Sami Yilmaz

Vitreoretinal Surgery For Patients With Severe Exudative And Proliferative Manifestations Of Retinal Capillary Hemangioblastoma Because Of Von Hippel–lindau Disease

Purpose: The evaluation of long-term results of vitreoretinal surgery and retinal capillary hemangioblastoma (RCH) resection in patients with complicated retinal detachment (RD) secondary to RCHs. Methods: Twelve eyes of 12 patients were operated on with vitreoretinal surgery, including occlusion of afferent and efferent feeder vessels with endodiathermy and endolaser photocoagulation, and subsequent resection of RCHs. The long-term anatomical and visual outcomes were retrospectively evaluated. Results: Total exudative RD was detected in six eyes and subtotal exudative RD was found in the remaining six eyes. A tractional component was present in eight eyes, and four eyes had pure exudative RD. Laser treatment had been previously applied to four eyes but vitreoretinal surgery was the primary treatment in eight eyes. A total of 19 RCHs were resected. The quadrant location of RCHs was superior temporal in six, superior nasal in five, inferior nasal in five, and inferior temporal in three. The dimensions of the RCHs ranged between 1 and 4 disk diameters (DD) (1-DD in 1 eye, 1.5-DD in 3, 2-DD in 10, 2.5-DD in 3, 3-DD in 1, and 4-DD in 1). Preoperative mean logarithm of the minimum angle of resolution visual acuity was 1.9 ± 1.0 (3.0–0.7) (20/1,588 ± 20/200 [20/20,000–20/100]). Silicone oil and C3F8 was applied to four and eight eyes, respectively. The median postoperative follow-up was 30.5 (18–48) months. Single operation and final anatomical success was obtained in 9 and 11 eyes, respectively. Mean logarithm of the minimum angle of resolution visual acuity in the postoperative 18th month and at the final visit were 1.05 ± 0.8 (3.0–0.2) (20/224 ± 20/125 [20/20,000–20/32]) and 0.96 ± 0.8 (3.0–0.2) (20/182 ± 20/125 [20/20,000–20/32]), respectively. New RCHs occurred in eight eyes. Rubeosis iridis was not present in any of the eyes. Conclusion: Promising anatomical and visual outcomes were obtained after vitreoretinal surgery and resection of RCHs in eyes with complicated RD secondary to RCH. However, life-long follow-up is needed to recognize recurrent RD seen even in the early period or recurrences of RCHs seen in the long-term period.

Comparison of the Effect of Intravitreal Dexamethasone Implant in Vitrectomized and Nonvitrectomized Eyes for the Treatment of Diabetic Macular Edema

Purpose To compare the effectiveness of sustained-release dexamethasone (DEX) intravitreal implant in nonvitrectomized eyes and vitrectomized eyes with diabetic macular edema (DME). Methods A retrospective review of the medical records of 40 eyes of 30 consecutive patients with diabetic macular edema who underwent intravitreal DEX implant injection. Patients were divided into 2 subgroups: 31 eyes that were nonvitrectomized (group 1) and 9 eyes that had previously undergone standard pars plana vitrectomy (group 2). The main outcome measures were BCVA and foveal thickness (FT). Results A significant improvement was seen in BCVA in both group 1 and group 2 at the 1st, 2nd, and 6th months after treatment with DEX implant (p < 0.05). In group 1, a significant reduction in FT was observed at the 1st, 2nd, and 6th months (p < 0.05). In group 2, a significant reduction in FT was seen at the 1st and 2nd months (p < 0.05), but the reduction rate at the 6th month after the injection was not statistically significant (p = 0.06). Conclusion DEX implant is effective for the treatment of diabetic macular edema, and the effectiveness of the drug is similar in vitrectomized and nonvitrectomized eyes.

Lens Yaralanmalarının Tedavisinde Pars Plana Vitrektomi

Özet Travmalara bağlı lens hasarı, kapsül bütünlüğünün bozulması, katarakt, lens subluksasyonu veya lens luksasyonu şeklinde görülebilir. Ek olarak psödofakik olgularda travmaya bağlı lens subluksasyonu ve lens luksasyonu oluşabilir. Travmalara bağlı lens hasarı tedavisinde korneal, skleral veya sklero-korneal fakoemülsifikasyon cerrahisi, pars plana vitrektomi, pars plana vitrektomi ile fakofragmantasyon veya pars plana vitrektomi ile korneal kesiden çıkarma teknikleri kullanılır. Cerrahi sırasında intraoküler lens, kapsül içine, sulkusa veya ön kamaraya yerleştirilebilir. Duruma göre skleral fiksasyonlu lensler veya iris kıskaçlı lensler de tercih edilebilir. Günümüzde bu tür hastaların rehabilitasyonu, vitreoretinal cerrahi ve katarakt cerrahisi tekniklerindeki gelişmeler ile ve günümüzün teknolojik düzeyi ile ciddi bir sorun olmaktan çıkmıştır. (Turk J Ophthalmol 2013; 43: 51-4) Anah tar Ke li me ler: Lens subluksasyonu, lens luksasyonu, pars plana vitrektomi, travma