Spontaneous Lens Absorption Initially Misdiagnosed as Crystalline Lens Luxation

Spontaneous lens absorption (SLA) is a rare complication of hypermature cataract. However, this condition has been reported in several cases of hypermature cataracts that were caused by trauma, senility, uveitic disorders such as Fuchs’ uveitis syndrome (FUS), and infectious disorders including leptospirosis and rubella. We report a case of spontaneous absorption of a hypermature cataract secondary to FUS. To our knowledge, this is the first report of SLA that was followed by dislocation of the capsular remnants into the vitreous and resulted in a misdiagnosis as crystalline lens luxation

Tip 1 diabetes mellituslu olgularda retina sinir lifi tabakası kalınlığının optik koherens tomografi ile değerlendirilmesi

Diabetik retinopati DM'nin en sık görülen komplikasyonudur ve günümüzde 20-65yaş arası körlüğün en önemli nedenidir. Diabetin vasküler yapıya etkileri iyi bilinmesinerağmen DR'nin retinal nöronlarda yaptığı patolojik değişiklikler pek iyi bilinmemektedir.OCT ile RSLT kalınlığının kantitatif olarak ölçülmesi, erken RSLT defektlerinin tespiti vetakibi mümkün olmaktadır. Bu çalışmada Tip 1 DM olgularında diabetin RSLT kalınlığınaetkisi, metabolik kontrol ve diabet süresi ile RSLT kalınlığı arasındaki ilişki incelendi.Toplam 167 olgu çalışmaya dahil edildi. Olgular üç grupta incelendi. Kontrolgrubu; yaşları 8 ile 31 arasında değişen (18.71±5.72 yıl) sağlıklı 49 olgudan oluşturuldu.DR olmayan grup; yaşları 6 ile 38 arasında değişen (17.02±8.00 yıl) Tip 1 DM'si bulunan,DR'si olmayan 98 olgudan oluşturuldu. DR olan grup; yaşları 16 ile 40 arasında değişen(27.35±7.50 yıl) Tip 1 DM'si ve NPDR'si bulunan 20 olgudan oluşturuldu. Olguların sağgözlerinden Stratus OCT kullanılarak alınan RSLT kalınlık ölçümleri değerlendirildi.Retinopati olan grupta hem OCT parametrelerinde hem de süperior, nazal veinferior kadranlarda ölçülen sinir lifi kalınlıkları ve ortalama RSLT kalınlığında incelmevardı. Retinopati olmayan grupta ise hem OCT parametrelerinde hem de kadran olarakRSLT kalınlığı ve ortalama RSLT kalınlığında incelme yoktu. Retinopati olan ve retinopatiolmayan olgular beraber ele alındığında ve retinopati olmayan grupta süperior, nazal veinferior kadrana ait sinir lifi kalınlığı ve ortalama RSLT kalınlığı ölçümleri ile HbA1cdüzeyi arasında anlamlı ve ters bir ilişki vardı. Retinopati olan ve retinopati olmayanolgular birlikte değerlendirildiğinde, inferior kadrana ait sinir lifi kalınlığı ve ortalamaRSLT kalınlığı ölçümleri ile AKŞ düzeyi arasında anlamlı ve ters bir ilişki vardı.Retinopati olan grupta saptanan RSLT incelmesinin, bu grupta diabet süresinindaha uzun olmasından kaynaklandığı kanısındayım. RSLT kalınlığı DR gelişimi ve kötümetabolik kontrole paralel olarak incelmektedir. DM'nin güncel tedavi yaklaşımında iyi63metabolik kontrol ile mikrovasküler komplikasyonların önlenmesinin yanında nöronkoruyucu prosedürlerin önemi ortaya çıkmaktadır. Glokomu ve diabeti bulunan olgulardaRSLT'de incelme görüldüğünde bu incelmenin glokomla bağlantılı olabileceği gibiDR'nin gelişmi ve kötü metabolik kontrol ile de ilişkili olabileceği göz önünde bulundurulmalıdır.Diabetic retinopathy, nowadays is the most commonly seen complication of DMand the most significant cause of blindness between the ages of 20 and 65. Although theeffects of diabetes on vascular system are well-known, pathologic changes of DR on retinalneurons have not been well established. OCT enables, RNFL thickness measurementquantitatively, early determination and follow-up of RNFL defects. In this study, effect ofType 1 diabetes on RNFL thickness, correlation between metabolic control and duration ofdiabetes and RNFL thickness were investigated.Totaly 167 cases were included into this study. Cases were investigated in threegroups. The control group was composed of 49 healthy persons, between the ages of 8 and31 (18.71 ± 5.72 years). The non-retinopathy group was composed of 98 cases, in the agegroup of 6-38 (17.02 ± 8.00 years), with Type 1 DM without DR. The retinopathy groupbetween the ages of 16 and 40 (27.35 ± 7.50 years) was composed of 20 cases, with Type 1DM and NPDR. RNFL thickness measurements taken from the right eyes of the casesusing Stratus OCT were evaluated.In the retinopathy group, there was thinning in the OCT parameters, neural fiberthickness measured in superior, nasal and inferior quadrants and average RNFL thickness.In the non-retinopathy group, no thinning was seen in the OCT parameters, RNFLthickness in none of the quadrants and average RNFL thickness. Retinopathy and non-retinopathy cases taken in consideration together and in the non-retinopathy group, therewas a significant and adverse relationship between neural fiber thickness of superior, nasaland inferior quadrants and average RNFL thickness measurement and HbA1c level. Whenretinopathy and non-retinopathy groups were evaluated together, there was a significantand adverse correlation between neural fiber thickness of inferior quadrant and averageRNFL thickness and fasting blood sugar (FBS) level.65It is suggested in our study that RNFL thinning determined in the retinopathy groupis based on the fact that the duration of diabetes was longer in this group. RNFL thicknessbecomes thinner along with DR development and poor metabolic control. As a currenttherapeutic approach to DM, neuron protection procedures are becoming important as wellas good metabolic control and prevention of microvascular complications. When a thinningis encountered in RNFL in the cases with glocom and DM, it should be taken into accountthat this thinning could be related to glaucoma, development of DR or poor metaboliccontrol

