Development of posttraumatic stress disorder and depression after open globe injury in adults.

PURPOSE: To investigate the prevalence of posttraumatic stress disorder (PTSD) and depression after open globe injury in adults. METHODS: A total of 95 participants, 43 adult patients with open globe injury and 52 age-sex similar subjects (control group), were included in this cross-sectional study. Age, gender, education level, occupation, accident history, psychiatric history, trauma type, cause of trauma, and visual acuity were recorded. One to six months after trauma, PTSD and depression symptoms of the participants were evaluated with the Posttraumatic Stress Disorder Questionnaire-Civil Version Scale (PTSD-S) and Beck Depression Inventory (BDI), respectively. RESULTS: Patients with open globe injury had a higher PTSD-S total score than the control group, but not significant (23.67 ± 20.41 vs. 18.56 ± 13.13, p = 0.580). Patients with eye trauma exhibited a much higher prevalence of PTSD compared to the control group (20.9% vs. 3.8%, p = 0.010). Patients with trauma had a significantly higher BDI total score than the control group (12.47 ± 10.08 vs. 7.69 ± 6.10, p = 0.015). Also, patients had a higher rate of depression symptoms than controls (25.6% vs. 7.7%, p = 0.017). A significant positive correlation was observed between PTSD-S and BDI scores in the trauma group (r = 0.720, p < 0.001). CONCLUSION: An increased prevalence of PTSD and depression was observed in adults after open globe injury. The significant relationship between PTSD-S and BDI scores indicates that patients with open globe injuries should be questioned in terms of both symptoms. For patients with open globe trauma, a holistic approach with psychosocial assessment in addition to physical intervention would be beneficial.

An objective evaluation of lens transparency after vitrectomy surgery with different intravitreal tamponades.

PURPOSE: To evaluate and compare the effects of different intraocular tamponade agents on lens density after vitrectomy. METHODS: The participating patients were divided into four groups according to the tamponade agent used: a sulfur hexafluoride (SF6) group, a perfluoropropane (C3F8) group, a silicone oil group, and a no tamponade group. Lens density measurements were performed preoperatively and two weeks, one month, and three months postoperatively using a Pentacam HR device with a Scheimpflug camera. The postoperative values were compared with the preoperative baseline values, also the values were compared between the four groups. RESULTS: The study included 82 eyes (82 patients). In the SF6 group, lens density significantly increased in all zones two weeks and one and three months postoperatively (all P < .05). In the C3F8 group, lens density significantly increased in all zones three months postoperatively (all P < .01). In the silicone oil group, the zone 1, zone 2, and average lens density (ALD) value significantly increased one and three months postoperatively (all P < .05). In the no tamponade group, the zone 1, zone 2, and ALD values significantly increased three months postoperatively (all P < .05). There were no significant differences between the four groups in any zone either preoperatively or postoperatively (all P > .05). CONCLUSIONS: Although increases in lens density were observed earlier in the tamponade groups than in the no tamponade group, between the groups over the follow-up period were no differences. We need the development of new surgical methods and materials to prevent post-vitrectomy lens damage in the future.

Vitreous levels of vascular endothelial growth factor, stromal cell-derived factor-1α, and angiopoietin-like protein 2 in patients with active proliferative diabetic retinopathy.

