Mesut Coskun

Relationship between mean platelet volume and retinopathy in patients with type 2 diabetes mellitus

ObjectivesTo evaluate the effect of mean platelet volume (MPV) on diabetic retinopathy in patients with type 2 diabetes mellitus.Materials and methodsIn this study, ocular findings and MPV values were retrospectively reviewed in 192 patients with type 2 diabetes mellitus. The patients were classified into four groups according to ocular findings, as follows: group 1, diabetic patients without diabetic retinopathy (n = 70); group 2, diabetic patients with non-proliferative diabetic retinopathy (n = 64); group 3, diabetic patients with proliferative diabetic retinopathy (n = 58); and group 4, healthy controls (n = 100).ResultsA significant difference was found in MPV values between groups 2 and 4 (P = 0.001), between groups 3 and 4 (P = 0.001), and between groups 1 and 4 (P = 0.004). No significant difference was found in MPV values between groups 1 and 2 (P = 0.241) and between groups 2 and 3 (P = 0.460); whereas there was a statistically significant difference between groups 1 and 3 (P = 0.015). The three diabetic groups (groups 1, 2, and 3) were compared with each other. While there was a statistically significant difference between groups 1 and 3 (P = 0.015), there was no significance between groups 2 and 3 (P = 0.46), and between group 1 and 2 (P = 0.241). Logistic regression analysis found a 1.40-fold increase in the risk of retinopathy development (OR: 1.404; P = 0.002) and a 1.46-fold increase in the risk of proliferative diabetic retinopathy (OR: 1.466; P = 0.002) as the MPV value increased.ConclusionsIn diabetic patients, the risk of retinopathy development increases with higher MPV values.

Assessment of Neutrophil/Lymphocyte Ratio in Patients with Age-related Macular Degeneration

Abstract Purpose: To investigate the neutrophil/lymphocyte ratio (NLR) as an indicator of inflammation in patients with age-related macular degeneration (AMD). Methods: Patients were evaluated by a review of records. The study included 81 patients with dry AMD (group 1), 84 patients with wet AMD (group 2), and 80 healthy age- and sex-matched controls (group 3). The NLR of the patients was obtained from the hospital laboratory archive and was measured by dividing the neutrophil count by the lymphocyte count. Results: A significant difference was found in NLR values between groups 1 and 2 (p = 0.017), groups 2 and 3 (p < 0.001), and groups 1 and 3 (p < 0.001). In correlation analyses, NLR was correlated positively with age (r = 0.22, p <0.001) and disease severity (r = 0.40, p < 0.001). Conclusions: Patients with AMD have higher NLR compared with controls, and NLR correlates with disease severity. NLR may be used as a biomarker of inflammation in AMD.

Pattern VEP is a useful technique in monitoring the effectiveness of occlusion therapy in amblyopic eyes under occlusion therapy

PurposeTo evaluate the effectiveness and clinical significance of pattern visual evoked potential (P-VEP) parameters on visual acuity in amblyopic patients under occlusion therapy.MethodsA total of 34 consecutive children with anisometropic amblyopia were included in this study. All patients underwent a full initial ophthalmologic and orthoptic evaluation. P-VEP test was performed in all cases and binocular vision was tested and recorded with Worth’s four-dot test and Bagolini striated glasses at each visit. Part-time occlusion therapy was performed by using adhesive patches.ResultsThe mean (±SEM) cycloplegic refractive error was +5.6 ± 0.6 diopters (D) in the amblyopic eyes and +1.8 ± 0.2 D in the normal eye. The mean levels of best-corrected visual acuity were statistically differed between each measurement for occlusion therapy (for each, p < 0.05). The ratio of the patients with binocular vision increased after 6 months occlusion therapy and the difference was statistically significant (p<0.05). In addition, P100 amplitude improved at each visit and the difference was significant when compared with baseline values (for each,p < 0.05).ConclusionsP100 amplitude of the P-VEP test parallels the improvement in subjective visual acuity in amblyopic eyes under occlusion therapy. Therefore, this test may be useful in monitoring the visual acuity in the preverbal or non-verbal patched patients.

The Significance of the Neutrophil/Lymphocyte Ratio as a Simple Indicator of Inflammation in Age-related Macular Degeneration

