Eylem Yaman Pinarci

The effect of smoking on choroidal thickness measured by optical coherence tomography

Background/aims To investigate the effect of smoking on choroidal thickness using Fourier domain optical coherence tomography. Methods 17 otherwise healthy smokers (study group) and 17 non-smokers (control group) were enrolled. In the study group, all participants underwent optical coherence tomography scanning at baseline, and 1 and 3 h following smoking one standard cigarette. Also the participants of the control group underwent optical coherence tomography scanning in the morning which was followed by two further examinations at the first and third hours, respectively. Choroidal thickness measurements were performed. Results The mean choroidal thickness at the fovea prior to smoking was 301.1±63.1 μm, which decreased to 284.2±56.7 μm at 1 h and 270.8±80.0 μm at 3 h following smoking (p=0.001). The mean choroidal thickness was significantly decreased following smoking at all five extrafoveal points. The difference in choroidal thickness was not statistically significant at 1 and 3 h of smoking at all six points. In the control group, the mean baseline choroidal thickness at the fovea was 270.6±57.9 μm, which was 272.5±52.4 μm at 1 h and 273.8±57.4 μm at 3 h (p=0.816). Conclusions Cigarette smoking causes a significant decrease in choroidal thickness following smoking. Fourier domain optical coherence tomography can effectively demonstrate choroidal thickness.

In vivo inhibition of l-buthionine-(S,R)-sulfoximine-induced cataracts by a novel antioxidant, N-acetylcysteine amide

The effects of N-acetylcysteine amide (NACA), a free radical scavenger, on cataract development were evaluated in Wistar rat pups. Cataract formation was induced in these animals with an intraperitoneal injection of a glutathione (GSH) synthesis inhibitor, l-buthionine-(S,R)-sulfoximine (BSO). To assess whether NACA has a significant impact on BSO-induced cataracts, the rats were divided into four groups: (1) control, (2) BSO only, (3) NACA only, and (4) NACA+BSO. The control group received only saline ip injections on postpartum day 3, the BSO-only group was given ip injections of BSO (4mmol/kg body wt), the NACA-only group received ip injections of only NACA (250mg/kg body wt), and the NACA+BSO group was given a dose of NACA 30min before administration of the BSO injection. The pups were sacrificed on postpartum day 15, after examination under a slit-lamp microscope. Their lenses were analyzed for selective oxidative stress parameters, including glutathione (reduced and oxidized), protein carbonyls, catalase, glutathione peroxidase, glutathione reductase, and malondialdehyde. The lenses of pups in both the control and the NACA-only groups were clear, whereas all pups within the BSO-only group developed well-defined cataracts. It was found that supplemental NACA injections during BSO treatment prevented cataract formation in most of the rat pups in the NACA+BSO group. Only 20% of these pups developed cataracts, and the rest retained clear lenses. Further, GSH levels were significantly decreased in the BSO-only treated group, but rats that received NACA injections during BSO treatment had these levels of GSH replenished. Our findings indicate that NACA inhibits cataract formation by limiting protein carbonylation, lipid peroxidation, and redox system components, as well as replenishing antioxidant enzymes.

Retinal and choroidal thickness changes after single anti-VEGF injection in neovascular age-related macular degeneration: ranibizumab vs bevacizumab

Purpose To evaluate and compare the effects of single intravitreal injection of ranibizumab and bevacizumab on central retinal and choroidal thickness in patients with neovascular age-related macular degeneration (AMD). Methods Forty eyes of 40 patients with neovascular AMD that underwent intravitreal injection of vascular endothelial growth factor inhibitors (anti-VEGFs) were included. Patients were randomized into 2 groups: 20 eyes received ranibizumab and 20 eyes received bevacizumab injection. Central retinal and choroidal thicknesses of all eyes at baseline and 1 month postinjection scans were measured with Fourier-domain optical coherence tomography (OCT). Student t test and Mann-Whitney U test were used to compare the data. Results The mean central retinal thickness (CRT) showed significant decrease after single injection of ranibizumab (from 345.0 μm to 253.5 μm, p<0.01) and bevacizumab (from 329.5 μm to 251.0 μm, p<0.01) at the first month, respectively. There was no significant difference regarding the CRT change between groups (p = 0.39). The mean choroidal thickness decreased from 158.6 μm (115-317) to 155.5 μm (111-322) in the ranibizumab group and from 211.5 μm (143-284) to 201.5 μm (93-338) in bevacizumab group. The decrease was not significant between groups (p = 0.35). Conclusions Intravitreal injection of both ranibizumab and bevacizumab provided a significant decrease in CRT; however, the agents caused no significant change in choroidal thickness. Additionally, no difference between ranibizumab versus bevacizumab was observed related to macular edema inhibition.

