A Rare Ocular Manifestation of Adult Onset Still's Disease: Purtscher's-like Retinopathy.

Adult-onset Still's disease (AOSD) is a rare multisystemic immune-mediated disease of unknown etiology with quotidian spiking fever, evanescent rash, arthralgia, and multiple organ involvement. The few AOSD cases that have been reported developed Purtscher's-like retinopathy associated with thrombotic microangiopathy (TMA). Here, we report Purtscher's-like retinopathy without TMA in a patient with AOSD. A 29-year-old-man who presented for evaluation of blurred vision was diagnosed with AOSD based on Yamaguchi criteria. He had Purtscher's-like retinopathy in his right eye. Lesions improved after steroid treatment. Although almost all reported AOSD cases with Purtscher's-like retinopathy are associated with TMA, in this case such a complication was not encountered.

Evaluation of Aflibercept Treatment Responses in Eyes with Bevacizumab/Ranibizumab-resistant Wet Age-related Macular Degeneration.

OBJECTIVES: To evaluate anatomic and functional results after switching from intravitreal bevacizumab or ranibizumab treatment to aflibercept for wet (neovascular) age-related macular degeneration. MATERIALS AND METHODS: This retrospective study included 22 eyes of 22 patients resistant to treatment with at least 6 injections of bevacizumab or ranibizumab. The first three injections had been applied monthly, the others pro re nata (PRN). Outcome measures were follow-up period, injection number, best corrected visual acuity (BCVA), central retinal thickness (CRT) and pigment epithelial detachment (PED) height. Dosing regimen of aflibercept was determined PRN. The patients were examined monthly. In all visits, BCVA and optical coherence tomography results were assessed together and injections were applied according to these findings. Patients with at least three months of follow-up were included in the study. RESULTS: Twenty-two eyes of 22 patients treated with bevacizumab or ranibizumab were switched to aflibercept therapy. Seven patients had serous PED and 4 patients had fibrovascular PED. The mean follow-up periods for these groups were 20.59±6.76 months and 8.68±3.79 months, respectively. The mean injection numbers were 10.5±3.61 vs 4.54±1.56. Statistically significant reductions were noted in CRT (533.86±164.06 µm vs 412.04±143.86 µm, p<0.05). BCVA levels were almost equal before and after switching (0.18±0.17 vs 0.18±0.14). Serous and fibrovascular PED heights decreased suboptimally from 460±281.51 µm to 282.42±175.76 µm (p>0.05) for serous PEDs and 251.25±43.85 µm to 225.75±73.09 µm (p>0.05) for fibrovascular PEDs. CONCLUSION: Switching to aflibercept resulted in significant improvement in CRT, but not in BCVA or PED heights.

Efficiency of Ozone Therapy in a Rat Model of Experimental Uveitis.

PURPOSE: To investigate efficiency of ozone therapy in uveitis. METHODS: A total of 24 albino Wistar rats were randomly assigned to four groups (n = 6); (a) control group; (b) sham group; (c) infliximab treatment group; (d) ozone therapy group. Vitreous haze scores of all groups were evaluated. Vitreous cytokine levels (TNF-α, IL-1, IL-6) measured by ELISA and eyes were enucleated for histopathologic examination. RESULTS: According to vitreous haze scores, there was statistically significant inflammation in Group (b) compared with Group (a), and there was less inflammation in infliximab and ozone groups compared with Group (b) (p < 0.05). Cytokine levels in infliximab and ozone groups were lower but not statistically significant when compared with Group (b) (p > 0.05). There was significantly less inflammation in histopathologic examination in treatment groups when compared with the sham group (p < 0.05). CONCLUSIONS: Clinical and histopathologic examination results indicate that systemic application of ozone may be efficient in the treatment of uveitis.

Comparison of Transcanalicular Multidiode Laser Dacryocystorhinostomy with and without Silicon Tube Intubation.

