Cenap Güler

Adverse effects of topical antiglaucoma drugs on the ocular surface.

Purpose: This study was designed to determine the effect of long‐term antiglaucoma topical medication on the ocular surface; measuring basal Schirmer’s and tear break‐up time tests using conjunctival impression cytology.

Cross-validation of the Turkish version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ 25).

Purpose: To test the validity and reliability of the Turkish version of the self-administered form of the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ 25). Methods: Patients with no limitations to respond to a health status interview and affected by a chronic eye disease were enrolled. The Turkish versions of the abbreviated form of World Health Organization Quality of Life (WHOQOL-BREF) and the NEI-VFQ 25 instruments were administered to all participants. Results: The mean (SD) age of the participants was 60.9 (14.5) years. There were 61 patients with one of the following conditions: Cataract (57.4%), diabetic retinopathy (13.2%), age related macular degeneration (ARMD) (11.4%), glaucoma (9.8%) and degenerative myopia (8.2%). The Cronbach alpha of the overall scale was 0.97; the Cronbach alpha ranged from 0.94 to 0.78 for the subscales. The physical, psychological, environmental and social domains of the WHOQOL-BREF had fair to good correlations with the NEI-VFQ 25 (r = 0.68 to r = 0.26), which indicated a sufficient convergent validity. Patients with lower visual acuity (VA) had lower index scores than those with higher VA (p = 0.001), which showed a sufficient responsiveness. Conclusion: Statistical analysis showed that Turkish version of the NEI-VFQ is a valid and reliable instrument to measure vision-related quality of life in patients with chronic eye diseases.

Tear function changes of postmenopausal women in response to hormone replacement therapy.

OBJECTIVE The goal of this study was to search the effect of hormone replacement therapy (HRT) on tear function changes in postmenopausal women. METHODS Following initial ophtalmic evaluation and tear sample collection, the subjects were given daily 0.625 mg conjugated estrogen, and either continuous combined or cyclic 5 mg medroxyprogesterone acetate was added. Eye examination included visual acuity, slit-lamp examination, fundus examination, tonometry, Schirmers test, and break up time (BUT) evaluation. Six months later, control examination was done and repeat tear samples were obtained. Tear immune globulin A (IgA) and lysozyme levels were measured by gel electrophoresis. The pictures of the bands were evaluated by digital image analysis with Scion Image program. RESULTS Conjunctival vascular congestion, laxity and corneal desquamation did not change before and after HRT (P>0.05). A significant improvement was noted in meibomian gland inflammation (P=0.034). We have not observed any significant difference in burning, foreign body sensation, and tearing (P>0.05). In addition, no significant difference was noted in BUT (P=0.370) and Schirmers test values (P=0.271). Though both lysozyme and IgA levels were elevated following the therapy, only IgA levels increased significantly (P=0.04). CONCLUSION HRT decreased meibomian gland inflammation and increased tear lysozyme and IgA levels in postmenopausal women.

Religious fasting and intraocular pressure.

Purpose: To determine the effects of Islamic religious fasting on intraocular pressure. Methods: The authors measured diurnal intraocular pressure values during religious fasting and 1 month later in 38 healthy male volunteers with a mean age of 22.4 ± 2.7 years. Body weight and urine specific gravity were determined to assess the extent of dehydration caused by fasting. Results: Although each patient had weight loss (0.1–1.4 kg) representing a slight dehydration caused by fasting, intraocular pressure values were not statistically different between fasting and nonfasting periods (P > 0.05). Conclusion: Fasting did not alter diurnal intraocular pressure values in healthy people.

Effects of betaxolol and latanoprost on ocular blood flow and visual fields in patients with primary open-angle glaucoma.

Purpose To evaluate the effects of betaxolol and latanoprost on ocular blood flow and visual fields in patients with primary open-angle glaucoma (POAG) by means of an obseiver-masked, prospective clinical study. METHODS Thirty-two patients with newly diagnosed POAG were included in the study. The patients were randomized into two groups. The first group was treated with betaxolol 0.50% twice daily and the second group with latanoprost 0.005% once daily. Baseline and post-treatment examinations on the first and third months of treatment included intraocular pressure (IOP) measurement, automated visual field testing, and ocular blood flow assessment. For evaluation of visual fields, mean defect and pattern standard deviation indices were used. Ocular blood flow was assessed by means of color Doppler imaging of the central retinal artery (CRA) and the temporal short posterior ciliary artery (PCA). For each vessel, peak systolic (PSV) and end-diastolic (EDV) blood flow velocities were measured and resistivity index (RI) calculated. Results After exclusion of one noncompliant patient, the study was completed with 31 eyes of 31 patients. Both drugs significantly reduced IOP (p<0.05). The mean IOP lowering effect of latanoprost was significantly higher than that of betaxolol (p=0.03). Visual field indices exhibited no significant changes in either group (p>0.05). There were no significant changes in PSV or EDV measurements of CRA or PCA in either group (p>0.05). RI decreased in both CRA and PCA with both drugs. The mean changes between baseline and 3 month blood flow measurements were not significantly different between betaxolol and latanoprost (p>0.05). CONCLUSIONS Over a treatment period of 3 months, both betaxolol and latanoprost tended to improve ocular blood flow without one of them being superior to the other. The results suggest that the direct (non IOP-dependent) influence on ocular circulation is better for betaxolol than for latanoprost. In addition, neither drug caused significant generalized improvements in visual fields during this period.

Ocular findings in a measles epidemic among young adults.

