Comparison of clinical outcomes between gonioscopy-assisted transluminal trabeculotomy and trabeculectomy in advanced-stage pseudoexfoliation glaucoma.

PURPOSE: To compare clinical outcomes between gonioscopy-assisted transluminal trabeculotomy (GATT) and trabeculectomy (TRAB) in patients with advanced-stage pseudoexfoliation glaucoma (PEXG). METHODS: This comparative study comprised 62 patients who underwent GATT (N = 31) or TRAB (N = 31) for advanced-stage PEXG. Primary outcome was cumulative probability of surgical success at the end of 12-month follow-up. Success was determined as intraocular pressure (IOP) reduction ≥ 30% from baseline, IOP between 6 and 18 mmHg and IOP upper limits for IOP < 15 mmHg and < 12 mmHg, separately. Secondary outcomes were IOP reduction, antiglaucoma medication (AGM) use, and complications in the study. RESULTS: Age, sex, cup/disc ratio, mean deviation, pattern standard deviation, and retinal nerve fiber layer thickness did not significantly differ between the groups (p > 0.05 for all). The probability of cumulative surgical success at the end of 12 months was similar between the two groups for IOP < 15 mmHg and < 18 mmHg but significantly higher after TRAB (92.0%) than GATT (82.5%) for IOP < 12 mmHg (log-rank test p = 0.035). Percentage of IOP reduction from baseline was similar between the groups (53.1 ± 18.6% in GATT group and 53.0 ± 16.6% in TRAB group, p = 0.98) at the end of 12 months. No significant difference in the mean number of AGM was present at the 12-month visit (1.3 ± 1.4 in GATT and 1.1 ± 1.4 in TRAB, p = 0.65). CONCLUSION: At the end of 12 months, IOP reduction rate was similar between GATT and TRAB. Cumulative surgical success was higher after TRAB than GATT for IOP < 12 mmHg.

Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy as a Primary Surgical Treatment for Glaucoma Secondary to Juvenile Idiopathic Arthritis-Associated Uveitis.

Gonioscopy-assisted transluminal trabeculotomy (GATT) has been used as a safe and effective procedure in the treatment of open angle glaucoma. In the present report, we demonstrated successful IOP control in two uveitic glaucoma cases secondary to juvenile idiopathic arthritis (JIA) following 360° GATT. Case 1 was a 7-year-old pseudophakic male with a preoperative IOP of 38 mmHg; his IOP stabilized at 17 mmHg with two topical antiglaucoma medications over 18 months. Case 2 was a 8-year-old aphakic male with a preoperative IOP of 42 mmHg; his IOP decreased to 12 mmHg over 15 months. We observed postoperative IOP spike in case 1 which was successfully controlled conservatively. Peripheral anterior synechia formation also occured in both cases during follow-up. One should be vigilant for possible complications after GATT in such cases. As glaucoma surgery success can have a tendency to decline with time in pediatric cases with uveitis-associated glaucoma, we believe that further evidence is still required to shed more light about the benefits of GATT technique in complex cases of pediatric secondary glaucoma subtypes like JIAU-induced glaucoma.

The evaluation of the efficacy of adalimumab in refractory non-infectious uveitis with ultra-widefield fundus fluorescein angiography.

AIM: To investigate the efficacy of adalimumab in the cases with refractory non-infectious uveitis and evaluate retinal vascular leakage changes on ultra-widefield fundus fluorescein angiography. METHODS: Twenty-three patients with refractory uveitis were included in study. RESULTS: Forty-four eyes of 23 patients with non-infectious uveitiswere evaluated. Clinically active inflammation was present in 19 eyes (43.18%), while 25 (56.8%) were inactive. The mean drug burden was a 9.91 ± 3.78 (5-21) in baseline, 7.3 ± 4.25 at third and 8.0 ± 4.71 at sixth month (p = 0.022). The mean choroidal thickness was 256.65 ± 43.63 µm in baseline, 240.49 ± 36.73 µm at third and 224.81 ± 34.91 µm at sixth month (p ≤ 0.05). In terms of leakage extend, leakage was initially present in a mean of 2.95 ± 4.55 clock hours, 2.41 ± 3.91 at third and 1.76 ± 3.44 at sixth month (p < 0.001). CONCLUSION: Adalimumab was found to be effective in establishing inflammation control by reducing drug burden, controlling retinal vascular leakage and choroidal inflammation in refractory uveitis.

