Ahmet Özer

Long-Term Results of Bare Sclera, Limbal-Conjunctival Autograft and Amniotic Membrane Graft Techniques in Primary Pterygium Excisions

Purpose: To compare the long-term follow-up results of the bare sclera technique (BST), limbal-conjunctival autograft technique (LCAT) and amniotic membrane graft technique (AMGT) in primary pterygium excisions. Materials and Methods: In this study, 48 eyes of 48 patients who underwent pterygium surgery using BST (group 1), 63 eyes of 63 patients who underwent pterygium surgery using LCAT (group 2) and 52 eyes of 52 patients who underwent pterygium surgery using AMGT (group 3) were compared with respect to corneal epithelialization, recurrence and complication of the procedures. The mean ages of the groups were 47.88 ± 14.21 years in group 1, 49.63 ± 14.42 years in group 2 and 47.92 ± 15.52 years in group 3. Patients were followed up to 72.39 ± 11.03 months in group 1, 69.91 ± 12.41 months in group 2 and 61.43 ± 9.83 months in group 3. Results: Postoperative corneal epithelialization was completed in 5.62 ± 1.74 days in group 1, 4.33 ± 0.91 days in group 2 and 4.79 ± 1.39 days in group 3. Corneal epithelialization time was earlier in group 2 than in groups 1 (p < 0.01) and 3 (p < 0.05). Recurrences were detected in 19 eyes (39.58%) in group 1, 11 eyes (14.29%) in group 2 and 12 eyes (23.08%) in group 3. The recurrence rate was significantly lower in group 2 than in groups 1 and 3 (p < 0.001). Postoperative complications were not seen in any of the groups. Graft retraction and necrosis were not detected in the LCAT and AMGT groups during the follow-up period. Conclusions: LCAT was found to be a more effective procedure than BST and AMGT, with decreased recurrence rates after pterygium excision. Limbal-conjunctival autograft seems to be a useful treatment in pterygium surgery due to higher success rates and lower recurrence rates. Amniotic membrane grafts may be an alternative surgical technique for pterygium treatment for patients with or without glaucoma who might need glaucoma surgery in the future.

A comparative study between diode laser cyclophotocoagulation and the Ahmed glaucoma valve implant in neovascular glaucoma: a long-term follow-up.

BackgroundTo compare the efficacy, safety, and long-term results of intraocular pressure (IOP) reduction by diode laser contact cyclophotocoagulation (DCPC) and Ahmed glaucoma valve (AGV) implant in cases of neovascular glaucoma. MethodsA total of 66 eyes of 66 patients with neovascular glaucoma were prospectively assigned to either DCPC or AGV implantation. All patients underwent a baseline complete ophthalmologic examination and IOP measurement by Goldmann applanation tonometry before and after 1,3, 6, 12, and 24 months follow-up. Complications and the number of medications were recorded. ResultsMean age of the patients was 60.0±11.7 years (range: 20 to 85) in the DCPC group and 57.2±10.3 years (range: 20 to 85) in the AGV group. The preoperative IOP was 43.4±11.9 mm Hg and 43.3±7.4 mm Hg for the DCPC and AGV group, respectively (P>0.05). The postoperative IOP was 16.5±11.3 mm Hg and 22.09±7.6 mm Hg for the DCPC and AGV groups, respectively (P>0.05) at the last visit. Kaplan-Meier survival analysis showed a probability of success at 24 months of 61.18% and 59.26% for the DCPC and AGV groups (P>0.05). All the patients had a visual acuity of hand movement or worse preoperatively. Visual acuity decreased in 6 eyes (24%) in the DCPC group and 9 eyes (27%) in AGV group. Complications included anterior segment inflammation in 5 eyes (20%), neurotrophic keratitis in 2 eyes (8%), and hypotony in 3 eyes (15%) in the DCPC group and hyphema in 5 eyes (15%) and tube occlusion in 3 eyes (9%) in AGV group. ConclusionsThere was no significant difference in the success rate between the DCPC and AGV implantation in neovascular glaucoma treatment. However, DCPC is less time consuming and easier method for lowering IOP in patients with neovascular glaucoma.

