Ptosis Surgery Using Mersilene Mesh Suspensory Material

Frontalis suspension procedure using a Mersilene mesh sling was performed on 23 ptotic eyelids of 22 patients (age range 3 to 35 years) with poor or absent levator function. The surgical technique used was a modified Fox's method. The mean palpebral fissure height was 3.1 mm preoperatively and increased to 8.0 mm after the operation. No serious complication was seen postoperatively and during an average follow-up of 25 months. In one case with a cosmetically inadequate result, the upper third of the initially implanted Mersilene mesh was removed during reoperation and histological examination of the specimen revealed fibrovascular tissue invasion through the mesh fibres. Mersilene mesh appears to be an effective and safe alternative sling material for brow suspension surgery, giving good permanent results for cases in which autogenous fascia lata was inappropriate.

Changes in the Conjunctival Flora after Conjunctivodacryocystorhinostomy (CDCR): A Preliminary Report

Purpose

To describe changes in the conjunctival flora due to retrograde flow after conjunctivodacryocystorhinostomy (CDCR) with Jones’ tube implantation.

Methods

In 20 patients, one year after unilateral CDCR with Jones’ tube implantation and a functionally successful outcome, conjunctival and nasal mucosal specimens were taken from the operated side for bacteriological analyses and non-operated eye conjunctival specimens were simultaneously taken as the control group. The samples were cultivated in conventional media and also in hypertonic media in order to isolate L-forms of bacteria and to increase the isolation rate and sensitivity.

Results

Bacterial growth was detected in 16 operated (80%) and 11 non-operated eyes (55%) and 26 bacteria were isolated from nasal mucosa in 20 cases (isolation rate 100%). Bacteria isolated from the non-operated specimens were S. epidermidis (63.6%, seven cases), S. aureus (27.2%, three cases) and Corynebacterium sp. (9.0%, one case). Conjunctival cultures of the operated eyes yielded S. epidermidis in three (18.7%), S. aureus in six (37.5%), Corynebacterium sp. in two (12.5%) and other bacteria in five (31.3%). Nasal mucosal cultures contained S. epidermidis in nine cases (45%), S. aureus in eight (40%), Corynebacterium sp. in two (10%) and miscellaneous bacteria in seven cases (35%).

Conclusions

After CDCR the conjunctival flora of the eye undergoes differentiation and becomes similar to the nasal flora.

Viscocanalostomy with Mitomycin-C: A Preliminary Study

Purpose

To compare the results of viscocanalostomy with and without mitomycin-C (MMC).

Methods

Retrospective results of 15 standard viscocanalostomy (VCO) operations (Group 1) were compared with the prospective results of 15 VCO operations performed with intraoperative adjunctive MMC (Group 2). MMC (0.2 mg/mL) was applied over and under the superficial scleral flap for 3 minutes in Group 2 before the deep flap was prepared. Each patient was followed up for at least 1 year, and results of examinations in the first 12 months were used in the statistical comparison of the two groups. Surgical success was defined as intraocular pressure (IOP) ≤ 18 mmHg.

Results

Pr eoperative mean intraocular pressures (IOP) in Group 1 and Group 2 wer e 35.3±11.0 and 39.1±8.9, respectively. Mean IOP levels at the 12th month were 14.4±2.6 and 11.9±4.0, respectively, showing a significant decrease in both groups (p<0.001). Postoperative IOP course appeared to be lower in the MMC group, however, the difference was not statistically significant (p=0.554). Complete success rates without medications were 40% in Group 1 and 67% in Group 2. No significant difference was found between the two groups in terms of early and late postoperative complications, pre- and postoperative number of antiglaucoma medications, and surgical success rates at the end of the study period (p>0.05 for all). A significant difference was verified between the two groups of eyes considering the conjunctival bleb types, as low-lying, localized blebs were the most frequent type in Group 1 and thin-walled, avascular blebs were more predominant in the MMC group (p=0.004).

Conclusions

Intraoperative adjunctive MMC use might improve the long-term results of viscocanalostomy by facilitating subconjunctival filtration and might widen the indication range of the technique.

Lipoprotein (a) in Behçet's disease as an indicator of disease activity and in thrombotic complications

PURPOSE

To evaluate the utility of plasma concentrations of lipoprotein (a) (Lp(a)) as an indicator of disease activity in Behçet's disease and to investigate its role in thrombotic complications of this disease.

