The effect of room illumination on the measurement of anterior segment parameters.

OBJECTIVE: To evaluate the effect of room illumination on the measurement of anterior segment parameters. METHODS: In this comparative study, measurements of anterior segment parameters of 25 eyes of 25 healthy patients were performed by optical low-coherence reflectometry (OLCR). Measurements were taken under photopic conditions (150 lux) and under mesopic conditions (3 lux). Paired t test by SPSS 16.0 was used to compare the anterior segment measurements performed in both conditions. A P value lower than 0.05 was accepted as statistically significant. RESULTS: The mean age of the patients was 27.09±1.72 years (range, 20-40 years). Of the anterior segment parameters, axial length and keratometry did not show significant difference between photopic and mesopic conditions (P=0.541 and P=0.812, respectively). The mean anterior chamber depth measurements was 3.04±0.35 mm and 3.06±0.35 mm, whereas the mean lens thickness was 3.75±0.36 mm and 3.77±0.36 mm in the mesopic and photopic conditions, respectively. The mean pupil diameter measurement was 4.86±0.70 mm under photopic conditions and 6.36±0.94 mm under mesopic conditions. The anterior chamber depth, lens thickness, and pupil diameter showed significant difference between photopic and mesopic conditions (P=0.01, P=0.006, and P=0.0001, respectively). CONCLUSION: Anterior chamber depth, lens thickness, and pupil diameter were affected by the changes in luminance while performing measurements with OLCR. Considering the age of the study group, further studies are needed to test the measurement of accommodation amplitude.

Exogenous group G Streptococcus endophthalmitis following intravitreal ranibizumab injection.

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.

Congenital ptosis and amblyopia.

PURPOSE: To investigate the incidence and causes of amblyopia in congenital ptosis. METHODS: The frequency and causes of amblyopia were evaluated in 83 eyes of 72 patients with congenital ptosis. Patient ages ranged between 10 months and 70 years. Amblyopia was defined as best-corrected visual acuity of 0.7 or less. After a complete ophthalmologic examination, the amount of ptosis and levator function was determined and the following amblyogenic factors were identified: ametropia, anisometropia, and strabismus. In cases with no other reason for amblyopia, stimulus deprivation amblyopia due to ptosis was assumed. RESULTS: The amount of ptosis was mild in 5 (6%), moderate in 26 (31%), and severe in 52 (63%) of 83 eyes with congenital ptosis. Strabismus was present in 17 (20%) eyes. Visual acuity could not be determined in 10 of 83 eyes with ptosis in children younger than 4 years. The overall incidence of amblyopia in the remaining 73 eyes was 48%. Of those patients with amblyopia, 54% had refractive errors such as anisometropia or ametropia, 20% had strabismus with or without refractive errors, and 26% had amblyopia solely attributed to ptosis. When all eyes with ptosis were included, the rate of stimulus deprivation amblyopia was 12% and all of these eyes had severe ptosis. CONCLUSION: Early detection and treatment of amblyogenic factors such as refractive errors and strabismus is recommended and, when the pupillary axis is occluded with severe ptotic eyelids, surgery should be performed as soon as possible to prevent stimulus deprivation amblyopia.

Toric intraocular Collamer lens for high myopic astigmatism after penetrating keratoplasty.

A toric intraocular Collamer lens (ICL) was used to correct myopic astigmatism after penetrating keratoplasty. The patient's manifest refraction improved from -8.0 -1.75 x 170 preoperatively, with an uncorrected distance visual acuity (UDVA) of 0.15 and a corrected distance visual acuity (CDVA) of 0.4, to +0.75 -0.50 x 130 postoperatively, with a UDVA of 0.8 and a CDVA of 1.0. No serious complications or refractive changes occurred during the 1-year follow-up. Implantation of a myopic toric ICL in phakic eyes is an option to correct postkeratoplasty anisometropia and astigmatism.

Inadvertent use of water-based ink instead of trypan blue in cataract surgery.

We report a case of iris atrophy and corneal endothelial decompensation following the inadvertent use of water-based ink for capsular staining during cataract surgery. The anterior chamber was thoroughly irrigated with balanced salt solution after the identification of the wrong dye. Phacoemulsification with minimal ultrasound energy and intraocular lens implantation were performed without complications, and the operation was completed. The patient finally developed bullous keratopathy and underwent penetrating keratoplasty 4 months later.

