Posterior segment parameters after uveitic cataract surgery: A prospective study with 1-year results.

PURPOSE: To evaluate the changes in posterior segment after uncomplicated cataract surgery in uveitic patients. METHODS: Retinal nerve fiber layer thickness (RNFLT), ganglion cell layer thickness (GCLT), central macular thickness (CMT), and choroidal thickness (CT) of 38 eyes of 28 patients were measured pre- and postoperatively on day 1, week 1, and month 1, 3, 6, 9, and 12. RESULTS: The RNFLT increased after surgery. Although the measurements taken were higher than the baseline CMT at all postoperative times, no significant difference was detected between the paired comparisons. The GCLT was found to be higher than the baseline value in all quadrants at the 12th month. A decrease in CT was observed at 5 measured points on the 1st day compared to the baseline. CONCLUSION: During the 1-year follow-up, the effect of cataract surgery on the retina and choroid in uveitic eyes was most evident at the postoperative month 1.

Anterior segment parameters after uveitic cataract surgery: A prospective study with 1-year results.

PURPOSE: To determine the changes in anterior segment parameters in uveitic patients undergoing uncomplicated cataract surgery. METHODS: The best corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), anterior chamber angle (ACA), anterior chamber depth (ACD), and axial length (AXL) of the 38 eyes of 28 well-controlled uveitic patients who underwent cataract surgery were monitored for 12 months. RESULTS: Mean BCVA improved significantly at the postoperative visits when compared to the baseline (all P<0.001). Mean CCT increased on the first day compared to the preoperative value (627.62±71.16 vs. 572.18±53.52 µm, P=0.015) and then returned to the preoperative value at 3 months (572.27±49.93 µm). ACA showed a significant increase postoperatively in the first month (54.65±5.52 vs. 43.50±9.13°) and then decreased at 3 months (51.85±5.52°), remaining stable afterwards (51.73±6.59° at 12 months). ACD as measured by Sirius topography and IOLMaster 500 was higher at the follow-up times compared to the preoperative value (P<0.001). AXL at 1. month was significantly lower than the preoperative level (23.14±0.74 vs. 23.54±0.68 mm, P=0.003). CONCLUSION: Following successful cataract surgery in well-controlled uveitic eyes, the CCT showed a rapid increase on the first day and then decreased to the preoperative level at the third month. ACA increased in the postoperative first month and then decreased, but it was higher than the baseline at all postoperative visits. ACD increased in the postoperative first week.

The Effect of Ranibizumab Loading Treatment on Vision-Related Quality of Life in Diabetic Macular Edema.

AIMS: To investigate the changes in vision-related quality of life after a loading dose of three consecutive intravitreal ranibizumab (IVR) injections in patients with unilateral diabetic macular edema (DME). MATERIALS AND METHODS: Fifty-two eyes of 52 patients who received IVR injections in only one eye with DME were included in our study. The following characteristics of the patients were recorded: gender, education status, marital status, work status, presence of chronic disease. The changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated at baseline (before treatment) and 1 month after the third intravitreal injection (after treatment). Patients were administered the Turkish form of the National Eye Institute 25-Item Visual Functions Questionnaire (NEI VFQ-25 TR). The quality of life scores assessed by the NEI VFQ-25 TR, the BCVA, intraocular pressure (IOP), and CMT measurements were compared at baseline (before treatment) and 1 month after the third intravitreal injection (after treatment). RESULTS: We enrolled 52 patients (25 females, 27 males) in our study; mean age was 64.35 ± 9.26 years. After treatment, BCVA improved significantly (p = 0.001), and macular thickness decreased significantly (p < 0.001). All NEI VFQ-25 TR subscale scores were significantly higher after treatment (p < 0.05). However, no significant correlation was found between the change in BCVA and CMT and the change in NEI VFQ-25 TR subscale and composite scores. The increase in near activities scores was significantly higher in males (p = 0.020) and in the retired group (p = 0.022). There were no significant differences in the changes in NEI VFQ-25 TR subscale and composite scores in relation to educational status. DISCUSSION: Significant improvements in BCVA, macular edema, and vision-related quality of life were found in DME patients who received IVR injections with a loading dose, as shown by the NEI VFQ-25 TR. Interestingly, a significant improvement in quality of life was observed even though the patients could see well with the fellow eye. In conclusion, the NEI VFQ-25 TR is a useful scale to evaluate the changes in visual function and psychosocial characteristics of DME patients after treatment.

