Tugba Goncu

Improvement in levator function after anterior levator resection for the treatment of congenital ptosis.

Purpose: To evaluate the surgical outcome of levator resection in congenital ptosis, and to assess the change in levator function (LF) after surgery, as well as its effect on surgical outcomes. Methods: The charts of patients who underwent an anterior levator resection for congenital ptosis between January 2010 and February 2013 were retrospectively reviewed. Preoperative and postoperative grades of blepharoptosis, margin-reflex distance, LF, and reoperation status were noted, and postoperative outcomes were evaluated. Results: A total of 42 eyelids of 37 patients were included of which 32 eyelids (76.2%) had severe ptosis while 10 eyelids (23.8%) had moderate ptosis. The mean follow up was 11.0 ± 7.2 months. The overall success rate after initial surgery was 78.6%, and undercorrection was the leading course of surgical failure, with a rate of 14.3% (6 eyelids) at the final visit. Lagophthalmus and/or overcorrection occurred in 7.1% (3 eyelids) at the final visit, respectively. The mean preoperative LF was 6.8 mm ± 3.1 mm, which increased postoperatively to 8.7 mm ± 3.4 mm (p < 0.05) at month 1 and 9.6 mm ± 3.8 mm (p < 0.05) at the final visit. The mean LF improvement following surgery was 2.9 mm ± 2.2 mm. Conclusions: The levator resection surgery was observed to be an effective treatment for congenital ptosis, including severe ptosis with poor LF. Levator resection resulted in substantial improvement of postoperative levator muscle functioning, which might have an additive effect on the surgical success, especially for those with poor LF.

Severe eyelid injury resulting from necrotic arachnidism in a child with leukemia.

Loxosceles spider envenomation, which is termed loxoscelism, has clinical presentations that vary from local cutaneous inflammation and necrosis to systemic loxoscelism, and may even result in death. Loxosceles species are responsible for cases of clinically significant envenomation worldwide, although these cases occur predominantly in the temperate zones. Loxosceles reclusa is reported to be endemic in the United States, and L. rufescens is indigenous to the Mediterranean region of Europe, as well as Africa and Asia. Furthermore, there is a peak of Loxosceles activity during the summer months and little activity during the winter months. Typically, a bite from the spider begins as an enlarging area of pallor with peripheral erythema, which may become larger with surrounding severe edema and erythema. The characteristic necrotic ulcer often appears later in the course of envenomation. Diagnosis is generally based on the morphologic appearance of the dermal lesion. We report a unique case of a 5-year-old female with loxoscelism who was in remission from acute lymphoblastic leukemia. She showed a severe necrotic ulcer on the upper eyelid, which resulted in a full-thickness tissue defect. We discuss the surgical management of this case. A 5-year-old female presented with erythema and severe edema of the left periorbital area accompanying ipsilateral hemifacial edema. The family reported that there was an erythematosus, tender, spotlike lesion on her upper eyelid, which enlarged dramatically over 2 days. We also learned from her medical history that the girl was in remission for acute lymphoblastic leukemia for a period of 1 year after undergoing the St. Jude Total XV chemotherapy protocol. Her vital signs were arterial blood pressure, 90/50 mm Hg; body temperature, 38.91C; pulse rate, 130 beats/min; respiratory rate, 32 breaths/min; and oxygen saturation, 98%. She had a patchy erythematous induration involving the entire eyelid of the left eye. The anterior segment structures were unremarkable. Systemic examination produced no noteworthy signs. Laboratory evaluation revealed a low white blood cell count of 0.7 10/L (neutrophils, 1.1%; lymphocytes, 55%; monocytes, 43%; eosinophils, 0.3%). The patient had a normal hematocrit of 29% and a hemoglobin concentration of 9.4 g/dL. Prothrombin time was 104 seconds, and the international normalized ratio was 0.97. The results of urinalysis were unremarkable. Orbital magnetic resonance imaging revealed soft tissue thickening. Whereas the blood cultures remained negative, culturing of wound swabs revealed the presence of Streptococcus epidermidis. As the patient was considered to have febrile neutropenia with preseptal cellulitis, she received intravenous therapy with meropenem, vancomycin, and metronidazole. However, on day 5 after admission, it was noted that the lesion on the upper eyelid had changed to a black, necrotic, crusty plaque (Fig. 1). After a meticulous

Evaluation of resistive index using color Doppler imaging of orbital arteries in geriatric patients with hypertension

