Eyup Duzgun

Evaluation of Color-Changing Effect and Complications After Nd: YAG Laser Application On Iris Surface

Background The aim of this study was to evaluate the color-changing effect and adverse effects after Nd: YAG laser application on the iris surface of rabbit eyes. Material/Methods The study was performed on right eyes of 12 pigmented rabbits. A laser device that produces frequency doubled 532 nm wavelength Nd: YAG laser with 900 μm spot diameter was used. The laser was applied in 3 sessions at 2-week intervals, at energy levels of 0.8 mJ in Group A and 1.5 mJ in Group B. Slit-lamp examinations and measurements of intraocular pressure (IOP) using a Tono-Pen were performed before and 1 day after each laser session. Iris thickness (IT) was measured at the beginning and the end using an ultrasonic biomicroscope. The eyes were enucleated for histopathologic examination on day 60. Results On the first day after each laser session, maximum grade 1 anterior chamber flare and cells were observed in both groups. In all eyes, flare and cells disappeared at the end of the first week. There was no significant difference in the IOP and IT values between measurements performed prior to and after laser sessions during the study (p>0.05). None of the eyes showed complications such as corneal edema, hypopyon, posterior synechia, transillumination defect, or pupillary defect. In histopathological examinations, reduction in pigment density was more profound in Group B compared to Group A, which was statistically significant (p<0.019). Conclusions There were no serious complications apart from mild transient inflammatory signs. Change in iris color was more evident at the end of the second month.

A Rare Ocular Manifestation of Adult Onset Still’s Disease: Purtscher’s-like Retinopathy

ABSTRACT Adult-onset Still’s disease (AOSD) is a rare multisystemic immune-mediated disease of unknown etiology with quotidian spiking fever, evanescent rash, arthralgia, and multiple organ involvement. The few AOSD cases that have been reported developed Purtscher’s-like retinopathy associated with thrombotic microangiopathy (TMA). Here, we report Purtscher’s-like retinopathy without TMA in a patient with AOSD. A 29-year-old-man who presented for evaluation of blurred vision was diagnosed with AOSD based on Yamaguchi criteria. He had Purtscher’s-like retinopathy in his right eye. Lesions improved after steroid treatment. Although almost all reported AOSD cases with Purtscher’s-like retinopathy are associated with TMA, in this case such a complication was not encountered.

Long-term effects of intravitreal ranibizumab treatment on retinal ganglion cell complex and choroidal thickness

Background: To evaluate the long-term effects of intravitreal ranibizumab treatment on both choroidal and retinal layers thicknesses using spectral domain optical coherence tomography (SD-OCT) and Enhanced Depth Imaging (EDI) mode. Methods: Thirty-two eyes of 27 patients with classic choroidal neovascularization that have been undergoing intravitreal 0.5 mg ranibizumab injections for a minimum of 2-year follow up were enrolled as the study group. Age and sex matched 31 eyes of 17 nonneovascular age-related macular degeneration subjects constituted the control group. Thickness of retinal layers measured by the program embedded in SD-OCT. Choroidal images were obtained by SD-OCT with EDI mode by the same certified operator. Results: The mean injection number of the study group was 12.1 ± 4.0. The mean follow-up time was 3.6 ± 1.6 years. The mean subfoveal choroidal thickness values tended to be lower in ranibizumab treated eyes than controls, but difference was not statistically significant (184 ± 75.5μ vs. 200.8 ± 60.2μ; p:0.336). The study and control groups’ mean retinal thickness values were not statistically significant (250.4 ± 29.4μ vs. 249.7 ± 15.2μ; p:0.906). The mean ganglion cell layer (GCL), internal plexiform layer (IPL) and ganglion cell complex (GCC) values of ranibizumab treated eyes were found to be statistically significantly lower than controls ([21.06 ± 8.03μ vs. 24.6 ± 5μ; p:0.036], [24.5 ± 7.8μ vs. 29.8 ± 3.8μ; p:0.001], [64.1 ± 16.5μ vs. 72.9 ± 8.03μ; p:0.010] respectively). Conclusions: Our study showed that long-term intravitreal ranibizumab treatment was associated with significant reduction in the GCL, IPL and GCC thicknesses. Randomized prospective studies must be conducted to determine if any difference exits between anti-VEGF agents or if this thinning induces any damage in the function of the retinal ganglion cells.