PURPOSE: To determine the vitreous levels of vascular endothelial growth factor (VEGF), stromal cell-derived factor-1α (SDF-1α) and angiopoietin-like protein 2 (ANGPTL2) in patients with active proliferative diabetic retinopathy (PDR), and to ascertain their contribution on different clinical presentation of active PDR. METHODS: This case-control study included 31 eyes with active PDR and 10 eyes with idiopathic macular hole (MH) (control group). Eyes with active PDR were divided into three subgroups: vitreous hemorrhage (VH), tractional retinal detachment (TRD) caused by active fibrovascular membrane (FVM), and coexistence of VH and TRD with FVM. Vitreous samples obtained during vitrectomy were analyzed for concentrations of VEGF, SDF-1α, and ANGPTL2. RESULTS: Vitreous level of VEGF (2021 (168-6550) pg/ml vs 110.1 (74.5-236) pg/ml), SDF-1α (517 (194-1044) pg/ml vs 388 (320-535) pg/ml), and ANGPTL2 (725 (131-1590) ng/ml vs 196 (75.9-437) ng/ml) were significantly higher in eyes with active PDR than in control group (p < 0.001, p = 0.002, and p < 0.001, respectively). The concentrations of these meaditors in each active PDR subgroups were also significantly higher than control group (p < 0.05). The vitreous level of ANGPTL2 was significantly higher in eyes with TRD caused by FVM (1033 ± 401 ng/ml) than in eyes with VH (561 ± 237 ng/ml; p = 0.008). CONCLUSION: High levels of SDF-1α, ANGPTL2 and particularly VEGF seem to be associated with PDR. Since the vitreous levels of ANGPTL2 tend to be higher in eyes with active fibrovascular tractional detachment, vitreous levels of this chemokine seem to be affected by the clinical presentation of vascularly active PDR eyes.

Autologous neurosensory retinal transplantation for large refractory idiopathic macular hole.

PURPOSE: To investigate the structural and functional reconstruction of the macula after autologous neurosensory retinal-free flap transplantation (ANRFFT) in eyes with large refractory idiopathic macular holes (IMHs). METHODS: Patients with refractory IMHs after multiple surgeries who underwent ANRFFT were retrospectively reviewed. The main outcomes were anatomic closure of MH, change in external limiting membrane (ELM) defect on optical coherence tomography (OCT) and best-corrected visual acuity (BCVA). RESULTS: A total of 7 patients (4 female and 3 male; mean age 60.6 ± 8.6 years) were included in the study. Mean preoperative largest basal diameter was 1146.7 ± 413.7 µm (range, 653-1768 µm), and mean narrowest inner-opening diameter was 788.9 ± 148.8 µm (range, 644-1100 µm). Mean BCVA (logarithm of the minimum angle of resolution [logMAR]) significantly improved from 1.53 ± 0.16 (range, 1.3-1.7) to 0.89 ± 0.23 (range, 0.6-1.3) at the final follow-up (P < 0.001). OCT revealed complete closure of MH in all eyes. Mean preoperative ELM defect significantly decreased from 1450.3 ± 306.5 µm (range, 1044-1908 mm) to 533.1 ± 399.2 µm (range, 0-1156 µm, P = 0.001). Postoperative complications included retinal detachment (n = 1), cystoid macular edema like changes in the graft (n = 1) and reactive pigment epithelial hyperplasia (n = 1). CONCLUSION: Although some postoperative complications did occur, ANRFFT seems to be an effective treatment for large refractory IMHs, and can promote recovery of the outer retinal structure resulting in functional improvement.

The significance of thiol/disulfide homeostasis and ischemia-modified albumin levels to assess the oxidative stress in patients with different stages of diabetes mellitus.

This study investigated the value of Thiol/Disulfide homeostasis and ischemia-modified albumin (IMA) levels in discriminating diabetic cases with different stages of retinopathy and without retinopathy. In total, 122 patients with type 2 diabetes mellitus (DM) were enrolled in this prospective cross-sectional study. These patients were separated into three subgroups: Group 1 included 42 patients with DM and no diabetic retinopathy (DR), Group 2 included 40 patients with DM having non-proliferative DR and the Group 3 had 40 patients with DM having proliferative DR. The native thiol, total thiol, and disulfide levels and disulfide-native thiol, disulfide-total thiol, and native thiol-total thiol ratios as well as the IMA levels were analyzed and compared among the groups. There were no statistically significant differences regarding the ages and genders of the patients between the groups. The native thiol level, the total thiol level and the native thiol-total thiol ratio showed a statistically significantly reduction, while the disulfide level, the disulfide-native thiol ratio, and the disulfide-total thiol ratio showed a statistically significantly elevation in the Group 3 compared with the Group 1 and Group 2. Additionally, the mean IMA levels were statistically significantly higher in Group 3 when compared to Group 1 and Group 2 (p = .003 and p = .014, respectively). In conclusion, both Thiol/Disulfide homeostasis parameters and IMA levels increase with the progression of DR. Thiol/Disuldife homeostasis balance and IMA levels may be used a biomarker to monitor the tissue ischemia in DM and to discriminate the different stages of DR, in the future.

