Pinar Aydin

Ocular complications with high-dose interferon alpha in chronic active hepatitis

Purpose Interferon alpha, which is used to treat various systemic disorders, has many reversible side-effects involving various organ systems. In this study, chronic active hepatitis patients undergoing interferon alpha therapy were followed with regard to the ocular side-effects.Methods Thirty-six patients with chronic active hepatitis undergoing subcutaneous interferon alpha therapy for 1 year were enrolled. Complete ocular examination and photographic documentation were performed at baseline of the therapy and monthly thereafter. Fishers exact chi-squared test and Mann-Whitney U-test were employed in the statistical evaluation of the results.Results Trichomegaly was noted in 2 (6%) patients. Fifteen patients (42%) were found to have retinopathy with cotton wool spot formation and splinter haemorrhages.Conclusions These findings emphasise the need to monitor these retinal complications, which may result in loss of vision in patients receiving interferon alpha therapy.

Elevated vitreous nitric oxide levels in patients with proliferative diabetic retinopathy

PURPOSE The aim of this study was to determine nitric oxide levels in the vitreous of patients with proliferative diabetic retinopathy. METHODS Using the spectrophotometric method based on Griess reaction, we measured levels of nitrite, the stable product of nitric oxide, in the vitreous of 21 eyes of 21 patients who underwent vitrectomy for the treatment of proliferative diabetic retinopathy with tractional retinal detachment, prospectively. Three samples were excluded from the study because of blood contamination. The control group was made up of vitreous samples from 15 eyes of 15 normal cadavers and five eyes of five patients who were undergoing vitrectomy for macular hole surgery. RESULTS Nitrite levels were 0. 524 +/- 0.27 microM and 0.383 +/- 0.17 microM in the vitreous of patients with proliferative diabetic retinopathy of diabetes type I and type II, respectively. In 15 cadaver eyes and five vitreous samples from patients who underwent macular hole surgery, nitrite levels were below the detection limit (less than 0.08 microM). There was no significant difference between nitrite levels in patients with type I and type II diabetes (P =.56), whereas there was a significant difference between diabetes groups and controls (P <. 00001). CONCLUSION Vitreous nitric oxide levels are elevated in patients with proliferative diabetic retinopathy with tractional retinal detachment. Nitric oxide may play a role in the pathogenesis of proliferative diabetic retinopathy.

Aqueous humor nitric oxide levels in patients with Behçet disease.

Purpose The purpose of this study was to quantify aqueous humor nitric oxide levels in patients with Behçet uveitis and age-matched controls to assess how nitric oxide is involved in this ocular condition. Methods Samples of aqueous humor were collected from 11 patients with Behçet uveitis who were undergoing cataract surgery. Sampling was done by paracentesis at the beginning of the operation. Similar samples were collected from 20 age-matched normal patients (controls). For each sample, we used the spectrophotometric method based on the Griess reaction to determine the amount of nitrite, which is the stable metabolite of nitric oxide. Results The amount of nitrite in aqueous humor samples from patients with Behçet disease was above the detection limit in 8 of 11 cases; the mean level ± SEM was 2.13 ± 0.621 &mgr;mol/L. Levels in the control group were below the detection limit in all cases (<0.08 &mgr;mol/L). There was a statistically significant difference between the aqueous humor nitrite levels in patients with Behçet disease and those in controls (P = 0.00002). Conclusions Aqueous humor nitric oxide levels are elevated in patients with a history of Behçet disease.

Indocyanine green and fluorescein angiography in nonarteritic anterior ischemic optic neuropathy.

Purpose To assess the value of indocyanine green angiography (ICGA) for demonstrating choroidal vascular abnormalities in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods The authors compared the ICGA and fluorescein fundus angiography characteristics of peripapillary circulation in 11 patients with acute NAION. There were 7 men and 4 women; the age range for the patients was 36 years to 72 years (mean ± SD, 47.7 ± 10.76 years). The angiographic factors considered significant were delay of peripapillary choroidal filling in the vertical watershed zone, leakage from the optic disk, and absolute filling defects on the disk. The authors compared the incidence of a vertical peripapillary watershed zone in the eyes of the 11 patients with that in the normal eyes of 50 controls (age range, 44–79 years) who had unilateral age-related macular degeneration. Results Indocyanine green angiography revealed a peripapillary watershed zone in 8 of 11 patient eyes and 23 of 50 control eyes. There was no statistical difference in the number of eyes affected in each group (&khgr;2 = 0.53;P = 0.47). Fluorescein fundus angiography showed leakage from the disk in 10 of 11 patients, whereas ICGA highlighted this problem in only 7 of the patients. The choroidal filling time of the watershed zones was significantly longer with ICGA (t = 3.13;P = 0.011). Conclusion Although ICGA allows better visualization of the choroidal watershed zones associated with NAION, it did not reveal any significantly different incidence of vertical choroidal watershed zone encompassing the optic disk for patients with NAION and controls. Fluorescein fundus angiography better visualized leakage from the disk in the patient group. These findings indicate that ICGA offers no significant advantage in terms of clinical diagnosis and management of NAION.

