Tugrul Altan

Early postoperative hypotony after 25-gauge sutureless vitrectomy with straight incisions.

Purpose: To evaluate the rate, duration, and associated complications of postoperative hypotony after 25-gauge sutureless vitrectomy. Methods: In a retrospective, interventional, institutional case series, 25-gauge sutureless vitrectomy with straight incisions was performed on 111 eyes. Postoperative intraocular pressure (IOP) was measured routinely at 2 hours, 1 day, 1 week, and 1 month. Postoperative IOP, hypotony (IOP, <8 mmHg) rates, and complications associated with low IOP were assessed to determine outcome. Results: Mean follow-up ± SD was 5.45 ± 3.44 months. Mean IOP decreased significantly by 2 hours and on postoperative day 1 (P < 0.001) and increased to preoperative levels at week 1 (P = 0.48). Postoperative hypotony rates were 26.12%, 17.11%, and 8.10% at 2 hours, 1 day, and 1 week, respectively. The ratio of postoperative vitreous hemorrhage in eyes with and without hypotony on day 1 was 2:6 (P = 0.412). Two eyes with macular holes (MHs) filled inadequately with gas endotamponade that remained hypotonic for the first postoperative week underwent reoperation due to unsealed MHs. Conclusions: Twenty-five–gauge sutureless vitrectomy with straight incisions resulted in a hypotony rate of 26.12% at 2 hours that decreased to 17.11% on day 1 and to 8.10% at week 1 but did not increase the incidence of postoperative complications.

Visual predictive value of the ocular trauma score in children

Background/aims: To analyse the predictive value of ocular trauma score (OTS) in open-globe injuries in children. Methods: Thirty open-globe injuries in children 16 years or younger treated at our facilities were included. OTS variables (visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment and afferent pupillary defect) were determined at the initial presentation and converted into the OTS categories as performed in the OTS Study. The distribution of the percentage of final visual acuity in each category was compared between the OTS study and our study. Results: Compared with the OTS Study, in our group no light perception ratios were lower in the first two categories (p = 0.012, p<0.001, respectively); light perception/hand motion, and 1/100–19/100 ratios were higher in categories 2 and 3 (p<0.001 each), and the 20/200 to 20/50 ratio was lower in categories 3, 4 and 5 (p<0.001, p<0.001, p = 0.028, respectively). The ratio of ⩾20/40 was lower in categories 2 and 3 (p<0.001, each) but higher in category 4 (p<0.001). In this study, the distribution of the percentage of final visual acuity in various OTS categories was found to be different between our study and the OTS study. Conclusion: In the paediatric population, OTS calculations might have limited value as predictors of visual outcome.

Transconjunctival 25-gauge sutureless vitrectomy and silicone oil injection in diabetic tractional retinal detachment.

Purpose: The purpose of this article was to evaluate the outcomes and complications of transconjunctival sutureless 25-gauge vitrectomy using silicone oil tamponade in diabetic tractional retinal detachment. Materials and Methods: Patients were retrospectively evaluated. Main outcome measure was the feasibility of pars plana vitrectomy and silicone oil injection with 25-gauge system in eyes with diabetic tractional retinal detachment. Results: Fourteen eyes of 14 patients were included in the study. Tractional retinal detachment was accompanied by vitreous hemorrhage in 9 eyes and combined traction/rhegmatogenous retinal detachment was present in 1 eye. All patients underwent transconjunctival sutureless 25-gauge vitrectomy and 1,000 centistokes silicone oil injection. Angled insertion of the trocars was made in all eyes. Bimanual surgery was performed in 6 (42.8%) eyes. The median preoperative best-corrected visual acuities were 3.00 logarithm of the minimum angle of resolution; it increased to 1.60 logarithm of the minimum angle of resolution at last visit. Retinal tear formation occurred in 4 (28.5%) eyes. Retinal detachment developed in 2 (14.2%) eyes. Intraocular pressure of 5 mmHg or less was detected in 3 (21.4%) eyes. One patient lost light perception due to anterior hyaloidal fibrovascular proliferation. Conclusion: Pars plana vitrectomy and 1,000 centistokes silicone oil injection with 25-gauge system is feasible in diabetic tractional retinal detachment even in complex cases. Indications of 25-gauge surgery may be expanded toward this area.

Primary 25-gauge sutureless vitrectomy with oblique sclerotomies in pseudophakic retinal detachment.

