Nurşen Aritürk

Secondary glaucoma after congenital cataract surgery

Purpose: Glaucoma has been recognized as an infrequent but serious complication following surgery for congenital cataract in childhood. We conducted a retrospective review of patients in whom glaucoma had developed after surgery for congenital cataract. Methods: We reviewed the records of 87 eyes of 53 patients on whom cataract surgery had been performed between February 1982 and March 1995 at Ondokuz Mayis University Hospital, Samsun. Results: The average postoperative follow-up is 4.5 years (range 1 to 12 years). We identified open angle glaucoma (OAG) in 17 eyes, chronic angle closure glaucoma (ACG) in six eyes, and acute angle closure glaucoma (AACG) in two eyes. The average time between cataract surgery and the diagnosis of glaucoma was 6.08 years (range one week to 10 years). The mean time to diagnosis of glaucoma was 4.7 years (range 4 months to 10 years) for OAG, 4.3 years (range 1 to 8 years) for ACG and, for AACG, 7 days and 10 months following surgery. Medication alone was successful in intraocular pressure control in 17 of 25 eyes (<21 mmHg), and additional surgical procedures resulted in intraocular pressure control in eight eyes in which they were performed. Conclusion: Patients undergoing cataract surgery early in life should be routinely examined for possible postoperative glaucoma.

Is Symptomatic Atherosclerotic Cerebrovascular Disease a Risk Factor for Normal-Tension Glaucoma?

Objective: To compare the incidence of glaucomatous optic disk appearance between patients with symptomatic atherosclerotic stroke and healthy individuals with normal intraocular pressures (IOP). Subjects and Methods: 46 patients with ischemic stroke with evident lacunar infarction or large vessel atherosclerosis, and 93 age- and sex-matched healthy individuals, all with normal IOP, were included. Patients and controls were examined for the presence of high cup-to-disk ratios (>0.5). Results: Seven patients (15.22%) in the ischemic cerebrovascular disease (CVD) group and 3 controls (3.23%) had glaucomatous optic disk appearance. All subjects with glaucomatous optic disk appearance in the control group and 3 patients in the study group had visual field defects in concordance with normal-tension glaucoma (NTG). The incidence of glaucomatous optic disk appearance was significantly higher in the group with symptomatic atherosclerotic CVD. Conclusion: Atherosclerotic CVD is a risk factor for having glaucomatous optic disk appearance. Symptomatic atherosclerosis involving the brain vasculature may also affect the eye and lead to NTG. Patients with ischemic strokes due to large artery atherosclerosis or small artery occlusion must be examined and followed for NTG.

Necrotizing scleritis due to varicella zoster infection: a case report.

Purpose: To report a case with necrotizing scleritis due to varicella-zoster infection. Methods: The patient records were evaluated. The present literature was investigated using MEDLINE. A six-year-old boy with varicella infection was admitted to our clinic with redness, pain, and lid edema on the right eye. Slit lamp examination revealed lid edema, purulent secretion, conjunctival injection and chemosis, and inferotemporal scleral necrosis. Sclera was avascular and the conjunctiva was spontaneously detached from sclera in the necrotic region. Results: Systemic and topical acyclovir treatment was started and a rapid improvement achieved in signs and symptoms. Conclusions: Ophthalmic manifestations of varicella infection are potentially blinding especially in the absence of appropriate diagnosis and medical intervention. Distinctive skin eruptions are specifically helpful in the early diagnosis of the disease.

A Possible Cause of Nasolacrimal Duct Obstruction: Narrow Angle Between Inferior Turbinate and Upper Part of the Medial Wall of the Maxillary Sinus

