Gursoy Alagoz

A Comparison of the Efficacy of Autologous Serum Eye Drops with Amniotic Membrane Transplantation in Neurotrophic Keratitis

Abstract Purpose: To investigate and compare the efficacy of autologous serum eye drops with amniotic membrane transplantation in eyes with neurotrophic corneal ulcers. Methods: In this retrospective study, 42 eyes of 42 patients (30 females and 12 males) with neurotrophic corneal ulcers were included and divided into group I (n = 20) who were treated with autologous serum eye drops and group II (n = 22) who underwent amniotic membrane transplantation. The epithelial healing time and best corrected visual acuity were performed before and after treatments. Results: In group I, the mean age was 57.1 ± 10.1 years; and at the end of 6.7 ± 2.05 months follow up, 14 (70%) of 20 eyes healed completely with a minimal scarring and vascularization. Two patients had persistent epithelial defects, four patients healed incomplete because of deep stromal ulcers in eyes with post-herpes neurotrophic ulcers. In group II, the mean age was 58.7 ± 14.7 years. Seventeen eyes (72.7%) of 22 patients healed completely and there was no recurrence in these patients at the 6.8 ± 3.9 months follow-up period. Two incomplete healed patients had persistent epithelial defects caused by HSV and the other three patients had deep stromal ulcers caused by the abuse of topical anesthetics. The mean epithelialization time was 22.1 ± 8.0 days in group I and 20.0 ± 4.64 days in group II. In group I, best corrected visual acuity improved in 18 of 20 (90%) eyes and 17 of 22 (77.2%) eyes in group II. Conclusions: Both autologous serum eye drops and amniotic membrane transplantation are effective for eyes with neurotrophic corneal ulcers because of many epitheliotrophic factors. Also, we observed that multilayered amniotic membrane transplantation is more effective than autologous serum in deep corneal ulcers with postherpes neurotrophic keratitis in our cases.

Changes in vision related quality of life in patients with diabetic macular edema: Ranibizumab or laser treatment?

PURPOSE To compare the changes in vision related quality of life (VR-QoL) in patients with diabetic macular edema (DME) undergoing intravitreal ranibizumab (IVR) injection or focal/grid laser. MATERIAL AND METHODS In this prospective study, 70 patients with clinically significant macular edema (CSME) were randomized to undergo IVR injection (n=35) and focal/grid laser (n=35). If necessary, the laser or ranibizumab injections were repeated. Distance and near visual acuities, central retinal thickness (CRT) and The 25-item Visual Function Questionnaire (VFQ-25) were used to measure the effectiveness of treatments and VR-QoL before and after 6 months following IVR or laser treatment. RESULTS The demographic and clinical findings before the treatments were similar in both main groups. The improvements in distance and near visual acuities were higher in IVR group than the laser group (p<0.01). The reduction in CRT in IVR group was higher than that in laser treatment group (p<0.01). In both groups, the VFQ-25 composite score tended to improve from baseline to 6 months. And at 6th month, the changes in composite score were significantly higher in IVR group than in laser group (p<0.05). The improvements in overall composite scores were 6.3 points for the IVR group compared with 3.0 points in the laser group. Patients treated with IVR and laser had large improvements in composite scores, general vision, near and distance visual acuities in VFQ-25 at 6 months, in comparison with baseline scores, and also mental health subscale in IVR group. CONCLUSION Our study revealed that IVR improved not only visual acuity or CRT, but also vision related quality of life more than laser treatment in DME. And these patient-reported outcomes may play an important role in the treatment choice in DME for clinicians.

Toxic anterior segment syndrome after uncomplicated cataract surgery possibly associated with intracamaral use of cefuroxime

Purpose To report toxic anterior segment syndrome (TASS) after cataract surgery possibly associated with intracameral use of cefuroxime. Methods We conducted a retrospective chart review and analysis on the pre- and postoperative conditions of the subjects who had developed TASS. Results The patient group consisted of 17 patients. Tyndallization and fibrin fibers were positive in all eyes. In four eyes, hypopyon formation developed. These reactions diminished on the third day and fully resolved 1 week after the operations with the use of intensive topical steroid and mydriatic therapy. To determine the etiology of TASS, infusion fluid, viscoelastics, and intracameral antibiotic agent were changed respectively. After changing intracameral antibiotic agent from cefuroxime axetile to moxifloxacin no new cases of TASS were diagnosed. Conclusion All agents injected into the anterior chamber can cause TASS. Ophthalmologists and operating room staff need to pay careful attention to all drugs and irrigating solutions.

Conjunctival attachment of a tick: case report.

