Şengül Özdek

Photorefractive keratectomy for post-penetrating keratoplasty myopia and astigmatism

Purpose: To determine the safety, effectiveness, and predictability of photorefractive keratectomy (PRK) for the correction of myopia and astigmatism after penetrating keratoplasty. Setting: Gazi University, Medical School, Department of Ophthalmology, Ankara, Turkey. Methods: Photorefractive keratectomy was performed in 16 eyes of 16 patients with postkeratoplasty myopia and astigmatism who were unable to wear glasses due to anisometropia and were contact lens intolerant. They were examined for uncorrected visual acuity (UCVA), best spectacle‐corrected visual acuity (BSCVA), and corneal transplant integrity before and after surgery. Results: The mean follow‐up after PRK was 26.0 months ± 15.7 (SD) (range 12 to 63 months). The mean preoperative spherical equivalent refraction of −4.47 ± 1.39 diopters (D) was −3.39 ± 1.84 D (P > .05) at the last postoperative visit and the mean preoperative cylinder of −5.62 ± 2.88 D was −3.23 ± 1.70 D (P < .05); refractive regression correlated with the amount of ablation performed. The BSCVA decreased in 3 eyes (18.8%), and the UCVA decreased in 2 (12.5%). Six eyes (37.5%) had grade 2 to 3 haze, which resolved spontaneously in 4 eyes within a relatively long time but caused a decrease in BSCVA in 2 (12.5%). Two of the eyes (12.5%) had a rejection episode after PRK and were successfully treated with topical steroids. Conclusions: Photorefractive keratectomy to correct postkeratoplasty myopia and astigmatism appears to be less effective and less predictable than PRK for naturally occurring myopia and astigmatism. Corneal haze and refractive regression are more prevalent, and patient satisfaction is not good.

Optical Coherence Tomographic Assessment of Diabetic Macular Edema: Comparison with Fluorescein Angiographic and Clinical Findings

Purpose: To compare the optical coherence tomographic (OCT) features with clinical and fluorescein angiographic (FA) findings in patients with diabetic retinopathy. Methods: In a retrospective study ophthalmologic examination together with FA and OCT images were obtained from 195 eyes of 110 patients with different stages of diabetic retinopathy and OCT images were obtained from 40 eyes of 20 control subjects. Fluorescein leakage characteristics were organized into five groups: no leakage (1), focal (2), diffuse (3), combined focal + diffuse leakage (4) and cystoid (5). The Pearson correlation test was used to test the correlation between visual acuity and central foveal thickness and ANOVA was used for the statistical comparison between the groups. Results: The OCT images demonstrated retinal swelling in 66.1% of eyes, cystoid macular edema (CME) in 11.8% of eyes, serous foveal detachment + swelling in 6.2% of eyes, serous foveal detachment + swelling + CME in 3.6% of eyes and normal foveal structure in 12.3% of eyes. The best-corrected visual acuity was significantly correlated with central foveal thickness (r: –0.528, p < 0.01). There was 77% agreement between clinical examination and OCT results. CME was detected with OCT in 15.4% of eyes in our study, 40% of which was not detected with slit-lamp biomicroscopy and 63.3% of which was not evident in FA. None of the serous foveal detachments could be detected during slit-lamp biomicroscopy or FA. Conclusions: OCT-3 provided objective documentation of foveal structural changes in eyes with diabetic retinopathy. Best-corrected visual acuity provided a significant correlation with the retinal thickness at the central fovea. These results indicate that OCT can facilitate deciding on the treatment protocol (surgical or medical) and follow-up of diabetic patients, which is especially important in the early stages of diabetic maculopathy when the structural changes are not yet evident with slit-lamp biomicroscopy or angiographically.

Alterations in ocular surface and corneal thickness in relation to metabolic control in patients with chronic renal failure

Aim:  Ocular surface changes and ocular symptoms may be encountered in patients with chronic renal failure (CRF) undergoing haemodialysis. The ocular surface changes and its relationship with metabolic control in CRF patients were aimed to be emphasized in this study.

