Branch retinal vein occlusion associated with platelet activation

Background/aim: The aim of this study is to study subclinical platelet activation by detecting three important platelet activation parameters of mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) in patients with branch retinal vein occlusion (BRVO) in comparison to those in healthy control subjects. Materials and methods: This prospective study included 43 patients with BRVO (Group 1)and 40 control subjects (Group 2). The levels of MPV, PDW, and PCT were measured in both of the studied groups Results: The mean serum level of MPV value was 7.64 ± 0.64 in Group 1 and 7.39 ± 0.42 in Group 2. Mean serum level of PDW was 15.01 ± 1.56 in Group 1 and 14.43 ± 1.03 in Group 2. Mean serum PCT value was 0.19 ± 0.05 in Group 1 and 0.16 ± 0.04 in Group 2. MPV, PDW, and PCT levels were significantly increased in BRVO patients (P < 0.05). Conclusion: Subclinical platelet activation reflected by MPV, PDW, and PCT may have an impact on the genesis of vessel occlusion in BRVO. The results may be important for the clinical management of patients with BRVO

Toxic Anterior Segment Syndrome Outbreak after Cataract Surgery Triggered by Viscoelastic Substance.

PURPOSE: The purpose of this study is to present toxic anterior segment syndrome (TASS) outbreak at our clinic and discuss possible causes of TASS. MATERIALS AND METHODS: Thirty-four eyes of 34 patients developed TASS in a consecutive 2 weeks period were included in this study. Both anterior segment and fundus examinations were performed before and after uncomplicated cataract surgery. During the follow-up period, clinical features and all possible causes were evaluated including perioperative products and processing such as sterilization technique of surgical instruments, irrigating solutions, drugs, viscoelastic substance (VES), and intraocular lens. RESULTS: Patients had corneal edema, anterior chamber reactions, and decreased vision. No patient had purulent secretion, chemosis, lid involvement, and pain. At first 2 postoperative days, patients treated as infectious endophthalmitis by topical and oral antibiotics and then TASS was suspected, and patients treated completely with topical steroids. Suspected cause for TASS was VES substance, 2% sodium hyaluronate which had newly been used as VES product in phacoemulsification surgery. No new case has occurred after stopped usage of this VES product. CONCLUSION: As far as we know, this is the largest report of TASS outbreak in the shortest period from the same clinic caused by VES. Suboptimal products of surgical materials can be the cause of TASS. Close monitoring of each surgical step and elimination of causative agent can prevent the outbreaks of TASS.

Treatment success of laser therapy for retinopathy of prematurity in referred and non-referred patients.

PURPOSE: Comparison of laser therapy (LT) outcomes in patients with retinopathy of prematurity (ROP) followed up in our clinic and referred from other centers. METHODS: Medical records of 1,856 ROP patients were retrospectively evaluated, and a total of 128 patients who underwent LT were included in the study. The study population was divided into the following two groups: patients who were followed up and treated in our clinic (group 1, N=45) and patients who were referred to our clinic from other centers (group 2, N=83). Data regarding birth weight, sex, gestational age, postnatal treatment time, disease localization, and stage were analyzed and compared between the two groups. Treatment success was defined by anatomic success 6 months after treatment. RESULTS: Patients in the referred group presented with a more advanced disease (p<0.01), a lower treatment success rate (p=0.01), and a longer time interval between diagnosis and LT (p=0.04). CONCLUSIONS: The treatment success rate of ROP was significantly lower in referred patients because of the potential delay in LT and more advanced disease at the time of treatment initiation.

Treatment success of laser therapy for retinopathy of prematurity in referred and non-referred patients / O sucesso do tratamento com terapia a laser para retinopatia da prematuridade em pacientes encaminhados e não encaminhados

ABSTRACT Purpose: Comparison of laser therapy (LT) outcomes in patients with retinopathy of prematurity (ROP) followed up in our clinic and referred from other centers. Methods: Medical records of 1,856 ROP patients were retrospectively evaluated, and a total of 128 patients who underwent LT were included in the study. The study population was divided into the following two groups: patients who were followed up and treated in our clinic (group 1, N=45) and patients who were referred to our clinic from other centers (group 2, N=83). Data regarding birth weight, sex, gestational age, postnatal treatment time, disease localization, and stage were analyzed and compared between the two groups. Treatment success was defined by anatomic success 6 months after treatment. Results: Patients in the referred group presented with a more advanced disease (p<0.01), a lower treatment success rate (p=0.01), and a longer time interval between diagnosis and LT (p=0.04). Conclusions: The treatment success rate of ROP was significantly lower in referred patients because of the potential delay in LT and more advanced disease at the time of treatment initiation.

