Fatih Horozoglu

Long-term Outcomes Of Pars Plana Vitrectomy With Internal Limiting Membrane Removal In Diabetic Macular Edema

Purpose: To report the long-term visual results and anatomical outcome as assessed by optical coherence tomography (OCT) after pars plana vitrectomy (PPV) with removal of the internal limiting membrane (ILM) in diabetic macular edema (DME). Methods: Medical records of 27 eyes of 27 patients who underwent PPV with ILM removal for DME attributable to diffuse leakage were reviewed. This retrospective study included eyes that underwent PPV with ILM removal at our institution with preoperative and postoperative OCT assessment of DME. None of the eyes had OCT evidence of anteroposterior vitreomacular traction. Main outcome measures were foveal thickness and visual acuity changes. Results: Foveal thickness decreased by at least 20% in 22 eyes (81.4%) and increased by at least 20% in 3 eyes (11.1%) with PPV and ILM removal (mean follow-up ± SD, 27.6 ± 7.2 months; range, 12–38 months). Mean foveal thickness decrease ± SD was 178 ± 164 &mgr;m (43.6%), with a mean preoperative foveal thickness ± SD of 408 ± 121 &mgr;m compared with a mean postoperative foveal thickness ± SD of 230 ± 74 &mgr;m (P < 0.001). Recurrence of DME was observed at postoperative month 24 in 2 eyes and postoperative month 30 in 1 eye. Visual acuity improved by ≥2 lines in 10 eyes (37%) and decreased by ≥2 lines in 3 eyes (11.1%). Mean best-corrected logMAR (logarithm of the minimum angle of resolution) visual acuity ± SD was 0.75 ± 0.35 preoperatively and 0.63 ± 0.33 postoperatively (P = 0.033). Conclusion: PPV with ILM removal appears to be effective in reducing DME and improving visual acuity, and its effectiveness is maintained in the long term. Recurrence of DME may be observed in the late postoperative period.

Primary 25-gauge transconjunctival sutureless vitrectomy in pseudophakic retinal detachment

AIMS There are few reports on 25-gauge transconjunctival sutureless vitrectomy (TSV) in cases of pseudophakic retinal detachment. We conducted this study to report the anatomic and functional outcomes of 25-gauge TSV in the treatment of primary pseudophakic retinal detachment (RD). DESIGN Prospective, interventional case series. MATERIALS AND METHODS Fifteen eyes of 15 patients with RD after cataract surgery with phacoemulsification were evaluated. Primary pseudophakic RDs with macular detachment and proliferative vitreoretinopathy Stage B or less were included in the study. Pars plana vitrectomy with the 25-gauge TSV system, perfluorocarbon liquid injection followed by air exchange, endolaser photocoagulation and sulfur hexafluoride gas (20%) injection were applied to all eyes. RESULTS Mean follow-up time was 9.2 months (range, six to 12 months). Retinal reattachment with a single operation was achieved in 93% of eyes and with additional surgery, the retina was reattached in 100% of eyes. Preoperative visual acuity was less than 20/200 in all eyes (range, hand motions to 20/400). Postoperative visual acuity was 20/40 or better in eight eyes (53%) and between 20/50 and 20/200 in seven eyes (47%). No severe hypotony was encountered and no sutures were required to close the scleral and conjunctival openings. Postoperative complications were macular pucker in one eye (7%) and cystoid macular edema in another eye (7%). CONCLUSIONS Primary 25-gauge TSV system appears to be an effective and safe procedure in the treatment of uncomplicated pseudophakic RD.

Quantitative Assessment of Photoreceptor Layer in Eyes with Resolved Edema after Pars Plana Vitrectomy with Internal Limiting Membrane Removal for Diabetic Macular Edema

Background/Aims: To evaluate the correlation between visual acuity (VA) and photoreceptor integrity in eyes with resolved diabetic macular edema (DME) after pars plana vitrectomy (PPV). Methods: Eleven eyes with resolved macular edema following PPV with internal limiting membrane removal for DME were included in this retrospective study. The integrity of the external limiting membrane (ELM) and inner and outer segments (IS/OS) of the photoreceptor junction was evaluated by spectral domain optical coherence tomography. The main outcome measures were percentage of disrupted ELM and IS/OS lines, and correlation between VA and photoreceptor integrity. Results: The mean time after PPV was 78 ± 17 months. The mean lengths of the disrupted ELM and IS/OS lines were 223 ± 167 µm (63%) and 189 ± 175 µm (54%) in the foveola, and 900 ± 522 µm (60%) and 835 ± 582 µm (55%) in the fovea, respectively. Intact ELM and IS/OS lines were positively correlated with VA in both the fovea (p = 0.09 and p = 0.02, respectively) and foveola (p = 0.004 and p = 0.03, respectively). Linear regression analysis showed a statistically significant association of intact ELM and IS/OS lines with VA in the fovea. Disrupted ELM and IS/OS lines had a strong correlation with each other in both the fovea (r = –0.71, p = 0.013) and foveola (r = 0.81, p = 0.02). Conclusions: The integrity of the ELM and IS/OS lines was positively correlated with VA in eyes with resolved DME after PPV.

