Reply: Pseudoexfoliation syndrome and cardiovascular disease: studies must control for all cardiovascular risk factors

[No Abstract Available

Cutaneous Anthrax on the Upper Eyelid

A 46-year-old female patient, who presented with a black, crusty lesion on the upper eyelid, was diagnosed with cutaneous anthrax after the detection of Bacillus anthracis in the skin culture. It was determined that the symptoms started after she cooked the meat she bought from a butcher. Anthrax is a disease that should be kept in mind in cutaneous infections even in isolated lesions, especially in endemic areas. © 202

YKL-40 is a local marker for inflammation in patients with pseudoexfoliation syndrome

Purpose: To investigate the YKL-40, as a marker of inflammation, in aqueous humor and serum of cataract patients with and without pseudoexfoliation syndrome (PEX). Methods: Aqueous humor and serum samples were obtained from 44 patients who underwent phacoemulsification surgery. All patients were divided into two groups: PEX (n = 24) and control (n = 20). YKL-40 levels were measured with enzyme-linked immunosorbent assay (ELISA). The differences between the groups were assessed by using Chi-square and independent sample t-tests. The Pearson correlation coefficient was used to evaluate the correlation between variables. Results: There was a significant difference between the mean YKL-40 levels in the aqueous humor of PEX group (112.0 ± 35.8 ng/mL) and control subjects (88.2 ± 30.6 ng/mL) (P = 0.025). However, the difference between the mean YKL-40 levels in the serum of PEX group (53.5 ± 29.1 ng/mL) and control subjects (44.6 ± 30.2 ng/mL) was non-significant (P = 0.326). The correlation between aqueous humor and serum YKL-40 concentrations was significant in both the groups (r = 0.833, P < 0.001; r = 0.840, P < 0.001, respectively). Conclusions: Increased aqueous humor levels of YKL-40 demonstrate that it is local, but not a systemic marker for inflammation in patients with PEX. © 2018, The Royal College of Ophthalmologists

Comparison of Clear Corneal Incision Morphology Changes in Biaxial Microincision Cataract Surgery by Transverse and Torsional Phacoemulsification: Cohort Study

Objective: To compare the effects of transverse versus torsional phacoemulsification by using the biaxial microincision cata ract surgery technique on corneal structures and clear corneal incision (CCI) morphology. Material and Methods: We evaluated comparative case series of patients with moderate density nuclear cataracts who un derwent biaxial microincision transverse or torsional phacoemulsifica tion. Seventy patients have included in the study and they were divided into 2 groups: transverse and torsional. The main outcome measures included, corrected distance visual acuity, central corneal thickness, central corneal endothelial cell density, endothelial cell loss (ECL), and changes in the CCI morphology. Results: Each group comprised 35 (35 eyes) patients. Epithelial misalignment on the CCI morphology was highly significantly meaningful with the transverse group on the po stoperative first day (p<0.001). Descemet membrane detachment on the first day postoperatively was high in both groups, especially in the transverse group, but the difference was not statistically significant (p=0.073). In the postoperative 3rd month, the mean ECL was 23.6% in the transverse group, and 19.0% in the torsional group, and there was no statistically significant difference between groups (p=0.187). Con clusion: In biaxial microincision cataract surgery, the corneal damage caused by transverse phacoemulsification seems to be higher compared to the torsional mode

