Comparison of locking and non-locking reconstruction plate-screw system in lateral mandibular defects by finite element analysis

PURPOSE

The purpose of this study is to analyze and compare stress distribution on bone screws and plate systems in locking and non-locking screw-plates design in lateral mandibular defects.

MATERIAL AND METHODS

Solid mathematical model of mandible was created by three-dimensional finite elements analysis and 25 mm length of lateral resection (L defect) was performed on the model. Models were reconstructed with 2.4 locking and non-locking reconstruction plate system. Each masticator muscles attached to mandible were simulated as direction, attachment area and magnitude on 3D model to compare with reality. The stress formation on bone and hardware system were evaluated.

RESULT

The stress values on the cortical bone, plate and screw system were higher in conventional plate model than the locking system model. The highest stress values were measured in the proximal segment especially in conjunction with conventional screw system. Furthermore, the distribution of stress on the bone surface was more homogenous in the locking system.

CONCLUSION

It is evident that the use of the locking system in 25 mm length lateral mandibular defects provides an additional advantage over conventional systems in reconstruction models.

THE EFFECTS OF VARIOUS DOSES OF PREDNISOLONE ADMINISTRATION ON SERUM VASPIN LEVELS IN RATS

AIM

The aim of this study was to investigate the dose-dependent effects of prednisolone administration on serum vaspin levels and correlate this with changes in the BMI and lipogenesis in rats.

MATERIALS AND METHODS

Twenty-four albino Wistar male rats weighing between 190-240 g were divided into four groups, three experimental (5 mg/kg, 10 mg/kg, and 20 mg/kg prednisolone) and one control. The prednisolone groups were given once-daily doses for 30 days, orally. In addition, the rats were weighed, and their height and waist circumferences were measured once a week. At the end of 30 days, vaspin and glucose levels were measured from blood samples.

RESULTS

In the prednisolone groups, the vaspin levels significantly increased when compared with the control group. The control group has a serum vaspin level of 155 ± 20.99 pg/mL and this level has been increased by prednisolone administration in a dose dependent manner. In the prednisolone groups, especially the 10 mg/kg and 20 mg/kg groups, the glucose levels increased in a dose dependent fashion.

CONCLUSION

Prednisolone administration significantly increased serum glucose and vaspin levels in a dose dependent manner, indicating that the increase in the serum vaspin levels could be related to the increase in the serum glucose concentration. Vaspin can be a molecule that is released in response to increased glucose and can be a rebound defense mechanism to modulate the blood glucose concentration. We suggest vaspin as a potential target for the treatment and diagnosis of diabetes mellitus and other metabolic disorders.

Slime Production by Coagulase-Negative Staphylococci Isolated in Chronic Blepharitis

Background

The purpose of the study was to determine the impact of slime-producing strains of coagulase-negative staphylococci (CNS) on non-ulcerative blepharitis. Formerly considered harmless organisms, CNS are now recognised as opportunistic pathogens. Although these microorganisms are a component of normal conjunctival flora, they often produce the typical signs and symptoms of chronic staphylococcal blepharoconjunctivitis. Certain strains produce a polysaccharide extracellular material called “slime”. Slime production is considered to be associated with the virulence of the organism.

Methods

Swabs were taken from the lids of 38 eyes of 19 patients with chronic non-ulcerative blepharitis and cultured for CNS. A group of 42 normal control eyes were similarly sampled. The strains of CNS isolated from 26 eyes (68.4%) of the patients with blepharitis and 25 eyes (59.5%) of the normal subjects were studied for slime layer production.

Results

No significant difference was found between normal subjects and patients in the incidence of slime producing CNS strains from the conjunctiva. The antibiotic sensitivity profiles of the slime-producing strains were no different from the slime-negative isolates in the blepharitis (p=0.85) and normal group (p=0.25).

Conclusions

Our data suggest that slime production by CNS does not play a significant role in the pathogenesis of staphylococcal blepharitis.

Optic Disc Measurements with the 78 Diopter Lens, Zeiss 4-Mirror Contact Lens and Computerized Image Analysing System

We evaluated the 78 diopter (D) lens and Zeiss 4-mirror lens for the measurement of vertical and horizontal optic disc diameters during slit-lamp biomicroscopy and compared the results with the measurements made with the computerized image analysing system (IMAGEnet 640, Topcon, Japan) in 30 eyes of 30 patients. The 78D lens and Zeiss 4-mirror lens measurements both correlated well with the computerized image analysis measurements (r=0.881 for vertical and r=0.895 for horizontal disc diameter measurements with the 78D lens and r=0.883 for vertical and r=0.891 for horizontal disc diameter measurements with the Zeiss 4-mirror lens). The 78D lens measurements overestimated vertical disc diameter by 5.3% and horizontal disc diameter by 4.4%. The Zeiss 4-mirror lens underestimated the vertical disc diameter by 2.4% and horizontal disc diameter by 2.2%. Thus either lens can be used for a quick estimation of the optic disc size, since the results correlate well with the computerized image analysis measurements.

