Aqueous humor and serum levels of 4-hydroxynonenal and 8-hydroxy-2'deoxyguanosine in pseudoexfoliation syndrome and glaucoma.

PURPOSE: To compare the aqueous humor (AH) and serum levels of 4-hydroxynenal (4-HNE) and 8-hydroxy-2'-deoxyguanosine (8-OhdG) in patients with pseudoexfoliation syndrome (PES) and pseudoexfoliation glaucoma (PEG) with each other and with age- and sex-matched control group. METHODS: This prospective study included 66 patients divided into three groups: PES (n = 24), PEG (n = 21), and a control group (n = 21). 4-HNE and 8-OhdG levels were analyzed using the enzyme-linked immunosorbent assay. RESULTS: Aqueous and serum 4-HNE levels were significantly higher in the PEG (466.52 ± 62.12 pg/mL and 313.47 ± 47.41 pg/mL) and PES (290.69 ± 63.63 pg/mL and 201.53 ± 39.57 pg/mL) groups than the control group (144.02 ± 39.58 pg/mL and 99.10 ± 16.96 pg/mL; p < 0.001, for all). Both aqueous and serum levels of 4-HNE in the PEG group were significantly higher than in the PES group (p < 0.001, for both). Similar to 4-HNE, the AH 8-OhdG levels were higher in the PEG group (21.18 ± 2.23 ng/mL) compared to the PES (14.90 ± 3.37 ng/mL) and control (4.86 ± 1.94 ng/mL) groups (p < 0.001, for all). Serum 8-OhdG levels were significantly higher in the PEG and PES groups than the control (p < 0.001, for both); however, there was no significant difference between the PES and PEG groups (p = 0.097). There were strong significant correlations between the aqueous and serum levels of 4-HNE (p < 0.001, r = 0.857) and 8-OhdG (p < 0.001, r = 0.807) among all the patients. CONCLUSIONS: Aqueous humor and serum levels of 4-HNE and 8-OhdG increased in the PES and PEG patients. These findings are potentially significant and add to the growing body of evidence concerning oxidative stress in PES and PEG.

Sutureless fixation of amniotic membrane using a soft ring for ocular surface diseases.

PURPOSE: To evaluate the efficacy of sutureless amniotic membrane transplantation using a soft bioavailable ring in the management of ocular surface disorders. METHODS: We present a modified technique using a soft, special designed bioavailable ring set (Amnioring) for sutureless amniotic membrane fixation to the ocular surface. A fresh amniotic membrane with a diameter greater than the outside diameter of the ring was folded inwardly over the ring such that the inner side of the ring was covered with the amniotic membrane. The ring was inserted onto the ocular surface. RESULTS: The ring was inserted in 4 eyes of 4 consecutive patients with ocular surface disorders. The mean total operating time was 3 min. The ring fixated the amniotic membrane to the bulbar conjunctiva and provided a quick and easy sutureless placement of amniotic membrane. In all cases, pain was significantly relieved. The corneal epithelial defect and inflammation were markedly reduced. CONCLUSIONS: This novel ring designed for sutureless placement of amniotic membrane provided very good anatomic and functional outcomes in patients with ocular surface disorders. It is less invasive, less time consuming and allows placement in the office conditions with low cost.

The relationship of tear osmolarity with tear meniscus curvature and contact angles in healthy subjects: anterior segment optical coherence tomography study.

