Prognostic factors for open-globe injuries: variables for poor visual outcome.

PURPOSE: To determine prognostic factors for open-globe Injuries (OGI). METHODS: Open-globe injuries referred to a tertiary referral clinic in Turkey between January 1998 and January 2016 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were conducted to find out the most important variables for poor visual outcome. RESULTS: Six hundred and thirty-three patients were studied with an average age of 24.37 ± 11.1 years (range 1-80).The male/female ratio was 18.6/1. Most of the cases (48.2%) were conflict related, whereas the rate of work, accidental, and sports related cases were (33.1%), (17.9%) and (0.01%), respectively. Final visual acuity (VA) ranged from no perception of light (23%) to 200/200 (17.1%). The number of cases with a final VA > 20/200 were 388 (49.3%). Initial visual acuity < 20/200, ocular trauma score category 1, zone 3 injury, additional vitrectomy surgery, and lens damage were found to be the main variables related with poor visual outcome in multivariate logistic regression analysis. CONCLUSION: Besides ocular trauma score category and initial VA; zone of injury, additional surgeries, and initial lens damage had negative effects on visual outcome in OGI.

An unusual complication of blunt ocular trauma: a horseshoe-shaped macular tear with spontaneous closure.

A case of horseshoe-shaped macular tear after blunt trauma with the course of the tear and the relevant findings obtained by spectral-domain optical coherence tomography (SD-OCT) is described. A 21-year-old man who had suffered blunt trauma 5 days previously visited our clinic complaining of vision loss in his left eye. Ophthalmic examination and SD-OCT images revealed a horseshoe-shaped macular tear. A month later at the second visit, the macular tear was found to have spontaneously closed. There have been many cases reported previously of the spontaneous closure of traumatic macular holes. A horseshoe-shaped macular tear is an atypical clinical presentation. However, the mechanism of spontaneous closure is hypothetically as same as that for a macular hole. High-resolution images and three-dimensional maps taken with SD-OCT can provide more details on macular diseases and are more useful than time-domain OCT images.

Comparison of grid laser, intravitreal triamcinolone, and intravitreal bevacizumab in the treatment of diffuse diabetic macular edema.

PURPOSE: To compare the effects of grid laser (GL), intravitreal bevacizumab (IVB), and intravitreal triamcinolone acetonide (IVTA) in diffuse diabetic macular edema (DDME). PROCEDURES: One hundred and twenty-six patients (126 eyes) treated with GL (modified grid), IVTA (4 mg), and IVB (1.25 mg) injections, matched for best corrected visual acuity (BCVA) and OCT-based central macular thickness at presentation, were enrolled. Primary outcome measure was change in best corrected logMAR visual acuity at 1-year follow-up. RESULTS: Rates of visual stabilization (within ±0.2 logMAR of baseline BCVA) (71.4, 83.3, 78.6%, respectively) were not different between the groups (p = 0.41) at 12-month follow-up. Higher rates of anatomical and functional success, however, were evident in IVB and IVTA groups within 6 months of treatment (p < 0.05 for both). No severe adverse effects except higher intraocular pressure (10 mm Hg from baseline) in one third (14 eyes) of the IVTA cases, who required trabeculectomy in 2 (4.8%) eyes, were observed. CONCLUSIONS: Intraocular injections may give favorable results within the first 6 months, and after 6 months, GL results seem to be more favorable in the treatment of treatment-naïve, acute, nonischemic, and center-involving DDME.

Evaluation of the nerve fiber layer and macula in the eyes of healthy children using spectral-domain optical coherence tomography.

