Mehmet Baykara

Tear function and ocular surface changes in keratoconus

PURPOSE To describe the ocular surface disorder in patients with keratoconus. DESIGN A prospective, case-controlled study. PARTICIPANTS Seventy-five eyes of 38 patients with keratoconus seen at Uludag University School of Medicine, Department of Ophthalmology, from March 2000 through April 2001, and 80 eyes of 40 normal control subjects were studied. INTERVENTION The subjects underwent routine ophthalmic examinations, corneal sensitivity measurements, Schirmer test, tear film breakup time (BUT), fluorescein and rose bengal staining of the ocular surface, and conjunctival impression cytology. MAIN OUTCOME MEASURES Patients and control subjects were compared for corneal sensitivity, tear function, ocular surface staining parameters, goblet cell density, and squamous metaplasia grade. The relation of these parameters to the severity of keratoconus progression was also investigated. RESULTS The mean corneal sensitivity was significantly lower in keratoconus patients compared with control subjects (P < 0.001). The BUT values were also significantly lower in the keratoconus group. Patients with keratoconus had significantly higher fluorescein and rose bengal staining scores (P < 0.001). Corneal sensitivity and tear function changes seemed to get worse with advanced stages of keratoconus. Impression cytology showed goblet cell loss and conjunctival squamous metaplasia, both of which again related to the extent of progression of keratoconus. CONCLUSIONS The ocular surface disease in keratoconus is characterized by disorder of tear quality, squamous metaplasia, and goblet cell loss, all of which seem to relate to the extent of keratoconus progression.

Pars plana vitrectomy and removal of the internal limiting membrane in the treatment of chronic macular oedema

BackgroundTo evaluate the results of pars plana vitrectomy with peeling of the internal limiting membrane (ILM) in eyes with chronic macular oedema.MethodsPPV with indocyanine green (ICG) assisted peeling of the ILM was performed in 33 eyes with diabetic (21 eyes) or non-diabetic (12 eyes) macular oedema. Postoperatively, resolution of macular oedema, improvement of visual acuity (VA) and complications were documented. The peeled membranes were submitted for light and transmission electron microscopic evaluation.ResultsThe mean follow-up time was 12.2 months. The macular oedema decreased or was resolved in 17 (81%) eyes in the diabetic group and in 11 (92%) eyes in the non-diabetic group. VA improved by at least 2 lines in 11 (52%) eyes in the diabetic group and in 7 (58%) eyes in the non-diabetic group. The difference between visual acuity improvements of the two groups was not statistically significant (P>0.05). However, in the diabetic group the difference of visual improvement between cystoid and diffuse type of macular oedema eyes was statistically significant (14% versus 71%, P=0.02). Light and transmission electron microscopy showed the presence of ILM in all specimens. During the follow-up period no recurrence of macular oedema or epiretinal membrane formation was observed.ConclusionPars plana vitrectomy with peeling of the ILM and epiretinal membrane leads to the resolution of macular oedema in the majority of eyes. This however, is not always associated with VA improvement. In diabetic eyes, cystoid type of macular oedema appears to be a poor prognostic factor for improved VA.

