Surgical anatomy of the deep lateral orbital wall.

PURPOSE: To determine the exact anatomic location and volume of the thickest section of the greater wing of the sphenoid bone (trigone), which is removed during deep lateral orbital wall decompression. METHODS: Eighteen dried skulls were used to determine the exact anatomic location and computed tomography (CT) images of 20 patients (10 male, 10 female) were used for volumetric calculations. RESULTS: Mean values were 14.5 mm for the orbital rim to inferior orbital fissure distance, 23.3 mm for rim to trigone distance, 13.0 mm for width of the trigone base, 5.8 mm for trigone to orbital apex distance, and 12.3 mm for trigone height. The width of the narrowest section of the trigone was 5.2 mm. The trigone was found to have a lower segment (0.92 cc) neighboring the inferior orbital fissure, and an upper segment (0.32 cc) adjoining the thick substance of frontal bone. The narrowest part between these two segments was located just at the superior border of the lateral rectus muscle. CONCLUSIONS: The authors recommend avoiding the thin rectangular portion located in the inter-fissural area adjacent to the superior orbital fissure. A high intersubject variability underscores the need for individualized preoperative analysis by imaging studies.

Lateral canthal dynamics, correlation with periorbital anthropometric measurements, and effect of age and sleep preference side on eyelid metrics and lateral canthal tendon.

PURPOSE: To evaluate dynamic and static properties of lateral canthal tendon and involutional periorbital anthropometric and lateral canthal changes with any possible effect of sleep reference side on these changes. METHODS: Ninety-two healthy adult subjects with a mean age of 43.5 years were enrolled in the study. Lateral canthal tendon lengths (LCT), canthal movement amplitudes, and other periorbital anthropometric parameters were measured. Any effects of age and sleep preference side on anthropometric and particularly lateral canthal tendon measurements were evaluated. Pearson correlation analysis, one-way analysis of variance, and t-test for paired samples were used for statistical evaluation. RESULTS: LCT length was weakly correlated with age, lower lid tractability, horizontal palpebral fissure length, and interpupillary distance and also inversely correlated with margin reflex distance, but not with other measurements. Age was also correlated with lower lid tractability, and with the ratio of LCT to the horizontal palpebral fissure length (LCT-HPFL). No correlation between age and horizontal palpebral fissure length was detected. Age was weakly and inversely correlated with canthal height but not with canthal movement amplitudes. No effect of sleep preference side on LCT length, canthal height, or lower lid tractability was detected. CONCLUSIONS: Lateral canthus has a dynamic structure that is not correlated with any other periorbital anthropometric measurements. LCT length is correlated with lower lid tractability, and increases with age, unlike horizontal palpebral fissure that stays constant with increasing LCT-HPFL ratio. Sleep preference side has no effect on the eyelid metrics and LCT.

Bcl-2 expression in skin pathergy reaction of Behçet's disease.

BACKGROUND: Bcl-2 expression in leukocytes plays an important role in autoimmune and inflammatory disease. OBJECTIVE: In the present study, we investigated the Bcl-2 expression in the skin pathergy reaction (SPR) of Behçet's disease (BD). METHODS: The skin pathergy test (SPT) was performed on 23 patients with BD and 7 healthy controls. After 48 h, SPT specimens were taken by punch biopsy. Control samples were also obtained from the normal skin of 7 patients with BD and 11 patients with BD-unrelated leukocytoclastic vasculitis. Biopsy specimens were evaluated by routine histopathological examination and immunohistochemical Bcl-2 staining. RESULTS: The SPT was clinically positive in 9 of 23 patients and histopathologically positive in 13 but never in the healthy controls. The majority of leukocytes in 12 of 13 histopathologically positive specimens were stained with Bcl-2. Only 3 BD-unrelated leukocytoclastic vasculitis samples showed Bcl-2 positivity. No Bcl-2 staining was found in healthy controls and normal skin samples of patients with BD. CONCLUSION: Our data may suggest a role of Bcl-2-mediated inflammation in the pathogenesis of the SPR in BD.

Expression of bcl-2 protein in active skin lesions of Behçet's disease.

BACKGROUND: Expression of bcl-2 protein has been shown to play an important role in the pathogenesis of some inflammatory as well as neoplastic disorders. In this study we have investigated the presence of bcl-2 protein in active skin lesions of Behçet's disease and compared these results with normal skin samples of Behçet's disease (BD) patients and BD unrelated leukocytoclastic vasculitis. METHODS: Active skin lesions of 23 Behçet's disease patients, normal skin samples of seven Behçet's disease patients, and archival biopsy specimens of 23 cutaneous leukocytoclastic vasculitis were investigated for the presence of bcl-2 protein by immunohistochemical methods. Results of staining were assessed semiquantitatively. Chi-square tests were used for statistical analysis. RESULTS: Expression of bcl-2 protein were demonstrated in 16 of 23 (69.5%) and 8 of 23 (34.7%) patients with Behçet's disease and leukocytoclastic vasculitis, respectively. There were statistically significant difference between two groups (x2 = 4.27, P < 0.05). None of the normal skin samples of Behçet's disease patients showed bcl-2 expression. CONCLUSION: Expression of bcl-2 protein may play a particular role in the development of skin lesions in Behçet's disease by causing prolonged survival of infiltrating lymphocytes.

