Intraocular Lens Opacification Following Silicone Oil Endotamponade.

BACKGROUND AND OBJECTIVE: To report cases with intraocular lens (IOL) opacification following silicone oil (SO) endotamponade. PATIENTS AND METHODS: Medical charts of 32 eyes with IOL opacification were evaluated retrospectively. All eyes had rhegmatogenous retinal detachment and had a history of previous hydrophilic acrylic IOL implantation. All patients underwent vitrectomy with SO endotamponade. Clinical features of all cases and the results of histochemical evaluation of explanted IOLs were reported. RESULTS: The mean duration of SO endotamponade was 4.6 ± 2.0 months. The mean follow-up was 67.0 ± 23.5 months. The interval between phacoemulsification surgery and IOL opacification was 27.4 ± 18.3 months. With the exception of two eyes, all IOL opacification was detected during the follow-up period after SO removal. IOL exchange was performed in 12 eyes (37.5%). Histochemical analysis revealed significant calcification mostly on the surface of explanted IOL optics. CONCLUSION: Vitreoretinal surgeons should be aware of that some hydrophilic IOLs may have the potential of opacification following SO endotamponade. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:37-43.].

The long-term effect of intravitreal ranibizumab on retinal nerve fiber layer thickness in exudative age-related macular degeneration.

The aim of this study was to evaluate the long-term effect of intravitreal ranibizumab on the retinal nerve fiber layer (RNFL) in exudative age-related macular degeneration (AMD). Patients with treatment naive neovascular AMD in one eye were enrolled into the study. Following 3 monthly intravitreal ranibizumab injections, the patients were evaluated according to disease activity and re-injections were performed according to "treat and extend" protocol. During the follow-up, peripapillary nerve fiber layer thickness measurements were compared with normal fellow eyes. Forty-four eyes of 11 women and 11 men with the mean age of 66.3 ± 8.8 years (50-80) were enrolled into the study. All patients had completed at least 12 months of follow-up time. Patients received an average of 4.7 (3-11 injections) intravitreal injections. At baseline, no significant difference was observed between two groups for RNFL thickness, which was assessed as quadrants (p = 0.250-0.944) and globally (p = 0.814). In each group, there was a significant RNFL thinning (p = 0.009 and 0.022) after the third month, whereas no significant difference was observed between treated and untreated eyes. Patients were also classified according to the number of injections, and RNFL thickness showed no difference between eyes treated with less or more than five intravitreal injections (p = 0.757-0.973). Although there was no statistically significant difference in RNFL thickness between study and control eyes during 12 months of follow-up, a significant thinning was recorded in both groups compared with baseline values. Cross-sectional images with higher resolutions and precise segmentation opportunities are needed to investigate the hypothesis "VEGF neutralization and inhibition of cell maintenance" in detail.

Evaluation of corneal thickness, anterior chamber depth, and iridocorneal angle following scleral buckling surgery with AS-OCT.

BACKGROUND AND OBJECTIVE: To evaluate the changes in central corneal thickness (CCT), anterior chamber depth (ACD), and iridocorneal angle (ICA) with anterior segment optical coherence tomography (AS-OCT) following scleral buckling surgery. PATIENTS AND METHODS: Thirty-one eyes with rhegmatogenous retinal detachment that underwent scleral buckling were included in this prospective study. Changes in CCT, ACD, and ICA were measured with AS-OCT. RESULTS: There was a significant increase in the CCT at 1 day and 1 week postoperatively. CCT became slightly thinner than the preoperative values at 1 month postoperatively. The ACD was relatively shallow at all visits after the surgery. The decrease in the ICA 0° and 180° values was statistically significant at 1 day, 1 week, and 1 month postoperatively. CONCLUSION: Changes in the CCT and ICA after scleral buckling were mild and almost returned to their preoperative levels within 6 months. However, ACD shallowing persisted even after 6 months.

Effect of silicone oil removal on central corneal thickness.