Evaluation of corneal topographic changes and surgically induced astigmatism after transconjunctival 27-gauge microincision vitrectomy surgery.

PURPOSE: To evaluate the corneal topographic changes and postvitrectomy astigmatism after 27-gauge (g) microincision vitrectomy surgery (MIVS) by using Pentacam HR-Scheimpflug imaging system. METHODS: This prospective descriptive study included 30 eyes of 30 patients who underwent 27-g MIVS. All eyes underwent a Pentacam HR examination preoperatively and on the first week, first month and third month postoperatively. The power of the corneal astigmatism, mean keratometry (K m), K 1 and K 2 values and corneal asphericity (Q value) values for the both front and back surfaces of the cornea, index of surface variance (ISV), index of vertical asymmetry (IVA), index of height asymmetry (IHA), index of height decentration (IHD) and higher-order aberrations including coma, trefoil, spherical aberration, higher-order root-mean-square and total RMS were recorded. Additionally, the mean induced astigmatism was estimated by vector analysis. RESULTS: No statistically significant changes were observed in the mean power of corneal astigmatism, mean keratometry, K 1 and K 2 values, corneal asphericity values, ISV, IVA, IHA, IHD and higher-order aberrations on the first week, first month and third month after the operation. The mean surgically induced astigmatism was calculated as 0.23 ± 0.11 D on the first week, 0.19 ± 0.10 D on the first month and 0.19 ± 0.08 D on the third month postoperatively. CONCLUSION: Minor corneal surface and induced astigmatic changes are expected to result in rapid visual rehabilitation after pars plana vitrectomy with the 27-g MIVS system.

Assessment of orbital blood flow velocities in retinopathy of prematurity.

The purpose of this study is to evaluate whether the presence of any stage retinopathy of prematurity (ROP) alters central retinal artery (CRA) and ophthalmic artery (OA) blood flow parameters in premature infants. The patients were divided into two groups according to the development of ROP; those who have ROP were defined as group I, those without ROP were defined as group II. Ninety eyes of 45 patients in group I and 40 eyes of 20 patients in group II were investigated. The blood flows in the CRA and OA were measured using ultrasound color doppler imaging (CDI) that allows to evaluate the peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI). The results were compared between two groups of subjects. There were no significant differences in the PSV, EDV, and RI of CRA between two groups (P = 0.09, P = 0.20 and P = 0.63, respectively). The mean PSV value of OA in group I was found to be significantly higher than the one in group II (P < 0.05), but there were no significant differences in the mean EDV and RI values of OA between two groups (P = 0.40, P = 0.17 respectively). The subgroup analysis revealed that the ocular blood dynamics were not found to be significant between eyes with stage I ROP and eyes with stage II ROP (P > 0.05), whereas the difference in the mean PSV values of OA were found to be significant among the eyes with stage 1 ROP, eyes with stage 2 ROP, and eyes without ROP (P = 0.03). This study demonstrated significant alterations in systolic flow velocities in the OA predicted by CDI in infants with ROP.

Ocular and adnexal injuries after two major earthquakes in Turkey on February 6, 2023.

