Vitamin B12 deficiency evaluation and treatment in severe dry eye disease with neuropathic ocular pain

OZER, MURAT ATABEY/0000-0003-1807-6911WOS: 000401437600016PubMed: 28299439This study aims to understand the effect of vitamin B12 deficiency on neuropathic ocular pain (NOP) and symptoms in patients with dry eye disease (DED). Patients with severe DED (without receiving topical artificial tears treatment) and ocular pain were enrolled (n = 90). Patients with severe DED and vitamin B12 deficiency (group 1, n = 45) received parenteral vitamin B12 supplement + topical treatment (artificial tears treatment + cyclosporine), and patients with severe DED and normal serum vitamin B12 level (group 2, n = 45) received only topical treatment (artificial tears treatment + cyclosporine). Patients were evaluated by the ocular surface disease index (OSDI) questionnaire, 3rd question (have you experienced painful or sore eyes during last week?) score of OSDI as a pain determiner and pain frequency measure), tear break up time (TBUT), and Schirmer's type 1 test. We compared the groups' OSDI, TBUT, and Schirmer's test recordings at the first visit and after 12 weeks retrospectively. The OSDI score, 3rd OSDI question score, TBUT, and Schirmer's test results improved after 12 weeks (p < 0.001 for each group). The mean vitamin B12 level at enrollment was 144.24 +/- 43.36 pg/ml in group 1 and 417.53 +/- 87.22 pg/ml in group 2. The mean vitamin B12 level in group 1 reached to 450 +/- 60.563 pg/ml after 12 weeks of treatment. The mean score changes between the groups were not statistically significant; however, the decrease in the OSDI questionnaire score (-30.80 +/- 5.24) and 3rd OSDI question score (-2.82 +/- 0.53) were remarkable in group 1 (Table 2). The mean TBUT increase was +7.98 +/- 2.90 s and Schirmer's test result increase was +12.16 +/- 2.01 mm in group 1. The mean TBUT increase was +6.18 +/- 1.49 s and Schirmer's test result increase was +6.71 +/- 1.47 mm in group 2. These findings indicate that vitamin B12 deficiency is related with NOP. It may be important to consider measuring the serum vitamin B12 level in patients with severe DED presenting with resistant ocular pain despite taking topical treatment

Sjogren syndrome and lipid keratopathy

Bu yazının amacı, Sjögren sendromu nedeniyle oluşan korneal neovaskülerizasyon ve se- konder lipid keratopatili bir olguyu sunmaktır. 38 yaşındaki kadın hasta bilateral korneal opasite ve 1 yıldır şiddeti artmış oküler iritasyon ve fotofobi ile kliniğimize sevk edildi. Hasta 10 yıl önce Sjögren sendromu tanısı almıştı ve 8 yıldır da kuru göz nedeniyle suni gözyaşı kul- lanıyordu. Her iki göze 7 yıl önce kalıcı punktum oklüzyonu yapılmıştı. Günde iki kez siklos- porin A %0,05 (Restasis, Allergan) (CSA) kullandığı suni gözyaşına eklendi. 6 ay sonrası tüm semptomları, lipid birikimi ve korneal vaskülerizasyon dışındaki tüm bulguları geriledi. Ciddi komplikasyonlara yol açabilecek kuru göz hastalığı dikkatli tedavi edilmeli ve takipleri düzenli bir şekilde yapılmalıdır.The purpose of this paper is to report a case of bilateral secondary lipid keratopathy and corneal vascularization as a result of Sjogren syndrome. A 38-year old woman was referred to our clinic with bilateral corneal opacity, ocular irritation and photophobia for 1 year. She had a history of Sjogren syndrome for 10 years and dry eye treatment with eye drops for 8 years. Permanent punctal occlusion had been performed 7 years ago in both eyes. For treatment Cyclosporine A, %0.05 (Restasis, Allergan) (CSA) was added to treatment twice a day, along with artificial tears. After 6 months all symptoms and signs other than lipid accumulation and corneal vascularization got better. Dry eye disease that can lead to serious complications should be treated with caution and follow-up should be done in an orderly manner

Long-term effect of botulinum toxin in the treatment of benign essential blepharospasm and hemifacial spasm

