Ali Hakan Durukan

Evaluation of the Nerve Fiber Layer and Macula in the Eyes of Healthy Children Using Spectral-Domain Optical Coherence Tomography

PURPOSE To determine the normative values of the peripapillary retinal nerve fiber layer (RNFL), macular thickness, and macular volume in healthy children using spectral-domain optical coherence tomography (SD-OCT) and analyze the correlation of such values with age, refraction error, and biometric measurements. DESIGN Observational case series. METHODS This institutional study involved 107 eyes from 107 healthy pediatric patients (54 female, 53 male) with ages between 6 and 16 years. After the biometric measurements and refractive error values (in spherical equivalent) of the cases were obtained, the peripapillary RNFL, macular thickness, and macular volume values were calculated using the Spectralis OCT device. RESULTS Among the study group, with an average age of 10.46 ± 2.94 years, the average axial length (AL) was 23.33 ± 0.89 mm; the average spherical equivalent (SE) value was -0.27 ± 0.99 diopter. The average peripapillary RNFL thickness was 106.45 ± 9.41 μm; the average macular thickness was 326.44 ± 14.17 μm; and the average macular volume was 0.257 ± 0.011 mm(3). The aforementioned OCT measurements were not significantly correlated with age, SE, or AL values (P > .05 for all). CONCLUSIONS This study reports SD-OCT findings among healthy pediatric cases. SD-OCT can be reliably used for pediatric patients because of its short exposure time and high degree of image resolution.

Effect of subconjunctival bevacizumab (Avastin) on experimental corneal neovascularization in guinea pigs.

Purpose: To evaluate the effect of subconjunctival bevacizumab (Avastin) on experimental corneal neovascularization in guinea pigs. Methods: Forty eyes of 40 guinea pigs were chemically cauterized with 75% silver nitrate and 25% potassium nitrate sticks. Fifteen eyes (group 1) received 2 subconjunctival injections of bevacizumab (0.1 mL, 1.25 mg) simultaneously with cauterization and 3 days later. Fifteen eyes (group 2) received 2 subconjunctival injections of bevacizumab (0.1 mL, 1.25 mg) 3 and 5 days after cauterization. Ten eyes (group 3, control group) received 2 subconjunctival injections of 0.1 mL of balanced salt solution 3 and 5 days after cauterization. After we determined the burn and neovascularization scores for all groups, the animals were killed on the 10th day. The percentages of neovascularization on the surface of the cornea were measured in terms of pixels on digital photographs. The average number of vessels at maximally vascularized areas was determined for each specimen. Results: Neovascularization score was 1.1 ± 0.3 in group 1, 2.46 ± 1.3 in group 2, and 3.5 ± 0.5 in the control group. The difference was statistically significant (P < 0.001). The area of neovascularization at the cornea surface was 15.6% ± 10.1% in group 1, 19.74% ± 11.2% in group 2, and 23.5% ± 7.4% in the control group (P = 0.194). The average number of neovascular vessels at group 1 was significantly reduced in comparison with group 2 and the control group (P < 0.001). Conclusions: Subconjunctival injection of bevacizumab decreases the extent of chemically induced corneal neovascularization in guinea pigs. The antineovascular effect of bevacizumab is higher if the injection is performed simultaneously with the chemical cauterization.

Long-term results of Nd:YAG laser treatment for premacular subhyaloid haemorrhage owing to Valsalva retinopathy

AimsValsalva retinopathy produces sudden visual loss, which may be prolonged if untreated. Nd:YAG laser enables rapid diffusion of premacular subhyaloid haemorrhage. This study was performed to assess the long-term results and safety of Nd:YAG laser treatment in cases with Valsalva retinopathy.MethodsSixteen patients had Nd:YAG laser treatment to drain premacular haemorrhage. The follow-up period was 24 months.ResultsAll eyes had marked clearing of haemorrhage and immediate improvement of vision following laser treatment. In 14 eyes visual acuity improved to 20/20 level at the end of the first week and the remaining two patients achieved 20/20 level within 1 month. No patient had evidence of retinal or choroidal damage.ConclusionNd:YAG laser treatment for Valsalva retinopathy is an effective, non-invasive, and safe procedure for patients with a premacular subhyaloid haemorrhage larger than 3 disc diameter and no longer than 3 weeks of duration.

