Adem Gül

The effectiveness of postoperative early ostium cleaning in transcanalicular diode laser-assisted dacryocystorhinostomy.

Purpose: To search the effectiveness of postoperative first week ostium cleaning in transcanalicular diode laser–assisted dacryocystorhinostomy (TDL-DCR). Materials and Methods: A total of 123 eyes of 123 patients with acquired dacryostenosis who had surgery were retrospectively evaluated. Diode laser was used in all patients. All patients were operated under local anesthesia by a single surgeon. Intranasal endoscopic cleaning of the ostium by surgical suction under local anesthesia was performed as an extra job in the postoperative first week visit. Results: Mean age of the patients was 55 (range, 41–78 years) years. Mean follow up was 13.4 months. Successful outcomes were achieved in 117 of 123 (95.1%) patients. Reoperation was performed in 6 patients with restenosis and were free of symptoms in 1-year follow up. Conclusion: Postoperative first week cleaning of the nasal ostium by surgical suction with the aiding of nasal endoscopy is a very effective method increasing the success rate of TDL-DCR.

MRI-Induced Migration of Retained Metallic Foreign Body in the Eye

A 50-year-old man presented to the out-patient clinic because of a sudden pain in his left eye just after lumbal magnetic resonance imaging (MRI) was started. Biomicroscopic examination of the left eye revealed the inferior anterior chamber angle including a foreign body and the superior anterior chamber angle including the iris portion, into which the foreign body had been stuck prior to the MRI examination. His history revealed an accidental penetrating eye trauma of the shotgun pellet of 28 years ago. The foreign body was easily removed using a forceps intraoperatively. The foreign body was defined as a metallic foreign body postoperatively.

A Possible Cause of Nasolacrimal Duct Obstruction: Narrow Angle Between Inferior Turbinate and Upper Part of the Medial Wall of the Maxillary Sinus

Abstract Background: To search the relationships between the primary nasolacrimal duct obstruction and the angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus. Design: Retrospective study. Participants and methods: Computed tomography findings of 35 patients with primary nasolacrimal duct obstruction and 100 sides of 50 individuals were reviewed. While the study group was composed of patients who had external dacryocystorhinostomy surgery, the control group was composed of patients who had CT scans due to headache, sinusitis and smell dysfunction. Epiphora complaint was evaluated with the lacrimal syringing. The exclusion criteria were: age less than 20 years, previous nose, sinus, turbinate or lacrimal surgery, prior history of maxillofacial fracture, nasopharyngeal malignancy, reflex hypersecretion, and associated pathology of the lacrimal canaliculi. Main outcome measures: The angle of inferior turbinate. Results: The mean angles were 53.2° (range, 37.9–82.9°) for affected side of the study group, 58.6° (range, 32–85.3°) for the unaffected side of the study group and 56.8° (range, 41.2–76.9°) in the control group. The difference between the angles was statistically significant between the study and the control groups (p < 0.05). The difference between the operated and non-operated sides of the study group was also statistically significant (p < 0.05). Conclusion: Although this study was performed in a small group, we thought that the narrow angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus might be a possible causative factor in primary acquired nasolacrimal duct obstructions.

The Modified Technique of External Dacryocystorhinostomy in the Management of Complicated Nasolacrimal Duct Obstruction.

Aim:To evaluate the outcome of the modified technique of external dacryocystorhinostomy (EDCR) with a “U”-shaped single flap that was fixed on to the orbicularis muscle with combined silicone tube in dacriostenosis. In cases with decreased visibility because of excessive bleeding during surgery, a small sac size, and difficulty of mutual suturing between nasal mucosal and sac flaps related to distance. Methods:This retrospective study included 118 patients with a nasolacrimal duct obstruction who underwent the modified technique of EDCR. The modified EDCR procedure envisions the creation of anastomosis of the single anterior “U”-shaped flaps suturing anterior flaps of the lacrimal sac and nasal mucosa. The sutured flap was fixed on to the orbicularis muscle. The silicone tube intubation was performed on all patients. Results:The average age of the patients was 39 ± 19.2 (9–70) years, including 94 women and 24 men. The average follow-up time was 18 ± 4.5 (9–36) months. Total 112 eyes (94.9%) showed a patent lacrimal system to irrigation, whereas 6 eyes (5.1%) had recurrence of epiphora and not patent lacrimal system to irrigation by the end of the first surgeries. The same surgery was planned for these patients. The patent lacrimal system was achieved in 3 of these 6 eyes. The overall success rate of the surgical procedure used in this study was 97.4%. Conclusions:This modified technique of EDCR with a “U”-shaped single anterior flaps that was fixed on to the orbicularis muscle with combined silicone tube simplifies the surgical procedure and is effective in the management of nasolacrimal duct obstruction.

A propranolol nonresponsive mass: lymphangioma-mimicking hemangioma.

the surgeons understanding of the paranasal sinus anatomy and helpful in performing a more complete anatomic dissection. This helped to reduce intraoperative complications and provide better outcomes. Moreover, we found the navigation platform a valuable teaching tool in the residency training program in our institute. To conclude, the use of intraoperative navigation system is firmly established as a valuable technology in the management of paranasal sinus disease. It may improve the confidence of the surgeon by confirming the position within the challenging anatomic fields. This increases surgical effectiveness and improves surgical safety. The effect of navigation-aided endoscopic surgery on the clinical outcomes is to date not demonstrated.

