Evaluation of serum vascular endothelial growth factor and netrin-1 levels in patients with neovascular age-related macular degeneration: case-control study

Amaç: Bu çalışmanın amacı, neovasküler yaşa bağlı makula dejenerasyonu (n-YBMD) hastalarında serum vasküler endotelyal büyüme faktörü [vascular endothelial growth factor (VEGF)] ve netrin-1 düzeyini sağlıklı kontrol grubu ile karşılaştırarak, bu vasküler belirteçlerin düzeyindeki değişikliğin sistemik problemlerin belirtisi olup olmadığını araştırmaktır. Gereç ve Yöntemler: Kliniğimizde n-YBMD teşhisi almış ve intravitreal enjeksiyon planlanan 37 hasta ve kontrol grubu olarak katarakt cerrahisi planlanan 34 hasta dâhil edildi. Çalışma ve kontrol grubu hastalarında serum VEGF ve netrin-1 düzeyi enzime bağlı immünosorbent deney yöntemi kullanılarak ölçüldü. Bulgular: Çalışma grubunun medyan yaş değeri 77 (61-84) kontrol grubunun ise 75 (50-87) idi. N-YBMD grubunda serum netrin-1 ve netrin-1/VEGF oranı kontrol grubuna göre anlamlı olarak düşük ve serum VEGF oranı anlamlı olarak yüksek bulundu (tümü p<0,001). Alıcı işletim karakteristiği [receiver operating characteristic (ROC)] analizine göre netrin1 seviyesi n-YBMD’yi tahmin etmek için orta düzeyde bir kesinliğe sahipti. ROC eğrisi altında kalan alan %83,78 [%95 GA (güven aralığı), 68-93,8)] duyarlılık ve %85,29 (%95 GA, 68,9-95) özgüllük ile 0,883 (%95 GA, 0,797-0,970) olarak bulundu. Netrin-1 seviyeleri için en iyi kesim değeri ≤485,1 mg/mL idi ve bu istatistiksel anlamlı olarak değerlendirildi (p<0,001). Sonuç: N-YBMD hastalarında bulunan yüksek VEGF ve düşük netrin-1 serum düzeyi bu hastalığın sistemik ve inflamatuar bir hastalık olduğunu göstermektedir. Düşük serum netrin1/VEGF oranı ise bu hastalıkta birbiri ile ilişkili anjiyogenik mediyatörlerin sistemik dengesinin bozukluğunun göstergesidir.Objective: To compare serum vascular endothelial growth factor (VEGF) and netrin-1 levels in patients with neovascular age-related macular degeneration (n-AMD) with a healthy control group, to investigate whether changes in the level of these vascular markers are a sign of systemic problems. Material and Methods: In our clinic, 37 patients who were diagnosed with n-AMD and were scheduled for intravitreal injection, and 34 patients who were scheduled for cataract surgery as the control group were included in the study. Serum VEGF and netrin-1 levels were measured using the enzymelinked immunosorbent assay method in the study and control group. Results: The median age of the study group was 77 (61-84) and the control group was 75 (50-87). Serum netrin-1/VEGF ratio and netrin1 levels were significantly lower and VEGF levels were significantly higher in n-AMD patients compared to the control group (p<0.001 for all). According to the receiver operating characteristic (ROC) analysis, the netrin-1 level had a moderate precision to predict n-AMD. The area under the ROC curve was 0.883 [95% confidence index (CI), 0.797- 0.970] with a sensitivity of 83.78% (95% CI, 68-93.8) and a specificity of 85.29% (95% CI, 68.9-95). For netrin-1 levels, the best cut-off value was ≤485.1 mg/mL, with a statistically significant difference (p<0.001). Conclusion: Low serum netrin-1 and high VEGF levels detected in patients with neovascular AMD indicate a manifestation of systemic inflammatory disease. The low serum netrin-1/VEGF ratio indicates that the systemic balance of these biomarkers is impaired in this disease

