Ates Yanyali

The effect of povidone iodine on the corneal endothelium.

Purpose. Povidone iodine has been proven to be a valuable antiseptic solution in preparing the eye for surgery and is an alternative to postoperative topical antibiotics. No study has addressed the intraocular toxicity of povidone iodine after injection into the anterior chamber. We investigated the potential toxicity of povidone iodine on the corneal endothelium after injections into the anterior chamber in a rabbit model. Methods. In this study we used 24 eyes of 12 albino rabbits. The eyes were divided into the following three groups according to the drugs tested: group A, 5% povidone iodine; group B, 10% povidone iodine; group C, balanced salt solution. The injected eyes were evaluated by biomicroscopy, specular microscopy, corneal pachymetry, and transmission and scanning electron microscopy. Results. Corneal edema was observed in all eyes of groups A and B. In groups A and C, the endothelial cell morphology was not significantly changed and the mean endothelial cell count of the eyes did not change significantly (p = 0.5054). There was no significant difference in corneal thickness between groups A and C (p = 0.3823), but there was a significant difference between groups B and C (p = 0.0002). Transmission and scanning electron microscopy results were normal in group C but not in groups A and B. Conclusion. Povidone iodine in both 5% and 10% concentrations demonstrates severe toxicity when one drop of either concentration is placed directly in the anterior chamber. When povidone iodine is used in preparing the eye for intraocular surgery and as an alternative to postoperative antibiotics, the inadvertent leakage of povidone iodine into the anterior chamber must definitely be prevented.

Intraoperative mitomycin C in the treatment of pterygium.

Purpose. To evaluate the effectiveness of intraoperative mitomycin C in preventing the recurrence of primary pterygium. Methods. In this prospective, randomized study, 38 eyes of 35 patients with primary pterygium were evaluated. In 19 eyes, the “bare sclera technique” combined with intraoperative application of 0.2 mg/mL (0.02%) mitomycin C for five minutes was performed (mitomycin C treated group). The other 19 eyes—taken as control group—underwent surgical excision alone. Statistics were analyzed using the Mann-Whitney U test and the Fischers exact test. Results. Patients were 20–38 years of age. The mean age was 25.29 ± 5.08 in the mitomycin C treated group and 25.00 ± 5.19 in the control group. During the mean follow-up of 17.04 months (range, 12–36 months; SD = 5.89), 4 recurrences (21%) were observed in the mitomycin C treated group and 11 (57.8%) in the control group. The difference between the two groups was significant (p = 0.045). No postoperative complication was encountered in both groups except for recurrences. Conclusion. Intraoperative mitomycin C was found to be effective in preventing the recurrence of primary pterygium.

Quantitative Assessment of Photoreceptor Layer in Eyes with Resolved Edema after Pars Plana Vitrectomy with Internal Limiting Membrane Removal for Diabetic Macular Edema

Background/Aims: To evaluate the correlation between visual acuity (VA) and photoreceptor integrity in eyes with resolved diabetic macular edema (DME) after pars plana vitrectomy (PPV). Methods: Eleven eyes with resolved macular edema following PPV with internal limiting membrane removal for DME were included in this retrospective study. The integrity of the external limiting membrane (ELM) and inner and outer segments (IS/OS) of the photoreceptor junction was evaluated by spectral domain optical coherence tomography. The main outcome measures were percentage of disrupted ELM and IS/OS lines, and correlation between VA and photoreceptor integrity. Results: The mean time after PPV was 78 ± 17 months. The mean lengths of the disrupted ELM and IS/OS lines were 223 ± 167 µm (63%) and 189 ± 175 µm (54%) in the foveola, and 900 ± 522 µm (60%) and 835 ± 582 µm (55%) in the fovea, respectively. Intact ELM and IS/OS lines were positively correlated with VA in both the fovea (p = 0.09 and p = 0.02, respectively) and foveola (p = 0.004 and p = 0.03, respectively). Linear regression analysis showed a statistically significant association of intact ELM and IS/OS lines with VA in the fovea. Disrupted ELM and IS/OS lines had a strong correlation with each other in both the fovea (r = –0.71, p = 0.013) and foveola (r = 0.81, p = 0.02). Conclusions: The integrity of the ELM and IS/OS lines was positively correlated with VA in eyes with resolved DME after PPV.

