Oğuz Gülecek

Management of retinal detachment due to closed globe injury by pars plana vitrectomy with and without scleral buckling.

Background and Purpose: To investigate the effect of circumferential scleral buckling on the prognosis for patients undergoing pars plana vitrectomy and lensectomy for severe closed globe injury. Methods: A total of 33 cases in which pars plana vitrectomy and lensectomy were performed after severe closed globe injury between January 1990 and January 2003 were studied retrospectively. All patients had zone III contusion type injury according to The Ocular Trauma Classification Group criteria. Of the 33 patients, 15 (group 1) also underwent peripheral scleral buckling; 18 did not (group 2). Results: The mean age ± SD was 34.8 ± 17.5 years (range, 8–73 years). There were 6 female (18%) and 27 male (82%) patients. The two groups did not differ significantly in terms of preoperative visual acuity (P = 0.76) or postoperative visual improvement (P = 0.46). In groups 1 and 2, 4 (26%) and 3 (17%) patients developed recurrent retinal detachment for which they underwent reoperation. Other postoperative complications were as follows: group 1—phthisis (1 patient; 7%), proliferative vitreoretinopathy (1 patient; 7%), and optic atrophy (1 patient; 7%); group 2, proliferative vitreoretinopathy (2 patients; 11%) and optic atrophy (2 patients; 11%). Conclusion: Circumferential scleral buckling did not appear to offer advantages for patients undergoing pars plana vitrectomy and lensectomy for severe closed ocular injury involving the posterior chamber.

The relationship between soluble L-selectin and the development of diabetic retinopathy

Diabetic retinopathy is a leading cause of adult vision loss and blindness. Earlier studies have shown that polymorphonuclear neutrophils play an important role in the pathogenesis of diabetic vascular complications. Stimulation of these cells is associated with the desquamation of L-selectin. The aim of the study was to evaluate the relationship between the serum concentration of L-selectin and the development of retinopathy in Type 2 diabetic patients. The study comprised 51 Type 2 diabetic patients, aged 65.2 ± 7.5 years, with a diabetes duration of 10.1 ± 8.9 years and HbA 1c of 8.2 ± 1.4. The study subjects were divided into two groups: Group A diabetic patients with retinopathy (n = 28) and Group B diabetic patients without retinopathy (n = 23). Twenty age- and sex-matched nondiabetic healthy subjects were enrolled as the control group. Patients with any inflammatory disease were excluded. Retinopathy was assessed by centrally graded retinal photographs. The serum concentration of sL-selectin was estimated using an ELISA test. We observed significantly higher serum concentrations of sL-selectin in Type 2 diabetic patients with retinopathy than in healthy subjects (36.5 ± 18.1 vs. 11.4 ± 7.5 ng/ml, p < 0.001). There was also a significant difference between Group A and Group B (36.5 ± 18.1 vs. 24.2 ± 13.5 ng/ml, p < 0.05) as well as between Group B and the controls (24.2 ± 13.5 vs. 11.4 ± 7.5 ng/ml, p < 0.01) with regard to sL-selectin levels. sL-selectin was significantly correlated with HbA 1c (r = 0.93, p < 0.001) and with diabetes duration (r = 0.44, p < 0.001). These results suggest that there was a strong relationship between sL-selectin and diabetic retinopathy. The strong correlation between sL-selectin and HbA 1c levels supports the concept that the sL-selectin level is increased with poor glycemic control, which may affect endothelial cell activity and cause subsequent microvascular complications.

Results of Pars Plana Vitrectomy in Closed-Globe Injuries

BACKGROUND AND OBJECTIVE To assess surgical and visual outcomes with pars plana vitrectomy (PPV) in closed-globe injuries resulting in anterior and posterior segment pathologies and evaluate the factors influencing the prognosis. PATIENTS AND METHODS Retrospective observational study. Forty-seven eyes of 47 consecutive patients who underwent PPV because of closed-globe injury between January 1992 and August 2003 were reviewed. Surgical and visual outcomes and prognostic factors were analyzed according to the Ocular Trauma Classification System. RESULTS Preoperative visual acuity was less than 4/200 in 49% of eyes, classified as grades IV to V. After surgery, this ratio was 23% (P < .05). Final visual acuity was statistically significantly better in grade I (P = .0001), grade II (P = .002), and relative afferent pupillary defect-negative (P = .0001) injuries. Maculopathy was the most common adverse outcome influencing final visual acuity (32%), followed by secondary glaucoma (13%) and proliferative vitreoretinopathy (8%). CONCLUSION PPV is a favorable treatment modality in severe closed-globe injuries. Assessment of injuries with respect to the Ocular Trauma Classification System seemed to predict visual outcomes in this series.

Retinal Toxicity of Intraocular Vancomycin and Ceftazidime in Vitrectomized Rabbit Eyes

The purpose of this study was to evaluate the retinal toxicity of vancomycin and ceftazidime combined into an infusion solution that was intraoculary given after or during vitrectomy. Forty albino rabbits were divided into 4 groups of 10 each. Vitrectomized right eyes of groups 1, 2, and 3 were given recommended doses of vancomycin and ceftazidime alone or combined, while right eyes in the fourth group were vitrectomized using an infusion solution to which was added ceftazidime and vancomycin combination. Toxicity was tested with electroretinography (ERG) and light microscopy. ERG and light microscopy did not show any toxicity signs associated with vancomycin or ceftazidime alone or with combined therapy. Vancomycin and/or ceftazidime can reliably and effectively be used combined in an infusion solution at recommended doses after and during vitrectomy. This treatment modality does not have any toxic effects to retinal structures and is an alternative method to separate injections of the two antimicrobial agents.