Thermal necrosis-aided dental implant removal: A rabbit model pilot study

BACKGROUND

The significant advances in the materials and biological aspects of dental implants haven't completely eradicated the implant failures. The removal of osseointegrated but otherwise failed implants present several challenges including adjacent tissues damage and necessity of bone augmentation for reimplantation. Controlled thermal necrosis has emerged as an alternative technique to aid removal of osseointegrated dental implants with minimal to no defect to healthy bone or surrounding tissues. This study aimed to evaluate the thermal necrosis-aided implant removal method in a rabbit osseointegration model.

MATERIAL AND METHODS

A total of 8 male New Zealand rabbits were used in the study. Two dental implants were placed on each femur of the rabbits. Heating of the implants was performed after 7 weeks following the implantation. Heating was done by contacting the tip of an electrosurgey tool in monopolar mode at different power settings and contact durations (5W - 2 seconds, 5W - 10 seconds, and 10 W - 10 seconds). No heating was done on the control group. Implant stability right after implantation, before heat application and after heat application was determined using an Osstell™ Mentor Device. Following the removal of implants histological analyses were performed to determine the effects of heat application at cellular level.

RESULTS

ISQ values of the 10W-10s group was significantly lower compared to the other groups (p<0.001). No indication of progressive necrosis or irreversible damage was observed in any of the groups. However, the percent of empty-apoptotic lacunae were statistically higher in the 5W-10s and the 10W-10s groups compared the control and the 5W-2s groups.

CONCLUSIONS

Within the conditions of this study, we conclude that heat application with an electrosurgery tool using monopolar mode at 10W power for 10 seconds is optimal for reversing osseointegration with no extensive or progressive damage to the bone.

Lacrimal Function and Ocular Complications in Patients Treated with Systemic Isotretinoin

Purpose

To evaluate the effect on lacrimal function and ocular complications in patients with severe acne vulgaris during systemic treatment with 13- cis -retinoic acid (isotretinoin).

Methods

Forty patients with acne vulgaris were treated with systemic isotretinoin at dosages of 0.5-1 mg/kg per day for two months. Full ophthalmologic examination, Schirmer / test, fluorescein break-up (BUT) and microbiological investigations of the conjunctival flora were done before, during the second month and at least one month after the end of the treatment.

Results

The average Schirmer values before and after the treatment were 21.6 mm/5 minutes (SD ± 7.01) and 18.48 mm/5 minutes (SD ± 7.87) respectively. After the treatment BUT was less than 10 seconds in 50% of the patients and 55% had blepharitis. Subjective symptoms like dryness, itching and contact lens intolerance occurred in 42.5% and colonization of the conjunctiva by Staphylococcus aureus increased significantly during treatment (p = 0.031). All abnormal findings disappeared one month after the cessation of treatment.

Discussion

Isotretinoin causes signs and symptoms of dry eye, probably by reducing meibomian gland function, but ocular complications are generally not serious when low doses are used for a limited time, and are reversible after discontinuation.

Morphometric evaluation and surgical implications of the infraorbital groove, canal and foramen on cone-beam computed tomography and a review of literature

BACKGROUND

The purpose of this study is to evaluate the anatomy, morphometry, and variations of infraorbital groove (IOG), infraorbital canal (IOC) and infraorbital foramen (IOF) on the cone-beam computed tomography (CBCT) images and to investigate their relations with surrounding structures.

METHODS

IOG, IOC and IOF were evaluated retrospectively in CBCT images of 75 female (F) and 75 male (M) cases with a range of 18-65 years (F: 37.62 ± ± 13.55, M: 37.53 ± 15.87) by Planmeca Romexis programme. IOG, IOC and IOF were examined bilaterally (300 sides) in the cases. The 13 parameters were measured on these images in axial, sagittal and coronal planes.

RESULTS

There was a very weak positive correlation between the age and the angle between IOC and IOG (p = 0.015, r = 0.198), there was a weak positive correlation between the age and skin thickness (p = 0.001, r = 0.281), and there was no correlation between the age and other parameters. A total of 21 (7%) IOCs were detected in maxillary sinus, bilaterally in 6 cases and unilaterally in 9 cases (5 on the left, 4 on the right). In 1 case, bilaterally, IOC was separated 2 canals while running anteriorly in the maxillary sinus. The larger one was directed to IOF in its normal course and the smaller one was directed to lateral wall of nasal cavity and opened to the inferior nasal meatus in front of the opening of nasolacrimal duct.

CONCLUSIONS

We suggest that the parameters found in the present study may facilitate prediction of the location of the infraorbital nerve. Knowledge of this exact position in relation to easily measurable parameters may decrease the risk of infraorbital nerve injury during surgical approaches directed to this region and might serve as a guide during local anaesthetic interventions for dentistry, ophthalmology, plastic surgery, rhinology, neurosurgery and dermatology.

Anatomical evaluation of nasopalatine canal on cone beam computed tomography images

BACKGROUND

Nasopalatine canal (NPC) (incisive canal) morphology is important for oral surgery techniques carried out on the maxilla, in the treatment of naso- palatine cyst, palatal pathologies that require a surgical intervention.

MATERIALS AND METHODS

The morphology of NPC was classified in sagittal, coronal and axial planes on the cone beam computed tomography (CBCT). The length of NPC was found by measuring the distance between the mid-points of nasopalatine foramen and incisive foramen. The numbers, shapes and diameters of incisive and nasopalatine foramina were examined. Nasopalatine angle present between the NPC and the palate and anterior to the NPC was measured.

