COMPARISON OF CORNEAL WETTING PROPERTIES OF DIFFERENT DISPERSIVE OPHTHALMIC VISCOSURGICAL DEVICES: An Optical Coherence Tomography Study.

PURPOSE: To compare corneal wetting performances of different dispersive ophthalmic viscosurgical devices. METHODS: Three different types of dispersive ophthalmic viscosurgical devices, hydroxypropyl methylcellulose %2 (HPMC), sodium hyaluronate %3-sodium chondroitin sulphate %4 (HACS), and sodium hyaluronate %3 (HA), were applied on corneal surfaces of 10 healthy volunteer subjects repeatedly at 3 different time points. Corneal wetting properties of the ophthalmic viscosurgical devices were compared qualitatively and quantitatively by anterior segment optical coherence tomography for 30 minutes. RESULTS: Sodium hyaluronate 3% and HACS applications had a higher mean precorneal ophthalmic viscosurgical device thickness than HPMC application at all time points (seventh minute HPMC: 105.2 ± 25.3 µm, HA: 561.4 ± 115.8 µm, HACS: 481.2 ± 55 µm, P < 0.001). All HPMC applications were terminated by the 12th minute because of insufficient corneal wetting. Mean survival estimate time was significantly shortest for HPMC (11.5 ± 0.5 minutes, P < 0.001) and longest for HA (29.7 ± 0.28 minutes). It was slightly shorter for HACS (26.9 ± 0.87 minutes, P = 0.007) than the HA application. CONCLUSION: Sodium hyaluronate 3% and HACS provide superior corneal covering compared with HPMC with an effect that can be maintained up to 30 minutes. They may be an effective option for corneal wetting during long vitreoretinal surgeries with longer duration of effect and fever number of applications.

Evaluation of the effect of fluorescein angiography on retinal vessel diameter: an optical coherence tomography study.

PURPOSE: To evaluate the effect of fluorescein angiography on retinal vessel diameter with Optical Coherence Tomography (OCT). METHODS: In this cross-sectional study, a total of 81 eyes of 81 patients who were performed fluorescein angiography (FA) procedure were included. Retinal vessels were examined with the Spectral-domain OCT at baseline and immediately after FA procedure. A cube scan consisting of seven horizontal scans were placed at the inferior border of the disk to include the inferior temporal retinal vessels. Vessels diameters were measured at five measurement points (480-1440 µm inferiorly from the optic disk border). RESULTS: The mean age of the study subjects was 58.02 ± 14.1 years. At baseline, the mean diameter of the retinal artery was 120.16 ± 24.56 µm and of the vein 157.94 ± 32.34 µm at the measurement point of 480 µm, with a gradual decrease to 114.91 ± 25.59 and 152.17 ± 28.17 µm, respectively, at 1440 µm. After FA procedure, the mean diameter of the retinal artery was 122.85 ± 26.35 and of the vein 158.30 ± 32.21 µm at the measurement point of 480 µm, with a gradual decrease to 115.22 ± 22.91 and 151.94 ± 28.93 µm, respectively, at 1440 µm. There were no statistical differences for either of these comparisons at any of the points of both artery and vein measurements. CONCLUSION: There was not any clinically significant change in retinal artery diameter such as a dilatatory response after FA procedure in patients with hypertension, diabetes, and age-related macular degeneration (AMD).

Obstructive sleep apnoea prevalence in non-arteritic anterior ischaemic optic neuropathy.

