Decreased retinal nerve fiber layer thickness in patients with cerebral venous thrombosis.

BACKGROUND: To identify thickness variations in the retinal nerve fiber layer around the optic disc and macula in patients with cerebral vein thrombosis (CVT) without papilledema. METHODS: This study included 28 patients with CVT diagnosis and appropriate treatment. Detailed ophthalmologic examination found bilateral vision 10/10, vision field test normal and fundus examination found no papilledema images. The patients had macular and optic retinal nerve fiber layer thickness (RNFL) measured with spectral domain-optical coherence tomography (SD-OCT) (Optovue, Fremont, CA). Patients had retinal nerve fiber thickness compared with a control group. RESULTS: When the effect on the macula and RNFL near the optic nerve disk is investigated, there was significant thinning identified in the macula inferior inner, temporal inner, superior inner and temporal outer quadrants (p = 0.009, 0.001, 0.026, 0.014, respectively) and in the inferior temporal quadrant of the optic nerve disk (p = 0.020) in CVT patients compared to normal individuals. CONCLUSIONS: Even after appropriate treatment of CVT patients, axonal loss was identified with OCT. As a result, it may be important to use OCT measurements to monitor CVT treatment.

Right ventricular geometry and mechanics in patients with obstructive sleep apnea living at high altitude.

PURPOSE: Repetitive obstruction of larynx during sleep can lead to daytime pulmonary hypertension and alterations in right ventricular morphology and function in a small fraction of obstructive sleep apnea syndrome (OSAS) patients. Environmental effects, particularly high altitude, can modify the effects of OSAS on pulmonary circulation, since altitude-related hypoxia is related with pulmonary vasoconstriction. This potential interaction, however, was not investigated in previous studies. METHODS: A total of 41 newly diagnosed OSAS patients were included in this study after pre-enrolment screening. Two-dimensional, three-dimensional, and Doppler echocardiographic data were collected after polysomnographic verification of OSAS. Three-dimensional echocardiograms were analyzed to calculate right ventricular volumes, volume indices, and ejection fraction. RESULTS: Systolic pulmonary artery pressure (38.35 ± 8.60 vs. 30.94 ± 6.47 mmHg; p = 0.002), pulmonary acceleration time (118.36 ± 16.36 vs. 103.13 ± 18.42 ms; p = 0.001), right ventricle (RV) end-diastolic volume index (48.15 ± 11.48 vs. 41.48 ± 6.45 ml; p = 0.009), and RV end-systolic volume index (26.50 ± 8.11 vs. 22.15 ± 3.85; p = 0.01) were significantly higher in OSAS patients, with similar RV ejection fraction (EF) between groups. No significant differences were noted in other two-dimensional, Doppler or speckle-tracking strain, measurements. Both RVEF and pulmonary acceleration time were predictors of disease severity. CONCLUSIONS: A greater degree of RV structural remodeling and higher systolic pulmonary pressure were observed in OSAS patients living at high altitude compared to healthy highlanders. The reversibility of these alterations with treatment remains to be studied.

Increased plasma soluble tumor necrosis factor receptor-1 and myeloperoxidase activity in patients with obstructive sleep apnea syndrome.

PURPOSE/AIM: Obstructive sleep apnea (OSA) is characterized by recurrent respiratory disorders associated with increased cardiovascular morbidity and mortality. The increment of systemic inflammation in OSA has been considered as the major pathogenic mechanism leading to cardiovascular diseases. There is limited and conflicting information in the literature investigating myeloperoxidase (MPO) activity and soluble tumor necrosis factor receptor-1 (sTNF-R1) levels in OSA patients. The aim of our study is to assess the clinical utility of plasma MPO activity and sTNF-R1 levels as risk markers for systemic inflammation and development of cardiovascular diseases in OSA patients. MATERIALS AND METHODS: 59 OSA patients diagnosed with polysomnograhpy for Apnea-Hypopnea index (AHI), and 26 healthy volunteers enrolled into the study. Plasma MPO activity was measured using a spectrophotometric method. An enzyme-linked immunosorbent assay (ELISA) method was used to detect plasma sTNF-R1 levels. RESULTS: Plasma MPO activity and sTNF-R1 levels were significantly higher (43.2 ± 21.65 vs. 30.44 ± 8.05 p = .0046; 2.379 ± 1.2 vs. 1.086 ± 0.86 p < .0001, respectively) in the total OSA patients compared to the control group. There was a significant weak correlation between MPO activity and disease severity indicator AHI (p = .03 r = .27). CONCLUSIONS: Elevated plasma MPO activity and sTNF-R1 levels in the OSA patients indicate increased systemic inflammation and oxidative stress which might contribute to the higher incidence of cardiovascular diseases. Therefore, we recommend measurement of plasma MPO activity and sTNF-R1 levels in the OSA patients as potential risk predictors for cardiovascular diseases.

