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.

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.

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.

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.

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 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.

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.

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.

Surgical management of intraocular lens dislocations / Tratamento cirúrgico dos deslocamentos de lentes intraoculares

ABSTRACTPurpose:To report and compare the surgical, visual, and anatomical outcomes following treatment of dislocated intraocular lenses (IOLs).Methods:The medical records of 28 eyes of 28 patients were evaluated. Age, gender, pre-and postoperative best-corrected visual acuity (BCVA), surgical methods, and complications were recorded.Results:Pre-and postoperative BCVA ranged from counting fingers to 20/32 and from counting fingers to 20/25, respectively. Late-onset dislocations were the most frequently observed complication. The most frequent surgical method was IOL repositioning in 15 of 28 patients, followed by IOL exchange in 11 patients, and IOL removal in 2 patients. Only 1 patient required surgical re-intervention with IOL capture.Conclusions:Visual acuity improved following the use of either IOL repositioning or IOL exchange. No superiority of one method over the other was observed. In the present retrospective case series, management of dislocated IOLs with repositioning or exchange of the primary implant conferred comparable surgical and visual outcomes.

RESUMOObjetivo:Relatar e comparar as abordagens cirúrgicas e os resultados visuais e anatômicos no tratamento de lentes intraoculares (IOL) deslocadas.Métodos:Foram avaliados os registros médicos de 28 olhos de 28 pacientes. Idade, sexo, melhor acuidade visual corrigida pré e pós-operatória, abordagens cirúrgicas e complicações foram registrados.Resultados:Melhor acuidade visual corrigida pré e pós-operatória variou de conta dedos a 20/32 e de conta dedos a 20/25, respectivamente. Os deslocamentos tardios foram os mais frequentemente encontrados. A cirurgia mais frequente foi o reposicionamento da IOL em 15 dos 28 pacientes, em seguida, o troca da IOL em 11 pacientes, e a remoção da IOL em dois pacientes. Apenas um caso de necessitou de reintervenção devido à captura da IOL.Conclusões:A acuidade visual melhorou em ambas as abordagens, reposicionamento e troca de IOL. Não houve superioridade de um método sobre o outro. Na presente série de casos retrospectiva, o tratamento do deslocamento de IOL com reposição ou troca do implante primário gerou resultados cirúrgicos e visuais comparáveis.

Hyaluronidase in ophthalmic evisceration surgery.

BACKGROUND: To research the effectiveness of hyaluronidase in evisceration surgery. METHODS: A total of 34 patients were studied as three groups: conventional surgery group (n = 13); isotonic fluid group (n = 8); and hyaluronidase group (n = 13). Hyaluronidase and isotonic fluid were introduced into the uveo-scleral space. Intraocular content was removed, if possible by a one-scoop method, with the aid of a spoon. RESULTS: Removing all the intraocular content as a one-scoop method was achieved in 10 of 13 (77%) in the hyaluronidase group and four of eight (50%) in the isotonic fluid group. The one-scoop method was not possible in any case without the introduction of fluid. The mean durations for the evisceration procedure were 32, 36.6 and 40.5 min in the three groups, respectively (P < 0.05). CONCLUSIONS: Using hyaluronidase in evisceration surgery greatly facilitates and speeds up the removal of all the intraocular content in ophthalmic evisceration surgery.