Meltem Yagmur

Visual Acuity and Corneal Topographic Changes Related With Pterygium Surgery

PURPOSE Applied pre- and postoperative corneal topography outcomes with visual acuities were evaluated to determine the surgical results in pterygium therapy. METHODS The study group consisted of 30 eyes of 26 patients with primary and recurrent pterygium. Mean patient age was 52.26+/-11.50 years (range: 27 to 68 years). Pre- and postoperative visual acuity and comeal topography were evaluated for each case. Statistical analysis was performed using the repeated-measure test. RESULTS The mean uncorrected visual acuity was 0.41+/-0.30 preoperatively and 0.63+/-0.26 postoperatively (P<.001). The mean best spectacle-corrected visual acuity was 0.59+/-0.28 preoperatively and 0.84+/-0.22 postoperatively (P<.001). Surface regularity index ranged from 1.96+/-1.08 preoperatively to 1.09+/-0.76 postoperatively (P<.001). The mean surface asymmetry index was 3.05+/-2.85 preoperatively and 1.39+/-1.70 postoperatively (P=.003). The mean topographic astigmatism was 4.65+/-3.02 preoperatively and 2.33+/-2.26 postoperatively (P=.003). CONCLUSIONS Examination of the topographic records reveals pterygium-associated corneal flattening in the horizontal meridian along the line of the pterygium. The improvement in topographic pattern and best spectacle-corrected visual acuity can be used as one indicator of the success of pterygium surgery.

Brush technique in ocular surface cytology

New techniques are being searched for the evaluation of cellular morphology and population of ocular surface. Impression cytology is one of the most preferred techniques in ocular surface sampling in dry eye, keratitis, and conjunctivitis. We evaluated and compared the efficacy of impression and brush cytology in 63 patients. All of the samples collected by the brush technique were sufficient for diagnosis: 88% of the slides revealed abundant cells and 12% adequate number of cells. In 21% of the samples observed by impression cytology the cell number was inadequate for diagnosis. In 58% of them the cells were abundant and in 21% few cells were observed. This study proved the value of brush cytology in collecting ocular surface cells. Diagn. Cytopathol. 17:88–91, 1997.

Surgical management of scleral defects.

Purpose: To evaluate the results of surgical management of scleral defects using fascia lata, cornea, and sclera as graft materials. Methods: The scleral defects of 8 patients were repaired surgically. Six had previous intraocular surgery, 1 had eye trauma, and the other had both intraocular surgery and trauma. Corneoscleral grafts were used in 3 eyes, scleral grafts in 4, and fascia lata was used in 1 eye. Results: In 7 patients, we achieved the desired cosmetic and tectonic success. During the follow-up period, a recurrent defect was seen in 1 patient, and a second operation was required. Conclusions: Surgical techniques using fascia lata, corneal, and scleral grafts are effective for scleral defects.

Umbilical cord blood serum therapy for the management of persistent corneal epithelial defects

AIM To evaluate the role of umbilical cord blood serum (CBS) therapy in cases with persistent corneal epithelial defects (PED). METHODS Sixteen eyes of 14 patients with PED who were resistant to conventional treatment were treated with 20% umbilical cord serum eye drops. Patients were followed-up weekly until epithelization was complete. The collected data included the grade of corneal lesion (Grade I: epithelial defect+superficial vascularization, Grade II: epithelial defect+stromal edema, Grade III: corneal ulcer+stromal melting), the size of epithelial defect (pretreatment, 7(th), 14(th) and 21(st) days of treatment), and follow-up time was evaluated retrospectively. RESULTS The mean size of epithelial defect on two perpendicular axes was 5.2×4.6-mm(2) (range: 2.5-8×2.2-9 mm(2)). Mean duration of treatment was 8.3±5wk. CBS therapy was effective in 12 eyes (75%) and ineffective in 4 eyes (25%). The epithelial defects in 4 ineffective eyes were healed with amniotic membrane transplantation and tarsorrhaphy. The rate of complete healing was 12.5% by 7d, 25% by 14d, and 75% by 21d. The healing time was prolonged in Grade III eyes in comparison to eyes in Grade I or Grade II. CONCLUSION The results of the current study indicated the safety effectiveness of CBS drops in the management of PED. The grade of disease seems have a role on the healing time.

Preoperative brush and impression cytology in ocular surface squamous neoplasms.

