State and Trait Anxiety Scores of Patients Receiving Intravitreal Injections.

BACKGROUND: To evaluate parameters on the state and trait anxiety scores of patients receiving intravitreal injections. METHODS: One hundred thirteen patients were included in the study. All subjects received intravitreal ranibizumab or bevacizumab injections. To measure the level of anxiety, Spielberg's State-Trait Anxiety Inventory questionnaire was used. RESULTS: The mean state anxiety scores were 45.19 ± 5.62 in experienced patients and 43.10 ± 6.62 in inexperienced patients (p = 0.078). The mean trait anxiety scores were 50.14 ± 6.62 in experienced patients and 49.17 ± 10.79 in inexperienced patients (p = 0.810). Additionally, there was no statistically significant difference in the state and trait anxiety scores between the male and female, employed, and retired patients (p > 0.05). CONCLUSION: Anxiety may not show significant differences according to sociodemographic status. High anxiety scores found in this study also emphasize that health care providers should try to decrease anxiety levels during the course of treatment.

Intravitreal aflibercept injection and photodynamic treatment of a patient with unilateral subretinal neovascular membrane associated with fundus flavimaculatus.

We report the good outcome of combined intravitreal aflibercept injection and photodynamic treatment in a case with fundus flavimaculatus (FFM) and unilateral subretinal neovascular membrane (SRNM). A 57-year-old man with FFM and unilateral SRNM who was treated with two consecutive ranibizumab injections with no improvement at another institution was referred to us. He was treated successfully with three aflibercept injections three months apart and a single photodynamic treatment performed a week after the initial aflibercept injection. Six weeks after the last aflibercept injection visual acuity was improved and submacular exudation exhibited dramatic resolution with a moderate degree of residual scarring. SRNM formation is rarely observed in eyes with FFM and a satisfactory outcome can be achieved with a proper treatment.

Efficacy of selective laser trabeculoplasty in phakic and pseudophakic eyes.

PURPOSE: To compare the efficacy of selective laser trabeculoplasty (SLT) in phakic and pseudophakic eyes in open-angle glaucoma and ocular hypertension. MATERIALS AND METHODS: Charts of 28 pseudophakic eyes and 60 phakic eyes that underwent 360-degree SLT were retrospectively reviewed. Patients were examined at 1, 3, 6, and 12 months. Treatment success was defined as ≥20% intraocular pressure (IOP) reduction, with no additional medications, laser, or glaucoma surgery. Mean IOP change, mean percentage of IOP reduction, and success rates for phakic and pseudophakic eyes were compared. RESULTS: Mean percentage of IOP reduction post-SLT at 1-, 3-, 6-, and 12-month visits were 21.4%, 25.8%, 24.8%, and 23.7%, respectively, in the pseudophakic group and 22.8%, 25.0%, 25.7%, and 21.2%, respectively, in the phakic group. Success rates ranged between 60% and 64% in the pseudophakic group and between 58% and 73% in the phakic group. No statistically significant differences in IOP change, percentage of IOP reduction, and success rate were seen between the groups at any of the post-SLT visits (P>0.05). CONCLUSIONS: Application of 360-degree SLT seems to be an efficient and safe treatment option for the management of phakic and pseudophakic open-angle glaucoma and ocular hypertension.

Comparison of dorzolamide/timolol versus brimonidine/timolol fixed combination therapy in the management of steroid-induced ocular hypertension.

