[Show abstract][Hide abstract] ABSTRACT: To evaluate the efficacy of the combined procedure in the management of involutional entropion.
In this study, we reviewed 45 eyes of 36 patients who underwent the combined procedure (lateral tarsal strip, retractor tightening, and everting sutures) for the management of involutional lower eyelid entropion and compared the results with 31 eyes of 25 patients who underwent the Wies procedure. Exclusion criteria included previous lower eyelid surgery and follow-up of less than 6 months.
No patients demonstrated entropion on the first postoperative day. The mean follow-up period was 18.4 months (6 to 52 months) in the Wies group and 22.6 months (6 to 59 months) in the combined procedure group. During the follow-up period, 9 of 31 eyes in the Wies group presented with recurrence and only 1 of 45 eyes in the combined procedure group presented with recurrence (p = 0.001). The average time of recurrence was 4.8 months in the Wies group. Recurrence occurred at 2 months postoperatively in the patient in the combined procedure group. Six of the 9 recurrences in the Wies group were managed by the combined procedure. None of these patients had further recurrence after correction. Three patients complained about a visible incision line after the Wies procedure.
The combined procedure seems to be more effective than the Wies procedure in the management of involutional entropion. The combined procedure addresses the three major causative factors in involutional entropion and makes it possible to perform the surgery using a small incision.
Korean Journal of Ophthalmology 12/2013; 27(6):405-8.
[Show abstract][Hide abstract] ABSTRACT: Abstract Purpose: To evaluate in a comparative manner the safety and efficacy of 1.0% sodium-Hyaluronate used during capsulorhexis and intraocular lens (IOL) implantation in phacoemulsification surgery. Materials and Methods: 1.0% sodium-Hyaluronate, which is commonly used as one of the ophthalmic viscoelastic devices, was compared to intraocular irrigating solution, which can bring up these effects. In addition, the effect of both methods on occurring corneal endothelial cell (CEC) loss was investigated. Results: Each group comprised 19 eyes. The mean preoperative CEC density was 2525.68 ± 181.85 in Group H and 2514.16 ± 174.59 in Group V; no statistically significant difference was found between the groups (p > 0.05). Preoperative and postoperative first and twelfth week CEC densities were 2438.21 ± 198.12 (p < 0.001) and 2390.74 ± 202.31, respectively, in group H (p < 0.001). Preoperative and postoperative first and twelfth week CEC densities were 2415.32 ± 197.24 (p < 0.001) and 2353.47 ± 212.69 in group V (p < 0.001). Compared with preoperative values, decrease in CEC density on the postoperative first and twelfth weeks was not statistically significant in either group (p > 0.05). Conclusion: Although it was found that there was no statistically difference in terms of preventing CEC loss between 1.0% sodium-Hyaluronate and the irrigation method during phacoemulsification, it was observed clinically that 1.0% sodium-hyaluronate can make the procedure easy, safer, very helpful, especially for understanding phacoemulsification.
Seminars in ophthalmology 10/2013; · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Purpose: To evaluate the efficacy of long scleral tunnel technique used in Ahmed glaucoma valve (AGV) implantation in preventing tube exposure through conjunctiva. Materials and Methods: Patients of adult age, who were unresponsive to maximum medical treatment and underwent AGV implantation, were divided into two groups and investigated retrospectively. Group 1 consisted of 40 eyes of 38 patients that underwent surgery by long scleral tunnel technique and Group 2 consisted of 38 eyes of 35 patients that underwent implantation by processed pericardium patch graft method. Results: The mean age was 54.8 ± 14.6 years (range 26-68 years) and the mean follow-up duration was 46.7 ± 19.4 months (range 18-76 months) for the patients in Group 1, whereas the mean age was 58.6 ± 16.7 years (range 32-74 years) and mean follow-up period was 43.6 ± 15.7 months (range 20-72 months) for the patients in Group 2 (p > 0.05). In the course of follow-up, tube exposure was detected in one (2.5%) eye in Group 1 and in three (7.9%) eyes in Group 2 (p = 0.042). Conclusion: Long scleral tunnel technique is beneficial in preventing conjunctival tube exposure in AGV implantation surgery.