PURPOSE: To determine the normative values of the peripapillary retinal nerve fiber layer (RNFL), macular thickness, and macular volume in healthy children using spectral-domain optical coherence tomography (SD-OCT) and analyze the correlation of such values with age, refraction error, and biometric measurements. DESIGN: Observational case series. METHODS: This institutional study involved 107 eyes from 107 healthy pediatric patients (54 female, 53 male) with ages between 6 and 16 years. After the biometric measurements and refractive error values (in spherical equivalent) of the cases were obtained, the peripapillary RNFL, macular thickness, and macular volume values were calculated using the Spectralis OCT device. RESULTS: Among the study group, with an average age of 10.46 ± 2.94 years, the average axial length (AL) was 23.33 ± 0.89 mm; the average spherical equivalent (SE) value was -0.27 ± 0.99 diopter. The average peripapillary RNFL thickness was 106.45 ± 9.41 µm; the average macular thickness was 326.44 ± 14.17 µm; and the average macular volume was 0.257 ± 0.011 mm(3). The aforementioned OCT measurements were not significantly correlated with age, SE, or AL values (P > .05 for all). CONCLUSIONS: This study reports SD-OCT findings among healthy pediatric cases. SD-OCT can be reliably used for pediatric patients because of its short exposure time and high degree of image resolution.

Comparison of Oculus Pentacam and Stratus optical coherence tomography for measurement of central corneal thickness.

PURPOSE: Measurement of central corneal thickness (CCT) plays an essential role in the diagnosis and treatment of many ocular diseases. In this study, we aimed to compare the CCT measurements obtained using the Scheimpflug system (Pentacam; Oculus, Inc) with a retinal optical coherence tomography device (Stratus OCT; Carl Zeiss Meditec, Inc) to examine healthy corneas. METHODS: CCT measurements of 80 eyes belonging to 40 male patients (mean age: 24.48 ± 6.01 years) were evaluated with the Pentacam and the Stratus OCT. The relationship between the CCT values obtained with these 2 devices was examined with a Pearson correlation analysis, a paired t test, and a Bland-Altman analysis. RESULTS: The average CCT value obtained with Pentacam was 546.11 ± 34.15 µm and that obtained with Stratus OCT was 567.76 ± 35.02 µm. Although the average difference between the devices was 21.65 ± 8.59 µm (P < 0.0001), the measurements obtained with both devices were significantly correlated (r = 0.969, P < 0.0001). In Bland-Altman analysis, there was a high consistency between measurements obtained with either Pentacam or Stratus OCT devices. CONCLUSIONS: Corneal thickness measurements differ depending on the device used. Corneal thicknesses that have been calculated with Pentacam were lower than the values obtained with Stratus OCT. Both devices used for CCT measurement are easily applied, noninvasive, and effective. However, the devices are not interchangeable. Stratus OCT is not optimal for CCT measurement because of the important limitations of using manual measurements, but it can be used if other measurement devices designed for the purpose are not available.

Outcomes of vitreoretinal surgery in patients with closed-globe injury.

PURPOSE: To evaluate the clinical features, visual outcomes, and prognostic factors in patients who underwent vitreoretinal surgery after closed-globe injury. METHODS: Retrospective review of patients with closed-globe injuries who underwent vitreoretinal surgery between January 2003 and December 2007. RESULTS: The study cohort included 46 eyes from 46 patients who underwent vitreoretinal surgery for posterior segment injury. Retinal detachment was the most frequent indication for the surgery, in 33 eyes (72%). After surgery, final visual acuity of 20/400 or better was achieved in 35 eyes (76%), while 11 eyes (24%) had visual acuity less than 20/400 (poor visual outcome). The most frequent reason for poor outcome was proliferative vitreoretinopathy (PVR) (6 eyes), followed by macular complications (3 eyes) and optic atrophy (2 eyes). Two cases with PVR became phthisical following repeated vitreoretinal procedures and also lost light perception. Prognostic factors associated with poor outcomes included delayed presentation, presenting visual acuity of less than 20/400, the presence of initial macular detachment, and the need for additional surgical intervention (p<0.05). No statistical difference was found in final visual acuity between eyes with or without retinal detachment (p>0.05). Also, the presence of damage to the anterior segment was not significantly associated with poor visual outcome (p>0.05). CONCLUSIONS: In patients with posterior segment pathology caused by closed-globe trauma, retinal detachment was the most common reason for vitreoretinal surgery and PVR was the main cause of surgical failure. The poor visual outcomes associated with delayed presentation suggest that patients need to be referred for further management.

