The Protective Effects of Pyridoxine on Linezolid-Induced Hematological Toxicity, Hepatotoxicity, and Oxidative Stress in Rats.

OBJECTIVE: Linezolid is often used to treat antibacterial-resistant infections. Linezolid can cause side effects. To date, the effectiveness of the simultaneous administration of pyridoxine and linezolid is unclear. Here we investigate the protective effect of pyridoxine on linezolid-induced hematological toxicity, hepatotoxicity, and oxidative stress in rats. MATERIAL AND METHODS: The 40 male pediatric Spraque-Dawley rats were separated into 4 groups: control, linezolid, pyridoxine, and linezolid-pyridoxine. A complete blood count, liver function test, and measurements of antioxidant enzyme activities for superoxide dismutase, glutathione peroxidase, catalase, and lipid peroxidation were performed in blood before treatment and 2 weeks after administration of the treatment. RESULTS: White blood cell and hemoglobin counts for the linezolid group decreased, and the alanine aminotransferase level in the linezolid group increased compared to their respective baseline values. Post-treatment white blood cell decreased in the linezolid and linezolid- pyridoxine groups compared to those in the control group (P < .001). Alanine aminotransferase levels increased in the linezolid and linezolid-pyridoxine groups compared to those in the control group (P < .001 and P < .05, respectively). The activity of superoxide dismutase, catalase, glutathione peroxidase, and malondialdehyde levels increased in the linezolid group compared to the control group (P < .001, P < .05, P < .001, and P < .001, respectively). Linezolid plus pyridoxine treatment caused a significant decrease in malondialdehyde levels and superoxide dismutase, catalase, and glutathione peroxidase enzyme activities compared to the linezolid group (P < .001, P < .01, P < .001, and P < .01, respectively). CONCLUSION: Pyridoxine may be an effective adjuvant agent for the prevention of linezolid toxicity in rat models.

Transconjunctival Approach: A Safe and Effective Access to Mass Lesions in the Anterior Orbit.

BACKGROUND: The orbit is an eloquent organ of the body. Safe surgical access to the orbit could be challenging due to the dense network of critical structures confined to it. There are versatile approaches to different parts of the orbit that could be used by neurosurgeons without causing injury to critical neurovascular structures. In this study, we aimed to present our surgical experience with the transconjunctival approach through the bulbar conjunctiva to anterior intraorbital lesions caused by diverse pathologies. METHODS: We conducted a retrospective review of cases with intraorbital lesions operated via the transconjunctival approach by the same senior surgeon between 2015 and 2017. All patients were evaluated before the surgery by computed tomography, magnetic resonance imaging, and plain anteroposterior and lateral radiographs. RESULTS: Five patients underwent surgery by the transconjunctival approach through the medial or lateral routes for different pathologies: cavernoma, lymphoma, inflammatory reaction, meningocele, and foreign body. No complications were recorded, and all patients were satisfied with their clinical and esthetic results. CONCLUSIONS: The transconjunctival approach is a safe, effective, and time-sparing surgical approach to diverse pathologies in the anterior orbit. Navigation systems enhance the ability to maneuver in selected cases. The transconjunctival approach could be performed in collaboration with ophthalmologists since it provides better esthetic outcomes and higher satisfaction rates in operated patients.

Choroidal osteoma in a preterm infant.

Choroidal osteoma (CO) is a rare, benign, and usually unilateral intraocular tumor composed of mature bone affecting the choroid. It appears as slightly elevated, yellowish-white, or orange choroidal mass with well-defined borders. It is commonly encountered in young female adults. Here, we report findings of a 4-week-old premature baby with CO in her left eye which was detected during a routine examination for "retinopathy of prematurity." We believe that this case is the youngest patient reported with CO which showing that this pathology can be encountered even in a newborn.

Evaluation of Aflibercept Treatment Responses in Eyes with Bevacizumab/Ranibizumab-resistant Wet Age-related Macular Degeneration.

