Topical apraclonidine testing discloses pupillary sympathetic denervation in diabetic patients.

BACKGROUND: Autonomic denervation is common in diabetes mellitus (DM). Pupillary sympathetic denervation (PSD) has been found in Horner syndrome following instillation of apraclonidine 0.5%. We have applied this technique to investigate the prevalence of PSD in DM. METHODS: Apraclonidine 0.5% was instilled in the eyes of 50 patients with DM and 30 age-matched and gender-matched subjects without DM (control subjects). Pupil diameters (PD) were measured before and 60 minutes after instillation. The duration of DM and the degree of diabetic retinopathy (DR) were recorded for each patient. RESULTS: Apraclonidine instillation caused an average of 0.9 mm of mydriasis (range 0 to 4.5 mm) in DM and -0.1 mm miosis (range 0.5 to -1 mm) in control subjects (P < 0.001). Mydriasis of at least 1 mm was observed in 42% of DM patients. The change in PD was highly correlated with the duration of DM (r = 0.368, P = 0.008) and the presence of DR (r = 0.532, P < 0.001). CONCLUSION: Apraclonidine testing, which is easy to perform and not distressing to the patient, identified PSD in nearly half of DM patients, the degree of mydriasis being correlated to the duration of DM and the presence of DR.

Single-stage adjustable strabismus surgery under topical anesthesia and propofol.

AIM: To present our experience with single-stage adjustable strabismus surgery (SSASS) under topical anesthesia and propofol. MATERIALS AND METHODS: Sixteen patients who either had diplopia before the surgery or were at risk of developing diplopia after the surgery were selected for this operation after evaluating their tolerance for an eyelid speculum. Recession of the lateral recti, recession, resection and advancement of the medial recti, anteriorization of the inferior oblique and marginal myotomy to the superior rectus were the procedures done under topical anesthesia and propofol. The operations were done in two phases; in the first phase, the patients were sedated for 10 minutes with intravenous propofol (2 mg/kg) and the operation was done under topical anesthesia with 2% lidocaine. In the second phase, the patients were conscious and the adjustments were made. RESULTS: None of the patients complained of significant pain during the surgery. No complications occurred during and after the procedure and no patients had diplopia during the postoperative follow-up. CONCLUSIONS: Single-stage adjustable surgery is practical and avoids the risks of regional and general anesthesia. The only disadvantage is the pain that some patients experience. We found that it is feasible to use propofol for this surgery; it provides deep sedation and prevents pain from being felt during the operation, and its short elimination half-life provides rapid awakening for the adjustment phase.

Evaluation of serum leptin concentration in Behçet's disease with ocular involvement.

PURPOSE: To assess the correlation between the serum leptin concentration and ocular involvement in patients with Behçet's disease. METHODS: The study included 28 male consecutive patients with Behçet's disease ( group A, aged 19-59, median 35.5 years) and 15 male healthy control subjects ( group B, aged 25-45, median 35 years). The body mass index (BMI) was calculated for each subject at the study enrollment stage. We measured serum leptin, neutrophil count and erythrocyte sedimentation rate (ESR). Kruskal-Wallis variance analysis and the Mann-Whitney U-test were used for statistical analysis. RESULTS: The age and BMI between the patients with ocular Behçet's disease and the control group were not different. White cell count and ESR values were found to be significantly higher among patients with Behçet's disease and ocular involvement (p<0.001). The median serum leptin concentrations were as follows: group A: 2.66 (0.57-7.02 ng/ml) and in group B: 2.55 (1.55-7.82 ng/ml). There was no statistically significant difference between the groups. CONCLUSION: Serum leptin level does not correlate with ocular involvement in patients with Behçet's disease.

Tolerated cilium in the anterior chamber.

PURPOSE: To describe a patient with a tolerated cilium in the anterior chamber. METHODS: A 15-year-old girl, referred with a 5-year trauma history, was examined. A cilium was noted in the anterior chamber without any inflammation during routine ophthalmological examination. RESULTS: The cilium was removed surgically and the prognosis was excellent. CONCLUSION: The decision to remove a cilium surgically is controversial and must be based on the individual clinical examination.

Health-related quality of life in Behçet patients with ocular involvement.

