The role of meibomian gland dysfunction on the development of dry eye disease in patients with facial nerve palsy.

PURPOSE: To investigate whether meibomian gland dysfunction is the cause of dry eye in facial nerve palsy and to identify the possible relationship between the grades and durations of facial nerve palsy and meibomian gland dysfunction. METHODS: This prospective observational study included 63 patients with unilateral facial nerve palsy. Facial nerve function and severity were assessed using the House-Brackmann grading system. Unaffected contralateral eyes were used as the control group. The following parameters were compared: tear breakup time, Schirmer 1 test score, area and density scores for corneal fluorescein staining, eyelid abnormality, meibomian gland expression, meibography scores, and areas of meibomian gland loss. A Pearson correlation analysis was performed between the grades and durations of facial nerve palsy and meibomian gland dysfunction. RESULTS: The eyes affected by facial nerve palsy demonstrated significantly lower tear breakup time (p<0.001) and significantly higher values for corneal fluorescein staining (p<0.001), Schirmer 1 test score (p=0.042), lid abnormality score (p<0.05), meibomian gland expression level (p=0.005), meibography scores (p<0.05), and areas of meibomian gland loss (p<0.05). The grade and duration of facial nerve palsy significantly correlated with meibomian gland dysfunction (p<0.05). CONCLUSIONS: Meibomian gland dysfunction has a significant contribution to the development of dry eye disease after facial nerve palsy. Furthermore, a strong correlation was observed between the grades and durations of facial nerve palsy and meibomian gland dysfunction.

Ocular Surface Changes in Hashimoto's Thyroiditis Without Thyroid Ophthalmopathy.

OBJECTIVE: We sought to evaluate ocular surface changes in patients with Hashimoto's thyroiditis without thyroid ophthalmopathy and elucidate the relationship between dry eye syndrome and meibomian gland dysfunction (MGD) in cases of Hashimoto's thyroiditis. METHODS: This prospective study included 105 patients with Hashimoto's thyroiditis and 105 age- and sex-matched controls. The 12-item Ocular Surface Disease Index (OSDI) questionnaire was administered to all patients. Both eyes affected by Hashimoto's thyroiditis and normal eyes were evaluated and compared with regard to the following parameters: Hertel exophthalmometry, palpebral fissure height, tear-film breakup time (TBUT), Schirmer 1 test, area and density scores for corneal fluorescein staining, eyelid abnormality, meibomian gland expression, meibography scores, and areas of meibomian gland loss. RESULTS: The eyes affected by Hashimoto's thyroiditis demonstrated significantly lower TBUTs (P<0.001), Schirmer 1 test scores (P<0.001), and meibomian gland expression (P<0.05) and significantly higher OSDI scores (P<0.001), corneal fluorescein staining results (P<0.05), eyelid abnormality scores (P<0.05), meibography scores (P<0.05), and areas of meibomian gland loss (P<0.05). Ocular Surface Disease Index scores were significantly positively correlated with eyelid abnormality scores (P=0.025), meibography scores (P<0.05), and areas of meibomian gland loss (P<0.05) and negatively correlated with meibomian gland expression (P<0.05). The duration of Hashimoto's thyroiditis was significantly positively correlated with MGD (P<0.05). CONCLUSION: Dry eye syndrome and ocular discomfort symptoms are significantly more common among patients with Hashimoto's thyroiditis, even in the absence of thyroid ophthalmopathy. Dry eye syndrome in patients with Hashimoto's thyroiditis is believed to result from MGD and is correlated with the duration of the thyroid disease.

Impact of the type of anterior lamellar reconstruction on the success of modified Hughes procedure / Impacto do tipo de reconstrução lamelar anterior no sucesso do procedimento de Hughes modificado

ABSTRACT Purpose: To determine the long-term functional and cosmetic outcomes in patients who underwent modified Hughes procedure with different types of anterior lamellar reconstruction for lower eyelid defects. Methods: This study included 58 patients who had undergone a modified Hughes flap for reconstruction of lower eyelids after tumor excision within a 10-year period. Data regarding patient demographics, size of eyelid defect, tumor pathology, surgical techniques, functional and cosmetic outcomes, and complications were recorded. Postoperative complications were evaluated according to the type of anterior lamella reconstruction (i.e., advancement flap or free skin graft). Multivariate logistic regression analysis was performed to identify risk factors affecting the success of the procedure. Results: The average size of the lower eyelid defect was 22 ± 6.3 mm (range: 11-30 mm). The anterior lamella was reconstructed with advancement flaps and full-thickness skin grafts in 36 (58.6%) and 24 (41.4%) patients, respectively. Mean follow-up time was 23.6 ± 11.9 months. Postoperative complications included trichiasis (three patients; 5.2%), ectropion (two patients; 3.0%), flap necrosis (one patient; 1.7%), flap dehiscence (one patient; 1.7%), infection (one patient; 1.7%), and eyelid margin erythema (one patient; 1.7%). The rates of complication and secondary surgery were similar among the different types of anterior lamellar reconstruction (p=768 and p=0.139, respectively). Success of the modified Hughes procedure was not significantly affected by any of the identified risk factors (p>0.05). Functional and cosmetic outcomes were 96.6% and 94.8%, respectively. Conclusion: Modified Hughes procedure is a safe and effective option for the reconstruction of small and large defects of the lower eyelid, regardless of the type of anterior lamella reconstruction (i.e., advancement flap or skin graft).

