Muhsin Eraslan

Recurrence After Primary Pterygium Excision: Amniotic Membrane Transplantation with Fibrin Glue Versus Conjunctival Autograft with Fibrin Glue

Abstract Purpose: The aim of the present study was to compare the surgical results and recurrence rates of primary pterygium excision with conjunctival autografts versus amniotic membrane grafts fixated with fibrin glue. Materials and methods: In this prospective study, 73 eyes of 65 patients who had undergone conjunctival autograft group (CAG) (n:37) or amniotic membrane group (AMG) (n:36) after pterygium excision were evaluated. Fibrin glue was used for the fixation of grafts in both groups. The patients were followed up for 12 months. Postoperative complications were recorded. The rate of recurrence was defined as the primary outcome measure. Results: In the CAG, partial dehiscence of the graft was observed on the nasal edge on postoperative day 1 in two (5.4%) eyes that healed with secondary re-epithelialization at week 1. Twelve (32.4%) eyes showed a yellowish-orange or hemorrhagic edema of the graft on postoperative day 7 that spontaneously resolved in 1 to 3 weeks. In the AMG, partial dehiscence and folding of the amniotic membrane occurred in two (5.5%) eyes. Two eyes (5.4 %) in the CAG developed corneal recurrence and five eyes (13.8%) in the amniotic membrane graft group developed recurrence; one limbal (2.7%), four corneal recurrences (11.1%) (p = 0.25). Conclusion: Fibrin glue is a safe and effective method for attaching conjunctival or amniotic membrane grafts for wound closure following pterygium surgery. Although the results were not statistically significant, amniotic membrane grafting using fibrin glue seems to have a higher pterygium recurrence rate compared with conjunctival autografting.

The choroid and lamina cribrosa is affected in patients with Parkinson's disease: enhanced depth imaging optical coherence tomography study

To compare lamina cribrosa (LC) and choroidal thicknesses using enhanced depth imaging optical coherence tomography (EDI‐OCT) in patients with Parkinsons disease (PD) and healthy controls.

Double-Organ Bias in Published Randomized Controlled Trials of Glaucoma.

Purpose:Most of the statistical tests used in significance testing are based on the assumption that each data entry is independent from other entries, however, we observe that in many articles researchers include data from 2 eyes as independent variables while performing these statistical tests. The aim of this study was to formally survey the prevalence of the above-mentioned “double-organ bias” in randomized controlled trials (RCT) of glaucoma. Materials and Methods:We did a PubMed search with the terms “glaucoma” and limitations “Humans” and “Randomized Controlled Trials” in 15 highest-impact-factor ophthalmology journals between November 2002 and November 2012. We only included RCTs published as an original article, where the aim was treating glaucoma. Two independent observers (M.K. and A.S.E.) read through each article and classified the articles according to treatment modality (medical, laser, or surgical) and presence of double-organ bias. Results:The PubMed search yielded 270 articles. A total of 130 articles qualified for the survey. Eighty-five of the RCTs were medical studies, 11 were laser studies, and 34 studies evaluated the outcome of a surgical procedure. In 17 of the 130 articles (13.1%), double-organ bias was found. Prevalence of the double-organ bias was not significantly different between medical (12.9%), laser (14.7%), and surgical (9.1%) studies. Conclusion:Double-organ bias was observed around 13.1% of the published RCTs, leading to inaccurate statistical testing.

Screening for Retinopathy of Prematurity in a Tertiary Ophthalmology Department in Turkey: Incidence, Outcomes, and Risk Factors

BACKGROUND AND OBJECTIVE The aim of this study is to determine the incidence of retinopathy of prematurity (ROP), the number of preterm infants requiring treatment for ROP, and the factors influencing the development of ROP requiring treatment in a Turkish population. PATIENTS AND METHODS Data on 1,252 infants who were screened for ROP in an ophthalmology department were retrospectively reviewed. Infants with a gestational age (GA) of no more than 28 weeks (n = 157) were designated group 1, those between 29 and 32 weeks (n = 572) were assigned to group 2, and those between 33 and 37 weeks (n = 523) were assigned to group 3. RESULTS In group 1, ROP was detected in 70.0% of infants, 17.8% of whom required therapy. In group 2, ROP was detected in 41.4%, and 4.0% of those required therapy. In group 3, 18.1% were diagnosed with ROP, with 0.8% requiring treatment. CONCLUSION Retinopathy of prematurity occurs, even among more mature infants, at a frequency that merits astute screening within parameters that reflect socioeconomic differences that appear to have an effect on the incidence.

