Comparison of the efficacy of latanoprost versus dorzolamide/timolol fixed combination therapy in patients with pseudoexfoliative glaucoma according to glaucoma stage / Comparação da eficácia da terapia de combinação fixa latanoprosta versus dorzolamida/timolol em pacientes com glaucoma pseudoesfoliativo de acordo com o estágio de glaucoma

ABSTRACT Purpose: Only a few trials have compared the intraocular pressure-lowering effects of prostaglandin analogs to carbonic anhydrase inhibitor plus beta-blocker fixed-dose combination therapy in patients with pseudoexfoliative glaucoma. Furthermore, the influence of the glaucoma stage on the intraocular pressure-lowering effects of these drug types has not been studied. The purpose of this study was to compare the IOP-lowering efficacy of latanoprost, a prostaglandin analog versus dorzolamide/timolol fixed combination, a carbonic anhydrase inhibitor plus beta-blocker fixed-dose combination therapy, in patients with pseudoexfoliative glaucoma based on glaucoma stage. Methods: The data of 32 eyes (32 patients) diagnosed with uniocular pseudoexfoliative glaucoma and treated with topical latanoprost (Group 1) or dorzolamide/timolol fixed combination (Group 2) were retrospectively assessed. The groups were subdivided into early and moderate-advanced stages. Patients' demographics, baseline intraocular pressure, final intraocular pressure, and intraocular pressure difference (the difference between the baseline and final intraocular pressure) were determined from medical records and compared between groups and according to glaucoma stage. Results: The mean drug use duration was 17.7 ± 13.5 months. No significant differences in mean baseline intraocular pressure, mean final intraocular pressure and mean intraocular pressure difference between Groups 1 and 2. In Group 2, the mean intraocular pressure difference was significantly greater in patients with early versus moderate-advanced stage glaucoma (p=0.015). The difference, however, was not detected in Group 1. The mean intraocular pressure difference in early-stage glaucoma was significantly greater in Group 2 versus 1 (p=0.033). Conclusions: Latanoprost and dorzolamide/timolol fixed combination are effective treatments for newly diagnosed pseudoexfoliative glaucoma. In early-stage pseudoexfoliative glaucoma, greater intraocular pressure reduction was noted with dorzolamide/timolol fixed combination than with latanoprost; thus, dorzolamide/timolol fixed combination should be considered when a significant decrease in intraocular pressure is desired in early-stage glaucoma.

RESUMO Objetivo: Estudos limitados examinaram os efeitos de redução de pressão intraocular de análogos de prostaglandina versus inibidor de anidrase carbônica mais terapia de combinação de dose fixa beta-bloqueador em pacientes com glaucoma pseudoesfoliativo. Além disso, a influência do estágio de glaucoma nos efeitos de redução da pressão intraocular desses tipos de drogas não foi avaliada. Este estudo teve como objetivo comparar a eficácia de redução do IOP do latanoprosta, uma combinação fixa análoga de prostaglandina versus dorzolamida/timolol, um inibidor de anidrase carbônica mais terapia de combinação de dose fixa beta-bloqueador, em pacientes com glaucoma pseudoesfoliativo de acordo com o estágio de glaucoma. Métodos: Os dados de 32 olhos (32 pacientes) diagnosticados com glaucoma pseudoesfoliativo monocular e tratados com latanoprosta tópica (Grupo 1) ou combinação fixa de dorzolamida/timolol (Grupo 2) foram avaliados retrospectivamente. Os grupos foram subdivididos em estágios inicial e moderado-avançado. A demografia dos pacientes, a pressão intraocular da linha de base, a pressão intraocular final e a diferença de pressão intraocular (a diferença entre a pressão intraocular da linha de base e a pressão intraocular final) foram determinadas a partir dos prontuários médicos e comparadas entre os dois grupos e de acordo com o estágio de glaucoma. Resultados: A duração média do uso de drogas foi de 17,7 ± 13,5 meses. Nenhuma diferença significativa foi observada entre os grupos 1 e 2 para a média da pressão intraocularda linha de base, média da pressão intraocular final e média da diferença da pressão intraocular. No Grupo 2, a média da diferença da pressão intraocular foi significativamente maior em pacientes com glaucoma de estágio precoce versus moderado-avançado (p=0,015). No entanto, essa diferença não foi observada no Grupo 1. A média da diferença da pressão intraocular em glaucoma de estágio inicial foi significativamente maior no Grupo 2 versus 1 (p=0,033). Conclusões: Terapias com Latanoprosta e dorzolamida/timolol são tratamentos eficazes para glaucoma pseudoesfoliativo recém-diagnosticado. Observou-se em glaucoma pseudoesfoliativo de estágio inicial, uma maior redução da pressão intraocular com combinação fixa de dorzolamida/timolol do que com latanoprosta; assim, a combinação fixa de dorzolamida/timolol deve ser considerada quando uma diminuição significativa da pressão intraocular é almejada em glaucoma de estágio inicial.