RESUMO Objetivos: A comparação dos resultados da terapia a laser (LT) em pacientes com retinopatia da prematuridade (ROP) acompanhados em nossa clínica e encaminhados por outras clínicas. Método: Os arquivos de 1.856 pacientes com ROP foram analisados retrospectivamente e um total de 128 pacientes submetidos à LT foram incluídos no estudo. A população do estudo foi dividida em dois grupos; os pacientes que foram acompanhados e tratados em nossa clínica (grupo 1, n=45) e os pacientes que foram encaminhados à nossa clínica por outros centros (grupo 2, n=83). Os dados referentes a peso de nascimento, sexo, idade gestacional, tempo de tratamento pós-natal, localização e fase da doença foram analisados e comparados entre os grupos. O sucesso do tratamento foi definido pelo sucesso anatômico no sexto mês após o tratamento. Resultados: Pacientes no grupo de pacientes encaminhados apresentaram doença mais avançada (p<0,01), taxa de sucesso inferior (p=0,01) e maior intervalo de tempo entre o diagnóstico e tratamento a laser (p=0,04). Conclusões: A taxa de sucesso do tratamento da ROP é significativamente menor em pacientes encaminhados por causa de possível atraso da LT e do estágio mais avançado da doença observado.

Histopathological Analysis of Internal Limiting Membrane Surgically Peeled From Eyes with Epiretinal Membrane.

PURPOSE: To investigate histopathological changes of internal limiting membrane (ILM) in patients with epiretinal membrane (ERM) Materials and Methods: Forty-two eyes of 42 patients who were diagnosed as ERM and enrolled for vitreoretinal surgery were included in this study. Brilliant Blue G (BBG) was used to stain the ILM in all patients. ILM was peeled in all subjects and analyzed by light microscopy (methylene blue-Azur II × 40). ILM samples were then fixed in 2.5% glutaraldehyde solution and examined in JEOL-JEM 1400 and 2100F electron microscope and photographed by CCD camera (Gatan Inc., Pleasanton, CA). RESULTS: Remained ERM fragments were observed on 80% of ILM's. Vacuolization of ILM was observed in a patient with diabetic ERM. There were cells and cellular fragments observed mostly at retinal side of ILM which was likely to be a fragment of Muller cells of retina. CONCLUSIONS: Most of the ILM's had residual ERM tissue and contained cells and cellular fragments at retinal side of ILM's. ILM peeling might have a role in decreasing ERM recurrence by removal of residual ERM tissues.

23-gauge vitrectomy and silicone oil tamponade with and without phacoemulsification in rhegmatogenous retinal detachment.

The aim of this study is to assess clinical outcomes of 23-gauge vitrectomy and silicone oil (SO) tamponade combined with and without phacoemulsification (PE) in rhegmatogenous retinal detachment (RRD). The study included forty eyes of 40 patients that underwent 23-gauge vitrectomy and SO tamponade combined with and without PE. Twenty eyes of 20 cases, of whom underwent 23-gauge vitrectomy and SO tamponade combined with PE were allocated to the group 1. Likewise, 20 eyes of 20 cases that underwent 23-gauge vitrectomy and SO tamponade alone were allocated to the group 2. Best corrected visual acuity (BCVA) between two groups was compared. There was no significant difference in BCVA between the two groups during the 6 months (P = 0.3). Recurrent retinal detachments were observed in 2 cases (10%) in both groups. There was no statistically significant difference between two groups as a point of recurrent retinal detachments (P = 1). We have found higher rates of post-vitrectomy cataract progression (45%) in the eyes with RRD who underwent 23-gauge vitrectomy and SO tamponade. Combined vitrectomy and PE is safe and effective for the patients with RRD.

Evaluation of Optical Low Coherence Reflectometry Parameters in Patients with Exfoliation Syndrome.

Purpose. To evaluate optical low coherence reflectometry (OLCR) parameters in patients with exfoliation syndrome (EXS) undergoing cataract surgery. Methods. Forty-seven eyes of 47 patients with EXS (Group 1), and 55 eyes of 55 healthy subjects (Group 2) were included in the study. Anterior chamber depth (ACD), lens thickness (LT), axial length (AL), central corneal thickness (CCT), horizontal corneal length (HCL), and pupil diameter (PD) parameters were measured by OLCR (Lenstar LS 900, Haag-Streit) and compared between groups. Shapiro-Wilk test and Mann Whitney U tests were used for statistical analyses. Results. The mean ACD, HCL, and PD values were significantly lower in EXS group than in healthy subjects (P = 0.01, P = 0.04, and P < 0.001, resp.). The mean LT was significantly higher in EXS group than in healthy subjects (P = 0.007). There was no significant difference between groups in means of AXL and CCT. Conclusions. According to OLCR measures, eyes with EXS have shallower ACD, smaller PD, thicker LT, shorter HCL, and no significantly different CCT levels.

