Evaluation of the relationship between tear meniscus changes and quality of life outcomes after external dacryocystorhinostomy.

PURPOSE: This study aims to investigate the effects of external dacryocystorhinostomy (DCR) surgery on tear meniscus parameters and assess its relationship with improvements in quality of life (QoL) in patients with nasolacrimal duct obstruction (NLDO). METHODS: This prospective study included 30 patients diagnosed with NLDO who underwent external DCR surgery. Tear meniscus (TM) parameters, including height, depth and area, were measured using anterior segment optical coherence tomography. Lacrimal symptom questionnaire (LacQ), Munk scores and Glasgow benefit inventories (GBI) were collected. Statistical analysis was performed to evaluate the correlation between tear meniscus changes and improvements in QoL. RESULTS: TM height, depth and area decreased from preoperative median measurements (0.09 mm2, 0.37 mm, 0.56 mm) to postoperative median measurements (0.03 mm2, 0.21 mm, 0.30 mm) (p < 0.001). Lacrimal symptom scores and Munk scores showed a significant improvement at 3-month postoperatively (p < 0.001). The GBI scores also demonstrated a significant improvement, indicating a positive impact on the patients' QoL. (p < 0.001). A statistically significant correlation was found between the change in TM parameters and LacQ lacrimal symptom scores. CONCLUSION: External DCR surgery leads to significant improvements in tear meniscus parameters and quality of life outcomes in patients with NLDO. The decreased in TM height and TM area indicates improved tear film dynamics and decreased tear volume, which positively impact the patients' ocular comfort and overall well-being. This study highlights the importance of tear meniscus evaluation as a potential market for assessing the success of DCR surgery and its impact on patients' QoL.

Outcomes of External Dacryocystorhinostomy under General and Local Anesthetics in a Tertiary Clinic.

Objectives: In our clinic, although we prefer to perform dacryocystorhinostomy (DCR) under general anesthetics, we also perform it under local anesthetics for patients with a high risk of general anesthesia. Herein this study, we aimed to present our experiences in external DCR under both general and local anesthetics in a tertiary clinic. Methods: Medical records of the patients who had epiphora, were followed up in the oculoplastic section between January 2014 and December 2020 were collected. Patients who underwent external DCR were included in the study. Patients were divided into two groups: local and general anesthesia. All demographic characteristics of patients, previous DCR, history of dacryocystitis, surgery time, perioperative complications, and the American Society of Anaesthesiology (ASA) physical status score were recorded. Results: A total of 106 eyes from 82 patients were included in the study. The mean age of the patients was 57±24 years (range 18-89) and the median age was 56. Of 82 patients, 49 were female and 33 were male. 24 patients underwent bilateral external DCR. The mean surgery time for the general group and the local group was 66±12 min and 52±7 min, respectively. A significant difference was observed between the general and local groups in terms of the duration of the surgery (p=0.03). Of these, 11 patients underwent revision DCR during the follow-ups, and 7 patients were in the general group and 3 patients were in the local group. The overall success rate was 90%. Conclusion: External DCR surgery with both general and local anesthesia is a very effective technique for the treatment of nasolacrimal duct obstruction. In addition, local anesthesia may be brought to mind as an option considering less bleeding, shorter discharge time, and cost-effectivity and also to avoid perioperative and postoperative systemic complications for patients with high risks of general anesthesia.

Comparing the symmetry of upper eyelid following unilateral ptosis correction.

BACKGROUND: Margin Reflex Distance 1(MRD 1) only describes the central height of upper eyelid and relies on the examiner's experience and disregards eyelid contour abnormalities. Therefore MRD 1 may not be sufficient for an acceptable result to evaluate the outcomes of ptosis surgery. The primary purpose of this study was to assess outcomes of unilateral ptosis correction based on parameters including degree of symmetry, MRD 1, peak height of the upper lid, temporal and nasal ocular surface area, and temporal/nasal area ratio with an objective, quantitative, and repeatable method. METHODS: This study was designed as a retrospective non-randomized case-control study. Medical records of the patients with unilateral ptosis between October 2015 and December 2020 were reviewed. Patients with unilateral ptosis who underwent surgical correction and levator function of 5 mm or greater were included in the study. Two groups were defined; ptotic eye was case group and contralateral eye was control group. Data analysis was performed Image J and Matlab softwares. RESULTS: Thirty-four patients were included in the study. Mean age of patients was 58.8 ± 12.7 years (range 15-75 years). Mean follow-up time was 19.5 ± 7.3 months (range 8-40 months). Four patients were diagnosed with congenital ptosis and 30 patients aponeurotic ptosis. Mean preoperative degree of symmetry for overall eyelid contour was 36.6 ± 27.5% (range 1-92%). Mean postoperative degree of symmetry for overall eyelid contour was 72.4 ± 16.5% (range 55-92%). Temporal/Nasal (T/N) area ratios for contralateral normal eye was 1.19 pre-postoperative, and it was 1.11 preoperatively, 1.15 postoperatively for operated ptotic eye. CONCLUSIONS: This study primarily demonstrated a quantitative, objective, and repeatable method to investigate the degree of symmetry after eyelid surgeries. Secondly, this study suggested that T/N ratio may not be a reliable parameter to evaluate the eyelid symmetry.

