İhsan Çaça

Comparison of accelerated and conventional corneal collagen cross-linking for progressive keratoconus

Abstract Purpose: To compare outcomes of accelerated and conventional corneal cross-linking (CXL) for progressive keratoconus (KC). Materials and methods: Patients were divided into two groups as the accelerated CXL group and the conventional CXL group. The uncorrected distant visual acuity (UDVA), corrected distant visual acuity (CDVA), refraction and keratometric values were measured preoperatively and postoperatively. The data of the two groups were compared statistically. Results: The mean UDVA and CDVA were better at the six month postoperative when compared with preoperative values in two groups. While change in UDVA and CDVA was statistically significant in the accelerated CXL group (p = 0.035 and p = 0.047, respectively), it did not reach statistical significance in the conventional CXL group (p = 0.184 and p = 0.113, respectively). The decrease in the mean corneal power (Km) and maximum keratometric value (Kmax) were statistically significant in both groups (p = 0.012 and 0.046, respectively in the accelerated CXL group, p = 0.012 and 0.041, respectively, in the conventional CXL group). There was no statistically significant difference in visual and refractive results between the two groups (p > 0.05). Conclusions: Refractive and visual results of the accelerated CXL method and the conventional CXL method for the treatment of KC in short time period were similar. The accelerated CXL method faster and provide high throughput of the patients.

Accelerated corneal collagen cross-linking for progressive keratoconus

Abstract Purpose: To evaluate the efficacy of accelerated corneal cross-linking (CXL) procedure for progressive keratoconus. Materials and methods: Twenty-three eyes of 23 patients undergone accelerated CXL procedure were evaluated preoperatively and postoperatively at 1st, 3rd and 6th month for uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (CDVA), spherical error, cylindrical error, spherical equivalent (SE), keratometric values and thinnest corneal thickness (TCT) values with corneal topography by Scheimpflug camera and endothelial cell density (ECD). Results: The mean UDVA was improved from 0.97 ± 0.41 logarithm of minimal angle of resolution (logMAR) to 0.76 ± 0.45 logMAR at the 6th month after CXL (p = 0.332). The mean CDVA was improved from 0.49 ± 0.30 logMAR to 0.34 ± 0.22 logMAR at the 6th month after CXL (p = 0.026). The mean sphere was decreased from −4.47 ± 4.1 diopter (D) to −3.79 ± 3.86 D and the mean cylinder was decreased from −5.60 ± 2.2 D to −4.55 ± 1.98 D and the mean SE was decreased from −7.22 ± 4.48 D to −6.36 ± 4.34 D at the 6th month after CXL (p = 0.128, p = 0.002 and p = 0.045, respectively). Flat keratometry, steep keratometry, mean keratometry and maximum keratometry were significantly reduced at the 6th month after CXL (p = 0.025, p < 0.001, p = 0.004 and p = 0.03, respectively). TCT and ECD were not changed significantly the 6th month after CXL (p = 0.135 and p = 0.082, respectively). Conclusion: Accelerated CXL procedure was effective to stabilize progression of keratoconus with significant reduction in topographic keratometric values and significant increase in CDVA in 6 months.

Color Doppler Imaging of Ocular Hemodynamic Changes in BehÇet’s Disease

PurposeA prospective evaluation of the ocular blood flow velocity in patients with BehÇet’s disease was carried out to determine its changes.MethodsSubjects were divided into three groups: those with ocular involvement in BehÇet’s disease (group I), those without ocular involvement in BehÇet’s disease (group II), and a control group (group III). Twenty-seven eyes in group I and 28 eyes each in groups II and III were investigated. The blood flow in the central retinal artery (CRA), ophthalmic artery (OA), nasal posterior ciliary artery (NPCA), and the temporal posterior ciliary artery (TPCA) was measured using color Doppler ultrasonography (CDU) to determine the peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI). The mean blood flow velocity of the central retinal vein (CRV) was also measured. These results were then compared among the three groups of subjects.ResultsThe PSV values of CRA in groups I and II were found to be significantly lower than those in the control group (P ≪ 0.001, P = 0.018, respectively). The PSV values of CRA in group I were found to be significantly lower than those in group II (P ≪ 0.001). The EDV values of CRA in groups I and II were found to be significantly lower than those in the control group (P ≪ 0.001, P = 0.034, respectively). The EDV values of CRA in group I were significantly lower than those in group II (P = 0.041). The PSV values of OA in group I were significantly lower than those in the control group (P = 0.002). The EDV values of OA in group I were significantly lower than those values in group II or the control group (P = 0.001 and P = 0.037, respectively). The PSV values of NPCA in group I were significantly lower than those in the control group (P = 0.007). The PSV values of TPCA in groups I and II were significantly lower than those in the control group (P ≪ 0.001, P ≪ 0.001, respectively). The EDV values of TPCA in group I were significantly lower than those values in group II or the control group (P = 0.014 and P = 0.003, respectively). There were no significant differences in the mean blood flow values of the CRV among all three groups (P ≫ 0.05).ConclusionsThere are significant reductions in the blood flow values of the orbital arteries in patients with BehÇet’s disease, and they are more evident in those with ocular involvement. This might be the result of occlusive vasculitis, which is frequently seen in the retinal vessels of patients with BehÇet’s disease. Jpn J Ophthalmol 2004;48:101–105