Abstract Background: To search the relationships between the primary nasolacrimal duct obstruction and the angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus. Design: Retrospective study. Participants and methods: Computed tomography findings of 35 patients with primary nasolacrimal duct obstruction and 100 sides of 50 individuals were reviewed. While the study group was composed of patients who had external dacryocystorhinostomy surgery, the control group was composed of patients who had CT scans due to headache, sinusitis and smell dysfunction. Epiphora complaint was evaluated with the lacrimal syringing. The exclusion criteria were: age less than 20 years, previous nose, sinus, turbinate or lacrimal surgery, prior history of maxillofacial fracture, nasopharyngeal malignancy, reflex hypersecretion, and associated pathology of the lacrimal canaliculi. Main outcome measures: The angle of inferior turbinate. Results: The mean angles were 53.2° (range, 37.9–82.9°) for affected side of the study group, 58.6° (range, 32–85.3°) for the unaffected side of the study group and 56.8° (range, 41.2–76.9°) in the control group. The difference between the angles was statistically significant between the study and the control groups (p < 0.05). The difference between the operated and non-operated sides of the study group was also statistically significant (p < 0.05). Conclusion: Although this study was performed in a small group, we thought that the narrow angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus might be a possible causative factor in primary acquired nasolacrimal duct obstructions.

Incidence of retinopathy of prematurity in the middle Black Sea region of Turkey over a 10-year period.

PURPOSE To report the incidence of retinopathy of prematurity (ROP) in babies with a birth weight of ≤1750 g over a 10-year period in the north of Turkey. METHODS The medical records of 2,365 preterm babies who had been referred for ophthalmological examination were retrospectively reviewed, and children with a birth weight of ≤1750 g were included. The incidence of ROP was compared between two successive 5-year periods: 2004-2008 and 2009-2013. RESULTS A total of 1,565 babies were included: 624 in the first period and 941 in the second. The incidence of ROP significantly increased during the second period compared to the first (35.3% vs 48.2% [P < 0.001]). The number of patients who required treatment was 11.9% in the first period and 11.4% in the second (P = 0.768). CONCLUSIONS Although the incidence of ROP increased during the latter period of study (2009-2013), the numbers of treatment-requiring cases were similar in both periods.

Comparison of anterior segment measurements with optical low-coherence reflectometry and partial-coherence interferometry optical biometers

Aims: To evaluate a new noncontact optical biometer using partial-coherence interferometry and to compare the clinical measurements with those obtained from the device using optical low-coherence reflectometry (OLCR). Setting and Design: Ondokuz Mayis University, Samsun, Turkey. Nonrandomized, prospective clinical trial Subjects and Methods: The study was performed on the healthy phakic eyes of volunteers in the year 2014. Measurements of axial length (AL), anterior chamber depth (ACD), central corneal thickness (CCT), mean keratometry (K), and white-to-white (WTW) measurements obtained with the low-time coherence interferometry (LTCI) were compared with those obtained with the OLCR. Statistical Analysis Used: The results were evaluated using Bland-Altman analyses. The differences between both methods were assessed using the paired t-test, and its correlation was evaluated by Pearson′s coefficient. RESULTS: We examined seventy participants with a mean age of 33.06 (±9.7) (range: 19-53) years. AL measurements with LTCI and OLCR were 23.7 (±1.08) mm and 23.7 (±1.1) mm, respectively. ACD was 3.6 (±0.4) mm and 3.5 (±0.4) mm for LTCI and OLCR, respectively. The mean CCT measurements for both devices were 533 (±28) mm and 522 (±28) mm, respectively. The mean K readings measurements for LTCI and OLCR were 43.3 (±1.5) D and 43.3 (±1.5) D, respectively. The mean WTW distance measurements for both devices were 12.0 (±0.5) mm and 12.1 (±0.5) mm, respectively. Conclusions: Measurements with LTCI correlated well with those with the OLCR. These two devices showed good agreement for the measurement of all parameters.

Suspected Endothelial Pencil Graphite Deposition

A 14-year-old male patient had an ocular trauma with a pencil. Biomicroscopic examination revealed a broken part of pencil into the cornea. Foreign body removal and corneal wound closure were performed in the same day. After corneal repair, there was a grade 4+ anterior chamber reaction just like in preoperative examination. Dilated examination showed a very small piece broken tip of pencil on the upper nasal quadrant of the lens. A small and linear deposition was also seen on endothelial surface. Endothelial deposition and foreign body disappeared with intensive topical steroid treatment.