Fluorescence of ocular surface in a Covid -19 patient after Favipiravir treatment: a case report.

BACKGROUND: Favipiravir is used in treatment of Covid-19 patients. We aimed to share of ocular surface fluorescence in a patient after Favipiravir treatment in this case report. CASE PRESENTATION: A 20-year-old male patient declared no known systemic disease prior to Covid-19. He applied to us with blurry vision and blue light reflection after Covid-19 treatment with Favipiravir. We observed bilateral fluorescence on his eyes and fluorescence of his nails. Biomicroscopic examination was insignificant. CONCLUSION: We investigated the fluorescence of favipiravir tablets under ultraviolet light. Drug demonstrated fluorescence. We recorded the favipiravir fluorescence in-vitro. This appears to be a strong evidence in terms of the linkage between the fluorescence of the ocular surface and favipiravir.

Detection of Coronavirus Disease 2019 Viral Material on Environmental Surfaces of an Ophthalmology Examination Room.

IMPORTANCE: The new coronavirus disease 2019 (COVID-19) pandemic poses a particular threat to health care professionals; however, there appear to be no objective data that demonstrate the risks of encountering individuals carrying the virus asymptomatically in the case of maintained elective examinations. OBJECTIVE: To investigate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the environmental surfaces of an ophthalmology examination room after visits by patients who were asymptomatic and had passed COVID-19 triage. DESIGN, SETTING, AND PARTICIPANTS: This is a quality improvement study conducted 1 week after the first officially confirmed COVID-19 case in Izmir Tepecik Training and Research Hospital, Izmir, Turkey, on March 20, 2020. A triage system was used to determine the risk of COVID-19 from patients who were asymptomatic and presented for examination in an ophthalmology clinic. Real-time polymerase chain reaction testing was used to detect the presence of viral RNA material in samples from the biomicroscope stage, slitlamp breath shield, phoropter, tonometer, and door handles. The first group of samples was taken before the beginning of the examinations, and the second group of the samples was taken after the last patient had left the room. MAIN OUTCOMES AND MEASURES: The main outcome was the presence of viral material on surfaces in 5 circular zones with a diameter of 1 m each around where the patients sat. RESULTS: Thirty-one persons visited the room, of whom 22 underwent ophthalmic examination and 9 were companions. The mean (SD) examination time was 9 (4) minutes (range, 5-13 minutes). Seven samples were taken before examinations and 7 after examinations. Two samples that were taken after examinations were found to be positive for COVID-19, 1 from the slitlamp breath shield and 1 from the phoropter. CONCLUSIONS AND RELEVANCE: This study showed the presence of COVID-19 viral material in a circle 1 m in diameter around where the patients sat. However, real-time polymerase chain reaction could only detect viral material, not the infectivity of these virus samples.

Evaluation of Prelaminar Region and Lamina Cribrosa with Enhanced Depth Imaging Optical Coherence Tomography in Pseudoexfoliation Glaucoma.