OBJECTIVES: To evaluate anatomic and functional results after switching from intravitreal bevacizumab or ranibizumab treatment to aflibercept for wet (neovascular) age-related macular degeneration. MATERIALS AND METHODS: This retrospective study included 22 eyes of 22 patients resistant to treatment with at least 6 injections of bevacizumab or ranibizumab. The first three injections had been applied monthly, the others pro re nata (PRN). Outcome measures were follow-up period, injection number, best corrected visual acuity (BCVA), central retinal thickness (CRT) and pigment epithelial detachment (PED) height. Dosing regimen of aflibercept was determined PRN. The patients were examined monthly. In all visits, BCVA and optical coherence tomography results were assessed together and injections were applied according to these findings. Patients with at least three months of follow-up were included in the study. RESULTS: Twenty-two eyes of 22 patients treated with bevacizumab or ranibizumab were switched to aflibercept therapy. Seven patients had serous PED and 4 patients had fibrovascular PED. The mean follow-up periods for these groups were 20.59±6.76 months and 8.68±3.79 months, respectively. The mean injection numbers were 10.5±3.61 vs 4.54±1.56. Statistically significant reductions were noted in CRT (533.86±164.06 µm vs 412.04±143.86 µm, p<0.05). BCVA levels were almost equal before and after switching (0.18±0.17 vs 0.18±0.14). Serous and fibrovascular PED heights decreased suboptimally from 460±281.51 µm to 282.42±175.76 µm (p>0.05) for serous PEDs and 251.25±43.85 µm to 225.75±73.09 µm (p>0.05) for fibrovascular PEDs. CONCLUSION: Switching to aflibercept resulted in significant improvement in CRT, but not in BCVA or PED heights.

Quantitative Scheimpflug camera study of the lens density in healthy Turkish population.

The purpose of this study is to evaluate the association between the age and the density of anterior, posterior, and nuclear parts of lens and detect the normal lens density (LD) values in different age groups. 370 eyes of 370 voluntary healthy Turkish subjects were included. These were divided in four groups according to their age. These were Group 1 (51-65 years), Group 2 (41-50 years), Group 3 (31-40 years) and Group 4 (20-30 years). LD values of anterior, nuclear, posterior, and total (average) were measured using Pentacam HR Scheimpflug camera system. Both eyes of each subject were scanned twice in automatic release and 50-picture 3-dimensional (3D) scan modes by one experienced observer. 207 of the participants were females and 163 were males, with a mean age of 40.57 ± 13.06 years. The differences between groups in terms of nuclear area, posterior area, and average LD measurements were significant but anterior area was not. The nuclear area and average LD had high positive correlation with age (r = 0.72, p < 0.001, r = 0.63, p < 0.001, respectively); posterior area LD had a weak negative correlation with age (r = -0.16, p = 0.001). The mean LD values between female and male subjects showed no significant difference. The anterior region of the lens has the highest and nuclear area has the lowest value of LD in young people. In older people, the anterior area did not show a significant change, nuclear and total areas showed a significant increase but posterior area showed a significant decrease.

Evaluation of the long-term results of trabectome surgery.

The aim of this study was to investigate the safety and efficacy of ab interno trabeculectomy which is a minimally invasive glaucoma surgery, in the late period, performed via trabectome instrument. A total of 70 eyes followed up with a diagnosis of open-angle glaucoma (OAG) and undertaken trabectome surgery were included in the study. Preoperative and postoperative intraocular pressures (IOPs), number of the drugs used, and complications were retrospectively investigated and the data were evaluated. The criteria of success were accepted as an IOP value ≤21 mmHg or ≥30 % reduction in IOP and no need for a second operation. Mean IOP was decreased by 38 % from a preoperative value of 28.77 ± 5.34 to 17.62 ± 2.81 mmHg at the end of 18 months. Likewise, mean drug usage was decreased by 48 % from a preoperative value of 3.3 ± 1.01 to 1.7 ± 1.16 at the end of 18 months. Both decreases were statistically significant (p < 0.05). Postoperative success rates were 82.8 % in the 6th month, 81.4 % in the 9th month, 77.1 % in the 12th month, and 70 % in the 18th month. Most common complication observed was intraoperative reflux hemorrhage and no serious complication was observed. Trabectome surgery is an effective and safe method in early-stage open-angle glaucoma types that cannot be controlled despite maximal medical therapy. This procedure is a proper surgical option in patients targeted for moderate IOP without the need for a topical medication or with less drug usage.

Prolidase Enzyme Activity in Conjunctiva and Pterygium Tissues.

BACKGROUND: The aim of this study was to determine prolidase activity in conjunctival tissue and its relationship with pterygium. MATERIAL AND METHODS: Prolidase activity was measured in 23 pterygium and 25 healthy conjunctival tissues and the 2 groups were compared. RESULTS: Prolidase enzyme activity could not be measured in either the healthy conjunctival or in pterygium tissues. The mean serum prolidase levels of the control and pterygium groups were 967.46±353.64 and 858.29±301.83, respectively. Statistically, there was no significant difference between the groups with regard to serum prolidase levels (p>0.05). CONCLUSIONS: In conclusion, absence of prolidase activity in pterygium tissue indicates that there is no collagen turnover in this tissue. We may explain this finding with the elastin-rich structure of the conjunctiva.