Effect of Body Position on Intraocular Pressure Measured by Rebound Tonometer in Healthy Children.

Objectives: To evaluate the effect of body position on intraocular pressure (IOP) measurement in the pediatric age group. Materials and Methods: Children whose general condition was healthy and ophthalmic examination was within normal limits were included. Forty-nine eyes of 49 pediatric patients were included in the study. IOP was measured with an ICARE rebound tonometer (ICARE PRO; ICARE, Helsinki, Finland) while patients were in standing, sitting, and supine positions. Differences between the consecutive measurements were compared statistically. Results: Twenty-two of the 49 patients were female, 27 were male. The mean age was 9.61±2.66 (5-15) years. Mean IOP values in the standing, sitting, and supine positions were 18.81±2.97 (11.6-26.2) mmHg, 18.88±3.44, (12-28.2) mmHg, and 19.01±2.8 (13.5-25.9) mmHg, respectively. There were no statistically significant differences in pairwise comparisons of the measurements taken in the different positions (p=0.846, p=0.751, p=0.606). There was a statistically significant correlation between corneal thickness and intraocular pressure values in all measurements (p=0.001, r=0.516). Conclusion: IOP values measured with the ICARE rebound tonometer in healthy children are not affected by body position.

Ultra-widefield fundus fluorescein angiography findings in patients with ankylosing spondylitis experiencing uveitis.

AIM: To evaluate ultra-widefield fundus fluorescein angiography (FFA) findings in cases of ankylosing spondylitis (AS)-associated uveitis. MATERIALS AND METHODS: Forty-five eyes of 23 AS patients followed up with a diagnosis of uveitis were included. RESULTS: Sixteen (69.6%) men and seven (30.4%) women with a mean age of 46.26 ± 10.87 years were included in the study. Retinal vascular leakage was observed in 19 (42.2%) eyes at FFA, diffuse in six (13.3%) and peripheral in 13 (28.9%) eyes. Active anterior uveitis attack was present in seven (36.8%) eyes with vascular leakage at FFA, while no active uveitis findings were present in 12 (63.15%) eyes. No statistical relation was determined between peripheral and diffuse leakage and active uveitis (p = 0.195). No significant association was also determined between both diffuse and peripheral leakage and visual acuity (p = 0.066). CONCLUSION: We observed widespread retinal vascular leakage at UWF angiography in AS patients (in eyes undergoing active uveitis attacks and inactive eyes).

A comparison of three different tonometric methods in the measurement of intraocular pressure in the pediatric age group.

INTRODUCTION AND AIM: To compare intraocular pressure (IOP) measurements obtained with non-contact tonometry (NCT), Icare rebound tonometry (IRT) and Goldmann applanation tonometry (GAT) in pediatric cases and to examine the effect of topical anesthesia on measurements obtained using IRT. MATERIALS AND METHODS: Pediatric cases in a healthy general condition and with ophthalmic examination findings within normal limits were included in the study. IOP measurements were taken with NCT and IRT devices in all cases. Topical anesthesia was subsequently applied, and IOP measurements were then repeated using IRT and GAT tonometer devices. Differences between measurements were subjected to statistical analysis. RESULTS: One hundred ten eyes of 55 patients, 27 male, with a mean age of 11.44 ± 2.31 years (7-17) were included. Mean pre-anesthesia IOP values were 16.47 ± 2.89 mmHg with NCT and 17.49 ± 2.57 mmHg with IRT. Mean IOP values after topical anesthesia were 16.91 ± 2.17 mmHg with IRT and 15.51 ± 2.41 mmHg with GAT. IOP measurement values obtained with all three devices exhibited positive correlation with central corneal thickness values. Statistically significant correlation was present in terms of IOP measurement values between all three devices. However, IOP values obtained with the three devices exhibited statistically significant differences. The application of topical anesthesia caused a statistically significant decrease in IRT measurements; however, statistically significant this small change (0.58 mmHg) in recorded IOP would not be considered clinically significant. CONCLUSION: IOP measurements obtained with NCT, IRT and GAT devices in the pediatric age group correlate with one another, but differ from one another in a statistically significant manner. Application of topical anesthesia affects IRT measurements; however, these small changes would not be considered clinically significant.

