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Ocular trauma affecting the anterior segment of the eye including conjunctiva, cornea, sclera, iris, and lens may be chemical, mechanical, or thermal. Although the eyelids and tear film layer act as a barrier for mild traumas, severe traumas need thorough evaluation and prompt management to prevent catastrophic complications, such as vision or globe loss. The initial treatment approaches to chemical injuries of the eye, abrasion, foreign body and lacerations in the conjunctiva, cornea and sclera, hyphema, secondary glaucoma, and traumatic cataract along with the examination with imaging techniques and history taking tips are going to be discussed in this chapter.

Purpose: To evaluate the incidence of posterior capsular opacification after cataract surgery in patients on hemodialysis. Patients and Methods: Fifty patients on hemodialysis undergoing cataract surgery and 50 patients undergoing cataract surgery in a similar age group without any systemic disease were compared retrospectively. All patients underwent uneventful phacoemulsification surgery. Hydrophilic monoblock, sharp-edged acrylic intraocular lens (Spectrafold™, Gujarat, India) was used. A complete ophthalmological examination was performed on the patients who were evaluated at the postoperative 12th month follow-up examination. Posterior capsular opacification was evaluated by the retroillumination method. According to the reflection from retroillumination, cases with posterior capsular opacification were divided into three groups as mild, moderate and severe. Results: Age groups and male to female ratios were similar. Mean best corrected visual acuity (BCVA) was 0.23 in the hemodialysis group and 0.22 in the control group, preoperatively. At the end of the first year, the mean BCVAwas 0.88 in the hemodialysis group and 0.94 in the control group. In the hemodialysis group, the percentage of posterior capsular opacification was 60% and was 14% in the control group; this difference was statistically significant (p < 0.05). While the capsular opacity was mild in all 7 patients in the control group, itwas mild in 19 patients, moderate in 8 and severe in 3 patients in the hemodialysis group. Conclusion: The incidence of posterior capsular opacification after uneventful cataract surgery is found to be higher in patients on hemodialysis than in the normal population.

Purpose: The contrast sensitivity (CS) function in patients with primary Sjögren’s syndrome (pSS) may be impaired either frequently as a result of dry eye diseases or rarely as a result of optic neuropathy. In this study, we aimed to evaluate the CS function in pSS patients as well as to assess corneal aberrations and thickness of the peripapillary retinal nerve fiber layer (pRNFL). Methods: Fourteen eyes of 14 pSS patients (pSS group) and 14 eyes of 14 healthy participants (control group) were subjected to assessment of CS at the spatial frequencies of 1.5, 3.0, 6.0, 12, and 18 cycles/degree (cpd) using a functional visual acuity contrast test (FACT); measurement of corneal high-order aberrations (HOAs) in terms of coma-like, spherical-like, and total HOAs using Scheimpflug corneal topography; and measurement of the thickness of both the macular ganglion cell-inner plexiform layer (mGCIPL) and pRNFL in all quadrants using optical coherence tomography. None of the participants were under treatment with artificial tears. Results: The results of the CS test did not differ between the 2 groups at all spatial frequencies (p>0.05). In addition, there were no statistically significant differences between the 2 groups in terms of corneal HOAs (p>0.05) and thickness of mGCIPL (p>0.05). However, among all quadrants, only the inferior quadrant of pRNFL in pSS patients was statistically significantly thinner than that in the healthy participants (p=0.04). Conclusions: The CS function in pSS patients can be maintained with normal thickness of both pRNFL and mGCIPL and with lack of increased corneal HOAs, which may be present even in the absence of artificial tear usage. RESUMO Objetivo: A função de sensibilidade ao contraste em pacientes com síndrome de Sjögren primário (pSS) pode ser prejudicada, quer frequentemente como resultado de doenças do olho seco, ou mais raramente como um resultado de neuropatia óptica. Neste estudo, objetivamos avaliar a função de sensibilidade ao contraste de pacientes com pSS, além da avaliação das aberrações da córnea e a espessura da camada de fibras nervosas da retina (pRNFL). Métodos: Catorze olhos de 14 pacientes com pSS e 14 olhos de 14 participantes saudáveis foram submetidos, respectivamente, à avaliação do teste de sensibilidade aos contrastes (CS) nas frequências espaciais de 1,5, 3,0, 6,0, 12 e 18 ciclos/grau (cpd), utilizando teste de contraste acuidade visual funcional (FACT); a medida das aberrações de alta ordem da córnea (HOAs) em termos de coma, aberrações esféricas e aberrações totais, utilizando topografia corneana por Scheimpflug; e medida de espessura da camada de macular de células ganglionares plexiforme interna (mGCIPL) e a espessura de pRNFL em todos os quadrantes usando tomografia de coerência óptica. Nenhum dos participantes estava sob tratamento com lágrimas artificiais. Resultados: O teste CS em pacientes pSS não diferiu do que o teste CS em participantes saudáveis em todas as frequências espaciais (p>0,05). Não houve também nenhuma diferença estatisticamente significativa entre os dois grupos em termos de HOAs da córnea (p>0,05), e espessura de mGCIPL (p>0,05). No entanto, entre todos os quadrantes, apenas o quadrante inferior da pRNFL em pacientes pSS foi significativamente mais fino que o quadrante inferior da pRNFL em participantes saudáveis (p=0,04). Conclusões: A função de CS em doentes com pSS pode ser mantida em condições de ambas as espessuras normais de pRNFL e mGCIPL, assim como nas condições de falta de aumento HOAs da córnea, que pode ser mantida, mesmo na ausência do uso de lágrimas artificiais.

