ISSN: 2459 - 1777 | E-ISSN 2587-0394
Volume: 4
Issue: 2
Year: 2019
Beyoglu Eye J: 4 (2)
Volume: 4  Issue: 2 - 2019
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EXPERIMENTAL STUDY
1.Evaluation of Retinol Palmitate Treatment of Photokeratitis in Rat Eyes Exposed to Ultraviolet B Radiation
Mehmet Caner Filizay, Nesrin Büyüktortop Gökçınar, Varol Şahinturk, Setenay Öner, Sedat Kaçar, Zafer Onaran, Erhan Yumusak
doi: 10.14744/bej.2019.51523  Pages 55 - 61
INTRODUCTION: Acute exposure to ultraviolet B radiation can cause photokeratitis. Retinol palmitate (RP) is known to have antioxidant properties and improve corneal healing. The aim of this study was to evaluate the effect of topical RP against phototoxic keratitis in rats.
METHODS: A total of 14 male Wistar Albino rats were exposed to 1 J/cm2 dose of 311 nm ultraviolet B radiation. The subjects were then divided into 4 study groups using the right and left eye: The RP-5 group (n=7) received topical 250 IU/g RP ointment and the Sham-5 group (n=7) received only the vehicle base component of the ointment 5 minutes after the exposure. The RP-120 group (n=7) received topical RP and the Sham-120 group (n=7) received the vehicle alone 120 minutes after the exposure. The eyes were enucleated 24 hours after the exposure and stained with hematoxylin and eosin for histopathological examination and a terminal deoxynucleotidyl transferase dUTP nick end labeling assay to test for apoptosis.
RESULTS: There was no statistically significant difference between the mean corneal epithelial thickness of the RP-5 group and the Sham-5 group (p=0.369). Furthermore, there was no significant difference between the RP-120 and the Sham-120 groups (p=0.765). The timing of the administration of RP resulted in no significant difference in the mean corneal epithelial thickness (p=0.608). Apoptotic cell count scores were not significantly different between corneas that received RP and those who received only the vehicle (p=0.530, p=0.107).

DISCUSSION AND CONCLUSION: Topical administration of a single dose of RP was not superior to the use of the vehicle base alone in a photokeratitis model produced using 1 J/cm2 of narrowband ultraviolet radiation in rats.


ORIGINAL ARTICLE
2.An Analysis of Scheimpflug Holladay-Equivalent Keratometry Readings Following Corneal Collagen Cross-Linking
Ayhan Sağlık, Hakim Çelik, Mustafa Aksoy
doi: 10.14744/bej.2019.35220  Pages 62 - 68
INTRODUCTION: The aim of this research was to compare Holladay equivalent keratometry readings (EKR) and anterior corneal simulated keratometry (SimK) values in keratoconus cases following corneal collagen cross-linking (CXL) treatment.
METHODS: This study included 42 eyes of 30 patients with progressive keratoconus. Scheimpflug imaging was performed pre-CXL and at post-CXL months 6 and 12. The mean Holladay EKR and SimK measurements from 1mm to 7mm were compared and repeated variance analysis was performed.

RESULTS: The mean age of the patients was 18.93±3.82 years (range: 12-27 years). A reduction was observed in the EKR and SimK values at 6 and 12 months postoperatively compared with the preoperative values, but the difference was not statistically significant (p>0.05). In the mild keratoconus group, the keratometric measurements were lower after treatment. Similar measurements were obtained in the moderate and severe keratoconus groups before and after treatment. In 1 patient, there was an increase of >1 diopter in the maximum keratometry value. No complications developed that would lead to vision loss.
DISCUSSION AND CONCLUSION: Corneal collagen CXL treatment is known to be effective to a depth of two-thirds of the anterior corneal stroma. The results of this study showed that Holladay EKR measurements differed from SimK measurements, especially in cases of mild keratoconus. In addition to anterior corneal surface measurements, methods that can evaluate anterior and posterior surface curves could provide more accurate results in progression analysis.