PURPOSE: This study aimed to determine the forms of ocular and adnexal injuries and to examine the treatment modalities applied after two major earthquakes in Turkey on February 6, 2023. METHODS: Following the earthquakes, the medical records of 34 patients admitted with emergency ophthalmic complaints to Hatay Training and Research Field Hospital and Etlik City Hospital were retrospectively reviewed. Of these patients, 35 eyes of 34 individuals diagnosed with earthquake-related ocular and adnexal injuries were included in the study. Demographic characteristics were recorded, including ocular and adnexal findings, treatment modalities, and postoperative complications. RESULTS: Of the patients, 16 (47.1%) were female, and 18 (52.9%) were male. The mean age was 37.38 ± 17.3 years. The mean time from the earthquake to the first admission to the hospital was 3.82 ± 1.78 days. Initial and final best-corrected visual acuities (BCVA) were 0.54 ± 0.66 logMAR and 0.22 ± 0.41 logMAR, respectively (p = 0.0003). The initial and final BCVA of 2 eyes was no light perception. The most common forms of ocular/periocular injury associated with earthquakes were eyelid laceration (n:25, 71.4%) and orbital fracture (n:17, 48.6%). The most common accompanied systemic trauma was extremity/rib fractures (38.2). The most frequently performed surgery was the primary repair of the eyelid/canalicular (n:17, 48.6%). CONCLUSION: While earthquake-related ocular and adnexal traumas are relatively uncommon, understanding the specific injury types, promptly identifying cases requiring urgent intervention, and mastering effective treatment modalities are essential for minimizing the risk of severe permanent visual impairment in these patients.

The role of macular hydration in the evaluation of the effect of intravitreal triamcinolone on visual acuity in eyes with diabetic macular edema.

To evaluate the efficacy of intravitreal triamcinolone (IVTA) in eyes with clinically definite diabetic macular edema (DME) by using the parameters visual acuity (VA), central macular thickness (CMT) and macular hydration (MH). Medical records of patients who received IVTA (4 mg/0.1 mL) for DME were reviewed. Optically non-reflective areas which appear dark spaces within the 1000 µm from the center of the macula on OCT scan defined as MH. Best corrected logarithm of minimum angle of resolution (logMAR) visual acuity, CMT as determined by optical coherence tomography (OCT) and MH quantified from the OCT scans by using metamorph analysis were evaluated before the injection and at 1, 3 and 6 months in all, and up to 12 months in some eyes, after the IVTA injection. The correlations between these variables were also studied. 28 eyes of 27 patients were included in the study. Eyes with DME treated by a single IVTA injection responded with a trend towards significant improvement in logMAR VA at 1 (p < 0.0001) and 3 months (p < 0.0001), but no significant improvement in relation to baseline at 6 months was observed (p = 0.07). CMT was significantly reduced at 1 month (p < 0.0001), 3 months (p < 0.0001) and 6 months (p = 0.01) compared to baseline. Like the trend observed in VA improvement, MH also significantly reduced at 1 month (p < 0.0001) and 3 months (p < 0.0001), but not at 6 months (p = 0.14) compared to baseline. There was no correlation between the VA ratio and the CMT ratio (r = 0.18, p = 0.36), but there was a significant correlation between the VA ratio and the MH ratio (r = 0.85, p < 0.0001). There was also an inverse relationship between MH ratio and the age of the patients (r = -0.7089, p = 0.0001). Macular hydration seems to be a better parameter than macular thickness for determining the effectiveness of IVTA treatment in a subset of eyes with DME. Although the treatment effect is temporary, younger patients with DME were more prone to respond with a greater reduction in MH after IVTA injection.

Atypical Presentation and Delayed Diagnosis of Gyrate Atrophy: Case Reports of Two Siblings.

Gyrate atrophy (GA) is a hereditary condition characterized by ornithine aminotransferase deficiency-related large areas of retinal pigment epithelium and choriocapillaris lobular-shaped atrophy in the peripheral retina. In this report, we present a case of atypical presentation of GA. The aim of this report is to present two siblings, one of which was associated with a lamellar macular hole and with a history of previous diagnosis of retinitis pigmentosa. The delayed diagnosis of GA was made only after her brother, who was 5 years younger than her was diagnosed with GA. In addition, in this report, we evaluated GA in terms of multimodal imaging findings, differential diagnosis, and treatment of macular complications.

