Ozlem Eski Yucel

Dexamethasone Implant in Chronic Diabetic Macular Edema Resistant to Intravitreal Ranibizumab Treatment

Purpose: The aim of this study was to assess the efficacy of a single intravitreal dexamethasone implant (IDI) over 6 months in eyes with chronic diabetic macular edema (DME) that were resistant to intravitreal ranibizumab (IR) treatment. Methods: This retrospective study was conducted at the Ondokuz Mayis University Hospital, Samsun, Turkey. Efficacy outcomes were considered as the change from baseline in best corrected visual acuity (BCVA) and central macular thickness (CMT). Results: Thirty eyes of 20 patients with a mean age of 61.6 ± 8.8 (45-85) years were included in the study. The mean BCVA significantly increased from 0.68 ± 0.27 to 0.56 ± 0.30 logMAR (p = 0.001) and 0.57 ± 0.30 logMAR (p = 0.002) at months 1 and 2, respectively. The proportion of patients who gained 3 or more lines in BCVA was 20%. The mean CMT significantly decreased from 578.93 ± 17.95 µm at baseline to 282.10 ± 21.42, 292.26 ± 19.69, 371.70 ± 21.23, and 463.60 ± 23.16 µm at months 1, 2, 3, and 4, respectively (p = 0.001). Intraocular pressure (IOP) increase occurred in 5 (16.7%) eyes. Cataract surgery was required in 3 (13%) out of 23 phakic eyes. Conclusion: IDI provides significant benefits in visual acuity gains and anatomic improvements in eyes with chronic DME that are resistant to IR treatment. Increases in IOP and cataract progression can be observed in IDI-treated patients. However, its safety profile is acceptable.

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.

A propranolol nonresponsive mass: lymphangioma-mimicking hemangioma.

the surgeons understanding of the paranasal sinus anatomy and helpful in performing a more complete anatomic dissection. This helped to reduce intraoperative complications and provide better outcomes. Moreover, we found the navigation platform a valuable teaching tool in the residency training program in our institute. To conclude, the use of intraoperative navigation system is firmly established as a valuable technology in the management of paranasal sinus disease. It may improve the confidence of the surgeon by confirming the position within the challenging anatomic fields. This increases surgical effectiveness and improves surgical safety. The effect of navigation-aided endoscopic surgery on the clinical outcomes is to date not demonstrated.

Surgical management of intraocular lens dislocations

PURPOSE To report and compare the surgical, visual, and anatomical outcomes following treatment of dislocated intraocular lenses (IOLs). METHODS The medical records of 28 eyes of 28 patients were evaluated. Age, gender, pre-and postoperative best-corrected visual acuity (BCVA), surgical methods, and complications were recorded. RESULTS Pre-and postoperative BCVA ranged from counting fingers to 20/32 and from counting fingers to 20/25, respectively. Late-onset dislocations were the most frequently observed complication. The most frequent surgical method was IOL repositioning in 15 of 28 patients, followed by IOL exchange in 11 patients, and IOL removal in 2 patients. Only 1 patient required surgical re-intervention with IOL capture. CONCLUSIONS Visual acuity improved following the use of either IOL repositioning or IOL exchange. No superiority of one method over the other was observed. In the present retrospective case series, management of dislocated IOLs with repositioning or exchange of the primary implant conferred comparable surgical and visual outcomes.

Retinopathy of prematurity in extremely low birth weight infants in Turkey.

PURPOSE This study was designed to determine the incidence rate of retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) infants in the middle Black Sea region of Turkey. METHODS The charts of 1,719 preterm infants were reviewed between January 2003 and September 2011. Of them, 225 (13.1%) infants with birth weights of less than 1,000 g were enrolled in the study. ROP was classified according to the international classification of retinopathy. RESULTS Of the 225 ELBW infants, 47.6% had advanced ROP, 23.1% had mild ROP, and 29.3% did not have ROP; 30.2% infants required treatment. ROP was detected in 75.6% of multiple births versus 69.6% of singleton births; there were no significant differences between the two groups (P = .388). CONCLUSION Extremely premature infants with low gestational ages had high incidence rates of advanced ROP. Most ELBW infants require ROP treatment. In addition, increased survival of ELBW infants owing to advancements in neonatal care warrants the specialization of ophthalmologists in regard to improved diagnosis and treatment of ROP.

