A simplified sclerocorneal tunnel approach in performing pediatric cataract surgery.

BACKGROUND/AIMS: Performing pediatric lensectomy, anterior vitrectomy with intraocular lens implantation in one session, using a long sclerocorneal tunnel and covering the incision site with 8/0 Vicryl sutures. MATERIALS AND METHODS: This study includes 52 eyes of 30 patients with pediatric cataracts. At the temporal side, the conjunctival peritomy was performed, followed by two long sclerocorneal side ports and the main incision for intraocular lens (IOLs) implantation. At the end of the operation, the side port and the conjunctiva incisions were sutured with 8/0 Vicryl sutures. The IOLs were implanted in children older than 24 months, not in smaller ones. The operations and intraoperative complications were recorded. After the operation, the patients were examined on the 1st postoperative day, then six times for the first 6 months. During follow-ups, the impact of the suture on the anterior segment complications and astigmatism was evaluated. RESULTS: The age of the patients ranged between 2 months and 8 years. The average operation time was 28 ± 6 min. Due to the suture-related complication, neither re-suturing nor stitch removal was carried out; therefore, general anesthesia was not repeated. The average astigmatism value of the children in the postoperative 1st week was 1.5 ± 1.2 D (0.5-4.0). The mean astigmatism value was 0.8 ± 0.5 D (0.5-1.5) in the 3rd postoperative month. CONCLUSION: The long corneoscleral tunnel method has been found safe in pediatric cataract surgery.

Iris-claw intraocular lens implantation: Anterior chamber versus retropupillary implantation.

PURPOSE: To compare the outcomes of anterior chamber and retropupillary implantation of iris-claw Artisan intraocular lenses (IOL). DESIGN: Prospective, randomized, single-blinded study. PATIENTS AND METHODS: Forty eyes of forty aphakic patients were enrolled. Patients were randomized into two groups. Each group includes twenty patients. Group 1 received anterior chamber Artisan IOL implantation. Group 2 received retropupillary Artisan IOL implantation. Preoperative and postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), and all complications were noted and compared at 6 months follow-up. RESULTS: Each two groups obtained a significant improvement in CDVA (P < 0.05). Four patients in Group 1 and five patients in Group 2 had significant but nonpermanent increase at IOP values. There were one and two pupillary irregularity in Group 1 and Group 2, respectively. In one patient, a shallow and inferior located retinal detachment were encountered in anterior chamber group. CONCLUSIONS: The results were not significantly different between the two fixation techniques for iris-claw lens. The surgery procedure is dependent to surgeon experience and eye's conditions.

Serous Macular Detachment Secondary to Optic Pit: Surgical Treatment and Long Time Results.

32-year-old Turkish male patient presented with an optic disk pit and serous macular detachment in the left eye. Spectral domain optical coherence tomography revealed serous macular detachment and retinoschisis. After vitrectomy the retina gradually flattened and vision was gradually improved. We aimed to report a case of serous macula detachment secondary to optic pit and long term result of surgical treatment.

Vitreous incarceration after ranibizumab injection: an ultrasound biomicroscopy study.

BACKGROUND AND OBJECTIVE: The aim of the study was to evaluate vitreous incarceration at the injection site using ultrasound biomicroscopy (UBM) after intravitreal injection of ranibizumab. PATIENTS AND METHODS: The study included 39 eyes of 34 patients who underwent intravitreal injection of 0.05 mL of ranibizumab. UBM (HiScan; Optikon, Rome, Italy) with a 50 MHz probe was performed 1 day after surgery to determine the existence of vitreous incarceration at the injection site. RESULTS: The mean patient age was 59.7 (± 10.1) years, and 58.9% were female. Vitreous incarceration into the pars plana site was detected in six eyes (15.3%) the day after intravitreal injection. CONCLUSION: Vitreous incarceration at the injection site after intravitreal injection is thought to lead to a higher risk for complications such as infection, retinal breaks, retinal detachment, vitreous hemorrhage, and fibrovascular proliferation at the injection site. To understand the clinical importance of vitreous incarceration, further long-term prospective studies are necessary.

Endoscopic dacryocystorhinostomy with silicone, polypropylene, and T-tube stents; randomized controlled trial of efficacy and safety.

