Surgical outcome of coaxial phacoemulsification with torsional ultrasound after a 2.4 mm versus 3.2 mm clear corneal temporal incision.

PURPOSE: This study aimed to evaluate and compare outcomes of phacoemulsification surgery with purely torsional ultrasound in coaxial small incision procedures. METHODS: This study was a prospective observational series of 50 eyes of 50 patients with age-related cataracts. There were two groups each with 25 eyes. Group 1 eyes were treated with microcoaxial phacoemulsification using a 2.4 mm temporal clear corneal incision; group 2 eyes were treated with phacoemulsification using a 3.2 mm temporal clear corneal incision. Both groups underwent a standardised surgical procedure using purely torsional ultrasound. Outcome measures were best corrected visual acuity, percentage increase in postoperative corneal thickness, and surgically-induced astigmatism assessed at day 1, week 1, month 1 and month 3 postoperatively. RESULTS: Both groups were comparable with respect to age, cataract grading and intraoperative parameters such as cumulative dissipated energy and irrigation volume. The only statistically significant outcome difference was surgically induced astigmatism at postoperative day 1 (higher in group 2). Intraoperative and early postoperative complications were similar in both groups. CONCLUSIONS: Coaxial phacoemulsification with purely torsional ultrasound produced satisfactory results for 2.4 mm and 3.2 mm incisions. There were no differences in outcomes between groups.

Alterations in central retinal sensitivity after intravitreal triamcinolone injection for diffuse diabetic macular edema.

PURPOSE: To evaluate alterations in central retinal sensitivity following intravitreal triamcinolone injection in patients with diffuse diabetic macular edema that persisted after laser treatment. METHODS: Fourteen eyes of 14 patients that received 4 mg 0.1 cc intravitreal triamcinolone underwent macular threshold test using computerized visual field analyzer before and after 1, 2, 3, and 5 months of triamcinolone injection. Pre- and postinjection values of total defect depth, total threshold, and best-corrected visual acuity were compared and correlated. RESULTS: At the last follow-up, compared to baseline, visual acuity improved from 1.4+/-0.4 (logMAR, mean +/- standard deviation) to 1.0+/0.4 (p=0.01). Total defect depth tended to recover from 148+/-64 dB to 121+/-48 dB (p=0.12), and total threshold tended to increase from 241+/-87 dB to 271+/-68 dB (p=0.16), but these values did not reach significance. There was a significant correlation between baseline and 5 months postinjection values of total defect depth (rho=0.60, p=0.02), and of total threshold of light sensitivity (rho=0.55, p=0.04). CONCLUSIONS: Best-corrected visual acuity was found improved in patients with diabetic macular edema 5 months after triamcinolone injection. Improvement in central retinal sensitivity did not reach significant level at the last follow-up. Macular threshold test may be a valuable tool in the follow- up of patients with diffuse diabetic macular edema after intravitreal triamcinolone injection.

Vessel diameter study: intravitreal vs posterior subtenon triamcinolone acetonide injection for diabetic macular edema.

PurposeTo detect and compare the vessel diameter effect of intravitreal vs subtenon injection of triamcinolone for diabetic macular edema (DME).MethodsSixty patients with DME who underwent triamcinolone injection either intravitreally (N=30) or under the tenon capsule (N=30) were included. Non-injected fellow eyes served as control. The main outcome measures were central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and artery-vein ratio (AVR).ResultsIn the intravitreal group, pre-injection mean CRAE (147.07 µ) decreased to 141.03 µ at 1 week and to 139.43 µ at 1 month (P<0.001) while baseline CRVE (209.61 µ) decreased initially to 198.85 µ at 1 week then to 198.49 µ at 1 month (P<0.001). In the subtenon group, pre-injection CRAE (152.18 µ) decreased to 149.49 µ at 1 week and to 147.47 µ at 1 month (P=0.017), while baseline CRVE (215.60 µ) decreased initially to 208.69 µ at 1 week then to 207.25 µ at 1 month (P=0.003). Pre-injection AVR values did not change at 1 week and at 1 month in both injection groups (P=0.66 and P=0.196, respectively). In the control group, none of the 3 parameters changed throughout the study period compared to the baseline (P>0.28).ConclusionIn eyes with DME, both intravitreal and subtenon triamcinolone injection led to a significant constriction of retinal arteries and veins.