May ganglion cell complex analysis be a marker for glaucoma susceptibility in unilateral Fuchs' uveitis syndrome?

PURPOSE: To compare retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer thickness (GCIPLT) in the affected eyes to fellow unaffected eyes of patients with unilateral Fuchs' uveitis syndrome (FUS) and analyze their change over time. METHODS: Twenty seven unilateral FUS patients who did not have concomitant systemic or ocular disease were retrospectively enrolled. Central macular thickness (CMT), RNFL thickness, and GCIPLT measurements were evaluated. Data was analyzed using the non-parametric Brunner-Langer model (LD-F2 design) and Wilcoxon signed-rank test. RESULTS: The mean age of the patients was 40.2 ± 10.2 years. The median disease duration was 11 (2-62) months. The median best-corrected visual acuity (BCVA) of the affected eyes and the fellow eyes was 0.22 (0.00-2.50) vs. 0.00 (0.0-0.10) logMAR at the initial visit and 0.05 (0.00-2.50) vs. 0.00 (0.0-0.30) logMAR at the final visit. The change in BCVA was found significant in the affected eyes, but not in the fellow eyes (p < 0.001 and p = 0.287, respectively). The median CMT in the affected eyes at the final visit was not statistically different from the value at the initial visit (255 (157-306) vs. 245 (140-310) µm, p = 0.256). The change in RNFL thickness over time in the affected eyes was similar to the fellow unaffected eyes of the patients with unilateral FUS at all quadrants, with non-significant time and group effects (p > 0.05). However, median GCIPLT in all quadrants (except superonasal) in the affected eyes was statistically lower than the fellow eyes at the initial and final visits (p < 0.05). The most affected quadrant of the ganglion cell complex was inferonasal in the involved eyes (79 (42-97) vs. 75 (43-87) µm) at initial and final visits (p = 0.033 for time effect and p < 0.001 for group effect, respectively). CONCLUSION: Median CMT and RNFL thickness did not change during follow-up in the affected eyes of patients with unilateral FUS. Median GCIPLT in the affected eyes declined over time in all quadrants. Ganglion cell loss was also most prominent in the inferonasal quadrant in the affected eyes. FUS patients should be followed up long-term in terms of ganglion cell loss, especially in the inferonasal quadrant.

Rapid response to systemic steroid in macular alexandrite laser exposure: Multimodal imaging.

PURPOSE: To report the management of accidental macular photocoagulation during a 750-nm Alexandrite laser hair removal procedure. METHODS: Single case report with images. RESULTS: A 23-year-old girl presented with an immediate visual field defect in her right eye after direct inadvertent exposure to a single discharge from a 750-nm Alexandrite laser used for laser hair removal. Baseline Snellen visual acuity was 20/20 in the involved right eye but the patient reported a subjective visual field defect. She was treated with oral methylprednisolone that was started at a dose of 1 mg/kg/day and then gradually reduced. Six months after the initial exposure, the final visual acuity was 20/20 and there was a significant improvement in the macular lesion. However, the subjective visual field defect continued. She underwent multimodal retinal imaging with optical coherence tomography, fundus fluorescence angiography, and optical coherence tomography angiography in addition to a visual field test and microperimety. CONCLUSION: The present case documents a gradual visual and anatomical improvement following macular photic damage after accidental occupational exposure to a 750-nm Alexandrite laser. The treatment should be arranged according to the localization of the laser damage. Optical coherence tomography angiography also has the potential to help noninvasively detect choriocapillaris damage.

Analysis of central macular thickness and choroidal thickness changes in patients with cardiovascular risk factors.

