Pinar Altiaylik Ozer

Clinical and demographic evaluation of Behçet disease among different paediatric age groups

Aim: The aim of the study is to describe the demographic and clinical features of Behçet disease (BD) in paediatric patients. Methods: The study included 62 patients who presented to the Department of Ophthalmology at Ankara Education and Research Hospital, Ankara, Turkey and diagnosed as having BD. These patients were placed into three age groups based on the age at the time of BD presentation: group 1, birth to 10 years old; group 2, 11–15 years old; group 3, 16–20 years old. Among these three age groups, the objective was to identify the ocular and extraocular clinical findings and complications of BD, and to uncover the role of gender, if exists, in the aetiology of the disease. Results: The findings indicated that gender played no significant role in the aetiology of BD. In group 1, a family history of BD was more prevalent, and the most common ocular finding was bilateral anterior uveitis. The most frequent form of ocular involvement in groups 2 and 3 was bilateral panuveitis with retinal vasculitis and retinitis. The majority of disease complications were glaucoma, maculopathy and cataract formation. Conclusion: Patient age appeared to define the type of ocular involvement in BD. While anterior uveitis was the most frequent ocular finding in BD patients younger than 10 years, panuveitis was the most frequent in patients older than 10 years. As a family history of BD was more frequent among patients younger than 10 years, family screening for BD is considered critical for early and accurate diagnosis of BD, as well as for the control of its complications.

Serum lipid profile in diabetic macular edema

PURPOSE To evaluate the correlation of lipid profile and clinical presentation of macular edema in Type 2 diabetes mellitus (DM) patients. MATERIALS AND METHODS The study included 20 patients with chronic diabetic macular edema and plaque-like hard exudates (Group 1), 20 patients with diabetic macular edema (Group 2), and 20 DM patients but without retinopathy (Group 3). Diabetic retinopathy was classified according to the Early Treatment Diabetic Retinopathy Study grading system. Sample t test was used to evaluate the association between the fasting serum lipid [total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL)], glycosylated hemoglobin (HbA1c), fasting blood glucose, creatinine levels, and the clinical findings. P values <.05 were considered statistically significant. RESULTS There was no difference between fasting serum lipids and HbA1c levels. Duration of diabetes was shorter in Group 3 than in Groups 1 and 2. Patients in Group 1 had longer duration of diabetes than others (P<.05). Creatinine levels in Group 1 were higher than in other groups (P<.05). Although there was no correlation between fasting blood glucose and HbA1c levels, HbA1c was higher in all three groups from the baseline-normal limits (P<.05). CONCLUSION No correlation was found between serum lipid levels and macular edema severity, but the duration of diabetes was demonstrated as a significant factor in the progression of macular edema. High HbA1c levels in all patients highlight the importance of intense glycemic control in diabetic patients.

The association of vitamin D deficiency with tear break-up time and Schirmer testing in non-Sjögren dry eye

PurposeTo investigate the effect of vitamin D deficiency on tear break-up time (TBUT) and Schirmer test scores and to assess their relationship in non-Sjögren dry-eye patients.MethodsThirty-four patients with serum vitamin D deficiency and 21 control subjects with normal vitamin D levels were included in this study. The TBUT and Schirmer-1 test without topical anesthesia were performed to all patients.ResultsThe mean TBUT were 5.18±2.15 and 7.36±3.10 s and Schirmer scores were 12.18±6.44 and 18.57±8.99 mm in the study and control groups, respectively. TBUT scores and Schirmer-1 results of the study group were significantly lower than the control group (P=0.01 and 0.007, respectively). The mean vitamin D levels were 11.50±1.8 ng/ml in the study group and 32.8±8.72 ng/ml in control group (P=0.001). Dry-eye symptoms were detected in all patients in the study group and 15% of the patients in the control group.ConclusionsWe demonstrated that vitamin D deficiency decreases the TBUT and Schirmer test values and may be associated with dry-eye symptoms in non-Sjögren syndrome.

