Non-penetrating deep sclerectomy in unilateral open-angle glaucoma secondary to idiopathic dilated episcleral veins.

PURPOSE: To investigate the efficacy of non-penetrating deep sclerectomy (NPDS) in a secondary open-angle glaucoma case due to dilated episcleral veins, on intraocular pressure and retrobulbar hemodynamics. METHODS: NPDS was done on a 32-year-old male unilateral open-angle glaucoma secondary to idiopathic dilated episcleral veins. RESULTS: Except for hyphema and shallow anterior chamber on the first post-operative day, no other complications were observed. Intraocular pressure was 18-20 mmHg during the first six months, without medication or visual loss. Retrobulbar color Doppler imaging showed normal mean and end-diastolic velocities and pulsatility indices of the posterior ciliary and central retinal arteries at end of the first post-operative year. CONCLUSIONS: NPDS may be an alternative to trabeculectomy in open-angle glaucoma secondary to dilated episcleral veins.

Combined ocular anesthesia via a single entry.

Although topical anesthesia techniques for cataract surgery are evolving, injections are unavoidable in some cases. Our technique of injecting local anesthetic agents for akinesia of the orbicularis oculi and the globe via a single entry near the lateral canthus decreases the pain and patient anxiety about the number of injections and avoids the complications of retrobulbar injection.

Relation between corneal thickness and intraocular pressure measurement by noncontact and applanation tonometry.

PURPOSE: To assess whether there is a significant difference in intraocular pressure (IOP) measurements between noncontact and applanation methods and if so, whether the difference is correlated with corneal thickness. SETTING: Isik Eye Clinic, Ankara, Turkey. METHODS: This prospective study comprised 120 eyes of 60 randomly selected patients. Noncontact tonometry, applanation tonometry, and pachymetry were performed in each eye. The results were compared and an analysis was performed to determine whether there was a correlation between the differences in IOP measurements and corneal thickness in the entire group and in subgroups composed of the halves and quarters of the group. RESULTS: The mean IOP in the entire group was 20.38 mm Hg +/- 4.97 (SD) with the noncontact tonometer and 18.84 +/- 4.47 mm Hg with the Goldmann applanation tonometer. The difference between the measurements with the noncontact method and those with the applanation method was statistically significant (P <.01) except in cases having a corneal thickness between 513 microm and 539 microm (P >.01). There was a positive correlation between corneal thickness and the difference in measurements by noncontact and applanation tonometry, and the magnitude of correlation was greater in cases with thicker corneas. CONCLUSION: The reliability of tonometers decreased with increasing corneal thickness, in which case higher readings were found, especially with the noncontact tonometer.

Correlation between intraocular pressure and corneal stromal thickness after laser in situ keratomileusis.

PURPOSE: To assess the relationship between intraocular pressure (IOP) and corneal stromal thickness following laser in situ keratomileusis (LASIK) for myopia or myopic astigmatism. SETTING: Private clinic in Turkey. METHODS: The database of patients who had LASIK was retrospectively reviewed. Preoperative and postoperative IOP and corneal thickness were measured in both eyes of 353 patients by noncontact tonometry and ultrasonic pachymetry, respectively. The correlation between changes in IOP and corneal thickness was evaluated by regression analysis. RESULTS: Laser in situ keratomileusis was associated with a mean decrease in pachymetry of 46.7 microm +/- 28.9 (SD) and a mean decrease in IOP of 2.8 +/- 2.1 mm Hg. There was a significant correlation between the decreases in IOP and pachymetry (P <.001). CONCLUSION: The decrease in IOP after LASIK was related to the decrease in corneal stromal thickness, although there may be other contributing factors.

Outcome of flap subluxation after laser in situ keratomileusis: results of 6 month follow-up.

PURPOSE: To evaluate the long-term outcome in cases with flap subluxation after laser in situ keratomileusis (LASIK). SETTING: Private clinic in Turkey. METHODS: Data of all patients who had LASIK were documented and the follow-ups of those who had flap subluxation evaluated. The number of LASIK cases was 1481 and the number of flap subluxations, 21. Laser in situ keratomileusis was performed with the Moria microkeratome and the VISX Twenty/Twenty B excimer laser using a multizone profile and the sutureless hinged corneal flap technique. RESULTS: The incidence of flap subluxation was 1.42%. Statistical analysis of uncorrected visual acuities, best corrected visual acuities, and mean spherical equivalents in eyes with and without flap subluxation was performed. No significant differences were found, although the results in eyes with flap subluxation were worse than those in eyes without flap subluxation. Additional complications were also higher in eyes with flap subluxation. CONCLUSION: Flap subluxation is a serious but manageable complication of LASIK. If it is detected early, the visual prognosis is as good as that in eyes without flap subluxation.

Hemodynamic changes after strabismus surgery.

