Sitki Samet Ermis

The Comparative Cardiovascular, Pulmonary, Ocular Blood Flow, and Ocular Hypotensive Effects of Topical Travoprost, Bimatoprost, Brimonidine, and Betaxolol

OBJECTIVE This study evaluated systemic and ocular acute safety and intraocular pressure (IOP)-lowering efficacy of travoprost 0.004% and bimatoprost 0.03%, compared to brimonidine 0.2% and betaxolol 0.25% in healthy subjects. PATIENTS AND METHOD Nineteen (19) young men, ages between 24 and 42, were enrolled in a single-center, institutional randomized, double-masked, crossover clinical trial. Baseline IOP, heart rate, blood pressure, and respiratory rate were recorded at hour 0. At minute 30, heart rate, blood pressure, respiratory rate, and spirometry were measured. At hour 1, color Doppler imaging of retrobulbar vessels was performed. At hour 2, heart rate, blood pressure, and respiratory rate were measured; spirometry and a 15-minute treadmill test were performed. The same protocol was applied after one drop of a study medication was instilled into each eye on four subsequent visits at 5-day intervals. RESULTS Travoprost and bimatoprost did not cause significant reductions in systolic blood pressure during exercise and recovery. The mean respiratory rate and forced expiratory volume in 1 second were not significantly altered by any study medication. Travoprost reduced the resistive index and increased blood velocities in the ophthalmic artery and its branches. Bimatoprost caused a significant increase in end diastolic velocity of the ophthalmic artery. At hour 6, all medications reduced IOP significantly (p < 0.05). The most frequent ocular side effect of travoprost and bimatoprost was conjunctival hyperemia. CONCLUSION Travoprost and bimatoprost were found to be systemically safe and caused an increase in blood-flow velocities of the retrobulbar vessels after a single-dose application. Their ocular hypotensive effect was comparable to that of brimonidine and greater than that of betaxolol in healthy subjects.

Effects of Intravitreal Moxifloxacin and Dexamethasone in Experimental Staphylococcus aureus Endophthalmitis

Purpose: To evaluate the effects of intravitreal moxifloxacin and moxifloxacin and dexamethasone combination in an experimental rabbit model of Staphylococcus aureus endophthalmitis. Methods: The right eyes of 24 rabbits weighing 2 to 3 kg were used. Ten thousand colony-forming units (CFU) of S. aureus in 0.1 ml saline solution were inoculated into the vitreous cavity. The eyes were randomly assigned to one of the four groups equally. Twenty-four hours after the inoculation of S. aureus, group 1 received 50 μ g moxifloxacin, group 2 received 50 μ g moxifloxacin plus 400 μ g dexamethasone, and group 3 received 1mg vancomycin intravitreally. No treatment was given to group 4. Clinical examination scores were recorded. Vitreous aspirates were obtained for microbiological analysis just before sacrifice, and the eyes were enucleated for histopathologic examination. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests. Results: In all treatment groups, mean number of CFU and histopathologic score were significantly lower compared with control group (p < 0.05), and the difference between treatment groups was not statistically significant (p > 0.05). The clinical score was not significantly different between groups (p > 0.05). Conclusions: Intravitreal injection of 50 μg moxifloxacin was effective in the treatment of S. aureus endophthalmitis. Bacteriological, histopathologic, and clinical outcomes after treatment using moxifloxacin, moxifloxacin and dexamethasone combination, and vancomycin were comparable. Intravitreal moxifloxacin may be an option in the treatment of S. aureus endophthalmitis.

A comparison among Humphrey field analyzer, Microperimetry, and Heidelberg Retina Tomograph in the evaluation of macula in primary open angle glaucoma.

PurposeIt is known that macula can be affected adversely in glaucoma. In this study, we aimed to evaluate the functional and morphologic changes of macula in patients having glaucoma using Microperimeter-1 (MP-1), Humphrey field analyzer (HFA), and Heidelberg Retina Tomograph II (HRT-II). Materials and MethodsThis prospective study consisted of 43 patients having primary open angle glaucoma. Control group consisted of 26 normal cases. Macular threshold was evaluated with HFA macula threshold test and MP-1 Humphrey macula pattern. Morphometric evaluation of macula was performed with HRT-II. The results were evaluated by independent samples t test and receiver operator curves. ResultsMacular sensitivity was lower in patients having glaucoma with both HFA and MP-1 in all quadrants (P=0.003 for HFA and P=0.002 for MP-1). The macular thickness measurements obtained with HRT-II was not significant between glaucoma patients and control group (P=0.153). The difference between HFA and MP-1, HFA and HRT-II, MP-1 and HRT-II was not statistically significant (P=0.302, 0.110, and 0.481, respectively). ConclusionsPerimetric macular changes can occur while macular topographic remains stable in patients with glaucoma. MP-1 correlates with HFA in detecting glaucomatous visual field defect in macular area.

Efficacy of topical caspofungin in experimental fusarium keratitis.

