Yildirim Bayezit Sakalar

Efficacy of topical cyclosporin A 0.05% in conjunctival impression cytology specimens and clinical findings of severe vernal keratoconjunctivitis in children.

PurposeTo evaluate the efficacy of topical cyclosporin A 0.05% in managing the symptoms of severe vernal keratoconjunctivitis (VKC).MethodsFifty-four children with severe VKC were included in this study. All 54 patients were treated with topical cyclosporin A (CsA) 0.05% for 3 months. Ocular signs and symptoms were scored in all patients at entry and after 3 months. Conjunctival impression cytology specimens were examined on the day of enrollment and at the end of the treatment period.ResultsThe mean scores for severity of signs and symptoms significantly decreased after 3 months compared with those at entry (P < 0.001). The density of inflammatory cells in the conjunctival impression cytology specimens decreased significantly. No side effects of the treatment with CsA 0.05% eyedrops were observed.ConclusionsTopical CsA 0.05% eyedrops were found to be safe and effective in the treatment of patients with VKC. Consistent with these results, topical CsA may efficiently reduce conjunctival inflammation in severe VKC.

Is it necessary to accompany probing with endoscopy in cases of congenital nasolacrimal canal obstruction

OBJECTIVE To compare the results of probing with and without endoscopy in cases of congenital nasolacrimal duct obstruction who had previously not undergone probing. METHODS Fifty-one children with congenital nasolacrimal duct obstruction who underwent surgical intervention between June 2007 and April 2009 in our hospital were included in the study. Patients who had had previous probings were excluded from the study. Conventional probing was performed in 37 eyes of 25 patients, and probing with intranasal endoscopic visualization in 36 eyes of 26 patients. Diagnosis was based on history of epiphora since birth or shortly after, and fluorescein dye disappearance test. RESULTS Thirty-two of 37 eyes (86.48%) were cured by probing. Of the 5 cases with complaints, 1 had lacrimal sac fistula. Thirty-four of 36 eyes (94.44%) were cured by probing guided by endoscope observation. Thirty-two cases had stenosis at the lower end of the nasolacrimal duct which required probing. In two cases the probe passed submucosally to the floor of the nose. In two cases a false passage was made at the upper end of the inferior meatus. In these cases, the operation was continued by repeating the process until the distal end of the nasolacrimal canal was seen to have been passed. CONCLUSION Probing with endoscopy may be excessive in primary cases but in cases which have undergone unsuccessful probing, it is useful for visualization of anomalies in the lower nasolacrimal canal and to obtain the correct anatomic position for the probe.

Intravitreal bevacizumab combined with panretinal photocoagulation in the treatment of open angle neovascular glaucoma.

Purpose To evaluate the clinical efficacy of intravitreal bevacizumab (IVB) combined with panretinal photocoagulation in patients with open angle neovascular glaucoma (NVG). Methods Nine patients (9 eyes) with NVG participated in this study. Patients received IVB (1.25 mg) as the initial treatment for NVG and were followed up for at least 4 months. IVB was offered as the first treatment of choice to patients with NVG. Panretinal photocoagulation was performed as soon as feasible after the second week and completed in all patients the fourth week after IVB. The main outcome measures are resolution of INV, inhibition of peripheral anterior synechia (PAS), and controllability of intraocular pressure (IOP). Results The mean follow-up period was 5.6±1.4 months (range, 4–9 months). The mean IOP before treatment was 35.1±9.7 mmHg (range, 24–56) under medication before IVB treatment. After IVB and after combined treatment, the mean IOP was reduced to 22.8±8.1 mmHg (range, 9–33) and 13.0±4.0 mmHg (range, 7–20), respectively. The mean referral INV was 3.6±0.4 grade (range, 3–4) and reduced to 1.6±0.4 (range 1–2) grade after IVB and 0.6±0.8 (range 0–2) grade after combined therapy. By IVB, combined panretinal photocoagulation recurrence of INV was not observed. Conclusions In NVG, IVB treatment can reduce iris and angle neovascularization and inhibits further PAS formation temporarily. Panretinal photocoagulation inhibits neovascularization constantly. Therefore, management of open angle NVG is more feasible with bevacizumab combined with panretinal photocoagulation.

