Ebru Nevin Çetin

Association of serum lipid levels with diabetic retinopathy.

AIM To assess the association between serum lipids and diabetic retinopathy (DR). METHODS Sixty-one diabetic patients without retinopathy(NDR), 55 diabetic patients with non-proliferative retinopathy(NPDR) and 75 diabetic patients with proliferative retinopathy (PDR) according to ETDRS grading scale were enrolled in this study. Total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL) and triglyceride values were compared between the groups. RESULTS The groups were well-balanced in terms of age and gender (P=0.071, P=0.265 respectively). The mean HbA1c values were significantly lower in NDR group than the NPDR and PDR groups (P=0.004, P=0.009 respectively). Mean total cholesterol, triglyceride, LDL, HDL and VLDL levels were not significantly different between the groups (P=0.693, P=0.774, P=0.644, P=0.910 and P=0.967 respectively, one way ANOVA). Mean total cholesterol, triglyceride, LDL, HDL and VLDL levels were not significantly different between the patients with ME and patients without ME (P=0.622, P=0.113, P=0.955, P=0.735 and P=0.490 respectively, t-test). The mean blood glucose significantly correlated with total cholesterol (r=0.173, P=0.017) and LDL (r=0.190, P=0.008). The mean HbA1c significantly correlated with total cholesterol (r=0.158, P=0.030) and triglyceride (r=0.148, P=0.042). CONCLUSION Serum lipid levels were not significantly associated with the severity of DR or existence of ME despite the significant correlation between the mean blood glucose, HbA1c and total cholesterol.

Ocular pulse amplitude and retina nerve fiber layer thickness in migraine patients without aura

BackgroundTo evaluate the ocular pulse amplitude (OPA), the posterior pole asymmetry analysis (PPAA), the peripapillary retinal nerve fiber layer (RNFL) thickness, the ganglion cell layer (GCL) thickness, macular thickness and visual field testing in migraine patients without aura.MethodsIn this prospective, cross-sectional and comparative study 38 migraine patients and 44 age and sex matched controls were included. OPA was measured by dynamic contour tonometry (DCT), PPAA, RNFL, GCL and macular thickness were measured by Heidelberg Spectral Domain Optical Coherence Tomography (SD-OCT) and standard perimetry was performed using the Humphrey automated field analyzer.ResultsThe difference in OPA was not statistically significant between the two groups (p ≥ 0.05). In the PPAA there was no significant difference between two hemispheres in each eye (p ≥ 0.05). The RNFL thickness was significantly reduced in the temporal and nasal superior sectors in the migraine group (p ≤ 0.05). The GCL and macular thickness measurements were thinner in migraine patients but the difference between groups was not statistically significant (p ≥ 0.05). There was no correlation between RNFL, GCL, macular thickness measurements and OPA values. There was no significant difference in the mean deviation (MD) and pattern standard deviation (PSD) between the two groups (p ≥ 0.05).ConclusionsMigraine patients without aura have normal OPA values, no significant asymmetry of the posterior pole and decreased peripapillary RNFL thickness in the temporal and nasal superior sectors compared with controls. These findings suggest that there is sectorial RNFL thinning in migraine patients without aura and pulsative choroidal blood flow may not be affected during the chronic course of disease.

Assessment of awareness of diabetic retinopathy and utilization of eye care services among Turkish diabetic patients.

AIMS Raising awareness of diabetic retinopathy (DR) was shown to be a key element for early diagnosis and treatment of this blinding disease. There is very limited data about the knowledge level, attitude, and behavior of diabetic patients regarding DR in Turkey. This study was planned to assess the awareness of DR and the utilization of eye care services among Turkish diabetic patients. METHODS Diabetic patients who were under the care of ophthalmologists, endocrinologists, and/or primary care physicians were administered a questionnaire in order to assess their awareness of diabetes and its ocular complications. RESULTS A total of 437 patients (51.8% female and 48.2% male) with a mean age of 55.2 ± 11.9 were included in the study. Of the 437 patients, 31.8% had not been educated about diabetes, 88.1% were aware that diabetes can affect the eyes, and 39.8% thought that diabetics with good glycaemic control might suffer from DR. While 86.7% thought that early diagnosis was possible in DR, 77.3% previously had eye examinations, and 41.9% stated that annual eye examinations were necessary for diabetics. An educational level of middle school or higher, duration of DM longer than 5 years, previous DM education, and recruitment from the university (ophthalmology department and endocrinology department) were associated with better awareness of DR. The independent factors associated with visiting an ophthalmologist on a regular basis were DM education, DM duration, and site of recruitment. CONCLUSION Although most of the patients know that DM affects the eye, there is a lack of appropriate knowledge and behavior about the management of DR. The importance of better control of DM and regular eye examination in the prevention of DR should be emphasized.