ResumenJustificación y objetivosLas alteraciones en la perfusión ocular desempeñan un rol importante en la patogénesis de la neuropatía óptica isquémica. La presión de perfusión ocular es igual a la presión arterial media menos la presión intraocular. El objetivo de este estudio fue evaluar las alteraciones de la presión intraocular y del espesor de la capa de fibras nerviosas de la retina en pacientes sometidos a cirugía de la columna vertebral en pronación.MétodosEste estudio prospectivo incluyó a 30 pacientes sometidos a cirugía de la columna vertebral. El espesor de la capa de fibras nerviosas de la retina se midió un día antes y uno después de la cirugía, con la tomografía de coherencia óptica. La presión intraocular se midió 6 veces con tonopen y el tiempo de duración en posiciones diferentes: en supinación (basal), 10min después de la intubación (supinación 1); después de la pronación a los 10min (pronación 1), 60min (pronación 2) y 120min (pronación 3), y justo después de la supinación en el período postoperatorio (supinación 2).ResultadosNuestro estudio contó con la participación de 10 pacientes del sexo masculino y 20 del femenino, con un promedio de edad de 57 años. En el postoperatorio, cuando las medidas del espesor de la capa de fibras nerviosas de la retina fueron comparadas con los valores del preoperatorio, se observó un adelgazamiento estadísticamente significativo de la retina en los cuadrantes nasales e inferiores (p=0,009 y p=0,003, respectivamente). Observamos una disminución de la presión intraocular estadísticamente significativa en supinación 1 y un aumento en pronación 2 y 3, en comparación con los valores basales. La presión arterial media y la presión de perfusión ocular fueron significativamente más bajas en pronación 1, pronación 2 y pronación 3, en comparación con los valores basales.ConclusionesNuestro estudio mostró un aumento de la presión intraocular durante la cirugía de la columna vertebral en pronación. Se observó un adelgazamiento estadísticamente significativo del espesor de la capa de fibras nerviosas de la retina en los cuadrantes nasales e inferiores un día después de la cirugía de columna vertebral.AbstractBackground and objectivesChanges in ocular perfusion play an important role in the pathogenesis of ischemic optic neuropathy. Ocular perfusion pressure is equal to mean arterial pressure minus intraocular pressure. The aim of this study was to evaluate the changes in the intraocular pressure and the retinal nerve fiber layer thickness in patients undergoing spinal surgery in the prone position.MethodsThis prospective study included 30 patients undergoing spinal surgery. Retinal nerve fiber layer thickness were measured one day before and after the surgery by using optical coherence tomography. Intraocular pressure was measured by tonopen six times at different position and time-duration: supine position (baseline); 10min after intubation (supine 1); 10min (prone 1), 60min (prone 2), 120min (prone 3) after prone position; and just after postoperative supine position (supine 2).ResultsOur study involved 10 male and 20 female patients with the median age of 57 years. When postoperative retinal nerve fiber layer thickness measurements were compared with preoperative values, a statistically significant thinning was observed in inferior and nasal quadrants (P=.009 and P=.003, respectively). We observed a statistically significant intraocular pressure decrease in Supine 1 and an increase in both Prone 2 and Prone 3 when compared to the baseline. Mean arterial pressure and ocular perfusion pressure were found to be significantly lower in prone 1, prone 2 and prone 3, when compared with the baseline.ConclusionsOur study has shown increase in intraocular pressure during spinal surgery in prone position. A statistically significant retinal nerve fiber layer thickness thinning was seen in inferior and nasal quadrants one day after the spinal surgery.

