Comparing techniques for pterygium surgery

Atilla Alpay, Suat Hayri Ugurbas, Berktug ErdoganDepartment of Ophthalmology, Faculty of Medicine, Zonguldak, Karaelmas University, Zonguldak, TurkeyPurpose: To compare various techniques of pterygium surgery including bare sclera, intraoperative mitomycin C application, conjunctival flap reconstruction, and conjunctival autografting technique.Methods: This study is designed to compare 4 currently used techniques in order to determine the complication and recurrence rates after pterygium exision. Included in the study were 77 eyes from 60 patients. Bare sclera technique was used to treat 21 primary pterygia; mitomycin C was used to treat 20 (16 primary, 4 recurrent) pterygia; 18 (17 primary, 1 recurrent) pterygia were treated by conjuntival flap reconstruction; and 18 (9 primary, 9 recurrent) pterygia were treated by conjunctival autografting technique. All patients who underwent surgery were followed up for between 6 months and 2 years.Results: Eight recurrences (38.09%) were observed in the bare sclera group whereas there were 5 (25%) recurrences in the mitomycin C group. In the conjunctival flap reconstruction group, 6 (33.33%) recurrences were detected. In the conjunctival autografting group, 3 recurrences were  observed. There were no major complications threatening visual ability in the surgical patients.Conclusion: A comparison of the groups demonstrated that the recurrence rate was highest in the bare sclera group, and lowest in conjunctival autografting and mitomycin C treatment groups respectively. Although the conjunctival autografting technique is a more difficult and time consuming technique than the others, cosmetic and surgical results were found to be superior. We advise conjunctival autografting for the treatment of pterygium in view of the high recurrence rates of other techniques, and the possible complications of mitomycin C treatment for benign disease.Keywords: pterygium, comparing, techniques, mitomycin

Bir elektronik tıbbi kayıt sistemi değerlendirmesi : Zonguldak Karaelmas Üniversitesi Hastanesi anketi

The present study investigated the electronic medical record system (EMR) of Zonguldak Karaelmas University Hospital which is used for six years now. The advantages and disadvantages of an EMR system in comparison with paper medical records were evaluated based on the user’s opinion. The recommendations for the development of EMR and more efficient use of the system are principle goals of this study. The purposes of this thesis include promoting the implantation of EMR by introducing the advantages and disadvantages from the user’s point of view. The main source of information used in this analysis is gathered from a questionnaire. Hundred and twenty six users of EMR selected voluntarily and randomly from the hospital staffs are included in this survey. The hospital staffs including physicians, nurses, clinicians, administrative clerks and technicians were included in this survey. Implementation for certain medical tasks and efficiency of using these tasks in EMR are evaluated. The advantages and disadvantages of the system were surveyed from the user's point of view. In spite of the fact that health care professionals understand the benefits of electronic medical records, barriers to the use of EMR are also important for the current impediments in EMR introduction. While the successful applications of EMR systems are evident in western word, the implementation of EMR to a hospital information system is a new topic in Turkey. There are mainly attempts to convert the paper-based medical record systems to the fully automated electronic record systems. Our study is a pioneering attempt to analyze the users’ opinion for a fully integrated EMR system in a Turkish academic hospital. The suggestions such as restricting the the access, improving the hardware, integrating to the internet are made for the improvement of the system in future.M.S. - Master of Scienc

Floppy-iris syndrome

Gevşek iris sendromu (GİS), fako tekniği ile yapılan katarakt ameliyatı sırasında görülen anormal pupil davranışı ile tanımlanan bir durumdur. Bu sendromun üç anahtar özelliği bulunmaktadır. Bunlar gevşek irisin normal sıvı akışı sırasında anormal dalgalanma göstermesi, irisin fako ve yan kesiye prolapsus eğilimi ve ameliyat sırasında ilerleyici pupiller miyozis gelişmesidir. Bu özellikler ameliyatın daha yorucu ve komplikasyonlara açık olmasına neden olmaktadır. Bu makalede GİS’nun özellikleri ve sebep olan etkenler tartışılıp, alınması gereken önlemler üzerinde durulmuşturFloppy-iris syndrome (FIS) is a condition defined as abnormal pupil behaviour during cataract surgery using the phacoemulsification technique. There are three key features of this syndrome: a floppy iris that undulates abnormally during normal fluid movement, propensity of the iris to prolapse towards the phaco and side-port incision, and development of progressive pupillary miosis during surgery. These features make the operation more tiresome and complications more likely. In this article the features and causative factors of IFIS are discussed and preventive measures that must be taken are mentione

