Nesrin Büyüktortop

Early results of dexamethasone implant, ranibizumab, and triamcinolone in macular edema due to branch retinal vein occlusion

Purpose To compare the short-term results of the efficacy and safety of dexamethasone intravitreal implant (DEX), ranibizumab (RAN), and intravitreal triamcinolone acetonide (IVTA) in macular edema secondary to branch retinal vein occlusion (BRVO). Methods One eye each of 32 patients who were treated with intravitreal injections for macular edema secondary to BRVO was studied. This retrospective study included 3 groups. The patients received DEX in group 1 (n = 11), RAN in group 2 (n = 11), and IVTA in group 3 (n = 10). Data were collected before and after the injections at the first and third months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were analyzed statistically. Results The median duration of the follow-up was 3.0 months in overall groups. The BCVA increased significantly in all groups (p = 0.018, p = 0.034, p = 0.014, respectively). The CMT increased significantly in groups 1 and 3 (p = 0.02, p<0.001, respectively), but not in group 2 (p = 0.14). The IOP increased significantly in groups 1 and 3 (p = 0.05, p<0.001, respectively). Antiglaucomatous treatment was required only in group 3. Cataract developed in 2 patients (20%) in group 3 and surgery was required. Conclusions Although RAN was the safest among the 3 agents, DEX and IVTA reduced CMT more than RAN, while significant improvement was achieved in BCVA in all groups. All 3 agents can be effectively used in the treatment of macular edema due to BRVO.

Peripapillary and macular retinoschisis in a patient with pseudoexfoliation glaucoma

A 55-year-old man was admitted with a 2-year history of pseudoexfoliation glaucoma. The best-corrected visual acuities were 10/10 in both eyes. Pseudoexfoliation material was noted on the iris and the lens capsule. Fundus examination evidenced cup-to-disc ratio of 0.7 OD and 0.9 OS with peripapillary atrophy. Gonioscopy revealed open angles. Optical coherence tomography demonstrated peripapillary retinoschisis extending to the nasal macula in the left eye and optic nerve head was almost fully excavated. Coexisting retinoschisis in a patient with glaucoma may interfere with the reliability of retinal nerve fibre layer and ganglion cell complex analysis and may change the treatment plan and follow-up intervals.

Effect of 1% brinzolamide and 0.5% timolol fixed combination on intraocular pressure after cataract surgery with phacoemulsification.

AIM To evaluate the effect of brinzolamide-timolol fixed combination on intraocular pressure (IOP) after cataract surgery. METHODS The study included 92 eyes of 87 patients who underwent cataract surgery and intraocular lens implantation. Patients scheduled for phacoemulsification were assigned to 1 of 2 groups. The treatment group received 1 drop of brinzolamide-timolol fixed combination immediately after surgery, and the control group received no treatment. The IOP was measured preoperatively and at 2h and 24h postoperatively. RESULTS The mean IOP change was lower in the treatment group than in the control group at 2h postoperatively. The difference between the mean IOP values of the two groups at 2h postoperatively was found to be statistically significant. Twenty-four hours after the surgery, the mean IOP change was still higher in the control group when compared to the treatment group. CONCLUSION The fixed combination brinzolamide-timolol can effectively reduce IOP after cataract surgery.

Bilateral Recurrent Optic Neuropathy with Unilateral Oculomotor Nerve Palsy in Giant Cell Arteritis

Giant cell arteritis (GCA) is a systemic vasculitis of the elderly affecting large and medium-size cranial arteries. Late recurrent ischemic optic neuropathy (ION) in GCA is not common. Recurrent symptoms generally include malaise, weight loss, myalgia, headache, or scalp tenderness. The oculomotor nerve palsy in GCA may be self-limited and respond to corticosteroid treatment. We report for the first time the combination of recurrence of bilateral optic neuropathy and unilateral third cranial nerve palsy in a case of histologically proven GCA. A 68-year-old man with sudden onset of painless visual loss in both eyes for 5 days was referred to us in 2008. He had suffered from scalp tenderness and headache. The right vision deteriorated rapidly in 2 days. Visual acuity in the left eye decreased the day before he was admitted. Visual acuities were 1/10 on the right and 2/10 on the left. Ophthalmoscopic examination revealed pale swelling of both optic discs. Superficial temporal arteries were hardened with absent pulsation on the right and reduced pulsation on the left. Laboratory investigations revealed an erythrocyte sedimentation rate (ESR) of 96 mm/h. A biopsy of the right superficial temporal artery revealed fragmentation of the internal elastic lamina. The vascular wall was infiltrated with lymphocytes and giant cells. The patient was treated with 1 mg/kg/day oral prednisolone. The symptoms resolved rapidly and visual acuities improved to 2/10 to 3/10, respectively. Four years later, the patient was admitted to us with a 4-week history of pain on his scalp and in the occipital area with bilateral acute vision loss and ptosis of the left eye. He complained of cloudy vision in both eyes. He had also experienced weight loss and fatigue during the last months. Ocular examination revealed a visual acuity of 1/10 in the right eye and perception of light with correct light projection in the left eye. The left pupil measured 6 mm in dim illumination and did not constrict to direct light. The left upper eyelid had 2 mm of ptosis (Figure 1). In the left eye, abduction was normal, but adduction, supraduction, and infraduction were absent. Ophthalmoscopy of the both eyes revealed pale optic discs. The ESR was 69 mm/h (normal value 515 mm/h), and C-reactive protein (CRP) was 8.2 mg/L (normal value 56 mg/L). Neurological examination and brain MRI was found to be normal. We started with a 3-day induction dose of iv methylprednisolone, 1 g/day, followed by oral prednisone maintenance therapy at an initial dose of 1 mg/kg/day. Three weeks later, the features of third cranial nerve palsy had disappeared except for a dilated unreactive pupil. The visual loss improved to 2/10 and counting fingers at 5 m, respectively. At the seventh month, the patient is still being treated with 10 mg/day oral prednisolone with monthly monitoring of ESR and CRP levels. Late recurrence of ION and oculomotor nerve palsy are rarely seen in patients with GCA. Liu et al. reported recurrent ION in the same eye in 2 patients after initiation of prednisone therapy in a series of 45 patients with GCA. Calamia and Hunder described a recurrent ipsilateral visual loss 5 months after initiation of treatment. Bilateral recurrent visual loss and unilateral oculomotor nerve palsy with pupillary involvement occurred in our patient. Pupillary sparing is the hallmark of an ischemic oculomotor palsy, as seen

Bilateral consecutive optic neuropathy in a patient with thrombophilia

A 39-year-old man was admitted with a sudden visual loss in the left eye. Visual acuities were 10/10 on the right and 1/10 on the left. Fundus examination did not show any abnormalities. Visual acuity improved to 10/10 and visual field defect regressed in the following 2 weeks. Three years later, the patient returned with acute visual loss in the right eye. Visual acuities were 2/10 on the right and 10/10 on the left. Right optic disc had blurred margins with mild oedema. The tests revealed methylenetetrahydrofolate reductase A1298C mutation with positive lupus anticoagulant and hyperhomocysteinaemia. Enoxaparin was initialised with vitamin B12 supplementation. Complete visual recovery occurred in the following 3 weeks in both eyes. Thrombophilic screening seems to be important in the treatment and prevention of an attack in the second eye of patients with non-arteritic anterior ischaemic optic neuropathy.