Differences in pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification.

The purpose of this study is to compare pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification in both eyes, using sub-Tenon's local anesthesia without sedation. In this study, 268 patients with bilateral senile cataracts were recruited. All operations were performed without sedation, using a clear corneal phacoemulsification technique and sub-Tenon's local anesthesia, by one of four surgeons. The first surgery was performed on the eye with the higher grade cataract. The other eye was operated on within 3 months by the same surgeon (mean interval 1.9 ± 1.1 months). All patients were asked to grade their pain experience during induction and maintenance of anesthesia and also during the phacoemulsification surgery, using a visual analogue scale (VAS) from 0 (no pain) to 10 (unbearable pain) administered after the surgery. The cooperation of the patient was graded from 0 (no event) to 3 (markedeye and head movement and lid squeezing) by the attending surgeon. The VAS scores and cooperation scores of the patients were the outcome measurements. The mean pain score was 2.11 ± 0.79 in the first eye and 3.33 ± 0.80 in the second eye during the administration of sub-Tenon's anesthesia, and 1.50 ± 0.60 in the first eye and 2.10 ± 0.57 in the second eye during the phacoemulsification surgery. The patient cooperation score was 1.60 ± 0.75 in the first surgery and 2.08 ± 0.72 in the second surgery. The differences between the first and second surgeries were statistically significant for all outcome measures (p < 0.01). Patients who previously underwent phaco surgery in one eye experienced more pain and showed worse cooperation during the phaco surgery in the second eye, especially if there was a short time between the surgeries, viz., less than 3 months. Therefore, if the surgeon has difficulty in the first operation gaining the patient's cooperation, the surgeon must be careful: if contralateral eye surgery is required, the addition of sedation/analgesia should be considered or the surgery postponed for a while to abolish the influence of recent memory on the patient's subsequent pain experience.

Persistent Symblepharon in an Infant Following Epidemic Keratoconjunctivitis.

Epidemic keratoconjunctivitis (EKC), caused by certain species D human adenoviruses (Ads), is a highly contagious severe disease involving both the conjunctiva and cornea. The hallmark of this disease is the subepithelial infiltration of leukocytes, which results in corneal opacities that may persist for months or even years. In this case, of a 6-month-old infant, we report a symblepharon formation, a relatively rare outcome of EKC. In this condition, the palpebral conjunctiva adheres tightly to the bulbar conjunctiva of the eyeball. Our report is the first documentation of a symblepharon formation in an infant. Only two similar cases have been reported to date; therefore, a detailed description is of considerable interest to ophthalmologists. This is particularly interesting since a previous publication has associated symblepharon formation with an adenovirus infection, which is not usually involved in EKC. The development of a symblepharon following EKC is rare in infants. Since topical treatment cannot be applied due to severe eyelid edema, oral steroid therapy can be administered with pediatric consultation and meticulous monitoring.

Posterior Subtenon's Capsule Triamcinolone Acetonide Injection for the Treatment of Diabetic Macular Edema.

PURPOSE: To evaluate and compare the efficacy of posterior subtenon's triamcinolone injections versus grid laser photocoagulation (GLP) combined with posterior subtenon's triamcinolone injection in eyes with diabetic macular edema (DME). METHODS: In this prospective clinical study, 42 eyes with DME that showed a decrease in visual acuity (VA) were included. The first group consisted of 22 eyes that received a posterior subtenon's injection of 40 mg of triamcinolone acetonide under topical anesthesia. The second group of 20 eyes received macular GLP applied 1 month after subtenon's triamcinolone acetonide (STTA) injection. All patients were evaluated at baseline and 1 day; 1, 2, 4, 6, and 8 weeks; and 3 and 6 months after injection. In some patients, injections were repeated after 3 months. The main outcome measures were VA, central macular thickness (CMT), intraocular pressure, cataract progression, and frequency of complications. RESULTS: The mean baseline CMT for Group I was 456.85 ± 56.90 µm. The mean baseline CMT for Group II was 455.66 ± 57 µm. In the first group, mean CMTs for second week, 8th week, 12th week, and 6th month were 258.15, 276.50, 280.05, and 433.30 µm, respectively. In the second group, mean CMTs for second week, 8th week, 12th week, and 6th month were 261.42, 272.76, 284.71, and 291.76 µm, respectively. Before treatment, in the first group, the mean best-corrected visual acuity (BCVA) measured using a Snellen chart was 0.19, while the first week, third, and sixth month BCVA means were 0.59, 0.57, and 0.41, respectively. Before treatment, BCVA in the second group was 0.17, while the first week, third, and sixth month means were 0.61, 0.64, and 0.60, respectively. Treatment complications included cataracts in 4 eyes and glaucoma in 1 eye. CONCLUSION: There is a temporary therapeutic effect of posterior subtenon's triamcinolone injection without laser photocoagulation. GLP improves VA and reduces the risk of recurrent macular edema after posterior STTA injection.

Administration of the fixed combination of latanoprost 0.005% and timolol 0.5% in glaucoma patients with an intraocular pressure over 30 mmHg.

