Exophthalmometry values of Turkish adult population and the effect of age, sex, refractive status, and Hertel base values on Hertel readings.

PURPOSE: To establish normal exophthalmometry values in the adult Turkish population, and the impact of age, gender, interpupillary distance, Hertel base selection, and refractive status on globe position. METHODS: Exophthalmometry measurements and refractive status of 2477 subjects were conducted in one tertiary and five primary health care centers. Change of globe position by age, intersex differences in terms of globe position, correlations of Hertel base with exophthalmometry results, and interpupillary distance (IPD) were evaluated. Multiple linear regression analysis was performed to test determination effect of each variable on final Hertel reading. RESULTS: Median Hertel reading was 13 mm, and 95% of the population had an upper limit of 17 mm for both eyes. There was a negative correlation between spherical equivalent of refractive status and exophthalmometry results and a weak positive correlation between IPD and exophthalmometry result. Mean Hertel value was found to decrease significantly after the third decade. Hertel base value was found to have moderate linear correlation with Hertel results. A weak correlation was detected with Hertel base/IPD ratio with final Hertel results. Multiple linear regression analysis was performed and only 13% and 20% of change in Hertel values bilaterally were found to be determined by other variables (age, IPD, refractive status, and Hertel base value) for females and males. CONCLUSIONS: Normative dataset for exophthalmometry results of the Turkish population is established to be used in clinical practice and research. Only 13% to 20% of change in Hertel values was detected to be determined by age, IPD and Hertel base values.

Effect of intraocular lens and anterior capsule opening type on posterior capsule opacification.

PURPOSE: To determine the effect of intraocular lens (IOL) type and anterior capsulectomy technique on the incidence of posterior capsule opacification. SETTING: Department of Ophthalmology, Medical Faculty, University of Ondokuz Mayis, Samsun, Turkey. METHODS: Three hundred two eyes of 294 patients were examined retrospectively after IOL implantation in the capsular bag performed between February 1991 and November 1996. Patients were divided into 3 groups according to IOL type: poly(methyl methacrylate) (PMMA); heparin-surface-modified PMMA (HSM PMMA); plate-haptic silicone. Envelope capsulectomy or continuous curvilinear capsulorhexis (CCC) was used. Mean follow-up was 27 months (range 12 to 33 months). RESULTS: Posterior capsule opacification developed in 47 cases (15.6%): 21.7% in the PMMA lens group after planned extracapsular cataract extraction (ECCE), 17.4% in the HSM PMMA lens group after planned ECCE, and 7.7% in the plate-haptic silicone lens group after phacoemulsification. Posterior capsule opacification occurred less in patients who had anterior capsulectomy using the CCC technique (11.5%) than in those having an envelope capsulectomy (24.5%) (P < .05). Posterior capsule opacification was significantly less in eyes with a capsular-bag-fixated plate-haptic silicone lens than in those with a PMMA or HSM PMMA IOL (P < .05). CONCLUSION: This study demonstrated that the anterior capsulectomy technique and the IOL type influence the incidence of PCO.

Lincoff temporary balloon buckle in retinal detachment surgery.

PURPOSE: To assess the long-term anatomical and functional results of balloon buckle surgery for rhegmatogenous retinal detachment. PATIENTS AND METHODS: Twenty-five selected detachments with a single break or a group of breaks close together were treated with a temporary parabulbar balloon. Adhesion was obtained with transconjunctival cryopexy and argon laser photocoagulation. Retinal detachment was associated with the following risk factors: myopia (15 eyes), aphakia (2 eyes), blunt trauma (1 eye). Twenty-three eyes had a detached macula. The balloon was withdrawn after one week. The patients were kept under observation for at least six months (mean 44.7 months). RESULTS: Initial retinal attachment was achieved in 29 eyes. After the balloon was removed redetachment occurred in two eyes; thus, complete attachment was attained in 27 eyes. Causes of failure were: undetected break (2 eyes), inadequate buckle (4 eyes), proliferative vitreoretinopathy (2 eyes). Conventional scleral buckling and subretinal fluid drainage was done in all failed cases. Vitrectomy and silicone oil were employed in one patient, and finally retinal attachment was achieved in all patients. CONCLUSIONS: Temporary balloon buckling is a simple and curative technique for a selected group of patients with retinal detachments.

Diabetic retinopathy and HLA antigens in type 2 diabetes mellitus.