Aim. To compare the surgical outcomes of surgery with and without bicanalicular silicon tube intubation for the treatment of patients who have primary uncomplicated nasolacrimal duct obstruction. Methods. This retrospective study is comprised of 113 patients with uncomplicated primary nasolacrimal duct obstruction. There were 2 groups in the study: Group 1 (n = 58) patients underwent transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation and Group 2 (n = 55) patients underwent transcanalicular diode laser dacryocystorhinostomy surgery without bicanalicular silicon tube intubation. The follow-up period was 18.42 ± 2.8 months for Group 1 and 18.8 ± 2.1 months for Group 2. Results. Success was defined by irrigation of the lacrimal system without regurgitation and by the absence of epiphora. Success rates were 84.4% for Group 1 and 63.6% for Group 2 (P = 0.011). Statistically a significant difference was found between the two groups. Conclusion. The results of the study showed that transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation was more successful than the other method of surgery. Consequently, the application of silicone tube intubation in transcanalicular diode laser dacryocystorhinostomy surgery is recommended.

Quantitative Scheimpflug camera study of the lens density in healthy Turkish population.

The purpose of this study is to evaluate the association between the age and the density of anterior, posterior, and nuclear parts of lens and detect the normal lens density (LD) values in different age groups. 370 eyes of 370 voluntary healthy Turkish subjects were included. These were divided in four groups according to their age. These were Group 1 (51-65 years), Group 2 (41-50 years), Group 3 (31-40 years) and Group 4 (20-30 years). LD values of anterior, nuclear, posterior, and total (average) were measured using Pentacam HR Scheimpflug camera system. Both eyes of each subject were scanned twice in automatic release and 50-picture 3-dimensional (3D) scan modes by one experienced observer. 207 of the participants were females and 163 were males, with a mean age of 40.57 ± 13.06 years. The differences between groups in terms of nuclear area, posterior area, and average LD measurements were significant but anterior area was not. The nuclear area and average LD had high positive correlation with age (r = 0.72, p < 0.001, r = 0.63, p < 0.001, respectively); posterior area LD had a weak negative correlation with age (r = -0.16, p = 0.001). The mean LD values between female and male subjects showed no significant difference. The anterior region of the lens has the highest and nuclear area has the lowest value of LD in young people. In older people, the anterior area did not show a significant change, nuclear and total areas showed a significant increase but posterior area showed a significant decrease.

Evaluation of the long-term results of trabectome surgery.

The aim of this study was to investigate the safety and efficacy of ab interno trabeculectomy which is a minimally invasive glaucoma surgery, in the late period, performed via trabectome instrument. A total of 70 eyes followed up with a diagnosis of open-angle glaucoma (OAG) and undertaken trabectome surgery were included in the study. Preoperative and postoperative intraocular pressures (IOPs), number of the drugs used, and complications were retrospectively investigated and the data were evaluated. The criteria of success were accepted as an IOP value ≤21 mmHg or ≥30 % reduction in IOP and no need for a second operation. Mean IOP was decreased by 38 % from a preoperative value of 28.77 ± 5.34 to 17.62 ± 2.81 mmHg at the end of 18 months. Likewise, mean drug usage was decreased by 48 % from a preoperative value of 3.3 ± 1.01 to 1.7 ± 1.16 at the end of 18 months. Both decreases were statistically significant (p < 0.05). Postoperative success rates were 82.8 % in the 6th month, 81.4 % in the 9th month, 77.1 % in the 12th month, and 70 % in the 18th month. Most common complication observed was intraoperative reflux hemorrhage and no serious complication was observed. Trabectome surgery is an effective and safe method in early-stage open-angle glaucoma types that cannot be controlled despite maximal medical therapy. This procedure is a proper surgical option in patients targeted for moderate IOP without the need for a topical medication or with less drug usage.

Evaluation of Color-Changing Effect and Complications After Nd: YAG Laser Application On Iris Surface.