Advanced oxidation protein products and ischaemia-modified albumin in obstructive sleep apnea.

BACKGROUND: Several studies have shown that obstructive sleep apnea increases incidence of cardiovascular morbidity and mortality. The high systemic oxidative stress in obstructive sleep apnea has been considered as a major pathogenic mechanism leading to cardiovascular disease. Oxidative stress-related lipid and DNA oxidation in obstructive sleep apnea have been reported in the previous studies. In contrast, there is limited and contradictory information regarding protein oxidation in obstructive sleep apnea patients such as ischaemia-modified albumin and advanced oxidation protein products. Therefore, we aimed to investigate plasma ischaemia-modified albumin and advanced oxidation protein products and their correlation with total oxidative status and total antioxidative capacity in the obstructive sleep apnea patients. METHODS: Plasma ischaemia-modified albumin, advanced oxidation protein products, total oxidative status and total antioxidative capacity were measured in 25 healthy volunteers and 59 obstructive sleep apnea patients diagnosed with polysomnography. RESULTS: Plasma total antioxidative capacity was significantly lower (P = 0·012) and total oxidative status was significantly higher (P < 0·001) in the patients compared to the controls demonstrating increased oxidative stress in the patients. Plasma advanced oxidation protein products were significantly higher in the patients than the controls (P = 0·024). Plasma ischaemia-modified albumin levels were not statistically different between the obstructive sleep apnea patients and controls (P = 0·74). CONCLUSIONS: We conclude that high systemic oxidative stress in obstructive sleep apnea is reflected by increased advanced oxidation protein products without causing an increase in ischaemia-modified albumin.

Retinal nerve fibre layer, ganglion cell layer and choroid thinning in migraine with aura.

BACKGROUND: The aim of this study was to investigate the thickness of the retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), and choroid thickness (CT) in patients who have migraines, with and without aura, using spectral optical coherence tomography (OCT). METHODS: Forty-five patients who had migraines without aura (Group 1), 45 patients who had migraines with aura (Group 2), and 30 healthy participants (control group) were included in the study. Spectral OCT was used to measure the RNFL, GCL and CT values for all patients. RESULTS: The mean age of Group 1, Group 2, and the control group was 34.6 ± 4.3, 32.8 ± 4.9, and 31.8 ± 4.6 years, respectively. The mean attack frequency was 3.6/month in Group 1 and 3.7/month in Group 2. The mean age among the groups (p = 0.27) and number of attacks in migraine patients (p = 0.73) were not significantly different. There was significant thinning in the RNFL and GCL in Group 2 (p < 0.05, p < 0.001 respectively), while there were no significant differences in RNFL and GCL measurements between Group 1 and the control group (p > 0.05). All groups were significantly different from one another with respect to CT, with the most thinning observed in Group 2 (p < 0.001). When all migraine patients (without grouping) were compared with the control group, there were significant differences on all parameters: RNFL thickness, GCC thickness and CT (p < 0.05). CONCLUSIONS: RNFL and GCL were significantly thinner in the migraine patients with aura as compared with both the migraine patients without aura and the control subjects. In migraine, both with aura and without aura, patients' choroid thinning should be considered when evaluating ophthalmological findings.

Optic disc and retinal nerve fiber layer parameters as indicators of neurodegenerative brain changes in patients with obstructive sleep apnea syndrome.

