Outcomes of Descemet's membrane keratoplasty in graft failure after penetrating keratoplasty.

PURPOSE: To analyze the outcomes and identify the risk factors of failure in Descemet's membrane endothelial keratoplasty (DMEK) for graft failure after penetrating keratoplasty (PKP). METHODS: Medical records and surgical videos of patients who underwent DMEK for graft failure after PKP were reviewed in this retrospective study. Demographic data, the indication for PKP, number of previous PKPs, duration between the last PKP and graft failure, graft diameter at the last PKP, best-corrected visual acuity (logMAR) before and after DMEK, preoperative additional ocular diseases, and intraoperative and postoperative complications were recorded. Descemet's membrane (DM) attachment was examined on the first day and the first month, postoperatively, and at the last follow-up visit. The patients were divided into two groups according to DM attachment at the last visit (group 1, patients with attached DM; group 2, patients with DM detachment). RESULTS: Twenty eyes of 20 patients were included in this study. At the last follow-up visit, DM was attached in 13 (65%) patients (Group 1) and detached in 7 (35%) cases (Group 2). The BCVA was improved significantly after DMEK in all patients (2.10 ± 0.4, preoperatively; 1.09 ± 0.8, postoperatively; p = 0.005). There were no significant differences between groups, in terms of age, the number and indication for PKP, the time between the last PKP and DMEK, or history of glaucoma. PKP was performed in all patients in group 2. CONCLUSION: DMEK is a feasible option with fast visual recovery and a low risk of complications in patients with graft failure after PKP. We found no risk factors for the DM graft detachment, so larger studies are needed to analyze intraoperative or donor-related factors as well.

Clinical results of combined penetrating keratoplasty and vitreoretinal surgery / Resultados clínicos da combinação de ceratoplastia penetrante e cirurgia vitreorretiniana

ABSTRACT Purpose: The study aimed to assess the anatomical and functional success rates of penetrating keratoplasty with temporary keratoprosthesis-assisted vitreoretinal surgery. Methods: This retrospective study included 15 eyes of 14 patients, recording demographic characteristics, pre-operative anterior and posterior segment pathologies, intraoperative complications, postoperative graft status, retinal attachment, and complications and evaluating anatomical and functional success rates. Results: The mean follow-up period was 29.8 ± 19.1(6-60) months. The most common pre-operative corneal pathology was graft abscess (7 eyes [46.7%]), and the most common diagnosis of the posterior segment was endophthalmitis (7 eyes [46.7%]). Five (33.3%) cases had visual acuity between 0.001-0.08. Pre-operative endophthalmitis was diagnosed in all five cases with anatomical failure.Conclusion: Temporary keratoprosthesis-assisted vitreoretinal surgery with penetrating keratoplasty is an effective method to treat acute/subacute pathologies of the concomitant anterior and posterior segment. However, results may vary on a case-by-case basis. Pre-operative endophthalmitis is a poor prognostic factor for long-term success.

RESUMO Objetivo: Avaliar as taxas de sucesso anatômico e funcional da ceratoplastia penetrante associada à cirurgia vitreorretiniana assistida por ceratoprótese temporária. Métodos: Foram incluídos neste estudo retrospectivo 15 olhos de 14 pacientes. Registraram-se as características demográficas, as patologias pré-operatórias dos segmentos anteriores e posteriores, as complicações perioperatórias, a condição pós-operatória do implante e a fixação e as complicações da retina. Foram avaliadas as taxas de sucesso anatômico e funcional. Resultados: O período médio de acompanhamento foi de 29,8 ± 19,1(6-60) meses. A patologia corneana pós-operatória mais comum foi o abscesso do implante (7 olhos, 46,7%) e o diagnóstico mais comum no segmento posterior foi a endoftalmite (7 olhos, 46,7%). Cinco casos (33,3%) mostraram acuidade visual entre 0,001 e 0,08. Foi diagnosticada endoftalmite pré-operatória em todos os 5 casos com insucesso anatômico. Conclusão: A cirurgia vitreorretiniana assistida por ceratoprótese temporária associada à ceratoplastia penetrante é um método eficaz de tratamento de patologias agudas e subagudas concomitantes nos segmentos anterior e posterior. Porém, os resultados podem variar de caso a caso. A endoftalmite pré-operatória é um fator de pior prognóstico de sucesso de longo prazo.

