The evaluation of the effect of Nd-YAG capsulotomy on posterior ocular vascular structures by Optical coherence tomography angiography

BACKGROUND

We aimed to examine the changes in retinal, choroidal and optic nerve head vascular structures after Nd-YAG laser application due to posterior capsule opacification after cataract surgery by Optical coherence tomography angiography (OCTA).

METHODS

Fifteen eyes of 15 patients who have posterior capsule opasification and underwent Nd-YAG laser capsulotomy were included in the study. OCTA imagings of patients were made before and one hour, one week and one month later after the laser procedure.

RESULTS

No significant change was determined before and after capsulotomy in macular thickness measurements, flow areas and vessel densities (all p > 0.05). Optic nerve head vessel densities and flow areas didn't differ preoperatively and postoperatively (p > 0.05).

CONCLUSIONS

Nd-YAG laser capsulotomy for posterior capsule opacification has no detectable effect on macular and optic nerve flows and vessel densities.

Effects of FSH Administered in Different ways on Superovulation Response and Blood FSH Levels in Cows

Bu çalışmada adjuvan kullanılarak tek doz Subkutan (SC) FSH uygulamasının ve adjuvan kullanılmadan tek doz epidural FSH uygulamasının kan FSH düzeyleri ve süperovülasyon yanıtı üzerine etkilerinin belirlenmesi amaçlanmıştır. Holştayn inekler (n:18) süperovülasyon prosedürü için üç gruba ayrıldı (n = 6). Gruptaki (İM) hayvanlara 4 gün süreyle 12 saat arayla İntramusculer (IM) azaltıcı FSH (Stimufol, 500 μg domuz FSH ve 100 μg domuz LH, Ulg FMV, Liège, Belçika) dozları verildi. (E) grubundaki hayvanlara epidural aralığa FSH (500 µg) verildi. (SC) grubundaki hayvanlara, 10 mL Montanide ISA 206 adjuvanı içinde FSH eklenerek hazırlanan bir karışım Subkutan (SC) ile uygulandı. Overdeki CL sayısı ultrasonografik yöntemle ölçüldü ve 4 CL varlığına göre süperovülasyon belirlendi. FSH ölçümü için tüm hayvanlardan V. jugularis'ten kan örnekleri alındı. Serum FSH (pFSH) seviyeleri ELISA ile belirlendi. Grup 1'deki tüm hayvanlar, süperovülasyon prosedüründen sonra süperovülasyon tepkisine (4>CL) sahipti. 2. grupta sadece bir hayvan yanıt verdi. Grup 3'te, altı hayvandan dördü yanıt verdi. Kan örneklerinin FSH analizinden sonra, IM ve SC uygulamaları arasındaki fark istatistiksel olarak önemsiz iken, IM ve epidural uygulamalar arasındaki fark istatistiksel olarak anlamlıydı. SC ve epidural uygulamalar arasındaki fark önemsizdi.

Early effects of viper envenomation on retina and optic nerve blood flow: An optical coherence tomography angiography study

In this study, the early retinal and optic nerve blood flows of patients exposed to Viper bite were evaluated with non-invasive optical coherence tomography angiography (OCTA) and compared with healthy controls. The retinal and optic disc OCTA data of 31 victims of viper bite (group S) without systemic envenomation clinical symptoms and 31 healthy controls (group C) were compared. Only patients with early signs of envenomation were included in the study. Optical coherence tomography angiographies were performed with RTVue XR Avanti with AngioVue software. Vascular densities in the whole image, foveal, parafoveal regions at the superficial and the deep capillary plexus segments were acquired and statistically analyzed. The flow area parameters were measured in the superficial retinal capillary plexus, deep retinal capillary plexus, outer retinal capillary plexus, and choriocapillaris layers of the macula in 1-mm and 3-mm diameter areas. The peripapillary flow areas were measured for the optic nerve head, vitreous, radial peripapillary capillary (RPC), and choroid in a 4.50-mm diameter area. Foveal and parafoveal thicknesses were also measured and compared. The average hospital admission time of the patients in group S was 1.24 ± 0.75 (0.50-3.00) hours. Age (p = 0.103) and gender (p = 0.714) were similar in both groups. Superficial (p = 0.010), deep flow areas (p = 0.034), and superficial parafoveal vascular density (p = 0.001) were significantly reduced in group S compared to group C. The outer retinal flow area (p < 0.001) increased significantly in group S. Nerve head flow area (p = 0.035), one of the optic disc flow areas, was found to be decreased in group S. Notably, foveal (p < 0.001) and parafoveal (p = 0.003) thicknesses and superficial (p = 0.001) and deep (p < 0.001) foveal vascular densities were greater in group S. Compared to group C, the superficial (p = 0.009) and deep (p = 0.009) foveal flow areas in the central foveal area with a diameter of 1 mm increased significantly in group S. Viper venom may cause blood flow changes in the retina and optic disc and an increase in retinal thickness in the early period although there are no signs of systemic envenomation.

Clinical and Optical Coherence Tomography Analysis of Intraretinal Microcysts in Patients with Epiretinal Membrane

Purpose: To perform clinical and optical coherence tomography analysis of intraretinal microcysts (IRM) in patients undergoing pars plana vitrectomy (PPV) for primary epiretinal membrane (ERM) treatment.Materials and Methods: The files of 137 patients who were operated on by a single surgeon for primary epiretinal membrane treatment in our clinic between September 2017 and January 2020 were retrospectively reviewed. Patients with ERM due to secondary pathology were excluded from the study. Twenty patients with post-operative IRM (group 1) were determined and were included as the study group. To determine the effect of IRMs on visual acuity 20 patients who did not have IRM, had primary ERM and underwent PPV for treatment were included as the control group (group 2). The demographic, clinical, and operative data of the patients were obtained from the hospital database. Retinal analysis of the patients before the operation and at the earliest 6 months after the operation was performed using 6 × 6 mm images taken with the macular cube 512 × 128 protocol on the Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA, USA) device in our clinic.Results: Intraretinal microcysts were present in 8 (5.8%) of preoperative 137 patients and 20 (14.6%) of 137 postoperative patients. All 8 patients with preoperative cysts in group 1 also had postoperative IRMs. Excluding patients with preoperative cysts, the postoperative IRM incidence was found to be 12/137 (8.75%). Preoperative (p = .392) and postoperative (p = .978) visions were similar in group 1 and group 2. Preoperative (p = .745) and postoperative retinal thicknesses were similar in both groups (p = .989). The incidence of postoperative (p = .642) IRM was similar in patients who underwent ERM and ERM + internal limiting membrane (ILM) peeling in group 1.Conclusions: Intraretinal microcysts may sometimes be seen before and after ERM surgery. The preoperative cyst presence in ERM patients is an important risk factor for postoperative cyst presence. The peeling of ILM with ERM does not increase the probability of IRM occurrence. The presence of these cysts before and/or after the operation does not affect the visual prognosis and macular thickness in ERM patients.

