Huseyin Bayramlar

Medium-term outcomes of three horizontal muscle surgery in large-angle infantile esotropia.

PURPOSE To evaluate the medium-term motor outcomes of three horizontal muscle surgery in patients with large-angle infantile esotropia. METHODS The charts of 18 patients with large-angle (> 55 prism diopters [PD]) infantile esotropia who underwent bilateral medial rectus muscle recession and one lateral rectus muscle resection were retrospectively reviewed. Preoperative and postoperative deviations at last examination, overcorrections and undercorrections, necessity of additional horizontal surgery, and follow-up durations were recorded. RESULTS The median age of patients at surgery was 22 months (range: 10 to 168 months). Orthotropia to within 10 PD or less was achieved in 14 of 18 patients (78%) in a median follow-up of 32 months (range: 5 to 63 months). The mean preoperative deviation of 68.8 ± 9.54 PD decreased to a median of 1 PD (range: esotropia 30 to exophoria 4 PD) postoperatively (P < .005). Marked residual esotropia necessitating additional surgery occurred in 4 patients, but significant overcorrection was not observed. CONCLUSIONS The success rate of the three horizontal muscle surgeries appears to be high enough in medium-term follow-up in patients with large-angle infantile esotropia. Overcorrection that necessitates additional horizontal muscle surgery does not seem to be significant in the medium term, according to this study.

Effect of accommodation on corneal topography.

Purpose: To investigate the effect of accommodation on corneal topography in healthy subjects. Methods: Using a Nidek OPD-Scan ARK-10000, corneal topographic images, images of the iris, and the refraction of 18 eyes of 10 normal subjects with a mean age of 26.3 ± 7.1 years (median, 24 years; range, 19–41 years) were simultaneously obtained before and during fixation of a near target in the Department of Ophthalmology, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey. At baseline, iris landmarks, such as nevi and crypts, were identified on each iris image that were on opposite sides of the pupil and 180 degrees apart. A line was drawn on the iris images between these 2 landmarks. The same landmarks were identified on the iris images obtained when the eye was fixating at the near target. A line was drawn between the landmarks. The angular rotation of the lines relative to the vertical meridian was measured to assess cyclotorsion of the eyes during accommodation. Results: At baseline, the mean spherical equivalent refraction of the eyes was −0.78 ± 0.38 diopters (D) (range, −0.25 to −1.67 D) with <0.5 D of astigmatism. During a mean accommodative amplitude of −4.55 ± 2.04 (median, −4.25 D; range, −1.75 D to −8.12 D), there was no apparent difference in corneal topography and no statistical difference in mean keratometry (P = 0.26) or cyclotorsion (P = 0.74). Conclusions: During accommodation, the cornea does not change curvature and the eye does not appear to significantly cyclotort.

Sutureless intrascleral posterior chamber intraocular lens fixation

Reply : Intraoperative miosis was one of the most significant intraoperative problems and complications in the early use of femtosecond laser–assisted cataract surgery. Dr. Yeoh described the role of NSAID drops, which has almost been forgotten in recent years because of the quick and safe phacoemulsification technique. We have also known that during the early phase of femtosecond laser–assisted cataract surgery, intraoperative miosis was more common than during routine phacoemulsification. The possible causes are the mechanical effect of the patient interface and the role of bubble and gas formation within the anterior chamber and within the lens. We have known for some time that prostaglandins are strong bioregulatory substances with high potential within the eye and within the entire body. Prostaglandins are synthesized by the cyclooxygenase pathway, and the most important intraocular source is the nonpigmented epithelial layer of the ciliary body. Mechanical and thermal stimuli may increase the level of prostaglandins in the aqueous humor. Our working team has studied intraoperative miosis, as have other authors. Recently, Schultz et al. reported that the prostaglandin level is elevated in the aqueous following femtosecond laser pretreatment. The cause might be the mechanical effect of the patient interface and the bubble formation within the anterior chamber. Based on the experiences of femtosecond laser surgeons, it is strongly advised that preoperative NSAIDs be included in the dilation regimen. The personal experiences of

