Combined Intracapsular Lens Removal and Scleral Fixation of Intraocular Lenses Through the Same Scleral Tunnel in Cases with Severely Dislocated Lenses.

OBJECTIVES: The management of severely dislocated lenses floating in the anterior vitreous is challenging. This study describes the clinical outcome of a surgical approach with intracapsular lens extraction (ICCE) and implantation of a scleral-fixated posterior chamber intraocular lens (SF-IOL) at the same surgical session. METHODS: Records of patients who had severely dislocated lenses were retrospectively reviewed. All included patients had undergone ICCE, followed by implantation of an SF-IOL during the same surgical session through the same scleral tunnel placed 1.5 mm posterior to the limbus. Clinical characteristics of the patients were collected, and surgical videos were watched again to review intraoperative complications. RESULTS: Thirty eyes of 30 patients (mean age, 68±11.1 years, 23 male, 7 female) were included in the study. Twenty-five patients had a history of blunt trauma, and five patients had pseudoexfoliation syndrome. The best-corrected visual acuity of the patient improved significantly after the procedure (p=0.001). The intraocular pressure of the patients remained unchanged (p=0.38). Three patients developed mild IOL dislocation that did not require any intervention. A patient developed transient hypotony, and another developed mild vitreous hemorrhage. These complications improved spontaneously without the need for further intervention. CONCLUSION: Simultaneous removal of dislocated lens and SF-IOL implantation through the same scleral tunnel was a safe and effective procedure for patients with severely dislocated IOLs.

Everything is ok on YouTube! Quality assessment of YouTube videos on the topic of phacoemulsification in eyes with small pupil.

OBJECTIVE: Usage of YouTube as an educational tool is gaining attention in academic research. To date, there has been no study on the content and quality of eye surgery videos on YouTube. The aim of this study was to analyze YouTube videos on phacoemulsification in eyes with small pupil. METHODS: We searched for the phrases "small pupil cataract surgery," "small pupil phacoemulsification," "small pupil cataract surgery complications," and "small pupil phacoemulsification complications" in January 2015. Each resulting video was evaluated by all authors, and Krippendorff's alpha was calculated to measure agreement. Videos were classified according to pupil size (small/very small) in the beginning of the surgery, and whether pupillary diameter was large enough to continue surgery safely after pupillary dilation by the surgeon in the video (safe/not safe). Methods of dilatation were also analyzed. Any stated ocular comorbidity or surgical complications were noted. RESULTS: A total of 96 videos were reviewed. No mechanical intervention for pupillary dilatation was performed in 46 videos. Fifty-eight operated eyes had no stated ocular comorbidity. Ninety-five operations ended successfully without major complication. There was fair agreement between the evaluators regarding pupil sizes (Kα = 0.670) but poor agreement regarding safety (Kα = 0.337). CONCLUSIONS: YouTube videos on small pupil phacoemulsification have low complication rates when compared to the literature, although no reliable mechanical dilatation methods are used in almost half of these videos. Until YouTube's place in e-learning becomes clearer, we suggest that viewers be cautious regarding small pupil phacoemulsification videos on YouTube.

The decrease in aqueous tear production associated with pepper spray.

PURPOSE: Pepper spray is used both by civilians and by law enforcement. Burning sensation occurs when exposed to skin, pain and temporary blindness occurs when exposed to the eyes. This study focused on the effect of pepper spray on lacrimal tear production and subsequently on corneal sensitivity in a large group after an intense exposure. METHODS: Ninety-six people who were exposed to pepper spray during the Gezi park protests volunteered. Subjects were asked if they wore any protective goggles and if they irrigated their eyes after exposure. They were asked to record their symptoms regarding dry eye in a standardized questionnaire. Schirmer I and II tests were performed. RESULTS: Eighty-two people wore protective goggles during exposure, whereas 14 people did not have any protection. Both Schirmer results in unprotected subjects were significantly lower than that in protected subjects. Schirmer I and II results of unprotected subjects were not statistically different, whereas they were statistically different in protected subjects. Thirty-five percent of unprotected subjects and 24% of protected subjects expressed symptoms of dry eye. DISCUSSION: The active ingredient of pepper spray is oleoresin capsicum. It is randomly diffused to polymodal nerve terminals, leading to opening of non-selective cationic channels and block neuronal transmission. The lower results of both Schirmer in unprotected group emphasize the importance of a protective Google glass around the eyes during exposal, serving as a barrier minimalizing the contact of the spray with the eyes. The combination of the low results and lack of symptoms could suggest that corneal reflex lacrimation in our subjects was not abundant enough. The findings of this study could not fully represent long term findings but it could be assumed that our findings could be indicative of the sensory denervation and alterations demonstrated in studies investigating the long term effects of oleoresin capsicum.