Surgical Treatment of Bullous Exudative Retinal Detachment Secondary to Atypical Bilateral Central Serous Chorioretinopathy

This study aimed to report the diagnostic process, treatment, and follow-up of a patient with bullous exudative retinal detachment (RD) associated with an atypical variant of bilateral central serous chorioretinopathy (CSCR). A 28-year-old woman was referred to our clinic for total bullous RD in the right eye with a vision level of light perception only. She had been previously diagnosed with idiopathic uveal effusion syndrome and treated with systemic corticosteroid therapy with no response, and was referred to us for scleral window surgery. Four-quadrant scleral window surgery with external drainage of the subretinal fluid was performed, resulting in a transient partial attachment of the retina. RD started to progress again within 3 weeks, which prompted comprehensive imaging together with more advanced systemic workup for systemic lupus erythematosus and other rheumatological and immunological diseases. Systemic corticosteroid therapy was initiated during this period but did not stop the progression and was discontinued after a short time. Fluorescein angiography and indocyanine green angiography revealed multifocal choroidal leakage foci and large choroidal vessels without any intraocular inflammation findings and led to the diagnosis of atypical CSCR. Pars plana vitrectomy (PPV), internal drainage of the subretinal fluid, endolaser to the focal leakage areas, and intravitreal aflibercept injection were performed. Visual acuity increased to 0.8 within 8 months after the surgery with no recurrence. Bullous exudative RD is a very rare and atypical form of CSCR, and a favorable outcome can be obtained with PPV and surgical drainage of subretinal fluid followed by laser photocoagulation.

Evaluation of Central and Peripheral Retinal Vascular Changes in the Fellow Eyes of Patients with Unilateral Retinal Vein Occlusions

Objectives

To evaluate the subtle peripheral retinal and macular vascular changes in the fellow eyes of patients with unilateral retinal vein occlusion (RVO).

Materials and Methods

This retrospective study included 53 patients with unilateral RVO and 44 age-matched controls. The frequency of peripheral retinal vascular pathologies in both eyes was evaluated using high quality ultra-wide field fluorescein angiography (UWFFA). Macular vascular density, flow area, and foveal avascular zone measurements from optical coherence tomography angiography (OCTA) were analyzed together with laser flare photometry values in patients and controls.

Results

Peripheral retinal vascular pathologies were detected on UWFFA in the fellow eyes of 36 (67.9%) patients. No significant central vascular pathologies were detected on OCTA and there was no significant difference in OCTA parameters between the fellow eyes and the controls. Flare values did not differ significantly between the control and the fellow eyes.

Conclusion

Two thirds of the fellow eyes of unilateral RVO patients had subtle peripheral retinal vascular changes, while there was no significant microvascular change detected with OCTA in the macula. This suggests that vascular changes caused by systemic vascular disorders probably first start in the peripheral retina of the fellow eyes of patients with RVO.

Analysis of corneal biomechanical properties 25 years after myopic photorefractive keratectomy

PURPOSE

To evaluate corneal biomechanical changes using Corvis ST in patients treated with photorefractive keratectomy (PRK) 25 years ago.

METHODS

In this study, 32 post-PRK and 38 normal eyes underwent Corvis ST (CST) assessments. The measured CST factors were: time of highest concavity (HC), time of applanation 1 (AT1), time of applanation 2 (AT2), length of applanation 1 (AL1), length of applanation 2 (AL2), velocity of applanation 1 (AV1), velocity of applanation 2 (AV2), deformation amplitude (DA), peak distance (PD), integrated radius (IR), Ambrosio relational thickness horizontal (ARTh), stiffness parameter at first applanation (SP-A1), DA ratio (2 mm), Belin/Ambrosio enhanced ectasia display (BAD) and corneal biomechanical index (CBI).

RESULTS

The mean [± standard deviation (SD)] age was 51.4 ± 7.36 years in PRK, 51.4 ± 3.62 in control group. PRK was performed 24.69 ± 1.78 years ago. ARTh, SP-A1, AT1, AL1, and AL2 were lower in PRK. PD, AT2, DA ratio (2 mm), and IR were statistically higher in PRK (P < 0.01). In PRK and control group the mean value of CBI was 0.91 ± 0.11 and 0.50 ± 0.27 (P < 0.001), and mean value of BAD was 3.34 ± 1.53 and 1.1 ± 0.70 (P < 0.001). In PRK 71.9% of eyes were classed "high risk CBI plus diseased BAD" and 25% remained in the "high risk CBI and normal BAD" group.