Evaluation of genotoxicity, oxidative stress and immune parameters of auto-paint workers.

The automotive industry is a very wide area from the manufacturing of the pieces of the engine, the body, plastics to the assembly of the car. There is a chemical risk at different stages of production because of the requirement of the use of many corrosive and irritant chemicals such as paints, adhesives, acids, and bases. The aim of the study was to determine the genotoxicity, oxidative stress and immune parameters of automotive paint workers in Ankara, Türkiye. DNA damage of workers mainly responsible from the painting of the automotives were evaluated using the alkaline comet assay and the levels of some oxidative stress and immune biomarkers were also investigated. Increased lymphocyte DNA damage and also higher 8-hydroxy-2'-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) levels were observed while decreased glutathione (GSH), glutathione peroxidase (GPx), and glutathione reductase (GR) levels were found in the workers compared to their controls There were no significant differences between the study groups in the levels of interleukin (IL)- 1beta, IL-17, IL-23, Clara cell secretory protein (CC16), tumor necrosis factor-alpha (TNF-alpha), catalase (CAT), and superoxide dismutase (SOD). The results show that occupational exposure to chemicals in automotive industry may cause DNA damage in workers due to oxidative stress.

Evaluation of the impact of subepithelial corneal infiltrates on corneal biomechanics after epidemic keratoconjunctivitis / Avaliação do impacto de infiltrados sub-epiteliais corneanos na biomecânica corneana após ceratoconjuntivite epidêmica

ABSTRACT Purpose: To examine the effect of subepithelial corneal infiltrates on corneal biomechanical properties after epidemic keratoconjunctivitis compared to that in healthy controls. Methods: The cross-sectional study included consecutive patients with bilateral subepithelial corneal infiltrates after epidemic keratoconjunctivitis and healthy controls. Best corrected visual acuity corneal subepithelial infiltrate scoring Fantes grading scale, and central corneal thickness were measured. Corneal hysteresis corneal resistance factor Goldmann correlated intraocular pressure and corneal compensated intraocular pressure were assessed using an ocular response analyzer. Results: This study included 66 eyes of 33 patients with subepithelial corneal infiltrates following epidemic keratoconjunctivitis and randomly selected 37 eyes of 37 healthy volunteers. The mean Fantes and CSIS scores were 1.8 ± 0.8 and 2.9 ± 1.3, respectively, in the first involved eyes and 1.3 ± 1.1 and 1.9 ± 1.7, respectively, in the fellow eyes (p=0.009 and p=0.002, respectively). The first (526.1 ± 28.1 µm; p=0.005) and second involved eyes (523.4 ± 38.1 µm; p=0.044) had significantly thinner corneas compared to that in healthy controls (557.0 ± 38.1 µm). While best-corrected visual acuity showed a positive correlation with corneal resistance factor (r=0.363, p=0.045) and corneal hysteresis (r=0.414, p=0.021), corneal subepithelial infiltrate scoring showed a negative correlation with Goldmann correlated intraocular pressure (r=-0.479, p=0.006) and corneal compensated intraocular pressure (r=-0.413, p=0.021). Conclusion: Eyes with subepithelial corneal infiltrates had significantly thinner corneas compared to that in healthy controls. A positive correlation of the corneal resistance factor and corneal hysteresis with best-corrected visual acuity and a negative correlation of the Goldmann correlated intraocular pressure and corneal compensated intraocular pressure with corneal subepithelial infiltrate scoring should be taken into account when measuring intraocular pressure values in patients with subepithelial corneal infiltrates.

