Vascularization of coralline versus synthetic hydroxyapatite orbital implants assessed by gadolinium enhanced magnetic resonance imaging.

PURPOSE: To evaluate the fibrovascular in-growth of coralline and synthetic hydroxyapatite orbital implants by reporting the enhancement patterns on Gadolinium-Dietilen triamin penta acetic acid (Gad-DTPA) enhanced magnetic resonance imaging (MRI). METHODS: The medical records of 26 patients who had undergone primary or secondary orbital implantation between April 2008 and February 2011 were reviewed. T1 weighted Gad-DTPA MRI was performed between 5 and 12 months (mean 9.2 ± 5.9 months) after implantation and graded as follows to evaluate the fibrovascular in-growth of the implants; grade 1 (rim enhancement), grade 2 (peripheral foci of enhancement, not including the center), grade 3 (central, non-homogenous enhancement), grade 4 (central, homogenous enhancement) and grade 5 (central, intense enhancement).Results were analysed according to vascularization patterns on Gad-DTPA MRI. RESULTS: Central vascularization patterns (grade 3, 4 or 5) were seen 62.5% of coralline orbital implants and 46.1% of synthetic orbital implants. Central fibrovascular in-growth of the coralline implants were found significantly more than synthetic implants (p < 0.05). Central vascularization of coralline implants with primary implantation was 75% and with secondary implantation was 50%. Synthetic orbital implantation with primary surgery demonstrated 66.6% and synthetic orbital implantation with secondary surgery demonstrated 26.6% central vascularization pattern. In both natural coralline and synthetic implants, primary orbital implantation was demonstrated significantly better fibrovascular in-growth than secondary implantation (p < 0.05). Two patients with synthetic orbital implants had dehiscence that was repaired by using autogenous fascia lata. CONCLUSIONS: In both coralline and synthetic orbital implants, central vascular in-growth was observed much more with primary orbital implantation. This study indicates that coralline HA orbital implants significantly supply more rapid and homogenous vascularization than synthetic implants.

Intraoperative floppy-iris syndrome: comparison of tamsulosin and drugs other than alpha antagonists.

BACKGROUND: To determine and compare the incidence of intraoperative floppy iris syndrome (IFIS) features in patients using tamsulosin, and other chronic medications. METHODS: We prospectively studied patients who underwent phacoemulsification (PE) between March 2006 and October 2007 on use of tamsulosin or a single medication like antihypertansive (AH), antiaggregant (AAg), antipsycotic (AP) or oral antidiabetic (OAD). Patients were grouped as tamsulosin users (Group 1), previous tamsulosin users (Group 2), chronic medication users (AH, AAg, AP or OAD) (Group 3) and patients with no medication (Group 4). Comparison of pre and postoperative visual acuities, intraocular pressures, intraoperative posterior capsular rupture (PCR) rates and grades of IFIS among groups were evaluated. RESULTS: We studied 1567 eyes of 1530 subjects. Twenty five eyes in the study demonstrated IFIS (1.6%). Five cases were included in Group 1 and IFIS incidence was 80%, while it was 60% in Group 2 (n = 5), 1 % in Group 3 (n = 1099), 1.7% in Group 4 (n = 421). IFIS incidence was significantly higher in Groups 1 and 2 compared to Groups 3 and 4 (p < 0.001). There was no difference between Groups 1 and 2 (p = 1.0) and between 3 and 4 (p = 0.29). Most cases (72%) had all three signs of IFIS. Complete IFIS was seen in one patient in Groups 1 and 2, whereas it was seen in all IFIS patients of Groups 3 and 4 (p < 0.001). Incidence of PCR was significantly higher in Group 1 (p = 0.045). CONCLUSION: Tamsulosin was found to be the drug which was most likely to be associated with IFIS, but IFIS was also observed in patients chronically using losartan, aspirin, chlorpromazine and metformin. Although, IFIS incidences were found to be similar between chronic users of these drugs and those using no medications at the time of surgery, new studies in the future will introduce the predisposing factors and the possible mechanisms of IFIS with these medications.