Effects of Systemic Diseases on Graft Preparation in Descemet Membrane Endothelial Keratoplasty.

OBJECTIVES: To evaluate the effects of the systemic diseases and drugs of the donor on Descemet membrane (DM) graft preparation. METHODS: Seventy-eight corneas of 58 donors, of whom the DM grafts were used in Descemet membrane endothelial keratoplasty (DMEK) surgery, between January 2018 and January 2020, were enrolled in this retrospective study. The hospital records of the donors were analyzed. Age, sex, blood type, systemic diseases, and drugs; complete blood count; biochemistry panel for liver and kidney functions in the past 48 hours; and the drugs used in the hospital, if any, in the past 24 hours were recorded. The grafts with tears that occurred while preparation were included in group 1, and the successful grafts with no tears were included in group 2. RESULTS: There were no statistically significant differences in the characteristics of the donors between groups. However, breast cancer and the use of sevelamer were found to be significantly higher in group 1 ( P =0.010, P =0.033, respectively). No statistically significant difference in the use of other drugs was found between groups. CONCLUSION: Although diabetic donors have been reported to be inappropriate candidates for the preparation of DM grafts for DMEK, most of the donors with several systemic diseases including diabetes can be used in DMEK surgery, with the right technique in DM graft preparation.

Clinical results of combined penetrating keratoplasty and vitreoretinal surgery.

PURPOSE: The study aimed to assess the anatomical and functional success rates of penetrating keratoplasty with temporary keratoprosthesis-assisted vitreoretinal surgery. METHODS: This retrospective study included 15 eyes of 14 patients, recording demographic characteristics, pre-operative anterior and posterior segment pathologies, intraoperative complications, postoperative graft status, retinal attachment, and complications and evaluating anatomical and functional success rates. RESULTS: The mean follow-up period was 29.8 ± 19.1(6-60) months. The most common pre-operative corneal pathology was graft abscess (7 eyes [46.7%]), and the most common diagnosis of the posterior segment was endophthalmitis (7 eyes [46.7%]). Five (33.3%) cases had visual acuity between 0.001-0.08. Pre-operative endophthalmitis was diagnosed in all five cases with anatomical failure.Conclusion: Temporary keratoprosthesis-assisted vitreoretinal surgery with penetrating keratoplasty is an effective method to treat acute/subacute pathologies of the concomitant anterior and posterior segment. However, results may vary on a case-by-case basis. Pre-operative endophthalmitis is a poor prognostic factor for long-term success.

Use of viscoelastic substance for preventing Descemet's membrane rupture in deep anterior lamellar keratoplasty / Uso de substância viscoelástica na prevenção da ruptura da membrana de Descemet na ceratoplastia lamelar anterior profunda

ABSTRACT Purpose: This study aimed to investigate the effect of using a viscoelastic substance in Descemet's membrane rupture in "double bubble" deep anterior lamellar keratoplasty. Methods: The medical records and videos of surgeries of 40 patients who underwent surgery between January 2014 and July 2015 were retrospectively evaluated. The patients were divided into two groups: 20 patients whose perforation of the posterior stromal wall was performed without administration of any viscoelastic substance (group 1) and 20 patients whose perforation of the posterior stromal wall was performed with administration of viscoelastic substance onto the posterior stroma (group 2). The Descemet's membrane perforation rate was compared between groups. Results: Perforation of the Descemet's membrane was observed in 12 (60.0%) patients in group 1 and only three (15.0%) patients in group 2. This difference was statistically significant (p=0.003). Only one (5%) patient in group 2 had macroperforation during the procedure, and the surgery was converted to penetrating keratoplasty. Eleven (55.0%) patients in group 1 had macroperforation of Descemet's membrane, and surgeries were converted to penetrating keratoplasty. This difference between the groups was statistically significant (p=0.001). Conclusions: Administering a viscoelastic substance onto the posterior stromal side just before puncture is an effective method to decrease the risk of Descemet's membrane perforation in deep anterior lamellar keratoplasty.(AU)