RESULTS

In the sagittal plane, the shape of NPC was classified in six groups: 26.7% hourglass, 14.7% cone, 13.3% funnel, 16.0% banana, 28.7% cylindrical and 0.7% reverse-cone-shaped. In the coronal plane, shape of NPC was classified in three groups: 63.3% Y-shaped, 36.0% single canal, 0.7% double canal and external border of NPC was classified in four groups: 26.7% U, 28.7% Y, 44.0% V and 0.7% reverse-V-shaped. In the axial plane, the shape of nasopalatine foramen, incisive foramen and NPC at the mid-level was evaluated. The shape of the canal was detected as four types at three evaluated levels: round, oval, heart- and triangle-shaped. It was seen in every three axial planes that the round group is more than the others.

CONCLUSIONS

The morphological properties and variations of NPC should be con- sidered with a correct radiological evaluation so as to prevent the complications and improper practices in local anaesthesia, maxillary surgery and implant surgery practices. Especially dentists, otolaryngologist and plastic surgeons need to know the anatomy and variations of NPC.

Lacrimal Sac Dacryolith: A Study with Atomic Absorption Spectrophotometry and Scanning Electron Microscopy

Dacryoliths are uncommon causes of partial or complete obstruction of the nasolacrimal drainage apparatus. We report our findings of a dacryolith that we studied by culture, light microscopy, atomic absorption spectrophotometry, and scanning electron microscopy. Although no fungi were recovered by culturing, hyphae-like structures were observed. No inorganic material was detected by atomic absorption spectrophotometry. Scanning electron microscopy of ultrastructure showed the stone was composed of lobes and lobules built on an amorphous core material.

Expression of p53 Protein in Pterygium

Purpose

The pathogenesis of pterygium is still not completely understood and many environmental factors, including ultraviolet (UV) radiation, play an important role in its etiology. Chronic exposure to UV radiation causes mutations in the p53 tumor suppressor gene, eventually leading to tumor formation. We analyzed the immunohistochemical expression of p53 proteins in pterygial tissues to determine the role of the p53 tumor suppressor gene in the development of pterygium.

Methods

Pterygial specimens were studied immunohistochemically using antibodies against p53 protein.

Results

Out of 38 specimens studied, 35 (92.1%) had conjunctival epithelial cells without p53 specific nuclear staining. Only three specimens (7.9%) had a few p53 stained cells. The role of UV radiation in the pathogenesis of pterygium is supported by epidemiological, geographical and microscopic findings. However, our results are not consistent with these data on a genetic basis.

Conclusions

We conclude that defective p53 tumor suppressor gene function seems to have no role in the pathogenesis of pterygium.

Conventional or Endoscopic Probing for Congenital Nasolacrimal Duct Obstruction

Purpose

To compare conventional and endoscopic probing for congenital nasolacrimal duct obstruction in infants.

Methods

Conventional probing was performed in 22 eyes of 18 patients, age range 7–14 months (mean 11.4 months). Probing was done with intranasal endoscopic visualization in 18 eyes of 14 patients, age range 7–13 months (mean 11.2 months). All were primary probing cases.

Results

After conventional probing 2 of the 22 cases required reprobing. After endoscopic probing only 1 of the 18 cases required reprobing.

Conclusions

In most cases of congenital nasolacrimal duct obstruction endoscopy is not required; however, in failed cases direct visualization of the inferior meatus with endoscopic guidance may be helpful.

Anatomical characteristics of the lingual foramen in ancient skulls: a cone beam computed tomography study in an Anatolian population

BACKGROUND

The purpose of this study is to evaluate the anatomical features of lingual foramina and their bony canals in Anatolian ancient mandibles (9-10th century) by using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

Fifty-eight ancient dry mandibles were scanned with CBCT. Lingual foramina were grouped into midline, paramedian, posterior foramina and combination of these groups. Midline group was also classified according to internal surface of the mandible (gonial tubercles [GTs]). The incidence, vertical distance and diameter of lingual foramina were measured according to age groups and gender.

RESULTS

The incidence of the lingual foramen was 96.6%. Midline of the symphysis had the highest incidence (34.4%) of foramina (p < 0.05), followed by both midline and paramedian type (32.8%; p < 0.05). Classification in terms of GT represented class 3 as the most encountered group (28.6%). Number of foramina observed in the mandibles ranged from 0 to 6 with the incidence of 3.4% and 32.8%, respectively. The male and < 35 years groups presented larger measurement values in midline region (p < 0.05).

CONCLUSIONS

Mandibular lingual foramina and bony canals are frequently present in ancient mandibles. When compared with modern subjects, similar findings are observed according to published literatures. CBCT is also proved to be an effective imaging modality in the detection of lingual foramina and canals in anthropological studies.

An anatomical study on the three-headed biceps brachii in human foetuses, and clinical relevance

The biceps brachii (BB) is as one of the most variable muscles in the human body in terms of number and morphology of its heads. The most frequent variation is the presence of a third head, which has been reported by several authors in different populations. Our aim was to find the occurrence of the supernumerary head of BB in Turkish foetuses. Out of the 24 upper limbs of the foetuses, two (8.33%) arms were found to have a three-headed BB. The variations were present unilaterally in the right arm of one male foetus and one female foetus. In one of the cases, the third head of BB originated from the anteromedial aspect of the humerus just distal to the insertion of the coracobrachilais, medial to the brachialis, and in the other the third head was a thin muscle bundle, which arose on the lateral side of the insertion of coracobrachialis and over the origin of the brachialis. Both of them were extended distally and joined the common tendon. The occasional presence of the three-headed BB in the foetuses observed in the present study was similar to those of adults reported in previous studies. In conclusion, these variations are not rare and are interesting not only to anatomists but also to orthopaedic surgeons, plastic surgeons, traumatologists, physiotherapists, doctors dealing with sports medicine, and radiologists.

Serum allergen specific immunoglobulin E levels in patients with allergic conjunctivitis

PURPOSE

To evaluate serum allergen specific immunoglobulin E (IgE) levels in patients with various types of allergic conjunctivitis.

