Does corneal tattooing affect the conjunctival microbiota?

PURPOSE

This study aimed to investigate the effects of commercial tattoo inks used in corneal tattooing on conjunctival microbiota.

METHOD

This prospective case control study consisted of 125 participants divided in the following three groups: 35 patients with corneal tattoos, 40 patients with corneal leukoma, and 50 healthy subjects. Corneal tattooing was performed in all the cases in this study using a tattoo pen machine and commercial tattoo ink. A total of 500 cultures were taken from 250 eyes of 125 individuals on chocolate and sheep blood agar. Bacteriological samples were taken from the inferior eyelid conjunctiva using a sterile cotton swab. Without any contact elsewhere, the swabs were smeared on bedside chocolate agars and 5% sheep blood agar.

RESULTS

In tattooed eyes, bacterial growth was detected in 42.9% of the chocolate and sheep blood agar samples. In other healthy eyes of patients with corneal tattoos, 54.5% bacterial growth on chocolate agar and 57.1% on sheep blood agar were detected. No statistical difference was detected in the conjunctival microbiota of chocolate and sheep blood agar (p = 0.254, p = 0.134, respectively) in the tattooed eyes compared to the other eye of the individual. No statistically significant difference was found in terms of bacterial growth in tattooed, leukoma, or healthy eyes on chocolate and sheep blood agar (p = 0.408, p = 0.349). The growth rate of Staphylococcus epidermidis decreased by 33.3% (from 12 to 8) on chocolate agar in 35 tattooed eyes, and it decreased by 28.5% (from 14 to 10) on sheep blood agar, while gram-negative bacteria Brevundimonas diminuta, Acinetobacter lwoffii, and Psychrobacter faecalis were detected in three patients.

CONCLUSION

Corneal tattooing using commercial dye does not affect conjunctival microbiota. In the past 3 years, 120 patients have been tattooed with commercial tattoo ink in Istanbul Medeniyet University Göztepe Training and Research Hospital. No complications related to infection were found in the 3-year follow-up. The gram-negative bacteria detected in the healthy control group and tattooed eyes were bacteria found on normal skin or in the respiratory tract. Although some gram-negative bacteria do not cause infection, careful eye examination, follow-up, and culture are required in suspicious cases.

Ocular surface lesions in clinical grades of Bell's phenomenon

Background

Bell's phenomenon, also known as the palpebral oculogyric reflex, is a critical reflex that protects the cornea. We developed an innovative, simple, and practical grading scale for Bell's phenomenon that includes the inverse Bell's phenomenon. Using this scale, we investigated the characteristics of Bell's phenomenon among asymptomatic individuals in different age groups and examined the frequency of ocular surface lesions in asymptomatic and symptomatic participants with different grades.

Methods

In this cross-sectional study, we randomly included 330 eyes of 165 asymptomatic, healthy, White Turkish individuals who attended the outpatient eye clinic, with a male-to-female ratio of 1:1.4, in the control group. These were categorized into four age groups: 4 - 20 years, 21 - 40 years, 41 - 60 years, and > 60 years. Eighty eyes from 40 patients with ocular surface lesions and absence of grade + 2 Bell's phenomenon were included in the symptomatic group. Bell's phenomenon was classified into five grades: grade + 2 (strong positive), grade + 1 (weak positive), grade 0 (no Bell's phenomenon, no eye movement), grade -1 (weak inverse), and grade -2 (strong inverse).

Results

We detected higher frequencies of grade + 2, + 1, and 0 in individuals aged 4 - 40, 41 - 60, and > 60 years, respectively. There was a significant difference between age groups in the frequencies of different grades (P < 0.001). Pairwise analysis revealed a significantly lower frequency of grade + 2 in the age group > 60 years compared with the 4 - 20 and 21 - 40 year groups (both P < 0.05). Grade + 2 was the most frequent in both sexes. We detected grade 0 in 27.1% of men and 22.1% of women in the control group, with no significant difference in the frequencies of different grades between sexes (P > 0.05). We observed significant differences between grades with respect to the frequency of ocular surface lesions (P < 0.001). Pairwise analysis revealed a significantly higher frequency of ocular surface lesions in asymptomatic individuals with grade 0 and all four other grades (all P < 0.001). However, the frequency of ocular surface lesions was comparable between sexes (P > 0.05). Of the 40 symptomatic individuals, 28 (70%), 5 (12.5%), 4 (10%), and 3 (7.5%) had grade 0, + 1, -1, and -2, respectively. The number of symptomatic patients was higher in grade 0 (n = 28) than in other grades (grade + 1, -1, and -2: n = 12 patients), and these individuals had a higher frequency of ocular surface lesions (n = 38 lesions) than others (grade + 1, -1, and -2: 7 lesions).

Conclusions

Using a simple, practical grading scale for Bell's phenomenon that includes inverse Bell's phenomenon, we observed that inverse Bell's phenomenon is a reflex that may be present in healthy individuals and could have a protective effect on the eye, although not to such a degree as a strong Bell's phenomenon. Our observations imply that bilateral conjunctival calcifications/Vogt's limbal girdle may be associated with grades 0 and + 1 Bell's phenomenon. Further large-scale studies are needed to determine the frequency of Bell's phenomenon in the general population using this innovative, simple, practical grading scale, and to identify the protective or injurious effect of each grade on the ocular surface.

Bacterial contamination of multi-use tear drops, gels, and ointments

PURPOSE

This study aimed to investigate the bacterial contamination of multi-use tear drops, gels, and ointments that patients use at home.

METHOD

A total of 271 multi-use containers used by 168 patients were examined. Conjunctival culture samples were obtained from patients who used tear drops, gels, and ointments that were found to be contaminated.

RESULTS

Bacterial contamination was detected in 33 (12.2 %) out of the 271 containers. The contamination rate was 7.9 % in tear drops, 11.7 % in gels, and 32 % in ointments. A statistically significant difference was found between the drops, gels, and ointment groups (P = 0.04). Bacterial contamination was detected in 25 (18.9 %) out of 132 collapsible tubes and 8 (5.8 %) out of 139 plastic bottles (P = 0.01). Important bacteria, including Pseudomonas stutzeri, Pseudomonas aeruginosa, Bacillus licheniformis, Paenibacillus pabuli, Proteus mirabilis, Pantoea agglomerans, Morganella morganii, Serratia marcescens, and Serratia liquefaciens, were detected. Mucorales spp. fungus was seen in a gel. Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus, and M. morganii were found in the conjunctival microbiota of three patients.

CONCLUSION

The overall contamination rate of ocular lubricants was low (12.2%); however, a significant difference was found between the drops, gels, and ointments. The contamination rate was higher in gels and ointments than that in drops. The contamination rate was found to be increased in the collapsible tube. The use of ocular lubricants is safe; however, patients must be cautious when using multi-use tear drops, gels, and ointments to avoid contamination. Whenever possible, bottles should be preferred instead of collapsible tubes.

Aesthetic corneal tattooing/keratopigmentation using tattoo pen machine: choosing suitable method and color

PURPOSE

This article aims to present the corneal tattooing method and how using a tattoo pen machine can improve aesthetic appearance in patients with corneal leukoma.

