Abuzer Gunduz

Incidence of keratoconus in subjects with vernal keratoconjunctivitis:: A videokeratographic study

PURPOSE To detect the incidence of keratoconus by videography in patients with vernal keratoconjunctivitis (VKC) and to evaluate the clinical characteristics of VKC associated with keratoconus. DESIGN a prospective, cross-sectional (prevalence) study. PARTICIPANTS Eighty-two consecutive subjects with the diagnosis of VKC. METHODS Both eyes of VKC subjects were investigated by videokeratography in comparison with slit-lamp biomicroscopy and keratometry. To detect keratoconus, corneal topography maps were examined with modified Robinowitz-McDonnell test. MAIN OUTCOME MEASURES In this test, maps with central corneal power greater than 47.2 diopters and/or the inferosuperior asymmetry value greater than 1.4 were considered to have a keratoconus pattern. The findings of VKC were also recorded, RESULTS The distribution of clinical forms of VKC were as follows: 46.34% mixed, 43.90% palpebral, and 9.76% limbal types. Twenty-six (31.7%) of 82 subjects had complications with keratopathy such as pseudo-genontoxon, punctate keratitis, and shield ulcer. Forty-four eyes (26.8%) were detected as keratoconus by quantitative evaluation of videokeratography maps. 14 eyes (8.5%) by biomicroscopy, and 30 eyes (18.3%) by keratometry. The increased incidence of keratoconus was associated with male gender, long-standing disease, mixed and palpebral forms, and advanced corneal lesions. CONCLUSIONS The higher incidence of keratoconus in our study compared with the previous reports may result from early detection of mild keratoconus by interpretation of color-coded videokeratographic maps with a sensitive quantitative method.

Craniofacial Anthropometry in a Turkish Population

OBJECTIVE To present norms and demonstrate the anthropometric variations in fronto-occipital circumference, inner and outer canthal distances, near and distant [far] anatomical interpupillary distance, canthal index, and circumference-interorbital index across age and sex in urban Turkish subjects. PARTICIPANTS Three thousand four hundred forty-eight subjects (1852 male, 1596 female) aged 7 to 40 years were included in this study. METHODS Three age groups were studied: children aged 7 to 15 years, young adults aged 16 to 25 years, and adults aged 26 to 40 years. Mean values for each measured parameter were determined at each age between 7 and 25 years. Subjects were also divided into nine age subgroups to observe the change of each parameter with advancing age. RESULTS The fronto-occipital circumference and outer canthal distance of males was significantly (p <.001) wider than females in all age groups. The near and distant interpupillary distances of male subjects were, on average, wider than the female subjects with greater differences with advancing age. Across all subjects aged 7 to 40 years, the mean of all measured parameters and calculated indexes of men and boys was significantly different from girls and women (p <.001). The mean for interpupillary distances in our study in both sexes were found to be similar to Arabian, Hong Kong, and British children; larger than those of Chinese, Black, Indian, and Caucasians; and smaller than those of Mexican children and a mixed European population. CONCLUSION This study clearly shows the anthropometric variation for fronto-occipital circumference, inner canthal distance, outer canthal distance, near and distant interpupillary distance, canthal index, and circumference-interorbital index with age. These developmental data and the normal values of these measurements in healthy subjects are useful for dysmorphologists in the early identification of some craniofacial syndromes, hyper- and hypotelorism, and congenital or posttraumatic telecanthus and of planning surgical intervention. We suggest that the comparison of craniofacial dimensions of a patient must be performed with normal standards specific for age as well as sex and race.

