Zafer Oztas

Suprachoroidal implant surgery in intractable glaucoma.

PurposeTo report the early results of suprachoroidal silicone implant surgery in intractable glaucoma.Materials and methodsA modified silicone implant with no valve was implanted into the suprachoroidal space of 15 eyes with intractable glaucoma.ResultsThe mean age of the patients was 53.0 ± 24.5 (range 7–85) years, the mean follow-up time was 17.1 ± 4.8 (range 10–28) months, and the mean preoperative intraocular pressure (IOP) of patients receiving two or more medications was 33.1 ± 9.8 mmHg. At the last follow-up visit, mean IOP was 16.5 ± 7.9 (range 10–35) mmHg (Wilcoxon signed rank test, p = 0.001). The functional success, i.e., IOP ≤21 mmHg both with and without antiglaucomatous drugs, was 93.3%. The total success rate, i.e., IOP ≤21 mmHg without medication, was 13.3%. The average number of antiglaucomatous drugs used was 3.8 (range 2–5) preoperatively, and 2.2 postoperatively (range 0–4) (Wilcoxon signed rank test, p = 0.011). There was a ≥30% decrease in the IOP of 66.6% of the eyes. Shallow choroidal detachment as proof of drainage was evident in all cases.ConclusionDrainage of the aqueous humor from the anterior chamber to the suprachoroidal space via implantation of a modified silicone implant is effective in lowering the IOP in intractable glaucoma.

Evaluation of posterior vitreous detachment after uneventful phacoemulsification surgery by optical coherence tomography and ultrasonography

The aim was to investigate the effect of uneventful phacoemulsification on vitreoretinal interface evaluated by optical coherence tomography (OCT) and ultrasound.

The Prevalence and Characteristics of Charles Bonnet Syndrome in Turkish Patients with Retinal Disease

Purpose: The aim of this study is to investigate the prevalence and clinical characteristics of Charles Bonnet syndrome (CBS) in a group of Turkish patients with various retinal diseases. Methods: Two hundred and sixty-four patients with a best-corrected visual acuity of ≤20/40 in the better-seeing eye were asked with a standardized question whether they had symptoms of CBS. If they responded positively, a questionnaire was verbally administered to learn more about the details of the symptoms. Results: There were 125 (47.3%) females and 139 (52.7%) males with a mean age of 72.1 years (range 31-90). Seventeen (6.4%) patients were diagnosed with CBS. Three (17.7%) patients had noncomplex hallucinations and 14 (82.3%) had complex hallucinations. Conclusion: CBS is not uncommon in visually impaired patients with retinal disease. Clinicians who care for visually impaired patients should be aware of CBS.

Long-term Choroidal Thickness Changes After Acute Solar Retinopathy.

BACKGROUND AND OBJECTIVE To identify long-term changes in choroidal thickness after solar retinopathy. PATIENTS AND METHODS The study included 25 eyes of 25 men with acute solar retinopathy. Ocular examination, best corrected visual acuity (BCVA), and retinal and choroidal thickness measurements obtained using spectral-domain optical coherence tomography were evaluated. RESULTS The mean follow-up was 6.1 ± 0.4 months. The initial BCVA decreased in the affected eyes (P < .001). The mean BCVA (logMAR) improved significantly from 0.16 ± 0.06 to 0.03 ± 0.05 at 6 months (P < .001). There were no significant differences in the initial retinal and choroidal thicknesses between the affected and other eyes, while there was a significant decrease in the mean macular thickness and mean macular volume at 1 month and the mean choroidal thickness increased (P < .001). CONCLUSION Significant retinal and choroidal thickness changes occurred after solar retinopathy. The changes in choroidal thickness suggest that the effects of solar retinopathy might not be limited to the retina.

