Nagihan Ugurlu

Macula and retinal nerve fiber layer in migraine patients: analysis by spectral domain optic coherence tomography.

Abstract Aim: Investigating the retinal nerve fiber layer (RNFL), macular and ganglion cell complex thickness in eyes of migraine patients using optical coherence tomography. Methods: The study was designed as an observational cross-sectional study. 50 patients with migraine (30 patients with aura and 20 patients without aura) and 50 healthy volunteers were included. Optical coherence tomography was performed with Optovue technology. The fast RNFL thickness (3.4) scan, MM5, and GCC acquisition protocols were used. Results: There was no statistically significant difference in retinal thickness in any of the quadrants between the control group and the migraine patients (p > 0.05). The average RNFL thickness (110.50 vs 102.84 microns, p = 0.03) was significantly thinner in migrainers as compared to the control. The ANOVA did not reveal any significant difference between migrainers with aura, migrainers without aura, and the control group. The VAS (visual analogue scale) score of migraine patients was not statistically significantly correlated with any of the parameters, while the length of migraine history was negatively correlated with the average RNFL thickness (r = −0.32, p = 0.03). Conclusıon: The average RNFL thickness in the migraine patients was found to be thinner than that in the control group. In addition, we found a negative weak correlation between length of migraine history and the average RNFL thickness, supporting the possible association between these pathologies.

Oxidative Stress and Anti-oxidative Defence in Patients with Age-related Macular Degeneration

Abstract Purpose: To evaluate the oxidative stress status and anti-oxidative defence in patients with age-related macular degeneration (AMD). Methods: A total of 22 patients diagnosed with AMD and 23 age-matched healthy controls were included in the present study. Serum levels of total oxidant status (TOS), total antioxidant status (TAS), total thiol status (TTS) and paraoxonase 1 (PON1) activity were investigated from samples. Results: Significant increase in TOS levels were observed in sera of AMD patients (25.3 ± 12.8) compared to controls (15.0 ± 4.4). TTS (404.3 ± 55.3) and serum PON1 enzyme activities (163.0 ± 65.5) were significantly lower in AMD patients (594.0 ± 64.2) relative to control groups (252.8 ± 132.7). Conclusion: The results of the present study show that there is a significant increase in oxidative stress in AMD patients and significant decrease in antioxidant defence, in the total thiol level and in PON1 activity in AMD patients compared with controls. The increased oxidative stress and decreased antioxidant levels may have a synergistic role in AMD development.

Evaluation of biochemical and clinical markers of endothelial dysfunction and their correlation with urinary albumin excretion in patients with type 1 diabetes mellitus

Objective Endothelial dysfunction (ED) plays an important role in the pathogenesis of diabetic nephropathy. The purpose of the study was to determine flow mediated endothelial dependent vasodilatation (FMD) measurements and serum soluble (s) endothelin-1 (ET-1), intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule (VCAM-1) levels in patients with type 1 diabetes mellitus (T1DM) with or without increased urinary albumin excretion (UAE) and compare them with the healthy controls. Subjects and methods Seventy three patients with T1DM were enrolled. Patients were divided into two subgroups according to microalbumin measurements in 24-hr urine collections. The diabetic patients without microalbuminuria (41 patients) were defined as Group I and those with microalbuminuria (32 patients) were defined as group II. A hundred age and sex matched healthy subjects participated as the control group (Group III). Serum sET-1, sICAM-1, sVCAM-1 levels and FMD measurements were determined in all participants. Results Median FMD measurement was significantly lower in the diabetic groups compared with the control group (6.6, 6.4 and 7.8% in Group I, II and III, respectively) (p < 0.05). FMD was negatively correlated with age (p = 0.042). Median serum sICAM-1 level was higher in the patient groups compared to the control group (p < 0.05). Median serum sVCAM-1 level was higher in the group of patients with increased albuminuria compared to the normoalbuinuric and the control group (p < 0.05). Serum sVCAM-1 level was found to be positively correlated with degree of urinary albumin excretion (p < 0.001). Conclusion We assume that sVCAM-1 may be used as a predictive marker for risk stratification for nephropathy development and progression.

Photorefractive keratectomy in treatment of refractive amblyopia in the adult population

