RISK OF HYPERCALCEMIA IN ELDERLY PATIENTS WITH HYPERVITAMINOSIS D AND INTOXICATION

OBJECTIVE

We aimed to determine the risk of hypercalcemia in a geriatric population with very high dose levels of 25-hydroxy-vitamin D (25(OH)D).

PATIENTS AND METHOD

This study was designed as a retrospective, cross-sectional two-center study for examining the elderly patients with very high 25(OH)D levels (>88ng/mL) between January 2014 and December 2019. After recruitment, subgroup analyses of the patients were performed based on their calcium and vitamin D levels.

RESULTS

A total of 81.101 elderly patients, who had been evaluated for their vitamin D levels, were screened. Of the 458 (0.6%) elderly patients with 25(OH)D>88 ng/mL according to our criteria, 217 patients with complete data were accepted into our study. The median 25(OH)D level was 103.7ng/mL (min-max:88.2-275.9). Most of the elderly patients (86.6%) with very high 25(OH)D levels were normocalcemic. When patients with hypercalcemia were compared with normocalcemic group, no difference was observed in the levels of 25(OH)D, intact parathormone (iPTH), phosphorus, alkaline phosphatase (ALP), and their age. However, the PTH suppression rate was significantly higher in hypercalcemic group (p=0.005).

CONCLUSION

The elderly patients with very high 25(OH)D levels would appear to be mostly normocalcemic whereas life-threatening hypercalcemia would also occur. Treatment and follow-up planning should be done according to the clinical guideline recommendations.

Relationship between Central Corneal Thickness and Parameters of Optic Nerve Head Topography in Healthy Subjects

Purpose

To investigate the relationship between central corneal thickness (CCT) and topographic parameters of optic nerve head (ONH) in healthy eyes.

Methods

Right eyes of 208 healthy subjects between 40 and 59 years of age with refractive error less than 1 D were enrolled in this cross-sectional study. Ultrasonic pachymeter was used to measure CCT, and the ONH parameters were obtained by using confocal scanning laser ophthalmoscope. Relationship of various topographic parameters to age and sex were also investigated. For statistical analysis Student t test, analysis of variance, Pearson and Spearman test, and partial correlation coefficients were used.

Results

Mean CCT of subjects was 540.71±35.53 μm (462–621 μm), and the mean disc area was 2.37±0.44 mm2 (1.28–3.66 mm2). CCT showed negative correlations to disc area, rim area, rim volume, and retinal nerve fiber layer (RNFL) area. These correlations were found to be stronger in females. Negative correlations were demonstrated between age and the mean cup depth, maximum cup depth, RNFL thickness, and RNFL cross sectional area. Women had lesser rim volumes, but bigger cup to disk (C/D) area and linear C/D ratios compared to those of men.

Conclusions

In addition to its effect in the accuracy of intraocular pressure measurements, CCT has a structural relationship with the ONH in healthy nonglaucomatous eyes. Therefore, its effect on disc area might be especially important to explain the structural strength of the ONH in the pathogenesis of glaucoma.

The Comparison of Eyelash Lengthening Effect of Latanoprost Therapy in Adults and Children

PURPOSE

To compare the eyelash lengthening effect of latanoprost in adults and children with glaucoma.

METHODS

Twenty eyes of 13 men and 7 women (mean age: 54.9, range 42-69 years) with primary open-angle glaucoma and 20 eyes of 9 boys and 11 girls (mean age: 10.7, range 6-16 years) with glaucoma were included in this prospective study. In 19 children, juvenile glaucoma and in one, pseudophakic glaucoma had been detected. A single eyelash was pulled from the center of the upper eyelid before latanoprost therapy and at the sixth month of therapy, and measured.

RESULTS

In adult cases, the mean eyelash length was 5.79+/-0.18 mm (5.5-6.1 mm) at baseline and 6.45+/-0.21 mm (6.2-6.8 mm) at the sixth month. In children, the mean length was 5.66+/-0.22 mm (5.3-6.0 mm) at baseline and 6.39+/-0.37 mm (5.9-6.9 mm) at the sixth month. The mean difference in eyelash lengths at baseline and the sixth month was 0.67+/-0.09 mm (0.5-0.7 mm) in adults and 0.75+/-0.25 mm (0.4-1.2 mm) in children.

