Clinical and Radiological Comparison of Effects of Platelet-Rich Plasma, Hyaluronic Acid, and Corticosteroid Injections on Temporomandibular Joint Osteoarthritis.

There are few studies in the literature that comparatively evaluate the use of intra-articular orticosteroids (CS), hyaluronic acid (HA), and platelet-rich plasma (PRP). In this study, the authors aimed to compare the clinical results of intra-articular CS, HA, and PRP injections in patients who presented to the authors' clinic with temporomandibular joint (TMJ) pain and clinically diagnosed with TMJ-osteoarthritis. Patients were evaluated in 2 groups as those patients who felt pain on lateral (n = 31), and posterior (n = 43) palpation. Patients who were evaluated in the study were randomly assigned to 3 different treatment groups as Group 1 (PRP), Group 2 (HA), and Group 3 (CS). Pain felt on the TMJ on lateral and posterior palpation was assessed before treatment and every month for 3 months using a 5-point pain scale. Presence of crepitation, loss of function, and loss of strength were assessed before treatment and every month for 3 months. Significant changes were observed in the PRP and HA groups when the patients were evaluated according to the VAS scores evaluated at different follow-up times for TMJ pain on lateral palpation. Significant changes were observed in the PRP, HA, and CS groups when VAS scores were evaluated according to the patients' follow-up times for TMJ pain on lateral palpation. In conclusion, the findings of this study have shown that intra-articular PRP injections decreased TMJ palpation pain more effectively compared with the HA and CS groups.

RACK1 Is an Interaction Partner of ATG5 and a Novel Regulator of Autophagy.

Autophagy is biological mechanism allowing recycling of long-lived proteins, abnormal protein aggregates, and damaged organelles under cellular stress conditions. Following sequestration in double- or multimembrane autophagic vesicles, the cargo is delivered to lysosomes for degradation. ATG5 is a key component of an E3-like ATG12-ATG5-ATG16 protein complex that catalyzes conjugation of the MAP1LC3 protein to lipids, thus controlling autophagic vesicle formation and expansion. Accumulating data indicate that ATG5 is a convergence point for autophagy regulation. Here, we describe the scaffold protein RACK1 (receptor activated C-kinase 1, GNB2L1) as a novel ATG5 interactor and an autophagy protein. Using several independent techniques, we showed that RACK1 interacted with ATG5. Importantly, classical autophagy inducers (starvation or mammalian target of rapamycin blockage) stimulated RACK1-ATG5 interaction. Knockdown of RACK1 or prevention of its binding to ATG5 using mutagenesis blocked autophagy activation. Therefore, the scaffold protein RACK1 is a new ATG5-interacting protein and an important and novel component of the autophagy pathways.

The effects of amphotericin B on angiogenesis in chick chorioallantoic membrane.

OBJECTIVE: Amphotericin B (AmB) is widely used as a mainstay in the treatment of sight-threatening fungal endophthalmitis. From the time that itraconazole was discovered to have a previously unknown anti-angiogenic activity, we have suspected that AmB may have possible effects on ocular angiogenesis. The purpose of this study was to evaluate the in vivo anti-angiogenic effect of AmB in the chick chorioallantoic membrane (CAM) model. MATERIALS AND METHODS: Atak-S type fertilized eggs obtained from the Poultry Institution were used. The eggs were kept under 37 °C at 85-90% relative humidity throughout the experiment. Amphotericin B was prepared in two different concentrations (AmB 125 µg/1 mL and 0.125 µg/1 mL). The CAMs treated with sterile distilled water was specified as controls. About 0.1 mL of each containing 12.5 and 0.0125 µg of AmB, respectively, were dropped to CAM surface. Thirteen eggs were used for each group. The results were evaluated at the 48th hour of the administration of the drugs and recorded by digital camera. RESULTS: A reduction of angiogenesis in CAM area which treated with 125 µg/1 mL of AmB was appreciable macroscopically. The affected areas showed impaired radial arrangement of small vessels with the presence of avascular zone at periphery. The dose of 0.125 µg/1 mL AmB did not show any visible anti-angiogenic effect. Numerous blood vessels with a radially arranged pattern developed toward the periphery after 48 h of treatment. In the CAMs that treated with distilled water, physiological angiogenesis was observed in allantoic vessels. Vessel formation seems to be similar in CAMs treated with 0.125 µg/1 mL AmB with the presence of visibly non-malformed alive embryos. CONCLUSIONS: The present study gives the impression that AmB has the capacity to serve as an anti-angiogenic treatment. As it is a preliminary CAM study only, further studies on both animals and humans are required.

The assessment of anterior and posterior ocular structures in hyperopic anisometropic amblyopia.

