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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.

To investigate the antiapoptotic effect of topically administered azithromycin (AZM) on corneal epithelial and endothelial cells in a rat model of corneal alkali burn.Twenty-four Wistar albino rats were divided into 4 equal groups as pseudovehicle (group 1), control (group 2), alkali burned (group 3), and treatment (group 4) groups. Alkali injury was induced only in the right corneas of rats belonging to groups 3 and 4 using 1N NaOH. The rats in group 3 and the rats in group 4 were respectively treated either with an artificial tear gel or with 1.5% AZM eye drops for 5 days. At the fifth day of the experiment, the apoptosis in the corneal epithelium and endothelium of all rats was assessed using a terminal dUTP nick-end labeling (TUNEL) assay. In addition, tumor necrosis factor-alpha (TNF-α) density in the corneal epithelium was measured in all rats.The mean numbers of TUNEL+ cells in the corneal epithelium and endothelium of rats in group 3 were 117.1 ± 23.8 and 34.6.± 11.3, respectively, whereas in group 4, they were 75.8 ± 15.7 and 14.7 ± 3.5, respectively. Also the mean TNF-α densities in the corneal epithelium in group 3 and group 4 were 2.65 ± 1.3 and 1.65 ± 1.1, respectively. There was a significant decrease in the mean number of TUNEL+ cells in the corneal epithelium and endothelium and in the mean TNF-α density in the corneal epithelium of rats in group 4, when compared with group 3.Topically applied AZM can decrease TNF-α-induced apoptosis in corneal alkali burn.

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.

Background and Objective To compare the success, complication, and patient discomfort rates of transcanalicular diode laser dacryocystorhinostomy (TCDL-DCR) and external dacryocystorhinostomy (EX-DCR) surgeries performed in patients with primary acquired nasolacrimal duct obstruction. Materials and Methods Eighty consecutive patients were included in the study, and groups were assigned according to DCR technique. Thirty-four (42.5%) patients received TCDL-DCR (Group A) and 46 (57.5%) patients (Group B) received EX-DCR with temporary silicone stent intubation. The success of surgery was determined by the relief of epiphora, patient satisfaction, endoscopic evaluation of ostium patency, and lacrimal system syringing. Pearson Chi-Square test, Fisher's Exact test, and Student's t-test were used for statistical analyses. Results Group A included 22 females and 12 males with a mean age of 49.1 ± 15.1 years, Group B included 35 females and 11 males with a mean age of 50.8 ± 11.7 years. There was no difference between groups in terms of age and gender (P = 0.905 and P = 0.167, respectively). The duration of the operation was 22.2 ± 4.8 minutes for Group A, while it was 56.3 ± 15.7 minutes for group B (P = 0.0001). In two patients in Group A, injury in the medial turbinate was recorded, and in Group B, 14 patients experienced mild to severe perioperative bleeding. The perioperative complication rate was significantly different between the groups (P = 0.004). Success in relieving symptoms was 79.4% for Group A and 89.1% for Group B. The difference in the success rates was not statistically significant (P = 0.229). Conclusions Although EX-DCR success rate was higher than that achieved with TCDL-DCR, the latter, with its shorter duration of surgery, lower perioperative complication rate, and a similar success rate, may be a good and acceptable surgical alternative in treatment of primary acquired nasolacrimal duct obstruction. Lasers Surg. Med. 46:275–280, 2014. © 2014 Wiley Periodicals, Inc.

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.

To evaluate the effects of different artificial tear eye drops on Ocular Surface Disease Index (OSDI), tear osmolarity, Schirmer's I test, and tear break-up time (TBUT) in patients with dry eye disease.This 12-week, single-institution, single-masked, randomized, pilot study was conducted in Turkey between March and July 2012 in patients with dry eye. Patients were randomly assigned to receive Systane® for their right eye and Eyestil® for their left eye or to receive Tears Naturale II® for their right eye and Refresh Tears® for their left eyes. Outcomes were assessed at baseline and weeks 2, 4 and 12 after treatment initiation.Twenty-two patients received Systane (right eye) and Eyestil (left eye) and 21 patients received Tears Naturale (right eye) and Refresh (left eye). At each visit and for each outcome, each treatment group demonstrated a significant improvement from baseline (p 0.001); however, none of these outcomes were significantly different among treatment groups at any visit. At week 12, the mean OSDI improvement was similar between the Systane/Eyestil group (-26.4 ± 10.6) and the Tears Naturale/Refresh group (-27.6 ± 14.8). The mean tear osmolarity decrease (mOsm/L) at week 12 was -33.8 ± 8.3 for Eyestil, -30.3 ± 9.2 for Refresh, -28.4 ± 8.2 for Systane and -25.7 ± 13.1 for Tears Naturale. The mean Schirmer's test increase at week 12 (mm/5 min) was 6.7 ± 3.4 for Eyestil, 6.4 ± 2.9 for Systane, 4.7 ± 2.4 for Tears Naturale and 4.7 ± 2.8 for Refresh. The mean TBUT increase at week 12 (s) was 7.0 ± 3.4 for Systane, 6.1 ± 3.3 for Eyestil, 5.8 ± 2.3 for Tears Naturale, and 5.6 ± 2.8 for Refresh.All four artificial tear formulations were effective in relieving dry eye signs and symptoms. Although the greatest improvement in two of the objective tests was achieved by Eyestil, the drug with the lowest osmolality, differences among the four artificial tear eye drops were not statistically significant.

