K. Cemil Apaydin

Endoscopic Transnasal Dacryocystorhinostomy and Bicanalicular Silicone Tube Intubation

Purpose: To evaluate the results of endoscopic transnasal dacryocystorhinostomy (ETDCR) combined with bicanalicular silicone tube intubation (BSTI) performed in 49 patients with nasolacrimal canal obstructions secondary to chronic dacryocystitis. Material and Methods: ETDCR combined with BSTI was applied as a primary procedure in 47 cases, and as a secondary procedure in 2 cases. All patients underwent dacryocystography, and 41 patients underwent radionuclide dacryoscintigraphy before the surgery. Silicone tubes were left in place for about 6.2 months. The patency of the lacrimal passages was controlled with a clinical examination, nasolacrimal canal lavage, and dacryoscintigraphy. Results: Patients were followed up for a mean period of 25.1 months after the removal of the tubes. The epiphora symptom disappeared and a successful drainage could be maintained in 43 out of 49 cases (87.7%). The obstruction rate found in the dacryoscintigraphy performed 15 days after extubation was 22.9%, while it was found to be 14.2% in the nasolacrimal canal lavage. Conclusion: ETDCR combined with BSTI proved to be an effective surgical method in chronic dacryocystitis. The sensitivity and specificity of the postoperative dacryoscintigraphy in determining the surgical success were lower than those of the nasolacrimal canal lavage.

Menstrual cycle dependent changes in blue‐on‐yellow visual field analysis of young diabetic women with severe non‐proliferative diabetic retinopathy

Purpose: To evaluate menstrual cycle dependent changes on blue‐on‐yellow visual fields of diabetic women, and to compare the results with those of healthy women.

Serum Prolactin Levels in Behçet's Disease

PURPOSE Evaluation of serum prolactin levels in Behçets disease patients in Turkey. METHODS Serum prolactin levels were measured by radioimmunoassay (RIA) in 17 patients with ocular findings, and 20 patients without ocular findings of Behçets disease, and in 17 healthy volunteers. RESULTS The average prolactin levels were measured as 9.53 ng/mL in patients with ocular findings, 8.84 ng/mL in patients without ocular findings, and 9.59 ng/mL in healthy controls. There was no statistical significance among these three groups. Also, the average levels were 9.84 ng/mL in remission periods and 7.54 ng/mL in attacks. CONCLUSIONS In some studies, it has been suggested there is a correlation between high serum prolactin levels and activation of some autoimmune diseases, such as systemic lupus erythematosus and rheumatoid arthritis. However, we found no such correlation in Behçets disease. On the contrary, prolactin levels were lower in attacks than in remissions.

Iatrogenic retinal breaks caused by infusion fluid during pars plana vitrectomy.

OBJECTIVE To describe a series of cases of iatrogenic retinal breaks (IRBs) caused by the infusion fluid flow of a 25-gauge pars plana vitrectomy (PPV) system. DESIGN Retrospective case series. METHODS During 25-gauge PPV, 4 cases had IRBs caused by infusion fluid flow. The IRBs rapidly progressed to localized retinal detachment. RESULTS The first 3 cases had IRBs on the nasal quadrant midperiphery of the retina. The IRBs were treated with laser retinopexy and tamponade during surgery. Case 4 had a macular hole and macular detachment during scleral indentation. The IRBs seemed to be caused by intraocular pressure (IOP) control mechanisms of the vitrectomy device. CONCLUSIONS To prevent IRBs caused by infusion fluid flow, we recommend using an IOP control limit of 4 mL/min for 25-gauge vitrectomy, with valved cannulas. In addition, the surgeon must be cautious during scleral indentation and air-fluid exchange not to cause a rebound hypotonia.

