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    Acinetobacter baumannii endophthalmitis following intravitreal Ranibizumab injection
    (2013) Çankaya C.; Cumurcu T.; Do?anay S.
    We aimed to report a case who developed Acitenobacter baumannii endophthalmitis after intravitreal Ranibizumab (Lucentis®) injection. A 79-year-old male patient was admitted with vision loss in both eyes. Fluorescein angiography showed dry type age-related macular degeneration (ARMD) in the right eye and subretinal hemorrhage secondary to subfoveal classic type choroidal neovascular membrane in the left eye. Intravitreal injections of 3-dose Ranibizumab (Lucentis®) at monthly intervals were planned for the left eye of the patient. After the injection of the third dose of Ranibizumab, on the third day, the patient returned to the clinic with a complaint of excruciating ocular pain, red eye and vision loss in the left eye. The visual acuity of the patient was at the level of light perception. A slit lamp examination and B-mode ultrasonography revealed endophthalmitis. The patient was promptly hospitalised and medical treatment was started. After the sampling of vitreous from the left eye, vancomycin and ceftazidime were intravitreally administered. Systemic cefazolin and gentamicin, topical fortified vancomycin and ceftazidime, and topical moxifloxacin along with topical cycloplegic drops were started. Pars plana vitrectomy could not be performed due to corneal opacification. Four days after the initialisation of the therapy, the culture of the vitreous sample yielded Acinetobacter baumannii. In the following days, no regression in the clinical picture was determined and the level of the visual acuity worsened to light perception loss. Acute Acinetobacter baumannii endophthalmitis following intravitreal Ranibizumab injection occurs rapidly and can result in severe loss of vision. Although endophthalmitis is rare, ophthalmologists should be alert to the possibility of patients having endophthalmitis caused by A. baumannii.
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    Comparison of silicone oil removal using 23 gauge and 20 gauge sclerotomy systems
    (2011) Do?anay S.; Koç B.; Çankaya C.; Demirel S.
    Purpose: To compare 23 and 20 Gauge (G) sclerotomy methods for silicone oil removal. Materials and Methods: Patients that had undergone pars plana vitrectomy (PPV) and received silicone oil as intraocular tamponade material because of retinal detachment and the complications of proliferative diabetic retinopathy were divided into two groups: those undergoing removal of silicone oil through 20 G sclerotomy (Group 1; 39 patients) and those undergoing removal of silicone oil through 23 G transconjunctival sclerotomies (Group 2; 34 patients). The groups were evaluated with regard to postoperative changes in BCVA and IOP, and complications that occurred during and after surgery. Results: In the postoperative follow-up, the mean values of BCVA on the first day, at the first week, and at the first, third, and sixth months were LogMAR 1.2±1.0, 1.0±1.0, 0.96±0.9, 0.9±0.85, and 0.86±0.8, respectively, in Group 1, and LogMAR 1.2±1.2, 0.96±1.0, 0.94±0.9, 0.9±0.94, and 0.9±0.94, respectively, in Group 2. In the postoperative follow-up, the mean values of IOP on the first day, at the first week, and at the first, third, and sixth months were 13±1.7, 14±2.6, 14±1.7, 14±1.6, and 15±3.2 mmHg, respectively, in Group 1, and 11±3.5, 12±1.8, 13±1.8, 13±2.0, and 14±2.6 mmHg, respectively, in Group 2. No patients from the Group 1 developed hypotonia on the first day after surgery, whereas hypotonia was determined in 3 patients (8.8%) from Group 2. During the postoperative checkups, re-detachment was found in 4 patients (10.2%) from Group 1, recurring vitreous hemorrhage (VH) was found in 3 patients (7.6%) from Group 1, re-detachment occurred in 2 patients (5.8%) from Group 2, and recurring VH occurred in 2 patients (5.8%) from Group 2. Conclusion: Silicone oil removal using a 23 G transconjunctival sutureless pars plana vitrectomy and the 20 G pars plana vitrectomy system shows similar characteristics. However, the 23 G transconjunctival system provides additional benefits such as the a vantages of a closed system, the conjunctiva is not opened, and the complications due to the sutures are reduced.
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    The effect on surgical success of intravitreal bevacizumab given before pars plana vitrectomy in diabetic patients
    (2010) Do?anay S.; Koç B.; Çankaya C.; Düz C.; Bilak S.
    Purpose: To investigate the effect on surgical success of intravitreal bevacizumab given before pars plana vitrectomy in diabetic patients. Materials and Methods: All patients were divided into two groups: those given bevacizumab before surgery (Group 1; 32 patients) and those not given bevacizumab (Group 2; 50 patients). The groups were compared with regard to the frequencies of retinal tear and active bleeding during surgery, postoperative changes in best corrected visual acuity (BCVA) and intraocular pressure (IOP), postoperative frequencies of retinal detachment and recurrent vitreous hemorrhage (VH), and development of rubeosis. Results: During the surgery, retinal tear was observed in 2 patients (6.3%) from Group 1 and in 4 patients (8%) from Group 2; active bleeding was seen in 2 patients (6.3%) from Group 1 and in 4 patients (8%) from Group 2. After the surgery, retinal detachment was found in 1 patient (3.1%) from Group 1 and in 2 patients (4%) from Group 2; recurrent VH was found in 4 patients (12.5%) from Group 1 and in 14 patients (28%) from Group 2. In the postoperative controls, an increase in IOP was determined in 6 patients (18.8%) from Group 1 and in 9 patients (18%) from Group 2. In the postoperative controls, an increase in the mean BCVA value was determined in 24 patients (75%) from Group 1 and in 32 patients (64%) from Group 2. Conclusion: In the patients with PDR, anti-VEGF (vascular endothelial growth factor) drugs positively influence the surgical success by causing the active new vasculature to be regressed and consequently allowing easy cleaning of the membranes during surgery. Due to the anti-inflammatory and anti-edematous effect of anti-VEGF drugs, better BCVA is obtained after surgery.
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    Outcomes of pars plana vitrectomy combined with phacoemulsification and intraocular lens implantation
    (2011) Koç B.; Do?anay S.; Çankaya C.
    Purpose: To investigate the outcomes of pars plana vitrectomy combined with phacoemulsification (PHACO) and intraocular lens (IOL) implantation surgery. Materials and Methods: The study included 29 eyes of 29 patients underwent PHACO surgery combined with PPV+IOL implantation. Patients' the best corrected visual acuities (BCVAs) and intraocular pressures (IOPs) were measured prior to surgery, and postoperatively on the first day, at the first week, on the first, third and sixth months. In the patients whose posterior segments were not evaluated, Aand B-scan ultrasonography was performed. The patients were controlled for the alterations in BCVA, IOP, intraoperative and postoperative complications. Results: On the basis of the findings of examinations on the postoperative sixth month, BCVA improved in 25 of 29 patients (86.2%) compared to preoperative values. On postoperative follow up, an increase in IOP occurred in 6 patients. Three patients (27.3%) of those who underwent surgery because of retinal detachment with tears developed redetachment, and recurrent VH occurred in two (18.1%) of the patients underwent surgery because of VH. During operation, iatrogenic retinal tear occurred in one patient and corneal epithelial edema occurred in four patients. Conclusion: Considering benefits of PHACO surgery combined with PPV and disadvantages of separate surgeries, combined surgery may be a safe way for appropriate patients.