Limbal autograft and allograft transplantations in patients with corneal burns.

AIM: To investigate and compare the surgical outcomes of limbal autograft and limbal allograft transplantations in patients with corneal burns. METHODS: In total, 20 patients (n=22 eyes) with chemical burn and two patients (n=2 eyes) with thermal burn were included in this study. Limbal autograft or limbal allograft transplantation surgery was performed in all patients. HLA-typing was tested before allograft surgeries. Limbal allografting was performed in all eyes using donor tissue from live relatives. Systemic cyclosporine A was administered for immunosuppression. RESULTS: The corneal surface was successfully reconstructed in all eyes (100%) after limbal autografting, two eyes required additional amniotic membrane transplantation and one eye required allografting. The mean follow-up period for limbal autografts was 13.9 +/- 7.0 months. Limbal allografting failed to reduce corneal vascularity and opacification in five (55.6%) eyes and was successful only in four (44.4%) eyes (mean follow-up 16.2 +/- 11.2 months) (P=0.002). In all, 15 eyes undergoing limbal autografting completed re-epithelialization of the cornea at a mean of 35.6 +/- 60.2 days. The mean epithelial healing time in nine eyes undergoing limbal allografting was 13.0 +/- 7.3 days (P=0.525). After limbal autografting, functional vision (> or =1/10) was attained in 12 (80%) eyes. Only one eye (11.1%) achieved functional vision after limbal allografting (P=0.036). Penetrating keratoplasty was performed in three patients following limbal allografting. No cyclosporine-associated side effects were observed. CONCLUSIONS: Limbal autograft transplantation is an effective and safe procedure for unilateral corneal burns. It seems that limbal allograft transplantation is better combined with penetrating keratoplasty for a better visual outcome and higher graft survival rate. Systemic immunosuppression seems to be necessary for limbal allografts even in the presence of HLA-matched donor tissues.

Heidelberg retina tomograph in ocular Behçet's disease.

PURPOSE: To compare the optic disc topography of patients with ocular Behçet's disease (BD) with age-matched controls, using Heidelberg retina tomograph (HRT). METHODS: This study included 32 patients (51 eyes) with ocular BD (active and/or inactive), 38 patients (74 eyes) with nonocular BD, and 62 normal subjects (62 eyes). All patients and control group underwent complete ophthalmologic evaluation. Intraocular pressure was less than 22 mmHg in patients and in the control group. The optic nerve heads of all subjects were imaged with the HRT (software 2.01a-M). The following stereometric parameters were calculated for each patient: disc area, cup area, cup/disc area ratio, rim area, height variation contour, cup volume, rim volume, mean cup depth, cup shape measure, mean RNFL thickness, and RNFL cross-sectional area. Differences among the groups were evaluated by Kruskal-Wallis variance analysis. When the Kruskal-Wallis test revealed a significant difference between groups, multiple comparison tests were used to find out which groups differed from which others. RESULTS: The mean disc area was significantly smaller (P<0.05) in patients with ocular and nonocular BD. The mean cup area, mean cup depth, and mean cup volume were significantly smaller (P<0.05) in patients with ocular BD. No significant differences were found between the groups in terms of the other stereometric parameters (P>0.05). CONCLUSION: A small disc and cup may be an additional risk factor for retinal vaso-occlusion in ocular Behçet's disease.

Acute optic neuropathy in Behet disease.

PURPOSE: To report a patient with Behet disease presenting with acute optic neuropathy. METHODS: A 47-year-old man was admitted to the authors clinic owing to sudden visual loss in the left eye. Ophthalmologic and systemic examinations were performed. RESULTS: Visual acuity was 4/10 in the left eye. Fundus examination demonstrated swollen optic disc with blurred margins. There was relative afferent pupil defect in the same eye. Mega-dose corticosteroid treatment was started with the diagnosis of acute optic neu-ropathy.Ocular findings resolved within 2 weeks. CONCLUSIONS: Behet disease rarely presents with acute optic neuropathy. (Eur J Ophthal-mol 2004; 14: 578-80).

Acute optic neuropathy in Behçet disease.

PURPOSE: To report a patient with Behcet disease presenting with acute optic neuropathy. METHODS: A 47-year-old man was admitted to the authors' clinic owing to sudden visual loss in the left eye. Ophthalmologic and systemic examinations were performed. RESULTS: Visual acuity was 4/10 in the left eye. Fundus examination demonstrated swollen optic disc with blurred margins. There was relative afferent pupil defect in the same eye. Mega-dose corticosteroid treatment was started with the diagnosis of acute optic neuropathy. Ocular findings resolved within 2 weeks. CONCLUSIONS: Behçet disease rarely presents with acute optic neuropathy.

In vitro Candidacidal effect of polymorphonuclear neutrophils of Behçet's patients with or without ocular involvement.

In this study our objective was to evaluate the in vitro candidacidal effect of polymorphonuclear neutrophils of Behçet's patients with or without ocular involvement (inactive phase). Fifteen patients with ocular involvement and 15 patients without ocular involvement were studied. Candidacidal assay was performed to assess the in vitro killing of Candida species by the polymorphonuclear neutrophils of both the study and control groups. In brief, peripheral venous polymorphonuclear neutrophils of healthy volunteers and patients with Behçet's disease were obtained by density gradient centrifugation. These cells were incubated with Candida spp. (Candida albicans, Candida tropicalis, Candida glabrata) for 3 h. Samples were seeded onto yeast extract peptone dextrose agar, incubated at 25 degrees C in a 5% humidified incubator for another 48 h, and formed colonies were counted. There was no significant difference between the candidacidal activity of polymorphonuclear neutrophils of healthy volunteers and of Behçet's patients with or without ocular involvement. Although various immunological abnormalities are reported in Behçet's disease, in vitro killing of Candida spp., which is one of the parameters for the phagocytic function of polymorphonuclear neutrophils, was not affected.