PURPOSE: Diabetic retinopathy is the most common complication of diabetes mellitus. No single predisposing factor has been identified, and genetic factors may play a role in the development of severe retinopathy. In this study, we investigated the association between diabetic retinopathy and HLA antigens in type 2 diabetes mellitus. METHODS: This study was conducted at the retina unit of the Department of Ophthalmology of Ondokuz Mayis University between October 1999 and March 2000, and included 46 diabetics with non-proliferative retinopathy and 30 with proliferative retinopathy, with 30 nondiabetic controls. HLA class I (A, B, C) antigens were studied by Terasaki's microlymphocytotoxicity test and HLA class II (DR, DQ) typing was carried out using a polymerase chain reaction-sequence specific primer. RESULTS: HLA-DR4 and DQ8 frequencies were higherin patients with non-proliferative retinopathy than those with proliferative retinopathy, and HLA-DR7 frequency was higher in patients with proliferative retinopathy than non-proliferative cases (p<0.05). No significant differences in HLA antigens were found between patient groups and controls. CONCLUSIONS: The differences in HLA antigen frequencies between patients with and without proliferative retinopathy suggest a genetic contribution to diabetic retinopathy.

Does surgical technique influence cataract surgery contamination?

PURPOSE: To compare cataract surgery contamination rates in large-incision extracapsular cataract extraction (ECCE) and phacoemulsification (PE), we studied 65 cases prospectively. METHODS: Thirty-five cases were operated by large-incision ECCE (Group I) and 30 by PE (Group II). Conjunctival swab cultures were taken immediately before surgery and anterior chamber aspirate was taken for culture upon completion of surgery for each case. RESULTS: Anterior chamber cultures were positive in 22.8% of the cases in group I and 23% in Group II. Frequencies of contamination in each group were no different (x2: 0.22, p>0.05). When the contaminations were evaluated in relation to operating time, prolongation of the operating time raised the contamination rate in Group I (p<0.05) but not in Group II (p>0.05). Silicone and PMMA intraocular lenses (IOL) were tested to see whether they had any additional risk of contamination. The frequencies of contaminated silicone IOL implanted cases (6/26) and contaminated PMMA IOL implanted cases (8/39) were similar (x2: 0.36, p>0. 05). CONCLUSIONS: Although the architecture of the incision and irrigation dynamics provided an advantage to the PE technique as the operating time became longer, routine PE was not superior to classical ECCE with respect to contamination when performed in the same circumstances. Prolonging the operating time raised the contamination rate in classical ECCE.

The evaluation of ocular trauma in children between ages 0-12.

Ocular trauma is the leading cause of noncongenital unilateral blindness in children under 20 years old. In this study, 138 patients (36 female, 102 male) with ocular trauma between November 1983 and October 1996 were reviewed retrospectively at the Department of Ophthalmology, Ondokuz Mayis University Faculty of Medicine. Twenty-four of these patients were blunt trauma and 114 were perforating eye injury. The mean age of the patients was 6.96+/-3.01 years. Mean post-treatment follow-up was 10.7 months (range 1 to 121 months). Forty-five patients were admitted to the eye clinic within the first 24 hours after trauma. The most frequent finding was hyphema in blunt injury, and corneal laceration in perforating injury. The most frequent cause of injury was wood and stone in blunt trauma and glass and knife in perforating trauma. While the ratio of visual acuities equal to or better than finger counting was 37.5 percent (9 eyes) in blunt trauma cases and 20.2 percent (23 eyes) in perforating trauma cases prior to treatment, it was 79.2 percent (19 eyes) and 55.3 percent (63 eyes), respectively, at last visit examination post-treatment. The most frequent complication was traumatic cataract in blunt trauma and corneal leukoma and anterior synechia in perforating trauma. The results obtained suggested that socioeconomic and sociocultural status and family negligence are important factors in eye injuries in children that occur during games.

The results of cataract extraction and intraocular lens implantation in patients with Behçet's disease.

PURPOSE: To evaluate the results of extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation in patients with Behçet's disease. METHODS: Retrospective study was based on 19 uveitic eyes of 12 patients with Behçet's disease who underwent classic ECCE with IOL implantation in 5 eyes and phacoemulsification with IOL implantation in 14 eyes between 1993-1999. RESULTS: In eyes with Behçet's uveitis 0.5 or better postoperative visual acuity was found in 21% at the end of mean 34.2-4.6 (range 5 to 66) months follow-up. The most frequent postoperative complications were posterior capsule opacification in 9 (47%), posterior synechiae in 5 (26%), anterior synechiae in 3 (16%). Anterior and posterior synechiae in the phacoemulsification group were less than those in the ECCE group (respectively p<0.05 and p<0.01). CONCLUSIONS: In eyes with chronic Behçet's uveitis, cataract extraction and IOL implantation by phacoemulsification had fewer postoperative complication than ECCE, but most of the patients had low visual acuity due to preoperatively existing optic atrophy and/or inflammatory degeneration or edema of macula.

