Long-term results of bare sclera, limbal-conjunctival autograft and amniotic membrane graft techniques in primary pterygium excisions.

PURPOSE: To compare the long-term follow-up results of the bare sclera technique (BST), limbal-conjunctival autograft technique (LCAT) and amniotic membrane graft technique (AMGT) in primary pterygium excisions. MATERIALS AND METHODS: In this study, 48 eyes of 48 patients who underwent pterygium surgery using BST (group 1), 63 eyes of 63 patients who underwent pterygium surgery using LCAT (group 2) and 52 eyes of 52 patients who underwent pterygium surgery using AMGT (group 3) were compared with respect to corneal epithelialization, recurrence and complication of the procedures. The mean ages of the groups were 47.88 +/- 14.21 years in group 1, 49.63 +/- 14.42 years in group 2 and 47.92 +/- 15.52 years in group 3. Patients were followed up to 72.39 +/- 11.03 months in group 1, 69.91 +/- 12.41 months in group 2 and 61.43 +/- 9.83 months in group 3. RESULTS: Postoperative corneal epithelialization was completed in 5.62 +/- 1.74 days in group 1, 4.33 +/- 0.91 days in group 2 and 4.79 +/- 1.39 days in group 3. Corneal epithelialization time was earlier in group 2 than in groups 1 (p < 0.01) and 3 (p < 0.05). Recurrences were detected in 19 eyes (39.58%) in group 1, 11 eyes (14.29%) in group 2 and 12 eyes (23.08%) in group 3. The recurrence rate was significantly lower in group 2 than in groups 1 and 3 (p < 0.001). Postoperative complications were not seen in any of the groups. Graft retraction and necrosis were not detected in the LCAT and AMGT groups during the follow-up period. CONCLUSIONS: LCAT was found to be a more effective procedure than BST and AMGT, with decreased recurrence rates after pterygium excision. Limbal-conjunctival autograft seems to be a useful treatment in pterygium surgery due to higher success rates and lower recurrence rates. Amniotic membrane grafts may be an alternative surgical technique for pterygium treatment for patients with or without glaucoma who might need glaucoma surgery in the future.

The angle kappa in strabismic individuals.

PURPOSE: To determine angle kappa values in strabismic individuals by means of a synoptophore. METHODS: One hundred-and-eight strabismic subjects and 102 healthy subjects who served as a control group were enrolled in the study. A complete ophthalmologic examination, including determination of refractive status, best-corrected visual acuity measurement, slit-lamp biomicroscopic anterior segment evaluation, intraocular pressure measurements with a Goldmann applanation tonometer, and dilated fundus examination, was done on all study participants. Orthoptic examination included Krimsky prism reflex test, prism cover test, and duction tests. Strabismic patients were grouped into two categories according to their deviation types: exotropic and esotropic. A synoptophore (Clement Clarke, London, England) with a specially designed slide (Maddox test slide series A White Binding No: 16; Clement Clarke, London, England) was used to measure angle kappa. RESULTS: Of the 108 strabismic patients, 62 were males and 46 were females with a mean age of 23.38 +/- 3.68 years (range: 8 to 82 years). There were 54 males and 48 females with a mean age of 32.74 +/- 1.63 years (range: 7 to 68 years) in the control group. The exotropic group had significantly higher angle kappa values than either the controls or the esotropic group (independent sample t-test, p < 0.001). None of the study participants had negative angle kappa values. Higher average kappa values were obtained in left eyes than in right eyes in all three groups (student t-test, p < 0.01 for all groups). CONCLUSION: This study showed that exotropic patients have higher angle kappa values when compared to esotropic patients. Ophthalmologists must take the kappa angle into account when performing a Hirschberg or Krimsky test in young and uncooperative patients in order to improve surgical results.

Chromosomal abnormalities, p53 and Bcl-2 expression and clinical outcome in choroidal melanoma.

OBJECTIVE: To determine whether alterations of p53, Bcl-2 and chromosomes were present in choroidal melanoma and to further characterize the prognosis of these changes. METHODS: The expression of p53 and Bcl-2 protein was assessed by immunohistochemistry from paraffin blocks. Tumours were analysed by comparative genomic hybridization (CGH) to identify chromosomal aberrations. Fifteen tumours were studied, and the survival results were compared by Spearman correlation analysis with a mean follow-up of 36.5+/-8 months. The majority of tumours were mixed (eight cases), and the others were spindle cell (four cases) and epithelioid cell (three cases) types. Four patients have already died due to metastatic disease. RESULTS: p53 was expressed at a low percentage in only two tumours. There were no differences in Bcl-2 expression in our cases. Bcl-2 was expressed by the majority of cells in all cases. Chromosomal copy number aberrations were detected in 10 of the 15 patients by CGH analyses. A gain at chromosome 8 and a loss at chromosome 3 were the most frequently seen abnormalities. The other aberrations observed were losses at 6q, 7q14 and 17p13-15, and gains at 6p and 18q. Two of the three cases with a loss at 17p13 showed a low percentage expression of p53. No relationship was determined between the chromosomal abnormalities, cell type, expression of p53 and survey. The presence of a chromosome 6q deletion in two of the four patients who died of metastatic disease may indicate that chromosome 6q deletion may be correlated with a poor prognosis. CONCLUSIONS: Our results suggest that choroidal melanomas show high levels of chromosomal alterations. Further studies are necessary to determine the correlation between chromosomal abnormalities and prognosis.

