Emre Ayintap

Central retinal artery occlusion secondary to orbital cellulitis and abscess following dacryocystitis.

Purpose To report a case of dacryocystitis that progressed to orbital abscess resulting in the rare complication of central retinal artery occlusion. Methods A patient without any other known health problems presented with dacryocystitis complicated by orbital cellulitis, orbital abscess, and finally central retinal artery occlusion despite medical treatment. Results After 48 hours of medical treatment, there was no recovery, and there was loss of light perception; because of this, surgery indication was determined. Fundus fluorescein angiogram demonstrated findings of central retinal artery occlusion. There was no recovery of light perception after surgical intervention. Conclusions We report a case of orbital abscess following dacryocystitis in a healthy middle-aged woman resulting in the rare complication of central retinal artery occlusion. To our knowledge, this is the first report of central retinal artery occlusion secondary to orbital abscess following dacryocystitis.

Repeated bevacizumab injections versus mitomycin C in rotational conjunctival flap for prevention of pterygium recurrence

Aims: To evaluate the efficacy of repeated bevacizumab injection in rotational conjunctival flap surgery versus rotational conjunctival flap with adjunctive mitomycin C (MMC) or rotational conjunctival flap alone. Materials and Methods: Ninety eyes of 90 patients who underwent primary pterygium surgery with rotational flap were evaluated. Patients were randomly assigned to undergo conjunctival rotational flap alone (Group A) or conjunctival rotational flap with either 0.02% MMC application (Group B) or adjunctive subconjunctival 2.5 mg/0.1 ml bevacizumab injection (Group C). Each group consisted of 30 eyes. Recurrence rates at 9 months were evaluated. Results: There were no statistically significant differences in mean size of the pterygium across the limbus in terms of length (P > 0.5). The recurrence rates at 9 months were 26.6% (n = 8) in Group A, 13.3% (n = 4) in Group B, and 10% (n = 3) in Group C. The recurrence rates in Group B and C were significantly lower than in Group A (P =0.1806). The recurrence rates were similar in Group B and C (P > 0.05). Conclusions: Subconjunctival bevacizumab injection may decrease the recurrence rate of primary pterygium surgery with rotational conjunctival flap. Further studies with a larger population and longer follow-up period are needed to supplement this study.

Intravitreal bevacizumab may increase diabetic macular edema in eyes with attached posterior vitreous.

Purpose: To report 2 eyes of a patient which developed vitreomacular traction (VMT)1 month after intravitreal bevacizumab (IVB) injection. Materials and Methods: A 45-year-old female with bilateral diffuse diabetic macular edema (DME) received bilateral IVB. Results: Her initial visual acuity (VA) was 0.15 and 0.2 in OD and OS, respectively. Central foveal thickness (CFT) was 568 and 662 µm in OD and OS, respectively, without any sign of VMT. Both eyes responded well initially but developed VMT at 1 month. This time, intravitreal triamcinolone (IVTA) injection was performed. One month after IVTA injection, VMT was released and CFT decreased to 163 and 181 µm in OD and OS, respectively. Six months after IVTA injection, CFT was 163 and 153 µm, and VA was 0.7 and 0.9 in OD and OS, respectively. Conclusion: In eyes with DME and attached posterior vitreous, VMT may develop after IVB injection and increase edema. IVTA injection might be an option to release VMT before considering vitrectomy.

Repair of Iridodialysis Using 8-0 Polypropylene

Abstract Purpose: Investigate the effectiveness of repair of iridodialysis with 8-0 polypropylene. Methods: We present four cases of traumatic iridodialysis that were repaired by 8-0 polypropylene suture. Results: Better iris reposition and stability were achieved with 8-0 polypropylene suture despite wide degree traumatic iridodialysis in all patients. Conclusion: In this study, we used 8-0 polypropylene suture, which is thicker, cheaper, and more durable than 10-0 sutures. We suggest that usage of 8-0 polypropylene sutures may provide better iris repositioning.

