Sait Egrilmez

Cyclosporine A-Loaded Solid Lipid Nanoparticles: Ocular Tolerance and In Vivo Drug Release in Rabbit Eyes

Purpose: To determine the in vivo efficacy of cyclosporine A-loaded solid lipid nanoparticles (SLNs) in rabbit eyes. Methods: SLNs were prepared and administered to the cul-de-sac of rabbits, and the drug amount in aqueous humor was detected by high performance liquid chromatography (HPLC). The irritation was evaluated by modified Draize testing. Results: The particle size of SLNs was detected as 225.9 ± 5.5 nm with a negative surface charge. Aqueous humor drug levels reached 50.53 ng/mL, and there was no serious irritation in rabbit eyes. Conclusions: Topical ophthalmic efficacy of cyclosporine A was enhanced via administration of SLNs.

The prevalence of Sjogren's syndrome in adult women

Objectives: The aim of this study was to determine the prevalence of primary Sjögrens syndrome (pSS) according to European criteria (1993) and to the US–European Consensus Group (US‐EU) criteria (2002) in adult women in Bornova, Izmir, Turkey. Materials and method: The study was designed as a two‐phase cross‐sectional survey consisting of a baseline questionnaire and collection of blood samples and clinical examination. In the initial phase, positivity for autoantibodies Ro(SS‐A), La(SS‐B), rheumatoid factor (RF), and anti‐nuclear antibodies (ANA) was determined, and in the clinical phase, clinical examination, salivary and ocular tests were performed. Minor salivary gland biopsy was performed for those who had at least three of these five criteria positive. Results: In our sample the prevalence of SS was 1.56% [95% confidence interval (CI) 0.92–2.66] according to the European criteria and 0.72% (95% CI 0.33–1.57) according to the US‐EU criteria. Conclusion: To prevent the loss in diagnosis of pSS, the addition of ANA, RF, and tear break‐up time (BUT) tests to US‐EU criteria would be appropriate.

Preparation and in vitro–in vivo evaluation of ofloxacin loaded ophthalmic nano structured lipid carriers modified with chitosan oligosaccharide lactate for the treatment of bacterial keratitis

The objective of this study was to explore the potential of the nanostructured lipid carriers (NLCs) modified with chitosan oligosaccharide lactate (COL) for topical ocular application. Ofloxacin (OFX) loaded NLCs were prepared by microemulsion or high shear homogenization methods. For combination of NLCs Compritol HD5 ATO was used as solid lipid, oleic acid as liquid lipid, Tween 80 as surfactant, ethanol as co-surfactant. The optimum NLCs was modified with 0.75% COL. The properties of NLCs in the absence or presence of OFX (0.3%) were characterized as zeta potential, particle size, viscosity and pH, TEM, drug loading, encapsulation efficiency and anti-microbial properties. Ex-vivo penetration/permeation studies were performed with rabbit cornea in Franz-diffusion cells. The penetration rate of OFX from NM-COL4OFX and NH-COL4OFX were significantly higher than commercial solution. Based on the selected formulations, in vivo tests were carried out by eye-drop instillation of NLCs in rabbit. The addition of COL improved the preocular residence time, controlled the drug release and enhanced the corneal bioavailability. In conclusion, OFX COL modified NLCs prepared by high shear homogenization method could be offered as a promising strategy for ocular drug delivery.

Surgically induced corneal refractive change following glaucoma surgery ☆: Nonpenetrating trabecular surgeries versus trabeculectomy

Purpose: To compare surgically induced corneal refractive change following trabeculectomy with the nonpenetrating trabecular filtering surgeries with and without implant. Setting: Department of Ophthalmology, Ege University School of Medicine, Izmir, Turkey. Methods: A consecutive series of 34 patients (34 eyes) with uncontrolled open‐angle glaucoma had trabecular filtering surgery. Patients were assigned randomly to receive viscocanalostomy (12 patients), nonpenetrating deep sclerectomy (NPDS) with T‐flux® implant (10 patients), and trabeculectomy (12 patients). Autokeratometry and computerized corneal videokeratoscopy with the Topcon KR‐7000P autokeratorefractometer were performed preoperatively and 1 day and 1, 3, and 6 months postoperatively to analyze surgically induced keratometric and topographic astigmatism. Results: Thirty patients (11 trabeculectomy, 11 viscocanalostomy, and 8 NPDS with nonabsorbable implant) completed the study. Mean patient age was 61.7 years ± 10.9 (SD) (range 37 to 81) and did not differ among groups. Postoperative intraocular pressure (IOP) levels and visual acuity (logMAR values) did not differ among groups compared with preoperative levels. Average induced astigmatism was lower in the NPDS group than the trabeculectomy group at postoperative month 3 and 6 based on autokeratometry values (P = .023 and .042, respectively). Nonpenetrating surgeries resulted in less induced astigmatism in the early postoperative period and less against‐the‐rule shift over 6 months. Conclusion: Despite larger flap size and surgical area, nonpenetrating trabecular surgeries induced less astigmatism than trabeculectomy.