AIM: The aim of this study was to investigate the hemodynamic changes that may occur in the retrobulbar circulation after strabismus surgery, using color Doppler ultrasonography (CDI). METHODS: Fifteen healthy volunteers (control group, n=15) and sixteen patients diagnosed with strabismus were enrolled in the study. Either recession or resection was planned on one horizontal rectus muscle in the eyes of Group 1 (n=11) and on two horizontal rectus muscles in the eyes of Group 2 (n=10). CDI was performed to measure peak systolic velocity (V(max)), end-diastolic velocity (V(min)) and mean blood flow velocity (V(mean)) in the ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary artery (PCA) in the control group and in Groups 1 and 2, both preoperatively and 2-7 days postoperatively. RESULTS: The postoperative resistivity indexes in Groups 1 and 2 were found to be different from those in the control group. Preoperative V(max) and postoperative V(min) and V(mean) values of the vessels in Group 2 were different from those in both Group 1 and the control group (p<0. 001). In both treatment groups, the differences between postoperative and preoperative measurements of the parameters in the OA, CRA and PCA demonstrated statistical significance (p<0.001). CONCLUSION: After strabismus surgery on the horizontal recti, there are some alterations in the retrobulbar blood flow with a significant difference between pre- and postoperative blood flow velocities after single and double rectus surgery. The clinical significance of these results needs to be determined because CDI may be a useful tool in the investigation of hemodynamic alterations after anterior segment interventions that may cause anterior segment ischemia.

A randomized trial of low-dose, topical mitomycin-C in the treatment of severe vernal keratoconjunctivitis.

OBJECTIVE: To evaluate the efficacy and safety of low-dose, topical mitomycin-C in patients with severe vernal keratoconjunctivitis. DESIGN: Placebo-controlled, double-masked, randomized clinical trial. PARTICIPANTS: Twenty-six patients with vernal keratoconjunctivitis refractory to combination of steroid and mast-cell stabilizer treatment. INTERVENTION: Patients were randomly assigned (2:1) to treatment with topical 0.01% mitomycin-C eye drops (n = 17) or placebo (n = 9) three times daily for 2 weeks. MAIN OUTCOME MEASURES: Symptoms (itching, tearing, photophobia, ropy mucous discharge, foreign body sensation) and signs (conjunctival hyperemia, epithelial punctate keratitis, Trantas' dots, limbal edema, and palpebral conjunctival giant papillae) of vernal keratoconjunctivitis recorded on the day of enrollment and at the end of the treatment period. RESULTS: There was a statistically significant decrease in ropy mucous discharge, photophobia, conjunctival hyperemia, and limbal edema in the mitomycin-C treated group compared with the placebo group at the end of the 2-week treatment period. In addition, none of the 17 treated patients, but all 9 of the placebo patients, required medication during the 4-week posttreatment follow-up period. No adverse effects of treatment with mitomycin-C were observed. CONCLUSIONS: Short-term, low-dose, topical mitomycin-C may be considered in the acute exacerbation periods of patients with severe vernal keratoconjunctivitis refractory to conventional treatment.

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.

Penetration of topical ciprofloxacin by presoaked medicated soft contact lenses.

PURPOSE: To assess the penetration of topical ciprofloxacin by a presoaked medicated disposable soft contact lens without topical drop administration. METHODS: Disposable soft contact lenses were presoaked in 0.3% topical ciprofloxacin (Ciloxan, Alcon Laboratories, Fort Worth,TX) for 10-12 hours. Presoaked lenses were placed on the eyes of patients with senile cataracts for 3 hours in group A, 5-6 hours in group B, and 8-12 hours in group C prior to their scheduled lens extraction surgery. Aqueous humor samples were drawn by paracentesis during the operation. Ciprofloxacin concentrations were determined by high pressure liquid chromatography-fluorescence detection. RESULTS: The mean ciprofloxacin concentration was 2.70 +/- 0.98 microg/mL in group A, 1.22 +/- 1.0 microg/mL in group B, and 0.5 +/- 0.2 microg/mL in group C. CONCLUSIONS: Penetration of topical ciprofloxacin is enhanced through a presoaked disposable soft contact lens, and at 3 hours therapeutic levels are obtained. Significant levels of ciprofloxacin are retained through 8-12 hours. This mode of treatment may increase patient compliance compared to frequent topical drop administration, and as a consequence, assure efficient treatment of keratitis, at least for the first 3 hours.

Risk factors in central retinal vein occlusion and activated protein C resistance.

