Ocular manifestations of late-onset behçet disease.

PURPOSE: to describe the demographic characteristics and ocular manifestations of patients with late-onset Behçet disease (BD). PATIENTS AND METHODS: The patients for this retrospective study were selected using the data obtained from the medical records of 16 patients with late-onset BD between January 2000 and May 2008. RESULTS: twelve (75%) of the cases were male and 4 (25%) were female. The mean age of patients was 53.8 ± 2.9 years (range, 51-60 years). The mean follow-up period was 4.3 ± 1.1 years (range, 3-8 years). Throughout the follow-up period, panuveitis, posterior uveitis, and anterior uveitis were detected in 11 (68.7%), 4 (25%) and 1 (6.2%) of 16 patients, respectively. CONCLUSION: in our series, the most frequent type of uveitis was panuveitis and male sex seems to be a significant risk factor for developing panuveitis. Late-onset BD showed a marked preponderance of males with a sex ratio of 3:1.

Combined cilioretinal artery and partial central retinal vein occlusion in the postpartum period.

PURPOSE: To report a combined cilioretinal artery and partial central retinal vein occlusion shortly after delivery in a twin-pregnant woman. METHODS: A 25-year-old woman presented to our clinic with the complaint of blurred vision in the right eye 1 week after delivery. She underwent detailed ophthalmic and systemic investigations. RESULTS: The patient had an uncomplicated twin pregnancy. Ocular examination showed combined cilioretinal artery and partial central retinal vein occlusion in the right eye. Systemic diseases were excluded. Laboratory evaluations revealed increased plasma d-dimer level (1.64 mg/mL). Spontaneous recovery occurred without treatment 1 month after delivery. CONCLUSION: Twin pregnancy may lead to exaggerated hypercoagulability and increased d-dimer level in pregnant women. This situation may be a risk factor for retinochoroidal vascular occlusions.

Laser in situ keratomileusis for treatment of fully or partially refractive accommodative esotropia.

PURPOSE: To evaluate the efficacy and safety of laser in situ keratomileusis (LASIK) in partially refractive accommodative esotropia (pRAE) and fully refractive accommodative esotropia (fRAE). METHODS: Forty-two eyes of 21 patients who had LASIK for correcting hyperopic refractive error were evaluated. Refractive errors, uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), ocular alignment, and stereopsis were recorded before and after LASIK. RESULTS: Sixteen patients with fRAE and 5 with pRAE were evaluated. Mean age at the time of surgery was 19.00+/-3.79 years. Mean follow-up time was 12.19+/-4.51 months. For the fRAE group, the mean preoperative angle of deviation without spectacle correction was +19.13+/-5.87 prism diopters (PD); all were orthophoric with spectacles. Postoperatively, all these patients achieved less than 10 PD of deviation without spectacles. For the pRAE group, the mean preoperative angle of deviation was +32.60+/-9.81 PD and +14.60+/-6.14 PD without and with spectacles, respectively. Postoperatively, the mean angle of deviation was +13.60+/-5.72 PD and +12.80+/-5.40 PD without and with spectacles, respectively. For all 21 patients, the preoperative mean spherical equivalent (SE) with cycloplegia was +4.94+/-1.43 diopters (D); it was +1.49D+/-0.70 D postoperatively. Three eyes lost 1 line of BCVA and 3 eyes gained 1 line. No intraoperative complication was recorded. CONCLUSIONS: LASIK is a safe and effective method for treating refractive error and creating orthophoria in fRAE. In pRAE, it eliminates the refractive component of deviation safely and effectively.

Ocular findings in childhood-onset Behçet disease.

PURPOSE: To investigate the demographic characteristics and ocular features of patients with childhood-onset Behçet disease. PATIENTS AND METHODS: Patients for this retrospective study were selected using the data obtained from medical records of 34 patients with childhood-onset Behçet disease being followed up in the Uveitis Department of Ankara Ulucanlar Eye Education and Research Hospital between January 2003 and May 2008. RESULTS: Of 34 patients, 24 were boys (70.5%) and 10 were girls (29.4%). The average age of patients was 14.5 +/- 1.9 years (range, 10-16 years). Mean follow-up period was 4.5 +/- 2 years (range, 2-10 years). During the follow-up, panuveitis, posterior uveitis, and anterior uveitis were diagnosed in 18 (52.9%), 11 (32.3%), and 5 (14.7%) patients, respectively. Ocular findings included cataract in 20 patients (58.8%), posterior synechiae in 8 (23.5%), posterior capsular opacification secondary to cataract surgery in 8 (23.5%), vitreous condensation due to previous episodes of vitritis in 17 (50%), optic atrophy in 10 (29.4%), cystoid macular edema in 5 patients (14.7%), narrowed and occluded retinal vessels due to retinal periphlebitis and branched retinal vein occlusion in 2 (5.8%), neovascularization of the disk in 1 (2.9%), and phthisis bulbi in 1 patient (2.9%). CONCLUSIONS: Based on the results that were obtained in this series, panuveitis was the most common type of uveitis in cases with childhood-onset Behçet disease. Cataract was the most common anterior segment complication. Optic atrophy was the most common posterior segment complication. Male predominance was determined in this study.

