Changes in Intraocular Lens Explantation Indications and Comparison of Various Explantation Techniques.

PURPOSE: To examine the current causes of intraocular lens (IOL) explantation, compare various IOL explantation techniques, and assess the visual outcomes and complications. DESIGN: Retrospective comparative case series. PARTICIPANTS: A total of 175 eyes of 160 patients who underwent IOL exchange for a one-piece foldable acrylic IOL between January 2010 and March 2022 were covered by the research. Group 1 included 74 eyes from 69 patients in which the IOL was removed after being grasped, pulled, and refolded inside the main incision. Group 2 consisted of 66 eyes from 60 patients in which the IOL was removed by bisecting it, whereas group 3 included 35 eyes from 31 patients in which the IOL was removed by enlarging the main incision. MAIN OUTCOMES: Surgical indications, interventions, visual outcomes and refraction, and complications. RESULTS: The mean patient age was 66.1 ± 10.5 years. The mean time between primary surgery and IOL explantation was 57.0 ± 38.9 months. IOL dislocation (in 85 eyes, 49.5%) was the most common reason for IOL explantation. When the patients were examined in terms of both surgical indication groups and IOL removal techniques, corrected-distance visual acuity increased significantly in all subgroups (P < .001). The increase in astigmatism after surgery was 0.08 ± 0.13 diopters (D) in group 1, 0.09 ± 0.17 D in group 2, and 0.83 ± 0.29 D in group 3 (P < .001). CONCLUSIONS: The grasp, pull, and refold technique for IOL explantation provides a simpler surgery, less complication, and good visual outcomes.

Clinical Outcomes of Piggybacking a One-Piece IOL With a Three-Piece IOL in Eyes With Nanophthalmos.

PURPOSE: To compare the nanophthalmic eyes in which a three-piece intraocular lens (IOL) along with a one-piece IOL and two one-piece IOLs were used for piggyback IOL implantation into the capsular bag. METHODS: This retrospective comparative case series included 61 eyes of 31 patients. Group 1 consisted of 31 eyes of 16 patients who underwent piggyback implantation of a one-piece IOL along with a three-piece IOL into the capsular bag. Group 2 consisted of 30 eyes of 15 patients who underwent piggyback implantation of two one-piece IOLs into the capsular bag. IOL spherical power was determined by calculating the arithmetic mean of the Holladay 1 formula and Hoffer Q formula, targeting emmetropia. Main outcomes were postoperative visual acuity and refraction, IOL centration and tilt, and complications. RESULTS: The mean postoperative follow-up time was 15.6 ± 5.2 months in Group 1 and 14.8 ± 4.3 months in Group 2 (P = .51). There was no significant difference between the two groups in terms of preoperative and postoperative spherical equivalent (P = .52 and .42, respectively). Twenty-six eyes (83.8%) in Group 1 and 26 eyes (86.60%) in Group 2 were within ±1.50 D of emmetropia. Mean IOL decentration was significantly lower in Group 1 (0.03 ± 0.08 mm) than Group 2 (0.14 ± 0.18 mm) (P = .003). The mean IOL tilt was 1.45 ± 2.94 degrees in Group 1 and 4.00 ± 4.23 degrees in Group 2 (P = .008). CONCLUSIONS: Piggyback implantation of a three-piece IOL combined with a one-piece IOL provides less IOL decentration and tilt in patients with nanophthalmos. The use of the arithmetic mean of the Holladay 1 and Hoffer Q formulas for IOL power calculation provides more accurate results. [J Refract Surg. 2022;38(12):812-818.].

Posterior capsular vacuuming to avoid PCO formation.