PURPOSE: To evaluate changes in corrected distance visual acuity (CDVA) after photorefractive keratectomy (PRK) in amblyopic cases. SETTING: Ankara Ataturk Training and Research Hospital 1st Ophthalmology Clinic, Ankara, Turkey. DESIGN: Retrospective case series. METHODS: The medical records of cases of anisometropic amblyopia treated by excimer laser PRK were reviewed. Inclusion criteria were no previous refractive correction, occlusion treatment, or chemical penalization before age 15 years. Anisometropic amblyopia was defined as a more than 2‐line difference in CDVA and a refractive error difference greater than 3.00 diopters (D) between 2 eyes of the same patient. Final visual acuity measurements were performed at the end of the sixth postoperative month. RESULTS: The study enrolled 16 hyperopic patients and 34 myopic patients with a mean age of 33.3 years. The mean preoperative spherical equivalent was −7.46 D ± 2.90 (SD) in myopic eyes and +4.15 ± 2.56 D in hyperopic eyes. The differences between the preoperative and postoperative uncorrected distance visual acuity and CDVA were statistically significant (P=.001). The mean CDVA was 0.47 ± 0.17 preoperatively and 0.61 ± 0.19 postoperatively. The CDVA decreased in 3 cases (6%), stayed the same in 12 cases (24%), and increased in 35 cases (70%). There was no statistically significant correlation between the severity of amblyopia and the increase in CDVA (r = 0.20, P=.165). CONCLUSION: After PRK to eliminate and correct refractive errors in anisometropic amblyopia, visual acuity improved significantly in 70% of adult patients with no previous occlusion or chemical penalization treatment. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Topographic and biomechanical evaluation of cornea in patients with acromegaly.

Purpose: The aim of this study was to compare topographic and biomechanical properties of corneas in patients with acromegaly with those of healthy individuals. Methods: Thirty-five patients with acromegaly (study group) and 35 healthy individuals (control group) were enrolled in this prospective study. Topographic measurements, including central corneal thickness (CCT), mean keratometry (K) value, K1, K2, surface asymmetry index, corneal volume (CV), and anterior chamber depth in the right eye of each participant were obtained using a Scheimpflug camera with a Placido disc topographer (Sirius; Costruzione Strumenti Oftalmici). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOP), and Goldmann-corelated intraocular pressure (IOPg) were measured using Reichert Ocular Response Analyzer (Reichert Ophthalmic Instruments). Results: Mean CCT, CV, CH, CRF, and IOPg values were higher in acromegalic eyes (549.3 ± 30.2 &mgr;m, 59.1 ± 3.1 &mgr;m, 11.3 ± 1.2 mm Hg, 11.3 ± 1.2 mm Hg, and 17.5 ± 2.9 mm Hg, respectively) than in healthy eyes (531.4 ± 33.6 &mgr;m, 57.4 ± 2.7 &mgr;m, 10.4 ± 1.2 mm Hg, 10.2 ± 1.6 mm Hg, and 14.8 ± 3.1 mm Hg, respectively; CCT, P = 0.042; CV, P = 0.032; CH, P = 0.044; CRF, P = 0.035; IOPg, P < 0.001). Conclusions: CCT, CV, CH, CRF, IOPg, and IOP with Goldmann applanation tonometry were significantly higher in acromegalic eyes. These corneal topographic and biomechanical properties, disease duration, and disease status should be considered when planning corneal refractive surgery and determining accurate intraocular pressure in patients with acromegaly.

Choroidal Changes and Duration of Diabetes

Abstract Purpose: We investigate changes in macular choroidal thickness in eyes without diabetic retinopathy of patients with various durations of diabetes, using enhanced depth imaging optical coherence tomography (EDI OCT). Methods: The 134 Type-2 diabetic patients who presented without diabetic retinopathy were prospectively imaged using EDI OCT on Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany) sd-OCT. The patients with diabetes were classified into three groups, according to the duration of diabetes: Group I (5–9 years, n = 63); Group II (10–14 years, n = 37); Group III (15–40 years, n = 34). The retinal and choroidal thickness was evaluated between these groups at central fovea and at the regions at 500-mm intervals up to 1500 mm temporal and nasal to the fovea. Results: The central foveal retinal thickness was significantly different between groups (group I: 273.05 ± 19.51 µ, group II: 267.12 ± 20.78 µ, group III: 261.34 ± 22.27 µ; p = 0.04). The choroidal thickness measurements at central fovea, at 500, 1000, and 1500 micron intervals temporal and nasal to the center of the fovea were not significantly different between groups. The duration of diabetes was weakly correlated with choroidal thickness in all measured distances and they were not statistically significant. The central foveal choroidal thickness was weakly correlated with serum creatinine (r = −0.18, p = 0.03). Conclusıon: Foveal retinal thickness was significantly decreased in patients with longer duration of diabetes. Duration of diabetes does not seem to be related to foveal chorodial thickness. On the other hand, the weak relation between creatinine and choroidal thickness may be evaluated further. The choroidal thickness changes that may be an early sign of nephropathy can be submitted to an easy, noninvasive scanning test at the same time.

