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PURPOSE: The main treatment for macular hole (MH) is pars plana vitrectomy, with or without internal limiting membrane (ILM) peeling, followed by gas tamponade and face-down positioning (FDP). This study aims to present the anatomical and visual outcomes following MH repair with optical coherence tomography (OCT)-guided FDP. METHODS: Thirty-two patients who underwent surgery for idiopathic MH were enrolled. The requirement for the prone position was lifted for those with MH closure observed under gas on postoperative day one OCT. Patients with unclosed MHs were instructed to maintain FDP until the 3rd day. Best-corrected visual acuity at preoperative, postoperative 1st month, and the last visit, closure time post-surgery, duration of prone position, and surgical success rate were recorded. RESULTS: Among the patients, 21 underwent phacovitrectomy + ILM peeling + gas tamponade, while 11 had vitrectomy + ILM peeling + gas tamponade. On postoperative day one, 28 out of 32 MHs closed, with 3 closures on day 3 and one on day 5. There were 18 stage two (56.3%), 13 stage three (40.6%) and 1 stage four (3.1%) MHs. The mean minimum MH diameter was 381.75 ± 68.07 (min 260-max 517) microns. All patients with MH closure time over postoperative day one had non-combined vitrectomy instead of phacovitrectomy. No late complications were observed. CONCLUSIONS: OCT-guided FDP approach yields excellent closure rates with no late complications and ensures good patient comfort.
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Perfurações Retinianas , Humanos , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/cirurgia , Tomografia de Coerência Óptica , Seguimentos , Período Pós-Operatório , VitrectomiaRESUMO
Purpose: To evaluate the macular microvascular changes in patients with intermediate uveitis (IU) using optical coherence tomography angiography (OCT-A) and to determine the relationship of OCT-A measurements with disease duration and activity. Methods: This cross-sectional study was performed at the uvea department of a tertiary hospital. Patients with IU (8 women, 8 men; mean age: 28.80 ± 12.80 years) were included in the study. The macular thickness measurements obtained by optical coherence tomography (OCT) (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany) and macular superficial and deep vessel density (VD) parameters obtained by OCT-A (Avanti RTVue-XR; Optovue, Fremont, CA, USA) were compared with healthy subjects (12 men, 22 women; mean age: 28.40 ± 8.32 years). Eyes with pathology including marked obvious edema in the macula were not included in the study. Results: The macular thickness was found to be higher in the patient group (p < 0.001). The deep and superficial VD measurements in almost all quadrants in both superficial and deep layers were significantly lower in the IU patient group (p < 0.05). Macular thickness was increased in the active state of IU (p = 0.03), however, none of the OCT-A parameters showed a significant difference between active and inactive IU patients (p > 0.05). No correlation was observed between OCT-A parameters and total IU disease duration. Conclusion: Quantitative analyses of macular vascular structures demonstrate significantly reduced VD in both superficial and deep retinal layers in IU patients. Considering the importance of the macula in visual prognosis, OCT-A can provide crucial data for the monitoring and follow-up of IU patients.
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Vasos Retinianos , Uveíte Intermediária , Masculino , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Vasos Retinianos/patologia , Angiofluoresceinografia/métodos , Tomografia de Coerência Óptica/métodos , Estudos Transversais , Uveíte Intermediária/diagnósticoRESUMO
A 60-year-old-male with refractory relapsed multiple myeloma presented with redness, pain, foreign body sensation, and blurred vision in both eyes that gradually increased after his third belantamab mafotodin infusion. Biomicroscopy revealed bilateral microcyst-like epithelial changes and epithelial crystal-like deposits, whereas in vivo confocal microscopy revealed intraepithelial and subepithelial hyperreflective deposits in corneal epithelium. Belantamab mafodotin therapy was discontinued for seven weeks due to corneal toxicity, which cleared progressively. We aim to demonstrate belantamab mafodotin-related corneal toxicity that may be detected using slit lamp and in vivo confocal biomicroscopy.