RESUMO Objetivo: Determinar os resultados funcionais e cosméticos a longo prazo de pacientes submetidos ao procedimento de Hughes modificado com diferentes tipos de reconstrução lamelar anterior para defeitos palpebrais inferiores. Métodos: Este estudo incluiu 58 pacientes que foram submetidos a um retalho de Hughes modificado para reconstrução das pálpebras inferiores após excisão do tumor durante um intervalo de 10 anos. Dados referentes à demografia dos pacientes, tamanho do defeito palpebral, patologia tumoral, técnicas cirúrgicas, resultados funcionais e cosméticos e complicações foram registrados. As complicações pós-operatórias foram avaliadas de acordo com o tipo de reconstrução da lamela anterior (ou seja, retalho de avanço ou enxerto de pele livre). A análise de regressão logística multivariada foi realizada para identificar os fatores de risco que afetam o sucesso do procedimento. Resultados: O tamanho médio do defeito da pálpebra inferior foi de 22 ± 6,3 mm (11-30 mm). A lamela anterior foi reconstruída com retalhos de avanço e enxertos de pele de espessura total em 36 (58,6%) e 24 (41,4%) pacientes, respectivamente. O tempo médio de acompanhamento foi de 23,6 ± 11,9 meses. Complicações pós-operatórias incluíram triquíase (três pacientes: 5,2%), ectrópio (dois pacientes: 3%), necrose de retalho (um paciente: 1,7%), deiscência de retalho (um paciente: 1,7%), infecção (um paciente: 1,7%) e eritema na margem palpebral (um paciente: 1,7%). As taxas de complicação e de cirurgia secundária foram semelhantes entre os diferentes tipos de reconstrução lamelar anterior (p=768 e p=0,139, respetivamente). O sucesso do procedimento de Hughes modificado não foi significativamente afetado por nenhum dos fatores de risco identificados (p>0,05). Resultados funcionais e cosméticos foram de 96,6% e 94,8%, respetivamente. Conclusão: O procedimento de Hughes modificado é uma opção segura e eficaz para a reconstrução de pequenos e grandes defeitos da pálpebra inferior, independentemente do tipo de reconstrução da lamela anterior (ou seja, retalho de avanço ou enxerto de pele).

The Effect of Uneventful Phacoemulsification on Intraocular Pressure and Anterior Segment Parameters in Pseudoexfoliation Syndrome.

OBJECTIVES: The aim of this study was to evaluate the effects of cataract surgery on anterior segment parameters and intraocular pressure (IOP) in non-glaucomatous pseudoexfoliation syndrome (PXS) eyes. METHODS: The cohort consisted of 65 patients who were to undergo cataract surgery; the participants were divided into 2 groups: patients with PXS (n=35) and controls without PXS (n=30). A complete ophthalmic examination, measurement of IOP (using an applanation tonometer), and evaluation of anterior segment parameters using a Sirius Scheimpflug/Placido topography device (CSO Italy, Firenze, Italy) were performed on all patients both prior to and 1 month after surgery. RESULTS: No significant difference was observed between groups in terms of preoperative IOP, pupil diameter, central corneal thickness, anterior chamber depth (ACD), anterior chamber volume (ACV), iridocorneal angle (ICA), or corneal volume (CV) values. A reduction in the postoperative mean IOP value was noted in both groups, with a difference of slightly >2 mmHg in the PXS group (PXS: p=0.000, control: p=0.002). Postoperatively, a statistically significant increase was observed in both groups in the ACD, ICA, ACV, and CV measurements. When comparing the preoperative and postoperative differences of the groups, the only parameter noted to be statistically significantly different was postoperative widening of the ICA. A greater degree of widening was noted in the PXS group (13.83±6.06°) compared with the control group (10.47±6.69°) (p=0.039). CONCLUSION: IOP values decreased and ACD values increased significantly following phacoemulsification in the PXS and the normal eyes. These findings support results reported in the literature. However, the results related to ICA changes are a new, previously unreported contribution. To more fully comprehend the effects of cataract surgery on patients with PXS in terms of ICA changes, prospective studies with a larger cohort are needed.

