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ABSTRACT: To investigate the neuroprotective effects of topically applied brimonidine tartrate 0.2% (BMD), an alpha(2)-receptor agonist, on the retinal ganglion cell (RGC) layer and inner nuclear layer (INL) of rabbit retina in endothelin-1 (ET-1)-induced optic nerve (ON) ischaemia model.
Osmotic minipumps were surgically implanted into one eye of 16 New Zealand Albino rabbits to deliver ET-1 at the constant rate of 0.5 microL/h for 2 weeks. Eyes were divided into four groups. ET-1 was given with (Group 3) and without topical BMD therapy (Group 1). Groups 2 and 4 were taken as controls. Rabbits were sacrificed at day 14. Morphological alterations, total cell number and proportion of cells undergoing apoptosis in INL and RGC layer were assessed by histopathological analysis to determine the survival of the cells of the INL and RGC layer.
Endothelin-1 led to severe reduction of cells in both the RGC layer and INL in Group 1 (P < 0.05). In Group 3, the total cell number and the proportion of cells undergoing apoptosis in the RGC layer were comparable with the control group (Group 4), whereas the former was found to be higher and the latter was found to be lower than those recorded for Group 1. However, the total cell number in the INL was found to be lower in Group 3 compared with that of Group 4, despite topical BMD therapy (P < 0.05).
Topically applied BMD seems to be neuroprotective and antiapoptotic in the ET-1-induced ON ischaemia model, especially for RGCs. BMD might be used as an adjuvant agent for its neuroprotective effects in hypoxic-ischaemic conditions such as diabetic retinopathy, normotensive glaucoma and other retinal vascular occlusive conditions which require further investigations.
Clinical and Experimental Ophthalmology 09/2007; 35(6):527-34. · 1.98 Impact Factor
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ABSTRACT: To investigate the effect of transpupillary thermotherapy (TTT) on choroidal neovascularization (CNV) secondary to angioid streaks.
Six eyes of 5 patients with an average age of 61 years were diagnosed to have subfoveal CNV secondary to angioid streaks. Four of the CNVs were predominantly classic and 2 were occult with no classic. Visual acuity (VA) measurement, ophthalmoscopic and fluorescein angiographic examination, and optic coherence tomography (OCT) were carried out before TTT treatment and at each follow-up visit. Activity scores (AS) based on clinical, angiographic, and OCT findings were also recorded.
The mean follow-up was 12 months. The VA initially ranged from counting fingers to 20/100 and remained stable in all patients. The mean greatest lesion diameter increased significantly from 2221 microm to 3109 microm at last follow-up (p=0.046). The mean AS decreased significantly from 6.5 to 4.8 at the 3rd month (p=0.039), but tended to increase thereafter. Retreatment with TTT was applied to 5 eyes after a mean of 7.8 months but did not decrease CNV activity as effectively as the first treatments. A fibrotic scar developed in 1 eye after the first treatment.
TTT may decrease the activity of CNVs secondary to angioid streaks in the short term, but retreatment may be necessary with unfavorable results. TTT appears to stabilize VA but not lesion size in this group of patients, which may be the natural history rather than a treatment effect.
Canadian Journal of Ophthalmology 03/2007; 42(1):95-100. · 1.47 Impact Factor
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ABSTRACT: Topical steroid use is usually avoided in cases of corneal epithelial defect. We evaluated the effect of topical steroid treatment on corneal epithelial healing after epithelial debridement in vitreoretinal surgery.
Our study population included 85 eyes undergoing vitreoretinal surgeries in our clinic. We prospectively compared the duration of corneal epithelial wound healing in 43 eyes in which topical dexamethasone was used with that in 42 eyes in which topical dexamethasone was not used in the early postoperative period after epithelial debridement. Factors that may retard corneal epithelial healing, including pre- and intraoperative topical solutions, median operative time, the presence of diabetes mellitus, prior ocular surgeries, pseudophakia, aphakia and the presence of intraocular gas or silicone oil in aphakic patients, were not significantly different between the two groups.
The mean corneal epithelial defect closure time was 59.7 +/- 2.6 hours (mean +/- SEM) in the group receiving topical steroid treatment, and 61.9 +/- 2.6 hours in the group that did not receive steroids.
