The role of anterior segment optical coherence tomography in the management of an intra-corneal foreign body.

INTRODUCTION: Corneal foreign bodies are reported to be the second most common type of ocular injury. Anterior segment optical coherence tomography (AS-OCT) is a valuable tool for the early diagnosis and monitoring the progress of treatment in cases of ocular trauma. Herein we aimed to report on a patient with an intra-corneal foreign body and the role of AS-OCT in management. CASE PRESENTATION: A 34-year-old male presented with foreign body sensation in his left eye. Slit-lamp biomicroscopic examination revealed a peripherally located intrastromally embedded foreign body with a free anterior edge extending outwards from the cornea. It was not possible to visualize the foreign body's entire route through the cornea because of localized corneal edema. AS-OCT showed shadowing of the corneal layers corresponding to the location of the corneal foreign body. A hyper-reflective lesion was observed close to the inside edge of the foreign body in the cornea, indicating that the foreign body had not completely penetrated the cornea. The foreign body was removed via the external route, as it had not completely penetrated the cornea. During the postoperative period the patient was asymptomatic, although the left eye's cornea healed with scar tissue. DISCUSSION AND EVALUATION: AS-OCT facilitates non-invasive rapid imaging of ocular tissue at va rious depths, thereby providing accurate assessment of foreign body characteristics.The location of an intracorneal foreign body and the status of the surrounding ocular structure dictate the optimal surgical technique to be employed. CONCLUSIONS: AS-OCT in the present case facilitated localization and determination of the size of a corneal foreign body. In addition, AS-OCT findings assisted in selection of the appropriate surgical intervention.

Hyperbaric oxygen for the treatment of the rare combination of central retinal vein occlusion and cilioretinal artery occlusion.

A 43-year-old male presented with sudden onset of painless, blurred vision in his left eye. Dilated fundoscopic examination showed signs consistent with the diagnosis of a combination of central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CLRAO). He received daily 2-h sessions of hyperbaric oxygen treatment (HBOT), 253 kPa for 14 days. At the end of the HBOT course, the patient's left visual acuity had improved from 20/200 to 20/20. Dilated fundoscopic examination showed that the intra-retinal haemorrhages in the entire retina and the retinal whitening along the course of the CLRA seen at presentation had completely resolved. The combination of CLRAO and CRVO comprises a discrete clinical entity. Even though there are many hypotheses concerning this condition, it is most likely the result of elevated intraluminal pressure in the retinal capillaries due to CRVO that exceeds the pressure in the CLRA. HBOT may be an effective treatment for CRVO-associated CLRAO.

Iris metastasis of gastric adenocarcinoma.

BACKGROUND: Iris metastasis in patients with gastric cancer is extremely rare. Herein, it is aimed to report on a patient with gastric adenocarcinoma and iris metastasis. CASE PRESENTATION: A 65-year-old patient with the history of gastric cancer was admitted for eye pain and eye redness on his left eye. There was ciliary injection, severe +4 cells with hypopyon in the anterior chamber and a solitary, friable, yellow-white, fleshy-creamy vascularized 2 mm × 4 mm mass on the upper nasal part of the iris within the left eye. The presented patient's mass lesion in the iris fulfilled the criteria of the metastatic iris lesion's appearance. The ocular metastasis occurred during chemotherapy. CONCLUSIONS: Iris metastasis can masquerade as iridocyclitis with pseudohypopyon or glaucoma. In patients with a history of gastric cancer that present with an iris mass, uveitis, and high intraocular pressure, ocular metastasis of gastric cancer should be a consideration.

Retinal tear: an unusual complication of ocular toxoplasmosis.

PURPOSE: It is aimed to report on a 16-year-old patient with acquired ocular toxoplasmosis complicated by a retinal tear. METHODS: Retrospective medical chart review. RESULTS: A 16-year-old Caucasian female presented with vision loss in her right eye. In addition to a white active lesion between the fovea and the optic nerve head, marked vitreous opacification was noted. She was diagnosed with ocular toxoplasmosis. The patient was treated with oral azithromycin, clindamycin, and trimethoprimsulfamethoxazole. One month later, retinochoroiditis resolved and vitreous cleared. Three months after onset, patient presented with floaters in the right eye and a retinal tear was located at the temporal region of the retina. Prophylactic argon laser treatment that encircled the retinal tear was performed. No other abnormalities were noted during 6 months of follow-up. CONCLUSIONS: Retinal tear associated with ocular toxoplasmosis is rare; however, a retinal tear can occur due to vitreoretinal traction following post-inflammatory structural alteration of the vitreous. Retinal tears may be seen during the healing phase, when the inflammation turns into tightening of vitreous substance. Careful retinal examination in cases of ocular toxoplasmosis is warranted, especially in patients with severe vitreous inflammation.