Ingestion of IH636 grape seed proanthocyanidin extract to prevent selenite-induced oxidative stress in experimental cataract

PURPOSE: To investigate whether dietary supplementation with IH636 grape seed proanthocyanidin extract (GSPE) prevents selenite‐induced cataract. SETTING: Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey. METHODS: Thirty Spraque‐Dawley rat litters were put randomly into 3 groups. In group 1 (n = 10), sodium selenite (30 nmol/g body weight) was injected subcutaneously on postpartum day 10. In group 2 (n = 10), sodium selenite (30 nmol/g body weight) was injected on postpartum day 10 and oral GSPE (100 mg/kg body weight) was given for 1 week after sodium selenite injection. Only subcutaneous saline was injected in group 3 (control, n = 10). The development of cataract was assessed for 3 weeks, and its density was graded and photographed with a slitlamp. Removed rat lenses were analyzed for glutathione (GSH) and malondialdehyde (MDA). RESULTS: All of the rats in group 1 had cataract between stage 6 and stage 3. In group 2, only 5 of 10 eyes had cataract between stage 3 and stage 2 and no cataract occurred in the remaining 5 rats. The difference between mean cataract stages in group 1 and group 2 was significant (P<.05). The mean GSH level in group 1 was significantly lower than in group 2 and controls (P<.05). The mean MDA level in group 1 was significantly higher than in group 2 and controls (P<.05). CONCLUSIONS: IH636 grape seed proanthocyanidin extract effectively suppressed cataract formation in rats. Routine consumption of grape seed proanthocyanidin extract in the form of food or dietary supplement may offer a prophylactic measure against onset and progression of cataract.

Ocular injuries from improvised explosive devices

PurposeTo document the characteristics, treatments, and anatomical and functional outcomes of patients with ocular trauma from improvised explosive devices (IEDs).MethodsRetrospective review of ocular injuries caused by IEDs, admitted to our tertiary referral centre.ResultsIn total, sixty-one eyes of the 39 patients with an average age of 24 years (range, 20–42 years) were included in the study. In total, 49 (80%) eyes of the patients had open-globe and 12 (20%) had closed-globe injury. In eyes with open-globe injury, intraocular foreign body (IOFB) injury was the most frequently encountered type of injury, observed in 76% of eyes. Evisceration or enucleation was required as a primary surgical intervention in 17 (28%) of the eyes. Twenty-two (36%) eyes had no light perception at presentation. Patients were followed up for an average of 6 months (range, 4–34 months). At the last follow-up, 26 (43%) of 61 eyes had no light perception. Postoperative proliferative vitreoretinopathy (PVR) developed in 12 (50%) of the 24 eyes that underwent vitreoretinal surgery, and four of these eyes became phthisical. There were no cases of endophthalmitis. The presence of open-globe injury and presenting visual acuity worse than 5/200 were significantly associated with poor visual outcome (<5/200, P<0.05). In eyes with open-globe injury, the presence of an IOFB was not associated with poor visual outcome (P>0.05).ConclusionOcular injuries from IEDs are highly associated with severe ocular damage requiring extensive surgical repair or evisceration/enucleation. Postoperative PVR is a common cause of poor anatomical and visual outcome.

Systemic toxicity of tacrolimus given by various routes and the response to dose reduction

Purpose: To evaluate the long‐term systemic toxicity of tacrolimus (FK‐506) administered by various routes, and to assess the effect of dose reduction on toxicity.

Association of CFH Y402H Polymorphism with Both Forms of Advanced Age-Related Macular Degeneration in Turkish Patients

Purpose: The purpose of this study was to investigate the association between complement factor H Y402H polymorphism and age-related macular degeneration (AMD) development in a cohort of Turkish patients. Methods: A total of 182 individuals, including 95 individuals with unrelated late age-related macular degeneration and 87 age-matched healthy individuals as a control group were genotyped with polymerase chain reaction followed by restriction enzyme digestion and direct sequence analysis. The statistical analysis was performed with statistical software R 2.9.2 and epicalc package. Results: The Y402H variant in the CFH gene was found to be associated with late AMD in our study population. Genotypic frequencies were highly different between all patients and control individuals compared for the heterozygotes carrying the risk allele C (AMD patients (CT) 70.5%, control individuals (CT) 54.02%; χ2= 5.285, d.f. = 1, p = 0.02). When all AMD patients were compared with the healthy control group, TC heterozygotes showed a significantly increased risk of AMD (O.R = 2.32, CI% 1.23–4.35). Conclusıon: This study suggests that the CFH Y402H polymorphism is associated with increased risk for both types of end-stage AMD in Turkish patients.