RESUMO Objetivo: Examinar o efeito de infiltrados sub-epiteliais corneanos nas propriedades biomecânicas da córnea após ceratoconjuntivite epidêmica, em comparação com controles saudáveis. Métodos: Este estudo transversal incluiu pacientes consecutivos com infiltrados sub-epiteliais corneanos bilaterais após ceratoconjuntivite epidêmica e controles saudáveis. Foram medidas a melhor acuidade visual corrigida, uma pontuação do infiltrado sub-epitelial da córnea, a escala de graduação de Fantes e a espessura central da córnea. A histerese da córnea, o fator de resistência da córnea, a pressão intraocular correlacionada à tonometria de Goldmann e a pressão intraocular compensada da córnea foram avaliados com o Ocular Response Analyzer. Resultados: Este estudo incluiu 66 olhos de 33 pacientes com infiltrados corneanos sub-epiteliais após ceratoconjuntivite epidêmica e selecionou aleatoriamente 37 olhos de 37 voluntários saudáveis. As pontuações médias da escala de Fantes e dos infiltrados sub-epiteliais corneanos nos primeiros olhos acometidos foram respectivamente de 1,8 ± 0,8 e 2,9 ± 1,3. Nos olhos contralaterais, foram respectivamente de 1,3 ± 1,1 e 1,9 ± 1,7 (p=0,009 e p=0,002, respectivamente). O primeiro e o segundo olhos envolvidos tinham córneas significativamente mais finas (respectivamente 526,1 ± 28,1 µm; p=0,005 e 523,4 ± 38,1 µm; p=0,044) em comparação com os controles saudáveis (557,0 ± 38,1 µm). Embora a acuidade visual melhor corrigida tenha mostrado uma correlação positiva com o fator de resistência da córnea (r=0,363, p=0,045) e com a histerese da córnea (r=0,414, p=0,021), a pontuação dos infiltrados sub-epiteliais corneanos mostrou uma correlação negativa com a pressão intraocular correlacionada à tonometria de Goldmann (r=-0,479, p=0,006) e com a pressão intraocular compensada da córnea (r=-0,413, p=0,021). Conclusão: Os olhos com infiltrados corneanos sub-epiteliais tinham córneas significativamente mais finas em comparação com os controles saudáveis. Ao se medirem os valores de pressão intraocular em pacientes com infiltrados sub-epiteliais corneanos, deve-se levar em consideração tanto as correlações positivas do fator de resistência da córnea e da histerese da córnea com a melhor acuidade visual corrigida quanto as correlações negativas da pressão intraocular correlacionada à tonometria de Goldmann e da pressão intraocular compensada da córnea com a pontuação do infiltrado sub-epitelial da córnea.

Comparison of the efficacy of latanoprost versus dorzolamide/timolol fixed combination therapy in patients with pseudoexfoliative glaucoma according to glaucoma stage.

PURPOSE: Only a few trials have compared the intraocular pressure-lowering effects of prostaglandin analogs to carbonic anhydrase inhibitor plus beta-blocker fixed-dose combination therapy in patients with pseudoexfoliative glaucoma. Furthermore, the influence of the glaucoma stage on the intraocular pressure-lowering effects of these drug types has not been studied. The purpose of this study was to compare the IOP-lowering efficacy of latanoprost, a prostaglandin analog versus dorzolamide/timolol fixed combination, a carbonic anhydrase inhibitor plus beta-blocker fixed-dose combination therapy, in patients with pseudoexfoliative glaucoma based on glaucoma stage. METHODS: The data of 32 eyes (32 patients) diagnosed with uniocular pseudoexfoliative glaucoma and treated with topical latanoprost (Group 1) or dorzolamide/timolol fixed combination (Group 2) were retrospectively assessed. The groups were subdivided into early and moderate-advanced stages. Patients' demographics, baseline intraocular pressure, final intraocular pressure, and intraocular pressure difference (the difference between the baseline and final intraocular pressure) were determined from medical records and compared between groups and according to glaucoma stage. RESULTS: The mean drug use duration was 17.7 ± 13.5 months. No significant differences in mean baseline intraocular pressure, mean final intraocular pressure and mean intraocular pressure difference between Groups 1 and 2. In Group 2, the mean intraocular pressure difference was significantly greater in patients with early versus moderate-advanced stage glaucoma (p=0.015). The difference, however, was not detected in Group 1. The mean intraocular pressure difference in early-stage glaucoma was significantly greater in Group 2 versus 1 (p=0.033). CONCLUSIONS: Latanoprost and dorzolamide/timolol fixed combination are effective treatments for newly diagnosed pseudoexfoliative glaucoma. In early-stage pseudoexfoliative glaucoma, greater intraocular pressure reduction was noted with dorzolamide/timolol fixed combination than with latanoprost; thus, dorzolamide/timolol fixed combination should be considered when a significant decrease in intraocular pressure is desired in early-stage glaucoma.

Factors Influencing the Success of Atropine Penalization Treatment in Amblyopia Patients Non-Responsive to Occlusion Treatment.

PURPOSE: To evaluate the efficacy of atropine penalization after non-response to patch therapy in amblyopic children and investigate the factors associated with treatment success. PATIENTS AND METHODS: In this retrospective study, 26 children with amblyopia who were non-responders to patch therapy who were then switched to 1% atropine eye drops in the sound eye for a minimum follow-up of one year were included. All patients underwent detailed eye examinations, including optical coherence tomography and fundus autofluorescence (FAF) imaging. Response to treatment was defined as a two-line improvement in best-corrected visual acuity (BCVA) in the amblyopic eye, and patients were divided into two groups: the responder group and the non-responder group. Demographic and clinical parameters were compared between the two groups. The average central macular thickness and FAF were analyzed. RESULTS: Sixteen of 26 patients (61.5%) showed treatment response. The mean age of the patients was 10.62 ± 3.42 (5-17) years. There was no difference between the groups in age, age at start of patch therapy, sex, follow-up period, refractive errors, type of amblyopia, reason for patch therapy non-response, or mean effective patching time per day. In the responder group, the LogMAR values of pretreatment BCVA, BCVA after optical correction, and BCVA after occlusion were significantly higher, but BCVA after atropine treatment showed no difference. FAF images of all patients were normal, and the mean central macular thickness did not significantly differ between the groups. CONCLUSIONS: Atropine penalization can improve BCVA in children with amblyopia who are non-responders to patch therapy. Atropine penalization may be more successful in children with poor BCVA at the start of atropine penalization in the amblyopic eye. The results of FAF imaging and mean central macular thickness were not associated with treatment outcomes.