Comparison of sutures and cyanoacrylate tissue adhesives for wound repair in a rat model of corneal laceration.

AIMS: The aim of the present study was to evaluate the cicatricial repair of a corneal artificial perforation in rats with 10-0 nylon suture, N-butyl-2-cyanoacrylate (NBCA) adhesive, or NBCA + methacryloxysulfolane (NBCA-MS) adhesive through microscopic and histological assays. METHODS: Twenty Wistar rats were randomly divided into 4 groups each containing 5 rats: (1) control group (corneal trauma without suturing and tissue adhesives), (2) suture group, (3) NBCA group and (4) NBCA-MS group. A central full-thickness 2-mm laceration was performed in the left eyes of the studied rats in all 4 groups. The presence of corneal edema, corneal neovascularization and tissue adhesive/suture were evaluated. On the 21st day, the rats were sacrificed and histological examination was performed to determine irregularity of corneal layers, superficial epithelization, polymorphonuclear leucocytes and neovascularization. RESULTS: Tissue adhesives were as effective as suturing in closing full-thickness corneal wounds and no difference in postoperative healing was observed clinically. As for the histological results, suture-treated eyes had persistent corneal irregularity that can limit visual acuity and may also lead to astigmatism. CONCLUSIONS: The use of tissue adhesives constitutes a viable alternative clinical procedure to conventional sutures. Possible influences on astigmatism are hypothetical, as no objective measure of astigmatism was performed in the test animals.

Clinical outcomes of amniotic membrane transplantation in patients with corneal and conjunctival disorders.

PURPOSE: To evaluate the effectiveness of amniotic membrane transplantation (AMT) in management of corneal and conjunctival diseases in large clinical series. METHODS: 130 patients who had undergone AMT between February 2004-March 2011 were evaluated. The cases were selected from two main groups: corneal (105) and conjunctival disorders (25). Results were analyzed by ANOVA test defining the outcomes as success, recurrence, and failure. P values less than 0.1 were defined as significant. The success criteria of the corneal group was complete re-epitelization of cornea in the first month and formation of a deep anterior chamber. The success criteria of conjunctival disorders was regarded as complete re-epitelization by the fifteenth day of follow-up. RESULTS: The cornea healed satisfactorily 85.7% of the corneal group and the success rate of conjunctival group was 92% (p=0.524 for success and p=0.245 for recurrence). There was not a significant difference between subgroups (p=0.167 for cornea subgroups and p=1.00 for conjunctiva subgroups). Corneal epithelial defect rapidly healed and there was significant visual acuity improvement after AMT (p=0.001). CONCLUSION: AMT is effective to promote corneal healing in patients with persistent epithelial defect and appeared to be helpful after surgery to release pain. It can be successfully used as an alternative to conjunctival autograft for conjunctival surface reconstruction.

Focal posterior pole viral retinitis.

PURPOSE: To describe the clinical features of an atypical form of viral retinitis in immunocompetent patients. METHODS: This was a retrospective noncomparative case series. The charts of 8 patients diagnosed with and treated for focal posterior viral retinitis were reviewed. Clinical and demographic features were evaluated. All the patients had extensive laboratory tests, fundus fluorescein angiography, optical coherence tomography of macula, and polymerase chain reaction of vitreous. RESULTS: All the patients were referred to our Uveitis Service from other hospitals, as their uveitis symptoms deteriorated in spite of treatment. The mean age of 4 male and 4 female patients was 32.1 years (range, 22-42 years). The mean follow-up period was 10 months (range, 6-18 months). All of the patients had unilateral disease. Polymerase chain reaction analysis of vitreous specimen was positive for herpes simplex virus-1 in 5 patients and varicella zoster virus in 3 patients. Retinitis resolved after systemic acyclovir treatment in all patients. CONCLUSIONS: Viral etiology must be borne in mind in the differential diagnosis of atypical retinitis. It can be a milder form of viral retinitis like focal viral retinitis, as mentioned in this study. The prognosis of this disease is better than the other forms of necrotizing retinopathies involving a larger area of retina.

Late-onset Behçet's disease: demographic, clinical, and ocular features.

