Short-term results of surgical treatment in large idiopathic macular hole cases.

PURPOSE: To evaluate results of the surgical treatment for large stage (Stage 3 and 4) idiopathic macular hole cases with and without ILM flap technique. METHODS: Sixty eyes of 60 patients diagnosed with idiopathic macular hole (MH) were included in the study. Complete ophthalmologic examination and SD-OCT examination were performed in all eyes. MH stages, MH base diameter, height and closest distance were measured quantitatively. Postoperative and 3 months visits were evaluated. RESULTS: The mean age of the cases was 65.0 ± 8.0 (range 30-84) years, there were 31 (51.7%) female and 29 (48.3%) male patients with a mean follow-up period of 18.1 ± 16.7 (range 3-63) months. The mean best corrected visual acuity recorded at preoperative and third month control visits were 0.89 ± 0.40(preoperative) logMAR, 0.82 ± 0.60(3 month) logMAR (p < 0.05). The mean MH index was 0.48 ± 0.16, the closest hole distance was 517.86 ± 210.89 µm and mean basal diameter of holes was 947.78 ± 361.90 µm and the average height was 448.93 ± 79.80 microns. There was no statistically significant difference between anatomic results of macular hole surgery with (n = 22) and without (n = 38) flap in terms of hole closure (86.4% vs. 92.1% p > 0.05). In 90% (54 cases) of the cases, closure was observed after the first surgery. Two eyes that failed macular hole surgery were reoperated. In one of these eyes, anatomical success was obtained with macular hole massage and mechanical cytumulation. However, anatomical success could not be achieved in the other eye. CONCLUSiON: In the treatment of large macular holes, pars plana vitrectomy, internal limiting membrane peeling with/without flap and gas tamponade demonstrated high anatomical and functional success.

Efficacy of subthreshold micropulse laser combined with ranibizumab in the treatment of diabetic macular edema.

PURPOSE: In this study, we aimed to evaluate and compare the visual acuity, macular volume, central macular thickness, change in number of intravitreal ranibizumab injections with micropulse laser applications after loading dose of anti-VEGF to DME patients. STUDY DESIGN: Retrospective study. METHODS: This study was carried out on 97 patients (45 ranibizumab and 52 micropulse grid laser+ranibizumab) with diabetic macular edema patients who were followed in the Retina Unit. At the control visit after three loading ranibizumab injections administered once a month, micropulse grid laser was applied to one group and ranibizumab injection was continued PRN to both groups for an average of 9.27 ± 2.42 months and central macular thickness, macular volume and visual acuity were recorded. RESULTS: There was no significant difference between the groups in terms of gender, smoking and systemic diseases, initial central macular thickness, macular volume and visual acuity measurements (p > 0.05). Central macular thickness, macular volume and visual acuity values measured at the last follow-up of the patients were not significantly different between the groups (p > 0.05). The mean post-treatment injection requirement was 4.19 ± 1.01 for the ranibizumab with micropulse laser combination group and 5.53 ± 1.14 for the ranibizumab group (p < 0.001). CONCLUSION: Micropulse laser treatment after initial loading doses reduces the need for anti-VEGF injections. There is no deleterious effect on visual acuity and retinal imagings. Therefore, while combination therapy provides an effective treatment, it can also reduce the risk of complications of intravitreal anti-VEGF injections. Studies with the participation of more patients may help in the selection of treatment methods by comparing micropulse laser combined with different injection protocols.

Toxicity of subretinal ribozyme to the proliferating cell nuclear antigen and 5-fluorouracil in rat eyes.

PURPOSE: To investigate the subretinal toxicity profile of the ribozyme to the proliferating cell nuclear antigen (PCNA-Rz) and 5-fluorouracil (5-FU), as well as the highest nontoxic subretinal dose of the mixture of the two agents in rat eyes. METHODS: Brown-Norway rats received subretinal injections of 1 microg, 10 microg, and 100 microg/microl PCNA-Rz and 0.06 microg/microl, 0.3 microg/microl, and 1.5 microg/microl 5-FU in the right eyes, and the left eyes were injected with H-BSS as control. Each dose was tested on 5 eyes in a 5 microl volume. In a second study, a combination of 5-FU (1.5 microg/microL) with varying 10-30-50 microg/microl doses of PCNA-Rz was tested in a regimen of four sequential subretinal injections. Toxicity was monitored by biomicroscopy, indirect ophthalmoscopy, electroretinography (ERG), and histology. RESULTS: The highest nontoxic dose for subretinal PCNA-Rz was 10 microg/microl, whereas 100 microg/microl showed disturbance of pigmentation with corresponding histological changes of retinal photoreceptor loss and retinal pigment epithelium proliferation or irregularities. Subretinal injection of all three doses of 5-FU did not show any toxicity. Serial injections of a mixture of 1.5 microg/microl 5-FU with 10 microg/microl of PCNA-Rz was found to be safe in rat eyes. CONCLUSIONS: Subretinal injections of the combination of PCNA-Rz (10 microg/microl) and 5-FU (1.5 microg/microl) demonstrated to be safe in rat eyes during the course of this study, even with a multiple administration of four injections.

