The role of apoptosis in blepharoptosis.

PURPOSE: The purpose of this study is to evaluate the role of apoptosis in the pathogenesis of blepharoptosis. PATIENTS AND METHODS: Forty-five eyelids of 43 consecutive patients (16 female, 27 males) that underwent levator resection surgery for ptosis correction were included in the study. Twenty-six of the eyelids had congenital myogenic ptosis and 19 had aponeurotic ptosis. Levator palpebrae superioris function and height of the vertical palpebral fissure were measured in all patients. After levator resection surgery, the distal part of the levator aponeurosis was fixed and sent for evaluation. Apoptotic cells were detected using Apop Tag Plus Peroxidase In Situ Apoptosis Detection Kit. RESULTS: The mean levator palpebrae superioris function was 8.4 mm (range 5-10 mm) in congenital ptosis group and 12.1 mm (range 10-17 mm) in the aponeurotic ptosis group. The mean height of the vertical palpebral fissure in patients with congenital ptosis and aponeurotic ptosis were 6.5 mm (range 5-9 mm) and 6.1 mm (3-9 mm), respectively. The mean apoptotic index of congenital ptosis and aponeurotic ptosis were 27.3 (16-39) and 29.8 (18-41), respectively. There was no statistically significant difference between congenital and aponeurotic ptosis groups in a mean apoptotic index (P<0.05). Apoptotic index was not correlated with age, levator palpebrae superioris function, palpebral fissure height, and lid crease height in two groups. CONCLUSION: We found no statistically significant difference between two subtypes of blepharoptosis regarding apoptosis. According to this study, apoptosis seems to have no significant role in the development of aponeurotic blepharoptosis.

Ciliary body thickness in unilateral high axial myopia.

PURPOSE: To compare the thickness of the ciliary bodies of eyes with unilateral high axial myopia with their relatively normal fellow eyes. METHODS: A total of 19 patients with unilateral high axial length (AL) were included in the study. Mean patient age was 28.4+/-10.4 (11-44) years. All eyes underwent ultrasound biometry to measure the AL, and ultrasound biomicroscopy to measure the anterior chamber depth, ciliary body thickness (CBT), and ciliary process thickness (CPT), ciliary muscle thickness (CMT). The results were compared between each subject's high myopic eye and relatively normal fellow eye. RESULTS: The mean AL was 27.24+/-1.52 mm (range: 25.16-30.21 mm) in high myopic eyes and 23.64+/-0.86 mm (range: 22.47-25.10 mm) in normal fellow eyes. The median +/-95% confidence interval of CBT, CPT, and CMT was 1.350+/-0.034, 0.626+/-0.072, and 0.698+/-0.057 mm, respectively, in high myopic eyes and 1.211+/-0.050, 0.535+/-0.064, and 0.644+/-0.065 mm, respectively, in normal fellow eyes. The anterior chamber depth, CBT, CPT, and CMT were significantly higher in myopic eyes compared with their relatively normal fellow eyes (P<0.05). CMT significantly increased with age in both groups (P<0.05). There was no significant correlation between age and CBT in both the groups (P>0.05). CONCLUSION: The CBT, CMT, and CPT are significantly higher in eyes with unilateral high axial myopia than in their relatively normal fellow eyes.

A comparative study of tissue glue and vicryl suture for conjunctival and scleral closure in conventional 20-gauge vitrectomy.

AIM: To describe the use of tissue glue to close scleral and conjunctival wounds, and to compare the clinical outcomes using tissue glue and vicryl suture for closing these areas in conventional 20-gauge (G) vitrectomy. METHODS: Thirty eyes of 30 patients were included in this study. The indications for vitreoretinal surgery were diabetic vitreous haemorrhage with severe vitreoretinal traction in 10 eyes, retinal detachment and proliferative vitreoretinopathy in 14 eyes, and vitreous opacity in 6 eyes. Tissue glue (Tisseel, Baxter AG Industries, Vienna, Austria) was used to attach scleral and conjunctival wounds in 15 eyes and vicryl sutures in 15 eyes. The patients were allotted into two subgroups as tissue glue group (TG) and vicryl suture group (VG). The sclerotomy sites were evaluated with ultrasound biomicroscopy (UBM) postoperatively in TG. Follow-up period was 2 months. The groups were statistically compared for ocular signs and symptoms by Mann-Whitney U-test. RESULTS: No scleral wound leakage and conjunctival reattachment were observed at the end of the surgical procedure and during the follow-up period. No adverse effects were seen in TG. Abnormal fibrous ingrowth was not detected at the sclerotomy sites by means of UBM in TG. Patient comfort was significantly higher in TG than VG (P<0.05). CONCLUSIONS: Tissue glue has no adverse effects on ocular tissue and can be used as a substitute for suture materials, and the use of tissue glue decreases patient symptoms during the postoperative period after 20-G vitrectomy. Tissue glue can enable to perform sutureless surgery in the conventional 20-G vitrectomy.

