Retinal nerve fiber layer thickness in the acute phase of sildenafil treatment.

OBJECTIVE: To evaluate the early effect of sildenafil on the retinal nerve fiber layer (RNFL) thickness. PATIENTS AND METHODS: Sixty eyes of 60 patients were enrolled in the study. The patients underwent RNFL analysis by scanning laser polarimetry (Nerve Fiber Analyzer, GDx VCC:5.3.3; Laser Diagnostic Technologies, San Diego, CA, USA) before and after a single 100 mg dose of sildenafil. Sixty eyes of 60 volunteers of similar age and sex distribution were taken as the control group. The RNFL thickness parameters evaluated included temporal, superior, nasal, inferior, temporal (TSNIT) average, superior average (SA), inferior average (IA), TSNIT standard deviation (SD), and nerve fiber index (NFI). RESULTS: The mean age of the patients was 53,52 ± 9,26 years. The mean pre- and post-treatment TSNIT, SA, IA, TSNIT SD, and NFI of the patients were 57.46 ± 4.94 µ versus 56.90 ± 4.59 microns (µ), 68.93 ± 6,12 µ versus 67,79 ± 5,49 µ, 66,71 ± 7.10 µ versus 66.31 ± 6.82 µ, 24 ± 3.86 µ versus 23.40 ± 4.05 µ, and 16.50 ± 6.08 µ versus 14.92 ± 6.76 µ, respectively. There were no statistically significant differences between pre- and post-treatment RNFL thicknesses (p = 0.527, p = 0.281, p = 0.754, p = 0.416, p = 0.185, respectively). CONCLUSIONS: A single 100 mg dose of sildenafil seems to have no unfavorable effect on RNFL thickness in the acute phase of treatment.

Mini mental state exam versus Montreal cognitive assessment in patients with age-related macular degeneration.

OBJECTIVE: To compare the ability of the MMSE and MoCA to identify cognitive dysfunction in patients with age-related macular degeneration (AMD). PATIENTS AND METHODS: The study included 81 (29 female, 52 male) AMD patients who were recruited from the Ophthalmology Department of Kirikkale University during 2012. Participants were screened for cognitive impairment using the MMSE and MoCA. The scores were recorded for all participants. The primary outcome measure was the proportion of patients with a score less than 21 on either test. RESULTS: The percentage of subjects who scored below a cut off of 21/30 was higher on the MoCA (48.1%) than on the MMSE (18.5%) (p = 0.05). The range and standard deviation of scores was larger with the MoCA (7-30, 5.34) than with the MMSE (19-30, 3.26). There was a more pronounced ceiling effect of the MMSE than of the MoCA. The mean MMSE scores of dry-and wet-type AMD patients was significantly higher than the MoCA scores of the same patients (p = 0.000 and p = 0.000). CONCLUSIONS: The MoCA seems to be more sensitive than the MMSE to early cognitive impairment in AMD patients.

Mean platelet volume in retinal vein occlusion.

OBJECTIVE: The exact pathogenic mechanism underlying the thrombotic tendency in retinal vein occlusion (RVO) is still not fully established. We investigated relationship between platelet indices including mean platelet volume (MPV) and platelet count in RVO patients compared to control group. PATIENTS AND METHODS: Forty six patients (19 female, 27 male) diagnosed as RVO were included in the study. Forty-six subjects (26 female, 20 male) served as controls. Patients were evaluated by careful biomicroscopic examination using a fundus contact lens and fluorescein angiography. Blood samples for total blood count with MPV were obtained after overnight fasting from the antecubital vein. RESULTS: The mean platelet volume was 8.11 ± 1.15 fl in RVO group. It was 8.68 ± 0.98 fl in controls. When compared, the mean MPV was significantly lower in RVO patients (p < 0.05). The mean platelet volume was also significantly lower in branch retinal vein occlusion group in comparison to controls (7.92 ± 1.19 fl. versus 8.68 ± 0.98 fl.) (p < 0.05). CONCLUSIONS: MPV was significantly lower in patients with RVO than control group. MPV does not seem to be a potentially useful biomarker for prediction of RVO.

Morphology of corneal nerves and corneal sensation in dry eye: a preliminary study.

PURPOSE: To evaluate the corneal sensitivity and nerve morphology in dry eyes. METHODS: A total of 32 eyes of 16 patients (10 Sjogren's syndrome and six non-Sjogren's syndrome) and 19 eyes of 10 age-matched controls were studied. Sensitivity of the central cornea was measured by the Cochet-Bonnet aesthesiometer. The morphology of corneal nerves was studied by in vivo confocal microscopy (ConfoScan 2.0, Fortune Technologies Srl, Vigonza (PD), Italy). Sub-basal epithelial nerve plexus, subepithelial nerve plexus, and stromal nerves were localized and evaluated for the number of nerves, thickness, reflectivity, and tortuosity for each frame. RESULTS: The mean corneal sensitivity of dry eye patients (5.6 mm/grs/S) was found significantly lower than that of the control (5.0 mm/grs/S) group (P<0.01). Although the subepithelial nerves were thicker in dry eyes (mean: 6.38+/-1.18 microm) than control eyes (mean: 5.72+/-1.27 microm), this difference was not significant (P>0.05). CONCLUSION: Decreased corneal sensitivity is not associated with morphological changes of corneal nerves in dry eyes.

Outcome at second-look laparotomy: anaesthesia related risk factors.

PURPOSE OF INVESTIGATION: To identify anaesthesia related risk factors associated with positive second-look laparotomy (SLL) findings in patients with epithelial ovarian carcinoma who had previous optimal cytoreduction surgery under general anaesthesia. METHODS: A retrospective review of the anaesthesia and medical records of patients with epithelial ovarian cancer who underwent SLL at our institution and analysis of patient related (age, haemoglobin, albumin), anaesthesia related (duration of anaesthesia, anaesthetics and dosages, transfusion of blood products), tumour related (stage, grade, presence of ascites, adhesion, histological type, capsule penetration and CA-125) data and outcome of SLL was undertaken. RESULTS: The patients had SLL 305 +/- 215 days after the first operation. Of the 83 patients 28 (33.7%) were SLL (+). SLL (+) patients were significantly more likely to have a mucinous histological subtype, required intraoperative packed red blood cell (PRBC) transfusion and longer anaesthesia duration (p < 0.05). Type of induction agent, whether narcotics were used or not, type of volatile agent used, dosages of induction agents and dosages of narcotic and muscle relaxants did not vary significantly between the patients with and without cancer recurrence (p > 0.05). Duration of anaesthesia (OR, 1.03; CI, 1-1.05, p = 0.031) and histological subtype (OR, 16.1; CI, 1.8-141.7, p = 0.012), were the independent variables predicting cancer recurrence in the multivariate logistic regression. CONCLUSION: We emphasize that duration of anaesthesia and histological subtype are risk factors for cancer recurrence in early stage ovarian carcinoma. From our data it seems that interventions to shorten the duration of general anaesthesia or reversing immunosuppression induced by anaesthesia and surgery must be carefully considered.