Ozgur Ilhan

The efficacy of intravitreal triamcinolone acetonide on macular edema in branch retinal vein occlusion

Purpose To evaluate the effectiveness of intravitreal triamcinolone acetonide as primary treatment of macular edema in branch retinal vein occlusion. Methods Fifteen eyes of 15 patients with macular edema due to branch retinal vein occlusion (Group 1) who received 8 mg/0.2 ml of intravitreal triamcinolone injection as primary treatment were retrospectively evaluated. The control group (Group 2) consisted of 19 eyes of 19 patients who had received laser treatment for macular edema. The main outcome measures included best-corrected visual acuity, intraocular pressure, and macular edema map values of Heidelberg Retinal Tomograph II. Results In Group 1, mean visual acuity improved significantly from a mean logMAR (logarithm of minimal angle of resolution) value of 0.98±0.19 at baseline to a maximum of 0.24±0.24 during a mean follow-up time of 6.3 months. In the control group, the mean baseline logMAR visual acuity before laser treatment was 1.02±0.22, and it was 0.50±0.28 at 6-month examinations. Mean improvement in visual acuity at 1–, 3–, and 6-month examinations was significantly higher in Group 1 when compared with the control group (for each, p<0.001). The mean edema map value of Group 1 significantly decreased by 40% at 6-month examinations when compared with preinjection value (p<0.001). In Group 1, mean increase in intraocular pressure elevation was 19.8% at the 1-month, 26.9% at 3-month, and 5.7% at 6-month visits, but intraocular pressures were under control with topical antiglaucomatous medications. Conclusions Intravitreal triamcinolone acetonide injection may be a new and promising approach as initial therapy for macular edema due to branch retinal vein occlusion.

Serum Levels of Soluble P-Selectin Are Increased and Associated With Disease Activity in Patients With Behcet's Syndrome

Behçets syndrome (BS) is a relapsing, chronic, inflammatory disease characterized by endothelial dysfunction, atherothromboembogenesis, and leukocytoclastic vasculitis with complex immunologic molecular interactions. Generalized derangements of the lymphocyte and neutrophil populations, activated monocytes, and increased PMNLs motility with upregulated cell surface molecules such as ICAM-1, VCAM-1, and E-selectin, which are found on the endothelial cells, leukocytes, and platelets, have all been demonstrated during the course of BS. Our aim is to investigate the association of serum concentrations of soluble P-selectin in patients with BS, and to evaluate whether disease activity has an effect on their blood levels. This multicenter study included 31 patients with BS (15 men and 16 women) and 20 age- and sex-matched healthy control volunteers (11 men and nine women). Neutrophil count, erythrocyte sedimentation rate, and acute-phase reactants as well as soluble P-selectin levels were determined. The mean age and sex distributions were similar (P > .05) between BS patients (35 years) and control volunteers (36 years). Serum levels of soluble P-selectin in patients with BS (399 ± 72 ng/mL) were significantly (P < .001) higher when compared with control subjects (164 ± 40 ng/mL). In addition, active BS patients (453 ± 37 ng/mL) had significantly (P < .001) elevated levels of soluble P-selectin than those in inactive period (341 ± 52 ng/mL). This study clearly demonstrated that serum soluble P-selectin levels are increased in BS patients when compared with control subjects, suggesting a modulator role for soluble P-selectin during the course of platelet activation and therefore, atherothrombogenesis formation in BS, especially in active disease.

Do Non-Steroidal Anti-Inflammatory Drugs Delay Posterior Capsule Opacification After Phacoemulsification in Children? A Randomized, Prospective Controlled Trial

Purpose: To evaluate the efficacy of topical ketorolac for the prevention of posterior capsule opacification (PCO) in pediatric cataract surgery. Materials and methods: The eyes were prospectively and randomly assigned to receive postoperative 3-month topical ketorolac 0.5% drops with intact posterior capsule (group 1) or primary posterior capsulotomy combined with anterior vitrectomy (group 2). All children had uneventful corneal small-incision phacoemulsification with a primary implantation of a foldable acrylic posterior chamber intraocular lens (IOL). The frequency and timing of severe PCO was evaluated for each group and documented by slit-lamp examination and photography. Results: A total of 38 eyes of 27 children (15 girls, 12 boys) were included in the study. Among them 16 children had unilateral and 11 had bilateral surgery. All cataracts were developmental cases diagnosed between 1 and 7 years of age. There were 20 eyes in group 1 and 18 eyes in group 2. Mean pediatric age at surgery was 38.1 months (12–72 months) in group 1 and 34.2 months in group 2 children (12–78 months) (p > 0.05). Overall mean follow up was 26.3 months (6–48 months). Clinically significant PCO that finally needed neodymium:YAG laser application developed in four eyes (20.0%) in group 1 and in two eyes (11.1%) in group 2, and the difference was not statistically significant (chi-square test, p >0.05). Conclusions: Long-term postoperative use of topical ketorolac drops with the preservation of posterior capsule was found to be effective for the prevention of PCO in pediatric cataract surgery, at least during the period of this study.

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.

Spectral domain-optical coherence tomographic findings in patients with ankylosing spondylitis under anti-tumor necrosis factor-alpha therapy.

Abstract Objective: To evaluate the effect of tumor necrosis factor-alpha (TNF-α) blockade on the thickness of the peripapillary retinal nerve fiber layer (RNFL), the ganglion cell-inner plexiform layers (GCIPL), and the macula in ankylosing spondylitis (AS) patients under anti-TNF-α therapy. Materials and methods: Twenty-one patients with AS received etanercept, or adalimumab, or infliximab for at least 6 months. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were measured before and 6 months after the beginning of the treatment. Peripapillary RNFL, four regional fields (superior, inferior, nasal, and temporal), GCIPL, and macular thicknesses of the patients were analyzed by optical coherence tomography before the treatment, at 3 months and 6 months after the beginning of the treatment. Results: The mean BASDAI, ESR, and CRP values were 5.2 ± 1.5, 31.6 ± 21.7, and 15.7 ± 13.9, respectively, at the beginning of the treatment and 2.3 ± 1.7, 21.3 ± 15.1, and 10.1 ± 10.3, respectively, 6 months after the beginning of treatment. There were significant differences among the mean BASDAI, ESR, and CRP values at the beginning of treatment and 6 months later (p < 0.001, p = 0.007, and p = 0.009, respectively). There were no significant differences among peripapillary RNFL (p = 0.24), four regional fields (p = 0.98, p = 0.23, p = 0.09, p = 0.47), GCIPL (p = 0.25), or macular (p = 0.33) thicknesses of the patients during anti-TNF-α treatment. In addition, the mean intraocular pressure levels throughout the follow-up did not show significant variation on repeated-measures ANOVA (p = 0.77). Conclusions: TNF-α blockade does not seem to influence RNFL, GCIPL, or macular thickness of patients with AS in the short term.