AIM: To retrospectively evaluate the effectiveness of the capsular vacuuming technique in reducing posterior capsule opacification (PCO). METHODS: Group 1 of the study consisted of 2752 eyes of 2752 patients with a cataract who had undergone phacoemulsification and IOL implantation surgery with anterior, equatorial, and posterior capsular polishing between January 2010 and December 2014. Group 2 consisted of 2761 eyes of 2761 patients with a cataract who had undergone phacoemulsification and IOL implantation surgery with anterior, equatorial, and posterior capsular polishing as well as posterior capsular vacuuming between January 2010 and December 2014. RESULTS: The mean patient age was 63.45 ± 12.23 years (range, 43-89) in Group 1 and 64.02 ± 13.36 years (range, 40-91) in Group 2. The two groups did not significantly differ with respect to age, sex, preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) measurements (p > 0.05). At the 5-year follow-up, 253 eyes (9.19%) in Group 1 developed PCO requiring Nd:YAG laser capsulotomy, whereas 24 eyes (0.86%) in Group 2 developed PCO requiring Nd:YAG laser capsulotomy (p < 0.001). During capsular vacuuming, posterior capsule rupture was observed in the shape of a hole in only 2 eyes in Group 2. But the IOLs were implanted in the capsular bag in all eyes in both groups. CONCLUSION: PCO is the most common complication of cataract surgery; therefore, surgical technique is important in preventing PCO formation. We recommend posterior capsular vacuuming together with anterior, equatorial, and posterior capsular polishing, as this method significantly reduced the PCO rate.

The effectiveness of the dacryocystorhinostomy operation with physiodispenser in nasolacrimal duct obstruction.

PURPOSE: To evaluate the effectiveness of the dacryocystorhinostomy (DCR) operation with physiodispenser in nasolacrimal duct obstruction. METHODS: Two hundred and twelve eyes from 150 patients with chronic dacryocystitis who had undergone external DCR operation with Kerrison punch were included in Group 1. Two hundred and fourteen eyes from 150 patients with chronic dacryocystitis who had undergone external DCR operation with physiodispenser were included in Group 2. RESULTS: There were no significant differences between the two groups in terms of age and sex (p > .05). Excessive bleeding requiring cauterization was observed in 41 (19%) patients in Group 1 and 8 (3%) patients in Group 2 (p < .05) during surgery. The mean operation duration was 32.36 ± 5.46 (26-42) minutes in the first group and 20.41 ± 4.98 (15-28) minutes in the second group (p < .05). Functional success rate at the end of the second postoperative year was 90.2% in the first group and 92.4% in the second (p > .05). Anatomical success rate at the end of second postoperative year was 95.8% in the first group and 98.1% in the second (p > .05). CONCLUSION: DCR operation with physiodispenser shortens the operation duration, reduces excessive bleeding, and has high functional and anatomical success rates.

Facilitated Tenon-Free Conjunctival Autograft Preparation and Limited Tenon Removal Technique in Pterygium Surgery.

BACKGROUND: The main complication of primary pterygium surgery is the recurrence of the pterygium. In the present study, we aimed to compare a classical technique and facilitated tenon-free conjunctival autograft preparation and a limited tenon removal technique in pterygium surgery in terms of recurrence rate, complications, and operation duration. MATERIAL AND METHODS: This is a retrospective, comparative, observational study. Group 1 comprised 120 eyes of 115 patients who underwent pterygium excision with a new facilitated tenon-free conjunctival-limbal autograft preparation and limited tenon removal technique between May 2017 and October 2019. Group 2 comprised 117 eyes of 113 patients who underwent pterygium excision with a conventional conjunctival-limbal autograft technique between January 2016 and May 2017. RESULTS: The mean follow-up time after surgery was 18.2 ± 5.8 months in group 1 and 19.1 ± 6.3 months in group 2 (p = 0.25). The mean operation duration was 5.54 ± 1.22 (4 - 7) minutes in group 1 and 8.23 ± 1.26 (8 - 10) minutes in group 2 (p = 0.02). Flap edema was present in 33 eyes (28.2%) in group 2 and in 11 eyes (9.16%) in group 1. Flap edema was significantly higher in group 2 (p < 0.001). At the end of the 1-year follow-up of the patients, we observed recurrence in only one (0.83%) eye in group 1 and 14 (11.96%) eyes in group 2. The recurrence rate of group 1 was significantly less than that of group 2 (p < 0.001). CONCLUSIONS: The simplified technique of tenon-free conjunctival autograft preparation and limited tenon removal yielded better clinical outcomes without serious complications. Additionally, this technique shortened the surgical time and reduced surgeon-dependent factors.

The Results of Preoperative Use of Topical Brimonidine in Strabismus Surgery.