Evaluation of Serum Fibrinogen, Plasminogen, α2-Anti-Plasmin, and Plasminogen Activator Inhibitor Levels (PAI) and Their Correlation with Presence of Retinopathy in Patients with Type 1 DM

Background. Diabetic retinopathy (DR) is the leading cause of blindness in the world. Retinopathy can still progress despite optimal metabolic control. The aim of the study was to determine whether different degrees of DR (proliferative or nonproliferative) were associated with abnormally modulated hemostatic parameters in patients with T1DM. Method. 52 T1DM patients and 40 healthy controls were enrolled in the study. Patients were subdivided into three categories. Group I was defined as those without retinopathy, group II with NPRP, and group III with PRP. We compared these subgroups with each other and the control group (Group IV) according to the serum fibrinogen, plasminogen, alpha2-anti-plasmin (α2-anti-plasmin), and PAI. Results. We detected that PAI-1, serum fibrinogen, and plasminogen levels were similar between the diabetic and control groups (P = 0.209, P = 0.224, and P = 0.244, resp.), whereas α2-anti-plasmin was higher in Groups I, II, and III compared to the control group (P < 0.01, P < 0.05, and P < 0.001, resp.). There was a positive correlation between serum α2-anti-plasmin and HbA1c levels (r = 0,268, P = 0.031). Conclusion. To our knowledge there is scarce data in the literature about α2-anti-plasmin levels in type 1 diabetes. A positive correlation between α2-anti-plasmin with HbA1c suggests that fibrinolytic markers may improve with disease regulation and better glycemic control.

Effect of refractive error on temperament and character properties.

AIM To determine the effect of refractive error on temperament and character properties using Cloningers psychobiological model of personality. METHODS Using the Temperament and Character Inventory (TCI), the temperament and character profiles of 41 participants with refractive errors (17 with myopia, 12 with hyperopia, and 12 with myopic astigmatism) were compared to those of 30 healthy control participants. Here, temperament comprised the traits of novelty seeking, harm-avoidance, and reward dependence, while character comprised traits of self-directedness, cooperativeness, and self-transcendence. RESULTS Participants with refractive error showed significantly lower scores on purposefulness, cooperativeness, empathy, helpfulness, and compassion (P<0.05, P<0.01, P<0.05, P<0.05, and P<0.01, respectively). CONCLUSION Refractive error might have a negative influence on some character traits, and different types of refractive error might have different temperament and character properties. These personality traits may be implicated in the onset and/or perpetuation of refractive errors and may be a productive focus for psychotherapy.

Early retinal and retinal nerve fiber layer effects of hydroxychloroquine: a follow up study by sdOCT

Abstract Context: The antimalarial drug hydroxychloroquine (HCQ), used in the treatment of rheumatologic disease, has been associated with the development of retinopathy. The long-term incidence of HCQ retinopathy has been estimated at 0.5% when recommended dosages (≤6.5 mg/kg per day) are used. Objective: Evaluating the patients for whom HCQ treatment will be started before and after treatment prospectively with spectral domain (sd) optical coherence tomography (OCT) to observe possible early changes in the retinal and retinal nerve fiber layer thickness. Materials and methods: Thirty-six patients from rheumatology clinic who have been started HCQ therapy had clinical examination and sdOCT imaging before and 6 months after starting treatment. The baseline ophthalmological examinations and visual field analysis (on automated Humphrey visual field (HVF) 10-2 perimetry, Humphrey HFA II-i 750 i, Carl Zeiss Meditec AG, Jena, Germany) were completely normal. The sdOCT was performed with the Optovue technology according to the manufacturer’s guidelines using EMM5, retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) scans. The retinal thickness values in central foveal, inferior and superior hemispheres, temporal, superior, nasal and inferior para- and perifoveal areas and the RNFL thickness of eyes were compared before and 6 months after starting treatment by the paired t test. Results: The retinal thickness values in central parafoveal (p = 0.02), and superior hemisphere (p = 0.01) in parafoveal area, parafoveal superior (p = 0.02), temporal (p = 0.03) and nasal (p = 0.04) quadrants were significantly thicker after 6 months of treatment. The thickness of the perifoveal area and the average RNFL thickness was not significantly different in any of the quadrants before and after starting HCQ treatment. The GCC thickness also did not change significantly different in superior and inferior hemisphere after starting treatment. Discussion and conclusion: We observe increased retinal thickness in parafoveal areas in patients on HCQ therapy at short term. Its clinical significance may be apparent in longer follow up studies.

Düşük-Orta Dereceli Miyopinin Düzeltilmesinde Ortokeratolojik Lens Uygulamalarımız

Gsm: +90 505 694 62 22 E-pos ta: sidikagerceger@mynet.com Ge lifl Ta ri hi/Re cei ved: 18.03.2013 Ka bul Ta ri hi/Ac cep ted: 23.05.2013 Emine Kalkan Akçay, Sıdıka Gerçeker*, Nurullah Çağıl, Nagihan Uğurlu, Fatma Turgut Yülek Atatürk Eğitim ve Araştırma Hastanesi, Göz Kliniği, Ankara, Türkiye *Nevşehir Dr. İ. Şevki Atasagun Devlet Hastanesi, Göz Kliniği, Nevşehir, Türkiye Öz gün Arafl t›r ma / Ori gi nal Ar tic le