Rahmi Duman

Corneal endothelial cell density in healthy Caucasian population

Aim To reveal the changes of corneal endothelial characteristics with aging among Caucasian population. Methods Non-contact specular microscopy was performed in 564 eyes of 282 healthy Caucasian Turkish patients. Endothelial cell density (MCD), mean cell area (MCA), coefficient of variation (CV) in cell size, percentage of hexagonal cells, and central corneal thickness (CCT) were measured. Results The mean age was 42 ± 17.1 (6–85) years. The MCD of the population was 2732 ± 305 cell/mm2 (range, 1904–3802 cell/mm2). The MCA was 368 ± 41 m2 (range, 263–522 m2). The mean CV in cell size was 34 ± 7 (range, 25–68), the mean percentage of hexagonal cells was 46 ± 8% (range, 25–76%), and CCT was 513 ± 39 (range, 407–623). There was statistically significantly negative correlation (p < 0.05) between age and cell density, hexagonality, and pachymetry. There was statistically significant correlation (p < 0.05) between age and MCA. Conclusion We report the normal values of corneal endothelial characteristics in Caucasian Turkish eyes. Over the age of 20, the MCD of Caucasian eyes is more than the Indian and Iranian eyes and less than the Chinese eyes. Caucasian population’s cell density in under the age of 20 is 3101 ± 268 cell/mm2.

A rare cause of blepharoconjunctivitis: Phthiriasis palpebrarum.

A 63‐year‐old female patient referred to ophthalmology service of our hospital with a complaint of left eye itch for about 3 weeks. İn fact, she had an uncommon infestation of eye lashes caused by the louse Pthirus pubis treatment after consulting primary health center. Clinical properties of the patient seemed like blepharoconjunctivitis at first look in biomicroscopic ophthalmological examination, but after performing magnification in biomicroscopy, parasites and their nits were found adhering to the eyelashes of bilateral superior eye lids and eye brows [Figures 1 and 2]. The diagnosis was phthiriasis palpebrarum because of the clinical appearance of the patient. We mechanically removed all lice and their nits with an aid of a forceps after application of liquid Vaseline (Mayaset med, Turkey). The diluted %5 povidone‐iodine was applied to the eyelashes of the patient. This treatment was performed in every day for about 1‐week. The lice and their nits were removed after this treatment.

Effect of smoking on the thickness of retinal layers in healthy smokers

Abstract Purpose: To compare the thicknesses of the retinal layers in smokers with those of nonsmoking healthy subjects using spectral-domain optical coherence tomography (SD-OCT). Methods: One hundred and eight subjects were included in the study. Two groups were separated as smokers and nonsmokers. Both groups were chosen to be similar in terms of age and gender. SD-OCT images were generated with Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). An automated algorithm was developed to segment the macular retina into eight layers and quantitate the thickness of each layer for the fovea, parafovea and perifovea. Results: The mean smoking history was 18.33 ± 8.45 years (range: 10–40). The mean number of pack-years was 22.22 ± 15.51 (range: 10–80). No significant difference was observed regarding retinal layer measurements between the smoker and nonsmoker groups. Also, no significant difference was observed for central macular thicknesses at 1000, 3000, and 6000 μm between two groups. Conclusion: The thickness of retinal layers in healthy smokers was similar to those of healthy individuals.

Evaluation of Carotid Intima Media Thickness and Renal Artery Resistive Index in Patients With Pseudoexfoliation Syndrome: A Prospective Case-Control Study.

Purpose:To investigate the significance of renal artery resistance and carotid intima media thickness (CIMT) parameters in patients with pseudoexfoliation syndrome (PES). Materials and Methods:In this prospective case-control study, 37 patients were involved and grouped as PES (n=19) and control groups (n=18). Ophthalmological evaluation included visual acuity, intraocular pressure, central corneal thickness measurement, and optic disc evaluation. In addition, renal artery resistive index and CIMT measurements were taken for all patients and compared between the groups. Results:The 2 groups were similar with respect to age, sex, and family history of glaucoma. The mean CIMT in the PES group was found to be significantly higher compared with the control group (0.73±0.02 vs. 0.59±0.06 mm, P=0.003). Renal artery resistive indices were found to be higher in the PES group than in the control group, however, the difference was not significant (P=0.46). A moderate positive correlation between CIMT and renal artery resistive indices was detected (r=0.447, P=0.01). However, a higher correlation rate was detected when the analysis was made in the PES group only (r=0.603, P=0.01). Conclusions:CIMT increases in PES patients and also the renal artery resistance index has a tendency to increase. Patients with PES should be informed about potential systemic consequences of this syndrome.

Corneal melanosis successfully treated using topical mitomycin-C and alcohol corneal epitheliectomy: a 3-year follow-up case report

We report a case of primary acquired corneal melanosis without atypia associated with corneal haze in a patient with a history of limbal malignant melanoma and the effect of mitomycin-C. A 75-year-old woman with a history of limbal malignant melanoma presented with loss of vision in right eye. Corneal examination showed a patchy melanotic pigmentation with a central haze. Topical mitomycin-C improved visual acuity and corneal haze. However, the pigmented lesions persisted, and they were removed with alcohol corneal epitheliectomy. Histopathological examination demonstrated primary acquired melanosis without atypia. The lesions were successfully removed, and there were no recurrences during the follow-up period of 36 months. The association of conjunctival and corneal melanosis without atypia is a rare condition. In addition, co-existence of central corneal haze and melanosis may decrease visual acuity. Topical mitomycin-C and alcohol corneal epitheliectomy can be useful treatments in this condition.

