Clinical Comparison of the Ocular Blood Flow Tonograph and the Goldmann Applanation Tonometer

Purpose

To compare the IOP readings of an ocular blood flow (OBF) tonograph (OBF Labs UK Ltd) with Goldmann applanation tonometry.

Methods

194 patients were studied. In group 1, the software version 8.2 of the OBF tonograph was used in 214 eyes of 107 patients and in group 2, the 11.2 version of the tonograph was used in 174 eyes of 87 patients.

Results

We found 63% of the OBF tonograph readings to be within ±2mm Hg of the Goldmann applanation tonometry readings in group 1 and 60% in group 2. In group 1 the correlation coefficient between the readings of the two instruments was 0.71 and 0.82 in group 2. The mean value for the paired differences in group 1 was –1.34±2.75mm Hg overall and –1.04±2.91mm Hg overall in group 2. There was a significant difference between the Goldmann applanation tonometer and OBF tonograph readings in the 8–10mm Hg interval (p<0.001) in group 1, but not in group 2 (p>0.1).

Conclusions

The 11.2 version of the OBF tonograph is more accurate than the 8.2 version and measures IOP in a manner that corresponds well to the Goldmann applanation tonometer in the 8–10mm Hg and 21–29mm Hg intervals. It corresponds fairly well in the 11–20mm Hg interval.

A Moyamoya Patient with Bilateral Consecutive Branch Retinal Vein Occlusion

We describe a moyamoya (MMD) patient with bilateral consecutive branch retinal vein occlusion (BRVO). The patient had a medical history of severe headache, cranial haemorrhage, bilateral supraclinoid carotid artery occlusion, and "puff of smoke" collaterals on cerebral angiography and an encephalomyosynangiosis operation. On ophthalmic examination, he had superior temporal branch vein occlusion with intraretinal haemorrhage and visual acuity of 20/25 in the right eye. Twelve years later, he presented with superior temporal branch vein occlusion in the left eye and visual acuity of 20/60. The patient was initially treated with a dexamethasone intravitreal implant, and later intravitreal ranibizumab injections. We describe the first reported case of bilateral consecutive BRVO and management in MMD.

Peripheral Vasculitis, Intermediate Uveitis and Interferon Use in Multiple Sclerosis

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. A 40-year-old female patient with a 12-year history of MS was admitted to our clinic with blurred vision and floaters in her right eye for about 1 month. Here, we share the findings and the management of intermediate uveitis and retinal periphlebitis in an MS case being treated with interferon beta-1a for 7 years.

Von Hippel-Lindau disease: the clinical manifestations and genetic analysis results of two cases from a single family

von Hippel-Lindau (VHL) disease is an autosomal dominant inherited multi systemic cancer syndrome that is classically associated with neoplasms in multiple organs, and caused by mutations in the VHL gene on chromosome 3p25-p26. Retinal hemangioblastoma (RH) is the most frequent and the earliest clinical sign of the disease, which is seen in 40.0-60.0% of patients. In recent years, studies of patients with VHL tried to put forward the relationship between genotype and phenotype. In this study, two VHL cases in the same family with clinical findings and genetic analysis results are presented. As a consequence of the genetic studies, a heterozygous missense mutation c.202 T>C, p.S68P (Ser68Pro) in exon 1 of the VHL gene that is mapped to chromosome 3p25.3, was found in the patients’ DNA sample. The germline mutation of [c.202T>C, p.S68P (Ser68Pro)] that was detected in both cases, has been reported in only two cases in the literature. However, in these reported cases, any systemic involvement except RH, were not reported. Although our cases had the same mutation, we detected renal involve-ment in both cases, and also central nervous system (CNS) involvement in one case, in addition to RH.

Candida pelliculosa endophthalmitis after cataract surgery: a case report

Background

Here we report the first case of postoperative endophthalmitis due to Candida pelliculosa after cataract surgery. We describe the clinical management of this type of candida infection in the eye.