Amaç: Bu çalışmada kliniğimizde uzun süreli botulinum toksin A (BTA) enjeksiyonu uyguladığımız benign esansiyel blefarospazm (BEB) ve hemifasiyal (HFS) spazm tanılı hastalarda erken ve geç dönem ilaç dozları ile iyilik süreleri karşılaştırıldı. Ge­reç ve Yön­tem: BEB ve HFS tanısı nedeniyle BTA tedavisi alan hastaların kayıtları geriye dönük olarak incelendi. On enjeksiyon ve üstü tedavi alan, düzenli takipli 12 hasta çalışmaya dahil edildi. İlk 5 enjeksiyon ve son 5 enjeksiyon dozları ile iyilik süreleri karşılaştırıldı. Bulgular: On iki hastanın 6’sı BEB (4 kadın, 2 erkek), 6’sı ise HFS (5 kadın, 1 erkek) nedeniyle tedavi almıştı. Hastaların ortalama takip süresi tüm hastalarda 66,17 ay, BEB grubunda 51,83 ay, HFS grubunda ise 90,33 ay idi. Ortalama tedavi dozu BEB grubunda 40,79 U, HFS grubunda 29,07 U idi. Tedavi sonrası iyilik süreleri değerlendirildiğinde, BEB grubunda ilk 5 enjeksiyon sonrası iyilik süreleri ortalaması 16,1 hafta iken, son 5 enjeksiyon sonrası ortalama iyilik süresi 18,9 hafta idi (p=0,172). HFS grubunda ise ilk 5 enjeksiyon sonrası iyilik süresi 23,6 hafta iken son 5 enjeksiyon sonrası iyilik süresi 23,0 hafta idi (p=0,463). BEB grubunda son 5 enjeksiyon sonrası iyilik süresinde, ilk 5 enjeksiyon sonrası iyilik süresine göre 2,7 hafta artış saptandı. Sonuç: BTA enjeksiyonu BEB ve HFS hastaları için güvenli, etkili bir tedavi yöntemidir. Enjeksiyon dozları uzun dönemde değişmemekle beraber tedavi sonrası iyilik süresi HFS grubunda değişmemişken, BEB hastalarında istatistiksel olarak anlamlı olmasa da iyilik süresinde uzama olmuştur. (Turk J Ophthalmol 2015; 45: 9-13)Objectives: In this study, we evaluated the long-term effects of botulinum toxin A (BTA) in patients diagnosed with benign essential blepharospasm (BEB) and hemifacial spasm (HFS) comparing the drug dose in early and late periods and mean duration of relief. Ma&shy;te&shy;ri&shy;als and Met&shy;hods: The records of patients who were treated with BTA for BEB and HFS were analyzed retrospectively. The patients who had <10 injections and did not attend the follow-up examinations were excluded from the study. The first and last 5 injection doses and the mean duration of relief in 12 patients were compared between the groups. Re&shy;sults: Of the 12 patients, 6 (4 females, 2 males) had treatment for BEB and 6 (5 females, 1 male) for HFS. The mean follow-up was 66.17 months for all patients, 51.83 months in the BEB group and 90.33 months in the HFS group. Average treatment dose was 40.79 U for BEB group and 29.07 U for HFS group. Mean duration of relief time was 16.1 weeks after the first 5 injections and 18.9 weeks after the last 5 injections (p=0.172). In HFS group, mean duration of relief time was 23.6 weeks after the first 5 injections and 23.0 weeks after the last 5 injections (p=0.463). In BEB group, mean duration of relief after the last 5 injections was increased by 2.7 weeks compared with the first 5 injections. Conclusion: BTA injection is a safe and effective method in the treatment of BEB and HFS. With similar injection doses in long-term, the mean duration of relief time after treatment was unchanged in the HFS group and was increased in the BEB group, although the difference was not statistically significant. (Turk J Ophthalmol 2015; 45: 9-13

Long-Term Effect of Botulinum Toxin in the Treatment of Benign Essential Blepharospasm and Hemifacial Spasm