Comparative toxicity of 4 commonly used intravitreal corticosteroids on rat retina.

OBJECTIVE: To investigate the effects of 4 commonly used steroids (dexamethasone, triamcinolone, betamethasone, and methylprednisolone) on 50 retinas of 25 adult pigmented rats. STUDY DESIGN: Experimental animal study. PARTICIPANTS: Twenty-five pigmented Long-Evans male rats. METHODS: Each steroid drug with 2 different doses (0.025 mL and 0.050 mL) was injected into the vitreous of each eye of 5 rats. The low drug dose was injected into the right eye and the high dose was injected into the left eye. Ten eyes of 5 randomly selected rats were used as a control group and intravitreal saline was injected into these eyes. Oxidative damage and intrinsic antioxidative capacity were determined by measuring retinal malondialdehyde (MDA) and glutathione (GSH) levels, respectively. RESULTS: No statistically meaningful difference was observed in retinal GSH and MDA measurements in the low- and high-dose triamcinolone (1 and 2 mg), low-dose betamethasone (0.075 mg), and low-dose dexamethasone (0.1 mg) groups, compared with the control group. Both doses of methylprednisolone (1.6 mg and 3.2 mg), high-dose betamethasone (0.15 mg), and high-dose dexamethasone (0.2 mg) markedly altered retinal GSH and MDA levels. CONCLUSIONS: The results of our study show that the toxicity of triamcinolone is not evident even in high doses. It may be used safely. We also suggest that intravitreal use of low doses of betamethasone and dexamethasone is safer than higher doses of these drugs and both doses of methylprednisolone.

Keratometric alterations following the 25-gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy.

PURPOSE: To assess the alterations in keratometric astigmatism following the 25-gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy. METHODS: Sixteen consecutive patients were enrolled into the study. Conventional vitrectomy was applied to eight of the cases and 25-gauge transconjunctival sutureless vitrectomy was performed in eight patients. Keratometry was performed before and after the surgery. RESULTS: In the 25-gauge transconjunctival sutureless pars plana vitrectomy group, statistically significant changes were not observed in the corneal curvature in any post-operative follow-up measurement (p > 0.05); whereas in the conventional pars plana vitrectomy group, statistically significant changes were observed in the first postoperative day (p = 0.01) and first postoperative month (p = 0.03). We noted that these changes returned to baseline in three months (p = 0.26). CONCLUSION: Both 25-gauge transconjunctival sutureless and conventional pars plana vitrectomy are effective surgical modalities for selected diseases of the posterior segment. Surgical procedures are critical for the visual rehabilitation of the patients. The post-operative corneal astigmatism of the vitrectomised eyes can be accurately determined at least two months post-operatively.

Vitreoretinal surgery in advanced coats disease.

PURPOSE: To report the outcomes of vitreoretinal surgery for a patient with total retinal detachment and a subretinal nodule associated with Coats disease (CD). METHODS: A 20-year-old woman stage 3B CD underwent vitreoretinal surgery with triamcinolone acetonide-assisted pars plana vitrectomy, limited retinotomy, removal of the subretinal nodule and membrane, endolaser photocoagulation, and silicone oil tamponade. The surgical outcomes were observed. RESULTS: Retinal attachment was achieved after vitreoretinal surgery, removal of the subretinal membrane, and endoresection of the subretinal fibrous nodule. No intraoperative or postoperative complications occurred due to the surgical technique. The retina remained attached during the postoperative follow-up period of 6 months. CONCLUSION: Vitreoretinal surgery is an effective surgical technique that provides successful reattachment of the retina and enables endoresection of the subretinal fibrous nodule in eyes with advanced CD. It also prevents the devastating intraocular complications leading to enucleation.

A comparative study of tissue glue and vicryl suture for closing limbal-conjunctival autografts and histologic evaluation after pterygium excision.

