Gungor Sobaci

A comparative study of recurrent pterygium surgery: Limbal conjunctival autograft transplantation versus mitomycin C with conjunctival flap

OBJECTIVE To compare the recurrence rate following treatment of recurrent pterygia using one of two techniques-limbal conjunctival autograft transplantation versus low-dose intraoperative mitomycin C (0.2 mg/ml) combined with conjunctival flap closure. DESIGN Randomized clinical trial. PARTICIPANTS Eighty-one patients with recurrent pterygia treated by limbal conjunctival autograft transplantation (n= 41) or mitomycin C combined with conjunctival flap (n= 40) participated. INTERVENTION Limbal conjunctival autograft transplantation or low-dose intraoperative mitomycin C application with conjunctival flap technique was performed on recurrent pterygium cases. MAIN OUTCOME MEASURES Recurrence of pterygium and postoperative complications. RESULTS During mean follow-up periods of 16+/-1.9 and 15.5+/-1.5 months, six recurrences (14.6%) in the limbal conjunctival autograft transplantation group and five recurrences (12.5%) in the mitomycin C group were observed (P=0.77). The difference between the mean ages of recurrent (26.4+/-8.0 years) and nonrecurrent (35.8+/-11.9 years) cases for all patients was statistically significant (P=0.014). Technically, limbal conjunctival autograft transplantation seemed to be more difficult. The most frequent complication in limbal conjunctival autograft transplantation was graft edema, whereas that in the mitomycin C group was superficial keratitis. CONCLUSION Both techniques showed similar recurrence rates in the treatment of recurrent pterygia. Although technically easier to perform, further follow-up is necessary to determine the long-term safety of low-dose intraoperative mitomycin C with conjunctival flap closure. The surgeons familiarity with either procedure should determine the method of choice.

Safety and Effectiveness of Interferon Alpha-2a in Treatment of Patients with Behçet's Uveitis Refractory to Conventional Treatments

PURPOSE To evaluate the intermediate-term safety and effectiveness of interferon alpha-2a (IFNalpha2a) in patients with Behçets uveitis (BU) refractory to corticosteroids and immunosuppressive agents. DESIGN Open, nonrandomized, uncontrolled, interventional, prospective study. PARTICIPANTS Fifty-three patients (106 eyes) with active, vision-threatening BU who failed to respond to conventional treatments. INTERVENTION In 53 patients, acute inflammation was suppressed with effective prednisolone dosage (1-2 mg/kg/day, tapered to 10 mg within 4-6 weeks). The patients were treated with IFNalpha2a 4.5 million international units (MIU) 3 times per week for the first 3 months followed by IFNalpha2a 3 MIU 3 times per week for the next 3 months. Observation or other treatment methods were performed according to the decision tree developed for this study. MAIN OUTCOME MEASURES Remission and complete response (primary outcome measures), frequency of uveitis attacks, visual acuity (VA), and adverse effects (secondary outcome measures). RESULTS During 2 years of follow-up (median 65 months, range 12-130 months), compliance with the therapy was excellent. At the end of 1-year follow-up, treatment response was obtained in 45 of 53 patients (84.9%). The mean attack rate of 3.6+/-1.1 per year (range, 2-8) decreased to 0.56+/-0.75 (range, 0-4) per year (P=0.001). Visual acuity improved (> or = 0.2 logarithm of the minimum angle of resolution units from initial VA) in 30 eyes (28.3%) and worsened in 12 eyes (11.3%). Five patients (9.4%) did not respond to the initial treatment, and 3 patients (5.6%) developed severe adverse effects, including psoriasis, epileptic seizure, and extreme tiredness. Fifteen patients (28.3%) were off treatment for all the medications and disease free for 28+/-13.1 months (range, 12-50 months). CONCLUSIONS These results suggest that IFNalpha2a may be a valuable treatment option in BU that is refractory to corticosteroids and conventional immunosuppressive agents. The possible role of IFNalpha2a as a first-line agent in BU should be validated in randomized controlled clinical trials against newly described biologic agents. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Ocular Trauma Score in childhood open-globe injuries

BACKGROUND To assess prognostic value of the Ocular Trauma Score (OTS) in childhood open-globe injuries. METHODS This retrospective, interventional case series included 61 children with open-globe injuries. Certain numerical values rendered to the OTS variables (visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment, afferent pupillary defect) at presentation were summated and converted into OTS categories; the likelihood of the final visual acuities in the OTS categories were calculated, and compared with those in the OTS Study. RESULTS Age ranged from 3 years to 14 years (mean, 8.0 years). Forty-two boys and 19 girls were included. Follow-up ranged from 6 months to 56 months (mean, 18 months). The likelihood of the final visual acuities (no light perception, light perception/hand motion, 1/200-19/200, 20/200-20/50, and > or = 20/40) in the OTS categories (1 through 5) in this group were similar to those in the OTS Study group. CONCLUSIONS OTS calculated at initial examination may provide prognostic information in children with open-globe injuries.