3.Evaluation of Factors Affecting Epiretinal Membrane Surgery Outcomes
Burak Erden, Ziya Kapran
doi: 10.14744/bej.2019.25743  Pages 69 - 75
INTRODUCTION: The aim of this study was to evaluate several factors affecting the outcome of epiretinal membrane (ERM) surgery.
METHODS: The data of a total of 41 eyes of 40 patients (20 female, 20 male) who underwent pars plana vitrectomy (PPV) and epiretinal membrane (ERM) peeling with/without internal limiting membrane (ILM) peeling between November 2001 and October 2005 at Beyoğlu Eye Training and Research Hospital with a minimum follow-up of 6 months were included in this retrospective study. The patients' best corrected visual acuity (BCVA; Snellen) and the biomicroscopic, funduscopic, and optical coherence tomography (OCT) findings measured preoperatively and at month 1,3,6, and a final visit were recorded. The surgical technique (partial 25-gauge vs 20-gauge), ILM peeling, intraoperative dyes, and the etiology of the ERM were evaluated as separate factors in the surgical outcome. Intraoperative, peroperative, and postoperative complications were assessed and compared.
RESULTS: The mean age of the study group participants was 63.56±14.96 years. The mean BCVA had increased from 0.28±0.149 to 0.35±0.24 Snellen lines (p=0.028) at the 6-month visit. In all, 18 of 41 eyes (43.9%) had gained ≥2 Snellen lines at the final visit. Cataract progression was detected in 17 cases (54.8%) of phakic eyes. The incidence of ERM recurrence was significantly greater in the ILM Intact group (37% vs 0%) than in the ILM Peeled group (p=0.009). There was no significant difference in anatomical or functional outcome between the partial 25-gauge and 20-gauge PPV techniques.
DISCUSSION AND CONCLUSION: ILM peeling significantly reduced ERM recurrence. Follow-up observations indicated that cataract progression was the primary factor limiting visual gain.


4.The Optimal Cutoff Value of Neutrophil/Lymphocyte Ratio for Severe Grades of Diabetic Retinopathy
Çağrı İlhan, Mehmet Çıtırık, Mehmet Murat Uzel, Kemal Tekin
doi: 10.14744/bej.2019.85698  Pages 76 - 81
INTRODUCTION: The aim of this study was to define the optimal cutoff value of the neutrophil/lymphocyte ratio (NLR) to predict severe grades of diabetic retinopathy (DR).

METHODS: A total of 40 patients with proliferative DR (PDR) and 40 patients with severe non-proliferative DR (NPDR) were included this prospective, case control study, and 35 age- and sex-matched healthy subjects were recruited as a control group. White blood cell (WBC) count mean values and ratios were compared between the groups.

RESULTS: The groups were statistically similar in terms of age and sex. The neutrophil, lymphocyte, monocyte, platelet counts, and main platelet volume (MPV) values were similar in all 3 groups (all p values >0.05). The mean NLR was 2.67±1.02 in the PDR cases, 2.16±0.58 in severe NPDR, and 1.85±0.49 in the control group, which represented a statistically significant difference between the 3 groups (p=0.003). In post-hoc analysis, the NLR of the PDR and severe NPDR groups was statistically significantly greater than that of the control group (p=0.002 and p=0.048, respectively), but there was no statistically significant difference between the PDR and severe NPDR groups (p=0.083). The monocyte/lymphocyte, platelet/lymphocyte, and MPV/lymphocyte ratios were also similar in all 3 groups (all p values >0.05).

DISCUSSION AND CONCLUSION: An NLR value of 2.11 or more predicted DR (PDR or severe NPDR) with a sensitivity of 76% and a specificity of 80%.


5.Intraobserver Repeatability of Corneal and Anterior Segment Parameters Obtained Using a Scheimpflug Camera-Placido Corneal Topography System
Elif Ertan, Mustafa Doğan
doi: 10.14744/bej.2019.74946  Pages 82 - 85
INTRODUCTION: The aim of this study was to assess the intraobserver repeatability of central corneal thickness, peripheral corneal thickness (PCT), keratometry values (steep K, flat K), white-to-white diameter, and anterior chamber depth using the Sirius topography device (Costruzione Strumenti Oftalmici, Florence, Italy) in healthy eyes.