PURPOSE: To evaluate the relationship of tear osmolarity (TO) with tear meniscus curvature and contact angles by anterior segment optical coherence tomography (AS-OCT) in healthy subjects. METHODS: The right eyes of 64 consecutive healthy subjects were included in the study. The eyes were scanned by AS-OCT for the measurements of upper and lower tear menisci. The geometrical components of the upper and lower menisci, including height, depth, area, and radius of the menisci, cornea-meniscus angle (α-angle), meniscus-eyelid angle (ß-angle), and curvature angle (θ-angle) were measured. TO was obtained by TearLab. All participants were administered Ocular Surface Disease Index questionnaires (OSDI), and tear film break-up time (TBUT), Schirmer I and II test measurements were also performed. RESULTS: There was no association of TO with height, depth, and area of both menisci while TO was negatively correlated to θ-angle and radius of the lower eyelid meniscus (r = - 0.41, P < 0.001 and r = - 0.40, P < 0.01, respectively). The θ-angle and the radius of the lower meniscus were also significantly associated with OSDI score, TBUT, Schirmer I and II (P < 0.01 for all). There was a statistically strong correlation between the θ-angle and the radius of the lower meniscus (r = 0.91, P < 0.001). CONCLUSION: The curvature angle and radius of the lower meniscus are significantly associated with TO. The curvature angle of the lower meniscus is a useful non-contact measure that may provide information indirectly about the osmolarity and the quality of the tear.

Use of choroidal vascularity index for choroidal structural evaluation in smokers: an optical coherence tomography study.

PURPOSE: To compare the choroidal vascularity index (CVI) and choroidal thickness (CT) in smokers and healthy non-smoking subjects using spectral-domain optical coherence tomography (SD-OCT). METHODS: Forty-two smokers with no systemic disorders and 46 age-sex matched healthy volunteers were included in the study. SD-OCT was used to measure choroidal thickness at the fovea and 1500 µm intervals from the foveal centre in both nasal and temporal directions. Choroidal images were binarized and segmented to the luminal area (LA), stromal area (SA), and total choroidal area (TCA) using ImageJ software. The choroidal vascularity index was calculated as the ratio of LA to TCA. Smoking subjects were divided into three groups according to pack-year exposure: 10-20 pack-years, 20-30 pack-years, and >30 pack-years. Subgroup analysis was performed to evaluate the relationship between CT/CVI/LA/SA/TCA and pack-years. RESULTS: The mean age of the smokers and non-smokers was 43.1 ± 7.26 years and 41.82 ± 9.92 years, respectively (p = 0.51). The mean subfoveal choroidal thickness was 301.57 ± 55.04 µm in smokers and 303.38 ± 53.42 µm in non-smokers (p = 0.826). No significant difference was observed between groups for CT values in the subfoveal location or at 1500 µm intervals in the nasal and temporal direction from the fovea. The CVI was significantly lower in smokers (65.4 ± 2.3%) than in non-smokers (66.3 ± 2.5%) (p = 0.021). In the subgroup analysis, subjects with >20 pack-years of smoking had a significantly lower CVI than non-smokers, but those between 10-20 pack-years did not. A negative correlation was found between the CVI and smoking, as measured by cigarette pack-years (r = -0.226, p = 0.04). CONCLUSION: The CVI was significantly decreased in smokers compared to healthy controls. The study results suggest that the CVI could be a non-invasive tool for evaluating choroidal vascular changes in smokers.

Chromosomal microarray analysis of patients with Duane retraction syndrome.

PURPOSE: Duane retraction syndrome (DS) is a rare congenital strabismus with genetic heterogeneity. The genetic causes of DS are not always of monogenic origin; various chromosomal copy number variations (CNVs) have also been reported. The objective of our study was to characterize the CNVs, including gains and losses detected by high-resolution chromosomal microarray in patients with DS. METHODS: Twenty patients with DS were investigated using high-resolution chromosomal microarray analysis (CMA) (Affymetrix CytoScan Array 750 K). Conventional cytogenetic analysis was also performed. RESULTS: All samples revealed normal karyotype by cytogenetic analysis. However, in all our patients, multiple CNVs, including gains and losses, were detected using the high-resolution CMA method. Chromosomal loci 1q21.2, 2p11.2-q11.1, 2q21.1-q21.2, 4p16.1, 7p11.2-q11.21, 14q32.33, 17p11.2-q11.1 and 20p11.1-q11.21 were the most frequently affected regions. CONCLUSIONS: This study emphasized that CNVs in several chromosomal regions are known to be involved in DS. We also underscore the genetic heterogeneity of DS. Our suggestion is that genes located in the most frequently affected regions should be focused on in the following candidate gene studies.

