Sevin Soker Cakmak

Color Doppler Imaging of Ocular Hemodynamic Changes in BehÇet’s Disease

PurposeA prospective evaluation of the ocular blood flow velocity in patients with BehÇet’s disease was carried out to determine its changes.MethodsSubjects were divided into three groups: those with ocular involvement in BehÇet’s disease (group I), those without ocular involvement in BehÇet’s disease (group II), and a control group (group III). Twenty-seven eyes in group I and 28 eyes each in groups II and III were investigated. The blood flow in the central retinal artery (CRA), ophthalmic artery (OA), nasal posterior ciliary artery (NPCA), and the temporal posterior ciliary artery (TPCA) was measured using color Doppler ultrasonography (CDU) to determine the peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI). The mean blood flow velocity of the central retinal vein (CRV) was also measured. These results were then compared among the three groups of subjects.ResultsThe PSV values of CRA in groups I and II were found to be significantly lower than those in the control group (P ≪ 0.001, P = 0.018, respectively). The PSV values of CRA in group I were found to be significantly lower than those in group II (P ≪ 0.001). The EDV values of CRA in groups I and II were found to be significantly lower than those in the control group (P ≪ 0.001, P = 0.034, respectively). The EDV values of CRA in group I were significantly lower than those in group II (P = 0.041). The PSV values of OA in group I were significantly lower than those in the control group (P = 0.002). The EDV values of OA in group I were significantly lower than those values in group II or the control group (P = 0.001 and P = 0.037, respectively). The PSV values of NPCA in group I were significantly lower than those in the control group (P = 0.007). The PSV values of TPCA in groups I and II were significantly lower than those in the control group (P ≪ 0.001, P ≪ 0.001, respectively). The EDV values of TPCA in group I were significantly lower than those values in group II or the control group (P = 0.014 and P = 0.003, respectively). There were no significant differences in the mean blood flow values of the CRV among all three groups (P ≫ 0.05).ConclusionsThere are significant reductions in the blood flow values of the orbital arteries in patients with BehÇet’s disease, and they are more evident in those with ocular involvement. This might be the result of occlusive vasculitis, which is frequently seen in the retinal vessels of patients with BehÇet’s disease. Jpn J Ophthalmol 2004;48:101–105

Orbital Myiasis : Case Report

BACKGROUND Orbital myiasis cases are very rare worldwide. We are reporting this case caused by Hypoderma bovis because invasive parasitic larvae can cause massive destruction. CASE An 85-year-old female patient was admitted to the Department of Ophthalmology of the Dicle University School of Medicine with the complaint of a wound in her right eye for over one year. Larvae had been in the same eye for one week. OBSERVATIONS The clinical examination showed no light perception in her right eye. The eyelid was thickened and there was a necrotic lesion 3 x 4 cm in diameter, invading inferiorly into the upper side of the maxilla, superiorly to the roof of the orbita, medially to the lateral part of the nose, and laterally to the ossa zygomatica. Pathological examination of orbital tissue specimens confirmed basal cell carcinoma. CONCLUSIONS Orbital exenteration, total maxillectomy and graft repair were conducted in the right eye. During the six-month follow-up period, orbital tomography was performed. No recurrence or metastasis was observed.

Effects of soft contact lenses on conjunctival surface.

Purpose To examine the effects of soft contact lenses on tear breakup time (TBUT), basal Schirmer test result, and the conjunctival surface in patients wearing contact lenses. Methods In this study, conjunctival cytologic changes, TBUT, and Schirmer test function alterations of soft contact lens wearers were evaluated by impression cytology. The study included 100 eyes of 50 soft contact lens wearers who were followed up in the Department of Ophthalmology of Dicle University and 80 eyes of 40 subjects as a control group. After TBUT and basal Schirmer test, conjunctival surface epithelial morphology was investigated using impression cytology. After the materials were appropriately stained, they were evaluated according to the Nelson grading scale. Results Contact lens wearers were divided into three groups according to the duration of contact lens wear. When these groups were evaluated according to the Nelson grading method, 21% of cases were grade 0; 32% were grade 1; and 28% were grade 3. There were statistically significant differences in epithelial cell morphology, goblet cell density, snakelike chromatin changes, TBUT, and basal Schirmer test result between the control and study groups. Conclusions We suggest that TBUT and Schirmer test result be carefully monitored in contact lens wearers. Impression cytology may be used as a safe, simple, and noninvasive method in the diagnosis of ocular surface alternations in patients with contact lens intolerance.