Purpose. This report aimed to describe a minor modification of the traditional direct browplasty technique that aids in surgical planning for patients with brow ptosis secondary to facial paralysis without changing the shape of the brow.Case Report. A 74-year-old male patient with left facial paralysis secondary to chronic otitis media was referred with a complaint of low vision due to brow ptosis. We performed direct browplasty with a minor modification in order to aid a treatment customized to the patient. In this technique, a transparent film paper is used to copy the brow shape. A brow-shaped excision is facilitated just superior to the ptotic brow.Conclusion. The authors found that thecopy-paste-exciseandstitch techniquewas effective and successful for deciding the shape and the amount of excision that should be performed in patients with brow ptosis without resulting in asymmetrical, arched, and feminized brows.

Background: To evaluate the efficacy and tolerance of two different foldable anterior chamber phakic intraocular lenses for high myopia. Design: A prospective interventional case series at the Eye Clinic, Kartal Training and Research Hospital, Istanbul, Turkey. Participants: Sixty-two eyes of 31 patients received iris-claw lens (group 1) (Artiflex AC 401, Ophtec), and 43 eyes of 22 patients received angle-supported lens (group 2) (I-Care, Corneal). Methods: The mean preoperative spherical equivalents for group 1 and group 2 were −12.13 D and −18.95 D, respectively. Endothelial cell density was measured at day 1 and at 1, 3, 6, 12 and 18 months for follow ups. Main Outcome Measures: Percentage change in endothelial cell density and improvement in visual acuity. Results: At the 18-months follow up, uncorrected visual acuity improved to logMAR 0.37 ± 0.23 from 1.60 ± 0.10 in group 1, and logMAR 0.47 ± 0.14 from 0.70 ± 0.20 in group 2; best spectacle corrected visual acuity improved to logMAR 0.23 ± 0.22 from logMAR 0.36 ± 0.14) in group 1, and logMAR 0.29 ± 0.18 from logMAR 0.50 ± 0.20) in group 2 (P

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)

Neonatal progeroid syndrome (NPS) is a rare, autosomal recessive disorder characterized by an aged face, wrinkled skin, decreased subcutaneous fat, and neonatal teeth. The authors describe herein a 2-month-old infant with NPS who underwent eyelid surgery for bilateral upper eyelid entropion and stromal keratitis. The preoperative examination revealed thin, narrow, and soft tarsal plates. The eyelids were large and floppy, and there was no preaponeurotic fat tissue. The entropion was successfully treated by the levator muscle advancing onto the tarsus, anterior lamellar repositioning, horizontal eyelid shortening, and canthal resuspension. Upper eyelid entropion may occur relatively frequently in infants with NPS, and the special anatomical features of the eyelid should be considered while performing entropion surgery.

Purpose To determine the astigmatism outcomes after cataract surgery performed using superonasal and superotemporal clear corneal incisions. Setting Department of Ophthalmology, Kartal Training and Research Hospital, Istanbul, Turkey. Methods This prospective study includes consecutive 45 eyes of 34 patients having phacoemulsification with implantation of foldable acrylic intraocular lens through a corneal tunnel incision between January and April 2004. The right eye always had a superotemporal incision while the left eye a superonasal incision. Astigmatism was measured by keratometry readings before surgery and 3rd, 15th, and 45th days postoperatively. The surgically induced astigmatism (SIA) was calculated by the vector analysis using the Holladay–Cravy–Koch method at 3rd day, 2nd and 6th weeks postoperatively. Results The mean preoperative astigmatism was 0.74 ± 0.45 diopter (D) in the temporal incision group and 0.69 ± 0.39 D in the nasal incision group. Fifty-eight percent of eyes had against-the-rule (ATR) astigmatism, 26% had with-the-rule (WTR) astigmatism, and 16% were astigmatically neutral. At 6 weeks, 46% of eyes had ATR astigmatism and 35% had WTR astigmatism. The mean total astigmatism was lower in the temporal incision group than in the nasal incision group at all successive examinations postoperatively. Although the total astigmatism decreased at 6 weeks in both groups, temporal incisions yielded less total and surgically induced astigmatism (P < .05). Conclusions Cataract surgery using superotemporal incision induced significantly less SIA in the early postoperative period.

