Serhat Imamoglu

An Outbreak of Early-Onset Endophthalmitis Caused by Fusarium Species following Cataract Surgery

Purpose: This study aimed to report an outbreak of early-onset endophthalmitis caused by Fusarium species following cataract surgery. Methods: The study was designed retrospectively to review microbiologic and medical records of eight cases of endophthalmitis caused by Fusarium species after cataract surgery performed in the same operating room and on the same date by different surgeons at Beyoğlu Eye Training and Research Hospital in Istanbul, Turkey. Seven patients had phacoemulsification and intraocular lens implantation surgery. Intracapsular cataract extraction was performed in one patient. The common feature of these surgeries was the use of intracameral injections of cefuroxime (1 mg in 0.1-ml balanced salt solution–BSS) solutions, which were preoperatively prepared from the same BSS bottle. Results: The duration between cataract surgery and the diagnosis of endophthalmitis was four days. Aqueous and vitreous specimens obtained from the patients grew fungus colonies that were identified according to their morphologic features and considered to be Fusarium solani. All patients underwent multiple vitrectomies with silicone oil injections. Patients were given local and systemic antifungal agents (amphotericin B and voriconazole). One patient with corneal involvement underwent evisceration despite a variety of treatments. One patient with unregulated diabetes was prephthisic without recurrence of infection. The final visual acuity of patients was between light perception and 20/100. Conclusion: Fusarium should be considered in the differential diagnosis of early-onset endophthalmitis after cataract surgery. An aggressive treatment with local and systemic antifungal agents and multiple vitrectomies with silicone oil injection is helpful in the management of postoperative early-onset Fusarium endophthalmitis. In the prevention of such outbreaks, it is important to use solutions prepared differently for each patient.

In vivo biometric evaluation of Schlemm's canal with spectral-domain optical coherence tomography in pseuduexfoliation glaucoma.

To perform in vivo imaging of the Schlemms canal (SC) with anterior segment spectral‐domain optical coherence tomography [AS‐spectral‐domain (SD)‐OCT] and also to measure its biometric parameters including the SC length and SC area in patients with pseudoexfoliation (PEX) glaucoma.

Corneal wavefront–guided customized laser in situ keratomileusis after penetrating keratoplasty

Purpose To assess the efficacy and safety of corneal wavefront‐guided custom laser in situ keratomileusis (LASIK) to correct refractive errors and higher‐order aberrations (HOAs) after penetrating keratoplasty (PKP). Setting Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. Design Noncomparative case series. Methods The study comprised consecutive patients who were unable to tolerate spectacles or contact lenses for the correction of anisometropia after PKP and had corneal wavefront‐guided custom LASIK. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction spherical equivalent (MRSE), and corneal HOAs were recorded before and after LASIK. Results The study evaluated 11 eyes (10 patients). The mean follow‐up after LASIK was 24.3 months ± 11.7 (SD) (range 9 to 36 months). The mean MRSE was −2.97 ± 1.66 diopters (D) (range −0.50 to −5.38 D) preoperatively and −0.88 ± 0.96 D (range −2.75 to 0.5 D) postoperatively. The mean total higher‐order root mean square (RMS) was 4.65 ± 1.14 &mgr;m (range 2.26 to 5.94 &mgr;m) preoperatively and 2.71 ± 1.31 &mgr;m (range 1.22 to 5.33 &mgr;m) postoperatively. Postoperatively, the UDVA improved in 7 eyes and remained unchanged in 4 eyes. The CDVA improved in all eyes postoperatively even cases in which the attempted astigmatic correction was not totally achieved. Conclusions Corneal wavefront‐guided custom LASIK after PKP did not totally correct both refractive errors and HOAs because of the high volume of laser ablation required and inadequate corneal stromal thickness. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Correlation of Dry Eye Workshop Dry Eye Severity Grading System With Tear Meniscus Measurement by Optical Coherence Tomography and Tear Osmolarity.

