Variations of the 6th cranial nerve (nervus abducens) in the petroclival region: A microsurgical study.

The aim of this study is to present the variations of nervus abducens in localization and number as it pierces the clival dura mater. The calvaria of 16 cadaveric heads were removed by making horizontal incisions from Glabella to Inion in both sides of the head. The dura mater was dissected. Cerebrum and cerebellum were taken out by obtuse dissection. Dissections of cavernous sinus were made under the stereomicroscope and the findings were photographed. Out of 16 specimens, one of them was excluded. Fifteen heads were bilaterally analyzed. Analysis of these nerves presented four different variations. Variation types a classified CN VI as a single trunk and entering a single dural pore with 77% occurrence. Variation type b classified CN VI with two branches running in the petroclival region and entering a single dural pore with 10% occurrence. Variation type c classified CN VI as 2 trunks and entering 2 separate but close dural pores with 10% occurrence. Variation type d classified CN VI with 2 distinct trunks and 2 branches entering 2 separate but close dural pores with 3% occurrence. CN VI plays a major role in the clinic of the eye. Due to its intracranial and extracranial course, injuries to the head and to the nerve may result in malfunctioning of the lateral muscles of the eye. Therefore, the variations of branching, relations and its course were analyzed.

22.5 MB DELETION OF 13q31.1-q34 ASSOCIATED WITH HPE, DWM, AND HSCR: A CASE REPORT AND REDEFINING THE SMALLEST DELETED REGIONS.

Partial deletion of the long arm of the chromosome 13, 13q deletion syndrome is a rare chromosomal disorder characterized by severe growth and mental retardation, microcephaly, facial dysmorphism, brain malformations (holoprosencephaly, Dandy-Walker malformation), distal limb defects, eye anomalies, genitourinary and gastrointestinal tract malformations (Hirschsprung's disease). Approximately 1.2 Mb region in 13q32 was suggested as minimal critical region which is responsible for severe mental and growth retardation and brain anomalies. Here we described a male patient with de novo interstitial deletion of 13q31.1-q34 associated with short stature, microcephaly, facial dysmorphism, clinodactyly, cryptorchidism, micropenis, epilepsy, HPE, DWM, and HSCR. According to the literature review, present case indicated that smallest deleted region associated with DWM and HPE might be located at the 13q32.3, limb defects 13q34, anogenital malformations 13q33.3-34, and HSCR 13q31.1-32.1.

A NEW ISOLATED 20q INTERSTITIAL DUPLICATION CASE AND ITS CLINICAL COMPARISON WITH SIMILAR ISOLATED CASES.

Duplications of 20q are rare. Here we report a 15 years old boy with de novo duplication of 17.1 Mb at chromosome 20q. We made a comparison with the other isolated 20q duplication cases. There are phenotypic similarities between the patients who have the same affected chromosomal regions. We also showed a clinical follow up of the patient. There may be a relationship with Glaucoma and Graves disease between the chromosomal region and these diseases may occur at the other patients when they get older.

One-year outcomes of less frequent bevacizumab in age-related macular degeneration.

PURPOSE: To evaluate whether a less frequent bevacizumab dosing schedule after repeated doses in short intervals would be effective in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration. METHODS: Twenty-seven treatment-naive eyes of patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration participated in this prospective, noncomparative, and interventional study at the Ulucanlar Eye Training and Research Hospital retina clinic. All lesion types were included. Intravitreal injections (1.25 mg/0.05 mL) of bevacizumab were given with a 6-week interval (Day 0, 6 weeks, and 12 weeks) for 3 months and then given at every 12-week interval up to 48 weeks. Main outcome measures of treatment were mean change in visual acuity and foveal center point retinal thickness from baseline documented by optical coherence tomography at 6, 12, 24, 36, and 48 weeks. The effects of patient age, baseline visual acuity, lesion composition, and lesion size on final visual acuity and loss of <15 letters of logarithm of the minimum angle of resolution (logMAR) at 48 weeks were also assessed. RESULTS: Of the 27 eyes, 24 eyes of 24 patients (14 men and 10 women) completed the 48-week follow-up and study protocol. Compared with baseline (0.95 ± 0.27 on Early Treatment Diabetic Retinopathy Study charts), mean best-corrected visual acuity improved to 0.77 ± 0.21 logMAR (P < 0.001) at Week 6, to 0.74 ± 0.2 logMAR (P < 0.001) at Week 12, to 0.79 ± 0.257 logMAR (P = 0.03) at Week 24, to 0.85 ± 0.26 logMAR (P = 0.54) at Week 36, and to 0.87 ± 0.27 logMAR (P = 1) at Week 48. The baseline mean center point retinal thickness that was 343 ± 64 µm decreased to 236 ± 40 µm (P < 0.001) at Week 6, to 222 ± 39 µm (P < 0.001) at Week 12, to 237 ± 37 (P < 0.001) at Week 24, to 253 ± 44 µm (P < 0.001) at Week 36, and to 268 ± 58 µm (P = 0.002) at Week 48. The maximal visual benefit obtained during the frequent dosing schedule significantly decreased by doses every 12 weeks at 48 weeks (P < 0.001). This decline in the best-corrected visual acuity gain was associated with an increase in the mean center point retinal thickness on optical coherence tomography. Patients aged <70 years and those having a baseline vision of 20/200 or worse were more likely to gain vision at 48 weeks (P = 0.001 and P = 0.02, respectively). In addition, a lesion ≤ 4 disk areas at baseline was less likely to lose <15 letters from baseline at 48 weeks (P = 0.03). No serious ocular and nonocular adverse events were noted. CONCLUSION: Although intravitreal bevacizumab administration on a schedule of a 6-week injection interval for 3 months followed by every 12-week interval for neovascular age-related macular degeneration provided an improvement or stabilization in best-corrected visual acuity with anatomical improvement. This dosing strategy is unable to maintain the visual acuity and optical coherence tomography benefits seen with more frequent dosing.

