Yaran Koban

Nonarteritic anterior ischemic optic neuropathy and obstructive sleep apnea.

Background: To evaluate the obstructive sleep apnea syndrome (OSAS) in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods: We recruited 27 patients with NAION and 27 age-matched and sex-matched controls who also were similar for systemic risk factors such as diabetes mellitus, hypertension, and hypercholesterolemia. All patients and controls underwent overnight polysomnography for the diagnosis of OSAS and calculation of apnea-hypopnea index (AHI). Results: Patients and controls were statistically similar in terms of age, sex, gender, smoking, systemic risk factors, neck circumference, and body mass index. The subjects with AHI ≥ 20 were accepted as OSAS. Fifteen of 27 patients (55.6%) with NAION and 6 of 27 controls (22.2%) had OSAS (P < 0.05). Conclusion: The prevalence of OSAS was higher in patients with NAION, and the difference between patient and control groups was statistically significant (P < 0.05). This result supports prior series suggesting the association between NAION and OSAS.

Long–Term Comparison of Fibrin Tissue Glue and Vicryl Suture in Conjunctival Autografting for Pterygium Surgery

Abstract Purpose: Pterygium is a common clinical entity that usually causes visual impairment, astigmatism and cosmetic problems. Although many surgical techniques to treat pterygium have been proposed, no single method, with minimal patient complications, has yet been accepted and established. Excision combined with conjunctival autograft is the most often used procedure for the treatment of primary pterygium, and the technique is associated with minimized recurrence rates in patients. The purpose of our study was to compare visual and refractive outcomes, complications, and recurrence rates with the use of fibrin glue versus 8.0 vicryl suture in pterygium surgery performed with conjunctival autograft. Materials and Methods: Our retrospective, comparative study included 106 eyes of 106 patients operated on for primary pterygium, between the years 2011 and 2012, and followed for ≥ 12 months. Patients were divided into 2 treatment groups: Group 1, vicryl suture use (n = 53), and Group 2, fibrin tissue glue (n = 53). Patient follow–up periods were 21.15 ± 5.3 months for Group 1 and 22.06 ± 5.2 months for Group 2. Results: Demographics and preoperative/follow–up clinical characteristics of patients revealed no significant differences between the 2 patient groups. Additionally, no significant differences were found between the patient groups in visual acuity level changes and refractive values. Although the rates of recurrence (7.5% in Group 1 and 1.9% in Group 2; P = 0.36) and graft dehiscence (Group 1, 7.5% compared with Group 2, 3.8%; P = 0.67) were slightly higher for patients in the suture group, differences did not reach significance. Conclusions: Our study results suggest that conjunctival autografting with fibrin glue has favorable visual and refractive results for patients, and is associated with lower complication rates, compared with use of the traditional 8.0 vicryl suturing technique. We suggest that fibrin tissue glue provides adequate adhesion and that graft loss will not be a problem if protective shields are used in patients postoperatively. The appropriate surgery technique should be selected by considering the advantages and disadvantages of each procedure.

Reduction of Conjunctival Fibrosis After Trabeculectomy Using Topical α-Lipoic Acid in Rabbit Eyes

Purpose:To evaluate the efficacy of &agr;-lipoic acid (ALA) in reducing scarring after trabeculectomy. Materials and Methods:Eighteen adult New Zealand white rabbits underwent trabeculectomy. During trabeculectomy, thin sponges were placed between the sclera and Tenon’s capsule for 3 minutes, saline solution, mitomycin-C (MMC) and ALA was applied to the control group (CG) (n=6 eyes), MMC group (MMCG) (n=6 eyes), and ALA group (ALAG) (n=6 eyes), respectively. After surgery, topical saline and ALA was applied for 28 days to the control and ALAGs, respectively. Filtrating bleb patency was evaluated by using 0.1% trepan blue. Hematoxylin and eosin and Masson trichrome staining for toxicity, total cellularity, and collagen organization; &agr;-smooth muscle actin immunohistochemistry staining performed for myofibroblast phenotype identification. Results:Clinical evaluation showed that all 6 blebs (100%) of the CG had failed, whereas there were only 2 failures (33%) in the ALAG and no failures in the MMCG on day 28. Histologic evaluation showed significantly lower inflammatory cell infiltration in the ALAGs and CGs than the MMCG. Toxicity change was more significant in the MMCG than the control and ALAGs. Collagen was better organized in the ALAG than control and MMCGs. In immunohistochemistry evaluation, ALA significantly reduced the population of cells expressing &agr;-smooth muscle action. Conclusions:&Agr;LA prevents and/or reduces fibrosis by inhibition of inflammation pathways, revascularization, and accumulation of extracellular matrix. It can be used as an agent for delaying tissue regeneration and for providing a more functional-permanent fistula.