Cerebral Oximetry as an Auxiliary Diagnostic Tool in the Diagnosis of Brain Death.

AIM: To investigate the efficacy of cerebral oximetry (CO) as an auxiliary diagnostic tool in brain death (BD). MATERIALS AND METHODS: This observational case-control study was performed on patients with suspected BD. Patients with diagnosis of BD confirmed by the brain death committee were enrolled as the BD group and other patients as the non-BD group. CO monitoring was performed at least 6 h, and cerebral tissue oxygen saturation (ScO2) parameters were compared. RESULTS: Mean ScO2 level in the BD group was lower than non-brain-dead patients: mean difference for right lobe = 6.48 (95% confidence interval [CI] 0.08-12.88) and for left lobe = 6.09 (95% CI -0.22-12.41). Maximum ScO2 values in the BD group were significantly lower than the non-BD group: mean difference for right lobe = 8.20 (95% CI 1.64-14.77) and for left lobe = 9.54 (95% CI 3.06-16.03). The area under the curve for right lobe maximum ScO2 was 0.69 (95% CI 0.55-0.81) and for left lobe was 0.72 (95% CI 0.58-0.84). CONCLUSION: Maximum ScO2 in brain-dead patients at CO monitoring is significantly low. However, this cannot be used to differentiate brain-dead and non-brain-dead patients. CO monitoring is therefore not an appropriate auxiliary diagnostic tool for confirming BD.

Ocular leech infestation in a child.

PURPOSE: To describe a patient with manifestations of ocular leech infestation. METHOD: Case report. RESULTS: The ocular foreign body was identified as a leech, Limnatis nilotica, by parasitologic examination. The leech was extracted, and the patient began using topical antibiotic and cycloplegic agents. By the third day after extraction, the patient had no obvious symptoms or signs, except for a limited subconjunctival hemorrhage, and no epithelial defect on the cornea was observed. CONCLUSIONS: Ocular leech infestation should be considered in patients with a history of swimming in streams and lakes. Attention should also be given to ocular leech infestation in the differential diagnosis of ocular trauma with iris prolapse.

Effect of Ca(2+)-free and Mg(2+)-free BSS Plus solution on the retinal pigment epithelium and retina in rabbits.

PURPOSE: To determine whether intravitreal irrigation with Ca(2+)-free and Mg(2+)-free BSS Plus (Alcon Laboratory, Fort Worth, Texas) solution alters the adhesiveness between the retinal pigment epithelium and the retina of rabbits. METHODS: Thirty-four eyes of 34 Dutch pigmented rabbits underwent lensectomy and vitrectomy. Subsequently, the vitreous cavity of 24 eyes was irrigated with Ca(2+)-free and Mg(2+)-free BSS Plus solution for 10 or 20 minutes. The other 10 eyes were irrigated with BSS Plus solution for 20 minutes as controls. To determine the adhesiveness between the retinal pigment epithelium and retina, a retinal detachment was produced in 12 of the 34 eyes. The apical surface of the retinal pigment epithelium and the photoreceptor outer segments were examined by scanning electron microscopy. Retinal physiology was assessed by electroretinography and retinal morphology by light microscopy. RESULTS: After retinal detachment was produced, the number of cone sheaths on the apical surface of the retinal pigment epithelium after irrigation with Ca(2+)-free and Mg(2+)-free BSS Plus solution for 20 minutes (33 +/- 15, mean +/- SD) was significantly less than the number of cone sheaths on the apical surface of the retinal pigment epithelium of eyes after irrigation with BSS Plus solution for 20 minutes (120 +/- 50) or the number of cone sheaths on the apical surface of the retinal pigment epithelium of eyes after 10 minutes of irrigation with Ca(2+)-free and Mg(2+)-free BSS Plus solution (115 +/- 49; P =.02). The b-wave amplitudes in the eyes irrigated with Ca(2+)-free and Mg(2+)-free BSS Plus solution for 20 minutes were depressed compared with the b-waves in eyes irrigated with BSS Plus solution for 20 minutes on the first postoperative day (P =.03). After the third postoperative day, there was no significant difference in the b-waves (P >.06). Light microscopy demonstrated no morphologic abnormalities after the use of both solutions. CONCLUSIONS: Intravitreal irrigation with Ca(2+)-free and Mg(2+)-free BSS Plus solution for 20 minutes altered the adhesion between the retinal pigment epithelium microvilli and retinal outer segments and made the creation of retinal detachment less traumatic. These results suggest that Ca(2+)-free and Mg(2+)-free BSS Plus solution may be of clinical value for the creation of an intentional retinal detachment for foveal translocation surgery.

