Evaluation of retrobulbar blood flow by color doppler ultrasonography after intravitreal ranibizumab injection in patients with neovascular age-related macular degeneration.

PURPOSE: This study aimed to evaluate the changes in retrobulbar blood flow by using color Doppler sonography in patients who had undergone intravitreal ranibizumab injection for neovascular age-related macular degeneration (AMD). METHODS: The study comprised 37 AMD patients who had undergone intravitreal 0.5 mg ranibizumab injection. The ophthalmic artery, central retinal artery, and short lateral posterior ciliary artery of both eyes of patients were evaluated by color Doppler sonography. Peak systolic velocity, end-diastolic velocity, and resistance index were calculated before injection, and after injection on day 7 and day 30. The pre- and postinjection values were compared using Wilcoxon signed rank test. RESULTS: In a comparison with the preinjection values of peak systolic velocity, end-diastolic velocity, and resistance index, the postinjection values at both day 7 and day 30 showed no statistically significant difference in ophthalmic artery, lateral posterior ciliary artery, and central retinal artery (p > 0.05). Similarly, for the same parameters, pre- and postinjection values in the uninjected fellow eye showed no statistically significant difference (P > 0.05). CONCLUSIONS: Intravitreal ranibizumab injection for neovascular AMD does not cause a significant change in the retrobulbar blood flow in either the injected eye or the fellow eye.

Effects of photodynamic therapy with verteporfin for the treatment of chronic central serous chorioretinopathy: An uncontrolled, open-label, observational study.

BACKGROUND: Central serous chorioretinopathy is an idiopathic disorder that leads to serous neurosensory retinal detachment. The disorder is usually self-limited and resolves spontaneously; however, sometimes neurosensory retinal detachment persists. This form of the disorder is called chronic central serous chorioretinopathy (CCSC). OBJECTIVE: The aim of this study was to assess the effects of photodynamic therapy (PDT) on visual acuity with full-dose verteporfin for CCSC. METHODS: The eyes of patients with CCSC were included in the study. Ophthalmic examination including best-corrected visual acuity (BCVA), fundus examination, fluorescein angiography, and optical coherence tomography was performed before treatment and at 1, 3, 6, 9, and 12 months. PDT with full-dose verteporfin (6 µ/m(2) of body surface area) was applied only to areas of active leakage. BCVA was converted to a log of the minimum angle of resolution (logMAR) equivalent for statistical analysis. Central foveal thickness and BCVA between baseline and follow-up were compared. RESULTS: Seventeen eyes of 16 patients (13 males, 3 females; mean [SD] age, 39.75 [7.51] years; mean duration of follow-up, 13.06 [1.82] months) were used in the study. The mean (SEM) logMAR BCVA was 0.26 (0.07) at baseline and 0.04 (0.02) at 12 months. Mean logMAR BCVA values at baseline (0.259) and after treatment (0.112, 0.053, 0.047, 0.041, and 0.041 at 1, 3, 6, 9, and 12 months, respectively) differed significantly (P = 0.006, P = 0.005, P = 0.005, P = 0.005, and P = 0.005). There was a significant difference in the mean central foveal thickness at the final visit (169 µm) compared with the baseline value (383 µm; P < 0.001). BCVA decreased in one eye (20/20 vs 20/25) and persisted during follow-up; in the other 16 eyes, BCVA either increased (n = 10) or remained stable (n = 6). CONCLUSIONS: In this small, open-label study, patients with CCSC treated with a single course of PDT with full-dose verteporfin had significant improvement from baseline in BCVA and resolution of subretinal fluid accumulation and active leakage. Treatment was generally well tolerated, but one patient had worsening in BCVA.

Intravitreal bevacizumab combined with panretinal photocoagulation in the treatment of open angle neovascular glaucoma.