AIM: To evaluate the effect of silicone oil removal(SOR) on central corneal thickness(CCT) in aphakic and pseudophakic eyes prospectively. METHODS: Patients who underwent SOR surgery between June 2005 - August 2007 were included in this study. Silicon oil was actively removed behind the posterior capsule through the pars plana sclerotomy site (posterior approach) in pseudophakic eyes and through the pupil and the corneal tunnel incision (anterior approach) in aphakic eyes with the 18-gauge cannula. CCT was assessed with Orbscan II corneal topography system preoperatively and at one month and three months postoperatively. A total of 34 eyes of 34 patients (26 males, 8 females) comprised the study group. Mean age was (55.6±12.3) years (Range: 25-80 years). Twenty-six eyes (76.5%) were pseudophakic and 8 (23.5%) aphakic. Mean time between silicone oil injection and removal was (15.1±13.6) months (Range: 5-54 months). At baseline, CCT was 576.4±46.0µm in pseudophakic eyes and 611.6±36.2µm in aphakic eyes. RESULTS: At the first postoperative month CCT was (573.3±40.1)µm and (630.9±72.9)µm in pseudophakic and aphakic eyes respectively. At the third postoperative month, CCT was (582.7±49.5)µm and (614.5±82.4)µm in pseudophakic and aphakic eyes respectively. There was no statistically significant difference in CCT measurements one month and 3 months after SOR when compared to preoperative values in both aphakic and pseudophakic eyes (P>0.05). CONCLUSION: Active SOR either by anterior or posterior approach did not affect the CCT.

Interaction with intraocular lens materials: does heavy silicone oil act like silicone oil?

PURPOSE: To determine the interaction of heavy silicone oil with various intraocular lens (IOL) materials and whether heavy silicone oil covers the silicone IOL optic as silicone oil does. SETTING: Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey. METHODS: The study group comprised 5 poly(methyl methacrylate) (PMMA) IOLs, 4 foldable silicone IOLs, 5 foldable hydrophilic acrylic IOLs, and 5 foldable hydrophobic acrylic IOLs. Each IOL was bathed in balanced salt solution (BSS) for 10 minutes and then placed in heavy silicone oil dyed with Sudan Black for another 10 minutes. Afterward, each IOL was reimmersed in BSS for 5 minutes and examined under the light microscope. Digital images were analyzed to determine the optic area covered with heavy silicone oil. RESULTS: The mean heavy silicone oil coverage was 7.05% +/- 7.88% (SD) (range 1.13% to 20.54%) on PMMA IOLs, 100% on silicone IOLs, 12.17% +/- 11.43% (range 1.25% to 31.52%) on hydrophobic acrylic IOLs, and 34.64% +/- 13.28% (range 12.57% to 44.42%) on hydrophilic acrylic IOLs. Heavy silicone oil coverage of silicone IOLs was statistically significantly greater than the coverage of other IOL materials. CONCLUSION: Heavy silicone oil acted the same as silicone oil and covered the entire surface of silicone IOLs.

Dislocation of capsular bag with intraocular lens and capsular tension ring.

We report a case in which the capsular bag with an intraocular lens (IOL) and a capsular tension ring (CTR) dislocated into the vitreous. The dislocated foldable posterior chamber IOL and CTR were removed with a pars plana vitrectomy and exchanged with a scleral-fixated IOL. No complications occurred intraoperatively or postoperatively. Although insertion of a CTR decreases the risk for IOL dislocation, spontaneous capsular bag dehiscence can occur.

Staining of vitreous with triamcinolone acetonide in retained lens surgery with phacofragmentation.

PURPOSE: To evaluate the beneficial effects of triamcinolone-assisted vitrectomy during management of retained nuclei with phacofragmentation. SETTING: Dokuz Eylul University, Medical Faculty, Ophthalmology Department, and Retina Eye Center, Izmir, Turkey. METHODS: Twelve eyes of 12 patients were operated on between January 2002 and September 2003. Eleven patients were referred because of nucleus drop during phacoemulsification surgery. Six of these patients had mature white cataracts, and in 5 cases total nucleus luxation into vitreous cavity had occurred. In 1 case, approximately half of the nucleus was luxated. Five of the referred patients had pseudoexfoliation (PEX), 3 of whom also had phacodonesis. All of these patients had luxated nucleus segments of more than half. One patient was referred with an intraocular lens (IOL) implanted in the sulcus region. One patient who was not referred also had PEX, iridodonesis, and phacodonesis; total drop of nucleus had occurred in this case. All patients were treated with pars plana vitrectomy with triamcinolone acetonide staining of the vitreous material and phacofragmentation of the dropped nucleus segments. In 2 cases, transscleral foldable IOL fixation surgery was combined simultaneously. One patient already had an IOL at the time of referral. Nine patients were left aphakic for secondary procedures. RESULTS: All patients except 1 with subretinal neovascular membrane achieved best corrected visual acuities of equal or better than 0.5. No intraoperative or postoperative retinal complications were observed after 9 to 15 months of follow-up. CONCLUSION: Staining of the vitreous material with triamcinolone acetonide during vitrectomy and phacofragmentation surgery for luxated nuclei helped in total removal of the vitreous body, thus preventing the aspiration of peripheral vitreous fibrils by the phaco tip, which might induce retinal detachment intraoperatively or postoperatively.

