Quantitative analysis of retinal microvascular structure and correlation with ocular parameters: A normative database of pediatric OCT angiography.

PURPOSE: To analyze the vascular structure of the healthy pediatric population using optical coherence tomography angiography (OCTA), and to investigate its relationship with ocular parameters. MATERIALS AND METHOD: This cross-sectional, prospective study included 142 eyes of 71 healthy subjects aged 8-18 years. All patients underwent a complete ocular assessment, biometric evaluation and OCTA analysis. Anterior chamber depth, axial length, corneal thickness values were also reported and their relationship with OCTA measurements was evaluated. RESULTS: There was no statistical difference between girls and boys in terms of demographic characteristics (p>0.05). Neither vascular density in the deep and superficial capillary plexus nor FAZ area was significantly related to the ocular parameters or age of any patient in the study. CONCLUSIONS: Despite the relatively small number of participants, this study may represent normative data for the Turkish pediatric population. It was also shown that vascular density and FAZ area in childhood are not affected by age, axis length, anterior chamber depth, cornea and foveal thickness.

Early-term Optical Coherence Tomography Angiographic Findings in Pediatric Patients Infected with COVID-19.

PURPOSE: The aim of this study was to investigate possible vascular changes in pediatric patients infected with COVID-19 and to compare these with an age-matched control group. METHODS: All patients underwent an ocular assessment and optical coherence tomography angiography examination. Two vascular networks were analyzed as the superficial and deep regions. RESULTS: Evaluation was made of 40 eyes of 20 patients who had recently recovered from COVID infection and 80 eyes of 40 healthy individuals. The DCP-VD values of the COVID group were significantly lower than the control group in most quadrants. The FAZ PERIM and FAZ area values in the COVID patients were higher than the control group, but not statistically significant (p>.05). CONCLUSION: Pediatric cases of COVID-19 may differ from adults based on structural and immune response differences, and that OCTA can be a noninvasive guide for analysis of the end-organ effects of pediatric COVID disease.

Longitudinal evaluation of retinal thickness and OCTA parameters before and following silicone oil removal in eyes with macula-on and macula-off retinal detachments.

BACKGROUND: To investigate the longitudinal retinal vascular and structural alterations by using OCTA following successful repair of retinal detachment (RD) by using silicone oil (SO) endotamponade. METHODS: A prospective cohort study was performed on 24 eyes of 24 subjects; 17 of them with macula-off and seven with macula-on RD. At least four OCTA scans were generated for each study eye; two before and two after SO removal (SOR). At each session, retinal thickness (RT), vascular density (VD) in the superficial (SCP) and deep capillary plexuses (DCP) and foveal avascular zone(FAZ) size were measured within the fovea, parafovea and whole macular image. The changes in repeated measures of the same parameters especially before and after SOR were performed and compared within macula-on and macula-off groups and between fellow eyes. RESULTS: "In the macula-off eyes, RT measurements within the whole macula, fovea and parafovea reduced as compared with their fellow eyes(p < 0.0001, p = 0.001 and p < 0.0001, respectively) and did not improve after SOR. Additionally, all of the whole macular, foveal, and parafoveal VD measurements at SCP and foveal VD at DCP were less than their fellow eyes after SOR (p = 0.026, p = 0.023 p = 0.026, and p = 0.002, respectively). In macula-on eyes, RT measurements decreased within the parafovea and whole macular area before SOR (p = 0.018 and p = 0.011, respectively) but improved after SOR. Also, VD measurements did not change during follow-up and were not statistically different than their fellow eyes (p > 0.05). FAZ enlargement was found in eyes with macular-off RD after SOR, whereas it was not observed with macular-on RD (p = 0.038and p = 0.237, respectively). CONCLUSIONS: Treatment of macula-off RD with SO tamponade has been associated with vascular retinal abnormalities which did not improve following SOR. On the contrary, successful treatment of RD with SO tamponade in macula-on eyes VD measurements of SCP and DCP were not statistically different than their fellow eyes.