Endothelial cell loss: Biaxial small-incision torsional phacoemulsification versus biaxial small-incision longitudinal phacoemulsification

PURPOSE: To compare clinical results of biaxial small‐incision torsional phacoemulsification and biaxial small‐incision longitudinal phacoemulsification. SETTING: Department of Ophthalmology, School of Medicine, Namik Kemal University, Tekirdag, Turkey. DESIGN: Randomized controlled clinical trial. METHODS: Eyes with high‐density nuclear cataract were assigned to have biaxial longitudinal (microburst mode) or biaxial torsional phacoemulsification. The main outcomes included corrected distance visual acuity (CDVA), central corneal thickness (CCT), central endothelial cell density (ECD), total ultrasound time (UST), cumulative dissipated energy (CDE), percentage total equivalent power in position 3, and balanced salt solution volume. Postoperative follow‐up was at 1 day, 1 week, and 1 and 3 months. RESULTS: Each group comprised 35 patients (35 eyes). Three months postoperatively, the mean CDVA for each group was 0.02 logMAR and the mean CCT returned to the preoperative level (P=.589 and P=.554, respectively). During the postoperative follow‐up, the percentage of mean endothelial cell loss in both groups was between 35.4% and 39.1%; there was no statistically significant difference between the groups (P>.05). The mean CDE, UST, percentage total equivalent power in position 3, and balanced salt solution volume values were similar in the 2 groups (P>.05). CONCLUSION: The risk for high endothelial cell loss should be considered when the phacoemulsification of high‐density nuclear cataracts is performed using either method. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

23-Gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery.

Purpose: The purpose of this study was to evaluate the effectiveness and safety of 23-gauge (23-G) transconjunctival sutureless vitrectomy in patients with retained lens fragments after complicated cataract surgery. Methods: In this retrospective consecutive case series, 17 eyes of 17 patients with retained lens fragments after complicated cataract surgery and managed by using 23-G transconjunctival sutureless vitrectomy were evaluated between January 2007 and March 2009 at our institution. Results: Mean follow-up time was 8.5 ± 3.00 months. Nine patients (53%) were pseudophakic, and 8 (47%) were aphakic. A foldable acrylic intraocular lens was implanted in eight eyes with aphakia. In 2 eyes (11.8%), one of 23-G sclerotomy port was enlarged and intravitreal phacoemulsification was performed with 20-gauge phacofragmatome to remove hard nucleus. Visual acuity improved in 100% of eyes and was 20/40 or better in 70.6% of eyes. Postoperative complications were transient elevation of intraocular pressure (29.4%), decentralization of the intraocular lens (5.9%), fibrin reaction (5.9%), mild vitreous hemorrhage (5.9%), and macular retinal pigment epithelial changes (5.9%). Conclusion: Twenty-three–gauge transconjunctival sutureless vitrectomy was observed to be effective and safe in patients with retained lens fragments after complicated cataract surgery. In cases with hard nucleus, 23-G vitrectomy probe may not be adequate to remove the lens fragments.

Steamroller versus basic technique in pneumatic retinopexy for primary rhegmatogenous retinal detachment.

Purpose: To compare the effectiveness and safety of the “basic” technique with those of the “steamroller” technique in pneumatic retinopexy (PR) for primary rhegmatogenous retinal detachment. Methods: In this prospective study, 40 eyes of 40 patients with primary rhegmatogenous retinal detachment were treated with PR by argon laser photocoagulation. PR with the steamroller technique (steamroller group) was performed randomly on 21 eyes of 21 patients, and 19 eyes of 19 patients were treated with PR with the basic technique (basic group). Main outcome measures were visual acuity, anatomical outcome, rate of proliferative vitreoretinopathy (PVR) development, and postoperative complications. Results: Mean follow-up ± SD was 14.7 ± 9.9 months (range, 6–48 months). Single-operation success rate for all patients was 70% (28/40 eyes). Single-operation success rate was 74% (14/19 eyes) for the basic group and 67% (14/21 eyes) for the steamroller group (P = 0.629). PVR grade C-1 developed in one eye (5%) in each group. Overall success rate, after reoperations, was 100% for each group. Preoperative logMAR (logarithm of the minimum angle of resolution) visual acuity ± SD was 2.01 ± 0.43 in the basic group and 1.89 ± 0.45 in the steamroller group (P = 0.434). Postoperative logMAR visual acuity ± SD was 0.64 ± 0.42 in the basic group and 0.46 ± 0.35 in the steamroller group (P = 0.152). There was no statistically significant difference between basic and steamroller groups in terms of postoperative complications (P > 0.05). Conclusion: Basic and steamroller techniques appear to be equally effective and safe in PR for primary rhegmatogenous retinal detachment. The risk for PVR development seems to be similar with either technique. Further studies with a large number of patients are required for a more reliable conclusion.