OBJECTIVE: To compare the efficacy and safety of endoscopic dacryocystorhinostomy (En-DCR) with different stent materials for lacrimal sac intubation in primary nasolacrimal ductal obstructions. STUDY DESIGN: Randomized controlled study with three parallel groups. Level of evidence is 1b. METHODS: A total of 91 patients (five bilateral) with primary nasolacrimal duct obstruction (NLDO) at a tertiary referral center scheduled for En-DCR were to allocated into three stent groups with a sealed envelope and were randomized into three treatments: silicone, Prolene (polypropylene), and otologic T-tube. Ophthalmology and otolaryngology clinics evaluated the patients preoperatively and postoperatively with endoscopes, lacrimal system syringing, and dacryocystography. The success of the stents was evaluated 12 months after surgery with symptom relief and ostial patency. Complications were also noted. RESULTS: The overall success rate of the En-DCR in the stent groups was 78.1% (75/96); specifically, 87.5% (28/32) with silicone, 84.4% (27/32) with Prolene, and 62.5% (20/32) with T-tube. The efficacy of the procedures with the T-tube was significantly lower than that of the Prolene and silicone (p = .031, χ(2) test). There were no significant differences between the silicone and Prolene (p = .718, χ(2) test). Prolene was found to be related with orbital complications. Spontaneous loss is a particular complication of otologic T-tube and highly portends to failure. CONCLUSIONS: The results of our study suggest that efficacy, defined as anatomic and functional success, is equally high for silicone and Prolene stents and lower for otologic T-tube in En-DCR.

A novel capsulorhexis technique in white cataract surgery.

PURPOSE: To investigate the efficacy and safety of novel capsulorhexis technique in white cataract surgery using the irrigation-aspiration system of a phaco device. MATERIALS AND METHODS: 53 eyes of 50 patients were included in the study. Patients were randomly divided into two groups. To 27 eyes of 27 patients in Group 1, continuous curvilinear capsulorhexis (CCC) was made using an irrigation-aspiration system by a phaco machine. To 26 eyes of 23 patients in Group 2, CCC was made using an ocular visco-elastic device (OVD) and utrata forceps. Surgical results were compared between two groups. RESULTS: No difference in outcome endothelial cell count or central corneal thickness was noted between the two groups. CCC-2 has been completed totally in Group 1 but only 22 eyes in the other group. CONCLUSIONS: Capsulorhexis with described technique is safe in white cataracts. This technique may be an alternative in capsulorhexis to the other method, which is made using OVD and forceps.

Effect of intravitreal injection of dexamethasone implant on corneal endothelium in macular edema due to retinal vein occlusion.

OBJECTIVE: To evaluate the effects of dexamethasone (DEX) implant (Ozurdex(®)) on corneal endothelium in patients with retinal vein occlusion complicated with macular edema. MATERIALS AND METHODS: Patients (n = 31) received 1-3 intravitreal DEX implants in one eye. Measurements were intraocular pressure (IOP) at baseline and 1, 3, and 6 months after the first intravitreal injection and corneal specular microscopy and central corneal thickness (CCT) at baseline and 1 and 6 months. We analyzed endothelial cell density (ECD), coefficient of variation of cell size (CV), and percentage of hexagonality. RESULTS: Mean follow-up period was 9.7 ± 3.3 months. Mean number of injections was 1.5 ± 0.8. Mean IOP values were 15.6 ± 2.6 mm Hg at baseline, 17.7 ± 3.6 mm Hg at one month, 16.4 ± 4.1 mm Hg at three months, and 16.0 ± 2.7 mm Hg at six months. There was a significant difference in mean IOPs at one month and six months (p = 0.008). There were no significant differences in mean ECD (p = 0.375), CV (p = 0.661), percentage of hexagonality (p = 0.287), and CCT (p = 0.331). CONCLUSION: Although intravitreal injection of 0.7 mg DEX causes moderate elevation of IOP, it does not seem to have detrimental effects on corneal endothelium at six months.

Effects of sub-Tenon's anaesthesia on ocular hemodynamics.

