Yildiray Yildirim

Postoperative changes in olfactory function after transcanalicular diode laser dacryocystorhinostomy.

Purpose: Transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) is used much in recent years for the surgery of nasolacrimal duct obstruction (NLDO). Although TCL-DCR is accepted to be minimally invasive, safe, and effective, there is no report focusing on postoperative changes in olfactory function after this procedure. Hence, the aim of this current study was to investigate the changes in olfactory function after TCL-DCR procedure. Materials and Methods: This study was carried out in 42 volunteers (16 men and 26 women) between the ages of 20 and 81 years. All participants received detailed lateralized olfactory tests preoperatively and at the postoperative first week, first month, third month, and sixth month. After lateralized olfactory tests were performed, the results were grouped according to the side of the nasal passage where the operation was performed for NLDO: the nonoperated side served as the control. Results: The current investigation produced 2 major findings: (1) olfactory function decreased significantly after TCL-DCR procedure at the operated side of the nose compared with the nonoperated side; (2) olfactory abilities of the patients returned to normal within 3 months. Conclusion: The results of this study showed that transcanalicular diode laser could be used safely in terms of olfactory function for dacryocystorhinostomy. Temporary decrease of olfactory function on the side having TCL-DCR should be taken into account when obtaining informed patient consent.

Evaluation of Color-Changing Effect and Complications After Nd: YAG Laser Application On Iris Surface

Background The aim of this study was to evaluate the color-changing effect and adverse effects after Nd: YAG laser application on the iris surface of rabbit eyes. Material/Methods The study was performed on right eyes of 12 pigmented rabbits. A laser device that produces frequency doubled 532 nm wavelength Nd: YAG laser with 900 μm spot diameter was used. The laser was applied in 3 sessions at 2-week intervals, at energy levels of 0.8 mJ in Group A and 1.5 mJ in Group B. Slit-lamp examinations and measurements of intraocular pressure (IOP) using a Tono-Pen were performed before and 1 day after each laser session. Iris thickness (IT) was measured at the beginning and the end using an ultrasonic biomicroscope. The eyes were enucleated for histopathologic examination on day 60. Results On the first day after each laser session, maximum grade 1 anterior chamber flare and cells were observed in both groups. In all eyes, flare and cells disappeared at the end of the first week. There was no significant difference in the IOP and IT values between measurements performed prior to and after laser sessions during the study (p>0.05). None of the eyes showed complications such as corneal edema, hypopyon, posterior synechia, transillumination defect, or pupillary defect. In histopathological examinations, reduction in pigment density was more profound in Group B compared to Group A, which was statistically significant (p<0.019). Conclusions There were no serious complications apart from mild transient inflammatory signs. Change in iris color was more evident at the end of the second month.

Comparison of Transcanalicular Multidiode Laser Dacryocystorhinostomy with and without Silicon Tube Intubation

Aim. To compare the surgical outcomes of surgery with and without bicanalicular silicon tube intubation for the treatment of patients who have primary uncomplicated nasolacrimal duct obstruction. Methods. This retrospective study is comprised of 113 patients with uncomplicated primary nasolacrimal duct obstruction. There were 2 groups in the study: Group 1 (n = 58) patients underwent transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation and Group 2 (n = 55) patients underwent transcanalicular diode laser dacryocystorhinostomy surgery without bicanalicular silicon tube intubation. The follow-up period was 18.42 ± 2.8 months for Group 1 and 18.8 ± 2.1 months for Group 2. Results. Success was defined by irrigation of the lacrimal system without regurgitation and by the absence of epiphora. Success rates were 84.4% for Group 1 and 63.6% for Group 2 (P = 0.011). Statistically a significant difference was found between the two groups. Conclusion. The results of the study showed that transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation was more successful than the other method of surgery. Consequently, the application of silicone tube intubation in transcanalicular diode laser dacryocystorhinostomy surgery is recommended.