Morphology of corneal nerves and corneal sensation in dry eye: a preliminary study.

PURPOSE: To evaluate the corneal sensitivity and nerve morphology in dry eyes. METHODS: A total of 32 eyes of 16 patients (10 Sjogren's syndrome and six non-Sjogren's syndrome) and 19 eyes of 10 age-matched controls were studied. Sensitivity of the central cornea was measured by the Cochet-Bonnet aesthesiometer. The morphology of corneal nerves was studied by in vivo confocal microscopy (ConfoScan 2.0, Fortune Technologies Srl, Vigonza (PD), Italy). Sub-basal epithelial nerve plexus, subepithelial nerve plexus, and stromal nerves were localized and evaluated for the number of nerves, thickness, reflectivity, and tortuosity for each frame. RESULTS: The mean corneal sensitivity of dry eye patients (5.6 mm/grs/S) was found significantly lower than that of the control (5.0 mm/grs/S) group (P<0.01). Although the subepithelial nerves were thicker in dry eyes (mean: 6.38+/-1.18 microm) than control eyes (mean: 5.72+/-1.27 microm), this difference was not significant (P>0.05). CONCLUSION: Decreased corneal sensitivity is not associated with morphological changes of corneal nerves in dry eyes.

Ocular complication of intralesional corticosteroid injection of a chalazion.

PURPOSE: To report a major complication of intralesional corticosteroid injection for the treatment of a chalazion. METHODS: A 28-year-old woman presented with a 4-day history of decreased vision in her left eye that developed after corticosteroid injection to her upper eyelid for the treatment of chalazion. The visual acuity was 20/20 in her right and finger counting in her left eye. Anterior segment examination showed an inferior corneal opacity with positive Seidel test and cataract. RESULTS: A soft contact lens was applied to cornea and antibiotic therapy was given to prevent endophthalmitis. Cataract was removed by lens aspiration and a posterior chamber intraocular lens was implanted. After surgery, the visual acuity increased to 20/20 in her left eye. CONCLUSIONS: Inadvertent corneal penetration and traumatic cataract are possible and serious complications of intralesional corticosteroid injection.

Otolaryngological findings in congenital nasolacrimal duct obstruction and implications for prognosis.

AIM: To investigate otolaryngological abnormalities associated with congenital nasolacrimal duct obstruction (CNLDO) and their effect on the prognosis. METHODS: 65 consecutive cases of CNLDO were followed up with routine otorhinolaryngological examination with tympanometry. RESULTS: Otitis media with effusion (OME) and uvula bifida were detected in 44.6% and 9.2% of the children, respectively. Medical treatment and probing were less effective in patients with OME (p<0. 05). CONCLUSIONS: OME and uvula bifida are significant anomalies associated with CNLDO and the former has a marked effect on the prognosis. This finding may help to determine the patients who will need further treatment after massage and probing.

Congenital lacrimal fistula.

PURPOSE: Congenital lacrimal fistula is a rare abnormality of the lacrimal system. The patients may be asymptomatic but treatment of those with symptoms such as epiphora and dacryocystitis is still controversial. METHODS: The clinical findings, methods of surgical treatment and results were evaluated in seven patients (four male, three female) with congenital lacrimal fistula. Three were asymptomatic, types of surgical treatment were fistula excision with dacryocystorhinostomy (DCR) (two cases), fistula excision with conjunctival DCR (one case) and closed fistula excision alone (one case). RESULTS: Three of the four patients who underwent surgery had relief of symptoms. The fistula recurred in the case that had undergone fistula excision alone. CONCLUSIONS: It is difficult to design controlled studies to detect which method is superior for the treatment of lacrimal fistula, considering the small number of cases in the literature. We recommend treating each case according to its own characteristics.

Superoxide dismutase, catalase, glutathione peroxidase and xanthine oxidase in diabetic rat lenses.

The activities of the protective enzymes, superoxide dismutase, catalase, glutathione peroxidase and of xanthine oxidase, an enzyme acting as a source of O(-)(2), were measured in the lenses of alloxan-induced diabetic and control rats. Superoxide dismutase and glutathione peroxidase activities were found to be significantly decreased, while catalase and xanthine oxidase activities were increased. This means that the ratio of the oxidant/antioxidant enzymes increases in the diabetic rat lens, suggesting an increased oxidative stress. This imbalance is possibly an important contributing factor in the pathogenesis of diabetic cataract.

Lacrimal sac dilatation in balloon dacryocystoplasty.