Meibomian Gland Dysfunction and Its Association With Ocular Discomfort in Patients With Ocular Prosthesis.

OBJECTIVE: To investigate the effects of ocular prosthesis on meibomian glands and also to identify the role of meibomian gland dysfunction (MGD) on ocular discomfort in prosthetic eyes. METHODS: This prospective study included 55 patients who had been wearing unilateral ocular prosthesis for more than 1 year. A 15-item questionnaire regarding MGD-related ocular symptoms was administered to all patients. Both prosthetic eyes and paired normal eyes were evaluated with slit-lamp, noncontact meibography and spectral optical coherence tomography. A multiple linear regression model was applied to evaluate factors on ocular symptom scores. RESULTS: The ocular symptom scores, meibography scores, meibomian gland loss, and lid margin abnormality scores of prosthetic eyes were significantly higher than those of normal eyes (P<0.05). Tear meniscus measurements of eyes with prosthesis were significantly lower from those of normal eyes (P<0.05). The ocular symptom scores were significantly positively correlated with meibography scores, meibomin gland loss, and lid margin abnormality scores and negatively correlated with tear meniscus measurements (P<0.05). There was a significant negative correlation between total meibography scores and all tear meniscus parameters (P<0.05). The patients who had used ocular prosthesis for longer durations had a significantly greater meibography scores, meibomin gland loss, lid margin abnormality scores, and ocular symptom scores but lesser tear meniscus parameters (P<0.05). CONCLUSION: Use of ocular prosthesis is significantly associated with MGD, which is proportional to the duration of prosthesis wear. Furthermore, ocular discomfort symptoms of prosthetic eye wearers significantly correlated with MGD-related dry eye.

Assessment of tear meniscus by optical coherence tomography in patients with canalicular laceration repair.

PURPOSE: To analyze tear meniscus measurements with optical coherence tomography (OCT) in patients with canalicular laceration repair. METHODS: Thirty-four consecutive patients who underwent unilateral canalicular repair due to canalicular laceration between January 2014 and December 2018 were included. All patients had canalicular repair followed by monocanalicular or annular silicone tube intubation. Anatomic patency of canalicular system was tested with probing and irrigation, while functional patency was evaluated with Munk score. Tear meniscus measurements of all patients were obtained following tube removal by spectral OCT. Tear meniscus height (TMH), tear meniscus depth (TMD) and tear meniscus area (TMA) of eyes with canalicular laceration repair and contralateral uninvolved eyes were compared. RESULTS: Average age of 34 patients was 32.8 ± 21.3 years (range 4-68 years). Lower canaliculus was involved in 27 (79.4%), upper canaliculus in five (14.7%), and both canaliculi in two (5.9%) patients. Mean follow-up period was 6.5 ± 5.7 months. Anatomic patency rate was 100%, and functional patency (patients free of epiphora) was 91.2%. Average TMH (317.9 ± 133.1 µm), TMD (198.1 ± 82.5 µm) and TMA (29,792.1 ± 21,285.3 µm2) values of eyes with canalicular repair were not significantly different from TMH (308.9 ± 111.9 µm), TMD (184.5 ± 61.4 µm) and TMA (26,682.5 ± 16,178.1 µm2) values of contralateral control eyes (p values: 0.758, 0.225 and 0.778, respectively). There was a strong positive correlation between TMA and Munk score (r = 0.637, p < 0.001) and moderate positive correlation between TMH (r = 521, p = 0.002), TMD (r = 0.481, p = 0.004) and Munk score. CONCLUSION: Tear meniscus measurement with OCT is a rapid, quantitative and objective tool for evaluation of canalicular patency in patients with canalicular laceration repair.

Prospective analysis of visual function changes in patients with dermatochalasis after upper eyelid blepharoplasty.

