Orhan Zilelioglu

A possible link between the pseudoexfoliation syndrome and coronary artery disease.

PurposeThis is a collaborative case–control study from Ophthalmology and Cardiology departments of a tertiary care hospital, designed to explore the relationship between coronary artery disease (CAD) and pseudoexfoliation syndrome (PEX).MethodIn all, 50 patients with CAD proven by coronary angiography, and 50 controls with normal coronary angiographic findings were compared in terms of PEX, other vascular diseases, and retinal vascular findings. χ2-test and Students t-test were used for statistical analysis.ResultsThe number of patients with PEX among CAD (+) patients was substantially larger than controls. In all, 28 of 50 CAD (+) patients and only 12 of 50 CAD (−) patients had PEX. PEX was significantly associated with CAD (P=0.001). When all patients were regrouped according to the presence of PEX, patients with PEX did not differ from patients without PEX in terms of age (P=0.360) and sex (P=0.507), but the prevalence of CAD was higher (P=0.001) and fundoscopic findings of vascular diseases were significantly more prominent (P=0.0001) in PEX (+) patients.DiscussionWe demonstrated statistically significant difference in the prevalence of PEX in CAD patients, and also in the prevalence of CAD in PEX (+) individuals. These were striking differences. We should consider the possibility of the presence of PEX in CAD patients; and the predisposition of PEX (+) persons for CAD, which necessitates a fundus examination for findings of systemic vascular diseases.

A comparative study of tissue glue and vicryl suture for closing limbal-conjunctival autografts and histologic evaluation after pterygium excision.

Purpose: To compare clinical and histopathologic outcomes of tissue glue and vicryl suture to attach limbal conjunctival autografts in pterygium surgery. Methods: Twenty-four eyes of 24 patients were included in this study. All eyes had primary pterygia and were treated with limbal conjunctival autograft transplantation after pterygium resection. Tissue glue (Tisseel) was used to attach the limbal conjunctival autograft in 12 eyes and vicryl sutures in 12 eyes. Patients were followed for 6 months. Histopathologic examination was performed in both groups on postoperative days 1, 15, and 45. Main outcome measures were patient comfort, graft success, complications, histopathologic evaluation, and recurrence of pterygium. Results: Patient comfort was significantly higher in the tissue glue group than the vicryl suture group (P < 0.05). All grafts were intact in both groups during the follow-up period. No recurrence was observed during the 6-month follow-up in both groups. Foreign-body granulation tissue was not seen in any histopathologic studies in eyes with tissue glue, whereas it was observed in eyes with vicryl sutures from day 15 to day 45. The tissue glue was seen under the conjunctiva on the first postoperative day and was not seen on days 15 and 45. Conclusions: Our results showed that limbal conjunctival autografting is an effective surgical technique for the treatment of pterygium, and tissue glue was efficacious in securing the limbal conjunctival autograft in pterygium surgery. The use of tissue glue decreases patient symptoms during the postoperative period after pterygium surgery. Compared with sutures, tissue glue had no adverse effects on ocular tissue.

Congenital Color Blindness in Young Turkish Men

We investigated a healthy population of men from different regions of Turkey for the presence of congenital red-green color blindness. Using Ishihara pseudoisochromatic plates, 941 healthy men from the Turkish army were tested for congenital red-green color blindness. The prevalence of red-green color blindness was 7.33 ± 0.98% (5.10% protans and 2.23% deutans). These ratios were higher than other reported samples from Mediterranean Europe. Higher percentages of color blindness were found in regions with a lower education level and more consanguineous marriages.

Aqueous humour levels of topically applied ciprofloxacin and ofloxacin in the same subjects

Purpose To evaluate aqueous humour levels of topical 0.3% ciprofloxacin and 0.3% ofloxacin in the same subjects.Methods Thirty-two bilateral cataractous patients received topical 0.3% ciprofloxacin in one eye and 0.3% ofloxacin in the other eye before each cataract extraction. Eyedrops were repetitively instilled for 6 h. Aqueous humour samples were collected and assayed for drug concentrations by a method described originally by us using high-performance liquid chromatography.Results Mean aqueous ciprofloxacin and ofloxacin levels were 0.33 ± 0.04 μg/ml (mean ± SEM) and 1.34 ± 0.14 μg/ml respectively (p<0.0001).Conclusion Ofloxacin level in the aqueous humour is 4 times higher than that of ciprofloxacin in the same subjects.