Functional and structural analysis of partial optic nerve avulsion due to blunt trauma: case report.

Partial optic nerve avulsion (ONA) secondary to finger gouging is an uncommon but devastating injury. A 21-year-old man who had an acute vision loss after accidentally getting poked by himself in his right eye when he fell down during jogging is reported. The patient was diagnosed with partial ONA. Magnetic resonance imaging revealed intact optic nerve. Optical coherence tomography (OCT) revealed deep cavity at the inferior-temporal half of the optic disc. Retinal nerve fiber layer thickness was also thin at the inferior quadrant with circumpapillary OCT scan. Visual field test and electrophysiological tests showed functional abnormality compatible with optic nerve lesion. Diagnostic tools for anatomical and functional evaluation may reveal the course of this injury.

Safety and effectiveness of interferon alpha-2a in treatment of patients with Behçet's uveitis refractory to conventional treatments.

PURPOSE: To evaluate the intermediate-term safety and effectiveness of interferon alpha-2a (IFNalpha2a) in patients with Behçet's uveitis (BU) refractory to corticosteroids and immunosuppressive agents. DESIGN: Open, nonrandomized, uncontrolled, interventional, prospective study. PARTICIPANTS: Fifty-three patients (106 eyes) with active, vision-threatening BU who failed to respond to conventional treatments. INTERVENTION: In 53 patients, acute inflammation was suppressed with effective prednisolone dosage (1-2 mg/kg/day, tapered to 10 mg within 4-6 weeks). The patients were treated with IFNalpha2a 4.5 million international units (MIU) 3 times per week for the first 3 months followed by IFNalpha2a 3 MIU 3 times per week for the next 3 months. Observation or other treatment methods were performed according to the decision tree developed for this study. MAIN OUTCOME MEASURES: Remission and complete response (primary outcome measures), frequency of uveitis attacks, visual acuity (VA), and adverse effects (secondary outcome measures). RESULTS: During 2 years of follow-up (median 65 months, range 12-130 months), compliance with the therapy was excellent. At the end of 1-year follow-up, treatment response was obtained in 45 of 53 patients (84.9%). The mean attack rate of 3.6+/-1.1 per year (range, 2-8) decreased to 0.56+/-0.75 (range, 0-4) per year (P=0.001). Visual acuity improved (> or = 0.2 logarithm of the minimum angle of resolution units from initial VA) in 30 eyes (28.3%) and worsened in 12 eyes (11.3%). Five patients (9.4%) did not respond to the initial treatment, and 3 patients (5.6%) developed severe adverse effects, including psoriasis, epileptic seizure, and extreme tiredness. Fifteen patients (28.3%) were off treatment for all the medications and disease free for 28+/-13.1 months (range, 12-50 months). CONCLUSIONS: These results suggest that IFNalpha2a may be a valuable treatment option in BU that is refractory to corticosteroids and conventional immunosuppressive agents. The possible role of IFNalpha2a as a first-line agent in BU should be validated in randomized controlled clinical trials against newly described biologic agents. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Outcomes of Nd:YAG laser treatment for Valsalva retinopathy due to intense military exercise.

BACKGROUND AND OBJECTIVE: Valsalva retinopathy may occur due to intense physical exercise. Soldiers must undergo vigorous physical training to sustain a high level of readiness. The aim of this study was to evaluate the recovery period and the outcomes of Valsalva retinopathy due to physical exercise in the Turkish Army. PATIENTS AND METHODS: Twelve soldiers had Valsalva retinopathy related to military exercise. All patients received Nd:YAG laser membranotomy and were observed for an average of 12.6 months. RESULTS: All eyes had visual acuities of 20/20 at the end of the first month of follow-up. Therefore, the soldiers could continue their training. No complications were observed and additional surgeries were not needed during the 1-year follow-up. CONCLUSIONS: Early visual recovery is important to continue training and reduce health costs in the Turkish Army, where military service is mandatory for a required period of time. For that reason, Nd:YAG laser treatment for Valsalva retinopathy related to military exercise is an effective and safe procedure.

