Nazmiye Erol

Long-Term Results of Bare Sclera, Limbal-Conjunctival Autograft and Amniotic Membrane Graft Techniques in Primary Pterygium Excisions

Purpose: To compare the long-term follow-up results of the bare sclera technique (BST), limbal-conjunctival autograft technique (LCAT) and amniotic membrane graft technique (AMGT) in primary pterygium excisions. Materials and Methods: In this study, 48 eyes of 48 patients who underwent pterygium surgery using BST (group 1), 63 eyes of 63 patients who underwent pterygium surgery using LCAT (group 2) and 52 eyes of 52 patients who underwent pterygium surgery using AMGT (group 3) were compared with respect to corneal epithelialization, recurrence and complication of the procedures. The mean ages of the groups were 47.88 ± 14.21 years in group 1, 49.63 ± 14.42 years in group 2 and 47.92 ± 15.52 years in group 3. Patients were followed up to 72.39 ± 11.03 months in group 1, 69.91 ± 12.41 months in group 2 and 61.43 ± 9.83 months in group 3. Results: Postoperative corneal epithelialization was completed in 5.62 ± 1.74 days in group 1, 4.33 ± 0.91 days in group 2 and 4.79 ± 1.39 days in group 3. Corneal epithelialization time was earlier in group 2 than in groups 1 (p < 0.01) and 3 (p < 0.05). Recurrences were detected in 19 eyes (39.58%) in group 1, 11 eyes (14.29%) in group 2 and 12 eyes (23.08%) in group 3. The recurrence rate was significantly lower in group 2 than in groups 1 and 3 (p < 0.001). Postoperative complications were not seen in any of the groups. Graft retraction and necrosis were not detected in the LCAT and AMGT groups during the follow-up period. Conclusions: LCAT was found to be a more effective procedure than BST and AMGT, with decreased recurrence rates after pterygium excision. Limbal-conjunctival autograft seems to be a useful treatment in pterygium surgery due to higher success rates and lower recurrence rates. Amniotic membrane grafts may be an alternative surgical technique for pterygium treatment for patients with or without glaucoma who might need glaucoma surgery in the future.

Retinopathy of prematurity: screening guidelines need to be reevaluated for developing countries.

Purpose. Timely screening of premature babies is an important initial step in the management of retinopathy of prematurity (ROP) as earlier treatment results in improved visual prognosis. Screening criteria for ROP currently recommended by the American Academy of Pediatrics may not be applicable in developing countries. The aim of the present study is to find out the incidence of ROP in infants with a gestational age (GA) of ≥32 weeks in Eskisehir, Turkey, to provide information to assist in determining screening criteria. Methods. A total of 96 infants with a GA of 32–35 weeks who were referred for ROP between January 1, 2004, and December 31, 2008, were studied. ROP screening, follow-up, and appropriate therapies were applied. Results. During ROP screening, there were 42 of 96 (43.8%) infants with no ROP. A total of 54/96 (56.2%) infants were noted to have ROP. Among all infants, 7 (7.3%) had threshold ROP. Two infants with threshold disease were born at the 32nd, 2 at the 33rd, and 3 at the 34th week of gestation. The mean birthweight was 1857.9 (range 1060–3200) grams. Conclusions. In our study, it was found that more mature infants may also develop threshold ROP and require early treatment. After more information is gained and widespread screening, screening protocols covering more mature infants can be designed especially for developing countries.

Treatment of intracameral fibrinous membranes with tissue plasminogen activator.

BACKGROUND AND OBJECTIVE To evaluate the efficacy of intracameral tissue plasminogen activator (tPA) in the treatment of severe fibrinous membranes that do not respond to anti-inflammatory treatment. PATIENTS AND METHODS In this technique, 0.1 mL of aqueous was aspirated, followed by injection of 0.1 mL (25 microg) of tPA into the anterior chamber in 15 patients with severe fibrinous membranes that developed after pars plana vitrectomy (n = 6), cataract extraction (n = 4), combined cataract and glaucoma surgery (n = 2), trabeculectomy (n = 1), and endophthalmitis (n = 2). The clearance of fibrinous membranes and changes in visual acuity and in intraocular pressure were observed. RESULTS Patients were treated 2 to 10 days postoperatively (mean, 5.6 +/- 0.57 days). Complete fibrinolysis was observed in all cases. The mean time for clearance of fibrin was 7.73 +/- 2.73 hours. A temporary increase in intraocular pressure was noted in two cases. CONCLUSION In this technique, intracameral injection of 25 microg of tPA is both effective and safe in the treatment of severe fibrinous membranes that do not respond to anti-inflammatory treatment.

The relationship between plasma MMP-9 and TIMP-2 levels and intraocular pressure elevation in diabetic patients after intravitreal triamcinolone injection.