A 20-year-old male patient presented at our clinic complaining of strange visual experiences (neither decreased nor blurred) and a mild headache while reading. His best corrected visual acuity revealed 20/20 with a fort myopic correction. Intraocular pressures measured with Dynamic Contour Tonometer (DCT) (Swiss Microtechnology AG, Port, Switzerland) were 23.3 mmHg in the right eye (OD) and 27.4 mmHg in the left eye (OS) with cenral corneal thicknesses (CCTs) of 588 (OD) and 591 (OS) microns, respectively. Optic discs were bilateral pale with indistinct and scalloped margins without cupping. Red free photos showed autofluorescence of both optic discs, representative of optic disc drusen. Visual field analysis (VFA) of both eyes revealed sensitivity depression with localized defects consistent with the Optical Coherence Tomography (OCT) findings. Optic nerve head drusen (ONHD), myopia and high intraocular pressures (IOPs), may cause ganglion cell damage resulting in RNFL thinning and visual field loss. Because of the difficulty in detecting the exact cause and the extent of the damage, patients with ONHD associated with high IOPs and myopia should be examined closely with serial monitoring using OCT and VFA. In case of RNFL thinning and visual field defects, topical antiglaucomatous therapy should also be determined.

Pur po se: To evaluate the repeatability and reliability of retinal nerve fiber layer (RNFL) thickness measurements using optical coherence tomography (OCT). Ma te ri al and Met hod: Two hundred sixty-six eyes of 135 subjects (glaucoma, glaucoma suspects and healthy) were included in this study. Three sequential inferior, superior, nasal and temporal RNFL thickness measurements were performed using Spectral OCT [Opko/OTI, Inc., Miami, FL] by one operator at one session without pupillary dilatation. The differences between these three measurements of each quadrant in each eye were compared in microns and percentages. Repeated measures analysis of variance was performed for statistical analysis. Reliability is measured by intraclass correlation coefficient (ICC) for each quadrant. Re sults: ICCs of all quadrants ranged between 0.77 and 0.92, with the measurements of nasal quadrant being the least reproducible and the inferior being the most reproducible of all quadrants. RNFL measurement errors over 20% were seen in 9.63% of nasal quadrant, 5.3% of temporal quadrant, 0.6% of superior quadrant and only 0.3% of inferior quadrant measurements. Dis cus si on: In order to get more repeatable and reliable results with OCT, sequential measurements more than one should be considered. We believe that special attention is required in the analysis of data of nasal and temporal quadrants. (Turk J Ophthalmol 2012; 42: 11-5)