Distribution of central corneal thickness and intraocular pressure in a large population of Turkish school children.

Purpose: To determine the distribution of central corneal thickness (CCT) and intraocular pressure (IOP) in a population of Turkish school children and to evaluate the relationships between these values and both age and gender. Methods: A total of 30,320 eyes from 15,160 healthy school children aged 5–18 years were examined. CCT and IOP were measured using an ultrasonic pachymeter and a non-contact tonometer, respectively. Measurements were compared with age, gender, and parental consanguinity of subjects. Results: The mean age of the school children was 10.43 ± 2.54 years. For right eyes, mean CCT was 557.91 ± 34.26 µm and mean IOP was 14.15 ± 2.87 mmHg. Mean CCT was significantly thicker in males compared to females (P < 0.0001). Mean IOP was significantly higher in females compared to males (P < 0.0001). CCT in children aged 14 years and older was significantly thinner than that in the younger age groups (P < 0.0001). There was a significant difference among the age groups for IOP (P < 0.05). No significant differences were observed in CCT or IOP related to parental consanguinity (P = 0.538, P = 0.319, respectively). Conclusion: Mean CCT in Turkish school children is of comparable thickness to that in Western school children. CCT reached adult values around 14 years of age in our children. Furthermore, males had thicker CCT than females. IOP was lower in males than females, and increased with age.

Brain Malformations Associated With Knobloch Syndrome—Review of Literature, Expanding Clinical Spectrum, and Identification of Novel Mutations

BACKGROUND Knobloch syndrome is a rare, autosomal recessive, developmental disorder characterized by stereotyped ocular abnormalities with or without occipital skull deformities (encephalocele, bone defects, and cutis aplasia). Although there is clear heterogeneity in clinical presentation, central nervous system malformations, aside from the characteristic encephalocele, have not typically been considered a component of the disease phenotype. METHODS Four patients originally presented for genetic evaluation of symptomatic structural brain malformations. Whole-genome genotyping, whole-exome sequencing, and confirmatory Sanger sequencing were performed. Using immunohistochemical analysis, we investigated the protein expression pattern of COL18A1 in the mid-fetal and adult human cerebral cortex and then analyzed the spatial and temporal changes in the expression pattern of COL18A1 during human cortical development using the Human Brain Transcriptome database. RESULTS We identified two novel homozygous deleterious frame-shift mutations in the COL18A1 gene. On further investigation of these patients and their families, we found that many exhibited certain characteristics of Knobloch syndrome, including pronounced ocular defects. Our data strongly support an important role for COL18A1 in brain development, and this report contributes to an enhanced characterization of the brain malformations that can result from deficiencies of collagen XVIII. CONCLUSIONS This case series highlights the diagnostic power and clinical utility of whole-exome sequencing technology-allowing clinicians and physician scientists to better understand the pathophysiology and presentations of rare diseases. We suggest that patients who are clinically diagnosed with Knobloch syndrome and/or found to have COL18A1 mutations via genetic screening should be investigated for potential structural brain abnormalities even in the absence of an encephalocele.

Treatment of Experimental Bacillus cereus Endophthalmitis Using Intravitreal Moxifloxacin With or Without Dexamethasone