Dexamethasone Implant in Chronic Diabetic Macular Edema Resistant to Intravitreal Ranibizumab Treatment.

PURPOSE: The aim of this study was to assess the efficacy of a single intravitreal dexamethasone implant (IDI) over 6 months in eyes with chronic diabetic macular edema (DME) that were resistant to intravitreal ranibizumab (IR) treatment. METHODS: This retrospective study was conducted at the Ondokuz Mayis University Hospital, Samsun, Turkey. Efficacy outcomes were considered as the change from baseline in best corrected visual acuity (BCVA) and central macular thickness (CMT). RESULTS: Thirty eyes of 20 patients with a mean age of 61.6 ± 8.8 (45-85) years were included in the study. The mean BCVA significantly increased from 0.68 ± 0.27 to 0.56 ± 0.30 logMAR (p = 0.001) and 0.57 ± 0.30 logMAR (p = 0.002) at months 1 and 2, respectively. The proportion of patients who gained 3 or more lines in BCVA was 20%. The mean CMT significantly decreased from 578.93 ± 17.95 µm at baseline to 282.10 ± 21.42, 292.26 ± 19.69, 371.70 ± 21.23, and 463.60 ± 23.16 µm at months 1, 2, 3, and 4, respectively (p = 0.001). Intraocular pressure (IOP) increase occurred in 5 (16.7%) eyes. Cataract surgery was required in 3 (13%) out of 23 phakic eyes. CONCLUSION: IDI provides significant benefits in visual acuity gains and anatomic improvements in eyes with chronic DME that are resistant to IR treatment. Increases in IOP and cataract progression can be observed in IDI-treated patients. However, its safety profile is acceptable.

Comparison of the corneal biomechanical properties, optic nerve head topographic parameters, and retinal nerve fiber layer thickness measurements in diabetic and non-diabetic primary open-angle glaucoma.

The purpose of this study is to investigate the corneal biomechanical properties, optic nerve head (ONH) topographic parameters, and retinal nerve fiber layer (RNFL) thickness changes in primary open-angle glaucoma (POAG) patients with and without diabetes, as well as to evaluate the effect of the metabolic control of diabetes on corneal biomechanical properties, ONH topography, and RNFL thickness. A total of 101 eyes of 101 POAG patients (60 with diabetes and 41 without diabetes) were recruited in this prospective study. Corneal hysteresis and corneal resistance factor (CRF) were both measured using the ocular response analyzer. Optic disk parameters were evaluated using the Heidelberg Retina Tomograph-III. RNFL thickness was measured by using Spectralis HRA + OCT. CRF, mean rim area, and rim volume were found to be significantly higher in the diabetic group when compared with non-diabetic group (p = 0.01 for CRF, p = 0.04 for rim area and p = 0.02 for rim volume). ANCOVA analysis showed statistically insignificant effects of age, gender, MD, and PSD values over rim area and rim volume (p > 0.05). CRF was not significantly correlated with HbA1c levels (p > 0.05). Cup area (CA), cup volume (CV), and cup shape measure (CSM) were weakly correlated with HbA1c levels (r = 0.35 and p = 0.006 for CA; r = 0.32 and p = 0.01 for CV; r = 0.32 and p = 0.01 for CSM). The difference in mean RNFL thickness values between the groups was found to be insignificant (p > 0.05). The results of this study raise doubts whether or not diabetes does in fact shield POAG patients from glaucomatous optic nerve damage from various perspectives.

A safe method of ciliary sulcus fixation of foldable intraocular lens using a ciliary sulcus guide.

