Özlem Yenice

Short-wavelength automated perimetry in patients with migraine

BackgroundThe aim was to investigate short-wavelength sensitivity deficits in patients with migraine.MethodsFifteen migraine and 18 age-matched healthy volunteers with normal ophthalmologic examination participated in this study. Migraine characteristics were graded by the Migraine Disability Assessment Questionnaire (MIDAS). All participants underwent SWAP (short wavelength amplitude perimetry) testing using a Humphrey field analyzer; there was a 30-2 presentation pattern.ResultsShort wavelength amplitude perimetry parameters for mean deviation (MD; p<0.0001) and pattern standard deviation (PSD; p<0.0001) were significantly worse in the migraine group. In the migraine group 53.3%. of eyes had glaucoma hemi-field tests (GHT) outside normal limits and 10 of these had early glaucomatous visual field loss. Statistically significant correlations were found between frequency of migraine attacks and MD (p=0.02; r=0.56) and PSD (p=0.03; r=0.41) and also between the MIDAS score and MD (p=0.03; r=0.49) and PSD (p=0.04; r=0.51). In all migraine cases with early glaucomatous visual field defect a corresponding site of the head was predominantly involved in headache (p=0.03).ConclusionSome patients with severe migraine have earlier defects on SWAP suggesting a common vascular insult of glaucoma and migraine, and all migraine cases with high MIDAS scores should be further evaluated for early glaucomatous visual field defects using SWAP.

Next generation sequencing identifies mutations in Atonal homolog 7 (ATOH7) in families with global eye developmental defects

The atonal homolog 7 (ATOH7) gene encodes a transcription factor involved in determining the fate of retinal progenitor cells and is particularly required for optic nerve and ganglion cell development. Using a combination of autozygosity mapping and next generation sequencing, we have identified homozygous mutations in this gene, p.E49V and p.P18RfsX69, in two consanguineous families diagnosed with multiple ocular developmental defects, including severe vitreoretinal dysplasia, optic nerve hypoplasia, persistent fetal vasculature, microphthalmia, congenital cataracts, microcornea, corneal opacity and nystagmus. Most of these clinical features overlap with defects in the Norrin/β-catenin signalling pathway that is characterized by dysgenesis of the retinal and hyaloid vasculature. Our findings document Mendelian mutations within ATOH7 and imply a role for this molecule in the development of structures at the front as well as the back of the eye. This work also provides further insights into the function of ATOH7, especially its importance in retinal vascular development and hyaloid regression.

Influence of serum levels of sex hormones on intraocular pressure in menopausal women.

PurposeThe purpose of this study was to assess the effect that changes in sex hormone levels have on intraocular pressure (IOP) in menopausal women. Subjects and MethodsThirty menopausal women on hormone replacement therapy and 32 menopausal women who had never received hormone replacement therapy (HRT), matched for age and duration of amenorrhea, participated in this study. Intraocular pressures were measured with Goldmann applanation tonometer. Serum levels were measured for estradiol, free testosterone, and follicle stimulating hormone (FSH). The influence of serum hormone levels on IOP was assessed by correlation analysis. ResultsThe mean IOP of postmenopausal women receiving HRT (13.29 ± 2.28 mm Hg) was not significantly different from that of menopausal women not receiving HRT (13.56 ± 2.5 mm Hg, P = 0.24). Higher testosterone levels were associated with higher IOPs in women receiving HRT (r = 0.48, P = 0.02) and in those not receiving HRT (r =0.42, P = 0.003). No significant correlations were observed between IOP and serum levels of estradiol and FSH in either group. ConclusionOur data provide evidence for a relation between serum testosterone levels and IOP in menopause. Higher testosterone seems to have a tendency to increase IOP in menopausal women.

Tear production during the neonatal period

PURPOSE To measure tear secretion in term and preterm infants to assess whether tear secretion correlates with the maturity of the infants and to evaluate the changes in tear production during the neonatal period. DESIGN Prospective, observational case series. METHODS Ninety-six term and 22 preterm medically stable infants were studied. Post-conceptional age and birth-weight of each infant were recorded. Tear secretion was measured by the Schirmer test before (total tear secretion) and after (basal tear secretion) the instillation of topical anesthetic agent. Both eyes were tested consecutively. The initial tear measurements were performed within the first 2 days of life, and tear measurements were repeated at 2 weeks and 4 weeks after birth. RESULTS The mean total tear production was 16.3 (+/-3.6) mm in term and 7.4 (+/-3.2) mm in preterm infants. The mean basal tear production was 7.3 (+/-3.2) mm in term and 3.5 (+/-1.3) mm in preterm infants. Total tear secretion significantly correlated with birth-weight (r, 0.42, P =.04) and post-conceptional age (r, 0.56, P =.006) in preterm infants. For term infants, total tear secretion significantly increased at 2 weeks (18.1 +/- 3.4 mm, P <.001) and 4 weeks (19.5 +/- 4.1 mm, P <.001) after birth. For preterm infants, a significant increase in total tear production was observed at the fourth week (11.5 +/- 3 mm, P <.001). CONCLUSION Tear production in newborns depends on the maturity of the infants and increases substantially during the neonatal period. Preterm infants have reduced tear secretion compared with term infants.

Problems with Attempted Chorioretinal Venous Anastomosis by Laser for Nonischemic CRVO and BRVO

Purpose: To report the complications and long-term results of laser-induced chorioretinal venous anastomosis in vein occlusions. Patients and Methods: Eight consecutive eyes, 3 with central retinal vein (CRVO) and 5 with branch retinal vein occlusion (BRVO), were observed for up to 5 years after attempted laser-induced chorioretinal venous anastomosis. Results: Successful chorioretinal venous anastomoses were created in 2 (25%) eyes. Patients had severe complications, including vitreous hemorrhage, choroidal neovascular membrane, choriovitreal neovascularization, rubeosis iridis and neovascular glaucoma. Conclusion: The utilization of a chorioretinal venous anastomosis by laser with proposed laser settings as a therapeutic modality should be further analyzed, and a careful long-term follow-up must be done to avoid vision-threatening complications.

