Erdal Kaydu

Cyclosporine a 0.05% eye drops for the treatment of subepithelial infiltrates after epidemic keratoconjunctivitis.

BackgroundTo evaluate the treatment with topical 0.05% cyclosporine A (CsA) in patients with subepithelial corneal infiltrates (SEI).MethodsWe reviewed 16 patients (22 eyes) before and after the treatment with 0.05% CsA eye drops. All patients had been treated previously with topical corticosteroids without any improvement and also they had to stop the medication secondary to intraocular pressure elevation. The objective data recorded included best-corrected visual acuity (BCVA), evaluation of corneal subepithelial infiltrate scores (CSIS), intraocular pressure (IOP) prior to treatment and the last follow-up visit.ResultsSix males (37.5%) and 10 females (62.5%), mean age of 35.2 ± 16.6 years, were included. The patients’ average topical CsA use duration was 5.1 ± 3.5 months (1 – 13 months). The average follow up time of the patients was 9.2 ± 4.7 months (4 – 22 months). One patient, although he didn’t have a 0 scale of SCIS, did not show up for follow up examinations after six months. The mean BCVA (logarithm of the minimum angle of resolution) before and after the treatment were 0.15 ± 0.15 and 0.07 ± 0.07 respectively, CSIS 1.68 ± 0.89 and 0.23 ± 0.53 respectively, IOP 18.50 ± 3.82 and 16.86 ± 2.76 mmHg respectively. There were statistically significant improvements in BCVA (p = 0.002), reduction of CSIS (p = 0.002) and reduction of IOP (p < 0.001) prior to treatment and the last follow-up visit. 18 eyes (81.9%) showed clinical improvement and 4 (18.1%) had decreased SEI which did not fully disappear during the treatment period. The eyes which reached CSIS score 0 (18 eyes) were treated with CsA for 1 – 13 months; while the eyes which had clinical improvement but had not CSIS score 0 (4 eyes) were decided to discontinue of CsA treatment in last follow-up visit. There were recurrences in 2 eyes 3 months after the treatment. Patients reported reduction in the severity of symptoms after the treatment. Most of the patients reported no foreign body sensation, glare, or other side effects with topical CsA treatment. Overall, patients noted an improvement in vision and satisfaction with topical 0.05% CsA treatment.ConclusionsTopical 0.05% CsA is a safe and effective alternative treatment in patients with SEI who do not respond to other treatment modalities or have undesired side effects from topical steroids.

Botulinum toxin injections for blepharospasm prior to ocular surgeries.

Purpose The aim of this study was to show the efficiency of preoperative botulinum toxin A (Botox A) in patients with benign essential blepharospasm who were to undergo ocular surgery with local anesthesia. Materials and methods Twenty-eight benign essential blepharospasm patients who were administered unilateral Botox A prior to ocular surgery between January 2004 and May 2011 were included in this study. Eleven cases had pterygiums, ten had cataracts, and four had glaucomas, while the remaining three had aphakia. All cases’ severity of spasm (stage 0–4) and eyelid closing forces (stage 1–4) were evaluated according to the Jankovic scale prior to the injection, at 3 days, 14 days, 1 month, and 3 months after Botox A injection. Results Of the patients enrolled in the study, 16 were female and 12 were male, with an average age of 55.52 ± 1.53 years (52–65). Average onset of the Botox injection’s effect was 2.8 ± 0.9 (2–5) days. Its effect lingered for about 11.5 ± 3.6 (8–22) weeks. The severity of spasm and eyelid closing forces of all the patients enrolled were compared prior to the injection at 3 and 14 days and the first and third months after the injection. There were statistically significant differences between prior to the injection and 3 days (P = 0.001), 14 days (P < 0.001) and 1 month after the injection (P < 0.001). There was no statistically significant difference between prior to the injection and 3 months after the injection (P = 0.513). Fourteen days following the injection, the surgeries were successfully performed. Conclusion Botox A administered prior to ocular surgery will control both blepharospasm and lower the risks that can be encountered before and during surgery, thus increasing the comfort of the patient and the surgeon.