OBJECTIVES: The aim of this study was to evaluate central macular thickness (CMT) and choroidal thickness (CT) in the eyes of patients with cardiovascular risk factors (CVRF). METHODS: A cross-sectional, prospective observational study of 92 patients with CVRF and 21 healthy individuals was conducted. Patients were divided into four groups according to the SCORE system. CMT was evaluated via spectral-domain-optical coherence tomography (SD-OCT). CT at five defined points (subfoveal) [SF] and nasal 500 µm [N0.5] and 1500 µm [N1.5] and 500 µm [T0.5] and temporal 1500 µm [T1.5] from the center of the fovea were measured via enhanced depth imaging (EDI)-OCT. RESULTS: Mean SFCT at right eyes (RE) and left eyes (LE) were 311.21 ± 77.7 µm and 303.5 ± 49.6 µm, respectively, in patients with mild CVRF (Group 1); 266.5 ± 63.2 µm and 267.0 ± 62.6 µm, respectively, in patients with moderate CVRF (Group 2); 264.7 ± 57.5 µm and 272.3 ± 64.6 µm, respectively, in patients with high CVRF (Group 3); 272.3 ± 64.6 µm and 271.2 ± 63.4 µm, respectively, in patients with very high-risk CVRF (with coronary arterial disease (CAD) (Group 4); and 352.0 ± 74.4 µm and 363.1 ± 89.0 µm, respectively, in the control group. CT (at both eyes) was significantly lower at the subfoveal location in all study groups (P < 0.05), but at nasal and at temporal quadrants of group 3 and group 4 (P < 0.05). No significant difference in CMT was detected between the study and control groups. CONCLUSIONS: This study demonstrated that CVRF might result in a remarkably thinner CT. Furthermore, subretinal drusenoid deposits were detected at a higher rate in the patients with CVRF than controls, and that rate increased in accordance with the severity of CAD. In the future, changes in CT may be used as a promising novel biomarker as part of the SCORE system prior to the development of CAD.

Central Serous Chorioretinopathy: A Complication Associated with Behçet's Disease Treatment

Central serous chorioretinopathy (CSCR) is characterized by a well-defined serous choroidal detachment of the retinal pigment epithelium with one or more focal lesions of the neurosensory retina. Risk factors for CSCR are psychosocial stress, increased endogenous catecholamine, and increased endogenous cortisol. Systemic steroids can cause ocular side effects such as cataract development, increased intraocular pressure, and less frequently the development of CSCR, which can resolve spontaneously with close follow-up and simple treatment modification. CSCR should be considered in patients who complain of worsening vision under steroid treatment for pathologies requiring steroid therapy. In this study we present two patients, one man and one woman, who developed acute CSCR while under systemic steroid treatment for Behçet's disease.

Corneal Biomechanical Properties and Central Corneal Thickness in Pediatric Noninfectious Uveitis: A Controlled Study.

OBJECTIVE: To compare the corneal biomechanics, intraocular pressure (IOP), and central corneal thickness (CCT) of 37 patients with pediatric noninfectious uveitis with 36 healthy children. METHODS: Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated and corneal-compensated IOP (IOPg and IOPcc, respectively), and CCT were measured. RESULTS: The mean CRF was significantly lower in the pediatric uveitic eyes than controls (9.7±1.9 vs. 10.8±1.5 mm Hg, P=0.009), whereas there was no significant difference for mean CH, IOPg, IOPcc, and CCT between the two groups (10.1±1.9 vs. 10.8±1.7, 12.9±3.3 vs. 13.9±3.1, 13.8±2.8 vs. 13.6±3.2 mm Hg, and 550.7±49.5 vs. 555.1±33.5 µm, respectively, all P>0.05). The CCT values correlated with CH and CRF, with a Pearson correlation of 0.511 and 0.670 (P=0.013 and P<0.001, respectively), whereas disease duration did not correlate with any corneal biomechanics or CCT in pediatric uveitic eyes (all P>0.05). CONCLUSIONS: Pediatric noninfectious uveitic eyes have lower CRF than controls but the CH, IOPg, IOPcc, and CCT values are similar.

Choroidal and central foveal thickness in patients with scleroderma and its systemic associations.

