Levent Karabas

The Effects of Menopause and Hormone Replacement Therapy on Quality and Quantity of Tear, Intraocular Pressure and Ocular Blood Flow

Objective: To evaluate the effects of menopause and hormone replacement therapy (HRT) on the quality and amount of tear, intraocular pressure (IOP) and retrobulbar blood flow velocities. Patients and Methods: Twenty women aged between 40 and 50 years, free of ocular and systemic diseases and planning to receive HRT were recruited as the study group. Twenty-four healthy, age-matched but still menstruating women were enrolled as controls. On the first day of study basal and reflex Schirmer test, tear break-up time and IOP measurements (at 08.00, 12.00 and 16.00 h) were performed for all groups. On the second day of the study, the peak systolic velocity (PSV), end diastolic velocity (EDV) and resistivity index (RI) of the ophthalmic (OA), central retinal (CRA), nasal (NSPCA) and temporal short posterior ciliary (TSPCA) arteries were determined by color Doppler imaging. The menopausal group received HRT for 2 months, when all measurements were repeated for the 15 women who had received HRT on a daily basis. Results: The quality and amount of tear decreased (p < 0.01), IOP (p < 0.01) and RI of the CRA, TPCA and NPCA (p < 0.05) increased in postmenopausal women compared with the control group. After 2 months of HRT, the quality and amount of tear had increased (p < 0.001) and the IOP had decreased (p < 0.001). The PSV of the CRA and TSPCA had decreased (p < 0.05), as had the RI in the CRA (p < 0.001), NSPCA and TSPCA (p < 0.05). Conclusion: We conclude that age-induced changes on quality and amount of tear, IOP and retrobulbar blood flow are intensified by the menopause and that it may be possible to decrease the menopausal effects on these parameters by HRT.

The effect of povidone iodine on the corneal endothelium.

Purpose. Povidone iodine has been proven to be a valuable antiseptic solution in preparing the eye for surgery and is an alternative to postoperative topical antibiotics. No study has addressed the intraocular toxicity of povidone iodine after injection into the anterior chamber. We investigated the potential toxicity of povidone iodine on the corneal endothelium after injections into the anterior chamber in a rabbit model. Methods. In this study we used 24 eyes of 12 albino rabbits. The eyes were divided into the following three groups according to the drugs tested: group A, 5% povidone iodine; group B, 10% povidone iodine; group C, balanced salt solution. The injected eyes were evaluated by biomicroscopy, specular microscopy, corneal pachymetry, and transmission and scanning electron microscopy. Results. Corneal edema was observed in all eyes of groups A and B. In groups A and C, the endothelial cell morphology was not significantly changed and the mean endothelial cell count of the eyes did not change significantly (p = 0.5054). There was no significant difference in corneal thickness between groups A and C (p = 0.3823), but there was a significant difference between groups B and C (p = 0.0002). Transmission and scanning electron microscopy results were normal in group C but not in groups A and B. Conclusion. Povidone iodine in both 5% and 10% concentrations demonstrates severe toxicity when one drop of either concentration is placed directly in the anterior chamber. When povidone iodine is used in preparing the eye for intraocular surgery and as an alternative to postoperative antibiotics, the inadvertent leakage of povidone iodine into the anterior chamber must definitely be prevented.

Intraoperative mitomycin C in the treatment of pterygium.

Purpose. To evaluate the effectiveness of intraoperative mitomycin C in preventing the recurrence of primary pterygium. Methods. In this prospective, randomized study, 38 eyes of 35 patients with primary pterygium were evaluated. In 19 eyes, the “bare sclera technique” combined with intraoperative application of 0.2 mg/mL (0.02%) mitomycin C for five minutes was performed (mitomycin C treated group). The other 19 eyes—taken as control group—underwent surgical excision alone. Statistics were analyzed using the Mann-Whitney U test and the Fischers exact test. Results. Patients were 20–38 years of age. The mean age was 25.29 ± 5.08 in the mitomycin C treated group and 25.00 ± 5.19 in the control group. During the mean follow-up of 17.04 months (range, 12–36 months; SD = 5.89), 4 recurrences (21%) were observed in the mitomycin C treated group and 11 (57.8%) in the control group. The difference between the two groups was significant (p = 0.045). No postoperative complication was encountered in both groups except for recurrences. Conclusion. Intraoperative mitomycin C was found to be effective in preventing the recurrence of primary pterygium.