Case presentation

A 57-year-old Turk man was seen at our clinic at the end of the first postoperative month after cataract surgery. He presented with eye redness, pain and decreased visual acuity. His ophthalmologic examination revealed moderate tyndall and a mild flare in the anterior chamber. Hypopyon in the capsular bag posterior to the intraocular lens was seen in the second postoperative month. Despite topical and subconjunctival bacterial endophthalmitis treatment, there was no improvement in the clinical situation. Candida pelliculosa was isolated from a sample culture obtained from the anterior chamber. Oral fluconazole could not be administered because of increased liver enzyme levels and intravenous amphotericin B could not be administered because of an allergic reaction. Intraocular lens explantation, pars plana vitrectomy and anterior chamber lavage by rupturing the posterior wall of the microabscesses were performed. Intravitreal and intracameral amphotericin B injections were given four times in addition to surgical interventions. The patient has been followed for 2 years and his best-corrected visual acuity was 0.4 at the last visit.

Conclusion

Nearly 1 month after cataract surgery, a patient presented with eye redness and blurred vision, with corneal endothelial deposits, hypopyon in the capsular bag and microabscesses on the incision sites and corneal endothelium. Candida pelliculosa should be considered in patients showing these symptoms. Multiple intraocular amphotericin B (5 μg) administrations can be used safely even in cases with high sensitivity to systemic use. Rupturing the posterior wall of the abscesses on the corneal endothelium surgically with intraocular lens explantation and pars plana vitrectomy are recommended.

Results of Mitochondrial DNA Sequence Analysis in Patients with Clinically Diagnosed Leber's Hereditary Optic Neuropathy

OBJECTIVE

To investigate possible mitochondrial DNA (mtDNA) mutations in patients with Leber's hereditary optic neuropathy (LHON) in order to provide a precise diagnosis and genetic counseling.

MATERIAL AND METHODS

Between 1982 and 2007, ten patients were clinically diagnosed with LHON and six of these patients agreed to be involved in this study. Six healthy individuals were also included as a control group. mtDNA was isolated from peripheral blood samples and polymerase chain reaction and mtDNA sequence analysis were performed.

RESULTS

In one of the six patients, a homoplasmic mutant m.11778G>A mutation was detected. All of the clinically diagnosed LHON patients and the control groups had the m.14212C>T and m.14580G>A single nucleotide polymorphisms (SNPs). The m.11719A>G SNP was detected in three of six patients and four of the controls. Two of the six patients had the m.3197T>C SNP and, in addition, the m.14258G>A SNP was found in one of these two patients, while neither of these mutations were present in the control group.

CONCLUSION

The clinical diagnosis of LHON could be supported by molecular genetics only in one patient by the detection of one mutation. The m.3197T>C and m.14258G>A SNPs should be considered as potential mtDNA mutations due to the fact that they were detected in the patient group. These mutations should be investigated further in large case groups for suspected gene loci that could lead to optic neuropathy.

[The factors affecting visual outcome in open globe injuries]

BACKGROUND

To evaluate the factors affecting visual acuity in cases subjected to surgical repair due to open globe injury.

METHODS

The records of the patients who have been subjected to emergency surgical repair due to open globe injury were examined retrospectively. From a total of 195 cases, 119 eyes of 119 cases who fulfilled the inclusion criteria were included into the study. Cases were examined in terms of age, gender, trauma type, localization, preoperative examination findings, the presence of additional surgical interventions and the findings in the last examination. Chi-square test and logistic regression analysis were used in statistical analysis.

RESULTS

Original visual acuity (p=0.042), zone (p=0.001), trauma type (p=0.003), preoperative anterior chamber loss (p=0.005), existence of hyphema (p=0.001), vitreous prolapse (p=0.000) and posterior segment pathology development (p=0.000) influenced the visual outcome. In cases with grade 4 or grade 5 resulting visual acuity, statistically significant factors were determined as "existence of pathology in the posterior segment" (p=0.000, Odds ratio=12.397) and "total anterior chamber loss" (p=0.015, Odds ratio=4.661).

CONCLUSION

Changes occurring at the posterior segment pathology and anterior chamber loss are determinant in terms of resulting visual acuity. For this reason, ophthalmoscopy and ultrasonography that should not be omitted in the follow-up period for cases with a transparent media and with media opacity, respectively.

