Development of ocular hypertension and persistent glaucoma after intravitreal injection of triamcinolone

M Selim Kocabora, Cemil Yilmazli, Muhittin Taskapili, Gokhan Gulkilik, Sahan DurmazVakif Gureba Education and Research Hospital, Istanbul, TurkeyPurpose: This study evaluates intraocular pressure (IOP) elevation secondary to intravitreal injection of triamcinolone acetonide (IVTA) and discusses its management.Methods: The records of 175 patients who underwent IVTA treatment and regular eye examinations in the period 2003–2006 were reviewed. One hundred and twenty-two of these patients were included in the study, of which 147 eyes that received IVTA (4 mg/0.1 ml) were followed for at least 9 months. Mean IOPs observed after IVTA injection as well as IOP elevations defined as moderate (≥5 mm Hg), important (≥10 mm Hg) and severe (>25 mm Hg) during the follow-up period were evaluated and compared statistically.Results: Overall, the mean IOPs following IVTA injection were statistically significantly higher than the preinjection IOP (15.8 ± 2.6), after the first hour (17.7 ± 2.9), the first week (18.7 ± 4.1), the first month (19.6 ± 6.2), the second month (19.1 ± 6.1), the third month (18.0 ± 4.1), the sixth month (17.3 ± 4.0), and the ninth month (17.0 ± 2.7), but not after the first day (16.3 ± 7.6). Important IOP elevations were observed mostly in the first (17.7%) and second months (10.2%). In 40 (27.7%) eyes, topical antiglaucomatous therapy was needed and 7 later required surgical intervention to lower the IOP. Of the remaining 33 eyes, topical treatment was continued in 14 (9.5%) because of IOPs ≥20 mm Hg.Conclusion: The persistence of IOP elevation beyond the IVTA clearance period and the development of intractable secondary glaucoma requiring surgical intervention substantiate the need for careful consideration of IVTA indication and follow-up.Keywords: intravitreal triamcinolone, intraocular pressure, steroid-induced glaucom

Açık açılı glokom tedavisinde ab interno jel implant kısa dönem sonuçlarının retrospektif incelenmesi

Aim: To evaluate the intraocular pressure (IOP) lowering and safety profiles of the Xen45 Gel Stent implantation with preoperative Mitomycin C injection during a 6 months follow-up in patients with primary open-angle glaucoma (POAG). Material and Methods: Records of fourteen eyes of 13 POAG patients who underwent surgery with XEN45 Gel Stent combined with phacoemulsification were evaluated retrospectively. IOP changes, all complications and additional procedures during follow-up period were evaluated. Primary outcome measure was IOP, and the IOP target for complete success was defined as a postoperative IOP drop of more than 20% from preoperative baseline and IOP≥6 and ≤21 at 6 months without any glaucoma medications and qualified success was defined as a postoperative IOP reduction of more than 20% and IOP≥6 and ≤21 at 6 months with or without medications. Results: Mean preoperative medicated IOP was 28.4 ± 2.7 mmHg with a mean of 2.6 ± 0.6 topical anti- glaucoma molecules. After 6 month follow-up period, mean IOP decreased to 17.8 ± 1.5 mmHg (mean IOP reduction of 37%) on 0.4 ± 1.1 antiglaucoma molecules. The complete success rate after 6 months was achieved in 42.8% and qualified success in 85.7. Totally only 2 (14.2%) patients required additional procedure (1 needling and 1 trabeculectomy). Conclusion: The study showed that the XEN45 Gel Stent implantation combined with phaco-cataract surgery is an effective surgical method in POAG in case of uncontrolled IOP with a favorable safety profile and low complication rate.Amaç: Primer açık açılı glokom (PAAG) hastalarında 6 aylık takip sırasında preoperatif Mitomycin C enjeksiyonu ile Xen45 Jel Stent implantasyonunun göz içi basıncını(GİB) düşürme ve güvenlik profillerini değerlendirmek. Gereç ve Yöntemler: Fakoemülsifikasyon ile kombine XEN45 Jel Stent ile ameliyat edilen 13 PAAG hastasının 14 gözünün kayıtları retrospektif olarak değerlendirildi. Takip süresince GİB değişiklikleri, tüm komplikasyonlar ve ek işlemler değerlendirildi. Çalışmada birincil değerlendirilen sonuç GİB idi. Tam başarı için belirlenen GİB hedefi ameliyat öncesine göre %20’nin üzerinde bir düşüş ve herhangi bir glokom ilacı olmaksızın 6. ayda GİB≥6 ve ≤21 olarak tanımlandı. Yeterli başarı ise ilaçlı veya ilaçsız olarak 6. ayda GİB’de %20’den fazla azalma ve GİB≥6 ve ≤21 olarak tanımlandı. Bulgular: Ortalama preoperatif ilaçlı GİB, ortalama 2,6 ± 0,6 topikal anti-glokom molekülü ile beraber 28,4 ± 2,7 mmHg idi. Altı aylık takip süresinden sonra ortalama GİB, 0,4 ± 1,1 anti-glokom molekülü ile beraber 17,8 ± 1,5 mmHg’ye (ortalama GİB düşüşü %37) düştü. 6 ay sonra tam başarı oranı %42,8 ve yeterli başarı oranı %85,7 olarak bulundu. Toplamda sadece 2 hastaya (%14,2) ek işlem (1 iğneleme ve 1 trabekülektomi) gerekti. Sonuç: Çalışma, fako-katarakt cerrahisi ile kombine XEN45 Jel Stent implantasyonunun, kontrolsüz GİB durumunda olumlu güvenlik profili ve düşük komplikasyon oranı ile PAAG’da etkili bir cerrahi yöntem olabileceğini göstermiştir

