The Effect of Intraoperative Antibiotics in Irrigating Solutions on Aqueous Humor Contamination and Endophthalmitis after Phacoemulsification Surgery

PURPOSE

To determine the efficacy of intraoperative antibiotic use in irrigating solutions on aqueous humor contamination during phacoemulsification surgery and to evaluate the corresponding risk of postoperative endophthalmitis.

METHODS

644 eyes of 640 patients who underwent phacoemulsification surgery with foldable intraocular lens (IOL) implantation were included in this study. Preoperative conjunctival smears were taken and eyes were allocated to receive irrigating infusion fluid containing either balanced salt solution (BSS)-only (group 1; 322 eyes) or BSS with antibiotics (vancomycin and gentamycin) during surgery (group 2; 322 eyes). Bacterial contamination rates of aqueous humor samples taken in the beginning and at the end of operation were compared. Predictive factors for the development of postoperative endophthalmitis were determined by clinical and microbiologic analyses.

RESULTS

The rates of culture-positivity were similar between group 1 and group 2 for both preoperative conjunctival smears and aqueous samples (p > 0.05). Aqueous samples taken at the end of operation were found to be contaminated in 68 (21.1%) eyes in group 1 and 22 (6.8%) eyes in group 2, and the difference was significant (p = 0.0001; OR = 3.65 (2.1-6.0)). Capsular rupture was associated with higher rate of contamination in both groups (p = 0.0001; OR = 7.7 and p = 0.0001; OR = 8.1). Two eyes in the BSS-only group developed postoperative endophthalmitis and these cases had posterior capsular rupture during the surgery and culture-positivity for staphylococcus epidermidis throughout the study.

CONCLUSIONS

Intraoperative antibiotic irrigation decreases aqueous humor contamination during phacoemulsification. Further studies are warranted to determine the interrelationship between aqueous humor contamination and endophthalmitis in eyes with posterior capsular rupture.

Effect of a single intravitreal bevacizumab injection on different optical coherence tomographic patterns of diabetic macular oedema

PURPOSE

The aim of this study is to compare the therapeutic effect of a single intravitreal bevacizumab (IVB) injection in eyes with diabetic macular oedema (DMO) of different patterns determined by optical coherence tomography (OCT).

METHODS

Medical records of patients who had a single IVB injection for DMO were analysed retrospectively. Eyes with a clinically significant DMO and a central foveal thickness (CFT) of 250 μm or more determined by OCT were included in the analysis. Best-corrected visual acuity (BCVA), CFT and total macular volume values before and after the injection were recorded. Eyes were divided into sponge-like diffuse retinal thickening (DRT), cystoid macular oedema (CMO) and serous retinal detachment (SRD) groups according to the morphology on OCT.

RESULTS

A total of 92 eyes (42 with DRT, 31 with CMO and 19 with SRD) were included in the study. There was no statistically significant variation between three groups regarding the change in BCVA (P=0.695). CMO and SRD groups had greater reductions in their mean CFT, and the amount of reduction showed statistically significant variation between three groups (P=0.048). However, no statistically significant difference was found between groups in terms of percentage of change in CFT (P=0.278).

CONCLUSION

CMO and SRD subtypes are associated with a greater reduction in the CFT than the DRT subtype. Although the change in BCVA was not significantly different between groups, the DRT group showed markedly better visual improvement in proportion to the decrease in CFT.

Primary malignant melanoma of the esophagus

Primary malignant melanoma of the esophagus (PMME) comprises only 0.1–0.2% of all malignant esophageal tumors. PMME tumors are highly aggressive and metastasize early via hematogenic and lymphatic pathways. Treatment outcome is poor because the cancer has often advanced at the time of diagnosis. Inoperability, unsuccessful treatment with radiotherapy and chemotherapy in advanced tumors and metastases have contributed to its poor prognosis. Here, we present the endoscopic features, endoscopic ultrasonography findings and management of a PMME case.

Granulomatous gastritis due to taeniasis

Taeniasis is very common all over the world and invades the upper small bowel in humans. It is very unusual to see this parasite in the stomach. We report a case of gastric taeniasis that led to granulomatous gastritis. The elimination of the parasite resulted in complete disappearance of the granulomas in the corpus and antrum and in complete recovery of the patient.

[Dynamic Contour Tonometry and Goldmann Applanation Tonometry: Difference of Intraocular Pressure Values Between Eyes with and without Glaucomatous Damage in Thin Corneas]

BACKGROUND

To examine the differences in intraocular pressure (IOP) measurements obtained with Goldmann applanation tonometry (GAT) and Pascal dynamic contour tonometry (DCT) in subjects with thin corneas and to correlate these with structural and functional parameters of glaucoma damage.

PATIENTS AND METHODS

One hundred and thirty participants (130 eyes) with central corneal thickness lower than 500 µm were included in five groups in this cross-sectional observational study: 52 eyes with primary open angle glaucoma (POAG), 19 eyes with normal tension glaucoma (NTG), 27 eyes with ocular hypertension (OHT), 21 participants suspected of having glaucoma (GS), and 11 healthy subjects. The measurements were obtained with GAT and DCT in a masked fashion. The corrected GAT-IOP for central corneal thickness (CCT), the difference between DCT and GAT (ΔIOP = DCT-GAT) and corrected ΔIOP (corrected ΔIOP = DCT-corrected GAT) were calculated. Age, mean deviation (MD) from the most recent reliable visual field examination, average retinal nerve fibre layer thickness (RNFL), cup-to-disc ratio (CDR), ocular pulse amplitude (OPA), and treatment status were recorded for statistical analysis.