Effect of cigarette smoking on copper, lead, and cadmium accumulation in human lens.

AIM: To identify cigarette smoking as a risk factor for development of cataract, to determine the importance of copper, lead, and cadmium in cataractogenesis, and to learn about any relation between those elements. METHODS: Copper, lead, and cadmium concentrations were measured by atomic absorption spectrophotometry in 37 cataractous and nine normal human lenses. RESULTS: All three element accumulations in lenses with cataract were statistically meaningful. Lenticular copper, lead, and cadmium were increased significantly with cigarette smoking. Cadmium had a positive correlation both with lead and copper in cataractous lenses. CONCLUSION: The accumulation of copper, lead, and cadmium occurs in cataract. The probable source of cadmium in humans is cigarettes. Lenticular cadmium accumulation also increases copper and lead precipitation in the lens. Cigarette smoking might be cataractogenic.

Subretinal fluid levels of topical, oral, and combined administered ciprofloxacin in humans.

AIMS: To investigate the subretinal fluid (SRF) penetration of ciprofloxacin following topical, oral, and combined administration. METHODS: 34 patients undergoing conventional retinal reattachment surgery were randomly assigned to three groups. Twelve patients received topical ciprofloxacin, 11 patients received oral ciprofloxacin, and the other 11 patients received combined drug administration. SRF drug level was measured by using high performance liquid chromatography method. RESULTS: The highest drug concentrations of all tested modes were attained following combined administration and lowest following topical administration (p<0.001). The SRF drug concentration following oral administration was also significantly higher than that of topical administration (p<0.001). Concentrations after oral and combined administration did not differ significantly (p = 0.217). CONCLUSIONS: Topical ciprofloxacin can penetrate SRF. Ocular bioavailability of ciprofloxacin in SRF after oral and combined administration is equivalent.

Plasma malondialdehyde and nitric oxide levels in age related macular degeneration.

AIMS: To evaluate alteration of plasma malondialdehyde (MDA) and nitric oxide (NO) levels in patients with exudative age related macular degeneration (ARMD). METHODS: Plasma nitrite plus nitrate concentrations as an index of plasma NO levels and plasma MDA level as a marker of lipid peroxidation were measured in patients with exudative ARMD and age and sex matched healthy subjects. RESULTS: Significantly higher MDA and lower NO levels were detected in plasma of patients with ARMD compared with their controls (p=0.01, p=0.001, respectively). CONCLUSION: The results may support involvement of oxidative damage and vascular theory in the pathogenesis of ARMD as part of the ageing process.

Penetration of topical, oral, and combined administered ofloxacin into the subretinal fluid.

AIMS: To assess the subretinal fluid (SRF) levels of ofloxacin following topical, oral or combined administration. METHODS: 31 patients undergoing conventional retinal reattachment surgery were randomly assigned to three groups. Nine patients received topical ofloxacin, 11 patients received oral ofloxacin, and the other 11 patients received combined administration. Collected SRF samples were analysed for drug level by using high performance liquid chromatography. RESULTS: SRF drug levels after oral and combined administration were significantly higher than that after topical administration (p=0.0002 and p=0.0002, respectively) while there was no significant difference between oral and combined administration (p=0.0844). CONCLUSIONS: Ocular bioavailability of ofloxacin in SRF after oral and combined administration is equivalent. The addition of oral ofloxacin to topical therapy increased drug SRF penetration sixfold.