The Importance Of The Peripheral Retina In Patients With Central Serous Chorioretinopathy

Purpose: This research investigated the peripheral retinas of patients with central serous chorioretinopathy (CSCR). Methods: Sixty patients with CSCR and 60 age- and gender-matched controls were included in this prospective cross-sectional study. All 120 participants underwent ocular examinations and peripheral retinal evaluations using a Goldmann three-mirror lens. Results: The examinations demonstrated peripheral retinal degeneration, atrophic or hyperplastic retinal pigment epithelial changes, and retinal breaks. The peripheral retinal degeneration rate was 39% in the CSCR group and 15% in the control group, and the CSCR group reported significantly more lattice degeneration than the control group (22 vs. 3%) (P = 0.004, odds ratio = 1.97, confidence interval = 0.68–5.65 and P = 0.002, odds ratio = 4.55, confidence interval = 0.77–26.83, respectively). Symptomatic U-shaped retinal breaks were found in three eyes (5%) in the CSCR group, and the rate of peripheral retinal degeneration was higher in the patients with chronic CSCR (vs. acute CSCR). However, this difference was not significant (P = 0.244). Conclusion: This study showed that peripheral retinal abnormalities, particularly lattice degeneration, are more common in patients with CSCR. Therefore, the authors recommend regular retinal examinations, with the inclusion of peripheral retinal assessments, for patients with CSCR.

Characteristics of Fundus Autofluorescence in Active Polypoidal Choroidal Vasculopathy

Objectives: To define characteristic fundus autofluorescence (FAF) findings in eyes with active polypoidal choroidal vasculopathy (PCV). Materials and Methods: Thirty-five eyes of 29 patients with active PCV who were diagnosed at Ege University Faculty of Medicine, Department of Ophthalmology, Retina Division between January 2012 and November 2014 were included in the study. All the patients underwent a complete ophthalmological examination including fundus photography, spectral-domain optical coherence tomography, fluorescein angiography, FAF photography, and indocyanine green angiography (ICGA). ICGA was used to diagnose active PCV and identify lesion components. FAF findings were described at the retinal site of the corresponding lesions identified and diagnosed using ICGA. Results: The mean age of the 29 study patients (15 men, 14 women) was 64.6±7.5 years (range, 54-82 years). ICGA revealed active PCV in 35 eyes, consisting of polypoid lesions in 11 eyes (31.4%), branching vascular networks (BVN) in 10 eyes (28.6%), and a combination of polypoid lesions and BVNs in 14 eyes (40%). On FAF images, 4 different patterns were detected at the corresponding retinal sites of 25 polypoid lesions detected by ICGA: confluent hypoautofluorescence with a hyperautofluorescent ring in 18 eyes (72%), hyperautofluorescence with hypoautofluorescent ring in 2 eyes (8%), confluent hypoautofluorescence in 1 eye (4%), and granular hypoautofluorescence in 1 eye (4%). The remaining 3 eyes (12%) demonstrated blocked hypoautofluorescence because of the excessive hemorrhaging in the macula. The FAF images showed the granular hypoautofluorescent FAF pattern in all 24 BVNs (100%) consistent with the location of the lesions on ICGA. Conclusion: The typical PCV lesions, polypoid lesions and BVNs had characteristic autofluorescent findings on FAF imaging. Non-invasive, quick, and repeatable FAF imaging can be considered a reliable and helpful diagnostic technique for the diagnosis of active PCV.

Minor trauma resulting in subretinal haemorrhage with choroidal rupture: a case of subtle pseudoxanthoma elasticum in a child.

Pseudoxanthoma elasticum (PXE) is a rare autosomal recessive inherited multisystem disease primarly affecting the skin, cardiovascular system and retina with a prevalence of one in 25,000 to 70,000 births. Pseudoxanthoma elasticum is attributed to mutations in the ABCC6 gene on chromosome 16p13.1 and is characterised by slow, progressive abnormalmineralisation and fragmentation of elastic fibres in affected tissues. Because of its slow progression, PXE is usually diagnosed in the second or third decade of life. The presentation of PXE in children or in young adults is often limited to subtle, asymptomatic cutaneous lesions. Furthermore, early retinal changes typical of PXE, including peau d’orange appearance and subsequent angioid streaks are asymptomatic and often overlooked in children. PXE-related severe ocular complications are very rare before the age of 15 years. We report here an unusual initial presentation of PXE in a child. To our knowledge, this is the first case of PXE in which minor eye trauma resulted in serious ophthalmologic findings before the onset of angioid streaks.