PURPOSE: To evaluate the clinical efficacy of intravitreal bevacizumab (IVB) combined with panretinal photocoagulation in patients with open angle neovascular glaucoma (NVG). METHODS: Nine patients (9 eyes) with NVG participated in this study. Patients received IVB (1.25 mg) as the initial treatment for NVG and were followed up for at least 4 months. IVB was offered as the first treatment of choice to patients with NVG. Panretinal photocoagulation was performed as soon as feasible after the second week and completed in all patients the fourth week after IVB. The main outcome measures are resolution of INV, inhibition of peripheral anterior synechia (PAS), and controllability of intraocular pressure (IOP). RESULTS: The mean follow-up period was 5.6+/-1.4 months (range, 4-9 months). The mean IOP before treatment was 35.1+/-9.7 mmHg (range, 24-56) under medication before IVB treatment. After IVB and after combined treatment, the mean IOP was reduced to 22.8+/-8.1 mmHg (range, 9-33) and 13.0+/-4.0 mmHg (range, 7-20), respectively. The mean referral INV was 3.6+/-0.4 grade (range, 3-4) and reduced to 1.6+/-0.4 (range 1-2) grade after IVB and 0.6+/-0.8 (range 0-2) grade after combined therapy. By IVB, combined panretinal photocoagulation recurrence of INV was not observed. CONCLUSIONS: In NVG, IVB treatment can reduce iris and angle neovascularization and inhibits further PAS formation temporarily. Panretinal photocoagulation inhibits neovascularization constantly. Therefore, management of open angle NVG is more feasible with bevacizumab combined with panretinal photocoagulation.

Phthiriasis palpebrarum in an infant.

The authors describe a case of phthiriasis palpebrarum embedded in the right upper eyelid of a 9-month-old male infant. The patient was successfully treated with mechanical removal of all lice and nits from the eyelashes. In children, phthiriasis palpebrarum should be considered in the differential diagnosis of blepharoconjunctivitis that is resistant to treatment.

Tick infestation of the eyelid: a case report in a child.

A three-year-old girl presented with a small brown lesion on the right upper eyelid margin. Close examination revealed an insect body attached to the eyelid margin. Microscopic examination of the specimen identified the species of the organism as Ixodes ricinus. The tick was completely removed with blunt forceps. She was treated with lid toilet, irrigation, and application of topical 0.3% ciprofloxacin four times daily to the affected eye. The lesion healed without scarring after one week. No systemic symptoms were observed. Mechanical removal with blunt forceps may be a quick, easy, safe and effective treatment for ticks located on the eyelids.

Efficacy of topical cyclosporin A 0.05% in conjunctival impression cytology specimens and clinical findings of severe vernal keratoconjunctivitis in children.

PURPOSE: To evaluate the efficacy of topical cyclosporin A 0.05% in managing the symptoms of severe vernal keratoconjunctivitis (VKC). METHODS: Fifty-four children with severe VKC were included in this study. All 54 patients were treated with topical cyclosporin A (CsA) 0.05% for 3 months. Ocular signs and symptoms were scored in all patients at entry and after 3 months. Conjunctival impression cytology specimens were examined on the day of enrollment and at the end of the treatment period. RESULTS: The mean scores for severity of signs and symptoms significantly decreased after 3 months compared with those at entry (P<0.001). The density of inflammatory cells in the conjunctival impression cytology specimens decreased significantly. No side effects of the treatment with CsA 0.05% eyedrops were observed. CONCLUSIONS: Topical CsA 0.05% eyedrops were found to be safe and effective in the treatment of patients with VKC. Consistent with these results, topical CsA may efficiently reduce conjunctival inflammation in severe VKC.

Persistent triamcinolone acetonide particles on the posterior lens capsule after intravitreal injection.

We report a rare case in which triamcinolone acetonide particles gathered on posterior lens capsule after injection of intravitreal triamcinolone acetonide. Intravitreal injection of triamcinolone acetonide is useful in the treatment of macular edema; however, accumulation of triamcinolone acetonide particles on the posterior lens capsule may decrease visual acuity and requires surgical treatment.

Trabeculectomy with mitomycin-C in neovascular galucoma patients.

We sought to determine the effectiveness of trabeculectomy with mitomycin-C (MMC) in neovascular glaucoma (NVG) patients. Trabeculectomy with MMC in NVG patients is a method that has high rate of short-term success.

