Ugur Erdener

Incidence of sympathetic ophthalmia after penetrating eye injury and choice of treatment

Introduction: Sympathetic ophthalmia, a diffuse bilateral granulomatous panuveitis, is a serious potential complication after penetrating eye injury. Many surgeons recommend enucleation within two weeks of trauma to prevent this condition. We retrospectively reviewed the medical records of patients with penetrating ocular injuries who had either evisceration or enucleation to determine the incidence of sympathetic ophthalmia and to evaluate the surgical interventions and their complications. Age at surgery, time after penetrating trauma, surgery technique, follow-up period, ophthalmic examination of the fellow eye, and surgical complications were evaluated. Results: In total, 217 patients were included in the study with a mean follow-up period of 10.3 ± 6.6 years. The longest time between the trauma and time of surgery was 43 years. Postoperative uveitis was observed in only one patient (0.5%) who had primary repair after injury. Histopathological review did not reveal typical sympathetic ophthalmia. Complications after enucleation were significantly higher than after evisceration. Conclusion: There was no histopathologically supported sympathetic ophthalmia in our series. Sympathetic ophthalmia is very rare even when the injured eye is retained. With this in mind, the first choice of treatment may not be enucleation. Furthermore, evisceration may be the procedure of choice if primary repair cannot be performed or for patients who have panophthalmitis.

Effect of peripapillary chorioretinal atrophy on GDx parameters in patients with degenerative myopia

Purpose: To determine the effect of peripapillary chorioretinal atrophy in degenerative myopia on the retinal nerve fibre layer (RNFL) thickness measurements performed by scanning laser polarimetry.

Tear eotaxin levels in giant papillary conjunctivitis associated with ocular prosthesis

Purpose: To examine the role of eotaxin and eosinophil recruitment in the immunopathogenesis of ocular prosthesis-associated giant papillary conjunctivitis (GPC). Methods: The tear eotaxin level was measured in 68 eyes with GPC, the fellow eyes of the GPC patients, and 22 normal subjects, using an ELISA method. Upper tarsal conjunctival specimens harvested from 18 patients with GPC were examined by light microscopy. Results: There was no significant difference in tear eotaxin levels between patients with GPC and healthy subjects. In patients with chronic GPC, the tear eotaxin levels were significantly lower. These eyes also had decreased conjunctival cellularity and increased fibrosis in the substantia propria. Biopsy specimens showed infiltration of lymphocytes and mast cells, but no eosinophils were found. Conclusion: Eotaxin and eotaxin-mediated eosinophil recruitment do not seem to have a major role in the immunopathology of chronic GPC associated with an ocular prosthesis.

Poland-Moebius Syndrome: A Case Report

BACKGROUND The primary site of pathology in Moebius syndrome is still unknown, although several studies have variably localized the lesion in the extraocular muscles, cranial nerves, or central nervous system. CASE A 24-year-old man with Poland-Moebius syndrome and acquired progressive bilateral paralytic lower eyelid ectropion is described. OBSERVATIONS In this patient, magnetic resonance imaging studies revealed a barely detectable pontine hypoplasia and normal recti muscles. Nerve conduction studies of the facial nerves showed a severe demyelinating or dysmyelinating type of neuropathy. Bilateral lower eyelid ectropium of the patient was successfully corrected by canthal tightening procedures. CONCLUSION Contrary to many reported cases, this patient serves as a rare example of a progressive type of Poland-Moebius syndrome presumably resulting from a combination of a brainstem abnormality and a peripheral neural degenerative process.

Topographical analysis of corneal astigmatism in patients with tilted-disc syndrome

Purpose. To evaluate the corneal topography in patients with tilted-disc syndrome to determine the relationship between optic disc dysversion and corneal astigmatism and the pattern of astigmatism in these patients. Methods. The study included 23 eyes of the 13 tilted-disc syndrome patients with spheric refractive errors ranging between +1.00 D and −9.00 D (mean −4.00 ± 3.4 D) and astigmatic errors ranging between −0.50 and −4.50 D (mean −1.95 ± 0.93 D). Corneal topography was performed by computer-assisted videokeratoscope topographic modelling system 2 (TMS-2) and incidence of corneal astigmatism, corneal topographic patterns, and mean values of the topographic indices were determined. Results. Corneal topographic analysis showed corneal astigmatism in 22 out of 23 patients with tilted discs. Corneal astigmatism was symmetric bow tie pattern in 10 eyes (45.45%), asymmetric bow tie pattern in 11 eyes (50%) and irregular in 1 eye (4.5%). Among the patients with bow tie pattern group (21 eyes), 14 eyes had with-the-rule astigmatism, 1 eye had against-the-rule astigmatism, and 6 eyes had oblique astigmatism. In 18 eyes, astigmatism was corneal, whereas combined corneal and lenticular in 4 eyes and lenticular in 1 eye. Conclusion. In the majority of tilted-disc cases, ocular astigmatism is mainly corneal. Morphogenetic factors in the development of the tilted disc might possibly influence the corneal development in such a way to result in corneal astigmatism.