Incidence and risk factors in secondary glaucomas after blunt and penetrating ocular trauma.

PurposeThis retrospective study was designed to evaluate the risk factors for the development of posttraumatic glaucoma after ocular trauma. MethodsData were obtained from the records of 102 patients (105 eyes) that experienced blunt or penetrating ocular trauma and presented to our center between January 1987 and April 2006. Logistic regression was used to evaluate the association between the baseline structural and functional ocular characteristics and posttraumatic glaucoma. Odds ratios with 95% confidence intervals (CI) were obtained. ResultsNeed for glaucoma surgery was independently associated with hyphema (odds ratio: 0.279; 95% CI: 0.085-0.916), corneal injury (odds ratio: 12.143; 95% CI: 2.029-72.66), presence of optic atrophy (odds ratio: 8.000; 95% CI: 1.615-39.636), visual acuity <20/200 (odds ratio: 50.00; 95% CI: 10.183-245.501), and a history of penetrating ocular trauma (odds ratio: 10.00; 95% CI: 2.819-38.635). Corneal (odds ratio: 1.113; 95% CI: 1.022-1.213) and vitreal injuries (odds ratio: 10.410; 95% CI: 1.232-87.97) were found to be statistically significant factors for the development of early glaucoma. ConclusionsThis study found several independent predictive factors that were significantly associated with the need for glaucoma surgery in cases of posttraumatic glaucoma, including hyphema, corneal injury, presence of optic atrophy, visual acuity <20/200, and a history of penetrating ocular trauma. Additionally, some factors were found to affect the development of early glaucoma after ocular trauma, such as corneal and vitreal injury.

Topical cyclosporine A for the dry eye findings of thyroid orbitopathy patients

The study was approved by the local ethics committee of Ministry of Health, Ankara Research and Training Hospital (14 February 2008, Number 00155) and patient recruitment began. The authors declared that they have no conflict of interest. A total of 90 eyes of 45 patients with TO were prospectively evaluated for this study between 1 April 2008 and 1 December 2008. The diagnosis of TO was made, when two of the following three signs of the disease were present: 2 (1) Concurrent or recently treated immune-related thyroid dysfunction: Graves hyperthyroidism, Hashimoto’s thyroiditis, and the presence of circulating thyroid antibodies without a coexisting dysthyroid state; (2) typical orbital signs (one or more of the following): unilateral or bilateral eyelid retraction with typical temporal flare (with/or without lagophthalmos), bilateral proptosis (as evidenced by comparison with patient’s old photos), restrictive strabismus in a typical pattern compressive optic neuropathy, fluctuating eyelid oedema/erythema, chemosis/caruncular oedema; and (3) radiographic evidence of TO including unilateral/bilateral fusiform enlargement of one or more of the following: medial rectus muscle, inferior rectus muscle, superior rectus–levator complex. In all patients, assessment of activity of TO was carried out using Clinical Activity Score (CAS) based on the classification system proposed by Mourits et al. 3

Endoscopic vs external dacryocystorhinostomy-comparison from the patients' aspect.