AIMS: The aim of this study was to show the prevalence of obstructive sleep apnoea (OSA) in non-arteritic anterior ischaemic optic neuropathy (NAION). METHODS: 20 patients diagnosed with NAION were included in the study. 20 age and sex matched subjects with similar risk factors for NAION, such as diabetes mellitus (DM) and hypertension (HT), constituted the control group. All cases underwent polysomnography for investigation of the presence of OSA. Cases with an Apnoea-Hypopnoea Index >5 were accepted as having OSA. RESULTS: Mean ages of the patients and controls were 60.90±8.14 and 61.15±7.23 years, respectively. There were no significant differences between the patient and control groups in terms of age, gender, body mass index, smoking/alcohol consumption or systemic diseases. In the patient group, 85% were diagnosed with OSA compared with 65% in the control group (p>0.05). CONCLUSIONS: We found a high prevalence of OSA in patients with NAION but it was also high in the control group (p>0.05). This may be due to the fact that the two groups were matched for the same risk factors for NAION. The study indicates that OSA is not a risk factor for NAION in itself but is the contributing factor as it has effects on the vascular endothelium in DM, HT and atherosclerosis.

Orbital apex syndrome in herpes zoster ophthalmicus.

Orbital apex syndrome is a rare manifestation of Herpes Zoster Ophthalmicus. Herein we report on a case of orbital apex syndrome secondary to Herpes Zoster Ophthalmicus. A 75 year-old male complained of vision loss, conjunctival hyperemia and proptosis on the left eye, was referred to our clinic. Visual acuity was 5/10 Snellen lines and he had conjunctival hyperemia, chemosis, minimal nuclear cataract and proptosis on the left eye. A diagnosis of orbital pseudotumor was demonstrated firstly. The patient received oral and topical corticosteroids, antiinflammatory and antibiotic agents. On day 2, vesiculopustular lesions were observed, Herpes Zoster Ophthalmicus was diagnosed and corticosteroid treatment stopped, oral acyclovir treatment initiated. Two days later, total ophthalmoplegia, ptosis and significant visual loss were observed on the left. The diagnosis of orbital apex syndrome was considered and the patient commenced on an intravenous acyclovir treatment. After the improvement of acute symptoms, a tapering dose of oral cortisone treatment initiated to accelarate the recovery of ophthalmoplegia. At 5-month follow-up, ptosis and ocular motility showed improvement. VA did not significantly improve because of cataract and choroidal detachment on the left. We conclude that ophthalmoplegia secondary to Herpes Zoster Ophthalmicus responds favourably to intravenous acyclovir and steroids.

The results of electrophysiological tests in unilateral extensive peripapillary myelinated nerve fibers: report of three cases.

The purpose of this study is to describe clinical and electrophysiological findings of three patients with unilateral extensive peripapillary myelinated nerve fibers. Three patients with unilateral extensive peripapillary myelinated nerve fibers were examined. A complete ophthalmologic examination including uncorrected and best spectacle corrected visual acuities (UCVA, BSCVA) on Snellen charts, dilated fundoscopy, fundus fluorescein angiography (FFA), optical coherence tomography (OCT), perimetry and electrophysiological tests was performed. ERG results of both eyes were normal in all cases. FFA showed hypofluorescence at the myelinated nerve fibers (MNF) area in the affected eyes. We found a visual field defect resembling arcuat scotom at perimetry of the affected eyes. In OCT, there was hyper-reflectivity in reply to MNF. In all cases, pattern ERG results of the affected eyes showed decreased amplitudes and increased latencies of P50 and N95 waves. P100 amplitudes of PVER and FVER were decreased, and latencies were increased in all affected eyes. Extensive peripapillary myelinated nerve fibers may cause changes in PERG and VER.

Evaluation of ocular surface damage and dry eye status in chronic hepatitis C at different stages of hepatic fibrosis.