PURPOSE: To evaluate the intraocular pressure (IOP) reducing effect of a fixed combination of 0.005% latanoprost and 0.5% timolol in patients with an IOP of 30 mmHg or higher. DESIGN: Prospective, randomized clinical trial. PARTICIPANTS: Twenty-eight patients. METHODS: Patients had received no prior medical glaucoma treatment. Routine ophthalmic examinations and visual field tests were performed before and after treatment for each patient. RESULTS: Mean IOP was 32.28 +/- 0.92 mmHg before treatment. Mean IOP levels were 18.75 +/- 0.68 for the first day, 17.96 +/- 0.90 for the first week and 17.64 +/- 0.66 for the first month after treatment. CONCLUSION: A fixed combination of latanoprost 0.005% and timolol 0.5% is effective in significantly reducing IOP in glaucoma patients with an IOP greater than 30 mmHg.

Refraction, intraocular pressure and anterior chamber depth changes after Nd:YAG laser treatment for posterior capsular opacification in pseudophakic eyes.

PURPOSE: The aim was to investigate the effect of Nd:YAG capsulotomy on refraction, intraocular pressure and anterior chamber depth changes and complications of Nd:YAG laser treatment for posterior capsular opacification in pseudophakic eyes. METHODS: Our study includes 26 eyes (23 patients) with posterior capsular opacification after uncomplicated phacoemulsification surgery and intraocular lens implantation. Complete ocular examinations were performed for all patients. The visual acuity, intraocular pressure and anterior chamber depth measurements were obtained in all examinations. Nd:YAG capsulotomy was measured in all patients. Eyes received one drop of aproclonidine 0.5 % before and immediately after YAG laser capsulotomy. Data were analysed statistically. RESULTS: Mean patient age was 53.73 +/- 13.53 years. Before Nd:YAG capsulotomy mean anterior chamber depth was 4.03 +/- 0.58 mm and in the first day after capsulotomy the mean value was 4.02 +/- 0.46 mm. Mean spherical equivalent refraction before laser treatment was -0.52 D and on the first day after laser treatment was -0.49 D. An improvement in visual acuity was achieved in all cases. Before Nd:YAG capsulotomy mean visual acuity was 0.38 +/- 0.13 and on the first day after capsulotomy, the mean value was 0.93 +/- 0.11, the difference of which was statistically significant. There were no statistically significant differences between the anterior chamber depth and intraocular pressure measurements before laser capsulotomy and on the first day, first month and third month after laser. CONCLUSION: Nd:YAG laser capsulotomy is an effective and safe method of treatment of posterior capsular opacification.

Rose K contact lens fitting for keratoconus.

PURPOSE: We evaluated the clinical outcome and fitting characteristics with Rose K contact lenses in patients with irregular astigmatism due to keratoconus. METHODS: About 19 patients with keratoconus were fitted with Rose K lens in the Cornea Department at the Fatih Sultan Mehmet Training and Research Hospital between May 2005 and April 2006. Patients were between 19 and 32 years of age. All the patients underwent a complete ophthalmic examination and best-corrected visual acuity measurements were taken with glasses at the baseline visit. During biomicroscopic evaluation, position, and centralization of the contact lens and fluorescein staining were noted. Visual acuity, contact lens comfort, and daily contact lens wearing time after fitting were evaluated. RESULTS: A total of 96% of the patients tolerated the fitting. The mean daily wearing time was 10.7 h. There was a significant increase in visual acuity with Rose K lens compared with best-corrected spectacle visual acuity. CONCLUSION: Rose K lenses are a viable alternative in the visual rehabilitation of patients with keratoconus.

Is dry eye syndrome a work-related disease among radiologists?

PURPOSE: To assess tear function in radiologists. MATERIALS AND METHODS: The study included 71 volunteers divided into 2 groups; 36 radiologists (Group 1) and 35 non-radiologist controls (Group 2). The noted ophthalmologic symptoms in both groups were burning, stinging, redness, sensation of a foreign body, photophobia, and blurred vision. Schirmer's 1 and tear break-up time tests were used to assess tear function. RESULTS: The distribution of eye symptoms in Group 1 was as follows: 16 radiologists (44.4%) presented with burning and stinging, 17 (47.2%) with the sensation of a foreign body, 23 (63.8%) with redness, 11 (30.5%) with blurred vision, and 5 (13.8%) with photophobia. As for Group 2, the following symptoms were noted: burning and stinging in 8 (22.8%), sensation of a foreign body in 5 (14.2%), redness in 6 (17.1%), blurred vision in 3 (8.5%), and photophobia in 1 control volunteer (2.8%). Tear break-up time test scores were 8.4 for Group 1 and 15.4 for Group 2, whereas Schirmer's 1 test scores were 9.1 and 16.1 for Groups 1 and 2, respectively. CONCLUSION: As a conclusion, dry eye syndrome occurs significantly more frequently in radiologists compared to non-radiologist. The working conditions and circumstances, including air-conditioned rooms, use of negatoscopes, and exposure to diagnostic radiation may be possible causative factors of this statistical outcome.