Evaluation of Long-term Posterior Segment Parameters in Children Who Had Recovered From Multisystem Inflammatory Syndrome.

BACKGROUND AND OBJECTIVE: To evaluate long-term posterior segment findings in children recovering from multisystemic inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2. PATIENTS AND METHODS: Our study included 22 patients who were admitted to an intensive care unit with a diagnosis of MIS-C between November 2021 and March 2022, and 25 healthy controls. The study included pediatric patients who had an eye examination an average of 12.35 ± 2.18 months after recovery from MIS-C. Detailed eye examinations and measurements of all participants were obtained retrospectively from patient files. Posterior segment parameters were measured using swept-source optical coherence tomography (OCT) and OCT-angiography (OCT-A); these parameters included peripapillary retinal nerve fiber layer (pRNFL) thickness, central macular thickness (CMT), subfoveal choroidal thickness (SCT), macular vascular densities (VD), and foveal avascular zone (FAZ) area. RESULTS: Mean age was 9.7 ± 3.6 years in the MIS-C group and 10.6 ± 2.8 years in the healthy control group (P = 0.316). There were no statistically significant differences between the MIS-C group and the healthy control group in terms of pRNFL thickness, CMT, and SCT. However, in the MIS-C group, the macular superficial vascular plexus and deep vascular plexus showed significantly lower VD in the superior, inferior, nasal, and temporal quadrants compared to the healthy controls (P < 0.05 for all). A comparison of the superficial and deep FAZ area parameters of both groups showed no statistically significant difference (P > 0.05). CONCLUSIONS: We showed that patients who had recovered from MIS-C had retinal vascular damage at the long-term follow-up. Following up with these patients after recovery with OCT and OCT-A, which are noninvasive methods commonly used in the detailed evaluation of the posterior segment of the eye, could be beneficial for understanding the long-term effects of MIS-C on retinal microvasculature. [Ophthalmic Surg Lasers Imaging Retina 2024;55:518-526.].

Clinical features, management, and outcomes of patients with sterile endophthalmitis associated with intravitreal bevacizumab injection: retrospective case series.

PURPOSE: To evaluate clinical features, treatment protocol, outcomes, and complications that developed in this case series of 24 patients who had consecutive sterile endophthalmitis after intravitreal bevacizumab (IVB) injection. METHODS: In this retrospective case series, IVB was repackaged in individual aliquots from the three batches that were used on the same day. IVB was injected into 26 eyes of 26 patients due to diabetic macular edema, age-related macular degeneration, and branch retinal vein occlusion. All patients had intraocular inflammation. Patients were divided into two groups severe and moderate inflammation according to the intraocular inflammation. The medical records of all patients were reviewed. At each follow-up visit, the complete ophthalmologic examination was performed, including best corrected visual acuity (BCVA), intraocular pressure, biomicroscopy, and posterior fundus examination. RESULTS: Twenty-four of 26 patients were included in the study. Two patients were excluded from this study since they didn't come to follow-up visits. The mean BCVA was 1.00 ± 0.52 Log MAR units before IVB. At the final visit, the BCVA was 1.04 ± 0.47 Log MAR units. These differences were not significant (p = 0.58). Of the 24 eyes, 16 eyes had severe, and 8 eyes had moderate intraocular inflammation. Eleven eyes in the severe inflammation group underwent pars plana vitrectomy due to intense vitreous opacity. Smear, culture results, and polymerase chain reaction results were negative. CONCLUSION: Sterile endophthalmitis may occur after IVB injection. Differential diagnosis of sterile endophthalmitis from infective endophthalmitis is crucial to adjust the appropriate treatment and prevent long-term complications due to unnecessary treatment.

New approach to AGV implantation with scleral tunnel method by prolene suture: Simsek Technique.

