Uğurcan Keskin

Assessment of Neutrophil/Lymphocyte Ratio in Patients with Age-related Macular Degeneration

Abstract Purpose: To investigate the neutrophil/lymphocyte ratio (NLR) as an indicator of inflammation in patients with age-related macular degeneration (AMD). Methods: Patients were evaluated by a review of records. The study included 81 patients with dry AMD (group 1), 84 patients with wet AMD (group 2), and 80 healthy age- and sex-matched controls (group 3). The NLR of the patients was obtained from the hospital laboratory archive and was measured by dividing the neutrophil count by the lymphocyte count. Results: A significant difference was found in NLR values between groups 1 and 2 (p = 0.017), groups 2 and 3 (p < 0.001), and groups 1 and 3 (p < 0.001). In correlation analyses, NLR was correlated positively with age (r = 0.22, p <0.001) and disease severity (r = 0.40, p < 0.001). Conclusions: Patients with AMD have higher NLR compared with controls, and NLR correlates with disease severity. NLR may be used as a biomarker of inflammation in AMD.

The Significance of the Neutrophil/Lymphocyte Ratio as a Simple Indicator of Inflammation in Age-related Macular Degeneration

We would like to thank Dr. Ozgonul and Dr. Sertoglu for their interest in our article ‘‘Assessment of neutrophil/lymphocyte ratio in patients with agerelated macular degeneration.’’ Please find below the responses to their comments. Regarding their first comment, the majority of the patients included in the current study were yet to commence treatment. The remaining patients were only on ranibizumab, an anti-vascular endothelial growth factor (VEGF) treatment. Unlike bevacizumab and aflibercept, the systemic exposure of ranibizumab is quite low after intravitreal administration. The concentration of ranibizumab in the vitreous was determined at almost 90,000 times that of blood plasma levels. Moreover, two recent studies demonstrated that ranibizumab had no remarkable effect on plasma VEGF levels. On the basis of these pieces of information, the neutrophil/lymphocyte ratio (NLR) of the patients with age-related macular degeneration (AMD) may not be affected by the treatment modalities of our study. Regarding the second comment, patients whose leukocyte count was 412,000 cells/mL or 54000 cells/mL were excluded. This exclusion criteria was based on the literature. Systemic inflammatory response syndrome (SIRS) describes the generalized abnormal inflammatory response caused by a variety of factors (infection, burns, trauma, surgery, etc.). The range of leukocytes mentioned in the exclusion criteria represents one of the SIRS criteria. All the patients blood samples were evaluated in the laboratory of our hospital. The blood samples were collected in tubes containing dipotassium ethylenediaminetetraacetic acid (EDTA) and assessed within 60 minutes of the sampling. The neutrophil and lymphocyte counts were measured using the automatic blood counter Cell-Dyn 3700 (Abbott Diagnostics, Santa Clara, CA, USA). This device is reliable in the evaluation of full blood count in daily practice. Regarding their third comment, we agree with the authors concerning the lack of receiver–operating characteristic (ROC) analysis in the current study. The determination of sensitivity and specificity of NLR for patients with and without AMD would provide more valuable results. Further studies utilizing ROC analysis to evaluate NLR as a marker of inflammation in AMD patients will specify the diagnostic value of NLR. We used NLR as a simple, inexpensive, reliable indicator of inflammation in patients with AMD. C-reactive protein and erythrocyte sedimentation rate may be used with NLR in the assessment of inflammation and prognosis in patients, but they were not evaluated in this retrospective study due to deficient patient data. Moreover, inflammatory markers, such as tumor necrosis factor-alpha and interleukin-6 tests, were not used because they are expensive and are nonroutine tests for AMD patients.

Central retinal artery occlusion secondary to orbital cellulitis and abscess following dacryocystitis.

Purpose To report a case of dacryocystitis that progressed to orbital abscess resulting in the rare complication of central retinal artery occlusion. Methods A patient without any other known health problems presented with dacryocystitis complicated by orbital cellulitis, orbital abscess, and finally central retinal artery occlusion despite medical treatment. Results After 48 hours of medical treatment, there was no recovery, and there was loss of light perception; because of this, surgery indication was determined. Fundus fluorescein angiogram demonstrated findings of central retinal artery occlusion. There was no recovery of light perception after surgical intervention. Conclusions We report a case of orbital abscess following dacryocystitis in a healthy middle-aged woman resulting in the rare complication of central retinal artery occlusion. To our knowledge, this is the first report of central retinal artery occlusion secondary to orbital abscess following dacryocystitis.

