULTS

All scanning laser polarimetry parameters related to RNFL thickness were found to be similar in subjects with congenital CVD and normal color vision (p>0.05).

CONCLUSIONS

This is the first report suggesting normal thickness of the RNFL in subjects with congenital red-green CVD.

Bevacizumab sterility in multiple doses from a single-use vial

BACKGROUND

Recent reports have demonstrated that refrigerated bevacizumab can be stored for up to 3 weeks at 4 degrees C without loss of efficacy. There have been no previous reports addressing bevacizumab's sterility when stored and used as multiple doses from a single-use vial.

OBJECTIVE

To evaluate the sterility of bevacizumab when used as multiple doses from a single-use vial.

METHODS

Four groups of vials were used to simulate the storage and use conditions for bevacizumab. Each group contained 11 doses of 0.2 mL of bevacizumab. One sample from each group was cultured once each day at 37 degrees C for 10 days; one sample from each group was left for 15 days. MacConkey agar, blood agar, thioglycollate broth, and Sabouraud medium were used to assess bacterial and fungal growth.

RESULTS

A total of 44 samples of bevacizumab were included in this study. Each sample was placed on 4 growth media for microbial readings. All samples were found to be negative for microbial growth. No significant differences were observed among the groups. Possible limitations of this study included the number of samples for each group and in vitro design of the study, which might have affected the growth of bacterial organisms.

CONCLUSIONS

Storage and multiple use of bevacizumab from single-use vials does not seem to result in microbial contamination.

Molecular and clinical spectrum of type I plasminogen deficiency: A series of 50 patients

Severe type I plasminogen (PLG) deficiency has been causally linked to a rare chronic inflammatory disease of the mucous membranes that may be life threatening. Here we report clinical manifestations, PLG plasma levels, and molecular genetic status of the PLG gene of 50 patients. The most common clinical manifestations among these patients were ligneous conjunctivitis (80%) and ligneous gingivitis (34%), followed by less common manifestations such as ligneous vaginitis (8%), and involvement of the respiratory tract (16%), the ears (14%), or the gastrointestinal tract (2%). Four patients showed congenital occlusive hydrocephalus, 2 with Dandy-Walker malformation of cerebellum. Venous thrombosis was not observed. In all patients, plasma PLG levels were markedly reduced. In 38 patients, distinct mutations in the PLG gene were identified. The most common genetic alteration was a K19E mutation found in 34% of patients. Transient in vitro expression of PLG mutants R134K, delK212, R216H, P285T, P285A, T319_N320insN, and R776H in transfected COS-7 cells revealed significantly impaired secretion and increased degradation of PLG. These results demonstrate impaired secretion of mutant PLG proteins as a common molecular pathomechanism in type I PLG deficiency.

Pattern electroretinography and visual evoked potentials in optic nerve diseases

BACKGROUND

To evaluate transient pattern electroretinography (PERG) and pattern visual evoked potential (VEP) for the diagnosis, differential diagnosis and follow-up of optic nerve diseases.

METHODS

Twenty-nine consecutive patients (14 female, 15 male) with the diagnosis of ischaemic optic neuropathy (n=14) and optic neuritis (n=15) were included in this study. Mean age of the patients with ischaemic optic neuropathy was 63.3+/-3.3 (60-78) years and the mean age of the patients with optic neuritis was 28.3+/-8.4 (19-43) years. In each patient ophthalmological examination and systemic evaluation were done and VEP and PERG were recorded. As a control group, VEP recordings of 35 healthy subjects were included.

RESULTS

In the ischaemic optic neuropathy group (group 1), mean VEP amplitude (+/-SD) (1.96+/-0.95 microV) was found to be decreased significantly in the affected eyes in comparison to the control group and the unaffected eyes. The delay in latency (116.3+/-20.14 msec in the affected eyes compared with 101.31+/-6.19 msec in unaffected eyes) was statistically significant when compared with the healthy subjects. In the optic neuritis group (group 2), VEP amplitude was decreased (4.13+/-4.04 microV vs 6.97+/-3.35 microV and 6.97+/-4.43 microV) and latency was increased (122.59+/-20.09 msec vs 101.31+/-6.19 msec and 108.76+/-13.57 msec) in affected eyes significantly in comparison to the unaffected eyes and control group, respectively. Even though there were no significant differences for P50 latency and N95/P50 ratios between affected and unaffected eyes in both groups, N95 amplitude decreased significantly in the affected eyes of the ischaemic optic neuropathy patients and N95 latency was found to be decreased in optic neuritis patients. There was no correlation between VEP and PERG findings in both groups.

