Psoriasis and uveitis.

PURPOSE: Psoriasis, which is a chronic, immune-mediated skin disease of unknown etiology, not only affects the skin, but also is linked to many systemic conditions such as arthritis, cardiovascular disease, depression, and malignancy. Although many types of eye involvement are encountered in psoriasis patients, dry eye is the first among them. Uveitis is an entity that can be associated with psoriasis and can cause severe vision loss as a result of late diagnosis, inadequate and inappropriate treatment. In this review, we aimed to shed light on the diagnosis, type, prognosis and treatment of uveitis in psoriasis patients by compiling current datas obtained from published studies and to guide the follow-up and treatment of these patients. METHODS: A systematic literature search was done on PubMed using key words including "psoriasis", "psoriatic arthritis", "uveitis", "TNF- inhibitors", "HLA B27". RESULTS: In the literature, the frequency, type and treatment of uveitis developing in the course of psoriatic arthritis are clearly defined. However, the coexistence of psoriasis and uveitis has not yet been clarified due to few numbers published studies and designs of these studies. Since we examined the existing studies, we determined that the coexistence of psoriasis and uveitis could be acute or insidious, and the probability and severity of uveitis increased as the severity of skin and joint involvement increased. In addition, we found that psoriasis-associated uveitis can be bilateral, chronic, severe progression and with a high recurrence rate. CONCLUSION: The relations between non-arthritic psoriasis and uveitis have not yet been fully elucidated. Physicians who treat these diseases must be cautious, and refer their patients who have psoriasis to an ophthalmologist for periodic examination, even if they do not have eye symptoms. On the other hand, ophthalmologists must be careful in uveitis patients in terms of skin and joint involvement, and must not overlook the underlying disease.

Long-Term Follow-Up Results of a Patient Undergoing Acute Retinal Necrosis: A Case Report and Literature Review.

PURPOSE: To describe the follow-up and treatment approach of a patient with acute retinal necrosis. Case Report. A 44-year-old male patient, who had complaints of pain in the right eye and blurred vision, was referred to our clinic. Best-corrected visual acuity (BCVA) was 0.4. There was 2+ anterior chamber reaction and diffuse smooth-rounded keratic precipitates. Fundus examination revealed optic nerve and vascular involvement. Fundus fluorescein angiography revealed extensive ischemia in the periphery. Oral antiviral therapy was preferred. In addition, systemic steroid and laser photocoagulation were applied. Nonetheless, retinal detachment developed 2 months later. Detachment, silicon removal, and cataract surgery were performed sequentially. It was observed that the patient was followed for 4.5 years and did not have contralateral eye involvement. Best-corrected visual acuity remained stable at 0.3. CONCLUSION: Early diagnosis, appropriate treatment, accurate complication management, and frequent follow-up may provide useful vision in patients with acute retinal necrosis.

The efficacy of subthreshold micropulse yellow laser (577 nm) in chronic central serous chorioretinopathy.

Central serous chorioretinopathy (CSC) is a disease characterized by a well-defined serous detachment of the neurosensory retina. Therapeutic options in chronic cases are limited, and side effects can result in a limited response. The aim of this article is to assess the efficacy of subthreshold micropulse laser therapy in patients with chronic central serous chorioretinopathy. The study included 20 eyes of 19 patients who had a history of chronic or chronic recurrent CSC and who underwent subthreshold micropulse laser therapy between January 2015 and June 2018. Twenty eyes of 19 patients with a mean age of 48.9 ± 9.40 years were included. The mean visual acuity was 0.24 ± 0.28 logMAR before laser, 0.19 ± 0.25 logMAR 3 months after laser, and 0.18 ± 0.27 logMAR after 6 months. A statistically significant difference was determined in terms of visual acuity before and after treatment (p = 0.0001). The mean central retinal thickness was 308.10 ± 95.25 µm before laser, 233.65 ± 81.17 µm 3 months after laser, and 203.88 ± 72.79 µm at 6 months. A statistically significant relationship was present between visual acuity and the duration of disease (p = 0.001), between visual acuity and the outer nuclear layer thickness (p = 0.005), and between the outer nuclear layer thickness and the duration of disease in chronic cases (p = 0.008). There was no evidence of retinal pigment epithelium or retinal damage on optical coherence tomography or fundus autofluorescence secondary to subthreshold micropulse laser therapy. Visual acuity appears to be more associated with the duration of disease and with changes in the outer nuclear layer thickness in chronic CSC. Subthreshold micropulse laser therapy seems to be effective at treating chronic CSC, while it increases success during early period of the disease before the development of permanent retinal damage.