A comparison of the effects of perindopril arginine and amlodipine on choroidal thickness in patients with primary hypertension

Background/aim: This study aimed to investigate the effects of two different medical treatment options on choroidal thickness (CT) in patients with primary hypertension. Materials and methods: Forty newly diagnosed primary hypertension patients and 21 healthy volunteers were included. The patients were randomly divided into two subgroups. Group I started on perindopril arginine and Group II started on amlodipine. Submacular CT using optical coherence tomography (OCT) was measured before treatment and at the third and sixth months after treatment. Results: Initial mean arterial pressure (MAP) values in Groups I and II and the control group were 113.4, 109.8, and 89.4 mmHg, respectively, and mean CT values were 257.9, 286.5, and 300.9 µm. Mean MAP values in Groups I and II and the control group at the sixth month after treatment were 99.7, 99.6, and 90.2 mmHg, respectively, and mean CT values were 293.1, 286, and 297.4 µm. Analysis of the changes occurring during the study revealed significant variation in MAP in Groups I and II, and in CT in Group I only. Conclusion: A gradual increase in CT developed with perindopril arginine therapy in patients with primary hypertension, while no significant change occurred in CT in the amlodipine group.

Evaluation of the effects on choroidal thickness of bimatoprost 0.03% versus a brinzolamide 1.0%/timolol maleate 0.5% fixed combination.

OBJECTIVE: To investigate the effects of two different medical treatment options on choroidal thickness (CT) in cases of open-angle glaucoma (OAG). METHODS: Sixty-seven eyes newly diagnosed with OAG and 52 healthy eyes constituting the control group were included in the study. Glaucomatous eyes were randomly divided into two subgroups; Group I was started on bimatoprost 0.03% and Group II on a brinzolamide 1.0%/timolol maleate 0.5% fixed combination (BTFC). Intraocular pressure (IOP), ocular pulse amplitude (OPA) and subfoveal CT measurements were performed in all eyes in the study before treatment and on weeks 2, 4 and 8 after treatment. RESULTS: Mean initial IOP values in groups I and II and the control group were 25.5 ± 4.7, 25.1 ± 5.2 and 16.1 ± 2.9 mmHg, mean OPA values were 3.7 ± 1, 3.6 ± 1.4 and 2.4 ± 0.6 mmHg and mean CT values were 269.4 ± 83, 264.5 ± 84.4 and 320.1 ± 56.6 µm, respectively. Eight weeks after treatment, mean IOP values in Groups I and II and the control group were 18.3 ± 2.6, 18.1 ± 3.4 and 15.7 ± 2.9 mmHg, mean OPA values were 2.9 ± 1.2, 2.8 ± 1.5 and 2.3 ± 0.8 mmHg and mean CT values were 290.2 ± 87.3, 271.8 ± 82.5 and 319.3 ± 56.8 µm, respectively. No significant difference was determined in terms of the decrease in IOP and OPA obtained after treatment in Group I and Group II. However, a significant difference was observed between the two groups in terms of choroidal thickening after treatment. CONCLUSION: The use of topical ocular hypotensive medication in eyes with OAG results in an increase in CT. This increase is relatively greater with bimatoprost 0.03% therapy compared to BTFC.