Spectral Domain Optical Coherence Tomography Findings in Carotid Artery Disease

Objectives: To evaluate the effect of carotid artery disease on retinal morphology by means of spectral domain optical coherence tomography (SD-OCT). Materials and Methods: We examined 23 eyes with internal carotid artery (ICA) stenosis and 24 age- and gender-matched healthy eyes as a control group in this prospective, case-control study. Compherensive ophthalmic examination and SD-OCT scan were performed to all the patients. The average RNFL and macular thicknesses (MT) in the nine macular ETDRS areas were the major OCT measurements for our study. Results: Although all of the average RNFL and MT measurements were lower in the ICA stenosis group, only the total MT and outer ETDRS area (temporal/superior/nasal/inferior outer macula) values were found to be significantly thinner compared to the control group (p=0.004, p=0.009, p<0.001, p=0.002, and p=0.001, respectively). Conclusion: In addition to our knowledge about the effects of ICA stenosis on the retino-choroidal circulation, we found that OCT measurements may be beneficial in the early detection of ocular damage due to ICA stenosis.

Surgical approach to retinal detachment with primary congenital glaucoma

We present the clinical features and treatment approach of a case with congenital glaucoma, trabeculectomy and rhegmatogenous RD, and other ophthalmic complications. A 41-year-old male patient with trabeculectomy due to congenital glaucoma in both eyes was admitted to our clinic due to decreased visual acuity for the past three days. Visual acuity was at the level of hand movement in the right eye, and his left eye was phthisic. The bleb on the upper nasal side of the right eye was well formed but cystic and avascular. Fundus examination revealed a patchy RD in the upper half including the macula. Phacoemulsification and intraocular lens (IOL) implantation combined with pars plana vitrectomy-liquid-perfluorocarbon-air-silicone oil change and endolaser application was performed under general anesthesia. Silicone oil tamponade was removed 2 months later, and IOL was implanted with optic capture in the same session. The final visual acuity was 1/10. There was non-functional, avascular and flat bleb due to bleb sclerosis. From the beginning to the last follow-ups, progressive shallowing of the bleb was observed in anterior OCT sections.In a patient with monocular buphthalmos, cataract surgery combined with RD surgery involves multiple risks. In this case, we achieved good visual and anatomic outcome of the retina, but we had bleb functional loss because of bleb sclerosis. We recommend periodic fundus examinations in patients with congenital glaucoma. Rhegmatogenous RD in patients with congenital glaucoma can be reattached, but full recovery may not be achieved.

Evaluation of the early results of ab interno trabeculectomy surgery appllied with trabectome device

The aim of the current study was to assess efficacy and safety of ab interno trabeculectomy surgery applied with trabectome device in early period. The study was designed among the 30 eyes of 26 patients who had undergone trabectome surgery with the diagnosis of open-angle glaucoma. Patients were evaluated as retrospectively in terms of preoperative and postoperative intraocular pressure (IOP), number of drugs used and complications. While the preoperative mean IOP was 28.78±5.57 mmHg (n:30) with the mean number of medications 3.40±1.04, the mean IOP was 18.24±5.54 mmHg (n:30) with the mean number of medications 0.90±1.27 at 1st month. At 3rd month the mean IOP was 16.37±3.36 mmHg (n:28) with the mean number of medications 0.70±1.10 and at 6th month the mean IOP was 16.51±3.80 mmHg (n:28) with the mean number of medications 1.13±0.96. When postoperative measurements compared with preoperative values, detected reductions in IOP and number of medications were statistically significant (P

A Comparative Study of the Effects of Intravitreal Anidulafungin, Voriconazole, and Amphotericin B in an Experimental Candida Endophthalmitis Model.