Cutaneous Anthrax on Eyelids

BackgroundOphthalmologists should be aware of the signs and symptoms of anthrax, although it is a rare disease in humans. We report our successful treatment of three patients with cutaneous lesions in the periorbital area.CasesIn this study, we report on the treatment of three female patients who were initially diagnosed as having preseptal cellulitis.ObservationsGram-positive robs were revealed in the microscopic examination of scrapings taken from the lesions. Bacillus anthracis was found in only two of the three scraping-material cultures. Intravenous penicillin G was administered in all cases. Black and necrotic eschar, which is characteristic of anthrax, developed on the eyelids of all three patients during treatment. At the final examinations of the patients after the completion of treatment, we recognized the development of cicatrisation, lagophthalmos, and slight ectropion in the upper eyelid of the first patient, and, in the second patient, restriction of upper eyelid movement and development of a corneal scar from exposure keratopathy and ectropion. The cutaneous lesions healed without any eyelid pathology in the third patient.ConclusionAlthough it is a rare disease in humans, anthrax should be considered in the differential diagnosis of preseptal and orbital cellulitis.

Is it necessary to accompany probing with endoscopy in cases of congenital nasolacrimal canal obstruction

OBJECTIVE To compare the results of probing with and without endoscopy in cases of congenital nasolacrimal duct obstruction who had previously not undergone probing. METHODS Fifty-one children with congenital nasolacrimal duct obstruction who underwent surgical intervention between June 2007 and April 2009 in our hospital were included in the study. Patients who had had previous probings were excluded from the study. Conventional probing was performed in 37 eyes of 25 patients, and probing with intranasal endoscopic visualization in 36 eyes of 26 patients. Diagnosis was based on history of epiphora since birth or shortly after, and fluorescein dye disappearance test. RESULTS Thirty-two of 37 eyes (86.48%) were cured by probing. Of the 5 cases with complaints, 1 had lacrimal sac fistula. Thirty-four of 36 eyes (94.44%) were cured by probing guided by endoscope observation. Thirty-two cases had stenosis at the lower end of the nasolacrimal duct which required probing. In two cases the probe passed submucosally to the floor of the nose. In two cases a false passage was made at the upper end of the inferior meatus. In these cases, the operation was continued by repeating the process until the distal end of the nasolacrimal canal was seen to have been passed. CONCLUSION Probing with endoscopy may be excessive in primary cases but in cases which have undergone unsuccessful probing, it is useful for visualization of anomalies in the lower nasolacrimal canal and to obtain the correct anatomic position for the probe.

Use of endocanalicular dacryocystorhinostomy with multidiode laser in children

OBJECTIVE To evaluate the clinical outcome and efficacy of endocanalicular laser dacryocystorhinostomy using a multidiode laser in cases unresponsive to medical therapy, probing or intubation of pediatric nasolacrimal duct obstruction. METHODS Eight children with nasolacrimal duct obstruction were treated with a multidiode laser. The study was prospective, non-randomized, and noncomparative. The patients, 2 (25%) males and 6 (75%) females, ranged in age from 8 to 13 years (mean 11.25±2.43). Surgery was performed under general anesthesia. All procedures were performed using a multidiode laser. The nasal passage was visualized with a 30° nasal video endoscope. In all cases, silicone stents were inserted. The main outcome measure was resolution or improvement of the epiphora and no major laser damage intranasally. Patients were followed for at least 6 months. RESULTS The endocanalicular laser dacryocystorhinostomy failed in one of the 8 (12.5%) cases, which had been secondary to trauma. The others were due to primary nasolacrimal duct obstruction. External dacryocystorhinostomy was performed on the failed case. None of the cases with primary nasolacrimal duct obstruction had obstruction after the endocanalicular laser dacryocystorhinostomy operation. CONCLUSIONS Endocanalicular laser dacryocystorhinostomy using a multidiode laser appears to be an effective technique in cases unresponsive to medical therapy, probing or intubation of primary nasolacrimal duct obstruction.

Loxosceles reclusa bite to the eyelid.

