Efficacy of Optic Nerve Sheath Fenestration in Patients with Increased Intracranial Pressure

Objectives:To evaluate the effectiveness of optic nerve sheath fenestration (ONSF) on visual functions in patients with increased intracranial pressure (İİP).Materials and Methods:The medical records of 24 eyes of 17 patients who had İİP due to idiopathic intracranial hypertension, cerebral venous sinus thrombosis, or intracranial cyst and underwent ONSF surgery to prevent visual loss were evaluated. Pre- and postoperative visual acuity, optic disc images, and visual field findings were reviewed.Results:The mean age of the patients was 30.4±8.5 years, and 88.2% were female. The patients’ mean body mass index was 28.67±6.1 kg/m2. The mean follow-up time was 24±12.1 months (range: 3-44). At postoperative 3 months, the mean best-corrected distance visual acuity had improved in 20 eyes (83.3%) and stabilized in 4 eyes (16.7%) compared to preoperative values. In visual field mean deviation, an improvement was observed in 10 eyes (90.9%), while 1 eye (9.1%) eye remained stable. Optic disc edema decreased in all patients.Conclusion:This study indicates that ONSF has beneficial effects on visual function in patients with rapidly progressive visual loss caused by increased intracranial pressure

Optic Nerve Head and Retinal Nerve Fiber Layer Analysis in Ocular Hypertension and Early-Stage Glucoma Using Spectral-Domain Optical Coherence Tomography Copernicus

Objectives: Evaluation of structural alterations of the optic nerve head (ONH) and the retinal nerve fiber layer (RNFL) in patients with ocular hypertension (OHT) and early-stage glaucoma and assessment of the discriminatory diagnostic performance of spectral-domain optical coherence tomography (SD-OCT) Copernicus (Optopol Technology S.A.). Materials and Methods: This study included 59 eyes of a total of 59 patients, 29 of whom were diagnosed with OHT (Group 1) and 30 with early-stage glaucoma (Group 2). The differentiation of early-stage glaucoma and OHT was carried out on the basis of standard achromatic visual field test results. Analysis of the ONH and RNFL thickness of all cases was made using SD-OCT. Group 1 and Group 2 were compared with respect to the ONH parameters and RNFL thickness. The diagnostic sensitivity of the OCT parameters was evaluated by the area under the receiver operating characteristics curves (AUC). Results: The average, superior, inferior, and nasal RNFL thicknesses in early-stage glaucoma cases were approximately 10% (12-14 µm) less compared to the OHT eyes, with differences being highly significant (p≤0.001). However, there was no statistically significant difference in the temporal RNFL thicknesses. The most sensitive parameter in the early diagnosis of glaucoma was average RNFL thickness corresponding to AUC: 0.852, followed by AUC: 0.816 and AUC: 0.773 values in superior and inferior RNFL thickness, respectively. In localized RNFL defects, the highest sensitivity corresponded to superior and superonasal quadrants (ACU: 0.805 and ACU: 0.781, respectively). There were not any statistically significant differences between the ONH morphological parameters of the two groups. Conclusion: RNFL analysis obtained using SD-OCT Copernicus is able to discriminate early-stage glaucoma eyes from those with OHT. However, ONH morphological parameters do not have the same diagnostic sensitivity. Turk J Ophthalmol 2014; 44: 35-41

Dominant ve dominant-olmayan el ile fakoemülsifikasyon (katarakt cerrahisi) sonuçları

Aim: The aim was to present the outcomes of phacoemulsification surgery with dominant and non-dominant hands. Methods: Eighty eyes of 72 patients undergoing phacoemulsification with a temporal clear corneal incision were included in the study by reviewing their medical records and were divided into two groups. Forty of operated eyes were right eyes and forty were left ones. We operated right eyes with dominant (right) hand, and left eyes with non-dominant (left) hand through a temporal clear corneal tunnel. The patients were followed up at week 1 st and month 1 st and 3rd. Keratometry and specular microscopy were performed preoperatively, at month 1 st and 3rd after surgery. We recorded the total volume of fluid used, phaco time and cumulative dissipated energy. We calculated surgically-induced astigmatism using vector analysis. Results: There was no statistically significant difference in intraoperative and postoperative outcomes between phacoemulsification surgeries performed with dominant and non-dominant hands. Conclusion: Phacoemulsification surgeries can be carried out with non-dominant hand and with excellent outcomes.Amaç: Sağ ve sol el ile yapılan fakoemülsifikasyon sonuçlarımızı sunmaktır. Yöntemler: Kliniğimizde temporal korneal insizyonla katarakt operasyonu olan 72 hastanın 80 gözü dahil edilmiştir. Kırk göz sağ el ile, 40 göz sol el ile opere edilmiştir. Hastaların 1 hafta,1 ay ve 3 ay sonra takipleri yapılmıştır. Hastalar 1. ve 3. ay kontrollerinde keratometri ve speküler mikroskopi ile değerlendirilmiştir. Fakoemülsifikasyon zamanı, kümülatif kullanılan enerji, total kullanılan sıvı kaydedilmiştir. Cerrahi ile indüklenen astigmatizma vektör analizi kullanılarak karşılaştırılmıştır. Bulgular: Sağ ve sol el ile yapılan fakoemülsifikasyonlarda; intra ve postoperatif sonuçlar istatistiksel farklılık göstermemiştir. Sonuç: Fakoemülsifikasyon; dominant-olmayan el ile de yapıldığı zaman iyi sonuçlar çıkabilir

