Structural Analysis of the Retina and Choroid before and after Carotid Artery Surgery.

Purpose: To evaluate retinal and choroidal changes in patients with internal carotid artery stenosis who had undergone carotid artery stenting or endarterectomy.Methods: The study included 43 patients with internal carotid artery (ICA) stenosis that required stenting or endarterectomy and 40 healthy controls. Patients were divided into two groups according to the degree of stenosis evaluated by magnetic resonance angiography. Group 1 consisted of patients having ICA stenosis of 50 to 70%, and Group 2 has more than 70%. Enhanced depth imaging optical coherence tomography (EDI-OCT) was used to measure the retinal thickness (RT) and choroidal thickness (CT) in all subjects before surgery and at 1, 3, and 6 months after surgery.Results: Subfoveal and parafoveal CT were significantly lower in patients with ICA stenosis than the control group (p < .05, respectively). Patients with 50-70% stenosis had a significant increase in the CT at 1, 3, and 6 months after ICA stenting or endarterectomy (p < .05). Patients with >%70 stenosis did not have a significant increase in the CT at any time after ICA stenting or endarterectomy. Retinal thickness was not statistically different between the patients with ICA stenosis and the control subjects, and RT showed no significant change in patients with ICA stenosis before and after the surgery.Conclusion: Choroidal thickness was significantly thinner in patients with internal carotid artery stenosis. ICA stenting provided a recovery in the choroidal thickness in patients with moderate to advanced stenosis.

Retinal and choroidal thickness changes after single anti-VEGF injection in neovascular age-related macular degeneration: ranibizumab vs bevacizumab.

PURPOSE: To evaluate and compare the effects of single intravitreal injection of ranibizumab and bevacizumab on central retinal and choroidal thickness in patients with neovascular age-related macular degeneration (AMD). METHODS: Forty eyes of 40 patients with neovascular AMD that underwent intravitreal injection of vascular endothelial growth factor inhibitors (anti-VEGFs) were included. Patients were randomized into 2 groups: 20 eyes received ranibizumab and 20 eyes received bevacizumab injection. Central retinal and choroidal thicknesses of all eyes at baseline and 1 month postinjection scans were measured with Fourier-domain optical coherence tomography (OCT). Student t test and Mann-Whitney U test were used to compare the data. RESULTS: The mean central retinal thickness (CRT) showed significant decrease after single injection of ranibizumab (from 345.0 µm to 253.5 µm, p<0.01) and bevacizumab (from 329.5 µm to 251.0 µm, p<0.01) at the first month, respectively. There was no significant difference regarding the CRT change between groups (p = 0.39). The mean choroidal thickness decreased from 158.6 µm (115-317) to 155.5 µm (111-322) in the ranibizumab group and from 211.5 µm (143-284) to 201.5 µm (93-338) in bevacizumab group. The decrease was not significant between groups (p = 0.35). CONCLUSIONS: Intravitreal injection of both ranibizumab and bevacizumab provided a significant decrease in CRT; however, the agents caused no significant change in choroidal thickness. Additionally, no difference between ranibizumab versus bevacizumab was observed related to macular edema inhibition.

Clear lens phacoemulsification in Alport syndrome: refractive results and electron microscopic analysis of the anterior lens capsule.

PURPOSE: To report the ocular findings of patients with Alport syndrome and the results of clear lens extraction in this patient group. METHODS: Twenty-three eyes of 15 patients with a diagnosis of Alport syndrome were included in this study. Clear corneal phacoemulsification and intraocular foldable lens implantation was performed in eyes with indeterminate refractive errors and/or poor visual acuity and anterior capsule samples were analyzed with electron microscopy. RESULTS: All patients had a history of hereditary nephritis and/or deafness as systemic involvement. Ophthalmologic examination revealed anterior lenticonus with high myopia and/or irregular astigmatism in all patients. The mean best-corrected visual acuity (BCVA) was 0.67 ± 0.17 logMAR (range 1.0-0.4) preoperatively and 0.17 ± 0.08 logMAR (range 0.3-0.0) postoperatively. Postoperative refractive lenticular astigmatism dramatically decreased and no ocular complications arose during the follow-up period. Transmission electron microscopic analysis of the lens capsules supported the diagnosis of Alport syndrome. CONCLUSIONS: Clear lens phacoemulsification and foldable intraocular lens implantation is a safe and effective therapeutic choice for the management of uncorrectable refractive errors and low visual acuity due to anterior lenticonus in patients with Alport syndrome.

