Comparison of decentration, tilt and lenticular astigmatism of intraocular lens between sutured and sutureless scleral fixation techniques.

PURPOSE: To evaluate at six months the intraocular lens (IOL) decentration, tilt and lenticular astigmatism between foldable sutured and sutureless scleral fixation IOLs compared to conventional phacoemulsification surgery. METHODS: We retrospectively reviewed records for 22 eyes with sutureless scleral fixation, 16 eyes with sutured scleral fixation and 23 eyes with conventional phacoemulsification. IOL decentration and angle of IOL tilt were compared on Scheimpflug images 6 months after surgery. Lenticular astigmatism is described as the difference between refractive and net corneal astigmatism. RESULTS: The angle of tilt in both meridians was significantly lower in the sutureless group than in the sutured group (P=0.008 horizontally and P=0.002 vertically). IOL decentration did not show a significant difference between the three groups in either horizontal or vertical meridians (P˃0.05). Lenticular astigmatism was significantly lower in the sutureless and control groups than in the sutured group (P=0.003 and P<0.001). CONCLUSION: In addition to being relatively quick and easy to perform, the sutureless scleral fixation technique showed superior results in terms of IOL tilt and lenticular astigmatism at the six-month follow-up compared to the sutured technique.

Optic disc microvascularity in patients with intravitreal dexamethasone implantation for branch retinal vein occlusion.

PURPOSE: To compare changes in optic disc microvascular parameters before and after treatment of patients who received IVD for macular edema secondary to BRVO, using optical coherence tomography angiography (OCT-A). METHODS: Eighteen BRVO patients who received only IVD treatment and 20 healthy controls were retrospectively reviewed. Patients with moderate or severe IOP spikes (>6mmHg) after implantation were excluded from the study. Whole, peripapillary, inside disc capillary density and retinal nerve fiber layer thickness (RNFLT) were recorded at the 2nd and 6th months after implantation. RESULTS: Whole, peripapillary and inside disc capillary densities were significantly lower in BRVO patients before implantation than in the control group (P<0.001 for all comparisons). Despite a mild mean IOP increase after IVD, no significant change was observed in whole, peripapillary and inside disc capillary vascular densities in the 2nd and 6th months (P>0.05 for all comparisons). The mean RNFLT of BRVO patients before IVD was lower than the control group, but this difference was not statistically significant (110.1±12.3µm and 115.6±10.7µm, P=0.131). The mean RNFLT at the 2nd and 6th months did not show a statistically significant difference after implantation (P=0.239, P=0.459). CONCLUSIONS: OCT-A shows the decrease in whole, peripapillary and inside disc microvascular parameters in BRVO patients compared to healthy subjects. No significant change in optic nerve head microvascular parameters was observed in patients without moderate or severe IOP spikes after treatment with IVD.

Is optical coherence tomography an effective device for evaluation of tear film meniscus in patients with acne rosacea?

PURPOSE: To investigate the tear meniscus using Fourier-domain optical coherence tomography (FD-OCT) in patients with acne rosacea and to determine the relationship between tear film break-up tests (TBUT), Schirmer test and FD-OCT values and to compare them with that of healthy controls. METHODS: One hundred and four patients with acne rosacea and 104 body mass index age-sex-matched healthy subjects were enrolled in this prospective case-control study. Tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus cross-sectional area (TMA) were measured using FD-OCT (RTVue-100); TBUT, Schirmer test and dry eye questionnaire (OSDI) were evaluated. Correlation was assessed using Spearman's correlation coefficient. RESULTS: Mean TMH, TMD, TMA, TBUT, and Schirmer test values of acne rosacea patients were significantly lower than and OSDI score significantly higher than those of controls. Tear mensicus values were significantly correlated with OSDI scores, TBUT, and Schirmer test results. The intraobserver intraclass correlation coefficient (ICC) for tear parameters ranged from 0.90 to 0.96 and interobserver ICC ranged from 0.92 to 0.94, which revealed high reproducibility for all measurements parameters both acne rosacea and control subjects. Accuracy of dry eye diagnosis by FD-OCT was 60.4% for TMH, 58.7% for TMD, and 64.8% for TMA. CONCLUSION: Tear meniscus measurement with FD-OCT could provide acceptable specificity and sensitivity in diagnosis of dry eye in acne rosacea patients.