METHODS

Twenty-five patients with seasonal allergic conjunctivitis (SAC), 17 patients with perennial allergic conjunctivitis (PAC), and 10 patients with vernal conjunctivitis (VC) were included in the study. Specific IgE levels to Dermatophagoides pteronyssinus (Dp), Dermatophagoides farinae (Df), mixed grass pollens, and animal epithelia were measured using Pharmacia CAP system (Pharmacia Diagnostic AB, Uppsala, Sweden).

RESULTS

The percentage of subjects with specific IgE against Dp and Df was statistically higher in VC (30%) compared to PAC (5.9%) and SAC (0%) (p=0.03). Specific IgE against mixed grass pollens was found in 30% of VC and 40% of SAC, whereas 10% of VC and 8% of SAC patients were found to be hypersensitive to animal epithelia.

CONCLUSIONS

Allergic reaction against house dust mites and pollens was common in VC, whereas specific IgE against grass pollens was remarkable in SAC. IgE levels specific to various antigens might be measured by UNICAP system, which is a rapid and practical technology.

Systemic associations and prevalence of exfoliation syndrome in patients scheduled for cataract surgery

PURPOSE

To study the frequency of exfoliation syndrome (XFS) and its association with intraocular pressure (IOP) and systemic diseases in patients with age-related cataract scheduled for surgery.

METHODS

All 1480 cataract patients had a comprehensive systemic and eye examination, including slit-lamp biomicroscopy before and after mydriasis, IOP measurement, gonioscopy, and fundus examination.

RESULTS

The percentage of XFS among patients scheduled for cataract surgery was 16.4, with no gender difference (p=0.833). The mean age of XFS patients (74.3+/-7.0 years) was significantly higher when compared to the ones without XFS (66.5+/-10.9 years) (p<0.001). XFS was unilateral in 41.3% of the subjects and bilateral in 58.7%. The number of subjects with XFS increased significantly with aging (p<0.001) (OR=1.093, 95% CI=1.073-1.14) (p<0.001). The most common type of cataract was nuclear in the XFS group (33.5%) and 24.6% of patients with mature cataract had XFS. In the XFS group, 11.2% of the subjects had glaucoma, which was statistically higher than the non-XFS group (4.6%) (p<0.001) (OR=2.67, 95% CI=1.65-4.32). Eighty-four patients had glaucoma and 27 of them (32.1%) had exfoliative glaucoma. The only systemic disease that was found to be associated with XFS was coronary heart disease with an OR of 1.49 (95% CI=1.068-2.072) (p=0.019).

CONCLUSIONS

XFS is a common problem in the aging cataract population of Turkey and increased IOP, glaucomatous optic neuropathy, and coronary heart disease occur more frequently in patients with XFS compared with subjects without XFS.

The relationship of the posterior inferior cerebellar artery to cranial nerves VII–XII

The posterior inferior cerebellar artery (PICA) is the largest branch of the vertebral artery. It usually arises at the anterolateral margin of the medulla oblongata close to the lower cranial nerves. The PICA had the most complex relationship to the cranial nerves of any artery and it is frequently exposed in approaches directed to the fourth ventricle. The aim of this article is to describe the anatomical relationship of the PICA to the lower cranial nerves. In this study, 12.5% of PICAs passed between the glossopharyngeal and vagus nerves, 20% between the vagus and accessory nerves, and 65% through the rootlets of the accessory nerve. The lateral medullary segment of the PICA showed a lateral loop which in 20% specimens pressed against the inferior surfaces of the facial and vestibulocochlear nerves. The lateral medullary segment of the PICA in 20% specimens passed superior to the hypoglossal nerve, in 47.5% through the rootlets of the hypoglossal nerve, and in 30% inferior to the hypoglossal nerve. The findings on the relationship of the PICA to the lower cranial nerves could be helpful in microsurgery of this region.

Relationship between short wavelength perimetry and central corneal thickness values in ocular hypertensive subjects

PURPOSE

To evaluate the results of short wavelength perimetry (SWAP) of ocular hypertensive (OHT) patients and correlate these findings with central corneal thickness (CCT) measurements.

METHODS

Thirty-seven OHT patients with a mean age of 50.2+/-8.2 (SD) years and 30 control subjects with a mean age of 50.3+/-8.5 (SD) years were included in this study. A questionnaire was applied to patients to evaluate the demographic risk factors that may predict glaucoma development. After a detailed ophthalmologic examination, achromatic and short wavelength perimetries and ultrasonic pachymetry were performed and the results were compared between the two groups with Student t test and Mann-Whitney U test. A p value<0.05 is considered as statistically significant.

RESULTS

Mean CCT was higher in the OHT group (right eye; 558.13+/-28.39 microm and left eye; 558.94+/-27.30 microm) when compared with the control subjects (524.66+/-30.53 microm and 525.86+/-30.46 microm, respectively) (p<0.01). A significant positive correlation was found between CCT measurements and intraocular pressure (r=0.5, p<0.001). Four right eyes (10.8%) and five left eyes (13.5%) of OHT patients had defects in SWAP. OHT patients with SWAP abnormalities had significantly lower CCT measurements in right (527.25+/-17.34 microm) and left eye (528.80+/-13.60 microm) when compared with OHT patients without SWAP defects (561.87+/-27.29 microm and 563.65+/-25.92 microm, respectively) (p<0.05). Significant correlations were found between CCT and SWAP MD, PSD, and CPSD (p<0.05).

CONCLUSIONS

OHT patients with SWAP abnormalities had significantly lower CCT measurements than those without. CCT is considered as a risk factor for the development of glaucomatous damage in OHT patients.

