Zeynep Aktas

Neuroprotective effect of topically applied brimonidine tartrate 0.2% in endothelin-1-induced optic nerve ischaemia model.

Background:  To investigate the neuroprotective effects of topically applied brimonidine tartrate 0.2% (BMD), an α2‐receptor agonist, on the retinal ganglion cell (RGC) layer and inner nuclear layer (INL) of rabbit retina in endothelin‐1 (ET‐1)‐induced optic nerve (ON) ischaemia model.

Enhancement of the success rate in trabeculectomy: large-area mitomycin-C application

Background:  To compare the effects of variable mitomycin‐C (MMC) applications during trabeculectomy on target intraocular pressure (IOP), number of antiglaucomatous therapy, bleb morphology and surgical complications.

Retinal ganglion cell toxicity due to oxcarbazepine and valproic acid treatment in rat

PURPOSE To evaluate and to compare the possible toxic effects of oxcarbazepine (OXC) and valproic acid (VPA) on retinal ganglion cells (RGCs) in rat. METHODS Forty female Wistar rats (21-24 days old and weighted between 44.6 and 57.3g) were divided equally into 4 experimental groups which were applied tap water (group 1), 300mg/(kgday) VPA (group 2), 100mg/(kgday) OXC (group 3), and both VPA and OXC (group 4) via gavage for 90 days. Enucleation was performed for histopathologic analysis. RGCs were counted under the light microscopic examination. RESULTS RGC numbers in OXC and combined OXC-VPA groups were found to be lower than those of control group. On the other hand RGC number was comparable with those of control group in VPA group. CONCLUSION OXC seems to be toxic to RGCs at 100mg/kg dose when it is been given as a monotherapy or combined with VPA. Single VPA treatment has no effect on RGC number.

Interferon Alpha-2a Therapy in Patients with Refractory Behçet Uveitis.

ABSTRACT Purpose: To report the results of IFNα2a therapy in patients with Behçet uveitis refractory to azathioprine-cyclosporine combination treatment. Methods: In a retrospective study, 39 patients treated with either azathioprine-cyclosporine combination treatment (group 1, n = 23) or IFNα2a (group 2, n = 16) with a diagnosis of ocular Behçet disease (BD), were included in the study. Group 2 consisted of patients who did not respond to conventional combination therapy, and were therefore treated with IFNα2a. Clinical response and relapse rates were recorded for each group. Results: The mean number of uveitis attacks/year per patient was 0.8 ± 1.6 in Group 1. In Group 2, a significant decrease in the mean number of uveitis attacks/year per patient was observed after initiation of IFNα2a (2.4 ± 1.8 vs 1.3 ± 2.0) (p<0.05). When the two groups were compared after administration of IFNα2a therapy, no statistical difference was found in terms of uveitis attack/year and attack-free intervals, with a partial response to both treatments. Conclusions: IFNα2a therapy is an effective alternative for Behçet uveitis patients where conventional combination therapy fails.

Multiple sclerosis and optic nerve: an analysis of retinal nerve fiber layer thickness and color Doppler imaging parameters

PurposeTo compare both retinal nerve fiber layer thickness and orbital color Doppler ultrasonography parameters in patients with multiple sclerosis (MS) versus healthy controls.MethodsThis is an observational case–control study. Forty eyes from MS patients and twenty eyes from healthy volunteers were examined. Eyes were classified into three groups as group 1, eyes from MS patients with previous optic neuritis (n=20); group 2, eyes from MS patients without previous optic neuritis (n=20); and group 3, eyes from healthy controls (n=20). Following complete ophthalmologic examination and retinal nerve fiber layer thickness measurement for each group, blood flow velocities of posterior ciliary arteries, central retinal artery, ophthalmic artery, and superior ophthalmic vein were measured. Pourcelot index (resistive index), an indicator of peripheral vascular resistance, was also calculated. The statistical assessment was performed with the assistance of Pearson’s Chi-square test, Mann–Whitney U-test, Kruskal–Wallis test, and Spearman’s correlation test.ResultsThe studied eyes exposed similar values in terms of intraocular pressure and central corneal thickness, implying no evidence in favor of glaucoma. All nerve fiber layer thickness values, except superior nasal quadrants, in group 1 were found to be significantly thinner than groups 2 and 3. Blood flow velocity and mean resistivity index parameters were similar in all the groups.ConclusionsIn MS patients, especially with previous optic neuritis, diminished retinal nerve fiber layer thickness was observed. Contrary to several studies in the current literature, no evidence supporting potential vascular origin of ocular involvement in MS was found.

Congenital glaucoma as an ophthalmic manifestation of Frank–Ter Haar syndrome

We report on a patient with Frank–Ter Haar syndrome that is associated with high intraocular pressures. A 21-day-old male patient was referred to our clinic for surgical treatment of congenital glaucoma. On ophthalmic examination, he had buphthalmos, mild corneal edema and high IOP readings in both eyes. The patient underwent uneventful trabeculotomy surgery, bilaterally. Marked bilateral anterior iris insertion was noted during the surgery. Childhood glaucoma may be associated with Frank–Ter Haar syndrome.