Peripapillary Retinal Nerve Fiber Layer and Ganglion Cell–Inner Plexiform Layers Thickness in Ankylosing Spondylitis

Abstract Objective: To assess the thickness of the retinal nerve fibril layer (RNFL) in cases with ankylosing spondylitis (AS). Materials and methods: The study included 40 AS patients who had no history of acute and/or previous uveitis and 50 healthy controls. After detailed ocular examination, the thickness of the peripapillary RNFL, the macula, and the ganglion cell–inner plexiform layers (GCIPL) were measured by spectral domain optic coherence tomography (SD-OCT). The correlation between the duration of the disease and the thickness of the RNFL, the macula, and the GCIPL were analyzed in the patients who had AS. These patients were then placed into 2 groups according to their BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) score: patients with BASDAI score <4 and those with BASDAI score ≥4. The correlations between the BASDAI score and the mean GCIPL and temporal RNFL thickness were evaluated. Results: No significant difference was detected in the RNFL thickness of the AS patients and that of the controls (p = 0.407). Nor was any significant difference detected in the GCIPL thickness of the AS and the control groups (p = 0.091). In addition, no significant difference was found in the macular thickness when the AS group was compared to the control group (p = 0.139). However, a negative correlation was detected between the duration of the disease and the thickness of the temporal quadrant RNFLs (r = −0.334; p = 0.035). The temporal quadrant RNFL thickness and the mean thickness of the GCPIL were significantly thinner in the AS patients with BASDAI score ≥4 (p = 0.034 and p = 0.025, respectively). Also, the BASDAI score were negatively correlated to the temporal quadrant RNFL and GCIPL thickness (r = −0.332; p = 0.036 and r = −0.348; p = 0.028, respectively). Conclusion: RNFL thickness and GCIPL thickness of ankylosing spondylitis may be affected by the severity and duration of the disease.

Effect of intravitreal injection of dexamethasone implant on corneal endothelium in macular edema due to retinal vein occlusion

Abstract Objective: To evaluate the effects of dexamethasone (DEX) implant (Ozurdex®) on corneal endothelium in patients with retinal vein occlusion complicated with macular edema. Materials and methods: Patients (n = 31) received 1–3 intravitreal DEX implants in one eye. Measurements were intraocular pressure (IOP) at baseline and 1, 3, and 6 months after the first intravitreal injection and corneal specular microscopy and central corneal thickness (CCT) at baseline and 1 and 6 months. We analyzed endothelial cell density (ECD), coefficient of variation of cell size (CV), and percentage of hexagonality. Results: Mean follow-up period was 9.7 ± 3.3 months. Mean number of injections was 1.5 ± 0.8. Mean IOP values were 15.6 ± 2.6 mm Hg at baseline, 17.7 ± 3.6 mm Hg at one month, 16.4 ± 4.1 mm Hg at three months, and 16.0 ± 2.7 mm Hg at six months. There was a significant difference in mean IOPs at one month and six months (p = 0.008). There were no significant differences in mean ECD (p = 0.375), CV (p = 0.661), percentage of hexagonality (p = 0.287), and CCT (p = 0.331). Conclusion: Although intravitreal injection of 0.7 mg DEX causes moderate elevation of IOP, it does not seem to have detrimental effects on corneal endothelium at six months.

Dual Approach Using Vitrectorhexis Combined with Anterior Vitrectomy in Pediatric Cataract Surgery

Purpose. To evaluate efficacy and safety of vitrectorhexis method for both anterior and posterior capsules combined with anterior vitrectomy in children with cataract. Methods. A retrospective chart review was performed for 19 children with cataract operated at a tertiary referral center. Dual approach including anterior and posterior segments was used during the surgery in terms of capsulotomy, intraocular lens (IOL) implantation, and anterior vitrectomy. Results. A total of 23 eyes of 19 patients were enrolled in the study. The mean age of the children was 39.4 ± 2.2 months (5–78). The mean postoperative followup duration was 20.6 ± 7.8 months (3–32). Intraoperative tear was observed only in one of 23 (4.3%) eyes during anterior capsulotomy. All of the patients had a clear visual axis and showed no IOL decentration. Conclusions. Dual approach using vitrectorhexis and anterior vitrectomy is an easy-to-perform technique that seems safe and effective in the short term for younger children.

Investigation of the association between glaucoma and Helicobacter pylori infection using the 14C-urea breath test

PURPOSE To investigate the association between glaucoma and Helicobacter pylori infection by evaluating for the presence of H. pylori infection in patients with glaucoma using the 14C-urea breath test (14C-UBT). METHODS Using 14C-UBT, H. pylori infection positivity was compared between a group of patients with primary open-angle glaucoma and a control group with normal intraocular pressure and a normal optic disc or normal perimetry. RESULTS The 14C-UBT was positive in 18 (51.42%) out of 35 patients in the glaucoma group and in 15 (42.85%) out of 35 patients in the control group. H. pylori infection positivity rates were similar between the glaucoma and control groups (p>0.05). CONCLUSION According to the 14C-UBT, there is no association between primary open-angle glaucoma and H. pylori infection.