A comparative study of the effectiveness of disinsertion and anterior transposition of the inferior oblique in the treatment of unilateral superior oblique palsy

PURPOSE. To compare the effectiveness of disinsertion of the inferior oblique muscle (DIO) with anterior transposition of the inferior oblique muscle (ATIO) in the treatment of vertical deviations resulting from superior oblique palsy. METHODS. In this prospective randomized study, 22 patients with unilateral superior oblique palsy were evaluated. Eleven patients underwent the DIO procedure (DIO group), and the other eleven underwent the ATIO procedure (ATIO group). Statistics were analyzed using the Wilcoxon and Mann-Whitney U tests. RESULTS. The mean preoperative primary-position hypertropia was 22.2 ± 6.2 prism diopters (?) in the DIO group and 23.1 ± 6.6 ? in the ATIO group; the mean preoperative hypertropia in adduction was 31.7 ± 6.9 ? in the DIO group and 31.8 ± 8.1 ? in the ATIO group. The mean follow-up was 18.8 months (SD: 10.2, range: 6–40 months). The mean reduction of hypertropia in primary-position in the ATIO group (mean: 18.5 ± 3.9 ?) was found to be significantly greater than in the DIO group (mean: 13.3 ± 1.9 ?) (p = 0.001). Even though the mean reduction of hypertropia in adduction in the ATIO group (mean: 27.7 ± 9.6 ?) was greater than in the DIO group (mean: 20.6 ± 6.2 ?), no statistically significant difference was found (p = 0.067). There was residual hypertropia in three (27.3%) patients who underwent the DIO procedure. No major postoperative complication was encountered in any of the patients. CONCLUSION. In vertical deviations resulting from superior oblique palsy, ATIO was found to be more effective than DIO in the reduction of primary-position hypertropia.

Conjunctival Rotation Autograft for Primary Pterygium

Purpose: To evaluate the safety and effectiveness of conjunctival rotation autograft technique in preventing the recurrence of primary pterygium. Methods: In this prospective study, 24 eyes of 24 consecutive patients with primary pterygium were evaluated. Conjunctival rotation autograft technique, which involved the removal of the underlying fibrovascular pterygium tissue and replacement of the original epithelium over the bare sclera with a 180° rotation was performed in all eyes. Results: Patients were 34–70 years of age (mean, 52.8; SD = 10.5). During the mean follow-up of 15.9 months (range, 12–23 months; SD: 4.0), 4 recurrences (16.6%) were observed. Neither intraoperative nor postoperative complications were encountered except for recurrences and 3 suture openings, which were re-sutured postoperatively without further complications. Conclusion: Conjunctival rotation autograft technique appears to be effective and safe in preventing the recurrence of primary pterygium. A prospective randomised trial comparing conjunctival rotation autografting with other adjunctive procedures in addition to simple pterygium excision is required to determine its effectiveness.

23-Gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery.

Purpose: The purpose of this study was to evaluate the effectiveness and safety of 23-gauge (23-G) transconjunctival sutureless vitrectomy in patients with retained lens fragments after complicated cataract surgery. Methods: In this retrospective consecutive case series, 17 eyes of 17 patients with retained lens fragments after complicated cataract surgery and managed by using 23-G transconjunctival sutureless vitrectomy were evaluated between January 2007 and March 2009 at our institution. Results: Mean follow-up time was 8.5 ± 3.00 months. Nine patients (53%) were pseudophakic, and 8 (47%) were aphakic. A foldable acrylic intraocular lens was implanted in eight eyes with aphakia. In 2 eyes (11.8%), one of 23-G sclerotomy port was enlarged and intravitreal phacoemulsification was performed with 20-gauge phacofragmatome to remove hard nucleus. Visual acuity improved in 100% of eyes and was 20/40 or better in 70.6% of eyes. Postoperative complications were transient elevation of intraocular pressure (29.4%), decentralization of the intraocular lens (5.9%), fibrin reaction (5.9%), mild vitreous hemorrhage (5.9%), and macular retinal pigment epithelial changes (5.9%). Conclusion: Twenty-three–gauge transconjunctival sutureless vitrectomy was observed to be effective and safe in patients with retained lens fragments after complicated cataract surgery. In cases with hard nucleus, 23-G vitrectomy probe may not be adequate to remove the lens fragments.

Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment.

AIM To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). METHODS In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. RESULTS Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P<0.001, Paired t-test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye (2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. CONCLUSION Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.

Macular thickness changes after phacoemulsification in previously vitrectomized eyes for diabetic macular edema.