CONCLUSIONS

The differences in mean eyelash lengths at baseline and at the sixth month of latanoprost therapy were statistically significant in both adults and children (p=0.000). The mean of the difference of the eyelash length in children was higher than in adults but the result was not statistically significant (p=0.678).

Serum ghrelin levels: Is there any association with malnutrition and depression in peritoneal dialysis patients?

BACKGROUND

Ghrelin is a physiologic regulatory hormone of appetite and body weight, and its concentrations increase in chronic kidney disease. This study aimed to analyze the effects of malnutrition and depression on the plasma ghrelin levels in peritoneal dialysis (PD) patients.

METHODS/PATIENTS

The relationship between fasting serum ghrelin concentration, type of dialysate solution, malnutrition-inflammation score (MIS), and depressive symptoms of 87 PD patients were analyzed. Depressive symptoms were evaluated using the Beck Depression Inventory.

RESULTS

No significant relationship between ghrelin concentration and body mass index (BMI), MIS or depression scores was detected. The mean serum ghrelin concentration in patients using amino acid-based solutions was higher than in non-users (p <0.001). The mean serum ghrelin concentration of the patients using icodextrin-based solutions was found to be significantly higher than non-users (8.69 ± 5.04 vs 6.61 ± 2.8 ng/ml respectively, p =0.02). There was no significant difference in MIS between the patients in terms of amino-acid and/or icodextrin usage.

CONCLUSIONS

There is no association between BMI, MIS, and depression with ghrelin concentrations in PD patients. Icodextrin and/or amino acid-based solutions usage may increase the serum ghrelin concentration without a significant effect on BMI and measures of malnutrition. HIPPOKRATIA 2018, 22(1): 43-48.

A new technique for endoscopic treatment of gastric phytobezoars: fragmentation using guidewire

BACKGROUND AND STUDY AIMS

Bezoars result from accumulation of indigestible materials in the gastrointestinal tract and often occur in the stomach. In this study, we evaluated the use of guidewires in patients with gastric phytobezoars (PBs) as a new method for PB removal and examined the safety of the procedure.

PATIENTS AND METHODS

Between February 2009 and January 2013, we analyzed data from 11 patients with gastric PBs. We fitted a transparent cap to a standard endoscope (EG450WR5, Fujinon), and a 0.025 inch guidewire was passed through the standart endoscope. PBs were surrounded by a loop in the guidewire and destroyed. After 2 weeks of treatment, patients were re-evaluated for effectiveness.

RESULTS

PB fragmentation time was 5-11 minutes. In five patients with a history of gastric surgery, we needed an additional 16-28 minutes for removal of the fragments. In six patients additionally treated with enzymatic degradation after the breaking procedure, PBs completely disappeared within 2 weeks. There were no complications during the procedure.

CONCLUSIONS

The guidewire and fragmentation procedure for PBs is an efficient and reliable method. When combined with enzymatic degradation, PBs can be managed quickly and effectively.

Comparison of optic disc topography in non-glaucomatous eyes of children with juvenile diabetes mellitus and normal children

PURPOSE

To compare the optic disc topography parameters of children with juvenile diabetes mellitus and normal children using the Heidelberg Retinal Tomograph (HRT III) (Heidelberg Engineering, Heidelberg, Germany).

METHODS

The topographic optic disc parameters (cup volume, cup area, rim volume, rim area, disc area, mean cup-to-disc ratio, and mean cup depth) of 28 non-glaucomatous eyes of 28 children with type 1 diabetes mellitus and 28 eyes of 28 age-matched healthy children were compared using the nonparametric Mann-Whitney U test.

RESULTS

No statistically significant differences were found between cup volume (P = .782), cup area (P = .878), rim volume (P = .853), disc area (P = .452), mean cup-to-disc ratio (P = .852), and mean cup depth (P = .711) of eyes of cases with diabetes mellitus and normal subjects.