Multifocal electroretinogram in mild to moderate essential hypertension.

PURPOSE: To investigate the local retinal dysfunctions in mild to moderate essential hypertensive patients by using multifocal electroretinogram (mfERG). METHODS: Thirty-one patients with stage 1 or stage 2 hypertension (HT) and 31 age- and sex-matched healthy normotensive (NT) subjects were included. Fourteen of the patients had stage 1 and 17 had stage 2 hypertension. Twenty had grade 1 and 11 had grade 2 hypertensive retinopathy. The local retinal functions from the fovea to the peripheral 30 degrees were evaluated by multifocal electroretinogram by dividing this area to central hexagonal area (CH) and four concentric rings around the central hexagon (Rings 1-4). The amplitude and the implicit times of the positive peak (P1) and the negative peak (N1) of the responses were compared between the control subjects and hypertensive patients. Only the right eyes were included. The differences between the hypertensive patients and control subjects were investigated using independent samples t test, and the differences between grade 1 and grade 2 hypertensive retinopathy and stage 1 and stage 2 hypertension were investigated using Mann-Whitney U test. RESULTS: P1 amplitudes in CH (HT: 129.0 +/- 29.5, NT: 149.1 +/- 45.5, p = 0.043) and in Ring 3 (HT: 37.0 +/- 8.0, NT: 41.7 +/- 7.8, p = 0.024) and N1 amplitude in Ring 1 (HT: 26.8 +/- 7.4, NT: 30.8 +/- 7.8, p = 0.048) in the hypertensive patients was significantly reduced when compared to healthy normotensive subjects. There was no significant difference in terms of P1 and N1 implicit times. There was also no significant difference between the patients with stage 1 or stage 2 hypertension and patients with grade 1 or grade 2 hypertensive retinopathy. CONCLUSION: Hypertensive subjects have local retinal dysfunctions with respect to healthy controls. This result probably originated from retinal ischemia due to changes in retinal and/or choroidal circulation in systemic arterial hypertension.

Effect of subconjunctival bevacizumab (Avastin) on experimental corneal neovascularization in guinea pigs.

PURPOSE: To evaluate the effect of subconjunctival bevacizumab (Avastin) on experimental corneal neovascularization in guinea pigs. METHODS: Forty eyes of 40 guinea pigs were chemically cauterized with 75% silver nitrate and 25% potassium nitrate sticks. Fifteen eyes (group 1) received 2 subconjunctival injections of bevacizumab (0.1 mL, 1.25 mg) simultaneously with cauterization and 3 days later. Fifteen eyes (group 2) received 2 subconjunctival injections of bevacizumab (0.1 mL, 1.25 mg) 3 and 5 days after cauterization. Ten eyes (group 3, control group) received 2 subconjunctival injections of 0.1 mL of balanced salt solution 3 and 5 days after cauterization. After we determined the burn and neovascularization scores for all groups, the animals were killed on the 10th day. The percentages of neovascularization on the surface of the cornea were measured in terms of pixels on digital photographs. The average number of vessels at maximally vascularized areas was determined for each specimen. RESULTS: Neovascularization score was 1.1 +/- 0.3 in group 1, 2.46 +/- 1.3 in group 2, and 3.5 +/- 0.5 in the control group. The difference was statistically significant (P < 0.001). The area of neovascularization at the cornea surface was 15.6% +/- 10.1% in group 1, 19.74% +/- 11.2% in group 2, and 23.5% +/- 7.4% in the control group (P = 0.194). The average number of neovascular vessels at group 1 was significantly reduced in comparison with group 2 and the control group (P < 0.001). CONCLUSIONS: Subconjunctival injection of bevacizumab decreases the extent of chemically induced corneal neovascularization in guinea pigs. The antineovascular effect of bevacizumab is higher if the injection is performed simultaneously with the chemical cauterization.

