Effect of heparin in the intraocular irrigating solution on postoperative inflammation in the pediatric cataract surgery

Yelda B Özkurt, Arzu Taskiran, Nadire Erdogan, Baran Kandemir, Ömer K Dog?anDepartment of Ophthalmology, Kartal Training and Research Hospital, Istanbul, TurkeyPurpose: To evaluate the influence of irrigation of the anterior chamber with heparin sodium on postoperative inflammation after pediatric cataract surgery. Setting: Kartal Training and Research Hospital, First Eye Clinic, Istanbul, Turkey.Design: Randomized prospective double-blind study.Methods: Fourteen consecutive eyes from 14 patients aged 8.9 ± 5.9 years, (range 3–18 years) (group 1) and 19 eyes from 19 patients aged 9.1 ± 5.2 (range 1.5–18 years) (group 2) underwent pediatric cataract surgery. Five patients in group 1 were between three and five years old. One patient was 1.5 years old and six patients in group 2 were between three and five years old. During the procedure, group 1 received anterior chamber irrigation with heparin sodium (5 IU/cc) and 1 ml of heparin sodium (concentration 10 IU/ml) added to the irrigating balanced salt solution (BSS Plus; Alcon Laboratories, Inc., Fort Worth, TX, USA) while group 2 received BSS without heparin sodium only. Cases aged under three years received anterior vitrectomy in addition to posterior capsulorrhexis. One eye received anterior vitrectomy in group 1 and two eyes received anterior vitrectomy in group 2. Cases with preoperative complications were not included in the study. Early and late postoperative inflammatory complications, including fibrin formation, anterior and posterior synechia, cyclitic and pupillary membrane formation were recorded and compared.Results: Mild anterior chamber reaction was observed in three patients in Group 1, while nine cases in group 2 experienced marked anterior chamber reaction. In four of nine patients from group 2, anterior chamber reaction was severe and resulted in pupillary membrane and synechia despite treatment in the postoperative 7th day, while in all three cases in group 1, reaction disappeared by the 7th day.Conclusion: Anterior chamber irrigation with heparin during pediatric cataract surgery may minimize early inflammatory reaction and decrease the number of postoperative inflammatory related complications.Keywords: pediatric, cataract, surgery, inflammatio

Is Single Measurement Enough to Get a Reliable Result with Optical Coherence Tomography?

Pur po se: To evaluate the repeatability and reliability of retinal nerve fiber layer (RNFL) thickness measurements using optical coherence tomography (OCT). Ma te ri al and Met hod: Two hundred sixty-six eyes of 135 subjects (glaucoma, glaucoma suspects and healthy) were included in this study. Three sequential inferior, superior, nasal and temporal RNFL thickness measurements were performed using Spectral OCT [Opko/OTI, Inc., Miami, FL] by one operator at one session without pupillary dilatation. The differences between these three measurements of each quadrant in each eye were compared in microns and percentages. Repeated measures analysis of variance was performed for statistical analysis. Reliability is measured by intraclass correlation coefficient (ICC) for each quadrant. Re sults: ICCs of all quadrants ranged between 0.77 and 0.92, with the measurements of nasal quadrant being the least reproducible and the inferior being the most reproducible of all quadrants. RNFL measurement errors over 20% were seen in 9.63% of nasal quadrant, 5.3% of temporal quadrant, 0.6% of superior quadrant and only 0.3% of inferior quadrant measurements. Dis cus si on: In order to get more repeatable and reliable results with OCT, sequential measurements more than one should be considered. We believe that special attention is required in the analysis of data of nasal and temporal quadrants. (Turk J Ophthalmol 2012; 42: 11-5

Motor control of the quadriceps muscle components in patellofemoral pain syndrome