BACKGROUND: The aim was to investigate the morphological changes in the fovea and choroid in patients with scleroderma and its systemic associations. METHODS: Thirty-four scleroderma patients and 31 healthy controls were enrolled. Choroidal thickness (CT) at five defined points (subfoveal [sfCT] and 1.0 [N1.0] and 3.0 µm nasal [N3.0] and 1.0 [T1.0] and 3.0 µm temporal [T3.0] from the centre of the fovea) and central foveal thickness were measured. RESULTS: The mean central foveal thickness (right eye 229.3 ± 28.6 versus 232.6 ± 29.7 and left eye 219.8 ± 21.4 versus 223.3 ± 21.9 µm) and sfCT (right eye 326.4 ± 56.5 versus 327.3 ± 62.1 and left eye 316.7 ± 53.4 versus 317.6 ± 51.6 µm) values were not different in patients with scleroderma compared with the controls (p > 0.05). The mean CT at N1.0, N3.0, T1.0 and T3.0 did not differ among these groups in both eyes (p > 0.05). There was no difference in the mean central foveal thickness and CT of both eyes in diffuse and limited scleroderma (p > 0.05). A negative correlation was found between anti-nuclear antibody positivity and CT at T3 and N3 (respectively, r = -0.439 and r = -0.383, p < 0.05). CONCLUSION: Choroidal thickness at five points and central foveal thickness in both eyes did not significantly differ in scleroderma patients compared with healthy controls. Choroidal thickness at the T3 and N3 points showed a negative correlation with anti-nuclear antibody positivity.

A Rare Patient With Orbital Apex Syndrome, Anterior Uveitis, and Necrotizing Scleritis Due to Herpes Zoster Ophthalmicus.

The purpose of this study was to describe a patient of orbital apex syndrome, anterior uveitis, secondary glaucoma, corneal dellen, and necrotizing scleritis following an attack of herpes zoster ophthalmicus, and the placement of a pericardial patch graft. A 64-year-old male patient with blepharoptosis of his right eye and multiple vesicles on the forehead, nose and cheeks, limitation on all gazes, blepharoptosis, and exophthalmia was eventually diagnosed with ophthalmic zona with orbital apex syndrome. After the treatment with systemic antiviral and steroid, there was complete recovery of the unilateral vesicular eruption, ophthalmoplegia, and ptosis at the third month follow-up. However, anterior uveitis, necrotizing scleritis, secondary glaucoma, and corneal dellen developed during follow-up. At the ninth month, pericardial patch graft (Tutoplast) was placed due to progression of the scleral thinning. Graft vascularization was completed. Careful and long-term follow-up of patients with ophthalmic zona is required for possible ophthalmic complications of varicella zoster virus infections. A pericardial patch graft might be placed due to the development of necrotizing scleritis.

Canaliculitis Awareness.

OBJECTIVES: To evaluate the demographic characteristics, treatment, and results of patients with canaliculitis. MATERIALS AND METHODS: Medical records including the demographic characteristics, clinical findings, and treatment outcomes of patients diagnosed and treated for canaliculitis between September 2009 and March 2014 were analyzed retrospectively. RESULTS: The median age of the 7 canaliculitis patients consisting of 4 women and 3 men was 49 (range 8-58) years. All patients had unilateral canaliculitis (on the right side in 2 and left side in 5 patients) and the inferior canaliculus was involved more frequently (71.4%). Epiphora, chronic conjunctivitis, a palpable and thickened canaliculus, and yellow discharge from the punctum were present in all cases. Actinomyces spp. was the most frequently cultured microorganism (75%). Dacryolith was observed in 6 patients. Canaliculotomy and dacryolith removal with canalicular curettage were performed, followed by medical treatment (topical penicillin 100,000 U/ml and oral ampicillin/sulbactam) for 10 days. Patients were followed up for a mean duration of 17.0±15.2 (range 3-46) months. Signs and symptoms resolved completely within a month. Epiphora recurred in the 36th month in a single patient and was treated with daily canalicular irrigation with antibiotics and there were no further symptoms during 10 months of follow-up after the recurrence. CONCLUSION: Canaliculitis is often overlooked and can be misdiagnosed. Every patient with chronic conjunctivitis and lacrimal infection should be examined carefully for canaliculitis.

Bacteriological profile in conjunctival, lacrimal sac, and nasal specimens and conjunctival normalization time following external, endoscopic, and transcanalicular multidiode laser dacryocystorhinostomy.