METHODS: A Sirius device was used by a single examiner to assess 100 eyes in 50 healthy patients. Two consecutive scans were acquired for each eye. Repeatability was assessed using test–retest variability, the coefficient of variation (COV), and the intraclass correlation coefficient (ICC).

RESULTS: Fifty patients (100 eyes) met the inclusion criteria. There were 18 women (36%) and 32 men (64%), with an age range of 23 to 56 years. The mean age was 30.38±8.03 years. A COV of 0.4% or less and an ICC of more than 0.99 (showing excellent repeatability) were achieved for most parameters, with the exception of PCT (at 2.5-mm temporal, superior, inferior, and nasal thickness).

DISCUSSION AND CONCLUSION: The anterior segment parameters obtained using the Sirius Scheimpflug camera- Placido corneal topography system were highly repeatable.


6.Anatomical Parameters of the Nasolacrimal Duct in Healthy Children Measured with Computed Tomography
Hasan Altınkaynak, Hasan Güneş
doi: 10.14744/bej.2019.83997  Pages 86 - 91
INTRODUCTION: This study is an evaluation of anatomical parameters at different levels of the bony nasolacrimal duct (NLD) in healthy children of different age groups using computed tomography (CT) measurements.
METHODS: Bony NLD CT images of 289 patients aged 0-15 years who presented at the emergency department with various indications and underwent a brain CT scan were retrospectively evaluated. The anterior-posterior and transverse diameter at the inferior orbital margin, the narrowest diameter of the NLD, NLD length, and the orientation angle in the sagittal plane (the angle between the line connecting the distal and proximal ends of the NLD and a line drawn parallel to the nasal floor) were analyzed by age group.

RESULTS: The anterior-posterior and transverse diameters at the level of the inferior orbital margin and the NLD length recorded in sagittal CT images were statistically significantly greater in patients older than 5 years of age (p<0.05). While there was an increase in the narrowest diameter of the NLD beginning at the age of 3 years, it was not statistically significant (p=0.25). The degree of the angle between the central line and the nasal floor did not change significantly between the groups. (p>0.05).

DISCUSSION AND CONCLUSION: A greater anterior-posterior diameter, transverse diameter, narrowest diameter of the NLD, and NLD length were observed with increasing age. The NLD anatomical parameters that we have identified in healthy children may serve as an important and useful guide in determining locations of the NLD and selecting surgical instruments of appropriate size and diameter before NLD surgery.


7.Macular Choroidal Thickness in Patients with Ocular Hypertension as Assessed Using Enhanced Depth Imaging Optical Coherence Tomography
Pinar Topcu-Yilmaz, Ozlem Gürbüz Köz, Alper Yarangumeli, Mehmet Numan Alp
doi: 10.14744/bej.2019.96268  Pages 92 - 96
INTRODUCTION: The aim of this study was to evaluate the macular choroidal thickness (CT) in patients with ocular hypertension (OHT) using spectral domain optical coherence tomography (SD-OCT) and compare the results with healthy individuals.
METHODS: Thirty eyes of 30 patients newly diagnosed with OHT and 24 eyes of 24 healthy controls were included in this cross-sectional study. After a detailed ophthalmological examination, macular CT was measured with enhanced depth imaging optical coherence tomography (EDI-OCT) (Cirrus HD-OCT, Carl Zeiss Meditec AG, Jena, Germany) at the fovea and at positions 500 µ, 1000 µ, 1500 µ nasal and temporal to the fovea. The Mann-Whitney U test was used to compare the CT measurements between groups. The correlation between the mean deviation, pattern standard deviation, and retinal nerve fiber layer thickness (RNFL) and CT was evaluated with the Spearman correlation coefficient. Statistical significance was accepted as p<0.05.