Results of multicenter registry for patients with inherited factor VII deficiency in Turkey.

INTRODUCTION: Inherited factor VII (FVII) deficiency (FVIID) is the most common of inherited rare bleeding disorders. Other determinants of clinical severity apart from FVII level (FVIIL) include genetic and environmental factors. We aimed to identify the cut-off FVIILs for general and severe bleedings in patients with FVIID by using an online national registry system including clinical, laboratory, and demographic characteristics of patients. METHODS: Demographic, clinical, and laboratory data of patients with FVIID extracted from the national database, constituted by the Turkish Society of Hematology, were examined. Bleeding phenotypes, general characteristics, and laboratory features were assessed in terms of FVIILs. Bleeding rates and prophylaxis during special procedures/interventions were also recorded. RESULTS: Data from 197 patients showed that 46.2% of patients had FVIIL< 10%. Most bleeds were of mucosal origin (67.7%), and severe bleeds tended to occur in younger patients (median age: 15 (IQR:6-29)). Cut-off FVIILs for all and severe bleeds were 16.5% and 7.5%, respectively. The major reason for long-term prophylaxis was observed as central nervous system bleeding (80%). CONCLUSION: Our data are consistent with most of the published literature in terms of cut-off FVIIL for bleeding, as well as reasons for prophylaxis, showing both an increased severity of bleeding and younger age at diagnosis with decreasing FVIIL. However, in order to offer a classification similar to that in Hemophilia A or B, data of a larger cohort with information about environmental and genetic factors are required.

Optical coherence tomography-signal strength index following trifocal and monofocal intraocular lens implantation.

PURPOSE: To evaluate the influence of trifocal and monofocal intraocular lens implantation on the optical coherence tomography-signal strength index values obtained during macular and peripapillary scanning. METHOD: Study group included 60 eyes of 60 patients with intraocular lens (Acriva BB UD 613 monofocal in 30 eyes and Acriva Trinova UD trifocal in 30 eyes) implantation after uneventful phacoemulsification. Thirty eyes of 30 healthy subjects without any intraocular surgery were selected as the control group. Eyes with best corrected visual acuity less than 20/20 due to any media opacity, high refractive errors excluded. Macular and retinal nerve fiber layer scans were generated by optical coherence tomography after pupillary dilation. Intergroup comparisons of signal strength index values of the macular and peripapillary scans were performed between eyes implanted with two different intraocular lenses and control group. RESULTS: The mean signal strength index of the peripapillary and macular scans obtained in the eyes implanted with both monofocal and trifocal intraocular lenses were statistically less than the control group (p < 0.05, for all). SSI's of macular and peripapillary scans recorded from the eyes implanted with either monofocal or trifocal intraocular lenses were not statistically different from each other (p = 0.957 and p = 0.877, respectively). CONCLUSION: In the present study despite different intraocular lenses properties, the image quality values were not found to be lower in eyes with trifocal sinusoidal intraocular lenses implantation compared to monofocal intraocular lenses during macular and peripapillary optical coherence tomography scans.

Assessment of lens autofluorescence in patients with well-controlled essential hypertension and those with renal failure secondary to hypertension undergoing hemodialysis.