The levels of cytokines and nitric oxide in rabbit vitreous humor after retinal laser photocoagulation

OBJECTIVE To determine the levels of nitric oxide (NO) and cytokines such as interleukin 1-beta (IL-1beta), interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha) on vitreous humor following retinal laser photocoagulation. MATERIALS AND METHODS The rabbits were divided into 3 groups of 4 animals (8 eyes) each. Twelve pigmented rabbit eyes underwent modified grid pattern photocoagulation with a power of 240 mW (group I); 300 mW (group II); and 360 mW (group III). The eyes received 200 burns using a spot size of 200 micro, and duration of 0.2 s. Vitreous humor samples were collected from each eye preoperatively and at 24 and 72 hours after the laser. RESULTS When compared to preoperative levels, IL-6 levels were increased in all groups; IL-1beta levels were increased significantly only in group III. IL-8 levels were high in groups II and III only at 72 hours (P <0.05). TNFalpha levels were elevated significantly in group II and III only at 24 hours (P <0.05). NO levels were significantly higher than preoperative values in all groups at all times. CONCLUSION Our results support that especially IL-6, IL-8, and NO levels increase significantly following laser photocoagulation. This preliminary study suggests that IL-6, IL-8, and NO might be dominant contributing factors in the occurrence of the inflammation postoperatively.

Evaluation of peripapillary retinal nerve fiber layer, macula and ganglion cell thickness in amblyopia using spectral optical coherence tomography

AIM To investigate peripapillary retinal nerve fiber layer (RNFL), macula and ganglion cell layer thicknesses (GCC) in amblyopic eyes with spectral domain optical coherence tomography (SD-OCT). METHODS Thirty six patients with a history of unilateral amblyopia and thirty two children who had emmetropia without amblyopia were included in this study. In this institutional study, 36 eyes of 36 patients with amblyopia (AE), 36 fellow eyes without amblyopia (FE), and 32 eyes of 32 normal subjects (NE) were included. RNFL, GCC and macular thickness measurements were performed with RS-3000 OCT Retina Scan (Nidek Inc CA. USA). RESULTS The mean global thicknesses of the RNFL were 113.22±21.47, 111.57±18.25, 109.96±11.31µm in the AE, FE, and NE, respectively. There was no statistically significant difference for mean global RNFL thickness among the eyes (P=0.13). The mean thicknesses of the macula were 258.25±18.31, 258.75±19.54, 248.62±10.57µm in the AE, FE and NE, respectively. There was no statistically significant difference for thickness of macula among the eyes (P=0.06). The GCC was investigated into two parts: superior and inferior. The mean thicknesses of superior GCC were 102.57±13.32, 103.32±10.64, 100.52±5.88µm in the AE, FE, and NE, respectively. The mean thicknesses of inferior GCC were 103.82±12.60, 107.82±12.33, 105.86±10.79µm in the AE, FE and NE, respectively. There was no statistically significant difference for thickness of superior and inferior GCC between the eyes (P=0.63, P=0.46). CONCLUSION The macular thicknesses of AE and FE were greater than the NE, although it was not statistically significant. Amblyopia does not seem to have a profound effect on the RNFL, macula and GCC.

Comparison of the results of primary and secondary implantation of flexible open-loop anterior chamber intraocular lens

Purpose To assess and compare the results of primary and secondary implantation of flexible open-loop anterior chamber intraocular lenses (AC-IOLs).Methods A series of 57 eyes of 56 patients with flexible AC-IOLs were reviewed in two groups. In group I (n = 35) an AC-IOL was implanted primarily, because of posterior capsule problems during extracapsular cataract extraction (ECCE), and in group II (n = 22) secondarily after intracapsular cataract extraction (ICCE). Follow-up was from 12 to 38 months.Results Mean post-operative best-corrected visual acuity in group I was significantly lower (20/37.38) than that of group II (20/29.20) (p = 0.044). Best corrected visual acuity of 20/40 or better was achieved in 19 of 29 eyes (65%) in group I, and in 16 of 21 eyes (76%) in group II. The difference was not statistically significant (p < 0.05). In group II18 eyes (86%) maintained or improved visual acuity. In group 1,17 eyes (49%) had a total of 22 complications, while 7 eyes (32%) had 9 complications in group II (p > 0.05).Conclusions Flexible open-loop AC-IOLs are suitable for both primary and secondary implantation to correct aphakia. Secondary implantation of flexible open-loop AC-IOLs after ICCE seems to have a more favourable visual outcome and a lower complication rate than primary implantation in complicated ECCE cases.

