Effectivity of intraoperative adjustable suture technique in horizontal strabismus.

AIM: To compare the long-term effectivity of intraoperative adjustable suture technique with traditional non-adjustable strabismus surgery. METHODS: Two hundred and thirty-three patients, who underwent strabismus surgery either with traditional procedures or one-stage intraoperative adjustable suture technique, were included in our long-term follow-up study. One hundred and eighteen patients were evaluated in traditional surgery group (TSG) and 115 who underwent adjustable suture were in the one-stage intraoperative adjustable surgery group (ASG). In this group 9 patients had paralytic strabismus and 16 had reoperations, 2 patients had restrictive strabismus related to thyroid eye disease. The mean follow up in the TSG was 26.2 months and it was 24.8 months in the ASG group. RESULTS: In patients with exotropia (XT) the mean correction of deviation for near fixation in ASG (32.4±13.2PD) and in TSG (26.4±8.2PD) were similar (P=0.112). The correction for distant fixation in ASG (33.2±11.4PD) and TSG (30.9±7.2PD) were not significantly different (P=0.321). In patients with esotropia (ET) even the mean correction of deviation for both near (31±12PD) and distant (30.6±12.8PD) fixations were higher in ASG than in TSG, for both near (28.27±14.2PD) and distant (28.9±12.9PD) fixations, the differences were not significant (P=0.346, 0.824 respectively). The overall success rate of XT patient was 78.9% in TSG and 78.78% in ASG, the difference was not significant (P=0.629). The success rates were 78.75% in TSG and 75.51% in ASG in ET patient, which was also not significantly different (P=0.821). CONCLUSION: Although patients in ASG had more complex deviation such as paralysis, reoperations and restrictive strabismus, success rates of this tecnique was as high as TSG which did not contain complicated deviation. One-stage intraoperative adjustable suture technique is a safe and effective method for cooperative patient who has complex deviation.

Long-term effects of prostaglandin analogues on the anterior chamber depth of patients with primary open-angle glaucoma.

OBJECTIVE: To evaluate the effect of long-term application of bimatoprost and latanoprost on the anterior chamber depth of primary open-angle glaucoma patients. METHODS: The anterior chamber depth (ACD) and axial length (AL) of patients using prostaglandin analogues for open-angle glaucoma (group I) and an age- and gender-adjusted control group (group II) were measured by ultrasonography. Patients using bimatoprost and those using latanoprost were also compared in terms of ACD and AL. RESULTS: The mean ACD of group I (27 eyes of 27 subjects) was significantly lower than that of group II (30 eyes of 30 subjects) (p = .012). Similarly, the ratio of ACD to AL was significantly lower in group I compared with group II (p = .001). The ACDs of patients using bimatoprost or latanoprost and the control group were not significantly different by Kruskal-Wallis test (p = .056), but the differences of these 3 groups in ACD/AL ratios were significant (p = .004). When the Mann Whitney U test was used for pairwise comparison, there was a significant difference between the control group and the patients using latanoprost or bimatoprost in terms of the ACD/AL ratio (p = .008 for each). There was no difference between the patients using latanoprost and those using bimatoprost in terms of the ACD/AL ratio (p = .4). CONCLUSION: The ACD of patients on prolonged therapy with prostaglandin analogues seems to be lower than than that of the control group. However, prospective long-term studies on large number of subjects are needed to evaluate the effect of each type of prostaglandin on ocular structures.

Primary viscocanalostomy versus trabeculectomy for primary open-angle glaucoma: three-year prospective randomized clinical trial.

PURPOSE: To compare the efficacy and safety of viscocanalostomy and trabeculectomy in patients with primary open-angle glaucoma (POAG). SETTING: Department of Ophthalmology, Ankara Education and Research Hospital, Ankara, Turkey. METHODS: In this prospective randomized trial, 50 eyes of 50 patients with medically uncontrolled POAG were randomized to have a trabeculectomy (25 eyes) or a viscocanalostomy (25 eyes). Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before surgery and 1 day, 1 week, 1, 3, and 6 months, and 1, 2, and 3 years postoperatively. RESULTS: At 3 years, the mean IOP was 16.0 mmHg +/- 7.07 (SD) in the trabeculectomy group and 17.8 +/- 4.6 mmHg in the viscocanalostomy group (P=.694). Complete success (IOP 6 to 21 mm Hg without medication) was achieved in 66.2% of eyes at 6 months and 55.1% at 3 years in the trabeculectomy group and in 52.9% and 35.3%, respectively, in the viscocanalostomy group (P>.05). Qualified success (IOP 6 to 21 mmHg with medication) was achieved in 95.8% of eyes at 6 months and 79.2% at 3 years in the trabeculectomy group and in 90.7% and 73.9%, respectively, in the viscocanalostomy group (P>.05). Postoperative hypotony and cataract formation occurred more frequently in the trabeculectomy group than in the viscocanalostomy group (P=.002). CONCLUSIONS: Primary trabeculectomy lowered IOP more than viscocanalostomy in POAG patients. However, the complication rate was lower in the viscocanalostomy group.

Evaluation of findings in Crouzon's syndrome.

PURPOSE. The purpose of this study was to investigate the ocular, facial and radiological signs of Crouzon's syndrome in a group of older patients who had not undergone previous craniofacial surgery. METHODS. Six cases of Crouzon's syndrome, four of whom belonged to a three-generation family, were examined systemically, ophthalmologically and roentgenographically; five of these cases were additionally evaluated with computed tomography and compared with Apert syndrome. RESULTS. On radiologic evaluation, all cases had synostosis of all cranial sutures and fontanelles and brachycephalic skulls, crowding of the upper teeth due to maxillary hypoplasia, and serious nasal septum deviation. Bilateral ethmoidal, maxillary and sphenoidal chronic sinusitis was found in 50% of cases. Three patients had hypertelorism and two others had a tendency toward hypertelorism. The typical facial appearance with shallow orbits, globe protrusion and exorbitism was present in all cases. Two of them had V-pattern exotropia while the other four were orthophoric. The single case with mental retardation had bilateral cataract. CONCLUSION. Crouzon's syndrome can present with different findings and must be evaluated multidisciplinarly.