Cagatay Caglar

Topiramate Induced Bilateral Angle-Closure Glaucoma: Low Dosage in a Short Time

PURPOSE The aim of this article is to create awareness among medical colleagues regarding the severe ophthalmic side effects associated with topiramate use. METHODS A case of severe acute bilateral angle closure glaucoma with visual blurring after oral topiramate therapy. RESULTS This case was successfully managed by discontinuing topiramate and by starting anti-glaucoma medication. Intraocular pressure, acute transient myopia, and anterior chamber depth were normalized. CONCLUSIONS It is important for clinicians to recognize these conditions and educate patients about these serious adverse effects when prescribing topiramate.

The effectiveness of postoperative early ostium cleaning in transcanalicular diode laser-assisted dacryocystorhinostomy.

Purpose: To search the effectiveness of postoperative first week ostium cleaning in transcanalicular diode laser–assisted dacryocystorhinostomy (TDL-DCR). Materials and Methods: A total of 123 eyes of 123 patients with acquired dacryostenosis who had surgery were retrospectively evaluated. Diode laser was used in all patients. All patients were operated under local anesthesia by a single surgeon. Intranasal endoscopic cleaning of the ostium by surgical suction under local anesthesia was performed as an extra job in the postoperative first week visit. Results: Mean age of the patients was 55 (range, 41–78 years) years. Mean follow up was 13.4 months. Successful outcomes were achieved in 117 of 123 (95.1%) patients. Reoperation was performed in 6 patients with restenosis and were free of symptoms in 1-year follow up. Conclusion: Postoperative first week cleaning of the nasal ostium by surgical suction with the aiding of nasal endoscopy is a very effective method increasing the success rate of TDL-DCR.

In Vivo Confocal Microscopy and Biomicroscopy of Filtering Blebs After Trabeculectomy.

Purpose:The aim of this study is to analyze filtering blebs (FBs) after trabeculectomy with in vivo confocal microscopy (IVCM) and slit-lamp biomicroscopy. Materials and Methods:IVCM using the Heidelberg Retina Tomograph/Rostock Cornea Module and biomicroscopic examination were performed in 67 FBs in 55 patients 3 months to 30 years postoperatively (mean, 3.2±2.1 y). Although the blebs were evaluated by slit-lamp biomicroscopy, standardized FB classification was used. Results:Of the patients, 9 were female (16.3%) and 46 were male (83.7%), ranging in age from 32 to 81 (51.5±13.2) years. The absence of vascularization and tortuous vessels and the presence of epithelial microcysts on the bleb were significantly correlated with good bleb function (P=0.001). IVCM findings significantly correlated with good bleb function, including the number of epithelial microcysts (P=0.002), the stromal cysts without capsule (P<0.001), minimal vascularization (P=0.002), and the absence of tortuous conjunctival vessels (P=0.003) and reticular and trabecular bleb patterns (P=0.01 and <0.01, respectively). In contrast, a hyperreflective condensed bleb stroma was significantly associated with bleb failure (P<0.001). Conclusions:IVCM supports biomicroscopic evaluation as the mainstay for FB analysis and permits diagnostic imaging of FBs to evaluate and follow-up the bleb, differentiation between good and insufficient bleb function, and a microscopic analysis at a cellular level including the structural pattern of the bleb.

The Modified Technique of External Dacryocystorhinostomy in the Management of Complicated Nasolacrimal Duct Obstruction.

Aim:To evaluate the outcome of the modified technique of external dacryocystorhinostomy (EDCR) with a “U”-shaped single flap that was fixed on to the orbicularis muscle with combined silicone tube in dacriostenosis. In cases with decreased visibility because of excessive bleeding during surgery, a small sac size, and difficulty of mutual suturing between nasal mucosal and sac flaps related to distance. Methods:This retrospective study included 118 patients with a nasolacrimal duct obstruction who underwent the modified technique of EDCR. The modified EDCR procedure envisions the creation of anastomosis of the single anterior “U”-shaped flaps suturing anterior flaps of the lacrimal sac and nasal mucosa. The sutured flap was fixed on to the orbicularis muscle. The silicone tube intubation was performed on all patients. Results:The average age of the patients was 39 ± 19.2 (9–70) years, including 94 women and 24 men. The average follow-up time was 18 ± 4.5 (9–36) months. Total 112 eyes (94.9%) showed a patent lacrimal system to irrigation, whereas 6 eyes (5.1%) had recurrence of epiphora and not patent lacrimal system to irrigation by the end of the first surgeries. The same surgery was planned for these patients. The patent lacrimal system was achieved in 3 of these 6 eyes. The overall success rate of the surgical procedure used in this study was 97.4%. Conclusions:This modified technique of EDCR with a “U”-shaped single anterior flaps that was fixed on to the orbicularis muscle with combined silicone tube simplifies the surgical procedure and is effective in the management of nasolacrimal duct obstruction.