The authors report a case of balloon dacryocystoplasty in a patient who had a dilated lacrimal sac found in conventional surgery. A 52-year-old woman presented with persistent epiphora after a failed balloon dacryocystoplasty. She underwent an external dacryocystorhinostomy. The lacrimal sac was found to be dilated at its lower part, adjacent to the nasolacrimal ductus. Flaps were created more superiorly than usual. The operation was unsuccessful after 3 months. Previous balloon dacryocystoplasty, which is reported to be a harmless procedure, may pose some difficulty in subsequent conventional surgery.

Corneal topography in patients with congenital ptosis.

PURPOSE: To determine the effect of congenital ptosis on corneal shape, and to assess the role of these topographic changes in the development of amblyopia. METHODS: Twenty-two patients with congenital ptosis were examined and a corneal topographic examination performed in both the ptotic and normal eyes. The qualitative corneal classification was done according to the colour-coded topographic maps. The surface regularity index (SRI) and the surface asymmetry index (SAI) were used as quantitative descriptors of the study. RESULTS: Ptotic eyes had an increased incidence of astigmatism, bow tie pattern on corneal topography, corneal asymmetry (SAI, p < 0.05) and corneal irregularity (SRI, p < 0.05). Lack of mirror-image symmetry with the fellow eye was higher in amblyopic eyes. CONCLUSION: Eyes with congenital ptosis have an increased incidence of astigmatism and a bow tie pattern on corneal topography. These features are associated with the presence of amblyopia.

Adjunctive use of mitomycin C on endoscopic lacrimal surgery.

AIMS: Endoscopic endonasal dacryocystorhinostomy (DCR) has some advantages over external DCR as a less invasive method with no skin incisions. But the success rate of the operation has not reached the level of external method. In this study, a wound healing inhibitor mitomycin C was used intraoperatively to prevent the closure of the osteum after the operation. METHODS: Endoscopic endonasal DCR was performed on 40 eyes of 39 patients (26 female, 13 male). Mitomycin C was applied to the ostium in 14 of 23 patients who had undergone primary endoscopic DCR by means of a microdrill and in eight of 17 patients who had a revision endoscopic DCR secondary to a previously failed external DCR. RESULTS: The postoperative follow up period was 9-27 (mean 18.2) months. The success rate of endoscopic DCR with intraoperative mitomycin C was 77.3%, whereas the success rate of endoscopic DCR without mitomycin C was 77.8%. The statistical analysis did not show a difference between the two groups according to the ostium size and their success rates. CONCLUSIONS: Adjunctive use of a wound healing inhibitor is considered to increase the success rate of endoscopic endonasal DCR. Its intraoperative use seems to be easy and safe. But the study of this limited series shows no benefit in using it.

Histopathologic effects of mitomycin-C on endoscopic transnasal dacryocystorhinostomy.

BACKGROUND AND OBJECTIVES: The antimetabolite mitomycin-C is now being used in endoscopic transnasal dacryocystorhinostomies to prevent the closure of osteotomies. PATIENTS AND METHODS: A 0.5-mg/ml solution of mitomycin-C was applied to the osteotomy site for 2 1/2 minutes intraoperatively. Specimens from four patients were collected during surgery and at 15 days, 1 months, 3 months, and 6 months after surgery. The specimens were examined under light and electron transmission microscopy and were compared with control specimens. RESULTS: Light microscopy showed attenuated epithelium with intracytoplasmic vacuoles. Subepithelial connective tissue was looser and hypocellular. Electron microscopy confirmed these findings and demonstrated swelling of mitochondria, dilatation of endoplasmic reticulum, and chromatin-dense granules in nuclei of fibroblasts. CONCLUSION: By causing a decrease in density and cellularity of mucosa, topical use of mitomycin-C may enhance the success of surgery; however, further studies are necessary to determine the ultimate potential of this agent for this procedure.

Color Doppler imaging in uveitis.

PURPOSE: To evaluate the vascular hemodynamic changes that can be detected with color Doppler imaging (CDI) in diagnosis, differential diagnosis and prognosis of uveitis with different etiologies including Behçet's disease. METHODS: Four groups consisting of healthy volunteers, uveitis patients with different etiologies and Behçet's disease patients with and without ocular involvement were examined by CDI. Central retinal artery (CRA), posterior ciliary artery (PCA), ophthalmic artery (OA) and central retinal vein (CRV) flow velocities and vascular resistances were measured prospectively by a radiologist blinded to the presence and etiology of uveitis. RESULTS: The peak systolic and end-diastolic velocities in CRA and PCA in Behçet's disease with ocular involvement were significantly lower than all other groups (p < 0.001). Peak systolic and end-diastolic velocities in CRA were lower than the control group in Behçet's disease patients without ocular involvement (p < 0.001) but there were no differences in PCA and OA flow velocity (p > 0.05). In the uveitis group, CRA and CRV flow velocities were significantly lower than in the control group (p < 0.001). CONCLUSIONS: According to our results, uveitis in Behçet's disease is associated with significant reductions of CRA and PCA flow velocities when compared with other types of uveitis and healthy subjects. In cases without ocular involvement, CRA flow velocities were lower than the control group, but there were no real differences in the PCA and OA values. This suggests that vasculitic involvement of PCA is more specific to Behçet's disease and occurs later in the course of the disease. The results also suggest that it may be possible to detect and follow hemodynamic changes in Behçet's disease with CDI before clinical findings of ocular involvement become evident.

