Search

To present the outcomes and factors affecting the success of trabeculectomy performed as the first surgery in primary pediatric glaucoma.Pediatric patients with primary glaucoma who underwent trabeculectomy as the first surgery were retrospectively reviewed. Age, gender, preoperative intraocular pressure (IOP), operation age, axial length, corneal diameter, anterior segment findings, antimetabolite used, complications, and 1-month, 3-months, 1-year, and most recent postoperative findings were recorded. Postoperative IOP with/without medication of 18 mmHg or less was considered successful. Factors that may have affected surgical success were also evaluated using multivariate analysis.Included in the study were 48 patients, of whom 30 had primary congenital glaucoma and 18 had juvenile glaucoma. The mean preoperative IOP was 36.84 ± 6.30 mmHg, and the mean follow-up time was 7.95 ± 6.93 years. The median operation age value was 100.00 ± 100.83 (median: 60; IQR: 153) months. The postoperative IOP at the 1-month, 3-months, 1-year, and most recent follow-ups were 15.39 ± 6.88, 15.70 ± 7.36, 16.28 ± 7.86, and 17.48 ± 8.44 mmHg, respectively (p = 0.565). While there were no postoperative complications in 24 of the patients (50.0%), the most common complications were choroidal detachment and hypotony. Postoperative complication development was found to be significant as a factor affecting surgical success in the multivariate logistic regression analysis. Surgical success rates for all of the patients were 71.7%, 65.9%, 65.0%, and 61.4% at the 1-month, 3-months, 1-year, and most recent follow-ups, respectively. A significant difference was found between the congenital and juvenile groups in terms of surgical success only at 3 months (p = 0.953, p = 0.042, p = 0.191, p = 0.218; respectively).The fact that surgical success was partially higher in the juvenile group confirmed the idea that the results of trabeculectomy will be more favorable in patients of older age and without anterior segment anomalies.

To compare changes in optic disc microvascular parameters before and after treatment of patients who received IVD for macular edema secondary to BRVO, using optical coherence tomography angiography (OCT-A).Eighteen BRVO patients who received only IVD treatment and 20 healthy controls were retrospectively reviewed. Patients with moderate or severe IOP spikes (6mmHg) after implantation were excluded from the study. Whole, peripapillary, inside disc capillary density and retinal nerve fiber layer thickness (RNFLT) were recorded at the 2nd and 6th months after implantation.Whole, peripapillary and inside disc capillary densities were significantly lower in BRVO patients before implantation than in the control group (P0.001 for all comparisons). Despite a mild mean IOP increase after IVD, no significant change was observed in whole, peripapillary and inside disc capillary vascular densities in the 2nd and 6th months (P0.05 for all comparisons). The mean RNFLT of BRVO patients before IVD was lower than the control group, but this difference was not statistically significant (110.1±12.3μm and 115.6±10.7μm, P=0.131). The mean RNFLT at the 2nd and 6th months did not show a statistically significant difference after implantation (P=0.239, P=0.459).OCT-A shows the decrease in whole, peripapillary and inside disc microvascular parameters in BRVO patients compared to healthy subjects. No significant change in optic nerve head microvascular parameters was observed in patients without moderate or severe IOP spikes after treatment with IVD.

