Adnan Yıldırım

Accelerated corneal collagen cross-linking for progressive keratoconus

Abstract Purpose: To evaluate the efficacy of accelerated corneal cross-linking (CXL) procedure for progressive keratoconus. Materials and methods: Twenty-three eyes of 23 patients undergone accelerated CXL procedure were evaluated preoperatively and postoperatively at 1st, 3rd and 6th month for uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (CDVA), spherical error, cylindrical error, spherical equivalent (SE), keratometric values and thinnest corneal thickness (TCT) values with corneal topography by Scheimpflug camera and endothelial cell density (ECD). Results: The mean UDVA was improved from 0.97 ± 0.41 logarithm of minimal angle of resolution (logMAR) to 0.76 ± 0.45 logMAR at the 6th month after CXL (p = 0.332). The mean CDVA was improved from 0.49 ± 0.30 logMAR to 0.34 ± 0.22 logMAR at the 6th month after CXL (p = 0.026). The mean sphere was decreased from −4.47 ± 4.1 diopter (D) to −3.79 ± 3.86 D and the mean cylinder was decreased from −5.60 ± 2.2 D to −4.55 ± 1.98 D and the mean SE was decreased from −7.22 ± 4.48 D to −6.36 ± 4.34 D at the 6th month after CXL (p = 0.128, p = 0.002 and p = 0.045, respectively). Flat keratometry, steep keratometry, mean keratometry and maximum keratometry were significantly reduced at the 6th month after CXL (p = 0.025, p < 0.001, p = 0.004 and p = 0.03, respectively). TCT and ECD were not changed significantly the 6th month after CXL (p = 0.135 and p = 0.082, respectively). Conclusion: Accelerated CXL procedure was effective to stabilize progression of keratoconus with significant reduction in topographic keratometric values and significant increase in CDVA in 6 months.

Topical and subconjunctival ranibizumab (lucentis) for corneal neovascularization in experimental rat model

Abstract Purpose: To compare the effectiveness of the topical and subconjunctival (SC) ranibizumab treatment in experimental corneal neovascularization (NV) model in rats. Methods: A model of NV was generated by cauterizing right corneas of 30 Sprague-Dawley rats with silver nitrate. The animals were separated into five groups randomly. first group (control group) received topical artificial tear drops two times daily while second and third groups received topical ranibizumab four times daily at concentrations of 5 mg/mL and 10 mg/mL, respectively. Forth and fifth groups were given 0.5 mg/0.05 mL and 1 mg/0.1 mL of SC ranibizumab in the 1st, 3rd and 7th days. The measurements (percentage of NV area and number of vessels) from digital photographs of the corneas were determined and analyzed using analysis software (ImageJ, v1.38). The animals were sacrificed on the 10th day and their corneas were subjected to hemotoxylin-eosin histopathological staining and antisera against CD34 and von-Willebrand factor to evaluate microvascular structures immunohistochemically. Results: The percentage of the corneal NV area and number of vessels in all treatment groups was found to be significantly lower than the control group. There was no significant difference in relation to the percentage of NV area and number of vessels in the treatment groups. Score of the corneal edema was determined to be significantly less in the groups that undertook treatment. Number of vessels and inflammatory cells were significantly lower in the histological and immunohistochemical sections in the treated groups than in the control group. In all treatment groups, fibroblast intensity was significantly lower than the control group (p = 0.005). Conclusion: Topical or SC administration of ranibizumab seems to be a promising and effective medication in the treatment of corneal NV. Further research is recommended to assess the potential side effects and effective dose.

Mean platelet volume in pseudoexfoliation syndrome and glaucoma.

