Suat Hayri Ugurbas

Adjunctive use of mitomycin C on endoscopic lacrimal surgery.

AIMS Endoscopic endonasal dacryocystorhinostomy (DCR) has some advantages over external DCR as a less invasive method with no skin incisions. But the success rate of the operation has not reached the level of external method. In this study, a wound healing inhibitor mitomycin C was used intraoperatively to prevent the closure of the osteum after the operation. METHODS Endoscopic endonasal DCR was performed on 40 eyes of 39 patients (26 female, 13 male). Mitomycin C was applied to the ostium in 14 of 23 patients who had undergone primary endoscopic DCR by means of a microdrill and in eight of 17 patients who had a revision endoscopic DCR secondary to a previously failed external DCR. RESULTS The postoperative follow up period was 9–27 (mean 18.2) months. The success rate of endoscopic DCR with intraoperative mitomycin C was 77.3%, whereas the success rate of endoscopic DCR without mitomycin C was 77.8%. The statistical analysis did not show a difference between the two groups according to the ostium size and their success rates. CONCLUSIONS Adjunctive use of a wound healing inhibitor is considered to increase the success rate of endoscopic endonasal DCR. Its intraoperative use seems to be easy and safe. But the study of this limited series shows no benefit in using it.

Retinal nerve fibre layer measurements are reduced in patients with obstructive sleep apnoea syndrome.

PurposeTo determine the retinal nerve fibre layer (RNFL) thickness in patients with obstructive sleep apnoea syndrome (OSAS) in order to investigate the possibility of detecting early signs of glaucoma in this population.MethodsA total of 66 consecutive patients admitted for polysomnographic evaluation of suspected OSAS. Patients underwent an overnight sleep study in an effort to diagnose and determine the severity of OSAS. Patients who had the disease were classified as having mild and severe OSAS, while patients who did not have the disease were classified as controls. All patients received physical, neurological, and ophthalmological evaluation including visual acuity, slit-lamp examination, Goldmann applanation tonometry, gonioscopy with a three mirror contact lens, and fundus examination. After these examinations, patients with glaucoma and patients who had ophthalmological and/or systemic disease known to affect RNFL thickness were excluded from the study. The RNFL thickness was assessed with a scanning laser polarimeter (Nerve Fiber Analyzer GDx, Laser Diagnostic Technologies Inc., San Diego, CA, USA).ResultsA total of 34 patients with obstructive sleep apnoea (19 mild, 15 severe) and 20 age-matched controls were included in the study. The thickness of RNFL was reduced in patients with OSAS compared to controls. The decrease in RNFL was found to be correlated with the severity of sleep apnoea (r=0.78, P=0.01).ConclusionsThe sleep apnoea syndrome is correlated with a proportional decrease in the RNFL. Decreased ocular perfusion related to hypoxia and vasospasm associated with OSAS may cause RNFL thinning, which may precede clinically detectable glaucoma.

Histopathologic Effects of Mitomycin-C on Endoscopic Transnasal Dacryocystorhinostomy

BACKGROUND AND OBJECTIVES The antimetabolite mitomycin-C is now being used in endoscopic transnasal dacryocystorhinostomies to prevent the closure of osteotomies. PATIENTS AND METHODS A 0.5-mg/ml solution of mitomycin-C was applied to the osteotomy site for 2 1/2 minutes intraoperatively. Specimens from four patients were collected during surgery and at 15 days, 1 months, 3 months, and 6 months after surgery. The specimens were examined under light and electron transmission microscopy and were compared with control specimens. RESULTS Light microscopy showed attenuated epithelium with intracytoplasmic vacuoles. Subepithelial connective tissue was looser and hypocellular. Electron microscopy confirmed these findings and demonstrated swelling of mitochondria, dilatation of endoplasmic reticulum, and chromatin-dense granules in nuclei of fibroblasts. CONCLUSION By causing a decrease in density and cellularity of mucosa, topical use of mitomycin-C may enhance the success of surgery; however, further studies are necessary to determine the ultimate potential of this agent for this procedure.

