Süleyman Okudan

Meibomian gland dysfunction and tear film abnormalities in rosacea.

In order to determine the relationship between meibomian gland dysfunction and tear film abnormalities in rosacea, tear film flow and stability and meibomian gland function were assessed in 43 consecutive patients. Schirmer, tear film break-up time, and meibomian gland function values in patients with ocular rosacea (n = 28) were found to be significantly decreased as compared with those of the patients with only cutaneous involvement and control patients (p > 0.05). In patients with dermatologic rosacea (n = 15) these values were not different from those of the age- and sex-matched controls (p > 0.05). The effects of tetracycline and meibomian gland expression therapy also were investigated in patients with ocular rosacea. Neither meibomian gland expression therapy nor tetracycline administration had beneficial effects on decreased tear secretion, but tetracycline improved the break-up time values. Our findings showed a positive relationship between tear film abnormalities and meibomian gland dysfunction in patients with rosacea. Decreased tear secretion in patients with ocular rosacea would seem to be a result of structural changes secondary to meibomian gland dysfunction, and short break-up time might be due to an abnormal meibum composition.

Comparison of intravitreal bevacizumab and ranibizumab treatment for diabetic macular edema.

AIM The aim of this study was to compare the effects of bevacizumab and ranibizumab on visual function and macular thickness in patients with diabetic macular edema (DME). METHODS The data of diabetic patients who had been treated with bevacizumab for DME were reviewed. Those patients who received 1 injection of intravitreal bevacizumab and ranibizumab with at least 6-month interval were considered for enrollment. The best-corrected visual acuity (BCVA) assesment with Early Treatment Diabetic Retinopathy Study (ETDRS) chart and central subfield macular thickness (CSMT) measurement using optical coherence tomography-3 before and after the injections were recorded as outcome measures. RESULTS The study included 29 eyes of 29 patients with a mean age of 56.18±13.07 years. The median BCVA was 59 ETDRS letters and the median CSMT was 411 μm preceeding the bevacizumab injection. At the 4th-6th week control after the injection, median BCVA increased to 61.50 ETDRS letters and the median CSMT decreased to 373 μm. This change in BCVA and CSMT was found to be statistically significant (P=0.029 and P=0.011, respectively). The mean interval between bevacizumab and ranibizumab treatment was 9.54±2.64 months. Ranibizumab treatment increased the median BCVA from 53 to 66 ETDRS letters and decreased the median CSMT from 428 μm to a level of 279 μm, which were statistically significant (P<0.001 and P<0.001, respectively). The median change in BCVA was 4.5 ETDRS letters in the bevacizumab group and 6 ETDRS letters in the ranibizumab group (P=0.58), whereas the median changes in CSMT were 41 and 100 μm after bevacizumab and ranibizumab injections, respectively (P=0.005). CONCLUSIONS Bevacizumab and ranibizumab are both effective antivascular endothelial growth factor drugs preferred in the treatment of DME. Our comparison of both therapies on the same patients suggested that the effect on BCVA was not statistically different, but ranibizumab provided more decrease in CSMT.

Glucose regulation influences treatment outcome in ranibizumab treatment for diabetic macular edema

PURPOSE To evaluate the effect of glucose regulation on intravitreal ranibizumab injection for clinically significant diabetic macular edema (DME). METHODS This retrospective study enrolled 65 eyes of 65 patients with persistent DME treated with intravitreal ranibizumab injection. The main outcome measures were the change in best corrected visual acuity (BCVA), the central subfield macular thickness (CSMT) recorded with optical coherence tomography (OCT), and its correlation with the serum hemoglobin A(1c) values (HbA(1c)). RESULTS The study included 24 (36.9%) female and 41 (63.1%) male patients with a mean age of 58.90±9.45 years. The mean HbA(1c) of the enrolled patients was 8.25±1.74% (range 5.7-12.7%). The median value of BCVA at baseline examination was 20/80 (52 letters), and the median CSMT was 468 μm (range 255-964 μm). In the final control after 4-6 weeks following injection, the median value of BCVA increased to 20/50 (59.50 letters) and the median CSMT decreased to 310 μm (range 129-652 μm). This change in BCVA and macular thickness was found to be significant (P<.001 for both). There was no correlation between BCVA and the change in macular thickness (coefficient=0.04, P=.78). The serum HbA(1c) values were found to be negatively correlated with the change in CSMT (coefficient=-0.50, P<.001). CONCLUSIONS The results of intravitreal ranibizumab injection for DME demonstrated a beneficial effect on visual acuity and a decrease in CSMT which is inversely correlated with the serum HbA(1c) level.