Macular function of successfully repaired macula-off retinal detachments

PURPOSE

To assess the macular function of successfully repaired macula-off retinal detachments in the long term and to evaluate the relationship between duration of macular detachment and functional recovery.

METHODS

Of 214 consecutive patients, 29 who were operated on because of unilateral retinal detachment with at least 6 months of follow-up and whose best-corrected visual acuity was better than 0.05 Snellen chart value in both eyes were examined. Operated eyes were included in group I, and the fellow eyes were included in group II. Macular functions were evaluated in terms of visual acuity, contrast sensitivity, color vision, visual field, and visual evoked potentials after reattachment.

RESULTS

All macular functions except P100 amplitudes in the operated eyes were significantly less than those in the fellow eyes (P = 0.28) following reattachment after nearly 5 years. It was found that the longer the duration of macular detachment (except detachment duration of < or = 7 days), the smaller the increase in visual acuity, contrast sensitivity, and color vision defect scores (P = 0.000, P = 0.034, and P = 0.0003, respectively).

CONCLUSIONS

Macular functions except P100 amplitude cannot be recovered completely 5 years after retinal reattachment. There was no relation between the duration of macular detachment and the mean deviation in visual field and the P100 latency and P100 amplitude difference between both eyes.

Optical coherence tomography in optic pit maculopathy

PURPOSE

To report the optical coherence tomography (OCT) findings in patients with optic pit maculopathy.

METHODS

Twelve eyes of 12 patients with optic pit maculopathy were evaluated. Cross-sectional OCT images were correlated with findings from slit-lamp biomicroscopy and fluorescein angiography. The presence of retinoschisis and serous macular detachment was evaluated and the height of the serous detachment also measured.

RESULTS

Visual acuities varied between 20/400 and 20/63. The height of the serous macular detachment at the fovea was between 323 and 548 mum. OCT findings showed that ten (83.3%) patients had both retinoschisis and serous macular detachment, one (8.3%) patient had only retinoschisis and one (8.3%) patient had only serous macular detachment. None of the patients had macular hole or vitreoretinal traction.

CONCLUSION

These findings support the concept of a bilaminar structure that contains retinoschisis and serous macular detachment. Our data also showed that in some patients, the sole component of maculopathy was serous macular detachment or retinoschisis.

Measurement of anterior lens growth after acute primary angle-closure glaucoma

BACKGROUND

To determine fundus fluorescein angiography (FA) findings in cases with intermediate uveitis in the inactive phase.

METHODS

This prospective study included all eligible cases with a diagnosis of intermediate uveitis that were treated at the uvea unit of Trakya University ophthalmology department between January 2002 and January 2004. Study criteria included patients in the inactive phase who had no complaints, no biomicroscopic or ophthalmoscopic inflammatory findings in the anterior and posterior segments, and no period of inflammation that had occurred within the previous 6 months. Cases receiving immunosuppressive treatment were not excluded. FA was performed in all cases, which were evaluated by 2 independent observers.

RESULTS

A total of 21 eyes from 21 cases with intermediate uveitis were included in the study. FAs of the cases were taken approximately 8.8 (SD 5.4) months (range 6-23 months) after the last activation. In these FAs, no pathological findings were identified in 5 eyes (23.8%); optic disc hyperfluorescence was observed in 14 eyes (66.7%); large vein staining was observed in 2 eyes (9.5%); peripheral venous leakage was observed in 6 eyes (28.6%); and cystoid macular edema was observed in 5 eyes (23.8%).

INTERPRETATION

These findings indicate that retinal vascular inflammatory changes persist in cases with intermediate uveitis even if the clinical manifestations have been treated.

Topical Ketorolac 0.5% for Ocular Pain Relief During Scatter Laser Photocoagulation with 532 nm Green Laser

PURPOSE

The aim of this study was to evaluate the analgesic effect of topical ketorolac tromethamine 0.5% during scatter laser photocoagulation procedure in proliferative diabetic retinopathy patients.