OBJECTIVE Preoperative cytologic diagnoses of ocular surface squamous neoplasms were evaluated and compared with histologic diagnoses. STUDY DESIGN Impression cytology (Millipore filter paper) and brush cytology were applied to 32 patients who had conjunctival neoplasms. Papanicolaou-stained cytologic preparations and hematoxylin and eosin-stained histologic sections were examined by light microscopy. RESULTS The brush technique was used on 27 patients; impression cytology was applied in 5 cases. Cytologic and histologic diagnoses were concordant in 26 cases. Squamous cell carcinoma or carcinoma in situ was diagnosed in 18 and dysplasia in 4 cases. Squamous metaplasia and normal-appearing conjunctival epithelial cells were diagnosed cytologically in four cases; of those histologic diagnoses, one was pterygium and three, conjunctival nevus. Four cases revealed discrepancies between the cytologic and histologic preparations. There was one false positive result, and one case was subconjunctival invasion of basal cell carcinoma of the eyelid. CONCLUSION Impression and brush cytology are fast, cost-effective, reliable and noninvasive diagnostic tools for ocular surface squamous neoplasms. However, the brush technique has several advantages over impression cytology.

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.

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.

Crystalline-Like Keratopathy after Intravenous Immunoglobulin Therapy with Incomplete Kawasaki Disease: Case Report and Literature Review

A 7-year-old girl had presented with high body temperature and joint pain which continued for 3 days. Because of the prolonged history of unexplained fever, rash, bilateral nonpurulent conjunctival injection, oropharyngeal erythema, strawberry tongue, and extreme of age, incomplete Kawasaki disease was considered and started on an intravenous immunoglobulin infusion. Six days after this treatment, patient was referred to eye clinic with decreased vision and photophobia. Visual acuity was reduced to 20/40 in both eyes. Slit-lamp examination revealed bilateral diffuse corneal punctate epitheliopathy and anterior stromal haze. Corneal epitheliopathy seemed like crystal deposits. One day after presentation, mild anterior uveitis was added to clinical picture. All ocular findings disappeared in one week with topical steroid and unpreserved artificial tear drops. We present a case who was diagnosed as incomplete Kawasaki disease along with bilateral diffuse crystalline-like keratopathy. We supposed that unusual ocular presentation may be associated with intravenous immunoglobulin treatment.

Topical Mitomycin C for the Treatment of Conjunctival Tumor

Background: To evaluate the efficacy of topical mitomycin C (MMC) for the treatment of conjunctival tumor in a prospective design. Methods: Nine patients (nine eyes) with conjunctival tumor were studied. The patients received topical MMC 0.04% four times daily by one to six courses. Each course consisted of medication for consecutive 7 days followed by 1 week without medication. Follow-up was conducted on patients for control of disease, and side effects. Results: In 7 patients, the tumor completely disappeared during the mean follow-up period of 24.57 ± 5.94 months (range 18–35 months) with no recurrence. In 1 patient, there was no regression of the tumor, and in 1 patient cessation of the treatment was needed because of an adverse effect of the drug. Conclusion: Topical MMC is effective for the treatment of conjunctival tumor. Longer follow-up and large series are needed to assess the duration of tumor control.

Non-contact lens use-related Acanthamoeba keratitis in southern Turkey: evaluation of risk factors and clinical features.

Purpose: To assess the diagnostic methods, risk factors, and clinical features of Acanthamoeba keratitis cases in patients who do not wear contact lenses. Methods: Medical records of 26 consecutive patients with non—contact lens—related Acanthamoeba keratitis, who were followed up at the tertiary eye care center between May 2010 and May 2012, were analyzed. Laboratory, demographic, and clinical findings were evaluated pertaining to the patients. Results: Twenty-six non—contact lens—related Acanthamoeba keratitis cases were included in the study. The main risk factors were trauma (group 1, n = 13 patients) and ocular surface disease (group 2, n = 12 patients). One patient had both of the risk factors mentioned above. Overall test results showed that Acanthamoeba positivity rates were 15.3% for direct microscopy, 46.1% for culture, 92.3% for conventional polymerase chain reaction (PCR), and 100% for real-time PCR. The rates of full-thickness corneal involvement and ring-shaped infiltrations were higher in group 2, whereas superficial keratitis and radial keratoneuritis were higher in group 1. The final visual acuities were significantly better in group 1 than group 2 (p<0.025). Conclusions: This study is the first regional report from Turkey about Acanthamoeba keratitis in non—contact lens users. A majority of cases admitted to a tertiary eye care center were related to trauma or ocular surface disease. Physician suspicion is critically important for the timely diagnosis of these cases. At this point, molecular diagnostic tests (PCR or real-time PCR) seem to support the clinical diagnosis of Acanthamoeba keratitis with the help of fast and reliable results.