The evaluation of retinal nerve fiber layer in pigment dispersion syndrome and pigmentary glaucoma using scanning laser polarimetry

PURPOSE

To measure the retinal nerve fiber layer thickness in patients with pigment dispersion syndrome (PDS) using scanning laser polarimetry and to compare these measurements with those of normal subjects and patients with pigmentary glaucoma (PG).

METHODS

Age-, sex-, and refractive error-matched subjects--18 patients with PDS, 18 patients with PG, and 20 healthy subjects--were evaluated by scanning laser polarimetry (Nerve Fiber Analyzer [NFA] GDx). The NFA did not have a compensator for corneal polarization. One randomly selected eye from each patient was included in the statistical analysis. The NFA measurements of patients with PDS and PG and healthy subjects were compared statistically using analysis of variance, Tukey multiple comparisons, chi-square, and independent t-tests.

RESULTS

The mean values for average thickness, superior and inferior maximum, superior and inferior average, ellipse average thickness, and superior integral were found to be lower in the patients with PDS (p < 0.02) and PG (p < 0.005) compared to the normal subjects. The mean values for maximum modulation, superior ratio, inferior ratio, and superior/nasal ratio in PDS were in between those of the PG and control groups (p > 0.05). The ellipse modulation was significantly lower in the PG group when compared to the other two groups (p < 0.03).

CONCLUSIONS

Retinal nerve fiber loss is present to some extent in patients with PDS and this loss is not age or sex dependent. Parameters of modulation might be more representative of significant damage of the nerve fiber layer.

Autogenous versus allograft fascia lata in frontal sling surgery --long-term results

PURPOSE

Either autogenous or allograft fascia lata frontal sling procedures can be used for the treatment of severe ptosis. We retrospectively evaluated the late outcomes of both approaches.

METHODS

Medical records of patients who underwent frontal sling ptosis surgery between 1978 and 2000, with a follow-up of one year or more were included in the study. Success rates and the complications of the surgery for autogenous and allograft fascia lata were recorded. The results were compared statistically.

RESULTS

Surgeries were performed with 82 autogenous or 43 allograft fascia lata. At last follow-up there were 71 eyes (86.6%) with good, 8 eyes (9.7%) with moderate, 3 eyes (3.7%) with poor results after autogenous fascia lata and 35 (81.4%), 3 (7%) and 5 (11.6%) after the allograft fascia lata frontal sling procedure. There was no significant difference between the two groups. Repeat surgery was carried out on three patients after autogenous and five after allograft fascia lata surgery. Two cases of preseptal cellulitis were observed, one abscess after autogenous and one lagophthalmus after allograft fascia lata sling surgery. All patients had slight edema early after surgery which resolved in a few days. Only one patient developed a hematoma at the site of the leg incision.

CONCLUSIONS

Although the long-term success rate with the autogenous fascia lata is slightly higher and this remains the first choice, allograft fascia lata is a good alternative in patients in whom fascia could not be harvested.

Corneal neovascularization possibly associated with latanoprost therapy

PURPOSE

To report a case of corneal neovascularization possibly associated with latanoprost therapy.

METHODS

CASE REPORT

A 67-year-old man developed a progressive stromal corneal neovascularization in his right eye within eight months of a corneal trauma. At admission, he was receiving latanoprost 0.005% therapy. His topical medications were rearranged: latanoprost was replaced with carteolol hydrochloride 1% twice daily bilaterally and prednisolone acetate 1% was added twice daily in the right eye.

RESULTS

One month later, he presented regression of the corneal neovascularization and an increase in visual acuity.

CONCLUSIONS

Latanoprost, an arachidonic acid derivative, could have directly or indirectly stimulated the corneal neovascularization in this patient with a history of nonpenetrating corneal trauma.

Scanning laser polarimetric analysis of retinal nerve fiber layer thickness in Turkish patients with glaucoma and ocular hypertension

PURPOSE

To assess the thickness of the retinal nerve fiber layer (RNFL) in patients with different stages of glaucoma, in comparison with ocular hypertensive (OHT) and healthy subjects in a Turkish population.

METHODS

Scanning laser polarimetry was done with a GDx Nerve Fiber Analyzer (NFA, GDx version, 1.0.08) on 270 eyes with glaucoma, 52 OHT eyes, and 81 normal eyes. The eyes were classified as having early (146 eyes), moderate (66 eyes) and severe (58 eyes) glaucoma based on the Humphrey Visual Field indices. We compared 14 NFA parameters by analysis of variance (ANOVA) and Scheffe multiple comparison analysis. Receiver operator characteristic curves (ROC) and Fisher linear discriminant analysis (LDF) were used to measure the sensitivity and specificity of the NFA parameters.

RESULTS

Except for symmetry, all NFA parameters showed significant differences between the groups (p<0.05). The eyes with glaucoma had significantly thinner RNFL than healthy eyes (p<0.01). The RNFL retardation measurements of OHT eyes were lower than controls, but higher than the early glaucoma group. The sensitivity and specificity of the GDx System were 87% and 72.8%, respectively. Applying LDF, the group with the highest sensitivity and specificity (85.9% and 74.1%) was determined as inferior ratio, superior/nasal ratio, superior maximum and the Number.

CONCLUSIONS

Assessment of RNFL thickness with scanning laser polarimetry can distinguish glaucoma, OHT and normal subjects with relatively high sensitivity and specificity.

Retinal nerve fiber layer analysis and interpretation of GDx parameters in patients with tilted disc syndrome

This study was conducted to determine abnormalities of the GDx Glaucoma Scanning System parameters in patients with tilted discs, in order to set guidelines for the evaluation of glaucomatous damage in this situation. The objective was to determine which GDx parameters displayed the highest level of variation, and which remained unchanged in tilted disc syndrome. RNFA was polarimetrically conducted on 45 eyes from 26 subjects with tilted discs, and 43 normal eyes with Nerve Fiber Analyzer II (Laser Diagnostic Technologies). All parameters except inferior maximum, average thickness, ellipse average, and inferior average displayed a significant difference between the two groups (p < 0.05). Although NFA is useful in glaucoma diagnosis, the majority of the GDx parameters, as shown in our study, are unreliable in tilted disc syndrome in this respect.