Chandelier retroillumination-assisted cataract surgery during vitrectomy.

PurposeTo present an alternative cataract surgical technique in patients with cataract and intravitreal hemorrhage.MethodsTwelve cases with poor fundus reflex caused by severe vitreus hemorrhage were included in the study. All patients underwent combined phaco surgery and 23-gauge vitrectomy. Chandelier retroillumination was inserted into the infusion trochar during the cataract operations and was used with low power (50-75%) in necessary steps.ResultsWe did not experience phaco complications or complications due to technique during surgery. Retroillumination assistance was especially useful during final stages of cataract surgery, particularly irrigation-aspiration of cortical material.ConclusionRetroillumination in absence of red fundus reflex may be helpful and can be practiced more often in cataract surgery combined with vitrectomy.

Hypotony: an unusual consequence of intraocular lens malposition.

Common causes of postoperative hypotony include wound leakage, inflammatory reaction of the ciliary body, cyclodialysis, and ciliochoroidal detachment. We present an unusual case of ocular hypotony in a pseudophakic eye associated with distortion of the ciliary body by a decentered posterior chamber intraocular lens (IOL) haptic. A simple surgical repositioning of the IOL relieved the hypotony by eliminating the irritation by the IOL haptic on the distorted edematous ciliary body. Ciliochoroidal irritation by IOL haptics should be considered a possible cause of ocular hypotony in a pseudophakic eye.

Religious fasting and intraocular pressure.

PURPOSE: To determine the effects of Islamic religious fasting on intraocular pressure. METHODS: The authors measured diurnal intraocular pressure values during religious fasting and 1 month later in 38 healthy male volunteers with a mean age of 22.4 +/- 2.7 years. Body weight and urine specific gravity were determined to assess the extent of dehydration caused by fasting. RESULTS: Although each patient had weight loss (0.1-1.4 kg) representing a slight dehydration caused by fasting, intraocular pressure values were not statistically different between fasting and nonfasting periods (P > 0.05). CONCLUSION: Fasting did not alter diurnal intraocular pressure values in healthy people.

Histopathologic effect of chronic use of sildenafil citrate on the choroid & retina in male rats.

BACKGROUND & OBJECTIVES: Sildenafil citrate is an oral medication used to treat male impotence by the inhibition of phosphodiesterase-5 in the corpus cavernosum and subsequent facilitation of penile erection. Though the ocular side effects of sildenafil have been reported, no information is available on the histopathologic effects of chronic use of sildenafil citrate on the ocular vasculature. The present study was undertaken to study the histopathologic effects of chronic use of sildenafil on the retina and choroid of male rats. METHODS: Twelve adult male Wistar rats were used in the study. Six of them were given 8 mg/kg/day sildenafil citrate orally on alternate days, the other six rats were used as control. The animals were sacrificed after 4 wk of treatment, and the eyes were fixed in 10 per cent formalin solution and sectioned after embedding in paraffin. Sections were cut, stained with haematoxylin-eosin (HE) or periodic acid Schiff (PAS) and examined under light microscope. The choroidal capillary diameter was also measured. RESULTS: The choroidal capillaries were more dilated in the sildenafil citrate treated group (mean capillary diameter 3.44 +/- 1.68 microm versus the control of 1.78 +/- 1.36 microm, P < 0.001). The retinal layers and their configuration were unchanged in both the groups. INTERPRETATION & CONCLUSION: Chronic use of sildenafil citrate can cause dilatation and congestion in the choroidal vasculature of male rats.

Ocular findings in a measles epidemic among young adults.