Objectives: High prevalence of Helicobacter pylori (HP) in the glaucoma patients was shown in recent studies. In our prospective study we aimed to compare the intraocular pressure (IOP) and the retinal nerve fiber layer thickness (RNFLT) in patients with HP positive and negative. Methods: In 91 patients with gastritis HP was investigated by urea breath test (UBT) and biopsy sample culture Following the full ophthalmologic examination the patients\' IOP was measured by Goldmann applanation tonometry and RNFLT was measured by spectral optic coherence tomography. The patients' demographic and clinical characteristics were compared with the χ² test for categorical variables and with the Mann Whitney U test for continuous variables. Results: Of the 90 patients who meet the including criteria, HP was detected in 74 patients (27 male, 47 female) positive, and in 16 patients (7 male, 9 female) negative. Median (minimum-maximum) age values were 46 (18-79) in HP positive group and 51 (18-67) in HP negative group. One hundred forty seven eyes in 74 HP positive patients and 31 eyes in 16 HP negative patients included in the study. Median IOP values were determined 14 (7-21) mmHg in HP positive group and 14 (8-18) mmHg in HP negative group. The measurements of RNFLT in superior, temporal, inferior and nasal quadrants found to be respectively 122(98-165), 68(50-101), 135(93-188), 79(51-120) micron in HP positive group and 120(94-161), 67(43-104), 129(94-166), 76(50-97) micron in HP negative group. No statistically significant difference was found when compared IOP and RNFLT measurements between the two groups (p, Amaç: Glokom olgularında Helikobakter pilori (HP) prevalansının yüksek olduğu geçmiş çalışmalarda gösterilmiştir. Prospektif çalışmamızda HP pozitif ve negatif olguların göz içi basınç (GİB) ve retina sinir lifi tabakası kalınlık (RSLTK) ölçümlerini karşılaştırmayı amaçladık. Yöntemler: Gastrit bulguları olan 91 hastada HP varlığı üre nefes testi veya gastrik biyopsi ile araştırıldı. Hastaların tam oftalmolojik muayeneleri takiben GİB\'ı Goldmann aplanasyon tonometresi ve RSLTK\'ı spektral optik koherens tomografi ile ölçüldü. Hastaların demografik ve klinik özellikleri kategorik değişkenler için χ² testi ve sürekli değişkenler için Mann Whitney U testi ile karşılaştırıldı. Bulgular: Çalışma kriterlerine uyan 74 hastada (27 erkek, 47 kadın) HP pozitif ve 16 hastada (7 erkek, 9 kadın) ise HP negatif olarak saptandı. Ortanca (minimum-maksium) yaş değerleri HP pozitif grup için 46 (18-79) ve HP negatif grup için 51 (18-67) idi. HP pozitif 74 hastanın 147 gözü ve HP negatif 16 hastanın 31 gözü çalışmaya dahil edildi. GİB ortanca değerleri HP pozitif grupta 14 (7-21) mmHg ve HP negatif grupta 14 (8-18) mmHg olarak saptandı. Üst, temporal, alt ve nazal kadranlarda ölçülen RSLTK\'ların ortanca değerleri HP pozitif grupta sırasıyla 122(98-165), 68(50-101), 135(93-188), 79(51-120) mikron ve HP negatif grupta ise sırasıyla 120(94-161), 67(43-104), 129(94-166), 76(50-97) mikron olarak bulundu. İki grup arasında GİB ve RSLTK ölçümleri karşılaştırıldığında aralarında istatiksel anlamlı fark olmadığı görüldü (p>0,05). Sonuç: Bu çalışmada HP pozitif olguların GİB ve RSLTK ölçümlerinin HP negatif olgu grubuna göre anlamlı farklılık göstermediği bulundu. Glokom ile HP arasında ilişki olduğunu göstermek için geniş olgu serilerinde randomize vaka kontrollü histolojik ve serolojik çalışmaların yapılması gerekmektedir.