PURPOSE: To present the short-term outcomes of our novel technique, the suture-assisted method, in long scleral tunnel Ahmed Glaucoma Valve (AGV) implantation. METHODS: This retrospective study included glaucoma patients who underwent AGV implantation using the suture-assisted long scleral tunnel method and were fellowed for at least 6 months between January 2022 and November 2022. Preoperative and postoperative assessments included best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior and posterior segment examinations, anti-glaucomatous medications, and intraoperative and postoperative complications were also evaluated. RESULTS: Eight eyes of seven patients were included in the study. The mean age was 52.25 ± 29.38 years (r:8-76 years), and there were 5 female and 2 male patients. The mean follow-up duration period was 8.62 ± 2.50 months (r:6-12 months). The mean IOP was 27.12 ± 3.48 mmHg preoperatively and 11.62 ± 3.48 mmHg on postoperative on 1st day, 11.62 ± 3.20 mmHg at 1st week, 18.75 ± 8.94 mmHg at 1st month, 16.62 ± 2.72 mmHg at 3rd month, 16.12 ± 3.75 mmHg at 6th month. Postoperative hyphema was observed in one eye, and tenon cyst excision was performed in two eyes. No tube exposure was observed in any eye during the follow-up period. No hypotony-related complications were observed during follow-up. CONCLUSION: We believe that suture-asissted application of the long scleral tunnel method not only prevents tube exposure but also facilitates the passage of the AGV silicone tube through the scleral tunnel, reducing the surgical time contributing to a decreased the risk of infection.

Infectious interface keratitis after Descemet membrane endothelial keratoplasty / Ceratite infecciosa de interface após ceratoplastia endotelial da membrana de Descemet

ABSTRACT Purpose: To evaluate the clinical course and management of infectious interface keratitis after Descemet membrane endothelial keratoplasty. Methods: A total of 352 cases that had undergone Descemet membrane endothelial keratoplasty were retrospectively reviewed. Patients with infectious interface keratitis during follow-up were analyzed. The microbiological analyses, time to infection onset, clinical findings, follow-up duration, treatment, and post-treatment corrected distance visual acuity were recorded. Results: IIK was detected in eight eyes of eight cases. Three fungal and three bacterial pathogens were identified in all cases. All patients received medical treatment according to culture sensitivity. Antifungal treatment was initiated in two cases with no growth on culture, with a preliminary diagnosis of fungal interface keratitis. Intrastromal antifungal injections were performed in all patients with fungal infections. The median time to infection onset was 164 days (range: 2-282 days). The postoperative infectious interface keratitis developed in the early period in two cases. The mean follow-up duration was 13.4 ± 6.2 months (range: 6-26 months). Re-Descemet membrane endothelial keratoplasty was performed in two patients (25%) and therapeutic penetrating keratoplasty in four patients (50%) who did not recover with medical treatment. The final corrected distance visual acuity was 20/40 or better in five patients (62.5%). Conclusion: The diagnosis and treatment of infectious interface keratitis following Descemet membrane endothelial keratoplasty are challenging. Early surgical intervention should be preferred in the absence of response to medical treatment. Better graft survival and visual acuity can be achieved with therapeutic penetrating keratoplasty and re-Descemet membrane endothelial keratoplasty in patients with infectious interface keratitis.