Purpose: To evaluate the anatomic and functional outcomes of 25-gauge sutureless vitrectomy in primary treatment of noncomplex pseudophakic rhegmatogenous retinal detachments (RRD). Methods: Prospective interventional institutional case series. Twenty-two eyes with pseudophakic RRD with proliferative vitreoretinopathy grade A or B underwent primary 25-gauge vitrectomy with oblique sclerotomies and gas endotamponade. Eyes with minimum follow-up of 6 months were evaluated. Main outcome measures were reattachment rate with single surgery, reoperation, complication rates, and changes in visual acuity (VA). Results: Mean duration of visual loss was 14.68 ± 12.87 days. Seventeen (77.27%) eyes had macular detachment. In all eyes 25-gauge sutureless vitrectomy was completed without complications. The mean follow-up period was 10.40 ± 5.77 months. Retinal attachment was achieved in 21 (95.45%) eyes with single surgery and in all (100%) eyes with second vitrectomy. Mean preoperative VA of 1.61 ± 1.18 improved to 0.50 ± 0.53 at the last visit (P < 0.001). Transient hypotony was detected in 2 (9.09%) eyes with spontaneous resolution. No other postoperative complication was observed. Conclusions: Twenty-five-gauge sutureless vitrectomy with oblique sclerotomies in primary treatment of noncomplex pseudophakic RRDs resulted in reattachment in 95.45% with single surgery, and in 100% with reoperation in one eye, accompanied by an increase in visual acuity in 86% of eyes.

Secondary iris claw intraocular lens implantation for the correction of aphakia after pars plana vitrectomy.

Purpose: The purpose of this study was to evaluate the safety and efficacy of iris claw intraocular lens implantation for correction of aphakia in vitrectomized eyes without capsular support. Methods: This was a prospective interventional case series. Twelve aphakic vitrectomized eyes without capsular support underwent iris claw intraocular lens implantation. The main outcome measures were changes in uncorrected visual acuity, best-corrected visual acuity, spheric equivalent, corneal endothelial cell density, corneal thickness, central macular thickness, and complications. Results: Mean follow-up was 15.58 ± 3.80 months with no intraoperative complications. Postoperatively, uncorrected visual acuity increased significantly at all follow-up visits (P < 0.05). Mean best-corrected visual acuity increased 10 letters/2 lines at the final follow-up visit (P = 0.023). Mean postoperative spheric equivalent at the last visit was −1.68 ± 063 D, and the spheric equivalent was within ±2.00 D of emmetropia in 9 (75%) eyes. Mean central macular thickness increased only at postoperative Month 3 (P = 0.043). Mean endothelial cell density loss was 23.87% at the last visit. Mean corneal thickness did not change during follow-up (P > 0.05). No corneal edema was observed. Complications were transient intraocular pressure increase (n = 1), cystoid macular edema (n = 1), and haptic dislocation replaced by surgery (n = 1). Retinas remained attached in all eyes. Conclusion: Secondary iris claw intraocular lens implantation is clinically safe and effective to correct aphakia in vitrectomized eyes without capsular support. Larger studies with longer follow-up are warranted.

Acute-onset endophthalmitis after cataract surgery: success of initial therapy, visual outcomes, and related factors.

Purpose: To evaluate the success of initial treatment and the factors influencing the outcome in acute-onset endophthalmitis after cataract surgery. Methods: We retrospectively reviewed the medical records of all patients with acute postoperative endophthalmitis between 2000 and 2007. We performed pars plana vitrectomy (PPV) to all eyes with initial visual acuity of light perception. Eyes with visual acuity of hand motions or better underwent either intraocular antibiotic injection (IOAI) or PPV. Eyes that did not give a good clinical response to initial therapy within 60 hours underwent a second procedure. The main outcome measure was the rate of early reintervention after PPV and IOAI. Results: We evaluated 88 eyes of 88 patients. Thirty-seven patients underwent PPV and 51 patients underwent IOAI alone. Six of 37 (16.2%) patients required 1 or more procedures within 60 hours of the initial procedure in the PPV group. Twenty-eight of 51 eyes (54.9%) in the IOAI group underwent PPV within 60 hours. The rate of response to primary PPV was significantly higher than to primary IOAI (P < 0.001). Gram-negative organisms composed 35.1% of the isolates. Conclusion: Pars plana vitrectomy may be preferable to IOAI in postoperative endophthalmitis since the rate of early reintervention is lower with initial PPV.

Hypotonic Maculopathy after Trabeculectomy with Postoperative Use of 5-Fluorouracil

We evaluated two patients who developed hypotonic maculopathy following trabeculectomy and adjunctive 5-fluorouracil injections. Both patients had ocular hypotony and decreased visual acuity following these injections. The first case showed marked choroidal foldings, retinal striae, increased retinal vascular tortuosity, engorgement and optic disc oedema. The second case had radial perifoveal retinal striae, increased retinal vascular tortuosity and engorgement. The first patient regained pre-operative visual acuity while the second case had a visual acuity of 20/25 without any intervention. Fundus changes were less marked 12 months after initial evaluation in both cases. Hypotonic maculopathy is a reversible complication of trabeculectomies with adjunctive use of 5-fluorouracil.