Purpose The authors report a case of Loxosceles reclusa infestation on the eyelid. Methods The specimen collected by swabbing the lesions with gauze was tested by using a venom-specific enzyme-linked immunosorbent assay Loxosceles venom was detected in specimen. The patient was managed with conservative therapy that included saline compresses and ocular lubrication. Results The case presented with severe edema and necrosis on the left upper eyelid. On laboratory examination, a significant left shift of white blood cell count was detected. Although residual scar of the eyelid and punctate epitheliopathy on the inferior of cornea was detected, vision was not impaired. Conclusions Supportive therapy may be reasonable treatment for Loxosceles reclusa infestation on the eyelids. The presence of venom proteins detected with an enzyme-linked immunosorbent assay technique is beneficial for supporting the diagnosis of Loxosceles envenomatio.

The effects of intracameral ropivacaine on the corneal endothelium.

Topical and intracameral anesthesia have been popularized as new techniques for use in cataract surgery, and these anesthetic routes have potential safety advantages over traditional techniques such as retrobulbar and peribulbar anesthesia. Intracameral techniques have included the use of preservative-free (PF) lidocaine hydrochloride 1% or PF bupivacaine hydrochloride 0.5%. Ropivacaine is a long-acting local anesthetic agent that has a greater margin of safety regarding cardiac and central nervous system toxicity than bupivacaine. Although ropivacaine has started to be used in topical anesthesia, it has not yet been used in intracameral anesthesia. Martini et al. reported that topical ropivacaine 1% performed at least as well as lidocaine 4% in cataract surgery. Moreover, it resulted in better subjective pain scores. Ropivacaine takes longer to become completely effective; however, it provides a longer postoperative analgesic effect.Although the higher incidence of corneal edema with ropivacaine may be a concern, the edema resolves rapidly and the medium-term endothelial data indicate that ropivacaine is safe for the endothelium. Therefore, ropivacaine seems to be a good alternative to lidocaine for topical use in cataract surgery. There is concern about the efficacy and safety of this procedure, particularly toxicity to the corneal endothelium. Animal studies are helpful in indicating potential toxicity, but application and relevance to human in vivo conditions is limited. No studies in the literature have investigated the effects of ropivacaine on ocular tissues. We carried out experimental studies on the effects of intracameral irrigation of ropivacaine on the corneal endothelial ultrastructure using transmission electron microscropy (TEM).

Conjunctival Inverted Follicular Keratosis : A Case Report

BackgroundWe report a case of inverted follicular keratosis (IFK) on the conjunctiva. A few cases of IFK have been reported in the literature, but it appears that IFK on the conjunctiva has never been reported.CaseA 21-year-old man was referred for evaluation of a conjunctival mass.ObservationsBy slit-lamp biomicroscopy, an 8 × 5 × 3 mm mass was observed over the nasal conjunctiva adjacent to the limbus in the left eye. An excisional biopsy of the lesion was carried out. The results of a pathologic examination showed IFK. During the 9-month follow-up period, the patient had no recurrence of the lesion.ConclusionIFK can be considered in the differential diagnosis of conjunctival masses as a rare specific lesion.

Evaluation of early results of quick-chop phacoemulsification in the patients with high myopic cataract

AIM To assess the early surgical outcomes of quick-chop phacoemulsification technique in patients with high myopia. METHODS The data of patients with high myopia who underwent quick-chop phacoemulsification were reviewed retrospectively. There were 42 eyes of 31 patients. The axial length was more than 26 mm in all eyes. All eyes underwent quick-chop phacoemulsification surgery with the placement of an intraocular lens (IOL) in the capsular bag. Postoperative visits were performed at 1, 3d; 2wk, 1mo. Early postoperative best corrected visual acuity (BCVA), preoperative and postoperative corneal endothelial cell density (ECD), central corneal thickness (CCT) and postoperative complications were assessed. Paired sample t-test or Wilcoxon tests were used to compare data between preoperative and postoperative data. RESULTS There was no statistically significant difference between preoperative and postoperative ECD and CCT. Retinal detachment was developed in one eye at postoperative first day. There was an iris prolapsus from side port insicion. CONCLUSION Quick-chop phacoemulsification technique is a safe surgical technique. However we can encounter some complications in high myopic eyes due to histopathological differences. Both side port and clear corneal tunnel insicion size is crucial for preventing postoperative complications. If any persistent leakage is noticed, suture should be placed.