Clinical Outcomes of Piggybacking a One-Piece IOL With a Three-Piece IOL in Eyes With Nanophthalmos.

PURPOSE: To compare the nanophthalmic eyes in which a three-piece intraocular lens (IOL) along with a one-piece IOL and two one-piece IOLs were used for piggyback IOL implantation into the capsular bag. METHODS: This retrospective comparative case series included 61 eyes of 31 patients. Group 1 consisted of 31 eyes of 16 patients who underwent piggyback implantation of a one-piece IOL along with a three-piece IOL into the capsular bag. Group 2 consisted of 30 eyes of 15 patients who underwent piggyback implantation of two one-piece IOLs into the capsular bag. IOL spherical power was determined by calculating the arithmetic mean of the Holladay 1 formula and Hoffer Q formula, targeting emmetropia. Main outcomes were postoperative visual acuity and refraction, IOL centration and tilt, and complications. RESULTS: The mean postoperative follow-up time was 15.6 ± 5.2 months in Group 1 and 14.8 ± 4.3 months in Group 2 (P = .51). There was no significant difference between the two groups in terms of preoperative and postoperative spherical equivalent (P = .52 and .42, respectively). Twenty-six eyes (83.8%) in Group 1 and 26 eyes (86.60%) in Group 2 were within ±1.50 D of emmetropia. Mean IOL decentration was significantly lower in Group 1 (0.03 ± 0.08 mm) than Group 2 (0.14 ± 0.18 mm) (P = .003). The mean IOL tilt was 1.45 ± 2.94 degrees in Group 1 and 4.00 ± 4.23 degrees in Group 2 (P = .008). CONCLUSIONS: Piggyback implantation of a three-piece IOL combined with a one-piece IOL provides less IOL decentration and tilt in patients with nanophthalmos. The use of the arithmetic mean of the Holladay 1 and Hoffer Q formulas for IOL power calculation provides more accurate results. [J Refract Surg. 2022;38(12):812-818.].

Posttraumatic Oculorrhea From the Eyelid.

We report a 21-month-old boy with a sutured laceration of the left upper eyelid with drainage of cerebrospinal fluid. Careful evaluation, including computerized tomography, revealed a penetrating injury of the left orbital wall and a linear bone fracture. The wound was resutured carefully. There was no cerebrospinal fluid leakage in the postoperative follow-up period.

Ultrasonic Elastography Evaluation in Optic Neuritis.

PURPOSE: In the present study, we attempted to determine whether ultrasonic elastography (USE) evaluation can be used in a diagnosis of optic neuritis (ON). MATERIALS AND METHODS: Thirteen patients who each had one normal eye and one eye with a diagnosis of ON were included in the study. Ultrasonography (US) and USE examinations were performed on the affected and non-affected eyes of all participants. Optic nerve and adjacent fat tissue regions at the same depth were selected, and USE measurements were obtained. The optic nerve diameter was measured in both normal and affected eyes. RESULTS: The mean USE values for the optic nerve were 2.58 ± 0.50 m/s in ON eyes and 1.91 ± 0.39 m/s in normal eyes (p = 0.001). The mean USE values for the optic-nerve adjacent tissue were 2.26 ± 0.45 m/s in ON eyes and 1.77 ± 0.22 m/s in normal eyes (p = 0.001). The mean optic-nerve diameter was 3.80 ± 1.09 mm in ON eyes and 3.28 ± 0.98 mm in normal eyes (p = 0.005). CONCLUSIONS: USE may be considered an accessible, safe technique for the detection of significant optic-nerve tissue stiffness in ON and may be used an adjunctive tool for confirming this diagnosis.

Wiedemann-Rautenstrauch Syndrome With Bilateral Tarsal Kink: Three Sutures for Correction.

The authors describe a 5-month-old male infant with Wiedemann-Rautenstrauch syndrome, which is an extremely rare condition. He had tarsal kink in upper eyelids in both eyes. The authors treated bilateral tarsal kink with an everting suture via a transconjunctival approach under local anesthesia.

Epidemiology of Adult Open Globe Injury.

