Yaşar Dağ

Medium-term outcomes of three horizontal muscle surgery in large-angle infantile esotropia.

PURPOSE To evaluate the medium-term motor outcomes of three horizontal muscle surgery in patients with large-angle infantile esotropia. METHODS The charts of 18 patients with large-angle (> 55 prism diopters [PD]) infantile esotropia who underwent bilateral medial rectus muscle recession and one lateral rectus muscle resection were retrospectively reviewed. Preoperative and postoperative deviations at last examination, overcorrections and undercorrections, necessity of additional horizontal surgery, and follow-up durations were recorded. RESULTS The median age of patients at surgery was 22 months (range: 10 to 168 months). Orthotropia to within 10 PD or less was achieved in 14 of 18 patients (78%) in a median follow-up of 32 months (range: 5 to 63 months). The mean preoperative deviation of 68.8 ± 9.54 PD decreased to a median of 1 PD (range: esotropia 30 to exophoria 4 PD) postoperatively (P < .005). Marked residual esotropia necessitating additional surgery occurred in 4 patients, but significant overcorrection was not observed. CONCLUSIONS The success rate of the three horizontal muscle surgeries appears to be high enough in medium-term follow-up in patients with large-angle infantile esotropia. Overcorrection that necessitates additional horizontal muscle surgery does not seem to be significant in the medium term, according to this study.

Slanted Medial Rectus Recession Is Effective in the Treatment of Convergence Excess Esotropia

PURPOSE To evaluate the surgical outcomes of slanted medial rectus recession in patients diagnosed as having convergence excess esotropia. METHODS Bilateral slanted recession of medial rectus muscles was performed in 16 patients with convergence excess esotropia. The lower margins of medial rectus muscles were recessed 1 to 2 mm more than the upper margins. Changes in near-distance disparity of the deviations were recorded. RESULTS The mean preoperative near-distance disparity of 20.3±6.5 prism diopters (PD) decreased to 4.37±5.6 PD postoperatively. The amount of collapse was significant (mean: 16 PD; P<.005). Near-distance disparity of 10 PD or less was obtained in 14 patients after surgery (87.5%), except 2 patients who had 16 PD of disparity. The authors did not encounter overcorrection except in 1 patient in whom minimal exophoria at distance and near with the glasses was observed and reduced the prescription. CONCLUSIONS Bilateral slanted medial rectus muscle recession procedure effectively decreases the disparity between near and distance deviations in patients with convergence excess esotropia.

On retrochop technique

On retrochop technique In their recent article, Falabella et al. described a retrochop technique for rock-hard cataracts. We have used the retrochop technique routinely for about 9 years and agree with the authors on the advantages, especially in dense cataract cases. As the authors stated, one of the most important aspects of the technique is the necessity of a large capsulorhexis. Instead of an oval 7.0 mm 5.5 mm diameter capsulorhexis, which Falabella et al. used, we prefer a 6.0 to 6.5 mm diameter circular capsulorhexis. After the nucleus is grabbed using strong suction, it is lifted from the capsular bag to facilitate access to the posterior pole of the nucleus with the chopper. Although an oval 7.0 mm 5.5 mm diameter capsulorhexis seems to be more advantageous in accessing the posterior pole, we usually do not encounter difficulty with a 6.0 mm diameter circular capsulorhexis. It is not easy to create an oval 7.0mm 5.5mm capsulorhexis every time because of the possibility of a tear extending to the periphery. We are aware of the disadvantages of a large capsulorhexis, such as increased likelihood of IOL decentration and an increased rate of posterior capsule opacification since the capsule edges do not overlap the optic edge circumferentially. However, we think the safety of the retrochop technique outweighs the drawbacks in dense cataracts and the complete division of the nucleus is warranted since it starts from the posterior pole, which is the most difficult part to crack. We encourage cataract surgeons to consider this technique for mature cataract cases.

