Long term outcomes of Yamane technique in various indications.

INTRODUCTION: To describe the clinical and refractive outcomes of Yamane transconjunctival sutureless intrascleral intraocular lens (SIS IOL) fixation technique in aphakic and dislocated IOLs. METHODS: The aphakic and IOL dispositioned patients who underwent Yamane surgery in Bozyaka Research and Training Hospital were evaluated retrospectively. The demographic data, preoperative & postoperative best-corrected visual acuity (BCVA), spherical equivalent (SE), indication for surgery, additional surgical interventions, complications, the final status of retina, and central macular thickness (CMT) through spectral-domain optic coherence tomography (SD-OCT) were recorded. RESULTS: A total of 30 eyes of 30 patients were evaluated. The indication for surgery was aphakia in 24 patients, lens dislocation in 1 patient, and IOL dislocation in 5 patients. The mean age of participants was 64.17 ± 14.69 years, and the mean follow-up was 46.07 ± 7.96 months. The mean BCVA was improved from 0.25 ± 0.22 (-0.94 ± 0.83 log MAR) to 0.49 ± 0.24 in decimals (-0.37 ± 0.27 log MAR) (p:0.041). The mean subjective refraction improved from 10.06 ± 3.10 to -1.45 ± 0.73 D in the final visit (p < 0.05). The mean of cylindrical refraction was -1.22 ± 1.03 D in the postoperative period. At the time surgery, 36.6% of patients required at least one additional surgical procedure. During follow-up period, two (6.7%) out of 30 of patients had retinal detachment, two of the patients (6.7%) occured epiretinal membrane, one of the patients (3.3%) had cystoid macular edema. CONCLUSION: Yamane SIS IOL fixation technique is an effective and reliable surgical option in complicated cases that require additional surgical interventions in long-term follow-up.

Simultaneous Cataract, Maculopathy and Optic Atrophy Secondary to High-Voltage Electrical Shock Injury.

A 32-year-old man presented to our clinic with complaint of vision loss in both eyes (oculus utro; OU). Past medical history revealed that he had been exposed to high-voltage electrical current that passed through the temporal region of the head 2 months ago. Slit-lamp examination demonstrated cortico-nuclear cataract and mature cataract in his right eye (oculus dexter; OD) and left eye (oculus sinister; OS), respectively. On fundus examination, a macular hole was observed in OD. Optic atrophy and foveal atrophy were observed in the left fundus examination after cataract surgery. Simultaneous cataract, maculopathy and optic atrophy may occur after high-voltage electrical current injury. Therefore, clinicians should perform detailed anterior and posterior segment examinations in such patients.

Orbital Metastasis Secondary to Breast Cancer: A Rare Cause of Unilateral External Ophthalmoplegia.

Orbital metastases are rare causes of orbital tumours, and may present with pain, photophobia, red eye, vision loss, diplopia, proptosis, or external ophthalmoplegia. Breast cancer is responsible for a great majority of orbital metastases. Herein, we report a 78-year-old female who had unilateral external ophthalmoplegia due to orbital metastasis of primary breast cancer.

The Effect of Nicotine on Macular Microcirculation in Healthy Subjects.

BACKGROUND AND OBJECTIVE: To evaluate the acute effects of nicotine on macular microvasculature by optical coherence tomography angiography (OCTA). PATIENTS AND METHODS: Non-smokers who were administered 4 mg nicotine gum (study group) or placebo gum (control group) were enrolled, 18 individuals in each group. All participants underwent OCTA at baseline and 1 hour after gum chewing. Macular flow area, macular vessel density, foveal avascular zone area, central foveal thickness, and subfoveal choroidal thickness were analyzed. RESULTS: Macular flow area, vessel density, and subfoveal choroidal thickness decreased in the nicotine group (P < .05). No statistically significant difference observed in central foveal thickness, when compared with baseline measurement (P > .05). CONCLUSIONS: Nicotine causes a significant decrease in macular microcirculation. Deterioration of macular microcirculation can be quantitatively detected by OCTA noninvasively. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:691-700.].

Olfactory Neuroblastoma: A Rare Cause of External Ophthalmoplegia, Proptosis and Compressive Optic Neuropathy.