Comparison of Optical Coherence Tomography Findings in Patients With Primary Open-angle Glaucoma and Parkinson Disease.

Purpose:To evaluate the peripapillary retinal nerve fiber layer (RNFL), ganglion cell complex, and macular thickness as well as their correlation with the severity of diseases. Materials and Methods:This is a cross-sectional study and comparing both eyes of 26 patients with primary open-angle glaucoma, 25 patients with Parkinson disease (PD), and 23 healthy subjects. RNFL, ganglion cell complex, and macular thickness were measured and analyzed with optical coherence tomography (OCT) in all cases and correlation with severity of the disease was assessed in PD group. Results:The mean RNFL of PD was significantly thinner compared with controls (P=0.002). In glaucoma group, the mean RNFL was significantly thinner (96.28±12.49 &mgr;m) than PD (105.43±13.45 &mgr;m) and the controls (113.75±8.53 &mgr;m) (P<0.001; P<0.001, respectively). The global loss volume (GLV) rates in the glaucoma and PD group were significantly higher than controls, respectively (P=0.006; P<0.001/P=0.002, P=0.013). However, the GLV rate was significantly lower in PD group compared with glaucoma group (P=0.001). There was no significant correlation between OCT measurements and disease duration or severity in the PD patients. Conclusions:Although RNFL thickness and GLV changes may show the ganglion cell loss in both disease but none of the OCT parameters are correlated with the severity of PD. OCT may help to reveal the ganglion cell damage but may not help in determination of severity during the clinical follow-up of PD patients.

The relationship of age when motor alignment is achieved and the subsequent development of stereopsis in infantile esotropia

PURPOSE To determine the oldest age beyond which the chance of developing stereopsis is not possible even with excellent motor alignment in patients with infantile esotropia. METHODS The medical records of children with infantile esotropia who underwent a single operation and had alignment within 10(Δ) of orthotropia at all follow-up examinations were retrospectively reviewed. Patients were assessed for stereopsis after the age of 48 months. RESULTS A total of 38 children were included. There was a statistically significant inverse correlation between age at surgery and final stereopsis (r = 0.494, P = 0.002). There was a significant difference at mean age at surgery between patients having stereopsis better than 1000 arcsec and those having no stereopsis (P = 0.002). Post hoc power analysis revealed a value of 85%. Receiver operating characteristic curve analysis revealed that the optimum cut-off value of the age at surgery for predicting stereopsis was 16 months (Youden index = 0.474; area under ROC curve, 0.784; 95% CI: 0.62-0.90; P = 0.0002). CONCLUSIONS Surgery for infantile esotropia is most likely to result in measureable stereopsis if patient age at alignment is not more than 16 months.

Efficacy of Epithelium-Off and Epithelium-On Corneal Collagen Cross-Linking in Pediatric Keratoconus.

Objectives: To evaluate the efficacy of riboflavin/ultraviolet A epithelium-off (epi-off) and epithelium-on (epi-on) corneal collagen cross-linking (CXL) in progressive pediatric keratoconus. Methods: Thirty-six eyes of 27 patients aged 18 years or younger (12–18 years) diagnosed with progressive keratoconus and treated with epi-off (n=18 eyes) or epi-on (n=18 eyes) CXL were included in this study. All patients were followed up for 24 months postoperatively. Results: At 24-month follow-up, the mean corrected distance visual acuity (CDVA) improved from 0.24±0.17 to 0.17±0.11 logMAR in the epi-off group (P=0.032). In the epi-on group, CDVA improved from 0.33±0.23 to 0.26±0.20 logMAR (P=0.012), but the improvement was not significantly different between groups (P>0.05). In the epi-off group, all mean K values improved: K1 (&Dgr;=−0.63 D, P=0.024), K2 (&Dgr;=−0.73 D, P=0.008), and Kmax (&Dgr;=−1.4 D, P=0.035), whereas in the epi-on group, Kmax and K2 did not change significantly and K1 (&Dgr;=0.68 D, P=0.029) significantly worsened. Postoperative mild corneal haze occurred in 5 eyes (28%) in the epi-off group. No postoperative complications were observed in the epi-on group. In 94.4% of the epi-off group, keratoconus regressed (44.4%) or stabilized (50.0%), whereas in the epi-on group, only 66.6% regressed (33.3%) or stabilized (33.3%), and the difference was significant (P=0.038). Conclusions: The efficacy of the epi-on procedure in terms of its ability to halt keratoconus progression appears to be 0.70 of the efficacy of epi-off CXL.

