Esin Firat

Nonpreserved human amniotic membrane transplantation in acute and chronic chemical eye injuries.

Purpose. To evaluate the safety and efficacy of nonpreserved amniotic membrane transplantation (AMT) with or without limbal autograft transplantation (LAT) in management of acute and chronic chemical eye injuries. Methods. Amniotic membrane transplantation or AMT + LAT was performed on nine eyes of seven consecutive patients, five eyes with acute chemical burn and four eyes with limbal stem cell deficiency secondary to previous chemical burn. Nonpreserved amniotic membrane was used in all procedures. Results. Five patients (71.5%) were men and two (28.5%) were women. The average age at the time of surgery was 32.7 ± 10.9 years (range, 20–45). Mean follow-up after last surgery was 8.9 ± 3.2 months (range, 6–14). The average epithelial healing time was 24.6 ± 17.3 days (range, 3–45). At the end of the follow-up period, visual acuity improved in all eyes, inflammation subsided, and the subjective complaints decreased remarkably. Conclusion. AMT with nonpreserved amniotic membrane promoted epithelial healing, reduced surface inflammation, increased patient comfort, and decreased the extent and severity of vascularization when used in patients with acute chemical burns. When used in limbal stem cell deficiency owing to past chemical burns, AMT alone or in combination with LAT aided in ocular surface reconstruction. Infectious, inflammatory, or toxic/allergic reactions were not encountered in any patient owing to the use of nonpreserved amniotic membrane. Further studies are required to establish the safety and efficacy of preserved and nonpreserved AMT in ocular surface reconstruction.

Health-related Quality of Life in Behçet Patients with Ocular Involvement

PURPOSE Health-related quality of life (HRQOL) is an important outcome factor in chronic diseases such as Behçet syndrome. We aimed to investigate the relation of HRQOL to the duration of illness, mental state, and visual acuity of patients with Behçet syndrome. METHODS We conducted a cross-sectional clinical trial of 45 consecutive Behçet patients with ocular involvement. The control group consisted of an age-, sex-, and education-matched group of 45 healthy individuals. All patients and the controls had been given a complete ophthalmic examination. In addition, they completed a questionnaire comprising the SF-36 Health Survey, Beck Depression Inventory, and Beck Anxiety Inventory. Eight multiple regression analyses were carried out in the patient group to determine whether total anxiety scores, total depression scores, duration of the disease, and visual acuity predicted the dependent variable SF-36 subscales. RESULTS Using the analysis of variance statistical method, comparisons of the patient and the control groups for depression, anxiety, and the subscales of the SF-36 Health Survey indicated a statistical significance for this battery of tests. CONCLUSIONS Behçet patients with ocular involvement are susceptible to anxiety and depression when compared to age and sex matched controls. It is important for the ophthalmologist to know that changes in the mental state of his patient may trigger a new ocular attack, and to be aware that these changes may play a critical role in the management and preventive measures for Behçet syndrome.

Topical Apraclonidine Testing Discloses Pupillary Sympathetic Denervation in Diabetic Patients

Background:Autonomic denervation is common in diabetes mellitus (DM). Pupillary sympathetic denervation (PSD) has been found in Horner syndrome following instillation of apraclonidine 0.5%. We have applied this technique to investigate the prevalence of PSD in DM. Methods:Apraclonidine 0.5% was instilled in the eyes of 50 patients with DM and 30 age-matched and gender-matched subjects without DM (control subjects). Pupil diameters (PD) were measured before and 60 minutes after instillation. The duration of DM and the degree of diabetic retinopathy (DR) were recorded for each patient. Results:Apraclonidine instillation caused an average of 0.9 mm of mydriasis (range 0 to 4.5 mm) in DM and −0.1 mm miosis (range 0.5 to −1 mm) in control subjects (P < 0.001). Mydriasis of at least 1 mm was observed in 42% of DM patients. The change in PD was highly correlated with the duration of DM (r = 0.368, P = 0.008) and the presence of DR (r = 0.532, P < 0.001). Conclusion:Apraclonidine testing, which is easy to perform and not distressing to the patient, identified PSD in nearly half of DM patients, the degree of mydriasis being correlated to the duration of DM and the presence of DR.

Single-Stage Adjustable Strabismus Surgery under Topical Anesthesia and Propofol

Aim: To present our experience with single-stage adjustable strabismus surgery (SSASS) under topical anesthesia and propofol. Materials and Methods: Sixteen patients who either had diplopia before the surgery or were at risk of developing diplopia after the surgery were selected for this operation after evaluating their tolerance for an eyelid speculum. Recession of the lateral recti, recession, resection and advancement of the medial recti, anteriorization of the inferior oblique and marginal myotomy to the superior rectus were the procedures done under topical anesthesia and propofol. The operations were done in two phases; in the first phase, the patients were sedated for 10 minutes with intravenous propofol (2 mg/kg) and the operation was done under topical anesthesia with 2% lidocaine. In the second phase, the patients were conscious and the adjustments were made. Results: None of the patients complained of significant pain during the surgery. No complications occurred during and after the procedure and no patients had diplopia during the postoperative follow-up. Conclusions: Single-stage adjustable surgery is practical and avoids the risks of regional and general anesthesia. The only disadvantage is the pain that some patients experience. We found that it is feasible to use propofol for this surgery; it provides deep sedation and prevents pain from being felt during the operation, and its short elimination half-life provides rapid awakening for the adjustment phase.

Bilateral Duane retraction syndrome associated with an extraordinary hand anomaly

Duane retraction syndrome is an ocular motility disorder with which an increasing number of congenital abnormalities appear to be associated. In the present paper the authors report a case of bilateral Duane retraction syndrome with an extraordinary hand abnormality. Numerous theories concerning the etiology and pathogenesis of Duane retraction syndrome and its relationship to the associated findings have been proposed, but the exact mechanism is still under investigation. Further multi-centered studies and the classification of the associated clinical findings in an organized manner may help to explain this mechanism.

Autonomic nervous system involvement in Behçet disease

We evaluated the autonomic nervous system involvement in Behçet disease by pupillary responses. Pupil cycle times were 969±189 ms and 840±62 ms patient and control groups, respectively. This difference was statistically significant. Behçet disease may affect the autonomic nervous system of the eye and is most probably related to neurologic involvement and the diseases vasculitic nature.