Optic disk analysis with heidelberg retina tomography in patients with branch retinal vein occlusion.

PURPOSE: To investigate the optic disk topography parameters of patients with branch retinal vein occlusion (BRVO) in a controlled study by using Heidelberg retinal tomography. METHODS: This prospective study included 35 eyes of 30 patients with BRVO who were followed-up at the Retina Clinic of the Ankara Ulucanlar Eye Education and Research Hospital, and 30 normal subjects (60 eyes). All patients and control subjects underwent complete ophthalmologic evaluation. The optic nerve heads of all subjects were imaged with the Heidelberg retinal tomography III (software 3.01a-M). The following stereometric parameters were calculated for each patient: disk area, cup area, cup-to-disk ratio, rim area, cup volume, rim volume, mean cup depth, maximum cup depth, and cup shape measure. Differences between the two groups were evaluated by the nonparametric independent sample t-test. RESULTS: The mean cup volume, rim volume, cup area, disk area, rim area, and cup depth in BRVO group were found to be statistically significantly smaller than those in the control group (P < 0.05). Significant differences in the same parameters were also noted between the unaffected and affected eyes in patients with BRVO (P < 0.05). No significant differences were found between the groups in terms of the other stereometric parameters (P > 0.05). CONCLUSION: Based on the results that were obtained in this series, a relationship was found between BRVO and various optic disk topography parameters determined by Heidelberg retinal tomography. Anatomical features of the optic disk may play a role in the pathogenesis of BRVO.

Angle-closure glaucoma in a patient with the nanophthalmos-ocular cystinosis-foveoschisis-pigmentary retinal dystrophy complex.

BACKGROUND: To report clinical features of bilateral angle-closure glaucoma in a patient with nanophthalmic eyes associated with ocular cystinosis, foveoschisis and pigmentary retinal dystrophy. This is probably the first published report of the possible association of all these five entities in the same patient. CASE PRESENTATION: A 50-year-old white male was referred for uncontrolled glaucoma in both eyes. He was previously diagnosed with angle-closure glaucoma in association with ocular cystinosis. Ocular examination revealed high hyperopia (+13.5 OD and +14 OS diopters) with reduced axial length (16.27 mm OD and 15.93 mm OS). Despite being on 3 topical medications, his IOP measured 37 mmHg OD and 35 mm Hg OS. Slit-lamp biomicroscopy showed refractile, polychromatic crystalline deposits throughout the cornea and conjunctiva in both eyes. Gonioscopy revealed an extremely narrow angle with peripheral anterior synechiae (PAS). Anterior chamber depths were shallow. Fundus examination disclosed punctate hypopigmentation of the retinal pigment epithelium mainly at the posterior pole. Optical coherence tomography showed foveal schisis appearing as small retinal cysts. The patient did not display any systemic abnormalities. CONCLUSIONS: This case brings into discussion a new clinical entity of angle closure glaucoma in nanophthalmos accompanied by ocular cystinosis-foveoschisis-pigmentary retinal dystrophy complex.

Outcomes and predictors of vitrectomy and silicone oil tamponade in retinal detachments complicated by proliferative vitreoretinopathy.