OBJECTIVE: The aim of this study was to evaluate the epidemiology and outcomes of adult open globe injuries (OGI) in the eastern part of Turkey. METHODS: The retrospective study included all the patients who were diagnosed with OGI (436 eyes in 425 patients) at our clinic between 1997 and 2015. The OGI patients aged over 16 years were included into the study. Open globe injuries were classified according to the Ocular Trauma Classification. Age, gender, medical history, time between trauma and hospital admission, and mechanism of injury were recorded for each patient. RESULTS: The incidence of OGI in adults was found to be 3.40/100,000, with 5.00/100,000 in males and 1.67/100,000 in females. Open globe injuries were mostly seen in the age group of 17 to 29 years and in October and November. The patients included 79.5% males and 20.5% females. Intraocular foreign body was detected in 99 (22.7%) eyes. A strong, linear, negative correlation was found between the Ocular Trauma Classification values and final visual LogMAR (rp = -0.602, P = 0.0001). The most common mechanism of injury was occupational accident (38.4%). CONCLUSION: Open globe injuries remain a serious public health problem, resulting in significant vision loss. Open globe injuries are mostly seen in the young, middle-aged, and male working population. Additional preventive measures should be taken for the individuals in these groups.

Comparing biometry in normal eyes of children with unilateral cataract/corneal disease to age-matched controls.

OBJECTIVE: To compare ocular biometry and central corneal thickness of unaffected healthy eyes of pediatric patients with monocular cataracts/corneal opacities and age- matched controls. MATERIALS AND METHODS: We studied 329 eyes of 329 children who were between 1 and 12 years old. The study group (n: 164) consisted of healthy fellow eyes of children operated for unilateral congenital/traumatic cataract and corneal laceration. Axial length, anterior chamber depth, lens thickness, vitreous chamber depth, and central corneal thickness were measured by ultrasound biometry/ pachymetry. RESULTS: Axial length was 22.16 mm in the study group and 21.99 mm in the control group. Anterior chamber depth, lens thickness, and vitreous chamber depth results were 3.35; 3.64 and 15.20 in the treatment group and 3.20; 3.63, and 15.15 mm in the control group, respectively. The axial length and all the components, i.e. anterior chamber depth, lens thickness, and vitreous chamber depth are higher in the unaffected healthy eyes of the pediatric patients than that of the control group but only the difference in the anterior chamber depth was statistically significant. The central corneal thickness was 548 microns and 559 microns in the study and the control groups, respectively, and the difference was found to be significant. CONCLUSION: Greater anterior chamber depth was chiefly responsible for the overall increase in the axial length in the study group. The central corneal thickness was significantly thinner in the study group than that of the control group. Keywords Ocular biometry; central corneal thickness; anterior chamber depth; lens thickness; vitreous chamber depth.

Ocular biometry and central corneal thickness in children: a hospital-based study.

PURPOSE: To investigate the distribution of axial length, anterior chamber depth, lens thickness, vitreous chamber depth, and central corneal thickness in children at different age groups. METHODS: We studied 364 eyes in 182 children with ages between 1 and 12 years. Axial length, anterior chamber depth, lens thickness, and vitreous chamber depth were measured by ultrasound biometry. Central corneal thickness was measured by ultrasound pachymetry in all children. RESULTS: The mean age was 6.54 ・} 3.42 years. The axial length was 20.95 mm in 1-2 years old and 22.95 mm in 11-12 years old. The central corneal thickness was 556 µm in 1-2 years old and 555 µm in 11-12 years old. The mean anterior chamber depth and vitreous chamber depth increased with age (3.06 mm to 3.44 mm in anterior chamber depth, 13.75 mm to 15.99 mm in vitreous chamber depth), and the lens thickness decreased as age increased (3.67-3.51 mm). CONCLUSION: The axial length increased with age and reached adult levels by the age of 9-10 years. The lens thickness gradually decreased until 12 years. The central corneal thickness measurements did not yield a linear algorithm.

Assessment of corneal endothelial cell density in patients with keratoconus not using contact lenses.

PURPOSE: To assess the corneal endothelial cell density (ECD) in keratoconus patients with no history of contact lens use. SETTING: Yuzuncu Yil University, School of Medicine and Van Training and Research Hospital, Department of Ophthalmology, Van, Turkey. DESIGN: Cross-sectional controlled study. METHODS: The eyes of 65 patients with the diagnosis of keratoconus with no history of contact lens wear and the eyes of 40 healthy controls were prospectively examined using the Heidelberg Retinal Tomography Rostock Cornea Module (HRT3/RCM). The average ECD from the two groups were then compared. RESULTS: Of the cases with keratoconus, 44 (67.7%) were men and 21 (32.3%) were women. The mean age was 20.9±6.8 (range=10-41) years. Of the controls, 28 (70%) were men and 12 (30%) were women. The mean age was 23.9±5.8 (range=14-35) years. Of the 65 eyes with keratoconus, 19 (29.2%) had mild keratoconus, 21 (32.3%) had moderate keratoconus, and 25 (38.5%) had severe keratoconus. The mean ECD was 2731.6±303.2 cells/mm2 in cases with keratoconus and 2664.9±319.5 cells/mm2 in controls. There was no difference between the densities (unpaired t-test, P=0.4). No significant relationships were found between the ECD data and central corneal thickness or steepest keratometric. CONCLUSIONS: Endothelial cell density was unaltered in keratoconic patients without a history of contact lens use when compared with healthy controls. Change in ECD is independent from the central corneal thickness and the stage of keratoconus.

