Ziya Kapran

Evaluation of Macular Changes After Uncomplicated Phacoemulsification Surgery by Optical Coherence Tomography

Purpose: To evaluate the effect of uncomplicated phacoemulsification surgery on macula by optical coherence tomography (OCT). Methods: A total of 110 eyes of 102 patients who underwent uncomplicated phacoemulsification and foldable intraocular lens implantation at Beyoglu Eye Research and Training Hospital between February and March 2005 and who were without any systemic disease, fundus or other ocular pathology were included. Postoperatively, topical prednisolone acetate (6× 1) and ofloxacine (5× 1) was started, and by decreasing the dosage progressively, treatment was continued for 6 weeks. Full ophthalmologic and OCT examinations were done preoperatively and at the postoperative 1st day, 1st week, 1st, 3rd, and 6th months. Mean retinal thicknesses, volumetric analyses at central fovea, superior, inferior, temporal, and nasal macular quadrants, and thinnest foveal retinal thicknesses were recorded. Preoperative and postoperative measurements were analyzed statistically by using ANOVA test, paired samples t-test with Bonferroni correction, and Pearsons correlation test. Results: The mean central foveal retinal thickness was preoperatively 202.4 ± 25.9 μ m, postoperatively 200.4 ± 26.1 μ m at 1st day (p = 0.29), 208.4 ± 27.6 μ m at 1st week (p = 0.29), 226.2 ± 54.9 μ m at 1st month, 215.2 ± 24.0 μ m at 3rd month, 213.5 ± 29.4 μ m at 6th month (p < 0.001). Perifoveal macular thicknesses at superior, inferior, temporal, and nasal quadrants were 264.9 ± 28.8 μ m, 266.1 ± 29.5 μ m, 255.0 ± 31.3 μ m, 260.3 ± 34.0 μ m, respectively, preoperatively; 287.9 ± 28.4 μ m, 288.0 ± 26.3 μ m, 286.8 ± 33.1 μ m, 272.0 ± 32.4 μ m, respectively, at postoperative 1st month (p < 0.001). The change in mean central foveal thickness, foveal thinnest retinal thickness, mean perifoveal retinal thickness and volumetric analyses was insignificant at postoperative 1st day (p > 0.05), and significant at 1st week, 1st, 3rd, and 6th months (p < 0.05 for all measurements). Conclusions: Statistically significant increase in macular thickness was detected at postoperative early periods, after the 1st week after uncomplicated cataract operation. The increase in macular thickness starts from parafoveal regions. Longer follow-up of patients is required for the macular consequences, and different treatment protocols should be studied in a randomized controlled fashion.

Twelve-month safety and visual acuity results from a feasibility study of intraocular, epiretinal radiation therapy for the treatment of subfoveal CNV secondary to AMD.

Purpose: The purpose of this study was to evaluate the short-term safety and feasibility of intraocular, epiretinal delivery of beta radiation for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration for 12 months. A 3-year follow-up period is planned to assess the long-term safety of the procedure. Methods: In this nonrandomized, multicenter feasibility study, 34 treatment-naïve patients with predominantly classic, minimally classic, or occult lesions due to subfoveal choroidal neovascularization secondary to age-related macular degeneration received a single treatment with either 15 Gray (Gy) (8 patients) or 24 Gy (26 patients) beta radiation (strontium-90) using a novel intraocular delivery device. Adverse events and safety endpoints were observed and recorded. Visual acuity was measured preoperatively and postoperatively using standard Early Treatment Diabetic Retinopathy Study vision charts. Results: Twelve months after treatment, no adverse events associated with exposure to radiation were observed. All patients in both 15 Gy (n = 4) and 24 Gy cohorts (n = 17) who met inclusion criteria and were treated according to protocol lost fewer than three lines of vision. Fifty percent (2/4) of the 15 Gy-treated patients and 76% (13/17) of the 24 Gy-treated patients improved or maintained their visual acuity at 12 months. In the 24 Gy group, 29% (5/17) gained three lines or more in visual acuity. The mean change in visual acuity observed at month 12 was +10.3 letters in the 24 Gy study cohort and −1.0 letters in the 15 Gy cohort. Conclusion: The short-term safety and efficacy of intraocular, epiretinal delivery of beta radiation for the treatment of subfoveal choroidal neovascularization was promising in this small study group and should be studied in a larger cohort of patients.