METHODS

In this study, 42 patients were evaluated who had no visual potential and who had undergone colored corneal tattooing using an automatic tattoo pen machine for aesthetic purposes. The procedure was conducted according to the principles of the Declaration of Helsinki. The commercially available tattoo ink that has traditionally been used on human skin (brown, green, and black) for years was used for all the patients in this study, and 252 corneal photographs (with a Topcon slit lamp imaging device at 16 magnifications, i.e., 16 ×) taken within the last 2 years were evaluated retrospectively. Red, green, and blue (RGB) and hue, saturation, and lightness (HSL) values of the tattooed areas, such as pupils and iris, in corneal photographs were determined online using the Color Code Finder program. The RGB and HSL values of the pupil and iris were compared before surgery on the first day and first week, first month, third month, and twelfth month after surgery.

RESULTS

In the first postoperative month, the mean pupil lightness (L) and iris L values were found to have increased by 10.7% and 5.7%, respectively. Between the first month and the first year, the L value of the mean pupil and that of the iris increased by 1.7% and 5.2%, respectively. The increase in the RGB value of the mean pupil in the first month was statistically significant (p = 0.02). The highest increase in RGB values of the iris was observed in the first week and first month (p = 0.113). This result shows that the majority of fading occurred in the first month. After the first month, the increase in the L value in the black-colored pupil was less than that in the brown- or green-colored iris. These results show that light colors fade faster and more.

CONCLUSION

Esthetically, corneal leukoma causes severe psychological problems. Many patients are unable to use prosthetic contact lenses. Evisceration surgery has many complications, and limbal stem cells are used in evisceration surgery. Corneal tattooing using a tattoo pen machine is an easy, practical, and repeatable method used for aesthetic purposes. Successful results require the use of appropriate methods, ink, and ophthalmologist's experience. All patients in this study had a more aesthetic appearance than the preoperative white eye. Further studies are needed to develop a colored aesthetic tattooing method with a tattoo pen machine.

Evaluation of the effect of unilateral and bilateral inferior oblique myectomy on fundus torsion in primary and secondary inferior oblique overaction

OBJECTIVE

This article evaluates the effects of unilateral and bilateral inferior oblique myectomy (IOM) on fundus torsion in primary and secondary inferior oblique overaction (IOOA).

METHODS

This study analyzed 230 OCT images of 53 eyes of 32 patients who had undergone IOM by a single surgeon in the last two years. The disc-foveal angle (DFA) was calculated by digitally measuring the angle between the horizontal line passing through the geometric center of the optic disc and the curved line connecting the fovea to the geometric center of the optic disc. DFA was classified into intorsion, normal torsion, and extortion. The DFA was measured from the OCT images before the operation in the first week, first month, third month, and sixth month.

RESULTS

When all the patients in our study were evaluated together, IOM statistically reduced the mean DFA in the third month (p=0.00). The DFA was higher in the secondary IOOA group than in the primary IOOA group (p=0.24). Bilateral IOM statistically significantly reduced DFA in the third month (p=0.00) and decreased the DFA difference between the two eyes in the third month (p=0.583). Unilateral IOM increased the DFA, rather than decreasing it, in the first week in operated eyes (p=0594) and increased the DFA difference between the two eyes after surgery (p=0.477). When we evaluated the localization of the macula as an intorsion, normal intorsion, or extortion, the extortion decreased from 36 to nine in the third month after bilateral IOM, and intorsion was seen in only two. Unilateral surgery did not significantly change fundus torsion in primary IOOA, and it caused intorsion in 3 of 6 (50%) operated eyes in secondary IOOA.

CONCLUSION

Although unilateral IOM provides a clinical improvement in secondary IOOA, it increases the difference in DFA between both eyes and causes intorsion in 50% of patients. Masked IOOA was detected in 3 of 11 (27.3%) patients who underwent unilateral IOM. When deciding on unilateral surgery, the possibility of increased DFA difference between both eyes, intorsion in the operated eye, and masked IOOA in the other eye should be considered.

Bacterial contamination of multi-use antibiotic steroid eye ointments and drops

PURPOSE

This comprehensive prospective study aimed to investigate the bacterial contamination of antibiotic steroid eye ointments and drops frequently used by eye patients.

METHOD

In this comprehensive prospective study, a total of 410 multi-use topical eye medications containing 15 different ingredients from 22 pharmaceutical companies used by 185 patients were analyzed. Four groups were formed as follows: group 1: antibiotic ointments (n: 109); group 2: antibiotic drops (n: 103); group 3: steroid ointments (n: 67); and group 4: steroid drops (n: 131). Topical multi-use eye drops and ointments used by patients at home for at least 1 week were randomly collected. The caps and contents were separately bacteriologically examined in a chocolate agar medium.

RESULTS

Our study detected bacterial contamination in 23 containers (5.6%) of the total 410 topical drugs. According to the groups, bacterial contamination was detected in 10 of 67 (14.9%) steroid ointments, 6 of 109 (5.5%) antibiotic ointments, 4 of 131(3.1%) steroid drops, and 3 of 103 (2.9%) antibiotic drops. While the bacterial contamination rate in ointments was 9.1%, this rate was 3% in drops. The difference between them was statistically significant (p = 0.015). According to the post-hoc pairwise comparisons, the difference between steroid drops and steroid ointment (p = 0.0023) was statistically significant. Among all drugs, contamination was detected in 12 of the 93 (12.9%) containers used after keratitis, conjunctivitis, and inflammatory conditions. It was determined that preservatives statistically reduced bacterial growth on the cap. The preservatives did not have a statistically significant effect on the bacterial contamination of the contents compared to the caps. While all contaminations were detected in illiterate and primary school graduates, no contamination was seen in the drugs used by any secondary school or university graduate.

CONCLUSION

Our study detected contamination in all topical ophthalmic drug groups. Contamination rates were found to be higher in ointments and steroids. Bacterial contamination was also seen in drugs containing preservatives. We should be careful in the use of topical medications. We do not recommend the bilateral use of ointments and drops in infected eyes, such as those with keratitis, or after intraocular surgeries, such as those for cataracts.

Anatomical Factors Which Influence the Formation of Peroneal Tendon Tears: A Retrospective Comparative Study

This study aims to investigate the anatomical factors that are effective in the formation of peroneal tendon tears comparing with the control group. The patients with ankle magnetic resonance imaging (MRI) due to pain on the lateral side of the ankle were retrospectively analyzed using the clinical archive between July 2015 and January 2020. Peroneal tendon tears, peroneal tubercle type and size, presence of peroneal quartus, presence and type of retromalleolar groove, retromalleolar groove area, lateral malleolus type, presence of os peroneum, peroneus brevis-lateral malleolus distance (PBLMD), and accompanying pathologies in coronal, axial, and sagittal planes MRI were evaluated. PBLMD was measured as 27.1 ± 12.3 mm in Group 1. With PBLMD, it was measured as 39.6 ± 11.68 mm in Group 2. There was a significant relationship between low-lying peroneus brevis muscle and peroneal tear (p < .001). Peroneal tendon tear was more common in patients with peroneal quartus muscle (p < .001). There was a relationship between the retromalleolar groove type and the presence of peroneal tear (p = .004). More peroneal tears were observed in the concave retromalleolar groove type. The presence of concave type retromalleolar groove, peroneus quartus, and low-lying peroneus brevis muscle was found to be associated with peroneal tendon tears.

Investigating the effect of intracameral cefuroxime on oxidative stress and apoptosis in the rat cornea

PURPOSE

We examined the effect of intracameral administration of cefuroxime on oxidative stress and endothelial apoptosis in rat corneal tissue.