PURPOSE: The purpose of this study was to explore changes in ocular surface and tear function parameters in chronic hepatitis C at different stages of hepatic fibrosis. METHODS: Fifty-four patients with biopsy-proven chronic hepatitis C and 54 age- and sex-matched healthy control subjects without systemic hepatitis C infection were examined with the Ocular Surface Disease Index questionnaire, Schirmer with and without anesthesia, tear film breakup time, and scoring of ocular surface Lissamine green staining using modified Oxford and van Bijsterveld scoring systems and corneal fluorescein staining. RESULTS: Patients with chronic hepatitis C scored significantly worse than the control subjects on all parameters: modified Oxford scores of Lissamine green staining (5.5/3.0; P <0.001), Oxford and van Bijsterveld scores (4.0/2.0; P <0.001), and corneal fluorescein staining (1.5/0.0; P = 0.001). The chronic hepatitis C group also had higher Ocular Surface Disease Index scores than the control subjects (22.3/13.7; P = 0.001). Schirmer with and without anesthesia and tear film breakup time scores were found to be lower in patients with chronic hepatitis C (P <0.001). Moreover, patients with advanced stages of hepatic fibrosis (stages 4-6) had significantly lower values of tear film breakup time and worse Ocular Surface Disease Index scores and ocular surface vital dye staining than those with initial stages of hepatic fibrosis (stages 0-3). CONCLUSION: Patients with chronic hepatitis C, especially those with advanced stages of hepatic fibrosis, were more likely to exhibit severe ocular surface damage and signs of dry eye.

Pattern electroretinographic recordings in eyes with myopia.

PURPOSE: Pattern electroretinography (PERG) is a specific test for the analysis of functions of the central retina. In this study, we investigated the PERG recordings in subjects with myopia. SUBJECTS AND METHODS: This study was performed on 1 eye of 80 subjects with varying degrees of myopia. Four groups were formed according to the refraction values: group 1: between 0.00 and -0.75 diopter (D); group 2: between -1.00 and -3.00 D; group 3: between -3.25 and -6.00 D; and group 4: between -6.25 and -10.00 D. Amplitudes and latencies of transient PERG P50 and N95 waves were recorded in all subjects. RESULTS: P50 and N95 wave amplitudes were lower in higher myopes (groups 3 and 4) when compared with lower myopes (groups 1 and 2; P<0.001). The amount of loss in P50 amplitude was 8% in group 2, 16% in group 3, and 36% in group 4 when compared with group 1. The amount of loss in N95 amplitude was 7% in group 2, 21% in group 3, and 43% in group 4 when compared with group 1. Although P50 wave latencies showed no difference between groups, N95 wave latencies were increased in higher myopes. The elongation in N95 wave latency in group 4 was 3.08 ms. CONCLUSIONS: Increased axial length may contribute to the decrease in PERG amplitudes in our study. PERG recordings must be carefully evaluated when the group in any study that involves myopic subjects.

Pattern electroretinographic results after photodynamic therapy alone and photodynamic therapy in combination with intravitreal bevacizumab for choroidal neovascularization in age-related macular degeneration.

PURPOSE: To evaluate the changes in pattern electroretinography (PERG) 1 month after photodynamic therapy alone and photodynamic therapy in combination with intravitreal bevacizumab for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: This is a prospective series of 45 eyes with subfoveal CNV secondary to AMD. Twenty eyes were treated with photodynamic therapy (PDT) with verteporfin and 1.25 mg of intravitreal bevacizumab, and 25 patients were treated with PDT alone. Visual acuities and serial PERG recordings were performed both before and 1 month after therapy. RESULTS: Following the 1-month therapy period, visual acuity improved in 56% of patients in the PDT group and 76% of patients in the combination group. No significant ocular or systemic adverse effects were observed in either group. According to the PERG results, the mean P50 amplitude was 1.5 +/- 0.9 microV before PDT and improved to 2.1 +/- 1.1 microV at 1 month after PDT. The mean P50 amplitudes in the combination therapy group before and after therapy were 1.6 +/- 0.8 microV and 2.7 +/- 1.2 microV, respectively, and the difference was statistically significant between the groups. CONCLUSIONS: In this small series of eyes with limited follow-up, the combined treatment of PDT with verteporfin and intravitreal bevacizumab seems to be associated with improvement in VA and pattern electroretinographic results when compared to those in the PDT group.

Demographic and clinical features of uveitis in tertiary centers in Turkey.