PURPOSE: To present ocular findings in a measles epidemic outbreak among young adults. METHODS: Ophthalmic lesions in an unselected group of 61 young military personnel with measles were followed. Eighteen of the patients had symmetric keratitis in both eyes. They were treated with diclofenac sodium eyedrops qid in the right eye, while the left eye was observed untreated. The disappearance of the corneal lesions in both eyes was compared. RESULTS: Forty patients (65.6%) had measles conjunctivitis with bulbar and tarsal conjunctival hyperemia. Five (8.2%) had increased mucous secretion. Thirty-five (57.4%) had superficial punctate corneal epithelial and subepithelial lesions which stained with fluorescein. Ten patients had corneal lesions without evident conjunctival pathology. Fourteen patients had subconjunctival hemorrhages, 12 of whom had bilateral lesions mostly in the superonasal quadrant. The time to disappearance of corneal lesions was 4.5±3.2 days in the diclophenac-treated right eyes, and 4.1±3.8 days in the left eyes. We did not observe a significant difference in the healing time between the two eyes (p=0.75). CONCLUSION: Measles did not cause major ocular complications in healthy patients. Keratitis was unresponsive to diclophenac sodium eyedrops with respect to healing time and end result.

Electrocardiographic changes during subconjunctival injections

Electrocardiographic changes were investigated in 53 patients duringsubconjunctival drug injections. Decrease in heart-rate of more than10% or arrhythmia was observed in 25 (47.2%) of the patients, whowere considered to have a positive oculocardiac reflex. In the control group of 35 patients, only 3 (8.6%) were found to have a significant decrease in heart rate during blood sampling from antecubital vein (p = 0.000). Young age was a significant risk factor for oculocardiac reflex during injections (p = 0.01). Patient gender, verbal pain score, satiety, experience of periocular injections, injected drug type were not found to be risk factors. All patients with oculocardiac reflex were asymptomatic; however, it is still wise to have emergency supplies readyfor any circulatory derangement during subconjunctival injections.

A histological analysis of the protective effect of ischemic preconditioning in the rat retina.

Purpose. Ischemic preconditioning (IP) protects the retina from the damaging effect of subsequent ischemia in vivo. We aimed to investigate the histological alterations induced by the protective effect of IP to the retina. Methods. The eyes of the rats were rendered ischemic by intra-ocular pressure (IOP) elevation. IP procedure consisted of producing ischemia for 5 minutes. Sham operation was similar to IP procedure except the pressure elevation. The operational eyes of sham and IP group underwent 60 minutes of ischemia 24 hours after the first procedure. The eyes contralateral to the experimental eyes made up the control group. The eyes were histologically analysed one week after the ischemia. Results. The total retinal thickness of the sham group was significantly less than total retinal thickness of the control group (p < 0.001). There was not a significant difference between control and IP group regarding the total retinal thickness (p > 0.05). The thickness of the inner retinal layers of the sham group were significantly less than corresponding retinal layers of the control group (p < 0.001). The inner plexiform layer (IPL) and inner nuclear layer (INL) thickness values of the sham group were significantly less than same layers of the IP group (p < 0.001). Ganglion cell layer (GCL) thickness of the IP group was significantly less than GCL thickness of the control group (p < 0.001). IPL thickness of the IP group was significantly less than that of control groups (p < 0.05). The GCL and total retinal thickness of the IP group were significantly more than thickness of the corresponding layers of the sham group (p < 0.05). Conclusion. IP considerably protects inner retinal layers from subsequent ischemic damage in a high IOP ischemic model. This endogenous process could further be utilized to tailor specific neuroprotective strategies for retinal cells.

Effect of Conjunctival Structure and Inflammatory Cell Counts on Intraocular Pressure after Trabeculectomy

Purpose: To evaluate the conjunctival structure and inflammatory cell counts and to determine the predictive value of these histological parameters for postoperative intraocular pressure (IOP) levels after trabeculectomy. Methods: A clinical and histological study was performed on consecutive patients. Postoperative (mean 32.8 ± 18.4 months; range 6–60 months) conjunctival biopsies of 36 eyes of 28 primary open-angle glaucoma patients who had trabeculectomy between 1992 and 1995 were included in the study. According to postoperative pressure control, patients with ≤16 mm Hg and those with >16 mm Hg were taken as groups 1 and 2, respectively. The control group (group 3) consisted of 15 age-matched patients without glaucoma, who had received no topical therapy. We compared the conjunctival structure and cell counts within these groups. Goblet cells, acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness, vascular density, mucopolysaccharides and collagen compositions were determined in groups 1, 2 and 3. Results: The number of goblet cells was significantly higher in group 1 (6.74 ± 7.23) than group 2 (3.09 ± 2.77; p = 0.017). No statistical difference was observed in the number of acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness, vascular density, mucopolysaccharide or collagen compositions between groups 1 and 2 (p > 0.05). In addition, when groups 1 and 2 were compared with the control group, there was a significant decrease in goblet cells (p < 0.001), an increase in acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness and vascular density (p < 0.001), but there was no significant difference in mucopolysaccharide and collagen compositions (p > 0.05). Conclusions: This study suggests that at the time of surgery a high number of goblet cells may be a predictor of lowered IOP (≤16 mm Hg) following trabeculectomy without antimetabolite.

Trypan Blue Staining of the Anterior Capsule Under an Air Bubble With a Modified Cannula

To attain good visibility of the anterior capsule in the advanced or white cataract, trypan blue 0.1% is used to stain the anterior capsule. The dye is usually injected under an air bubble. However, it is difficult to inject the dye properly due to capillary forces. An ordinary anterior chamber cannula was modified and its coverage area increased to facilitate the staining of the anterior capsule under an air bubble. The anterior capsule was stained properly by using the modified cannula in all of the cases.