METHODS

In total, 30 rats were divided into 3 groups of 10 rats each (intracameral administration of cefuroxime 0.1 mg/0.01 mL (cefuroxime group); intracameral administration of balanced salt solution 0.01 mL (control group); or absence of intracameral injection (sham group). Corneal endothelial apoptosis was assessed by immunohistochemical analysis using caspase-3 and caspase-8. Total oxidant status, total antioxidant status, oxidative stress index, and paraoxonase and arylesterase levels were examined in corneal endothelial tissue and serum.

RESULTS

Paraoxonase levels in the serum were significantly different between the sham and cefuroxime groups (p=0.027). A significant difference was also observed in total oxidant status levels between the cefuroxime and balanced salt solution groups (p=0.023). In addition, there were significant differences in total antioxidant status levels in corneal tissue between the cefuroxime and sham groups (p<0.001) and between the cefuroxime and balanced salt solution groups (p<0.001). Furthermore, significant differences were also observed in oxidative stress index levels between the cefuroxime and balanced salt solution groups (p=0.001) and between the cefuroxime and sham groups (p=0.026). According to the immunohistochemical staining results, a significant association with caspase-3 activity existed between the cefuroxime and balanced salt solution groups (p=0.007), while no significant difference was found with caspase-8 activity (p=0.541). Caspase-3 activity exhibited a significant relationship between the sham and balanced salt solution groups (p=0.018), but no relationship was found with caspase-8 activity (p=0.623).

CONCLUSION

Immunohistochemical examination revealed that intracameral cefuroxime increased apoptosis when compared to the sham and balanced salt solution groups. Moreover, intracameral cefuroxime increased oxidative stress in the cornea and simultaneously induced apoptosis.

Effects of 0.5% and 0.25% Apraclonidine on Postoperative Intraocular Hypertension after Cataract Extraction

Purpose

We conducted a double-masked, prospective study to evaluate the effect of 0.5% and 0.25% apraclonidine on postoperative intraocular pressure (IOP) in patients undergoing extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation.

Methods

Fifty-four patients scheduled for ECCE were randomly divided into three groups of 18. The first group received one drop of 0.50% apraclonidine topically one hour before surgery and immediately after the end of the procedure. The second group received the same regimen but with 0.25% apraclonidine. The third group received artificial tears as the control group. IOP was measured 12 h preoperatively and 6 and 24 h postoperatively. All the measurements were made using the same Goldmann applanation tonometer by the same surgeon who did not know to which group the patient belonged.

Results

Preoperative mean IOP was 13.66 ± 2.76 mmHg in the first group, 14.27 ± 2.24 mmHg in the second and 14.5 ± 1.34 mmHg in the control group. The differences were not significant (p=0.398). Mean IOP at the early postoperative visit (6 h) was significantly lower in the first group (17.44 ± 4.95 mmHg) than the second (21.78 ± 7.19 mmHg) and the control group (24.55 ± 5.65 mmHg) (p<0.001). Mean postoperative IOP at 24 h was again significantly lower in the first group (14.33 ± 3.75 mmHg) than the second (17.11 ± 4.16 mmHg) and the control group (19.61 ± 3.20 mmHg) (p<0.001).

Conclusions

Our findings indicate that topical 0.5% apraclonidine controlled early postoperative intraocular hypertension after cataract extraction without any side effects, while the 0.25% drops were not effective.

ThinOptX vs AcrySof: Comparison of visual and Refractive Results, Contrast Sensitivity, and the Incidence of Posterior Capsule Opacification

PURPOSE

To evaluate the visual and refractive results, the changes in contrast sensitivity, and the incidence of posterior capsule opacification (PCO) after the implantation of UltraChoice 1.0 ThinOp-tX (ThinOptX Inc.) intraocular lens (IOL) and conventional acrylic foldable IOL (AcrySof MA30AC).

METHODS

Twenty-five patients were randomized into two groups prospectively. In Group 1, microincisional phacoemulsification and the ThinOptX IOL implantation were applied in one eye, and in Group 2, conventional phacoemulsification and the AcrySof IOL implantation were applied in the fellow eye. Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), contrast sensitivity, and the incidence of PCO were observed in the two groups and comparisons were made.

RESULTS

Mean follow-up period was 12.8+/-1.5 months (range 11 to 14 months). In the last follow-up examination, UCVA and BCVA were significantly lower and the PCO scores were significantly higher in Group 1 (p<0.05). Although SIA was lower in Group 1, the difference was not statistically significant. Contrast sensitivity in higher spatial frequencies was significantly lower in Group 1 in the 6th month and 12th month visits. Capsular contraction was seen in 3 eyes (12%) in Group 1 whereas there was no capsular contraction or phimosis in Group 2.

CONCLUSIONS

Long-term evaluation of the ThinOptX IOL concludes with an increased rate of PCO, a diminished resistance to the capsular contraction vs the AcrySof IOL, and a decrease in visual performance. The poor after cataract performance of this rollable lens shows that microphacoemulsification and ThinOptX IOL implantation is not as effective as conventional hacoemulsification and AcrySof IOL implantation in the long term.

A Comparison of Central Corneal Thicknesses Measured with Two Different Methods in Cases of Primary Open-Angle Glaucoma

Accurate and repeatable measurement of the central cornea thickness (CCT) is important in terms of follow-up of glaucoma patients. The aim of this study was to compare CCT measurements made with an ultrasonic pachymeter (USP) and with the Spectralis Anterior Segment Module optical coherence tomography (OCT) device. The study included 52 eyes of 26 primary open-angle glaucoma patients. CCT measurements were taken with the USP device and then with the OCT by imaging cornea slices. The mean CCT was measured as 555.71 ± 47.76 μm with USP and 569.46 ± 49.5 μm with OCT. Despite the differences between the measurements of the two methods, a very strong degree of consistency was seen between the CCT measurement with USP and OCT (ICC = 0.93, p < 0.001).

Evaluation of resistive index using color Doppler imaging of orbital arteries in geriatric patients with hypertension

Background and Aim:

Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage in ophthalmologic disease. The purpose of this study was to evaluate the association between RI values of orbital arteries using the color Doppler imaging (CDI) in geriatric hypertensive patients with or without retinopathy.

Setting and Design:

Designed as a cross-sectional study.

Materials and Methods:

We evaluated 60 geriatric patients with hypertension (Group 1) and 30 healthy subjects (Group 2). Further, the patients with hypertension were grouped into two: Group 1a consisted of patients with retinopathy (n = 30), and group 1b consisted of patients without retinopathy (n = 30). The mean RI values of ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) were measured using CDI.

Results:

Compared to group 2, group 1 had significantly higher mean resistive index of PCA levels (P = 0.017), whereas there were no statistical difference in mean resistive indexes of OA and CRA (both P > 0.05). Besides, there were no statistical difference in mean resistive indexes of OA, CRA, and PCA between the group 1a and group 1b (P > 0.05 for all). Mean resistive indexes of OA, CRA, and PCA were significantly correlated with the duration of hypertension (r = 0.268, P = 0.038; r = 0.315, P = 0.014; r = 0.324, P = 0.012, respectively).

Conclusions:

Our study indicates that RI might be a useful marker for the ocular hemodynamic of retinal vessels, provides morphologic and vascular information in hypertension and hypertensive retinopathy.

A new combined surgical approach in a patient with microspherophakia and developmental iridocorneal angle anomaly

BACKROUND

We describe a patient with microspherophakia due to Weill-Marchesani syndrome accompanied by developmental angle anomaly who was successfully treated with a surgery of combined PPL and goniotomy.