Excimer laser-assisted anterior lamellar keratoplasty for keratoconus, corneal problems after laser in situ keratomileusis, and corneal stromal opacities

PURPOSE: To evaluate excimer laser‐assisted anterior lamellar keratoplasty to augment thin corneas as in keratoconus (<350 μm) and corneal ectasia after laser in situ keratomileusis (LASIK) and to treat anterior stromal opacities. SETTING: Ophthalmology Department, School of Medicine, Gazi University, Ankara, Turkey. METHODS: Thirteen eyes (5 keratoconus, 3 macular dystrophies, 1 post‐LASIK ectasia, 1 post‐LASIK interstitial keratitis, 3 post‐herpetic keratitis sequelae) of 13 patients were included in this prospective study. The treatment group was divided into corneal ectasia and stromal opacity groups. A donor stromal button approximately 350 μm thick received a 100 μm excimer laser ablation on the endothelium. The remaining cornea (epithelium, Bowmans membrane, and stroma) was punched with a 7.5 or 7.7 mm trephine. After transepithelial ablation of the host cornea to 200 μm thickness, the corneal button was sutured with interrupted 10‐0 monofilament nylon. Sutures were removed between 3 months and 6 months postoperatively. Preoperative and postoperative simulated keratometric cylinders and corneal thickness values were compared using the Wilcoxon signed rank test. The postoperative spherical equivalent refraction and best spectacle‐corrected visual acuity (BSCVA) between the groups were compared using the Mann‐Whitney U test. RESULTS: The mean follow‐up was 27.6 months ± 8.3 (SD). All patients gained 2 lines or more of BSCVA, and no patient lost a line. The mean corneal thickness was 381.2 ± 88.2 μm preoperatively, which significantly increased to 534.9 ± 96.6 μm postoperatively (P<.05). The mean preoperative simulated keratometric cylinder was 7.44 ± 7.18 diopters (D); postoperatively, it decreased to 2.61 ± 1.73 D (P<.05). There was no significant difference in postoperative spherical equivalent refraction or BSCVA between the groups (P>.05). CONCLUSIONS: This technique presents a different modality for the treatment of keratoconus, post‐LASIK corneal problems, and other corneal stromal opacities with anterior lamellar keratoplasty. Additional studies with more patients and longer follow‐up will help determine the role of this technique as a substitute for penetrating keratoplasty in these patients.

EPIRETINAL MEMBRANES IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Effect on Outcomes of Anti-vascular Endothelial Growth Factor Therapy.

Purpose: To iatients with neovascular age-related macular degenernvestigate the role of epiretinal membrane (ERM) on outcomes of anti-vascular endothelial growth factor therapy in pation (nAMD). Methods: This study is a retrospective observational case series and was conducted at the Gazi University School of Medicine, Ankara, Turkey. The reports of the patients with a diagnosis of new-onset nAMD, who were aged at least 50 years and treated with intravitreal anti-vascular endothelial growth factors (ranibizumab or bevacuzimab) between October 2010 and September 2013 in our retina clinic, were reviewed for the vitreomacular interface changes. Results: The study included 90 eyes of 90 patients with nAMD. The mean age of the patients was 70 ± 7.5 years, with 35 (38.9%) being male and 55 (61.1%) being female. According to the examinations with optical coherence tomography and B-mode ultrasonography, 43 patients had “concurrent” vitreomacular adhesion (30 focal, 13 broad; Group 1). Twenty-nine patients had complete posterior vitreous detachment (Group 2) and 18 patients (Group 3) had ERM. The number of injections was highest for the patients with ERM (Group 3), and this difference was statistically significant (P < 0.001). The mean interval between injections and the mean longest interval were shorter in Group 3 (P < 0.05). Conclusion: The presence of ERM in association with nAMD seems to increase the number of anti-vascular endothelial growth factor injections and decrease the injection intervals for the treatment of nAMD. Although the anatomical and functional results are similar in eyes with or without ERM, the increased need for anti-vascular endothelial growth factors may mean that these membranes may decrease the penetration of the drugs through these membranes, which may act as a physical barrier. Additionally, increased inflammation in patients with ERM probably requires more frequent injections.

Pars plana lensectomy with double-capsule-supported intraocular lens implantation in children.