Purpose Pseudoexfoliation (PEX) syndrome (PES) is characterized by the widespread deposition of abnormal extracellular fibrillary material on many ocular and extraocular tissues. The objective of this study was to evaluate the association among PES, PEX glaucoma (PEG), and mean platelet volume (MPV). Methods Forty patients with PES (mean age 62.6 ± 7.8 years), 31 with PEG (mean age 65.9 ± 6.6 years), and 37 healthy individuals (control group) (mean age 64.0 ± 7.1 years) were included in the study. The MPV of the 3 groups were compared. Results Age and sex distribution were similar among groups (p>0.05). Mean MPV in PES, PEG, and control groups were 9.59 ± 0.94 fl, 9.53 ± 0.80 fl, and 7.7 ± 0.67 fl, respectively. In the PEX group, MPV values were significantly higher than in the control group (p<0.05). However, there was no difference between the PES and PEG groups (p>0.05). Conclusions The MPV values in both groups with PEX were higher than those in the healthy group.

Mean platelet volume in patients with retinal artery occlusion

PURPOSE The aim of this study was to investigate the mean platelet volume (MPV) of patients with retinal artery occlusion (RAO). METHODS Thirty-seven patients diagnosed with RAO and 32 control subjects were included in this retrospective study. Retinal artery occlusion was diagnosed on the basis of clinical examination and fundus fluorescein angiography. All participants underwent complete ocular examination, and MPV, hematocrit, hemoglobin, and platelet counts were recorded. RAO patient data were compared with those of the control subjects. RESULTS Patients with RAO had significantly higher MPV values (7.96 ± 1.2 fL) compared with control subjects (7.33 ± 0.7 fL, p<0.001). No significant difference was found with regard to platelet count between the RAO group and the control group (262 ± 70.1 × 109/L and 251 ± 56.6 × 109/L, respectively, p=0.50). MPV was an independent predictor of RAO [odds ratio (OR)=0.50; 95% confidence interval (CI)=0.28-0.89; p=0.019). CONCLUSIONS Our results demonstrated that MPV values were significantly higher in patients with RAO, suggesting that larger platelets may contribute to the pathogenesis of the RAOs.

Demographic and etiologic characteristics of children with traumatic serious hyphema

BACKGROUND We aimed to evaluate the etiologic factors, complications, follow-up, and treatment outcomes in serious hyphema following blunt ocular trauma in childhood. METHODS The medical records of 136 patients diagnosed as grade 3 or 4 hyphema due to blunt ocular trauma between January 2006 and December 2011 were evaluated. Visual acuity (VA), complications, and medical and surgical treatments were analyzed. Factors affecting visual prognosis were compared in grade 3 and 4 hyphema cases. RESULTS The mean age of patients was 9.7±4 years. Etiologic factors for trauma were stone in 53 (39%), bead bullet in 25 (18.4%) and others in 58 (42.6%) patients. The most common complication of grade 3 and 4 hyphema was traumatic mydriasis (19.1%), followed by cataract (9.6%) and glaucoma (5.1%). Medical treatment was successful in 114 (83.8%) patients, and 22 (16.2%) patients underwent surgery. Mean initial and final VA of grade 4 patients were found to be significantly lower than those of grade 3 patients. CONCLUSION In grade 3 and 4 hyphema due to blunt trauma, visual prognosis worsened in the presence of additional ocular pathologies. Considering the bad visual prognosis of severe hyphema patients, prompt treatment and close follow-up may prevent complications resulting in poor VA.

Impact of Collagen Cross-linking on Psychological Distress and Vision and Health-Related Quality of Life in Patients With Keratoconus.

Objective: To evaluate the changes in psychological distress level and quality of life (QoL) scores of keratoconus (KC) patients 1 year after corneal collagen cross-linking (CXL). Methods: Observational cross-sectional study. Thirty-three, consecutive progressive KC patients who received CXL treatment were enrolled in the study. All patients were evaluated before and 1 year after CXL ophthalmologically and psychologically. Main outcome measures were the visual, refractive, and topographic changes and the Beck Depression Inventory, State-Trait Anxiety Inventory (STAI), Short Form-36 (SF-36), and The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Results: There were significant improvements in the keratometric readings at flat axis, steep axis, the mean keratometric reading, the corneal astigmatism (Kast), and the maximum keratometric reading. State-Trait Anxiety Inventory-II scores, QoL dimensions, such as physical role difficulty, general health, mental health, ocular pain, near activities, distance activities, peripheral vision, and mental health scores, and the composite score of NEI-VFQ-25, were higher after surgery. There was a positive correlation between the changes observed in Kast and mental health; a negative correlation between the changes in Kast and STAI-II, and a negative correlation between the changes in mental health and STAI-II. Change in STAI-II has significantly predicted the improvement observed in general health. Conclusions: Our results suggested lower trait anxiety and better vision-related and health-related QoL in KC patients 1 year after successful CXL treatment. Better QoL in these patients seems to be related not only with the visual and refractive results but also improvement observed in trait anxiety.

