Gul Arikan

Efficacy of Occlusion Treatment in Amblyopia and Clinical Risk Factors Affecting the Results of Treatment

Purpose: To evaluate the factors influencing visual outcome in strabismic, strabismic-anisometropic and anisometropic amblyopia following occlusion treatment. Methods: Records of 128 pediatric patients who had been treated for amblyopia by occlusion of the fellow eye between March 1992 and March 2003 were reviewed retrospectively. Age and level of visual acuity at initiation of treatment, occlusion time (full-time, part-time or minimal) and type of amblyopia were analyzed for the effect on visual outcome. Results: The mean age of the patients was 5.69 ± 2.01 years (3 to 12 years). Mean follow-up time was 3 years 2 months (6 months to 10 years). Mean visual acuity improvements were similar for the subtypes of amblyopia (strabismic amblyopia 0.38 ± 0.29 logMAR units, strabismic-anisometropic amblyopia 0.46 ± 0.40 logMAR units, anisometropic amblyopia 0.35 ± 0.24 logMAR units). Level of initial visual acuity, age at initiation of treatment and type of occlusion correlated with the final visual acuity (p = 0.000, p = 0.035, p = 0.012, respectively). When the analysis was performed according to the subtypes of amblyopia, initial visual acuity was the only factor associated with the final visual acuity in all types of amblyopia (p < 0.05). Conclusion: The level of initial visual acuity is the most significant factor determining the success of treatment in amblyopia.

Necrotic arachnidism of the eyelid due to Loxosceles rufescens spider bite

A 69-year-old woman was awakened with redness and swelling of the left upper eyelid a few days before her presentation. She also noticed a dead spider on her bed. Ophthalmic examination revealed severe left periorbital hyperemia, edema and a wide necrotic area on the upper eyelid. Systemic condition of the patient was well. She was hospitalized with the diagnosis of necrotic arachnidism of the left upper eyelid. Systemic corticosteroid and antibiotic treatment was commenced. No surgical intervention was carried out. A week later, whole upper eyelid was covered with a black eschar. This black eschar shrank with time, and it detached completely within 8 weeks and the lesion healed without a disfiguring scar. Meanwhile, the offending spider was identified as Loxosceles rufescens. Although rare, eyelid may be a biting site for Loxosceles spiders and a favorable result may be obtained with conservative management.

Involution of endophytic optic disc hemangioma with a single session of photodynamic treatment.

We report a 58-year-old otherwise healthy woman with unilateral endophytic optic disc hemangioma and associated serous retinal detachment and exudation. A standard verteporfin dose was given and a photodynamic treatment (PDT) protocol was followed. A moderate vitreous hemorrhage occurred four days after PDT. The hemangioma regressed markedly 6 weeks after the procedure and serous retinal detachment showed marked resolution.

Adherence of triamcinolone acetonide to various intraocular lens materials

PURPOSE: To determine the adherence of triamcinolone acetonide to various intraocular lens (IOL) materials. SETTING: Department of Ophthalmology, Dokuz Eylül University, İzmir, Turkey. METHODS: Four IOLs of 4 materials (single‐piece poly(methyl methacrylate) [PMMA], 3‐piece foldable silicone, 3‐piece hydrophobic acrylic, and single‐piece hydrophilic acrylic) were first immersed in triamcinolone acetonide (40 mg/mL) for 15 minutes and then bathed in a balanced salt solution for another 15 minutes. Afterward, each lens optic was examined under light microscopy and digital images were obtained with a digital color video camera. The percentage of optic area covered with triamcinolone acetonide was determined by image analysis. RESULTS: Mean triamcinolone coverage was 7.62% ± 4.06% (SD) for PMMA IOLs (range 1.97% to 11.43%), 9.09% ± 4.60% for silicone IOLs (range 4.70% to 15.32%), 8.75 ± 7.20% for hydrophobic acrylic IOLs (range 1.31% to 16.86%), and 23.16 ± 8.53% for hydrophilic acrylic IOLs (range 15.02% to 35.12%). Adherence of triamcinolone acetonide to hydrophilic acrylic lenses was statistically significant when compared with other IOL materials. CONCLUSION: Intraoperative triamcinolone injection may obscure visualization intraoperatively and postoperatively, especially in eyes with hydrophilic acrylic lenses, because triamcinolone acetonide seems to have a tendency to adhere to hydrophilic acrylic lenses in vitro.

Effect of diode laser cyclophotocoagulation on the anterior segment: an Orbscan Study.

Purpose: To evaluate the effect of transscleral contact diode laser cyclophotocoagulation (TCDLC) on corneal topography, central corneal thickness (CCT), and anterior-chamber depth (ACD). Methods: The Orbscan II system was used to determine the changes in corneal topography, CCT, and ACD before and after TCDLC in 25 eyes of 24 patients. Results: Mean prelaser astigmatism was 4.51 ± 1.81, 4.64 ± 3.47, and 5.40 ± 3.04 D at central and 3- and 5-mm zones, respectively. Mean postlaser astigmatism was 4.54 ± 2.59, 4.75 ± 3.33, and 5.57 ± 3.12 D at central and 3- and 5-mm zones at 10 days and 3.99 ± 2.01, 4.05 ± 2.20, 5.52 ± 4.60 D at 1 month, respectively, showing no statistically significant difference. Prelaser CCT was 540.72 ± 103.48 μm. Postlaser CCT was 617.08 ± 86.35 μm at 10 days and 569.88 ± 70.36 μm at 1 month. CCT was significantly thicker at 10 days compared with prelaser CCT, whereas CCT at 1 month was not statistically different. ACD showed a nonsignificant decrease after TCDLC from 3.77 ± 0.81 to 3.38 ± 0.85 mm at 10 days and 3.58 ± 0.78 mm at 1 month. Conclusions: TCDLC does not alter corneal topography or ACD significantly. However, CCT increases during the 10 days after TCDLC and returns to normal at 1 month, which might be related to the inflammation induced by cyclophotocoagulation. Increased CCT may lead to artificially high intraocular pressure measurements within the first 4 weeks after surgery.