PURPOSE: To compare the lens autofluorescence (AF) levels among patients with end-stage renal failure and undergoing hemodialysis secondary to hypertension, patients with well-controlled hypertension, and healthy controls. METHOD: This study was a prospective, cross-sectional, comparative study conducted between February and April 2018. Two groups of patients and a group of healthy individuals were included in the study. The first group of patients included individuals with a renal insufficiency due to essential hypertension who underwent regular hemodialysis treatment (dialysis group). The second group included patients with well-controlled essential hypertension (hypertension group). Lens autofluorescence was measured via a scanning confocal lens fluorescence biomicroscope optical system for all participants. The measurement of fluorescence ratio is given as a numerical data. The AF results were compared in all groups. RESULTS: The study included 87 individuals. There were 29 individuals (33.3 %) in the dialysis group, 30 (34.5 %) in the hypertension group, and 28 (32.2 %) in the healthy group. The mean fluorescence ratio(FR) was 0.20 ± 0.06, 0.20 ± 0.04, and 0.17 ± 0.04 in the dialysis, hypertension, and healthy groups respectively. There was a significant difference in the mean FR measurements between the three groups (p = .004). As a result of a binary comparison, mean FR values for patients in the dialysis group were higher (0.20 ± 0.06) than for healthy individuals (0.17 ± 0.04), which was statistically significant (p = .025). Mean FR measurements of hypertensive patients were higher (0.20 ± 0.04) than healthy individuals (0.17 ± 0.04), which was also statistically significant (p = .02). However, there was no statistically significant difference among the mean FR measurements between the hypertension and dialysis groups (p = .63). CONCLUSION: We demonstrated that lens autofluorescence increased in patients with renal failure undergoing hemodialysis and those with well-controlled hypertension. The mean lens autofluorescence levels were significantly higher in both patient groups than the healthy control group.

Visual performance and patient satisfaction following the implantation of a novel trifocal supplementary intraocular lens.

PURPOSE: To evaluate the visual quality, visual performance, and patient satisfaction after the implantation of the last generation supplementary intraocular lens (1stQ AddOn Trifocal) for achieving near vision spectacle-independence in pseudophakic patients who had primary monofocal capsular bag implantation. METHODS: Patients who underwent monofocal lens surgery in the past year, and who expressed their explicit desire to become spectacle-independent were included in this prospective observational study. Uncorrected and corrected distance, intermediate and near visual acuities (CDVA, UDVA, DCIVA, UIVA, CNVA, and UNVA), refractive outcomes, lens positioning, contrast sensitivity and patient satisfaction were assessed 6 months postoperatively. RESULTS: About 28 eyes of 18 patients were evaluated. No intra- or postoperative complications (iris chafing, iris capture, interlenticular opacification, IOL-dislocation, etc.) could be observed. The postoperative mean UDVA and CDVA were 0.05 ± 0.08 and 0.01 ± 0.03 (logMAR), respectively. The mean UNVA improved from the preoperative 0.50 ± 0.23 to 0.02 ± 0.05 (logMAR), postoperatively (p = 0.0104). The postoperative mean UIVA and DCIVA were 0.06 ± 0.020 and 0.01 ± 0.00 (logMAR), respectively. Twenty-five eyes (89%) had a residual spherical equivalent within 1.0 D from the target refraction, emmetropia. Contrast sensitivity measured in photopic and mesopic conditions were statistically indifferent from the preoperative curves. All patients had better visual function and quality scores compared to the preoperative responses. The highest improvement could be achieved in near vision activities, dependency, and limitation of social functioning. CONCLUSION: The 1stQ AddOn Trifocal lens represents a safe and effective option for pseudophakic patients aiming for high quality, spectacle-free vision.

Inter-Ocular Symmetry of Vascular Density and Retinal Thickness in Unilateral Anisometropic Amblyopia.