CONCLUSIONS

In this study, most of the post-PRK eyes which were clinically and topographically normal were classified as "high risk CBI plus diseased BAD" and had significantly worse CBI and BAD values than the control group. This leads to the conclusion that CBI and BAD alone are not appropriate to evaluate post-PRK ectasia.

Bilateral acute Iris transillumination after COVID-19 pneumonia

PURPOSE

To report the diagnosis, treatment and follow-up of a case of bilateral acute iris transillumination (BAIT) developed after COVID-19 pneumonia.

METHOD

Case report.

CASE

A 66-year-old male patient with COVID-19 pneumonia received systemic treatments of favipiravir, prednisolone, moxifloxacin and piperacillin-tazobactam during hospitalization. The patient applied to our clinic with the complaint of blurred vision 20 days after the diagnosis of COVID-19. The best corrected visual acuity (BCVA) was 0.3 in the right eye and 0.5 in the left eye. In the anterior segment examination; ciliary injection, intense pigment dispersion in the anterior chamber, pigment deposits on the lens and iris, 2-3 + cells in the anterior chamber, posterior synechia, and 360 degrees diffuse iris transillumination were observed in both eyes. The pupillary response to light was weak. Bilateral fundus examination were normal. In the anterior chamber sample; HSV, VZV, CMV and Toxoplasma PCR were negative. Bilateral acute iris transillumination (BAIT) diagnosed in the patient and topical 0.1% dexamethasone and topical 1% cyclopentolate were started. In the follow-up, visual acuity increased 1.0 in both eyes, there were no cells in the anterior chamber, and the pigment dispersion was still continuing despite a decrease.

CONCLUSION

BAIT, which can usually be seen after upper respiratory tract infections, can also be seen after covid 19 pneumonia and be kept in mind as a possible eye involvement in patients with COVID-19 infection.

Intraocular mitomycin C use in the treatment and prophylaxis of proliferative vitreoretinopathy in severe traumatic retinal detachments

PURPOSE

To evaluate the anatomic and visual outcomes of a new intraocular mitomycin c (MMC) application technique in the treatment of severe traumatic retinal detachment (RD) with advance proliferative vitreoretinopathy (PVR).

METHODS

The records of 15 eyes of 14 patients who underwent vitreoretinal surgery and intraoperative MMC application were reviewed retrospectively.

SURGICAL TECHNIQUE

After performing complicated vitreoretinal surgical procedures (Pars plana vitrectomy, PVR membrane stripping, large retinotomy/retinectomies and intraocular foreign body removal if found etc. . .) retina was attached with perfluorocarbon liquid (PFCL) and partial fluid-air exchange. Endolaser was performed. PFCL was removed to the posterior borders of retinochoroidal wounds, breaks or retinectomy sites. The remaining PFCL was enough to cover and prevent MMC contact with the posterior vital structures including optic disc, macula and underlying RPE and major vascular arcades. Ciliary epithelium and other anterior segment structures were protected from MMC contact with the use of air in the rest of the eye. Then, a 10 µg/mL concentrated MMC solution was carefully injected above the PFCL bubble until it covered PVR or potential areas of PVR development and removed after 60 s. Finally, the remaining PFCL was removed and all eyes were filled with silicone oil. The patients were followed at least 6 months after silicone oil removal. Visual and anatomic outcomes were determined during follow-up period.

RESULTS

The mean follow-up time was 19.6 ± 6 months (range 12-27 months). About 100% retinal attachment was achieved with one vitreoretinal surgery during the follow-up period. PVR was not detected around the retinal breaks or retinotomy sites in any eye. Limited macular epiretinal membrane was detected in two eyes and subsequently peeled during silicone oil removal. Preoperative visual acuities were hand motions in seven eyes and light perception in eight eyes. Nine of 15 eyes had a visual acuity of ⩾0.1 during the follow-up period. The mean preoperative visual acuity was logMAR 2.16 ± 0.15 and postoperative visual acuity was 0.80 ± 0.50 (p = 0.001). There were no additional complications related to intraoperative MMC use during follow-up period.

CONCLUSION

Temporary intraocular MMC use in vitreoretinal surgery yielded good anatomic and visual outcomes after the treatment of traumatic RDs with PVR or those with high risk of PVR development. Furthermore, MMC application appeared to prevent further PVR development after vitreoretinal surgery.

Intravitreal Dexamethasone Implant in the Treatment of Non-infectious Uveitis

Objectives:

To evaluate the long-term results of intravitreal dexamethasone implant (DEX) for noninfectious uveitis.

