Branch retinal vein occlusion: the importance of the topographical distribution of retinal vessels among risk factors.

PurposeTo investigate the role of the topographical distribution of temporal retinal vessels in anatomical predisposition to branch retinal vein occlusion (BRVO).Patients and methodsSixty patients with BRVO and 60 control subjects were included in this retrospective-observational study. The fundus images of the individuals were classified into four topographical vessel positions: P1, the superior and inferior temporal retinal veins were closer to the foveal center; P2, the superior and inferior temporal retinal arteries were closer to the foveal center; and P3 and P4, the superior temporal retinal vein and inferior temporal retinal artery were closer to the foveal center or vice versa. The groups were compared in terms of demographics and topographical vessel positions.ResultsThere were no significant differences between the groups in terms of age and gender (P>0.05). The topographical distribution of temporal retinal vessels among the BRVO and control eyes were significant (P<0.001). P1 was less common in BRVO eyes (5%) when compared with control eyes (33.3%); however, P2 was more common in BRVO eyes (46.7 vs 20%). There were no significant differences in terms of the distribution of P3 and P4 vessel positions in the BRVO and control groups (P>0.05). A logistic regression test revealed that the risk of BRVO increases 15-fold in P2, 6-fold in P3, and 8-fold in P4 when compared with eyes having P1.ConclusionP1 eyes are less likely to be affected by BRVO. Therefore, the topographical distribution of retinal vessels can be assessed as a risk factor for BRVO.

Regressive course of oxalate deposition in primary hyperoxaluria after kidney transplantation.

Primary hyperoxaluria (PH) is a rare autosomal recessive disease caused by the functional defect of alanine-glyoxylate aminotransferase (AGT) enzyme in the liver and it is characterized by the deposition of diffuse calcium oxalate crystals. A 38-year-old male patient presented with history of recurrent nephrolithiasis and has received chronic hemodialysis treatment for 2 years. Cadaveric renal transplantation was applied to the case. The patient was reoperated on postoperative day 13 because of the collection surrounding the urethra. During this operation, kidney biopsy was made due to late decrease in creatinine levels. Deposition of diffuse oxalate crystal was detected in allograft kidney biopsy, whereas in the 0-hour biopsy there were no oxalate crystals. Oxalate level was found to be high in a 24-hour urine specimen (118 mg/L, normal level: 7-44 mg/L). The patient was identified with primary hyperoxaluria and followed up in terms of systemic oxalate deposition as well as allograft kidney. In the kidney biopsy taken after 18 months, we detected that oxalate crystals almost entirely disappeared. In our case, bilateral preretinal, intraretinal, and intravascular diffuse oxalate crystals were detected, and argon laser photocoagulation treatments were needed for choroidal and retinal neovascularization. Repeated ophthalmic examinations showed the regressive nature of oxalate depositions. In the 18th month, fundus examination and fluorescein angiography revealed that oxalate crystals were significantly regressed. To increase the quality of life and slow down the systemic effects of oxalosis, kidney-only transplantation is beneficial.

Illuminated endochopper in the management of posteriorly dislocated lens nucleus.

We describe the use of an illuminated endochopper (a prototype instrument produced by DORC International) in the management of a posteriorly dislocated lens nucleus or lens particles. This instrument helps to divide the lens nucleus or its fragments into small pieces and thus reduces time and ultrasound energy.

Anatomic outcome of scleral buckling surgery in primary rhegmatogenous retinal detachment.