PURPOSE: Health-related quality of life (HRQOL) is an important outcome factor in chronic diseases such as Behçet syndrome. We aimed to investigate the relation of HRQOL to the duration of illness, mental state, and visual acuity of patients with Behçet syndrome. METHODS: We conducted a cross-sectional clinical trial of 45 consecutive Behçet patients with ocular involvement. The control group consisted of an age-, sex-, and education-matched group of 45 healthy individuals. All patients and the controls had been given a complete ophthalmic examination. In addition, they completed a questionnaire comprising the SF-36 Health Survey, Beck Depression Inventory, and Beck Anxiety Inventory. Eight multiple regression analyses were carried out in the patient group to determine whether total anxiety scores, total depression scores, duration of the disease, and visual acuity predicted the dependent variable SF-36 subscales. RESULTS: Using the analysis of variance statistical method, comparisons of the patient and the control groups for depression, anxiety, and the subscales of the SF-36 Health Survey indicated a statistical significance for this battery of tests. CONCLUSIONS: Behçet patients with ocular involvement are susceptible to anxiety and depression when compared to age and sex matched controls. It is important for the ophthalmologist to know that changes in the mental state of his patient may trigger a new ocular attack, and to be aware that these changes may play a critical role in the management and preventive measures for Behçet syndrome.

Bilateral Duane retraction syndrome associated with an extraordinary hand anomaly.

Duane retraction syndrome is an ocular motility disorder with which an increasing number of congenital abnormalities appear to be associated. In the present paper the authors report a case of bilateral Duane retraction syndrome with an extraordinary hand abnormality. Numerous theories concerning the etiology and pathogenesis of Duane retraction syndrome and its relationship to the associated findings have been proposed, but the exact mechanism is still under investigation. Further multi-centered studies and the classification of the associated clinical findings in an organized manner may help to explain this mechanism.

Nonpreserved human amniotic membrane transplantation in acute and chronic chemical eye injuries.

PURPOSE: To evaluate the safety and efficacy of nonpreserved amniotic membrane transplantation (AMT) with or without limbal autograft transplantation (LAT) in management of acute and chronic chemical eye injuries. METHODS: Amniotic membrane transplantation or AMT + LAT was performed on nine eyes of seven consecutive patients, five eyes with acute chemical burn and four eyes with limbal stem cell deficiency secondary to previous chemical burn. Nonpreserved amniotic membrane was used in all procedures. RESULTS: Five patients (71.5%) were men and two (28.5%) were women. The average age at the time of surgery was 32.7 +/- 10.9 years (range, 20-45). Mean follow-up after last surgery was 8.9 +/- 3.2 months (range, 6-14). The average epithelial healing time was 24.6 +/- 17.3 days (range, 3-45). At the end of the follow-up period, visual acuity improved in all eyes, inflammation subsided, and the subjective complaints decreased remarkably. CONCLUSION: AMT with nonpreserved amniotic membrane promoted epithelial healing, reduced surface inflammation, increased patient comfort, and decreased the extent and severity of vascularization when used in patients with acute chemical burns. When used in limbal stem cell deficiency owing to past chemical burns, AMT alone or in combination with LAT aided in ocular surface reconstruction. Infectious, inflammatory, or toxic/allergic reactions were not encountered in any patient owing to the use of nonpreserved amniotic membrane. Further studies are required to establish the safety and efficacy of preserved and nonpreserved AMT in ocular surface reconstruction.

Long-term therapy with low dose cyclosporin A in ocular Behçet's disease.

Ocular complications of Behçet's disease can be severe and lead to blindness in 90% of untreated patients. We aimed to evaluate the long-term use of low dose cyclosporin-A (CsA) which is a potent immunomodulatory agent in the treatment of ocular Behçet's disease. Fifty-two patients (104 eyes) with ocular Behçet's disease using CsA for at least 1 year were included in this study. All the patients underwent complete ophthalmological and systemic examination. Five mg/kg/per day CsA was started to the patients with severe posterior uveitis and/or frequent anterior inflammatory attacks unresponsive to the conventional therapeutic agents. According to ocular response and adverse effects, the dose was tapered gradually over 2 months to a maintenance dose of 3 mg/kg/per day. Prednisone (0.2-0.8 mg/kg/per day) was added when necessary. Forty-six of the patients (88.5%) were males and six (11.5%) were females. The mean age was 33.65 +/- 7.75 (range, 19-53) years. The mean ocular involvement period was 64.1 (range, 12-180) months. Posterior uveitis was present in 49 (94.21%) and severe, recurrent anterior uveitis in three (5.8%) patients. The mean CsA administration period was 38 +/- 18.1 months. Visual acuity improved in 31(29.8%), deteriorated in 32 (30.8%) and unchanged in 41(39.4%) of the 104 eyes. No ocular attacks occurred in 50% of the eyes during therapy. Nine (17.3%) of the patients had to stop the therapy because of the adverse effects of the CsA and the others tolerated well for a long-term period. CsA is not the ideal therapeutic agent in ocular Behçet's disease because it can not completely eliminate the disease, but it is currently one of the most effective and efficient drug to control the uveitis and its complications until better treatment modalities are developed.