RESULTS: The mean CT in the OHT group was significantly thinner than that of the controls at locations 1000 µ (250.13±69.53µ vs 275.92±47.34µ; p=0.02) and 1500µ (236.03±65.44µ vs 265.46±47.56µ; p=0.009) temporal to the fovea. The CT at the other measurement points was also thinner in eyes with OHT, but the difference failed to reach statistical significance. A moderately negative correlation was detected between the mean deviation and CT at locations 1000µ (r=-0.42; p=0.03) and 1500µ (r=-0.44; p=0.02) temporal to the fovea There was a moderate correlation between the average RNFL thickness and CT at locations 500µ (r=0.44; p=0.03), 1000µ (r=0.42; p=0.04) and 1500µ (r=0.56; p=0.005) temporal to the fovea.

DISCUSSION AND CONCLUSION: In the present study, the macular CT was thinner in patients with OHT and this thinning was statistically significant at the temporal macula. A longitudinal, prospective study involving multiple EDI-OCT measurements is required to further understand the relationship.


8.The Effects of Silicone Oil Endotamponade on Subfoveal Choroidal Thickness after Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment
Selim Bolukbasi, Burak Erden, Akin Cakir
doi: 10.14744/bej.2019.25338  Pages 97 - 101
INTRODUCTION: To evaluate the potential effects of 1000-cSt silicone oil (SO), which is used for pars plana vitrectomy (PPV) surgery on subfoveal choroidal thickness.
METHODS: In this retrospective study, 20 eyes of 20 patients who had undergone PPV and SO injection surgery for macula-off rhegmatogenous retinal detachment were included. Complete ophthalmologic examinations were performed before the surgery, one month, three months after PPV and two months after silicone oil removal. After one month following PPV and SO injection and two months following silicone oil removal, subfoveal choroidal thickness was evaluated using EDI (enhanced depth imaging) mode of spectral-domain optical coherence tomography.
RESULTS: Subfoveal choroidal thickness measurements decreased statistically significantly at two months after silicone oil removal compared to the first month of PPV and SO injection. The mean subfoveal choroidal thickness was 284.2±54.2 µm at one month after PPV and SO injection, while it was 258.8±52.8 µm at two months after SO removal (p<0.001).
DISCUSSION AND CONCLUSION: After the removal of SO subfoveal choroidal thickness measurements decreased, the changes of subfoveal choroidal thickness measurements may be a parameter for the timing of SO removal.

9.Anterior Segment Optic Coherence Tomography Changes Before and After Phacoemulsification in Primary Open-Angle Glaucoma
Sibel Zirtiloglu, Ozen Ayranci Osmanbasoglu, Tulay Alpar Akcetin, Yeliz Acar, Mustafa Suat Alikma, Erkan Unsal, Kadir Eltutar
doi: 10.14744/bej.2019.39306  Pages 102 - 107
INTRODUCTION: The goal of this study was to compare measurements of values such as the anterior chamber angle (ACA), thickness of the iris, thickness of the cornea, and the angle-opening distance (AOD) of eyes with primary open-angle glaucoma before and after undergoing phacoemulsification with intraocular lens implantation using anterior segment optical coherence tomography (AS-OCT).
METHODS: The data of 49 eyes of 39 glaucoma patients who presented at the Cataract and Refractive Surgery Unit of the Ophthalmology Clinic of, University of Health Sciences, Istanbul Traning and Research Hospital between December 2014 and May 2016 were included in the study. All of the patients were examined with AS-OCT. All of the preoperative and postoperative data were evaluated statistically using a paired t-test and the Wilcoxon test. A statistical significance level of alpha was accepted as p<0.05.
RESULTS: The AS-OCT measurements of 39 patients (22 women and 17 men) with primary open-angle glaucoma were included in the study. The median age of the total population was 67±8years. No statistically significant difference was found between preoperative and postoperative measurements of the corneal thickness (p=0.480). However, there was a statistically significant difference between measurements of the ACA, AOD (500μm and 750μm), thickness of the iris curvature, anterior chamber depth, and trabecular-iris space area before and after the operation (p<0.001). Intraocular pressure (IOP) levels decreased significantly in the first and third months after surgery (p=0.019; p=0.003, respectively).
DISCUSSION AND CONCLUSION: This study with AS-OCT imaging has confirmed after phacoemulsification and intraocular lens implantation in patients with glaucoma, the angle of the anterior chamber grows wider. As a result, IOP decreases and becomes easier to control.