The protective effect of Capparis ovata on 6-mercaptopurine-induced hepatotoxicity and oxidative stress in rats.

Capparis ovata is a member of Capparidacaeae family has been used in phytomedicine with a lot of positive effects such as an antioxidative, antihyperlipidemic, anti-inflammatory, and antihepatotoxic agent. The aim of this study was to research the protective effect of C. ovata on 6-mercaptopurine (6-MP) induced to hepatotoxicity and oxidative stress in rats. The rats were divided into 4 groups: control, 6-MP, C. ovataovate, and 6-MP + C. ovata. A complete blood count was performed, liver function test and antioxidant enzymes levels such as superoxide dismutase, glutathione peroxidase, catalase, and malondialdehyde were measured in blood before and after a 14-day test period. White blood cell and platelet counts were lower in the 6-MP group than other 3 groups (P < 0.005). Hepatic transaminase levels were higher in 6-MP group than the 3 groups (P < 0.05). Superoxide dismutase, glutathione peroxidase, and CAT levels were lower and malondialdehyde was higher in blood samples in 6-MP group than other 3 groups (P < 0.005). In conclusion, our tests were showed that C. ovata may be useful in patients receiving 6-MP therapy to prevent hepatotoxicity and in order to maintain uninterrupted therapy possibly reducing the risk of relapse. Although additional studies ensure that Capparis does not affect 6-MP antileukemic activity. We believe these results are important contribution to the literature.

The effect of chronic smoking on lens density in young adults.

PURPOSE: To investigate the effect of chronic cigarette smoking on lens density by Pentacam HR lens densitometry in young adults. METHODS: Sixty chronic smokers who smoked at least 10 cigarettes per day for at least 2 years and 60 age- and sex-matched healthy control subjects were included in this prospective cross-sectional, comparative study. Presence of an ocular or systemic disease that might affect lens were determined as exclusion criteria. All individuals underwent complete ocular examination. Lens densitometry (LD) measurements were performed with Pentacam HR (Oculus, Wetzlar, Germany), dividing the lens into 3 areas: anterior area (anterior subcapsular and anterior cortical), nuclear area, and posterior area (posterior subcapsular and posterior cortical). Three-dimensional scan modes were used for measurements. RESULTS: The mean ages of group 1 and 2 were 25.85 ± 4.32 and 25.60 ± 5.14 years, respectively. The mean LD values in the 3 areas were higher in group 1 than group 2. However, only the mean LD value at the anterior area of group 1 was found to be statistically significantly higher (p = 0.047). There was no statistically significant difference in the mean LD measurements at the nuclear and posterior areas between the groups. CONCLUSIONS: Our study demonstrated that the mean LD value of the anterior area was significantly higher in group 1, suggesting that chronic smoking may contribute to anterior cortical and subcapsular cataract development in young adults.

Influence of hyperbaric oxygen therapy on central corneal thickness.

BACKGROUND/AIMS: Hyperbaric oxygen (HBO) therapy is used in the treatment of several disorders. Little is known about the effects of HBO treatment on corneal thickness. The aim of this study was to investigate the effect of HBO treatment on central corneal thickness. METHODS: Thirty-two subjects (18 males and 14 females, mean age 57.3 ± 16.7 years) undergoing HBO treatment were consecutively enrolled. The subjects were assigned into diabetic (n = 16) and nondiabetic groups (n = 16). Best-corrected visual acuity was recorded before HBO treatment, and anterior and posterior segment examinations were performed on a slit lamp biomicrosope. Central corneal thickness was measured with an ultrasonic pachymeter before and immediately after HBO treatment, which lasted 120 min at 2.4 atmospheres absolute with three 30-min oxygen and two 5-min air breathing periods. RESULTS: HBO treatment did not change the central corneal thickness in diabetic subjects (547.6 ± 34.5 vs. 548.6 ± 34.6 µm; p = 0.606). In nondiabetic subjects, however, the central corneal thickness was significantly reduced after HBO treatment (576.5 ± 34.8 vs. 569.0 ± 34.8 µm; p < 0.001). CONCLUSION: A single exposure to HBO treatment reduced the central corneal thickness in nondiabetic subjects but not in diabetic subjects. However, the change in central corneal thickness was minor.

Intracameral Perfluoropropane (C(3)F(8)) Gas in the Repair of Extensive Descemet's Membrane Detachment During Phacoemulsification Surgery.

