In vivo generated autologous plasmin assisted vitrectomy in young patients.

BACKGROUND: Autologous plasmin enzyme facilitates the induction of posterior vitreous detachment(PVD) during vitrectomy in young patients. We proposed the concept of in-vivo generated plasmin which is based on the injection of tissue plasminogen activator(t-PA) and autologous whole blood(AWB) into the vitreous cavity. The purpose of this pilot study is to report the efficacy of preoperative simultaneous intravitreal injection of(t-PA) and autologous whole blood in facilitating the intraoperative induction of PVD in young patients with various vitreoretinal pathologies. METHODS: Seventeen eyes of 16 young patients with various vitreoretinal pathologies requiring vitrectomy, who received simultaneous intravitreal injection of 0.1 ml of AWB and 25 µg of t-PA, 3 days prior to surgery were retrospectively reviewed. Outcome measures were the number of attempts required to achieve successful intraoperative separation of the posterior hyaloid; the postoperative visual acuity; and intraoperative and postoperative complications. RESULTS: The mean age of the patients was 23.87 ± 10.09 years, ranging from 10 to 39 years. Eight of 16 patients were men. The mean follow-up time was 19.35 ± 5.04 months, ranging from 12 to 26 months. Surgical indications for vitrectomy were chronic retinal detachment (n = 7), traumatic retinal detachment without proliferative vitreoretinopathy(n = 3), traumatic macular hole(n = 1), secondary vasoproliferative tumor(n = 4) and optic pit maculopathy(n = 2). Patients with retinal detachment complicated with PVR and those who were older than 40 years of age were excluded from the study. Separation of the Weiss ring from the optic nerve head was achieved intraoperatively in all cases, with a mean number of 2.86 ± 1.4 attempts. While the mean preoperative LogMAR visual acuity was 1.38 ± 0.59, ranging from 2.40 to 0.50, it was a mean of 0.51 ± 0.29, ranging from 1.00 to 0.10 at final postoperative exam(p < 0.001; paired samples t-test). No preoperative or intraoperative complications were noted. CONCLUSION: Preoperative simultaneous intravitreal injection of 25 µg t-PA with 0.1 ml of AWB facilitates the intraoperative induction of posterior vitreous detachment in young patients.

Tear osmolarity and tear film parameters in patients with unilateral pterygium.

PURPOSE: The aim of this study was to evaluate the differences in tear osmolarity and tear film parameters between pterygium-affected and healthy fellow eyes. METHODS: The study enrolled 65 patients with unilateral pterygium. Tear osmolarity, tear film break-up time (TBUT), Schirmer I test measurements, fluorescein corneal staining, and conjunctival redness were evaluated. The results were compared between pterygium-affected eyes and healthy fellow eyes of the same patient (controls). The pterygium thickness was measured using optical coherence tomography. We also evaluated the relationship between pterygium thickness and tear osmolarity and between TBUT and Schirmer I test results in eyes with pterygium. RESULTS: The mean tear osmolarity was 307 mOsm/L in pterygium-affected eyes and 294 mOsm/L in control eyes. The mean values of TBUT, Schirmer I test, corneal staining, and conjunctival redness scores were 10.3 ± 3.4 seconds, 14.8 ± 9.2 mm, 1.2 ± 1.1, and 0.9 ± 0.9 in the pterygium group, whereas the mean values were 12.3 ± 4.4 seconds, 16.2 ± 7.2 mm, 0.4 ± 0.8, and 0.4 ± 0.7 in the control group, respectively. Eyes with pterygium had significantly higher tear osmolarity levels, corneal staining, and conjunctival redness scores; and lower tear film TBUT and Schirmer I test values than eyes without pterygium (Wilcoxon signed rank test, P < 0.05). There was no significant correlation between pterygium thickness versus tear osmolarity, TBUT, and Schirmer I test values in eyes with pterygium (r = 0.159, 0.738, 0.321, respectively; P > 0.05). CONCLUSIONS: This study showed that pterygium is associated with tear hyperosmolarity and abnormal tear film function.

Intravitreal bevacizumab for persistent macular edema with proliferative diabetic retinopathy.