RESUMO Objetivo: Avaliar o curso clínico e o manejo da ceratite infecciosa de interface após ceratoplastia endotelial da membrana de Descemet. Métodos: Um total de 352 casos submetidos a ceratoplastia endotelial da membrana de Descemet foram revisados retrospectivamente. Pacientes com ceratite infecciosa de interface foram analisados durante o acompanhamento. As análises microbiológicas, o tempo até o início da infecção, os achados clínicos, a duração do acompanhamento, o tratamento e a acuidade visual para longe corrigida pós-tratamento foram registrados. Resultados: Ceratite infecciosa de interface foi detectada em 8 olhos de 8 casos. Três patógenos fúngicos e três bacterianos foram identificados em todos os casos e receberam tratamento médico de acordo com a sensibilidade da cultura. O tratamento antifúngico foi iniciado em dois casos sem crescimento em cultura, com diagnóstico preliminar de ceratite infecciosa fúngica. Injeções antifúngicas intraestromais foram usadas em todos os casos com infecções fúngicas. O tempo médio para o início da infecção foi de 164 dias (variação: 2-282 dias). A ceratite infecciosa de interface pós-operatória desenvolveu-se no período inicial em dois casos. A duração média do acompanhamento foi de 13,4 ± 6,2 meses (variação: 6-26 meses). A ceratoplastia endotelial de membrana de Descemet foi realizada em dois casos (25%) e ceratoplastia penetrante terapêutica em quatro casos (50%) que não se recuperaram com tratamento médico. A acuidade visual para longe corrigida final foi de 20/40 ou melhor em 5/8 (62,5%) dos pacientes. Conclusões: O diagnóstico e o tratamento da ceratite infecciosa de interface após ceratoplastia endotelial da membrana de Descemet são difíceis. A intervenção cirúrgica precoce deve ser o procedimento preferido se não houver resposta ao tratamento médico. Melhor sobrevida do enxerto e melhor acuidade visual podem ser alcançadas com ceratoplastia penetrante terapêutica e ceratoplastia endotelial da membrana de Descemet em pacientes com ceratite infecciosa de interface

Two-year results of a novel sutureless scleral fixation surgery with the haptic hook technique.

PURPOSE: In this study, we evaluated the visual results and complication rates of the novel technique of sutureless scleral fixated intraocular lens (SFIOL) surgery in patients without capsular support. METHODS: In this retrospective study, patients who did not have adequate capsular support and who underwent sutureless SFIOL between 2013 and 2017 at the University of Health Science Dr. Lütfi Kirdar Kartal Training and Research Hospital's Eye Clinic were included. Preoperative and postoperative best corrected visual acuity (BCVA), perioperative and postoperative complications, surgical indications, previous surgeries, and surgical procedures were evaluated. RESULTS: The study included 131 eyes of 162 patients who underwent sutureless SFIOL surgery. Thirty-one patients were excluded from the study because of missing data. The mean age of the patients was 61.5 ± 23.2 years, 72 of whom were female, and the mean follow-up period was 24.3 ± 11.4 months. When all the patients were evaluated together, the preoperative mean BCVA was 1.11 ± 1.01, 0.86 ± 0.76 in the first month, 0.71 ± 0.69 in the third month, and 0.60 ± 0.50 in the second year after surgery according to logMAR. CONCLUSION: The 2-year results of our study demonstrate that the haptic hook technique for sutureless SFIOL surgery is effective and safe in aphakia rehabilitation. However, haptic hooks and their associated future complications must be monitored for a longer period of time to reach a definite conclusion.

The impact of delayed anti-vascular endothelial growth factor treatment for retinal diseases during the COVID-19 lockdown.

PURPOSE: To assess the clinical status of treatment-naive patients who had to delay 3-dose loading anti-VEGF (anti-vascular endothelial growth factor) injections during the COVID-19 lockdown, and to evaluate the effect of the delayed visual acuity treatment on spectral domain optical coherence tomography (SD-OCT) parameters. METHOD: A total of 55 eyes of 46 patients who were received in the study period participated in this retrospective study, including 28 patients (37 eyes) with diabetic macular edema (DME), 11 patients (11 eyes) with retinal vein occlusion (RVO), and 7 patients (7 eyes) with wet age-related macular degeneration (wet-AMD). The patients were diagnosed with DME, RVO, or wet-AMD in February 2020 and had planned 3-dose loading injections in March, April, and May 2020, but could not be injected due to the COVID-19 pandemic. RESULTS: From the patients' initial examination in February 2020, the mean best corrected visual acuity (BCVA) was 0.72 ± 59 logMAR. After the patients' lockdown visit in July 2020, the mean BCVA was 0.76 ± 64 logMAR. BCVA was stable in 11 eyes, decreased in 12 eyes, and increased in 14 eyes for patients with DME. BCVA was stable in 6, decreased in 3, and increased in 2 eyes for patients with RVO, and it was stable in 4 eyes and decreased in 3 eyes for patients with wet-AMD. CONCLUSION: We concluded that 6-month delay in treatment of DME patients with non-proliferative DRP had no adverse effect on the visual acuity. However, the loading dose in wet-AMD and RVO patients should be applied as soon as possible.

