A novel surgical technique for prevention of Ahmed glaucoma valve tube exposure: long scleral flap augmented with Tenon advancement and duplication.

BACKGROUND: To describe a new technique and present its long-term outcome for prevention of Ahmed glaucoma valve (AGV) tube exposure in patients with refractory glaucoma. METHODS: Twenty-seven eyes of 24 patients (mean age, 50 years; age range, 16-78 years; 8 females, 16 males) with refractory glaucoma who had the AGV implant were retrospectively reviewed. For AGV implantation, a long scleral flap combined with Tenon advancement and duplication was used. In this technique, a long scleral flap is created to completely cover the extraocular part of valve's tube, and the flap surface is covered with duplicated Tenon's tissue. The average follow-up after AGV implantation was 21.7 months (range, 12-36 months). RESULTS: The mean intraocular pressure before the operation, which was 44.1 mmHg (range, 26-62 mmHg), decreased to 14.2 mmHg (range, 8-20 mmHg) at the last follow-up visit, showing 67% reduction with AGV implantation. The mean number of antiglaucomatous medications was 4.1 before the AGV implantation and decreased to 0.9 after the operation, showing 88% reduction. In 14 eyes (51.9%), there was no change in the best corrected visual acuity (BCVA), and in 11 eyes (40.7%), the BCVA increased by 2 lines on the Snellen chart postoperatively. No patient developed postoperative hypotony, flat anterior chamber, diplopia, strabismus, erosion or exposure of the tube, or tube/plate migration. CONCLUSIONS: The long scleral flap augmented with Tenon advancement and duplication is an effective and safe surgical technique for the implantation of AGV and preventing tube exposure in cases of refractory glaucoma.

The influence of the learning effect on automated perimetry in a Turkish population.

PURPOSE: To evaluate the influence of learning effect on the outcome of automated perimetry and to assess the factors associated with the learning effect in a Turkish population. METHODS: The Swedish Interactive Threshold Algorithm (SITA) standard 30-2 test was performed on a Humphrey Visual Field Analyzer in 102 normal Turkish subjects who had not previously undertaken any form of perimetry. Each subject completed three testing sessions, each separated by at least one day. The SITA standard 30-2 testing sessions included both eyes. The right eye was always tested before left eye. The reliability parameters, test duration and visual field (VF) global indices (mean deviation [MD] and pattern standard deviation [PSD]) obtained from right eyes in the first and third sessions were compared to assess the learning effect. Change in these parameters between the first and third sessions was calculated, and the effect of gender, age and educational level on this change was evaluated. RESULTS: The reliability parameters, test duration and VF global indices each improved between the first and third sessions (P ≤ 0.001). The change in the parameters was greater in subjects over 50 years of age and with an educational level less than high school (P ≤ 0.01). No correlation was found between learning effect and gender. CONCLUSION: In normal Turkish subjects, a significant learning effect was observed during VF testing with the SITA standard 30-2. The learning effect was correlated with age and educational level.

[Effectiveness of topical ciclosporin A treatment after excision of primary pterygium and limbal conjunctival autograft]. / Efficacité du traitement topique de ciclosporine A après excision du ptérygion primaire et autogreffe conjonctivo-limbique.

AIM: To study the efficacy and safety of topical ciclosporin A (CsA) as an adjunctive therapy after surgical treatment of primary pterygium including excision and limbal conjunctival autograft (LCA) with respect to postoperative pain and complications. PATIENTS AND METHOD: A prospective randomized clinical study was conducted in 60 consecutive patients with primary pterygium. Sixty eyes were operated on using the same surgical technique including excision and LCA. Thirty eyes were randomly treated with topical 0.05% CsA for 3 months after the surgery as a supplement to the standard topical therapy. All patients were followed for postoperative pain using the visual analog scale (VAS) for 1 week after surgery and for complications including recurrences for a period of 1 year. RESULTS: The average VAS was significantly lower in the CsA group (p=0.034). There was only one recurrence (3.4%) in the CsA group (n=28) and five recurrences (17.9%) in the control group (n=29). The other complications were substantial graft scarring (one in the CsA group, three in the control group), Tenon's granuloma (0/2), and fibrovascular proliferation (1/3). The ratio of the cases with no complications was statistically significantly higher in the CsA group (p=0.017). CONCLUSION: This study shows that topical CsA therapy after pterygium surgery may reduce postoperative pain and also decreases complications including recurrences.