Effect of mitomycin C on revision endoscopic dacryocystorhinostomy.

OBJECTIVE: The objectives of the study were to compare the outcome and success rate of revision endoscopic dacryocystorhinostomy (EN-DCR) with or without use of adjunctive mitomycin C (MMC) in cases with dacryocystorhinostomy (DCR) failure. METHODS: Thirty-six consecutive adult patients underwent revision EN-DCR. The patients were divided into 2 groups. In group 1 (18 patients), a neurosurgical cottonoid soaked in MMC at 0.5 mg/mL was placed at the osteotomy site for 5 minutes (using canalicular silicone intubation tube). In the other group (18 patients), standard endoscopic dacryocystorhinostomy technique was used without MMC (using canalicular silicone intubation tube). Successful DCR was defined as relief of symptoms (resolution of epiphora and absence of discharge) as demonstrated by saline irrigation at the last postoperative visit. RESULTS: The EN-DCR procedure with adjunctive MMC was successful in 16 (88.88%) cases. The mean follow-up was 11.5 months (7-19 months). No significant complications were encountered. In the control group, the EN-DCR was successful in 10 patients (55.55%). The mean follow-up was 12.7 months (6-22 months). The difference between the 2 groups was statistically significant (P < 0.05). CONCLUSIONS: Recurrent nasolacrimal duct obstruction after primary DCR is mainly due to reclosure of the nasolacrimal stoma and osteotomy site with granulation tissue. Adjunctive use of intraoperative MMC seems to be a safe adjuvant that could help in increasing the success rates of revision EN-DCR surgery.

Endoscopic dacryocystorhinostomy not using canalicular silicone intubation tube with and without mitomycin C: a comparative study.

PURPOSE: To determine the outcome and safety of endoscopic dacryocystorhinostomy (EN-DCR) with the use of adjunctive mitomycin C (MMC) in nasolacrimal duct obstruction in adults. METHODS: In this retrospective, comparative case series, 54 consecutive adult patients underwent EN-DCR. We performed endonasal dacryocystorhinostomy with adjunctive MMC in 28 patients and endonasal dacryocystorhinostomy without MMC in 26 patients. All patients underwent a standardized procedure, with an endonasal approach to the lacrimal sac, surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was removed completely. In the study group (28 patients), a neurosurgical cottonoid soaked in MMC at 0.5 mg/mL was placed at the osteotomy site for 5 minutes (not using canalicular silicone intubation tube). In the other group (26 patients), standard endonasal dacryocystorhinostomy technique was used without MMC (not using canalicular silicone intubation tube). Main outcome measures were resolution of epiphora, absence of discharge, and patency of the ostium confirmed by irrigation at 6 months. RESULTS: The EN-DCR procedure with adjunctive MMC was successful in 24 (85.71%) cases. The mean follow-up was 14.3 months (8-24 months). No significant complications were encountered. In the control group, the EN-DCR was successful in 19 patients (73.07%). The mean follow-up was 13.2 months (6-24 months). CONCLUSIONS: Endoscopic dacryocystorhinostomy with MMC is a safe and successful procedure for the treatment of nasolacrimal duct obstruction in adults.

A novel surgical technique to prevent postoperative Ahmed valve tube exposure through conjunctiva: tenon advancement and duplication.