Conjunctivodacryocystorhinostomy with Jones tube. A 10-year study.

One hundred and eight patients (111 eyes) underwent conjunctivodacryocystorhinostomy with a Jones tube for treatment of epiphora resulting from canalicular obstruction. Sixty-nine patients (63.9%) were females and thirty-nine (36.1%) were males. Their ages ranged from 9 to 64 years, the mean age being 30.1 years. The causes of lacrimal drainage abnormalities included idiopathy (76 cases, 68.5%), trauma (15 cases 13.5%), tumors (8 cases, 7.2%) congenital abnormalities (6 cases, 5.4%) and conjunctival inflammation (6 cases, 5.4%). Twenty-eight (36.8%) eyes in the idiopathic group had previous failed dacryocystorhinostomies. The operation was successful in 90.1% of the eyes with relief of epiphora. Fifty-one out of 111 (45.9%) eyes had complications. Extrusion of the tube was the most frequent complication occurring in 20 (18%) eyes. Malposition (12 eyes 10.8%), infection (12 eyes, 10.8%) and obstruction of the tube (7 eyes, 6.3%) were the other major complications. Of the 20 eyes with tube extrusion, 11 experienced recurrent tube losses. Five of 11 eyes were free of epiphora after tube loss. Four out of five had the tube in place for 2 to 5 years and one had the tube, in place for one year. The remaining 6 eyes which had the tubes for 6 months to 3 years were complicated by epiphora. Our experience confirms the general belief that the tube should stay in place forever. The large majority of our patients could wear their tubes successfully and have done so in our practice for as long as 10 years.

Diagnosis of ocular involvement in Behçet's disease: value of spectral and color Doppler sonography.

OBJECTIVE: The purpose of this study was to determine the value of duplex and color Doppler sonography in the detection of ocular involvement in Behçet's disease. SUBJECTS AND METHODS: Duplex and color Doppler sonography was done in 21 patients with Behçet's disease and ocular involvement and in 22 patients with Behçet's disease but without ocular involvement. Twenty health volunteers also were examined as a control group. Flow velocities in the central retinal artery, posterior ciliary arteries, and ophthalmic artery were measured in the patients with Behçet's disease. RESULTS: In patients with Behçet's disease and ocular involvement, peak systolic velocities in the central retinal, posterior ciliary, and ophthalmic arteries were 7.3 +/- 2.3, 12.8 +/- 3.1, and 35.8 +/- 7.2 cm/sec, respectively. In patients with Behçet's disease but without ocular involvement, these values were 10.0 +/- 1.9, 17.3 +/- 3.4, and 33.5 +/- 4.0 cm/sec, respectively. In control subjects, the respective calculated values were 12.3 +/- 1.0, 16.5 +/- 1.6, and 35.8 +/- 4.4 cm/sec. For the central retinal and posterior ciliary arteries, peak systolic and diastolic velocities were significantly lower in patients with Behçet's disease and ocular involvement than in control subjects and patients with Behçet's disease but without ocular involvement (p < .001). Peak systolic and diastolic velocities in the central retinal artery were significantly lower in patients with Behçet's disease but without ocular involvement than in the control group (p < .001); however, no difference was observed for the posterior ciliary artery. Flow velocities in the ophthalmic artery were not significantly different among groups. CONCLUSION: These findings suggest that duplex and color Doppler sonography may be helpful in the diagnosis of ocular involvement in patients with Behçet's disease.

Ultrasonic findings in intraocular retinoblastoma and correlation with histopathologic diagnosis.

A and B-scan ultrasonographic records of 132 eyes of 126 patients with suspected retinoblastoma were evaluated retrospectively. Six patients had bilateral lesions. The results were compared with the histopathologic diagnoses obtained after enucleation in 129 cases and with the indirect ophthalmoscopic examination in 3 bilateral cases. Ultrasonographic diagnosis was correct in 115 cases (87.12%), false-negative in 12 cases (9.09%) and false-positive in 5 cases (3.79%). Echographic tumor typing was made in 88 cases and the mixed tumor type was the most frequent with 74 cases (84.09%). Cystic, solid and diffuse infiltrating types were the other echographic diagnoses. Our experience confirms the accuracy of ultrasonography in the diagnosis of retinoblastoma.