Rana Altan-Yaycioglu

Surgical results of combined pars plana vitrectomy and phacoemulsification for vitreous hemorrhage in PDR.

Background The purpose of this study was to evaluate the effectiveness, safety, and incidence of complications after combined clear corneal phacoemulsification with intraocular lens implantation and pars plana vitrectomy in eyes with proliferative diabetic retinopathy coexistent with significant cataract. Methods Eighty-five eyes of 85 patients with proliferative diabetic retinopathy underwent primary standard three-port vitrectomy with 20-gauge instruments and phacoemulsification with intraocular lens implantation for vitreous hemorrhage from 2008 to 2011. The main outcome measures were visual outcomes and surgical complications. Results Forty patients were male and 45 were female. Their age ranged from 40 to 77 years with a mean of 59.6 years. The mean follow-up was 13 months, with a range of 6–48 months. The preoperative logMAR visual acuity changed from 2.62 ± 0.6 to 0.8 ± 0.7 postoperatively. Postoperatively, visual acuity improved in 79 eyes (92.9%), and did not change in six eyes (7.1%). Intraoperative complications were transient corneal edema (five eyes) and posterior capsular rupture (one eye). Postoperative complications consisted of transient intraocular pressure elevation (25 eyes), corneal epithelial defects (six eyes), anterior chamber reaction (four eyes), hyphema (two eyes), posterior synechiae (four eyes), vitreous hemorrhage (23 eyes), retinal tears (five eyes), retinal detachment (one eye), and neovascular glaucoma (one eye). Conclusion Our study suggests that the combined operation of pars plana vitrectomy, phacoemulsification, and intraocular lens implantation is safe and effective for patients with proliferative diabetic retinopathy. We believe that the visual outcome and complications depended primarily on underlying posterior segment pathology and were not related to the combined procedure technique.

Management of facial disfigurement in orbitotemporal neurofibromatosis.

A 19-year-old woman with type I neurofibromatosis requested reconstruction of her severe facial disfigurement caused by the plexiform neurofibroma of the right upper eyelid. Previously, she had glaucoma surgery for buphthalmus and enucleation with dermis fat transplantation. She was unable to wear prosthesis in the last year. Transverse palpebral resection of the lesion, lateral canthal reconstruction, and frontal sling ptosis surgery were performed at the same session. Postoperatively, the cosmetic appearance of the patient was markedly improved. No complication or progression was observed during 2 years follow-up. We believe that an individual-based surgical plan may give acceptable results in these challenging cases.

Visual outcome of intravitreal ranibizumab for exudative age-related macular degeneration: timing and prognosis.

Purpose To describe 1-year clinical results of intravitreal ranibizumab treatment in patients with choroidal neovascularization secondary to exudative age-related macular degeneration (AMD) and to evaluate whether early treatment is a predictive value for prognosis of the disease. Materials and methods Clinical records were retrospectively reviewed of 104 eyes that underwent intravitreal ranibizumab therapy for exudative AMD. Patients were divided into two groups according to their symptom duration: group 1, <1 month; and group 2, 1–3 months. After three monthly injections, patients were examined monthly, and subsequent injections were performed as needed. Results There were 43 female (48.9%) and 45 males (51.1%). The follow-up time was 13.7±1.9 (12–19) months. The mean logarithm of minimum angle of resolution best-corrected visual acuity (BCVA) improved significantly, from 0.45±0.639 at baseline to 0.08±0.267 at 12 months in group 1, and from 1.06±0.687 at baseline to 0.75±0.563 at 12 months in group 2. The increase in BCVA was statistically significant in group 1 (P=0.009). The mean central retinal thickness (CRT) decreased significantly, from 355.13±119.93 μm at baseline to 250.85±45.48 μm at 12 months in group 1, and from 371.88±91.047 μm at baseline to 268.61±53.51 μm at 12 months in group 2. The decrease in CRT was statistically significant in group 1 (P=0.001). Conclusion Intravitreal ranibizumab therapy was effective in significantly increasing mean BVCA and reducing CRT. Shorter duration of AMD, as measured by the subjective duration of visual symptoms, is associated with better visual outcome after treatment.

Intraocular pressure after phacoemulsification in eyes with pseudoexfoliation

eventful phacoemulsification resulted in a small but positive effect on IOP. Their retrospective analysis of 1122 eyes with PXF showed that the preoperative IOP level had a significant effect on the postoperative IOP reduction. Although the patient number is smaller and the follow-up shorter, we would like to add the results of our study of postoperative IOP in PXF cases, part of which has been presented (R. Altan-Yaycioglu, MD, et al., ‘‘The Results of Phacoemulsification in Pseudoexfoliative Cataracts: A Comparative Study,’’ presented at the ASCRS Symposium on Cataract, IOL and Refractive Surgery, Chicago, Illinois, USA, April 2008).

Assessment of tear meniscus with optical coherence tomography in thyroid-associated ophtalmopathy.

