A Moyamoya Patient with Bilateral Consecutive Branch Retinal Vein Occlusion.

We describe a moyamoya (MMD) patient with bilateral consecutive branch retinal vein occlusion (BRVO). The patient had a medical history of severe headache, cranial haemorrhage, bilateral supraclinoid carotid artery occlusion, and "puff of smoke" collaterals on cerebral angiography and an encephalomyosynangiosis operation. On ophthalmic examination, he had superior temporal branch vein occlusion with intraretinal haemorrhage and visual acuity of 20/25 in the right eye. Twelve years later, he presented with superior temporal branch vein occlusion in the left eye and visual acuity of 20/60. The patient was initially treated with a dexamethasone intravitreal implant, and later intravitreal ranibizumab injections. We describe the first reported case of bilateral consecutive BRVO and management in MMD.

Peripheral Vasculitis, Intermediate Uveitis and Interferon Use in Multiple Sclerosis.

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. A 40-year-old female patient with a 12-year history of MS was admitted to our clinic with blurred vision and floaters in her right eye for about 1 month. Here, we share the findings and the management of intermediate uveitis and retinal periphlebitis in an MS case being treated with interferon beta-1a for 7 years.

Candida pelliculosa endophthalmitis after cataract surgery: a case report.

BACKGROUND: Here we report the first case of postoperative endophthalmitis due to Candida pelliculosa after cataract surgery. We describe the clinical management of this type of candida infection in the eye. CASE PRESENTATION: A 57-year-old Turk man was seen at our clinic at the end of the first postoperative month after cataract surgery. He presented with eye redness, pain and decreased visual acuity. His ophthalmologic examination revealed moderate tyndall and a mild flare in the anterior chamber. Hypopyon in the capsular bag posterior to the intraocular lens was seen in the second postoperative month. Despite topical and subconjunctival bacterial endophthalmitis treatment, there was no improvement in the clinical situation. Candida pelliculosa was isolated from a sample culture obtained from the anterior chamber. Oral fluconazole could not be administered because of increased liver enzyme levels and intravenous amphotericin B could not be administered because of an allergic reaction. Intraocular lens explantation, pars plana vitrectomy and anterior chamber lavage by rupturing the posterior wall of the microabscesses were performed. Intravitreal and intracameral amphotericin B injections were given four times in addition to surgical interventions. The patient has been followed for 2 years and his best-corrected visual acuity was 0.4 at the last visit. CONCLUSION: Nearly 1 month after cataract surgery, a patient presented with eye redness and blurred vision, with corneal endothelial deposits, hypopyon in the capsular bag and microabscesses on the incision sites and corneal endothelium. Candida pelliculosa should be considered in patients showing these symptoms. Multiple intraocular amphotericin B (5 µg) administrations can be used safely even in cases with high sensitivity to systemic use. Rupturing the posterior wall of the abscesses on the corneal endothelium surgically with intraocular lens explantation and pars plana vitrectomy are recommended.

Results of Mitochondrial DNA Sequence Analysis in Patients with Clinically Diagnosed Leber's Hereditary Optic Neuropathy.

OBJECTIVE: To investigate possible mitochondrial DNA (mtDNA) mutations in patients with Leber's hereditary optic neuropathy (LHON) in order to provide a precise diagnosis and genetic counseling. MATERIAL AND METHODS: Between 1982 and 2007, ten patients were clinically diagnosed with LHON and six of these patients agreed to be involved in this study. Six healthy individuals were also included as a control group. mtDNA was isolated from peripheral blood samples and polymerase chain reaction and mtDNA sequence analysis were performed. RESULTS: In one of the six patients, a homoplasmic mutant m.11778G>A mutation was detected. All of the clinically diagnosed LHON patients and the control groups had the m.14212C>T and m.14580G>A single nucleotide polymorphisms (SNPs). The m.11719A>G SNP was detected in three of six patients and four of the controls. Two of the six patients had the m.3197T>C SNP and, in addition, the m.14258G>A SNP was found in one of these two patients, while neither of these mutations were present in the control group. CONCLUSION: The clinical diagnosis of LHON could be supported by molecular genetics only in one patient by the detection of one mutation. The m.3197T>C and m.14258G>A SNPs should be considered as potential mtDNA mutations due to the fact that they were detected in the patient group. These mutations should be investigated further in large case groups for suspected gene loci that could lead to optic neuropathy.

