Elif Betul Turkoglu

The relation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume with the presence and severity of Behçet's syndrome.

Behçets syndrome (BS) is associated with chronic inflammation and endothelial dysfunction. Although there have been extensive investigations on neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and mean platelet volume (MPV) in many diseases, their roles in BS is unclear. The purpose of the present study was to evaluate NLR, PLR, and MPV levels in BS patients and explore their clinical significance. The study included 254 patients with BS and 173 healthy individuals. Age, sex, age of onset, duration of disease, smoking, Behçet activity score, total white blood counts, neutrophil, platelet, and T lymphocyte counts of the patients were recorded. White blood cell (WBC), neutrophil, platelet, NLR, and PLR were significantly higher in patients with BS when compared with healthy controls (all p < 0.001). Lymphocyte counts and MPVs of the BS group were not statistically different from healthy controls (all p > 0.05). In the BS group, PLR and MPV were significantly different among the three severity groups (p = 0.037 and p = 0.016, respectively). We showed that any laboratory markers were not associated with joint, eye, central nervous system, large vessel, or gastrointestinal involvement in BS. NLR was shown to be an independent factor for BS by multivariate analysis. We suggest that NLR can be considered to be a diagnostic criterion of BS given the support of the findings from larger prospective studies.

Changes in vision related quality of life in patients with diabetic macular edema: Ranibizumab or laser treatment?

PURPOSE To compare the changes in vision related quality of life (VR-QoL) in patients with diabetic macular edema (DME) undergoing intravitreal ranibizumab (IVR) injection or focal/grid laser. MATERIAL AND METHODS In this prospective study, 70 patients with clinically significant macular edema (CSME) were randomized to undergo IVR injection (n=35) and focal/grid laser (n=35). If necessary, the laser or ranibizumab injections were repeated. Distance and near visual acuities, central retinal thickness (CRT) and The 25-item Visual Function Questionnaire (VFQ-25) were used to measure the effectiveness of treatments and VR-QoL before and after 6 months following IVR or laser treatment. RESULTS The demographic and clinical findings before the treatments were similar in both main groups. The improvements in distance and near visual acuities were higher in IVR group than the laser group (p<0.01). The reduction in CRT in IVR group was higher than that in laser treatment group (p<0.01). In both groups, the VFQ-25 composite score tended to improve from baseline to 6 months. And at 6th month, the changes in composite score were significantly higher in IVR group than in laser group (p<0.05). The improvements in overall composite scores were 6.3 points for the IVR group compared with 3.0 points in the laser group. Patients treated with IVR and laser had large improvements in composite scores, general vision, near and distance visual acuities in VFQ-25 at 6 months, in comparison with baseline scores, and also mental health subscale in IVR group. CONCLUSION Our study revealed that IVR improved not only visual acuity or CRT, but also vision related quality of life more than laser treatment in DME. And these patient-reported outcomes may play an important role in the treatment choice in DME for clinicians.

Is Smoking a Risk Factor in Ocular Behçet Disease

Abstract Purpose: To investigate the association between smoking and prognosis of ocular Behçet disease. Material/Methods: Medical records of 202 patients with Behçet uveitis were collected retrospectively. Patients were assigned to two groups according to smoking habits. In group I, 72 patients were current smokers. In group II, 130 were nonsmokers. The localization of uveitis, time to resolution of uveitis, time to recurrences, visual acuities, and presence of cystoid macular edema were compared between groups. Results: The demographic characteristics were similar in both groups. Smoking was not associated with types of uveitis with OR of 1.01 (95% CI, 0.99–1.04; p = 0.21) for anterior uveitis, 0.96 (95%CI, 0.90–1.02; p = 0.18) for posterior uveitis, and 1.80 (95% CI, 0.75–2.77; p = 0.24) for panuveitis. The average times to inflammation resolution were 48 ± 10.1 days in group I and 51 ± 14 days in group II (p = 0.82). The average times to recurrence were 8.6 ± 5 months for smokers and 9.1 ± 7 months for nonsmokers (p = 0.43). Patients with CME in groups were 18 (25%) and 42 (32.3%), respectively (p = 0.08). Conclusions: Our findings suggest that smoking does not have a negative effect on the clinical findings and prognosis of uveitis in Behçet disease.

