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Adrenomedullin and leptin levels in diabetic retinopathy and retinal diseases
(Karger, 2005) Er, H; Doganay, S; Özerol, E; Yürekli, M
Purpose: Proliferative and vascular retinal diseases are important cause of irreversible blindness. Consistent features of these diseases are endothelial dysfunction and angiogenesis. Adrenomedullin (ADM) is a multifunctional vasorelaxant peptide. Leptin is a recently discovered metabolic peptide that regulates energy metabolism in human In the present study, we aimed to investigate the possible roles of adrenomedullin and leptin in the pathophysiology of diabetic and proliferative diseases. Methods: Ten patients with proliferative diabetic retinopathy (57.1 years, 5 female and 5 male) and 8 patients (51 years, 5 female and 3 male) with other retinal diseases including macular hole and epiretinal membrane were included in this study. All the patients had undergone pars plana vitrectomy for complications of the diseases. Vitreous samples were collected by vitreous tap during the vitrectomy. Adrenomedullin analysis was made by using reverse-phase high-performance liquid chromatography (HPLC). Leptin was measured by enzyme-linked immunosorbent assay (ELISA). Body mass index (BMI) [weight (kg)/height (m(2))] was calculated for each group. The Mann-Whitney U test was used for statistics. Results: The age, gender ratio and BMI were not substantially different between the two groups. The mean vitreous adrenomedullin levels (63.9 +/- 7.1 pmol/l) were significantly higher (p < 0.05) in group I than in group II (34.25 +/- 3.0 pmol/l). Leptin levels in vitreous (4.54 +/- 1.6 ng/ml) were also significantly higher (p < 0.05) in patients with diabetic retinopathy than in those without diabetes (1.83 +/- 0.5 ng/ml). Conclusion: Increased adrenomedullin and leptin levels in vitreous humor might be a possible newly associated factor in the course of vascular and proliferative retinal diseases. Copyright (C) 2005 S. Karger AG, Basel.
Anaesthetic management of an infant with Conradi's syndrome
(Blackwell Publishing Ltd, 2003) Hascalik, M; Togal, T; Doganay, S; Ersoy, MO
[Abstract Not Available]
Aqueous humor adrenomedullin levels differ in patients with different types of glaucoma
(Springer Japan Kk, 2002) Evereklioglu, C; Doganay, S; Er, H; Yurekli, M
Purpose: Adrenomedullin is a multifunctional 52 amino acid large peptide. Recent studies have reported that it is expressed in the iris-ciliary body in the eye and that it decreases intraocular pressure (IOP) by increasing outflow facility via specific adrenomedullin receptors, suggesting a role for this peptide in controlling IOP. In the present study, we aimed to explore clinically the possible involvement of adrenomedullin in the pathophysiology of glaucoma. Methods: Reverse-phase high-performance liquid chromatography was used to determine the aqueous humor adrenomedullin levels in 41 patients (41 eyes) undergoing elective surgery for a variety of ocular diseases in the Research Hospital of Inonu University Medical Faculty between 1999 and 2000. The ocular diseases of the patients included primary open-angle glaucoma (POAG, n = 16), neovascular glaucoma (NG, n = 11). and cataract (n = 14). The study was an open trial with purposive sampling. Aqueous humor samples were taken by paracentesis. Mann-Whitney U-test was used in the statistical analysis and P < .05 was considered as significant. Results were expressed as mean +/- SE. Results: The mean age and sex distribution between groups were comparable. Mean adrenomedullin levels in patients with POAG (22.3 +/- 0.6 pmol/L) were significantly higher than those in patients with NG (5.6 +/- 0.2. pmol/L; P < .001) and cataract (11.9 +/- 0.5, pmol/L., P < .001). On the other hand, the mean aqueous humor adrenomedullin levels in patients with NG were significantly (P < .001) lower than those in cataract patients. Conclusions: This first clinical in vivo study on aqueous humor adrenomedullin levels showed that this peptide may be involved in the pathophysiology of glaucoma. Increased aqueous humor adrenomedullin levels in patients with POAG may indicate a compensatory defense response against increased IOP to slow the formation and progression of a vicious cycle, On the other hand, there may be deficient production of the peptide in patients with NG, or adrenomedullin-producing cells may be lost because of very high IOP during the course of the disease. The control of adrenomedullin levels in the eve might be a target that could be considered in the therapeutic strategies for glaucoma. Further studies in this respect are needed. (C) 2002 Japanese Ophthalmological Society.