OBJECTIVES: To analyze optic nerve head images of pseudoexfoliative glaucoma (PXG) patients and healthy volunteers obtained with enhanced depth imaging spectral domain-optical coherence tomography (SD-OCT). MATERIALS AND METHODS: Seventy patients with PXG and 68 age- and gender-matched healthy subjects were included in this prospective study. The prelaminar tissue and lamina cribrosa were imaged using spectralis OCT with the enhanced depth imaging technique. PXG disease stage was determined with visual field to evaluate relationships between prelaminar tissue thickness (PTT), lamina cribrosa thickness (LT) and disease severity. RESULTS: There was no significant difference between the PXG group and control group with regard to age, gender, central corneal thickness, or axial length. The mean PTT (93.1±44.5 µm, p<0.05) and LT (206.3±33.6 µm p<0.05) values of the PXG group were significantly lower compared to the control group in enhanced depth imaging OCT measurements. The PXG patients were divided into stages according to visual field defect severity. While a significant difference was not detected in PTT based on disease stage (p>0.05), a statistically significant difference was detected between stages for LT (p<0.05). CONCLUSION: A thinner PTT was correlated with the presence of PXG but not with the severity of glaucoma. In addition, LT has a stronger relationship with disease severity and progression compared to PTT.

MR Imaging of the Anterior Visual Pathway in Primary Open-Angle Glaucoma: Correlation with Octopus 101 Perimetry and Spectralis Optical Coherence Tomography Findings.

PURPOSE: To investigate structural changes in the visual pathway measured by magnetic resonance imaging (MRI) and its relationship with the clinical severity of glaucoma in primary open-angle glaucoma (POAG) patients. MATERIALS AND METHODS: The study included 28 patients with POAG and 26 age- and sex-matched healthy volunteers. All the subjects underwent spectral domain optical coherence tomography (OCT) of the peripapillary retina nerve fiber layer (RNFL). The optic nerve diameter (OND), chiasma height (Ch), and lateral geniculate nucleus height (LGNh) were measured bilaterally using a 1.5-Tesla MRI system. RESULTS: The mean values of the OND and LGNh were significantly lower in the POAG group (OND: right p = 0.043 and left p = 0.048; LGNh: right p = 0.008 and left p = 0.025). The OND was not correlated with the clinical stage of glaucoma, but it was correlated with the ipsilateral RNFL thickness. The Ch was correlated with the ipsilateral clinical stage (right r = -0.536, p = 0.004; left r = -0.537, p = 0.004) and average RNFL thickness (RNFLav) (right r = 0.655, p < 0.001; left r = 0.626, p < 0.001). The sum of bilateral clinical stages and left clinical stages showed significant correlations with the right and left LGNh and the sum of both the right and left LGNh. The left RNFLav and the sum of the right-left RNFLav were significantly correlated with all LGNh measurements. CONCLUSIONS: 1.5-Tesla MRI can detect structural changes in the visual pathway early in the course of glaucoma. Thin optic nerve can be a risk factor for glaucoma. The Ch and LGNh seem to be correlated with the clinical stage of glaucoma and RNFL thickness. In particular, LGN can be a target of glaucomatous damage.

The factors influencing peripapillary choroidal thickness in primary open-angle glaucoma.

PURPOSE: To investigate whether there is a difference between primary open-angle glaucoma (POAG) patients and control group with regard to choroidal thickness (CT) and the factors influencing CT. METHODS: Ninety eyes of 90 patients who were being followed up with POAG and 72 eyes of 72 healthy subjects matched for age and gender were included. Peripapillary retinal nerve fiber layer thickness (RNFLT), peripapillary CT, lamina cribrosa thickness (LCT), and prelaminar tissue thickness (PTT) were measured with spectral-domain optical coherence tomography (SD-OCT) enhanced depth imaging (EDI) in all patients. RESULTS: According to multi-variable linear regression analysis results, the factors influencing CT were found as axial length (AL) (B = -22.78, p = 0.002), intraocular pressure (IOP) (B = -7.95, p = 0.001), age (B  = -1.77, p = 0.009), and radial pulse rate (B  = 1.42, p = 0.015). A statistically significant relationship was not detected between CT and central corneal thickness, mean deviation value of visual field, cup/disk ratio, RNFLT, LCT, PTT. CT was found significantly thinner in glaucoma group (147.5 ± 61.2 µm) compared to control group (167.1 ± 37.3 µm). However, IOP was found significantly higher (p < 0.001) and pulse rate was found significantly lower (p = 0.021) in POAG group. IOP and pulse rate were considered to have affected CT difference between the groups. In advanced and worser stage patients, there were significant positive correlations between CT and RNFLT in inferior and superior quadrants. CONCLUSIONS: In addition to previous studies, IOP and pulse rate were detected to be effective on CT. Further studies are required for determining the whole factors effective on CT and better understanding CT and glaucoma relationship.