BACKGROUND: Inter-ocular symmetry of macular vascular anatomy in healthy subjects has been well documented in previous optical coherence tomography angiography (OCTA) studies. In our present study, we have demonstrated that the presence of anisometropic amblyopia in one eye does not alter this unique feature significantly. We investigated whether the presence of unilateral anisometropic amblyopia due to moderate amounts of hyperopia and/or astigmatism would have any significant influence on measurements of retinal thickness (RT) and superficial vessel density (SVD) in adult subjects. SUBJECTS AND METHODS: In the study group, both eyes of 21 adult subjects with unilateral anisometropic amblyopia were enrolled. Only one eye of an age-matched control group including 33 subjects was randomly selected. RT and SVD were measured in foveal and parafoveal retinal areas and compared in amblyopic eyes, their fellow eyes and in the control group. Inter-ocular symmetry of RT and SVD in amblyopic and fellow eyes were investigated by using correlation analysis. RESULTS: There were statistically significant inter-ocular correlations of foveal and parafoveal RT in amblyopic and fellow eyes (P < 0.0001, for both). Foveal and parafoveal RT of the control group were not statistically different from amblyopic eyes (P = 0.072 and P = 0.46, respectively). There was no difference between foveal SVD of amblyopic eyes and control group (P = 0.10) and a significant inter-ocular correlation was found between amblyopic and fellow eyes (P = 0.029). CONCLUSION: For our adult subjects, none of the investigated OCTA parameters of the amblyopic eyes were found to be statistically different from those of age-matched controls. The preservation of inter-ocular symmetry in the amblyopic and fellow eyes implies that the influence of anisometropic amblyopia in one eye would be relatively small and negligible on routine OCTA examination.

Results of Callisto Eye System in Toric Intraocular Lens Alignment.

OBJECTIVES: This study was an evaluation of the effectiveness of the Callisto eye image-guided, markerless system (Carl Zeiss Meditec AG, Jena, Germany) in toric intraocular lens (IOL) positioning. METHODS: The results of a novel, markerless, alignment system used for IOL positioning were analyzed in this retrospective study. Preoperatively, reference image registration was performed with the IOLMaster 700 biometer (Carl Zeiss Meditec AG, Jena, Germany) and transferred to the Callisto eye system, which was used in conjunction with an Opmi Lumera 700 microscope (Carl Zeiss Meditec AG, Jena, Germany). Using the Callisto Z Align technology, a toric IOL was aligned precisely with the steep axis. One day after surgery, the pupil was fully dilated and a thin slit was placed on the marker of the toric IOL and the angle was measured using an axis calculator smartphone application. The degree of the measured angle and the preoperatively determined angle were compared. RESULTS: Sixty eyes of 46 patients were included. The difference in the absolute angle between the intended and the postoperative (at day 1) axes was a mean of 2.71±1.64°. CONCLUSION: The Callisto eye image-guided, markerless system successfully provided assistance in precisely positioning the toric IOL.

Pantoe Agglomerans Endophthalmitis after Phaco Surgery: The First Case in Literature.

Purpose: The aim of this study was to report endophthalmitis caused by pantoe agglomerans after phacoemulsification surgery for the first time in English literature.Material-method: A 44-year-old male patient was referred to Yeniyuzyil University Gaziosmanpasa Hospital because of sudden painful vision loss in his right eye.Result: Pantoea agglomerans was identified in the culture of humor from the anterior chamber and vitreous. Based on the antibiotic susceptibility test, P.Agglomerans species culture was sensitive to ciprofloxacin.Conclusion: This is the first reported case of endophthalmitis after cataract surgery.

5-Fluorouracyl added infusion fluid in patients with recurrent rhegmatogeneous retinal detachment.

PURPOSE: To compare the efficacy of 5-fluorouracil (5-FU) added the infusion fluid with a control group in the event of grade C PVR in recurrent retinal detachment (RD). METHODS: The records of the patients with recurrent retinal detachment with grade C PVR who underwent vitrectomy for retinal detachment surgery between April 2003 and October 2004 were reviewed retrospectively for this comparative study. The recurrent retinal detachment patients with grade C PVR who underwent vitrectomy and had a minimum post-operative follow-up period of 12 months were included. The patients were divided into two groups as study and control groups. 5-FU (200 microgram/ml) and low-molecular-weight-heparin (LMWH) (5 IU/ml) was added into the infusion solution of the study group. Primary outcome measure of this study was the single operation anatomical success at month 12. RESULTS: A total of 43 eyes of 43 patients were included. The control group was consisted of 26 eyes (60.5%) and the 5-FU group was consisted of 17 eyes (39.5%). At month 12, single operation anatomical success was obtained in 14 of the 26 patients (53.8%) in the control group and in 16 of the 17 patients (94.1%) in the 5-FU group (p = 0.005). CONCLUSION: Favorable outcomes were obtained in the patients with recurrent RD and grade C PVR in whom 5-FU and LMWH added infusion fluid which was used during vitrectomy.