Aqueous humor heat-shock protein 70, periostin, and irisin levels in patients with pseudoexfoliation syndrome

PURPOSE

To measure humor heat-shock protein 70, periostin, and irisin levels in patients with pseudoexfoliation syndrome and cataract (without glaucoma), and compare them with those of patients with cataract but without pseudoexfoliation.

METHODS

We examined 31 eyes of 31 patients with pseudoexfoliation and cataract (without glaucoma) and 30 eyes of 30 patients with cataract. We collected aqueous humor samples from all patients at the time of cataract surgery through a limbal paracentesis via a 25-gauge cannula mounted on a tuberculin syringe that received 100 to 150 µL of aqueous humor. We measured levels of aqueous humor Heat shock protein 70, periostin, and irisin using enzyme-linked immunosorbent assay methods.

RESULTS

The age (p=0.221) and gender (p=0.530) means were similar between the pseudoexfoliation and control groups. The mean Heat shock protein 70 level (29.22 ± 9.46 ng/mL; 17.88-74.46) in the pseudoexfoliation group was significantly higher than that in the control group (19.03 ± 7.05 ng/mL; 9.93-35.52; p<0.0001). The mean periostin level was significantly higher (6017.32 ± 1271.79 pg/mL; 3787.50-10803.57) in the pseu doexfoliation group than that in the control group (4073.63 ± 1422.79 pg/mL; 2110.44-7490.64; p<0.0001). The mean irisin level (53.77 ± 10.19 ng/mL; 29.46-71.16) was significantly higher than that in the control group (39.29 ± 13.58 ng/mL; 19.41-70.56; p<0.0001).

CONCLUSIONS

Heat shock protein 70, periostin, and irisin levels increase in the aqueous humor of patients with pseudoexfoliation without glaucoma.

Are Retinal and Peripapillary Blood Flows Affected during Migraine Attack?

Migraine pathophysiology is complex and partially includes the vasculature. This study compared retinal and peripapillary blood flow parameters in migraine patients during an attack with healthy controls using optical coherence tomography angiography (OCTA). A prospective clinical study was conducted including 52 eyes from 26 migraineurs and 48 eyes from 24 healthy controls. OCTAs were performed with RTVue XR Avanti using AngioVue software. OCTA imaging was performed during the attack period in migraineurs before any treatment for the attack. Vascular densities in the whole image, fovea, superior hemisphere, inferior hemisphere, and temporal, superior, nasal, and inferior regions of the parafoveal area and in the superficial and deep capillary plexuses were acquired and statistically analysed. The flow density parameters were measured in the superficial retinal capillary plexus, deep retinal capillary plexus, outer retinal capillary plexus, and choriocapillaris layers of the macula in a 3-mm diameter area. The peripapillary flow densities were measured for the optic nerve head, vitreous, radial peripapillary capillaries, and choroid in a 4.50-mm diameter area around the optic disc. Vascular density measurements in the superficial plexus were similar between migraineurs and controls (p > .05). Vascular densities in the deep capillary plexus were similar between groups (p > .05), except in the deep superior area (p = .05). Flow areas in the nerve head, vitreous, peripapillary capillary, and choroid segments were similar between migraineurs and controls (p > .05). Macular thickness parameters were also similar between groups (p > .05). The results suggest that an acute migraine attack does not affect retinal or peripapillary blood flow.

Evaluation of Anterior Segment Parameter Changes Using the Sirius after Uneventful Phacoemulsification

Purpose

To investigate changes in anterior chamber depth (ACD), corneal volume (CV), anterior chamber angle (ACA), anterior chamber volume (ACV), central corneal thickness (CCT), horizontal visible iris diameter (HVID), pupil diameter (PD), and intraocular pressure (IOP) after uneventful phacoemulsification cataract surgery with intraocular lens implantation.

Methods

A total of 132 eyes of 132 patients (87 men and 45 women) that underwent uneventful phacoemulsification cataract surgery and intraocular lens implantation were prospectively studied. The mean age of the patients was 63.68 ± 12.51 years. All patients were evaluated preoperatively and at 1 month postoperatively with the Sirius 3D Rotating Scheimpflug camera topography system. The ACD, CV, ACA, ACV, CCT, HVID, and PD measurements were recorded. IOP was measured using the Goldmann applanation tonometer, which was corrected for CCT of the Sirius device using Ehlers' formula.

Results

The preoperative mean ACD, ACV, ACA, CCT, CV, PD, HVID, and IOP were 2.79 ± 0.45 mm, 124.73 ± 25.72 mm³, 42.09 ± 7.49⁰, 523.87 ± 41.97 microns, 55.37 ± 4.89 mm³, 3.98 ± 1.23 mm, 11.72 ± 0.67 mm, and 14.74 ± 2.59 mmHg, respectively. Three months postoperatively, the mean ACD, ACV, ACA, CCT, CV, PD, HVID, and IOP were 3.45 ± 0.6 mm, 162.52 ± 23.79 mm³, 51.46 ± 5.63⁰, 526.21 ± 44.45 microns, 56.23 ± 5.12 mm³, 2.87 ± 0.45 mm, 11.91 ± 0.75 mm, and 12.02 ± 1.83 mmHg, respectively. There was a statistically significant increase in mean postoperative ACD, ACV, ACA, CV, and HVID compared with the corresponding preoperative values (p < 0.05). CCT remained stable after surgery. Postoperative PD and IOP were significantly decreased compared to corresponding preoperative values (p < 0.05).

Conclusions

Preoperative measurements by the Sirius 3D Rotating Scheimpflug camera topography system might help surgeons to predict postoperative changes resulting from phacoemulsification and intraocular lens implantation. This is a noncontact, noninvasive, and comfortable system for patients that is highly reliable and repeatable for anterior segment measurements.

