Raşit Kılıç

Comparison of dose-related ocular side effects during systemic isotretinoin administration.

Purpose To compare the effects of high- (Group 1) and low-dose (Group 2) isotretinoin treatments for acne vulgaris on lacrimal functions and other ocular complications. Methods Twenty-six patients receiving high-dose (>0.5 mg/kg per day) systemic isotretinoin treatment and 25 patients treated with low-dose systemic isotretinoin (<0.5 mg/kg per day) underwent complete ophthalmologic assessment of both eyes before treatment, at days 45 and 90 of treatment, and 1 month after the completion of treatment, together with a microbiologic evaluation of conjunctival flora, tear film break-up time (BUT), and anesthetized Schirmer test of the right eye of each patient. Results When the results of the anesthetized Schirmer test for Groups 1 and 2 were compared (pretreatment, days 45 and 90 of treatment, and 1 month after treatment), there was no statistically significant difference between the groups (p > 0.05). Although BUT did not differ significantly between the two groups before treatment (p > 0.05), there was a statistically significant decrease in BUT in Group 1 when compared with Group 2 at days 45 and 90 of treatment (p < 0.05). One month after the completion of treatment, there was no difference in BUT between the two groups (p > 0.05). No difference in Staphylococcus aureus colonization was detected between the two groups at days 45 and 90 of treatment (p > 0.05). Conclusions During systemic isotretinoin treatment, eye dryness was related to the dose used, at least during the period of treatment. Conversely, the rate of conjunctival S aureus colonization was unrelated to the dose of isotretinoin.

Balloon dilatation for treatment of congenital nasolacrimal duct obstruction.

Purpose To evaluate the safety and effectiveness of balloon dacryocystoplasty in the treatment of congenital nasolacrimal duct obstructions. Methods Balloon dacryocystoplasty was attempted in 25 eyes of 21 patients. The procedure was performed successfully in 24 eyes of 20 patients, age range 21–72 months. Nineteen eyes had no previous procedure. The mean age of this group was 43.9 months (range 36–72 months). Five eyes had failed probing of lacrimal system. The mean age of this group was 22.2 months (range 21–24 months). The authors performed balloon dacryocystoplasty under endoscopic guidance. Clinical success was defined as complete remission of epiphora within follow-up period of 7–34 months (mean 25.2 months). Results The authors performed balloon dacryocystoplasty in 24 eyes. The first procedure was successful in 20 of them and the clinic success rate was 83.3%. The technique was repeated in the one eye that recurred and as it ended successfully, the clinic success rate increased to 87.5%. In 17 of the 19 eyes (89.4%) in which balloon dacryocystoplasty was performed primarily, and in 4 of 5 eyes (80%) in which balloon dacryocystoplasty was performed secondarily after unsuccessful probing, the procedure was clinically successful. There was intermittent epiphora in 3 eyes (15%) and these were considered as recurrence. Conclusions This experience shows that balloon dilatation is a safe and effective treatment of congenital nasolacrimal duct obstruction as a primary procedure in children over 36 months of age and as a secondary procedure after failure of lacrimal system probing. As a result, balloon dacryocystoplasty can be an alternative treatment in older children and can be preferred to silicone intubation and dacryocystorhinostomy performed after unsuccessful probing.

The frequency of pseudoexfoliation syndrome in the middle Black Sea region of Turkey.

Purpose To assess the frequency of Pseudoexfoliation syndrome (PEX) and evaluate its association with specific ocular diseases in patients attending the Department of Ophthalmology at Gaziosmanpasa University Hospital. Methods A prospective study was conducted at the Gaziosmanpasa University Hospital between December 2007 and December 2008. A total of 831 subjects aged 45 or above attending the general ophthalmic clinics were recruited for this study. Each patient underwent complete ophthalmic assessment, including ocular history, visual acuity testing, slit-lamp examination, applanation tonometry, gonioscopy and fundus examination. Results Of the 831 subjects, 12.2% had PEX. Pseudoexfoliation was bilateral in 74.2% of cases, significantly associated with cataract, glaucoma, age-related macular degeneration (AMD), and phacodenesis. Of the patients with PEX, 43.6% had cataract, 6.9% had glaucoma, 7.9% had AMD, and 0.9% had phacodenesis. In addition, 9.8% had cataract + glaucoma, 13.7% had cataract + phacodenesis, and 17.8% had all of them. The prevalence of PEX had a tendency to increase with age but had no sex predilection. Conclusions The study findings enhance our knowledge of PEX in Anatolia, particularly in the Middle Black Sea region.

