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.

Effect of a single intravitreal bevacizumab injection on different optical coherence tomographic patterns of diabetic macular oedema.

PURPOSE: The aim of this study is to compare the therapeutic effect of a single intravitreal bevacizumab (IVB) injection in eyes with diabetic macular oedema (DMO) of different patterns determined by optical coherence tomography (OCT). METHODS: Medical records of patients who had a single IVB injection for DMO were analysed retrospectively. Eyes with a clinically significant DMO and a central foveal thickness (CFT) of 250 µm or more determined by OCT were included in the analysis. Best-corrected visual acuity (BCVA), CFT and total macular volume values before and after the injection were recorded. Eyes were divided into sponge-like diffuse retinal thickening (DRT), cystoid macular oedema (CMO) and serous retinal detachment (SRD) groups according to the morphology on OCT. RESULTS: A total of 92 eyes (42 with DRT, 31 with CMO and 19 with SRD) were included in the study. There was no statistically significant variation between three groups regarding the change in BCVA (P=0.695). CMO and SRD groups had greater reductions in their mean CFT, and the amount of reduction showed statistically significant variation between three groups (P=0.048). However, no statistically significant difference was found between groups in terms of percentage of change in CFT (P=0.278). CONCLUSION: CMO and SRD subtypes are associated with a greater reduction in the CFT than the DRT subtype. Although the change in BCVA was not significantly different between groups, the DRT group showed markedly better visual improvement in proportion to the decrease in CFT.

The effects of MK-801 and U-83836E on post-ischemic reperfusion injury in rat brain.

Rats were subjected to incomplete cerebral ischemia induced by occlusion of common carotid arteries for 30 min, and subsequent reperfusion for 15 min. The concentrations of reduced glutathione (GSH), malondialdehyde (MDA) and superoxide dismutase (SOD) activity were determined in the dorsal hippocampus in order to evaluate their changes during ischemia and reperfusion following ischemia. The depletion of GSH was observed during ischemia with a further depletion during post-ischemic reperfusion (P < 0.001), while a significant increase in SOD activity and MDA levels was found only after reperfusion following ischemia (P < 0.001). Animals in which ischemia was followed by reperfusion were treated with a non-competitive NMDA receptor antagonist, MK-801 (1 mg/kg, i.v.), and a radical scavenger, U-83836E (5 mg/kg, i.v.), prior to ischemia. Although a full recovery of GSH levels was not observed following MK-801 and U-83836E pretreatment as compared to control (P < 0.05), MK-801 was more potent than U-83836E in the partial protection of the GSH pool (P < 0.05 and P < 0.01, respectively). The rise in SOD activity and MDA level were brought close to those of control due to the effects of both MK-801 and U-83836E (P > 0.05). In conclusion, the tissue changes in GSH concentrations evoked by ischemia and reperfusion were partially prevented by the effects of both drugs, MK-801 having the greater effect. This suggests that the NMDA receptor activation may play a role in the generation of reactive oxygen species. On the other hand, the inhibition of lipid peroxidation brought about by both MK-801 or U-83836E suggests the therapeutic efficiency of these agents in ischemia/reperfusion injury.

Problems in running a tuberculosis dispensary in a developing country: Turkey.

Declining use of the services of local dispensaries has often been suggested as a significant factor in the rising trend of tuberculosis in Turkey after 1970. Data confirming this view were insufficient until this study, which consists of an evaluation of the records of 51,086 subjects seen by the tuberculosis dispensary in Elazig between 1985-1989. We found that, despite an expected yearly population increase, there were no significant differences in the numbers of diagnostic and follow-up procedures as well as preventive and therapeutic interventions recorded in different years, and that cases of active tuberculosis lost to follow-up had gradually increased. The least effective method of case-finding, mass screening, had been employed most frequently. These results revealed a less than optimum use of the services of the tuberculosis dispensary and prompted us to suggest the following changes: (1) diversion of economic resources currently used for mass screening in order to use them for better purposes; (2) functional integration of tuberculosis dispensaries with local, general or university hospitals, since a separate system for tuberculosis care is accompanied by a segregating and stigmatising effect for all concerned; (3) entering all patients and contacts into a computerised database to alleviate the problems associated with inadequate follow-up. We conclude that existing control programmes should be reviewed and improved to prevent an increase of tuberculosis, particularly in developing countries like Turkey.