AIM: To evaluate outcomes and determine factors influencing the outcomes of vitrectomy with silicone oil (SO) endotamponade for the management of rhegmatogenous retinal detachment (RRD) complicated by advanced proliferative vitreoretinopathy (PVR). METHODS: This is a retrospective, interventional case series of eyes with PVR grade C associated RRD with or without prior surgery that underwent vitreoretinal surgery and SO tamponade. Eyes with a minimum follow-up of 6mo after SO extraction were included. Eyes were classified into three PVR subgroups according to severity and extension of proliferation. The influence of several preoperative, intraoperative and postoperative factors upon the functional and anatomical outcomes was assessed using multivariate logistic regression analysis. RESULTS: A hundred and one eyes of 101 patients that met the inclusion criteria were studied. Seventy-five of 101 eyes (74.3%) had successful retinal reattachment after one operation. Increased aqueous cell and flare at the first week exam had a statistically significant association with redetachment, recurrent membrane proliferation and keratopathy. Visual acuity improvement was significantly associated with faint postoperative aqueous inflammation values, primary vitrectomy and PVR outside of the posterior pole. CONCLUSION: Although encouraging anatomical and functional outcomes are achieved after vitrectomy and SO tamponade in eyes with RRD complicated by PVR, an increase in aqueous flare or cells at the first week follow-up is most likely to result in postoperative late complications. Primary vitrectomy, PVR associated with minimal posterior pole extension and absent to mild postoperative aqueous inflammation are associated with improved post-operative final visual acuity.

Evaluation of QT and P wave dispersion and mean platelet volume among inflammatory bowel disease patients.

BACKGROUND: In inflammatory bowel disease (IBD) number of thromboembolic events are increased due to hypercoagulupathy and platelet activation. Increases in mean platelet volume (MPV) can lead to platelet activation, this leads to thromboembolic events and can cause acute coronary syndromes. In IBD patients, QT-dispersion and P-wave dispersion are predictors of ventricular arrhythmias and atrial fibrilation; MPV is accepted as a risk factor for acute coronary syndromes, we aimed at evaluating the correlations of these with the duration of disease, its localization and activity. METHODS: The study group consisted of 69 IBD (Ulcerative colitis n: 54, Crohn's Disease n: 15) patients and the control group included 38 healthy individuals. Disease activity was evaluated both endoscopically and clinically. Patients with existing cardiac conditions, those using QT prolonging medications and having systemic diseases, anemia and electrolyte imbalances were excluded from the study. QT-dispersion, P-wave dispersion and MPV values of both groups were compared with disease activity, its localization, duration of disease and the antibiotics used. RESULTS: The P-wave dispersion values of the study group were significantly higher than those of the control group. Duration of the disease was not associated with QT-dispersion, and MPV levels. QT-dispersion, P-wave dispersion, MPV and platelet count levels were similar between the active and in mild ulcerative colitis patients. QT-dispersion levels were similar between IBD patients and the control group. No difference was observed between P-wave dispersion, QT-dispersion and MPV values; with regards to disease duration, disease activity, and localization in the study group (p>0.05). CONCLUSIONS: P-wave dispersion which is accepted as a risk factor for the development of atrial fibirilation was found to be high in our IBD patients. This demonstrates us that the risk of developing atrial fibrillation may be high in patients with IBD. No significant difference was found in the QT-dispersion, and in the MPV values when compared to the control group.

One-year outcomes of less frequent bevacizumab in age-related macular degeneration.