Autogenous versus allograft fascia lata in frontal sling surgery --long-term results.

Purpose Either autogenous or allograft fascia lata frontal sling procedures can be used for the treatment of severe ptosis. We retrospectively evaluated the late outcomes of both approaches. Methods Medical records of patients who underwent frontal sling ptosis surgery between 1978 and 2000, with a follow-up of one year or more were included in the study. Success rates and the complications of the surgery for autogenous and allograft fascia lata were recorded. The results were compared statistically. Results Surgeries were performed with 82 autogenous or 43 allograft fascia lata. At last follow-up there were 71 eyes (86.6%) with good, 8 eyes (9.7%) with moderate, 3 eyes (3.7%) with poor results after autogenous fascia lata and 35 (81.4%), 3 (7%) and 5 (11.6%) after the allograft fascia lata frontal sling procedure. There was no significant difference between the two groups. Repeat surgery was carried out on three patients after autogenous and five after allograft fascia lata surgery. Two cases of preseptal cellulitis were observed, one abscess after autogenous and one lagophthalmus after allograft fascia lata sling surgery. All patients had slight edema early after surgery which resolved in a few days. Only one patient developed a hematoma at the site of the leg incision. Conclusions Although the long-term success rate with the autogenous fascia lata is slightly higher and this remains the first choice, allograft fascia lata is a good alternative in patients in whom fascia could not be harvested.

Immunohistochemical findings in prosthesis-associated giant papillary conjunctivitis

Purpose:  To identify functional subsets of inflammatory cells and expression of cytokines in the conjunctiva of patients with ocular prosthesis‐associated giant papillary conjunctivitis (P‐GPC).

Ocular ferning during the menstrual cycle in healthy women.

Purpose The aim of the study is to investigate whether tear ferning patterns change during different phases of the menstrual cycle. Methods The tear ferning test was performed on twelve normal women of childbearing age at three day intervals throughout one complete menstrual cycle. Serum hormone levels (progesterone, estrogen, testosterone) were measured. Results Eight women showed type I ferning, and the other four had type II ferning initially. These patterns did not change during the menstrual cycle. Serum hormone levels were all in the normal range. Since no change in ferning pattern was detected during the menstrual cycle, the ferning test can be done at any time in women. Conclusions This study showed no effect of different menstrual cycle phases on tear ferning patterns.

Intranasal Endoscopic Surgery With Silicone Intubation for Lacrimal Obstruction

Endoscopic intranasal dacryocystorhinostomy (DCR) with silicone intubation has been evaluated as a primary treatment of lacrimal obstruction in 30 patients and for revision of conventional DCRs in 4 patients. Lacrimal obstruction was completely relieved in 28 (93.3%) of 30 primary procedure patients, and in three of four previously operated patients after a mean follow-up of 18 months. No intraoperative complications were observed. The average period of time of silicone tube intubation was 2 months. Intranasal endoscopic DCR with silicone intubation is an effective method in treatment of nasolacrimal duct obstructions and should also be considered in patients with recurrent epiphora after external DCR.

The Expression and Comparison of Healthy and Ptotic Upper Eyelid Contours Using a Polynomial Mathematical Function

Abstract Purpose: To derive a mathematical expression for the healthy upper eyelid (UE) contour and to use this expression to differentiate the normal UE curve from its abnormal configuration in the setting of blepharoptosis. Methods: The study was designed as a cross-sectional study. Fifty healthy subjects (26M/24F) and 50 patients with blepharoptosis (28M/22F) with a margin–reflex distance (MRD1) of ≤2.5 mm were recruited. A polynomial interpolation was used to approximate UE curve. The polynomial coefficients were calculated from digital eyelid images of all participants using a set of operator defined points along the UE curve. Coefficients up to the fourth-order polynomial, iris area covered by the UE, iris area covered by the lower eyelid and total iris area covered by both the upper and the lower eyelids were defined using the polynomial function and used in statistical comparisons. The t-test, Mann–Whitney U test and the Spearman’s correlation test were used for statistical comparisons. Results: The mathematical expression derived from the data of 50 healthy subjects aged 24.1 ± 2.6 years was defined as y = 22.0915 + (−1.3213)x + 0.0318x2 + (−0.0005x)3. The fifth and the consecutive coefficients were <0.00001 in all cases and were not included in the polynomial function. None of the first fourth-order coefficients of the equation were found to be significantly different in male versus female subjects. In normal subjects, the percentage of the iris area covered by upper and lower lids was 6.46 ± 5.17% and 0.66% ± 1.62%, respectively. All coefficients and mean iris area covered by the UE were significantly different between healthy and ptotic eyelids. Conclusions: The healthy and abnormal eyelid contour can be defined and differentiated using a polynomial mathematical function.