Assessment of patient pain experience during intravitreal 27-gauge bevacizumab and 30-gauge ranibizumab injection

PURPOSE

To compare pain scores of patients during intravitreal 27-gauge bevacizumab and 30-gauge ranibizumab injection procedures.

METHODS

Seventy eyes of 70 patients who had not previously undergone intravitreal anti-vascular endothelial growth factor therapy were included in this study. Thirty-five patients received ranibizumab and 35 patients received bevacizumab. The diagnoses of the patients were: 27 age related macular degeneration, 15 diabetic macular edema, 9 diabetic vitreous hemorrhage, 6 central retinal vein occlusion, 11 branch retinal vein occlusion and 2 central serous chorioretinopathy. Bevacizumab (1.25 mg/0.05 mL) was injected into the vitreous cavity using a 27-gauge needle, and ranibizumab (0.5 mg/0.05 mL) was injected with 30-gauge needle. Patients were asked just after the injection to rate their perceived pain during the injection using the visual analogue scale (VAS) of 0 (no pain) to 10 (unbearable/worst pain). The average of these scores was used as the primary outcome.

RESULTS

The VAS pain scores in the ranibizumab and bevacizumab groups were 1.06 ± 0.91 (range, 0 to 3) and 1.94 ± 1.55 (range, 0 to 7), respectively, a significant difference (p = 0.005). Patients <65 and ≥65 years of age in both the ranibizumab and bevacizumab groups were then compared. For patients <65, there was a significant difference in the average VAS pain scores between groups (p = 0.003). However, for patients ≥65 years, there was not a significant difference in the average VAS pain scores between groups (p = 0.238). Female and male patients in both ranibizumab and bevacizumab groups were also compared. For female patients, there was a significant difference in the average VAS pain scores between groups (p = 0.016), although not for male patients (p = 0.078).

CONCLUSIONS

Thirty-gauge intravitreal injection is more comfortable than 27-gauge injection. Injection of bevacizumab with 30-gauge needle syringes may be more tolerable for patients.

Comparison of Central Corneal Thickness Measurements Obtained by RTVue OCT, Lenstar, Sirius Topography, and Ultrasound Pachymetry in Healthy Subjects

PURPOSE

To compare central corneal thickness (CCT) measurement results obtained by RTVue OCT, Lenstar, Sirius topography, and ultrasound pachymetry (UP) (OcuScan RxP Ophthalmic Ultrasound System, Alcon Laboratories) in healthy subjects.

MATERIALS AND METHODS

256 eyes of 128 healthy subjects were included in the study. CCT measurements were obtained from the eyes for each subject using the UP, Lenstar, Sirius topography, and RTVue OCT instruments. Ultrasound pachymetry measurements were performed after the eyes were anesthetized with one drop of 0.5% proparacaine hydrochloride and were performed at the same day after 15 minutes after previous measurements.

RESULTS

Of 128 participants, 84 were male and 44 were female with a mean age of 33.15 ± 12.95 years (ranging from 18 to 75 years). The mean CCTs for UP, Lenstar, Sirius topography, and RTVue OCT were 535.60 ± 35.15 (440,00-668,00); 532.63 ± 34.44 (449,00-650,00); 526.05 ± 36.45 (314,00-640,00); 525.89 ± 33.21 (437,00-646,00) µm, respectively. The mean CCT measurements were statistically different among the three groups (p = 0.002). CCT measurements obtained using RTVue-OCT were significantly thinner than those obtained using UP (p = 0.009). Sirius CCT measurements were also thinner than UP (p = 0.011). Mean CCT measurements between UP and Lenstar were similar (p = 0.769). Measurements with Lenstar (r = 0.849), Sirius topography (r = 0.883), and RTVue OCT (0.949) were highly correlated with UP measurements.

CONCLUSION

RTVue OCT and Sirius topography significantly underestimated the CCT compared with UP. Although highly correlated, the measurement values with these devices are not directly interchangeable in clinical practice.

Short-term effects of intravitreal bevacizumab on cornea and anterior chamber

PURPOSE

To determine the short-term effects of single-dose intravitreal bevacizumab injection on central corneal thickness (CCT), simulated keratometry (Sim K), anterior chamber depth (ACD), iridocorneal angle (ICA) and intraocular pressure (IOP) measurements.

DESIGN

Prospective, nonrandomized, interventional clinical trial.

MATERIALS AND METHODS

Forty-three eyes of 43 patients aged between 41 and 78 years (average 62 ± 13 years) received an intravitreal injection of 2.5 mg/0.1 mL bevacizumab. Patients who had not undergone additional intravitreal anti-vascular endothelial growth factor therapy within 6 months were included in the study. CCT, Sim K, ACD and ICA measurements were obtained with Sirius Topographer. IOP measurements were taken after topographic measurements with Goldmann applanation tonometer. The CCT, ACD, ICA and IOP measurements were taken before and after 3rd, 15th days and 1st month of intravitreal bevacizumab injection.

RESULTS

Pre- and postinjection of 3rd, 15th days and 1st month CCT (p = 0.999), Sim K (p = 0.746), ACD (p = 0.996), ICA (p = 0.632) and IOP (p = 0.707) measurements were not statistically different. Mean CCT (p = 1.000), Sim K (0.972), ACD (p = 0.998), ICA (0.667) and IOP (0.951) values were similar before and after 3rd day of bevacizumab injection. Mean CCT (p = 0.999), Sim K (p = 0.994), ACD (p = 1.000), ICA (p = 0.999) and IOP (p = 1.000) measurements were also similar before and after 15th day of injection. Preinjection and 1st month of postinjection CCT (p = 0.999), Sim K (p = 0.932), ACD (p = 0.998), ICA (p = 1.000) and IOP (p = 0.741) measurements did not change significantly.

CONCLUSIONS

Single-dose intravitreal bevacizumab injection does not affect CCT, Sim K, ACD, ICA and IOP in short-term period.

