Comparison of two scleral incision techniques in 23-gauge transconjunctival vitrectomy.

BACKGROUND AND OBJECTIVE: To compare two 23-gauge transconjunctival vitrectomy incision techniques, parallel and perpendicular to the alignment of scleral fibers, in terms of hypotony and postoperative intraocular pressure (IOP). PATIENTS AND METHODS: Fifty-three eyes of 53 patients who underwent 23-gauge one-step trocar pars plana vitrectomy were randomly assigned to undergo scleral incision parallel (group 1, 26 eyes) or perpendicular (group 2, 27 eyes) to the limbus. Patients were observed postoperatively for wound healing, leakage, endophthalmitis, IOP, and hypotony at 1 day, 1 week, and 1, 3, 6, and 9 months. RESULTS: No difference in preoperative IOP was observed (P = .229). Postoperative IOP was significantly lower in group 2 (P = .009). Hypotony rates did not differ between the groups. Intraocular gas or silicone tamponade was used intraoperatively in 26 cases. In cases in which no gas or silicone was given (n = 27), IOP measurements were significantly lower in group 2 (P = .021). There was no difference in hypotony ratios for gas/silicone injection versus no injection (P = 1.00) or in postoperative visual acuity (P = .350). Visual acuity improved significantly in both groups at follow-up examinations. CONCLUSION: Parallel and perpendicular incisions resulted in similar postoperative hypotony rates, but perpendicular incisions were associated with lower IOP.

Effect on anterior chamber bevacizumab injection combined with seton implantation in treatment of rubeosis iridis in neovascular glaucoma.

OBJECTIVE: To evaluate the effect of anti-VEGF (bevacizumab) injection to the posterior chamber (BIPC) behind the iris combined with seton implantation in treatment of neovascular glaucoma (NVG). METHODS: Twenty-eight eyes with NVG who underwent BIPC, prospectively evaluated. Anterior segment photographs were taken for grading of neovascularization on anterior segment in pretreatment period and at each follow-up. Grading and regression of rubeosis iridis was classified according to Teich and Walsh grading system and glaucoma filtration surgery with drainage device was performed following BIPC. RESULTS: The mean pre-BIPC IOP was 39.71 ± 7.09 mmHg, post-BIPC IOP in the 1st, 2nd day, 1st week, 1st, 3rd, 6th month were 19.7 ± 8.9 mmHg, 13.5 ± 6.7 mmHg, 9.9 ± 3.4 mmHg, 13.07 ± 5.3 mmHg, 16.6 ± 5.03 mmHg, 18.5 ± 3.8 mmHg, respectively. Twenty seven eyes underwent seton implantation surgery. No one had anterior segment bleeding during surgery. The pre-BIPC grades were Grade 4: 67.58%, Grade 3: 28.57%, Grade 2: 3.57%, no one had Grade 1or Grade 0, while post BIPC grade were at the 1st week Grade 1: 64.28%, Grade 0: 35.71%, no one had Grade 2 or more, at 1st month Grade 2: 3.57%, Grade 1: 39.28%, Grade 0: 57.14%, at 3rd month Grade 2: 17.85% Grade 1: 28.57%, Grade 0: 53.57%, no one had Grade 3 or more both in first and the third month, at 6th month Grade 3: 7.14%, Grade 2: 28.57%, Grade 1: 42.85%, Grade 0: 21.42%. and no one had Grade 4. CONCLUSION: Significant reduction of NV was observed during the first week. Minimal increasement was seen in third month, significant regression effect persisted for 6 months. BIPC inhibited the peroperative risk of anterior segment bleeding, increased the surgical comfort and prevented the failure of filtration procedure by inhibiting reproliferation.

Early results of suprachoroidal drainage tube implantation for the surgical treatment of glaucoma.