Wolfram syndrome: case report and review of the literature.

Wolfram syndrome (WFS) is a rare diffuse neurodegenerative disorder characterized by diabetes insipidus, diabetes mellitus, optic atrophy, deafness, and a wide variety of central nervous system abnormalities. Insulin-dependent diabetes mellitus with optic nerve atrophy is a sufficient criterion for the diagnosis. WFS is a devastating disease for the patients and their families. This study emphasizes the need for careful evaluation of cases having insulin-dependent diabetes mellitus and optic atrophy.

Two cases of Goldenhar syndrome.

We describe two boys with Goldenhar syndrome. The 8-year-old boy had an epibulbar dermoid in his left eye, type 1 Duane syndrome, bilateral preauricular appendages, and an interauricular septal defect. The 10-year-old boy had an epibulbar dermoid in his right eye, appendages in the right preauricular region, and sensorineural hearing loss.

Effects of trypan blue on corneal endothelium and anterior lens capsule in albino wistar rats: An investigator-masked, controlled, two-period, experimental study.

BACKGROUND: The development of continuous curvilinear capsulorrhexis (CCC) has contributed significantly to the tolerability and effectiveness of cataract extraction and intraocular lens implantation. Staining of the anterior capsule has become a popular method of increasing visibility when performing CCC. OBJECTIVE: The aim of this study was to determine, using scanning electron microscopy (SEM) and transmission electron microscopy (TEM), the highest concentrations of trypan blue dye that would not cause long-term toxicity after injection into the anterior chamber of rat eyes. METHODS: The eyes of healthy female albino Wistar rats were used in this investigator-masked, controlled, 2-period, experimental study conducted over 12 weeks at the Dicle University Experimental Animal Laboratory, Diyarbakir, Turkey. The rats were randomly divided into 5 groups of 4 using a random-number table. Each rat was administered a 0.05-mL injection of trypan blue into the right eye in 1 of the following concentrations: 0.4%, 0.2%, 0.1%, 0.05%, or 0.025%. A 0.05-mL pH-balanced saline solution was injected into the left eye of each rat to act as a control. At 1 day after injection and 4 weeks after injection (early period), 1 rat from each concentration group was euthanized and their eyes were enucleated. At 12 weeks after injection (late period) the remaining 2 rats from each group were euthanized and their eyes were enucleated. Corneal endothelial cells and the anterior lens capsule of the enucleated eyes were analyzed using SEM and TEM, and the results were compared with those of the control group. In the TEM analysis, the primary end point was the histopathologic changes in the cellular organelles when compared with those in the control group. In the SEM analysis, the primary end point was changes in cell shape, intracellular junctions, and density of the microvilli when compared with those in the control group. RESULTS: Forty eyes from 20 albino Wistar rats (mean [SD] age, 8.2 [1.6] weeks; mean [SD] weight, 175.6 [16.5] g) were used in the study. Each group of rats received a different concentration of trypan blue in the right eye. In the early period, both the 0.4% and 0.2% concentrations were associated with the impairment of the hexagonal structure of corneal endothelial cells and intercellular junctions. Those concentrations were also associated with an increased occurrence of cellular vacuolation, cytoplasmic edema, extensive granulation of the endoplasmic reticulum, pyknotic nuclei, and mitochondrial degeneration. In the late period, these changes were observed as persisting in a decreasing manner. With the 0.1% and 0.05% concentrations, the density of microvilli decreased, nuclei appeared normal, granulation of the endoplasmic reticulum and Golgi apparatus was active, and minimal levels of mitochondrial degeneration were observed. CONCLUSIONS: In this small experimental study in rat eyes, trypan blue at concentrations >0.025% was associated with impaired morphology and structure of corneal endothelial cells after short-term exposure. This effect continued in a decreasing fashion after long-term exposure. No significant changes were noted in the control group or the group administered the 0.025% concentration.

Color doppler imaging of ocular hemodynamic changes in Behçet's disease.

