Selcuk Sizmaz

The effect of smoking on choroidal thickness measured by optical coherence tomography

Background/aims To investigate the effect of smoking on choroidal thickness using Fourier domain optical coherence tomography. Methods 17 otherwise healthy smokers (study group) and 17 non-smokers (control group) were enrolled. In the study group, all participants underwent optical coherence tomography scanning at baseline, and 1 and 3 h following smoking one standard cigarette. Also the participants of the control group underwent optical coherence tomography scanning in the morning which was followed by two further examinations at the first and third hours, respectively. Choroidal thickness measurements were performed. Results The mean choroidal thickness at the fovea prior to smoking was 301.1±63.1 μm, which decreased to 284.2±56.7 μm at 1 h and 270.8±80.0 μm at 3 h following smoking (p=0.001). The mean choroidal thickness was significantly decreased following smoking at all five extrafoveal points. The difference in choroidal thickness was not statistically significant at 1 and 3 h of smoking at all six points. In the control group, the mean baseline choroidal thickness at the fovea was 270.6±57.9 μm, which was 272.5±52.4 μm at 1 h and 273.8±57.4 μm at 3 h (p=0.816). Conclusions Cigarette smoking causes a significant decrease in choroidal thickness following smoking. Fourier domain optical coherence tomography can effectively demonstrate choroidal thickness.

Optical Coherence Tomography for Measuring the Tear Film Meniscus: Correlation with Schirmer Test and Tear-Film Breakup Time

Abstract Purpose: To compare tear meniscus height (TMH) and area (TMA) values obtained by optical coherence tomography (OCT) with the Schirmer test and tear-film break-up time (TBUT) values. Materials and methods: In this prospective cross-sectional study, the right eyes of 300 consecutive patients were studied. All patients underwent routine ophthalmologic examination. Schirmer and TBUT measurements were taken, and tear-film OCT images were obtained. Using OCT, the TMH (i.e. the line connecting the intersection of the meniscus with the cornea and eyelid) and cross-sectional TMA were calculated. Patients were divided into Groups 1 (Schirmer values ≤5 mm) and 2 (Schirmer values >5 mm). Data were analyzed using SPSS 13.0 software. The Mann–Whitney U-test was used for the comparison of groups. Correlations between tear parameters were analyzed. Results: There were no significant differences in age, logMAR, or IOP values (p = 0.480, 0.077 and 0.146, respectively) between the two groups. Mean TBUTs were 5.1 ± 2.9 and 9.5 ± 4.2 s for Groups 1 and 2, respectively (p < 0.001). Mean TMHs were 237.9 ± 108.9 and 324.3 ± 158.9 μm for Groups 1 and 2, respectively (p < 0.001). Mean TMAs were significantly lower in Group 1 compared to Group 2 (p < 0.001; 0.027 ± 0.028 versus 0.055 ± 0.059 mm2, respectively). Correlations between Schirmer values and TMH, and between Schirmer values and TMA, were significant (p = 0.001 and <0.001, respectively). Conclusions: OCT values were significantly lower in patients with Schirmer values of <5 mm. Tear meniscus measurements obtained by OCT are reliable for establishing a diagnosis of dry eye.

Nasolacrimal Duct Obstruction: Clinicopathologic Analysis of 205 Cases

Purpose: To investigate the histopathological results of lacrimal sac biopsies in patients with primary acquired nasolacrimal duct obstruction. Methods: In this prospective non-comparative study, 205 consecutive patients, who were diagnosed as primary acquired nasolacrimal duct obstruction, were included. Patients with history of trauma and/ or surgery in the periorbital area, punctum or canalicular obstruction were excluded from the study. Patients were evaluated for age, gender, history, and presenting symptoms. Lacrimal drainage system abnormalities were assessed. Lacrimal system irrigation, dacryocystography, and in selected cases dacryoscintigraphy was performed. All patients underwent external dacryocystorhinostomy. Biopsy specimens were obtained from the posterior inferior flap and examined by the same pathologist. Results: Forty-seven male and 158 females with age ranging from 6 to 81 years (mean 47.5 ± 16.2 years) were included in the study. Only one patient had the diagnosis of chronic leukemia, others had no preexisting history of systemic disease. Pathologic examination revealed chronic inflammation (n= 178), fibrosis without inflammation (n= 19), normal mucosa (n= 4), and lymphoid hyperplasia (n= 1). Three patients had abnormal pathology: Lymphoproliferative disease in the patient with chronic leukemia, granulomatous inflammation, and basosquamous cell carcinoma. Conclusion: In primary nasolacrimal duct obstruction, pathological examination of the lacrimal sac revealed chronic inflammatory changes in most patients. Even though rare, malignant or systemic disease in patients with neither specific history nor clinical or radiological finding might be observed in these cases. Thus, we recommend taking biopsy if any suspicion of abnormality of the lacrimal sac exists.