The short-term effect of adding brimonidine 0.2% to timolol treatment in patients with open-angle glaucoma.

Brimonidine, a highly selective α2-adrenoceptor agonist, was studied to determine its ocular hypotensive effect and side effects in patients with elevated intraocular pressure (IOP) while on continuing therapy with timolol. This was a prospective, randomized, placebo-controlled study in 15 patients with primary open-angle or pseudoexfoliation glaucoma on therapy receiving timolol 0.5% twice daily, with IOP greater than or equal to 22 mm Hg in one eye. IOP measurements, blood pressure and pulse rate were assessed on 2 days at a baseline and 1, 2, 4, 6 and 8 h later. A single drop of brimonidine 0.2% or placebo was added to treatment with timolol. The reductions in IOP at all time intervals observed with brimonidine + timolol were significantly greater than those with timolol + placebo. The maximum mean net decrease in IOP was 19.23 ± 10.60% at 4 h. Statistically significant decreases in systemic blood pressure and pulse rate without clinical symptoms were observed in the group receiving brimonidine + timolol. This study suggests that a combination of brimonidine and timolol may have potential in the treatment of glaucoma. Further clinical trials with brimonidine are indicated to assess its further role as adjunctive agent.

Acanthamoeba keratitis in a 5-year-old boy without a history of contact lens usage.

Purpose: This study was designed to report a case of acanthamoeba keratitis in a 5-year-old child without a history of trauma or contact lens usage. Methods: The history, clinical presentation, diagnostic, and therapeutic approaches were reviewed. Results: A 5-year-old child without any history of trauma or contact lens use was referred to our university clinic with an initial diagnosis of disciform herpetic keratitis. After 2 weeks of antibacterial and antiviral therapy, a corneal biopsy was performed for diagnostic purposes. The biopsy revealed acanthamoeba. Subsequently intensive therapy with chlorhexidine diacetate 0.02%, ketoconazole tb, hexamidine di-isethionate 0.1% was initiated. At the end of the first month, topical prednisolone acetate 1% was added to reduce inflammation, Chlorhexidine diacetate 0.02% and oral ketoconazole were discontinued, and hexamidine di-isethionate 0.1% was lowered to 4 × 1 and was administered for an additional 4 months. At the end of 5 months, all medications were withdrawn and amblyopia treatment was started. Conclusion: When dealing with keratitis in children, acanthamoeba should be considered even without history of contact lens usage or trauma.

A comparative study of the effectiveness of disinsertion and anterior transposition of the inferior oblique in the treatment of unilateral superior oblique palsy

PURPOSE. To compare the effectiveness of disinsertion of the inferior oblique muscle (DIO) with anterior transposition of the inferior oblique muscle (ATIO) in the treatment of vertical deviations resulting from superior oblique palsy. METHODS. In this prospective randomized study, 22 patients with unilateral superior oblique palsy were evaluated. Eleven patients underwent the DIO procedure (DIO group), and the other eleven underwent the ATIO procedure (ATIO group). Statistics were analyzed using the Wilcoxon and Mann-Whitney U tests. RESULTS. The mean preoperative primary-position hypertropia was 22.2 ± 6.2 prism diopters (?) in the DIO group and 23.1 ± 6.6 ? in the ATIO group; the mean preoperative hypertropia in adduction was 31.7 ± 6.9 ? in the DIO group and 31.8 ± 8.1 ? in the ATIO group. The mean follow-up was 18.8 months (SD: 10.2, range: 6–40 months). The mean reduction of hypertropia in primary-position in the ATIO group (mean: 18.5 ± 3.9 ?) was found to be significantly greater than in the DIO group (mean: 13.3 ± 1.9 ?) (p = 0.001). Even though the mean reduction of hypertropia in adduction in the ATIO group (mean: 27.7 ± 9.6 ?) was greater than in the DIO group (mean: 20.6 ± 6.2 ?), no statistically significant difference was found (p = 0.067). There was residual hypertropia in three (27.3%) patients who underwent the DIO procedure. No major postoperative complication was encountered in any of the patients. CONCLUSION. In vertical deviations resulting from superior oblique palsy, ATIO was found to be more effective than DIO in the reduction of primary-position hypertropia.

