Ibrahim Erbagci

Rapid improvement of human orf (ecthyma contagiosum) with topical imiquimod cream: report of four complicated cases

Orf is a zoonosis caused by an epitheliotropic DNA parapox virus. Human orf is a generally benign, self‐limiting condition that usually regresses in 6–8 weeks without specific treatment. However, it may be accompanied by local symptoms including pain, pruritus, lymphangitis and axillary adenitis, or less frequently by systemic symptoms such as fever or malaise. Furthermore, it may be complicated by erythema multiforme, Stevens‐Johnson syndrome, erysipelas, generalized mucocutaneous eruption, toxic erythema, eyelid oedema and giant, persistent or recurrent lesions in immunocompromised patients. Imiquimod, a potent topical immune response modifier, enhances both the innate and acquired immunity by stimulation of immune system cells resulting in local antiviral, antitumour and immunoregulatory activity. We present, for the first time, four complicated cases of orf successfully treated by topical imiquimod resulting in rapid regression of both orf and associated lesions. Two of the cases were complicated with erythema multiforme, one with recurrent eyelid oedema, and another had giant orf associated with axillary lymphadenitis. We suggest that topical imiquimod may be an effective and safe therapy for complicated orf cases.

High incidence of demodicidosis in eyelid basal cell carcinomas

Background Although UV radiation is the major cause of basal cell carcinoma (BCC), local factors, such as chronic trauma, irritation, or inflammation, may also have some role in its etiopathogenesis. The pilosebaceous follicle mites, Demodex folliculorum and D. brevis, inhabit most commonly and densely certain facial skin areas, including the nose and periorbital regions, where BCC also develops most frequently.

Visual evoked potential changes in migraine. Influence of migraine attack and aura.

OBJECTIVE To assess the visual evoked potential (VEP) changes in migraines with and without aura. STUDY DESIGN A clinical study in which the VEP results of 45 migraineurs (study group) and 22 healthy volunteers (control group) were compared. Of 45 migraineurs, 29 had migraine with aura (MA) and 16 had migraine without aura (MOA), and they were examined both during and between the migraine attacks. METHODS The patients and healthy controls underwent VEP assessment. On VEP recording, mono-ocular stimulation was performed by means of the pattern reversal check board. The latencies of N1, P1 and N2, and the N1--P1 amplitude were noted. The following comparisons were made between NI, P1 and N2 latencies and N1--P1 amplitudes of the migraine and control groups; during and between attack the VEP results of the patients with MA and MOA. RESULTS The VEP results of the migraineurs and healthy controls were similar (P>0.05). The during attack results of MA, during and between attack results of MOA, and the results of the control group were also similar (P>0.05). N2 latency significantly elongated in patients with MA in the attack free period than it was during the attack (P=0.01), and was also longer than it was in the control group (P=0.01). CONCLUSIONS There is involvement of the visual pathway in MA rather than MOA, and differentiation between these subtypes of the migraine disease may be performed on the basis of VEP findings manifesting by the prolongation of the N2 wave latency. This contention should be confirmed by further studies.

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.

Dexmedetomidine use during strabismus surgery in agitated children.