Ocular biometry and central corneal thickness in children: a hospital-based study

PURPOSE To investigate the distribution of axial length, anterior chamber depth, lens thickness, vitreous chamber depth, and central corneal thickness in children at different age groups. METHODS We studied 364 eyes in 182 children with ages between 1 and 12 years. Axial length, anterior chamber depth, lens thickness, and vitreous chamber depth were measured by ultrasound biometry. Central corneal thickness was measured by ultrasound pachymetry in all children. RESULTS The mean age was 6.54 ・} 3.42 years. The axial length was 20.95 mm in 1-2 years old and 22.95 mm in 11-12 years old. The central corneal thickness was 556 μm in 1-2 years old and 555 μm in 11-12 years old. The mean anterior chamber depth and vitreous chamber depth increased with age (3.06 mm to 3.44 mm in anterior chamber depth, 13.75 mm to 15.99 mm in vitreous chamber depth), and the lens thickness decreased as age increased (3.67-3.51 mm). CONCLUSION The axial length increased with age and reached adult levels by the age of 9-10 years. The lens thickness gradually decreased until 12 years. The central corneal thickness measurements did not yield a linear algorithm.

Argon Green Laser for Valsalva Retinopathy Treatment and Long-term Follow-up of the Internal Limiting Membrane Changes in Optical Coherence Tomography

Dear Editor, We experienced a case of sub-internal limiting membrane (ILM) hemorrhage successfully treated with an argon green laser (AGL) posterior hyaloidotomy. We could not identify any report in the ophthalmic literature describing spectral domain optic coherence tomography (OCT) localization of AGL spots or preoperative exact anatomic localization in valsalva retinopathy. A 35-year-old man presented with sudden blurred vision in the right eye that occurred one day before examination. Dilated fundus examination of the right eye showed a well-circumscribed large sub-ILM hemorrhage in the temporal macular area (Fig. 1A). Fluid was noted in the upper part of the hemorrhage. OCT (Spectralis; Heidelberg Engineering, Heidelberg, Germany) revealed a dome-shaped hypo-reflective area, consistent with blood beneath a hyper-reflective band at the macula (Fig. 1B). OCT scans just above the level of sedimented blood revealed two distinct membranes overlying a preretinal hemorrhage. The membrane on the retinal side, more apparent and reflective, was identified as ILM. The slight and patchy overlying membrane was identified as posterior hyaloid, and a mild vitreous hemorrhage was noted (Fig. 1C). A dense preretinal hemorrhage produced shadowing that precluded analysis of the retina and subretinal space. We used AGL photocoagulation (Lightlas 532 Green Laser; Lightmed, San Clemente, CA, USA) to perforate the hyaloid and ILM in order to drain the sub-ILM blood into the vitreous cavity. Four exposures of AGL were performed at the inferior margin of the hematomas anterior surface with a spot size of 100 µm, exposure duration of 0.1 seconds, and power of 200 mW. Patient informed consent was obtained. Consequently, the hemorrhage was rapidly drained inferiorly into the vitreous cavity (Fig. 1D). Fundus photography revealed strong resolution of the hemorrhage (Fig. 1E). OCT revealed laser perforation points along the ILM and hyaloid (Fig. 1F). The hyporeflective space between the ILM and the nerve fiber layer was possibly due to the presence of residual blood. In addition, blood in the vitreous cavity was still observable on the OCT (Fig. 1G). At a two-year follow-up visit, visual acuity was stable at 1.0, and the patient did not mention any symptoms of metamorphopsia. Although the hemorrhage was completely resolved (Fig. 1H), laser perforation points were incurred during the procedure, and a lamellar hole and failed reattachment of ILM were observed in the temporal macular area in the OCT at final follow-up (Fig. 1I). The OCT also revealed that the detached ILM had attached to the posterior hyaloid (Fig. 1J). Fig. 1 (A) Fundus photograph of the right eye showed a huge sub-internal limiting membrane (ILM) hemorrhage in the temporal macular area. (B) Spectral domain optic coherence tomography (OCT) revealed a dome-shaped hypo-reflective area, consistent with blood ... The anatomical location of premacular hemorrhage, either under the ILM (sub-ILM) or subhyaloid, is still controversial and is not possible to distinguish using indirect fundus examination [1,2]. Intraoperative findings and time-domain and spectral domain OCT images in recent articles support previous histologic reports of premacular hemorrhage beneath the ILM in Valsalva retinopathy [3]. In the present case report, the sub-ILM location of the hemorrhage was confirmed in spectral domain OCT. Thus, in our opinion, valsalva retinopathy caused the sub-ILM hemorrhage. In this sense, the term subhyaloid hemorrhage is a misnomer. We think that the term sub-ILM hemorrhage should be used instead of subhyaloid hemorrhage. According to our previous experience, Nd:YAG laser membranotomy requires relatively many spots with higher energy levels for the treatment of the premacular hemorrhage [4]. We used AGL with low energy to stretch the posterior hyaloid and the ILM. OCT revealed localization of the ILM and hyaloid membrane disruptions and attachment caused by the laser spots and the safety of the procedure, with minimal involvement of the underlying retinal layers after two years of follow-up. We punctured the posterior hyaloid face and ILM with an AGL in order to drain a premacular hemorrhage into the vitreous and to allow absorption of the blood in the vitreous space. We concluded that spectral domain OCT evaluation of laser treatment for valsalva retinopathy can confirm the cleavage plane of a valsalva hemorrhage. In order to avoid retinal tissue damage, exact anatomical localization of hemorrhage was determined using spectral domain OCT. This method can also be used for follow-up after laser application. The treatment of AGL seems to be helpful in the rapid clearing of a premacular hemorrhage by causing disruption of the ILM. However, larger case studies are required to compare the effects of the different laser techniques.

