Effects on visual function of glistenings and folding marks in AcrySof intraocular lenses.

PURPOSE: To study the effects on visual function of glistenings and folding marks in AcrySof (Alcon) intraocular lenses (IOLs). SETTING: Department of Ophthalmology, Dokuz Eylül University, School of Medicine, Izmir, Turkey. METHODS: This study included 91 eyes that had phacoemulsification and in-the-bag AcrySof IOL implantation. Slitlamp, visual acuity, and contrast sensitivity evaluations were used to assess all cases. Observations of folding marks and glistenings in the IOL optic were noted. The glistenings were graded from 0 to +4. Eyes with coexisting pathology that could affect visual acuity (n = 15) were excluded from the study. After the exclusion, the visual acuity and contrast sensitivity in 28 eyes with glistenings were compared with those in 48 eyes without glistenings. RESULTS: Localized folding marks away from the central visual axis of the IOL were identified in 25 eyes (27.4%). Glistenings were observed in 34 eyes (37.1%), 6 of which were excluded for coexisting pathology. There was no statistically significant difference in visual acuity and contrast sensitivity at low or medium spatial frequencies between eyes with glistenings and those without (P >.05); however, a statistically significant difference was noted at the high spatial frequency (P <.01). There was no difference in visual acuity or contrast sensitivity between eyes with folding marks and those without (P >.05). CONCLUSION: Although glistenings and folding marks were observed after the implantation of AcrySof IOLs, they did not significantly affect visual function.

Penetration of amikacin into aqueous humor of rabbits.

Amikacin is an aminoglycoside antibiotic that has poor corneal penetration due to its hydrophilic properties. The purpose of this study was to compare and evaluate the penetration of amikacin sulfate into aqueous humor of the rabbit eye when applied by different routes and concentrations, namely 100 or 250 mg/ml topical fortified amikacin eye drops, 100 or 250 mg/ml amikacin-embedded soft contact lenses and 25 mg subconjunctival amikacin injection. One hour after application, amikacin was not detectable in any of the 100 mg/ml concentration groups. High levels of amikacin above the minimum inhibitory concentration for susceptible bacteria were detected when applied subconjunctivally and by 250 mg/ml topical fortified routes. Topical fortified amikacin 250 mg/ml reached the highest value in the aqueous (p < 0.05). Our results point out the poor corneal penetration of amikacin in standard concentrations from the intact rabbit cornea and that subconjunctival injections might provide satisfactory penetration.

Early postoperative capsular block syndrome.

PURPOSE: To report the results of early postoperative capsular block syndrome (CBS) after phacoemulsification and intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Dokuz Eylül University School of Medicine, Izmir, Turkey. METHODS: Thirteen eyes of 13 patients with CBS who had uneventful phacoemulsification were included in the study. Twelve patients had in-the-bag implantation of a foldable IOL, and 1 had implantation of a poly(methyl methacrylate) IOL in the ciliary sulcus. Continuous curvilinear capsulorhexis was performed in all eyes, and sodium hyaluronate 1.4% (Healon GV(R)) was used during all steps of surgery. The patients were closely followed without intervention during the first month after surgery. If resolution did not occur during follow-up, a neodymium:YAG (Nd:YAG) laser peripheral anterior capsulotomy was performed first, followed by posterior capsulotomy if the anterior capsulotomy was not successful. RESULTS: The CBS resolved without intervention in 2 eyes by 1 month postoperatively. A small Nd:YAG laser peripheral anterior capsulotomy was attempted in 10 cases after 1 month but could not be performed in 2 eyes because of inadequate pupil dilation. Peripheral anterior capsulotomy was successful in 5 of 8 eyes, with resolution of CBS in a few days. The Nd:YAG laser posterior capsulotomy was successful in 5 cases after the failure of the anterior capsulotomy. One patient chose to postpone treatment for 11 months, at which time posterior capsulotomy was performed successfully and the CBS resolved. CONCLUSIONS: Resolution of CBS occurred spontaneously in only a small percentage of cases during the first month after phacoemulsification with IOL implantation. Neodymium:YAG laser peripheral anterior capsulotomy and posterior capsulotomy were successful in treating CBS.

Long-term results of various anterior capsulotomies and radial tears on intraocular lens centration.

