Effects of cisplatin-5-fluorouracil combination therapy on oxidative stress, DNA damage, mitochondrial apoptosis, and death receptor signalling in retinal pigment epithelium cells.

AIM: Combination therapies of cisplatin with 5-FU (PF) are an effective solution and have been widely used for the treatment of various categories of cancer including anal, gastrointestinal, and oral cancer, as well as head and neck tumors. The effects of combined PF treatment on vital intracellular signalling pathways in nontargeted cells remain unclear. The aim of this study is to explain the possible mechanisms by which combined PF treatment results in retinal toxicity and to investigate the effects of PF on important vital signalling pathways in ARPE 19 retinal pigmented epithelial cells. MATERIALS AND METHODS: We analysed the cellular and molecular effects of PF on cell viability, oxidative stress, gene repair response, and induction of apoptosis in ARPE 19 cells using molecular probe fluorescent staining, cell cytometer, RAPD, qRT-PCR, and western blot assays. RESULTS: We determined that PF causes excessive generation of reactive oxygen species (ROS) and prevents ROS scavenging by suppressing antioxidant systems. We found induction of DNA damage, particularly mismatch and double strand break repair, in ARPE 19 cells treated with PF. In this study, PF also induced both the intrinsic apoptosis pathway and death receptor signalling in ARPE 19 cells. CONCLUSIONS: Our data proved that PF causes cytotoxicity and genotoxicity, at both the cellular and molecular levels, in ARPE 19 cells following particularly prolonged treatment (48 h). Additionally, our results suggest key molecular signals for prevention strategies that can be developed to reduce the severe side effects of PF chemotherapy.

Effects of Selective Serotonin Reuptake Inhibitors on Macular Ganglion Cell Complex Thickness and Peripapillary Retinal Nerve Fiber Layer Thickness.

PURPOSE: To evaluate macular ganglion cell complex (GCC) thickness and peripapillary retinal nerve fiber layer (RNFL) thickness in patients treated with SSRIs. METHODS: The present study included 62 eyes of 31 patients who were using SSRIs and 60 eyes of 30 healthy, age- and gender-matched control subjects. All patients underwent a full ophthalmological examination in which macular thickness, GCC thickness, and peripapillary RNFL thickness were measured using optical coherence tomography (OCT). The Mann-Whitney U test was used to compare the patients' group with the age- and gender-matched control group. Pearson correlation analyses were also performed to assess the relationships between macular thickness, GCC thickness, RNFL thickness, and the duration of SSRI usage. RESULTS: The mean duration of SSRI usage was 29.96 ± 27.19 (range 6-120) months. The foveal thickness was 253.48 ± 22.77µm in the patients' group and 266.60 ± 20.64 µm in the control group; the difference between the groups was statistically significant. In addition, the perifoveal GCC thickness in the inferonasal and inferotemporal quadrant were significantly smaller thinner in the patient group (Mann-Whitney U test, p = 0.021and p = 0.013, respectively). CONCLUSIONS: Our results suggest a relation between SSRIs and decreased retinal GCC thickness and RNFL thickness. Future long-term prospective studies should elucidate the actual effect of SSRIs on GCC and RNFL thickness.

A Moyamoya Patient with Bilateral Consecutive Branch Retinal Vein Occlusion.

We describe a moyamoya (MMD) patient with bilateral consecutive branch retinal vein occlusion (BRVO). The patient had a medical history of severe headache, cranial haemorrhage, bilateral supraclinoid carotid artery occlusion, and "puff of smoke" collaterals on cerebral angiography and an encephalomyosynangiosis operation. On ophthalmic examination, he had superior temporal branch vein occlusion with intraretinal haemorrhage and visual acuity of 20/25 in the right eye. Twelve years later, he presented with superior temporal branch vein occlusion in the left eye and visual acuity of 20/60. The patient was initially treated with a dexamethasone intravitreal implant, and later intravitreal ranibizumab injections. We describe the first reported case of bilateral consecutive BRVO and management in MMD.

Central Retinal Artery Occlusion in Takayasu's Arteritis as the First Presentation of the Disease.

Takayasu's arteritis (TA) is a chronic inflammatory granulomatous vasculitis which affects large and medium arterial vessels. The disease involves especially subclavian arteries and aortic branches but it can consist of any arteries. The major pathology is granulomatous panarteritis with intima proliferation and defects of the elastic lamina of the vessels. We present a case of central retinal artery occlusion in TA as the first presentation of the disease. To the best of our knowledge, the present case is the first case that demonstrates central retinal artery occlusion as an initial manifestation in TA. A 48-year-old woman was admitted to our clinic with the complaint of sudden and painless vision loss in her right eye for one day. Although retinal artery involvement is a very rare presentation in TA, it is important to recall TA particularly in young patients with retinal artery occlusion.

Prognostic factors for stereopsis in refractive accommodative esotropia.