The results of cataract extraction and intraocular lens implantation in patients with Behçet's disease.

PURPOSE: To evaluate the results of extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation in patients with Behçet's disease. METHODS: Retrospective study was based on 19 uveitic eyes of 12 patients with Behçet's disease who underwent classic ECCE with IOL implantation in 5 eyes and phacoemulsification with IOL implantation in 14 eyes between 1993-1999. RESULTS: In eyes with Behçet's uveitis 0.5 or better postoperative visual acuity was found in 21% at the end of mean 34.2-4.6 (range 5 to 66) months follow-up. The most frequent postoperative complications were posterior capsule opacification in 9 (47%), posterior synechiae in 5 (26%), anterior synechiae in 3 (16%). Anterior and posterior synechiae in the phacoemulsification group were less than those in the ECCE group (respectively p<0.05 and p<0.01). CONCLUSIONS: In eyes with chronic Behçet's uveitis, cataract extraction and IOL implantation by phacoemulsification had fewer postoperative complication than ECCE, but most of the patients had low visual acuity due to preoperatively existing optic atrophy and/or inflammatory degeneration or edema of macula.

The evaluation of ocular trauma in children between ages 0-12.

Ocular trauma is the leading cause of noncongenital unilateral blindness in children under 20 years old. In this study, 138 patients (36 female, 102 male) with ocular trauma between November 1983 and October 1996 were reviewed retrospectively at the Department of Ophthalmology, Ondokuz Mayis University Faculty of Medicine. Twenty-four of these patients were blunt trauma and 114 were perforating eye injury. The mean age of the patients was 6.96+/-3.01 years. Mean post-treatment follow-up was 10.7 months (range 1 to 121 months). Forty-five patients were admitted to the eye clinic within the first 24 hours after trauma. The most frequent finding was hyphema in blunt injury, and corneal laceration in perforating injury. The most frequent cause of injury was wood and stone in blunt trauma and glass and knife in perforating trauma. While the ratio of visual acuities equal to or better than finger counting was 37.5 percent (9 eyes) in blunt trauma cases and 20.2 percent (23 eyes) in perforating trauma cases prior to treatment, it was 79.2 percent (19 eyes) and 55.3 percent (63 eyes), respectively, at last visit examination post-treatment. The most frequent complication was traumatic cataract in blunt trauma and corneal leukoma and anterior synechia in perforating trauma. The results obtained suggested that socioeconomic and sociocultural status and family negligence are important factors in eye injuries in children that occur during games.

Cyclosporin-A therapy in severe uveitis of Behçet's disease.

PURPOSE: Cyclosporine-A (CSA) combined with corticosteroid therapy was administered to 12 patients with severe Behçet's uveitis who were resistant to colchicine or cytotoxic therapy. METHODS: Previous colchicine or cytotoxic therapies were tapered off one month before CSA therapy. All patients were started on an initial oral dose of 5 mg/kg/day of CSA. After the first three months, the CSA dose was reduced to a maintenance dose according to the intraocular inflammatory response. RESULTS: The average follow-up period was 20 (12-36) months. Visual acuity remained the same in 12 (%54.5) and improved in 8 (%36.4) eyes. There was a decrease in the frequency (p<0.01) and severity (p<0.01) of ocular attacks and in the maintenance steroid dose (p<0.01) when compared with conventional therapy. The frequent side effects were paraesthesia-hyperesthesia, fatigue, nausea, hirsutism and dose-related nephrotoxicity in one patient. CONCLUSION: The results of the study suggest that low dose CSA combined with low dose corticosteroid may be an effective therapeutic alternative in the treatment of severe refractory Behçet's uveitis.

The effects of nasolacrimal canal blockage on topical medications for glaucoma.

Twenty patients with primary open angle glaucoma who have been treated with identical antiglaucoma eye drops in both eyes were examined. Silicone punctal plugs were used to occlude the inferior punctum of one eye, in order to block the nasolacrimal canal. The intraocular pressures and effects of the medical therapy before and after punctal occlusion were compared. Punctal occlusion significantly decreased the intraocular pressure with an average of 2.00 +/- 0.43 mmHg in the plugged eyes (p < 0.001). The intraocular pressure in the unplugged control eyes did not change significantly (p > 0.05) after punctal occlusion of the fellow treated eye.

Relation between retinal vein occlusions and axial length.