PurposeTo find out the relationship between steroid-induced intraocular pressure (IOP) rise and the plasma levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of MMP-2 (TIMP-2) in diabetic patients who underwent intravitreal triamcinolone acetonide (IVTA) injection for the treatment of diabetic macular edema. Subjects and MethodsA total of 34 patients with diabetic macular edema who were treated with IVTA and 17 healthy subjects who served as control group for plasma MMP and TIMP levels were participated. Before IVTA treatment, patients and control subjects underwent complete ophthalmologic examination, including best-corrected visual acuity, slit-lamp biomicroscopy, IOP measurement with Goldmann applanation tonometry, and indirect ophthalmoscopy; and peripheral blood samples were collected from each study participants. Plasma levels of MMP-9, TIMP-2, and HbA1c levels were measured. Patients were seen 1, 6, 12, and 24 weeks after treatment and then every 6 months for up to 1 year for probable IOP rise. Patients were divided into 2 groups as having nonproliferative or proliferative diabetic retinopathy. These 2 groups were further classified according to their IOP levels as normal or elevated IOP (>21 mm Hg). ResultsThe mean age of diabetic group of patients (n=34) and healthy control subjects (n=17) were 57.6±10.2 years (range: 22 to 70 y) and 53.1±10.3 years (range: 29 to 68 y), respectively. Seventeen (50%) diabetic patients had developed elevated IOP after a mean 2.2 months after IVTA injection. MMP-9 and TIMP-2 levels were found to be significantly higher in the diabetic groups with and without elevated IOP when compared with control group (P<0.001). MMP-9/TIMP-2 did not change significantly among the groups. Logistic regression analysis showed that only higher plasma TIMP-2 levels increase the risk of IOP elevation after IVTA injection in proliferative diabetic retinopathy (odds ratio=1.06, P<0.05). No significant relationship was found between IOP rise and HbA1c levels. ConclusionsThe high levels of TIMP in diabetic patients might have a role on steroid-induced IOP rise. The key pathogenetic events that up-regulate TIMP levels should be investigated in steroid IOP rise in diabetics.

Vision, Retinal Thickness, and Foveal Avascular Zone Size After Intravitreal Bevacizumab for Diabetic Macular Edema

IntroductionTo investigate three monthly intravitreal bevacizumab (IVB) injections effects in chronic diabetic macular edema (DME).MethodsA prospective, noncomparative study in which inclusion criteria were; DME with central macular thickness (CMT) of at least 250 μm, and no treatment for diabetic retinopathy (DR) within 4 months before the first injection. All eyes received three monthly 1.25 mg IVB injections. CMT by optical coherence tomography, visual acuity (VA), foveal avascular zone (FAZ) greatest linear dimension (GLD), and area of FAZ by fundus fluorescein angiography were documented initially and 1 month after last injection. Outcomes (P < 0.05 were significant) and correlations (r values) were analyzed.ResultsA total of 29 eyes of 29 patients (group 1, 19 female, 10 male), aged 60.7 ± 6.6 years were analyzed. The patients were split into two groups; group 2 included 15 mild-to-moderate nonproliferative DR, and group 3 included 14 more-severe DR. VA gain was significant in all groups (P < 0.05). Mean CMT decrease was approximately 46, 36, and 55 μm in groups 1, 2, and 3, respectively (P < 0.05 only in group 1). A 0.045-mm2 increase in FAZ area was obtained in group 1 (P < 0.05). In group 2, an increase in GLD and area of FAZ was 0.048 mm and 0.058 mm2, respectively (P < 0.05), whereas in group 3, FAZ enlargement was nonsignificant. VA and CMT were significantly correlated (r values = 0.5−0.6), except for the final VA-final CMT in group 2. FAZ dimensions and other parameters (VA and CMT) were noncorrelated.ConclusionAccording to the authors’ short-term results, three monthly IVB injections can be used for chronic DME regardless of VA, CMT, or FAZ dimensions, despite the FAZ enlargement encountered, especially in cases with milder DR.

Results of Autografting of Marginal Conjunctiva in Pterygium Excision

Purpose: To investigate and compare the efficiency of autografting of marginal conjunctiva (autograft of marginal conjunctiva technique, AMCT) and the bare sclera technique (BST) in pterygium excision. Materials and Methods: In this study, 51 eyes of 51 patients who underwent pterygium surgery using the AMCT (group 1) were compared to 45 eyes of 45 patients who underwent pterygium excision using the BST (group 2), with regard to epithelialisation, recurrence and complication of the procedures. Patients were followed up for 15.37 ± 12.01 months in group 1 and for 18.57 ± 10.42 months in group 2. Results: Postoperative epithelialisation was completed in 4.34 ± 1.27 days in group 1 and in 5.61 ± 1.71 days in group 2. Epithelialisation was completed earlier in group 1 than group 2 (p < 0.05). Recurrences were detected in 7 eyes (13.73%) of group 1 and in 17 eyes (37.78%) of group 2. The difference between the groups was statistically significant (p < 0.01). No postoperative complications were seen in either of the groups. Conclusions: The AMCT was found to be a more efficient procedure than the BST. Autografting of marginal conjunctiva may be a useful alternative treatment in pterygium surgery due to higher success and lower recurrence rates.