OBJECTIVE: To determine the prognostic factors affecting stereoacuity in patients with refractive accommodative esotropia (RAE) according to the results of long follow- up period. METHODS: We reviewed the charts of 70 patients with RAE between the years 1985-2014. Patients were classified into three groups. G-1: Stereoacuity score 40 second/arc. G-2: Stereoacuity score >40 second/arc (50-3000). G-3: No binocular vision. Initiation age of RAE, duration of deviation, refractive error, amblyopia, amblyopia treatment, anisometropia, visual acuity, family history, angle of deviation for distance and near at each group and the prognostic factors affecting stereoacuity were analyzed. RESULTS: The mean initiation age of RAE was 2.7±1.5 years, the mean age at first visit was 6.4±4.2 years. The mean follow up time was 7.3±4.4 years. Seven patients had 40 second/arc, 48 patients had 50 to 3000 second/arc stereoacuity, 15 patients had no binocular vision. Mean deviation for near was statistically higher in group 2 and 3. Visual acuity levels were higher in group 1 and 2 and was statistically significant. Low visual acuity (p=0.001, 0.008), higher angle of deviation at near (p=0.01), increased duration of deviation (p=0.01), presence of amblyopia (p=0.001) and irregularity of amblyopia treatment (p=0.01) were significantly related with poor stereoacuity. CONCLUSION: According to the prognostic factors low stereoacuity was mostly related with amblyopia as a result the late presentation of the patients in seeking care. Appropriate treatment as full refractive correction and amblyopia treatment during the RAE is important for development of good stereopsis. Also angle of deviation at near and duration of deviation can be a useful predictor for poor stereoacuity levels.

Diagnostic occlusion test in intermittent exotropia.

PURPOSE: We sought to determine the ideal length of time to use the diagnostic occlusion test (DOT) in the evaluation of patients with intermittent exotropia. METHODS: Eighty-two consecutive intermittent exotropia patients were prospectively evaluated. After the routine ophthalmic examination, the DOT was applied for 1, 3, and 24 hours. The mean distance and near deviations, obtained with the DOTs, were compared, and the DOT periods at which deviations were stabilized were determined. The Nonparametric Tukey HSD test was used for statistical analysis. RESULTS: Before occlusion, the mean distance exotropia was 28.4 +/- 14.5, and the mean near exotropia was 25.7 +/- 15.5. After 1 hour of DOT, the exotropia measured 30.0 +/- 14.8 (p = 0.023) and 31.2 +/- 14.0 (p = 0.000), respectively. A clinically and statistically significant difference was not found after 3-hour and 24-hour DOT at either distance or near. CONCLUSIONS: Although the distance deviation stabilized after the 1-hour DOT and the near deviation was stabilized after the 3-hour DOT in intermittent exotropia cases, the change of mean near deviation between 1 and 3 hours was clinically negligible. The 1 hour DOT was at least as effective as the 3- and 24-hour DOT in most cases. Therefore, we recommend that the 1 hour DOT is sufficient for clinical applications.

Effects of different contact lens materials and contact lens-wearing periods on conjunctival cytology in asymptomatic contact lens wearers.

PURPOSE: To investigate the conjunctival cytologic changes induced by different contact lens materials and contact lens-wearing periods in asymptomatic contact lens wearers. METHODS: Seventy-five patients (150 eyes) who were to wear contact lenses for the first time were evaluated in this study. Forty eyes of 20 soft hydroxyethylmethacrylate (vinyl pyrrolidone copolymer) contact lens wearers, 70 eyes of 35 soft Polymacon contact lens wearers, and 40 eyes of 20 hard gas-permeable contact lens wearers used the lenses on a daily-wear basis. Conjunctival cytologic changes were investigated by using impression cytology. Impression cytologic samples were obtained before contact lens fitting and after contact lens wear (mean evaluation time, 6.9 +/- 2.6 months; range, 4-12 months). The samples were appropriately stained and were assessed by using the Nelson grading system and for the presence of snakelike chromatin. The Kruskal-Wallis test, the Wilcoxon test, and logistic regression were used for statistical analysis. RESULTS: There were statistically significant differences in impression cytologic findings for all three materials before versus after contact lens wear (P=0.00, P=0.00, P=0.00, Wilcoxon test). The contact lens-wearing period produced a statistically significant effect on conjunctival cytologic changes and snakelike chromatin formation (P=0.00, P=0.00, logistic regression analysis), but the effects of different contact lens materials were insignificant (P=0.88, P=0.62). CONCLUSIONS: Conjunctival cytologic changes occurred in asymptomatic contact lens wearers and were related to the duration of lens wear. For this reason, asymptomatic contact lens wearers may be followed up because of conjunctival cytologic changes.

Systemic and topical fresh-frozen plasma treatment in a newborn with ligneous conjunctivitis.