90 Yaş Üzerindeki Hastalarda Fakoemülsifi kasyon Katarakt Cerrahisi Klinik Sonuçları

Purpose: The aim of this study was to investigate the clinical outcomes of phacoemulsifi cation cataract surgery in subjects aged over 90 years. Materials and Methods: We retrospectively reviewed the charts of 34 (41 eyes) eligible patients who underwent phacoemulsifi cation cataract surgery. Demographics, co-existing ocular diseases, preoperative and postoperative best-corrected visual acuity (BCVA), intraoperative and postoperative complications were noted. Results: The mean age of the patients was 93.42 years (range 90-103). The most frequent coexisting ocular diseases were age-related macular degeneration and glaucoma. Preoperative BCVA was above 1 logMAR in 16 eyes (47%) and 1 logMAR or below in 18 (53%) eyes. In the third month after surgery, BCVA improved in all subjects and was below 0.3 logMAR in 26 (76%) eyes. A mean improvement of 1.15 logMAR was obtained postoperatively (p<0.001). The most frequent intraoperative complications were zonular dialysis (3 eyes) and posterior capsule rupture with vitreus loss (3 eyes). Conclusion: Cataract removal with phacoemulsifi cation seems to be effective in subjects over 90 years of age. Advanced age alone may not be a barrier to perform cataract surgery in this age group but benefi t-risk assessment should be individualized.Amaç: Bu çalışmanın amacı 90 yaş ve üzerindeki hastalarda fakoemülsifi kasyon katarakt cerrahisi sonuçlarını araştırmaktır. Gereç-Yöntem: Fakoemülsifi kasyon katarakt cerrahisi geçiren ve çalışmaya dahil edilme kriterlerine uyan 34 hastanın (41 göz) dosyaları geriye dönük incelendi. Hastaların demografi k bilgileri, eşlik eden oküler hastalıkları, ameliyat öncesi ve sonrası en iyi düzeltilmiş görme keskinlikleri (EİDGK), intraoperatif ve postoperatif komplikasyonlar not edildi. Bulgular: Hastaların yaş ortalaması 93.42 yıl (90-103) olarak saptandı. En sık görülen eşlikçi oküler hastalıklar yaşa bağlı makula dejenerasyonu ve glokom idi. Ameliyat öncesi EİDGK, 16 gözde (%47) 1 logMAR üzerinde, 18 gözde (%53) ise 1 logMAR ve altındaydı. Ameliyattan 3 ay sonra tüm gözlerde görme keskinliğinde artış izlendi ve 26 gözde (%76) 0.3 logMAR altındaydı. Gözlerdeki ortalama görme keskinliği iyileşmesi 1.15 logMAR idi (p<0.001). En sık karşılaşılan intraoperatif komplikasyonlar zonül dializi (3 göz) ve vitreus kaybının eşlik ettiği arka kapsül rüptürü (3 göz) idi. Sonuç: Fakoemülsifi kasyon katarakt cerrahisi 90 yaş üzerindeki hastalarda etkin bir tedavi yöntemidir. Bu yaş grubunda tek başına ileri yaş katarakt cerrahisine engel olarak görülmemeli ve fayda-zarar değerlendirmesi her hastaya özgü bireysel olarak yapılmalıdır

Surgical management of traumatic nasolacrimal duct obstruction

Uzun, Feyzahan/0000-0002-3050-0714WOS: 000393691000012PubMed: 26833234Purpose: To evaluate etiologies, demographics, and surgical outcomes in cases of traumatic nasolacrimal duct obstruction (NLDO). Methods: Charts of 35 patients with the diagnosis of traumatic NLDO were reviewed retrospectively. Patient demographics, type of trauma, previous lacrimal surgery history, surgical treatment, follow-up time, and anatomical and functional outcomes were evaluated. Results: Forty eyes of 35 patients were included in this study over 12 years. Twenty-four patients were male (68.5%) and the mean age of the patients was 31.52 +/- 14.58 years (range 9-68). the most common etiology was motor vehicle accidents (52.5%), followed by high velocity blunt injury (27.5%), accidental fall (7.5%), occupational trauma (5%), iatrogenic surgical trauma (5%), and animal bite (2.5%). A total of 21 eyes (52.5%) were treated with external dacryocystorhinostomy (DCR), 30% with conjunctival DCR, 15% with endoscopic DCR, and 2.5% with diode laser-assisted DCR. Mean follow-up time was 23.02 +/- 13.53 months. Functional and anatomical success was recorded in 37 out of 40 eyes (92.5%). Conclusions: Naso-orbitoethmoidal fracture is the main etiology of traumatic NLDO. the majority of the injuries occurred in male participants from motor vehicle accidents and high-velocity blunt injury. Dacryocystorhinostomy provides anatomical and functional success in 92.5% of cases of traumatic NLDO