Olfactory neuroblastoma (ONB), which is a neuroectodermal tumor of the nasal cavity, is a rare and locally aggressive malignancy that may invade the orbit via local destruction. In this study, we report a patient with proptosis, external ophthalmoplegia, and compressive optic neuropathy caused by ONB. A detailed clinical examination including ocular imaging and histopathological studies were performed. The 62-year-old female patient presented to our clinic with complaints of proptosis and visual deterioration in the left eye. Her complaints started 2 months prior to admission. Visual acuity in the left eye was counting fingers from 2 meters. There was relative afferent pupillary defect. She had 6 mm of proptosis and limitation of motility. Fundus examination was normal in the right eye, but there was a hyperemic disc, and increased vascular tortuosity and dilation of the retinal veins in the left eye. Computerized tomography and magnetic resonance imaging of the brain and orbits demonstrated a large heterogeneous mass in the left superior nasal cavity with extensions into the ethmoidal sinuses as well as into the left orbit, compressing the medial rectus muscle and optic nerve. Endoscopic biopsy of the lesion was consistent with an ONB (Hyams' grade III). Orbital invasion may occur in patients with ONB. Therefore, it is important to be aware of this malignancy because some patients present with ophthalmic signs such as external ophthalmoplegia, proptosis, or compressive optic neuropathy.

An Evaluation of the Relationship Between Clinically Unilateral Pseudoexfoliation Syndrome and Age-Related Macular Degeneration.

BACKGROUND AND OBJECTIVE: To evaluate the relationship between age-related macular degeneration (AMD) and clinically unilateral pseudoexfoliation syndrome (XFS). PATIENTS AND METHODS: Seventy-six patients (152 eyes) with bilateral AMD and clinically unilateral XFS were included. Eyes with AMD were divided into three stages (early, intermediate, and late), based on the Beckman Initiative for Macular Research Classification Committee of fundus findings. The distribution of AMD lesions was assessed in both groups, and the subfoveal choroidal thickness (SFCT) was measured using enhanced depth imaging spectral-domain optical coherence tomography (SD-OCT). RESULTS: There were significantly more early and intermediate-stage AMD cases in eyes with XFS than in non-XFS fellow eyes (P < .05). In contrast, there were significantly fewer wet AMD cases in XFS eyes than in non-XFS fellow eyes (P < .05). SFCT in all AMD stages was significantly lower in eyes with XFS (P < .05). CONCLUSION: XFS was associated with a lower prevalence of wet AMD. Further studies are required to elucidate this association. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:12-19.].

Risk factors for multiple retinal tears in patients with acute posterior vitreous detachment.

PURPOSE: To evaluate possible risk factors for multiple retinal tears in patients with acute posterior vitreous detachment. MATERIALS AND METHODS: Three hundred and seventy-six consecutive patients presenting with symptoms of floaters and/or flashes were examined. The associations of retinal tears with the duration of symptoms, multiple floaters, flashing, a family history of retinal detachment, peripheral retinal degeneration, lens status, myopia, tobacco dust, and retinal or vitreous hemorrhage were analyzed. RESULTS: Fifty-four (14.4%) of the 376 patients had 71 initial retinal tears. Forty of the 54 eyes had one retinal tear, and 14 eyes had multiple retinal tears. The presence of retinal or vitreous hemorrhage increased the risk of multiple retinal tears 6.1 times using univariate analysis and 7.0 times using multivariate analysis. CONCLUSION: Unrecognized retinal tears in patients with acute posterior vitreous detachment can cause subsequent retinal detachment. It is therefore important to consider multiple retinal tears, especially in patients with retinal or vitreous hemorrhage.

Effect of 1- and 6-Hour-Delayed Corneal Collagen Cross-Linking on Corneal Healing in a Rabbit Alkali-Burn Model: Clinical and Histological Observations.