Prevalence and Risk Factors of Work-Related Asthma in Hospital Cleaning Workers.

OBJECTIVE: This study aimed to determine the prevalence and evaluate the risk factors of work-related asthma among professional hospital cleaning workers. MATERIAL AND METHODS: In total, 278 cleaning workers were interviewed (response rate: 75.7%), and pulmonary function tests were performed. The presence of asthma and its work-relatedness was evaluated. Serial peak expiratory flow measurements were planned according to symptoms increased at work or spirometric findings. RESULTS: Totally 40 cleaning workers had asthma (14.3%); of these, 17 (6.1%) had work-related asthma, and 23 (8.2%) had non-work- related asthma. Non-work-related asthma and work-related asthma were significantly associated with the females(odds ratio 95% CI: 3.0, 1.1-8.4, and 3.2, 1.0-10.3, respectively). Non-work-related asthma was significantly associated with a family history of asthma (odds ratio 95%CI: 5.1, 2.0-13.2 and 2.8, 0.99-7.9, respectively) and limescale remover use at work (odds ratio, 95% CI: 0.21, 0.04-0.97, and 1.7, 0.5-5.2, respectively). Only 7 (28.0%) of 25 cleaning workers who were suggested serial peak expiratory flow measurements could complete the measurements. Of those, measurements of 2 cleaning workers were consistent with occupational asthma. CONCLUSION: The negative association between limescale remover use at work and non-work-related asthma suggested health selec- tion bias (avoidance behavior) due to the asthmatic effects of these chemicals.

Comparison of horizontal muscle transposition and Inferior oblique weakening combined with horizontal surgery in V-pattern exotropia.

PURPOSE: The objective of this study was to compare the effects of horizontal muscle transposition and inferior oblique weakening combined with horizontal surgery performed for V-pattern exotropia (XT) and to determine the most successful approach. METHODS: In our retrospective study, 52 patients who underwent horizontal surgery due to V-pattern XT and were followed up for at least 6 months were divided into two groups. Group 1 (n = 26) consisted of patients who underwent vertical transposition of the rectus muscles combined with horizontal surgery, and group 2 (n = 26) consisted of patients who underwent inferior oblique weakening combined with horizontal surgery. The two groups were compared before and after surgery in terms of visual acuity, refractive errors, deviation angles, pattern strabismus, fusion, stereopsis, over/under correction and surgical success. RESULTS: There was no difference between the two groups in terms of age, follow-up period, visual acuity, refractive errors, fusion or stereopsis. The amount of horizontal deviation was smaller in group 2 at the 1-6-month follow-ups. There was no difference between the two groups in terms of pattern collapse; however, the amount of pattern postoperatively was lower in group 2. The two groups were similar in terms of overcorrection; however, the undercorrection rate was higher in group 1. The surgical success rate was higher in group 2. CONCLUSIONS: Inferior oblique weakening combined with horizontal surgery due to V-pattern XT was found to be superior to vertical transposition of the horizontal muscles in terms of surgical success and the amount of pattern postoperatively.

Evaluation of the impact of subepithelial corneal infiltrates on corneal biomechanics after epidemic keratoconjunctivitis.

PURPOSE: To examine the effect of subepithelial corneal infiltrates on corneal biomechanical properties after epidemic keratoconjunctivitis compared to that in healthy controls. METHODS: The cross-sectional study included consecutive patients with bilateral subepithelial corneal infiltrates after epidemic keratoconjunctivitis and healthy controls. Best corrected visual acuity corneal subepithelial infiltrate scoring Fantes grading scale, and central corneal thickness were measured. Corneal hysteresis corneal resistance factor Goldmann correlated intraocular pressure and corneal compensated intraocular pressure were assessed using an ocular response analyzer. RESULTS: This study included 66 eyes of 33 patients with subepithelial corneal infiltrates following epidemic keratoconjunctivitis and randomly selected 37 eyes of 37 healthy volunteers. The mean Fantes and CSIS scores were 1.8 ± 0.8 and 2.9 ± 1.3, respectively, in the first involved eyes and 1.3 ± 1.1 and 1.9 ± 1.7, respectively, in the fellow eyes (p=0.009 and p=0.002, respectively). The first (526.1 ± 28.1 µm; p=0.005) and second involved eyes (523.4 ± 38.1 µm; p=0.044) had significantly thinner corneas compared to that in healthy controls (557.0 ± 38.1 µm). While best-corrected visual acuity showed a positive correlation with corneal resistance factor (r=0.363, p=0.045) and corneal hysteresis (r=0.414, p=0.021), corneal subepithelial infiltrate scoring showed a negative correlation with Goldmann correlated intraocular pressure (r=-0.479, p=0.006) and corneal compensated intraocular pressure (r=-0.413, p=0.021). CONCLUSION: Eyes with subepithelial corneal infiltrates had significantly thinner corneas compared to that in healthy controls. A positive correlation of the corneal resistance factor and corneal hysteresis with best-corrected visual acuity and a negative correlation of the Goldmann correlated intraocular pressure and corneal compensated intraocular pressure with corneal subepithelial infiltrate scoring should be taken into account when measuring intraocular pressure values in patients with subepithelial corneal infiltrates.