Comparing techniques for pterygium surgery

Purpose: To compare various techniques of pterygium surgery including bare sclera, intraoperative mitomycin C application, conjunctival flap reconstruction, and conjunctival autografting technique. Methods: This study is designed to compare 4 currently used techniques in order to determine the complication and recurrence rates after pterygium exision. Included in the study were 77 eyes from 60 patients. Bare sclera technique was used to treat 21 primary pterygia;mitomycin C was used to treat 20 (16 primary, 4 recurrent) pterygia;18 (17 primary, 1 recurrent) pterygia were treated by conjuntival flap reconstruction;and 18 (9 primary, 9 recurrent) pterygia were treated by conjunctival autografting technique. All patients who underwent surgery were followed up for between 6 months and 2 years. Results: Eight recurrences (38.09%) were observed in the bare sclera group whereas there were 5 (25%) recurrences in the mitomycin C group. In the conjunctival flap reconstruction group, 6 (33.33%) recurrences were detected. In the conjunctival autografting group, 3 recurrences were observed. There were no major complications threatening visual ability in the surgical patients. Conclusion: A comparison of the groups demonstrated that the recurrence rate was highest in the bare sclera group, and lowest in conjunctival autografting and mitomycin C treatment groups respectively. Although the conjunctival autografting technique is a more difficult and time consuming technique than the others, cosmetic and surgical results were found to be superior. We advise conjunctival autografting for the treatment of pterygium in view of the high recurrence rates of other techniques, and the possible complications of mitomycin C treatment for benign disease.

Corneal topography in patients with congenital ptosis

Purpose To determine the effect of congenital ptosis on corneal shape, and to assess the role of these topographic changes in the development of amblyopia.Methods Twenty-two patients with congenital ptosis were examined and a corneal topographic examination performed in both the ptotic and normal eyes. The qualitative corneal classification was done according to the colour-coded topographic maps. The surface regularity index (SRI) and the surface asymmetry index (SAI) were used as quantitative descriptors of the study.Results Ptotic eyes had an increased incidence of astigmatism, bow tie pattern on corneal topography, corneal asymmetry (SAI, p < 0.05) and corneal irregularity (SRI, p < 0.05). Lack of mirror-image symmetry with the fellow eye was higher in amblyopic eyes.Conclusion Eyes with congenital ptosis have an increased incidence of astigmatism and a bow tie pattern on corneal topography. These features are associated with the presence of amblyopia.

The course of corneal and intraocular pressure changes during pregnancy

OBJECTIVE To determine concurrent changes in corneal thickness, intraocular pressure (IOP), and corneal topography measurements during normal pregnancy. DESIGN Prospective cohort study. PARTICIPANTS We studied 50 eyes from 25 healthy women whose ages ranged from 21 to 35 years and who were first seen during the 10th week of pregnancy. METHODS Measurements included IOP (noncontact tonometry); corneal thickness (ultrasound pachymetry); and corneal topography (TMS 2N, TOMEY, Nagoya, Japan). Changes in IOP, central corneal thickness (CCT), and corneal power were calculated at 4 time periods: first trimester, second trimester, third trimester, and 3 months postpartum. RESULTS The mean IOPs in the second and third trimesters of pregnancy were found to be lower than those in the first trimester and at 3 months postpartum (p = 0.001). The mean CCT in the second and third trimester of pregnancy was measured to be higher than in the first trimester and at 3 months postpartum (p < 0.001). Both IOP and CCT returned to first-trimester levels following delivery. In the third trimester, a 3.1% increase in CCT was associated with a 9.5 % decrease in IOP. Topographic measurements did not show statistically significant changes throughout the trimesters or after pregnancy. CONCLUSIONS An increase in CCT was accompanied by a decrease in IOP in the second and third trimesters. Physiologic changes occurring in CCT and IOP should be considered in the management of glaucoma during pregnancy.

Tear Film Osmolarity in Patients with Diabetes Mellitus

Purpose: To compare tear film osmolarity (TFO) between patients with diabetes mellitus (DM) and normal healthy individuals. Methods: In this prospective case-controlled study, the TFO in 46 normal subjects (control group) and 55 patients with DM (study group) was evaluated. TFO in milliosmole (mOsm) was measured by using an auto-osmometer. The serum levels of glycosylated hemoglobin (HbA1c) and blood glucose in all participants were also measured. Mean outcome measures were TFO and its relationship with HbA1c level and duration of DM. Results: Mean TFO was 320.40 ± 21.80 mOsm/l in the study group and 308.22 ± 18.16 mOsm/l in the control group (p < 0.001). The TFO values were significantly associated with duration of DM (r = 0.476, p < 0.001), but no significant correlation was found with HbA1c level (r = 0.225, p = 0.114). Conclusions: The study shows a significantly higher TFO in patients with DM than in the healthy controls. TFO also correlates with the duration of DM.