To describe a novel technique for implantation of intraocular lens in the absence of capsular support using a ciliary sulcus guide. Based on the anatomic knowledge of the ciliary sulcus and the sclera, a new instrument was developed to pierce the needle safely through the ciliary sulcus and sclera. While the foldable lens is stored inside the cartridge, the leading haptic is sutured with a cow-hitch knot. The needle is then inserted into the ciliary sulcus guide. The tip of the guide is inserted from the corneal incision and proceeded under the iris to touch and fit the ciliary sulcus. The needle is pushed from back side. The needle comes out at precise point at the sclera. Implantation of the lens was performed through a 2.8 mm clear cornea incision using the injector. The trailing haptic is tied after implantation, and then the same procedure is performed at the opposite side. We performed this technique to 15 aphakic eyes without sufficient capsular support. There was no bleeding or other intraoperative complication. All the points coming out the sclera were between 2 and 2.5 mm from the limbus. The ab interno technique for scleral fixation of IOL is quicker, easier and less traumatic then ab externo techniques. A new ciliary sulcus guide which is usable with both straight and curved needles eliminates the blind maneuvers of ab interno technique and makes this technique more safe and precise.

The effect of pupil dilation on AL-Scan biometric parameters.

The purpose of this study was to investigate the effects of pupil dilation on the parameters of the AL-Scan (Nidek Co., Ltd, Gamagori, Japan). We compared the measurements of axial length (AL), anterior chamber depth (ACD), central corneal keratometry reading, pupil diameter, and intraocular lens (IOL) power of 72 eyes of 72 healthy volunteers and patients scheduled for cataract surgery before and 45 min after instillation of cyclopentolate hydrochloride 1 % using the AL-Scan. Intraobserver repeatability was assessed by taking three consecutive recordings of ACD and AL. Only ACD readings were significantly different between predilation and postdilation (P < 0.001). The difference of the other measurements between two sessions was not statistically significant (P > 0.001). Only two cases in the study demonstrated changes in IOL power higher than 0.5 D. The intraobserver repeatability of both devices was good (CV values for ACD and AL were 0.16 and 0.20 %, respectively). Dilated pupil size did not affect the measurement of IOL power using the A-Scan optical biometer, but increase in ACD after dilation should be taken into account when performing refractive surgeries in which ACD is very important such as phakic anterior chamber IOL implantation.

Comparison of central corneal thickness measurements using different imaging devices and ultrasound pachymetry.

PURPOSE: To compare central corneal thickness (CCT) measurements obtained by the AL-Scan, Lenstar LS900, Galilei, and ultrasound pachymetry (UP) in normal and cataractous eyes. METHODS: Eighty eyes of healthy subjects were included in the study. Each subject was assessed by four different methods of measurements using the AL-Scan, Lenstar LS900, Galilei, and UP by a single examiner. To assess the intraobserver repeatability, three consecutive measurements were taken for the AL-Scan. RESULTS: The mean CCT [± standard deviation (SD)] for the AL-Scan, Lenstar LS900, Galilei, and UP were 554.6 ± 30.9 µm, 542.9 ± 31.3 µm, 570.7 ± 30 µm, and 552.7 ± 32.8 µm, respectively. The differences between pairs of mean CCT for the methods are statistically significant for the pairs of Galilei-UP, AL-Scan-Galilei, and Lenstar LS900-Galilei. Bland-Altman plots showed that AL-Scan-UP have the closest agreement, followed by Lenstar-UP and AL-Scan-Lenstar. Galilei was found to have the poorest agreement with the other three methods. The intraobserver repeatability of the AL-Scan was very good with an intraclass correlation coefficient (ICC) of 0.980. CONCLUSION: We found that CCT measurements between the AL-Scan-UP, Lenstar LS900-UP, and AL-Scan-Lenstar LS900 showed very strong correlation and comparable agreement. AL-Scan-UP showed the closest agreement and these devices can be used interchangeably in clinical practice. Galilei significantly showed higher value of CCT compared to other methods. It was also observed that the Al-Scan had excellent intraobserver repeatability.

Flapless and sutureless intrascleral fixation of posterior chamber intraocular lens for correction of aphakia.