Comments on corneal astigmatic marking methods

Comments on corneal astigmatic marking methods In their recent paper, Popp et al. investigated and compared 4 methods of corneal marking for astigmatism correction when the surgeon intended to correct astigmatism surgically with or without cataract surgery: pendular marker, bubble marker, tonometer marker, and scratching the cornea with an insulin needle at the slitlamp. We propose a different and simple technique for the same purpose: marking the astigmatic axis directly with the patient sitting at the slitlamp. In this technique, the slit light of the slitlamp is turned in the steep astigmatic meridian in the orthograde position using the rotator switch of the slit light. The patient is instructed to look at a distant target at head height with the fellow eye, and the slit is centered on the apex of the cornea. Then, 2 tips of the astigmaticmeridian are marked where they cross at the limbus 180 degrees away with a marking pen. As ophthalmologists know, the rotator switch of the slitlamp is ordinarily used at the 90-degree position to see the slit light vertically. When the rotator switch is turned to the right side of the examiner, the axis of the slit light turns from 90 degrees toward 0 degree. When the rotator switch is turned to the left side, the axis of the slit light turns from 90 degrees toward 180 degrees. In this way, the delicate alignment to find the exact meridian can be made. The main advantage of this technique is simplicity. We mark the intended steep astigmatic axis directly and also the surgical entry site, if we desire. We need only a slitlamp and a marking pen so we can perform the task at 1 time instead of 2.

Ocular surface findings in patients with rheumatoid arthritis under methotrexate or biological agent therapy.

Abstract Purpose: To evaluate the ocular findings in patients with rheumatoid arthritis (RA) treated with disease-modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX) or MTX with biological agents. Methods: One hundred and twelve eyes of 56 patients with RA and treated with MTX or MTX with biological agents were included in the study. Patients were divided into two groups using DMARDs only (group 1) and patients using DMARDs and biologic agents together (group 2). In both groups; Schirmer’s II test, tear film break-up time (tBUT), central corneal thickness (CCT), corneal volume (CV), intraocular pressure (IOP) measurement, and anterior segment and fundus examinations of the eye with slit lamp were carried out. Ocular surface disease index (OSDI) score questionnaire were performed. Results: Thirty-eight patients with a mean age of 53.00 ± 8.19 years were in group 1 and 18 patients with a mean age of 51.00 ± 9.54 years were in group 2. The mean duration of RA was 6.89 ± 7.96 years in group 1 and 5.70 ± 9.00 years in group 2. There was a statistically significant difference between two groups with tBUT, CCT, CV, IOP (p < 0.05) and there was no significant difference with age, sex, disease duration, disease activity, and Schirmer’s II test (p > 0.05). The disease duration showed a significant moderate negative correlation with CCT and CV in group 2 (p < 0.05). Conclusions: Although tBUT values were significantly higher in the combination treatment group, CCT and CV values were significantly lower. Due to the decrease in corneal thickness, IOP was determined to be significantly lower.

A reasonable option in vitrectomized eyes: manual small incision cataract surgery.

Dear Sir,It is known that cataract surgery is challenging in vitrectomized eyes.Cataract surgeons may have encountered with posterior capsular complications and nucleus drop events even with minimal ocular manipulations and low irrigation bottle height.Inadvertent damage to the zonular fibers,posterior or peripheral lens capsule with ocutome or microvitreoretinal(MVR)blade in previous

Cilioretinal artery: Vasculogenesis might be promoted by plasminogen activator inhibitor-1 5G allele.

ABSTRACT Background: Cilioretinal arteries (CAs) represent enlargements of microscopic and early established collaterals formed via vasculogenesis between choroidal and retinal circulations. We aimed to investigate whether genetic tendency to thrombosis due to well-known gene polymorphisms may induce CA vasculogenesis in embryonic life. Methods: We assessed plasminogen activator inhibitor-1 (PAI-1) 4G/5G, methylenetetrahydrofolatereductase (MTHFR), FACTOR V LEIDEN and PROTHROMBIN gene polymorphisms on 130 patients [82/48 females/males; Median age: 57 (18–84) with visible CAs and 100 (64/36: female/male; Median age: 55 (19–90)] without visible CAs. Results: Using multiple logistic regression models, we found PAI-1 4G/5G; MTHFR (C677T and A1298C) polymorphisms to have significant effects on the probability of visible CAs, that having at least one 5G allele would increase the odds of having visible cilioretinal artery by 98.4% [Odds ratio: 1984 (95% CI: 1.320–3.000, p = 0.001)], and having at least one MTHFR C677T or A1298C allele would decrease the odds of having visible CAs by approximately 38% (OR = 0.618, 95% CI: 0.394–0.961, p = 0.035) or 44% (OR = 0.558, 95% CI: 0.354–0.871, p = 0.011), respectively. Conclusions: This is the first study to test the existence of significant association between presence of enlarged and visible CAs and genetic factors predisposing to thrombosis, according to the literature. Here we suggest that not only the lack of genetic predisposition to thrombosis by MTHFR gene polymorphisms, but also the PAI-1 5G allele might promote vasculogenesis of CAs.