Melih Ünal

Systematic, combined treatment approach to nasolacrimal duct obstruction in different age groups

Purpose To report the outcome of a step-by-step treatment approach for congenital nasolacrimal duct obstruction (CNDO). Methods Three-hundred and fifty eyes with CNDO were included in the study. A number of treatment methods were applied systematically until a successful outcome was achieved. Listed in order from simple to more complex, the following methods were used: conservative management (massage and topical antibiotics), high-pressure syringing, probing, and silicone intubation. Treatment efficacy was determined according to age (Group 1: 0–6 months, Group 2: 7–12 months, Group 3: 13–24 months, Group 4: 25–72 months) and success rates were compared. Results Conservative management was applied only in children less than 1 year of age, and was successful in 91.8% of Group 1 and 60% of Group 2 eyes. The difference between these two success rates was significant (p = 0.003). High-pressure syringing was performed in children under 24 months of age, with success rates of 41.7% in Group 1, 33.3% in Group 2, and 12.5% in Group 3. The overall success rate for first probing in all groups was 76.1%, with a range of 69.4% to 80.9%. After second probing, the overall cure rate for the entire cohort was 88.0%, with a range of 74.9% to 94.8%. There was no real difference in probing cure rates relative to age (p > 0.05). Silicone intubation was indicated and performed in two eyes of Group 2 children, three eyes of Group 3, and nine eyes of Group 4. Two ducts in Group 4 eyes remained obstructed after silicone intubation. Conclusions The systematic treatment approach to CNDO, including conservative management and minimally invasive procedures such as high-pressure syringing, probing, and silicone intubation, is highly successful. In this study, the cure rate for this combined approach was 100% in youngsters under 2 years of age and 94.5% in children 2 to 6 years old.

Retinal Toxicity of Intraocular Vancomycin and Ceftazidime in Vitrectomized Rabbit Eyes

The purpose of this study was to evaluate the retinal toxicity of vancomycin and ceftazidime combined into an infusion solution that was intraoculary given after or during vitrectomy. Forty albino rabbits were divided into 4 groups of 10 each. Vitrectomized right eyes of groups 1, 2, and 3 were given recommended doses of vancomycin and ceftazidime alone or combined, while right eyes in the fourth group were vitrectomized using an infusion solution to which was added ceftazidime and vancomycin combination. Toxicity was tested with electroretinography (ERG) and light microscopy. ERG and light microscopy did not show any toxicity signs associated with vancomycin or ceftazidime alone or with combined therapy. Vancomycin and/or ceftazidime can reliably and effectively be used combined in an infusion solution at recommended doses after and during vitrectomy. This treatment modality does not have any toxic effects to retinal structures and is an alternative method to separate injections of the two antimicrobial agents.

The effect of chronic smoking on lens density in young adults.

Purpose To investigate the effect of chronic cigarette smoking on lens density by Pentacam HR lens densitometry in young adults. Methods Sixty chronic smokers who smoked at least 10 cigarettes per day for at least 2 years and 60 age- and sex-matched healthy control subjects were included in this prospective cross-sectional, comparative study. Presence of an ocular or systemic disease that might affect lens were determined as exclusion criteria. All individuals underwent complete ocular examination. Lens densitometry (LD) measurements were performed with Pentacam HR (Oculus, Wetzlar, Germany), dividing the lens into 3 areas: anterior area (anterior subcapsular and anterior cortical), nuclear area, and posterior area (posterior subcapsular and posterior cortical). Three-dimensional scan modes were used for measurements. Results The mean ages of group 1 and 2 were 25.85 ± 4.32 and 25.60 ± 5.14 years, respectively. The mean LD values in the 3 areas were higher in group 1 than group 2. However, only the mean LD value at the anterior area of group 1 was found to be statistically significantly higher (p = 0.047). There was no statistically significant difference in the mean LD measurements at the nuclear and posterior areas between the groups. Conclusions Our study demonstrated that the mean LD value of the anterior area was significantly higher in group 1, suggesting that chronic smoking may contribute to anterior cortical and subcapsular cataract development in young adults.

Current Concepts and Management of Severely Traumatized Tissues in the Inner Coatings (The Posterior Segment: The Ciliary Body, the Choroid and the Retina) of the Globe: Nonmechanical Injuries

“Nonmechanical closed-globe injuries of the inner coatings (the ciliary body, the choroid and the retina) of the globe” has not been defined in the classifications of both BETT (Birmingham Eye Trauma Terminology) (Kuhn et al. 2008) and OTCS (Ocular Trauma Classification System) (Pieramici et al. 1997) clearly, and, besides, those can be categorized as follows.