A new intrascleral fixation technique for a standard 3-piece posterior chamber intraocular lens (PC IOL) using a simple guide is described. To secure the haptics, 27-gauge scleral tunnels are created. Both haptics are secured extraocularly. The leading haptic of the PC IOL placed in the cartridge is released partly and introduced into the lumen of the guide. The PC IOL is inserted into the eye, and the leading haptic is externalized by pulling the guide gently through the 27-gauge sclerotomy site. The trailing haptic is externalized using the same procedure. This technique facilitates achieving minimally invasive sutureless intrascleral PC IOL fixation.

Evaluation of the lamina cribrosa in patients with diabetes mellitus using enhanced depth imaging spectral-domain optical coherence tomography.

PURPOSE: To compare the lamina cribrosa thickness and anterior lamina cribrosa depth between patients with and without diabetes mellitus and to investigate the effect of metabolic control and duration of diabetes mellitus on lamina cribrosa thickness and anterior lamina cribrosa depth using enhanced depth imaging spectral-domain optical coherence tomography. METHODS: A total of 70 patients were enrolled in this cross-sectional study and were divided into the diabetes and control groups. Intraocular pressure, circumpapillary retinal nerve fibre layer thickness, anterior lamina cribrosa depth and lamina cribrosa thickness were compared between the groups. RESULTS: In the control group, the mean intraocular pressure was 14.6 ± 3.1 (mean ± standard deviation) mmHg, mean circumpapillary retinal nerve fibre layer thickness was 105.41 ± 5.86 µm, mean anterior lamina cribrosa depth was 420.3 ± 90.2 µm and mean lamina cribrosa thickness was 248.5 ± 5.4 µm. In the diabetes group, the mean intraocular pressure was 13.9 ± 2.2 mmHg, mean circumpapillary retinal nerve fibre layer thickness was 101.37 ± 10.97 µm, mean anterior lamina cribrosa depth was 351.4 ± 58.6 µm and mean lamina cribrosa thickness was 271.6 ± 33.9 µm. Lamina cribrosa thickness was significantly higher ( p < 0.001) and anterior lamina cribrosa depth was significantly lower ( p = 0.003) in the diabetes group. There was no statistical difference between the groups with regard to age, spherical equivalent, axial length, circumpapillary retinal nerve fibre layer thickness and intraocular pressure ( p = 0.69, 0.26, 0.47, 0.06 and 0.46, respectively). Lamina cribrosa thickness and anterior lamina cribrosa depth were not significantly correlated with duration of diabetes mellitus (lamina cribrosa thickness: r = -0.078, p = 0.643; anterior lamina cribrosa depth: r = -0.062, p = 0.710) or HbA1c levels (lamina cribrosa thickness: r = -0.078, p = 0.596; anterior lamina cribrosa depth: r = -0.228, p = 0.169). CONCLUSION: The results of this study showed that the optical coherence tomography measurement of lamina cribrosa revealed thicker and more anteriorly positioned lamina cribrosa for patients with diabetes mellitus compared with those for healthy controls.

Comparison of Optic Nerve Head Topographic Parameters in Patients With Primary Open-Angle Glaucoma With and Without Diabetes Mellitus.

