Necdet Bekir

Comparison of secondary implantation of flexible open-loop anterior chamber and scleral-fixated posterior chamber intraocular lenses

Purpose: To analyze and compare the outcomes and complication rates of secondary implantation of flexible, open‐loop, anterior chamber intraocular lenses (AC IOLs) and single‐piece, scleral‐fixated, posterior chamber IOLs (PC IOLs). Setting: Departments of Ophthalmology, Gaziantep University Medical Faculty, Research Hospital, Gaziantep, and Inönü University Medical Faculty, Research Hospital, Malatya, Turkey. Methods: This study comprised 124 eyes of 113 aphakic patients (61 men, 52 women) with insufficient capsule support who had secondary IOL implantation from January 1997 to June 2001. In Group 1 (n = 73 eyes), a flexible, open‐loop AC IOL was implanted and in Group 2 (n = 51 eyes), a single‐piece, scleral‐fixated PC IOL. The mean follow‐up was 34 months (range 6 to 53 months) and took place at several different clinical settings. The mean interval between the initial cataract operation and secondary IOL implantation was 63 months (range 6 months to 12 years). The postoperative outcomes, safety, efficacy, and complication rates were analyzed, and the preoperative and postoperative best spectacle‐corrected visual acuities (BSCVAs) were compared. Results: The postoperative mean BSCVA was 20/34.8 ± 45.2 (SD) in Group 1 and 20/32.1 ± 33.7 in Group 2; the difference was not significant (P = .718). A BSCVA of 20/40 or better was achieved in 62 eyes (84.9%) in Group 1 and 45 eyes (88.2%) in Group 2. A BSCVA of 20/25 or better was achieved in 40 eyes (54.8%) and 33 eyes (64.7%), respectively. The difference between the 2 groups was not significant (P = .472). Complications occurred in 25 eyes (34.2%) in Group 1 and 13 eyes (25.5%) in Group 2 (P > .05). The most frequent complications in Group 1 were early transient corneal edema, intraocular pressure elevation, cystoid macular edema, hyphema, secondary glaucoma, and iris capture or pupil decentration and in Group 2, suture erosion, a tilted or decentered IOL, fibrin reaction, and vitreous prolapse into the anterior chamber. Conclusions: The AC IOLs and PC IOLs were safe and effective for secondary implantation to correct aphakia. Secondary implantation of the scleral‐fixated PC IOL seemed to provide a more favorable outcome and a lower complication rate than the open‐loop AC IOL in complicated cataract cases with inadequate capsule and zonular support. As scleral‐fixated PC IOL implantation is technically more difficult than AC IOL implantation, the decisive factor in choosing a secondary IOL is surgical experience. Long‐term comparison of both techniques is required.

Central corneal thickness is lower in osteogenesis imperfecta and negatively correlates with the presence of blue sclera

Background:  Osteogenesis imperfecta (OI) is a rare, autosomal‐inherited, connective tissue disorder characterised by bone fractures, deafness and blue sclera. Additional ocular findings are decreased ocular rigidity, myopia, glaucoma, keratoconus, corneal opacity, small corneal diameter and congenital Bowmans layer agenesis.

Ocular complications associated with brucellosis in an endemic area

PURPOSE To report the ocular manifestations associated with brucellosis in an endemic area. METHODS We prospectively evaluated 147 patients with the diagnosis of brucellosis between May 1996 to May 2000 and recorded the ocular and systemic findings. The diagnosis was based on clinical findings, positive serological and bacteriological tests (Brucella agglutination test: over 1/160 titer, blood culture). RESULTS Thirty-eight patients (26.0%) with brucellosis had ocular complications: conjunctivitis in 26 (17.7%), anterior uveitis in six (4.1%), posterior uveitis in one (0.7%), dacryoadenitis in two (1.4%), episcleritis in three (2.1%). Three of the seven patients with uveitis had spondylitis associated with brucellosis. Osteoarticular complications in brucellosis were more frequent in the patients with ocular involvement though the difference was not statistically significant compared with patients without ocular involvement. CONCLUSIONS Ocular manifestations are frequent in brucellosis so an ophthalmologic examination should be routinely performed in patients with brucellosis in endemic areas. (Eur J Ophthalmol 2002; 12: 232-7).