BACKGROUND: The aim of this study was to examine the relationship or differences in ocular structures of amblyopic eyes compared to fellow eyes in children and young adults with hyperopic anisometropic amblyopia. MATERIAL/METHODS: Hyperopic participants with anisometropic amblyopia, defined as the presence of best-corrected visual acuity differences of at least 2 Snellen lines and 1.5 diopters between amblyopic and fellow eyes, were studied. Using the IOL Master, Pentacam Scheimpflug imaging and Spectralis optical coherence tomography, the axial length, corneal curvature, and anterior chamber depth (ACD), as well as the thickness of the cornea, peripapillary retinal nerve fiber layer (RNFL), and macula, were compared between children and young adults and between their amblyopic and fellow eyes. RESULTS: In 53 participants with hyperopic anisometropic amblyopia, there were significant differences in the anterior corneal curvature, ACD and axial length between the amblyopic and fellow eyes of all the patients. The mean central macular thickness in the amblyopic eyes was significantly thicker (P=.001) in the group aged 5 to 12 years; however, this was not the case in the group aged 13 to 42 years. There was no significant difference in average RNFL thickness in either group. CONCLUSIONS: We found significantly greater mean central macular thickness in anisometropic amblyopic eyes among participants aged 5 to 12 years, but not among those who were older. Similarly, the interocular differences in axial length parameters seemed to be related to the central macular thickness differences between the amblyopic and fellow eyes in the younger group.

Assessment of Macular Peripapillary Nerve Fiber Layer and Choroidal Thickness Changes in Pregnant Women with Gestational Diabetes Mellitus, Healthy Pregnant Women, and Healthy Non-Pregnant Women.

BACKGROUND: Gestational diabetes mellitus (GDM) is a risk factor for the development of type II diabetes and it causes maternal and child morbidity. Screening for diabetic retinopathy (DR) is important because patients who develop DR have no symptoms until macular edema and/or proliferative diabetic retinopathy (PDR) are already present. The aim of this study was to determine the early retinal findings of GDM. MATERIAL AND METHODS: This study was conducted in a tertiary research center. We conducted a prospective cross-sectional study with 3 groups: Group 1 consisted of 36 pregnant women with GDM, Group 2 consisted of 24 healthy pregnant women, and Group 3 consisted of 38 healthy non-pregnant women of reproductive age. Spectralis optical coherence tomography (OCT) was used for the assessment. Macular, choroid, and retinal nerve fiber layer (RNFL) thicknesses were evaluated in patients with GDM and comparisons were made among pregnant women with GDM, healthy pregnant women, and healthy non-pregnant women for these parameters. RESULTS: The nasal part of the RNFL was significantly thinner in the GDM group than in the healthy pregnant group. None of the patients had retinopathy or macular edema at the time of examination. CONCLUSIONS: Decreased nasal part of RNFL thickness may be the first retinal change in patients with GDM. Our study suggests that OCT should be performed for the patients with GDM for detection of early retinal changes associated with GDM.

Bidirectional Synergistic Vergence.

A 14-year-old boy presented with left ptosis and squint since his childhood. In primary position he had left hypotropia with ptosis (levator function 2 mm). With elevation of the right eye, the left eye depresses and adducts; with depression of the right eye, the left eye elevates and abducts. Forced duction test revealed no restrictive pattern. The synergistic divergence described in the literature was unidirectional and wholly compatible with inferior rectus co-contraction. But this case is bidirectional, and the aberrant upward movement cannot be explained by rectus muscle co-contraction. The two vertical rectus muscles show reciprocal misinnervation, or this effect could be coming from co-contraction of one of the oblique muscles for the movement in one direction.

Comprasion of ICare rebound tonometer and Goldmann applanation tonometer in high myopia.

PURPOSE: To compare intraocular pressure (IOP) measurements with the Goldmann applanation tonometer (GAT) and the ICare rebound tonometer (RBT) in high myopic eyes. PATIENTS AND METHODS: This randomized prospective study included 40 eyes of 40 patients with high myopia. All patients' central corneal thickness (CCT), anterior chamber depth (ACD), axial length (AXL), keratometry, and refractive measurements were recorded and followed by IOP measurement with RBT and GAT. RESULTS: The average CCT, AXL, and ACD were determined to be 514.65 ± 32 µm, 27.65 ± 2.22 mm, and 3.25 ± 0.51 mm, respectively. Mean K was 43.27 ± 1.4 D and mean spherical equivalent was -11.31 ± 4.30 D. The mean IOP values obtained by RBT and GAT were 17.18 ± 3.72 mmHg and 16.48 ± 3.19 mmHg, respectively. The deviations of RBT readings from corrected GAT values were highly correlated with CCT values (r = 0.588, P = 0.0001). The mean corrected GAT reading was 17.49 ± 3.01 mmHg. Linear regression analysis showed that a CCT change of 10 µm resulted in an RBT reading deviation of 0.57 mmHg. The Bland-Altman scatter-plot and McNemar test showed a clinically good level of agreement between the two tonometers. CONCLUSION: This study found a good agreement level between the two tonometers in high myopic patients and that RBT measurements are influenced by CCT variations.