PURPOSE: To compare clinical and histopathologic outcomes of tissue glue and vicryl suture to attach limbal conjunctival autografts in pterygium surgery. METHODS: Twenty-four eyes of 24 patients were included in this study. All eyes had primary pterygia and were treated with limbal conjunctival autograft transplantation after pterygium resection. Tissue glue (Tisseel) was used to attach the limbal conjunctival autograft in 12 eyes and vicryl sutures in 12 eyes. Patients were followed for 6 months. Histopathologic examination was performed in both groups on postoperative days 1, 15, and 45. Main outcome measures were patient comfort, graft success, complications, histopathologic evaluation, and recurrence of pterygium. RESULTS: Patient comfort was significantly higher in the tissue glue group than the vicryl suture group (P < 0.05). All grafts were intact in both groups during the follow-up period. No recurrence was observed during the 6-month follow-up in both groups. Foreign-body granulation tissue was not seen in any histopathologic studies in eyes with tissue glue, whereas it was observed in eyes with vicryl sutures from day 15 to day 45. The tissue glue was seen under the conjunctiva on the first postoperative day and was not seen on days 15 and 45. CONCLUSIONS: Our results showed that limbal conjunctival autografting is an effective surgical technique for the treatment of pterygium, and tissue glue was efficacious in securing the limbal conjunctival autograft in pterygium surgery. The use of tissue glue decreases patient symptoms during the postoperative period after pterygium surgery. Compared with sutures, tissue glue had no adverse effects on ocular tissue.

Retinopathy in patients with diabetic ophthalmoplegia.

PURPOSE: To compare patients with palsy of the 3rd, 4th or 6th cranial nerve due to diabetes mellitus (DM) with controls matched for age, sex and disease duration in terms of the presence and severity of diabetic retinopathy. PATIENTS AND METHOD: Thirty-three diabetic patients with cranial nerve palsies and 33 age- and sex-matched controls with the same duration of disease were included in this case-control study. Groups were evaluated in terms of the type of DM, presence and level of diabetic retinopathy and coexisting systemic diseases. Outcomes were compared by chi(2) and paired-sample tests. RESULTS: Eleven patients had diabetic retinopathy in the study group. In the control group, 23 patients had diabetic retinopathy. Differences in the presence and severity of diabetic retinopathy between the two groups were found to be statistically significant (p = 0.028 and p = 0.018, respectively). CONCLUSION: Presence and level of diabetic retinopathy are significantly lower in diabetics with cranial nerve palsy than in the age-, sex- and disease-duration-matched controls.

Phacoemulsification in pseudoexfoliation syndrome.

PURPOSE: To compare the incidence of intraoperative and early postoperative complications (IEPC), visual outcomes, and change in intraocular pressure (IOP) between eyes with and without pseudoexfoliation syndrome (PEX) having cataract extraction by phacoemulsification. MATERIAL AND METHOD: 800 eyes with PEX and 1,600 eyes without PEX having cataract extraction by phacoemulsification were included in this retrospective study. Evaluated parameters were incidence of IEPC, visual outcomes and change in IOP. chi2 and Student's t test were used for statistical analysis. RESULTS: There were no significant differences in the incidence of IEPC and visual acuity gain between the two groups (p > 0.05). Rise in IOP in the early postoperative period was significantly higher in the PEX group (p < 0.02). CONCLUSION: Patients with PEX who have phacoemulsification can achieve results similar to patients without PEX. IOP control in the early postoperative period seems to be more important in patients with PEX.

Bilateral permanent concentric visual field defect secondary to severe pre-eclampsia.

PURPOSE: To present a patient with bilateral permanent concentric visual field defect secondary to severe pre-eclampsia. CASE REPORT: A forty-year-old woman presented to the ophthalmology department with partial visual field defect affecting her both eyes. She gave a history of emergent uterine curettage for severe uncontrolled pre-eclampsia in the 24th week of her second gestation which was 10 years before. Two days after the procedure, the patient complained of peripheral visual field defect in her both eyes which persisted until her last presentation. Her best-corrected visual acuity, color vision, intraocular pressures, and anterior segment examination findings were normal bilaterally. Fundus examination showed a normal optic nerve head with reduction of arteriole to vein ratio in both eyes. Humphrey Field Analyzer revealed a bilateral concentric visual field defect. Visual Evoked Potentials (VEP) and Electroretinography (ERG) were within normal limits in both eyes. Cranial magnetic resonance imaging (MRI) was normal. DISCUSSION: Herein, we presented a case of permanent concentric visual field defect which developed as a complication of severe uncontrolled pre-eclampsia. To the best of our knowledge; such a case has not been reported to date.

A case of bilateral iris mammillations with unusual pupillary appearance and pseudo-hypertension.