CASE

We report ocular findings of a 1-year-old girl who was diagnosed with Weill-Marchesani syndrome with a positive family history of glaucoma in her cousins and glaucoma with anterior segment dysgenesis in her older brother. Anterior segment examination revealed clear corneas with 13 mm horizontal diameter in the right and 12.5 mm in the left and very shallow anterior chambers centrally and peripherally in both eyes. Although axial lengths were 18.9 mm in the right and 19.1 mm in the left eye, cycloplegic refractive errors were -7.75 DS (-2.75 at 1800) in the right eye and -8.50 DS (-2,75 at 1800) in the left eye. Intraocular pressures were 34 mmHg in the right and 38 mmHg in the left eye.

OBSERVATION

Following pars plana lensectomy, gonioscopy revealed developmental iridocorneal angle anomaly and goniotomy was performed at the same session. During 3 years of follow-up, the patient experienced no complications. IOP was 12 mmHg without medication in the last visit; cup-to-disc ratio and corneal diameters were stable.

CONCLUSION

The coexistent microspherophakia and developmental iridocorneal angle anomaly can be successfully treated with combined pars plana lensectomy and goniotomy.

Evaluating the safety of intracameral bevacizumab application using oxidative stress and apoptotic parameters in corneal tissue

AIM

To investigate the possible effects of intracameral bevacizumab on oxidative stress parameters and apoptosis in corneal tissue.

METHODS

In total, 30 rats were assigned randomly into the following three groups of 10 rats each: a sham group (Group 1; n=10), a control group [Group 2; balanced salt solution (BSS) was administered at 0.01 mL; n=10], and a treatment group (Group 3; bevacizumab was administered at 0.25 mg/0.01 mL; n=10). The total antioxidant status (TAS) and the total oxidant status (TOS) in the corneal tissue and blood samples were measured, and the oxidative stress index (OSI) was calculated. Additionally, corneal tissue histopathology was evaluated for caspase-3 and -8 staining and apoptotic activity.

RESULTS

In the blood samples, the TAS, TOS, and OSI levels were not significantly different (all P>0.05). Compared with the sham and control groups, the TOS and OSI levels in the corneal tissues were significantly different in the bevacizumab group (all P<0.05). No statistically significant differences were observed between the sham and control groups (all P>0.05). However, compared with the sham and control groups, greater immunohistochemical staining for caspases-3 and -8 and an elevated level of apoptotic activity were observed in the bevacizumab group.

CONCLUSION

This study revealed that intracameral bevacizumab injections seemed to be systemically safe but may have elicited local toxic effects in the corneal tissue, as indicated by the oxidative stress parameters and histopathological evaluations.

Corneal hysteresis, corneal resistance factor, and intraocular pressure measurements in eyes implanted with a small aperture corneal inlay

PURPOSE

To compare the postoperative corneal hysteresis (CH) and corneal resistance factor (CRF) of eyes implanted with a small aperture corneal inlay versus fellow eyes.

METHODS

Medical records of patients who underwent small aperture corneal inlay (KAMRA; AcuFocus, Inc., Irvine, CA) implantation were retrospectively reviewed. There were two groups: the implanted and non-implanted. Main outcome measures were CH, CRF, Goldmann-correlated intraocular pressure (IOPg), corneal-compensated IOP (IOPcc), and Goldmann applanation tonometry measurements performed preoperatively and at postoperative week 1 and months 1, 3, and 6.

RESULTS

The study included 68 eyes of 34 patients. CH was higher in the implanted group when compared with the non-implanted group at postoperative week 1 (12.2 ± 3.1 vs 10.9 ± 1.7 mm Hg; P = .007) and month 1 (12.3 ± 2.5 vs 10.9 ± 1.8 mm Hg; P = .001). CRF was higher in the implanted group when compared with the non-implanted group at postoperative week 1 (11.9 ± 2.9 vs 10.7 ± 1.6 mm Hg; P = .003) and month 1 (12.5 ± 2.5 vs 10.4 ± 1.8 mm Hg; P < .001). IOPcc was higher in the implanted group when compared with the non-implanted group at only the first postoperative month (17.1 ± 3.5 vs 14.3 ± 2.9 mm Hg; P < .001). There were no statistically significant differences in Goldmann applanation tonometry or IOPg measurements between the two groups (P > .05). At the 3-month postoperative visit, all parameters had returned to baseline and there was no change at the 6-month visit.

CONCLUSIONS

Implantation of the KAMRA corneal inlay does not induce a permanent change in CH or CRF. A transient increase in both was seen in the early postoperative period.

Evaluation of early results of quick-chop phacoemulsification in the patients with high myopic cataract

AIM

To assess the early surgical outcomes of quick-chop phacoemulsification technique in patients with high myopia.

METHODS

The data of patients with high myopia who underwent quick-chop phacoemulsification were reviewed retrospectively. There were 42 eyes of 31 patients. The axial length was more than 26 mm in all eyes. All eyes underwent quick-chop phacoemulsification surgery with the placement of an intraocular lens (IOL) in the capsular bag. Postoperative visits were performed at 1, 3d; 2wk, 1mo. Early postoperative best corrected visual acuity (BCVA), preoperative and postoperative corneal endothelial cell density (ECD), central corneal thickness (CCT) and postoperative complications were assessed. Paired sample t-test or Wilcoxon tests were used to compare data between preoperative and postoperative data.

RESULTS

There was no statistically significant difference between preoperative and postoperative ECD and CCT. Retinal detachment was developed in one eye at postoperative first day. There was an iris prolapsus from side port insicion.

CONCLUSION

Quick-chop phacoemulsification technique is a safe surgical technique. However we can encounter some complications in high myopic eyes due to histopathological differences. Both side port and clear corneal tunnel insicion size is crucial for preventing postoperative complications. If any persistent leakage is noticed, suture should be placed.

Does the use of preoperative antiglaucoma medications influence trabeculectomy success?

PURPOSE

To investigate the influence of preoperative antiglaucoma medications on trabeculectomy outcome.

METHODS

Two hundred fifteen eyes, which underwent primary trabeculectomy, were retrospectively analyzed. The average follow-up was 39.8±30.3 months. The only cases of primary open-angle glaucoma, with or without pseudoexfoliation (PXF), were included. "Complete success" was defined as intraocular pressure (IOP) <18 mmHg without glaucoma medications, whereas relative success was defined as the same IOP target with medications. The influence of the preoperatively used glaucoma medications on surgical success was analyzed by univariate Pearson correlation and multivariate (ordinal) regression analysis.

RESULTS

There were 118 male (54.9%) and 97 female (45.1%) patients with a mean age of 66.9±9.3 years. PXF glaucoma (PXFG) was present in 93 eyes (43.3%). In 33 patients (15.3%), diabetes mellitus (DM) was present. Complete success was achieved in 116 eyes (54%), relative success in 81 eyes (37.6%), and failure in 18 eyes (8.4%). Neither the total number nor the duration of glaucoma medications used before trabeculectomy was found to have any statistically significant influence on surgical success. In statistical analysis, a combination of topical beta-blocker and carbonic anhydrase inhibitor (BB+CAI) used before surgery was found to be associated with statistically better outcome, whereas the preoperative use of topical beta-blockers alone could have a negative influence on success. PXF was shown to be independently associated with trabeculectomy outcome on multivariate regression analysis.

