Possible Association of Papillophlebitis with Guillain-Barre Syndrome: Case Report

In this case report, we presented a patient with visual deterioration as a result of papillophlebitis in the right eye who was later diagnosed with Guillain-Barre syndrome (GBS). Upon systemic and laboratory work-up to determine the etiology of papillophlebitis, the diagnosis of GBS was made and treatment was initiated immediately. The ocular and systemic symptoms resolved quickly after starting intravenous immunoglobulin therapy. We present this case to emphasize the importance of etiological diagnosis in papillophlebitis and the unusual presentation of GBS

Ischemic Retinopathy and Neovascular Proliferation Secondary to Severe Head Injury

We report a case with severe head trauma and perforating globe injury in one eye and ischemic retinopathy and neovascular proliferation in the other eye. A 37-year-old male was brought to the emergency department after a motor vehicle accident with severe maxillofacial trauma. Ophthalmic examination revealed hematoma of the left eyelids as well as traumatic rupture and disorganization of the left globe. On the right eye, anterior segment and fundoscopic examination were normal. Primary globe repair was performed. At postoperative one-month visit, the right eye revealed no pathology of the optic disc and macula but severe neovascularization in the temporal peripheral retina. The patient was diagnosed as ischemic retinopathy and neovascular proliferation due to head trauma

Orbital Dermis-Fat Graft Transplantation: Results in Primary and Secondary Implantation

Objectives: Autologous dermis fat graft (DFG) is being used in both primary and secondary socket surgeries. In the present study, we aimed to evaluate patients' satisfaction and possible intra- and postoperative complications in patients who had DFG transplantation. Materials and Methods: In this retrospective study, the results of 17 patients who were operated between October 2008 and October 2012 were evaluated. Of these cases, 7 had primary and 10 had secondary DFG. Patient satisfaction was evaluated by asking the patients to fill out a questionnaire graded from 1 (not satisfied) to 4 (very satisfied). Additionally, the incidence of complications and requirement for another operation was noted. Results: The average patient age was 30.5 +/- 17.9 years. Patients with primary grafts were 100% satisfied with the outcome and could wear their prosthesis without any discomfort. In this group, one patient had delay in epithelialisation of the graft and ptosis, which was treated with frontal sling surgery and artificial tears. In patients with secondary grafts, 6 patients (60%) were satisfied with the outcome. Four patients were not satisfied from the result. One had inferior lid laxity; however, after lateral tarsal strip surgery, she could wear her prosthesis. Another patient developed inferior forniceal adhesion. He was treated with mucous membrane grafting and artificial tears and could wear his prosthesis. One patient had infection and contraction of the socket due to inappropriate postoperative medication use. Following repeated DFG transplantation, he was able to wear his prosthesis. Another patient had fat atrophy prior to secondary DFG transplantation and developed atrophy of the graft following surgery. Her family refused additional surgery. This patient could not wear any prosthesis. Conclusion: According to our results, we believe that DFG transplantation is successful in primary implantation. In secondary cases, correct patient selection is important to achieve good outcome

Effect of aggression management training program on knowledge and attitudes of nurses working at psychiatric clinics

Objective: The purpose of this study was to determine the effect of Aggression Management Training Program (AMTP) on knowledge levels and aggression perceptions of nurses working at psychiatric inpatient clinics in Kayseri/Turkey. Methods: This study was conducted with 27 nurses who participated to the AMTP as the one group pretest-posttest experimental design. Data were collected by using Personal Information Form, Perception of Aggression Scale, and Assessment Form of Knowledge Levels of Nurses Regarding Aggression Management. AMTP was carried out interactively with totally 3 groups including 2 groups (10 participants in each group) and 1 group of 7 participants. Knowledge levels and perceptions of aggression of nurses were evaluated before, after and three months after AMTP. Results: In this study, AMTP was found to increase knowledge level of nurses and led to positive changes at their aggression perceptions. Conclusion: Consequently, it was determined that AMTP increased knowledge levels of nurses working at psychiatric clinics and provided positive changes at their aggression perceptions. It could be recommended to continue training on aggression management with regular intervals