PURPOSE: To compare the conjunctival, lacrimal sac, and nasal flora cultures and conjunctival normalization time following external (EX-), endoscopic (EN-), and transcanalicular multidiode laser (TC-) dacryocystorhinostomy (DCR) and to evaluate the relationship between culture positivity and surgical success. We further performed antibiotic sensitivity analyses for lacrimal sac culture samples. METHODS: A total of 90 patients with primary acquired nasolacrimal duct obstruction were recruited and divided into EX-DCR (n=32), EN-DCR (n=28), and TC-DCR (n=30) groups. Conjunctival, nasal, and lacrimal sac cultures and antibiograms were analyzed. RESULTS: In all three groups, coagulase-negative Staphylococcus (CNS) was predominantly isolated preoperatively from the conjunctiva, nose, and lacrimal sac and postoperatively from the conjunctiva. Preoperative and postoperative conjunctival culture positivity rates were similar between all the groups (p>0.05). A statistically significant difference in the growth rate of culture in the lacrimal sac was observed between the three groups (p=0.001). CNS and Staphylococcus aureus cultures were predominantly sensitive to linezolid, teicoplanin, tigecycline, vancomycin, and mupirocin. Conjunctival normalization times were similar between the three groups (p>0.05). Anatomical and functional success rates were not found to be significantly correlated with preoperative conjunctival and lacrimal sac culture positivity (p>0.05). CONCLUSIONS: Similar rates of preoperative and 1-week postoperative conjunctival culture positivity were observed in all the groups; a significantly lower bacterial growth rate was observed in postoperative conjunctival cultures. CNS was the most commonly isolated organism. Bacterial growth rates in the lacrimal sac samples were significantly higher in the EN-DCR group. Bacterial growth rates obtained preoperatively from the conjunctival and lacrimal sac culture samples were not correlated with DCR success.

Bacteriological profile in conjunctival, lacrimal sac, and nasal specimens and conjunctival normalization time following external, endoscopic, and transcanalicular multidiode laser dacryocystorhinostomy / Perfil bacteriológico e tempo de normalização conjuntival de espécimes de conjuntiva, saco lacrimal e nasais após dacriocistorrinostomia externa, endoscópica e transcanalicular com laser de multi diodo

ABSTRACT Purpose: To compare the conjunctival, lacrimal sac, and nasal flora cultures and conjunctival normalization time following external (EX-), endoscopic (EN-), and transcanalicular multidiode laser (TC-) dacryocystorhinostomy (DCR) and to evaluate the relationship between culture positivity and surgical success. We further performed antibiotic sensitivity analyses for lacrimal sac culture samples. Methods: A total of 90 patients with primary acquired nasolacrimal duct obstruction were recruited and divided into EX-DCR (n=32), EN-DCR (n=28), and TC-DCR (n=30) groups. Conjunctival, nasal, and lacrimal sac cultures and antibiograms were analyzed. Results: In all three groups, coagulase-negative Staphylococcus (CNS) was predominantly isolated preoperatively from the conjunctiva, nose, and lacrimal sac and postoperatively from the conjunctiva. Preoperative and postoperative conjunctival culture positivity rates were similar between all the groups (p>0.05). A statistically significant difference in the growth rate of culture in the lacrimal sac was observed between the three groups (p=0.001). CNS and Staphylococcus aureus cultures were predominantly sensitive to linezolid, teicoplanin, tigecycline, vancomycin, and mupirocin. Conjunctival normalization times were similar between the three groups (p>0.05). Anatomical and functional success rates were not found to be significantly correlated with preoperative conjunctival and lacrimal sac culture positivity (p>0.05). Conclusions: Similar rates of preoperative and 1-week postoperative conjunctival culture positivity were observed in all the groups; a significantly lower bacterial growth rate was observed in postoperative conjunctival cultures. CNS was the most commonly isolated organism. Bacterial growth rates in the lacrimal sac samples were significantly higher in the EN-DCR group. Bacterial growth rates obtained preoperatively from the conjunctival and lacrimal sac culture samples were not correlated with DCR success.

