Osman Bulut Ocak

Millard-Gubler Sendromu (MGS), 6. ve 7. kraniyal sinir periferik felcine eşlik eden vücut karşı tarafında hemiparezi ya da hemipleji ile seyreder. Etiyolojide yaşa göre değişkenlik görülmekle birlikte pons hasarı ön plandadır. Tedavi ve prognoz esas olarak etiyolojiye bağlıdır. Kliniğimize sağ gözde içe kayma şikayetiyle başvuran 18 yaşındaki erkek hastada Millard-Gubler Sendromu düşünülmüş, ancak etiyoloji belirlenememiştir. Hastaya şaşılık ve lagoftalmus nedeniyle operasyonlar uygulanmış, sonuç olarak ortofori sağlanmış ve lagoftalmus düzeltilmiştir. Hastalara nöroloji kliniğinin bilgisi dışında yapılacak cerrahi müdahalelerin, hastalığın oküler bulgularını maskeleyebileceği unutulmamalı, multidisipliner yaklaşımla, nörolojik rehabilitasyonu da içeren konservatif tedavi uygulanmalıdır.

Aim This study aims to evaluate the long-term results of sliding shape extraocular muscle transposition, which is a novel operation method of delivering both vascular protection and strengthening of the muscles and transposition of the muscles. Methods The patients’ files were scanned retrospectively. All patients underwent a complete eye examination in addition to motility examination, both preoperatively and postoperatively. Patients were followed up for at least 1 year. Pre- and postoperative deviation measurement values and transposition effects were compared statistically. The two parameters were evaluated separately. Results In patients where 7-mm (or greater) resection was planned, the complete muscle widening transposition procedure was successful. Only two-thirds of transpositions could be achieved in patients who underwent less than 7 mm of strengthening. There was no anterior segment ischemia in the patients who underwent three rectus’ muscle surgery in the same eye. Transposition effects were perfect in those whose vertical deviation was not due to monocular elevation deficiency. While resection effect was excellent in those MED (monocular elevation deficiency) and CEOMF (congenital extraocular muscle fibrosis) cases, transposition effects were limited but found at similar rates as with the standard resection and transposition procedures in CCDD (congenital cranial dis-innervation diseases) (R2–1). Conclusion Even transposition effects were limited in CCDD. ‘Sliding shape’ design extraocular muscle plication was found to be a simple, safe, and effective procedure for patients who needed resection and transposition operation.

Objectives: To determine and evaluate the rate of diplopia after Ahmed glaucoma valve (AGV) implantation surgery. Materials and Methods: The records of patients who underwent AGV implantation in our hospital between the years of 2010 and 2017 were retrospectively reviewed. Patients who were referred to our strabismus department due to binocular diplopia after AGV implantation surgery were included. The details of postoperative day 1, day 7, day 15, and 1 month examinations were recorded. In the postoperative period, the onset time of diplopia complaints, diplopia type, and the presence of diplopia at distance and near fixation were noted. Ocular motility examination and deviation measurements were evaluated. Results: Ten (47%) of 211 patients who underwent AGV implantation in our hospital between 2010 and 2017 met the study inclusion criteria. Six of the 10 patients were men (60%) and 4 were women ( 40%). The mean age of the patients was 44.5 (34-63) years. Complaints of diplopia developed at a mean of 14.5 +/- 12.3 (1-30) days after AGV implantation. The prism measurements of the patients were found to be 8.4 +/- 1.4 prism diopters (PD) exotropia and 7.1 +/- 8.8 PD hypotropia. While 8 patients had diplopia only at near distance, 2 patients had diplopia at both distance and near. Three patients were treated with prismatic glasses, and their complaints of diplopia recovered spontaneously in 5.11 +/- 4.10 months. The other 7 patients were followed up without treatment, and their diplopia complaints resolved spontaneously in 6.11 +/- 4.40 months. Conclusion: Although most of the diplopia that develops after AGV implant surgery resolves without treatment, prismatic glasses might be considered as a treatment option in patients whose diplopia affects their daily lives.