The effect of smoking on choroidal thickness measured by optical coherence tomography.

BACKGROUND/AIMS: To investigate the effect of smoking on choroidal thickness using Fourier domain optical coherence tomography. METHODS: 17 otherwise healthy smokers (study group) and 17 non-smokers (control group) were enrolled. In the study group, all participants underwent optical coherence tomography scanning at baseline, and 1 and 3 h following smoking one standard cigarette. Also the participants of the control group underwent optical coherence tomography scanning in the morning which was followed by two further examinations at the first and third hours, respectively. Choroidal thickness measurements were performed. RESULTS: The mean choroidal thickness at the fovea prior to smoking was 301.1±63.1 µm, which decreased to 284.2±56.7 µm at 1 h and 270.8±80.0 µm at 3 h following smoking (p=0.001). The mean choroidal thickness was significantly decreased following smoking at all five extrafoveal points. The difference in choroidal thickness was not statistically significant at 1 and 3 h of smoking at all six points. In the control group, the mean baseline choroidal thickness at the fovea was 270.6±57.9 µm, which was 272.5±52.4 µm at 1 h and 273.8±57.4 µm at 3 h (p=0.816). CONCLUSIONS: Cigarette smoking causes a significant decrease in choroidal thickness following smoking. Fourier domain optical coherence tomography can effectively demonstrate choroidal thickness.

Analysis of iris structure and iridocorneal angle parameters with anterior segment optical coherence tomography in Fuchs' uveitis syndrome.

To evaluate the differences in the biometric parameters of iridocorneal angle and iris structure measured by anterior segment optical coherence tomography (AS-OCT) in Fuchs' uveitis syndrome (FUS). Seventy-six eyes of 38 consecutive patients with the diagnosis of unilateral FUS were recruited into this prospective, cross-sectional and comparative study. After a complete ocular examination, anterior segment biometric parameters were measured by Visante(®) AS-OCT. All parameters were compared between the two eyes of each patient statistically. The mean age of the 38 subjects was 32.5 ± 7.5 years (18 female and 20 male). The mean visual acuity was lower in eyes with FUS (0.55 ± 0.31) than in healthy eyes (0.93 ± 0.17). The central corneal thickness did not differ significantly between eyes. All iridocorneal angle parameters (angle-opening distance 500 and 750, scleral spur angle, trabecular-iris space (TISA) 500 and 750) except TISA 500 in temporal quadrant were significantly larger in eyes with FUS than in healthy eyes. Anterior chamber depth was deeper in the eyes with FUS than in the unaffected eyes. With regard to iris measurements, iris thickness in the thickest part, iris bowing and iris shape were all statistically different between the affected eye and the healthy eye in individual patients with FUS. However, no statistically significant differences were evident in iris thickness 500 µm, thickness in the middle and iris length. There were significant difference in iris shape between the two eyes of patients with glaucoma. AS-OCT as an imaging method provides us with many informative resultsin the analysis of anterior segment parameters in FUS.

The results of pars plana vitrectomy and silicone oil tamponade for endophthalmitis after intravitreal injections.

To report the role of early vitrectomy and silicone oil tamponade in acute endophthalmitis following intravitreal injection. Medical records of eight patients who presented with acute endophthalmitis after intravitreal injection of different drugs were retrospectively reviewed. Initial treatment consisted of vitreous tap with cultures and injection of intravitreal antibiotics, with the patients subsequently undergoing pars plana vitrectomy and silicone oil tamponade within 24 h following initial vitreous tap. The mean time to presentation was 1.7 days (1-3 days). The initial best-corrected visual acuity was hand motion to 0.05 before treatment and 0.05-0.8 (Snellen) after treatment. Vitreous cultures were obtained from all patients, of which four were culture positive. Endophthalmitis was controlled in all patients. There was no retinal detachment or phthisis bulbi during the follow-up period (1-4 years). Acute endophthalmitis following intravitreal injection occurs rapidly and requires urgent treatment. If intravitreal antibiotics fail to control inflammation, early pars plana vitrectomy and silicone oil tamponade would be an appropriate option.