Effect of dorzolamide-timolol fixed combination prophylaxis on intraocular pressure spikes after intravitreal bevacizumab injection.

AIM: To evaluate the effect of topical dorzolamide-timolol fixed combination prophylaxis on short term intraocular pressure (IOP) changes in patients who had intravitreal bevacizumab injection. METHODS: One hundred and fifty one eyes of 151 patients which were followed up in retina clinic in Ulucanlar Eye Training and Research Hospital were evaluated in this study. Patients were divided into two groups. Group 1 consists of 75 patients who had topical dorzolamid-timolol medication two hours before injection; while Group 2 consists of 76 patients without prophylaxis. Demographic data, IOP measurements prior to the injection and one, thirty and sixty minutes and twenty-four hours after the injection were recorded. The data were analyzed using SPSS software version 15.0 (SPSS Inc., Chicago, IL, USA). RESULTS: There were no significant difference between two groups in age, gender distrubition and indications for injections. The mean IOPs in Groups 1 and 2 prior to the injection (T0) were 17.84±0.43 and 18.15±0.43 mm Hg, one minute after the injection (T1) were 29.75±1.6 and 34.44±1.59 mm Hg, 30min after the injection (T30) were 20.06±0.6 and 21.71±0.59 mm Hg respectively. The mean IOPs were 18.26±0.56 mm Hg in Group 1 and 19.78±0.56 mm Hg in Group 2 sixty minutes after the injection (T60). All IOP values after the injection were compared between two groups, there was a significant difference between two groups only on T1; one minute after the injection (P=0.04). There were a statiscially significant difference between the baseline values and other recorded values; except on T60, in Groups 1 and 2 (P<0.05). CONCLUSION: After intravitreal bevacizumab injection; we observe a transient IOP elevation which normalizes about one hour after intravitreal injection. In patients who had topical dorzolamid-timolol combination prophylaxis before injections, a significant decrease is seen in IOP spikes due to this injection. The appropiate approach will monitor IOP after intravitreal injection and evaluate the using prophylactic antiglaucomatous drugs before the injection in patients with ganglion nerve cell damage.

Idiopathic bilateral bloody tearing.

Bloody tear is a rare and distinct clinic phenomenon. We report a case presenting with the complaint of recurrent episodes of bilateral bloody tearing. A 16-year-old girl presented to our clinic with complaint of bloody tearing in both eyes for 3 months. Bloody tearing was not associated with her menses. A blood-stained discharge from the punctum was not observed during the compression of both nasolacrimal ducts. Nasolacrimal passage was not obstructed. Imaging studies such as dacryocystography and gradient-echo magnetic resonance imaging (MRI) of nasolacrimal canal were normal. Intranasal endoscopic evaluation was normal. We collected samples from bloody tears two times and pathological examination was performed. Pathological analysis showed lots of squamous cells and no endometrial cells; dysplastic cells were found. Further evaluations for underlying causes were unremarkable. No abnormalities were found in ophthalmologic, radiologic, and pathologic investigations. This condition is likely a rare abnormality and the least recognized aetiology for the idiopathic phenomenon.

Comparison of ocular response analyzer parameters in primary open angle glaucoma and exfoliative glaucoma patients.

AIM: We sought to identify differences in the following measures of the ocular response analyser (ORA) between primary open angle glaucoma (POAG) and exfoliative glaucoma (EXG) patients: Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc) and Goldmann-correlated intraocular pressure (IOPg). We also sought to relate these ORA measures with central corneal thickness (CCT). MATERIALS AND METHODS: This cross-sectional study was conducted on a total of 162 individuals (46 EXG patients, 66 POAG patients and 50 healthy subjects without any ocular and systemic disease). ORA measurements were performed, and a minimum of three readings were obtained from each test subject. Groups were compared according to their ORA parameters. RESULTS: The mean CH levels of the EXG, POAG and healthy subjects were 7.6 ± 2.1, 9.1 ± 1.9 and 9.6 ± 1.7 mmHg, respectively. CH was significantly lower in the EXG patients compared to the other groups (P < 0.001).The mean CRF levels of the EXG, POAG and healthy subjects were 9.0 ± 2.0, 10.1 ± 1.7 and 9.8 ± 1.8mmHg, respectively. CRF levels in the eyes of the EXG patients were significantly lower compared to those of either the POAG patients (P = 0.005) or the healthy subjects (P = 0.03), but there was no significant difference in CRF levels between the POAG patients and the healthy subjects (P = 0.59). There was a significant positive correlation between CH and CCT in the EXG patients and healthy subjects (P < 0.001), but this correlation was not present in the POAG patients (P = 0.70). CONCLUSIONS: In this study, CH and CRF were found to be significantly reduced in the eyes of EXG patients compared to both the POAG patients and healthy subjects. Reduced CH in EXG patients might result in decreased support of peripapillary scleral structure and increased damage to the optic nerve during IOP increase.

