Nilay Yuksel

High-density silicone oil as an intraocular tamponade in complex retinal detachments

OBJECTIVE To evaluate the efficacy and safety of high-density silicone oil (HDSO) as an internal retinal tamponade after vitrectomy for complicated retinal detachment. DESIGN Retrospective, non-randomized study. PARTICIPANTS Forty-one eyes of 41 patients who were 5-73 years of age. METHODS Medical records of patients with retinal detachment (RD) complicated with inferior proliferative vitreoretinopathy (PVR) requiring internal tamponade with HDSO were reviewed. Eyes with retinal vascular diseases and inflammatory diseases were excluded from the study. Follow-up examinations were scheduled at 1 week and 1, 3, 6, and 12 months after the initial surgery. RESULTS Median value of follow-up was 8 months (range, 3-40 months). Twenty-five patients had rhegmatogenous RD with significant PVR and the remaining patients had complicated RD secondary to trauma. Preoperative visual acuity was 2.55 ± 0.75 logMAR, which became 1.89 ± 0.91 at the last follow-up visit (p < 0.05). Complications included increased intraocular pressure (9.7%), hypotony (2.4%), cataract (57.1%), silicone oil in anterior chamber (17%), persistent total corneal edema (7.3%), band keratopathy (7.3%), and significant inflammation (2.4%). Intraretinal or subretinal fibrosis was found in 12 eyes (29.2%). HDSO removal was performed after a mean period of 5.7 months (range, 3-34 months) in 34 patients. The anatomical success was 87.8%. CONCLUSIONS The high anatomical success rate of 87.8% is a satisfactory result for these complicated RD cases. Subretinal proliferations and early emulsification limit the results. Further studies, with longer follow-ups and more patients, are needed to be conclusive.

Long term results of Epi-LASIK and LASEK for myopia

PURPOSE To evaluate the long term clinical and confocal results of mechanical (Epi-LASIK) versus alcohol-assisted laser epithelial keratomileusis (LASEK) for correction of myopia. SETTING Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey. DESIGN Retrospective study. METHODS Twenty-two eyes treated with LASEK and twenty eyes treated with Epi-LASIK were evaluated with a mean follow-up duration of 45 months. Mechanical separation of the epithelium was performed with Lasitome epithelial separator, and alcohol-assisted separation with 25s application of 18% alcohol. Laser ablation was performed with the ESIRIS laser. All patients were examined daily until epithelial closure; at 1, 3, 6, and 12 months; and every year subsequently. Main outcome measures were uncorrected visual acuity (UCVA), manifest refraction, haze, and gray scale value in confocal microscopy, efficacy and safety indexes. RESULTS Preoperative myopic spherical equivalent refraction was -4.65 ± 1.74 D in the LASEK and -3.87 ± 1.30 D in the Epi-LASIK-treated eyes (p=0.36). Of both LASEK and Epi-LASIK-treated eyes, 95% achieved 20/25 or better final UCVA. The grade of haze and mean gray scale value in confocal microscopy were similar in LASEK and Epi-LASIK-treated eyes at all postoperative periods. The efficacy index was 0.94 in LASEK group and 0.96 in Epi-LASIK group (p=0.44). The safety index was 1.01 in LASEK group and 1.02 in Epi-LASIK group (p=0.42). CONCLUSIONS Both LASEK and Epi-LASIK offer safe and effective correction of myopia in the long term.

Evaluation of anterior segment parameters using the Pentacam in hyperopic anisometropic amblyopic and normal eyes

PURPOSE To evaluate differences in anterior segment parameters using the Pentacam between hyperopic anisometropic amblyopic eyes and normal eyes. METHODS The amblyopic and fellow eyes of children with hyperopic anisometropic amblyopia and the right eyes of normal control subjects were prospectively evaluated using the Pentacam under photopic, scotopic, and cycloplegic conditions. Hyperopic anisometropic amblyopia was defined as hyperopia of ≥1.5 D, an interocular difference of at least 1.5 D in spherical equivalent, and a visual acuity difference between the amblyopic and normal eyes of at least 2 lines on the Snellen chart. RESULTS A total of 34 amblyopic subjects and 36 controls were included. There were no significant differences in the anterior corneal curvature, posterior corneal curvature, central corneal thickness, corneal volume, anterior chamber depth, anterior chamber volume, and pupil diameter between amblyopic, fellow, and normal eyes (P > 0.05). CONCLUSIONS In this patient cohort the Pentacam detected no significant differences in anterior segment parameters in hyperopic anisometropic amblyopic, fellow, and normal eyes under photopic, scotopic, and cycloplegic conditions.