Oculomotor Nerve Palsy and Vascular Causes: a Case Report

Seksen iki yaşındaki kadın hasta sağ göz kapağında düşüklük, çift görme ve göz hareketlerinde kısıtlılık şikayetleriyle kliniğimize başvurdu. Yapılan muayenede sağda pitozis ile birlikte içe, yukarı ve aşağı bakış kısıtlılığı görüldü. İki ay önce şikayetleri ortaya çıktığında başka bir merkezde yapılan muayenesinde bulgularımızdan farklı olarak anizokori (sağ>sol)saptanmıştı. Hipertansiyon tedavisi gören hastaya 3. sinir felci ön tanısıyla kranyal manyetikrezonans ve manyetik rezonans anjiyografi tetkikleri yapıldı. Sol mediyal oksipital lob ve para hipokampal girus kortekslerinde subakut dönemde sol posterior serebral arter infarktı ileuyumlu kortikal lezyon izlendi. Sağ internal karotid arterin tam tıkalı, sol vertebral ve posterior komünikan arterin hipoplazik olduğu görüldü. Bir ay sonra tüm belirti ve bulgular kendiliğinden düzeldiA 82 years old female patient admitted to our clinic with ptosis of the right eye, restriction of eye movements and double vision. In physical examination, with ptosis in the right eye, there were also movement restrictions to upward, downward and inward directions. Two months before when first symptoms appeared, in the medical centre that our patient admitted, there was also anisocoria (right&gt;left) that was not present in our physical examination. With possible diagnosis of third cranial nerve palsy, cranial MRI and MRI angiography procedures were performed for our patient taking antihypertensive medications. Lesions suitable for subacute infarction of left posterior cerebral artery watershed were seen in left medial occipital lobe and para hippocampal gyrus cortex. Right internal carotid artery was totally ocluded and left vertebral and posterior comminican artery were hypoplasic. After one month, all lesions were subsided spontaneously

Fakoemülsifikasyon Cerrahisinde İmplantasyon Sırasında Gelişen Göz İçi Lens Hasarına Neden Olan Faktörler

Aim: To evaluate the factors affecting intraocular lens (IOL) integrity during implantation in phacoemulsification surgery.Materials and Methods: In this study, medical records of 3,856 patients (4,778 eyes) who underwent phacoemulsification and foldable IOLimplantation by cartridge between August 2010 and July 2019 were retrospectively reviewed. The 11 eyes of 11 patients who had undergone IOLremoval and reimplantation were noted for IOL damage during implantation. In other eyes, implanted IOL material, injector and cartridge typeinformation were recorded.Results: The properties of implanted 4,195 IOLs of 4,778 were hydrophobic acrylic (835 SA60AT, 2,438 AAB00, 922 ZCB00). The remaining 583 IOLswere hydrophobic surfaced high water content acrylic (UD 613). Hydrophobic acrylic IOLs with high water content were inserted with a disposableplastic syringe and foldable cartridge, and hydrophobic acrylic IOLs were inserted with a reusable metal syringe and disposable non-foldablecartridge. Of the 11 IOLs whose integrity was impaired during implantation, 8 were hydrophobic surfaced high water content acrylic and 3 werehydrophobic acrylic (p<0.001). There was no statistically significant difference between hydrophobic acrylic lenses (p=0.103).Conclusion: The material structure of the one-piece hydrophobic surfaced high water content acrylic foldable IOLs, the implantation systemand foldable cartridge used are the factors that can potentiate the development of damage in the IOL during implantation. For a problem-freeimplantation, it should be done carefully and slowly from inserting the IOL into the cartridge until it is placed in the capsule bag.Amaç: Fakoemülsifikasyon cerrahisinde implantasyon sırasında göz içi lens (GİL) bütünlüğünü etkileyen faktörleri değerlendirmek. Gereç ve Yöntem: Bu çalışmada, Ağustos 2010-Temmuz 2019 tarihleri arasında fakoemülsifikasyon ve kartuş yardımlı katlanabilir GİL implantasyonu yapılmış 3.856 hastanın (4.778 göz) tıbbi kayıtları geriye dönük olarak incelendi. İmplantasyon sırasında GİL bütünlüğü bozulan 11 hastanın 11 gözü çalışmaya dahil edildi. Diğer gözlerin GİL ve implantasyon sistemi verileri kaydedildi. Bulgular: İncelenen 4.778 GİL’nin 4.195’i hidrofobik akrilik (835’i SA60AT, 2.438’i AAB00 ve 922’si ZCB00) ve 583’ü hidrofobik yüzeyli yüksek su içerikli akrilik (UD 613) idi. Hidrofobik yüksek su içerikli akrilik GİL’ler tek kullanımlık plastik enjektör ve katlanan kartuş, hidrofobik akrilik GİL’ler yeniden kullanılabilir metal enjektör ve tek kullanımlık katlanmayan kartuş ile göz içine yerleştirilmişti. Bütünlüğü bozulmuş 11 GİL’in 8’i hidrofobik yüzeyli yüksek su içerikli akrilik iken 3’ü hidrofobik akrilikti (p<0,001). Hidrofobik akrilik GİL’ler kendi aralarında kıyaslandığında istatistiksel olarak anlamlı fark görülmedi (p=0,103). Sonuç: Tek parça hidrofobik yüzeyli yüksek su içerikli akrilik katlanabilir GİL’lerin materyal yapısı, kullanılan implantasyon sistemi ve katlanabilir kartuş yapısı, implantasyon sırasında GİL’de hasar gelişimine neden olabilecek faktörlerdir. Sorunsuz bir implantasyon için, GİL’nin kartuşa yerleştirilmesinden kapsül içine yerleştirilene kadar geçen süreçte dikkatli ve yavaş uygulama yapılmalıdır