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Purpose: Since quantification and communication of ocular pain is important for a healthier patient follow-up and postoperative guidance, reliable measures like the Ophthalmic Pain Assessment Survey (OPAS) are needed to assess the outcome and management of different operations. To address that need, we carried out the adaptation of OPAS into Turkish to reach different age groups and backgrounds, widening the use of OPAS on patients who underwent an ophthalmic operation. Methods: We used back-translation method and achieved cultural adaptation through content validity scoring by 5 independent ophthalmologists. The survey is then administered three times: preoperatively, postoperatively within 24 hours, and finally a week later in the follow-up visit. Validity is measured in comparison to Visual Analog Scale using Spearman's correlation coefficient and reliability is measured using Cronbach's alpha. Factor analysis is performed by principal component analysis and rotation is performed using Varimax method when necessary. Results: We reached a total of 132 patients with a mean age of 64.2 years. Most of them underwent phacoemulsification (n = 83), followed by PRK (n = 37). Overall, the T-OPAS demonstrated good reliability (mean C. alpha: 0.830) and its correlation with the VAS was especially high (S. coeff. >0.5) in the first three sections in all three surveys. Factor analysis yielded 5 subscales, allowing us to shape the final form of T-OPAS. Conclusion: Through this adaptation of OPAS into a foreign language, we present a reliable and valid tool for postoperative pain quantification, allowing objective measurement of pain in different populations such as the elderly.
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A 33-year-old male presented with unilateral subacute infectious keratitis 4 weeks after surgery. Corneal inflammation was resistant to standard topical antibiotic regimens. During diagnostic flap lifting and sampling, the corneal flap melted and separated. Through flap lifting, corneal scraping, microbiological diagnosis of atypical mycobacteria, and treatment with topical fortified amikacin, clarithromycin, and systemic clarithromycin, clinical improvement was achieved.
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PURPOSE: To grade myopic choroidal neovascularization (CNV) patients according to the new myopic maculopathy classification (A: atrophy, T: traction, N: neovascularization-ATN) and analyze the correlation in between atrophy, traction and neovascularization. METHODS: Fifty-one eyes of 41 patients with the diagnosis of pathologic myopia and myopic CNV were included in this clinical practice study. Patients were graded according to the recently described ATN classification. Color fundus photographs were used to grade the atrophy and spectral domain optical coherence tomography scans were used to grade traction and neovascularization. Active myopic CNVs were treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. Chi-square test was used to test the categorical variants and univariate logistic regression analysis was used to predict the independent risk factors of myopic CNV scar formation. RESULTS: Active myopic CNV was observed most frequently in the group with patchy chorioretinal atrophy. Grade of the atrophy and female gender were significantly associated with myopic CNV scar in the univariate logistic regression tests. Multivariate logistic regression showed that atrophy grading is the independent predictor of myopic CNV scar. CONCLUSION: ATN classification is a practical and comprehensive system to grade myopic CNV. Atrophy is an independent predictor for myopic CNV scar and patchy chorioretinal atrophy requires a more careful examination and close follow-up for the risk of CNV development.