The assessment of autofluorescence of the crystalline lens in diabetic patients and healthy controls: can it be used as a screening test?

BACKGROUND: Our purpose was to demonstrate if measuring lens autofluorescence (AF) with a scanning confocal biomicroscope may be used to identify subjects with undiagnosed type II diabetes mellitus (DM), and hence, for it to be used as a marker for the severity of diabetic retinopathy in diabetic patients. PATIENTS AND METHODS: In this cross-sectional, comparative study, lens AF was measured with scanning confocal lens fluorescence biomicroscope in diabetic and healthy groups. Full ophthalmological examination was performed. Blood tests of fasting plasma glucose, and glycosylated hemoglobin were also analyzed. The correlation between lens AF results and blood tests was evaluated in both groups. The cutoff value for the diagnosis of DM using lens AF was investigated. RESULTS: The study included 191 subjects with a mean age of 52.09±6.75 years. One hundred and seven (56.0%) subjects were female, and 84 (44.0%) were male. Eighty-two (42.9%) patients had type II DM, and 109 (57.1%) subjects self-reported as normal. The fluorescence ratio (FR) values ranged from 0.09 to 0.46 (0.23±0.06) in the total group. Mean FR measurements of diabetic subjects were significantly higher (0.27±0.06) than those without DM (0.20±0.05), (p=0.001). A statistically significant correlation was found between glycosylated hemoglobin, fasting plasma glucose, and FR. The cutoff point for the FR according to the presence of DM was found to be 0.24 and above (p=0.001), with a sensitivity of 71.95% and a specificity of 80.73%. CONCLUSION: Measuring AF of human lens as an indirect evidence of increased advanced glycaton end products may helpful in detecting impaired glucose metabolism. Our results show highly significant correlation between possibility of DM and FR.

Impact of body mass index on left ventricular diastolic dysfunction.

BACKGROUND: The prevalence of obesity is increasing in the developed and developing world. It is an independent risk factor for heart failure. Left ventricular (LV) diastolic dysfunction has been demonstrated to be a strong predictor of heart failure. In the present study we aimed to assess the impact of body weight on LV diastolic function. METHODS: The study was conducted on 2,228 participants (1,424 women, 804 men with a mean age of 49). Traditional and tissue Doppler echocardiographic examination were performed in all of the participants. The demographic and echocardiographic data were compared. Multivariate logistic regression analysis was used to assess the independent predictors of association of LV diastolic function. The study sample was divided into four groups: group 1 (body mass index [BMI] < 25.0 kg/m(2) ), group 2 (BMI 25.0-29.9 kg/m(2)), group 3 (BMI ≥ 30-39.9 kg/m(2)), and group 4 (BMI ≥ 40 kg/m(2)). RESULTS: Septal E was significantly lower in groups 2 and 3 compared to group 1 (P = 0.003). Septal A and septal A' were significantly higher whereas septal E' and lateral E' were significantly lower in the groups 2, 3, and 4 compared to the normal weight group (P < 0.001). Lateral A', deceleration time, and ejection time were significantly higher in obese when compared to the normal weight (P = 0.025, P < 0.001, and P = 0.009, respectively). The E/E' ratio was significantly higher in groups 2, 3, and 4 compared to the group 1 (P < 0.001). Logistic regression analysis revealed that age, BMI (OR = 1.060 [95% CI = 1.040 and 1.080]; P < 0.001), hypertension, and diabetes mellitus were independent predictors of LV diastolic dysfunction. CONCLUSION: BMI is an independent predictor of LV diastolic dysfunction along with age, hypertension, and diabetes mellitus.