METHODS

60 eyes of 30 consecutive proliferative diabetic retinopathy patients were included to this prospective, randomized, double-masked, controlled study. One (1) h before laser treatment session, ketorolac tromethamine 0.5% was instilled to 1 eye and artificial tear drop to the fellow eye. Just after treatment, the patients were asked for the severity of pain in both eyes. Visual analog scale was used to assess the level of pain.

RESULTS

Mean pain level for placebo-instilled eyes was 4.88+/-2.56 and ketorolac instilled eyes were 4.45+/-2.25. There was no significant difference for pain levels between placebo and ketorolac-instilled eyes (P=0.29).

CONCLUSIONS

Topical ketorolac tromethamine usage is no more effective than artificial tears for pain relief during posterior segment laser procedures in proliferative diabetic retinopathy patients.

Functional assessment of reattached macula in nine cases with excellent Snellen acuities

PURPOSE

To compare the macular functions of patients with excellent visual acuity after retinal detachment (RD) surgery, with the healthy fellow eye.

METHODS

Of 214 patients, nine patients, who were successfully operated because of unilateral RD involving the macula and achieved excellent visual acuity, were analysed. The fellow eyes of the patients were taken as the control group. The macular functions were evaluated with visual acuity, contrast sensitivity, colour vision, visual field, and pattern VEP in operated and nonoperated eyes.

RESULTS

There was no significant difference in visual acuity, contrast sensitivity, colour vision, and VEP outcomes between operated and nonoperated eyes. However, it was seen that the mean deviation in the visual field was significantly higher in the operated eyes (5.8+/-1.8 dB) when compared with the undetached fellow eyes (3.1+/-1.8 dB), (t=12.5; P=0.013).

CONCLUSION

Even though the visual acuity, colour vision, contrast sensitivity, and VEP results returned to normal after a successful RD surgery, we found that the mean deviation measured by the visual field, which reflects the retinal sensitivity, was still significantly low after nearly 5 years follow-up.

Long-term macular function in eyes with central serous chorioretinopathy

BACKGROUND

This study aimed to investigate the long-term effects of central serous chorioretinopathy (CSCR) on macular function.

METHODS

Sixty-two eyes of 31 patients were included in this study. All patients were diagnosed with unilateral CSCR at the Retina Unit of the Ophthalmology Department, Trakya University Medical Faculty, and had a post-attack bilateral visual acuity of 6/6 and a follow-up period of a minimum of 6 months. Visual function was assessed using the Amsler grid, 40-hue colour discrimination test, visual field examination by means of Octopus automatic perimeter and Cambridge contrast sensitivity tests.

RESULTS

Of the 31 patients, 71% were men and 29% were women, with a mean age of 39.3 +/- 7.6 years. The patients had a mean follow-up period of 50.6 +/- 40.5 months after the acute attack. Metamorphopsia was observed in 67.7% of the cases with CSCR. A colour discrimination defect was found in 48.4% of the CSCR eyes and in 54.8% of the fellow eyes. As compared with the fellow eyes, the mean deviation in the central 10 degrees of visual field was significantly higher (t = 2.9, P = 0.007) and the mean contrast sensitivity score was significantly lower (t = -3.2, P = 0.004) in the CSCR eyes.

DISCUSSION

Patients with unilateral CSCR were observed to have long-term bilateral colour discrimination defects, and eyes with clinical CSCR were determined to have central relative scotoma and loss of contrast sensitivity.

Corneal endothelial polymegethism and pleomorphism induced by daily-wear rigid gas-permeable contact lenses

PURPOSE

To determine if there are any corneal endothelial cell size and shape changes (and the time course of these changes) in subjects wearing rigid high gas-permeable (RGP) contact lenses for daily wear.

METHODS

Ninety-seven eyes of 57 new wearers were fitted with a fluoroperm contact lens material (Persecon92E, oxygen transmissibility (Dk)= 92 x 10(-11)). Prior to lens wear and after 1 week, 1 month, 3 months, 6 months, and 1 year, noncontact endothelial photographs were taken. Maximum cell size/Minimum cell size (Max/Min) was measured as an index of polymegethism and the relative frequency of 5-, 6-, and 7-sided cells was evaluated.