PURPOSE: A prospective evaluation of the ocular blood flow velocity in patients with BehCet's disease was carried out to determine its changes. METHODS: Subjects were divided into three groups: those with ocular involvement in BehCet's disease (group I), those without ocular involvement in BehCet's disease (group II), and a control group (group III). Twenty-seven eyes in group I and 28 eyes each in groups II and III were investigated. The blood flow in the central retinal artery (CRA), ophthalmic artery (OA), nasal posterior ciliary artery (NPCA), and the temporal posterior ciliary artery (TPCA) was measured using color Doppler ultrasonography (CDU) to determine the peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI). The mean blood flow velocity of the central retinal vein (CRV) was also measured. These results were then compared among the three groups of subjects. RESULTS: The PSV values of CRA in groups I and II were found to be significantly lower than those in the control group ( P < 0.001, P = 0.018, respectively). The PSV values of CRA in group I were found to be significantly lower than those in group II ( P< 0.001). The EDV values of CRA in groups I and II were found to be significantly lower than those in the control group ( P< 0.001, P = 0.034, respectively). The EDV values of CRA in group I were significantly lower than those in group II ( P = 0.041). The PSV values of OA in group I were significantly lower than those in the control group ( P = 0.002). The EDV values of OA in group I were significantly lower than those values in group II or the control group ( P = 0.001 and P = 0.037, respectively). The PSV values of NPCA in group I were significantly lower than those in the control group ( P = 0.007). The PSV values of TPCA in groups I and II were significantly lower than those in the control group ( P< 0.001, P < 0.001, respectively). The EDV values of TPCA in group I were significantly lower than those values in group II or the control group ( P = 0.014 and P = 0.003, respectively). There were no significant differences in the mean blood flow values of the CRV among all three groups ( P > 0.05). CONCLUSIONS: There are significant reductions in the blood flow values of the orbital arteries in patients with BehCet's disease, and they are more evident in those with ocular involvement. This might be the result of occlusive vasculitis, which is frequently seen in the retinal vessels of patients with BehCet's disease.

Cutaneous anthrax on eyelids.

BACKGROUND: Ophthalmologists should be aware of the signs and symptoms of anthrax, although it is a rare disease in humans. We report our successful treatment of three patients with cutaneous lesions in the periorbital area. CASES: In this study, we report on the treatment of three female patients who were initially diagnosed as having preseptal cellulitis. OBSERVATIONS: Gram-positive robs were revealed in the microscopic examination of scrapings taken from the lesions. Bacillus anthracis was found in only two of the three scraping-material cultures. Intravenous penicillin G was administered in all cases. Black and necrotic eschar, which is characteristic of anthrax, developed on the eyelids of all three patients during treatment. At the final examinations of the patients after the completion of treatment, we recognized the development of cicatrisation, lagophthalmos, and slight ectropion in the upper eyelid of the first patient, and, in the second patient, restriction of upper eyelid movement and development of a corneal scar from exposure keratopathy and ectropion. The cutaneous lesions healed without any eyelid pathology in the third patient. CONCLUSION: Although it is a rare disease in humans, anthrax should be considered in the differential diagnosis of preseptal and orbital cellulitis.

Orbital myiasis: case report.

BACKGROUND: Orbital myiasis cases are very rare worldwide. We are reporting this case caused by Hypoderma bovis because invasive parasitic larvae can cause massive destruction. CASE: An 85-year-old female patient was admitted to the Department of Ophthalmology of the Dicle University School of Medicine with the complaint of a wound in her right eye for over one year. Larvae had been in the same eye for one week. OBSERVATIONS: The clinical examination showed no light perception in her right eye. The eyelid was thickened and there was a necrotic lesion 3 x 4 cm in diameter, invading inferiorly into the upper side of the maxilla, superiorly to the roof of the orbita, medially to the lateral part of the nose, and laterally to the ossa zygomatica. Pathological examination of orbital tissue specimens confirmed basal cell carcinoma. CONCLUSIONS: Orbital exenteration, total maxillectomy and graft repair were conducted in the right eye. During the six-month follow-up period, orbital tomography was performed. No recurrence or metastasis was observed.

Distribution of central corneal thickness and intraocular pressure in a large population of Turkish school children.

