Ali Riza Cenk Celebi

The role of anterior segment optical coherence tomography in the management of an intra-corneal foreign body

AbstractIntroductionCorneal foreign bodies are reported to be the second most common type of ocular injury. Anterior segment optical coherence tomography (AS-OCT) is a valuable tool for the early diagnosis and monitoring the progress of treatment in cases of ocular trauma. Herein we aimed to report on a patient with an intra-corneal foreign body and the role of AS-OCT in management.Case presentationA 34-year-old male presented with foreign body sensation in his left eye. Slit-lamp biomicroscopic examination revealed a peripherally located intrastromally embedded foreign body with a free anterior edge extending outwards from the cornea. It was not possible to visualize the foreign body’s entire route through the cornea because of localized corneal edema. AS-OCT showed shadowing of the corneal layers corresponding to the location of the corneal foreign body. A hyper-reflective lesion was observed close to the inside edge of the foreign body in the cornea, indicating that the foreign body had not completely penetrated the cornea. The foreign body was removed via the external route, as it had not completely penetrated the cornea. During the postoperative period the patient was asymptomatic, although the left eye’s cornea healed with scar tissue. Discussion and EvaluationAS-OCT facilitates non-invasive rapid imaging of ocular tissue at va rious depths, thereby providing accurate assessment of foreign body characteristics.The location of an intracorneal foreign body and the status of the surrounding ocular structure dictate the optimal surgical technique to be employed.ConclusionsAS-OCT in the present case facilitated localization and determination of the size of a corneal foreign body. In addition, AS-OCT findings assisted in selection of the appropriate surgical intervention.

Iris metastasis of gastric adenocarcinoma

BackgroundIris metastasis in patients with gastric cancer is extremely rare. Herein, it is aimed to report on a patient with gastric adenocarcinoma and iris metastasis.Case presentationA 65-year-old patient with the history of gastric cancer was admitted for eye pain and eye redness on his left eye. There was ciliary injection, severe +4 cells with hypopyon in the anterior chamber and a solitary, friable, yellow-white, fleshy-creamy vascularized 2 mm × 4 mm mass on the upper nasal part of the iris within the left eye. The presented patient’s mass lesion in the iris fulfilled the criteria of the metastatic iris lesion’s appearance. The ocular metastasis occurred during chemotherapy.ConclusionsIris metastasis can masquerade as iridocyclitis with pseudohypopyon or glaucoma. In patients with a history of gastric cancer that present with an iris mass, uveitis, and high intraocular pressure, ocular metastasis of gastric cancer should be a consideration.

The effect of hemodialysis on intraocular pressure

BACKGROUND The effect of hemodialysis (HD) on intraocular pressure (IOP) has been investigated before, but there is a lack of consensus. Clinicians dealing with renal failure patients are interested in the potential negative effects of HD on IOP and the course of glaucoma. OBJECTIVES The aim of this study was to investigate the effects of HD on IOP in patients with end-stage renal disease. MATERIAL AND METHODS This prospective study included 106 patients who were receiving outpatient hemodialysis. Patient history of systemic and ophthalmologic conditions was recorded. Serum osmolality (mOsm), blood urea nitrogen (BUN), blood glucose (BG), bicarbonate (BC), and hematocrit (Hct) levels at the start of HD (pre-HD), at the end of HD (end-HD), and 30 min after HD (post-HD) were measured. Systolic and diastolic blood pressures (SBP and DBP) and IOP were measured at pre-HD, 1-hour intervals during HD, end-HD, and post-HD. RESULTS A significant decrease in mOsm and BUN and a significant increase in BG, BC, and Hct levels were observed at end-HD (p < 0.05). Mean IOP was 16.71 ±2.51 mm Hg at pre-HD, 15.52 ±3.18 mm Hg at endHD, and 15.23 ±2.73 mm Hg at post-HD (p = 0.001; F = 4.439). Post-HD SBP and DBP were significantly lower than at pre-HD (p < 0.001). There was a positive correlation between the change in IOP and the change in mOsm and the change in BUN at end-HD (r = 0.315, p = 0.004; and r = 0.279, p = 0.012, respectively). CONCLUSIONS IOP decreased significantly during HD in this study. Additional research on the effects of the change in blood parameters and ocular perfusion pressure on IOP and optic nerve perfusion during HD is recommended.

Evaluation of the 'Hedgehog' signaling pathways in squamous and basal cell carcinomas of the eyelids and conjunctiva.

