Mücella Arıkan Yorgun

Time course of silicone oil emulsification.

Purpose: To investigate the natural course of silicone oil emulsification after silicone oil tamponade usage in retinal detachment surgery. The presence of a group of patients whose silicone oil tamponades we preferred to keep as long as possible because of high risk of redetachment enabled us to investigate the course of in vivo silicone oil emulsification. Methods: Thirty-two cases that were considered to have a high risk of redetachment after silicone oil removal were closely monitored, and it was preferred to keep the silicon oil as long as possible until first signs of silicone oil emulsification were observed. Any ocular complication directly related to the silicone oil tamponade did not arise in any of these cases, and the only indication for silicone oil removal was the signs of emulsification. Results: The silicone oil emulsification time ranges from 5 months to 24 months with a mean of 13.2 ± 4.8 months. In most cases, it occurs within the first year. However, there are also 2 cases where emulsification is not observed until the 24th month. Conclusion: It could be possible to extend the silicone oil removal time up to 1 year to achieve a stable retinal status in cases with a high risk of redetachment.

Suspected Bacterial Endophthalmitis Following Sustained-release Dexamethasone Intravitreal Implant: A Case Report

A 58-year-old man admitted to our opthalmology department with the complaint of branch retinal vein occlusion. He was treated with intravitreal Ozurdex in the right eye. Two days after the injection, the patient presented with ocular pain and the visual acuity was hand movement. A diagnosis of endophthalmitis was made. We performed emergent pars plana vitrectomy (PPV) and the implant was removed from the vitreous cavity using a retinal forceps. A combination of vancomycin 1.0 mg and amikacin 0.4 mg was injected intravitreally. However, because of the blurring in the vitreus one week after the procedure, phacoemulsification and a repeat PPV was performed. Five days after the last procedure the signs and symptoms of endophthalmitis were resolved. Our case demonstrated that endophthalmitis could develop after intravitreal implantation of Ozurdex. Surgical removal of the implant and immediate vitrectomy seems to be a useful treatment option in these cases.

Isolated sixth nerve palsy after intravitreal bevacizumab injection.

Purpose: To report a case of sixth nerve palsy after intravitreal bevacuzimab injection. Methods: After intravitreal bevacizumab injection in a 64-year-old man, the patient admitted to our clinic with the complaint of diplopia. A complete ophthalmologic examination was done to clear the symptomatology of patient. Results: Examination of ductions revealed marked limitation of abduction of the right eye and full ductions of the left eye, consistent with right lateral rectus paralysis. Conclusions: Although intravitreal bevacizumab injections are generally well tolerated, it is possible that some serious systemic adverse events may occur. For this reason, patients must be closely monitored following these injections.

Can Corneal Biomechanical Properties Give Clues About Elasticity of Optic Nerve Scleral Component in Nonarteritic Anterior Ischemic Optic Neuropathy

Objective: To investigate corneal biomechanical properties among individuals with unilateral nonarteritic anterior ischemic optic neuropathy (NAION) compared to healthy gender- and age-matched subjects. Methods: The study subjects were separated into 2 groups: 66 eyes of 33 patients with unilateral NAION (study group) and 33 eyes of 33 healthy individuals (control group). Reichert ocular response analyzer (Reichert Ophthalmic Instruments) was used to assess corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated intraocular pressure values. Also, central corneal thickness was measured using Scheimpflug camera combined with a Placido disc corneal topographer (Sirius; Costruzioni Strumenti Oftalmici). Results: Mean CH and median CRF values were significantly lower in the affected eyes (8.8 ± 1.8 mm Hg, 9.4 mm Hg, respectively) and contralateral unaffected eyes (9.1 ± 1.6 mm Hg, 9.8 mm Hg, respectively) of NAION patients than those in the control group (9.9 ± 1.3 mm Hg, 10.4 mm Hg, respectively; all P < 0.017). Mean IOPcc was significantly higher in the affected eyes of NAION patients (19.2 ± 3.5 mm Hg) than in the eyes of control group (17.1 ± 3.6 mm Hg; P = 0.002). Conclusions: CH and CRF are significantly reduced in patients with NAION, possibly indirectly reflecting structural weakness in the lamina cribrosa.

A Novel Tool for the Assessment Oxidative Stress in Age-Related Macular Degeneration: Thiol/Disulfide Homeostasis Revisited

ABSTRACT Purpose: To investigate thiol/disulfide status using a novel automated assay in patients with age-related macular degeneration (AMD) compared to age-matched healthy controls. Methods: A total of 64 AMD patients [51 (79%) non-exudative, 13 (21%) exudative AMD] and 21 age-matched healthy control subjects were enrolled in this study. Plasma total thiol, native thiol, disulfide levels were measured and native thiol/disulfide ratio (TDR) was calculated using a novel spectrophotometric assay. Results: Patients with AMD had significantly lower levels of total thiol (434.8 ± 7.0 μmol/L vs. 472.2 ± 7.9 μmol/L, p < 0.001), native thiol (393.6 ± 6.5 μmol/L vs. 437.5 ± 7.1 μmol/L, p = 0.004) compared to healthy controls. However, plasma disulfide levels were higher in AMD patients (20.6 ± 0.9 μmol/L vs. 17.3 ± 1.3 μmol/L, p = 0.113) compared to healthy controls. The TDR was not statistically different between the early AMD group and healthy controls (24.2 ± 2.3 vs. 29.5 ± 3.1, p = 0.345). However, intermediate and advanced stage AMD groups had significantly lower levels of TDR compared to healthy controls (21.6 ± 2.6 vs. 29.5 ± 3.1, p = 0.023 and 20.3 ± 1.2 vs. 29.5 ± 3.1, p = 0.005, respectively). Native TDR was significantly lower in patients with exudative and non-exudative AMD (19.9 ± 2.3 vs. 29.5 ± 3.1, p = 0.024 and 21.8 ± 1.14 vs. 29.47 ± 3.1 respectively, p = 0.011). Conclusion: A greater extent of thiol consumption occurred in AMD patients compared to age-matched healthy controls. However, despite the similar levels of total thiol levels between several grades of AMD, the plasma native TDR value was decreased in accordance with the severity of the disease, which reflected the disease grade better.