To evaluate the effectiveness of an intravitreal bevacizumab injection on retinal neovascularization and diabetic macular edema (DME) refractory to laser photocoagulation therapy. Thirty-four eyes of 22 patients with proliferative diabetic retinopathy and DME refractory to laser photocoagulation therapy received an intravitreal injection of 1.25 mg/0.05 ml of bevazicumab. Changes in mean best-corrected visual acuity (BCVA), central macular thickness (CMT), regression of neovascularization over time, and correlation between BCVA and CMT were evaluated. Follow-up visits were at weeks 1, 2 and 4 and months 3 and 6. Mean BCVA was significantly better than baseline only at week 2 (P = 0.036). Mean CMT decreased significantly from baseline at weeks 1, 2, and 4 (P = 0.001). At months 3 and 6, mean CMT increased, albeit insignificantly (P = 0.804 and P = 1.0). The decrease in fluorescein leakage was moderate in all eyes at the end of week 1. At week 2, there was total resolution of fluorescein leakage in 24 (70.5%) eyes and moderate resolution in 10 (29.5%) eyes. At the end of month 3, the fluorescein leakage was fully resolved in 5 (14.7%) eyes, moderately resolved in 24 (70.5%) eyes, and was similar to baseline in 5 (14.7%) eyes. At month 6, the fluorescein leakage was fully resolved in 3 (8.8%) eyes, moderately resolved in 20 (58.8%) eyes, and was similar to baseline in 11 (32.4%) eyes. A moderate but insignificant negative correlation was found between visual acuity and CMT (P > 0.05). Persistence or recurrence of neovascular tissue after panretinal photocoagulation may be attributed to the production of vascular endothelial growth factor by the residual ischemic retina, which also results in persistent or recurrent DME despite macular grid photocoagulation.

Association between visual acuity loss and optical coherence tomography findings in patients with late solar retinopathy.

PURPOSE: To describe optical coherence tomography findings in patients with late solar retinopathy and their association with visual loss. METHODS: Twenty-one eyes of 21 patients who had a history of watching a solar eclipse in 1999 with or without visual loss were evaluated with colored and red-free fundus photography and optical coherence tomography analysis using the macular thickness protocol. RESULTS: Ten of the eyes (47.6%) had no visual acuity loss and 11 eyes (52.4%) had visual acuities ranging from 0.3 to 0.8. There was a strong correlation between central foveal thickness and visual acuity. Empty spaces involving the full thickness of the photoreceptor layer band of the entire fovea were observed in 10 eyes and found to be associated with visual acuity loss. Signal defects in the outer and inner segments of the photoreceptors were identified in 12 and 15 eyes, respectively, and were not associated with visual acuity loss. CONCLUSION: Decreased central foveal thickness and full-thickness empty spaces beneath the fovea in optical coherence tomography analysis can be associated with permanent visual acuity loss in patients with a history of watching a solar eclipse.

The capsular tension ring in eyes with traumatic subluxated cataracts: a comparative study.

We investigated the results of phacoemulsification surgery with or without capsular tension ring in eyes with traumatic subluxated cataracts with zonular dialysis. Capsular tension ring implantation before nucleus emulsification in subluxated cataracts will reduce various complications.

Unusual ocular complications of the HELLP syndrome: persistent macular elevation and localized tractional retinal detachment.

We report a case of HELLP syndrome with bilateral decreased vision at 25 weeks' gestation. Fundus examination revealed serous retinal detachment involving the macula. Systemic steroid and oral dorzolamide therapy was initiated and visual acuity improved. At 2 months, peripheral localized tractional retinal detachment was present in the left eye and argon laser photocoagulation was performed. Macular elevation did not resolve; therefore, in the right eye intravitreal triamcinolone acetonide injection was performed.

A new technique for pterygium excision: air-assisted dissection.