PURPOSE: To study the effect of 1- and 6-hour-delayed corneal collagen cross-linking (CXL) on wound-healing of experimental alkali burns of the cornea. METHODS: Twenty-four albino rabbits were used. Alkali burns were created using 1 M NaOH. The animals were divided randomly into 2 groups: group 1 (control group, n = 6) and group 2 (experimental group, n = 18). The experimental group was further divided into 3 subgroups as follows: group 2A, untreated (non-CXL) subgroup; group 2B, 1-hour-delayed CXL treatment subgroup; and group 2C, 6-hour-delayed CXL treatment subgroup. All rabbits were examined periodically for 21 days after treatment and then killed. The corneas were excised and histologically examined. RESULTS: Corneal ulceration, edema, and opacity scores were 4.0 ± 1.64, 1.6 ± 0.65, and 3.5 ± 1.21 in group 2A, 1.5 ± 1.76, 1.3 ± 0.87, and 3.1 ± 1.12 in group 2B, and 2.0 ± 1.90, 1.5 ± 0.79, and 3.3 ± 1.09 in group 2C, respectively. These scores were significantly less in groups 2B and 2C than in group 2A (P = 0.023, P = 0.043, and P = 0.034, respectively). Corneal epithelialization, evident upon staining, was best in group 2B and worst in group 2A (P = 0.012). Histopathology revealed that destruction of corneal collagen fibers and infiltration of inflammatory cells into corneal tissue were reduced in groups 2B and 2C compared with group 2A. CONCLUSIONS: We found that CXL treatment exerted positive effects on severe alkali-induced corneal burns. However, the effects were more pronounced in the 1-hour treatment group. We believe that CXL treatment may be a possible treatment for corneal alkali burn.

Optic nerve and dura mater involvement as the first sign of multiple myeloma.

PURPOSE: To report a case of optic nerve and dura mater involvement as the first sign of multiple myeloma. METHODS: Case report. RESULTS: A 43-year-old woman presented with a headache and decreased vision in both eyes. Ophthalmic examination revealed anterior uveitis and subretinal mass around the optic nerves with accompanying disc edema bilaterally. Magnetic resonance imaging showed dural and optic nerve infiltration with tram-track enhancement in the optic nerve sheath. The diagnosis of multiple myeloma was made as a result of systemic investigations. The patient underwent systemic chemotherapy and cranial radiotherapy. After treatment, the patient's headache disappeared, the papilledema regressed, and the ocular findings improved but complete recovery could not be achieved because of fibrous subretinal tissue and degenerative changes of the optic nerve. CONCLUSIONS: Neurologic and ophthalmic involvement in multiple myeloma may appear as the first manifestation of disease. The correct diagnosis is important because it can be life-saving.

Spontaneous resolution of macular edema after silicone oil removal.

AIM: To investigate the macular changes in eyes filled with silicone oil (SO) and course of these changes after SO removal. METHODS: A retrospective optical coherence tomography scan review was conducted for twenty-four patients who underwent uncomplicated pars plana vitrectomy with SO tamponade for complex retinal detachments were detected with optical coherence tomography before, and one week, one month and three months after SO removal. RESULTS: Mean duration of SO tamponade was 3.6±1.0mo (range: 3-7mo). Cystoid macular edema (CME) was detected in 3 eyes before SO removal. Submacular fluid was represented in 1 eye before silicone SO removal. Resolution of CME and submacular fluid was achieved 1mo after SO removal in all eyes. Mean best corrected visual acuity (BCVA) was 1.15±0.65 (range, hand movement to 0.2) before SO removal in the eyes without macular changes. After SO removal, the mean BCVA values at 1wk and 1 and 3mo, and 0.82±0.23, 0.76±0.21, and 0.70±0.19, all of which were significantly better than baseline (P=0.030, 0.017, 0.006 respectively). In the eyes with macular CME and subretinal fluid the mean BCVA was significantly improved at 3mo after SO removal compared with baseline (P=0.037). CONCLUSION: Decreased visual acuity in eyes filled with SO could be caused by macular complications due to SO. CME and subretinal fluid may resolve without any additional macular surgery after SO removal.

Changes in choroidal thickness in patients with obstructive sleep apnea syndrome.

BACKGROUND AND OBJECTIVE: To evaluate choroidal thickness using spectral-domain optical coherence tomography (SD-OCT) in patients with obstructive sleep apnea syndrome (OSAS) in comparison to healthy controls. PATIENTS AND METHODS: This observational, comparative study consisted of 35 patients with OSAS and 32 age- and sex-matched controls. The controls did not have systemic or ocular diseases. All study participants underwent complete ophthalmic examination as well as choroidal thickness measurement using a high-speed, high-resolution SD-OCT device. RESULTS: The mean horizontal and vertical choroidal thicknesses, respectively, were 237.84 ± 69.9 µm and 234.97 ± 62.0 µm (P = .654) in patients with OSAS and 244.09 ± 41.2 µm and 241.88 ± 40.9 µm (P = .590) in the healthy controls. The mean choroidal thicknesses were thinner in patients with OSAS, but the difference was not significant (P > .05 for all values). CONCLUSION: No differences in choroidal thickness were found between patients with OSAS and healthy controls.