RESUMO Objetivo: Investigar o efeito do uso de uma substância viscoelástica na ruptura da membrana de Descemet em casos de ceratoplastia lamelar anterior profunda em "bolha dupla". Métodos: Foram avaliados retrospectivamente prontuários e vídeos de cirurgias de 40 pacientes operados entre janeiro de 2014 e julho de 2015. Os pacientes foram divididos em dois grupos: 20 pacientes nos quais a parede posterior do estroma foi puncionada sem a colocação de nenhuma substância viscoelástica (grupo 1) e 20 pacientes nos quais uma substância viscoelástica foi aplicada sobre o estroma posterior ao ser puncionada a parede posterior do estroma (grupo 2). A taxa de perfuração da membrana de Descemet foi comparada entre os grupos. Resultados: Observou-se perfuração da membrana de Descemet em 12 casos (60,0%) no grupo 1 e em apenas 3 casos (15,0%) no grupo 2. Essa diferença foi estatisticamente significativa (p=0,003). Apenas um caso (5%) no grupo 2 teve macroperfuração durante o procedimento, sendo a cirurgia então convertida em uma ceratoplastia penetrante. Onze casos (55,0%) no grupo 1 tiveram macroperfuração da membrana de Descemet e essas cirurgias foram convertidas em ceratoplastias penetrantes. Essa diferença entre os grupos foi estatisticamente significativa (p=0,001). Conclusões: A aplicação de substância viscoelástica sobre o lado posterior do estroma logo antes da punção é um método eficaz para diminuir o risco de perfuração da membrana de Descemet na ceratoplastia lamelar anterior profunda.(AU)

Effective Cannula Vacuuming Maneuver to Unfold the Descemet Membrane Graft.

OBJECTIVES: To present the cannula vacuuming maneuver (CVM) in the Descemet membrane endothelial keratoplasty (DMEK) and to investigate the efficacy of CVM in reducing the unfolding time (UT) of the graft in cases with an unstable anterior chamber (AC). SUBJECTS/METHODS: Forty-four eyes of 44 patients, who underwent DMEK at the ophthalmology clinic of a training and research hospital, were included in this retrospective study. Surgical videos and patient charts were examined retrospectively. In 21 cases, only no-touch technique maneuvers were used (group 1), and in 23 cases, CVM was used in addition to the no-touch technique (group 2). Demographic data, the status of AC, graft diameter, width, and formation of graft rolls and UT were recorded and compared between the groups. The causes of increased UT and the reason for using CVM were investigated in group 2. RESULTS: Although an unstable AC was observed more frequently in group 2, the difference between the groups was not statistically significant (P=0.054). Unfolding time of rolls in group 2 was significantly shorter than group 1 (P=0.040). CONCLUSION: Cannula vacuuming maneuver shortens the UT of the graft roll in the AC and facilitates the graft unfolding maneuvers in complicated cases.

Use of viscoelastic substance for preventing Descemet's membrane rupture in deep anterior lamellar keratoplasty.

PURPOSE: This study aimed to investigate the effect of using a viscoelastic substance in Descemet's membrane rupture in "double bubble" deep anterior lamellar keratoplasty. METHODS: The medical records and videos of surgeries of 40 patients who underwent surgery between January 2014 and July 2015 were retrospectively evaluated. The patients were divided into two groups: 20 patients whose perforation of the posterior stromal wall was performed without administration of any viscoelastic substance (group 1) and 20 patients whose perforation of the posterior stromal wall was performed with administration of viscoelastic substance onto the posterior stroma (group 2). The Descemet's membrane perforation rate was compared between groups. RESULTS: Perforation of the Descemet's membrane was observed in 12 (60.0%) patients in group 1 and only three (15.0%) patients in group 2. This difference was statistically significant (p=0.003). Only one (5%) patient in group 2 had macroperforation during the procedure, and the surgery was converted to penetrating keratoplasty. Eleven (55.0%) patients in group 1 had macroperforation of Descemet's membrane, and surgeries were converted to penetrating keratoplasty. This difference between the groups was statistically significant (p=0.001). CONCLUSIONS: Administering a viscoelastic substance onto the posterior stromal side just before puncture is an effective method to decrease the risk of Descemet's membrane perforation in deep anterior lamellar keratoplasty.

Penetrating Keratoplasty With Sutureless Intrasclerally Fixated Intraocular Lens.