Seminars in ophthalmology 08/2013; · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: To assess the efficacy of preoperative intravitreal bevacizumab injection (IVB) before Ahmed glaucoma valve (AGV) implantation in the treatment of neovascular glaucoma (NVG). Methods: This retrospective, comparative and consecutive case series study included 41 eyes from 41 patients who underwent AGV implantation for treatment of NVG. The study group was composed of 19 patients (19 eyes) to whom IVB was administered before surgery, while the control group was composed of 22 patients (22 eyes) to whom IVB was not administered before AGV implantation. Findings such as intraocular pressures measured before and after surgery, surgical success rates, and postoperative complications were compared between the groups. Results: There were no significant differences in preoperative data between groups. The surgical success rate in the study group (79%) was better than in the control group (64%), but this difference was not statistically significant (p = 0.28). Early postoperative complications such as fibrinous reaction in the anterior chamber as well as hyphema were less frequently observed in the study group. Conclusions: Intravitreal bevacizumab is a useful preparatory step to safely and effectively implant an aqueous shunting tube in eyes with severe NVG and intractable intraocular pressure.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effect of the shape of Bowman probes on the success of primary probing for congenital nasolacrimal duct obstruction.
Records of 42 nasolacrimal duct obstructions in 37 children who underwent probing with straight Bowman probes (group A) and 128 nasolacrimal duct obstructions in 110 children who underwent probing with Bowman probes manually bent to mimic the natural curve of the bony nasolacrimal pathway (group B) were evaluated and compared. All children were under 2 years of age. The main outcome was successful probing. Successful probing was defined as a complete resolution of signs and symptoms.
The mean age of the patients was 16.4 ± 4.1 months (range 8-24 months) in group A and 16.8 ± 4.2 months (range 7-24 months) in group B. No canalicular or nasolacrimal sac pathologies were diagnosed during probing. The success rate was 76.2% (32/42) in group A and 91.4% (117/128) in group B. The difference was statistically significant (P < 0.01).
Manually curved probes can be used efficiently during probing and increase the success rates.
[Show abstract][Hide abstract] ABSTRACT: Purpose: To compare the efficacy of intravitreal triamcinolone acetonide injection versus 23-gauge pars plana vitrectomy with internal limiting membrane peeling for the treatment of chronic pseudophakic cystoid macular edema (CME) after uncomplicated cataract surgery. Methods: This retrospective, comparative, consecutive case series study included 39 patients with chronic pseudophakic CME. Twenty eyes in 20 patients were treated with intravitreal triamcinolone acetonide injection (IVT group), and 19 eyes in 19 patients were treated with pars plana vitrectomy with internal limiting membrane peeling (PPV group). In both groups, complete ophthalmologic examinations were performed before and after procedures. Findings were compared between the groups. Results: Both groups experienced a significant improvement in visual acuity and macular thickness after 12 months follow-up. At months 1 and 2, the IVT group showed a significant improvement in visual acuity and a significant reduction in macular thickness compared with the PPV group (p < 0.05), but these differences were not statistically significant between the groups after the 12-month period. Conclusion: Both intravitreal steroid injection and pars plana vitrectomy with internal limiting membrane peeling had a favorable effect on visual and anatomic results in patients with chronic pseudophakic CME. However, surgical treatment had no advantage over intravitreal triamcinolone acetonide injection after 12-months follow-up.
Current eye research 08/2012; · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: This study aimed to investigate the biomechanical changes in cornea in patients with recurrent anterior uveitis in comparison to healthy controls. Methods: Eighty-five eyes in 51 patients with inactive recurrent anterior uveitis (25 male, 26 female) and 34 eyes of 34 age-matched control subjects (16 male, 18 female) were included. The following measurements were done and compared between patients and controls: corneal hysteresis, corneal response factor, intraocular pressure, and central corneal thickness. Results: Patients had significantly lower mean corneal hysteresis (8.57 ± 1.60 versus 10.91 ± 1.41, p = .001) and corneal resistance factor (9.24 ± 1.68 versus 11.56 ± 1.46, p = .001) when compared to controls. Among patients, corneal hysteresis and corneal resistance factor did not correlate with duration of the disease or number of attacks per year. Conclusions: Anterior uveitis seems to be associated with impaired biomechanical strength of the cornea, although no correlations with the duration of illness or attack frequency could be determined.
