Filiz Afrashi

Incidence of cystoid macular edema after uncomplicated phacoemulsification.

We determined the incidence and causes of clinical and angiographic cystoid macular edema (CME) after uncomplicated phacoemulsification and intraocular lens implantation in otherwise normal eyes. This study comprised 252 eyes of 252 patients who had uncomplicated phacoemulsification with continuous curvilinear capsulorhexis and in-the-bag acrylic intraocular lens implantation. The presence of clinical and angiographic CME was evaluated 45 days after surgery, using fundus fluorescein angiography. Age, sex, cataract type, iris color, and real phacoemulsification time of the patients were also recorded. The mean age of the patients was 69.86 (range 60–82) years). Clinical CME was not detected in any eye at any postoperative visit. There were 23 cases with angiographic CME (9.1%). There were no significant differences between the groups who were later found to be angiographically CME-positive or CME-negative in any variable recorded (p >0.05). The incidences of clinical and angiographic CME after uncomplicated phacoemulsification were 0 and 9.1%, respectively. These results indicate that the occurrence of clinical CME has greatly reduced after uncomplicated phacoemulsification operations, but the incidence of angiographic CME is still nearly equal to the incidence of the extracapsular technique.

Conventional buckling surgery or primary vitrectomy with silicone oil tamponade in rhegmatogenous retinal detachment with multiple breaks

BackgroundThere is controversy about the most appropriate operating methods for complicated rhegmatogenous retinal detachment (RD) including multiple tears, and surgical techniques may be changed according to the preference of the surgeon. In this retrospective study, we compared the surgical results of conventional buckling surgery and vitrectomy with silicone oil tamponade for rhegmatogenous (RD) with multiple breaks.MethodsThirty patients who underwent scleral buckling surgery (group 1) and 22 patients who underwent pars plana vitrectomy with silicone oil tamponade (group 2) as the primary surgery for rhegmatogenous RD with multiple breaks were included in this study. The follow-up period was longer than 6 months after surgery. The anatomical success rates and complications were evaluated for both groups.ResultsRetinal reattachment was achieved in 24 of 30 eyes (80%) in group 1 and in 20 of 22 eyes (90.9%) in group 2 after the initial surgery. In group 1, subretinal hemorrhage developed due to the drainage of subretinal fluid in 2 eyes (6.6%) intraoperatively. Elevated intraocular pressure (3.3%), ocular motility disturbances (13.2%), and proliferative vitreoretinopathy (3.3%) were seen in the postoperative period. In group 2, iatrogenic breaks (7.3%) and lens damage (9.09%) occurred during the operation. Macular pucker (4.5%), postoperative cataract progression (22.7%), ocular hypertension (9.09%) and PVR (9.09%) were noted postoperatively.ConclusionsBoth surgical procedures can achieve favorable and comparable anatomic outcomes in the majority of patients in the treatment of RD with multiple breaks. Intra-and postoperative complications are different in the two procedures.

Blue-on-yellow perimetry versus achromatic perimetry in type 1 diabetes patients without retinopathy.

In this study, we compared the blue-on-yellow perimetric parameters with conventional automated static threshold perimetric parameters in the detection of psychophysical abnormality in patients with type 1 diabetes mellitus (DM) without diabetic retinopathy. Forty-three patients with type 1 DM without diabetic retinopathy were included this study. Thirty subjects served as age-matched control group. Blue-on yellow perimetry was performed and the results compared to white-on-white perimetry. The values of mean deviation by blue-on-yellow perimetry in the diabetic group were significantly higher than in the control group (P=0.0001). The indices of short fluctuation, pattern standard deviation, corrected pattern standard deviation and foveal sensitivity which all relate to localized depression in sensitivity were similar in both groups. The achromatic perimetric parameters were not different between the groups. We conclude that the short-wavelength-sensitive cones are vulnerable to damage from hyperglycemia and this influence can be detected early by blue-on-yellow perimetry in diabetic patients without retinopathy.

Anatomic outcome of scleral buckling surgery in primary rhegmatogenous retinal detachment

PurposeTo evaluate the factors affecting the anatomic success of treatment of retinal detachments (RD) by scleral buckling surgery.MethodsOne-hundred and two eyes of 102 patients with rhegmatogenous RD operated on by scleral buckling surgery were included in the study. Results were analyzed according to the anatomic status of the retina at the most recent follow-up examination. The chi-squared test was used to determine the relationship between preoperative and intraoperative variables and anatomic results, and the relative risk of failure was determined for each variable.ResultsRetinal reattachment was achieved in 85 of 102 eyes (82.5%) after initial surgery. The success rate for anatomic reattachment was 95% after two operations. After three operations reattachment was achieved for 98 eyes (96%). Predictive factors for anatomic failure (P<0.05) were the presence of grade C1 PVR and multiple breaks.ConclusionGrade C1 PVR and multiple breaks were found to be significant risk factors for anatomic failure in rhegmatogenous RD treated by conventional buckling surgery.

Effect of corneal wetting solutions on corneal thickness during ophthalmic surgery.