Assessment of the circle of Willis with cranial tomography angiography

PubMed ID: 26343887Background: The circle of Willis is a major collateral pathway important in ischemic conditions. The aim of our study was to assess the structural characteristics of the circle of Willis within the Turkish adult population, along with variations and arteries involved in the measurement of diameters and lengths on cranial computed tomography angiography (CTA). Material/Methods: One hundred adult patients who underwent CTA images were evaluated retrospectively. Results: Results of the study revealed 82% adult, 17% fetal, and 1% transitional configurations. A complete polygonal structure was observed in 28% of cases. Variations of the circle of Willis were more common in the posterior portion. Hypoplasia was found to be the most common variation and was observed as a maximum in the posterior communicating artery (AComP). Conclusions: The patency and size of arteries in the circle of Willis are important in occlusive cerebrovascular diseases and cerebrovascular surgery. Although CTA is an easily accessible non-invasive clinical method for demonstrating the vascular structure, CTA should be evaluated taking into account image resolution quality and difficulties in the identification of small vessels. © Med Sci Monit

Spindle cell carcinoma of the conjunctiva: A rare entity

An 85-year-old male presented with painless bulging lesion over the cornea. Clinical history, diagnostic imaging studies, and histopathologic sections were evaluated. The patient clinically displayed an vascularized conjunctival lesion located at the superior bulbar conjunctiva with extension onto cornea covering 2/3 of his pupillary aperture superiorly. His visual acuity was counting fingers at 4 m. The patient underwent a total excision of the lesion including conjunctival and corneal parts. Histopathologic evaluation revealed spindle cell carcinoma which involves the whole conjunctival squamous epithelium with significant polarity loss, nuclear enlargement with hyperchromasia and pleomorphism, and mitotic activity. Diagnosis of spindle cell carcinoma is challenging because of overlapping histopathological features with other spindle cell tumors. The detailed pathologic examination is very important for the decision of proper treatment

Comparison of sub-Tenon's anaesthesia in phacoemulsification with 3 and 5 mL lidocaine

AIM: To compare the outcomes of combined phacoemulsification and non-penetrating deep sclerectomy(P-DS)with combined phacoemulsification and trabeculectomy(P-T)in patients who have cataract and moderate-to-severe primary open angle glaucoma(POAG)or pseudoexfoliative glaucoma(PXG).<p>METHODS: In this prospective randomized study 40 eyes of 40 patients with cataract and POAG or PXG were evaluated. Complete eye examination and glaucoma tests were performed in all patients. Combined P-DS and P-T were performed under local anesthesia in 20 eyes in each group. Visual acuity(VA), intraocular pressure(IOP)and number of glaucoma medications were all recorded preoperatively and postoperative on 10d, 1, 3, 6 and 12mo. Complications, laser goniopuncture in P-DS group and needling in P-T group were also recorded.<p>RESULTS: The age(P-DS, 66.3±11.0 and P-T, 70.2±9.3y)and sex distribution(P-DS, 7 female and 13 male, P-T, 9 female and 11 male)were similar in both groups(<i>P</i>>0.05). Number of POAG and PXG patients were 12 and 8, and 13 and 7 in P-DS and P-T groups, respectively(<i>P</i>>0.05). There was no difference between groups in terms of preoperative VA(P-DS, 0.69±0.22 and P-T, 0.76±0.22 logMAR), IOP(P-DS, 17.9±1.6 and P-T, 18.1±1.9 mm Hg)and number of medications(P-DS: 2.7±0.7 and P-T: 2.9±0.8),(<i>P</i>>0.05). VA increased, IOP and number of medications decreased in both groups postoperatively(<i>P</i><0.01). Postoperative IOPs were 15.0±1.7 and 14.5±1.6 mm Hg in P-DS and P-T groups respectively(<i>P</i>=0.472). Postoperative number of medications were slightly better in P-T group(0.5±0.7)than in P-DS group(0.8±0.9)(<i>P</i>=0.307). There were no complications in both groups. Laser goniopuncture was applied in 7 eyes(once in 5 eyes and twice in 2 eyes)in P-DS group. Needling was performed in 1 eye in P-T group. <p>CONCLUSION: In patients with coexisting cataract and glaucoma, both combined P-DS and P-T may be performed safely. Reliability and efficacy were similar in both groups. Follow-up of P-DS should be done cautiously and when necessary laser goniopuncture should be performed