Optic Atrophy Secondary to Preseptal Cutaneous Anthrax: Case Report.

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

Choroidal Thickening in Patients with Sleep Apnea Syndrome.

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

The relationship between microalbuminuria, left ventricular hypertrophy, retinopathy, and sex hormone status in newly diagnosed hypertensive women.

An increased incidence of hypertension (HT) in postmenopausal female population has been shown in previous studies and this has been ascribed to an association with altered status of estrogen (E2) and other female sex hormones. Hypertension is associated with certain target organ damage (TOD) and related clinical conditions. The aim of this study was to determine the relationship between microalbuminuria, left ventricular hypertrophy (LVH), retinopathy, and sex hormone status in newly diagnosed hypertensive women. A total of 66 hypertensive women (39 postmenopausal and 27 premenopausal) were included in the study. Along with the tests recommended in the HT guidelines, LVH, hypertensive retinopathy, and microalbuminuria were investigated in all the patients. Sex hormones (follicle stimulating hormone, luteinizing hormone, progesterone, and E2) of the patients were also measured. The results show that there was no statistically significant difference between the two groups in regard to TOD except microalbuminuria. The frequency of microalbuminuria in premenopausal group patients was higher than that of the postmenopausal group patients (P = .038). This study suggests that TOD caused by HT is a very important health problem, seeming to be related with female sex hormones.

The long-term follow-up results of external dacryocystorhinostomy skin incision scar with "W incision".

OBJECTIVE: To determine the effect of "W incision" instead of classical vertical incision at external DCR on scar formation. MATERIALS AND METHODS: Patients with acquired nasolacrimal duct obstruction (NLDO) who were treated with external DCR with classical vertical incision, and patients who were treated with external DCR with "W incision" were included in the study. The first 39 eyes were operated with a vertical incision, and the remaining 37 eyes were operated with a "W incision". All the skin incision scars of the patients were assessed and scored by at least the 6th month. The assessment was made by both the patients themselves, and by an ophthalmologist other than the surgeon himself, each scored the incision scar separately (single-masked study). Scores for both groups were compared, and statistical analyses were performed. RESULTS: Self-assessment scores for the incision scar were Grade 2.28 ± 0.94 in the Vertical incision group, and Grade 1.68 ± 0.57 in the "W incision" group (p < 0.01). The "W incision" scar formation was significantly less noticable than the Vertical incision scar formation. Similarly, the assessment scores of the ophthalmologist other than the surgeon himself were significantly lower for the "W incision" group than for the Vertical incision group. The mean scar assessment scores were Grade 2.13 ± 0.95 in the Vertical incision group, and Grade 1.57 ± 0.68 in the "W incision" group (p < 0.01). CONCLUSION: Skin scar tissue was found to be significantly reduced with a "W incision" in external DCR operations.

Recurrent Alternating Oculomotor Nerve Palsy: An Unusual Presentation of Parasagittal Meningioma.

We present a previously unreported case of 57-year-old man suffering from diplopia. Motility assessment revealed a total right oculomotor nerve palsy that spontaneously resolved in about 10-18 days. Three years later, sudden oculomotor nerve palsy occurred in his left eye and complete resolution with out any treatment was observed after a month. Five years from the second episode there was a further recurrence in the right eye. Magnetic resonance imaging demonstrated a parasagittal meningioma.

Soccer ball related posterior segment closed-globe injuries in outdoor amateur players.

BACKGROUND: The aim of this study is to report the characteristics, treatment, and anatomical and functional outcomes of outdoor amateur soccer players with soccer ball-related posterior segment ocular trauma. METHODS: We conducted a retrospective chart review of 22 patients with diagnoses of closed-globe ocular trauma caused by soccer play activity from 2004 through 2008. Injuries were classified according to Ocular Trauma Classification. RESULTS: All patients (n=22) were male, and all injuries were caused by contact with the soccer ball itself. Sixteen (72%) patients did not require any treatment. Surgery was performed on 5 (22%) patients. Twenty (91%) patients had 5/200 or better visual acuity (VA) at presentation and 2 (9%) had hand movements or worse VA. At the final visit, all patients had 5/200 or better VA (p<0.01). CONCLUSION: A soccer ball can cause significant posterior segment trauma, and using eye protection equipment might be an appropriate solution.

Treatment with enhanced external counterpulsation improves cognitive functions in chronic heart failure patients.

