Duygu Gulmez Sevim

Corneal pseudodendritic lesions masquerading as herpetic keratitis in a patient with tyrosinemia type I

Objective: To describe the clinical findings of a patient with tyrosinemia type I with noncompliance to a protein-restricted diet, treated with 2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione (NTBC). Methods: Clinical findings at the initial examination and after strict compliance to a protein-restricted diet after 4 weeks follow-up are described in a patient with tyrosinemia type I on NTBC treatment, who had been treated with presumed herpetic keratitis. Results: A 10-year-old girl diagnosed with hereditary tyrosinemia type I and on NTBC treatment presented with photophobia and ocular discomfort in both eyes. An ophthalmologic examination demonstrated bilateral dendritiform epithelial lesions in the central cornea, staining faintly with fluorescein. These lesions were subsequently intermittently treated with topical antivirals for presumed herpes simplex virus keratitis and lubricant eye drops for 9 months without resolution; however, when strict compliance with a protein-restricted diet was instituted, nearly a complete resolution of the lesions was noted at the 4-week follow-up. Conclusions: Although type II tyrosinemia is known to have corneal involvement, the natural course of tyrosinemia type I has not been shown to have corneal involvement. Corneal involvement in type I tyrosinemia may be an indicator of dietary noncompliance and may show complete resolution with a strict compliance to protein-restricted diet only.

Serum adiponectin, insulin resistance, and uveal melanoma: clinicopathological correlations.

To investigate the status of insulin resistance, metabolic syndrome, dyslipidemia, and serum adiponectin levels in patients with uveal melanoma and choroidal nevus were investigated. Our study included 86 patients with uveal melanoma, 38 patients with choroidal nevus, and 86 controls. Uveal melanomas were classified as small, medium, and large on the basis of Collaborative Ocular Melanoma Study (COMS) criteria. Patients with uveal melanoma had significantly higher homeostatic model assessment scores compared with patients with choroidal nevus (P<0.001). Patients with uveal melanoma and choroidal nevus had significantly lower levels of serum adiponectin compared with controls (P<0.001). Patients with uveal melanoma who developed systemic metastases had significantly lower levels of serum adiponectin levels compared with patients with nonmetastases during follow-up (P=0.018). When the largest tumors (COMS III) were compared, ciliary body melanomas were associated with significantly lower levels of serum adiponectin than choroidal melanomas. In patients who were treated with enucleation, epitheloid predominant and mixed cell-type tumors were associated with lower levels of serum adiponectin compared with tumors with spindle cell type, but this did not reach statistical significance. By providing an antiapoptotic and proangiogenic environment, low serum adiponectin levels and insulin resistance may play a role in promoting the growth of uveal melanocytic tumors and may contribute toward a more aggressive clinical course, adversely affecting the prognosis.

The Effects of Anti-Vascular Endothelial Growth Factor Drugs on Retinal Pigment Epithelial Cell Culture

Objectives: To assess the effects of anti-vascular endothelial growth factor (VEGF) drugs on retinal pigment epithelium cell culture. Materials and Methods: Aflibercept (0.5 mg/mL), bevacizumab (0.3125 mg/mL), and ranibizumab (0.125 mg/mL) were applied to retinal pigment epithelium cell cultures isolated from the enucleated eyes of New Zealand white rabbits. Viability, apoptosis, proliferation, and senescence of the cells were evaluated in control and drug-treated cultures at the end of 72 hours. Results: Cells treated with aflibercept showed increased viability and decreased apoptosis compared to the control culture and both the bevacizumab- and ranibizumab-treated groups (p<0.05). Statistically increased apoptosis and decreased viability were found in the bevacizumab and ranibizumab-treated groups compared with the control group (p<0.05). There were no statistically significant differences in cell proliferation and senescence between the groups (p>0.05). Conclusion: Anti-VEGF drugs did not affect senescence or proliferation of retinal pigment epithelium cells. Aflibercept was found to decrease apoptosis and increase cell viability, while ranibizumab and bevacizumab increased apoptosis and reduced cell viability in retinal pigment epithelium culture.

Correlations among multifocal electroretinography and optical coherence tomography findings in patients with Parkinson’s disease

To assess the correlation between functional and anatomical evaluations with multifocal electroretinography (mfERG) and spectral-domain optical coherence tomography (SD-OCT) in patients with Parkinson’s disease (PD). This cross-sectional study involved 116 eyes of 58 patients with PD and 30 age- and sex-matched control subjects. All study participants underwent a comprehensive neuro-ophthalmic examination, retinal single-layer thicknesses and volumes, and peripapillary retinal nerve fiber layer (pRNFL) measurements with SD-OCT, and the patients’ mfERG recordings were evaluated. The macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE), and photoreceptor layer (PR) thicknesses, and mRNFL, RPE, and PR volumes were found lower in PD compared to those of controls, while outer plexiform layer (OPL) volumes were increased (p < 0.05). We found delayed implicit times and decreased amplitudes in the mfERG of PD patients versus those in control subjects (p < 0.05). We found significant correlations between outer macular volumes, PR thicknesses, and N1 amplitudes of rings 2 and 3and P1 amplitudes of rings 3, 4, and 5. Our study revealed thinning of both inner and outer retinal single layers, increased OPL volume, and delayed implicit times and decreased amplitudes in the mfERG of PD patients versus control subjects and correlation between structural and functional parameters. Our findings point out that SD-OCT and mfERG could both serve as non-invasive tools for evaluating ophthalmic manifestations of Parkinson’s disease.