Occupational Exposure to Lead Decreases Macular, Choroidal, and Retinal Nerve Fiber Layer Thickness in Industrial Battery Workers

Abstract Purpose: To evaluate the toxic effects of chronic lead (Pb) exposure on retinal nerve fiber layer thickness (RNFLT), macular thickness (MT) and choroidal thickness (CT) in battery industry workers. Materials and Methods: Male factory workers (n = 50) and healthy non-employees (n = 20) participated in the study. Group 1 (n = 22) comprised lead workers; Group 2 (n = 16), box makers; Group 3 (n = 12), assistant personnel; and Group 4 (n = 20), healthy non-employees. All participants were given Best-Corrected Visual Acuity (BCVA) tests, full ophthalmologic examinations, and Spectral Domain Optical Coherence Tomography (SD-OCT) of the optic nerve head, RNFL, macula, and choroid. Blood lead levels (BLL) in venous blood samples were determined. The duration of exposure to lead varied, and is expressed in months. Results: Average (mean ± SD) ages of participants were 27.55 ± 4.00, 28.69 ± 3.48, 32.00 ± 3.38, and 29.85 ± 5.48 yrs (Groups 1–4, respectively). BLL were 46.2 ± 2.32, 29.31 ± 3.30, 16.9 ± 1.9, and 2.85 ± 0.98 µg/dL (Groups 1–4, respectively). Durations of exposure to lead were 43.86 ± 10.81, 42.81 ± 4.86, and 49.42 ± 6.14 mo (Groups 1–3, respectively). OCT averages for RNFL were 101.68 ± 5.32, 119.50 ± 13.47, 127.67 ± 8.92, and 130.9 ± 6.63 μm (Groups 1–4, respectively). Although RNFLTs of Group 1 were significantly less than those of for Groups 2–4, and, RNFLTs of Groups 2 and 3 were significantly less than that of Group 4, there were no significant differences between Group 2 and 3. MTs were 94.50 ± 6.78, 105.63 ± 5.43, 111.50 ± 6.74 and 147.95 ± 6.67 μm, (Groups 1–4, respectively). CTs were 176.41 ± 15.39, 222.19 ± 17.79, 239.17 ± 15.64, and 251.50 ± 10.98 μm (Groups 1–4, respectively). Both MTs and CTs displayed significant differences among the four groups. Conclusions: Ocular changes in individuals who are chronically exposed to lead include decrease in RNFT, MT, and CT, and thus these parameters should be evaluated during ophthalmologic examination of individuals working in lead-based industries.

Oculogyric crisis in a patient taking metoclopramide

Oculogyric crisis is an acute dystonic reaction of the ocular muscles characterized by bilateral dystonic elevation of visual gaze lasting from seconds to hours. This reaction is most commonly explained as an adverse reaction to drugs such as antiemetics, antipsychotics, antidepressants, antiepileptics, and antimalarials. Although the incidence of metoclopramide-induced acute dystonic reactions has been reported as 25% in children, there have been few published cases on oculogyric crisis in general. It is important to be able to recognize this ocular side effect because, without a thorough patient history, symptoms can be confused with other diseases such as versive seizures, paroxysmal tonic upward gaze, and encephalopathy. In this paper, we report a case of oculogyric crisis induced by metoclopramide.

Comparison of Results of Accelerated Corneal Cross-Linking With Hypo-Osmolar Riboflavin Solution Performed on Corneas Thicker and Thinner Than 400 μm.

Purpose: To evaluate the effect of accelerated corneal cross-linking (CXL) according to corneal thickness in keratoconus. Methods: Patients undergoing corneal CXL (9 mW/cm2) with hypo-osmolar riboflavin solution were included in this study. The patients were divided into 2 groups. Group 1 included patients with corneal thickness below 400 &mgr;m (50 eyes from 45 patients), and group 2 included patients with corneal thickness above 400 &mgr;m (50 eyes from 47 patients). Visual acuity (VA), refraction, topographic values, and higher-order aberrations were evaluated in the preoperative term and postoperatively at months 1, 3, and 6. Results: The improvements in VA were significant and similar in both groups [0.25/0.19 logMAR, P = 0.130]. In group 1, the rate of decrease in spherical refraction [0.85/0.27 diopters (D), P = 0.012] and maximum keratometry (Kmax, 2.49/0.68 D, P < 0.001) was significantly higher than that in group 2. The cylindrical change was similar (0.43/0.29 D P = 0.173). Corneal thinning was higher in group 2 (25/40.4 &mgr;m P < 0.001). Anterior elevation values decreased at higher rates in group 1 (3.73/0.24 &mgr;m P < 0.001); neither group showed a significant difference in posterior elevation (−0.14/−0.4 &mgr;m P > 0.05). In group 1, all aberration values except trefoil significantly decreased, whereas in group 2 none of the aberrations decreased except the total root mean square. All higher-order aberration values decreased at significantly higher rates in group 1 (P < 0.05). Conclusions: In thin corneas, accelerated corneal CXL provides better anatomical changes; however, the improvement in VA is similar to that in thick corneas.