Effect of capsulorhexis size on postoperative intraocular pressure.

OBJECTIVE: To determine whether capsulorhexis diameter has an effect on intraocular pressure (IOP) after phacoemulsification. SETTING: SSK Ankara Eye Hospital, Ankara, Turkey. METHODS: This prospective study comprised 58 patients selected for cataract extraction by phacoemulsification using a 5.2 mm temporal, clear corneal incision. Twenty-nine of 58 patients had a 4.0 mm capsulorhexis and the rest, 6.0 mm. All patients received a multipiece poly(methyl methacrylate) posterior chamber intraocular lens with a 5.0 mm diameter bioconvex optic and flexible haptics. Follow-up was 3 months. Postoperative IOP was obtained by Goldmann applanation tonometry 1 and 2 days before surgery and 1 and 7 days and 1, 2, and 3 months postoperatively. RESULTS: A significant decrease in IOP was observed in both the 4.0 and 6.0 mm capsulorhexis groups 1 day postoperatively (P < .0001 and P < .0001, respectively). At 3 months postoperatively, IOP decreased significantly over preoperative values both in the 4.0 mm (P < .0001) and 6.0 mm capsulorhexis (P = .0014) groups. There was a statistical difference between the mean 1 month IOP values in the 4.0 mm (11.34 +/- 2.18 mm Hg [SD]) and 6.0 mm capsulorhexis (13.00 +/- 2.30 mm Hg) groups (P = .0059). A statistical difference between the groups also existed at 3 months postoperatively (P = .0028). CONCLUSION: A 4.0 mm capsulorhexis resulted in lower postoperative IOP than a 6.0 mm capsulorhexis 1 month postoperatively.

Manual tunnel incision extracapsular cataract extraction using the sandwich technique.

Small incision extracapsular cataract extraction (ECCE) using the sandwich technique is described. After capsulorhexis, hydrodissection, and hydrodelineation, the endonucleus is moved into the anterior chamber and extracted by sandwiching it between the irrigating vectis and iris spatula. In a series of 37 eyes, most achieved a best corrected visual acuity of 5/10 or better postoperatively. Complications were posterior capsule rupture, vitreous loss, and transient corneal edema. Small incision ECCE using the sandwich technique is safe, easy, and does not require expensive instrumentation.

Combined phacoemulsification, vitrectomy, foreign-body extraction, and intraocular lens implantation.

PURPOSE: To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and intraocular lens (IOL) implantation. SETTING: SSK Ankara Eye Hospital, Department of Vitreoretinal Surgery, Ankara, Turkey. METHODS: Seventeen patients with corneal perforation, intraocular foreign body, vitreous hemorrhage, and lens opacity had simultaneous clear corneal phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and IOL implantation. RESULTS: Postoperative complications included massive retinal fibrosis in 2 patients, retinal detachment in 1, and cilioretinal artery occlusion in 1. At a mean follow-up of 15.2 months, best corrected visual acuity improved in the remaining 13 eyes (76%). The IOL was stable in all cases. CONCLUSION: Combined phacoemulsification with IOL implantation and vitreoretinal surgery was safe in selected cases of penetrating ocular trauma resulting from an intraocular foreign body.

Small incision extracapsular cataract surgery with manual phacotrisection.

PURPOSE: To evaluate the safety and efficacy of small incision extracapsular cataract extraction (ECCE) using the manual phacotrisection technique. SETTING: Department of Ophthalmology, Turgut Ozal Medical Center, InönüUniversity, Malatya, Turkey. METHODS: Fifty-nine eyes of 54 patients had small incision ECCE by the manual phacotrisection technique. Mean follow-up was 10 months. After capsulorhexis and hydrodissection were performed, the endonucleus was prolapsed into the anterior chamber and trisected using an anteriorly positioned triangular trisector and posteriorly placed solid vectis. Pieces were extracted with a forceps through a small incision. RESULTS: Postoperatively, best spectacle-corrected visual acuity of 20/40 or better was achieved in 48 eyes (83%) and of 20/25 or better in 28 eyes (47%). The most frequent intraoperative complication was posterior capsule rupture (n = 5). Of eyes that developed posterior capsule rupture, 3 had vitreous loss and 2 had implantation of an anterior chamber intraocular lens (IOL). In 44 eyes, the IOL was implanted in the bag and in 12 eyes, in the ciliary sulcus. The most significant postoperative complication was transient corneal edema, which developed in 32 eyes (54%). No permanent complications (e.g., corneal endothelial decompensation) occurred in any case. CONCLUSIONS: Manual phacotrisection has several advantages such as nucleus safety, less dependence on assistant personnel, the elimination of the phaco machine, and cost effectiveness.