RESULTS

An increase in the ratio of Max/Min was present 1 week after lens fitting and increased further over the subsequent year. This study showed significant increase in endothelial polymegethism and in the relative frequency of 7-sided cells, but a significant decrease in the relative frequency of 6-sided cells.

CONCLUSIONS

Daily-wear high Dk gas-permeable contact lenses can cause endothelial polymegethism and pleomorphism similar to those caused by soft and hard contact lenses.

The effect of systemic hypertension on pulsatile ocular blood flow in diabetic patients

PURPOSE

To determine the haemodynamics of the ciliary choroidal system in diabetics with or without systemic hypertension.

METHODS

90 eyes of 45 diabetic patients were included into the study. Patients were divided into two groups based on the presence of systemic hypertension. The pulsatile component of the total ocular blood flow in diabetics with or without hypertension was analyzed using ocular blood flow tonograph (OBF Labs, UK). The control group was comprised of 40 age-matched eyes of 20 volunteers with no ocular or systemic disease. Results were compared with the control group.

RESULTS

Pulse amplitude (PA), pulse volume (PV) and pulsatile ocular blood flow (POBF) were significantly lower (p<0.05) in diabetics without systemic hypertension than the controls. In diabetics with hypertension, although the systolic and diastolic blood pressures were significantly higher than the control group, there was not any statistically significant difference (p>0.05) between PA, PV and POBF results.

CONCLUSION

POBF was found to be lower in diabetics without hypertension compared to the controls. Such a presence of systemic hypertension may increase the choroidal blood flow in diabetics.

Endothelial cell density of the cornea during rigid gas permeable contact lens wear

PURPOSE

To determine the influence of a daily wear rigid gas permeable (RGP) high DK lens (CIBA Vision Persecon92E, Dk=92 x 10(-11)) on corneal endothelial cell density (ECD).

METHODS

A prospective longitudinal, follow-up study was conducted. Variations in corneal ECD during the first year were reported. For this purpose, the endothelium of 97 eyes of 57 unadapted subjects were compared by specular microscopy before and after 1 week (n= 74), 1 month (n=67), 3 months (n=51), and 1 year (n=23) of wearing contact lenses.

RESULTS

There was a significant decrease in cell density vs age (r=-0.28, P=0.005). ECD significantly increased 1 week (3.6%) (P=0.001), 1 month (3.6%) (P=-0.003), and 3 months (4.5%) (P=0.003) after contact lens wear. One year after the lens fitting, a similar but not significant increase was found. While ECD increase was insignificant with initially high ECD subjects (>2700 cells/mm2), subjects with low ECD initially (<2700 cells/mm2) showed a significant increase in ECD in all time intervals.

CONCLUSIONS

In the 1 week RGP contact lens wearing period, the endotheliums with low ECD probably adapted to a new oxygen environment by cell migration or mitotic activity. The increased ECD was perhaps related to the daily wear schedule in which the oxygen partial pressure was sufficient.

Ocular pulse amplitude in patients with Graves' disease: a preliminary study

PURPOSE

The purpose of this study was to evaluate the ocular pulse amplitude changes in patients with Graves' disease.

METHODS

The pulse amplitudes of 31 patients with Graves' disease were measured with the OBF-Tonograph (OBF Labs UK). All patients were in the euthyroid phase of the disease. 17 patients (Group I) had no ocular involvement or only mild lid retraction. 14 patients (Group II) had either proptosis and/or extraocular muscle involvement. Only the worst involved eye of each patient was included into the study.

RESULTS

There was no statistically significant difference between the two groups among the parameters which might influence the pulse amplitude measurement. The pulse amplitude was statistically significantly lower in Group II than in Group I (2.34+/-0.79 and 3.22+/-0.94 mmHg respectively, p<0.013).

CONCLUSION

Pulse amplitude measurements may be an important discrimination and classification parameter for patients with ophthalmic Graves' disease.