Pyogenic granuloma : A rare complication of silicone punctal plugs

To describe pyogenic granuloma formation associated with silicone punctal plugs. A 65-year-old woman with severe dry eye was treated with silicone punctal plugs in both upper and lower puncta. After 14 months of success with the plugs, the patient presented with a fleshy ampullary lesion overlying the plugged superior punctum of her right eye. It was clinically diagnosed as a pyogenic granuloma, and the silicone plug was removed. Since the lesion persisted for 1 month, it was surgically removed. Histopathologic examination confirmed the diagnosis of pyogenic granuloma. A new plug was inserted and tolerated well. The routine use of silicone plugs are recommended as long as patients are informed of possible rare complications.

Impression cytology of the conjunctival epithelium in patients with chronic renal failure

AIMS To assess ocular surface changes in patients with chronic renal failure (CRF), to compare the results with the degree of corneo-conjunctival calcium deposits, and to determine whether precipitation of calcium salts predisposes ocular surface modifications. METHODS Impression cytology from 50 CRF patients on regular haemodialysis and 22 age and sex matched control subjects were studied. Specimens were obtained from the temporal bulbar conjunctiva using cellulose acetate filter paper. The samples were fixed in 95% ethanol, stained with the periodic acid Schiff (PAS) stain, and evaluated by light microscopy and were graded by a masked observer. Corneo-conjunctival calcification was graded by the Porter and Crombie classification. RESULTS In the study group, three patients (6%) disclosed grade 0, 14 patients (28%) grade 1, and 33 patients (66%) grade 2–3 cytological changes. There was a statistically significant difference between the patient and the control groups (p= 0.0007), but no correlation could be found between the impression cytology grades and the calcium deposit grades (p=0.62). CONCLUSION The ocular surfaces of CRF patients differ significantly from those of normal individuals, and it can be detected using impression cytology. These data suggest that the severity of conjunctival changes are not related to the presence or extent of calcium deposition.

Retinal vein occlusion and factor V Leiden and prothrombin 20210 G:A mutations

Purpose The aim of this study was to establish whether the factor V Leiden mutation and the prothrombin 20210 G:A mutation were risk factors for retinal vein occlusion. Methods Blood samples were obtained from 40 patients with retinal vein occlusion and from 50 healthy normal volunteers as controls. Polymerase chain reaction assays were done to detect factor V Leiden and prothrombin 20210 G:A mutations, and the two groups were compared. Results Two (5%) of 40 patients with retinal vein occlusion and three (6%) of 50 controls were heterozygous for factor V Leiden (p=0.84). None of the individuals in either group had the prothrombin 20210 G:A mutation. Conclusions There was no significant association between retinal vein occlusion and the factor V Leiden mutation.

Effect of wind instrument playing on intraocular pressure.

Purpose: To evaluate the effect of wind instrument playing on intraocular pressure. Methods: In a prospective, nonrandomized clinical trial, 24 eyes of 24 wind instrument players with no history of any ocular or systemic disease were evaluated. The musicians were members of Bilkent Academic Symphony Orchestra of Bilkent University in Ankara. A complete eye examination, including best‐corrected visual acuity, slit‐lamp examination, and fundus examination, was performed. The intraocular pressure was measured before and after a 90‐minute rehearsal of a piece by Wagner. All intraocular pressure measurements were carried out by the same researcher using Goldmann applanation tonometry. The difference in intraocular pressure measurements before and after the 90‐minute wind instrument‐playing performance was analyzed. Results: The mean intraocular pressure was 13.79 ± 1.93 mm Hg before and 15.12 ± 2.44 mm Hg after the performance. Wind instrument playing significantly increased the mean intraocular pressure by 9.6% (P = 0.0149). Conclusion: These results indicate that wind instrument playing may significantly increase intraocular pressure in healthy patients. The significance of this finding for patients with suspected normal‐tension or high‐tension glaucoma needs further evaluation.

Indocyanine green angiographic findings in a case of punctate inner choroidopathy

Purpose To report indocyanine green angiographic findings in a case of punctate inner choroidopathy. Methods Fundoscopy, fluorescein angiography and indocyanine green angiography were carried out on a 23-year-old woman who presented with features typical of punctate inner choroidopathy. Results Fundoscopy showed multiple small yellow lesions in the retinal pigment epithelium and inner choroid in both eyes and a subfoveal choroidal neovascular membrane in the left eye. The lesions showed early hyperfluorescence with mild leakage in the late phases of the fluorescein angiogram. On indocyanine green angiography, the lesions demonstrated obvious hypofluorescence in the early, mid and late phases. Conclusions The fluorescein and indocyanine green angiographic findings indicate that punctate inner choroidopathy affects the choriocapillaris as well as the retinal pigment epithelium and photoreceptors. However, it is still not known whether the primary pathology is in the retinal pigment epithelium, the photoreceptors or the choriocapillaris.

Macular ischaemia in Behçet's disease.

Purpose To report macular ischaemia and visual loss in patients with panuveitis due to Behçets disease.Methods We describe macular ischaemia, a rare finding, in 3 eyes of 3 patients with panuveitis who were diagnosed and treated as having Behets disease. The patients underwent fundus fluorescein angiography (FFA) using a digital imaging system and were treated with topical and oral steroids and cyclosporine in 2 cases, and with added azathioprine in the third case.Results The 3 eyes showed macular ischaemia associated with peripheral retinal vasculitis on FFA and control of inflammation was achieved in all cases. After an average of 2 years follow-up, visual acuity and macular ischaemia improved in 2 eyes, while no recovery was seen in the third. Conclusion The presence of macular ischaemia on FFA in Behçets disease is a predictor of poor visual outcome. Macular ischaemia may show partial recovery with the treatment of the disease.