Ahmet Ali Yucel

Pars plana vitrectomy and removal of the internal limiting membrane in the treatment of chronic macular oedema

BackgroundTo evaluate the results of pars plana vitrectomy with peeling of the internal limiting membrane (ILM) in eyes with chronic macular oedema.MethodsPPV with indocyanine green (ICG) assisted peeling of the ILM was performed in 33 eyes with diabetic (21 eyes) or non-diabetic (12 eyes) macular oedema. Postoperatively, resolution of macular oedema, improvement of visual acuity (VA) and complications were documented. The peeled membranes were submitted for light and transmission electron microscopic evaluation.ResultsThe mean follow-up time was 12.2 months. The macular oedema decreased or was resolved in 17 (81%) eyes in the diabetic group and in 11 (92%) eyes in the non-diabetic group. VA improved by at least 2 lines in 11 (52%) eyes in the diabetic group and in 7 (58%) eyes in the non-diabetic group. The difference between visual acuity improvements of the two groups was not statistically significant (P>0.05). However, in the diabetic group the difference of visual improvement between cystoid and diffuse type of macular oedema eyes was statistically significant (14% versus 71%, P=0.02). Light and transmission electron microscopy showed the presence of ILM in all specimens. During the follow-up period no recurrence of macular oedema or epiretinal membrane formation was observed.ConclusionPars plana vitrectomy with peeling of the ILM and epiretinal membrane leads to the resolution of macular oedema in the majority of eyes. This however, is not always associated with VA improvement. In diabetic eyes, cystoid type of macular oedema appears to be a poor prognostic factor for improved VA.

Correlation Of Spectral Domain Optical Coherence Tomography Findings And Visual Acuity In Central Serous Chorioretinopathy

Purpose: To investigate the correlation between spectral domain optical coherence tomography findings and best-corrected visual acuity (BCVA) in patients with central serous chorioretinopathy (CSC) and to determine the visual prognostic factors. Methods: We retrospectively studied 56 eyes of 49 patients who had the diagnosis of CSC. Patients were categorized into subgroups depending on symptoms and clinical findings. Together with the overall foveal integrity of inner segment/outer segment (IS/OS) and external limiting membrane, several features of CSC including hyperreflective dots and hypertrophy of retinal pigment epithelium were investigated with spectral domain optical coherence tomography. Thickness measurements within the retina and choroid were performed. Results: Best-corrected visual acuity was closely associated with IS/OS line integrity (P < 0.001). The length of IS/OS disruption also had significant correlation with BCVA (r = −0.324, P = 0.016). Loss of foveal IS/OS and external limiting membrane line integrity was related to low BCVA (P < 0.001 for both). Presence of hyperreflective dots (P < 0.001) and retinal pigment epithelium hypertrophy (P = 0.011) had significant association with visual status. In cases with sequelae of CSC, BCVA was correlated with parameters of outer retinal damage. Conclusion: Besides the overall integrity of IS/OS line and the length of disruption, loss of foveal IS/OS and external limiting membrane integrity are also noteworthy in cases with CSC. Hyperreflective dots and retinal pigment epithelium hypertrophy are closely associated with BCVA in cases with CSC. Analysis of the subgroups has shown that morphologic changes that persist until the late phases of the disease could potentially affect the visual outcome.

Myocardial performance is impaired in patients with branch retinal vein occlusion

Objective To investigate whether the Tei index, which is an indicator of global myocardial function and an independent predictor of cardiac death, is increased in patients with branch retinal vein occlusion (BRVO). Methods The Tei index was used to evaluate myocardial performance, in addition to conventional echocardiographic evaluation of myocardial structural and functional changes, in patients with BRVO, patients with hypertension and healthy controls. Results Out of 36 patients with BRVO (18 female, 18 male; 17 hypertensive, 19 normotensive), 29 patients with hypertension (15 female, 14 male) and 28 healthy controls (15 female, 13 male), there were no significant between-group differences in age and sex. The mitral A wave was higher and mitral E/A ratio, mitral E wave and ejection time were lower, in patients with BRVO than in healthy controls. Mean Tei index was significantly higher in the BRVO group than in patients with hypertension or healthy controls. Compared with healthy controls, the Tei index was significantly higher in hypertensive and normotensive patients with BRVO. Conclusion Myocardial performance is decreased in patients with BRVO, independent of whether or not they have hypertension.

Efficacy of Dexamethasone Implants in Uveitic Macular Edema in Cases with Behçet Disease

Purpose: Investigation of the efficacy of intravitreal dexamethasone implants (0.7 mg) in patients with Behçet disease (BD) who had cystoid macular edema (CME) despite immunomodulatory treatment. Materials and Methods: Twenty-seven eyes of 20 patients who had intravitreal dexamethasone implant injections and follow-up for more than 6 months were included in this study. Best corrected visual acuities (BCVA), intraocular pressures (IOP), and central macular thicknesses (CMT) were recorded. Systemic immunomodulatory treatment was noted. Injection-related complications and the need for recurrent injections were recorded. Results: Statistically significant anatomical and functional success was achieved with a single injection. BCVA increased from 0.85 ± 0.72 to 0.45 ± 0.52 logMAR, while the mean CMT decreased from 406 ± 190 to 243 ± 101 µm at the sixth month. The peak of visual acuity gain was reached within the first 2 months and a substantial proportion of the patients gained 3 or more lines. There was no complication other than transient IOP elevation in 4 eyes and cataract surgery in 2 eyes. Conclusion: Adjuvant intravitreal dexamethasone implant injections offer promising results in cases of BD with CME. It is effective in preserving the macular anatomy and vision particularly in transition to biological agents.

SUBCONJUNCTIVAL INTERFERON α-2A APPLICATION IN A CASE WITH SERPIGINOUS CHOROIDOPATHY.

BACKGROUND Serpiginous choroidopathy (SC) is a chronic, inflammatory disease which progresses with recurrences leading to visual loss. Diverse immunosuppressive regimens have been used for treatment. In case of an unanticipated side effect with immunosuppressive agents, alternative modalities in SC are limited. METHODS A 38-year-old woman presented with slight deterioration in visual acuity in her right eye. She had had a visually devastating episode of SC in the left eye 8 months previously. She received combination therapy of prednisone, cyclosporine, and intravitreal triamcinolone for the left eye. With that treatment, vision in her left eye declined to light perception due to macular involvement and renal functions were impaired. Eight months later, she was hospitalized with the diagnosis of SC in the right eye. In the quest for an alternative modality, a combination of antituberculosis medications was given initially, because of the high PPD reading. Despite 10 days of treatment, the lesion persistently progressed. Subsequently, interferon (INF) α-2a therapy was initiated solely as daily injections of 1 million unit (MIU) subconjunctivally. The frequency of injections was tapered within the course. Currently, injections are still being dispensed once a month. RESULTS Throughout the 12 months of follow-up, the patient had no major side effects due to INF α-2a therapy. At present, SC in the right eye is inactive and the macula is safe in terms of incurring. The vision is 20/20 in the right eye, whereas it is light perception in the left eye. CONCLUSION Interferon α-2a administration in SC can be an efficient modality and is free of immunosuppression related side effects. Subconjunctival application seems to be a promising and safe tool for treatment.