Audio-vestibular evaluation in patients with Behcet's syndrome
(Headley Brothers Ltd, 2001) Evereklioglu, C; Cokkeser, Y; Doganay, S; Er, H; Kizilay, A
A prospective controlled clinical study was carried out at the Department of Ophthalmology and ENT, Inonu University Medical Faculty, Turgut Ozal Medical Center, Research Hospital, to evaluate the audiovestibular involvement in patients with Behcet's syndrome compared with controls. Twenty-five consecutive patients with Behcet's syndrome (mean age :+/- SD, 34.96 +/- 8.50) and 20 ageand sex-matched healthy volunteers (hospital staff) as control subjects (mean age +/- SD, 34.45 +/- 9.16) were included in this study. Behcet's patients were divided into two groups according to the number of criteria, complete (all four major criteria) and incomplete (three major criteria without ocular involvement). The groups were compared with each other or controls regarding inner ear involvement. Audiometric pure-tone thresholds at 125 to 8000 Hz were obtained in all subjects in both groups, and pure tone average (PTA) hearing thresholds were calculated for the middle, high and low frequencies. In addition, short increment sensitivity index (SISI), tone decay and BERA examinations were performed in all Behcet's patients. Sensorineural hearing loss (SNHL) was present in six of 25 patients with Behcet's syndrome. Two Behcet's patients had unilateral total SNHL, two had bilateral moderate level SNHL, one had bilateral low-frequency SNHL and one bilateral high frequency SNHL. In two, BERA, and in five SISI, examination disclosed inner ear involvement. In control subjects, the past medical history was normal and there was no consistent audio-vestibular complaint. Their PTA thresholds were all in the normal range. Otoscopic examination findings were normal, with intact, mobile tympanic membranes in both groups. The present study showed that audio-vestibular involvement is not infrequent in Behcet's syndrome compared with age-and sex-matched healthy controls, and it is under-estimated. All Behcet's patients should regularly be followed by an otolaryngologists and be given information about the possibility of inner ear involvement. According to our results, hearing loss occurs more often in older patients and also in the complete form of Behcet's syndrome.
Bilateral myopia following blunt trauma to one eye
(Wichtig Editore, 2001) Doganay, S; Er, H; Hepsen, IF; Evereklioglu, C
PURPOSE. To evaluate bilateral myopia following blunt trauma to one eye. CASE REPORT. Traumatic myopia is a rare transient situation which may be seen in the injured eye or both eyes after blunt ocular trauma. We examined one case with transient myopia in the left eye which had been exposed to a blunt ocular injury. Myopia was also observed in the right eye 12 hours after the trauma. The right eye and left eye had reverted to emmetropia respectively two and six weeks after trauma. DISCUSSION. The myopia may have been due to ciliary spasm arising from stimulation of the efferent autonomic system in the right eye and ciliary body edema in the left eye. CONCLUSIONS. To our knowledge, this is the first reported case developing bilateral transient myopia after the blunt trauma to only one eye.
Comparison of serum NO, TNF-?, IL-1?, sIL-2R, IL-6 and IL-8 levels with grades of retinopathy in patients with diabetes mellitus
(Nature Publishing Group, 2002) Doganay, S; Evereklioglu, C; Er, H; Türköz, Y; Sevinç, A; Mehmet, N; Savli, H
Background Vitreal interleukin (IL)-1beta (IL-1beta), IL-6, IL-8, tumor necrosis factor-alpha (TNF-alpha) and nitric oxide (NO) levels have previously been determined in patients with proliferative diabetic retinopathy (PDR). However, at present there is no cohort study linking serum levels of NO and many inflammatory cytokines such as TNF-alpha, IL-1beta, soluble IL-2 receptor (sIL-2R), IL-6 and IL-8 to the grade of the microvascular complications. Purpose To determine the relation between the stages of DR and the levels of serum NO, TNF-alpha, IL-1beta, sIL-2R, IL-6 and chemokine IL-8 in patients with diabetes compared with healthy controls. Methods Fifty-three consecutive patients with diabetes (25 men, 28 women) with or without DR and 15 non-diabetic healthy subjects (seven men, eight women) as controls were included in this prospective study. As an indicator for NO, serum total nitrite (NO2- + NO3-) levels (end-product of NO) were measured by the Griess reaction. Serum TNF-alpha, IL-1beta, sIL-2R, IL-6 and IL-8 levels were determined by a spectrophotometric technique using an Immulite chemiluminescent immunometric assay. The patients with diabetes were classified into three groups according to the stage of DR: no DR (NDR; n = 16), non-proliferative DR (NPDR; n = 18) and PDR (n = 19). The data were analysed using a Mann-Whitney U-test and the results were expressed as mean +/- SE (range). Results The levels of IL-1beta and IL-6 were below the detection limits of the assay (for each, <5.0 pg/ml) in all patients with diabetes and controls. Soluble IL-2R levels ranged from 260 to 958 U/ml, with the highest values observed in the patients with PDR. In 47 of the 53 samples (89%) tested for diabetic patients, IL-8 levels were above the detection limits of the assay (5.0 pg/ml). IL-8 levels ranged from <5.0 to 25.0 pg/ml, with the highest mean values observed in PDR patients. TNF-alpha was detectable in 46 of 53 patients with diabetes (87%), ranging from <4.0 to 26.4 pg/ml, with again the highest values obtained in the patients with PDR. Serum NO levels ranged from 80 to 188 mumol/l, with the highest values obtained in patients with PDR. Taken together, the mean serum NO, sIL-2R, IL-8 and TNF-alpha levels increased with the stage of DR and the highest levels were found in patients with PDR. The PDR patients had significantly (for each, P < 0.001) higher serum NO (166.8 +/- 3.2 mumol/l), sIL-2R (807.9 +/- 33.3 U/ml), IL-8 (17.9 +/- 0.4 pg/ml) ;and TNF-alpha (15.0 +/- 0.8 pg/ml) levels compared with NPDR patients (149.5 +/- 2.1, 659.4 +/- 23.4, 12.9 +/- 1.1, 11.5 +/- 0.6, respectively), NDR patients (115.9 +/- 5.8, 373.8 +/- 15.0, 8.3 +/- 1.0, 6.6 +/- 0.9, respectively) and controls (116.6 +/- 2.3, 392.4 +/- 16.6, 7.2 +/- 0.3, 7.3 +/- 0.3, respectively). Serum levels of these parameters for NPDR patients were also significantly (for each, P < 0.01) higher compared with those of NDR patients and controls. On the other hand, serum NO, sIL-2R, IL-8 and TNF-alpha levels of patients with NDR were comparable with those of controls (for each, P > 0.05). Conclusion The results of the present study suggest that NO, sIL-2R, IL-8 and TNF-alpha may play important roles in the pathophysiology and progression of DR. We think that these potentially inflammatory cytokines and NO with their endothelial implications may act together during the course and progression of DR. These molecules may serve as therapeutic targets for the treatment and/or prevention of diabetes with its systemic and ocular microvascular complications.