PURPOSE: To evaluate the factors affecting the anatomic success of treatment of retinal detachments (RD) by scleral buckling surgery. METHODS: One-hundred and two eyes of 102 patients with rhegmatogenous RD operated on by scleral buckling surgery were included in the study. Results were analyzed according to the anatomic status of the retina at the most recent follow-up examination. The chi-squared test was used to determine the relationship between preoperative and intraoperative variables and anatomic results, and the relative risk of failure was determined for each variable. RESULTS: Retinal reattachment was achieved in 85 of 102 eyes (82.5%) after initial surgery. The success rate for anatomic reattachment was 95% after two operations. After three operations reattachment was achieved for 98 eyes (96%). Predictive factors for anatomic failure (P<0.05) were the presence of grade C(1) PVR and multiple breaks. CONCLUSION: Grade C(1) PVR and multiple breaks were found to be significant risk factors for anatomic failure in rhegmatogenous RD treated by conventional buckling surgery.

A novel suture technique in stellate corneal lacerations.

A novel suture technique for regular stellate corneal lacerations, called a star-shaped suture is described. The suturing begins from inside any of the wound lips in a clockwise direction. Suture placement proceeds in a counterclockwise direction by the adjacent wound limb, while the suture passes are all in clockwise direction. Finally, a star-shaped suture is achieved with the knot self-buried in the corneal stroma at the initial entry site. This is a continuous suture, of which tractional forces direct to the center of the wound providing good apical apposition for stellate lacerations. This suture technique can be an alternative for the reconstruction of stellate corneal lacerations.

An alternative technique in (1) determining the placement of scleral buckles in (2) retinal detachment surgery.

We have developed a simple technique to verify the final and exact position of the explant on the retinal break before placing the radial or circumferential scleral buckles during the retinal detachment surgery. For this purpose, we used the back end of a dismantled blade holder which is essentially the same size as a sponge.

A simple "lasso" for intraocular foreign bodies.

Three patients had foreign bodies in their anterior chambers following penetrating ocular injuries. These foreign bodies were removed by a closed chamber technique using a simple loop. The loop was created by a 22-gauge intravenous cannula and a 7-0 polypropylene suture. Retained cilia in one patient and metallic foreign bodies in two patients were removed using this intraocular "lasso." Sutures were not placed at the incision sites at the end of the surgery. This is an inexpensive and easy to prepare technique that introduces minimal surgical trauma. In addition, two hands are not needed for loop manipulation. This technique may be an excellent alternative for removal of small intraocular foreign bodies.

Hypotony: an unusual consequence of intraocular lens malposition.

Common causes of postoperative hypotony include wound leakage, inflammatory reaction of the ciliary body, cyclodialysis, and ciliochoroidal detachment. We present an unusual case of ocular hypotony in a pseudophakic eye associated with distortion of the ciliary body by a decentered posterior chamber intraocular lens (IOL) haptic. A simple surgical repositioning of the IOL relieved the hypotony by eliminating the irritation by the IOL haptic on the distorted edematous ciliary body. Ciliochoroidal irritation by IOL haptics should be considered a possible cause of ocular hypotony in a pseudophakic eye.

Determining fluid level in a translucent eye-drop bottle: transillumination by penlight.

We describe an easy way to determine eye-drop contents in translucent bottles. Transillumination of eye-drop bottles from behind or the bottom by using a penlight clearly defines the fluid levels. The described procedure may prevent disposal of eye-drop bottles containing useful amounts of medication and prevent Ophthalmologists and Patients unexpectedly coming across an empty bottle.

Alcohol liberates dye of syringes.

Foreign particles may contaminate intraocular surgery and have a role in postoperative inflammation. Irrigation solutions, viscoelastics, air and instruments introduced into the eye may carry in a number of organic or inorganic, inert or reactive foreign material. Dye of colored indicators on syringes may also behave as an unrecognized contaminant. This dye material is easily released from syringes by exposure to alcohol. The significance of dye contamination and possible outcomes were discussed.

The results of surgery in a series of partially accommodative esotropic patients.

