Dilek Dursun Altinors

Comparison of conjunctival autograft with amniotic membrane transplantation for pterygium surgery: surgical and cosmetic outcome.

Purpose: To compare the clinical results of conjunctival autograft and amniotic membrane transplantation (AMT) for primary and recurrent pterygium excision. In an effort to determine whether AMT yields acceptable cosmetic results as conjunctival autografting in pterygium surgery, we compared the final cosmetic outcomes of these 2 techniques. Methods: We performed a prospective, randomized clinical study of 78 eyes (78 patients) divided into 2 groups. Forty eyes (28 with primary and 12 with recurrent pterygia) received conjunctival limbal autograft (group 1), and 38 eyes (27 with primary and 11 with recurrent pterygia) received AMT (group 2) after extensive removal of pterygium. Mean follow-up time was 16.6 ± 3.52 months in group 1 and 13.4 ± 2.08 months in group 2. The results were evaluated by clinical examination and photographing and final appearances were graded from 1 to 4. Grade 4 represented true recurrence, whereas grade 3 indicated unacceptable cosmetic appearance. Results: Recurrence rates of primary, recurrent, and all pterygia in group 1 and group 2 were 3.6%, 16.7%, and 7.5% and 3.7%, 18.2%, and 7.9%, respectively. There was no significant difference in recurrence rates between the 2 groups (P = 1.00 for all). The rates of final appearance as grade 3 were 10.0% in group 1 and 21.1% in group 2, and the difference was statistically significant (P = 0.048). No major complications occurred during the follow-up period. Conclusions: Although better results in the final appearance were achieved using conjunctival autografting than with AMT, AMT can be a useful alternative in pterygium surgery, especially in those patients who may have a limited amount of conjunctiva for future surgeries.

Conjunctival impression cytology, ocular surface, and tear-film changes in patients treated with systemic isotretinoin.

Purpose: To evaluate the ocular surface changes and tear-film functions in patients treated with systemic isotretinoin. Methods: Fifty subjects treated with 0.8 mg/kg oral isotretinoin were enrolled in this prospective clinical trial. All patients underwent a full ophthalmoscopic examination before, during, and after treatment with isotretinoin. Ocular surface changes of the cell content of the surface conjunctival epithelium were evaluated by conjunctival impression cytology and tear-film functions using the Schirmer test, anesthetized Schirmer test, tear breakup time, and rose bengal staining. Subjective ocular complaints were scored with an Ocular Surface Disease Index questionnaire. Results: There were no significant differences observed in average Schirmer test scores for patients before, during, or after isotretinoin treatment. Mean anesthetized Schirmer test scores and tear breakup time decreased significantly during treatment (P < 0.001). Mean impression cytology scores, Ocular Surface Disease Index scores, and rose bengal staining scores increased significantly during treatment (P < 0.05, P < 0.001 and P < 0.001, respectively). Blepharitis was seen in 36% of patients. All abnormal findings disappeared 1 month after the cessation of treatment. Conclusions: Conjunctival epithelial cells, tear basal secretion, and tear quality are markedly affected in patients during systemic treatment with isotretinoin (0.8 mg/kg). Ocular adverse effects of isotretinoin are generally not serious and are reversible after discontinuation.

Evaluation of Ocular Surface Changes in a Rabbit Dry Eye Model Using a Modified Impression Cytology Technique

Purpose: To evaluate the ocular surface changes in a rabbit dry eye model by using a modified impression cytology technique. Methods: Nitrocellulose filter paper with a pore diameter of 0.45 μ m was used to collect the specimens from 12 rabbits that were injected with atropine every day for 3 days. Filter papers were kept in distilled water overnight and then dried to increase cell pickup. Samples were stained with periodic acid–Schiff. The mean temporal and superior bulbar conjunctival goblet cell densities were counted. The data were compared with transmission (ocular surface) and scanning electron microscopic (filter paper) examination of the ocular surface. Results: In the acute stage of atropine injection, there was not a major change in the goblet cell count. Although the goblet cell distribution was variable over the ocular surface, the average cell density was 55.4 ± 22 in the superior quadrant and 69.2 ± 9 in the temporal quadrant. In the 3-day atropine-injection group, there was a marked decrease in goblet cells, and there was mucin accumulation rather than accumulation of the goblet cells. No morphologic differences could be observed with scanning electron microscopy between the regular nitrocellulose filter paper and the paper kept in distilled water. Conclusions: The findings indicate that keeping the filter paper in distilled water and then drying it improves cell pickup and ocular surface evaluation in rabbits.

