Ceyhun Arici

Evaluation of the Nerve Fiber Layer and Macula in the Eyes of Healthy Children Using Spectral-Domain Optical Coherence Tomography

PURPOSE To determine the normative values of the peripapillary retinal nerve fiber layer (RNFL), macular thickness, and macular volume in healthy children using spectral-domain optical coherence tomography (SD-OCT) and analyze the correlation of such values with age, refraction error, and biometric measurements. DESIGN Observational case series. METHODS This institutional study involved 107 eyes from 107 healthy pediatric patients (54 female, 53 male) with ages between 6 and 16 years. After the biometric measurements and refractive error values (in spherical equivalent) of the cases were obtained, the peripapillary RNFL, macular thickness, and macular volume values were calculated using the Spectralis OCT device. RESULTS Among the study group, with an average age of 10.46 ± 2.94 years, the average axial length (AL) was 23.33 ± 0.89 mm; the average spherical equivalent (SE) value was -0.27 ± 0.99 diopter. The average peripapillary RNFL thickness was 106.45 ± 9.41 μm; the average macular thickness was 326.44 ± 14.17 μm; and the average macular volume was 0.257 ± 0.011 mm(3). The aforementioned OCT measurements were not significantly correlated with age, SE, or AL values (P > .05 for all). CONCLUSIONS This study reports SD-OCT findings among healthy pediatric cases. SD-OCT can be reliably used for pediatric patients because of its short exposure time and high degree of image resolution.

Corneal Endothelial Cell Density and Morphology in Healthy Turkish Eyes

Purpose. To describe the normative values of corneal endothelial cell density, morphology, and central corneal thickness in healthy Turkish eyes. Methods. Specular microscopy was performed in 252 eyes of 126 healthy volunteers (M : F, 42 : 84). Parameters studied included mean endothelial cell density (MCD), mean cell area (MCA), coefficient of variation (CV) in cell size, percentage of hexagonal cells, and central corneal thickness (CCT). Results. The mean age of volunteers was 44.3 ± 13.5 (range, 20 to 70) years. There was a statistically significant decrease in MCD (P < 0.001; correlation, −0.388) and percentage of hexagonal cells, (P < 0.001; correlation, −0.199) with age. There was also a statistically significant increase in MCA (P < 0.001; correlation, 0.363) with increasing age. There was no statistically significant difference in MCD, MCA, CV in cell size, percentage of hexagonal cells, and CCT between genders and there was also no significant difference in these parameters between fellow eyes of subjects. Conclusions. Normotive data for the endothelium in the Turkish population are reported. Endothelial cell density in the Turkish eyes is less than that described in the Japanese, American, Chinese, and Filipino eyes and higher than that described in Indian, Thai, and Iranian eyes.

Descemet-stripping automated endothelial keratoplasty in eyes with toxic anterior segment syndrome after cataract surgery

PURPOSE: To report the results of Descemet‐stripping automated endothelial keratoplasty (DSAEK) in eyes with toxic anterior segment syndrome (TASS) after cataract surgery. SETTING: Department of Ophthalmology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey. METHODS: In this prospective study of consecutive patients who had DSAEK for corneal failure due to TASS, the main outcome measures were corneal clarity, mean spherical equivalent (SE) refraction, preoperative and postoperative visual acuities, central corneal thickness, and endothelial cell count (ECC). RESULTS: The mean follow‐up in the 10 eyes (10 patients) was 17.1 months ± 2.4 (SD). There were no graft dislocations postoperatively, and no graft required repositioning. All grafts were clear at 12 months. Two eyes had initial graft rejection that resolved with treatment. All eyes had improved postoperative corrected distance visual acuity, with 7 eyes (70%) attaining 0.5 or better. The mean SE refraction in measurable cases (5 eyes) was 1.2 ± 0.6 preoperatively and 0.9 ± 1.0 postoperatively (P = .141). The decrease in mean pachymetry from preoperatively (691 ± 15 μm) to 12 months postoperatively (614 ± 23 μm) was statistically significant (P = .005). The mean ECC was 2740 ± 236 cells/mm2 preoperatively, 1690 ± 209 cells/mm2 at 6 months, and 1683 ± 206 cells/mm2 at 12 months. The decrease between preoperatively and 6 and 12 months (P = .05) and between 6 months and 12 months (P = .008) was statistically significant. CONCLUSION: Descemet‐stripping automated endothelial keratoplasty was safe and effective in eyes with TASS‐associated corneal edema, yielding encouraging surgical and visual outcomes. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Comparison of the effects of first and second generation silicone hydrogel contact lens wear on tear film osmolarity.

