Tuncay Küsbeci

Preoperative topical indomethacin to prevent pseudophakic cystoid macular edema

PURPOSE: To evaluate the effectiveness of a nonsteroidal antiinflammatory drug (NSAID) on pseudophakic cystoid macular edema (CME) and determine the efficacy when used preoperatively and after uneventful phacoemulsification surgery. SETTING: Department of Ophthalmology, Kocatepe University, School of Medicine, Afyonkarahisar, Turkey. METHODS: One hundred seventy‐nine eyes of 189 patients having uneventful phacoemulsification surgery were enrolled in the study. After surgery, all patients used topical steroids and antibiotics 4 times daily. Sixty‐one eyes, chosen randomly, received a topical NSAID (indomethacin) 4 times daily for 3 days preoperatively and 1 month postoperatively. Sixty eyes received topical indomethacin 4 times daily for 1 month postoperatively. Fifty‐eight eyes served as a control group and received only topical steroids and antibiotics. At the third postoperative month, visual acuity, fluorescein angiograms, and macular thresholds were evaluated. Statistical analysis was by chi‐square and 1‐way analysis of variance tests. RESULTS: Cystoid macular edema was not seen in the group receiving indomethacin preoperatively and postoperatively. The incidence of angiographic CME was 15.0% in the group receiving postoperative indomethacin and 32.8% in the control group (P<.001). Mean sensitivity in the macular threshold test did not show a significant change between groups (P = .83). Postoperative visual acuity was significantly higher in the group receiving preoperative indomethacin (P<.001). CONCLUSION: Nonsteroidal antiinflammatory drugs decreased the incidence of CME, and their efficacy increased when begun preoperatively.

Evaluation of cystoid macular edema using optical coherence tomography and fundus fluorescein angiography after uncomplicated phacoemulsification surgery.

Purpose: To evaluate the central macular thickness (CMT) and the cystoid macular edema (CME) after uncomplicated phacoemulsification surgery. Material and methods: Ninety-one eyes of 88 patients who underwent uncomplicated phacoemulsification surgery between December 2008 and May 2009 were included in the study. Detailed ophthalmologic examinations and spectral domain optical coherence tomography (OCT) measurements were done preoperatively and at postoperative 1st, 4th, 12th, and 24th weeks. Best corrected visual acuity (BCVA) was measured as logMAR units at preoperative and all postoperative visits. Mean CMT, and perifoveal macular thickness in superior, inferior, nasal and temporal quadrants were recorded. CME was defined as three standard deviations (SD) above the preoperative mean CMT in OCT measurements. Fundus fluorescein angiography (FFA) was performed at postoperative 12th weeks. Data was analyzed statistically by using ANOVA test, and paired samples t test with Bonferroni correction. Results: The mean preoperative CMT was 255.68 ± 23.04 µm. The increase in CMT was statistically significant at postoperative 1st, 4th, 12th, and 24th weeks (p = 0.043). The most significant increase in CMT was seen at 12th weeks (p = 0.028). The change in perifoveal macular thickness measurements in the temporal, nasal, superior and inferior quadrant was statistically significant at postoperative 12th weeks (p < 0.001, for all measurements). The increase in macular thickness did not correlate with BCVA at postoperative 1st and 4th weeks but there was a significant correlation at postoperative 12th and 24th weeks. The incidence of angiographic CME at postoperative 12th weeks was 3.2%. The appearance of CME in OCT was observed in 5.5% of eyes at postoperative 12th weeks. Conclusion: Macular thickness changes after uncomplicated phacoemulsification surgery and Spectral domain OCT is helpful in detecting cystoid abnormalities and any increase in macular thickness at postoperative early periods. Changes seen on OCT do not completely correlate with FFA findings.

The effect of levodopa and dopamine agonists on optic nerve head in Parkinson disease.

Purpose To evaluate the effects of levodopa and dopamine agonists on retinal nerve fiber layer using scanning laser ophthalmoscope. Methods Forty-four patients with the diagnosis of Parkinson disease and receiving levodopa or dopamine agonist monotherapy were included in this prospective study. The control group consisted of 21 normal cases. The optic nerve head images were taken with Heidelberg Retina Tomograph; rim area, rim volume, mean retinal nerve fiber layer thickness, and the results of Moorfields regression analysis were calculated. The measurement results were evaluated with Kruskal Wallis test and Mann-Whitney U-test. Results There was no significant difference in mean age among groups (p=0.093). Retinal nerve fiber layer was measured to be significantly decreased in cases with Parkinson disease (p=0.004) while rim area and rim volume did not show a significant change (p=0.224, p=0.804 respectively). Rim area, rim volume, and retinal nerve fiber layer were significantly greater in the group treated with levodopa while it was the thinnest in the group receiving dopamine agonists. Conclusions Levodopa can have a protective affect to retinal nerve fiber layer in Parkinson disease compared to dopamine agonists.