Comparison of the effects of Argon and Neodymium: YAG laser iridotomy on cytokines in the rabbit aqueous humor
(Wichtig Editore, 2002) Er, H; Doganay, S; Evereklioglu, C; Turkoz, Y; Gündüz, A; Borazan, M; Ozyalin, F
PURPOSE. We compared the effects in rabbits of iridotomy using the argon or Nd:YAG laser on cytokines such as interleukin 1-beta (IL-1beta), interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha). METHODS. Twenty pigmented rabbits (20 eyes) underwent argon and Nd:YAG iridotomy under general and topical anesthesia. Group 1 (10 right eyes) was treated with the argon laser and group 2 (10 right eyes) with the Nd:YAG laser, using an equal number of shots and the same laser parameters for each group. Left eyes in both groups were evaluated as controls. Aqueous humor specimens were collected from each eye preoperatively and 1 and 3 days postoperatively. RESULTS. Aqueous IL-6 and TNF-a levels rose more on day 1 in the Nd:YAG group than the argon group. IL-6 and TNF-a levels were significantly higher on days 1 and 3 than the pre-operative and control levels (p<0.05). TNF-alpha levels on day 1 were significantly lower in the Nd:YAG than the argon group. There were no significant differences between the two laser groups for IL-6 on days 1 and 3. IL-1beta and IL-8 did not change CONCLUSIONS. Our findings suggest that cytokines, particularly IL-6 and TNF-alpha, may be inflammatory mediators in the early inflammation following argon and Nd:YAG laser iridotomies. These results also indicate that cytokines contribute to the acute effects of Nd:YAG and argon laser applications on inflammation.
Craniofacial anthropometry in a Turkish population
(Alliance Communications Group Division Allen Press, 2002) Evereklioglu, C; Doganay, S; Er, H; Gunduz, A; Tercan, M; Balat, A; Cumurcu, T
Objective: To present norms and demonstrate the anthropometric variations in fronto-occipital circumference, inner and outer canthal distances, near and distant [far] anatomical interpupillary distance, canthal index, and circumference-interorbital index across age and sex in urban Turkish subjects. Participants: Three thousand four hundred forty-eight subjects (1852 male, 1596 female) aged 7 to 40 years were included in this study. Methods: Three age groups were studied: children aged 7 to 15 years, young adults aged 16 to 25 years, and adults aged 26 to 40 years. Mean values for each measured parameter were determined at each age between 7 and 25 years. Subjects were also divided into nine age subgroups to observe the change of each parameter with advancing age. Results: The fronto-occipital circumference and outer canthal distance of males was significantly (p < .001) wider than females in all age groups. The near and distant interpupillary distances of male subjects were, on average, wider than the female subjects with greater differences with advancing age. Across all subjects aged 7 to 40 years, the mean of all measured parameters and calculated indexes of men and boys was significantly different from girls and women (p < .001). The mean for interpupillary distances in our study in both sexes were found to be similar to Arabian, Hong Kong, and British children; larger than those of Chinese, Black, Indian, and Caucasians; and smaller than those of Mexican children and a mixed European population. Conclusion: This study clearly shows the anthropometric variation for fronto-occipital circumference, inner canthal distance, outer canthal distance, near and distant interpupillary distance, canthal index, and circumference-interorbital index with age. These developmental data and the normal values of these measurements in healthy subjects are useful for dysmorphologists in the early identification of some craniofacial syndromes, hyper- and hypotelorism, and congenital or posttraumatic telecanthus and of planning surgical intervention. We suggest that the comparison of craniofacial dimensions of a patient must be performed with normal standards specific for age as well as sex and race.