Topical dexamethasone administered five times/day did not significantly retard corneal epithelial healing in subjects undergoing vitreoretinal surgery with postoperative topical steroid treatment, compared with subjects who did not receive steroid treatment.
Acta Ophthalmologica Scandinavica 07/2006; 84(3):319-22. · 1.85 Impact Factor
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Retina 02/2006; 26(1):102-4. · 2.81 Impact Factor
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Journal of Cataract [?] Refractive Surgery 07/2005; 31(6):1261-2. · 2.26 Impact Factor
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ABSTRACT: AimTo determine the effect of intravitreal triamcinolone injection on macular edema and the visual prognosis in cases with CRVO.
MethodsEyes with CRVO were classified as ischemic or nonischemic according to extend of retinal capillary nonperfusion. The patients
received intravitreal triamcinolone acetonide injection (4mg/0.1ml). A complete ophthalmologic evaluation together with
flourescein angiography (FA) and optical coherence tomography (OCT) were performed for each patient at presentation and at
follow-up visits. The functional and anatomical results of both groups were assessed separately.
ResultsA total of 22 eyes (11 ischemic, 11 nonischemic) were included in the study. Mean duration of symptoms before steroid injection
was 4.9±5.5months. Mean follow-up time was 11.5±2.4. All the eyes completed at least 9months of examination. At least 3
lines of visual acuity increase using snellen visual acuity chart was observed in 81.8% of the eyes in nonischemic group,
while only in 18.2% of the eyes in the ischemic group. In ischemic group, the mean foveal thickness was 766±320.7µm at presentation,
which significantly decreased to 441.7±166.9µm at 9th month. In nonischemic group, the mean foveal thickness was 667±223µm
at presentation, which significantly decreased to 320±175.5 at 9th month. Significant IOP elevation was observed in 8 (36.4%)
of the eyes, 75% of which could be controlled with medical treatment.
ConclusionIntravitreal triamcinolone injection may be a promising and effective method for the treatment of macular edema associated
with CRVO. Although anatomical results are similar in both groups, functional results are better in non-ischemic CRVO cases.
International Ophthalmology 03/2005; 26(1):27-34.
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Retina 09/2004; 24(4):602-9. · 2.81 Impact Factor
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ABSTRACT: To emphasize the effectiveness of phototherapeutic keratectomy (PTK) in a patient with Schnyder crystalline corneal dystrophy (SCCD).
Case report.
Two eyes of a patient with SCCD underwent PTK. Best corrected visual acuity (BCVA) increased from 2/10 to 8/10 (plano/-1.50 x 10) in the right eye in a lit room. BCVA of the left eye was 4/10 (-8.00/-1.50 x 170) and did not change after treatment because of anisometropic amblyopia. No recurrence was detected after 68 months of follow-up.
PTK may be effective in the treatment of SCCD, especially if the crystals are the cause of visual disturbance.
Cornea 05/2004; 23(3):311-3. · 1.73 Impact Factor
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ABSTRACT: We report a patient with reactivation of presumed adenoviral keratoconjunctivitis after laser in situ keratomileusis (LASIK) to correct high myopia. The preoperative refraction was -13.00 diopters (D) in the right eye and -14.00 D in the left eye, and the best corrected visual acuity was 20/20 in both eyes. On the first postoperative day, mild conjunctival hyperemia and multiple subepithelial infiltrations localized in the flap zone consistent with adenoviral keratoconjunctivitis were seen. After prompt treatment, the lesions resolved. As a consequence, LASIK successfully corrected the high myopia. Adenoviral keratoconjunctivitis can be reactivated after LASIK, unlike after photorefractive keratectomy, despite the absence of symptomatic and clinical findings before the procedure.