Vascularization of conjunctival autografts in pterygium surgery: comparison of fibrin glue with sutures.

PURPOSE: To monitor the development of graft vascularization after pterygium excision with conjunctival autograft transplantation (CAT) using indocyanine green angiography (ICGA) and to compare the graft vascularization between 2 different fixation techniques (fibrin glue and sutures). METHODS: A total of 26 eyes of 26 patients with primary pterygium were randomly assigned after pterygium excision as having either fibrin glue (13 eyes) or Vicryl sutures (13 eyes) for CAT. Anterior segment ICGA findings were evaluated postoperatively at 1, 7, and 15 days and the percentages of graft vascularization in both groups were compared using pixel analysis software program. RESULTS: The mean ± SD age of patients in the suture and fibrin glue groups was 52.1 ± 12.7 years and 57.1 ± 9.82 years, respectively. There was no statistically significant difference between the groups regarding age, sex, or follow-up (p<0.05 for all). Also, the mean intraoperative defect size was not significantly different between the groups, which was measured as 20.11 ± 10.44 mm2 in the suture group and 23.44 ± 12.34 mm2 in the fibrin glue group (p = 0.343). The mean percentage of vascularized graft area at postoperative day 1 and 7 was 18.1 ± 7.8% and 25.3 ± 8.6% in the suture group and 34.8 ± 10.2% and 66.1 ± 17.8% in the fibrin glue group. The difference between the groups was statistically significant (p<0.01 for both). At postoperative day 15, all grafts were 100% perfused in both groups. CONCLUSIONS: Fibrin glue fixation of conjunctival autografts led to more vascularization in the early postoperative period than suture fixated grafts, which in turn may have significance in terms of graft health and pterygium recurrence.

The ocular biometric differences of diabetic patients.

PURPOSE: To investigate the differences in ocular biometric and keratometric characteristics in comparison with biometric measurements using the noncontact optical low coherence reflectometer (OLCR) (Lenstar LS 900, Haag-Streit) on diabetic patients. METHODS: The eyes of 170 patients were included in this study, including 81 diabetic and 89 nondiabetic subjects. Optical biometric measurements of diabetic and nondiabetic patients (between the ages of 25 and 85 years) who applied to the ophthalmology clinic were noted from March to June 2013. Detailed ophthalmologic examinations were done for every subject. Biometric measurements were done using the noncontact OLCR device. RESULTS: Patient age ranged from 29 to 83 years. Subgroup analyses were done in diabetic patients according to their Hba1C levels. The minimum Hba1C value was 5.3, maximum was 12.4, and mean was 7.56 ± 1.48. The median duration of diabetes was 5 years (25th-75th percentile 3.00-11.75). Diabetic patients were found to have thicker lens and shallower anterior chamber in both eyes compared to nondiabetic control subjects. There were no statistical differences between the groups according to central corneal thickness, axial length, or keratometric values in both eyes. However, lens thicknesses were found to be thicker and anterior chamber depth values were found to be shallower in the diabetic group in both eyes. CONCLUSIONS: It may useful to determine eyeglasses prescription, refractive surgery calculation, lens selection, and previous cataract surgery according to biometric measurements after the regulation of blood glucose.

The return of the jedi: comparison of the outcomes of endolaser dacryocystorhinostomy and endonasal dacryocystorhinostomy.

BACKGROUND: External dacryocystorhinostomy (DCR) is considered to be the gold standard treatment of primary acquired nasolacrimal duct obstruction. A better understanding of the endoscopic anatomy of the lacrimal sac has increased the success rate of endonasal DCR. Laser DCR has become popular in recent years and has a success rate comparable with those of other endonasal techniques. The aim of this study was to compare the surgical results of endonasal DCR (EDCR) and endonasal laser DCR (ELDCR). METHODS: Fifty-four patients treated with ELDCR and 42 patients treated with EDCR for nasolacrimal duct obstruction from 2009 to 2012 with at least 1.5 years of follow-up were retrospectively enrolled in this comparative study. Lack of patient complaints and irrigation testing were used as subjective and objective assessment tools, respectively. RESULTS: Both groups were similar in terms of age and sex. ELDCR had a success rate of 85.2%, and EDCR had a success rate of 92.9%. The difference between the 2 procedures was not statistically significant. ELDCR had a significantly shorter operative time than did EDCR (16.9 vs 24.4 minutes, respectively; p < 0.001). CONCLUSION: Endonasal procedures have the advantage of no scar formation and do not disturb the pumping mechanism of the lacrimal sac. Their success rates are comparable with those of external DCR. Surgery is quicker, and with use of a laser, even less time is spent in the operating room. In selected cases, ELDCR can be a good alternative method with a high success rate.