Crocodile tears syndrome: botulinum toxin treatment under EMG guidance
(C I C-Edizioni Internazionali Srl, 2005) Kizkin, S; Doganay, S; Ozisik, HI; Ozcan, C
In conclusion, we recommend EMG guidance in the treatment of crocodile tears syndrome with botulinum toxin.Crocodile tears syndrome is one of the rare complications of facial paralysis. There have been several reports of cases in which botulinum toxin was found to be useful in the treatment of crocodile tears syndrome. The adverse effects, due to the paralytic action of botulinum toxin, have been reported to involve the palpebral muscle, lateral rectus and superior rectus. Therefore, we considered that it might be more appropriate to carry out the injection procedure under electromyographic guidance in order to inject botulinum toxin selectively into the lacrimal gland and protect the above-mentioned muscles.
Decreased nitric oxide production in primary open-angle glaucoma
(Wichtig Publ, 2002) Doganay, S; Evereklioglu, C; Turkoz, Y; Er, H
PURPOSE. Raised intraocular pressure (IOP) is the major risk factor responsible for optic nerve damage in primary open-angle glaucoma (POAG). The trabecular meshwork acts as a valve in aqueous outflow and relaxes with nitric oxide (NO) agonists. Since NO is synthesized by endothelium and smooth muscle elsewhere in the body, this study investigated the NO levels in the aqueous humor of patients with POAG compared with cataract patients. MATERIALS AND METHODS. Aqueous humor samples were taken by paracentesis from 16 consecutive patients with POAG (9 male and 7 female; mean age 69.0 +/- 3.4 yrs) and 14 age and sex-matched controls with cataract (8 male and 6 female; mean age 66.7 +/- 4.1 yrs) during elective surgery. As an indicator for NO, aqueous total nitrite levels (end - product of NO) were measured by Greiss reaction. The Mann-Whitney U test was used for statistical analysis and P <0.05 was considered significant. RESULTS. The mean age and sex in two groups were comparable. The mean aqueous humor NO levels were significantly (P = 0.001) lower in patients with glaucoma (72.72 +/- 11.21 mumol/L) than in patients with cataract and no glaucoma (86.92 +/- 11.23 mumol/L). CONCLUSIONS. Decreased NO production in patients with POAG indicates that NO-producing cells may be lost as the disease progresses. The control of NO levels in the eye might be a therapeutic target in glaucoma.
The effect of resveratrol in experimental cataract model formed by sodium selenite
(Taylor & Francis Inc, 2006) Doganay, S; Borazan, M; Iraz, M; Cigremis, Y
Purpose : To investigate if resveratrol can prevent sodium selenite-induced experimental cataract model in rats. Methods : Forty-eight Spraque-Dawley rat pups were divided into 3 treatment groups: (1) normal saline-% 5 ethanol injected i.p. on postpatum day 10; (2) Na selenite (30 nmol/g body wt) injected s.c on day 10; (3) Na selenite s.c on day 10 + resveratrol (40 mg/kg) i.p on days 10-13. On day 21, cataract development was graded by slit-lamp examination and photography. Encapsulated lenses and erythrocytes were analyzed for reduced glutathione (GSH) and malondialdehyde (MDA), a marker of lipid peroxidation. Lenses were also analyzed for total nitrite (TN). Results : All control lenses in group 1 were clear. In group 2, all rats developed cataracts (grade 3-grade 6), whereas in group 3, only 9 of 16 rats developed cataracts (grade 2-grade 3). The difference of cataract frequency between groups 2 and 3 was statistically significant (p p < 0.05). Group 3 lenses and erythrocytes had higher mean GSH and lower mean MDA levels than those in group 2 (p < 0.05). TN was highest in group 3 and lowest in group 1 (p < 0.05). Conclusions: Resveratrol suppressed selenite-induced oxidative stress and cataract formation in rats. This protective effect was supported by higher GSH and lower MDA in lens and erythrocytes. The presence of oxidative stress in selenite cataract development and its prevention by resveratrol support the possibility that high natural consumption of resveratrol in food can help prevent human senile cataract.