CONCLUSION

The glaucoma medications used preoperatively were not found to have any statistically significant negative influence on the trabeculectomy outcome and use of the combined BB+CAI preparation could have a positive influence, whereas the use of topical beta-blockers alone could have a negative influence on success, although not statistically significant. The presence of PXF was independently associated with a better surgical outcome.

Remove, rotate, and reimplant: a novel technique for the management of exposed porous anophthalmic implants in eviscerated patients

PURPOSE

To describe and to evaluate a new and relatively easy technique for porous implant exposure repair.

METHODS

Eleven patients with exposed porous orbital implants after evisceration were included in this study. Five patients with large exposures (diameter >7 mm) and six patients with small exposures of orbital implants (diameter <7 mm) that persisted despite posterior vaulting of the prosthesis and usage of antibiotics and steroids for more than 6 weeks, underwent revision surgery with the remove-rotate-reimplant technique (3R technique). Negative microbiological culture taken from the exposed socket surface before surgery was the major inclusion criterion. Five patients with insufficient conjunctival tissue also underwent additional mucosa or hard palate grafting of the defect in addition to the remove-rotate-reimplant procedure.

RESULTS

Patients have been followed up for more than 18 months (ranging from 18-30 months). None of them received motility peg insertion after repair. Implant reexposure was detected in one patient during the follow-up period, which was managed by dermis fat grafting with implant removal.

CONCLUSION

The remove-rotate-reimplant technique is an effective surgical method for repairing exposed porous anophthalmic implants after evisceration with a 90% success in this study. It avoids the removal of the implant from the sclera, which is a traumatic procedure that may lead to the tearing and loss of scleral tissue covering the implant. Saving the porous implant and scleral cover reduces the surgical time and cost.

Transconjunctival dacryocystorhinostomy: Long term results

Purpose

To evaluate the outcomes of transconjunctival dacryocystorhinostomy (TRC-DCR) surgery in patients with epiphora due to primary acquired nasolacrimal duct obstruction (PANDO) at second year follow-up.

Methods

In this retrospective, interventional study, 33 eyes of 29 patients, with epiphora due to PANDO, are included. Lower eyelid conjunctiva is incised at vestibulum inferomedially to access the lacrimal sac and nasal mucosa. Bone is perforated with burr and rongeurs and saccal and nasal flaps are anastomosed. Conjunctival wound edges are apposed and left unsutured. Intraoperative difficulties, surgical time and complications are noted. Average follow-up time was 2 years. Anatomical success was defined as patent lacrimal passages upon irrigation and functional success was defined as relief of epiphora.

Results

In nineteen (57.6%) eyes the surgeries were completed with the anterior and the posterior flaps sutured. In eight eyes (24.2%) only anterior flaps could be sutured. In 6 eyes (18.2%), the surgical procedure was converted to external dacryocystorhinostomy since the nasal mucosa could not be exposed adequately via transconjunctival route. The mean surgical time was 65.1 min. One patient had a millimeter long lower eyelid margin laceration in one eye (3.7%) intraoperatively due to traction for visualization of the operative site.

Epiphora resolved in 25 of 27 eyes (92.5%) in whom TRC-DCR could be completed. Epiphora and failure to irrigation were noted in two eyes (7.4%) at the postoperative 4th and 8th months, respectively and required reoperation. No complications occurred, except granuloma formation at the conjunctival incision site in three eyes (11.1%).

Epiphora resolved in all the six eyes of patients who underwent an external DCR (100%).

Conclusion

Transconjunctival dacryocystorhinostomy is a scarless dacryocystorhinostomy technique which is performed without endoscope and/or laser assistance, with 92.5% success rate comparable to external DCR at the second year follow-up without major complications.

A novel technique for inferior rectus recession

PURPOSE

To introduce a novel technique of inferior rectus recession operation to allow larger amounts of recession without causing lower lid retraction and to compare this method with the results obtained in standard inferior rectus recession.

MATERIAL AND METHODS

This study included 20 patients operated on in the authors' clinic. The median age of the patients was 24.5±18.6 (4-73) years and the median follow-up was 9.3±11.8 (3-43) months. Ten patients operated on with the standard method were labeled Group 1 and ten patients operated on with the new method were labeled Group 2. Without exceeding 4 mm, inferior rectus recession to the whole muscle was performed in Group 1 patients. Inferior rectus recession was also performed on patients in Group 2 following the new method. Using a spatula, approximately 10% of the muscle surface fibers were detached intact as a thin layer, and the remaining 90% of deeper fibers were recessed 4-8 mm as planned. Patients' preoperative deviations and lower lid positions were recorded. The same parameters were checked in the first and third month postoperatively. Both groups were evaluated retrospectively by screening their files, and the Mann-Whitney U test was used for statistical evaluation.

RESULTS

Lower lid retraction was seen in four patients of Group 1. There was no retraction in Group 2. While there was a need to perform additional vertical muscle procedures for vertical deviations and lower lid retractions in Group 1, it was observed that there was no need for additional procedures in Group 2 patients. There was a statistically meaningful difference between the two procedures (P<0.05).

CONCLUSION

This novel technique was found to be an effective surgical method for permitting more recession without the risk of lower lid retraction.

Long-term results of deeper muscle fibers recession of an inferior rectus operation

PURPOSE

To report the efficacy in preventing lower eyelid retraction and long-term results of a new technique of inferior rectus (IR) recession for vertical strabismus and compare this method with the results obtained by a conventional IR recession operation.

METHODS

This retrospective study included 35 patients who underwent a new IR recession method (study group) and 22 patients who underwent the conventional IR recession (control group) for vertical strabismus. In the study group, an IR recession was applied to the deeper fibers and included approximately 90% of the IR muscle thickness. This group was divided into two subgroups: small IR recessions (4 to 6 mm) and large IR recessions (7 to 8 mm). In the control group, an IR recession of the entire muscle was applied without exceeding 6 mm. The photographs were analyzed for lower eyelid position. Digital image analysis was used to standardize each patient's preoperative and postoperative photographs at final follow-up examination. The main outcome measures were the margin-to-reflex distance, lower eyelid retraction, and vertical deviation angles (at near and distance fixation).

RESULTS

The mean change in margin-to-reflex distance after surgery was 0.03 mm in the small IR recessions group, 0.1 mm in the large IR recessions group, and 2.04 mm in the control group. Postoperatively, the lower eyelid retraction in the study group, which occurred after both small and large IR recessions, was significantly less than that in the control group (P < .001). There was no significant difference between the study and control groups in improvements in near and distance vertical deviations and success ratios (P > .05).

CONCLUSIONS

At long-term follow-up, recession of the deeper fibers layer, including approximately 90% of the IR muscle thickness, was a procedure that minimized or eliminated the possibility of lower eyelid retraction and did not limit the success of strabismus surgery.

Femtosecond lenticule extraction for correction of myopia: a 6 month follow-up study

Aims

To report our initial experience with femtosecond lenticule extraction (FLEX) compared with femtosecond laser-assisted in situ keratomileusis (LASIK).

Settings and design

This was a prospective pilot study carried out at the Refractive Surgery Department of the Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.

Materials and methods

Surgery was performed on both eyes of 14 consecutive patients with myopia or myopic astigmatism. Patients underwent FLEX in one eye and femtosecond LASIK (FemtoLASIK) in the other eye. The primary outcome was based on uncorrected distance visual acuity, corrected distance visual acuity, and spherical equivalent of the subjective manifest refraction, at 1 week, 1 month, and 6 months postsurgery. Statistical analyses were performed using PAWS Statistics 18. Unpaired Student’s t-test was used to compare the groups.