AIM To compare the effects of first and second generation silicone hydrogel (SiH) contact lens wear on tear film osmolarity. METHODS The healthy subjects who have never used contact lenses before were enrolled in the study. Tear film osmolarity values of 16 eyes (group 1) who wore first generation SiH contact lenses were compared with those of 18 eyes (group 2) who wore second generation SiH contact lenses after three months follow-up. RESULTS Before contact lens wear, tear film osmolarity of groups 1 and 2 were 305.02±49.08 milliosmole (mOsm) and 284.66±30.18mOsm, respectively. After three months of contact lens wear, osmolarity values were found 317.74±60.23mOsm in group 1 and 298.40±37.77mOsm in group 2. Although osmolarity values for both groups of SiH contact lens wear after three months periods were slightly higher than before the contact lens wear, the difference was not statistically significant. CONCLUSION Contact lens wear may cause evaporation from the tear film and can increase tear film osmolarity leading to symptoms of dry eye disease. In the current study, there is a tendency to increase tear film osmolarity for both groups of SiH contact lens wear, but the difference is not statistically significant.

Patient with late-onset Wilson's disease: deterioration with penicillamine.

We report on a 77-year-old woman whose symptoms and laboratory findings suggested Wilson’s disease (WD) and markedly deteriorated after initiation of penicillamine therapy. When she was 67, she had developed a mild head tremor and a slight forgetfulness. At the age of 75, she developed slurred speech and tremor in both hands followed by postural instability, which caused falls within the last 6 months. Her parents had a remote consanguinity. Neurological examination revealed head titubation, cerebellar dysarthria, high-amplitude kinetic tremor in arms, dysmetria, dysdiadochokinesia, symmetrical bradykinesia, prominent postural instability, and mild cognitive impairment. MRI of the brain (October 2005) showed bilateral hyperintense lesions in the basal ganglia on T2-weighted images and a coincidental subdural hematoma on the left frontoparietal region related to a recent fall (Fig. 1A). Kaiser–Fleischer rings were present bilaterally. The 24-hour urinary copper was 231 g (normal, 0 –100) and free copper was 45 g/dL. The serum levels of copper and ceruloplasmin were normal (105 and 20 g/dL, respectively). The liver biopsy specimen revealed increased copper content on dry weight (281.1 g/g; normal, 30). Penicillamine was started at a low dose and escalated to 900 mg together with zinc 150 mg t.i.d. Two weeks later, her symptoms worsened markedly so that she became bedridden with severe Parkinsonism and a jaw-closing dystonia. The 24-hour urine copper was 457.6 g, and 1 month later 1,500 g. Although penicillamine was stopped and zinc monotherapy was continued, the clinical picture got worse. In the control MRI (March 2006), the previous lesions were more prominent (Fig. 1B) and in the last MRI (June 2006) there was an additional white matter involvement (Fig. 1C). On reexamination in June, a severe startle response was observed in addition to the previous symptoms. A few days later, she deceased due to a cardiopulmonary arrest. This case is instructive because of the late presentation of WD and the worsening effect of penicillamine. To our knowledge, she is the oldest-onset neurological WD patient reported in English literature. WD has been very seldom reported in the 6th decade.1–3 Up to now, the oldest WD patient was a 65-year-old man who developed liver failure without neurological involvement.4 A 60-year-old patient with the diagnosis of asymptomatic WD was also reported.5 To verify the diagnosis of WD on genetic analysis is difficult, because there are over 200 identified different mutations of the ATP7B gene. According to Diagnosis and Phenotypic Classification of WD,6 our patient scored 8 points, which stood for “the diagnosis of WD is highly likely.” Classically, it has been known that penicillamine is beneficial for WD patients.7 However, Brewer and colleagues8,9 have argued that neurologically presenting WD patients should never be treated with penicillamine, since symptoms may worsen within a few weeks in 52% of patients, and in 50% of whom this deterioration may become permanent and repeated MRIs may show new and severe white matter lesions, as we have observed with our patient. Because of all these concerns, Brewer and colleague9,10 have recommended for initial therapy safer drugs such as zinc, as well as tetrathiomolybdate, which is currently under investigation. Trientine has not been proposed because of its initial worsening effect in about 20% of WD patients. We conclude that the diagnosis of WD should be considered, though rarely seen, in patients with atypical neurological abnormalities, especially movement disorders, even though age at onset is older than 65 years. Moreover, it may be better to avoid penicillamine as an initial therapy, especially in elderly patients with neurological WD.

Novel method to avoid the open-sky condition in penetrating keratoplasty: covered cornea technique.

Purpose: The aim of this study was to present a novel technique to avoid the open-sky condition in pediatric and adult penetrating keratoplasty (PK). Methods: Seventy-two eyes of 65 infants and children and 44 eyes of 44 adult patients were operated on using this technique. After trephining the recipient cornea up to a depth of 50% to 70%, the anterior chamber was entered at 1 point. Then, only a 2 clock hour segment of the recipient button was incised, and this segment was sutured to the recipient rim with a single tight suture. The procedure was repeated until the entire recipient button was excised and resutured. The donor corneal button was sutured to the recipient corneal rim. The sutures between the recipient button and the rim were then cut off, and the recipient button was drawn out. Results: None of the patients operated on with this technique developed complications related to the open-sky condition. Visual acuities, graft failure rates, and endothelial cell loss were comparable with the findings of studies performed for conventional PK. Conclusions: The technique described avoids the open-sky condition during the entire PK procedure. Endothelial cell loss rates are acceptable.

Comparison of Different Types of Complications in the Phacoemulsification Surgery Learning Curve According to Number of Operations Performed.