Effects of L-NAME and timolol on aqueous IL-1?, IL-6 IL-8, TNF-? and NO levels after Nd:YAG laser iridotomy in rabbits
(Sage Publications Ltd, 2002) Er, H; Doganay, S; Evereklioglu, C; Cekmen, M; Daglioglu, MC; Isci, N
PURPOSE. Pro-inflammatory cytokines are produced by tissues and play a vital role in the host inflammatory response and uveitis. Nitric oxide (NO) can be produced in large amounts as a response to experimentally-induced uveitis or cytokines. In this study, we measured the levels of pro-inflammatory cytokines such as interleukin (IL)-1beta, IL-6, IL-8, tumor necrosis factor (TNF)-alpha and free-radical in aqueous humor after Nd:YAG laser iridotomy in rabbits, and investigated whether timolol maleate an anti-glaucoma drug, or a NO synthase inhibitor, NG-nitro-L-arginine methyl esther (L-NAME) had an inhibitory effect on these molecules, since L-NAME is a known anti-inflammatory agent in rabbits. METHODS. Bilateral experimental Nd:YAG laser iridotomy (power 7.5 mJ, mode single burst, aiming beam 4) was performed on 18 rabbits under general plus topical anesthesia. Aqueous humor samples were taken by clear corneal paracentesis preoperatively, and 1 and 24 h postoperatively. Six rabbits (12 eyes) were given bilateral topical timolol maleate 0.5% (Timoptic(R)) drop b.i.d (group 1), six rabbits (12 eyes) received bilateral 0.1 ml subconjuntival injections of L-NAME (150 mg/kg) (group 2), and six rabbits (12 eyes) were treated with topical balanced salt solution (BSS) b.i.d. (control). RESULTS. Preoperative cytokine and NO levels were comparable in the three groups, with no significant differences. In addition, there was no significant difference in baseline cytokine levels between the right and left eyes. In all groups, pre- and postoperative mean IL-1beta levels were below the:detection limit of the assay (< 5.0 pg/ml). In the control group, postoperative mean IL-6, IL-8 and NO levels were significantly higher after Nd: YAG laser iridotomy than before (for each, p < 0.01). Timolol and L-NAME both inhibited the rise in IL-8 and TNF-alpha levels. Timolol also inhibited the rise in IL-6 but not NO. L-NAME had an inhibitory effect against NO, but not IL-6. CONCLUSIONS. L-NAME has an inhibitory effect on IL-8, TNF-alpha and NO, but not on IL-6. Timolol had inhibitory effects on IL-6, IL-8 and TNF-alpha. but not on NO. These preliminary experimental results might help in assessing the effect of Nd: YAG laser iridotomy in aqueous humor, and to understand the inhibitory effects of timolol and L-NAME against these molecules.
The levels of cytokines and nitric oxide in rabbit vitreous humor after retinal laser photocoagulation
(Slack Inc, 2000) Er, H; Doganay, S; Turkoz, Y; Cekmen, M; Daglioglu, MC; Gunduz, A; Evereklioglu, C
OBJECTIVE: To determine the levels of nitric oxide (NO) and cytokines such as interleukin 1-beta (IL-1 beta), interleukin G (IL-6), interleukin 8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha) on vitreous humor following retinal laser photocoagulation. MATERIALS AND METHODS: The rabbits were divided into 3 groups of 4 animals (8 eyes) each. Twelve pigmented rabbit eyes underwent modified grid pattern photocoagulation with a power of 240 mW (group I); 300 mW (group II); and 360 mW (group III). The eyes received 200 burns using a spot size of 200 mu, and duration of 0.2 s. Vitreous humor samples were collected from each eye preoperatively and at 24 and 72 hours after the laser. RESULTS: When compared to preoperative levels, IL-6 levels were increased in all groups; IL-1 beta levels were increased significantly only in group III. IL-8 levels were high in groups II and III only at 72 hours (P <0.05). TNF levels were elevated significantly in group II and III only at 24 hours (P <0.05). NO levels were significantly higher than preoperative values in all groups at all times. CONCLUSION: Our results support that especially IL-6, IL-8, and NO levels increase significantly following laser photocogulation. This preliminary study suggests that IL-6, IL-8, and NO might be dominant contributing factors in the occurrence of the inflammation postoperatively.
Nitric oxide and lipid peroxidation are increased and associated with decreased antioxidant enzyme activities in patients with age-related macular degeneration
(Springer, 2003) Evereklioglu, C; Er, H; Doganay, S; Cekmen, M; Turkoz, Y; Otlu, B; Ozerol, E
Background: Nitric oxide (NO), hydroxyl radical (OH.), superoxide anion (02) and hydrogen peroxide (H2O2) are free-radicals released in oxidative stress. Superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and catalase (CAT) are antioxidant enzymes, mediating defense against oxidative stress. Excess NO and/or defective antioxidants cause lipid peroxidation, cellular dysfunction and death. Age-related maculopathy (ARM) or degeneration (ARMD) is the leading cause of irreversible blindness in developed countries. The etiology is unclear and the molecular factors contributing this disease remain to be specified. Aims: This multicenter, double-blind, cross-sectional study aimed to investigate plasma NO and lipid peroxidation levels with relation to antioxidant enzyme activities in erythrocyte and plasma of patients with ARMD compared with healthy control subjects. Methods: NO, lipid peroxidation (measured as plasma malondialdehyde [MDA] levels) and the catalytic activity of SOD, GSHPx and CAT were measured in a group of 41 patients with maculopathy (19 men, 22 women; 67.12 +/- 3.70 years) and compared with 25 age- and sex-matched healthy control subjects without maculopathy (12 men, 13 women; 68.04 +/- 3.02 years). NO and MDA levels were measured in plasma, CAT in red blood cells (RBCs), and SOD and GSHPx in both plasma and RBCs. Color fundus photographs were used to assess the presence of maculopathy, and the patients were divided into two groups using clinical examination and grading of photographs; early-ARM (n = 22) and late-ARMD (n = 19). Results: All patients with maculopathy had significantly (p < 0.001) higher plasma NO levels over control subjects (mean +/- SD, 48.58 +/- 8.81 vs. 28.22 +/- 3.39 mu mol/l). Plasma MDA levels in patients and control subjects were 4.99 +/- 1.00 and 2.16 +/- 0.24 mu mol/l, respectively, and the difference was significant (p < 0.001). On the other hand, SOD and GSHPx activities were significantly lower in both RBCs and plasma of patients with maculopathy than in control subjects (RBCs-SOD, 3509.30 +/- 478.22 vs. 5033.30 +/- 363.98 U/g Hb. p < 0.001; plasma-SOD, 560.95 +/- 52.52 vs. 704.76 +/- 24.59 U/g protein, p < 0.001; RBCs-GSHPx, 663.43 +/- 41.74 vs. 748.80 +/- 25.50 U/g Hb, p < 0.001; plasma-GSHPx, 98.26 +/- 15.67 vs. 131.80 +/- 8.73 U/g protein, p < 0.001). RBCs-CAT levels were not different between groups (131.68 +/- 12.89 vs. 133.00 +/- 13.29 k/g Hb, p = 0.811). Late-ARMD patients had significantly lower antioxidant enzyme levels and higher MDA levels when compared with early-ARM patients (for each, p < 0.001). In addition, plasma NO and MDA levels were negatively correlated with SOD and GSHPx activities. Conclusions: This study demonstrated for the first time that NO, the most abundant free-radical in the body, might be implicated in the pathophysiology of ARMD in association with decreased antioxidant enzymes and increased lipid peroxidation status.