Primer psödofakik retina dekolmanı cerrahisi sonuçlarının değerlendirilmesi

Objective: To evaluate the results of pars plana vitrectomy (PPV) alone and combined with circumferential scleral buckling (CSB) surgeries for aphakic or pseudophakic rhegmatogenous retinal detachment (RRD). Materials and Methods: Thirty-seven eyes of 37 patients who underwent PPV (20 and 23 Gauge) alone or PPV combined with CSB due to pseudophakic or aphakic primary RRD were included in the study. Postoperative anatomical success (AS) and functional success (FS) were evaluated. The AS was defined as a completely flattened retina without any subretinal fluids after the removal of the silicone oil tamponade, if used. The FS was defined as two or more decimal improvements in the logMAR equivalent of Snellen visual acuity. Results: The mean age of the patients was 62.43 +/- 11.40 (32-80) years, 21 (56.8%) patients were male, and 16 (43.2%) were female. The mean follow-up time was 21.35 +/- 16.86 (6-84) months. PPV combined with CSB were performed in 23 patients. AS was found to be 86.5% (32/37), FS was 49.9% (17/37). No statistically significant difference was observed in both AS and FS between the groups according to preoperative PVR presence (AS-p=0.61, FS-p=0.14), preoperative macular involvement (AS-p=0.98, FS-p=0.36), whether PPV combined with CSB (AS-p=0.97, FS p=0.29), and the type of tamponade (p>0.05 in all). Conclusion: PPV with or without CSB is safe and effective in cases with primary pseudophakic retinal detachment and achieves good AS without being affected by the presence of PVR or macular involvement. However, functional success may not always follow.Amaç: Afakik veya psödofakik regmatojen retina dekolmanı (RRD) için tek başına pars plana vitrektomi (PPV) ve çevresel skleral çökertme (ÇSÇ) ile kombine ameliyatların sonuçlarını değerlendirmek. Gereç ve Yöntem: Psödofakik veya afakik primer RRD’ye nedeniyle tek başına veya ÇSÇ ile kombine PPV (20 ve 23 Gauge) uygulanan 37 hastanın 37 gözü çalışmaya dahil edildi. Postoperatif anatomik başarı (AB) ve fonksiyonel başarı (FB) değerlendirildi. AB, eğer kullanılmışsa silikon yağı tamponadının çıkarılmasından sonra hiç subretinal sıvının olmadığı tamamen yatışmış retina olarak tanımlandı. Ayrıca FB, Snellen görme keskinliğinin logMAR eşdeğerinde iki veya daha fazla ondalık artış olarak tanımlandı. Bulgular: Hastaların ortalama yaşı 62,43±11,40 (32-80) yıl, 21’i (%56,8) erkek, 16’sı (%43,2) kadındı. Ortalama takip süresi 21,35±16,86 (6-84) aydı. 23 hastaya ÇSÇ ile kombine PPV uygulandı. AB %86,5 (32/37), FB %49,9 (17/37) olarak bulundu. Hem AB ile hem de FB ile; preoperatif PVR varlığı (AB-p=0,61, FB-p=0,14), preoperartif maküla tutulumu (AB-p=0,98, FB-p=0,36), PPV’nin ÇSÇ ile kombine olup olmaması (AB-p=0,97, FB-p=0,29), ve kullanılan tamponad tipi (tümü p>0,05) gibi durumlara göre oluşturulan gruplar arasında istatistiksel olarak anlamlı bir fark gözlenmedi. Sonuç: Primer psödofakik retina dekolmanı olan olgularda PPV yalnız veya ÇSÇ ile kombine olarak uygulandığında, maküla tutulumundan veya PVR varlığından etkilenmeden iyi AB ulaşmak için etkili ve güvenlidir. Bununla birlikte, fonksiyonel başarı her zaman eşlik etmeyebilir