Serum anti-carbonic anhydrase antibodies and oxidant-antioxidant balance in patients with acute anterior uveitis.

PURPOSE: To study the existence of anti-carbonic anhydrase antibodies (anti-CA-I&II) in acute anterior uveitis (AAU) patients and to analyze the relationship between the levels of these antibodies and the total antioxidant capacity (TAC), total oxidant capacity (TOC), oxidative stress index (OSI), and malondialdehyde (MDA) level. METHODS: Forty-five AAU cases and 43 healthy controls were enrolled in this prospective study. RESULTS: The average anti-CA I and II antibody levels were 0.433 ± 0.306 and 0.358 ± 0.261 IU/mL, respectively, in the AAU group and 0.275 ± 0.147 and 0.268 ± 0.108 IU/mL, respectively, in the control group (p = 0.004 and p = 0.036, respectively). In addition, it was found that the TOC, OSI, and MDA levels in the AAU subjects were statistically significantly higher than those of the control subjects. CONCLUSIONS: These results suggest that autoimmune responses against CA I and CA II and an altered serum oxidant-antioxidant balance may be involved in the pathogenesis of AAU.

Pulsatile ocular blood flow changes after panretinal photocoagulation treatment in patients with proliferative diabetic retinopathy.

BACKGROUND/AIM: To prospectively assess the effects of panretinal photocoagulation (PRP) treatment on pulsatile ocular blood flow (POBF) in patients with proliferative diabetic retinopathy (PDRP). MATERIALS AND METHODS: The study included 40 eyes with PDRP in 27 patients. The PRP treatments were completed in 3 sessions with 3-week intervals. The intraocular pressure (IOP), pulse amplitude (PA), pulse volume (PV), and POBF changes that arose during the sessions were recorded using a blood flow analyzer. RESULTS: The average age of the patients was 57.37 ± 11.14 years. The pre-PRP basal IOP, PA, PV, and POBF values were 20.44 ± 4.13 mmHg, 4.23 ± 1.73 mmHg, 6.89 ± 2.28 µL, and 21.86 ± 5.83 µL/s, respectively. One month after the completion of the PRP sessions, the values were 18.49 ± 4.44 mmHg, 2.78 ± 1.13 mmHg, 5.27 ± 2.08 µL, and 15.89 ± 5.05 µL/s, respectively, and the differences were significant (P = 0.001, P < 0.0001, P < 0.0001, and P < 0.0001, respectively). CONCLUSION: PRP treatment reduces the choroidal blood flow and consequently causes significant decreases in IOP, PA, PV, and POBE .

Effects of phacoemulsification surgery on ocular hemodynamics.

AIM: To evaluate the possible effects of phacoemulsification cataract surgery on ocular hemodynamics. METHODS: In this prospective study, intraocular pressure (IOP), pulsatile ocular blood flow (POBF), and ocular pulse amplitude (OPA) were measured pre-operatively (baseline) and at 1 week and 3 weeks postoperation in 52 eyes of 26 patients (mean age 63.15±10.25 years) scheduled for unilateral phacoemulsification cataract surgery with intraocular lens implantation. In all of the eyes, a blood flow analyzer (Paradigm DICON; Paradigm Medical Industries Inc.; USA) was used to obtain measurements of IOP, POBF, and OPA. The data obtained from operated eyes were compared statistically to untreated fellow phakic eyes of the patients. RESULTS: For operated eyes, the mean baseline IOP, POBF, and OPA values were 15.9±4.64mmHg, 17.41±4.84µL/s, and 2.91±1.12mmHg, respectively. The IOP, POBF, and OPA values were 17.19±4.34mmHg, 17.56±6.46µL/s, and 3.12±1.1mmHg, respectively, in the nonoperated control eyes. Statistically significant differences from baseline measurements were not observed 1 week and 3 weeks postoperation for the operated or nonoperated eyes. There were also no statistically significant differences in any measurements between the operated and nonoperated eyes in all the examination periods (P>0.05 for all). CONCLUSION: Uncomplicated phacoemulsification surgery does not affect ocular hemodynamics in normotensive eyes with cataracts.

