Ahmet Maden

Efficacy of intracameral amphotericin B injection in the management of refractory keratomycosis and endophthalmitis.

Purpose: To evaluate the efficacy of intracameral amphotericin B injection in the adjunctive management of keratomycosis with probable intraocular extension not responding to conventional antifungal therapy. Methods: Fourteen eyes of 12 patients with fungal keratitis that did not respond to initial treatment with topical and intravenous fluconazole and oral itraconazole were treated with up to 5 intracameral injections of 5 μg of amphotericin B. Six eyes received one injection, and 8 required subsequent injections. Results: Twelve eyes responded to amphotericin B therapy, including 5 that healed with a central corneal scar and 8 that healed with a peripheral opacity. Two eyes progressed to evisceration. Four eyes developed anterior subcapsular cataract after intracameral amphotericin B. Conclusions: Intracameral amphotericin B may be an effective adjunctive treatment of fungal keratitis unresponsive to conventional antifungal therapy, although cataract may occur.

Magnetic resonance imaging and computed tomography in the detection and localization of intraocular foreign bodies

In this experimental study, various foreign bodies were inserted into fresh bovine eyes, in different localizations. Twenty-one magnetic and non-magnetic foreign bodies, dimensions of which varied from 1.5 × 1.5 × 2 mm to 3.5 × 6 × 7 mm, were tried to detect by computed tomography (CT) and magnetic resonance imaging (MRI) scanning. In addition, further dissections were applied to check the ocular damage attributable to movement of the foreign bodies. Ferromagnetic foreign bodies have been shown to move in the eye and the risk of torsional forces being applied to the ferromagnetic foreign body seemed to cause intraocular complications during MRI scanning. All of the foreign bodies that were implanted in bovine eyes were recognized on CT scanning, except intraocular lenses. As a general rule, metallic foreign bodies produced beamhardening artifacts, but these artifacts did not cause any problem in detecting the localizations of foreign bodies.

Hereditary Lacrimal Fistula

Hereditary lacrimal fistula is a rare developmental anomaly. We report three patients with congenital lacrimal fistulae in the same family. Only one of our cases had bilateral lacrimal fistula while two had unilateral lacrimal fistulae. No other systemic or ocular anomaly was found in the affected subjects. In the absence of significant symptoms, we did not feel the necessity of any treatment for these lacrimal fistulae. The presence of a lacrimal fistula is an indication for the search for a variety of systemic and ocular associations in affected patients.

Factors affecting changes in astigmatism before and after suture removal following penetrating keratoplasty

Purpose. To analyze the factors related to changes in astigmatism before and after suture removal in patients who underwent penetrating keratoplasty (PK). Methods. The study group consisted of 171 consecutive PKs in 171 patients. Keratometric astigmatism was measured before and after suture removal in all patients. The vectorial difference for each eye was calculated between the examination before suture removal and the first year after suture removal. The vectorial difference values were compared with the possible factors affecting astigmatic change such as age of the patient, donor-recipient trephine diameter difference, preoperative diagnosis, and time of suture removal. All sutures were removed completely in one session. The vectorial difference values of all groups were compared with each other statistically. Results. Before suture removal, the mean cylinder was 4.40±3.24 D; it was 3.96±2.19 D at 1 year after suture removal. The net difference of astigmatism was −0.27±3.50. The mean value of vectorial difference for all patients was 4.93±4.02 D. There was a statistically significant negative correlation between the trephine diameter difference and the vectorial difference (r=-0.582, p<0.01). There was a significant change in vectorial difference values in patients with high pre-suture removal astigmatism. Patients with keratoconus had a positive correlation between the pre-suture removal astigmatism and the vectorial difference (r=0.615, p=0.038). Conclusions. After suture removal following PK, unexpected high levels of astigmatic change could be encountered due to donor-recipient trephine diameter difference and underlying primary diagnosis such as keratoconus. In particular, high level astigmatism before suture removal has a greater risk of increased astigmatic change after suture removal.

Extranodal Rosai-Dorfman disease with bilateral orbital involvement: Report of a case treated with systemic steroid alone

We report the case of a 41-year-old female with bilateral orbital Rosai-Dorfman disease (RDD) and the result of corticosteroid therapy. The patient developed a swollen mass of bilateral upper and lower eye-lid over a six-month period. Diagnosis was based on the characteristic histopathologic features. She was treated with oral corticosteroids 60 mg/per day for ten days and the dose of corticostreoid was tapered every week. She is currently being treated with 10 mg/per day for 4 months. In general, the prognosis is good, with experiencing remission following a course of oral corticosteroids. There is no evidence that corticosteroids are beneficial in the treatment of RDD in the literature, but data regarding such treatment are sparse. A more formalized surveillance of these cases would help to define more clearly the natural history of the disease and the effects of various treatment modalities.