PURPOSE: To present ocular findings in a measles epidemic outbreak among young adults. METHODS: Ophthalmic lesions in an unselected group of 61 young military personnel with measles were followed. Eighteen of the patients had symmetric keratitis in both eyes. They were treated with diclofenac sodium eyedrops qid in the right eye, while the left eye was observed untreated. The disappearance of the corneal lesions in both eyes was compared. RESULTS: Forty patients (65.6%) had measles conjunctivitis with bulbar and tarsal conjunctival hyperemia. Five (8.2%) had increased mucous secretion. Thirty-five (57.4%) had superficial punctate corneal epithelial and subepithelial lesions which stained with fluorescein. Ten patients had corneal lesions without evident conjunctival pathology. Fourteen patients had subconjunctival hemorrhages, 12 of whom had bilateral lesions mostly in the superonasal quadrant. The time to disappearance of corneal lesions was 4.5+/-3.2 days in the diclophenac-treated right eyes, and 4.1+/-3.8 days in the left eyes. We did not observe a significant difference in the healing time between the two eyes (p = 0.75). CONCLUSION: Measles did not cause major ocular complications in healthy patients. Keratitis was unresponsive to diclophenac sodium eyedrops with respect to healing time and end result.

Fluorescein dye disappearance test in patients with different degrees of epiphora.

PURPOSE: To assess the diagnostic efficacy of a modification of the fluorescein dye disappearance test (DDT) in patients with different degrees of epiphora. METHODS: DDT was performed by instilling a drop of 2% fluorescein in the eye. Schirmer tear test strips were placed in the lower conjunctival fornix, after 3 and 10 minutes. The colour dilution on the strips was compared to a scale with known standards and the most closely comparable colour dilution was chosen and recorded as the visual scale test (VST) grade of the strip. The grey-scale value (GV) of each strip was calculated by computer image analysis. The control group comprised 44 patients, mean age 44.8 years (SD 7.5, range 30-60). There were 13 patients in group 1 with moderate epiphora; mean age was 44.2 years (SD 9.5, range 30-60). There were 17 patients in group 2 with severe epiphora; mean age was 48.3 years (SD 7.7, range 37- 60). RESULTS: VST and GV differed significantly between controls and group 1 patients at 3 minutes (p=0.002, p=0.001), and between controls and group 2 patients at 3 minutes (p<0.001, p<0.001). There was no difference between groups 1 and 2 patients in VST and GV at 3 minutes. The differences were highly significant between controls and group 1 at 10 minutes (p=0.001, p=0.007), and between controls and group 2 at 10 minutes (p<0.001, p<0.001). The differences in GV and VST between groups 1 and 2 were significant at 10 minutes (p=0.026, p=0.018). CONCLUSIONS: This modified DDT permits identification of different degrees of epiphora in a non-invasive manner, it can therefore be used to evaluate the outcome of different treatment strategies.

Effects of betaxolol and latanoprost on ocular blood flow and visual fields in patients with primary open-angle glaucoma.

PURPOSE: To evaluate the effects of betaxolol and latanoprost on ocular blood flow and visual fields in patients with primary open-angle glaucoma (POAG) by means of an observer-masked, prospective clinical study. METHODS: Thirty-two patients with newly diagnosed POAG were included in the study. The patients were randomized into two groups. The first group was treated with betaxolol 0.50% twice daily and the second group with latanoprost 0.005% once daily. Baseline and posttreatment examinations on the first and third months of treatment included intraocular pressure (IOP) measurement, automated visual field testing, and ocular blood flow assessment. For evaluation of visual fields, mean defect and pattern standard deviation indices were used. Ocular blood flow was assessed by means of color Doppler imaging of the central retinal artery (CRA) and the temporal short posterior ciliary artery (PCA). For each vessel, peak systolic (PSV) and end-diastolic (EDV) blood flow velocities were measured and resistivity index (RI) calculated. RESULTS: After exclusion of one noncompliant patient, the study was completed with 31 eyes of 31 patients. Both drugs significantly reduced IOP (p<0.05). The mean IOP lowering effect of latanoprost was significantly higher than that of betaxolol (p=0.03). Visual field indices exhibited no significant changes in either group (p>0.05). There were no significant changes in PSV or EDV measurements of CRA or PCA in either group (p>0.05). RI decreased in both CRA and PCA with both drugs. The mean changes between baseline and 3 month blood flow measurements were not significantly different between betaxolol and latanoprost (p>0.05). CONCLUSIONS: Over a treatment period of 3 months, both betaxolol and latanoprost tended to improve ocular blood flow without one of them being superior to the other. The results suggest that the direct (non IOP-dependent) influence on ocular circulation is better for betaxolol than for latanoprost. In addition, neither drug caused significant generalized improvements in visual fields during this period.