Descemet's membrane detachment (DMD) is one of the rare complications seen during or after cataract surgery. It can cause permanent corneal decompensation if untreated or not reattached spontaneously. A patient with an extensive DMD (involving approximately upper two-thirds of the cornea) during uncomplicated phacoemulsification surgery is reported. After the aspiration of cortical remnants, Descemet's membrane was detached progressively from the clear corneal incision. Descemet's membrane was reattached at the end of the procedure using an air bubble injection. However, DMD was observed again the day after surgery. It was successfully treated with intracameral injection of 0.2 mL volume of 14% perfluoropropane (C(3)F(8)) gas with resultant immediate resolution of his corneal edema. It is believed that early surgical intervention (if possible intraoperatively) with intracameral injection of 14% isoexpansile mixture of C(3)F(8) is a safe and efficient treatment modality for DMD. Appropriate and prompt management may prevent the complications and visual loss.

Autofluorescence findings in Vogt-Koyanagi-Harada disease.

PURPOSE: To report shortwave autofluorescence (SW-AF) and near infrared autofluorescence (NIR-AF) findings in a case of Vogt-Koyanagi-Harada (VKH) disease. METHODS: A 22-year-old man presented with a 2-week history of headache, moderate hearing loss, discolored hair, and bilateral gradually decreased vision (20/800 bilaterally). Ophthalmologic examinations revealed bilateral granulomatous anterior uveitis and multiple patchy bullous retinal detachments. Fundus fluorescein angiography (FFA), SW-AF, and NIR-AF imaging were performed with a confocal scanning laser ophthalmoscope at the beginning and after resolution. The patient responded well to systemic prednisolone treatment. Visual acuity and hearing loss improved quickly (visual acuity 16/20 bilaterally). RESULTS: Multilobular dye pooling with a dark rim was observed in serous detached retinal areas on late-phase FFA. These areas were observed as hypoAF in SW-AF and NIR-AF mode due to the blockage. After resolution of serous detachment, numerous hypoAF granular dots were observed scattered over the previously serous detached areas in SW-AF and NIR-AF mode. These hypoAF granular dots were seen as window defect lesion in FFA and interpreted as retinal pigment epithelial damage or atrophy. CONCLUSIONS: SW-AF and NIR-AF imaging confirmed granular retinal pigment epithelium atrophy which corresponds to FFA findings. SW-AF and NIR-AF imaging methods are noninvasive and useful techniques for documentation of fundus changes in VKH disease.

Hemicentral retinal artery occlusion in a breast cancer patient using anastrozole.

BACKGROUND: Anastrozole, an aromatase inhibitor, is commonly used in the adjuvant treatment of breast cancer. Anastrozole treatment is associated with a risk of thromboembolic events and retinal vascular side effects. Herein, we present a case of hemi-central retinal artery occlusion diagnosed in a breast cancer patient using anastrozole. CASE REPORT: A 53-year-old woman with a hypertensive and diabetic background was admitted to our hospital with breast cancer. Anastrozole treatment was started after surgery, adjuvant chemotherapy, and radiotherapy. Sudden painless loss of vision in the patient's right eye occurred within 13 months of Anastrozole treatment. A fluorescein angiogram revealed hemi-central retinal artery occlusion. CONCLUSION: To the best knowledge of the authors, this is the first report of hemi-central retinal artery occlusion in an anastrozole user.

Carbon monoxide-induced cortical visual loss: treatment with hyperbaric oxygen four years later.

OBJECTIVE: We present a patient who developed visual loss after carbon monoxide (CO) poisoning and was treated with hyperbaric oxygen. CLINICAL PRESENTATION AND INTERVENTION: A 21-year-old woman poisoned with CO (with coma lasting 4 h and carboxyhemoglobin level 46%) developed seizures and cortical blindness 3 days after poisoning. Four years later, her visual acuity was 0.2 in both eyes. An (18)F-fluorodeoxyglucose positron emission tomography (PET) scan showed reduced metabolism in the bilateral posterior temporal and occipital lobes. The patient received a total of 50 hyperbaric oxygen sessions over 3 months for visual loss and the visual acuity improved to 0.5 in both eyes. In addition, increased metabolism was detected in the brain in post-treatment PET scans. CONCLUSION: PET documented brain hypoperfusion 4 years after CO poisoning and hyperbaric oxygen therapy improved visual acuity. However, we cannot endorse routine use of hyperbaric oxygen for such patients, until results of further clinical trials demonstrate efficacy of hyperbaric oxygen in CO-induced chronic brain injury.