BACKGROUND: The aim of this study was to evaluate the color-changing effect and adverse effects after Nd: YAG laser application on the iris surface of rabbit eyes. MATERIAL/METHODS: The study was performed on right eyes of 12 pigmented rabbits. A laser device that produces frequency doubled 532 nm wavelength Nd: YAG laser with 900 µm spot diameter was used. The laser was applied in 3 sessions at 2-week intervals, at energy levels of 0.8 mJ in Group A and 1.5 mJ in Group B. Slit-lamp examinations and measurements of intraocular pressure (IOP) using a Tono-Pen were performed before and 1 day after each laser session. Iris thickness (IT) was measured at the beginning and the end using an ultrasonic biomicroscope. The eyes were enucleated for histopathologic examination on day 60. RESULTS: On the first day after each laser session, maximum grade 1 anterior chamber flare and cells were observed in both groups. In all eyes, flare and cells disappeared at the end of the first week. There was no significant difference in the IOP and IT values between measurements performed prior to and after laser sessions during the study (p>0.05). None of the eyes showed complications such as corneal edema, hypopyon, posterior synechia, transillumination defect, or pupillary defect. In histopathological examinations, reduction in pigment density was more profound in Group B compared to Group A, which was statistically significant (p<0.019). CONCLUSIONS: There were no serious complications apart from mild transient inflammatory signs. Change in iris color was more evident at the end of the second month.

Efficacy of adjunctive mitomycin C in transcanalicular diode laser dacryocystorhinostomy in different age groups.

PURPOSE: To evaluate the efficacy of adjunctive mitomycin C (MMC) in transcanalicular multidiode laser dacryocystorhinostomy (TCL-DCR) in different age groups. METHODS: Ninety-six eyes of 96 patients who underwent TCL-DCR for the treatment of nasolacrimal duct obstruction were included in this retrospective, comparative study. Patients were divided into 4 groups based on age and intraoperative use of MMC: group 1, TCL-DCR without MMC in the 20- to 44-year age group; group 2, TCL-DCR with MMC in the 20- to 44-year age group; group 3, TCL-DCR without MMC in the 45- to 76-year age group; group 4, TCL-DCR with MMC in the 45- to 76-year age group. The postoperative evaluation consisted of calculating and comparing the success rates between groups. RESULTS: Success rates at the final visit were 50% for group 1, 66.66% for group 2, 79.16% for group 3, and 84.61% for group 4. The differences between group 1 and group 4, and group 1 and group 3, were significant (p = 0.01 and p = 0.038, respectively). Logistic regression showed that age group had significant effect on success rate (p = 0.013). However, use of MMC had no significant effect on success rate (p = 0.23). CONCLUSIONS: The success rates of the TCL-DCR with MMC application were found to be higher than those of TCL-DCR without MMC in different age groups. However, the differences did not reach statistical significance. In addition, our study demonstrated that age may be a significant factor influencing the surgical outcome of TCL-DCR.

Prolidase Enzyme Activity in Conjunctiva and Pterygium Tissues.

BACKGROUND: The aim of this study was to determine prolidase activity in conjunctival tissue and its relationship with pterygium. MATERIAL AND METHODS: Prolidase activity was measured in 23 pterygium and 25 healthy conjunctival tissues and the 2 groups were compared. RESULTS: Prolidase enzyme activity could not be measured in either the healthy conjunctival or in pterygium tissues. The mean serum prolidase levels of the control and pterygium groups were 967.46±353.64 and 858.29±301.83, respectively. Statistically, there was no significant difference between the groups with regard to serum prolidase levels (p>0.05). CONCLUSIONS: In conclusion, absence of prolidase activity in pterygium tissue indicates that there is no collagen turnover in this tissue. We may explain this finding with the elastin-rich structure of the conjunctiva.

Evaluation of interpupillary distance in the Turkish population.

PURPOSE: The aim of this study was to report normative values and ranges of interpupillary distance (IPD) in different age groups of a Turkish population. METHODS: A total of 756 healthy subjects were included in this prospective study. After a complete ophthalmic evaluation, subjects were divided into four age groups to assess differences between age groups in relation to IPD. The age groups were 20-30, 31-50, 51-70, and 71-89 years. Far IPD measurements were performed using an autorefractometer (Topcon RM-8800). RESULTS: The mean age was 48.42±20.55 years, ranging from 19 to 89 years. The mean IPD was calculated as 62.5±4.1 mm (range 49-76). The mean IPD value was observed to be significantly higher among males compared to females (P<0.001). The difference among groups in terms of mean IPD was statistically significant (P<0.001). IPD increased by 4.19 mm in males and 3.11 mm in females from the young adults (20-30 years) to older adults (51-70 years), and then a decrease (2.6 and 0.19 mm for males and females, respectively) occurred between 70 and 89 years of age. CONCLUSION: The current study offers the population-specific normative data on far IPD in different age groups. Our study showed that sex and age had a significant effect on IPD. Knowledge of normal values in this population subgroup may be useful in studying orbito-cranial growth patterns, syndrome diagnosis, surgical management of cranio-facial deformities and trauma, and manufactures of optical frames and lenses.

