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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

Efficacy of topical cyclosporin A 0.05% in conjunctival impression cytology specimens and clinical findings of severe vernal keratoconjunctivitis in children.

PurposeTo evaluate the efficacy of topical cyclosporin A 0.05% in managing the symptoms of severe vernal keratoconjunctivitis (VKC).MethodsFifty-four children with severe VKC were included in this study. All 54 patients were treated with topical cyclosporin A (CsA) 0.05% for 3 months. Ocular signs and symptoms were scored in all patients at entry and after 3 months. Conjunctival impression cytology specimens were examined on the day of enrollment and at the end of the treatment period.ResultsThe mean scores for severity of signs and symptoms significantly decreased after 3 months compared with those at entry (P < 0.001). The density of inflammatory cells in the conjunctival impression cytology specimens decreased significantly. No side effects of the treatment with CsA 0.05% eyedrops were observed.ConclusionsTopical CsA 0.05% eyedrops were found to be safe and effective in the treatment of patients with VKC. Consistent with these results, topical CsA may efficiently reduce conjunctival inflammation in severe VKC.

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.

Descemet membrane detachment after viscocanalostomy

PURPOSE To report a case that developed a large Descemet membrane detachment after viscocanalostomy. METHODS Case report. A 60-year-old man with primary open-angle glaucoma underwent viscocanalostomy RE. One day after surgery, a small, localized detachment of Descemet membrane was present at the operation site. Six months after surgery, he had a large superior Descemet membrane detachment involving his visual axis. RESULTS The Descemet membrane remained attached after descemetopexy with sodium hyaluronate and air. Final visual acuity was 20/80, and intraocular pressure was 17 mm Hg without medication. CONCLUSION Detachment of the Descemet membrane should be recognized as a potential complication of viscocanalostomy.

Incidence, clinical findings and management of intraoperative floppy iris syndrome associated with tamsulosin

Purpose:  To determine the risk ratios and incidence of intraoperative floppy iris syndrome (IFIS) during cataract surgery in patients using tamsulosin, and to assess management strategies for IFIS.

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.

Intravitreal bevacizumab combined with panretinal photocoagulation in the treatment of open angle neovascular glaucoma.

Purpose To evaluate the clinical efficacy of intravitreal bevacizumab (IVB) combined with panretinal photocoagulation in patients with open angle neovascular glaucoma (NVG). Methods Nine patients (9 eyes) with NVG participated in this study. Patients received IVB (1.25 mg) as the initial treatment for NVG and were followed up for at least 4 months. IVB was offered as the first treatment of choice to patients with NVG. Panretinal photocoagulation was performed as soon as feasible after the second week and completed in all patients the fourth week after IVB. The main outcome measures are resolution of INV, inhibition of peripheral anterior synechia (PAS), and controllability of intraocular pressure (IOP). Results The mean follow-up period was 5.6±1.4 months (range, 4–9 months). The mean IOP before treatment was 35.1±9.7 mmHg (range, 24–56) under medication before IVB treatment. After IVB and after combined treatment, the mean IOP was reduced to 22.8±8.1 mmHg (range, 9–33) and 13.0±4.0 mmHg (range, 7–20), respectively. The mean referral INV was 3.6±0.4 grade (range, 3–4) and reduced to 1.6±0.4 (range 1–2) grade after IVB and 0.6±0.8 (range 0–2) grade after combined therapy. By IVB, combined panretinal photocoagulation recurrence of INV was not observed. Conclusions In NVG, IVB treatment can reduce iris and angle neovascularization and inhibits further PAS formation temporarily. Panretinal photocoagulation inhibits neovascularization constantly. Therefore, management of open angle NVG is more feasible with bevacizumab combined with panretinal photocoagulation.

Mitomycin C Primary Trabeculectomy with Releasable Sutures in Primary Glaucoma

PURPOSE To evaluate the effects of mitomycin C and a releasable suture technique on outcomes of primary trabeculectomy in primary glaucoma patients. METHODS A prospective analysis of patients who underwent primary trabeculectomy with a mitomycin C concentration of 0.2 mg/mL for 2 minutes. For closing the scleral flap, releasable sutures were used in 18 patients (17 eyes), Group 1, or permanent sutures in 18 patients (20 eyes), Group 2. Clinical outcome factors including postoperative intraocular pressure (IOP), visual acuity, and incidence of complications were determined. RESULTS The mean follow-up periods were 8.1 +/- 1.3 months in Group 1 and 8.3 +/- 1.3 months in Group 2. The postoperative reduction in IOP was highly significant (P <.0001) at all time intervals in both groups. In all measurement of IOP before the second week, mean IOP in Group 2 was found significantly lower than the mean IOP in Group 1 (P =.01). No statistically significant differences were found between the groups at later mean IOP measurements. At the last visit, the complete success rate was 88.8% in Group 1 and 85.0% in Group 2. No serious complications such as hypotonous maculopathy were observed in any patient. CONCLUSION Primary trabeculectomy with mitomycin C in eyes with primary glaucoma showed effective IOP pressure reduction. There were no cases of serious complications. In the early postoperative period IOP was controlled better in the releasable suture group.

Distribution of central corneal thickness and intraocular pressure in a large population of Turkish school children.

Purpose: To determine the distribution of central corneal thickness (CCT) and intraocular pressure (IOP) in a population of Turkish school children and to evaluate the relationships between these values and both age and gender. Methods: A total of 30,320 eyes from 15,160 healthy school children aged 5–18 years were examined. CCT and IOP were measured using an ultrasonic pachymeter and a non-contact tonometer, respectively. Measurements were compared with age, gender, and parental consanguinity of subjects. Results: The mean age of the school children was 10.43 ± 2.54 years. For right eyes, mean CCT was 557.91 ± 34.26 µm and mean IOP was 14.15 ± 2.87 mmHg. Mean CCT was significantly thicker in males compared to females (P < 0.0001). Mean IOP was significantly higher in females compared to males (P < 0.0001). CCT in children aged 14 years and older was significantly thinner than that in the younger age groups (P < 0.0001). There was a significant difference among the age groups for IOP (P < 0.05). No significant differences were observed in CCT or IOP related to parental consanguinity (P = 0.538, P = 0.319, respectively). Conclusion: Mean CCT in Turkish school children is of comparable thickness to that in Western school children. CCT reached adult values around 14 years of age in our children. Furthermore, males had thicker CCT than females. IOP was lower in males than females, and increased with age.

Impression cytology, tear film break up, and Schirmer test in patients with inactive trachoma.

Schirmer I and tear film break up time (BUT) test were used to determine cytological changes and conjunctival surface epithelial morphology was investigated using impression cytology in patients with inactive trachoma; patients with mild and severe scarring, and control subjects, were compared. Schirmer I, BUT, and goblet cell populations were significantly lower whereas the grade of squamous metaplasia was significantly higher in patients with inactive trachoma. There was a close correlation between our findings and the clinical severity of trachoma.