Objectives: In this study, we evaluated the long-term effects of botulinum toxin A (BTA) in patients diagnosed with benign essential blepharospasm (BEB) and hemifacial spasm (HFS) comparing the drug dose in early and late periods and mean duration of relief. Materials and Methods: The records of patients who were treated with BTA for BEB and HFS were analyzed retrospectively. The patients who had <10 injections and did not attend the follow-up examinations were excluded from the study. The first and last 5 injection doses and the mean duration of relief in 12 patients were compared between the groups. Results: Of the 12 patients, 6 (4 females, 2 males) had treatment for BEB and 6 (5 females, 1 male) for HFS. The mean follow-up was 66.17 months for all patients, 51.83 months in the BEB group and 90.33 months in the HFS group. Average treatment dose was 40.79 U for BEB group and 29.07 U for HFS group. Mean duration of relief time was 16.1 weeks after the first 5 injections and 18.9 weeks after the last 5 injections (p=0.172). In HFS group, mean duration of relief time was 23.6 weeks after the first 5 injections and 23.0 weeks after the last 5 injections (p=0.463). In BEB group, mean duration of relief after the last 5 injections was increased by 2.7 weeks compared with the first 5 injections. Conclusion: BTA injection is a safe and effective method in the treatment of BEB and HFS. With similar injection doses in long-term, the mean duration of relief time after treatment was unchanged in the HFS group and was increased in the BEB group, although the difference was not statistically significant. (Turk J Ophthalmol 2015; 45: 9-13

Total Tiroidektomi Sonrası Gelişen Hipokalseminin Göz Doktoru Tarafından Tanımlanması

Bu çalışmada total tiroidektomi sonrası çift taraflı katarakt gelişimi ile ilişkili hipokalsemi olgusunu sunmayı amaçladık. Otuzüç yaşında kadın hasta 8 aydır olan görme azlığı şikâyetiyle kliniğimize başvurdu. Aynı zamanda distal ekstremitelerde hafif parestezi mevcuttu. Katarakt cerrahisi öncesinde kalsiyum seviyesi 8.0 mg/dl, tiroid stimülan hormon seviyesi 0.628 IU/ml , serbest T4 seviyesi 1.12 ng/dl (Referans Aralığı: 0.89-1.76), serbest T3 4.13 pg/ml (Referans Aralığı: 1.8-4.7) ve paratiroid hormonu seviyesi 8 pg/ml idi (Referans Aralığı: 16-87 pg/ml). Hasta klinik olarak ötiroid idi fakat paratiroid hormon seviyesi düşüktü. Düzeltilmiş en iyi görme keskinliği 0.016 seviyesindeydi. Biyomikroskopik muayenesinde bilateral simetrik kortikal katarakt tespit edildi. Hasta bize başvurana kadar yeterli tedavi almıyordu. Tedavi sonrasında parestezi semptomlarında düzelme oldu. Belirgin sistemik semptomlar yokluğunda dahi hipokalsemi tanısını atlamamak çok önemlidir. Göz doktorları, bizim vakamızda olduğu gibi hipokalsemi tanısı koyan ilk doktorlar olabilirler. Özellikle katarakt ile başvuran genç hastalar tiroid cerrahisi açısından sorgulanmalı ve ayrıca kalsiyum seviyeleri kontrol edilmelidir.To present a case of profound hypocalcaemia associated with the development of bilateral cataracts after total thyroidectomy. A 33-year-old woman applied to our clinic because of vision loss for 8 months. She had also mild paresthesia in distal extremities. Preoperative calcium level was 8.0 mg/dl , thyroid stimulating hormone was 0.628 IU/ml , free T4 was 1.12 ng/dl (Reference Range: 0.89-1.76), free T3 was 4.13 pg/ml (Reference Range: 1.8-4.7) and parathyroid hormone was 8pg/ml (Reference Range: 16-87 pg/ml). The patient was clinically euthyroid but parathyroid hormone level was low. Uncorrected visual acuity in both eyes were 0.016. Biomicroscopic examination revealed symmetric complete cortical cataract in both eyes. Patient had not taken sufficient treatment for hypocalcemia till she came to our hospital. After treatment, her paresthesia symptoms improved. It is very important not to overlook hypocalcaemia diagnosis which is a rare cause of cataract even without any obvious systemic symptoms. Ophthalmologists can be the first doctors that diagnose hypocalcaemia as in our case. Especially young patients presenting with cataract should be questioned about thyroid surgery and also checked for calcium levels

Diş Çekimi Sonrası Bilateral Santral Seröz Koryoretinopat

Kırkiki yaşında erkek hasta, yaklaşık 2 haftadır özellikle okur-ken aniden görme bulanıklaşması ile kliniğimize başvurdu. Detaylı hikâyesinde hastanın diş ağrısı nedeniyle diş hekimine başvurduğu öğrenildi. Hastanın okuma ile ilgili şikâyetleri diş çekiminden 2 hafta sonra başlamıştı. Hasta diş çekilmesinden 1 ay öncesinde amoksisilin, sonrasında 2 hafta süreyle non-steroid anti-inflamatuar ilaç kullanmıştı. Bu vakada diş çekimi sonra-sında görülen çift taraflı SSKR olgusu sunulmuşturA 42-year-old male presented to our clinic with acute blurring of vision in both eyes especially in reading for about 2 weeks. Detailed history revealed that the patient recently applied to his dentist because of tooth ache. The patient's complaints abo-ut reading had started 2 weeks after tooth extraction. He had a medication of amoxicillin for a month prior to tooth removal and non-steroidal anti-inflammatory drugs after extraction. In this case we report a bilateral CSCR case after tooth extractio