Mask-Associated Dry Eye (MADE) in healthcare professionals working at COVID-19 pandemic clinics

Background: Healthcare professionals working at COVID-19 pandemic clinics have to work with masks during long hours. After the widespread use of masks in the community, many mask-related side effects were reported to clinics. The increase in the number of applicants with dry eye symptoms due to mask use in ophthalmology clinics has led to the emergence of the concept of mask-associated dry eye (MADE). We think that it would be valuable to evaluate ocular surface tests with a comparative study using healthcare professionals working in pandemic clinics, which we think is the right study group to examine the effects of long-term mask use. Aims: We aimed to evaluate the mask-associated dry eye (MADE) symptoms and findings in healthcare professionals who have to work prolonged time with face masks in coronavirus disease 2019 (COVID-19) pandemic clinics. Patients and Methods: In this prospective, observational comparative clinical study, healthcare professionals who use the mask for a long time and work in COVID-19 pandemic clinics were compared with an age and sex-matched control group consisting of short-term masks users, from April 2021 to November 2021. All participants underwent the Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time (T-BUT), Oxford staining score, Schirmer's test I, and meibography with infrared transillumination. Results: The long-term mask user group consisted of 64 people, while the short-term mask user group consisted of 66 people (260 eyes, total). The OSDI score and Schirmer I measurement were not statistically different between the two groups. T-BUT was statistically significantly shorter in the long-term group (P: 0.008); lid parallel-conjunctival fold, Oxford staining score, and upper and lower lid meibography score were found to be significantly higher in the long-term group (P < 0.001, P: 0.004, P: 0.049, P: 0.044, respectively). Conclusion: Healthcare professionals with longer mask-wearing times are at greater risk of ocular surface damage. It may be considered to prevent this damage by blocking airflow to the ocular surface, such as by wearing a face mask properly or fitting it over the nose with surgical tape. Those who have to work with a mask for a long time during the COVID-19 pandemic should keep in mind the ophthalmology follow-up for eye comfort and ocular surface health

The evaluation of the effect of pilocarpine induced accomodation on anterior chamber depth in pseudophakic eyes using magnetic resonance imaging