Materials and Methods:

The study included 62 eyes of 44 patients treated with DEX implant due to noninfectious uveitis and followed up for at least a year. Best-corrected visual acuity (BCVA), central foveal thickness, intraocular pressure (IOP), vitreous haze score, indications, immunomodulatory therapy and steroid usage before/after injection, number of injections, and adverse events were analyzed retrospectively.

Results:

Average follow-up was 20 months (range 12-64 months). The female/male ratio was 29/15. Mean age was 50 years (range 22-75 years). The most frequent uveitis etiologies were idiopathic (25 patients, 40.3%) and Behçet’s uveitis. (17 patients, 27.4%) The signedmost common indication for DEX injection was cystoid macular edema together with resistant vitreous haze (26 eyes, 41.9%). Twenty-two eyes (30%) received more than one DEX injection. Mean BCVA was improved from 0.55 logMAR at baseline to 0.38, 0.32, and 0.35 after 1, 3, and 6 months, respectively (p<0.001 for each). Mean CFT was decreased from 386 μm at baseline to 288, 311, and 302 μm after 1, 3, and 6 months, respectively (p<0.001 for each). Mean IOP did not change significantly during follow-up. Five eyes (8%) received topical anti-glaucoma medication (IOP ≥25 mmHg). Eighteen (46%) of 39 phakic eyes underwent cataract surgery during follow-up. Similar efficacy of the DEX implant was observed in eyes that received multiple injections. Systemic immunomodulatory therapy did not change significantly during follow-up.

Conclusion:

Intravitreal DEX injection does not alter systemic immunomodulatory therapy, but may facilitate the management of noninfectious uveitis by suppressing local intraocular inflammation. Multiple injections yielded comparable visual and anatomical outcomes to single injections. Follow-up for ocular hypertension and cataract formation are important, especially in eyes receiving multiple injections.

Effectiveness of Intravitreal Dexamethasone Implant Treatment for Diabetic Macular Edema in Vitrectomized Eyes

Objectives:

To report the effectiveness and long-term outcomes of intravitreal dexamethasone implantation for diabetic macular edema (DME) in vitrectomized eyes

Materials and Methods:

Medical records of patients were retrospectively reviewed. Time of pars plana vitrectomy (PPV), PPV indications, interval between DEX injection and PPV, other intravitreal treatment prior to DEX application, best corrected visual acuity (BCVA), intraocular pressure (IOP), and central retinal thickness (CRT) measured by optical coherence tomography were recorded.

Results:

Seventeen eyes of 17 patients were included in the study. The mean follow-up after DEX injection was 21±2.4 months (12-43 months). The female/male ratio was 11/6. Mean age was 60.7 years (46-70 years). Sixteen eyes (94.1%) were pseudophakic at the time of DEX treatment. The most common indication for PPV was tractional retinal detachment (8 eyes, 47.1%). Ten eyes (58.8%) received a single injection and a total of 30 DEX implantations were performed. Mean BCVA was 0.77 logarithm of the minimum angle of resolution (logMAR) units before the first injection and improved to 0.64, 0.68 and 0.66 logMAR after 1, 3 and 6 months, respectively (p<0.01). CRT decreased significantly from 452 µm at baseline to 310, 368±34 and 375 µm after 1, 3 and 6 months, respectively (p<0.04). Mean IOP was 16±1.2 mmHg at baseline and 18.2, 18.8 and 18.5 mmHg after 1, 3, and 6 months (p>0.05). Two eyes (%8) received topical anti-glaucoma medication (IOP≥25 mmHg). Similar results were observed in eyes receiving repeated DEX injections.

Conclusion:

Intravitreal DEX injection treatment seems to be effective for improving BCVA and decreasing CRT in vitrectomized eyes with DME. This effect seemed to last for 6 months in most eyes, but maximized at 3 months. Patients with repeated injections often require injection before 6 months.

A Novel Surgical Method to Treat Chronic Ocular Hypotony

BACKGROUND AND OBJECTIVES

To assess the effect of a novel surgical method for the treatment of chronic ocular hypotony (COH). The surgical method involves partially blocking the iridocorneal angle and decreasing aqueous humor outflow. A capsular tension ring (CTR) is placed in the iridocorneal angle.

PATIENTS AND METHODS

Thirteen eyes of 13 patients were included in this retrospective, interventional case series. All of the eyes had severe ocular hypotony with a diagnosis of hypotony after vitreoretinal surgery or glaucoma filtration surgery. A CTR was placed in the iridocorneal angle via a corneal incision. The follow-up period was at least 1 year. Main outcome measurement was intraocular pressure (IOP).