The purpose of the present study was to assess the role of hedgehog signaling pathway in the carcinogenesis of eyelid skin and conjunctival epithelial malignant tumors. The study was conducted on specimens from 41 patients with cutaneous eyelid basal cell carcinoma, 22 with bulbar conjunctival squamous cell carcinoma, 12 with bulbar conjunctival intraepithelial neoplasia. Major molecules of Hedgehog signaling pathway (Sonic Hedgehog [Shh] and Patched-1 [Ptch-1] and Glioma-associated oncogene [Gli-1]) were evaluated in paraffin-embedded tissue specimens using immunohistochemical staining. For each specimen, the percentage (<10%, 10–50%, >50%) and the intensity of the immunohistochemical staining (graded from 0 to 3) were calculated and the scores obtained by multiplication of two values were analyzed using the Kruskall-Wallis test. Shh and Ptch-1 expression levels were statistically significantly lower in the basal cell carcinoma group compared with the squamous cell carcinoma group (P=0.043 for Shh; P=0.030 for Ptch-1). In the conjunctival squamous cell carcinoma group, the Ptch-1 score was 0 in ~25% of specimens and the Gli-1 score was ≤2 in ~45% of cases. In the conjunctival intraepithelial neoplasia group, the Ptch-1 score was ≥2 in 66% of specimens, the Gli-1 score was ≤2 in ~92% of cases. Ptch-1 mutations contribute to the development of cutaneous eyelid basal cell carcinoma. The present study provides evidence that alterations in hedgehog signaling pathways may lead to transformation of the conjunctival intraepithelial neoplasia into invasive squamous cell carcinoma.

Age-related change in corneal biomechanical parameters in a healthy Caucasian population

ABSTRACT Purpose: To determine the effect of aging on corneal biomechanical parameters measured via ocular response analyzer in a homogenous healthy Caucasian population. Methods: A total of 2039 Caucasian adults were consecutively recruited and divided into seven groups according to decades of age. The difference in mean corneal hysteresis (CH), mean corneal resistance factor (CRF), mean Goldmann-correlated intraocular pressure (IOPg), and mean corneal-compensated IOP (IOPcc) between decades of age were investigated. The strength of the correlations between corneal biomechanical parameters, and between each biomechanical parameter and age were evaluated. The effect of age on each corneal biomechanical parameter was analyzed. Results: Mean age of the participants (1173 female and 866 male) was 43.30 ± 14.64 years. Mean CH, CRF, IOPcc, and IOPg were 11.49 ± 1.89 mmHg, 11.40 ± 2.30 mmHg, 15.01 ± 3.11 mmHg, and 15.72 ± 3.80 mmHg, respectively. There were significant differences in mean CH, CRF, IOPcc, and IOPg between groups (p < 0.001 for all parameters). There was a significant negative correlation between age and CH (r = –0.067 and p = 0.003), and a significant negative correlation between age and CRF (r = –0.053 and p = 0.017). There was a significant positive correlation between age and IOPg (r = 0.25 and p < 0.001), and between age and IOPcc (r = 0.20 and p < 0.001). Linear regression analysis showed that for every 1-year increase CH decreased 0.011 mmHg, CRF decreased 0.004 mmHg, IOPcc increased 0.053 mmHg, and IOPg increased 0.047 mmHg. Conclusions: Aging can cause significant changes in corneal biomechanical parameters. Corneal biomechanical parameters were correlated with each other, and each was correlated with aging.

The Effect of Topical Ocular Anesthetic Proparacaine on Conjunctival and Nasal Mucosal Flora in Dry Eye Disease Patients

The aim of this study was to investigate the effect of topically applied ocular anesthetic proparacaine on conjunctival and nasal bacterial mucosal flora in patients with dry eye disease. A Schirmer test was done with (group 1) and without (group 2) topical anesthetic proparacaine to 40 patients in each group. Conjunctival and nasal cultures were obtained before and 10 min after performing the Schirmer test. The bacterial culture results and the isolated bacteria were recorded in two groups. Patients’ mean age was 62 years (70 female, 10 male). Before the application of topical anesthetic, 50 (62.5%) and 62 (77.5%) had positive conjunctival and nasal culture, respectively, with the most commonly isolated organism being coagulase-negative Staphylococcus in each group. In group 1 the conjunctival bacterial culture positivity rate decreased from 26 (65%) to six (15%) eyes (p < 0.001); however, this rate decreased slightly from 24 (60%) to 20 (50%) eyes in group 2 (p > 0.05). For the nasal cultures, the bacterial culture positivity rate decreased from 80% to 20% and from 75% to 65% in groups 1 (p < 0.001) and 2 (p > 0.05), respectively. Topical ocular anesthetic proparacaine has antibacterial activity in both conjunctival and nasal flora in patients with dry eye disease.

