Serpil Akar

Transcanalicular Diode Laser Assisted Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction: 2-year Follow Up

Purpose: To evaluate the success rate of 980 nm transcanalicular diode laser-assisted dacryocystorhinostomy (TDL-DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO) and to consider the time and the reasons of failure. Methods: Hundred and thirty eyes of 125 patients who underwent of TDL-DCR for the treatment of PANDO are included in this retrospective, noncomparative, nonrandomized, interventional study. The mean follow-up time was 24.29 months (range 8–34 months). Functional success was described as disappearance of epiphora and presence of a patent ostium on lacrimal irrigation. Anatomical success was described as a patent ostium to irrigation but continuing epiphora. Patients with persistent epiphora and a closed ostium were classified as a surgical failure. Results: At third month follow up, 85.4% of cases had complete resolution of their symptoms. The functional success rate decreased to 67.7% at 6 months, to 63.3% at first year, and to 60.3% at second year, while the patency of the lacrimal drainage system was restored in 93.1%, 74.6%, 69.5%, and 68.2% of the cases, respectively. The average total amount of delivered laser energy was 1322.7 J. No correlation could be found between the age of the patient, delivered laser energy, and the surgical success (p = 0.38, p = 0.62). Conclusions: Transcanalicular diode laser-assisted DCR is a fast and relatively easy alternative surgical method, which avoids a facial skin scar, to treat PANDO. The functional success rate is higher in the first months but decreases to low 60 %’s at the end of first year and remains the same at the second-year follow up.

Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy.

PURPOSE To evaluate the effect on ocular alignment of Y splitting the lateral rectus muscle and then reattaching the 2 ends near the medial rectus muscle insertion in patients with complete oculomotor nerve palsy. METHODS All eyes with oculomotor nerve palsy treated between May 2008 and February 2010 with Y splitting and transposition of the lateral rectus muscle to the medial rectus muscle were prospectively studied. In this procedure, the lateral rectus muscle was split: the upper half was transposed to the superior border and the lower half to the inferior border of the medial rectus insertion. For the muscles that had lost the ability to stretch and strain due to fibrosis, a hang-back technique was used. In some patients, the medial rectus muscle of the same eye was subsequently strengthened or the lateral rectus muscle of the fellow eye was recessed. Final deviation from 0(Δ) to 10(Δ) was considered a successful result. RESULTS A total of 10 patients were included. Patients had a preoperative horizontal deviation >45(Δ) (range, 45(Δ)-90(Δ)). Of the 10 patients, 5 attained stable results following surgery, and 5 with postoperative undercorrection between 20(Δ) and 30(Δ) required further surgeries. Postoperatively, 2 patients improved their sensorial status in a very limited range of gaze and 2 patients had symptomatic diplopia. CONCLUSIONS Acceptable aesthetic results can be achieved in the treatment of complete oculomotor nerve palsy with the transposition of the split lateral rectus muscle to the medial rectus muscle area.

Medial rectus Faden operations with or without recession for partially accommodative esotropia associated with a high accommodative convergence to accommodation ratio

Aims To evaluate the results of Faden operations on the medial rectus (MR) muscles with or without recession for the treatment of partially accommodative esotropia associated with a high accommodative convergence to accommodation (AC : A) ratio and to determine whether there was a decrease in the effects of posterior fixation over time. Methods In this retrospective study, 108 of 473 patients who underwent surgery for partially accommodative esotropia with a high AC : A ratio received Faden operations on both MR muscles, and 365 received symmetric MR muscle recessions combined with a Faden operation. Results For the Faden operation, a satisfactory outcome of 76.9% at 1 month postoperation, decreased to 71.3% by the final follow-up visit (mean 4.8 years). A moderate positive correlation was observed between the increase in the postoperative near deviation and postoperative time. For the Faden operations combined with MR recession, a satisfactory outcome of 78.9% at 1 month post-operation, decreased to 78.4% by the final follow-up visit. Conclusion A Faden operation of the MR muscles with or without recession is an effective surgical option for treating partially accommodative esotropia associated with a high AC : A ratio. For Faden operations of the MR muscles without recession, the effects of the posterior fixation decline over time.