Early postoperative hypotony after 25-gauge sutureless vitrectomy with straight incisions.

Purpose: To evaluate the rate, duration, and associated complications of postoperative hypotony after 25-gauge sutureless vitrectomy. Methods: In a retrospective, interventional, institutional case series, 25-gauge sutureless vitrectomy with straight incisions was performed on 111 eyes. Postoperative intraocular pressure (IOP) was measured routinely at 2 hours, 1 day, 1 week, and 1 month. Postoperative IOP, hypotony (IOP, <8 mmHg) rates, and complications associated with low IOP were assessed to determine outcome. Results: Mean follow-up ± SD was 5.45 ± 3.44 months. Mean IOP decreased significantly by 2 hours and on postoperative day 1 (P < 0.001) and increased to preoperative levels at week 1 (P = 0.48). Postoperative hypotony rates were 26.12%, 17.11%, and 8.10% at 2 hours, 1 day, and 1 week, respectively. The ratio of postoperative vitreous hemorrhage in eyes with and without hypotony on day 1 was 2:6 (P = 0.412). Two eyes with macular holes (MHs) filled inadequately with gas endotamponade that remained hypotonic for the first postoperative week underwent reoperation due to unsealed MHs. Conclusions: Twenty-five–gauge sutureless vitrectomy with straight incisions resulted in a hypotony rate of 26.12% at 2 hours that decreased to 17.11% on day 1 and to 8.10% at week 1 but did not increase the incidence of postoperative complications.

Efficacy of intravitreal triamcinolone for the treatment of macular edema secondary to branch retinal vein occlusion in eyes with or without grid laser photocoagulation.

Purpose: To evaluate the efficacy of primary and secondary (following grid laser photocoagulation) intravitreal triamcinolone acetonide (IVTA) injection for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). Methods: Eyes with macular edema secondary to BRVO and best-corrected visual acuity (BCVA) worse than 20/40 were included. Eyes eligible for Branch Retinal Vein Occlusion Study (BVOS) guidelines received grid laser treatment first. Those that were not improved at least two lines following grid laser or that did not meet those guidelines received 4 mg IVTA injection. The efficacy of IVTA treatment was assessed by analyzing the change in BCVA and reduction in central macular thickness (CMT) measured by optical coherence tomography. Intraocular pressure (IOP) spikes and other complications were recorded. Results: The data from 37 eyes were included; in 12 of them IVTA injection was given after grid laser while 25 of them received IVTA as a primary treatment. Mean follow-up was 9.6 ± 4.5 months. BCVA was 0.06 ± 0.30 and 0.17 ± 0.50 in the primary and secondary IVTA injection groups, respectively. In the primary injection group, there was a statistically significant gain in BCVA throughout the follow-up (P < 0.05), while a small increase in BCVA was noted only at the third month visit in the secondary IVTA injection group (P = 0.04). Average CMT were 434.8 ± 122.1μm and 389.0 ± 171.9 μm before IVTA injection in the two groups, respectively. In the primary IVTA injection group, CMT decreased at 1 month following IVTA injection and remained statistically significant until the sixth month visit (P < 0.05). In the secondary IVTA injection group, a slight reduction in CMT was noted only in the first month visit (P = 0.02). Pre-IVTA BCVA was found to be the single statistically significant predictor of BCVA gain following IVTA injection. In 8 patients (21.6%), the IOP increased above 25 mmHg postoperatively, and was successfully managed by medical treatment. Endophthalmitis did not develop in any of the patients. Conclusion: IVTA injection produced a significant reduction of macular edema in eyes with BRVO either with or without prior grid laser treatment. Reduction of CMT increased the BCVA in most of the eyes receiving IVTA primarily, while only a slight improvement of BCVA was found in eyes with prior grid laser. The IVTA effect was transient. Larger studies are necessary to find the best approach (either grid laser or IVTA) to patients with macular edema associated with BRVO.

