Kemal Örnek

Bevacizumab Sterility in Multiple Doses from a Single-Use Vial

Background: Recent reports have demonstrated that refrigerated bevacizumab can be stored for up to 3 weeks at 4 °C without loss of efficacy. There have been no previous reports addressing bevacizumabs sterility when stored and used as multiple doses from a single-use vial. Objective: To evaluate the sterility of bevacizumab when used as multiple doses from a single-use vial. Methods: Four groups of vials were used to simulate the storage and use conditions for bevacizumab. Each group contained 11 doses of 0.2 mL of bevacizumab. One sample from each group was cultured once each day at 37 °C for 10 days; one sample from each group was left for 15 days. MacConkey agar, blood agar, thioglycollate broth, and Sabouraud medium were used to assess bacterial and fungal growth. Results: A total of 44 samples of bevacizumab were included in this study. Each sample was placed on 4 growth media for microbial readings. All samples were found to be negative for microbial growth. No significant differences were observed among the groups. Possible limitations of this study included the number of samples for each group and in vitro design of the study, which might have affected the growth of bacterial organisms. Conclusions: Storage and multiple use of bevacizumab from single-use vials does not seem to result in microbial contamination.

Intravitreal Bevacizumab Treatment for Refractory Diabetic Macular Edema

AIMS The aim of this study was to report the short-term clinical and angiographic outcomes after an intravitreal injection of bevacizumab in eyes with refractory diabetic macular edema. METHODS Patients who had been treated with both grid-laser photocoagulation and intravitreal trimacinolone acetonide injections for diabetic macular edema received intravitreal bevacizumab (0.125 mg/0.05 mL). Snellen visual acuity testing and fluorescien angiography were performed before and 1 month after the injection for each patient. RESULTS Seventeen (17) eyes of 16 patients were included in the study. All patients completed 6 weeks of follow-up. Visual acuity improved in 12 eyes (70%) and remained the same in 5 eyes (30%). Eight (8) eyes (47%) revealed a marked improvement of macular edema, 6 eyes (35%) revealed mild improvement, and 3 eyes (18%) had no change. None of the patients developed local or systemic adverse events. CONCLUSIONS Intravitreal injection of bevacizumab may be effective in the treatment of refractory diabetic edema unresponsive to laser photocoagulation and an intravitreal triamcinolone injection.

Intravitreal Bevacizumab for Diabetic Papillopathy

A 43-year-old woman presented with a visual acuity of 1/10 in the right eye and 3/10 in the left eye. Ophthalmologic examination disclosed optic disc swelling on both sides with mild nonproliferative diabetic retinopathy. The pupils were equal and reactive without an afferent pupillary defect. Visual field testing showed no significant defect in both eyes. Systemic investigations revealed no abnormality. The patient was injected with bevacizumab intravitreally with the diagnosis of diabetic papillopathy (DP). Three weeks later, the vision increased to 7/10 in the right eye and optic disc edema disappeared. Intravitreal injection of bevacizumab effectively treated DP.

Short-term effect of topical brinzolamide on human central corneal thickness.

Purpose To investigate the effect of short-term brinzolamide application on human central corneal thickness (CCT). Methods Seventeen eyes of 16 patients who underwent neodymium:YAG laser posterior capsulotomy were included in the study group. Twenty-two subjects served as controls. Brinzolamide twice daily and fluorometholone four times daily were initiated after the procedure. Corneal thickness was evaluated with an ultrasound pachymetry from the central region. CCT measurements were performed before the procedure, at first day, and at the end of first week. Results The mean baseline CCT value was 535.1±37.8 μm. In comparison to the control group (546.4±22.2 μm), there was no statistically significant difference (p=0.248). After brinzolamide instillation, the mean CCT values at first day and at first week was measured as 545.1±40.1 μm and 538.8±39.4 μm, respectively. The difference at first day was statistically significant when compared to the baseline values (p=0.00017). When compared to the control group, no statistically significant difference was observed for the mean CCT values of the first day and first week (p=0.906 and p=0.484, respectively). In the fellow eyes, mean CCT values increased following the dorzolamide instillation (529.3±42.6 μm, 534±41.7 μm, and 533±41.9 μm, respectively). No statistically significant difference was observed between the control group and fellow eye group when compared (p=0.162, p=0.247, p=0.270, respectively). Conclusions Brinzolamide may cause a short-term increase in the human CCT, particularly on the first day.

