Osman Sevki Arslan

Diode Laser Transscleral Cyclophotocoagulation for the Treatment of Refractory Glaucoma After Penetrating Keratoplasty

Purpose: To evaluate the effect and safety of diode laser transscleral cyclophotocoagulation (TSCPC) in eyes with refractory glaucoma after penetrating keratoplasty (PK). Methods: Diode laser TSCPC was performed on 32 eyes of 32 patients with secondary glaucoma after penetrating keratoplasty. The mean follow-up period was 11.4 ± 3.8 months (range, 6–20 months). The intraocular pressure (IOP), number of glaucoma medications, graft status, side effects, and complications of the procedure were all recorded during the follow-up period. The treatment was considered successful if after one cyclodiode treatment the IOP could be reduced to or below 22 mmHg with or without medication. The success rate of the diode laser treatment was analyzed by the Kaplan-Meier survival analysis method during the 6th and 12th months of the follow-up period and the end of the study. The decrease in drug requirement after laser treatment was analyzed by the Wilcoxon nonparametric test. Statistical significance was set at p < 0.05. Results: During the follow-up period, diode laser TSCPC reduced the IOP significantly. Our cumulative success rate was 56% at the end of the study. Cyclodiode treatment resulted in an IOP less than 22 mmHg in 97% of the eyes on the 6th month and 72% of the eyes on the 12th month with or without medication. The total retreatment rate of the study was 44%. More than one treatment was necessary, 8 times in the 1st month, 9 times in the 3rd month, 5 times in the 6th month and 3 times in the 12th month. The average number of antiglaucomatous drugs used was 2.8 before surgery and 1.2 after the 12th month follow-up period (p < 0.05). No eyes with graft failure after treatment were present. Visual acuity improved (> 2 Snellen lines of acuity) in two eyes and remained the same in the others. No serious side effects such as phthisis bulbi or hypotonia were observed. Conclusions: Diode laser TSCPC appears to be a safe and effective procedure for the treatment of uncontrolled glaucoma secondary to penetrating keratoplasty.

The effect of artificial tears on corneal surface regularity in patients with Sjögren syndrome

Purpose: To evaluate the effect of artificial tears on the topographic parameters associated with corneal surface regularity in patients with Sjögren syndrome. Methods: A total of 38 eyes of 20 patients with Sjögren syndrome were evaluated prospectively. The mean age of the patients was 50.5 ± 15.3 years (range, 28–76). Corneal topography with the Topographic Modeling System (TMS-2, Tomey) was performed before and after the instillation of artificial tears. The surface regularity index (SRI), surface asymmetry index (SAI), potential visual acuity (PVA) and mean astigmatism were compared in dry eyes before and after the instillation of artificial tears. Results: Before the instillation of artificial tears SAI, SRI, PVA and mean antigmatism values were found to be 1.37 ± 1.47, 0.74 ± 0.42, 20/30.92 ± 20/8.12 and 1.53 ± 1.47 D, respectively. In corneal topography performed after the instillation of artificial tears SAI, SRI, PVA and mean astigmatism values were 0.71 ± 0.82, 0.43 ± 0.36, 20/25.92 ± 20/5.55 and 1.08 ± 1.18, respectively. When compared statistically, the SRI, SAI, and mean astigmatism all decreased significantly and the PVA improved (p = 0.0001). Conclusion: Irregular corneal surface in dry eye patients affects optical quality. The statistically significant improvement observed in SRI and SAI values after the instillation of artificial tears also improves the PVA that is especially related to SRI.

Effects of Frequency-Doubled Nd:YAG Laser Trabeculoplasty on Diurnal Intraocular Pressure Variations in Primary Open-Angle Glaucoma

In order to investigate the effects of laser trabeculoplasty (LT) on diurnal intraocular pressure (IOP) variations in 36 eyes of 30 cases with primary open-angle glaucoma (POAG) in which medical treatment was terminated, the IOP curves, recorded 24 h before as well as 24 h and 12 weeks after LT were compared. Twelve weeks after LT, significant IOP decreases were observed: 36.42% in the mean IOP, 29.77% in the mean peak IOP and 50.04% in the mean pressure range. LT might therefore have beneficial effects on the diurnal IOP variations in cases with POAG.

