Bengu Ekinci Koktekir

Comparison of the ganglion cell complex and retinal nerve fibre layer measurements using Fourier domain optical coherence tomography to detect ganglion cell loss in non-arteritic anterior ischaemic optic neuropathy

Objective To evaluate the diagnostic ability of macular ganglion cell complex (GCC) and peripapillary nerve fibre layer (NFL) measurements to detect ganglion cell loss (GCL) in patients with non-arteritic anterior ischaemic optic neuropathy (NAION), at the chronic stage. Methods This study included 10 eyes from 10 patients with NAION and 15 eyes from 15 age-matched healthy subjects. The measurements included the GCC thicknesses as average, superior and inferior, the GCC parameters as focal loss volume (FLV) and global loss volume (GLV), the NFL thicknesses as average, superior hemisphere and inferior hemisphere, and the disc parameters as rim area and rim volume. The curves for the area under the receiver operator characteristic (AUROC) were generated to assess the ability of each parameter to detect GCL. Results The patient group had significantly lower GCC thicknesses than the control group (p<0.001, <0.001 and 0.004, for the GCC average, superior and inferior, respectively), and also significantly higher FLV and GLV measurements (p<0.001). The NFL thicknesses were found to be significantly lower in the patient group than the control subjects (p<0.001). Among all the parameters, the FLV and the GLV had the highest levels of AUROC values (1.000, 0.990, respectively). Conclusions The FLV and the GLV showed the strongest abilities to detect GCL in patients with NAION. In addition, peripapillary NFL thickness was comparable to macular GCC thickness in detecting GCL. Therefore, macular GCC scans may provide a good alternative or a complementary practice to NFL scans in the detection of GCL in patients with NAION.

Safety of prophylactic intracameral moxifloxacin use in cataract surgery.

PURPOSE To evaluate posterior and anterior segment safety of an intracameral injection of moxifloxacin as prophylaxis for endophthalmitis in cataract surgery. METHODS In this study, 60 eyes of 60 patients were included. In the first group, only 5% povidine iodine drop was administrated to 30 patients at the end of the surgery, while 30 patients were treated with intracameral moxifloxacin (250 μg/0.050 mL) additionally in the second group. Visual acuity, intraocular pressure, corneal pachymetry, corneal clarity, and edema and retinal thickness were evaluated preoperatively and for day 3 postoperatively for each group and were compared. RESULTS Mean preoperative visual acuity was 0.7 ± 0.9 LogMAR in both groups 1 and 2, while mean postoperative visual acuity was 0.05 ± 1.00 LogMAR in both groups. Preoperative and postoperative intraocular pressure averaged 13.2 ± 2.0 and 13.2 ± 2.1 mmHg, respectively, in the first group, while preoperative and postoperative intraocular pressure was 14.9 ± 2.1 and 14.3 ± 2.0, respectively, in the second group. Preoperative and postoperative visual acuity changes and intraocular pressure changes were not significantly different between 2 groups. There was no single case of corneal edema. In the first group, preoperative pachymetry was 523 ± 44 and postoperative pachmetry was 536 ± 45 μm, while in the second group preoperative pachymetry was 527 ± 43 and postoperative pachymetry was 543 ± 42 μm. Preoperative and postoperative pachymetry changes were not significantly different between 2 groups. Mean preoperative macular thickness in the first group was 188 ± 7.73 μm, while it was measured as 189 ± 7.75 μm postoperatively. In the second group, mean preoperative macular thickness was 188 ± 8.89 μm, while it was 189 ± 9.61 μm postoperatively. Preoperative and postoperative optical coherence tomography (OCT) measure changes were not significantly different between the 2 groups. No study-related adverse events were noted. CONCLUSION There was no increased safety risk associated with a 250 μm/0.050 mL intracameral injection of moxifloxacin, which appears to be safe in the prophylaxis of endophthalmitis after cataract surgery.

Comparison of central corneal thickness measurements with optical low-coherence reflectometry and ultrasound pachymetry and reproducibility of both devices.

Purpose: To compare the accuracy of optical low-coherence reflectometry (Lenstar LS 900; Haag Streit, Köniz, Switzerland) and conventional ultrasound pachymetry (UP) (US 4000; Nidek, Japan) for measuring central corneal thickness and to assess the interexaminer reproducibilities of both devices. Methods: Department of Ophthalmology, Selcuklu Faculty of Medicine, Selcuk University was the study setting. Central corneal thickness (CCT) was measured in both eyes of 65 emmetropic patients by the same examiner using Lenstar LS 900 noncontact biometry and UP. To assess the interexaminer reproducibility, 2 different examiners consecutively obtained CCT measurements in 16 eyes with Lenstar LS 900 noncontact biometry and UP. Results: Mean CCT measurements with Lenstar LS 900 noncontact biometry and ultrasound biometry were 541.09 ± 33.8 and 545.69 ± 34.0, respectively. Significant correlation was present between these 2 measurements; intraclass correlation coefficient was found to be 95.8% (95% confidence interval: 93.2%–97.4%)(P < 0.001). Interexaminer reproducibility with Lenstar was high, and the intraclass correlation was found to be 99.3% (95% confidence interval: 98.0%–99.7%). We have also investigated the interexaminer reproducibility with UP in these 16 patients, and the results showed a 99.2% (95% confidence interval: 97.7%–99.7%) intraclass correlation. Conclusions: The results of Lenstar LS 900 noncontact biometry correlated with the results of UP. It may be used as an alternative method to UP for measuring CCT. Because of the mild underestimation of CCT by Lenstar, the measurements should be carefully evaluated in patients whose intraocular pressure must strictly be monitored.