Lenstar versus ultrasound for ocular biometry in a pediatric population.

Purpose. To compare the central corneal thickness (CCT), axial length (AL), anterior chamber depth (ACD), and lens thickness (LT) measured with Lenstar with those obtained with ultrasound pachymetry and A-scan contact ultrasound (ASU) in children. Methods. ODs of 565 school children were included. All measurements were obtained 30 min after instilling 1% tropicamide. For each instrument, three consecutive measurements per each child were performed. Initially, examiner 1 performed measurements with Lenstar to obtain CCT, AL, ACD, and LT. Later, examiner 2 performed measurements with corneal pachymetry to obtain CCT. Finally, ASU was used by examiner 2 to obtain AL, ACD, and LT. Four parameters obtained with Lenstar were compared with those obtained with pachymetry and ASU using Pearson correlation coefficients (r) and Bland-Altman analyses. Result. Lenstar measurements were obtained in 557 of 565 subjects(mean age; 10.48 ± 2.11 years, mean spherical equivalent of the ODs; +0.47 ± 1.18 diopters) whereas ASU and pachymetry could be performed in 530 of 565. Four hundred seventy-nine subjects were statistically assessed after 41 subjects were extracted as outliers from 530 subjects in whom all instruments could be performed. Mean difference between pachymetry and Lenstar was 13.20 ± 13.13 &mgr;m [95% confidence interval (CI): 12.01 to 14.37]. Mean difference between ASU and Lenstar was −0.72 ± 0.35 mm (95% CI: −0.75 to −0.69) for AL, −0.27 ± 0.32 mm (95% CI: −0.30 to −0.24) for ACD, and 0.24 ± 0.28 mm (95% CI: 0.22 to 0.27) for LT. R values were 0.912 (p < 0.001), 0.904 (p < 0.001), 0.487 (p < 0.001), 0.369 (p < 0.001) for CCT, AL, ACD, and LT respectively. Conclusions. AL and ACD were found to be greater with Lenstar, whereas CCT and LT measures were smaller. It is concluded that there was agreement between instruments for CCT and ACD, because the small differences between measures were clinically insignificant. AL and LT values cannot be used interchangeably. If these differences are considered, Lenstar can replace ASU and pachymetry for the majority of children.

Glaucoma after Penetrating Keratoplasty: Incidence, Risk Factors, and Management

Purpose. To report the incidence and risk factors for postkeratoplasty glaucoma (PKG), as well as its management. Subjects and Methods. 122 eyes, (43% with pseudophakic and aphakic bullous keratopathy (PABK)) which underwent penetrating keratoplasty (PK), were analyzed. Results. The rate of PKG development was 34% within 39 months of follow-up. PABK, corneal perforations, keratitis, and previous high intraocular pressure (PHIOP) were high risk factors for PKG. Glaucoma was controlled medically in 62% of PKG cases. Surgery (Ex-PRESS shunt in 63%) and diode laser cyclophotocoagulation were applied in others (38%). The rate of postoperative complications and graft survival was similar in eyes with and without PKG. Conclusion. PHIOP, preoperative diagnoses other than keratoconus, and corneal dystrophies were highly associated with PKG. Ex-PRESS shunts were effective in refractory PKG. If glaucoma is controlled, it is possible to obtain similar rates of graft survival and postoperative complications in eyes with and without PKG.

Doppler sonography of ocular and carotid arteries in Behçet patients

To evalute by Doppler sonography carotid and ocular hemodynamics in Behçet disease with and without ocular involvement.

Treatment of intracameral fibrinous membranes with tissue plasminogen activator.