BACKGROUND AND OBJECTIVE: To present and evaluate a novel surgical technique to prevent exposure of the Ahmed valve implant tube (New World Medical, Rancho Cucamonga, CA) through conjunctiva in congenital glaucoma called "combined short scleral tunnel technique with Tenon advancement and duplication." PATIENTS AND METHODS: Patients with failed previous congenital glaucoma surgeries were divided into two groups. In group 1, 32 eyes of 28 patients with a mean age of 8.82 +/- 5.39 years underwent classic Ahmed valve implant surgery. In group 2, 28 eyes of 24 patients with a mean age of 8.79 +/- 5.55 years underwent the novel combined short scleral tunnel with Tenon advancement and duplication technique. RESULTS: After a mean 31.68 +/- 9.25 months of follow-up, conjunctival tube exposure was seen in 3 patients (9.4%) in group 1. There was no conjunctival tube exposure in group 2 after a mean 34.96 +/- 7.93 months of follow-up. CONCLUSION: The combined short scleral tunnel with Tenon advancement and duplication technique is able to prevent conjunctival tube exposure after Ahmed valve implantation surgery in patients with congenital glaucoma.

Pattern electroretinogram changes after intravitreal bevacizumab injection for diabetic macular edema.

We aimed at investigating the efficacy of intravitreal bevacizumab injection by evaluation of pattern electroretinogram (PERG) in diabetic patients with clinically significant macular edema (CSME). Thirty-five eyes of 35 patients with diabetes were treated with 2.5 mg of intravitreal bevacizumab injection as the primary therapy for CSME. The main outcome measures included best-corrected visual acuity, fundus fluorescein angiography, and P(50) amplitudes of pattern electroretinogram (PERG) before and after intravitreal injection. Mean visual acuity improved significantly from a mean LogMAR value of 1.1 +/- 0.2 at baseline to a maximum of 0.7 +/- 0.3 after a mean follow-up time of 6.4 months. The mean baseline P(50) and N(95) amplitudes of PERG before intravitreal injection were 1.4 +/- 0.7 and 2.4 +/- 0.8 microV, respectively. After the treatment, the mean P(50) amplitude of PERG was 2.4 +/- 0.9 microV at 1-month, 2.3 +/- 0.8 microV at 3-month, and 2.2 +/- 0.8 microV at the last visit, and the mean N(95) amplitude of PERG was 3.4 +/- 1.05 microV at 1-month, 3.3 +/- 0.9 microV at 3-month, and 3.2 +/- 0.9 microV at the last visit, and the mean P(50) and N(95) amplitudes were significantly higher when compared with baseline values (for each, P < .001). Mild anterior chamber inflammation in four eyes was controlled with topical corticosteroids. Eyes with diabetic macular edema treated with intravitreal bevacizumab showed improvement in visual acuity that was accompanied by improvement in PERG amplitudes. Further randomized trials are needed to investigate the role of PERG measurements in the evaluation of the efficacy of intravitreal bevacizumab injection.

Anti-VEGF agents for age-related macular degeneration.

Age-related macular degeneration (AMD) is a leading cause of legal blindness in the elderly in the industrialized world and the third major cause of blindness around the globe. Although neovascular AMD is less prevalent than atrophic AMD, it accounts for most cases with severe visual loss from AMD. VEGF seems to be a key contributary factor in the pathophysiology underlying neovascular AMD. Until recently, treatment options for neovascular AMD were limited. With the recent development of anti-VEGF therapies that have demonstrated efficacy in studies with broad eligibility criteria, the repertoire of treatments for neovascular AMD has been significantly expanded to now include the various recognized angiographic lesion subtypes. To discuss recent anti-VEGF agents in the management of AMD. Although therapy with anti-VEGF agents is the gold standard with promising results, many intravitreal injections are often required, and they do not cure all cases of wet AMD. With the recent advances in the medical therapy of exudative AMD, there is reason to be optimistic about future management of AMD as well.

Comparison of 0.5% levobupivacaine, 0.5% bupivacaine, and 2% lidocaine for retrobulbar anesthesia in vitreoretinal surgery.

PURPOSE: The authors compared the efficacy of local anesthetics levobupivacaine, bupivacaine, and lidocaine for retrobulbar anesthesia in vitreoretinal surgery. METHODS: A total of 135 patients presenting for vitreoretinal surgery under local anesthesia were included in the study. Patients were randomly allocated to one of three groups. Group LB patients received 5 mL of 0.5% levobupivacaine, Group L patients received 5 mL of 2% lidocaine, and Group B patients received 5 mL of 0.5% bupivacaine for retrobulbar anesthesia via inferotemporal injection. Sensory and motor block durations were recorded. Intraoperative and postoperative pain was assessed by using verbal pain scala. Anesthesia efficiency, patient and surgeon satisfaction, and akinesia were assessed by using point scales. Hemodynamic data and adverse events were recorded. RESULTS: The demographic characteristics of patients, duration of surgery, and hemodynamic data in both groups were similar. The duration of motor and sensory block was longer in levobupivacaine and bupivacaine groups than lidocaine group. Pain on injection was found more frequent in Group L and Group B than Group LB and the difference between the Groups LB and B was significant (p<0.05). Surgeon and patient satisfaction were also higher and intraoperative pain was less in levobupivacaine group than lidocaine and bupivacaine groups. CONCLUSIONS: Levobupivacaine provides longer motor and sensory block duration and higher surgeon and patient satisfaction than lidocaine and bupivacaine when used for retrobulbar anesthesia in vitreoretinal surgery.