Characteristics and Seasonal Variations of Rhegmatogenous Retinal Detachment in the Eastern Black Sea Region of Turkey: 8-Year Results.

Objectives: To assess seasonal variations in the incidence of rhegmatogenous retinal detachment (RRD) in the Eastern Black Sea region of Turkey. Materials and Methods: Patients presenting due to primary RRD to a university hospital operating as a reference clinic in the region between 2011 and 2018 were evaluated retrospectively. Patients' ages, sex, affected eye, and presentation times were recorded. Years were divided into months, quarters, seasons, and half-year periods, and these periods were analyzed in terms of differences in patient numbers. Results: Two hundred eighty-one eyes of 276 patients meeting the study criteria were included. The patients' mean age was 60.2 years, and the male:female ratio was 1.35:1. Right and left eye rates were similar. Detachments were most common (49.4%) in the upper temporal quadrant. Eighty-nine patients (31.6%) had undergone uncomplicated phacoemulsification surgery a mean 2.7 years previously. The mean annual case number was 35.13±5.43, and no statistically significant variation was determined in case numbers by year (p=0.558). Analysis of all years revealed a monthly mean case number of 23.42±4.4, with the highest number of cases, 29 (10.3%), being seen in September and the lowest number, 13 (4.7%), in December. No statistically significant monthly variation was determined (p=0.613). Similarly, no statistically significant variation was observed in case numbers analyzed by quarter, season, or half-year (p>0.05). Conclusion: The incidence of cases of uncomplicated RRD does not exhibit seasonal variation in our region. We also think that since 31.6% had a history of cataract surgery, patients undergoing phacoemulsification surgery, even if uncomplicated, should be periodically assessed for detachment.

Developments and current approaches in the treatment of pterygium.

PURPOSE: To assess and compare the studies conducted in the literature with recurrence rates and the summary of the justified treatment approaches be presented. METHOD: Pterygium, a fibrovascular tissue that proceeds from the bulbar conjunctiva towards the cornea, is quite a commonly seen ocular surface deterioration. The treatment is performed through a surgical excision, and the frequent recurrence of this disorder, despite the developments of today, is the major problem experienced in the wake of the surgery. There are various treatment methods applied for the prevention of recurrence; yet, there is no definite view as to what treatment is the most effective one. Since the recurrent pterygium cases are more aggressive than the primary pterygium, it is of great importance to determine the treatment method in which recurrence rate is the lowest. In different studies seen in the literature, there is difficulty in comparing the results due to the fact that the follow-up periods, recurrence criteria and the doses and durations of the medications administered differ from one another. CONCLUSION: When the literature is reviewed, the bare sclera technique is not used due to the high rate of recurrence, whereas successful results can be achieved through the conjunctival autograft technique. Lower recurrence rates have been reported along with the administration of mitomycin C, 5-FU and other agents that were used as an adjuvant treatment.

The effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide injection in branch retinal vein occlusion-related macular edema.