PURPOSE: To evaluate the optic nerve head (ONH) parameters of primary open-angle glaucoma (POAG) patients with and without diabetes and to investigate the effect of the metabolic control of diabetes on ONH topography. MATERIALS AND METHODS: A study group of 60 eyes of 60 POAG patients with type 2 diabetes mellitus and a control group of 41 eyes of 41 POAG patients without diabetes were recruited for the study. Complete ophthalmic examinations of all patients were performed and the quantitative optic disc parameters were evaluated with Heidelberg retina tomography (HRT) III. HbA1c measurements of diabetic patients were assessed on the same day when the ophthalmic assessments were performed. RESULTS: Mean rim area and rim volume of the study group was statistically higher than the control group (P=0.04 for rim area and P=0.02 for rim volume). The difference in other parameters of the HRT between the groups were insignificant (P>0.05). In the study group, the duration of the diabetes was not significantly correlated to rim area and rim volume (r=0.03, P=0.81 for rim area; r=0.03, P=0.79 for rim volume). Analysis of covariance showed insignificant effects of age, sex, MD, and PSD values over rim area and rim volume (P>0.05). There were weak but statistically significant correlations between HbA1c levels and some HRT parameters including disc area, cup area, cup volume, and cup shape measure (r=0.35 and P=0.006 for disc area; r=0.35 and P=0.006 for cup area; r=0.32 and P=0.01 for cup volume; r=0.32 and P=0.01 for cup shape measure). CONCLUSIONS: The results of this study imply the protective effect of diabetes over glaucomatous optic nerve damage in POAG patients. However, larger and controlled studies are warranted to confirm those findings.

Comparison of Anterior Segment Parameters Obtained by Dual-Scheimpflug Analyzer Before and After Cycloplegia in Children.

PURPOSE: To assess the changes of anterior segment parameters with cycloplegia. METHODS: A cross-sectional study of healthy pediatric patients was performed. Anterior segment parameters were obtained by the Galilei Dual-Scheimpflug analyzer (Ziemer Group, Port, Switzerland) before and 40 minutes after the instillation of cyclopentolate. The effect of gender was evaluated. RESULTS: There were 43 boys and 50 girls with a mean age of 7.76 ± 2.7 years. There was a significant increase in anterior chamber depth, anterior chamber volume, and pupil diameter after the cycloplegia (P < .05). The anterior chamber angle increased after cycloplegia in the nasal, temporal, and inferior quadrants (P < .05), but not in the superior quadrant (P > .05). The mean values of anterior segment parameters were similar in both genders. CONCLUSIONS: The values of anterior chamber depth, anterior chamber volume, anterior chamber angle, and pupil diameter measured with the Galilei Dual-Scheimpflug analyzer increased significantly after cycloplegia. Gender did not have an effect on anterior segment parameters. [J Pediatr Ophthalmol Strabismus. 2016;53(4):234-237.].

Comparison of Anterior Segment Measurements with Optical Low-coherence Reflectometry and Partial-coherence Interferometry Optical Biometers.

AIMS: To evaluate a new noncontact optical biometer using partial-coherence interferometry and to compare the clinical measurements with those obtained from the device using optical low-coherence reflectometry (OLCR). SETTING AND DESIGN: Ondokuz Mayis University, Samsun, Turkey. Nonrandomized, prospective clinical trial. SUBJECTS AND METHODS: The study was performed on the healthy phakic eyes of volunteers in the year 2014. Measurements of axial length (AL), anterior chamber depth (ACD), central corneal thickness (CCT), mean keratometry (K), and white-to-white (WTW) measurements obtained with the low-time coherence interferometry (LTCI) were compared with those obtained with the OLCR. STATISTICAL ANALYSIS USED: The results were evaluated using Bland-Altman analyses. The differences between both methods were assessed using the paired t-test, and its correlation was evaluated by Pearson's coefficient. RESULTS: We examined seventy participants with a mean age of 33.06 (±9.7) (range: 19-53) years. AL measurements with LTCI and OLCR were 23.7 (±1.08) mm and 23.7 (±1.1) mm, respectively. ACD was 3.6 (±0.4) mm and 3.5 (±0.4) mm for LTCI and OLCR, respectively. The mean CCT measurements for both devices were 533 (±28) mm and 522 (±28) mm, respectively. The mean K readings measurements for LTCI and OLCR were 43.3 (±1.5) D and 43.3 (±1.5) D, respectively. The mean WTW distance measurements for both devices were 12.0 (±0.5) mm and 12.1 (±0.5) mm, respectively. CONCLUSIONS: Measurements with LTCI correlated well with those with the OLCR. These two devices showed good agreement for the measurement of all parameters.