PURPOSE: To analyze the referral patterns and clinical features of uveitis in tertiary eye care centers in Turkey. METHODS: Uveitis services of eight university clinics collected data on uveitis patients who presented during 2004. Data were collected on a form including a questionnaire on socio-demographic and clinical features which were documented at presentation. RESULTS: A total of 761 patients (1187 eyes) with a mean age of 35.5 years were included in the study. Male to female ratio was 1.04:1. The majority of patients (89.6%) were from an urban population, 53% were referrals and 43% had had uveitis for more than one year. The most common type of uveitis was anterior uveitis (52.5%) followed by panuveitis (28.1%), posterior uveitis (12.7%) and intermediate uveitis (6.7%). In 56.8% of patients an etiological classification was established. The most common etiology was Behcet's disease (32.1%), followed by Fuchs' heterochromic iridocyclitis (5.1%) and ocular toxoplasmosis (4.7%). Among 48 pediatric patients uveitis associated with juvenile idiopathic arthritis and ocular toxoplasmosis both having equal frequencies (12.5%) were the most common diagnosis. These were followed by Behcet's disease with juvenile-onset (10.4%). At the time of presentation, 6.25% of the patients were legally blind (having visual acuity less than 0.1 in the better seeing eye). CONCLUSION: Compared to the uveitis series reported from other countries, Behcet uveitis was the leading cause of uveitis in this series. Uveitis associated with juvenile idiopathic arthritis and ocular toxoplasmosis were the most common cause of uveitis in childhood. On the other hand, entities like acquired immunodeficiency syndrome-related uveitis, presumed ocular histoplasmosis and Birdshot retinochoroidopathy were rare.

Invasive squamous cell carcinoma of the conjunctiva first misdiagnosed as a pterygium: a clinicopathologic case report.

PURPOSE: To describe the clinical findings of a patient who initially underwent surgery for a pterygium and who was finally diagnosed with invasive squamous cell carcinoma, and to determine the necessity and importance of pathologic investigation in all cases of a presumed pterygium. METHODS: A case report. RESULTS: A 63-year-old man was referred for severe pain, redness, and purulent secretion in his right eye. A year earlier, he had undergone excision of a pterygium in his right eye by a bare sclera technique without any adjunctive antimetabolite in a private eye clinic. Furthermore, 6 months after this operation, he had undergone autologous conjunctival graft surgery because of dehiscence of the surgical site. His visual acuity was only light perception in the right eye. Slitlamp biomicroscopy showed severe nasal corneoscleral melting, purulent secretion, conjunctival hyperemia, corneal edema, hypopyon, intracamaral hemorrhage, and lid swelling. Ultrasonography showed a right hypoechoic mass invading the nasal part of the globe and a totally detached retina. Orbital magnetic resonance imaging showed a large (2 cm in diameter), irregular, lobulated mass invading the globe in the medial part of the right orbit. Results of a biopsy were consistent with squamous cell carcinoma. Because of the extensive intraocular involvement at the time of the diagnosis, subtotal orbital exenteration was performed. CONCLUSIONS: All pterygia should be evaluated meticulously with regard to possible underlying causes, such as carcinoma in situ or squamous cell carcinoma, and all excised lesions should also be evaluated pathologically to prevent such serious adverse outcomes that are mentioned in this case report.

Corneal injury from a metallic foreign body: an occupational hazard.

PURPOSE: To describe a patient with a corneal injury from a metallic foreign body caused by negligence, and to highlight the importance of measures that must be taken to prevent corneal injuries. METHODS: A 21-year-old man experienced a foreign body sensation, pain, and redness in his left eye after he cut some iron material without using any eye protection. Slitlamp examination showed a thin, curled piece of iron material stuck into the cornea horizontally. The nasal part had penetrated the nasal tarsal conjunctiva below the upper lid. RESULTS: After removal of the foreign body, the cornea healed without scarring after a short follow-up. CONCLUSIONS: A corneal foreign body is a common cause of ocular morbidity and loss of working hours. Most workers do not use protective eyewear during work. By consistently wearing proper safety eyewear, which is the easiest and most effective preventive measure, loss of sight can easily be prevented after an eye injury.