OBJECTIVE: To evaluate the changes of visual acuity, contrast sensitivity, astigmatism, and higher order aberrations after blepharoplasty in patients with dermatochalasis. METHODS: Two hundred six eyelids of 103 patients with dermatochalasis were prospectively studied. Visual acuity, contrast sensitivity, corneal topography, astigmatism degree, and higher order aberrations were examined and recorded before and at 1 month after upper eyelid blepharoplasty. Change in contrast sensitivity and astigmatism values were determined according to margin reflex distance of patients, which were classified into three following groups: <2 mm, 2-3 mm, and ⩾ 4 mm. A Wilcoxon signed rank test was performed to compare the difference. RESULTS: No significant differences were observed for visual acuity (p = 0.157). The contrast sensitivity of patients significantly increased at all spatial frequencies both under glare and nonglare conditions (p < 0.05). The mean refractive astigmatism significantly decreased from ‒1.01 ± 1.3 to ‒0.79 ± 0.71, postoperatively (p = 0.029). In patients with marginal reflex distance < 2 mm, mean contrast sensitivity was increased (p < 0.001) and mean astigmatism was decreased significantly (p < 0.001) compared with those with ⩾ 2 mm. Higher order aberrations decreased significantly from 0.62 ± 0.41 µm to 0.55 ± 0.38 µm (p = 0.038) after blepharoplasty. Root mean square of the vertical trefoil (p = 0.038), vertical coma (p = 0.002), horizontal trefoil (p = 0.027), third-order aberration (p = 0.005), secondary vertical stigmatism (p = 0.001), spherical aberration (p = 0.023), secondary horizontal astigmatism (p = 0.002), fourth-order aberration (p = 0.024), vertical pentafoil (p = 0.015), secondary horizontal coma (p = 0.035), secondary horizontal trefoil (p = 0.030), and horizontal pentafoil (p = 0.048) were decreased significantly. CONCLUSION: Upper eyelid blepharoplasty in patients with dermatochalasis has a significant improvement in visual function in terms of contrast sensitivity, astigmatism, and higher order aberrations.

Failure in Revision Dacryocystorhinostomy: A Study of Surgical Technique and Etiology.

The aim of this study is to assess the etiologic factors of primary dacryocystorhinostomy (DCR) failure according to DCR techniques and also to determine risk factors for the prediction of failure in revision external DCR. Retrospective review was performed in patients who underwent revision external DCR for previous DCR failure between 2008 and 2018. All patients underwent full ophthalmic and intranasal examination, lacrimal probing, and irrigation. Patients were classified into following groups according to previous DCR type: external, endoscopic endonasal, and transcanalicular laser DCR. Potential etiologic factors were compared between 3 groups. Multivariate analysis was performed to identify risk factors for failure in revision external DCR. About 115 eyes from 109 patients constituted the external (50.4%), endonasal (31.3%), and laser (18.3%) DCR groups. Among 27 (23.5%) patients with intranasal pathologies, septal deviation (33.3%) is the most common finding. The commonest cause of failure was inadequate ostium size in external (37.9%), endonasal (36.1%), and laser (66.7%) DCR groups. Inadequate ostium size and cicatricial lacrimal ostium scarring were observed significantly more common in the laser (P = 0.047) and external DCR group (P = 0.043), respectively. The success rate for revision external DCR was 85.2%. Canalicular or common canalicular obstruction (P = 0.032), intranasal pathology (P = 0.003), and bilateral obstruction (P = 0.025) demonstrated a significant independent association with failure in revision external DCR. Inadequate ostium size was the most common cause of failure in primary external, endonasal, and laser DCR. Canalicular or common canalicular obstruction, intranasal pathology, and bilateral lacrimal obstruction were significant predictors of failure in revision external DCR.

Impact of the type of anterior lamellar reconstruction on the success of modified Hughes procedure.

PURPOSE: To determine the long-term functional and cosmetic outcomes in patients who underwent modified Hughes procedure with different types of anterior lamellar reconstruction for lower eyelid defects. METHODS: This study included 58 patients who had undergone a modified Hughes flap for reconstruction of lower eyelids after tumor excision within a 10-year period. Data regarding patient demographics, size of eyelid defect, tumor pathology, surgical techniques, functional and cosmetic outcomes, and complications were recorded. Postoperative complications were evaluated according to the type of anterior lamella reconstruction (i.e., advancement flap or free skin graft). Multivariate logistic regression analysis was performed to identify risk factors affecting the success of the procedure. RESULTS: The average size of the lower eyelid defect was 22 ± 6.3 mm (range: 11-30 mm). The anterior lamella was reconstructed with advancement flaps and full-thickness skin grafts in 36 (58.6%) and 24 (41.4%) patients, respectively. Mean follow-up time was 23.6 ± 11.9 months. Postoperative complications included trichiasis (three patients; 5.2%), ectropion (two patients; 3.0%), flap necrosis (one patient; 1.7%), flap dehiscence (one patient; 1.7%), infection (one patient; 1.7%), and eyelid margin erythema (one patient; 1.7%). The rates of complication and secondary surgery were similar among the different types of anterior lamellar reconstruction (p=768 and p=0.139, respectively). Success of the modified Hughes procedure was not significantly affected by any of the identified risk factors (p>0.05). Functional and cosmetic outcomes were 96.6% and 94.8%, respectively. CONCLUSION: Modified Hughes procedure is a safe and effective option for the reconstruction of small and large defects of the lower eyelid, regardless of the type of anterior lamella reconstruction (i.e., advancement flap or skin graft).

