Sevil Ari Yaylali

A cluster of acute-onset postoperative endophthalmitis over a 1-month period: investigation of an outbreak caused by uncommon species

Aim To report the clinical course, treatment response and prognosis of eight cases which developed acute-onset postoperative endophthalmitis over a 1-month period. Methods 8 patients who were operated on over a period of 1 month and developed acute postoperative endophthalmitis were evaluated. Five of the patients had cataract surgery, one had cataract surgery combined with silicone extraction, and two patients had pars plana vitrectomy (PPV). Clinical patterns were observed, intraocular cultures were obtained, and the source of the organisms causing the epidemic was investigated. All patients had intravitreal antibiotic injections, three had PPV, and in two patients anterior chamber irrigation was performed. Results Vitreous cultures showed Cellulosimicrobium cellulans in three cases and Stenotrophomonas maltophilia in one case. Four of the cases were culture negative. Stenotrophomonas maltophilia were also isolated from unused bottles of irrigating solutions. The final visual acuity of the patients ranged between HM and 7/10. All three patients with Cellulosimicrobium cellulans had a final visual acuity of ≥5/10. The available irrigating solutions were changed, and the endophthalmitis did not recur. Conclusions The authors are unaware of any previous reports of postoperative endophthalmitis associated with Cellulosimicrobium cellulans. Prompt management with microbiological support, intravitreal antibiotics and PPV when needed were the key to good visual outcomes in this endophthalmitis outbreak.

Visual Performances With Monofocal, Accommodating, and Multifocal Intraocular Lenses in Patients With Unilateral Cataract

PURPOSE To compare the visual performance of patients with unilateral cataract following implantation of monofocal, accommodating, refractive, and diffractive multifocal intraocular lenses (IOL). DESIGN Prospective nonrandomized clinical trial. METHODS Eighty-seven patients with unilateral cataract were enrolled in 4 groups for phacoemulsification and IOL implantation. Twenty-four patients had monofocal (Alcon Acrysof) (group 1), 21 patients had accommodating (Human Optics 1CU) (group 2), 22 patients had diffractive multifocal (Tecnis ZM900) (group 3), and 20 patients had refractive multifocal (AMO Rezoom) (group 4) IOL implantations. Ages of patients were between 40 and 70. Parameters analyzed at the 18th postoperative month were subjective refractions, monocular and binocular distance, intermediate and near uncorrected visual acuities, monocular distance and near best-corrected visual acuities, monocular distance-corrected intermediate and near visual acuities, stereopsis, visual complaints, and spectacle dependency. RESULTS No significant difference was observed between distance and near best-corrected visual acuities of IOL groups, and between intermediate visual acuities of groups 2, 3, and 4. Groups 3 and 4 had statistically better near vision than the other groups (P < .05). No significant difference was observed between near visual acuities of groups 3 and 4. Number of patients with better stereoscopic function, spectacle independence, and complaints of halo in groups 3 and 4 was significantly higher than in other groups (P < .05). CONCLUSIONS Multifocal IOLs provide better stereopsis, higher spectacle independence rates, and satisfactory functional vision over a broad range of distances in presbyopic patients with unilateral cataract compared with the monofocal and accommodating IOLs.

Screening for Retinopathy of Prematurity in a Tertiary Hospital in Istanbul: Incidence and Risk Factors

PURPOSE To study the incidence and risk factors of retinopathy of prematurity (ROP) in premature infants examined in a tertiary hospital in Istanbul. METHODS Data of infants screened for ROP from April 2007 to September 2009 were retrospectively reviewed. Possible risk factors and eye examinations were recorded and analyzed using the chi-square test and univariate and multivariate regressions. RESULTS ROP was detected in 177 (34.3%) of the 517 infants enrolled in the study; 64 had mild ROP (77.4%) and 38 had severe ROP (22.6%). The mean gestational age and birth weight of patients who were treated for ROP were 28.6 ± 2.3 and 1,143.5 ± 337.4, respectively. Two of these infants had a gestational age of 32 g or greater and three had a birth weight of 1,500 g or greater. The multivariate regression analyses showed gestational age, birth weight, sepsis, respiratory distress syndrome, and length of oxygen therapy as independent predictors of ROP. CONCLUSION The incidence of ROP observed in this study was higher than that in developed countries and relatively more mature infants were affected. Criteria including gestational age of less than 34 weeks or birth weight of less than 2,000 g would have identified all infants who were at risk.

HIV-related Eye Disease in Patients Presenting to a Tertiary Care Government Hospital in Turkey

Aim: To document the ocular involvement in HIV-infected individuals in Turkey and to compare the findings with those from other centers throughout the world. Methods: In this cross-sectional study, patients with HIV infection being monitored in a tertiary hospital in Istanbul were enrolled. Ocular examination was performed, and the prevalence of ocular manifestations determined. Results: In total, 93 patients were enrolled, of whom 37.6% had ocular pathology. HIV retinopathy was the most frequent retinal finding, affecting 8.6% of the enrolled patients, but none of the affected individuals had any ophthalmic complaints. There were no ocular lesions suggestive of cytomegalovirus (CMV) retinitis. Discussion: In contrast to the case in the developed world, sight-threatening infections are uncommon in Turkish HIV+ patients. The reasons for this are not clear, but it is possible that there are some genetic or environmental protective factors against CMV retinitis in the population studied.