AIM To compare the success and complication rates, duration of surgeries and clinical comfort after endoscopic dacryocystorhinostomy (END-DCR) or external dacryocystorhinostomy (EXT-DCR). METHODS Fifty patients who underwent EXT- or END-DCR between January 2010-2012 were involved in the study. A questionnaire was applied to patients preoperatively, and postoperatively. Subjective success was defined by absence of epiphora, objective success by a normal nasolacrimal lavage and a positive functional endoscopic dye test (FEDT). Postoperative pain and cosmetic result of surgery were interpreted by the patients, who were also asked whether they would offer this surgery to a friend or would prefer this surgery once more if necessary. RESULTS Twenty-five patients underwent END-DCR and 25 underwent EXT-DCR. Mean duration of surgeries were 35min both for EXT-DCR (30-50) and END-DCR (35-50) (P=0.778). Intraoperative bleeding were documented in 48% of EXT-DCR and 4% of END-DCR cases (P<0.001). In total 96% of EXT-DCR and 100% of END-DCR patients had subjective success. Objective success was 100% in each group. There was no significant difference between the epiphora scorings and FDDT results in postoperative visits among the groups. END-DCR group reported less pain in first week and month (P<0.05, P<0.05). More patients in END-DCR group were happy with the cosmetic result in first week and month (P<0.001, P<0.001). More patients in END-DCR group offered this surgery to a friend (P<0.001). All patients in END-DCR group preferred this surgery once more if necessary, only 48% in EXT-DCR preferred the same method (P<0.001). CONCLUSION Although both END- and EXT-DCRs provide satisfactory outcomes with similar objective and subjective success rates, we demonstrated that the endonasal approach caused significantly less pain in early postoperative period than the external approach. Clinical comfort defined by the patients was quite higher in END-DCR group, in which patients mainly were pleased to encounter a sutureless surgical area.

Intraoperative Floppy-Iris Syndrome: Comparison of Tamsulosin and Drugs Other Than Alpha Antagonists

Abstract Background: To determine and compare the incidence of intraoperative floppy iris syndrome (IFIS) features in patients using tamsulosin, and other chronic medications. Methods: We prospectively studied patients who underwent phacoemulsification (PE) between March 2006 and October 2007 on use of tamsulosin or a single medication like antihypertansive (AH), antiaggregant (AAg), antipsycotic (AP) or oral antidiabetic (OAD). Patients were grouped as tamsulosin users (Group 1), previous tamsulosin users (Group 2), chronic medication users (AH, AAg, AP or OAD) (Group 3) and patients with no medication (Group 4). Comparison of pre and postoperative visual acuities, intraocular pressures, intraoperative posterior capsular rupture (PCR) rates and grades of IFIS among groups were evaluated. Results: We studied 1567 eyes of 1530 subjects. Twenty five eyes in the study demonstrated IFIS (1.6%). Five cases were included in Group 1 and IFIS incidence was 80%, while it was 60% in Group 2 (n = 5), 1 % in Group 3 (n = 1099), 1.7% in Group 4 (n = 421). IFIS incidence was significantly higher in Groups 1 and 2 compared to Groups 3 and 4 (p < 0.001). There was no difference between Groups 1 and 2 (p = 1.0) and between 3 and 4 (p = 0.29). Most cases (72%) had all three signs of IFIS. Complete IFIS was seen in one patient in Groups 1 and 2, whereas it was seen in all IFIS patients of Groups 3 and 4 (p < 0.001). Incidence of PCR was significantly higher in Group 1 (p = 0.045). Conclusion: Tamsulosin was found to be the drug which was most likely to be associated with IFIS, but IFIS was also observed in patients chronically using losartan, aspirin, chlorpromazine and metformin. Although, IFIS incidences were found to be similar between chronic users of these drugs and those using no medications at the time of surgery, new studies in the future will introduce the predisposing factors and the possible mechanisms of IFIS with these medications.

The Relationship between Neutrophil-to-lymphocyte Ratio and Age-related Macular Degeneration

