Necip Kara

Prophylactic Selective Laser Trabeculoplasty in the Prevention of Intraocular Pressure Elevation After Intravitreal Triamcinolone Acetonide Injection

PURPOSEnTo evaluate the prophylactic efficacy of selective laser trabeculoplasty for preventing an increase in intraocular pressure (IOP) after intravitreal triamcinolone acetonide injection.nnnDESIGNnProspective, comparative, interventional case series.nnnMETHODSnWe studied 31 eyes with a baseline IOP of 21 mm Hg or more of 31 patients for which intravitreal triamcinolone acetonide injection was planned for diabetic macular edema. The patients were divided into 2 groups, a study group and control group. The study group comprised 15 eyes of 15 patients that underwent selective laser trabeculoplasty a mean of 8.3 ± 4.1 days before intravitreal triamcinolone acetonide injection. The control group comprised 16 eyes of 16 patients who underwent only intravitreal triamcinolone acetonide injection. Main outcomes measures were mean IOP and number of patients requiring antiglaucomatous therapy.nnnRESULTSnMean baseline IOP was 21.6 ± 0.9 mm Hg in the study group and 21.5 ± 0.8 mm Hg in the control group (P = .98). Mean IOP at 1 day after injection was 17.0 ± 2.0 mm Hg in the study group and 19.5 ± 4.3 mm Hg in the control group (P = .23). Mean IOP at 1 week after injection was 16.9 ± 1.7 mm Hg and 18.4 ± 4.0 mm Hg, respectively (P = .49); mean IOP at 1 month after injection was 16.4 ± 1.5 mm Hg and 20.8 ± 5.6 mm Hg, respectively (P = .003); mean IOP at 3 months after injection was 15.8 ± 2.5 mm Hg and 18.3 ± 5.5 mm Hg, respectively (P = .01); and mean IOP at 6 months after injection was 15.7 ± 1.4 mm Hg and 17.1 ± 1.5 mm Hg, respectively (P = .03). The number of patients requiring antiglaucomatous therapy during follow-up was 0 of 15 eyes in the study group and 8 of 16 eyes in the control group (P = .001).nnnCONCLUSIONSnThe IOP elevation after intravitreal triamcinolone acetonide injection may be prevented by performing selective laser trabeculoplasty before intravitreal triamcinolone acetonide injection, especially in cases with a baseline IOP of 21 mm Hg or more.

Comparison of Selective Laser Trabeculoplasty Success in Patients Treated with Either Prostaglandin or Timolol/Dorzolamide Fixed Combination

PURPOSEnThe purpose of this study was to compare the efficacy of selective laser trabeculoplasty (SLT) in eyes of patients with open-angle glaucoma receiving either a prostaglandin (PG) analog or a timolol/dorzolamide fixed combination (TDFC).nnnMETHODSnIn this retrospective study, we analyzed 48 eyes of 35 patients who underwent SLT for open-angle glaucoma receiving either a PG analog (n=20) or a TDFC (n=28). Mean decrease in intraocular pressure (IOP) and success rates were compared between patients treated with PG and those treated with TDFC. Success was defined as an IOP reduction of at least 20% at postoperative 1 year.nnnRESULTSnThe mean decrease in IOP in eyes treated with PG and in eyes treated with TDFC were 4.1±3.1 and 4.6±3.5 at 1 week (P=0.579), 5.3±3.4 and 5.7±2.0 at 1 month (P=0.485), 5.2±3.1 and 5.5±2.5 at 3 months (P=0.271), 5.0±3.1 and 6.1±2.5 and at 6 months (P=0.044), and 4.7±3.1 and 6.5±2.9 at 1 year (P=0.017), respectively. The success rate at postoperative 1 year was 50.0% (standard deviation±16) in eyes receiving PG and 78.6% (standard deviation:±11) in eyes receiving TDFC (P=0.041).nnnCONCLUSIONnThis study shows that the SLT seems to be more effective in TDFC users than PG analog users.