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.

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.

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.

A 42-year-old man presented with a white plastic-like material exposed in the left medial canthal area, with a fistula and purulent discharge. He had undergone endonasal dacryocystorhinostomy 7 years earlier for left eye epiphora; he had persistent postoperative epiphora and recurrent dacryocystitis despite multiple drainage attempts and antibiotics elsewhere. Computed tomography showed bilateral enlarged cystic lacrimal sacs, with a well-defined contoured tunnel-like hole at the center of the left sac. Treatment included excision of the foreign body, which was a Griffiths' collar button nasolacrimal stent, excision of the fistula tract, and revision dacryocystorhinostomy with implantation of bicanalicular silicone stent. He recovered with no further symptoms or complications. This case highlights the importance of follow-up for removal of an implanted Griffiths' stent after dacryocystorhinostomy. Patients with recurrent dacryocystitis may benefit from a detailed history of previous surgery, careful examination, and imaging to evaluate for endogenous and exogenous foreign bodies such as lacrimal sac calculi, and retained lacrimal sac stents.

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 compare the effects of dorzolamide-timolol combination and brimonidine on intraocular pressure (IOP) after phacoemulsification surgery. METHODS This prospective, randomized study included 69 eyes of 43 patients undergoing phacoemulsification and foldable intraocular lens implantation. Twenty-one patients were women and 22 were men. The mean patient age was 69.7+/-12.4 years. Patients were randomly assigned to one of three treatment groups preoperatively. Group A (n=23) received one drop of dorzolamide-timolol fixed combination and group B (n=23) received one drop of brimonidine tartrate 0.2% immediately after surgery. In group C (n=23), patients received no treatment and served as a control group. IOP was measured by Goldmann applanation tonometry 6 hours and 24 hours after surgery. RESULTS Six hours after surgery, the mean IOP was significantly lower in group A (16.3+/-2.9 mm Hg) than in groups B (20.6+/-2.9 mm Hg) and C (24.6+/-5.4 mm Hg). However, 24 hours after surgery, the mean IOP was higher in group C (19.8+/-4.7 mm Hg) than in the other two groups (14.1+/-2.8 mm Hg in group A and 17.5+/-2.7 mm Hg in group B). CONCLUSIONS Prophylactic treatment with dorzolamide-timolol fixed combination was more effective than brimonidine in reducing IOP 6 hours and 24 hours after phacoemulsification surgery.

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.

To evaluate structural alterations of iris and pupil diameters (PDs) in patients using systemic α-1-adrenergic receptor antagonists (α-1ARAs), which are associated with intraoperative floppy iris syndrome (IFIS).Eighty-eight eyes of 49 male were evaluated prospectively. Patients were assigned to 2 different groups. Study group included 23 patients taking any systemic α-1ARAs treatment, and control group included 26 patients not taking any systemic α-1ARAs treatment. All patients underwent anterior segment optical coherence tomography to evaluate iris thickness at the dilator muscle region (DMR) and at the sphincter muscle region (SMR). The PD was measured using a computerized infrared pupillometer under scotopic and photopic illumination.The study group included 46 eyes of 23 patients and the control group included 42 eyes of 26 patients. Most treated patients were on tamsulosin (16/23). Mean age was similar in the study and control groups (61.9±7.1 vs. 60.3±8, 2 years, nonsignificant). DMR (506.5±89.4 vs. 503.6±83.5 μm), SMR (507.8±78.1 vs. 522.1±96.4 μm) and the DMR/SMR ratio (1.0±0.15 vs. 0.99±0.23 μm) was similar in the study and control groups and these differences were nonsignificant. Scotopic PDs were also similar in both groups (3.99±1.11 vs. 3.74±1.35, nonsignificant). A significantly reduced photopic PD (2.89±0.55 vs. 3.62±0.64, P0.001) and an increased scotopic/photopic PD (1.42±0.44 vs. 1.02±0.30, P0.001) were found in the study group.Evaluating PD alterations might be more useful than evaluating iris structural alterations in predicting IFIS. There is still a need for a reliable method that will determine the possibility of IFIS.

