Trapezoid-quadrilateral technique of frontalis suspension with synthetic material

To describe a new method of frontal suspension [FS] to prevent recurrences, undercorrection, and cosmetic problems, and to share our experience in treatment of congenital ptosis using the trapezoid quadrilateral technique [TQT] and synthetic materials. Twenty-four eyes of 18 patients, admitted to Ankara Numune Training and Research Hospital 3rd Eye Clinic, Ankara, Turkey, between January 2002 to December 2004, were operated with a new method. All the patients had congenital ptosis, and they were 2-27 years old. Twelve of them were female and 6 of them were male. In this new method, the upper eyelid is fixed to the frontalis muscle from 2 points. The visual axis was open, and there was good symmetry between both eyes at the end of a mean of 14 months follow-up. There was granuloma formation in both eyes of one patient, exposure keratopathy in both eyes of another patient, and recurrence of ptosis in one eye of one patient. The TQT of FS with synthetic material does not cause any esthetic deformity and produces a balanced lifting in the upper eyelid. Therefore, we propose that it could be the preferred method in FS procedures performed with inorganic materials

Plasma homocysteine levels and vitamin B status in patients with pseudoexfoliation syndrome

To determine and compare the plasma levels of homocysteine and vitamin B [B6, B12 and folate] in patients with Pseudoexfoliation syndrome [PEXS], pseudoexfoliation glaucoma [PEXG], retinal vein occlusion with pseudoexfoliation [PEX+RVO] and in normal individuals. The current study was conducted in the Third Eye Clinic, Ankara Numune Training and Research Hospital, Turkey, between August 2004 and February 2005. Twenty cases with PEXS [Group 1], 20 cases with PEXG [Group 2], 16 cases with PEX+RVO [central or branch retinal vein occlusion] [Group 3] and 20 normal individuals [control group] were included in the study. Those who use vitamin supplements or drugs affecting the plasma homocysteine levels were excluded from the study. Plasma homocysteine levels were 17.6 +/- 4.4 mmol/l in Group 1, 18.5 +/- 4.5 mmol/l in Group 2, 22.2 +/- 6.0 mmol/l in Group 3, and 14.0 +/- 3.1 mmol/l in the control group. It was highest in Group 3 [p<0.001]. The ratio of hyperhomocysteinemia was calculated as 35% [Group 1], 45% [Group 2], 68.7% [Groups 3] and 15% [control]. These values were statistically higher in the groups with PEXS than in the control group [p=0.009]. We did not find any statistically significant difference between the groups with respect to the levels of vitamin B6 and B12 [p>0.05], but the level of folate was lowest in Group 3 [p<0.001]. Hyperhomocysteinemia is a risk factor for thromboembolic vasculopathy in patients with PEXS and PEXG. Therefore, vitamin B supplementation should be considered in these patients when hyperhomocysteinemia is detected