Evaluation of Ocular Surface Health in Patients with Obstructive Sleep Apnea Syndrome

Objectives: To evaluate ocular surface health in obstructive sleep apnea syndrome (OSAS) and to investigate the tendency of these patients toward dry eyes. Materials and Methods: Fifty patients who underwent polysomnography and were diagnosed with OSAS and 50 normal control subjects were compared with respect to ocular surface disease index (OSDI), Schirmer I test and tear film break-up time (TBUT) values. Results: Patients were grouped as mild (n=15, 30%), moderate (n=15, 30%) and severe (n=20, 40%) according to apnea-hypopnea index values. The right eyes of patients were included in both groups. OSDI values were as follows: control group, 18.7±8.5; mild OSAS group, 40.2±2.8; moderate OSAS group, 48.5±2.2 and severe OSAS group, 62.7±2.3 (p<0.001). TBUT values were as follows: control group, 12.3±4.9; mild OSAS group, 8.2±4.7; moderate OSAS group, 5.8±2.1 and severe OSAS group, 4.2±3.7 (p<0.001). Schirmer values were as follows: control group, 18±6.1 mm; mild OSAS group, 12.9±6.7 mm; moderate OSAS group, 8.5±5.2 mm and severe OSAS group, 7.9±4.7 mm (p<0.001). Conclusion: Patients with OSAS seem to have a tendency toward dry eyes. Clinicians should be aware of dry eye development in these patient

The acute effects of single cup of coffee on ocular biometric parameters in healthy subjects

Aslan, Mehmet Gokhan/0000-0002-3250-1606WOS: 000500535600007PubMed: 31844789Purpose: To evaluate ocular biometric changes in healthy subjects after caffeine consumption from a cup of coffee. Methods: A total of 36 subjects were included in this prospective observational study. Axial length (AL) and anterior segment parameters including aqueous depth (AD), anterior chamber depth (ACD), lens thickness (LT), and central corneal thickness (CCT) were measured with optic biometry, Lenstar LS 900 (Haag-Streit, Inc., Koeniz, Switzerland) before and 1 and 4 h after ingesting a cup of coffee (60 mg caffeine/100 mL). Results: Mean age of the participants was 30.05 +/- 7.43 years (range, 19-45). At baseline, 1st, and 4th hour, AL values were 23.9 +/- 1.04 mm, 23.91 +/- 1.04 mm, and 23.89 +/- 1.04 mm, respectively, and no significant difference was observed (P>0.05). At baseline, 1st, and 4th hour, AD values were 3.06 +/- 0.3 mm, 3.11 +/- 0.3 mm, and 3.09 +/- 0.3 mm, and ACD values were 3.6 +/- 0.32, 3.66 +/- 0.31, and 3.64 +/- 0.31, respectively. AD and ACD values were significantly greater than baseline at 1st and 4th hours following coffee ingestion. Coffee intake caused a significant reduction in LT, compared with baseline and at the 1st and 4th hours which were 3.76 +/- 0.28 mm, 3.69 +/- 0.32 mm, and 3.72 +/- 0.27 mm, respectively. No statistically significant difference was determined in between the 3 measurements in terms of CCT (P>0.05). Conclusion: Caffeine causes a significant increase in AD and ACD and a significant decrease in LT following oral intake, for at least 4 h. Copyright (C) 2019, Iranian Society of Ophthalmology. Production and hosting by Elsevier B.V

