Banu Bozkurt

Juvenile xanthogranuloma of the corneal limbus: report of two cases and review of the literature.

PURPOSE To report the clinical and histopathologic findings of limbal juvenile xanthogranuloma lesions in 2 pediatric cases. METHODS Case report and literature review. RESULTS Two cases (a 7-month-old girl and a 7-year-old boy), both of whom developed a yellowish corneoscleral limbal mass not associated with other ocular or systemic findings, were evaluated. Both cases underwent simple excision of the lesion followed by local steroid treatment. Histopathologic examination in both cases revealed foamy histiocytes within an inflammatory infiltrate. One of the lesions also harbored multinucleate giant cells. Immunohistochemical staining was positive for CD68 and negative for S-100 and CD1a in both cases. CONCLUSIONS Juvenile xanthogranuloma may rarely present with an isolated lesion occurring only at the corneoscleral limbus. The diagnosis in the early stages of this disorder may be established with immunophenotyping and characteristic histopathologic features even without the presence of the multinucleate giant cells.

Effect of glycemic control on refractive changes in diabetic patients with hyperglycemia

Purpose: To investigate the effect of intensive glycemic control on hyperglycemia- induced changes in refraction, corneal topography, lenticular and corneal thickness in diabetic patients. Methods: Eighteen diabetic patients with plasma glucose >300 mg/dl were enrolled in the study consecutively. Autorefraction, C-Scan corneal topography, Javal keratometry, corneal pachymetry and ultrasonic biometric measurements were carried out at presentation and after metabolic control of blood sugar (plasma glucose profile <200 mg/dl). One eye of each patient was selected randomly for statistical analysis. Results: Mean plasma glucose levels were 356.00 mg/dl before and 133.78 mg/dl after treatment. The median values of the autorefractometric measurements were - 0.125 D on admission and + 0.375 D at the second examination. The difference in the refraction was statistically significant (P = 0.022). Nine of 18 patients became hyperopic, 2 became myopic and 7 showed no change after treatment. There was a significant change in the corneal topographic keratometric measurements at the flattest corneal meridian after treatment (P = 0.037). After treatment no statistically significant changes were observed in the pachymetric corneal thickness, anterior chamber depth, biometric dioptric lens calculations and Javal keratometric data. Conclusions: Hyperglycemia is the major cause of the transient refractive changes in diabetic patients. Following intensive medical treatment, a considerable number of patients tend to become more hyperopic compared with the hyperglycemic state. During the treatment period, changes in the corneal topographic parameters might be a potential source of error for keratorefractive and cataract surgery.

Effects of topical antiglaucoma drugs on apoptosis rates of conjunctival epithelial cells in glaucoma patients

Background: To investigate the effects of topical antiglaucoma drugs on apoptosis rates of conjunctival epithelial cells in vivo.

Comparison of intravitreal bevacizumab and ranibizumab treatment for diabetic macular edema.

AIM The aim of this study was to compare the effects of bevacizumab and ranibizumab on visual function and macular thickness in patients with diabetic macular edema (DME). METHODS The data of diabetic patients who had been treated with bevacizumab for DME were reviewed. Those patients who received 1 injection of intravitreal bevacizumab and ranibizumab with at least 6-month interval were considered for enrollment. The best-corrected visual acuity (BCVA) assesment with Early Treatment Diabetic Retinopathy Study (ETDRS) chart and central subfield macular thickness (CSMT) measurement using optical coherence tomography-3 before and after the injections were recorded as outcome measures. RESULTS The study included 29 eyes of 29 patients with a mean age of 56.18±13.07 years. The median BCVA was 59 ETDRS letters and the median CSMT was 411 μm preceeding the bevacizumab injection. At the 4th-6th week control after the injection, median BCVA increased to 61.50 ETDRS letters and the median CSMT decreased to 373 μm. This change in BCVA and CSMT was found to be statistically significant (P=0.029 and P=0.011, respectively). The mean interval between bevacizumab and ranibizumab treatment was 9.54±2.64 months. Ranibizumab treatment increased the median BCVA from 53 to 66 ETDRS letters and decreased the median CSMT from 428 μm to a level of 279 μm, which were statistically significant (P<0.001 and P<0.001, respectively). The median change in BCVA was 4.5 ETDRS letters in the bevacizumab group and 6 ETDRS letters in the ranibizumab group (P=0.58), whereas the median changes in CSMT were 41 and 100 μm after bevacizumab and ranibizumab injections, respectively (P=0.005). CONCLUSIONS Bevacizumab and ranibizumab are both effective antivascular endothelial growth factor drugs preferred in the treatment of DME. Our comparison of both therapies on the same patients suggested that the effect on BCVA was not statistically different, but ranibizumab provided more decrease in CSMT.