Journal of Cataract [?] Refractive Surgery 05/2002; 28(4):725-7. · 2.26 Impact Factor
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ABSTRACT: We report a patient with reactivation of presumed adenoviral keratoconjunctivitis after laser in situ keratomileusis (LASIK) to correct high myopia. The preoperative refraction was −13.00 diopters (D) in the right eye and −14.00 D in the left eye, and the best corrected visual acuity was 20/20 in both eyes. On the first postoperative day, mild conjunctival hyperemia and multiple subepithelial infiltrations localized in the flap zone consistent with adenoviral keratoconjunctivitis were seen. After prompt treatment, the lesions resolved. As a consequence, LASIK successfully corrected the high myopia. Adenoviral keratoconjunctivitis can be reactivated after LASIK, unlike after photorefractive keratectomy, despite the absence of symptomatic and clinical findings before the procedure.
Journal of Cataract and Refractive Surgery - J CATARACT REFRACT SURG. 01/2002; 28(4):725-727.
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ABSTRACT: To determine the effect of intravitreal triamcinolone injection on macular edema and the visual prognosis in cases with CRVO.
Eyes with CRVO were classified as ischemic or nonischemic according to extend of retinal capillary nonperfusion. The patients received intravitreal triamcinolone acetonide injection (4 mg/0.1 ml). A complete ophthalmologic evaluation together with flourescein angiography (FA) and optical coherence tomography (OCT) were performed for each patient at presentation and at follow-up visits. The functional and anatomical results of both groups were assessed separately.
A total of 22 eyes (11 ischemic, 11 nonischemic) were included in the study. Mean duration of symptoms before steroid injection was 4.9+/-5.5 months. Mean follow-up time was 11.5+/-2.4. All the eyes completed at least 9 months of examination. At least 3 lines of visual acuity increase using snellen visual acuity chart was observed in 81.8% of the eyes in nonischemic group, while only in 18.2% of the eyes in the ischemic group. In ischemic group, the mean foveal thickness was 766+/-320.7 microm at presentation, which significantly decreased to 441.7+/-166.9 microm at 9th month. In nonischemic group, the mean foveal thickness was 667+/-223 microm at presentation, which significantly decreased to 320+/-175.5 at 9th month. Significant IOP elevation was observed in 8 (36.4%) of the eyes, 75% of which could be controlled with medical treatment.
Intravitreal triamcinolone injection may be a promising and effective method for the treatment of macular edema associated with CRVO. Although anatomical results are similar in both groups, functional results are better in non-ischemic CRVO cases.
International Ophthalmology 26(1-2):27-34.
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ABSTRACT: To evaluate the effect of blood glucose (BG) regulation on the retinal nerve fiber layer (RNFL) in diabetic patients by using a scanning laser polarimeter (NFA-GDx).
We prospectively assessed RNFL thickness in diabetic patients and an age-matched control group. Patients without diabetic retinopathy, with BG >250 mg/dl, HbA1c >8%, fructosamine >285 micromol/l and triglyceride >200 mg/dl were included in the study. RNFL assessment was performed before and after metabolic regulation of diabetes. Symmetry, superior maximum, ellipse modulation and the average thickness variables of NFA-GDx were used for the assessment. Mann-Whitney U and Wilcoxon tests were used for the statistical analysis.
A total of 40 diabetic patients were included in the study and a repeat RNFL examination could be performed in 22 of them following regulation of BG levels. None of the GDx variables were significantly different between pre- and postregulation measurements (p > 0.05, Wilcoxon test). The mean superior maximum, ellipse modulation and average thickness values of the diabetic group were significantly lower than the control group (p < 0.05, Mann-Whitney U-test).
Poor metabolic control of diabetes mellitus adversely affects the thickness of RNFL and this effect does not seem to be acute since it was not reversed by short-term BG regulation. This issue needs to be kept in mind when assessing glaucomatous progress in diabetic patients.
Ophthalmologica 217(5):347-50. · 1.42 Impact Factor
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ABSTRACT: To evaluate retroprospectively the clinical consequences of posterior subtenon (PSTT) and intravitreal (IVT) triamcinolone acetonide injections in diabetic macular edema (DME) refractory to conventional grid laser photocoagulation.
Eyes with clinically significant DME refractory to grid laser photocoagulation were assessed for the inclusion in the study. Complete ophthalmic examination with fluorescein angiography (FA) and optic coherence tomography (OCT) were performed before and in the 1st, 3rd, and 6th months of the treatment. The IVT group received 4 mg/0.1 ml and the PSTT group received 20 mg/0.5 ml triamcinolone injection. PSTT but not IVT injection was repeated in case of recurrent edema. IVT was also applied to the eyes with resistant macular edema after PSTT injection (secondary IVT group).