The inner diameter of the optic disc pit decreases with pars plana vitrectomy.

To report a patient with optic disc pit who showed decreased inner diameter of the optic disc pit along with resolution of recurrent macular detachment after pars plana vitrectomy. Pneumatic retinopexy and peripapillary laser photocoagulation was performed in a 28-year-old female with optic disc pit and serous macular detachment. Two months after the initial therapy, serous macular detachment recurred. Then, pars plana vitrectomy with removal of the posterior hyaloid was performed, and intraocular perfluoro-octane (C3F8) tamponade was used. Fundus photography and ocular coherence tomography were obtained at each visit. The patient was followed up for 1 year. Visual acuity was 20/400 (Snellen) at first presentation, improved to 20/40 at 2 weeks after pneumatic retinopexy and peripapillary laser treatment. Then, 2 months later visual acuity decreased to 20/200, improved to 20/40 at 2 weeks after the vitreoretinal surgery, and stayed stable during the 1-year follow-up. It was also noticed on clinical examinations as well as fundus photographs that the inner diameter of the optic disc pit had decreased significantly. Vitreous traction plays an important role in the formation of serous macular detachments with optic disc pits. In these patients, pars plana vitrectomy and posterior hyaloid removal may be an effective treatment for reduction of the inner diameter of the optic pit and resolution of the serous macular detachments.

Anterior segment complications after phacovitrectomy in diabetic and nondiabetic patients.

PURPOSE: To evaluate early and late postoperative anterior segment complications of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with cataract and coexisting vitreoretinal disease in diabetic and nondiabetic patients. SETTING: Department of Ophthalmology, Baskent University Hospital, Ankara, Turkey. METHODS: The records of 189 consecutive patients with cataract and posterior segment pathology necessitating phacovitrectomy were retrospectively analyzed. Patient profile, indications for surgery, preoperative findings, intraoperative and postoperative course, and postoperative outcome were evaluated. Phacoemulsification was performed through a clear corneal incision with IOL implantation prior to 23-G pars plana vitrectomy. RESULTS: There were 97 (51.3%) diabetic and 92 (48.6%) nondiabetic patients. The most common indications for surgery were vitreous hemorrhage (57; 58.7%), tractional detachment (35; 36%), and premacular hemorrhage (5; 5.1%) in diabetic patients, and rhegmatogenous retinal detachment (40; 43.4%), macular hole (22; 23.9%), epiretinal membrane (20; 21.7%), and vitreomacular traction (10; 10.8%) in nondiabetic patients. Early (within 4 weeks) postoperative complications included elevation of intraocular pressure, fibrinous uveitis, corneal edema, and development of posterior synechia. Long-term (after 4 weeks) complications included migration of silicone oil into the anterior chamber, posterior capsule opacification, and decentered IOL. The ratio of fibrinous uveitis, posterior synechia, and posterior capsule opacification was found higher in the diabetic group (all p<0.05). CONCLUSIONS: Combined vitreoretinal surgery and phacoemulsification is safe and effective in treating vitreoretinal abnormalities coexisting with cataract in diabetic and nondiabetic patients. Diabetic patients should be monitored more carefully for fibrinous uveitis and posterior synechia in the early postoperative period and for posterior capsular opacification in the late postoperative period.

Adhesion of heavy silicone oil to the anterior surfaces of the posterior lens capsule.

PURPOSE: To report a case of heavy silicone oil adhesion to the anterior surfaces of posterior lens capsule.
 METHODS: Descriptive case report.
 RESULTS: A healthy 56-year-old pseudophakic man presented with visual disturbance in his right eye for a week. There was a large irregular retinal tear at 5-7 o'clock, mild vitreous hemorrhage, and total retinal detachment. He underwent 23-G pars plana vitrectomy and heavy silicone oil tamponade was injected. The retina remained attached postoperatively and heavy silicone oil was removed 2 months later. Anatomic and functional success was achieved and his vision had improved. Five months later, he presented with blurred and decreased vision secondary to tiny droplets of heavy silicone oil at the anterior surfaces of the posterior capsule. After applying Nd:YAG laser capsulotomy, visual acuity improved and stayed stable during 1 year follow-up. 
 CONCLUSIONS: Heavy silicone oil adhesion to the anterior surfaces of the posterior lens capsule has not been reported before. This complication may be seen rarely and treated by Nd:YAG laser capsulotomy successfully.

