Tansu Gönen

Comparison of Keratometric Data Obtained by Automated Keratometer, Dicon CT 200, Allegro Topolyzer, and Pentacam

PURPOSE To compare the keratometric values measured by the automated keratometer, two Placido-based computerized topography systems (Dicon CT 200 [Vismed Inc] and Allegro Topolyzer [WaveLight Inc]), and Scheimpflug analysis (Pentacam [Oculus Optikgeräte GmbH]). METHODS The keratometric data of 200 eyes from 200 patients evaluated for refractive surgery were reviewed retrospectively. Mean simulated keratometry (Sim K) and mean corneal astigmatism measured by the four devices were compared using repeated measures analysis of variance with Bonferroni correction. The analysis of agreement between two measurements was assessed using the method of Bland and Altman. RESULTS Mean Sim K as measured by the automated keratometer, Dicon CT 200, Allegro Topolyzer, and Pentacam was 43.39±1.50 diopters (D), 43.55±1.50 D, 43.45±1.50 D, and 43.43±1.45 D, respectively. The Dicon CT 200 measured the mean Sim K to be steeper and the automated keratometer measured the mean Sim K to be flatter than the other devices. Significant differences in corneal astigmatism were noted among the four devices except Dicon CT 200 versus Allegro Topolyzer and Allegro Topolyzer versus Pentacam comparisons (P<.013). For mean Sim K, the 95% limits of agreement between the Pentacam and other three devices were significantly wider than the other comparisons. In Bland-Altman plots comparing the Pentacam to the other devices, extreme outliers were present in 11 (5.5%) eyes. CONCLUSIONS Because of the wide distribution range and presence of extreme outliers, Pentacam data should be used cautiously in IOL power calculation and astigmatic keratotomy procedures.

Posttraumatic subperiosteal hematomas of the orbit in children.

Purpose: To describe 5 pediatric patients with traumatic orbital subperiosteal hematoma and review the relevant literature. Methods: Retrospective chart analysis of 5 children with posttraumatic subperiosteal hematoma and a systematic review of the English language literature. Results: Five new pediatric cases of orbital subperiosteal hematoma are presented with varying clinical and radiologic manifestations and treatments. Literature review (including the current 5 cases) yielded 23 cases in total. Eighteen (78%) of the patients were boys, and 5 (22%) were girls. The children ranged in age from 5 to 17 years, with the mean and median ages being 12 years. The leading cause was blunt trauma related to falls or direct impact. Two patients (9%) had an inherited coagulopathy, predisposing them to orbital hemorrhage. The hematomas developed in the superior orbit in all cases except one. In 3 patients (13%), orbital hematomas were bilateral. In 9 patients (39%), the hematomas extended in subgaleal or frontal subdural spaces. In 7 patients (30%), subperiosteal hematoma was associated with compressive optic neuropathy. Four patients (17%) had a nondisplaced orbital roof fracture. Seventeen patients were treated with surgical evacuation of hematoma (52%) or with needle aspiration (22%), and 5 patients (22%) were observed for spontaneous resolution. Three patients (13%) experienced a recurrence of hemorrhage. Conclusions: In children, traumatic subperiosteal hematomas of the orbit typically occur after blunt trauma in the superior orbit. The risk of compressive optic neuropathy may be higher in patients with bilateral hematoma and massive subgaleal hematoma. Most patients are treated with evacuation of the hematoma.

Comparison of visual acuity, refractive results and complications of femtosecond laser with mechanical microkeratome in LASIK.

AIM To compare the outcomes of laser in situ keratomileusis (LASIK) performed with a femtosecond laser (Femtec, Technolas Perfect Vision GmbH, Germany) versus a mechanical microkeratome (Hansatome, Bausch and Lomb, USA) for the correction of myopia and astigmatism. METHODS In this retrospective study, patients who had undergone LASIK using the 80-kHz Femtec femtosecond laser were compared to age- and refraction-matched patients in whom the Hansatome microkeratome was used. Refractive and visual results 1 month and 3 months postoperatively, and complication rates were compared between the two groups. RESULTS A total of 280 eyes were analyzed (140 in each group). At 3 months postoperatively in the Femtec vs Hansatome group, spherical equivalent refraction was within ±1.00D of emmetropia in 140 vs 138 eyes (P=0.498), the cylinder was within ±0.50D in 137 vs 139 eyes (P=0.622), and the UDVA was 20/20 or better in 136 vs 137 eyes (P=0.724), respectively. There was no statistically significant difference in the complication rates between the two groups (P=0.099). CONCLUSION LASIK performed both with Femtec femtosecond laser and Hansatome microkeratome achieved satisfactory refractive and visual results at 3 months postoperatively, without significant differences in efficacy, safety, and complication rates between the two procedures.

Intravitreal tigecycline treatment in experimental Acinetobacter baumannii endophthalmitis.

