Cuneyt Erdurman

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.

Safety and Effectiveness of Interferon Alpha-2a in Treatment of Patients with Behçet's Uveitis Refractory to Conventional Treatments

PURPOSE To evaluate the intermediate-term safety and effectiveness of interferon alpha-2a (IFNalpha2a) in patients with Behçets uveitis (BU) refractory to corticosteroids and immunosuppressive agents. DESIGN Open, nonrandomized, uncontrolled, interventional, prospective study. PARTICIPANTS Fifty-three patients (106 eyes) with active, vision-threatening BU who failed to respond to conventional treatments. INTERVENTION In 53 patients, acute inflammation was suppressed with effective prednisolone dosage (1-2 mg/kg/day, tapered to 10 mg within 4-6 weeks). The patients were treated with IFNalpha2a 4.5 million international units (MIU) 3 times per week for the first 3 months followed by IFNalpha2a 3 MIU 3 times per week for the next 3 months. Observation or other treatment methods were performed according to the decision tree developed for this study. MAIN OUTCOME MEASURES Remission and complete response (primary outcome measures), frequency of uveitis attacks, visual acuity (VA), and adverse effects (secondary outcome measures). RESULTS During 2 years of follow-up (median 65 months, range 12-130 months), compliance with the therapy was excellent. At the end of 1-year follow-up, treatment response was obtained in 45 of 53 patients (84.9%). The mean attack rate of 3.6+/-1.1 per year (range, 2-8) decreased to 0.56+/-0.75 (range, 0-4) per year (P=0.001). Visual acuity improved (> or = 0.2 logarithm of the minimum angle of resolution units from initial VA) in 30 eyes (28.3%) and worsened in 12 eyes (11.3%). Five patients (9.4%) did not respond to the initial treatment, and 3 patients (5.6%) developed severe adverse effects, including psoriasis, epileptic seizure, and extreme tiredness. Fifteen patients (28.3%) were off treatment for all the medications and disease free for 28+/-13.1 months (range, 12-50 months). CONCLUSIONS These results suggest that IFNalpha2a may be a valuable treatment option in BU that is refractory to corticosteroids and conventional immunosuppressive agents. The possible role of IFNalpha2a as a first-line agent in BU should be validated in randomized controlled clinical trials against newly described biologic agents. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Effect of subconjunctival bevacizumab (Avastin) on experimental corneal neovascularization in guinea pigs.

Purpose: To evaluate the effect of subconjunctival bevacizumab (Avastin) on experimental corneal neovascularization in guinea pigs. Methods: Forty eyes of 40 guinea pigs were chemically cauterized with 75% silver nitrate and 25% potassium nitrate sticks. Fifteen eyes (group 1) received 2 subconjunctival injections of bevacizumab (0.1 mL, 1.25 mg) simultaneously with cauterization and 3 days later. Fifteen eyes (group 2) received 2 subconjunctival injections of bevacizumab (0.1 mL, 1.25 mg) 3 and 5 days after cauterization. Ten eyes (group 3, control group) received 2 subconjunctival injections of 0.1 mL of balanced salt solution 3 and 5 days after cauterization. After we determined the burn and neovascularization scores for all groups, the animals were killed on the 10th day. The percentages of neovascularization on the surface of the cornea were measured in terms of pixels on digital photographs. The average number of vessels at maximally vascularized areas was determined for each specimen. Results: Neovascularization score was 1.1 ± 0.3 in group 1, 2.46 ± 1.3 in group 2, and 3.5 ± 0.5 in the control group. The difference was statistically significant (P < 0.001). The area of neovascularization at the cornea surface was 15.6% ± 10.1% in group 1, 19.74% ± 11.2% in group 2, and 23.5% ± 7.4% in the control group (P = 0.194). The average number of neovascular vessels at group 1 was significantly reduced in comparison with group 2 and the control group (P < 0.001). Conclusions: Subconjunctival injection of bevacizumab decreases the extent of chemically induced corneal neovascularization in guinea pigs. The antineovascular effect of bevacizumab is higher if the injection is performed simultaneously with the chemical cauterization.