Results

During the last follow-up visit (6 months postsurgery), the mean spherical was −0.37 ± 0.60 diopters (D) (range −1.00 to 0.50) (P < 0.001) and −0.25 ± 0.41 D (range −0.88 to 0.12 D) (P < 0.001) in the FLEX and FemtoLASIK eyes, respectively. The spherical was within ± 0.50 D of the intended correction in ten (72%) of the FLEX eyes and 12 (86%) of the FemtoLASIK eyes (P > 0.05). No complications occurred during surgery or the postoperative period.

Conclusion

FLEX is a safe, effective, and predictable procedure for surgical correction of myopia. Refractive results were stabilized within the first postoperative week, and visual acuities were stabilized within the first month, comparable to FemtoLASIK.

Accuracy and precision of cap thickness in small incision lenticule extraction

Aims

To report and compare the cap thickness predictability of small incision lenticule extraction (SMILE) and flap thickness of femtosecond laser-assisted in situ keratomileusis (femto-LASIK).

Settings and design

Beyoglu Eye Training and Research Hospital, Refractive Surgery Department, Istanbul, Turkey. Retrospective pilot study.

Materials and methods

Medical records of patients who had SMILE in one eye and femto-LASIK in the other eye were reviewed. Visante corneal Optical Coherence Tomography (OCT) images at 1 week and 1 month post-surgery were analyzed. Both cap and flap thickness at the temporal edge and the nasal edge were measured and compared to each other.

Statistical analyses used

PAWS Statistics 18 and unpaired student t-test were used to compare the groups.

Results

The study included 66 eyes of 33 patients (24.7 ± 3.8 years, 20 females and 13 males). Mean flap thickness was 114.88 μm ± 4.96 μm, and mean cap thickness was 114.63 μm ± 5.18 μm. In group 1 (SMILE), cap thickness values were 115.84 μm ± 6.84 μm, 114.75 μm ± 7.36 μm, 113.66 μm ± 6.88 μm, and 114.27 μm ± 6.90 μm in measurement zones 1, 2, 3, and 4, respectively. In group 2 (FemtoLASIK), flap corneal thickness values were 115.96 mmHg ± 7.01 mmHg, 114.72 mmHg ± 7.17 mmHg, 113.54 mmHg ± 6.45 mmHg, and 115.30 mmHg ± 6.64 mmHg in measurement zones 1, 2, 3, and 4, respectively. In both groups, no statistically significant change within the measurement zones was observed.

Conclusion

The predictability of cap thickness in SMILE surgery does not differ from the femto-LASIK flaps created using the same femtosecond laser platform.

New method of microwave thermokeratoplasty to correct myopia in 33 eyes: one-year results

PURPOSE

To assess the safety, predictability, and stability of a new microwave thermokeratoplasty procedure to correct myopia.

SETTING

Cornea and refractive surgery subspecialty.

DESIGN

Prospective clinical trial.

METHOD

Thermokeratoplasty was performed in myopic eyes at a single center in Turkey from June 2009 to June 2010. The attempted corrections ranged from -1.25 to -5.75 diopters (D). The main outcome measures were changes in logMAR uncorrected distance visual acuity (UDVA) and in keratometry (K) values.

RESULTS

The procedure was performed in 33 eyes (patients aged 20 to 45 years). The mean preoperative logMAR UDVA (0.76 ± 0.24 [SD]) significantly improved to 0.19 ± 0.20 at 1 month, postoperatively. By 3 months, the mean UDVA had markedly regressed to 0.59 ± 0.29; however, the residual improvement remained statistically significant. At 12 months, the mean logMAR UDVA was 0.72 ± 0.26. The mean K values were 43.9 ± 1.36 D preoperatively, 41.25 ± 2.63 D at 1 month, 43.4 ± 1.69 D at 3 months, and 44.1 ± 1.09 D at 12 months. The mean endothelial cell density was 2836 ± 342 cells/mm(2) preoperatively and were statistically unchanged 12 months postoperatively (2732 ± 353 cell/mm(2)). No patient lost lines of corrected distance visual acuity by 12 months postoperatively.

CONCLUSIONS

The new thermokeratoplasty procedure produced the desired reduction in myopia and improvement in postoperative UDVA 1 month postoperatively without significant side effects. However, early and complete regression shows the need for further development of this technique.

FINANCIAL DISCLOSURE

Drs. Yilmaz and Marshall are paid consultants to Avedro, Inc., and Dr. Muller is president and CEO of Avedro, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Medial rectus Faden operations with or without recession for partially accommodative esotropia associated with a high accommodative convergence to accommodation ratio

AIMS

To evaluate the results of Faden operations on the medial rectus (MR) muscles with or without recession for the treatment of partially accommodative esotropia associated with a high accommodative convergence to accommodation (AC : A) ratio and to determine whether there was a decrease in the effects of posterior fixation over time.

METHODS

In this retrospective study, 108 of 473 patients who underwent surgery for partially accommodative esotropia with a high AC : A ratio received Faden operations on both MR muscles, and 365 received symmetric MR muscle recessions combined with a Faden operation.

RESULTS

For the Faden operation, a satisfactory outcome of 76.9% at 1 month postoperation, decreased to 71.3% by the final follow-up visit (mean 4.8 years). A moderate positive correlation was observed between the increase in the postoperative near deviation and postoperative time. For the Faden operations combined with MR recession, a satisfactory outcome of 78.9% at 1 month post-operation, decreased to 78.4% by the final follow-up visit.

CONCLUSION

A Faden operation of the MR muscles with or without recession is an effective surgical option for treating partially accommodative esotropia associated with a high AC : A ratio. For Faden operations of the MR muscles without recession, the effects of the posterior fixation decline over time.

Long-term results of phacoemulsification combined with primary posterior curvilinear capsulorhexis in adults

Objective:

To evaluate the 2-year outcomes of phacoemulsification combined with primary posterior curvilinear capsulorhexis (PPCC) in adults.

Materials and Methods:

In this retrospective case series, 93 eyes of 91 patients with bilateral age-related cataract who underwent phacoemulsification combined with PPCC were evaluated. The study included cases due to postoperative residual posterior capsule opacification despite careful polishing. Data were evaluated on preoperative and postoperative best corrected visual acuity (CDVA) (Snellen acuity), slit-lamp biomicroscopy and intraocular pressure (IOP) measurement. Perioperative and postoperative complications were also recorded.

Results:

The mean follow-up was 24.9 ±13.5 months (range, 12-53 months). At the last visit, 87.1% of the eyes had CDVA ≥ 20/40 and 58% had ≥ 20/25. Posterior capsular opacification (PCO) occurred in 2 (2.2%) of patients. No serious complications such as retinal detachment and endophthalmitis were observed during follow-up.

Conclusions:

Cataract surgery combined with PPCC is a safe procedure with a low rate of complications over the long term. This procedure reduced the necessity of Nd:YAG laser capsulotomy in adults with postoperative residual posterior capsule opacification despite careful polishing.

Graded anterior transposition of the inferior oblique muscle for V-pattern strabismus

PURPOSE

To evaluate the efficacy of bilateral graded anterior transposition of the inferior oblique muscle for the correction of V-pattern strabismus associated with inferior oblique overaction.