There were 85 eyes of 60 patients in the PSTT group and 41 eyes of 35 patients in IVT group. There were 24 eyes in the primary IVT group and 17 eyes in the secondary IVT group. Mean follow-up time was 4.1+/-1.9 and 4.6+/-2.2 months after PSTT and IVT injections, respectively. In the PSTT group, the mean visual acuity increased from 0.19+/-0.18 to 0.22+/-0.19 and the mean central foveal thickness decreased from 413.1+/-117.5 to 312.1+/-103.1 microm (P=.001 and P=.0001, respectively) during the first 3 months. In the IVT group, the mean visual acuity and central foveal thickness were found to be 0.15+/-0.14 and 494.5+/-141.3 microm before the treatment and 0.20+/-0.16 and 288.4+/-88.5 microm 3 months after the treatment, respectively (P=.008 and P=.001, respectively). The effect in central foveal thickness was significantly greater in the primary IVT group than in the PSTT group (P=.002). There was no significant difference with respect to the decrease in the central foveal thickness and increase in visual acuity between the primary and secondary IVT injections (Mann-Whitney U test, P>.05). The steroid effect started to diminish after the 3rd month. The recurrence of macular edema was seen in 7.1% in the PSTT group starting after 3 months. Twenty percent of the eyes in the PSTT group did not respond to the treatment at all and had secondary IVT injections. Significant intraocular pressure increase was found in 8.2% of the PSTT group and in 24.3% of IVT injection. There was one case of pseudomonas endophthalmitis in the IVT group.
This study is the first study comparing the clinical outcomes of PSTT and IVT injections for the treatment of DME. Both PSTT and IVT injections caused a significant increase in visual acuity and a decrease in central foveal thickness, especially in the short term. The effect was more pronounced in the IVT group; however, PSTT injection also seemed to be a safe and effective technique for the treatment of DME. Further prospective studies are warranted to assess the efficacy and side effects of IVT and PSTT injections for the treatment of DME.
Journal of Diabetes and its Complications 20(4):246-51. · 2.03 Impact Factor
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ABSTRACT: To compare the optical coherence tomographic (OCT) features with clinical and fluorescein angiographic (FA) findings in patients with diabetic retinopathy.
In a retrospective study ophthalmologic examination together with FA and OCT images were obtained from 195 eyes of 110 patients with different stages of diabetic retinopathy and OCT images were obtained from 40 eyes of 20 control subjects. Fluorescein leakage characteristics were organized into five groups: no leakage (1), focal (2), diffuse (3), combined focal+diffuse leakage (4) and cystoid (5). The Pearson correlation test was used to test the correlation between visual acuity and central foveal thickness and ANOVA was used for the statistical comparison between the groups.
The OCT images demonstrated retinal swelling in 66.1% of eyes, cystoid macular edema (CME) in 11.8% of eyes, serous foveal detachment + swelling in 6.2% of eyes, serous foveal detachment+swelling+CME in 3.6% of eyes and normal foveal structure in 12.3% of eyes. The best-corrected visual acuity was significantly correlated with central foveal thickness (r:-0.528, p<0.01). There was 77% agreement between clinical examination and OCT results. CME was detected with OCT in 15.4% of eyes in our study, 40% of which was not detected with slit-lamp biomicroscopy and 63.3% of which was not evident in FA. None of the serous foveal detachments could be detected during slit-lamp biomicroscopy or FA.
OCT-3 provided objective documentation of foveal structural changes in eyes with diabetic retinopathy. Best-corrected visual acuity provided a significant correlation with the retinal thickness at the central fovea. These results indicate that OCT can facilitate deciding on the treatment protocol (surgical or medical) and follow-up of diabetic patients, which is especially important in the early stages of diabetic maculopathy when the structural changes are not yet evident with slit-lamp biomicroscopy or angiographically.
Ophthalmologica 219(2):86-92. · 1.42 Impact Factor
