Optic Nerve Head Topographic Measurements and Retinal Nerve Fiber Layer Thickness in Patients with Physiological Macrodiscs, Normal and Glaucomatous Optic Discs

Amaç: Geniş optik diske sahip sağlıklı gözlerde optik sinir başı(OSB) parametrelerinin ve retina sinir lifi tabakası (RSLT) ölçümlerinin incelenmesi ve bu parametrelerin erken glokoma sahip hastalarla ve normal popülasyonla karşılaştırılması.Gereç ve Yöntem: Fizyolojik makrodiske sahip 92 göz, yaş uyumlu 92 normal kontrol olguları ve erken glokomatöz optik sinir başı hasarı olan 50 göz çalışmaya dahil edildi. Tüm hastalara genel oftalmolojik muayene yapıldıktan sonra Stratus OCT ile OSB ve RSLT ölçümü yapıldı. Disk alanı 2.80 mm2'nin üstü büyük disk olarak kabul edildi. Tüm OKT parametreleri 3 grup arasında kıyaslandı. Bulgular: Normal grubunun OD alanı ortalamaları diğer gruplardan istatistiksel olarak anlamlı derecede düşük bulunmuş (p=0.0001), sağlıklı makrodisk ve glokom grupları arasında istatistiksel olarak anlamlı farklılık gözlenmemiştir (p=0.705). Glokom grubunun rim alanı ortalamaları diğer 2 gruptan istatistiksel olarak anlamlı derecede düşük bulundu (p=0.022, p=0.0001). Glokom grubunda çukurlaşma alanının (CA), horizontal çukurluk disk oranı(HCDR), vertikal çukurluk disk oranı (VCDR), çukurlukdisk alanı oranı (CDAR) kontrol ve sağlıklı makrodisk grubuna göre anlamlı derecede yüksek bulundu. (p0.05).Sonuç: Büyük diskler geniş çukurluğa sahip olabilirler ve yanlış glokom tanısına neden olabilirler. Bu çalışma, makrodisklerin rim alanı ve RSLT kalınlığı açısından normal disklere benzediğini göstermiştir. Fizyolojik makrodiskleri, glokomatöz optik nöropatiden ayırımını sağlayan parametreler ise geniş rim alanı, düşük çukurlaşma ve çukurlaşma/disk oranları idiPurpose: To evaluate the parameters of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in healthy patients with large optic disc area and to compare these parameters with those of the normal and early glaucoma patients. Material and Methods: Ninety two eyes with physiological macrodiscs (PM), age-matched 92 eyes with normal eyes and 50 eyes with early glaucoma (EG) findings were enrolled. After a complete ophthalmic evaluation, measurement of optic nerve head parameters and RNFL thickness using OCT was performed in all subjects. Optic disc areas larger than 2.80 mm2 were accepted as macrodiscs. All OCT parameters were compared between normal-sized discs and macrodiscs. Central corneal thickness, intra ocular pressure and axial length measurements were found to be similar between 3 groups.Results: Mean optic disc area of PM and EG were similar and larger than the control group. Rim area of EG group was thinner than the other groups (p=0.022, p=0.0001). Also, EG group had larger horizontal cup disc ratio, vertical cup disc ratio and cup disc area ratio (p>0.001). Average,superior and inferior RNFL thicknesses were thinner in the EG group (p<0.05).Conclusion: Macrodisc may have a macrocup and should not be misdiagnosed as glaucoma. The present study showed that macrodiscs are identical to normal-sized discs in terms of rim area and RNFL thickness. We suggest that these 2 OCT parameters can help to differentiate a healthy macrodisc from a glaucomatous optic disc

Blunt Ocular Trauma Associated with Paintball Gun

A 21-year-old male patient presented to our hospital with a blunt paintball trauma to his left eye. The patient had corneal edema, traumatic cataract, traumatic mydriasis, and secondary glaucoma in his left eye. After corneal edema resolved, cataract surgery was performed. Because of uncontrolled intraocular pressure despite antiglaucoma medications, an Ahmed glaucoma valve was implanted. In the postoperative period, the patient’s visual acuity was 1/10. Paintball-related ocular injuries can be severe and visually devastating. (Turk J Ophthalmol 2013; 43: 135-7

Correlation Between Optical Coherence Tomography and Visual Field Parameters in Primary Open-Angle Glaucoma

