Intraocular Hemorrhage due to use of Sildenafil in a Patient with Diabetes

Sildenafil is one of the most commonly used drugs for sexual dysfunction or to increase libido, and it regulates endothelial nitric oxide synthase enzyme via selective phosphodiesterase-V inhibition. Sildenafil can be easily obtained without a medical indication or prescription yet it is not considered as a completely safe medication. Hemoptysis and hemorrhagic stroke are some important adverse effects of sildenafil. The case of the current report was a 67-year-old diabetic patient with simultaneous anterior and posterior segment hemorrhage after the use of 100 mg sildenafil citrate. Anterior chamber clearance and pars plana vitrectomy were performed for the patient because the hyphema and vitreous hemorrhage did not resolve during the follow-up period. There are very limited data available in the literature suggesting an increase in the risk of hyphema or vitreous hemorrhage due to the use of sildenafil. This is the first report that reveals the bleeding effect of sildenafil use in a patient with type 2 diabetes

The Relationship of Neutrophil to Lymphocyte Ratio with Vitreomacular Traction Syndrome

This study was conducted to reveal the role of systemic low-grade inflammation by calculating the Neutrophil/Lymphocyte Ratio (NLR) in Vitreomacular Traction Syndrome (VMTS) of different etiologies. A retrospective examination was made of the medical records at a tertiary referral hospital. The study included 31 patients with diabetic VMTS, 27 patients with idiopathic VMTS, and 35 healthy subjects as the control group. The White Blood Cell (WBC) counts and Neutrophil-to-Lymphocyte Ratio (NLR) was compared. There were  insignificant differences between the groups in terms of mean age and female/male ratio (P>0.05). The mean ± Standard Deviation (SD) of NLR was calculated as 2.43 ± 0.83 in the diabetic VMTS group, 2.38 ± 0.96 in the idiopathic VMTS group, and 1.83 ± 0.52 in the control group (P=0.007). The values of the diabetic and idiopathic VMTS groups were significantly higher than those of the control group (P=0.002 and P=0.032, respectively). However, differences between the diabetic and idiopathic VMTS groups were insignificant (P=0.651). This study found significantly higher NLR in patients with diabetic and idiopathic VMTS than the control group. Elevated NLR could therefore be a potential indicator of VMTS, irrespective of the etiology

Relationship Between Chronic Obstructive Pulmonary Disease and Severity of Diabetic Retinopathy

The negative effects of chronic obstructive pulmonary disease (COPD) on diabetes mellitus (DM) patients are known. For these reasons, we aimed to investigate the effect of COPD on the severity of diabetic retinopathy (DRP) in patients with DM. Materials and Methods: This prospective cross-sectional study included one-hundred and fifty-six eyes of 156 patients with COPD and DM. Multinomial logistic regression models were applied to evaluate the independent relationships between DRP and COPD, including adjusting for patients’ characteristics. Results: After adjustment for potential confounders, patients with low-level COPD were found to have less PDR and severe PDR. (RRR 0.01 95% CI 0.01-0.03, RRR 0.01 95% CI 0.01-0.08, respectively). Conclusion: The findings suggest an increased risk of DRP severity in patients with severe COPD. Ophthalmologists following these patients should consider the relationship between COPD and DRP

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effect of topical pilocarpine on refractive surgery outcomes

Purpose: To investigate the effect of topical pilocarpine on topical cycloplegia and on the results of refractive surgery. Methods: The study included 100 eyes of 100 patients who underwent laser-assisted in situ keratomileusis. Group 1 comprised patients who wanted to undergo surgery on the same day after cycloplegic examination and were applied with 2% pilocarpine hydrochloride; group 2 comprised patients whose pupils spontaneously went into the natural position. Corneal thickness, mean refractive spherical equivalent (MRSE), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), pupil diameter, pupil center shift and high-order aberrations (HOAs) were compared between the two groups. Results: There were no statistically significant differences between the groups in respect of preoperative age, gender, corneal thickness, MRSE, UDVA and CDVA. The pupil diameter was not statistically significant between the groups. Pupil diameter after pilocarpine was not statistically significant when compared with the natural pupil diameter. There were no statistically significant differences in postoperative HOA between the two groups. Conclusions: The pupillary dilatation and the associated pupillary shift were reduced with pilocarpine. Postoperative refractive values and aberrations showed no difference between the groups

Importance of measuring ambulatory blood pressure in subconjonctival hemorrhage

Gürlevik, Uğur ( Aksaray, Yazar )Amaç: Subkonjonktival hemoraji hastalarında ambulatuvar kan basıncı ölçümü ile hipertansiyon açısından detaylı araştırma yapmak. Gereç ve Yöntem: Diğer etyolojik faktörleri ekarte edilen subkonjonktival hemoraji tanılı 41 hastaya 2 farklı zamanda kan basıncı ölçümü yapıldı. Bu ölçümlerde kan basıncı normal sınırlarda çıkan hastalardan rutin kan tetkikleri istendi ve holter tansiyon cihazı takılarak 24 saatlik kan basıncı ölçümü yapıldı. Bulgular: Çalışmaya alınan 41 subkonjonktival hemorajili hastanın iki farklı zamanda ölçülen kan basıncı sonucu ile 27 hastaya hipertansiyon tanısı konuldu. Daha sonra kan basıncı ile rutin kan testleri normal çıkan 14 hastaya ambulatuvar kan basıncı ölçümü yapıldı ve 11’ine (%78,6) hipertansiyon tanısı konuldu. Ambulatuvar kan basıncı ve kan testleri normal çıkan 3 hasta ise idyopatik olarak değerlendirildi. Sonuç: Subkonjonktival hemoroji yapabilecek nedenler ekarte edildiğinde hipertansiyon açısından 2 farklı zamanda ölçülen kan basıncı normal çıksa bile hastalar idyopatik olarak değerlendirilmeden önce mutlaka ambulatuvar kan basıncı ölçümü ile detaylı araştırılmalıdır.Objective: To investigate hypertension and ambulatory blood pressure in patients with subconjunctival hemorrhage. Material and Method: Blood pressures of 41 subconjunctival hemorrhage patients who were excluded from other etiologic factors were measured twice at different time points. After blood pressure measuring, routine blood testing was performed for all patients with normal range of blood pressures and a 24-hour blood pressure was recorded by a Holter device. Results: Of the 41 subconjunctival hemorrhagic patients included in the study, 27 patients were diagnosed with hypertension with blood pressure measured at two different times. Ambulatory blood pressure was measured in 14 patients whose blood pressure and blood tests were normal and 11 (78.6%) were diagnosed ashypertension. Three patients with normal ambulatory blood pressures and blood tests were evaluated as idiopathic. Conclusions: When etiologic factors of subconjunctival hemorrhage are excluded, even if the blood pressures measured at 2 different time point is normal in terms of hypertension, patients should be investigated thoroughly by ambulatory blood pressures measurement before identified as idiopathic

Relationships of the Lateral Femoral Cutaneous Nerve to Bony Landmarks

Background The lateral femoral cutaneous nerve (LFCN) can be at risk during, for example, the insertion of pins in the anterior superior iliac spine (ASIS) during external fixation of the pelvis, total hip arthroplasty through a direct anterior approach, open surgery for impingement in the hip through an anterior approach, and periacetabular osteotomy. During surgery, the surgeon usually assumes the location of the LFCN by using the ASIS as a landmark. Questions/purposes We investigated (1) whether there is any relationship between the LFCN and the ASIS and (2) the anatomy of the LFCN at the lateral border of the psoas major. Methods Using 25 formalin-fixed cadavers, we determined the location of the LFCN emergence point as above, same level with, or below the iliac crest (IC). We measured the distances between the LFCN emergence point and the crossing of the IC and psoas major, ASIS, and pubic tubercle. We measured the distances between the ASIS and pubic tubercle (AB) and the ASIS and the point where the LFCN crossed the inguinal ligament (AC) and then calculated AC/AB. Results The LFCN was below the IC on 19 sides, at the same level on 13 sides, and above on 12 sides. The distances were -0.98 +/- A 5.57 cm to the IC, 12.39 +/- A 2.67 cm to the ASIS, and 17.76 +/- A 3.33 cm to the pubic tubercle. AB was 13.11 +/- A 1.08 cm, AC 2.95 +/- A 2.01 cm, and AC/AB 0.22 +/- A 0.16. Conclusions/Clinical Relevance The LFCN may emerge from the lateral border of the psoas major above or below the IC. The AC/AB ratio can help surgeons to find the LFCN in patients with different body types