RESULTS

IOP increased in all of the eyes. The increase in IOP persisted during the follow-up period. Visual acuity increased or stabilized in all of the eyes. No ocular complications were noted due to the procedure.

CONCLUSIONS

The authors have described a novel and simple technique for the setting of IOP in COH. Mechanical obstruction of aqueous humor outflow with a CTR can increase IOP and stabilize or improve vision in eyes with COH for a follow-up time longer than 12 months. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e56-e60.].

A Short Duration Transient Ischemia Induces Apoptosis in Retinal Layers: An Experimental Study in Rabbits

Purpose

To investigate retinal cell apoptosis in an experimental transient, short duration ocular ischemia model.

Methods

An experimental ischemia model, which simulates creating temporary high intraocular pressure to control intraocular bleeding during pars plana vitrectomy, was set up. Rabbits were randomly divided into three groups. Group 1 was the control group. In Group 2, intraocular pressure was increased to 97 mmHg for 5 minutes. In Group 3, intraocular pressure was increased to 97 mmHg for 10 minutes. After 24 hours, terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling assay was used to detect retinal apoptosis in rabbit eyes. Only nuclear staining in retinal cells was counted.

Results

Groups with 5 minutes and 10 minutes of ischemia showed significantly higher amount of ganglion cell layer apoptosis when compared with the control group (p<0.05). Light microscopy and standard hematoxylin-eosin did not show any significant damage in the retina cells.

Conclusions

Apoptotic cell death in the retinal cell layers occurs in temporary ischemia-reperfusion as early as 5 and 10 minutes duration.

Ciliary Tissue Transplantation in the Rabbit Eye: Does the Localization of the Graft Affect Survival?

PURPOSE

To examine whether ciliary body transplantation is applicable, the graft is viable and the localization of the graft material affects graft survival.

METHODS

Fifteen female New Zealand white rabbits were used. Three of them were used as donors, and a ciliary body graft was prepared from their enucleated eyes. There are two groups in the study according to the localization of the ciliary body graft in the anterior chamber. The graft was placed on the iris surface close to the pupil margin in group 1 and adjacent to the anterior chamber angle in group 2. Immunosuppressive treatment with cyclosporine A was given to the rabbits of both groups. The rabbits were sacrificed 1 month after ciliary transplantation, and their eyes were enucleated. After fixation, the graft and the surrounding tissue were examined by a pathologist macroscopically and microscopically with hematoxylin and eosin staining.

RESULTS

One month after the transplantation, the treated eyes remained inflammation free, and the transplants seemed to be viable with evident vascularization and without hemorrhage and necrotic tissue. When we compared groups 1 and 2, there were no statistically significant differences in the histopathological findings between the groups. The grafts were found to be similar with normal ciliary tissue in regard to necrosis, hemorrhage and fibrosis, and there were no statistically significant differences in inflammatory cell density and in the epithelial cell morphology between the normal ciliary tissue and the grafts.

CONCLUSION

Transplantation of allograft ciliary tissue either onto the surface of the iris or the anterior chamber angle under immunosuppression could be an effective treatment for chronic ocular hypotony.

Neuroprotective effect of topically applied brimonidine tartrate 0.2% in endothelin-1-induced optic nerve ischaemia model

BACKGROUND

To investigate the neuroprotective effects of topically applied brimonidine tartrate 0.2% (BMD), an alpha(2)-receptor agonist, on the retinal ganglion cell (RGC) layer and inner nuclear layer (INL) of rabbit retina in endothelin-1 (ET-1)-induced optic nerve (ON) ischaemia model.

METHODS

Osmotic minipumps were surgically implanted into one eye of 16 New Zealand Albino rabbits to deliver ET-1 at the constant rate of 0.5 microL/h for 2 weeks. Eyes were divided into four groups. ET-1 was given with (Group 3) and without topical BMD therapy (Group 1). Groups 2 and 4 were taken as controls. Rabbits were sacrificed at day 14. Morphological alterations, total cell number and proportion of cells undergoing apoptosis in INL and RGC layer were assessed by histopathological analysis to determine the survival of the cells of the INL and RGC layer.

RESULTS

Endothelin-1 led to severe reduction of cells in both the RGC layer and INL in Group 1 (P < 0.05). In Group 3, the total cell number and the proportion of cells undergoing apoptosis in the RGC layer were comparable with the control group (Group 4), whereas the former was found to be higher and the latter was found to be lower than those recorded for Group 1. However, the total cell number in the INL was found to be lower in Group 3 compared with that of Group 4, despite topical BMD therapy (P < 0.05).