Normative values of craniofacial measurements in idiopathic benign macrocephalic children
(Alliance Communications Group Division Allen Press, 2001) Evereklioglu, C; Yakinci, C; Er, H; Doganay, S; Durmaz, Y
Objective: To determine normal standard values at each age for head circumference; inner canthal distance; outer canthal distance; near interpupillary distance; distant Cfar] interpupillary distance; canthal index; and circumference-interorbital index specific for the age, sex, and race in 7- to 16-year-old idiopathic benign macrocephalic male and female children, Methods: The measurements of head circumference were obtained in 8736 children (4591 boys and 4145 girls) in the city center of Malatya. From these, macrocephalic children (boys = 103, girls = 93) were chosen and invited to our clinic for detailed examination. Mean values for each parameter were obtained at each age from 7 to 16 years. Results: The mean age for male and female children were 11.87 +/- 2.87 and 11.72 +/- 2.75 years, respectively. The overall mean values for head circumference, inner canthal distance, outer canthal distance, near interpupillary distance, distant interpupillary distance, canthal index and circumference-interorbital index in boys were found to be 57.43 +/- 1.46 cm, 31.90 +/- 2.41 mm, 89.29 +/- 4.34 mm, 58.79 +/- 2.97 mm, 62.10 +/- 3.23 mm, 35.73 +/- 2.24, and 5.56 +/- 0.44, respectively. In girls, these values were 56.57 +/- 1.24 cm, 31.45 +/- 2.65 mm, 87.71 +/- 4.11 mm, 58.16 +/- 3.46 mm, 61.26 +/- 3.66 mm, 35.84 +/- 2.31, and 5.56 +/- 0.43, respectively, Conclusion: Normal values of craniofacial measurements for idiopathic benign macrocephalic healthy children are useful in early identification of some craniofacial syndromes, congenital or posttraumatic telecanthus, epicanthus, and hypo-hypertelorism and of planning surgical intervention, We suggest that the comparison of craniofacial dimensions of macrocephalic healthy children must be performed with normal standards specific for age as well as sex and race.
Retrospective comparison of surgical techniques to prevent secondary opacification in pediatric cataracts
(Slack Inc, 2000) Er, H; Doganay, S; Evereklioglu, C; Erten, A; Cumurcu, T; Bayramlar, H
Purpose: To evaluate the effect of different surgical methods for management of the posterior capsule and anterior vitreous on the rate of posterior capsule opacification in pediatric cataracts. Methods: Charts of 34 children (47 eyes) aged 40 days to 18 years (mean: 8.5 years) who had primary cataract surgery with or without posterior chamber intraocular lens (IOL) implantation during the past 5 years were reviewed. In 26 eyes, cataracts were managed with a posterior continuous curvilinear capsulorhexis, and in 21 eyes, the posterior capsule was left intact. Follow-up averaged 10 months (range: 6.5 months to 5 years). Results: Visually significant secondary cataract developed in nine eyes with intact posterior capsules, and seven eyes required Nd:YAG laser posterior capsulotomy. The average time for YAC capsulotomy postcataract removal in the second group was 4 months. The visual axis remained clear in all eyes that had posterior continuous curvilinear capsulorhexis with or without posterior chamber IOL. Complications such as fibrinoid membrane, stromal edema, posterior synechiae, updrawn pupil, and transient glaucoma occurred in both groups at a similar rate. Conclusion: Primary posterior continuous curvilinear capsulorhexis is an effective method for preventing secondary cataract formation in pediatric cataracts.