Sensitivity and specificity of Heidelberg Retinal Tomography II parameters in detecting early and moderate glaucomatous damage: effect of disc size.

PURPOSE: To determine the efficacy of Heidelberg Retinal Tomography II (HRTII) parameters in differentiating normal eyes from eyes with early or moderate glaucomatous damage. METHODS: HRTII tests were performed on 70 eyes of 70 patients with early or moderate glaucomatous damage, and 70 eyes of 70 healthy subjects. HRTII stereometric parameters, global and sectorial rim area parameters were recorded. Sensitivity and specificity of each parameter were calculated. Cases were divided into three groups according to disc size as large, medium and small, and mean values of parameters in glaucoma and control groups were compared. RESULTS: Mean disc area was larger in the glaucoma group (P < 0.05). There was a significant difference between the two groups for all stereometric parameters, except height variation contour, mean retinal nerve fibre layer thickness and retinal nerve fibre layer cross-sectional area stereometric parameters. There was also a significant difference between the groups for global, temporal, superior temporal and inferior temporal rim area parameters. In small discs, however, this difference disappeared in all parameters except temporal rim area and superior temporal rim area sectorial parameters. When all the cases were included, the quartet parameters having the highest specificity (80%) and sensitivity (74.3%) were cup volume, rim volume, cup shape measure and height variation contour parameters. CONCLUSION: Some HRTII parameters have better sensitivity and specificity than the others. It is necessary to pay special attention in evaluating small discs.

Acute effects of cigarette smoking on multifocal electroretinogram.

BACKGROUND: Cigarette smoking was shown to have stimulant effects on pattern visual-evoked potentials. The aim of this study was to investigate the acute effects of cigarette smoking on multifocal electroretinogram (mfERG). METHODS: This prospective case-control study was held in a tertiary referral centre in Turkish Armed Forces. mfERGs were investigated in a group of habitual smokers (30 right eyes of 30 subjects) in separate real smoking and sham smoking sessions. mfERG responses of the subjects were recorded after overnight abstinence. The responses were averaged over five retinal regions, the central hexagon (CH; central 6 degrees) and four concentric rings (ring 1 [R1; 7-12 degrees], ring 2 [R2; 13-18 degrees], ring 3 [R3; 19-24 degrees], ring 4 [R4; 25-30 degrees]). On each session mfERGs were recorded before (BS) and after smoking (AS) conditions. RESULTS: Regarding P1 amplitudes (first positive deflection of the mfERG) in the real smoking sessions, the differences were significant in the CH (BS: 66.2 +/- 16.3 microV, AS: 73.3 +/- 19.6 microV, P < 0.001), in R1 (BS: 44.3 +/- 13.0, AS: 48.3 +/- 16.0, P = 0.004) and in R2 (BS: 30.1 +/- 8.3, AS: 33.7 +/- 9.7, P = 0.002). Similar results were found for N1 amplitudes and P1 and N1 (first negative deflection of the mfERG) latencies in the CH, R1 and R2. The differences in outer retinal areas (R3, R4) in the real smoking sessions and in all rings in the sham smoking sessions were not significant. CONCLUSION: Cigarette smoking may stimulate the central retinal areas in the acute phase. This effect may be related with the stimulant effect of nicotine on neurotransmission, deleterious effects on retinal and/or choroidal circulation, carbon monoxide toxicity and nicotine withdrawal.

Primary nasolacrymal tuberculosis diagnosed after dacryocytorhinostomy.