The Effect of Ocular Lubricants Containing Benzalkonium Chloride on Nasal Mucosal Flora

Abstract Purpose: The effect of ocular artificial teardrop containing benzalkonium chloride (BAC) on nasal mucosa was investigated. Materials and methods: There were two different treatment trial groups. Each dry eye syndrome (DES) patient received the ocular lubricant treatment four times a day in both groups (one group containing BAC, the other group was not). Moistened sterile cotton-tipped applicators were placed in both nostrils and were immediately cultured prior to ocular lubricant treatment and at the end of treatment trial. The bacterial culture-positivity rate, species of bacteria, and drug sensitivity were recorded in the two groups during pre-treatment and post-treatment. Results: There were 20 patients in each group with a mean age of 53.14 years (36 female, 4 male). At the beginning of the treatment trial, Staphylococcus epidermidis was the most frequently isolated organism from the nasal cavity accounting in 24/40 patients (60%). Of the 40 organisms isolated from the nares prior to treatment trial, 37 (92.5%) were sensitive to gentamycin. At the end of 1 month of treatment trial in patients who were treated with ocular lubricants containing BAC, none of the nasal cultures showed growth of any organisms. However, patients who were treated with ocular lubricants not containing BAC demonstrated persistent positive nasal cultures with the same species and the same antibiotic susceptibility profile at the end of the treatment trial period. Conclusion: Topically applied ocular lubricants including BAC has an anti-bacterial activity on nasal flora in DES patients.

The Effect of Smoking on Corneal Biomechanics

ABSTRACT Purpose: To determine the effect of smoking on corneal biomechanical behavior. Materials and Methods: The medical records of consecutive patients that presented to the ophthalmology department were reviewed. History of smoking and ophthalmological examination findings were recorded. The smoking group met the following criteria: a clear history of and present smoking habit, negative history of corneal disease and surgery, ocular response analyzer measurement at the time of examination, and a waveform score ≥3.7. Nonsmokers (never smoked or quit smoking ≥6 months earlier) that met the same criteria constituted the control group. Corneal biomechanical parameters were measured using ocular response analyzer. Data were analyzed using Pearson’s χ2 test, Mann–Whitney U test, and Spearman’s correlation coefficient. Results: The smoking group included 166 eyes of 166 patients with a mean age of 38.7 ± 11.95 years, and the control group consisted of 170 eyes of 170 patients with a mean age of 38.40 ± 12.2 years. Mean cumulative smoking dose in the smoking group was 9.59 ± 11.87 pack-years (0.04– 75.00). There was no significant correlation between cumulative smoking dose and corneal hysteresis and corneal resistance factor (P = 0.382 and 0.074, respectively). There were no significant differences in corneal hysteresis or the corneal resistance factor between the two groups (P > 0.05). There was no significant difference in corneal hysteresis between those in the smoking group aged 18–44 years and those aged 45–64 years (P = 0.258), whereas in the control group mean corneal hysteresis was significantly lower in the 45–64 year olds than in the 18–44 year olds (P = 0.034). Conclusions: Although there was no significant difference in corneal biomechanics between smoking and control groups, the decrease in corneal hysteresis with aging was less apparent in the smoking group, which may be due to the potential changes in the cornea’s microstructure induced by smoking during aging and the effect of smoking in aged corneal tissue viscosity.

Corneal Biomechanical Properties in Aspirin Users

Purpose: To analyze corneal biomechanical properties in aspirin users using an ocular response analyzer. Methods: This study included 80 eyes of 40 aspirin users and 80 eyes of 40 individuals who did not use aspirin. Corneal hysteresis (CH), the corneal resistance factor (CRF), Goldman-correlated intraocular pressure (IOPg), and corneal compensated intraocular pressure (IOPcc) were measured in all participants. The independent samples t test was used to compare measurements in the aspirin users and nonusers in the total study population, and in the diabetic patient subgroup. Pearsons correlation analysis was used to examine the relationship between the measured variables in the aspirin users and nonusers. Results: Aspirin users (59.08 ± 11.83 years) were older than nonusers (39.82 ± 12.97 years; p < 0.001). The mean CH was significantly lower in the aspirin user group than in the nonuser group (p = 0.013). Mean IOPg and mean IOPcc were also significantly higher in the aspirin user group (p = 0.027 and p = 0.002, respectively). The mean CRF was lower in the aspirin user group, but not significantly (p = 0.70). There was a positive correlation between CH and CRF (r = 0.767, p < 0.001), and between CRF and IOPg (r = 0.680, p < 0.001), and a negative correlation between CH and IOPcc (r = -0.415, p < 0.001). Conclusions: Aspirin should be taken into account when interpreting the results of corneal biomechanical measurements.

Contents Vol. 55, 2016

Basel • Freiburg • Paris • London • New York • Chennai • New Delhi • Bangkok • Beijing • Shanghai • Tokyo • Kuala Lumpur • Singapore • Sydney Journal for Translational and Clinical Research Founded 1970 by O. Hockwin, Bonn, G. Naumann, Hamburg and D.F. Cole, London Continued by O. Hockwin, Bonn (1981–1994); G.F.J.M. Vrensen, Zeist (1994–2003); Uwe Pleyer, Berlin (2003–2014); David E. Pelayes, Buenos Aires, Borja Corcόstegui, Barcelona (2012–2014)