The effects of artificial tear application on contrast sensitivity in dry and normal eyes.

PURPOSE: To investigate the effects of artificial tear application on contrast sensitivity in dry and normal eyes. METHODS: A total of 55 patients with normal (10/10) corrected or uncorrected visual acuity referring to GATA Gulhane Military Medical Academy Haydarpasa Ophthalmology Outpatient Clinic were evaluated in regard to dry eye diagnostic criteria, and assigned into the dry eye group (Group 1; 35 patients) and the control group (Group 2; 20 patients). All patients were given a contrast sensitivity testing at low and high spatial frequencies using the gradual contrast sensitivity chart before and at 5 minutes after application of artificial tears, and the two groups were compared. Wilcoxon test was used in statistical analysis, accepting a p value of <0.05 as significant. RESULTS: In the dry eye group, there was a statistically significant increase in contrast sensitivity scores both at low and high frequencies after application of artificial tears (p<0.05). In the control group, although there was a significant increase in low frequency scores after artificial tear application (p< 0.05), there was not a significant change in high frequency scores (p>0.05). CONCLUSIONS: The decreased contrast sensitivity in dry eyes improves with application of artificial tears. Therefore, the impeded quality of vision seen in dry eye patients could be restored closer to normal with artificial tear therapy. Besides, contrast sensitivity testing could be used in the follow-up of artificial tear therapy.

The effects of artificial tear application on contrast sensitivity in dry and normal eyes.

PURPOSE: To investigate the effects of artificial tear application on contrast sensitivity in dry and normal eyes. METHODS: A total of 55 patients with normal (10/10) corrected or uncorrected visual acuity referring to GATA Gulhane Military Medical Academy Haydarpasa Ophthalmology Outpatient Clinic were evaluated in regard to dry eye diagnostic criteria, and assigned into the dry eye group (Group 1; 35 patients) and the control group (Group 2; 20 patients). All patients were given a contrast sensitivity testing at low and high spatial frequencies using the gradual contrast sensitivity chart before and at 5 minutes after application of artificial tears, and the two groups were compared. Wilcoxon test was used in statistical analysis, accepting a p value of <0.05 as significant. RESULTS: In the dry eye group, there was a statistically significant increase in contrast sensitivity scores both at low and high frequencies after application of artificial tears (p<0.05). In the control group, although there was a significant increase in low frequency scores after artificial tear application (p< 0.05), there was not a significant change in high frequency scores (p>0.05). CONCLUSIONS: The decreased contrast sensitivity in dry eyes improves with application of artificial tears. Therefore, the impeded quality of vision seen in dry eye patients could be restored closer to normal with artificial tear therapy. Besides, contrast sensitivity testing could be used in the follow-up of artificial tear therapy.

Review of sterile, postoperative, anterior segment inflammation following cataract extraction and intraocular lens implantation.

PURPOSE: To evaluate unexpected, acute intraocular anterior segment inflammation following uneventful cataract extraction by phacoemulsification and foldable posterior chamber intraocular lens (PCIOL) implantation. METHODS: This retrospective study evaluated five cases of postoperative inflammation that occurred after cataract extraction with foldable PCIOL implantation. Medical records were reviewed to analyze the unexplained postoperative inflammation. RESULTS: The five patients who developed inflammatory activity during the postoperative period responded well to corticosteroid treatment. Toxic maculopathy developed in one patient after aggressive antibacterial therapy. Vitrectomy was performed for one patient with prolonged vitreal inflammatory activity. CONCLUSIONS: Noninfectious endophthalmitis developing upon surgery may be caused by a multifactorial process or an interindividual variable response to a common factor as a hypersensitivity reaction. It should be remembered in inflammatory cases after surgery in order to prevent the toxic, irreversible side effects of bacterial endophthalmitis treatment.

The effects of three-piece or single-piece acrylic intraocular lens implantation on posterior capsule opacification.