INTRODUCTION: Central retinal vein occlusion (CRVO) tends to be a disease of older individuals, with some known major risk factors, and activated protein C resistance seems to be one of the causes in younger patients. In this study, we reviewed risk factors including activated protein C resistance in a series of patients with CRVO. METHODS: Twenty-four patients with a diagnosis of CRVO presenting either acutely or for a follow-up visit during the study period, were enrolled. Ages ranged between 31 and 83 years (mean 59.7). The risk factors, presence of ischemia, the results of biochemical serological and hematological tests, especially activated protein C resistance (APC-R), were analysed. RESULTS: In 17 patients (71%) one or more of the following risk factors existed: hypertension, diabetes, oral contraceptive usage, family history of thrombosis, and previous operation. In 40% of the eyes, there were ischemic changes. Serum triglycerides were high in 4 of 21 patients (19%) and cholesterol and urea were high in 10 of 21 patients (19%). APC-R was found in 6 out of 24 patients (25%). CONCLUSIONS: Besides known predisposing factors like hypertension, diabetes, glaucoma and hyperlipidemia, APC-R seems to be a risk factor for CRVO at all ages.

Postoperative topical mitomycin C in conjunctival squamous cell neoplasia.

PURPOSE: To report the efficacy of topical mitomycin C in preventing local recurrences after incomplete surgical excision of conjunctival squamous cell neoplasia. METHODS: Four patients presented with unilateral conjunctival tumors. Excisional biopsy results revealed conjunctival intraepithelial neoplasia with an intact basement membrane. Neoplastic cells were present in at least one of the surgical borders of the excised conjunctiva in all four cases. Patients were treated with topical mitomycin C 0.02% three times daily for 2 weeks to prevent recurrences. RESULTS: All four patients were free of clinically detectable tumors after a mean follow-up period of 20 months (range, 16-23 months). Side effects included mild discomfort, redness, photophobia, and punctate epithelial keratopathy that subsided on discontinuation of the medication. CONCLUSION: Postoperative topical mitomycin C application may be a useful adjunct to prevent recurrences in patients with incompletely excised conjunctival squamous cell neoplasia.

The effect of latanoprost on aqueous humor PGF2alpha levels in glaucoma patients.

AIM: The purpose of this study is to evaluate the effect of the PGF2alpha isopropyl ester analogue, Latanoprost which is a new ocular hypotensive topical agent, on the aqueous humor PGF2alpha levels in open-angle glaucoma patients. METHODS: Patients diagnosed with either capsular or primary open-angle glaucoma and scheduled for trabeculectomy, were consecutively enrolled in the study. Group 1 represented the control group (n = 17) and Group 2 represented the Latanoprost treatment group (n = 9). All the topical drugs were stopped 10 days preoperatively and only systemic carbonic anhydrase inhibitors were continued if necessary. Group 2 patients received topical 0.005% Latanoprost once daily for 5-10 days preoperatively. During trabeculectomy operation, aqueous samples were taken through paracentesis from the patients. Aqueous humor levels of PGF2alpha and its metabolite 13,14-dihydro-15-keto-PGF2alpha were measured using enzyme-immunoassay. RESULTS: The mean PGF2alpha levels were 24.38 +/- 5.79 pg/ml in the control group and 10.99 +/- 4.11 pg/ml in the Latanoprost group, the difference of which was statistically significant (p < 0.05). In the Latanoprost group, there was a positive correlation between levels of PGF2alpha, and its metabolite (p < 0.05). CONCLUSION: Pretreatment with PGF2alpha isopropyl ester analogue, Latanoprost topically decreased PGF2alpha levels in the aqueous humor of glaucomatous eyes, probably due to its uveoscleral outflow increasing effect. The clinical importance and application of this result has to be determined.

Factor V Leiden and prothrombin 20210 A mutations in patients with central and branch retinal vein occlusion.

PURPOSE: The role of factor V Leiden and prothrombin 20210 A mutations has been investigated in patients with central retinal vein occlusion (CRVO), hemispheric retinal vein occlusion (HRVO), and branch retinal vein occlusion (BRVO). METHODS: Factor V Leiden and prothrombin 20210 A were investigated in DNA obtained from the peripheral blood of 52 patients with retinal vein occlusion. Twenty-five of the patients had either CRVO or HRVO, and 27 patients had BRVO. The control groups for factor V Leiden and prothrombin 20210 A were comprised of two separate groups of 81 and 87 healthy individuals, respectively, who had been previously investigated for the mutations at Hacettepe University Department of Hematology. The frequencies of factor V Leiden and prothrombin 20210 A mutations were compared between the patients and the controls using Fisher's exact test. RESULTS: Factor V Leiden mutation was found in 8% of all patients, 4% of the CRVO-HRVO group and 11% of the BRVO patients. Prothrombin 20210 A mutation was not found in any of the patients. Factor V Leiden and prothrombin 20210 A mutations have been previously found in 7% and 2% of the healthy controls, respectively. The differences of frequencies between the patients and the controls were not statistically significant. CONCLUSION: Factor V Leiden and prothrombin 20210 A mutations have not been found to be risk factors in either type of retinal vein occlusion.