PURPOSE: To determine the distribution of central corneal thickness (CCT) and intraocular pressure (IOP) in a population of Turkish school children and to evaluate the relationships between these values and both age and gender. METHODS: A total of 30,320 eyes from 15,160 healthy school children aged 5-18 years were examined. CCT and IOP were measured using an ultrasonic pachymeter and a non-contact tonometer, respectively. Measurements were compared with age, gender, and parental consanguinity of subjects. RESULTS: The mean age of the school children was 10.43 ±â€…2.54 years. For right eyes, mean CCT was 557.91 ±â€…34.26 µm and mean IOP was 14.15 ±â€…2.87 mmHg. Mean CCT was significantly thicker in males compared to females (P < 0.0001). Mean IOP was significantly higher in females compared to males (P < 0.0001). CCT in children aged 14 years and older was significantly thinner than that in the younger age groups (P < 0.0001). There was a significant difference among the age groups for IOP (P < 0.05). No significant differences were observed in CCT or IOP related to parental consanguinity (P = 0.538, P = 0.319, respectively). CONCLUSION: Mean CCT in Turkish school children is of comparable thickness to that in Western school children. CCT reached adult values around 14 years of age in our children. Furthermore, males had thicker CCT than females. IOP was lower in males than females, and increased with age.

Incidence, clinical findings and management of intraoperative floppy iris syndrome associated with tamsulosin.

PURPOSE: To determine the risk ratios and incidence of intraoperative floppy iris syndrome (IFIS) during cataract surgery in patients using tamsulosin, and to assess management strategies for IFIS. METHODS: We performed a non-randomized, observational, prospective study, in which 594 eyes of 579 patients undergoing cataract surgery were enrolled. Surgeons were masked to the patients' drug history. Usage or non-usage of tamsulosin, duration of tamsulosin use, presence or absence of IFIS, management of IFIS and intraoperative complications were recorded in the patients' theatre notes. RESULTS: Twelve of 15 (80%) IFIS patients were taking systemic tamsulosin. Twelve of 23 (52%) patients using tamsulosin showed features of IFIS. The odds ratios (ORs) and relative risk (RR) ratios show strong positive correlations between tamsulosin use and IFIS. The ORs and RR ratios and the 95% confidence intervals (CIs) are as follows: OR 206.5 (95% CI 50.9-836.5); RR 99.3 (95% CI 30.0-327.8). There were no statistically significant differences between patients with or without IFIS, who were using tamsulosin, in terms of age or duration of tamsulosin use (p > 0.05). Seven eyes (46.6%) with IFIS were successfully managed with epinephrine. Eight eyes (53.4%) with IFIS needed iris hooks. CONCLUSIONS: Patients using tamsulosin appear to be at high risk of IFIS during cataract surgery. The occurrence of IFIS may not be affected by duration of tamsulosin use or age. Epinephrine may be effective in approximately 50% of eyes with IFIS. The iris hook procedure represents an effective management strategy in IFIS.

The effect of extremely low frequency magnetic field on the conjunctiva and goblet cells.

PURPOSE: The aim of this study was to examine the effects of extremely low frequency magnetic field (ELF MF) on the conjunctiva and goblet cells density. METHODS: Thirty adult female Spraque Dawley rats were assigned to one of two groups, each containing 15 rats. The experimental group received magnetic field 4 hr/day for 7 days. The second group received standard laboratory care and served as a control. The specimens were evaluated by light microscopy for goblet cell density, conjunctival edema, inflammation, and fibroblast proliferation. RESULTS: In ELF MF exposure group rats, the number of goblet cells was less than the control group. We also observed a significant difference between ELF MF exposure group and control group in terms of goblet cell density (p = 0.010). The ELF MF exposure group manifested conjunctival edema and inflammation compared to the control group (p < 0.001 and p = 0.003). There was no statistical difference between the groups for fibroblast proliferation (p = 0.422). CONCLUSION: This study suggests that ELF MF exposure leads to morphological alterations of the conjunctiva and reductions in the number of goblet cells. We believe that ELF MF may cause dry eye symptoms.