BACKGROUND AND OBJECTIVE: To evaluate the long-term effects of various anterior capsulotomies and radial tears on intraocular lens (IOL) centration. MATERIALS AND METHODS: Ninety-five eyes of 87 senile cataract patients operated with extracapsular technique were evaluated in IOL tilt and decentration with a new method of measurement. According to the type of anterior capsulotomy and number of radial tears, five groups were constituted as, can opener, envelope, continous curvilinear capsulorrhexis (CCC), CCC with one radial tear (relaxing incision at quadrant 12), and CCC with two relaxing incisions (relaxing incisions at quadrants 6 and 12), respectively. RESULTS: Early decentration and tilt in groups CCC and CCC with one radial tear were significantly lower than the other groups (P < 0.05). Late decentration and tilt in the CCC group were significantly lower than the other groups (P < 0.01). Highest values of tilt and decentration were determined in envelope capsulotomy. Additional symmetric relaxing incision at quadrant 6 revealed no effect on the prevention of decentration and tilt compared to one relaxing incision. CONCLUSION: CCC with one radial tear is not ideal but sufficient for IOL centration. All other anterior capsulotomy techniques, other than intact CCC, do not guarantee the IOL centration.

Analysis of the pterygium size inducing marked refractive astigmatism.

PURPOSE: Astigmatic changes induced by the pterygium and their relation to its size and morphology were analysed to establish the critical size for surgery before significant astigmatism occurs. MATERIALS AND METHODS: We evaluated the refraction in 148 eyes of 108 adult patients with primary pterygia. We grouped the astigmatic values according to the keratometric results correlating with the maximal length, width and the approximate total area of the pterigium encroaching on the corneal surface. RESULTS: Pterygia with length or width > or = 3.00 mm were related to significantly higher astigmatism than other groups (p<0.01). The effect of the pterygium morphology on corneal astigmatism was not significant. CONCLUSIONS: Pterygia exceeding 3.00 mm of length or width should be considered within the limits of surgery.

Posterior capsule opacification after phacoemulsification: foldable acrylic versus poly(methyl methacrylate) intraocular lenses.

PURPOSE: To study the effects of foldable acrylic and poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation on posterior capsule opacification (PCO). SETTING: Department of Ophthalmology, Dokuz Eylül University School of Medicine, Izmir, Turkey. METHODS: This consecutive series comprised 157 eyes having phacoemulsification with implantation of a foldable acrylic IOL with rectangular optic edges and a 5.5 mm optic (AcrySof) (n = 80 eyes) or a PMMA IOL with rounded optic edges and 5.5 mm optic (n = 77). Evaluated were incidence, location, and degree of PCO. Mean postoperative follow-up was 17.8 months +/- 1.7 (SD) (range 16 to 22 months). RESULTS: Posterior capsule opacification occurred in 8.7% of eyes in the foldable acrylic IOL group and in 24.7% of eyes in the PMMA IOL group. The difference between the 2 groups was statistically significant (P < .01). Centrally located PCO was significantly lower in the acrylic group (P < .01). There were 3 eyes with severe PCO in the PMMA group and none in the acrylic group. Anterior capsule contraction and fibrosis were present in 4 eyes in the PMMA group but none in the acrylic group. Soemmering's ring cataract formation was detected in 3 eyes, all with the AcrySof IOL. CONCLUSION: In addition to its optic material and rectangular optic edges, the AcrySof IOL provides additional advantages in lowering the incidence of PCO compared with rounded-edge PMMA IOLs.

Unilateral refractive keratotomy for anisometropia.

BACKGROUND: In anisometropia, the asymmetry of refractive error produces disparity of image magnification (aniseikonia) that can create visual discomfort, especially when asymmetry is 3.00 diopters or more. METHODS: A prospective study of 20 eyes of 20 patients between 18 and 61 years of age who underwent unilateral radial and/or transverse keratotomy was conducted; results of at least 12 months follow-up are presented. The efficacy of keratotomy was evaluated by the following criteria: 1) change in spherical and cylindrical refraction, 2) decrease in refraction difference between two eyes of each patient, 3) change in spectacle-corrected visual acuity, and 4) change in binocular vision functions and asthenopic complaints. RESULTS: Mean decrease in spherical refractive error was 3.66 +/- 1.58 D (range, 1.25 to 7.50 D) and 2.08 +/- 0.81 D (range, 1.00 to 3.50 D) in astigmatic refraction. The mean refraction difference between two eyes was 4.90 +/- 2.20 D preoperatively, and this difference regressed to 1.79 +/- 1.42 D postoperatively. Spectacle-corrected visual acuity increased in seven eyes (35%), remained the same in 12 eyes (60%) and decreased in one eye (5%). All patients reported relief of asthenopic complaints. Fusion amplitudes increased in 12 (60%) patients. Stereoscopic vision improved in five (25%) patients. CONCLUSION: Monocular refractive keratotomy can significantly decrease anisometropia.