OBJECTIVES: Chronic heart failure (CHF) has been associated with an increased risk of poorer cognitive performance in older adults. Reversibility of cognitive impairment after medical treatment has been reported, although the restorative effects of enhanced external counterpulsation (EECP) on cognitive performance have not been studied. We investigated the effect of EECP on cognitive functions in CHF patients. STUDY DESIGN: Thirty-six individuals (mean age: 66±8 years) who were diagnosed with CHF and were New York Heart Association (NYHA) Class II-III and Canadian Cardiovascular Society (CCS) Class II-III participated in this study. Neuropsychological assessment was performed in these patients. RESULTS: Patients in the EECP treatment group showed a statistically significant improvement in spontaneous naming (p=0.011) and forward row score of the attention subset among domains of cognition (p=0.020) and interference time of executive function (p=0.012). CONCLUSION: Enhanced external counter pulsation resulted in improvement in all domains of cognitive functions except verbal and visual memory tests.

Scheimpflug imaging of the anterior segment following simultaneous cross-linking with topography-guided custom ablation treatment for keratoconus.

PURPOSE: To report alterations in the anterior segment following accelerated corneal collagen cross-linking and topo-guided customized ablation treatment with the Nidek vision excimer laser system (Nidek Co., Ltd., Gamagori, Japan) in a single procedure. METHODS: We reviewed the medical records of patients who underwent cross-linking for progressive keratoconus. We divided patients into four groups based on the treatment protocol. Eyes were evaluated regarding uncorrected distance visual acuity, corrected distance visual acuity, keratometry (maximum [Kmax], equivalent keratometry readings, Ksteep and Kflat parameters), corneal elevations (anterior and posterior), the anterior radius of curvature, the posterior radius of curvature, anterior chamber volume, anterior chamber depth, anterior chamber angle and the pachymeter of the thinnest locale of the cornea before the surgery and at 1, 3, 6, and 12 months after the procedure. RESULTS: We included 259 eyes of 227 patients with progressive keratoconus who underwent treatment. The mean respective baseline uncorrected distance visual acuity and corrected distance visual acuity were: 0.68 ± 0.45 and 0.34 ± 0.40 in Group 1; 0.82 ± 0.44 and 0.33 ± 0.23 in Group 2; 0.61 ± 0.36 and 0.21 ± 0.17 in Group 3; and 0.65 ± 0.38 and 0.23 ± 0.18 in Group 4; logMAR did not show significant difference among the groups (p=0.14 and p=0.06, respectively). Visual improvements were better in the combined surgery groups. Mean Kmax in Groups 1, 2, 3, and 4 were 57.24 ± 7.51, 59.26 ± 6.94, 53.73 ± 4.60, and 54.31 ± 4.25 diopter (D), respectively. Group 1 demonstrated increased Kmax for 6 months. Maximum flattening by 3.38 ± 2.35 D 1 year after surgery was observed in Group 4 (p<0.05). Decreased anterior chamber angle, anterior chamber depth, and anterior chamber volume were similar, indicating the stability of the anterior chamber. CONCLUSION: Visual and anatomical improvement is better, with improved stability of the anterior segment, in combined surgery groups compared with cross-linking alone.

Fourier analysis of corneal Scheimpflug imaging: clinical use in keratoconus.

AIM: To evaluate the clinical use of Fourier analysis of videokeratography data in the diagnosis and follow-up of keratoconus (KC). METHODS: We conducted a chart review of consecutive patients presented to our cornea clinic. A team of two experienced cornea specialists divided the patients into three groups: normal cornea, forme fruste KC (FFKC), and clinical KC. The exclusion criteria were a history of previous ocular surgery, any accompanying corneal pathology other than KC, high myopia (>6.00 diopters), amblyopia, pregnancy, breastfeeding, or any current autoimmune disease. The data of Fourier series harmonic analysis were evaluated for their diagnostic capacity using the receiver operating characteristic (ROC) curve. A binary logistic regression analysis was also conducted to construct a diagnostic model. A total of 259 eyes showed progression in the clinical KC group and underwent a combination of accelerated corneal collagen cross-linking and topography-guided customized treatment with an excimer laser. RESULTS: The study included 1262 eyes (618 normal, 530 KC, and 114 FFKC) of 1262 patients. We observed that maximum decentration (MaxDec) was almost as good as maximum keratometry (Kmax) in detecting progressive KC. The area under the curve (AUC) was 0.95 for KC [95% confidence interval (CI): 0.93-0.96] and 0.84 for FFKC (95%CI: 0.79-0.88). Higher predictive accuracy was obtained using a model combining the spherical component, MaxDec, irregularity, and regular astigmatism in the center of the cornea (AUC: 0.97; sensitivity: 89%, and specificity: 96%). CONCLUSION: Decentration, Kmax, and posterior radii of curvatures from a 3.0-mm optical zone centered on the thinnest point of the cornea provide the highest accuracy with low reproducibility of Kmax.