PURPOSE To evaluate the effects of intravitreal moxifloxacin with or without dexamethasone on experimental Bacillus cereus endophthalmitis. METHODS The right eyes of 21 New Zealand albino rabbits weighing 2-3 kg were used in this study. Each eye was inoculated with 1×10(6) colony-forming units of B. cereus microorganisms via intravitreal injection into the vitreous cavity, and an experimental model of B. cereus endophthalmitis was formed. The rabbits were separated into 3 groups: Group 1 was given 0.1 mL of balanced saline solution intravitreally, group 2 was given 50 μg of moxifloxacin, and group 3 was given 50 μg of moxifloxacin plus 400 μg of dexamethasone 24 h after the inoculation. Vitreous aspirates were taken for microbiological examination on the 3rd day. Clinical inflammation scores were evaluated on days 1, 7, and 14. The rabbits were killed on the 14th day, and the eyes were enucleated for histopathological examination. RESULTS On the 7th day, only the vitreous scores of the treatment groups were significantly low compared with those of the control group (P<0.05). On day 14, the clinical scores of vitreous inflammation were 2.43±0.79, 1.43±0.53, and 1.29±0.49 in Groups 1, 2, and 3, respectively. The clinical scores of the treatment groups were significantly lower compared with those of the control group on day 14 (P<0.05). Histopathological scores were 2.43±0.79, 1.43±0.53, and 1.43±0.79 for the iris and 2.14±0.69, 1.57±0.53, and 1.14±0.38 for the vitreous in Groups 1, 2, and 3, respectively. Apart from the conjunctiva, the histopathological scores of the other tissues in the treatment groups were significantly lower compared with those of the control group (P<0.05). No significant differences were found in the histopathological or clinical scores among the treatment groups (P>0.05). Microbiological scores at day 14 were 151±6.43, 125.43±13.44, and 131.14±16.99 for Groups 1, 2, and 3, respectively. The microbiological scores of the treatment groups were significantly lower compared with those of the control group (P<0.05). CONCLUSIONS Intravitreal moxifloxacin injection is effective in experimental B. cereus endophthalmitis. The addition of intravitreal dexamethasone may not significantly affect treatment efficacy.

Loxosceles reclusa bite to the eyelid.

Purpose The authors report a case of Loxosceles reclusa infestation on the eyelid. Methods The specimen collected by swabbing the lesions with gauze was tested by using a venom-specific enzyme-linked immunosorbent assay Loxosceles venom was detected in specimen. The patient was managed with conservative therapy that included saline compresses and ocular lubrication. Results The case presented with severe edema and necrosis on the left upper eyelid. On laboratory examination, a significant left shift of white blood cell count was detected. Although residual scar of the eyelid and punctate epitheliopathy on the inferior of cornea was detected, vision was not impaired. Conclusions Supportive therapy may be reasonable treatment for Loxosceles reclusa infestation on the eyelids. The presence of venom proteins detected with an enzyme-linked immunosorbent assay technique is beneficial for supporting the diagnosis of Loxosceles envenomatio.

Evaluation of retrobulbar blood flow by color doppler ultrasonography after intravitreal ranibizumab injection in patients with neovascular age-related macular degeneration.

This study aimed to evaluate the changes in retrobulbar blood flow by using color Doppler sonography in patients who had undergone intravitreal ranibizumab injection for neovascular age‐related macular degeneration (AMD).

Unilateral vernal keratoconjunctivitis: a case report.

Purpose A rare case of unilateral vernal keratoconjunctivitis is presented. Methods A 5-year-old boy had itching, foreign body sensation, redness, and ptosis in his left eye. Impression cytology specimens were taken from both upper eyelid tarsal conjunctiva. Results On slit-lamp biomicroscopy, unilateral cobblestone papillae and a shield ulcer were found in the left eye. On impression cytology examination, there was a significant increase in inflammation, presence of a honeycomb pattern, plasma cells, and mucus strands in the upper tarsal conjunctiva of the specimens. Conclusions Giant papillary conjunctivitis must be considered in differential diagnosis of unilateral vernal conjunctivitis. Impression cytology method may be combined with the clinical findings in vernal keratoconjunctivitis diagnosis.

Conjunctival Inverted Follicular Keratosis : A Case Report

BackgroundWe report a case of inverted follicular keratosis (IFK) on the conjunctiva. A few cases of IFK have been reported in the literature, but it appears that IFK on the conjunctiva has never been reported.CaseA 21-year-old man was referred for evaluation of a conjunctival mass.ObservationsBy slit-lamp biomicroscopy, an 8 × 5 × 3 mm mass was observed over the nasal conjunctiva adjacent to the limbus in the left eye. An excisional biopsy of the lesion was carried out. The results of a pathologic examination showed IFK. During the 9-month follow-up period, the patient had no recurrence of the lesion.ConclusionIFK can be considered in the differential diagnosis of conjunctival masses as a rare specific lesion.