The Impact of Bilateral Subepithelial Corneal Infiltrates on Tear Film After Epidemic Keratoconjunctivitis.

OBJECTIVES: To evaluate the effect of corneal subepithelial infiltrates (SEIs) on tear film function and best-corrected visual acuity (BCVA) after persistent epidemic keratoconjunctivitis (EKC) and to compare the findings with controls. METHODS: In this prospective, cross-sectional study, 38 patients with EKC and 42 healthy volunteers were enrolled. While patients with SEIs after EKC made up groups 1a (first involved eye) and 1b (second involved eye), healthy controls made up group 2. Best-corrected visual acuity, corneal subepithelial infiltrate scoring (CSIS), Fantes score, tear breakup time (TBUT), Schirmer test, and ocular surface disease index (OSDI) scores were measured. The Oxford grading system was used to score corneal staining. RESULTS: The mean Fantes score was 1.8±0.8 for group 1a and 1.3±1.1 for group 1b (P=0.03). The mean CSIS was 2.9±1.3 for group 1a and 1.9±1.7 for group 1b (P=0.005). But there was no significant difference in terms of the mean BCVA, TBUT, Schirmer, OSDI, and Oxford grading (P=0.66, 0.9, 0.9, 0.9, and 1.0, respectively) between group 1a and group 1b. The mean BCVA, TBUT, Schirmer, and OSDI values were worse in group 1a and group 1b in comparison to group 2 (P=0.001). CONCLUSIONS: We showed that the first involved eyes of patients with SEIs may be affected more significantly, but this difference may not have a clinical reflection on the difference in tear film functions between two eyes. However, compared with the healthy eyes, tear film function and BCVA were equally compromised in both eyes of the patients with SEIs irrelevant to the involved eye.

TNF-α and IL-6 as Biomarkers of Impaired Lung Functions in Dimethylacetamide Exposure.

BACKGROUND: Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) are well-known biomarkers of systemic inflammation that have been associated with many diseases in the past. In this study, we aimed to determine the relationship between impaired lung functions and the levels of these biomarkers in DMAc exposed people. METHODS: 101 non-exposed control subjects (Group 1) and 109 DMAc-exposed workers from the polyvinyl chloride (PVC) industry were included in the study. In the next step, the exposed group was divided into two groups according to the level of exposure (Group 2 and 3). DMAc, TNF-α, IL-6, creatinine, ALT, AST, GFR and standard spirometry measurements were carried out in all subjects. RESULTS: When compared to the control group, TNF-α and IL-6 levels were significantly high compatible with the increase of DMAc levels, in the exposed groups. Urinary DMAc Levels were 0.06 mg/L in the control group. This level is significantly low when compared to exposed and severely exposed group (2.43 mg/L and 3.17 mg/L). TNF-α levels were 56.86 pg/mL, 145.52 pg/mL and 230.52 pg/mL in control, exposed and severely exposed groups. IL-6 levels were found to be 38.08 pg/mL, 89.19 pg/mL and 116 pg/mL for control, exposed and severely exposed groups, respectively. Similarly, the FEV1/FVC ratio decreased especially in the severely exposed group (p 0.001). CONCLUSIONS: In our study, results have revealed that TNF-and IL-6 levels are promising biomarkers in the early diagnosis of lung function impairment in inhalational DMAc exposure.

Arsenic-induced inflammation in workers.

