Helin Deniz Demir

Aqueous humor erythropoietin levels in patients with primary open-angle glaucoma.

PurposeTo evaluate the levels of erythropoietin (EPO) in the aqueous humor in eyes with primary open-angle glaucoma (POAG) and without glaucoma. MethodsLevels of EPO were measured using a sandwich enzyme-linked immunosorbent assay kit in aqueous humor aspirates taken during anterior segment surgery from 45 patients, of whom 20 had POAG and 25 had senile cataract only. ResultsThe mean aqueous humor EPO concentration in eyes with POAG (10.91±4.32 mU/mL) was significantly higher than that from eyes with cataract (8.24±1.77 mU/mL, P=0.008). There was no significant difference between the serum EPO concentrations of POAG (26.46±10.36 mU/mL) and the control group (24.50±7.59 mU/mL, P=0.468). There was no correlation (P=0.165) between the EPO aqueous humor concentration and the EPO serum concentration while there was no correlation between the EPO aqueous humor concentration and the EPO serum concentration in the control group (P=0.819). ConclusionsThe aqueous humor EPO level is increased in eyes with POAG.

Association of Plasma Homocysteine and Macular Edema in Type 2 Diabetes Mellitus

Purpose The aim of this study was to assess the association of macular edema (ME) with plasma homocysteine, vitamin B6, vitamin B12, and folic acid levels in patients with Type 2 diabetes. Methods Sixty-five diabetic subjects with no retinopathy and nonproliferative diabetic retinopathy (NPDR) (no DR, without ME, with ME: 16, 25, 24, respectively), 28 with proliferative diabetic retinopathy (PDR) (with and without ME: 14, 14, respectively), and 19 healthy subjects as control were recruited in this cross-sectional study Plasma homocysteine, vitamin B12, vitamin B6, and folate levels were determined after 8-hour of fasting for all subjects. The levels of serum homocysteine and vitamin B6 were measured using high performance liquid chromatography (HPLC) with fluorescence detection, and the levels of serum vitamin B12 and folic acid were measured by electrochemiluminescence immunoassay. Results When diabetic groups with ME were compared with diabetic groups without ME for homocysteine, vitamin B12, vitamin B6, and folic acid, the only significant difference was detected in homocysteine levels (p=0.001). There was no significant difference between NPDR with ME group compared with NPDR without ME group and no DR group for plasma homocysteine, vitamin B12, vitamin B6, and folic acid (p=0.200, p=0.660; p=0.999, p=0.678; p=1.0, p=0.248; p=1.0, p=0.982, respectively). On the other hand, when PDR with ME group was compared with PDR without ME group, there was only significant difference in homocysteine levels (p=0.023). Conclusions Mild to moderate elevation of homocysteine may explain the role of vascular dysregulation and endothelial dysfunction in patients with DR. The present study suggests hyperhomocysteinemia may be one of the crucial risk factors for development of ME.

Serum alpha-1-antitriypsin levels in patients with pseudoexfolative syndrome.

Purpose: To evaluate the levels of serum α 1-antitrypsin in patients with pseudoexfoliation syndrome (PEX) and healthy control subjects without PEX. Material and Methods: Forty-four patient with PEX and 40 healthy control subjects (84 subjects total) were enrolled into the study. Serum ATT levels were measured using nephelometry. Results: The mean serum AAT concentration in PEX group was significantly higher than in the controls (p = 0.0001). Conclusion: Serum AAT levels were found to be increased in patients with PEX. Increased serum AAT levels in PEX may explain the role of inflammation in this group of patients.

Plasma and aqueous humor angiotensin-converting enzyme levels in patients with diabetic retinopathy.

Purpose: To assess angiotensin-converting enzyme (ACE) levels in aqueous humor and plasma of patients with nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) as another potent ischemia-induced angiogenic factor. Methods: The clinical comparative study included 40 patients with diabetic retinopathy and 16 healthy subjects. For all patients, aqueous humors were collected during the cataract surgery or intravitreal injection of triamcinolone acetonide. ACE levels were measured using a solid-phase chemiluminescence immunoassay. Results: We observed significantly elevated ACE level in aqueous humor of patients with PDR compared with the patients with NPDR and normal subjects (P = 0.023), but no significant difference was detected between nonproliferative diabetics and control group (P = 0.239). There was no significant difference in plasma ACE levels among diabetic and control groups (P = 0.816). Conclusion: Elevated ACE level may induce retinal angiogenesis and proliferative retinopathy in patients with DM. We consider that high levels of ACE in aqueous humor can reflect the association between retinal angiogenesis and DM serve as predictor in the progression of diabetic retinopathy.

Idiopathic pigmented free-floating posterior vitreous cyst

A 28-year-old female who complained of visual symptoms in the right eye was admitted to the ophthalmology clinic. She had been suffering from visual disturbance for about 5 years and her symptoms had become worse during the last 2 months. There was no previous history of trauma, infection or inflammatory disorders. A pigmented vitreous cyst was detected in her ophthalmologic examination. As the patient refused, laser cystotomy could not be performed. The pigmented vitreous cyst was possibly congenital in origin and described as a cystic choristoma from the primitive hyaloid system in the literature. The movements of the cyst, causing only transient blurring of vision, may rarely affect the visual axis. The visual acuity was 20/20 in the affected eye so it was suggested that she should be followed-up periodically for her cyst.

