Mahmut Oğuz Ulusoy

Effect of fingolimod (FTY720) on choroidal thickness in patients with multiple sclerosis

OBJECTIVE Using spectral domain optical coherence tomography (SD-OCT), to compare the choroidal thickness in a healthy population (group 1), with newly diagnosed multiple sclerosis (MS) patients (group 2), with MS patients who underwent β-interferon monotherapy (group 3) and MS patients who underwent fingolimod therapy for 1 year (group 4) METHODS: Twenty-five control subjects (25 eyes), 24 newly diagnosed (24 eyes) MS patients, 22 MS patients who underwent fingolimod monotherapy for 1 year (22 eyes), and 24 MS patients who underwent β-interferon monotherapy for 1 year (24 eyes) were included in this study. The control group consisted of age- and gender-matched healthy individuals. The choroidal thickness measurements were performed using a high-speed and high-resolution SD-OCT device. The choroidal thickness measurements were compared using a One Way Anova and Post-Hoc Tukey test. RESULTS Ninety-five eyes of 95 participants were included in this study. The mean age of the control group was 27.83±4.60, and it was 26.83±6.79, 27.87±6. 46 and 27.58±6.65 in the newly diagnosed MS group, fingolimod group and β-interferon group, respectively. In fingolimod group N-1000, N-1500 and T-1500 was significantly lower than control group. (p=0.026, p=0.06 p=0.13) CONCLUSION: Choroidal thickness values at N-1000, N-1500 and T-1500 levels in fingolimod group were found lower than in control but higher than in newly diagnosed MS group. This result can be explained with the therapeutic effect of the fingolimod on MS.

Evaluation of the acute effect of haemodialysis on retina and optic nerve with optical coherence tomography

Purpose The primary objective of haemodialysis (HD) was to correct the composition and volume of body fluids. The aim of this study was to evaluate the acute effect of HD on mean arterial pressure changes and on retina and optic nerve with optical coherence tomography (OCT). Methods Fifty-three eyes of 28 patients were enrolled in this study. The patients’ retinal and RNFL thicknesses were measured by OCT and mean arterial pressure alterations were recorded before and immediately after HD session. Results The results show that while there was a reduction at central foveal thickness and ganglion cell layer thickness, central subfield and RNFL thickness were increased with HD session. But none of them were statistically significant (p = 0.320, p = 0.792, p = 0.744, p = 0.390). The mean arterial pressure of the patients decreased significantly (p < 0.05) but it was not correlated with retinal and RNFL values. Conclusion The changes in retinal and RNFL findings were not significant. But these alterations may effect the long term follow-up of the patients with retinal and optic nerve disease. Therefore it is important to pay attention HD session time for these patients’ measurements.

Is Ciliary Muscle Affected in Migraine Patients with Aura and without Aura

Background The aim of this study was to compare spherical equivalents (SE) and spherical equivalents with cycloplegic (CSE) values of migraine patients with and without visual aura, with those patients without migraine complaints. Material/Methods We included patients over the age of 18 years, who had 20/20 uncorrected vision, and who did not have ocular pathology in their examination. The patients were divided into 3 groups: Group 1: 86 eyes of 43 migraine patients without aura, Group 2: 38 eyes of 19 migraine patients with aura, and Group 3: 60 eyes of 30 patients without migraine. Spherical equivalents and spherical equivalents with cycloplegic from the auto-refractometrical values of the patients were compared. Results The mean age of the migraine and control patients was 34.2±8.3 and 33.6±10.8 years, respectively. Forty-three (69%) of 62 migraine patients had migraine without aura and 19 (31%) had migraine with aura. The right and left eyes of the patients were evaluated together and a significant correlation was found between the groups. To evaluate the impact of cycloplegia in patients, SE and CSE values were obtained and differences between these values were evaluated. It was found that the change in Group 2 patients was significantly lower than the change in Group 3 patients (p=0.024). Conclusions We found that the cycloplegic spherical equivalents values of our patients with aura were lower than control patients. We need further studies to reveal whether migraine with aura is the trigger or the result of those attacks.

Evaluation of Dry Eye Using Anterior Segment Optical Coherence Tomography in Patients With End-Stage Renal Disease Undergoing Hemodialysis: Dry Eye Disease in Hemodialysis Patients

The aim of the present study was to evaluate dry eye parameters with conventional tests and tear meniscus with Anterior Segment Optical Coherence Tomography (AS‐OCT) in patients with end‐stage renal disease (ESRD). Thirty‐eight ESRD patients undergoing hemodialysis, and 40 healthy individuals were enrolled. An ocular surface disease index questionnaire (OSDI) was administered. Before conventional dry eye tests, tear meniscus were evaluated using AS‐OCT. After a complete ocular examination, Schirmer and break‐up time (BUT) tests were performed and probable corneal staining was investigated. Schirmer test and BUT values were significantly lower in ESRD patients (P < 0.05). OSDI scores and corneal staining scores were significantly higher in ESRD patients (P < 0.05). Tear meniscus height, tear meniscus depth, and tear meniscus area, which were obtained by AS‐OCT were significantly lower in patients with ESRD (P < 0.05). Tear meniscus evaluation using AS‐OCT is an effective and non‐invasive method to assess tear meniscus in patients with ESRD. Patients with ESRD undergoing hemodialysis should obtain regular ophthalmic examination, especially for dry eye.