Efficacy of adjunctive mitomycin C in transcanalicular diode laser dacryocystorhinostomy in different age groups.

Purpose To evaluate the efficacy of adjunctive mitomycin C (MMC) in transcanalicular multidiode laser dacryocystorhinostomy (TCL-DCR) in different age groups. Methods Ninety-six eyes of 96 patients who underwent TCL-DCR for the treatment of nasolacrimal duct obstruction were included in this retrospective, comparative study. Patients were divided into 4 groups based on age and intraoperative use of MMC: group 1, TCL-DCR without MMC in the 20- to 44-year age group; group 2, TCL-DCR with MMC in the 20- to 44-year age group; group 3, TCL-DCR without MMC in the 45- to 76-year age group; group 4, TCL-DCR with MMC in the 45- to 76-year age group. The postoperative evaluation consisted of calculating and comparing the success rates between groups. Results Success rates at the final visit were 50% for group 1, 66.66% for group 2, 79.16% for group 3, and 84.61% for group 4. The differences between group 1 and group 4, and group 1 and group 3, were significant (p = 0.01 and p = 0.038, respectively). Logistic regression showed that age group had significant effect on success rate (p = 0.013). However, use of MMC had no significant effect on success rate (p = 0.23). Conclusions The success rates of the TCL-DCR with MMC application were found to be higher than those of TCL-DCR without MMC in different age groups. However, the differences did not reach statistical significance. In addition, our study demonstrated that age may be a significant factor influencing the surgical outcome of TCL-DCR.

Central Serous Chorioretinopathy Following Pulse Corticosteroid Therapy in Multiple Sclerosis

The purpose of this paper was to report a case of central serous chorioretinopathy following pulse corticosteroid therapy in multiple sclerosis. The patient was a 40-year-old female patient admitted to neurology clinic with muscle weakness and difficulty in moving. Having the diagnosis of multiple sclerosis, she was hospitalised for the treatment of the acute attack. Pulse intravenous methylprednisolone therapy was introduced and on the third day of the therapy, patient reported acute visual loss. Magnetic resonance imaging was performed to exclude optic neuritis. Complete eye examination and imaging of the fundus revealed retinal pigment epithelial detachment as the cause of the visual loss. Corticosteroids (endogenous or exogenous) are known risk factors for central serous chorioretinopathy. As retinal pigment epithelial detachment is a component of central serous chorioretinopathy, systemic corticosteroid was thought to be responsible for acute visual loss in this case. Steroid therapy was gradually tapered and acetazolamid was introduced. Her visual acuity improved but retinal pigment epithelial detachment was found to be persisting 2 years later. Although optic neuritis, the most common ocular presentation, is generally responsible for acute visual loss in multiple sclerosis, one should consider that systemic corticosteroid therapy for the acute attack may be in charge.

Systematic, combined treatment approach to nasolacrimal duct obstruction in different

PURPOSE To report the outcome of a step-by-step treatment approach for congenital nasolacrimal duct obstruction (CNDO). METHODS Three-hundred and fifty eyes with CNDO were included in the study. A number of treatment methods were applied systematically until a successful outcome was achieved. Listed in order from simple to more complex, the following methods were used: conservative management (massage and topical antibiotics), high-pressure syringing, probing, and silicone intubation. Treatment efficacy was determined according to age (Group 1: 0-6 months, Group 2: 7-12 months, Group 3: 13-24 months, Group 4: 25-72 months) and success rates were compared. RESULTS Conservative management was applied only in children less than 1 year of age, and was successful in 91.8% of Group 1 and 60% of Group 2 eyes. The difference between these two success rates was significant (p = 0.003). High-pressure syringing was performed in children under 24 months of age, with success rates of 41.7% in Group 1, 33.3% in Group 2, and 12.5% in Group 3. The overall success rate for first probing in all groups was 76.1%, with a range of 69.4% to 80.9%. After second probing, the overall cure rate for the entire cohort was 88.0%, with a range of 74.9% to 94.8%. There was no real difference in probing cure rates relative to age (p > 0.05). Silicone intubation was indicated and performed in two eyes of Group 2 children, three eyes of Group 3, and nine eyes of Group 4. Two ducts in Group 4 eyes remained obstructed after silicone intubation. CONCLUSIONS The systematic treatment approach to CNDO, including conservative management and minimally invasive procedures such as high-pressure syringing, probing, and silicone intubation, is highly successful. In this study, the cure rate for this combined approach was 100% in youngsters under 2 years of age and 94.5% in children 2 to 6 years old. (Eur J Ophthalmol 2000; 10: 324-9).