Alper Mete

Effects of intravitreal bevacizumab (Avastin®) therapy on retrobulbar blood flow parameters in patients with neovascular age‐related macular degeneration

To investigate the effects of intravitreal bevacizumab on retrobulbar circulation in patients with neovascular age‐related macular degeneration (AMD).

Personalized medicine beyond genomics: alternative futures in big data—proteomics, environtome and the social proteome

No field in science and medicine today remains untouched by Big Data, and psychiatry is no exception. Proteomics is a Big Data technology and a next generation biomarker, supporting novel system diagnostics and therapeutics in psychiatry. Proteomics technology is, in fact, much older than genomics and dates to the 1970s, well before the launch of the international Human Genome Project. While the genome has long been framed as the master or “elite” executive molecule in cell biology, the proteome by contrast is humble. Yet the proteome is critical for life—it ensures the daily functioning of cells and whole organisms. In short, proteins are the blue-collar workers of biology, the down-to-earth molecules that we cannot live without. Since 2010, proteomics has found renewed meaning and international attention with the launch of the Human Proteome Project and the growing interest in Big Data technologies such as proteomics. This article presents an interdisciplinary technology foresight analysis and conceptualizes the terms “environtome” and “social proteome”. We define “environtome” as the entire complement of elements external to the human host, from microbiome, ambient temperature and weather conditions to government innovation policies, stock market dynamics, human values, political power and social norms that collectively shape the human host spatially and temporally. The “social proteome” is the subset of the environtome that influences the transition of proteomics technology to innovative applications in society. The social proteome encompasses, for example, new reimbursement schemes and business innovation models for proteomics diagnostics that depart from the “once-a-life-time” genotypic tests and the anticipated hype attendant to context and time sensitive proteomics tests. Building on the “nesting principle” for governance of complex systems as discussed by Elinor Ostrom, we propose here a 3-tiered organizational architecture for Big Data science such as proteomics. The proposed nested governance structure is comprised of (a) scientists, (b) ethicists, and (c) scholars in the nascent field of “ethics-of-ethics”, and aims to cultivate a robust social proteome for personalized medicine. Ostrom often noted that such nested governance designs offer assurance that political power embedded in innovation processes is distributed evenly and is not concentrated disproportionately in a single overbearing stakeholder or person. We agree with this assessment and conclude by underscoring the synergistic value of social and biological proteomes to realize the full potentials of proteomics science for personalized medicine in psychiatry in the present era of Big Data.

Maximal Levator Muscle Resection for Primary Congenital Blepharoptosis with Poor Levator Function

ABSTRACT Purpose: To evaluate the clinical outcomes of maximal levator muscle resection surgery in patients with poor levator function. Methods: This prospective study included 29 eyelids of 23 patients who underwent maximal levator resection surgery. Pre- and postoperatively, all patients’ routine ophthalmic examination including evaluation of upper eyelid skin crease positions; levator muscle function (LF), rima palpebrarum (RP), and margin-reflex distance (MRD) measurements were recorded. Outcome was considered successful when the difference between the two upper eyelids was ≤1 mm; if the difference between the two eyelid margins was more than 1 mm and less than 2 mm, it was considered to be satisfactory. More than 2 mm difference was considered to be poor. Results: Mean patient age was 11.3 ± 8.6 years (3 months to 24 years). Mean follow-up time was 22.8 ± 6.9 months (10 to 36 months). Preoperatively mean RP, MRD, and LF measurements were 5.5 ± 1.7 mm, −0.14 ± 1.6 mm, 2.5 ± 1.4 mm (0–4 mm), respectively. Preoperatively, eight (27,6%) patients had skin crease. Abnormal head posture was detected in eight (34.8%) of the patients. Postoperatively, RP, MRD, and LF values increased significantly (p < 0.05). Mean RP, MRD, and LF measurements were 8.3 ± 1.5 mm, 2.6 ± 1.2 mm, 5.1 ± 2.1 mm, respectively. Fourteen subjects (60.9%) had successful results, two subjects (8.7%) had satisfactory results, and seven subjects (30.4%) had poor results. Abnormal head postures of all patients were resolved. Conclusions: Maximal levator resection may be a good alternative method to frontalis suspension in congenital blepharoptosis patients with poor levator function.