Performance of bioelectrical impedance analysis in the diagnosis of metabolic syndrome.

OBJECTIVE: Central obesity is a prerequisite for the diagnosis of metabolic syndrome (MetS). Precise measurement of visceral fat by bioelectrical impedance analysis (BIA) has been validated. The aim of this study was to investigate the diagnostic performance of BIA in MetS and validate the best cutoff in a large adult cohort. MATERIALS AND METHODS: The study was performed on the MELEN Study cohort-a prospectively designed survey on the prevalence of cardiometabolic risk factors in Turkish adults. The final cohort consisted of 2219 participants. Weight and visceral body composition were measured without shoes in light indoor clothes using a bioimpedance analyzer (Omron BF 510; Omron Corp, Kyoto, Japan). Plasma concentrations of cholesterol, insulin, fasting triglycerides, high-density lipoprotein cholesterol, glucose, and other biochemical variables were measured. The diagnostic performance of visceral fat measurement by BIA in patients with MetS was assessed. RESULTS: Metabolic syndrome was detected in 751 participants (520 women and 231 men with a mean age of 55 [12] years; 34% of the whole study population). Total body fat and visceral fat levels were higher in subjects with MetS. Correlation analyses showed that there were significant correlations between anthropometric and BIA measurements. Receiver operating curve characteristics of visceral adiposity revealed the best cutoff values as greater than 12% for men and greater than 9% for women. The diagnostic performance was good in both sexes (the sensitivity/specificity and area-under-the-curve values were 76%/75% and 0.83 for men and 83%/67% and 0.81 for women, respectively). CONCLUSIONS: Visceral fat measured with BIA is an easily applicable and useful method for identifying people with MetS. The best cutoff values were higher than 12% for men and higher than 9% for women.

[Relation of asymmetric dimethylarginine levels with conventional risk score systems in the healthy subjects with positive family history for coronary artery disease]. / Koroner arter hastaligi için aile öyküsü pozitif olan bireylerde asimetrik dimetilarjinin düzeylerinin geleneksel risk puanlama yöntemleri ile iliskisi.

OBJECTIVE: Coronary artery disease is the most common cause of death in Turkey and the world. Asymmetric dimethylarginine is the major inhibitor of nitric oxide synthesis in humans. It has been shown that increased levels of asymmetric dimethylarginine is associated with endothelial dysfunction and increased atherogenesis. In this study, we aimed to investigate whether asymmetric dimethylarginine level is related with conventional risk score systems in subjects who had family history of coronary artery disease. METHODS: Fifty two subjects within 20-40 years old of whom first degree relatives had myocardial infarction at young ages and 26 age and sex matched control subjects were included in this cross-sectional observational study. Frequency of diabetes, hyperlipidemia, smoking and serum levels of homocysteine, high-sensitive C-reactive protein (hsCRP) and asymmetric dimethylarginine were compared between risk group and control subjects. Relation of asymmetric dimethylarginine level with Framingham and TEKHARF risk scores was also compared. Chi-square and Mann-Whitney U tests were used to compare categorical and continuous variables, respectively. RESULTS: Fasting serum glucose, triglyceride, high-density lipoprotein, diastolic blood pressure, waist circumference and TEKHARF scores were increased in the subjects who had family history of myocardial infarction. Total cholesterol, low-density lipoprotein, hsCRP, homocysteine, creatinine and Framingham risk score were similar in studied groups . Asymmetric dimethylarginine levels were 0.1 µmol/L higher in the risk group; however this difference could not reach significance (0.7±0.1 µmol/l vs 0.8±0.1 µmol/l; p=0.061). CONCLUSION: Measurement of serum asymmetric dimethylarginine levels did not reveal utility in defining conventional coronary artery disease risk score systems in cases that had positive family history. Larger studies including patients with different risk tertiles are needed.

