Erhan Yumusak

Early results of dexamethasone implant, ranibizumab, and triamcinolone in macular edema due to branch retinal vein occlusion

Purpose To compare the short-term results of the efficacy and safety of dexamethasone intravitreal implant (DEX), ranibizumab (RAN), and intravitreal triamcinolone acetonide (IVTA) in macular edema secondary to branch retinal vein occlusion (BRVO). Methods One eye each of 32 patients who were treated with intravitreal injections for macular edema secondary to BRVO was studied. This retrospective study included 3 groups. The patients received DEX in group 1 (n = 11), RAN in group 2 (n = 11), and IVTA in group 3 (n = 10). Data were collected before and after the injections at the first and third months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were analyzed statistically. Results The median duration of the follow-up was 3.0 months in overall groups. The BCVA increased significantly in all groups (p = 0.018, p = 0.034, p = 0.014, respectively). The CMT increased significantly in groups 1 and 3 (p = 0.02, p<0.001, respectively), but not in group 2 (p = 0.14). The IOP increased significantly in groups 1 and 3 (p = 0.05, p<0.001, respectively). Antiglaucomatous treatment was required only in group 3. Cataract developed in 2 patients (20%) in group 3 and surgery was required. Conclusions Although RAN was the safest among the 3 agents, DEX and IVTA reduced CMT more than RAN, while significant improvement was achieved in BCVA in all groups. All 3 agents can be effectively used in the treatment of macular edema due to BRVO.

Comparison of choroidal thickness changes following intravitreal dexamethasone, ranibizumab, and triamcinolone in eyes with retinal vein occlusion.

Purpose To evaluate short-term choroidal thickness changes following intravitreal dexamethasone implant (DEX), ranibizumab (RAN), and triamcinolone acetonide (TA) in eyes with retinal vein occlusion (RVO) and macular edema (ME). Methods In this prospective study, 35 eyes of 35 patients with RVO and ME who were treated with intravitreal injections of DEX, RAN, and TA were included. Choroidal thickness was measured using semiautomated segmentation of enhanced depth imaging with optical coherence tomography at fovea and parafoveal areas. Changes in choroidal thickness following treatment were compared statistically. Results Choroidal thickness decreased following DEX, RAN, and TA treatments (all p>0.05). In the DEX group, at the first month nasal 1,500 µm (N11,500) and at the third month subfoveal (SF3) and nasal 500 µm (N3500) choroidal thickness revealed a significant reduction compared to RAN and TA groups (all p<0.05). In the TA group, choroidal thickness showed a significant reduction only at nasal 1,500 µm (N31,500) at the third month (p<0.05). Conclusions Choroidal thickness was decreased in all 3 groups. The DEX and TA groups showed a significant reduction at some areas. Ranibizumab had the smallest effect on choroidal thickness after 3 months among all groups.

Elevated Tear Human Neutrophil Peptides 1-3, Human Beta Defensin-2 Levels and Conjunctival Cathelicidin LL-37 Gene Expression in Ocular Rosacea

ABSTRACT Purpose: To investigate the role of innate immunity in ocular rosacea. Methods: Thirty-two patients with ocular rosacea patients (group-1) and 28 healthy volunteers (group-2) who served as controls were enrolled in the study. Tear function parameters were assessed, conjunctival impression cytology was performed and tear samples were collected. Human-neutrophil-peptides (HNP) 1–3 and human-beta-defensin-2 (hBD-2) levels were measured in tears by using ELISA tests. Cathelicidin leucin-leucin-37 (LL-37), hBD-2, human-beta-defensin-9 (hBD-9) gene expression levels were measured in the conjunctival impression cytology samples using real-time polymerase chain reaction. Results: Tear HNP1-3 (p = 0.024), hBD-2 (p < 0.001), conjunctival LL-37 gene expression rate (p = 0.014) and ocular surface disease index scores (p = 0.001) were higher and the tear break-up time was lower (p = 0.003) in group-1. No other differences were found between the groups. Conclusion: The results of this study suggest the role of abnormal innate immunity in the pathophysiology of ocular rosacea by revealing elevated antimicrobial peptide levels.