Corneal Endothelial Cell Density and Morphology in Healthy Turkish Eyes

Purpose. To describe the normative values of corneal endothelial cell density, morphology, and central corneal thickness in healthy Turkish eyes. Methods. Specular microscopy was performed in 252 eyes of 126 healthy volunteers (M : F, 42 : 84). Parameters studied included mean endothelial cell density (MCD), mean cell area (MCA), coefficient of variation (CV) in cell size, percentage of hexagonal cells, and central corneal thickness (CCT). Results. The mean age of volunteers was 44.3 ± 13.5 (range, 20 to 70) years. There was a statistically significant decrease in MCD (P < 0.001; correlation, −0.388) and percentage of hexagonal cells, (P < 0.001; correlation, −0.199) with age. There was also a statistically significant increase in MCA (P < 0.001; correlation, 0.363) with increasing age. There was no statistically significant difference in MCD, MCA, CV in cell size, percentage of hexagonal cells, and CCT between genders and there was also no significant difference in these parameters between fellow eyes of subjects. Conclusions. Normotive data for the endothelium in the Turkish population are reported. Endothelial cell density in the Turkish eyes is less than that described in the Japanese, American, Chinese, and Filipino eyes and higher than that described in Indian, Thai, and Iranian eyes.

Corneal endothelial cell density and morphology in patients with acromegaly

OBJECTIVE Acromegaly has various impacts on many organs. The ophthalmologic effects of acromegaly have not yet been investigated in detail. The aim of the current study was to evaluate qualitative and quantitative changes in corneal endothelial cells and central corneal thickness (CCT) of the patients with acromegaly. DESIGN In this prospective, cross-sectional study, 128 eyes of 64 patients with acromegaly (female/male=40/24) and 208 eyes of 104 age and gender-matched healthy volunteers (female/male=69/35) were included. Endothelial cell density (ECD), cellular area (CA), coefficient of variation (CV) in cell size, percentage of hexagonal cells, and CCT were measured in patients with acromegaly and in healthy volunteers using the noncontact specular microscopy (SP-3000P: Topcon Corporation, Tokyo, Japan). RESULTS ECD and CA were lower in cases with acromegaly than in controls (ECD in acromegaly: 2615.65 cell/mm(2) and in controls: 2700.35 cell/mm(2); p=0.002. CA in acromegaly: 382.30μm(2) and in controls: 400.30μm(2); p=0.02). In the entire group with acromegaly, the time elapsed since diagnosis was positively correlated with CA and was negatively correlated with ECD (r=+0.39, p=0.001 and r=-0.42, p=0.001). CONCLUSIONS The endothelial layer of the cornea may be under risk of impairment with prolonged disease duration in acromegaly. Consistency of the corneal endothelium should be also sought during long-term follow-up of the cases with acromegaly.

Safety of prophylactic intracameral moxifloxacin ophthalmic solution after cataract surgery in patients with penetrating keratoplasty.

AIM To determine the safety of prophylactic intracameral moxifloxacin after cataract surgery in patients with penetrating keratoplasty (PKP). METHODS In this retrospective study of consecutive patients who had phacoemulsification cataract surgery after PKP, were treated with intracameral moxifloxacin 0.5% ophthalmic solution (0.5 mg/0.1 mL). The main outcome measures were anterior chamber reaction, best corrected visual acuity (BCVA), corneal endothelial cell count (ECC), and central corneal thickness (CCT). RESULTS Fifty-five patients were recruited (26 males, 29 females). The mean age was 54.36±4.97y (range 45-64y). All eyes had improved postoperative BCVA. The mean BCVA was 0.25 preoperatively and 0.57 postoperatively, which was statistically significant (P<0.001). One eye had 3+, 7 eyes had 2+, 12 eyes had 1+ and 8 eyes had trace amount of aqueous cells on the first day after surgery. All eyes had no anterior chamber cells at subsequent follow up examinations. Effective phacoemulsification time was 4.33±1.01s. The mean ECC was 2340.20 cells/mm(2) preoperatively and 1948.75 cells/mm(2) 1mo postoperatively (P<0.001). The increase of 21.09 µm in postoperative pachymetry 1mo after surgery was statistically significant (P<0.001). CONCLUSION No untoward effects were observed after intracameral injection of moxifloxacin (0.5 mg/0.1 mL) in terms of anterior chamber reaction, CCT, ECC, and visual rehabilitation at the conclusion of cataract surgery in patients with PKP.

Histologic Findings of Corneal Buttons in Decompensated Corneas With Toxic Anterior Segment Syndrome After Cataract Surgery.