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.

To investigate the potential role of serum cortisol and testosterone levels in chronic central serous chorioretinopathy (CSC). Serum cortisol and testosterone levels of six male patients with chronic CSC were evaluated by chemiluminescent immunassay. Hormone levels were compared with the normal reference values of healthy people. All patients were male, and the median age was 48 years (range: 42–54). The median duration of visual disturbance at presentation was 23 months (range: 12–48). Median 8:00 a.m. serum cortisol level was 11.6 μg/dl (min. 4.74, max. 18.3) and the cortisol levels were within the normal range in five of the six patients. All patients had normal serum testosterone levels, with a median value of 549.5 ng/ml (min. 246, max. 794). Serum cortisol and testosterone levels were within normal ranges and in patients with chronic CSC. The association between these hormones and chronic CSC might be weak.

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.

To evaluate the efficacy and tolerance of two different foldable anterior chamber phakic intraocular lenses for high myopia.A prospective interventional case series at the Eye Clinic, Kartal Training and Research Hospital, Istanbul, Turkey.Sixty-two eyes of 31 patients received iris-claw lens (group 1) (Artiflex AC 401, Ophtec), and 43 eyes of 22 patients received angle-supported lens (group 2) (I-Care, Corneal).The mean preoperative spherical equivalents for group 1 and group 2 were -12.13 D and -18.95 D, respectively. Endothelial cell density was measured at day 1 and at 1, 3, 6, 12 and 18 months for follow ups. Percentage change in endothelial cell density and improvement in visual acuity.At the 18-months follow up, uncorrected visual acuity improved to logMAR 0.37 ± 0.23 from 1.60 ± 0.10 in group 1, and logMAR 0.47 ± 0.14 from 0.70 ± 0.20 in group 2; best spectacle corrected visual acuity improved to logMAR 0.23 ± 0.22 from logMAR 0.36 ± 0.14) in group 1, and logMAR 0.29 ± 0.18 from logMAR 0.50 ± 0.20) in group 2 (P0.001, in both groups). Mean decreased endothelial cell density was 241 cells/mm(2) (8.61%) and 223 cells/mm(2) (8.42%) at 18 months follow up in group 1 and 2, respectively (P=0.17) but significant in comparison to preoperative values for both groups (P0.001).Although both iris-claw and angle-supported lenses offer good refractive outcomes significant endothelial cell density was observed at 18 months follow up.

Purpose To compare preserved human amniotic membrane transplantation and conjunctival autografts for treatment of primary pterygium. Methods Thirty-seven eyes of 35 patients with primary pterygium underwent surgical excision. In group A, 25 eyes were treated with conjunctival autografts. In group B, 12 eyes were treated with preserved human amniotic membrane transplantation. These two groups were compared in terms of complications, recurrence, and final appearance, prospectively. Results We observed two cases of recurrence in group A and five cases of recurrence in group B. The onset of recurrence was about 5.5 months in both groups. We observed two eyes with Dellen ulcer and one case with a Tenon's cyst in the superior temporal quadrant in group A and one case of Dellen ulcer and granulation tissue of one eye in group B. Conclusions We suggest that free conjunctival autografting is a more effective technique in primary pterygium in terms of lowering recurrences compared with the amniotic membrane transplantation technique.

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: To investigate the effectiveness of silicone hydrogel soft contact lenses for therapeutic applications. METHODS: The study included 37 patients who had bullous keratopathy (n=12), recurrent corneal erosion (n=9), filamentous keratitis (n=3), corneal melting after corneal surgery (n=4), lamellar lacerations (n=4), or chemical trauma (n=5) and were fitted with silicone hydrogel soft contact lenses between May 2000 and August 2003 in First Eye Clinic of Kartal Training and Research Hospital. Changes in corneal signs by slitlamp evaluation, judgment of pain relief, additional complications, and success of therapeutic lens treatment were reported. Appropriate medical therapy was given as required. RESULTS: A total of 83.78% of the patients had complete healing, and 8.1% of the patients showed at least partial improvement. Visual acuity improved in 56% of patients, and pain relief was achieved in 91.16% of the patients. No additional complications were reported in relation to the lenses. CONCLUSIONS: The use of high-Dk lotrafilcon A soft contact lenses for therapeutic purposes is safe, effective, and practical.

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. Resumo: 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. Keywords: Retinal nerve fiber layer thickness, Prone position, Spinal surgery, Intraocular pressure, Palavras-chave: Espessura da camada de fibras nervosas da retina, Pronação, Cirurgia da coluna vertebral, Pressão Intraocular

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.