Objective: We aimed to investigate the effects of dexmedetomidine premedication before intravenous infusion of ketamine in agitated children undergoing strabismus surgery. Subjects and Methods: We enrolled 60 agitated pediatric patients, aged 4.5–11 years. The patients were randomly allocated to one of two anesthesia regimens. Group D patients were premedicated with a single dose of intravenous dexmedetomidine 0.5 µg/kg whereas group P patients received a placebo. Patients in both groups were administered intravenous ketamine 1 mg/kg i.v. over 1 min followed by a continuous infusion of ketamine 1–3 mg/kg/h i.v. (n = 30). Patients were intubated after receiving fentanyl 1 µg/kg and rocuronium bromide 0.5 mg/kg. Results: 21 (70%) patients in group D did not show the oculocardiac reflex (OCR) versus 7 (23%) in group P (p = 0.0006). The preoperative and postoperative agitation scores (p = 0.0001 and p = 0.03, respectively), the score on the Faces Pain Scale during awakening [3.0 (interquartile range, IQR 2.0–4.0) in group D and 0.0 (IQR 1.0–2.25) in group P] (p = 0.001) and at the 60th postoperative minute [IQR 2.0 (1.5–3.0) in group D and 2.0 (IQR 1.5–3.0) in group P] (p = 0.004), sore throat (26.6% in group D and 60% in group P) (p = 0.01) and analgesic requirement (20% in group D and 53% in group P) (p = 0.01) in group P were significantly higher than in group D. The Ramsay Sedation Score (RSS) in group D was significantly higher than in group P during awakening [2.0 (2.0–2.0) in group D and 4.5 (4.0–5.0) in group P] (p = 0.0001). Conclusion: Dexmedetomidine premedication followed by intravenous infusion of ketamine was effective in decreasing OCR, agitation, pain, analgesic requirement in agitated children undergoing strabismus surgery.

Effects of corrective surgery on social phobia, psychological distress, disease-related disability and quality of life in adult strabismus patients

Background Corrective surgery is done for ocular alignment and disrupted facial expression in some cases of adult strabismus patients. The effects of corrective surgery on the presence of social phobia (SP) diagnosis, the severity of social anxiety symptoms, the disease-related disability and the quality of life (QoL) among strabismus patients have not been thoroughly studied yet. Methods The study sample was composed of patients who had undergone corrective surgery for strabismus. Preoperative and postoperative evaluations made by using standardised measures of social phobia diagnosis (DSM-IV-TR) and severity (Liebowitz Social Anxiety Scale (LSAS)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), disability (Sheehan Disability Scale) and quality of life (short form-36). Results Preoperatively, SP diagnosis was detected in 17 of 31 (54.8%) patients, whereas postoperatively 6 of 31 (19.4%) patients had SP (p=0.001). Participants showed a significant decrease in all subscale scores and total score of both LSAS and HADS compared with their preoperative scores. Significant improvements were observed in QoL and disability scores as well. Conclusions Adult strabismus patients seem to gain benefits from corrective surgery not only for their ocular misalignment but also for social anxiety levels that may be associated with improvements in their QoL and disability levels.

Effectiveness of retroequatorial recession surgery in congenital nystagmus.

OBJECTIVE The aim of this retrospective study was to evaluate the effectiveness of the retroequatorial recession technique in the surgical treatment of nystagmus and associated strabismus. METHOD The effect of large recessions of four horizontal extraocular muscles was analyzed qualitatively in seven patients with congenital nystagmus. RESULTS The ages of the patients ranged between 12 and 42 years (mean, 21.5 years). Of the seven patients, four had motor and three had sensory nystagmus. Visual acuity increased in five (71.4%) patients. Planned recovery of associated strabismus was attained in six patients (85.7%). In five patients who had abnormal head position, the head positions and nystagmus intensities were found to be decreased. No postoperative complication, such as diplopia, was encountered. CONCLUSION The retroequatorial recession technique is preferable in patients who have congenital nystagmus, especially in the presence of horizontal squint associated with low visual acuity, because of its success in increasing visual acuity and decreasing the amplitude of nystagmus, its reversibility, making posssible new operations in the future, as well as the absence of any significant complications.