Birt Hogg Dube syndrome: Rare family lung disease.

Birt Hogg Dube syndrome is a rare disease characterized by autosomal dominant inherited multiple cysts in the lungs, renal tumors and skin fibrofolliculomas. It was first described in 1977 by Birt et al. In this case report, a patient who was diagnosed with symptoms and his first degree relative is presented. Diseases that should be considered in differential diagnosis are discussed. The diagnosis of this disease is usually made after recurrent pneumothorax. Since it is a genetic disease, the importance of follow-up and screening needs of patients and their relatives is emphasized.

From an asymptomatic lesion to a vision-threatening condition: Congenital hypertrophy of the retinal pigment epithelium complicated by choroidal neovascular membrane.

We reported a case of congenital hypertrophy of the retinal pigment epithelium (CHRPE) complicated by choroidal neovascular membrane (CNVM). A 41-year-old woman presented to our clinic with visual loss in the left eye. She was diagnosed as CHRPE complicated by a CNVM. The patient was treated with 2 consecutive monthly intravitreal aflibercept (IVA) injections. The best-corrected visual acuity (BCVA) improved and stabilized at 6/6. Subretinal fluid depending on CNVM resolved completely. CHRPE complicated by CNVM in the macular area is a rare condition and these cases can be treated with IVA therapy.

Partial Schlemm Canal, Trabecular Meshwork, and Descemet Membrane Separation During Gonioscopy-assisted Transluminal Trabeculotomy: A Case Report.

Gonioscopy-assisted transluminal trabeculotomy (GATT) is a surgery that opens the trabecular meshwork (TM) circumferentially after cannulation of the Schlemm canal (SC) with a flexible illuminated microcatheter or suture. The main purpose of this case report was to describe a new complication of GATT. Herein, we report a case of partial SC, TM, and Descemet membrane (DM) separation during GATT. The patient was a 60-year-old man with a history of glaucoma who underwent GATT. SC, TM, and DM separation occurred intraoperatively during 360 degrees trabeculotomy. The separated tissue fragment was removed from the anterior chamber and later confirmed to be a part of the SC, TM, and DM by histopathologic examination. In our patient, this complication did not cause surgical failure. Various complications associated with GATT have been reported previously. Partial SC, TM, and DM separation may occur during this surgery.

Blood lead and cadmium in age related macular degeneration in a Turkish urban population.

PURPOSE: To evaluate the blood lead (Pb) and cadmium (Cd) levels in age related macular degeneration (AMD) in a turkish urban population. METHODS: Blood Pb and Cd levels of 31 AMD patients and 24 age and gender matched controls with no sign of AMD were measured using dual atomic absorption spectrophotometer system (AAS). History of hypertension, diabetes mellitus, cigarette smoking, myocardial infarction and stroke were obtained from all subjects. Degree of AMD was grade 4 according to the Age-Related Eye Disease Study grading system. Median blood Pb and Cd levels were compared by using Students' t-test. RESULTS: Demographic properties like smoking status, presence of diabetes mellitus or hypertension, cerebrovascular occlusion history, serum cholesterol and lipid levels were not significantly different between groups except history of ischemic heart disease (3.22% vs 25% in AMD and control groups respectively, p = .022). Overall in AMD group blood Pb level was 2.83 ±â€¯0.15 µg/l and it was 2.63 ±â€¯0.23 µg/l in control group (p = .36). The Cd level was 3.25 ±â€¯0.20 µg/l in AMD group and 3.11 ±â€¯0.25 µg/l in control group (p = .67). The mean Pb (2.38 ±â€¯0.88 µg/l vs 2.91 ±â€¯1.37 µg/l for AMD vs control, p = .61) and Cd levels (3.06 ±â€¯1.34 µg/l vs 3.35 ±â€¯1.26 µg/l for AMD vs control, p = .56) in current and previous smokers with AMD were not significantly different from those of the current and previous smokers in control group. CONCLUSION: Blood Pb and Cd levels which reflect short term exposure were not significantly different in AMD patients and the control group. The difference was not significant either after involvement of previous or current smoker subjects.