CONCLUSIONS

Topically applied BMD seems to be neuroprotective and antiapoptotic in the ET-1-induced ON ischaemia model, especially for RGCs. BMD might be used as an adjuvant agent for its neuroprotective effects in hypoxic-ischaemic conditions such as diabetic retinopathy, normotensive glaucoma and other retinal vascular occlusive conditions which require further investigations.

Measurement of anterior lens growth after acute primary angle-closure glaucoma

BACKGROUND

To investigate the effect of transpupillary thermotherapy (TTT) on choroidal neovascularization (CNV) secondary to angioid streaks.

METHODS

Six eyes of 5 patients with an average age of 61 years were diagnosed to have subfoveal CNV secondary to angioid streaks. Four of the CNVs were predominantly classic and 2 were occult with no classic. Visual acuity (VA) measurement, ophthalmoscopic and fluorescein angiographic examination, and optic coherence tomography (OCT) were carried out before TTT treatment and at each follow-up visit. Activity scores (AS) based on clinical, angiographic, and OCT findings were also recorded.

RESULTS

The mean follow-up was 12 months. The VA initially ranged from counting fingers to 20/100 and remained stable in all patients. The mean greatest lesion diameter increased significantly from 2221 microm to 3109 microm at last follow-up (p=0.046). The mean AS decreased significantly from 6.5 to 4.8 at the 3rd month (p=0.039), but tended to increase thereafter. Retreatment with TTT was applied to 5 eyes after a mean of 7.8 months but did not decrease CNV activity as effectively as the first treatments. A fibrotic scar developed in 1 eye after the first treatment.

INTERPRETATION

TTT may decrease the activity of CNVs secondary to angioid streaks in the short term, but retreatment may be necessary with unfavorable results. TTT appears to stabilize VA but not lesion size in this group of patients, which may be the natural history rather than a treatment effect.

Posterior subtenon and intravitreal triamcinolone acetonide for diabetic macular edema

AIM

To evaluate retroprospectively the clinical consequences of posterior subtenon (PSTT) and intravitreal (IVT) triamcinolone acetonide injections in diabetic macular edema (DME) refractory to conventional grid laser photocoagulation.

MATERIAL AND METHODS

Eyes with clinically significant DME refractory to grid laser photocoagulation were assessed for the inclusion in the study. Complete ophthalmic examination with fluorescein angiography (FA) and optic coherence tomography (OCT) were performed before and in the 1st, 3rd, and 6th months of the treatment. The IVT group received 4 mg/0.1 ml and the PSTT group received 20 mg/0.5 ml triamcinolone injection. PSTT but not IVT injection was repeated in case of recurrent edema. IVT was also applied to the eyes with resistant macular edema after PSTT injection (secondary IVT group).

RESULTS

There were 85 eyes of 60 patients in the PSTT group and 41 eyes of 35 patients in IVT group. There were 24 eyes in the primary IVT group and 17 eyes in the secondary IVT group. Mean follow-up time was 4.1+/-1.9 and 4.6+/-2.2 months after PSTT and IVT injections, respectively. In the PSTT group, the mean visual acuity increased from 0.19+/-0.18 to 0.22+/-0.19 and the mean central foveal thickness decreased from 413.1+/-117.5 to 312.1+/-103.1 microm (P=.001 and P=.0001, respectively) during the first 3 months. In the IVT group, the mean visual acuity and central foveal thickness were found to be 0.15+/-0.14 and 494.5+/-141.3 microm before the treatment and 0.20+/-0.16 and 288.4+/-88.5 microm 3 months after the treatment, respectively (P=.008 and P=.001, respectively). The effect in central foveal thickness was significantly greater in the primary IVT group than in the PSTT group (P=.002). There was no significant difference with respect to the decrease in the central foveal thickness and increase in visual acuity between the primary and secondary IVT injections (Mann-Whitney U test, P>.05). The steroid effect started to diminish after the 3rd month. The recurrence of macular edema was seen in 7.1% in the PSTT group starting after 3 months. Twenty percent of the eyes in the PSTT group did not respond to the treatment at all and had secondary IVT injections. Significant intraocular pressure increase was found in 8.2% of the PSTT group and in 24.3% of IVT injection. There was one case of pseudomonas endophthalmitis in the IVT group.

CONCLUSION

This study is the first study comparing the clinical outcomes of PSTT and IVT injections for the treatment of DME. Both PSTT and IVT injections caused a significant increase in visual acuity and a decrease in central foveal thickness, especially in the short term. The effect was more pronounced in the IVT group; however, PSTT injection also seemed to be a safe and effective technique for the treatment of DME. Further prospective studies are warranted to assess the efficacy and side effects of IVT and PSTT injections for the treatment of DME.