Evaluation of Aflibercept Treatment Responses in Eyes with Bevacizumab/Ranibizumab-resistant Wet Age-related Macular Degeneration

Objectives: To evaluate anatomic and functional results after switching from intravitreal bevacizumab or ranibizumab treatment to aflibercept for wet (neovascular) age-related macular degeneration. Materials and Methods: This retrospective study included 22 eyes of 22 patients resistant to treatment with at least 6 injections of bevacizumab or ranibizumab. The first three injections had been applied monthly, the others pro re nata (PRN). Outcome measures were follow-up period, injection number, best corrected visual acuity (BCVA), central retinal thickness (CRT) and pigment epithelial detachment (PED) height. Dosing regimen of aflibercept was determined PRN. The patients were examined monthly. In all visits, BCVA and optical coherence tomography results were assessed together and injections were applied according to these findings. Patients with at least three months of follow-up were included in the study. Results: Twenty-two eyes of 22 patients treated with bevacizumab or ranibizumab were switched to aflibercept therapy. Seven patients had serous PED and 4 patients had fibrovascular PED. The mean follow-up periods for these groups were 20.59±6.76 months and 8.68±3.79 months, respectively. The mean injection numbers were 10.5±3.61 vs 4.54±1.56. Statistically significant reductions were noted in CRT (533.86±164.06 µm vs 412.04±143.86 µm, p<0.05). BCVA levels were almost equal before and after switching (0.18±0.17 vs 0.18±0.14). Serous and fibrovascular PED heights decreased suboptimally from 460±281.51 µm to 282.42±175.76 µm (p>0.05) for serous PEDs and 251.25±43.85 µm to 225.75±73.09 µm (p>0.05) for fibrovascular PEDs. Conclusion: Switching to aflibercept resulted in significant improvement in CRT, but not in BCVA or PED heights.

Choroidal Thinning may Change Scleral Architecture

We read the article entitled “Changes in Scleral Architecture in Chronic Vogt–Koyanagi–Harada Disease” by Harada et al., with great interest. The authors found progressive scleral changes that were associated with chorioretinal atrophy in Vogt–Koyanagi–Harada (VKH) disease. We thank the authors for this well-organized study. VKH is an inflammatory disease of the choroid. It is interesting to associate it with scleral changes without the existence of scleritis. While the authors conclude that chronic inflammation is a cause of these changes, sclera is not a primary tissue that is affected from inflammation. We hypothesize that choroidal atrophy may be the main cause of these changes. Choroidal tissue has the highest blood flow in the body. Hydrostatic pressure of the blood provides a stable pressure at the anterior side of the posterior sclera. As with a sponge, choroid may absorb and distribute force of intraocular pressure. A thin choroid may allow intraocular pressure to affect posterior sclera easily and cause sclera to replace through the posterior. Choroidal and scleral thicknesses have been reported to decrease in congenital glaucoma. Lamina cribrosa is a relatively thicker scleral tissue. Thinning of this tissue and development of cupping as a result of high intraocular pressure indicates that there is a balance between posterior scleral structure and intraocular pressure. Thus, scleral changes may develop as a result of thinning of the choroidal barrier in chronic VKH.

Prolidase Enzyme Activity in Conjunctiva and Pterygium Tissues

Background The aim of this study was to determine prolidase activity in conjunctival tissue and its relationship with pterygium. Material/Methods Prolidase activity was measured in 23 pterygium and 25 healthy conjunctival tissues and the 2 groups were compared. Results Prolidase enzyme activity could not be measured in either the healthy conjunctival or in pterygium tissues. The mean serum prolidase levels of the control and pterygium groups were 967.46±353.64 and 858.29±301.83, respectively. Statistically, there was no significant difference between the groups with regard to serum prolidase levels (p>0.05). Conclusions In conclusion, absence of prolidase activity in pterygium tissue indicates that there is no collagen turnover in this tissue. We may explain this finding with the elastin-rich structure of the conjunctiva.

Evaluation of interpupillary distance in the Turkish population.