The effect of pupil dilation on biometric parameters of the Lenstar 900.

Purpose: To evaluate the effect of pupil dilation on the biometric parameters of the Lenstar LS 900 (Haag Streit AG, Koeniz, Switzerland). Methods: In this cross-sectional study of 33 eyes with cataracts, axial length (AL), anterior chamber depth, intraocular lens (IOL) power, keratometry, and pupil diameter measurements were performed using Lenstar biometry before and after pupil dilatation. Intraobserver repeatability was assessed by taking 2 consecutive recordings of biometric parameters using Lenstar biometry in the undilated pupils of 30 eyes with cataracts. Results: The mean difference in AL measurements from intraobserver readings was −0.001 ± 0.01 mm. The study group showed a statistically significant change in the first keratometry reading and anterior chamber depth values (P < 0.05); however, the mean difference in AL and IOL power was statistically insignificant between the undilated and dilated pupil Lenstar biometry readings. Three cases in the study group (9.1%) and 1 case in the control group (3.3%) demonstrated changes in IOL power >0.50 diopter. Conclusions: Dilated and undilated pupil size did not affect the measurement of IOL using the Lenstar biometry.

Dry eyes and migraines: is there really a correlation?

Purpose: The purpose of this study was to evaluate the tear film functions and clinical symptoms of patients with migraines. Methods: This observational comparative study consisted of 33 migraine (26 women and 7 men) patients referred from neurology clinics and 33 (22 women and 11 men) control subjects referred from ophthalmology outpatient clinics. The control subjects had neither systemic nor ocular disease nor any type of headache. All 66 patients underwent a complete ophthalmic examination and diagnostic tests for dry eye, including tear break-up time, Schirmer test with topical anesthesia, lissamine green staining, and an ocular surface disease score. Patients with migraine were classified as migraine with an aura, migraine without an aura, and basilar migraine; a pain score from 1 to 4 was determined for each patient, based on the American Headache Societys Migraine Disability Assessment Test. Results: Of the 33 patients who participated in the migraine group, 17 (51%) suffered from migraine with aura, 11 (33%) suffered from migraine without aura, and 5 (15%) suffered from basilar migraine. Significant differences in dry eye scores were found between the patients with migraine and the control subjects. In the migraine group, the mean tear break-up time was 7.75 ± 2.37 seconds, whereas in the control group it was 9.15 ± 1.93 seconds. For the Schirmer test, the migraine group had a mean value of 12.09 ± 4.95 mm/5 minutes, whereas the control group had a mean value of 14.90 ± 4.26 mm/5 minutes. Testing with lissamine green staining resulted in a mean value of 1.00 ± 0.16 in the migraine group and 0.30 ± 0.46 in the control group. In the migraine group, the mean for the ocular surface disease index scoring was 36.27 ± 17.54. In the control group, it was 28.42 ± 9.0. A significant difference (P < 0.05) was found in the dry eye syndrome testing results between the 2 groups in this study. Conclusions: An increased frequency of dry eye disease was found to occur in patients with migraine, which might suggest that migraine headaches are related to dry eye disease. Some migraine attacks may be aggravated in the presence of dry eye syndrome.

Bilateral severe anterior uveitis after unilateral selective laser trabeculoplasty.

ing to malignancy was not convincing, and the likely cause for bone growth would be inflammation related to ISOI. In cases of chronic refractory sinusitis, lytic and blastic forms of osteitis occur, and can result in hyperostosis of the nasal and paranasal bones, which was seen in 64% of patients with recurrent rhinosinusitis. The chronic inflammation of ISOI likely caused a corresponding osteitis, an osteoblastic type in this case, producing hyperostosis and the bony changes seen in this case. Diagnosing ISOI is difficult and can further be complicated by the unusual finding of hyperostosis. Treatment of ISOI is controversial as studies using steroids, azathioprine, cyclosporine and radiation have been used with limited success. With our patient’s age and the systemic complications associated with his mesothelioma, treatment was deferred. This case highlights ISOI associated with hyperostosis, and it is important with this presentation that a concomitant work-up for occult malignancy is considered.