Infrequent Complications of Inferior Oblique Recession Surgery

ABSTRACT Purpose: To report the infrequent complications, including antielevation and adherence syndrome, after a unilateral and bilateral inferior oblique (IO) recession procedure and to discuss the possible causes. Methods: A retrospective chart review was conducted for patients on whom unilateral or bilateral IO weakening surgeries were performed. Results: Forty-three patients were included in the study. In 23 patients unilateral and in 20 patients bilateral IO weakening was performed. All patients underwent IO recession surgery. Mild limitation of elevation developed in two patients and adherence syndrome developed in one patient. All occurred after unilateral IO recession. No duction deficiency was observed in patients after bilateral IO recession. Conclusion: Antielevation and adherence syndrome can develop after unilateral IO recession surgery. Care should be taken not to tighten the neurofibrovascular bundle of the IO muscle during surgery.

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.

Vitreomacular Interface Disorders in Behçet’s Uveitis

Objectives: To determine the prevalence of vitreomacular interface (VMI) disorders in patients with Behçet’s uveitis and assess the relationship between VMI disorders and clinical characteristics. Materials and Methods: The macular optical coherence tomography (OCT) images of 160 eyes of 96 patients with Behçet’s uveitis who were being followed in the Uvea-Behçet’s clinic were assessed retrospectively for VMI disorders including posterior vitreous detachment (PVD), epiretinal membrane (ERM), vitreomacular adhesion (VMA), vitreomacular traction (VMT), full-thickness macular hole (FTMH), lamellar hole (LH) and pseudohole. Results: Twenty-four patients (25%) with unilateral and 72 patients with bilateral uveitis were included in the study. Six (30%) of 20 eyes with anterior uveitis and 57 (40.7%) of 140 eyes with posterior uveitis, in total 63 (39.4%) eyes of 160 eyes had at least one VMI disorder. PVD was detected in 4 eyes (2.5%), ERM in 48 eyes (30%), VMA in 12 eyes (7.5%), and LH in 1 eye (0.6%). None of the eyes had VMT, FTMH, or pseudohole. ERM was detected in 13 eyes (8.1%) on fundus examination and 48 (30%) eyes by OCT (p=0.001). VMI was detected in 12 (50%) of 24 eyes with prior intraocular surgery and 51 (37.5%) of 136 eyes without. The mean duration of uveitis was 7.3±5.8 years in patients with VMI disorders and 5.8±7.7 years in patients without (p=0.04). There was no relation between VMI disorders and anatomic location of uveitis, history of past ocular surgery, number of ocular/periocular steroid injections, or visual acuity. Conclusion: VMI disorders are common in patients with Behçet’s uveitis. Their frequency increases with the duration of uveitis. OCT is more sensitive than fundus examination in the detection of VMI disorders.

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.

Medial and Lateral Rectus Muscle Insertion Distance and Width in Esotropia and Exotropia Patients

ABSTRACT Purpose: The hypothesis that the extraocular muscle insertion distance and muscle width may be associated with the type and size of deviation was tested. Methods: This was a prospective study of 129 patients who had surgery for horizontal strabismus or retinal detachment. The insertion distances and widths of the medial rectus (MR) and lateral rectus (LR) muscles were measured intraoperatively in esotropia, exotropia, and buckling surgery (control group) patients. Statistical analysis was performed to compare measured factors between the groups. Results: Median medial and lateral muscle insertions were 5.7 and 6.9 mm in esotropia (ET), 6.0 and 7.1 mm in exotropia (XT), and 5.5 and 6.7 mm in the control groups (p > 0.05). The widths of the medial and lateral muscles ranged from 7.0 to 13.0 mm in ET and XT groups and from 9.5 to 11.0 mm in the control group (p > 0.05). Muscle insertion distance and LR muscle width were not correlated with deviation size. Only the MR muscle width was positively correlated with the deviation size. Conclusions: Insertion distances of the medial and LR muscles are not statistically different in ET, XT, and control patients. Only MR muscle width was affected by the size of the deviation in ET patients.