Nilufer Ilhan

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.

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.

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 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.

Magnetic resonance imaging findings of the abducens nerves in type 1 Duane's retraction syndrome.

Abstract Purpose: To investigate nervus abducens and extraocular mucles in patients with Type 1 Duane’s retraction syndrome using high-definition magnetic resonance imaging. Methods: The study included 10 patients with Type I Duane’s retraction syndrome who underwent magnetic resonance imaging (MRI) of the brain and orbits. Results: Overall, 10 cases were included in the study. There were seven women and three men. The mean age was 5.2 years (1–15 years). MRI of the abducens nerve was performed in all cases. Of the cases, the left eye was involved in eight cases, whereas the right eye was involved in two cases. There was no bilateral eye involvement. Among the 10 patients clinically diagnosed as Type 1 Duane’s retraction syndrome, the abducens nerve could not be visualized in eight cases, whereas the nerve was hypoplastic in one case and bilateral abducens nerves were present in one case by MRI. The extraocular muscles were normal in all cases on T2 weighted coronal MRI of the orbits. Conclusion: Absence of abducens nerve and normal extraocular muscles was detected in patients with Type 1 Duane’s retraction syndrome at the affected side.

Repair of Iridodialysis Using 8-0 Polypropylene

Abstract Purpose: Investigate the effectiveness of repair of iridodialysis with 8-0 polypropylene. Methods: We present four cases of traumatic iridodialysis that were repaired by 8-0 polypropylene suture. Results: Better iris reposition and stability were achieved with 8-0 polypropylene suture despite wide degree traumatic iridodialysis in all patients. Conclusion: In this study, we used 8-0 polypropylene suture, which is thicker, cheaper, and more durable than 10-0 sutures. We suggest that usage of 8-0 polypropylene sutures may provide better iris repositioning.

Dual Approach Using Vitrectorhexis Combined with Anterior Vitrectomy in Pediatric Cataract Surgery

Purpose. To evaluate efficacy and safety of vitrectorhexis method for both anterior and posterior capsules combined with anterior vitrectomy in children with cataract. Methods. A retrospective chart review was performed for 19 children with cataract operated at a tertiary referral center. Dual approach including anterior and posterior segments was used during the surgery in terms of capsulotomy, intraocular lens (IOL) implantation, and anterior vitrectomy. Results. A total of 23 eyes of 19 patients were enrolled in the study. The mean age of the children was 39.4 ± 2.2 months (5–78). The mean postoperative followup duration was 20.6 ± 7.8 months (3–32). Intraoperative tear was observed only in one of 23 (4.3%) eyes during anterior capsulotomy. All of the patients had a clear visual axis and showed no IOL decentration. Conclusions. Dual approach using vitrectorhexis and anterior vitrectomy is an easy-to-perform technique that seems safe and effective in the short term for younger children.

Changes in the cornea related to sickle cell disease: a pilot investigation.

Purpose To investigate corneal structural changes (central corneal thickness, endothelial cell count, and cellular morphology) in patients with sickle cell disease (SCD). Methods This prospective study included 56 patients with SCD and 50 age- and sex-matched healthy subjects without any eye disease aside from refractive errors. Endothelial cell density (ECD), percentage of hexagonality, and the coefficient of variation in cell size (CV) were measured using noncontact specular microscopy, and central corneal thickness (CCT) was measured by pachymetry. Results The mean CCT value was 509.6 ± 20.7 μm in the study group and 520.8 ± 23.6 μm in the control group. The mean ECD, CV, and percentage of hexagonality values in the study group were 2712 ± 335 cells/mm2, 34.5 ± 5.3%, and 57.2 ± 6.6%, respectively, and 3030 ± 247 cells/mm2, 31.6 ± 5.0%, and 60.4 ± 6.9% in the control group, respectively. Endothelial cell density (p = 0.001), CCT (p = 0.011), CV (p = 0.005), and percentage of hexagonality values (p = 0.018) were significantly different between the study and control groups. Conclusions The results of the current study indicate that patients with SCD had considerable morphologic changes in the structure of the cornea when compared to healthy subjects.