The effect of anterior chamber depth on endothelial cell count and postoperative corneal edema in phacoemulsification surgery

To investigate the effect of anterior chamber depth on corneal endothelial cell loss and development of postoperative corneal edema in patients undergoing phacoemulsification surgery.Materials and methods: The effect of preoperative anterior chamber depth was evaluated by ultrasound biometry of 35 eyes with senile cataract and treated with phacoemulsification on intraoperative endothelial cell loss and at postoperative central corneal thicknesses by specular microscopy.Results: The mean age was 64.8 ± 10.7 years (range 42-84). Preoperative anterior chamber depth, cell density and central corneal thickness were 3.37 ± 0.51 mm (1.61-4.33 mm), 2345 ± 341 cell/mm² (1600-2915 cell/mm²) and 536 ± 32 μ (457-588 μ) respectively. Postoperative endothelial cell densities were detected 1876 ± 443 cell/mm², 1882 ± 457 cell/mm² and 1920 ± 456 cell/mm² at first week, first month and at third month respectively. Compared to preoperative values, decreases of endothelial cell densities at postoperative first week, first month and third month were found to be significant (p0.05).Conclusion: Phacoemulsification surgery leaded to more endothelial cell loss than expected in patients with shallow anterior chamber. Anterior chamber depth should preoperatively be evaluated especially in the elderly and/or patients with endothelial dystrophy

Optical coherence tomography findings in optic disk melanocytoma

A 49 years old male patient admitted to hospital with difficulty in reading. Distant visual acuity, anterior segment examination, and intraocular pressure measurements were normal in his both eyes. The fundus examination was normal in his right eye but in the left eye a pigmented lesion overlying and surrounding the optic disk was detected. Visual field examination (HFA II version 740 Humphrey Instruments, Inc SanLeandro, CA, Central 30-2 Threshold Test) was unremarkable in his right eye but an enlarged blind spot was detected in his left eye. Optical coherence tomography (OCT) scans showed high reflectance layer with optical shadowing behind it. OCT is a useful device in describing the actual size of melanocytoma and its follow up. OCT has a role to find out associated subretinal fluid, cystoid retinal edema, retinal traction and epiretinal membrane. We are presenting this case to emphasize the OCT findings of melanocytoma