OBJECTIVE: To investigate the effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide (PSTA) application in branch retinal vein occlusion (BRVO)-related macular edema. METHODS: Patients with confirmed BRVO-related macular edema were enrolled in the study. Patients were injected with a single, therapeutic dose of 40 mg PSTA. Detailed ophthalmic examination was performed at baseline and at 1, 3 and 6 months after the treatment. Best corrected visual acuity (BCVA), intraocular pressure (IOP), cataractogenic change (CC) and macular optical coherence tomography (OCT) analysis results were evaluated. The results were compared statistically. RESULTS: Forty-one eyes of 41 patients with a mean age of 63.49 ± 10.99 (55-86) years, 15 (36.6%) females, were included in the study. BCVA in LogMAR values at 1 and 3 months were significantly better than at baseline, while no significant difference from baseline was observed in sixth month values (p < 0.001, p < 0.001 and p = 0.846, respectively). Central macular thickness values obtained using OCT were significantly lower at the first, third and sixth months compared to baseline (p < 0.001 for all). IOP elevation was determined in only two eyes (4.8%) at the end of the study period, and no CC was detected in any case. CONCLUSION: PSTA application is an effective and safe option in BRVO-related macular edema.

Effects of phacoemulsification surgery on ocular hemodynamics.

AIM: To evaluate the possible effects of phacoemulsification cataract surgery on ocular hemodynamics. METHODS: In this prospective study, intraocular pressure (IOP), pulsatile ocular blood flow (POBF), and ocular pulse amplitude (OPA) were measured pre-operatively (baseline) and at 1 week and 3 weeks postoperation in 52 eyes of 26 patients (mean age 63.15±10.25 years) scheduled for unilateral phacoemulsification cataract surgery with intraocular lens implantation. In all of the eyes, a blood flow analyzer (Paradigm DICON; Paradigm Medical Industries Inc.; USA) was used to obtain measurements of IOP, POBF, and OPA. The data obtained from operated eyes were compared statistically to untreated fellow phakic eyes of the patients. RESULTS: For operated eyes, the mean baseline IOP, POBF, and OPA values were 15.9±4.64mmHg, 17.41±4.84µL/s, and 2.91±1.12mmHg, respectively. The IOP, POBF, and OPA values were 17.19±4.34mmHg, 17.56±6.46µL/s, and 3.12±1.1mmHg, respectively, in the nonoperated control eyes. Statistically significant differences from baseline measurements were not observed 1 week and 3 weeks postoperation for the operated or nonoperated eyes. There were also no statistically significant differences in any measurements between the operated and nonoperated eyes in all the examination periods (P>0.05 for all). CONCLUSION: Uncomplicated phacoemulsification surgery does not affect ocular hemodynamics in normotensive eyes with cataracts.

The results of intravitreal bevacizumab injections for persistent neovascularizations in proliferative diabetic retinopathy after photocoagulation therapy.

PURPOSE: The purpose of this study was to evaluate the effectiveness of intravitreal bevacizumab on persistent retinal neovascularizations in proliferative diabetic retinopathy. METHODS: Thirty-three eyes of 24 patients (mean age, 52.75 +/- 8.2 years) with proliferative diabetic retinopathy showing recurrences or no regressions in neovascularizations were evaluated in this study. After the intravitreal injection of 1.25 mg/0.05 mL of bevacizumab, the first examination was performed within 3 days and repeated at 1 week, 1 month, 3 months, and 6 months. In these examinations, localization and dimensions of neovascularizations were evaluated with red-free photographs and/or fluorescein angiography. RESULTS: All patients had type II diabetes for a period of 12 +/- 4.4 years (range, 2-20 years). After a single dose of bevacizumab, complete resolution rate of neovascularizations was 78.8% at 1 month, 63.6% at 3 months, and 45.4% at 6 months. When evaluated together with 9 eyes that had a second injection at 3 months, the complete resolution rate was 60.6% at 6 months. Mean best-corrected visual acuity and macular volume were 1.06 logarithm of the minimum angle of resolution (20/225 in Snellen) and 11.65 mm3 before treatment. Six months after treatment, these were 0.73 logarithm of the minimum angle of resolution (20/108 in Snellen) and 8.92 mm3 (P = 0.048 and 0.003, respectively). CONCLUSION: Bevacizumab can be used safely and successfully in patients with proliferative diabetic retinopathy who do not experience any resolution or experience recurrences after panretinal photocoagulation.

