Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes

ABSTRACT Purpose: To analyze the indications for explantation or exchange of intraocular lenses (IOLs), which were originally implanted for the correction of aphakia during cataract extraction. Methods: All cases that involved intraocular lens explantation or exchange in one institution between January 2008 and December 2014 were analyzed retrospectively. Results: In total, 93 eyes of 93 patients were analyzed. The median time interval between implantation and explantation of the anterior chamber intraocular lenses (AC IOL) and posterior chamber intraocular lenses (PC IOL) was 83.40 ± 83.14 months (range: 1-276 months) and 55.14 ± 39.25 months (range: 1-168 months), respectively. Pseudophakic bullous keratopathy (17 eyes, 38.6%) and persistent iritis (12 eyes, 27.8%) in the AC IOL group and dislocation or decentration (30 eyes, 61.2%) and incorrect IOL power (nine eyes, 18.4%) in the PC IOL group were the most common indications for explantation of IOLs. The mean logMAR best corrected visual acuity (BCVA) improved significantly from 1.30 preoperatively to 0.62 postoperatively in the PC IOL group (p<0.001) but did not improve significantly in the AC IOL group (p=0.186). Conclusions: The primary indication for IOL explantation or exchange was pseudophakic bullous keratopathy in the AC IOL group and was dislocation or decentration in the PC IOL group. PC IOL explantation or exchange is safe and improves visual acuity

Short-term impact of glycaemic control and intravitreal ranibizumab treatment on serum cytokine levels and diabetic macular edema in patients with unregulated blood glucose

Objective: To evaluate the short-term effect of glycaemic control and intravitreal ranibizumab treatment on diabetic macular edema (DME) and to assess the correlation between HbA1c and certain serum cytokines. Design: A prospective study of 43 participants with HbA1c levels exceeding 53 mmol/mol (7%) and with DME, as detected by spectral domain optical coherence tomography (SDOCT). Subjects: Participants were grouped according to their initial best corrected distance visual acuity (BCVA). Group 1 was treated with three monthly doses of intravitreal ranibizumab (0.5 mg) injections, and Group 2 was followed without treatment. Methods: Serum cytokine levels, including interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1(MCP-1), and vascular endothelial growth factor (VEGF) were analysed at the beginning and at the end of 3 months, using enzyme-linked immunosorbent assays (ELISA). Results: A significant decrease in macular thicknesses (except for one quadrant) was observed in Group. Changes in serum cytokine levels were not correlated with HbA1c decrease. Serum VEGF level was significantly increased in Group 1, despite the intravitreal treatment. Conclusion: Short-term glycaemic control alone had limited value in the treatment of DME. The therapeutic effect of intravitreal treatment on DME supports the role of the local cytokine milieu in the pathophysiology

Current Status of Fundus Florescein Angiography in Ophthalmology Practice

Floresein anjiyografinin gelişimi retinal ve koroidal patolojilerin anlaşılabilirliğini artırmış, hem klinikte sıkça karşılaşılan retinal hastalıkların tanısında ve tedavisinin takibinde hem de bilimsel araştırmalarda standart görüntüleme yöntemi haline gelmiştir. Dijital görüntüleme, geniş açılı görüntüleme ve veri analizindeki teknolojik gelişmeler floresein anjiyografinin klinik ve araştırma amaçlı kullanımını daha da yaygınlaştırmıştır. Her ne kadar optik koherens tomografi retina kliniklerinde yaygın olarak kullanılmaktaysa da floresein anjiyografi retinal ve koroidal dolaşımların değerlendirilmesinde tercih edilen yöntem olarak önemini korumakta ve göz hekimleri için retinal hastalıkların tanısında vazgeçilmez bir tetkik olmaya devam etmektedirThe development of fluorescein angiography increased the understanding of retinal and choroidal pathology and has become the standard both in the literature and in clinical practice to diagnose and guide the treatment of the most common retinal diseases encountered in ophthalmology. Recent technological advances in digital imaging, wide angle imaging and computer analysis have further expanded the clinical and research applications of fluorescein angiography. Although optical coherence tomography is now widely used in retinal clinics, fluorescein angiography remains as the preferred method to image the choroidal and retinal circulation and it is still an essential tool used by many ophthalmologists to diagnose a multitude of retinal disease