Background and Aim: Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage in ophthalmologic disease. The purpose of this study was to evaluate the association between RI values of orbital arteries using the color Doppler imaging (CDI) in geriatric hypertensive patients with or without retinopathy. Setting and Design: Designed as a cross-sectional study. Materials and Methods: We evaluated 60 geriatric patients with hypertension (Group 1) and 30 healthy subjects (Group 2). Further, the patients with hypertension were grouped into two: Group 1a consisted of patients with retinopathy (n = 30), and group 1b consisted of patients without retinopathy (n = 30). The mean RI values of ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) were measured using CDI. Results: Compared to group 2, group 1 had significantly higher mean resistive index of PCA levels (P = 0.017), whereas there were no statistical difference in mean resistive indexes of OA and CRA (both P > 0.05). Besides, there were no statistical difference in mean resistive indexes of OA, CRA, and PCA between the group 1a and group 1b (P > 0.05 for all). Mean resistive indexes of OA, CRA, and PCA were significantly correlated with the duration of hypertension (r = 0.268, P = 0.038; r = 0.315, P = 0.014; r = 0.324, P = 0.012, respectively). Conclusions: Our study indicates that RI might be a useful marker for the ocular hemodynamic of retinal vessels, provides morphologic and vascular information in hypertension and hypertensive retinopathy.

The role of intraoperative bevacizumab for prevention of postoperative vitreous hemorrhage in diabetic vitreous hemorrhage.

Purpose To assess the effect of intravitreal bevacizumab (IVB) on the incidence of postoperative recurrent vitreous hemorrhage (VH) in eyes operated for diabetic VH when injected at the end of the surgery. Methods A prospective, comparative clinical trial was conducted on a consecutive series of patients requiring vitrectomy for diabetic nonclearing VH. Intravitreal bevacizumab (2.5 mg/0.1 mL) was injected at the completion of surgery. Patients underwent best-corrected visual acuity (VA), applanation tonometry, and biomicroscopic anterior and posterior segment evaluation for VH grading. Postoperative visits were performed at the first day, first week, first month, third month, and sixth month. The VH was graded at each visit, and the rate of postoperative VH and VA improvement and potential complications were evaluated and compared between the groups. Results A total of 72 eyes of 66 patients were included. Thirty-four eyes were enrolled in the IVB group and 38 eyes were enrolled in the control group. The rate of postoperative VH did not differ significantly between the groups at any postoperative visit (p>0.05). Three eyes (8.8%) in the IVB group and 5 eyes (13.1%) in the control group had postoperative VH throughout the follow-up period and only one eye from each group underwent a second surgery. Postoperative VA significantly increased in both groups but did not differ significantly between the groups at any postoperative visit (p>0.05). Conclusions Intravitreal bevacizumab does not seem to have any beneficial effect on the incidence of postoperative VH in eyes operated for diabetic VH when injected at the end of surgery.

Anti-inflammatory effect of lycopene on endotoxin-induced uveitis in rats

Purpose: We evaluated the efficacy of lycopene, a dietary carotenoid and potent antioxidant, against ocular inflammation and oxidative stress in an experimental uveitis model. Methods: Endotoxin-induced uveitis (EIU) was induced in Sprague-Dawley rats by a single subcutaneous injection of 200 μg lipopolysaccharide (LPS). Induction of EIU was preceded by daily intraperitoneal injection of 10 mg/kg lycopene for three consecutive days (Lycopene + LPS group) or equivolume vehicle (Vehicle + LPS group). A positive control group received 1 mg/kg dexamethasone pretreatment (DEX + LPS), and a negative control group received daily vehicle injection but no LPS (Vehicle Control). Twenty-four hours after LPS or final vehicle administration, eyes were enucleated, and aqueous humor was collected for measurement of the number of infiltrating cells, total protein concentration, and levels of nitric oxide (NO), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and oxidative stress markers. Inflammatory response severity was compared among groups clinically and histopathologically. Results: Infiltrating cell number, total protein concentration, and NO, TNF-α, and IL-6 levels were significantly elevated in the aqueous humor of Vehicle + LPS group rats compared to Vehicle Controls. Compared to the Vehicle + LPS group, lycopene pretreatment significantly reduced aqueous humor concentrations of oxidative stress markers, NO (0.29 ± 0.1 μM vs. 0.19 ± 0.1 μM, p=0.003), TNF-α (71.0 ± 22.3 ng/ml vs. 50.1 ± 2.1 ng/ml, p=0.043), and IL-6 (121.6 ± 3.0 pg/ml vs. 111.1 ± 5.6 pg/ml, p=0.008). Inflammatory score was also reduced (2.0 ± 0.0 vs. 0.4 ± 0.5, p=0.001). Lycopene reduced the infiltrating cell count and protein concentration, but differences did not reach significance. Most lycopene effects were equivalent to dexamethasone. Conclusions: Lycopene may aid in the clinical management of uveitis by suppressing inflammation and oxidative stress.