BACKGROUND AND OBJECTIVE To evaluate the efficacy of intracameral tissue plasminogen activator (tPA) in the treatment of severe fibrinous membranes that do not respond to anti-inflammatory treatment. PATIENTS AND METHODS In this technique, 0.1 mL of aqueous was aspirated, followed by injection of 0.1 mL (25 microg) of tPA into the anterior chamber in 15 patients with severe fibrinous membranes that developed after pars plana vitrectomy (n = 6), cataract extraction (n = 4), combined cataract and glaucoma surgery (n = 2), trabeculectomy (n = 1), and endophthalmitis (n = 2). The clearance of fibrinous membranes and changes in visual acuity and in intraocular pressure were observed. RESULTS Patients were treated 2 to 10 days postoperatively (mean, 5.6 +/- 0.57 days). Complete fibrinolysis was observed in all cases. The mean time for clearance of fibrin was 7.73 +/- 2.73 hours. A temporary increase in intraocular pressure was noted in two cases. CONCLUSION In this technique, intracameral injection of 25 microg of tPA is both effective and safe in the treatment of severe fibrinous membranes that do not respond to anti-inflammatory treatment.

What is the role of partial middle turbinectomy in endocanalicular laser-assisted endonasal dacryocystorhinostomy?

Background This study was designed to compare outcomes of endocanalicular laser-assisted endonasal dacryocystorhinostomy (DCR) with and without partial anterior middle turbinectomy. Methods A prospective randomized comparative study was conducted on 91 subjects with primary acquired nasolacrimal duct obstruction, undergoing endocanalicular (ECL) procedures. Group 1 was composed of 44 (7 bilateral) patients undergoing ECL diode laser-assisted endonasal DCR without partial anterior middle turbinectomy and group 2 was composed of 47 (7 bilateral) patients undergoing partial anterior middle turbinectomy and ECL diode laser-assisted endonasal DCR. Follow-up period was 11.0 (6.0–14.5 months) months for group 1 and 9.2 (5.0–14.2 months) months for group 2. Functional success was defined as absence of epiphora and anatomic success was defined as ability to irrigate the lacrimal system. Anatomic and functional success at the 1st week, 3rd month, and final postoperative examinations of two groups were compared using chi-square tests. Results Final anatomic successes were 39/51 (76%) cases for group 1 and 51/54 (94%) cases for group 2. Final functional successes were 36/51 (%71) patients in group 1 and 48/54 (88%) patients in group 2. Group 2 had higher success at the final examination and the difference was statistically significant. Conclusion We recommend partial anterior middle turbinectomy in all laser ECL laser-assisted endonasal DCR, but further studies with larger sample sizes are needed to strengthen our hypothesis.

Results of Autografting of Marginal Conjunctiva in Pterygium Excision

Purpose: To investigate and compare the efficiency of autografting of marginal conjunctiva (autograft of marginal conjunctiva technique, AMCT) and the bare sclera technique (BST) in pterygium excision. Materials and Methods: In this study, 51 eyes of 51 patients who underwent pterygium surgery using the AMCT (group 1) were compared to 45 eyes of 45 patients who underwent pterygium excision using the BST (group 2), with regard to epithelialisation, recurrence and complication of the procedures. Patients were followed up for 15.37 ± 12.01 months in group 1 and for 18.57 ± 10.42 months in group 2. Results: Postoperative epithelialisation was completed in 4.34 ± 1.27 days in group 1 and in 5.61 ± 1.71 days in group 2. Epithelialisation was completed earlier in group 1 than group 2 (p < 0.05). Recurrences were detected in 7 eyes (13.73%) of group 1 and in 17 eyes (37.78%) of group 2. The difference between the groups was statistically significant (p < 0.01). No postoperative complications were seen in either of the groups. Conclusions: The AMCT was found to be a more efficient procedure than the BST. Autografting of marginal conjunctiva may be a useful alternative treatment in pterygium surgery due to higher success and lower recurrence rates.