Analysis of Age as a Possible Prognostic Factor for Transcanalicular Multidiode Laser Dacryocystorhinostomy

Purpose. To assess the prognostic value of age on the outcome of transcanalicular multidiode laser dacryocystorhinostomy (TCL-DCR) in patients with acquired nasolacrimal duct obstruction (NLDO). Methods. The medical records of TCL-DCR performed between March 2009 and September 2013 were reviewed retrospectively. Inclusion criteria include over 20 years of age, similar mean follow-up period, and similar mean duration of stenting. The main outcome is surgical success. The effect of age on success rate is also evaluated. Results. The anatomical success was 52% in Group 1 (20–30 years), 56% in Group 2 (31–40 years), 64% in Group 3 (41–50 years), 76% in Group 4 (51–60 years), and 88% in Group 5 (over 60 years). The statistical difference among Group 1 and Group 5, in terms of surgical success rate, was found to be significant (P = 0.009). Additionally, the 20–30-year-old patients had a failure rate 6.76 times higher than that of the over-60-year-old patients (P = 0.009; 95% CI, 1.605–28.542). Conclusion. TCL-DCR is a surgical treatment option for NLDO for which a skin incision can be avoided. The success rate of TCL-DCR for younger population is lower when compared with elderly population.

Dual Approach Using Vitrectorhexis Combined with Anterior Vitrectomy in Pediatric Cataract Surgery

Purpose. To evaluate efficacy and safety of vitrectorhexis method for both anterior and posterior capsules combined with anterior vitrectomy in children with cataract. Methods. A retrospective chart review was performed for 19 children with cataract operated at a tertiary referral center. Dual approach including anterior and posterior segments was used during the surgery in terms of capsulotomy, intraocular lens (IOL) implantation, and anterior vitrectomy. Results. A total of 23 eyes of 19 patients were enrolled in the study. The mean age of the children was 39.4 ± 2.2 months (5–78). The mean postoperative followup duration was 20.6 ± 7.8 months (3–32). Intraoperative tear was observed only in one of 23 (4.3%) eyes during anterior capsulotomy. All of the patients had a clear visual axis and showed no IOL decentration. Conclusions. Dual approach using vitrectorhexis and anterior vitrectomy is an easy-to-perform technique that seems safe and effective in the short term for younger children.

Comparison of revision surgeries with transcanalicular diode laser and external approaches in cases with failed transcanalicular diode laser dacryocystorhinostomy.

Purpose: To compare the success rates of revision surgeries with transcanalicular diode laser (TCDL) and external approaches in cases with failed TCDL dacryocystorhinostomy (DCR). Methods: The medical records of the consecutive TCDL DCR surgeries performed for nasolacrimal duct obstruction between October 2009 and March 2013 were reviewed. Cases with the presence of canalicular stenosis, bone deformities, lacrimal sac neoplasms, additional intranasal deformities, dacryolithiasis, history of previous nasolacrimal surgery, and follow up less than 3 months were excluded from the study. Patency to irrigation was obtained in all patients during surgery. Patients with surgical failure during the follow-up period underwent external DCR or TCDL DCR for revision. Data regarding surgical outcomes after primary surgeries and revision surgeries were analyzed. Results: One hundred seventy-six primary TCDL DCR surgeries were performed on 162 patients. Forty-four (25.0%) surgeries considered failure during follow up. Four patients had canalicular obstruction and were excluded from study. Six patients declined a second intervention. Eighteen patients underwent external DCR and 16 patients underwent repeated TCDL DCR for revision. Success rates of revision surgeries were 94.4% (17/18) with external DCR and 43.8% (7/16) with TCDL DCR. The difference was statistically significant (p = 0.002). Conclusions: Revisions with external DCR are recommended for failed TCDL DCR. Revision TCDL DCR should be performed only in patients avoiding facial incision and preferring incision-sparing surgical techniques for revision.

[Dynamic Contour Tonometry and Goldmann Applanation Tonometry: Difference of Intraocular Pressure Values Between Eyes with and without Glaucomatous Damage in Thin Corneas].