Acute effects of cigarette smoking on multifocal electroretinogram.

Background:  Cigarette smoking was shown to have stimulant effects on pattern visual‐evoked potentials. The aim of this study was to investigate the acute effects of cigarette smoking on multifocal electroretinogram (mfERG).

Intravitreal triamcinolone acetonide compared with bevacizumab for the treatment of patients with macular edema secondary to central retinal vein occlusion.

Abstract Purpose: To compare 12-month outcomes achieved using intravitreal triamcinolone acetonide (IVTA) injections with those achieved using intravitreal bevacizumab (IVB) injections for the treatment of patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO). Materials and Methods: Between 2007 and 2011, 17 patient eyes were administered IVTA(4 mg/0.1 mL) and 30 patient eyes were administered IVB (1.25 mg/0.05 mL) injections for the treatment of ME secondary to CRVO. Patients were retrospectively evaluated within and between treatment groups. Results: Patients in both groups (IVTA and IVB) were similar in terms of demographic characteristics. Improvements in log of the minimum angle of resolution-visual acuity (logMAR-VA) at 3-month follow-up (P = 0.02), and in the logarithmic transformation of optical coherence tomography (OCT)-determined central subfoveal thickness (logOCT) at all visits, were significantly greater in the IVTA-treated group than in the group treated with IVB (P < 0.05). In patient eyes with nonischemic CRVO (n = 21), while no significant difference in improvement in logMAR-VA was seen between the groups, significantly greater improvements in logOCT were observed in the IVTA-treated group for all visits (P < 0.05). Inpatient eyes with ischemic CRVO (n = 26) treated with IVTA (n = 9), improvement in logMAR-VA was significantly greater at months 1 and 3 (P = 0.01), and was significantly greater for logOCT at months 6 and 12 (P < 0.05). A significantly higher percentage (29.4%) of eyes treated with IVTA had an intraocular pressure ≥ 30 mmHg (P = 0.004), 2 eyes (11%) developed glaucoma, and 23.5% of eyes developed cataracts at the 12-month follow-up examination (P = 0.05). Conclusion: Treatment with IVTA injections seems to be more effective in improving best-corrected visual acuity during the early postinjection period in patients with ischemic CRVO, and in decreasing central subfoveal thickness in patients with nonischemic CRVO. However, higher intraocular pressure and development of glaucoma and cataracts must be considered seriously in patients with CRVO who receive IVTA injections. Change in logOCT may be used to monitor patient response to treatments for CRVO-related ME.

Anatomical and functional outcomes in contusion injuries of posterior segment

PurposeTo evaluate the clinical features, and anatomical and visual outcomes in patients with closed-globe contusion injury involving the posterior segment.MethodsRetrospective review of posterior segment contusion injuries admitted to our tertiary referral center.ResultsIn all, 115 patients (115 eyes) with complete data were reviewed. Surgery had been performed in 79 (69%) patients. The mean follow-up period was 6 months (range, 2–34 months). Retinal detachment, in 31% of eyes, was the most frequently encountered posterior segment pathology. The presence of retinal detachment was associated with poor visual outcome (<20/100), (P<0.001). Coexisting (five patients, 4%) and postoperative proliferative vitreoretinopathy (PVR) (two patients, 2%) was the main cause of failure in these cases. A significant positive correlation was obtained between initial and final visual acuity levels in both the medical treatment group and the surgical treatment group (P<0.05). The presenting visual acuity of <20/400 was associated with poor visual outcome (P<0.05 for both groups). Poor visual outcome in 13 patients with successful repair of retinal detachment was due to the macular lesions and the optic atrophy.ConclusionRetinal detachment was the most frequently encountered posterior segment pathology subsequent to closed-globe contusion injuries. In addition to macular scarring and optic nerve damage, development of PVR has prognostic significance in these eyes.