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Neovascularização de Coroide , Degeneração Macular , Miopia Degenerativa , Doenças Retinianas , Inibidores da Angiogênese , Atrofia , Doenças da Coroide , Cicatriz , Feminino , Angiofluoresceinografia , Humanos , Estudos Retrospectivos , Tomografia de Coerência Óptica , Tração , Acuidade VisualRESUMO
Objectives: To evaluate the efficacy and safety of heavy silicone oil as an endotamponade in patients with recurrent or complicated retinal detachment and macular hole. Materials and Methods: Nineteen eyes of 19 patients who underwent heavy silicone oil endotamponade for different indications were included in the study and evaluated by retrospective chart review. At each visit, patients underwent detailed ophthalmological examination and anatomical and functional outcomes, silicone oil emulsification, intraocular inflammation, presence of proliferative vitreoretinopathy, preoperative and postoperative visual acuity, and postoperative complications were recorded. Results: The study included 19 eyes of 19 consecutive patients: 13 women (68.4%) and 6 men (31.6%). The patients' median age was 60 years (interquartile range [IQR]: 44-70 years) and the median follow-up time was 19 months (IQR: 9-31 months). Indications for heavy silicone oil endotamponade were recurrent retinal detachment in 11 eyes (57.8%), inferior retinal detachment in 5 eyes (26.3%), inferior rhegmatogenous retinal detachment, recurrent macular hole in 2 patients (10.5%), and macular hole in 1 patient (5.2%). Median best corrected visual acuity was 2 logMAR (IQR: 1-2.6) preoperatively and 0.99 logMAR (IQR: 0.4-2) postoperatively (p<0.001). Postoperative anatomical success was achieved in all patients. Densiron 68 was used for endotamponade in 14 patients (73.7%), Densiron XTRA in 3 patients (15.8%), and AlaHeavy 1.07 in 2 patients. Heavy silicone oil emulsification was observed in only 3 patients (15.8%). Conclusion: Although heavy silicone oil has limitations as an endotamponade, such as intraocular pressure increase, emulsification, intraocular inflammation, and the risk of complications during removal, it is a safe and effective alternative in eyes requiring inferior retinal tamponade for indications like proliferative vitreoretinopathy and recurrent macular holes.
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Descolamento Retiniano , Perfurações Retinianas , Doenças da Úvea , Vitreorretinopatia Proliferativa , Pré-Escolar , Tamponamento Interno , Feminino , Humanos , Inflamação/complicações , Inflamação/cirurgia , Masculino , Estudos Prospectivos , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Perfurações Retinianas/complicações , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Óleos de Silicone , Doenças da Úvea/complicações , Vitrectomia , Vitreorretinopatia Proliferativa/complicaçõesRESUMO
PURPOSE: To report neurotrophic keratopathy after vitreoretinal surgery combined with aggressive photocoagulation. METHODS: We report a series of three cases with neurotrophic keratopathy after pars plana vitrectomy combined with endolaser photocoagulation. RESULTS: Three patients who had pars plana vitrectomy with different indications were identified. On follow-up, all patients were diagnosed with neurotrophic keratopathy. Two of the patients underwent amniotic membrane transplantation for the treatment of resistant neurotrophic corneal ulcers. CONCLUSION: Neurotrophic keratopathy may occur after pars plana vitrectomy. The possible mechanism is long ciliary nerve damage related to the extensive endolaser photocoagulation.
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Ceratite , Fotocoagulação a Laser , Descolamento Retiniano , Vitrectomia , Humanos , Ceratite/etiologia , Fotocoagulação a Laser/efeitos adversos , Descolamento Retiniano/cirurgia , Vitrectomia/efeitos adversosRESUMO
OBJECTIVES: This study was performed to assess and analyze the retinal and choroidal thickness in amblyopic eyes using spectral-domain optical coherence tomography and enhanced depth imaging optical coherence tomography. METHODS: A total of 67 children with amblyopia and 31 age- and gender-matched healthy non-amblyopic control subjects were enrolled in the study. The 67 amblyopic children were divided into 3 groups: hypermetropic amblyopia (Group 1). microesotropia (Group 2). and myopic anisometropia (Group 3). All of the participants underwent a detailed ophthalmologic examination and orthoptic assessment. The subfoveal choroidal thickness was measured at 500-. 750-. 1000-. and 15000-micron intervals nasally and temporally. Central macular thickness was also measured in the subfoveal. parafoveal inferior. parafoveal superior. parafoveal nasal. and parafoveal temporal superior. inferior. nasal. and temporal quadrants. All of the parameters of the amblyopic eyes. fellow eyes. and control eyes were compared. RESULTS: In all. 34 female and 33 male patients were studied. The mean age was 8.6±2.8 years (range: 5-12 years). Comparison of the choroidal thickness and macular thickness measurements between the amblyopic and non-amblyopic eye of the same patient within each group revealed no statistically significant differences. Comparison of the findings in the amblyopic eyes of Group 1 and Group 3 with the control group revealed that the choroidal thickness measurements were smaller in the amblyopic eyes in all quadrants. however. only the nasal quadrant measurements demonstrated a statistical significance. The subfoveal macular thickness value was also smaller in both groups when compared with the control eyes. CONCLUSION: Our results indicated that amblyopia. whether anisometropic or microtropic. did not seem to significantly affect choroidal thickness.
