Short-term effects of intravitreal ranibizumab and bevacizumab administration on 24-h ambulatory blood pressure monitoring recordings in normotensive patients with age-related macular degeneration.

PurposeTo evaluate effects of intravitreal ranibizumab and bevacizumab administration on ambulatory blood pressure monitoring (ABPM) recordings in normotensive patients with age-related macular degeneration (AMD).Patients and methodsA total of 72 patients (mean age: 61.8(6.2) years, 52.8% were females) diagnosed with AMD were included in this study as divided into ranibizumab (n=34) and bevacizumab (n=38) treatment groups. Twenty-four hour, nighttime, and daytime ABMP values for systolic and diastolic BP were recorded in study groups before and after the third intravitreal injection of ranibizumab or bevacizumab.ResultsRanibizumab injection had no impact on ABPM recordings and dipping status. In the bevacizumab group, increased daytime (129.0(6.6) vs 127.7(6.6) mm Hg, P=0.002) and nighttime systolic (116.9(7.5) vs 112.6(7.1) mmHg, p<0.001) BP and decreased daytime diastolic (80.1(6.5) vs 82.4(6.1)mm Hg, P=0.001) BP were noted in the post-injection period. Also, percentage of non-dippers was significantly increased from 5.3% at pre-injection to 28.9% (P=0.004) at the post-injection period.ConclusionIn conclusion, given that it has no significant impact on ABPM recordings and dipping status, in our study, intravitreal ranibizumab injection may be the better choice in the management of AMD.

Incidence and management of acute endophthalmitis after intravitreal bevacizumab (Avastin) injection.

INTRODUCTION: The aim of this study was to report the incidence and management of acute endophthalmitis after intravitreal injection of Avastin (bevacizumab), and visual acuity outcomes of three eyes of three patients who developed acute endophthalmitis following intravitreal injection of Avastin. METHODS: This clinical retrospective, non-comparative study included 3022 intravitreal injections of 1.25 mg bevacizumab consecutively performed for 1822 eyes with exudative age-related macular degeneration and other retinal diseases. Of 3022 injections, 1200 were reinjections. After clinical appearance of post-injection endophthalmitis, immediate intervention was performed, including injection of intravitreal antibiotics and early pars plana vitrectomy. RESULTS: Three eyes of three patients with acute postoperative endophthalmitis were identified in the first week following intravitreal injections of 1.25 mg bevacizumab. Among of these patients, two cases were culture-positive and one case was culture-negative. Compared with presenting visual acuities, all of three patients improved at the end of follow-up time. The overall incidence rate of post-injection culture-proven endophthalmitis was 0.066%. DISCUSSION: Acute culture-proven endophthalmitis is still a potential complication of intravitreal bevacizumab injection (approximately 0.066%) despite using maximal sterile techniques. Acute post-injection endophthalmitis following intravitreal bevacizumab occurs rapidly and can result in severe loss of vision. Prompt recognition and treatment are key in maximizing outcomes in patients who developed endophthalmitis after intravitreal injection of bevacizumab.

The effect of intravitreal bevacizumab (avastin) administration on systemic hypertension.

AIMS: To determine the short-term effect of intravitreal bevacizumab administration on systemic blood pressure levels of patients and to evaluate the safety of the drug in these patients. METHODS: Study population was divided into two groups: group A comprised patients who had hypertension and were under medication with antihypertensive drugs; group B comprised patients with normal blood pressure and were not under medication with antihypertensive drugs. All patients were graded according to their blood pressure levels before single dose of bevacizumab (0.05 ml; 1.25 mg) injection, and at day 1 and weeks 1, 3, and 6 thereafter. The blood pressure levels were analysed using repeated measures of analysis of variance (ANOVA). A P-value of <0.05 was considered significant. RESULTS: The study population included 82 patients with a mean age of 67.2+/-5.2 years. In group A, the systolic blood pressure levels showed significant increases at weeks 1, 3, and 6 (P=0.001, P<0.001, and P=0.003, respectively) compared with baseline. Similarly, diastolic blood pressure levels were significantly higher at weeks 3 (P<0.001) and 6 (P=0.016). In group B, the mean systolic and diastolic blood pressure levels showed significant elevations only at week 3 (P=0.004 and P<0.001, respectively). The percentages of both group A and B patients with normal blood pressure decreased at week 3 compared with baseline (P<0.001 and P=0.012 for groups A and B, respectively). CONCLUSIONS: The findings of this study show that there is a risk of disregulation of blood pressure levels or persistence of hypertension in hypertensive patients after intravitreal bevacizumab injections.

