Cem Kucukerdonmez

Fibrin glue versus sutures for conjunctival autografting in pterygium surgery: a prospective comparative study

Aim: To compare the use of fibrin glue versus sutures for fixating conjunctival autografts in patients undergoing pterygium excision. Methods: Fifty patients (50 eyes) with primary pterygium were randomised to undergo pterygium surgery using either fibrin glue (25 eyes) or 8-0 Vicryl sutures (25 eyes) to attach the conjunctival autograft. The patients were followed up for 12 months. Outcome measures were postoperative patient comfort, duration of surgery and recurrence of pterygium. Results: In the fibrin glue group, the mean operation time was 15.7 (SD 2.4) min (range 12–18 min) and in the suture group (p<0.001) it was 32.5 (6.7) min (range 25–40 min). The intensity of the postoperative pain, foreign-body sensation, irritation and epiphora were significantly lower in the fibrin glue group than in the suture group (p<0.001). The intensity of itchy sensation at the first two postoperative visits was lower among patients in the fibrin glue group (five patients, 20%) than in the suture group (12 patients, 48%) (p<0.05). Two patients in the fibrin glue group had partial graft dehiscence; these grafts were successfully reattached with fibrin glue. At the end of follow-up, pterygium recurrence was observed in one eye (4%) in the fibrin glue group and in three eyes (12%) in the suture group (p<0.05). Conclusion: The use of fibrin glue in pterygium surgery with conjunctival autografting significantly reduces surgery time, improves postoperative patient comfort and results in a lower recurrence rate compared with suturing.

The effect of nicotine on choroidal thickness

Purpose To investigate the effect of nicotine on choroidal thickness using optical coherence tomography (OCT). Design Prospective, case–control study. Methods Sixteen young, healthy subjects and 16 age and gender matched control cases were included in this study; 4u2005mg nicotine gum was given to the study group and placebo gum to the control group. All participants underwent OCT scanning with a high-speed and resolution spectral-domain OCT device (3D OCT 2000, Topcon, Japan) at baseline, and 1u2005h following nicotine or placebo administration. The measurements were taken in the morning (10:00–12:00 hours) to avoid diurnal fluctuation. Results The median foveal choroidal thickness at baseline was 337.00u2005μm (IQR 84.50), which decreased to 311.00u2005μm (IQR 78.00) at 1u2005h following oral nicotine intake (p=0.001). The median choroidal thickness was also significantly decreased at five other extrafoveal points (p<0.05 for all). In the control group, the median baseline choroidal thickness at the fovea was 330.50u2005μm (IQR 104.25), and was 332.00u2005μm (IQR 103.75) at 1u2005h (p=0.271). Conclusions Nicotine causes a significant decrease in choroidal thickness following oral intake. This acute decrease might be a result of reduced ocular blood flow due to the vasoconstrictive effect of nicotine.

Choroidal thickness changes in patients with migraine.

This observational study evaluated choroidal thickness using spectral domain optical coherence tomography (SD-OCT) in patients with migraine and compared the results with healthy controls. The study population consisted of 42 migraine patients (36 females and 6 males) who were referred from neurology clinics and 42 controls (36 female and 6 male) with no systemic or ocular disease and no headache of any type. All 84 patients underwent complete ophthalmic examination as well as determination of choroidal thickness using a high-speed, high-resolution SD-OCT device (λxa0=xa0840xa0nm, 27.000xa0A-scans/s, 5-µm axial resolution). The migraine patients were classified into the migraine with aura group or the migraine without aura group, and a pain score from 1 to 10 was determined for each patient based on the Visual Analogue Scale (VAS). The mean choroidal thicknesses were 276.81xa0±xa037.76xa0µm in the migraine group and 300.44xa0±xa024.93xa0µm in controls. The difference in choroidal thickness between the migraine patients and the controls was significant (Pxa0=xa00.001). Choroidal thickness measurements of five patients during an attack showed an acute decrease (mean 45.50xa0µm) in choroidal thickness from the values in the same patients during the attack-free period. There was no correlation between VAS score and the type of migraine with choroidal thickness (Pxa0>xa00.05). The decrease in mean choroidal thickness in patients with migraine compared to controls may be related to the vascular pathology of the migraine. The acute decrease in choroidal thickness during an attack also lends support to this hypothesis of reduced ocular blood flow in these patients.