Decreased central corneal thickness in children with Down syndrome.

PURPOSE A cross-sectional, masked, case-control study was undertaken to investigate whether central corneal thickness is affected in children with Down syndrome and to focus on its clinical significance. PARTICIPANTS AND METHODS Twenty-eight children with Down syndrome (15 boys and 13 girls) aged 5 to 15 years and 20 age-matched and gender-matched healthy control subjects (11 boys and 9 girls) from a similar ethnic background were enrolled in the study. Central corneal thickness was measured by ultrasound pachymetry. Only the right eye of each child in each group was included in the statistical analysis. The Mann-Whitney U test was used and a P value of less than .05 was considered significant. RESULTS The mean ages of the children with Down syndrome (9.28 +/- 3.47 years) and the healthy control subjects (8.75 +/- 3.30 years) were comparable (P > .05). Central corneal thickness values were below 500 microm in 19 (67.8%) of the 28 children with Down syndrome, 4 of which were less than 450 microm. However, all central corneal thickness measurements in the control eyes were more than 500 microm. The mean central corneal thickness in the children with Down syndrome was significantly (P < .001) less (488.39 +/- 39.87 microm) than that in the healthy control subjects (536.25 +/- 20.70 microm). Mean keratometric values were significantly (P < .001) higher in the eyes of the children with Down syndrome (46.35 +/- 1.28 D) than in the eyes of the control subjects (43.32 +/- 1.15 D). CONCLUSIONS Children with Down syndrome had a decreased central corneal thickness compared with healthy control subjects. Decreased central corneal thickness may give an artificially low intraocular pressure measurement by applanation tonometry. Central corneal thickness must be considered when developing approaches for keratorefractive treatment of patients with Down syndrome.

The Impact of Acute Dynamic Exercise on Intraocular Pressure: Role of the β2-Adrenergic Receptor Polymorphism

Effects of mutations in the β2-adrenergic receptor (β2AR) gene on intraocular pressure (IOP), in response to acute dynamic exercise, were investigated in 19 healthy males (age 22.6 ± 2.8 years). Intraocular pressures were measured pre- and post-exercise. Weight, height, body mass index, and maximal oxygen (VO2max) uptake were recorded and subjects were genotyped for Arg16Gly, Gln27Glu and Thr164Ile mutations of the β2AR gene. Post-exercise, reductions in mean IOP values were found in 16 subjects with the Gly16Gly and Arg16Gly genotypes, but these values remained low in the eight patients with the Gly16Gly genotype 3 h post-exercise, whereas they returned to baseline within 1 h in the eight subjects with the Arg16Gly genotype. β2AR stimulation during exercise could be an important regulator of IOP response and determining β2AR polymorphisms may improve understanding of pathogenesis and treatment selection in ophthalmic diseases, e.g. glaucoma.

Effects of intravitreal bevacizumab (Avastin®) therapy on retrobulbar blood flow parameters in patients with neovascular age‐related macular degeneration

To investigate the effects of intravitreal bevacizumab on retrobulbar circulation in patients with neovascular age‐related macular degeneration (AMD).

Effectiveness of retroequatorial recession surgery in congenital nystagmus.

OBJECTIVE The aim of this retrospective study was to evaluate the effectiveness of the retroequatorial recession technique in the surgical treatment of nystagmus and associated strabismus. METHOD The effect of large recessions of four horizontal extraocular muscles was analyzed qualitatively in seven patients with congenital nystagmus. RESULTS The ages of the patients ranged between 12 and 42 years (mean, 21.5 years). Of the seven patients, four had motor and three had sensory nystagmus. Visual acuity increased in five (71.4%) patients. Planned recovery of associated strabismus was attained in six patients (85.7%). In five patients who had abnormal head position, the head positions and nystagmus intensities were found to be decreased. No postoperative complication, such as diplopia, was encountered. CONCLUSION The retroequatorial recession technique is preferable in patients who have congenital nystagmus, especially in the presence of horizontal squint associated with low visual acuity, because of its success in increasing visual acuity and decreasing the amplitude of nystagmus, its reversibility, making posssible new operations in the future, as well as the absence of any significant complications.

