Hande Celiker

The choroid and lamina cribrosa is affected in patients with Parkinson's disease: enhanced depth imaging optical coherence tomography study

To compare lamina cribrosa (LC) and choroidal thicknesses using enhanced depth imaging optical coherence tomography (EDI‐OCT) in patients with Parkinsons disease (PD) and healthy controls.

Screening for Retinopathy of Prematurity in a Tertiary Ophthalmology Department in Turkey: Incidence, Outcomes, and Risk Factors

BACKGROUND AND OBJECTIVE The aim of this study is to determine the incidence of retinopathy of prematurity (ROP), the number of preterm infants requiring treatment for ROP, and the factors influencing the development of ROP requiring treatment in a Turkish population. PATIENTS AND METHODS Data on 1,252 infants who were screened for ROP in an ophthalmology department were retrospectively reviewed. Infants with a gestational age (GA) of no more than 28 weeks (n = 157) were designated group 1, those between 29 and 32 weeks (n = 572) were assigned to group 2, and those between 33 and 37 weeks (n = 523) were assigned to group 3. RESULTS In group 1, ROP was detected in 70.0% of infants, 17.8% of whom required therapy. In group 2, ROP was detected in 41.4%, and 4.0% of those required therapy. In group 3, 18.1% were diagnosed with ROP, with 0.8% requiring treatment. CONCLUSION Retinopathy of prematurity occurs, even among more mature infants, at a frequency that merits astute screening within parameters that reflect socioeconomic differences that appear to have an effect on the incidence.

A Comparison of Topical or Retrobulbar Anesthesia for 23-Gauge Posterior Vitrectomy

Background. To compare the efficacy and safety of topical anesthesia versus retrobulbar anesthesia in 23-gauge vitreoretinal surgery. Materials and Methods. A total of 63 patients scheduled for 23 G posterior vitrectomy without scleral buckling procedures were included in the study. The patients were randomly assigned to receive either topical (Group 1, n = 31) or retrobulbar anesthesia (Group 2, n = 32). Postoperatively, patients were shown a visual analogue pain scale (VAPS) from 1 (no pain or discomfort) to 4 (severe pain or discomfort) to rate the levels of pain. Results. There was more discomfort in patients in Group 2 while anesthetic was administered (Group 1:  1.0 ± 0, Group 2: 2.3 ± 0.7, P = 0.0001). Between the two groups the level of pain during surgery (Group 1: 1.4 ± 0.5, Group 2: 1.5 ± 0.5; P = 0.85) was noted. There was also no significant difference between two groups postoperatively (Group 1: 1.2 ± 0.4, Group 2: 1.3 ± 0.4; P = 0.28). There were no complications in either group related to the anesthetic technique. No patient needed sedation or anesthesia supplement during the surgery or postoperative period. Conclusion. Topical anesthesia in posterior vitrectomy procedures is an effective and safe method that is alternative to retrobulbar anesthesia.

NEUROPROTECTIVE EFFECTS OF MEMANTINE IN THE RETINA OF GLAUCOMATOUS RATS: AN ELECTRON MICROSCOPIC STUDY

Purpose: In this experimental study, the effects of systemic memantine administration on the retinal ultrastructure of experimentally induced glaucomatous rats were investigated. Methods: Twenty-four Wistar albino rats were included in this study. Glaucoma was induced by injecting sodium hyaluronate into the anterior chamber of the rats for a period of three weeks. As a control, 8 rats were sham treated (Group C). Glaucoma induced animals were divided into two groups; Group M (n = 8) received a single daily dose of 10 mg/kg memantine, and Group G received the same volume of saline (n = 8), via intraperitoneal route for a period of six weeks, starting with the induction of glaucoma. Then, all rats were sacrificed and the retinas were prepared for electron microscopic examination. Electron microscopic damage findings were graded between 0 and 4 and mean damage scores for each cell or layer was calculated for each group. Statistical comparison was made between group G and group M. Results: Including the photoreceptor cells, marked ultrastructural changes were observed in the retinas of the animals in group G. The ultrastructural changes in group M were modest and there was no significant cell death. Statistical findings indicated these results. Conclusion: Results of the present study suggest that memantine treatment, when started in the early phase of glaucomatous process, may help to preserve the retinal ultrastructure and thus prevent neuronal injury in experimentally induced glaucoma.