Objectives: To compare tear meniscus measurements obtained by optical coherence tomography (OCT) and tear osmolarity with dry eye severity according to the Dry Eye Workshop (DEWS) classification system. Methods: Forty-four eyes of 22 patients with dry eye disease (DED) were recruited in this prospective study. In all eyes, ophthalmic examination was performed in the same order as follows: Ocular Surface Disease Index (OSDI) survey, tear film osmolarity measurement with TearLab Osmolarity System, tear meniscus measurements by OCT, corneal fluorescein staining scoring, conjunctival lissamine green staining scoring, tear film breakup time assessment, and anesthetized Schirmer test. Dry eye disease severity was graded according to the DEWS dry eye severity grading system, and the patients were divided into two groups. Group 1 composed of the patients with grades 1 and 2 DED, and group 2 composed of the patients with grades 3 and 4 DED. Results: The mean tear osmolarity value was significantly higher in group 2 (318.9±12.8 mOsm/L) than in group 1 (308.1±8.5 mOsm/L) (P<0.01). The mean tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) values were significantly lower in group 2 (172.9±73.5 &mgr;m, 121.57±46.2 &mgr;m, and 0.013±0.012 mm2, respectively) than in group 1 (218.5±70.2 &mgr;m, 157.94±49.1 &mgr;m, and 0.022±0.013 mm2, respectively) (P=0.05, P=0.02, and P=0.026, respectively). There was a negative correlation between TMH and OSDI at the level of 45% (r=−0.450; P<0.05), between TMD and OSDI at the level of 47% (r=−0.470, P<0.05), and lastly between TMA and OSDI at the level of 48.5% (r=−0.485, P<0.05). There was no correlation between OSDI and tear osmolarity (P>0.05). Conclusions: Both tear osmolarity and tear meniscus OCT measurements comply with the DEWS grading system, and they can be used in the diagnosis and follow-up of dry eye patients in addition to conventional tests.

Bilateral Preexisting Congenital Posterior Capsular Defects with Accompanying Membranes

Purpose: To present three cases having bilateral congenital posterior capsular defects accompanying bilateral congenital cataracts. Cases: Similar to the previous reports there were characteristic demarcation of thickened margins on the posterior capsule defects and white dots on the anterior vitreous face in all of our cases. In addition to previous reports, we detected a semi-transparent membrane at the location of the posterior capsule defect bilaterally in all of our cases. Observations: This membrane was loosely attached to the borders of the posterior capsular opening and we removed it with vitreus cutter in two cases and with forceps in the other. In two cases the membranes covered the entire posterior capsular defect area; but in one case the membrane covered only the half of the defect. The cases were managed by standard irrigation - aspiration and anterior vitrectomy. Conclusion: Ophthalmologists should be aware that in some congenital cataracts, they may notice congenital posterior capsular defects with accompanying membranes.

Novel Zinc Finger Protein Gene 469 (ZNF469) Variants in Advanced Keratoconus

ABSTRACT Purpose: Common polymorphic variants upstream of Zinc finger protein gene 469 (ZNF469) have been associated with central corneal thickness. Rare ZNF469 variants have been shown in keratoconus patients. The aim of the current study was to investigate the frequency of ZNF 469 gene variants in rapidly progressive advance keratoconus patients who underwent corneal transplant surgery by the age of 30, compared to their frequency in the normal Turkish population. Methods: A search in a patient database was performed to identify patients with a rapidly progressive keratoconus requiring corneal transplant surgery by the age of 30 in at least one eye. Twenty-six advance keratoconus patients (study group) and 109 health subjects (control group) were included in the study. Blood samples were donated, and genomic DNA was extracted. The entire coding sequence of the ZNF469 gene including the 84 bp of the putative intron was amplified using PCR primers and analyzed using next generation sequencing (NGS). Results: Fifteen single nucleotide polymorphisms previously reported and registered to the dbSNP database were detected in the study group. The allele frequencies of these polymorphisms were higher in the keratoconus group compared to the control group and to the ExAC genome database. Three new missense heterozygote variants and one new synonym variant were detected in keratoconus group. According to prediction software, the P873T and Q2188H variants were shown to be non-tolerated, whereas G3424S could be tolerated. The synonymous variant R1060R is not predicted to lead to abnormal splicing by Human Splicing Finder in silico analysis. Conclusion: New detected ZNF 469 P873T and Q2188H heterozygote coding variants in isolated advance keratoconus patients may be associated with the disease pathogenesis.