The effect of pseudoexfoliation syndrome on choroidal thickness in open-angle glaucoma / O efeito do glaucoma pseudoesfoliativo sobre a espessura da coroide em comparação com o glaucoma de ângulo abertos

ABSTRACT Purpose: To investigate the effect of pseudoex foliation syndrome on choroidal thickness as compared with healthy individuals and subjects with primary open-angle glaucoma. Methods: This prospective, randomized study included 30 primary open angle glaucoma patients and 30 pseudoexfoliation glaucoma patients with similar demographic characteristics and 30 eyes of 30 healthy individuals comprised the control group. Regular optic nerve and macular images were obtained using a Cirrus HD spectral domain optical coherence tomography instrument, along with macular choroidal thickness measurements with enhanced depth imaging mode. Results: Age, sex, and axial length values were similar among the three groups (p>0.05). The primary open angle glaucoma and pseudoexfoliation glaucoma groups had comparable levels of glaucomatous damage. The mean subfoveal choroidal thickness values in the primary open angle glaucoma, pseudoexfoliation glaucoma, and control groups were 271.80 ± 19.96 μm, 241.43 ± 32.47 μm, and 268.03 ± 24.50 μm, respectively. The pseudoexfoliation glaucoma group had the lowest choroidal thickness values of the three groups (p values: pseudoexfoliation-control: 0.001; pseudoexfoliation-primary open angle glaucoma: <0.001, primary open angle glaucoma-control: 0.516, independent samples t-test). Conclusion: The macular choroid was thinner in patients with pseudoexfoliation glaucoma, as compared with both healthy individuals and open-angle glaucoma patients with similar degrees of glaucomatous damage.

RESUMO Objetivo: Investigar o efeito do glaucoma pseudoexfoliativo sobre a espessura da coroide em comparação com indivíduos saudáveis e com glaucoma primário de ângulo aberto. Métodos: Este estudo prospectivo e randomizado incluiu 30 pacientes com glaucoma primário de ângulo aberto e 30 com glaucoma pseudoexfoliativo, com características demográficas semelhantes e 30 olhos de 30 indivíduos saudáveis compuseram o grupo controle. Imagens da área macular e do nervo óptico foram obtidas usando um tomógrafo por coerência óptica no domínio espectral do modelo Cirrus HD, juntamente com medições da espessura da coroide na área macular através do modo de imagem de profundidade realçada. Resultados: Os valores de idade, sexo e comprimento axial foram semelhantes nos três grupos (p>0,05). Os grupos de glaucoma primário de ângulo aberto e de glaucoma pseudoexfoliativo tinham níveis comparáveis de lesões glaucomatosas. Os valores médios da espessura subfoveal da coroide nos grupos do glaucoma primário de ângulo aberto, glaucoma pseudoexfoliativo e de controle foram 271,80 ± 19,96 μm, 241,43 ± 32,47 μm e 268,03 ± 24,50 μm, respectivamente. O grupo glaucoma pseudoexfoliativo apresentou os menores valores de espessura de coroide dos três grupos (valores de p: pseudoexfoliativo-controle: 0,001; pseudoexfoliativo-glaucoma primário de ângulo aberto: <0,001, controle de glaucoma primário de ângulo aberto: 0,516; teste de t de amostras independentes). Conclusão: A coroide na área macular era mais fina em pacientes com glaucoma pseudoexfoliativo, quando comparada com indivíduos saudáveis e pacientes com glaucoma de ângulo aberto com graus similares de lesão glaucomatosa.

Effect of Eyelid Involvement in the Reconstruction of Medial Canthal Defects.