Amaç: Tek parçalı ve 3 parçalı hidrofobik akrilik göz içi lensi (GİL) implante edilmiş hastalarda, siklopentolat hidroklorür (HCI) ve pilokarpin HCI’nin ön kamera derinliğine (ÖKD) etkisinin karşılaştırılması. Gereç ve Yöntem: Komplikasyonsuz saydam kornea kesili fakoemülsifikasyon ve GİL implantasyonu yapılmış 19 hastanın 19 gözü değerlendirildi. Hastaların 9’una (grup 1) tek parçalı (AcrySof SA60AT, Alcon) ve 10’una da (grup 2) 3 parçalı (AcrySof MA60BM, Alcon) katlanabilir, hidrofobik akrilik GİL implante edilmişti. Hastaların opere edilen gözlerinin ÖKD’ leri üç gün arayla, sırasıyla pilokarpin HCI %2 ve siklopentolat HCI %1 damlatıldıktan sonra T2 ağırlıklı manyetik rezonans görüntüleri kullanılarak aksiyel ve sagittal planda hesaplandı. Cerrahi ile manyetik rezonans görüntüleme arasındaki ortalama süre grup 1’de 16,1, grup 2’de 13.7 aydı. Wilcoxin ve Mann-Whitney U testleri ile grup içi ve gruplar arası kıyaslamalar yapıldı. Bulgular: Pilokarpin HCI sonrası ortalama ÖKD, grup 1 de 3,67 ± 0,39 mm ve grup 2’de 4,06 ± 0,24 mm idi (p=0,35). Siklopentolat HCI sonrası ÖKD, grup 1’de 3,70±0,37 mm ve grup 2’de 4,01 ± 0,20 mm idi (p=0,53). Pilokarpin HCI ve siklopentolat HCI sonrası ÖKD arasındaki ortalama fark, grup 1 ve grup 2’de, sırasıyla 0,027±0,087 mm ve -0,045±0,10 mm idi (p>0,05). Sonuç: Fakoemülsifikasyon ve GİL implantasyonu sonrası uzun dönemde siklopentolat HCI ve pilokarpin HCI, tek parçalı ve üç parçalı hidrofobik akrilik GİL’de anlamlı bir aksiyel harekete neden olmamaktadır.Aim: To compare the effect of cyclopentolate hydrochloride (HCI) and pilocarpine HCI on anterior chamber depth (ACD) between single-piece and three-piece hydrophobic acrylic intraocular lens (IOL) after uneventful phacoemulsification using magnetic resonance imaging. Material and Method: Nineteen eyes of 19 patients who had uneventful sutureless clear corneal phacoemulsification with IOL implantation were included in the study. Nine eyes (group 1) had single-piece (AcrySof SA60AT, Alcon) and 10 eyes (group 2) had three-piece (AcrySof MA60BM, Alcon) foldable hydrophobic acrylic IOL. ACD was measured in the axial and sagittal T2 weighted magnetic resonance images after 2% pilocarpine HCI installation. Three days later, the same procedure was repeated after 1% cyclopentolate HCI installation. The average time interval between surgery and MR imaging was 16.1&plusmn;0.9 months in group 1 and 13.7&plusmn;0.8 months in group 2. Statistical analysis were performed with the Mann-Whitney U test between groups and the Wilcoxon signed rank test within them. Results: The average ACD after pilocarpine HCI instillation was 3.67&plusmn;0.39 mm and 4.06 &plusmn; 0.24 mm in group 1 and group 2, respectively (p=0.35). The average ACD after cyclopentolate HCI instillation was 3.70&plusmn;0.37 mm and 4.01&plusmn;0.20 mm in group 1 and group 2, respectively (p=0.53). The difference between the average ACD after pilocarpine HCI and cyclopentolate HCI instillations were 0.027&plusmn;0.087 mm and -0.045 &plusmn; 0.10 mm in group 1 and group 2, respectively (p&gt;0.05). Conclusion: Pilocarpine HCI and cyclopentolate HCI do not cause a significant axial shift on single-piece and three-piece hydrophobic acrylic IOL in the late period after phacoemulsification and IOL implantation

EVALUATION OF THE ASSOCIATION OF PIGMENTARY MACULOPATHY IN PRIMARY BLADDER PAIN SYNDROME PATIENTS RECEIVING PENTOSAN POLYSULFATE SODIUM TREATMENT