PURPOSE: To evaluate whether a less frequent bevacizumab dosing schedule after repeated doses in short intervals would be effective in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration. METHODS: Twenty-seven treatment-naive eyes of patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration participated in this prospective, noncomparative, and interventional study at the Ulucanlar Eye Training and Research Hospital retina clinic. All lesion types were included. Intravitreal injections (1.25 mg/0.05 mL) of bevacizumab were given with a 6-week interval (Day 0, 6 weeks, and 12 weeks) for 3 months and then given at every 12-week interval up to 48 weeks. Main outcome measures of treatment were mean change in visual acuity and foveal center point retinal thickness from baseline documented by optical coherence tomography at 6, 12, 24, 36, and 48 weeks. The effects of patient age, baseline visual acuity, lesion composition, and lesion size on final visual acuity and loss of <15 letters of logarithm of the minimum angle of resolution (logMAR) at 48 weeks were also assessed. RESULTS: Of the 27 eyes, 24 eyes of 24 patients (14 men and 10 women) completed the 48-week follow-up and study protocol. Compared with baseline (0.95 ± 0.27 on Early Treatment Diabetic Retinopathy Study charts), mean best-corrected visual acuity improved to 0.77 ± 0.21 logMAR (P < 0.001) at Week 6, to 0.74 ± 0.2 logMAR (P < 0.001) at Week 12, to 0.79 ± 0.257 logMAR (P = 0.03) at Week 24, to 0.85 ± 0.26 logMAR (P = 0.54) at Week 36, and to 0.87 ± 0.27 logMAR (P = 1) at Week 48. The baseline mean center point retinal thickness that was 343 ± 64 µm decreased to 236 ± 40 µm (P < 0.001) at Week 6, to 222 ± 39 µm (P < 0.001) at Week 12, to 237 ± 37 (P < 0.001) at Week 24, to 253 ± 44 µm (P < 0.001) at Week 36, and to 268 ± 58 µm (P = 0.002) at Week 48. The maximal visual benefit obtained during the frequent dosing schedule significantly decreased by doses every 12 weeks at 48 weeks (P < 0.001). This decline in the best-corrected visual acuity gain was associated with an increase in the mean center point retinal thickness on optical coherence tomography. Patients aged <70 years and those having a baseline vision of 20/200 or worse were more likely to gain vision at 48 weeks (P = 0.001 and P = 0.02, respectively). In addition, a lesion ≤ 4 disk areas at baseline was less likely to lose <15 letters from baseline at 48 weeks (P = 0.03). No serious ocular and nonocular adverse events were noted. CONCLUSION: Although intravitreal bevacizumab administration on a schedule of a 6-week injection interval for 3 months followed by every 12-week interval for neovascular age-related macular degeneration provided an improvement or stabilization in best-corrected visual acuity with anatomical improvement. This dosing strategy is unable to maintain the visual acuity and optical coherence tomography benefits seen with more frequent dosing.

Surgical repair of scrolled descemet's membrane detachment with intracameral injection of 1.8% sodium hyaluronate.

We report the case of a 76-year-old woman with scrolled Descemet's membrane detachment (DMD) that was successfully treated by an intracameral injection of 1.8% sodium hyaluronate. During phacoemulsification cataract surgery, an undulating DMD involving the central cornea was observed and air tamponade into the anterior chamber was performed. The patient underwent surgical repair 2 weeks after the unsuccessful intracameral air injection. To increase the tamponade pressure and surface tension on the scrolled flap, viscoelastic material was injected into the air-filled anterior chamber. Corneal edema started subsiding clinically after the injection of sodium hyaluronate. Descemetopexy with sodium hyaluronate can successfully repair scrolled DMD and injection of viscoelastic material into the air-filled anterior chamber facilitates unfolding of the scrolled flap of DMD.

Acute kidney infarction secondary to intracardiac thrombus embolization in a patient with ischemic dilated cardiomyopathy.

Acute renal infarction due to emboli represents a very rare but significant threat for kidney loss, and the clinical presentation is challenging. The differential diagnosis of massive renal thrombi includes all other causes of abdominal pain, and they can be easily misdiagnosed as renal colic due to nephrolithiasis. Although there are a few case reports regarding the possibility that cardiac emboli may cause acute kidney infarction, intracardiac thrombi within the ventricular cavity diagnosed by echocardiography as a cause of such renal artery occlusion have never been reported in patients with cardiomyopathy. Herein, we describe a 39-year-old male with a history of ischemic dilated cardiomyopathy. He was admitted to our hospital with left upper abdominal pain and vomiting. After serial examinations and tests, the diagnosis of acute renal infarction due to intracardiac thrombus embolization as a result of severely reduced cardiac function was made.

The value of hepatic diffusion-weighted MR imaging in demonstrating hepatic congestion secondary to pulmonary hypertension.

