Aylin Ardagil Akçakaya

Purpose:It is estimated that type 2 diabetes mellitus affects 530 million people worldwide and 10.5 per cent of these patients have diabetic retinopathy. This study aims to investigate the predictive value of cardiometabolic control, GGT and malnutrition-related inflammation markers for predicting Diabetic retinopathy prevalence and prognosis. Materials and Methods:Type 2 Diabetes Mellitus patients who were consecutively admitted to Internal and Ophthalmology outpatient clinics were included in this study. Clinical, haematological and biochemical data were recorded. Cut-off values of GGT, PNI, NRI and HALP scores were determined by receiver operator characteristic curve analysis. Univariate and multivariate analyses were performed to determine the association of all variables with Diabetic retinopathy. As a result, we evaluated which of these tests were predictive and prognostic for the development of diabetic retinopathy. Results:This study included 166 patients. Fasting blood glucose(p

The purpose of this study is to compare the efficacy and safety of 577-nm subthreshold micropulse laser (SML) and intravitreal bevacizumab injection (IVB) combined therapy with IVB monotherapy in the treatment of diabetic macular edema (DME). This retrospective study included 80 eyes of 80 patients; 40 eyes were treated with IVB monotherapy, and 40 eyes were treated with SML-IVB combined therapy. The mean number of required IVB injections and changes of best corrected visual acuity (BCVA) and central macular thickness (CMT) values were compared between the groups. The mean age of the patients was 60.19±7.43 years. The baseline characteristics of the patients were similar between the groups. In the SML-IVB combined group, the mean number of required SML sessions was 2.1±0.81. The mean number of required IVB injections was 4.38±0.81 in the SML-IVB combined group and 5.65±1.51 in the IVB monotherapy group (pp0.05); only at the 6th month was it significantly lower in the SML-IVB combined group (pp<0.05). In this study, a significant benefit of adding SML to IVB therapy was found with less IVB need, although a very significant increase in BCVA could not be achieved. The use of SML-IVB combined treatment may be an effective and safe alternative for DME.

Ophthalmomyiasis externa, results from infestation of the conjunctiva by the larval form of Oestrus ovis. It is usually seen in rural areas. We report a case with ophthalmomyiasis externa in a young man living in an urban area (Istanbul, Turkey) who had no known history of traveling to the rural area. Even in patients living in urban areas ophthalmomyiasis externa should be taken into consideration in differential diagnosis of red eye.

Aim: To document the ocular involvement in HIV-infected individuals in Turkey and to compare the findings with those from other centers throughout the world. Methods: In this cross-sectional study, patients with HIV infection being monitored in a tertiary hospital in Istanbul were enrolled. Ocular examination was performed, and the prevalence of ocular manifestations determined. Results: In total, 93 patients were enrolled, of whom 37.6% had ocular pathology. HIV retinopathy was the most frequent retinal finding, affecting 8.6% of the enrolled patients, but none of the affected individuals had any ophthalmic complaints. There were no ocular lesions suggestive of cytomegalovirus (CMV) retinitis. Discussion: In contrast to the case in the developed world, sight-threatening infections are uncommon in Turkish HIV+ patients. The reasons for this are not clear, but it is possible that there are some genetic or environmental protective factors against CMV retinitis in the population studied.

To assess the relationships between visual acuity (VA), fluorescein angiographic parameters and optical coherence tomography (OCT) patterns in exudative age-related macular degeneration (AMD). Fifty eyes with confirmed diagnosis of new exudative AMD who underwent fluorescein angiography (FA) and OCT evaluation were reviewed retrospectively. The greatest linear diameter of lesion (GLD) by FA and central foveal thickness (CFT) by OCT were measured. The OCT scans were evaluated for the presence of diffuse retinal thickening (D), cystic spaces (C), subretinal fluid (S) and pigment epithelial detachment (P) and five OCT patterns were detected (D + S; C; C + S; P + C + S; P + D + S). Angiographic classification of choroidal neovascularizations was performed. Correlations were statistically significant for VA and CFT in all patients whereas VA and GLD correlation was statistically significant only in predominantly classic and minimal classic lesions. The lowest VA values were detected in patients with COCT pattern and/or predominantly classic lesion type by FA. The OCT and FA findings when evaluated simultaneously may provide information regarding visual function in AMD.