METHODS

Medical records of patients who underwent graded anterior transposition of the inferior oblique muscle for bilateral primary inferior oblique overaction associated with V-pattern strabismus were reviewed. The surgical technique entailed recessing and anteriorly transposing the inferior oblique muscle to various locations along the temporal border of the inferior rectus muscle. The amount of anterior transposition was determined by both the severity of the overaction and the extent of the V pattern. We analyzed the changes in inferior oblique muscle overaction and V-pattern strabismus and the frequency of limited elevation after surgery.

RESULTS

The record review identified 69 patients (138 eyes) who met inclusion criteria. V-pattern esotropia was present in 44 patients (64%) and V-pattern exotropia in 25 (36%). Full correction or undercorrection to <10(Δ) of V pattern was achieved in 82% of esotropia cases and 80% of exotropia cases. Response to surgery was influenced by the severity of the preoperative inferior oblique muscle overaction and the extent of the preoperative V pattern. The grading of the anterior transposition was not a significant independent predictor of surgical response. No patient suffered limitation of elevation postoperatively.

CONCLUSIONS

Anterior transposition of the inferior oblique muscles corrected V-pattern strabismus and reduced inferior oblique muscle overaction without creating limitation of elevation; however, it is unclear whether grading the transposition contribute to the success of the procedure.

Bilateral Morning Glory Optic Disc Anomaly ASsociated with Asymmetry of Right and Left Optic Nerve Sheath Complexes

A female child with morning glory disc anomaly (MGDA) in two eyes is described in this report. The patient had no systemic abnormalities. Magnetic resonance imaging of the cranium, sella and orbits revealed an asymmetry of the right and left optic nerve sheath complexes. The presence of asymmetric optic nerve sheath complexes in patients with bilateral MGDA has not been previously reported.

Prophylactic selective laser trabeculoplasty in the prevention of intraocular pressure elevation after intravitreal triamcinolone acetonide injection

PURPOSE

To evaluate the prophylactic efficacy of selective laser trabeculoplasty for preventing an increase in intraocular pressure (IOP) after intravitreal triamcinolone acetonide injection.

DESIGN

Prospective, comparative, interventional case series.

METHODS

We studied 31 eyes with a baseline IOP of 21 mm Hg or more of 31 patients for which intravitreal triamcinolone acetonide injection was planned for diabetic macular edema. The patients were divided into 2 groups, a study group and control group. The study group comprised 15 eyes of 15 patients that underwent selective laser trabeculoplasty a mean of 8.3 ± 4.1 days before intravitreal triamcinolone acetonide injection. The control group comprised 16 eyes of 16 patients who underwent only intravitreal triamcinolone acetonide injection. Main outcomes measures were mean IOP and number of patients requiring antiglaucomatous therapy.

RESULTS

Mean baseline IOP was 21.6 ± 0.9 mm Hg in the study group and 21.5 ± 0.8 mm Hg in the control group (P = .98). Mean IOP at 1 day after injection was 17.0 ± 2.0 mm Hg in the study group and 19.5 ± 4.3 mm Hg in the control group (P = .23). Mean IOP at 1 week after injection was 16.9 ± 1.7 mm Hg and 18.4 ± 4.0 mm Hg, respectively (P = .49); mean IOP at 1 month after injection was 16.4 ± 1.5 mm Hg and 20.8 ± 5.6 mm Hg, respectively (P = .003); mean IOP at 3 months after injection was 15.8 ± 2.5 mm Hg and 18.3 ± 5.5 mm Hg, respectively (P = .01); and mean IOP at 6 months after injection was 15.7 ± 1.4 mm Hg and 17.1 ± 1.5 mm Hg, respectively (P = .03). The number of patients requiring antiglaucomatous therapy during follow-up was 0 of 15 eyes in the study group and 8 of 16 eyes in the control group (P = .001).

CONCLUSIONS

The IOP elevation after intravitreal triamcinolone acetonide injection may be prevented by performing selective laser trabeculoplasty before intravitreal triamcinolone acetonide injection, especially in cases with a baseline IOP of 21 mm Hg or more.

Which procedure has more effect on macular thickness: primary posterior continuous capsulorhexis (PPCC) combined with phacoemulsification or Nd:YAG laser capsulotomy?

To compare the effect of Nd:YAG laser capsulotomy and primary posterior continuous capsulorhexis (PPCC) combined with phacoemulsification on macular thickness using optical coherence tomography (OCT) in adults. This prospective comparative interventional study included 32 eyes of 30 patients who underwent Nd:YAG laser capsulotomy and 33 eyes of 33 patients who underwent cataract surgery with PPCC. Detailed ocular examinations, including macular thickness measurements by OCT, were performed in all patients preoperatively and postoperatively on the 1st day, 1st week, and 1st, 3rd and 6th months. No significant differences were found in macular thickness between the two groups in preoperative and postoperative follow-up. No cystoid changes were observed in OCT during the postoperative period in both groups. Nd:YAG laser capsulotomy and PPCC combined with cataract surgery are safe and effective procedures that are not associated with an increase in macular thickness.

Combined 23-gauge transconjunctival sutureless vitrectomy and cataract surgery in cases with cataract and posterior segment diseases

BACKGROUND

Combined cataract surgery and transconjunctival sutureless vitrectomy are a good option in patients with cataract and vitreoretinal diseases.

AIM

To evaluate the effectiveness, outcomes, and complications of combined 23-gauge transconjunctival sutureless vitrectomy and cataract surgery.

SETTINGS AND DESIGN

A retrospective case series was conducted at the Beyoglu Eye Education and Research Hospital.

MATERIALS AND METHODS

In this study, 28 eyes of 28 patients underwent combined 23-gauge transconjunctival sutureless vitrectomy and phacoemulsification and IOL implantation for cataract and various posterior segment diseases. The outcome measures included, visual acuity, intraocular pressure changes, and anatomical success were evaluated.

RESULTS

The mean follow-up was 4.8 months (range, 3-15 months). Mean overall preoperative visual acuity was 20/333, and final acuity was 20/95 (P < 0.001). Mean intraocular pressure (IOP) on the preoperative and first postoperative day was 15.6 ± 7.5 and 13.8 ± 3.3 mmHg, respectively (P > 0.05). Three eyes (10.7%) had postoperative hypotony (<6 mmHg)that all recovered spontaneously within the first postoperative week. Three eyes (10.7%) required laser treatment for iatrogenic retinal tears. Anatomical success was obtained in all cases. No serious complications such as endophthalmitis were observed during the follow-up period.

CONCLUSION

Combined transconjunctival sutureless vitrectomy and phacoemulsification was effective and safe in patients with significant lens opacities and vitreoretinal pathology. Although the anatomic and visual outcomes were satisfactory, the outcomes depended mainly on underlying vitreoretinal pathology.

Higher-order dispersion compensation to enable a 3.6 micros wavelength-maintaining delay of a 100 Gb/s DQPSK signal

We demonstrate a method for dispersion slope compensation of a conversion/dispersion-based optical delay to enable 100 Gb/s operation based on a spatial light modulator and fiber Bragg gratings. A continuous delay of up to 3.6 micros for 100, 80, and 20 Gb/s differential quadrature phase-shift-keyed (DQSPK) and 50, 40, and 10 Gb/s differential phase-shift-keyed (DPSK) waveforms is shown. A time-delay bit-rate product of approximately 360,000 for 100 Gb/s DQPSK with wavelength-maintaining operation is achieved.