PURPOSE: To compare the efficacy of fixed combinations of dorzolamide-timolol (FCDT) and brimonidine-timolol (FCBT) in patients with intraocular pressure (IOP) elevations after intravitreal triamcinolone acetonide (IVTA) injections. MATERIALS AND METHODS: This was a prospective, randomized, open-label study. Patients who received IVTA injections due to diffuse diabetic macular edema and who had an IOP of 24 mm Hg or higher after IVTA treatment were included. They were randomized to receive either FCBT or FCDT twice daily. Follow-up visits were scheduled on week 4 and 12 weeks after starting the study medication. At all follow-up visits, IOP was measured with Goldmann applanation tonometry. The primary outcome measure was mean IOP, the secondary outcome was reduction in mean IOP at 4 and 12 weeks compared with postinjection values. RESULTS: Sixty patients were randomized in 1:1 ratio. The FCBT and FCDT groups were similar in terms of age, sex, and preinjection IOP (P>0.05 for all). Mean postinjection IOP was 31.95±7.39 and 29.83±5.17 mm Hg in FCBT and FCDT groups, respectively (P=0.239). After 4 weeks, mean IOP was 17.05±3.61 mm Hg in FCBT and 18.93±3.30 mm Hg in FCDT groups (P=0.063). After 12 weeks, mean IOP in the FCBT and FCDT study groups was 16.35±2.70 and 18.43±2.82 mm Hg, respectively (P=0.012). Both fixed combinations significantly reduced IOP in comparison with the postinjection values (P<0.05). Mean reduction in IOP after 4 weeks were 14.90±7.28 mm Hg in FCBT and 10.90±4.83 mm Hg in FCDT groups (P=0.024); after 12 weeks, these values were 15.60±7.77 and 11.40±5.89 mm Hg in FCBT and FCDT groups, respectively (P=0.035). CONCLUSIONS: Both FCBT and FCDT are effective in controlling IOP elevations after IVTA injections. The results of this study suggest that FCBT is superior to FCDT in reducing IOP and provides better IOP control after IVTA injections.

Bilateral intravitreal dexamethasone implant for retinitis pigmentosa-related macular edema.

PURPOSE: To report the efficacy of intravitreal dexamethasone implant in a patient with retinitis pigmentosa and bilateral cystoid macular edema unresponsive to topical carbonic anhydrase inhibitors. CASE REPORT: A 36-year-old man with bilateral cystoid macular edema associated with retinitis pigmentosa that was unresponsive to topical carbonic anhydrase inhibitors underwent bilateral 0.7-mg intravitreal dexamethasone implants two weeks apart. Spectral domain optical coherence tomography revealed resolution of macular edema one week following each injection in both eyes and his visual acuity improved. However, macular edema recurred two months later in OS and three months later in OD. Second implant was considered for both eyes. No implant-related complication was experienced during the follow-up of seven months. CONCLUSION: Inflammatory process seems to play a role in retinitis pigmentosa. Intravitreal dexamethasone implant may offer retina specialists a therapeutic option especially in cases unresponsive to other treatment regimens in eyes with retinitis pigmentosa-related macular edema.

Comparison of spectral-domain optical coherence tomography and Heidelberg retina tomograph III optic nerve head parameters in glaucoma.

BACKGROUND: To evaluate the agreement between the optic nerve head (ONH) measurements obtained by spectral-domain optical coherence tomography/scanning laser ophthalmoscope (SD-OCT/SLO) and the Heidelberg retinal tomograph III (HRT-III), and to compare the ONH measurements of both devices in different glaucoma types. METHODS: In a prospective study, 30 patients with primary open-angle glaucoma (POAG) and 30 patients with pseudoexfoliation glaucoma (PXG) were enrolled. All patients underwent SD-OCT/SLO and HRT-III evaluation of the ONH during the same visit. Agreement between measurements of SD-OCT/SLO and HRT-III were evaluated by determination of intraclass correlation coeficients. In addition, mean ONH measurements obtained with both devices were compared between POAG and PXG patient groups. RESULTS: Mean SD-OCT/SLO measurements were greater than those of HRT-III, except for mean and maximum cup depth. Intraclass correlation coefficient values for disc area, rim area, cup area, cup/disc area ratio, mean cup depth and maximum cup depth were 0.367, 0.213, 0.632, 0.681, 0.775 and 0.661, respectively. No significant differences were found between ONH parameters of POAG and PXG patients as measured with both devices (p > 0.01). CONCLUSION: ONH measurements with SD-OCT/SLO and HRT-III did not show clinically acceptable agreement in glaucoma patients. This precludes interchangeable use of these measurements in clinical practice. PXG and POAG patient groups displayed similar ONH measurements with both devices.