Bilateral cataract surgery in adult and pediatric patients in a single session.

PURPOSE: To evaluate the results of bilateral simultaneous cataract surgery in adult and pediatric patients under local or general anesthesia. SETTING: Department of Ophthalmology, Inönü University, Turgut Ozal Medical Center, Malatya,Turkey. METHODS: Eighty-two eyes of 41 patients were included in the study. Twelve of 17 pediatric patients with congenital cataract had bilateral simultaneous lensectomy, posterior capsulotomy, and anterior vitrectomy; 5 patients, aged 10 to 19 years, had bilateral extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PC IOL) implantation. Forty-eight eyes of 24 adult patients had bilateral simultaneous ECCE with primary (43 eyes) or secondary (5 eyes) PC IOL implantation. Local anesthesia was administered to 20 adult patients by retrobulbar injection; the other cases were performed using general anesthesia. The procedures were treated as 2 separate surgeries in the same session; care was taken to ensure surgical asepsis. RESULTS: No serious intraoperative complications occurred such as posterior capsule rupture, vitreous loss, endophthalmitis, and anesthesia-related problems. Of patients tested, 84.4% achieved a final best corrected visual acuity of 6/12 or better and 31.0%, of 6/6 or better. CONCLUSIONS: Simultaneous bilateral cataract surgery was not associated with an increased rate of complications, and visual results were good. If strict rules of surgical asepsis are followed, this may be a useful option in a variety of bilateral cases using general or local anesthesia.

Effect of caffeic acid phenethyl ester on corneal neovascularization in rats.

PURPOSE: Caffeic acid phenethyl ester (CAPE), a biologically active component of propolis from honeybee hives, has potent antiinflammatory and antioxidant properties. We aimed to evaluate the ability of topically applied CAPE in comparison with known steroidal (dexamethasone sodium phosphate) and nonsteroidal (indomethacin) topical agents to reduce corneal neovascularization (CNV) induced by silver nitrate cauterization in rats. METHODS: Following silver nitrate cauterization on both eyes, male rats were randomly assigned to the study and control groups, each consisting of ten rats. The inhibitory effects of the test drugs against a placebo (isotonic saline) on CNV were tested and compared to each other using a previously described method in which extent of neovascularization and burn stimulus intensity were scored by a masked examiner. Briefly, burn stimulus intensity was scored from 0 to +3 according to the height of blister from corneal surface, and extent of neovascularization was recorded from 0 to +6 according to the distance from limbus to the end point of CNV toward the central corneal burn. Results. The mean burn stimulus score were not different among the groups (P = 0.807). Percent inhibition of CNV compared to the placebo control and its significance were 31.5 %, P = 0.011 for indomethacin; 56 %, P < 0.001 for dexamethasone; and 52 %, P < 0.001 for CAPE. Dexamethasone was significantly (P < 0.05) more effective than indomethacin in inhibition of neovascular growth. CAPE was found to be superior (P < 0.05) to indomethacin and almost as effective as (P > 0.05) dexamethasone in reducing CNV. Conclusion. Topically applied CAPE was demonstrated to have an inhibitory effect, comparable to that of topical dexamethasone, on CNV in this rat model. Antiinflammatory and antioxidant properties of CAPE may contribute to its suppression on CNV.

Intraocular gas tamponades.