[Corneal ring segments (INTACS) for the treatment of asymmetrical astigmatism of the keratoconus. Follow-up after 2 years]. / Anneaux intracornéens (INTACS) pour le traitement de l'astigmatisme asymétrique du kératocône. Recul de plus de deux ans.

OBJECTIVE: To evaluate the use of corneal ring segments (INTACS) for the treatment of asymmetrical astigmatism in keratoconus. MATERIAL AND METHODS: This prospective study involved nine eyes of seven patients who were operated on between December 1998 and June 2000. A case of keratoconus with opacified cornea was excluded from this study. The patients chosen were contact lens-intolerant. The surgical intervention was carried out under topical anesthesia. The INTACS (Addition Technology) corneal ring insert was inserted approximately 68% of the peripheral corneal depth and was centered to the cone of the cornea. RESULTS: No intraoperative complications occurred. We noted a flattening of the central cornea and a decrease in irregular astigmatism for all patients. Mean preoperative uncorrected visual acuity was less than 1/10. Postoperatively two eyes had an uncorrected visual acuity of 10/10, seven eyes showed an improvement from an uncorrected visual acuity of 2/10 to 7/10. CONCLUSION: We have observed that the flattening effect of INTACS inserts on the soft corneal keratoconic tissue and on the high astigmatic tissue seems greater than that produced in normal cornea. Implantation of INTACS resulted in a significant reduction in asymmetrical astigmatism of the keratoconus.

Ocular penetration of cefepime following systemic administration in humans.

OBJECTIVE: To investigate the penetration of cefepime (a fourth generation cephalosporin) into the aqueous humor after single-dose intravenous administration in humans. PATIENTS AND METHODS: Before receiving cataract surgery, 30 patients received randomly 1 g (group 1, 15 patients) and 2 g (group 2, 15 patients) single intravenous injection of cefepime before surgery. Samples of aqueous humor and serum were obtained at 0.5, 1, 2, 4, and 12 hours after injection. Three patients were sampled each time for 1 g and 2 g of cefepime. Samples were assayed for cefepime concentrations with high performance liquid chromatography (HPLC). RESULTS: All the patients had detectable cefepime in their aqueous humor and serum measurable by HPLC. A mean peak aqueous humor level was 5.16 +/- 0.88 microg/mL in group 1 and 5.87 +/- 1.64 microg/mL in group 2 at 0.5 hour after injection. The mean level of cefepime in aqueous humor decreased after 0.5-hour measurements in both groups and was measured as 0.82 +/- 0.21 microg/mL in group 1 and 2.04 +/- 0.30 microg/mL in group 2 at 12 hours after injection. CONCLUSION: Aqueous humor levels of cefepime after single IV injection were above the minimum inhibitory concentration (MIC90) for most ocular pathogens, but the duration of exposure to an antibiotic was not sufficient for therapeutic effect.

Corneal iron ring associated with iatrogenic keratectasia after myopic laser in situ keratomileusis.

A 23-year-old woman had bilateral myopic laser in situ keratomileusis (LASIK). Two months postoperatively, she reported decreased visual acuity. Biomicroscopic examination revealed a corneal epithelial iron ring around the central keratectasia on both corneas. The appearance of the ring pattern was similar to the iron deposits of the Fleischer ring of keratoconus.

Optical coherence tomography for evaluation of anatomical changes in the cornea after laser in situ keratomileusis.