Risk factors for intraocular pressure rise following phacoemulsification

Purpose: This study was designed to analyze the risk factors resulting in high intraocular pressure (IOP), which was accepted as IOP higher than 22 mmHg, following uncomplicated phacoemulsification. Materials and Methods: The records of 812 eyes of 584 patients who underwent uncomplicated phacoemulsification were evaluated. There were 330 men and 254 women ranging between the age of 26 and 89 years (65.4 ± 9.8 years). The preoperative, postoperative first day (day 1), first week (day 7), and first month (day 30) IOP values were analyzed. Data on history of diabetes, glaucoma, pseudoexfoliation (PXF), incision site, capsular staining with trypan blue, and surgeon were recorded. A multinomial regression analysis was performed to analyse the relationship of the factors with postoperative high IOP. Results: The mean IOP was 15.6 ± 4.3 mmHg preoperatively. Postoperatively that were changed to 19.7 ± 9.0 mmHg at day 1, 12.7 ± 4.5 mmHg at day 7, and 12.8 ± 3.7 mmHg at day 30. The factors such as surgeon, presence of PXF, diabetes, surgical incision site, and trypan blue were not related to the postoperative high IOP (P > 0.05, in all). The only factor that related to high IOP at all visits was glaucoma (P < 0.005). Conclusion: According to our results, preoperative diagnosis of glaucoma seems to be the only factor to affect the postoperative IOP higher than 22 mmHg

Choroidal thickness measurements with optical coherence tomography in branch retinal vein occlusion

AIM: To evaluate central macular thickness (CMT) and mean choroidal thickness (MCT) in eyes with branch retinal vein occlusion (BRVO), before and after ranibizumab treatment using spectral domain -optical coherence tomography (SD-OCT). METHODS: Forty -two patients with unilateral BRVO and macular edema were included in this study. There were 25 men and 17 women. Using SD-OCT, choroidal thickness was measured at 500 mu m intervals up to 1500 mu m temporal and nasal to the fovea. MCT was calculated based on the average of the 7 locations. All the eyes with BRVO were treated with intravitreal ranibizumab (0.5 mg/0.05 mL). Comparisons between the BRVO and fellow eyes were analyzed using Mann-Whitney test. Pre-injection and post-injection measurements were analyzed using Wilcoxon test and repeated measure analysis. RESULTS: At baseline, there was a significant difference between the BRVO and fellow eyes in MCT [BRVO eyes 245 (165-330) mu m, fellow eyes 229 (157-327) mu m] and CMT [BRVO eyes 463 (266-899) mu m, fellow eyes 235 (148-378) mu m (P=0.041, 0.0001, respectively)]. Following treatment, CMT [295 (141-558) mu m] and MCT [229 (157329) mu m] decreased significantly compared to the baseline measurements (P=0.001, 0.006, respectively). Also BCVA (logMAR) improved significantly (P=0.0001) in the BRVO eyes following treatment. After treatment CMT [BRVO eyes 295 (141-558) mu m, fellow eyes 234 (157-351) mu m] and MCT [BRVO eyes 229 (157-329) mu m, fellow eyes 233 (162-286) mu m] values did not reveal any significant difference in BRVO eyes and fellow eyes (P=0.051, 0.824, respectively). CONCLUSION: In eyes with BRVO, CMT and MCT values are greater than the fellow eyes, and decrease significantly following ranibizumab injection

Intraocular Pressure Changes Following Phacoemulsification

WOS: 000314145000003Objective: To analyze the effect of phacoemulsification on intraocular pressure (IOP) and to evaluate the management for high postoperative IOP. Material and Methods: Data of 812 eyes of 584 consecutive patients (330 males and 254 females) who underwent Uneventful phacoemulsification in Department of Ophthalmology, Baskent University Adana Research Center were investigated retrospectively. The ages ranged between 26 and 89 years (65.5 +/- 9.8 years). Intraocular pressure values of preoperative and postoperative first day, first week and first month visits were recorded. Intraocular pressures over 22 mm Hg were considered as high IOP. Either anterior chamber decompression or antiglaucomatous medication was used to decrease the postoperative rise in IOP. Changes in TOP were analyzed using ANOVA. Results: The mean preoperative TOP was 15.6 +/- 4.3 mmHg, which increased to 19.7 +/- 9.0 mmHg on the 1st day (p<0.001). The IOP decreased significantly to 12.7 +/- 4.5 mmHg at 1st week, and 12.8 +/- 3.7 mmHg at 1st month (p<0.001, both). In 249 (30.7%) eyes, high IOP was detected on the first day. In 114 (45.8%) of these eyes, TOP was reduced by anterior chamber decompression while in 73 (29.3%) eyes glaucoma medication was prescribed. At first month 13 (1.6%) eyes had high IOP. Conclusion: Although, a rise in IOP remains a problem in the postoperative first day; both anterior chamber decompression and glaucoma medication seem to be effective and safe to overcome this condition. In short term, uneventful phacoemulsification and intraocular lens implantation results in a decrease in IOP