Ocular findings in childhood-onset Behçet disease

PURPOSE To investigate the demographic characteristics and ocular features of patients with childhood-onset Behçet disease. PATIENTS AND METHODS Patients for this retrospective study were selected using the data obtained from medical records of 34 patients with childhood-onset Behçet disease being followed up in the Uveitis Department of Ankara Ulucanlar Eye Education and Research Hospital between January 2003 and May 2008. RESULTS Of 34 patients, 24 were boys (70.5%) and 10 were girls (29.4%). The average age of patients was 14.5 +/- 1.9 years (range, 10-16 years). Mean follow-up period was 4.5 +/- 2 years (range, 2-10 years). During the follow-up, panuveitis, posterior uveitis, and anterior uveitis were diagnosed in 18 (52.9%), 11 (32.3%), and 5 (14.7%) patients, respectively. Ocular findings included cataract in 20 patients (58.8%), posterior synechiae in 8 (23.5%), posterior capsular opacification secondary to cataract surgery in 8 (23.5%), vitreous condensation due to previous episodes of vitritis in 17 (50%), optic atrophy in 10 (29.4%), cystoid macular edema in 5 patients (14.7%), narrowed and occluded retinal vessels due to retinal periphlebitis and branched retinal vein occlusion in 2 (5.8%), neovascularization of the disk in 1 (2.9%), and phthisis bulbi in 1 patient (2.9%). CONCLUSIONS Based on the results that were obtained in this series, panuveitis was the most common type of uveitis in cases with childhood-onset Behçet disease. Cataract was the most common anterior segment complication. Optic atrophy was the most common posterior segment complication. Male predominance was determined in this study.

Phacoemulsification in Pseudoexfoliation Syndrome

Purpose: To compare the incidence of intraoperative and early postoperative complications (IEPC), visual outcomes, and change in intraocular pressure (IOP) between eyes with and without pseudoexfoliation syndrome (PEX) having cataract extraction by phacoemulsification. Material and Method: 800 eyes with PEX and 1,600 eyes without PEX having cataract extraction by phacoemulsification were included in this retrospective study. Evaluated parameters were incidence of IEPC, visual outcomes and change in IOP. χ2 and Student’s t test were used for statistical analysis. Results: There were no significant differences in the incidence of IEPC and visual acuity gain between the two groups (p > 0.05). Rise in IOP in the early postoperative period was significantly higher in the PEX group (p < 0.02). Conclusion: Patients with PEX who have phacoemulsification can achieve results similar to patients without PEX. IOP control in the early postoperative period seems to be more important in patients with PEX.

Long-term outcomes of heavy silicone oil tamponade for complicated retinal detachment.

Purpose To assess the long-term success rates and complications of heavy silicone oil tamponade (Oxane HD) in the management of complicated retinal detachment with proliferative vitreoretinopathy (PVR). Methods Twenty-one eyes of 21 patients with complicated retinal detachment and PVR were included in this study. Vitreoretinal surgery with heavy silicone oil (Oxane HD) tamponade was performed in all patients. Heavy silicone oil was injected by perfluorocarbon liquid-air-silicone oil exchange, and was removed after 3 months. The main outcomes of the surgery including the success and complication rates were evaluated during the mean follow-up period of 11.4±0.88 months. Wilcoxon signed ranks test was used for statistical analysis of visual acuity changes. The outcomes of our study were compared with those of the previous studies. Results All eyes had complicated retinal detachment with PVR Grade C3 or worse. Retinal detachment was rhegmatogenous in 6 eyes, secondary to previous detachment surgery in 11 eyes, secondary to proliferative diabetic retinopathy in 3 eyes, and secondary to perforating eye injury in 1 eye. The overall anatomic success rate was 80.9% at the end of the follow-up period. The overall visual success rate was 42.8%, with no statistically significant difference from baseline (p>0.05). Postoperative complications included severe reproliferation (4 eyes), intraocular pressure rise (3 eyes), anterior dislocation of silicone oil (2 eyes), posterior subcapsular cataract formation (4 eyes), vitreous hemorrhage (1 eye), rubeosis iridis (3 eyes), optic atrophy (1 eye), and ocular pain and photophobia (21 eyes). Conclusions According to the results of this study, vitreoretinal surgery with temporary heavy silicone oil tamponade appears to increase the anatomic success rates with minimal complication rate in cases with complicated retinal detachment and PVR.