Toxic Anterior Segment Syndrome following Phacoemulsification Secondary to Overdose of Intracameral Gentamicin

Objective. To report a case of toxic anterior segment syndrome (TASS) that was caused by inadvertent anterior chamber and cornea stromal injection with high dose gentamicin following cataract surgery. Methods. Case report. Results. We report a 72-year-old female patient who developed TASS that was caused by high dose gentamicin (20 mg/0.5 mL), which was inadvertently used during the formation of the anterior chamber and hydration of the corneal incision. Unlike previous cases, hyphema and hemorrhagic fibrinous reaction were seen in the anterior chamber. Despite treatment, bullous keratopathy developed and penetrating keratoplasty was performed. The excised corneal button was sent for histopathological examination. Conclusions. Subconjunctival gentamicin is highly toxic to the corneal endothelium and anterior chamber structures. Including it on the surgical table carries a potentially serious risk for contamination of the anterior chamber.

The Effect of Dexamethasone Intravitreal Implant on Retinal Nerve Fiber Layer in Patients Diagnosed with Branch Retinal Vein Occlusion

ABSTRACT Purpose: To evaluate the effect of a single dose of intravitreal dexamethasone (DEX) implant on retinal nerve fiber layer (RNFL) thickness in patients with branch retinal vein occlusion (BRVO) in a 6-month period. Materials and methods: This retrospective observational study included the patients with BRVO who received intravitreal DEX implant and whose assessment included the baseline RNFL thickness measurements. The data of 26 eyes of 24 patients were retrospectively analyzed. Spectral domain optic coherence tomography was used to measure peripapillary RNFL thickness in six regional subfields. Intraocular pressure (IOP) values at each visit were recorded. The data of single dose DEX implant during 6 months were assessed. Results: The mean preoperative and postoperative 6th month nasal RNFL values were 85.4 ± 23.0 μm and 82.1 ± 17.6 μm, respectively, and the difference between the measurements was not statistically significant (p = 0.372). There was a slight decrease in the mean RNFL values postoperatively compared to the baseline values in all quadrants except supero-temporal quadrant; however, none of them reached statistically significant level (p > 0.05). The mean IOP values before and 6 months after implantation were 15.7 ± 2.9 mmHg and 16.5 ± 4.2 mmHg, respectively. The difference between the 6th month IOP values and baseline IOP values was not statistically significant (p = 0.236). Conclusion: Intravitreal DEX implant seems to have no adverse effect on RNFL thickness in BRVO patients in a 6-month period.

Effect of selective laser trabeculoplasty on macular thickness.

Background To investigate the effects of selective laser trabeculoplasty (SLT) on macular thickness change. Methods Forty eyes of 40 consecutive patients with uncontrolled primary open-angle glaucoma with medical treatment were included in this prospective study. SLT was performed to the inferior 180°, and macular thickness was measured. Data were collected before SLT, and 1 week and 1 month after SLT. Macular thickness evaluation was performed in five quadrants, the central 1 mm quadrant (fovea = F), the nasal 3 mm quadrant surrounding F (NQ), temporal quadrant, superior quadrant (SQ), and inferior quadrant (IQ). The preoperative and postoperative thicknesses were compared. Results There was an increase in macular thickness in the NQ, IQ, and SQ on the first week after SLT compared to preoperative measurements. On the other hand, there was no significant increase in the F and temporal quadrant. On the first month after SLT, thickness in the NQ, IQ, and SQ was back to preoperative measurements, and there was no significant change between the preoperative measurements in any quadrant. Conclusion There was no significant increase in macular thickness shortly after SLT in our study.

Accelerated Corneal Cross-Linking With a Hypoosmolar Riboflavin Solution in Keratoconic Thin Corneas: Short-Term Results.

Purpose: The aim of this study was to evaluate the early term topographic and aberration results of accelerated (9 mW/cm2) corneal cross-linking (CXL) treatment in keratoconic thin corneas. Methods: Forty-nine eyes from 43 patients (mean age of 21.2 ± 7.1) with progressive keratoconic thin corneas (<400 &mgr;m without epithelium) who had accelerated corneal CXL with hypoosmolar riboflavin solution throughout the procedure were enrolled. We measured the uncorrected and corrected distance visual acuity, refraction, slit-lamp examination, topographic values, and corneal higher-order aberrations (Pentacam HR, Oculus Optikgeräte GmbH) preoperatively and 1, 3, and 6 months after surgery. Results: Before surgery, the corneal thickness was 404 ± 18 &mgr;m, and the thickness was reduced to 360 ± 24 &mgr;m after removing the epithelium. After the application of hypoosmolar riboflavin solution, the thickness increased to 432 ± 44 &mgr;m. At month 6, there was a significant increase in uncorrected distance visual acuity (P = 0.043) and corrected distance visual acuity (P = 0.024), a decrease in spherical refraction (P = 0.041), maximum keratometry (Kmax, P = 0.003), anterior elevation values (P = 0.008), corneal thickness (P < 0.001), coma (P = 0.022), spherical aberration (P = 0.001), higher-order root mean square (P = 0.004), and total root mean square (P < 0.001), whereas the cylindrical refraction (P = 0.627), anterior (P = 0.665) and posterior astigmatism (P = 0.165) of the cornea, posterior elevation (P = 0.198), and trefoil (P = 0.141) remained unchanged. No patients showed any complications or scar formation during follow-up. Conclusions: Accelerated corneal CXL with hypoosmolar riboflavin solution throughout the procedure is effective in thin corneas.