OBJECTIVES: In this retrospective study, we reviewed the use of penetrating keratoplasty with sutureless intrasclerally fixated intraocular lens implantation in a closed anterior chamber in patients with several corneal pathologies and aphakia. MATERIALS AND METHODS: The medical records of 6 patients, who underwent the procedure, were reviewed. In the procedure, lamellar scleral tunnels at the 2- and 8-o'clock positions were created with a microvitreoretinal blade, 1.5 mm away from the limbus. Two 27-gauge bent needles were passed, first horizontally, through these tunnels, and then vertically, which allowed them to enter the posterior chamber and to be left in position. Partial thickness trephination was made, and anterior stroma was removed where necessary. An incision was made at the 11-o'clock position, where the trephination was made, which was then extended to both sides for about 6 mm with corneal scissors. From the superior incision, the anterior haptic of a 3-piece intraocular lens was pushed through the needle at the 2-o'clock position, then the posterior haptic was pushed through the needle at the 8-o'clock position, and both haptics were removed through the sclera. Both ends were cauterized and placed into the sclera. Residual stroma was removed, and the donor graft was sutured. RESULTS: At the last follow-up visit, the mean bestcorrected visual acuity was significantly increased. No serious complications were seen, with the exception of increased intraocular pressure in 3 patients. CONCLUSIONS: Penetrating keratoplasty with sutureless intrasclerally fixated intraocular lens implantation can be used safely in patients with aphakia. With this technique, the globe stabilization can be maintained, and the trauma to the donor graft endothelium can be minimized.

Long-term outcomes of therapeutic penetrating keratoplasty for microbial keratitis in a tertiary care center in Turkey.

PURPOSE: To present the long-term results of therapeutic keratoplasty for microbial keratitis in moderate to advanced phases. METHODS: The medical records of 44 patients who underwent therapeutic keratoplasty for microbial keratitis at the ophthalmology clinic of a training and research hospital between June 2012 and March 2018 were reviewed in this retrospective study. RESULTS: Of the 65 patients that underwent TPKP, 44 eyes of 44 patients met the inclusion criteria and enrolled in this study. The most commonly found predisposing factor for keratitis was a history of trauma (n = 17, 38.6%), and most of them had occurred with a vegetative matter (n = 14, 31.8%). The most common clinically suspected cause was fungal (n = 17, 38.6%) followed by bacterial (n = 12, 27.3%). In 26 (59.1%) cases, the causative microorganism could not be proved with a microbial culture. The most common causative microorganism was Staphylococcus spp. (n = 4, 9.1%), followed by Fusarium solanii (n = 3, 6.8%). The mean follow-up time was 42 (range 12-54) months. At the last follow-up visit, anatomical success was achieved in 40 (90.9%) cases and the BCVA of more than half of the patients was over 1.0 (logMAR, n = 24, 54.5%). Most commonly seen complication was found to be secondary glaucoma (n = 19, 43.2%), followed by cataracts (n = 9, 34.6%) and graft rejection (n = 12, 27.3%). CONCLUSIONS: TPKP offers a definitive solution in the management of microbial keratitis with high rates of anatomical and functional success. However, secondary glaucoma is the most common complication after TPKP, which was seen in almost half of the patients.

Evaluation of Foveal Avascular Zone and Capillary Plexus in Smokers Using Optical Coherence Tomography Angiography.

PURPOSE: To evaluate the macular microvasculature in smokers in comparison to healthy subjects using optical coherence tomography angiography (OCTA). METHODS: Fifty chronic, regular smokers and 50 healthy non-smokers, as a control group, were recruited for the study. Foveal avascular zone (FAZ) area (mm2) and vessel density (VD) (%) in the superficial (SCP) and deep capillary plexus (DCP) were evaluated. RESULTS: FAZ area was 0.424 ± 0.100 mm2 in the smoker group and 0.333 ± 0.093 mm2 in the non-smoking control group (P = 0.002). The deep foveal VD was 31.76 ± 6.33% in the smoker group and 53.09 ± 5.88% in the non-smoking control group (P = 0.006). Superficial foveal and parafoveal, deep parafoveal VD were not statistically different between the groups (P = 0.120), (P = 0.337), (P = 0.287), respectively. CONCLUSION: In our study, there was an enlargement of FAZ and reduction of foveal VD at DCP in the eyes of smokers compared with non-smoking adults.