A comparison of the short-term hypotensive effects and side effects of unilateral brimonidine and apraclonidine in patients with elevated intraocular pressure

Purpose: To compare the short-term ocular hypotensive efficacy and side effects of 0.2% brimonidine and 0.5% apraclonidine in patients with elevated intraocular pressure (IOP). Methods: We performed a double-masked, placebo-controlled study to compare the efficacy of the application of 0.2% brimonidine and 0.5% apraclonidine for the effect of IOP, systemic blood pressure and heart rate in 20 newly diagnosed ocular hypertensive patients. Effects on the untreated fellow eye and ocular side effects were also determined. All measurements were performed 1, 2, 4, 6 and 8 h after the instillation of one drop. Results: Brimonidine and apraclonidine significantly reduced IOP from baseline at all observation times. No significant difference was observed between the treatment groups. IOP decreased significantly in the untreated fellow eye in the brimonidine group at 4-, 6- and 8-hour checks and at 6-hour checks in the apraclonidine group when compared with placebo. Blood pressure and heart rate decreased significantly in the brimonidine group compared with placebo. Apraclonidine did not affect blood pressure or heart rate any differently than placebo. The pupil diameter and the interpalpebral fissure width significantly increased in the apraclonidine group, but not in the brimonidine group. There were no significant differences in the overall incidence of foreign body sensation, burning and stinging and dry mouth in the treatment groups. Conclusions: In the short-term, brimonidine was effective in reducing IOP in patients with elevated IOP and was equivalent in efficacy to apraclonidine. On the other hand, a significant change in blood pressure and heart rate was observed with brimonidine; there was no change at all in the apraclonidine group.

Plasma antiphospholipid antibody levels in age-related macular degeneration.

PURPOSE To investigate the association of age-related macular degeneration (AMD) with plasma antiphospholipid antibody levels. METHODS This prospective study included 19 patients diagnosed as having dry-type AMD, 23 patients with exudative-type AMD, and 25 control subjects. Venous blood samples of the participants were obtained. Anticardiolipin antibodies (aCL) isotypes IgG and IgM were measured by means of an enzyme-linked immunosorbent assay. Lupus anticoagulant (LA) antibodies were measured by the dilute Russell viper venom time screen test. RESULTS The mean aCL IgG concentration in patients with exudative-type AMD was significantly higher than in patients with dry-type AMD and control subjects. The mean ± SE of aCL IgG levels in patients with exudative-type AMD and dry-type AMD and control subjects was 5.46 ± 1.26; 2.55 ± 0.78; and 0.32 ± 0.1, respectively. The mean aCL IgM levels and LA levels in the 3 groups were not statistically different. CONCLUSIONS Our findings suggest that elevated levels of serum aCL, a risk factor for cardiovascular and cerebrovascular diseases, may be associated with exudative-type AMD.

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.

A Modified Perfluoro-n-octane-Assisted Autologous Internal Limiting Membrane Transplant for Failed Macular Hole Reintervention: A Case Series.

The authors describe a modified perfluoro-n-octane (PFO)-assisted autologous internal limiting membrane (ILM) transplantation technique for macular hole (MH) reintervention and present results from a series of 11 patients. The authors harvested a free ILM flap and transplanted it into the MH under a PFO bubble. The time at which PFO is injected, the extent of coverage of PFO, and the sequence of fluid-air exchange (FAE) are crucial to overcome previously described technical difficulties of relieving the flap from forceps, stabilizing the flap into the MH, and prevention of flap dislodgement during FAE. A successful U-shaped closure was observed in 10 of 11 cases (90.9%). One case (9.1%) showed flat open closure. The postoperative visual gain was statistically significant (P = .01). [Ophthalmic Surg Lasers Imaging Retina. 2017;48:416-420.].