Intravitreal Anti-VEGF Drug Injections in Vitrectomized Eyes

İntravitreal anti-vasküler endotelyal büyüme faktörü (anti-VEGF) enjeksiyonları günümüzde retina sahasında en çok uygulanan tedavi yönte-midir. Klinisyenler anti-VEGF tedavisi uygulanan gözlerde pars plana vitrektomi gerektiren durumlarla karşı karşıya kalmakta ve birçok hasta-da arka segment hastalığının kronik ve rekürren doğasından dolayı intravitreal enjeksiyonlara cerrahiden sonra da devam etmek gerekmektedir.Vitrektomize gözlerde ilaç klirensinin arttığı ve etkinliğinin azaldığı genel kabul görmektedir. Anti-VEGF ilaçlarla yapılan geniş serili klinikçalışmaların çoğu vitrektomize olmayan gözlerde yapılmış olup vitrektomize gözlerde bu ilaçlarla tedavi etkinliğinin nasıl bir değişim gös-terdiği sorusuna yanıt vermezler. Vitrektomize gözlerde intravitreal anti-VEGF konsantrasyonunu vitrektomize olmayan gözlerle kıyaslayanaz sayıda hayvan çalışması olsa da eldeki verilerle vitrektomize insan gözlerinde kesin yargıya varabilmek zor görünmektedir. Bu derlemedevitrektominin anti-VEGF ilaçların farmakokinetiğine ve klinik sonuçlara olan etkisini irdelemeyi amaçladık.Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents is currently the most commonly performed procedure inthe fi eld of retina. In eyes undergoing anti-VEGF treatment, clinicians are frequently challenged with conditions necessitating pars plana vitre-ctomy. However, for many patients, the chronic and recurrent nature of posterior segment disease necessitates continued intravitreal injectionsafter surgery. Generally, drug clearance has been assumed to increase and drug effectiveness decrease in vitrectomized eyes. Most of the largeclinical trials of anti-VEGF drugs were performed in nonvitrectomized eyes and do not answer how the effect of treatment with these drugsmay be altered in vitrectomized eyes. Although few animal studies have compared intravitreal anti-VEGF concentrations of vitrectomized eyeswith those of nonvitrectomized eyes, it is diffi cult to draw defi nite conclusions from the available data in vitrectomized human eyes. We aimedto discuss effects of vitrectomy on pharmacokinetics of anti-VEGF agents and clinical outcomes in this review

Pathogenesis of Diabetic Retinopathy and Diabetic Macular Edema

Diabetik retinopatinin (DR) patogenezi vasküler, inflamatuar ve nöronal mekanizmaları içeren karmaşık bir yapıdadır. Diabet retinada metabolik ve fizyolojik anomalilere neden olur ancak bunların diyabetik retinopatinin bilinen bulgularının gelişimine ne kadar katkısı olduğu aşikar değildir. Anjiyogenez ve inflamasyonun hastalığın patogenezi ile ilişkili olduğu gösterilmiştir. Hiperglisemi ve hipoksi tarafından tetiklenen moleküler mediatörler ve beraberindeki metabolik yolaklar doğrudan endotel hücrelerine etki ederek artmış vasküler geçirgenlik, endotel hücreleri arasındaki bağlantıların bozulması, lökostaz ve sonunda diyabetik maküler ödeme (DMÖ) neden olabilir. Moleküler mediatörler ve matabolik yolaklar arasındaki etkileşim, sinyal iletimi ve geri besleme mekanizmaları oldukça karmaşıktır ve tam olarak anlaşılamamıştır. Bu derlemede DR ve DMÖ gelişiminde rol oynayan mekanizmalar mikrovasküler ve moleküler seviyede ele alınmıştırThe pathogenesis of diabetic retinopathy (DR) is complex and several vascular, inflammatory and neuronal mechanisms are involved. Diabetes causes a number of metabolic and physiologic abnormalities in the retina, but which of these abnormalities contribute to recognized features of DR is less clear. Angiogenesis and inflammation have been shown to be involved in the pathogenesis of this disease. Molecular mediators, acting in conjunction with metabolic pathways, which are all stimulated in part by the hyperglycaemia and hypoxia, can have a direct endothelial effect leading to hyperpermeability, disruption of vascular endothelial cell junctions, leukostasis and ultimately diabetic macular edema (DME). The interactions, signalling events and feedback loops between the various molecular mediators and metabolic pathways are complicated and are not completely understood. The underlying mechanisms of DR and DME, on both microvascular and molecular levels, are discussed in this revie