Primary repair and intraocular lens implantation after perforating eye injury

Purpose: To evaluate the clinical outcome after primary treatment of lens injuries with corneal or corneoscleral trauma. Methods: Ten eyes of 10 patients were retrospectively evaluated. There were no foreign bodies in any eye. After primary repair, an anterior chamber maintainer (ACM) was introduced through the inferotemporal corneal quadrant. Sodium hyaluronate 1.4% (Healon GV®) was injected, and the anterior capsule was stained with trypan blue 0.1% vital stain (Vision Blue®) under the viscoelastic substance. After a capsulorhexis was created, the lens material was aspirated. The nucleus was delivered from the scleral tunnel, which was opened from the superior/superotemporal corneal quadrant. A conventional 21.0 diopter poly(methyl methacrylate) intraocular lens (IOL) with a 5.5 mm optic and overall diameter of 12.5 mm (Dr. Schmidth®, Hannan Kibbutz) was implanted through the scleral tunnel. The scleral tunnel was not sutured, and the corneal entry sites were closed with stromal hydration. Results: The final best spectacle‐corrected visual acuity (BSCVA) was better than 20/100 in all patients, and 6 patients had a BSCVA of 20/20. The IOL was in the capsular bag in all patients at the last follow‐up. The mean follow‐up was 12.3 months (range 7 to 25 months). The main visually limiting factors were corneal scar, irregular astigmatism, and traumatic maculopathy. Conclusions: Primary IOL implantation in carefully selected patients with penetrating corneoscleral lens injury may yield visually rewarding results. The use of a vital stain to increase the visibility of the injured anterior capsule and of a closed scleral tunnel system with an ACM increased the surgical safety.

Microincisional cataract surgery (MICS) with pulse and burst modes

PURPOSE To compare the amount of ultrasound (US) energy and balanced solution (BS) required for burst mode and pulse mode during bimanual phacoemulsification surgery. METHODS One hundred cases were divided into two groups (the pulse mode Group 1 [50 eyes], the burst mode Group 2 [50 eyes]). One surgeon (M.B.) performed phacoemulsification procedures using topical anesthesia with the AMO Sovereign in all patients. The technique was based on the nuclear hardness and surgeons criteria and performed bimanually. The surgery time, total ultrasound time (UST) and effective US power (USP), and used balanced solution (BS) were retrospectively compared. RESULTS The mean surgery time, mean UST, and mean used BS volume were not statistically different in both groups (p>0.05). The mean EPT was statistically highly different in both groups (p>0.001). There was a slight tendency toward more surgery time in Group 2 than in Group 1, although the difference was not significant (p=0.146). Statistically significant higher results (Group 1: r=0,889, p<0.001, and Group 2: r=0,834, p<0.001) were seen in Group 1 when both groups were evaluated for the surgery time and used BS volume. When UST and used BS volume were evaluated in Groups 1 and 2, significant relation was seen in both but the correlation is statistically higher in Group 1 (Group 1: r=0,765, p<0.001, and Group 2: r=0,544, p<0.001). CONCLUSIONS The very low energy modes with the WhiteStar technology are suitable for bimanual cataract surgery.

Benign neonatal hemangiomatosis with conjunctival involvement. Report of a case and review of the literature.

Hemangiomas are the most common tumours of infancy. When limited to the skin, multiple lesions have a benign course and excellent prognosis but in cases of visceral involvement, the morbidity and mortality rates are high. We report a rare case of a female infant with benign neonatal hemangiomatosis who had dramatic conjunctival involvement. The spectrum of neonatal hemangiomatosis is reviewed, highlighting the importance of differentiation of the two extremes of this disorder.

Modifying the position of cataract incisions in triple procedure.

Purpose The authors present a surgical technique for enhancing the visualization of the lens capsule by lamellar corneal dissection and performing phacoemulsification through the partially trephined recipient bed in eyes undergoing penetrating keratoplasty combined with cataract surgery. Methods First, the cornea was thinned by lamellar dissection in 11 patients undergoing triple procedure (penetrating keratoplasty phacoemulsification, and intraocular lens implantation). After continuous curvilinear capsulorhexis (CCC) was performed in the closed system, phacoemulsification was carried out through the incisions that were created on the partially trephined recipient bed. The trephination was completed by excising the remaining corneal tissue and intraocular lens was implanted. At the end of the surgery, donor cornea was sutured into the recipient bed. Results The cataract surgery was performed in a closed system and the cataract incision places were removed at the end of the surgery; therefore both CCC and phacoemulsification could be completed easily without any intraoperative complication in 11 eyes of 11 patients. Conclusions Phacoemulsification, through the recipient bed that is thinned by lamellar dissection, could be safely performed in a short time, under good view of the lens.