Long-term results of Nd:YAG laser treatment for premacular subhyaloid haemorrhage owing to Valsalva retinopathy

AimsValsalva retinopathy produces sudden visual loss, which may be prolonged if untreated. Nd:YAG laser enables rapid diffusion of premacular subhyaloid haemorrhage. This study was performed to assess the long-term results and safety of Nd:YAG laser treatment in cases with Valsalva retinopathy.MethodsSixteen patients had Nd:YAG laser treatment to drain premacular haemorrhage. The follow-up period was 24 months.ResultsAll eyes had marked clearing of haemorrhage and immediate improvement of vision following laser treatment. In 14 eyes visual acuity improved to 20/20 level at the end of the first week and the remaining two patients achieved 20/20 level within 1 month. No patient had evidence of retinal or choroidal damage.ConclusionNd:YAG laser treatment for Valsalva retinopathy is an effective, non-invasive, and safe procedure for patients with a premacular subhyaloid haemorrhage larger than 3 disc diameter and no longer than 3 weeks of duration.

Comparison of tilt and decentration of 1-piece and 3-piece hydrophobic acrylic intraocular lenses.

Purpose: To determine the amount of tilt and decentration of 1‐piece and 3‐piece hydrophobic acrylic intraocular lenses (IOLs) in patients having cataract surgery. Setting: Department of Ophthalmology, Gülhane Military Medical Academy and Medical School, Ankara, Turkey. Methods: Eighty‐eight patients having phacoemulsification with IOL implantation were divided into 2 groups. One group received a 3‐piece hydrophobic acrylic IOL with 12.5 mm poly(methyl methacrylate) haptics and the other, a 1‐piece hydrophobic acrylic IOL with 12.5 mm haptics. The amount of IOL decentration and tilt was quantitated using Purkinje reflections and photographic documentation at the last postoperative control. The results of the 2 groups were compared. Results: Bag fixation of the IOL and an intact continuous curvilinear capsulorhexis (CCC) were confirmed in all cases at the last postoperative control, which was at a mean of 27.1 months ± 5.4 (SD) and 26.7 ± 4.4 months in the 3‐piece group and 1‐piece group, respectively (P = 0.659). There was no significant difference between groups in the percentage of patients with measurable tilt and decentration and of patients without measurable tilt and decentration (P = .956). The mean IOL tilt was 2.72 ± 0.55 degrees in the 3‐piece group and 2.70 ± 0.84 degrees in the 1‐piece group and the mean IOL decentration, 0.39 ± 0.13 mm and 0.34 ± 0.08 mm, respectively. There were no significant between‐group differences in tilt or decentration (P = .897 and P = .103, respectively). Conclusion: There were no significant differences in tilt and decentration between 1‐piece and 3‐piece hydrophobic acrylic IOLs in eyes with capsular bag IOL implantation and an intact CCC.

Ingestion of IH636 grape seed proanthocyanidin extract to prevent selenite-induced oxidative stress in experimental cataract