ABSTRACT Purpose: To compare the safety and efficacy of intravitreal anidulafungin injection with voriconazole and amphotericin B (Amp B) in an experimental Candida endophthalmitis (CE) model. Methods: Intravitreal 1 × 105 CFU/0.1 ml Candida albicans was injected into the right eyes of 24 New Zealand rabbits, which were divided into 4 groups. Voriconazole 50 μg/0.1 ml, Amp B 10 μg/0.1 ml, and Anidulafungin 50 μg/0.1 ml were injected by intravitreal injection 72 h after inoculation. The control group was injected with 0.1 ml 0.9% NaCl. Clinical scoring was performed by assessing the cornea, conjunctiva, iris, and vitreous on days 3 and 7 of therapy. At the end of the study, the right eyes of all rabbits were enucleated and histopathological evaluation was performed. Therapy groups were compared according to the clinical, histopathological, and microbiological analysis scores. Results: Total clinical scores were significantly different between treatment groups and the control group (p < 0.05). On day 7 of the therapy, clinical scores of the anidulafungin group were found to be significantly lower when compared with the other therapy groups, while a significant improvement was observed in the eyes of rabbits in the anidulafungin group (p < 0.05). Also, microbiological scores of the anidulafungin group were lower than those of the control group (p < 0.05). Histopathological scores of the anidulafungin treatment group were significantly better than the voriconazole and control groups. Inflammation was evidently suppressed and marked retinal toxicity was not observed with anidulafungin. Conclusions: This is the first study comparing the efficacy of anidulafungin with other antifungal agents. In this CE model, an intravitreal single dose of anidulafungin was shown to be noninferior to voriconazole and Amp B. As an alternative to Amp B or voriconazole, intravitreal anidulafungin is suggested as an effective antifungal agent for the treatment of CE.

Unusual intraocular foreign bodies after an explosion: patient's hand bone fragments

A 26-year-old Turkish Army soldier underwent full ophthalmoscopic examination after a penetrating ocular injury in the left eye due to the accidental explosion of a detonating fuse during handling. Visual acuity of the left eye was hand motion level. Funduscopy revealed foreign bodies suspended in the vitreous gel and accompanying vitreous haemorrhage. B-scan ultrasonography, CT of the orbits and microscopic examination of the intraocular foreign bodies (IOFBs) were performed prior to removal of bone fragments and pars plana vitrectomy. The IOFBs were fragments of the patients’ bone tissue. Bone fragments from victims body may cause IOFBs after an explosion in military personnel.

Analysing the Progression Rates of Macular Lesions with Autofluorescence Imaging Modes in Dry Age-Related Macular Degeneration.

Objectives: In this study we aimed to compare the sensitivity of blue-light fundus autofluorescence (FAF) and near-infrared autofluorescence (NI-AF) imaging for determining the progression rates of macular lesions in dry age-related macular degeneration (AMD). Materials and Methods: The study was designed retrospectively and included patients diagnosed with intermediate and advanced stage dry AMD. Best corrected visual acuities and FAF and NI-AF images were recorded in 46 eyes of 33 patients. Lesion borders were drawn manually on the images using Heidelberg Eye Explorer software and lesion areas were calculated using Microsoft Excel software. BCVA and lesion areas were compared with each other. Results: Patients’ mean follow-up time was 30.98±13.30 months. The lesion area progression rates were 0.85±0.93 mm2/y in FAF and 0.93±1.01 mm2/y in NI-AF, showing statistically significant correlation with each other (r=0.883; p<0.01). Both imaging methods are moderately correlated with visual acuity impairment (r=0.362; p<0.05 and r=0.311; p<0.05, respectively). In addition, larger lesions showed higher progression rates than smaller ones in both imaging methods. Conclusion: NI-AF imaging is as important and effective as FAF imaging for follow-up of dry AMD patients.

Bilateral Iris Atrophy after the Femtosecond Assisted Laser In Situ Keratomileusis Surgery

Purpose. To report an unknown complication of laser in situ keratomileusis (LASIK) surgery. Case Presentation. A 28-year-old female presented with photophobia and glare to our eye service. She stated in her medical history that she had undergone femtosecond assisted LASIK surgery in both eyes 15 months ago and her symptoms started just after this surgery. On admission, her best-corrected visual acuity was 10/10 in both eyes. She had mydriatic pupils with no direct light reflex. Examination of the anterior segment revealed bilateral iris atrophy projecting within the LASIK ablation zone and a transillumination defect was remarkable on the slit lamp examination. Conclusion. We hypothesized that this condition may have been caused by the abnormally increased IOP that resulted in ischemia in the iris vascular plexus during the suction process of surgery.