Baran Kandemir

Toric intraocular Collamer lens for high myopic astigmatism after penetrating keratoplasty.

A toric intraocular Collamer lens (ICL) was used to correct myopic astigmatism after penetrating keratoplasty. The patients manifest refraction improved from -8.0 -1.75 x 170 preoperatively, with an uncorrected distance visual acuity (UDVA) of 0.15 and a corrected distance visual acuity (CDVA) of 0.4, to +0.75 -0.50 x 130 postoperatively, with a UDVA of 0.8 and a CDVA of 1.0. No serious complications or refractive changes occurred during the 1-year follow-up. Implantation of a myopic toric ICL in phakic eyes is an option to correct postkeratoplasty anisometropia and astigmatism.

effect of heparin in the intraocular irrigating solution on postoperative inflammation in the pediatric cataract surgery

Purpose: To evaluate the influence of irrigation of the anterior chamber with heparin sodium on postoperative inflammation after pediatric cataract surgery. Setting: Kartal Training and Research Hospital, First Eye Clinic, Istanbul, Turkey. Design: Randomized prospective double-blind study. Methods: Fourteen consecutive eyes from 14 patients aged 8.9 ± 5.9 years, (range 3–18 years) (group 1) and 19 eyes from 19 patients aged 9.1 ± 5.2 (range 1.5–18 years) (group 2) underwent pediatric cataract surgery. Five patients in group 1 were between three and five years old. One patient was 1.5 years old and six patients in group 2 were between three and five years old. During the procedure, group 1 received anterior chamber irrigation with heparin sodium (5 IU/cc) and 1 ml of heparin sodium (concentration 10 IU/ml) added to the irrigating balanced salt solution (BSS Plus; Alcon Laboratories, Inc., Fort Worth, TX, USA) while group 2 received BSS without heparin sodium only. Cases aged under three years received anterior vitrectomy in addition to posterior capsulorrhexis. One eye received anterior vitrectomy in group 1 and two eyes received anterior vitrectomy in group 2. Cases with preoperative complications were not included in the study. Early and late postoperative inflammatory complications, including fibrin formation, anterior and posterior synechia, cyclitic and pupillary membrane formation were recorded and compared. Results: Mild anterior chamber reaction was observed in three patients in Group 1, while nine cases in group 2 experienced marked anterior chamber reaction. In four of nine patients from group 2, anterior chamber reaction was severe and resulted in pupillary membrane and synechia despite treatment in the postoperative 7th day, while in all three cases in group 1, reaction disappeared by the 7th day. Conclusion: Anterior chamber irrigation with heparin during pediatric cataract surgery may minimize early inflammatory reaction and decrease the number of postoperative inflammatory related complications.

Traumatic wound dehiscence after penetrating keratoplasty

BACKGROUND We aimed to evaluate the risk factors, clinical features and outcomes of surgery for traumatic wound dehiscence (TWD) following penetrating keratoplasty (PK). METHODS Twenty-six patients with TWD following PK were evaluated retrospectively in terms of factors related to the trauma, types of reconstructive surgery, final graft clarity, and visual acuity. RESULTS There were 26 patients with a mean age of 40.7±19.6 years. In 12 (46.1%) patients, the better eye was affected by the trauma. The most frequent type of trauma was blunt trauma by various objects (9). In all cases, the dehiscence was at the graft host junction. The mean extent of detachment was 135.4°±57.6°. Crystalline or intraocular lens damage was present in 42.3% of cases. Median follow-up time after the reconstructive surgery was 36 months. The graft remained clear in 13 (50%) patients, whereas graft insufficiency/graft rejection developed in 13 (50%) patients. Final visual acuity was over 20/200 in 13 (50%) patients. CONCLUSION TWD may occur at any time after PK, most frequently within the first postoperative year. Low visual acuity in the other eye seems to be a major risk factor. In patients without major complications such as posterior segment damage, visual outcomes and graft survival can be favorable.

Long-term vision-threatening complications of phakic intraocular lens implantation for high myopia.

AIM To report the long-term vision-threatening complications in patients who underwent phakic intraocular lens (pIOLs) implantation for high myopia. METHODS This study was designed from a consecutive series of phakic intraocular lens complication and corrective surgeries. Sixteen eyes of 13 patients had implantation of phakic intraocular lens for correction high myopia and developed serious complications have been included in this study. The mean age of patients was 38.6±6.35y (range 32-50y) and the mean time of history of pIOL implantation for high myopia was 6±2y (range 2-10y). Before corrective surgery, best spectacle-corrective visual acuity (BSCVA) ranged from perception to 20/200 in the eyes in which severe complications occurred. RESULTS Corneal decompensation occurred in 12 eyes of 9 high myopic patients after anterior chamber pIOL implantation. Rhegmatogenous retinal detachment (RRD) occurred in 4 eyes of 4 high myopic patients following anterior chamber and posterior chamber pIOL implantation. Patients with corneal decompensation, had combined procedures consisting of pIOL removal and penetrating keratoplasty (PKP). Removals of pIOL, phacoemulsification and pars plana vitrectomy (PPV) with silicone oil tamponade were performed in patients with RRD. After corrective surgeries, all patients but one (P+, patient 2, right eye) achieved moderate BSCVA ranged from 20/200 to 20/50 at the last visit. CONCLUSION Phakic IOLs may be effective for the correction of high myopia. Although these IOLs may have severe complications and it affects safety and efficacy of this surgery. As seen here, corneal decompensation and rhegmatogenous retinal detachment are possible postoperative vision-threatening complications of phakic IOLs. Patients must be carefully examined before and after surgery for possible endothelial cell loss and vitreoretinal problems.

