Erdogan Cicik

Interleukin-8, Nitric Oxide and Glutathione Status in Proliferative Vitreoretinopathy and Proliferative Diabetic Retinopathy

Purpose: To evaluate interleukin-8 (IL-8), nitric oxide (NO) and glutathione (GSH) profiles in vitreous humor and blood samples in patients with proliferative diabetic retinopathy (PDR) and in patients with proliferative vitreoretinopathy (PVR) and to compare the levels with those of controls. Patients and Methods: NO concentrations were determined by using the Greiss reaction in plasma and vitreous humor samples. GSH levels were determined in both blood and vitreous humor samples, using DTNB, a disulfide chromogen. Vitreous IL-8 were assayed by ELISA. Twenty-three patients with PDR, 18 patients with PVR and 21 cadavers as the control group were included in the study. Results: Plasma and vitreous NO levels were found to be25.6 ± 2.1 and 36.9 ± 3.0 µmol/l in patients with PDR, 27.0 ± 4.7 and 34.3 ± 2.9 µmol/l in patients with PVR and 17.4 ± 2.7 and 15.9 ± 1.4 µmol/l in controls, respectively. Vitreous humor and plasma NO levels did not show any statistically significant difference between PDR and PVR groups. However, the values for vitreous in both groups were significantly higher than those of controls (p < 0.0001). Although IL-8 levels in vitreous samples of patients with PDR were not significantly different (79.6 ± 9.7 pg/ml) from those of patients with PVR (42.2 ± 7.3 pg/ml) (p = 0.06), the levels in both groups were significantly higher than those of controls (19.0 ± 3.9 pg/ml) (p < 0.0001 and p < 0.05, respectively). Blood and vitreousGSH levels were found to be5.3 ± 0.4 µmol/g·Hb and 0.58 ± 0.16 µmol/l in patients with PDR and 8.4 ± 0.5 µmol/g·Hb and 15.7 ± 2.2 µmol/l in patients with PVR and 12.0 ± 1.1 µmol/g·Hb and 0.26 ± 0.03 mmol/l in controls, respectively. Vitreous and blood GSH levels were significantly lower in patients with PDR compared to those with PVR (p < 0.0001 for both). Conclusion: Elevated levels of vitreous and plasma NO and vitreous IL-8 in PDR and PVR implicate a role for these parameters in the proliferation in these ocular disorders. GSH concentrations both in vitreous and blood samples of the PVR and PDR patients were much less than those observed in the control group. Lower GSH concentrations detected in PDR in comparison with those in PVR in vitreous humor and to a lesser degree in blood may play an important role in pathogenesis of new retinal vessel formation in patients with PDR. This also suggests that oxidative stress may be involved in the pathogenesis of PVR and particularly that of PDR.

Treatment of trichiasis with argon laser

Purpose In this prospective study, argon laser photocoagulation was used to eliminate misdirected cilia. The cases were followed up to see the results and recurrences with this treatment. Methods 60 eyelids of 45 patients with trichiasis were treated with the argon laser. After topical anesthesia a blue-green argon laser was used with 1 watt power, for 0.20 seconds, with 100 micrometer beam diameter. The beam was directed coaxially to the lash follicle to create a 2–3 mm crater and vaporization was observed. After crater formation, the laser parameters were changed to 1.2 watt power, for 0.20 seconds, with 200 micrometer beam diameter, to destroy residual follicular tissue. Up to five lashes were treated in one session. At the end of each session an antibiotic ointment was used t.i.d. for a week. Results Patients have been followed for 4–12 months (mean 6 months). Recurrences have been seen in 15 of 60 eyelids (25%). Laser treatment has been used with the same protocol for the cases with recurrence and results have been successful in eight of them. Post-operatively severe pain, hemorrhage, scar formation, neovascularization of lid margin, or infection were not seen in any patient. In three cases mild hypopigmentation and in three other cases mild lid notching were observed. Conclusions Argon laser lash ablation can be done as an effective office procedure with topical anesthesia. The advantages include low recurrence and complication rates in carefully selected patients and minimal postoperative discomfort.