Ocular Trauma Score in Open-Globe Injuries

BACKGROUND To determine the value of calculating an ocular trauma score (OTS) for patients with open-globe injuries. OTS evaluating system can provide valuable prognostic information, and its use may be an asset in counseling patients with open-globe injuries. METHODS This study was conducted as a retrospective review of 114 eyes of 114 patients who presented with open-globe injuries between January 2001 and July 2006. OTS variables (visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment, and afferent pupillary defect) were determined and OTS was calculated in 114 eyes of 114 patients at the time of initial examination. In this study, presenting and final visual acuity were grouped (1 through 5) as > or = 20/40, 20/200 to 20/50, 1/200 to 19/200, light perception (LP)/hand motion (HM), and no light perception (NLP), similar to the OTS study group. Numerical values to the OTS variables were converted into OTS categories. Similarity of final visual acuities by groups was compared with those in the OTS study. Patients under the age of two and the ones with incomplete data for OTS variables were excluded. RESULTS When comparing the distribution of final visual acuity in all OTS categories, no statistically significant difference was found (p = 0.35) between the results of our study and the OTS study group. NLP ratio in category 1 and > or = 20/40 ratio in category 5 were statistically higher than in our study (p = 0.01). However, in our study, category 2 of LP/HM ratio (p < 0.0001) was statistically higher than in the OTS study. The likelihood of the final visual acuities (NLP, LP/HM, 1/200 to 19/200, 20/200 to 20/50, and > or = 20/40) in the other OTS categories in this group was similar to those in the OTS study group. The OTS showed positive correlation with final visual acuity (p < 0.001). CONCLUSION In open-globe injuries, a commonly accepted system for calculating ocular trauma score (OTS) can provide reliable prognostic information.

Visual predictive value of the ocular trauma score in children

Background/aims: To analyse the predictive value of ocular trauma score (OTS) in open-globe injuries in children. Methods: Thirty open-globe injuries in children 16 years or younger treated at our facilities were included. OTS variables (visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment and afferent pupillary defect) were determined at the initial presentation and converted into the OTS categories as performed in the OTS Study. The distribution of the percentage of final visual acuity in each category was compared between the OTS study and our study. Results: Compared with the OTS Study, in our group no light perception ratios were lower in the first two categories (p = 0.012, p<0.001, respectively); light perception/hand motion, and 1/100–19/100 ratios were higher in categories 2 and 3 (p<0.001 each), and the 20/200 to 20/50 ratio was lower in categories 3, 4 and 5 (p<0.001, p<0.001, p = 0.028, respectively). The ratio of ⩾20/40 was lower in categories 2 and 3 (p<0.001, each) but higher in category 4 (p<0.001). In this study, the distribution of the percentage of final visual acuity in various OTS categories was found to be different between our study and the OTS study. Conclusion: In the paediatric population, OTS calculations might have limited value as predictors of visual outcome.

Transconjunctival 25-gauge sutureless vitrectomy and silicone oil injection in diabetic tractional retinal detachment.

Purpose: The purpose of this article was to evaluate the outcomes and complications of transconjunctival sutureless 25-gauge vitrectomy using silicone oil tamponade in diabetic tractional retinal detachment. Materials and Methods: Patients were retrospectively evaluated. Main outcome measure was the feasibility of pars plana vitrectomy and silicone oil injection with 25-gauge system in eyes with diabetic tractional retinal detachment. Results: Fourteen eyes of 14 patients were included in the study. Tractional retinal detachment was accompanied by vitreous hemorrhage in 9 eyes and combined traction/rhegmatogenous retinal detachment was present in 1 eye. All patients underwent transconjunctival sutureless 25-gauge vitrectomy and 1,000 centistokes silicone oil injection. Angled insertion of the trocars was made in all eyes. Bimanual surgery was performed in 6 (42.8%) eyes. The median preoperative best-corrected visual acuities were 3.00 logarithm of the minimum angle of resolution; it increased to 1.60 logarithm of the minimum angle of resolution at last visit. Retinal tear formation occurred in 4 (28.5%) eyes. Retinal detachment developed in 2 (14.2%) eyes. Intraocular pressure of 5 mmHg or less was detected in 3 (21.4%) eyes. One patient lost light perception due to anterior hyaloidal fibrovascular proliferation. Conclusion: Pars plana vitrectomy and 1,000 centistokes silicone oil injection with 25-gauge system is feasible in diabetic tractional retinal detachment even in complex cases. Indications of 25-gauge surgery may be expanded toward this area.

Primary 25-gauge sutureless vitrectomy with oblique sclerotomies in pseudophakic retinal detachment.

