Ugur E. Altiparmak

Comparison of Three Methods for the Treatment of Pterygium: Amniotic Membrane Graft, Conjunctival Autograft and Conjunctival Autograft plus Mitomycin C.

Objective: To compare three techniques combined with excision in the treatment of primary and recurrent pterygium: amniotic membrane transplantation, conjunctival autograft, and conjunctival autograft plus mitomycin C. Materials and Methods: Forty-nine eyes of 49 subjects (30 primary, 19 recurrent pterygium) were included in this study. Combined with excision, 25 eyes (18 primary, 7 recurrent pterygium) were treated with conjunctival autografts (Group 1), and 16 eyes (12 primary, 4 recurrent pterygium) were treated with amniotic membrane transplantation for the closure of the defect (Group 2). In 8 eyes (all recurrent pterygium) low-dose mitomycin C (0.02%) was applied topically to the defect area and a conjunctival autograft was applied thereafter (Group 3). The three groups were compared with regard to the recurrence of pterygium and the defect area requiring treatment. Results: The number and percentages of recurrence seen in groups 1, 2 and 3 were as follows: 4 (16%), 4 (25%), and 0(−), respectively. For the treatment of primary pterygium cases, amniotic membrane closure and conjunctival autograft closure were comparable in effectiveness (p > 0.05). In the treatment of recurrent pterygium, there was no significant difference between the three techniques (p > 0.05). Amniotic membrane closure and conjunctival autografts were equally effective for the treatment of both primary and recurrent pterygium (p > 0.05). The graft size was significantly larger in the cases with recurrent pterygium (p = 0.016). Conclusions: Amniotic membrane closure and conjunctival autografts seem to be equally effective in the prevention of recurrence of primary pterygium. Conjunctival autografts combined with mitomycin C are as effective as the above two techniques to prevent recurrence in the treatment of recurrent pterygium. Due to the larger area of subconjunctival fibrosis, a larger defect area is created after the excision of pterygium tissue and a larger graft is needed to close this defect in recurrent pterygium. This factor can guide the surgeon during the planning of the surgery to choose the most appropriate technique for closure of the defect.

Role of posterior vitreous detachment on outcome of anti-vascular endothelial growth factor treatment in age-related macular degeneration.

Purpose: The aim of this study was to determine the effect of posterior vitreous detachment on outcome of anti–vascular endothelial growth factor injection. Methods: Sixty-one eyes with age-related macular degeneration that had received intravitreal bevacizumab or ranibizumab injections were retrospectively reviewed. The vitreomacular interface was evaluated, and eyes were grouped according to the presence of posterior vitreous detachment (Group 1, n = 25) or vitreomacular adhesion (Group 2, n = 36). All patients received three loading doses of intravitreal anti–vascular endothelial growth factor injections at monthly intervals, and subsequently, pro re nata regimen was performed. Best-corrected visual acuity and central foveal thickness measurement at follow-up were evaluated. The development of posterior vitreous detachment during the follow-up was also reported. Results: The best-corrected visual acuity changes at each visit compared with baseline were significantly better in Group 1 (P = 0.01, 0.02, 0.02, 0.009, 0.009, respectively at third, sixth, ninth, 12th month, and last visit). When best-corrected visual acuity was classified according to the change in visual acuity of 10 letters or more, the rate of improved or stable best-corrected visual acuity was greater in Group 1 (P = 0.02). During the follow-up, 5 eyes (14.3%) developed posterior vitreous detachment. Conclusion: Vitreomacular adhesion seems to have an adverse effect on the visual prognosis of anti–vascular endothelial growth factor treatment for age-related macular degeneration.

The ratio of square wave jerk rates to blink rates distinguishes progressive supranuclear palsy from Parkinson disease

Background: Distinguishing progressive supranuclear palsy (PSP) from Parkinson disease (PD) may be difficult, particularly in the early stages, because the characteristic vertical supranuclear eye movement abnormalities of PSP may be absent or delayed until late in the course of the disease. In this study we investigated the usefulness of comparing the square wave jerk rate (SWJR) and blink rate (BR) in the differentiation of these two disorders. Methods: We studied 10 patients with PD (PD group) and 5 patients with PSP (PSP group) who met published diagnostic criteria. The SWJR and BR were measured from video recordings and were used to calculate a ratio (SWJR:BR). Results: The PSP group exhibited a significantly higher SWJR, higher SWJR:BR, and lower BR than did the PD group. No patient with PSP exhibited a SWJR:BR of <3; however, one patient with PD had a SWJR:BR of 5.3, creating overlap between the two groups. Conclusions: The SWJR:BR is a simple and reasonably useful clinical measure to distinguish established PSP from PD. Determining the value of this measure in differentiating early PSP from PD requires a prospective study.

Ocular complications in 2 cases with porphyria.