Yazisma Adresi/Address for Correspondence: Dr. Baran Gencer, Canakkale Onsekiz Mart Universitesi Tip Fakultesi, Goz Hastaliklari Anabilim Dali, Canakkale, Turkiye Tel.: +90 286 263 59 50-1045 E-posta: barangencer@gmail.com Gelis Tarihi/Received: 31.01.2013 Kabul Tarihi/Accepted: 22.05.2013 Kunt goz travmalari gozun on ve arka segmentinde ciddi okuler problemlere, hatta glob perforasyonlarina neden olabilmektedir. Fakoemulsifikasyon ile katarakt cerrahisi gecirmis psodofakik gozlerde ise kunt travma ardindan travmatik iris ekspulsiyonuna bagli aniridi ile birlikte goz ici lensin korundugu olgular literaturde bildirilmistir. Bizim olgumuz da dort ay once dis merkezde seffaf kornea kesi ile fakoemulsifikasyon cerrahisi gecirmis ve ayni goze odun carpmasi sonucu total aniridi ile birlikte zonullerin kismi olarak koptugu ancak goz ici lensin santralize kaldigi gozlenmistir. Bu olgu ulkemizden bildirilen ilk psodofakik gozde kunt travma sonrasi gelisen aniridi olgusudur ve biz kucuk boyutlu katarakt cerrahisi giris yerlerinin kunt travmalarda rolatif olarak koruyucu etkisinin olabilecegini gostermeyi amacladik. (Turk J Ophthalmol 2014; 44: 80-2) Anahtar Kelimeler: Aniridi, kunt goz travmasi, fakoemulsifikasyon

We report the first case, in Medline-based literature, of conjunctivitis caused by gram negative diplococcus, Neisseria sicca. Although it is not widely accepted as such, isolation from cultures of repeated eye swab samples suggests that N. sicca may be a pathogen in conjunctival infections. Positive culture for this organism should not be readily dismissed. Such conjunctivitis responded favorably to treatment with netilmicin eye drops.