Intron F G79A Polymorphism of the Protein Z Gene in Turkish Behçet Patients

Purpose: Vasculitis is one of the major findings of Behçet’s disease (BD). Protein Z (PZ) is a glycoprotein that acts as a cofactor of PZ-dependent protease inhibitor and suppresses trombus formation by inhibiting activated factor Xa. Polymorphism of the PZ gene was mentioned as a genetic risk factor for various thrombotic events. The aim of this study is to investigate the intron F G79A polymorphism of the PZ gene in Behçet patients with and without ocular involvement. Methods: Seventy-six patients and 70 controls were included in the study. Intron F G79A polymorphism of PZ gene was determined by polymerase chain reaction based DNA analysis. The frequency of A allele and the distribution of genotypes were assessed by χ2 test and the genotype distribution and Hardy–Weinberg equilibrium were tested with the χ2 test for quality of fit. Results: The frequency of the A allele was significantly higher in overall Behçet patients than in controls (odds ratio [OR] = 6.8; 95% CI, 2.6 to 17.9; p = 0.0001). It was also significantly higher in patients with (OR = 5.3; 95% CI, 1.83 to 15.6; p = 0.0024) or without (OR = 8.2; 95% CI, 2.95 to 22.5; p = 0.0001) ocular involvement compared to controls. However, A allele frequency was not significantly different between patients with eye involvement versus patients without eye involvement (OR = 0.65; 95% CI, 0.3 to 1.4; p = 0.28). Conclusions: Although thrombosis in BD is multifactorial, intron F G79A polymorphism of PZ gene in BD may be one of the factors that contribute to this pathological process.

Perfluorodecaline residue in the anterior chamber of a patient with an intact crystalline lens: a case report

BackgroundPerfluorocarbon liquids are frequently used as intraoperative tools in vitreoretinal surgery and may occasionally be retained in the vitreous cavity. We report a patient who underwent pars plana vitrectomy for a giant tear after receiving blunt trauma to his right eye and sustained postoperative perfluorocarbon liquid residue in the anterior chamber in spite of an intact crystalline lens.Case presentationPerfluorodecaline was used as a temporary retinal tamponade. Three weeks after the surgery, a residue of heavy liquid was observed in the anterior chamber, even though the patient had an intact crystalline lens without any tilt or dislocation. The remnant of the heavy liquid was taken out of the anterior chamber immediately to avoid secondary complications.ConclusionPresence of heavy liquids in the anterior chamber may be associated with zonular defects even though the patient has an intact crystalline lens.

Predictive value of the vitamin K epoxide reductase complex subunit 1 G-1639A and C1173T single nucleotide polymorphisms in retinal vein occlusion

Background:  To determine if vitamin K epoxide reductase complex subunit 1 gene polymorphisms have an effect on the risk of having a retinal vein occlusion.

A rare brain developmental anomaly in a patient with Usher’s syndrome

We report a rare brain developmental anomaly in Usher’s syndrome. We present a 43-year-old male with visual disturbance, hearing loss, and headache. Retinitis pigmentosa and sensorineural hearing loss were determined and he was diagnosed with Usher’s syndrome according to the clinical findings. Magnetic resonance imaging showed an arachnoid cyst on the left temporal lobe, cavum septum pellucidum et vergae. Uneventful cataract surgery was performed in both eyes. He was suggested to be followed up periodically for the arachnoid cyst and to use a hearing device. Although auditory and visual disturbances are the typical findings of this syndrome, it may affect other parts of the central nervous system as well. Morphological abnormalities of central nervous system and related disorders can be seen in patients with Usher’s syndrome.

Efficacy of intravitreal triamcinolone after or concomitant with laser photocoagulation in nonproliferative diabetic retinopathy with macular edema.

Purpose To investigate the clinical effects and outcomes of intravitreal injection of 4 mg of triamcinolone acetonide (IVTA) after or concomitant with macular laser photocoagulation (MP) for clinically significant macular edema (CSME). Methods Forty-nine eyes of 49 patients with nonproliferative diabetic retinopathy and CSME were randomized into three groups. The eyes in the laser group (n=17), group 1, were subjected to MP 3 weeks after IVTA; the eyes in the IVTA group (n=13), group 2, were subjected to MP, concomitant with IVTA; the eyes in the control group (n=19), group 3, underwent only IVTA application. Visual acuity (VA), fundus fluorescein angiography, and photography were performed in each group. Results In the first group, the mean VA improved from 0.17±0.09 at baseline to 0.28±0.15 (p=0.114) and in the second group, deteriorated from 0.19±0.08 at baseline to 0.14±0.08 at the sixth month (p=0.141), respectively. In Group 3, the mean VA improved from 0.16±0.08 at baseline to 0.28±0.18 (p=0.118) at the end of the follow-up. When VA was compared between the control and study groups, significant difference was detected at the sixth month (p=0.038). Conclusions MP after IVTA improved VA, rather than MP concomitant with IVTA, and only IVTA application for CSME. MP after IVTA may reduce the recurrence of CSME and needs further investigations in a longer period.