Conjunctival Dermolipomas: Surgical Results

Amaç: Cerrahi uygulanan konjonktival dermolipoma olgularının tanı, cerrahi tedavi ve sonuçlarının değerlendirilmesi.Gereç ve Yöntem: Göz kapak aralığında kitle nedeniyle 2012-2014 yılları arasında hastanemize başvuran ve cerrahi eksizyon önerilen konjonktival dermolipoma olguları retrospektif olarak incelendi. Yaş, cinsiyet, başvuru şikayeti, klinik bulgular, uygulanan cerrahi ve komplikasyonlar analiz edildi. Bulgular: Yaşları 2 ile 56 arasında değişen hastaların dördü erkek, ikisi kadın idi. Dermolipoma beş hastada temporal yerleşimli iken birhastada süperotemporal yerleşimli idi. Olguların biri hariç hepsinde lezyon tek taraflı idi. İritasyon nedeniyle cerrahi uygulanan 2 olgu haricinde diğer olgulara estetik nedeniyle cerrahi uygulandı. Olguların 2 yıllık takiplerinde herhangi bir nüks ile karşılaşılmadı.Sonuç: Konjonktival kitleler değerlendirilirken dermolipoma da ayırıcı tanılar arasında yer almalıdır. Cerrahiye karar verildiğinde ise lezyonun tamamen çıkarılmasına çalışmaktan ziyade subtotal eksizyon tercih edilmesi komplikasyon oranlarını azaltırken, kabul edilebilir sonuçlar elde etmekte yeterli olacaktır.Objective: To evaluate the results of surgical treatment of conjunctival dermolipoma cases. Materials and Method: The data of the patients diagnosed with conjunctival dermolipoma at our hospital between 2012 and 2014 were retrospectively evaluated. Age, sex, presenting complaint, clinical findings, type of surgeries and complications were recorded. Results: Of the patients 4 were male and 2 were female, ages ranged from 2-56. In 5 patients dermolipoma was located temporally while in 1 patient it was located superotemporally. Of the 6 cases 5 were unilateral. Four patients had undergone surgery due to aesthetic reasons whereas 2 patients had undergone surgery for irritation. In the 2 year follow up period there were no case of recurrence. Conclusion: Conjunctival dermolipoma should be considered in the differential diagnosis when evaluating conjunctival masses. If the surgery is decided to perform, subtotal excision should be preferred in order not to encounter complications with relatively good results

Long-Term Effect of Botulinum Toxin in the Treatment of Benign Essential Blepharospasm and Hemifacial Spasm

Objectives: In this study, we evaluated the long-term effects of botulinum toxin A (BTA) in patients diagnosed with benign essential blepharospasm (BEB) and hemifacial spasm (HFS) comparing the drug dose in early and late periods and mean duration of relief. Materials and Methods: The records of patients who were treated with BTA for BEB and HFS were analyzed retrospectively. The patients who had <10 injections and did not attend the follow-up examinations were excluded from the study. The first and last 5 injection doses and the mean duration of relief in 12 patients were compared between the groups. Results: Of the 12 patients, 6 (4 females, 2 males) had treatment for BEB and 6 (5 females, 1 male) for HFS. The mean follow-up was 66.17 months for all patients, 51.83 months in the BEB group and 90.33 months in the HFS group. Average treatment dose was 40.79 U for BEB group and 29.07 U for HFS group. Mean duration of relief time was 16.1 weeks after the first 5 injections and 18.9 weeks after the last 5 injections (p=0.172). In HFS group, mean duration of relief time was 23.6 weeks after the first 5 injections and 23.0 weeks after the last 5 injections (p=0.463). In BEB group, mean duration of relief after the last 5 injections was increased by 2.7 weeks compared with the first 5 injections. Conclusion: BTA injection is a safe and effective method in the treatment of BEB and HFS. With similar injection doses in long-term, the mean duration of relief time after treatment was unchanged in the HFS group and was increased in the BEB group, although the difference was not statistically significant. (Turk J Ophthalmol 2015; 45: 9-13