Occupational and environmental exposures to metal and metalloids can result in neurotoxicity and immunotoxicity. Selenium (Se) is essential for the proper functioning of neutrophils, macrophages, natural killer (NK) cells, T-lymphocytes and other immune mechanisms, while zinc (Zn) is a trace element essential for basic cell activities, including cell growth and differentiation. Arsenic (As) may lead to different types of immunosuppressive effects. This study consisted of 62 male workers, who had been exposed to arsenic for different durations and 73 non-exposed male workers (control group) with no history of occupational toxic metal exposure. Whole blood and serum samples were taken from each participant for immunological, toxicological and routine analysis during their annual periodical examination. Arsenic, selenium and zinc levels were determined by the ICP-MS and cytokines, IL-6, IL-10, TNF-α, sE-selectin and VCAM-1, were measured by ELISA. There were statistically significant differences (p < 0.001) between control and As-exposed group in As (1.37 ± 0.42 vs. 4.27 ± 1.54 µg/L) and Se levels (106.37 ± 48.04 vs. 74.70 ± 30.45 µg/L). The changing levels of As, Zn and Se seems to affect the severity of inflammatory reactions based on IL-6, IL-10 and TNF-α levels (r = 0.755, r = 0.679 and r = 0.617, respectively, for all p < 0.01). Selenium was found to have a suppressive effect on cytokines, as evidenced by Pearson correlations and regression analysis. These findings support the need to closely monitor Se levels in individuals exposed to arsenic and benefits for Se supplementation in the case of arsenic exposure, occupationally or environmentally.

Serum sCTLA-4 levels and clinical manifestations in ankylosing spondylitis patients.

OBJECTIVE: T cell abnormal activation is thought to have a main role in the etiology of ankylosing spondylitis (AS). While cytotoxic T lymphocyte-associated molecule-4 (CTLA-4) is suppressing the immune system, in previous studies serum soluble CTLA-4 (sCTLA-4) was detected at high amounts in autoimmune disorders. We sought to evaluate the association between soluble CTLA-4 in serum and disease activity in AS patients. METHODS: Thirty-eight patients with AS, 28 rheumatoid arthritis (RA) patients, and 27 disease-free controls were enrolled to the study. The levels of sCTLA-4 were determined for each participant using an enzyme-linked immunosorbent assay. The erythrocyte sedimentation rate (ESR), C-reactive peptide, and demographic characteristics were documented. The data were analyzed by using relevant statistical methods. RESULTS: In comparison with RA patients and controls, patients with AS showed high sCTLA-4 levels (p<0.001). The sCTLA-4 levels did not correlate with the severity of the disease in AS patients (p=0.370). The ESR levels and Bath Ankylosing Spondylitis Disease Activity Index were correlated in AS patients (p=0.012). CONCLUSION: We evaluated the association between the disease severity of AS and sCTLA-4. Although, the correlation was not shown, sCTLA-4 was highest in the AS group. Further studies with larger samples should be completed to attain a better understanding of the AS etiology.

Efficacy and Safety of Intravitreal Dexamethasone Implants for Treatment of Refractory Diabetic Macular Edema.

PURPOSE: To evaluate the safety and efficacy of intravitreal dexamethasone (IVD) implants in eyes with diabetic macular edema that did not respond to previous treatment. METHODS: We included 46 eyes of 46 patients in this retrospective study. Each month, we recorded patient visual acuity with logarithm of the minimum angle of resolution using the Early Treatment Diabetic Retinopathy Study chart, central macular thickness measurements with optical coherence tomography, intraocular pressure (IOP), and posttreatment complication occurrence. RESULTS: The mean follow-up time was 8.95 ± 1.33 months (range, 6 to 12). Best-corrected visual acuity improved significantly in the first 4 months after IVD, but no statistically significant change was observed over the following 2 months. Although a statistically significant decrease in central macular thickness was observed in the first 3 months, the change was not statistically significant in the following 3 months. There was a statistically significant increase in IOP in the first 2 months, but no statistically significant change was observed in the following months. IOP was controlled with medication in all patients with elevated IOP. Of the 26 phakic patients, two had cataracts requiring surgery. CONCLUSIONS: Cases of refractory diabetic macular edema that did not respond to previous treatment, such as anti-vascular endothelial growth factor injections and laser photocoagulation, exhibited improvements in visual acuity and decreases in retinal thickness after IVD implantation. Both functional and anatomical effects were observed in the first 3 months after injection. Repeat injections and frequent examination might be required for continued improvement. Side effects, such as cataracts and elevation of IOP, may require medical or surgical treatment.

A Comparison of Refraction Defects in Childhood Measured Using Plusoptix S09, 2WIN Photorefractometer, Benchtop Autorefractometer, and Cycloplegic Retinoscopy.