Evaluating the safety of intracameral bevacizumab application using oxidative stress and apoptotic parameters in corneal tissue

AIM To investigate the possible effects of intracameral bevacizumab on oxidative stress parameters and apoptosis in corneal tissue. METHODS In total, 30 rats were assigned randomly into the following three groups of 10 rats each: a sham group (Group 1; n=10), a control group [Group 2; balanced salt solution (BSS) was administered at 0.01 mL; n=10], and a treatment group (Group 3; bevacizumab was administered at 0.25 mg/0.01 mL; n=10). The total antioxidant status (TAS) and the total oxidant status (TOS) in the corneal tissue and blood samples were measured, and the oxidative stress index (OSI) was calculated. Additionally, corneal tissue histopathology was evaluated for caspase-3 and -8 staining and apoptotic activity. RESULTS In the blood samples, the TAS, TOS, and OSI levels were not significantly different (all P>0.05). Compared with the sham and control groups, the TOS and OSI levels in the corneal tissues were significantly different in the bevacizumab group (all P<0.05). No statistically significant differences were observed between the sham and control groups (all P>0.05). However, compared with the sham and control groups, greater immunohistochemical staining for caspases-3 and -8 and an elevated level of apoptotic activity were observed in the bevacizumab group. CONCLUSION This study revealed that intracameral bevacizumab injections seemed to be systemically safe but may have elicited local toxic effects in the corneal tissue, as indicated by the oxidative stress parameters and histopathological evaluations.

Does moxifloxacin alter oxidant status in the cornea? An experimental study

Abstract Objective: In this experimental study, we investigated the possible effects of intracameral moxifloxacin on oxidative stress parameters and endothelial cell morphology in corneal tissue. Methods: In total, 30 rats were randomly assigned to three groups of 10 rats: the sham group (Group 1, n = 10); the control group (Group 2), where balanced salt solution (BSS) was administered at a dose of 0.01 cc (n = 10); and the treatment group (Group 3), where moxifloxacin was administered at a dose of 0.05 mg/0.01 cc (n = 10). Total antioxidant status (TAS) and total oxidant status (TOS) in corneal tissue and blood samples were measured and the oxidative stress index (OSI) was calculated. Also, corneal tissue histopathology was evaluated with caspase-3 and caspase-8 staining. Apoptotic activity was also evaluated. Results: In blood samples, TAS, TOS, and OSI levels were not statistically significantly different (all p > 0.05). Compared with the sham and control groups, TOS and OSI levels in cornea tissue were significantly different in the moxifloxacin group (all p < 0.05). However, compared with the control group, no statistically significant difference was found in the sham group (all p > 0.05). Compared with the sham and control groups, apoptotic activity was higher in the moxifloxacin group, in both immunohistochemical staining for caspase-3 and caspase-8. Conclusions: Intracameral moxifloxacin injection seems to be safe systemically, but it may have toxic effects on corneal tissues, as suggested by oxidative stress parameters and a histopathological evaluation.

Lacrimal gland prolapse in two cases of blepharochalasis syndrome and its treatment

Blepharochalasis is a rare disorder characterized by recurrent non-painful eyelid edema, which leads to atrophy and stretching of the supporting connective tissue around the eye. As a consequence, prolapse of the lacrimal gland can occur which results in fullness in the temporal third of the upper eyelids and may cause visual field restriction or cosmetic blemish for patients. Thus, correct diagnosis is important to plan appropriate surgery and obtain a successful postoperative result. We present two young patients with lacrimal gland prolapse associated with blepharochalasis and report on their treatment.

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.

Evaluation of the safety of intracameral trypan blue injection on corneal tissue using oxidative stress parameters and apoptotic activity: an experimental study

PURPOSE The present experimental study aimed to investigate the effects of intracameral trypan blue (TB) on oxidative stress parameters and apoptosis in corneal tissue. METHODS Thirty rats were randomly assigned to three groups of 10 rats each: the sham group (Group 1); control group (Group 2); and treatment group (Group 3). The control group was administered 0.01 cc of balanced salt solution. The treatment group was administered 0.006 mg/0.01 cc of TB. The total antioxidant status (TAS) and total oxidant status (TOS) in corneal tissue and blood were measured and the oxidative stress index (OSI) was calculated. Finally, corneal tissue histopathology was evaluated using staining for caspase-3 and -8, and apoptotic activity was examined. RESULTS The TAS, TOS and OSI levels in the blood samples were not significantly different (p>0.05 for all). Compared with the sham and control groups, the TOS and OSI levels in corneal tissue were significantly different in the treatment group (p<0.05 for all). No significant difference was observed between the sham group and the control group (p>0.05). Immunohistochemical staining for caspase-3 and caspase-8 demonstrated higher apoptotic activity in the TB group than in the sham and control groups. CONCLUSION The present study showed that intracameral TB injection is safe systematically but may be toxic to corneal tissue, as demonstrated using oxidative stress parameters and histopathological evaluation.