Evaluation of retrobulbar blood flow and choroidal thickness in patients with rheumatoid arthritis

PurposeTo evaluate whether retrobulbar blood flow and choroidal thickness (CT) are affected in patients with rheumatoid arthritis (RA), and the relationship between these values.MethodsWe evaluated 40 eyes of 20 RA patients and 40 eyes of 20 healthy controls. The enhanced depth imaging optical coherence tomography, color Doppler imaging, was held. Statistical analysis was performed.ResultsPeak systolic velocity (PSV) of ophthalmic (OA) and central retinal artery (CRA) were significantly higher in RA. No significant difference was observed when end-diastolic velocity (EDV) of OA and CRA was compared between the groups. The resistivity index (RI) of OA and CRA was higher in RA. Perifoveal/subfoveal CT was lower in RA. Negative correlation was detected between the RI of OA and the perifoveal CT, and a positive correlation was detected between RI of CRA and CT.ConclusionsOcular hemodynamics is effected by RA and can exaggerate ocular complications of various vascular diseases such as diabetes mellitus, hypertension, retinal vascular occlusions.

Prevalence of Corneal Astigmatism in Cataract Surgery Candidates from Turkey

ataract is the cause of the half of blindness worldwide and cataract extraction is one of the most commonly performed surgeries.1 Cataract surgery has made great progress since that first performed. Results of the surgeries became more satisfactory with advances in surgery techniques, intraocular lens (IOL) calculation formulas, IOL technologies and biometry techniques. But the patients always demand near-perfect vision in one step surgery without any postop spectacles. After correction of the spherical refractive error, residual corneal astigmatism became main factor affecting postoperative vision. Prevalence of Corneal Astigmatism in Cataract Surgery Candidates from Turkey

Are optic discs with large physiological cups really healthy

Glaucoma is a chronic progressive neurological optic nerve disorder that causes progressive loss of vision. There are two main factors that lead us to suspect glaucoma during an eye examination. These are high intraocular pressure and large optic disc cupping. With a lack of disease-specific changes on the optic nerve heads with glaucomatous cupping, even experienced clinicians make mistakes in discriminating normal cases from large physiologic cupping (LPC) cases. LPC was described in Lopes et al.’s [1] report as a vertical cup-to-disc ratio 0.6, normal visual field testing in both eyes, and at least 30 months of follow-up with no evidence of progressive optic neuropathy (assessed using serial color stereophotographs performed at least twice a year, with a maximum interval of 6 months) prior to spectral domain optical coherence tomography (OCT) imaging. Because of these mistakes, 20% of cases are misdiagnosed glaucoma as illustrated in studies and this is not a low rate given the other pathologies leading to cupping [2]. However, if the eye is not healthy, an early diagnosis opportunity of an existing disease can be missed. The most challenging cases for clinicians are individuals with LPC, normal intraocular pressure, and visual field, and there are no existing guidelines that explain what sort of management is to be used for these cases [1]. The retinal nerve fiber layer (RNFL) thickness is crucially important with regard to glaucoma diagnosis and follow-up [3]. Based on glaucomatous destruction, thinning is observed in RNFL. In our study, it was found that the RNFL thickness of the cases with LPC was significantly lower than healthy individuals (pZ 0.005). Although the cases evaluated in our study were not early glaucoma, this result can

Prevalence and associated factors of external punctal stenosis among elderly patients in Turkey

PURPOSE To estimate the prevalence of external punctal stenosis (EPS) in the elderly population and investigate associated factors. METHODS A total of 278 patients ≥65 years of age were evaluated for evidence of EPS from January to July 2016. Associated systemic, ocular, demographic, and lifestyle factors were investigated. Multiple logistic regression analyses were applied to evaluate the factors related to having EPS. P values <0.05 were considered statistically significant. RESULTS The prevalence of EPS in this study population was 63.3%, with a mean age of 70.67 ± 7.85 (65-92 years). The ocular factor that was most commonly related to EPS was chronic blepharitis (48.9%). EPS was also associated with taking glaucoma medications (95% CI, 0.08-0.96, p=0.043), smoking history (95% CI, 0.13-0.84, p=0.021), ectropion (95% CI, 0.004-0.26, p=0.001), complaints of tearing (95% CI, 1.11-3.52, p=0.02), and outdoor occupational activity (95% CI, 3.42-9.97, p<0.05). CONCLUSIONS EPS is more common in elderly patients than in the general population. Outdoor occupational activity, taking antiglaucomatous medications, ectropion, and smoking are significantly associated with EPS. In addition, surgical treatment decisions should be made after complete evaluation and interviewing the patients.

Post-thyroidectomy iatrogenic Horner's syndrome with heterochromia

Purpose To present a case of iatrogenic Horners syndrome seen together with the heterochromia in the post-thyroidectomy period. Methods A 23-year-old female patient was admitted to our clinic with complaints of low vision in the eye and difference in eye color that developed over the past two years. In the left eye, myosis and minimal ptosis (∼1 mm) was detected, and the color of the iris was lighter than the right eye. Results The pre-diagnosis of left iatrogenic Horners syndrome was finalized after 0.5% topical apraclonidine test. Conclusion Heterochromia can be observed in iatrogenic Horners syndrome.