Güler Zilelioğlu

Adjunctive use of mitomycin C on endoscopic lacrimal surgery.

AIMS Endoscopic endonasal dacryocystorhinostomy (DCR) has some advantages over external DCR as a less invasive method with no skin incisions. But the success rate of the operation has not reached the level of external method. In this study, a wound healing inhibitor mitomycin C was used intraoperatively to prevent the closure of the osteum after the operation. METHODS Endoscopic endonasal DCR was performed on 40 eyes of 39 patients (26 female, 13 male). Mitomycin C was applied to the ostium in 14 of 23 patients who had undergone primary endoscopic DCR by means of a microdrill and in eight of 17 patients who had a revision endoscopic DCR secondary to a previously failed external DCR. RESULTS The postoperative follow up period was 9–27 (mean 18.2) months. The success rate of endoscopic DCR with intraoperative mitomycin C was 77.3%, whereas the success rate of endoscopic DCR without mitomycin C was 77.8%. The statistical analysis did not show a difference between the two groups according to the ostium size and their success rates. CONCLUSIONS Adjunctive use of a wound healing inhibitor is considered to increase the success rate of endoscopic endonasal DCR. Its intraoperative use seems to be easy and safe. But the study of this limited series shows no benefit in using it.

Histopathologic Effects of Mitomycin-C on Endoscopic Transnasal Dacryocystorhinostomy

BACKGROUND AND OBJECTIVES The antimetabolite mitomycin-C is now being used in endoscopic transnasal dacryocystorhinostomies to prevent the closure of osteotomies. PATIENTS AND METHODS A 0.5-mg/ml solution of mitomycin-C was applied to the osteotomy site for 2 1/2 minutes intraoperatively. Specimens from four patients were collected during surgery and at 15 days, 1 months, 3 months, and 6 months after surgery. The specimens were examined under light and electron transmission microscopy and were compared with control specimens. RESULTS Light microscopy showed attenuated epithelium with intracytoplasmic vacuoles. Subepithelial connective tissue was looser and hypocellular. Electron microscopy confirmed these findings and demonstrated swelling of mitochondria, dilatation of endoplasmic reticulum, and chromatin-dense granules in nuclei of fibroblasts. CONCLUSION By causing a decrease in density and cellularity of mucosa, topical use of mitomycin-C may enhance the success of surgery; however, further studies are necessary to determine the ultimate potential of this agent for this procedure.

Corneal topography in patients with congenital ptosis

Purpose To determine the effect of congenital ptosis on corneal shape, and to assess the role of these topographic changes in the development of amblyopia.Methods Twenty-two patients with congenital ptosis were examined and a corneal topographic examination performed in both the ptotic and normal eyes. The qualitative corneal classification was done according to the colour-coded topographic maps. The surface regularity index (SRI) and the surface asymmetry index (SAI) were used as quantitative descriptors of the study.Results Ptotic eyes had an increased incidence of astigmatism, bow tie pattern on corneal topography, corneal asymmetry (SAI, p < 0.05) and corneal irregularity (SRI, p < 0.05). Lack of mirror-image symmetry with the fellow eye was higher in amblyopic eyes.Conclusion Eyes with congenital ptosis have an increased incidence of astigmatism and a bow tie pattern on corneal topography. These features are associated with the presence of amblyopia.

Ciliary body thickness in unilateral high axial myopia.

PurposeTo compare the thickness of the ciliary bodies of eyes with unilateral high axial myopia with their relatively normal fellow eyes.MethodsA total of 19 patients with unilateral high axial length (AL) were included in the study. Mean patient age was 28.4±10.4 (11–44) years. All eyes underwent ultrasound biometry to measure the AL, and ultrasound biomicroscopy to measure the anterior chamber depth, ciliary body thickness (CBT), and ciliary process thickness (CPT), ciliary muscle thickness (CMT). The results were compared between each subjects high myopic eye and relatively normal fellow eye.ResultsThe mean AL was 27.24±1.52 mm (range: 25.16–30.21 mm) in high myopic eyes and 23.64±0.86 mm (range: 22.47–25.10 mm) in normal fellow eyes. The median ±95% confidence interval of CBT, CPT, and CMT was 1.350±0.034, 0.626±0.072, and 0.698±0.057 mm, respectively, in high myopic eyes and 1.211±0.050, 0.535±0.064, and 0.644±0.065 mm, respectively, in normal fellow eyes. The anterior chamber depth, CBT, CPT, and CMT were significantly higher in myopic eyes compared with their relatively normal fellow eyes (P<0.05). CMT significantly increased with age in both groups (P<0.05). There was no significant correlation between age and CBT in both the groups (P>0.05).ConclusionThe CBT, CMT, and CPT are significantly higher in eyes with unilateral high axial myopia than in their relatively normal fellow eyes.

