Combined choroidal neovascularization and hypopituitarism in a patient with homozygous mutation in methylenetetrahydrofolate reductase gene.

We report a case of choroidal neovascularization (CNV) secondary to methylenetetrahydrofolate reductase (MTHFR) gene mutation in a 20-year-old male patient with hypopituitarism. Treatment with three consecutive injections of intravitreal ranibizumab (anti-vascular endothelial growth factor) resulted in significant improvement of the patient's vision and the appearance of the macula. A search of the literature produced no previously reported case of MTHFR gene mutation associated both CNV and possibly hypopituitarism. With hormone replacement therapy of hypopituitarism, acetyl salicylic acid 100 mg/day also was started. The patient was clinically stable both for CNV and other thromboembolic disorders over a 6-month follow-up and also 1-year follow-up period.

Disorganization of the retinal inner layers as a prognostic factor in eyes with central retinal artery occlusion.

AIM: To evaluate baseline foveal disorganisation of retinal inner layers (DRIL) as a prognostic factor in eyes with central retinal artery occlusion (CRAO). METHODS: Twenty-eight CRAO patients who were followed-up between 2010 and 2016 were retrospectively investigated. Demographic characteristics and detailed ophthalmological examination findings of all patients were recorded. Macular thicknesses (MTs) from 5 separate spots and DRIL were measured with spectral-domain optic coherence tomography (SD-OCT). Correlations between DRIL score and logMAR converted visual acuity (VA), change in VA, patient reference time (RT), number of hyperbaric oxygen therapy (HBOT) sessions, MT and MT change were investigated. RESULTS: There was a positive correlation between the DRIL score and the final VA (r=0.787) and a negative correlation with the change in VA (r=-0.763). The RT and MT were closely related to the DRIL score. A negative correlation was found between the number of HBOT sessions and the DRIL score (r=-0.341). CONCLUSION: The DRIL score is a parameter assessed by SD-OCT, which can provide us reliable information regarding the prognosis of visual functions and response to the treatment for CRAO patients at acute phase.

Effect of subconjunctival bevacizumab (Avastin) on experimental corneal neovascularization in guinea pigs.

PURPOSE: To evaluate the effect of subconjunctival bevacizumab (Avastin) on experimental corneal neovascularization in guinea pigs. METHODS: Forty eyes of 40 guinea pigs were chemically cauterized with 75% silver nitrate and 25% potassium nitrate sticks. Fifteen eyes (group 1) received 2 subconjunctival injections of bevacizumab (0.1 mL, 1.25 mg) simultaneously with cauterization and 3 days later. Fifteen eyes (group 2) received 2 subconjunctival injections of bevacizumab (0.1 mL, 1.25 mg) 3 and 5 days after cauterization. Ten eyes (group 3, control group) received 2 subconjunctival injections of 0.1 mL of balanced salt solution 3 and 5 days after cauterization. After we determined the burn and neovascularization scores for all groups, the animals were killed on the 10th day. The percentages of neovascularization on the surface of the cornea were measured in terms of pixels on digital photographs. The average number of vessels at maximally vascularized areas was determined for each specimen. RESULTS: Neovascularization score was 1.1 +/- 0.3 in group 1, 2.46 +/- 1.3 in group 2, and 3.5 +/- 0.5 in the control group. The difference was statistically significant (P < 0.001). The area of neovascularization at the cornea surface was 15.6% +/- 10.1% in group 1, 19.74% +/- 11.2% in group 2, and 23.5% +/- 7.4% in the control group (P = 0.194). The average number of neovascular vessels at group 1 was significantly reduced in comparison with group 2 and the control group (P < 0.001). CONCLUSIONS: Subconjunctival injection of bevacizumab decreases the extent of chemically induced corneal neovascularization in guinea pigs. The antineovascular effect of bevacizumab is higher if the injection is performed simultaneously with the chemical cauterization.

Multifocal electroretinogram in mild to moderate essential hypertension.

