Kapsül ve/veya zonül yetmezlikli afakinin cerrahi tedavisinde iris kıskaçlı lensler

Purpose: To evaluate the anatomic and functional results of iris claw lenses (ICL) in the surgical management of aphakic cases with capsular and/or zonular insufficiency. Materials and Methods: The data of 25 eyes of 25 cases who had undergone ICL (Artisan Aphakia, Ophtec) implantation in Ege University Faculty of Medicine, Department of Ophthalmology between February 2006 and November 2008 were retrospectively evaluated. Pre- and post-operative best corrected visual acuity (BCVA) were calculated according to Logmar equivalents, and keratometry values and corneal thickness were measured. Scheimpflug camera system (Pentacam, Oculus, Wetzlar, Germany) was used to if any demonstrate the presence of tilt or dislocation of ICL and measure the central corneal thickness. Results: A total of 0.23 Logmar equivalent (2.3 standart line) increase in post-operative BCVA was evident (p=0.019, T Test). The comparison of pre- and post-operative BCVA revealed increment in 14, decrement in 4 cases and no change in 7 cases. Post-operative keratometric astigmatism increased with a mean of 1.04 diopters (p=0.001, T Test), central corneal thickness increased approximately 1% (p=0.000, T Test). In the early post-operative period pupillary block was detected in 1, ICL tilt in 3 cystoid macular edema in 3 cases. In the late post-operative period retinal detachment in 1, cystoid macular edema in 1, graft failure due to herpetic keratitis in 1 case were experienced. Conclusion: ICL lenses were found to have satisfactory anatomic and functional results in the treatment of aphakic cases with capsular/zonular insufficiency.Amaç: Kapsül ve/veya zonül yetmezlikli afakik olguların cerrahi tedavisinde kullanılan iris kıskaçlı lenslerin (İKL) anato mik ve fonksiyonel sonuçlarını araştırmak. Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi Göz Hastalıkları Kliniği’nde Şubat 2006-Kasım 2008 tarihleri arasında İKL (Artisan Aphakia, Ophtec) implantasyonu yapılmış olan toplam 25 olgunun 25 gözüne ait veriler retrospektif olarak in celendi. Ameliyat öncesi ve sonrası en iyi düzeltilmiş görme keskinliği (EİDGK) Logmar eşdeğerleri ile hesaplandı, kerato metri değerleri, kornea kalınlıkları ölçüldü. İKL’de tilt veya dislokasyon varlığının gösterilmesi ve merkezi kornea kalınlığı ölçümlerinde Scheimpflug kamera sistemi (Pentacam, Oculus, Wetzlar, Germany) kullanıldı. Bulgular: Ameliyat sonrası EİDGK’da 0.23 Logmar eşdeğeri (2.3 standart ETDRS sırası) artış elde edildi (p=0.019, T Test). Ameliyat sonrasında ameliyat öncesine göre 14 olguda EİDGK’da artış, 4 olguda azalma saptanırken, 7 olguda fark bulunmadı. Ameliyat sonrası keratometrik astigmatizmada ortalama 1.04 diyoptri artış (p=0.001, T Test), merkezi kornea kalınlığında yaklaşık olarak %1 artış bulundu (p=0.000, T Test). Ameliyat sonrası erken dönemde 1 olguda pupil bloğu, 3 ol guda İKL’de tilt, 3 olguda erken dönemde kistoid maküler ödem saptandı. Ameliyat sonrası geç dönemde 1 olguda retina de kolmanı, 1 olguda geç dönem kistoid maküler ödem saptanırken, 1 olguda herpetik keratit nüksüne bağlı greft reddi gelişti. Sonuç: Kapsül/zonül yetersizliği bulunan afakik olgularda kullanılan İKL’lerin anatomik ve fonksiyonel sonuçları tatmin edici bulunmuştur

External validation of the T.O.HO. score and derivation of the modified T.O.HO. score for predicting stone-free status after flexible ureteroscopy in ureteral and renal stones

Objective: The T.O.HO. scoring system was developed to predict stone-free status after flexible ureterenoscopy (fURS) lithotripsy applied for ureter and renal stones. This study aimed to perform the external validation of the T.O.HO. score in the Turkish population and propose a modification for this system. Material methods: Patients who underwent fURS for kidney and ureteral stones between January 2017 and January 2020 were retrospectively analysed. The patient and stone characteristics and perioperative findings were noted. The T.O.HO. score was externally validated and compared with the STONE score. Stone-free parameters were evaluated with the multivariate analysis. Based on the results of this analysis, the T.O.HO. score was modified and internally validated. Results: A total of 621 patients were included in the study. The stone-free rate was determined as 79.8% (496/621) after fURS. The regression analysis showed that stone area had better predictive power than stone diameter (P =.025). Lower pole (reference), middle pole [odds ratio (OR) = 0.492 P =.016] and middle ureteral (OR = 0.227, P =.024) localisations, stone density (OR = 1.001, P <.001), and stone volume (OR = 1.008, P <.001) were determined as independent predictive markers for stone-free status. Based on the effect size of the stone surface area in the nomogram, stone volume was divided into five categories, at 1-point intervals. The AUC values of the T.O.HO., STONE, and modified T.O.HO. score in predicting stone-free status were calculated as 0.758, 0.634, and 0.821, respectively. The modified T.O.HO. created by adding stone volume was statistically significantly superior to the original version (ROC curve comparison, P <.001). Conclusion: The T.O.HO. score effectively predicted stone-free status after fURS. However, modified T.O.HO. SS showed the best predictive performance compared with original T.O.HO. SS

A Rare Case of a Gunshot Injury: No Urinary Symptoms with a Voided Bullet

Gunshot injuries to the abdominal cavity are cases of emergency which can be life-threatening depending on the organ/s affected. High-velocity penetrating injuries can cause both a penetrating injury to the organs on its’ route or can cause blast injury nearby. In most of the cases, the bullet can be found and the defect can be repaired intraoperatively. Here, we present a rare case of a patient with an intrabdominal penetrating gunshot wound with no organ injury, including the bladder, who voided the bullet spontaneously 30 days after the injury

Co-insidental, Ipsilateral Renal Cell Carcinoma and Urothelial Carcinoma of Ureter: A Rare Case

Renal cell carcinoma and urothelial carcinoma of the upper urinary tract are not rare urological malignancies, however, in a patient with renal cell carcinoma and urothelial carcinoma seen simultaneously in the same kidney is a rare event. We present a patient with a renal mass who underwent laparoscopic radical nephrectomy in our clinic. Pathology results revealed renal cell carcinoma and urothelial carcinoma, therefore, ureterectomy and cuff excision were performed. Pathological investigation of the ureterectomy specimen revealed urothelial carcinoma of the proximal ureter. We report this rare case with a literature review

Co-insidental, Ipsilateral Renal Cell Carcinoma and Urothelial Carcinoma of Ureter: A Rare Case

Renal cell carcinoma and urothelial carcinoma of the upper urinary tract are not rare urological malignancies, however, in a patient with renal cell carcinoma and urothelial carcinoma seen simultaneously in the same kidney is a rare event. We present a patient with a renal mass who underwent laparoscopic radical nephrectomy in our clinic. Pathology results revealed renal cell carcinoma and urothelial carcinoma, therefore, ureterectomy and cuff excision were performed. Pathological investigation of the ureterectomy specimen revealed urothelial carcinoma of the proximal ureter. We report this rare case with a literature review