A simple closed chamber technique for repair of traumatic iridodialysis in phakic eyes.

A surgical technique was developed for traumatic iridodialysis repair using a small partial-thickness scleral flap and a 24-gauge disposible hypodermic needle. This procedure is a "direct iridodialysis-site approach" closed chamber technique with minimal surgical trauma that can be used in phakic, pseudophakic, or aphakic eyes.

A novel suture technique in stellate corneal lacerations.

A novel suture technique for regular stellate corneal lacerations, called a star-shaped suture is described. The suturing begins from inside any of the wound lips in a clockwise direction. Suture placement proceeds in a counterclockwise direction by the adjacent wound limb, while the suture passes are all in clockwise direction. Finally, a star-shaped suture is achieved with the knot self-buried in the corneal stroma at the initial entry site. This is a continuous suture, of which tractional forces direct to the center of the wound providing good apical apposition for stellate lacerations. This suture technique can be an alternative for the reconstruction of stellate corneal lacerations.

Comparison of 4 mg versus 20 mg intravitreal triamcinolone acetonide injections.

AIMS: To compare the non-decanted (standard) 4 mg versus the decanted 20 mg intravitreal triamcinolone acetonide (IVTA) injections and to assess their effect on intraocular pressure (IOP). METHODS: We retrospectively reviewed the records of 92 consecutive eyes, which received an intravitreal injection of either dose of triamcinolone acetonide, at a single retina centre. The change in IOP (elevation of at least 5 mm Hg from baseline or above 21 mm Hg) was analysed with a multivariate logistic analysis. The mean follow-up period in both groups was 27 weeks. A subgroup analysis comparing vitrectomised to non-vitrectomised eyes in both groups was also performed. RESULTS: Of the 92 eyes, 46% (23 of 51) in the 4 mg group versus 30% (12 of 41) in the 20 mg group had an IOP >21 mm of Hg (p = 0.14) after a mean follow-up period of 27 weeks. The vitrectomised eyes (3 of 24) in the 20 mg group had a significantly lower rate of IVTA induced IOP elevation than the non-vitrectomised eyes (9 of 17) (p = 0.013). The IOP elevation occurred significantly earlier in the 4 mg group (vitrectomised eyes 27 (SD 43) days and non-vitrectomised eyes 61 (52) days) than in the 20 mg group (vitrectomised eyes 104 (56) days and non-vitrectomised eyes 119 (82) days), independent of the vitreous status (vitrectomised p = 0.05 and non-vitrectomised p = 0.04). The mean value of initial high IOP in the non-vitrectomised eyes was higher in the 4 mg group than in the corresponding 20 mg group (p = 0.048). CONCLUSION: Decanted 20 mg IVTA may not pose a significantly greater risk of IOP elevation than the 4 mg non-decanted IVTA.

Alcohol liberates dye of syringes.

Foreign particles may contaminate intraocular surgery and have a role in postoperative inflammation. Irrigation solutions, viscoelastics, air and instruments introduced into the eye may carry in a number of organic or inorganic, inert or reactive foreign material. Dye of colored indicators on syringes may also behave as an unrecognized contaminant. This dye material is easily released from syringes by exposure to alcohol. The significance of dye contamination and possible outcomes were discussed.

Bilateral angle closure glaucoma following general anesthesia.

Although unilateral angle closure glaucoma is quite common, simultaneous bilateral acute angle closure is very rare and is usually induced by an external cause. General anesthesia is a triggering factor for acute angle closure glaucoma. We report two cases of simultaneous bilateral angle closure glaucoma following non-ocular surgery under general anesthesia. One patient had cholecystectomy, the other craniotomy for tumor resection. In the postoperative period following general anesthesia, any patient at risk for angle closure glaucoma should be followed closely; patients with periorbital pain and visual symptoms should be examined for angle closure glaucoma attack in both eyes.

Determining fluid level in a translucent eye-drop bottle: transillumination by penlight.

We describe an easy way to determine eye-drop contents in translucent bottles. Transillumination of eye-drop bottles from behind or the bottom by using a penlight clearly defines the fluid levels. The described procedure may prevent disposal of eye-drop bottles containing useful amounts of medication and prevent Ophthalmologists and Patients unexpectedly coming across an empty bottle.