Evaluation of Corneal Morphologic and Functional Parameters After Use of Topical Cyclosporine-A 0.05% in Dry Eye

PURPOSEnTo report the effect of topical Cyclosporine-A (CsA) 0.05% on corneal morphologic and functional parameters in patients with dry eye.nnnMETHODnIn this prospective and observational study 30 eyes of 30 patients who received topical CsA 0.05% for treatment of dry eye were evaluated. Each clinical examination included a routine Schirmer I test and tear film break-up time (TBUT) was performed at baseline and after 1, 2, 3, and 6 months of treatment. All participants also underwent central corneal thickness (CCT) measurements with ultrasound pachymetry, endothelial cell density (ECD) with specular microscopy, corneal topographical evaluation with Orbscan II, and corneal biomechanical parameters with Ocular Response Analyzer measurements at baseline and after treatment.nnnRESULTSnThe Schirmer I test and TBUT were significantly improved after treatment (for both; P<0.01). The CCT, topographical findings, ECD, and corneal biomechanical parameters were not significantly different at baseline and follow-up visits (P>0.05). No serious adverse effects were seen at follow up visits.nnnCONCLUSIONnThe study showed that Topical CsA 0.05% caused no changes on corneal morphology and function.

Choroidal thickness changes after dynamic exercise as measured by spectral-domain optical coherence tomography

Purpose: To measure the choroidal thickness (CT) after dynamic exercise by using enhanced depth imaging optical coherence tomography (EDI-OCT). Materials and Methods: A total of 19 healthy participants performed 10 min of low-impact, moderate-intensity exercise (i.e., riding a bicycle ergometer) and were examined with EDI-OCT. Each participant was scanned before exercise and afterward at 5 min and 15 min. CT measurement was taken at the fovea and 1000 μ away from the fovea in the nasal, temporal, superior, and inferior regions. Retinal thickness, intraocular pressure, ocular perfusion pressure (OPP), heart rate, and mean blood pressure (mBP) were also measured. Results: A significant increase occurred in OPP and mBP at 5 min and 15 min following exercise (P ˂ 0.05). The mean subfoveal CT at baseline was 344.00 ± 64.71 μm compared to 370.63 ± 66.87 μm at 5 min and 345.31 ± 63.58 μm at 15 min after exercise. CT measurements at all locations significantly increased at 5 min following exercise compared to the baseline (P ˂ 0.001), while measurements at 15 min following exercise did not significant differ compared to the baseline (P ˃ 0.05). There was no significant difference in retinal thickness at any location before and at 5 min and 15 min following exercise (P ˃ 0.05). Conclusion: Findings revealed that dynamic exercise causes a significant increase in CT for at least 5 min following exercise.

Corneal biomechanical properties and intraocular pressure measurement in patients with nanophthalmos

Aims To compare the biomechanical properties of the cornea and intraocular pressure (IOP) between patients with nanophthalmos and age-matched controls. Methods In this prospective, cross-sectional and comparative study, 27 eyes of 27 healthy individuals (control group) and 27 eyes of 27 patients with nanophthalmos (study group) were enrolled. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated intraocular pressure (IOPcc) and Goldmann correlated intraocular pressure (IOPg) were recorded for the right eye of each participant using Reichert Ocular Response Analyser measurements. Also, all participants in this study underwent a standardised ocular examination including IOP measurement with Goldmann applanation tonometry (IOPGAT), central corneal thickness and axial length (AL) assessments. Results Mean CH in the nanophthalmic eyes and in the control eyes were 13.3±2.4u2005mmu2002Hg and 11.6±1.7u2005mmu2002Hg, respectively (p=0.003); mean CRF values in the nanophthalmic and the control eyes were 13.2±1.8u2005mmu2002Hg and 11.4±1.9u2005mmu2002Hg, respectively (p=0.001). Mean IOPGAT was 15.2±3.3u2005mmu2002Hg in the nanophthalmic eyes and 13.4±2.7u2005mmu2002Hg in the control group (p=0.031); mean IOPg values for the nanophthalmic and the control groups were 17.1±5.3u2005mmu2002Hg and 14.7±3.5u2005mmu2002Hg, respectively (p=0.042). Mean IOPcc values in the nanophthalmic and the control group were 13.6±6.1u2005mmu2002Hg and 14.8±3.2u2005mmu2002Hg, respectively (p=0.365). Conclusion The CH, CRF, IOPg and IOPGAT were significantly higher in the nanophthalmic eyes, whereas no significant differences in IOPcc were observed. These findings may be taken into account when measuring IOP values in patients with nanophthalmos.

Unilateral superior pellucid marginal degeneration in a case with ichthyosis

A 47-year-old man with ichthyosis vulgaris presented to our hospital complaining of reduced visual acuity and ocular discomfort in the left eye. Slit-lamp biomicroscopy revealed a thinning about 2mm from the superior limbus and superficial punctate corneal lesions in the left eyes. Corneal topography was butterfly-like in an area of increased elevation in the left eye. Although ichthyosis vulgaris and unilateral superior pellucid marginal degeneration are both uncommon conditions, this is first report about these two conditions in studied together.