Diurnal variation of the tear osmolarity in normal subjects measured by a new microchip system

Purpose To show the diurnal variation of tear osmolarity in normal subjects. Methods Thirty volunteers were recruited. Tear osmolarity was measured with TearLab osmolarity system at 3-hour regular intervals between 8:00 AM and 5:00 PM. One-way analysis of variance test was used for statistical analysis. Results Thirty healthy volunteers (all men) with a mean age of 29.6±4.3 years (range 18-45) were recruited. The difference between measurements at 8:00 AM and 11:00 AM, 8:00 AM and 2:00 PM, 8:00 AM and 5:00 PM, 11:00 AM and 2:00 PM, 11:00 AM and 5:00 PM, and 2:00 PM and 5:00 PM were not statistically significant (one-way analysis of variance test, p>0.05). Conclusions In normal subjects, tear osmolarity seems to have a stable profile during the daytime.

The use of a supplemental sulcus fixated IOL (HumanOptics Add-On IOL) to correct pseudophakic refractive errors:

Purpose. To evaluate the safety and efficacy of piggybacking with the HumanOptics Add-On intraocular lens (IOL) to correct pseudophakic refractive errors. Materials and Methods. Ten eyes of 10 patients with pseudophakic refractive errors were included in this study. All patients were targeted for a range of refraction −0.50 to +0.50 D. Uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively), endothelial cell count (ECC), anterior chamber depth (ACD), the distance between intraocular lenses, and contrast sensitivity measurements under mesopic, scotopic, and scotopic with glare conditions were evaluated preoperatively and postoperatively. Results. The mean age of the patients was 54±27 years (range 4-78). Mean follow-up time was 10.5±1.36 months (range 6-15 months). Mean diopters of implanted Add-On IOLs were −1.4±6.9 (range −12 to +9 D). Mean preoperative and postoperative UDVA was 0.133±0.12 and 0.73±0.27, respectively (p=0.0001); mean preoperative and postoperative CDVA were 0.77±0.26 and 0.79±0.27, respectively (p=0.066). Mean preoperative and postoperative ACD were 3.87±0.91 mm vs 3.58±1.05 mm, respectively (p=0.343); mean inter-IOL distance was 0.53±0.08 mm. Mean preoperative and postoperative ECC were 2455±302 and 2426±294, respectively (p=0.55). All patients were within the targeted refractive range of −0.50 D to +0.50 D. No complications were observed during the operations or postoperative follow-up period. Conclusions Piggybacking with the Add-On IOL is a safe, efficient, and reliable technique to correct pseudophakic refractive errors.

Late capsular block syndrome presenting with posterior capsule opacification

PURPOSE: To assess the results of posterior neodymium:YAG (Nd:YAG) laser capsulotomy in patients with late postoperative capsular block syndrome (CBS) with decreased vision because of posterior capsule opacification (PCO). SETTING: Baskent University Hospital, Department of Ophthalmology, Ankara, Turkey. DESIGN: Case‐control study. METHODS: Patients with CBS who had phacoemulsification and foldable hydrophilic or hydrophobic acrylic intraocular lens implantation with continuous curvilinear capsulorhexis were retrospectively reviewed. Transparent to slight milky fluid had collected in the capsular bag. Capsular block syndrome was undiagnosed before the PCO developed. The CBS was treated with Nd:YAG laser capsulotomy, after which the change in refraction, corrected distance visual acuity (CDVA), intraocular pressure (IOP), complications, and inflammation rate were evaluated. Follow‐up examinations were at 1 day, 1 week, and 1 and 6 months. RESULTS: The mean time between cataract surgery and laser capsulotomy was 48 months ± 10.27 (SD) (range 28 to 66 months). The Nd:YAG capsulotomy was successful in all eyes. Capsulotomy did not change the refraction in 14 eyes (93.3%). One patient (6.6%) had a change of +0.75 diopter. After capsulotomy, the logMAR CDVA improved in 13 cases (mean 0.26 ± 0.18; range 0.0 to 0.7) and did not change in 2 cases. There were no complications, inflammation, or significant IOP changes. CONCLUSIONS: Neodymium:YAG laser capsulotomy in patients with PCO associated with late CBS increased visual acuity without a significant change in refraction or IOP. Capsular block syndrome may be asymptomatic and remain undiagnosed for a long time after cataract surgery before PCO develops. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Anterior segment complications after phacovitrectomy in diabetic and nondiabetic patients