PURPOSE: We report the results of systemic and topical fresh-frozen plasma (FFP) treatment and conjunctival membrane excision of a newborn with ligneous conjunctivitis. METHODS: The newborn, referred because of bilateral membranous conjunctivitis, was hospitalized with the preliminary diagnosis of gonococcic conjunctivitis. The conjunctival membranes were excised on the fourth day of topical antibiotherapy. Plasminogen deficiency and ligneous conjunctivitis were diagnosed from the hematology consultation after recurrence of the conjunctival membranes. RESULTS: FFP was used systemically and topically. After this medical treatment period, the conjunctival membranes were excised with electrocautery under general anesthesia. Topical FFP was gradually decreased after surgery and ended in the third postoperative month. Recurrence was not seen through the first postoperative year. CONCLUSIONS: Topical and systemic FFP treatment and conjunctival membrane excision may help rapid rehabilitation and prevent recurrence in cases with ligneous conjunctivitis.

Late dislocation of an anterior chamber intraocular lens into the vitreous.

We report the case of a patient with dislocation of an anterior chamber intraocular lens (AC IOL) into the vitreous, 5 years after surgery. The cause of the dislocation may have been the size of the pupil and habitual eye rubbing. This case report describes a rare complication of AC IOL implantation in eyes of previous iris lesions or pupil abnormalities. This complication should be kept in mind when an AC IOL implantation is planned for the correction of aphakia.

Fluorescein angiographic findings in cases with intermediate uveitis in the inactive phase.

BACKGROUND: To determine fundus fluorescein angiography (FA) findings in cases with intermediate uveitis in the inactive phase. METHODS: This prospective study included all eligible cases with a diagnosis of intermediate uveitis that were treated at the uvea unit of Trakya University ophthalmology department between January 2002 and January 2004. Study criteria included patients in the inactive phase who had no complaints, no biomicroscopic or ophthalmoscopic inflammatory findings in the anterior and posterior segments, and no period of inflammation that had occurred within the previous 6 months. Cases receiving immunosuppressive treatment were not excluded. FA was performed in all cases, which were evaluated by 2 independent observers. RESULTS: A total of 21 eyes from 21 cases with intermediate uveitis were included in the study. FAs of the cases were taken approximately 8.8 (SD 5.4) months (range 6-23 months) after the last activation. In these FAs, no pathological findings were identified in 5 eyes (23.8%); optic disc hyperfluorescence was observed in 14 eyes (66.7%); large vein staining was observed in 2 eyes (9.5%); peripheral venous leakage was observed in 6 eyes (28.6%); and cystoid macular edema was observed in 5 eyes (23.8%). INTERPRETATION: These findings indicate that retinal vascular inflammatory changes persist in cases with intermediate uveitis even if the clinical manifestations have been treated.

Corneal bee sting-induced endothelial changes.

PURPOSE: To report the acute management and clinical findings of a case of corneal bee sting and to report the outcome of corneal endothelial cell analysis 1 year after trauma. METHODS: Clinical findings, anterior segment photographs, corneal endothelial images, and medical treatment of a case of right corneal bee sting are presented. Right and left central corneal endothelial cell analysis was performed by noncontact specular microscopy. RESULTS: The stinger was removed from the cornea. Systemic, subconjunctival, and topical steroids and systemic and topical antibiotics were given. One year later, a corneal scar and anterior capsular opacity of the lens in the right eye were shown by slit-lamp examination. Endothelial cell analysis determined that the endothelial cell density of the right eye was substantially decreased compared with the left eye. CONCLUSION: Corneal infiltration gradually decreased, presumably because of the systemic, topical, and subconjunctival steroids. Late complications observed in this case included a substantial decrease in cornea endothelial cell density, a corneal scar, and anterior capsular opacity.

Retinal nerve fiber analysis and tomography of the optic disc in eyes with tilted disc syndrome.

BACKGROUND AND OBJECTIVE: To investigate retinal nerve fiber layer thickness and optic disc parameters in eyes with tilted disc syndrome. PATIENTS AND METHODS: Thirty-eight eyes with tilted disc syndrome (20 myopic control eyes, and 20 emmetropic control eyes) were examined. After a routine ophthalmologic examination of all eyes, scanning laser polarimetry (for retinal nerve fiber layer thickness) and scanning laser tomography (for optic disc parameters) were performed. Scanning laser polarimetry and scanning laser tomography parameters were compared in the different groups. RESULTS: On scanning laser polarimetry evaluation, statistically significant differences were found in the superior integral, nasal integral, and superior nasal quadrants of eyes with tilted disc syndrome compared with control groups (P = .01, P = .04, P = .00, P = .00, P = .00, and P = .00, respectively). On scanning laser tomography evaluation, statistically significant differences were found in average diameter, total contour area, effective area, average depth, volume above, neuroretinal rim area, and cup-disc ratio in eyes with tilted disc syndrome compared with control groups (P = .00, P = .00, P = .00, P = .04, P = .02, P = .00, and P = .01, respectively). CONCLUSION: Parameters acquired through imaging with scanning laser polarimetry and scanning laser tomography in eyes with tilted disc syndrome are different from those of normal eyes.