Burkholderia cepacia keratitis with endophthalmitis

Keratitis with endophthalmitis of the right eye occurred in a 78-year-female following a complicated cataract surgery. Prompt intravitreal vancomycin and ceftazidime with topical fortified tobramycin and cefazolin treatments were started. The corneal, aqueous and vitreous cultures grew a Burkholderia cepacia complex (Bcc) strain on the fourth day. Restriction fragment length polymorphism analysis of the recA amplicon revealed B. cepacia genomovar I. The organism was found to be susceptible to ceftazidime, ciprofloxacin and ofloxacin. Topical ciprofloxacin was given immediately. At day 10, the pain relieved and the clinical condition of the patient improved with resolution of the purulent discharge, severe circumcorneal congestion and chemosis. The size of the corneal abscess and anterior chamber exudation decreased. The Bcc should be included among the bacterial species that may cause keratitis following intraocular surgeries.

Early results of dexamethasone implant, ranibizumab, and triamcinolone in macular edema due to branch retinal vein occlusion

Purpose To compare the short-term results of the efficacy and safety of dexamethasone intravitreal implant (DEX), ranibizumab (RAN), and intravitreal triamcinolone acetonide (IVTA) in macular edema secondary to branch retinal vein occlusion (BRVO). Methods One eye each of 32 patients who were treated with intravitreal injections for macular edema secondary to BRVO was studied. This retrospective study included 3 groups. The patients received DEX in group 1 (n = 11), RAN in group 2 (n = 11), and IVTA in group 3 (n = 10). Data were collected before and after the injections at the first and third months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were analyzed statistically. Results The median duration of the follow-up was 3.0 months in overall groups. The BCVA increased significantly in all groups (p = 0.018, p = 0.034, p = 0.014, respectively). The CMT increased significantly in groups 1 and 3 (p = 0.02, p<0.001, respectively), but not in group 2 (p = 0.14). The IOP increased significantly in groups 1 and 3 (p = 0.05, p<0.001, respectively). Antiglaucomatous treatment was required only in group 3. Cataract developed in 2 patients (20%) in group 3 and surgery was required. Conclusions Although RAN was the safest among the 3 agents, DEX and IVTA reduced CMT more than RAN, while significant improvement was achieved in BCVA in all groups. All 3 agents can be effectively used in the treatment of macular edema due to BRVO.

Corneal Sensitivity and Tear Function in Neurodegenerative Diseases

Abstract Purpose: To measure corneal sensitivity and tear function in neurodegenerative diseases (NDs) and to compare them with age and sex-matched controls. Methods: Twenty patients with Alzheimers disease (AD), 20 patients with multiple sclerosis (MS), 30 patients with Parkinsons disease (PD), 10 patients with Friedreichs ataxia (FA) and 21 patients with epilepsy (EP) who were recruited from the Kırıkkale University Neurology Department during 2012 were included in this prospective study. Five groups of age and sex-matched subjects were selected as controls. Corneal sensitivity was measured using a Cochet–Bonnet esthesiometer. Tear function tests included tear break-up time (TBUT) and Schirmers 1 tests. Results: Compared to their controls, mean corneal sensitivity was significantly reduced in AD, MS, PD and EP patients (all p < 0.05), mean TBUT level was significantly shorter in patients with AD and MS (all p < 0.05) and mean Schirmers 1 test score was significantly lower in EP patients (p < 0.05). When all groups were compared with each other, reduction of mean corneal sensitivity in AD and PD groups were significantly more than in FA and MS groups (overall p = 0.034). Mean TBUT levels in AD, MS and PD groups were significantly shorter than in FA and EP groups (overall p = 0.001). Mean Schirmers 1 test scores in AD and PD groups were significantly lower than in MS, FA and EP groups (overall p = 0.040). Conclusions: Neurodegenerative diseases may be associated with reduced corneal sensitivity and abnormal tear function.