Corneal Viscoelastic Differences Between Pseudoexfoliative Glaucoma and Primary Open-angle Glaucoma

Purpose:The aims of this study were to assess the biomechanical properties of corneas with pseudoexfoliative glaucoma (PEXG) and to compare them with those of patients with primary open-angle glaucoma (POAG). Methods:This prospective, comparative case series consisted of 73 eyes of 73 patients, 35 eyes with PEXG (PEXG group) and 38 eyes with POAG (POAG group). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPCC), and Goldmann-correlated intraocular pressure (IOPG) were determined by using ocular response analyzer (ORA). IOP using Goldmann applanation tonometer (GAT) and ultrasonic central corneal thickness (CCT) were also measured for each eye. Exclusion criteria included refractive error/astigmatism of >3.00 D, history of intraocular surgery, corneal disease, angle-closure glaucoma, and secondary glaucoma other than PEXG. In cases where both eyes were eligible, the right eye was preferred for analysis. The main outcome measures were CH, CRF, IOPCC, IOPG, and GAT. The results were statistically analyzed by using t test, general linear model, and the Pearson correlation test. Results:The mean CH was found to be significantly lower in patients with PEXG (8.8±1.4 mm Hg) than those with primary open-angle glaucoma (9.9±1.2 mm Hg; P=0.0007). The mean CRF was found to be significantly lower in patients with PEXG (9.5±1.8 mm Hg) than those with POAG (11.1±1.3 mm Hg; P<0.0001). IOPCC was not significantly different between the groups (PEXG, 16.7 ±2.5 mm Hg; POAG, 16.9±2.4 mm Hg; P=0.72). IOPG was significantly lower in PEXG group (14.7±2.7 mm Hg) compared with the POAG group (16.5±2.5 mm Hg; P=0.004). GAT was significantly lower in the PEXG group (14.6±2.7 mm Hg) compared with the POAG group (16.4±2.8 mm Hg; P=0.007). There was no significant difference between the groups regarding mean CCT (PEXG, 546.1±34.9 &mgr;; POAG, 549.1±25 &mgr;; P=0.66) and mean age (PEXG, 70.3±8.2; POAG, 67.6±8.8; P=0.17). The difference between the IOPCC and the GAT was 2.1 and 0.5 mm Hg in both PEXG and POAG groups, respectively. Conclusions:Patients with PEXG had lower CH and CRF values than those with POAG. These findings require further investigation to assess the role of differing corneal biomechanical properties between the 2 groups and its association with poor prognosis among patients with PEXG.

Descemet-stripping automated endothelial keratoplasty in eyes with toxic anterior segment syndrome after cataract surgery

PURPOSE: To report the results of Descemet‐stripping automated endothelial keratoplasty (DSAEK) in eyes with toxic anterior segment syndrome (TASS) after cataract surgery. SETTING: Department of Ophthalmology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey. METHODS: In this prospective study of consecutive patients who had DSAEK for corneal failure due to TASS, the main outcome measures were corneal clarity, mean spherical equivalent (SE) refraction, preoperative and postoperative visual acuities, central corneal thickness, and endothelial cell count (ECC). RESULTS: The mean follow‐up in the 10 eyes (10 patients) was 17.1 months ± 2.4 (SD). There were no graft dislocations postoperatively, and no graft required repositioning. All grafts were clear at 12 months. Two eyes had initial graft rejection that resolved with treatment. All eyes had improved postoperative corrected distance visual acuity, with 7 eyes (70%) attaining 0.5 or better. The mean SE refraction in measurable cases (5 eyes) was 1.2 ± 0.6 preoperatively and 0.9 ± 1.0 postoperatively (P = .141). The decrease in mean pachymetry from preoperatively (691 ± 15 μm) to 12 months postoperatively (614 ± 23 μm) was statistically significant (P = .005). The mean ECC was 2740 ± 236 cells/mm2 preoperatively, 1690 ± 209 cells/mm2 at 6 months, and 1683 ± 206 cells/mm2 at 12 months. The decrease between preoperatively and 6 and 12 months (P = .05) and between 6 months and 12 months (P = .008) was statistically significant. CONCLUSION: Descemet‐stripping automated endothelial keratoplasty was safe and effective in eyes with TASS‐associated corneal edema, yielding encouraging surgical and visual outcomes. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Comparability of Icare Pro Rebound Tonometer with Goldmann Applanation and Noncontact Tonometer in a Wide Range of Intraocular Pressure and Central Corneal Thickness