PURPOSE: Retina is a unique part of the central nervous system (CNS) for visualizing the processes of axonal and neuronal degeneration. Optical coherence tomography (OCT) allows direct visualization and measurement of retinal nerve fiber layer (RNFL) thickness, macular volume, and optic disc (OD) parameters. One of the disorders associated with atrophy in different brain regions is obstructive sleep apnea syndrome (OSAS). In the present study, we aimed to determine OD and RNFL changes measured by OCT for investigating the progress of neurodegeneration development in OSAS, excluding all the other conditions that can directly affect RNFL thickness and optic nerve parameters. METHODS: Both eyes of 101 patients with OSAS and 20 controls were investigated by OCT. Full-night polysomnography (PSG) and ophthalmologic examination including automated visual field (VF) examination and OCT were performed in all of the patients. RESULTS: According to the OSAS grading, patients were grouped as mild (n=15), moderate (n=27), and severe (n=59). We found significant decrease in RNFL thickness only in the patients with severe OSAS compared with the other groups and decreased macular ganglion cell thickness in the severe OSAS group compared with the control group. VF parameters were significantly worsened in all the OSAS subgroups compared to the control group. We found different data such as normal or increased optic nerve parameters as result of subtle OD edema, which may mask possible peripapillar axonal loss. CONCLUSIONS: We think that evaluation of neurodegeneration in OSAS is not always possible by examining OD and RNFL because there are difficulties due to the confounding issues of cerebral atrophy and OD edema.

Relationship between Structural and Functional Assessment of the Visual System in Mildly Disabled Relapsing-Remitting Multiple Sclerosis Patients.

Studies that explored the anterior visual pathway in the patients with multiple sclerosis (MS) have demonstrated contradictory results about the correlation between structural and functional status of optic nerve and retina. We aimed to investigate the functional and structural findings in our cohort of mildly disabled relapsing-remitting MS patients. A total of 134 eyes (80 eyes of the patients with MS and 54 eyes of the control group) were investigated. Eyes of MS patients were divided into two groups-as eyes with history of optic neuritis (ON group) and without history of optic neuritis (NON group). Ophthalmological investigation including visual evoked potentials, standard automated perimetry, and optical coherence tomography were performed for all participants. Retinal and macular thicknesses were significantly decreased in ON and NON groups compared with controls. Also, visual evoked potential latencies and visual field loss were worse in the both MS groups compared with control group. We did not find any correlation between visual evoked potentials and retinal or macular thickness values but visual field parameters were correlated between retinal and macular layer loss in the NON group. According to our results and some previous studies, although both functional and structural changes were detected in patients with MS, functional status markers do not always show parallelism (or synchrony) with structural changes, especially in eyes with history of optic neuritis.

Optic Atrophy Secondary to Preseptal Cutaneous Anthrax: Case Report.

Bacillus anthracis, the agent of anthrax, is a nonmotile, aerobic gram-positive rod that can form very resistant spores in economically poor environments. Anthrax can manifest as cutaneous, gastrointestinal, or inhalational form. Cutaneous anthrax, caused by direct skin contact, presents with eschar, lymphadenopathy, and a febrile illness. The face and eyelids are most commonly involved in cutaneous anthrax. A 45-year-old man was admitted to our clinic with high fever and swelling of the right eyelid. One day later on re-examination, formation of ulcerous lesions in the right medial canthal region was observed, with general oedema in the upper and lower eyelids. The patient was evaluated as having cutaneous anthrax and medical treatment was continued until the 28th day; he was discharged from the hospital with no loss of vision. He returned for a follow-up examination after 2 months, with decreased visual acuity (

Choroidal Thickening in Patients with Sleep Apnea Syndrome.

Sleep apnoea syndrome (SAS) is characterised by repetitive episodes of cessation of breathing during sleep, resulting in hypoxaemia and hypercapnia. Ophthalmological consequences such as glaucoma, non-arteritic anterior ischaemic neuropathy and papilloedema are relevant to hypoxaemia. The choroid is a vascular structure that performs several regulatory functions for the retina. Defects in this structure contribute to degenerative, inflammatory, and neovascular changes in the retina. The authors examined the choroidal thickness (CT) in sleep apnoea patients using optical coherence tomograpy (OCT). The sleep apnoea patients were divided into subgroups according to their apnoea-hypopnoea index (AHI) scores, and statistical analysis was performed using the AHI and minimal arterial oxygen saturation (min. Spo2) values. There was a medium-high negative correlation between CT and AHI (Spearman rho: r = -0.744, p = 0.000), and a positive correlation between CT and min. Spo2 values (Pearson correlation: r = 0.308, p = 0.000).