Descemet membrane endothelial keratoplasty and intraocular lens implantation in cases of aphakic bullous keratopathy.

Purpose: To present the results of a modified sutured transcleral or sutureless intrascleral three-piece foldable intraocular lens (IOL) implantation with Descemet membrane endothelial keratoplasty (DMEK) in cases of aphakic bullous keratopathy (ABK) with inadequate capsular support.Methods: Twenty-one eyes of 21 patients with ABK and inadequate capsular support who underwent DMEK with three-piece foldable IOL implantation from September 2015 to June 2018 were analyzed, retrospectively. Two techniques were used in IOL implantation; sutureless intrascleral fixation of the IOL (ISF-IOL) and sutured transscleral-fixated IOL (TSF-IOL) implantation.Results: Rebubblings due to the graft detachment were needed in 9 (43%) of 21 eyes in the early postoperative period. At the last follow-up visit, 18 (85.7%) of DM grafts were attached. Any complication related to IOL implantation was not observed in the ISF-IOL cases. Exposure of the fixation suture in 1 (25%) of 4 TSF-IOL cases was seen, postoperatively. The increase in the mean best-corrected visual acuity (BCVA) at the last follow-up visit was statistically significant when compared to the mean preoperative BCVA (p < .001). The mean preoperative central corneal thickness was decreased from 883.3 ± 111.8 (700-1150) µm to 582.3 ± 118.2 (490-990) µm at the last follow-up visit (p < .001).Conclusion: DMEK combined with sutureless/sutured three-piece foldable IOL implantation appears to be a feasible method for the management in ABK without adequate capsular support. A faster visual recovery can be obtained with the techniques presented.

Evaluation of Foveal Avascular Zone and Capillary Plexuses in Diabetic Patients by Optical Coherence Tomography Angiography.

PURPOSE: To investigate the foveal avascular zone (AVZ), superficial and deep foveal and parafoveal vessel density (VD) changes related to diabetic retinopathy. METHODS: Forty-nine type 2 diabetes mellitus (DM) and 45 healthy control subjects were included in this study. The demographic data (age and sex), disease duration, and level of glycated hemoglobin were collected. Superficial VD (%), superficial AVZ area (mm²), deep VD (%) and deep AVZ area (mm²) were evaluated via optic coherence tomography angiography. RESULTS: Superficial AVZ was 0.438 ± 0.05 mm² in the DM group, 0.246 ± 0.022 mm² in the control group (p < 0.001). Deep AVZ was 0.732 ± 0.06 mm² in the DM group, and 0.342 ± 0.022 mm² in the control group (p < 0.001). Superficial foveal VD was 29.45 ± 0.76 mm² in the DM group, and 34.86 ± 0.75 mm² in the control group (p < 0.001). Deep foveal VD was 24.85 ± 1.08 mm² in the DM group, and 33.47 ± 0.56 mm² in the control group (p < 0.001). CONCLUSIONS: In this study, we demonstrated an enlargement in the foveal AVZ along with a reduction in the vascular density of the superficial and deep capillary network in the foveal and parafoveal area using optic coherence tomography angiography in patients with nonproliferative diabetic retinopathy. This technique can be used to monitor the progression of the disease and to evaluate the response to treatment.

Interface fluid syndrome secondary to endothelial failure due to toxic anterior segment syndrome after cataract surgery.

PURPOSE: To present a case of previous laser in situ keratomileusis with interface fluid syndrome secondary to toxic anterior segment syndrome following cataract surgery. CASE REPORT: A 52-year-old woman, complaining blurred vision in her right eye for 18 months after cataract surgery, was referred to our clinic. She was diagnosed with toxic anterior segment syndrome, postoperatively, which resolved in 3 days. She had a history of laser in situ keratomileusis surgery 15 years ago. Slit-lamp examination of the right eye showed corneal haze, limited to laser in situ keratomileusis flap. The patient was diagnosed with interface fluid syndrome secondary to endothelial decompensation due to toxic anterior segment syndrome. Descemet's membrane endothelial keratoplasy was performed along with full thickness fenestrations in the laser in situ keratomileusis flap to the right eye of the patient. The fluid was resolved in 1 week and visual acuity was improved rapidly. CONCLUSION: This case shows the importance of considering the diagnosis and determining the specific etiology of interface fluid syndrome, even years after the laser in situ keratomileusis surgery, when endothelial cell function has been compromised with any factor, such as intraocular surgery and its complications.

