Mehmet Orcun Akdemir

External ophthalmomyiasis caused by Oestrus ovis misdiagnosed as bacterial conjunctivitis.

Ophthalmomyiasis is the infestation of the eye by maggots or bots of certain flies which is mostly caused by Oestrus ovis. The most common form of ophthalmomyiasis is external that only the external surface of the eye is involved. Symptoms of external myiasis are nonspecific so it can be misdiagnosed as any other conjunctivitis if the doctors do not take myiasis into consideration. We report a case series of external ophthalmomyiasis. All the patients complained of mild foreign body sensation, redness, watery eyes and some of them had lid swelling. Larvae on the external surface of the patients must be removed under dim light. Larvae can hide in the fornices of the patients as happened in our two cases. Because of our lack of experience about ophthalmomyiasis, we misdiagnosed the first patient as bacterial conjunctivitis. Ophthalmomyiasis may be difficult to detect so ophthalmologists must keep in mind the possibility of ophthalmic myiasis especially in rural regions.

Plateletcrit in Ocular Pseudoexfoliation Syndrome.

Purpose: The aim of this study was to compare all platelet markers, especially plateletcrit (PCT, total platelet mass), in patients with and without ocular pseudoexfoliation (PEX) syndrome. Methods: One hundred six patients with ocular PEX syndrome (study group) and 106 individuals without ocular PEX syndrome (control group) were enrolled in this retrospective case-control study. The biochemical/hematological laboratory results of both the study and control groups were analyzed by a clinician blinded to the group assignments. The main outcome measures were the PCT, platelet count (PLT), mean platelet volume (MPV), and platelet distribution width (PDW). Results: The mean PCT in the study and control groups were 0.206%±0.520% and 0.171%±0.410%, respectively (P<0.001), and the mean PDW in the study and control groups were 16.12%±1.21% and 14.68%±1.40%, respectively (P<0.001). There were no differences in the MPV or mean PLT (P=0.138 and P=0.055, respectively). The PCT cutoff value was 0.180 (area under the receiver operating characteristics curve, 0.706; P<0.001; 65% sensitivity; 74% specificity). Conclusions: The PCT and PDW were significantly higher in patients with than without ocular PEX syndrome. These increased parameters may cause microvascular blood flow resistance and the heightened inflammatory response caused by excessive platelet activity, as with other cardiovascular diseases, and may also decrease aqueous humor outflow in ocular PEX syndrome.

The Effect of Dexamethasone Intravitreal Implant on Retinal Nerve Fiber Layer in Patients Diagnosed with Branch Retinal Vein Occlusion

ABSTRACT Purpose: To evaluate the effect of a single dose of intravitreal dexamethasone (DEX) implant on retinal nerve fiber layer (RNFL) thickness in patients with branch retinal vein occlusion (BRVO) in a 6-month period. Materials and methods: This retrospective observational study included the patients with BRVO who received intravitreal DEX implant and whose assessment included the baseline RNFL thickness measurements. The data of 26 eyes of 24 patients were retrospectively analyzed. Spectral domain optic coherence tomography was used to measure peripapillary RNFL thickness in six regional subfields. Intraocular pressure (IOP) values at each visit were recorded. The data of single dose DEX implant during 6 months were assessed. Results: The mean preoperative and postoperative 6th month nasal RNFL values were 85.4 ± 23.0 μm and 82.1 ± 17.6 μm, respectively, and the difference between the measurements was not statistically significant (p = 0.372). There was a slight decrease in the mean RNFL values postoperatively compared to the baseline values in all quadrants except supero-temporal quadrant; however, none of them reached statistically significant level (p > 0.05). The mean IOP values before and 6 months after implantation were 15.7 ± 2.9 mmHg and 16.5 ± 4.2 mmHg, respectively. The difference between the 6th month IOP values and baseline IOP values was not statistically significant (p = 0.236). Conclusion: Intravitreal DEX implant seems to have no adverse effect on RNFL thickness in BRVO patients in a 6-month period.