Abstract Purpose: To describe a case of conjuctival tick attachment and the method of removal with blunt forceps. Methods: Case report. Results: A 36-year-old man presented with a complaint of foreign body sensation in his right eye. He was found to have a tick (Ixodes spp) embedded in his conjunctiva. The tick was removed completely mechanically with a blunt forceps. The patient was examined and followed for tick-transmitted diseases. The patient had no systemic signs and symptoms in follow-up. Conclusions: The ophthalmologist should maintain an index of suspicion that tick infestation of ocular tissues may present in urban locations. Careful examination, obtaining serology to check for zoonoses, and complete removal should be performed to ensure an uneventful recovery.

Effect of cataract surgery on subfoveal choroidal and ganglion cell complex thicknesses measured by enhanced depth imaging optical coherence tomography

Purpose We aimed to evaluate the effect of cataract surgery on subfoveal choroidal thickness (CT) and ganglion cell complex (GCC) thickness, as measured by enhanced depth imaging-optical coherence tomography (OCT). Methods This prospective study included 30 eyes of 30 patients who had undergone uneventful phacoemulsification surgery for senile cataract but had no previous ocular surgery or other ocular abnormality. Best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure, axial length, and central corneal thickness were measured preoperatively. The operative times (OTs) and effective phaco times were also recorded in each case. OCT measurements were performed at the preoperative visit and 1 month after cataract surgery. Study of CT and GCC thickness changes was the primary objective, but central macular thickness (CMT) and peripapillary retinal nerve fiber layer (RNFL) thicknesses were also obtained by OCT. Results The mean subfoveal CT was 294.4±39.2 μm preoperatively and 301.4±39.9 μm postoperatively (P<0.001). The mean GCC thickness was 85.0±4.4 μm preoperatively and 89.2±5.3 μm postoperatively (P<0.001). The mean CMT was 247.9±17.6 μm preoperatively and 249.0±17.8 μm postoperatively (P=0.029). The mean RNFL thickness was 97.4±5.4 μm preoperatively and 101.7±5.6 μm postoperatively (P<0.001). Regression analysis showed that age, sex, axial length, central corneal thickness, operative time, and effective phaco time were not associated with CT changes (P=0.834, P=0.129, P=0.203, P=0.343, P=0.547, and P=0.147, respectively) and GCC thickness changes (P=0.645, P=0.542, P=0.152, P=0.664, P=0.448, and P=0.268, respectively) after cataract surgery. Conclusion Our results indicate that all subfoveal CT, CMT, as well as RNFL and GCC thicknesses are slightly affected after uneventful phacoemulsification surgery. After cataract surgery, the examiners should consider obtaining new baseline measurements.

Indications and clinical outcomes of capsular tension ring implantation in phacoemulsification surgery at a tertiary teaching hospital: A review of 4316 cataract surgeries.

PURPOSE To reveal the indications, clinical outcomes and complications of capsular tension ring (CTR) implantation in a series of consecutive phacoemulsification surgeries during a three-year interval. METHODS A review of all patients undergoing cataract surgery with insertion of a CTR between 2010 and 2013 was conducted at our tertiary teaching ophthalmology department. The demographic details of patients, indications and clinical outcomes of CTR implantation were evaluated. RESULTS Between 2010 and 2013, 4316 phacoemulsification surgeries were performed and of these surgeries CTR implantation was done in 41 eyes of 36 patients. The indications of CTR implantation were zonular dehiscence or weakness associated with mature cataract (29.2%), trauma (24.3%), pseudoexfoliation syndrome (19.5%), retinitis pigmentosa (14.6%), degenerative myopia (9.7%), and lens coloboma (2.4%). Posterior chamber intraocular lens (PCIOL) was implanted into the capsular bag in all eyes. Dislocation of PCIOL was not observed in any case. Transient IOP increased in 5 eyes (12%) and corneal edema in 14 eyes were noted. Posterior capsular opasification in 1 eye (2.4%), anterior capsule phimosis in 1 eye (2.4%) and cystoid macular edema in 1 eye (2.4%) were detected as late complications. CONCLUSION The frequency of CTR implantation was 0.97% due to our study. In complicated cataract surgeries, CTR implantation seems to improve clinical outcomes.

Serous retinal detachment in patients with macular edema secondary to branch retinal vein occlusion.

PURPOSE The aim of the present study was to evaluate visual acuity (VA) and central macular thickness (CMT) to assess the influence of serous retinal detachment (SRD) in eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS Sixty-one eyes with BRVO from 61 patients with ME were analyzed and divided into two groups according to the spectral domain optical coherence tomography (OCT) findings of SRD and cystoid macular edema (CME). All patients underwent complete ophthalmic examinations and OCT measurements (Cirrus, Carl Zeiss Meditec Inc, Dublin, CA). Patients with marked retinal hemorrhage, diabetic retinopathy, previous laser photocoagulation, and/or intravitreal injection were excluded. RESULTS The mean age of included patients (37 males, 24 females) was 65.4 ± 11.4 (53-77) years. There were 21 patients with SRD and 40 patients with CME. All of the 21 patients with SRD had CME. VA was significantly worse in the SRD group compared with the CME (non-SRD) group (0.82 ± 0.34 logMAR vs 0.64 ± 0.38 logMAR; P=0.005). Conversely, CMT was significantly greater in the SRD group than in the CME group (465 ± 115 µ vs 387 ± 85 µ; P=0.00004). CONCLUSION SRD may be associated with decreased VA. The prognosis of patients with BRVO and SRD requires further investigation.

