Kemal Yar

Topical anesthetic eye drops abuse: are we aware of the danger?

Abstract Objective: To investigate the clinical results of topical anesthetic drug (TAD) abuse and to evaluate the results in terms of preventive medicine and public health. Methods: Patients who had been followed in a cornea unit between March 2009 and November 2011 for TAD abuse keratopathy were included in the study. The demographics, duration of TAD use, symptoms, ocular findings, treatment modalities, visual acuities, complications and accompanying psychiatric problems data were obtained from medical records. Results: Twelve eyes of 8 patients (3 females and 5 males) were evaluated retrospectively. One of the patients was provided the drug with a primary care pratitioner’s prescription and for the other 7 patients, it was available from pharmacies without prescription. According to their clinical history, 4 patients were suffering from exposure to welding flash with a corneal foreign body, 2 from lagophthalmus-related keratopathy, 1 from traumatic corneal abrasion, and 1 from exposure to silica dust at work. The mean duration of TAD usage was 14.8 ± 7.78 days. Slit-lamp examination revealed corneal epithelial defect in all eyes, stromal opacity in 11 eyes and ring-shaped infiltrates in 8 eyes. Conclusion: Uncontrolled overuse of TAD can lead to serious ocular morbidities. Similarity of the clinical signs of this abuse to those of infectious keratitis together with the fact practitioners and managers to take measures to prevent the ready supply of these drugs from pharmacies and to raise public awareness with education programs.

Evaluation of the Innermost Retinal Layers and Visual Evoked Potentials in Patients with Multiple Sclerosis

ABSTRACT Purpose: The present study was conducted to investigate alterations in the innermost layers of the retina using optical coherence tomography (OCT) and to assess potential associations of structural measures with functional markers in patients with Multiple Sclerosis (MS). Materials and Methods: Ninety-four eyes of 47 MS patients and 60 eyes of 30 healthy individuals were included in the study. All patients underwent complete ophthalmological examination and OCT imaging to analyze peripapillary retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness. Visual evoked potentials (VEPs) and expanded disability status scale (EDSS) score were assessed for MS patients. Results: The average RNFL and GCIPL thicknesses were thinner in MS patients (86.2 ± 11.9 µm and 73.6 ± 9.7 µm, respectively) when compared with those of healthy controls (96.7 ± 8.2 µm and 85.9 ± 4.6 µm, respectively, p < 0.001 for both). Within MS patients, the average RNFL and GCIPL thicknesses were lower in eyes with a prior history of optic neuritis (MS ON) than in eyes with no optic neuritis history (MS non-ON) (p = 0.012 and p < 0.001, respectively). RNFL and GCIPL thicknesses were inversely correlated with VEP latency (r = −0.40, p < 0.001 and r = −0.36, p < 0.001, respectively) in MS patient eyes. There was a correlation between GCIPL thickness and VEP amplitude in eyes with previous ON history (r = 0.34, p = 0.035). No significant correlations were found between OCT measurements and EDSS score. Conclusions: Innermost layers of the retina are highly affected by the pathophysiologic process in MS disease, manifesting as a reduction in RNFL and GCIPL thickness. The structural retinal changes show correlation with alterations in potentials showing the optic pathway function.

A rare devastating complication of LASIK: bilateral fungal keratitis.

Purpose. To report an unusual case of severe bilateral fungal keratitis following laser in situ keratomileusis (LASIK). Method. A 48-year-old man developed bilateral diffuse corneal infiltration two weeks after LASIK. The corneal scrapings revealed fungal filaments but cultures were negative. Results. The corneal ulceration was improved on the left eye whereas spontaneous perforation occurred and finally evisceration was needed on the right eye despite topical and systemic antifungal treatment. Conclusions. Fungal keratitis, especially with bilateral involvement, is a very rare and serious complication of LASIK surgery. Clinical suspicion is crucial because most of fungal keratitis are misdiagnosed as bacterial keratitis and can lead serious visual results, even eye loss.

Guillain–Barré syndrome with hyperreflexia and bilateral papillitis in a child

Guillain–Barré syndrome (GBS) is an acute inflammatory polyneuropathy characterized by rapidly progressive symmetric weakness, and areflexia. Areflexia is necessary for the diagnosis of GBS. However, recently there have been studies of hyperreflexia with axonal neuropathy form of GBS. We report a 14-year-old boy with GBS, who presented with hyperreflexia and bilateral papillitis. To the best of our knowledge, this is the first pediatric patient presenting with papillitis and hyperreflexia with acute motor and sensory axonal neuropathy form of GBS.