Acknowledgement to the Reviewers

Iester Michele M., Genoa (Italy) Jandeck Claudia, Dillenburg (Germany) Jonas Jost B., Mannheim (Germany) Jordan Jens, Freiburg (Germany) Kashii Satoshi, Osaka (Japan) Katori Nobutada, Hamamatsu (Japan) Kazim Michael, New York, N.Y. (USA) Kishi Shoiji, Gunma (Japan) Kita Mihori, Shiga (Japan) Kitaoka Takashi, Nagasaki (Japan) Klauss Volker, München (Germany) Kniestedt Christoph, Zürich (Switzerland) Koh Adrian, Singapore (Singapore) Kohnen Thomas, Frankfurt (Germany) Konstas Anastasios G.P., Thessaloniki (Greece) Kotecha Aachal, London (United Kingdom) Kroll Peter, Marburg (Germany) Küchle Michael, Erlangen (Germany) Kurz Schmitz Sabine, Mainz (Germany) Kusaka Shunji, Osaka (Japan) Lagrèze Wolf A., Freiburg (Germany) Langmann Andrea, Graz (Austria) Lee Shu-Yen, Singapore (Singapore) Lorenz Birgit, Giessen (Germany) Lüchtenberg Marc, Frankfurt (Germany) Mackey David A., East Melbourne, Vic. (Australia) Menapace Rupert, Vienna (Austria) Mennel Stefan, Marburg (Germany) Mermoud André, Lausanne (Switzerland) Mester Ulrich, Sulzbach/Saar (Germany) Meyer Carsten H., Bonn (Germany) Meyer Peter, Basel (Switzerland) Meyer-Rüsenberg H.-W., Hagen (Germany) Michels Stephan, Zürich (Switzerland) Mimura Osamu, Hyogo (Japan) Mizota Atsushi, Urayasu (Japan) Mochizuki Manabu, Tokyo (Japan) Mohamed Moin, Leeds (United Kingdom) Mojon Daniel S., St. Gallen (Switzerland) Morse Lawrence S., Sacramento, Calif. (USA) Moshirfar Majid, Salt Lake City, Utah (USA) Murdoch Ian, London (United Kingdom) Nao-i Nobuhisa, Miyazaki (Japan) Ness Thomas, Freiburg (Germany) Olson Randall J., Salt Lake City, Utah (USA) Otani A., Kyoto (Japan) Pauleikhoff Daniel, Münster (Germany) Abe Haruki, Niigata (Japan) Alió Jorge L., Alicante (Spain) Araie Makoto, Tokyo (Japan) Augustin Albert J., Karlsruhe (Germany) Baatz Holger, Recklinghausen (Germany) Behrens-Baumann Wolfgang, Magdeburg (Germany) Birnbaum Florian, Freiburg (Germany) Blumberg Dana, Baltimore, Md. (USA) Brookes John, London (United Kingdom) Brusini P., Udine (Italy) Callizo Planas Josep, Marburg (Germany) Catoira-Boyle Yara, Indianapolis, Ind. (USA) Chee Soon-Phaik, Singapore (Singapore) Cheng Bobby, Singapore (Singapore) Chihara Etsuo, Kyoto (Japan) Clemens Stefan, Greifswald (Germany) Crandall Alan, Salt Lake City, Utah (USA) Cunha-Vaz José G., Coimbra (Portugal) Degenring Robert, Mannheim (Germany) Deuter Christoph, Tübingen (Germany) Dick H. Burkard, Bochum (Germany) Duncker Gernot I.W., Halle (Germany) Emmerich K.-H., Darmstadt (Germany) Esser Joachim, Essen (Germany) Forlini Cesare, Ravenna (Italy) Friedburg Dieter, Krefeld (Germany) Fries Ulrich, Bonn (Germany) Frisen Lars, Göteborg (Sweden) Geerling Gerd, Würzburg (Germany) Gelisken Faik, Tübingen (Germany) Goldblum David, Basel (Switzerland) Grunz Christiane, Marburg (Germany) Güell Joseph L., Barcelona (Spain) Gümbel Hermann O. C., Ulm (Germany) Guthoff Rudolf, Rostock (Germany) Hammer Beat, Aarau (Switzerland) Hansen Lutz Lothar, Freiburg (Germany) Haritoglou Christos, München (Germany) Hattenbach Lars-Olof, Ludwigshafen (Germany) Heiligenhaus Arnd, Münster (Germany) Helbig Horst, Regensburg (Germany) Hesse Lutz, Heilbronn (Germany) Holló Gábor, Budapest (Hungary) Holmes Jonathan, Rochester, N.Y. (USA) Holz Frank G., Bonn (Germany) Honda Shigeru, Kobe (Japan) Hörle Steffen, Marburg (Germany)