BACKGROUND: To evaluate the demographic, clinical, and ocular features of patients with Behçet's disease (BD) who had first symptom onset after 40 years of age and fulfilled the diagnostic criteria afterwards. METHODS: This retrospective study included 42 patients with initial BD symptom onset after 40 years of age who fulfilled the diagnostic criteria afterwards, according to the International Study Group for BD. Patients were divided into two groups based on the presence of ocular involvement: group 1 had uveitis and group 2 did not have uveitis. The ocular characteristics of patients in group 1 were further examined according to age groups. Group 1A included patients between 40-50 years of age, and group 1B included patients older than 50 years of age. Clinical and demographic features of uveitic and non-uveitic patients were compared. Ocular manifestations, treatment protocols, and ocular complications in uveitic patients were noted. The ocular characteristics of group 1A and group 1B were further evaluated. RESULTS: Twenty-six patients (61.9%) had uveitis (group 1) and 16 (39.1%) had no uveitis (group 2). There was no significant difference between groups according to sex, age at initial admission, age at the time of initial symptom of BD, and period between initial symptom and the diagnosis of BD. The most frequent initial manifestation was oral ulcer in both groups. No statistical difference between the groups was detected with regard to the mean age of onset of each symptom. Anterior uveitis (73.1%) was the most frequent type of uveitis followed by panuveitis (19.2%) and sclerouveitis (7.7%). Uveitis was bilateral in 80.8% of patients. The incidence of anterior uveitis was higher in group 1B than in group 1A (P = 0.023). Cataract was the most common ocular complication, followed by macular edema sequelae, glaucoma, optic disc paleness, and branch retinal vein occlusion. CONCLUSION: Late-onset BD usually affects both genders equally, and the prognosis of ocular involvement is usually good. The incidence of panuveitis decreases as age increases, while the incidence of anterior uveitis increases. Ocular involvement is usually bilateral and there is no correlation between gender and uveitis type.

Prevalence of pinguecula and pterygium in patients with thyroid orbitopathy.

PURPOSE: To determine the prevalence of pinguecula and pterygium in patients with thyroid orbitopathy (TO) and to evaluate its correlation with clinical findings. METHODS: All patients underwent a thorough ophthalmic examination, including tear function analysis using tear film breakup time (BUT) measurement. For patients with TO, lid retraction, Hertel exophthalmometry, and clinical activity scores were also measured. All patients were evaluated for the presence of pinguecula and pterygium. RESULTS: The groups were age (P = 0.15) and gender matched (P = 0.2). The prevalence of pinguecula was significantly higher in group 1 (196 patients, 98%) than in group 2 (23 patients, 46%) and group 3 (64 patients, 32%) (P < 0.001). In group 1, lid retraction was significantly correlated with pinguecula prevalence (P < 0.001), whereas there was no correlation between pinguecula prevalence and BUT values (P = 0.624), clinical activity score levels (P = 0.325), or exophthalmometer findings (P = 0.155) In groups 2 and 3, pinguecula was seen more frequently in patients with subnormal BUT measurements (P < 0.001). Pterygium was seen at very low rates in all groups and analysis could not be performed. CONCLUSIONS: Pinguecula was seen more frequently in patients with TO than in both control groups. Lid retraction was the only clinical factor determined with significant impact on the prevalence of pinguecula in patients with TO. Impaired tear function did not influence pinguecula prevalence in patients with TO, in contrast to both control groups. Increased exposure to UV light because of lid retraction may be the major underlying causative factor on pinguecula prevalence in patients with TO, compared with tear dysfunction in both control groups.

The impact of Nd:YAG capsulotomy on foveal thickness measurement by optical coherence tomography.