PURPOSE: To evaluate the efficacy and safety of suprachoroidal silicone tube shunt implantation in glaucoma. PATIENTS AND METHODS: Twenty-four glaucomatous eyes unresponsive to medical treatment were included, 7 of them had earlier trabeculectomy. After preparation of a limbus-based scleral flap, 1.5 mm deep sclerotomy was made adjacent to scleral flap opening. Posterior end of the silicone tube was placed posteriorly in suprachoroidal space, anterior end was placed into anterior chamber. Intraocular pressure (IOP) and best corrected visual acuities (BCVA) were measured preoperatively and postoperatively on the first day, at the first week, in the first, third, sixth, twelfth, and eighteenth months. Postoperative IOP >21 mm Hg, <5 mm Hg (after 3 months), or additional glaucoma surgery were accepted as failure. Eyes not failed and not on supplemental medical therapy are considered as complete success. Eyes that have not failed, with or without supplemental medical therapy, are considered as qualified success. Hypotony was defined as early, when IOP below 5 mm Hg was observed within 4 weeks. RESULTS: Mean postoperative follow-up period was 34.4±23.7 weeks (range 4 to 78 wk). Complete success rates were 95.8%±4.1 at the first week, 79.2%±8.3 in the first and the third month, 63.3%±12.0 for the sixth and twelfth month. Qualified success rates were 95.8%±4.1 in the first week, 87.5%±6.8 in the first, third, sixth, twelfth months. Mean postoperative IOP's (8.5±4.9mm Hg, 12.9±5.6 mm Hg, 17.0±7.9 mm Hg, 15.3±3.6 mm Hg, 18.3±6.0, 15.1±6.0 mm Hg, respectively for the first week, first, third, sixth and twelfth mo) were significantly lower than preoperative mean IOP's. The success rates in cases without earlier trabeculectomy were significantly higher than in cases with earlier trabeculectomy (P=0.035). Postoperative first day mean±SD BCVA value was significantly lower than preoperative value (P=0.004). Failure was seen in 7 eyes of which 3 of them underwent reoperation for glaucoma. Early hypotony was seen in 6 eyes. No infection, choroidal, or retinal detachment was seen. There was a fibrin reaction in the anterior chamber in 3 patients. Two patients had intracameral bleeding, 1 of them underwent anterior chamber lavage. CONCLUSIONS: Suprachoroidal tube drainage of aqueous humor from the anterior chamber to the suprachoroidal space is effective in reducing IOP in glaucoma patients, with lower serious complication rates, and may be preferred as initial surgery in cases without earlier trabeculectomy.

Effect of doxycycline on postoperative scarring after trabeculectomy in an experimental rabbit model.

PURPOSE: To investigate effectiveness of doxycycline after trabeculectomy in rabbits by evaluating bleb appearance, intraocular pressure, and levels of matrix metalloproteinase-1, -2, -3, and -9 and tissue inhibitors of metalloproteinase (TIMP)-1 and -2 in the subconjunctival (sc) area. METHODS: Twenty-nine New Zealand White rabbits were assigned into 1 of 6 groups as follows: topical doxycycline (0.1%), postoperative sc injection of doxycycline (100 mg/2 mL), and intraoperative mitomycin-C (MMC) (0.2 mg/mL) and their respective control groups. RESULTS: There was significant difference between intraocular pressure in the case groups, but there was no significant difference in topical doxycycline and MMC groups during the follow up. In the topical doxycycline group, levels of TIMP-1 and perifericTIMP-1 were higher and levels of perifericMMP-2 and inflammation were lower than their controls. In the sc doxycycline group, peripheral inflammation was higher than in the corresponding control. Only peripheral inflammation was significantly different between case groups, with the highest level in sc and the lowest level in MMC groups. Further, topical doxycycline group showed no significant difference in bleb appearance or peripheral inflammation compared with MMC group. Conjunctival burn and corneal vascularization were detected only in the sc doxycycline group. CONCLUSIONS: Topical doxycycline is more effective than sc doxycycline but is similar to MMC, and it can be an alternative to MMC in trabeculectomy in rabbits.

Trimethoprim/Sulfamethoxazole and azithromycin combination therapy for ocular toxoplasmosis.

PURPOSE: To evaluate the efficacy and safety of trimethoprim/sulfamethoxazole and azithromycin combination for the treatment of ocular toxoplasmosis. METHODS: Nineteen ocular toxoplasmosis patients treated with trimethoprim/sulfamethoxazole and azithromycin +/- corticosteroid combination were retrospectively reviewed. Demographic data, clinical findings, the time interval until resolution of inflammation, recurrences, and drug side effects were collected. RESULTS: The mean follow-up time of the patients was 25.0 +/- 22.5 (range; 6 -66) months. Final visual acuity improved with a mean of 6 +/- 4 lines in 15 patients (78.9%). Inflammatory findings began to subside within 14.8 +/- 10.0 days. Three patients (15.8%) had recurrent attack. Only 1 patient (5.3%) had side effects from therapy. CONCLUSIONS: Trimethoprim/sulfamethoxazole and azithromycin combination is an effective and safe treatment modality for the treatment of ocular toxoplasmosis.