In-vivo corneal biomechanical analysis of unilateral keratoconus

AIM To evaluate and compare corneal biomechanical findings measured by ocular response analyzer, topographic and pachymetric findings in patients with unilateral keratoconus patients and healthy controls. METHODS This is an observational, case-control study. Patients with keratoconus in one eye and forme fruste keratoconus in the fellow eye were compared with sex and age matched with controls healthy subjects. All subjects were evaluated with rotating scheimpflug imaging system. The receiver-operating-characteristic curves were analyzed to evaluate the sensitivity and specificity of the parameters. RESULTS Twenty-seven patients with keratoconus in one eye and forme fruste keratoconus in the fellow eye were compared with 40 eyes of 40 normal subjects. Corneal hysteresis (CH) was 8.0±1.7 mm Hg in keratoconus group, 8.3±1.6 mm Hg in forme fruste keratoconus group, and 9.8±1.6 mm Hg in control groups (P=0.54 between keratoconus and forme fruste keratoconus groups, P<0.01 between control group and other groups). Corneal resistance factor (CRF) was 7.1±2.2 mm Hg in keratoconus group, 7.8±1.2 mm Hg in forme fruste keratoconus group and 9.9±1.5 mm Hg in control group (P<0.001 between control group and other groups). Using receiver-operating-characteristic analysis, the area under curve values of the parameters to distinguish forme fruste keratoconus from control subjects were: CH (0.768), CRF (0.866). Best cut-off points were 9.3 mm Hg and 8.8 mm Hg for CH and CRF respectively. CONCLUSION Ocular response analyzer parameters (CH and CRF) are found to be significantly lower in forme fruste keratoconus patients compared to normal control subjects.

An 11-year Review of Keratoplasty in a Tertiary Referral Center in Turkey: Changing Surgical Techniques for Similar Indications

Objectives: Study aims to evaluate the indications and surgical techniques for corneal transplantation and to report changes in trends for preferred keratoplasty surgical techniques. Methods: Clinical records of 815 consecutive corneal transplantations between January 1, 2004 and December 31, 2014 in Haydarpasa Numune Training and Research Hospital Eye Clinic were analyzed and classified into seven broad groups according to indications. Main outcome measures were change of leading indications and trends for surgical techniques. Results: Leading indications for keratoplasty were keratoconus (KCN) (27.7%), bullous keratopathy (BK) (23%), postinfectious corneal scars (13.5%), regrafts (13.1%), corneal dystrophies (12.1%), and noninfectious corneal scars (5.4%). Regrafts were the only indication with a significantly increasing trend (P<0.01). Since the introduction of lamellar keratoplasty (LK) techniques including deep anterior lamellar keratoplasty (DALK) and Descemet stripping automated endothelial keratoplasty (DSAEK), there was a significant increasing trend in number and percentage of both LK techniques (DALK; P=0.001 and P=0.007, and DSAEK; P<0.001 and P<0.001, respectively) and a significant corresponding decline in the percentage of penetrating keratoplasty (PK) (P<0.01). Similarly, DALK and DSAEK replaced PK as the preferred surgical technique for KCN and BK indications, (P=0.007 and P=0.01, respectively). Although PK was the most common surgical technique over the 11-year period (54.7%), both anterior and posterior LK techniques showed an emerging trend as the procedures of choice when indicated. Conclusions: No major shift was observed in the clinical indications for corneal transplantation over the previous 11 years, except for regrafts. Lamellar keratoplasty techniques largely overtook the PK technique, but PK was still the overall preferred technique in the era when both LK techniques were used.

Vitamin B12 deficiency evaluation and treatment in severe dry eye disease with neuropathic ocular pain