Is Tear Calcium An Indicator of Ocular Calcification in Patients with Chronic Renal Failure?

BACKGROUND

In patients with chronic renal failure (CRF) on regular dialysis treatment, limboconjunctival degeneration and calcifications are common. The mechanisms of ectopic conjunctival and corneal calcification remain largely speculative. The aim of the present work was to study tear calcium levels in patients with chronic renal failure, which could alter calcium excretion patterns, and to examine whether the calcium level in tear fluid is of more diagnostic importance than static calcium levels in blood.

METHODS

Tear calcium levels were measured in 25 patients with chronic renal failure, compared with 14 normal subjects. Conjunctival and corneal calcium deposits were graded by the Porter and Crombie classification.

RESULTS

While 11 of the 25 patients had no clinically apparent calcium deposits, six had Grade 1 or 2, and eight had Grade 3 and over limboconjunctival calcification. Mean tear calcium levels were 1.436 +/- 0.165 mg/dl in the patients and 1.307 +/- 0.155 mg/dl in the normal group. The difference was not significant (P = 0.572). No correlation was found between the grade of the calcium deposits and tear calcium levels.

CONCLUSIONS

Tear calcium level has no diagnostic importance for the development of ocular calcification in chronic renal failure.

A Case of Duane's Retraction Syndrome with Multiple Congenital Malformations

Duane's retraction syndrome is associated with various ocular and systemic abnormalities. We report a case with bilateral Duane's retraction syndrome type I accompanied by renal agenesis, vesico-ureteral reflux, patent ductus arteriosus, and external ear malpositioning. Because of disabling consequences, we recommend a thorough physical examination and screening for renal and cardiac abnormalities in all patients presenting with Duane's reaction syndrome.

Retinal Vein Occlusion in a Woman with Heterozygous Fabry's Disease

Fabry's disease is associated with high incidence of thrombosis in hemizygous males and heterozygous females. We describe a woman with Fabry's disease who developed hemi-central retinal vein occlusion during the follow-up. The vein occlusion showed a fulminant course ending with a painful blind eye within a short period. Fabry's disease should be considered in the differential diagnosis of the vascular occlusive disorders especially in young patients.

Effects of Hypertension on the Retinal Vein Width at the Retinal Arteriovenous Crossings

Purpose

The study was designed to quantify retinal vein width changes at the arterio-venous crossing and to evaluate the effects of hypertension on vein widths at “vein posterior to the artery” (VPA) and “vein anterior to the artery” (VAA) crossings.

Methods

The width of the retinal veins was measured at points before and after the arterio-venous crossings by a computerized image analysis system in ten normal subjects and 35 hypertensive patients. Retinal vein width changes at fixed intervals from the arterio-venous crossing points, both VAA and VPA, were measured as a function of the stage of the hypertensive retinopathy in the subjects.

Results

Mean retinal vein width showed significant (p<0.05) narrowing at VPA crossings at stages 2,3 and 4 of hypertensive retinopathy. For the VAA crossings, there was no significant decrease in the width of the vein at any stage. There was no significant narrowing of the vein at VPA crossings in normal subjects or in stage 0 and stage 1 hypertensive retinopathy patients.

Conclusions

The decrease in the width of the retinal vein in stages 2, 3 and 4 hypertensive retinopathy patients at VPA crossings can cause turbulence in blood flow, leading to intimal damage and occlusion. The absence of narrowing may explain the low incidence of branch retinal vein occlusions at VAA crossings.

Indocyanine Green Angiographic Findings in a Case of Punctate Inner Choroidopathy

Purpose

To report indocyanine green angiographic findings in a case of punctate inner choroidopathy.

Methods

Fundoscopy, fluorescein angiography and indocyanine green angiography were carried out on a 23-year-old woman who presented with features typical of punctate inner choroidopathy.

Results

Fundoscopy showed multiple small yellow lesions in the retinal pigment epithelium and inner choroid in both eyes and a subfoveal choroidal neovascular membrane in the left eye. The lesions showed early hyperfluorescence with mild leakage in the late phases of the fluorescein angiogram. On indocyanine green angiography, the lesions demonstrated obvious hypofluorescence in the early, mid and late phases.