Purpose: To report the histologic findings of penetrating keratoplasty buttons in decompensated corneas with toxic anterior segment syndrome (TASS) after a cataract surgery is performed. Methods: We evaluated the histologic findings of 16 corneal buttons of 16 patients who exhibited decompensation findings because of TASS by means of light microscopy. The patients were classified into 3 groups: The first group consisted of 5 corneal buttons with mild symptoms in which the central corneal thicknesses (CCTs) were ⩽650 &mgr;m, and the visual acuities (VAs) were ≥0.1. The second group consisted of 7 corneal buttons that exhibited moderate symptoms in which the CCTs were between 650 and 750 &mgr;m and the VAs were between 0.1 and 0.03. The third group consisted of 4 corneal buttons that had severe symptoms in which the CCTs were ≥750 &mgr;m and the VAs were ⩽0.03. Results: Light microscopy showed endothelial cell loss, vacuolated and thinned epithelial cell layers, disturbed collagen bonds, and Descemet membrane invaginations in patients in group I. Group II corneal buttons exhibited inflammatory cells (lymphocytes) and extended intercellular space between the epithelial cells, wrinkled Bowman membrane separated from the stroma in some local areas, stromal edema, and early vascularization. In group III, endothelial and epithelial cell layer loss, wrinkled Descemet and Bowman membranes, inflammatory cells, and structurally disturbed collagen bonds located beneath the Bowman membrane, and a greater amount of vascularization in the area of inflammation were observed. Conclusions: The results of the histologic evaluation of the decompensated corneas caused by the TASS are compatible with the clinical severity of the disease. In mild cases, the histologic findings were insignificant; however, when the clinical situation deteriorated, histologic findings became increasingly worse.

Effect of Hemifacial Spasm on Intraocular Pressure Measurement

Purpose To evaluate the effect of hemifacial spasm (HFS) on intraocular pressure (IOP) measurement. Methods Twenty-four consecutive patients with HFS and 25 age- and gender-matched randomly selected eyes of healthy volunteers underwent corneal pachymetry and IOP measurements using Goldmann applanation tonometer (GAT) and noncontact tonometer (NCT). IOP measurements were performed before (during HFS) and 2 weeks after Botox injections in HFS patients and in healthy volunteers without Botox injections. Results There was no statistical difference between involved eye side and uninvolved eye side of HFS patients in measured central corneal thickness. Similarly, no difference was found between involved eye side of HFS patients and controls. There were no statistically significant differences comparing IOP values before treatment and levels measured at 2 weeks of Botox injections, either with GAT (p = 0.33, 0.11) or NCT (p = 0.80, 0.43) devices in the involved eyes and uninvolved eyes of patients with HFS, respectively. There were also no significant differences in these parameters (GAT (p = 0.63) and NCT (p = 0.54)) in controls. Conclusions Contractions in facial muscles may not lead to significant increase in IOP in HFS patients. This result may help clinical decision making in the treatment of glaucoma patients with HFS. This trial is registered with NCT03390803.

Bilateral -14.0 diopters index myopia successfully treated with cataract surgery: a case report.

We report a 60-year-old man with bilateral nuclear cataract and −14.0 diopters index myopia. Following uncomplicated phacoemulsifications and posterior chamber intraocular lens implantations on both eyes, right and left axial lengths were 22.58 and 22.60 mm with otobiomeric A-scan ultrasound, respectively. Three-month corrected visual acuity was 20/20 in the right eye with a −1.00×130° cylinder and 20/20 in the left eye with −0.50 spheres and −1.00×100° cylinders.

Book Reviews · Livres nouveaux · Buchbesprechungen

Conjunctival inflammation is one of the most frequent conditions presenting to the ophthalmologist. While in the past decades, bacterial infections of the conjunctiva have become much easier to diagnose and treat, the non-infectious disorders still pose confounding problems. Inflammatory Diseases of the Conjunctiva provides an in-depth review of the pathological mechanisms causing these diseases. The strength of this book lies in its presentation of immunological knowledge which is indispensable for the understanding of conjunctival inflammation. As immunology is a very dynamic field of research, the authors put great emphasis on giving up-to-date information on basic research findings and putting them in perspective regarding their clinical relevance. In this the book is of great value for the clinician. It is also very well structured, dealing with individual disease entities in separate chapters and providing sections on laboratory investigations, differential diagnosis and treatment options in each of them. Some topics are given special consideration in ‘focus’ sections, among them dry eye syndrome, laboratory investigations of conjunctival inflammation and apoptosis in the conjunctiva. Dr. Holger Baatz, Frankfurt G.A. Fishman, D.G. Birch, G.H. Holder, et al.