Neutrophil-to-lymphocyte ratio increases in patients with dry eye

Uzun, Feyzahan/0000-0002-3050-0714WOS: 000379614000014PubMed: 27158804Purpose:To assess the neutrophil-to-lymphocyte ratio (NLR) as an indicator of inflammation in patients with non-Sjogren dry eye disease.Methods:Serum NLR and C-reactive protein values were determined in 33 patients with dry eye and in 32 controls. the NLR was calculated by dividing the neutrophil count by the lymphocyte count.Results:Characteristics of the dry eye and control groups were similar. the mean NLR value was 2.8 1.4 (range: 1.1-6.1) in the dry eye group and 1.6 +/- 0.7 (range: 0.8-2.8) in the control group (P = 0.002, t test). the mean C-reactive protein value was 0.6 +/- 0.7 mg/dL (range: 0-2.3 mg/dL) in the dry eye group and 0.5 +/- 0.6 mg/dL (range: 0-1.9 mg/dL) in the control group (P = 0.307, t test).Conclusions:The NLR values were found to be higher in patients with non-Sjogren dry eye than in controls. This result suggests that non-Sjogren dry eye disease may be associated with systemic inflammation or the NLR values may increase in local inflammatory ocular diseases

Kardiopulmoner Bypass Cerrahisinin Koroid, Makula ve Retina Sinir Lifi Tabakası Kalınlığına Kısa Dönemdeki Etkisi

Purpose: We aimed to evaluate the changes in choroidal, macular and retinal nerve fi ber layer (RNFL) thickness after cardiopulmonary bypass (CPB) surgery. Materials-Methods: A total of 31 patients underwent heart surgery with CPB were included in this prospective case series. Each subject underwent a standard ophthalmological examination. The choroidal, macular and peripapillary RNFL thickness measurements were performed using spectral-domain optical coherence tomography. Results: The mean age of the patients was 60.77±8.8 years. The change in choroidal thickness was not signifi cant at subfoveal, temporal and nasal macular locations (p>0.05). There were no statistically signifi cant differences between the pre- and postoperative period with regard to macular thickness and peripapillary RNFL thickness measurements (p>0.05). Conclusion: Choroidal, macular and RNFL thickness remained unchanged one month after CPB surgeryAmaç: Bu çalışmada kardiopulmoner bypass (KPB) cerrahisi sonrasında koroid, makula ve retina sinir lifi tabakasındaki (RSLT) değişiklikleri araştırmayı amaçladık. Gereç-Yöntem: KPB yöntemi ile kalp cerrahisi geçiren 31 hasta çalışmaya dahil edildi. Her hastaya tam oftalmolojik muayene yapıldı. Koroid, makula ve RSLT kalınlıkları spektral-domain optik koherans tomografi yardımıyla ölçüldü. Bulgular: Hastaların ortalama yaşı 60.77±8.8 yıl idi. Subfoveal, temporal ve nazal bölgelerde ölçülen koroid kalınlığındaki değişim anlamlı değildi (p>0.05). Ameliyat öncesi ve sonrası ölçümler karşılaştırıldığında makula ve RSLT kalınlıklarında da istatistiksel farklılık izlenmedi (p>0.05). Sonuç: Koroid, makula ve RSLT kalınlığı KPB cerrahisi sonrası 1. ayda değişmemektedir

Choroidal Thickness in Turkish Children with Anisometric Amblyopia

Uzun, Feyzahan/0000-0002-3050-0714;WOS: 000399807200008PubMed: 26308188Purpose: To assess macular choroidal thickness (CT) and axial length measurements in children with anisometropic amblyopia and to compare the measurements with that of fellow non-amblyopic eyes and age-sex matched controls. Methods: Forty patients with anisometropic amblyopia and 40 age-/sex-matched controls were evaluated in this study. Eyes were classified into three groups as follows: amblyopic eyes (n=40), fellow non-amblyopic eyes, and healthy eyes (n=40). All subjects underwent complete ophthalmic examination and macular choroidal thickness measurements by enhanced depth imaging method of the Spectralis optical coherence tomography system. CT was measured at the fovea and at 1000-m intervals from the foveal center in both temporal and nasal directions. the statistical assessment was performed with the assistance of one-way analysis of variance (ANOVA) and Pearson's correlation test. Results: the mean subfoveal CT was 389.35, 349.07, and 315.8m in the amblyopic, fellow non-amblyopic and healthy eyes, respectively. Choroid was thickest in subfoveal and thinnest in nasal regions among all groups. Both amblyopic and fellow non-amblopic eyes were more hyperopic than healthy eyes. While the subfoveal and nasal CT in amblyopic eyes and fellow eyes were significantly higher than healthy eyes, the temporal CT in amblyopic eyes was significantly higher than in healthy eyes. There was a significant positive correlation between the CT of the subfoveal, nasal, and temporal regions and the refractive state (r=0.432 p=0.001; r=0.324 p=0.001; r=0.215 p=0.01, respectively). Conclusion: the macular choroidal thicknessnot only in amblyopic eyes but also in non-amblyopic fellow eyeswas significantly thicker than in the healthy subjects. the thick choroid in amblyopic and non-amblyopic fellow eyes may indicate bilateral delay of emmetropization, which probably means amblyopia affecting the visual feedback of both eyes

