Yüksel Totan

Ocular Leech Infestation in a Child

PURPOSE To describe a patient with manifestations of ocular leech infestation. METHOD Case report. RESULTS The ocular foreign body was identified as a leech, Limnatis nilotica, by parasitologic examination. The leech was extracted, and the patient began using topical antibiotic and cycloplegic agents. By the third day after extraction, the patient had no obvious symptoms or signs, except for a limited subconjunctival hemorrhage, and no epithelial defect on the cornea was observed. CONCLUSIONS Ocular leech infestation should be considered in patients with a history of swimming in streams and lakes. Attention should also be given to ocular leech infestation in the differential diagnosis of ocular trauma with iris prolapse.

Bilateral cataract surgery in adult and pediatric patients in a single session.

PURPOSE To evaluate the results of bilateral simultaneous cataract surgery in adult and pediatric patients under local or general anesthesia. SETTING Department of Ophthalmology, Inönü University, Turgut Ozal Medical Center, Malatya,Turkey. METHODS Eighty-two eyes of 41 patients were included in the study. Twelve of 17 pediatric patients with congenital cataract had bilateral simultaneous lensectomy, posterior capsulotomy, and anterior vitrectomy; 5 patients, aged 10 to 19 years, had bilateral extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PC IOL) implantation. Forty-eight eyes of 24 adult patients had bilateral simultaneous ECCE with primary (43 eyes) or secondary (5 eyes) PC IOL implantation. Local anesthesia was administered to 20 adult patients by retrobulbar injection; the other cases were performed using general anesthesia. The procedures were treated as 2 separate surgeries in the same session; care was taken to ensure surgical asepsis. RESULTS No serious intraoperative complications occurred such as posterior capsule rupture, vitreous loss, endophthalmitis, and anesthesia-related problems. Of patients tested, 84.4% achieved a final best corrected visual acuity of 6/12 or better and 31.0%, of 6/6 or better. CONCLUSIONS Simultaneous bilateral cataract surgery was not associated with an increased rate of complications, and visual results were good. If strict rules of surgical asepsis are followed, this may be a useful option in a variety of bilateral cases using general or local anesthesia.

Dexamethasone Intravitreal Implant for Chronic Diabetic Macular Edema Resistant to Intravitreal Bevacizumab Treatment

Abstract Purpose: To evaluate the safety and efficacy of intravitreal dexamethasone implant (Ozurdex) in patients with chronic diabetic macular edema (DME) resistant to prior intravitreal bevacizumab (IVB) treatment. Materials and Methods: Thirty eyes of 30 patients were administered intravitreal Ozurdex and examined at baseline and 1, 3, and 6 months postinjection in this prospective study. Main outcomes were the best corrected visual acuity (BCVA, logMAR), central foveal thickness (CFT), mean cube volume (MCV), and intraocular pressure (IOP). Patients had a CFT over 275 µm (measured by OCT) and were unresponsive to 3 consecutive IVB injections. All data are presented as mean ± standard deviation. Results: The mean BCVA significantly increased from 0.56 ± 0.38 to 0.41 ± 0.27 (p < 0.001), and 0.44 ± 0.28 (p = 0.008) at 1 and 3 months, respectively. At months 1, 3, and 6, the mean CFT significantly decreased from 517 ± 136 µm at baseline, to 290 ± 60 µm (p < 0.001), 314 ± 88 µm (p < 0.001) and 411 ± 126 µm (p = 0.01), respectively. However, the mean CFT (p < 0.001) and MCV (p = 0.01) significantly increased and BCVA significantly decreased (p = 0.04) at 6 month compared to 3 month. Compared to baseline, IOP increased significantly at 1 week (p = 0.01), 1 month (p = 0.01) and 3 months (p = 0.04). However eyes with IOP higher than 21 mmHg were treated and well controlled with topical anti-glaucoma monotherapy. Macular edema recurrence occurred in 25 eyes (CFT ranged from 321 µm to 800 µm) at 6 months. Conclusion: Dexamethasone intravitreal implant may be an effective and safe alternative in treatment of chronic DME nonresponsive to regular IVB. However, its therapeutic efficacy decreases between the third and sixth months following the injection.

Superoxide Dismutase, Catalase, Glutathione Peroxidase and Xanthine Oxidase in Diabetic Rat Lenses

The activities of the protective enzymes, superoxide dismutase, catalase, glutathione peroxidase and of xanthine oxidase, an enzyme acting as a source of O–2, were measured in the lenses of alloxan-induced diabetic and control rats. Superoxide dismutase and glutathione peroxidase activities were found to be significantly decreased, while catalase and xanthine oxidase activities were increased. This means that the ratio of the oxidant/antioxidant enzymes increases in the diabetic rat lens, suggesting an increased oxidative stress. This imbalance is possibly an important contributing factor in the pathogenesis of diabetic cataract.