Validation of plusoptiX S04 photoscreener as a vision screening tool in children with intellectual disability

PURPOSE Intellectual disability (ID) is a major public health issue, affecting more than 1% of children worldwide. Pediatric vision screening using standard eye charts may be challenging for children with ID, who may benefit from a quick noninvasive vision screening tool. This study evaluated the accuracy of plusoptiX S04 (Plusoptix Gmbh, Nuremberg, Germany) in detecting amblyopia risk factors in children with ID. METHODS Children diagnosed with ID according to age-appropriate psychological tests were examined consecutively. Vision screening was performed using the plusoptiX S04 prior to complete ophthalmological examination, including cycloplegic refraction. Pass/refer screening results was compared with findings of ophthalmological examination. Amblyogenic risk factors were defined according to American Association for Pediatric Ophthalmology and Strabismus referral criteria. RESULTS A total of 182 infants and children were examined. Only 3% of children were uncooperative for screening. Ophthalmological examination detected amblyogenic risk factors in 32% of patients. The sensitivity of plusoptiX S04 was 95% (95% CI, 85.6%-98.9%), and specificity was 50% (95% CI, 40.8%-59.1%). The positive predictive value was 47% (95% CI, 37.7%-56.4%) and the negative predictive value was 95.4% (95% CI, 87.1%-99.1%). CONCLUSIONS High sensitivity and negative predictive values suggest that the plusoptiX S04 will detect most children with ID who have amblyogenic risk factors, but one-half of all children referred will have no risk factors.

Effects of a new hemostatic agent Ankaferd Blood Stopper® on the intraocular tissues in rat model

Purpose: To investigate the histopathological changes due to administration of Ankaferd Blood Stopper® (ABS) into intraocular tissues by an anterior chamber and intravitreal injections. Methods: Twenty Wistar albino rats were divided into four equal groups. Group 1 was injected 0.01 mL ABS into anterior chamber. Group 2 was injected intravitreal 0.02 mL ABS. Groups 3 and 4, which were used as controls, were injected into the anterior chamber and intravitreal 0.01 mL and 0.02 mL balanced salt solution (BSS), respectively. At 2, 5, 10, 15 and 20 days after injection, the eyes were examined under an operating microscope and were subsequently enucleated for histopathological examination. Results: Ophthalmic examination of the rats prior to enucleation revealed ocular complications ranging from conjunctival hyperemia to corneal perforation in group 1 and increased conjunctival hyperemia and discharge in group 2. No physical and histopathological anomalies were detected in groups 3 and 4. All eyes in group 1 showed mixed type inflammatory cell reaction, foreign-body reaction, stromal congestion, disintegration of the collagen fibers and loss of the epithelium of the posterior wall in the iris and ciliary body were observed histopathologically. All eyes in group 2 showed disintegration and separation of the retina, brown pigment accumulation and mixed type inflammatory cell reaction. Conclusion: Our results indicate that the commercially available form of ABS solution exerts a toxic effect on intraocular tissues. We consider that the intraocular use of different concentrations, rather than multiple time point of ABS should be investigated.

Effects of the folk medicinal plant extract Ankaferd Blood Stopper® on the ocular surface

Purpose: To investigate the effects of Ankaferd Blood Stopper® (ABS) on the ocular surface. Methods: Twenty adult male Wistar albino rats, weighing 390–530 g, were used in this prospective, controlled trial. One drop of ABS and one drop of balanced salt solution (BSS) were instilled into the lower conjunctival sac of the right and left eyes, respectively. After the rats were anesthetized, the ocular surface was evaluated based on the Draize criteria, and fluorescein tests were performed at 1, 2, 4, 18, 24, and 48 h. Subsequently, the rats were killed and all eyes were enucleated for histopathological examination. Results: The outcome of the Draize and fluorescein tests revealed that ABS caused more irritation of the ocular surface than BSS (P < 0.001). The highest mean ABS score was 4.9 for the Draize test and 0.4 for the fluorescein test, and ABS was considered to be a slight irritant. Histopathological examinations of the cornea and the conjunctiva revealed no significant difference between the eyes instilled with BSS and those instilled with ABS. Conclusions: ABS is a hemostatic drug that exerts a slight toxic effect on the ocular surface. Given its ease of use and antibacterial activity, as well as its efficiency in stopping bleeding, the use of ABS during ocular surgery should be further investigated in experimental and clinical studies.