Localized Unilateral Hyperhidrosis and Neurofibromatosis Type 1: Case Report of a New Association

Localized unilateral hyperhidrosis (LUH) is an uncommon but well-defined special form of localized hyperhidrosis with diverse causes. It often occurs within a sharply demarcated area on the face or upper extremities. Here, we report a case of LUH in a 16-year-old male with neurofibromatosis type 1 (NF1) and review related data in the literature. The association of this rare entity and NF1 has not yet been described. Subcutaneous botulinum toxin A injection provided a good clinical response with symptomatic relief.

Oculocardiac reflex in a nonsedated laser in situ keratomileusis patient.

A healthy 21-year-old man had laser in situ keratomileusis (LASIK) in the right eye for a refractive error of -7.0 diopters. The electrocardiogram findings and heart rate were recorded before LASIK; during eye lid speculum insertion, vacuum application, corneal flap preparation, and excimer laser keratectomy; and after the procedure. The pre-LASIK heart rate was 90 pulses/min. Severe bradycardia of 40 beats/min developed during vacuum application, and the procedure was terminated. Severe bradycardia caused by an oculocardiac reflex may occur during LASIK, and patients should be closely monitored during the procedure.

Ultrasound biomicroscopic evaluation of anterior segment cysts as a risk factor for ocular hypertension and closure angle glaucoma

AIM To investigate the relationship between the ultrasound biomicroscopic (UBM) features of anterior-segment cysts (ASCs) and increased intraocular pressure (IOP) as a risk factor for closed-angle glaucoma (CAG). METHODS Totally 24 eyes with recently diagnosed ASCs were divided into two groups. First group with ASC and ocular normotension (n=13), second group with ASC and ocular hypertension (n=11). An ophthalmologic examination, including tonometry, slit-lamp biomicroscopy (SLBM), gonioscopy, fundoscopy, pentacam, and UBM, was performed. The features of the ASCs were compared with the IOP. RESULTS ASCs were accurately diagnosed and delineated in 24 eyes using UBM. IOP was elevated in those ASCs with a secondary aetiology (P=0.027), iridociliary location (P=0.006), deformed shape (P=0.013), increased size (P=0.001) and elongated pupillary aperture (P=0.009). However, the count (P=0.343) of ASCs, anterior chamber depth (ACD; P=0.22) and axial lenght (AL; P=0.31) were not associated with ocular hypertension. Correlations were found between the IOP and ASC size (r=-0.712; P=0.003), anterior chamber angle (ACA; r=-0.985; P<0.001), angle opening area (AOA; r=0.885; P<0.001), angulation of iris (r=-0.776, P<0.001), and affected iris quadrant (r =-0.655, P=0.002). CONCLUSION Ocular hypertension in some eyes with ASC might be associated with various mechanisms, including secondary aetiology, iridociliary location, deformed shape, increased size and elongated pupill, which can be determined by UBM.

The effect of anterior chamber maintainer on anterior chamber contamination.

Purpose To evaluate the effect of anterior chamber continuous infusion maintainer system on the contamination of anterior chamber in phacoemulsification surgery. Methods Clear corneal phacoemulsification surgery was performed in 132 eyes of 132 randomly selected patients with cataract who were divided into two groups of 66 eyes according to the use of an anterior chamber maintainer (ACM) system. The fluid specimens were taken from anterior chamber in the beginning and at the end of the surgery. They were transferred under anaerobic conditions and investigated by culturing onto blood agar and thiogluconate broth media. Differences between the two groups with respect to contamination of the specimens were investigated. Results The mean age of the group undergoing surgery without a maintainer system (Group A) was 63±10 years (min = 41, max = 80) versus 59±10 years (min = 33, max = 80) in the other group (Group B) in which the maintainer was used during surgery. In the postoperative specimen, Micrococcus species were isolated from one eye (1.5%) in Group A and S. pyogenes in one eye (1.5%) from Group B. Mean follow-up interval was 12±6 (min = 4, max = 28) months. Conclusions The use of ACM system in clear corneal phacoemulsification surgery carries no additional risks as far as contamination is concerned.