RESUMO Objetivo: Comparar a flora conjuntival, do saco lacrimal e nasal com o tempo de normalização após dacriocistorrinostomia (DCR) externa (EX-), endoscópica (EN-) e transcanalicular a laser de multi diodo (TC-) para correlacionar a positividade da cultura com o sucesso cirúrgico, assim como identificar a sensibilidade aos antibióticos em amostras de saco lacrimal. Métodos: Neste estudo prospectivo, 90 pacientes com obstrução do canal nasolacrimal adquirida primária foram incluídos e divididos em grupos EX-DCR (n=32), EN-DCR (n=28) e TC-DCR (n=30). Culturas e antibiogramas conjuntivais, nasais e do saco lacrimal foram analisados. Resultados: Staphylococcus coagulase-negativo (CNS) foi o organismo predominante isolado no pré-operatório (conjuntiva e nariz), no transoperatório (saco lacrimal) e pós-operatório (conjuntiva), nos 3 grupos. Taxas de positividade de cultura da conjuntiva pré- e pós-operatórias nos três grupos foram semelhantes (p>0,05). A diferença nas taxas de crescimento do saco lacrimal dos três grupos foi estatisticamente significativa (p=0,001). CNS e S. aureus foram mais sensíveis a linezolida, teicoplanina, a tigeciclina, vancomicina e mupirocina. O tempo de normalização conjuntival foi semelhante nos três grupos (p>0,05). Não houve relação estatisticamente significativa entre as taxas de sucesso anatômicas e funcionais e a positividade da cultura conjuntival e de saco lacrimal pré-operatória (p>0,05). Conclusões: Pacientes submetidos a EX-DCR, EN-DCR, e TC-DCR apresentaram positividades de cultura conjuntival semelhantes no pré-operatório e na 1a semana pós-operatória. Houve uma redução significativa na taxa de crescimento das culturas da conjuntiva pós-operatórias. O organismo mais comumente isolado foi o CNS. A taxa de crescimento de bactérias a partir do saco lacrimal foi significativamente maior no grupo PT-DCR. O crescimento bacteriano da conjuntiva no pré-operatório e de amostras do saco lacrimal no transoperatório não se relacionaram com o sucesso da DCR.

Are There Any Changes in Corneal Biomechanics and Central Corneal Thickness in Fuchs' Uveitis?

PURPOSE: To compare corneal biomechanics, intraocular pressure (IOP) and central corneal thickness (CCT) of 38 patients with unilateral Fuchs' uveitis (FU) with 42 healthy controls. METHODS: Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated and corneal-compensated IOP (IOPg and IOPcc, respectively) and CCT were measured. RESULTS: The mean CH, CRF, and IOPg of the involved FU eyes were significantly lower (9.5 ± 1.6, 9.0 ± 1.9 and 13.1 ± 4.3 mmHg) than contralateral eyes (10.1 ± 1.7, 9.9 ± 1.7 and 14.6 ± 3.4 mmHg), and controls (10.5 ± 1.5, 10.3 ± 1.5 and 14.8 ± 2.5 mmHg), respectively. There was no significant difference for mean IOPcc between involved FU or contralateral eyes and controls (14.8 ± 4.1, 15.5 ± 3.4 and 15.0 ± 2.7 mmHg). The CCT values correlated with CH and CRF in the involved and contralateral eyes. CONCLUSIONS: Involved FU eyes had lower CH, CRF, and IOPg than contralateral eyes and controls, with no difference regarding IOPcc.

Prospective comparison of 3 dacryocystorhinostomy surgeries: external versus endoscopic versus transcanalicular multidiode laser.

PURPOSE: To analyze the clinical outcomes of external (EX-), endoscopic (EN-), and transcanalicular multidiode laser (TC-) with dacryocystorhinostomy (DCR). METHODS: Ninety-two patients with primary acquired nasolacrimal duct obstruction were enrolled (divided into EX-DCR [n = 33], EN-DCR [n = 30], and TC-DCR groups [n = 29]) in this prospective study. Primary outcome measures were the anatomical and functional success of operations at the last control examination. Secondary outcome measures were the ostium size, surgical time, and complications. RESULTS: The difference in mean surgical time among the 3 groups was statistically significant (p < 0.0001). External DCR required the longest surgical time (46.6 ± 15.3 minutes), while TC-DCR was the shortest (20.3 ± 7.7 minutes). There were no significant differences between the groups regarding anatomical (81.8%, 75.9%, and 76.7% in EX-, EN-, and TC-DCR groups, respectively; p = 0.824) and functional success rates (81.8%, 72.4%, and 73.3% in EX-, EN-, and TC-DCR groups, respectively; p = 0.626). Final ostium size was the largest with EX-DCR (33.7 ± 17.4 mm) and smallest with EN-DCR (19.0 ± 8.9 mm; p = 0.001). The complication rate was similar in all groups. The most common complications were the formation of granulation tissue (16.3%) and intranasal synechiae (9.8%), all of which led to surgical failure and were more frequent in the EN- and TC-DCR groups. CONCLUSIONS: External DCR, EN-DCR, and TC-DCR had similar success and complication rates in patients with primary acquired nasolacrimal duct obstruction. External DCR resulted in the largest ostium size. Transcanalicular DCR appeared to be effective with the shortest surgical time.