PURPOSE: To evaluate the development of posterior capsule opacification (PCO) in patients implanted with 5.5 mm optics, single-piece or three-piece acrylic intraocular lens (IOL) in cataract surgery prospectively. METHODS: This study was carried out on 267 eyes of 249 patients implanted with three-piece, 5.5 mm optics, acrylic IOL and 252 eyes of 244 patients implanted with single-piece, 5.5 mm optics, acrylic IOL by phacoemulsification technique between September 2001 and February 2003. A total of 519 eyes of 493 patients were prospectively evaluated for PCO development during the 25-month period. All the patients were analyzed periodically with anterior segment retroillumination photography. The data provided were analyzed with chi-square method. RESULTS: The results between the two groups for PCO development were not statistically significant. However, there was a prominent opacification of the posterior capsule where the optic and haptic junction of IOL was positioned in some patients implanted with single-piece IOL. During the follow-up period, no patients implanted with either three-piece or single-piece acrylic IOL required Nd:YAG laser capsulotomy. CONCLUSIONS: Biocompatibility and reduced rate of PCO development are among the leading features of new generation IOLs. The intracapsular implantation of 5.5 mm optics acrylic IOLs resulted in decreased incidence of PCO and therefore greater patient satisfaction. Further studies investigating the effects of IOL optics, haptic structure and length, capsulorrhexis size, and IOL material and design features on PCO development will clarify the subject.

The effects of three-piece or single-piece acrylic intraocular lens (IOL) implantation on posterior capsule opacification.

PURPOSE: To evaluate the development of posterior capsule opacification (PCO) in patients implanted with 5.5 mm optics, single-piece or three-piece acrylic intraocular lens (IOL) in cataract surgery prospectively. METHODS: This study was carried out on 267 eyes of 249 patients implanted with three-piece, 5.5 mm optics, acrylic IOL and 252 eyes of 244 patients implanted with single-piece, 5.5 mm optics, acrylic IOL by phacoemulsification technique between September 2001 and February 2003. A total of 519 eyes of 493 patients were prospectively evaluated for PCO development during the 25-month period. All the patients were analyzed periodically with anterior segment retroillumination photography. The data provided were analyzed with chi-square method. RESULTS: The results between the two groups for PCO development were not statistically significant. However, there was a prominent opacification of the posterior capsule where the optic and haptic junction of IOL was positioned in some patients implanted with single-piece IOL. During the follow-up period, no patients implanted with either three-piece or single-piece acrylic IOL required Nd:YAG laser capsulotomy. CONCLUSIONS: Biocompatibility and reduced rate of PCO development are among the leading features of new generation IOLs. The intracapsular implantation of 5.5 mm optics acrylic IOLs resulted in decreased incidence of PCO and therefore greater patient satisfaction. Further studies investigating the effects of IOL optics, haptic structure and length, capsulorrhexis size, and IOL material and design features on PCO development will clarify the subject. (Eur J Ophthalmol 2004; 14: #-80).

The effect of capsulorhexis size on development of posterior capsule opacification: small (4.5 to 5.0 mm) versus large (6.0 to 7.0 mm).

PURPOSE: The most common surgically related cause of reduced vision after extracapsular cataract extraction is posterior capsule opacification (PCO), which occurs in up to 50% of eyes following cataract extraction. This study examined whether small capsulorhexes of 4.5 to 5.0 mm, which lie completely on the 5.5 mm intraocular lens (IOL), and large capsulorhexes of 6.0 to 7.0 mm, which lie completely off the lens optic, are effective in preventing PCO development. METHODS: In this prospective study, 496 eyes of 367 patients underwent standardized phacoemulsification with capsulorhexis and capsular bag foldable acrylic IOL implantation. The patients were randomly assigned to receive either a small capsulorhexis of 4.5 to 5 mm to lie completely on the IOL optic or a large capsulorhexis of 6 to 7 mm to lie completely off the lens optic. Retroillumination photographs were taken at 6 months and then yearly. RESULTS: Throughout the follow-up, there was less PCO in the small capsulorhexis group than in the large capsulorhexis group. CONCLUSIONS.:Small capsulorhexes were associated with less wrinkling of the posterior capsule and less PCO than were large capsulorhexes. PCO after IOL implantation has a multifactored pathogenesis. Small (4.5 to 5.0 mm) capsulorhexis and capsular bag implantation of 5.5 mm acrylic IOL are likely to reduce the PCO incidence when compared with the 6.0 to 7.0 mm capsulorhexis. The significance of the IOL optic diameter in association with the capsulorhexis size should also be documented by further studies.

Palbebral anthrax.