BACKGROUND To examine the differences in intraocular pressure (IOP) measurements obtained with Goldmann applanation tonometry (GAT) and Pascal dynamic contour tonometry (DCT) in subjects with thin corneas and to correlate these with structural and functional parameters of glaucoma damage. PATIENTS AND METHODS One hundred and thirty participants (130 eyes) with central corneal thickness lower than 500 µm were included in five groups in this cross-sectional observational study: 52 eyes with primary open angle glaucoma (POAG), 19 eyes with normal tension glaucoma (NTG), 27 eyes with ocular hypertension (OHT), 21 participants suspected of having glaucoma (GS), and 11 healthy subjects. The measurements were obtained with GAT and DCT in a masked fashion. The corrected GAT-IOP for central corneal thickness (CCT), the difference between DCT and GAT (ΔIOP = DCT-GAT) and corrected ΔIOP (corrected ΔIOP = DCT-corrected GAT) were calculated. Age, mean deviation (MD) from the most recent reliable visual field examination, average retinal nerve fibre layer thickness (RNFL), cup-to-disc ratio (CDR), ocular pulse amplitude (OPA), and treatment status were recorded for statistical analysis. RESULTS In all of the subjects (n = 130), the mean DCT, GAT and corrected GAT values were 17.6 ± 3.4 mmHg, 13.2 ± 3.8 mmHg, and 15.5 ± 2.1 mmHg, respectively. ΔIOP and corrected ΔIOP were 4.4 ± 2 mmHg and 1.7 ± 2 mmHg, respectively. ΔIOP was correlated negatively with MD (rs = -0.32, p < 0.0001) and average RNFL thickness (r = -0.46, p < 0.0001) and positively with CDR (rs = 0.50, p < 0.0001). The mean IOP measured by GAT differed statistically significantly between eyes with glaucoma (n = 71, POAG and NTG) and eyes without damage (n = 59; OHT, GS, and healthy) (p < 0.0001), whereas the mean IOP by DCT did not (p = 0.935). The mean ΔIOP values were also statistically significantly higher in the glaucomatous group, with and without correction for CCT (p < 0.001). OPA and glaucoma diagnoses statistically significantly predicted ΔIOP (R(2) = 0.41, F2.127 = 47.46, p < 0.0001). CONCLUSION Greater underestimation of IOP by GAT was observed in the glaucomatous eyes with thin corneas. Performing DCT on patients with thin corneas might be advantageous in establishing the need for more aggressive treatment.

Effects of sub-Tenon’s anaesthesia on ocular hemodynamics

OBJECTIVE To research the effects of sub-Tenons anaesthesia (STA) on ocular hemodynamics in patients with cataract using colour Doppler imaging (CDI). DESIGN Prospective clinical study. PARTICIPANTS Thirty-four eyes of 34 patients with age-related cataract. METHODS Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) values of the ophthalmic artery (OA), central retinal artery, and central retinal vein were measured by CDI before and immediately after performing sub-Tenon block using 2 mL of 2% lidocaine with adrenaline (1:200 000). RESULTS Both PSV and EDV values were significantly decreased after sub-Tenon injection in all the studied vessels of the patients. However, no important changes were observed in the RI values of the vessels. CONCLUSIONS STA markedly reduced ocular blood flow. The reduction may be more acceptable compared with other retrobulbar block methods. Sub-Tenon block should be performed carefully to senile patients with cataract with vascular occlusive disorder.

Vacuum-assisted continuous circular capsulorhexis using bimanual irrigation and aspiration system of phaco machine in immature cataract.

Seventy-eight eye of 65 patients were enrolled in this retrospective clinical study. Two-side ports are made with a 23-gauge stiletto knife. The irrigation handpiece is introduced into the anterior chamber through one side port and 27-gauge cystotome is introduced through the other one. Anterior capsular flap is created with cystotome. The capsular flap is vacuumed with a 25-gauge visco elastics cannula, which connected to the phaco machine vacuum. The continuous circular capsulorhexis (CCC) is completed with the using bimanual irrigation and aspiration system of phaco machine. Vacuum-assisted CCC technique was used in 78 cases of uncomplicated immature senile cataracts. All cases were done under sub-Tenons anesthesia. A complete CCC was achieved in all cases. Performing CCC with our technique is easy, safe, and cheap. It may be an alternative method to CCC by using OVD and forceps.