Temporary blindness and ophthalmoplegia due to local anesthetic infiltration of the nasal septum.

We report the case of a 35-year-old man who developed blindness and ophthalmoplegia during local anesthetic infiltration of the nasal septum. The complications were temporary, and the patient had full recovery without treatment. The vascular anatomy of the area and possible pathogenic mechanisms are discussed, with some suggestions on the prevention of this complication.

Surgical outcomes for rhinogenic contact point headaches.

OBJECTIVE: To evaluate the surgical outcome in patients diagnosed as having rhinogenic contact point headaches (RCPH). SUBJECTS AND METHODS: Thirty-six patients (aged 17-58 years) with RCPH underwent mini functional endoscopic sinus surgery procedures. Patients' pain complaints were evaluated with a visual analog scale (VAS) both pre- and postoperatively. RESULTS: All patients reported a decrease in the intensity of pain postoperatively. Nineteen patients (52.7%) reported complete relief. The difference between the preoperative (mean 8.62) and postoperative VAS pain scores (mean 2.11) was statistically very significant (p = 0.0000). No major complications were encountered. CONCLUSION: The removal of contact points in patients with RCPH is very effective in carefully selected patients.

The results of intravitreal bevacizumab injections for persistent neovascularizations in proliferative diabetic retinopathy after photocoagulation therapy.

PURPOSE: The purpose of this study was to evaluate the effectiveness of intravitreal bevacizumab on persistent retinal neovascularizations in proliferative diabetic retinopathy. METHODS: Thirty-three eyes of 24 patients (mean age, 52.75 +/- 8.2 years) with proliferative diabetic retinopathy showing recurrences or no regressions in neovascularizations were evaluated in this study. After the intravitreal injection of 1.25 mg/0.05 mL of bevacizumab, the first examination was performed within 3 days and repeated at 1 week, 1 month, 3 months, and 6 months. In these examinations, localization and dimensions of neovascularizations were evaluated with red-free photographs and/or fluorescein angiography. RESULTS: All patients had type II diabetes for a period of 12 +/- 4.4 years (range, 2-20 years). After a single dose of bevacizumab, complete resolution rate of neovascularizations was 78.8% at 1 month, 63.6% at 3 months, and 45.4% at 6 months. When evaluated together with 9 eyes that had a second injection at 3 months, the complete resolution rate was 60.6% at 6 months. Mean best-corrected visual acuity and macular volume were 1.06 logarithm of the minimum angle of resolution (20/225 in Snellen) and 11.65 mm3 before treatment. Six months after treatment, these were 0.73 logarithm of the minimum angle of resolution (20/108 in Snellen) and 8.92 mm3 (P = 0.048 and 0.003, respectively). CONCLUSION: Bevacizumab can be used safely and successfully in patients with proliferative diabetic retinopathy who do not experience any resolution or experience recurrences after panretinal photocoagulation.

Lacrimal sac removal made easy by methylene blue in endoscopic dacrocystorhinostomy.

Endonasal dacrocystorhinostomy (DCR) has gained interest in the last decade. Especially when a novice surgeon is performing the surgery, difficulty in identification of the lacrimal apparatus may complicate the procedure. We investigated the efficacy of methylene blue (MB) solution as a marker for lacrimal sac (LS) in endoscopic DCR. A total of 24 endoscopic DCR cases were performed (16 primary and 8 revision cases). During surgery, LS was irrigated with MB solution. Following lacrimal bone removal, medial wall of the LS is seen with a bluish hue. When the sac is dissected, the epithelium of the LS, which is heavily stained with MB contrasts with the surrounding nasal mucosa and therefore tailoring of the extent of the LS mucosa removal is facilitated. The follow-up period of the patients was 23 +/- 7.5 months. Of the 24 cases operated, only one case needed a re-operation. Use of MB solution is effective in both identifying LS and distinguishing it from surrounding nasal mucosa in DCR.