Association Between Thr21Met and Ser89Asn Polymorphisms of the Urotensin-II (UTS2) Gene, Diabetes Mellitus, and Diabetic Retinopathy

Purpose: To evaluate possible role of the UTS2 gene polymorphisms (Thr21Met and Ser89Asn) in the genetic susceptibility to diabetic retinopathy (DR) in a Turkish population. Methods: Total number of 280 patients with DR (nonproliferative DR 170 and proliferative DR 110), 291 nondiabetic healthy controls, and 113 diabetic controls (without DR) were included to this study. The detection of UTS2 gene polymorphisms was achieved with PCR-RFLP technique. The Discovery Studio 2.1 program was used for molecular modeling analysis. Results: Thr21Met (T21M) and Ser89Asn (S89N) polymorphisms of the UTS2 gene were associated with the risk of developing diabetes and DR. M21M genotype frequencies were high in PDR (8.9% in diabetic control vs. 54.6% in PDR, P = 0.0092) group. Increases in 21M allele frequency (52.7% in diabetic control vs. 76.4% in PDR, P < 0.0001) frequency in PDR group were detected. However, there were no changes in genotype and allele frequencies for T21M in NPDR group. There were decreases in the S89N genotype (23.9% in diabetic control vs. 13.5%) and 89N allele frequencies (11.9% in diabetic control vs. 6.8%) in NPDR group. However, S89S genotype (76.1% in diabetic control vs. 86.4%) and 89S allele frequencies (88.1% in diabetic control vs. 93.2%) were high in NPDR group. Three haplotypes (MN, MS and TS) were associated with NPDR patients (P < 0.001), but only MN (P < 0.001) and TS haplotypes (P = 0.018) were associated in PDR group. Molecular modeling analysis showed that these two polymorphisms changed the 3D structure of UTS2, and provided interactions with neighboring residues. Conclusion: The associations between Thr21Met and Ser89Asn polymorphisms in the UTS2 gene and DR strongly suggest that these SNPs may be an important a risk factor for the development of DR in Caucasians, and could be candidate markers for earlier diagnosis and targets for DR therapy.

Ketamine versus propofol for strabismus surgery in children

Purpose: To compare the effects of intravenous infusion of ketamine and propofol anesthesia in children undergoing strabismus surgery. Methods: Sixty pediatric patients aged 4–11 years were enrolled for the study. Patients in Group K were infused ketamine 1–3 mg/kg/hr (n = 30) and patients in Group P were infused with propofol 6–9 mg/kg/hr (n = 30). After giving fentanyl 1 μg/kg and rocuronium bromide 0.5 mg/kg, patients were intubated. Results: The consumption of anesthetics (P = 0.0001) and antiemetics (P = 0.004), the incidence of oculocardiac reflex (P = 0.02) in Group K were significantly lower than in Group P. The recovery time (P = 0.008), postoperative agitation score (P = 0.005), Face Pain Scale (P = 0.001), Ramsay Sedation Score (P = 0.01) during awakening and at postoperative 30th min (P = 0.02) in Group K were significantly lower than in Group P. The postoperative agitation score during awakening was significantly lower than the preoperative values in Group K (P = 0.0001). Conclusions: The infusion of ketamine is more advantageous than the infusion of propofol in children for use in strabismus surgery.

Intravitreal Dexamethasone Implant for Treatment of Refractory Behçet Posterior Uveitis: One-year Follow-up Results.

ABSTRACT Purpose: To investigate the results of dexamethasone (DEX) implant in the treatment of eyes with refractory Behçet posterior uveitis. Methods: A total of 17 eyes of 12 patients with active Behçet posterior uveitis were enrolled in the study. A single intravitreal injection of DEX implant was applied to each eye. Best corrected visual acuity (BCVA), central macular thickness (CMT), vitreous haze score, and intraocular pressure (IOP) were determined, at baseline and control visits of months 1, 3, 6, and 12. Results: The mean BCVA was significantly increased from baseline at each control visit (all p < 0.05). The mean CMT and vitreous haze score were significantly decreased from baseline at each control visit (all p < 0.05). Three eyes showed IOP spikes requiring topical anti-glaucomatous treatment. Conclusions: A single injection of DEX implant was safe and effective, as an additional treatment to systemic immunomodulatory drugs, in the treatment of refractory Behçet posterior uveitis, for a 6-month period.