Surgically induced changes in corneal viscoelastic properties after 23-gauge pars plana vitrectomy using ocular response analyzer.

PURPOSE: To evaluate surgically induced changes in corneal viscoelastic properties of patients undergoing 23-gauge transconjunctival sutureless vitrectomy (23-G TSV). METHODS: The study group consisted of 29 eyes of 29 patients undergoing 23-G TSV. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), corneal compensated intraocular pressure (IOPcc) and central corneal thickness (CCT) were measured by ocular response analyser (ORA), preoperatively and 1 and 3 months postoperatively. Goldmann applanation tonometry (GAT) was also performed in the same time periods. The ORA measurements before and after the surgery were compared statistically. In addition, the ORA measurements of a control group comprising of 29 normal subjects were also compared with the preoperative measurements of the patient group. Finally the relationship between the CH values and the CCT and GAT values was also assessed. RESULTS: The preoperative ORA measurements of the study group were similar to those of the control groups' (p > 0.05 for all). In the study group, mean CH decreased and mean IOPcc increased significantly at 1 month compared with their respective preoperative values (p = 0.04 and p = 0.03, respectively). However CH and IOPcc measurements at 3 months were similar to the preoperative measurements (p > 0.05). Mean CRF, IOPg, GAT and CCT measurements did not change significantly during the study period (p > 0.05). CH was weakly correlated with CCT preoperatively, 1 and 3 months postoperatively (r = 0.33, r = 0.33, r = 0.43, p < 0.05 for all, respectively). There was also a weak but significant correlation between CH and GAT preoperatively (r = 0.42, p = 0.008), 1 month postoperatively (r = 0.36, p = 0.03), 3 months postoperatively (r = 0.40, p = 0.01). CONCLUSION: Corneal viscoelastic properties are not significantly influenced in the late postoperative period by 23-G TSV which is a minimal invasive vitreoretinal surgical technique.

An unusual association of Goldenhar syndrome.

Goldenhar syndrome is well known for its classical triad of epibulbar dermoids or lipodermoids, auricular appendages and pretragal fistulas. Here we report a case of Goldenhar syndrome with an unusual association of a fibroepithelial polyp attached to a limbal dermoid. A case of Goldenhar syndrome in a 5-month-old male infant presented with the features of a fibroepithelial polyp attached to a limbal dermoid, right-sided polydactylia with hypoplastic thumb, and accessory preauricular appendages on the left side. The association of a fibroepithelial polyp attached to a limbal dermoid with Goldenhar syndrome is a rare report in the literature. In these cases, regular follow-up with an ophthalmologist is important to monitor the visual development of the patient. Ideally, a multidisciplinary approach is required to manage the other associated anomalies.

Idiopathic Inflammatory Neuroretinitis Simulating Optic Nerve Sheath Dural Ectasia.

We report a case of a 32-year-old female patient who presented with decreased vision on both eyes and headache. In fundus examination, both eyes had elevation of the optic disc and star shaped hard exudates in the macula. Magnetic resonance imaging was completely normal except the saccular dilatation of bilateral optic nerve sheath. The patient was treated with oral steroids following high-dose intravenous methylprednisolone. She displayed good anatomical and functional results during the follow-up. This case raises the possibility that optic nerve sheath enlargement, probably induced by an idiopathic inflammatory optic neuritis, may simulate dural ectasia of the optic nerve sheath.

Resolution of vitreomacular traction following intravitreal triamcinolone acetonide injection in an eye with branch retinal vein occlusion.

A 60-year-old woman with a past medical history of branch retinal vein occlusion presented with decreased vision and metamorphopsia in her left eye. A fundus examination revealed a tortuous retinal vein with a few retinal hemorrhages in the inferotemporal quadrant. Optical coherence tomography revealed a partially separated posterior vitreous membrane pulling up the fovea. The patient refused surgical treatment so intravitreal triamcinolone acetonide (4 mg/0.1 mL) was administered. The patient reported resolution of symptoms in her left eye following this treatment, but her visual acuity did not show any improvement. Optical coherence tomography scanning revealed a complete detachment of the posterior hyaloid with release of the vitreomacular traction. In patients with vitreomacular traction and branch retinal vein occlusion, the combination of the possible vitreous liquefaction and mechanical increase of vitreous volume caused by an intravitreal injection with a degree of reduction in retinal thickness may play a role in the resolution of vitreomacular traction.