The effect of Nd:YAG laser capsulotomy size on refraction and visual acuity.

PURPOSE To determine the effect of Nd:YAG laser posterior capsulotomy size on refraction and visual acuity. METHODS A total of 128 pseudophakic eyes (108 patients) were included in this study and divided into two groups by capsulotomy size: 80 eyes had small capsulotomies (<4 mm) without dilating the pupil and 48 eyes had large capsulotomies (> or = 4 mm and <7 mm) after dilating the pupil. Visual acuities and refractive errors were measured preoperatively and 1, 14, 30, and 90 days postoperatively. Results were analyzed statistically. RESULTS The change in spherical equivalent refraction was 0.38 +/- 0.52 diopters (D) in the small capsulotomy group and 0.22 +/- 0.36 D in the large capsulotomy group. No statistically significant differences were noted in spherical equivalent refraction change (P=.47) or capsulotomy size (P=.0387) between the two groups. CONCLUSIONS The size of posterior capsulotomy does not significantly affect refraction and visual acuity.

Traumatic subconjunctival crystalline lens dislocation

Purpose: To evaluate the clinical features and visual outcomes in patients with traumatic subconjunctival crystalline lens dislocation. Setting: Izmir Atatürk Education and Research Hospital, Department of Ophthalmology, Izmir, Turkey. Methods: The clinical records of 5 patients with subconjunctival crystalline lens dislocation secondary to blunt trauma were reviewed. Results: The median age of 3 women and 2 men was 63 years (range 62 to 73 years). The lenses were dislocated to the superior (n = 1), temporal (n = 1), superotemporal (n = 1), and superonasal (n = 2) quadrants. All patients had various degrees of hyphema and vitreous hemorrhage. One patient had traumatic optic neuropathy. Visual acuity improved in all patients after lens removal and scleral rupture repair. Conclusion: With timely intervention, the visual outcome was reasonably good in patients with subconjunctival dislocation of the crystalline lens.

Keratitis complicated by endophthalmitis 3 years after astigmatic keratotomy.

Abstract Endophthalmitis after keratotomy is rare and usually occurs soon after surgery. A 56‐year‐old woman with mild dry‐eye symptoms developed keratitis complicated by endophthalmitis 3 years after astigmatic keratotomy (AK). The keratitis lasted for less than 1 day in the upper keratotomy incision. Corneal cultures yielded Pseudomonas aeruginosa. Keratitis progressed to endophthalmitis 1 day after the detection of keratitis. The inflammation was controlled with intravitreal, subconjunctival, topical, and systemic antibiotics. This case demonstrates the potential risk of endophthalmitis developing very shortly after late keratitis of AK incisions. Vigorous, early treatment and close follow‐up seem justifiable in any keratitis associated with a keratotomy incision.

Aspergillus niger infection of exenterated orbit.

Purpose To present two immunocompetent patients with Aspergillus niger infection of the exenterated orbit. Methods Case reports. Results The patients were treated with oral itraconazole and socket irrigation with amphotericin B. The sockets cleared completely; no growth was observed on reculturing. Conclusions A niger infection of an exenterated socket can be effectively treated with oral itraconazole and topical amphotericin B in immunocompetent patients.

Unilateral Refractive Keratotomy for Anisometropia

BACKGROUND In anisometropia, the asymmetry of refractive error produces disparity of image magnification (aniseikonia) that can create visual discomfort, especially when asymmetry is 3.00 diopters or more. METHODS A prospective study of 20 eyes of 20 patients between 18 and 61 years of age who underwent unilateral radial and/or transverse keratotomy was conducted; results of at least 12 months follow-up are presented. The efficacy of keratotomy was evaluated by the following criteria: 1) change in spherical and cylindrical refraction, 2) decrease in refraction difference between two eyes of each patient, 3) change in spectacle-corrected visual acuity, and 4) change in binocular vision functions and asthenopic complaints. RESULTS Mean decrease in spherical refractive error was 3.66 +/- 1.58 D (range, 1.25 to 7.50 D) and 2.08 +/- 0.81 D (range, 1.00 to 3.50 D) in astigmatic refraction. The mean refraction difference between two eyes was 4.90 +/- 2.20 D preoperatively, and this difference regressed to 1.79 +/- 1.42 D postoperatively. Spectacle-corrected visual acuity increased in seven eyes (35%), remained the same in 12 eyes (60%) and decreased in one eye (5%). All patients reported relief of asthenopic complaints. Fusion amplitudes increased in 12 (60%) patients. Stereoscopic vision improved in five (25%) patients. CONCLUSION Monocular refractive keratotomy can significantly decrease anisometropia.