Kemal Gündüz

Effect of altered eating habits and periods during Ramadan fasting on intraocular pressure, tear secretion, corneal and anterior chamber parameters.

PurposeTo determine whether altered eating habits and periods, especially the pre-dawn meal, during Ramadan fasting have any significant effect on intraocular pressure (IOP), tear secretion, corneal and anterior chamber parameters.MethodsIOP, basal tear secretion (BTS), reflex tear secretion (RTS), and Pentacam measurements of 31 healthy volunteers were performed at 0800 and 1600 hours during Ramadan fasting and 1 month later during non-fasting period.ResultsComparison of measurements between fasting and non-fasting periods at 0800 hours revealed significantly higher values for IOP (P=0.005), RTS (P=0.006), and BTS (P=0.014) during fasting. Conversely at 1600 hours, IOP was significantly lower during fasting (P=0.013) and no statistically significant difference was noted for RTS and BTS. IOP showed a diurnal variation of 2.45 mmHg (P<0.001) and BTS showed a 3.06 mm decrease (P=0.04) during the fasting period. No significant differences could be found in the corneal and anterior chamber parameters during fasting and non-fasting periods.ConclusionsOur results revealed that fluid loading at the pre-dawn meal during Ramadan fasting might increase the IOP and tear secretion in the early morning period and these values decrease remarkably at the end of 12 h of fasting due to dehydration.

Glucose regulation influences treatment outcome in ranibizumab treatment for diabetic macular edema

PURPOSE To evaluate the effect of glucose regulation on intravitreal ranibizumab injection for clinically significant diabetic macular edema (DME). METHODS This retrospective study enrolled 65 eyes of 65 patients with persistent DME treated with intravitreal ranibizumab injection. The main outcome measures were the change in best corrected visual acuity (BCVA), the central subfield macular thickness (CSMT) recorded with optical coherence tomography (OCT), and its correlation with the serum hemoglobin A(1c) values (HbA(1c)). RESULTS The study included 24 (36.9%) female and 41 (63.1%) male patients with a mean age of 58.90±9.45 years. The mean HbA(1c) of the enrolled patients was 8.25±1.74% (range 5.7-12.7%). The median value of BCVA at baseline examination was 20/80 (52 letters), and the median CSMT was 468 μm (range 255-964 μm). In the final control after 4-6 weeks following injection, the median value of BCVA increased to 20/50 (59.50 letters) and the median CSMT decreased to 310 μm (range 129-652 μm). This change in BCVA and macular thickness was found to be significant (P<.001 for both). There was no correlation between BCVA and the change in macular thickness (coefficient=0.04, P=.78). The serum HbA(1c) values were found to be negatively correlated with the change in CSMT (coefficient=-0.50, P<.001). CONCLUSIONS The results of intravitreal ranibizumab injection for DME demonstrated a beneficial effect on visual acuity and a decrease in CSMT which is inversely correlated with the serum HbA(1c) level.

Control of steroid-induced glaucoma with surgical excision of sub-Tenon triamcinolone acetonide deposits: a clinical and biochemical approach

OBJECTIVE To assess the efficacy of surgical excision of sub-Tenon triamcinolone acetonide (TA) deposits in the control of steroid-induced glaucoma. DESIGN Prospective, nonrandomized, interventional case series. PARTICIPANTS Eighteen eyes of 14 subjects with increased IOP within 6 months of sub-Tenon TA injection who did not respond to medical antiglaucomatous treatment were included in the study. METHODS Under topical anaesthesia, steroid deposits were completely excised and placed in ethyl alcohol for the determination of the TA amount using high-performance liquid chromatography. The patients were followed up for 6 months and a paired-sample t test was used to compare mean IOP before and after excision of sub-Tenon TA deposits. RESULTS The mean IOP levels before and after the sub-Tenon steroid injections were 15.9 (SD 2.9) mm Hg and 36.4 (SD 8.4) mm Hg, respectively (p < 0.001). IOP levels decreased significantly after the removal of the deposits (mean 15.3 [SD 2.1] mm Hg) (p < 0.001). Within 6 months of follow-up, all glaucoma medications were stopped in 9 subjects without further IOP increase, whereas IOP control in 5 subjects necessitated using glaucoma medications. The median TA amount was found to be 7.35 mg (range 3.3-29.68 mg). IOP decrease after the excision showed no correlation with the amount of TA (p = 0.8). CONCLUSIONS Surgical excision of the sub-Tenon steroid deposit should be considered as the primary treatment for steroid-induced glaucoma refractory to medical treatment.

Unilateral chemosis, acute onset myopia and choroidal detachment following the use of tamsulosin