Comparative Evaluation of Olopatadine 0.01% Combined Fluorometholone 0.1% Treatment Versus Olopatadine 0.01% Combined Ketorolac 0.4% Treatment in Patients with Acute Seasonal Allergic Conjunctivitis

Abstract Purpose: To evaluate the therapeutic effects of low-effective steroid fluorometholone 0.1% and non-steroidal anti-inflammatory ketorolac 0.4% when concomitantly used with olopatadine 0.01% in relieving clinical signs and symptoms of acute seasonal allergic conjunctivitis (SAC). Methods: In this randomized, placebo-controlled, multi-center study, 104 eyes of 52 patients with the diagnosis of SAC were conducted. The patients were assigned into two groups to receive either olopatadine and fluorometholone one eye and placebo in the contralateral eye or olopatadine and ketorolac one eye and placebo in the contralateral. The clinical signs (chemosis, mucus secretion, eyelid edema) and symptoms (itching, redness, tearing, burning) of the patients were evaluated by summing up the scores using a 3-point scale. Results were analyzed by Mann-Whitney U test, p values less than 0.05 were defined as significant. Results: All parameters were improved less amount on the first day of the treatment in both groups, however, significant reduction in clinical signs and symptoms were seen on the 10th day compared with those receiving placebo. Fluorometholone was found superior to ketorolac in reducing redness, mucus secretion, chemosis and eyelid edema (p = 0.032 for redness, p = 0.028 for mucus secretion, p = 0.030 for chemosis, p = 0.042 for eyelid edema) and both drugs were similar in alleviating the symptoms itching, burning and tearing (p = 0.074 for itching, p = 0.064 for burning, p = 0.072 for tearing). Conclusions: Fluorometholone was better than ketorolac in relieving redness, chemosis, mucus secretion and eyelid edema when concomitantly used with olopatadine, however, these two drugs were found equal in attenuating the symptoms itching, burning and tearing.

Unilateral Acute Dacryocystitis Associated with Oculoglandular Tularemia: A Case Report

ABSTRACT Purpose: To describe an unusual case of oculoglandular tularemia associated with unilateral acute dacryocystitis and purulent conjunctivitis with 18 weeks pregnancy. Methods: It is difficult to culture francisella tularensis on media so serological tests such as micro-agglutination methods are used to diagnose the infection. PCR test results were weak positive. The serum sample was analyzed for the presence of f. tularensis antibody, which was determined positive with a titer of 1/160. Results: Oral amoksicilin–clavulonic acid treatment was applied to the patient because of the side-effects of other antibiotics on the fetus. Dacryocystitis was surgically drained but relapsed a few weeks later, so it was drained again and a ciprofloksasin-impregnated sponge was placed into the tissue defect that occured after drainage. No relapses were seen after recovery of dacryocystitis. Conclusions: Oculoglandular tularemia is not only suspected in cases who complain of fever, cervical lymphadenopathy and purulent conjunctivitis, it should also be suspected in cases who are admitted to the hospital with acute dacryocystitis, which is a rare component of oculoglandular syndrome.

Thiol/Disulfide Homeostasis in Patients with Central Serous Chorioretinopathy

ABSTRACT Purpose: To evaluate dynamic thiol/disulfide homeostasis in patients with chronic central serous chorioretinopathy (cCSC). Methods: This prospective study included 34 cCSC cases and 37 healthy individuals who were age- and sex-matched. A new colorimetric method for measuring thiol/disulfide homeostasis was used. Native thiol, total thiol/disulfide levels, disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were measured. Results: The age and gender distributions were similar in both main groups. The mean duration of disease was 47.29 ± 24 months. Native and total thiol levels were significantly lower among the cCSC group relative to the control group (p < 0.001). There was not a statistically significant difference between the cCSC and the control group in terms of disulfide levels (p = 0.492). While disulfide/native thiol and disulfide/total thiol ratios were elevated, the native thiol/total thiol ratio was decreased in the cCSC group (p = 0.017, 0.021, 0.036, respectively). Ratios obtained using plasma native thiol, total thiol, and disulfide levels differed significantly between the both groups. Conclusion: Disulfide/thiol ratio was significantly greater in cCSC patients relative to healthy control subjects. Our results suggest that the oxidative process is involved in the pathogenesis of the cCSC.