BACKGROUND AND OBJECTIVES: Changes in ocular perfusion play an important role in the pathogenesis of ischemic optic neuropathy. Ocular perfusion pressure is equal to mean arterial pressure minus intraocular pressure. The aim of this study was to evaluate the changes in the intraocular pressure and the retinal nerve fiber layer thickness in patients undergoing spinal surgery in the prone position. METHODS: This prospective study included 30 patients undergoing spinal surgery. Retinal nerve fiber layer thickness were measured one day before and after the surgery by using optical coherence tomography. Intraocular pressure was measured by tonopen six times at different position and time-duration: supine position (baseline); 10 min after intubation (Supine 1); 10 (Prone 1), 60 (Prone 2), 120 (Prone 3) min after prone position; and just after postoperative supine position (Supine 2). RESULTS: Our study involved 10 male and 20 female patients with the median age of 57 years. When postoperative retinal nerve fiber layer thickness measurements were compared with preoperative values, a statistically significant thinning was observed in inferior and nasal quadrants (p = 0.009 and p = 0.003, respectively). We observed a statistically significant intraocular pressure decrease in Supine 1 and an increase in both Prone 2 and Prone 3 when compared to the baseline. Mean arterial pressure and ocular perfusion pressure were found to be significantly lower in Prone 1, Prone 2 and Prone 3, when compared with the baseline. CONCLUSIONS: Our study has shown increase in intraocular pressure during spinal surgery in prone position. A statistically significant retinal nerve fiber layer thickness thinning was seen in inferior and nasal quadrants one day after the spinal surgery. JUSTIFICATIVA E OBJETIVOS: As alterações de perfusão ocular desempenham um papel importante na patogênese da neuropatia óptica isquêmica. A pressão de perfusão ocular é igual à pressão arterial média menos a pressão intraocular. O objetivo deste estudo foi avaliar as alterações da pressão intraocular e da espessura da camada de fibras nervosas da retina em pacientes submetidos à cirurgia da coluna vertebral em pronação. MÉTODOS: Este estudo prospectivo incluiu 30 pacientes submetidos à cirurgia da coluna vertebral. A espessura da camada de fibras nervosas da retina foi medida um dia antes e um depois da cirurgia, com o uso da tomografia de coerência óptica. A pressão intraocular foi medida seis vezes com o Tonopen e o tempo de duração em posições diferentes: em supinação (basal), 10 minutos após a intubação (Supinação 1); após a pronação aos 10 minutos (Pronação 1), 60 minutos (Pronação 2) e 120 minutos (Pronação 3) e logo após a supinação no período pós-operatório (Supinação 2). RESULTADOS: Nosso estudo envolveu 10 pacientes do sexo masculino e 20 do feminino, com média de 57 anos. No pós-operatório, quando as medidas da espessura da camada de fibras nervosas da retina foram comparadas com os valores do pré-operatório, um afinamento estatisticamente significativo da retina foi observado nos quadrantes nasais e inferiores (p = 0,009 e p = 0,003, respectivamente). Observamos uma diminuição da pressão intraocular estatisticamente significante em Supinação 1 e um aumento em ambos momentos Pronação 2 e Pronação 3, em comparação com os valores basais. A pressão arterial média e a pressão de perfusão ocular foram significativamente mais baixas em Pronação 1, Pronação 2 e Pronação 3, em comparação com os valores basais. CONCLUSÕES: Nosso estudo mostrou aumento da pressão intraocular durante a cirurgia da coluna vertebral em pronação. Um afinamento estatisticamente significante da espessura da camada de fibras nervosas da retina foi observado nos quadrantes nasais e inferiores um dia após a cirurgia da coluna vertebral. JUSTIFICACIÓN Y OBJETIVOS: Las alteraciones en la perfusión ocular desempeñan un rol importante en la patogénesis de la neuropatía óptica isquémica. La presión de perfusión ocular es igual a la presión arterial media menos la presión intraocular. El objetivo de este estudio fue evaluar las alteraciones de la presión intraocular y del espesor de la capa de fibras nerviosas de la retina en pacientes sometidos a cirugía de la columna vertebral en pronación. MÉTODOS: Este estudio prospectivo incluyó a 30 pacientes sometidos a cirugía de la columna vertebral. El espesor de la capa de fibras nerviosas de la retina se midió un día antes y uno después de la cirugía, con la tomografía de coherencia óptica. La presión intraocular se midió 6 veces con tonopen y el tiempo de duración en posiciones diferentes: en supinación (basal), 10 min después de la intubación (supinación 1); después de la pronación a los 10 min (pronación 1), 60 min (pronación 2) y 120 min (pronación 3), y justo después de la supinación en el período postoperatorio (supinación 2). RESULTADOS: Nuestro estudio contó con la participación de 10 pacientes del sexo masculino y 20 del femenino, con un promedio de edad de 57 años. En el postoperatorio, cuando las medidas del espesor de la capa de fibras nerviosas de la retina fueron comparadas con los valores del preoperatorio, se observó un adelgazamiento estadísticamente significativo de la retina en los cuadrantes nasales e inferiores (p = 0,009 y p = 0,003, respectivamente). Observamos una disminución de la presión intraocular estadísticamente significativa en supinación 1 y un aumento en pronación 2 y 3, en comparación con los valores basales. La presión arterial media y la presión de perfusión ocular fueron significativamente más bajas en pronación 1, pronación 2 y pronación 3, en comparación con los valores basales. CONCLUSIONES: Nuestro estudio mostró un aumento de la presión intraocular durante la cirugía de la columna vertebral en pronación. Se observó un adelgazamiento estadísticamente significativo del espesor de la capa de fibras nerviosas de la retina en los cuadrantes nasales e inferiores un día después de la cirugía de columna vertebral.

A 40-year-old woman with a history of recurrent attacks of dacryocystitis for 2 years developed a lacrimal sac abscess. β-Lactam antibiotics, considered the first-line treatment for dacryocystitis, were ineffective. She underwent dacryocystorhinostomy. Cultures from the lacrimal sac demonstrated the presence of Stenotrophomonas maltophilia and methicillin-sensitive Staphylococcus aureus, both of which are sensitive to trimethoprim-sulfamethoxazole. This rare and antibiotic-resistant bacterial species should be considered in atypical cases of dacryocystitis, and appropriate antibiotics should be started immediately.