Conclusions

The fluorescein and indocyanine green angiographic findings indicate that punctate inner choroidopathy affects the choriocapillaris as well as the retinal pigment epithelium and photoreceptors. However, it is still not known whether the primary pathology is in the retinal pigment epithelium, the photoreceptors or the choriocapillaris.

Prevalence of the association of subacromial impingement with subcoracoid impingement and their clinical effects

OBJECTIVES

A prospective study to determine how commonly chronic subacromial impingement is associated with subcoracoid impingement and to evaluate clinical outcome after arthroscopic subacromial decompression (ASD).

METHODS

Subacromial and coracohumeral distances were evaluated in patients with chronic shoulder pain before and after ASD, using magnetic resonance imaging and the University of California at Los Angeles (UCLA) shoulder scale and Constant-Murley shoulder assessment.

RESULTS

A total of 40 patients were included in the study; patients were followed up for a mean of 27.3 months. Before ASD, 14 (35%) patients with chronic subacromial impingement also had subcoracoid impingement. In these patients, the mean coracohumeral distance was 7.18 mm (range 5.00 - 11.00 mm). After ASD, no patient had subcoracoid impingement, and the mean coracohumeral distance was significantly longer than pre-ASD, 12.85 mm (range 11.00 - 15.00 mm). The Constant-Murley shoulder assessment and UCLA shoulder scale both showed improvement after ASD.

CONCLUSIONS

Chronic subacromial impingement occurred together with subcoracoid impingement in 35% of patients presenting with chronic shoulder pain. Following ASD, the coracohumeral distance increased with remission from pain.

A pilot study of the use of objective structural clinical examinations for the assessment of ophthalmology education

PURPOSE

A pilot study was carried out to evaluate the practicality, reliability, and validity of an objective structured clinical examination (OSCE) for assessing the clinical skills and abilities of specialists in ophthalmology.

METHODS

Ten unfolded OSCE style, criterion referenced questions were asked to nine candidates to assess their clinical skills and abilities, as opposed to subject knowledge. Candidate and assessor reactions to the examination process were monitored and analyzed using participant observation and questionnaires administered immediately after the event. Relevant statistical techniques were applied to the results.

RESULTS

A total of 89% of candidates passed the examination, with the pass boundary set at 70%. Candidates revealed themselves more successful in meeting clinical skill criteria (mean 77%) than clinical ability criteria (mean 72%). Candidates, assessors, and observers all expressed the view that the OSCE pilot had been a successful way of assessing clinical skills and abilities.

CONCLUSIONS

OSCE style assessment is an effective and efficient means of assessing skills and abilities in clinical ophthalmology education.

Tear function tests and conjunctival impression cytology before and after hormone replacement therapy in postmenopausal women

PURPOSE

To investigate the effect of hormone replacement therapy (HRT) on postmenopausal tear function and the conjunctival epithelium.

METHODS

Schirmer I-Jones test, tear film break-up time (BUT), and impression cytology findings were analyzed in 34 eyes of 17 women who were at least two years postmenopausal and not taking HRT: This series of tests was repeated after three months on HRT.

RESULTS

The patients' average age was 53.82 +/- 3.6 years, and the mean time postmenopause was 35.29 +/- 11.59 months. There was no significant difference in the Schirmer I-Jones test results before and after three months of HRT (p > 0.05). However, the BUT (p < 0.05) and impression cytology (p < 0.05) findings were significantly affected by HRT.

CONCLUSIONS

HRT may alleviate postmenopausal dry eye symptoms by increasing goblet cell density.

Results of cataract surgery in renal transplantation patients

PURPOSE

To evaluate the results of conventional extracapsular cataract extraction and phacoemulsification cataract surgery, in renal transplant patients.

METHODS

A total of 11 eyes of eight renal transplant recipients who underwent cataract surgery in Ankara between 1995 and January 2001 were evaluated. Each individual underwent routine ophthalmologic examination including visual acuity with Snellen chart testing, slit-lamp examination, intraocular pressure measurement, and fundus examination. Of these, seven patients had posterior subcapsular cataracts and four had nuclear cataracts. Conventional extracapsular cataract extraction (cECCE) was performed in four eyes with single-piece all-polymethylmethacrylate posterior chamber intraocular lens implantation. The other seven eyes were treated with small-incision phacoemulsification and implantation of a foldable hydrophilic acrylic lens.

RESULTS

We observed intraoperative posterior capsule rupture and vitreous loss in one patient, postoperative intraocular tension elevation in one patient, and sterile suture infiltration in one patient in our series. Average of the visual acuities 6 months after the operation was 20/30 (range, 20/60-20/20).