Severe corneal changes following intravitreal injection of bevacizumab.

Purpose: To report a series of severe corneal changes following intravitreal injection of bevacizumab (Avastin) for age-related macular degeneration. Design: Retrospective noncomparative case series. Methods: The authors retrospectively reviewed the corneal changes that developed after the procedure in 1200 (460 patients) intravitreal injections of bevacizumab. Results: Five significant corneal changes (1.1%) occurred in these patients within the 1st postinjection week. The severe corneal changes included corneal infiltrative keratitis (n = 2) and corneal stromal edema and descemet folds (n = 3). The findings depended on clinical examination and biomicroscopic and confocal evaluation. In terms of causality assessment, no rechallenge was possible. The appropriate treatment was applied and recovery was achieved in all patients during the follow-up period. Conclusions: Intravitreal injection of bevacizumab may cause corneal changes. The safety and effects of bevacizumab on the cornea should be evaluated in detail.

A silicone hydrogel contact lens after 7 years of continuous wear

PURPOSE To report an unusual case with a bandage silicone hydrogel lens that was applied over cyanoacrylate glue application for corneal perforation. DESIGN Retrospective, interventional case report. METHODS A 67-year-old woman with a history of corneal trauma experienced spontaneous corneal perforation in her left eye. Upon arrival, her anterior chamber was flat and Seidel test was positive. After initial treatment with cyanoacrylate adhesive and a bandage silicone hydrogel contact lens, there was no leakage and the anterior chamber was formed at the follow-up period. She was started topical antibiotics. RESULTS After 7 years, she came back with the complaint of permanent redness in her left eye with the same silicone hydrogel lens in her eye. CONCLUSIONS Corneal healing may occur under cyanoacrylate adhesive glue with therapeutic contact lenses and with proper antibiotic application. Silicone hydrogel contact lenses exhibit good efficacy and safety when utilized as a continuous wear therapeutic lens with antibiotics.

Human Breast Milk Drops Promote Corneal Epithelial Wound Healing

ABSTRACT Purpose: To investigate the effects of human breast milk on corneal epithelial wound healing. Methods: The effects of human breast milk on epithelial healing is compared with autologous serum and artificial tears on 24 female Bal-b/C mice. A central corneal epithelial defect was created using a 2 mm trephine. Four groups were formed. By a random pick-up, topical human breast milk 4 × 1 was given to Group 1, topical mouse autologous serum 4 × 1 was applied to Group 2, and preservative-free artificial tears 4 × 1 was applied to Group 3.Group 4 was evaluated as control. Biomicroscopical examination was performed on days 1, 2, and 3. Mice were sacrificed on the third day. Histopathological and electron microscopic examinations were performed as well. Results: The fastest and best healing group was Group 1, followed by Group 2. Re-epithelization was not complete even at the end of the second day in groups 3 and 4. Conclusions: The rich content of human breast milk may be an alternative to epithelial healers and artificial tears.