CONCLUSION

This result suggests that non-glaucomatous eyes of children with type 1 diabetes mellitus and healthy subjects have similar topographic optic disc characteristics.

Nd:YAG laser iridotomy in the management of secondary glaucoma associated with Behçet's disease

PURPOSE

To report the outcome of Nd:YAG laser iridotomy in the management of secondary glaucoma associated with Behçet's disease (BD).

METHODS

In this prospective study, Nd:YAG laser iridotomy was performed on eyes with secondary angle-closure and pupillary block glaucoma associated with BD. The pretreatment and post-treatment intraocular pressures (IOP) and the number of antiglaucoma medications were compared by Mann-Whitney U test.

RESULTS

The study consisted of 16 eyes of 11 patients (2 female, 9 male, mean age 39.2+/-8.9 years). Post-treatment follow-up ranged from 6 to 36 months (mean 13.8+/-8.9). The mean IOP was 21.6+/-2.5 mmHg on 2.5+/-0.6 medications before iridotomy. IOP reduced to 17.7+/-2.5 mmHg on 1+/-0.6 medications at the first month and 17.1+/-3.2 mmHg on 1.7+/-0.9 medications at the sixth month of treatment. The differences between IOP and number of antiglaucoma medications at baseline and at the sixth month of the treatment was statistically significant (p<0.00001). For four eyes trabeculectomy with mitomycin C and for one eye Ahmed valve implantation were performed in the follow-up period.

CONCLUSIONS

Nd:YAG laser iridotomy can provide reduction of IOP and the number of antiglaucoma medications in selected cases with secondary glaucoma associated with Behcet's disease.

Use of the ex-press miniature glaucoma implant in a child with Sturge-Weber syndrome

A two-stage antiglaucoma operation was planned for the left eye of an 11-year-old boy with bilateral Sturge-Weber syndrome to avoid intraoperative and postoperative choroidal and retinal effusion as with previous trabeculectomy. The Ex-Press miniature glaucoma implant was placed 10 days before trabeculectomy with mitomycin C. There were no complications with either procedure.

Topographic optic disc analysis by Heidelberg retinal tomography in ocular Behcet's disease

AIM

To compare the topographic characteristics of the optic discs in patients with severe and mild ocular Behçet's disease by using Heidelberg retinal tomographaphy (HRT).

METHODS

This prospective study included 47 eyes of 47 patients with ocular BD who were being followed-up at the Uveitis Clinic of the Ankara Ulucanlar Eye Research Hospital, Ankara, Turkey. The patients were divided into two groups. Group 1 consisted of 21 eyes with mild uveitis, and group 2 consisted of 26 eyes with severe uveitis. All patients underwent topographic optic disc analysis by HRT II, and the quantitative optic disc parameters of both groups were compared by non-parametric Mann-Whitney U test.

RESULTS

The mean cup volume, rim volume, cup area, disc area and cup depth in group 1 were found to be statistically significantly greater than those in group 2 (p<0.0001, p = 0.03, p = 0.021, p = 0.01 and p = 0.017, respectively), while the difference between the mean cup-to-disc ratios in group 1 and group 2 were found to be statistically insignificant (p = 0.148).

CONCLUSION

A relationship was found between the severity of ocular BD and optic disc topography determined by HRT. In eyes with smaller optic discs, uveitis was observed to have a more severe course with more frequent relapses than those with larger discs.

Trabeculectomy With Mitomycin C in Secondary Glaucoma Associated With Behçet Disease

PURPOSE

To determine the outcome of initial trabeculectomy with mitomycin C (MMC) in the management of secondary glaucoma associated with Behçet disease (BD) in a 1-year follow-up period.

METHODS

Twenty-three eyes of 13 cases with secondary glaucoma associated with BD, were evaluated prospectively. They underwent primary trabeculectomy with MMC. The operative success was defined as an intraocular pressure (IOP) < or =20 mm Hg (+/- medical therapy) in the absence of phthisis and without the necessity of further surgery for glaucoma and success rates at the postoperative first day, first month, sixth month, and first year were determined.