PURPOSE: To examine the use of optical coherence tomography (OCT) in evaluating anatomical changes after laser in situ keratomileusis (LASIK) and complications related to the interface and corneal flap. SETTING: Istanbul University Eye Research Center and Department of Ophthalmology, Cerrahpasa Medical School, Istanbul, Turkey. METHODS: Eleven eyes of 11 patients who had myopic LASIK were included in the study. Mean age of the 7 men and 4 women was 29.4 years +/- 6.9 (SD). Cases analyzed included uneventful LASIK (4 eyes), epithelial ingrowth (5 eyes), and flap striae (2 eyes). Corneas were examined by OCT (Humphrey Systems). RESULTS: Optical coherence tomography resolved corneal flap and residual stromal layers in all cases. The mean thickness of the corneal flap and residual stroma was 138.2 +/- 16.5 microm and 321.7 +/- 32.1 microm, respectively. Interface between the corneal flap and residual stroma was shown by OCT. Optical coherence tomography revealed that the eye with flap striae had flap displacement undetected by biomicroscopy. Epithelial ingrowth was shown as a highly reflective area. CONCLUSION: Optical coherence tomography appears to be a promising method for evaluating anatomical changes in the cornea after LASIK.

Decreased tear secretion after laser in situ keratomileusis for high myopia.

PURPOSE: To investigate the changes in tear secretion and tear film stability after excimer laser in situ keratomileusis (LASIK) for high myopia. METHODS: One eye of 28 patients underwent unilateral LASIK for the correction of myopia with spherical equivalent refractions ranging from -6.37 to -18.25 D (mean, -11.98 +/- 3.45 D). Schirmer tear test values without anesthesia at 5 minutes and tear break-up time values were measured 4 weeks after LASIK. Unoperated contralateral eyes were used as a control for each patient. The Schirmer tear test and tear break-up time values were analyzed statistically using the independent t-test. RESULTS: The mean Schirmer tear test value was 16.17 +/- 2.50 mm in the operated eyes and 21.07 +/- 7.03 mm in the unoperated (control) eyes of the same patients (P = .001). The mean tear break-up time value was 21.0 +/- 3.55 seconds in the operated eyes and 21.27 +/- 6.79 seconds in the control eyes (P = .85). CONCLUSION: Tear secretion decreased following LASIK probably due to decrease in corneal sensitivity, but tear film stability appeared unaltered.

Retinal detachment following laser in situ keratomileusis.

OBJECTIVE: To report the clinical characteristics, surgical management and outcome of retinal detachment following laser in situ keratomileusis (LASIK) in myopic patients. PATIENTS AND METHODS: Retrospective review of 10 eyes of 10 myopic patients with retinal detachment who had previously undergone LASIK surgery were analyzed. Included in the study were 7 males and 3 females, aged 22 to 68 years (35.2+/-2.8). RESULTS: Mean spherical equivalent refraction was -10.51+/-3.90 D (ranging from -6.37 D to -17.00 D) before surgery. The time interval between the LASIK procedure and the development of retinal detachment varied from two months to nine months (5.2 +/- 2.78 months). The number of retinal breaks was one in 7 patients, two in 2 patients and three in 1 patient. The type of retinal breaks included 7 patients with horse shoe tears, 1 patient with a retinal hole, 1 patient with a giant retinal tear, and 1 patient with retinal dialysis. Retinal breaks were located anterior to the equator in 9 patients and posterior to the equator in 1 patient. Retinal reattachment was achieved with one operation in 8 eyes (80%) and the remaining 2 eyes required a second surgery for the reattachment of the retina. CONCLUSION: This study suggests the possible association between retinal detachment and LASIK procedure in patients with myopia. Clinicians should be aware of retinal pathology predisposing to retinal detachment in patients undergoing LASIK.

Reproducibility of corneal flap thickness in laser in situ keratomileusis using the Hansatome microkeratome.