Orbital Myiasis : Case Report

BACKGROUND Orbital myiasis cases are very rare worldwide. We are reporting this case caused by Hypoderma bovis because invasive parasitic larvae can cause massive destruction. CASE An 85-year-old female patient was admitted to the Department of Ophthalmology of the Dicle University School of Medicine with the complaint of a wound in her right eye for over one year. Larvae had been in the same eye for one week. OBSERVATIONS The clinical examination showed no light perception in her right eye. The eyelid was thickened and there was a necrotic lesion 3 x 4 cm in diameter, invading inferiorly into the upper side of the maxilla, superiorly to the roof of the orbita, medially to the lateral part of the nose, and laterally to the ossa zygomatica. Pathological examination of orbital tissue specimens confirmed basal cell carcinoma. CONCLUSIONS Orbital exenteration, total maxillectomy and graft repair were conducted in the right eye. During the six-month follow-up period, orbital tomography was performed. No recurrence or metastasis was observed.

Transient corneal endothelial changes following accelerated collagen cross-linking for the treatment of progressive keratoconus

Abstract Purpose: To evaluate the corneal endothelial changes following accelerated collagen cross-linking (CXL) for the treatment of progressive keratoconus. Methods: Thirty-six consecutive progressive keratoconus patients who received accelerated CXL treatment were enrolled in the study. Following de-epithelization, isoosmolar 0.1% riboflavin solution without dextran was instilled every 3 min throughout the 30 min of soaking time before the 5 min of 18 mW/cm2 UVA irradiation and every 2 min during the UVA irradiation. Corneal specular microscopy was performed on both treated and fellow eyes of each patient preoperatively, in the first week, and in the first, third and sixth month postoperatively. Results: There were significant differences in endothelial cell density (ECD), percentages of hexagonality (6A) and coefficient of variation of endothelial cell area (CV) in the first week and first month postoperatively in the treated eyes when compared to their preoperative values and also to the first week and first month ECD, 6A and CV values of the non-operative eyes. ECD returned to the preoperative values at sixth month whereas 6A and CV returned to the preoperative values at third month. Conclusion: Our results suggested that there may be transient changes in human corneal endothelium following accelerated UVA/riboflavin CXL. Resolution of these changes during the follow-up may indicate a safe recovery. However, the treatment guidelines for accelerated CXL including irradiance level and soaking time should be clearly established to minimize the toxic effects of the treatment.

Amblyopia and Refractive Errors Among School- Aged Children With Low Socioeconomic Status in Southeastern Turkey

PURPOSE To investigate the prevalence of refractive errors and other eye diseases, incidence and types of amblyopia in school-aged children, and their relation to gender, age, parental education, and socioeconomic factors. METHODS A total of 21,062 children 6 to 14 years old were screened. The examination included visual acuity measurements and ocular motility evaluation. Autorefraction under cycloplegia and examination of the external eye, anterior segment, media, and fundus were performed. RESULTS There were 11,118 females and 9,944 males. The average age was 10.56 ± 3.59 years. When all of the children were evaluated, 3.2% had myopia and 5.9% had hyperopia. Astigmatism 0.50 D or greater was present in 14.3% of children. Myopia was associated with older age, female gender, and higher parental education. Hyperopia was inversely proportional with older age. Spectacles were needed in 4,476 (22.7%) children with refractive errors, and 10.6% of children were unaware of their spectacle needs. Amblyopia was detected in 2.6% of all children. The most common causes of amblyopia were anisometropia (1.2%) and strabismus (0.9%). CONCLUSION Visual impairment is a common disorder in school-aged children. Eye health screening programs are beneficial in early detection and proper treatment of refractive errors.