Does lens status affect the course of early intraocular pressure and anterior chamber changes after intravitreal injection

Purpose:  This study aimed to observe changes in anterior chamber parameters and the course of intraocular pressure (IOP) after injection of 0.1 ml intravitreal triamcinolone acetonide (TA) and to determine differences between phakic and pseudophakic eyes without vitreous reflux.

Effect of religious fasting on tear osmolarity and ocular surface.

Objective: To evaluate the effects of religious fasting on tear secretion, tear osmolarity, corneal topography, and ocular aberrations. Methods: This prospective controlled study comprised 29 eyes of 29 healthy men. Before ophthalmologic examination, all subjects underwent corneal topography by a placido disc corneal topography and aberrometry device (OPD Scan II). Tear osmolarity was measured using OcuSense TearLab osmometer. Ocular surface disease index (OSDI) scores, tear break-up time (BUT), Schirmer I test, and lissamine green staining were evaluated. The measurements taken before and during Ramadan at the same hours between 4.00 and 5.00 PM were compared using paired sample t test, and a P value less than 0.05 was accepted as statistically significant. Results: The mean age of the study group was 27.8±5.9 years (range, 20–47 years). The mean tear osmolarity values were measured as 285.6±8.2 mOsm/L and 293.3±16.0 mOsm/L, whereas the mean Schirmer I values were 14.8±6.0 mm and 10.6±5.3 mm in nonfasting and fasting periods, respectively. Tear osmolarity, OSDI, and Oxford grading scores significantly increased (P=0.02, P=0.002, P=0.003, respectively), whereas Schirmer I values and intraocular pressure decreased (both, P<0.001) during the fasting period compared with the nonfasting period. There were no significant differences in tear BUT, keratometry values, and corneal aberration measurements between nonfasting and fasting periods (P>0.05, for all). Conclusion: Fasting significantly decreases tear production and increases tear osmolarity; however, it does not deteriorate corneal topographic parameters and ocular aberrations in healthy subjects.

Control of steroid-induced glaucoma with surgical excision of sub-Tenon triamcinolone acetonide deposits: a clinical and biochemical approach

OBJECTIVE To assess the efficacy of surgical excision of sub-Tenon triamcinolone acetonide (TA) deposits in the control of steroid-induced glaucoma. DESIGN Prospective, nonrandomized, interventional case series. PARTICIPANTS Eighteen eyes of 14 subjects with increased IOP within 6 months of sub-Tenon TA injection who did not respond to medical antiglaucomatous treatment were included in the study. METHODS Under topical anaesthesia, steroid deposits were completely excised and placed in ethyl alcohol for the determination of the TA amount using high-performance liquid chromatography. The patients were followed up for 6 months and a paired-sample t test was used to compare mean IOP before and after excision of sub-Tenon TA deposits. RESULTS The mean IOP levels before and after the sub-Tenon steroid injections were 15.9 (SD 2.9) mm Hg and 36.4 (SD 8.4) mm Hg, respectively (p < 0.001). IOP levels decreased significantly after the removal of the deposits (mean 15.3 [SD 2.1] mm Hg) (p < 0.001). Within 6 months of follow-up, all glaucoma medications were stopped in 9 subjects without further IOP increase, whereas IOP control in 5 subjects necessitated using glaucoma medications. The median TA amount was found to be 7.35 mg (range 3.3-29.68 mg). IOP decrease after the excision showed no correlation with the amount of TA (p = 0.8). CONCLUSIONS Surgical excision of the sub-Tenon steroid deposit should be considered as the primary treatment for steroid-induced glaucoma refractory to medical treatment.