AIMS: To evaluate the ocular axial length as a risk factor for development of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). METHODS: Ocular axial lengths were measured, by A-scan ultrasonography, in 17 patients with CRVO and 41 patients with BRVO and compared with those of contralateral unaffected eyes and 66 age matched controls. RESULTS: In 17 patients with CRVO the mean axial length of affected eyes was 22.25 (SD 0.19) mm and of unaffected eyes was 22.61 (0.13) mm. In 41 patients with BRVO the mean axial length of affected eyes was 22.89 (0.11) mm and of unaffected eyes was 22.99 (0.12) mm. CONCLUSION: These findings confirm that the axial lengths in CRVO and BRVO were significantly shorter than in the controls. This significant difference may be a risk factor in the development of CRVO and BRVO.

The effects of antiglaucomatous agents on conjunctiva used for various durations.

PURPOSE: The effect of antiglaucomatous agents on conjunctiva used for various durations evaluated histopathologically. METHODS: Conjunctiva biopsies were taken in 19 Mayis University Faculty of Medicine Ophthalmology Department from 31 eyes of 30 patients who underwent filtration surgery after a period of antiglaucomatous agent use and examined under light microscope. The results were compared with the results of conjunctival biopsies from 10 similar aged patients undergoing retinal detachment of cataract surgery and with no other ocular pathology. RESULTS: Five of the cases were using antiglaucomatous treatment for two months (Group A), four cases for two to 12 months (Group B) and 22 cases for more than 12 months (Group C) before the surgery. Four cases were using a beta blocker only, eight cases beta blocker + sympathomimetic or beta blocker + myotic and the remaining 19 cases were using a combination of beta blocker + sympathomimetic + myotic. Histopathologic evaluation with light microscope showed no pathologic change in group A, but, subepithelial increase of lymphocytes, mast cells, macrophages and fibroblasts in group C. CONCLUSIONS: It was detected that subconjunctival inflammatory reaction increases as the number of antiglaucomatous agents and the treatment duration increase. These changes might be considered as risk factors that decrease the success rate of filtration surgery.

Variant high-origin radial artery: a bilateral case.

During a dissection of both upper extremities, an abnormally high origin of the radial a. was found on each side. However, the arterial patterns were not the same. On the right side, the radial a. arose 2 cm above the junction of the two roots of the median n. On the left side, the radial a. arose from the brachial a. 3 cm distal to the origin of the profunda brachii a. The course of these arteries in the forearm were normal. However, in the hand, on the right side, the contributions of the radial and ulnar aa. to the superficial and deep palmar arches were, unusually, equal. On the left side, the superficial palmar arch was formed as usual mainly by the ulnar a. and the deep palmar arch was formed mainly by the radial a. The high origin of the radial aa. in this case is explained on the basis of the embryologic development and is distinguished from the other common arterial variations in the upper limb.

Vertebral level of the ending of the spinal cord and its relationship to the length of the vertebral column in northern Turkish neonates.

Racial and sex differences in the level of ending of the spinal cord of the adult have been reported. It is lower in Africans and in females. Since such differences may affect even fetuses and newborns we aimed to study in Northern Turkish neonates. The study was made on 40 full-term newborn still-births (23 male, 17 female). In all cases, the length of the vertebral column, the length of the spinal cord and the body weight were measured and the vertebral level of ending of the spinal cord was noted. It was found that the termination of the spinal cord varied from the first lumbar to the second sacral vertebra, with a mean level between L2 and L3. In female neonates, it was observed that the spinal cord ended at a slightly lower level (0.2 vertebra) than in males. Our findings approximately agreed with those of Barson [2] who studied neonates in England and of Jit and Charnalia [5] in North India. However, we found that the spinal cord ended one and half vertebrae lower in Northern Turkish neonates than in South African and South Indian subjects. The correlations between body-weight and length of the spinal cord, weight and length of the vertebral column, length of the spinal cord and length of vertebral column, length of the vertebral column and level of ending of the cord were statistically highly significant for males, females and both sexes together (p < 0.001). The longer the vertebral column, the higher the termination of the spinal cord.

A primary intraocular hydatid cyst.

Ultrasonography and computerized tomography (CT) of the painful and blind right eye of a 13-year-old girl showed a cystic mass almost filling the vitreous cavity and narrowing the anterior chamber. The histopathologic diagnosis of the enucleated eye was an echinococcus cyst. Abdominal ultrasonography, brain CT and chest X-rays gave no abnormal findings when first examined, nor during the follow-up 18 months after surgery. Indirect hemagglutination test was negative at the last control. The case was accepted as a primary hydatid cyst (echinococcosis) of the eyeball.

An experimental study on the use of fibrin sealants in strabismus surgery.

Fibrin sealants were used in place of the classical suture materials in strabismus surgery. Classical recession operations were performed on the right eyes of ten albino rabbits, while the recessed anterior rectus muscles of the left eyes were fixed to the sclera with the tissue sealant. Better histopathological results were obtained with the fibrin sealant than with the classical sutures, but the functional results were worse.