Effect of intracameral epinephrine use on macular thickness after uneventful phacoemulsification.

PURPOSE: To evaluate changes in central macular thickness using optical coherence tomography after uneventful cataract surgery combined with intracameral epinephrine use. SETTING: Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. METHODS: This prospective case series comprised eyes of consecutive patients who had uneventful phacoemulsification and in-the-bag intraocular lens (IOL) implantation between August 2005 and January 2006. The eyes were randomly assigned to 1 of 2 groups. In 1 group, 0.2 mL epinephrine (1:5000 solution) was injected just after the clear corneal incision was created. The other group (control) did not receive epinephrine. Optical coherence tomography was performed in all eyes preoperatively as well as postoperatively at 1 day, 1 week, and 1, 3, and 6 months. RESULTS: The epinephrine group comprised 73 eyes (73 patients) and the control group, 76 eyes (86 patients). In both groups, the increase in retinal thickness from preoperatively to 1, 3, and 6 months postoperatively was statistically significant (P<.05); the difference was not statistically significant at 1 day or 1 week in either group (P>.05). There were no statistically significant differences between the 2 groups in mean retinal thickness throughout the follow-up (P>.05). Clinically significant macular edema occurred in 3 eyes in the epinephrine group and 3 eyes in the control group. CONCLUSION: Although epinephrine is a well-known risk factor for central macular edema, intracameral injection of 0.2 mL epinephrine (1:5000) did not increase the risk for central macular edema in eyes with no risk factors that had uneventful phacoemulsification with IOL implantation. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Macular thickness changes after phacoemulsification combined with primary posterior curvilinear capsulorhexis.

PURPOSE: To evaluate the changes in central macular thickness measured with optical coherence tomography (OCT) after cataract surgery combined with primary posterior continuous curvilinear capsulorhexis (PCCC). METHODS: Forty-six eyes of 40 consecutive patients who had uneventful phacoemulsification and in-the-bag intraocular lens implantation surgery with primary PCCC, taking place between August 2005 and January 2006 in Beyoglu Eye Training and Research Hospital, were enrolled. Patients with a history of previous ocular surgery, eye trauma, uveitis, or glaucoma, or any systemic disease such as diabetes mellitus, were excluded from the study. None of the cases had macular pathology before surgery. OCT was performed in all patients preoperatively and postoperatively on the first day, first week, and first, third, and sixth months. RESULTS: Significant quantitative changes from the preoperative examination were observed in the postoperative first week, first month, and third month (p<0.05). The difference between the mean preoperative and postoperative sixth month central macular thickness was not statistically significant (p=0.20). The greatest change in mean macular thickness was noted in the first month visit. No patient developed cystoid macular edema. CONCLUSIONS: Because primary PCCC does not have an adverse effect on macular integrity, this procedure may be preferred especially in patients with a high risk of posterior capsular opacification.

Efficacy of nebivolol on flow-mediated dilation in patients with slow coronary flow.

Slow coronary flow (SCF) is the phenomenon of slow progression of angiographic contrast in the coronary arteries in the absence of stenosis in the epicardial vessels in some patients presenting with chest pain. There are no definite treatment modalities for patients with SCF. Our aim was to investigate the efficacy of nebivolol in patients with slow coronary flow by monitoring its effects on endothelial function and different markers of inflammation. Forty-two patients (16 females, 26 males; mean age, 55 +/- 10) with slow coronary flow (SCF) were included in the study. After baseline assessment, the patients were administered nebivolol 5 mg once daily. After 12 weeks of nebivolol therapy, the biochemical and ultrasonographic examinations were repeated. Chest pain relief was detected in 38 patients after treatment (90%). Systolic and diastolic blood pressure and high sensitive CRP were significantly decreased after nebivolol therapy. Among brachial artery dilation variables that reflect endothelial function, basal resistive index (RI), post-flow mediated dilation RI, and post-nitrate mediated dilation RI were significantly decreased after therapy. Nebivolol is effective at improving endothelial function in patients with SCF. It controls chest pain, decreases CRP, and has favorable effects on brachial artery dilation variables in patients with coronary slow flow.