Three different surgical procedures were performed in 32 partially accommodative esotropic patients with a high accommodative convergence/accommodation (AC/A) ratio. The patients were followed-up for an average period of 2.5 years (range: four months to seven years). Recession of the medial rectus and resection of the lateral rectus (group I), bimedial recession (group 2) or bimedial recession with bimedial Faden operation (group 3) were performed, guided by the preoperative AC/A ratio, the difference between the distance and near deviations, and the alternation pattern. At the end of the follow-up period, the average distance and near deviations were found to be less than 10$DL in all three groups. The AC/A ratio of all patients was normal or close to normal in the postoperative period.

Coexistence of intraocular eyelashes and anterior chamber cyst after penetrating eye injury: a case presentation.

We herein describe a patient in whom two intraocular eyelashes and an anterior chamber cyst embedded into the anterior surface of the iris was detected following penetrating eye injury. After a one year asymptomatic period, the patient was hospitalized because of uveitic reaction in the anterior chamber which may be due to cyst development. The lashes and cyst were removed surgically, and examined pathologically. There was no complication in one year follow-up period.

Tilt and decentration of bag-fixated intraocular lenses: a comparative study between capsulorhexis and envelope techniques.

Malposition of an intraocular lens (IOL) may cause symptoms such as glare, halos, and other visual aberrations. The purpose of this study is to determine the effect of two different anterior capsulotomy techniques on IOL tilt and decentration. Bag-fixated IOL implantation after uncomplicated extracapsular cataract extraction was performed using both envelope (65 eyes) and continuous circular capsulorhexis (CCC) technique (42 eyes). Eyes were followed-up at least 6 months postoperatively. While the mean IOL decentration after envelope technique was found to be 0.65 mm, this was 0.15 mm after CCC technique. On the other hand, the mean actual tilting angle of IOL after envelope technique was 5.66 degrees, whereas this was 1.13 degrees after CCC technique. The aforementioned differences were statistically significant (p < 0.01, and p < 0.01). Furthermore, in 17 eyes (26.1%) where envelope technique and in 29 (69.0%) eyes where CCC technique was used demonstrated no IOL tilt and decentration. This study shows that the CCC technique may result in less optical problems due to IOL malposition compared to the envelope technique.

Effect of bimedial rectus recession with a loop on the deviation in essential infantile esotropia.

Thirty-two patients with essential infantile esotropia were treated by using a 2.5 millimeter loop, added to a 4 millimeter medial recti recession bilaterally. Objective deviation was more than 45 prism diopters (PD) in all of the patients preoperatively. After surgery the deviation ranged between -10 PD and +IO PD in 26 (81.2%) patients, and limitation of abduction disappeared in all of the cases. A slight limitation of adduction was encountered in two (6.2%) patients. The authors concluded that bimedial rectus recession with a loop is an effective method as an early surgical procedure in patients with infantile esotropia with a large deviation.

Effects of intraocular lens malposition on binocular single vision in bilaterally pseudophakic patients.

PURPOSE: To investigate the relationship between intraocular lens (IOL) malposition and quality of binocular single vision following uncomplicated extracapsular cataract extraction and posterior chamber IOL implantation. METHODS: Fifty-two bilaterally pseudophakic patients were included. The main outcome measures were visual acuity, stereoscopic acuity, horizontal and vertical amplitudes of fusion and heterophoria, tilting angle and decentration amount of the pseudophacos and summation of these values in somewhat vectorial manner to define the total decentration and tilt of IOLS. RESULTS: The mean total horizontal decentration was 0.19 mm and vertical decentration was 0.90 mm, mean total horizontal tilt being 1.55 degrees and vertical tilt 7.52 degrees. The mean stereoscopic acuity was found to be 1020 seconds of arc. Although the stereoscopic acuity threshold increased as decentration and tilt of IOLS increased, only the horizontal tilt was found to be statistically significantly correlated with stereoscopic acuity (pc0.01). CONCLUSION: The quality of binocular single vision may be affected by IOL malposition in pseudophakic patients. Therefore, when an IOL implantation is planned, the most appropriate IOL design and surgical technique causing least decentration and tilt should be preferred.