Diffuse Corneal Edema after Uneventful Pterygium Surgery: Toxic Anterior Segment Syndrome or Toxic Keratopathy?

A 29-year-old woman was referred to our department for corneal edema after uneventful pterygium excision surgery with conjunctival autografting. She was prescribed topical dexamethasone and showed a complete response within 2 weeks of treatment. Specular microscopic examination revealed severe endothelial cell loss in the operated eye. Mild corneal haze causing a decrease in vision (20/50) was observed in long-term follow-up. This steroid-responsive complication was linked to two possible etiologies: mild toxic anterior segment syndrome or povidone-iodine (PVP-I) corneal toxicity. Surgeons should be careful during pterygium surgery to completely clear PVP-I and avoid any penetration into the anterior chamber to prevent possible serious complications. When diffuse corneal edema is encountered after pterygium surgery, intense steroid treatment should be prescribed as in the present case.

Evaluation of risk factors for complications after colostomy closure.

OBJECTIVE: The goal of the study is to describe postoperative complications observed after colostomy reversal and to define possible risk factor(s) for complication.s after colostomy closure PATIENTS-METHODS: Patients who underwent colostomy closure in Department of General Surgery, Dr Lutfi Kirdar Kartal Education and Research Hospital between January 2007 and January 2015 were enrolled. Patients with double-barrel ileo-colostomy, Devine's colostomy and tube cecostomy were excluded from study. Demographics, data regarding the first operation and those regarding the reversal operation were analyzed and compared. RESULTS: Total 168 patients [118 (70.1%) male, average age=52.8±15.6] were included. Most common reasons for stoma formation were malignancy [n=63 (37.5%)] and diverticular perforation [40 (23.8%)]. Index operation was performed under emergency conditions in 142 (84.5%) patients. End colostomy was the most common stoma type in emergent cases and loop sigmoidostomy in elective cases. Postoperative complication was observed in 36 (21.4%) patients. Nine (5.3%) patients developed anastomotic leak. Of those, 8 (4.8%) was necessitated reoperation and 1 (0.6%) was treated conservatively. Postoperative mortality was 5 (2.9%). At multivariate analysis, DM was the independent risk factor for surgical site infection and evisceration (p<0.01). DM was present in 6 (66.7%) cases who had had an anastomotic leak and leak was more common compared to non-diabetics (p<0.05). Patients waiting more than 3 months before stoma reversal had experienced more anastomotic leak compared to those waiting less (p<0.05). CONCLUSION: Closure of colostomy has a significant morbidity and mortality, and the physician should be more careful in postoperative follow-up in patients who had comorbidities, especially diabetes mellitus. KEY WORDS: Anastomotic leak, Colostomy, Postoperative complication.

Selective Laser Trabeculoplasty vs. Fixed Combinations with Timolol in Practice: A Replacement Study in Primary Open Angle Glaucoma.

OBJECTIVES: To evaluate the potential of selective laser trabeculoplasty (SLT) in two arms (360˚ vs. 180˚) as a replacement for fixed combinations (FCs) with timolol in primary open angle glaucoma over 6 months. MATERIALS AND METHODS: Of 40 patients in a prospective, comparative, interventional case series, 18 eyes and 22 eyes were randomized to SLT 180º and SLT 360º groups, respectively, along with 40 fellow-control eyes. FC with timolol was discontinued on the day of treatment for the eye to be operated on, while ongoing therapy was not interrupted for the contralateral eye. Eyes were examined for intraocular pressure (IOP) elevation 1 hour and 1 day after SLT. The follow-up visits were then scheduled for 1 week, 1 month, 3 months, and 6 months after, during the which the IOP of both eyes and any possible complications were evaluated. RESULTS: There were no statistically significant differences in mean IOPs through 6 months among the groups with exception of postlaser 1 hour and postlaser 1 day (p<0.001 and p=0.010, respectively). Multiple comparison analysis showed significantly higher IOP in both SLT 180º and SLT 360º subgroups compared to their controls at postlaser 1 hour (p=0.007, p<0.001) but significantly lower IOP only in SLT 360º subgroup compared to the controls at postlaser day 1 (p=0.013). CONCLUSION: SLT offers promising potential as a substitute equivalent to efficacy of FCs with timolol. However, SLT 360˚ may not achieve additional IOP reduction.