Graded anterior transposition of the inferior oblique muscle for V-pattern strabismus

PURPOSE To evaluate the efficacy of bilateral graded anterior transposition of the inferior oblique muscle for the correction of V-pattern strabismus associated with inferior oblique overaction. METHODS Medical records of patients who underwent graded anterior transposition of the inferior oblique muscle for bilateral primary inferior oblique overaction associated with V-pattern strabismus were reviewed. The surgical technique entailed recessing and anteriorly transposing the inferior oblique muscle to various locations along the temporal border of the inferior rectus muscle. The amount of anterior transposition was determined by both the severity of the overaction and the extent of the V pattern. We analyzed the changes in inferior oblique muscle overaction and V-pattern strabismus and the frequency of limited elevation after surgery. RESULTS The record review identified 69 patients (138 eyes) who met inclusion criteria. V-pattern esotropia was present in 44 patients (64%) and V-pattern exotropia in 25 (36%). Full correction or undercorrection to <10(Δ) of V pattern was achieved in 82% of esotropia cases and 80% of exotropia cases. Response to surgery was influenced by the severity of the preoperative inferior oblique muscle overaction and the extent of the preoperative V pattern. The grading of the anterior transposition was not a significant independent predictor of surgical response. No patient suffered limitation of elevation postoperatively. CONCLUSIONS Anterior transposition of the inferior oblique muscles corrected V-pattern strabismus and reduced inferior oblique muscle overaction without creating limitation of elevation; however, it is unclear whether grading the transposition contribute to the success of the procedure.

Surgical procedure joining the lateral rectus and superior rectus muscles with or without medial rectus recession for the treatment of strabismus associated with high myopia.

PURPOSE To evaluate the outcomes of a surgical procedure involving the muscle union of the superior rectus (SR) and lateral rectus (LR) muscles with or without medial rectus (MR) recession for the treatment of strabismus associated with high myopia and the anatomic changes from before and after surgery. METHODS Thirty-five eyes of 20 patients who had undergone a muscle union of the SR and LR muscles with or without MR recession for treatment of acquired strabismus associated with an inferior displacement of the LR and nasal displacement of the SR in magnetic resonance imaging of the orbit due to axial high myopia were observed prospectively. Main outcome measures were the angles of the dislocation of the globe, angles of horizontal or vertical deviations, abductions, and supraductions. The angles of the dislocation of the globe were analyzed using magnetic resonance imaging (1.5 Tesla Magnet; Siemens Symphonia, Munich, Germany). RESULTS The axial lengths ranged from 26 to 36 mm (mean: 30.6 ± 2.8 mm). The angle of dislocation of the globe changed from 178º ± 10º to 101º ± 6º, the angle of esotropia changed from 58.6 ± 2.5 to 6.8 ± 1.4 prism diopters (PD); and the angle of hypotropia changed from 12.5 ± 1.3 to 3.3 ± 1.1 PD postoperatively. Abduction and supraduction improved significantly after surgery. At the 4-year follow-up, the postoperative outcomes were stable. CONCLUSIONS In the treatment of strabismus caused by high myopia, the surgical procedure involving the muscle union of the SR and LR muscles with or without MR recession was effective on both the restoration of the dislocated globe into the muscle cone and the improvement of ocular motility.

A novel technique for inferior rectus recession

Purpose To introduce a novel technique of inferior rectus recession operation to allow larger amounts of recession without causing lower lid retraction and to compare this method with the results obtained in standard inferior rectus recession. Material and methods This study included 20 patients operated on in the authors’ clinic. The median age of the patients was 24.5±18.6 (4–73) years and the median follow-up was 9.3±11.8 (3–43) months. Ten patients operated on with the standard method were labeled Group 1 and ten patients operated on with the new method were labeled Group 2. Without exceeding 4 mm, inferior rectus recession to the whole muscle was performed in Group 1 patients. Inferior rectus recession was also performed on patients in Group 2 following the new method. Using a spatula, approximately 10% of the muscle surface fibers were detached intact as a thin layer, and the remaining 90% of deeper fibers were recessed 4–8 mm as planned. Patients’ preoperative deviations and lower lid positions were recorded. The same parameters were checked in the first and third month postoperatively. Both groups were evaluated retrospectively by screening their files, and the Mann–Whitney U test was used for statistical evaluation. Results Lower lid retraction was seen in four patients of Group 1. There was no retraction in Group 2. While there was a need to perform additional vertical muscle procedures for vertical deviations and lower lid retractions in Group 1, it was observed that there was no need for additional procedures in Group 2 patients. There was a statistically meaningful difference between the two procedures (P<0.05). Conclusion This novel technique was found to be an effective surgical method for permitting more recession without the risk of lower lid retraction.