Assessment of keratocyte density in patients with keratoconus not using contact lenses.

PURPOSE: To assess the keratocyte density (KD) in the cornea of patients with keratoconus not using contact lenses. METHOD: In this pilot study, the eyes (n = 68) of 35 patients with the diagnosis of keratoconus, who did not use contact lenses and the eyes(n = 70) of 35 healthy controls were prospectively examined using the Heidelberg Retinal Tomography Rostock cornea module (HRT3/RCM). The cases with keratoconus and controls were compared with regard to KD in the anteroposterior stromal layers. RESULTS: Of the cases with keratoconus, 15 (42.9%) were men and 20 (57.1%) were women. The mean age was 21.1 ± 11.1 (range =14-41) years. Of the controls, 26 (73.9%) were men and 9 (26.1%)were women. The mean age was 23.9 ± 12.9 (range = 14-35) years.Of the 68 eyes with keratoconus, 22 (28.2%) had mild keratoconus, 23 (35.9%) had moderate keratoconus, and 23 (35.9%) had severe keratoconus. The mean anterior stromal KD was 651.4 ± 89 cells per square millimeter in cases with keratoconus and 879.4 ± 75 cells per square millimeter in controls (P < 0.05). The mean anterior stromal KD decreased by 25.9% in corneas with keratoconus. The mean posterior stromal KD was found to be 363.6 ± 74 cells per square millimeter in cases with keratoconus and 469.7 ± 56 cells per square millimeter in controls (P< 0.01). The mean posterior stromal KD decreased by 22.6% in corneas with keratoconus. The anterior stromal KD was higher than the posterior stromal KD (P < 0.001). No significant relationships were found between the stromal KD data and central corneal thickness or steepest keratometric. CONCLUSIONS: The KD in the anterior and posterior corneal stroma was decreased in patients with keratoconus, but without the use of contact lens, compared with healthy controls. This density difference was independent from the central corneal thickness and the stage of keratoconus.

Intravitreal bevacizumab for treatment of serous macular detachment in central retinal vein occlusion.

PURPOSE: To report the long-term effect of intravitreal bevacizumab on serous macular detachment (SMD) in central retinal vein occlusion (CRVO). METHODS: Retrospective, interventional, noncomparative case series. Nineteen consecutive patients (19 eyes) with SMD secondary to CRVO were included. Primary outcomes were the change of the best-corrected visual acuity (BCVA) and the central foveal thickness (CFT) at final visit. Secondary outcome was the resolution of the SMD. RESULTS: The mean patient age was 65.6 years, and the mean follow-up time 21.6 months. Of the 19 eyes, 15 eyes were non-ischemic. The average number of bevacizumab injections was 5.9 from baseline to the final visit. Mean logMAR BCVA improved from 1.20 ± 0.45 (20/317) to [Formula: see text] and mean CFT decreased from 918 ± 280 µm to [Formula: see text] at the final visit. The SMD resolved in 16 of the 19 eyes completely. No local or systemic complication was observed. CONCLUSION: In this retrospective case series, a significant improvement of the vision and resolution of the SMD was found after bevacizumab treatment for CRVO with SMD. Large case series are necessary to evaluate the role of the intravitreal bevacizumab treatment for CRVO associated with SMD.

Conjunctival Lymphangiectasis.

The authors report the case of a 41-year-old woman presenting with both intermittent conjunctival swelling and dilated conjunctival vessels on ocular examination in the right eye who was diagnosed as having conjunctival lymphangiectasis. This is a rare disease that occurs as the result of a connection between conjunctival lymphatic and blood vessels.

MRI-Induced Migration of Retained Metallic Foreign Body in the Eye.

A 50-year-old man presented to the out-patient clinic because of a sudden pain in his left eye just after lumbal magnetic resonance imaging (MRI) was started. Biomicroscopic examination of the left eye revealed the inferior anterior chamber angle including a foreign body and the superior anterior chamber angle including the iris portion, into which the foreign body had been stuck prior to the MRI examination. His history revealed an accidental penetrating eye trauma of the shotgun pellet of 28 years ago. The foreign body was easily removed using a forceps intraoperatively. The foreign body was defined as a metallic foreign body postoperatively.