The use of the QuantiFERON-tuberculosis gold test in the diagnosis of ocular tuberculosis.

Ocular tuberculosis without systemic manifestations may rarely occur. The diagnosis of ocular tuberculosis is important because it has a wide spectrum of presentations and requires a multidisciplinary approach. The QuantiFERON-tuberculosis gold test is a new diagnostic test that may be useful in making a suitable diagnosis.

Is there a change of corneal thickness in uveitis with Behçet disease?

PURPOSE: To report the measurements of central corneal thickness (CCT) in uveitic eyes with Behçet disease (BD) and compare it with age- and sex-matched healthy controls. MATERIALS AND METHODS: This study included 69 eyes with ocular BD with no history of corneal disease, glaucoma, or ocular surgery and 50 eyes of healthy controls. Eyes with ocular BD were subdivided into active and inactive groups. Active group was defined as the presence of anterior uveitis or panuveitis, whereas inactive group was defined as having had at least 1 previous attack and absence of any active inflammation in the eye within the last 3 months. CCT was measured with ultrasonic pachymeter. Statistical analyses were performed, and P < 0.05 was considered statistically significant. RESULTS: Active group had 24 patients and inactive group had 45 patients. Demographic characteristics of patients with ocular BD and control subjects were similar (P > 0.05). There was no significant difference in respect to the disease duration between active and inactive groups (P = 0.160). The mean CCT was significantly greater in active group (584.75 ± 20.94 µm) than in inactive group (540.55 ± 36.16 µm) and control group (543.04 ± 25.35 µm) (P = 0.0001). CONCLUSIONS: We found that eyes with active BD had increased CCT because of active inflammation when compared with inactive and control groups, and mean CCT of inactive BD was normal. Therefore, we assume that CCT is in normal range in the inactive phase, and recurrent uveitis does not lead to a permanent change in CCT in BD.

Topographic optic disc analysis by Heidelberg retinal tomography in ocular Behcet's disease.

AIM: To compare the topographic characteristics of the optic discs in patients with severe and mild ocular Behçet's disease by using Heidelberg retinal tomographaphy (HRT). METHODS: This prospective study included 47 eyes of 47 patients with ocular BD who were being followed-up at the Uveitis Clinic of the Ankara Ulucanlar Eye Research Hospital, Ankara, Turkey. The patients were divided into two groups. Group 1 consisted of 21 eyes with mild uveitis, and group 2 consisted of 26 eyes with severe uveitis. All patients underwent topographic optic disc analysis by HRT II, and the quantitative optic disc parameters of both groups were compared by non-parametric Mann-Whitney U test. RESULTS: The mean cup volume, rim volume, cup area, disc area and cup depth in group 1 were found to be statistically significantly greater than those in group 2 (p<0.0001, p = 0.03, p = 0.021, p = 0.01 and p = 0.017, respectively), while the difference between the mean cup-to-disc ratios in group 1 and group 2 were found to be statistically insignificant (p = 0.148). CONCLUSION: A relationship was found between the severity of ocular BD and optic disc topography determined by HRT. In eyes with smaller optic discs, uveitis was observed to have a more severe course with more frequent relapses than those with larger discs.

Convenient synthesis of (S)-(+)-apomorphine from (R)-(-)-apomorphine.

A method was devised for preparing (S)-(+)-apomorphine from (R)-(-)-apomorphine. Dehydrogenation of the dimethyl ether of (R)-(-)-apomorphine with 10% palladium-on-carbon followed by reduction with sodium cyanoborohydride under acidic conditions resulted in quantitative racemization to give (R,S)-apomorphine dimethyl ether, which then was resolved with (-)-tartaric acid. Ether cleavage of (S)-(+)-apomorphine dimethyl ether (-)-tartrate with hydriodic acid in acetic anhydride yielded (S)-(+)-apomorphine, which was isolated as the hydrochloride salt in 99% enantiomeric excess.