AIM: We evaluated the relationship between increased intraocular pressure (IOP), ischemia-modified albumin levels in serum (IMA-s) and in humor aqueous (IMA-HA) in rabbits.METHODS: Twenty-five albino New Zealand rabbits weighing between 2.0 and 2.8 kg were used in this pilot study. With permission from Canakkale Onsekiz Mart University Animal Ethics Committee, the IOP of both eyes of each rabbit were recorded with a Tonopen (Tono-Pen XL, Reichart Inc., Depew, NY, USA) after the application of topical proparacaine 0.5% HCl anesthesia. Blood (4 mL) was collected from the marginal ear vein and an intracameral injection of 2.3 mg/mL sodium hyaluronate and subconjunctival dexamethasone was given in the right eye. Anterior chamber aqueous fluid was obtained using a limbal approach with a 27 gauge needle from both eyes. The left eyes were used as controls. IOP was measured on the 1st, 3rd and 10th day after the initial injection, with Tonopen, IMA-s levels and IMA-HA examined simultaneously.RESULTS:Before the injections, IOP was 11.4±3.0 mm Hg in the right eye and 11.3±3.1 mm Hg in the left eye (P>0.05). There was a statistically significant difference between IMA-s levels before the IOP increase (IMA-s0) and IMA-s levels on the 1st and 3rd days after the increase in IOP (P=0.012 and P=0.01, respectively). No difference was observed between IMA-s0 and serum IMA levels on the 10th day (IMA-s10) after IOP increase (P=0.989). IMA-HA in the right eye in the first day after the injection was positively correlated with IOP (r=0.748; P=0.02). No other correlation is found between any other parameter with IMA-HA levels at any test time. A statistically significant positive correlation was observed between IMA-s values and IOP on the 1st and 3rd days (r=0.398, P=0.04 and r=0.382, P=0.04, respectively). There was no correlation between IMA-s levels and increased IOP on the 10th day after IOP increase (r=0.026, P=0.902).CONCLUSION: IMA may be an important indicator of acute damage caused by diseases involving ischemic damage to the eye, especially in case of increased intraocular pressure.

Purpose. To describe a surgical technique using amniotic membrane transplant (AMT) with fibrin glue (FG) for treating smaller corneal perforations more practically and appropriately filling the defect.Method. A patient with noninfectious central corneal perforation, in 1 mm in diameter, was treated with FG-assisted AMT-plug. An AMT was folded in on itself twice by using FG then a small piece of this FG-AMT mixture was cut to maintain an appropriate plug for the site of the corneal perforation. The FG-assisted AMT-plug was placed in the perforation area by using FG. An amniotic membrane patch was placed over the plug, which was then secured by a bandage contact lens.Result. Surgery to restore corneal stromal thickness without recurrence of perforation.Conclusion. The FG-assisted AMT-plug allowed a successful repair of 1 mm in diameter corneal perforation. This technique was easily performed, thus seeming to be a good alternative to treat corneal perforations with restoring corneal thickness.

Aspergillus species have been implicated in a wide variety of primary ocular conditions, characterized by either slow and asymptomatic infection, or rapid, uncontrollable progression and sometimes death. The study design is a case series including chronic asymptomatic dacryocystitis, dacryocystitis with dacryoliths and endogenous endophthalmitis. Due to this variable clinical presentation of aspergillosis a high level of suspicion must be maintained as fulminant aspergillosis may lead to a rapidly progressive infection which may result in death.

