Evaluation of peripheral blood inflammatory biomarkers in sickle cell disease with and without retinopathy.

BACKGROUND: The aim of this study was to evaluate the clinical significance of blood-cell associated inflammation markers in patients with sickle cell disease (SCD) and sickle cell retinopathy (SCR). METHODS: Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), systemic immune inflammation index (SIII), systemic inflammation response index (SIRI), systemic inflammation modulation index (SIMI) and aggregate systemic inflammation index (AISI) were calculated. This study included 45 healthy controls (Group 1) and 100 SCD (Group 2). Patients in Group 2 were then divided into two groups: without SCR (Group 3) and with SCR (Group 4), and patients with SCR (Group 4) were further divided into two groups: non-proliferative sickle cell retinopathy (NPSCR) (Group 5) and proliferative sickle cell retinopathy (PSCR) (Group 6). RESULTS: The mean values for NLR, PLR, SIII, SIRI, AISI, and SIMI were significantly higher in Group 2 compared to Group 1 (p = 0.011 for NLR, p = 0.004 for SIII, and p < 0.001 for others). Furthermore, AISI and SIMI parameters demonstrated statistically significant discriminatory power to distinguish Group 5 from Group 6 (p = 0.0016 and p = 0.0006, respectively). CONCLUSION: Given the critical role of inflammatory mechanisms in the pathogenesis of SCD and its related complications, the assessment of blood-cell-associated inflammatory markers may present a pragmatic and advantageous approach to the clinical oversight and therapeutic intervention of SCD.

Pediatric Canalicular Lacerations: Epidemiology and Surgical Outcomes.

BACKGROUND: The aim of this study was to report the epidemiology and surgical outcomes of canalicular lacerations in the pediatric age group. METHODS: All pediatric patients who underwent repair of canalicular lacerations of any cause were included in this study. Age, sex, mechanism of trauma, and type of stent used were recorded. RESULTS: The study group consisted of 47 patients with a median age of 6.4 years (22 mo-17 y). Thirty of the patients were male (63.8%). The lower canaliculus was affected in 76.6% (n=36), the upper canaliculus in 40.4% (n=19), and both canaliculi in 17% (n=8). The most common cause of canalicular laceration was sharp objects (n=33, 70.2%). CONCLUSION: Canalicular laceration most commonly affects boys and especially involves the lower canaliculus. There was no difference in functional success between monocanalicular and bicanalicular stents. Prevention of canalicular lacerations should be the main focus.

Oleuropein exhibits anticarcinogen effects against gastric cancer cell lines.

BACKGROUND: Oleuropein (OLE), the main phenolic compound of the olive fruit and leaves, has many heathful effects. Gastric cancer is the most fatal malignancy in many parts of the world and it is generally related to harmful dietetic factors. The anticarcinogenic role of OLE in gastric cancer has not been studied sufficiently yet. In this study, we aimed to research the cytotoxic, genotoxic and apoptotic effects of OLE on gastric adenocancer (AGS) cells in vitro. METHODS AND RESULTS: A standard cell line derived from gastric adeno cancer (AGS) cells was employed, and its performance following a 24-hour exposure to OLE at various doses was examined. The ATP cell viability assay, 2',7'-dichlorodihydrofluorescein-diacetate assay (H2DCF-DA) and alkaline single cell gel electrophoresis assay (Comet Assay) were used to study the cytotoxicity, production of reactive oxygen species (ROS) and genotoxicity respectively. The induction of apoptosis was discovered using flow cytometry. OLE reduced AGS cells viability about 60% at maximum concentration (500 µmol/L) and also resulted in approximately 100% DNA damage and about 40% apoptosis with necrosis in AGS cells depending on the increased doses. Cell viability was also significantly decreased in relation to increased intracellular reactive oxygen species (ROS) levels (p < 0.05 - 0.001). CONCLUSIONS: Oleuropein has shown significant anticarcinogen effects against gastric adenocancer (AGS) cells in vitro. Oleuropein, a nutrient rich in olive and olive oil, seems to be both protective and therapeutic against gastric cancer and may be a new chemotherapeutic agent in the future.

Evaluation of Tear Stability and Ocular Surface in Patients Undergoing External Endonasal Dacryocystorhinostomy (EE-DCR) for Primary Acquired Nasolacrimal Duct Occlusion (PANDO).