PURPOSE: To evaluate the reproducibility of flap thickness during laser in situ keratomileusis (LASIK) and to analyze the effect of preoperative central corneal thickness and corneal keratometric power on flap thickness. SETTING: Department of Ophthalmology, Cerrahpasa Medical School, Istanbul, Turkey. METHODS: One hundred forty eyes with a mean preoperative pachymetry of 554.4 microm +/- 36.3 (SD) and a mean keratometry of 43.5 +/- 1.9 diopters had LASIK using the Hansatome automated microkeratome (Bausch & Lomb Surgical) and a 193 nm argon-fluoride excimer laser (Summit SVS Apex Plus). The 180 microm microkeratome plate was used in all procedures. Corneal thickness was measured with an ultrasonic pachymeter (Advent, Mentor O&O Inc.) before and during the flap procedure, and the difference was taken as flap thickness. The data were analyzed using a 1-tailed t test and Pearson correlation coefficient. RESULTS: The mean flap thickness was 120. 8 +/- 26.3 microm. There was a low correlation between baseline central corneal thickness and corneal flap thickness (P =.6, r = 0. 046). There was no correlation between preoperative keratometry and flap thickness (P =.01, r = 0.203). CONCLUSIONS: The Hansatome microkeratome does not always produce a corneal flap of the intended thickness. Factors other than keratometry and pachymetry must affect flap thickness.

Secondary laser in situ keratomileusis 1 year after primary LASIK for high myopia.

PURPOSE: To report the results of the laser in situ keratomileusis (LASIK) using a second-cut hinged corneal flap to treat regression 1 year after primary LASIK for high myopia. SETTING: Istanbul University, Eye Research Center, Istanbul, Turkey. METHODS: Six eyes of 4 patients who had a mean myopic regression of -6.20 diopters (D) +/- 1.10 (SD) 1 year after primary LASIK were retreated with secondary LASIK performed using the Automated Corneal Shaper (Chiron Vision) and a 193 nm excimer laser (Chiron Technolas, Keracor 116). Fluence was 130 mJ/cm2 and the repetition rate, 10 Hz. RESULTS: Mean follow-up was 12.16 +/- 0.75 months. At the last follow-up, the mean spherical equivalent was -0.18 +/- 0.77 D (range +0.12 to -1.25 D). Two eyes (33.3%) remained within +/- 0.50 D of emmetropia; 5 eyes (83.3%) were within +/- 1.00 D of emmetropia. No patient lost best spectacle-corrected visual acuity. No complications occurred such as detachment of the former corneal flap and rolling, irregularity, or tearing of the new corneal flap. CONCLUSION: Secondary LASIK was an effective, safe method to treat regression after primary LASIK for high myopia.

Silicone oil removal using a self-sealing corneal incision under topical anesthesia.

BACKGROUND AND OBJECTIVE: To report the results of silicone oil removal from aphakic eyes using a self-sealing clear corneal incision under topical anesthesia. PATIENTS AND METHODS: Twenty-two eyes of 22 patients who had pars plana vitrectomy combined with silicone oil injection underwent silicone oil removal under topical anesthesia using a self-sealing clear corneal incision. Mean time between silicone oil injection and removal was 3.1+/-1.42 months. Fourteen eyes were filled with 1300 cs of silicone oil and 8 eyes were filled with 5700 cs of silicone oil. The removal was performed with passive washout in the eyes filled with 1300 cs of silicone oil and with active aspiration in the eyes filled with 5700 cs of silicone oil. RESULTS: All of the 22 silicone oil removal procedures performed under topical anesthesia had clear corneal incisions that did not require suturing at the end of surgery. Three cases that had 1300 cs of silicone oil required aspiration because of residual silicone oil bubbles. CONCLUSION: Silicone oil can be removed from the aphakic eye using a self-sealing corneal tunnel incision under topical anesthesia.

Two-year results of photorefractive keratectomy with scanning spot ablation for myopia of less than -6.0 diopters.