Purpose To compare the efficacy of contact lens use with low vision aids (LVA) with the efficacy of spectacle use with low vision aids. Methods Thirty-six pediatric patients with low vision were enrolled in this study between January 2015 and March 2017. The patients were examined for best-corrected visual acuity (BCVA) with spectacles, spectacles with LVA, contact lenses and contact lenses with LVA. Toleration of the patients with contact lenses and LVA were recorded at the final follow-up exam. Results The mean BCVA with spectacles was detected as 1.11 ± 0.25 log MAR and the mean BCVA improved to 0.35 ± 0.13 log MAR with the use of spectacles and LVA, which was statistically significant. The mean BCVA with contact lens, which was 0.99 ± 0.22 log MAR, improved to 0.40 ± 0.21 log MAR with contact lens and LVA, which was also significant. There was a statistically significant improvement in BCVA of the patients with contact lenses only when compared to spectacles only. The mean BCVA significantly improved in patients using LVA with contact lenses when compared to LVA with spectacles. Tolerations of the patients with contact lenses and LVA were found to be well at 29 of 36 (80.55%) at final follow-up (26.11 ± 6.85 months). Conclusion Contact lens use in pediatric patients with low vision especially with LVA offers better visual acuity, a decrease in nystagmus amplitude, wider field of view and comfort.

Amaç: İdiyopatik makula deliği cerrahi tedavisinde uygulanan 25 gauge (G) pars plana vitrektomi (PPV) cerrahisinin anatomik ve fonksiyonel başarısını ve komplikasyonlarını değerlendirmek. Gereç ve Yöntemler: Mart 2005 – Mayıs 2008 tarihleri arasında hastanemizde makula deliği nedeniyle vitreoretinal cerrahi geçiren 28 hastanın 30 gözüne ait veriler retrospektif olarak incelendi ve olgular anatomik ve fonksiyonel başarı ile görülen komplikasyonlar açısından değerlendirildi.Bulgular: Yasları 40 ile 84 arasında değişen (ortalama 65 ± 10,68 yıl) olguların 18’i (%64,2) kadın ve 10’u (%35,8) erkekti. 22 olguda (%73,3) evre 3, 6 olguda (%20) evre 4, 2 olguda ise (%6,7) evre 2 makuler delik mevcut idi. Cerrahi öncesi en iyi düzeltilmiş görme keskinlikleri (EDGK) ortalama 0,12 ± 0,09 (logMAR 0,98 ± 0,33, 0,05 – 0,4 arası) olarak saptandı. Makula deliklerinin süresi ortalama 9,55 ± 8,97 ay idi. (1 – 24 ay) 25 G PPV cerrahisi sonrası ortalama 13,81 ± 9,44 ay (1-30 ay) takip edilen 30 gözün 29 ‘unda (%96,6) anatomik başarı elde edildi. Olguların cerrahi öncesi ve sonrası EDGK arasındaki fark istatistiksel olarak anlamlıydı (p<0,05). Ameliyat sonrası, 9 olguda (%30) retina pigment epiteli (RPE) değişiklikleri, 8 olguda (%26,67) katarakt, 3 olguda (%10) hipotoni ve 1 olguda (%3,34) retina dekolmanı gelişti. Sonuç: İdiyopatik makula deliği cerrahi tedavisinde 25 G sütürsüz vitrektomi tekniği hem anatomik hem fonksiyonel iyileşme açısından etkili bulunmuştur.