The effect of topical cyclosporine A on clinical findings and cytological grade of the disease in patients with dry eye.

Purpose: To compare the clinical findings and the cytological grade of the disease before and after 6 months of topical cyclosporine A treatment in patients with dry eye. Setting: This single-center prospective study was performed at the Department of Ophthalmology, Ankara University School of Medicine, between January 2007 and June 2008. Method: Forty-five patients with dry eye (with 5 mm/5 minutes or less Schirmer test) were included in the study. Patients were treated with cyclosporine A 0.005% ophthalmic emulsion (RESTASIS) twice daily in addition to lubricant eyedrops 5 times a day. Schirmer test values, tear breakup time (BUT), and impression cytology (goblet cell density, nucleus to cytoplasmic ratio, and epithelial cell morphology) were evaluated at baseline and after 6 months. Results: Before and after 6 months of the treatment with topical cyclosporine A, the median Schirmer test scores were found as 3.00 and 4.00 mm, respectively. The median BUT score at baseline was 4.00 seconds, and after treatment, the median score was 5.00 seconds. There were statistically significant differences in the median Schirmer and BUT values between, before, and after 6 months of treatment (P < 0.05). The mean cytological grade according to Nelson grading system was 1.84 at baseline and 1.51 after treatment with topical cyclosporine A for 6 months. Statistically significant improvement in cytological grades after treatment was observed (P < 0.05). Conclusion: Treatment of patients with dry eye for 6 months with topical cyclosporine A resulted in an increase in Schirmer test results, an increase in BUT scores, and an improvement in cytological grade of the disease.

The Results of Late Probing in Congenital Nasolacrimal Duct Obstruction

Purpose: To evaluate the results of lacrimal probing in children at or older than 1 year of age with congenital nasolacrimal duct obstruction. Materials and Methods: Fifty eyes of 38 children (24 males, 14 females) with congenital epiphora who underwent nasolacrimal duct probing were evaluated in a prospective study. The age of the patients was between 12 and 101 months (mean: 33 months). Success of probing was defined as complete resolution of preoperative symptoms and signs. The mean follow-up was 8 months (3–28 months). Results: The success rate of probing was 88% (44/50 eyes). Residual epiphora was observed in 6 eyes of 4 patients (12%). Age of the patient, gender, the frequency of epiphora before probing and the unilaterality or bilaterality of epiphora did not correlate with the success of probing (p > 0.05). Conclusion: Nasolacrimal duct probing is advocated as a primary treatment in children younger than 9 years of age before proceeding to more complex treatment options. Unsuccessful probing may result from the selection of nonmembranous obstructions rather than the increased age of the patients.

The Use of Ultrasound Biomicroscopy in the Evaluation of Anterior Segment Tumors and Simulating Conditions

Purpose: To report the ultrasound biomicroscopy (UBM) findings of anterior segment tumors and simulating conditions. Methods: Thirty-five patients underwent UBM. Of those, 16 had histopathologically or cytopathologically diagnosed tumors, and 19 had clinically diagnosed lesions. Results: The study material comprised 13 iris pigment epithelial (IPE) cysts, 7 ciliary body melanomas, 4 iris melanomas, 4 iris nevi, 3 intraocular invasions of conjunctival squamous cell carcinoma, 2 ring melanomas of the anterior chamber angle, 1 medulloepithelioma and 1 pars plana cyst. On UBM, all IPE cysts presented as cystic lesions with a thin cyst wall and no solid components. All ciliary body melanomas showed low to medium reflectivity, with cavitation in one case and extraocular extension in another. Iris melanomas presented as anterior (stromal) iris lesions with medium to high internal reflectivity. There was irregularity and convex bowing of the posterior iris plane in iris melanomas, a feature not seen in iris nevi. Intraocular invasion of conjunctival squamous cell carcinoma was evidenced as areas of medium to high reflectivity in the ciliary body and iris, loss of the acute angle shape and highly reflective spots in the anterior chamber. Conclusions: UBM was particularly useful in the diagnosis of IPE cysts, in the visualization of small ciliary body melanomas, in the differentiation of iris melanomas from iris nevi and in the demonstration of intraocular invasion from conjunctival squamous cell carcinoma.