Intravitreal PRN ranibizumab treatment for macular edemadue to branch retinal vein occlusion

BACKGROUND/AIM To evaluate the effect of intravitreal pro re nata (PRN) ranibizumab treatment from the start on the best-corrected visual acuity (BCVA) and the central retinal thickness (CRT) in macular edema (ME) due to branch retinal vein occlusion (BRVO). MATERIALS AND METHODS Patients with ME secondary to BRVO, who were treated on a PRN basis after a single intravitreal ranibizumab injection, were retrospectively evaluated. The main outcome measures were changes in BCVA and CRT as measured by optical coherence tomography. RESULTS The number of injections over 6 months was 2.43 ± 1.16. The mean BCVA of the patients was 0.84 ± 0.10 logMAR at baseline and 0.41 ± 0.06 at the 6th month (P < 0.001). Mean BCVA of the ischemic BRVO group was 1.06 ± 0.68 logMAR at baseline and 0.44 ± 0.30 logMAR at the 6th month (P < 0.05). Similarly, the mean BCVA of the nonischemic BRVO group was 0.77 ± 0.53 logMAR at baseline and 0.41 ± 0.36 logMAR at the 6th month (P < 0.05). Between groups, there was no significant difference in mean BCVA at any examination. CONCLUSION Intravitreal ranibizumab is a safe and effective treatment option for ME due to ischemic and nonischemic BRVO using PRN from the start.

Clinical outcomes of 25-gauge vitrectomy surgery for vitreoretinal diseases: comparison of vitrectomy alone and phaco-vitrectomy.

AIM To compare the clinical outcomes of combined 25-gauge pars plana vitrectomy (PPV) and phacoemulsification/posterior chamber intraocular lens (PC-IOL) implantation with vitrectomy alone surgery in patients with various vitreoretinal diseases. METHODS A total of 306 eyes (145 with PPV alone and 161 with phaco-vitrectomy) were enrolled in this retrospective analysis. The surgical approach was 25-gauge PPV combined with phacoemulsification and PC-IOL implantation at the same time in eyes in phaco-vitrectomy group and only PPV in eyes in vitrectomy alone surgery group. The main outcome measures were postoperative clinical outcomes included anterior chamber inflammation, changes in intraocular pressure (IOP) and best corrected visual acuity (BCVA). RESULTS The most common postoperative complication was anterior chamber reaction which has higher incidence in phaco-vitrectomy group (P<0.001). The mean postoperative 1(st) day IOP of vitrectomy alone group was significantly lower than that of phaco-vitrectomy group (16.3±5.8 mm Hg vs 17.8±8.1 mm Hg, respectively, P=0.02). Hypotony (IOP≤8 mm Hg) was not different between groups in the postoperative 1(st) day (P>0.05). The mean preoperative visual acuity was not different between groups (1.6±0.9 logMAR vs 1.8±0.9 logMAR, respectively, P>0.05). However, the mean visual acuity was decreased in vitrectomy alone group at the final visit compared to phaco-vitrectomy group (1.2±0.8 logMAR, 0.9±0.7 logMAR, respectively P<0.05). CONCLUSION Twenty-five gauge PPV combined with phacoemulsification surgery is a safe and efficient procedure, which can be preferred in phacic patients with a variety of vitreoretinal diseases compared to vitrectomy alone. Despite improved outcomes, this approach is not free of limitations as anterior chamber complications especially with combined surgery.

Diagnosis of Chronic Renal Failure Established after Fundus Examination-Report of Two Cases

Yaz›flma Adresi/Address for Correspondence: Dr. Elif Damar, Ankara Atatürk E¤itim ve Araflt›rma Hastanesi, 1. Göz Klini¤i, Ankara, Türkiye Tel.: +90 312 291 25 25 E-posta: damarelif@hotmail.com Gelifl Tarihi/Received: 04.01.2010 Kabul Tarihi/Accepted: 19.07.2010 Özet Görme azl›¤› flikayeti ile klini¤imize baflvuran iki olguda her iki gözde diffüz makula ödemi, arka kutupta retina önü kanamalar ve yumuflak eksudalar, retina arteriyollerinde sklerotik de¤ifliklikler, venlerde dolgunluk, Gunn araz› ile bir olgunun sa¤ gözünde makula y›ld›z› saptand›. Fundus fluoresein anjiyografide (FFA) arka kutupta geç dönemde artan s›z›nt› odaklar› mevcuttu. Bulgular ileri derece hipertansif retinopati ile uyumlu idi. Bir olguda sistemik hipertansiyon öyküsü ve her iki olguda halsizlik mevcut olmas› sebebiyle yap›lan laboratuar incelemelerinde üre ve kreatinin de¤erleri yüksek bulundu. Dahiliye bölümüne yönlendirilen iki olgu kronik böbrek yetmezli¤i (KBY) tan›s› ile hemodiyaliz program›na al›nd›. Hemodiyaliz sonras›nda iki olguda görme keskinli¤i artt› ve göz dibi bulgular› geriledi. (TJO 2010; 310-3) Anahtar Kelimeler: Kronik böbrek yetmezli¤i, hipertansif retinopati