PURPOSE: To introduce a new technique which aids to remove the pterygium head and facilitates the establishment of a smooth and clear corneal surface without extra scraping or polishing. MATERIAL AND METHODS: We used 12 eyes of 12 patients undergoing pterygium excision. Air was injected into the side of the cap of the pterygium head with a 30-gauge needle, to create a dissection plane between the pterygium head and the cornea. After blunt dissection and excision of the pterygium, the conjunctival autograft technique was applied. Complications, postoperative smoothness and clarity of the cornea, and the recurrence rates were evaluated. RESULTS: Dissection with air was successfully performed in 9 eyes (75%) in which blunt dissection was carried out easily. The corneas were clear and smooth postoperatively. In 3 eyes (25%) dissection with air was not completely successful, and scraping with a crescent blade had to be performed. One of the eyes with incomplete air dissection could not be clearly scraped. No major complications were observed. The recurrence rate was 8.3% (1 eye). CONCLUSION: This new technique is a safe, easy and cheap method for removing the pterygium head from the corneal surface, which also facilitates the establishment of a clear and smooth corneal surface.

Sodium hyaluronate in trabeculectomy: effect on early complications.

PURPOSE: To evaluate the effect of sodium hyaluronate on the early complications of trabeculectomy. METHODS: In this prospective study, trabeculectomy was performed in 51 eyes of 51 patients with different types of glaucoma. Patients were divided into two groups randomly. In 24 eyes (study group) sodium hyaluronate was injected into the anterior chamber after suturing the scleral flap. In the remaining 27 eyes (control group) only balanced salt solution was injected. Visual acuities, intraocular pressures and early complications were evaluated. RESULTS: Preoperative mean intraocular pressures were similar in the two groups (34.5 +/- 18.7 mmHg in the study group and 37.2 +/- 18.1 mmHg in the control group). In the first postoperative day mean intraocular pressure difference was significant (16.8 +/- 7.1 mmHg in the study group and 9.0 +/- 6.6 mmHg in the control group, P < 0.01). There was significant difference in occurrence of hypotony (8.3% study vs. 40.7% control), anterior chamber shallowing (8.3% study vs. 37% control) and choroidal detachment (none in study vs. 33.3% control) between the two groups (P < 0.01). Early intraocular pressure peak, occurred more common in the study group (20.8%) than in the control group (11.1%), but the difference was not significant (P > 0.01). Hyphema occurred in two (8.3%) eyes in the study group, and three (11.1%) in the control group. This was not significant (P > 0.01). The clearance time of blood from the anterior chamber (less than 1 week) was also similar in the two groups. CONCLUSION: Sodium hyaluronate-assisted trabeculectomy decreased the incidence of early postoperative complications like anterior chamber shallowing, choroidal detachment and hypotony, but it did not have any effect on hyphema or its clearance.

Cystoid macular edema after phacoemulsification: risk factors and effect on visual acuity.

BACKGROUND: To determine the incidence and risk factors for cystoid macular edema (CME) after phacoemulsification surgery and its effect on visual acuity. METHODS: This prospective study evaluated 98 eyes of 98 patients (43 women) with a mean (SD) age of 61.8 (11.3) years. Phacoemulsification was performed with temporal clear corneal incision and implantation of foldable hydrophilic acrylic intraocular lens in the bag. Postoperative visits were on day 1, week 1, and at 1, 3, and 6 months. In addition, at week 10 all patients had fundus fluorescein angiography, and presence of CME was determined. Age, sex, iris colour, pseudoexfoliation, type of cataract, phaco time, status of the posterior vitreous, iris trauma, severity of anterior chamber reaction, and visual acuities were evaluated. RESULTS: No major intraoperative complications occurred. Twenty-five (25.5%) eyes were CME(+), and 73 (74.4%) eyes were CME(-). CME occurred in 70% of patients with iris trauma and 20.5% of patients with no iris trauma. CME was more common in patients who had postoperative anterior chamber inflammation of 2+ or more than in patients with less inflammation (43.2% vs. 11.5%). Complete posterior vitreous detachment had some apparent protective effect against CME development. The mean visual acuities of CME(+) patients were lower than those of CME(-) patients in all postoperative periods. The difference was significant in the third month (p < 0.05). INTERPRETATION: CME after phacoemulsification was associated with iris trauma and severe postoperative inflammation. Complete posterior vitreous detachment had some apparent protective effect against CME development. CME may be associated with decreased visual acuity.