The Relationship between Age-Related Macular Degeneration and Olfactory Function.

BACKGROUND: Olfactory dysfunction is a common symptom of many neurodegenerative diseases, and age-related macular degeneration (AMD) is a late-onset neurodegenerative disease. OBJECTIVE: Thus, the aim of this study was to investigate olfactory functions in patients with AMD. METHODS: A total of 69 subjects with AMD and 69 age- and sex-matched healthy controls were enrolled. After a complete ophthalmic evaluation, the AMD patients were subclassified as early- and late-stage AMD. Psychophysical testing of olfactory function was performed using the validated Sniffin' Sticks test. RESULTS: This study was carried out in 138 subjects, with a mean age of 74.3 ± 8.9 years (range 51-89). The current investigation showed the following two major findings: (1) patients with AMD had decreased olfactory abilities, especially in odor discrimination and odor identification, even at early stages compared to controls, whereas patients had decreased olfactory abilities in all subtasks of olfactory testings in advanced stages of AMD disease, and (2) as the visual acuity of AMD patients decreased, the olfactory abilities of these patients worsened. CONCLUSION: This study demonstrated that AMD had significant negative effects on all orthonasal olfactory tasks, particularly in advanced stages. Similar to other neurodegenerative diseases, odor discrimination and identification seemed to be more affected than odor detection threshold tasks.

Postoperative changes in olfactory function after transcanalicular diode laser dacryocystorhinostomy.

PURPOSE: Transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) is used much in recent years for the surgery of nasolacrimal duct obstruction (NLDO). Although TCL-DCR is accepted to be minimally invasive, safe, and effective, there is no report focusing on postoperative changes in olfactory function after this procedure. Hence, the aim of this current study was to investigate the changes in olfactory function after TCL-DCR procedure. MATERIALS AND METHODS: This study was carried out in 42 volunteers (16 men and 26 women) between the ages of 20 and 81 years. All participants received detailed lateralized olfactory tests preoperatively and at the postoperative first week, first month, third month, and sixth month. After lateralized olfactory tests were performed, the results were grouped according to the side of the nasal passage where the operation was performed for NLDO: the nonoperated side served as the control. RESULTS: The current investigation produced 2 major findings: (1) olfactory function decreased significantly after TCL-DCR procedure at the operated side of the nose compared with the nonoperated side; (2) olfactory abilities of the patients returned to normal within 3 months. CONCLUSION: The results of this study showed that transcanalicular diode laser could be used safely in terms of olfactory function for dacryocystorhinostomy. Temporary decrease of olfactory function on the side having TCL-DCR should be taken into account when obtaining informed patient consent.

The effect of chronic smoking on lens density in young adults.

PURPOSE: To investigate the effect of chronic cigarette smoking on lens density by Pentacam HR lens densitometry in young adults. METHODS: Sixty chronic smokers who smoked at least 10 cigarettes per day for at least 2 years and 60 age- and sex-matched healthy control subjects were included in this prospective cross-sectional, comparative study. Presence of an ocular or systemic disease that might affect lens were determined as exclusion criteria. All individuals underwent complete ocular examination. Lens densitometry (LD) measurements were performed with Pentacam HR (Oculus, Wetzlar, Germany), dividing the lens into 3 areas: anterior area (anterior subcapsular and anterior cortical), nuclear area, and posterior area (posterior subcapsular and posterior cortical). Three-dimensional scan modes were used for measurements. RESULTS: The mean ages of group 1 and 2 were 25.85 ± 4.32 and 25.60 ± 5.14 years, respectively. The mean LD values in the 3 areas were higher in group 1 than group 2. However, only the mean LD value at the anterior area of group 1 was found to be statistically significantly higher (p = 0.047). There was no statistically significant difference in the mean LD measurements at the nuclear and posterior areas between the groups. CONCLUSIONS: Our study demonstrated that the mean LD value of the anterior area was significantly higher in group 1, suggesting that chronic smoking may contribute to anterior cortical and subcapsular cataract development in young adults.