Posterior Capsular Opacification in Preschool- and School-Age Patients after Pediatric Cataract Surgery without Posterior Capsulotomy.

OBJECTIVES: We aimed to evaluate the development of posterior capsular opacification (PCO) in preschool- and school-age children with cataract who underwent cataract surgery without posterior capsulotomy and anterior vitrectomy. MATERIALS AND METHODS: The records of 30 eyes of 21 patients who underwent pediatric cataract surgery and intraocular lens (IOL) implantation were retrospectively reviewed. Patients' age, PCO status and duration, need for neodymium-doped yttrium aluminium garnet (Nd:YAG) laser treatment based on coverage of visual axis, and follow-up period were recorded. RESULTS: The mean age of the patients was 7.6±2.83 (4-12) years. Unilateral cataract surgery and IOL implantation were performed in 12 patients (57.14%) and bilateral cataract surgery and IOL implantation were performed in nine patients (42.86%). Average follow-up time was 17.7±22.67 (3-83) months. PCO developed in 21 eyes (70%) and covered the visual axis in 15 eyes (50%), which therefore required Nd:YAG laser posterior capsulotomy. The mean duration of postoperative PCO development was 8.91±18.7 months (1 week-71 months). CONCLUSION: We believe that with adequately experienced surgeons, performing both cataract surgery and posterior capsulotomy with anterior vitrectomy in the same session is appropriate for selected preschool- and school-age children with cataract.

A Possible Cause of Nasolacrimal Duct Obstruction: Narrow Angle Between Inferior Turbinate and Upper Part of the Medial Wall of the Maxillary Sinus.

BACKGROUND: To search the relationships between the primary nasolacrimal duct obstruction and the angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus. DESIGN: Retrospective study. PARTICIPANTS AND METHODS: Computed tomography findings of 35 patients with primary nasolacrimal duct obstruction and 100 sides of 50 individuals were reviewed. While the study group was composed of patients who had external dacryocystorhinostomy surgery, the control group was composed of patients who had CT scans due to headache, sinusitis and smell dysfunction. Epiphora complaint was evaluated with the lacrimal syringing. The exclusion criteria were: age less than 20 years, previous nose, sinus, turbinate or lacrimal surgery, prior history of maxillofacial fracture, nasopharyngeal malignancy, reflex hypersecretion, and associated pathology of the lacrimal canaliculi. MAIN OUTCOME MEASURES: The angle of inferior turbinate. RESULTS: The mean angles were 53.2° (range, 37.9-82.9°) for affected side of the study group, 58.6° (range, 32-85.3°) for the unaffected side of the study group and 56.8° (range, 41.2-76.9°) in the control group. The difference between the angles was statistically significant between the study and the control groups (p < 0.05). The difference between the operated and non-operated sides of the study group was also statistically significant (p < 0.05). CONCLUSION: Although this study was performed in a small group, we thought that the narrow angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus might be a possible causative factor in primary acquired nasolacrimal duct obstructions.

Ab-interno scleral suture loop fixation with cow-hitch knot in posterior chamber intraocular lens decentration.

AIM OF STUDY: To describe a simplified ab-interno cow-hitch suture fixation technique for repositioning decentered posterior chamber intraocular lens (PC IOL). MATERIALS AND METHODS: Two cases are presented with the surgical correction of decentered and subluxated IOL. Ab-interno scleral suture fixation technique with hitch-cow knot in the eye was performed with a ciliary sulcus guide instrument and 1 year follow-up was completed. RESULTS: Both of the patients had well centered lenses postoperatively. Corrected distant and near visual acuities of the patients were improved. There was no significant postoperative complication. In the follow-up period of 1 year, no evidence of suture erosion was found. CONCLUSIONS: Ab-interno scleral suture loop fixation with hitch-cow knot in the eye was effective in repositioning decentered or subluxated PC IOLs with excellent postoperative centered lenses and visual outcomes.