Primary implant placement with evisceration in patients with endophthalmitis.

PURPOSE: We report the results of 25 patients with endophthalmitis treated with evisceration with and without cornea preservation and primary orbital implants. DESIGN: Retrospective observational case series. METHODS: The records of 25 consecutive patients who underwent evisceration for endophthalmitis between June 1999 and November 2005 were reviewed. Ages ranged between three and 90 years (mean 57.6 years). The cause of endophthalmitis and bacterial agents were documented. All the patients were treated with topical, intravitreal, and intravenous antibiotics for endophthalmitis before evisceration. RESULTS: The follow-up period was between two months and 79 months (mean 25.4 months). All patients had relief from their pain and were satisfied with their cosmetic appearance and motility. Implant exposure was noted in three (12%) patients and pyogenic granuloma in one (4%) patient, which were treated successfully. Eighteen of the patients had prosthesis fitting at least eight weeks after operation. Seven patients elected to not have prosthesis. CONCLUSION: Unless the endophthalmitis is secondary to severe devastating trauma in which there is no sclera left, primary orbital implant placement with evisceration in these patients is an acceptable treatment.

Pseudallescheria boydii keratitis.

We describe a patient with Pseudallescheria boydii keratitis. The treatment of mycotic keratitis remains difficult. This case demonstrates that identification and susceptibility testing should be rapidly performed. In cases of indolent keratitis, the possibility of fungal infection should be kept in mind.

Therapeutic applications of lotrafilcon a silicone hydrogel soft contact lenses.

PURPOSE: To investigate the effectiveness of silicone hydrogel soft contact lenses for therapeutic applications. METHODS: The study included 37 patients who had bullous keratopathy (n=12), recurrent corneal erosion (n=9), filamentous keratitis (n=3), corneal melting after corneal surgery (n=4), lamellar lacerations (n=4), or chemical trauma (n=5) and were fitted with silicone hydrogel soft contact lenses between May 2000 and August 2003 in First Eye Clinic of Kartal Training and Research Hospital. Changes in corneal signs by slitlamp evaluation, judgment of pain relief, additional complications, and success of therapeutic lens treatment were reported. Appropriate medical therapy was given as required. RESULTS: A total of 83.78% of the patients had complete healing, and 8.1% of the patients showed at least partial improvement. Visual acuity improved in 56% of patients, and pain relief was achieved in 91.16% of the patients. No additional complications were reported in relation to the lenses. CONCLUSIONS: The use of high-Dk lotrafilcon A soft contact lenses for therapeutic purposes is safe, effective, and practical.

Evisceration via superior temporal sclerotomy.

PURPOSE: To describe evisceration via superior temporal equatorial sclerotomy with preservation of the cornea as an alternative technique. DESIGN: Retrospective case series. METHODS: Records of 31 consecutive patients who underwent evisceration via superior temporal equatorial sclerotomy between November 1996 and November 2002 were reviewed. Patient age ranged from 1 to 79 years (mean, 27.93 years). Posterior sclerotomies were performed in 14 eyes (45%). The surgical indications, prior ocular surgeries, complications, cornea alterations, cornea sensitivities, size and material of the implants, and the motility of the globes with and without prosthesis were evaluated. RESULTS: Average follow-up was 31.68 months (range, 5-77 months). No intraoperative complications occurred. One patient had late-term pain due to partial implant extrusion from the melted cornea. All corneas remained clear until the 1st month after surgery. After the 2nd month some corneas became semiopaque (61%) and totally opaque (16%). Seven corneas remained clear (23%). Cornea vascularization started in the second week postsurgery in all patients. It was limited peripherally in six patients and moved forward to the central part in 25 patients. No patient had corneal sensation. In one case, keratitis occurred at month 13 postsurgery; in another, conjunctival dehiscence in the superior temporal region was noted, 26 months after surgery, due to esotropia resulting from pressure exerted on the region by the prosthesis. Globe motility was satisfactory in all patients. CONCLUSIONS: Implant motility is satisfactory and the implant exposure rate is low with this technique.