Purpose The aim of this study was to report normative values and ranges of interpupillary distance (IPD) in different age groups of a Turkish population. Methods A total of 756 healthy subjects were included in this prospective study. After a complete ophthalmic evaluation, subjects were divided into four age groups to assess differences between age groups in relation to IPD. The age groups were 20–30, 31–50, 51–70, and 71–89 years. Far IPD measurements were performed using an autorefractometer (Topcon RM-8800). Results The mean age was 48.42±20.55 years, ranging from 19 to 89 years. The mean IPD was calculated as 62.5±4.1 mm (range 49–76). The mean IPD value was observed to be significantly higher among males compared to females (P<0.001). The difference among groups in terms of mean IPD was statistically significant (P<0.001). IPD increased by 4.19 mm in males and 3.11 mm in females from the young adults (20–30 years) to older adults (51–70 years), and then a decrease (2.6 and 0.19 mm for males and females, respectively) occurred between 70 and 89 years of age. Conclusion The current study offers the population-specific normative data on far IPD in different age groups. Our study showed that sex and age had a significant effect on IPD. Knowledge of normal values in this population subgroup may be useful in studying orbito-cranial growth patterns, syndrome diagnosis, surgical management of cranio-facial deformities and trauma, and manufactures of optical frames and lenses.

Diode laser-assisted transcanalicular dacryocystorhinostomy: the effect of age on the results

PURPOSE The aim of this study was to explore the effect of age on the success of transcanalicular diode laser-assisted dacryocystorhinostomy (TCDCR). METHODS Seventy patients (70 eyes) who underwent transcanalicular diode laser-assisted dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction as a primary surgery were included in this retrospective, nonrandomized study. The patients were divided into two groups according to age. Mean ages were 21.3 ± 3.3 in group 1 and 60.3 ± 7.3 in group 2. The records of the 3-, 6-, and 12-month follow-up examinations were evaluated, and the anatomical and functional outcomes were noted. Functional success was defined as the absence of epiphora as indicated by the patient. Anatomical success was determined as patency of the neo-ostium with irrigation. RESULTS At the 3-month follow-up, 67% cases in group 1 showed anatomical success and 52% showed functional success; in group 2, the rates were 100% and 92%, respectively. Functional and anatomical success rates were the same for both the 6- and 12-month visits; 46% in group 1 and 76% in group 2. The results in group 2 were significantly better at all three follow-up visits (p<0.05). CONCLUSIONS This study clearly showed that the older patients experienced better transcanalicular diode laser-assisted dacryocystorhinostomy results than the younger patients. The diminished inflammatory response in the older population may be a possible contributing factor to these results.

Progression of retinal artery occlusion from one eye to the other seems to be a characteristic finding in Susac syndrome

Correspondence address: Abdullah Kaya. GATA Haydarpasa Training Hospital Department of Ophthalmology Istanbul Turkey E-mail: abdullahkayamd@gmail.com Dear Editor; We read the article “Unilateral central retinal artery occlusion as the sole presenting sign of Susac syndrome in a young man: case report” written by Apóstolos-Pereira et al., with interest. They represented a patient who was diagnosed as Susac syndrome. Retinal artery occlusion is one of the pathognomonic sign of the Susac syndrome. This case was also reported to have retinal artery occlusion first in right eye and 3 weeks later in left eye. When we analyze literature, we see progression of eye impairment to be same among Susac patients. Retinal artery occlusion develops in one eye and in other eye within weeks or months. O’Halloran et al., reported a series of 5 Susac patients. Eye impairment of two patients have been reported to be unilateral initially but became bilateral within 3 months. Same progression pattern was reported for 5 patients by Martinet et al.. In two case reports, branch retinal artery occlusion (BRAO) have been reported to occur in one eye and in other eye within months. We understand from these case reports that, retinal artery occlusion in Susac syndrome begins in one eye and pass to other eye within weeks or months. This progression pattern seems to be characteristic for Susac syndrome. Therefore, Susac syndrome should be kept in mind especially for young patients who have unexplained retinal artery occlusion in one eye. Aggressive steroid treatment in these patients may survive their healthy eye.

Comment on: ‘Plasma, aqueous and vitreous homocysteine levels in proliferative diabetic retinopathy’

We read with great interest the paper by Lim et al 1 entitled ‘Plasma, aqueous and vitreous homocysteine levels in proliferative diabetic retinopathy’. We want to add a short notation to help the readers interpret the results of the study objectively. We do congratulate the authors for their valuable article. It is not so easy to collect simultaneously three …