Multifocal electroretinogram for assessing sun damage following the solar eclipse of 29 March 2006: multifocal electroretinography in solar maculopathy.

AIM: To evaluate the clinical findings and multifocal electroretinography results of cases with solar maculopathy due to eclipse watching. PATIENTS AND METHOD: Eight eyes of six patients (ages ranged 12-42) who presented to our clinic after the solar eclipse of 29 March 2006 were evaluated in the study. All patients underwent a full ophthalmologic examination and multifocal electroretinography (mfERG). RESULTS: Visual acuities at the initial examination were between 20/32 and 20/20; and at final examination between 20/25 and 20/20 respectively. Fundoscopic examination disclosed macular pigmentary changes in almost all patients. Fundus Fluorescein Angiography revealed a window defect in six eyes. The initial findings of the mfERG at the first visit showed a decrease in the P1 and N1 amplitudes of the central responses. The following mfERG recordings showed a recovery in central P1 and N1 amplitudes. CONCLUSION: Decrease in P1 and N1 amplitudes of central macular region can be detected by mfERG in patients with solar maculopathy. Follow-up mfERG test results may recover with the increase of visual acuity.

Figure-of-eight vertical mattress suture technique for anterior flap suspension to overlying tissues in external dacryocystorhinostomy.

PURPOSE: To describe figure-of-eight vertical mattress suture technique in external dacryocystorhinostomy for a combined one-step closure of anterior mucosal flaps and overlying wound tissues and to evaluate its effectiveness on surgical outcome. DESIGN: A prospective, single surgeon, uncontrolled, interventional case series. METHODS: A total of 112 consecutive lacrimal drainage systems of 106 patients (84 women, 22 men; 100 unilateral, six bilateral) from June 2002 to January 2006 with acquired nasolacrimal duct obstruction without canalicular disease underwent external dacryocystorhinostomy with this modified technique. Relief of epiphora and anatomic patency were defined as success. Operative time and success rate were evaluated and advantages were stressed and compared with our previous reports. RESULTS: Mean age was 40.1 years (range, 6 to 75). The etiology was idiopathic in 109 patients and traumatic in three cases. Of 112 lacrimal drainage systems, epiphora was the presenting symptom in 88, combined epiphora and recurrent dacryocystitis in 15, and combined epiphora and mucocele in nine cases. Seven lacrimal drainage systems were revision cases. Mean follow-up was 26.3 months (range, 6 to 48). Success rate was 99.1% (111/112) and mean operative time was 38.2 minutes (range, 28 to 69). CONCLUSIONS: Such a modified suture technique reveals a rapid and simultaneous one-step closure of two different layers that speeds up surgical procedure; simplifies closure process as the knots are tied completely outside the wound, avoiding the disadvantages of suture tying in a small and deep area; eliminates the dead space between anterior flaps and overlying wound tissues; keeps anterior mucosal flap complex away from posterior flaps that prevents collapse back onto the anastomosis and decreases the possibility of mucosal adhesions and, therefore, fibrotic band formation with underlying tissues that may also be useful in cases with small sacs or osseous openings and in revision cases where scarring is a large concern.

Experimental posterior perforating ocular injury in rabbit eyes: effects of radiotherapy with or without intravitreal cyclosporin on vitreous proliferation.

Double perforating ocular injuries were made in 30 rabbits and the effects of radiotherapy (RT) alone or in combination with cyclosporin (CS) on vitreous proliferation investigated. Thirteen rabbits in group 1 received RT alone (600 cGy), and 13 rabbits in group 2 received RT combined with 100 microg of intravitreal CS. No treatment was given to 4 rabbits in the control group (group 3). All animals were ophthalmologically examined on the 1st, 3rd, 7th, 14th and 28th days following the injury and the clinical findings scored; they were sacrificed on the 28th day, and histopathological scoring was made. The median histopathological score of the RT group (4.0; range: 0-8) was significantly higher than that of the CS + RT group (1.0; range: 0-5; p = 0.018). We conclude that intravitreal CS may be used as an adjunctive agent to RT to inhibit intraocular proliferation following penetrating ocular injury in rabbits.