Effect of dry eye on Scheimpflug imaging of the cornea and elevation data

OBJECTIVE To evaluate the effect of dry eye on Scheimpflug imaging of the cornea and elevation data. DESIGN Prospective observational study. PARTICIPANTS Scheimpflug images of 50 patients with dry eye who were being tested for eligibility for corneal refractive surgery were screened. Twelve eyes of 12 patients with abnormal Belin/Ambrosio enhanced ectasia display (BAD) anterior elevation difference were included in the study. The patients had no history of contact lens wear or any other sign of ectasia. METHODS Peak central corneal densitometry value, corneal volume, pachymetry at the thinnest point, and BAD anterior elevation difference value at the centre of the 9 mm zone were recorded before and after 4 weeks of dry eye treatment. Measurements were compared with the Wilcoxon signed rank test. RESULTS The mean corneal peak densitometry and volume were similar before and after therapy (p = 0.465 and p = 0.441, respectively). The mean anterior elevation difference value at the centre of the 9 mm zone before treatment (6.67 ± 1.72 µm) was significantly higher than the mean post-treatment value (4.00 ± 1.48 µm) (p = 0.002). The mean pachymetry at the thinnest location after treatment (548 ± 11.0) was significantly higher than the pretreatment value (538 ± 8.5) (p = 0.027). CONCLUSIONS BAD anterior elevation differences and pachymetric measurements may be affected by ocular surface or tear film abnormalities associated with dry eye disease. Repeated evaluations after treatment may reveal normal results.

Effect of dexamethasone intravitreal implant in a corneal graft rejection.

Department of Cornea, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA 2Ankara Training and Research Hospital, Ankara 06340, Turkey Baskent University Hospital, Ankara 06490, Turkey Correspondence to: Nilufer Yesilirmak. Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17 St., Miami, Florida 33136, USA. nxy28@med.miami.edu Received: 2015-02-10 Accepted: 2015-06-16

Surgical Treatment of A Superiorly Located Pellucid Marginal Degeneration Associated With Cataract: Case Report

ripheral cornea causing corneal thinning, generally located at the inferior quadrants of the cornea. However the involvement can rarely include superior, temporal and nasal sides of the cornea.1 It can be associated with atopic dermatitis and keratoconjunctivitis.2 The disease generally occurs in the fourth or fifth decade and can cause irregular against-the rule astigmatism with crescent like thinning of the affected corneal zone.3 There are some methods described in the treatment of PMD such as contact lenses, which can be sometimes difficult to fit, or surgical treatments like lamellar

Descemetʼs Membrane Endothelial Keratoplasty (DMEK): 6-Month Clinical Outcomes

Introduction Our purpose was to report the clinical outcomes of Descemets membrane endothelial keratoplasty (DMEK), at the postoperative 6th month. Patients and Methods Patients who underwent DMEK at Baskent University Faculty of Medicine, Department of Ophthalmology, between 2016 and 2017 were included in the study. Patient demographics, etiology of endothelial dysfunction, best corrected visual acuity, central corneal thickness, graft survival, intraoperative and postoperative complications and postoperative interventions were recorded. Results Six eyes of 6 patients (4 female, 2 male) with a mean age of 53.4±12.7 were included. Etiology of endothelial dysfunction was corneal endothelial distrophy in 3 patients, pseudophakic bullous keratopathy in 2 patients and endothelial graft failure after previous penetrating keratoplasty in 1 patient. Pre-stripped descemet’s membranes obtained from the Ankara State Hospital Eye Bank were used. Mean preoperative Snellen best corrected visual acuity (BCVA) and central corneal thickness (CCT) were 0.24±0.15 and 625.5±97.4 &mgr;m. Mean BCVA increased to 0.67±0.26 (p=.02) in the first month and to 0.84±0.11 (p<.01) at the end of the follow up. Mean CCT decreased to 546.6±28.4 &mgr;m (p=.03). Graft detachment was observed in 2 cases on the first and third postoperative days and the grafts were reattached succesfully by injection of air into the anterior chamber. There were no intraoperative complications. Five corneas were clear at the end of the follow-up. One patient had a re-DMEK and a following penetrating keratoplasty. Conclusions DMEK provides a new and exciting option for endothelial transplantation and has the potential to become the primary procedure for surgical management of Fuchs’ endothelial dystrophy and corneal endothelial disease. Rapid visual rehabilitation with few and managable complications and good visual outcomes are the major advantages of this procedure.