PURPOSE: To investigate the local retinal dysfunctions in mild to moderate essential hypertensive patients by using multifocal electroretinogram (mfERG). METHODS: Thirty-one patients with stage 1 or stage 2 hypertension (HT) and 31 age- and sex-matched healthy normotensive (NT) subjects were included. Fourteen of the patients had stage 1 and 17 had stage 2 hypertension. Twenty had grade 1 and 11 had grade 2 hypertensive retinopathy. The local retinal functions from the fovea to the peripheral 30 degrees were evaluated by multifocal electroretinogram by dividing this area to central hexagonal area (CH) and four concentric rings around the central hexagon (Rings 1-4). The amplitude and the implicit times of the positive peak (P1) and the negative peak (N1) of the responses were compared between the control subjects and hypertensive patients. Only the right eyes were included. The differences between the hypertensive patients and control subjects were investigated using independent samples t test, and the differences between grade 1 and grade 2 hypertensive retinopathy and stage 1 and stage 2 hypertension were investigated using Mann-Whitney U test. RESULTS: P1 amplitudes in CH (HT: 129.0 +/- 29.5, NT: 149.1 +/- 45.5, p = 0.043) and in Ring 3 (HT: 37.0 +/- 8.0, NT: 41.7 +/- 7.8, p = 0.024) and N1 amplitude in Ring 1 (HT: 26.8 +/- 7.4, NT: 30.8 +/- 7.8, p = 0.048) in the hypertensive patients was significantly reduced when compared to healthy normotensive subjects. There was no significant difference in terms of P1 and N1 implicit times. There was also no significant difference between the patients with stage 1 or stage 2 hypertension and patients with grade 1 or grade 2 hypertensive retinopathy. CONCLUSION: Hypertensive subjects have local retinal dysfunctions with respect to healthy controls. This result probably originated from retinal ischemia due to changes in retinal and/or choroidal circulation in systemic arterial hypertension.

Urinary neopterin levels in uveitis: is it a new activity marker?

PURPOSE: Neopterin is an immunologic marker for the activation of the cell-mediated immune system and it is found to be elevated in autoimmune diseases. We aimed in this study to investigate the relationship between urinary neopterin levels and disease activity in patients with uveitis. METHODS: 31 patients with active uveitis and 13 patients with inactive uveitis were compared with 27 age and sex matched controls. Disease activity was evaluated by clinical examination and fundus florescein angiography findings. Samples were studied with High Performance Liquid Chromatography. RESULTS: Urinary neopterin levels in patients with active uveitis, inactive uveitis and control subjects were 274 +/- 98, 179 +/- 61 and 166 +/- 38 micromol/mol creatinine respectively (p < 001). The difference between active uveitis, inactive uveitis and control groups were statistically significant (p < 001). CONCLUSIONS: Urinary neopterin levels are found to be increased in patients with active uveitis. Neopterin can be used as a biochemical activity marker to support the clinical findings in patients with uveitis.

Ingestion of IH636 grape seed proanthocyanidin extract to prevent selenite-induced oxidative stress in experimental cataract.

PURPOSE: To investigate whether dietary supplementation with IH636 grape seed proanthocyanidin extract (GSPE) prevents selenite-induced cataract. SETTING: Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey. METHODS: Thirty Spraque-Dawley rat litters were put randomly into 3 groups. In group 1 (n = 10), sodium selenite (30 nmol/g body weight) was injected subcutaneously on postpartum day 10. In group 2 (n = 10), sodium selenite (30 nmol/g body weight) was injected on postpartum day 10 and oral GSPE (100 mg/kg body weight) was given for 1 week after sodium selenite injection. Only subcutaneous saline was injected in group 3 (control, n = 10). The development of cataract was assessed for 3 weeks, and its density was graded and photographed with a slitlamp. Removed rat lenses were analyzed for glutathione (GSH) and malondialdehyde (MDA). RESULTS: All of the rats in group 1 had cataract between stage 6 and stage 3. In group 2, only 5 of 10 eyes had cataract between stage 3 and stage 2 and no cataract occurred in the remaining 5 rats. The difference between mean cataract stages in group 1 and group 2 was significant (P<.05). The mean GSH level in group 1 was significantly lower than in group 2 and controls (P<.05). The mean MDA level in group 1 was significantly higher than in group 2 and controls (P<.05). CONCLUSIONS: IH636 grape seed proanthocyanidin extract effectively suppressed cataract formation in rats. Routine consumption of grape seed proanthocyanidin extract in the form of food or dietary supplement may offer a prophylactic measure against onset and progression of cataract.