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Ectopic orbital meningioma is a rare tumor usually affecting the medial orbit. We present two cases that occurred in a 56-year-old woman and a 28-year-old man. The tumors in both patients were subtotally excised via orbitotomy surgery and were located in the superior quadrant in one of our patients and in the temporal quadrant in the other. Following histopathologic diagnosis, external beam radiotherapy (EBRT) was administered to one patient and intensity modulated radiotherapy to the other. We identified 12 other well-documented cases of ectopic orbital meningioma previously reported. Ectopic meningioma should be considered in the differential diagnosis of medial as well as lateral and superior orbital tumors. The tumor is usually well circumscribed but can be ill defined in imaging studies. There are intralesional calcifications and sclerosis of adjacent bone in some cases. Ectopic orbital meningioma can recur after incomplete excision. Based on the efficacy of EBRT in optic nerve sheath meningioma, we used this treatment to decrease the risk of recurrence in our two patients and found no tumor recurrence at follow-ups of 24 and 74 months, but one patient had severe vision loss from radiation retinopathy.
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Coristoma/patologia , Neoplasias Meníngeas , Meningioma/patologia , Neoplasias Orbitárias/patologia , Adulto , Coristoma/radioterapia , Coristoma/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningioma/radioterapia , Meningioma/cirurgia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos , Neoplasias Orbitárias/radioterapia , Neoplasias Orbitárias/cirurgia , Terapia com Prótons , Radioterapia de Intensidade Modulada , Tomografia Computadorizada por Raios X , Acuidade VisualRESUMO
PURPOSE: To evaluate the presentation patterns and results of management of retinoblastoma at a tertiary care center in Ankara, Turkey, with special emphasis on globe conservation rate in unilateral and bilateral intraocular retinoblastoma. METHODS: Patients were grouped according to the International Classification of Retinoblastoma. For intraocular retinoblastoma, group E and some group D eyes underwent primary enucleation. Secondary enucleation was performed after failure of chemoreduction, focal treatments, external beam radiotherapy (EBRT), and intra-arterial chemotherapy used in various combinations. For extraocular retinoblastoma cases, treatment consisted of enucleation/exenteration or orbital biopsy, high-dose chemotherapy, and EBRT to the orbit and metastatic sites. RESULTS: During the study period from October 1998 to May 2010, 165 of 192 (85.9%) patients had intraocular disease and 27 (14.1%) patients had extraocular disease. In total, primary or secondary enucleation was performed in 70 of 94 eyes with unilateral retinoblastoma (74.5%) and in 34 of 142 eyes with bilateral retinoblastoma (23.9%). The overall globe conservation rate was 69.6%. Only one patient in the intraocular retinoblastoma group died of metastatic retinoblastoma to the central nervous system. Twenty of 27 patients (74.1%) with extraocular retinoblastoma were found to have metastasis to the central nervous system, bone, bone marrow, and/or lymph nodes. At a mean follow-up of 28.0 months (median: 12 months; range: 1 to 120 months), survival was 33.3% despite intensive treatment. CONCLUSIONS: The overall risk of enucleation was 75% in eyes with unilateral retinoblastoma and 24% in eyes with bilateral retinoblastoma. Extraocular retinoblastoma carries a 75% risk of systemic metastasis and 67% risk of death.