Effect of olmesartan medoxomil on cystatin C level, left ventricular hypertrophy and diastolic function.

Serum cystatin C concentration is an alternative measure of kidney function that is less affected by age, sex or muscle mass, and is a more sensitive indicator of early renal dysfunction than creatinine-based estimations of glomerular filtration rate. Cardiovascular sequela increases progressively with the increase in left ventricular mass. Our goal was to evaluate the effect of olmesartan medoxomil on cystatin C levels and left ventricular hypertrophy (LVH) in patients with hypertension. Forty-four newly diagnosed hypertensive patients (27 women and 17 men) were recruited in the study. Olmesartan medoxomil (20mg/day) was started and the patients were followed up for 6 months. Baseline echocardiographic findings (i.e. left ventricular mass index), serum creatinine, urine albumin/creatinine ratio (ACR) and serum cystatin C levels were compared with the levels of these variables measured at the end of 6-month follow-up period. After 6 months of treatment with olmesartan medoxomil, there was a significant reduction in systolic and diastolic blood pressure (p<0.001) and in urine ACR (p=0.04). Mean serum cystatin C levels decreased from 1.61+/-0.24 mg/l to 1.31+/-0.29 mg/l (p<0.001). Olmesartan medoxomil treatment also reduced left ventricular mass index (p<0.001) and LVH (p<0.001). Our findings indicate that olmesartan medoxomil decreases serum cystatin C levels, urine ACR and reduces LVH in patients with hypertension. To our knowledge, this study is the first to show that olmesartan medoxomil decreases serum cystatin C levels, indicating that in patients with essential hypertension it may counteract end organ damage.

Lifestyle modification decreases the mean platelet volume in prehypertensive patients.

Mean platelet volume (MPV) is an indicator of platelet activation. The present study was designed to investigate platelet function by measuring MPV, platelet count (PLC) and platelet mass (PLM) in prehypertensive (PHT) subjects. Additionally, we also evaluated the effects of lifestyle modification on platelet functions by measuring MPV, PLC and PLM. We selected 36 newly diagnosed PHT patients and 21 control subjects (BP < 120/80 mmHg) matched for age and sex. Lifestyle modifications (weight loss, reduced sodium intake, increased physical activity, limited alcohol consumption and the Dietary Approaches to Stop Hypertension (DASH) diet) were recommended to PHT individuals for 20 weeks. At entry into the study, although PLM and PLC values were similar between study groups, MPV values were significantly higher in the PHT group than in the control group (respectively, 10.41 +/- 0.93 fl vs. 9.56 +/- 1.04 fl, p < 0.01). Additionally, MPV was positively correlated with the systolic blood pressure (BP), body mass index (BMI) and insulin resistance (IR) in the PHT group (r: 0.41; p < 0.02, r: 0.37; p < 0.04, r: 0.35; p < 0.05, respectively). Only age and PHT were found to be independent predictors of MPV after regression analysis. The program substantially lowered BP (net reductions in systolic and diastolic BPs of 16.2 and 8.7 mmHg, p < 0.001, p < 0.001, respectively). In addition, BMI, waist circumference (WC) and IR were significantly reduced in the PHT group (p < 0.01, p < 0.01, p < 0.05, respectively). At the end of study, although PLM, PLC values were reduced in the PHT group, only the decrease in MPV reached statistical significance (respectively, 10.41 +/- 0.93 fl vs. 9.67 +/- 1.2 fl, p < 0.01). In closing, to our best notice, our study is the first to display a significant increase in MPV in PHT subjects and to show a decrease in MPV by lifestyle modification after 20 weeks. As a result, we consider that decreased platelet activation with multi-aspect effects of lifestyle modification therapy might play an important role in reducing thrombotic risk in PHT patients.