METHODS

30 patients (19 male, 11 female) with Behçet's disease (8 active, 22 inactive) were enrolled in the study group and 30 healthy individuals (16 male, 14 female) in the control group. Seven of the inactive Behçet's disease patients had a history of thrombotic complications. The disease activity was evaluated by clinical manifestations (oral aphthous lesions, genital ulcerations, uveitis and vasculitis) and laboratory investigations (leucocyte count, lipoprotein (a), C-reactive protein (CRP), complement 3 (C3) and complement 4 (C4) concentrations).

RESULTS

Plasma Lp(a) and other acute phase reactant concentrations were significantly higher in the study group than in the controls (p < 0.01). These concentrations were also higher during the active period of the disease than during the inactive phase (p < 0.01). Lp(a) concentrations were significantly correlated with concentrations of other acute phase reactants. There was no difference between the groups with and without thrombotic complications for any of these measurements. CONCLUSIONS. Plasma levels of Lp(a) might be an indicator of disease activity in Behçet's disease. There is no correlation between Lp(a) levels and thrombotic sequela in inactive Behçet's disease. However, further studies are needed on the thrombogenic role of Lp(a) during the active phase of thrombophlebitis, and in larger series.

Correlation of clinical and neuroradiological findings in down-gaze palsy

BACKGROUND

Isolated down-gaze palsy is the least common pathology of vertical gaze. Patients with low-gaze palsy may consult an ophthalmologist with difficulty in reading and this may be the only ocular finding of a central nervous system lesion.

METHODS

A 43-year-old man with isolated down-gaze palsy was examined. The medical history of the patient revealed that he had had myocardial infarction.

RESULT

Magnetic resonance imaging disclosed an ischemic area at the right thalamus.

CONCLUSION

Down-gaze palsy may be an important sign for the diagnosis of thalamic infarctions due to embolic syndrome.

Effect of botulinum toxin injections into rabbit eye

The aim of this study was to investigate the adverse effects of the intraocular injection of botulinum toxin in rabbits. Intravitreal injections of botulinum toxin A in five doses, 1.25, 2.5, 5, 10, 25 units, were given into five rabbit eyes. The same volume of saline was injected into the second eye of the rabbit as a control. External examination, ophthalmoscopy, visual evoked potentials and electroretinography were done before injection and repeated at the first and second weeks after the injection. There were no significant differences in retinal function between toxin- and saline-injected eyes, neither ophthalmoscopically nor electrophysiologically. Ipsilateral mydriasis developed in the eyes injected with botulinum toxin. This study suggests that botulinum toxin has no harmful effect on retinal function.

Acute blindness and putaminal necrosis in methanol intoxication

PURPOSE

To review the neuro-ophthalmological and radiological findings of acute methyl alcohol intoxication.

METHOD

8 acute methyl alcohol intoxication cases were evaluated.

RESULTS

All patients were male and their ages varied between 21 and 55. At the initial examination, 6 to 12 days after methanol intake, visual acuity ranged from no light perception to counting fingers at 2 meters with no color perception. Bilateral dense central scotomas were detected in patients whose vision was slightly preserved. Pupillary light reactions were either absent or sluggish. In 4 cases, edema of the optic disk and the peripapillary nerve fiber layer was observed. Three months later, optic atrophy had developed. Five patients underwent magnetic resonance imaging. Bilateral putaminal hyperintense lesions on T2 weighted images were observed in 3 cases. Two patients died and autopsy permission could not be obtained. Follow-up examination 12 months later revealed optic atrophy in the other six cases, with no improvement in vision.

CONCLUSION

Methanol intoxication is detrimental to health, possibly resulting in blindness and occasionally death. In association with ocular signs and the other systemic and laboratory features, the ophthalmologist should be alert to the diagnosis of methanol intoxication in which visual loss may be the only symptom.

A case of congenital orbital cyst originating from the common sheath of superior rectus and levator palpebrae superioris muscles

PURPOSE

To assess the clinical and histopathological features of a case of congenital orbital cyst originating from the common sheath of the superior rectus and levator palpebrae superior muscles.

METHODS

Preoperative, peroperative and postoperative characteristics of the described clinical condition in a 37-year-old woman is documented.

RESULTS

The cyst was found to be related with the common sheath of the superior rectus and levator muscles during the surgical intervention and histopathological examination revealed a cystic structure with a lining resembling that of conjunctiva.

CONCLUSION

Our findings support the proposal by Rose & O'Donnell who first reported four cases in 1995 suggesting a new group of congenital orbital cysts distinct from dermoid, epidermoid or conjunctival cysts.

Clinical and histopathologic findings of iris nevus (Cogan-Reese) syndrome

PURPOSE

To report a case of Cogan-Reese syndrome.

METHOD

Case report. A 37-year-old man presented with Cogan-Reese syndrome.