Peripapillary Retinal Nerve Fibre Layer Thinning Secondary to Nutritional Folic Acid Deficiency.

Folic acid has a fundamental role in central nervous system (CNS) function at all ages, especially the methionine synthase-mediated conversion of homocysteine to methionine, which is essential for nucleotide synthesis and genomic and non-genomic methylation. Folic acid and vitamin B12 may have roles in the prevention of disorders of CNS development, mood disorders, and dementias, including Alzheimer disease and vascular dementia in elderly people. The authors examined the peripapillary retinal nerve fibre layer thickness (RNFLT) in patients with nutritional folic acid deficiency using optical coherence tomography (OCT). Patients were divided into two groups according to blood folic acid levels: blood folic acid <7 nmol/L as Group 1 and >7 nmol/L as Group 2. Peripapillary RNFL measurements were performed. There were significant positive correlations between serum folate levels and RNFLT in all quadrants (p < 0.05), except for the temportal quadrant (p = 0.41).

Low serum copeptin levels in patients with obstructive sleep apnea.

PURPOSE: Copeptin, the C-terminal fragment of antidiuretic hormone (ADH), is a new biomarker that has been found to be elevated in several cardiovascular disorders and is related with prognosis. Patients with obstructive sleep apnea demonstrate a tendency to develop coronary and cerebral atherosclerotic disease. Our aim was to investigate copeptin levels in untreated new diagnosed obstructive sleep apnea patients without manifest cardiovascular disorders in order to determine whether copeptin could be used as a biomarker in this group. METHODS: A total of 60 patients with obstructive sleep apnea, diagnosed with polysomnography, and 23 healthy volunteers were enrolled into this study. Blood samples were collected after overnight fasting, and copeptin level was measured with an enzyme immunoassay method. RESULTS: Patients with obstructive sleep apnea had a higher incidence of hypertension and body mass index but lower serum copeptin level (0.48 ± 0.24. vs. 0.64 ± 0.28 ng/ml, p = 0.007) compared with the healthy controls. There was no significant difference regarding to serum copeptin levels between the moderate (n = 13) and severe (n = 47) obstructive sleep apnea patients (0.42 ± 0.18 vs. 0.49 ± 0.26 ng/ml, p = 0.409). CONCLUSIONS: Rather than reflecting a reduced risk for cardiovascular disorders, we consider that reduced copeptin level is related with disturbed ADH secretion in obstructive sleep apnea patients. Therefore, it would not be advisable to measure copeptin levels in obstructive sleep apnea patients to determine cardiovascular risk, while this marker could be valuable to demonstrate impairment in ADH regulation in this patient group.

Optical Coherence Tomography in Patients with Relapsing-Remitting Multiple Sclerosis without Optic Neuritis: A 20-Month Longitudinal Study.

Optical coherence tomography is supported and used as a technique for visualisation of neuro-axonal loss in multiple sclerosis, but there are also a few studies expressing the opposite view. The aim of our study was to investigate retinal nerve fibre layer and optic nerve head parameters in patients with multiple sclerosis without a history of prior optic neuritis and symptoms of a new clinical attack during the follow-up for a total of 20-month period. Full ophthalmic evaluation was performed for all of the participants. The baseline retinal nerve fibre layer and macular thicknesses and focal and global loss of macular volume values were significantly lower in the eyes of the patients with multiple sclerosis compared with the healthy controls. No significant change between baseline and follow-up scans were found in all optical coherence tomography parameters in the multiple sclerosis group. Statistical analyses revealed significant retinal nerve fibre layer and macular thickness differences between baseline and second measurements in the controls. No significant difference in percent change between baseline and second measurements was observed between the patient and control groups. We conclude that whereas healthy subjects have an age-related tendency toward a decrease in retinal nerve fibre layer thickness, patients with multiple sclerosis patients are likely to pass through different stages of retinal thinning and thickening due to subclinical optic neuritis and, as a result, we could not detect any statistically significant change between baseline and second measurements in our multiple sclerosis patients.

Cytological and cytometric analysis of oral mucosa in patients with Alzheimer's and Parkinson's disease.