Purpose: To compare the effect of intravitreal ranibizumab (IVR) or intravitreal dexamethasone implants (IVD) on regression of hyperreflective dots (HRDs) on optical coherence tomography (OCT) B-scan in patients with branch retinal vein occlusion (BRVO). Methods: 37 eyes of 37 patients with cystoid macular edema who received IVR or IVD and followed up for at least 12 months were included in this study. The patients were divided into three groups according to intravitreal treatment. Group 1 consisted of 12 eyes who received only IVD, group 2 consisted of 10 eyes who received only IVR on a pro re nata and group 3 consisted of 15 eyes who received both IVD and IVR. OCT parameters (CMT, number of HRDs, status of external limiting membrane (ELM) and ellipsoid zone (EZ)) and best-corrected visual acuity (BCVA) were compared between the groups over the follow-up time. HRDs were categorized as HRD in inner retinal layers (from the internal limiting membrane to the inner nuclear layer) or HRD in outer retinal layers (from the outer plexiform layer to the outer border of the photoreceptor layer).Results: There was no significant difference between groups in terms of BCVA, CMT, HRDs in the inner and the outer retinal layers at baseline visit. (p˃0.05 for all) Comparing the baseline values in all groups, a significant decrease was observed in CMT in the first year. (For group 1; p=0.013, group 2; p=0.010; group 3, pConclusion: The reduction in HRDs at 12 months and better BCVA after IVD intimates that the HRDs should be considered as inflammatory markers in the follow-up of CME in BRVO. Thus, IVD injection could be more appropriate for patients with higher HRDs after BRVO.

To assess the risk factors associated with the development of hypotony after Ahmed glaucoma valve (AGV) implantation. One hundred and ninety-three eyes of 177 patients with various types of glaucoma that were treated with AGV implantation were retrospectively evaluated. Intraocular pressure lower than 6 mmHg related to the surgery is defined as postoperative hypotony. Patients’ demographic characteristics, type of glaucoma, preoperative and postoperative visual acuity, necessity of antiglaucoma treatments, lens status, previous ocular surgeries, intraocular pressure (IOP) measurements before and after surgeries, the need for additional procedures and postoperative complications were recorded from the patients’ charts. Hypotony was seen in 68 of 193 eyes (35.2%) postoperatively. In 45 eyes (23.3%), it has occurred in first postoperative day and in 23 eyes (11.9%) after the first day within the first week. There was no difference in intraocular pressures between two groups in the first year follow-up. Pre- and postoperative best-corrected visual acuities, age and gender were not statistically different between hypotony and no hypotony groups (p > 0.05). Also, lens status, history of previous ocular surgery, type of glaucoma and number of preoperative glaucoma medication usage were not found to be different between groups (p > 0.05). Potential risk factors such as age, sex, lens status, history of previous ocular surgeries, preoperative glaucoma medication usage or glaucoma type are not found to influence upon postoperative hypotony prevalence for AGV surgery. Surgery type and personal ocular factors, which could not be determined beforehand, could be more important than demographic features.

Purpose: The purpose of this study is to evaluate the factors affecting the success of needling surgery for early filtering bleb failure after trabeculectomy. Methods: Patients who underwent a single needling surgery within 3 months after trabeculectomy were retrospectively evaluated. Glaucoma type, intraocular pressure (IOP), and medical treatments before trabeculectomy; the presence of hypotony after trabeculectomy; bleb type; IOP before needling; lens status; complications; IOP after 1, 6, and 12 months; and medical treatments after needling were recorded. Risk factors were evaluated for complete success at 1, 6, and 12 months after needling. Results: Thirty-three eyes of 33 patients were analyzed. The mean IOP after needling at 1, 6, and 12 months was 16.09 ± 3.70, 15.64 ± 2.68, and 15.79 ± 2.61 mmHg, respectively. The mean age of the patients was 53.97 (25–79) years. The mean IOP after needling at 1, 6, and 12 months was 16.09 ± 3.70, 15.64 ± 2.68, and 15.79 ± 2.61 mmHg, respectively. The pre-needling IOP and IOP decrease on the first day affected the complete and qualified success at 1, 6, and 12 months, but the glaucoma type, presence of hypotony after trabeculectomy, lens status, interval between trabeculectomy and needling, and bleb type were not found to affect success. In the receiver operating curve analysis, the pre-needling IOP value was found to be significant in determining complete success. Complete success at 1 month was more likely when the pre-needling IOP cutoff value was