Bilateral choroidal metastasis from carcinoma ex pleomorphic adenoma of the parotid gland.

The histological, clinical and angiographic findings are reported of a 34-year-old man with bilateral visual loss who had left parotidectomy with subsequent radiotherapy due to carcinoma ex pleomorphic adenoma of the parotid gland 1 year before. Funduscopy disclosed choroidal masses with surrounding serous retinal detachment in both posterior poles. At the time of ocular diagnosis, lung, pleura and pharynx metastases had recently been revealed. Because of the extent of disease and its poor prognosis, no treatment was offered. Although parotid gland carcinoma usually spreads via lymphatics, choroidal involvement may rarely occur due to haematogenous dissemination.

Transscleral fixation of foldable intraocular lenses.

PURPOSE: To report the results of transscleral implantation of foldable intraocular lenses (IOLs). SETTING: Department of Ophthalmology Dokuz Eylül University School of Medicine, Izmir, Turkey. METHODS: Twenty eyes of 20 patients had transscleral fixation of a foldable IOL combined with conventional 3-port pars plana vitrectomy or anterior vitrectomy. Twelve eyes had lens luxation, 8 traumatic and 4 idiopathic. Six eyes were aphakic, 3 after extracapsular cataract extraction and 3 as a result of complicated phacoemulsification. One patient with a mature cataract and pseudoexfoliation had a wide zonular dialysis during phacoemulsification. One patient had an opacified hydrophilic acrylic IOL. RESULTS: The mean age of the patients was 52.9 years (range 17 to 80 years). The mean preoperative best corrected visual acuity (BCVA) was 20/63 (range counting fingers to 20/25). The mean preoperative refraction was +10.8 diopters (D) (range +10 to +13 D) and the mean preoperative astigmatism, 1.8 D (range 1.0 to 5.5 D). Sixteen IOLs were hydrophobic acrylic, 14 of which were 3-piece AcrySof MA60BM (Alcon) and 2 of which were Sensar AR40 (Allergan). Four IOLs, all VisaAcryl(Staar), were hydrophilic acrylic. The mean power of the IOLs was +22.0 D (range 19.0 to 26.0 D). The mean follow-up was 12 months (range 1 to 18 months). The postoperative BCVA ranged between 20/100 and 20/20, and the mean postoperative astigmatism was 1.1 D (range 0.5 to 4.0 D) at the last follow-up visit. The difference was statistically significant (P<.05). Suture exposure and cystoid macular edema were the only complications, each occurring in 2 eyes. CONCLUSION: Transscleral fixation of foldable IOLs takes less time and results in fewer complications and better visual outcomes.

Surgical management of postoperative endophthalmitis: comparison of 2 techniques.

PURPOSE: To evaluate the results of 2 surgical techniques in eyes with postoperative endophthalmitis. SETTING: Department of Ophthalmology, Dokuz Eylul University, School of Medicine, Izmir, Turkey. METHODS: Twenty-four eyes with endophthalmitis after cataract surgery had vitrectomy as an initial procedure according to the Endophthalmitis Vitrectomy Study (EVS) criteria (Group 1, n = 24). These eyes were compared with 28 eyes that had total pars plana vitrectomy with an encircling band, silicone tamponade, and endolaser (Group 2, n = 28). The visual and anatomical outcomes and the need for additional procedures (repeat vitrectomy) were evaluated in the 2 groups. RESULTS: In Group 1, 6 eyes (25.0%) had an additional procedure, 3 eyes (12.5%) had phthisis, and 21 eyes (87.5%) had successful surgery. In Group 2, no eye had an additional procedure, 1 eye (3.5%) had phthisis, and 27 eyes (96.4%) had successful surgery. The number of additional procedures was significantly less and the rate of surgical success was significantly higher in Group 2 than in Group 1 (P<.01). CONCLUSION: Despite the poor visual prognosis of endophthalmitis surgery, more radical intervention can increase the chance of surgical success and decrease the number of additional procedures in eyes with postoperative endophthalmitis.

Interaction of intraocular lenses with various concentrations of silicone oil: an experimental study.