Objective Primary bladder pain syndrome (PBPS) is characterized with suprapubic pain accompanied by at least one lower urinary tract symptoms including frequent urination, urinary urgency and nocturia for more than 6 weeks. While there are many alternative therapies for the treatment of PBPS, the only approved oral medication is PPS (pentosan polysulfate sodium). As it has been associated with retinal toxicity after its widespread use, this study aims to evaluate the relationship between PPS use and maculopathy. Material and Methods The patients diagnosed with PBPS between 2010 and 2020 who may only benefit from PPS use were included into the study after subgroup and phenotype assessment (urinary and non-ulcerative organspecific subgroups). In our study, patients who had history of degenerative maculopathy or diseases predisposing to maculopathy (age-related macular degeneration, diabetes mellitus, hypertension, chronic vascular disorders, central serous chorioretinopathy, retinal dystrophy, epiretinal membrane, and chronic exposure to hydroxychloroquine) were excluded to prevent possible misdirection. Patients underwent best-corrected visual acuity assessment using Snellen chart, anterior segment and fundus examination using slit lamp biomicroscopy, and intraocular pressure measurement. Color vision test (Ishihara test), posterior segment optical coherence examination and 10-2 visual field test were performed, and color images of the fundus and autofluorescence imaging were obtained. Best-corrected visual acuity, color vision results, macular, choroidal and mean retinal nerve fiber thicknesses, mean deviation of the visual field and fundus findings were recorded. Results Out of 15 patients included into the study, 4 (37.5%) were male and 11 (73.3%) were female. The mean age of the patients was 53.3±11.2 years. During the follow-up, the duration of oral PPS use was found to be 33.01±10.59 months, cumulative oral PPS dose to be 216.02±97.63 g and duration of diagnosis to be 66.64±39.37 months. The mean central macular thickness of the patients was measured to be 254.55±33.11 ?m, and the mean choroidal thickness to be 261.82±34.22 ?m. Mean deviation of the visual field of the patients was found to be -1.89 ±-1.25 dB. The mean retinal nerve fiber thickness was measured to be 98.1±17.62 ?m from the fundus autofluorescence images of the patients. Furthermore, in the present study, the ocular findings of the patients who are at below and above the mean cumulative dose and exposure period were compared. Conclusion This study detected no correlation between longterm PPS use and maculopathy. When forming the patient group; it is crucial to exclude patients with comorbidities such as diabetes mellitus and hypertension, and to form a homogeneous group by phenotype and subgroup assessment. Randomized, prospective, multi-center studies are needed to better assess this correlation

Comparison of corneal endothelial changes after a single-dose ınjection of bevacizumab or ranibizumab