Purpose: The aim of the study was to evaluate the macular and optic nerve head blood flow in pediatric epilepsy patients treated with levetiracetam for at least 12 months with optical coherence tomography-angiography (OCTA).Methods: 33 pediatric epilepsy patients and 30 sex and age-matched healthy volunteer children were included in the study. OCTA was used to evaluate the optic nerve head and macular perfusion chages. Mean ocular perfusion pressures (MOPP) were also calculated. Patients using multiple antiepileptic drugs or prior history of different drug use were exluded from the study.Results: Choriocapillaris flow area was significantly lower in the study group than the control group (p=0.006). However, foveal avascular zone, vessel densities of macula in superficial, deep capillary plexus and optic nerve head were not significantly different from healty eyes (p>0.05). There was also no significant difference between the two groups in means of MOPP (p=0.211). No obvious correlation is found between treatment duration and OCTA parameters or MOPP. None of the patients had diplopia, nystagmus, blurred vision, color vision deficiency or increased intraocular pressure.Conclusions: In children taking levetiracetam for at least 12 months, choroidal perfusion was reduced compared to controls, while retinal perfusion was not affected in this OCTA study.

Purpose: To evaluate the postoperative high-order aberration differences of femto-LASIK surgery in 6.5 and 7 mm optic zones. Patients and Methods: We retrospectively reviewed 80 eyes of 40 patients with myopia or myopia with astigmatism who underwent femtosecond LASIK surgery. Q values, z3, 3 (h. trefoil), z3, –3 (v. trefoil), z3, 1 (h. coma), z3, –1 (vertical coma), z4, 0 (spherical aberration), z5, –1 (second other v. coma), aberration coefficients were evaluated 3 months after surgery. Central corneal thicknesses, intraocular pressures, patient ages and genders, optical zone diameters and ablation depths are collected from patients’ medical records. Results: The mean age was 28.4 ± 0.69 years (range, 20–47 years). Lower z4, 0 spherical aberrations and aberration coefficient values were associated with larger optical zones (7 mm) (z4, 0 spherical aberrations = 1.25, p = 0.01; coefficient value = –1.21, p Discussion: LASIK treatment with 6.5 and 7 mm optical zones is safe and effective for correcting myopia and myopic astigmatism and has statistically similar visual outcomes. Moreover, larger optical zone (7 mm) was found to be associated with lower spherical aberration induction and smaller aberration coefficient values compared to 6.5 mm optical zone. This can be important for decision-making in femto-LASIK surgery for better postoperative results.