Comparison of efficiency of intravitreal ceftazidime and intravitreal cefepime in the treatment of experimental Pseudomonas aeruginosa endophthalmitis

In this study, we evaluated the efficiency of cefepime in the treatment of experimental Pseudomonas aeruginosa endophthalmitis. We compared the findings with the standard dose of ceftazidime (1 mg/0.1 ml). Thirty-six New-Zealand White rabbits were divided into 6 equal groups and were treated with different methods (Group 1 = sham, Group 2 = 0.5 mg/0.1 ml cefepime, Group 3 = 1 mg/0.1 ml cefepime, Group 4 = 2 mg/0.1 ml cefepime, Group 5 = 1 mg/0.1 ml ceftazidime, Group 6 = control). The eyes of rabbits in each group were examined clinically on 1^st, 3^rd, and 6^th day of the experiment. At 6^th day, 0.1 ml vitreous humor aspirates were obtained and plated for quantification on the blood agar and the results were expressed as colony-forming unit/ml. Subsequently, the eyeballs were enucleated and the histopathological evaluation was performed. Our findings denoted beneficial effects of cefepime in treatment groups (especially, in Groups 3 and 4). Intravitreal cefepime may be an alternative drug in the treatment of P. aeruginosa endophthalmitis.

Anterior vitrectomy and partial capsulectomy via anterior approach to treat chronic postoperative endophthalmitis

AIM

To describe the results of vitrectomy and partial capsulectomy via anterior approach surgical technique in treatment of chronic postoperative endophthalmitis (CPE).

METHODS

Clinical records of 9 patients treated for CPE between 2006 and 2010 were reviewed retrospectively. All of these patients were treated with vitrectomy and partial capsulectomy via anterior approach.

RESULTS

Six of 9 patients were male. The average patients' age was (60±8.1) years. The average period between cataract extraction and onset of signs and symptoms was (3.6±1.3) weeks. The average presenting visual acuity was 0.3±0.1 and the average final post operative visual acuity was 0.7±0.2. The mean follow-up period was (28.1±8.9) weeks. In all patients, the inflammation subsided after surgery.

CONCLUSION

Our results suggest that anterior vitrectomy and partial capsulectomy via anterior approach may be considered as potentially useful and relatively less invasive technique to treat CPE.

Protective effects of ebselen on sodium-selenite-induced experimental cataract in rats

PURPOSE

To determine whether ebselen has a protective effect or antioxidative potential in a sodium-selenite-induced experimental cataract model.

SETTING

Fırat University, Elazığ, Turkey.

DESIGN

Experimental study.

METHODS

Twenty-one Sprague-Dawley rat pups were randomly divided into a control group, a sodium-selenite-induced-cataract group, and an ebselen-treated group; each group contained 7 rat pups. Rats in the control group received dimethyl sulfoxide (DMSO) intraperitoneally only and rats in the sodium-selenite-induced-cataract group received 30 nmol/g body weight sodium selenite subcutaneously and DMSO intraperitoneally 10 days postpartum. Rats in the ebselen group received 30 nmol/g body weight sodium selenite subcutaneously 10 days postpartum and were treated with 5 mg/kg body weight ebselen once a day for 4 consecutive days. Cataract development was assessed weekly for 3 weeks by slitlamp examination and graded using a scale. Reduced glutathione (GSH), total nitrite, and malondialdehyde (MDA) levels in lens supernatants were measured at the end of 3 weeks.

RESULTS

In the control group, all lenses were clear. In the ebselen-treated group, the mean cataract stage was significantly lower than in the sodium-selenite-induced-cataract group (P = .022). The GSH levels were significantly lower in the sodium-selenite-induced-cataract group than in the control and ebselen groups (P < .001). The MDA levels were lower in the ebselen group than in the sodium-selenite-induced-cataract group (P < .001). The mean total nitrite level was significantly lower in the sodium-selenite-induced-cataract group than in the ebselen group (P = .001).

CONCLUSIONS

Ebselen had a protective effect on cataract development in a sodium-selenite-induced experimental model. The protective effect of ebselen appears to be due to inhibition of oxidative stress.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Modulation of postoperative scarring with tacrolimus and octreotide in experimental glaucoma filtration surgery

PURPOSE

The purposes of this study were to investigate the effects of topically administrated Tacrolimus and Octreotide on modulation of postoperative scarring in experimental glaucoma filtration surgery and to compare the antifibrotic properties of these agents with mitomycin-C (MMC).

MATERIAL AND METHODS

A total of 28 New Zealand rabbits weighing 2.5-3 kg were randomly divided into a surgical control (SC) group and three experimental groups. Standard filtration surgeries were performed on the right eyes of all the rabbits. The rabbits in the SC group received only vehicle after the surgeries, whereas the rabbits in the three experimental groups were treated either with 0.4 mg/mL MMC during the surgery (MMC group) or with 0.3 mg/mL Tacrolimus drop four times a day (TT group) or with 10 µg/mL Octreotide drop three times a day (OT group) for 14 days. The animals were killed on day 14, eyes were enucleated and histologically and immunohistochemically analyzed.

RESULTS

In SC group mean fibroblast, mononuclear cell number and fibroblast growth factor-β (FGF-β), transforming growth factor-β (TGF-β) immunostaining intensity was higher than all treatment groups. In OT group mean fibroblast number was lesser than MMC (p < 0.01) and TT (p < 0.05) group. In TT group mean fibroblast number was lesser than MMC group (p < 0.05). Mean mononuclear cell number was similar between MMC, OT and TT groups (p > 0.05). In MMC, OT and TT groups mean TGF-β and FGF-β immunostaining intensity was similar (p > 0.05).

CONCLUSIONS

Topically administration of Tacrolimus and Octreotide effectively reduced the subconjuntival scarring response 2 weeks after experimental glaucoma filtration surgery.