Comparison of clinical outcomes of intravitreal ranibizumab and aflibercept treatment for retinopathy of prematurity.

PURPOSE: To compare the results of ranibizumab and aflibercept treatment in infants with treatment-requiring retinopathy of prematurity (ROP) in the posterior zone. METHODS: In this single-center, retrospective study, the records of the infants, who were treated between January 2015 and June 2017 in a tertiary center for screening and treatment of ROP, were reviewed. Infants who were administered ranibizumab or aflibercept as initial treatment and completed at least 1 year of corrected age were included. The patients were evaluated in terms of regression, progression or recurrence of the disease, vascularization of the peripheral retina, and ocular complication profile in early or late period. RESULTS: Fifty-four eyes of 27 infants who received ranibizumab treatment (ranibizumab group) and 72 eyes of 36 infants who received aflibercept treatment (aflibercept group) were enrolled. The rate of recurrence was 48.1% in ranibizumab group and 13.9% in aflibercept group. The mean recurrence times were at 8.2 ± 0.92 weeks following the injection of ranibizumab and at 14.2 ± 1.03 weeks following the injection of aflibercept. There were significant statistical differences between the groups in the rate of ROP recurrence, the time of recurrence, and the time of vascularization of peripheral retina (p = 0.001, p < 0.001, p < 0.001, respectively). CONCLUSION: Although both ranibizumab and aflibercept are effective therapies for the treatment of ROP, more frequent and much earlier recurrences can be seen with ranibizumab treatment. Further studies are needed to obtain ideal options for the treatment of ROP.

A practical and easy surgical technique for recovery of an incarcerated haptic.

PURPOSE: To present a surgical intervention for a posterior haptic trapped between the cartridge and plunger during intraocular lens (IOL) implantation. MATERIALS AND METHODS: Posterior haptic incarceration was detected in 36 cases during implantation of a one-piece foldable IOL during cataract surgery with phacoemulsification. In 11 of the patients (Group 1), recovery was achieved by forcibly pulling out the incarcerated posterior haptic. In 25 cases (Group 2), the haptic was recovered by using an MVR knife to cut the cartridge tip from the bottom up parallel to the trapped haptic. RESULTS: In Group 1, tears were seen on the incarcerated haptic in all cases (100%). In Group 2, the procedure was successful in all 25 cases and there was no accidental cutting of the haptic. In all cases, the surgeries were completed with the recovered IOL in Group 2. CONCLUSIONS: Posterior haptic incarceration in cataract surgery can be solved by the simple and easy method of cutting the cartridge tip from the bottom upwards and releasing the haptic.

Macular thickness and retinal nerve fiber thickness analysis in ocular dominance / Espessura macular e fibra nervosa da retina análise de espessura no domínio ocular

Abstract Objective: To compare macular and peripapillary retinal nerve fiber layer thicknesses of dominant eye and non-dominant eye using optical coherence tomography (OCT). Methods: 104 eyes of 52 healthy young adults were included. Ophthalmological examinations; including measuring refraction, best corrected visual acuity, intraocular pressure (IOP) measurement, slit-lamb biomicroscopy, dilated fundus examination, measuring of central macular thickness (CMT), and peripapillary retinal nerve fiber layer (PRNFL) thickness were performed on each subject. Hole-in-the-card test was used to detect the ocular dominance. Results: There were 25 females (48%) and 27 males (52%) in the study. Eight participants had left eye dominance (15%), forty-four participants had right eye dominance (85%). Mean CMT was 192.5µm in dominant group and 191.9 µm in non-dominant group. There was no statistically significant difference between dominant eye group and non-dominant eye group in either macular thickness or peripapillary retinal nerve fiber layer thickness. Conclusions: No difference between macular and peripapillary retinal nerve fiber layer thicknesses were detected in dominant and non-dominant groups. Further evaluation is needed.