Long-term effect of botulinum toxin in the treatment of benign essential blepharospasm and hemifacial spasm

Amaç: Bu çalışmada kliniğimizde uzun süreli botulinum toksin A (BTA) enjeksiyonu uyguladığımız benign esansiyel blefarospazm (BEB) ve hemifasiyal (HFS) spazm tanılı hastalarda erken ve geç dönem ilaç dozları ile iyilik süreleri karşılaştırıldı. Ge­reç ve Yön­tem: BEB ve HFS tanısı nedeniyle BTA tedavisi alan hastaların kayıtları geriye dönük olarak incelendi. On enjeksiyon ve üstü tedavi alan, düzenli takipli 12 hasta çalışmaya dahil edildi. İlk 5 enjeksiyon ve son 5 enjeksiyon dozları ile iyilik süreleri karşılaştırıldı. Bulgular: On iki hastanın 6’sı BEB (4 kadın, 2 erkek), 6’sı ise HFS (5 kadın, 1 erkek) nedeniyle tedavi almıştı. Hastaların ortalama takip süresi tüm hastalarda 66,17 ay, BEB grubunda 51,83 ay, HFS grubunda ise 90,33 ay idi. Ortalama tedavi dozu BEB grubunda 40,79 U, HFS grubunda 29,07 U idi. Tedavi sonrası iyilik süreleri değerlendirildiğinde, BEB grubunda ilk 5 enjeksiyon sonrası iyilik süreleri ortalaması 16,1 hafta iken, son 5 enjeksiyon sonrası ortalama iyilik süresi 18,9 hafta idi (p=0,172). HFS grubunda ise ilk 5 enjeksiyon sonrası iyilik süresi 23,6 hafta iken son 5 enjeksiyon sonrası iyilik süresi 23,0 hafta idi (p=0,463). BEB grubunda son 5 enjeksiyon sonrası iyilik süresinde, ilk 5 enjeksiyon sonrası iyilik süresine göre 2,7 hafta artış saptandı. Sonuç: BTA enjeksiyonu BEB ve HFS hastaları için güvenli, etkili bir tedavi yöntemidir. Enjeksiyon dozları uzun dönemde değişmemekle beraber tedavi sonrası iyilik süresi HFS grubunda değişmemişken, BEB hastalarında istatistiksel olarak anlamlı olmasa da iyilik süresinde uzama olmuştur. (Turk J Ophthalmol 2015; 45: 9-13)Objectives: In this study, we evaluated the long-term effects of botulinum toxin A (BTA) in patients diagnosed with benign essential blepharospasm (BEB) and hemifacial spasm (HFS) comparing the drug dose in early and late periods and mean duration of relief. Ma&shy;te&shy;ri&shy;als and Met&shy;hods: The records of patients who were treated with BTA for BEB and HFS were analyzed retrospectively. The patients who had <10 injections and did not attend the follow-up examinations were excluded from the study. The first and last 5 injection doses and the mean duration of relief in 12 patients were compared between the groups. Re&shy;sults: Of the 12 patients, 6 (4 females, 2 males) had treatment for BEB and 6 (5 females, 1 male) for HFS. The mean follow-up was 66.17 months for all patients, 51.83 months in the BEB group and 90.33 months in the HFS group. Average treatment dose was 40.79 U for BEB group and 29.07 U for HFS group. Mean duration of relief time was 16.1 weeks after the first 5 injections and 18.9 weeks after the last 5 injections (p=0.172). In HFS group, mean duration of relief time was 23.6 weeks after the first 5 injections and 23.0 weeks after the last 5 injections (p=0.463). In BEB group, mean duration of relief after the last 5 injections was increased by 2.7 weeks compared with the first 5 injections. Conclusion: BTA injection is a safe and effective method in the treatment of BEB and HFS. With similar injection doses in long-term, the mean duration of relief time after treatment was unchanged in the HFS group and was increased in the BEB group, although the difference was not statistically significant. (Turk J Ophthalmol 2015; 45: 9-13