The surgical treatment of congenital divided nevus of the eyelid: a case report and review of the literature

We describe a 16-year-old male patient with congenital divided nevus of the eyelids who underwent surgical management using musculocutaneous and tarsoconjunctival flap, and discuss the alternative surgical approaches in the light of the literature. Musculocutaneous flap in conjunction with a tarsoconjunctical flap can be considered as a suitable surgical approach in the management of divided nevus. The patient’s age, gender, the diameter of the lesion, and involvement degree of the entire tarsus, must be kept in mind before the surgery. If the surgical treatment method is tailored for the patient, a better cosmesis can be achieved.

Intravitreal Bevacizumab Following Laser Therapy for Severe Retinopathy of Prematurity

Trial of intravitreal bevacizumab injection in 7 eyes of 4 infants with continued retinopathy of prematurity progression despite previous laser therapy was reported. Six of the eyes benefited from the therapy. Intravitreal bevacizumab injection may be an alternative therapy in progressive stage 3 retinopathy of prematurity despite laser photocoagulation.

The effects of mild-to-severe retinopathy of prematurity on the development of refractive errors and strabismus.

Abstract Purpose: To investigate the effects of mild-to-severe retinopathy of prematurity (ROP) on refractive state and the incidence of strabismus. Materials and methods: Infants born ≤32 weeks of gestation were prospectively evaluated. Inclusion criteria were a follow-up of at least 6 months and at least stage 1 ROP. Group 1 included stage 1 ROP cases. Cases with stage 2 or 3 ROP without indication for treatment formed the second group. Group 3 included cases who received treatment for ROP. Logistic regression, adjusted for birth weight and gestational age, and multiple comparison tests were used to compare outcomes among groups. Results: The mean follow-up time was 20.9 ± 6.6 months. In the first (n = 21), second (n = 22), and third groups (n = 23), the right spherical equivalents (SE) were 1.17 ± 1.33, −0.18 ± 3.09, and −1.08 ± 4.05 diopters, and the left SEs were 1.23 ± 1.34, −0.09 ± 3.24, and −1.46 ± 4.02 diopters, respectively (p = 0.026 for right SE and 0.008 for left SE). The incidences of anisometropia were 3/21, 4/22, and 11/23 in the first, second, and third groups, respectively (adjusted odds ratios [aOR] for group 3 vs 1 = 5.39, aOR for group 3 vs 2 = 4.06). Strabismus developed in 7/21, 6/22, and 10/23 in groups one, two, and three, respectively (aOR for group 3 vs 1 = 2.06, aOR for group 3 vs 2 = 2.27). Eighteen of these were esotropias. Conclusions: Refractive errors and strabismus were associated with mild-to-severe ROP. Esotropia was the most frequent type of strabismus.

The Relationship between the Breast Arterial Calcification Detected by Mammography and the Hypertensive Retinopathy in Hypertensive Women

Objective The purpose of this study was to investigate the relationship between the breast arterial calcification (BAC) detected by mammograms and the hypertensive retinopathy (HR) in hypertensive women who underwent ophthalmologic examination. Materials and Methods Screening mammography was performed in 99 hypertensive women and these women also underwent an ophthalmologic examination. The presence of arterial calcification and the number of calcified blood vessels in each breast were evaluated. The grade of HR was determined. The presence of BAC and the number of blood vessels involved was compared according to the presence of HR and the grade of HR. Results Among the 99 patients, HR was detected in 70 patients, and of these 70 patients, 42 patients had grade I HR and 28 had grade II HR. BAC was detected in 54 cases. Forty-six patients with HR (66%) and eight patients without HR (27%) were diagnosed with BAC after they underwent mammographic examination. The prevalence of BAC in the subjects who had HR was statistically higher than that in those subjects who did not have HR (p < 0.01). The grade of HR was not significantly associated with BAC (p > 0.05). The positive predictive value of the BAC detected on mammography for HR was 0.80 in those subjects who were ≥ 60 years old. Conclusion The detection of BAC by mammography is associated with an increased risk of HR, and particularly for patients after the age of 60. The findings of BAC may be related to hypertensive end-organ damage, and performing mammograms might contribute to predicting the presence of ophthalmologic hypertensive complications in these patients.