Matrix metalloproteinase-2, tissue inhibitor of matrix metalloproteinase-2, and transforming growth factor beta 1 in the aqueous humor and serum of patients with pseudoexfoliation syndrome

Purpose The aim of the study reported in this article was to determine the presence and quantitative differences of matrix metalloproteinase-2 (MMP-2), its tissue inhibitor (TIMP-2) and transforming growth factor beta 1 (TGF-β1) in the aqueous humor and serum samples of patients with pseudoexfoliation (PEX) syndrome. Methods Aqueous humor and serum samples were collected from 32 patients with PEX syndrome (with and without glaucoma) and a control group, who underwent routine cataract surgery. Levels of MMP-2, TIMP-2, and TGF-β1 were determined by specific immunoassays (enzyme-linked immunosorbent assay). Results MMP-2, TIMP-2, and TGF-β1 were identified in aqueous humor and serum samples from all groups of patients. The aqueous and serum samples of MMP-2, TIMP-2, and TGF-β1 showed no significant differences between PEX syndrome and control groups. Serum levels of MMP-2, TIMP-2, and TGF-β1 were statistically greater than their aqueous levels (P<0.05), except for TIMP-2 levels in the control group. Conclusion No statistically significant difference among mean MMP-2, TIMP-2, and TGF-β1 levels in both aqueous humor and serum samples was found between patients with PEX syndrome and the control group. It is important to simultaneously evaluate serum and aqueous samples from patients with PEX syndrome, which is related to an impaired blood–aqueous barrier.

The Effect of N-Acetyl Serotonin on Ultraviolet-Radiation-Induced Cataracts in Rats

Aims: To investigate the effects of ultraviolet radiation (UVR) on cataract development in rat lenses and whether or not N-acetyl serotonin has an effect on changes in these lenses. Material and Methods: The study was performed using 5 groups of Sprague-Dawley albino rats, with each group consisting of 15 rats. The 5th group being the control group did not receive any applications, whilst the other 4 groups received a daily dose of 0.2 J/cm2/day UVR (305 nm wavelength) for 60 days. A dose of 4 mg/kg/0.1 ml N-acetyl serotonin was injected intraperitoneally to group 1 and group 2 every day and on alternate days, respectively. Group 3 received an intraperitoneal injection of 0.1 ml phosphate buffer solution every day, whilst group 4 received no injection. On the 60th day, an intracardiac withdrawal of blood was performed, after the rats had been anesthetized with ether. Following the withdrawal of blood, the rats were killed using a high dose of ether and their eyes were enucleated. The lens fresh weights, plasma malondialdehyde (P-MDA), erythrocyte glutathione peroxidase (E-GSHPx), erythrocyte glutathione reductase, blood reduced glutathione (B-RGSH), erythrocyte catalase (E-CAT), lenticular malondialdehyde, lenticular superoxide dismutase (L-SOD), lenticular glutathione peroxidase (L-GSHPx) and lenticular glutathione (L-GSH) levels were all assessed. Results: The lens fresh weights were determined to be lower in group 1 and in the control group in comparison with the other groups (p < 0.01). Whilst the P-MDA level was found to be lower (p < 0.001), the E-GSHPx level was higher (p < 0.01) in the control group than in the other groups. The E-GSHPx level was higher in groups 1 and 2 than in groups 3 and 4 (p < 0.01). The B-RGSH level was higher in the control group than in the other groups (p < 0.001). The E-CAT level was higher in both the control group and group 1 than in groups 2, 3 and 4 (p < 0.01), whilst it was higher in group 2 when compared to groups 3 and 4 (p < 0.01). The L-SOD levels were found to be higher in the control group and group 1 than in groups 2, 3 and 4 (p < 0.001). Whilst the L-GSHPx levels were determined to be higher only in the control group (p < 0.001), the L-GSH levels were higher in the control group and group 1 than in the other groups (p < 0.001). Conclusions: In recent years, the depletion of the atmospheric ozone layer has resulted in the penetration of more UVR to the earth, which causes various effects on different tissues of organisms. N-acetyl serotonin, a melatonin precursor, may well be effective in the prevention of the negative effects induced by the UVR upon the lens tissue, in which case the capability of melatonin to capture free radicals as well as its antioxidative properties should be taken into consideration.