Risk factors in central retinal vein occlusion an activated protein C resistance.

INTRODUCTION: Central retinal vein occlusion (CRVO) tends to be a disease of older individuals, with some known major risk factors, and activated protein C resistance seems to be one of the causes in younger patients. In this study, we reviewed risk factors including activated protein C resistance in a series of patients with CRVO. METHODS: Twenty-four patients with a diagnosis of CRVO presenting either acutely or for a follow-up visit during the study period, were enrolled. Ages ranged between 31 and 83 years (mean 59.7). The risk factors, presence of ischemia, the results of biochemical serological and hematological tests, especially activated protein C resistance (APC-R), were analysed. RESULTS in 17 patients (71%) one or more of the following risk factors existed: hypertension, diabetes, oral contraceptive usage, family history of thrombosis, and previous operation. In 40% of the eyes, there were ischemic changes. Serum triglycerides were high in 4 of 21 patients (19%) and cholesterol and urea were high in 10 of 21 patients (19%). APC-R was found in 6 out of 24 patients (25%). CONCLUSIONS: Besides known predisposing factors like hypertension, diabetes, glaucoma and hyperlipidemia, APC-R seems to be a risk factor for CRVO at all ages. (Eur J Ophthalmol 1999; 9: 43-9).

Synostotic plagiocephaly causing pseudoparalysis of the superior oblique and ocular torticollis: report of a case with unique sensory findings.

PURPOSE: To report a case in which strabismus surgery did not eliminate the abnormal head posture although it did improve the vertical strabismus; and to consider the causes of this situation. CASE REPORT: The patient had a right eso-hypertropia and ocular torticollis to the left shoulder as a result of a right superior oblique mechanical deficiency, secondary to her craniosynostosis. A myectomy of the right inferior oblique muscle and a tucking procedure of the right superior oblique muscle were performed. Postoperatively, the abnormal head posture persisted, although strabismus surgery improved the vertical deviation. However, improvement of the abnormal head posture upon patching the deviated eye only indicated that the origin of the persistent abnormal head posture must be ocular. Further tests revealed that an anomalous retinal correspondence (ARC) with eccentric fixation was responsible. CONCLUSIONS: In patients with ocular torticollis, ARC with eccentric fixation must be ruled out prior to surgery as these may negatively affect the outcome.

Accurate time interval in repeated tonometry.

PURPOSE: Determination of the accurate interval between the measurements in repeated tonometry. METHODS: Two hundred-and-seventy subjects were randomly divided into 6 groups. Two successive intraocular pressure (IOP) measurements were performed with Goldmann-type applanation tonometer at different time intervals in each group. The time intervals between the two measurements were 1, 2, 3, 4, 5 and 10 minutes. The results in each group were statistically analyzed with the significance test for matched observations. RESULTS: We recorded a statistically significant difference between the first and the second IOP measurements at 1, 3, 4 and 5-minute-intervals. The differences were not significant at 2 and 10 minute-groups. CONCLUSION: The time interval between successive IOP measurements should be 2 or 10 minutes for accurate tonometry.

Clinical status, ocular surface changes and tear ferning in patients with cystic fibrosis.

Twenty-three cystic fibrosis patients and 20 controls were examined for ocular surface changes and tear fluid ferning characteristics. The patients were also evaluated systemically and given numerical scores according to Schwachman's scoring system. Frequency of blepharitis, fluorescein staining, and the Schirmer's test values did not differ between patients and controls. Patients with cystic fibrosis had a higher frequency of altered ferning pattern that corresponded to the disease severity as measured by the Schwachman score (r = -0.48, p < 0.05). Although altered ferning pattern was frequent, the rate of type I ferning was also high (30%) in patients with cystic fibrosis. We conclude that the ferning test should not be used as an aid in diagnosis of cystic fibrosis but it may be used as an indicator of clinical status during follow-up.

Penetration of topical 0.3% ciprofloxacin into human aqueous humor.

BACKGROUND AND OBJECTIVE: Investigation of the penetration of topical ciprofloxacin into aqueous humor. PATIENTS AND METHODS: Topical 0.3% ciprofloxacin drops were administered to 17 patients with cataracts before lens extraction surgery. The time interval between the first dose and sampling was 3 hours in 9 patients (group A) and 6 hours in 8 (group B). In both groups, aqueous samples were collected 30 minutes after the last ciprofloxacin application. Ciprofloxacin concentration was determined by high-performance liquid chromatography-fluorescence detection. RESULTS: Mean aqueous concentration was 0.83+/-0.48 microgram/ml in group A and 2.42+/-1.42 micrograms/ml in group B. CONCLUSION: Topical 0.3% ciprofloxacin penetrates into the aqueous in a significant concentration.