The Course of the Changes in Anterior Chamber Parameters After Laser Peripheral Iridotomy: Follow-up for 6 Months With a Scheimpflug-Placido Disc Topographer.

PURPOSE: To evaluate the course of the changes in anterior chamber (AC) parameters using a Scheimpflug-Placido disc topographer before and through 6 months after laser peripheral iridotomy (LPI). MATERIALS AND METHODS: A total of 109 eyes of 56 consecutive patients classified as primary angle closure suspect (PACS), primary angle closure (PAC), and primary angle closure glaucoma (PACG) were included in this prospective, interventional, observational case series. Anterior chamber volume (ACV), central anterior chamber depth (CACD), and anterior chamber angle (ACA) were measured by Scheimpflug photography preoperatively and at 1, 3, and 6 months after LPI. With respect to the parameters above, alterations in the measurements were assessed to determine whether the effects induced by LPI on AC morphology persisted with time. RESULTS: At 1 month after LPI, mean ACV, CACD, and ACA increased significantly in all groups (P<0.05). However, in eyes with PACG, significant reductions at 3 months in ACA [0.00 (-1.00 to 0.00) degrees, median (Md) [quartile 1 (Q1) to quartile 3 (Q3)], P=0.032] and at 6 months in ACV [-1.00 (-2.25 to 1.00) µL, P=0.043) and CACD (-0.01 (-0.02 to 0.00) mm, P=0.006) were shown. On analysis of all eyes together, a weak correlation was found between axial length and the change in CACD (r=0.266, P=0.007). Eyes with ACA≤25 degrees widened by 6.6±2.8 degrees versus 4.9±2.4 degrees in eyes with ACA>25 degrees at 1 month after the procedure (P=0.002). CONCLUSIONS: Scheimpflug-Placido disc topographer detected significant changes in the AC parameters after LPI in all groups. However, compared with PACS and PAC, the PACG showed significant alterations in the AC parameters through 6 months.

Comparison of two laser capsulotomy techniques: cruciate versus circular.

PURPOSE: To compare the safety and efficacy of two Nd: YAG laser capsulotomy techniques. METHODS: In this prospective comparative interventional case series, 60 eyes of 57 patients with posterior capsular opacification were enrolled. Thirty eyes were selected to undergo a cruciate capsulotomy (Cross group) and the other 30 eyes were selected to undergo a circular capsulotomy (Circular group). Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), amount of energy used, mean macular thickness (MMT), and floater symptoms. RESULTS: The amount of energy used was significantly higher in the Circular group than in the Cross group (p < 0.001). BCVA and IOP were not significantly different between the two groups at baseline or follow-up. MMT was significantly higher in the Circular group than in the Cross group at one day after the laser procedure (p = 0.032). MMT was not significantly different between groups at one week, one month, and three months (p > 0.05). The number of patients with floater symptoms was significantly higher in the Circular group than in the Cross group at one week and one month (p < 0.05). CONCLUSION: Both the cross-like and circular Nd:YAG laser capsulotomy techniques induce similar visual and IOP changes. The circular technique is associated with a higher amount of energy used, more floater symptoms, and has a greater effect on macular thickness at one day after laser capsulotomy.

Influence of axial length on peripapillary retinal nerve fiber layer thickness in children: a study by RTVue spectral-domain optical coherence tomography.

PURPOSE: To evaluate the influence of axial length on peripapillary retinal nerve fiber layer (RNFL) thickness in myopic, hyperopic and emmetropic children eyes by RTVue optical coherence tomography (OCT). METHODS: One hundred twenty eyes of 120 children including 40 myopic, 40 emmetropic and 40 hyperopic eyes were enrolled in the study. Peripapillary RNFL thickness measurements were performed using spectral-domain RTVue OCT (Optovue, Fremont, CA). RNFL thickness parameters were obtained from all octametric sections: upper temporal (TU), superotemporal (ST), superonasal (SN), upper nasal (NU), lower nasal (NL), inferonasal (IN), inferotemporal (IT) and lower temporal (TL). Spherical equivalent refractive error was determined via cycloplegic auto-refraction (Topcon, Tokyo, Japan). The axial length was measured using IOLMaster (Carl Zeiss MEDITEC). Littmann formula was used for correction of axial length-related ocular magnification effect. RESULTS: Peripapillary RNFL thicknesses were significantly different among the three groups in all sectors except for NU and IT sectors. RNFL thicknesses in all sectors except for TU and TL sectors had significant negative correlations with axial length. However, these differences (excluding TU and TL sectors) and correlations disappeared after correction of magnification effect. CONCLUSION: In conclusion, axial length influences peripapillary RNFL thickness as measured by RTVue OCT. However, this appears to be due to the ocular magnification effects associated with axial length and can be corrected for with the application of the Littman formula.