The purpose of this study was to present surgical techniques for the reconstruction of medial canthal defects with and without the involvement of the eyelid. This study included 31 patients who underwent medial canthal reconstruction after tumor excision during a 6-year period. Data regarding patient demographics, defect size, tumor pathology, surgery techniques, functional and cosmetic outcomes, and complications were recorded. The reconstructive methods used in the study were divided into groups as per the site of the defect (medial canthal, medial canthal with upper eyelid, medial canthal with lower eyelid, and medial canthal with both eyelids). The most common histopathological diagnosis of the lesions was basal cell carcinoma (74.2%). Postoperative complications (6.4%) included flap necrosis in one patient and lid margin notching in another. Among patients who underwent reconstruction, 8 (25.8%) had only medial canthal defect, 6 (19.3%) had medial canthal defect extending to the upper eyelid, 7 (22.6%) had medial canthal defect extending to the lower eyelid, and 10 (32.3%) had medial canthal defect extending to both the eyelids. The functional outcome was regarded as normal in 30 (96.8%) patients and limited in 1 (3.2%) patient. Cosmetic outcomes were satisfactory in all the patients. The use of alternative reconstructive approaches for different subunits of the medial canthus is an efficient method to achieve superior functional and cosmetic outcomes.

The effect of pseudoexfoliation syndrome on choroidal thickness in open-angle glaucoma.

PURPOSE: To investigate the effect of pseudoex foliation syndrome on choroidal thickness as compared with healthy individuals and subjects with primary open-angle glaucoma. METHODS: This prospective, randomized study included 30 primary open angle glaucoma patients and 30 pseudoexfoliation glaucoma patients with similar demographic characteristics and 30 eyes of 30 healthy individuals comprised the control group. Regular optic nerve and macular images were obtained using a Cirrus HD spectral domain optical coherence tomography instrument, along with macular choroidal thickness measurements with enhanced depth imaging mode. RESULTS: Age, sex, and axial length values were similar among the three groups (p>0.05). The primary open angle glaucoma and pseudoexfoliation glaucoma groups had comparable levels of glaucomatous damage. The mean subfoveal choroidal thickness values in the primary open angle glaucoma, pseudoexfoliation glaucoma, and control groups were 271.80 ± 19.96 µm, 241.43 ± 32.47 µm, and 268.03 ± 24.50 µm, respectively. The pseudoexfoliation glaucoma group had the lowest choroidal thickness values of the three groups (p values: pseudoexfoliation-control: 0.001; pseudoexfoliation-primary open angle glaucoma: <0.001, primary open angle glaucoma-control: 0.516, independent samples t-test). CONCLUSION: The macular choroid was thinner in patients with pseudoexfoliation glaucoma, as compared with both healthy individuals and open-angle glaucoma patients with similar degrees of glaucomatous damage.

Open Globe Injury: Demographic and Clinical Features.

BACKGROUND: Open globe injuries (OGIs) are the main cause of visual impairment worldwide. The aim of this study was to evaluate the clinical features and the visual outcome of OGIs presented to the largest Teaching Hospital in Western part of Turkey. METHODS: The study included patients presented with OGI between Jan 2009 and Dec 2013. Data including patient demographics, causes of injury, visual acuity (VA) at presentation, and final VA were collected. Ocular Trauma Scores (OTS) were calculated. Statistical analyses were performed to identify prognostic factors. RESULTS: One hundred fifty-nine eyes of 156 patients with OGIs were included. The mean age was 36.89 ±â€Š20.07 years. Significant male predominance was noted (77.6%). Domestic (28.3%) and work-related (22%) accidents were the most common causes of all OGIs. While some improvement in best corrected visual acuity (BCVA) after treatment has been noted in 68 eyes (55.7%), the final BCVA was equal to or worse than the initial BCVA in 54 eyes (44.3%). According to the OTS and final BCVA associations in our study, while the eyes with OGI included in OTS category 1 and 2 (n = 84) consist of 68.8% of all the OGI cases, 48.8% (n = 41) of them were classified as having a poor visual outcome. All of the eyes in OTS category 3 and 4 cases (n = 38) (31.2% of all the OGI cases) showed good visual outcome. CONCLUSION: Some clinical features may have a potential to correctly predict final visual outcomes. Although the OTS has not been fully validated yet, it could potentially be one of the best indicators available for the prognosis in OGI.

Unusual intraconal localization of orbital giant cell angiofibroma.

Giant cell angiofibroma (GCA) is a recently reported rare soft-tissue tumor that can develop in various sites including orbit. Orbital GCAs were mainly located in the eyelid or extraconal regions such as lacrimal gland and conjunctiva. We report an atypical case of a GCA arising in the intraconal area of the orbit in a 65-year-old male patient. The tumor was excised in total by lateral orbitotomy. Histological and immunohistochemical features were consistent with the diagnosis of GCA. No recurrence was observed during the follow-up of over 2 years. GCA is a rare tumor that should be considered in the differential diagnosis of intraconal orbital tumors. Complete surgical removal is the current optimal treatment option.