Abstract Purpose: To investigate the clinical and microbiological effectivity of intravitreal tigecycline in an experimental rabbit endophthalmitis model caused by imipenem resistant Acinetobacter baumannii. Materials and Methods: Forty-eight eyes of 24 New Zealand white albino rabbits were divided into six groups (n = 8 in each). The right eyes were divided into three groups and defined as infected group; left eyes were divided into three groups and defined as uninfected group. Infected group received 0·1 ml intravitreal A. baumannii suspension. Twenty-four hours after bacterial inoculation, group 1 received 1 mg/0·1 ml tigecycline and group 2 received 0·5 mg/0·1 ml tigecycline. Group 3 eyes received no treatment. In group 4, 0·1 ml of saline solution was injected. Groups 5 and 6 were received intravitreal tigecycline injection of 1 mg/0·1 ml and 0·5 mg/0·1 ml respectively. The eyes were enucleated for histopathological evaluation on the sixth day. Clinical and histological scoring systems were used to evaluate clinical and histological severity of the intraocular infection. Results: The mean clinical scores of the six groups at the sixth day were 11±1·92, 12·4±6·2, 8·5±2·7, 0, 3±1·3, and 3±1·4 respectively. Mean histopathological scores were 7·8±2·8, 7·0±1·5, 5·6±1·4, 0, 0, and 0 respectively. There was no significant difference in mean clinical and histopathological scores of infected group (groups 1, 2 and 3). There was significant difference in mean clinical scores of groups 5 and 6 compared with group 4. Groups 4, 5 and 6 showed normal histological structure in histopathological evaluation and showed no significant difference. Microbiological cure was achieved in all infected eyes. Conclusions: Experimental rabbit endophthalmitis model caused by imipenem resistant A. baumannii was microbiologically cured by intravitreal tigecycline injection. However, a hypersensitivity-like reaction due to intravitreal application of tigecycline limits the use of this antimicrobial agent in A. baumannii endophthalmitis.

Reply: Gas-forced infusion prevents endothelial cell loss in phacoemulsification.

Gas-forced infusion prevents endothelial cell loss in phacoemulsification In their recent study comparing endothelial cell loss in longitudinal and torsional biaxial smallincision phacoemulsification techniques, Gonen et al. found no significant difference between the 2 techniques. In this context, we would like the authors to clarify whether gas-forced infusion (air pump) was an option in any of these eyes during surgery. The use of gas-forced infusion prevents endothelial cell loss by decreasing the intraoperative surge. A gas-forced infusion system is connected through a nitrocellulose membrane air filter to the infusion fluid bottle. The air filter prevents contaminants in the operating room air from entering the eye. The air pump produces a positive pressure head above the fluid in the bottle, significantly increasing the amount of fluid entering the eye and balancing the excess outflow occurring when the occlusion is broken. It also blunts the fluctuations in intraocular pressure. In our prospective study of gas-forced infusion in longitudinal phacoemulsification, we noted that the mean endothelial cell loss was lower in the infusion group than in the control group (6.98% G 8.46% [SD] versus 10.54% G 11.24%, PZ.045). Gonen et al. used a 19-gauge irrigating chopper for irrigation and a 20-gauge phaco tip for aspiration. The intraoperative vacuum was set at 250 mm Hg and the flow rate at 30 mL/min. However, despite the claimed anterior chamber stability, the endothelial cell loss exceeded 35% in both groups. In our study, the cell loss was 6.98% G 8.46% in eyes that had phacoemulsification with gas-forced infusion but 10.54% G 11.24% in eyes without gas-forced infusion. Gonen et al. should have calculated the incidence of intraoperative surge, which can affect the endothelial loss. From our experience with phakonit, we noted that an air pump deepens the anterior chamber, increasing the surgical space available for maneuvering, and thus prevents complications such as posterior capsule tears and corneal endothelial damage. The phenomenon of surge is neutralized by rapid inflow of fluid at the time of occlusion break. The irrigating chopper and the bimanual irrigation/aspiration of a 22-gauge will provide better chamber stability. In our analysis of wound architecture, we noted that good endothelial alignment was seen in eyes with microphakonit (with gas-forced infusion) as early as 3 days postoperatively. We would like to recommend the use of air-forced infusion during phacoemulsification. A built-in device for pressurized infusion has been adapted in various phacoemulsification systems.

Basal Cell Carcinoma in a Full-Thickness Skin Graft in the Upper Eyelid

A 75-year-old woman presented with a nodular lesion on a skin graft in her left upper eyelid. The lesion had grown gradually over the previous 2 years. She had undergone multiple surgeries and full-thickness skin graft procedures 61 years previously, because of cutaneous leishmaniasis. The diagnosis of nodular basal cell carcinoma was made by means of an excisional biopsy of the lesion. During a follow-up period of 27 months, the tumor did not recur. Malignant tumors may rarely develop at the site of traumatic or surgical scar. To our knowledge, this is the first reported case of basal cell carcinoma arising in a skin graft in the eyelid.