Long-term results of pars plana lensectomy with double-capsule-supported intraocular lens implantation in children

BACKGROUND To report the long-term results of the pars plana lensectomy with double-capsule-supported intraocular lens implantation technique for the treatment of pediatric cataracts. METHODS A lensectomy and an anterior vitrectomy were performed through the pars plana approach, followed by implantation of a posterior chamber intraocular lens (IOL) to the sulcus over the capsules. Patients with a minimum follow-up of 5 years were included in the study and patient data were collected retrospectively from the patient reports. RESULTS Sixteen eyes of 10 patients with a mean age of 4.3 (SD 1.1) years were included in the study. Only one case was traumatic, and the others were congenital cataract cases. A 6.5 mm polymethyl methacrylate posterior chamber IOL was used in all cases. The visual axis was clear in all the cases through the mean follow-up period of 79.2 (SD 14.1) months. IOL decentration was observed in 1 eye at postoperative month 24, and it needed to be repositioned. There was no posterior capsular opacification in any of the cases. Best-corrected visual acuity was 20/40 or better in 81.3% of the eyes. INTERPRETATION The pars plana lensectomy with double-capsule-supported intraocular lens implantation technique seems to be a safe and easy method in children, limiting postoperative IOL-related complications and posterior capsule opacification in the long term.

The effect of systemic erythropoietin treatment on retinal nerve fiber layer parameters in patients with chronic renal failure undergoing peritoneal dialysis.

Purpose:To evaluate the effect of erythropoietin (EPO) treatment on retinal nerve fiber layer (RNFL) parameters in patients with chronic renal failure (CRF) undergoing peritoneal dialysis (PD). Methods:Fifty-eight eyes of 29 patients with CRF undergoing PD were evaluated. Fifteen patients have been treated with EPO (group 1), 14 patients without EPO treatment (group 2), and 30 eyes of 15 age-matched normal control subjects were assessed in group 3. A complete ophthalmologic examination and RNFL measurements were performed for each patient after PD. Anemia parameters were also measured. RNFL thickness protocol was used to acquire circular scans of 3.4 mm in diameter around optic nerve. RNFL thicknesses were evaluated in 4 quadrants. Only the left eyes were recruited for statistical analysis. The mean and quadrantal RNFL thickness values in group 1 were compared with those of groups 2 and 3. Results:The mean RNFL thickness values in patients undergoing PD were statistically lower than the control group at superior, inferior, nasal, and temporal quadrant, respectively (P=0.03, 0.04, 0.04, and 0.03). Differences between the RNFL thickness values in group 1 and group 2 were statistically significant only in the temporal quadrant (P=0.02). Conclusions:In patients with CRF undergoing PD, RNFL thickness parameters were found to be significantly reduced. The effect of EPO on RNFL parameters was statistically significant only in the temporal quadrant.

Fungal keratitis secondary to Scedosporium apiospermum infection and successful treatment with surgical and medical intervention

To report a rare case of severe fungal keratitis caused by Scedosporium apiospermum, which was treated with a penetrating tectonic keratoplasty and aggressive medical treatment. A 62-year-old woman with a history of soil contamination of the right eye while planting vegetables presented with a severe corneal abscess and ocular pain. The patient received medical treatment and underwent tectonic keratoplasty. Both corneal scrapings and the corneal button were evaluated microscopically. The samples were sent for aerobic and anaerobic bacterial and fungal cultures. Microbiological examinations showed S. apiospermum. The isolate was sensitive to amphoterycine B, caspofungin, voriconazole, and resistant to fluconazole. No clinical improvement was achieved with topical voriconazole, vancomycin, ceftazidime, and systemic voriconazole. A penetrating tectonic keratoplasty and lensectomy with continuation of anti-fungal therapy achieved satisfactory results. A fungal etiology should be suspected in a progressive and untreatable corneal abscess. Microbiological investigation is very important in early diagnosis. Despite early diagnosis and aggressive treatment, in selected cases removing the infected tissue surgically is vital in preserving the ocular globe and vision.

Trabeculectomy with large area mitomycin-C application as a first-line treatment in advanced glaucoma: retrospective review.

AIM To evaluate the outcomes of trabeculectomy with large area mitomycin-C (MMC) application as a first line treatment in advanced glaucoma. METHODS The records of 55 patients with severe visual field defects undergoing trabeculectomy were retrospectively reviewed. The patients were classified as first-line therapy to either early trabeculectomy (initial trabeculectomy-Group 1) or long term medical therapy followed by trabeculectomy (primary trabeculectomy-Group 2). Trabeculectomy was performed with large-area MMC application. Intraocular pressure (IOP) values, visual acuities, mean deviations, morphology and function of the blebs, necessity for anti-glaucomatous medications and surgical complications were reported. RESULTS There were 20 eyes of 18 patients in Group 1 and 37 eyes of 37 patients in Group 2. The mean preoperative IOPs in Groups 1 and 2 were 40.2±10.0mmHg (27-68mmHg) and 29.0±4.4mmHg (21-41mmHg), respectively (P=0.001). Average preoperative mean deviations (MD) in Groups 1 and 2 were 17.4±2.8dB (13.3-23dB) and 17.9±2.4 dB (13.7-23.2dB), respectively (P=0.441). Postoperative IOPs significantly decreased and were comparable in both Groups. The mean number of medications was significantly higher in Group 2 (P=0.005). No cystic bleb formation was observed in Group 1, whereas 4 patients from Group 2 (10.8 %) developed cystic bleb (P=0.040). No visually devastating complication has occurred in both Groups. CONCLUSION Initial trabeculectomy with large area MMC application might be applied in patients with advanced glaucoma with low complication rates. Long-term topically applied anti-glaucomatous medications seem to increase the risk of cystic bleb formation.