OBJECTIVE: To research the effects of sub-Tenon's anaesthesia (STA) on ocular hemodynamics in patients with cataract using colour Doppler imaging (CDI). DESIGN: Prospective clinical study. PARTICIPANTS: Thirty-four eyes of 34 patients with age-related cataract. METHODS: Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) values of the ophthalmic artery (OA), central retinal artery, and central retinal vein were measured by CDI before and immediately after performing sub-Tenon block using 2 mL of 2% lidocaine with adrenaline (1:200 000). RESULTS: Both PSV and EDV values were significantly decreased after sub-Tenon injection in all the studied vessels of the patients. However, no important changes were observed in the RI values of the vessels. CONCLUSIONS: STA markedly reduced ocular blood flow. The reduction may be more acceptable compared with other retrobulbar block methods. Sub-Tenon block should be performed carefully to senile patients with cataract with vascular occlusive disorder.

Protective effects of N-acetylcysteine on triamcinolone acetonide-induced lens damage in rats.

OBJECTIVE: To examine the relationship of cataract forming effect of intravitreal triamcinolone acetonide (IVTA) injection with oxidative status and the effect of N-acetylcysteine (NAC) on these alterations. MATERIALS AND METHODS: Twenty-six Wistar-Albino rats were included in the study. Rats were assigned into four groups as follows: intravitreal saline injection group (controls); IVTA injection group; IVTA + intraperitoneal NAC injection group (IVTA + NAC); and intraperitoneal NAC injection group (NAC). Triamcinolone acetonide was intravitreally injected at a dose of 1 mg. NAC was intraperitoneally injected at a dose of 150 µg/g body weight. Animals were sacrificed and lens specimens were analyzed for levels of malondialdehyde (MDA) and protein carbonyl (PC) and activities of glutathione (GSH) and glutathione peroxidase (GSH-Px). RESULTS: We found that the MDA and PC levels of lenses were increased in the IVTA group (p < 0.01). It was seen that GSH and GSH-Px in lenses were decreased in the IVTA group (p < 0.01). NAC administration significantly ameliorated these changes in the IVTA + NAC group (p < 0.05). CONCLUSION: These results indicate that the NAC produces a protective mechanism against IVTA-induced cataract and suggest a role of oxidative stress in pathogenesis.

Repair of iridodialysis using 8-0 polypropylene.

PURPOSE: Investigate the effectiveness of repair of iridodialysis with 8-0 polypropylene. METHODS: We present four cases of traumatic iridodialysis that were repaired by 8-0 polypropylene suture. RESULTS: Better iris reposition and stability were achieved with 8-0 polypropylene suture despite wide degree traumatic iridodialysis in all patients. CONCLUSION: In this study, we used 8-0 polypropylene suture, which is thicker, cheaper, and more durable than 10-0 sutures. We suggest that usage of 8-0 polypropylene sutures may provide better iris repositioning.

The effects of soft contact lens use on cornea and patient's recovery after autograft pterygium surgery.

PURPOSE: To investigate usage of soft contact lens (SCL) on post-operative pain relief and daily, activity due to pterygium surgery. METHODS: Autograft pterygium surgery was performed to 63 eyes of 63 patients. After surgery in 30, eyes of 30 patients in group-1, SCL was placed on the cornea. In 33 patients of group-2, antibiotic, pomade was applied and tightly covered with bandage. Follow-up visits were performed on 24th and, 48th h after the surgery. Re-epithelization time and pain scores were compared. RESULTS: Patients' 24th h pain score was 2.96 ± 0.76 in group-1, and 4.15 ± 0.75 in group-2. The mean, pain score for 48 h was 1.66 ± 0.66 in group-1, and 2.96 ± 0.68 in group-2. Patients' pain scores for, both 24th h and 48th h were lower in group-1 (p<0.01). The mean re-epithelization times in, group 1 and 2 were 48 and 56.7h, respectively. Corneal re-epithelization is improved in patients, with SCL compared to group 2. CONCLUSION: SCL seems effective on reducing post-operative pain and eye stinging, and may accelerate, corneal re-epithelization and maintaining daily activities.

Vacuum-assisted continuous circular capsulorhexis using bimanual irrigation and aspiration system of phaco machine in immature cataract.

