Akin Cakir

Isolated extraocular muscle involvement as the ophthalmic manifestation of leukaemia: an alternative explanation

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Intraocular pressure elevation in isolated extraocular muscle infiltration by leukaemia

We report a 34-year-old man who presented with a 1-month history of gradually increasing proptosis, ocular pain, blurring of vision, diplopia and redness in the right eye. He was diagnosed with acute myeloid leukaemia 6 months ago and received two cycle of consolidation therapy after the first remission induction chemotherapy. Ocular symptoms appeared approximately 1 month after the second consolidation course. Medical history revealed hyperthyroidism treated by iodine-131 radioisotope therapy 4 years ago. External examination showed a right proptosis (Hertel readings of 21 mm OD and 13 mm OS) (Fig. 1a,b). There were not orbital bruits or pulsation. In the right eye, there was no abduction movement, and all other ductions were minimally limited in ocular motility examination (Fig. 1c). Slit-lamp examination showed apparent dilation of lateral episcleral veins. On gonioscopy of the right eye, angles were open with blood in the Schlemm canal inferiorly and temporally (Fig. 1d). Dilated funduscopy revealed mild vascular tortuosity and disc oedema in the right eye. Goldmann applanation tonometry measurements were 42 mmHg OD and 14 mmHg OS. Visual acuities were 6/9 OD and 6/6 OS. Orbital magnetic resonance imaging demonstrated diffuse enlargement of right lateral rectus muscle, and the adjacent orbital tissues were not involved (Fig. 1e). The magnetic resonance imaging of brain was normal, and there was no evidence of cavernous sinus involvement. Based on these findings, isolated leukemic infiltration of extraocular muscle and thyroid ophthalmopathy appeared to be most probable diagnoses. We decided to perform right lateral rectus muscle biopsy for differential diagnosis. An incisional biopsy with lateral limbal conjunctival approach was performed, and a specimen was obtained from the margin of the right lateral rectus muscle tendon and Tenon’s capsule. Histopathological evaluation of the specimen revealed diffuse infiltration of the rectus tendon and Tenon’s capsule with mononuclear cells with high nucleocytoplasmic ratio (Fig. 1f). These cells expressed CD117 diffusely and myeloperoxidase focally in immunohistochemical studies. These findings were suggestive of myelomonoblastic infiltration of isolated

Long-term effects of intravitreal ranibizumab treatment on retinal ganglion cell complex and choroidal thickness

Background: To evaluate the long-term effects of intravitreal ranibizumab treatment on both choroidal and retinal layers thicknesses using spectral domain optical coherence tomography (SD-OCT) and Enhanced Depth Imaging (EDI) mode. Methods: Thirty-two eyes of 27 patients with classic choroidal neovascularization that have been undergoing intravitreal 0.5 mg ranibizumab injections for a minimum of 2-year follow up were enrolled as the study group. Age and sex matched 31 eyes of 17 nonneovascular age-related macular degeneration subjects constituted the control group. Thickness of retinal layers measured by the program embedded in SD-OCT. Choroidal images were obtained by SD-OCT with EDI mode by the same certified operator. Results: The mean injection number of the study group was 12.1 ± 4.0. The mean follow-up time was 3.6 ± 1.6 years. The mean subfoveal choroidal thickness values tended to be lower in ranibizumab treated eyes than controls, but difference was not statistically significant (184 ± 75.5μ vs. 200.8 ± 60.2μ; p:0.336). The study and control groups’ mean retinal thickness values were not statistically significant (250.4 ± 29.4μ vs. 249.7 ± 15.2μ; p:0.906). The mean ganglion cell layer (GCL), internal plexiform layer (IPL) and ganglion cell complex (GCC) values of ranibizumab treated eyes were found to be statistically significantly lower than controls ([21.06 ± 8.03μ vs. 24.6 ± 5μ; p:0.036], [24.5 ± 7.8μ vs. 29.8 ± 3.8μ; p:0.001], [64.1 ± 16.5μ vs. 72.9 ± 8.03μ; p:0.010] respectively). Conclusions: Our study showed that long-term intravitreal ranibizumab treatment was associated with significant reduction in the GCL, IPL and GCC thicknesses. Randomized prospective studies must be conducted to determine if any difference exits between anti-VEGF agents or if this thinning induces any damage in the function of the retinal ganglion cells.