Cornea plana associated with open-angle glaucoma: a case report.

Cornea plana is a rare disease in which the cornea is flattened with a low refractive power. In addition to these features, hypermetropia, deep central corneal opacities, hazy corneal limbus, peripheral scleralization of the cornea and early arcus senilis can also be seen. Closed-angle glaucoma may occur as a result of shallow anterior chamber and narrow angle; however, open-angle glaucoma has also been reported in these patients. Measuring the real intraocular pressure (IOP) value of such eyes is difficult since tonometers are affected by corneal curvature. Therefore, the diagnosis of glaucoma may be delayed for a long time. In this case report we aimed to present a case of cornea plana with early open-angle glaucoma and to investigate which tonometer was appropriate for measuring the correct IOP value in such eyes.

Trabeculectomy for advanced glaucoma.

The objective of this study is to evaluate the visual prognosis and postoperative course in advanced glaucoma patients who underwent trabeculectomy. The records of 30 patients with advanced visual field (VF) defects undergoing trabeculectomy were retrospectively reviewed. Severe VF defects were defined as those with a sensitivity of ≤5 dB either in more than 85% of test points, excluding the central four points, or in >75% of test points, including three of the central four points with threshold automated perimetry. Main outcome measures were intraocular pressure (IOP), corrected visual acuity (VA) and mean deviation (MD) of VF tests. Mean preoperative IOP, VA and MD values were compared with their respective postoperative values. The latest examination of each patient was used to determine postoperative outcome measures. In addition, any complications encountered were recorded. A total of 34 trabeculectomies were performed. The mean age was 59.3 years (13-80 years). The mean follow-up time was 41.1 months (3-120 months). Preoperatively the mean IOP was 28.4 ± 13.1 mmHg, and the mean postoperative IOP was 14.8 ± 5.0 mmHg (P = 0.001). Preoperatively the mean VA was 0.87 ± 80, and the mean value of the MD was -24.5 ± 6.7 dB. At the latest follow-up there was no significant difference in VA (0.89 ± 79, P = 0.699) and MD (-23.9 ± 6.7, P = 0.244) values. Transient hypotony occured in five eyes while one eye with mitomycin C trabeculectomy experienced extended hypotony. Ten eyes showed reduction of VA between 1 and 5 lines due to cataracts and five eyes had late bleb failure with uncontrolled IOP. One patient had late endophthalmitis and one patient presented with blebitis, both of which were successfully treated. No patients experienced wipe-out phenomenon. In conclusion, our study of advanced glaucoma patients undergoing trabeculectomy, vision was preserved with no cases of unexplained loss of central vision. IOP was largely controllable, with cataract being the leading factor decreasing VA at late term.

Corneal biomechanical properties during the menstrual cycle.

PURPOSE: To determine if corneal biomechanical properties change during phases of the menstrual cycle. METHODS: Twenty-five healthy women of reproductive age with no ocular pathology or systemic diseases were recruited. Corneal hysteresis, corneal resistance factor, Goldman-correlated intraocular pressure, and corneal-compensated intraocular pressure were measured by a Reichert ocular response analyzer at three phases of the menstrual cycle, beginning on days 3 to 5 (follicular phase), again at ovulation (days 14-16, ovulatory phase), and at the end of the cycle (days 25-28, luteal phase). RESULTS: Twenty-one participants completed the study. The mean corneal hysteresis values at follicular, ovulatory, and luteal phases were 10.7, 10.7, and 10.7 mmHg (p > 0.05), and the mean corneal resistance factor values at the same time points were 9.9, 9.9, and 9.8 mmHg (p > 0.05), respectively. Corneal-compensated intraocular pressure and Goldman-correlated intraocular pressure readings were stable during the course (p > 0.05 for all). CONCLUSIONS: Corneal biomechanical properties and intraocular pressure as measured by an ocular response analyzer do not change statistically significantly during the different phases of the menstrual cycle. We conclude that measurements of the ocular response analyzer can be safely utilized in healthy female subjects without considering the possible effects of varying hormonal levels during the menstrual cycle.