Ocular immunology and inflammation 07/2012; 20(5):349-53. · 0.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE:: To evaluate the diagnostic ability of Fourier-domain optical coherence tomography (FD-OCT) measurements in both normal individuals and patients with different stages of glaucoma. PATIENTS AND METHODS:: A total of 113 patients diagnosed with glaucoma and classified into different stages of glaucoma according to Glaucoma Staging System 2 and 30 healthy individuals were included in this study. In all patients, parameters of both the retinal ganglion cell complex (GCC) and the peripapillary retinal nerve fiber layer were measured by FD-OCT (RTVue-100). Comparisons were made from measurements in patients with different stages of glaucoma. RESULTS:: Both GCC and retinal nerve fiber layer thickness values of patients with glaucoma were statistically significantly lower compared with those of healthy individuals. As the stage of glaucoma progressed, the mean GCC and retinal nerve fiber layer thickness values decreased. CONCLUSIONS:: GCC and retinal nerve fiber layer thickness measurements performed by FD-OCT showed high diagnostic ability in detecting glaucoma. Mean thickness values can be determined for each glaucoma stage.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the outcomes of implantation of a Cionni modified capsular tension ring (CTR) and a posterior chamber intraocular lens (PC IOL) in patients with traumatic cataract and loss of zonular support.
Eye Clinic II, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey.
Eyes with traumatic cataract and loss of zonular support had phacoemulsification with implantation of a foldable IOL and a 1- or 2-eyelet modified CTR. Preoperative features, preoperative and postoperative corrected distance visual acuity (CDVA), intraoperative performance, IOL position, and complications were evaluated.
The study enrolled 16 eyes (16 patients). The mean CDVA was 0.89 logMAR ± 0.41 (SD) preoperatively and 0.33 ± 0.43 logMAR at the last postoperative examination (P=.001). Postoperatively, the mean spherical equivalent was -0.23 diopter (D) (range -1.50 to +1.00 D) and the mean postoperative astigmatism, 1.59 D (range 0.50 to 4.00 D). Eight eyes (50.0%) had phacodonesis preoperatively; no eye had pseudophacodonesis postoperatively. Preoperatively, 10 eyes (62.5%) had symptomatic decentration. Two eyes (12.5%) had asymptomatic nonprogressive decentration in the early postoperative period; no eye had symptomatic decentration throughout the follow-up. Three eyes (18.8%) preoperatively and 1 eye (6.2%) postoperatively had vitreous in the anterior chamber. Four eyes (25.0%) required anterior vitrectomy. Other complications were symptomatic posterior capsule opacification in 8 eyes (50.0%) and transient increased intraocular pressure in 2 eyes (12.5%).
The use of a modified CTR preserved the capsular bag and resulted in good PC IOL centration with few significant complications in patients with traumatic cataract and loss of zonular support.
No author has a financial or proprietary interest in any material or method mentioned.
Journal of Cataract and Refractive Surgery 03/2012; 38(3):431-6. · 2.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose. To evaluate the outcome of silicone intubation and tube removal in external dacryocystorhinostomy (DCR) patients with distal canalicular or common canalicular obstruction. Method. Seventy-five eyes of 69 patients with distal or common canalicular obstruction who had undergone external DCR and silicone tube insertion were included in the study. Silicone tube was left in place at least for 3 months. Presence of epiphora was questioned and patency was assessed by irrigation at each control after tube removal. Results. Mean patient age was 49.8±14.4 years (range 15-78) and mean follow-up after surgery was 13.2±4.2 months (range 6-25). After tube removal, 16 eyes (21.3%) presented with epiphora and occluded canalicular systems. Two eyes (2.7%) presented with epiphora which started just after tube removal and had a patent canalicular system. Fifty-seven eyes (76%) were free of symptoms and had patent canalicular systems and 3 of these eyes (4%) had epiphora while the tube was in place. Conclusions. Silicone intubation is indicated in patients with distal or common canalicular obstruction. The majority of patients with canalicular problems are relieved of epiphora after silicone tube removal. However, the tube itself may transiently occlude the canalicular system and cause epiphora in some patients, and in some it can aid tear flow even in the presence of a patent system.
European journal of ophthalmology 02/2012; 22(6):878-881. · 0.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a case of group G Streptococcus endophthalmitis following an intravitreal ranibizumab injection for a choroidal neovascular membrane. Pars plana vitrectomy was applied for endophthalmitis and group G Streptococcus cultures were isolated in the vitreous samples taken from the patient. Twenty-four hours following pars plana vitrectomy the patient underwent myocardial infarction and cardiac arrest. To our knowledge this is the first reported case of group G Streptococcus endophthalmitis following an intravitreal injection.