The Effect of Perioperative Topical Ketorolac 0.5% on Macular Thickness after Uneventful Phacoemulsification.

BACKGROUND: To evaluate the effects of topical 0.5% ketorolac treatment combined with topical steroids on macular thickness in cases who had uneventful phacoemulsification surgery. METHODS: 58 eyes of 58 consecutive cases were included. The mean foveal thickness (MFT), parafoveal thickness (ParaFT), and perifoveal thickness (PeriFT) measurements were performed with optical coherence tomography (RTVue-100, Optovue, Fremont, CA, USA) preoperatively and at postoperative 1 week, 1 month, and 2 months. All cases received topical 0.1% dexamethasone postoperatively. Randomly selected cases additionally received topical 0.5% ketorolac, which started 2 days prior to surgery. Cases who received both topical steroids and ketorolac formed group 1 and subjects who received only topical steroids formed group 2. RESULTS: The increase in mean MFT at the 1st week, 1st month, and 2nd months after surgery in group 1 was significantly lower than group 2 (P = 0.008, P ≤ 0.001, and P ≤ 0.001, resp.). In group 1, the increase in mean ParaFT and PeriFT was significantly lower than group 2 at the 1st and 2nd months of the surgery (P < 0.05 for all variables). CONCLUSIONS: Topical ketorolac combined with steroids is highly efficacious in order to prevent increment in thickness on each part of the macula even after an uneventful phacoemulsification surgery comparing to steroid monotheraphy.

Clinical outcomes of a new diffractive trifocal intraocular lens with Enhanced Depth of Focus (EDOF).

BACKGROUND: To evaluate the clinical outcomes after the implantation of a new trifocal diffractive intraocular lens (IOL) combined with Enhanced depth of focus (EDOF) technology. METHODS: The study enrolled 80 eyes of 40 patients who underwent cataract surgery with bilateral implantation of a diffractive trifocal IOL (Reviol Tri-ED) designed with a combination of enhanced depth of focus. Mean age was 52.09 ± 11.32 years (range from 45 to 70 years). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), corrected intermediate visual acuity (CIVA), uncorrected near visual acuity (UNVA), corrected near visual acuity (CNVA), keratometry (K), and manifest refraction spherical equivalent (MRSE) were evaluated pre- and postoperatively. The contrast sensitivity, defocus curves, and a questionnaire evaluating individual satisfaction were also estimated. RESULTS: There was a significant improvement in UDVA, CDVA, UNVA, CNVA, CIVA postoperatively. The defocus curve confirmed good visual acuity also in the intermediate distance. The postoperative MRSE was ranged from -0.75 to 0.75 diopters. Contrast sensitivity also significantly improved postoperatively. The patient satisfaction was high. CONCLUSION: The new trifocal EDOF IOL provides visual improvement for far, intermediate, and near distances with a high level of visual quality and patient satisfaction.

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.

Long-term results of simultaneous bilateral external dacryocystorhinostomy in cases with bilateral dacryostenosis.