Congenital keratoglobus with blue sclera in two siblings with overlapping Marshall/Stickler phenotype

We aimed to describe congenital keratoglobus with blue sclera in two siblings with overlapping Marshall/Stickler phenotype. Two sisters (ages four and six) with bilateral high astigmatism were evaluated by slit-lamp microscopy. Corneal topography and pachymetry maps were also obtained. Slit-lamp examination revealed that both corneas were globular in shape with peripheral corneal thinning. Pachymetry maps showed diffuse corneal thinning. Two siblings had in common the features of keratoglobus, blue sclera, atypical face, hearing loss, and hypermobile joints. We tentatively diagnosed the sisters as having an overlapping Marshall-Stickler phenotype based on clinical and radiological findings. Marshall-Stickler syndrome may exist in the differential diagnosis of keratoglobus with blue sclera.

Influence of the epiretinal membrane on ranibizumab therapy outcomes in patients with diabetic macular edema

Purpose: To investigate the influence of the epiretinal membrane (ERM) on intravitreal ranibizumab (IVR) therapy for diabetic macular edema (DME). Methods: This retrospective study included 56 eyes of 48 patients with DME divided into two groups: the DME with ERM (study) and only DME (control) groups. Changes in the central macular thickness (CMT) and best-corrected visual acuity (BCVA) were evaluated. Results: In the study group, although the CMT was significantly reduced following the first injection (p<0.001), BCVA did not improve significantly (p=0.296). However, after the first injection, the control group exhibited both a significant decrease in CMT (p<0.001) and improvement in BCVA (p<0.001). However, the improvement in BCVA in the control group was not significantly different from the outcome of the study group. Conclusions: We observed a negative short-term influence of the ERM on IVR treatment for DME.

Ahmed Glaucoma Valve Implantation in Vitrectomized Eyes

Purpose To evaluate the outcomes of Ahmed glaucoma valve (AGV) implantation in vitrectomized eyes. Materials and Methods The medical records of 13 eyes that developed glaucoma due to emulsified silicon oil or neovascularization following pars plana vitrectomy and underwent AGV implantation were retrospectively reviewed. The main outcome measures were intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of antiglaucoma medications, and postoperative complications. Surgical success was defined as last IOP ≤21 mmHg or ≥6 mmHg and without loss of light perception. Results The mean follow-up duration was 11.7 ± 5.5 (range, 6–23) months. The mean IOP before the AGV implantation was 37.9 ± 6.7 mmHg with an average of 3.5 ± 1.2 drugs. At the final visit, the mean IOP was 15.9 ± 4.6 mmHg (p=0.001) and the mean number of glaucoma medications decreased to 2.3 ± 1.3 (p=0.021). At the last visit, 11 eyes (84.4%) had stable or improved VA and one eye (7.7%) had a final VA of no light perception. Surgical success was achieved in 11 of the 13 eyes (84.4%). Postoperative complications were bleb encapsulation (69.2%), early hypotony (38.5%), hyphema (23.1%), decompression retinopathy (23.1%), choroidal detachment (15.4%), intraocular hemorrhage (7.7%), and late endophthalmitis (7.7%). One eye (7.7%) was enucleated because of late endophthalmitis. Conclusions Despite complications necessitating medical and surgical interventions, vitrectomized eyes were effectively managed with AGV implantation.

Influence of serous retinal detachment on the outcome of ranibizumab treatment in diabetic macular oedema

Abstract Purpose: The purpose of this study was to evaluate the influence of serous retinal detachment (SRD) on the outcome of intravitreal ranibizumab (IVR) therapy in diabetic macular oedema (DME). Materials and methods: Fifty-one eyes with cystoid macular oedema (CME) and SRD (study group) and 57 eyes with only CME (control group) that received pro re nata (PRN) IVR injections during a 6-month period were retrospectively evaluated. The outcome measures included changes in the central macular thickness (CMT) and best corrected visual acuity (BCVA) and injection numbers. Results: The mean initial CMT in the study and control groups was 467 ± 101 and 440 ± 89 µm, respectively. The mean BCVA in the study and control groups was 0.75 ± 0.38 and 0.59 ± 0.36 logarithm of minimal angle of resolution (LogMAR), respectively (p = 0.010). The study group received a mean of 2.2 ± 0.92 injections, whereas the control group received a mean of 2.54 ± 0.9 injections. The decrease in CMT was greater, but not significantly greater, in the study group than in the control group. Conclusion: The presence of SRD resulted in a less favourable visual acuity (VA) outcome with IVR. Disruption of the ellipsoid zone and abnormality of the foveal avascular zone at the baseline examination were correlated with a lower VA. Both of the pathologies occurred more frequently in the SRD group.