Retinal and choroidal thickness changes after single anti-VEGF injection in neovascular age-related macular degeneration: ranibizumab vs bevacizumab

Purpose To evaluate and compare the effects of single intravitreal injection of ranibizumab and bevacizumab on central retinal and choroidal thickness in patients with neovascular age-related macular degeneration (AMD). Methods Forty eyes of 40 patients with neovascular AMD that underwent intravitreal injection of vascular endothelial growth factor inhibitors (anti-VEGFs) were included. Patients were randomized into 2 groups: 20 eyes received ranibizumab and 20 eyes received bevacizumab injection. Central retinal and choroidal thicknesses of all eyes at baseline and 1 month postinjection scans were measured with Fourier-domain optical coherence tomography (OCT). Student t test and Mann-Whitney U test were used to compare the data. Results The mean central retinal thickness (CRT) showed significant decrease after single injection of ranibizumab (from 345.0 μm to 253.5 μm, p<0.01) and bevacizumab (from 329.5 μm to 251.0 μm, p<0.01) at the first month, respectively. There was no significant difference regarding the CRT change between groups (p = 0.39). The mean choroidal thickness decreased from 158.6 μm (115-317) to 155.5 μm (111-322) in the ranibizumab group and from 211.5 μm (143-284) to 201.5 μm (93-338) in bevacizumab group. The decrease was not significant between groups (p = 0.35). Conclusions Intravitreal injection of both ranibizumab and bevacizumab provided a significant decrease in CRT; however, the agents caused no significant change in choroidal thickness. Additionally, no difference between ranibizumab versus bevacizumab was observed related to macular edema inhibition.

Switching intravitreal anti-VEGF treatment in neovascular age-related macular degeneration

Purpose To compare the outcomes after switching between bevacizumab and ranibizumab therapy due to poor treatment effect in neovascular age-related macular degeneration (AMD). Methods This is a retrospective review of patients with neovascular AMD with first treatment using intravitreal bevacizumab (group 1) or ranibizumab (group 2) who switched to the other drug due to poor treatment effect. Primary outcome measures were change in mean best-corrected visual acuity (BCVA) and mean central retinal thickness (CRT) at 1 year and last visit. Results Eighty-seven eyes met the inclusion criteria. In group 1 (43 eyes), the mean BCVA decreased from 20/94 to 20/100 at 1 year after being switched (p = 0.573) and to 20/150 (p = 0.015) at final visit (mean 29.2 months, range 12-53). In group 2 (44 eyes), mean BCVA decreased from 20/72 to 20/90 (p = 0.401) and 20/100 (p = 0.081) at 1 year after switch and at final visit (mean 20.1 months, range 10-40), respectively. The mean CRT at switch, 1 year after switch, and at final visit were 344.4 ± 140 µm (mean ± SD), 286.26 ± 155 µm (p = 0.019), and 290.58 ± 196 µm (p = 0.009) in group 1 and 329.36 ± 144 µm, 302.0 ± 179 µm (p = 0.215), and 309.5 ± 220 µm (p = 0.154) in group 2, respectively. Conclusions The mean BCVA decreased over time in both groups; however, nearly 30% of the eyes in each group showed vision improvement after switching. Mean CRT decreased in both groups, which was more pronounced after being switched from bevacizumab to ranibizumab. In neovascular AMD, a switch between ranibizumab and bevacizumab can be considered as a further therapy option if poor treatment effect is seen with the initial therapy.

Subconjunctival bevacizumab in the impending recurrent pterygia

The aim of this study is to evaluate the efficacy and safety of subconjunctival bevacizumab injection(s) in the treatment of impending recurrent pterygia. Twenty-three eyes of 23 patients who developed impending recurrence after pterygium surgery with conjunctival autografting and were treated with subconjunctival bevacizumab injection(s) (2.5xa0mg/0.1xa0mL) were included in the study. Anterior segment photographs were taken prior to and at 1xa0week, 1, 3 and 6xa0months after the injection, and at the end of the follow-up period. Image analysis was performed using an image processing and analysis software program. Recurrence rate and complications were recorded. The mean age and follow-up time of the patients were 51.2xa0±xa06.2 (31–60xa0years) and 16.8xa0±xa03.1 (12–22xa0months), respectively. The average number of injections was 2xa0±xa00.78 (1–3). Sixteen eyes required re-injection (two injections in nine eyes, three injections in seven eyes), due to progression of vascularization. There were significant differences between size percentage of lesions before injection and at 1xa0week, 1, 3 and 6xa0months after the injection (pxa0<xa00.05 for all). Corneal recurrence developed in only one patient and no ocular or systemic side-effects of bevacizumab were observed. Repeated injections of bevacizumab may help to prevent the high recurrence rate of residual impending pterygium, due to its adjuvant role in decreasing lesion size, especially in the first year after surgery.

Evaluation of choroidal thickness using spectral-domain optical coherence tomography in patients with migraine: a comparative study.