Treatment of intracameral fibrinous membranes with tissue plasminogen activator.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of intracameral tissue plasminogen activator (tPA) in the treatment of severe fibrinous membranes that do not respond to anti-inflammatory treatment. PATIENTS AND METHODS: In this technique, 0.1 mL of aqueous was aspirated, followed by injection of 0.1 mL (25 microg) of tPA into the anterior chamber in 15 patients with severe fibrinous membranes that developed after pars plana vitrectomy (n = 6), cataract extraction (n = 4), combined cataract and glaucoma surgery (n = 2), trabeculectomy (n = 1), and endophthalmitis (n = 2). The clearance of fibrinous membranes and changes in visual acuity and in intraocular pressure were observed. RESULTS: Patients were treated 2 to 10 days postoperatively (mean, 5.6 +/- 0.57 days). Complete fibrinolysis was observed in all cases. The mean time for clearance of fibrin was 7.73 +/- 2.73 hours. A temporary increase in intraocular pressure was noted in two cases. CONCLUSION: In this technique, intracameral injection of 25 microg of tPA is both effective and safe in the treatment of severe fibrinous membranes that do not respond to anti-inflammatory treatment.

Results of autografting of marginal conjunctiva in pterygium excision.

PURPOSE: To investigate and compare the efficiency of autografting of marginal conjunctiva (autograft of marginal conjunctiva technique, AMCT) and the bare sclera technique (BST) in pterygium excision. MATERIALS AND METHODS: In this study, 51 eyes of 51 patients who underwent pterygium surgery using the AMCT (group 1) were compared to 45 eyes of 45 patients who underwent pterygium excision using the BST (group 2), with regard to epithelialisation, recurrence and complication of the procedures. Patients were followed up for 15.37 +/- 12.01 months in group 1 and for 18.57 +/- 10.42 months in group 2. RESULTS: Postoperative epithelialisation was completed in 4.34 +/- 1.27 days in group 1 and in 5.61 +/- 1.71 days in group 2. Epithelialisation was completed earlier in group 1 than group 2 (p < 0.05). Recurrences were detected in 7 eyes (13.73%) of group 1 and in 17 eyes (37.78%) of group 2. The difference between the groups was statistically significant (p < 0.01). No postoperative complications were seen in either of the groups. CONCLUSIONS: The AMCT was found to be a more efficient procedure than the BST. Autografting of marginal conjunctiva may be a useful alternative treatment in pterygium surgery due to higher success and lower recurrence rates.

The effect of N-acetyl serotonin on ultraviolet-radiation-induced cataracts in rats.

AIMS: To investigate the effects of ultraviolet radiation (UVR) on cataract development in rat lenses and whether or not N-acetyl serotonin has an effect on changes in these lenses. MATERIAL AND METHODS: The study was performed using 5 groups of Sprague-Dawley albino rats, with each group consisting of 15 rats. The 5th group being the control group did not receive any applications, whilst the other 4 groups received a daily dose of 0.2 J/cm(2)/day UVR (305 nm wavelength) for 60 days. A dose of 4 mg/kg/0.1 ml N-acetyl serotonin was injected intraperitoneally to group 1 and group 2 every day and on alternate days, respectively. Group 3 received an intraperitoneal injection of 0.1 ml phosphate buffer solution every day, whilst group 4 received no injection. On the 60th day, an intracardiac withdrawal of blood was performed, after the rats had been anesthetized with ether. Following the withdrawal of blood, the rats were killed using a high dose of ether and their eyes were enucleated. The lens fresh weights, plasma malondialdehyde (P-MDA), erythrocyte glutathione peroxidase (E-GSHPx), erythrocyte glutathione reductase, blood reduced glutathione (B-RGSH), erythrocyte catalase (E-CAT), lenticular malondialdehyde, lenticular superoxide dismutase (L-SOD), lenticular glutathione peroxidase (L-GSHPx) and lenticular glutathione (L-GSH) levels were all assessed. RESULTS: The lens fresh weights were determined to be lower in group 1 and in the control group in comparison with the other groups (p < 0.01). Whilst the P-MDA level was found to be lower (p < 0.001), the E-GSHPx level was higher (p < 0.01) in the control group than in the other groups. The E-GSHPx level was higher in groups 1 and 2 than in groups 3 and 4 (p < 0.01). The B-RGSH level was higher in the control group than in the other groups (p < 0.001). The E-CAT level was higher in both the control group and group 1 than in groups 2, 3 and 4 (p < 0.01), whilst it was higher in group 2 when compared to groups 3 and 4 (p < 0.01). The L-SOD levels were found to be higher in the control group and group 1 than in groups 2, 3 and 4 (p < 0.001). Whilst the L-GSHPx levels were determined to be higher only in the control group (p < 0.001), the L-GSH levels were higher in the control group and group 1 than in the other groups (p < 0.001). CONCLUSIONS: In recent years, the depletion of the atmospheric ozone layer has resulted in the penetration of more UVR to the earth, which causes various effects on different tissues of organisms. N-acetyl serotonin, a melatonin precursor, may well be effective in the prevention of the negative effects induced by the UVR upon the lens tissue, in which case the capability of melatonin to capture free radicals as well as its antioxidative properties should be taken into consideration.