Purpose. To evaluate early and late postoperative anterior segment complications of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with cataract and coexisting vitreoretinal disease in diabetic and nondiabetic patients. Setting. Department of Ophthalmology, Baskent University Hospital, Ankara, Turkey. Methods. The records of 189 consecutive patients with cataract and posterior segment pathology necessitating phacovitrectomy were retrospectively analyzed. Patient profile, indications for surgery, preoperative findings, intraoperative and postoperative course, and postoperative outcome were evaluated. Phacoemulsification was performed through a clear corneal incision with IOL implantation prior to 23-G pars plana vitrectomy. Results. There were 97 (51.3%) diabetic and 92 (48.6%) nondiabetic patients. The most common indications for surgery were vitreous hemorrhage (57; 58.7%), tractional detachment (35; 36%), and premacular hemorrhage (5; 5.1%) in diabetic patients, and rhegmatogenous retinal detachment (40; 43.4%), macular hole (22; 23.9%), epiretinal membrane (20; 21.7%), and vitreomacular traction (10; 10.8%) in nondiabetic patients. Early (within 4 weeks) postoperative complications included elevation of intraocular pressure, fibrinous uveitis, corneal edema, and development of posterior synechia. Long-term (after 4 weeks) complications included migration of silicone oil into the anterior chamber, posterior capsule opacification, and decentered IOL. The ratio of fibrinous uveitis, posterior synechia, and posterior capsule opacification was found higher in the diabetic group (all p<0.05). Conclusions. Combined vitreoretinal surgery and phacoemulsification is safe and effective in treating vitreoretinal abnormalities coexisting with cataract in diabetic and nondiabetic patients. Diabetic patients should be monitored more carefully for fibrinous uveitis and posterior synechia in the early postoperative period and for posterior capsular opacification in the late postoperative period.

An outbreak of Fusarium solani endophthalmitis after cataract surgery in an eye training and research hospital in Istanbul

To report an outbreak of Fusarium solani endophthalmitis after uneventful cataract surgeries performed on the same day in the same operating room. Nine patients underwent phacoemulsification at 4th Clinic of Beyoglu Eye Training and Research Hospital in Istanbul. Cefuroxime axetyl was injected intracamerally from the same vial to all patients at the end of surgery. All patients developed acute postoperative endophthalmitis. Presentation, cultural studies, treatment, clinical responses and risk factors were evaluated. Cultural and DNA sequence findings revealed F. solani. Antifungal therapy was begun and pars plana vitrectomy, intraocular lens and capsule extraction were performed. Corneal involvement was correlated with old age and systemic disease. Fusarium solani should be considered in acute postoperative endophthalmitis. This infection can be controlled with early and aggressive combined antifungal and surgical treatment. The patients with corneal involvement had poor prognosis. It is important to use solutions prepared separately for each patient.

Tear osmolarity in unilateral pseudoexfoliation syndrome.

Purpose:  The aim was to evaluate tear osmolarity of patients with clinically unilateral pseudoexfoliation (PEX) syndrome and to compare the values with otherwise normal subjects.

An uncommon case with intravitreal worm

A 51-year-old woman who lives in northeastern Turkey presented with diminished vision in the right eye with a 1-year duration. On examination, best corrected visual acuity was 2/10 in the right eye and 10/10 in the left eye. The slit-lamp examination of the anterior segment revealed no significant findings in either eye. Intraocular pressure was within normal limits. Ophthalmoscopic examination disclosed a slender motile parasite held on the Weiss ring and old multiple chorioretinitis foci in …