Results of Frontalis Suspension Surgery in Eyes with Poor Levator Muscle Function

Aim: To evaluate the results of frontal suspension surgery with autologous fascia lata or silicon rod. Methods: We retrospectively evaluated the results and the complications of frontalis suspension surgery performed in patients with levator muscle function ≤5 mm, who presented with the complaint of ptosis. In patients operated unilaterally, the success of the surgery was graded according the difference between eyelid heights: a difference of <1 mm was considered successful, 1-2 mm - satisfactory, and a difference of >2 mm was accepted as unsuccessful. In those who were operated bilaterally, the success of the surgery was graded according the upper eyelid level: an eyelid level 0-3 mm below the limbus was recorded as successful, >3 mm below the limbus with an open optic axis - satisfactory, and occluded axis was considered unsuccessful. Results: Seventeen eyes of 14 patients enrolled in the study. Silicon rod was used in 9 eyes and autogenous fascia lata was used in 8 eyes. Surgical outcome was recorded as successful in 9 eyes, as satisfactory in 4 eyes and as unsuccessful in 4 eyes. In eyes with unsuccessful outcome, revision surgery was performed within 10 days after surgery. Punctate keratopathy (5 eyes), lagophthalmos (1 eye), mild undercorrection in the temporal side of the eyelid (1 eye) and severe upper eyelid edema (1 eye) were recorded as complications. One patient who was operated with autologous fascia lata complained of leg pain in donor site and, in one patient, incision dehiscence needed to be repaired. Conclusion: Surgical success after primary and revision surgeries were rated as successful in 13 of 17 eyes (76.47%) and as satisfactory in 4 of 17 eyes (23.53%). (The Medical Bulletin of Haseki 2015; 53:36-40

Development of Secondary Glaucoma After Congenital Cataract Surgery and the Underlying Risk Factors

Pur po se: To determine the risk factors and incidence of glaucoma following congenital cataract surgery in our case series. Patients and Methods: Records of children who underwent cataract surgery between January 2001 and December 2009 were reviewed retrospectively. Age at primary surgery, microcornea, aphakia/ pseudophakia and associated systemic pathology were analyzed as potential risk factors for glaucoma secondary to surgery. Sixty-five eyes of 37 patients having a minimum 6-month follow-up were included in the study. Results: Age at surgery was 35.6±43.9 months (2 months-17 years) with a follow-up period of 38.6±28.1 months (6 months-8.5 years). Glaucoma developed in 8 patients (14 eyes; 21.5%). Time between surgery and glaucoma diagnosis was 47.3±23.3 months (20 months-7 years). Glaucoma incidence in aphakic and pseudophakic cases did not differ. Glaucoma development significantly correlated with age at surgery (p<0.001), microcornea (p=0.001) and presence of systemic pathology (p=0.007). Mean age at surgery was significantly lower in patients with glaucoma diagnosis (7.4 months) than in those who did not develop glaucoma (43.4 months). However, the mean follow-up period was significantly longer in patients with glaucoma (p=0.003). Whereas glaucoma developed in 60% and 38.5% of the eyes of patients with microcornea and systemic pathology, respectively, this dropped to 14.5% and 10.3% in cases with normal corneal diameter and absence of systemic pathology, respectively. Discussion: Early age at cataract surgery, microcornea and systemic pathologies are important risk factors for development of secondary glaucoma and the incidence of glaucoma increases with longer follow-up. To prevent visual loss, patients should be followed up lifelong.(Turk J Ophthalmol 2011; 41: 358-63