Lenticular astigmatism in tilted disc syndrome

Purpose: To evaluate whether an abnormal optic disc shape in patients with tilted disc syndrome (TDS) is associated with an abnormal configuration of the crystalline lens measured as lenticular astigmatism. Setting: Department of Ophthalmology, Inönü University Medical Faculty, Turgut Özal Medical Center, Malatya, Turkey. Methods: This cross‐sectional masked case‐control study comprised 32 eyes of 32 patients with established TDS (13 men, 19 women; mean age 21.31 years ± 7.05 [SD]) and 20 age‐ and sex‐matched healthy control subjects (8 men, 12 women; mean age 22.65 ± 7.11 years) with a comparable amount of myopic astigmatism (spherical equivalent) without TDS. The optic disc was morphometrically analyzed by planimetric evaluation of optic disc photographs. The total refractive and keratometric corneal astigmatism was obtained, and lenticular astigmatism was calculated by vector analysis. The Mann‐Whitney U test was used for statistical analysis; 1 eye of each patient was evaluated in both groups. A P value less than 0.05 was considered statistically significant. Results: The mean spherical equivalent refraction was comparable in TDS patients (−4.73 ± 1.12 diopters [D]) and controls (−4.28 ± 1.29 D) (P = .210). The mean total astigmatism was higher in TDS patients (−2.96 ± 1.04 D) than in the controls (−2.51 ± 1.09 D), but the difference was not significant (P = .151). The mean corneal astigmatism was comparable in TDS patients (−2.07 ± 0.83 D) and controls (−2.28 ± 0.87 D) (P = .454), but the calculated mean lenticular astigmatism was significantly higher in TDS patients (−1.31 ± 0.98 D and −0.20 ± 0.35 D, respectively) (P < .001). Twenty‐nine of 32 TDS patients (90.6%) had lenticular astigmatism; in 16 (50%), it was greater than −1.00 D. Lenticular astigmatism was present in 7 controls (35%); in 2 (10%), it was greater than −1.00 D. The mean keratometry was significantly higher in TDS patients (43.84 ± 1.06 D) than in the controls (42.75 ± 1.45 D) (P = .011). Conclusions: Clinically significant lenticular astigmatism was present in TDS patients. If an abnormal optic disc shape is found on ophthalmoscopy, lenticular astigmatism as well as corneal astigmatism should be carefully evaluated to prevent an unsatisfactory refractive outcome, especially in refractive surgery candidates.

Endoscopic Transcanalicular Diode Laser Dacryocystorhinostomy: Is It an Alternative Method to Conventional External Dacryocystorhinostomy?

Purpose: To compare the success rates of endoscopic transcanalicular diode laser dacryocystorhinostomy (EL-DCR) and external DCR. Materials and Methods: Operations were performed on 55 eyes of 54 patients who had distal nasolacrimal canal obstruction. External DCR was performed on 29 of the eyes and EL-DCR on 26 of them. Success was defined based on subjective relief of patients reported at their final examinations. Results: There were 23 women and 6 men in group 1 and 19 women and 6 men in group 2 (p = 0.77). The mean ages of groups were 45.24 ± 12.08 (range, 15–74) and 43.2 ± 17.01 (range, 11–72) years, respectively (p = 0.63). The mean follow-up times were 8.82 ± 5.51 (range, 3–18) and 7.12 ± 2.96 (range, 2–12) months, respectively in groups (p = 0.58). The success rates based on symptoms were measured at 25 of 29 (86%) and 17 of 25 (68%) for 2 groups. The difference in the success rates was higher but not found to be statistically significant (p = 0.202). The authors found various conditions related to nasal passage in 4 of 8 unsuccessful EL-DCR, including allergic rhinitis, nasal crust, silicone tube reaction, and unsuitable passage for endoscopic surgery. Conclusions: The success rate of EL-DCR was lower than that of the external DCR; however, no statistically significant difference was observed. Endoscopic transcanalicular diode laser DCR may be considered as an alternative method to external DCR with these results.