PURPOSE: To investigate whether dietary supplementation with IH636 grape seed proanthocyanidin extract (GSPE) prevents selenite‐induced cataract. SETTING: Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey. METHODS: Thirty Spraque‐Dawley rat litters were put randomly into 3 groups. In group 1 (n = 10), sodium selenite (30 nmol/g body weight) was injected subcutaneously on postpartum day 10. In group 2 (n = 10), sodium selenite (30 nmol/g body weight) was injected on postpartum day 10 and oral GSPE (100 mg/kg body weight) was given for 1 week after sodium selenite injection. Only subcutaneous saline was injected in group 3 (control, n = 10). The development of cataract was assessed for 3 weeks, and its density was graded and photographed with a slitlamp. Removed rat lenses were analyzed for glutathione (GSH) and malondialdehyde (MDA). RESULTS: All of the rats in group 1 had cataract between stage 6 and stage 3. In group 2, only 5 of 10 eyes had cataract between stage 3 and stage 2 and no cataract occurred in the remaining 5 rats. The difference between mean cataract stages in group 1 and group 2 was significant (P<.05). The mean GSH level in group 1 was significantly lower than in group 2 and controls (P<.05). The mean MDA level in group 1 was significantly higher than in group 2 and controls (P<.05). CONCLUSIONS: IH636 grape seed proanthocyanidin extract effectively suppressed cataract formation in rats. Routine consumption of grape seed proanthocyanidin extract in the form of food or dietary supplement may offer a prophylactic measure against onset and progression of cataract.

Acute effects of cigarette smoking on multifocal electroretinogram.

Background:  Cigarette smoking was shown to have stimulant effects on pattern visual‐evoked potentials. The aim of this study was to investigate the acute effects of cigarette smoking on multifocal electroretinogram (mfERG).

Sensitivity and specificity of Heidelberg Retinal Tomography II parameters in detecting early and moderate glaucomatous damage: effect of disc size.

Purpose:  To determine the efficacy of Heidelberg Retinal Tomography II (HRTII) parameters in differentiating normal eyes from eyes with early or moderate glaucomatous damage.

Comparison of Oculus Pentacam and Stratus optical coherence tomography for measurement of central corneal thickness.

Purpose: Measurement of central corneal thickness (CCT) plays an essential role in the diagnosis and treatment of many ocular diseases. In this study, we aimed to compare the CCT measurements obtained using the Scheimpflug system (Pentacam; Oculus, Inc) with a retinal optical coherence tomography device (Stratus OCT; Carl Zeiss Meditec, Inc) to examine healthy corneas. Methods: CCT measurements of 80 eyes belonging to 40 male patients (mean age: 24.48 ± 6.01 years) were evaluated with the Pentacam and the Stratus OCT. The relationship between the CCT values obtained with these 2 devices was examined with a Pearson correlation analysis, a paired t test, and a Bland-Altman analysis. Results: The average CCT value obtained with Pentacam was 546.11 ± 34.15 μm and that obtained with Stratus OCT was 567.76 ± 35.02 μm. Although the average difference between the devices was 21.65 ± 8.59 μm (P < 0.0001), the measurements obtained with both devices were significantly correlated (r = 0.969, P < 0.0001). In Bland-Altman analysis, there was a high consistency between measurements obtained with either Pentacam or Stratus OCT devices. Conclusions: Corneal thickness measurements differ depending on the device used. Corneal thicknesses that have been calculated with Pentacam were lower than the values obtained with Stratus OCT. Both devices used for CCT measurement are easily applied, noninvasive, and effective. However, the devices are not interchangeable. Stratus OCT is not optimal for CCT measurement because of the important limitations of using manual measurements, but it can be used if other measurement devices designed for the purpose are not available.

An unusual complication of blunt ocular trauma: A horseshoe-shaped macular tear with spontaneous closure

A case of horseshoe-shaped macular tear after blunt trauma with the course of the tear and the relevant findings obtained by spectral-domain optical coherence tomography (SD-OCT) is described. A 21-year-old man who had suffered blunt trauma 5 days previously visited our clinic complaining of vision loss in his left eye. Ophthalmic examination and SD-OCT images revealed a horseshoe-shaped macular tear. A month later at the second visit, the macular tear was found to have spontaneously closed. There have been many cases reported previously of the spontaneous closure of traumatic macular holes. A horseshoe-shaped macular tear is an atypical clinical presentation. However, the mechanism of spontaneous closure is hypothetically as same as that for a macular hole. High-resolution images and three-dimensional maps taken with SD-OCT can provide more details on macular diseases and are more useful than time-domain OCT images.