Rehabilitation of Eyelid Malpositions Secondary to Facial Palsy.

OBJECTIVES: To evaluate patient satisfaction and outcomes of surgical treatment of eyelid malpositions secondary to facial palsy. MATERIALS AND METHODS: Consecutive patients with facial palsy who underwent surgical treatment by the same surgeon at Izmir Katip Çelebi University Atatürk Training and Research Hospital between Jan 2007 and Dec 2012 were included in the study. Ophthalmic examination findings, surgical approaches, and their outcomes were evaluated. A successful result for upper eyelid position was defined as more than 50% reduction in lagophthalmos and induction of less than 2 mm of ptosis. A successful outcome for lower eyelid position was defined as the lower eyelid residing at or within 1 mm above or below the limbus. Linear visual analog scale 1 (VAS-1) (subjective complaints) and VAS-2 (cosmetic outcome), both ranging from 0 to 10, were used to compare preoperative findings with findings at last postoperative visit. RESULTS: The mean age of the 14 female and 21 male patients was 54.5±19.9 years. Gold weight implantation (n=31), lateral tarsal strip (n=22), tarsorrhaphy (n=15), suborbicularis oculi fat elevation (n=16), hard palate graft (n=14), and eyebrow ptosis repair (n=6) were performed. Average follow-up time was 17.9±16.9 months (range, 2-60). Surgical success rates were 90% for upper lids and 75% for lower lids. Mean lagophthalmos decreased from 7.1±2.7 mm to 1.6±1.6 mm postoperatively (p=0.000). The use of lubricating drops and gels was reduced from average preoperative daily values of 5.3±2.5 drops and 1.3±0.6 gel applications to 4.4±1.4 and 0.6±0.6, respectively (p=0.003, p=0.001). CONCLUSION: An individualized surgical approach tailored according to each patient's severity of facial palsy and associated malpositions resulted in both functional and aesthetic improvements in our patients.

Von Hippel-Lindau Disease: The Importance of Retinal Hemangioblastomas in Diagnosis.

Von Hippel-Lindau (VHL) disease is a familial cancer syndrome characterized by benign or malignant tumors which may involve more than one system. Retinal hemangioblastomas are usually the initial manifestation of VHL disease and can cause vision loss. A 32-year-old man presented to our clinic with vision loss in the left eye for 2 months. He had a history of cerebral hemangioblastoma operation. Family history showed that his mother had unilateral vision loss and died because of renal cell carcinoma. Ophthalmologic examination revealed multiple retinal hemangioblastomas in both eyes. VHL gene sequencing was performed and heterozygous p.R161X mutation was detected. His sister and daughter were also found to have the same variant. A treatment and follow-up plan was initiated for the patient and affected family members. Considering VHL disease in the differential diagnosis of retinal hemangioblastomas has a very important role in the early detection of life-threatening tumors in these patients.

Evaluation of anatomical and functional outcomes in patients undergoing repair of traumatic canalicular laceration.

BACKGROUND: The present study was designed to evaluate functional and anatomical success of traumatic canalicular laceration repair. METHODS: Consecutive patients who presented at Atatürk Training and Research Hospital Eye Clinic, Izmir Katip Çelebi University Faculty of Medicine and had canalicular laceration repair performed by the same surgeon between January 2009 and December 2014 were included in the study. Demographic data, length of time between injury and surgery, and cause of the trauma, surgical method employed, and duration of follow-up were recorded. Postoperative epiphora was evaluated using Munk score. Patency of lacrimal system was assessed with canalicular irrigation. RESULTS: Thirty-five male and 6 female patients were included in the study. Mean age of 41 participants was 31.85±18.9 years (range: 1-79 years). Avulsive injury was observed in 66% (n=27), and direct (penetrating) injury in 34% (n=14). Distribution of injured canaliculi was as follows: left inferior canaliculus 63.4% (n=26), right inferior canaliculus 19.5% (n=8), right superior canaliculus 9.8% (n=4), and left superior canaliculus 7.3% (n=3). Thirty-four patients had monocanalicular tube implantation (mini-Monoka) and 10 patients had bicanalicular annular intubation using pigtail probe. Average follow-up time was 6±5.7 months. Munk score was Grade 0 in all patients. Canalicular irrigation indicated all canaliculi were patent. CONCLUSION: Recent microsurgical techniques result in successful repair of canalicular laceration.

Peripapillary retinal nerve fiber layer thickness in patients with iron deficiency anemia.