Macular thickness changes after phacoemulsification combined with primary posterior curvilinear capsulorhexis

PURPOSE

To evaluate the changes in central macular thickness measured with optical coherence tomography (OCT) after cataract surgery combined with primary posterior continuous curvilinear capsulorhexis (PCCC).

METHODS

Forty-six eyes of 40 consecutive patients who had uneventful phacoemulsification and in-the-bag intraocular lens implantation surgery with primary PCCC, taking place between August 2005 and January 2006 in Beyoglu Eye Training and Research Hospital, were enrolled. Patients with a history of previous ocular surgery, eye trauma, uveitis, or glaucoma, or any systemic disease such as diabetes mellitus, were excluded from the study. None of the cases had macular pathology before surgery. OCT was performed in all patients preoperatively and postoperatively on the first day, first week, and first, third, and sixth months.

RESULTS

Significant quantitative changes from the preoperative examination were observed in the postoperative first week, first month, and third month (p<0.05). The difference between the mean preoperative and postoperative sixth month central macular thickness was not statistically significant (p=0.20). The greatest change in mean macular thickness was noted in the first month visit. No patient developed cystoid macular edema.

CONCLUSIONS

Because primary PCCC does not have an adverse effect on macular integrity, this procedure may be preferred especially in patients with a high risk of posterior capsular opacification.

Continuously tunable 1.16 micros optical delay of 100 Gbit/s DQPSK and 50 Gbit/s DPSK signals using wavelength conversion and chromatic dispersion

We demonstrate a variable optical delay element that uses tunable wavelength conversion and phase conjugation in highly nonlinear fiber and uses chromatic dispersion in dispersion-compensating fiber. A continuous delay of up to 1.16mus, equaling a >110,000 time-delay bit-rate product for 100 Gbit/s non-return-to-zero differential quadrature phase-shift-keying (NRZ-DQSPK) and >55,000 for 50 Gbit/s NRZ differential phase-shift-keying (NRZ-DPSK) modulation formats, is demonstrated. Bit error rates <10(-9) are demonstrated for each waveform at various delay settings.

Fine tuning of conversion/dispersion based optical delays with a 1 pm tunable laser using cascaded acousto-optic mixing

We demonstrate a technique for fine tuning of optical delays using cascaded acousto-optic modulators to improve the delay resolution by 5 orders of magnitude compared to a 1 pm tunable laser. A 256 ns delay with <0.5 ps resolution is shown for 40 Gbits/s return-to-zero on-off keying with no added penalty.

A case of spina bifida with ocular manifestations

Neural tube defects are common congenital abnormalities associated with a variety of complications. Spina bifida, among the most common, results from failure of the neural tube and the vertebral bones to close during embryogenesis. Myelomeningocele is the most common severe form of spina bifida. It may be associated with various anomalies in different tissues. Here we report a case of spina bifida with associated ocular anomalies and review the literature of previous spina bifida cases with ocular manifestations.

The effects of posterior continuous curvilinear capsulorhexis on contrast sensitivity

PURPOSE

We aimed at evaluating the effects of posterior continuous curvilinear capsulorhexis (PCCC) on contrast sensitivity.

MATERIALS AND METHODS

In this prospective, randomized, bilateral clinical study, 40 eyes of 20 patients who underwent bilateral cataract surgery were included. The phacoemulsification machine, viscoelastic substances, surgical tools, and intraocular lenses (IOLs) were the same for both eyes. The only difference was that we conducted the PCCC procedure before IOL implantation to one of the eyes of the patients. The selection of the eye that underwent the PCCC procedure was decided randomly.

RESULTS

The mean photopic contrast sensitivity values at spatial frequencies of 1.5, 3, 6, 12, and 18 cpd (cycles per degree) were 41.55, 59.90, 61.25, 32.35, and 9.75, respectively, and for the control group these values were 39.05, 56.60, 57.95, 29.80, and 8.75, respectively. The mean mesopic contrast sensitivity values at special frequencies of 1.5, 3, 6, 12, and 18 cpd were 41.20, 54.75, 55.55, 31.70, and 9.00, respectively, and for the control group these values were 38.35, 51.70, 52.15, 30.05, and 8.00, respectively. The mean contrast sensitivity values of the eyes that underwent the PCCC procedure were slightly better than the fellow eyes at all spatial frequencies, but the difference was statistically insignificant (P>0.05).

CONCLUSIONS

In early post-operative period, the PCCC procedure exerts some positive effects on contrast sensitivity although these effects are statistically insignificant.

Post-trabeculectomy choroidal detachment: not an adverse prognostic sign for either visual acuity or surgical success

PURPOSE

To report the incidence of choroidal detachment (CD) following trabeculectomy and to evaluate its effect on long-term surgical success and best-corrected visual acuity (BCVA).

METHODS

A total of 253 eyes of 198 subjects who underwent trabeculectomy between 1993 and 2003 with at least 1 year follow-up were reviewed retrospectively. Twenty-eight eyes of 28 subjects which developed CD postoperatively were classified as Group 1 and the remaining 225 eyes of 170 subjects as Group 2. The risk factors for the development of CD and the influence of CD on BCVA and on the success of trabeculectomy were analyzed and compared between the two groups.

RESULTS

In Group 1, preoperative BCVA was significantly lower and cup to disc ratio and the frequency of pseudoexfoliative glaucoma were higher with respect to the control group (p=0.009, p=0.01, p=0.02). The correlations between the development of CD and postoperative findings such as shallowing of the anterior chamber, hypotony, hypotonic maculopathy, hyphema, and fibrin reaction in the anterior chamber were statistically significant.CD was not associated with a significant reduction of BCVA. Intraocular pressures at postoperative first day, sixth month, and first year were lower in Group 1. The success of trabeculectomy and the average number of medications used were not significantly different between the two groups.

CONCLUSIONS

CD following trabeculectomy occurred in 11% of our patients. CD was not associated with either a significant drop in BCVA or an adverse influence on long-term IOP control.

Isolates and antibiotic sensitivity of eighty culture-proven endophthalmitis cases from Istanbul

PURPOSE

To investigate the spectrum of organisms causing endophthalmitis and their sensitivity to commonly used antimicrobial agents.

METHODS

Medical records of 80 consecutive patients treated at Beyoglu Eye Hospital for endophthalmitis from January 2001 to April 2006 were reviewed. Specimens were obtained from either the vitreous (93%, 81/87) or anterior chamber (7%, 6/87) during pars plana vitrectomy or vitreous tap, and were inoculated into blood culture bottles. A Kirby-Bauer disk diffusion test was performed to determine antibiotic susceptibility. The outcome measures included isolates identified and antibiotic sensitivity of the specimens.

RESULTS

Fifty-six of 87 (64.4%) isolates were Gram-positive organisms, 29 (33.3%) were Gram-negative organisms, and 2 (2.3%) were fungi. The most common organism group identified was coagulase-negative staphylococci in 26.4% (23/87). While vancomycin was active against all Gram-positive isolates tested (100%), ceftazidime had the highest susceptibility rate (100%) for Gram-negative organisms isolated.

CONCLUSIONS

Although coagulase-negative micrococci predominated in this series, a high isolation rate for Gram-negative organisms was obtained. High susceptibility rates for ofloxacin make it an alternative to ceftazidime and vancomycin in both Gram-negative- and Gram-positive-derived endophthalmitis, respectively. Studies with larger series and additional antibiotics are needed to confirm these findings.