RESULTS

Visual acuity was 0.5 in the right eye and 1.0 in the left eye. There were corneal edema and pigmented nodules on the anterior surface of the iris, iris atrophy and ectropion uvea in the right eye. The intraocular pressure was 42 mmHg in the right eye and there was glaucomatous optic atrophy of the optic disk. Trabeculectomy with mitomycin C has been performed as the intraocular pressure did not decrease with the maximum medical treatment. Electron microscopic examination of the trabeculum and the iris tissue revealed a lot of melanocytic cells in the stroma.

CONCLUSION

Trabeculectomy with mitomycin C might be effective in Cogan-Reese cases with glaucoma resistant to medical treatment.

CDCR with buccal mucosal graft: comparative and histopathological study

BACKGROUND AND OBJECTIVE

Conjunctivodacryocystorhinostomy (CDCR) is a procedure with a high functional success rate, on the other hand post-operative complications are frequent and tube replacement is often required. Therefore, new investigations were undertaken in order to relieve the undesired effects of the tube. Implantation of the Jones tube circumscribed with a buccal mucosal graft and subsequent removal of the tube when an epithelium lined track was formed has been reported in the literature in recent years. In this study efficacy and safety of this alternative technique was evaluated.

PATIENTS AND METHODS

CDCR with insertion of Jones tube surrounded with a buccal mucosal graft was performed on 14 patients (14 eyes) between September 1995 and March 1997 and results were evaluated. Results were compared with our previous series of traditional CDCR, involving 22 patients (22 eyes).

RESULTS

Functional success was obtained in all cases with relief of epiphora after a mean follow-up of 13.7+/-5.7 months. In 11 cases, tubes were removed at the sixth post-operative month and passage was blocked in 9 cases. Subsequent surgical tube reinsertion was performed in those patients. Biopsy specimens were obtained in two cases during tube replacement and were examined histologically. Disarrangement of the basal epithelial cells and infiltration of the surrounding connective tissue with round cells were observed. These histopathological findings suggested a significant graft degeneration threatening the continuity of the passage. Tube displacement existed in two patients, and partial mucosal graft extrusion was apparent in one case during the period with the tube still inserted. Surgical tube replacement was required in only two cases to correct lateral migration of the tube. Incidence of complications and need for surgical tube replacement were found to be less than our previous series of 22 CDCR patients without buccal mucosa grafting.

CONCLUSION

These findings suggest that CDCR with buccal mucosal graft is a promising new method for the treatment of epiphora because of its low incidence of complications during the period with the tube. However, tube removal at the sixth post-operative month is probably not indicated. Therefore, studies with larger series and longer follow-up should be undertaken to confirm the advantages of the technique.

Anticardiolipin antibodies and retinal vascular complications in Behçet's disease

BACKGROUND AND OBJECTIVE

Intravascular thrombosis is a well-recognized feature of Behçet's disease (BD). In this study, the existence of a connection between serum anticardiolipin (aCL) antibodies and retinal vascular complications in BD is investigated.

PATIENTS AND METHODS

Serum aCL antibody levels were quantified in 31 patients with BD, all of whom fulfilled the major criteria of the disease. Patients were evaluated in terms of retinal vascular complications. Serum aCL antibody levels were determined through the ELISA method. Statistical analysis was performed with the chi-squared test and the Fisher exact test.

RESULTS

Of 12 patients with high aCL antibody levels, retinal vascular thrombosis was detected in 5 and retinal vasculitis was present in 8. However, there was no statistically significant relation between these complications and serum aCL antibody elevation (P > .05).

CONCLUSION

Based on this series of 31 patients with BD, there does not seem to be a significant correlation between retinal vascular complications and serum aCL antibody levels.

Brown's syndrome with cyclic characteristic: case report and review of physiopathologic mechanism

This article reports on an acquired Brown's syndrome case presenting with cyclic characteristics. Restriction of elevation in adduction was observed in the right eye of a 15-year-old boy who had been referred with a complaint of diplopia that occurred on waking in the morning and continuing until noon. The same situation was noted following afternoon naps. The patient was able to improve his complaint by performing a forced elevation in adduction while massaging his right trochlear region and the restriction did not recur until the next morning.

Traumatic globe luxation

A case of globe luxation which followed a relatively slight trauma is presented. The luxation was accompanied by laceration of the conjunctiva in this case. After achieving reposition in the emergency room, the patient underwent a surgical exploration of extraocular muscles and conjunctival fornices where many eyelashes were removed. The clinical features and management of globe luxation is discussed, importance of surgical exploration is emphasized.

A case of aberrant lacrimal gland and fistula

A case of aberrant lacrimal gland and fistula sited extraorbitally is presented in view of its rare incidence.