The Efficacy and Safety of Intravitreal Dexamethasone Implant for the Treatment of Macular Edema Related to Retinal Vein Occlusion: Real-life Data and Prognostic Factors in a Turkish Population

Objectives: To evaluate the efficacy and safety of dexamethasone (DEX) implants as mono or combination therapy for macular edema in retinal vein occlusion (RVO) with real-life conditions, and to detect factors that influence final visual acuity. Materials and Methods: Twenty-five eyes with macular edema secondary to RVO underwent assessments for central macular thickness (CMT), best-corrected visual acuity (BCVA), adverse events, and also morphologic changes in optical coherence tomography at an interval of 4-8 weeks after at least one DEX implant. Results: Seventeen eyes with branch RVO and 8 eyes with central RVO were eligible for the study. The mean follow-up duration was 17 months (range, 12-26 months). Both mean BCVA (p=0.009) and CMT (p=0.006) improved significantly, and visual gains of ≥3 lines were achieved in 32% and ≥2 lines in 52% at the end of the follow-up period. The most powerful individual predictor of final visual acuity was baseline BCVA (r2=0.611, p<0.001, stepwise multiple regression), but the most efficient model was the combination of the ellipsoid zone (EZ) integrity and baseline BCVA (r2=0.766, p<0.001, stepwise multiple regression). Complication rates were very low after repeated DEX implants. Conclusion: DEX implant seems to be an effective and safe treatment for macular edema in RVO despite negative real-life factors, and visual outcomes are associated with baseline visual acuity and EZ integrity.

Cilioretinal artery: Vasculogenesis might be promoted by plasminogen activator inhibitor-1 5G allele.

ABSTRACT Background: Cilioretinal arteries (CAs) represent enlargements of microscopic and early established collaterals formed via vasculogenesis between choroidal and retinal circulations. We aimed to investigate whether genetic tendency to thrombosis due to well-known gene polymorphisms may induce CA vasculogenesis in embryonic life. Methods: We assessed plasminogen activator inhibitor-1 (PAI-1) 4G/5G, methylenetetrahydrofolatereductase (MTHFR), FACTOR V LEIDEN and PROTHROMBIN gene polymorphisms on 130 patients [82/48 females/males; Median age: 57 (18–84) with visible CAs and 100 (64/36: female/male; Median age: 55 (19–90)] without visible CAs. Results: Using multiple logistic regression models, we found PAI-1 4G/5G; MTHFR (C677T and A1298C) polymorphisms to have significant effects on the probability of visible CAs, that having at least one 5G allele would increase the odds of having visible cilioretinal artery by 98.4% [Odds ratio: 1984 (95% CI: 1.320–3.000, p = 0.001)], and having at least one MTHFR C677T or A1298C allele would decrease the odds of having visible CAs by approximately 38% (OR = 0.618, 95% CI: 0.394–0.961, p = 0.035) or 44% (OR = 0.558, 95% CI: 0.354–0.871, p = 0.011), respectively. Conclusions: This is the first study to test the existence of significant association between presence of enlarged and visible CAs and genetic factors predisposing to thrombosis, according to the literature. Here we suggest that not only the lack of genetic predisposition to thrombosis by MTHFR gene polymorphisms, but also the PAI-1 5G allele might promote vasculogenesis of CAs.

Idiopathic Hypertrophic Cranial Pachymeningitis Associated With Intermediate Uveitis

The authors report a case with idiopathic hypertrophic cranial pachymeningitis associated with intermediate uveitis. The patient complained of decreased vision in both eyes, especially the right. Ophthalmic examination revealed right optic disc pallor, bilateral vitritis, and cystoid macular edema. Magnetic resonance imaging revealed marked enhancement of a dural lesion. The macular edema responded well to medical treatment. Intermediate uveitis has not yet been reported in the context of idiopathic hypertrophic cranial pachymeningitis.

Ocular Angiographic Findings in Patients with Neurofibromatosis Type 1

Purpose: To describe the ocular angiographic findings in patients with Neurofibromatosis type 1 (NF-1). Methods: We examined 20 consecutive patients diagnosed with NF1 by conventional ophthalmoscopy and fluorescein angiography (FA), indocyanine green angiograms (ICGA) were also obtained from 11 of the patients. Forty FAs and 25 ICGAs were also obtained from age-matched controls. Results: Fluorescein angiography revealed patchy hyperfluorescence in 30%, retinal pigment epithelial (RPE) atrophy in 30%, “corkscrew” vessels in 50%, optic disc abnormalities in 25% and choroidal nevi in 30% of the patients. All the patients investigated by ICGA (n = 11) demonstrated hypofluorescent lesions corresponding to the patchy hyperfluorescence on fluorescein angiography. None of the control patients had any of the findings described neither on FA nor on ICGA. Conclusion: Because of their high frequency (100%), the hypofluorescent lesions on ICGA should be added as a new diagnostic criterion in NF1. RPE atrophy and the high frequency of optic disc abnormalities appear to be novel findings in patients with NF-1.