The effect of nicotine on choroidal thickness.

PURPOSE: To investigate the effect of nicotine on choroidal thickness using optical coherence tomography (OCT). DESIGN: Prospective, case-control study. METHODS: Sixteen young, healthy subjects and 16 age and gender matched control cases were included in this study; 4 mg nicotine gum was given to the study group and placebo gum to the control group. All participants underwent OCT scanning with a high-speed and resolution spectral-domain OCT device (3D OCT 2000, Topcon, Japan) at baseline, and 1 h following nicotine or placebo administration. The measurements were taken in the morning (10:00-12:00 hours) to avoid diurnal fluctuation. RESULTS: The median foveal choroidal thickness at baseline was 337.00 µm (IQR 84.50), which decreased to 311.00 µm (IQR 78.00) at 1 h following oral nicotine intake (p=0.001). The median choroidal thickness was also significantly decreased at five other extrafoveal points (p<0.05 for all). In the control group, the median baseline choroidal thickness at the fovea was 330.50 µm (IQR 104.25), and was 332.00 µm (IQR 103.75) at 1 h (p=0.271). CONCLUSIONS: Nicotine causes a significant decrease in choroidal thickness following oral intake. This acute decrease might be a result of reduced ocular blood flow due to the vasoconstrictive effect of nicotine.

Correlation of choroidal thickness with outer and inner retinal layers.

BACKGROUND AND OBJECTIVE: To investigate the correlation of choroidal thickness with the outer and inner retinal layers. PATIENTS AND METHODS: A retrospective OCT scan review was conducted for healthy patients. Choroidal, outer retinal layer, and inner retinal layer thicknesses were measured at the fovea and 500 µm, 1,000 µm, and 1,500 µm temporal and nasal to the fovea. Retinal thickness was also measured at the foveal center. Choroidal thickness (CT) was compared at different locations, and correlation of CT with the outer and inner retinal layers was examined. RESULTS: Mean CT was thinnest nasally, thicker in the subfoveal region, and then thinner again temporally. Correlations found between CT and outer retinal layer thicknesses at temporal points to the fovea were slightly higher than correlations between CT and inner layer thicknesses. CONCLUSION: The correlation between choroidal thickness and the outer retinal layer was very weak. Similar prospective trials are needed to assess the correlation of CT with retinal layers.

[Our endoscopic transcanalicular multidiode laser dacryocystorhinostomy results through bicanalicular silicone tube intubation]. / Bikanaliküler silikon tüp entübasyonu ile endoskopik transkanaliküler multidiod lazer dakriyosistorinostomi sonuçlarimiz.

OBJECTIVES: This study aims to evaluate the results of transcanalicular multidiode laser dacryocystorhinostomy (TMDL-DCR) through bicanalicular silicone tube intubation (BSTI). PATIENTS AND METHODS: Between September 2011 and March 2012, treatment-naïve 43 eyes of 43 patients (24 males, 19 females; mean age 53.6±4.1 years; range 37 to 69 years) who presented with the complaint of watery eyes with a nasolacrimal duct obstruction and underwent TMDL-DCR through endoscopic silicone tube were included. Patients were assessed postoperatively. During follow-up, changes from baseline in signs and symptoms and the duration of intubation were recorded. RESULTS: The mean age of the patients was 53.6 years (range, 37 to 69 years). The mean follow-up was 19.4±2.2 months (range, 18 to 23 months). The mean duration of surgery was 16.5 min (range, 11 to 32 min). Epiphora was seen in seven patients following surgery. Nasolacrimal duct was open in 36 patients. The success rate was 83.7%. CONCLUSION: Transcanalicular multidiode laser DCR through BSTE is an effective and safe method in the management of nasolacrimal stenosis.