Anatomic outcome of scleral buckling surgery in primary rhegmatogenous retinal detachment

PurposeTo evaluate the factors affecting the anatomic success of treatment of retinal detachments (RD) by scleral buckling surgery.MethodsOne-hundred and two eyes of 102 patients with rhegmatogenous RD operated on by scleral buckling surgery were included in the study. Results were analyzed according to the anatomic status of the retina at the most recent follow-up examination. The chi-squared test was used to determine the relationship between preoperative and intraoperative variables and anatomic results, and the relative risk of failure was determined for each variable.ResultsRetinal reattachment was achieved in 85 of 102 eyes (82.5%) after initial surgery. The success rate for anatomic reattachment was 95% after two operations. After three operations reattachment was achieved for 98 eyes (96%). Predictive factors for anatomic failure (P<0.05) were the presence of grade C1 PVR and multiple breaks.ConclusionGrade C1 PVR and multiple breaks were found to be significant risk factors for anatomic failure in rhegmatogenous RD treated by conventional buckling surgery.

Reply re: "Anterior Segment Ischemia and Retinochoroidal Vascular Occlusion After Intralesional Steroid Injection".

A 19-year-old woman was admitted with sudden severe pain and loss of light perception that began immediately after eyelid injection of the depot form of corticosteroid. Ecchymosis of the lower eyelid, corneal edema, and a fixed dilated pupil were noted. Fundus examination could not be performed because of corneal edema. Embolic material packed in the episcleral vessels was detected. With these findings, the diagnosis was anterior and posterior segment ischemia. Despite administration of an intravenous hyperosmotic agent, in addition to topical and systemic pulse corticosteroid (1.0 g/day), vision was not recovered. The most serious complication of intralesional injection of corticosteroid is vascular occlusion. This catastrophic complication after intralesional steroid injection should prompt immediate ophthalmoscopic fundus examination to allow early recognition of ischemic signs and immediate intervention.

Surgical outcomes of transconjunctival sutureless 23-gauge vitrectomy with silicone oil injection

Aims To evaluate the outcomes and complications of 23-gauge transconjunctival sutureless vitrectomy (TSV) with Silicone oil (SO) tamponade in complex vitreoretinal diseases. Settings and Design Ege university hospital ophthalmology department. Retrospective case series. Materials and Methods Forty eyes of 40 patients with diabetic tractional retinal detachment (DTRD) and proliferative vitreoretinopathy (PVR) were included in the study. Vitrectomy using 23-gauge system with SO endotamponade was performed. Peroperative and postoperative complications, anatomical and visual results were evaluated. Statistical analysis used Paired Students t-test. Results Simultaneous cataract surgery was performed in 17 eyes. Peroperative complications were posterior capsule rupture during phacoemulsification in one patient, vitreous and retinal incarceration in one patient. One eye required suture placement at the end of surgery due to SO leakage. Postoperatively, a small subconjunctival SO bubble in three patients, and hypotony in one patient (6 mmHg) were observed. Recurrent retinal detachment under SO occurred in one patient. Mean follow-up was 6.5 months (±2.7). Pre- and postoperative mean visual acuity was 2.22±0.91 logMAR and 1.11±0.8 logMAR, respectively (P<0.001). Mean intraocular pressure (IOP) on the first postoperative day was lower than preoperative IOP (11.3 ±3.2 versus 14.0 ±2.4 mmHg) (P<0.001). Conclusions Twenty-three gauge instrumentation seems to be feasible, effective and safe for vitrectomy with SO injection in DTRD and PVR, and can be considered in the surgical management of these complex vitreoretinal diseases.