Comparison of Samfilcon A and Lotrafilcon B silicone hydrogel bandage contact lenses in reducing postoperative pain and accelerating re-epithelialization after photorefractive keratectomy

Purpose: To compare the efficacy of Samfilcon A and Lotrafilcon B bandage contact lenses after photorefractive keratectomy (PRK). Methods: In this study, patients with bilateral PRK were assigned for the fitting of Lotrafilcon B lens and Samfilcon A lens. The patients were examined on the day of surgery and on postoperative days 1, 2 and 3. Slit biomicroscopy was performed to assess epithelial defect size in the postoperative examinations. The subjective evaluation of pain and visual symptoms was recorded on postoperative days 1, 2 and 3. Results: Analysis was made of 68 eyes of 34 patients who fulfilled the criteria and had PRK for correction of low to moderate myopia/astigmatism. On postoperative days 1 and 2, pain and epiphora scores were significantly lower in eyes with Samfilcon A lens (p < 0.001 for all), and on postoperative day 3, the differences were not significant (p = 0.414 and p = 0.180, respectively). There was no significant difference between the two lenses in respect of the levels of photophobia. The difference in epithelial defect size was statistically lower in eyes with Samfilcon A lens compared to Lotrafilcon B on day 1 (16.89 mm2 vs. 21.07 mm2; p = 0.003) and day 2 (1.49 mm2 vs. 2.46 mm2; p < 0.001). The difference was not significant on day 3. (0.05 mm2 vs. 0.05 mm2; p = 1.000). Conclusions: The Samfilcon A lens is superior to the Lotrafilcon B lens in reducing postoperative pain and accelerating re-epithelialization. © 2019, Springer Nature B.V

Effect of vitamin D deficiency on ocular blood flow

Aim: In this study, we aimed to evaluate the effects of vitamin D deficiency (VDD) on retrobulbar blood flow in healthy eyes.Material and Methods: In this prospective study, thirty eyes of 30 patients with VDD (Group 1) and 25 eyes of 25 individuals without VDD (Group 2) were included. The peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV) and vascular resistance index (RI) were obtained from the ophthalmic artery (OA) with color doppler imaging. Multiple linear regression was performed for the covariate-adjusted comparison.Results: Mean ages were 37.83 +/- 9.89 years in Group 1 and 35.32 +/- 9.61 years in Group 2, (p = 0.347). Mean values of serum 25(OH)D3 level were 11.38 +/- 3.85 ng/dl in Group 1 and 26.80 +/- 10.03 ng/dl in Group 2 (p < 0.001). PSV and EDV were significantly higher in Group 2 than in Group 1 (p<0.001, p=0.001, respectively). RI was slightly higher in Group 1 than in Group 2, but this difference was not statistically significant. In multivariate linear regression, PSV and EDV were positively correlated with OPP, and negatively affected by the presence of VDD.Discussion: VDD can be an important factor in reducing ocular blood flow

Pierre Robin sequence with esophageal atresia and congenital radioulnar synostosis

A wide spectrum of anomalies can be associated with Pierre Robin sequence. This report presents a 3-day-old infant with micrognathia, U-shaped cleft palate, low-set right ear with microtia, glossoptosis, esophageal atresia, and right congenital radioulnar synostosis. The association of congenital radioulnar synostosis and esophageal atresia with Pierre Robin sequence has not been previously described