RESULTS

Success was achieved in all of the eyes (100%) at the postoperative first day and month, in 21 eyes (91.3%) at the postoperative sixth month and in 19 eyes (82.6%) at the postoperative first year. The mean preoperative IOP was 30.9+/-5.3 mm Hg under the mean 3.3+/-0.7 antiglaucoma medications but it reduced to 16.8+/-3.1 mm Hg under the mean 1.7+/-0.8 medications at the postoperative sixth month and 18.5+/-3.2 mm Hg under the mean 2.6+/-1.1 medications at the postoperative first year.

CONCLUSIONS

Trabeculectomy with MMC provides reduction of IOP and the number of antiglaucoma medications in cases with secondary glaucoma associated with BD in a 1-year follow-up period.

Trabeculectomy with mitomycin C combined with direct cauterization of peripheral iris in the management of neovascular glaucoma

PURPOSE

To determine the outcomes of trabeculectomy with mitomycin C (MMC) combined with direct cauterization of peripheral iris before iridectomy in the management of neovascular glaucoma (NVG), and to demonstrate the effect of this surgical technique on decreasing the incidence of intraoperative bleeding and early postoperative hyphema.

METHODS

This prospective study was based on 72 eyes of 72 patients with NVG who underwent primary trabeculectomy with MMC combined with direct cauterization of peripheral iris before iridectomy. The patients were evaluated for intraoperative and early postoperative complications such as hyphema, and operative success rates. Operative success was defined as an intraocular pressure (IOP) < or =22 mm Hg (+/-medical therapy) in the absence of phthisis. The mean IOP and the mean number of antiglaucomatous medications at baseline and at the posttrabeculectomy sixth month were compared by paired Student t test.

RESULTS

The mean preoperative IOP was 39.3+/-5.6 mm Hg (range, 29 to 60 mm Hg) whereas it was 20.02+/-4.3 mm Hg (range, 14 to 38 mm Hg) at the postoperative sixth month. The mean preoperative number of antiglaucoma medications was 3.2+/-0.4 (range, 2 to 4) but it reduced to 1.8+/-0.6 (range, 1 to 4) at the postoperative sixth month. These differences were statistically significant (P<0.00001). The IOP was < or =22 mm Hg (+/-medical therapy) in 69 eyes (95.8%) at the postoperative first week, in 62 eyes (86.1%) at the postoperative first month, in 60 eyes (83.3%) at the postoperative third month and in 48 eyes (66%) at the postoperative sixth month. Hyphema occurred in 15 eyes (20.8%) within the first week of the surgery. In 12 eyes it was transient; however, in 3 eyes irrigation of anterior chamber was required.

CONCLUSIONS

Trabeculectomy with MMC combined with direct cauterization of peripheral iris decreases the incidence of both intraoperative bleeding, and early postoperative hyphema, and provides reduction of IOP and the number of antiglaucomatous medications in cases with NVG in a 6-month follow-up period.

Efficacy and complications of releasable suture trabeculectomy and standard trabeculectomy

PURPOSE

To compare the efficacy and complications of releasable suture trabeculectomy and standard trabeculectomy.

PATIENTS AND METHODS

Sixty-four patients with uncontrolled glaucoma despite maximally tolerated medical therapy were included in a prospective, comparative, randomized clinical study. Standard trabeculectomy was performed on the 32 patients (Group 1) by one ophthalmologist and releasable suture trabeculectomy was also performed on the 32 patients (Group 2) by another ophthalmologist. Intraocular pressure, hypotony, shallow anterior chamber, iridocorneal touch and other complications were evaluated postoperatively. Examinations were performed daily for 1 week, for the 1st month and thereafter for every 3 months.

RESULTS

The mean follow-up period was 11.0 +/- 2.4 months in Group 1 and 11.5 +/- 3.8 months in Group 2. On the first postoperative day mean intraocular pressure was determined 9 +/- 2.7 mmHg in Group 1, and 21.6 +/- 1.1 mmHg in Group 2 (p = 0.007). The mean intraocular pressure was 10.1 +/- 1.4 mmHg in Group 2 after suture removal. Shallow anterior chamber was observed in 11 (34.3%) patients of Group 1 and 2 (6.2%) patients of the Group 2 in the early postoperative period (p = 0.005). Iridocorneal touch was observed in 5 (15.6%) patients of Group 1 and 1 (3.1%) patient of Group 2 (p = 0.196). There was no statistically significant difference in the mean intraocular pressure between the two groups at 3, 6 and 12 months (p = 0.663, p = 0.362, p = 0.182, respectively).