The effect of anisometropic amblyopia on retrobulbar blood flow parameters. Anisometropic amblyopia and retrobulbar blood flow

To look for a correlation between or the effect of anisometropia amblyopia on retrobulbar blood flow parameters. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) of the ophthalmic artery (OA), central retinal artery (CRA), and temporal posterior ciliary artery (tPCA) were measured with color Doppler imaging, and systolic/diastolic ratio, resistivity index (RI), and pulsatility index (PI) were computed in 42 patients with anisometropic amblyopia. The mean PSV of OA, CRA, and tPCA in amblyopic and fellow eyes were 62.69 ± 24.04, 62.64 ± 20.18; 9.28 ± 3.71, 10.27 ± 4.18; 10.81 ± 4.59, 11.28 ± 4.91, respectively. The mean EDV of OA, CRA, and tPCA in amblyopic and fellow eyes were 15.87 ± 11.31, 14.52 ± 6.54; 2.48 ± 1.17, 2.62 ± 2.06; 3.04 ± 2.34, 3.14 ± 2.18, respectively. The mean RI of OA, CRA, and tPCA in amblyopic and fellow eyes were 0.76 ± 0.08, 0.76 ± 0.08; 0.72 ± 0.08, 0.74 ± 0.95; 0.72 ± 0.09, 0.72 ± 0.08, respectively. The mean PI of OA, CRA, and tPCA in amblyopic and fellow eyes were 1.77 ± 0.42, 1.81 ± 0.46; 01.58 ± 0.42, 1.59 ± 0.43; 1.54 ± 0.43, 1.58 ± 0.49, respectively. There was no statistically significant difference in any of the measured parameters between the amblyopic and fellow eyes. Anisometropic amblyopia did not cause any change in retrobulbar blood flow in amblyopic eyes.

A case of a retained intralenticular foreign body for two years

We report a case of a missed metallic intraocular foreign body retained in the lens over a two-year period without causing inflammatory reaction, which presented with cataract later. A 24-year-old man presented with a progressive blurring of vision in the left eye for two years. He had had a history of metal-on-metal activity two years before. He had pain for one day in left eye and it was healed by the following day. Biomicroscopic examination revealed cataract, an intralenticular foreign body, and a corneal scar at seven o’clock meridian of the cornea in the left eye. Best-corrected visual acuity was 20/200 in the left eye. Intralenticular foreign body removal, phacoemulsification, and an intraocular lens implantation was performed under local anesthesia. The intralenticular foreign body was metallic and its size was about 2 × 2 mm. Two weeks after the operation best corrected visual acuity was 20/20 in left eye. A retained foreign body should be considered in each patient with a history of penetrating ocular trauma and all efforts must be made to exclude presumptive diagnosis of intraocular foreign body.

Levels of circulating homocysteine, vitamin B6, vitamin B12, and folate in different types of open-angle glaucoma

OBJECTIVE

To compare the levels of plasma homocysteine (Hcy), vitamin B6 (vit-B6), serum vitamin B12 (vit-B12), and folate in healthy individuals and in patients with normal tension glaucoma (NTG), pseudoexfoliative glaucoma (PXG), or primary open-angle glaucoma (POAG).

STUDY DESIGN

A prospective controlled trial.

PARTICIPANTS AND METHODS

Forty healthy subjects, 48 patients with NTG, 38 patients with PXG, and 34 patients with POAG were included in the study. Those who used vitamin supplements or medications affecting Hcy and vitamin levels were excluded from the study. The levels of Hcy and vit-B6 were measured by High Performance Liquid Chromatography (HPLC). The levels of serum vit-B12 and folic acid were measured by competitive chemiluminescent enzyme immunoassay (CEI). One-way analysis if variance (ANOVA), analysis of covariance (ANCOVA), and the Tukey honestly significant difference test were used for statistical analysis.

RESULTS

The mean Hcy level of the PXG group was 15.46+/-9.27 micromol/L which was significantly higher (P=0.03) than that of the control group. There were no statistical differences in serum vit-B12 and folate levels among control subjects and NTG, PXG and POAG groups (P>0.05). It was found that the mean plasma vit-B6 level was significantly higher in subjects with NTG (P=0.03) and POAG (P=0.025) versus controls. Mean vit-B6 levels in NTG and POAG were 30.50+/-11.29 microg/L and 30+/-12.15 microg/L, respectively.

CONCLUSIONS

The plasma level of Hcy was found to be increased only in PXG patients and the plasma levels of vit-B6 were found to increase in the NTG and POAG sample groups. Using homocysteine and vit-B6 levels as the determinants of hyperhomocysteinemia still needs further research.

Aspects of thermal martensite in a FeNiMnCo alloy

Thermal martensite characteristics in Fe-29%Ni-2%Mn-2%Co alloy were investigated with scanning electron microscopy (SEM) and Mössbauer spectroscopy characterization techniques. SEM observations obviously revealed the lath martensite morphology in the prior austenite phase of examined alloy. As well, the martensitic transformation kinetics was found to be as athermal type. On the other hand, Mössbauer spectroscopy offered the paramagnetic austenite phase and ferromagnetic martensite phase with their volume fractions. Also, the internal magnetic field of the martensite was measured as 32.9T from the Mössbauer spectrometer.

Malignity-like peritoneal tuberculosis associated with abdominal mass, ascites and elevated serum Ca125 level

Peritoneal tuberculosis (TB) is similar to ovarian cancers with respect to clinical, radiological laboratory findings. In this report, we present 10 TB cases with malignity pre-diagnosis based on the presence of ascites, pelvic mass, abdominal lymph nodes and elevated Ca125. The mean age of the cases was 29 +/- 14.4 years (18-63). Eight cases were associated with ascites, and the mean adenosine deaminase (ADA) value in ascitic fluid was 130.37 +/- 92.2. All cases had elevated levels of serum Ca125. In 6 cases, we identified lung pathologies based on chest radiography. Diagnoses were made based on diagnostic laparotomy in four cases, laparoscopy in two cases, percutaneous needle biopsy in two cases, and clinical evaluation in two cases. Anti-TB treatments lasted 12 months. Serum Ca125 levels normalised in the 3rd month of treatment. In the differential diagnosis of ascites and high serum Ca125 levels, tuberculosis should be considered in patients from developing countries.

Coats-like retinitis pigmentosa: Reports of three cases

PURPOSE

Describing the ophthalmic findings of an exudative vasculopathy called as Coats-like retinitis pigmentosa on three patients. The etiology of the Coats-like retinitis pigmentosa is obscure. The principal theories have been discussed in this article.

METHODS

Three observational case series have been discussed. Complete ophthalmic examinations and color fundus photos, visual field, and fluorescein angiography have been performed.

RESULTS

We have identified 3 patients who have some typical clinical features of Coats-like retinitis pigmentosa; peripheral serous retinal detachment, telangiectasia, prominent lipid deposition, pigmentary changes in peripheral retina, and loss of vision. None of the three patients had positive family history. All of the patients have had symptoms of nyctalopia, decreased central vision, and two of them have had constriction of visual field. All of the patients have had cataracts and two of them underwent cataract surgery. Fundus examination and fluorescein angiography of patients revealed typical retinitis pigmentosa with Coats-type changes in bilateral inferiotemporal quadrants.