The effects of antiglaucomatous agents on conjunctiva used for various durations.

Purpose: The effect of antiglaucomatous agents on conjunctiva used for various durations evaluated histopatho-logically. Methods: Conjunctiva biopsies were taken in 19 Mayis University Faculty of Medicine Ophthalmology Department from 31 eyes of 30 patients who underwent filtration surgery after a period of antiglaucomatous agent use and examined under light microscope. The results were compared with the results of conjunctival biopsies from 10 similar aged patients undergoing retinal detachment of cataract surgery and with no other ocular pathology. Results: Five of the cases were using antiglaucomatous treatment for two months (Group A), four cases for two to 12 months (Group B) and 22 cases for more than 12 months (Group C) before the surgery. Four cases were using a beta blocker only, eight cases beta blocker + sympathomimetic or beta blocker + myotic and the remaining 19 cases were using a combination of beta blocker + sympathomimetic + myotic. Histopathologic evaluation with light microscope showed no pathologic change in group A, but, subepithelial increase of lymphocytes, mast cells, macrophages and fibroblasts in group C. Conclusion: It was detected that subconjunctival inflammatory reaction increases as the number of antiglaucomatous agents and the treatment duration increase. These changes might be considered as risk factors that decrease the success rate of filtration surgery.

Choroidal Thickness in Strabismus and Amblyopia Cases

ABSTRACT Purpose: The aim of our study was to examine the effect of hypermetropia and anisometropic, exotropic, and esotropic amblyopia on choroidal thickness. Methods: A prospective, cross-sectional, comparative study of 120 children under the age of 16 years was conducted. Choroidal thickness was measured in patients with hypermetropia, anisometropia, esotropia, exotropia, and controls. Results: The mean subfoveal choroidal thickness in the control and hypermetropia groups was 323.9±69.0 µm and 348.9±64.5 µm, respectively. Mean choroidal thickness in amblyopic and fellow eyes was 387.4 and 351.9 µm in anisometropic, 353.8 and 338.7 µm in exotropic, 347.5 and 336.5 µm in esotropic, and 389.3 and 359.3 µm in esotropic+anisometropic groups, respectively. Choroid was significantly thicker in amblyopic eyes of anisometropic group compared to fellow (P=0.004) and control (P=0.03) eyes. The difference of choroidal thickness was not significant between both eyes and when compared to control eyes in the other groups. Conclusions: Anisometropic amblyopic eyes had thicker choroids compared to controls and fellow eyes. However the choroidal thickness was not significantly different between amblyopic and fellow eyes of esotropic or exotropic patients.

Optic Disc, Macula, and Retinal Nerve Fiber Layer Measurements Obtained by OCT in Thyroid-Associated Ophthalmopathy.

Aim. To compare the measurements of retinal nerve fiber layer (RNFL), macula and optic disc parameters obtained by optical coherence tomography (OCT), and intraocular pressure (IOP) between the patients with thyroid-associated ophthalmopathy (TAO) and healthy controls. Methods. One hundred and thirty-two eyes of 66 patients with TAO and 72 eyes of 36 healthy controls were included in the study. Proptosis level was determined by Hertel exophthalmometer. Optic disc, peripapillary retinal nerve fiber layer, and macula parameters were measured by OCT. All measurements of the patients were compared with those of age- and sex-matched healthy controls. Results. No statistically significant difference was found between the patients with TAO and control group in terms of demographic characteristics (P > 0.05). Exophthalmometer measurements and IOP were higher in TAO group (P < 0.05). Mean macula thicknesses in TAO and control groups were 239.3 ± 29.8 μm and 246.6 ± 31.8 μm, respectively, and the difference between the groups was statistically significant (P = 0.000). TAO group had thinner inferior RNFL thickness and macular thicknesses (superior, inferior, temporal, and nasal) and higher disc area and C/D ratio when compared with the control group (P < 0.05). Conclusion. IOP, disc area, and C/D area ratio were higher in the patients with TAO and the thicknesses of macula and inferior RNFL were thinner when compared with healthy controls. This trial is registered with registration number at clinicaltrials.gov NCT02766660.