OBJECTIVES: To evaluate the long-term results of simultaneous bilateral external dacryocystorhinostomy (EX-DCR) in cases with bilateral dacryostenosis. METHODS: Thirty-four eyes of 17 consecutive patients with a history of bilateral epiphora were included in the study between 2007 and 2011. Demographic information, etiology of the obstruction, history of lacrimal surgery, type of anesthesia, duration of surgery, incidence of postoperative nasal bleeding and infection, surgical outcomes, and duration of follow-up were recorded. During the lacrimal irrigation, there was not any passage noticed in the patients' eyes. The post-operative follow-up was 13 to 44 months (mean 33.6 months). RESULTS: Of 17 patients undergoing simultaneous bilateral EX-DCR with a mean age of 42.8 years, one of the patients had a history of bilateral unsuccessful DCR performed in a different center. One patient had previously failed bilateral probing before undergoing bilateral EX-DCR. This latter patient was a four-month-old baby with bilateral dacryoceles. Bicanalicular silicone intubation was performed in 15 eyes of 10 patients that had a canalicular problem or fibrotic lacrimal sac. It has been discerned that complaints about epiphora disappeared in 33 of the eyes (97%) and that the passage was open during the lacrimal irrigation. One eye with a history of unsuccessful dacryocystorhinostomy failed to respond positively to our operation. CONCLUSIONS: In our study, high success rates of simultaneous bilateral EX-DCR were found in both children and adult patients with bilateral dacryostenosis during a long-term follow-up. We believe that simultaneous bilateral dacryocystorhinostomy has medical, social, and economic advantages.

The effect of intravitreal bevacizumab as a pretreatment of vitrectomy for diabetic vitreous hemorrhage on recurrent hemorrhage.

PURPOSE: This study was constructed to compare the rate of rehemorrhage in patients with diabetic vitreous hemorrhage (VH) undergoing pars plana vitrectomy (PPV) with versus without preoperative intravitreal bevacizumab (IVB) injection. METHODS: It is a retrospective chart review of all patients who had undergone PPV for diabetic VH from January 2008 to January 2011. Patients who had undergone IVB injection before PPV were assigned to Group 1; the others were assigned to Group 2. Postoperative VH was the main outcome. RESULTS: A total of 65 eyes of 60 patients (19 eyes in Group 1 and 46 eyes in Group 2) were examined. Postoperative VH occured in three eyes (15.8%) in Group 1 and in 13 eyes (28.3%) in Group 2, but this was not statistically significant (p: 0.347). CONCLUSION: Further studies to evaluate the effect of IVB on postoperative VH are needed.

Surgical treatment of mucoepidermoid carcinoma of the lacrimal sac.

PURPOSE: We report successful management of a case with high-grade mucoepidermoid carcinoma of the lacrimal sac managed by aggressive soft tissue and bony resection with adjuvant radiotherapy. METHODS: Case report. RESULTS: A 32-year-old man was referred to us with a two-year history of epiphora and slow-growing mass in the area of the lacrimal sac. On physical examination, a firm and nontender mass was visible overlying the area of the right lacrimal sac. Computed tomography and magnetic resonance imaging confirmed a 30 mm × 15 mm, well-enhanced soft tissue mass occupying the lacrimal fossa and extending to include the nasolacrimal duct, and FNA biopsy of the mass demonstrated high-grade mucoepidermoid carcinoma. On this basis, the tumor, lacrimal sac, and nasolacrimal duct were removed en bloc with the frontal process of the maxilla, lateral nasal wall, lacrimal fossa, ethmoids, and anterior part of the medial orbital wall with two intraoperative frozen section examinations. Postoperatively, the patient received adjuvant radiotherapy. The clinical evaluation and positron emission tomography at 38 months showed recovery and no recurrence of the disease. CONCLUSIONS: MEC of the lacrimal sac is extremely rare and spreads locally in an aggressive manner. Despite the fact that orbital exenteration have generally been recommended for these tumors, radical surgical resections with external radiation therapy might be effective. In our case, despite the high-grade MEC, the patient underwent successful radical surgical excision and postoperative adjuvant external radiotherapy. As a result, we achieved an aesthetically satisfying result by preserving the eye and the vision.

Effectivity of intraoperative adjustable suture technique in horizontal strabismus.