Isolates and Antibiotic Sensitivity of Eighty Culture-Proven Endophthalmitis Cases from Istanbul

Purpose: To investigate the spectrum of organisms causing endophthalmitis and their sensitivity to commonly used antimicrobial agents. Methods: Medical records of 80 consecutive patients treated at Beyoglu Eye Hospital for endophthalmitis from January 2001 to April 2006 were reviewed. Specimens were obtained from either the vitreous (93%, 81/87) or anterior chamber (7%, 6/87) during pars plana vitrectomy or vitreous tap, and were inoculated into blood culture bottles. A Kirby-Bauer disk diffusion test was performed to determine antibiotic susceptibility. The outcome measures included isolates identified and antibiotic sensitivity of the specimens. Results: Fifty-six of 87 (64.4%) isolates were Gram-positive organisms, 29 (33.3%) were Gram-negative organisms, and 2 (2.3%) were fungi. The most common organism group identified was coagulase-negative staphylococci in 26.4% (23/87). While vancomycin was active against all Gram-positive isolates tested (100%), ceftazidime had the highest susceptibility rate (100%) for Gram-negative organisms isolated. Conclusions: Although coagulase-negative micrococci predominated in this series, a high isolation rate for Gram-negative organisms was obtained. High susceptibility rates for ofloxacin make it an alternative to ceftazidime and vancomycin in both Gram-negative- and Gram-positive-derived endophthalmitis, respectively. Studies with larger series and additional antibiotics are needed to confirm these findings.

Pars plana vitrectomy with and without triamcinolone acetonide assistance in pseudophakic retinal detachment complicated with proliferative vitreoretinopathy

PurposeTo evaluate the anatomical and functional outcomes of pars plana vitrectomy (PPV) in pseudophakic retinal detachment (RD) complicated with proliferative vitreoretinopathy (PVR) without previous scleral buckling (SB) or vitrectomy, both with and without triamcinolone acetonide (TA) assistance.MethodsIn this retrospective, interventional, comparative case series, 72 pseudophakic eyes with RD with PVR grade C1 or greater underwent PPV either with (group 1, n = 40) or without (group 2, n = 32) TA assistance. Eyes with a minimum of 6 months of follow-up were evaluated. Main outcome measures were reattachment, redetachment, complication rate, and changes in visual acuity (VA).ResultsThe mean follow-up period was 14.57 ± 8.55 months. Single-surgery and final reattachment rates were 87.50% and 95% in group 1, and 78.12 % and 96.87% in group 2, (P = 0.349, P = 1.000). Redetachment rates were 12.50% in group 1 and 21.87% group 2 (P = 0.349). In both groups the mean VA increased significantly in postoperative week 1 and in all control visits (P< 0.001) with no difference in complication rate (P > 0.05).ConclusionsIn this study PPV with TA assistance resulted in a lower, albeit statistically insignificant, redetachment rate in the treatment of RD complicated with PVR compared to PPV without TA assistance in eyes without previous SB or PPV. Visual acuity improved in 72% of eyes in both groups. Intraoperative and postoperative complication rates were also similar.

Comparative Outcomes of Pars Plana Vitrectomy in Acute Postoperative Endophthalmitis with 25-Gauge and 20-Gauge Techniques

PurposeTo evaluate the safety and outcomes of 25-gauge pars plana vitrectomy (PPV) in the treatment of postoperative endophthalmitis and compare it with 20-gauge PPV.MethodsThe medical records of all patients diagnosed with acute endophthalmitis following cataract surgery who underwent PPV between December 2000 and December 2007 were reviewed. Main outcome measures included final visual acuity (VA), additional interventions, and both intraoperative and postoperative complications.ResultsRecords of 70 eyes of 70 patients with a condition diagnosed as postoperative endophthalmitis were evaluated. Fifty-eight eyes underwent 20-gauge PPV (group 1), and 12 eyes underwent 25-gauge PPV (group 2). Mean follow-up time for group 1 was 9.6 ± 8.8 months, and for group 2, 7.9 ± 12.7 months (P = 0.57). Median VA at presentation was hand motion in both groups. The differences between the two groups in frequencies of visual outcome levels of 20/800 and 20/100 were significant in favor of group 2 (20/800, P = 0.006; 20/100, P = 0.01). In group 2, fewer additional interventions were required, and postoperative complications tended to be less frequent.ConclusionsTwenty-five-gauge PPV seems to be safe and effective in the management of postoperative endophthalmitis. This sutureless technique may have some advantages over 20-gauge surgery, but controlled studies are needed to confirm the results.