Nihal Demircan

Pars plana vitrectomy in ocular Behçet's disease

Purpose: To evaluate the results of pars plana vitrectomy in Behçet patients with dense vitreous opacities, and its effect on intraocular inflammatory episodes and visual prognosis. Methods: The study group consisted of nine patients (one eye in eight patients, both eyes in one) with Behçets disease who underwent pars plana vitrectomy because of dense vitreous opacification. The indications for vitrectomy, the effect of vitrectomy on the frequency of severe intraocular inflammatory episodes, and visual prognosis were investigated in these patients. All the patients were male, and their ages ranged between 28–45 years. Combined lensectomy was performed on those with complicated cataracts. The postoperative follow-up was between 12–66 months. Results: In all of the patients preoperative visual acuity was hand motions. Postoperatively there was no change in vision in five eyes, however visual acuity improvedin five eyes, between counting fingers and 0.4. None of the patients showed any severepostoperative intraocular inflammatory episodes, and phthisis did not develop in any ofthe patients. Conclusion: In this study, pars plana vitrectomy was found to have a beneficial effect on the prognosis of vision. There was also a decrease in the frequency of severe intraocular inflammatory episodes in patients with Behçets disease with severe vitreous opacities, who did not respond to maximum medical treatment. However, further studies on larger groups should be performed in order to confirm the findings of this study.

Clinical features of Bardet-Biedl syndrome

Six patients with Bardet‐Biedl syndrome who have been followed in our clinics for the last 5 years are reported in this study. Of the five classic features of this syndrome; obesity and mental retardation were present in all cases, retinal disturbances were present in five, Polydactyly in three and hypogenitalism was observed in all four male patients. Renal involvement, often suggested as a cardinal feature of this syndrome, was described in two patients. Iron deficiency anemia occurred in three patients, two patients were of short stature, one patient presented with an empty sella, and in two patients clinodactyly was detected. The results are compared to previously published literature and discussed.

Evaluation of Choroidal Vascular Changes in Patients with Multiple Sclerosis Using Enhanced Depth Imaging Optical Coherence Tomography

Objective: To evaluate the choroidal thickness in patients with multiple sclerosis (MS) using enhanced depth imaging optical coherence tomography (EDI-OCT). Methods: In this observational comparative study, 68 eyes of 34 MS patients and 60 eyes of 30 healthy subjects were evaluated. All participants underwent complete ophthalmologic examination and OCT scanning. Choroidal thickness measurements were performed at seven points. Results: The mean subfoveal choroidal thickness was reduced significantly in MS patients (310.71 ± 61.85 μm) versus healthy controls (364.85 ± 41.81 μm) (p < 0.001). The difference was also significant at all six measurement points (p < 0.001 for all). Choroidal thickness measurements revealed no significant difference between MS eyes with a prior optic neuritis (ON) history (MS ON) and those without ON history (MS non-ON). Subfoveal choroidal thickness did not correlate with retinal nerve fiber layer and Expanded Disability Status Scale score, but reduced choroidal thickness was associated with longer disease duration (r = -0.28, p = 0.019) in MS patients. Conclusion: In MS patients, choroidal structural changes occur both in MS ON and MS non-ON eyes. The decreased choroidal thickness might provide evidence to support a potential role of vascular dysregulation in the pathophysiology of MS.

Haemodynamic changes in ocular Behçet's disease

Editor,—Behcet’s disease (BD) is an immune system related obstructive vasculitis characterised by recurrent inflammation that affects multiple systems. Posterior uveitis and retinal vasculitis are the common features of ocular involvement.1-3 Colour Doppler imaging (CDI) is a non-invasive ultrasonographic method which permits simultaneous grey scale imaging of structure and colour coded imaging of blood velocity. CDI has successfully demonstrated changes in orbital haemodynamics associated with a variety of pathological conditions.4-7In the present study the haemodynamic changes in ophthalmic (OA), central retinal (CRA), and posterior ciliary arteries (PCA) of the patients with BD were investigated by using CDI. ### CASE REPORT The study group consisted of 26 patients with BD (five females, 21 males), aged between 22 and 58 (mean 32.19 (SD 8.27)). Diagnosis was made according to the criteria recommended by International Study Group for Behcet’s disease.8 Control group consisted of 20 males, six females, aged between 21 and 58 (31.49 (8.60)), who had no ocular or systemic pathology other than presbyopia. After performing full ophthalmological evaluation, transocular CDI was performed in all the patients and controls with a colour Doppler sonographic unit (General Electric Sonochrome …

Evaluation of the Innermost Retinal Layers and Visual Evoked Potentials in Patients with Multiple Sclerosis

ABSTRACT Purpose: The present study was conducted to investigate alterations in the innermost layers of the retina using optical coherence tomography (OCT) and to assess potential associations of structural measures with functional markers in patients with Multiple Sclerosis (MS). Materials and Methods: Ninety-four eyes of 47 MS patients and 60 eyes of 30 healthy individuals were included in the study. All patients underwent complete ophthalmological examination and OCT imaging to analyze peripapillary retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness. Visual evoked potentials (VEPs) and expanded disability status scale (EDSS) score were assessed for MS patients. Results: The average RNFL and GCIPL thicknesses were thinner in MS patients (86.2 ± 11.9 µm and 73.6 ± 9.7 µm, respectively) when compared with those of healthy controls (96.7 ± 8.2 µm and 85.9 ± 4.6 µm, respectively, p < 0.001 for both). Within MS patients, the average RNFL and GCIPL thicknesses were lower in eyes with a prior history of optic neuritis (MS ON) than in eyes with no optic neuritis history (MS non-ON) (p = 0.012 and p < 0.001, respectively). RNFL and GCIPL thicknesses were inversely correlated with VEP latency (r = −0.40, p < 0.001 and r = −0.36, p < 0.001, respectively) in MS patient eyes. There was a correlation between GCIPL thickness and VEP amplitude in eyes with previous ON history (r = 0.34, p = 0.035). No significant correlations were found between OCT measurements and EDSS score. Conclusions: Innermost layers of the retina are highly affected by the pathophysiologic process in MS disease, manifesting as a reduction in RNFL and GCIPL thickness. The structural retinal changes show correlation with alterations in potentials showing the optic pathway function.