Intraocular gas tamponades are an important part of vitreoretinal surgery and have become a standard of care. The use of intraocular gas began in 1911. Modem use of intraocular gases as a surgical adjunct is continuously broadening. Today, sulfur hexafluoride and perfluoropropane are increasingly being used as intraocular gas tamponades for a wide range of complicated vitreoretinal diseases. This article reviews the types and function of commonly used gases, their indications and efficacy in certain types of vitreoretinal diseases, and their complications.

Comparison of aqueous humour and vitreous humour levels of two 0.3% ciprofloxacin eyedrops.

BACKGROUND: Two ophthalmic solutions of 0.3% ciprofloxacin eyedrops are available in Turkey: Ciloxan and Siprogut. The objective of this study was to compare the concentrations of drug produced by the two products in the aqueous humour and vitreous humour after local administration. METHODS: Twenty-one patients undergoing primary vitreoretinal surgery received either Ciloxan (10 patients) or Siprogut (11 patients). Six hours before surgery, two drops of solution were instilled onto the operative eye. Drops were then instilled every 30 minutes for the first 3 hours and then hourly for the next 3 hours. Aqueous and vitreous samples were collected 30 minutes after administration of the last dose and were assayed for ciprofloxacin concentration by means of high-performance liquid chromatography with fluorometric detection. RESULTS: The mean aqueous humour concentrations of Ciloxan and Siprogut were 0.36 (standard error of the mean [SEM] 0.09) microgram/mL and 0.44 (SEM 0.17) microgram/mL respectively. The corresponding vitreous humour concentrations were 0.21 (SEM 0.05) microgram/mL and 0.22 (SEM 0.06) microgram/mL. Neither of these differences was statistically significant. The aqueous and vitreous levels of both products exceeded the minimum inhibitory concentrations for certain bacterial species that frequently cause intraocular infections. INTERPRETATION: Our results show that the ocular bioavailability of Ciloxan and Siprogut after local administration is equivalent. Penetration of ciprofloxacin into the vitreous humour seems to be poorer than that into the aqueous humour.

Evaluation of hemodynamic changes in the ophthalmic artery with color Doppler ultrasonography after strabismus surgery.

PURPOSE: To investigate the blood flow changes in ophthalmic artery with color Doppler ultrasonography after strabismus surgery. METHODS: Twenty eyes of 19 patients who underwent recession or resection surgery on two horizontal rectus muscles in 1 eye were examined using color Doppler ultrasonography preoperatively and 1 week and 1 month postoperatively. Measurements from both eyes of 16 age- and sex-matched normal subjects served as control data. The systolic maximum velocity, mean velocity, end-diastolic velocity, pulsatility index, and resistance index of the ophthalmic artery were determined. The Mann-Whitney U test was performed for comparison of the control and study group preoperatively for any hemodynamic parameter. Statistical comparison of the preoperative and postoperative measures in the study group was performed with Friedman's two-way analysis of variance. RESULTS: No difference (P>.05) was observed preoperatively between the study and control groups for any hemodynamic parameter in the ophthalmic artery. Although the ophthalmic artery showed a slight increase in systolic maximum velocity 1 month postoperatively, there were no statistically significant differences (P>.05) in velocities or resistance in the ophthalmic artery at any interval. CONCLUSION: Two horizontal rectus muscle operations in a previously unoperated eye do not cause significant hemodynamic changes in the ophthalmic artery. However, further studies are needed to obtain more information about the effect of multiple vertical rectus muscle operations on the blood flow parameters of the ophthalmic artery.

Effects of the long-term use of perfluoroperhydrophenanthrene on the retina.

Perfluorocarbon liquids have gained wide acceptance as intraoperative tools that can simplify vitreoretinal surgical maneuvers. These low-viscosity liquids facilitate injection into the eye and removal from the eye during surgery. Tolerance to perfluoroperhydrophenanthrene and the development of proliferative vitreoretinopathy with its extended use are not clear. The authors present the clinical and histologic findings of a patient, previously lost to follow-up, who was examined after several weeks of intraocular tamponade with perfluoroperhydrophenanthrene. Damage to the retina was seen in response to the long-term postoperative use of perfluoroperhydrophenanthrene.