Investigation of Corneal Biomechanical Properties in Patients with High Myopia

Amaç: Yüksek miyopi olgularında oküler cevap analizörü kullanılarak korneanın biyomekanik özelliklerini araştırmak.Gereç ve Yöntem: İleriye dönük randomize-kontrollü çalışmada sferik eşdeğeri (SE) >=-6.00 Diyoptri (D) olan 24 olgunun 42 gözü çalışma grubu, yaş-cinsiyet bakımından benzer, +0.50 -12.00 D [Grup 3]). Gruplar korneanın biyomekanik özellikleri (korneal histerezis [CH], korneal direnç faktörü [CRF], Goldmann uyumlu göziçi basıncı [IOPg] ve korneadan bağımsız göziçi basıncı [IOPcc]), aksiyel uzunluk (AL) ve merkezi kornea kalınlığı (MKK) bakımından karşılaştırıldı. Bulgular: AL, CH, CRF, IOPcc ve MKK çoklu grup karşılaştırmasında farklı iken (p=-6.00 Diopters (D) were included in the study group and 43 eyes of 27 age-sex matched patients with +0.50-12.00D group 3). Biomechanic properties of cornea (corneal hysteresis [CH], corneal resistance factor [CRF], Goldmann-correlated pressure [IOPg], corneal-compensated pressure [IOPcc]), axial length (AL) and central corneal thickness (CCT) were compared between groups.Results: AL, CH, CRF, IOPcc and CCT were different in multiple group analysis (p<0.001), IOPg was similar (p=0.321). CH and CRF values were lower in high myopia groups (CHp1-2 =0.004, p1-3<0.001; CRFp1-2=0.012, p1-3<0.001). IOPcc was higher in high myopia groups (p1-2=0.049, p1-3<0.001). Between group 1-3, CCT was statistically different (p=0.002) whereas there were no difference between group 1-2, and between group 2-3 (p1-2=0.106, p2-3=0.719). While there was a strong relation between SE and CH, CRF, IOPcc and AL (r=-0.554 p<0.001; r=-0.428 p<0.001; r=0.402 p<0.001; r=0.916 p<0.001, respectively) there was a moderate relation with CCT.Discussion: According to this study CH and CRF values decrease while SE and AL increase. While there is a strong positive relation between IOPcc with AL and SE no relation was with IOPg. So it may be assumed that measuring intraocular pressure (IOP) lower than normal may probably be a result of decrease in corneal biomechanical power. In high myopic patients IOP measurement techniques which take corneal biomechanic properties into consideration should be use

In-vivo corneal biomechanical analysis of unilateral keratoconus

WOS: 000364730200011PubMed ID: 26682162AIM: To evaluate and compare corneal biomechanical findings measured by ocular response analyzer, topographic and pachymetric findings in patients with unilateral keratoconus patients and healthy controls. METHODS: This is an observational, case -control study. Patients with keratoconus in one eye and forme fruste keratoconus in the fellow eye were compared with sex and age matched with controls healthy subjects. All subjects were evaluated with rotating scheimpflug imaging system. The receiver -operating -characteristic curves were analyzed to evaluate the sensitivity and specificity of the parameters. RESULTS: Twenty-seven patients with keratoconus in one eye and forme fruste keratoconus in the fellow eye were compared with 40 eyes of 40 normal subjects. Corneal hysteresis (CH) was 8.0 +/- 1.7 mm Hg in keratoconus group, 8.3 +/- 1.6 mm Hg in forme fruste keratoconus group, and 9.8 +/- 1.6 mm Hg in control groups (P=0.54 between keratoconus and forme fruste keratoconus groups, P<0.01 between control group and other groups). Corneal resistance factor (CRF) was 7.1 +/- 2.2 mm Hg in keratoconus group, 7.8 +/- 1.2 mm Hg in forme fruste keratoconus group and 9.9 +/- 1.5 mm Hg in control group (P < 0.001 between control group and other groups). Using receiver-operating-characteristic analysis, the area under curve values of the parameters to distinguish forme fruste keratoconus from control subjects were: CH (0.768), CRF (0.866). Best cut-off points were 9.3 mm Hg and 8.8 mm Hg for CH and CRF respectively. CONCLUSION: Ocular response analyzer parameters (CH and CRF) are found to be significantly lower in forme fruste keratoconus patients compared to normal control subjects