Serum homocysteine level is increased and correlated with endothelin-1 and nitric oxide in Behcet's disease
(Bmj Publishing Group, 2002) Er, H; Evereklioglu, C; Cumurcu, T; Türköz, Y; Özerol, E; Sahin, K; Doganay, S
Background/aims: Beligei's disease (BD) is a systemic inflammatory vasculitis of young adults with unknown aetiology, characterised by endothelial dysfunction and occlusion in both deep venous and retinal circulation. Ocular involvement occurs in 70% of cases and is characterised by periphlebitis, periarteritis, vascular occlusion, and thrombosis leading to blindness despite vigorous treatment. Endothelin-1 (ET-1) is a vasoconstricting peptide while nitric oxide (NO) is a relaxing molecule and both are released by endothelium for blood flow regulation. Homocysteinaemia is a newly defined term connected to the increased risk of atherothrombotic and atherosclerotic systemic and retinal vascular occlusive diseases, and its role in the course of BID has not been previously described. The authors aimed to detect serum total homocysteine (tHcy), ET-1, and NO in BID and to assess if tHcy, ET-1, and NO are associated with ocular BD or disease activity. Methods: 43 consecutive patients with ocular (n = 27) or non-ocular (n = 16) BD (36.95 (SD 9.80) years, 22 male, 21 female) satisfying international criteria, and 25 age and sex matched healthy control subjects (37.88 (8.73) years, 13 male, 12 female) without a history of systemic or retinal venous thrombosis were included in this study. Patients were examined by two ophthalmologists with an interest in BID. Serum tHcy, ET-1, and NO concentrations were measured in both groups. Hype rhomocysteinaemia was defined as a tHcy level above the 95th percentile in the control group. Patients were divided into active and inactive period by acute phase reactants including (X, antitrypsin, alpha(2), macroglobulin, erythrocyte sedimentation rate, and neutrophil count. Results: The overall mean serum tHcy, ET-1, and NO levels were significantly higher in patients with BD than in control subjects (tHcy = 15,83 (4.44) v7.96 (2.66) ng/ml, p <0.001; ET-1 = 17.47 (4.33) v 5.74 (2.34) mumol/ml, p <0.001; NO = 37.60 (10.31) v 27.08 (7.76) mumol/l, p <0.00 1). Serum I tHcy, ET-1, and NO levels were significantly higher in active patients than in inactive patients and control subjects. In addition, among patients with ocular BID, the mean tHcy levels were significantly increased and correlated with ET-1 and NO levels when compared with non-ocular disease and control subjects. All acute phase reactant levels were significantly higher in active period than in inactive stage and controls. Conclusions: Elevated tHcy may be responsible for the endothelial damage in BD and may be an additional risk Factor for the development of retinal vascular occlusive disease, contributing to the poor visual outcome in these patients. Assessment of tHcy may be important in the investigation and management of patients with BD, especially with ocular disease.
Serum leptin concentration is increased in patients with Behcet's syndrome and is correlated with disease activity
(Blackwell Publishing Ltd, 2002) Evereklioglu, C; Inalöz, HS; Kirtak, N; Doganay, S; Bülbül, M; Otlu, B; Özerol, E
Background Behcet's syndrome is a systemic, relapsing immuno-inflammatory disease with a generalized vasculitis of the microvasculature endothelial dysfunction. Leptin, a recently discovered neuroendocrine hormone, is a metabolic peptide that appears to be involved. Serum proinflammatory cytokines upregulate leptin levels and leptin itself directly induces nitric oxide production from endothelial cells with its specific receptors. Objectives To detect changes of serum leptin concentrations in patients with Behcet's syndrome compared with age- and sex-matched healthy volunteers by using enzyme-linked immunosorbent assay. We also investigated whether disease activity or the duration of Behcet's syndrome correlates with leptin concentration. Methods Thirty-five consecutive patients with Behcet's syndrome (41.2 +/- 8.4 years, 16 male, 19 female) and 20 age- and sex-matched healthy control subjects (40.4 +/- 10.91 years, nine male, 11 female) were included in this study. The body mass index (BMI) [weight (kg) height(-1) (m(2) )] was calculated for subjects at study enrolment. We measured serum leptin with a leptin enzyme immunoassay kit, and acute-phase reactants, including erythrocyte sedimentation rate, alpha(1) -antitrypsin, alpha(2) -macroglobulin and neutrophil count. The Mann-Whitney U -test was used for statistical analysis and P < 0.05 was considered significant. Values were expressed as mean +/- SD. Results The gender ratio, age and BMI were not substantially different among Behcet's patients and controls. The mean serum leptin concentrations in patients with Behcet's syndrome (16.8 +/- 7.49 ng mL(-1) ) were significantly (P < 0.001) higher than in healthy control volunteers (7.5 +/- 2.77 ng mL(-1) ). Active Behcet's patients had significantly (P = 0.001) higher leptin concentrations (20.5 +/- 7.99 ng mL(-1) ) when compared with patients in inactive periods (12.8 +/- 4.43 ng mL(-1) ). In addition, patients with longer disease duration (mean, 20.1 +/- 5.15 years) had also significantly (P = 0.013) higher leptin concentrations (20.2 +/- 8.52 ng mL(-1) ) than those with shorter disease duration (13.4 +/- 4.52 ng mL(-1) ) (mean, 7.4 +/- 3.29 years). All acute-phase reaction parameters were found to be significantly (for each, P < 0.01) increased in active disease. Conclusions Leptinmay have a role in modulating endothelial function and may be involved in mechanisms for vessel endothelium repair, during an exacerbation as well as in chronic disease.