Exogenous group G Streptococcus endophthalmitis following intravitreal ranibizumab injection

We report a case of group G Streptococcus endophthalmitis following an intravitreal ranibizumab injection for a choroidal neovascular membrane. Pars plana vitrectomy was applied for endophthalmitis and group G Streptococcus cultures were isolated in the vitreous samples taken from the patient. Twenty-four hours following pars plana vitrectomy the patient underwent myocardial infarction and cardiac arrest. To our knowledge this is the first reported case of group G Streptococcus endophthalmitis following an intravitreal injection.

Effect of oral Colchicine on Peripapillary retinal nerve fiber layer thickness in patients with familial Mediterranean fever

BackgroundThe purpose of this study is to investigate whether oral colchicine has an effect on peripapillary retinal nerve fiber layer (pRNFL) thickness of familial Mediterranean fever (FMF) patients.MethodsWe conducted a cross sectional study by comparing pRNFL thickness of FMF patients on colchicine (treated group), newly diagnosed colchicine naïve FMF patients (untreated group) and healthy controls. The study included 66 FMF patients and 32 healthy control subjects. Treated FMF patients were grouped according to colchicine use, duration of use and dosage. pRNFL thickness of the patients and controls were measured by using optical coherence tomography and the measurements were compared.ResultsNo statistically significant difference was found between the pRNFL thickness in untreated group, treated group and the healthy control group (all p > 0.05). No statistically significant difference was found between pRNFL thickness in the healthy control group and FMF patients grouped according to duration or dosage of colchicine use (all p > 0.05).ConclusionsAccording to our study, FMF and oral colchicine use had no statistically significant effect on pRNFL thickness.

Use of an Intravitreal Dexamethasone Implant (Ozurdex) in a Case with Accidental Foveal Photocoagulation by Alexandrite Laser.

Alexandrite laser is one of the most common methods of hair removal. Its utilization is gradually increasing due to easy accessibility and high effectiveness. However, the disuse of protective goggles during the application of this laser is a serious problem. In this case report, we presented a 35-year-old male patient who had foveal injury by alexandrite laser. The inflammatory process secondary to the foveal injury and subsequent macular edema were treated with Ozurdex because of its potent antiedematous effect.

A Rare Cause of Sympathetic Ophthalmia: Combined Penetrating Keratoplasty and Pupilloplasty

A 60-year-old male patient was referred to our clinic with the diagnosis of corneal staphyloma secondary to keratitis in the left eye. Penetrating keratoplasty (PK) and pupilloplasty were performed and one month after the intervention, the patient was admitted to our clinic with decreased vision in his right eye. Based on clinical findings, Fundus Fluorescein Angiography (FFA), and optical coherence tomography (OCT) results, he was diagnosed with sympathetic ophthalmia (SO) secondary to combined keratoplasty and pupilloplasty. The patient was treated with topical and systemic corticosteroids with immunosuppressive drugs. To the best of our knowledge, this is the first case of SO, on the basis of combined PK and pupilloplasty performed in a patient with acquired anterior staphyloma secondary to keratitis.

Psödoeksfoliasyon sendromlu gözlerin heidelberg retinal tomografi ile değerlendirilmesi

Evaluation of patients with pseudoexfoliation syndrome with heidelberg retinal tomography Objective: To evaluate the optic disk and retinal nerve fiber layer (RNFL) in patients with Pseudoexfoliation Syndrome (PES) with Heidelberg Retinal Tomography (HRT) and its comparison with normal control group. Materials and Methods: 40 patients were included in this retrospective study. Group 1 was formed by 20 patients who had pseudoexfoliation in their anterior chamber but no other eye disease and Group 2 was formed by 20 persons who had not any eye disease. Mean age was 66.5±9.20 (52-78) for Group 1 and 65±5.93 (50-74) for Group 2. Mean intraocular pressure was 16.9±2.1 mmHg (1220) for Group 1 and 15.0±1.9 mmHg (13-20) for Group 2. There was no difference in age, gender and intraocular pressure (p=0.433; p=0.621; p=0.771). Optic nerve head and retinal nerve fiber layer measurements were taken with HRT3 for all cases and compared. Results: There was no difference between two groups in parameters; disc area, cup area, rim area, cup-disc ratio, rim volume, mean cup depth, maximum cup depth, cup shape measure. Parameters; Cup volume, height variation contour, mean RNFL thickness, RNFL cross sectional area were significantly worse in Group 1 and they work to the advantage of glaucoma. Conclusion: With using HRT device we found that glaucomatous changes are began in patients with PES. Because of that we believe that patients with PES have to be follow up closely, medical or surgical intraocular pressure reducing treatments may be a good alternative even they do not have glaucoma diagnosis and have normal intraocular pressure.

Inadvertent use of water-based ink instead of trypan blue in cataract surgery

We report a case of iris atrophy and corneal endothelial decompensation following the inadvertent use of water-based ink for capsular staining during cataract surgery. The anterior chamber was thoroughly irrigated with balanced salt solution after the identification of the wrong dye. Phacoemulsification with minimal ultrasound energy and intraocular lens implantation were performed without complications, and the operation was completed. The patient finally developed bullous keratopathy and underwent penetrating keratoplasty 4 months later.