Effects of Valsalva Maneuver on Ocular Biometric Parameters: Optical Low-Coherence Reflectometry Biometer Study

Abstract Purpose: To evaluate the effects of the Valsalva Maneuver (VM) on ocular biometry and intraocular pressure (IOP). Methods: This prospective observational study included 55 eyes of 55 healthy volunteers. Axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), corneal curvature (K-steep, K-flat and K-mean), corneal diameter (WtW), and pupil diameter (PD) were measured with a LenStar LS 900® biometer at rest and during VM. The IOP was also measured at rest and during VM measurements were compared. Results: The VM did not have any significant influence on AL, WtW, K-flat, and K-mean (p > 0.05), but it decreased K-steep significantly (p < 0.001). Moreover, CCT and ACD decreased significantly during VM (p < 0.001), but VM increased IOP, PD (p < 0.001), and LT significantly (p = 0.002). Conclusions: The VM might reversibly change in IOP and ocular biometry, so it should be considered during anterior segment examinations.

Dynamic changes in optic disc morphology, choroidal thickness, anterior chamber parameters, and intraocular pressure during Valsalva maneuver

PURPOSE To investigate the effects of the Valsalva maneuver (VM) on optic disc morphology, choroidal thickness, and anterior chamber parameters. METHODS This prospective observational study included 60 eyes of 60 healthy subjects. The anterior chamber parameters, including central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), pupil diameter (PD), axial length (AL), subfoveal and peripapillary choroidal thickness, optic disc parameters, and intraocular pressure (IOP), were measured at rest and during VM. RESULTS VM did not have any significant influence on AL, subfoveal and peripapillary choroidal thickness, optic disc area, rim area, cup area, cup-to-disc area ratio, vertical cup-to-disc ratio, rim volume, cup volume, and nerve head volume measurements (for all; p >0.05). IOP and PD significantly increased during VM (for both; p <0.001). VM significantly decreased CCT, ACD, ACA, and ACV values (for all; p <0.001). Moreover, the optic nerve cup volume decreased and the horizontal cup-to-disc ratio significantly increased during VM (for both; p <0.05). CONCLUSIONS VM may cause transient changes in IOP, optic disc morphology, and anterior chamber parameters.

A Novel Technique for Surgical Video Recording and Imaging Smartphone and Selfie Stick

To the Editor, Video imaging is a very useful tool in medical training, education and research. There are several methods for video recording of surgeries like light-mounted cameras, laparoscopic cameras, and head-mounted cameras designed for hospital environments. However, these systems are very expensive and cannot be afforded by most of the hospitals. We present a cost-effective and simple method for the recording of surgical procedures using a smartphone and a selfie stick. We used Samsung Galaxy S4 (Samsung Electronics Co, Ltd, Suwon, South Korea) to record the surgical procedures. Galaxy S4 has a 13-megapixel rear camera that has autofocus ability. It has a LED flash and can record high-definition (HD) (720p) or full-HD videos (1080p). It also can take 4128 × 3096 pixels photographs. A selfie stick that is compatible with all smartphones was used (Figure 1A). It has a Bluetooth remote control, which allowed us to stop video recording and take photos. Remote control cannot start video recording, so a nonsterile operating room technician started recording. We attached the selfie stick on the operating theatre lamp using 2 hose clamps (Figure 1B), placed the smartphone on and directed it into a suitable position for video recording according to the type of the procedure. We cut a finger of a sterile surgical glove and placed the remote in it before the procedure so that the assisting nurse can use it without disrupting the sterility (Figure 1C). The LED flash was active during recording. It served as an additional light source. We set the phone to flight mode to prevent possible disturbances of video recording from incoming calls. We resized and reencoded our videos and uploaded as 360p MPEG-2 files for this article. We obtained informed consent from the patients before uploading the videos. We were able to record full-HD videos and take 4128 × 3096 pixels images (Figure 1F-N). Video recording have enabled us to take recordings of operations that can be used for medical training, education, and research. Rehim and Chung used a camcoder to record the hand surgeries. The disadvantages are the requirement of an extra personnel to hold the camcoder, video can be shaky because of the hand movements, and the extra cost of camcoder. Matsumoto et al used a headmounted camera to record trauma surgeries. However, the surgeon cannot see where the camera records during the procedure and this may cause alignment issues. The extra cost of the camera still remains. With advancing technology, smartphones are now able to record full-HD videos and take high-quality pictures. Most of the physicians own a smartphone. Carey et al reported that 94% of British maxillofacial surgery trainees own a smartphone. Since smartphones are commonly used among doctors, our method only needs a selfie stick that can be bought for approximately