Inclinometer method for recording and transferring natural head position in cephalometrics

The purposes of this study were (1) to construct a device to record natural head position and transfer it to the cephalostat, (2) to assess its clinical use, and (3) to evaluate the reproducibility of lateral cephalograms taken with the device. The device, incorporated into a pair of eyeglass frames, included 2 tilt sensors to measure pitch and roll of the head. The natural head positions of 20 subjects were established 10 times by self balance and mirror position, recorded with the device, and reproduced in the cephalostat by using the average of these 10 measurements. Three lateral cephalograms were obtained in this manner at 30-minute intervals. The first 2 films were made with the subject wearing the device to assess the reproducibility of the recorded position in the cephalostat by the inclinometer. During exposure of the third film, the device was not worn, and this film was used to determine the stability of the established position when the inclinometer was removed. The results revealed method errors of 0.6 degrees (SD, 0.9) between the first 2 sets of radiographs with a correlation coefficient of 0.985. Method errors between the first and third and the second and third sets were 0.6 degrees (SD, 0.8) and 0.7 degrees (SD, 1), respectively, with correlation coefficients of 0.989 and 0.982. The reproducibility of the method was high, and the system was clinically practical for both recording and transferring natural head position in cephalometrics. This technique should make it possible to measure and reproduce head position accurately. Minimizing the size of the device, making it radiolucent, and integrating it into the radiographic device will make it more versatile and decrease error.

Polarimetric nerve fiber analysis in patients with visible optic nerve head drusen

OBJECTIVE

To evaluate the effect of visible optic nerve head drusen (ONHD) on retinal nerve fiber layer (RNFL) thickness retardation by using scanning laser polarimetry.

METHODS

Twenty-three eyes of 13 patients with visible ONHD and 26 eyes of 13 age- and sex-matched control subjects were involved in the study. Ophthalmologic examination, scanning laser polarimetry with nerve fiber analyser (NFA) type II GDX, automated Humphrey visual field testing, and red-free fundus photography were performed. Eyes with ONHD were classified from grade 0 to III according to the amount of visible drusen. Thus, grade 0 discs had no clinically visible ONHD and grade III discs represented the presence of dense drusen.

RESULTS

Measurements with NFA of RNFL thickness retardation showed significant decrease in eyes with visible ONHD compared with control eyes (P < 0.05). Although no significant difference was found between grade I and grade II discs regarding NFA measurements, grade III discs had significantly lower values, indicating the greater amount of RNFL loss with higher grade ONHD. Documentation of increased percentage of visual field defects with higher grade drusen was also in accordance with this finding.

CONCLUSIONS

NFA can quantitatively detect the decrease in retardation of RNFL thickness in eyes with visible ONHD and can be used as an indicator of nerve fiber layer loss in these cases.

Polarimetric nerve fiber analysis in patients with peripapillary myelinated retinal nerve fibers

PURPOSE

The aim of this study was to compare the RNFL thickness in eyes with myelinated retinal nerve fibers (MRNF) and age, sex-matched controls using scanning laser polarimetry.

METHODS

Seventeen patients with MRNF underwent a comprehensive ophthalmological examination including automated visual field testing, and scanning laser polarimetry with Nerve Fiber Analyser (NFA II). Twenty eyes with MRNF from 17 patients were available for the study. Sixteen healthy, age and sex-matched subjects were taken as controls. Retinal nerve fiber thickness measurements of the four sectors (superior, inferior, nasal, temporal) and along the whole circumference of the optic disc were obtained for affected and control eyes, and compared.

RESULTS

Inferior average and inferior integral parameters of the NFA revealed significantly thinner RNFL thickness measurements in eyes with inferiorly located MRNF compared to controls.

CONCLUSION

Retinal myelination alters the birefringent property of the RNFL, and results in diminished thickness measurements. Hence, NFA measurements in patients with MRNF may not be reliable.

Corneal topographical study of the effect of lacrimal punctum occlusion on corneal surface regularity in dry eye patients

PURPOSE

To compare topographic indices of surface regularity in dry eye patients and in normal subjects (controls) and to investigate the short-term effect of lacrimal punctal plugs on these indices in dry eye patients.

METHODS

The surface regularity index (SRI) and surface asymmetry index (SAI) of the TMS-2 corneal topographic modelling system were used to evaluate corneal surface regularity in 20 eyes of 10 dry eye patients before and after the insertion of Herrick silicon lacrimal plugs (Lacrimedics, Rialto, CA, USA) and in 24 eyes of 12 normal subjects as controls.

RESULTS

SRI and SAI were significantly lower in controls than dry eye patients (p=0.00). Median SRI was 1.72 in dry eye patients before punctal occlusion and 0.525 in the control group. Median SAI was 1.305 in dry eye patients and 0.240 in controls. After lacrimal punctal occlusion, Schirmer test results and fluorescein breakup time increased in nine patients and remained the same in one patient. After occlusion, the SRI decreased in 9 eyes, and increased in 11 (p=0.970); SAI decreased in 13 eyes and increased in 7 (p=0.135).

CONCLUSIONS

No significant change in topographic indices of corneal surface irregularity could be detected in severe dry eye patients with lacrimal punctal plugs in the short-term follow-up.

Ocular ferning during the menstrual cycle in healthy women

PURPOSE

The aim of the study is to investigate whether tear ferning patterns change during different phases of the menstrual cycle.