BACKGROUND AND OBJECTIVE: To investigate the efficacy, predictability, stability, and safety of photorefractive keratectomy (PRK) with scanning spot ablation for the treatment of myopia of less than -6.0 D. PATIENTS AND METHODS: Twenty eyes of 20 patients (11 men, 9 women) were enrolled into the study. The mean age was 26.2 +/- 5.4 years. Mean spherical equivalent myopia was -3.53 +/- 1.13 D, ranging from -2.25 to -6.00 D. Patients underwent excimer laser PRK for the treatment of myopia. Follow-up time was at least 24 months in all patients. RESULTS: Mean spherical equivalent refraction was +0.84 +/- 0.99 D at 1 month, +0.19 +/- 0.54 at 3 months, -0.01 +/- 0.53 at 12 months, and -0.13 +/- 0.50 at 24 months. There was a mean regression of 0.65 D between 1 and 3 months. At 24 months, 16 (80%) of the eyes remained within +0.50 D of emmetropia and 18 (90%) of the eyes remained within +/- 1.0 D of emmetropia. Nineteen (95%) of the eyes had uncorrected visual acuity of 20/40 or better. The mean corneal haze score was maximum at 3 months (0.88 +/- 0.22). There was no clinically significant corneal haze (greater than 2+). One eye (5%) lost 2 or more lines of best-corrected visual acuity. CONCLUSION: Excimer laser PRK with the scanning spot ablation technique is effective, predictable, stable, and safe for the treatment of myopia of less than -6.0 D.

Corneal interface abscess after excimer laser in situ keratomileusis.

Laser in situ keratomileusis (LASIK) carries the risk of infection. We report a case culture-negative interface abscess following LASIK that was successfully treated with antibiotics and povidone iodine.

Double zone PRK for high myopia.

INTRODUCTION: Although excimer laser PRK is our operation of choice for treating myopia, the correction of myopia exceeding -8.00 dpt is still a challenge as this procedure requires a deeper keratectomy. Therefore a double zone treatment may be beneficial to reduce ablation depth. METHODS: Twenty-one eyes with myopia between -8.00 dpt and -14.00 dpt were included in this study. Twelve eyes were treated 60% of myopia by 5 mm zone and the remaining 40% in a 4 mm zone in the same session (Group 1). RESULTS: Nine eyes achieved 60% of the desired correction treated with a 4 mm zone whereas 40% correction was achieved in a 5 mm zone (Group 2). No significant difference in postoperative healing, pain, hyperopic shift, myopic regression and haze was observed at the end of the mean follow-up time (10.4 months) but photophobic complaints were less in Group 2. Best corrected visual acuity did not decrease significantly. CONCLUSIONS: Double zone treatment seems to be an interesting method for treating moderate to high myopia.

Simultaneous and sequential photorefractive keratectomy.

The purpose of this study was to show the safety, effectiveness, and predictability of simultaneous bilateral as compared to sequential unilateral photorefractive keratectomy in 273 normally sighted myopic eyes. An excimer laser with a fluence of 180 mj/cm2 at a frequency of 10 Hz was used at three ablation zones (5 mm, 6 mm, and 6.5 mm). There were no significant differences between the two groups' results. Mean refraction at six months was 0.34-0.96 D in group 1 simultaneous group and 0.32-0.95 D in group 2 sequential group. At 9 months after surgery, 84% of eyes had an uncorrected visual acuity of at least 20/40. The average pain score on the first postoperative day was 2.4 for group 1 simultaneous group and 2.3 for group 2 sequential group. No serious complications occurred. Despite the short follow up, simultaneous bilateral photorefractive keratectomy appears to be an effective and safe procedure for the correction of myopia.

Short term cyclosporin A treatment of Behçet's disease.

Eleven separate three-month courses of cyclosporin A, an oral solution 10 mg/kg/day, were administered to eight patients with Behçet's disease with sight-threatening posterior uveitis. It was found to be effective in arresting the inflammatory activity in the eye as well as the mucocutaneous lesions of Behçet's disease. Improvement in visual acuity was observed within one week of starting therapy. Severe exacerbations in the ocular and mucocutaneous lesions occurred on withdrawal of the drug. At this dosage side effects included hirsutism in all women, and a slight rise of serum bilirubins in two patients and of blood urea in one patient. The latter two conditions responded rapidly to dose adjustment.