Intraoperative and early postoperative flap-related complications of laser in situ keratomileusis using two types of Moria microkeratomes

WOS: 000341838700012PubMed ID: 24531872The purpose of this study is to describe the incidence, management, and visual outcomes of intraoperative and early postoperative flap-related complications of laser in situ keratomileusis (LASIK) surgery using two types of Moria M2 microkeratomes. This retrospective analysis was performed on 806 primary LASIK cases. The intraoperative and early postoperative flap-related complications were identified and categorized according to type of Moria microkeratome. There were 52 intraoperative and early postoperative complications-one case of partial flap (0.124 %), one case of free flap (0.124 %), one case of small flap (0.124 %), 13 cases of epithelial defect (1.61 %), 12 cases of flap striae (1.49 %), 10 cases of diffuse lamellar keratitis (1.24 %), 10 cases of interface debris (1.24 %), three cases of epithelial ingrowth (0.37 %), and one case of microbial infection (0.124 %). The overall incidence of flap complications was 6.45 %. There were 27 right eye (6.73 %) and 25 left eye (6.17 %) complications. The incidence of complications with the Moria automated metallic head 130 microkeratome was 4.22 % and with the Moria single-use head 90 microkeratome was 2.23 %. We observed one culture-negative interface abscess which was cured with surgical cleaning and intensive medical treatment. The most common complication encountered was epithelial defects, followed by flap striae. Our study showed that LASIK with a microkeratome has a relatively low incidence of intraoperative and early postoperative flap complications. The authors have no financial interest in any of the issues contained in this article and have no proprietary interest in the development of marketing of or materials used in this study

Measurement of intraocular pressure with applanation, dynamic contour, and air-puff tonometers: A comparative study in primary open-angle glaucoma and healthy cases

Objectives: This study aimed to investigate and compare the reliability of Goldmann applanation tonometer (GAT), dynamic contour (DCT), and noncontact (NCT) tonometers in intraocular pressure (IOP) measurement and the affecting parameters in healthy subjects and cases with primary open-angle glaucoma (POAG). Methods: Left eyes of 64 cases (32 males and 32 females) were selected for this prospective, controlled study. Of these cases, 33 had POAG, and 31 were selected as control. IOP measurement was performed using NCT, DCT, and GAT consecutively for each patient, and then central corneal thickness (CCT) was measured. Ocular pulse amplitude (OPA) and all values were recorded. Results: The mean age was 53.36±10 years (31–80 years), and CCT was 561±45 μ. IOP was found as 16.39±3.75 mmHg with GAT, 17.89±3.55 mmHg with DCT, and 15.76±3.49 mmHg with NCT. A significant difference was found between DCT with NCT and GAT. Whereas, a positive correlation was found between CCT with all the three methods used, with DCT as the weakest. While the correlation between all the three methods was excellent, the strongest was found to be between DCT and GAT. Thick corneas affected all the three methods, but DCT was the least affected. While DCT tends to measure higher than both GAT and NCT, this difference decreased as the corneal thickness increased. OPA was found to be 2.56±1.04 mmHg; no statistical difference was found between the groups. A correlation was found between OPA and IOP, and OPA was found to be significantly higher in women. Conclusion: DCT is minimally affected by corneal factors, especially in thin corneas, and shows excellent correlation with GAT. This new-generation digital tonometer can be used safely in glaucoma diagnosis and follow-u