METHODS

The tear ferning test was performed on twelve normal women of childbearing age at three day intervals throughout one complete menstrual cycle. Serum hormone levels (progesterone, estrogen, testosterone) were measured.

RESULTS

Eight women showed type I ferning, and the other four had type II ferning initially. These patterns did not change during the menstrual cycle. Serum hormone levels were all in the normal range. Since no change in ferning pattern was detected during the menstrual cycle, the ferning test can be done at any time in women.

CONCLUSIONS

This study showed no effect of different menstrual cycle phases on tear ferning patterns.

Evaluation of retinoic acid ophthalmic emulsion in dry eye

PURPOSE

An oil in water emulsion of 0.01% all-trans-retinoic acid (tretinoin) was prepared and clinically evaluated in dry eye patients.

METHODS

The ophthalmic emulsion consisted of 10% of arachis oil and 90% of the hydrogel of Carbopol 940. To evaluate retinoic acid emulsion clinically, a placebo-controlled, open-labeled, randomized study was performed with 22 dry-eye patients. Symptoms were recorded before and after the treatments. The Schirmer I test, measurement of tear film break-up time (BUT), rose Bengal and fluorescein staining of cornea and conjunctiva, and mucus fern test were done.

RESULTS

Retinoic acid did not improve the dryness, photophobia and foreign body sensation more than placebo. Schirmer test and BUT were significantly improved by retinoic acid treatment. Corneal and conjunctival epithelium maintained their characteristics during the use of retinoic acid, as indicated by rose Bengal and fluorescein staining.

CONCLUSIONS

Ophthalmic emulsion of retinoic acid can be suggested as a promising approach for the treatment of dry eye.

Long-term results and reasons for failure of intranasal endoscopic dacryocystorhinostomy

The aim of this study was to evaluate the long-term results and the factors influencing the success in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryocystorhinostomy (DCR) and silicone tube intubation (STI). We prospectively investigated 158 patients with lacrimal obstruction in two groups, one of which comprised 108 patients treated primarily with intranasal endoscopic DCR by experienced surgeons and the other comprised 50 patients who were operated on by inexperienced surgeons. In a mean follow-up time of 49 months the surgical success was 94.4% in experienced hands and 58.0% in inexperienced hands. The endoscopic examination of six patients with failure in the first group revealed granulation tissue around the tube in four, atonic sac in one and persistence of bone that was supposed to have been excised in the nasal cavity in one. There were 21 failures out of 50 patients in the second group: granulation tissue in 2 cases, fenestration to the nasolacrimal duct instead of the sac in 6 cases, synechia between the lateral nasal wall and the middle turbinate in 2 cases, bony spicles causing obstruction in 5 cases and fenestration anterior to the sac in 2 cases. In 4 cases no reasons were found for failure, but perhaps the small fenestration and failure to remove the medial half of the membranous sac wall was the reason. DCR and STI can be performed for primary treatment in lacrimal obstruction. There is a learning curve for the operation. False localization of the lacrimal sac, granulation tissue formation around the tubes, retained bony spicles, inadequate removal of the medial wall of the sac and the synechia between the lateral wall and the middle turbinate are the most common causes of failure.

Tear lactoferrin levels in chronic meibomitis associated with acne rosacea

PURPOSE

To determine tear lactoferrin levels in patients with chronic diffuse meibomitis associated with acne rosacea and to investigate their role in the development and perpetuation of some inflammatory ocular surface complications.

METHODS

In this non-randomized, controlled trial performed in a tertiary care center, eight patients with biopsy-proven acne rosacea and blepharitis, and ten patients with seborrheic blepharitis not associated with acne rosacea formed the study groups and ten normal patients were used as controls. Schirmer I test results, tear break-up time and radial immunodiffusion (Lactoplate) tests on tear samples of the three groups were compared.

RESULTS

Compared to controls, tear lactoferrin concentrations were lower in both the acne rosacea and seborrheic blepharitis groups. However, this decrease was significant in only the seborrheic blepharitis group (p = 0.026). One patient in the acne rosacea group, with the lowest measurement, developed bacterial keratitis.

CONCLUSIONS

Though within the normal range, tear lactoferrin levels in patients with acne rosacea and seborrheic blepharitis were lower than controls. Low concentrations of lactoferrin may play a role in the ocular surface inflammatory components associated with these diseases.

The pharmacokinetics and effects of diltiazem in rabbits

PURPOSE

To investigate the effect of diltiazem on wound healing after the creation of conjunctival flaps in rabbit eyes. Also, to investigate the pharmacokinetics of diltiazem in rabbits after subconjunctival and topical administration.

METHODS

For the histopathological study, a limbal-based flap was prepared and diltiazem was injected subconjunctivally for five days after the surgery. The rabbits were euthanised 20 days after surgery. The effectiveness of diltiazem on wound healing was evaluated by histopathological examination and measurement of the thickness of subconjunctival fibrous tissue. For the pharmacokinetic study, diltiazem was applied topically or injected subconjunctivally. Aqueous paracenteses were performed 0.5, 1, 2, 4 hours thereafter.

RESULTS

The histopathological study found no difference in thickness of the subconjunctival fibrous tissue in control and diltiazem-treated eyes. No significant toxicity was observed in eyes treated with diltiazem. The peak aqueous concentration was 3.8 +/- 0.4 microg/ml after topical application and 15.3 +/- 1.1 microg/ml after subconjunctival injection. The peak aqueous concentration was achieved 1/2 hours after administration in both cases.

CONCLUSIONS

Diltiazem did not appear to affect wound healing at the dose tested. Topical and subconjunctival diltiazem successfully penetrated the aqueous humor of rabbit eyes.