Cutaneous Anthrax on Eyelids

BackgroundOphthalmologists should be aware of the signs and symptoms of anthrax, although it is a rare disease in humans. We report our successful treatment of three patients with cutaneous lesions in the periorbital area.CasesIn this study, we report on the treatment of three female patients who were initially diagnosed as having preseptal cellulitis.ObservationsGram-positive robs were revealed in the microscopic examination of scrapings taken from the lesions. Bacillus anthracis was found in only two of the three scraping-material cultures. Intravenous penicillin G was administered in all cases. Black and necrotic eschar, which is characteristic of anthrax, developed on the eyelids of all three patients during treatment. At the final examinations of the patients after the completion of treatment, we recognized the development of cicatrisation, lagophthalmos, and slight ectropion in the upper eyelid of the first patient, and, in the second patient, restriction of upper eyelid movement and development of a corneal scar from exposure keratopathy and ectropion. The cutaneous lesions healed without any eyelid pathology in the third patient.ConclusionAlthough it is a rare disease in humans, anthrax should be considered in the differential diagnosis of preseptal and orbital cellulitis.

Effects of vernal and allergic conjunctivitis on severity of keratoconus

AIM To demonstrate the effects of two different types of allergic conjunctivitis on severity of keratoconus (KC). METHODS We retrospectively reviewed the medical records of 171 KC patients referred between June 2010 and June 2011. The KC patients were divided into 3 groups as KC (group A), KC with vernal keratoconjunctivitis (VKC) (group B) and KC with allergic conjunctivitis (AC) (group C). Main outcome measures were demographic and ocular clinical features including age at presentation, gender, spherical equivalent (SE), best spectacle corrected visual acuity (BCVA), mean keratometric measurement (Km), central corneal thickness (CCT), and intraocular pressure (IOP). Groups were compared in term of study variables. RESULTS The median age at presentation was significantly lower in group B (P<0.001). According to the median SE (P=0.003), BCVA (P=0.022), Km (P<0.001), CCT (P=0.015) and Amsler-Krumeich classification (P<0.001), KC was more severe in group B. There was no significant difference in terms of IOP and corrected IOP among the groups (P=0.44), however there were 4 patients who had increased corrected IOP developed after topical corticosteroid use in group B. The differences among the groups persisted even after controlling for age and gender. CONCLUSION Our findings demonstrated a more severe KC in VKC patients despite their younger age which suggests evaluation of VKC patients as a separate group in keratoconus disease.

Intravitreal bevacizumab monotherapy for retinopathy of prematurity.

The aim of this study was to evaluate the treatment outcomes of intravitreal bevacizumab (IVB) injections, used as a monotherapy in type 1 retinopathy of prematurity (ROP).

The effects of Nd:YAG laser posterior capsulotomy on macular thickness, intraocular pressure, and visual acuity.

BACKGROUND AND OBJECTIVE To evaluate how different energy levels of Nd:YAG laser posterior capsulotomy affect best-corrected visual acuity (BCVA), intraocular pressure (IOP), and macular thickness of patients with posterior capsule opacification. PATIENTS AND METHODS Thirty eyes of 30 patients with posterior capsule opacification following phacoemulsification were enrolled in the study. Patients were classified according to total energy used during Nd:YAG laser capsulotomy (≤ 80 mJ = group I, > 80 mJ = group II). RESULTS Mean total energy levels were 58 ± 18 mJ (range: 14 to 80 mJ) in group I and 117 ± 36 mJ (range: 84 to 200 mJ) in group II. BCVA at 1 week preoperatively and 1 and 3 months postoperatively was significantly better compared to preoperative BCVA in both groups (P < .001). In group I, IOP increased 1 week postoperatively (P = .007) and declined to preoperative levels at 1 month. In group II, IOP increased 1 week postoperatively (P = .001) and did not return to preoperative levels during 3 months of follow-up (P = .04). Both groups had increased macular thickness compared to preoperative levels, but group II measurements were significantly higher 1 week and 1 month postoperatively compared to group I (P = .004 and .03, respectively). CONCLUSION Increased IOP and macular thickness are inevitable after Nd:YAG laser capsulotomy, but the severity and duration are less when a total energy level less than 80 mJ is used.