The Frequency of Serous Macular Detachment in Diabetic Macular Edema

Objectives: To investigate the epidemiology and frequency of serous macular detachment (SMD) in patients diagnosed with diabetic macular edema (DME). Materials and Methods: Hundred and forty-three eyes of 104 patients with DME were examined retrospectively. According to the results of OCT, the patients were separated into two groups; patients diagnosed with SMD and DME (group 1) and patients diagnosed with DME (group 2). They were assessed based on demographic characteristics, average age, duration of diabetes mellitus (DM), hypertension (HT) history, best-corrected visual acuity, and diabetic retinopathy stages. Results: The average age of the patients was 61±8.7 years. Forty-three patients (41.3%) were female and 61 patients (58.7%) were male. Fifty-four of 104 patients (51.9%) had DME with SMD. 21 (38.8%) patients had bilateral SMD. In group 1, 31 patients were male (57.4%) and 23 patients were female (42.6%). In group 2, 30 (60%) patients were male and 20 (40%) patients were female. In group 1, average age was 60.2±9.6 and the average duration of DM was 12.2±7.0 years, whereas the average age was 61.9±7.6 and the average duration of DM was 14.06±6.8 years in group 2. Forty-two patients in group 1 (77.8%) and 30 patients (60%) in group 2 had history of HT. Before the treatment, the average best-corrected visual acuity was found to be 0.30±0.24 in group 1 and 0.32±0.25 in group 2. Conclusion: Today, it is thought that diabetic maculopathy is the leading cause of SMD and it is a determining factor of treatment applications. In our study, we aimed at investigating the frequency of SMD in DME and the risk factors for the development of SMD. Although there were some differences between the factors, only the history of HT was found statistically higher in patients with SMD (p=0.04). (Turk J Ophthalmol 2015; 45: 92-96

Primary Conjunctival Tuberculosis

A 12-year-old girl was referred to our clinic because of unilateral conjunctivitis not responding to treatment. In the left eye, lower bulbar and tarsal conjunctiva had a polypoidal appearance due to micronodules and there was a subconjunctival nodular mass in the inferior fornix. Systemic examination was unremarkable except for a left preauricular lymphadenopathy. Excision biopsy of the subconjunctival mass revealed a granulomatous inflammation with caseation necrosis, but acid-fast bacilli (AFB) was negative. Fine needle-aspiration biopsy of the preauricular lymph node was performed. In microbiological examination, both AFB and mycobacterial culture were positive. The isolated mycobacteria strains were identified as Mycobacterium tuberculosis complex and full remission was achieved with 6 months of anti-tuberculosis treatment. Although primary tuberculous conjunctivitis is a very rare condition, it should be considered in the differential diagnosis of treatment-resistant unilateral conjunctivitis. For definitive diagnosis, microbiological and histopathological examinations should be performed both in conjunctiva and regional lymph node

Purtscher-Like Retinopathy Associated with Atypical Hemolytic Uremic Syndrome

A 25-year-old woman presented with acute bilateral blurred vision and history of headache, dizziness, and syncope for three days. Her visual acuity was 20/60 in both eyes. Fundoscopy revealed multiple bilateral peripapillary yellow-white patches like cotton wool spots, intraretinal hemorrhages and macular edema. The patient was diagnosed with Purtscher-like retinopathy based on the retinal findings and lack of trauma history. She was urgently admitted to the nephrology clinic due to thrombotic microangiopathy findings (hemoglobinemia, thrombocytopenia, and acute renal failure). After excluding thrombotic microangiopathy, the patient was diagnosed with atypical hemolytic uremic syndrome (aHUS) with the clinical and laboratory findings. Eculizumab treatment was added to hemodialysis and plasmapheresis therapy. Three months after starting treatment, retinal lesions regressed and visual acuity increased to 20/20 in both eyes. To the best of our knowledge, this is the first reported case of Purtscher-like retinopathy associated with aHUS

Bilateral Primary Lacrimal Gland Lymphoma

Lymphoma involving the lacrimal gland is rare. Most of the cases are unilateral at presentation. In this case, we present the diagnostic evaluation of a patient with bilateral lacrimal gland lymphoma. At presentation, the patient had inferomedial eccentric proptosis of the right eye. The patient also had limitation in the upper and lateral gaze in this eye. On magnetic resonance imaging, a mass was detected not only in the right but also in the left eye corresponding to the area of the lacrimal gland. Excisional biopsy was performed in the right eye with lateral orbitotomy approach. Histopathological examination revealed extranodal marginal zone lymphoma involving the lacrimal gland. No concurrent systemic lymphoma was detected during systemic evaluation of the patient. The patient was directed to the oncology department for systemic treatment planning. In conclusion, bilateral involvement is rare in lacrimal gland diseases but it can show severe diseases like lymphoma