Diplopia due to Dacryops

Dacryops is a lacrimal ductal cyst. It is known that it can cause globe displacement, motility restriction, and proptosis because of the mass effect. Diplopia due to dacryops has not been reported previously. Here, we present a 57-year-old man with binocular horizontal diplopia that occurred during left direction gaze due to dacryops.

Periorbital Cellulitis that Developed after Alternative Medication of Hirudo Medicinalis Application

We aimed to present a case of periorbital (preseptal) cellulitis that developed after Hirudo medicinalis alternative medicine application for glaucoma treatment which can be rarely seen in routine ophthalmology practice. A 36 year old woman with a glaucoma was admitted to our outpatient clinic because of redness, pain and swelling around the right eye for three days and gave a history of leech application 1 week ago, that recommended by her relatives as a remedy for glaucoma. Orbital cellulitis was excluded and cure was achieved with oral ciprofloxacin and flurbiprofen treatment. Patients with chronic diseases such as glaucoma, they are abandoning the treatment over time, will seek solutions from alternative medicine. These inappropriate treatments without scientific evidence can cause various complications. Physicians should maintain proper communication with the patients inform them about their chronic diseases (e.g. glaucoma) to make them the part of the solution and treatments.

Lens opacities in children using methylphenidate hydrochloride

Abstract Purpose: To assess clinical findings of eye examination in children having attention deficit hyperactivity disorder (ADHD) administered with methylphenidate hydrochloride. Methods: Fifty-seven consecutive patients diagnosed of ADHD and administered with oral methylphenidate hydrochloride treatment for at least one year were involved in this study (Group 1). Sixty healthy subjects (Group 2) having demographic features similar to group 1 were involved as a control group. All patients underwent detailed ophthalmological examination. Results: One hundred and seventeen consecutive subjects with a mean age of 11.2 ± 2.4 years (7–18 years) were enrolled. Fifty-seven consecutive patient (32 males, 25 females) under oral methylphenidate hydrochloride treatment (Group 1) and 60 healthy control subjects (30 males, 30 females) (Group 2)) were recruited for this prospective study. The mean methylphenidate hydrochloride dosage was 0.9 ± 0.1 mg/kg/day and the mean duration of methylphenidate hydrochloride usage was for 2.73 ± 0.73 years (1–7 years). High intraocular pressure was not observed in any of the patients in our study. We detected lens opacities in five eyes of five patients in group 1 (p = 0.019). The patient with the highest degree of cataract formation had been using MPH for 84 months and this patient’s cataract score was P4. Conclusion: Long-term use of methylphenidate may cause lens opacities. In particular, patients who have been using methylphenidate for more than two years should go for regular eye examination.

Repeatability and reproducibility of automatic segmentation of retinal layers in healthy subjects using Spectralis optical coherence tomography

PURPOSE To evaluate the repeatability and reproducibility of automatic segmentation in healthy subjects using a Spectralis optical coherence tomography (OCT) system. METHODS A total of 60 eyes from 60 patients were included in this prospective study. Spectral-domain optical coherence tomography images were generated using the Spectralis OCT system. An automated algorithm was used to segment the macular retina into nine layers and evaluate the thickness of each layer in the foveal, inner, and outer Early Treatment Diabetic Retinopathy Study (ETDRS) subfield rings. The eyes were imaged three times by an examiner to assess intraobserver repeatability and imaged once by a second examiner to assess interobserver reproducibility. The first scan was used for reference, whereas the second and third scans were collected using the devices follow-up mode. Intraclass correlation coefficients (ICCs) of repeatability and reproducibility were analyzed. RESULTS The examiners achieved high repeatability and reproducibility for all parameters. Good agreement was found for all parameters in all ETDRS subdivisions with an ICC of >0.96 for all measurements. CONCLUSION It is possible to obtain cross-sections from the same location using the devices follow-up mode, making it virtually impossible to distinguish between repeated measurements taken with the device by different examiners.

Evaluation of Depression and Anxiety Levels in Mothers of Babies' Following Due to Premature Retinopathy

AIM: There are significant increases in the survival rates of premature babies owing to rapid developments in medical technology. As the number of premature babies that can survive in neonatal intensive care increases, so does the frequency of complications due to prematurity. The aim of this study was to investigate the depressive and anxiety symptom levels, and factors affecting these, in mothers of infants who were followed up owing to a diagnosis of premature retinopathy (ROP). METHODS: This study involved 78 consecutive mothers of premature babies, who applied to the ophthalmology clinic between February and May 2016. The mothers completed the Sociodemographic Information Form, Symptom Check List (SCL‐90‐R), Edinburgh Postnatal Depression Scale (EPDS), and State‐Trait Anxiety Scale (STAI). RESULTS: The mean scores of SCL‐90‐R Depression, Anxiety, and Global Severity Index (GSI) subscales, as well as STAI‐1 and STAI‐2 were higher in mothers of ROP‐diagnosed babies. Factors affecting maternal depression and anxiety levels were the absence of maternal social support and the level of premature retinopathy. Mothers whose babies are diagnosed with ROP may have high levels of depression and anxiety. CONCLUSION: The psychiatric follow‐up, treatment, and social support provided to the mother, and regular follow‐up of the baby after birth are important both for the mental health of the mother and the healthy development of the baby. Further research is needed to understand the role of parental mental health problems on the development and treatment processes of infants with premature retinopathy. HIGHLIGHTSHigh levels of depression and anxiety among family members, especially the mother, can have a negative impact on their ability to meet the needs of children.The psychiatric follow‐up, treatment, and social support provided to the mother, and regular follow‐up of the baby after birth is important both for the mental health of the mother and the healthy development of the baby.