Bilateral punctum atresia and lacrimal sac fistula in a child with CHARGE syndrome

membrane closer, and thus facilitates migration of endothelial cells. Although intracameral gas is preferred to air for treating corneal hydrops, there is a risk of endothelial toxicity, Urrets-Zavalia syndrome and secondary glaucoma with the use of long-acting gases intracamerally. A fixed dilated pupil with iris atrophy (Urrets-Zavalia Syndrome) is an uncommon postoperative complication that was originally described after penetrating keratoplasty for keratoconus. Although the precise aetiology of the syndrome is unknown, it has been proposed that ischaemia of the iris may develop after raised intraocular pressure and leave a fixed dilated pupil. To the best of our knowledge this is the first report on the use of intracameral C2F6 for managing bilateral acute hydrops secondary to keratoglobus. We chose to use C2F6 as this had a shorter duration of action when compared with C3F8. In spite of the formation of a paracentesis to decompress the anterior segment and postoperative acetazolamide treatment our patient developed Urrets-Zavalia syndrome in the RE. In conclusion, we believe that pneumodescemetopexy can be a safe and effective option for the treatment of acute hydrops secondary to keratoglobus. This case demonstrates how the procedure can lead to rapid resolution of corneal oedema and improvement of vision.

Comparison of choroidal thickness changes following intravitreal dexamethasone, ranibizumab, and triamcinolone in eyes with retinal vein occlusion.

Purpose To evaluate short-term choroidal thickness changes following intravitreal dexamethasone implant (DEX), ranibizumab (RAN), and triamcinolone acetonide (TA) in eyes with retinal vein occlusion (RVO) and macular edema (ME). Methods In this prospective study, 35 eyes of 35 patients with RVO and ME who were treated with intravitreal injections of DEX, RAN, and TA were included. Choroidal thickness was measured using semiautomated segmentation of enhanced depth imaging with optical coherence tomography at fovea and parafoveal areas. Changes in choroidal thickness following treatment were compared statistically. Results Choroidal thickness decreased following DEX, RAN, and TA treatments (all p>0.05). In the DEX group, at the first month nasal 1,500 µm (N11,500) and at the third month subfoveal (SF3) and nasal 500 µm (N3500) choroidal thickness revealed a significant reduction compared to RAN and TA groups (all p<0.05). In the TA group, choroidal thickness showed a significant reduction only at nasal 1,500 µm (N31,500) at the third month (p<0.05). Conclusions Choroidal thickness was decreased in all 3 groups. The DEX and TA groups showed a significant reduction at some areas. Ranibizumab had the smallest effect on choroidal thickness after 3 months among all groups.

Peripapillary and macular retinoschisis in a patient with pseudoexfoliation glaucoma

A 55-year-old man was admitted with a 2-year history of pseudoexfoliation glaucoma. The best-corrected visual acuities were 10/10 in both eyes. Pseudoexfoliation material was noted on the iris and the lens capsule. Fundus examination evidenced cup-to-disc ratio of 0.7 OD and 0.9 OS with peripapillary atrophy. Gonioscopy revealed open angles. Optical coherence tomography demonstrated peripapillary retinoschisis extending to the nasal macula in the left eye and optic nerve head was almost fully excavated. Coexisting retinoschisis in a patient with glaucoma may interfere with the reliability of retinal nerve fibre layer and ganglion cell complex analysis and may change the treatment plan and follow-up intervals.