Serum paraoxonase 1 activity and lipid peroxidation levels in patients with age-related macular degeneration.

Our objective was to investigate antioxidant paraoxonase 1 (PON1) activity together with malondialdehyde (MDA) levels to evaluate oxidative stress in patients with age-related macular degeneration (AMD), an important cause of blindness in the elderly population. Serum PON1 activity and MDA levels were analyzed in 37 patients with AMD and compared with 29 healthy controls using a spectrophotometric method. Serum MDA levels were significantly higher in the patient group (2.76 +/- 1.28 nmol/ml) than controls (1.00 +/- 0.36 nmol/ml; p < 0.001), whereas PON1 activity was lower in the patient group (132.27 +/- 63.39 U/l) than controls (312.13 +/- 136.23 U/l; p < 0.001). There was a negative correlation between MDA and PON1 levels (r = -0.470, p < 0.001). We conclude that the observed increase in MDA levels may be related to decreased PON1 activity; the present data also demonstrated that an obvious negative correlation between PON1 activity and MDA levels exists in patients with AMD. PON1 is also an antioxidant agent, therefore effective antioxidant therapy to inhibit lipid peroxidation is necessary and agents to increase PON1 activity may be a therapeutic option in AMD.

Electrooculography after photodynamic therapy.

PURPOSE: To evaluate the changes in electrooculography (EOG) after photodynamic therapy (PDT). METHODS: Thirty-eight eyes of 38 patients (21 males, 17 females) with choroidal neovascularization secondary to age related macular degeneration were included in this study. Standart PDT with verteporfin was performed on each patient. Serial EOG recordings were performed before, 1 week, and 1 month after PDT. RESULTS: Mean age of the patients was 69.8+/-9.7 years (range 56 and 90 years). Seven days after PDT the visual acuity improved in 17 eyes, remained unchanged in 16 eyes and deteriorated in 5 eyes. One month after PDT the visual acuity findings were the same as the first week. New hemorrhages were seen in three eyes in the first week after PDT and visual acuity was decreased in those patients. No other patient complained of ocular and systemic adverse events. There was a statistically significant reduction in the Arden ratio of the EOG 1 week after PDT and the reduction persisted in the first month recordings. CONCLUSIONS: The reduction in Arden ratio of EOG findings may indicate that retina pigment epithelium function could be affected after PDT.

The changes of pattern electroretinography at the early stage of photodynamic therapy.

PURPOSE: To evaluate the short-term changes in pattern electroretinography (PERG) after photodynamic therapy (PDT). METHODS: Thirty eyes of 30 patients (17 males, 13 females) with choroidal neovascularization secondary to age related macular degeneration were included in this study. Standard PDT with verteporfin was performed on each patient. Serial PERG recordings were performed before, 1 week, and 1 month after PDT. RESULTS: Mean age of the patients was 69.6+/-8.4 years (range 56 and 90 years). One month after PDT, the visual acuity improved in 16 eyes, remained unchanged in 12 eyes and deteriorated in two eyes. New hemorrhages were seen in two eyes in the first week after PDT and visual acuity was decreased in those patients. No other patient complained of ocular and systemic adverse events. There was a statistically significant reduction in the amplitudes of P50 and N95 waves at the first week recordings after PDT. At 1 month after PDT, no significant differences in the P50 and N95 amplitudes were observed compared with pre-PDT PERG recordings. There were no significant changes in the latencies of P50 and N95 at the first week and first month recordings when compared with pre-treatment PERG values. CONCLUSIONS: Reduction in P50 and N95 amplitudes suggests that transient impairments in macular function occur at the first week after PDT.