Ocular complications of severe corneal abrasions after cosmetic blepharopigmentation

ABSTRACT A 53-year-old woman with hemiparesis and poor dexterity, underwent cosmetic blepharopigmentation on the both upper eyelids in the dermatology clinic of a private hospital. She was not asked for any information on her medical history and no informed consent was obtained and the procedure was performed without any protective ocular shields. The patient experienced severe lacrimation, discomfort, and increased sensitivity to light during and after the procedure. She also noticed blurred vision after the procedure. Ophthalmologic examination revealed tender and oedematous eyelids and corneal abrasions in both of her eyes. Topical antibiotics and preservative-free lubricants were able to recover her from her signs and symptoms at 1-week follow-up. It is recommended that cosmetic blepharopigmentation should be applied cautiously with patient’s informed consent after obtaining a thorough medical history and with protective ocular shields to avoid potential complications.

Ocular complications after cosmetic periocular diode laser application to the eyelids

ABSTRACT A 25-year-old woman underwent diode laser application on the both upper eyelids in the dermatology department of a private hospital to obtain a cosmetic healing of the reddish look on her eyelids without any protective lenses. The patient experienced severe uveitis, atonic pupils, raised intraocular pressure, and increased sensitivity to light in her eyes on the following day of the procedure. Topical steroids and pressure-lowering agents were able to treat the acute uveitis and glaucoma, unfortunately the patient suffered from irreversible atonic and atrophic pupils and photosensitivity. It is recommended that cosmetic laser application on the periocular area should be avoided, and if it is still to be performed, it should be applied cautiously and the patient should be informed of the potential ocular complications.

Evaluation of Retinal Changes in Progressive Supranuclear Palsy and Parkinson Disease

Background: Differentiating Parkinson disease (PD) from progressive supranuclear palsy (PSP) can be challenging early in the clinical course. The aim of our study was to see if specific retinal changes could serve as a distinguishing feature. Methods: We used spectral domain optical coherence tomography (SD-OCT) with automatic segmentation to measure peripapillary nerve fiber layer thickness and the thickness and volume of retinal layers at the macula. Results: Thicknesses of superior peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer, inner plexiform layer, inner nuclear layer, and macular volume were more affected in PSP compared with PD (P < 0.05). Thicker inferotemporal pRNFL and lower macular volume were detected in levodopa users compared with nonusers in patients with PD. Conclusions: PD and PSP are associated with distinct changes in retinal morphology, which can be assessed with SD-OCT.

Effects of Commonly Used Intravitreal Anti-VEGF Drugs on Mesenchymal Stem Cells Derived from the Limbus and Ciliary Body.

To investigate the effects of commonly used intravitreal anti‐vascular endothelial growth factor (anti‐VEGF) antibodies on proliferation index and viability of mesenchymal stem cells derived from ciliary body and limbus (CB‐MSC and LMSC).

Effects of commonly used intravitreal anti-vascular endothelial growth factor drugs on mesenchymal stem cells derived from the limbus and ciliary body

To investigate the effects of commonly used intravitreal anti‐vascular endothelial growth factor (anti‐VEGF) antibodies on proliferation index and viability of mesenchymal stem cells derived from ciliary body and limbus (CB‐MSC and LMSC).

Prognostic value of metal-metal contact during nasolacrimal duct probing.

OBJECTIVE To evaluate the prognostic value of metal-metal contact during nasolacrimal duct (NLD) probing in patients with simple membranous versus complex congenital NLD obstructions (CNLDO). DESIGN Retrospective case series. PARTICIPANTS Infants diagnosed with CNLDO. METHODS Seventy-nine eyes of 70 infants with CNLDO who underwent probing were recruited. Metal-metal contact was sought during probing in every patient. CNLDO was classified into simple membranous versus complex type of obstruction. Complete resolution of epiphora, increased tear meniscus, and mucous discharge were defined as successful outcome. RESULTS The mean age of patients at the time of probing was 21.0 ± 8.3 (range 1-42) months. Postoperative evaluations were performed in all patients between the first and second postoperative months. Overall success rate of probing was 84.9%. A higher success rate was obtained in membranous (89.7%) versus complex (54.5%) obstructions (p = 0.01). A metal-metal contact could be established in 62 (78.5%) eyes. Treatment success was achieved in 93.5% of cases in which metal-metal contact was detected versus 52.9% of cases without metal-metal contact (p < 0.001). Among cases with metal-metal contact, a trend toward successful outcomes was observed with membranous as compared with complex obstructions (96.4% vs 71.4%, p = 0.059). Logistic regression analysis revealed the presence of metal-metal touch (odds ratio [OR] 13.3, p = 0.001) and membranous type obstruction (OR 7.7, p = 0.019) as significant factors for a successful outcome. CONCLUSIONS Establishment of metal-metal contact is an important prognostic sign for surgical success in both the membranous and the complex type of CNLDO.