Late capsular block syndrome presenting with posterior capsule opacification

PURPOSE: To assess the results of posterior neodymium:YAG (Nd:YAG) laser capsulotomy in patients with late postoperative capsular block syndrome (CBS) with decreased vision because of posterior capsule opacification (PCO). SETTING: Baskent University Hospital, Department of Ophthalmology, Ankara, Turkey. DESIGN: Case‐control study. METHODS: Patients with CBS who had phacoemulsification and foldable hydrophilic or hydrophobic acrylic intraocular lens implantation with continuous curvilinear capsulorhexis were retrospectively reviewed. Transparent to slight milky fluid had collected in the capsular bag. Capsular block syndrome was undiagnosed before the PCO developed. The CBS was treated with Nd:YAG laser capsulotomy, after which the change in refraction, corrected distance visual acuity (CDVA), intraocular pressure (IOP), complications, and inflammation rate were evaluated. Follow‐up examinations were at 1 day, 1 week, and 1 and 6 months. RESULTS: The mean time between cataract surgery and laser capsulotomy was 48 months ± 10.27 (SD) (range 28 to 66 months). The Nd:YAG capsulotomy was successful in all eyes. Capsulotomy did not change the refraction in 14 eyes (93.3%). One patient (6.6%) had a change of +0.75 diopter. After capsulotomy, the logMAR CDVA improved in 13 cases (mean 0.26 ± 0.18; range 0.0 to 0.7) and did not change in 2 cases. There were no complications, inflammation, or significant IOP changes. CONCLUSIONS: Neodymium:YAG laser capsulotomy in patients with PCO associated with late CBS increased visual acuity without a significant change in refraction or IOP. Capsular block syndrome may be asymptomatic and remain undiagnosed for a long time after cataract surgery before PCO develops. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Interexaminer Reproducibility of Optical Coherence Tomography for Measuring the Tear Film Meniscus

Abstract Purpose: New optical coherence tomography (OCT) devices with anterior segment module are able to measure the tear meniscus height (TMH) and tear meniscus area (TMA). Since the borders of the area and the height are to be marked by an examiner, the measurements are prone to be subjective. Herein, we aimed to evaluate the interexaminer reproducibility of the tear meniscus measurements with OCT. Materials and Methods: In this prospective cross-sectional study, both eyes of 300 consecutive patients with and without dry eye were studied. Following routine ophthalmologic examination, tear-film OCT images were obtained. Two examiners, who were unaware of the other examiner’s results, measured the TMH (i.e. the line connecting the intersection of the meniscus with the cornea/sclera and eyelid) and cross-sectional TMA. The reliability and correlation of the two examiners’ results were assessed. Results: Four right and six left eyes were excluded from the final analysis, so a total of 590 eyes were evaluated. The mean difference of the two examiners’ measurements of both eyes was −0.001 ± 0.027 mm2 in TMA, and −21.29 ± 39.95 μm in TMH. An agreement between the two examiners was found regarding TMA and TMH measurements for right and left, as well as both eyes (Cronbach’s alpha > 0.900, for all). Also, the correlation between both variables was high (inter item correlation matrix > 0.840, for all). Conclusions: We showed a strong statistical agreement for both TMA and TMH measurements. According to our results, we believe that FD-OCT device is dependable in measuring the TMA and TMH values, given that its results are reproducible.