Amaç: Primer açık açılı glokomlu (PAAG) olgularda optik koherens tomografi (OKT) ile retina sinir lifi tabakası (RSLT) kalınlığındaki ve optik sinir başındaki (OSB) yapısal değişikliklerin saptanması ve bu bulguların görme alanı (GA) parametreleriyle korelasyonunun araştırılması.Yöntem: Çalışmaya PAAG tanısı alan 32 hastanın 64 gözü dahil edildi. Tüm olgulara tam oftalmik muayene, göz içi basıncı (GİB) ölçümü, santral kornea kalınlığı (SKK), OKT ile RSLT-OSB analizleri ve Humphrey SITA 30-2 ile GA testi yapıldı. Olgular 8 ay aralıklı olacak şekilde 24 aya kadar takip edildi. Bulgular: Yirmi beşi kadın, 7'si erkek 32 olgunun yaş ortalaması 51,6±11,6 yıl idi. İlk başvuru sırasındaki ortalama GİB 21.2±3.7 mm Hg olan olguların ortalama SKK 546,0±33,1 ?m idi. Yaş ile ortalama RSLT kalınlığı arasında istatistiksel olarak anlamlı ters yönlü doğrusal korelasyon saptandı. OKT ile elde edilen RSLT parametreleri olan maksimum üst ve alt kadran RSLT ile ortalama üst, alt kadran RSLT kalınlık düzeyleri değerlendirildiğinde özellikle ilk muayene ve 24. ay arasında daha belirgin olmak üzere tüm kontrollerde belirtilen değerlerde istatiksel olarak anlamlı fark saptandı (p:< 0.001, Pearson Ki-Kare testi ). GA'da ortalama sapma (OS) ve patern standart sapmada (PSD)'de ilk muayene ve 24.ay arasında anlamlı fark saptandı (p< 0.001, Pearson Ki-Kare testi ). Ortalama sapma ile ortalama üst kadran RSLT, üst ve alt kadran maksimum RSLT kalınlığı arasında negatif korelasyon olduğu saptandı.Sonuç: Glokomda GA parametreleri ile OKT RSLT ölçümleri arasında korelasyon saptanmış olup glokom tanısı ve progresyonun takibinde bu testler birbirini tamamlayıcı olarak kullanılmalıdır.Purpose: To evaluate the retinal nerve fi ber layer ( RNFL) thickness and optic nerve head (ONH) parameters measured by optical coherence tomography (OCT) and the correlation with visual fi eld (VF) parameters in patients with primary open-angle glaucoma (POAG).Material and Methods: Sixty-four eyes of 32 POAG patients were enrolled in this prospective study. All patients underwent a full ophthalmological assessment, including measurement of intraocular pressure (IOP), central corneal thickness (CCT), ONH and RNFL thickness parameters measured by OCT and VF parameters measured by Humphrey automated perimetry. OCT and VF measurements were repeated every 8 months up to 24 months. Results: The mean age of 7 male and 25 female cases in the study group was 51,6&plusmn;11,6 years. The mean IOP was 21.2&plusmn;3.7 mmHg and mean CCT was 546,0&plusmn;33,1 ?m at presentation. There was a signifi cant linear negative correlation between age and RNFL thickness. RNFL thickness ( maximum superior, inferior and mean superior, inferior quadrant) were statistically signifi cant among all follow-up especially fi rst and 24. month examination (p:&lt; 0.001, Pearson Chi-Square test). Signifi cant differences were detected in mean deviation (MD) and pattern standard deviation between fi rst and 24th months examinations (p&lt; 0.001, Pearson Chi-Square test). There was a signifi cant negative correlation between mean deviation and RNFL thickness (mean superior, maximum superior and inferior quadrant ).Conclusion: Correlation was identifi ed between OCT RNFL thicknesses and VF parameters. These tests should be used in conjunction for the diagnosis and follow-up of POAG

A Case of Presumed Tuberculosis Uveitis with Occlusive Vasculitis from an Endemic Region

In this report, we present a case with presumed unilateral tuberculosis uveitis from an endemic region. A 23-year-old male presented with decreased vision in his left eye for 15 days. Visual acuities were 1.0 in his right eye and 0.3 in his left eye. Ophthalmologic examination was normal for the right eye. Slit-lamp examination revealed 2+ cells in the vitreous without anterior chamber reaction in his left eye. Fundus examination revealed occlusive vasculitis and granuloma. His history revealed that he had a respiratory infection with fever 3 months ago while visiting his native country, Rwanda, and was treated with non-specific antibiotic therapy. His visual symptom started 2 weeks after his systemic symptoms resolved. Laboratory findings included 15 mm induration in purified protein derivative tuberculin skin test, HIV negativity, and parenchymal lesions in chest X-ray. Bronchoalveolar lavage was negative for acid-fast bacillus. A pulmonary disease consultant reported presumed tuberculosis because of the patient’s history. Anti-tuberculosis treatment was initiated. The patient’s visual acuity improved rapidly and his signs regressed. A careful history should be taken from patients with uveitis. Travel to tuberculosis-endemic areas may be important for diagnosis and should be asked about directly

Evaluation of Factors Influencing the Outcomes of Selective Laser Trabeculoplasty in Primary Open-Angle Glaucom