Comparison of thiol/disulphide homeostasis parameters in patients with COPD, asthma and ACOS.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD), asthma and asthma-COPD overlap syndrome (ACOS) are obstructive pulmonary disorders with different manifestations. Status of oxidation in tissues is important in obstructive pulmonary disorders. Smoking, acute exacerbations of COPD and asthma were associated with a marked imbalance in oxidant or antioxidant status due to increased oxidative stress in tissues and blood. Oxidative conditions may cause a reversible formation of mixed disulphides among protein thiol groups. The aim of this study was to compare parameters related with thiol/disulphide homeostasis in patients with COPD, asthma and ACOS. PATIENTS AND METHODS: Patients (n= 135, 69 females, 66 males) who were referred with a diagnosis of COPD, asthma or ACOS were included in the study. Thiol/ disulphide homeostasis parameters in blood were analysed by a newly established method that measures the exact thiol/ disulphide status in the body. RESULTS: The patients with COPD, asthma or ACOS were similar for demographic parameters other than age and number of cigarettes smoked. Measured thiol/disulphide homeostasis parameters were similar among these patient groups. When these biochemical measurements were adjusted for age and number of cigarettes by using regression analysis, similarity for thiol/disulphide homeostasis parameters among patient groups persisted. CONCLUSIONS: To best of our knowledge, this is the first study to compare thiol/disulphide homeostasis parameters in COPD, asthma and ACOS patients. Similarity of thiol/disulphide homeostasis parameters among these patient groups supports the current view of Dutch hypothesis that COPD, asthma and ACOS share similar pathophysiological features but display different clinical manifestations.

Hospital based survey of lung cancer in Turkey, a developing country, where smoking is highly prevalent.

While the trend of cigarette consumption in some developed countries is on the decline, it has been noted that in many developing countries, smoking is on the increase. Compared to developed countries, there are more male smokers than female smokers in these countries. The aim of this study was to investigate the prevalence and characteristics of the smoking habit in patients having lung cancer (LC) and to find out if there is any relationship with the smoking habit and the pathological diagnosis in our patient population. This hospital-based study was carried out between 1990 and 1996 in two major medical centres. LC was diagnosed in 1046 patients, 966 of whom were males (93%), and the remaining 80 (7%) of whom were females. Upon diagnosing the male patients, it was noted that 83% were current smokers (CS), 12% were ex-smokers (ES defined as abstinence from smoking at least for 1 year), and the remaining 5% were non-smokers (NS). In the female population the findings were as follows, 16% were CS; 8% were ES, and 76% were NS. The period of abstinence in the ES was 10 years or less in 77% of the patients. Among the male patients, squamous cell carcinoma was the most common tumor type seen in the CS group (46%) while adenocarcinoma (45%) was the most commonly seen tumor in the NS group. On the other hand, in the females, CS, the most commonly noted tumor types were small cell (54%), and adenocarcinoma (39%) was most frequently found in NS group. These results indicate that ES patients having LC in this study was quite low. On the other hand, in contrast to the findings of many other studies, from developed countries, the majority of male LC patients were in the CS group, however the majority of female LC patients were in the NS group. This smoking habit data obtained from our LC patients suggests that, similar to underdeveloped or developing countries, smoking cessation rates are very low in men during the past decade, and interestingly smoking rates may increase in women in the near future in our country.

Evaluation of pentavalent Tc-99m DMSA scintigraphy in small cell and nonsmall cell lung cancers.