Purpose: We aimed to report our observation regarding the long-term follow-up results of 2 cases with similar ophthalmic manifestations of 2 different porphyrias, congenital erythropoietic porphyria (CEP), and porphyria cutanea tarda (PCT). Methods: Both patients presented with ocular pain and photophobia in both eyes. The patient with CEP had a scleral necrosis of 3 mm in diameter at the lateral limbus of the right eye and medial limbus of the left eye, accompanied with cicatricial ectropion and lid swelling OU. The patient with PCT had scleral necrosis in the interpalpebral area nasally, OU. Results: Both patients were followed-up for 4 years. The patients received intensive topical lubrication and topical and oral immune-suppressive medication. They underwent amniotic membrane grafting, when required, and were advised to wear UV glasses. The case with PCT followed a more salient course and remained symptom free until the end of the follow-up period. In contrast, the patient with CEP developed further scleral necrosis, despite the treatment and evisceration surgery were inevitable owing to endophthalmitis unresponsive to the treatment. Conclusions: Ocular complications are rarely reported in porphyrias, and the studies on the long-term follow-up results are fewer. Despite careful follow-up and intensive treatment, scleral necrosis can be progressive and results in the loss of vision or even the loss of eye. Further studies regarding the care of patients with porphyrias are required to more effectively treat these rare ophthalmic conditions.

Comparison of Two Techniques for the Treatment of Recurrent Pterygium: Amniotic Membrane vs Conjunctival Autograft Combined with Mitomycin C

Abstract Purpose: To compare the results of amniotic membrane transplantation (AMT) combined with mitomycin C (MMC) to the results of free conjunctival autograft (CA) combined with MMC for the treatment of patients with recurrent pterygium. Methods: In this prospective study, 60 eyes of 55 patients with recurrent pterygium were included and randomly assigned into group I (n = 30) who underwent AMT combined with MMC (AMT-MMC) and group II (n = 30) who underwent CA combined with MMC (CA-MMC). During a mean follow-up of 27.2 ± 20.8 months, recurrence of pterygium, change in uncorrected visual acuity and complications (including pain, corneal, conjunctival or scleral changes) were analyzed and were compared between groups. Results: Five eyes of 5 patients were lost to follow-up and were removed from analysis. The mean age (p = 0.274), the mean follow-up (p = 0.063), the number of prior pterygium excision surgeries (p = 0.641) and the mean preoperative visual acuity (p = 0.959) were similar in both groups. Recurrence was seen in 2 eyes (8%) in AMT-MMC group and 4 patients (13.3%) in CA-MMC group (p = 0.531). Postoperative visual acuity (p = 0.237), change in visual acuity (p = 0.525), severe pain (p = 0.531) and epithelial defect lasting more than 5 days (p = 0.510) were similar in both groups. Conclusions: Amniotic membrane combined with MMC has similar recurrence rate to CA combined with MMC, in patients with recurrent pterygium. Similar outcomes and complication rates make AMT-MMC a promising method for the treatment of recurrent pterygium cases.

Topical cyclosporine A for the dry eye findings of thyroid orbitopathy patients

The study was approved by the local ethics committee of Ministry of Health, Ankara Research and Training Hospital (14 February 2008, Number 00155) and patient recruitment began. The authors declared that they have no conflict of interest. A total of 90 eyes of 45 patients with TO were prospectively evaluated for this study between 1 April 2008 and 1 December 2008. The diagnosis of TO was made, when two of the following three signs of the disease were present: 2 (1) Concurrent or recently treated immune-related thyroid dysfunction: Graves hyperthyroidism, Hashimoto’s thyroiditis, and the presence of circulating thyroid antibodies without a coexisting dysthyroid state; (2) typical orbital signs (one or more of the following): unilateral or bilateral eyelid retraction with typical temporal flare (with/or without lagophthalmos), bilateral proptosis (as evidenced by comparison with patient’s old photos), restrictive strabismus in a typical pattern compressive optic neuropathy, fluctuating eyelid oedema/erythema, chemosis/caruncular oedema; and (3) radiographic evidence of TO including unilateral/bilateral fusiform enlargement of one or more of the following: medial rectus muscle, inferior rectus muscle, superior rectus–levator complex. In all patients, assessment of activity of TO was carried out using Clinical Activity Score (CAS) based on the classification system proposed by Mourits et al. 3

Vitrectorhexis versus forceps capsulorhexis for anterior and posterior capsulotomy in congenital cataract surgery.

PURPOSE To compare the results of anterior and posterior continuous curvilinear capsulorhexis created using forceps with those created using vitrector in eyes suffering from congenital cataract. METHODS Twenty-eight eyes with congenital cataract were included in the study. The anterior and posterior continuous curvilinear capsulorhexes were created using microforceps in 17 eyes or through a vitrector in 11 eyes. RESULTS Corneal edema (P = .56) and anterior chamber flare (P = 1.0) were comparable in both groups. In addition, the time for optical axis clarity was also similar between the groups (P = .98). CONCLUSION The current results suggest that the use of both techniques appears to be equally safe and effective for the achievement of anterior and posterior capsulorhexis.

Toxic optic neuropathies.