Which procedure has more effect on macular thickness: primary posterior continuous capsulorhexis (PPCC) combined with phacoemulsification or Nd:YAG laser capsulotomy?

To compare the effect of Nd:YAG laser capsulotomy and primary posterior continuous capsulorhexis (PPCC) combined with phacoemulsification on macular thickness using optical coherence tomography (OCT) in adults. This prospective comparative interventional study included 32 eyes of 30 patients who underwent Nd:YAG laser capsulotomy and 33 eyes of 33 patients who underwent cataract surgery with PPCC. Detailed ocular examinations, including macular thickness measurements by OCT, were performed in all patients preoperatively and postoperatively on the 1st day, 1st week, and 1st, 3rd and 6th months. No significant differences were found in macular thickness between the two groups in preoperative and postoperative follow-up. No cystoid changes were observed in OCT during the postoperative period in both groups. Nd:YAG laser capsulotomy and PPCC combined with cataract surgery are safe and effective procedures that are not associated with an increase in macular thickness.

Effects of Valsalva Maneuver on Ocular Biometric Parameters: Optical Low-Coherence Reflectometry Biometer Study

Abstract Purpose: To evaluate the effects of the Valsalva Maneuver (VM) on ocular biometry and intraocular pressure (IOP). Methods: This prospective observational study included 55 eyes of 55 healthy volunteers. Axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), corneal curvature (K-steep, K-flat and K-mean), corneal diameter (WtW), and pupil diameter (PD) were measured with a LenStar LS 900® biometer at rest and during VM. The IOP was also measured at rest and during VM measurements were compared. Results: The VM did not have any significant influence on AL, WtW, K-flat, and K-mean (pu2009>u20090.05), but it decreased K-steep significantly (pu2009<u20090.001). Moreover, CCT and ACD decreased significantly during VM (pu2009<u20090.001), but VM increased IOP, PD (pu2009<u20090.001), and LT significantly (pu2009=u20090.002). Conclusions: The VM might reversibly change in IOP and ocular biometry, so it should be considered during anterior segment examinations.

Long-term outcomes of intrastromal corneal ring segment implantation for post-LASIK ectasia

PURPOSEnTo report the long-term results of intrastromal corneal ring segments (ICRS) for postoperative LASIK ectasia.nnnMETHODnIn this retrospective interventional cases series, 8 eyes of 6 patients who underwent femtosecond laser-assisted ICRS implantation for post-LASIK ectasia were enrolled. Main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent refraction, and average keratometry (Kavg) values were assessed.nnnRESULTSnMean±SD follow-up was 67±21 months (range, 36-96 months). The mean UDVA, CDVA, spherical equivalent refraction, and Kavg values were significantly improved at all postoperative visits when compared to baseline values. No serious complications were observed during follow-up.nnnCONCLUSIONnOur long-term findings showed that ICRS yielded improvements in visual acuity, refractive status, and keratometric values without any progression in cases with post-LASIK corneal ectasia.

Effect of refractive status on Valsalva-induced anterior segment changes

PurposeTo evaluate the effect of the Valsalva maneuver (VM) on anterior segment parameters and its association with refractive status.MethodIn this prospective study, 120 eyes of 120 subjects were evaluated. Subjects were divided into three groups: myopic (nxa0=xa040 patients), hyperopic (nxa0=xa040 patients), and emmetropic (control group, nxa0=xa040 subjects). The anterior segment parameters, including keratometric, pachymetric, and anterior chamber parameters, were measured using the Sirius System (Costruzione Strumenti Oftalmici, Florence, Italy) before and during VM.ResultsThere was no statistically significant difference in corneal parameters including keratometric and pachymetric values at rest or during VM in myopic, hyperopic, and control groups (pxa0>xa00.05 for all). In the myopic and control groups, anterior chamber depth, anterior chamber volume (ACV), and anterior chamber angle (ACA) were significantly decreased during VM. In the hyperopic group, only anterior chamber depth was significantly decreased during VM, while ACV and ACA did not significantly change.ConclusionThe Valsalva maneuver may cause significant narrowing in anterior chamber depth, anterior chamber volume, and anterior chamber angle in the myopic and emmetropic groups, whereas it may affect only anterior chamber depth in the hyperopic group.