Effect of Laser Spot Diameter on the Reproducibility of Visual Field Analysis in Diabetic Patients with Upper Temporal Retinal Vein Occlusion

Aim: To evaluate the effect of the laser spot diameter on the reproducibility of the visual field analysis in diabetic patients with upper temporal retinal vein occlusion. Material and Methods: Thirty-six eyes of 36 consecutive type-2 diabetes mellitus patients with upper temporal retinal vein occlusion who required sectoral retinal photocoagulation (SRP) treatment were enrolled for the study. Patients with a history of previous retinal laser photocoagulation, significant lenticular opacities and those whose perimetric test reliability criteria were low (fixation loss >20% and false-positive or false-negative responses >33%) were excluded from the study. SRP was applied to the upper temporal retinal quadrant. Nineteen eyes received SRP treatment with 500-µm laser spots (group 1) while the rest of the eyes (n = 17) received SRP with 300-µm laser spots (group 2). Patients underwent five consecutive visual field analyses, each on a different day during a 2-week period, both before and 6 weeks after SRP. The Humphrey field analyzer central 30–2 threshold test using SITA Standard strategy was applied for visual field testing. Results: The mean age of the patients in groups 1 and 2 were 58.6 ± 6.7 and 59.1 ± 7.1 years, respectively (p > 0.05). Pre-SRP mean retinal sensitivities of the lower nasal quadrant in groups 1 and 2 were not different statistically (p > 0.05). Post-SRP mean retinal sensitivity of the lower nasal quadrant was significantly higher in group 2 than group 1. Moreover, mean defect has been found to be lower in group 2 (p < 0.05). The coefficient of variation for pre-SRP retinal sensitivity measurements were 7.9 and 7.6% for groups 1 and 2, respectively (p > 0.05). The coefficient of variation for post-SRP retinal sensitivity measurements were 3.8 and 2.1% for groups 1 and 2, respectively (p < 0.05). Conclusion: SRP treatment with 300-µm diameter laser spots may yield more reproducible visual field data than that with 500-µm diameter laser spots. Moreover, the improvement in the retinal sensitivity of the patients with branch retinal vein occlusion is more marked in case where 300-µm laser spots are used.

Menstrual Cycle-Dependent Changes in White-on-White Visual Field Analysis of Diabetic Women

Aim: To determine the effect of the menstrual cycle on white-on-white perimetry (WWP) tests of diabetic women. Subjects and Methods: Left eyes of 129 normally menstruating women (81 type 1 diabetes mellitus (DM) with mild (n = 43) and severe (n = 38) non-proliferative diabetic retinopathy (NPDR), and 48 healthy control females) were included in the study. All subjects underwent complete ocular examination and WWP tests both in the follicular (7–10th day of the cycle) and luteal phases (days 3–7 before the bleeding) of two consecutive menstrual cycles. WWP was performed using Humphrey Field Analyzer II with SITA Standard, central 30-2 program. Mean sensitivity (MS) of points located at central 3, 9, 15, 21 and 27° retinal locations (4, 12, 18, 24 and 16 points, respectively) were calculated in all menstrual phases. Results: The mean age of diabetic patients with mild and severe NPDR and control subjects were 28.8 ± 4.7, 30.1 ± 5.9 and 29.4 ± 5.1 years, respectively (p > 0.05). Their mean MS values were 30.7 ± 1.0, 30.4 ± 1.0 and 30.8 ± 0.8 dB, respectively (p > 0.05). Diabetic patients with severe NPDR demonstrated significant decreases in mean MS values of peripheral 21 and 27° visual field locations in the luteal phase (p < 0.05). However, changes in that of the locations within central 15° visual field were non-significant (p > 0.05). Diabetic patients with mild NPDR and control subjects demonstrated no significant changes in mean MS values of any of the visual field locations (p > 0.05). Conclusion: Peripheral, rather than central, locations of central visual field of diabetic women with severe NPDR demonstrated a significant retinal sensitivity loss in the luteal phase. These findings should be taken into consideration during the clinical follow-up of diabetic women at risk of glaucoma and ocular hypertension.