An uncommon ocular manifestation of Sweet syndrome: peripheral ulcerative keratitis and nodular scleritis

Sweet syndrome (acute febrile neutrophilic dermatosis) is characterized by fever, neutrophilic leukocytosis, and abrupt appearance of painful erythematous nodules and plaques, particularly on the face, neck, and limbs. In this study, we report a very rare case of Sweet syndrome in which the patient presented nodular scleritis and peripheral ulcerative keratitis during the dermatologically inactive period of the disease.

Iatrogenic retinal breaks caused by infusion fluid during pars plana vitrectomy.

OBJECTIVE To describe a series of cases of iatrogenic retinal breaks (IRBs) caused by the infusion fluid flow of a 25-gauge pars plana vitrectomy (PPV) system. DESIGN Retrospective case series. METHODS During 25-gauge PPV, 4 cases had IRBs caused by infusion fluid flow. The IRBs rapidly progressed to localized retinal detachment. RESULTS The first 3 cases had IRBs on the nasal quadrant midperiphery of the retina. The IRBs were treated with laser retinopexy and tamponade during surgery. Case 4 had a macular hole and macular detachment during scleral indentation. The IRBs seemed to be caused by intraocular pressure (IOP) control mechanisms of the vitrectomy device. CONCLUSIONS To prevent IRBs caused by infusion fluid flow, we recommend using an IOP control limit of 4 mL/min for 25-gauge vitrectomy, with valved cannulas. In addition, the surgeon must be cautious during scleral indentation and air-fluid exchange not to cause a rebound hypotonia.

Could Topical Minoxidil Cause Non-Arteritic Anterior Ischemic Optic Neuropathy?

Minoxidil hair formulation is commonly used for the treatment of male or female androgenic alopecia. Minoxidil is a Health Canada and US FDA-approved medication for hair loss in men and women. The drug is marketed as 2% and 5% topical solutions. This over-the-counter product is considered safe, but should be used with caution. Furthermore, minoxidil is an orally active vasodilator for treatment of severe hypertension. Typical side effects of minoxidil are faster heart rate, augmented heart function and stroke volume (which can be associated with reduced vascular resistance upon baroflex stimulus), retained sodium and water and abnormal hair growth. The most common adverse reactions of the topical formulation are limited to irritant and allergic contact dermatitis on the scalp. Herein, we report a non-arteritic anterior ischemic optic neuropathy caused by topical 5% minoxidil treatment that was resolved after discontinuation of minoxidil.

Effect of cataract surgery on subfoveal choroidal and ganglion cell complex thicknesses measured by enhanced depth imaging optical coherence tomography

Purpose We aimed to evaluate the effect of cataract surgery on subfoveal choroidal thickness (CT) and ganglion cell complex (GCC) thickness, as measured by enhanced depth imaging-optical coherence tomography (OCT). Methods This prospective study included 30 eyes of 30 patients who had undergone uneventful phacoemulsification surgery for senile cataract but had no previous ocular surgery or other ocular abnormality. Best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure, axial length, and central corneal thickness were measured preoperatively. The operative times (OTs) and effective phaco times were also recorded in each case. OCT measurements were performed at the preoperative visit and 1 month after cataract surgery. Study of CT and GCC thickness changes was the primary objective, but central macular thickness (CMT) and peripapillary retinal nerve fiber layer (RNFL) thicknesses were also obtained by OCT. Results The mean subfoveal CT was 294.4±39.2 μm preoperatively and 301.4±39.9 μm postoperatively (P<0.001). The mean GCC thickness was 85.0±4.4 μm preoperatively and 89.2±5.3 μm postoperatively (P<0.001). The mean CMT was 247.9±17.6 μm preoperatively and 249.0±17.8 μm postoperatively (P=0.029). The mean RNFL thickness was 97.4±5.4 μm preoperatively and 101.7±5.6 μm postoperatively (P<0.001). Regression analysis showed that age, sex, axial length, central corneal thickness, operative time, and effective phaco time were not associated with CT changes (P=0.834, P=0.129, P=0.203, P=0.343, P=0.547, and P=0.147, respectively) and GCC thickness changes (P=0.645, P=0.542, P=0.152, P=0.664, P=0.448, and P=0.268, respectively) after cataract surgery. Conclusion Our results indicate that all subfoveal CT, CMT, as well as RNFL and GCC thicknesses are slightly affected after uneventful phacoemulsification surgery. After cataract surgery, the examiners should consider obtaining new baseline measurements.