PURPOSE: Anthrax is a rare infection transmitted to humans from animals or animal products. In cutaneous anthrax it may produce lesions of the eyelids which can lead to cicatricial ectropion. METHODS: We examined three women and five men with anthrax of the eyelids. Intravenous penicillin G was used alone as therapy. RESULTS: All patients presented with a localized itchy erythematous papule of the eyelid. A necrotising ulcer formed in each case, resulting in black eschar. The lesions resolved, with only mild cicatrization of the eyelid in all the patients. CONCLUSIONS: Anthrax is primarily an infectious disease of domestic animals but it is also seen in humans. Eyelids are rarely affected but cutaneous anthrax should be considered in any patient with a painless ulcer or black eschar who has a history of exposure to animals.

Ocular findings in Sturge-Weber syndrome.

PURPOSE: We reviewed the rare ocular findings of Sturge-Weber syndrome (SWS) and the results of implantation of the Ahmed valve in cases associated with glaucoma. METHODS: Seven patients (range 18 to 52 years) diagnosed as SWS were reviewed as clinical findings over two years. An anterior chamber maintainer was placed in patients with glaucoma to maintain stable intraocular pressure and minimize the risk of intraocular hemorrhage due to sudden pressure changes during surgery, when an Ahmed valve is implanted. RESULTS: Episcleral venous vessels were prominent in all cases. Diffuse choroidal hemangiomas were seen in three cases. Nevus of Ota was observed in only one case. Three cases had juvenile glaucoma. One also had buphthalmos. No intraocular hemorrhage or choroidal effusion was observed intraoperatively in valve-implant patients. The surgical treatment of the patients with glaucoma gave favorable outcomes. CONCLUSIONS: Rare ocular findings such as choroidal hemangioma and nevus of Ota are sometimes seen in SWS. Drainage valve implantation, with an anterior chamber maintainer, is a good choice for treatment when surgery is done in cases with glaucoma. This method may reduce the risk of intraoperative suprachoroidal effusion and expulsive hemorrhage by stabilizing intraocular pressure within normal limits during the surgery.

The comparison of cyclopentolate and atropine in patients with refractive accommodative esotropia by means of retinoscopy, autorefractometry and biometric lens thickness.

PURPOSE: In this study, we aimed to compare the cycloplegic effect of cyclopentolate HCI 1% and atropine sulphate 1% in patients with refractive accommodative esotropia by means of retinoscopy, autorefractometer and the measurement of lens thickness by biometry. METHODS: Thirty-two patients with refractive accommodative esotropia aged from 5 to 10 (mean 6.8+/-1.4), had a deviation under 10 prism diopters, and underwent retinoscopic, autorefractometric and biometric study in dry and wet conditions. RESULTS: The retinoscopic, autorefractometric and biometric findings of the right eye were 5.10+/-1.21 diopter (D), 5.03+/-1.20 D, 3.43+/-0.16 mm with cyclopentolate, and 5.2+/-1.2 D, 5.2+/-1.2 D, 3.4+/-0.1 mm with atropine. In the left eye, the measurements were 5.2+/-1.4 D, 5.1+/-1.4 D, 3.5+/-0.2 mm with cyclopentolate, and 5.3+/-1.2 D, 5.20+/-1.3 D, 3.4+/-0.2 mm with atropine, respectively. When these obtained data were compared by the Student's t test no statistical significance was found (p > 0.05). CONCLUSIONS: We suggest that the cyclopentolate cycloplegia applied to the patients with refractive accommodative esotropia is sufficient to produce good cycloplegia, with an effect similar to atropine.

Penetration of oral and topical ciprofloxacin into human aqueous humor.

PURPOSE: This study was planned to investigate the penetration of ciprofloxacin into aqueous humor following oral and topical application as a prophylactic antimicrobial agent. METHODS: Forty-six patients undergoing cataract surgery were randomly divided into two groups. In the first group, the patients received 500 mg oral ciprofloxacin eight hours before surgery and in the second, 5 drops of 0.3% ciprofloxacin were applied to the patients every twenty minutes, starting 100 minutes before the surgery. By paracentesis, aqueous samples were taken just before the operation so the interval between the first topical application and paracentesis was 100 minutes. RESULTS: The mean concentration of ciprofloxacin in aqueous humor was 0.63+/-0.29 microg/ml in the first group. The concentration was 0.69+/-0.30 microg/ml in the second group. Both of these mean concentrations were higher than the levels of MIC90 of S.aureus , S. epidermidis, P. aeruginosa and Gram (-) bacteriae. CONCLUSION: As a result, both topically and orally applied ciprofloxacin achieved a significant aqueous concentration. Each route studied might be suitable for surgical prophylaxis or treatment of infections.