BACKGROUND: Congestive hepatomegaly might be the first sign for pulmonary hypertension. Apparent diffusion coefficient (ADC) value obtained with quantitative diffusion-weighted magnetic resonance imaging (DW-MRI) is affected by liver fibrosis and perfusion. We aimed to evaluate the diagnostic value of DW-MRI in cooperation with biochemical markers, ultrasonography (US) and echocardiography (TTE) in determining the degree of hepatic congestion secondary to pulmonary hypertension (PHT). METHODS: 35 patients with PHT and 26 control subjects were included in the study. PHT was diagnosed if pulmonary artery systolic pressure (PASP) was measured above 35 mmHg with TTE. Study group was classified into mild and moderate PHT. DW-MRI was performed with b-factors of 0, 500 and 1000 sec/mm(2). Mean ADC, ADC-II (Average of the ADC values of right lobe anterior and posterior segments), US, TTE and blood biochemical parameters of both groups were compared. RESULTS: There exists a positive correlation between liver size and the diameters of vena cava inferior, right atrium, right hepatic vein(RHV), mid-hepatic vein(MHV), left hepatic vein(LHV) (p < 0.01). There was a positive correlation between PASP and RHV, MHV, LHV. The patients had lower ejection fractions (p < 0.01) and higher LDH (p < 0.01) and ALP (p < 0.05) levels than the control group. The ADC values of the patients with moderate PASP were higher than those with a mild PASP (p < 0.05). Mean ADC was higher in patients with moderate PHT compared to control group (p = 0.009). There was a positive correlation between PASP and ADC values of right lobe posterior segment of the liver (p < 0.05). The ADC-II and mean ADC values of the patients with moderate PASP were higher than those of the control group (p < 0.01). CONCLUSIONS: Congestion due to moderate PHT might be diagnosed with DW-MRI. As PASP increase; mean ADC and ADC-II values increase.

Evaluation of Plasma Amino Acid Levels in Preterm Infants and Their Potential Correlation with Retinopathy of Prematurity.

AIM: The aim of this study is to ascertain whether the level of circulating amino acids (aa) is associated with retinopathy of prematurity (ROP). METHODS: This is a randomized controlled study of 55 infants born at gestational age (GA) ≤32 weeks or birth weight (BW) ≤1500 grams. Serum samples were obtained from two groups: Group A comprised of 26 preterm infants with ROP and Group B comprised of 29 preterm infants without ROP. Plasma aa levels were analyzed using liquid chromatography with tandem mass spectrometry (LC-MS/MS). Correlation test and multivariate regression analysis were used to evaluate the relationship between plasma aa levels and variables. RESULTS: The mean serum arginine and glutamine levels were significantly higher, but the mean lysine and aspartic acid levels were significantly lower in Group A, compared to Group B (p = 0.04, p = 0.002, p = 0.029, and p = 0.002, respectively). In multivariate analysis, the mean arginine and lysine levels were significantly associated with the stage of the disease (p = 0.03 and p = 0.01, respectively). No significant differences were determined between the groups in terms of alanine, asparagine, valine, leucine, phenylalanine, tyrosine, serine, proline, citrulline, cysteine, ornithine, tryptophan, methionine, threonine, taurine, and isoleucine amino acids (p > 0.05, respectively). CONCLUSIONS: These results indicate a significant association between high arginine and glutamine, with low lysine and aspartic acid serum concentrations with ROP. Due to higher serum concentrations in ROP, extra arginine-glutamine supplementation in hyperoxic conditions may be unfavorable through pathways involving reactive oxygen, particularly in patients with ROP.

Double-orifice mitral valve associated with bicuspid aortic valve: a rare case of incomplete form of Shone's complex.

Double-orifice mitral valve (DOMV) is a rare congenital malformation characterized by two separate valve orifices of varying sizes in association with the abnormalities of the subvalvular apparatus. It has been reported to be associated with a variety of other congenital malformations. We report a rare case of incomplete form of Shone's complex composed of a complete bridge-type DOMV and bicuspid aortic valve, well demonstrated by both transthoracic and transoesophageal echocardiography and cardiac magnetic resonance imaging.