Seventy-eight eye of 65 patients were enrolled in this retrospective clinical study. Two-side ports are made with a 23-gauge stiletto knife. The irrigation handpiece is introduced into the anterior chamber through one side port and 27-gauge cystotome is introduced through the other one. Anterior capsular flap is created with cystotome. The capsular flap is vacuumed with a 25-gauge visco elastic's cannula, which connected to the phaco machine vacuum. The continuous circular capsulorhexis (CCC) is completed with the using bimanual irrigation and aspiration system of phaco machine. Vacuum-assisted CCC technique was used in 78 cases of uncomplicated immature senile cataracts. All cases were done under sub-Tenon's anesthesia. A complete CCC was achieved in all cases. Performing CCC with our technique is easy, safe, and cheap. It may be an alternative method to CCC by using OVD and forceps.

The effect of enoxaparin-containing irrigation fluid used during cataract surgery on postoperative inflammation in patients with diabetes.

PURPOSE: To investigate effects of enoxaparin on postoperative inflammation in patients with moderate nonproliferative diabetic retinopathy (NPDR) and nuclear cataract. DESIGN: Prospective masked controlled trial. METHODS: setting: Institutional practice. study population: The study included 51 eyes of 51 diabetes mellitus (DM) patients with moderate NPDR and grade 2-3 nuclear cataracts. Group 1 included randomly selected patients who received enoxaparin in balanced salt solution (BSS) during cataract surgery, while standard BSS was used in Group 2. observation procedure: Patients were followed up 1 day, 1 week, and 1 and 2 months after the surgery. main outcome measures: Anterior chamber cell and flare. RESULTS: Postoperatively, 20 patients from Group 1 and 4 patients in Group 2 had less than a mean of 10 cells at day 1 (P = .012). At the first week, 20 patients from Group 1 and 10 patients from Group 2 had less than a mean of 10 cells (P = .004). When compared for flare, 20 patients from Group 1 and 8 patients from Group 2 had a flare between 0 and +1 at postoperative day 1 (P < .001). By the end of postoperative first week, 24 patients from Group 1and 18 patients from Group 2 had a flare between 0 and +1 (P = .012). There was no difference between groups in terms of postoperative inflammation at the first and second months after the surgery. CONCLUSION: The results of the study suggest that enoxaparin added into the infusion fluid may reduce postoperative inflammation in patients with DM, and this result supports the anti-inflammatory effect of enoxaparin.

Dual approach using vitrectorhexis combined with anterior vitrectomy in pediatric cataract surgery.

Purpose. To evaluate efficacy and safety of vitrectorhexis method for both anterior and posterior capsules combined with anterior vitrectomy in children with cataract. Methods. A retrospective chart review was performed for 19 children with cataract operated at a tertiary referral center. Dual approach including anterior and posterior segments was used during the surgery in terms of capsulotomy, intraocular lens (IOL) implantation, and anterior vitrectomy. Results. A total of 23 eyes of 19 patients were enrolled in the study. The mean age of the children was 39.4 ± 2.2 months (5-78). The mean postoperative followup duration was 20.6 ± 7.8 months (3-32). Intraoperative tear was observed only in one of 23 (4.3%) eyes during anterior capsulotomy. All of the patients had a clear visual axis and showed no IOL decentration. Conclusions. Dual approach using vitrectorhexis and anterior vitrectomy is an easy-to-perform technique that seems safe and effective in the short term for younger children.

Bilateral serous detachment associated with latanoprost/timolol fixed combination use: a report of one phakic case.

We present a case of bilateral diffuse serous detachment associated with latanoprost/timolol fixed combination treatment which was recovered after changing treatment.

Central retinal artery occlusion secondary to orbital cellulitis and abscess following dacryocystitis.

PURPOSE: To report a case of dacryocystitis that progressed to orbital abscess resulting in the rare complication of central retinal artery occlusion. METHODS: A patient without any other known health problems presented with dacryocystitis complicated by orbital cellulitis, orbital abscess, and finally central retinal artery occlusion despite medical treatment. RESULTS: After 48 hours of medical treatment, there was no recovery, and there was loss of light perception; because of this, surgery indication was determined. Fundus fluorescein angiogram demonstrated findings of central retinal artery occlusion. There was no recovery of light perception after surgical intervention. CONCLUSIONS: We report a case of orbital abscess following dacryocystitis in a healthy middle-aged woman resulting in the rare complication of central retinal artery occlusion. To our knowledge, this is the first report of central retinal artery occlusion secondary to orbital abscess following dacryocystitis.

