Altan Atakan Özcan

The Aqueous Levels of TGF-β2 in Patients with Glaucoma

Purpose: To evaluate the aqueous levels of transforming growth factor beta-2 (TGF-β2) in open angle glaucoma patients. Methods: The aqueous levels of active TGF-β2 were detected in 17 eyes of 17 patients using ELISA method. The control group consisted of 6 cataract extracted patients. Results: Mean age of the patients (60.8 ± 8.8 years) was similar to that of the controls (57.5 ± 9.8 years) (p = 0.516). Levels of TGF-β2 in aqueous samples of glaucoma patients (2.74 ± 1.23 ng/ml) were found to be elevated when compared to those of controls (1.67 ± 0.32 ng/ml) (p = 0.020). Conclusion: We might suggest that the elevated levels of TGF-β2 in the aqueous of glaucoma patients could play a role in the pathogenesis of glaucoma.

Interleukin (IL)-6, Interleukin (IL)-8 Levels and Cellular Composition of the Vitreous Humor in Proliferative Diabetic Retinopathy, Proliferative Vitreoretinopathy, and Traumatic Proliferative Vitreoretinopathy

Purpose: To investigate the interleukin (IL)-6 levels, IL-8 levels, and cellular composition of the vitreous humor in patients with proliferative diabetic retinopathy (PDR), proliferative vitreoretinopathy (PVR), and traumatic PVR. Methods: Vitreous samples from 14 patients with PDR, 10 patients with PVR, and 10 patients with traumatic PVR were analyzed. Fifteen cadaver eyes were used as controls. Cytokine levels were measured by ELISA. Results: Elevated IL-6 levels were detected in the vitreous of 12 (85.7%) of the PDR patients, eight (80%) of the PVR patients, and all (100%) of the traumatic PVR patients. None of the control IL-6 results were elevated. Vitreous IL-8 levels were elevated in 12 (85.7%) of the PDR patients, six (60%) of the PVR patients, all (100%) of the traumatic PVR patients, and one (6.7%) of the control eyes. Cytological examination of the vitreous specimens revealed a predominance of macrophages (50%) in the PDR samples and a predominance of retinal pigment epithelial (RPE) cells (60%) in the PVR samples. In contrast, neutrophils predominated (88%) in the traumatic PVR samples. Conclusion: The findings suggest that IL-6 and IL-8 may be involved in the pathogenesis of PDR, PVR, and traumatic PVR. High proportions of RPE cells and macrophages are associated with elevated IL-6 and IL-8 levels in the vitreous of PDR and PVR patients; however, the fact that these cells are not predominant in traumatic PVR suggests that different immune response mechanisms may be active in the pathogenesis of these disorders.

Visual Acuity and Corneal Topographic Changes Related With Pterygium Surgery

PURPOSE Applied pre- and postoperative corneal topography outcomes with visual acuities were evaluated to determine the surgical results in pterygium therapy. METHODS The study group consisted of 30 eyes of 26 patients with primary and recurrent pterygium. Mean patient age was 52.26+/-11.50 years (range: 27 to 68 years). Pre- and postoperative visual acuity and comeal topography were evaluated for each case. Statistical analysis was performed using the repeated-measure test. RESULTS The mean uncorrected visual acuity was 0.41+/-0.30 preoperatively and 0.63+/-0.26 postoperatively (P<.001). The mean best spectacle-corrected visual acuity was 0.59+/-0.28 preoperatively and 0.84+/-0.22 postoperatively (P<.001). Surface regularity index ranged from 1.96+/-1.08 preoperatively to 1.09+/-0.76 postoperatively (P<.001). The mean surface asymmetry index was 3.05+/-2.85 preoperatively and 1.39+/-1.70 postoperatively (P=.003). The mean topographic astigmatism was 4.65+/-3.02 preoperatively and 2.33+/-2.26 postoperatively (P=.003). CONCLUSIONS Examination of the topographic records reveals pterygium-associated corneal flattening in the horizontal meridian along the line of the pterygium. The improvement in topographic pattern and best spectacle-corrected visual acuity can be used as one indicator of the success of pterygium surgery.

Surgical management of scleral defects.

Purpose: To evaluate the results of surgical management of scleral defects using fascia lata, cornea, and sclera as graft materials. Methods: The scleral defects of 8 patients were repaired surgically. Six had previous intraocular surgery, 1 had eye trauma, and the other had both intraocular surgery and trauma. Corneoscleral grafts were used in 3 eyes, scleral grafts in 4, and fascia lata was used in 1 eye. Results: In 7 patients, we achieved the desired cosmetic and tectonic success. During the follow-up period, a recurrent defect was seen in 1 patient, and a second operation was required. Conclusions: Surgical techniques using fascia lata, corneal, and scleral grafts are effective for scleral defects.

Using diazepam and atropine before strabismus surgery to prevent postoperative nausea and vomiting: a randomized, controlled study

OBJECTIVE To evaluate the efficacy of diazepam and atropine sulfate premedication in preventing nausea and vomiting after strabismus surgery under general anesthesia. METHODS Fifty children age 4 to 15 years who underwent strabismus surgery at Cukurova University Medical Faculty, Department of Ophthalmology, from February 2000 to June 2000 were randomized into 2 groups: 25 children in the control group did not receive premedication, whereas 25 children in the treatment group received premedication with 0.15 mg/kg diazepam and 0.015 mg/kg atropine sulfate. Occurrence of postoperative nausea and vomiting (PONV) was recorded. RESULTS The incidence of PONV was lower in the premedicated group (P <.018, chi(2) test). CONCLUSIONS It is concluded that diazepam and atropine sulfate premedication decreases nausea and vomiting after strabismus surgery.