&NA; An alternative technique to manage pediatric cataracts comprises a pars plana lensectomy and anterior vitrectomy with anterior and posterior capsulotomies and posterior chamber heparin‐surface‐modified intraocular lens (IOL) implantation in the ciliary sulcus through a scleral tunnel. The surgical results in 7 eyes of 6 consecutive patients between 3.5 and 12.0 years old with developmental or traumatic cataract who had surgery using this technique were evaluated prospectively. Follow‐up ranged from 12 to 19 months. All 7 eyes maintained a clear pupillary axis and a well‐centered IOL from immediately after surgery to the last follow‐up. Final best corrected visual acuity was 20/40 or better in 71% of cases.

Idiopathic multiple tiny serous retinal pigment epithelial detachments: report of 2 cases and review of the literature.

BACKGROUND Bilateral multiple serous retinal pigment epithelial detachments (PEDs) are a very rare entity. Such conditions may be idiopathic or a presentation of some ocular and/or systemic pathologies. We report 2 unique cases of bilateral multiple serous PEDs without any known cause. Additionally, similar cases of multiple serous idiopathic PEDs reported in the literature were reviewed. CASE REPORT The patients were middle-age women with no known related ocular and systemic problems. Fundus examination, fluorescein angiography, and optical coherence tomography found innumerable, small, serous, idiopathic PEDs mainly located in the macular area. One woman also had an associated subretinal pigment epithelial hemorrhage in 1 eye, which regressed spontaneously. There are only a few similar cases reported in the literature. CONCLUSION Idiopathic bilateral, multiple, tiny, serous PEDs in middle-age healthy people are rare entities that may be a variant of central serous choroidopathy in which retinal pigment epithelium is predominantly involved. The visual prognosis seems to be good without any intervention unless complicated by hemorrhages.

Evaluation of Ocular Surface Health in Patients with Obstructive Sleep Apnea Syndrome

Objectives: To evaluate ocular surface health in obstructive sleep apnea syndrome (OSAS) and to investigate the tendency of these patients toward dry eyes. Materials and Methods: Fifty patients who underwent polysomnography and were diagnosed with OSAS and 50 normal control subjects were compared with respect to ocular surface disease index (OSDI), Schirmer I test and tear film break-up time (TBUT) values. Results: Patients were grouped as mild (n=15, 30%), moderate (n=15, 30%) and severe (n=20, 40%) according to apnea-hypopnea index values. The right eyes of patients were included in both groups. OSDI values were as follows: control group, 18.7±8.5; mild OSAS group, 40.2±2.8; moderate OSAS group, 48.5±2.2 and severe OSAS group, 62.7±2.3 (p<0.001). TBUT values were as follows: control group, 12.3±4.9; mild OSAS group, 8.2±4.7; moderate OSAS group, 5.8±2.1 and severe OSAS group, 4.2±3.7 (p<0.001). Schirmer values were as follows: control group, 18±6.1 mm; mild OSAS group, 12.9±6.7 mm; moderate OSAS group, 8.5±5.2 mm and severe OSAS group, 7.9±4.7 mm (p<0.001). Conclusion: Patients with OSAS seem to have a tendency toward dry eyes. Clinicians should be aware of dry eye development in these patients.

Safety of Polyacrylamide 1.5% Left in Anterior Chamber in Combined Phacoemulsification and Pars Plana Vitrectomy Surgery.

ABSTRACT Purpose: To evaluate safety, efficacy and postoperative characteristics of polyacrylamide 1.5% ophthalmic viscosurgical device (OVD) left in anterior chamber during and at the end of combined phacoemulsification and pars plana vitrectomy surgery. Materials and Methods: This prospective study comprised 20 eyes that received combined phacoemulsification and pars plana vitrectomy performed by the same surgeon. Polyacrylamide 1.5% was left in anterior chamber at the end of the surgery. Preoperative and postoperative examinations (4, 12 and 24 hours; 14 days; 1 and 3 months) included measurement of intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell density and assessment of any ocular adverse reactions. Results: Four of the 20 patients (20%) showed increased IOP at hours postoperatively and needed medical treatment for IOP control. There was no significant difference in IOP between the preoperative visit and postoperative 3 months (p > 0.05). CCT measurements were similar between preoperative and postoperative visits (p > 0.05). A mean endothelial cell density loss of 6.7% was observed at postoperative day 14, however there was no change after this visit. Conclusion: Polyacrylamide 1.5% is safe, well-tolerated and protective in eyes undergoing combined phacoemulsification and pars plana vitrectomy.