Retinal Alterations Detected Using Optical Coherence Tomography in Children with Strabismus

The aim of this study was to compare the thickness of the retinal nerve fiber layer (RNFL) and fovea of strabismus cases with normal cases and assess the effect of amblyopia on the results. The partipicians were divided into four groups. Group 1 included both eyes (40 eyes) of strabismus patients without amblyopia. Patients eyes, who had stabismic amblyopia, divided in two group as amblyopic eyes (21 eyes in Group 2) and the other eyes ( 21 eyes in Group 3). Group 4 enclosed both eyes (40 eyes) of the controls. The thickness of the RNFL across the superior quadrant in Group 1 was thinner with respect to that of the control group (Group 4) (p<0.05). The mean thickness of the RNFL across the superior and inferior quadrants in Group 2 and Group 3 was thinner in comparison to Group 4 (p<0.05). Moreover, the macular thickness in the nasal quadrant was thicker in Group 3 than Group 1 (p=0.041). The macular thickness in the inferior quadrant was thicker in Group 2 than Group 1 (p=0.043). The thickness of the fovea center and macular temporal quadrant in Group 3 was thicker than Group 4 (p=0.04, p=0.005, respectively). In this study, that was observed the structural changes in the retina of the strabismus patients with and without amblyopia. These retinal alterations may be result of structural changes in lateral geniculate body in cases with amblyopia which has been reported in previous studies. Larger case series are needed to clarify this hypothesis.

Tedavi gerektirmeyen prematüre retinopatili yenidoğanlarda gecikmiş retina damar matürasyonuyla ilişkili faktörler

Amac: Bu calismanin amaci tedavi gerektirmeyen premature retinopatisi olan hastalarda, retinopatinin gerilemesinde gecikme ve retina damar maturasyonunda uzama ile iliskili olabilecek risk faktorlerini belirlemektir.Gerec ve Yontem: Tedavi gerektirmeyen premature retinopatili hastalar, retina damarlanmasinin 50. postkonsepsiyonel haftadan once tamamlanmis olup olmamasina gore kontrol ve gecikmis maturasyon grubu olarak ikiye ayrildi. Tedavi gerektiren premature retinopatili hastalar ise tedavi grubunu olusturdu. Premature retinopatisi hastalarinda retinanin damarlanma surecini etkileyebilecek 17 olasi risk faktoru gruplar arsinda karsilastirildi.Bulgular: Coklu regresyon analizinde, 5. dakikadaki dusuk Apgar skoru ve kan transfuzyonu oykusu kontrol grubu kiyaslandiginda gecikmis maturasyon ile iliskili bulundu. Gecikmis maturasyonlu hastalar tedavi gerektiren premature retinopatili bebeklerle kiyaslandiginda ise, dusuk dogum haftasi ve patent duktus arteriosus varligi, tedavi gerektiren premature retinopatisi gelismesi ile iliskili bulundu.Sonuc: Tedavi gerektirmeyen premature retinopatisi hastalarinda 5. dakikadaki Apgar skorunun dusuk olmasi ve kan transfuzyonu oykusu, retina damarlanmasinin uzun surede tamamlanacaginin habercisi olabilir. Dogum haftasinin yuksek olmasi ve patent duktus arteriosus bulunmamasi ise premature retinopatisi yavas gerileyen infantlarda tedavi gerekecek evrelere ilerleme riskinin dusuk olacagi konusunda fikir verebilir.

An unexpected delayed complication of cataract surgery: retinal detachment secondary to capsular tension ring dislocation.

We aim to present a case of retinal detachment secondary to capsular tension ring dislocation following cataract surgery. A 45-year-old man who underwent cataract surgery 2 years previously presented with decreased vision in his left eye. The patient’s posterior capsule was intact with a well-located posterior chamber intraocular lens. Fundus examination revealed retinal detachment with retinal tears, and a capsular tension ring located around the tear was noticed during pars plana vitrectomy; it was removed through the sclerotomy site. In conclusion, dislocation of the capsular tension ring is a rare and unexpected complication of cataract surgery. Although the integrity of the posterior lens capsule is partially preserved, the ring may shift through a small tear in the bag even during its placement, and may cause retinal tears, retinal detachment or just remain silently suspended in the vitreous.