Bilateral acute angle-closure glaucoma as a first presentation of granulomatosis with polyangiitis (Wegener's)

10. Some video recording systems may limit the surgeons working area and complicate the procedures. In our system, the selfie stick is mounted on an operating room lamp and the smartphone was placed high enough to give the surgeon enough space for fine movements and low enough to get clear and detailed images (Figure 1D and E). Battery life and limited internal memory may prevent recording of longer surgeries but these problems can be solved by using smartphone cases with batteries and SD cards. In conclusion, using a smartphone and a selfie stick in the operating room for recording the surgical procedures is a low-cost, effective, and safe system. This method can be used for recording of all surgical procedures in all surgical branches. 660631 SRIXXX10.1177/1553350616660631Surgical InnovationKimyon et al letter2016

Intraorbital haematoma during a commercial flight: a case report

We report a case of bilateral acute angle-closure glaucoma in a patient with undiagnosed granulomatosis with polyangiitis (Wegeners). A 59-year-old man presented with a severe headache, ocular pain, blurred vision, shortness of breath, and mild fever. Clinical examination revealed conjunctival chemosis, corneal edema, and shallow anterior chambers. Closed angles were observed bilaterally on gonioscopy. The patient was treated with intravenous mannitol, oral acetazolamide, and anti-glaucomatous eye drops. Over the following two days, his vision improved and intraocular pressures decreased. Subsequently, laser iridotomies were performed bilaterally and the patient attended consultations with our departments of respiratory medicine, nephrology, and rheumatology and was subsequently diagnosed with granulomatosis with polyangiitis. Bilateral acute angle-closure glaucoma is a very rare ocular manifestation of granulomatosis with polyangiitis. The association of this clinical entity with Wegeners granulomatosis remains unknown.

Does phacoemulsification under topical anesthesia affect retrobulbar blood flow

BackgroundIntraorbital haematoma is a rare clinical entity which can be caused by orbital traumas, neoplasms, surgeries nearby sinuses and orbit, vascular malformations, acute sinusitis, systemic abnormalities, barotrauma and valsalva maneuver.Case PresentationA 74-year-old male presented with sudden onset of ocular pain, upper eye lid swelling, proptosis and diplopia after a commercial flight. After complete ophthalmic ocular examination including pupillary light reflexes and laboratory examinations; computed tomography and magnetic resonance imaging of orbit revealed a subperiostal mass-like lesion in the right retrobulbar-extraconal region which was compatible with intraorbital haematoma. Visual acuity was not compromised so we planned a conservative approach with close observation. We administered systemic corticosteroid and topical dorzolamide/timolol combination therapy. At the first month follow-up, intraorbital haematoma resolved without significant sequelae.ConclusionIntraorbital haematoma can be managed by conservative approach without any intervention if it does not threat visual acuity or optic nerve. We experienced a case of intraorbital haematoma during a commercial flight. We discussed the rarity of this condition and its management.

Comparison of Bevacizumab and Ranibizumab in the Treatment of Type 1 Retinopathy of Prematurity Affecting Zone 1

To investigate with color Doppler imaging the effects of phacoemulsification surgery under topical anesthesia on retrobulbar vessels hemodynamics.