PURPOSE: To compare Plusoptix (Gmbh, Nuremberg, Germany), 2WIN (Adaptica, Padua, Italy), the benchtop refractometer (Auto-Kerato-Refractometer KR-8900; Topcon Co, Tokyo, Japan), and retinoscopy with regard to the consistencies. MATERIALS AND METHODS: In our prospective study, 200 eyes of 100 patients were included. We analyzed the demographics and characteristics of the patients, the percentage of patients from whom measurements could not be obtained, the measurements from both patients' eyes of pupil diameter, spherical, cylindrical, axis, and spherical equivalence. RESULTS: The mean age ± SD was 7.8±4.5 years (range, 1-18 years). Pupil diameter measurements were found to be consistent (Cronbach's alpha value >0.8). The sphere and spherical equivalence measurements for both eyes were found to be consistent with each other in all apparatus (Cronbach's alpha value >0.8). However, consistency was found to be lower in cylindrical values and the Jackson cross-cylinder measurements at 0° and 45° axis were found to be inconsistent with each other (Cronbach's alpha value <0.8). CONCLUSIONS: While consistency was observed in all methods in terms of sphere and spherical equivalence, consistency dropped in cylindrical values and no consistency was observed in axis values. It is important to take this point into consideration, especially in axis measurements.

In Vivo Evaluation of the Biomechanical Properties of Optic Nerve and Peripapillary Structures by Ultrasonic Shear Wave Elastography in Glaucoma.

BACKGROUND: Primary open-angle glaucoma is a multifactorial serious disease characterized by progressive retinal ganglion cell death and loss of visual field. OBJECTIVES: The purposes of this study were to investigate shear wave elastography (SWE) use in the evaluation of the optic nerve (ON) and peripapillary structures, and to compare the findings between glaucomatous and control eyes. PATIENTS AND METHODS: A case-controlled study, including 21 patients with primary open-angle glaucoma and 21 age-matched control subjects, was carried out. All of the participants had comprehensive ophthalmological exams that included corneal biomechanical measurements with ocular response analyzer. In vivo evaluation of the biomechanical properties of the ON and peripapillary structures were performed with SWE in all participants. The Kolmogorov-Smirnov test was used to analyze the normal distribution of data. Differences of parameters in ophthalmologic data and stiffness values of patients with and without glaucoma were evaluated using the Mann-Whitney U test. RESULTS: There were no statistically significant differences between the glaucoma and control groups in terms of age (P > 0.05) and gender (P > 0.05). Corneal hysteresis was lower in the glaucoma group (P < 0.05). Corneal compensated intraocular pressure and Goldmann correlated intraocular pressure were higher in the glaucoma group (P < 0.0001 for both). The mean stiffness of the ON and peripapillary structures were significantly higher in glaucoma patients for each measured region (P < 0.05). CONCLUSION: The study evaluated the biomechanical properties of the ON and peripapillary structures in vivo with SWE in glaucoma. We observed stiffer ON and peripapillary tissue in glaucomatous eyes, indicating that SWE claims new perspectives in the evaluation of ON and peripapillary structures in glaucoma disease.

Optic nerve head topography and retinal structural changes in eyes with macrodisks: a comparative study with spectral domain optical coherence tomography.

PURPOSE: To compare optic nerve head parameters, the thicknesses of the peripapillary retinal nerve fiber layer (pRNFL), the macular retinal nerve fiber layer (mRNFL), the ganglion cell complex (GCC), and the ganglion cell-inner plexiform layer (GCIPL) in macrodisks and normal-sized healthy disks using spectral domain optical coherence tomography. PATIENTS AND METHODS: A total of 88 healthy eyes (42 macrodisks and 46 normal-sized disks) were prospectively enrolled in the study. Optic nerve head parameters as well as pRNFL, mRNFL, GCC, and GCIPL thicknesses were measured in all subjects. Optic disk areas (ODAs) >2.70 mm(2) were defined as macrodisks. All spectral domain optical coherence tomography parameters were compared between normal-sized disks and macrodisks. RESULTS: The mean age of the participants was 49.4±5.7 years in the normal size group and 51.55±6.3 years in the macrodisk group (P=0.65). The average ODAs were 2.23±0.29 mm(2) and 3.30±0.59 mm(2) in the normal size and the macrodisk groups, respectively. ODA (P<0.001), cup area (P<0.001), cup disk area ratio (P<0.001), horizontal cup disk ratio (P<0.001), vertical cup disk ratio (P<0.001), horizontal disk diameter (P<0.001), vertical disk diameter (P<0.001), and cup volume (P<0.001) were significantly higher in the macrodisk group. The inferior mRNFL thickness was significantly lower (P=0.042), and the GCC inferior and GCIPL inferior thicknesses were found to be lower with low significance (P=0.052, P=0.059, respectively) in the macrodisk group. Rim volume (P=0.622), total pRNFL (P=0.201), superior pRNFL (P=0.123), inferior pRNFL (P=0.168), average macular thickness (P=0.162), total mRNFL (P=0.171), superior mRNFL (P=0.356), total GCC (P=0.080), superior GCC (P=0.261), total GCIPL (P=0.214), and superior GCIPL (P=0.515) thicknesses were similar in both groups. CONCLUSION: Optic disk topography and retinal structures show different characteristics in healthy eyes with macrodisks. These disk size-dependent variations suggest that large optic disks may be more susceptible to glaucomatous damage.