Iris mammillations are congenital abnormalities characterised by villiform elevations regularly spaced on the surface of the iris. The aetiology of iris mammillations is unknown. They can be either isolated or associated with melanocytosis involving the uveal tract and the periocular tissue, resulting in a risk for uveal melanoma. These lesions can be complicated by high intraocular pressure and, in the case of associated melanocytosis of the iris, sclera or periocular tissues, by uveal melanoma. Patients with iris mammillations should be followed regularly due to these potential complications. We report a case of bilateral iris mammillations with unusual pupillary appearance and pseudo-hypertension and emphasise the importance of iris mammillations and that central corneal thickness should be considered when intraocular pressure is measured.

Comparison of limbal-conjunctival autograft and intraoperative 0.02% mitomycin-C for treatment of primary pterygium.

PURPOSE: To compare the outcomes of use of intraoperative 0.02% mitomycin-C (MMC) and limbal-conjunctival autograft (LCAG) for treatment of primary pterygia. MATERIAL AND METHOD: One hundred and twelve eyes of eighty patients with primary pterygia were randomly treated either by intraoperative 0.02% MMC for 5 min or LCAG. Recurrence (defined as fibrovascular tissue invading the cornea >1.5 mm) and complications were evaluated. RESULTS: Fifty-two eyes were included in the MMC group and sixty in the LCAG group. Recurrence occurred in three eyes (5.76%) in the MMC group and in two eyes (3.33%) in the LCAG group. This difference between recurrence in the two groups was not statistically significant (P > 0.05). Incidence of complications such as conjunctival cysts, symblephara, conjunctival hyperemia, and subconjunctival hemorrhage was similar in both groups (P > 0.05) whereas corneal epithelial defects (CED), irritation, lacrimation, and photophobia were more common in the MMC group (P < 0.05). CONCLUSION: Simple excision then intraoperative use of 0.02% (MMC) for 5 min or LCAG are similarly successful in the treatment of primary pterygia. Some complications, for example irritation, lacrimation, photophobia, and CED are more common when simple excision is followed by MMC.

Electron microscopic examination of the anterior lens capsule in a case of Alport's syndrome.

PURPOSE: To report a case of Alport's syndrome and to present electronmicroscopic examination findings of the anterior lens capsule of this patient. METHOD: A 21-year-old man was referred for low visual acuity and retinal pigment epithelial changes in the left eye. The patient and his relatives underwent detailed ophthalmological examination, including electrophysiological testing. The patient also underwent electronmicroscopic examination of the anterior lens capsule. RESULTS: His visual acuity was 6/18 OD and 6/15 OS. Anterior lenticonus and subcapsular opacities were observed in the left eye. Cataract extraction by phacoemulsification with intraocular lens implantation was performed for his poor visual performance. During the capsulorhexis, the remarkably thin and fragile anterior capsule was noted and removed. Ultrastructural analysis of the anterior lens capsule showed a thinner central zone compared with the periphery. CONCLUSIONS: The course of Alport's syndrome can be ameliorated by early diagnosis. Therefore, the ophthalmological examination of a patient with anterior lenticonus must be combined with a detailed medical evaluation. Ultrastructural analysis of the lens capsule can support the diagnosis of Alport's syndrome.

Does blunt ocular trauma induce corneal astigmatism?

PURPOSE: To determine the effect of blunt ocular trauma on refractive astigmatism. METHODS: Eighty-six eyes of 86 patients with known previous refractive status exposed to blunt ocular trauma were included in the study. Trauma-induced astigmatism (TIA) was calculated using vector analysis. In eyes with TIA, central corneal thickness was assessed by ultrasound pachymetry, and corneal topographies were obtained. Anterior-chamber angles were examined by Goldmann 3-mirror lens to find microhemorrhages, scarring, or recession. Patients were followed up between 8 and 12 months (average, 9.2 months). RESULTS: In 18 eyes (21%), TIA was detected. Six (7%) of these eyes had lenticular astigmatism caused by traumatic lens subluxation. In the remaining 12 eyes (14%), corneal topography showed regular astigmatic patterns, which were symmetrical in 3 eyes and asymmetric in the remaining 9. The etiologic factor was a game marble in 6 eyes and a stone in the remaining 6. The mean central corneal thickness was 535.75 microm (range, 498-570 microm) in these 12 eyes. In 9 of these 12 eyes, recession or scarring in the anterior-chamber angle was detected at 1 edge of the steepest axis. CONCLUSIONS: Blunt trauma can induce astigmatism. Hard and small objects are more likely to induce astigmatism.

Traumatic optic nerve avulsion.

A 10-year-old boy presented with optic nerve avulsion associated with ptosis and limitation of elevation and adduction secondary to blunt ocular trauma. At the initial examination the funduscopic view was hazy because of concurrent vitreous hemorrhage. Ultrasonography revealed a posterior ocular wall defect and a hypolucent area in the region of the optic nerve head.