The aim of our study was to show the changes in ocular surface and tear film parameters of patients who underwent external endonasal dacryocystorhinostomy (EE-DCR). For this purpose, tear film break-up time, corneal staining score, ocular surface disease index (OSDI), and Schirmer I test were performed preoperatively and postoperatively. The data obtained were compared with healthy controls. In the preoperative period, ocular surface disease index scores and corneal staining scores were higher, and Schirmer 1 and tear film break-up time were lower in group 1 compared with group 2. The ocular surface parameters were similar between the groups in the first and third postoperative months. External endonasal dacryocystorhinostomy is an important method for the restoration of deteriorated tear stability. Restoration of these disorders may be an important determinant of patient satisfaction and visual quality after surgery.

Blunt Eye Trauma: Epidemiology, Prognostic Factors and Visual Outcome-A 10-Year Retrospective Study.

The aim of this study is to define the accompanying prognostic factors and evaluate the final visual acuity of patients presenting with blunt eye trauma. The data of this study included the demographic characteristics of the patients, the mechanism of injury, initial and final visual acuities and accompanying pathologies. A total of 259 eyes of 259 patients who presented with blunt eye trauma were included. Eighty-three percent of the patients were male. The most common mechanisms are beaten, accidents, and falls. The visual acuity of the patient at admission was no perception of light, and the final visual acuity was also no perception of light. The incidence of blunt eye trauma was more common in males and in advanced age. A higher final visual acuity level is achieved with successful management of concomitant pathologies.

User profile of an online cognitive behavioral therapy self-help platform in Turkey.

Online mental health self-help services are of societal importance and increasingly popular. Therefore, we have developed an online platform offering free self-help to the Turkish public with modules based on Cognitive Behavioral Therapy (CBT) targeting depression, anxiety, and stress respectively. The main purpose of this study is to describe the user profile of this platform. A pre-intervention self-report assessment including general demographic information and the Brief Symptom Inventory questionnaire during October 2020 until September 2022. 8331 participants completed the assessment and created an account out of the 11.228 users who registered during a two-year period, of which 8.331 (74%) completed the assessment and created an account. The majority of these users were female (76.17%), highly educated (82%), single (68%) and actively studying or working (84%). Slightly more than half (57%) of the platform user had not received psychological assistance before, while those who did receive previous assistance indicate to have benefitted from that (74%). The psychological symptoms of users are widely distributed, encompassing a broad range of user profiles. Approximately half of all users actively used the platform, while the other half did not complete any module. Among active users, the course "coping with depressive mood" was the most popular (41.45%), followed by "coping with anxiety" (37.25%) and "coping with stress" (21.30%). Offering a free online CBT self-help platform to the Turkish public seems feasible, with strong uptake among both man and woman struggling with a variety of psychological symptoms. Further research is needed to assess user satisfaction and change in symptoms over time during platform use by means of a feasibility trial.

Comparison of Two Scoring Systems in Pediatric Open Globe Injuries.

PURPOSE: The aim of this study is to determine the demographic characteristics of pediatric open globe injuries, evaluate the ocular trauma scores (OTS), and predict the visual outcomes. METHODS: All patients with pediatric open globe injuries who applied to Department of Ophthalmology, Faculty of Medicine, Mersin University between January 2018 and December 2019 were included in this study. Age, gender, type of injury, time of admission, time to surgery, OTS, and pediatric ocular trauma score (POTS) were calculated for each patient. The relation between these findings and final visual acuity (VA) after 12 months of follow-up was examined. RESULTS: Forty-two eyes of 41 patients were included in this study. The most common injuries observed were sharp objects such as knives (23.8%) and stones (23.8%). The wound locations were zone I in 36 patients (85.7%) and zone II in 6 patients (14.3%). The most common concomitant eye pathologies were iris prolapse in 37 (88.1%) and hyphema in 29 (69.1%). The mean original OTS was 77.21 and the mean POTS was 46.78. Association between OTS/POTS and final VA was very good (Kendall Tau-b = 0.665, P < 0.001, Kendall Tau-b = 0.505, P < 0.001, respectively). The level of agreement between the predicted VA for OTS and that for POTS was almost perfect (kappa = 0.8726). CONCLUSIONS: This study shows that the original OTS is still the gold standard in pediatric cases.