Effects of NG-nitro L-arginine and corticosteroids on aqueous humor levels of nitric oxide and cytokines after cataract surgery

PURPOSE To assess the efficacy of nitric oxide synthesis (NOS) inhibitor, topical steroids, and nonsteroidal anti-inflammatory drugs on aqueous levels of nitric oxide (NO) and cytokines after cataract surgery. SETTING Research Laboratory, Inonu University Turgut Ozal Medical Center, Malatya, Turkey. METHODS Fifteen rabbits had intercapsular phacoemulsification and were randomly divided into 3 treatment groups: Group 1 was treated with topical prednisolone acetate 1% drops 5 times a day for 1 week; Group 2, flurbiprofen 0.03% drops 5 times a day for 1 week; Group 3, a 0.1 cc subconjunctival injection of NG-nitro L-arginine (L-NAME) (150 mg/kg) 1 day and 3 days after surgery. Three rabbits serving as controls received a subconjunctival injection of an equal volume of balanced salt solution (BSS) at the same times as the L-NAME injections. Aqueous humor specimens were collected from each eye to determine NO and cytokine levels including interleukin-1-beta (IL-1 beta), interleukin-2R (IL-2R), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha). RESULTS The levels of IL-1 beta and IL-6 were higher in Group 2 and the control group than in Groups 1 and 3 at all times. The differences were not statistically significant (P < .05). Nitric oxide and TNF-alpha levels in Groups 1 and 3 were significantly lower than in Groups 2 and the controls 1, 3, and 7 days postoperatively (P < .05). CONCLUSION These findings suggest a strong inhibitory effect of NOS inhibitors and corticosteroids on aqueous levels of TNF-alpha and NO and no inhibitory effect on IL-1 beta and IL-6 levels after cataract surgery.

Conjunctival flora in Behçet patients

BACKGROUND To determine the difference in conjunctival flora in Behçet patients compared with the normal population. METHODS This study was carried out on a study group of 50 patients in the inactive period of Behçets disease and a control group of 50 age- and sex-matched healthy subjects with no systemic or ocular disease. A swab was taken from the lower fornix using a sterile swab and inoculated into bloody eosin methylene blue, chocolate, and Sabouraud dextrose agar media. RESULTS The mean age was 36.04 (SD 2.16) years for the Behçet group and 35.64 (SD 1.96) years for the control group. Bacterial growth was observed in 92% (n = 46) of the Behçet group and 56% (n = 29) of the control group. The Behçet group results were Staphylococcus aureus in 12 (24%), coagulase negative staphylococci (CNS) in 32 (64%), Moraxella spp in 8 (16%), Streptococcus spp in 8 (16%), Bacillus spp in 4 (8%), Neisseria spp in 4 (8%), Candida spp in 3 (6%), and Haemophilus spp in 1 (2%). In the control group, the results were S. aureus in 2 (4%), CNS in 24 (48%), Moraxella spp in 2 (4%), Streptococcus spp in 1 (2%), Bacillus spp in 3 (6%), Neisseria spp in 3 (6%), and Candida spp in 1 (2%). INTERPRETATION S. aureus, Moraxella spp, and Streptococcus spp colonization was significantly higher in the conjunctival flora of Behçet patients than in that of the control group. A bacterial etiology may be involved in the pathogenesis of Behçets disease.

Increased oxidative stress in patients with pseudoexfoliation syndrome.

Purpose: The objective of this study was to investigate the antioxidant/oxidant status of serum in patients with pseudoexfoliation syndrome (PEX). Methods: Forty-seven patients with PEX and 32 healthy controls were included in the study. Serum total antioxidant capacity (TAC) and total oxidant status (TOS) levels were determined by using a novel automated method. Results: A significant increase in serum TOS (p < 0.001) and a significant decrease in serum TAC (p < 0.0001) were observed in PEX patients compared to control subjects. Conclusion: TAC decreases while the oxidative stress increases in PEX.