Purpose: To evaluate the anatomic and functional outcomes of 25-gauge sutureless vitrectomy in primary treatment of noncomplex pseudophakic rhegmatogenous retinal detachments (RRD). Methods: Prospective interventional institutional case series. Twenty-two eyes with pseudophakic RRD with proliferative vitreoretinopathy grade A or B underwent primary 25-gauge vitrectomy with oblique sclerotomies and gas endotamponade. Eyes with minimum follow-up of 6 months were evaluated. Main outcome measures were reattachment rate with single surgery, reoperation, complication rates, and changes in visual acuity (VA). Results: Mean duration of visual loss was 14.68 ± 12.87 days. Seventeen (77.27%) eyes had macular detachment. In all eyes 25-gauge sutureless vitrectomy was completed without complications. The mean follow-up period was 10.40 ± 5.77 months. Retinal attachment was achieved in 21 (95.45%) eyes with single surgery and in all (100%) eyes with second vitrectomy. Mean preoperative VA of 1.61 ± 1.18 improved to 0.50 ± 0.53 at the last visit (P < 0.001). Transient hypotony was detected in 2 (9.09%) eyes with spontaneous resolution. No other postoperative complication was observed. Conclusions: Twenty-five-gauge sutureless vitrectomy with oblique sclerotomies in primary treatment of noncomplex pseudophakic RRDs resulted in reattachment in 95.45% with single surgery, and in 100% with reoperation in one eye, accompanied by an increase in visual acuity in 86% of eyes.

Optical coherence tomography evaluation of macular edema after intravitreal triamcinolone acetonide in patients with parafoveal telangiectasis.

Purpose Parafoveal telangiectasis (PT) is a developmental or acquired microvascular abnormality of the macula. Leakage of the abnormal parafoveal capillaries leads to macular edema with subsequent decrease in visual acuity. Intravitreal triamcinolone acetonide is recently widely used in the management of intraocular proliferative, edematous, and neovascular diseases. Methods This report presents the evaluation of three cases with PT in whom intravitreal triamcinolone acetonide (IVTA) injection was performed. Fundus fluorescein angiography (FA) and optical coherence tomography (OCT) were used in follow-up of the patients. Results Following pars plana intravitreal injection of 4 mg of triamcinolone acetonide, the patients had angiographic improvement of the macular edema and minimal decrease in retinal thickness on OCT, accompanied by improvement in visual acuity and subjective visual assessment. Conclusions The results of the present study on parafoveal capillary telangiectasis suggest that the intravitreal injection of triamcinolone acetonide may be a therapeutic option to increase visual acuity and decrease vascular leakage on FA. Following IVTA procedure, follow-up of these patients with both OCT and FA is important for correct clinical evaluation. Future studies on this method seem to be warranted.

Removal of silicone oil with 25-gauge transconjunctival sutureless vitrectomy system.

Purpose: To report a new and simple technique for silicone oil removal from pars plana with 25-gauge (G) transconjunctival sutureless vitrectomy system (TSVS). Methods: In this prospective, interventional clinical trial, 13 eyes underwent silicone oil (1000 centistokes) removal from pars plana passively, with 25-G TSVS, between January and May 2005. Main outcome measures were postoperative visual acuity, intraocular pressure (IOP), silicone oil removal time, complications, and number of sutured sites. Results: In all eyes silicone oil was removed successfully under sub-Tenon (n = 12) and topical (n = 1) anesthesia. The mean silicone oil removal time was 7.27 ± 0.48 minutes. No intraoperative complications were reported. No suture placement was necessary. Mean postoperative follow-up period was 3.92 ± 1.49 (range: 3–7) months. Visual acuity improved or stabilized in 11 (84.61%) eyes. Retinal redetachment occurred in 2 (15.38%) eyes resulting in a decrease in vision. Decrease in postoperative IOP was found only at 2 hours (P = 0.003). Postoperatively, transient hypotony at 2 hours (n = 1) and transient vitreous hemorrhage (n = 1) were noted. There were no cases of choroidal detachment, endophthalmitis, clinically significant corneal endothelial decompensation, or macular edema. Conclusion: Removal of silicone oil of 1000 centistokes with 25-G transconjunctival sutureless sclerotomies was effective and safe.