Editor, T amsulosin is a subtype-selective a1A and a1D adrenoceptor antagonist which improves maximal urine flow by relaxing the prostate and bladder smooth muscles (Dunn et al. 2002). Its well-known ocular side-effect is intraoperative floppy iris syndrome (Keklikci et al. 2008). We present a case report of unilateral chemosis, acute onset myopia and choroidal detachment following tamsulosin treatment in a patient who had undergone a vesical diverticulectomy procedure 1 month previously. A 44-year-old man was referred to our clinic with painless conjunctival swelling and blurred vision in his right eye of 5 days’ duration. The patient had undergone an uncomplicated vesical diverticulectomy 1 month earlier and had been put on oral ciprofloxacin and tamsulosin (Flomax; Boehringer Ingelheim, Istanbul, Turkey) treatment the day after the operation. He had stopped taking antibiotic pills 10 days after the operation and had not used any medications other than Flomax since then. He had no systemic diseases, history of drug allergy or ocular trauma. The subject’s best corrected visual acuity (BCVA) was 20 ⁄ 25 with ) 3.75 to 0.50 · 70 in the right eye. Uncorrected visual acuity was 20 ⁄ 20 in the left eye. Ocular examination revealed conjunctival hyperaemia and severe chemosis protruding over the lower lid margin in the right eye (Fig. 1A). No purulent discharge was observed. The anterior chamber was shallow without any cellular reaction and intraocular pressure was 19 mmHg in the right eye. Fundus examination revealed a ring-shaped anterior choroidal detachment preserving the posterior pole. The optic disc, macula and vascular structures were normal. No pathology was noted in the left eye. Orbital magnetic resonance imaging confirmed cilio–choroidal detachment and there were no orbital pathologies to explain severe chemosis in the right eye (Fig. 1B). Anterior segment examination with Scheimpflug imaging revealed a shallow anterior chamber in the right eye (Fig. 2A). Anterior chamber depths were 2.03 mm OD and 2.68 mm OS. Anterior chamber volumes were 92 mm OD and 159 mm OS. Anterior chamber angles were 26.2 degrees OD and 36.5 degrees OS. After consultation with his urologist, the patient’s systemic treatment (Flomax) was stopped and topical prednisolone and cyclopentolate was started. Chemosis and choroidal detachment was entirely resolved at the end of 1 month. The anterior chamber depth and iridocorneal angle in the right eye were normalized (Fig. 2B) and BCVA was 20 ⁄ 20 with ) 0.75 to 0.75 · 70 (equal to the former spectacle correction).

The Effect of Hypothyroidism on Color Contrast Sensitivity: A Prospective Study

Background: Thyroid hormone has been shown to control retinal cone opsin expression, the protein of color vision, in adult rodents. Objectives: The aim of this study was to evaluate the effect of hypothyroidism on color contrast sensitivity in adult overt hypothyroid patients. Methods: Thirty-eight overt hypothyroid (31 females, 7 males) subjects and 20 euthyroid (16 females, 4 males) controls were studied prospectively. Color vision examination was performed by Chromatest, a software program analyzing the tritan (blue-yellow) color contrast threshold (tritan CCT) and protan (red-green) color contrast threshold (protan CCT). Color contrast sensitivity analyses of hypothyroid subjects were performed on admission and after L-thyroxine treatment when biochemical euthyroidism was achieved. Results: After a median period of 90 (90-210) days, 24 (19 females, 5 males) patients were euthyroid and eligible for a second color vision examination. Baseline tritan CCT and protan CCT values were significantly higher in the hypothyroid group compared to euthyroid controls, which clinically translates into impaired color contrast sensitivity (p < 0.001 and p < 0.001, respectively). There was a significant decrease in tritan CCT (p = 0.002) and protan CCT (p < 0.001) values in the hypothyroid group after euthyroidism was achieved, which denotes improvement in color contrast sensitivity. Conclusions: It is a novel finding of the current study that color contrast sensitivity is impaired in hypothyroidism and significantly improves after euthyroidism is achieved.

Cavernous hemangioma with cone dysfunction.

We report a 13-year-old male who complained of strabismus and low visual acuity in the right eye. Saccular aneurysms filled with dark-colored blood were noted in the upper nasal quadrant of the right fundus. Ishihara color plates and Lanthonys new color test revealed a red-green color defect. Cone response and 30-Hz flicker responses were nearly absent. Cavernous hemangioma of the retina is a rare vascular hamartoma; the associated findings show cone dysfunction concomitant with this peripheral lesion.

Pattern-reversal electroretinograms and visual evoked potentials in branch retinal vein occlusion

We recorded pattern electroretinograms and visual evoked potentials in a group of selected patients with unilateral uncomplicated branch retinal vein occlusion. To document the effects of preexisting risk factors, patients were divided into three groups: diabetes mellitus, hypertension with hyperlipidemia and no systemic disease. The transient and steady-state pattern electroretinogram and visual evoked potential amplitudes were significantly reduced and visual evoked potential peak times were delayed relative to the fellow eyes and agematched normal subjects. There was a second amplitude reduction relative to the other patient groups in both the affected and fellow eyes of the diabetes mellitus group, which was indicative of an additive effect of diabetes mellitus.

Tip 2 diabetes mellituslu hastalarda plazma homosistein düzeyinin normal popülasyonla karşılaştırılması

Objectives: To compare the plasma homocysteine levels between control group and diabetic patients with no diabetic retinopathy, with preproliferative diabetic retinopathy, with proliferative diabetic retinopathy. Materials and methods: Plasma homocysteine levels of 23 diabetic patients were measured and were compared with 25 age-matched controls with no systemic problem and no ocular disease. Plasma homocysteine levels were measured using high-performance liquid chromatography.

An unusual fundus finding in a patient with optic nerve pit syndrome

In a study of 12 patients with optic nerve pits, a female patient presented an unusual fundus finding in which there were many flat grey-white lesions in both eyes. These lesions covered a large area of the fundus and extended from the posterior pole to the periphery. There was an optic pit in the right eye and an inferior coloboma in the left eye. The visual acuities and the clinical findings remained unchanged over the follow-up period of 2 years. Fluorescein angiographic and electrophysiological examinations suggested that these lesions were probably located at or beneath the retinal pigment epithelium.