Purpose: To evaluate the efficacy of caspofungin in an experimental rabbit model of Fusarium keratitis and to compare it with amphotericin B. Methods: Eighteen New Zealand white rabbits were randomly divided into 2 treatment groups and 1 control group. One cornea of each rabbit was inoculated with Fusarium solani spores. The first group received topical amphotericin B 0.15%, the second group received topical caspofungin 1%, and the control group received topical balanced salt solution hourly for 2 days and then 4 times daily for 3 additional days. Treatment effects were evaluated by clinical assessment at days 3 and 5 and by fungal culture after 5 days of treatment. Results: In the treatment groups, progression of keratitis was inhibited, and cultures were sterile at the end of the study. In the control group, keratitis progressed, and cultures were positive for F. solani. Conclusions: Topical caspofungin is effective in Fusarium keratitis, and clinical efficacy studies seem justified.

The effect of dehydration and fasting on ocular blood flow.

PURPOSE To investigate the effects of dehydration and fasting on retrobulbar-vessel blood velocity in healthy subjects. METHODS Twenty-eight eyes of 28 normal subjects without ocular disease were enrolled in this study. Each subject had a baseline color-Doppler imaging ultrasound of the central retinal artery, temporal short posterior ciliary arteries, and ophthalmic artery after 14 hours of religious fasting and dehydration. The first measurements were performed in the fasting conditions. The mean blood flow velocities and resistive index were measured in each artery. One month after the fasting period, color-Doppler imaging measurements were performed in nonfasting conditions. Blood pressure, heart rate, and intraocular pressure were measured before color-Doppler imaging measurements in both the fasting and nonfasting conditions. RESULTS Although systolic/diastolic blood pressure, heart rate, and intraocular pressure (111.78 +/- 8.18/76.42 +/- 5.75 mm Hg, 71.00 +/- 2.88 beats/min, and 12.71 +/- 2.25 mm Hg) were higher in nonfasting conditions (112.32 +/- 7.97/78.98 +/- 5.50 mm Hg, 70.71 +/- 2.77 beats/min, and 13.14 +/- 2.62 mm Hg, respectively), differences were not statistically significant. A statistically significant increase in peak systolic velocity in the ophthalmic artery, central retinal artery, and temporal short posterior ciliary artery was noted at the second measurements. A peak systolic velocity value of 48.90 +/- 14.66 cm/sec in the ophthalmic artery increased to 58.28 +/- 14.65 cm/sec in the nonfasting conditions ( < 0.05). A peak systolic velocity value of 16.88 +/- 4.30 cm/sec and an end diastolic velocity of 6.69 +/- 2.15 cm/sec in the central retinal artery increased to 24.24 +/- 6.45 cm/sec and 9.32 +/- 3.08 cm/sec, respectively, was recorded in the nonfasting and nondehydration condition ( < 0.05). Peak systolic velocity measurement of 23.42 +/- 6.19 cm/sec in temporal short posterior ciliary artery increased to 26.68 +/- 7.52 cm/sec at the second measurement ( < 0.05). The only significant change observed in the resistive index measurements was an increase in the ophthalmic artery resistive index in the nonfasting conditions ( < 0.05). CONCLUSIONS Color-Doppler measurement may vary significantly in conditions of fasting and dehydration conditions compared with hydrated conditions. Therefore, the fasting and dehydration conditions should be considered when interpreting color-Doppler imaging results and comparing different groups of diseased or healthy subjects.

The effects of caspofungin and voriconazole in experimental Candida endophthalmitis.

Purpose: To evaluate the efficacy of newly developed antifungal agents caspofungin and voriconazole in Candida albicans endophthalmitis in rabbit eyes. Methods: Thirty New Zealand white rabbits were divided into four treatment groups and one control group. One eye of each rabbit was infected by inoculation of 1 × 104 CFU/ml of C. albicans. Seventy-two hours after the inoculation, caspofungin 100 μg/0.1 ml in group 1 (n = 6), voriconazole 50 μg/0.1 ml in group 2 (n = 6), amphotericin B 10 μg/0.1 ml in group 3 (n = 6), itraconazole 10 μg/0.1 ml in group 4 (n = 6), and 0.1 ml NaCl 0.9% in control group (n = 6) were injected into the vitreous cavity. Clinical and histopathologic examination scores and microbiological analysis of vitreous aspirates were compared. Results: There was statistically significant difference in the clinical scores, histopathologic scores, and mean CFU/ml between the treatment and control groups (p < 0.05). In caspofungin and voriconazole groups, histopathologic scores and mean CFU were lower than other treatment groups and control group. Conclusions: Intravitreal injection of caspofungin and voriconazole was effective against C. albicans endophthalmitis in this experimental rabbit model.