Intravitreal triamcinolone acetonide injection for the treatment of posterior uveitis.

PURPOSE: To assess the efficacy and complications of intravitreal triamcinolone acetonide (IVTA) injection in the treatment of posterior uveitis and to compare the outcomes with patients who had received systemic corticosteroids. METHODS: This prospective, interventional, clinical case series study included 11 eyes of 9 patients who received 8 mg/0.2 ml of IVTA injection for posterior uveitis that involved vitreous inflammation (group 1). Control group (group 2) consisted of 15 eyes of 12 patients who had received systemic corticosteroids for treatment of posterior uveitis with vitreous inflammation. The main outcome measures included best-corrected visual acuity, vitreous inflammation score and intraocular pressure. RESULTS: In group 1, mean visual acuity improved significantly (P < 0.001) from a mean logarithm of the minimum angle of resolution (LogMAR) value of 2.05 +/- 0.82 at baseline to a maximum of 0.33 +/- 0.22 during the follow-up period of 5.0 +/- 2.8 months. In control group, mean LogMAR visual acuity before systemic corticosteroid therapy was 1.82 +/- 0.78, and it has reached a maximum of 0.40 +/- 0.22 after treatment (P < 0.001). The mean inflammatory scores decreased significantly in both groups when compared with preinjection values (for each, P < 0.05). There were no statistically significant differences between group 1 and group 2 when pre-and posttreatment visual acuities and inflammatory scores at 1-, 3-, and 5-month follow-up examinations were compared (for each, P > 0.05). In group 1, mean intraocular pressure (IOP) increased significantly from 13.4 +/- 2.6 mmHg to a mean maximal value of 19.3 +/- 4.3 mmHg (P < 0.001), but there was no statistically significant difference between mean IOP at 5-month after IVTA injection and pretreatment value (P = 0.06). Cataract progression was observed in one eye. CONCLUSIONS: IVTA application may be an alternative therapeutic option for the treatment of acute posterior uveitis that involves vitreous inflammation, especially in patients who carry risks for systemic corticosteroid therapy.

Serum levels of soluble P-selectin are increased and associated with disease activity in patients with Behçet's syndrome.

Behçet's syndrome (BS) is a relapsing, chronic, inflammatory disease characterized by endothelial dysfunction, atherothromboembogenesis, and leukocytoclastic vasculitis with complex immunologic molecular interactions. Generalized derangements of the lymphocyte and neutrophil populations, activated monocytes, and increased PMNLs motility with upregulated cell surface molecules such as ICAM-1, VCAM-1, and E-selectin, which are found on the endothelial cells, leukocytes, and platelets, have all been demonstrated during the course of BS. Our aim is to investigate the association of serum concentrations of soluble P-selectin in patients with BS, and to evaluate whether disease activity has an effect on their blood levels. This multicenter study included 31 patients with BS (15 men and 16 women) and 20 age- and sex-matched healthy control volunteers (11 men and nine women). Neutrophil count, erythrocyte sedimentation rate, and acute-phase reactants as well as soluble P-selectin levels were determined. The mean age and sex distributions were similar (P > .05) between BS patients (35 years) and control volunteers (36 years). Serum levels of soluble P-selectin in patients with BS (399 +/- 72 ng/mL) were significantly (P < .001) higher when compared with control subjects (164 +/- 40 ng/mL). In addition, active BS patients (453 +/- 37 ng/mL) had significantly (P < .001) elevated levels of soluble P-selectin than those in inactive period (341 +/- 52 ng/mL). This study clearly demonstrated that serum soluble P-selectin levels are increased in BS patients when compared with control subjects, suggesting a modulator role for soluble P-selectin during the course of platelet activation and therefore, atherothrombogenesis formation in BS, especially in active disease.