AIM: The purpose of this study was to evaluate the clinical usefulness of Tc-99m (V) DMSA in patients suspected of lung cancer and determine whether this agent may have value in differentiation between small cell (SCLC) and non-small cell (NSCLC) lung carcinoma. METHODS: Thirty-six patients with clinical and radiological suspicion of primary lung carcinoma were injected 450-600 MBq of Tc-99m (V) DMSA intravenously. Whole body and planar anterior, posterior thorax images were obtained 4-5 h after injection of the radioactive complex. RESULTS: Histopathological results confirmed 23 NSCLC, 10 SCLC and 1 metastatic lung carcinoma and 2 lung abscess. Nineteen of the 23 (82%) NSCLC and all of the 10 (100%) SCLC cases showed Tc-99m (V) DMSA uptake. Single metastatic lung cancer also accumulated radiotracer. Lung abscess did not show uptake. Lesion/Nonlesion (L/N) ratio of SCLC (1.59 +/- 0.32) and NSCLC (1.43 +/- 0.19) tumour types did not show statistical difference (p > 0.05). Tc-99m (V) DMSA whole body imaging also showed bone metastases. CONCLUSION: Tc-99m (V) DMSA is a noninvasive and cheap imaging method to detect malignant lung cancers and their bone metastases but, differentiation of SCLC and NSCLC is not possible.

Evaluation of choroidal thickness using spectral-domain optical coherence tomography in migraine patients during acute migraine attacks: a comparative study.

PURPOSE: The purpose of this study was to assess choroidal thickness in migraine patients during acute migraine attacks and compare them with healthy controls, using spectral domain optical coherence tomography (OCT). PATIENTS AND METHODS: In this prospective case-control study, choroidal thicknesses of 46 migraine patients during acute migraine attacks and 46 age- and sex-matched healthy subjects were measured using a high-speed, high-resolution frequency domain-OCT device. All patients underwent a complete ophthalmic examination before the measurements. OCT measurements were taken at the same time of day (0900 hours), in order to minimize the effects of diurnal variation. RESULTS: There was a statistically significant difference in mean choroidal thickness between the migraine patients during acute migraine attacks (356.3±21.46 µm) and the controls (302.3±18.34 µm; P=0.000). There were significant differences at all measurement points (P<0.001 for all). CONCLUSION: The increased choroidal thickness of the migraine patients during acute migraine attacks might be related to the vascular pathology of the disease. Further studies are needed to evaluate the etiopathologic relationship between choroidal thickness and acute migraine attack.

Amniotic membrane transplantation using fibrin glue in pterygium surgery: a comparative randomised clinical trial.

PURPOSE: To compare the results of amniotic membrane transplantation (AMT) using fibrin glue vs vicryl sutures in pterygium surgery. METHODS: We carried out a prospective, randomised clinical study of 70 eyes (70 patients) with primary pterygium. After the removal of pterygium, patients were randomised to undergo AMT using fibrin glue (Tisseel, 32 eyes) or 8-0 vicryl sutures (38 eyes). Clinical examination and digital photographing were performed at each visit and the patients were followed up for at least 12 months. Post-operative symptoms in the first month were evaluated according to a five-point scale. Final appearances were graded from 1 to 4 in which grade 4 represented true (corneal) recurrence and grade 3 indicated conjunctival recurrence. RESULTS: The average operation time in the fibrin glue and suture groups were 11.2+/-2.4 min (mean+/-SD) and 18.7+/-2.2 min, respectively (P=0.018). Significantly fewer post-operative symptoms were observed in the fibrin glue group at post-operative days 1, 7, and 14 (P<0.05 for all). At the end of the follow-up, true recurrence (grade 4) was developed in three eyes (9.4%) in the fibrin glue group, and in four eyes (10.5%) in the suture group (P=0.33). The rates of conjunctival recurrence (grade 3) were 21.9% (seven eyes) and 23.7% (nine eyes) in the fibrin glue and suture groups, respectively (P=0.38). CONCLUSIONS: Amniotic membrane grafts can be successfully attached without any major complication in patients undergoing pterygium surgery. In addition, it is effective in shortening the duration of surgery and preventing post-operative discomfort. Although there seems to be no difference in the recurrence rates and cosmetic outcomes between both groups, neither technique represents best results.

Effect of intracameral triamcinolone acetonide on postoperative intraocular pressure after cataract surgery.