The relationship between angiotensin converting enzyme insertion/deletion polymorphism and age-related macular degeneration.

BACKGROUND: To assess the role of serum angiotensin converting enzyme (ACE) levels and ACE insertion /deletion (I/D) genetic polymorphism in Turkish age-related macular degeneration (AMD) patients and control subjects. METHODS: This prospective study consisted of 78 patients with AMD and 68 control subjects. The I/D polymorphism of the ACE was carried out by polymerase chain reaction. Serum ACE levels were determined by using the ELISA method. RESULTS: There was no significant difference in the mean serum values of ACE between the control and patient groups (p = 0.107). The genotypic frequencies of ACE polymorphism in the control and patient groups were not significantly different either (p = 0.218). CONCLUSION: We could not show a significant role of serum ACE levels and ACE I/D genetic polymorphism in the etiopathogenesis of AMD in the Turkish population, and our findings did not support the idea that serum ACE levels and ACE DD genotype were risk factors for AMD.

Congenital iris ectropion associated with juvenile glaucoma.

Congenital iris ectropion is an uncommon malformation of the anterior segment of the eye. The authors describe a case of bilateral congenital iris ectropion associated with juvenile glaucoma in an otherwise healthy 9-year-old girl. Intra-ocular pressure (IOP) measured by Goldmann applanation tonometry was 40 mmHg in the right eye and 32 mmHg in the left eye. Despite maximum IOP lowering therapy, the desired IOP levels needed to prevent further progression of the glaucoma could not be achieved. Visual field testing and confocal scanning laser tomography showed glaucomatous neuropathy. Trabeculectomy with antimetabolites (mitomycin C 0.2 mg/ml) was performed in both eyes and IOP was normalized without IOP lowering medications during a follow-up of 4 years. The authors point out the importance of recognizing congenital iris ectropion early to prevent blindness in young patients and improve their prognosis.

Ocular manifestations and surgical results in patients with Alport syndrome.

We report the ocular manifestations of Alport syndrome and the surgical results in 4 patients. All 4 patients had anterior lenticonus; 2 also had posterior lenticonus in both eyes, 3 had flecked retina, and 1 had posterior polymorphous dystrophy. In both eyes of the 4 patients, phacoemulsification with intraocular lens (IOL) implantation was performed to treat anterior and posterior lenticonus. The postoperative visual acuity was excellent in all patients. We recommend phacoemulsification with IOL implantation as a safe and effective procedure in patients with lenticonus secondary to Alport syndrome.

Macular edema in unregulated type 2 diabetic patients following glycemic control.

BACKGROUND: We undertook this study to evaluate the changes in macular edema of uncontrolled type 2 diabetes mellitus patients with the regulation of hyperglycemia. METHODS: The study population was comprised of 35 type 2 diabetes mellitus patients who had poorly regulated blood glucose values. Ophthalmic examinations including baseline and 6-month macular edema index values of patients by Heidelberg Retinal Tomography (HRT) macular module were done. RESULTS: Twenty four (68.6%) female patients and 11 (31.4%) male patients with a mean age of 50.7 +/- 10.3 (mean +/- SD) years and mean diabetic duration of 9.8 +/- 7.5 years participated in the study. Twenty two (62.9%) did not have diabetic retinopathy (DR), whereas 13 (37.2%) had background DR with macular edema. There was a significant correlation between duration of diabetes and HRT-II macula edema index for the right and left eyes (r = 0.40, p = 0.21 and r = 0.40, p = 0.22, respectively). CONCLUSIONS: Macular edema did not change significantly by regulation of glycemic control in the study group.