Nonarteritic ischemic optic neuropathy developed after capsular block syndrome.

A 65-year-old man developed capsular block syndrome in the early postoperative period, following phacoemulsification surgery. After neodymium-doped yttrium aluminum garnet (Nd:YAG) laser anterior capsulotomy, the intraocular pressure remained elevated for 4 days despite antiglaucomatous medication. On the postoperative fifth day, nonarteritic ischemic optic neuropathy was diagnosed. To the best of our knowledge, this is the first report of a case with nonarteritic ischemic optic neuropathy associated with early postoperative capsular block syndrome after phacoemulsification surgery.

Acute effects of cigarette smoking on multifocal electroretinogram.

BACKGROUND: Cigarette smoking was shown to have stimulant effects on pattern visual-evoked potentials. The aim of this study was to investigate the acute effects of cigarette smoking on multifocal electroretinogram (mfERG). METHODS: This prospective case-control study was held in a tertiary referral centre in Turkish Armed Forces. mfERGs were investigated in a group of habitual smokers (30 right eyes of 30 subjects) in separate real smoking and sham smoking sessions. mfERG responses of the subjects were recorded after overnight abstinence. The responses were averaged over five retinal regions, the central hexagon (CH; central 6 degrees) and four concentric rings (ring 1 [R1; 7-12 degrees], ring 2 [R2; 13-18 degrees], ring 3 [R3; 19-24 degrees], ring 4 [R4; 25-30 degrees]). On each session mfERGs were recorded before (BS) and after smoking (AS) conditions. RESULTS: Regarding P1 amplitudes (first positive deflection of the mfERG) in the real smoking sessions, the differences were significant in the CH (BS: 66.2 +/- 16.3 microV, AS: 73.3 +/- 19.6 microV, P < 0.001), in R1 (BS: 44.3 +/- 13.0, AS: 48.3 +/- 16.0, P = 0.004) and in R2 (BS: 30.1 +/- 8.3, AS: 33.7 +/- 9.7, P = 0.002). Similar results were found for N1 amplitudes and P1 and N1 (first negative deflection of the mfERG) latencies in the CH, R1 and R2. The differences in outer retinal areas (R3, R4) in the real smoking sessions and in all rings in the sham smoking sessions were not significant. CONCLUSION: Cigarette smoking may stimulate the central retinal areas in the acute phase. This effect may be related with the stimulant effect of nicotine on neurotransmission, deleterious effects on retinal and/or choroidal circulation, carbon monoxide toxicity and nicotine withdrawal.

The acute effect of cigarette smoking on pattern visual evoked potentials.

Reports of tobacco-induced electrocortical activation and decrements in ocular blood flow in the acute phase indicated that this effect is mediated via nicotine's action or neuronal systems. In this study, pattern visual evoked potentials were investigated in a group of male smokers (22 right eyes of 22 subjects) in separate real smoking and sham smoking sessions. On each session, pattern visual evoked potentials were recorded before smoking, immediately after smoking, and five minutes after smoking. Latency and amplitude values for P100 peaks were assessed and analyzed in each smoking condition for both real smoking and sham smoking sessions. Real smoking significantly decreased P100 latency values (p value related to difference between pre-smoking and immediately after smoking conditions is 0.009) and increased P100 amplitude values (p value related to difference between pre-smoking and fifth minute after smoking is 0.039). Statistically no significant difference was observed in sham smoking sessions. Our results are consistent with smoking-induced stimulant effects on pattern visual evoked potentials.