Effect of caffeic acid phenethyl ester on corneal neovascularization in rats

Purpose. Caffeic acid phenethyl ester (CAPE), a biologically active component of propolis from honeybee hives, has potent antiinflammatory and antioxidant properties. We aimed to evaluate the ability of topically applied CAPE in comparison with known steroidal (dexamethasone sodium phosphate) and nonsteroidal (indomethacin) topical agents to reduce corneal neovascularization (CNV) induced by silver nitrate cauterization in rats. Methods. Following silver nitrate cauterization on both eyes, male rats were randomly assigned to the study and control groups, each consisting of ten rats. The inhibitory effects of the test drugs against a placebo (isotonic saline) on CNV were tested and compared to each other using a previously described method in which extent of neovascularization and burn stimulus intensity were scored by a masked examiner. Briefly, burn stimulus intensity was scored from 0 to +3 according to the height of blister from corneal surface, and extent of neovascularization was recorded from 0 to +6 according to the distance from limbus to the end point of CNV toward the central corneal burn. Results. The mean burn stimulus score were not different among the groups (P = 0.807). Percent inhibition of CNV compared to the placebo control and its significance were 31.5 %, P = 0.011 for indomethacin; 56 %, P < 0.001 for dexamethasone; and 52 %, P < 0.001 for CAPE. Dexamethasone was significantly (P < 0.05) more effective than indomethacin in inhibition of neovascular growth. CAPE was found to be superior (P < 0.05) to indomethacin and almost as effective as (P > 0.05) dexamethasone in reducing CNV. Conclusion. Topically applied CAPE was demonstrated to have an inhibitory effect, comparable to that of topical dexamethasone, on CNV in this rat model. Antiinflammatory and antioxidant properties of CAPE may contribute to its suppression on CNV.

Combined phacoemulsification, vitrectomy, foreign-body extraction, and intraocular lens implantation

PURPOSE To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and intraocular lens (IOL) implantation. SETTING SSK Ankara Eye Hospital, Department of Vitreoretinal Surgery, Ankara, Turkey. METHODS Seventeen patients with corneal perforation, intraocular foreign body, vitreous hemorrhage, and lens opacity had simultaneous clear corneal phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and IOL implantation. RESULTS Postoperative complications included massive retinal fibrosis in 2 patients, retinal detachment in 1, and cilioretinal artery occlusion in 1. At a mean follow-up of 15.2 months, best corrected visual acuity improved in the remaining 13 eyes (76%). The IOL was stable in all cases. CONCLUSION Combined phacoemulsification with IOL implantation and vitreoretinal surgery was safe in selected cases of penetrating ocular trauma resulting from an intraocular foreign body.

Nickel, chromium, manganese, iron and aluminum levels in human cataractous and normal lenses.

Atomic absorption spectrophotometry was used to detect lenticular nickel, chromium, manganese, iron and aluminum levels in 37 senile cataractous and 9 normal human lenses. The nuclear parts of the lenses were used for the study in both groups. It was found that the concentrations of nickel and iron were significantly higher, and those of chromium, manganese and aluminum were significantly lower in human cataractous lenses than those in normal human lenses. None of the elements showed a significant difference according to sex in both groups. As remarkable differences in chromium, manganese, iron, aluminum and nickel levels exist in cataractous lenses, all the five elements may play some roles in cataractogenesis.

The role of axial length in central and branch retinal vein occlusion.

BACKGROUND AND OBJECTIVE To assess whether the axial length is a local risk factor in central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). PATIENTS AND METHODS The axial lengths of affected and fellow eyes of 19 patients with CRVO and 27 with BRVO and of their controls were measured with A-scan ultrasonography. The control group consisted of 17 individuals for CRVO and 25 for BRVO matched in age, sex and the prevalence of hypertension and diabetes in patient groups. The results of measurements in affected, unaffected and control eyes were compared. RESULTS The mean axial length was different among the affected and unaffected eyes in patients with CRVO and their controls (P < .05). The affected eyes had significantly shorter axial length compared to the fellow and control eyes (P < .01 and P < .01, respectively). In the BRVO group, the mean axial length did not differ among affected, unaffected and control eyes (P > .05). CONCLUSIONS Our study demonstrates a significantly shorter axial length in eyes with CRVO and not significantly shorter axial length in those with BRVO. The shorter axial length could be an additional risk factor in the pathogenesis of CRVO.

Cyclosporin effectively inhibits posterior capsule opacification after phacoemulsification in rabbits: a preliminary study

Purpose:  To evaluate whether cyclosporin A prevents or reduce posterior capsule opacification after phacoemulsification surgery in rabbit eyes.

Evaluation of Choroidal Thickness in Amblyopia Using Enhanced Depth Imaging Optical Coherence Tomography

ABSTRACT Purpose: To evaluate the choroidal thickness (CT) in hyperopic anisometropic amblyopic eyes, fellow non-amblyopic eyes, and age-matched normal eyes, using spectral-domain optical coherence tomography (SD-OCT). Materials and methods: In total 53 subjects (17.8 ± 11.0 years, mean ± SD) with hyperopic anisometropic amblyopia (AE) and 53 age-matched controls (17.7 ± 11.0 years) were included in this prospective study. Each subject underwent a dilated eye examination, cycloplegic refraction and axial length (AL) measurement using Nidek AL-Scan optical biometer (Nidek CO, Aichi, Japan). The CT of subfoveal area and at a radius of 1 and 3 mm around the fovea was determined using the enhanced depth imaging program of a SD-OCT (Cirrus HD OCT, Carl-Zeiss Meditec, Dublin, CA). CT, AL and spherical equivalent refraction (SER) of the amblyopic eyes were compared to that of the fellow and control eyes. Results: The mean subfoveal CT was 305.6 ± 26.0 µm in the amblyopic eyes, 282.6 ± 30.7 µm in the fellow eyes and 280.1 ± 8.8 in the control eyes. The subfoveal choroid in amblyopic eyes was significantly thicker than that of the fellow eyes and control eyes (p <  0.001). There was a significant negative correlation between the subfoveal CT and the AL in amblyopic (r = −0.298, p=0.03) eyes but not in the control and fellow eyes. Conclusions: The subfoveal choroid of eyes with hyperopic AE is significantly thicker than that of the fellow eye and the age-matched controls. Hence, CT seems to be effected in AE.