DISCUSSION

Releasable scleral flap sutures reduce the incidence of shallow anterior chamber and iridocorneal touch after trabeculectomy. Releasable scleral flap suture technique and standard trabeculectomy are similar in terms of lowering intraocular pressure at 1-year-follow up.

Glaucoma and increased central corneal thickness in aphakic and pseudophakic patients after congenital cataract surgery

AIM

To compare the mean central corneal thickness (CCT) among aphakic and pseudophakic patients following congenital cataract surgery with age matched controls.

METHODS

This study included 43 eyes of 43 aphakic and pseudophakic patients following congenital cataract surgery. 44 healthy, age and sex matched volunteers were recruited for comparison with the patients. After a complete eye examination, corneal thickness and intraocular pressure were measured.

RESULTS

In the study group, 33 eyes were aphakic, and the remaining 10 eyes were pseudophakic. The median CCT was 556.0 microm (range 490-640 microm) in the control group and 626 microm (range 523-870 microm) in the study group (p<0.05). There was a significant difference in CCT between aphakic and pseudophakic eyes in which an intraocular lens (IOL) had been implanted at the time of congenital cataract surgery (p = 0.011). The same difference was not observed between aphakic and pseudophakic eyes in which an IOL had been implanted secondarily (p = 0.835). The median age of the patients at the time of lensectomy was 24 months (range 1 week to 120 months). There was a negative correlation between the age at lensectomy and CCT (r = -0.485, p = 0.001).

CONCLUSION

Aphakic and pseudophakic patients have significantly thicker corneas than age matched controls. This difference can have an important effect on interpreting intraocular pressures in these patients. It is also important to assess the effects of early surgery for congenital cataracts, as well as those of primary and secondary IOL implantation, on CCT.

Incidence of Secondary Glaucoma in Beh??et Disease

PURPOSE

To determine the incidence of secondary glaucoma in Behcet disease.

METHODS

A total of 230 eyes of 129 patients with Behcet disease, were examined in uveitis and glaucoma clinics of Ankara Social Security Eye Hospital between January 1997 and September 2002. The data from all patients were investigated both retrospectively and prospectively.

RESULTS

The mean age of 129 patients was 34.2 +/- 7.4 years (range, 18 to 55 years). In 22 patients (17%), the disease was diagnosed on the basis of the ocular findings, while in the remaining 107 patients (83%), the period between the diagnosis of Behcet disease and the onset of the ocular symptoms was 23.3 +/- 17 months (range, 1 month to 5.3 years); 122 eyes (53%) had the episodes of acute recurrent iridocyclitis, while 108 eyes (47%) developed chronic posterior uveitis, including vitreitis, retinitis, vasculitis, or optic nerve involvement. Secondary glaucoma was diagnosed in 25 eyes (10.9%); 11 eyes (44%) with steroid or inflammation induced open angle glaucoma, 6 eyes (24%) with partial angle-closure glaucoma and peripheral anterior synechiae, 5 eyes (20%) with angle closure glaucoma, peripheral anterior synechiae, and pupil block and 3 eyes (12%) with neovascular glaucoma. The treatments included YAG-laser iridotomy in 5 eyes, diode-laser cyclodestruction in 3 eyes, primary trabeculectomies with mitomycin-c in 4 eyes, secondary trabeculectomies with mitomycin-c in 2 eyes, Ahmed valve implantations in 2 eyes, and cyclocryotherapy in 3 eyes.

CONCLUSIONS

We suggest that secondary glaucoma is a common and serious complication of Behcet disease. It develops as a result of multiple factors, generally triggered by recurrent intraocular inflammation. Early recognition and treatment of these factors have vital importance to avoid the visual morbidity.