Effects of intravitreal triamcinolone injection on macular edema and visual prognosis in central retinal vein occlusion

AIM

To determine the effect of intravitreal triamcinolone injection on macular edema and the visual prognosis in cases with CRVO.

METHODS

Eyes with CRVO were classified as ischemic or nonischemic according to extend of retinal capillary nonperfusion. The patients received intravitreal triamcinolone acetonide injection (4 mg/0.1 ml). A complete ophthalmologic evaluation together with flourescein angiography (FA) and optical coherence tomography (OCT) were performed for each patient at presentation and at follow-up visits. The functional and anatomical results of both groups were assessed separately.

RESULTS

A total of 22 eyes (11 ischemic, 11 nonischemic) were included in the study. Mean duration of symptoms before steroid injection was 4.9+/-5.5 months. Mean follow-up time was 11.5+/-2.4. All the eyes completed at least 9 months of examination. At least 3 lines of visual acuity increase using snellen visual acuity chart was observed in 81.8% of the eyes in nonischemic group, while only in 18.2% of the eyes in the ischemic group. In ischemic group, the mean foveal thickness was 766+/-320.7 microm at presentation, which significantly decreased to 441.7+/-166.9 microm at 9th month. In nonischemic group, the mean foveal thickness was 667+/-223 microm at presentation, which significantly decreased to 320+/-175.5 at 9th month. Significant IOP elevation was observed in 8 (36.4%) of the eyes, 75% of which could be controlled with medical treatment.

CONCLUSION

Intravitreal triamcinolone injection may be a promising and effective method for the treatment of macular edema associated with CRVO. Although anatomical results are similar in both groups, functional results are better in non-ischemic CRVO cases.

Effect of topical steroids on corneal epithelial healing after vitreoretinal surgery

PURPOSE

Topical steroid use is usually avoided in cases of corneal epithelial defect. We evaluated the effect of topical steroid treatment on corneal epithelial healing after epithelial debridement in vitreoretinal surgery.

METHODS

Our study population included 85 eyes undergoing vitreoretinal surgeries in our clinic. We prospectively compared the duration of corneal epithelial wound healing in 43 eyes in which topical dexamethasone was used with that in 42 eyes in which topical dexamethasone was not used in the early postoperative period after epithelial debridement. Factors that may retard corneal epithelial healing, including pre- and intraoperative topical solutions, median operative time, the presence of diabetes mellitus, prior ocular surgeries, pseudophakia, aphakia and the presence of intraocular gas or silicone oil in aphakic patients, were not significantly different between the two groups.

RESULTS

The mean corneal epithelial defect closure time was 59.7 +/- 2.6 hours (mean +/- SEM) in the group receiving topical steroid treatment, and 61.9 +/- 2.6 hours in the group that did not receive steroids.

CONCLUSION

Topical dexamethasone administered five times/day did not significantly retard corneal epithelial healing in subjects undergoing vitreoretinal surgery with postoperative topical steroid treatment, compared with subjects who did not receive steroid treatment.

Optical Coherence Tomographic Assessment of Diabetic Macular Edema: Comparison with Fluorescein Angiographic and Clinical Findings

PURPOSE

To compare the optical coherence tomographic (OCT) features with clinical and fluorescein angiographic (FA) findings in patients with diabetic retinopathy.

METHODS

In a retrospective study ophthalmologic examination together with FA and OCT images were obtained from 195 eyes of 110 patients with different stages of diabetic retinopathy and OCT images were obtained from 40 eyes of 20 control subjects. Fluorescein leakage characteristics were organized into five groups: no leakage (1), focal (2), diffuse (3), combined focal+diffuse leakage (4) and cystoid (5). The Pearson correlation test was used to test the correlation between visual acuity and central foveal thickness and ANOVA was used for the statistical comparison between the groups.

RESULTS

The OCT images demonstrated retinal swelling in 66.1% of eyes, cystoid macular edema (CME) in 11.8% of eyes, serous foveal detachment + swelling in 6.2% of eyes, serous foveal detachment+swelling+CME in 3.6% of eyes and normal foveal structure in 12.3% of eyes. The best-corrected visual acuity was significantly correlated with central foveal thickness (r:-0.528, p<0.01). There was 77% agreement between clinical examination and OCT results. CME was detected with OCT in 15.4% of eyes in our study, 40% of which was not detected with slit-lamp biomicroscopy and 63.3% of which was not evident in FA. None of the serous foveal detachments could be detected during slit-lamp biomicroscopy or FA.