The Management of a Patient with Elevated Intraocular Pressure Resistant to Medical Treatment: Anterior Chamber Irrigation

A 7-year-old male patient was medically treated in another center for hyphema which occurred after blunt trauma to his right eye. He was admitted to our clinic when his visual acuity decreased after being discharged. Biomicroscopic examination revealed total hyphema. Intraocular pressure (IOP) was 48 mm Hg in the right eye with Goldmann applanation tonometry. Since IOP could not be managed by medical therapy and there was no regression in hyphema, anterior chamber was irrigated. As in our case, it should not be forgotten that re-hemorrhage may occur in the first week of hyphema during childhood. Moreover, surgical treatment should be considered when hemorrhage does not regress with medical treatment, increased IOP persists, and when there is a risk of corneal endothelial staining (corneal blood staining). (Turk J Ophthalmol 2014; 44: 400-2

Wolfram Sendromlu Hastalarda Optik Koherans Tomografi Bulguları

Objectives: To report the optical coherence tomography (OCT) findings in patients with Wolfram syndrome. Materials and Methods: Four patients who fulfilled the criteria for Wolfram syndrome were recruited to the study. In all patients, OCT was performed with Stratus OCT (OCT-3, Carl Zeiss Meditec, Inc. Germany). The fast retinal nerve fiber layer (RNFL) and fast macular thickness protocols were used to measure the RNFL and macular thickness, respectively. The fast optic disc protocol was used to determine the cup-to-disc ratios of the optic disc. All patients were examined with VEP (Retimax, CSO Strumenti Oftalmici, Florence, Italy). Results: In eight eyes of four patients (3 male and 1 female) with a mean age of 18.5±2.08 years (range 16-21 years), RNFL, macular thickness, and cup-to-disc ratios were determined. The mean RNFL was 42.2±5.6 µm (range 34.1-49.5 µm), while the mean macular thickness and cup-to-disc ratios were 145±15 µm (range 125-160 µm) and 0.79±0.07 (range 0.7-0.92), respectively. There was a moderate negative correlation between VEP latencies and macular and RNFL thicknesses (Spearman correlation coefficient was -0.23 and -0.34, respectively). Conclusions: RNFL loss and secondary optical atrophy are severe complications that may affect the visual acuity in patients with Wolfram syndrome. Retinal changes in these patients may be quantified and can be observed using OCT. (Turk J Ophthalmol 2014; 44: 212-5

Tonic Pupil Following Traumatic Hyphema: Case Report

A 7-year-old girl was admitted to our clinic after crash injury with air gun pellet in her right eye. There was an intense anterior chamber reaction and hyphema on the biomicroscopic examination. During the control examination after treatment of hyphema including cyclopentolate 1%, prednisolone acetate 1% and lomefloxacin 0.3%, anisocoria and mydriasis in the right eye were observed and the difference between both pupils was less in darkness. The case was diagnosed as tonic pupil following trauma, and diluted pilocarpine 0.125% test was performed. On diluted pilocarpine test, right pupil responded excessively to pilocarpine compared with the other pupil. As in our case, in cases with anisocoria following blunt trauma to orbit, tonic pupil should be keep in mind. (Turk J Ophthalmol 2013; 43: 132-4

Topikal proparakain suistimaline bağlı gelişen toksik keratopati

Gözde ağrı, yanma, batma ve yaşarma şikayetleri ile başvuran kırk iki yaşındaki erkek olguda kornea santralinde epitel defekti, stromal ülserasyon ve korneal ödem saptandı. Sanayide kaynak işi yapan ve şikayetlerinin 40 gündür mevcut olduğunu ifade eden olgunun ısrarlı sorgulanması sonucunda proparakainin topikal formunu kullandığı öğrenildi. Özellikle sanayi, inşaat gibi kornea yaralanması oranı yüksek olan meslek gruplarında proparakain suistimali daha sık görülmektedir. Bu nedenle, kornea epitel defekti, epitel iyileşmesinde gecikme, stromal erime, şiddetli ağrı ve görme keskinliğinde azalma görülen özellikle bu meslek gruplarındaki hastalarda propakain suistimali akla getirilmelidi