The spectrum of Vogt-Koyanagi-Harada disease in Turkey: VKH in Turkey.

AIM: The aim of this report was to provide a detailed description of the clinical features of Vogt-Koyanagi-Harada (VKH) disease in Turkish patients. METHODS: We retrospectively analyzed 45 patients diagnosed with VKH disease at seven referral centers in Turkey. A standard data acquisition form was used for the analysis of demographic and clinical features. RESULTS: The study cohort consisted of 45 patients (32 female, 13 male) who had a mean age at presentation of 31 years. Seven patients (15%) were aged 16 years or younger. Nineteen (42%) patients presented in the acute or subacute stage and 26 (58%) in the chronic stage. According to the revised diagnostic criteria, nine (20%) patients had the complete form of the disease, 23 (51%) had the incomplete form, and 13 (29%) had probable VKH disease. All patients had bilateral ocular involvement. Sunset-glow fundus was observed in 89% of the patients, pigment clumping in 73%, nummular depigmented scars in 71%, cataract in 53%, optic atrophy in 31%, glaucoma in 29%, subretinal fibrosis in 22%, choroidal neovascular membranes in 7%, and phthisis in 4%. All patients who presented at the acute uveitic stage received systemic corticosteroid therapy. Immunosuppressive treatment was employed in 30 (66%) patients, which was initiated at the acute uveitic stage in ten (22%) patients. Final visual acuity was better than 0.5 in 59% of the patients' eyes, between 0.1 and 0.5 in 21%, and less than 0.1 in 20%. CONCLUSIONS: VKH disease is rare in Turkey. We conclude that the majority of patients with VKH in Turkey do not have the complete form of the disease. Based on our results, most patients with VKH seem to be late referrals. Ocular complications were common among these patients.

Comparison of efficacy of oral valacyclovir and topical acyclovir in the treatment of herpes simplex keratitis: a randomized clinical trial.

Thirty eyes of 28 patients with herpetic disease were included in the study. Group 1 patients (15 eyes of 15 subjects) received topical acyclovir (ACV) ointment. Oral valacyclovir (VACV) was prescribed to group 2 (15 eyes of 13 patients). The anterior segment of each eye was carefully examined by slit lamp and scored. Each patient was also instructed to grade his/her subjective symptoms. The corneal lesion healed significantly faster in the group 2 eyes compared to the group 1 eyes. Photophobia score on day 3 and slit-lamp score on day 10 were at significantly lower levels in group 2 compared to group 1. In herpetic keratitis, oral VACV can be a good alternative to ACV ointment therapy.

Comparison of the effects of ketotifen fumarate 0.025% and olopatadine HCl 0.1% ophthalmic solutions in seasonal allergic conjunctivities: a 30-day, randomized, double-masked, artificial tear substitute-controlled trial.