The Use of Hyperbaric Oxygen Therapy in Ophthalmology

Hyperbaric oxygen therapy is a primary or adjuvant therapeutic method used in treatment of various acute or chronic disorders. Currently, eye diseases are among the off-label use of hyperbaric oxygen. However, there is an increasing body of evidence showing its safety and efficacy in retinal artery occlusion, cystoid macular edema secondary to retinal vein occlusion, scleral thinning and necrosis faced after pterygium surgery, orbital rhino-cerebral mucormycosis, nonhealing corneal edema, and anterior segment ischemia. Its potential to treat some blinding disease has also been pointed out in recent studies. This article constitutes an up-to-date summary of knowledge and therapeutic use of hyperbaric oxygen, and aims to contribute understanding of current and potential use of hyperbaric oxygen therapy in ophthalmology.

Comparison of tilt and decentration of 1-piece and 3-piece hydrophobic acrylic intraocular lenses.

Purpose: To determine the amount of tilt and decentration of 1‐piece and 3‐piece hydrophobic acrylic intraocular lenses (IOLs) in patients having cataract surgery. Setting: Department of Ophthalmology, Gülhane Military Medical Academy and Medical School, Ankara, Turkey. Methods: Eighty‐eight patients having phacoemulsification with IOL implantation were divided into 2 groups. One group received a 3‐piece hydrophobic acrylic IOL with 12.5 mm poly(methyl methacrylate) haptics and the other, a 1‐piece hydrophobic acrylic IOL with 12.5 mm haptics. The amount of IOL decentration and tilt was quantitated using Purkinje reflections and photographic documentation at the last postoperative control. The results of the 2 groups were compared. Results: Bag fixation of the IOL and an intact continuous curvilinear capsulorhexis (CCC) were confirmed in all cases at the last postoperative control, which was at a mean of 27.1 months ± 5.4 (SD) and 26.7 ± 4.4 months in the 3‐piece group and 1‐piece group, respectively (P = 0.659). There was no significant difference between groups in the percentage of patients with measurable tilt and decentration and of patients without measurable tilt and decentration (P = .956). The mean IOL tilt was 2.72 ± 0.55 degrees in the 3‐piece group and 2.70 ± 0.84 degrees in the 1‐piece group and the mean IOL decentration, 0.39 ± 0.13 mm and 0.34 ± 0.08 mm, respectively. There were no significant between‐group differences in tilt or decentration (P = .897 and P = .103, respectively). Conclusion: There were no significant differences in tilt and decentration between 1‐piece and 3‐piece hydrophobic acrylic IOLs in eyes with capsular bag IOL implantation and an intact CCC.

The effect of intraoperative antibiotics in irrigating solutions on aqueous humor contamination and endophthalmitis after phacoemulsification surgery

Purpose To determine the efficacy of intraoperative antibiotic use in irrigating solutions on aqueous humor contamination during phacoemulsification surgery and to evaluate the corresponding risk of postoperative endophthalmitis. Methods 644 eyes of 640 patients who underwent phacoemulsification surgery with foldable intraocular lens (IOL) implantation were included in this study. Preoperative conjunctival smears were taken and eyes were allocated to receive irrigating infusion fluid containing either balanced salt solution (BSS)-only (group 1; 322 eyes) or BSS with antibiotics (vancomycin and gentamycin) during surgery (group 2; 322 eyes). Bacterial contamination rates of aqueous humor samples taken in the beginning and at the end of operation were compared. Predictive factors for the development of postoperative endophthalmitis were determined by clinical and microbiologic analyses. Results The rates of culture-positivity were similar between group 1 and group 2 for both preoperative conjunctival smears and aqueous samples (p > 0.05). Aqueous samples taken at the end of operation were found to be contaminated in 68 (21.1%) eyes in group 1 and 22 (6.8%) eyes in group 2, and the difference was significant (p = 0.0001; OR = 3.65 (2.1–6.0)). Capsular rupture was associated with higher rate of contamination in both groups (p = 0.0001; OR = 7.7 and p = 0.0001; OR = 8.1). Two eyes in the BSS-only group developed postoperative endophthalmitis and these cases had posterior capsular rupture during the surgery and culture-positivity forstaphylococcus epidermidis throughout the study. Conclusions Intraoperative antibiotic irrigation decreases aqueous humor contamination during phacoemulsification. Further studies are warranted to determine the interrelationship between aqueous humor contamination and endophthalmitis in eyes with posterior capsular rupture.