Efficacy of topical mesenchymal stem cell therapy in the treatment of experimental dry eye syndrome model.

Purpose. The current study was set out to address the therapeutic efficacy of topically applied mesenchymal stem cells (MSCs) on dry eye syndrome (DES) induced by benzalkonium chloride (BAC) in rats. Methods. Rats were divided into two groups just after establishment of DES. Eye drops containing either bromodeoxyuridine labeled MSCs (n = 9) or phosphate buffer solution (n = 7) were topically applied once daily for one week. Schirmer test, break-up time score, ocular surface evaluation tests, and corneal inflammatory index scoring tests were applied to all rats at baseline and after treatment. All rats were sacrificed after one week for histological and electron microscopic analysis. Results. Mean aqueous tear volume and tear film stability were significantly increased in rats treated with MSCs (P < 0.05). Infiltration of bromodeoxyuridine labeled MSCs into the meibomian glands and conjunctival epithelium was observed in MSCs treated rats. Increased number of secretory granules and number of goblet cells were observed in MSCs treated rats. Conclusion. Topical application of MSCs could be a safe and effective method for the treatment of DES and could potentially be used for further clinical research studies.

Disturbed oxidant/antioxidant balance in aqueous humour of patients with exfoliation syndrome.

PURPOSE: To establish the total oxidant status (TOS), total antioxidant capacity (TAC) and oxidative stress index (OSI) of the aqueous humour in patients presenting exfoliation syndrome (EXS) without glaucoma. METHODS: The TOS, TAC and OSI of the aqueous humour of patients with EXS (group 1, n = 17) and patients without EXS (group 2, n = 25) who underwent cataract surgery were evaluated. Samples were measured spectrophotometrically using a colourimetric method. The Mann-Whitney U, independent-samples t tests, Pearson correlation and analysis of covariance tests were used in the statistical analyses. RESULTS: The mean TOS in group 1 and 2 patients was 57.6 ± 32.4 and 30.4 ± 22.6 mmol/L, respectively, which is a statistically significant difference (p = 0.001). The mean TAC level in group 1 and 2 patients was 2.3 ± 0.7 and 2.5 ± 0.7 mmol/L, respectively, and although TAC was decreased in group 1 relative to group 2, the difference was not statistically significant (p = 0.55). The mean OSI in group 1 and 2 patients was 27.4 ± 17.1 and 12.5 ± 8.3 mmol/L, respectively, with the mean OSI level statistically higher in group 1 (p = 0.03). CONCLUSION: Our findings provide evidence that the aqueous humour of EXS patients is characterised by increased oxidative stress and a disturbed oxidant/antioxidant balance. The increased oxidative stress and decreased levels of antioxidants in ocular fluids of EXS patients may play a significant role in the pathogenesis and complications of EXS.

Comparison of prednisolone acetate and loteprednol etabonate for the treatment of benzalkonium chloride-induced dry eye syndrome in rats.

PURPOSE: The aim of the current study is to compare the effects of two corticosteroids, prednisolone acetate 1% (PA) and loteprednol etabonate 0.5% (LE), for the treatment of benzalkonium chloride (BAC)-induced dry eye syndrome (DES) in rats. METHODS: DES was established by topical administration of 0.2% BAC, a commonly used preservative in ophthalmic drugs, for 1 week. Rats were divided into 3 groups just after establishment of DES: PA-treated (Group 1, n=10), LE-treated (Group 2, n=10), and vehicle-treated (Group 3, n=10). Rats were treated by topical administration of PA, LE, or vehicle twice daily for 1 week. The Schirmer test, break-up time score, Fluorescein staining, Rose Bengal staining, and inflammatory index scoring (IIS) tests were performed at all weeks. After the end of the study, eyes of the rats were enucleated and analyzed using light microscopy. RESULTS: The mean aqueous tear volume was significantly increased in both PA- and LE-treated rats (P<0.05), although decreased in vehicle-treated rats (P>0.05). Histologically, diffuse inflammatory cell infiltration was observed in vehicle-treated rats, while inflammation induced by BAC was almost completely resolved in both PA- and LE-treated groups. CONCLUSIONS: In the current study, we showed that both PA and LE are effective treatments in a rat model of BAC-induced DES, which is commonly observed in clinics. No significant differences were observed between the 2 corticosteroids in the efficacy of BAC-induced type of DES treatment.