[The factors affecting visual outcome in open globe injuries]. / Açik göz küresi yaralanmalarinda sonuç görme keskinligi üzerine etkisi olan faktörler.

BACKGROUND: To evaluate the factors affecting visual acuity in cases subjected to surgical repair due to open globe injury. METHODS: The records of the patients who have been subjected to emergency surgical repair due to open globe injury were examined retrospectively. From a total of 195 cases, 119 eyes of 119 cases who fulfilled the inclusion criteria were included into the study. Cases were examined in terms of age, gender, trauma type, localization, preoperative examination findings, the presence of additional surgical interventions and the findings in the last examination. Chi-square test and logistic regression analysis were used in statistical analysis. RESULTS: Original visual acuity (p=0.042), zone (p=0.001), trauma type (p=0.003), preoperative anterior chamber loss (p=0.005), existence of hyphema (p=0.001), vitreous prolapse (p=0.000) and posterior segment pathology development (p=0.000) influenced the visual outcome. In cases with grade 4 or grade 5 resulting visual acuity, statistically significant factors were determined as "existence of pathology in the posterior segment" (p=0.000, Odds ratio=12.397) and "total anterior chamber loss" (p=0.015, Odds ratio=4.661). CONCLUSION: Changes occurring at the posterior segment pathology and anterior chamber loss are determinant in terms of resulting visual acuity. For this reason, ophthalmoscopy and ultrasonography that should not be omitted in the follow-up period for cases with a transparent media and with media opacity, respectively.

Optical coherence tomography in optic pit maculopathy.

PURPOSE: To report the optical coherence tomography (OCT) findings in patients with optic pit maculopathy. METHODS: Twelve eyes of 12 patients with optic pit maculopathy were evaluated. Cross-sectional OCT images were correlated with findings from slit-lamp biomicroscopy and fluorescein angiography. The presence of retinoschisis and serous macular detachment was evaluated and the height of the serous detachment also measured. RESULTS: Visual acuities varied between 20/400 and 20/63. The height of the serous macular detachment at the fovea was between 323 and 548 mum. OCT findings showed that ten (83.3%) patients had both retinoschisis and serous macular detachment, one (8.3%) patient had only retinoschisis and one (8.3%) patient had only serous macular detachment. None of the patients had macular hole or vitreoretinal traction. CONCLUSION: These findings support the concept of a bilaminar structure that contains retinoschisis and serous macular detachment. Our data also showed that in some patients, the sole component of maculopathy was serous macular detachment or retinoschisis.

Macular function of successfully repaired macula-off retinal detachments.

PURPOSE: To assess the macular function of successfully repaired macula-off retinal detachments in the long term and to evaluate the relationship between duration of macular detachment and functional recovery. METHODS: Of 214 consecutive patients, 29 who were operated on because of unilateral retinal detachment with at least 6 months of follow-up and whose best-corrected visual acuity was better than 0.05 Snellen chart value in both eyes were examined. Operated eyes were included in group I, and the fellow eyes were included in group II. Macular functions were evaluated in terms of visual acuity, contrast sensitivity, color vision, visual field, and visual evoked potentials after reattachment. RESULTS: All macular functions except P100 amplitudes in the operated eyes were significantly less than those in the fellow eyes (P = 0.28) following reattachment after nearly 5 years. It was found that the longer the duration of macular detachment (except detachment duration of < or = 7 days), the smaller the increase in visual acuity, contrast sensitivity, and color vision defect scores (P = 0.000, P = 0.034, and P = 0.0003, respectively). CONCLUSIONS: Macular functions except P100 amplitude cannot be recovered completely 5 years after retinal reattachment. There was no relation between the duration of macular detachment and the mean deviation in visual field and the P100 latency and P100 amplitude difference between both eyes.

Fluorescein angiographic findings in cases with intermediate uveitis in the inactive phase.