CONCLUSIONS

OCT-3 provided objective documentation of foveal structural changes in eyes with diabetic retinopathy. Best-corrected visual acuity provided a significant correlation with the retinal thickness at the central fovea. These results indicate that OCT can facilitate deciding on the treatment protocol (surgical or medical) and follow-up of diabetic patients, which is especially important in the early stages of diabetic maculopathy when the structural changes are not yet evident with slit-lamp biomicroscopy or angiographically.

Phototherapeutic keratectomy in Schnyder crystalline corneal dystrophy

OBJECTIVE

To emphasize the effectiveness of phototherapeutic keratectomy (PTK) in a patient with Schnyder crystalline corneal dystrophy (SCCD).

METHODS

Case report.

RESULTS

Two eyes of a patient with SCCD underwent PTK. Best corrected visual acuity (BCVA) increased from 2/10 to 8/10 (plano/-1.50 x 10) in the right eye in a lit room. BCVA of the left eye was 4/10 (-8.00/-1.50 x 170) and did not change after treatment because of anisometropic amblyopia. No recurrence was detected after 68 months of follow-up.

CONCLUSION

PTK may be effective in the treatment of SCCD, especially if the crystals are the cause of visual disturbance.

The effect of blood glucose regulation on retinal nerve fiber layer thickness in diabetic patients

PURPOSE

To evaluate the effect of blood glucose (BG) regulation on the retinal nerve fiber layer (RNFL) in diabetic patients by using a scanning laser polarimeter (NFA-GDx).

METHODS

We prospectively assessed RNFL thickness in diabetic patients and an age-matched control group. Patients without diabetic retinopathy, with BG >250 mg/dl, HbA1c >8%, fructosamine >285 micromol/l and triglyceride >200 mg/dl were included in the study. RNFL assessment was performed before and after metabolic regulation of diabetes. Symmetry, superior maximum, ellipse modulation and the average thickness variables of NFA-GDx were used for the assessment. Mann-Whitney U and Wilcoxon tests were used for the statistical analysis.

RESULTS

A total of 40 diabetic patients were included in the study and a repeat RNFL examination could be performed in 22 of them following regulation of BG levels. None of the GDx variables were significantly different between pre- and postregulation measurements (p > 0.05, Wilcoxon test). The mean superior maximum, ellipse modulation and average thickness values of the diabetic group were significantly lower than the control group (p < 0.05, Mann-Whitney U-test).

CONCLUSIONS

Poor metabolic control of diabetes mellitus adversely affects the thickness of RNFL and this effect does not seem to be acute since it was not reversed by short-term BG regulation. This issue needs to be kept in mind when assessing glaucomatous progress in diabetic patients.

Reactivation of presumed adenoviral keratitis after laser in situ keratomileusis

We report a patient with reactivation of presumed adenoviral keratoconjunctivitis after laser in situ keratomileusis (LASIK) to correct high myopia. The preoperative refraction was -13.00 diopters (D) in the right eye and -14.00 D in the left eye, and the best corrected visual acuity was 20/20 in both eyes. On the first postoperative day, mild conjunctival hyperemia and multiple subepithelial infiltrations localized in the flap zone consistent with adenoviral keratoconjunctivitis were seen. After prompt treatment, the lesions resolved. As a consequence, LASIK successfully corrected the high myopia. Adenoviral keratoconjunctivitis can be reactivated after LASIK, unlike after photorefractive keratectomy, despite the absence of symptomatic and clinical findings before the procedure.

Scanning laser polarimetry in normal subjects and patients with myopia

AIMS

To examine the changes in the retinal nerve fibre layer (NFL) thickness with age and myopia in normal population.

METHODS

Retinal nerve fibre layer thickness was measured with a scanning laser polarimeter (NFA-I) in 180 normal subjects of varying age (range 7-83 years) and in 110 eyes of 85 patients with myopia of varying degrees (range -1.00 to -15.00D). They were all voluntary Anatolian people. Superior to nasal (S/N), inferior to nasal (I/N), and the superior to inferior (S/I) ratios were used for the assessment of retinal NFL thickness.