Purpose: To study the incidence and risk factors of retinopathy of prematurity (ROP) in premature infants examined in a tertiary hospital in Istanbul.Methods: Data of infants screened for ROP from April 2007 to September 2009 were retrospectively reviewed. Possible risk factors and eye examinations were recorded and analyzed using the chi-square test and univariate and multivariate regressions.Results: ROP was detected in 177 (34.3%) of the 517 infants enrolled in the study; 64 had mild ROP (77.4%) and 38 had severe ROP (22.6%). The mean gestational age and birth weight of patients who were treated for ROP were 28.6 ± 2.3 and 1,143.5 ± 337.4, respectively. Two of these infants had a gestational age of 32 g or greater and three had a birth weight of 1,500 g or greater. The multivariate regression analyses showed gestational age, birth weight, sepsis, respiratory distress syndrome, and length of oxygen therapy as independent predictors of ROP.Conclusion: The incidence of ROP observed in this study was higher than that in developed countries and relatively more mature infants were affected. Criteria including gestational age of less than 34 weeks or birth weight of less than 2,000 g would have identified all infants who were at risk.

Aim To report the clinical course, treatment response and prognosis of eight cases which developed acute-onset postoperative endophthalmitis over a 1-month period. Methods 8 patients who were operated on over a period of 1 month and developed acute postoperative endophthalmitis were evaluated. Five of the patients had cataract surgery, one had cataract surgery combined with silicone extraction, and two patients had pars plana vitrectomy (PPV). Clinical patterns were observed, intraocular cultures were obtained, and the source of the organisms causing the epidemic was investigated. All patients had intravitreal antibiotic injections, three had PPV, and in two patients anterior chamber irrigation was performed. Results Vitreous cultures showed Cellulosimicrobium cellulans in three cases and Stenotrophomonas maltophilia in one case. Four of the cases were culture negative. Stenotrophomonas maltophilia were also isolated from unused bottles of irrigating solutions. The final visual acuity of the patients ranged between HM and 7/10. All three patients with Cellulosimicrobium cellulans had a final visual acuity of ≥5/10. The available irrigating solutions were changed, and the endophthalmitis did not recur. Conclusions The authors are unaware of any previous reports of postoperative endophthalmitis associated with Cellulosimicrobium cellulans. Prompt management with microbiological support, intravitreal antibiotics and PPV when needed were the key to good visual outcomes in this endophthalmitis outbreak.

Purpose.: Detecting retinal vigabatrin toxicity in patients with partial symptomatic or cryptogenic epilepsy can be challenging because of preexisting visual field defects secondary to a structural abnormality in the brain or lack of collaboration. The aim of this study was to measure the retinal nerve fiber layer thickness (RNFLT) with optic coherence tomography (OCT), as well as contrast sensitivity, color vision, and perimetry, in patients with partial symptomatic or cryptogenic epilepsy on vigabatrin, and to determine the efficacy of these tests as markers of vigabatrin-related retinal damage in these subgroups of epileptic patients. Methods.: The study involved 38 patients with either partial symptomatic or cryptogenic epilepsy and 16 healthy individuals comprising the control group. At the time of the study, 14 of the patients were using vigabatrin, 10 were receiving sodium valproate monotherapy, and 14 were on carbamazepine monotherapy. All the participants underwent RNFLT imaging with OCT, contrast sensitivity, color discrimination assessment, and perimetry. Results.: The average 360° RNFLT of the vigabatrin group was significantly lower when compared to the other groups. The average RNFLT of all quadrants except the temporal one in the vigabatrin group was also significantly reduced. There was no difference in the mean deviation, contrast sensitivity, and color discrimination between the study groups, but they were all significantly lower than the control group. Conclusions.: RNFLT measurement with OCT can efficiently identify vigabatrin toxicity in patients with partial symptomatic and cryptogenic epilepsy. Perimetry, contrast sensitivity, and color discrimination assessment might be inconclusive in these particular subgroups of epileptic patients.

Purpose: The purpose of this study was to document the prevalence of anisometropia, anisoastigmatism, and anisometropic amblyopia in patients with neurofibromatosis-1 (NF1) and to compare it with that in age- and sex-matched controls. Methods: Fifty patients with NF1 and 150 age- and sex-matched controls were examined in this study. Cycloplegic autorefraction was attempted on all patients 16 years old. Anisometropia was defined as absolute interocular difference of spherical equivalent more than or equal to 1 D. Aniso-astigmatism was defined as interocular difference of refractive astigmatism of more than or equal to 1 D. Amblyopia was defined as two-line decrease in Snellen acuity between the two eyes. Results: The overall prevalence of anisometropia, aniso-astigmatism, and amblyopia in patients with NF1 was 16%, 20%, and 10%, respectively, and they were all significantly higher than in the controls. The amblyopia was either moderate or severe in nature and all affected patients had significant astigmatism (>2.5 D) in the amblyopic eye. Conclusions: NF1 is a risk factor for anisometropia, aniso-astigmatism, and aniso-astigmatic amblyopia and screening patients with NF1 for refractive errors before age 3 will help to detect patients at risk of amblyopia and give them proper treatment.