Comparing acromegalic patients to healthy controls with respect to intraocular pressure, central corneal thickness, and optic disc topography findings.

AIMS: The aim was to compare the intraocular pressure (IOP), central corneal thickness (CCT), and optic disc topography findings of biochemically controlled acromegalic patients and the control group and to evaluate the effect of the duration of acromegaly and serum growth hormone and insulin-like growth factor-1 (IGF-1) levels on these ocular parameters. MATERIALS AND METHODS: IOP measurement with Goldmann applanation tonometry, CCT measurement with ultrasonic pachymetry, and topographic analysis with Heidelberg retinal tomograph III were performed on 35 biochemically controlled acromegalic patients and 36 age- and gender-matched controls. RESULTS: Mean IOP and CCT were 14.7 ± 2.9 mmHg and 559.5 ± 44.9 µm in the acromegaly patients and 13.0 ± 1.6 mmHg and 547.1 ± 26.7 µm in controls (P = 0.006 and P = 0.15, respectively). A significant moderate correlation was found between the duration of acromegaly and CCT (r = 0.391) and IOP (r = 0.367). Mean retinal nerve fiber layer (RNFL) thickness was significantly lower in the acromegalic patients (0.25 ± 0.05 mm) as compared to controls (0.31 ± 0.09 mm) (P = 0.01). A significant moderate correlation was detected between IGF-1 level and disc area (r = 0.362), cup area (r = 0.389) and cup volume (r = 0.491). CONCLUSION: Biochemically controlled acromegalic patients showed significantly higher CCT and IOP levels and lower RNFL thickness compared to healthy controls and the duration of disease was correlated with CCT and IOP levels.

Surgical outcomes and incidence of retinal redetachment in cases with complicated retinal detachment after silicone oil removal: univariate and multiple risk factors analysis.

PURPOSE: To analyze the surgical outcomes and retinal redetachment frequency after silicone oil (SO) removal for complex retinal detachment. METHODS: This institutional-based study included 894 consecutive patients who underwent pars plana vitrectomy with SO endotamponade for complicated retinal detachment. The effects of preoperative best-corrected visual acuity, vitreous base shaving, intraoperative scleral buckling, retinectomy, SO viscosity, duration of SO, and vitreous hemorrhage at the first postoperative week on the risk of redetachment were investigated. RESULTS: During a mean follow-up of 39.9 months, anatomical success was not achieved in 118 patients (13.2%) after SO removal. On multivariate analysis, risk factors for recurrent retinal detachment included giant retinal tear (adjusted odds ratio [aOR], 12.39; P < 0.001), high myopia (aOR, 2.70; P = 0.011), surgeries without scleral buckling (aOR, 1.97; P = 0.039), inadequate vitreous base shaving (aOR, 117.62; P < 0.001), and vitreous hemorrhage at the first postoperative week (aOR, 12.13; P < 0.001). CONCLUSION: Retinal detachment etiology, inadequate vitreous base shaving, lack of intraoperative scleral buckling, and vitreous hemorrhage at the first postoperative week after SO removal were significant risk factors for retinal redetachment after SO removal, but preoperative visual acuity, SO viscosity, and duration of SO had no significant effect on redetachment.

Comparison of scanning electron microscopy findings regarding biofilm colonization with microbiological results in nasolacrimal stents for external, endoscopic and transcanalicular dacryocystorhinostomy.