CONCLUSIONS

In this, the first published report to describe outcomes of cataract surgery in renal transplant patients, most complications were associated with high of steroids use and immunosuppressives, and were independent of the type of cataract surgery used, either ECCE or phacoemulsification surgery. The study suggests the need for additional care before, during, and after operation.

Retinal vein occlusion and factor V Leiden and prothrombin 20210 G:A mutations

PURPOSE

The aim of this study was to establish whether the factor V Leiden mutation and the prothrombin 20210 G:A mutation were risk factors for retinal vein occlusion.

METHODS

Blood samples were obtained from 40 patients with retinal vein occlusion and from 50 healthy normal volunteers as controls. Polymerase chain reaction assays were done to detect factor V Leiden and prothrombin 20210 G:A mutations, and the two groups were compared.

RESULTS

Two (5%) of 40 patients with retinal vein occlusion and three (6%) of 50 controls were heterozygous for factor V Leiden (p=0.84). None of the individuals in either group had the prothrombin 20210 G:A mutation.

CONCLUSIONS

There was no significant association between retinal vein occlusion and the factor V Leiden mutation.

Pachymeningitis and optic neuritis in rheumatoid arthritis: successful treatment with cyclophosphamide

Pachymeningitis is a rare complication of rheumatoid arthritis. The case of a 52-year-old male rheumatoid arthritis patient with pachymeningitis and optic neuritis who was successfully treated with intravenous cyclophosphamide is described.

Aqueous humor nitric oxide levels in patients with central retinal artery occlusion

BACKGROUND/PURPOSE

There is increasing evidence suggesting that nitric oxide (NO) is implicated in the pathogenic process of ischemic disease. The purpose of this study was to quantify the aqueous humor NO levels in patients with central retinal artery occlusion (CRAO) and in age-matched controls.

METHODS

Aqueous humor specimens were obtained from seven patients who had been diagnosed with CRAO; the sampling was done within 12 to 24 hours of diagnosis. All specimens were obtained by paracentesis, which was performed as a therapeutic intervention. Samples of aqueous humor were also collected from 15 age-matched healthy patients undergoing cataract surgery, to be used as controls. For each sample, we assayed the amount of nitrite, which is the stable metabolite of NO, using the spectrophotometric method based on the Griess reaction.

RESULTS

There were detectable levels of nitrite in the aqueous humor from five of seven patients with CRAO (mean level, 0.32 +/- 0.08 micromol/L). The levels in the control group were below the detection limit in all cases (<0.08 micromol/L). There was a statistically significant difference between the aqueous humor nitrite levels in the CRAO group and the controls (P = 0.0008).

CONCLUSIONS

Our study shows that patients with CRAO present with elevated levels of NO in the aqueous humor. These findings may provide insight into the role that NO plays in CRAO.

Management of hypotony maculopathy and a large filtering bleb after trabeculectomy with mitomycin C: success with argon laser therapy

We report a patient with postkeratoplasty glaucoma that developed a large, filtering bleb following trabeculectomy with intraoperative antimetabolite treatment. The hypotony and the bleb were managed using argon laser photocoagulation. A 26-year-old female patient underwent penetrating keratoplasty in the left eye for keratoconus. Postoperatively, her elevated intraocular pressure could not be controlled medically, and the patient underwent a trabeculectomy with intraoperative antimetabolite application. Two months later, hypotony maculopathy, optic disc edema, and choroidal folds developed, and her vision dropped. Steroid treatment and soft contact lenses did not help. Photocoagulation was applied twice to the surface of the bleb and the surrounding area. After the photocoagulation therapy, the patient's vision improved, intraocular pressure increased, and the optic disc edema and macular folds had resolved. Argon laser photocoagulation applied to a large filtering bleb associated with hypotony maculopathy is a useful treatment for bleb remodeling and elevating intraocular pressure.

Impression cytology of the conjunctival epithelium in patients with chronic renal failure

AIMS

To assess ocular surface changes in patients with chronic renal failure (CRF), to compare the results with the degree of corneo-conjunctival calcium deposits, and to determine whether precipitation of calcium salts predisposes ocular surface modifications.

METHODS

Impression cytology from 50 CRF patients on regular haemodialysis and 22 age and sex matched control subjects were studied. Specimens were obtained from the temporal bulbar conjunctiva using cellulose acetate filter paper. The samples were fixed in 95% ethanol, stained with the periodic acid Schiff (PAS) stain, and evaluated by light microscopy and were graded by a masked observer. Corneo-conjunctival calcification was graded by the Porter and Crombie classification.