Anterior segment complications after phacovitrectomy in diabetic and nondiabetic patients

Purpose. To evaluate early and late postoperative anterior segment complications of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with cataract and coexisting vitreoretinal disease in diabetic and nondiabetic patients. Setting. Department of Ophthalmology, Baskent University Hospital, Ankara, Turkey. Methods. The records of 189 consecutive patients with cataract and posterior segment pathology necessitating phacovitrectomy were retrospectively analyzed. Patient profile, indications for surgery, preoperative findings, intraoperative and postoperative course, and postoperative outcome were evaluated. Phacoemulsification was performed through a clear corneal incision with IOL implantation prior to 23-G pars plana vitrectomy. Results. There were 97 (51.3%) diabetic and 92 (48.6%) nondiabetic patients. The most common indications for surgery were vitreous hemorrhage (57; 58.7%), tractional detachment (35; 36%), and premacular hemorrhage (5; 5.1%) in diabetic patients, and rhegmatogenous retinal detachment (40; 43.4%), macular hole (22; 23.9%), epiretinal membrane (20; 21.7%), and vitreomacular traction (10; 10.8%) in nondiabetic patients. Early (within 4 weeks) postoperative complications included elevation of intraocular pressure, fibrinous uveitis, corneal edema, and development of posterior synechia. Long-term (after 4 weeks) complications included migration of silicone oil into the anterior chamber, posterior capsule opacification, and decentered IOL. The ratio of fibrinous uveitis, posterior synechia, and posterior capsule opacification was found higher in the diabetic group (all p<0.05). Conclusions. Combined vitreoretinal surgery and phacoemulsification is safe and effective in treating vitreoretinal abnormalities coexisting with cataract in diabetic and nondiabetic patients. Diabetic patients should be monitored more carefully for fibrinous uveitis and posterior synechia in the early postoperative period and for posterior capsular opacification in the late postoperative period.

Risk factors for intraocular pressure rise following phacoemulsification

Purpose: This study was designed to analyze the risk factors resulting in high intraocular pressure (IOP), which was accepted as IOP higher than 22 mmHg, following uncomplicated phacoemulsification. Materials and Methods: The records of 812 eyes of 584 patients who underwent uncomplicated phacoemulsification were evaluated. There were 330 men and 254 women ranging between the age of 26 and 89 years (65.4 ± 9.8 years). The preoperative, postoperative first day (day 1), first week (day 7), and first month (day 30) IOP values were analyzed. Data on history of diabetes, glaucoma, pseudoexfoliation (PXF), incision site, capsular staining with trypan blue, and surgeon were recorded. A multinomial regression analysis was performed to analyse the relationship of the factors with postoperative high IOP. Results: The mean IOP was 15.6 ± 4.3 mmHg preoperatively. Postoperatively that were changed to 19.7 ± 9.0 mmHg at day 1, 12.7 ± 4.5 mmHg at day 7, and 12.8 ± 3.7 mmHg at day 30. The factors such as surgeon, presence of PXF, diabetes, surgical incision site, and trypan blue were not related to the postoperative high IOP (P > 0.05, in all). The only factor that related to high IOP at all visits was glaucoma (P < 0.005). Conclusion: According to our results, preoperative diagnosis of glaucoma seems to be the only factor to affect the postoperative IOP higher than 22 mmHg.

Serum Immunoglobulin G4 levels are elevated in patients with Graves’ ophthalmopathy

Recent studies have shown close association between serum Immunoglobulin G4 (IgG4) levels and forms of autoimmune thyroiditis. However, there are limited data about the relationship between IgG4 and Graves’ ophthalmopathy (GO). In the present study, we aimed to determine the possible association between IgG4 and GO.

Periorbital necrobiosis lipoidica diabeticorum: case report

Necrobiosis lipoidica diabeticorum (NLD) is a relatively common manifestation of diabetes mellitus that is thought to be related to immune-complex vasculitis. The legs are the most common site for NLD, but other locations, such as the forearms or hands, have been reported. We describe a case of periorbital NLD that was diagnosed on the basis of histopathology.

Laser Photocoagulation in Intermediate Uveitis Associated with Retinoschisis

Purpose: To describe cases of pars planitis associated with retinoschisis, in which laser photocoagulation was carried out. Methods: Retrospective review. Results: Three pars planitis cases were associated with retinoschisis and underwent laser photocoagulation. All cases were idiopathic. Retinoschisis was located in the inferior retinal quadrants in all cases and all of them were in bullous formation. None of the cases developed retinal detachment. Conclusion: As well as posterior vitreous detachment, or peripheral retinal tears, retinoschisis may accompany pars planitis. Laser photocoagulation of the pars plana is effective in these cases both as a treatment and to prevent sight-threatening complications like retinal detachment.