Purpose: To evaluate the agreement between the reading values of the Goldmann applanation tonometer (GAT), Icare Pro rebound tonometer (IRT) and noncontact tonometer (NCT) in glaucoma patients. Methods: This cross-sectional study comprised 292 eyes of 292 patients selected from a glaucoma outpatient clinic. The intraocular pressure (IOP) was measured sequentially, at a 10-min interval each, in the following order: NCT, IRT and GAT. The central corneal thickness (CCT) was measured using Pentacam HR before the IOP measurements. Results: The mean IOPs measured by the GAT, NCT and IRT were 20.17 ± 6.73 mm Hg (range: 4-48), 19.77 ± 6.88 mm Hg (range: 3-46) and 19.30 ± 5.15 mm Hg (range: 7.30-44.5), respectively. The correlation coefficients of the GAT and IRT, NCT and IRT, and GAT and NCT measurements were r2 = 0.673, r2 = 0.663 and r2 = 0.938 (all p < 0.001), respectively. The IRT tends to overestimate in the low GAT-measured IOPs, whereas it underestimates in high GAT-measured IOPs. The measurements of all 3 devices were also correlated with the CCT at a statistically significant level (GAT: r2 = 0.063, NCT: r2 = 0.063, IRT: r2 = 0.058). Conclusion: The agreement between the IRT and GAT measurements is higher in the IOP range of 9-22 mm Hg, whereas significant discrepancies occur as the IOP deviates from normal values. The variability of the IRT and GAT measurements over a wide range of CCT is minimal.

Vitreoretinal surgery for a subretinal hydatid cyst

PURPOSE To report the vitreoretinal surgery for management of a subretinal hydatid cyst. METHODS Conventional pars plana vitrectomy was performed for the removal of a subretinal hydatid cyst and treatment of retinal detachment in the right eye (RE) of a 34-year-old woman. The cyst content was aspirated by a flute needle after retinotomy and cystotomy. The cyst wall was separated from overlying retina and removed. The retina was attached by liquid perfluorocarbon and silicone oil. Postoperatively, the patient was followed for 15 months. RESULTS After vitreoretinal surgery, the retina RE was attached and recurrence of hydatid disease was not seen in vitreous cavity or subretinal space during the follow-up period. Visual acuity increased from counting fingers to 20/63 at the end of the follow-up time. CONCLUSION A subretinal hydatid cyst that causes retinal detachment may be treated effectively with vitreoretinal surgery.

Novel method to avoid the open-sky condition in penetrating keratoplasty: covered cornea technique.

Purpose: The aim of this study was to present a novel technique to avoid the open-sky condition in pediatric and adult penetrating keratoplasty (PK). Methods: Seventy-two eyes of 65 infants and children and 44 eyes of 44 adult patients were operated on using this technique. After trephining the recipient cornea up to a depth of 50% to 70%, the anterior chamber was entered at 1 point. Then, only a 2 clock hour segment of the recipient button was incised, and this segment was sutured to the recipient rim with a single tight suture. The procedure was repeated until the entire recipient button was excised and resutured. The donor corneal button was sutured to the recipient corneal rim. The sutures between the recipient button and the rim were then cut off, and the recipient button was drawn out. Results: None of the patients operated on with this technique developed complications related to the open-sky condition. Visual acuities, graft failure rates, and endothelial cell loss were comparable with the findings of studies performed for conventional PK. Conclusions: The technique described avoids the open-sky condition during the entire PK procedure. Endothelial cell loss rates are acceptable.

