Effect of Myopic Femtosecond Laser-Assisted LASIK on Anterior Chamber Inflammation (Flare Values) and Corneal Endothelium: A Prospective before and after Study.

PURPOSE: This study aimed to investigate whether femtosecond laser-assisted LASIK (FS-LASIK) surgery causes inflammation in the anterior chamber and to analyze its effect on endothelial cells. METHODS: This prospective, longitudinal study included left eyes of 30 patients (19 females) who had undergone FS-LASIK surgery due to myopia and myopic astigmatism. Endothelial cell density (ECD) and morphological measurements were performed using a specular microscopy, and laser flare photometry was used to measure the anterior chamber flare values on the day of surgery. iFS™ Advanced FS and VISX STAR S4-IR Wavescan Excimer Laser platforms were used. Flare measurements were repeated on the postoperative 1st day and 7th day and the 1st and 3rd months. The endothelial measurements were repeated in the 3rd month. RESULTS: Preoperatively, the mean flare was 5.59 ± 1.24 photons/ms; it was 6.49 ± 2.42 on the postoperative 1st day, 5.87 ± 2.27 on the 7th day, 5.68 ± 1.66 on the 1st month, and 5.35 ± 1.24 on the 3rd month. A significant difference was observed only between the preoperative and postoperative 1st day flare values (p=0.047). The decrease in the ECD was clinically insignificant but statistically significant, with an average of 97.0 ± 209.9 cell count/mm2 (3.3%, p=0.017). However, there was no significant change in the coefficient of variation (p=0.448) and hexagonality (p=0.096). No significant correlation was found between the increase in the flare value on the postoperative 1st day and variables. A significant correlation was found between the decrease in ECD and the preoperative ECD (r = 0.356, p=0.027). CONCLUSION: FS-LASIK caused minimal inflammation in the anterior chamber on only the 1st postoperative day; additionally, a minimal decrease of cell count with no morphological changes were noted in the endothelial cells on postoperative 3rd month. This trial is registered with NCT04899258.

Evaluation of cystoid macular edema using optical coherence tomography and fundus autofluorescence after uncomplicated phacoemulsification surgery.

Aim. To investigate the utility of fundus autofluorescence (FAF) and optical coherence tomography (OCT) in the evaluation of cystoid macular edema (CME) following cataract surgery. Materials and Methods. Forty eyes of 29 patients undergone phacoemulsification, with posterior chamber intraocular lens implantation surgery. Central macular thickness (CMT) of the patients was evaluated using OCT and FAF preoperatively and postoperative 1st, 30th, 60th, 90th, and 180th days. Results. CME was detected in three eyes (7.5%) of two patients using OCT. Hyperautofluorescence (HAF) was detected in two of these three eyes and resolved with treatment. In the remaining 37 eyes without CME, there was a significant increase in visual acuity when compared to preoperative values (P = 0.008) Mean macular thicknesses (MMT) of the eyes without CME were 174 ± 20 µ m preoperatively and 179 ± 22 µ m at day 1, 178 ± 19 µ m at 1st month, and 168 ± 10 µ m at 6th month postoperatively. In the eyes with CME, the MMTs, measured with OCT were 189 ± 23 µ m preoperatively and 432 ± 361 on day 1, 343 ± 123 µ m at 1st month, 345 ± 196 at 2nd month, and 200 ± 36 µ m at 6th month postoperatively. Conclusion. We found a moderate increase in CMT in the first 3 months postoperatively, in the eyes without CME which did not cause visual disturbances. FAF is a noninvasive, rapid method for the evaluation and follow-up of CME following cataract surgery.

Lens opacities in Bloom syndrome: case report and review of the literature.

Bloom syndrome is an autosomal recessive disorder characterized by proportionate short stature, photosensitivity, immunodeficiency, hypogonadism and a tendency to develop various malignancies. The greatly increased frequency of sister chromatid exchanges (reciprocal exchange of homologous segments between the two sister chromatids of a chromosome) is regarded as pathognomonic for BS. We describe an 18-year old girl who presented with short stature. She was diagnosed with BS based on an extremely increased frequency of sister chromatid exchanges. Ophthalmological examination revealed mild lens opacities bilaterally, which, to our knowledge, has not been previously reported to be associated with BS.

Effect of apraclonidine versus dorzolamide on intraocular pressure after phacoemulsification.

BACKGROUND AND OBJECTIVE: To investigate the efficacy of 1% apraclonidine hydrochloride and 2% dorzolamide hydrochloride in controlling postoperative intraocular pressure elevation in patients undergoing phacoemulsification. PATIENTS AND METHODS: A prospective, randomized, double-blind, placebo-controlled study was conducted. Seventy-five patients were randomized to receive either 1% apraclonidine hydrochloride, 2% dorzolamide hydrochloride, or artificial tears immediately after uncomplicated phacoemulsification. Intraocular pressure was measured by Goldmann applanation tonometer 1 to 3 hours preoperatively and 24 hours and 5 days postoperatively. RESULTS: Mean intraocular pressure measured at 24 hours and 5 days after surgery was not significantly different between groups. None of the patients had an elevated intraocular pressure of 30 mm Hg or higher. No marked difference was observed in patient age, preoperative intraocular pressure, mean ultrasound time, degree of nuclear hardness, and amount of postoperative intraocular inflammation between groups. CONCLUSION: Uneventful phacoemulsification involving meticulous cortical and viscoelastic removal does not cause a significant increase in intraocular pressure 24 hours following surgery.