Role of tear inflammatory mediators in contact lens-associated giant papillary conjunctivitis in soft contact lens wearers

Contact lens-associated giant papillary conjunctivitis (CL-GPC) caused by mechanical and immune mechanisms is a significant problem resulting in contact lens intolerance and discontinuation of contact lens wear. In the present study, tear fluid leukotriene C4 (LTC4) level was evaluated in soft contact lens wearers with and without CL-GPC using ELISA. Statistical analysis showed no significant difference in tear fluid LTC4 between contact lens wearers without GPC and normal controls (p>0.05), but a significant increase in tear LTC4 level in CL-GPC patients (p<0.05). On the basis of this finding, it might be possible to explain redness, conjunctival edema, increased mucoid secretion, and papillary changes by the effect of LTC4 on eye tissues. Effective treatment of CL-GPC might be possible in the future by employing inhibitors of leukotriene synthesis and action.

Surface deposits on frequent replacement and conventional daily wear soft contact lenses: a scanning electron microscopic study

PURPOSE

We performed a prospective study to compare the surface deposits on frequent replacement soft contact lenses with deposits on conventional daily wear soft contact lenses.

METHODS

We fit two groups of young myopic patients with either conventional daily wear or frequent replacement soft contact lenses. Subjects in both groups wore their lenses on a daily wear basis and used a hydrogen peroxide/catalytic disk based care system. Contact lenses were obtained from patients in the frequent replacement group after 1 month of wear and from the conventional contact lens group after 12 months. Contact lenses from each group were examined with scanning electron microscopy and surface deposits were compared.

RESULTS

Frequent replacement lenses were covered with significantly fewer deposits than conventional daily wear soft contact lenses (P = 0.0003). No microorganisms were seen on frequent replacement contact lenses. Bacteria in the form of coccus on two contact lenses were seen in the other group.

CONCLUSIONS

Surface deposits occur less often on frequent replacement lenses but they cannot be totally prevented. Surface deposit related contact lens complications may be expected to occur less frequently with the use of frequent replacement lenses.

Multiple orbital intraosseous hemangiomas

The case of a 36-year-old healthy, asymptomatic man who was monitored for a slowly growing subcutaneous mass under his right inferior orbital rim for more than ten years is presented. The mass was hard, immobile, and nontender. Computed tomography (CT) documented a lytic lesion at the frontal process of the right maxilla. Four years later, magnetic resonance imaging (MRI) of the orbits revealed distinct lesions in the right zygoma, maxillary, and greater wing of the sphenoid bones. These lesions were hypointense with respect to orbital fat on T1-weighted images and hyperintense on T2-weighted series. There was moderate enhancement after contrast agent administration. These findings combined with the clinical features of the patient were suggestive of presumed multiple orbital intraosseous hemangiomas. Differential diagnosis between other osseous tumors of the orbit can be reasonably made based on imaging characteristics.

Effect of lodoxamide on tear leukotriene levels in giant papillary conjunctivitis associated with ocular prosthesis

Leukotrienes have been shown to play a role in the pathogenesis of ocular inflammatory and allergic reactions like vernal keratoconjunctivitis and contact lens-associated giant papillary conjunctivitis. This study was designed to determine leukotriene B4 (LTB4) and leukotriene C4 (LTC4) levels in the tears of patients with ocular prosthesis-associated giant papillary conjunctivitis (OP-GPC) and to evaluate the effects of lodoxamide 0.1% on tear LTB4 and LTC4 levels of OP-GPC patients. Tear LTB4 and LTC4 levels were determined by an ELISA technique in the tears of ten OP-GPC patients before and after treatment with lodoxamide 0.1% for one month. The results were compared with that of ten healthy control subjects. The mean tear LTB4 and LTC4 levels of the OP-GPC patients were significantly higher than those of the control group. After treatment with lodoxamide 0.1%, tear LTB4 and LTC4 levels of the OP-GPC patients decreased significantly. This is the first report of elevated LTB4 and LTC4 levels in tears of OP-GPC patients and it points to the possible role of leukotrienes in the immunopathogenesis of OP-GPC. The results also indicate that lodoxamide 0.1%, a mast cell membrane stabilizer, is effective in significantly reducing tear LTB4 and LTC4 levels in OP-GPC patients.

Effects of lodoxamide, disodium cromoglycate and fluorometholone on tear leukotriene levels in vernal keratoconjunctivitis

PURPOSE

We compared tear leukotriene B4 (LTB4) and leukotriene C4 (LTC4) levels of vernal keratoconjunctivitis (VKC) patients with those of age-matched controls and evaluated the effects of disodium cromoglycate (DCG) 2%, lodoxamide 0.1% and fluorometholone 0.1% on the tear LTB4 and LTC4 levels of the VKC patients.

METHODS

Thirty VKC patients were divided into three groups and their tear LTB4 and LTC4 levels measured with an enzyme-linked immunoassay technique before and after treatment with either lodoxamide 0.1%, DCG 2% or fluorometholone 0.1%. The results were compared with the tear LTB4 and LTC4 levels of 10 healthy control subjects. During this trial period, clinical scores for signs and symptoms of VKC were also evaluated.

RESULTS

In the VKC patients median tear LTB4 and LTC4 levels were 349.0 pg/ml (range 213.3-707.7 pg/ml) and 225.2 pg/ml (range 196.1-241.1 pg/ml) respectively--significantly higher than the control group (p = 0.0065 for LTB4 and p = 0.0003 for LTC4). After treatment, LTB4 levels decreased significantly in all treatment groups when compared with baseline (for the lodoxamide group, p = 0.01; for the DCG group, p = 0.008; for the fluorometholone group, p = 0.045). LTC4 levels were also significantly reduced after treatment in all three treatment groups (for the lodoxamide group, p = 0.0209; for the DCG group, p = 0.0284; for the fluorometholone group, p = 0.0109).