Subretinal fluid levels of topical, oral, and combined administered ciprofloxacin in humans

AIMS To investigate the subretinal fluid (SRF) penetration of ciprofloxacin following topical, oral, and combined administration. METHODS 34 patients undergoing conventional retinal reattachment surgery were randomly assigned to three groups. Twelve patients received topical ciprofloxacin, 11 patients received oral ciprofloxacin, and the other 11 patients received combined drug administration. SRF drug level was measured by using high performance liquid chromatography method. RESULTS The highest drug concentrations of all tested modes were attained following combined administration and lowest following topical administration (p <0.001). The SRF drug concentration following oral administration was also significantly higher than that of topical administration (p <0.001). Concentrations after oral and combined administration did not differ significantly (p = 0.217). CONCLUSIONS Topical ciprofloxacin can penetrate SRF. Ocular bioavailability of ciprofloxacin in SRF after oral and combined administration is equivalent.

Penetration of topical, oral, and combined administered ofloxacin into the subretinal fluid

AIMS To assess the subretinal fluid (SRF) levels of ofloxacin following topical, oral or combined administration. METHODS 31 patients undergoing conventional retinal reattachment surgery were randomly assigned to three groups. Nine patients received topical ofloxacin, 11 patients received oral ofloxacin, and the other 11 patients received combined administration. Collected SRF samples were analysed for drug level by using high performance liquid chromatography. RESULTS SRF drug levels after oral and combined administration were significantly higher than that after topical administration (p=0.0002 and p=0.0002, respectively) while there was no significant difference between oral and combined administration (p=0.0844). CONCLUSIONS Ocular bioavailability of ofloxacin in SRF after oral and combined administration is equivalent. The addition of oral ofloxacin to topical therapy increased drug SRF penetration sixfold.

Comparative toxicity of 4 commonly used intravitreal corticosteroids on rat retina

OBJECTIVE To investigate the effects of 4 commonly used steroids (dexamethasone, triamcinolone, betamethasone, and methylprednisolone) on 50 retinas of 25 adult pigmented rats. STUDY DESIGN Experimental animal study. PARTICIPANTS Twenty-five pigmented Long-Evans male rats. METHODS Each steroid drug with 2 different doses (0.025 mL and 0.050 mL) was injected into the vitreous of each eye of 5 rats. The low drug dose was injected into the right eye and the high dose was injected into the left eye. Ten eyes of 5 randomly selected rats were used as a control group and intravitreal saline was injected into these eyes. Oxidative damage and intrinsic antioxidative capacity were determined by measuring retinal malondialdehyde (MDA) and glutathione (GSH) levels, respectively. RESULTS No statistically meaningful difference was observed in retinal GSH and MDA measurements in the low- and high-dose triamcinolone (1 and 2 mg), low-dose betamethasone (0.075 mg), and low-dose dexamethasone (0.1 mg) groups, compared with the control group. Both doses of methylprednisolone (1.6 mg and 3.2 mg), high-dose betamethasone (0.15 mg), and high-dose dexamethasone (0.2 mg) markedly altered retinal GSH and MDA levels. CONCLUSIONS The results of our study show that the toxicity of triamcinolone is not evident even in high doses. It may be used safely. We also suggest that intravitreal use of low doses of betamethasone and dexamethasone is safer than higher doses of these drugs and both doses of methylprednisolone.