Purpose: To report visual results and anatomical outcome after uncomplicated phacoemulsification in eyes that previously underwent pars plana vitrectomy for diabetic macular edema. Methods: This retrospective noncomparative study included 22 eyes of 19 diabetic patients who underwent uncomplicated cataract surgery with phacoemulsification and intraocular lens implantation after pars plana vitrectomy with internal limiting membrane removal for diabetic macular edema. Main outcome measures included visual acuity and foveal thickness (FT) changes as assessed by optical coherence tomography. Wilcoxon test was used for statistical analysis. Results: Mean follow-up time was 11.9 ± 8.75 months. Mean FT increased by 20.5 ± 67.6 μm (8.4%), with a mean preoperative FT of 237 ± 69 μm compared with a mean postoperative FT of 257.6 ± 89.8 μm (P = 0.236). Foveal thickness increased by at least 20% in 6 eyes (27.3%), remained within 20% in 14 eyes (63.6%), and decreased by 20% in 2 eyes (9.1%). Visual acuity improved by ≥2 lines in 16 eyes (72.7%) and remained stable in 6 eyes (27.3%). Visual acuity was 20/40 or better in 11 eyes (50%). Conclusion: Moderate but insignificant increase in FT was observed after phacoemulsification in eyes that previously underwent pars plana vitrectomy for diabetic macular edema. Prospective studies with a large number of patients are warranted for a more reliable conclusion.

Intravitreal tigecycline treatment in experimental Acinetobacter baumannii endophthalmitis.

Abstract Purpose: To investigate the clinical and microbiological effectivity of intravitreal tigecycline in an experimental rabbit endophthalmitis model caused by imipenem resistant Acinetobacter baumannii. Materials and Methods: Forty-eight eyes of 24 New Zealand white albino rabbits were divided into six groups (n = 8 in each). The right eyes were divided into three groups and defined as infected group; left eyes were divided into three groups and defined as uninfected group. Infected group received 0·1 ml intravitreal A. baumannii suspension. Twenty-four hours after bacterial inoculation, group 1 received 1 mg/0·1 ml tigecycline and group 2 received 0·5 mg/0·1 ml tigecycline. Group 3 eyes received no treatment. In group 4, 0·1 ml of saline solution was injected. Groups 5 and 6 were received intravitreal tigecycline injection of 1 mg/0·1 ml and 0·5 mg/0·1 ml respectively. The eyes were enucleated for histopathological evaluation on the sixth day. Clinical and histological scoring systems were used to evaluate clinical and histological severity of the intraocular infection. Results: The mean clinical scores of the six groups at the sixth day were 11±1·92, 12·4±6·2, 8·5±2·7, 0, 3±1·3, and 3±1·4 respectively. Mean histopathological scores were 7·8±2·8, 7·0±1·5, 5·6±1·4, 0, 0, and 0 respectively. There was no significant difference in mean clinical and histopathological scores of infected group (groups 1, 2 and 3). There was significant difference in mean clinical scores of groups 5 and 6 compared with group 4. Groups 4, 5 and 6 showed normal histological structure in histopathological evaluation and showed no significant difference. Microbiological cure was achieved in all infected eyes. Conclusions: Experimental rabbit endophthalmitis model caused by imipenem resistant A. baumannii was microbiologically cured by intravitreal tigecycline injection. However, a hypersensitivity-like reaction due to intravitreal application of tigecycline limits the use of this antimicrobial agent in A. baumannii endophthalmitis.

Segmentation and removal of fibrovascular membranes with high-speed 23 G transconjunctival sutureless vitrectomy, in severe proliferative diabetic retinopathy

Aim To evaluate the effectiveness and safety of high-speed (5,000 cuts per minute) 23 G transconjunctival sutureless vitrectomy (TSV) in severe diabetic fibrovascular proliferation (DFVP). Patients and methods In this retrospective consecutive case series, patients who underwent 23 G TSV for severe DFVP between October 2011 and March 2014 at our institution were evaluated. 23 G TSV was performed with a high-speed (5,000 cuts per minute) cutter without a chandelier light. Results The mean follow-up period was 8 months (range: 4–23 months). Of the 27 eyes of 27 patients, 14 eyes (52%) underwent concomitant phacoemulsification with posterior chamber intraocular lens implantation, nine eyes (33%) were pseudophakic, and four eyes were phakic (15%). DFVP was removed with ease in all, and visual acuity was improved in 18 (67%) eyes. Iatrogenic retinal tear was observed in four eyes (15%) and treated successfully during surgery. Suture placement to a single sclerotomy was performed in eight eyes (30%). Postoperative intraocular hemorrhage was observed in five eyes (18%). Cataract formation was observed in two of the four phakic eyes. Three (11%) patients had postoperative intraocular pressure rise. Postoperative hypotony (≤6 mmHg) and endophthalmitis were not observed in any eye. Conclusion The segmentation and removal of fibrovascular membranes with high-speed 23 G TSV seems to be a safe and easy method in severe diabetic eye disease.