Resumo Objetivo: Comparar as espessuras da camada de fibras nervosas da retina macular e peripapilar do olho dominante e não dominante usando a tomografia de coerência óptica (OCT). Métodos: 104 olhos de 52 adultos jovens saudáveis foram incluídos. Exames oftalmológicos; incluindo medidas de refração, melhor acuidade visual corrigida, medição da pressão intraocular (PIO), biomicroscopia de fenda-cordeiro, exame do fundo dilatado, medição da espessura macular central (CMT) e espessura da camada de fibras nervosas da retina peripapilar (PRNFL) foram realizadas em cada sujeito. O teste Hole-in-the-card foi usado para detectar a dominância ocular. Resultados: houve 25 mulheres (48%) e 27 homens (52%) no estudo. Oito participantes tinham deixado a dominância do olho (15%), quarenta e quatro participantes tinham dominância do olho direito (85%). A CMT média foi de 192,5 µm no grupo dominante e 191,9 µm no grupo não dominante. Não houve diferença estatisticamente significativa entre o grupo dominante de olho e o grupo de olho não dominante tanto na espessura macular quanto na espessura da camada de fibras nervosas da retina peripapilar. Conclusões: Não houve diferença entre as espessuras das camadas de fibras nervosas da retina macular e peripapilar nos grupos dominante e não dominante. Mais avaliações são necessárias.

Does Fluid Temperature Affect Corneal Endothelium-Descemet Membrane Scroll Formation? An In Vitro Study.

OBJECTIVES: To investigate whether unfolding time of Descemet membrane (DM) graft rolls changes at various fluid temperatures. MATERIALS AND METHODS: The study was prospective, ex vivo, and experimental. The study was conducted at the tertiary center for corneal disease in Adana Numune Training and Research Hospital between June 2014 and June 2015. DMs were divided into 4 categories according to baseline roll tightness and these were distributed among 4 different groups using 4 different balanced salt solution (BSS) temperatures (8, 16, 23, and 36 °C). Sixteen donor corneas were obtained from the hospital eye bank. RESULTS: DM roll formations may vary according to the donor cornea received. Some form tighter rolls while others can form a more open roll. No differences in roll tightness were observed in any of the DM rolls after 5 or 10 minutes in the different BBS temperatures. In all groups, neither tightening nor opening was observed in DM roll formations. CONCLUSION: Different BSS temperatures were found to have no effects on DM unfolding time in this study.

A new surgical technique for scleral fixation using a "knot ball" for scleral-fixated intraocular lenses: impact on clinical outcomes / Uma nova técnica cirúrgica para fixação escleral usando um "nó esférico" (knot ball) para lentes ntraoculares para fixação escleral: impacto nos resultados clínicos

ABSTRACT Purpose: Scleral fixation surgery is a pivotal procedure that depends on the availability of robust and innovative surgical fixation methods. There continues to be a need for innovation in suture fixation techniques, particularly for intraocular lens implantation. Methods: We conceived and designed a "knot ball" scleral fixation technique for suture burial in a retrospective sample of 108 patients with primary (n=40) or secondary (n=68) scleral-fixated intraocular lens. Importantly, our technique did not require additional scleral flap or tunnel procedures. We evaluated pre- and postoperative best-corrected visual aquity (BCVA) and postoperative complications. All data were analyzed and compared between groups. Results: The preoperative mean BCVA improved significantly in both groups using the "knot ball" fixation technique (p<0.01). The extent of the improvement in the best-corrected visual acuity and late complications one month post-surgery were not significantly different between the groups (p>0.05). These clinical outcomes were consistent with those described in the ophthalmology literature. Conclusion: A "knot ball" scleral fixation technique is reported; to the best of our knowledge, this is the first report of such a technique, which offers a less invasive and simplified surgical procedure for transscleral fixation of scleral-fixated intraocular lenses. Moreover, the technique appears to display similar effectiveness and safety compared with existing scleral fixation techniques. We suggest that the "knot ball" technique warrants further research focus and clinical evaluation in future studies.

