Sibel Oto

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.

Structural consequences after intravitreal bevacizumab injection without increasing apoptotic cell death in a retinopathy of prematurity mouse model

Purpose:  To evaluate the effect of different bevacizumab concentrations on retinal endothelial cell proliferation, retinal structures and apoptotic activity after intravitreal injection in a retinopathy of prematurity (ROP) mouse model.

Congenital cataract, microphthalmia, hypoplasia of corpus callosum and hypogenitalism: Report and review of Micro syndrome

We report on a 7‐month‐old boy with Micro syndrome who was referred for assessment of mental‐motor retardation and reduced vision with cataract. The characteristics of Micro syndrome are mental retardation, microcephaly, congenital cataract, microcornea, microphthalmia, agenesis/hypoplasia of the corpus callosum, and hypogenitalism. The differential diagnosis includes cerebro‐oculo‐facio‐skeletal syndrome (COFS); a syndrome involving cataract, arthrogryposis, microcephaly, and kyphoscoliosis (CAMAK); a syndrome with cataract, microcephaly, failure to thrive, and kyphoscoliosis (CAMFAK); Martsolf syndrome; Neu–Laxova syndrome; Lenz microphthalmia syndrome; and Smith–Lemli–Opitz syndrome. Till date, no renal malformations have been reported in Micro syndrome. Our patient had fusion of the lower poles of the kidneys and his left kidney was ectopic. Ocular findings are the most reliable neonatal diagnostic signs of Micro syndrome. Minör anomalies in Micro syndrome may be subtle and therefore not of significant diagnostic value. Micro syndrome is an autosomal recessive trait. Till date, most reported cases have been in individuals of Muslim origin. In countries with high rates of consanguineous marriage, such as Turkey, it is important that physicians be able to recognize this syndrome. Micro syndrome should be considered in any infant with congenital cataract.

Cerebellar Vermis Hypoplasia in a Patient With Bardet-Biedl Syndrome:

Laurence-Moon-Bardet-Biedl syndome is an autosomal recessive condition characterized by retinal dystrophy, obesity, mental retardation, distal limb anomaly, hypogonadism, and renal dysfunction. The symptoms vary among families and even among affected siblings. Certain clinical signs have been used to identify subgroups of patients with this complex condition. Laurence-Moon syndrome as a distinct entity is rare and features paraplegia in the absence of polydactyly or obesity. Bardet-Biedl syndrome is characterized by distal limb anomaly, obesity, and renal involvement, but neurologic symptoms are very unusual. We report a patient exhibiting characteristic features of Bardet-Biedl syndrome in addition to cerebellar vermis hypoplasia and mega cisterna magna. (J Child Neurol 2002;17:385-387).

Induction of apoptosis of rabbit corneal endothelial cells by preservative-free lidocaine hydrochloride 2%, ropivacaine 1%, or levobupivacaine 0.75%

PURPOSE: To determine and compare the amount of apoptosis and changes in rabbit corneal endothelial cell morphology after intracameral administration of different anesthetic agents. SETTING: Department of Ophthalmology, Baskent University Medical Faculty, Ankara, Turkey. METHODS: Right eyes of 64 Vienna white rabbits were injected intracamerally with preservative‐free lidocaine hydrochloride 2%, ropivacaine 1%, levobupivacaine 0.75%, or fortified balanced salt solution (BSS Plus) (control). Animals were humanely killed 1 day or 7 days later. Terminal deoxynucleotidyl transferase deoxy‐UTP‐nick end labeling was used to detect apoptosis. Corneal endothelial cells and apoptotic cells were counted by light microscopy. The morphologic appearance was determined by transmission electron microscopy (TEM). RESULTS: Apoptotic cell density was high in the anesthetic groups on day 1 (P<.01); there was no significant difference between groups at 7 days. Apoptotic cell density declined significantly between 1 day and 7 days in the anesthetic groups (P<.05) but not in the control group. There was no difference in endothelial cell density between the 4 groups at 1 or 7 days. All anesthetic groups showed degenerative changes on TEM, with the least change in the preservative‐free lidocaine hydrochloride 2% group. CONCLUSIONS: Intracameral injections of preservative‐free lidocaine, ropivacaine, and levobupivacaine induced significantly more apoptotic endothelial cell loss than BSS Plus and led to morphologic changes in the corneal endothelial cells in the early period. This effect was temporary, with recovery by 7 days. Considering the limited proliferative capacity in human eyes, the induced apoptosis might result in the permanent cell loss and enlargement in human corneal endothelium.