Patellofemoral pain syndrome is a chronic condition characterised by ffa;amp;fufSpisodes of the anterior knee. In this study, motpMfİOT;amp;itials evoked by transcranial magnetic stimulation of the motor cortex, M responses evoked by femoral nerve stimulation, patellar tendon responses and EMG activity during maximal isomet;not;ric contraction were recorded from Vastus Medialis Oblique and Vastus Lateralis muscles in ten knees of eight patients with PFPS. The findings were cqmpared with those obtained from matched controls in order to find out how a chronic joint pain modulates the neural control of the quadriceps muscle involved in motor function. We found an increase in the ampli;not;tude of the motor potential evoked by transcranial magnetic stimulation of the motor cortex, in the face of decreased M and tendon response in patients with patellofemoral pain syndrome. Both muscles exhib;not;ited lower EMG activity in the patients with patellofemoral pain syndrome than those in the con;not;trol group. The changes in the neurbphysiological parameters occuring in patellofemoral pain syndrome suggested that a chronic joint pain modulates the neu;not;ral control of the quadriceps muscle. They might be ascribed to the plastic changes at the motor cortical level owing to the inhibition of the movements con;not;nected with chronic pain condition.Patellofemoral ağrısendromu, dizde ağrılı epizodlarla giden kronik bir sendromdur. Bu çalışmada, 8 olgunun patellofemoral ağrılı 10 dizinde, Vastus Medialis Ob¬lique ve Vastus Lateralis kaslarından transkranial manyetik uyarılmış potansiyeller, M yanıtları, patellar tendon refleks yanıtları ve maksimal izometrik kontraksiyon sırasında EMG aktiviteleri kayıtlandı. Bulgular, aynı yaş grubundaki 10 sağlıklı kişiden elde edilen bulgularla karşılaştırılarak, kronik diz ağrısının kuadriseps kası nöral kontrolü üzerindeki etkisi araştırıldı. Patellofemoral ağrılı hastalarda transkranial manyetik uyarı ile elde edilen potansiyel amplitüdlerinin kontrollere göre anlamlı büyük olduğu, buna karşın M yanıtı ye patellar tendon refleks amplitüdlerinin ise anlamlı küçük olduğu bulundu. Patellofemoral ağrılı hastalarda her iki kastan da kontrollere göre daha düşük EMG dktivitesi kayıtlandı. Patellofemoral ağrı sendromunda nörofizyolojik parametrelerde saptanan değişiklikler, kronik bir eklem ağrısının kuadriseps kasının nöral kontrolünü module ettiğini düşündürmüştür. Bu değişiklikler, kronik ağrıya bağlı hareket inhibisyonu sonucu motor kortikal düzeydeki plastik değişikliklerle açıklanabilir

Retina and Optic Disc Characteristics in Amblyopic and Non-amblyopic Eyes of Patients with Myopic or Hyperopic Anisometropia

Objectives: To compare retinal and optic disc characteristics between amblyopic and non-amblyopic eyes in patients with myopic and hyperopic anisometropia measured with optical coherence tomography (OCT). Materials and Methods: Patients with myopic (25 patients: 17 female, 8 male; median age 27 years, range 16-40 years) and hyperopic (31 patients: 19 female, 12 male; median age 20 years, range 13-41 years) anisometropic amblyopia were included. Eye examination included determination of best-corrected visual acuity (BCVA) with a Snellen chart, measurement of manifest and cycloplegic refraction after pupillary dilation, alternate cover testing, globe movement evaluation, A-scan biometry for axial length, biomicroscopy, fundus examination, and OCT scanning. Main outcome measures were spherical equivalence, BCVA, axial length, retinal nerve fiber layer (RNFL) thickness, macular thickness, macular volume, and optic disc area. Results: In both myopic and hyperopic patients, the absolute value of the mean spherical equivalence was significantly greater in the amblyopic than non-amblyopic eyes, and the mean BCVA was significantly less in the amblyopic than the non-amblyopic eyes. In both myopic and hyperopic patients, there were no significant differences in mean RNFL thickness, macular thickness, macular volume, axial length, or optic disc area between amblyopic and non-amblyopic eyes. Conclusion: The amblyopic process may have no significant effect on the RNFL, macula, or optic disc. Further studies with more patients, including postmortem studies, may clarify the retinal, histopathologic, and anatomic differences between amblyopic and non-amblyopic eyes