Retinal Electrophysiological Effects of Intravitreal Bone Marrow Derived Mesenchymal Stem Cells in Streptozotocin Induced Diabetic Rats

Diabetic retinopathy is the most common cause of legal blindness in developed countries at middle age adults. In this study diabetes was induced by streptozotocin (STZ) in male Wistar albino rats. After 3 months of diabetes, rights eye were injected intravitreally with green fluorescein protein (GFP) labelled bone marrow derived stem cells (BMSC) and left eyes with balanced salt solution (Sham). Animals were grouped as Baseline (n = 51), Diabetic (n = 45), Diabetic+BMSC (n = 45 eyes), Diabetic+Sham (n = 45 eyes), Healthy+BMSC (n = 6 eyes), Healthy+Sham (n = 6 eyes). Immunohistology analysis showed an increased retinal gliosis in the Diabetic group, compared to Baseline group, which was assessed with GFAP and vimentin expression. In the immunofluorescence analysis BMSC were observed to integrate mostly into the inner retina and expressing GFP. Diabetic group had prominently lower oscillatory potential wave amplitudes than the Baseline group. Three weeks after intravitreal injection Diabetic+BMSC group had significantly better amplitudes than the Diabetic+Sham group. Taken together intravitreal BMSC were thought to improve visual function.

Decreased subfoveal choroidal thickness and failure of emmetropisation in patients with oculocutaneous albinism

Purpose The purpose of this work was to describe the choroidal structure in patients with oculocutaneous albinism (OCA). Methods 20 eyes of 10 patients with OCA and 14 eyes of 7 healthy controls were recruited for the study. Enhanced depth imaging optical coherence tomography (OCT) images of the subjects were taken. The choroidal thickness (CT) was measured from the outer boarder of the retinal pigment epithelium to the inner boarder of sclera at 500 µm intervals of a horizontal section from the optic disc. Statistical analysis was performed to evaluate variations in CT at subfoveal and peripapillary areas. Results In the fundoscopic examination and OCT imaging, the foveal light reflex was absent and the foveal pit could not be observed in all of the patients with OCA. The mean subfoveal CT of the patients with OCA was significantly thinner (242±56 µm) compared with healthy controls (349±70 µm) (p<0.001); while there was no statistically significant difference in the peripapillary CTs of the patients with OCA and controls (157±42 µm vs 151±31 µm respectively, p=0.77), indicating a localised abnormality of choroidal anatomy. Conclusions This study for the first time demonstrated that CT is decreased in patients with OCA at the subfoveal region. These data combined with the underdevelopment of the foveal pit indicate that there is a generalised developmental or genetic abnormality in the posterior pole of patients with OCA. This choroidal structural abnormality might be related to the previously reported failure of emmetropisation in these children. Further research is needed to understand choroidal metabolism and its relationship with these anatomical changes in albinism.

Orbital Cellulitis Presenting as a First Sign of Incomplete Kawasaki Disease

A 6-year-old boy was referred to our hospital with orbital cellulitis. He had a history of 7 days of fever despite antibiotherapy. At first, he only had pharyngitis and conjunctivitis, but then an orbital mass evolved which restricted the movement of his right eye and there was also periorbital inflammation resembling orbital cellulitis. Examination at presentation revealed conjunctivitis with secretion, periocular inflammation and edema, right-preauricular lymphadenopathy and restriction of upgaze in the right eye. Laboratory findings included a white blood cell count of 19,000 cells per mm3, with 81.5% neutrophils, 15.0% lymphocytes, 1.2% monocytes and 0.4% basophils. The erythrocyte sedimentation rate was 52 mm/h and the C-reactive protein level was 46.3 mg/dl. Magnetic resonance imaging confirmed orbital cellulitis and pansinusitis. Vancomycin (60 mg/kg/day) and meropenem (100 mg/kg/day) were administered, but desquamation on his fingertips and a rash appeared on the tenth day. A pediatric consultation resulted in a diagnosis of incomplete Kawasaki disease (KD). After administration of aspirin, the orbital inflammation regressed in 3 days. No coronary artery lesions were detected on the first echocardiography, but these did appear 6 weeks later. This confirmed the KD diagnosis.