Diagnosis of Malignant Hypertension with Ocular Examination: A Child Case

ABSTRACT A 12-year-old female patient was admitted to our clinic complaining about low vision. Bilateral optic disc edema, macular star, and preretinal hemorrhages were found in fundoscopic examination. In fundus fluorescein angiography, massive leakage in the late phase was seen in the optic nerve head and macular area. These findings were compatible with high-grade hypertensive retinopathy. The patient consulted with pediatrics and a diagnosis of vesicourethral reflux and malignant hypertension was made.

Spontaneous bilateral corneal perforation in a patient with ichthyosis

We present an 8-month-old female patient with bilateral spontaneous corneal perforation and lamellar ichthyosis. On examination, the skin of the body and face of the patient was completely dry and scaly. Cicatricial ectropion and descemetocele with small perforations were seen. Double-layered amniotic membrane transplantation on the cornea with eyelid construction was performed on both eyes. At the 6-month follow-up, lower eyelid minimal ectropion formation and inferior corneal leukoma were seen bilaterally. In ichthyosis patients, the cornea should be monitored closely due to the risk of severe visual loss and corneal perforation.

Retinopathy of prematurity screening with mobile phones

We read with interest the article “Mobile phones for retinopathy of prematurity screening in Lagos, Nigeria, subSaharan Africa” by Oluleye et al (1). In their study, they reported that an iPhone combined with a 20-D lens appears to be useful in retinopathy of prematurity (ROP) screening in resource-poor settings. We have some additional comments with regard to this publication. First, the authors reported that a 20-D lens was used to capture retinal images. Lenses with higher magnification, such as 40 D, provide wider retinal images than obtained with a 20-D lens. The 40-D lens also allows the user to obtain images of the optic nerve and approximately middle zone 2 in the same photograph. This is an advantage of the 40-D lens for stage imaging in ROP over low-magnification lenses such as the 16 and 20 D. In Figure 1, we show a retinal image obtained with a 40-D lens. Second, we agreed with the authors that mobile phone fundus photography appears to be useful in ROP screening, including in documentation, patient education, and teaching, in resource-poor settings where RetCam is not available. However, mobile devices for retinal imaging of patients with ROP should be used by experienced ophthalmologists. The use of these devices requires approximately similar experience as with the indirect ophthalmoscope. Moreover, the examiner should also examine the peripheral retina, which is of vital importance in ROP monitoring. For this, we use assistance from scleral indentation to capture peripheral retinal images. Figure 2 shows a peripheral image of a patient with ROP obtained with a 40-D lens. Fig. 2 Peripheral retinal image of a patient with retinopathy of prematurity obtained with a 40-D lens. Scleral indentation was also performed in this case. The indented temporal retina corresponding zone 3 is seen.

Author reply to: Mean platelet volume in pseudoexfoliation syndrome and glaucoma.

We are pleased with the interest in our article and appreciate the comments that complement the presented article and provide useful information. This was a retrospectively designed study and any patient with a known systemic disease that may affect the value of MPV was excluded. As we mentioned in the study, because we excluded patients with liver and renal diseases, other blood parameters were in the normal range, so we did not need to provide them in the article. Although some studies report better results with citrate, others report similar results with with citrate and EDTA. (1-4). However, due to the retrospective study design, we used tubes with EDTA, which is routinely used in our laboratory. As mentioned in the article, blood parameters were analyzed within 1 hour following blood draw. Financial Support: No financial support was received for this submission.