[Show abstract][Hide abstract] ABSTRACT: To compare the changes in endothelial cell density (ECD) in post-penetrating keratoplasty (PKP) patients after cataract extraction with phacoemulsification or planned extracapsular cataract extraction (ECCE).
Haydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey.
Eyes with hard nuclear cataract that had previous PKP were randomly assigned to have phacoemulsification or ECCE. Noncontact specular microscopy was performed preoperatively and 1, 3, and 6 months postoperatively.
Twenty-six eyes of 26 patients were enrolled (14 phacoemulsification; 12 ECCE). Six months postoperatively, the mean corneal ECD was statistically significantly lower in the phacoemulsification group (1869.50 cells/mm(2) ± 158.05 [SD]) than in the ECCE group (1996.00 ± 127.96 cells/mm(2)) (P=.024). The mean percentage of endothelial cell loss at 6 months was 20.3% and 12.7%, respectively (P<.05). In both groups, there was no significant difference in the percentage hexagonality between preoperatively and postoperatively (P>.05).
Extracapsular cataract extraction seemed to cause less endothelial cell damage than phacoemulsification in post-PKP patients with hard nuclear cataract.
Journal of Cataract and Refractive Surgery 08/2011; 37(8):1512-6. · 2.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We compared outcomes of deep anterior lamellar keratoplasty (DALK) and automated lamellar therapeutic keratoplasty (ALTK) in patients with keratoconus.
Seventy eyes with keratoconus that underwent corneal transplantation using either DALK (n = 40) or ALTK (n = 30) were included in this retrospective study. DALK was performed with Anwar's big-bubble technique and ALTK using an ALTK system. Best-corrected visual acuity (BCVA), refractive results, and complications were analyzed.
Mean follow-up in the DALK (16.68 ± 3.36 months) and ALTK (15.27 ± 2.50 months) groups were similar (p = 0.058). Mean final BCVA of patients in the DALK group was 0.31 ± 0.14 logarithm of the minimum angle of resolution (logMAR) and in the ALTK group 0.34 ± 0.15 logMAR, (p = 0.492). Corresponding figures for final postoperative spherical equivalents were -3.45 ± 0.77 D and -4.19 ± 0.99 D, respectively (p = 0.001). Final postoperative degree of astigmatism was similar in the two groups: DALK -4.28 ± 0.66 D; ALTK -4.50 ± 1.05 D (p = 0.307).
Final visual acuity outcomes were comparable for the DALK and ALTK groups. Thus, ALTK seem to be as efficacious as DALK for surgical treatment of keratoconus.
Japanese Journal of Ophthalmology 06/2011; 55(4):327-32. · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The evaluation of anatomic and visual outcomes in macular hole cases treated with internal limiting membrane (ILM) peeling, brilliant blue (BB), and 23-gauge pars plana vitrectomy (PPV).
Fifty eyes of 48 patients who presented between July 2007 and December 2009 with the diagnosis of stage 2, 3, or 4 macular holes according to Gass Classification who had undergone PPV and ILM peeling were included in this study. Pre- and postoperative macular examinations were assessed with spectral-domain optical coherence tomography. 23 G sutureless PPV and ILM peeling with BB was performed on all patients.
The mean age of patients was 63.34 ± 9.6 years. Stage 2 macular hole was determined in 17 eyes (34%), stage 3 in 24 eyes (48%), and stage 4 in 9 eyes (18%). The mean follow-up time was 13.6 ± 1.09 months. Anatomic closure was detected in 46/50 eyes (92%), whereas, in four cases, macular hole persisted and a second operation was not required due to subretinal fluid drainage. At follow-up after 2 months, persistant macular hole was detected in one case and it was closed with reoperation. At 12 months, an increase in visual acuity in 41 eyes was observed, while it remained at the same level in six eyes. In three eyes visual acuity decreased. There was a postoperative statistically significant increase in visual acuity in stage 2 and 3 cases (P < 0.05), however, no increase in visual acuity in stage 4 cases was observed.
PPV and ILM peeling in stage 2, 3, and 4 macular hole cases provide successful anatomic outcomes, however, in delayed cases, due to photoreceptor loss, it has no effect on functional recovery. BB, used for clarity of ILM, may be beneficial due to its low retinal toxicity.