We would like to thank Dr. Ozgonul and Dr. Sertoglu for their interest in our article ‘‘Assessment of neutrophil/lymphocyte ratio in patients with agerelated macular degeneration.’’ Please find below the responses to their comments. Regarding their first comment, the majority of the patients included in the current study were yet to commence treatment. The remaining patients were only on ranibizumab, an anti-vascular endothelial growth factor (VEGF) treatment. Unlike bevacizumab and aflibercept, the systemic exposure of ranibizumab is quite low after intravitreal administration. The concentration of ranibizumab in the vitreous was determined at almost 90,000 times that of blood plasma levels. Moreover, two recent studies demonstrated that ranibizumab had no remarkable effect on plasma VEGF levels. On the basis of these pieces of information, the neutrophil/lymphocyte ratio (NLR) of the patients with age-related macular degeneration (AMD) may not be affected by the treatment modalities of our study. Regarding the second comment, patients whose leukocyte count was 412,000 cells/mL or 54000 cells/mL were excluded. This exclusion criteria was based on the literature. Systemic inflammatory response syndrome (SIRS) describes the generalized abnormal inflammatory response caused by a variety of factors (infection, burns, trauma, surgery, etc.). The range of leukocytes mentioned in the exclusion criteria represents one of the SIRS criteria. All the patients blood samples were evaluated in the laboratory of our hospital. The blood samples were collected in tubes containing dipotassium ethylenediaminetetraacetic acid (EDTA) and assessed within 60 minutes of the sampling. The neutrophil and lymphocyte counts were measured using the automatic blood counter Cell-Dyn 3700 (Abbott Diagnostics, Santa Clara, CA, USA). This device is reliable in the evaluation of full blood count in daily practice. Regarding their third comment, we agree with the authors concerning the lack of receiver–operating characteristic (ROC) analysis in the current study. The determination of sensitivity and specificity of NLR for patients with and without AMD would provide more valuable results. Further studies utilizing ROC analysis to evaluate NLR as a marker of inflammation in AMD patients will specify the diagnostic value of NLR. We used NLR as a simple, inexpensive, reliable indicator of inflammation in patients with AMD. C-reactive protein and erythrocyte sedimentation rate may be used with NLR in the assessment of inflammation and prognosis in patients, but they were not evaluated in this retrospective study due to deficient patient data. Moreover, inflammatory markers, such as tumor necrosis factor-alpha and interleukin-6 tests, were not used because they are expensive and are nonroutine tests for AMD patients.

Central retinal artery occlusion secondary to orbital cellulitis and abscess following dacryocystitis.

Purpose To report a case of dacryocystitis that progressed to orbital abscess resulting in the rare complication of central retinal artery occlusion. Methods A patient without any other known health problems presented with dacryocystitis complicated by orbital cellulitis, orbital abscess, and finally central retinal artery occlusion despite medical treatment. Results After 48 hours of medical treatment, there was no recovery, and there was loss of light perception; because of this, surgery indication was determined. Fundus fluorescein angiogram demonstrated findings of central retinal artery occlusion. There was no recovery of light perception after surgical intervention. Conclusions We report a case of orbital abscess following dacryocystitis in a healthy middle-aged woman resulting in the rare complication of central retinal artery occlusion. To our knowledge, this is the first report of central retinal artery occlusion secondary to orbital abscess following dacryocystitis.

Peripapillary Retinal Nerve Fiber Layer and Ganglion Cell–Inner Plexiform Layers Thickness in Ankylosing Spondylitis

Abstract Objective: To assess the thickness of the retinal nerve fibril layer (RNFL) in cases with ankylosing spondylitis (AS). Materials and methods: The study included 40 AS patients who had no history of acute and/or previous uveitis and 50 healthy controls. After detailed ocular examination, the thickness of the peripapillary RNFL, the macula, and the ganglion cell–inner plexiform layers (GCIPL) were measured by spectral domain optic coherence tomography (SD-OCT). The correlation between the duration of the disease and the thickness of the RNFL, the macula, and the GCIPL were analyzed in the patients who had AS. These patients were then placed into 2 groups according to their BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) score: patients with BASDAI score <4 and those with BASDAI score ≥4. The correlations between the BASDAI score and the mean GCIPL and temporal RNFL thickness were evaluated. Results: No significant difference was detected in the RNFL thickness of the AS patients and that of the controls (p = 0.407). Nor was any significant difference detected in the GCIPL thickness of the AS and the control groups (p = 0.091). In addition, no significant difference was found in the macular thickness when the AS group was compared to the control group (p = 0.139). However, a negative correlation was detected between the duration of the disease and the thickness of the temporal quadrant RNFLs (r = −0.334; p = 0.035). The temporal quadrant RNFL thickness and the mean thickness of the GCPIL were significantly thinner in the AS patients with BASDAI score ≥4 (p = 0.034 and p = 0.025, respectively). Also, the BASDAI score were negatively correlated to the temporal quadrant RNFL and GCIPL thickness (r = −0.332; p = 0.036 and r = −0.348; p = 0.028, respectively). Conclusion: RNFL thickness and GCIPL thickness of ankylosing spondylitis may be affected by the severity and duration of the disease.

Orbital compression syndrome complicated by epidural hematoma and wide cephalohematoma in a patient with sickle cell disease.

Orbital wall infarctions resulting in orbital and epidural hematomas are rare manifestations of sickle cell disease (SCD). We report orbital compression syndrome associated with an epidural hematoma and wide cephalohematoma in a 15-year-old boy with SCD. An infarcted orbital bone was observed on magnetic resonance imaging and three-phase bone scintigraphy with Technetium-99m methylene diphosphonate. The patient recovered completely without surgical intervention at the end of the fourth week. Prompt diagnosis and proper management are critical for complete recovery.