Posterior Corneal Steepening in Posterior Polymorphous Corneal Dystrophy.

Purpose The aim was to evaluate the anterior and posterior corneal topographic characteristics of three patients with posterior polymorphous corneal dystrophy (PPCD) using a rotating Scheimpflug camera combined with a Placido disc system (Sirius, CSO, Italy). Case Reports Two children with unilateral PPCD and a 53-year-old woman with bilateral PPCD were diagnosed by the presence of vesicles and railroad track lesions at the level of the Descemet membrane with slitlamp biomicroscopy and in vivo confocal microscopy. Anisometropic and/or meridional amblyopia was detected in both children. In the 16-year-old child, there was unilateral anterior corneal steepening with high astigmatism (plano −7.00 x170) in the eye with PPCD. The 5-year-old boy had unilateral axial myopia and against-the-rule corneal astigmatism (−12.00 –2.00 x90). Corneal topography of the woman revealed with-the-rule astigmatism and thin corneas (464 &mgr;m OD and 445 &mgr;m OS) in both eyes. Posterior corneal steepening greater than 25 &mgr;m either in a vertical or in a horizontal pattern changing with the orientation of the railroad track band lesions was detected in all subjects. Conclusions Besides anterior corneal changes, PPCD seems to cause posterior corneal elevation, which necessitates corneal tomographic evaluation. In unilateral or highly asymmetric cases, children with PPCD should be screened for amblyopia.

Postoperative fungal endophthalmitis caused by Trichosporon asahii treated with voriconazole

Postoperative fungal endophthalmitis is a rare but devastating complication of cataract surgery. Vitrectomy and intravitreal amphotericin B injection as well as administration of systemic antifungal agents have been suggested as optimal treatments for fungal endophthalmitis. However, this therapy may fail to eliminate fungal species resistant to current antifungal agents. The saprophytic fungus Trichosporon asahii is frequently observed as a cause of endogenous endophthalmitis in immunosuppressed patients. We report a case of postoperative endophthalmitis caused by T. asahii, resistant to amphotericin B. To the best of our knowledge, this is the first report of T. asahii endophthalmitis successfully treated with intravitreal and systemic voriconazole, pars plana vitrectomy, and removal of the intraocular lens and entire lens capsule.

Cavernous hemangioma with cone dysfunction.

We report a 13-year-old male who complained of strabismus and low visual acuity in the right eye. Saccular aneurysms filled with dark-colored blood were noted in the upper nasal quadrant of the right fundus. Ishihara color plates and Lanthonys new color test revealed a red-green color defect. Cone response and 30-Hz flicker responses were nearly absent. Cavernous hemangioma of the retina is a rare vascular hamartoma; the associated findings show cone dysfunction concomitant with this peripheral lesion.

Pattern-reversal electroretinograms and visual evoked potentials in branch retinal vein occlusion

We recorded pattern electroretinograms and visual evoked potentials in a group of selected patients with unilateral uncomplicated branch retinal vein occlusion. To document the effects of preexisting risk factors, patients were divided into three groups: diabetes mellitus, hypertension with hyperlipidemia and no systemic disease. The transient and steady-state pattern electroretinogram and visual evoked potential amplitudes were significantly reduced and visual evoked potential peak times were delayed relative to the fellow eyes and agematched normal subjects. There was a second amplitude reduction relative to the other patient groups in both the affected and fellow eyes of the diabetes mellitus group, which was indicative of an additive effect of diabetes mellitus.