Beta 2-adrenergic receptor polymorphism and susceptibility to primary congenital and primary open angle glaucoma

ObjectiveIt has been shown that arginine to glycine (Arg16Gly), glutamine to glutamic acid (Gln27Glu) and threonine to isoleucine (Thr164Ile) exchanges in codons 16, 27 and 164, respectively, of the beta 2-adrenergic receptor (B2AR) gene significantly alter receptor function. As B2ARs are located on the afferent blood vessels supplying the ciliary body and trabecular meshwork cells, which control aqueous humour dynamics, polymorphisms of B2AR may be involved in the pathophysiology of certain eye diseases, such as glaucoma. Therefore, the aim of the present study was to investigate the distribution of B2AR polymorphisms in patients with primary congenital and primary open angle glaucoma.MethodsA group of 30 patients with primary congenital glaucoma, 105 with primary open angle glaucoma and 92 control patients were analysed for the Arg16Gly, Gln27Glu, and Thr164IIe polymorphisms of the B2AR by polymerase chain reaction–restriction fragment length polymorphism.ResultsThe allelic frequencies of Gly16, Glu27 and IIe164 variant alleles were 66.7, 38.3 and 3.3% in patients with congenital glaucoma, 59.5, 31.0 and 1.0% with glaucoma, and 54.9, 26.6 and 0.5% in controls, respectively. Although statistically non-significant, the frequencies of variant alleles were slightly higher in both groups of the glaucoma patients.ConclusionsThese results suggest no evidence of an association between the Arg16Gly, Glu27Gln and Thr164Ile polymorphisms of the B2AR gene and risk of developing primary open angle glaucoma or primary congenital glaucoma. However, further studies are needed to understand the role of B2AR polymorphisms in patients with eye disease.

The predictive value of auditory brainstem responses for diabetic retinopathy.

OBJECTIVE The purpose was to find out whether there is a relationship between the central nervous system involvement and retinopathy in diabetes mellitus. STUDY DESIGN In a multidisciplinary clinical study, diabetic patients with and without retinopathy were examined utilising auditory brainstem response (ABR) testing, and the results were interpreted from clinical and pathophysiological point of view. PATIENTS AND METHODS Thirty-three diabetic patients with retinopathy (study group) and 20 diabetic patients without retinopathy (control group) were included. Audiometry and ABR testing were made. The results of both groups were compared for ABR parameters. RESULTS Audimetric results of the study and control groups were similar. In the study group, ABR testing revealed prolonged absolute and interpeak latency of the waves. The difference was significant for I-III interval (P<0.01). The amplitudes of the waves were similar in both groups and wave V amplitude was significantly diminished in the study group. Abnormal waveforms were recorded by 40 and 12.5% in the study and control groups, respectively. CONCLUSION Retinopathy is accompanied with lower brainstem disintegration. Microangiopathy is the possible mechanism that is involved in the occurrence of retinopathy and brainstem neuropathy. ABR can help diagnose retinopathy. Better understanding the role of ABR in diagnosis and early detection of retinopathy in diabetic patients needs further study.

Sutureless Closure of the Conjunctiva with a Commercial Fibrin Sealant in Extraocular Muscle Surgery for Strabismus

Purpose Suturing is a time-consuming process and patients may suffer from sutures because of discomfort and tearing. This prospective study was done to determine the efficacy of an available commercial fibrin sealant for conjunctival wound closure following extraocular muscle surgery for strabismus. Methods Fibrin sealant (Beriplast®) was used in 48 conjunctival wounds of 25 patients with strabismus during the period February 2004 to May 2005. There were 12 males and 13 females, whose mean age was 9.3 years. Results No allergic reactions, chemosis or infections were seen, but suturing was necessary a day after surgery in 3 wounds of 2 cases (3/48 eyes, 6%). All conjunctival wounds were healed at the end of the second week. Conclusion The use of Beriplast® for conjunctival wound closure is an effective method that is easy to apply and should be considered a solution in strabismus surgical practice.