A Rare Ocular Complication of Autologous Fat Injection: Subconjunctival Fat Infiltration.

ABSTRACT: The aim of this brief clinical study to describe and discuss the subconjunctival fat infiltration encountered in a patient with autologous fat injection. A 50-year-old female patient, who had an autologous fat injection 2 days ago, applied to our clinic with the complaint of redness and burning in the left eye. On anterior segment examination, a raised 20 × 15 mm adipose tissue was observed in the temporal region under the conjunctiva. Infiltrated fat tissue was surgically removed from the subconjunctival area. Subconjunctival fat infiltration is an extremely rare complication after autologous fat injection.

Serum SUR1 and TRPM4 in patients with subarachnoid hemorrhage.

Neuroinflammation plays an important role in neuronal injury after aneurysmal subarachnoid hemorrhage (aSAH). Sulfonylurea receptor 1 (SUR1) and transient receptor potential cation channel subfamily M member 4 (TRPM4) receptors play an important role in the pathogenesis of several neural injuries, such as neural edema, spinal cord damage, stroke, and neuronal damage in aSAH. This study aimed to investigate the relationship of serum SUR1 and TRPM4 levels with the neurological status within the first 15 days after aSAH. In this prospective study, blood samples were collected from 44 consecutive patients on the 1st, 4th, and 14th days after aSAH. Serum SUR1 and TRPM4 levels were measured using an enzyme-linked immunosorbent assay kit. Glasgow coma scale and World Federation of Neurosurgical Societies (WFNS) scores upon presentation and Glasgow outcome scale (GOS) score on the 14th day were recorded. Serum SUR1 and TRPM4 levels on the 1st, 4th, and 14th days were significantly higher in patients with aSAH than in normal individuals. This increase in the levels varied among the 1st, 4th, and 14th days. On the first day, a correlation was observed between serum SUR1, but not TRPM4, levels and the WFNS score. Moreover, on the 14th day, an association of serum SUR1 and TRPM4 levels with the GOS score was noted. Serum SUR1 and TRPM4 levels were significantly upregulated in the peripheral blood samples. Further study is warranted to establish the utility of SUR1 and TRPM4 as biomarkers in patients with aSAH.

Repetitive Transcranial Magnetic Stimulation in the Treatment of Skin Picking Disorder: An Exploratory Trial.

OBJECTIVES: Skin picking disorder (SPD) falls into the category of "obsessive-compulsive disorder and related disorders" in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Repetitive transcranial magnetic stimulation (rTMS) treatment has been reported to be a promising therapy in obsessive-compulsive disorder-related disorders. The purpose of this study was to demonstrate the efficacy of rTMS treatment in patients with SPD. METHODS: Fifteen patients with SPD were assigned to receive 3 weeks' treatment with either active (n = 8) or sham rTMS targeting the pre-supplementary motor area. Patients were evaluated using the Beck Depression Inventory, Beck Anxiety Inventory, Skin Picking Impact Scale, and the Yale-Brown Obsessive Compulsive Scale Modified for Neurotic Excoriation. Response to treatment was defined as a ≥35% decrease on Yale-Brown Obsessive Compulsive Scale modified for Neurotic Excoriation. RESULTS: Treatment response was achieved in 62.5% of patients (5/8) in the active group and 33.3% of patients (2/6) in the sham group. However, there were no significant differences between the groups in terms of primary and secondary outcomes. CONCLUSIONS: In this exploratory study, active rTMS could not be demonstrated to be superior over sham in treatment of SPD. The results of this study indicate the need for further rTMS studies to be conducted with larger sample sizes and subtypes of SPD.

The Relationship Between Anxiety, Depression, Suicidal Ideation and Quality of Life in Patients with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic disease and many patients with RA experience lifelong anxiety and depression. The aim of this study is to provide an assessment of anxiety, depression, suicidal ideation, disease activity and quality of life in patients with RA. Fifty patients were included in the study. Hospital Anxiety and Depression Scale (HADS), Short Form Health Survey (SF-36), Beck Scale for Suicide Ideation (BSSI) and Disease Activity Score (DAS-28) were applied. A statistically negative correlation was found between HADS-A and HADS-D scores and all subscales of SF-36. There was a statistically negative correlation between the DAS-28 score and the subscales of the SF-36 except mental health and bodily pain. Suicidal ideation was associated with anxiety and depression and BSSI scores of patients suffering from anxiety and depression are higher than the patients not suffering from anxiety and depression. There was a statistically negative correlation between BSSI and the subscales of SF-36 excepting physical role. This study indicated that anxiety, depression, quality of life, disease activity and suicidal ideation are related to each other in patients with RA. The presence of concomitant anxiety and depression may lead to suicide and poor quality of life and may worsen the prognosis of the RA.