Is this really sutureless scleral intraocular lens fixation

Is this really sutureless scleral intraocular lens fixation? In their recent article, Ohta et al. describe a technique of sutureless intrascleral fixation of a posterior chamber intraocular lens (IOL). This definition does not seem to be correct. As the authors fixated the haptics in the scleral bed in the scleral groove using a nonabsorbable suture to prevent slippage, this is a modified sutured technique. If they had used an absorbable suture, the definition would apply. Ohta et al. stated that they encountered difficulty placing the haptics in the scleral tunnel with the 24gauge needle technique of Gabor et al. We agree with the authors because placement of the haptics using this technique may be difficult in some cases. Therefore, we developed the trocar-assisted sutureless intrascleral fixation IOL method. In previously reported techniques of sutureless intrascleral fixation, a nonabsorbable suture was not used. In our trocar-assisted technique, we placed a nonabsorbable suture transconjunctivally after placing the haptics in the scleral groove for stabilization during the early postoperative period and removing it 1 week later. Ohta et al. obtained a triangular-shaped flap. They did not mention how much of the haptics were inserted into the scleral bed. Despite a permanent suture, they reported IOL-related complications as 5%,which is higher than the rates in previous studies of sutureless intrascleral IOL fixation (0% to 4.8% except traumatic dislocations). The authors concluded that their technique was more secure and simpler than the others. We do not agree with this for the reasons mentioned above. Our trocar-assisted technique appears to be simpler and quicker. In conclusion, the technique that Ohta et al. presented may be considered a modified intrascleral fixation of the IOL rather than a sutureless method. In this

Evaluation of ocular findings in patients with vitiligo.

In this study, we aimed to investigate ocular manifestations in patients with vitiligo. Sixty‐one patients with vitiligo were included in the study. From the patients who referred for examination to the dermatology and ophthalmology clinic, 57 patients without any systemic disease were taken as the control group. In both groups, otorefractometry, keratometry, visual acuity test, intraocular pressure measurement, anterior segment, and fundus examinations of the eye with slit lamp, Schirmer test, and perimetry were carried out. The mean age was 24.54 ± 11.90 years and 23.03 ± 8.72 years in the patients and control group, respectively. The mean Schirmer test results were as follows: 16.74 ± 9.11 mm and 17.64 ± 9.41 mm for the right and left eyes of the patients, and 21.96 ± 12.51 mm and 23.42 ± 12.51 mm for the right and left eyes of controls, respectively. Of the patients, 36 eyes showed lenticular findings. However, only 12 eyes of the controls have some lenticular findings. Twenty‐nine eyes in the vitiligo group and four in the controls showed some fundus findings. When the two groups were compared with each other, there was a statistically significant difference between them in terms of Schirmer test results, lens, and fundus findings (P < 0.05 for all). However, there was no significant difference in terms of age, gender, visual acuity, refraction, keratometry, intraocular pressure, perimetry, and corneal findings (P > 0.05 for all). Patients with vitiligo may have more lenticular and retinal findings than normal. They can be more prone to dry eye syndrome as well.

Sutureless Intrascleral Fixated Intraocular Lens Implantation.

PURPOSE To review sutureless intrascleral intraocular lens (IOL) fixation methods. METHODS Review of published literature. RESULTS Sutureless intrascleral IOL fixation methods are newer and have been developed to eliminate the suture-related complications of sutured scleral fixation methods such as suture-induced inflammation or infection and IOL dislocation or subluxation due to suture degradation or suture breakage. Sutureless intrascleral fixation methods aim for intrascleral haptic fixation to achieve stability of the IOL. Various methods of sutureless scleral fixation have been described. Using a needle, a blade, or a trochar, sclerostomies are created in all techniques for intraocular access. Some surgeons prefer to create scleral tunnels, whereas others use scleral flaps for scleral fixation of haptics. The stability of IOLs is attained by the scar tissue formed around the haptics. CONCLUSIONS Short-term results of these new methods are acceptable; studies including more cases with longer follow-up are needed to determine their long-term success. [J Cataract Refract Surg. 2016;32(9):586-597.].

Investigation of Glutathione S-Transferase Isoenzyme Protein Expression in Patients With Pterygium.

Purpose: We investigated glutathione S-transferase (GST) enzymes in terms of their potential effects on the pathogenesis of pterygium. Methods: Twenty-six pterygium specimens and 15 normal conjunctival specimens of 15 control subjects were investigated. Expressions of GST (alpha, mu, pi, and theta) enzymes were assessed by immunohistochemical staining. A brown color in the cytoplasm and/or nuclei of epithelial cells was evaluated as positive staining for GST enzymes. For each antibody, the intensity of the reaction [negative (−), weak (1+), moderate (2+), or strong (3+)] was determined to describe the immunoreactions. Results: The median age was 52 years in the both groups. There was no significant difference between the groups in terms of age, sex, and intraocular pressure measurements (P > 0.05 for all). Of the 26 pterygium specimens, 15 (57.7%) (8 weak, 4 moderate, and 3 strong staining) were identified with GST pi-1 (GSTP1) expression and 20 (76.9%) (12 weak, 7 moderate, and 1 strong staining) with GST theta-1 (GSTT1) expression. Of the 15 control specimens, 4 (26.7%) (4 weak staining) were identified with the GSTP1 expression, and 1 (6.7%) with GSTT1 expression. GSTP1 and GSTT1 expressions were significantly higher in the pterygium specimens than in the controls (P = 0.043, P < 0.001; respectively). None of tissue specimens had positive staining for GST mu-1 or GST alpha-1 in both groups (both; P = 1.00). Conclusions: The significant increase of GSTP1 and GSTT1 expressions in pterygium may be because of the increased activation of GST in response to excessive free radical formation from ultraviolet exposure to maintain antioxidant capacity in pterygium.