Objectives: To compare the differences in intraoperative complications rates by the number of resident-performed sequential phacoemulsification surgeries. Materials and Methods: Preoperative and postoperative ophthalmological examination records and intraoperative data of 180 eyes of 140 patients who underwent cataract surgery by two residents between November 2009 and February 2012 were analyzed retrospectively. The data of 180 eyes were separated into 3 groups based on the number of operations performed: Group A (first 1-60 eyes), group B (61-120 eyes) and group C (last 121-180 eyes). The number of direct supervisor interventions and the rates of different types of complications were compared between the three groups. Results: The number of direct supervisor interventions was 45, 35 and 19 in group A, B and C, respectively. The number of complications anterior to the iris plane was 3, 4 and 12 in group A, B and C, respectively. The difference in the rate of complications between group B and C was statistically significant (p=0.029). The number of complications posterior to the iris plane was 6, 14 and 3 in group A, B and C, respectively. The difference in the rate of complications between the groups was statistically significant (p=0.042, p=0.004). Conclusion: This study provides insight into which types of complications might arise during the phacoemulsification training period. The trends in the rates of different complication types in clinics may be analyzed, and this analysis may be used to improve and modify phacoemulsification training programmes according to the needs of residents.

Effects of 1% cyclopentolate hydrochloride on anterior segment parameters obtained with Pentacam in young adults

PURPOSE To investigate the effects of topically applied 1% cyclopentolate hydrochloride on anterior segment parameters obtained with a Pentacam rotating Scheimpflug camera in healthy young adults. METHODS Anterior segment analyses of 25 eyes from 25 young adults (Group 1), before and after 45 min of 1% cyclopentolate hydrochloride application, were performed. For a control group (cycloplegia-free, Group 2), 24 eyes of 24 age- and sex-matched healthy cases were evaluated twice at 45 min intervals. The results obtained from the groups were compared statistically. RESULTS The mean ages of the groups were 23.04 ± 3.42 (range, 18-29) and 22.4 ± 2.05 (range, 18-27) years for Groups 1 and 2, respectively (p=0.259). In Group 1, measurements between the two analyses were significantly different for the values of anterior chamber depth (ACD), anterior chamber angle (ACA), and anterior chamber volume (ACV) (p<0.05), whereas no statistical difference was found for the central corneal thickness (CCT) and keratometry (K1, K2) measurements. In Group 2, none of these parameters were statistically different between the two analyses. CONCLUSIONS Topically applied 1% cyclopentolate hydrochloride caused an increase in the ACD and ACV values, and a decrease in the ACA value. However, it had no significant effect on the CCT and keratometry measurements. It is important to consider these effects when using the Pentacam device on young adults with cycloplegia and when applying it for various reasons.

Use of Botulinum Neurotoxin in Ophthalmology

Botulinum neurotoxin (BoNT) is the first biological toxin used in the treatment of ophthalmic diseases and to decrease skin wrinkles as an aesthetic agent. When used appropriately, it weakens the force of muscular contraction and/or inhibits glandular secretion. The most common areas for botulinum toxin treatment are the upper face, including the glabella, forehead, brows, and lateral canthal lines, or crow’s feet. By relaxing the muscles causing wrinkles, non-permanent results may be achieved with its use. BoNT has gained widespread use in a variety of ophthalmic diseases. The effect of BoNT is temporary, but the therapeutic benefit is usually maintained even after repeated injections. Treatment is usually well tolerated. Complications and side effects associated with the treatment are rare and temporary. Complications occur due to weakness (chemodenervation) of adjacent muscle groups, immunological mechanisms and injection technique. Current therapeutic indications, doses, complications and contraindications of BoNT use in the following disorders related to ophthalmology were investigated: aesthetic use, strabismus, blepharospasm, hemifacial spasm, eyelid retraction, entropion, lacrimal hypersecretion syndrome, and facial paralysis.

An in Vitro Experimental Study on the Antimicrobial Activity of Silicone Oil against Anaerobic Bacteria

Abstract Purpose: To investigate the in vitro antimicrobial activity of silicone oil against anaerobic agents, specifically Propionibacterium acnes, Peptostreptococcus spp., Peptostreptococcus anaerobius, Bacteroides fragilis, Fuobacterium spp., and Clostridium tertium. Method: A 0.5 McFarland turbidity of Propionibacterium acnes, Peptostreptococcus spp., Peptostreptococcus anaerobius, Bacteroides fragilis, Fuobacterium spp., and Clostridium tertium was prepared, and 0.1 mL was inoculated into 0.9 mL of silicone oil. Control inoculations were performed in anaerobic blood agar and fluid thioglycollate medium without silicone oil. Results: Propionibacterium acnes retained their viability on the 3rd day in the presence of silicone oil. In total, 9.7 × 106 colonies were enumerated from 1 mL of silicone oil. After a prolonged incubation of 7 days, the number of colonies observed was 9.2 × 106. The other bacteria disappeared after the 3rd day of incubation in silicone oil. Conclusions: Propionibacterium acnes, which is the most common chronic postoperative endophthalmitis agent, is thought to be resistant to silicone oil.