Cem Ozgonul

The effect of bevacizumab on wound healing modulation in an experimental trabeculectomy model.

Abstract Purpose: Glaucoma filtration surgery remains the most effective surgical procedure for lowering intraocular pressure (IOP) in uncontrolled glaucoma. Modulation of wound healing is critical to ensure long-term surgical success. This study aimed to determine if bevacizumab is an alternative agent for wound modulation in glaucoma surgery. Materials and methods: Forty-eight eyes of New Zealand rabbits were divided into four groups undergoing standard trabeculectomy surgery in the right eye. In group 1, balanced salt solution injections (0.1 ml) were performed into the bleb. Bevacizumab (0.1 ml, 1.25 mg) was injected into the bleb in group two and into the vitreous body in group three. Subconjunctival injections of 5-fluorouracil (5-FU) were performed into the non-bleb area in group four. Postoperatively; IOP, bleb size, bleb height, bleb vascularity were evaluated. Right eyes of two animals from each group were enucleated in 10th, 20th and 30th d postoperatively and evaluated histopathologically for inflammation, neovascularization and fibrosis. Results: The length, the width and the height of the bleb in the group two were greater than other groups. Mean IOP values were lower in group two. IOP measurements in the operated eyes of group two were statistically significantly lower than the other groups until the 28th d. Inflammation (p = 0.030), neovascularization (p = 0.004) and fibrosis (p < 0.000) in group two were lower in histopathological evaluation. Conclusions: Post-operative subconjunctival injection of bevacizumab is more effective than intravitreal bevacizumab or subconjunctival 5-FU injections for bleb survival. Furthermore, IOP is lower for a long period with lower level of fibrosis, which increases the success of trabeculectomy.

A comparison of anchored conjunctival rotation flap and conjunctival autograft techniques in pterygium surgery

Purpose: To compare conjunctival autograft and anchored conjunctival rotation flap techniques, in terms of recurrence and complication rates, after performing a primary pterygium surgery. Methods: Sixty patients who underwent pterygium surgery, which was performed on 1 eye (M:F = 25:35), either using conjunctival autograft (25 eyes) or anchored conjunctival rotation flap (35 eyes) techniques, were followed up postoperatively for a minimum period of 18 months. The anchored conjunctival rotation flap surgery was conducted by designing a conjunctival flap with a similar shape as that of the autograft, but with the preservation of the inferior limbal anchoring point (1 mm) by the incomplete cutting of the limbal area. After rotation of the flap around the anchoring point, the flap was tightened with sutures to cover the bare scleral area. Early postoperative complications, such as flap or graft edema and granuloma formation, were assessed. The recurrence rate of pterygium was evaluated, and a comparison was made between the 2 surgical techniques. Results: The recurrence rate was 8.0% in the conjunctival autograft group and 8.6% in the anchored conjunctival rotational flap group (P = 0.659). However, the occurrence of flap or graft edema was lower for anchored conjunctival rotational flap surgery (14.3% vs. 72.0%, P < 0.001). No granuloma formation was observed in either group. Conclusions: The anchored conjunctival rotational flap surgery showed similar pterygium recurrence rates and a lower incidence of flap edema, while enabling simple recognition of flap orientation, compared with the conjunctival autograft technique.

Post-Traumatic Endophthalmitis: A Mini-Review

Abstract Post-traumatic endophthalmitis comprises 25–30% of all endophthalmitis cases. Post-traumatic endophthalmitis is an important clinical condition that may have serious anatomical and functional consequences. The type of pathogenic microorganism, nature of the injury, the presence of a foreign body, and the geographical region in which the trauma occurred are all important factors influencing both treatment and prognosis. Unlike postoperative endophthalmitis, there is not a confirmed treatment protocol recommended by the Endophthalmitis-Vitrectomy Study Group in traumatic cases. In this study, we examine the incidence, risk factors, diagnosis, microbiological features, and treatment principles of post-traumatic endophthalmitis in order to guide clinicians who often encounter eye trauma related to this potential complication.

Recent Developments in the Diagnosis and Treatment of Ocular Toxoplasmosis.