Arcuate keratotomy on post-keratoplasty astigmatism is unpredictable and frequently needs repeat procedures to increase its success rate.

Purpose To evaluate the effectiveness and predictability of arcuate keratotomy (AK) for post-keratoplasty astigmatism and to present the complications and rate of repeat procedures. Methods Sixteen eyes from 14 patients were included. Paired 70–80° arc length AKs centred on the steep axis were carried out 0.5 mm within the graft–host junction. The depth of the AKs was set at approximately 80–90% of the depth of the cornea, based on a topographic pachymeter at the incision location. The outcome measures included preoperative and postoperative topographic astigmatism, uncorrected and corrected visual acuity, surgical complications and repeat procedures. Results In 12 of the 16 eyes (75%), at least one additional surgical procedure was required to obtain the desired result: suturing for overcorrection or wound gape in six eyes (38%), lengthening of the incisions for undercorrection in four eyes (25%) and additional AKs for marked astigmatic axis displacement in three eyes (19%). The mean preoperative astigmatism was 10.45±3.82 dioptres (D); the postoperative astigmatism at the last visit was 2.99±1.14 D (in a mean follow-up of 17.6±5.55 months). The efficacy index was 0.83 and the safety index was 1.68. Conclusions In treatment of post-keratoplasty astigmatism, AK does not have a good predictability. Additional procedures such as lengthening of the AK incisions for undercorrection or using compression sutures for overcorrection with significantly gaping wounds are frequently required to improve the final outcome.

Periorbital discoid lupus: a rare localization in a patient with systemic lupus erythematosus

A 40-year-old female patient with a 5-year history of systemic lupus erythematosus was referred to our policlinic with complaints of erythema, atrophy, and telangiectasia on the upper eyelids for 8 months. No associated mucocutaneous lesion was present. Biopsy taken by our ophthalmology department revealed discoid lupus erythematosus. Topical tacrolimus was augmented to the systemic therapeutic regimen of the patient, which consisted of continuous antimalarial treatment and intermittent corticosteroid drugs. We observed no remission in spite of the 6-month supervised therapy. Periorbital discoid lupus erythematosus is very unusual and should be considered in the differential diagnosis of erythematous lesions of the periorbital area..

Anterior segment optical coherence tomography evaluation of corneal epithelium healing time after 2 different surface ablation methods

Objectives: To compare epithelial healing time following laser epithelial keratomileusis (LASEK) and photorefractive keratectomy (PRK) with anterior segment optic coherence tomography (AS-OCT). Methods: This prospective interventional case series study comprised 56 eyes of 28 patients that underwent laser refractive surgery in the Department of Ophthalmology, Medipol University Medical Faculty, Istanbul, Turkey, between March 2014 and May 2014. Each patient was randomized to have one eye operated on with PRK, and the other with LASEK. Patients were examined daily for 5 days, and epithelial healing time was assessed by using AS-OCT without removing therapeutic contact lens (TCL). Average discomfort scores were calculated from ratings obtained from questions regarding pain, photophobia, and lacrimation according to a scale of 0 (none) to 5. Results: The mean re-epithelialization time assessed with AS-OCT was 3.07±0.64 days in the PRK group, 3.55±0.54 days in the LASEK group, and the difference was statistically significant (p=0.03). Mean subjective discomfort score was 4.42±0.50 in the PRK eyes, and 2.85±0.44 in the LASEK eyes on the first exam day (p=0.001). The score obtained on the second (p=0.024), and third day (p=0.03) were also statistically significant. The fourth (p=0.069), and fifth days scores (p=0.1) showed no statistically significant difference between groups. Conclusion: The PRK showed a statistically significant shorter epithelial healing time, but had a statistically significant higher discomfort score until the postoperative fourth day compared with LASEK.