Purpose: To measure the changes in corneal thickness with wetting solutions used in ophthalmic surgery. Settings: Ege University, School of Medicine, Department of Ophthalmology, İzmir, Turkey. Methods: Thirty‐one adult pigmented rabbits that weighed about 2.5 kg each were anesthetized with pentobarbital sodium. The rabbits were randomly divided into 3 groups to receive 3 wetting solutions: Group 1, Ringers lactate; Group 2, balanced salt solution (BSS®); and Group 3, BSS with glutation (BSS Plus®). The solutions were dropped on the right cornea of the rabbits at a rate of 6.0 cc in 12 minutes using an intravenous infusion pump. Corneal thickness was measured by ultrasonic pachymetry before and after the procedure, and the between‐group changes in corneal thickness were compared. Results: The corneal thickness before and after the procedure was 361.27 &mgr;m ± 19.3 (SD) and 380.00 ± 25.0 &mgr;m, respectively, in Group 1 (P = .000); 372.10 ± 18.8 &mgr;m and 388.60 ± 24.1 &mgr;m, respectively, in Group 2 (P = .003); and 358.10 ± 26.5 &mgr;m and 360.10 ± 24.1 &mgr;m, respectively, in Group 3 (P = .316). Conclusion: As a corneal wetting solution, BSS Plus resulted in significantly fewer changes in corneal thickness than Ringers lactate or BSS. This should be considered in cases involving long intraocular surgery.

Asymptomatic Cytomegalovirus Retinitis after Cardiac Transplantation

Purpose: To determine the prevalence and the risk factors of cytomegalovirus (CMV) retinitis after cardiac transplantation in visually asymptomatic patients. Methods: Ophthalmoscopic examinations including fundus fluorescein angiography were performed in asymptomatic patients who had cardiac transplantation at Ege University Hospital between April 1998 and June 2002 to screen for evidence of diagnostic CMV retinitis lesions to determine the prevalence in this population. Results: Thirteen patients (aged 40 ± 12.6) who had cardiac transplantation underwent ophthalmoscopic examination 2–50 months (23.5 ± 16.2 months; mean ± SD) after transplantation. All recipients had positive serology to CMV before transplantation. During the study period, 3 patients developed asymptomatic CMV reactivation. One patient developed CMV disease (pneumonia). All of the patients were visually asymptomatic during the study period. Two patients (15%) had a history of diabetes mellitus and chronic severe arterial hypertension. Seven recipients (53%) had been heavy cigarette smokers and 3 patients (23%) had hyperlipidemia. Two (15%) of 13 patients with arterial hypertension and diabetes had evidence of asymptomatic active CMV retinitis. These patients were treated with intravenous ganciclovir. Conclusions: Active cytomegalovirus retinitis lesions were found in 2 (15%) of 13 cardiac transplantation patients who had no visual symptoms. We think that the patients with systemic microvascular risk factors such as diabetes, hypertension and smoking should be screened closely for the development of CMV retinitis after cardiac transplantation even if the patients have no visual symptoms.

Evaluation of posterior vitreous detachment after uneventful phacoemulsification surgery by optical coherence tomography and ultrasonography

The aim was to investigate the effect of uneventful phacoemulsification on vitreoretinal interface evaluated by optical coherence tomography (OCT) and ultrasound.

The Prevalence and Characteristics of Charles Bonnet Syndrome in Turkish Patients with Retinal Disease

Purpose: The aim of this study is to investigate the prevalence and clinical characteristics of Charles Bonnet syndrome (CBS) in a group of Turkish patients with various retinal diseases. Methods: Two hundred and sixty-four patients with a best-corrected visual acuity of ≤20/40 in the better-seeing eye were asked with a standardized question whether they had symptoms of CBS. If they responded positively, a questionnaire was verbally administered to learn more about the details of the symptoms. Results: There were 125 (47.3%) females and 139 (52.7%) males with a mean age of 72.1 years (range 31-90). Seventeen (6.4%) patients were diagnosed with CBS. Three (17.7%) patients had noncomplex hallucinations and 14 (82.3%) had complex hallucinations. Conclusion: CBS is not uncommon in visually impaired patients with retinal disease. Clinicians who care for visually impaired patients should be aware of CBS.

Illuminated endochopper in the management of posteriorly dislocated lens nucleus

&NA; We describe the use of an illuminated endochopper (a prototype instrument produced by DORC International) in the management of a posteriorly dislocated lens nucleus or lens particles. This instrument helps to divide the lens nucleus or its fragments into small pieces and thus reduces time and ultrasound energy.

Comparison of Achromatic and Blue-on-Yellow Perimetry in Patients with Resolved Central Serous Chorioretinopathy

Central serous chorioretinopathy (CSCR) is a disorder characterized by the serous detachment of the sensory retina in the posterior pole. Although CSCR usually resolves spontaneously, the patients may notice residual visual deficits, despite recovering normal visual acuity. The aim of this study is to compare the blue-on-yellow perimetric parameters with conventional automated perimetric parameters in the detection of visual deficits in patients with resolved CSCR. Eighteen patients who had spontaneous recovered from CSCR were enrolled this study. All subjects were examined twice with each type of perimetry. Wilcoxon test was used for statistical analysis. The achromatic perimetric mean deviation values were significantly higher in patients with CSCR than in the control group, while statistically a significant difference was determined for all of blue-on-yellow perimetric values. In conclusion the loss of central retinal sensitivity remains after resolution of the CSCR even if the visual acuity has recovered to normal. Blue-on-yellow perimetry is more sensitive than achromatic perimetry to reveal this central sensitivity loss.