Ocular toxoplasmosis, a chorioretinal infection with Toxoplasma gondii, is the most common etiology of posterior uveitis in many countries. Accurate diagnosis depends heavily on the characteristic clinical features of this disease, but atypical presentations, especially in immunocompromised patients, may create diagnostic challenges and lead to misdiagnosis and inappropriate treatment. Molecular biology techniques to diagnose ocular toxoplasmosis have been available for many years and are now accessible as standard laboratory tests in many countries. Aqueous humor or vitreous evaluation to detect parasite DNA by polymerase chain reaction or specific antibody may provide definitive evidence for rapid diagnosis. Oral pyrimethamine and sulfadiazine plus systemic corticosteroids are an effective therapy for ocular toxoplasmosis. Recent data supports the use of other treatment approaches, including intravitreal antibiotics. The aim of the present review is to discuss briefly the new diagnostic tools and treatment options for ocular toxoplasmosis.

Prediction of Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma by Using Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio.

ABSTRACT Purpose: To assess the levels of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in patients with pseudoexfoliation syndrome (PEX) and to compare the NLR and PLR results of patients with PEX, PEX glaucoma (PXG), and healthy controls. Methods: In total, 34 patients with PEX, 29 patients with PXG, and 42 healthy subjects were enrolled in this retrospective study. Complete ophthalmologic examination and complete blood count measurements were performed of all subjects. Complete blood counts were performed within 2 h of blood collection. Results: There was a significant difference in NLR between PEX and control groups (p = 0.012) and PXG and control groups (p = 0.003). Also, a significant difference was found in PLR values between control and PXG groups (p = 0.024). Conclusions: Our study for the first time provides evidence that PLR and NLR may be useful for predicting the prognosis of PEX patients and progression to PXG.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Novel Biomarkers of Primary Open-Angle Glaucoma.

Purpose:We aimed to assess the levels of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with primary open-angle glaucoma (POAG) and to compare the NLR and PLR results of patients with POAG and ocular hypertension, as well as in healthy controls. Patients and Methods:Eighty-four patients with POAG, 94 patients with ocular hypertension, and 80 healthy subjects were enrolled in this retrospective study. Complete ophthalmological examination and complete blood count measurements were performed for all subjects. Results:There was a significant difference in the NLR (P=0.003) and PLR (P=0.049) between POAG and control groups. In addition, there was a correlation between pattern standard deviation and NLR in the POAG group. The receiver operating characteristics analysis revealed that the value of NLR to distinguish patients with POAG and controls was found to be 0.651. The best cutoff value was 2.1, with a sensitivity of 65% and a specificity of 65%. Conclusions:Our study for the first time provides evidence that NLR and PLR may be useful as biomarkers in patients with POAG.

Novel Classification System For Combined Hamartoma Of The Retina And Retinal Pigment Epithelium

Purpose: To develop an anatomical classification scheme for combined hamartoma of the retina and retinal pigment epithelium (RPE) and specify recommendations for follow-up interval. Methods: Retrospective review of patients with combined hamartoma of the retina and RPE examined during a 7-year period (2008–2015). The clinical presentation, fundus examination, and optical coherence tomography were analyzed. Results: Lesions were classified based on location, fundus features, and optical coherence tomography findings. Lesion location: macular/peripapillary—Zone 1; mid-periphery—Zone 2; and far periphery—Zone 3. Associated fundus findings: no retinal traction—Stage 1; retinal traction and/or retinoschisis—Stage 2; and retinal detachment—Stage 3. Optical coherence tomography findings: epiretinal component only—A; partial retinal involvement—B; and complete retinal and RPE involvement—C. Complete ophthalmologic evaluation is recommended at least every 6 months for patients younger than 12 years, with more frequent follow-up in patients with: lesions in the macula/peripapillary (Zone 1) or with retinal traction, retinoschisis, or retinal detachment (Stage 2 and 3). Surgical intervention is recommended in patients with vision loss secondary to macular traction or retinal detachment. Conclusion: A new clinical classification system is proposed for evaluating and managing patients with combined hamartoma of the retina and RPE. The zone and stage of combined hamartoma of the retina and RPE lesion will assist in determining follow-up interval and surgical intervention. Application of a uniform classification scheme will facilitate assessment and comparison of findings across different studies.

The Use of Integra® Dermal Regeneration Template for the Orbital Exenteration Socket: A Novel Technique.