Abstract Purpose: To evaluate the tear-film meniscus with optical coherence tomography (OCT) in patients with Graves’ disease (GD). Materials and methods: Patients with GD without clinical features of thyroid-associated ophthalmopathy (TAO) (Group 1, n = 35), patients with signs of TAO (Group 2, n = 31) and healthy participants (Group 3, n = 31) were enrolled. Palpebral fissure width, Schirmer test, tear break-up time (TBUT) test and tear-film meniscus height and area obtained with Fourier-domain-OCT were analyzed. Results: TBUT test scores were 8 s (2–25) in Group 1, 8 s (2–15) in Group 2 (p = 0.380); and10 s (5–17) in Group 3 (p = 0.000 Group 1 versus 3, and 0.000 for Group 2 versus 3). Tear-film meniscus height did not significantly differ between Groups 1 and 2 (257.5 µm (86–962) and 258 µm (99–1340), respectively, p = 0.980). In Group 3, tear-film meniscus height was 316 µm (122–720) (p = 0.005 Group 1 versus 3 and 0.004 for Group 2 versus 3). Tear-film meniscus area did not significantly differ between Groups 1 and 2 (0.025 mm2 (0.004–0.250) and 0.024 mm2 (0.003–0.316), respectively, p = 0.850). In Group 3, tear-film meniscus area was 0.048 mm2 (0.006–0.75) (p = 0.000 Group 1 versus 3 and 0.000 for Group 2 versus 3). Conclusion: Tear function is significantly disturbed in GD. OCT is an effective way to assess the tearing function also in patients with GD.

Choroidal thickness measurements with optical coherence tomography in branch retinal vein occlusion

AIM To evaluate central macular thickness (CMT) and mean choroidal thickness (MCT) in eyes with branch retinal vein occlusion (BRVO), before and after ranibizumab treatment using spectral domain-optical coherence tomography (SD-OCT). METHODS Forty-two patients with unilateral BRVO and macular edema were included in this study. There were 25 men and 17 women. Using SD-OCT, choroidal thickness was measured at 500 µm intervals up to 1500 µm temporal and nasal to the fovea. MCT was calculated based on the average of the 7 locations. All the eyes with BRVO were treated with intravitreal ranibizumab (0.5 mg/0.05 mL). Comparisons between the BRVO and fellow eyes were analyzed using Mann-Whitney U test. Pre-injection and post-injection measurements were analyzed using Wilcoxon test and repeated measure analysis. RESULTS At baseline, there was a significant difference between the BRVO and fellow eyes in MCT [BRVO eyes 245 (165-330) µm, fellow eyes 229 (157-327) µm] and CMT [BRVO eyes 463 (266-899) µm, fellow eyes 235 (148-378) µm (P=0.041, 0.0001, respectively)]. Following treatment, CMT [295 (141-558) µm] and MCT [229 (157-329) µm] decreased significantly compared to the baseline measurements (P=0.001, 0.006, respectively). Also BCVA (logMAR) improved significantly (P=0.0001) in the BRVO eyes following treatment. After treatment CMT [BRVO eyes 295 (141-558) µm, fellow eyes 234 (157-351) µm] and MCT [BRVO eyes 229 (157-329) µm, fellow eyes 233 (162-286) µm] values did not reveal any significant difference in BRVO eyes and fellow eyes (P=0.051, 0.824, respectively). CONCLUSION In eyes with BRVO, CMT and MCT values are greater than the fellow eyes, and decrease significantly following ranibizumab injection.

Ischemic retinopathy and neovascular proliferation secondary to severe head injury.

We report a case with severe head trauma and perforating globe injury in one eye and ischemic retinopathy and neovascular proliferation in the other eye. A 37-year-old male was brought to the emergency department after a motor vehicle accident with severe maxillofacial trauma. Ophthalmic examination revealed hematoma of the left eyelids as well as traumatic rupture and disorganization of the left globe. On the right eye, anterior segment and fundoscopic examination were normal. Primary globe repair was performed. At postoperative one-month visit, the right eye revealed no pathology of the optic disc and macula but severe neovascularization in the temporal peripheral retina. The patient was diagnosed as ischemic retinopathy and neovascular proliferation due to head trauma.

Intravitreal Ranibizumab Injection in Peripapillary CNVM Related to Idiopathic Intracranial Hypertension

Peripapillary choroidal neovascular membrane (CNVM) may develop in papilledema related to idiopathic intracranial hypertension. The authors present a teenaged boy who responded well to one dose of intravitreal ranibizumab injection. [J Pediatr Ophthalmol Strabismus. 2017;54:e27-e30.].

Epidermoid Cyst of Orbit in a Newborn

A 3-day-old male newborn presented with a severe proptosis of the left eye leading to exposure keratopathy. He underwent debulking of the cyst and biopsy of the tumour and received the pathological diagnosis of epidermoid cyst of orbit. Clinicopathological features of this rare disease are discussed.

Role of intraocular pressure in wound closure at the end of phacoemulsification

Participation in the EUREQUO database report In the June issue, we published cataract surgery guidelines based on data in the EUREQUO (European Registry of Quality Outcomes for Cataract and Refractive Surgery) database. Developing and publishing guidelines was the principal objective of the EUREQUO project, co-funded by the European Union and the European Society of Cataract & Refractive Surgeons. An equally important goal was to create a database for quality assurance and benchmarking for surgeons. Eleven European national societies for cataract and refractive surgery were associated partners in the project. Within this framework, a great number of surgeons, clinics, and hospitals reported data to the EUREQUO database. It would have been impossible to successfully complete this project without the dedication of these surgeons to quality surgery. The contributions to the database are anonymous, and the contact details for the participating clinics and hospitals are not available to the Steering Committee members, who are the authors of this report. We intended to thank the contributors with an acknowledgement to all participating societies in the report. Unfortunately, this acknowledgement appeared only as supplementary material on the JCRS website and not in the printed article. Therefore, we want to include the acknowledgment in this letter, with thanks to all surgeons, clinics, and hospitals contributing data to the database. With thanks to the following: