Sansal Gedik

Corneal topographical study of the effect of lacrimal punctum occlusion on corneal surface regularity in dry eye patients

Purpose To compare topographic indices of surface regularity in dry eye patients and in normal subjects (controls) and to investigate the short-term effect of lacrimal punctal plugs on these indices in dry eye patients. Methods The surface regularity index (SRI) and surface asymmetry index (SAI) of the TMS-2 corneal topographic modelling system were used to evaluate corneal surface regularity in 20 eyes of 10 dry eye patients before and after the insertion of Herrick silicon lacrimal plugs (Lacrimedics, Rialto, CA, USA) and in 24 eyes of 12 normal subjects as controls. Results SRI and SAI were significantly lower in controls than dry eye patients (p=0.00). Median SRI was 1.72 in dry eye patients before punctal occlusion and 0.525 in the control group. Median SAI was 1.305 in dry eye patients and 0.240 in controls. After lacrimal punctal occlusion, Schirmer test results and fluorescein breakup time increased in nine patients and remained the same in one patient. After occlusion, the SRI decreased in 9 eyes, and increased in 11 (p=0.970); SAI decreased in 13 eyes and increased in 7 (p=0.135). Conclusions No significant change in topographic indices of corneal surface irregularity could be detected in severe dry eye patients with lacrimal punctal plugs in the short-term follow-up.

Topographical analysis of corneal astigmatism in patients with tilted-disc syndrome

Purpose. To evaluate the corneal topography in patients with tilted-disc syndrome to determine the relationship between optic disc dysversion and corneal astigmatism and the pattern of astigmatism in these patients. Methods. The study included 23 eyes of the 13 tilted-disc syndrome patients with spheric refractive errors ranging between +1.00 D and −9.00 D (mean −4.00 ± 3.4 D) and astigmatic errors ranging between −0.50 and −4.50 D (mean −1.95 ± 0.93 D). Corneal topography was performed by computer-assisted videokeratoscope topographic modelling system 2 (TMS-2) and incidence of corneal astigmatism, corneal topographic patterns, and mean values of the topographic indices were determined. Results. Corneal topographic analysis showed corneal astigmatism in 22 out of 23 patients with tilted discs. Corneal astigmatism was symmetric bow tie pattern in 10 eyes (45.45%), asymmetric bow tie pattern in 11 eyes (50%) and irregular in 1 eye (4.5%). Among the patients with bow tie pattern group (21 eyes), 14 eyes had with-the-rule astigmatism, 1 eye had against-the-rule astigmatism, and 6 eyes had oblique astigmatism. In 18 eyes, astigmatism was corneal, whereas combined corneal and lenticular in 4 eyes and lenticular in 1 eye. Conclusion. In the majority of tilted-disc cases, ocular astigmatism is mainly corneal. Morphogenetic factors in the development of the tilted disc might possibly influence the corneal development in such a way to result in corneal astigmatism.

Clinical results of phacoemulsification in patients with uveitis.

To determine whether prone postoperative near visual acuity following macular hole surgery can be used as a reliable indicator of successful hole closure, data from 21 patients undergoing macular hole surgery were collected. Seventeen of the 18 patients with hole closure and all 3 patients with persistent macular holes had a Rosenbaum acuity better than preoperative visual acuity, yielding 94% sensitivity, 0% specificity, 85% positive predictive value, and 0% negative predictive value. Fourteen of the 18 patients with macular hole closure and all 3 patients with persistent macular holes had a Rosenbaum acuity better than 20/40, yielding 78% sensitivity, 0% specificity, 82% positive predictive value, and 0% negative predictive value. Although postoperative near visual acuity can predict macular hole closure with 94% sensitivity, the test is not clinically useful to predict hole closure because of the high surgical success rate of macular hole surgery. The test could be useful in encouraging patients to maintain head prone positioning and alleviate patient anxiety.

Secondary bacterial keratitis associated with shield ulcer caused by vernal conjunctivitis.

Purpose: To report a patient with vernal keratoconjunctivitis-induced shield ulcer superinfected with Staphylococcus aureus. Methods: Observational case report. A 12-year-old boy who had been followed for vernal keratoconjunctivitis for 3 years was admitted to our clinic complaining of visual loss, photophobia, and a ropy discharge. On slit-lamp examination, a transversely oval shield ulcer, which was situated in the center of the superior third of the cornea, was seen in the left eye. The vernal corneal plaque area and margins were infiltrated, and hypopyon was also observed. With the diagnosis of shield ulcer with secondary bacterial keratitis and hypopyon, the patient underwent medical treatment consisting of topical fortified cefazolin (50 mg/mL) and tobramycin (14 mg/mL), lodoxamide 0.1%, prednisolone acetate 1%, cyclopentolate, and systemic cetirizine. Results: After treatment, the bacterial keratitis, shield ulcer, and inflammation in the anterior chamber disappeared. Conclusion: Bacterial keratitis associated with shield ulcer may be rarely observed in patients with vernal keratoconjunctivitis. Prompt diagnosis and treatment may prevent permanent complications and vision loss.

Ocular ferning during the menstrual cycle in healthy women.

Purpose The aim of the study is to investigate whether tear ferning patterns change during different phases of the menstrual cycle. Methods The tear ferning test was performed on twelve normal women of childbearing age at three day intervals throughout one complete menstrual cycle. Serum hormone levels (progesterone, estrogen, testosterone) were measured. Results Eight women showed type I ferning, and the other four had type II ferning initially. These patterns did not change during the menstrual cycle. Serum hormone levels were all in the normal range. Since no change in ferning pattern was detected during the menstrual cycle, the ferning test can be done at any time in women. Conclusions This study showed no effect of different menstrual cycle phases on tear ferning patterns.

Retinal arterial macroaneurysm rupture following fundus fluorescein angiography and treatment with Nd:YAG laser membranectomy.

BACKGROUND AND OBJECTIVE To determine which skills are most important to clinicians and how they correlate with Accreditation Council for Graduate Medical Education (ACGME) competencies. PATIENTS AND METHODS A descriptive analysis to test four hypotheses: specific skill sets are likely to be important/mandatory for residents to obtain during training; comprehensive and subspecialist ophthalmologists would likely value skills similarly; year of training would likely affect the ranking of skills; and surveying practicing ophthalmologist could help to modify the educational curriculum. RESULTS Highest-ranked skill sets included interpersonal and communication skills (mean, 1.17 +/- 0.08), ocular trauma (mean, 1.28 +/- 0.26), and practice-based learning (mean, 1.37). Comprehensive ophthalmologists and subspecialists did not significantly differ in the ranking of skill sets. Year of graduation did not affect the ranking of skill sets. CONCLUSION The ACGME core competencies of interpersonal and communication skills and practice-based learning were ranked as highly important to both comprehensive and subspecialty ophthalmologists. These are included in ACGME core competency requirements. These findings support ACGME core competencies and the need for continued evaluation of ophthalmology residents in all areas of medical training.

Retinal nerve fiber layer analysis and interpretation of GDx parameters in patients with tilted disc syndrome

This study was conducted to determine abnormalities of the GDx Glaucoma Scanning System parameters in patients with tilted discs, in order to set guidelines for the evaluation of glaucomatous damage in this situation. The objective was to determine which GDx parameters displayed the highest level of variation, and which remained unchanged in tilted disc syndrome. RNFA was polarimetrically conducted on 45 eyes from 26 subjects with tilted discs, and 43 normal eyes withNerve Fiber Analyzer II (Laser Diagnostic Technologies). All parameters except inferior maximum, average thickness, ellipse average, and inferior average displayed a significant difference between the two groups (p < 0.05). Although NFA is useful in glaucoma diagnosis, the majority of the GDx parameters, as shown in our study, are unreliable in tilted disc syndrome in this respect.