BACKGROUND: Alzheimer's disease (AD) and Parkinson's disease (PD) are the two most common neurodegenerative diseases. Recent studies have sought to identify precursor symptoms of AD and PD that occur before the onset of the disease. We evaluated changes in the oral mucosa of patients with AD and PD using a stereological method. PATIENTS AND METHODS: The study included 29 patients with AD, 30 patients with idiopathic PD, and 30 healthy volunteers. Brush biopsies were obtained from all participants, and the nucleator method was used to estimate the volume of cells obtained from the buccal mucosa. RESULTS: Cytomorphometric analysis revealed that the nuclear volume was 484.39±117.10 µm3 in the AD group, 509.71±132.26 µm3 in PD patients, and 509.30±100.21 µm3 in the control group. The cytoplasmic volume was 115,456.60±30,664.98 µm3 in the AD group, 103,097.93±25,034.65 µm3 in PD patients, and 109,528.45±28,381.43 µm3 in the control group. The nuclear and cytoplasmic volumes were not significantly different among groups (P>0.05). CONCLUSION: The cytomorphometric analysis revealed no significant differences in the cytoplasmic and nuclear volumes of buccal cells obtained from patients with AD and PD and healthy volunteers.

Frequency of subclinical peripheral neuropathy in cases of untreated brucellosis.

INTRODUCTION: Brucellosis is a common zoonotic disease in some areas of the world. It may affect several organs and is known to involve the nervous system in 2.7-17.8% of affected patients. During the progression of brucellosis, peripheral neuropathies (PNs) have been reported. However, there are few studies investigating the presence of subclinical neuropathy in asymptomatic patients. In our study, we aimed to evaluate the presence of peripheral neuropathy using electrophysiological methods in newly-diagnosed untreated brucellosis patients. METHODOLOGY: The study included a control group of 60 healthy volunteers and 60 untreated brucellosis patients with a positive result of 1/160 or above on a brucella tube agglutination test. The patient and control groups were evaluated by electrophysiological methods. RESULTS: In the patient group, all investigated motor nerves had slower average motor conduction speeds, reduced compound muscle action potential (CMAP) amplitudes and delayed F response and terminal latency compared to the control group. The sural nerve sensory conduction speed was slower and the sensory nerve action potential (SNAP) was found to be reduced. CONCLUSION: Among the 60 patients with acute brucellosis, 18% had sensorimotor peripheral neuropathy of widespread axonal character. Brucellosis can have many effects in the nervous system, including clinical or subclinical peripheral neuropathy in the peripheral nervous system. Brucellosis should be considered for differential diagnosis of patients with unexplained neurological and clinically relevant electrophysiological findings, especially in regions with endemic brucellosis.

Ultrasonographic and Electrophysiological Evaluation of the Ulnar Nerve in Patients Diagnosed With Carpal Tunnel Syndrome.

PURPOSE: In this study, we evaluated the ulnar nerve of patients diagnosed with carpal tunnel syndrome (CTS) using electrophysiology and ultrasonography. METHODS: The study included 86 patients (136 hands) and 39 controls (78 hands) with normal electrophysiological assessment. According to Bland's classification, patients were divided into group 1 (grades 1-3 CTS) or group 2 (grades 4-6 CTS). The ulnar nerve was evaluated at the wrist using nerve conduction studies and ultrasonography. RESULTS: The sensory velocity was slower in group 2 than in group 1 (P < 0.001), slower in group 2 than in controls (P < 0.001), and slower in group 1 than in controls (P < 0.005). Although the ultrasonography results showed a reduction in the ulnar nerve cross-sectional area in group 1 compared with controls, the difference was not statistically significant. However, the reduction was significant in group 2 compared with group 1 and controls (P < 0.001). CONCLUSIONS: Based on our study results, the ulnar nerve is affected electrophysiologically and morphologically in patients with CTS, especially those with advanced-stage CTS.

Genetic polymorphisms variants in interleukin-6 and interleukin-1beta patients with obstructive sleep apnea syndrome in East Northern Turkey.