The factors affecting the development of phthisis bulbi after penetrating eye injuries

BACKGROUND We aimed to investigate the factors affecting the development of phthisis bulbi after penetrating eye injuries. METHODS The medical records of 132 patients admitted to our clinic between 2000-2006 with the diagnosis of penetrating eye injury were collected. The records of the eight patients who developed phthisis bulbi were evaluated retrospectively. The aspects of anatomic localization, type of trauma, associated events, and development of phthisis bulbi were also investigated. RESULTS The mean age of the eight patients (5 males, 3 females) was 7.12±4.70 years (range: 2-16 years) and the mean follow-up time was 2.06±1.47 years (range: 6 months-5 years). Three of eight patients developed post-perforation endophthalmitis. Three patients had zone 2-3 scleral perforation and associated retinal detachment and the remaining two patients had proliferative vitreoretinopathy according to the trauma; all eight patients eventually developed phthisis bulbi. The mean time for the development of phthisis bulbi was 5.5±2.13 months (range: 3-10 months). CONCLUSION After penetrating eye injuries, visual prognosis and development of phthisis bulbi were affected significantly by the factors including anatomic localization, size of the injury, associated anterior or posterior segment pathologies, and endophthalmitis secondary to the trauma.BACKGROUND We aimed to investigate the factors affecting the development of phthisis bulbi after penetrating eye injuries. METHODS The medical records of 132 patients admitted to our clinic between 2000-2006 with the diagnosis of penetrating eye injury were collected. The records of the eight patients who developed phthisis bulbi were evaluated retrospectively. The aspects of anatomic localization, type of trauma, associated events, and development of phthisis bulbi were also investigated. RESULTS The mean age of the eight patients (5 males, 3 females) was 7.12±4.70 years (range: 2-16 years) and the mean follow-up time was 2.06±1.47 years (range: 6 months-5 years). Three of eight patients developed post-perforation endophthalmitis. Three patients had zone 2-3 scleral perforation and associated retinal detachment and the remaining two patients had proliferative vitreoretinopathy according to the trauma; all eight patients eventually developed phthisis bulbi. The mean time for the development of phthisis bulbi was 5.5±2.13 months (range: 3-10 months). CONCLUSION After penetrating eye injuries, visual prognosis and development of phthisis bulbi were affected significantly by the factors including anatomic localization, size of the injury, associated anterior or posterior segment pathologies, and endophthalmitis secondary to the trauma.

Endothelin-1 and Nitric Oxide Levels in Exudative Age-Related Macular Degeneration.

Purpose: To evaluate plasma levels of endothelin-1 (ET-1) and nitric oxide (NO) in patients with exudative age-related macular degeneration (AMD). Methods: In this study, ET-1 levels, as well as nitrite plus nitrate concentrations as an indicator of plasma NO level, were measured in the plasma of 20 subjects with exudative AMD and compared with 20 healthy age and sex matched controls. Results: Mean plasma ET-1 level was significantly higher in exudative AMD patients as compared to control subjects (0.35 ± 0.06 fmol/ml versus 0.17 ± 0.03 fmol/ml, P = 0.015). Patients with exudative AMD also showed significantly lower mean plasma levels of nitrite plus nitrate as compared to the controls (58.9 ± 2.7 µmol/l versus 82.6 ± 5.9 µmol/l, P = 0.001). Conclusion: Increased concentrations of ET-1 and reduced levels of NO in the plasma may suggest an imbalance between vasoconstrictor and vasodilator agents, respectively, as a reflection of endothelial dysfunction in the pathogenesis of AMD. These findings may also imply the role of vasoconstriction in exudative AMD.

Effects of sub-Tenon’s anaesthesia on ocular hemodynamics

OBJECTIVE To research the effects of sub-Tenons anaesthesia (STA) on ocular hemodynamics in patients with cataract using colour Doppler imaging (CDI). DESIGN Prospective clinical study. PARTICIPANTS Thirty-four eyes of 34 patients with age-related cataract. METHODS Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) values of the ophthalmic artery (OA), central retinal artery, and central retinal vein were measured by CDI before and immediately after performing sub-Tenon block using 2 mL of 2% lidocaine with adrenaline (1:200 000). RESULTS Both PSV and EDV values were significantly decreased after sub-Tenon injection in all the studied vessels of the patients. However, no important changes were observed in the RI values of the vessels. CONCLUSIONS STA markedly reduced ocular blood flow. The reduction may be more acceptable compared with other retrobulbar block methods. Sub-Tenon block should be performed carefully to senile patients with cataract with vascular occlusive disorder.