CONCLUSION

A better understanding of clinical features and genetic etiology of Coats-type retinitis pigmentosa will aid diagnosis and development of new therapies. If sufficient conditions arise, genetic factors that influence the expression of CRB1 mutations in Coats-like retinitis pigmentosa should be detected.

Factors influencing sputum smear and culture conversion time among patients with new case pulmonary tuberculosis

Sputum smear and culture conversion are important indicators for the effectiveness of treatment and the infectivity of the patient. The aim of this study was to identify the factors influencing both sputum smear and culture conversion time among patients with new case pulmonary tuberculosis (TB). The study was conducted in a reference hospital in Turkey in which 737 patients with pulmonary TB were hospitalised between January 2000 and 2005. We evaluated 306 (193 men and 113 women) human immunodeficiency virus-negative patients diagnosed with new case pulmonary TB. Factors associated with both sputum smear and culture conversion time (days) were investigated. Patients with diabetes mellitus (DM), cavitary disease, radiologically extensive disease had longer sputum smear and culture conversion time than the other groups. In addition, old age, male sex, smoking and thrombocytosis were found to be significantly associated with sputum smear conversion time. In the logistic regression analysis, the presence of DM and extensive disease were determined as independent factors associated with persistent sputum smear and culture positivity at the end of 2 months. The presence of DM and extensive disease were found to be independent risk factors influencing both sputum smear and culture conversion time in pulmonary TB. Sputum smear and culture examinations should be considered together to assess the poor prognosis.

A model with an intrinsic property of learning higher order correlations

A neural network model that can learn higher order correlations within the input data without suffering from the combinatorial explosion problem is introduced. The number of parameters scales as M x N, where M is the number such that no higher order network with less than M higher order terms can implement the same input data set and N is the dimensionality of the input vectors. In order to have better generalization, the model was designed to realize a supervised learning such that after learning, output for any input vector is the same as the output of a higher order network that implements the same input data set using M number of higher order terms. Unlike the case in product units, the local minima problem does not pose itself as a severe problem in the model. Simulation results for some problems are presented and the results are compared with the results of a multilayer feedforward network. It is observed that the model can generalize better than the multilayer feedforward network.

Surgical treatment of Brucella endocarditis

BACKGROUND

Brucella endocarditis (BE) is a lethal complication of human brucellosis, which is rarely seen and hardly described.

METHODS

In the present report, six successfully treated cases of BE involving three native aortic valves, two native mitral-aortic valves, and a mitral bioprosthesis are described. The diagnosis of BE was based on clinical features, high brucella serologic titers, and positive blood cultures. Although the blood cultures were positive in all patients, all the resected valve materials and tissue cultures were negative. The patients received rifampicin, streptomycin, and doxycycline (in 3 patients), rifampicin, tetracycline, and cotrimoxazole (in 2 patients), and rifampicin, doxycycline, and cotrimoxazole (in 1 patient). Infected native valves and bioprosthesis were replaced by mechanical valves.

RESULTS

There was no early or late mortality. No recurrent infection developed after management with a combination of antibiotherapy lasting 6 months postoperatively during a mean follow-up of 47 months (range 20 to 84 months).

CONCLUSIONS

This report suggests that the combination of valve replacement and antibiotic therapy produces successful results in the treatment of BE.

Fifteen-year clinical experience with the biocor porcine bioprostheses in the mitral position

BACKGROUND

Bioprosthetic valve use represents a crucial improvement in surgical treatment of mitral valve disease. The aim of this study is to determine the long-term durability of the Biocor porcine bioprosthetic mitral valve.

METHODS

Between 1985 and 1989, a total of 158 Biocor porcine bioprosthetic valves were placed in the mitral position, and long-term results of these patients were investigated retrospectively in 1999.

RESULTS

Thirty-day mortality was 4.4% (7 patients). Total follow-up was 1,499 patient-years. Actuarial survival was 83.66% +/- 3% at 5 years, 77.78% +/- 3.36% at 13 years (1.8% patient-year). Multivariate analysis demonstrated younger age, duration of implantation, congestive heart failure, and functional class to be significant predictors of late mortality. Actuarial freedom from valve-related mortality was 98.58% +/- 1% at 15 years (0.13% patient-year). Actuarial freedom from structural valve deterioration was 95.49% +/- 1.8% at 5 years, 70.2% +/- 4.12% at 10 years, and 64.82% +/- 5.34% at 13 years (2.6% patient-year). Actuarial freedom from structural valve deterioration-related reoperation was 98.43% +/- 1.1% at 5 years, 89.15% +/- 2.85% at 10 years, and 76.82% +/- 7.91% at 14 years. Multivariate analysis showed younger age and duration of implantation to be significant predictors of structural valve deterioration and its related reoperation.

CONCLUSIONS

By studying a 15-year time period, it is seen that this new generation porcine bioprosthetic valve should be considered an alternative for mechanical valves in selected patients.

Different CABG methods in patients with chronic obstructive pulmonary disease

BACKGROUND

Pulmonary dysfunction is still a major problem in coronary artery bypass grafting (CABG). The purpose of this randomized study was to determine the effect of different CABG techniques on pulmonary function.

METHODS

Fifty eight patients with severe obstructive pulmonary disease had elective isolated coronary surgery. The surgical methods for the patients with chronic obstructive pulmonary disease (COPD) were standard CABG in 18 patients (group 1), beating heart surgery in 19 patients (group 2), and minimally invasive direct coronary artery bypass grafting (MIDCABG) in 21 patients (group 3).

RESULTS

The earliest extubation time was from group 3 (p < 0.001). The average stay in the intensive care unit was significantly longer in group 1 (2.6 +/- 1.5 days) than in groups 2 (1.4 +/- 0.8 days) and 3 (1.1 +/- 0.8 days) (p < 0.05). The most prevalent respiratory morbidity was atelectasis that developed in 6 patients from group 1, in 2 patients from group 2, and in 3 patients from group 3. Forced expiratory volumes in 1 second (FEV1) obtained in the second postoperative month were significantly lower than preoperative values only in group 1 (p < 0.05). Forced vital capacity (FVC) values were significantly lower than the preoperative values in all three groups (p < 0.05).