Prognostic Factors in Vitrectomy for Posterior Segment Intraocular Foreign Bodies

BACKGROUND The aim of this study was to identify the prognostic factors influencing outcome after the removal of retained posterior segment intraocular foreign bodies (IOFBs) by pars plana vitrectomy. METHODS We reviewed the records of 42 consecutive patients (39 men and 3 women with a mean age of 26.8 years) operated between January 2001 and January 2005 by the same surgeon for IOFB after penetrating ocular injury. All eyes underwent IOFB removal via pars plana vitrectomy. Postoperative retinal detachment was considered as the anatomic failure. Associations between anatomic outcome and various preoperative, operative, and postoperative variables were statistically analyzed. Chi-square test and Mann-Whitney U test were used to evaluate the association between two categorical variables. RESULTS The mean time interval between the trauma and the IOFB removal was 5.3 days (range, 1 day to 30 days). The mean length of follow-up was 18.3 months (range, 6 months to 3 years). Preoperative retinal detachment was present in 19% of patients. After the IOFB removal, the retina was detached in 28.5% of patients (12 of 42 patients). After a second vitrectomy performed in 10 patients, final anatomic success rate was 89.8% (37 of 42 patients). Time between trauma and IOFB extraction, presence of intraocular hemorrhage, preoperative retinal detachment and primary surgical repair combined with the IOFB removal were significantly associated with the postoperative retinal detachment. Age, sex, entrance wound location, presence of endophthalmitis, location of IOFB, nature of IOFB, preoperative visual acuity, use of an encircling band, type of endotamponade, use of lensectomy were not significantly associated with the presence of postoperative retinal detachment. CONCLUSIONS Delay in IOFB extraction, presence of intraocular hemorrhage, preoperative retinal detachment, primary surgical repair combined with IOFB removal are the predictive factors for anatomic failure.

Topical anesthetic abuse keratopathy: a commonly overlooked health care problem.

Purpose: To evaluate the clinical course, treatment modality, factors affecting the epithelization period, and visual outcome in patients with topical anesthetic abuse keratopathy. Methods: The medical records of 19 patients with a confirmed diagnosis of topical anesthetic abuse keratopathy were retrospectively examined; occupation, initiating event, biomicroscopic findings, treatment modality, epithelization period, and best-corrected visual acuity (BCVA) were noted. The Wilcoxon signed rank test was used to compare BCVA before and after treatment; P values <0.05 were considered statistically significant. Results: In all, 26 eyes in 19 men aged 21-44 (mean age: 31 ± 6) years were included. Initiating events included exposure to arc welding flash (8 patients), metallic foreign body injury (8 patients), and chemical injury (3 patients). On admission to hospital, 10 patients (52.6%) reported that they were using topical anesthetics. Upon admission to the hospital, 10 patients (52.6%) self reported that they were using topical anesthetics. The remaining 9 subjects were discovered to be using topical anaesthetic drops during hospitalization. Twelve patients (63.2%) were found to continue using these agents during their hospitalization. Oval corneal epithelial defect, stromal infiltrate, ring-shaped keratitis, and hypopyon were noted in 100%, 46.2%, 57.7%, and 42.3% of the eyes, respectively. Topical antibiotics (fluoroquinolones or combined fortified cephalosporins and aminoglycosides), preservative-free lubricants/autologous serum, and bandage contact lens/eye patches were used for treatment. Mean epithelization period was 19.96 ± 11.16 days (range: 6-50 days). Mean pretreatment and posttreatment BCVA was 0.12 ± 0.16 (range: 0.001-0.7) and 0.66 ± 0.30 (range: 0.0-1.0), respectively (P < 0.001). Conclusions: Ophthalmologists should be suspicious of topical anesthetic abuse keratopathy in young male manual laborers specialized in welding business and foundry work presenting with persistent epithelial defects, ring-shaped keratitis, and accompanying severe ocular pain.

Comparison of cosmetic results in frontalis sling operations: the eyelid crease incision versus the supralash stab incision.

PURPOSE In addition to ptosis, the lack of eyelid crease is one of the main cosmetic problems of patients with poor levator function. In this study, we aimed to evaluate the effect of the incision site on ptosis correction and eyelid crease formation in frontalis sling operations. MATERIALS AND METHODS Photographs and charts of 27 patients (45 eyelids) who underwent frontalis sling operations were retrospectively reviewed. All patients had congenital ptosis with poor levator function ranging from 0 to 4 mm. In group I (15 eyelids), 3 supralash eyelid skin incisions were performed and the sling material was threaded along the tarsal surface. In group 11 (30 eyelids), the eyelid crease approach was used with the suturing of the sling material directly to the tarsus. RESULTS Although lid contour and lid crease symmetry were good in 46.6% of the cases in group I, eyelid crease formation was not satisfactory in any of the cases. Lid contour and lid crease symmetry were good in 76.6% of the cases in group II. CONCLUSION Our results indicated that the eyelid crease approach provided better functional and cosmetic results than did the supralash stab incision in frontalis sling operations. The passage of the sling material behind the orbital septum by direct visualization in the eyelid crease approach is one of the main factors affecting the surgical success of the frontalis sling operation.