Variability of serum oxidative stress biomarkers relative to biochemical data and clinical parameters of glaucoma patients.

PURPOSE: The importance of oxidative stress in both the formation and the course of glaucoma has been known. Among the antioxidants, vitamin E possesses the specific effects and regulatory mechanisms of a neurohormone. The serum oxidant/antioxidant profile is reportedly altered in ocular pathologies. In this study, we analyzed the effect of the clinical parameters of glaucoma and biochemical data on antioxidants and serum oxidative stress markers as oxidation degradation products. METHODS: In this multicenter case control study, control and patient groups consisted of 31 healthy individuals and 160 glaucoma patients with no known additional abnormalities, respectively. We analyzed the oxidation degradation products malonyl dialdehyde (MDA), advanced oxidation protein products (AOPP), antioxidants, vitamins E and A, Serine (Ser), superoxide dismutase (SOD), glutathione peroxidase (Gpx), transferrine (TF), and total antioxidant capacity (TADA). All of these parameters and their relationships with serum cholesterol, glucose, protein, albumin, triglyceride levels, age, gender, visual acuities, intraocular pressure (IOP), c/d ratio, gonioscopic findings, medications, presence of pseudoexfoliation (px), central visual field and Optical Coherence Tomography (OCT) data, pachymetry, and Laplace values, were evaluated individually. Statistical comparisons were performed among them, and with the control group as well. RESULTS: TADA, AOPP, SOD, and Gpx were found to be decreased, and MDA, Ser, TF, vitamins A and E increased in the patient group. All data, excluding AOPP, varied significantly. Vitamin E was the most consistent parameter. CONCLUSIONS: In this study, the association between glaucoma and lipid oxidation was shown on a systematic basis, and the significance of vitamin E as a neuroprotective agent has been revealed once more.

Phacoemulsification in patients with nanophthalmos.

OBJECTIVE: To evaluate phacoemulsification surgery and its possible risks in patients with nanophthalmos. DESIGN: The surgical procedure, corneal diameter, keratometry, axial length, visual acuity, and intraoperative and postoperative complications were reviewed. Scleral thickness was determined by echography. PARTICIPANTS: 5 patients, 8 eyes. METHODS: The results of cataract surgery in nanophthalmic eyes were reviewed. Inclusion criteria was based on a clinical diagnosis of nanophthalmos and ocular surgery for cataract. Nanophthalmos was diagnosed according to a shorter than average axial length (usually less than 20.0 mm), typically a shallow anterior chamber, hyperopia, and scleral thickening greater than 1.5 mm. The procedure was planned as phacoemulsification, and foldable acrylic PCIOL implantation via a clear corneal tunnel. RESULTS: The procedure was planned as phacoemulsification. Six eyes had cataract extraction with posterior chamber intraocular lens implantation by phacoemulsification. It was necessary to change the procedure to extracapsular cataract surgery in 2 cases because of uncontrolled shallowing of the anterior chamber. Postoperative trabeculectomy was needed in 1 eye, and Nd:YAG laser capsulotomy was performed on 4 eyes. No postoperative uveal effusion or infections were seen in any of the eyes. Complications included iritis with posterior synechia (n = 1), transient choroidal hemorrhage (n = 1), vitreous loss (n = 1), posterior capsule opacity (n = 4), and glaucoma (n = 1). In 1 case retinal detachment developed 3 weeks postoperatively. Prophylactic laser iridoplasty or iridotomy was not performed for surgery. CONCLUSIONS: Although phacoemulsification seems to be relatively safe in nanophthalmic patients without performing any prophylactic surgical procedure, surgeons need to be attentive of the challenges of working through them when performing phacoemulsification in these high-risk eyes. However, with careful preoperative evaluation and planning, complications can be avoided.