ORIGINAL ARTICLE, Interferon Alpha-2A Treatment for Serpiginous Choroiditis

Purpose: To describe the management and long-term outcome of patients with serpiginous choroiditis (SPC) treated with interferon (IFN) alpha-2a. Design: Prospective, non-comparative case series. Participants: Five patients (8 eyes) with active vision-threatening SPC, who failed to respond and/or presented with side effects to the combination of steroid-cyclosporin-A or chlorambucil, at a tertiary care referral center. Intervention: The patients were treated with IFN alpha-2a (4,500,000 IU, 3 times a week for the first 3 months, followed by once a week for the next 3 months). Prednisone was also given initially, then tapered and discontinued. Main outcome measures: Visual acuity, control of inflammation, duration of drug-free disease remission, and side effects of IFN alpha-2a therapy. Results: Argon laser photocoagulation (ALP) was applied in three eyes with extrafoveal choroidal neovascular membrane (CNM). All active lesions, including complicating subfoveal CNM in one eye, resolved within six months. The patients had no recurrences and recovered (4 out of 8; 50%) or maintained (4 out of 8; 50%) useful vision during the 16–48-month follow-up. Except for flu-like symptoms at the beginning of the therapy, no noticeable adverse reaction was observed. Conclusions: IFN alpha-2a seems to be a novel treatment option for SPC. In the five patients (8 eyes) with SPC, who were intolerant or unresponsive to the combination of steroid-cyclosporin-A or chlorambucil, IFN alpha-2a treatment prevented recurrences and stabilized the lesions during the long-term follow-up (16–48 months). These promising results support the use of this mode of therapy in controlled clinical trials.

Fungal endophthalmitis caused by Aspergillus ustus in a patient following cataract surgery

The first case of postoperative endophthalmitis after cataract surgery caused by Aspergillus ustus, a species that has only rarely been implicated in human disease, is described. Six weeks after cataract surgery, a 67-year-old medically controlled diabetic patient presented with uveitis, mild ciliary injection and ocular discomfort. Anterior chamber paracentesis, vitreous tap and finally complete vitrectomy with removal of the capsular bag including the intraocular lens were performed and several sets of culture yielded A. ustus. Despite vigorous systemic (itraconazole and caspofungin) and intravitreal (amphotericin B and caspofungin) antifungal therapy, the endophthalmitis did not improve. The painful eye with marked inflammation was finally enucleated. In vitro susceptibility testing of the isolate showed that it appeared resistant to amphotericin B, caspofungin, itraconazole, voriconazole, and posaconazole, and susceptible to terbinafine.

Effects of multiple intravitreal anti-VEGF injections on retinal nerve fiber layer and intraocular pressure:a comparative clinical study

AIM To determine the effect of multiple injections of ranibizumab or bevacizumab on retinal nerve fiber layer (RNFL) and intraocular pressure (IOP) in patients with age-related macular degeneration (AMD). METHODS This retrospective study includes 35 eyes of 35 patients treated with intravitreal bevacizumab (IVB, 1.25mg/0.05mL) and 30 eyes of 30 patients with intravitreal ranibizumab (IVR, 0.5mg/0.05mL) who had Fast RNFL analysis (Stratus™); IOP measurements were taken 30 minutes and 24 hours after each injection. RESULTS The mean ages were 68.0±7.5 and 69.1±7.7 years in the IVR and IVB groups, respectively (P=0.55). They underwent (6.3±1.9) and (5.1±1.3) injections (P=0.07) over (13.6±2.1) and (14.05±2.6) months (P=0.45) in the IVR and IVB groups, respectively. Changes in overall and temporal RNFL thickness in IVR-treated eyes (105.3±6.9µm and 74.4±11.2µm) were not different from those in untreated eyes in the IVR group (104.6± 8.4µm and 75.1±12.6µm) (P=0.57 and P=0.41, respectively). Similarly, overall and temporal RNFL thickness in IVB-treated eyes (105.8±8.1µm and 74.5±11.8µm) were not different from those in untreated eyes in the IVB group (104.6±8µm and 74.8±12.9µm) (P=0.42 and P=0.80, respectively). The frequencies of IOP rise (P=0.60) and changes in RNFL thickness from baseline (P=0.16) were comparable between groups. CONCLUSION Repeated intravitreal injection of ranibizumab or bevacizumab does not seem have adverse effects on RNFL thickness or IOP in wet AMD patients.

Acute effects of cigarette smoking on multifocal electroretinogram.

Background:  Cigarette smoking was shown to have stimulant effects on pattern visual‐evoked potentials. The aim of this study was to investigate the acute effects of cigarette smoking on multifocal electroretinogram (mfERG).