Central serous chorioretinopathy

Retina kaynaklı görme kaybının sık görülen nedenlerinden biri kabul edilen santral seröz koriyoretinopati (SSKR), retina pigment epitelinde bir veya daha fazla fokal sızıntının olması sonucunda nörosensöriyel retinanın dekolmanı ile karakteri- zedir. Daha çok genç erkeklerde görüldüğü ve yıllık insidansının 10.000de 10 olduğu bildirilmiştir. Risk faktörleri arasında hiperkortisolism, A-tipi kişilik ve gebelik başta olmak üzere farklı nedenler gösterilmiştir. Akut, rekürren ve kronik olarak sınıflandırılan SSKRnin akut formu çoğunlukla 2-3 ay içerisinde düzelmektedir. Optik koherens tomografi fundus mua- yenesinde görülemeyen bulguların izlenebilmesi ve hastalık progresyonu takibinin yapılabilmesi için değerlidir. Fundus floresein anjiyografi, retina pigment epitelindeki sızıntıları gösterme ve bu noktaların fovea dışında olduğu durumlarda argon laser fotokoagulasyon tedavisinin yönlendirilmesi aşamasında yardımcıdır. Kesin tanının konulamadığı durumlarda, orta faz hiperfloresansın gösterilebilmesi için indosiyanin yeşili anjiyografiden yararlanılmaktadır. Üç aydan daha uzun süren akut formlarında ve kronik SSKRde tedavi planlanmalıdır. Tedavinin uzun dönem etkileri halen tam olarak bilin- memektedir. Tedavi seçenekleri arasında argon laser fotokoagülasyon, yarım-doz fotodinamik tedavi, mikropals diod laser, transpupiller termoterapi, intravitreal vasküler endotelyal büyüme faktörü enjeksiyonu ve farklı farmakolojik ajanlar sa- yılabilir. Prognoz başlangıç görme keskinliğine bağlıdır ve kronik ve büllöz SSKR olguları dışında çoğunlukla iyidir. Bu yazıda SSKRnin epidemiyolojisi, risk faktörleri, patofizyolojisi, sınıflandırması, tanı ve tedavi seçenekleri derlenmiştir.Considered as one of the main reasons of visual loss of retinal origin, central serous chorioretinopathy (CSCR) is charac- terised neurosensorial reinal detachment caused by one or more focal leakage points on retinal pigment epithelium. It has been reported to be seen mostly in young male adults with an annual incidence rate of 10 per 10.000. Many risk factors have been identified including hypercortisolism, type-A personality and pregnancy. CSCR has been classified as acute, recurrent and chronic, in which acute form usually resolves in 2-3 months. Optical coherence tomography is valuable for both imaging subtle fundoscopic findings and monitoring disease progression. Fluorescein angiography aids identification of pigment epithelial leaks and guides argon laser treatment if outside the fovea. Where the diagnosis is uncertain, indocya- nine green angiography can demonstrate classic midphase hyperpermeability. Treatment should be considered in chronic forms and acute forms lasting beyond 3 months. Long term results of therapy is not yet well established. Treatment options are argon laser photocoagulatin, half-fluence photodynamic therapy, micropulse diod laser, transpupillary thermotherapy, intravitreal anti-vascular endothelial growth factor injection and various pharmacologic ajents. Prognosis mostly depends on presenting visual acuity, and is usually good excluding chronic and bullous forms. This paper reviews epidemiology, risk factors, classification, diagnosis and treatment modalities of CSCR