RESUMO Objetivo: A cirurgia de fixação escleral é um procedimento fundamental que depende da disponibilidade de métodos robustos e inovadores de fixação cirúrgica. No entanto, existe uma necessidade de inovação nas técnicas de fixação de sutura, particularmente para a implantação de lentes intraoculares. Métodos: Concebemos e desenhamos uma técnica de fixação escleral utilizando um "nó esférico" para o encerramento da sutura em uma amostra retrospectiva de 108 pacientes com lente intraocular de fixação escleral (SF-IOL) primária (n=40) e secundária (n=68). Importante considerar que nossa técnica não exigiu procedimentos adicionais de aleta escleral ou de túnel. Observamos a melhor acuidade visual corrigida (MAVC) pré e pós-operatória e as complicações pós-operatórias. Todos os dados foram analisados entre os grupos. Resultados: A melhor acuidade visual corrigida média pré-operatória (logMAR) melhorou significativamente em ambos os grupos com a utilização da técnica de fixação do nó esférico (p<0,01). A extensão da melhora melhor acuidade visual corrigida e as complicações tardias, um mês após a cirurgia, não foram significativamente diferentes entre os grupos (p>0,05). Esses resultados clínicos foram, em geral, comparáveis aos publicados na literatura de oftalmologia. Conclusão: Até onde sabemos, a técnica de fixação escleral de "nó esférico" é relatada pela primeira vez na literatura e representa um procedimento cirúrgico promissor, menos invasivo e simplificado para a fixação transescleral de SF-IOLs. Além disso, a técnica parece exibir eficácia e segurança comparáveis às técnicas de fixação escleral existentes. Sugerimos que a técnica do nó esférico receba mais atenção e avaliações clínicas no futuro.

A new surgical technique for scleral fixation using a "knot ball" for scleral-fixated intraocular lenses: impact on clinical outcomes.

PURPOSE: Scleral fixation surgery is a pivotal procedure that depends on the availability of robust and innovative surgical fixation methods. There continues to be a need for innovation in suture fixation techniques, particularly for intraocular lens implantation. METHODS: We conceived and designed a "knot ball" scleral fixation technique for suture burial in a retrospective sample of 108 patients with primary (n=40) or secondary (n=68) scleral-fixated intraocular lens. Importantly, our technique did not require additional scleral flap or tunnel procedures. We evaluated pre- and postoperative best-corrected visual aquity (BCVA) and postoperative complications. All data were analyzed and compared between groups. RESULTS: The preoperative mean BCVA improved significantly in both groups using the "knot ball" fixation technique (p<0.01). The extent of the improvement in the best-corrected visual acuity and late complications one month post-surgery were not significantly different between the groups (p>0.05). These clinical outcomes were consistent with those described in the ophthalmology literature. CONCLUSION: A "knot ball" scleral fixation technique is reported; to the best of our knowledge, this is the first report of such a technique, which offers a less invasive and simplified surgical procedure for transscleral fixation of scleral-fixated intraocular lenses. Moreover, the technique appears to display similar effectiveness and safety compared with existing scleral fixation techniques. We suggest that the "knot ball" technique warrants further research focus and clinical evaluation in future studies.

Descemet membrane endothelial keratoplasty (DMEK): intraoperative and postoperative complications and clinical results.

PURPOSE: To evaluate the complications and clinical results of Descemet membrane endothelial keratoplasty (DMEK) in patients with endothelial failure that occurred during the learning curve of a surgeon. METHODS: Fifty eyes of 50 patients with DMEK and ≥6 months of follow-up were included. The patients were divided into the first 25 (group 1) and the second 25 (group 2) procedures performed by the surgeon. Best corrected visual acuity (BCVA), central corneal thickness (CCT), unfolding time of the Descemet membrane (DM) graft, and intraoperative and postoperative complications were compared between groups. RESULTS: The differences in postoperative increase of BCVA (p=0.595) and decrease of CCT (p=0.725) in the two groups were not significant. The unfolding time of the DM was longer in group 1 than in group 2 (p=0.001). Primary graft failure occurred in three patients in group 1 and none in group 2. At the last visit, 42 (85.7%) of patients' corneas were clear, with significant difference between groups (p=0.584). A patient in group 1 with a history of pars plana vitrectomy, inferior iridectomy, and fluid as a tamponade experienced drop of the DM graft into the iridectomy space. All other intraoperative complications occurred in group 1. CONCLUSIONS: Occurrence of intraoperative and postoperative complications was increased in patients with coexisting ocular pathology or complicated endothelial dysfunction and during the surgeon's learning curve of DM endothelial keratoplasty procedures.