Total oxidant and antioxidant status and paraoxonase 1 levels of children with noncystic fibrosis bronchiectasis

Background/aim: To evaluate total oxidant status (TOS), total antioxidant capacity (TAC), and paraoxonase 1 (PON1) levels in children with noncystic fibrosis (CF) bronchiectasis (BE), and to compare these levels with those of healthy controls. The study parameters were also evaluated according to some demographic, anthropometric, and clinical characteristics, as well as lung functions. Materials and methods: Enrolled in the study were 118 children with non-CF BE and 68 healthy controls. Serum TOS, TAC, and PON1 levels were determined. Lung function tests were performed by spirometry. Results: Serum TOS was higher in the patients [median 9.54 (IQR 25­75 = 7.05­13.30) µmol H2O2 Eq/L] than in the healthy subjects [6.64 (5.45­9.53) µmol H2O2 Eq/L] (P < 0.001). TAC was higher in patients with non-CF BE [1.07 (1.0­1.07) mmol Trolox Eq/L] than in the healthy controls [0.87 (0.77­0.98) mmol Trolox Eq/L] (P < 0.001). In addition, serum PON1 levels were significantly higher in the patients [106.5 (42.5­154.2) U/L] than in the controls [47.7 (27.5­82.1) U/L] (P < 0.001). The patients with low FEV1 had decreased TAC when compared to those who had normal FEV1 in non-CF BE. Conclusion: The present study demonstrated that compared with the control group the children with non-CF BE had elevated oxidative status, antioxidant defenses parameters, and PON1 values.

Evidence for an association of serum melatonin concentrations with recognition and circadian preferences in patients with schizophrenia.

Melatonin, a neuro-differentiation factor, may play a role in the neurodevelopmental origins of schizophrenia. Cognitive impairment and decreased melatonin are reported in schizophrenia; however, the relationship between them remains unclear. We hypothesised that patients with schizophrenia would have lower concentrations of circulating melatonin than healthy controls and that melatonin levels would be associated with cognitive impairment. This study included 47 patients with schizophrenia and 40 healthy controls (HC). Serum melatonin concentrations were measured using the enzyme-linked immunosorbent assay. Positive and Negative Syndrome Scales (PANSS), The Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI), the Stroop and Oktem verbal memory processes (VMPT) tests were applied. Patients with schizophrenia had lower levels of melatonin compared to the HC group (p = 0.016), also after controlling for age, sex, and body mass index (BMI) (p = 0.024). In patients with schizophrenia, melatonin concentrations were associated with higher BMI (rho = 0.34, p = 0.01) and lower MEQ score (rho = -0.29, p = 0.035). The patient sample was split into low and high melatonin categories by using the median melatonin concentration in HC as the cut-off. Patients in the low melatonin group had poorer performance in VMPT-Recognition (p = 0.026) and Stroop-Colour Error (p = 0.032). Notwithstanding its limitations, the findings of this exploratory study suggest that decreased serum melatonin concentrations observed in schizophrenia might also be associated with cognitive impairment and circadian preferences. Future studies are required to investigate the role of melatonergic pathways in patients with schizophrenia.

Oxidative stress and phenotype frequencies of paraoxonase-1 in teratozoospermia.

Oxidative stress causes infertility in men by affecting especially sperm morphology. The aim of the study was to examine the frequencies of paraoxonase-1 (PON1) phenotypes and the serum PON1, arylesterase, total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index, catalase and thiol levels in teratozoospermic infertile men and normospermic fertile men. The study included 184 teratozoospermic infertile men and 72 normospermic fertile men. The double substrate method was employed to determine the phenotype distribution of PON1. The evaluation of sperm morphology was made in accordance with the Kruger's criteria. TAS, catalase and thiol levels were determined to be significantly lower in teratozoospermic infertile men compared to normospermic fertile men. A significant change was not observed in the levels of TOS, PON1 and arylesterase. There was a positive correlation between catalase and thiol levels and sperm morphology. While there were significantly more teratozoospermic men with AA phenotypes compared to normospermic men, there were significantly more persons with AB and BB phenotypes in normospermic men than in teratozoospermic men. As far as we know, such a study was conducted for the first time and suggests that PON1 phenotypic distribution may play a significant role in sterile males because of impaired sperm morphology.