Effect of chronic topical glaucoma medications on aerobic conjunctival bacterial flora.

PURPOSE: To investigate whether the chronic topical medications affect aerobic conjunctival bacterial flora of patients with glaucoma and to compare their findings with the findings of the controls. METHODS: Eighty-one patients and 67 healthy control subjects participated in this case-control study. Duplicate conjunctival swab specimens were collected from each patient at the microbiology laboratory and were investigated for the presence of aerobic bacteria. All bacterial species from isolated colonies were identified. RESULTS: Thirty seven (45.7%) of the 81 patients and 25 (37.3%) of 67 controls had positive conjunctival cultures. Coagulase-negative Staphylococcus was the most commonly isolated bacterial species in both groups. There were no statistically significant differences between the prevalence of other conjunctival cultures testing positive for any of the isolated organisms. The patients were also evaluated with respect to the presence of a systemic illness. Age, sex, presence of diabetes and asthma, duration of antiglaucomatous medication, and number of medications used did not have an effect on culture positivity in both groups when evaluated by logistic regression model. CONCLUSIONS: The conjunctival culture positivity was higher in patients with glaucoma than in the healthy controls and in patients with diabetes than in patients without diabetes, although both were statistically insignificant. Aerobic conjunctival flora of the patients using topical glaucoma medications and the controls did not differ. Further studies are needed to comment on the clinical importance of these findings.

Comparison of the effects of latanoprost and bimatoprost on central corneal thickness.

PURPOSE: To compare the effects of latanoprost and bimatoprost on central corneal thickness (CCT). MATERIALS AND METHODS: A total of 188 eyes of 94 patients who were being followed in our hospital's glaucoma clinic and were receiving either latanoprost (55.3%) or bimatoprost (44.7%) monotherapy were recruited for the study. The data were collected prospectively from the patients, who were medicated with bimatoprost or latanoprost, at the initial diagnosis of glaucoma. Measurements were performed at the initial diagnosis, 6th, 12th, and 24th months. All the measurements were carried out by the same doctor between 9 AM and 11 AM, using Goldmann applanation tonometer for intraocular pressure (IOP) and ultrasound biopachymeter for CCT. RESULTS: There were no significant differences between the patient groups receiving latanoprost or bimatoprost for sex, age, baseline IOP, and CCT. The mean baseline CCT values were 559.5+/-35.3 mum for latanoprost group and 553.4+/-31.7 mum for bimatoprost group. CCT of both groups at 6, 12, and 24 months were significantly thinner when compared with baseline CCT. The percent reduction rates were 1.9+/-2.4% for latanoprost and 2.8+/-1.8% for bimatoprost in the 24th month. CONCLUSION: A significant reduction in CCT was observed at the 6th, 12th, and 24th months with latanoprost and bimatoprost. Serial CCT measurements in determining the IOP values may be helpful in the follow-up of prostaglandin analogs.

Nonpreserved human amniotic membrane transplantation in acute and chronic chemical eye injuries.

PURPOSE: To evaluate the safety and efficacy of nonpreserved amniotic membrane transplantation (AMT) with or without limbal autograft transplantation (LAT) in management of acute and chronic chemical eye injuries. METHODS: Amniotic membrane transplantation or AMT + LAT was performed on nine eyes of seven consecutive patients, five eyes with acute chemical burn and four eyes with limbal stem cell deficiency secondary to previous chemical burn. Nonpreserved amniotic membrane was used in all procedures. RESULTS: Five patients (71.5%) were men and two (28.5%) were women. The average age at the time of surgery was 32.7 +/- 10.9 years (range, 20-45). Mean follow-up after last surgery was 8.9 +/- 3.2 months (range, 6-14). The average epithelial healing time was 24.6 +/- 17.3 days (range, 3-45). At the end of the follow-up period, visual acuity improved in all eyes, inflammation subsided, and the subjective complaints decreased remarkably. CONCLUSION: AMT with nonpreserved amniotic membrane promoted epithelial healing, reduced surface inflammation, increased patient comfort, and decreased the extent and severity of vascularization when used in patients with acute chemical burns. When used in limbal stem cell deficiency owing to past chemical burns, AMT alone or in combination with LAT aided in ocular surface reconstruction. Infectious, inflammatory, or toxic/allergic reactions were not encountered in any patient owing to the use of nonpreserved amniotic membrane. Further studies are required to establish the safety and efficacy of preserved and nonpreserved AMT in ocular surface reconstruction.