Protein Oxidation Levels After Different Corneal Collagen Cross-Linking Methods.

Purpose: To evaluate advanced oxidation protein products (AOPP) levels, superoxide dismutase (SOD) enzyme activity, and total sulfhydryl (TSH) levels in rabbit corneas after different corneal collagen cross-linking (CXL) methods. Methods: Eighteen eyes of 9 adult New Zealand rabbits were divided into 3 groups of 6 eyes. The standard CXL group was continuously exposed to UV-A at a power setting of 3 mW/cm2 for 30 minutes. The accelerated CXL (A-CXL) group was continuously exposed to UV-A at a power setting of 30 mW/cm2 for 3 minutes. The pulse light–accelerated CXL (PLA-CXL) group received UV-A at a power setting of 30 mW/cm2 for 6 minutes of pulsed exposure (1 second on, 1 second off). Corneas were obtained after 1 hour of UV-A exposure, and 360-degree keratotomy was performed. SOD enzyme activity, AOPP, and TSH levels were measured in the corneal tissues. Results: Compared with the standard CXL and A-CXL groups (133.2 ± 8.5 and 140.2 ± 6.2 &mgr;mol/mg, respectively), AOPP levels were found to be significantly increased in the PLA-CXL group (230.7 ± 30.2 &mgr;mol/mg) (P = 0.005 and 0.009, respectively). SOD enzyme activities and TSH levels did not differ between the groups (P = 0.167 and 0.187, respectively). Conclusions: CXL creates covalent bonds between collagen fibers because of reactive oxygen species. This means that more oxygen concentration during the CXL method will produce more reactive oxygen species and, thereby, AOPP. This means that in which CXL method occurs in more oxygen concentration that will produce more reactive oxygen species and thereby AOPP. This study demonstrated that PLA-CXL results in more AOPP formation than did standard CXL and A-CXL.

Anterior segment morphologic changes related to α-1 adrenergic receptor antagonists use.

Purpose To investigate possible changes in anterior segment parameters with the Pentacam in patients taking tamsulosin or doxazosin for benign prostatic hyperplasia. Methods This prospective, cross-sectional study was conducted at Necip Fazil City Hospital, Kahramanmaras, Turkey. Patients included in the study were grouped as follows: 29 patients treated with tamsulosin (group 1), 27 patients treated with doxazosin (group 2), and 40 untreated controls (group 3). Right eyes of each patient were included in the study. All patients underwent examination with the Pentacam under standard dim light conditions and with undilated pupils. Anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA) width, central corneal thickness (CCT), corneal volume (CV), and pupil diameter (PD) were recorded. Results Mean duration of treatments was 2.7 ± 1.2 (1–5) and 2.4 ± 0.9 (1–5) years in groups 1 and 2 (p = 0.276). The ACD, ACV, ACA width, and PD were statistically significantly decreased in groups 1 and 2 when compared to group 3 (p<0.05). There were no statistically significant differences among the groups in mean values of CCT and CV. Conclusions In this study, decreased ACD, ACV, ACA width, and PD values were detected in tamsulosin and doxazosin groups when compared to controls. These findings should be considered during anterior segment examinations and surgeries.

The Management of Refractory Dry Eye With Semi-Scleral Contact Lens.

We presented a case of refractory dry eye management with semi-scleral contact lens. Dry eye was associated with facial nerve (cranial nerve VII) palsy as a result of cerebellopontine angle tumor surgery. She was treated with several topical treatments and punctal plug. Despite the treatments, her symptoms still persisted. Her ophthalmic examination revealed scleral exposure because of lagophthalmos, conjunctival hyperemia, corneal debris, scar, and diffuse punctate epitheliopathy on her right eye. Lissamine green staining showed diffuse conjunctival and corneal staining. Therapeutic semi-scleral lenses were fitted. The corneal findings were resolved and the quality of patient life was improved with the aid of semi-scleral lens after 3 months.

Childhood glaucoma as an ophthalmic manifestation of Seckel syndrome.

Purpose:The purpose of the study was to report a patient with Seckel syndrome associated with high intraocular pressures despite intensive antiglaucoma treatment. Methods:Case report. Results:High intraocular pressure readings in both eyes measured with the Goldman applanation tonometer, bilateral pigmentary retinopathy and total cupping of optic discs were found. The patient underwent bilateral trabeculectomy surgery as he had medically uncontrolled glaucoma. Conclusions:Childhood glaucoma may be associated with Seckel syndrome.

Tear-Film Osmolarity Changes Following Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction.