Surgical management of intraocular lens dislocations

PURPOSE To report and compare the surgical, visual, and anatomical outcomes following treatment of dislocated intraocular lenses (IOLs). METHODS The medical records of 28 eyes of 28 patients were evaluated. Age, gender, pre-and postoperative best-corrected visual acuity (BCVA), surgical methods, and complications were recorded. RESULTS Pre-and postoperative BCVA ranged from counting fingers to 20/32 and from counting fingers to 20/25, respectively. Late-onset dislocations were the most frequently observed complication. The most frequent surgical method was IOL repositioning in 15 of 28 patients, followed by IOL exchange in 11 patients, and IOL removal in 2 patients. Only 1 patient required surgical re-intervention with IOL capture. CONCLUSIONS Visual acuity improved following the use of either IOL repositioning or IOL exchange. No superiority of one method over the other was observed. In the present retrospective case series, management of dislocated IOLs with repositioning or exchange of the primary implant conferred comparable surgical and visual outcomes.

Scleral fixation of one piece intraocular lens by injector implantation

Aim of Study: With an ab-interno technique of transscleral suturing of current one-piece posterior chamber intraocular lenses (PC IOLs) by injector implantation in the absence of capsular support, we aimed to demonstrate the possibility of the implantation of one-piece acrylic PC IOLs that might be produced in the future for only scleral fixation through small clear corneal incision. Materials and Methods: Case report and literature review. Results: This procedure has been performed in eight aphakic eyes with four different types of IOLs. Good centration was achieved with minimal technical effort. All patients had well-centered and stable lenses postoperatively during 9-18 months follow-up. Conclusion: We managed to decrease the risks of surgical trauma and intricate surgical maneuvers requirement. With this technique, excessive fluid leakage and consecutive hypotony can be minimized.

Ocular biometry and central corneal thickness in children: a hospital-based study

PURPOSE To investigate the distribution of axial length, anterior chamber depth, lens thickness, vitreous chamber depth, and central corneal thickness in children at different age groups. METHODS We studied 364 eyes in 182 children with ages between 1 and 12 years. Axial length, anterior chamber depth, lens thickness, and vitreous chamber depth were measured by ultrasound biometry. Central corneal thickness was measured by ultrasound pachymetry in all children. RESULTS The mean age was 6.54 ・} 3.42 years. The axial length was 20.95 mm in 1-2 years old and 22.95 mm in 11-12 years old. The central corneal thickness was 556 μm in 1-2 years old and 555 μm in 11-12 years old. The mean anterior chamber depth and vitreous chamber depth increased with age (3.06 mm to 3.44 mm in anterior chamber depth, 13.75 mm to 15.99 mm in vitreous chamber depth), and the lens thickness decreased as age increased (3.67-3.51 mm). CONCLUSION The axial length increased with age and reached adult levels by the age of 9-10 years. The lens thickness gradually decreased until 12 years. The central corneal thickness measurements did not yield a linear algorithm.

Infrequent Complications of Inferior Oblique Recession Surgery

ABSTRACT Purpose: To report the infrequent complications, including antielevation and adherence syndrome, after a unilateral and bilateral inferior oblique (IO) recession procedure and to discuss the possible causes. Methods: A retrospective chart review was conducted for patients on whom unilateral or bilateral IO weakening surgeries were performed. Results: Forty-three patients were included in the study. In 23 patients unilateral and in 20 patients bilateral IO weakening was performed. All patients underwent IO recession surgery. Mild limitation of elevation developed in two patients and adherence syndrome developed in one patient. All occurred after unilateral IO recession. No duction deficiency was observed in patients after bilateral IO recession. Conclusion: Antielevation and adherence syndrome can develop after unilateral IO recession surgery. Care should be taken not to tighten the neurofibrovascular bundle of the IO muscle during surgery.

Posterior Capsular Opacification in Preschool- and School-Age Patients after Pediatric Cataract Surgery without Posterior Capsulotomy

Objectives: We aimed to evaluate the development of posterior capsular opacification (PCO) in preschool- and school-age children with cataract who underwent cataract surgery without posterior capsulotomy and anterior vitrectomy. Materials and Methods: The records of 30 eyes of 21 patients who underwent pediatric cataract surgery and intraocular lens (IOL) implantation were retrospectively reviewed. Patients’ age, PCO status and duration, need for neodymium-doped yttrium aluminium garnet (Nd:YAG) laser treatment based on coverage of visual axis, and follow-up period were recorded. Results: The mean age of the patients was 7.6±2.83 (4-12) years. Unilateral cataract surgery and IOL implantation were performed in 12 patients (57.14%) and bilateral cataract surgery and IOL implantation were performed in nine patients (42.86%). Average follow-up time was 17.7±22.67 (3-83) months. PCO developed in 21 eyes (70%) and covered the visual axis in 15 eyes (50%), which therefore required Nd:YAG laser posterior capsulotomy. The mean duration of postoperative PCO development was 8.91±18.7 months (1 week-71 months). Conclusion: We believe that with adequately experienced surgeons, performing both cataract surgery and posterior capsulotomy with anterior vitrectomy in the same session is appropriate for selected preschool- and school-age children with cataract.