PURPOSE: To evaluate the effect of 1 mg intracameral triamcinolone acetonide (TA) on postoperative intraocular pressure (IOP) after routine cataract surgery. PATIENTS AND METHODS: This prospective, randomized, placebo-controlled study comprised 120 eyes of 120 patients with uncomplicated cataract surgery. The patients were randomized into two groups. Eyes in group 1 (60 eyes) received an injection of 1 mg TA into the anterior chamber at the end of the surgery, but eyes in group 2 (60 eyes) did not. The biomicroscopic evaluation, visual acuity (VA), and IOP measurements were done at baseline (preoperatively) and 6, 20-24 h, 1 week, and permonthly until 6 months postoperatively. RESULTS: Mean IOP at 6 and 20-24 h postoperatively were significantly higher than baseline measurements in both groups (P<0.001). Also, the mean IOP values at postoperative 6 and 20-24 h were slightly higher in group 1 than in group 2 (P>0.05 for both). The mean IOPs at week 1 and 1-6 months after surgery were not significantly different from baseline values in both groups (P>0.05 for both time periods). At 6 and 20-24 h postoperatively, the number of eyes with an IOP increase>5 and 10 mm Hg with respect to baseline were not statistically different between the two groups (P>0.05). There were no statistically significant differences in mean VA and the amount of anterior chamber cells and flare between the two groups at any postoperative visit (P>0.05). CONCLUSION: Intracameral injection of 1 mg TA after uncomplicated phacoemulsification surgery had no significant effects on postoperative IOP.

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops.

PURPOSE: To assess the safety and efficacy of topical lidocaine, levobupivacaine, and ropivacaine in cataract surgery with phacoemulsification. METHODS: One hundred and five patients scheduled for cataract surgery with topical anaesthesia were randomly allocated into 3 groups of 35 patients each to receive eye drops of lidocaine 2%, levobupivacaine 0.75%, or ropivacaine 1% every 5 min starting 30 min before surgery. Patients graded their pain using a 0-10-point verbal pain score (VPS) at different stages of the procedure. The levels of patient and surgeon satisfaction, the duration of surgery, complications, and the need for supplemental anaesthesia were recorded. RESULTS: There was no significant difference in duration of surgery and demographic variables among the groups. At the intraoperative period, end of surgery, and postoperative first hour the mean VPS in the lidocaine group was significantly higher than the others (P<0.01), but no significant difference was found between the levobupivacaine and ropivacaine groups. At incision and 24 h after surgery, it was not significantly different among the groups. Surgeon and patient satisfaction scores were significantly better in the levobupivacaine and ropivacaine groups than in the lidocaine group (P<0.01). CONCLUSIONS: Topical anaesthesia with levobupivacaine and ropivacaine were safe, feasible and more effective than lidocaine in cataract surgery. Levobupivacaine and ropivacaine provided sufficient and long-lasting analgesia without the need of supplemental anaesthesia for each patient.

Fibrin glue versus sutures for conjunctival autografting in pterygium surgery: a prospective comparative study.

AIM: To compare the use of fibrin glue versus sutures for fixating conjunctival autografts in patients undergoing pterygium excision. METHODS: Fifty patients (50 eyes) with primary pterygium were randomised to undergo pterygium surgery using either fibrin glue (25 eyes) or 8-0 Vicryl sutures (25 eyes) to attach the conjunctival autograft. The patients were followed up for 12 months. Outcome measures were postoperative patient comfort, duration of surgery and recurrence of pterygium. RESULTS: In the fibrin glue group, the mean operation time was 15.7 (SD 2.4) min (range 12-18 min) and in the suture group (p<0.001) it was 32.5 (6.7) min (range 25-40 min). The intensity of the postoperative pain, foreign-body sensation, irritation and epiphora were significantly lower in the fibrin glue group than in the suture group (p<0.001). The intensity of itchy sensation at the first two postoperative visits was lower among patients in the fibrin glue group (five patients, 20%) than in the suture group (12 patients, 48%) (p<0.05). Two patients in the fibrin glue group had partial graft dehiscence; these grafts were successfully reattached with fibrin glue. At the end of follow-up, pterygium recurrence was observed in one eye (4%) in the fibrin glue group and in three eyes (12%) in the suture group (p<0.05). CONCLUSION: The use of fibrin glue in pterygium surgery with conjunctival autografting significantly reduces surgery time, improves postoperative patient comfort and results in a lower recurrence rate compared with suturing.