AIM: To investigate the relationship of IL-1ß and IL-6 cytokine gene polymorphisms with obstructive sleep apnea syndrome (OSAS) in 61 patients admitted to the neurology clinic in Kafkas University Hospital with insomnia problem who were diagnosed with OSAS in sleeping labs, and 80 healthy subjects not associated with the syndrome. METHODS :Blood samples were taken to isolate DNA from patients diagnosed with OSAS based on polysomnography results and healthy controls. DNA amplification of the genes was performed with PCR. Amplification products were cut with the restriction enzymes in order to determine IL-1 gene (TaqI) and IL-6 gene (Lwel) polymorphisms. The cut DNA fragments were carried out in agarose gel electrophoresis, and RFLP analysis was performed by utilizing the images with gel imaging system. PCR products were sequenced with an Applied Biosystems Automated Sequencer. RESULTS: Polymorphic changes were observed for IL-1ß gene in 26 of 62 patients (41.9%), and 16 of the 80 (25.8%) in the control group. The incidence of polymorphic changes in IL-6 gene was in seen in seven (of the 62 patients) (11.3%), and in the 16 (20%) controls. CONCLUSION: The findings on the genomic level in OSAS may provide an important contribution to diagnosis of obstructive sleep apnea syndrome in clinical practice, as well as it helps to obtain the results easily about environmental and genetic interaction of OSAS patients.

Alterations in semen parameters in men with epilepsy treated with valproate.

BACKGROUND: Besides the well-known adverse effects of valproate (VPA), disorders related to male reproductive functions have been reported. Furthermore, only a limited number of previous studies have reported the relationship between VPA dose and impairment of the hormonal axis and semen quality. A patient with reversible changes that occurred in the sperm parameters after a dose increment of VPA. METHODS: A 34-year-old male patient who was diagnosed with juvenile myoclonic epilepsy almost 15 years ago was admitted to our clinic. His seizures responded well to high doses of VPA treatment. RESULTS: As the VPA dose was increased, consecutive semen analyses were performed and averaged for each dose; the results showed a remarkable decline in the sperm count and a manifest loss of sperm motility. VPA treatment was gradually diminished and stopped; meanwhile, treatment with another antiepileptic (lamotrigin) was initiated to control the patient's seizures. Nine months later, the patient's semen analysis was within normal ranges. After modification of the patient's treatment regimen, he and his wife had a healthy baby. CONCLUSION: We suggest that VPA-dependent impairments in the hormone and semen analysis parameters were reversible after the termination of medical treatment, and that the VPA treatment did not cause permanent hormonal deregulation and, these side effects are dose dependent.

Clinical and radiological comparison of posterolateral fusion and posterior interbody fusion techniques for multilevel lumbar spinal stabilization in manual workers.

STUDY DESIGN: Eighty-four patients who had been treated for degenerative spinal diseases between January 2006 and June 2009 were reviewed retrospectively. PURPOSE: We aimed to compare the clinical and radiologic findings of manual workers who underwent posterolateral fusion (PLF) or posterior interbody fusion (PLIF) involving fusion of 3 or more levels of the spine. OVERVIEW OF LITERATURE: Previous studies have concluded that there is no significant difference between the clinical outcome of PLF and PLIF techniques. METHODS: After standard decompression, 42 patients underwent PLF and the other 42 patients underwent PLIF. Radiologic findings, Oswestry disability index (ODI) scores, and visual analogue scale (VAS) scores were assessed preoperatively and at 6-month intervals postoperatively and return to work times/rates were assessed for 48 months. RESULTS: Patients who underwent PLF had significantly shorter surgical time and less blood loss. According to the 48-month clinical results, ODI and VAS scores were reduced significantly in the two groups, but the PLIF group showed better results than the PLF group at the last follow-up. Return to work rate was 63% in the PLF group and 87% in the PLIF group. Union rates were found to be 81% and 89%, respectively, after 24 months (p=0.154). CONCLUSIONS: PLIF is a preferable technique with respect to stability and correction, but the result does not depend on only the fusion rates. Discectomy and fusion mass localization should be considered for achieving clinical success with the fusion technique. Before performing PLIF, the association of the long operative time and high blood loss with mortality and morbidity should be taken into consideration, particularly in the elderly and disabled patients.

Occupational exposure to lead decreases macular, choroidal, and retinal nerve fiber layer thickness in industrial battery workers.