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 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.

Obstructive Sleep Apnea in Patients with Central Serous Chorioretinopathy

Abstract Purpose: In this study, we aimed to evaluate the relation between obstructive sleep apnea (OSA) and central serous retinopathy (CSR). Methods: Twenty-three consecutive subjects aged >18 years with the diagnosis of CSR were included in this prospective study. Overnight polysomnography was performed to all subjects. Desaturation index and apnea-hypopnea index (AHI) were recorded. Obstructive sleep apnea was classified according to AHI as mild, moderate, or severe. Statistical analysis was performed using chi-square test, Fisher’s exact test, and Mann–Whitney U test. Results: Fourteen of 23 CSR patients (60.9%) had OSA. Prevalence of OSA was significantly higher in male subjects with CSR compared to female subjects with CSR (p = 0.018). One (16.7%) female subject with CSR had OSA whereas thirteen (76.5%) male subjects were found to have OSA. Desaturation index was found to be 5.1 ± 4.2 in females and 12.9 ± 11.1 in males (p = 0.036). Conclusion: Obstructive sleep apnea is seen nearly in 2/3 of patients with the diagnosis of CSR. There are possible common pathophysiological mechanisms like oxidative stress, vasoconstriction, or blood coagulation abnormalities. Screening for OSA should be considered in subjects with the diagnosis of CSR.

Age-Related Macular Degeneration and Association of CFH Y402H and LOC387715 A69S Polymorphisms in a Turkish Population

Age-related macular degeneration (AMD) is a disease with multifactorial etiology characterized by irreversible loss of central visual acuity. The discovery of susceptive single-nucleotide polymorphisms (SNPs) has progressed our understanding of AMD. Complement factor H (CFH) gene Y402H polymorphism and high-temperature requirement A-1 (HTRA1) LOC387715 gene A69S polymorphisms are the most important SNPs reported in the literature. Determination of genetic risk factors and genotype-phenotype relationship in AMD may result in rapid and cost-effective therapeutic applications for young and old population. In this study, we hypothesized a potential association between CFH gene Y402H and HTRA1 LOC387715 gene A69S polymorphism in Turkish AMD patients. In blood samples from a total of 252 individuals, 147 clinically diagnosed as AMD and the others control, polymorphic sites in CFH, Y402H (Tsp509I T/C), and HTRA1, LOC387715 A69S (FnuHI G/T), were determined by polymerase chain reaction-restriction fragment length polymorphism analysis. There was significant difference between CFH genotypes in the AMD group, TT 21.8%, TC 48.3%, and CC 29.9%, and in the control subjects, TT 45% (p=0.003), TC 41% (p=0.0001), and CC 14% (p=0.0001). Further, the A69S polymorphism of LOC387715 was investigated and found to be significantly associated with AMD. LOC387715 genotypes in the AMD group were GG 30.6%, GT 38.1%, and TT 31.3% and in the control subjects were GG 59% (p=0.027), GT 39% (p=0.0001), and TT 2% (p=0.0001), respectively. We also found that Y402H C and A69S T allele were associated with AMD. This is the first study showing that Y402H and LOC387715 are associated with AMD in Turkish population.

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.

Conjunctival Flora in Patients with Parkinson's Disease

Purpose: To identify the conjunctival flora in patients with Parkinsons disease (PD) and compare it with the conjunctival flora of healthy subjects. Methods: One hundred six eyes of 106 patients with PD and 102 eyes of 102 age-matched healthy subjects were included in the study. All subjects had a detailed anterior segment examination, including eye blink rate and conjunctival cultures. Conjunctival cultures were taken with a sterile cotton-tipped dry swab without topical anesthesia. The culture samples were inoculated onto 5% sheep blood agar and chocolate agar, as well as brain heart infusion broth. The bacterial growth was evaluated in a quantitative manner as colony-forming units (CFU). All bacterial isolates were identified, and statistical analyses were performed by chi-square test to determine if there were differences in flora between PD and control groups. Results: Eighty-six (81.1%) of the 106 eyes in patients with PD and 73 (71.5%) of the 102 eyes in control group were found to have positive conjunctival cultures (p = 0.144). Coagulase-negative Staphylococcus was the most commonly isolated bacterial species in both groups, found in 45 (42.4%) and 49 (48%) of eyes in patients with PD and control group, respectively (p = 0.503). Among all bacterial isolates, only Staphylococcus aureus was found to be statistically different between the two groups, noted in 32 (30.1%) and 10 (9.8%) of eyes in patients with PD and control group, respectively (p = 0.001). Conclusions: Coagulase-negative Staphylococcus, Staphylococcus aureus, and Corynebacterium species were the most commonly isolated bacterial species in the PD group. Among all bacterial isolates, only Staphylococcus aureus was significantly higher in the conjunctival flora of patients with PD than in those in the control group.