CONCLUSIONS

Tear LTB4 and LTC4 levels are significantly higher in VKC patients than controls, which points to a possible role of lipoxygenase pathway products in the pathophysiology of ocular allergic disorders. Lodoxamide 0.1%, DCG 2% and fluorometholone 0.1% were all effective in reducing LTB4 and LTC4 levels in VKC.

Tear functions in patients with pterygium

PURPOSE

In the etiology of pterygium abnormalities in tear functions have also been emphasized. In this study, tear function tests are evaluated in patients with pterygium.

METHODS

Schirmer's test 1, tear film break-up time and mucus fern patterns were evaluated in 70 eyes with pterygium and in 70 eyes of the age matched control group. Marginal tear films were also assessed.

RESULTS

Tear film break-up time was significantly reduced in the pterygium group. Mucus fern patterns and marginal tear films were found to be markedly abnormal in the eyes with pterygium, however, there was no significant difference in Schirmer's test 1.

CONCLUSION

Tear function tests disclosed disrupted tear film stability which is more likely to be due to the altered mucin. This change may either be the primary factor inducing pterygium formation or reflect an existing pathology in the cells lining the ocular surface.

"En masse" retraction of maxillary anterior teeth with anterior headgear

In the treatment of the first premolar extraction cases with certain techniques, incisor retraction is realized after canine distalization. In maximum anchorage cases, retraction of anterior segments require more posterior anchorage. This treatment concept is still valid, however, the difficult anchorage control is considered a major drawback. The purpose of this study is to introduce our technique for the "en masse" retraction of maxillary anterior teeth after first premolar extraction and discuss its effects. The technique consists of the application of extraoral traction on canines, followed by banding of maxillary anterior teeth, to form them as a mass. Advantages of our mechanics are as follows: (1) Anterior headgear may have the advantage of retracting anterior teeth with minimum strain on posterior anchorage. (2) The adjustability of the outer bow in relation to the premaxilla's center of resistance, provides effective desired movements. (3) Intrusion and torque control are achieved in the course of anterior segment retraction.

Intranasal endoscopic silicone intubation for congenital obstruction of the nasolacrimal duct in children

Aim of the present study was to determine the efficacy of intranasal endoscopic silicone intubation to treat congenital nasolacrimal duct obstruction in children who failed conventional lacrimal system probing. Silicone intubation with intranasal endoscopic visualization was performed in 18 eyes of 16 patients with an age range of 18-48 months (mean, 25 months) to treat congenital nasolacrimal duct obstruction. Out of 16 patients, ten had already undergone previous probings with failure, the other six were primary intubation cases without any previous probings. The tubes were left in place an average of 6 months. Follow-up ranged from 4 months to 2 years (mean, 12 months) following removal of the silicone tubing. Intranasal endoscopic silicone intubation is effective in the treatment of congenital nasolacrimal duct obstruction as a primary procedure in children over 18 months of age and, it is also recommended as the next step in the management of epiphora which fails to resolve after probing.

Electron microscopy of the senile changes in lens epithelium

Lens epithelia obtained from 37 patients who had undergone cataract surgery operation were examined by using transmission electron microscope. Their ages varied between 60-79 years and mean age was 70.2 years. Additionally, the lens epithelia of 14 patients, which were obtained in the same way were examined by using scanning electron microscope. Their ages varied between 58-78 years and mean age 70.7 years. In transmission electron microscopy, the normal appearing epithelial cells were intermingled with abnormals and the abnormal cells increased in number and in degree of abnormality with aging. The three dimensional structure of the interdigitating interlocking processes of lens cuboidal cells were visualised by using scanning electron microscope.

Selçuk type headgear-timer (STHT)

The Selçuk type headgear-timer (STHT) is described and tested under laboratory conditions first and then in a controlled patient study. The timing device was compared with real time measurements for 4 months. Accuracy was determined to be absolute (100%). The STHT was determined to be independent of force variables, easy to construct, rugged, and inexpensive. In the clinical test, 10 patients were instructed to wear the extraoral appliance for 16 hours a day. After a 2-month treatment period, the timing mechanisms were introduced to the patients and a subsequent 2-month treatment period was initiated. At the end of the second period, headgear wear was increased 26%. This significant improvement in patient compliance with the STHT timing device, attached to a standard breakaway type headgear, has the likelihood of enhancing treatment results. A foolproof method of assessing actual duration of wear is now available.

Intraoperative and postoperative use of mitomycin-C in the treatment of primary pterygium

BACKGROUND AND OBJECTIVE

The effectiveness of 0.04% mitomycin-C, either postoperatively for 2 weeks or intraoperatively as a single dose, as an adjunct in the surgical treatment of primary pterygium was evaluated.

PATIENTS AND METHODS

Mitomycin-C was used in addition to the bare sclera technique in 43 eyes with pterygia. The mean follow-up time was 18.5 months for the 24 eyes in the postoperative mitomycin-C group, 10.3 months for the 19 eyes in the intraoperative mitomycin-C group, and 17.3 months for the 17 eyes in the control group (eyes that had undergone surgical excision only).

RESULTS

The recurrence rate was 4.2% with postoperative administration, 5.3% with intraoperative application, and 41.2% in the control group. There was a significant reduction in recurrence rates for both the postoperative and the intraoperative mitomycin-C groups compared with the control group (P = .005 and P = .01, respectively). However, recurrence rates were not statistically different according to the type of application. No serious side effect occurred during the follow-up period.

CONCLUSION

Topical mitomycin-C, either intraoperatively or postoperatively, as an adjunct decreases the recurrence rate of primary pterygium. Intraoperative application seems advantageous because it decreases the symptomatic side effects and restricts the inappropriate use by the patient.