Laceration of lacrimal sac by a sharp metallic body

1- M.Selim Kocabora, KT Özbilen, K.Fazıl Laceration of lacrimal sac by a sharp metallic body. 9. Congress of the International Society of Dacriology and Dry eye. 16-18 May, 2008, Istanbul S:68 (Poster

Predicting the refractive outcome and accuracy of IOL power calculation after phacoemulsification using the SRK/T formula with ultrasound biometry in medium axial lengths

WOS: 000403959400001PubMed ID: 28670106Purpose: To evaluate the accuracy of the SRK/T formula using ultrasound (US) biometry in predicting a target postoperative refraction of +/- 1.00D in eyes with medium axial length (AL) that underwent phacoemulsification. Methods: The present study was a retrospective analysis, which included 538 eyes with an AL from 22.0 to 24.60 mm that underwent phacoemulsification and foldable intraocular lens (IOL) implantation (six different IOLs) in the bag. Preoperative AL was measured by US biometry and IOL power (IOLp) was calculated with the SRK/T formula. Patients had a complete ophthalmic examination, preoperatively and 1, 7, and 30 days after surgery. The achieved spherical equivalent (SE) and the prediction error (PE) were calculated. The prediction error was defined as the difference between attempted predicted target refraction and the achieved postoperative SE refraction. Statistical analysis was performed with SPSS V21. Results: The mean age of the patients was 66.96 +/- 9.67 years, the mean AL was 23.29 +/- 0.62 mm, the mean K1 was 43.62 +/- 1.49D, the mean K2 was 43.69 +/- 1.53D, the mean IOL power was 21.066 +/- 1.464D, the mean attempted (predicted) SE was -0.178 +/- 0.266D, and the mean achieved SE was -0.252 +/- 0.562D. The mean PE (difference between predicted and achieved SE) showed a relatively hyperopic shift (mean +/- standard deviation: 0.074 +/- 0.542D, ranging from -1.855 to 2.170D, P=0.001). A total of 93.87% of eyes were within +/- 1.00D of the PE and 92.75% of eyes within +/- 1.00D of achieved postoperative refraction. A total of 39 eyes (7.25%) had a refractive surprise. A total of 32 of 39 eyes were more myopic than -1.00D and 7 of them were more hypermetropic than +1.00D. There was no correlation between the mean PE and IOL type, AL, K1, K2, and IOLp. There were a positive statistically significant correlation between PE and age (r=0.095; P=0.028) and a negative statistically significant correlation between achieved SE and AL (Spearmans r=-0.125; P=0.04), and age (r=-0.141; P=0.01). Conclusion: The IOLp calculation using the SRK/T formula with US biometry may demonstrate very good postoperative refractive outcomes in medium eyes with a few refractive surprises

Bilateral Choroidal Metastases Presenting as Acute Glaucoma Crisis

We report a case of bilateral choroidal metastasis presenting with acute unilateral glaucoma. Primary tumor was found in the lung and choroidal masses in both eyes. Anterior segment neovascularization causing intraocular pressure elevation was the only presenting sign of metastatic choroidal tumor. A painful and hypertensive eye could be symptoms of choroidal metastasis even if no systemic malignancy is encountered

The significance of neutrophil-to-lymphocyte ratio in idiopathic epiretinal membrane

WOS: 000439166500005PubMed ID: 28608032To assess the levels of neutrophil-to-lymphocyte ratio (NLR) in patients with idiopathic epiretinal membrane (iERM) and to compare the NLR results of patients with iERM and healthy controls. This retrospective study enrolled 43 patients with iERM and 40 healthy subjects. Complete ophthalmologic examination and complete blood count measurements were performed of all subjects. Complete blood counts were performed within 2 h of blood collection. There was a significant difference in NLR between iERM and control groups (p <0.01). The receiver operating characteristics analysis revealed that the value of NLR to distinguish patients with iERM and controls was found to be 0.832. The best cutoff value was 1.90, with a sensitivity of 72% and specificity 70%. Our study for the first time provides evidence that subclinical systemic inflammation may cause or at least accompanies iERM using a novel biomarker NLR