RESULTS

The mean superior NFL ratio was 2.96 and the mean inferior NFL ratio was 2.93 in normal subjects. There was a gradual decrease in NFL ratio with increasing age (simple regression analysis, p<0.05). The mean S/I ratio was 1.01 with a large variation. In patients with myopia, the mean superior NFL ratio was 2.60 and the mean inferior NFL ratio was 2.72. Superior and inferior NFL retardations, and S/I ratio in myopic patients were significantly (15.5%, 10.8%, and 4.9% respectively) lower than that of age matched normals (t test, p<0.05). There was also a gradual decrease in NFL thickness with increasing degree of myopia (simple regression analysis, p<0.05).

CONCLUSIONS

Nomograms we obtained for retinal NFL thickness may serve as reference points for the assessment of normal Anatolian people and myopic patients in future studies. NFL thicknesses gradually decreased with increasing age. Patients with myopia had significantly lower NFL thicknesses than normal subjects and, although weakened by wide age range of myopic group, there is a linear relation between severity of myopia and NFL thickness in myopic patients.

Photorefractive Keratectomy for Visual Rehabilitation of Anisometropia Induced by Retinal Detachment Surgery

PURPOSE

To evaluate the efficacy of unilateral photorefractive keratectomy to correct anisometropia induced by retinal detachment surgery.

METHODS

Photorefractive keratectomy was performed in 10 eyes of 10 patients with anisometropia induced by previous retinal detachment surgery. The Aesculap Meditec MEL 60 excimer laser was used.

RESULTS

Preoperative mean spherical equivalent refraction was -5.20 D. Mean postoperative spherical equivalent refraction was -0.25 D after a mean follow-up of 12.9 months. Mean preoperative spherical equivalent refraction difference between two eyes of 4.87 D was decreased to a mean 0.60 D postoperatively (t-test, P < .0001). All patients were free of anisometropic symptoms after laser surgery.

CONCLUSION

Unilateral photorefractive keratectomy seems to be an effective method to correct anisometropia induced by conventional retinal detachment surgery, especially for patients with spectacle and contact lens intolerance.

Corneal iron ring after hyperopic photorefractive keratectomy

PURPOSE

To report the incidence and course of corneal iron deposition after hyperopic photorefractive keratectomy (PRK).

SETTING

Gazi University, Medical School, Department of Ophthalmology, Ankara, Turkey.

METHODS

Between January 1995 and December 1997, 62 eyes had PRK to correct hyperopia.

RESULTS

Nine eyes developed corneal iron ring 5 to 8 months (mean 6.25 months +/- 1.3 [SD]) after PRK for hyperopia. The rings persisted during the mean follow-up of 19 +/- 11.09 months.

CONCLUSION

The ring-shaped iron deposition after PRK for hyperopia must be differentiated from the Fleischer ring. Our results suggest that the slitlamp findings of peripheral corneal iron deposition in hyperopic PRK patients correlate with achieved correction.

Aqueous transforming growth factor-beta-I levels in rabbit eyes after excimer laser photoablation

Transforming growth factor beta (TGF-beta) plays an important role in anterior segment wound healing, by controlling the cell proliferation and differentiation, angiogenesis, extracellular matrix composition and mediating the immunosuppressive properties of the aqueous humor. The present study was undertaken to clarify the possible changes of aqueous humor TGF-betaI levels after excimer laser photoablation. Twenty-eight New Zealand rabbits were divided into four groups of 7 rabbits each. Group 1 served as control, the central 7 mm of corneal epithelium was removed in groups 2, 3 and 4. We performed 50-microm corneal photoablation in group 3, and 100-microm ablation in group 4. After 48 h we measured the TGF-betaI levels of the aqueous humor by ELISA method. The mean TGF-betaI value of the aqueous humor was found to be 162.94+/-13.73 pg/ml in the control group. Mechanical deepithelialization did not change the TGF-betaI levels of the aqueous humor (p > 0.05). There was no significant difference between the 50-microm photoablated group and the controls (p > 0.05), but the TGF-betaI levels of the 100-microm photoablated group were found to be significantly higher than those of both the control group and 50-microm photoablated group (p < 0.05). Many factors and cytokines may induce corneal haze and myopic regression after excimer laser photoablation; our study demonstrated that TGF-betaI is one of these factors and there is a positive correlation between the depth of corneal photoablation and aqueous TGF-betaI concentrations.

Fluorometholone-induced cataract after photorefractive keratectomy

The use of topical corticosteroids following photorefractive keratectomy (PRK) is widespread. The major complications of potent corticosteroids are glaucoma and cataract formation; in order to decrease these complications, 0.1% fluorometholone administration is usually preferred after PRK. We report here a case of lens opacification which was induced by 0.1% fluorometholone administration after PRK in a period of 4 months. To our knowledge, this is the first reported case of 0.1% fluorometholone-induced cataract after PRK.