Serum leptin concentrations are decreased and correlated with disease severity in age-related macular degeneration
(Nature Publishing Group, 2003) Evereklioglu, C; Doganay, S; Er, H; Çekmen, M; Özerol, E; Otlu, B
Background Age-related maculopathy (ARM) or degeneration (ARMD) is the leading cause of irreversible blindness in developed countries. Despite several studies on the morphology of ARMD, the aetiology is unknown and factor(s) contributing to the pathogenesis remain to be characterised. More recent studies have demonstrated that cholesterol esters and lipids are present within Bruch's membrane deposits and drusen, and dietary fat intake is associated with ARMD. The product of Ob gene, leptin, is a recently discovered peptide participating in human metabolism. There is a direct relationship between serum leptin and diet, and lipoprotein metabolism, but the role of leptin in the course of ARMD has not previously been investigated. Purpose This cross-sectional case-control study investigated whether serum leptin level was associated with ARMD as a new possible risk factor and to assess its relationship with disease severity. Methods A total of 32 patients with ARM or ARMD (17 men, 15 women) and 20 age- and sex-matched healthy control subjects without ARMD (11 men, nine women) from a similar ethnic background were enrolled in this multicentre study. Body mass index (BMI) (weight (kg)/height (m(2))) was calculated for each group. The presence of maculopathy was assessed on the basis of colour fundus photographs using an international classification system. Patients were classified as early-ARM (n = 16) or late-ARMD (n = 16) using clinical examination and grading of photographs. Serum leptin levels were measured by an enzyme-linked immunosorbent assay kit. The Mann-Whitney U test or chi(2) test was used for statistics as indicated, and P<0.05 was considered to be significant. Results The age, sex ratio, and BMI between groups were comparable. Patients with maculopathy had significantly (P<0.001) lower leptin levels (mean +/- SD, 6.01 +/- 2.55 ng/ ml) than control subjects (13.21+/- 2.27 ng/ml). In addition, late-ARMD patients had significantly lower leptin levels (3.81 +/- 0.58 ng/ ml) than early-ARM patients (8.21 +/- 1.68 ng/ml, P<0.001) or control subjects (P<0.001). Conclusion Leptin seems to be a possible newly associated factor in the course of ARM and may be involved in the lipid composition of the macular lesions, especially in late-ARMD.
Use of caffeic acid phenethyl ester to prevent sodium-selenite-induced cataract in rat eyes
(Elsevier Science Inc, 2002) Doganay, S; Turkoz, Y; Evereklioglu, C; Er, H; Bozaran, M; Ozerol, E
Purpose: To investigate whether caffeic acid phenethyl ester (CAPE) prevents sodium-selenite-induced cataract. Setting: Department of Ophthalmology and Biochemistry, Inonu University Medical Faculty, Turgut Ozal Medical Center, Research Hospital, Malatya, Turkey. Methods: Sixty Spraque-Dawley rat litters were randomized into 3 groups. In Group 1 (n = 18), sodium selenite (30 nmol/g body weight) was injected subcutaneously on postpartum day 10. In Group 2 (n = 22), subcutaneous CAPE (15 mumol/kg) and sodium selenite (30 nmol/g body weight) were injected on postpartum day 10. The CAPE dose was continued subcutaneously for 3 days after the initial injection. Only subcutaneous saline was injected in Group 3 (control, n = 20). The development of cataract was assessed weekly, and its density was graded by slitlamp biomicroscopy and photography. Removed rat lenses were analyzed for glutathione (GSH) and malondialdehyde (MDA, marker of lipid peroxidation). Results: Group 2 rats had clear lenses or minor cataract. All Group 1 rats developed more severe cataract or complete opacification. The between-group difference was statistically significant (P < .05). All control lenses (Group 3) were clear. The mean GSH level in Group 1 (4.49 mumol/g wet weight +/- 0.93 [SD]) was significantly lower than that in Group 2 (8.63 +/- 0.88 mumol/g wet weight) (P < .05) and controls (10.76 +/- 1.97 mumol/g wet weight) (P < .05). The mean MDA level in Group 1 (8.54 +/- 1.31 nmol/g wet weight) was significantly higher than that in Group 2 (5.23 +/- 0.84 nmol/g wet weight) (P < .05) and controls (4.19 +/- 0.81 nmol/g wet weight) (P < .05). Conclusion: Caffeic acid phenethyl ester effectively suppressed cataract formation in rats. The protective effect was supported by lower GSH and higher MDA levels in Group 1 than in Group 2, suggesting the antioxidant efficacy of this agent. Since CAPE has no known harmful effect on normal cells, it may be beneficial in clinical use in humans. (C) 2002 ASCRS and ESCRS.

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