PurposeThis study aims to understand the effect of vitamin B12 deficiency on neuropathic ocular pain (NOP) and symptoms in patients with dry eye disease (DED).MethodsPatients with severe DED (without receiving topical artificial tears treatment) and ocular pain were enrolled (n = 90). Patients with severe DED and vitamin B12 deficiency (group 1, n = 45) received parenteral vitamin B12 supplement + topical treatment (artificial tears treatment + cyclosporine), and patients with severe DED and normal serum vitamin B12 level (group 2, n = 45) received only topical treatment (artificial tears treatment + cyclosporine). Patients were evaluated by the ocular surface disease index (OSDI) questionnaire, 3rd question (have you experienced painful or sore eyes during last week?) score of OSDI as a pain determiner and pain frequency measure), tear break up time (TBUT), and Schirmer’s type 1 test. We compared the groups’ OSDI, TBUT, and Schirmer’s test recordings at the first visit and after 12 weeks retrospectively.ResultsThe OSDI score, 3rd OSDI question score, TBUT, and Schirmer’s test results improved after 12 weeks (p < 0.001 for each group). The mean vitamin B12 level at enrollment was 144.24 ±43.36 pg/ml in group 1 and 417.53 ±87.22 pg/ml in group 2. The mean vitamin B12 level in group 1 reached to 450 ±60.563 pg/ml after 12 weeks of treatment. The mean score changes between the groups were not statistically significant; however, the decrease in the OSDI questionnaire score (-30.80 ±5.24) and 3rd OSDI question score (-2.82 ±0.53) were remarkable in group 1 (Table 2). The mean TBUT increase was +7.98 ±2.90 s and Schirmer’s test result increase was +12.16 ±2.01 mm in group 1. The mean TBUT increase was +6.18 ±1.49 s and Schirmer’s test result increase was +6.71 ±1.47 mm in group 2.ConclusionsThese findings indicate that vitamin B12 deficiency is related with NOP. It may be important to consider measuring the serum vitamin B12 level in patients with severe DED presenting with resistant ocular pain despite taking topical treatment.

Peripapillary Choroidal Thickness and Retinal Nerve Fiber Layer in Untreated Patients with Obstructive Sleep Apnea-Hypopnea Syndrome: A Case–Control Study

ABSTRACT Purpose: To evaluate peripapillary choroidal thickness (PPCT), central macular choroidal thickness (CMCT), and retinal nerve fiber layer (RNFL) thickness in untreated patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: This prospective, randomized, and comparative study was conducted in a university ophthalmology clinic. 106 eyes of 106 patients with OSAHS and 44 eyes of 44 healthy individuals were evaluated in this study. Only right eyes were evaluated. The patients with OSAHS were divided into three groups as mild (group 1), moderate (group 2), and severe (group 3) according to apnea-hypopnea index. The PPCT, CMCT, and RNFL measurements were performed by using spectral domain optical coherence tomography with enhanced depth imaging technique. The main parameters assessed were PPCT-Temporal, PPCT-Superior, PPCT-Nasal, PPCT-Inferior quadrants, CMCT, and RNFL thicknesses. Results: The PPCT of all quadrants was significantly thicker in the control group compared with the moderate and severe subgroups of OSAHS (p < 0.05). The PPCT-Superior and PPCT-Temporal were significantly thinner in the mild subgroup compared with the control group (p = 0.003 and p = 0.028, respectively). There was no difference between the control and mild groups regarding the RNFL thicknesses except nasal RNFL and inferotemporal RNFL which are thinner in the mild group. The RNFL thicknesses of all quadrants were significantly thicker in the control group compared with moderate and severe subgroups (p < 0.05). The CMCT was significantly thicker in the control group compared with all subgroups of OSAHS (p < 0.05). Conclusions: In OSAHS patients, PPCT, CMCT, and RNFL were significantly thinner compared with the control group. These results may explain why OSAHS patients are prone to normotensive glaucoma.

Long-Term Effect of Botulinum Toxin in the Treatment of Benign Essential Blepharospasm and Hemifacial Spasm