AIM: To compare bacterial biofilm colonization in lacrimal stents following external dacryocystorhinostomy (EX-DCR), endoscopic dacryocystorhinostomy (EN-DCR), and transcanalicular dacryocystorhinostomy (TC-DCR) with multidiode laser. METHODS: This prospective study included 30 consecutive patients with nasolacrimal duct obstruction who underwent EXT-, EN-, or TC-DCR. Thirty removed lacrimal stent fragments and conjunctival samples were cultured. The lacrimal stent biofilms were examined by scanning electron microscopy (SEM). RESULTS: Eleven (36.7%) of the 30 lacrimal stent cultures were positive for aerobic bacteria (most commonly Staphylococcus epidermidis and Pseudomonas aeruginosa). However anaerobic bacteria and fungi were not identified in the lacrimal stent cultures. Twenty-seven (90%) patients had biofilm-positive lacrimal stents. The conjunctival culture positivity after the DCR, biofilm positivity on stents, the grade of biofilm colonization, and the presence of mucus and coccoid and rod-shaped organisms did not significantly differ between any of the groups (P>0.05). However, a significant difference was found when the SEM results were compared to the results of the lacrimal stent and conjunctival cultures (P<0.001). CONCLUSION: Type of dacryocystorhinostomy (DCR) surgery did not affect the biofilm colonization of the lacrimal stents. SEM also appears to be more precise than microbiological culture for evaluating the presence of biofilms on lacrimal stents.

Corneal biomechanical properties measured by the ocular response analyzer in acromegalic patients.

PURPOSE: To investigate the effect of acromegaly on corneal biomechanical parameters. METHODS: This cross-sectional, comparative clinical study included 34 acromegalic patients and 30 age-matched and sex-matched healthy controls. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated and corneal-compensated intraocular pressure (IOPg and IOPcc, respectively) were measured using the Ocular Response Analyzer. Central corneal thickness (CCT) was determined with the ultrasonic pachymeter. RESULTS: The mean duration of disease for the acromegalic patients was 5.3 years. There was no significant difference between the groups regarding mean CH, CRF, IOPg and IOPcc values. The respective mean values in patients with acromegaly and controls were 10.3 ± 2.2 and 9.5 ± 1.5 mmHg (p = 0.13) for CH; 10.5 ± 2.4 and 9.7 ± 1.7 mmHg (p = 0.16) for CRF, 16.1 ± 3.6 and 15.5 ± 2.9 mmHg (p = 0.49) for IOPg, 16.8 ± 3.4 and 17.0 ± 2.8 mmHg (p = 0.82) for IOPcc, and 544.8 ± 32.2 and 530.7 ± 22.9 µm (p = 0.05) for CCT. A significant moderate correlation was detected between the duration of acromegaly and IOPg OD (r = 0.430, p = 0.01). There was no significant correlation between other ocular parameters and levels of GH and IGF-1 at the time of diagnosis, the status of control, adenoma type, radiotherapy treatment, and drug usage. CONCLUSIONS: In acromegalic patients, the duration of disease was correlated with IOPg OD level. Corneal biomechanical parameters and CCT values were not significantly different than those in age-matched and sex-matched healthy individuals.

Thirteen-year vitreoretinal surgical outcomes of 5,097 cases from a tertiary referral center in Turkey.

A 13-year retrospective chart review of 5,097 consecutive cases that underwent pars plana vitrectomy (PPV) in a tertiary referral center in Turkey was performed. Age at onset, sex, laterality, associated systemic disease, pre- and postoperative visual acuities (VA), indications, type of surgery and outcomes of surgery were analyzed. The most common indications for vitreoretinal surgery (VRS) were rhegmatogenous retinal detachment (n = 1,802, 35.4%) and proliferative diabetic retinopathy (n = 1,505, 29.5%). The most common vitreoretinal technique combinations performed were PPV with encircling endolaser (EL) and phacoemulsification with intraocular lens implantation (33.0%), PPV with encircling EL (30.4%), and only PPV (7.0%). A statistically significant increase in the mean VA was noted at the first- (1.16 ± 0.44 logarithm of the minimum angle of resolution, logMAR) and sixth-month (1.06 ± 0.61 logMAR) visits when compared to the preoperative VA (1.77 ± 0.58 logMAR; p < 0.001). Comparisons in the top surgical indications, techniques and outcomes for vitrectomy between the countries could be important for the development of subspecialization in VRS.