CONCLUSION

VEP amplitude decreased significantly in ischaemic optic neuropathies while latency delay was more significant in patients with optic neuritis. PERG findings showed decreased N95 amplitude in ischemic optic neuropathy without associated latency changes.

Limbal autograft and allograft transplantations in patients with corneal burns

AIM

To investigate and compare the surgical outcomes of limbal autograft and limbal allograft transplantations in patients with corneal burns.

METHODS

In total, 20 patients (n=22 eyes) with chemical burn and two patients (n=2 eyes) with thermal burn were included in this study. Limbal autograft or limbal allograft transplantation surgery was performed in all patients. HLA-typing was tested before allograft surgeries. Limbal allografting was performed in all eyes using donor tissue from live relatives. Systemic cyclosporine A was administered for immunosuppression.

RESULTS

The corneal surface was successfully reconstructed in all eyes (100%) after limbal autografting, two eyes required additional amniotic membrane transplantation and one eye required allografting. The mean follow-up period for limbal autografts was 13.9 +/- 7.0 months. Limbal allografting failed to reduce corneal vascularity and opacification in five (55.6%) eyes and was successful only in four (44.4%) eyes (mean follow-up 16.2 +/- 11.2 months) (P=0.002). In all, 15 eyes undergoing limbal autografting completed re-epithelialization of the cornea at a mean of 35.6 +/- 60.2 days. The mean epithelial healing time in nine eyes undergoing limbal allografting was 13.0 +/- 7.3 days (P=0.525). After limbal autografting, functional vision (> or =1/10) was attained in 12 (80%) eyes. Only one eye (11.1%) achieved functional vision after limbal allografting (P=0.036). Penetrating keratoplasty was performed in three patients following limbal allografting. No cyclosporine-associated side effects were observed.

CONCLUSIONS

Limbal autograft transplantation is an effective and safe procedure for unilateral corneal burns. It seems that limbal allograft transplantation is better combined with penetrating keratoplasty for a better visual outcome and higher graft survival rate. Systemic immunosuppression seems to be necessary for limbal allografts even in the presence of HLA-matched donor tissues.

May nitric oxide molecule have a role in the pathogenesis of human cataract?

Recent studies have shown that nitric oxide molecule may have a role in the development of cataract. In this study, we measured the levels of a nitric oxide metabolite (nitrite) in the cataractous and normal human lenses. A modified Griess assay was used to determine the nitrite levels in the lenses as a measure of nitric oxide, based on the spectrophotometric method. Nitrite was detected in 26 (44.1%) cataractous lenses and was found below the detection limit in 33 (55.9%) cataractous lenses. Mean nitrite levels in cataractous lenses (2.77+/-5.26nmol/100mg) was found higher than the normal lenses (0.77+/-0.79nmol/100mg) but this increase was not statistically significant. Comparison of nitrite levels among lenses with various types of cataracts revealed higher levels in lenses with posterior subcapsular cataracts. Hypertensive patients had also significantly higher nitrite levels in their cataractous lenses. The increased levels in the cataractous lenses display a possible role of nitric oxide in the pathogenesis of cataract in human eyes.

Corneal topographic changes after retinal detachment surgery

PURPOSE

To evaluate the changes in corneal topography after scleral buckling surgery for retinal detachment.

METHODS

Twenty-one eyes of 21 patients with the diagnosis of retinal detachment were included in this prospective study. Scleral buckling surgery was performed on all patients. The corneal topography of each was measured before surgery and at 1 week and 1 and 6 months after surgery by computer-assisted videokeratoscopy using the EyeSys 2000 Corneal Analysis System. Changes in corneal videokeratographies were analyzed using the Holladay Diagnostic Summary (HDS) software package.

RESULTS

A statistically significant central corneal steepening (average, 1.8 diopter) was noted 1 week after surgery. The total and irregular astigmatic components both revealed a significant but transient increase in the first postoperative month. All these topographic changes persisted for as long as 6 months but returned to preoperative values afterward.

CONCLUSION

Scleral buckling was found to induce transient changes in corneal topography producing both myopia and corneal astigmatism. Videokeratography is helpful for documenting such corneal changes after scleral buckling surgery for retinal detachment.

Pediatric alacrima, achalasia, and mental retardation

Absence or deficiency of tear volume (alacrima) is rarely seen in pediatric ophthalmology. It is often a part of the multiple systemic anomalies like Riley-Day syndrome and anhidrotic ectodermal dysplasia, or it may be associated with adrenal gland insufficiency, achalasia, and neurologic disorders like Allgrove's syndrome. We report on a 7-year-old girl presenting alacrima, achalasia, and mental retardation with normal adrenocortical function.