Meibomian Gland Alterations in Polycystic Ovary Syndrome

Purpose: Polycystic ovary syndrome (PCOS) is an endocrinopathy characterized by chronic anovulation and hyperandrogenism where hyperinsulinemia can be seen. Hormonal changes can affect meibomian gland function. In this study, we evaluated tear function in PCOS. Materials and Methods: Twenty-seven women having PCOS and 22 normal individuals aged between 18–42 years were enrolled in the study. Patients were asked about dry eye symptoms. Schirmer test, tear film breakup time, and rose Bengal staining were performed. Conjunctival brush cytology specimens were obtained and goblet cell count was done. Results: Dry eye symptoms were more frequent in subjects with PCOS (p = 0.025). Mean breakup time was shorter in women with PCOS (p = 0.034). Schirmer test results, rose Bengal staining scores, and goblet cell count were not different between groups (p = 0.48, p = 0.18, p = 0.82, respectively). Conclusion: Meibomian gland function and tear film lipid layer can be affected in cases with PCOS.

Effects of Postural Variation on Anterior Chamber Depth in Pseudoexfoliative Eyes with Normal Intraocular Pressure

Purpose: Pseudoexfoliation (PEX) is a condition characterized by widespread intraocular and systemic production and deposition of an abnormal fibrillar extracellular material. Zonular instability is frequently associated with PEX. Anterior chamber depth (ACD) and intraocular pressure (IOP) changes in normotensive eyes with PEX after prone position was investigated in this study. Methods: Thirty subjects with normotensive pseudoexfoliative eyes and 30 healthy control subjects were enrolled. None of the eyes had cataract or posterior synechia. Central ACD, axial length (AL), and IOP were measured 5 min after supine and prone positions by using A-scan ultrasonography and TonoPen. Results: Mean ACD decreased from 2.89 ± 0.27 mm to 2.71 ± 0.23 mm in eyes with PEX and from 2.94 ± 0.25 mm to 2.84 ± 0.30 mm in normal eyes with postural change. The ACD decreased significantly in both group of eyes in prone position (p < 0.001 in PEX group, p = 0.005 in normal group), but the decrease in ACD in eyes with PEX was significantly greater than the decrease in normal control eyes (p = 0.03). Mean IOP was 16.9 ± 2.1 mmHg after supine position and 17.1 ± 2.04 mmHg after prone position in eyes with PEX, 16.1 ± 2.7 mmHg after supine position and 16.3 ± 2.6 mmHg after prone position in normal eyes. Postural changes in IOP and AL were not statistically significant in both groups of eyes (p = 0.096 in the PEX group and p = 0.484 in the normal group for IOP; p = 0.177 in the PEX group and p = 0.276 in the normal group for AL). Conclusion: The lens is more mobile in pseudoexfoliative eyes than normal eyes after supine to prone position. Although the ACD of pseuodoexfoliative eyes decreased statistically significantly after 5 min of prone position, IOP did not change significantly.

Effects of fentanyl on pain and hemodynamic response after retrobulbar block in patients having phacoemulsification.

Purpose: To determine the effects of systemic fentanyl analgesia in preventing the pain related to the administration of retrobulbar anesthesia and cataract surgery. Setting: Departments of Ophthalmology and Anesthesiology, School of Medicine, Kocatepe University, Afyon, Turkey. Methods: One hundred twenty patients with American Society of Anesthesiologists physical status I to III scheduled for cataract surgery were evaluated in a single‐blind randomized study. Patients with a history of hypertension, hyperthyroidism, or neurologic or psychiatric disorders were excluded. In the study (fentanyl) group, an intravenous bolus of fentanyl 2 &mgr;g/kg was slowly given 5 minutes before retrobulbar anesthesia was administered. In the control group, fentanyl was not given. There were 60 patients in each group. Demographic data were not statistically different between the 2 groups. The intensity of pain during injection and intraoperatively was measured by verbal pain scores. Hemodynamic stability was assessed by the heart rate (HR) and mean arterial pressure (MAP). End‐tidal carbon dioxide concentrations and oxygen saturations were also recorded. Results: The changes in HR and MAP at 0, 10, 20, and 30 minutes were statistically significant between the fentanyl and control groups (P<.05). Fentanyl reduced pain scores significantly at all evaluations (P<.05). Conclusion: The results suggest that fentanyl preemptively decreases injection and intraoperative hyperalgesia and provides hemodynamic stability without affecting patient cooperation, resulting in cataract surgery with retrobulbar anesthesia that is comfortable for both surgeon and patient.

Acute Effects of Sildenafil on Humphrey Visual Field and Intraocular Pressure

Purpose: To evaluate the effects of sildenafil on visual field and intraocular pressure in a group of healthy subjects. Methods: Twenty-eight healthy male volunteers with normal eyes were included in the study. Visual field examinations were performed using FASTPAC 30-2 program (white-on-white and blue-on-yellow) with the Humphrey field analyzer before and one hour after receiving oral 50 and 100 mg sildenafil citrate. Results: The mean age was 51.1 ± 8.9 years. Mean deviation, pattern standard deviation, short-term fluctuation and corrected pattern standard deviation did not differ significantly among tests both in white-on-white and blue-on-yellow visual field examinations. Changes in intraocular pressure were not statistically significant. Conclusions: No significant effect of sildenafil was seen on visual field and intraocular pressure in healthy subjects.