Outcomes of 23-gauge pars plana vitrectomy and internal limiting membrane peeling with brilliant blue in macular hole

Huseyin Sanisoglu1, Mehmet Sahin Sevim1, Betul Aktas1, Semra Sevim2, Ahmet Nohutcu11Haydarpasa Numune Education and Research Hospital, Department of Ophthalmology, 2Uskudar State Hospital, Eye Clinic, Istanbul, TurkeyPurpose: The evaluation of anatomic and visual outcomes in macular hole cases treated with internal limiting membrane (ILM) peeling, brilliant blue (BB), and 23-gauge pars plana vitrectomy (PPV).Materials and methods: Fifty eyes of 48 patients who presented between July 2007 and December 2009 with the diagnosis of stage 2, 3, or 4 macular holes according to Gass Classification who had undergone PPV and ILM peeling were included in this study. Pre- and postoperative macular examinations were assessed with spectral-domain optical coherence tomography. 23 G sutureless PPV and ILM peeling with BB was performed on all patients.Results: The mean age of patients was 63.34 ± 9.6 years. Stage 2 macular hole was determined in 17 eyes (34%), stage 3 in 24 eyes (48%), and stage 4 in 9 eyes (18%). The mean follow-up time was 13.6 ± 1.09 months. Anatomic closure was detected in 46/50 eyes (92%), whereas, in four cases, macular hole persisted and a second operation was not required due to subretinal fluid drainage. At follow-up after 2 months, persistant macular hole was detected in one case and it was closed with reoperation. At 12 months, an increase in visual acuity in 41 eyes was observed, while it remained at the same level in six eyes. In three eyes visual acuity decreased. There was a postoperative statistically significant increase in visual acuity in stage 2 and 3 cases (P < 0.05), however, no increase in visual acuity in stage 4 cases was observed.Conclusion: PPV and ILM peeling in stage 2, 3, and 4 macular hole cases provide successful anatomic outcomes, however, in delayed cases, due to photoreceptor loss, it has no effect on functional recovery. BB, used for clarity of ILM, may be beneficial due to its low retinal toxicity.Keywords: macular hole, internal limiting membrane, ILM peeling, brilliant blu

Primary probing for congenital nasolacrimal duct obstruction with manually curved Bowman probes

Didem Serin,1 Ibrahim Bulent Buttanri,1 Mehmet Sahin Sevim,1 Bahtinur Buttanri21Eye Clinic, Haydarpasa Numune Education and Research Hospital, 2Eye Clinic, Sisli Etfal Education and Research Hospital, Istanbul, TurkeyPurpose: To evaluate the effect of the shape of Bowman probes on the success of primary probing for congenital nasolacrimal duct obstruction.Materials and methods: Records of 42 nasolacrimal duct obstructions in 37 children who underwent probing with straight Bowman probes (group A) and 128 nasolacrimal duct obstructions in 110 children who underwent probing with Bowman probes manually bent to mimic the natural curve of the bony nasolacrimal pathway (group B) were evaluated and compared. All children were under 2 years of age. The main outcome was successful probing. Successful probing was defined as a complete resolution of signs and symptoms.Results: The mean age of the patients was 16.4 ± 4.1 months (range 8–24 months) in group A and 16.8 ± 4.2 months (range 7–24 months) in group B. No canalicular or nasolacrimal sac pathologies were diagnosed during probing. The success rate was 76.2% (32/42) in group A and 91.4% (117/128) in group B. The difference was statistically significant (P < 0.01).Conclusion: Manually curved probes can be used efficiently during probing and increase the success rates.Keywords: nasolacrimal duct obstruction, success rate, curved Bowman probe, <2-year-old childre

Exogenous group G Streptococcus endophthalmitis following intravitreal ranibizumab injection

Suleyman Kugu,1 Mehmet Sahin Sevim,2 Nilufer Zorlutuna Kaymak,1 Gurkan Erdogan,3 Baran Kandemir,1 Omer Kamil Dogan41Lutfi Kirdar Kartal Training and Research Hospital, Eye Clinic, Istanbul, 2Haydarpasa Numune Training and Research Hospital, Eye Clinic, Istanbul, 3Umraniye Training and Research Hospital, Eye Clinic, Istanbul, 4World Eye Hospital, Eye Clinic, Istanbul, TurkeyAbstract: We report a case of group G Streptococcus endophthalmitis following an intravitreal ranibizumab injection for a choroidal neovascular membrane. Pars plana vitrectomy was applied for endophthalmitis and group G Streptococcus cultures were isolated in the vitreous samples taken from the patient. Twenty-four hours following pars plana vitrectomy the patient underwent myocardial infarction and cardiac arrest. To our knowledge this is the first reported case of group G Streptococcus endophthalmitis following an intravitreal injection.Keywords: group G Streptococcus, endophthalmitis, intravitreal injectio

Minimum Rim Width and Visual Field Defects in Advanced Glaucoma

Purpose: To investigate the relationship between the Bruch membrane opening-minimum rim width (BMO-MRW) (global and temporal) parameters with spectral-domain optical coherence tomography (SD-OCT) and visual field (VF) sensitivity on the 10-2 test in patients with advanced glaucoma.Materials and Methods: This cross-sectional, observational study included a total of 33 eyes of 29 patients. To evaluate VF sensitivity, automated white-on-white perimetry was performed using a Humphrey field analyzer. The mean deviation (MD) and pattern SD values were used to characterize the degree of functional damage. BMO-MRW and peripapillary retinal nerve fiber layer thickness were obtained with SD-OCT. According to the Garway-Heath map and fovea and BMO axis, the 90 degrees temporal sector of the optic disc corresponding to the central VF was divided into upper and lower parts.Results: The upper and lower temporal BMO-MRW parameters showed stronger correlations with the MD parameters of their corresponding VFs when compared with both global and temporal MRW parameters. Global and temporal retinal nerve fiber layer thickness parameters were also correlated with global MD parameters.Conclusions: BMO-MRW measurements in the upper and lower parts of the 90 degrees temporal sector of the optic nerve head by SD-OCT and their corresponding VF sensitivity on the 10-2 test were found highly correlated. These BMO-MRW measurements could offer a means of predicting the status of visual hemifields in patients who are unable to undergo VF testing. Further longitudinal studies with larger series evaluating BMO-MRW parameters with SD-OCT are also needed to monitor progression in advanced glaucoma