CONCLUSIONS

Off-pump bypass surgical procedures are more advantageous than on-pump methods for patients with COPD. These patients can be operated on using the beating heart technique or by using MIDCABG to prevent side effects of CPB on pulmonary function and effects of sternotomy.

Midterm angiographic assessment of coronary artery bypass grafting without cardiopulmonary bypass

BACKGROUND

Coronary bypass surgery that provides good long-term graft patency can be performed on the beating heart as a viable alternative to conventional coronary artery bypass grafting (CABG).

METHODS

From September 1993 to December 1996, 696 patients underwent CABG on the beating heart at the Koşuyolu Heart and Research Hospital in Istanbul. Among them, 70 patients were chosen randomly for angiographic assessment of off-pump coronary artery bypass grafting.

RESULTS

The interval from operation to angiography varied from 24 to 61 months (mean, 36.1+/-10.9 months). The patency rate of left internal mammary-left anterior descending artery anastomoses was 95.59% (patency achieved in 65 of 68 patients) and of vein grafts was 47.06% (patency achieved in 16 of 34 patients) (p < 0.0001). The patency rates of grafts anastomosed to the left anterior descending artery were significantly higher than the rates of the grafts anastomosed to the other coronary arteries (95.71% versus 45.45%, p < 0.0001). Multivariate analysis showed that graft type (p < 0.0001) and hyperlipidemia (p = 0.023) were significant predictors for graft occlusion. Left ventricular function improved significantly after CABG (p = 0.04). Reintervention (using percutaneous transluminal cardiac angioplasty) and reoperation rates were 0.97% and 1.4%, respectively.

CONCLUSIONS

Off-pump coronary artery bypass grafting appears to produce midterm and long-term patency rates that are comparable to those of conventional techniques; that is especially true in cases of arterial conduits and of conduits anastomosed to the left anterior descending artery.

Reconstruction of foot defects due to mine explosion using muscle flaps

Landmine explosions bring a formidable challenge to both patients and reconstructive surgeons. Free tissue transfer is the only method of repairing such extensive soft tissue defects of the foot after serial debridements. Sixty-five consecutive free muscle flap transfers were performed in 54 patients who had foot defects involving soft tissue and bone due to mine explosions. Although posttraumatic vessel disease had complicated most of the cases, overall flap survival rate was 83%. Each patient was ambulatory. Ulceration in long-term period was seen in only one patient. Eighty-five percent of patients with successful bone reconstruction and 41.6% of patients without adequate bone replacement demonstrated normal weightbearing in footprints and gait analysis. Free muscle flaps with split thickness skin graft and bone replacement are recommended for the reconstruction of such devastating wounds.

Simultaneous surgical intervention to coronary artery disease, peripheral arterial disease and superior mesenteric artery stenosis

A patient, suffering from angina pectoris, claudicatio intermittens and postprandial abdominal pain underwent coronary and peripheral arteriographic examination; coronary arterial disease and aortoiliac occlusive disease was diagnosed. Color Doppler ultrasonography revealed superior mesenteric artery stenosis. CABG with MIDCAB (minimal invasive direct coronary artery bypass) technique was performed together with aortabifemoral graft interposition and graft bypass to superior mesenteric artery and considerable success was obtained.

Surgical repair in ruptured congenital sinus of Valsalva aneurysms: a 13-year experience

BACKGROUND AND AIM OF THE STUDY

Rupture of congenital sinus of Valsalva aneurysm is a rare cardiac malformation that usually causes reduced cardiac performance.

METHODS

Twenty patients (mean age 28.3 +/- 10.7 years; range: 14 to 55 years) with rupture of congenital sinus of Valsalva aneurysm were operated on at our institution between January 1985 and March 1999. The origin of the ruptured aneurysms was the right coronary sinus in 18 patients (90%) and the non-coronary sinus in two (10%). No ruptures were observed originating from the left coronary sinus. The aneurysms ruptured into the right ventricle in 14 patients (70%), into the right atrium in five (25%), and into the left ventricle in one patient (5%). Subarterial ventricular septal defect (VSD) was the most common associated defect (30%), and aortic insufficiency the second (20%). No correlation was found between subarterial VSDs and aortic insufficiency (p > 0.05). To achieve repair, the aorta and cavity into which the aneurysm had ruptured were opened. The aneurysmal sac was excised and the defect closed with a patch in 18 patients, and without patch in two.

RESULTS

One patient died in hospital (mortality rate 5%); no late mortality was observed. Surviving patients were followed up for 4.4 +/- 3.3 years (range: 1 to 13 years). The actuarial survival rate was 95% at 12.35 years. Recurrence of fistula was observed in one patient (5%) in whom the ruptured aneurysm had been closed by primary suture without the use of a patch. At 12.35 years, the actuarial freedom from recurrence of fistula was 94.74% for all survivors, and 100% for patients with patch closure. No late complications have been observed.

CONCLUSIONS

Following diagnosis of ruptured sinus of Valsalva aneurysm, surgical repair is the treatment of choice. Surgery performed as rapidly as possible after diagnosis in general leads to an excellent outcome.

Less invasive approaches for closed mitral commissurotomy

OBJECTIVE

Recently, closed mitral commissurotomy (CMC) has been reexplored due to the concepts of less invasive valvular surgery. The feasibility of closed mitral commissurotomy via port access or limited thoracotomy by aid transesophageal echocardiography (TEE) was investigated in this clinical study.

METHODS

Between August 1996 and April 1998, 42 patients (32 women, ten men with a mean age of 36.2+/-7.8 years) underwent less invasive CMC at the Kosuyolu Heart and Research Hospital. CMC procedure were done through a limited (12-16 cm) thoracotomy incision in 23 patients, a very limited or mini thoracotomy incision (7-8 cm) in 11 patients and port access by aid TEE in eight patients. Preoperative mean mitral valve area was calculated as 1.19+/-0.13 cm2 and mean mitral valve gradient was measured as 14.8+/-3.2 mmHg. TEE provided information about the mitral valve anatomy and functions during the procedure in all patients.