PURPOSE: To evaluate the effect of iron deficiency anemia (IDA) on peripapillary retinal nerve fiber layer (RNFL) thickness with optical coherence tomography (OCT). MATERIALS AND METHODS: 102 female patients who had IDA (hemoglobin <12 g/dl, serum transferrin saturation <15%, serum iron <50 µg/dl, and serum ferritin <15 µg/dl) were enrolled in the study. Optic disc and RNFL parameters obtained by Cirrus high-definition OCT 4000 were compared with those of 49 age and sex-matched nonanemic individuals. The time between blood analysis and OCT measurements was 3.14 ± 5.6 (range, 0-28) days in the anemia group, and 3.5 ± 6.7 (range, 0-27) days in the control group (P = 0.76). RESULTS: Average ages of 102 patients and 49 control subjects were 35.76 ± 10.112 (range, 18-66) years, and 36.08 ± 8.416 (range, 19-57) years (P = 0.850), respectively. The average RNFL thickness was 94.67 ± 9.380 in the anemia group, and 100.22 ± 9.12 in the control group (P = 0.001). Temporal, nasal, and lower quadrant average RNFL thicknesses of IDA group were thinner than the control group (P = 0.001, P = 0.013, P = 0.008). Upper quadrant RNFL thicknesses in IDA and control groups were similar. Correlation analysis revealed positive correlation between mean RNFL thickness and hemoglobin (r = 0.273), iron (r = 0.177), ferritin (r = 0.163), and transferrin saturations (r = 0.185), while a negative correlation was found between total iron binding capacity (r = -0.199) and mean RNFL thickness. CONCLUSIONS: Peripapillary RNFL thickness measured by OCT is thinner in adult female patients with IDA. It may have a significant influence on the management of many disorders such as glaucoma and neuro-ophthalmological diseases.

Rhino-orbital Mucormycosis: Clinical Findings and Treatment Outcomes of Four Cases.

In this case report, we present the clinical findings and therapeutic outcomes of four rhino-orbital mucormycosis patients. The four patients (1 female, 3 male; age range, 55-77 years) all had diabetes mellitus and two also had chronic renal failure. All patients exhibited proptosis, sinusitis, and dark-colored lesions on the nasopharynx and/or hard palate; three patients had ipsilateral peripheral facial paralysis. Visual acuity was no light perception in the two patients with severe orbital involvement and 0.8 in two patients with limited orbital involvement. Histopathological examination of the hard palate, nasopharynx or sinus biopsy revealed typical Mucor hyphae. Systemic liposomal amphotericin B was initiated in all patients. The patients with limited ocular involvement received amphotericin B both intravenously and by local irrigation; both patients had complete recovery. The other two patients underwent orbital exenteration; one patient died after declining systemic treatment postoperatively. Rapid diagnosis and treatment are important for the survival of rhino-orbital mucormycosis patients. With orbital involvement, surgical debridement and systemic and local treatment with antifungal agents may help avoid mutilating surgery like exenteration.

Ocular findings in breast cancer patients using tamoxifen.

AIM: To examine ocular findings of breast cancer patients using tamoxifen. METHODS: The records of 79 consecutive breast cancer patients were examined, retrospectively. Female patients who had previously been diagnosed to have breast cancer with either stage I, II, or III disease, and were older than 25 years of age were included in the study. Results of the ophthalmic examination, color discrimination, and contrast sensitivity tests were recorded. Short wavelength automated perimetry (SWAP) sensitivity values were obtained, and average sensitivity values of test points at 5°, 9°, 15°, and 21° from the fixation were calculated. RESULTS: Forty-nine of the patients had received 20 mg daily dose of tamoxifen therapy (tamoxifen group), while remaining 30 patients had not used tamoxifen (control group). Anterior and posterior segment examination revealed no pathologic findings in both groups. Two patients (5%) in the tamoxifen group had diffuse color loss, while none did in the control group (p = 0.523). Statistically significant differences were not detected between two groups when square roots of total error in color vision, red-green, and blue-yellow partial error scores were compared. Contrast sensitivity values were similar in both groups. Average mean deviation (MD) and average sensitivity values of test points at each 4° were statistically significantly lower in the tamoxifen group than the control group (p = 0.002, p = 0.001, p < 0.001 and p < 0.001 for right eye; p = 0.002, p= 0.001, p < 0.001 and p < 0.001 for left eye). Strong correlation was detected between MD, and duration (r = -0.832 and r = -0.842 for right and left eyes, respectively) and cumulative dose of tamoxifen use (r = -0.864 and r = -0.854 for right and left eyes, respectively). CONCLUSION: Clinically significant ocular toxicity is not frequently encountered in breast cancer patients, however, SWAP changes may occur early after tamoxifen utilization.