Pentacam (Oculus, Inc., Almanya), RTVue (OptovueInc., Freemont, ABD) ve Spectralis (Heidelberg GmbH, Almanya) cihazları ile saptanan iridokorneal açı (İKA) ölçümlerinin tutarlılık ve uyumluluğunun değerlendirilmesi amaçlanmıştır. 22 sağlıklı katılımcının 22 gözü retrospektif olarak değerlendirilmiştir. Pentacam cihazında ölçümler her gözde saat 3 ve 9 kadranlarda (nazal ve temporal) otomatik olarak alınmış olup, trabeküler-iris açı değerleri kaydedilmiştir. RTVue ve Spectralis ön segment optik koherens tomografilerinde (ÖS-OKT) ise, ön kamara girintisi açısı (ÖKGA), skleral mahmuz açısı (SMA) ve 500 µm uzaklıktan açı açılış uzaklığı (AAU500) parametreleri kaydedilmiştir. Tüm ölçümler benzer aydınlatma koşulları altında gerçekleştirilmiştir. 18 yaş altı olgular, geçirilmiş oküler cerrahi veya lazer öyküsü, İKA ölçümleri üzerinde farklılık yaratabilecek refraktif kusurlar, fiksasyon bozukluğu ya da yetersiz ön segment görüntü kalitesi, muayene esnasında GİB’si 21 mmHg üzerinde olan olgular çalışma dışında bırakılmıştır. Tüm cihazlar hem nazal hem temporal kadranlarda ÖKGA-SMA yönünden birbirleriyle uyumlu bulunmuştur (sırasıyla temporal-nazal ICC; 0.871, 0.837; 0.872, 0.839). Bland-Altman analizine göre Pentacam referans cihaz olarak alındığında, ÖKGA değeri yükseldikçe hem RTVue hem de Spectralis ölçümleri daha yüksek uyumluluk göstermektedir. ÖKGA, Pentacam ve RTVue için hem nazal hem temporal kadranlarda istatistiksel benzer sonuçlar verirken, Spectralis’te daha dar sonuçlar vermiştir (nazal kadran p=0.003, temporal kadran p=0.007). RTVue ve Spectralis arasında AAU500 değerleri arasında iyi tutarlılık görülse de (temporal kadran ICC: 0.825, nazal kadran ICC: 0.882), Spectralis’in RTVue’ya göre daha yüksek sonuçlar gösterdiği belirlenmiştir (p˂0.001). IKA değerlendirilmesi için Pentacam, RTVue ve Spectralis ölçümlerinin birbirleriyle uyumlu olduğu saptansa da gerek ÖKGA-SMA, gerekse AAU500 değerlerinin cihazlar arası farklılığı göz önüne alındığında, hasta takibinde ilgili cihazların birbirleri yerine kullanılmasının uygun olmayabileceği düşünülebilir., To evaluate the compatibility and consistency of iridocorneal angle (ICA) measurements detected with Pentacam (Oculus, Inc., Germany), RTVue (Optovue Inc., Freemont, USA) and Spectralis (Heidelberg GmbH, Germany) devices. Twenty-two eyes of 22 healthy participants were evaluated retrospectively. In Pentacam, measurements were taken automatically in each eye at 3 and 9 o'clock (nasal and temporal), and trabecular-iris angle values were recorded. In RTVue and Spectralis anterior segment optical coherence tomographies, the parameters of anterior chamber recess angle (ACA), scleral spur angle (SSA) and angle opening distance from 500 µm distance (AOD500) were recorded. All measurements were taken under similar lighting conditions. Cases under the age of 18 years, history of previous ocular surgery orophthalmic laser, refractive errors that may alter ICA measurements, fixation abilities, insufficient anterior segment image quality or cases with intraocular pressure above 21 mmHg during examinations were excluded from the study. All devices were found to be consistent with each other in terms of ACA-SSA in both nasal and temporal quadrants (for temporal-nasal quadrants respectively ICC; 0.871, 0.837; 0.872, 0.839). According to the Bland-Altman analysis, when Pentacam is taken as the reference device, as the ACA value widens, both RTVue and Spectralis measurements show higher agreement. While ACA degrees were statistically similar in both the nasal and temporal quadrants for Pentacam and RTVue, it was found narrower in Spectralis (for nasal quadrant p=0.003, for temporal quadrant p=0.007). Although there was a good consistency between the AOD500 values between RTVue and Spectralis, (for temporal quadrant ICC: 0.825, for nasal quadrant ICC: 0.882) it was determined that Spectralis showed higher results than RTVue (p˂0.001). Although Pentacam, RTVue and Spectralis measurements are found to be consistent with each other for the evaluation of ICA, considering the differences between the devices of both ACA-SSA and AAU500 values, it may be considered that the relevant devices may not be used inter changeably in patient follow-ups.

Summary Purpose To evaluate at six months the intraocular lens (IOL) decentration, tilt and lenticular astigmatism between foldable sutured and sutureless scleral fixation IOLs compared to conventional phacoemulsification surgery. Methods We retrospectively reviewed records for 22 eyes with sutureless scleral fixation, 16 eyes with sutured scleral fixation and 23 eyes with conventional phacoemulsification. IOL decentration and angle of IOL tilt were compared on Scheimpflug images 6 months after surgery. Lenticular astigmatism is described as the difference between refractive and net corneal astigmatism. Results The angle of tilt in both meridians was significantly lower in the sutureless group than in the sutured group (P = 0.008 horizontally and P = 0.002 vertically). IOL decentration did not show a significant difference between the three groups in either horizontal or vertical meridians (P ˃ 0.05). Lenticular astigmatism was significantly lower in the sutureless and control groups than in the sutured group (P = 0.003 and P Conclusion In addition to being relatively quick and easy to perform, the sutureless scleral fixation technique showed superior results in terms of IOL tilt and lenticular astigmatism at the six-month follow-up compared to the sutured technique.