A retrospective analysis of vision correction and safety in keratoconus patients wearing Toris K soft contact lenses.

The purpose of this study was to investigate the efficacy and safety of the Toris K silicone hydrogel contact lens (SwissLens; Prilly, Switzerland) in keratoconus patients. A database with information on 50 keratoconus patients (64 eyes) fitted with Toris K soft contact lenses over a 2-year period was retrospectively reviewed. Demographic data, prefitting refraction, the reason for choosing the Toris K soft contact lens, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), best-corrected visual acuity with a rigid gas permeable lens (BCVA RGP), best-corrected visual acuity with the Toris K lens (BCVA Toris K), and complications were evaluated. The mean age ± standard deviation at the time of fitting was 27.92 ± 9.86 years. The mean spherical refractive power was -4.62 ± 6.53 dioptres, and the mean cylinder was -3.78 ± 2.43 dioptres. The most common reason for using Toris K soft contact lenses was an inability to fit the patient with a RGP contact lens. There was a statistically significant difference between UCVA and BCVA Toris K (p = 0.0001), as well as between BSCVA and BCVA Toris K (p = 0.0001). However, there was no statistically significant difference between BCVA Toris K and BCVA RGP (p = 0.20). Superficial punctate keratitis and giant papillary conjunctivitis were the most common complications. The Toris K contact lens is a viable alternative for the optical management of all grades of keratoconus. The Toris K soft contact lens is a promising alternative for the visual rehabilitation of keratoconus patients who cannot tolerate RGP lenses or achieve a good fit.

The Efficiency of Intravitreal Dexamethasone Implants in the Treatment of Macular Edema Secondary to Retinal Vein Occlusion.

PURPOSE: To evaluate the efficacy and safety of dexamethasone (DEX) intravitreal implant for the treatment of macular edema due to branch retinal vein occlusion. METHODS: We included 22 eyes of 22 patients in this retrospective study. Visual acuity tested in logMAR with Early Treatment Diabetic Retinopathy Study (ETDRS) chart, central macular thickness (CMT) measurements, intraocular pressure (IOP), and side effects after treatment were observed monthly. RESULTS: Best corrected visual acuity improved significantly in the first 3 months after the first intravitreal DEX implantation, but no statistically significant change was observed in the following 3 months. Statistically significant improvement was observed in the first 4 months after the second injection of DEX implant, but no statistically significant change was observed in the 2 following months. A statistically significant decrease in CMT was observed in the first 4 months after the first injection, but no statistically significant change was observed in the following 2 months. A statistically significant decrease in CMT was observed in the first 3 months after the second injection, but no statistically significant change was observed in the following 3 months. The IOP could be controlled with medication in all the participants with elevated IOP. Of the patients, 3 had cataracts requiring surgery. CONCLUSION: Both functional and anatomical effects of DEX implant were obvious in the first 3 months after injection. Repeated injections and frequent examination might be required. Side effects such as cataract may require surgical intervention, whereas IOP elevation may be managed by topical drops.

Efficacy and safety of Pro Re Nata regimen without loading dose ranibizumab injections in retinal vein occlusion.

OBJECTIVES: To evaluate the effects and safety of intravitreal ranibizumab on visual acuity and anatomic results in the treatment of macular edema due to retinal vein occlusion (RVO). METHODS: Forty Six eyes of 45 patients who were administered intravitreal ranibizumab because of macular edema due to Retinal Vein Occlusion (RVO) were included in this retrospective clinical study. During monthly follow-up, the best corrected visual acuity values in terms of LogMAR with The Early Treatment Diabetic Retinopathy Study (ETDRS) chart, central macular thickness (CMT), and complications were examined. Cases were classified as central retinal vein occlusion (CRVO), superotemporal branch retinal vein occlusion (BRVO), and inferotemporal BRVO. We only included RVO patients but using ETDRS chart for the vision measurement. RESULTS: In all follow-up months, there was a significant increase in BCVA in all RVO cases and in superotemporal BRVO cases after the first injection of ranibizumab. Although there was no significant increase in the 1(st) month of follow-up period compared to pre-treatment, there was significant increase in 2-6 months in inferotemporal BRVO patients. There was no statistically significant increase in 1(st) and 2(nd) month follow-up periods compared to pre-treatment; however there was a significant increase in 3-6 months in the CRVO patients. There was a significant decrease in average CMT measurements in all follow-up months compared to pre-treatment in all RVO cases, in superotemporal and inferotemporal BRVO cases. There was no significant decrease in average CMT measurements in the 1(st), 2nd, and 3(rd) months compared to pre-treatment although there was a significant decrease in 4-6 months in cases included in the CRVO patients. CONCLUSIONS: Intraocular ranibizumab injections provided rapid, effective treatment for macular edema due to RVO with low rates of ocular and nonocular safety events. However, repeated injections and frequent follow-up intervals may be required.