Although tuberculosis (TB) is common and well recognized in many countries, unusual presentations of the disease sometimes raise difficulties in differential diagnosis. Primary tuberculosis of the lacrimal sac and the nasolacrimal duct is an extremely rare presentation of extra-pulmonary tuberculosis. Dacryocystorhinostomy alone is not sufficient for the treatment of these patients and an anti-tuberculous therapy has to be added. Here we present a patient with primary tuberculosis, which is limited to the inferior meatus and filled the entire lacrimal sac on the left side. The patient underwent endoscopic dacryocystorhinostomy due to obstruction of the nasolacrimal duct and culture of the granulation tissue, taken from the lacrimal sac revealed mycobacterial tuberculosis. The patient was improved with anti-tuberculous therapy that was added to the surgery. Primary tuberculosis is a rare granulomatous disease of the nasolacrimal system, which should be considered in the differential diagnosis to plan the effective treatment.

Ingestion of IH636 grape seed proanthocyanidin extract to prevent selenite-induced oxidative stress in experimental cataract.

PURPOSE: To investigate whether dietary supplementation with IH636 grape seed proanthocyanidin extract (GSPE) prevents selenite-induced cataract. SETTING: Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey. METHODS: Thirty Spraque-Dawley rat litters were put randomly into 3 groups. In group 1 (n = 10), sodium selenite (30 nmol/g body weight) was injected subcutaneously on postpartum day 10. In group 2 (n = 10), sodium selenite (30 nmol/g body weight) was injected on postpartum day 10 and oral GSPE (100 mg/kg body weight) was given for 1 week after sodium selenite injection. Only subcutaneous saline was injected in group 3 (control, n = 10). The development of cataract was assessed for 3 weeks, and its density was graded and photographed with a slitlamp. Removed rat lenses were analyzed for glutathione (GSH) and malondialdehyde (MDA). RESULTS: All of the rats in group 1 had cataract between stage 6 and stage 3. In group 2, only 5 of 10 eyes had cataract between stage 3 and stage 2 and no cataract occurred in the remaining 5 rats. The difference between mean cataract stages in group 1 and group 2 was significant (P<.05). The mean GSH level in group 1 was significantly lower than in group 2 and controls (P<.05). The mean MDA level in group 1 was significantly higher than in group 2 and controls (P<.05). CONCLUSIONS: IH636 grape seed proanthocyanidin extract effectively suppressed cataract formation in rats. Routine consumption of grape seed proanthocyanidin extract in the form of food or dietary supplement may offer a prophylactic measure against onset and progression of cataract.

Comparison of tilt and decentration of 1-piece and 3-piece hydrophobic acrylic intraocular lenses.

PURPOSE: To determine the amount of tilt and decentration of 1-piece and 3-piece hydrophobic acrylic intraocular lenses (IOLs) in patients having cataract surgery. SETTING: Department of Ophthalmology, Gulhane Military Medical Academy and Medical School, Ankara, Turkey. METHODS: Eighty-eight patients having phacoemulsification with IOL implantation were divided into 2 groups. One group received a 3-piece hydrophobic acrylic IOL with 12.5 mm poly(methyl methacrylate) haptics and the other, a 1-piece hydrophobic acrylic IOL with 12.5 mm haptics. The amount of IOL decentration and tilt was quantitated using Purkinje reflections and photographic documentation at the last postoperative control. The results of the 2 groups were compared. RESULTS: Bag fixation of the IOL and an intact continuous curvilinear capsulorhexis (CCC) were confirmed in all cases at the last postoperative control, which was at a mean of 27.1 months +/- 5.4 (SD) and 26.7 +/- 4.4 months in the 3-piece group and 1-piece group, respectively (P = 0.659). There was no significant difference between groups in the percentage of patients with measurable tilt and decentration and of patients without measurable tilt and decentration (P = .956). The mean IOL tilt was 2.72 +/- 0.55 degrees in the 3-piece group and 2.70 +/- 0.84 degrees in the 1-piece group and the mean IOL decentration, 0.39 +/- 0.13 mm and 0.34 +/- 0.08 mm, respectively. There were no significant between-group differences in tilt or decentration (P = .897 and P = .103, respectively). CONCLUSION: There were no significant differences in tilt and decentration between 1-piece and 3-piece hydrophobic acrylic IOLs in eyes with capsular bag IOL implantation and an intact CCC.