BACKGROUND: Topical antiallergic agents, such as antihistamines and mast-cell stabilizers, are the main therapeutic options for seasonal allergic conjunctivitis (SAC). Ketotifen fumarate and olopatadine HCl have dual action that offers a combination of these 2 mechanisms. Although clinical studies comparing the efficacy of these 2 drugs have shown that both were effective in the treatment of SAC, the results were contradictory and did not include the effects of these drugs on inflammatory markers. OBJECTIVES: The aims of this study were to compare the clinical efficacy of topical ketotifen and olopatadine eye drops and to determine the effects of these 2 drugs on the expression of cell adhesion molecules (CAMs) and inflammatory markers in conjunctival surface cells in patients with SAC. METHODS: This 30-day, randomized, double-masked, artificial tear substitute (ATS)-controlled clinical trial was conducted at the Department of Ophthalmology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. Patients with SAC were included in the study and randomly assigned to 1 of 3 groups: topical ketotifen fumarate 0.025% ophthalmic solution, topical olopatadine HCl 0.1% ophthalmic solution, or ATS (control group). All drugs were administered 2 drops per eye BID for 30 days. At the beginning of the study (day 0; baseline), on day 15, and on day 30, clinical scores (itching, tearing, redness, eyelid, swelling, and chemosis) and conjunctival impression cytology specimens were obtained. The percentages of cells expressing intercellular adhesion molecule 1, vascular CAM-1, human leukocyte antigen-DR, and beta1-integrin (CD29) from conjunctival impression cytology specimens were determined using flow cytometry. Patients were questioned about adverse events (AEs) at each visit. Ocular discomfort on installation of the drugs was recorded as an AE. RESULTS: Thirty-nine patients (20 men, 19 women; age range, 18-61 years) with SAC were included. Twelve patients received ketotifen; 13, olopatadine; and 14, ATS. In both active-treatment groups, the improvements of clinical scores (tearing and itching) were more pronounced compared with those in the ATS group, although the day-30 difference in tearing score between the olopatadine and ATS groups was not statistically significant. No significant within-group or between-group differences in mean scores for redness, chemosis, or eyelid swelling were found. The expression rates of CAMs and inflammatory markers in conjunctival surface cells were significantly more reduced with ketotifen and olopatadine compared with ATS. However, clinical and flow cytometric parameters were improved with ATS at 15 and 30 days compared with baseline. No AEs were observed during the study period. CONCLUSIONS: In this short-term study in a selected, small study population with SAC, ketotifen and olopatadine diminished the expression of CAMs and inflammatory markers on the conjunctival surface cells effectively. Both active treatments were more efficacious compared with ATS and were well tolerated.

Long-term follow-up of external dacryocystorhinostomy and the factors affecting its success.

AIM: To evaluate the long-term follow-up results of external dacryocystorhinostomy (Ex-DCR) and to assess the role of some factors in its success. PATIENTS AND METHODS: Between January 1990 and November 2002, 437 nasolacrimal systems of 387 patients were operated on and included in the study. The success rates were determined on the basis of the last examinations of the patients, and the correlations between success rates and factors such as age, gender, the duration of obstruction, history of acute dacryocystitis, the side of obstruction, and the postoperative follow-up period were calculated. RESULTS: The mean follow-up period was 5.9 +/- 2.5 years. Fifty cases (12.9%) were operated bilaterally. The initial success rate was 91.5% and the last success rate was 98.4% after reoperations. We found meaningful correlations between success and duration of obstruction, age of the patient, and the duration of postoperative follow-up (r = 0.18, 0.17 and -0.14, p = 0.036, 0.001 and 0.002, respectively). DISCUSSION: In comparison to newly developed surgical techniques for the treatment of nasolacrimal duct obstruction, Ex-DCR still appears to offer higher success rates, even after long-term follow-up. In addition to being a cost-effective procedure, it requires no sophisticated instruments. In our opinion, the high success rates may be explained by the nature of the operation, which creates a fistula between the sac and the nasal mucosa.

Adult onset tubulointerstitial nephritis and uveitis syndrome.

A Turkish woman aged 44 years who presented with a 1 month history of abdominal pain, fatigue and weight loss of 10 kg was diagnosed as having acute tubulointerstitial nephritis. Opthalmological evaluation revealed unilateral uveitis and contralateral chorioretinal scarring. X-ray films of the pelvis revealed unilateral sacroileitis. An elevated erythrocyte sedimentation rate, C-reactive protein, tubular proteinuria and renal glucosuria returned to normal 2 weeks after treatment was started. It is important to be aware of tubulointerstitial nephritis and uveitis syndrome in order to achieve a quick diagnosis in patients with renal impairment and tubular dysfunction with minor symptoms so that appropriate management can be started early.