10.Alterations in Corneal Biomechanical and Topographic Features After Accelerated Crosslinking: 1-Year Results
Ahmet Kirgiz, Sevil Karaman Erdur, Kubra Serefoglu Cabuk, Kursat Atalay, Senay Asik Nacaroglu
doi: 10.14744/bej.2019.44154  Pages 108 - 114
INTRODUCTION: To determine the biomechanical and topographic alterations within the first year after accelerated crosslinking (CXL) treatment in patients with keratoconus.
METHODS: In this prospective study, 52 eyes of 52 patients with progressive keratoconus underwent accelerated CXL were included. All patients had a detailed preoperative ophthalmologic examination, including slit-lamp evaluation, Goldmann tonometry, fundoscopy, topography by Scheimpflug imaging (Sirius), and corneal biomechanical evaluation with a biomechanical waveform analysis device (ORA). Alterations in visual acuity and topographic findings were evaluated before the treatment and at 12 months follow-up. Corneal biomechanical features were obtained before the treatment, and at 1st, 3rd, 6th and 12th months.
RESULTS: Uncorrected-visual acuity and best-corrected visual acuity both statistically significantly improved at 12th month (p=0.001). There were no statistically significant differences in keratometry values, whereas maximum K (AKfront) and symmetry index front (SIfront) decreased significantly (p=0.015 and p=0.009, respectively). Corneal thinnest point and volume also decreased significantly at 12th month (p=0.001 for both). Goldmann-correlated intraocular pressure (IOPg) and corneal compensated IOP (IOPcc) values transiently increased in the first three months, while corneal hysteresis (CH) and the corneal resistance factor (CRF) transiently decreased, with the difference not statistically significant (p>0.05). However, central corneal thickness significantly decreased at the end of the 12th month (p=0.001).
DISCUSSION AND CONCLUSION: Accelerated CXL seems to be effective in stopping the progression of keratoconus. Our findings showed transient alterations in biomechanical features, which will end with the preoperative values at the end of the 12th month. Further studies are needed to demonstrate the changes in corneal biomechanics in vivo.

11.Ciliary Sulcus Implantation of Ahmed Glaucoma Valve in Patients with Corneal Decompensation Risk
Serhat Imamoglu, Nimet Yesim Ercalik, Buse Guneri Beser, Nimet Burcu Celik
doi: 10.14744/bej.2019.00710  Pages 115 - 119
INTRODUCTION: The goal of this study was to examine the safety and efficacy of ciliary sulcus implantation of the Ahmed glaucoma valve (AGV; New World Medical, Inc., Rancho Cucamonga, CA, USA) in patients with a risk of corneal decompensation.
METHODS: Patients with a corneal decompensation risk who underwent AGV implantation at a single institution were included in this retrospective study. The patients’ preoperative intraocular pressure (IOP), best corrected visual acuity (BCVA), and the number of anti-glaucomatous eye drop medications used was compared with postoperative values. The success criteria were defined as a postoperative IOP of 5 to 21 mmHg and no loss of light perception.
RESULTS: Twenty-three eyes of 23 (16 male, 7 female) patients were included in the study. The mean age of the patients was 64.6±14.6 years and the mean follow-up period was 15.8±8.3 months. The preoperative mean IOP was reduced from 33.6±9.1 mmHg to 16.9±5.1 mmHg at the last follow-up (p=0.000). The mean preoperative number of anti-glaucomatous eye drop medications used was 3.5±1.3. Postoperatively the mean was 1.7±1.4 at the last follow-up (p=0.000). The rate of total success was determined to be 78%. The postoperative mean BCVA did not change significantly. One patient lost light perception. A decrease in corneal clarity was observed in only 1 patient (4.3%). The postoperative complications observed were: bleb encapsulation (43%), hyphema (39%), tube occlusion (13%), choroidal detachment (8.7%), decompression retinopathy (8.7%), and corneal decompensation (4.3%).
DISCUSSION AND CONCLUSION: Ciliary sulcus implantation of an AGV was effective, both in terms of IOP and the decrease in anti-glaucomatous drug use in the short term. This technique may be a good choice in patients with a corneal decompensation risk due to the posterior chamber implantation.