Toward Novel Diagnostics for Primary Open-Angle Glaucoma? An Association Study of Polymorphic Variation in Ras Homolog Family Member (A, B, C, D) Genes RHOA, RHOB, RHOC, and RHOD

The annual economic burden of visual disorders in the United States was estimated as

The Results of Cross-Linking With Riboflavin/UV-A in Patients With Progressive Keratoconus

139 billion. The World Health Organization has listed glaucoma in the top 10 priority eye diseases. Primary open-angle glaucoma (POAG) is a common subtype, with a lack of clinical tools for early diagnosis. The Rho GTPases belong to the Ras superfamily of proteins; the RhoA immunostaining in the optic nerve head in human glaucoma is reportedly increased. We investigated the association of polymorphisms in the Ras Homolog Family Member A, B, C, and D genes (RHOA, RHOB, RHOC, and RHOD, respectively). In a total sample of 361 unrelated subjects (179 patients with POAG and 182 age- and sex-matched healthy controls), RHOA (rs6784820, rs974495), RHOB (rs62121967), RHOC (rs11102522), and RHOD (rs61891303, rs2282502) polymorphisms were characterized by the BioMark HD dynamic array system with real-time polymerarse chain reaction. Among these candidate genetic markers and considering the Bonferroni correction, RHOA rs974495 polymorphism was significantly associated with POAG (p = 0.0011), with the TT genotype increasing the disease risk 4.9 times (95% CI 1.630-15.023). The allele and haplotype distributions of the above RHO candidate polymorphisms did not diplay a significant association. This is the first study, to the best of our knowledge, to identify a significant genotypic association between POAG and RHOA gene rs974495 polymorphism. These observations warrant replication in independent samples in the pursuit of precision medicine for rapid and early glaucoma diagnosis, and molecular targets for innovation in therapeutics of this common eye disease.

A case that developed orbital apex syndrome after strabismus surgery

Objective: To evaluate the results of corneal cross-linking with UV-A/riboflavin in patients with progressive keratoconus. Methods: Forty-seven eyes of 30 patients with progressive keratoconus (16 female, 14 male) were included in the study. Uncorrected and the best corrected distance visual acuities, biomicroscopic findings, intraocular pressure measurements, fundoscopic findings, pachymetric measurements and corneal topography parameters were recorded for each patient. Results: The mean age of the patients was 18.3±5.34 (range: 8-31) years and the mean follow-up duration was 7±2.4 (range: 3-12) months. Following the procedure, the mean decrease in K1, K2, Kav, spherical and cylindrical values were 0.77 D, 0.85 D, 0.80 D, 0.50 D and 0.74 D, respectively (p<0.05). There were no cases with decrease in visual acuity and significant complication during or after the treatment. Conclusion: Cross-linking with riboflavin/UV-A in patients with progressive keratoconus is an effective procedure. In addition, the preservation of visual acuity and not seen a significant complication indicate that a safe metod. However, large prospective randomized controlled studies are needed to evaluate the long-term effects of this treatment. Key words: corneal cross-linking, keratoconus, corneal topography

Choroidal thickness in healthy Turkish subjects

In our study, we present a case that developed orbital apex syndrome after strabismus surgery. Nineteen years old female patient referred to our clinic with a decrease of vision, ptosis, limitation of eye movements and pain on left eye that began 5 days ago. There was a strabismus surgery history about 4 months ago on left eye. With ophthalmologic examination, best corrected visual acuity was 10/10, intraocular pressure was 15 mmHg, eyelids, eye movements, anterior segment and fundus was normal on the right eye. On the left eye, best corrected visual acuity was 5/10, intraocular pressure was 23 mmHg. There was ptosis that close approximately 2/3 of pupil field. At the evaluation of extraocular muscle movements, there was limitation while looking up, down, in, and out. At the examination of the anterior segment, pupil was dilated; there was no direct and indirect light reflex. Fundus examination of left eye was normal. With remaining findings, we diagnosed the object as orbital apex syndrome and planned the treatment. Orbital apex syndrome after strabismus surgery has not been described yet. For this reason, this case report has been found worth to present.