The alteration of retinal nerve fibre layer thickness with repetitive transcranial magnetic stimulation in patients with treatment resistant major depression.

OBJECTIVE: The nerves and axons of the retinal nerve fibre layer (RNFL) are similar to those in the brain and therefore retina is considered as the extension of the brain. We aimed to evaluate the RNFL thickness in the treatment-resistant major depressive patients before and after repetitive transcranial magnetic stimulation (rTMS) treatment and at least 6 months later after rTMS treatment using optical coherence tomography (OCT). METHODS: Thirty patients with treatment resistant major depression and 24 healthy controls were included in the study. rTMS was applied to the left dorsolateral prefrontal cortex (DLPFC) of the patients. RESULTS: rTMS was initiated in 28 patients. OCT assessments were performed in 24 patients at baseline and after rTMS treatment and in 19 patients at least sixth months after the rTMS treatment. We found significant increase in RNFL thickness compared with controls at the baseline and further increase in RNFL thickness after rTMS treatment. Although there was a decreasing trend in RNFL thickness 6 months after rTMS treatment, 6 months later RNFL thickness was still higher compared with controls. CONCLUSIONS: RNFL thickness is increased in treatment resistant major depression and rTMS over the left DLPFC further increases RNFL thickness in treatment resistant major depressive patients.

Raftlin, presepsin levels and thiol-disulphide homeostasis in acute appendicitis: A pilot study.

OBJECTIVE: To investigate some of the new inflammatory and oxidative stress markers in acute appendicitis. METHODS: This clinical pilot study was conducted at the emergency department of Bezmialem Vakif University, Istanbul, Turkey, between January and July 2015, and comprised patients with definitive diagnosis of acute appendicitis and as many healthy controls. Venous blood was collected to assess white blood cell count, C-reactive protein, raftlin, presepsin, total thiol, native thiol and disulphide levels. Alvarado scores of patients were determined at the time of admission. Surgical excisions were sent for pathological examination. The results of histopathology of appendectomy specimens were categorised as non-perforated or perforated appendicitis. RESULTS: There were130 subjects with 65(50%) patients and 65(50%) controls. Serum raftlin, presepsin, white blood count, C-reactive protein and disulphide levels were higher, and the total and native thiol levels were significantly lower in patients compared to controls (p<0.05). There was no significant difference between the non-perforated and perforated appendicitis patients regarding all the measured parameters (p>0.05) except mean Alvarado scores which were higher in perforated than non-perforated appendicitis (p<0.05). CONCLUSIONS: Inflammatory and oxidative stress markers were significantly different in acute appendicitis patients compared to healthy controls.

Comparison of the biochemical and radiological criteria for lumbar disc degeneration.

BACKGROUND: The relationship between radiological degeneration criteria on lumbar magnetic resonance imaging (MRI) and both the keratan sulfate (KS) and chondroitin sulfate (ChS) levels was examined in disc material taken from patients undergoing lumbar disc herniation (LDH) surgery. To examine whether the biochemical and radiological degeneration criteria testing the reliability of radiological degeneration findings agreed and to evaluate the contribution of the KS/ChS ratio to disc form (protruding or extruding). METHODS: This was a prospective experimental cohort study. Using enzyme-linked immunosorbent assay, KS and ChS levels were measured in the degenerate nucleus pulposus taken from 71 patients with a diagnosis of LDH who underwent surgery. The degeneration levels and disc form (protruding or extruding) were determined according to the Pfirrmann five-stage grading system on preoperative T2-weighted lumbar MRIs. According to the Pfirrmann system, 28 patients were grade III and 43 were grade IV. The relationship between radiological criteria and the KS/ChS ratio was statistically evaluated. RESULTS: The KS levels (p=0.046) and the KS/ChS ratio (p=0.001) were significantly higher in grade IV patients than in grade III patients. However, there was no difference between the KS and ChS levels and the KS/ChS ratio when patients were classified as protruding or extruding according to their disc structure. Disc structure and biochemical degeneration indicators were not correlated. CONCLUSIONS: The KS level and the KS/ChS ratio were high in patients with marked radiological degeneration on lumbar MRI, demonstrating the sensitivity and reliability of the Pfirrmann five-stage grading system for showing radiological degeneration.