Pur po se: To determine demographic and clinical factors that affect the outcomes of selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG). Ma te ri al and Met hod: In this retrospective study, we analyzed the medical records of 54 eyes of 39 patients who underwent SLT treatment for POAG. Effects of demographic characteristics including age, sex, treated eyes, and family history of glaucoma on SLT success were investigated. Effects of clinical features including baseline intraocular pressure (IOP), baseline number of antiglaucomatous medications, baseline cup to disc ratio (c/d), trabecular meshwork (TM) pigmentation, central corneal thickness, and number of laser spots on SLT success were also evaluated. Success was defined as a ≥ 20% reduction in IOP without additional medications, laser, or glaucoma surgery. Re sults: Overall, 1-year after SLT, the mean IOP reduction was 4.7±3.2 mmHg and the mean success rate was 59.3±6%. Among the all investigated factors, only baseline IOP was a significant predictor for the efficacy of SLT in POAG (p<0.001, r=570). The SLT success was 45±10% in patients with a baseline IOP values less than 21 mmHg and 72±8% in patients with a baseline IOP of 21 mmHg or higher (p=0.036). Other factors were not significantly associated with SLT treatment efficacy. Dis cus si on: SLT success is significantly predicted by baseline IOP value. However, age, sex, family history of glaucoma, treated eye, baseline number of medications, c/d, degree of TM pigmentation, CCT, and number of laser spots are not associated with SLT efficacy. (Turk J Ophthalmol 2011; 41: 304-

Effectiveness of Laser Suture Lysis After Trabeculectomy with High Early-Postoperative Intraocular Pressure

Pur po se: To evaluate the effectiveness of laser suture lysis in patients with high intraocular pressure (IOP) after trabeculectomy. Ma te ri al and Met hod: We evaluated retrospectively 22 eyes of 22 patients who had undergone trabeculectomy followed by laser suture lysis due to high IOP between July 2009 and February 2011. The process was performed in patients who had high IOP with bleb formation after ocular massage in early postoperative period. Re sults: The mean age was 62.7±10.8 (38-77) years and the male/female ratio was 11/11 in the study group. The mean interval time between trabeculectomy and performance of suture lysis was 18.5 ±31.1 days (2-150 days). The mean IOPs before and immediately after laser suture lysis were 25 ±8.6 mmHg (14-45 mmHg) and 14±5.8 mmHg (6-27 mmHg), respectively (p<0.001). At the last visit, the mean IOP was 13.5±3.4 mmHg (6-26 mmHg) (p<0.001). The mean follow-up time was 6.1±3.4 months (3-13 months). Dis cus si on: Laser suture lysis is a safe and effective method in the management of the patients in whom the target IOP was not reached after trabeculectomy. (Turk J Ophthalmol 2013; 43: 91-3

Management of Encapsulated Blebs After Filtering Surgery

Pur po se: To evaluate the results of bleb needling of encapsulated blebs with 1% mitomycine-C (Mtm-C) after trabeculectomy surgery. Ma te ri al and Met hod: 98 eyes of 90 glaucoma patients who had undergone trabeculectomy between July 2009 and September 2011 were evaluated retrospectively. Twenty-five eyes of 24 patients who developed encapsulated bleb with at least 3-month follow-up were enrolled in the study. These patients had undergone bleb needling with 1% Mtm-C (16 eyes) since medications were not efficient for IOP control. The preand post-needling intraocular pressures (IOP) were compared with IOPs being controlled with anti-glaucoma medications (9 eyes). Re sults: Encapsulated bleb was seen in 25 (25.6%) eyes of 24 patients out of 98 eyes of 90 patients who had trabeculectomy. The mean age was 62.6±13.6 (23-83) years and the mean follow-up time was 5.7±4.4 (3-20) months. The mean time that encapsulated blebs were diagnosed was 4.1±1.5 (2.5-8) weeks after the trabeculectomy. The number of eyes with IOP controlled with medication only was 9 (36%) with 5.7±4.0 (3- 14) months mean follow-up time. Mtm-C 1% bleb needling was performed at mean 9.1±3.2 (3-15) weeks after trabeculectomy in 16 eyes (64%) which had uncontrolled IOP with medical treatment. The IOPs before surgery and at postoperative 1st week, 1st, 3rd, and 6th months were 26.5±8.6 mmHg, 11.9±2.6 (5-18) mmHg, 14.5±3.8 (11-20) mmHg, 15.2±5.6 (8-20) mmHg, and 14.8±1.4 (8-28) mmHg, respectively (p<0,01). The numbers of anti-glaucoma medication before surgery and at postoperative 1st week, 1st, 3rd, and 6th months of needling were 2.1±0.7, 0.3±1.2, 1.1±1.4, 0.7±1.2, and 1.3± 0.8, respectively (p<0.05). Dis cus si on: One of the complications which compromises the IOP reduction after filtrating glaucoma surgery is formation of encapsulated bleb. Needling of encapsulated bleb with 1% Mtm-C is a safe and efficient surgical treatment in patients who have inadequate IOP reduction with anti-glaucoma medications. (Turk J Ophthalmol 2013; 43: 173-7