The efficacy of intravitreal piperacillin/tazobactam in rabbits with experimental Staphylococcus epidermidis endophthalmitis: a comparison with vancomycin.

BACKGROUND: To investigate the efficacy of intravitreal piperacillin/tazobactam in rabbit eyes with experimental S. epidermidis endophthalmitis and to compare the outcomes with intravitreal vancomycin application. MATERIAL AND METHODS: Twenty-four New Zealand white albino rabbits were divided into three equal groups (n=8 in each), and the right eyes received 0.1-ml intravitreal injections of S. epidermidis suspension. The left eyes served as uninfected controls and were injected with 0.1 ml of saline solution. The right eyes of rabbits in group 1 were treated with intravitreal injection of 250 microg/0.1 ml piperacillin/tazobactam 24 h after intravitreal inoculation of S. epidermidis whereas group 2 eyes received intravitreal 1 mg/0.1 ml vancomycin. Group 3 eyes received no treatment and served as infected controls. Clinical examination of the eyes in each group was performed on the 1st, 3rd and 6th day after the inoculation of S. epidermidis. On the 6th day, 0.1-ml vitreous aspirates were obtained for microbiological analysis, and then the eyes were enucleated for histopathological evaluation. RESULTS: There were no statistically significant differences in mean clinical scores between the groups on the first day after S. epidermidis inoculation (p>0.05). On the 6th day, the mean clinical score of group 3 was significantly higher (p<0.001), but the mean clinical scores of groups 1 and 2 were similar (p=0.812). The mean logarithmic value of colony-forming units per milliliter of groups 1, 2 and 3 were 0.6+/-1.3, 0.5+/-1.5 and 5.3+/-0.7, respectively. Mean histopathological scores of the groups were 8.3+/-0.9, 7.5+/-1.3 and 15.6+/-1.2, respectively. Group 3 eyes had significantly more colony-forming units per milliliter and a higher histopathological score (for each, p<0.001), and there were no statistically significant differences in microbiological and histopathological scores between groups 1 and 2 (for each, p>0.05). CONCLUSION: Intravitreal application of 250 microg/0.1 ml piperacillin/tazobactam seems to be approximately equally effective with intravitreal 1 mg/0.1 vancomycin application in the treatment of experimental S. epidermidis endophthalmitis. Therefore, intravitreal piperacillin/tazobactam may be an alternative therapeutic option in the treatment of S. epidermidis endophthalmitis.

The efficacy of piperacillin/tazobactam in experimental Pseudomonas aeruginosa endophthalmitis: a histopathological and microbiological evaluation.

PURPOSE: To investigate the efficacy of intravitreal piperacillin/tazobactam (250 microg/0.1 ml) in the treatment of experimental Pseudomonas aeruginosa endophthalmitis in rabbits. MATERIALS AND METHODS: Twenty New Zealand White albino rabbits were used in this study. The rabbits were divided into two groups (10 rabbits in each), and the right eyes were treated with 0.1 ml intravitreal injections of P. aeruginosa suspension (ATCC 27853, 2 x 10(4) CFU); the left eyes served as uninfected control and were injected with 0.1 ml of saline solution. The right eyes of rabbits in group 1 (n = 10) received intravitreal injection of 250 microg piperacillin/tazobactam 24 h after intravitreal inoculation of P. aeruginosa. Group 2 eyes (n = 10) received no treatment and served as infected controls. Clinical examination of the eyes in each group was performed on the first, third, and sixth day after the inoculation of P. aeruginosa. After the last ophthalmic examination, 0.1 ml vitreous aspirates were obtained for microbiological analysis, and then the eyes were enucleated for histopathological evaluation. RESULTS: The mean clinical scores of group 1 and group 2 at the first day after P. aeruginosa inoculation were similar (p > 0.05). At the sixth day, the mean clinical score of group 1 was significantly lower when compared with group 2 eyes (p < 0.001). Microbiological analysis revealed that group 2 had a significantly more cfu/ml than group 1 (p < 0.001), and the mean histopathological score of group 2 was significantly higher than group 2 (p = 0.009). CONCLUSIONS: Intravitreal application of 250 microg/0.1 ml piperacillin/tazobactam seems to be effective in the treatment of P. aeruginosa endophthalmitis in rabbits. Intravitreal piperacillin/tazobactam combination may be a new therapy for P. aeruginosa endophthalmitis.