Purpose: To compare the measurements of cycloplegic refraction and refraction (R1-1) under general anesthesia (GA) when using the same portable auto-refractometer (ARF) in pediatric patients. Methods: 36Thirty-six to 60-month-old patients who underwent refraction measurements using a portable ARF (Retinomax® K plus 3, Righton, Japan), who did not receive prior cycloplegics under this GA and who had cycloplegic refraction using 1% cyclopentolate and the same Retinomax® device < 3 months prior this GA, between 2015 and 2018, were included in this study. The agreement (Bland-Altman analysis) and correlation (Pearson correlation) between the mean values of the measurements were analyzed. Results: Two-hundred-twenty-two right eyes of 222 patients (114 male and 108 female) were included in this study. The mean age was 45.04 ± 11.24 months. The mean spherical refractions (R1-1, R2-1) under GA and cycloplegic refraction were 1.08 ± 3.50 diopter (D) (−8.00 to +8.00) and 2.58 ± 3.28 D (−6.50 to +9.25), respectively. A strong positive correlation was detected between the two measurements (r = 0.95). When comparing measurements, the mean measurement under GA was −1.49 D (95% confidence interval: lower limit, −3.63; upper limit, +0.63) more myopic than the mean cycloplegic refraction (R1-1) value (Bland-Altman analysis test). The differences between the measurements were within ± 1 D in 92 eyes (41.44%) and within ± 2 D in 180 eyes (81.01%). No significant difference was detected when comparing the cylindrical refractive error values (p > .05). Conclusion: Refractive measurements under GA were more myopic than cycloplegic refraction (R1-1) measurements. It is important to consider that complete cycloplegia is not achieved under GA.

Purpose To assess the effect of the intense pulse light (IPL) therapy for the treatment of meibomian gland dysfunction (MGD) and dry eye parameters. Methods Patients who underwent an IPL therapy for the treatment of MGD were included in this retrospective study. Ocular Surface Disease Index (OSDI) scores, the frequency of daily lubricant use, non-invasive tear break-up time (NIBUT), meibomian glad dropout scores, corneal staining scores, and Schirmer test results were collected from patient charts that recorded at baseline and follow-up visits at 1 month, 3 months, and 12 months. For the analysis, patients were grouped based on the severity of their baseline meibomian gland dropout score as mild, moderate, and severe atrophy. Results Forty-three patients (mild atrophy = 22, moderate atrophy = 17, and severe atrophy = 4) were included for analysis. Except for the Schirmer test, all dry eye parameters significantly improved in patients with mild and moderate atrophy following the treatment and this effect lasted until the 12-month follow-up visit (p < 0.001). No significant improvement in any parameter was observed in patients with severe atrophy at any time point (p > 0.05). In the mild and moderate atrophy groups, OSDI scores, as well as NIBUT, started improving at 1 month (p < 0.01), while corneal staining and meibomian gland dropout scores showed earliest improvements at 3 months (p < 0.01). No adverse events were observed, except for temporary redness in 4 patients. Conclusion The IPL treatment seems an effective and safe treatment for patients with MGD. This study shows that the IPL resulting in an earlier improvement in symptoms and signs with long-lasting beneficial effect on the meibomian glands.

Purpose:To evaluate the outcome of surgical treatment in patients with type 1 monocular elevation deficiency. Methods: Patients who were diagnosed as having type 1 monocular elevation deficiency by forced duction test and exaggerated traction test between 2000 and 2016 were retrospectively reviewed. Epidemiologic and clinical features of the patients were noted. The efficacy of ipsilateral inferior rectus recession to vertical misalignments and limitation of elevation were evaluated. The clinical features of the patients who did not achieve surgical success after inferior rectus recession were determined. The surgical and functional results of contralateral superior rectus recession were evaluated for patients who had residual hypotropia under inferior rectus recession. Results: Thirty-nine patients were included in the study. Preoperatively, vertical deviations were 20.53 +/- 4.50 prism diopters (PD) for near and 22.21 +/- 5.12 PD for distance. After inferior rectus recession, the amount of vertical deviation corrected was 15 +/- 1.14 PD for near and 17.01 +/- 2.00 PD for distance. Ten (25.64%) patients did not achieve surgical success (> 6 PD residual hypotropia). Nine patients (preoperative inferior rectus recession measurements = 28.77 +/- 7.25 PD for near and 27 +/- 7.44 PD for distance) underwent contralateral superior rectus recession as a second surgery. After contralateral superior rectus recession, 7 of 9 (77.78%) patients achieved surgical success. The limitation of elevation significantly improved after both surgeries (Wilcoxon test, P < .05). No diplopia or other complications after surgeries were reported. Conclusions: Inferior rectus recession is the first surgical option for patients with type 1 monocular elevation deficiency. Contralateral superior rectus recession is an effective alternative surgical treatment for residual hypotropia after ipsilateral inferior rectus recession.