The effect of posterior capsulotomy size on refraction and anterior chamber parameters following Nd:YAG laser treatment

To investigate the effect of capsulotomy size on refraction and anterior chamber parameters following Nd:YAG laser treatment. Fifty-six eyes of 56 pseudophakic patients with posterior capsular opacification (PCO) were reviewed. Patients were divided into two groups according to the capsulotomy size. Changes in best corrected visual acuity (BCVA), spherical equivalent (SE), anterior chamber depth (ACD), anterior chamber volume (ACV) and anterior chamber angle (ACA) were compared between groups. A hyperopic shift was remarkable in the 1st week in both groups but SE declined about to preoperative levels at 1 month after laser capsulotomy in both groups (p=0,056). In both groups, ACD decreased 1 week after laser capsulotomy (p

Restoration of photoreceptor layer and its prognostic value in eyes with macular edema due to branch retinal vein occlusion

To evaluate the restoration of outer segment ellipsoid zone (EZ) layer and its prognostic value in visual gain following resolution of macular edema (ME) due to branch retinal vein occlusion (BRVO). In this retrospective study,33 eyes of 33 patients with ME due to BRVO who underwent intravitreal ranibizumab (IVR) injections were studied. All of the patients had the resolution of macular edema after IVR therapy. At baseline and final visit, SD-OCT scans were obtained. Best-corrected visual acuity (BCVA), central macular thickness (CMT) and integrity of outer segment ellipsoid zone (EZ) defects were determined. We divided the eyes with initial EZ defects into two groups. Group-1 had restoration of EZ and group-2 had EZ defects before and after treatment. 14 of 33 eyes (42.4%) did not have EZ defects and 19 of 33 eyes had EZ defects before treatment. 9 eyes (27.3%) had restoration of EZ defects and 2 patients (6.1%) had EZ defects after treatment while they did not have at initial visit. According to EZ change status (group-1 and group-2) the groups were similar in terms of initial BCVA and CMT. Group-1 had better final BCVA (p=0.005). There was a statically significant difference in BCVA improvement between groups (p=0.001). Disorganization of photoreceptors can have recovery after resolution of ME with ranibizumab treatment and to have better BCVA after resolution of ME, restoration of the structure of the photoreceptors is required.

Spectral Domain Optical Coherence Tomography Findings in Carotid Artery Disease

Objectives: To evaluate the effect of carotid artery disease on retinal morphology by means of spectral domain optical coherence tomography (SD-OCT). Materials and Methods: We examined 23 eyes with internal carotid artery (ICA) stenosis and 24 age- and gender-matched healthy eyes as a control group in this prospective, case-control study. Compherensive ophthalmic examination and SD-OCT scan were performed to all the patients. The average RNFL and macular thicknesses (MT) in the nine macular ETDRS areas were the major OCT measurements for our study. Results: Although all of the average RNFL and MT measurements were lower in the ICA stenosis group, only the total MT and outer ETDRS area (temporal/superior/nasal/inferior outer macula) values were found to be significantly thinner compared to the control group (p=0.004, p=0.009, p<0.001, p=0.002, and p=0.001, respectively). Conclusion: In addition to our knowledge about the effects of ICA stenosis on the retino-choroidal circulation, we found that OCT measurements may be beneficial in the early detection of ocular damage due to ICA stenosis.