Complications of intravitreal injection of triamcinolone acetonide.

BACKGROUND: Intravitreal injection of triamcinolone acetonide appears to be a promising treatment for a variety of proliferative, edematous, neovascular and inflammatory ocular disorders. Reported complications include intraocular pressure (IOP) elevation, cataract formation, retinal detachment, vitreous hemorrhage and endophthalmitis. The purpose of this investigation was to report the complications of intravitreal triamcinolone injection that may be attributable to the injection procedure or to the corticosteroid suspension. METHODS: A total of 212 eyes of 180 patients who underwent intravitreal triamcinolone acetonide injection for various indications were enrolled. All patients received 8 mg/0.2 mL of triamcinolone. A total of 270 injections were performed by the same surgeon under topical anesthesia. The patients were followed for a mean of 9.2 months. Complications related to the injection procedure and to the corticosteroid were recorded. RESULTS: The most common complication encountered during follow-up was transient elevation of the IOP above 21 mm Hg (44 eyes [20.8%]). The average IOP rose by 28.5%, 38.2%, 16.7% and 4.2% from baseline at 1, 3, 6 and 9 months respectively. The mean IOP values at 1, 3 and 6 months were statistically significantly higher than the mean preinjection value (p < 0.001). Fourteen eyes (6.6%) had cataract progression and underwent cataract surgery with intraocular lens implantation. Endophthalmitis developed in one eye (0.5%); the patient underwent vitrectomy with silicone oil injection. Pseudoendophthalmitis occurred in one eye (0.5%), and pseudohypopyon was observed in two eyes (0.9%). INTERPRETATION: Intravitreal triamcinolone injection was effective in a variety of ocular disorders. Patients should be monitored closely given the potential for complications of the injection procedure or the corticosteroid suspension.

Long-term results of trabeculectomy with different concentrations of mitomycin C in refractory developmental glaucoma.

PURPOSE: To evaluate the long-term results of trabeculectomy with two different concentrations of mitomycin C in refractory developmental glaucoma. PATIENTS AND METHODS: A total of 48 eyes of 37 patients with previous failure of congenital glaucoma surgery underwent mitomycin C-augmented trabeculectomy. Data were analyzed retrospectively, and patients were divided into two groups. Group 1 consisted of 18 patients (25 eyes) who underwent trabeculectomy with a 0.4 mg/mL mitomycin C solution and group 2 consisted of 19 patients (23 eyes) who underwent trabeculectomy with a 0.2 mg/mL mitomycin C solution. Pre- and postoperative intraocular pressure (IOP), best-corrected visual acuity, bleb characteristics, success rate, and complications were compared for both groups. RESULTS: Mean time between primary surgery and mitomycin C-augmented trabeculectomy was 19.3 months (range, 11 months to 7 years). Mean preoperative IOP was 28.4 +/- 2.9 mm Hg in group 1 and 29.0 +/- 2.4 mm Hg in group 2. Final postoperative IOP was 17.0 +/- 1.6 for group 1 and 17.1 +/- 1.4 mm Hg for group 2. There were no significant differences between the groups for IOP, success rate, and complications (P > .05). The most common postoperative complication was shallow anterior chamber (11 [22.9%] of 48 eyes). CONCLUSIONS: A 0.4 or 0.2 mg/mL mitomycin C solution for 4 minutes may be used during trabeculectomy in refractory developmental glaucoma.

A comparison of intravitreal piperacillin/tazobactam with ceftazidime in experimental Pseudomonas aeruginosa endophthalmitis.