Lacrimal function and ocular complications in patients treated with systemic isotretinoin

PURPOSE To evaluate the effect on lacrimal function and ocular complications in patients with severe acne vulgaris during systemic treatment with 13- cis-retinoic acid (isotretinoin). METHODS Forty patients with acne vulgaris were treated with systemic isotretinoin at dosages of 0.5-1 mg/kg per day for two months. Full ophthalmologic examination, Schirmer I test, fluorescein break-up (BUT) and microbiological investigations of the conjunctival flora were done before, during the second month and at least one month after the end of the treatment. RESULTS The average Schirmer values before and after the treatment were 21.6 mm/5 minutes (SD 7.01) and 18.48 mm/5 minutes (SD 7.87) respectively. After the treatment BUT was less than 10 seconds in 50% of the patients and 55% had blepharitis. Subjective symptoms like dryness, itching and contact lens intolerance occurred in 42.5% and colonization of the conjunctiva by Staphylococcus aureus increased significantly during treatment ( p = 0.031 ). All abnormal findings disappeared one month after the cessation of treatment. DISCUSSION Isotretinoin causes signs and symptoms of dry eye, probably by reducing meibomian gland function, but ocular complications are generally not serious when low doses are used for a limited time, and are reversible after discontinuation. PDF NOT AVAILABLE!

Systemic associations and prevalence of exfoliation syndrome in patients scheduled for cataract surgery.

Purpose To study the frequency of exfoliation syndrome (XFS) and its association with intraocular pressure (IOP) and systemic diseases in patients with age-related cataract scheduled for surgery. Methods All 1480 cataract patients had a comprehensive systemic and eye examination, including slit-lamp biomicroscopy before and after mydriasis, IOP measurement, gonioscopy, and fundus examination. Results The percentage of XFS among patients scheduled for cataract surgery was 16.4, with no gender difference (p=0.833). The mean age of XFS patients (74.3±7.0 years) was significantly higher when compared to the ones without XFS (66.5±10.9 years) (p<0.001). XFS was unilateral in 41.3% of the subjects and bilateral in 58.7%. The number of subjects with XFS increased significantly with aging (p<0.001) (OR=1.093, 95% CI=1.073–1.14) (p<0.001). The most common type of cataract was nuclear in the XFS group (33.5%) and 24.6% of patients with mature cataract had XFS. In the XFS group, 11.2% of the subjects had glaucoma, which was statistically higher than the non-XFS group (4.6%) (p<0.001) (OR=2.67, 95% CI=1.65–4.32). Eighty-four patients had glaucoma and 27 of them (32.1%) had exfoliative glaucoma. The only systemic disease that was found to be associated with XFS was coronary heart disease with an OR of 1.49 (95% CI=1.068–2.072) (p=0.019). Conclusions XFS is a common problem in the aging cataract population of Turkey and increased IOP, glaucomatous optic neuropathy, and coronary heart disease occur more frequently in patients with XFS compared with subjects without XFS.

Thickness of the retinal nerve fiber layer in patients with anisometropic and strabismic amblyopia.