Does topical bevacizumab prevent postoperative recurrence after pterygium surgery with conjunctival autografting

AIM To assess the effect of topical bevacizumab use on postoperative pterygium recurrence in eyes who underwent pterygium excision with limbal-conjunctival autograft transplantation (LCAT). METHODS Eighty-eight eyes of 88 patients with primary pterygium were included. Pterygia were graded preoperatively from type 1 to type 3 (type 1 atrophic, type 3 inflamed) according to the inflammatory status. The eyes were preoperatively randomized to receive topical steroid and antibiotic treatment (group 1, 46 eyes) and additional topical bevacizumab (5 mg/mL; group 2, 42 eyes) in the postoperative period. All eyes underwent pterygium excision and LCAT. Medications were tapered and discontinued at one month. Postoperative complications and recurrence rates were recorded. RESULTS The mean follow-up duration was 29.3±4.2mo (24-52mo) and 28.5±3.4 (24-48mo) in group 1 and 2, respectively (P>0.05). There were no statistically significant differences regarding the age or gender between groups (P>0.05). Also, the difference between groups with respect to pterygium type was not significant. During the follow-up period, recurrence developed in 2 eyes (4.3%) in group 1, whereas in one eye (2.4%) in group 2. No statistically significant difference between groups was found in recurrence rates (P>0.05). No re-operation for recurrence was necessary during the follow-up period in both groups. CONCLUSION Topical bevacizumab seems to have no additonal effect on pterygium recurrence after LCAT.

Effect of religious fasting on tear osmolarity and ocular surface.

Objective: To evaluate the effects of religious fasting on tear secretion, tear osmolarity, corneal topography, and ocular aberrations. Methods: This prospective controlled study comprised 29 eyes of 29 healthy men. Before ophthalmologic examination, all subjects underwent corneal topography by a placido disc corneal topography and aberrometry device (OPD Scan II). Tear osmolarity was measured using OcuSense TearLab osmometer. Ocular surface disease index (OSDI) scores, tear break-up time (BUT), Schirmer I test, and lissamine green staining were evaluated. The measurements taken before and during Ramadan at the same hours between 4.00 and 5.00 PM were compared using paired sample t test, and a P value less than 0.05 was accepted as statistically significant. Results: The mean age of the study group was 27.8±5.9 years (range, 20–47 years). The mean tear osmolarity values were measured as 285.6±8.2 mOsm/L and 293.3±16.0 mOsm/L, whereas the mean Schirmer I values were 14.8±6.0 mm and 10.6±5.3 mm in nonfasting and fasting periods, respectively. Tear osmolarity, OSDI, and Oxford grading scores significantly increased (P=0.02, P=0.002, P=0.003, respectively), whereas Schirmer I values and intraocular pressure decreased (both, P<0.001) during the fasting period compared with the nonfasting period. There were no significant differences in tear BUT, keratometry values, and corneal aberration measurements between nonfasting and fasting periods (P>0.05, for all). Conclusion: Fasting significantly decreases tear production and increases tear osmolarity; however, it does not deteriorate corneal topographic parameters and ocular aberrations in healthy subjects.

Giant ethmoido-orbital osteoma presenting with dacryocystitis and metamorphopsia.

Osteoma is the most common benign neoplasm of the paranasal sinuses. Intraorbital extension is rare. Here we report a 16-year-old adolescent boy who presented with epiphora and pain in the medial canthal area. A computed tomographic scan revealed a bone density mass in the left ethmoid cavity extending into the adjacent orbit. The tumor was removed via endoscopic endonasal surgery. The pathologic evaluation was consistent with osteoma. After surgery, all complaints have been resolved and there was not any sign of recurrence in the computed tomographic scan.

Topiramate-Induced Changes in Anterior Chamber Angle and Choroidal Thickness.

Purpose: To investigate the acute effects of topiramate on the anterior chamber angle (ACA) and choroidal thickness in patients with migraine. Methods: This prospective study included 15 eyes of 15 patients with migraine who have been scheduled to start topiramate therapy. All patients underwent complete ophthalmic examination including measurement of the ACA and choroidal thickness using a spectral domain optical coherence tomography device (Optovue Inc.) and refractive status evaluation with an autorefractokeratometer (KR-8100; Topcon) at the baseline and 1 week after starting therapy. The patients were asked to report any pain or discomfort in their eyes during therapy at the follow-up visit. Results: None of the patients experienced pain or discomfort in their eyes. The mean ACA significantly decreased at the first week of the therapy compared with the baseline levels (40.34±7.06° and 36.89±6.87°, respectively) (P=0.001). However, the mean choroidal thickness increased from 277.33±95.60 &mgr;m at the baseline to 323.40±84.50 &mgr;m at the first week (P=0.01). There was a nonsignificant increase in the mean refractive error (from −0.25±0.54 diopter [D] at the baseline to −0.38±0.49 D after 1 week) (P=0.06). Conclusions: Topiramate can acutely decrease the ACA and increase the choroidal thickness. Because these effects may be asymptomatic, patients with migraine who start this therapy should be warned to be closely followed up by an ophthalmologist.