The impact of hybrid contact lenses on keratoconus progression after accelerated transepithelial corneal cross-linking

Aslan, Mehmet Gokhan/0000-0002-3250-1606; Findik, Huseyin/0000-0001-7343-8757; Okutucu, Murat/0000-0002-3104-8838WOS: 000564935100004PubMed: 32856196Purpose To investigate the effect of hybrid contact lenses (HCLs) on keratoconus (KCN) progression after accelerated transepithelial cross-linking (A-TE CXL). Methods Thirty-five eyes of 26 patients who preferred Ultrahealth HCLs for an optical correction after A-TE CXL formed the study group, and 45 eyes of 34 patients who preferred spectacle correction were age- and sex-matched to form the control group. Corrected distance visual acuity (CDVA), maximum keratometry, mean keratometry, apical posterior keratometry, cylindrical power, minimum corneal thickness, keratoconus vertex indices and curvature asymmetry indices obtained by Scheimpflug corneal topography were compared before, 6 and 12 months after the procedure. Anterior segment optic coherence tomography (AS-OCT) was performed to measure the apical corneal clearance of HCL-wearing patients. Results the median pre-CXL CDVA value of the patients in the HCL group was logMAR 0.30 (0.20-1.0), and it was logMAR 0.30 (0.10-1.0) in the spectacle-corrected group. There was a significant increase in CDVA 6 and 12 months after CXL procedure in both groups (p 0.05). Conclusion the CDVA significantly improved, and KCN progression was halted in patients wearing HCL 12 months after A-TE CXL. Besides, FCAsym indices can be considered for follow-up of the HCL-wearing patients as an assistive parameter to AS-OCT measurements

Pupillometry measurement and its relationship to retinal structural changes in children with attention deficit hyperactivity disorder

Aslan, Mehmet Gokhan/0000-0002-3250-1606; Okutucu, Murat/0000-0002-3104-8838; Findik, Huseyin/0000-0001-7343-8757; KACAR, MURAT/0000-0002-8887-2991WOS: 000522698600002PubMed: 32236704Purpose This study aims to assess the pupillometry measurements of the attention deficit hyperactivity disorder (ADHD) patients and to investigate their correlations with macular and RNFL thickness parameters by comparing the values with a healthy control group. Methods Newly diagnosed ADHD patients in a child and adolescent clinic of a tertiary hospital were consulted in an ophthalmology clinic. All participants had undergone a standard ophthalmological examination including refractometry, best corrected visual acuity, color vision, anterior segment biomicroscopy, fundoscopy, pupillometry, and OCT. All results were compared with a healthy control group at the same age. Results the study group consisted of 32 patients and there were 43 children in the control group. Mean pupillary velocities of ADHD patients and control group were 0.60 +/- 0.11 mm/s and 0.63 +/- 0.11 mm/s, and 0.49 +/- 0.12 mm/s and 0.50 +/- 0.10 mm/s, for right and left eyes, respectively. the difference was statistically significant for both eyes (p < 0.05). Mean RNFL thickness measurements of the study group were 90.69 +/- 8.58 mu m and 89.63 +/- 8.14 mu m for right and left eyes, respectively and those were 87.35 +/- 7.67 mu m and 88.77 +/- 7.44 mu m, respectively in the healthy group. Correlation between right pupillary velocity and RNFL thickness was statistically significant (r = 0.339, p = 0.003). Conclusion Higher pupillary velocity values were observed in both eyes of children with ADHD and that was positively correlated with RNFL measurements of their right eyes