The Results of Toric Intraocular Lens Implantation in Cataract Patients with Preexistıng Corneal Astigmatism

Amaç: Kataraktı ve ?1.0 D korneal astigmatizması olan gözlerde fakoemülsifikasyon cerrahisi sonrasında uygulanan torik göziçi lens implantasyonunun görsel ve refraktif sonuçlarının değerlendirilmesi. Gereç ve Yöntemler: Özel Kudret Göz Hastanesinde 2010-2012 yılları arasında kataraktı ve ?1.0 D korneal astigmatizması olan komplikasyonsuz fakoemülsifikasyon cerrahisi sonrasında torik göziçi lens implantasyonu uygulanmış 18 hastanın 26 gözüne ait veriler retrospektif olarak incelendi. Hastaların cerrahi öncesi ve 1.ay, 3.ay, 6.ay düzeltilmemiş ve en iyi düzeltilmiş görme keskinlikleri (logMAR), astigmatizma değerleri, rotasyon dereceleri kaydedildi. Bulgular: Hastaların ortalama yaşı 57.8±15.4 (47-78) yıl olup 12 hasta kadın ve 6 hasta erkekti. Cerrahi sonrası takip süresi 4.1±2.3 (1-12) ay idi. Cerrahi öncesi düzeltilmemiş GK 1.03±0.32 (logMAR) ve düzeltilmiş GK 0.48±0.25 (logMAR) iken cerrahi sonrası 1. ayda düzeltilmemiş GK 0.32±0.28 (logMAR) ve düzeltilmiş uzak GK 0.18±0.15 (logMAR) seviyesinde idi. Ortalama refraktif silindirik değerler cerrahi öncesinde -2.94±1.0 D ve cerrahi sonrası 1. ayda -0.65±0.60 D saptandı. Son kontrol muayenelerinde GK 0.13±0.15 (logMAR) seviyesine yükseldi ve astigmatizma değeri -0.79±0.65 D saptandı. Cerrahi sonrası 1. ayda yapılan kontrollerde GİL rotasyon değerleri 6.42±2.45 derece ölçüldü. Tartışma: Katarakt cerrahisinde torik göziçi lens implantasyonu cerrahi öncesi korneal astigmatizmayı düzeltmek için etkili ve güvenilir bir cerrahi seçenektir. Çalışmamızda torik GİL implantasyonunun astigmatizmayı belirgin olarak azalttığı, görme keskinliğinde belirgin düzelme sağladığı gösterilmiştir.Purpose: Evaluating visual and refractive results of toric intraocular lens implantation after phacoemulsification surgery in patients with cataract and &amp;#8805;1.0 D corneal astigmatism. Materials and Methods: The records of 26 eyes of 18 patients who had cataract, &amp;#8805;1.0 D corneal astigmatism and undergone uncomplicated phacoemulsification surgery with toric intraocular lens implantation between 2010 and 2012 were retrospectively evaluated. Uncorrected and best corrected visual acuity (logMAR), astigmatism values preoperatively and in the postoperative first, third and sixth month and intraocular lens axis rotation degrees were recorded. Results: The mean age was 57.8±15.4 (47-78) years. Twelve were women and 6 were men. The mean postoperative follow up period was 4.1±2.3 (1-12) months. Preoperative uncorrected visual acuity was 1.03±0.32 (logMAR) and best corrected visual acuity was 0.48±0.25 (logMAR). In the postoperative first month uncorrected visual acuity was 0.32±0.28 (logMAR) and best corrected visual acuity was 0.18±0.15 (logMAR). The mean cylinder values was -2.94±1.0 D preoperatively and -0.65±0.60 D in the postoperative first month. At last visits the mean best corrected visual acuity was improved to 0.13±0.15 (logMAR) and the mean astigmatism values was -0.79±0.65 D. The mean axis rotation was 6.42±2.45 degree in the first postoperative month. Conclusion: Toric intraocular lens implantation is an effective safe surgical option in correcting preexisting corneal astigmatism. In our study it is shown that toric intraocular lens implantation reduced astigmatism and improved visual acuity significantly