Lacrimal sac removal made easy by methylene blue in endoscopic dacrocystorhinostomy.

Endonasal dacrocystorhinostomy (DCR) has gained interest in the last decade. Especially when a novice surgeon is performing the surgery, difficulty in identification of the lacrimal apparatus may complicate the procedure. We investigated the efficacy of methylene blue (MB) solution as a marker for lacrimal sac (LS) in endoscopic DCR. A total of 24 endoscopic DCR cases were performed (16 primary and 8 revision cases). During surgery, LS was irrigated with MB solution. Following lacrimal bone removal, medial wall of the LS is seen with a bluish hue. When the sac is dissected, the epithelium of the LS, which is heavily stained with MB contrasts with the surrounding nasal mucosa and therefore tailoring of the extent of the LS mucosa removal is facilitated. The follow-up period of the patients was 23 +/- 7.5 months. Of the 24 cases operated, only one case needed a re-operation. Use of MB solution is effective in both identifying LS and distinguishing it from surrounding nasal mucosa in DCR.

MYO15A (DFNB3) mutations in Turkish hearing loss families and functional modeling of a novel motor domain mutation.

Myosin XVA is an unconventional myosin which has been implicated in autosomal recessive nonsyndromic hearing impairment (ARNSHI) in humans. In Myo15A mouse models, vestibular dysfunction accompanies the autosomal recessive hearing loss. Genomewide homozygosity mapping and subsequent fine mapping in two Turkish families with ARNSHI revealed significant linkage to a critical interval harboring a known deafness gene MYO15A on chromosome 17p13.1-17q11.2. Subsequent sequencing of the MYO15A gene led to the identification of a novel missense mutation, c.5492G-->T (p.Gly1831Val) and a novel splice site mutation, c.8968-1G-->C. These mutations were not detected in additional 64 unrelated ARNSHI index patients and in 230 Turkish control chromosomes. Gly1831 is a conserved residue located in the motor domains of the different classes of myosins of different species. Molecular modeling of the motor head domain of the human myosin XVa protein suggests that the Gly1831Val mutation inhibits the powerstroke by reducing backbone flexibility and weakening the hydrophobic interactions necessary for signal transmission to the converter domain.

Nephropathy and retinopathy in type 2 diabetic patients living at moderately high altitude and sea level.

BACKGROUND: High-altitude-induced hypoxia results in various diseases, such as chronic mountain sickness and high altitude retinal edema, and may affect severity and incidence of some cardiovascular diseases. In order to evaluate the effects of moderately high altitude on diabetic nephropathy and retinopathy, a cross-sectional study was planned. MATERIAL METHOD: Long-term type II diabetic residents of sea level (n=75, 38 male, 37 female, mean age 51.9+/-10.5 in Trabzon and Zonguldak cities) and moderately high altitude (h = 1,727 m, n = 73, 28 male, 45 female, mean age 48.3+/-12.1, Van city) were compared. RESULTS: No difference was observed in terms of age, gender, diabetes duration, body mass index, smoking, systolic, diastolic, and mean arterial blood pressure values, serum glucose levels, cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, hemoglobin, HbA1C, hypertension control, or blood pressure medications and retinopathy incidence. Mean 24 h protein excretion (210.0+/-139.9, 127.8+/-112.1 mg; P=0.00), proteinuria prevalence (57.5% versus 33.3%, p=0.003), and serum creatinine levels (1.04+/-0.22 versus 0.84+/-0.21, p = 0.00) were significantly higher in the highlanders, glomerular filtration rate (GFR) was significantly lower in sea level (SL) patients (90.9+/-26.5 versus 83+/-21.1, p=0.05). CONCLUSION: Tendency to diabetic nephropathy as indicated by higher proteinuria and creatinine levels is increased among type 2 diabetic patients living at moderately high altitude. Prospective studies are needed to confirm these findings.