Bilateral choroidal infiltration from indolent non-Hodgkin's lymphoma: A rapid course with poor prognosis

A 42-year-old-woman, with a 2 year history of non-Hodgkins lymphoma suffered sudden bilateral visual loss. This unusual patient presented with an unifocal choroidal tumor in the superionasal quadrant in both eyes. Fluorescein angiography revealed early and late intense subretinal fluorescence. Cytological examination of the anterior chamber and vitreous tap material revealed abnormal lymphocytes compatible with NHL. Diffuse choroidal infiltration was diagnosed and treated with radiotherapy. Radiotherapy did not provide local control and preservation of the vision. Non-Hodgkins lymphoma can infiltrate to the choroid and radiotherapy may not be efffective in every case.

NON-HODGKIN LYMPHOMA PRESENTING WITH UVEITIS OCCURRING AFTER BLUNT TRAUMA

We report here an unusual patient suffering from visual loss with refractory uveitis which was occured after a blunt trauma to her left eye. While in the hospital cervical lymph node and anterior chamber aspiration cytology with immunohistochemical staining were performed. The histopathologic diagnosis was highly malignant B-cell non-Hodgkin lymphoma. After the inflammation of the eye was regressed with chemotherapy, pars plana vitrectomy-lensectomy was performed. She was free of inflammation and the best corrected visual acuity was increased. However, she had a refractory inflammatory episode with clumps of cells in the anterior chamber 10 months after the operation. Local radiotherapy to the left eye was applied. Radiotherapy provided local control and preservation of the vision. The present case is presented in order to emphasize the importance of systemic evaluation in uveitis and possible role of trauma leading migration of atypical cells into the eye.

Topical Mitomycin C for the Treatment of Conjunctival Tumor

Background: To evaluate the efficacy of topical mitomycin C (MMC) for the treatment of conjunctival tumor in a prospective design. Methods: Nine patients (nine eyes) with conjunctival tumor were studied. The patients received topical MMC 0.04% four times daily by one to six courses. Each course consisted of medication for consecutive 7 days followed by 1 week without medication. Follow-up was conducted on patients for control of disease, and side effects. Results: In 7 patients, the tumor completely disappeared during the mean follow-up period of 24.57 ± 5.94 months (range 18–35 months) with no recurrence. In 1 patient, there was no regression of the tumor, and in 1 patient cessation of the treatment was needed because of an adverse effect of the drug. Conclusion: Topical MMC is effective for the treatment of conjunctival tumor. Longer follow-up and large series are needed to assess the duration of tumor control.

Lacrimal Intubation with the Ritleng System in Recurrent Congenital Nasolacrimal Duct Obstruction in Children

Purpose: To evaluate the efficacy of the Ritleng lacrimal intubation system in the treatment of congenital nasolacrimal duct obstruction. Methods: Twenty-six patients (29 eyes) with congenital nasolacrimal duct obstruction, who ranged in age from 2 to 12 years (mean, 4.85 ± 2.9 years), underwent silicone intubation with the Ritleng lacrimal intubation system. The Ritleng lacrimal intubation system is composed of a Ritleng probe, a monofilament guide thread and a silicone tube. The prolene tip was removed from the inferior meatus with nasal endoscopy in 26 eyes, whereas this was done by using a Ritleng hook in 3. Clinical success was defined by the relief from symptoms and signs of obstruction. The tubes were left in place for an average of 6 months. The patients were followed up between 6 and 25 months (mean, 8.3 months). Results: All cases were successfully intubated with the Ritleng system. Two cases underwent reintubation because of tube dislocation during the first week. Granuloma developed at the edge of the inferior punctum in 1 case. We observed relief from symptoms in all cases. Conclusion: The Ritleng lacrimal intubation system is an easy, effective and nontraumatizing procedure for the treatment of congenital nasolacrimal duct obstruction.

Use of topical bevacizumab for conjunctival intraepithelial neoplasia.

Purpose: To report our experience in the treatment of intraepithelial neoplasia of the conjunctiva using topical bevacizumab. Methods: Ten eyes of 10 patients with conjunctival neoplasia received 25 mg/mL bevacizumab topically. Changes in the lesions were documented weekly using digital photography. After topical treatment, excisional biopsy was performed. Results: The mean age of the patients was 60.5 ± 12 (33–77) years. The mean duration of topical treatment was 7.8 ± 1.3 (5–14) weeks. The size and vascularity of the tumors reduced weekly. All patients underwent excisional biopsy, cryotherapy, and amnion membrane transplantation. The histopathologic diagnosis of the lesions was carcinoma in situ. No recurrence was observed during the follow-up of patients for 6 months. Conclusions: Topical bevacizumab is an effective treatment to reduce the tumor size before surgery and may be a good alternative for adjuvant therapy of conjunctival neoplasms.