SURGICAL TECHNIQUE
12.Sliding Shape Extraocular Muscle Transposition with Plication: A Novel Method
Birsen Gokyigit, Aslı İnal, Bulut Ocak, Ebru Demet Aygit
doi: 10.14744/bej.2019.28199  Pages 120 - 122
Objectives: This study aims to present a novel operation method of delivering both vascular protection and strengthening of the muscles, as well as the transposition of the muscles.
Methods: The patients’ files were scanned retrospectively. All patients underwent a complete eye examination in addition to motility examination, both preoperatively and postoperatively. Patients were followed up at least six months. Pre- and post-operative deviation measurement values were compared statistically. Operation technique: After being exposed and the rectus muscle was freed from the facial structure as far as planned resection amount. 6-0 coated vicryl sutures were then placed through the two sides of the muscle while protecting the blood vessels. Then, each suture was placed close to the muscle insertion and was aimed at transposition side. For example, if the target was to transpose the superior rectus at the temporal side, nasal side suture was placed at temporal edge of muscle insertion, and temporal side suture is placed approximately a tendon width laterally to the insertion.
Results: In patients who were planned resection 7 mm and over, the procedure for complete muscle widening transposition was successful. Only 2/3 transpositions could be achieved in four patients who underwent less than 7 mm of strengthening. There was no anterior segment ischemia in three patients who underwent three rectus muscle surgery in the same eye.
Conclusion: ‘Sliding shape’ design extraocular muscle plication found a simple, safe and effective procedure for patients who needed resection and transposition operation. More patients and longer follow-up are needed to understand the real effectiveness.

CASE REPORT
13.Acute Bilateral External Ophthalmoplegia in Miller Fisher Syndrome
Feyza Calis Karanfil, Huban Atilla
doi: 10.14744/bej.2019.97269  Pages 123 - 125
Miller Fischer syndrome is a rare entity characterized by the triad of external ophthalmoplegia, ataxia, and areflexia. It is thought to be a form of Guillain-Barre syndrome. Presently described is the case of a 68-year-old woman who presented with bilateral, external ophthalmoplegia, areflexia, and ataxia. After excluding other conditions, a diagnosis of Miller Fisher syndrome was made. She was treated with intravenous immunoglobulin and completely recovered in 8 weeks.

14.Manual Intracorneal Silicone Oil Insertion for Symptomatic Treatment of Bullous Keratopathy in a Patient with Corneal Scarring
Selim Genc, Semih Cakmak, Yusuf Yildirim
doi: 10.14744/bej.2019.79553  Pages 126 - 129
Bullous keratopathy is a result of endothelial loss and the failure of the remaining corneal epithelium to pump leaking water molecules away from the corneal tissue, causing overhydration. In eyes with good visual potential, keratoplasty is the primary treatment. There are also several other approaches to provide temporary improvement until a permanent solution with keratoplasty can be achieved. These alternatives include hypertonic topical sodium chloride (5%) drops, bandage contact lenses, anterior stromal puncture, phototherapeutic keratectomy, amniotic membrane transplantation, conjunctival flaps, and collagen crosslinking. This case report is a description of a different surgical technique using manual lamellar corneal dissection and intrastromal silicone oil insertion to provide symptomatic treatment of bullous keratopathy in an eye with no light perception and significant corneal scarring.



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