Effect of radioactive iodine therapy on lacrimal gland functions in patients with hyperthyroidism.

Background Radioactive iodine (RAI) therapy is preferred in the treatment of hyperthyroidism because of its effectiveness, noninvasiveness, and low costs. 131I has been detected in extrathyroidal tissues, such as in gastric mucosa, salivary glands, and lacrimal glands. To the best of our knowledge, there is no publication concerning the effects of RAI therapy for hyperthyroidism on tear production. In the present study, we evaluated whether or not the lacrimal glands are affected after RAI therapy when compared with pretreatment period. Methods The Schirmer and tear break-up time (TBUT) tests were used to assess 32 eyes of 16 patients with conditions that were diagnosed as hyperthyroidism before and at 3 and 6 months after RAI treatment. In addition, pretreatment values of patients were compared with that of controls. It was evaluated whether or not a correlation exists between the results and the dose or iodine uptake values. Results There was no significant difference between pretreatment values of Schirmer and TBUT tests obtained in the patient group and those of the control group (P > 0.05). In the patient group, there was a significant difference between the posttreatment and pretreatment values (P < 0.05). There was a positive correlation between uptake values obtained at 24 hours and the values obtained by TBUT and Schirmer tests on both eyes at 3 and 6 months. At 6 months, the uptake value at 24 hours was 28.83 ± 60 for both eyes in patients with TBUT test values less than 10, whereas it was 39.25 ± 7.88 for the right eye and 39.00 ± 6.85 for the left eyes in patients with TBUT test values greater than 10. The difference was statistically significant (P < 0.05). Conclusions In our study, we concluded that the decrease in mucin and aqueous production occurs due to affected lacrimal glands by RAI therapy; however, this effect is not dose dependent.

The effects of remifentanil and esmolol on increase in intraocular pressure due to laryngoscopy and tracheal intubation: a double-blind, randomized clinical trial.

Purpose:This study aimed to compare the effects of remifentanil and esmolol on the elevation of intraocular pressure (IOP) and hemodynamic response. Methods:After approval of the institutional Ethics Committee and obtaining informed consent, 60 adult patients with American Society of Anesthesiologists I-II status undergoing elective, nonophthalmic surgery were included in the study. Exclusion criteria were preexisting eye disease, neuromuscular disease, esophageal reflux, hiatus hernia, allergy to any of the study drugs, and the use of &bgr;-blockers, diuretics, or other antihypertensive agents. The patients were randomized into 2 groups by using the sealed-envelope method, as follows: group E (esmolol) and group R (remifentanil). A single intravenous dose of esmolol (0.5 mg/kg) or remifentanil (1 &mgr;g/kg) just before induction agents were given to patients in groups E and R, respectively. IOP, heart rate (HR), and mean arterial pressure (MAP) values were recorded before intubation and at 1, 3, 5, and 10 minutes after intubation. Results:The IOP decrease in group R was statistically significant compared with group E (P<0.01). HR values at 10 minutes after intubation were significantly decreased in group E compared with group R (P<0.05). There was no significant difference in MAP values between the groups. Conclusions:It was concluded that remifentanil is more effective than esmolol in preventing IOP elevation related to laryngoscopy and tracheal intubation, while there is no significant difference between the 2 agents in terms of HR and MAP.

Effect of intravitreal injection of dexamethasone implant on corneal endothelium in macular edema due to retinal vein occlusion

Abstract Objective: To evaluate the effects of dexamethasone (DEX) implant (Ozurdex®) on corneal endothelium in patients with retinal vein occlusion complicated with macular edema. Materials and methods: Patients (n = 31) received 1–3 intravitreal DEX implants in one eye. Measurements were intraocular pressure (IOP) at baseline and 1, 3, and 6 months after the first intravitreal injection and corneal specular microscopy and central corneal thickness (CCT) at baseline and 1 and 6 months. We analyzed endothelial cell density (ECD), coefficient of variation of cell size (CV), and percentage of hexagonality. Results: Mean follow-up period was 9.7 ± 3.3 months. Mean number of injections was 1.5 ± 0.8. Mean IOP values were 15.6 ± 2.6 mm Hg at baseline, 17.7 ± 3.6 mm Hg at one month, 16.4 ± 4.1 mm Hg at three months, and 16.0 ± 2.7 mm Hg at six months. There was a significant difference in mean IOPs at one month and six months (p = 0.008). There were no significant differences in mean ECD (p = 0.375), CV (p = 0.661), percentage of hexagonality (p = 0.287), and CCT (p = 0.331). Conclusion: Although intravitreal injection of 0.7 mg DEX causes moderate elevation of IOP, it does not seem to have detrimental effects on corneal endothelium at six months.