Comparative analysis of the effects of brimonidine and dorzolamide on ocular blood flow velocity in patients with newly diagnosed primary open-angle glaucoma.

The aim of this study was to evaluate the effects of brimonidine 0.2% and dorzolamide 2% on the ocular blood flow velocity in patients with newly diagnosed primary open-angle glaucoma (POAG). Forty-four (44) patients with newly diagnosed POAG were included in a prospective, comparative, randomized clinical study. Twenty-six (26) healthy volunteers, whose age and gender matched, were recruited to compare the baseline hemodynamic characteristics of the patients. After a complete eye examination, baseline blood flow velocity measurements of the retrobulbar vessels were made with color Doppler ultrasonography. Patients were randomly assigned to receive either brimonidine 0.2% or dorzolamide 2% for a 3-month period. Blood flow velocity measurements were repeated after 3 months. Both brimonidine and dorzolamide significantly reduced the intraocular pressure. The baseline ophthalmic artery pulsatility index was higher in patients with POAG than control subjects. Whereas there was a significant increase in peak systolic velocity of the central retinal artery, no significant change was observed in the other vessels with brimonidine and dorzolamide treatment. There was little difference, in terms of ocular blood flow velocity, between newly diagnosed glaucoma patients and control subjects. Both topical brimonidine and dorzolamide significantly reduced the intraocular pressure without altering ocular blood flow velocity in patients with newly diagnosed POAG.

Congenital color blindness in young Turkish men.

We investigated a healthy population of men from different regions of Turkey for the presence of congenital red-green color blindness. Using Ishihara pseudoisochromatic plates, 941 healthy men from the Turkish army were tested for congenital red-green color blindness. The prevalence of red-green color blindness was 7.33 +/- 0.98% (5.10% protans and 2.23% deutans). These ratios were higher than other reported samples from Mediterranean Europe. Higher percentages of color blindness were found in regions with a lower education level and more consanguineous marriages.

Lepromatous iridocyclitis.

A 36-year-old woman with no prior medical history presented with a unilateral decrease in vision and iridocyclitis to our hospital. External examination demonstrated multifocal, firm, elevated, non-tender skin nodules on the patient's face and left hand. In addition, slit-lamp biomicroscopy revealed gray, cheesy-appearing nodules on the iris surface of the affected eye. Anterior chamber paracentesis and pars plana vitrectomy did not reveal further information. Skin nodule biopsy, however, demonstrated multiple fragmented organisms within histiocytes, consistent with leprosy. The iridocyclitis resolved after treatment with dapsone, corticosteroids, and rifampin and her vision returned to 20/20.

Efficacy and complications of releasable suture trabeculectomy and standard trabeculectomy.

PURPOSE: To compare the efficacy and complications of releasable suture trabeculectomy and standard trabeculectomy. PATIENTS AND METHODS: Sixty-four patients with uncontrolled glaucoma despite maximally tolerated medical therapy were included in a prospective, comparative, randomized clinical study. Standard trabeculectomy was performed on the 32 patients (Group 1) by one ophthalmologist and releasable suture trabeculectomy was also performed on the 32 patients (Group 2) by another ophthalmologist. Intraocular pressure, hypotony, shallow anterior chamber, iridocorneal touch and other complications were evaluated postoperatively. Examinations were performed daily for 1 week, for the 1st month and thereafter for every 3 months. RESULTS: The mean follow-up period was 11.0 +/- 2.4 months in Group 1 and 11.5 +/- 3.8 months in Group 2. On the first postoperative day mean intraocular pressure was determined 9 +/- 2.7 mmHg in Group 1, and 21.6 +/- 1.1 mmHg in Group 2 (p = 0.007). The mean intraocular pressure was 10.1 +/- 1.4 mmHg in Group 2 after suture removal. Shallow anterior chamber was observed in 11 (34.3%) patients of Group 1 and 2 (6.2%) patients of the Group 2 in the early postoperative period (p = 0.005). Iridocorneal touch was observed in 5 (15.6%) patients of Group 1 and 1 (3.1%) patient of Group 2 (p = 0.196). There was no statistically significant difference in the mean intraocular pressure between the two groups at 3, 6 and 12 months (p = 0.663, p = 0.362, p = 0.182, respectively). DISCUSSION: Releasable scleral flap sutures reduce the incidence of shallow anterior chamber and iridocorneal touch after trabeculectomy. Releasable scleral flap suture technique and standard trabeculectomy are similar in terms of lowering intraocular pressure at 1-year-follow up.