RESULTS

In all of the subjects (n = 130), the mean DCT, GAT and corrected GAT values were 17.6 ± 3.4 mmHg, 13.2 ± 3.8 mmHg, and 15.5 ± 2.1 mmHg, respectively. ΔIOP and corrected ΔIOP were 4.4 ± 2 mmHg and 1.7 ± 2 mmHg, respectively. ΔIOP was correlated negatively with MD (rs = -0.32, p < 0.0001) and average RNFL thickness (r = -0.46, p < 0.0001) and positively with CDR (rs = 0.50, p < 0.0001). The mean IOP measured by GAT differed statistically significantly between eyes with glaucoma (n = 71, POAG and NTG) and eyes without damage (n = 59; OHT, GS, and healthy) (p < 0.0001), whereas the mean IOP by DCT did not (p = 0.935). The mean ΔIOP values were also statistically significantly higher in the glaucomatous group, with and without correction for CCT (p < 0.001). OPA and glaucoma diagnoses statistically significantly predicted ΔIOP (R(2) = 0.41, F2.127 = 47.46, p < 0.0001).

CONCLUSION

Greater underestimation of IOP by GAT was observed in the glaucomatous eyes with thin corneas. Performing DCT on patients with thin corneas might be advantageous in establishing the need for more aggressive treatment.

Evaluation of the Quality and Reliability of YouTubeTM Videos Created by Orthodontists as an Information Source for Clear Aligners

Objective

This study aimed to evaluate the quality, reliability, and content usefulness of videos created by orthodontists on clear orthodontic aligners.

Methods

Videos were screened using YouTubeTM by conducting a search for "Invisalign". After a preliminary evaluation of the first 250 results, 61 videos that met the selection criteria were scored and their length, days since upload, and numbers of views, likes, dislikes, and comments were recorded. These data were used to calculate the interaction index and viewing rate. Video reliability was assessed using a five-item modified DISCERN index, and video quality was assessed using the Video Information and Quality Index. A 10-item content usefulness index was created to determine the usefulness of the video content. Descriptive statistics of the parameters were calculated, and correlation coefficients were calculated to evaluate the relationships between the parameters.

Results

The mean reliability score was 2.75±1.02 (out of 5), and the total quality score was 11.80±3.38 (out of 20). The total content usefulness index was quite low, with a mean score of 2.52±2.14 (out of 10). Interaction index and viewing rate were positively correlated with reliability score (r=0.463, p<0.01; r=0.295, p<0.05) and total quality score (r=0.365, p<0.01; r=0.295, p<0.01, respectively). The reliability score was positively correlated with the total quality score (r=0.842, p<0.01) and total content usefulness index (r=0.346, p<0.01).

Conclusion

Videos about orthodontic aligner treatment have average reliability and quality but largely insufficient content.

The prevalence of Barrett's esophagus and erosive esophagitis in a tertiary referral center in Turkey

BACKGROUND/AIMS

In recent years, changes in the definition of Barrett's esophagus have resulted in some difficulties in its diagnosis. Very few epidemiological data on Barrett's esophagus and erosive esophagitis in Turkey are available in the literature. The aim of this study was to determine the prevalence of Barrett's esophagus and erosive esophagitis in a tertiary referral center in Turkey.

METHODS

18,766 endoscopic examinations done in Ege University between October 1996 and June 2001 were included in this retrospective study. The histologic identification of goblet cells confirming the presence of intestinal metaplasia within the esophagus was considered as Barrett's esophagus.

RESULTS

280/18,766 (1.5%) cases were suspected as Barrett's esophagus by endoscopy. 84/18,766 (0.4%) cases were confirmed pathologically. Thirty-six cases were women and 48 men; mean age was 55.6 years. Pathology did not confirm the diagnosis in 46% of the long-segment Barrett's esophagus and in 72% of the short-segment Barrett's esophagus cases (p<0.01). Erosive esophagitis was diagnosed in 12.8% of overall patients by endoscopy and was significantly higher in patients with Barrett's esophagus (27%, p=0.0001). Hiatal hernia was found in 5% of Barrett's esophagus cases and in 11.2% of the endoscopically suspected Barrett's esophagus cases (p>0.05).

CONCLUSION

The prevalence of Barrett's esophagus and erosive esophagitis are much lower than in developed countries. In the endoscopic examination, overdiagnosis of Barrett's esophagus is still a problem, especially in the presence of short-segment Barrett's esophagus. The presence of hiatal hernia did not affect the diagnosis.

Extrusion and granuloma formation with mersilene mesh brow suspension

BACKGROUND AND OBJECTIVE

A variety of biologic or synthetic materials have been used in brow suspension ptosis surgery. We describe extrusion and granuloma formation in 5 cases of congenital ptosis operated with Mersilene mesh sling.

PATIENTS AND METHODS

Case reports with review of literature.

RESULTS

Two cases of extrusion and 3 cases of granuloma formation were encountered in 79 eye lids of 52 (6.3%) patients performed for the treatment of congenital ptosis. Mersilene mesh fibers in the cut surface and a foreign body reaction were found by microscopic evaluation of tissue harvested at the time of surgical removal of the sling.

CONCLUSION

Despite the operative precautions, the probability of extrusion and granuloma formation should be in mind in cases of congenital ptosis operated with Mersilene mesh sling, a synthetic material.