PURPOSE: To evaluate the toxic effects of chronic lead (Pb) exposure on retinal nerve fiber layer thickness (RNFLT), macular thickness (MT) and choroidal thickness (CT) in battery industry workers. MATERIALS AND METHODS: Male factory workers (n = 50) and healthy non-employees (n = 20) participated in the study. Group 1 (n = 22) comprised lead workers; Group 2 (n = 16), box makers; Group 3 (n = 12), assistant personnel; and Group 4 (n = 20), healthy non-employees. All participants were given Best-Corrected Visual Acuity (BCVA) tests, full ophthalmologic examinations, and Spectral Domain Optical Coherence Tomography (SD-OCT) of the optic nerve head, RNFL, macula, and choroid. Blood lead levels (BLL) in venous blood samples were determined. The duration of exposure to lead varied, and is expressed in months. RESULTS: Average (mean ± SD) ages of participants were 27.55 ± 4.00, 28.69 ± 3.48, 32.00 ± 3.38, and 29.85 ± 5.48 yrs (Groups 1-4, respectively). BLL were 46.2 ± 2.32, 29.31 ± 3.30, 16.9 ± 1.9, and 2.85 ± 0.98 µg/dL (Groups 1-4, respectively). Durations of exposure to lead were 43.86 ± 10.81, 42.81 ± 4.86, and 49.42 ± 6.14 mo (Groups 1-3, respectively). OCT averages for RNFL were 101.68 ± 5.32, 119.50 ± 13.47, 127.67 ± 8.92, and 130.9 ± 6.63 µm (Groups 1-4, respectively). Although RNFLTs of Group 1 were significantly less than those of for Groups 2-4, and, RNFLTs of Groups 2 and 3 were significantly less than that of Group 4, there were no significant differences between Group 2 and 3. MTs were 94.50 ± 6.78, 105.63 ± 5.43, 111.50 ± 6.74 and 147.95 ± 6.67 µm, (Groups 1-4, respectively). CTs were 176.41 ± 15.39, 222.19 ± 17.79, 239.17 ± 15.64, and 251.50 ± 10.98 µm (Groups 1-4, respectively). Both MTs and CTs displayed significant differences among the four groups. CONCLUSIONS: Ocular changes in individuals who are chronically exposed to lead include decrease in RNFT, MT, and CT, and thus these parameters should be evaluated during ophthalmologic examination of individuals working in lead-based industries.

Is there a relationship between sleep apnea and central corneal thickness?

PURPOSE: The objective of this study was to determine the central corneal thickness (CCT) measurements in patients with Sleep Apnea Syndrome (SAS) and the relationship between the severity of SAS and minimal arterial oxygen saturation (min. SpO2) with respect to CCT. MATERIALS AND METHODS: Two hundred and fourteen eyes of 107 patients (58 males, 49 females) who were diagnosed as SAS and 80 eyes of 40 healthy subjects (20 males, 20 females) were included in the study. The SAS patients were divided into subgroups according to their Apnea-Hypopnea Index (AHI) values as: AHI values between 5 and 15 as subgroup 1, between 15 and 30 as subgroup 2, and the values ≥30 as subgroup 3. The CCT was measured by an ultrasonic pachymetric system. Statistical analyses were an analysis of variance test and, for post-hoc analysis, the Dunnett C test. RESULTS: Mean age was 52.5 ± 10.96 years in the study group, and 40.7 ± 10.14 years in the control group. There were 58 (54.2%) males and 49 (45.8%) females in the study group, and 20 (50%) males and 20 (50%) females in the control group. Mean CCT values were 526.65 ± 25.06, 525.26 ± 29.25, 512.93 ± 43.20 and 539.90 ± 17.28 in subgroup 1, subgroup 2, subgroup 3 and the control group, respectively. There were no statistically significant differences between gender and age groups with respect to CCT (p > 0.05). When the mean CCT values of each subgroups were compared with the control group, the differences were statistically significant (p < 0.05). There was a negative correlation between CCT and AHI values and a positive correlation between CCT and min. SpO2 values. CONCLUSIONS: CCT measurements differ significantly in patients with SAS compared with healthy control subjects. It should be taken into consideration that SAS may reduce CCT over time and that CCT should be measured in each ophthalmic examination.