ABSTRACT Purpose: To evaluate tear osmolarity (TO) in patients with epiphora caused by primary-acquired nasolacrimal-duct obstruction (PANDO), before and after an external dacryocystorhinostomy (DCR) and to compare with healthy control subjects. Materials and Methods: Twenty eyes of 20 patients (15 women, 5 men) who suffered from epiphora for at least one year due to PANDO, and 20 eyes of 20 healthy subjects (13 women, 7 men), were included in this study. External DCR was applied to all patients with PANDO, and TO measurements were repeated during the first month follow-up visit after surgery. Results: The mean period for complaints of epiphora was 1.7 ± 0.6 years (1–3). Patients had a mean TO of 282.6 ± 10 mOsm/l (range: 269–302) prior to DCR, and this increased to 297.7 ± 7.7 mOsm/l (range: 284–310) one month after DCR (p = 0.0001). Preoperative TO values were significantly lower when compared with the healthy control subjects’ (301.7 ± 10.6 mOsm/l (range: 280–316) (p = 0.0001). No significant differences were detected between postoperative and control group TO values (p = 0.18). Conclusions: Epiphora due to PANDO causes lower TO values. One month after DCR, TO came to similar TO levels when compared to healthy subjects.

Evaluation of Intraocular Pressure by Ocular Response Analyzer in Patients Undergoing Hemodialysis.

Purpose:The aim of this study was to compare the biomechanical parameters of the cornea and intraocular pressure (IOP) before and after hemodialysis (HD) in patients with end-stage renal disease (ESRD) and also healthy subjects. Materials and Methods:Twenty-one patients with ESRD undergoing HD treatment (study group) and 21 healthy individuals (control group) were enrolled in this prospective study. Right eyes of each subjects were included. Central corneal thickness (CCT) were measured using Sirius Scheimpflug camera. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann-related IOP (IOPg) were measured using ocular response analyzer. In the study group, measurements were taken just before HD and 30 minutes after HD. Results:The mean CCT, CRF, IOPg values did not differ between pre-HD, post-HD, and controls (P>0.05). CH was found to be significantly higher in control group (10.6±1.2 mm Hg) when compared with pre-HD (8.07±1.8 mm Hg) and post-HD (8.8±1.6 mm Hg) CH values (P=0.0001). The mean IOPcc values did not differ pre-HD (18.5±3.5 mm Hg) and post-HD (17.8±3.9 mm Hg) (P=0.39). The mean IOPcc values were lower significantly in control group (15.4±2.8 mm Hg) when compared with pre-HD and post-HD values (P=0.02 and 0.02, respectively). Significant correlations were seen between post-HD CRF and post-HD CCT (r=0.6, P=0.03); and post-HD IOPg and post-HD CCT (r=0.51, P=0.01). Conclusions:ESRD may disrupt the biomechanical properties of the cornea. Changes in ocular response analyzer parameters should be kept in mind to evaluate accurate IOP measurements in patients with ESRD.

The effects of tamsulosin and alfuzosin on iris morphology: an ultrasound biomicroscopic comparison

Abstract Context: It is well known that Alpha-1 adrenergic receptor antagonists affect the receptors in the prostate and also iris dilator muscle, leading to loss of iris muscle tone. Objective: To compare morphological alterations of iris secondary to tamsulosin and alfuzosin use. Participants: Patients included in the study were grouped as follows: 16 patients treated with tamsulosin (Group 1), 14 patients treated with alfuzosin (Group 2) and 18 untreated controls (Group 3). Materials and methods: All patients underwent ultrasound biomicroscopic and pupillometric examination. Iris thickness was measured at the dilator muscle region (DMR; measured at half of the distance between the scleral spur and the pupillary margin) and sphincter muscle region (SMR; Standardized at 0.75 mm from the pupillary margin). DMR/SMR was also calculated for each patient. Differences among groups were analysed. Main outcome measures were DMR, SMR, DMR/SMR and pupillary diameter. Results: Mean duration of treatments were 2.4 ± 0.96 years (1–4) and 2.3 ± 1.01 years (1–4) in Groups 1 and 2. Pupillary diameters were reduced in Groups 1–2 compared to Group 3 (p < 0.001, p < 0.001). The SMR was similar in Groups 1 and 2 (p: 0.114). These values were not significantly different from that of Group 3 (p: 0.196, p: 0.209). However, thickness in the DMR in Groups 1–2 were significantly lower than that of controls (Group 3) whereas there was no significant difference between Groups 1 and 2 (p: 0.041, p: 0.039 and 0.986, respectively). Mean DMR/SMR ratios were significantly lower in Groups 1–2 than that of Group 3 (p: 0.040 and p: 0.040, respectively). Conclusions: In patients using these medications, the iris seems to be thinner at the dilator muscle region, but preserving the sphincter muscle region.