Colobomatous macrophthalmia with microcornea syndrome: report of a new pedigree.

Colobomatous macrophthalmia with microcornea syndrome (MIM 602499) is a very rare eye malformation. To date, only two families with a total number of eight patients have been reported. We report on 13 additional cases in a single three‐generation family and describe the eye findings and quantitative parameters of corneal curvature and axial ocular dimensions. All affected relatives had bilateral involvement with typical inferonasal iris coloboma, chorioretinal coloboma, microcornea, and varying degrees of axial enlargement associated with myopia. Additional findings included flatter corneal curvatures and shallower anterior chambers. Iridocorneal angle abnormalities associated with elevation of intraocular pressure were detected in three patients. The pedigree confirms the autosomal dominant pattern of inheritance with complete penetrance.

Pars Plana Vitrectomy and Intravitreal Liposomal Amphotericin B in the Treatment of Candida Endophthalmitis.

Candida endophthalmitis is a common cause of fungal endophthalmitis. A case of bilateral endogenous endophthalmitis caused by Candida albicans without candidemia in an otherwise healthy 77-year-old man was reported. The patient underwent bilateral pars plana vitrectomy and intravitreal liposomal amphotericin B injections in addition to systemic fluconazole therapy. Postoperatively, a significant decrease of inflammation and resolution of abscesses were observed in both eyes. Vision improved in the left eye but remained constant in the right eye because of secondary cataract formation. To the best of our knowledge, this is the first report on the use of liposomal amphotericin B intravitreally in a patient with bilateral endogenous candida endophthalmitis. No evidence of clinical ocular toxicity was observed with the liposomal form of amphotericin B injection.

Conservative Treatment of Isolated Medial Orbital Wall Fractures

The authors report a case of acute development of an extensive retrobulbar abscess 3 weeks after an orbital floor fracture. Urgent drainage of the abscess was performed by an anterior transconjunctival approach. A dramatic recovery was observed a few days following the operation. The visual acuity increased from hand motions to 0.7 to 0.8 in the early postoperative period and to 1.0 shortly thereafter. The severity of infection, the importance of antibiotic prophylaxis for blowout fractures, and the efficacy of the transconjunctival approach on the final visual and functional outcome are described.A 38-year-old man with human immunodeficiency virus was referred for evaluation of retinal lesions in both eyes. Optical coherence tomography was performed after dilating the pupils. Biomicroscopy of the retina showed an atypical, solitary, yellowish-white lesion in the macula of both eyes with no inflammation of the vitreous. Optical coherence tomography of the lesions showed an area of extremely low reflectivity with well-defined but irregular borders in the outer retina. The surrounding retina showed normal reflectivity and was of normal thickness. Optical coherence tomography showed selective necrosis of the outer layers due to progressive outer retinal necrosis. Optical coherence tomography may serve as a useful tool for the early diagnosis of progressive outer retinal necrosis.

Evaluation of two Humphrey perimetry programs: full threshold and SITA standard testing strategy for learning effect.

Purpose To compare learning effect of Swedish interactive threshold algorithm (SITA) standard strategy with full threshold testing. Methods Thirty-nine medical students with no experience in visual field testing had full threshold (FT) and SITA standard for either right or left eyes. They were chosen in such a way that 20 (Group I) had FT for right and SITA for left eyes and 19 (Group II) had SITA standard for right and FT for left eyes. It was designed to have both strategies on same person whereby eliminating inter-individual variability. Visual field testing was repeated in the same week of the first test on the same subject with the same strategy that was chosen for that eye. Results The authors found an improvement in mean deviation (MD) and pattern standard deviation (PSD) of first and second testings correspondingly for FT (MD from –3.04 to –2.55; PSD from –2.60 to –2.29) and SITA standard (MD from –2.86 to –2.20; PSD from 2.25 to 2.10) and changes were statistically significant (p<0.05). To analyze learning effect of visual field testings, we calculated percentage change in MD and PSD for full threshold and SITA standard strategy. The percentage changes in visual field parameters were significantly lower in SITA standard strategy testing for MD (p=0.02) and PSD (p=0.01). Conclusions This study shows that a learning effect is present for both strategies and SITA standard may have a reduced learning effect compared to FT.

Screening for Retinopathy of Prematurity in a Tertiary Ophthalmology Department in Turkey: Incidence, Outcomes, and Risk Factors

BACKGROUND AND OBJECTIVE The aim of this study is to determine the incidence of retinopathy of prematurity (ROP), the number of preterm infants requiring treatment for ROP, and the factors influencing the development of ROP requiring treatment in a Turkish population. PATIENTS AND METHODS Data on 1,252 infants who were screened for ROP in an ophthalmology department were retrospectively reviewed. Infants with a gestational age (GA) of no more than 28 weeks (n = 157) were designated group 1, those between 29 and 32 weeks (n = 572) were assigned to group 2, and those between 33 and 37 weeks (n = 523) were assigned to group 3. RESULTS In group 1, ROP was detected in 70.0% of infants, 17.8% of whom required therapy. In group 2, ROP was detected in 41.4%, and 4.0% of those required therapy. In group 3, 18.1% were diagnosed with ROP, with 0.8% requiring treatment. CONCLUSION Retinopathy of prematurity occurs, even among more mature infants, at a frequency that merits astute screening within parameters that reflect socioeconomic differences that appear to have an effect on the incidence.