A novel capsulorhexis technique in white cataract surgery.

PURPOSE: To investigate the efficacy and safety of novel capsulorhexis technique in white cataract surgery using the irrigation-aspiration system of a phaco device. MATERIALS AND METHODS: 53 eyes of 50 patients were included in the study. Patients were randomly divided into two groups. To 27 eyes of 27 patients in Group 1, continuous curvilinear capsulorhexis (CCC) was made using an irrigation-aspiration system by a phaco machine. To 26 eyes of 23 patients in Group 2, CCC was made using an ocular visco-elastic device (OVD) and utrata forceps. Surgical results were compared between two groups. RESULTS: No difference in outcome endothelial cell count or central corneal thickness was noted between the two groups. CCC-2 has been completed totally in Group 1 but only 22 eyes in the other group. CONCLUSIONS: Capsulorhexis with described technique is safe in white cataracts. This technique may be an alternative in capsulorhexis to the other method, which is made using OVD and forceps.

Analysis of age as a possible prognostic factor for transcanalicular multidiode laser dacryocystorhinostomy.

Purpose. To assess the prognostic value of age on the outcome of transcanalicular multidiode laser dacryocystorhinostomy (TCL-DCR) in patients with acquired nasolacrimal duct obstruction (NLDO). Methods. The medical records of TCL-DCR performed between March 2009 and September 2013 were reviewed retrospectively. Inclusion criteria include over 20 years of age, similar mean follow-up period, and similar mean duration of stenting. The main outcome is surgical success. The effect of age on success rate is also evaluated. Results. The anatomical success was 52% in Group 1 (20-30 years), 56% in Group 2 (31-40 years), 64% in Group 3 (41-50 years), 76% in Group 4 (51-60 years), and 88% in Group 5 (over 60 years). The statistical difference among Group 1 and Group 5, in terms of surgical success rate, was found to be significant (P = 0.009). Additionally, the 20-30-year-old patients had a failure rate 6.76 times higher than that of the over-60-year-old patients (P = 0.009; 95% CI, 1.605-28.542). Conclusion. TCL-DCR is a surgical treatment option for NLDO for which a skin incision can be avoided. The success rate of TCL-DCR for younger population is lower when compared with elderly population.

The injection of air/oxygen bubble into the anterior chamber of rabbits as a treatment for hyphema in patients with sickle cell disease.

Purpose. To investigate the changes of partial oxygen pressure (PaO2) in aqueous humour after injecting air or oxygen bubble into the anterior chamber in sickle cell hyphema. Methods. Blood samples were taken from the same patient with sickle cell disease. Thirty-two rabbits were divided into 4 groups. In group 1 (n = 8), there was no injection. Only blood injection constituted group 2 (n = 8), both blood and air bubble injection constituted group 3 (n = 8), and both blood and oxygen bubble injection constituted group 4 (n = 8). Results. The PaO2 in the aqueous humour after 10 hours from the injections was 78.45 ± 9.9 mmHg (Mean ± SD) for group 1, 73.97 ± 8.86 mmHg for group 2, 123.35 ± 13.6 mmHg for group 3, and 306.47 ± 16.5 mmHg for group 4. There was statistically significant difference between group 1 and group 2, when compared with group 3 and group 4. Conclusions. PaO2 in aqueous humour was increased after injecting air or oxygen bubble into the anterior chamber. We offer to leave an air bubble in the anterior chamber of patients with sickle cell hemoglobinopathies and hyphema undergoing an anterior chamber washout.

Peripapillary retinal nerve fiber layer changes in asymptomatic essential thrombocythemia patients.

PURPOSE: To investigate peripapillary retinal nerve fiber layer (RNFL) changes using optical coherence tomography (OCT) in patients with asymptomatic essential thrombocythemia (ET). MATERIALS AND METHODS: A consecutive case-control series of 30 patients with asymptomatic ET and age-similar, gender, refractive error, race-matched controls underwent a comprehensive eye examination and OCT of the peripapillary RNFL. Subjects with glaucoma, diabetes mellitus, hemoglobinopaties or other ocular diseases and those who underwent any retinal treatment were excluded. Inferior, superior, nasal and temporal peripapillary RNFL thicknesses were analyzed. One randomly selected eye per subject was compared with those of healthy ones. RESULTS: In the ET patients, the peripapillary RNFL thickness was particularly thin at the temporal quadrant (61.38 ± 9.82 µm, mean ± SD), and the difference was statistically significant (p = 0.036) when compared with the control group (71.24 ± 10.28 µm). The average RNFL thickness was 88.73 ± 12.26 µm in the ET patients and 96.91 ± 13.66 µm in the control group. Although the difference was not statistically significant (p = 0.226), the average RNFL was 8.44% thinner in ET patients than in healthy subjects. CONCLUSIONS: Asymptomatic ET patients may have peripapillary RNFL thinning as a result of their systemic illness. This study is the first to demonstrate peripapillary RFNL changes in asymptomatic ET patients.