Yazışma Adresi/Address for Correspondence: Dr. Mehmet Orçun Akdemir, Bülent Ecevit Üniversitesi Tıp Fakültesi, Göz Hastalıkları Anabilim Dalı, Zonguldak, Türkiye Tel.: +90 372 261 29 72 E-posta: doktorcun@yahoo.com Geliş Tarihi/Received: 29.11.2013 Kabul Tarihi/Accepted: 24.06.2014 Türk Oftalmoloji Derneği 47. Ulusal kongresinde sözlü bildiri olarak sunulmuştur. Amaç: Bu çalışmada kliniğimizde uzun süreli botulinum toksin A (BTA) enjeksiyonu uyguladığımız benign esansiyel blefarospazm (BEB) ve hemifasiyal (HFS) spazm tanılı hastalarda erken ve geç dönem ilaç dozları ile iyilik süreleri karşılaştırıldı. Ge reç ve Yön tem: BEB ve HFS tanısı nedeniyle BTA tedavisi alan hastaların kayıtları geriye dönük olarak incelendi. On enjeksiyon ve üstü tedavi alan, düzenli takipli 12 hasta çalışmaya dahil edildi. İlk 5 enjeksiyon ve son 5 enjeksiyon dozları ile iyilik süreleri karşılaştırıldı. Bulgular: On iki hastanın 6’sı BEB (4 kadın, 2 erkek), 6’sı ise HFS (5 kadın, 1 erkek) nedeniyle tedavi almıştı. Hastaların ortalama takip süresi tüm hastalarda 66,17 ay, BEB grubunda 51,83 ay, HFS grubunda ise 90,33 ay idi. Ortalama tedavi dozu BEB grubunda 40,79 U, HFS grubunda 29,07 U idi. Tedavi sonrası iyilik süreleri değerlendirildiğinde, BEB grubunda ilk 5 enjeksiyon sonrası iyilik süreleri ortalaması 16,1 hafta iken, son 5 enjeksiyon sonrası ortalama iyilik süresi 18,9 hafta idi (p=0,172). HFS grubunda ise ilk 5 enjeksiyon sonrası iyilik süresi 23,6 hafta iken son 5 enjeksiyon sonrası iyilik süresi 23,0 hafta idi (p=0,463). BEB grubunda son 5 enjeksiyon sonrası iyilik süresinde, ilk 5 enjeksiyon sonrası iyilik süresine göre 2,7 hafta artış saptandı. Sonuç: BTA enjeksiyonu BEB ve HFS hastaları için güvenli, etkili bir tedavi yöntemidir. Enjeksiyon dozları uzun dönemde değişmemekle beraber tedavi sonrası iyilik süresi HFS grubunda değişmemişken, BEB hastalarında istatistiksel olarak anlamlı olmasa da iyilik süresinde uzama olmuştur. (Turk J Ophthalmol 2015; 45: 9-13) Anah tar Ke li me ler: Blephrospazm, botulinum toksin, hemifasiyal spazm

Spontaneous Resolution of Posterior Subcapsular Cataract in a Patient with Newly Diagnosed Type 1 Diabetes Mellitus

Yazışma Adresi/Address for Correspondence: Dr. Mehmet Orçun Akdemir, Bülent Ecevit Üniversitesi Tıp Fakültesi, Göz Hastalıkları Anabilim Dalı, Zonguldak, Türkiye Gsm: +90 505 397 46 92 E-posta: doktorcun@yahoo.com Geliş Tarihi/Received: 06.01.2014 Kabul Tarihi/Accepted: 24.06.2014 Sayın Editör, Erkek, 25 yaşındaki hasta üç aydır iki gözde az görme şikayetiyle kliniğimize başvurdu. Oftalmolojik muayenesinde, her iki gözde de en iyi düzeltilmiş görme keskinlikleri üç metreden parmak sayma düzeyindeydi. Göz içi basıncı sağda 10, solda 12 mmHg ölçüldü. Biyomikroskopik muayenede her iki gözde arka kapsül altı katarakt izlendi (Resim 1). Fundus incelemesinde normal muayene bulguları gözlendi. Hastanın öyküsünde; iki ay önce tip 1 diabetes mellitus tanısı konulduğu ve insülin tedavisi başlandığı öğrenildi. Oftalmolojik muayene esnasındaki açlık kan şekeri 110 mg/dL, tokluk kan şekeri 89 mg/dL idi. Sağ göze komplikasyonsuz fakoemülsifikasyon cerrahisi ve göz içi lens implantasyonu yapıldı. Ameliyat sonrası birinci gün görme keskinliği 20/32, göz içi basıncı 15 mmHg idi. Biyomikroskopik muayenesinde hafif ön kamara hücre reaksiyonu dışında özellik saptanmadı. Ameliyat sonrası birinci ay kontrolünde hastanın şikayeti yoktu ve ameliyat edilmeyen sol gözün görmesinin arttığını belirtti. Sağ gözün görme keskinliği 20/20 idi. İlk muayenesinde üç metreden parmak sayma düzeyinde olan sol gözün en iyi düzeltilmiş görme keskinliği, herhangi bir oftalmolojik müdahale yapılmadan 20/32 seviyesine yükselmişti. Biyomikroskopik muayenede sol gözdeki arka kapsül altı kataraktın tedavisiz gerilediği görüldü (Resim 2). Ameliyat ertelenerek hasta takibe alındı.