Drug-induced intraocular lens movement and near visual acuity after AcrySof intraocular lens implantation

Purpose: To evaluate the factors influencing AcrySof intraocular lens (IOL) (Alcon Laboratories) movement and near visual acuity after cyclopentolate 1% and pilocarpine 2%. Setting: Department of Ophthalmology, University of Ankara, Ankara, Turkey. Methods: Thirty eyes of 22 patients with AcrySof IOL implantation were included in this prospective study. Near visual acuity (Jaeger) at 35 cm through best distance correction without an add and pupil diameter were measured and correlated with anterior chamber depth (ACD) measured with ultrasound biomicroscopy (UBM) after application of cyclopentolate 1% and pilocarpine 2%, respectively. The magnitude of the change in the ACD was correlated with the accommodation amplitude, patient age, time interval between surgery and imaging, preoperative axial length, capsulorhexis diameter, ACD during cycloplegia, IOL diameter, and presence of posterior capsule opacification (PCO). Results: Near visual acuity significantly decreased after application of cyclopentolate 1% and increased after application of pilocarpine 2% (P<.001) in all eyes. The IOL moved anteriorly in 8 (26%) eyes and posteriorly in 22 (74%) eyes after pilocarpine 2%. There was no correlation between the ACD and near visual acuity under cyclopentolate 1% (r = 0.06, P>.05) or pilocarpine 2% (r = 0.04, P>.05). There was a moderate correlation between the anterior IOL movement and accommodation amplitude (P<.05, r = 0.42). There was no correlation between the magnitude of the IOL movement and patient age, time interval between surgery and imaging, the preoperative axial length, capsulorhexis diameter, ACD during cycloplegia, IOL diameter, and the presence of PCO (P>.05). Conclusions: There was better near visual acuity in all eyes with the AcrySof MAIOL, although most IOLs move slightly backward after of pilocarpine 2%. This points out pseudoaccommodation rather than pseudophakic accommodation. Ultrasound biomicroscopy is useful in determining the ACD and the relation between the IOL and the surrounding tissues after cataract surgery.

Ultrasound biomicroscopic evaluation of the efficacy of a transillumination technique for ciliary sulcus localization in transscleral fixation of posterior chamber intraocular lenses.

PURPOSE: To evaluate the efficacy of the transillumination technique for precisely locating the ciliary sulcus in transscleral fixation of posterior chamber intraocular lenses (PC IOLs) by determining the haptic positions with ultrasound biomicroscopy (UBM). SETTING: Department of Ophthalmology, Numune Training and Research Hospital, Ankara, Turkey. METHODS: Ultrasound biomicroscopy was used to determine the haptic positions in eyes with ab externo transsclerally fixated PC IOLs. Eyes were randomly assigned to a control group, in which transscleral fixation of a PC IOL was performed, or an endoilluminator‐assisted group, in which transscleral fixation was combined with transillumination. RESULTS: The study evaluated 33 eyes of 28 patients ranging in age from 16 to 81 years. The control group comprised 19 eyes (17 patients) and the endoilluminator‐assisted group, 14 eyes (12 patients). All haptics were easily visualized with UBM. The UBM examination showed that the rate of haptics located in the sulcus was statistically significantly higher in the endoilluminator‐assisted group (64%) than in the control group (24%) (P = .001). There was no significant difference in either group in the rate of precise sulcus location between the straight needle and the 28‐gauge insulin needle (P>.05). CONCLUSIONS: Ultrasound biomicroscopy showed the difficulty in reliably suturing the haptics in the ciliary sulcus, even with the use of a transillumination technique. However, the results suggest that the transillumination technique is a safe and easy procedure and helps the surgeon identify the ciliary sulcus during transscleral fixation of PC IOLs more precisely than without the use of transillumination.

Lacrimal sac dilatation in balloon dacryocystoplasty.

The authors report a case of balloon dacryocystoplasty in a patient who had a dilated lacrimal sac found in conventional surgery. A 52-year-old woman presented with persistent epiphora after a failed balloon dacryocystoplasty. She underwent an external dacryocystorhinostomy. The lacrimal sac was found to be dilated at its lower part, adjacent to the nasolacrimal ductus. Flaps were created more superiorly than usual. The operation was unsuccessful after 3 months. Previous balloon dacryocystoplasty, which is reported to be a harmless procedure, may pose some difficulty in subsequent conventional surgery.