PURPOSE Integra® dermal regeneration template is a bilayer membrane system that acts as a scaffold for regenerating dermal skin cells. It is used for wound reconstruction following burns, extensive injuries, and a large tumor excision in multiple parts of the body. The dermal layer is made of porous matrix of bovine tendon collagen and glycosaminoglycan. The epidermal layer is made of polysiloxane layer. In this study, the authors evaluated the use of Integra® dermal regeneration template for the immediate reconstruction of the orbital exenteration socket. METHODS Five patients who underwent exenteration and immediate reconstruction of the socket with Integra® dermal regeneration template were included in this study. Demographic and clinical features, healing time, complications, and follow-up time were recorded. RESULTS The study included 4 male patients and 1 female patient with a mean age of 74 years (range, 49-87 years). The primary diagnoses were orbital extension of conjunctival melanoma in 2 patients, squamous cell carcinoma in 1 patient, and uveal melanoma in 1 patient, and aggressive orbital Wegener granulomatosis in 1 patient. There was no postoperative infection, necrosis, hematoma, or fluid accumulation in any patients. The mean postoperative follow-up period was 20 months (range, 11-42 months). The sockets were completely granulated by 4 weeks, and epithelized, getting ready for the prosthesis in 8 weeks. CONCLUSIONS Integra® dermal regeneration template can be used for the immediate reconstruction of the socket following exenteration. It is easy to use, and provides a short healing time without any need for any additional reconstructive procedures.

Evaluation of retinal nerve fiber layer thickness and choroidal thickness in pseudoexfoliative glaucoma and pseudoexfoliative syndrome.

ABSTRACT Objectives: To compare retinal nerve fiber layer thickness (RNFLT) and choroidal thickness (ChT) measurements in eyes with pseudoexfoliative (PEX) glaucoma, PEX syndrome and healthy control eyes. Methods: Eighteen patients with PEX glaucoma in one eye and PEX syndrome in the fellow eye were included. The right eyes of thirty-nine age- and sex-matched healthy subjects were included as control group. All participants underwent a detailed biomicroscopic and funduscopic examination. RNFLT and ChT measurements were performed with a commercially available spectral-domain optical coherence tomography (SD-OCT). ChT measurements were performed by using enhanced depth imaging (EDI) mode. Patients with PEX underwent diurnal IOP measurements with 4-hour intervals before inclusion in the study. RNFLT results included the average measurement and 6 quadrants (temporal, inferotemporal, inferonasal, nasal, superonasal and supero-temporal). ChT measurements were performed in the subfoveal region and around the fovea (500µm and 1500 µm nasal and temporal to the fovea), as well as around the optic disc (average peripapillary and eight quadrants in the peripapillary region (temporal, inferotemporal, inferior, inferonasal, nasal, superonasal, superior, supero-temporal)). Results: RNFLT in all quadrants and average thickness were significantly lower in PEX glaucoma eyes compared to PEX syndrome eyes and healthy control eyes (p<0.001 for both). RNFLT comparisons between PEX syndrome and healthy control eyes did not show a significant difference (p>0.05) except the inferotemporal quadrant. ChT measurements were similar between groups (p>0.05). Conclusions: Thinning of the RNFL in association with unchanged ChT may mean that the presence of PEX material is a much more significant risk factor than choroidal changes in the progression of PEX syndrome to PEX glaucoma.

Is there a relationship between outer retinal destruction and choroidal changes in cone dystrophy

Purpose: The aim of the present study was to use enhanced depth imaging optical coherence tomography (EDI-OCT) to investigate choroidal changes in patients with cone dystrophy (CD) and to correlate these findings with clinical and electroretinography (ERG) findings. Methods: This case-control study included 40 eyes of 20 patients with CD and 40 eyes of 40 age- and refraction-matched healthy individuals. Choroidal thickness (CT) measurements were obtained under the foveal center and at 500 and 1,500 μm from the nasal and temporal regions to the center of the fovea, respectively. EDI-OCT and ERG data were analyzed, and the correlations of CT with the best-corrected visual acuity (BCVA) and the central foveal thickness (CFT) were evaluated. Results: The mean subfoveal CTs in the CD and control groups were 240.70 ± 70.78 and 356.18 ± 48.55 μm, respectively. The subfoveal CT was significantly thinner in patients with CD than in the controls (p<0.001). The patients with CD also had significantly thinner choroids than the controls at each measurement location relative to the fovea (p<0.001). The subfoveal CT in the CD group correlated with CFT (p=0.012), but no significant correlation was found between the subfoveal CT and BCVA or photopic ERG responses. Conclusions: The present study demonstrated a significant thinning of the choroid in patients with CD. EDI-OCT is a useful technique for describing the choroidal changes occurring in CD. Future studies investigating the association between choroidal changes and outer retinal destruction or the disease stage may provide a better understanding of the pathophysiology of CD.