Mersilene mesh: long-term results in oculoplastic surgery

We evaluated the long-term results of Mersilene mesh application in 72 patients with various ophthalmic disorders. Mersilene mesh was used as a cover material for primary and secondary orbital implantation, as a sling material for the upper and lower lids, and as a spacer material for lid retraction. The postoperative follow-up period ranged from 15 to 62 months (average 43.21±12.8). Orbital implant exposure developed in 10 of 35 cases who had undergone enucleation and primary orbital implantation. Sphere exposure developed in one of 18 cases who had undergone secondary orbital implantation. We used Mersilene mesh as a frontalis sling material in 19 ptotic lids of 15 cases. Suture granuloma developed in 3 cases, and in 2 cases we observed Mersilene mesh extrusion associated with chronic discharge near the free edge of the lid. When used as a spacer material in lid retraction surgery, Mersilene mesh extruded through the conjunctiva of both lower lids in one of three cases. These long-term results indicate ...

PUVA TREATMENT AND CHOROIDAL MALIGNANT MELANOMA

Abstract. Choroidal malign melanoma showing rapid progression in a boy 17 years old is presented. The patient was under therapy with methoxy psoralen + Ultraviolet A (PUVA)* for psoriasis vulgaris. He had undergone complete ophthalmologic examinations with three‐month intervals from the beginning of this therapy. The tumor was detected in the seventh month, rapidly enlarging within the next twenty days, and eventually leading to enucleation. PUVA is known to be a risk factor for cutaneous malign melanoma. However, there is no reported incidence of choroidal malign melanoma in PUVA treated patients. To our knowledge, this is the only case showing the possible role of PUVA therapy as a predisposing factor in the development of uveal malign melanoma.

TWO CASES OF ACUTE ENDOPHTHALMITIS AFTER INTRAVITREAL DEXAMETHASONE IMPLANT INJECTION.

PURPOSE To present two cases of acute endophthalmitis after intravitreal dexamethasone implant injection and discuss the management of intravitreal implant-associated endophthalmitis. METHODS Two patients, who underwent intravitreal dexamethasone implant injection for macular edema secondary to diabetic retinopathy in one and branch retinal vein occlusion in the other, were admitted with decreased vision, pain, and redness in their treated eyes, 3 days and 5 days after the injection, respectively. The clinical findings of both patients were consistent with acute endophthalmitis. RESULTS After obtaining aqueous and vitreous samples, the patients were treated with intravitreal antibiotic injection and topical fortified antibiotics. Both patients revealed favorable clinical response and functional vision was recovered. CONCLUSION Intravitreal dexamethasone implant-associated endophthalmitis is an uncommon and a challenging situation. Intravitreal antibiotics may lead to favorable visual outcomes without the need for a pars plana vitrectomy and implant removal in selected cases.

Intravitreal aflibercept for management of subfoveal choroidal neovascularization secondary to angioid streaks.

In this study, we reported the clinical results of switching from ranibizumab to aflibercept for the treatment of an insufficient responder with choroidal neovascularization (CNV) secondary to angioid streaks (AS). A 39-year-old female patient with CNV secondary to AS had bilateral persistent intraretinal and subretinal fluid on the optical coherence tomography despite prior intravitreal 0.5 mg ranibizumab injections. The therapy was switched to intravitreal injection of aflibercept. The patient received a loading dose of three intravitreal 2 mg aflibercept injections at 4-week intervals for both eyes. Morphological and functional effects were observed as early as 1-week after the first injection. After the third aflibercept injection, her visual acuity improved, intraretinal and subretinal fluid resolved, and central macular thickness reduced in both eyes. This is an early, but encouraging and promising result indicating that aflibercept might be a good alternative management for CNV secondary to AS that is insufficiently responding to prior ranibizumab injections.

Evaluating Choroidal Characteristics in Systemic Sclerosis Using Enhanced Depth Imaging Optical Coherence Tomography

ABSTRACT Purpose: To evaluate choroidal thickness (CT) and investigate the involvement of choroidal circulation in patients with systemic sclerosis (SSc). Methods: A total of 120 eyes of 60 SSc patients and 60 eyes of 30 healthy controls were evaluated. CT measurements were performed at the subfoveal region, 1000 µm nasal and 1000 µm temporal to the fovea, using enhanced depth imaging optical coherence tomography. CT measurements were compared between the patients and controls. Results: The average subfoveal, parafoveal nasal and parafoveal temporal CT were significantly thinner in SSc patients when compared with healthy controls (297.77 ± 60.8 µm vs 339.8 ± 50.4 µm; 267.32 ± 51.1 µm vs 308.65 ± 49.9 µm; 270.63 ± 46.3 µm vs 309.22 ± 42.4 µm, respectively; p<0.001 for all). Conclusions: Reduced CT in SSc patients supports the hypothesis of widespread vascular injury, including the ocular microcirculation.