BACKGROUND: To determine fundus fluorescein angiography (FA) findings in cases with intermediate uveitis in the inactive phase. METHODS: This prospective study included all eligible cases with a diagnosis of intermediate uveitis that were treated at the uvea unit of Trakya University ophthalmology department between January 2002 and January 2004. Study criteria included patients in the inactive phase who had no complaints, no biomicroscopic or ophthalmoscopic inflammatory findings in the anterior and posterior segments, and no period of inflammation that had occurred within the previous 6 months. Cases receiving immunosuppressive treatment were not excluded. FA was performed in all cases, which were evaluated by 2 independent observers. RESULTS: A total of 21 eyes from 21 cases with intermediate uveitis were included in the study. FAs of the cases were taken approximately 8.8 (SD 5.4) months (range 6-23 months) after the last activation. In these FAs, no pathological findings were identified in 5 eyes (23.8%); optic disc hyperfluorescence was observed in 14 eyes (66.7%); large vein staining was observed in 2 eyes (9.5%); peripheral venous leakage was observed in 6 eyes (28.6%); and cystoid macular edema was observed in 5 eyes (23.8%). INTERPRETATION: These findings indicate that retinal vascular inflammatory changes persist in cases with intermediate uveitis even if the clinical manifestations have been treated.

Topical ketorolac 0.5% for ocular pain relief during scatter laser photocoagulation with 532 nm green laser.

PURPOSE: The aim of this study was to evaluate the analgesic effect of topical ketorolac tromethamine 0.5% during scatter laser photocoagulation procedure in proliferative diabetic retinopathy patients. METHODS: 60 eyes of 30 consecutive proliferative diabetic retinopathy patients were included to this prospective, randomized, double-masked, controlled study. One (1) h before laser treatment session, ketorolac tromethamine 0.5% was instilled to 1 eye and artificial tear drop to the fellow eye. Just after treatment, the patients were asked for the severity of pain in both eyes. Visual analog scale was used to assess the level of pain. RESULTS: Mean pain level for placebo-instilled eyes was 4.88+/-2.56 and ketorolac instilled eyes were 4.45+/-2.25. There was no significant difference for pain levels between placebo and ketorolac-instilled eyes (P=0.29). CONCLUSIONS: Topical ketorolac tromethamine usage is no more effective than artificial tears for pain relief during posterior segment laser procedures in proliferative diabetic retinopathy patients.

Long-term macular function in eyes with central serous chorioretinopathy.

BACKGROUND: This study aimed to investigate the long-term effects of central serous chorioretinopathy (CSCR) on macular function. METHODS: Sixty-two eyes of 31 patients were included in this study. All patients were diagnosed with unilateral CSCR at the Retina Unit of the Ophthalmology Department, Trakya University Medical Faculty, and had a post-attack bilateral visual acuity of 6/6 and a follow-up period of a minimum of 6 months. Visual function was assessed using the Amsler grid, 40-hue colour discrimination test, visual field examination by means of Octopus automatic perimeter and Cambridge contrast sensitivity tests. RESULTS: Of the 31 patients, 71% were men and 29% were women, with a mean age of 39.3 +/- 7.6 years. The patients had a mean follow-up period of 50.6 +/- 40.5 months after the acute attack. Metamorphopsia was observed in 67.7% of the cases with CSCR. A colour discrimination defect was found in 48.4% of the CSCR eyes and in 54.8% of the fellow eyes. As compared with the fellow eyes, the mean deviation in the central 10 degrees of visual field was significantly higher (t = 2.9, P = 0.007) and the mean contrast sensitivity score was significantly lower (t = -3.2, P = 0.004) in the CSCR eyes. DISCUSSION: Patients with unilateral CSCR were observed to have long-term bilateral colour discrimination defects, and eyes with clinical CSCR were determined to have central relative scotoma and loss of contrast sensitivity.

Corneal endothelial polymegethism and pleomorphism induced by daily-wear rigid gas-permeable contact lenses.

PURPOSE: To determine if there are any corneal endothelial cell size and shape changes (and the time course of these changes) in subjects wearing rigid high gas-permeable (RGP) contact lenses for daily wear. METHODS: Ninety-seven eyes of 57 new wearers were fitted with a fluoroperm contact lens material (Persecon92E, oxygen transmissibility (Dk)= 92 x 10(-11)). Prior to lens wear and after 1 week, 1 month, 3 months, 6 months, and 1 year, noncontact endothelial photographs were taken. Maximum cell size/Minimum cell size (Max/Min) was measured as an index of polymegethism and the relative frequency of 5-, 6-, and 7-sided cells was evaluated. RESULTS: An increase in the ratio of Max/Min was present 1 week after lens fitting and increased further over the subsequent year. This study showed significant increase in endothelial polymegethism and in the relative frequency of 7-sided cells, but a significant decrease in the relative frequency of 6-sided cells. CONCLUSIONS: Daily-wear high Dk gas-permeable contact lenses can cause endothelial polymegethism and pleomorphism similar to those caused by soft and hard contact lenses.