Kaderli, Sema/0000-0003-4851-6527; Eksioglu, Umit/0000-0002-3061-7162 WOS: 000547899200008 PubMed: 32300919 Purpose To evaluate alterations in corneal biomechanical properties before and 6 months after conventional trabeculectomy (TRAB) and Ahmed glaucoma valve (AGV) implantation. Methods Thirty-nine eyes of 39 patients were evaluated retrospectively. Complete ophthalmological examinations including evaluation of corneal biomechanical properties using the Ocular Response Analyzer were performed before and after 6 months postoperatively. A mean of four measurements for corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann correlated intraocular pressure (IOPg), and corneal compensated intraocular pressure (IOPcc) was recorded. The participants had undergone trabeculectomy or shunt surgery as the first surgical procedure for glaucoma treatment of uncontrolled IOP with maximum antiglaucoma eyedrops. Results There were 20 eyes of 20 patients in trabeculectomy group and 19 eyes of 19 patients in AGV implantation group. There was no significant difference between two groups in terms of sex, age, eye laterality, lens status, antiglaucoma drug usage, preoperatively measured Mean Deviation of Humphrey Visual Field Analyzer, CH, CRF, IOPcc, and IOPg (p > 0.05). CH and CRF increased significantly after shunt surgery (p < 0.001). CH increased in trabeculectomy group postoperatively (p < 0.001); however, CRF showed a small amount of decrease, but this reduction was not statistically significant (p > 0.05). CH and CRF showed higher increase after AGV surgery than trabeculectomy surgery (p < 0.05). There was no significant correlation between IOP changes and CH-CRF changes in both TRAB and AGV groups (p > 0.05). Conclusion According to our results, surgical technique differences may have an impact on postoperative corneal biomechanical outcomes. AGV surgery offers better corneal biomechanical results than standard trabeculectomy in 6-month follow-up.

This study evaluates the effect of axial length and hyperopia error on macular choroidal thickness as well as choroidal vessel lumen diameter and area with EDI-OCT in short eyes. The study includes 64 volunteers who are over 18 years of ages and applied to Eye Clinic of Ankara Training and Research Hospital. Choroidal thickness, choroidal vessel lumen diameter and areas were measured with Spectralis® OCT device using EDI technique. The study group included 44 volunteers with hyperopic refractive error, and control group included 20 emmetropic volunteers. Macular choroid was statistically significantly thicker in all quadrants as the hyperopia error increased (p

Purpose To discuss surgical intervention strategies among patients with horizontal gaze palsy with concurrent esotropia. Methods Five consecutive patients with dorsal pontine lesions are presented. Each patient had horizontal gaze palsy with symptomatic diplopia as a consequence of esotropia in primary gaze and an anomalous head turn to attain single binocular vision. Results Clinical findings in the first 2 patients led us to presume there was complete loss of rectus muscle function from rectus muscle palsy. Based on this assumption, medial rectus recessions with simultaneous partial vertical muscle transposition (VRT) on the ipsilateral eye of the gaze palsy and recession-resection surgery on the contralateral eye were performed, resulting in significant motility limitation. Sequential recession-resection surgery without simultaneous VRT on the 3rd patient created an unexpected motility improvement to the side of gaze palsy, an observation differentiating rectus muscle palsy from paresis. Recession combined with VRT approach in the esotropic eye was abandoned on subsequent patients. Simultaneous recession-resection surgery without VRT in the next 2 patients resulted in alleviation of head postures, resolution of esotropia, and also substantial motility improvements to the ipsilateral hemifield of gaze palsy without limitations in adduction and vertical deviations. Conclusions Ocular misalignment and abnormal head posture as a result of conjugate gaze palsy can be successfully treated by basic recession-resection surgery, with the advantage of increasing versions to the ipsilateral side of the gaze palsy. Improved motility after surgery presumably represents paresis, not "paralysis," with residual innervation in rectus muscles.