PURPOSE: To compare the retinal nerve fiber layer [RNFL] thickness of the amblyopic eye with that of the normal eye in patients with anisometropic and strabismic amblyopia. METHODS: Scanning laser polarimetry was performed with the GDx Nerve Fiber Analyzer (NFA), a scanning laser ophthalmoscope that measures the thickness of the peripapillary RNFL quantitatively and objectively, in vivo, based on the birefringence of the RNFL. Eighteen anisometropic, two strabismic and four combined amblyopic (both anisometropia and strabismus) patients were enrolled in the study. There were 9 male and 15 female patients, age range 7-66 years. Using Student’s t -test, 14 GDx parameters in the amblyopic eyes and sound eyes were compared. RESULTS: The GDx parameters showed no significant differences between the two groups [p > 0.5]. The superior average and inferior average values were 79.50µm and 80.41µm, respectively, in the amblyopic group, and 80.75µm and 82.75µm, respectively, in the healthy eyes. The average thickness did not differ between amblyopic and sound eyes (65.50µm and 66.45µm, respectively). CONCLUSION: Assessment of RNFL thickness by means of scanning laser polarimetry revealed no difference between the two eyes in patients with unilateral amblyopia.

Elevated tear interleukin-6 and interleukin-8 levels in patients with conjunctivochalasis.

Purpose: To determine the interleukin (IL)-6 and IL-8 levels in the tear samples of patients with conjunctivochalasis (CCh) and to correlate the severity of symptoms with tear IL levels. Methods: Fifty-one eyes at different stages of CCh and 10 eyes of healthy controls were recruited for this prospective study undertaken at a single university-based hospital. CCh was graded based on the extent of inferior lid margin involvement as follows: 1 = single (temporal) location, 2 = 2 locations, and 3 = whole lid. The presence of punctal occlusion and fluorescein clearance patterns were recorded. Enzyme-linked immunosorbent assay was used to determine IL levels. Severity of symptoms was assessed with the ocular surface disease index. Results: Of the 51 study patients (mean age = 63.4 ± 6.9 years), 16 had grade 1, 21 had grade 2, and 14 had grade 3 CCh. Tear IL-6 and IL-8 levels were significantly higher in patients with CCh than in controls (P ≤ 0.001). Higher IL levels were observed in grades 2 and 3 CCh than in grade 1 CCh and control eyes (P < 0.001). Patients with CCh who also had punctal occlusion and delayed fluorescein clearance results had higher tear IL levels than those who did not (P ≤ 0.001). Tear IL levels were positively correlated with the clinical severity of CCh as evaluated with the ocular surface disease index (r = 0.826, P < 0.001 for IL-6 and r = 0.726, P < 0.001 for IL-8). Conclusions: Inflammation may have a role in the pathogenesis of CCh. The clinical severity of CCh parallels the increased tear IL levels. Markers for inflammation are more pronounced in the advanced stages of this disease.

Effect of peripapillary chorioretinal atrophy on GDx parameters in patients with degenerative myopia

Purpose: To determine the effect of peripapillary chorioretinal atrophy in degenerative myopia on the retinal nerve fibre layer (RNFL) thickness measurements performed by scanning laser polarimetry.

Topical cyclosporine a in the treatment of superior limbic keratoconjunctivitis: a long-term follow-up.

Purpose: To report the efficacy of topical cyclosporine A (CsA) 0.05% drops (Restasis; Allergan, Irvine, CA) in the treatment of superior limbic keratoconjunctivitis (SLK). Methods: Seven patients with SLK refractory to corticosteroid drops and topical silver nitrate application were treated with 0.05% topical CsA 4 times a day, preservative-free artificial tears, and a lubricant ointment. The patients were evaluated for symptomatic and clinical improvement after 2 weeks, 1 month, 3 months, 6 months, and in 6 patients, >12 months. Results: After 2 weeks of topical CsA treatment, symptoms of foreign-body sensation, irritation, and photophobia and signs of conjunctival hyperemia, tarsal papillary reaction, and filamentous keratopathy improved remarkably in all patients. The patients had some burning of short duration after administration of topical CsA. However, none of them suffered from systemic or serious local side effects. After cessation of the topical CsA treatment, 6 patients were followed up for at least 6 months. In this period, the patients continued using lubricant agents. Three patients (50%) showed signs of recurrence after 3 months, and topical CsA was restarted. The clinical findings improved again within a 2-week period, and none of these patients needed further use of topical steroids. Conclusions: Topical CsA 0.05% can be effective in patients with SLK who do not respond to other treatment modalities. It can also be used in the long term to prevent recurrences during treatment and to avoid steroid dependency and the side effects of steroids.