Yüksek doz oral fluoksetin alımı sonrası gelişen oküler herpes simpleks virus aktivasyonu

A 51-year-old man with high intraocular pressure on the left eye was referred to our clinic. A laser iridotomy was performed with full anti-glaucoma medication prior to the referral. There was a fixed dilated irregular pupil of the left eye, accompanied with mild corneal edema, a paracentral stromal corneal haze, patchy iris atrophy, fine keratic precipitates, trace amounts of cells and pigments in the anterior chamber and a patent iridotomy. Medical history was revealed a previous herpetic episode 7 years ago and fluoxetine use for major depression for 2 years which he overdosed 5 days before his ocular symptoms have started. Ocular herpes simplex virus activation associated with high dose fluoxetine was suspected. Fluoxetine was discontinued. Oral acyclovir, topical steroids and anti-glaucoma medication has been prescribed. A week later, on his control visit, the intraocular pressure was normalized and clinical findings have subsided. Fluoxetine, a selective serotonin re-uptake inhibitor, and some other anti-depressants, has been proved to suppress cellular immunity. Herpes simplex virus activation after surreptitious self-administration of high dose fluoxetine in this case is much more probable than coincidence. This is the first reported case of ocular herpes activation related to fluoxetine use.Yüksek Doz Oral Fluoksetin Alımı Sonrası Gelişen Oküler Herpes Simpleks Virus AktivasyonuElli bir yaşında erkek hasta, kliniğimize yüksek göz içi basıncı nedeniyle refere edilmiş. Öncesinde hastaya tam antiglokomatöz tedavi ve lazer iridotomi uygulanmış. Hastanın sol gözünde fikse dilate düzensiz pupilla ve eşlik eden hafif kornea ödemi, parasantral stromal korneal bulanıklık, yama şeklinde iris atrofisi, keratik presipitatlar, ön kamarada eser miktarda hücre ve pigment kümeleri ve açık iridotomi izlendi. Medikal öyküsünde 7 yıl önce geçirilmiş herpetik atak öyküsü belirlendi ve major depresyon nedeniyle 2 yıldır fluoksetin kullanan hastanın göz yakınmalarının başlamasından 5 gün öncesinde ilacı yüksek dozda aldığı belirlendi. Oküler herpes simpleks virus aktivasyonunun yüksek doz fluoksetin alımından olabileceğinden şüphelenildi. Fluoksetin kesildi. Oral asiklovir, topikal steroid ve anti-glokomatöz tedavi başlandı. Bir hafta sonra, hastanın kontrol muayenesinde göz içi basıncının normale geldiği ve klinik bulguların yatışmış olduğu izlendi. Fluoksetin, selektif serotonin geri alım inhibitörü olup, bazı diğer antidepresan ilaçlar gibi, hücresel immüniteyi baskıladığı kanıtlanmıştır. Bu olguda olduğu gibi hastanın gizlice yüksek doz fluoksetin alımı sonrası gelişen herpes simpleks virus aktivasyonu tesadüf olmasından daha olasıdır. Fluoksetin kullanımıyla ilişkili oküler herpes aktivasyonu olgusu ilk kez rapor edilmektedir

Comparative Results of Viscotrabeculotomy and Classical Trabeculotomy in Congenital Glaucoma in a Longer-Term Follow-Up

Purpose: To evaluate the results of previously described viscotrabeculotomy technique and to compare them with those of conventional trabeculotomy in longer-term follow-up. Material and Method: This retrospective study included the eyes of 64 patients who underwent either viscotrabeculotomy (group 1) or conventional trabeculotomy (group 2) between February 1992 and April 2011. Group 1 consisted of 58 eyes of 34 patients who underwent viscotrabeculotomy surgery and group 2 consisted of 51 eyes of 30 patients who underwent conventional trabeculotomy. 3 patients (5 eyes) in group 1 and 2 patients (3 eyes) in group 2 left the follow-up for some reasons. At the last visit, group 1 comprised 53 eyes of 31 patients and group 2 comprised 48 eyes of 28 patients. Outcome measures were intraocular pressure (IOP), antiglaucomatous medications, horizontal corneal diameter, and success rate. Results: Success rates in group 1 at 12, 36, 60, 72, 96, 120 months, and at the last visit were 93.10%, 91.30% 89.30%, 87.00%, 84.90%, 83.00%, and 83.00%, respectively. The success rates in group 2 at the above-mentioned follow-up visits were 72.50%, 68.60%, 68.60%, 66.10%, 66.00%, 64.50%, and 62.50%, respectively. The success rate in group 1 was statistically significantly higher than in group 2 at the last visit (p=0.027). IOP and anti-glaucomatous medications at each follow-up examination were lower in group 1 compared to group 2, and these differences were with statistical significance (for each, p<0.05). Horizontal corneal diameters did not differ between the two groups in the postoperative follow-up. Discussion: Viscotrabeculotomy has been found safer and more effective than classical trabeculotomy in longer-term evaluation. Viscodissection of the trabecular meshwork, viscodilation of the Schlemm’s canal, keeping away the lips of trabeculotomy incision, and possibly prevention of postoperative hemorrhage and fibroblastic proliferation by means of high-viscosity sodium hyaluronate are the possible factors that play an important role in the overall success of this procedure. (Turk J Ophthalmol 2013; 43: 380-