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Neoplasias da Retina/epidemiologia , Retinoblastoma/epidemiologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , Enucleação Ocular , Evisceração do Olho , Feminino , Humanos , Lactente , Masculino , Radioterapia Adjuvante , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/terapia , Retinoblastoma/diagnóstico , Retinoblastoma/terapia , Centros de Atenção Terciária , Resultado do Tratamento , Turquia/epidemiologiaRESUMO
PURPOSE: To evaluate the results of ruthenium-106 (Ru-106) plaque radiotherapy alone (group A) or in combination with transpupillary thermotherapy (TTT) (group B) in the management of choroidal melanoma with tumor thickness (height) <8 mm. The tumors in each group were subclassified as those with thickness
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Braquiterapia , Neoplasias da Coroide/radioterapia , Neoplasias da Coroide/terapia , Hipertermia Induzida , Melanoma/radioterapia , Melanoma/terapia , Radioisótopos de Rutênio/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Coroide/patologia , Terapia Combinada , Feminino , Angiofluoresceinografia , Humanos , Pressão Intraocular , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Oftalmoscopia , Pupila , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To evaluate the results and complications of exoresection via a partial lamellar sclerouvectomy (PLSU) procedure for uveal tumors performed by a novice surgeon without help from an experienced surgeon. METHODS: Medical records of 22 patients who underwent exoresection for uveal tumors between February 1999 and January 2009 were evaluated retrospectively. Exoresection was considered for tumors with their epicenter in the iris or in the ciliary body. RESULTS: Twenty-two patients with a mean age of 45.9 years (range: 19-72 years) were included in this study. The histopathologic diagnosis was uveal malignant melanoma in 16 patients, iridociliary nevus in 2 patients, iris nevus in 2 patients, and iridociliary melanocytoma in 2 patients. Postoperative complications included cataract in 11 patients (50%), scleral thinning in 4 patients (18%), vitreous hemorrhage in 2 patients (9%), hyphema in 2 patients (9%), secondary glaucoma in 2 patients (9%), iridodialysis in 1 patient (4.5%), bullous keratopathy in 1 patient (4.5%), and posterior synechiae in 1 patient (4.5%). At a mean follow-up of 40.1 months (range: 1-98 months), there were no recurrences or metastatic events. CONCLUSIONS: Exoresection seems to be an effective treatment option in selected cases of iridociliary and ciliary body tumors. Novice surgeons with limited training in PLSU should not discourage themselves from doing this type of surgery. Several postoperative complications inevitably occur and require frequent patient monitoring.
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An 8-month-old healthy girl presented with a left orbital mass, which orbital magnetic resonance imaging revealed to be a well-circumscribed, mostly cystic lesion. The patient underwent orbitotomy via inferior fornicial conjunctival approach. Tumour shrinkage was accomplished by aspiration of the intralesional fluid, and the remaining debulked mass was removed by total excisional biopsy. Pathological examination revealed a cystic tumour lined mainly with keratinized stratified squamous epithelium, in addition to small foci of mucinous ciliated epithelium resembling respiratory epithelium. Histopathological findings were consistent with the diagnosis of mature orbital teratoma (hair follicles, adipose tissue, mature glial elements, choroid plexus-like papillary organizations and small foci of cartilage in the cyst wall). Derivatives of all three germ lines were present. At 56-month follow up, uncorrected visual acuity in the affected eye was 6/9. This case demonstrates the importance of decompressing the tumour before dissecting it from the periorbital tissues in an eye-conserving approach to orbital teratoma.
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Neoplasias Orbitárias/congênito , Neoplasias Orbitárias/cirurgia , Teratoma/congênito , Teratoma/cirurgia , Biópsia por Agulha , Dissecação , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Neoplasias Orbitárias/patologia , Recuperação de Função Fisiológica , Teratoma/patologia , Resultado do Tratamento , Acuidade VisualRESUMO
We evaluated the efficacy and safety of topical cyclosporine-A in dry eye associated with chronic graft versus host disease (GVHD) in 8 patients. Visual acuity, fluorescein staining of cornea and conjunctiva, tear break-up time, Schirmer test results and subjective complaints were recorded. Topical cyclosporine-A might be an effective and safe treatment option in dry eye related to chronic GVHD.