RESULTS

In the study group, three patients (6%) disclosed grade 0, 14 patients (28%) grade 1, and 33 patients (66%) grade 2-3 cytological changes. There was a statistically significant difference between the patient and the control groups (p= 0.0007), but no correlation could be found between the impression cytology grades and the calcium deposit grades (p=0.62).

CONCLUSION

The ocular surfaces of CRF patients differ significantly from those of normal individuals, and it can be detected using impression cytology. These data suggest that the severity of conjunctival changes are not related to the presence or extent of calcium deposition.

Macular ischaemia in Behçet's disease

PURPOSE

To report macular ischaemia and visual loss in patients with panuveitis due to Behçet's disease.

METHODS

We describe macular ischaemia, a rare finding, in 3 eyes of 3 patients with panuveitis who were diagnosed and treated as having Behçet's disease. The patients underwent fundus fluorescein angiography (FFA) using a digital imaging system and were treated with topical and oral steroids and cyclosporine in 2 cases, and with added azathioprine in the third case.

RESULTS

The 3 eyes showed macular ischaemia associated with peripheral retinal vasculitis on FFA and control of inflammation was achieved in all cases. After an average of 2 years follow-up, visual acuity and macular ischaemia improved in 2 eyes, while no recovery was seen in the third.

CONCLUSION

The presence of macular ischaemia on FFA in Behçet's disease is a predictor of poor visual outcome. Macular ischaemia may show partial recovery with the treatment of the disease.

Granulomatous anterior uveitis in a patient with CREST syndrome

The CREST syndrome is a variant form of progressive systemic sclerosis. Apart from the occurrence of keratoconjunctivitis sicca, other types of ocular involvement associated with this variant are quite rare. We present the case of a 73-year-old woman with the CREST variant of progressive systemic sclerosis who developed unilateral granulomatous anterior uveitis. Systemic and laboratory testing failed to suggest evidence for any other associated systemic disease as a possible cause of the granulomatous uveitis. The inflammation was successfully controlled with topical steroids and mydriatics. While a small number of cases of uveitis have been reported in other variant forms of progressive systemic sclerosis, to date there have been no descriptions of uveitis associated with the CREST syndrome.

Effect of wind instrument playing on intraocular pressure

PURPOSE

To evaluate the effect of wind instrument playing on intraocular pressure.

METHODS

In a prospective, nonrandomized clinical trial, 24 eyes of 24 wind instrument players with no history of any ocular or systemic disease were evaluated. The musicians were members of Bilkent Academic Symphony Orchestra of Bilkent University in Ankara. A complete eye examination, including best-corrected visual acuity, slit-lamp examination, and fundus examination, was performed. The intraocular pressure was measured before and after a 90-minute rehearsal of a piece by Wagner. All intraocular pressure measurements were carried out by the same researcher using Goldmann applanation tonometry. The difference in intraocular pressure measurements before and after the 90-minute wind instrument-playing performance was analyzed.

RESULTS

The mean intraocular pressure was 13.79 +/- 1.93 mm Hg before and 15.12 +/- 2.44 mm Hg after the performance. Wind instrument playing significantly increased the mean intraocular pressure by 9.6% (P = 0.0149).

CONCLUSION

These results indicate that wind instrument playing may significantly increase intraocular pressure in healthy patients. The significance of this finding for patients with suspected normal-tension or high-tension glaucoma needs further evaluation.

Elevated vitreous nitric oxide levels in patients with proliferative diabetic retinopathy

PURPOSE

The aim of this study was to determine nitric oxide levels in the vitreous of patients with proliferative diabetic retinopathy.

METHODS

Using the spectrophotometric method based on Griess reaction, we measured levels of nitrite, the stable product of nitric oxide, in the vitreous of 21 eyes of 21 patients who underwent vitrectomy for the treatment of proliferative diabetic retinopathy with tractional retinal detachment, prospectively. Three samples were excluded from the study because of blood contamination. The control group was made up of vitreous samples from 15 eyes of 15 normal cadavers and five eyes of five patients who were undergoing vitrectomy for macular hole surgery.

RESULTS

Nitrite levels were 0. 524 +/- 0.27 microM and 0.383 +/- 0.17 microM in the vitreous of patients with proliferative diabetic retinopathy of diabetes type I and type II, respectively. In 15 cadaver eyes and five vitreous samples from patients who underwent macular hole surgery, nitrite levels were below the detection limit (less than 0.08 microM). There was no significant difference between nitrite levels in patients with type I and type II diabetes (P =.56), whereas there was a significant difference between diabetes groups and controls (P <. 00001).