Bilaterale, gleichzeitige rhegmatogene Netzhautablösung nach Laser-in-situ-Keratomileusis

Bei einer 21-jährigen Frau trat nach einer Laser-in-situ-Keratomileusis (LASIK) beider Augen bilateral gleichzeitig eine rhegmatogene Netzhautablösung auf. Sie unterzog sich daraufhin einer Pars-plana-Vitrektomie in Kombination mit Endolaser-Photokoagulation und Silikonöl-Tamponade im rechten Auge. Eine Woche später wurde am linken Auge eine pneumatische Retinopexie durchgeführt. Da sich der Netzhautriss nicht verschloss, wurde eine 360°-Sklera-Eindellung durchgeführt und die Netzhaut so befestigt. Die bilaterale simultane rhegmatogene Netzhautablösung nach LASIK zur Myopiekorrektur kann eine schwerwiegende Komplikation darstellen. Die Patienten sollten über die Möglichkeit dieser Komplikation aufgeklärt werden. Übersetzung aus Case Rep Ophthalmol 2016;7:340-344 (DOI:10.1159/000446602)

Retinal Nerve Fiber Layer and Peripapillary Choroidal Thicknesses in Non-Glaucomatous Unilateral Optic Atrophy Compared with Unilateral Advanced Pseudoexfoliative Glaucoma

ABSTRACT Purpose: To investigate retinal nerve fiber layer thickness (RNFL-T) and peripapillary choroidal thickness (PC-T) in non-glaucomatous optic atrophy (OA) patients in comparison with unaffected and control eyes, furthermore, to compare thickness profiles with unilateral pseudoexfoliative advanced glaucoma. Materials and Methods: Thirty-three eyes with OA (Group A), 33 unaffected fellow eyes (Group B), 25 right eyes of 25 control subjects (Group C), and 15 eyes with advanced glaucoma (Group D) were enrolled. RNFL-T was measured in six regions by spectral-domain optical coherence tomography. Enhanced depth imaging optical coherence tomography was obtained to evaluate PC-T in corresponding regions. Results: RNFL-T was significantly lower in Group A than in Groups B and C globally and at all peripapillary regions (all p < 0.001). P-CT in Group A was significantly lower globally (p = 0.03) and in three regions (temporal, p = 0.001; temporal-superior, p = 0.01; and nasal-inferior, p = 0.037) versus Group C. However, it was significantly thinner than in Group B in all regions (temporal, p = 0.02; temporal-superior, p = 0.013; nasal-superior, p = 0.044; nasal, p = 0.02; nasal-inferior, p < 0.001; and temporal-inferior, p < 0.001) and globally (p < 0.001). In Group A RNFL-T (thicker superiorly and inferiorly; thinner temporally and nasally) and PC-T (superior > temporal > nasal > inferior) profiles were almost identical to that in unaffected fellow eyes and control eyes. However, Group D showed different patterns with less regional differences in RNFL-T, and the greatest value of PC-T in nasal quadrant. Conclusions: Besides retinal nerve fiber layer thinning, non-glaucomatous OA is associated with choroidal thinning. The RNFL-T and PC-T profiles in advanced glaucoma eyes differed from the common patterns seen among OA eyes, unaffected fellow eyes, and control eyes.