Effects of sub-Tenon's anaesthesia on ocular hemodynamics.

OBJECTIVE: To research the effects of sub-Tenon's anaesthesia (STA) on ocular hemodynamics in patients with cataract using colour Doppler imaging (CDI). DESIGN: Prospective clinical study. PARTICIPANTS: Thirty-four eyes of 34 patients with age-related cataract. METHODS: Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) values of the ophthalmic artery (OA), central retinal artery, and central retinal vein were measured by CDI before and immediately after performing sub-Tenon block using 2 mL of 2% lidocaine with adrenaline (1:200 000). RESULTS: Both PSV and EDV values were significantly decreased after sub-Tenon injection in all the studied vessels of the patients. However, no important changes were observed in the RI values of the vessels. CONCLUSIONS: STA markedly reduced ocular blood flow. The reduction may be more acceptable compared with other retrobulbar block methods. Sub-Tenon block should be performed carefully to senile patients with cataract with vascular occlusive disorder.

Comparison of revision surgeries with transcanalicular diode laser and external approaches in cases with failed transcanalicular diode laser dacryocystorhinostomy.

PURPOSE: To compare the success rates of revision surgeries with transcanalicular diode laser (TCDL) and external approaches in cases with failed TCDL dacryocystorhinostomy (DCR). METHODS: The medical records of the consecutive TCDL DCR surgeries performed for nasolacrimal duct obstruction between October 2009 and March 2013 were reviewed. Cases with the presence of canalicular stenosis, bone deformities, lacrimal sac neoplasms, additional intranasal deformities, dacryolithiasis, history of previous nasolacrimal surgery, and follow up less than 3 months were excluded from the study. Patency to irrigation was obtained in all patients during surgery. Patients with surgical failure during the follow-up period underwent external DCR or TCDL DCR for revision. Data regarding surgical outcomes after primary surgeries and revision surgeries were analyzed. RESULTS: One hundred seventy-six primary TCDL DCR surgeries were performed on 162 patients. Forty-four (25.0%) surgeries considered failure during follow up. Four patients had canalicular obstruction and were excluded from study. Six patients declined a second intervention. Eighteen patients underwent external DCR and 16 patients underwent repeated TCDL DCR for revision. Success rates of revision surgeries were 94.4% (17/18) with external DCR and 43.8% (7/16) with TCDL DCR. The difference was statistically significant (p = 0.002). CONCLUSIONS: Revisions with external DCR are recommended for failed TCDL DCR. Revision TCDL DCR should be performed only in patients avoiding facial incision and preferring incision-sparing surgical techniques for revision.

Protective effects of N-acetylcysteine on triamcinolone acetonide-induced lens damage in rats.

OBJECTIVE: To examine the relationship of cataract forming effect of intravitreal triamcinolone acetonide (IVTA) injection with oxidative status and the effect of N-acetylcysteine (NAC) on these alterations. MATERIALS AND METHODS: Twenty-six Wistar-Albino rats were included in the study. Rats were assigned into four groups as follows: intravitreal saline injection group (controls); IVTA injection group; IVTA + intraperitoneal NAC injection group (IVTA + NAC); and intraperitoneal NAC injection group (NAC). Triamcinolone acetonide was intravitreally injected at a dose of 1 mg. NAC was intraperitoneally injected at a dose of 150 µg/g body weight. Animals were sacrificed and lens specimens were analyzed for levels of malondialdehyde (MDA) and protein carbonyl (PC) and activities of glutathione (GSH) and glutathione peroxidase (GSH-Px). RESULTS: We found that the MDA and PC levels of lenses were increased in the IVTA group (p < 0.01). It was seen that GSH and GSH-Px in lenses were decreased in the IVTA group (p < 0.01). NAC administration significantly ameliorated these changes in the IVTA + NAC group (p < 0.05). CONCLUSION: These results indicate that the NAC produces a protective mechanism against IVTA-induced cataract and suggest a role of oxidative stress in pathogenesis.