CONCLUSION

Vitreous nitric oxide levels are elevated in patients with proliferative diabetic retinopathy with tractional retinal detachment. Nitric oxide may play a role in the pathogenesis of proliferative diabetic retinopathy.

Retinal arterial macroaneurysm in a young patient with chronic renal failure

PURPOSE

To report the youngest case of retinal arterial macroaneurysm.

METHOD

Case Report.

RESULTS

Clinical examination and fundus fluoroscein angiography revealed retinal arterial macroaneurysm in a 23-year-old patient with chronic renal failure.

CONCLUSIONS

Acquired macroaneurysm may develop even in a very young patient, especially with chronic renal failure.

Anterior segment indocyanine green angiography in scleral inflammation

PURPOSE

To assess the feasibility of using indocyanine green angiography in scleral inflammation; to define the characteristic patterns of the anterior segment vasculature for this anterior segment disease; and to correlate the findings with those of anterior segment fluorescein angiography.

METHODS

Anterior segment fluorescein and indocyanine green digital angiography were used to evaluate scleral inflammation in 3 patients with diffuse episcleritis, 2 patients with nodular episcleritis and 5 patients with nodular scleritis. Angiograms from both techniques were assessed based on the time for complete disappearance of the dye and the type of leakage.

RESULTS

Both fluorescein and indocyanine green dye appeared in vessels at approximately the same time, but, whereas fluorescein had disappeared completely from vessels by the 70th second, indocyanine green was observed within vessels for up to 23 min. Leakage of fluorescein occurred in all patients with diffuse episcleritis but staining occurred in only 1 patient with nodular scleritis. No leakage of indocyanine green, or staining, occurred in patients with diffuse episcleritis. However, leakage of indocyanine green was apparent in all nodular episcleritis and scleritis patients, staining the nodules in patchy form.

CONCLUSION

The longer transit time, as well as leakage and staining patterns due to its protein-binding properties, make indocyanine green angiography a potentially useful technique in the investigation of patients with scleral inflammation, and in distinguishing diffuse from nodular variants. Further studies are necessary to correlate staining patterns with clinical findings.

Complications of extracapsular cataract surgery in chronic renal failure patients

PURPOSE

In chronic renal failure (CRF) patients the risk of per- and post-operative complications in cataract surgery is high. The most frequent complications observed in these patients and the prevalence of cataract were studied.

METHODS

Eighty-two CRF patients who had undergone ophthalmic examination between December 1996 and April 1998 at Başkent University, Department of Ophthalmology, were retrospectively analysed. Of 82 patients, 18 eyes of 14 CRF patients between 37 and 79 years of age underwent cataract extraction. Planned extracapsular cataract extraction was performed in all patients and all but one had posterior chamber intraocular lens implantation. In the post-operative period, scrapings of the corneal infiltrates were cultured and smears were examined, and the conjunctiva was swabbed and cultured also.

RESULTS

Per-operative hypotony and scleral collapse occurred in 1 patient, and another had haemorrhage in the anterior chamber. Post-operatively, suture infiltration was observed in 10 eyes. These lesions disappeared after topical steroid and antibiotic treatment.

CONCLUSIONS

Patients with CRF require special surgical considerations since they face both general surgical problems and others that arise due to their disease.

Optic disk neovascularization in a patient with cytomegalovirus retinitis associated with renal transplantation

PURPOSE

To report the development of optic nerve head neovascularization during the recovery phase of cytomegalovirus (CMV) retinitis in a renal allograft recipient.

CASE REPORT

A 46-year-old male renal allograft recipient developed CMV retinitis seven months after transplantation. At the time of the diagnosis, the patient was being immunosuppressed with prednisone, cyclosporine, and azathioprine, and was treated with repeated intravitreal and intravenous ganciclovir. Six weeks after the initiation of therapy, optic disk neovascularization developed. This was confirmed by fluorescein angiography, which showed no areas of retinal capillary nonperfusion. At this stage, active retinal lesions were partially resolved. Apart from intraocular inflammation, no other cause of neovascularization was detected. Over the following six months, optic disk neovascularization regressed spontaneously without causing vitreous hemorrhage or visual loss. There was no recurrence of CMV retinitis during follow-up.

CONCLUSION

Optic disk neovascularization may develop in the healing phase of CMV retinitis in renal transplant recipients.