Tear Osmolarity and Ocular Surface Changes in Patient with Polycystic Ovary Syndrome

Purpose: To evaluate the tear osmolarity and ocular surface changes in patients with polycystic ovary syndrome (PCOS). Materials and Methods: Forty-eight patients with recently diagnosed PCOS and thirty-three control volunteers were enrolled in this prospective, observational study. Ocular surface disease index (OSDI) score was calculated. Tear osmolarity was measured using the TearLab Osmolarity System (Tearlab, San Diego, CA, USA). All subjects also underwent the following ophthalmologic evaluation: Schirmer I test, tear-film breakup time (TBUT), ocular surface flourescein staining, and conjunctival impression cytology. Results: Mean OSDI score was significantly higher in patients with PCOS than control subjects (P = 0.001). Tear osmolarity was similar in both groups (P = 0.404). There were no significant differences between groups in Schirmer I test results, TBUT, and ocular surface flourescein staining scores (P > 0.05). Compared to control group, a statistically significant squamous metaplasia was observed in temporal bulbar conjunctival impression cytology specimens in PCOS group (P = 0.032). Conclusions: In patients with recently diagnosed PCOS, tear volume and osmolarity are not affected but, conjunctival morphology may be affected, though on a limited scale.

Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment.

AIM To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). METHODS In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. RESULTS Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P<0.001, Paired t-test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye (2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. CONCLUSION Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.

Macular thickness changes after phacoemulsification in previously vitrectomized eyes for diabetic macular edema.

Purpose: To report visual results and anatomical outcome after uncomplicated phacoemulsification in eyes that previously underwent pars plana vitrectomy for diabetic macular edema. Methods: This retrospective noncomparative study included 22 eyes of 19 diabetic patients who underwent uncomplicated cataract surgery with phacoemulsification and intraocular lens implantation after pars plana vitrectomy with internal limiting membrane removal for diabetic macular edema. Main outcome measures included visual acuity and foveal thickness (FT) changes as assessed by optical coherence tomography. Wilcoxon test was used for statistical analysis. Results: Mean follow-up time was 11.9 ± 8.75 months. Mean FT increased by 20.5 ± 67.6 μm (8.4%), with a mean preoperative FT of 237 ± 69 μm compared with a mean postoperative FT of 257.6 ± 89.8 μm (P = 0.236). Foveal thickness increased by at least 20% in 6 eyes (27.3%), remained within 20% in 14 eyes (63.6%), and decreased by 20% in 2 eyes (9.1%). Visual acuity improved by ≥2 lines in 16 eyes (72.7%) and remained stable in 6 eyes (27.3%). Visual acuity was 20/40 or better in 11 eyes (50%). Conclusion: Moderate but insignificant increase in FT was observed after phacoemulsification in eyes that previously underwent pars plana vitrectomy for diabetic macular edema. Prospective studies with a large number of patients are warranted for a more reliable conclusion.

Intravitreal tigecycline treatment in experimental Acinetobacter baumannii endophthalmitis.

Abstract Purpose: To investigate the clinical and microbiological effectivity of intravitreal tigecycline in an experimental rabbit endophthalmitis model caused by imipenem resistant Acinetobacter baumannii. Materials and Methods: Forty-eight eyes of 24 New Zealand white albino rabbits were divided into six groups (n = 8 in each). The right eyes were divided into three groups and defined as infected group; left eyes were divided into three groups and defined as uninfected group. Infected group received 0·1 ml intravitreal A. baumannii suspension. Twenty-four hours after bacterial inoculation, group 1 received 1 mg/0·1 ml tigecycline and group 2 received 0·5 mg/0·1 ml tigecycline. Group 3 eyes received no treatment. In group 4, 0·1 ml of saline solution was injected. Groups 5 and 6 were received intravitreal tigecycline injection of 1 mg/0·1 ml and 0·5 mg/0·1 ml respectively. The eyes were enucleated for histopathological evaluation on the sixth day. Clinical and histological scoring systems were used to evaluate clinical and histological severity of the intraocular infection. Results: The mean clinical scores of the six groups at the sixth day were 11±1·92, 12·4±6·2, 8·5±2·7, 0, 3±1·3, and 3±1·4 respectively. Mean histopathological scores were 7·8±2·8, 7·0±1·5, 5·6±1·4, 0, 0, and 0 respectively. There was no significant difference in mean clinical and histopathological scores of infected group (groups 1, 2 and 3). There was significant difference in mean clinical scores of groups 5 and 6 compared with group 4. Groups 4, 5 and 6 showed normal histological structure in histopathological evaluation and showed no significant difference. Microbiological cure was achieved in all infected eyes. Conclusions: Experimental rabbit endophthalmitis model caused by imipenem resistant A. baumannii was microbiologically cured by intravitreal tigecycline injection. However, a hypersensitivity-like reaction due to intravitreal application of tigecycline limits the use of this antimicrobial agent in A. baumannii endophthalmitis.