Evaluation of the early results of ab interno trabeculectomy surgery appllied with trabectome device

The aim of the current study was to assess efficacy and safety of ab interno trabeculectomy surgery applied with trabectome device in early period. The study was designed among the 30 eyes of 26 patients who had undergone trabectome surgery with the diagnosis of open-angle glaucoma. Patients were evaluated as retrospectively in terms of preoperative and postoperative intraocular pressure (IOP), number of drugs used and complications. While the preoperative mean IOP was 28.78±5.57 mmHg (n:30) with the mean number of medications 3.40±1.04, the mean IOP was 18.24±5.54 mmHg (n:30) with the mean number of medications 0.90±1.27 at 1st month. At 3rd month the mean IOP was 16.37±3.36 mmHg (n:28) with the mean number of medications 0.70±1.10 and at 6th month the mean IOP was 16.51±3.80 mmHg (n:28) with the mean number of medications 1.13±0.96. When postoperative measurements compared with preoperative values, detected reductions in IOP and number of medications were statistically significant (P

Real-life outcomes in patients with neovascular age-related macular degeneration switched from ranibizumab to aflibercept

Background: To report the short term real-life outcomes of neovascular age-related macular degeneration (nAMD) patients switched to intravitreal aflibercept after failure to prior ranibizumab treatment. Methods: Thirty eyes of thirty refractory nAMD patients with previously treated with intravitreal ranibizumab, that switched to intravitreal aflibercept injections were enrolled. The best corrected visual acuity (BCVA) measurements and spectral domain optical coherence tomography (SD OCT) characteristics over time were evaluated. Results: The mean age of the patients was 73.76 ± 6.75 years (range 58–88 years). The mean central macular thickness (CMT) decreased from 319.7 ± 85.2μm at baseline to 261.7 ± 74.3μm at 12th week. This reduction was found to be statistically significant (p<0.001). After 12 weeks treatment period, the number of patients that presented with intraretinal fluid (IRF) decreased from 19 (63.3%) to 10 (33.3%). This improvement was found to be statistically significant (p<0.001). By the same treatment period 24 patients (80%) with high reflective foci (HRF) was reduced to 12 patients (40%) (p<0.001). The mean BCVA improved from 1.0±0.75 logMAR at baseline to 0.91 ± 0.75; however this change was not statistically signficant (p:0.097). Conclusion: Switching to aflibercept resulted in a better anatomic response and visual stabilization in patients with nAMD resistant to ranibizumab treatment. Correspondence to: Akin Cakir, Okmeydani Training and Research Hospital, Eye Clinic, Istanbul, Tel: +905054984514; E-mail: dracakir@gmail.com.

Current Concepts and Management of Severely Traumatized Tissues in the Inner Coatings (The Posterior Segment: The Ciliary Body, the Choroid and the Retina) of the Globe: Nonmechanical Injuries

“Nonmechanical closed-globe injuries of the inner coatings (the ciliary body, the choroid and the retina) of the globe” has not been defined in the classifications of both BETT (Birmingham Eye Trauma Terminology) (Kuhn et al. 2008) and OTCS (Ocular Trauma Classification System) (Pieramici et al. 1997) clearly, and, besides, those can be categorized as follows.

Analysing the Progression Rates of Macular Lesions with Autofluorescence Imaging Modes in Dry Age-Related Macular Degeneration.

Objectives: In this study we aimed to compare the sensitivity of blue-light fundus autofluorescence (FAF) and near-infrared autofluorescence (NI-AF) imaging for determining the progression rates of macular lesions in dry age-related macular degeneration (AMD). Materials and Methods: The study was designed retrospectively and included patients diagnosed with intermediate and advanced stage dry AMD. Best corrected visual acuities and FAF and NI-AF images were recorded in 46 eyes of 33 patients. Lesion borders were drawn manually on the images using Heidelberg Eye Explorer software and lesion areas were calculated using Microsoft Excel software. BCVA and lesion areas were compared with each other. Results: Patients’ mean follow-up time was 30.98±13.30 months. The lesion area progression rates were 0.85±0.93 mm2/y in FAF and 0.93±1.01 mm2/y in NI-AF, showing statistically significant correlation with each other (r=0.883; p<0.01). Both imaging methods are moderately correlated with visual acuity impairment (r=0.362; p<0.05 and r=0.311; p<0.05, respectively). In addition, larger lesions showed higher progression rates than smaller ones in both imaging methods. Conclusion: NI-AF imaging is as important and effective as FAF imaging for follow-up of dry AMD patients.