Outcomes of Unilateral Inferior Oblique Myectomy Surgery in Inferior Oblique Overaction Due to Superior Oblique Palsy

Objectives: To present the outcomes of unilateral inferior oblique myectomy performed in patients with inferior oblique overaction due to superior oblique palsy. Materials and Methods: Twenty-seven eyes of 27 patients that underwent inferior oblique myectomy surgery for superior oblique palsy between 2002 and 2008 were included. Inferior oblique overaction scores (between 0-4) at preoperative, early postoperative (within 1 week after surgery) and late postoperative (earliest 6 months) visits were reviewed. Results: There were 12 male and 15 female patients. Eighteen were operated on the right eye, and 9 were operated on the left eye. The mean age was 15.62±13.31 years, and the mean follow-up was 17±11.28 months (range, 6-60 months). Patients who had horizontal component and V-pattern deviation were excluded. Preoperative and early postoperative inferior oblique overaction scores were 2.55±0.75 and 0.14±0.36, respectively, and the difference was statistically significant (p<0.01). This improvement was maintained up to the late postoperative period. Conclusion: Due to its promising short-term and long-term results, inferior oblique myectomy can be the first choice of surgery for inferior oblique overaction due to superior oblique palsy.

An Unusual Cause of Pseudopapillary Oedema: Hyperphosphatemic Hyperostosis Syndrome

Abstract For the first time, we report hyperphosphatemic hyperostosis syndrome as a cause for pseudopapillary oedema in a pediatric case. Clinical findings are presented and discussed with tomographic evaluation (optical coherence tomography and Heidelberg retinal tomography) of optic discs, visual-evoked potentials, and visual fields.

Comparison of Perioperative Ranibizumab Injections for Diabetic Macular Edema in Patients Undergoing Cataract Surgery

Purpose. To compare the efficacy of perioperative ranibizumab injections on diabetic macular edema (DME) in patients undergoing cataract surgery. Methods. This study included 59 eyes of 59 patients. All patients had advanced cataract with DME and underwent an uneventful phacoemulsification surgery. There were 3 subgroups. The first group received intravitreal ranibizumab injection 2 weeks preoperatively, the second group received intraoperatively, and the third group received 2 weeks postoperatively. Follow-up examinations were performed at 1 week as well as at 1 and 3 months. Results. Baseline visual acuity showed a significant increase in all groups at 1 month. In group 1, compared to baseline value, foveal thickness (FT) increased significantly at 1 month and showed a significant decrease up to month 3. In group 2, FT increased at month 1 and this continued up to month 3. In group 3, FT increased at month 1 and was almost stable up to month 3. There were not any significant differences for visual acuity and FT between the groups. Conclusions. Although intrapostoperative ranibizumab injection for DME seems to be more effective than preoperative injections in patients undergoing cataract surgery, the treatment still needs to be continued following surgery.

Bilateral Simultaneous Rhegmatogenous Retinal Detachment following Laser in situ Keratomileusis

A 21-year-old woman developed simultaneous rhegmatogenous retinal detachment after laser in situ keratomileusis (LASIK) in both eyes. She underwent pars plana vitrectomy surgery combined with endolaser photocoagulation and silicone oil tamponade in the right eye. A week later, pneumatic retinopexy was done in the left eye. As the retinal tear did not seal, 360° scleral buckling surgery was performed and retina was attached. Bilateral simultaneous rhegmatogenous retinal detachment after LASIK for correction of myopia can be a serious complication. Patients should be informed about the possibility of this complication.

Choroidal Thickness Changes After Photodynamic Therapy and Recurrence of Chronic Central Serous Chorioretinopathy

WE READWITH INTEREST THE ARTICLE ‘‘CHOROIDAL THICKness changes after photodynamic therapy and recurrence of chronic central serous chorioretinopathy’’ by Kim and associates. They have reported long-term outcomes of chronic central serous chorioretinopathy (CSC) patients treated with either half-fluence or half-dose photodynamic therapy (PDT) in a well-designed study. They confirmed a wellknown finding, ‘‘resolution of subfoveal choroidal thickening’’ after treatment in chronic CSC. Interestingly, they found choroidal thickness ratio (choroidal thickness at 1 month after treatment/choroidal thickness at baseline) to be a strong indicator of persistent or recurrent disease in the long term. This may really help clinicians and may modify follow-up schemes applied to these patients. Contrary to relatively quicker resolution of the subretinal fluid and associated thinning of the central retinal thickness, choroidal thinning took longer, which was related to remodeling of the choroidal vasculature by the authors of