In the present study, we aimed at comparing the efficacies of intravitreal piperacillin/tazobactam and ceftazidime applications in the treatment of experimental Pseudomonasaeruginosa endophthalmitis in rabbit eyes. Twenty-four New Zealand white albino rabbits were divided into three groups (n=8 in each), and the right eyes received 0.1 ml intravitreal injections of P. aeruginosa suspension. The left eyes served as uninfected control and were injected with 0.1 ml of saline solution. The right eyes of rabbits in group 1 were treated with intravitreal injection of 250 microg/0.1 ml piperacillin/tazobactam 24 hr after intravitreal inoculation of P. aeruginosa, whereas group 2 eyes received intravitreal 1 mg/0.1 ml ceftazidime. Group 3 eyes received no treatment and served as infected controls. Clinical, microbiological and histopathological evaluations of the eyes in each group were performed on the 1st, 3rd, and 6th day after the inoculation of P. aeruginosa. The mean clinical scores of each group were similar at the first day after P. aeruginosa inoculation (P>0.05). At the 6th day, there was no statistically significant difference in mean clinical scores between group 1 and 2, but mean clinical score of group 3 was significantly higher (P<0.001). Microbiological analysis and histopathological scoring demonstrated no statistically significant difference between group 1 and 2 (for each, P>0.05). Group 3 eyes had a significantly more CFU/ml and higher histopathological score (for each, P<0.001). In conclusion, intravitreal application of 250 microg/0.1 ml piperacillin/tazobactam seems to be effective in the treatment of P. aeruginosa endophthalmitis in rabbits, but is not superior to intravitreal ceftazidime application. Therefore, intravitreal piperacillin/tazobactam may be a useful alternative to ceftazidime for pseudomonal endophthalmitis.

A comparison of viscogoniotomy with classical goniotomy in Turkish patients.

PURPOSE: To compare the success and complication rates of viscogoniotomy and goniotomy in Turkish patients. METHODS: In a retrospective review, the medical records of patients with primary congenital glaucoma were divided into two groups. Group 1 consisted of 21 patients (38 eyes) who had undergone classical goniotomy, and group 2 consisted of 25 patients (44 eyes) who had undergone viscogoniotomy. The success rates and intra- and postoperative complications were compared between the two groups. RESULTS: Mean preoperative introcular pressure (IOP) was 28.9 +/- 3.6 mmHg in group 1 and 29.3 +/- 2.8 mmHg in group 2. At the last postoperative visit, it was 17.3 +/- 3.1 mmHg and 16.2 +/- 2.1 mmHg, respectively (P < 0.001). The success rates at the last visit of group 1 and group 2 were 68.4% and 88.6%, respectively (P < 0.05). The most common early postoperative complication was hyphema in group 1 and transient IOP elevation in group 2. CONCLUSION: Viscogoniotomy may increase the success rate and decrease the complications rate by preventing hyphema and flat anterior chamber.

Deep sclerectomy with various implants: an experimental and histopathologic study in a rabbit model.

BACKGROUND AND OBJECTIVE: To investigate the effectiveness of various implants used in experimental deep sclerectomy and to report tissue reactions developed to these implants histopathologically. MATERIALS AND METHODS: Forty eyes of 40 New Zealand white albino rabbits underwent deep sclerectomy with various implants. The rabbits were divided into four groups; each consisted of 10 eyes. Deep sclerectomy was performed using copolymer materials in group 1, silicone materials in group 2 and chromic catgut suture in group 3. No implants were used in the control group (group 4). Clinical and histopathological examinations were performed to investigate the effectiveness of implants. RESULTS: Mean preoperative intraocular pressure (IOP) was 14.4 +/- 1.6 mm Hg in group 1, 14.5 +/- 1.8 mm Hg in group 2, 13.8 +/- 1.5 mm Hg in group 3 and 14.5 +/- 1.2 mm Hg in group 4. The final postoperative IOPs were 10.7 +/- 0.9, 10.6 +/- 0.8, 13.5 +/- 1.0, and 14.5 +/- 1.4 mm Hg, respectively. At 2 months, the decrease in IOPs from baseline and the persistence of the filtering bleb were significantly marked in group 1 and group 2 (p < 0.001). Histopathological evaluation revealed that copolymer and silicone materials formed a smooth and regular intrascleral space. There were no foreign body reaction, tissue destruction or fibrosis in group 1 and group 2, but chromic catgut sutures caused severe fibrosis and inflammatory reaction in group 3. Mean histopathologic score of group 1, group 2, group 3 and group 4 was 0.7 +/- 0.5, 0.8 +/- 0.5, 2.4 +/- 0.6, and 0.1 +/- 0.3, respectively. CONCLUSION: Copolymer or silicone materials may increase the success rate of surgery by maintenance of a large and regular intrascleral space after deep sclerectomy and prevention of collapse of the flap.