Persistant Pupillary Membrane Surgery.

A 21-year-old woman presented with bilateral poor visual acuity due to the bilateral remnants of pupillary membrane in June 2007. The patient underwent excisional removal of pupillary membrane remnant in both the eyes, 1 week apart. Postoperatively, the pupillary area was completely free of any membrane remnant, no complication was observed. Visual acuities were 0.6 right eye and 0.4 left eye.

Comparison of argon laser photocoagulation-induced cutaneous inflammation and skin pathergy test in Behçet's disease.

Nonspecific increased inflammatory response is an important feature of Behçet's disease (BD). The skin pathergy reaction (SPR) which tests this hyperreactivity in the skin is frequently used as a diagnostic tool. This study aims to investigate the argon laser photocoagulation (ALP)-induced cutaneous inflammation in BD patients and controls and also to compare the results with the skin pathergy test (SPT). The study group consisted of 35 patients with BD and 28 healthy volunteers. The ALP was applied to the left forearms of all cases from 20-cm distance (2,000 mW, 100 microm) with exposure times ranging from 0.2 to 0.7 s with 0.1-s increments. Also, a SPT with three prics was performed to both forearms of all cases. The ALP-induced cutaneous inflammation and SPT were evaluated and scored with the same method at 48 h, and the SPR scores of 2+ and above was accepted as positive. Positive results as defined above were found in eight cases (23%) with the ALP and in nine (26%) with the SPT in patients with BD. There was no clear correlation between the ALP and SPT results and also between the exposure time to laser beam and SPR scores. The preliminary results of this study reveal that ALP can induce a skin hyperreactivity similar to the needle prick-induced SPR in patients with BD. We, herein, showed that ALP can induce skin inflammation with its thermal effect and without any inoculation of antigen in BD. This method would help to develop another experimental method to investigate the cutaneous inflammation in BD.

Conjunctival myxoma: a clinicopathologic report.

A conjunctival myxoma was identified in a specimen obtained from a 45-year-old woman via excisional biopsy. The patient presented with a slowly growing painless epibulbar mass. The paucicellular tumor included stellate and spindle-shaped cells, mast cells, and dilated lymphatic channels embedded in a loose collagenous matrix. The differential diagnosis of conjunctival myxoma should include tumors that have myxoid patterns and richly myxoid malignant neoplasms.

The risk factors of pterygium development: a hospital-based study.

We evaluated the risk factors for pterygium development in Eastern Turkey. Mean protrusion value of all eyes with pterygium (all eyes in bilateral pterygium subgroups and only eyes with pterygium in unilateral pterygium subgroup, n = 130) was 16.76 +/- 2.69 mm. In all cases pterygium occurred in the eye that had greater protrusion value suggesting greater protrusion degree might be a risk factor.

Brucellosis and uveitis.

A 30-year-old-lady, (Case 1) was found to have brucella uveitis in her left eye. Serum agglutination (SAT) and SAT/Coombs titers were positive at 1:320 and 1:160, respectively. In Case 2, a 12-year-old-girl diagnosis of left brucellosis uveitis was made. Both SAT and SAT/Coombs titers were positive at 1:1280. This report confirms that Brucellae organisms as a cause of uveitis.

Nd:YAG laser posterior capsulotomy after pediatric and adult cataract surgery.

We evaluated neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy procedure with or without anesthesia in 35 pediatric eyes and 51 adult eyes. We concluded that Nd:YAG laser posterior capsulotomies in children are similar to adults in general aspects and that Nd:YAG laser capsulotomy can be performed safely and effectively in children under topical or no anesthesia.

Reconstruction of lower eyelid defects using a cross upper eyelid flap composited with ear cartilage.

BACKGROUND: Basal cell carcinomas (BCC) most frequently involve the lower eyelid and are treated with total excision. Various techniques have been proposed for reconstruction of the excised eyelid. OBJECTIVE: Because most flaps used in such techniques are bulky, thinner, and aesthetically more favorable, flaps have been sought recently. METHODS: Defects of the lower lid have been closed with a combination of cross-flaps and choncal cartilage prepared from the upper eyelid. RESULTS: Eleven lower lids from 10 patients operated for BCC were reconstructed. All flaps survived. The duration of follow-up was 10 months, and no complications such as relapse, ectropion, or lagophthalmus occurred. CONCLUSIONS: The upper eyelid flap was found to be an appropriate cover for both the skin and the conjunctiva due to its hairless and smooth structure. The outcome in patients followed up for a mean of 10 months was successful, cosmetically and functionally.