The effects of Nd:YAG laser capsulotomy on anterior segment parameters in patients with posterior capsular opacification.

The aim was to investigate the effects of neodymium‐doped yttrium aluminum garnet laser capsulotomy on the main numerical parameters of the anterior segment with Pentacam in patients with opacification of the posterior capsule.

Retinal Angiomatous Proliferation: Multimodal Imaging Characteristics and Follow-up with Eye-Tracked Spectral Domain Optical Coherence Tomography of Precursor Lesions

Objectives: To present the multimodal imaging characteristics of precursor retinal angiomatous proliferation (RAP) lesions and follow-up results with eye-tracked spectral-domain optical coherence tomography (SD-OCT). Materials and Methods: Six eyes of 6 patients aged 77.5±5.9 years diagnosed with precursor RAP lesion were included in this prospective observational case series. Best corrected visual acuity (BCVA) measurement and complete ophthalmologic examination were performed for all subjects, as well as fundus photography (FP), fundus autofluorescence (FAF), SD-OCT, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography angiography (OCTA), and their long-term follow-up results are presented. Results: The mean BCVA was 0.8±0.16 (0.6-1) Snellen and the mean follow-up was 26.3±14.8 months. Images of the precursor RAP lesions demonstrated no specific findings on FP and FAF, showed focal hypofluorescent foci with no leakage on FA and IGA, and appeared as extrafoveal small, round, well-defined, hyperreflective foci typically located in the outer retinal layers on SD-OCT B-scans with high sampling density. OCTA demonstrated the precursor lesions as the deep capillary plexus abnormalities in 3 eyes. Two eyes progressed to stage 1 RAP during the follow-up period. Conclusion: This study defined the diagnostic characteristics and clinical course of precursor RAP lesions. Our findings highlight the importance of B-scans with high sampling density for the diagnosis of precursor lesions and using eye-tracking mode SD-OCT during follow-up.

Direct Treatment Costs of Neovascular Age-related Macular Degeneration and Comparison of Gained and/or Preserved Vision with Expenditure

Objectives: The aim was to quantify the direct medical cost of neovascular age-related macular degeneration (AMD) versus gained or preserved vision. Materials and Methods: Data of patients treated for neovascular AMD between January 2009 to January 2014 were reviewed. Patients with complete follow-up for two years, treated with only intravitreal ranibizumab injections and with no intraocular surgery were included. Demographics, diagnostic investigations, the number of visits and injections, changes in visual acuity (VA) at one year and two years from baseline were noted. Total cost was calculated for the first and second years, and the cost of improving or preserving initial vision level was determined with subgroup analysis. Results: Two-hundred eyes of 175 patients (86 male and 89 female) with a mean age of 72.3±7.8 years were included. Mean VA was 0.67 logMAR at baseline, 0.60 logMAR at the end of the first year, and 0.67 logMAR at the end of the second year. At the end of the 2 years, VA increased in 82 eyes (41%), remained the same in 42 eyes (21%), and decreased in 76 eyes (38%). The mean number of visits in the first and second years were 6.56 (3-12) and 5.74 (3-10), respectively. An average of 4.42 (1-8) injections were performed in the first year and 2.25 (0-7) in the second. The total direct medical cost for AMD was 9,628 TL (Turkish Lira) per patient for 2 years, which consisted of 529 TL in visit costs, 115 TL in fluorescein and indocyanine angiography costs, 611 TL in injection procedure costs, and 8,371 TL in drug costs. The cost of one line of VA gain was 11,911 TL in the first year. Conclusion: This study showed that treatment increased or stabilized vision in a reasonable proportion of patients, that cost of management decreases in the second year, and that drug expenses are the leading item in reimbursement.