Late capsular block syndrome presenting with posterior capsule opacification.

PURPOSE: To assess the results of posterior neodymium:YAG (Nd:YAG) laser capsulotomy in patients with late postoperative capsular block syndrome (CBS) with decreased vision because of posterior capsule opacification (PCO). SETTING: Baskent University Hospital, Department of Ophthalmology, Ankara, Turkey. DESIGN: Case-control study. METHODS: Patients with CBS who had phacoemulsification and foldable hydrophilic or hydrophobic acrylic intraocular lens implantation with continuous curvilinear capsulorhexis were retrospectively reviewed. Transparent to slight milky fluid had collected in the capsular bag. Capsular block syndrome was undiagnosed before the PCO developed. The CBS was treated with Nd:YAG laser capsulotomy, after which the change in refraction, corrected distance visual acuity (CDVA), intraocular pressure (IOP), complications, and inflammation rate were evaluated. Follow-up examinations were at 1 day, 1 week, and 1 and 6 months. RESULTS: The mean time between cataract surgery and laser capsulotomy was 48 months ± 10.27 (SD) (range 28 to 66 months). The Nd:YAG capsulotomy was successful in all eyes. Capsulotomy did not change the refraction in 14 eyes (93.3%). One patient (6.6%) had a change of +0.75 diopter. After capsulotomy, the logMAR CDVA improved in 13 cases (mean 0.26 ± 0.18; range 0.0 to 0.7) and did not change in 2 cases. There were no complications, inflammation, or significant IOP changes. CONCLUSIONS: Neodymium:YAG laser capsulotomy in patients with PCO associated with late CBS increased visual acuity without a significant change in refraction or IOP. Capsular block syndrome may be asymptomatic and remain undiagnosed for a long time after cataract surgery before PCO develops.

Intravitreal bevacizumab followed by laser photocoagulation for retinal capillary hemanginoblastomas.

PURPOSE: To report a patient with retinal capillary hemangioblastomas associated with Von Hippel-Lindau syndrome who achieved long-term visual improvement with single intravitreal bevacizumab injection followed by laser photocoagulation. METHODS: Intravitreal bevacizumab injection was performed in a 17-year-old girl with bilateral multiple retinal capillary hemangioblastomas. Laser photocoagulation was then performed to augment the initial response to bevacizumab. The visual acuity, fundus photography, fundus fluorescein angiography, and ocular coherence tomography were obtained at each visit. The patient was followed-up for 3 years. RESULTS: Two weeks after injection, the macular edema and exudation significantly decreased with an improvement in the visual acuity. Laser photocoagulation performed 2 weeks after the intravitreal bevacizumab injection provided further regression of exudation and scarring of the hemangioblastomas. No further intervention was required, and the visual acuity returned to baseline at the third year of follow-up. CONCLUSION: Combined intravitreal bevacizumab with laser photocoagulation is a viable option in retinal capillary hemangioblastomas associated with Von Hippel-Lindau syndrome.

An outbreak of Fusarium solani endophthalmitis after cataract surgery in an eye training and research hospital in Istanbul.

To report an outbreak of Fusarium solani endophthalmitis after uneventful cataract surgeries performed on the same day in the same operating room. Nine patients underwent phacoemulsification at 4th Clinic of Beyoglu Eye Training and Research Hospital in Istanbul. Cefuroxime axetyl was injected intracamerally from the same vial to all patients at the end of surgery. All patients developed acute postoperative endophthalmitis. Presentation, cultural studies, treatment, clinical responses and risk factors were evaluated. Cultural and DNA sequence findings revealed F. solani. Antifungal therapy was begun and pars plana vitrectomy, intraocular lens and capsule extraction were performed. Corneal involvement was correlated with old age and systemic disease. Fusarium solani should be considered in acute postoperative endophthalmitis. This infection can be controlled with early and aggressive combined antifungal and surgical treatment. The patients with corneal involvement had poor prognosis. It is important to use solutions prepared separately for each patient.