Risk factors for vitreous loss in cataract surgery.

PURPOSE: To evaluate the risk factors for posterior capsule rupture with or without vitreous loss (PCR +/- VL) in extracapsular cataract extraction (ECCE). METHODS: The charts of 2794 consecutive patients who had ECCE with or without intraocular lens implantation between January 1992 and December 1997 were reviewed retrospectively. Probable risk factors included age, sex, operated eye (right or left), presence of diabetes mellitus, systemic hypertension, history of vitreous loss in the other eye (if operated), type of cataract, axial length of the eye, preoperative visual acuity, glaucoma, presence of pseudoexfoliation, preoperative shallow anterior chamber and experience of surgeon (resident, general ophthalmologist, cataract surgeon). We compared 192 patients who had PCR +/- VL with complete data and 275 randomly selected patients who had no complications, using multiple logistic regression analysis. RESULTS: Two hundred and fifty-four patients (9.09%) had PCR and 197 (7.05%) had PCR + VL. The surgeon's experience (p < 0.0005), glaucoma (p < 0.005), type of cataract (p < 0.005), presence of pseudoexfoliation (p < 0.05) and systemic hypertension (p < 0.05) were significant risk factors. CONCLUSIONS: Patients with risk factors such as glaucoma, pseudoexfoliation, traumatic cataract and systemic hypertension should be operated by experienced surgeons.

A topical or oral carbonic anhydrase inhibitor to control ocular hypertension after cataract surgery.

PURPOSE: To compare the effects of oral acetozolamide and topical 2% dorzolamide to prevent ocular hypertension after cataract surgery. METHODS: This prospective, randomized study comprised 62 consecutive patients who had extracapsular cataract extraction and posterior chamber intraocular lens implantation. Patients received either oral acetozolamide (Diazomide) 250 mg three times daily or topical dorzolamide 2% (Trusopt) three times daily, for three days. Intraocular pressures (IOP) were measured by Goldmann applanation tonometry preoperatively and 16, 40, 64 hours postoperatively. RESULTS: IOP in the dorzolamide group peaked at 16 hours and had returned to preoperative values by 40 hours. In the acetozolamide group mean IOP was significantly higher than preoperative values at 16, 40 and 64 hours (p<0.05). At all three postoperative measurement times, mean IOP was significantly higher in the acetozolamide group (p<0.05). CONCLUSIONS: Topical dorzolamide 2% offers better IOP control than oral acetozolamide to prevent ocular hypertension after cataract surgery.

Divergence paralysis & intracranial hypertension due to neurobrucellosis. A case report.

CASE REPORT: A 22 year old female presented with sudden onset of uncrossed diplopia at distance, intracranial hypertension, esotropia and was evaluated. Microbiological tests of CSF and sera showed for brucellosis and the patient received therapy for this and her intracranial hypertension. The papilledema, headache, esotropia and diplopia all disappeared after therapy. CONCLUSIONS: Diagnostic tests for brucella must be considered for patients who have divergence palsy and papilledema, especially those living in endemic areas.

Protein C, protein S and antithrombin III deficiencies in retinal vein occlusion.

PURPOSE: The role of decreased levels of protein C, protein S and antithrombin III were investigated in patients with branch and central retinal vein occlusion. METHODS: Forty-five patients with retinal vein occlusion and 20 healthy subjects as a control group was studied. Fourteen patients (31%) had central retinal vein occlusion and 31 (69%) had branch retinal vein occlusion. The concentrations of protein C, protein S and antithrombin III were measured. RESULTS: Plasma levels of protein C, protein S and antithrombin III were not reduced in the control group. Six of the 14 central retinal vein occlusion cases and 3 of the 31 retinal branch vein occlusion cases had decreased levels of protein C. One of the 14 central retinal vein occlusion cases and 1 of the 31 retinal branch vein occlusion cases had decreased levels of protein S. Antithrombin III was reduced in 1 patient of the 31 retinal branch vein occlusions. We found statistically significant differences for number of cases with protein C deficiency between the central retinal vein occlusion cases and the branch retinal vein occlusion cases (p<0.05). CONCLUSION: Deficiency of anticoagulant proteins, especially protein C, may play a role in the etiology of retinal vein occlusion. Measurement of these parameters may be useful in preventing venous thrombosis elsewhere in the body.

Eyelid malpositions after cataract surgery.

PURPOSE: To estimate the incidence and the factors that may play a role in the etiology of eyelid malpositions after cataract extraction. METHODS: We followed up 124 patients for six months after cataract extraction. Palpebral aperture, levator function, height of the upper lid crease, lower eyelid laxity and position of the punctums were recorded preoperatively and postoperatively. Post-cataract ptosis was defined as a 2 mm or greater drop in the lid margin after correcting for any change in the fellow eye. RESULTS: None of the patients developed ectropion or entropion, but five (4%) developed punctal ectropion after surgery. The incidence of post-cataract ptosis was 7.3% at six months. Age, sex, preoperative measurements of levator function, lid crease and dermatochalasis were not predictive for the development of ptosis at six months. However, there was a significant difference in the preoperative palpebral fissure width between the patients with ptosis and those without (p<0.05). There was a positive correlation between the mean volume of local anesthetic and the degree of ptosis on the first postoperative day (p<0.05, r: 0.1873). The presence and amount of ptosis on the first postoperative day was the best predictor of post-cataract ptosis at six months (p<0.001). CONCLUSIONS: Several factors are involved in the development of post-cataract ptosis. Temporary ptosis may be related to the myotoxicity of the local anesthetic. The presence of ptosis on the first postoperative day is the best predictor for the development of ptosis at six months.