AIM: To compare the long-term effectivity of intraoperative adjustable suture technique with traditional non-adjustable strabismus surgery. METHODS: Two hundred and thirty-three patients, who underwent strabismus surgery either with traditional procedures or one-stage intraoperative adjustable suture technique, were included in our long-term follow-up study. One hundred and eighteen patients were evaluated in traditional surgery group (TSG) and 115 who underwent adjustable suture were in the one-stage intraoperative adjustable surgery group (ASG). In this group 9 patients had paralytic strabismus and 16 had reoperations, 2 patients had restrictive strabismus related to thyroid eye disease. The mean follow up in the TSG was 26.2 months and it was 24.8 months in the ASG group. RESULTS: In patients with exotropia (XT) the mean correction of deviation for near fixation in ASG (32.4±13.2PD) and in TSG (26.4±8.2PD) were similar (P=0.112). The correction for distant fixation in ASG (33.2±11.4PD) and TSG (30.9±7.2PD) were not significantly different (P=0.321). In patients with esotropia (ET) even the mean correction of deviation for both near (31±12PD) and distant (30.6±12.8PD) fixations were higher in ASG than in TSG, for both near (28.27±14.2PD) and distant (28.9±12.9PD) fixations, the differences were not significant (P=0.346, 0.824 respectively). The overall success rate of XT patient was 78.9% in TSG and 78.78% in ASG, the difference was not significant (P=0.629). The success rates were 78.75% in TSG and 75.51% in ASG in ET patient, which was also not significantly different (P=0.821). CONCLUSION: Although patients in ASG had more complex deviation such as paralysis, reoperations and restrictive strabismus, success rates of this tecnique was as high as TSG which did not contain complicated deviation. One-stage intraoperative adjustable suture technique is a safe and effective method for cooperative patient who has complex deviation.

Phacoemulsification with intraocular lens implantation in patients with anterior uveitis.

PURPOSE: To assess the results of phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation in patients with cataract secondary to anterior uveitis. SETTING: Department of Ophthalmology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey. DESIGN: Case series. METHOD: Consecutive patients with anterior uveitis and cataract were prospectively studied for outcomes after phacoemulsification and PC IOL implantation. RESULTS: Fifty-five eyes (48 patients; mean age 44.9 years ± 15.6 [SD]) were included. Patients were followed for 6 months. The etiology of uveitis was presumed idiopathic anterior uveitis (n = 22), herpes simplex virus-associated anterior uveitis (n = 10), Fuchs heterochromic iridocyclitis (n = 10), and anterior uveitis associated with collagen vascular disease (n = 13). Preoperative complications secondary to uveitis included posterior synechiae (12 eyes), glaucoma (26 eyes), and sequelae of cystoid macular edema (CME) (21 eyes). At the final visit, the corrected distance visual acuity (CDVA) was 20/40 or better in 52 eyes (94.5%) and 20/20 in 33 eyes (60.0%). The CDVA was worse than 20/40 in 3 eyes because of preoperative anterior and posterior segment abnormalities. Postoperative complications were CME, recurrent uveitis, and posterior capsule opacity in 7 eyes (12.7%) each; fibrinous anterior chamber reaction in 6 eyes (10.9%); raised intraocular pressure in 4 eyes; peripheral anterior synechiae in 1 eye (1.8%); and hypotony in 1 eye (1.8%). CONCLUSION: Patients with a history of anterior uveitis and cataract having phacoemulsification with PC IOL implantation had excellent visual results with a relatively low complication rate. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

The treatment of lacrimal gland prolapse in blepharoplasty by repositioning the glands.

Prolapse of the lacrimal gland is an unusual condition. An appearance of bilateral dermatochalasis was observed in the medical examination of a 30-year-old female patient with bilateral upper eyelid edema.The patient underwent bilateral blepharopylasty. During the surgery, it was noticed that in the temporal portions of the eyelids, there was a prolabed tissue-like lacrimal gland. We did incisional biopsy from the prolabed tissue that was thought to be orbital lobe of the lacrimal gland and carried out reposition of the orbital rim with 5-0 polyester suture and closed the orbital septum. Lacrimal gland reposition is a procedure which entails the separation of such anatomic structures as orbital septum, adipose tissue, and levator complex. However, failure to recognize a prolapsed lacrimal gland may mistreat by simple excision, and will lead to important alterations in ocular lubrication. In our case, repositioning of the glands was successfully performed during upper-lid blepharoplasty.