The effects of soft contact lens use on cornea and patient's recovery after autograft pterygium surgery.

PURPOSE: To investigate usage of soft contact lens (SCL) on post-operative pain relief and daily, activity due to pterygium surgery. METHODS: Autograft pterygium surgery was performed to 63 eyes of 63 patients. After surgery in 30, eyes of 30 patients in group-1, SCL was placed on the cornea. In 33 patients of group-2, antibiotic, pomade was applied and tightly covered with bandage. Follow-up visits were performed on 24th and, 48th h after the surgery. Re-epithelization time and pain scores were compared. RESULTS: Patients' 24th h pain score was 2.96 ± 0.76 in group-1, and 4.15 ± 0.75 in group-2. The mean, pain score for 48 h was 1.66 ± 0.66 in group-1, and 2.96 ± 0.68 in group-2. Patients' pain scores for, both 24th h and 48th h were lower in group-1 (p<0.01). The mean re-epithelization times in, group 1 and 2 were 48 and 56.7h, respectively. Corneal re-epithelization is improved in patients, with SCL compared to group 2. CONCLUSION: SCL seems effective on reducing post-operative pain and eye stinging, and may accelerate, corneal re-epithelization and maintaining daily activities.

Repair of iridodialysis using 8-0 polypropylene.

PURPOSE: Investigate the effectiveness of repair of iridodialysis with 8-0 polypropylene. METHODS: We present four cases of traumatic iridodialysis that were repaired by 8-0 polypropylene suture. RESULTS: Better iris reposition and stability were achieved with 8-0 polypropylene suture despite wide degree traumatic iridodialysis in all patients. CONCLUSION: In this study, we used 8-0 polypropylene suture, which is thicker, cheaper, and more durable than 10-0 sutures. We suggest that usage of 8-0 polypropylene sutures may provide better iris repositioning.

Repeated bevacizumab injections versus mitomycin C in rotational conjunctival flap for prevention of pterygium recurrence.

AIMS: To evaluate the efficacy of repeated bevacizumab injection in rotational conjunctival flap surgery versus rotational conjunctival flap with adjunctive mitomycin C (MMC) or rotational conjunctival flap alone. MATERIALS AND METHODS: Ninety eyes of 90 patients who underwent primary pterygium surgery with rotational flap were evaluated. Patients were randomly assigned to undergo conjunctival rotational flap alone (Group A) or conjunctival rotational flap with either 0.02% MMC application (Group B) or adjunctive subconjunctival 2.5 mg/0.1 ml bevacizumab injection (Group C). Each group consisted of 30 eyes. Recurrence rates at 9 months were evaluated. RESULTS: There were no statistically significant differences in mean size of the pterygium across the limbus in terms of length (P > 0.5). The recurrence rates at 9 months were 26.6% (n = 8) in Group A, 13.3% (n = 4) in Group B, and 10% (n = 3) in Group C. The recurrence rates in Group B and C were significantly lower than in Group A (P = 0.1806). The recurrence rates were similar in Group B and C (P > 0.05). CONCLUSIONS: Subconjunctival bevacizumab injection may decrease the recurrence rate of primary pterygium surgery with rotational conjunctival flap. Further studies with a larger population and longer follow-up period are needed to supplement this study.

Vacuum-assisted continuous circular capsulorhexis using bimanual irrigation and aspiration system of phaco machine in immature cataract.

Seventy-eight eye of 65 patients were enrolled in this retrospective clinical study. Two-side ports are made with a 23-gauge stiletto knife. The irrigation handpiece is introduced into the anterior chamber through one side port and 27-gauge cystotome is introduced through the other one. Anterior capsular flap is created with cystotome. The capsular flap is vacuumed with a 25-gauge visco elastic's cannula, which connected to the phaco machine vacuum. The continuous circular capsulorhexis (CCC) is completed with the using bimanual irrigation and aspiration system of phaco machine. Vacuum-assisted CCC technique was used in 78 cases of uncomplicated immature senile cataracts. All cases were done under sub-Tenon's anesthesia. A complete CCC was achieved in all cases. Performing CCC with our technique is easy, safe, and cheap. It may be an alternative method to CCC by using OVD and forceps.