Granulomatous Anterior Uveitis, Internal Ophthalmoplegia, and Retinal Vasculitis During Chickenpox Disease in A Child

Herein, we report the case of a patient who had granulomatous anterior uveitis, internal ophthalmoplegia, and retinal vasculitis during chickenpox disease. A 9-year-old girl was admitted to our clinic with blurred vision and hyperemia in the right eye. Corrected visual acuity was 20/20 in both eyes. Direct/indirect pupillary reactions were negative in the right eye and pupil was dilated. Biomicroscopic examination revealed middle-sized granulomatous keratic precipitates and a severe anterior chamber reaction. Fundus examination was normal. As there were red papules all over the body she was diagnosed as anterior uveitis secondary to chickenpox and systemic/ topical acyclovir, topical steroid, antihistaminic suspension, isolation, and follow-up were recommended. On day 6, anterior chamber inflammation decreased remarkably, whereas a salt-pepper appearance was observed in the retina. On day 10, a perivascular sheathing was observed, which regressed after 1 month, and her medications were slowly tapered and discontinued. Although anterior uveitis is a common finding after chickenpox, the occurrence of three different involvements is very rare. (Turk J Ophthalmol 2013; 43: 358-61

Spectral Domain Optical Coherence Tomography Findings in Posterior Microphthalmia

The retinal spectral domain optical coherence tomography (SD-OCT) findings of two posterior microphthalmia cases are presented in this case report. For this purpose, the findings of two siblings aged five and seven years who presented to our clinic with the complain of far-sightedness and high hypermetropia were evaluated. Both cases diagnosed to have posterior microphthalmia demonstrated normal biomicroscopic anterior segment examination and gonioscopy findings and the axial lengths were measured to be shorter than 17mm. The SD-OCT analysis of papillomacular folds detected in fundus examination revealed contribution of only neurosensorial retina. Beneath the retinal fold, we observed bilateral cysts in the intraretinal area in one of the cases and a triangle-shaped hyporeflective space with an apex corresponding to that of the retinal fold in the subretinal area in both cases. SD-OCT is an adjunctive imaging tool for diagnosis and follow-up of degenerative changes in posterior microphthalmia. These changes may be also important for visual prognosis. (Turk J Ophthalmol 2014; 44: 240-2

Kaza ile nd:YAG lazer sonrası gelişen maküler deliğin spontan kapanması

Neodymium:yttrium aluminum garnet (Nd:YAG) lazerin yol açtığı maküler deliklerin seyri, bu tip kazaların ender olmasın- dan dolayı bilinmemektedir. Kaza ile Nd:YAG lazer hasarına bağlı maküler delik tanısı alan 47 yaşında erkek fizik uzmanı takibe alındı. Maküler deliğin boyutu azaldı ve vitre hemorajisi çekildi. Kaza ile yüksek enerjili Nd:YAG lazere maruz kalın- ması, retinada ciddi hasarlara neden olabilir. Ancak, lazere bağlı gelişen bu maküler delikler spontan kapanabilir. Lazere bağlı maküla hasarında, doğal seyri etkileyen en sık bulgular epiretinal membranın varlığı ve maküler deliğin boyutudur.The natural history of Neodymium:yttrium aluminum garnet (Nd:YAG) laser-induced macular holes remains uncertain because this type of injury is uncommon. A 47 years old male physicist with the diagnosis of macular hole induced by ac- cidental Nd:YAG laser injury was followed-up. The size of the macular hole decreased and vitreous hemorrhage resolved spontaneously. Accidental exposure to high-energy Nd:YAG laser may lead to concussive retinal damage and create a macu- lar hole. Laser-induced macular holes can resolve spontaneously. The presence of an epiretinal membrane and the size of the macular hole are the common ocular signs that seem to affect the natural course of laser-induced macular holes