A novel tool reflecting the role of oxidative stress in the cataracts: thiol/disulfide homeostasis.

We investigated serum and aqueous humor thiol/disulfide (T-D) homeostasis in patients with cataracts versus healthy controls. In total, 56 patients with cataracts and 49 healthy controls were enrolled in this case-control study. Serum total thiol (TT), native thiol (NT), and disulfide (DS) concentrations were determined using a novel automated measurement method. Additionally, DS/TT, DS/NT and NT/TT percentage ratios were compared between the groups. In comparison with the control group, serum NT levels and aqueous humor TT and NT levels were significantly lower (p < .05, p < .05 and p < .001, respectively), whereas serum and aqueous humor DS levels were significantly higher in cataract patients (p < .01 and p < .001). DS/TT and DS/NT ratios were significantly higher and the NT/TT ratio was lower in cataract patients in serum (p < .005) and aqueous humor samples (p < .001). In conclusion, serum T-D homeostasis may be useful as biochemical markers, indicating the role of oxidative stress in the development of cataracts. Further studies are needed to confirm the pathophysiological role of T-D homeostasis in cataractogenesis.

Serum oxidative stress parameters and paraoxonase-1 in children and adolescents exposed to passive smoking.

BACKGROUND: Exposure to secondhand smoke is too common in many countries. The mechanism of the detrimental effects of passive smoking on childhood health, however, is poorly described. The purpose of this study was therefore to examine the effect of passive smoking on total antioxidant status (TAS), total oxidant status (TOS), and paraoxonase-1 in children compared with healthy non-passive smokers. METHODS: This study included 40 children and adolescents passively exposed to cigarette smoke (as verified on urine cotinines) and 40 age- and gender-matched healthy controls not regularly exposed to cigarette smoke. TAS, TOS, and paraoxonase-1 were all measured, and the oxidative stress index (OSI) calculated for each child to determine the degree of oxidative stress. RESULTS: Age and gender distribution were not statistically different between the two groups (P = 0.619 and 0.712, respectively). Urine cotinine/creatinine was significantly higher in the passive smoking group (127.89 ± 57.14 ng/mL) compared with the controls (5.05 ± 16.66 ng/mL; P < 0.001). TAS was not different between the two groups (P = 0.767), but TOS and OSI were significantly higher for the passive smoke-exposed children (P < 0.001), and serum paraoxonase-1 was significantly lower than in the controls (P = 0.047). CONCLUSIONS: Secondhand smoke exposure is associated with increased oxidative stress and decreased paraoxonase-1 without any change in antioxidant status.

Comparison of serum thiol-disulphide homeostasis and total antioxidant-oxidant levels between exudative age-related macular degeneration patients and healthy subjects.

PURPOSE: The purpose of the study was to calculate serum total oxidant status (TOS), total antioxidant status (TAS), and dynamic thiol-disulphide (T-D) homeostasis in patients with age-related macular degeneration (AMD), and compare the results with healthy individuals. METHODS: Thirty-three exudative AMD patients and 33 healthy controls were included in this case-control study. Participants' serum TAS and TOS levels were measured. In addition, total thiol (TT), native thiol (NT), and disulphide (DS) concentrations were assessed using a novel automated method of measurement. RESULTS: In comparison with the control group, serum TAS, TT, and NT levels were found to be significantly lower (p < 0.0001, p = 0.004, p = 0.003, respectively) and TOS levels were detected higher (p = 0.032) in AMD patients. Serum DS levels were elevated in the AMD patient group, but the difference was not statistically significant (p = 0.219). DS/TT and DS/NT ratios were significantly higher (p = 0.012, p = 0.013, respectively) in AMD patients. A positive correlation was found between TT and NT (p < 0.0001) in AMD group. CONCLUSIONS: Serum TOS levels are higher, TAS levels are lower, and the T-D balance is shifted to the DS bond side in AMD patients. These results suggest that increased oxidative stress and decreased antioxidant levels may play a role in AMD progression. Further studies are needed to confirm the pathophysiologic role of T-D homeostasis in AMD.