Cytomegalovirus Retinitis in an ALL Child during Maintenance Therapy Treated Successfully with Intravenous Ganciclovir

Purpose. In here we described cytomegalovirus retinitis (CMVR) in 12-year-old male patient with acute lymphoblastic leukemia (ALL) who was on maintenance phase therapy. Methods. He was referred to our clinic for seeing of spots with the right eye for 3 days. At presentation, his best corrected visual acuity was 20/20 in the right eye and 20/20 in the left eye. Slit-lamp biomicroscopic examination of the anterior chamber of the left eye was within normal limits, whereas we observed 3+ anterior chamber cellular reaction in the right eye. On retinal examination, we found active retinitis lesions (cream-colored lesions associated with hemorrhages) and perivascular cuffing in the retinal periphery in the right eye. Left eye was normal. Results. On the basis of clinical picture, we made the diagnosis of CMVR in the right eye. Vitreous aspiration was performed and 23096 copies/mL of CMV DNA was detected by polymerase chain reaction (PCR) technique. The patient was successfully treated with intravenous ganciclovir for two weeks and discharged with oral valganciclovir prophylaxis. Conclusion. CMVR should be in mind in children with ALL on maintenance phase therapy even in those without hematopoietic stem cell transplantation. These patients can be treated successfully by intravenous ganciclovir alone.

Decreased subfoveal choroidal thickness and failure of emmetropisation in patients with oculocutaneous albinism

Purpose The purpose of this work was to describe the choroidal structure in patients with oculocutaneous albinism (OCA). Methods 20 eyes of 10 patients with OCA and 14 eyes of 7 healthy controls were recruited for the study. Enhanced depth imaging optical coherence tomography (OCT) images of the subjects were taken. The choroidal thickness (CT) was measured from the outer boarder of the retinal pigment epithelium to the inner boarder of sclera at 500 µm intervals of a horizontal section from the optic disc. Statistical analysis was performed to evaluate variations in CT at subfoveal and peripapillary areas. Results In the fundoscopic examination and OCT imaging, the foveal light reflex was absent and the foveal pit could not be observed in all of the patients with OCA. The mean subfoveal CT of the patients with OCA was significantly thinner (242±56 µm) compared with healthy controls (349±70 µm) (p<0.001); while there was no statistically significant difference in the peripapillary CTs of the patients with OCA and controls (157±42 µm vs 151±31 µm respectively, p=0.77), indicating a localised abnormality of choroidal anatomy. Conclusions This study for the first time demonstrated that CT is decreased in patients with OCA at the subfoveal region. These data combined with the underdevelopment of the foveal pit indicate that there is a generalised developmental or genetic abnormality in the posterior pole of patients with OCA. This choroidal structural abnormality might be related to the previously reported failure of emmetropisation in these children. Further research is needed to understand choroidal metabolism and its relationship with these anatomical changes in albinism.

Factors Affecting Relapse and Remission in Behçet's Uveitis Treated with Interferon Alpha2a

PURPOSE To investigate factors affecting relapse and remission in patients with Behçet uveitis (BU) in the context of using the interferon alpha2a (IFNα2a) therapy. METHODS Clinical records were reviewed of 32 patients (totaling 54 eyes) presenting with severe BU who had been treated with IFNα2a therapy. Factors influencing relapsing-remitting course of BU during IFNα2a therapy and after the cessation of the agent were evaluated. Possible affecting factors of recurrence were age, gender, duration of the Behçet disease, time elapsed before starting the drug, number of relapses before the starting of IFNα2a, laterality, and presence of panuveitis. RESULTS Thirty patients (93.7%) responded to IFNα2a therapy. Annual attack rate before and after IFNα2a treatment was determined to be 4.03 ± 3.19 (attack per year) and 0.58 ± 1.07, respectively (P < 0.001). In univariable statistical evaluation, women tended to have a lower relapse risk than men. Multivariable analyses showed that age was the major factor determining relapse rate, while the effect of gender was not statistically significant (P = 0.196). The other probable influencing factors were not found to be statistically significant (P > 0.05). Increase in visual acuity observed during last examination compared to initial examination was determined to be statistically significant (P = 0.018). CONCLUSIONS Even if the female gender was evaluated as a good prognostic factor in univariable analyses, it was not assessed as an effective prognostic factor in multivariable analyses. Being aged may be regarded a good prognostic factor on the relapsing-remitting course of patients with BU who were treated with IFNα2a therapy.