The effect of dacryocystorhinostomy on mucociliary function.

OBJECTIVE: External dacryocystorhinostomy is suspected to cause mucociliary dysfunction by affecting ciliary activity and quality of the mucus. We hypothesized that patients who undergo endoscopic dacryocystorhinostomy may also experience mucociliary dysfunction. We evaluated the effects of surgery on mucociliary clearance time in patients who underwent endoscopic dacryocstorhinostomy and external dacryocstorhinostomy. STUDY DESIGN: A prospective controlled study. SUBJECTS AND METHODS: Forty-four patients were studied: 22 had undergone one-sided endoscopic surgery and 22 had undergone one-sided external surgery for nasolacrimal duct obstruction. Nonoperated sides of the both groups were remained as controls. The saccharin test was used to evaluate the mucociliary clearance time of the both sides. RESULTS: Dacryocystorhinostomy, results in prolonged mucociliary clearance times either endoscopic or external approach is performed (P < 0.001, paired t test). There was no significant difference between the mucociliary clearance times after endoscopic and external dacryocystorhinostomy (P = 0.22, Student's t test). CONCLUSION: Dacryocystorhinostomy impairs mucociliary function independent of the type of surgery.

Prolene: a novel, cheap, and effective material in dacryocystorhinostomy.

CONCLUSION: Prolene is cheap, effective, and readily available in almost all operating theaters. It might be used successfully in endoscopic dacryocystorhinostomy and is promising as an alternative to silicone stent intubations, especially in settings with limited resources. OBJECTIVE: To evaluate the clinical efficacy and results of stenting with polypropylene (Prolene; Ethicon, Inc.) suture material instead of silicone tube in endoscopic dacryocystorhinostomy. PATIENTS AND METHODS: Forty-two endoscopic dacryocystorhinostomy operations were performed in 36 patients (11 men and 25 women; mean age 34.7 + or - 9.5 years, range 16-60 years) between 2007 and 2008. After creating an aperture in the medial wall of the lacrimal sac, 2/0 Prolene was inserted through the canaliculi into the sac. The Prolene was left in the lacrimal sac for 3 months. The patients were followed up for between 6 and 18 months (mean 8.1 + or - 3.6 months). The improvement in the complaint of epiphora was grouped as very good, good, or no change. RESULTS: The improvement in 34 eyes (81%) was reported as very good, whereas improvement was noted as good in 5 eyes (11.9%), and there was no change in 3 eyes (7.1%). We observed granulation tissue formation around the Prolene in two patients.

Protective effects of N-acetylcysteine on cyclosporine-A-induced nephrotoxicity.

OBJECTIVES: Cyclosporine A (CsA) is used for the treatment of autoimmune and inflammatory disorders. However, CsA-induced nephrotoxicity remains an important clinical problem, and oxidative stress has been implicated as a possible responsible mechanism. We assessed the protective ability of N-acetylcysteine (NAC), an antioxidant, against CsA-induced nephrotoxicity. MATERIALS AND METHODS: Wistar albino rats were randomly assigned into four groups. Group 1 rats were treated with sodium chloride as control, group 2 with CsA, group 3 with CsA and NAC, and group 4 with NAC alone. Animals were sacrificed and blood samples were analyzed for blood urea nitrogen (BUN), serum creatinine (Cr), malondialdehyde (MDA) and nitric oxide (NO) levels, and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities. Kidney sections were analyzed for MDA and NO levels and SOD and GSH-Px activities, as well as histopathological changes. RESULTS: Overall, the treatment of rats with CsA alone produced significant increases in NO and MDA levels and significant decreases in SOD and GSH-Px activities in serum and renal samples. Morphological changes, including tubular epithelial atrophy, vacuolizations, and cellular desquamations, were clearly observed in the rats treated with CsA alone. Concurrent NAC administration with CsA improved renal function, as indicated by lower BUN and Cr values. Moreover, NAC significantly reduced MAD and NO levels and increased SOD and GSH-Px activities in serum and renal tissue, as well as provided a histologically proven protection against CsA-induced nephrotoxicity. CONCLUSION: These results indicate that NAC produces a protective mechanism against CsA-induced nephrotoxicity and suggest a role for oxidative stress in pathogenesis.