Eye injuries at a tertiary health center in the west Black Sea region, Turkey

AMAÇ Türkiye’nin Batı Karadeniz bölgesindeki göz yaralanmalarının klinik özelliklerini ve görsel prognozunu belirlemek, ulusal istatistiklere veri oluşturmaktır. GEREÇ VE YÖNTEM Zonguldak Karaelmas Üniversitesi Hastanesi Acil Servisi’ne 2001-2010 yılları arasında başvuran 281 göz yaralanması olgusu geriye dönük olarak incelendi. BULGULAR Göz yaralanmalarının büyük kısmı (%42,7) 30-50 yaşları arasında meydana gelmişti. Yaralanmaların en sık (%28,8) nedeni kırsal alanda ahşap kaynaklı maddelerle yaralanmalar iken, 30-50 yaş arası erkeklerde en sık neden işyeri yaralanmalarıydı. Kornea-skleral kesiler ilk ve son görme keskinliği açısından en ciddi yaralanma olarak belirlendi. SONUÇ Göz yaralanmaları hala sık ve önlenebilir bir körlük sebebidir. Alınacak basit tedbirler ve halkın eğitimi sayesinde iş gücü kaybı, ekonomik kayıp ve psikolojik sorunlara yol açan bu önemli problemin önüne geçilebilir. Trafikte emniyet kemeri takılması, iş yerlerinde ve kırsal alanda çalışırken koruyucu gözlük takılması konusunda halkın bilinçlendirilmesi alınacak tedbirlerin başında gelmektedir.BACKGROUND We aimed to investigate the clinical aspects and visual prognosis in eye injury and to constitute data in the west Black Sea region in Turkey for national statistics. METHODS A retrospective analysis of 281 eye trauma cases admitted to the Emergency Department of Zonguldak Karaelmas University Hospital between 2001 and 2010 was performed. RESULTS A majority of eye injuries (42.7%) affected individuals aged 30 to 50 years. The most frequent cause of injury in the rural areas was wooden objects. The most frequent cause of injury in males aged 30 to 50 years was work-site injuries. Corneal-scleral lacerations were found to be the most serious injuries with regard to initial and final visual acuities. CONCLUSION Eye injuries are still the most common and preventable cause of blindness. Simple precautions and public education might prevent this health problem, which causes economic and labor force loss and psychological problems. One of the basic precautions would be raising public awareness on wearing a seat belt inside the car and protective eyeglasses at the work site and while working in rural areas

Tear function and ocular surface after muller muscle-conjunctival resection

Muller muscle-conjunctival resection (MCR) is a surgical technique to correct mild and moderate ptosis. In this study, tear function tests and ocular surface are evaluated in patients who underwent unilateral surgery. Sixteen patients with normal preoperative tear function who underwent unilateral MCR were evaluated prospectively. The fellow eyes of the patients were taken as the control group. A dry eye assessment questionnaire, Schirmer testing, tear film break-up time, fluorescein stain, Rose-Bengal stain, and conjunctival impression cytology were used to assess the tear film functions and ocular surface changes in the operated and non-operated eyes. There was no statistically significant difference in the tear function tests and goblet cell densities between the operated and non-operated eyes. The results indicate that an MCR procedure has no apparent effect on tear function tests and goblet cell density in patients with normal preoperative tear function

Bir elektronik tıbbi kayıt sistemi değerlendirmesi: Zonguldak Karaelmas Üniversitesi hastanesi anketi