The central retinal artery occlusion in the right eye followed by a branch retinal artery occlusion in the left eye four days later

A 65-year-old woman was admitted to our clinic with complaints of sudden, painless, decrease in vision, and sectoral visual field defect in the left eye and later presented to our clinic again with a history of sudden loss of vision in her right eye. In this case study we reported that the patient had branch retinal artery occlusion (BRAO) in the left eye and at the same time progressing central retinal artery occlusion (CRAO) in the right eye.

The Stabilization Time of Ocular Measurements after Cataract Surgery.

ABSTRACT Purpose: To determine the stabilization time of automated refraction, ocular biometric parameters, keratometry, and central corneal thickness (CCT) and to find the optimal time for glasses’ prescription after cataract surgery. Methods: This was a prospective, case series study of 62 consecutive eyes with senile cataracts. Patients undergoing uncomplicated phacoemulsification surgery were included in the study. Automated refraction, keratometry, ocular biometric parameters, and CCT were recorded at baseline before cataract surgery and at follow-up visits at one day, one week, two weeks, and four weeks after surgery. Results: The study was composed of 62 eyes of 62 patients with a mean age of 66±12.38 (range, 40 to 84 years). The automated refraction stabilized one week after surgery and changed minimally between the first week and the first month after cataract surgery. The stabilization of average keratometric corneal astigmatism in keratometry, average anterior chamber depth, and CCT was achieved after the second postsurgical week. Conclusion: It may be possible to prescribe glasses starting from two weeks after an uneventful phacoemulsification cataract surgery for most patients.

Congenital Hypothyroidism in Axenfeld-Rieger Syndrome

This report was presented as a poster presentation “43. National Congress of Turkish Ophthalmology Association, 11 -15 November 2009, Beldibi, Antalya, Turkey”. *Corresponding Author: Erbil Seven MD. Department of Ophthalmology, Faculty of Medicine, Yuzuncu Yil University, 65080, Tusba, Van, Turkey, Phone Number: +90 (505) 292 56 28, Fax Number: +90 (432) 216 83 52, E-mail address: erbilseven@gmail.com Received: 06.12.2016, Accepted: 05.01.2017 CASE REPORT

Comparing biometry in normal eyes of children with unilateral cataract/corneal disease to age-matched controls

OBJECTIVE To compare ocular biometry and central corneal thickness of unaffected healthy eyes of pediatric patients with monocular cataracts/corneal opacities and age- matched controls. MATERIALS AND METHODS We studied 329 eyes of 329 children who were between 1 and 12 years old. The study group (n: 164) consisted of healthy fellow eyes of children operated for unilateral congenital/traumatic cataract and corneal laceration. Axial length, anterior chamber depth, lens thickness, vitreous chamber depth, and central corneal thickness were measured by ultrasound biometry/ pachymetry. RESULTS Axial length was 22.16 mm in the study group and 21.99 mm in the control group. Anterior chamber depth, lens thickness, and vitreous chamber depth results were 3.35; 3.64 and 15.20 in the treatment group and 3.20; 3.63, and 15.15 mm in the control group, respectively. The axial length and all the components, i.e. anterior chamber depth, lens thickness, and vitreous chamber depth are higher in the unaffected healthy eyes of the pediatric patients than that of the control group but only the difference in the anterior chamber depth was statistically significant. The central corneal thickness was 548 microns and 559 microns in the study and the control groups, respectively, and the difference was found to be significant. CONCLUSION Greater anterior chamber depth was chiefly responsible for the overall increase in the axial length in the study group. The central corneal thickness was significantly thinner in the study group than that of the control group. Keywords Ocular biometry; central corneal thickness; anterior chamber depth; lens thickness; vitreous chamber depth.