Simultane Bilateral Fakoemulsifikasyon ve Göz İçi Lens İmplantasyonu

Pur po se: To assess the visual outcomes, benefits, and drawbacks of simultaneous same-day phacoemulsification and intraocular lens (IOL) implantation in patients having bilateral cataracts. Ma te ri al and Met hod: The medical records of 346 patients (692 eyes) with bilateral cataracts who have undergone simultaneous bilateral cataract extraction (SBCE) with phacoemulsification and IOL implantation performed by a single surgeon (LA), were reviewed retrospectively. Outcome measures were intraoperative and postoperative complications, best-corrected postoperative visual acuity (BCVA), refractive errors, and patient satisfaction. Re sults: BCVA increased in 633 (91.5%) eyes, decreased in 12 (1.73%) eyes, and remained the same in 47 (6.8%) eyes. The incidence of intraoperative complications was 7.2% (n=50). These complications included posterior capsule rupture with vitreous loss in 20 eyes (2.8%) and without vitreous loss in 17 eyes (2.4%), zonular dehiscence in 9 eyes (1.3%), IOL haptic fracture in 2 eyes (0.28%), iridodialysis in 1 eye (0.14%), and nuclear drop in 1 eye (0.14%). Late postoperative complications occurred in 31 eyes (4.5%). Dis cus si on: With a careful preoperative evaluation performed by an experienced surgeon under strict surgical protocol, simultaneous bilateral phacoemulsification and IOL implantation may be a beneficial procedure.surgical success rate. (Turk J Ophthalmol 2013; 43: 149-55

Tip 2 diabetes mellitusta egzersizin Adma düzeyine etkisi

Amaç: Simetri (SDMA) ve asimetri dimetil argininde (ADMA)artış endotelyal disfonksiyona işaret eder. Bu projenini amacı tip 2 diabetes mellitusta egzersizden sonraki düzeylerini incelemektir. Hastalar ve Yöntemler: Tip 2 DM bulunan 36 kadın ve 44 sağlıklı kadın dahil edildi. Sırasıyla 14 ve 19'u 4 haftalık orta yoğunlukta egzersize alındı. Başlangıçta, ilk egzersiz seansından sonra ve bir ay sonra plazmada SDMA, ADMA ve L-arginin düzeyleri HPLC yöntemiyle ölçüldü. Bulgular: Her iki grupta da tüm ölçümler normal aralıktaydı ve ne egzersizden sonra ne de bir ayın sonunda belirgin olarak değişmedi. Egzersiz yapan sağlıklı grupta bir ayın sonunda L-arginin/ADMA ve L-arginin/SDMA oranları başlangıç değerlerine göre belirgin olarak yüksek bulundu (sırasıyla, p<0.022 ve 0.017). Bir aylık egzersizin sonunda, ilk egzersiz seansı sonundaki değerlere göre oranlar diyabetiklerde arttı ve sağlıklı kişilerde azaldı. Sonuç: Mutlak değerlerden ziyade L-arginin/ADMA ve L-arginin/SDMA oranlarının kullanılması gerektiğini düşünüyoruz. Sağlıklı kişilerde egzersizin yararlı etkileri açısından bu moleküllerin önemli rolü bulunurken diyabetiklerde bu rol çok azdır.Objective: The increase in symmetric (SDMA) and asymmetric dimethyl arginine (ADMA) is associated with endothelial dysfunction. The aim of this study was to evaluate the effect of exercise on ADMA and SDMA levels and related ratios in type 2 DM. Material and Methods: Thirty-six women with type 2 DM and 44 healthy women were recruited to the study. Fourteen and 19 subjects, respectively, attended four-weeks of moderate intensity exercise. Plasma SDMA, ADMA, and L-arginine levels were measured by the HPLC method initially, after the first exercise session, and after one month. Results: All measurements were within the normal range in both groups and did not change significantly immediately after exercise and after the first month. In the healthy group, L-arginine/ADMA and L-arginine/SDMA ratios after one month were significantly higher than the initial values (p&lt;0.022 and p=0.017, respectively). After one month of exercise, L-arginine/ADMA and L-arginine/SDMA ratios increased in diabetics and decreased in healthy subjects when compared to those after the first exercise session (p=0.026 and p=0.037, respectively). Conclusion: We suggest that L-arginine/ADMA and L-arginine/SDMA ratios should be used in spite of absolute values. These molecules have a substantial role in the beneficial effects of exercise in healthy subjects while their role is small in diabetics