Ocular culture-proven endogenous endophthalmitis: a 5-year retrospective study of the microorganism spectrum at a tertiary referral center in Turkey

PurposeThe aim of this study was to review the clinical profile of endogenous endophthalmitis (EE), including predisposing systemic conditions, responsible microorganisms, clinical presentations, and outcomes.MethodsWe reviewed data from 21 eyes of 15 patients diagnosed with EE and compared their clinical characteristics over a 5-year period. All patients were ocular fluid cultures proven. Generalized estimating equations (GEE) were used to analyze the effects of vitrectomy, diabetes, malignity, and clinical presentation condition on VA.ResultsDiabetes was the most common illness of EE patients (40.0%). In this geographical region, Pseudomonas aeruginosa (4.8%), Methicillin-sensitive Staphylococcus aureus (4.8%), Methicillin-resistant Staphylococcus aureus (4.8%), and Mycobacterium tuberculosis (4.8%) were identified as causative bacterial microorganisms (n = 5) in patients with EE, and Candida Species (71.4%) and Aspergillus (4.8%) were identified as causative fungal microorganisms (n = 16) in patients with EE in the vitreous specimens. Fungemia (76.2%) (especially yeasts) was the most common extraocular infection source among patients with EE. Fourteen eyes (66.7%) were managed with intravitreal injections of antimicrobial medicines, and seven eyes (33.3%) also underwent vitrectomy. GEE models revealed that logMAR final VA values were found as lower than initial VA assessments.ConclusionDepending on the different regions of the world, the characteristics of disease have been declared invariable. This study provides information about the clinical and microbiological profile of ocular culture-proven EE patients in a region of straddling the Asia and European continents. Aggressive medical and surgical treatment may result in favorable outcomes.

Conventional immunosuppressive therapy in severe Behcet’s Uveitis: the switch rate to the biological agents

BackgroundTo report the switch rate of conventional immunosuppressive (CIS) therapies to the biological agents (BA) in patients with refractory Behcet’s uveitis (BU).MethodsIn this retrospective study, clinical records were reviewed of 76 patients’ 116 eyes presenting with BU who had been treated with immunosuppressive drug therapy. Mann Whitney U test was used for the intergroup comparisons of parameters without normal distribution as well as calculation of descriptive statistical methods (mean, standard deviation, median, frequency and rate). Wilcoxon Signed Ranks test was used for the intragroup comparisons of parameters without normal distribution. Pearson’s Chi-Square test and Fisher-Freeman-Halton test were used for the comparisons of qualitative data.ResultsExcept for one, all patients were first treated with CIS regimens for BU. Thirty-one patients (41.3%) who were unresponsive to CIS regimens were switched to IFNα2a therapy. After that, eight of these cases were switched to the anti-TNF-α treatments. The presence of initial ocular complications were found to be statistically higher in BA treated patients than the CIS treated cases (p < 0.001). Both in CIS treated and in BA treated cases, an increase in visual acuity (VA) was observed during the last examination compared to the initial examination and was significant (p < 0.001 and p = 0.018, respectively).ConclusionsCIS treatment was found to be effective and safe, as suggested in the management guidelines for severe BU. Biological therapy was also found effective for the improvement of the VA. We observed that 58.7% of cases could be treated with strong immunosuppressive therapies, however, nearly half of the patients could have lost their VA if BAs were not existent. During the treatment course of severe cases with BU, classical therapy stage must still be protected as the first-line therapy due to the their reasonable activity and safety.

Long-Term Efficacy of Pegylated Interferon Alpha-2b in Behçet’s Uveitis: A Small Case Series

ABSTRACT Purpose: To assess the long-term efficacy and safety of pegylated interferon alpha-2b (peg-IFN-α-2b) for severe uveitis associated with Behçet’s disease. Methods: Peg-IFN-α-2b was administrated at an initial dosage of 0,5–1,5 µg/kg/week. If any complications were observed, the dosage was tapered. Ocular examinations, systemic findings, and treatment compliance of the patients were evaluated. Results: Control of ocular inflammation was achieved in all patients (n = 4). The average increase in visual acuity after drug administration of 0,425 ± 0,125 logMAR was not statistically significant (Wilcoxon Test, p = 0,066) due to small number of cases. Any side-effects with laboratory abnormalities returned to baseline levels with reduction of the doses. Due to less frequent injections, increased satisfaction of the patients was noted. Conclusions: This series highlights the peg-IFN-α-2b administration in Behçet’s uveitis. Peg-IFN-α-2b has a potential long-term therapeutic effect for the treatment of severe uveitis. Efficacy with a reduced number of injections improved the quality of Behçet patients’ lives.