Amaç: Tek doz intravitreal bevacizumab veya intravitreal ranibizumab enjeksiyonu uygulanan olgularda kornea endotel değişikliklerini karşılaştırmak. Ge­reç ve Yön­tem: Kliniğimiz retina biriminde diyabetik maküla ödemi, yaşa bağlı maküla dejenerasyonu gibi nedenlerle 1,25 mg/0,05 ml intravitreal bevacizumab ya da 0,5 mg/0,05 ml ranibizumab enjeksiyonu yapılan herhangi bir kornea patolojisi olmayan 27 hastanın 27 gözü retrospektif olarak incelendi. Ondört hastanın 14 gözüne intravitreal ranibizumab, diğer 13 hastanın 13 gözüne ise intravitreal bevacizumab enjeksiyonu yapılmıştı. Enjeksiyon öncesi ve postoperatif 1. hafta ve 1. ayda görme keskinliği, mm2deki kornea endotel sayısı, göziçi basıncı, pakimetri ölçüm kayıtları incelendi. İstatistiksel analizlerde Mann-Whitney U ve Wilcoxon testleri kullanıldı. So­nuç­lar: Ortalama yaş 69,3±12,5 (44-85 yıl) idi. Bevacizumab ve ranibizumab gruplarında sırasıyla ortalama kornea endotel sayısı enjeksiyon öncesi 2358,1±487 ve 2348,9±598, enjeksiyon sonrası 1. haftada 2360,8±474,1 ve 2398,3±585,6, enjeksiyon sonrası 1. ayda ise 2315,1±465 ve 2407,4±585,6 idi. Enjeksiyon öncesi ile enjeksiyon sonrası 1. hafta ve 1. ay endotel sayılarındaki değişim her iki grupta da anlamlı bulunmadı (Sırasıyla 1. haftada p=0,953 ve p=0,59; 1. ayda p=0,26 ve p=0,555). Bevacizumab ve ranibizumab gruplarında sırasıyla ortalama merkezi kornea kalınlığı enjeksiyon öncesi 527,3±36,9 ve 544,1±55,5 ?m, enjeksiyon sonrası 1. haftada 529,2±49,9 ve 543,5±51,8 ?m, enjeksiyon sonrası 1. ayda ise 530,3±55 ve 543,9±46,4 ?m idi. Enjeksiyon öncesi ile enjeksiyon sonrası 1. hafta ve 1. ay merkezi kornea kalınlığındaki değişim her iki grupta da anlamlı bulunmadı (Sırasıyla 1. haftada p=0,515 ve p=0,838; 1. ayda p=0,678 ve p=0,444). Tar­t fl­ma: İntravitreal olarak tek doz uygulanan 1,25 mg/0,05 ml bevacizumab ya da 0,5 mg/0,05 ml ranibizumab uygulama sonrası 1. hafta ve 1. ayda kornea endotel sayısında anlamlı bir değişikliğe neden olmamaktadır. (Turk J Ophthalmol 2013; 43: 391-4)Pur&shy;po&shy;se: To compare the corneal endothelial changes after injection of a single-dose intravitreal bevacizumab or intravitrearanibizumab. Ma&shy;te&shy;ri&shy;al and Met&shy;hod: In this retrospective study, we evaluated 27 eyes of 27 patients with either diabetic macular edema or senile macular degeneration, who underwent 1.25 mg/0.05 ml intravitreal bevacizumab or 0.5 mg/0.05 ml ranibizumab injection. None of the patients had corneal pathology. Fourteen eyes of 14 patients received intravitreal ranibizumab, other 13 eyes of 13 patients received intravitreal bevacizumab. We evaluated preoperative and postoperative 1st week and 1st month visual acuity, corneal endothelial count at mm2, intraocular pressure, and pachymetry results. For statistical analysis, Mann-Whitney U and Wilcoxon tests were used. Re&shy;sults: Mean age of the patients was 69.3&plusmn;12.5 (44-85 year). Average corneal endothelial cell count for bevacizumab and ranibizumab was preoperatively 2358.1&plusmn;487 and 2348.9&plusmn;598, postoperative 1. week 2360.8&plusmn;474.1 and 2398.3&plusmn;585.6, postoperative 1. month 2315.1&plusmn;465 and 2407.4&plusmn;585.6, respectively. Preoperative and postoperative corneal endothelial cell counts were not statistically significantly different in both groups (respectively, 1. week p=0.953 and p=0.59; 1. month p=0.26 and p=0.555). Average central macular thickness for bevacizumab and ranibizumab was preoperatively 527.3&plusmn;36.9 and 544.1&plusmn;55.5 &amp;#956;m, postoperative 1. week 529.2&plusmn;49.9 and 543.5&plusmn;51.8 &amp;#956;m, postoperative 1. month 530.3&plusmn;55 and 543.9&plusmn;46.6 &amp;#956;m, respectively. Preoperative and postoperative central macular thickness values for both groups were not statistically significantly different (respectively, 1. week P=0.515 and P=0.838; 1. month P=0.678 and P=0.444). Dis&shy;cus&shy;si&shy;on: Injection of a single dose of 1.25 mg/0.05 ml bevacizumab or 0.5 mg/0.05 ml ranibizumab does not affect the corneal endothelial cell count at 1. week and 1. month. (Turk J Ophthalmol 2013; 43: 391-4