Retinal tears associated with panuveitis and Behçet's disease

To report retinal tears formation in 3 eyes of 2 patients with active panuveitis and Behçet's disease. We describe 2 patients that were diagnosed and treated for Behçet's disease with active panuveitis. Retinal tears developed while the inflammation was active. The patients were treated with topical, oral steroids, and cyclosporine therapy for bilateral panuveitis. One patient presented with a retinal tear located at the periphery of the active retinal lesion. The other had multiple tears associated with active retinal lesions in both eyes. Argon laser photocoagulation was performed in both patients as soon as the tears were detected. Ocular inflammation was controlled with this therapy, and only a few mild flare-ups occurred. The patients have been followed up for 8 and 16 months, respectively. During this period no new retinal tears have developed. Although retinal tear formation is rarely associated with Behçet's panuveitis, the clinician should be aware of this as a possible complication. When structural changes are present in the vitreous, detailed ophthalmoscopy is indicated to assess for retinal tears. If a tear is detected in a patient with panuveitis and Behçet's disease, laser photocoagulation therapy should be performed immediately to prevent retinal detachment.

Comparison of mydriatic efficacy of spray application and drop instillation of tropicamide 1%

PURPOSE

To determine whether the mydriatic efficacy of spray application of tropicamide 1% is comparable to drop instillation of tropicamide 1%, and to compare the ocular discomfort caused by these methods.

METHODS

Thirty-four healthy volunteers were randomly assigned to one of two groups, and received either a single drop of tropicamide 1% eye drops or a single puff of tropicamide 1% spray into open eyes. Pupil diameters were measured from anterior segment images taken using a Topcon Imagenet system at baseline and at the fifth, tenth and fifteenth minute after drug administration. Ocular discomfort experienced with each method was also compared.

RESULTS

Repeated measures analysis of variance revealed that a statistically significant increase in pupil diameter was achieved with both application methods over time (p < 0.0001), and that there were no statistically significant differences in pupil diameter between the two groups at each time point (p = 0.409). The mean ocular discomfort score for tropicamide 1% spray was 1.45 +/- 0.56, and for tropicamide 1% eye drops was 2.71 +/- 0.67. This difference was statistically significant (p < 0.001).

CONCLUSIONS

The mydriatic efficacy of tropicamide 1% spray is similar to that of conventional tropicamide 1% eye drops, and spray application causes less ocular discomfort.

Pyogenic granuloma: a rare complication of silicone punctal plugs

To describe pyogenic granuloma formation associated with silicone punctal plugs. A 65-year-old woman with severe dry eye was treated with silicone punctal plugs in both upper and lower puncta. After 14 months of success with the plugs, the patient presented with a fleshy ampullary lesion overlying the plugged superior punctum of her right eye. It was clinically diagnosed as a pyogenic granuloma, and the silicone plug was removed. Since the lesion persisted for 1 month, it was surgically removed. Histopathologic examination confirmed the diagnosis of pyogenic granuloma. A new plug was inserted and tolerated well. The routine use of silicone plugs are recommended as long as patients are informed of possible rare complications.

[Evaluation of nasolacrimal duct function in chronic paranasal sinus infections with 99mTc dacryoscintigraphy]

BACKGROUND

Paranasal sinus infections and nasolacrimal duct obstructions are commonly encountered problems. However the relationship between these two conditions is not yet clear. Trauma, surgery, tumors, and systemic diseases are among the causes of acquired nasolacrimal duct obstructions but most of the cases are idiopathic. In this study patients diagnosed with chronic paranasal sinus infection were examined with 99mTc lacrimal dacryoscintigraphy to assess their nasolacrimal duct function.

METHODS

Twenty-four patients diagnosed with chronic paranasal sinus infection are included in the study. These patients were observed for at least three months awaiting surgical treatment following unsuccessful medical treatment. The control group included 16 persons admitted to the ophthalmology department without any nasolacrimal duct disease. Nasal endoscopy and paranasal sinus CT revealed normal findings. The age of the patients with chronic paranasal sinus infection and examined in regard to nasolacrimal duct function was between 15 to 17 with a mean age of 34.2 years. Fourteen patients were male and 10 patients were female. The control group included 9 male and 7 female patients between 18 to 60 years with a mean of 30.5 years.

RESULTS

The dacryoscintigraphic examination of 48 nasolacrimal ducts in 24 patients with chronic paranasal sinus infection revealed 7 complete and 18 partial obstructions of the duct, and 23 normal findings. In the control group with 32 nasolacrimal ducts of 16 patients, there was no complete obstruction. Partial obstruction (10.6, 12.0, 14.7 minutes) was be observed in three cases. The statistical workup resulted in a significant difference between paranasal sinus patients and control group (x2 = 15,840 p < 0.001). The paranasal sinus CTs of the patients with paranasal sinus disease were staged using the Lund-Mackay staging system: There is no correlation between the staging score of the paranasal sinus infection and the degree of the obstruction the nasolacrimal duct.