Systemic Prolidase Activity and Oxidative Stress in Keratoconus

ABSTRACT Aim: Our aim was to evaluate the serum prolidase activity, total antioxidant capacity (TAC) and total oxidant status (TOS) in patients with keratoconus. Material and method: A total 69 keratoconus patients and 72 control subjects with similar age and gender were evaluated within the scope of this study. The keratoconus group was divided into four stages with the modified Krumeich classification. Serum prolidase activity, TAC and TOS were measured and compared between the patient and control groups. Results: The median serum prolidase enzyme activity value was 528.3 (684.1–416.7) U/L in the keratoconus group and 606.2 (812.9–482.3) U/L in the control group. The difference between the groups was statistically significant (p = 0.027). The median TAC value was 1.24 (1.37–1.05) mmol/L in the keratoconus group and 1.29 (1.38–1.18) mmol/L in the control group. The median TOS value was 2 (4–1) μmol/L in the keratoconus group and 3 (4–2) μmol/L in the control group. There was no statistically significant difference between the two groups in terms of TAC or TOS (p = 0.113 and p = 0.366, respectively). There was a positive correlation between TAC and TOS in keratoconus group but not in the control group (r = 0.670, p = 0.001 and r = 0.141, p = 0.241, respectively). No significant relationship was seen between the keratoconus group stages and serum prolidase activity, TAS or TOS (p = 0.894, p = 0.155 and p = 0.381, respectively). Conclusion: In conclusion, a significant relationship was found between decreased serum prolidase activity and keratoconus but there was no significant relationship between keratoconus and serum TAC or TOS.

The frequency of exfoliation syndrome in the central anatolia region of Turkey.

Aim. The aim of this study was to investigate the frequency of exfoliation syndrome in the Central Anatolia region of Turkey and to evaluate its relationship with cardiovascular and ocular diseases. Methods. Patients over the age of 45 years who presented to the clinic were included in the study. All cases underwent a comprehensive ophthalmology examination. Exfoliation syndrome was diagnosed with the presence of exfoliative material on the lens anterior capsule or iris on slit lamp examination. The patients were divided into two groups as the exfoliation syndrome group and nonexfoliation syndrome group according to the presence of exfoliative material. Results. Exfoliative material was found in one or both eyes of 212 of the 2103 patients (10.1%) evaluated within the scope of the study. A significant relationship was found between exfoliation syndrome and increasing age and male gender. A significant relationship was found between exfoliation syndrome and glaucoma, cataracts, age-related macular degeneration, and phacodonesis. While no relationship was found between exfoliation syndrome and hypertension or diabetes mellitus, a significant relationship was found with coronary artery disease. Conclusion. The unilateral or bilateral exfoliation syndrome frequency was 10.1% in this hospital-based study. A statistically significant relationship was found between exfoliation syndrome and advancing age, gender, and coronary artery disease.

Evaluation of Serum Superoxide Dismutase Activity, Malondialdehyde, and Zinc and Copper Levels in Patients With Keratoconus.

Purpose: The aim of this study was to evaluate the relationship between antioxidant superoxide dismutase (SOD) enzyme activity, malondialdehyde (MDA) as a lipid peroxidation marker, and some trace elements such as zinc (Zn) and copper (Cu) levels in patients with keratoconus. Methods: A total of 58 patients with keratoconus and 53 control subjects with similar age and sex were evaluated in this study. The modified Krumeich keratoconus classification was used to divide the patients into 4 stages. Serum SOD activity, MDA, and zinc and copper levels were compared between the patient and control groups. Results: The median serum SOD activity, MDA, and Zn and Cu levels were 27.2 (42.4–13.7) U/mL, 10.2 (11.9–8.5) nmol/mL, 87.9 (104.6–76.5) &mgr;mol/L, and 103.2 (117.9–90.3) &mgr;mol/L in the keratoconus group and 26.2 (32.5–14.4) U/mL, 8.8 (11.4–7.1) nmol/mL, 100.5 (121.1–81.8) &mgr;mol/L, and 98.4 (120.3–83.4) &mgr;mol/L in the control group, respectively. There was a statistically significant difference between the MDA and Zn levels of the keratoconus group and control subjects but not between the respective SOD activities or Cu levels (P = 0.016, P = 0.031, P = 0.440, and P = 0.376, respectively). We found no significant difference between the keratoconus group stages for serum SOD activity, serum MDA, and Zn and Cu levels (P > 0.05), and there was also no significant correlation between the keratoconus group stages and serum SOD activity, serum MDA, and Zn and Cu levels (P > 0.05). Conclusions: There is imbalance in the systemic oxidant/antioxidant status where Zn deficiency also plays a role in patients with keratoconus.