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

PurposeTo assess the safety and efficacy of topical lidocaine, levobupivacaine, and ropivacaine in cataract surgery with phacoemulsification.MethodsOne hundred and five patients scheduled for cataract surgery with topical anaesthesia were randomly allocated into 3 groups of 35 patients each to receive eye drops of lidocaine 2%, levobupivacaine 0.75%, or ropivacaine 1% every 5 min starting 30 min before surgery. Patients graded their pain using a 0–10-point verbal pain score (VPS) at different stages of the procedure. The levels of patient and surgeon satisfaction, the duration of surgery, complications, and the need for supplemental anaesthesia were recorded.ResultsThere was no significant difference in duration of surgery and demographic variables among the groups. At the intraoperative period, end of surgery, and postoperative first hour the mean VPS in the lidocaine group was significantly higher than the others (P<0.01), but no significant difference was found between the levobupivacaine and ropivacaine groups. At incision and 24 h after surgery, it was not significantly different among the groups. Surgeon and patient satisfaction scores were significantly better in the levobupivacaine and ropivacaine groups than in the lidocaine group (P<0.01).ConclusionsTopical anaesthesia with levobupivacaine and ropivacaine were safe, feasible and more effective than lidocaine in cataract surgery. Levobupivacaine and ropivacaine provided sufficient and long-lasting analgesia without the need of supplemental anaesthesia for each patient.

Amniotic membrane transplantation for treatment of symblepharon in a patient with recessive dystrophic epidermolysis bullosa.

Purpose: To report the surgical treatment of a case with epidermolysis bullosa. Methods: A 12-year-old girl with dystrophic epidermolysis bullosa presented to our clinic with a symblepharon connecting the lateral half of the left upper lid to the upper temporal quadrant of the cornea. The central cornea exhibited diffuse opacity and vascularization. Results: During surgery, the symblepharon was lysed, and lamellar keratectomy was performed. The operated portion of cornea and palpebral conjunctiva was covered with amniotic membrane to promote healing. Fourteen months later, the operated eyelid margin was normal and the eye was fully mobile. The temporal portion of the corneal stroma was still thinner than normal and showed mild superficial vascularization and opacification. Conclusion: We believe that amniotic membrane transplantation is a valuable way to treat symblepharon in cases of epidermolysis bullosa.

Retinal vein occlusion in a woman with heterozygous Fabry's disease

Fabrys disease is associated with high incidence of thrombosis in hemizygous males and heterozygous females. We describe a woman with Fabrys disease who developed hemi-central retinal vein occlusion during the follow-up. The vein occlusion showed a fulminant course ending with a painful blind eye within a short period. Fabrys disease should be considered in the differential diagnosis of the vascular occlusive disorders especially in young patients.

Non-concordance in amblyopia treatment: the effective use of 'smileys'.

PURPOSE The success of any specific occlusion regimen is limited by the level of concordance, which is difficult to measure accurately in patching treatment. The aim of this study was to investigate prospectively the concordance rate of a group of children with strabismic and/or anisometropic amblyopia using a schematic diary based on completing ‘smiley’ images, filled in by the child under parental supervision, and to assess the effect of correlates such as initial visual acuity, age, and total and daily occlusion time on concordance. METHODS We recruited 51 amblyopic children aged 13 months to 12 years (mean 6.57 ± 2.82). The median duration of treatment was 16 weeks. Non-concordance was defined as occluding less than 75% of the prescribed time and was analyzed using a concordance index calculated from occlusion time recorded in the diary / prescribed occlusion time. RESULTS Of the 51 patients followed prospectively, 12 (23.5%) failed to return their diaries (Group 1); 27 (52.9%) complied with occlusion (Group 2); and 12 (23.5%) failed to comply with occlusion completely (Group 3). The total proportion of non-concordance was 47.1% (Group1 + Group 3). Concordance was not significantly related to initial visual acuity (r = -0.22, p = 0.19), patient age (F = 1.0787, p = 0.349) or total occlusion time (X 2 = 2.779, p = 0.249), but the number of daily occlusion hours showed significant difference in Group 1 (X 2 = 15.894, p = 0.000). When the three groups were compared for change in visual acuity, a significant difference was found between group 1 and group 2 (X 2 = 6.125, p = 0.047). CONCLUSION The substantial proportion of non-concordance in our study suggests that, although useful for recording purposes, parental diaries may not be stimulating enough to increase the overall level of concordance. Therefore, other forms of monitoring need to be explored.

Is tear calcium an indicator of ocular calcification in patients with chronic renal failure

Background. In patients with chronic renal failure (CRF) on regular dialysis treatment, limboconjunctival degeneration and calcifications are common. The mechanisms of ectopic conjunctival and corneal calcification remain largely speculative. The aim of the present work was to study tear calcium levels in patients with chronic renal failure, which could alter calcium excretion patterns, and to examine whether the calcium level in tear fluid is of more diagnostic importance than static calcium levels in blood. Methods. Tear calcium levels were measured in 25 patients with chronic renal failure, compared with 14 normal subjects. Conjunctival and corneal calcium deposits were graded by the Porter and Crombie classification. Results. While 11 of the 25 patients had no clinically apparent calcium deposits, six had Grade 1 or 2, and eight had Grade 3 and over limboconjunctival calcification. Mean tear calcium levels were 1.436±0.165 mg/dl in the patients and 1.307±0.155 mg/dl in the normal group. The difference was not significant (P=0.572). No correlation was found between the grade of the calcium deposits and tear calcium levels. Conclusions. Tear calcium level has no diagnostic importance for the development of ocular calcification in chronic renal failure.