The effects of antiglaucomatous agents on conjunctiva used for various durations.

PURPOSE: The effect of antiglaucomatous agents on conjunctiva used for various durations evaluated histopathologically. METHODS: Conjunctiva biopsies were taken in 19 Mayis University Faculty of Medicine Ophthalmology Department from 31 eyes of 30 patients who underwent filtration surgery after a period of antiglaucomatous agent use and examined under light microscope. The results were compared with the results of conjunctival biopsies from 10 similar aged patients undergoing retinal detachment of cataract surgery and with no other ocular pathology. RESULTS: Five of the cases were using antiglaucomatous treatment for two months (Group A), four cases for two to 12 months (Group B) and 22 cases for more than 12 months (Group C) before the surgery. Four cases were using a beta blocker only, eight cases beta blocker + sympathomimetic or beta blocker + myotic and the remaining 19 cases were using a combination of beta blocker + sympathomimetic + myotic. Histopathologic evaluation with light microscope showed no pathologic change in group A, but, subepithelial increase of lymphocytes, mast cells, macrophages and fibroblasts in group C. CONCLUSIONS: It was detected that subconjunctival inflammatory reaction increases as the number of antiglaucomatous agents and the treatment duration increase. These changes might be considered as risk factors that decrease the success rate of filtration surgery.

Cyclosporin-A therapy in severe uveitis of Behçet's disease.

PURPOSE: Cyclosporine-A (CSA) combined with corticosteroid therapy was administered to 12 patients with severe Behçet's uveitis who were resistant to colchicine or cytotoxic therapy. METHODS: Previous colchicine or cytotoxic therapies were tapered off one month before CSA therapy. All patients were started on an initial oral dose of 5 mg/kg/day of CSA. After the first three months, the CSA dose was reduced to a maintenance dose according to the intraocular inflammatory response. RESULTS: The average follow-up period was 20 (12-36) months. Visual acuity remained the same in 12 (%54.5) and improved in 8 (%36.4) eyes. There was a decrease in the frequency (p<0.01) and severity (p<0.01) of ocular attacks and in the maintenance steroid dose (p<0.01) when compared with conventional therapy. The frequent side effects were paraesthesia-hyperesthesia, fatigue, nausea, hirsutism and dose-related nephrotoxicity in one patient. CONCLUSION: The results of the study suggest that low dose CSA combined with low dose corticosteroid may be an effective therapeutic alternative in the treatment of severe refractory Behçet's uveitis.

The effects of nasolacrimal canal blockage on topical medications for glaucoma.

Twenty patients with primary open angle glaucoma who have been treated with identical antiglaucoma eye drops in both eyes were examined. Silicone punctal plugs were used to occlude the inferior punctum of one eye, in order to block the nasolacrimal canal. The intraocular pressures and effects of the medical therapy before and after punctal occlusion were compared. Punctal occlusion significantly decreased the intraocular pressure with an average of 2.00 +/- 0.43 mmHg in the plugged eyes (p < 0.001). The intraocular pressure in the unplugged control eyes did not change significantly (p > 0.05) after punctal occlusion of the fellow treated eye.

Secondary glaucoma after congenital cataract surgery.

PURPOSE: Glaucoma has been recognized as an infrequent but serious complication following surgery for congenital cataract in childhood. We conducted a retrospective review of patients in whom glaucoma had developed after surgery for congenital cataract. METHODS: We reviewed the records of 87 eyes of 53 patients on whom cataract surgery had been performed between February 1982 and March 1995 at Ondokuz Mayis University Hospital, Samsun. RESULTS: The average postoperative follow-up is 4.5 years (range 1 to 12 years). We identified open angle glaucoma (OAG) in 17 eyes, chronic angle closure glaucoma (ACG) in six eyes, and acute angle closure glaucoma (AACG) in two eyes. The average time between cataract surgery and the diagnosis of glaucoma was 6.08 years (range one week to 10 years). The mean time to diagnosis of glaucoma was 4.7 years (range 4 months to 10 years) for OAG, 4.3 years (range 1 to 8 years) for ACG and, for AACG, 7 days and 10 months following surgery. Medication alone was successful in intraocular pressure control in 17 of 25 eyes (<21 mmHg), and additional surgical procedures resulted in intraocular pressure control in eight eyes in which they were performed. CONCLUSION: Patients undergoing cataract surgery early in life should be routinely examined for possible postoperative glaucoma.