Bu çalışma Zonguldak Karaelmas Üniversitesi Hastanesinde altı yıldır kullanılmakta olan elektronik tıbbi kayıt sistemini incelemektedir. Bu çalışmanın temel amacı, elektronik tıbbi kayıt sisteminin geliştirilmesi ve daha verimli kullanımı için önerilerde bulunmaktır. Kullanıcı görüşüne göre avantaj ve dezavantajlarını ortaya koyarak elektronik tıbbi kayıt sisteminin yaygınlaştırılmasını desteklemek bu çalışmanın amaçları arasında yer almaktadır. Batı dünyasında başarılı elektronik tıbbi kayıt sistemi uygulamaları yerleşmekteyken elektronik tıbbi kayıtların bir hastane enformasyon sistemine uyarlanması Türkiye için yeni bir konudur. Uygulamalar genel olarak kâğıt kayıt sistemlerinin tam elektronik tıbbi kayıt sistemlerine dönüştürülmesi olmaktadır. Bu araştırma akademik bir hastanede tam otomatik bir elektronik kayıt sistemi için kullanıcıların görüşlerini inceleyen öncü bir çalışmadır. Sistemin gelecekte daha da iyileştirilmesi için erişimin kısıtlanması, donanımın güçlendirilmesi, internete açılım sağlanması gibi öneriler ortaya konulmaktadır.This study investigated the electronic medical record system (EMR) of Zonguldak Karaelmas University Hospital which is in use for the last six years. The recommendations for the development of EMR and more efficient use of the system are principle goal of this study. The purposes of this study include promoting the implementation of EMR by introducing the advantages and disadvantages from the user&amp;#8217;s point of view. While the successful applications of EMR systems are evident in western word, the implementation of EMR to a hospital information system is a new topic in Turkey. Some applications are mainly in the form of converting the paper-based medical record systems to the fully automated electronic record systems. Our study is a pioneering attempt to analyze the users&amp;#8217; opinion for a fully integrated EMR system in a Turkish academic hospital. The suggestions such as restricting the access, improving the hardware, integrating to the internet are made for the improvement of the system in future

Outcomes of primary pars plana vitrectomy in patients with retinal detachment

Amaç: Yırtıklı ve traksiyonel retina dekolmanı tedavisinde, primer pars plana vitrektomi (PPV) ve internal tamponad uygulanan hastaların cerrahi sonuçlarını değerlendirmek. Gereç ve Yöntem: Ocak 2010-Haziran 2012 tarihleri arasında retina dekolmanı tanısıyla opere olan 60 hastanın 62 gözü retrospektif olarak incelendi. Olguların ameliyat öncesi ve sonrası görme keskinlikleri, ön ve arka segment muayene bulguları ile ameliyat sonrasındaki erken ve geç dönem komplikasyonları irdelendi. Bulgular: Hastaların yaş ortalaması 58,15±13,38 yıldı. Olguların 36’sı (%60) erkek, 24’ü (%40) kadındı. Traksiyonel retina dekolmanı oranı %61,2, regmatojen retina dekolmanı %38,8’di. Olguların %82,3’ünde anatomik, %51,6’sında fonksiyonel başarı sağlandı. Erken dönemdeki en sık komplikasyon pupilla alanında membran (%23,3) ve ön kamarada silikon kabarcığı (%8,6) idi. Geç dönemde en sık katarakt (%25,8) görülmüştür. Sonuç: Primer PPV ve göz içi tamponad uygulaması retina dekolmanı olgular için uygun olup, anatomik ve fonksiyonel düzelme sağlamaktadır.Aim: Our aim was to present our primary pars plana vitrectomy (PPV) with internal tamponade surgical results in retinal detachment patients. Material and Method: Sixty-two eyes of 60 patients, who underwent PPV with internal tamponades in Bulent Ecevit University Hospital between January 2010 and June 2012. Patients preoperative visual acuity, lens status, fundus examination, early and late surgical complications were reviewed retrospectively. Results: The mean ages of patients was 58.15±13.38 years. There was a 36 male (60%) and 24 female (40%) patients. The retinal detachment cases of 61.2% had tractional retinal detachment and 38.8 percent had rhegmatogen retinal detachment. The anatomic success rate was 82.3% and functional success rate was 51.6 percent. Pupillary membran (23.3%) and silicon oil in the anterior chamber (8.6%) were the common early complications in the patients. The most common late postoperative complication was cataract (25.8%). Conclusion: Pars plana vitrectomy with internal tamponades is effective and improved anatomic and functional success in retinal detachment patients