CONCLUSION

This study shows that chronic paranasal sinus disease plays an important role in the pathogenesis of nasolacrimal duct obstructions. The presence of infection has an influence on the nasolacrimal drainage system, but the distribution (staging) of the infection does not appear to correlate with the degree of nasolacrimal duct obstruction. Partial obstruction cases that may progress to complete obstruction may be detected by dacryoscintigraphy, and the treatment of chronic paranasal sinus disease may help to overcome the lacrimal drainage problems in these cases.

Ocular complications with high-dose interferon alpha in chronic active hepatitis

PURPOSE

Interferon alpha, which is used to treat various systemic disorders, has many reversible side-effects involving various organ systems. In this study, chronic active hepatitis patients undergoing interferon alpha therapy were followed with regard to the ocular side-effects.

METHODS

Thirty-six patients with chronic active hepatitis undergoing subcutaneous interferon alpha therapy for 1 year were enrolled. Complete ocular examination and photographic documentation were performed at baseline of the therapy and monthly thereafter. Fisher's exact chi-squared test and Mann-Whitney U-test were employed in the statistical evaluation of the results.

RESULTS

Trichomegaly was noted in 2 (6%) patients. Fifteen patients (42%) were found to have retinopathy with cotton wool spot formation and splinter haemorrhages.

CONCLUSIONS

These findings emphasise the need to monitor these retinal complications, which may result in loss of vision in patients receiving interferon alpha therapy.

Pachymeningitis and optic neuritis in rheumatoid arthritis: MRI findings

Rheumatoid arthritis is a systemic disease in which cerebral and eye involvement is neither common nor fully understood. Although it is rarely the cause of pachymeningitis and optic neuritis, rheumatoid arthritis should always be kept in mind in these two conditions. We present a 52-year-old male with an 8 month history of rheumatoid arthritis who was referred to the neurology department with headache and decreasing vision and was diagnosed as having rheumatoid pachymeningitis and optic neuritis on the basis of MRI findings.

Indocyanine green angiography of optic nerve head melanocytoma

PURPOSE

To determine the features of fluorescein and indocyanine green angiography of melanocytoma.

METHODS

Fluorescein and indocyanine green angiography is used to assess an optic nerve head melanocytoma in a 45-year-old female.

RESULTS

Fluorescein angiography revealed increased vascularity on the surface, with staining around the lesion in the late stages. The lesion was hypofluorescent in all stages of indocyanine green angiography.

CONCLUSIONS

Indocyanine green angiography is helpful in identifying the benign nature of the lesion by showing hypofluorescence, indicating lack of vascularity in the tumor.

Indocyanine green angiographic features of traumatic choroidal ruptures

PURPOSE

To investigate the indocyanine green (ICG) angiographic findings of healed traumatic choroidal ruptures.

METHODS

Three eyes of two patients with choroidal ruptures underwent both fluorescein angiography and ICG angiography with a digital high-resolution system.

RESULTS

Fundus examination showed healed choroidal ruptures in all three eyes. Two of the eyes had old macular scars and one eye had a recent choroidal neovascular membrane with serous detachment of the macula. On fluorescein angiography, the choroidal ruptures showed hypofluorescence at very early stages followed by late hyperfluorescence. On ICG angiography, the choroidal ruptures were hypofluorescent in early, mid and late phases. ICG angiography provided a clear delineation of the choroidal ruptures. In all eyes, the lesion was better defined on the ICG angiogram than on the fluorescein angiogram.

CONCLUSIONS

ICG angiography can be helpful in the clinical evaluation of choroidal ruptures and can be used together with fluorescein angiography for the diagnosis and follow-up of choroidal ruptures.

Intermittent diplopia in chordoma

The symptoms and findings of three patients with clivus chordomas who had episodes of intermittent diplopia are presented. The causes of intermittent diplopia are reviewed, and the possible mechanisms of this symptom in chordomas are discussed.

High myopia causing bilateral abduction deficiency

We present two cases of degenerative myopia with abduction deficiency. Three mechanisms can explain the defect in the abduction: (a) the size of the long globe filling the space of the orbits, (b) the tightness of the medial recti due to long axis of the globe, and (c) longstanding esotropia becoming decompensated later in life. We believe that high myopia is not a well-known cause of abduction deficiency, and it should be considered in the differential diagnosis.