Purpose of review Many causes of toxic optic neuropathy have been described to date and novel causes of toxicity are continuously being added to the current literature. The pathophysiological basis for the toxicity or a direct causal relationship is yet to be determined for many of these agents. This review highlights the reports made over the last year about the commonly reported agents, with emphasis on the mechanisms of toxicity. Recent findings Mitochondria of retinal ganglion cells and papillomacular bundle in particular could be the common target of many causes of toxic optic neuropathy, if not all. Agents or their metabolites responsible for the toxicity seem to interfere with the oxidative phosphorylation in mitochondria, causing a buildup of reactive oxidation species, energy depletion, oxidative stress, and activation of apoptosis. Summary Further data are still necessary to understand how some of the usual suspects cause damage to the optic nerve or whether they indeed cause damage or not. A basic algorithm, as proposed, could be a useful addition to discriminate the novel causes of toxic optic neuropathy. Video abstract See the Supplemental Digital Content 1 (http://links.lww.com/COOP/A11)

Posttraumatic Intraocular Pressure Elevation and Associated Factors in Patients with Zone I Open Globe Injuries

1Department of Ophthalmology, Kastamonu State Hospital, Kastamonu; 2Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey. #Current affiliation: Department of Ophthalmology, Hacettepe University, Kastamonu Faculty of Medicine, Ankara, Turkey. 1Kastamonu Devlet Hastanesi, Goz Klinigi, Kastamonu; 2Ankara Egitim ve Arastirma Hastanesi, Goz Klinigi, Ankara. #Şimdiki kurumu: Hacettepe Universitesi Kastamonu Tip Fakultesi Goz Hastaliklari Anabilim Dali, Ankara.BACKGROUND The object of this study was to determine factors that might be associated with intraocular pressure (IOP) elevation after anterior segment open globe injuries (zone I). METHODS Data were obtained from the records of 68 patients who experienced zone I open globe injury between January 2008 and October 2010. Group I was composed of patients with chronically elevated IOP of at least 21 mmHg within a 1-year follow-up period. The rate of posttraumatic IOP elevation and associated structural and functional risk factors were evaluated. RESULTS Of the 68 patients, 17 (25%) developed posttraumatic IOP elevation (Group 1). The mean age in group I was significantly older compared to group II (36.8±24.4 and 15.7±15.3 years, respectively [p=0.003]). Iris damage, postoperative inflammation, and use of long-term corticosteroids were significantly greater in group I (p<0.001, p<0.001, p=0.005 respectively). In group I, 13 of 17 patients (76.5%) had a wound size larger than 6 mm compared to only one patient (1/51, 2%) in group II, and the result was statistically significant (p<0.001). The size of wound larger than 6 mm also retained its statistical significance in multivariate analysis (p<0.001, odds ratio: 162.5). CONCLUSION This study shows a significant relationship between larger wound size (>6 mm) and elevation of IOP after trauma in zone I open globe injuries.

Intraoperative Floppy-Iris Syndrome: Comparison of Tamsulosin and Drugs Other Than Alpha Antagonists

Abstract Background: To determine and compare the incidence of intraoperative floppy iris syndrome (IFIS) features in patients using tamsulosin, and other chronic medications. Methods: We prospectively studied patients who underwent phacoemulsification (PE) between March 2006 and October 2007 on use of tamsulosin or a single medication like antihypertansive (AH), antiaggregant (AAg), antipsycotic (AP) or oral antidiabetic (OAD). Patients were grouped as tamsulosin users (Group 1), previous tamsulosin users (Group 2), chronic medication users (AH, AAg, AP or OAD) (Group 3) and patients with no medication (Group 4). Comparison of pre and postoperative visual acuities, intraocular pressures, intraoperative posterior capsular rupture (PCR) rates and grades of IFIS among groups were evaluated. Results: We studied 1567 eyes of 1530 subjects. Twenty five eyes in the study demonstrated IFIS (1.6%). Five cases were included in Group 1 and IFIS incidence was 80%, while it was 60% in Group 2 (n = 5), 1 % in Group 3 (n = 1099), 1.7% in Group 4 (n = 421). IFIS incidence was significantly higher in Groups 1 and 2 compared to Groups 3 and 4 (p < 0.001). There was no difference between Groups 1 and 2 (p = 1.0) and between 3 and 4 (p = 0.29). Most cases (72%) had all three signs of IFIS. Complete IFIS was seen in one patient in Groups 1 and 2, whereas it was seen in all IFIS patients of Groups 3 and 4 (p < 0.001). Incidence of PCR was significantly higher in Group 1 (p = 0.045). Conclusion: Tamsulosin was found to be the drug which was most likely to be associated with IFIS, but IFIS was also observed in patients chronically using losartan, aspirin, chlorpromazine and metformin. Although, IFIS incidences were found to be similar between chronic users of these drugs and those using no medications at the time of surgery, new studies in the future will introduce the predisposing factors and the possible mechanisms of IFIS with these medications.