Cataract extraction and primary hydrophobic acrylic intraocular lens implantation in infants.

PURPOSE: We sought to report the incidence of visual axis opacification and to evaluate the complication and reoperation rates after intraocular lens implantation in infants. METHODS: Twenty-one infants (31 eyes) who had cataract extraction with primary hydrophobic acrylic IOL implantation between October 1996 and May 2002 were reviewed. Posterior capsule was left intact in 14 eyes (group A); posterior capsulorrhexis or capsulotomy with anterior vitrectomy was performed in 17 eyes (group B). Complication and reoperation rates were compared with an age-matched control group of 17 patients (33 eyes) who were left aphakic after pars plicata lensectomy. Mean follow-up period was 41 months (range, 22-75 months) in group A, 37 months (range, 10-75 months) in group B, and 52 months (range, 7-97 months) in the control group. RESULTS: Mean age of the patients was 6.8 months (range, 3-10 months) in group A, 8.9 months (range, 3-18 months) in group B, and 4.9 months (range, 1-15 months) in the control group. Visual axis opacification was significantly higher in group A (86%) when compared with group B (17.6%; P < 0.0001). No significant difference was found in terms of pupillary irregularities and peripheral anterior synechiae formation between pseudophakic and aphakic group ( P = 0.43 and P = 0.306, respectively), whereas pigment dispersion and fibrinous reaction were significantly more common in the pseudophakic group ( P = 0.002). Serious complications, such as retinal detachment, pseudophakic bullous keratopathy, and secondary glaucoma, did not develop in any eye. Reoperation rate was significantly higher in group A (78%) when compared with group B (17%) and the control group (12%; P = 0.0011 and P < 0.0001, respectively). CONCLUSIONS: Visual axis opacification requiring a reoperation was significantly more common in patients with an intact posterior capsule. To decrease the reoperation rate and maintain a clear visual axis, posterior capsulorrhexis with anterior vitrectomy should be performed. Even although early complications were quite frequent, serious late complications were not encountered in any eye. Therefore, under appropriate conditions, IOL implantation is a suitable alternative in infants.

Visual results and complications of posterior chamber intraocular lens implantation after capsular tear during phacoemulsification.

BACKGROUND AND OBJECTIVE: To determine the visual outcome and complications of posterior chamber intraocular lens implantation after capsular tear in patients undergoing phacoemulsification at Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey. PATIENTS AND METHODS: The medical records of patients who underwent phacoemulsification surgery for senile cataract from January 1, 1996, to December 31, 1998, were reviewed. Patient inclusion criteria were implantation of a posterior chamber intraocular lens after phacoemulsification, being operated on by one of two surgeons, and a follow-up of at least 1 year. There were 58 eyes in the group with capsular tear and 159 eyes in the group with intact capsule. RESULTS: A final visual acuity of 0.8 or more was more common in eyes with uncomplicated phacoemulsification surgery (chi-square = 16.25, P = .03). Refraction stabilized most commonly at 2 to 6 months postoperatively in patients with capsular tear and 1 to 21 days postoperatively in patients with uncomplicated phacoemulsification (chi-square = 22.61, P < .001). Complications such as retinal detachment (odds ratio = 11.70, P < .05), cystoid macular edema (odds ratio = 26.33, P < .01), increased intraocular pressure (odds ratio = 14.54, P < .05), and decentration of the intraocular lens (odds ratio = 32.79, P = .001) were more frequently observed in eyes with capsular tear. CONCLUSIONS: It takes longer for the refraction to stabilize in eyes with posterior chamber intraocular lens implantation after capsular tear during phacoemulsification. Complications such as retinal detachment, cystoid macular edema, increased intraocular pressure, and decentration of the intraocular lens are more common in these patients, and therefore they should be observed for a longer period of time.

Holmium laser thermal keratoplasty for hyperopia in eyes overcorrected with laser in situ keratomileusis for myopia.

PURPOSE: To assess the efficacy and safety of holmium laser thermal keratoplasty (Ho:LTK) for hyperopia in eyes overcorrected after laser in situ keratomileusis (LASIK) for myopia. METHODS: We performed a prospective evaluation of Ho:LTK in eyes with secondary hyperopia from +1.00 to +5.50 D after LASIK. Thirty-seven eyes of 23 patients received one concentric 8-spot application at the 6-mm-diameter zone. Mean patient age was 41.3 +/- 13.0 years (range 20 to 68 yr). Mean corneal thickness was 455.86 +/- 31.20 microm (range 373 to 506 microm). RESULTS: Mean spherical equivalent refraction changed from +2.30 +/- 1.08 D to +0.45 +/- 1.00 D at 12 months after Ho:LTK. Thirty-one eyes (84%) were within +/- 1.00 D of emmetropia and 25 eyes (68%) were within +/- 0.50 D at 1 year. Mean change in refraction was 1.84 +/- 0.92 D. No eye lost 2 lines of best spectacle-corrected visual acuity. CONCLUSIONS: Ho:LTK is a suitable alternative for correcting secondary hyperopia resulting from LASIK for myopia. Parameter adjustments may be necessary for improving the results.