Comparison of 3 pupillometers for determining scotopic pupil diameter

Purpose. The pupil diameter under low ambient illumination is diagnostically valuable for refractive surgery. The aim of study was to compare the NeurOptics® Pupillometer, Sirius®, and Ocular Wavefront Analyser® in determining scotopic pupil diameter. Methods. A total of 96 eyes of 48 subjects were included. The scotopic pupil size was measured with 3 instruments and the measurements repeated following instillations of 1% cyclopentolate. Agreement between the instruments was assessed. Results. The mean measurement obtained by Sirius was significantly larger than Ocular Wavefront Analyser and NeurOptics. The Ocular Wavefront Analyser measured significantly smaller than the others. The mean cycloplegic pupillary diameters (7.73±0.70 mm with NeurOptics, 7.42±0.45 mm with Ocular Wavefront Analyser, and 8.06±0.76 mm with Sirius) were significantly different obtained by 3 instruments (p<0.001, for each; one-way analysis of variance and paired t tests). Conclusions The differences between measured pupil diameters with or without cycloplegia obtained by the NeurOptics, Sirius, and Ocular Wavefront Analyser were significant and have unacceptable levels of disagreement. These results may not be related to illumination and accommodation only, but also to measurement algorithms and technical differences of the devices.

Management of Duane retraction syndrome with prismatic glasses

Purpose To report the results of using prismatic glasses for Duane retraction syndrome (DRS). Methods Data were obtained from the records of patients who were evaluated during the year 2000 in the Strabismus Unit of the Beyoglu Eye Training and Research Hospital. The average follow-up was 12.2±17.7 months. In all cases, 2 main variables were evaluated: horizontal deviation in the primary position and face turn. Prismatic glasses were provided to patients according to the degree of shift in the primary position. Results The mean age of patients was 11.2 years. An analysis was performed on the data collected from 12 cases; 7 patients were females (58.3%) and 5 were males (41.7%), with 11 (91.7%) cases being of type I DRS. All 12 patients had abnormal head posture (face turn) and an angle of mean deviation equaling 10 PD (prism dioptri). Conclusion Treatment was individualized on a case-by-case basis. Prismatic glasses are useful for eliminating abnormal head posture and ocular misalignment in selected cases.

Normal Binoküler Görmeye Sahip Olan Türk Popülasyonunda, Farklı Yaş Grupları için Konverjansın Yakın Kırılma Noktası: Normatif Veri

Nihat Sayın, Serpil Akar*, Birsen Gökyiğit*, Pelin Kaynak**, Duygu Tüzün Sayın***, Ahmet Demirok**** Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi, Oftalmoloji Kliniği, İstanbul, Türkiye *Prof. Dr. N. Reşat Belger Beyoğlu Göz Eğitim ve Araştırma Hastanesi, Şaşılık Kliniği, İstanbul, Türkiye **Prof. Dr. N. Reşat Belger Beyoğlu Göz Eğitim ve Araştırma Hastanesi, Okuloplastik Cerrahi Kliniği, İstanbul, Türkiye ***İstanbul Eğitim ve Araştırma Hastanesi, Oftalmoloji Kliniği, İstanbul, Türkiye ****Prof. Dr. N. Reşat Belger Beyoğlu Göz Eğitim ve Araştırma Hastanesi, Yönetici/Başhekim, İstanbul, Türkiye Öz gün Arafl t›r ma / Ori gi nal Ar tic le DOI: 10.4274/tjo.78700

Long-Term Results of Deeper Muscle Fibers Recession of an Inferior Rectus Operation

PURPOSE To report the efficacy in preventing lower eyelid retraction and long-term results of a new technique of inferior rectus (IR) recession for vertical strabismus and compare this method with the results obtained by a conventional IR recession operation. METHODS This retrospective study included 35 patients who underwent a new IR recession method (study group) and 22 patients who underwent the conventional IR recession (control group) for vertical strabismus. In the study group, an IR recession was applied to the deeper fibers and included approximately 90% of the IR muscle thickness. This group was divided into two subgroups: small IR recessions (4 to 6 mm) and large IR recessions (7 to 8 mm). In the control group, an IR recession of the entire muscle was applied without exceeding 6 mm. The photographs were analyzed for lower eyelid position. Digital image analysis was used to standardize each patients preoperative and postoperative photographs at final follow-up examination. The main outcome measures were the margin-to-reflex distance, lower eyelid retraction, and vertical deviation angles (at near and distance fixation). RESULTS The mean change in margin-to-reflex distance after surgery was 0.03 mm in the small IR recessions group, 0.1 mm in the large IR recessions group, and 2.04 mm in the control group. Postoperatively, the lower eyelid retraction in the study group, which occurred after both small and large IR recessions, was significantly less than that in the control group (P < .001). There was no significant difference between the study and control groups in improvements in near and distance vertical deviations and success ratios (P > .05). CONCLUSIONS At long-term follow-up, recession of the deeper fibers layer, including approximately 90% of the IR muscle thickness, was a procedure that minimized or eliminated the possibility of lower eyelid retraction and did not limit the success of strabismus surgery.