Purpose To investigate the possible associations of neutrophil-to-lymphocyte ratio (NLR) and high sensitivity C-reactive protein (hs-CRP) level with age-related macular degeneration (ARMD). Methods Patients were divided to three groups of 40 patients with non-neovascular ARMD (group 1), 40 patients with neovascular ARMD (group 2), and 40 healthy control subjects (group 3). The neutrophil and lymphocyte counts were evaluated using an ABX Pentra DF120/USA biochemical analyzer, and hs-CRP levels were measured using a Beckman Coulter Immage 800. The NLR was measured by dividing neutrophil count by lymphocyte count. Results The patients in group 2 were older and more often diabetic than the patients in groups 1 and 3 (p < 0.001 and p < 0.001, respectively). The NLR level was 1.65 ± 0.71 in group 1, 1.98 ± 0.84 in group 2, and 1.46 ± 0.44 in group 3. The hs-CRP value was 1.98 ± 0.251 mg/L in group 1, 3.242 ± 0.211 mg/L in group 2, and 1.145 ± 0.193 mg/L in group 3. Both NLR and hs-CRP values were significantly higher in group 2 compared to group 3 (p = 0.002 and p = 0.002, respectively). In multivariate analysis, NLR remained an independent predictor of neovascular ARMD (odds ratio, 3.882; 95% confidence interval, 1.574 to 9.576; p = 0.003) together with age (p < 0.001), diabetes mellitus (p = 0.041), and hs-CRP (p = 0.018). Conclusions Our study suggests that increased NLR value is independently associated with neovascular ARMD.

Postoperative endophthalmitis caused by Bacillus cereus and Chlamydia trachomatis

PURPOSE: To describe the clinical manifestations and outcomes in 4 patients with endophthalmitis caused by Bacillus cereus and Chlamydia trachomatis. SETTING: Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey. METHODS: Four patients who had cataract extraction and intraocular lens implantation with phacoemulsification at a secondary eye‐care center presented with endophthalmitis. Cultures and direct fluorescein assay (DFA) were performed on vitreous aspirates from all patients. RESULTS: Cultures were positive for B cereus and DFAs were positive for C trachomatis in all patients. Despite timely intervention, at the end of follow‐up, 1 patient had 20/200 visual acuity and another, counting fingers at 3 m. Phthisis bulbi developed in the 2 other patients. CONCLUSION: The course of infection with B cereus and C trachomatis poses a potential threat, especially because of the limited data on treatment of endophthalmitis secondary to C trachomatis.

Comparison of Intravitreal Bevacizumab, Intravitreal Ranibizumab and Laser Photocoagulation for Treatment of Type 1 Retinopathy of Prematurity in Turkish Preterm Children

ABSTRACT Purpose: To evaluate effectiveness of treatment modalities, major complications and refractive errors in children who were treated with intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR) or laser photocoagulation (LP) for type 1 retinopathy of prematurity (ROP). Methods: Premature infants who underwent IVB monotherapy (Group 1), IVR monotherapy (Group 2) or LP (Group 3) for type 1 ROP and infants with spontaneously regressed ROP (Group 4) were included for the study. Major complications, recurrence rate, recurrence time, total retinal vascularization time and refractive errors at 18 months of corrected age (CA) were determined. Results: Groups 1, 2, 3 and 4 included 24 eyes of 12 patients, 12 eyes of six patients, 72 eyes of 36 patients and 148 eyes of 74 patients, respectively. Recurrence of the disease occurred in two eyes of one patient in Group 1 at 52 weeks of postmenstrual age (PMA) and two eyes of one patient at 48 weeks of PMA in Group 2. In Group 3, disease did not regress after the first treatment in 10 eyes of five patients. The mean vascularization time in Group 1 was 73 ± 10.1 weeks of PMA and 61.8 ± 6.6 weeks of PMA in Group 2 (p = 0.027). Macular ectopia was seen in two eyes of one patient and exudative retinal detachment (ERD) occurred in two eyes of one patient in Group 3. Mean spherical equivalent was 1.49 ± 3.04 diopters (D) in Group 1, −1.79 ± 2.87D in Group 2, −1.27 ± 2.8 D in Group 3 and 1.52 ± 1.07 D in Group 4 at 18 months of CA. There was no significant difference in astigmatism values in all groups. Conclusion: IVB, IVR and LP are options that can successfully treat ROP. Myopia was observed to be the main refractive error in all treatment groups. Vascularization of the retina was completed later in the IVB group than in the IVR group.