Effects of artificial tear treatment on corneal epithelial thickness and corneal topography findings in dry eye patients

PURPOSE To investigate the effects of artificial tear treatment on central corneal epithelial thickness, and central, mid-peripheral and peripheral corneal thicknesses in patients with dry eye disease (DED). MATERIAL-METHODS Patients with DED underwent ocular examinations, including Schirmer-2 test, slit lamp examination for tear break-up time (BUT), corneal topography (CT) for measuring mean central, mid-peripheral and peripheral corneal thickness values and anterior segment optic coherence tomography (AS-OCT) for obtaining central corneal epithelial thickness. After artificial tear treatment (carboxymethylcellulose and sodium hyaluronate formulations) for one month, patients were examined again at a second visit and the results were compared. RESULTS Sixty-one eyes of 33 female dry eye patients (mean age: 38.3±5.7 years) were enrolled. The mean follow-up time was 36.4±3.3 days. The mean tear BUT and Schirmer-1 tests revealed significant improvement after treatment (P=0.000, P=0.000, respectively). Central corneal epithelium and mean mid-peripheral corneal thicknesses measured significantly higher after treatment (P=0.001, P=0.02). Changes in central and peripheral corneal thicknesses were not statistically significant. CONCLUSION Artificial tear treatment in dry eye patients seems to increase central corneal epithelial and mid-peripheral corneal thicknesses. Measurement of corneal epithelial thickness can be a useful tool for evaluation of treatment response in dry eye patients. Further long-term prospective studies are needed to investigate this item.

Factors influencing stereopsis in patients with both refractive accommodative esotropia and amblyopia

PurposePotential factors influencing stereopsis were investigated in patients with both refractive accommodative esotropia (RAE) and amblyopia.Materials and methodsA retrospective chart review was performed to find out all patients with the diagnosis of both RAE and amblyopia. Patients are classified into two groups: group 1 (with stereopsis) and group 2 (without stereopsis). Onset age of RAE, history of strabismus in family members, time of amblyopia treatment, mean spherical equivalent, anisometropia, ocular movement disorders, especially, overaction of inferior oblique (IO) muscle, visual acuity difference (VAD) between eyes, best-corrected visual acuity (BCVA) levels of amblyopic and normal eyes and the presence of alternation of fixation (AOF) were investigated as possible factors. These factors were compared statistically between groups.ResultsGroups 1 and 2 consisted of 21 and 26 patients, respectively. There was no statistical significant difference in terms of onset age of RAE, family history, amblyopia treatment, BCVA of normal eyes and anisometropia. IO overaction and higher VAD were found to be statistically different between groups (p: 0.019, p: 0.022, respectively). Besides, there was significant difference in terms of AOF and better BCVA in amblyopic eyes (p: 0.000, p: 0.009, respectively).ConclusionIO overaction, BCVA in amblyopic eyes, VAD and AOF were found to be potential risk factors for the development of stereopsis in patients with both RAE and amblyopia.

Is topical corticosteroid necessary in traumatic hyphema

PURPOSE To compare the outcomes in the management of traumatic hyphema treated with topical corticosteroid plus supportive therapy versus only supportive therapy. PATIENTS AND METHODS In this retrospective study, 206 patients were divided into two groups; group I, 98 eyes were treated with topical corticosteroid 12 × 1 and supportive therapy including bed rest, keeping the head elevated (45 degrees), and hydration. In group II, 108 eyes were treated with only supportive therapy. Hyphema size, initial and final visual acuities and intraocular pressure, time to hyphema clearance, and incidence of rebleeding were evaluated. RESULTS The time needed for hyphema resorption in the two groups were 60.25 ± 33.9 and 62.3 ± 28.9 hours respectively (P=0.62). There was no significant difference in rebleeding rate between the topical corticosteroid group (4.01%) and non-steroid group (6.48%) (P=0.67). The initial and final visual acuities were similar in the two groups (P=0.86). In Groups I and II, the average intraocular pressures were 19.7 ± 8.01 and 14.2 ± 10.2 mmHg respectively. The difference between the two groups was statistically significant (P=0.04). CONCLUSION Patients who were treated with topical corticosteroids were no less likely to experience a rebleed or a poor visual outcome than those treated with supportive therapy alone. Supportive therapy alone may be convenient and cost-effective management strategy in uncomplicated traumatic hyphema.