Bilateral combined cilioretinal artery and central retinal vein occlusion

A rare case with bilateral combined cilioretinal artery and central retinal vein occlusion (CRVO) is reported in a 45-year-old man. Work-up was positive only for already-present type 2 diabetes. The patient first developed ischemic-type CRVO and cilioretinal artery occlusion in his right eye, and underwent successful trabeculectomy with mitomycin-C following panretinal and grid macular photocoagulation. The fellow eye developed a nonischemic type of CRVO and cilioretinal artery occlusion 4 years after the first episode with good visual outcome.

Anterior Migration of the Encircling Band: A Report of Two Cases

Aim: To reiterate the clinical course and management of the cases with anteriorly migrated encircling band. Report of the Cases: We describe two patients with the migration of a solid silicone encircling band through the insertions of rectus muscles after the successful retinal detachment surgery (cheesewiring phenomenon). While the first patient had also refractory secondary glaucoma and underwent transscleral diode laser photocoagulation several times, the second patient had high myopia with the axial length of 30.06 mm. In both cases, encircling band was cut without further complication. Conclusion: Cheesewiring phenomenon can be rarely seen after buckling procedures and retina specialists should be aware of this rare complication and its possible causes to prevent its

Photodynamic therapy as an adjunct to systemic treatment in a case with unilateral presumed vascularized choroidal tuberculous granuloma.

Intraocular tuberculosis cannot be diagnosed easily in some clinical circumstances. A 29-year-old otherwise healthy woman who was initially misdiagnosed and treated empirically with systemic steroids and sulfamethoxazole–trimethoprim for toxoplasmosis was referred to us for severe visual loss. We instituted quadruple antituberculosis treatment upon chest medicine consultation as all attempts, including consecutive intravitreal antibiotic injections, could not prevent the enlargement of lesion. Systemic antituberculosis treatment halted the fulminant course but the granuloma became vascularized. Because photodynamic therapy (PDT) has very recently been shown to reduce viable mycobacterial cells in animal experiments we performed PDT, and the vascularized tuberculous granuloma was successfully treated. PDT may have an antimycobacterial effect besides its well-known antiangiogenic effect.

Corneal Biomechanical Properties in Patients With Arcus Senilis.

Purpose: To compare the corneal biomechanical properties and intraocular pressure (IOP) levels in patients with and without arcus senilis (AS). Methods: Ocular response analyzer measurements were performed on the right eyes of 37 patients with AS (group 1) and 37 control eyes (group 2). Corneal hysteresis, corneal resistance factor, Goldmann-correlated IOP, and corneal compensated IOP were recorded with Ocular response analyzer. Spherical equivalent value of the refractive errors, axial length, central corneal thickness, and IOP measured with Goldmann applanation tonometer were noted for each study eyes. Statistical analyses were performed with Student t, Kruskal–Wallis, and Pearson correlation tests. Results: Mean age was 67.6 ± 9.8 years in group 1 and 65.3 ± 8.1 years in group 2 (P = 0.308). Mean corneal hysteresis and corneal resistance factor readings were 9.8 ± 0.9 versus 10.6 ± 0.8 (P < 0.001) and 10.05 ± 1.07 versus 10.9 ± 0.9 (P < 0.001) in groups 1 and 2, respectively. Mean corneal compensated IOP and Goldmann-correlated IOP values were found as 16.1 ± 3.3 mm Hg versus 15.8 ± 2.6 mm Hg (P = 0.719) and 15.1 ± 3.3 mm Hg versus 15.0 ± 2.6 mm Hg (P = 0.912) in groups 1 and 2, respectively. There was no statistical difference in IOP measured with Goldmann applanation tonometer, central corneal thickness, spherical equivalent value of the refractive error, axial length measurements, and mean keratometry readings between the 2 groups (P = 0.983, P = 0.289, P = 0.938, P = 0.886, P = 0.07, respectively). Conclusions: The mean corneal hysteresis and corneal resistance factor values of eyes with AS were lower when compared with the controls. This study demonstrated that AS may change the corneal biomechanical properties.

Combined transscleral fixation of an artificial iris prosthesis with an intraocular lens

Post-traumatic aniridia combined with aphakia may be seen after globe injury. Aside from esthetic aspects, partial or total loss of the iris tissue may also be related to various degrees of glare and photophobia. Such patients suffer from severe visual impairment secondary to aphakia. Herein we describe a novel surgical technique for the management of an aphakic eye with traumatic aniridia for a patient who underwent transscleral fixation of a custom-tailored artificial iris prosthesis combined with a rigid intraocular lens (IOL). Tight suturing of the IOL haptic eyelets on the silicone iris prosthesis and fixation of such a complex to the scleral wall may provide excellent cosmetic and functional outcomes in aphakic eyes with aniridia.