RESULTS

Commissurotomy was successfully performed in all patients. In eight patients, a Tubbs dilator was inserted via port access at the 6th intercostal space from a 3-cm incision. Incision by guidance of TEE and CMC could be performed without thoracotomy in five patients. In three patients of the port access group, a very limited thoracotomy was required to perform CMC by digital guidance. Postoperative mean MVA was 2.37+/-0.29 cm2, minimal mitral gradient was 5.3+/-1.7 mmHg. In eleven patients, minimal mitral regurgitation was observed. The operations and postoperative period were free of complications in all patients. Following an average 12+/-2.8 h intensive care unit period, all patients were discharged after an average of 3.4+/-0.8 days of hospitalization.

CONCLUSION

Limited thoracotomy has less detrimental structural effects in patients. Port access by aid TEE approach to CMC may offer less invasiveness, lower cost effectiveness and be an alternative to percutaneous balloon mitral valvotomy.

Saving the zone of stasis in burns with recombinant tissue-type plasminogen activator (r-tPA): an experimental study in rats

Hypercoagulability 2-3 h following scald injury and vessel thrombosis are well-known complications of burn injury. The present study was designed to determine the effect of recombinant tissue-type plasminogen activator (r-tPA) on vessels thrombosis in zones of stasis postburn. Twenty rats were assigned to experimental and control groups (N:10). After shaving the backs, a 'comb burn' was given bilaterally on the back of the rats 0.5 cm lateral and parallel to the midline by using a brass probe consisting of four rows (10 x 20 mm) and three interspaces (5 x 20 mm). Standardized full-thickness burns of the experimental group were treated with r-tPA via femoral veins 2 h after the burn, while the control group rats were infused the same volume of saline. Interspaces between the rows and vertical space area were evaluated as zone of stasis. The skin blood flow measurements of interspaces revealed a decreased level immediately and 2 h after the burn injury, averaging 11.3 and 9.8 perfusion units, respectively. On day 7, blood flow measurements of interspace and vertical space areas significantly differed between the groups, averaging 11.9 PU in the experimental and 1.8 PU in the control groups (P<0.05). To evaluate perfusion, each rat received 3 mCi of technetium-99m methoxyisobutylisonitrile on the first or seventh day postburn. After 30 min, the entire back skins including the panniculus carnosus muscle layer were dissected away. Gamma camera images revealed that in the experimental group the interspace areas took up 60-90 per cent more radioactivity than the burned areas while in the control group 20-50 per cent more activity was taken up by the interspace area when compared to burned areas. Autoradiography gave the exact borders of the necrotic and survived tissues. The percentage of live interspace and vertical space areas in the experimental group was 87.8 per cent on day 7, while it was 31.8 per cent in the control group (P<0.05). Dry/wet ratios did not reveal any significant difference at 24 h postburn. These results confirm that treatment with this selective fibrinolytic agent (r-tPA) after burn injury would have some benefits on saving the zone of stasis in burns.

Reconstruction of saddle nose deformities using porous polyethylene implant

Various materials have been employed for nasal contour restoration. We used porous polyethylene implants in reconstruction of saddle nose deformity in 36 cases. Only one complication occurred in the 8-18 months follow-up period. No implant was removed. Both cosmetic and functional results were accepted as pleasing by the patients.

Ameloblastic fibrodentinoma. Report of two cases

Two cases of ameloblastic fibrodentinoma localized in the posterior mandibular area are presented. The clinical and histological findings are discussed.

Burn scar carcinoma with longer lag period arising in previously grafted area

A case of Marjolin's ulcer that arose in previously grafted area of right ankle 55 years after initial burn injury was managed by below knee amputation and right inguinal lymph node dissection. The characteristics of this malignancy were reviewed, and rarely seen features particular to this case, which are a longer lag period and rapid growth in a previously grafted area, were discussed.

Subcutaneous metallic mercury injection: early, massive excision

The case of a patient who injected 10 cc of metallic mercury subcutaneously into his left forearm through multiple punctures in an attempt at suicide is presented. Diagnosis was made by plain radiography of his left forearm, which exhibited redness, edema, and tenderness on the third day postinjection. Early excision of all affected subcutaneous tissues including metallic mercury deposits was performed on the fifth day postinjection. Blood and urine mercury levels that were initially found in high levels decreased dramatically to normal ranges after the excision and remained unchanged at the follow-up period of 6 months. No renal or hepatic functional impairment was encountered. The patient was free of toxic symptoms and mercury embolism. The local, aseptic lytic property of metallic mercury, which could cause severe damage to vital structures, was observed perioperatively. Early diagnosis and early, massive excision of mercury deposits in affected tissues is the important treatment modality in these rare cases.

Limbal-conjunctival autograft transplantation in cases with recurrent pterygium

This prospective study was undertaken to evaluate limbal conjunctival autotransplantation in the management of cases with recurrent pterygium. At present, new surgical techniques to prevent pterygium recurrence following surgery are in investigation. In recent years, it has been postulated that pterygium is due to hypofunction of limbal stem cells. Thirty-one out of 49 patients with recurrent pterygium were treated by limbal-conjunctival autograft transplantation and the other 18 treated by Czermak technique, including two line of limbal cauterization intraoperatively, and used as a control group. During a mean follow-up period of 10 months (ranging 3-18 months), 4 recurrences (13.3%) in the limbal-conjunctival autograft transplantation group and 9 recurrences (50%) in the control group were observed. We conclude that this was a successful method to prevent secondary recurrence in the management of recurrent pterygium patients under 40 years of age.

Fine needle aspiration cytology of malignant lymphoepithelial lesion of the salivary gland. A report of two cases

Fine needle aspiration cytologic findings in two cases of malignant lymphoepithelial lesion (MLEL) of the parotid glands are presented. Aspirates of both cases showed individual or cohesive clusters of tumor cells intermingling with mature lymphocytes. Cervical lymph node aspirates in both cases were similar to those seen in the parotids. Our findings suggest that neither cytology nor histology of the cervical lymph nodes is conclusive in establishing the primary site of a metastatic lymphoepitheliomalike carcinoma. MLEL of the salivary glands must be included in the differential diagnosis.

[Occurrence and radiological studies of different teat changes in milk cows]

The aim of this study was to investigate the incidence of different teat lesions in cows that cause obstruction of milk flow. 18,400 teats were palpated in Konya slaughterhouse. From these 1000 hard milking or obstructed teats were found (5.4%). Based on the radiographical results, distal 1/3, proximal 2/3, complete teat lesions and congenital obstructions were found in 70.1, 16.6 and 0.7% respectively.