Purpose To assess choroidal thickness in patients with migraine and compare them with healthy controls, using spectral-domain optical coherence tomography (OCT). Methods In this prospective case-control study, choroidal thicknesses of 20 newly diagnosed migraine patients and 20 age- and sex-matched healthy subjects were measured using a high-speed, high-resolution frequency domain (FD) OCT device (λ = 840 nm, 26.000 A-scans/s, 5 µm axial resolution). All patients underwent a complete ophthalmic examination before the measurements. OCT measurements were taken at the same time of day (9:00 AM), in order to minimize the effects of diurnal variation. Results There was a statistically significant difference in median choroidal thickness between the migraine patients (277.00 [interquartile range (IQR) 85.75] µm) and controls (301.00 [IQR 90.50] µm) (p = 0.012). There were significant differences at all measurement points (p<0.05 for all). Conclusions The decreased choroidal thickness of patients with migraine might be related to the vascular pathology of the disease. Further studies are needed to evaluate the etiopathologic relationship between choroidal thickness and migraine.

The effect of caffeine on choroidal thickness in young healthy subjects

Abstract Background: To investigate the effect of oral caffeine intake on choroidal thickness using optical coherence tomography (OCT). Methods: Eighteen otherwise healthy caffeine users and 18 controls were enrolled. All participants underwent OCT scanning with high-speed and resolution spectral-domain OCT device (3D OCT 2000, Topcon, Japan) at baseline, and 1 and 3u2009h following 200-mg oral caffeine intake in the study and after oral placebo in the control group. The measurements were taken in the morning (10–12 am) to avoid diurnal fluctuation. Results: The median choroidal thickness at the fovea prior to oral caffeine intake was 337.00 (IQR 83.75) μm, which decreased to 311.00 (IQR 79.25) μm at 1u2009h and 311.00 (IQR 75.00) μm at 3u2009h following oral caffeine intake (pu2009=u20090.001, 0.002, respectively). The median choroidal thickness was also significantly decreased following oral caffeine intake at other five extrafoveal points (pu2009<u20090.05 for all). The difference in choroidal thickness was not statistically significant between 1 and 3u2009h of caffeine intake at all six points. In the control group, the median baseline choroidal thickness at the fovea was 330.00 (IQR 88.75) μm, which was 330.50 (IQR 80.75) μm at 1u2009h and 330.50 (IQR 90.75) μm at 3u2009h (pu2009=u20090.552, 0.704, respectively). Conclusions: Caffeine causes a significant decrease in choroidal thickness following oral intake. This decrease might be a result of reduced ocular blood flow due to its vasoconstrictive effect.

Choroidal thickness changes in patients with pseudoexfoliation syndrome.

To evaluate the choroidal thickness using spectral-domain optical coherence tomography (OCT) in patients with pseudoexfoliation syndrome (PXS) and to compare them with healthy controls. This observational comparative study consisted of 35 PXS patients and 35 age- and sex-matched control cases. The control cases had neither systemic nor ocular disease. All 70 patients underwent a complete ophthalmic examination as well as choroidal thickness measurement using a high speed and high resolution SD-OCT device (Topcon 3D OCT-2000, Japan). There was no significant difference with respect to mean refractive error and intraocular pressure measurement between patients with PXS and controls (pxa0=xa00.237 and 0.433, respectively). The mean choroidal thickness was found as 206.6xa0±xa037.6xa0µm in the PXS group and 215.9xa0±xa047.3xa0µm in controls, respectively. The mean choroidal thickness was not significant between the PXS patients and the control cases (pxa0=xa00.362). Although PXS patients had lower mean choroidal thickness than controls, our results did not reach any statistical significance.

Vascularization of conjunctival autografts in pterygium surgery: comparison of fibrin glue with sutures.

Purpose To monitor the development of graft vascularization after pterygium excision with conjunctival autograft transplantation (CAT) using indocyanine green angiography (ICGA) and to compare the graft vascularization between 2 different fixation techniques (fibrin glue and sutures). Methods A total of 26 eyes of 26 patients with primary pterygium were randomly assigned after pterygium excision as having either fibrin glue (13 eyes) or Vicryl sutures (13 eyes) for CAT. Anterior segment ICGA findings were evaluated postoperatively at 1, 7, and 15 days and the percentages of graft vascularization in both groups were compared using pixel analysis software program. Results The mean ± SD age of patients in the suture and fibrin glue groups was 52.1 ± 12.7 years and 57.1 ± 9.82 years, respectively. There was no statistically significant difference between the groups regarding age, sex, or follow-up (p<0.05 for all). Also, the mean intraoperative defect size was not significantly different between the groups, which was measured as 20.11 ± 10.44 mm2 in the suture group and 23.44 ± 12.34 mm2 in the fibrin glue group (p = 0.343). The mean percentage of vascularized graft area at postoperative day 1 and 7 was 18.1 ± 7.8% and 25.3 ± 8.6% in the suture group and 34.8 ± 10.2% and 66.1 ± 17.8% in the fibrin glue group. The difference between the groups was statistically significant (p<0.01 for both). At postoperative day 15, all grafts were 100% perfused in both groups. Conclusions Fibrin glue fixation of conjunctival autografts led to more vascularization in the early postoperative period than suture fixated grafts, which in turn may have significance in terms of graft health and pterygium recurrence.