The aim of this study was to evaluate the interaction between various widely used intraocular lenses (IOLs) and silicone oils of different viscosities. Four groups of IOLs, including monoblock foldable hydrophilic acrylic IOLs (Morcher, type 92s); monoblock hydrophobic acrylic IOLs (Acrysof-SA60AT, Alcon); single-piece rigid polymethylmethacrylate (PMMA) IOLs (Intraocular Optical International-IOI-65130) and a three-piece foldable silicone optic IOL (CeeOn Edge 911A, Pharmacia UpJohn) were analyzed in vitro to determine the percentage adherence 1,000-centistoke, 1,300-centistoke or 5,000-centistokes silicone oil on the IOL optic. For each IOL type, there was no statistically significant difference in the mean silicone oil coverage (MSC) of the IOL optics for the different viscosities of silicone oil. Silicone IOLs had the highest MSC percentage (79.9%) whereas hydrophilic acrylic IOLs were the least silicone-covered IOLs (7.8%) compared to the other IOL types tested in this study. It is not the concentration of silicone oil that affects silicone oil coverage. When performing small-incision cataract surgery in patients who may require silicone oil injection, foldable hydrophilic acrylic or hydrophobic acrylic lenses should be preferred over standard foldable silicone lenses.

Indocyanine green angiography in Bietti's crystalline retinopathy.

BACKGROUND: To our knowledge, the indocyanine green (ICG) angiographic features of Bietti's crystalline retinopathy have been described in a single case only. We report the ICG angiographic findings in four patients with Bietti's crystalline retinopathy and compare them with the fluorescein angiographic findings. METHODS: Review of the records of four patients with Bietti's crystalline retinopathy, three of whom were from a single consanguineous family. Fluorescein and ICG angiography were performed with the Heidelberg scanning laser ophthalmoscope. RESULTS: The ICG angiographic findings varied according to the stage of the disease. In the early stages no retinal pigment epithelium (RPE) alterations or choriocapillaris loss were noted. In advanced cases there was extensive chorioretinal atrophy. Most notably, intraretinal crystals did not exhibit fluorescence/cyanescence and had no masking effect on fluorescein or ICG angiography. In all cases angiography showed hypofluorescent/hypocyanescent dots, most likely corresponding to RPE alterations adjacent to atrophic areas. INTERPRETATION: ICG angiography does not give additional information in Bietti's crystalline retinopathy and probably is not superior to fluorescein angiography. However, it delineates the atrophic areas slightly better than does fluorescein angiography.

Electroretinographic findings in Duchenne/Becker muscular dystrophy and correlation with genotype.

PURPOSE: To correlate the electroretinography (ERG) findings in patients with Duchenne/Becker muscular dystrophy (D/BMD) with the genotype and evaluate the ERG findings in DMD carriers. MATERIALS AND METHODS: Fifteen deletion positive patients with DMD, two deletion positive patients with BMD and six DMD carriers in two families having a positive disease history were evaluated with DNA analysis, ophthalmologic and ERG findings. RESULTS: The mean age of the deletion positive D/BMD patients was 11.1 +/- 3.7 (range: 7-20). No abnormality was detected in the ophthalmic examination of the patients. In three out of 17 patients with D/BMD, ERG was normal whereas in 14 patients electronegative ERG was recorded in scotopic conditions. Mutational alterations observed in these three cases with normal ERG were located exceptionally at 5' hot spot; not like the others within central region. In all DMD carriers ERG findings were recorded as normal. CONCLUSION: ERG findings in D/BMD patients may show some correlations with molecular analysis, whereas it is not useful in DMD carriers.

Unilateral neuroretinitis and periparillary serous retinal detachment in cat-scratch disease.

Cat-scratch disease is a self-limited infection characterized by subacute regional lymphadenitis, which is usually preceded by a history of being scratched by a cat infected with the Bartonella species. Neuroretinitis, retinochoroiditis, isolated papillitis and peripapillary angiomatosis are features of posterior segment involvement. However, vision loss is very rare. We report a patient with cat-scratch disease associated with unilateral neuroretinitis and peripapillary serous retinal detachment, and discuss its fluorescein and indocyanine green angiographic features.

Bilateral massive choroidal hemorrhage secondary to Glanzmann's syndrome.

Characteristics of intraocular bleeding and its management in association with blood dyscrasias are discussed. We present a patient with massive bilateral choroidal hemorrhage secondary to Glanzmann's syndrome. Magnetic resonance imaging and ultrasonographic findings were ordered. During the clinical course, bilateral intravitreal hemorrhage and tractional retinal detachment occurred. Left pars plana vitrectomy was performed under general anaesthesia. The procedure was unsuccessful because of intraoperative uncontrolled bleeding.

Ocular findings in cutis laxa acquisita.

PURPOSE: To report ocular findings in a patient with cutis laxa acquisita. METHODS: Case report RESULTS: A 44-year-old man complained of excessively loose skin for 4 years and had no family history of skin disease. Dermatological examination showed lax and wrinkled skin all over his body. He had bilateral subconjunctival fat prolapse and dermatochalasis. CONCLUSIONS: This case of acquired form of cutis laxa is noteworthy because subconjunctival fat prolapse and dermatochalasis are uncommon at this relatively young age.