Factors influencing the outcome of strabismus surgery in patients with exotropia.

PURPOSE: To determine the factors associated with favorable and less favorable outcomes in strabismus surgery for treatment of exotropia and to show the factors influencing the efficacy of the surgical procedure. METHODS: Case files of 225 patients with a diagnosis of primary exotropia were evaluated. Information about patient age at onset of deviation, patient age at surgery, interval between onset and surgery, preoperative deviation, refractive errors, degree of anisometropia, visual acuity, presence of amblyopia, presence of an A- or a V-pattern, amount of surgery performed, type of exotropia (intermittent or constant), and existence of binocular single vision before surgery were obtained and evaluated using multiple regression analysis. RESULTS: Preoperative deviation and refractive errors were proved to be significant factors influencing a favorable outcome in patients with surgically treated exotropia (r(2) = 0.12, P <.001, and r(2) = 0.07, P <.001 respectively). Preoperative deviation, amount of surgery performed, and refractive errors shifting toward myopia significantly influenced the efficacy of the surgery performed (r(2) = 0.31, 0.06, and 0.025, respectively). CONCLUSION: Special care should be paid to refractive errors in patients with exotropia before determining the amount of surgical intervention.

Effect of 30-day continuous wear of silicone hydrogel contact lenses on corneal thickness.

PURPOSE: To investigate the effect of 30-day continuous-wear contact lenses (Focus Night & Day) on corneal thickness and physiology. METHODS: Twenty-six myopic eyes with no history of contact lens wear were fitted with silicone hydrogel contact lenses. Complete ophthalmologic examinations, corneal topography, and corneal thickness measurements at the center and eight peripheral areas were performed before fitting and at each visit, namely on day 1, day 10, and 1 month. Mean corneal thicknesses were statistically compared by using one-way repeated-measures analysis of variance. RESULTS: All patients maintained their 20/20 vision with correction. Limbal vascularization was noted in one patient at the end of the study. No patient had subjective complaints. In another patient, a punctate corneal epithelial defect was noted on the 15th day, but it healed when the contact lens was removed for a day. The mean corneal thicknesses in different regions were significantly increased by approximately 14 to 38 microm compared with baseline measurements. There were no significant differences between the corneal topography taken on the first day and the one taken at the end of the first month. CONCLUSIONS: All patients maintained their visual acuity. Apart from the limbal vascularization and punctate epithelial corneal defects, which resolved when the contact lens was removed for 1 day, no serious complications were noted. Despite the high oxygen permeability of the monthly Night & Day contact lenses, the mean central and peripheral corneal thicknesses increased. These increases indicate that these lenses may have an effect on corneal metabolism.

Internal ophthalmomyiasis presenting as endophthalmitis associated with an intraocular foreign body.

Ophthalmomyiasis interna infestation by fly larva can present in various forms. A 3-year-old girl with a 15-day history of pain, redness, and tearing of the right eye was referred to our clinic with the diagnosis of endophthalmitis associated with an intraocular foreign body, based on clinical and ultrasonographic findings. The patient underwent pars plana vitrectomy, during which an 8-mm long larva was encountered within the vitreous cavity. It was removed and identified as a cattle botfly. The patient developed a retinal detachment 1 month postoperatively, but the family refused further treatment and the patient was lost to follow-up. Ophthalmomyiasis should be included in the differential diagnosis of endophthalmitis and intraocular foreign bodies in patients from rural areas.

Pseudo-accommodation with intraocular lenses implanted in the bag.

PURPOSE: To evaluate the accommodation potential in eyes after intraocular lens in-the-bag implantation. METHODS: Fifty-one consecutive patients were included in the study. Group 1 included 26 eyes that had phacoemulsification with continuous curvilinear capsulorhexis and in-the-bag implanted foldable IOL. Twenty-five eyes in Group 2 had capsulotomy with extracapsular cataract extraction and were implanted with polymethylmethacrylate IOL. Time elapsed from surgery was at least 6 months. There was no significant difference for age or gender between groups (P > .05). We measured accommodation amplitude and depth of the anterior chamber at distance and near fixation with an ultrasonic biometry device. The results were compared using the unpaired Student t-test. RESULTS: The anterior chamber depths while fixating at a distant object were not significantly different between groups (P>.05), however, at near the difference was statistically significant (P=.008). The change in depths between far and near fixation was significantly different (P=.002) and was more pronounced in the the capsulorhexis group (P < .001). The accommodation amplitudes in this group were significantly greater than in the capsulotomy group (P = .025). CONCLUSION: Patients who had uncomplicated small incision phacoemulsification surgery with continuous curvilinear capsulorhexis and in-the-bag implanted lens seemed to preserve some pseudo-accommodation after surgery.