Outcome of office probing and irrigation under topical anesthesia for congenital nasolacrimal duct obstruction

PurposeTo evaluate the office probing and minimal irrigation under topical anesthesia in congenital nasolacrimal duct obstruction for children older than 1 year.MethodsOffice probing and minimal irrigation under topical anesthesia were carried out on 88 lacrimal systems of 76 children (39 male and 37 female) with an age range of 7 to 60 months (mean: 18 months). If the relief of the symptoms of epiphora was not achieved with the first probing, a second probing and irrigation was performed with the same strategy 2 weeks after the first probing. The patients were followed up for 3.5 to 30 months (mean: 10 months).ResultsThe cure rate was 75% with the initial office probing and irrigation, and 90.9% with the repeat probing. Complications, such as laceration of the puncta or canaliculus, creating a false passage, cellulitis, or aspiration of irrigating fluid were not seen in the patients.ConclusionsA simple office probing and irrigation for the treatment of epiphora under topical anesthesia can be easily and safely performed for older children by an experienced ophthalmologist if there is no question with regard to the children’s airways and systemic health.

Safety of prophylactic intracameral moxifloxacin ophthalmic solution after cataract surgery in patients with penetrating keratoplasty.

AIM To determine the safety of prophylactic intracameral moxifloxacin after cataract surgery in patients with penetrating keratoplasty (PKP). METHODS In this retrospective study of consecutive patients who had phacoemulsification cataract surgery after PKP, were treated with intracameral moxifloxacin 0.5% ophthalmic solution (0.5 mg/0.1 mL). The main outcome measures were anterior chamber reaction, best corrected visual acuity (BCVA), corneal endothelial cell count (ECC), and central corneal thickness (CCT). RESULTS Fifty-five patients were recruited (26 males, 29 females). The mean age was 54.36±4.97y (range 45-64y). All eyes had improved postoperative BCVA. The mean BCVA was 0.25 preoperatively and 0.57 postoperatively, which was statistically significant (P<0.001). One eye had 3+, 7 eyes had 2+, 12 eyes had 1+ and 8 eyes had trace amount of aqueous cells on the first day after surgery. All eyes had no anterior chamber cells at subsequent follow up examinations. Effective phacoemulsification time was 4.33±1.01s. The mean ECC was 2340.20 cells/mm(2) preoperatively and 1948.75 cells/mm(2) 1mo postoperatively (P<0.001). The increase of 21.09 µm in postoperative pachymetry 1mo after surgery was statistically significant (P<0.001). CONCLUSION No untoward effects were observed after intracameral injection of moxifloxacin (0.5 mg/0.1 mL) in terms of anterior chamber reaction, CCT, ECC, and visual rehabilitation at the conclusion of cataract surgery in patients with PKP.

Histologic Findings of Corneal Buttons in Decompensated Corneas With Toxic Anterior Segment Syndrome After Cataract Surgery.

Purpose: To report the histologic findings of penetrating keratoplasty buttons in decompensated corneas with toxic anterior segment syndrome (TASS) after a cataract surgery is performed. Methods: We evaluated the histologic findings of 16 corneal buttons of 16 patients who exhibited decompensation findings because of TASS by means of light microscopy. The patients were classified into 3 groups: The first group consisted of 5 corneal buttons with mild symptoms in which the central corneal thicknesses (CCTs) were ⩽650 &mgr;m, and the visual acuities (VAs) were ≥0.1. The second group consisted of 7 corneal buttons that exhibited moderate symptoms in which the CCTs were between 650 and 750 &mgr;m and the VAs were between 0.1 and 0.03. The third group consisted of 4 corneal buttons that had severe symptoms in which the CCTs were ≥750 &mgr;m and the VAs were ⩽0.03. Results: Light microscopy showed endothelial cell loss, vacuolated and thinned epithelial cell layers, disturbed collagen bonds, and Descemet membrane invaginations in patients in group I. Group II corneal buttons exhibited inflammatory cells (lymphocytes) and extended intercellular space between the epithelial cells, wrinkled Bowman membrane separated from the stroma in some local areas, stromal edema, and early vascularization. In group III, endothelial and epithelial cell layer loss, wrinkled Descemet and Bowman membranes, inflammatory cells, and structurally disturbed collagen bonds located beneath the Bowman membrane, and a greater amount of vascularization in the area of inflammation were observed. Conclusions: The results of the histologic evaluation of the decompensated corneas caused by the TASS are compatible with the clinical severity of the disease. In mild cases, the histologic findings were insignificant; however, when the clinical situation deteriorated, histologic findings became increasingly worse.