Naturally occurring (idiopathic) astigmatism is frequent, with up to 95% of eyes having detectable astigmatism. It is estimated that approximately 70% of the general cataract population has at least 1.00 D of astigmatism, and approximately 33% of patients undergoing cataract surgery are eligible for treatment of preexisting astigmatism.1,2 Today, cataract surgery is regarded as a refractive surgery, aiming pseudophakic emmetropia, which makes eliminating corneal astigmatism critical.3-8 Ferrer-Blasco et al studied prevalance of corneal astigmatism before cataract surgery and found that; in 13.2% of eyes no corneal astigmatism was present; in 64.4%, corneal astigmatism was between 0.25 and 1.25 diopters (D) and in 22.2%, it was 1.50 D or higher.9 This finding implies that, when planning a surgery, both the spherical and the astigmatic components should be taken into account to achieve post-operative outcomes as close to emmetropia as possible. Due to new developments in phacoemulsification devices, changes in operation techniques and the use of small incisions in cataract surgery which reduce the operation-induced astigmatism or make an inconsiderable change in the existing corneal astigmatism, the general aim of cataract surgery has gone from simple cataract extraction to ensuring the best visual acuity and quality without spectacle dependence. With the wide-spread use of phakic, aphakic, bifocal, multifocal and accommodative intraocular lenses (IOLs); all surgeons aim to eliminate any small ametropia, especially astigmatism, existing before or after cataract surgery. There are several techniques for dealing with the pre-existing astigmatism intraoperatively as well as postoperative approaches for dealing with residual or induced astigmatism. However; the most important and critical step in treating the astigmatism is to find out the exact source, magnitude and axis of the astigmatism and making the decision about which technique is appropriate for that patient. The cylindrical component is evaluated by automated and/or manifest refraction, placido ring reflections, keratometry and/or corneal topography and wavefront aberrometry primarily, but other factors need to be taken into account, such as age of the patient and the corneal characteristics of both eyes.

A schwannoma is a rare benign tumour of peripheral nerve origin. We present a case of a 65-year-old woman with a 1-year history of a slowly enlarging, painless and movable mass, palpable by fingers in her right lower eyelid, adjacent to the inferior orbital rim. No apparent mass was present by macroscopic examination. A subciliary incision and blunt dissection through the septum revealed a pearl-like round and encapsulated cystic mass between the fat pads just below the septum. A total excision of the tumour was performed. Histopathology and immunohistochemistry led to the diagnosis of schwannoma. Although rare, schwannoma should be considered in the differential diagnosis of well-capsulated masses in the periorbital region.

Purpose: Punctal stenosis can result in symptoms such as epiphora and can significantly reduce the quality of life of patients. Perforated punctal plug insertion is an easy procedure that is commonly used as the first step of treatment for punctal stenosis. Methods: Clinical, demographic, and outcome data were retrospectively collected for 54 eyes of 21 males and 11 females who consecutively presented to our Oculoplastic Clinic and underwent silicone Micro Flow perforated punctal plug insertion. All patients had epiphora with punctal stenosis. Results: Of the 54 plugs, 26 plugs (48.1%) were lost and 28 (51.8%) stayed in place. Of the latter, eight were explanted because of the occlusion of the plug with secretions and recurrent conjunctivitis; moreover, two plugs migrated deep into the vertical canaliculus. Of the 54 plugs, only 18 (33.3%) were well-tolerated with significant symptomatic improvement. Conclusion: Plug loss is a prominent problem in patients implanted with perforated punctal plugs. Silicone punctal plugs failed in 66.7% of our patients over a mean follow-up of 14.2 months. RESUMO Objetivo: A estenose punctal pode resultar em sintomas como a epífora e diminuir significativamente a qualidade de vida dos pacientes. A inserção de um tampão perfurado é um procedimento fácil que é comumente usado como o primeiro passo do tratamento para a estenose punctal. Métodos: Dados clínicos, demográficos e de resultado foram coletados retrospectivamente de 54 olhos de 21 homens e 11 mulheres que consecutivamente se apresentaram em nossa Clínica de Oculoplástica e foram submetidos a inserção de um tampão de silicone perfurado Micro Flow. Todos os pacientes tinham epífora com estenose punctal. Resultados: Dos 54 tampões, 26 (48,1%) foram perdidos e 28 (51,8%) permaneceram no local. Destes últimos, 8 foram removidos devido a oclusão do tampão com secreção e conjuntivite recorrente, além disso, 2 migraram profundamente no canalículo vertical. Dos 54 tampões, apenas 18 (33,3%) foram bem tolerados com significativa melhora dos sintomas. Conclusão: A perda de tampões é um problema de destaque em pacientes implantados com tampões perfurados. Tampões de silicone falharam em 66,7% dos pacientes durante um seguimento médio de 14,2 meses.