BACKGROUND AND OBJECTIVE: To measure the foveal thickness change after Nd:YAG laser capsulotomy by optical coherence tomography (OCT). PATIENTS AND METHODS: Fifty-four eyes of 54 patients who had posterior capsule opacification underwent Nd:YAG laser capsulotomy. OCT of the foveal region was performed preoperatively and postoperatively (on days 1 and 7 and months 1, 3, 6, and 12). The preoperative and postoperative measurements were compared. RESULTS: The foveal thickness did not significantly change in the first year after laser treatment. Cystoid macular edema developed in only 1 patient (2%). Patient age and gender, time between surgery and laser capsulotomy, total laser shots, total laser energy, or mean laser energy per shot did not affect the foveal thickness. CONCLUSION: Foveal thickness does not change in the first year after Nd:YAG laser capsulotomy, as determined by OCT.

Prospective comparison of two suturing techniques of amniotic membrane transplantation for symptomatic bullous keratopathy.

PURPOSE: To determine the outcomes of a modified amniotic membrane transplantation (AMT) suturing technique for pain and discomfort relief in patients with symptomatic bullous keratopathy (BK). DESIGN: Randomized, double-blind controlled clinical trial. METHODS: setting: Ankara Research and Training Hospital 1st and 2nd Eye Clinics, Ankara, Turkey. study population: This prospective study included 39 eyes (39 patients) with BK presenting with intractable pain or discomfort and poor visual potential. intervention: Patients were randomly assigned into two groups: in group 1 (21 patients), patients underwent a modified AMT suturing technique; a groove was prepared by vacuum trephine on the recipient cornea and the edges of the punch-shaped amniotic membrane (AM) were sutured to this groove with the basement membrane side up. In group 2 (18 patients), patients underwent the standard AMT suturing to the cornea. main outcome measure: During a mean follow-up of 27.3 +/- 8.5 months (standard deviation) (range, 12 to 36 months), epithelial healing, persistence of AM, pain relief, and visual changes were analyzed and were compared between groups. RESULTS: The mean age (P = .15), the mean follow-up (P = .73), and the mean preoperative visual acuity (P = .53) were similar in both groups. With the modified suturing technique, the postoperative visual acuity was better (P = .03), epithelialization time was shorter (P < .001), and the AM remained longer (P < .001). Successful epithelialization was achieved in 20 eyes (95.3%) in group 1, and in 16 eyes (88.9%) in group 2 (P = .586). The pain scores of patients in group 1 remained stable (P = .223) over time, however increased from the first week to the third month postoperatively in group 2 (P = .046). CONCLUSIONS: The modified AMT suturing technique has a similar epithelialization rate to standard AMT suturing to cornea. Though technically more demanding, shorter epithelialization time, longer persistence of AM, and stable pain scores in the postoperative period makes this a promising method for the treatment of symptomatic BK.

Fuchs' heterochromic uveitis associated with retinal break or dialysis.

BACKGROUND: Three cases of Fuchs' heterochromic uveitis (FHU) are described, 2 with peripheral retinal breaks and 1 with retinal dialysis. METHODS: Argon laser photocoagulation was applied around the breaks and the dialysis. RESULTS: The retinal breaks and dialysis were successfully photocoagulated. INTERPRETATION: Thorough inspection of the fundus, including the peripheral retina, is important in patients with FHU to exclude a retinal break or a dialysis.

Tear function and ocular surface changes in multinodular goiter patients.

AIMS: To evaluate preoperative and postoperative conjunctival surface changes in multinodular goiter (MNG) patients and to compare their results with healthy control subjects. METHODS: Twenty MNG patients who had undergone near total thyroidectomy were evaluated pre- and postoperatively at the end of the 3rd month and the 1st year by performing tear function tests and conjunctival impression cytologic analysis. These results were compared with the results of 15 healthy volunteers. RESULTS: When preoperative and postoperative tear function parameters were compared, the mean Schirmer test value and BUT value were decreased, the mean Rose Bengal staining score was increased during the postoperative period. These differences were statistically significant at the end of the 1st year (p < 0.001). The average goblet cell density of the MNG patients decreased significantly during the postoperative period when compared with the preoperative values (p < 0.001). All these findings of the MNG cases were significantly different from the results of the control group both before and after the operation. CONCLUSION: Tear function tests and the impression cytology findings of the MNG cases were statistically different from the results of the control group during the pre- and postoperative period. We recommend postoperative follow-up of these patients for ocular surface changes.