Causes and characteristics of work-related eye injuries in western Turkey

Objectives: To analyze descriptive data and characteristics of work-related eye injuries (WREI) admitted into the emergency department (ED) and obtain information to utilize in planning measures to prevent WREI. Materials and Methods: This prospective study recruited patients with WREI admitted to the center in the two-year study period. Only the casualties occurred at the workplace and while working constituted the sample. The data were collected via face-to-face contact in the ED. Results: Males comprised the majority of the sample (95.3%, n = 778) and mean age of the patients was 28.1 ± 6.5 (range: 15-54) with the biggest percentage in between 25 and 34 years of age (46.2%, n = 377). Most patients were working in the metal and machinery sectors (66.4%, n = 542). Nearly half of the patients had less than 1 year of experience (50.4%, n = 411). The most common mechanism of WREI was noted to be exposures to welding light (26.9%, n = 219), followed by drilling/cutting injuries (21.1%, n = 172). “Carelessness” and “hurrying up” were the most commonly reported causes of WREIs among ‘worker-related causes’ (21.4% and 16.1%, respectively). Lack of protective measures ranked the highest among workplace-related causes (18.7%, n = 207). Conclusions: Programs to increase awareness on workplace safety and sound preventive strategies for both parties-employers and employees are to be pursued. Occupational safety efforts should include training on workplace eye safety and campaigns to raise knowledgeability on this disease among workers.

Optical densitometric measurements of the cornea and lens in children with allergic rhinoconjunctivitis.

Our aim was to investigate the impact of allergic rhinoconjunctivitis on corneal and lenticular optical densitometry, pachymetry and anterior chamber depth in children.

Isolated optic neuropathy in a case of Behçet’s disease

A 57-year-old male with a 1-year history of recurrent oral ulceration and papulopustular lesions presented with acute visual loss in his left eye. He had an oedematous disc without any signs of uveitis. Laboratory work-up regarding infectious diseases was negative. The patient was diagnosed with acute optic neuropathy secondary to Behçet’s disease. Systemic steroid and colchicine treatments were started but his vision did not improve. Isolated optic neuropathy is rare in Behçet’s disease and early treatment with high-dose steroids may not be successful in some cases.

Posterior pole asymmetry analysis and retinal thickness measurements in young relatives of glaucoma patients

The presence of a family history of glaucoma is a known risk factor for primary open‐angle glaucoma (POAG) in middle‐aged and older individuals. In this study, our aim was to demonstrate possible early glaucomatous alterations in young first‐ and second‐degree relatives of POAG patients by spectral‐domain optical coherence tomography. A total of 104 participants (52 relatives of POAG patients and 52 healthy individuals) were recruited in this cross‐sectional study. All the participants were between 17 years and 45 years of age. All eyes underwent testing with spectral‐domain optical coherence tomography. Peripapillary retinal nerve fiber layer thickness, hemifield macular thickness, macular ganglion cell complex thickness, posterior pole asymmetry analysis, and retinal arteriolar caliber measurements were taken for comparison between the study and control groups. The mean peripapillary retinal nerve fiber layer thickness was 104.9 ± 8.8 μm in the study group and 105.6 ± 7.4 μm in the control group (p = 0.68). Although whole macular thickness measurements were higher in the control group when compared with the study group (p = 0.008), the macular ganglion cell complex thickness was similar in both groups (p = 0.87). The posterior pole asymmetry analysis revealed no statistically significant difference between the groups in the aspect of consecutive black squares (p = 0.79). The mean retinal arteriolar caliber was 85.9 ± 4.8 μm in the study group and 86.0 ± 5.0 μm in the control group (p = 0.90). In conclusion, young relatives of POAG patients do not show characteristic glaucomatous damage when compared with the controls.

Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in a patient presenting with papilledema

MERS is a clinically mild encephalitis/encephalopathy characterized by the MRI finding of a reversible lesion with transiently reduced diffusion in the corpus callosum at least involving the splenium of the corpus callosum (SCC) [1]. The most common neurological symptom is delirious behavior, followed by consciousness disturbance, and seizures, all of which completely recover within a month. Takanashi et al. [2] first described a solitary lesion in the splenium of the corpus callosum on magnetic resonance imaging (MRI) in two patients with influenza-associated encephalitis/encephalopathy in 2004. Such lesions of the SCC are reported various types of viral infections [3, 4]. In this paper, we report on an adult patient who presented with papilledema diagnosed as MERS due to viral encephalitis/encephalopathy. A previously healthy 27-year-old man referred to our hospital from a psychiatry clinic with the complaints of headache, apathy, indifference, and rarely agitation for 10 days. The patient reported that he had complained about nausea and vomited two times in last 2 days. There was bilateral papilledema and mildly altered mental status in his neurological examination. There was no neck stiffness and the meningeal irritation signs were negative. His routine blood tests, initial cranial imaging findings including the conventional MR, MR-venography, computed tomography (CT) angiography images of cerebral vessels and electroencephalography were unremarkable. Further diagnostic tests to evaluate papilledema and mild encephalopathy such a young, male patient including vasculitis markers, paraneoplastic markers and autoimmune encephalitis’ markers (Potassium channel complex antibody, NMDA antibody and thyroid auto-antibodies) were negative. Lumbar puncture showed elevated cerebrospinal fluid (CSF) pressure of 31 cm H2O and elevated CSF protein of 114.9 mg/dL. Glucose concentration of CSF was 62 mg/dL (Blood glucose 96 mg/dL) and direct microscopic evaluation showed no cells. Microscopic and serological examination of CSF for mycobacterium tuberculosis, neurobrucellosis, syphilis, and Lyme disease was negative. In addition, Mycobacterium tuberculosis Real-Time PCR and Herpes virus Real-Time PCR were unremarkable. The patient was put on acetazolamide (1,000 mg/day) and empirical antibiotherapy (Ceftriaxone 2 9 2 g IV) and his headache and papilledema resolved in the follow-up, but his control LP showed 150 leukocytes/mm with a normal opening CSF pressure of 15 cm H2O. In addition, CSF protein was found to be increased at a level of 365.2 mg/dL. All repeated microbiological analyses were again negative. The control brain MR images demonstrated a solitary, non-enhancing, ovoid lesion (10 9 5 mm in E. Degirmenci (&) Department of Neurology, School of Medicine, Pamukkale University, Denizli, Turkey e-mail: eylemteke@yahoo.com

Optic Disc and Retinal Nerve Fibre Layer Changes in Parkinson’s Disease

Abstract This study was conducted to assess optic nerve and peripapillary retinal nerve fibre layer (RNFL) changes in patients with idiopathic Parkinson’s disease (PD) and its correlation with disease duration and severity. Optic nerve parameters and RNFL thickness were measured in 24 PD patients and 25 age–gender-matched controls by Heidelberg Retinal Tomography II (Heidelberg Engineering, Dossenheim, Germany). Patients with visual acuity below 20/25 were excluded. The mean RNFL in the temporal sector was significantly thinner in the study group than the control group (p = 0.020). Additionally, disease severity and duration negatively correlated with optic disc parameters in some sectors.

HIF1A as a major vascular endothelial growth factor regulator: do its polymorphisms have an association with age-related macular degeneration?

To investigate the association between age‐related macular degeneration (AMD) and the polymorphisms of HIF1A, a major vascular epithelial growth factor regulator under hypoxic conditions. The associations of AMD and polymorphisms of genes CFH, SKIV2L and MYRIP were also studied.