Increased central corneal thickness in children with cerebral palsy.

Purpose: To evaluate central corneal thickness (CCT) values in children with cerebral palsy (CP). Methods: Sixty-seven children with CP and 58 healthy control children (125 children total) were enrolled into the study. The CCT value was measured by ultrasound pachymetry. The consecutive measurements were taken from the center of the cornea of each eye. Results: In the CP group, the mean CCT value was 568.46 ± 31.94 μm in the right eye and 568.01 ± 32.50 μm in the left eye. In the control group, the mean CCT value was 549.53 ± 26.16 μm in the right eye and 549.62 ± 27.58 μm in the left eye. The CCT value was significantly higher in the CP group than in the control group for both eyes (P < 0.001). There was no statistically significant difference between the right and left eyes of children with CP and intellectual disability (ID) and those with CP and no ID (P = 0.344 and 0.076, respectively). Conclusions: Children with CP had an increased CCT compared with healthy control subjects. There was however no significant difference in CCT values between the children with and without ID in our CP group.

The prevalence of exfoliation syndrome in Turkey

To investigate the prevalence of the exfoliation syndrome and its relationship with ocular and cardiovascular diseases in the Central Anatolia region of Turkey.

ÖN KAMARADA PERFLORODEKALİN BAKİYESİ: İKİ OLGU SUNUMU

Perflorodekalin sivisi vitreoretinal cerrahide gecici goz ici tamponati olarak kullanilir. Bu calismada sunulan 65 ve 71 yasindaki iki olguya, regmatojen retina dekolmani tanisi ile pars plana vitrektomi ameliyati yapilmis ve her iki hastada da perflorodekalin sivisi gecici goz ici tamponati olarak kullanilmistir. Her iki olgununda ameliyat oncesinde psodofakik oldugu gorulmus ve arka kapsulun saglam oldugu saptanmistir. Ilk olguda birinci hafta da, ikinci olguda birinci ayda on kamarada perflorodekalin kalintisi saptanmistir. Ilk olguda ameliyattan 2 hafta sonra, ikinci olguda ise 7 ay sonra on kamara lavaji yapilarak perflorodekalin bakiyesi uzaklastirilmistir. Iki olguda da on kamara lavaji oncesi ve sonrasinda kornea saydam olarak degerlendirilmis ve herhangi bir korneal toksisite bulgusu saptanmamistir.

Evaluation of choroidal thickness in patients with ulcerative colitis

Purpose: To evaluate the effect of ulcerative colitis (UC) on the choroid by measuring the choroidal thickness (CT) and also to determine any difference between CT in the Montreal classification groups. Materials and Methods: We included 36 eyes of 36 UC patients and 36 controls in the study. The UC patients were classified as ulcerative proctitis, left-sided (distal) UC, and extensive UC (pancolitis) according to the Montreal classification. CT was measured using enhanced depth imaging optic coherence tomography at the foveal center and at 500 μm, 1000 μm, and 1500 μm from the foveal center for each eye. Results: CT was significantly thinner in patients with UC than controls at 500 μm temporal to the fovea (P = 0.026), at 500 μm nasal to the fovea (P = 0.019), at 1000 μm nasal to the fovea (P = 0.042), and at 1500 μm nasal to the fovea (P = 0.013). There was no statistically significant difference between these three groups regarding the CT value (P > 0.05). Conclusions: Perifoveal CT was significantly thinner in patients with UC than in healthy controls. There was no statistically significant difference between these three groups (ulcerative proctitis, left-sided UC, and extensive UC) regarding the CT value.