External Orbitotomy in Subperiosteal Abscess of the Orbit

Yaz›flma Adresi/Address for Correspondence: Dr. Bülent Yaz›c›, Uluda¤ Üniversitesi T›p Fakültesi, Göz Hastal›klar› Anabilim Dal›, Görükle, 16059, Bursa, Türkiye Tel.: +90 224 295 24 15 Gsm: +90 532 472 20 97 E-posta: byazici@uludag.edu.tr Gelifl Tarihi/Received: 07.08.2010 Kabul Tarihi/Accepted: 26.10.2010 Özet Amaç: Orbital subperiostal absesi bulunan ve cilt kesisi yoluyla orbitotomi ve abse boflalt›m› yap›lan hastalarda muayene bulgular› ve tedavi sonuçlar›n› gözden geçirmek. Gereç ve Yöntem: Ocak 1998 Aral›k 2009 aras›nda orbita subperiostal absesi nedeniyle ameliyat edilen 17 hastan›n kay›tlar› gözden geçirildi. Derlenen veriler, hasta yafl›, cinsiyeti, klinik muayene ve radyolojik inceleme bulgular›, mikrobiyolojik inceleme sonuçlar›, tedavi yöntemleri ve izlem süresini içerdi. Sonuçlar: Onbir hasta erkek, 6 hasta kad›nd›; ortalama hasta yafl› 22 y›ld› (veri aral›¤›: 5-74 y›l). Onüç hasta (%76) 9 yafl›ndan büyüktü. Subperiostal abse 14 hastada (%82) paranazal sinüzite, 3 hastada (%18) orbita travmas›na ba¤l› olarak geliflmiflti. Abse 10 hastada (%59) üst, 3 hastada (%18) iç, 4 hastada (%23) üst ve iç orbitada yerleflikti. Onbefl hastada (%88) relatif afferent pupilla defekti pozitifti. Radyolojik inceleme iki hastada (%13) kafaiçi abse varl›¤›n› gösterdi. Cerrahi tedavi 17 hastada (%100) orbitotomi ve abse drenaj›n›, 4 hastada (%23) anterior etmoidektomiyi içerdi. Bir hastaya kranyotomi yoluyla intrakranyal abse boflalt›m› yap›ld›. ‹ntraoperatif kültür sonuçlar› 17 hastan›n 6s›nda (%35) pozitifti. Bir hastada (%6) abse nüksü ve kal›c› görme kayb› geliflti. Postoperatif izlem süresi 3 ile 14 ay aras›nda de¤iflti (ortalama 5,5 ay). Tart›flma: Orbitan›n subperiostal abseleri optik nöropati ve kafaiçi enfeksiyona yolaçabilir ve cerrahi tedavi gerektirebilir. Eksternal orbitotomi yoluyla abse boflalt›m› orbital belirti ve görsel ifllevlerde h›zl› ve tam bir iyileflme sa¤lar. (Turk J Ophthalmol 2011; 41: 16-21) Anahtar Kelimeler: Orbita, subperiosteal abse, eksternal orbitotomi

Suborbicularis Oculi Fat (SOOF) Lift in Patients with Facial Paralysis: Surgical Results

Amaç: Fasiyal paralizili hastalarda, orbiküler kas alt› ya¤ paketi yükseltme (“SOOF lift”) ameliyat›n›n sonuçlar›n› de¤erlendirmek. Gereç ve Yöntem: Ocak 2000-Nisan 2007 tarihleri aras›nda kronik fasiyal paralizi nedeniyle tek tarafl› “SOOF lift” ameliyat› geçiren 12 hastan›n (7 erkek, 5 kad›n; yafl aral›¤›: 49-67 y›l) kay›tlar› gözden geçirildi. Preoperatif muayene bulgular›, lagoftalmi miktar›, cerrahi teknik, komplikasyonlar, ameliyat sonuçlar›, ikincil cerrahi gereksinimi ve izlem süresi kaydedildi. Sonuçlar: Ameliyattan önce hastalar›n 6 mm ile 13 mm aras›nda de¤iflen (ortalama: 9 mm) lagoftalmisi vard›. “SOOF lift” ifllemi 8 gözde transkonjonktival, 4 gözde subsilyer yaklafl›mla gerçeklefltirildi. Bu ifllem tüm hastalarda lateral kantal ask› ifllemiyle birlikte uyguland›. Ameliyattan sonra erken dönemde, tüm hastalarda, alt gözkapa¤› pozisyonu ve yanak ptozisinde düzelme gözlendi. Lagoftalmi miktar› 3 ile 9 mm aras›nda azald› (ortalama: 5 mm). Yanak konumundaki düzelme biri d›fl›nda tüm hastalarda son muayeneye de¤in sürdü. Bafll›ca ameliyat komplikasyonlar› periorbital hematom (1 hasta) ve cilt alt› sütür granülomuydu (1 hasta). Hiçbir hastada infraorbital sinir hipoestezisi veya nüks alt gözkapa¤› sark›kl›¤› geliflmedi. Ortalama izlem süresi 13 ayd› (1 ile 46 ay aras›nda). Tart›flma: “SOOF lift” ifllemi, kronik fasiyal paralizili hastalarda yanak ptozisi, alt gözkapa¤› retraksiyonu ve lagoftalminin düzeltilmesine önemli bir katk›da bulunur. (TOD Dergisi 2010; 40: 130-4) Anahtar Kelimeler: Fasiyal paralizi, orbiküler kas alt› ya¤ paketi yükseltme