Purpose: In this study, we wanted to retrospectively evaluate the effect of the use of topical brimonidine on intraoperative bleeding and surgical hemostasis before strabismus surgery. Methods: Brimonidine tartrate 0.15% (Brimogut, Bilim Ilac, Turkey) eye drops were applied 6 and 3 min before surgery to 44 eyes of 22 patients in group 1 for vasoconstriction. Drops were not applied to 46 eyes of 23 patients in group 2. Preoperative and postoperative photographs and video images were taken. Black-and-white images were used to define the surface areas of the blood vessels. The surface area was calculated by counting the black pixels with ImageJ software. Results: In group 1, redness of eye was observed, on average, at preoperative 339.25 ± 11.52 pixels and intraoperative 247.93 ± 10.63 pixels (P < 0.001). But there was no change in group 2 (preoperative 338.87 ± 8.45 pixels to intraoperative 339.71 ± 9.52 pixels, P > 0.05). The incidence of intraoperative bleeding evaluated by the number of eyes on which cautery was used shows that it was significantly less in group 1 than in group 2 (P < 0.001). Conclusions: The use of topical brimonidine before strabismus surgery facilitates clear monitoring of anatomical structures during surgery by effectively controlling hemorrhage. In the postoperative period, it significantly reduces subconjunctival hemorrhage.

Changes in Visual Field Indices after Pterygium Surgery.

OBJECTIVES: This study was a prospective evaluation of changes in the results of visual field tests taken before and after pterygium excision. METHODS: This was a prospective, single-center study. Seventy-five eyes of 75 patients who had undergone pterygium excision with autograft implantation were enrolled. All of the patients had stage III pterygium according to the Johnston classification. The mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI) global index changes after pterygium excision were compared to evaluate the effect of pterygium on visual field analysis. RESULTS: The mean preoperative MD value was -3.04±2.63 dB (range: -14.84-0.62 dB) and the mean postoperative MD value was -1.83±2.09 dB (range: -13.82-1.74 dB) (p<0.001). The mean preoperative PSD value was 2.59±1.92 dB (range: 1.16-12.76 dB) and the mean postoperative PSD value was 2.41±1.62 dB (1.15-13.29 dB) (p>0.05). The mean preoperative VFI value was 96.01±4.46% (range: 68-100%) and the mean postoperative VFI value was 96.28±4.18% (range: 70-100%) (p>0.05). CONCLUSION: After pterygium excision, the MD improved significantly. However, the PSD and VFI did not change significantly. The significant change in MD value was related to the reduction in corneal light scattering, contrast sensitivity, aberrations, and blockage on the optic axis.

The evaluation of postoperative objective and subjective refraction for premium intraocular lenses / A avaliação da refração objetiva e subjetiva pós-operatória para lentes intraoculares premium

Abstract Purpose: To evaluate six different premium IOLs retrospectively in respect to both subjective and objective refraction after cataract operation. Methods: Five hundreds and seventy eyes of 285 patients with bilateral cataract who had undergone phacoemulsification and IOL implantation operation between February 2017 and September 2018 were enrolled in this study. The mean age of the patients was 57.78 ± 7.49 (41-71) years. Out of 285 patients 137 were male (48.07%) and 148 were female (51.93%). TheIOLsusedare: RayOne Trifocal (Rayner, Worthing, UK), Lucidis (Swiss Advanced Vision, Neuchâtel, Switzerland), PanOptix (Alcon, Fort Worth, USA), LentisMplus (Oculentis, Berlin, Germany), TecnisSymfony (Abbott, Illinois, USA) and Acriva Trinova (VSY Biotechnology, Istanbul, Turkey). Results: There were no significant differences among the groups regarding age, sex, axial length, the mean preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), the mean preoperative spherical equivalent (SE) and the mean postoperative SE (subjective measurement) (P> .05). The postoperative refractions measured with autorefractometer were more myopic than subjective refractions in all patients except the patients who had PanOptix IOL. In postoperative twelfth month, the mean UCVA arrived 0.00 logMAR in 405 eyes (78.48%) , however, the mean autorefractometric measurement was -1.28 ± 1.02 (0.00_-2.75) D. Conclusion: The autorefractometer measurements of all patients who had premium IOLs except PanOptix IOL were not coherent with their visual acuities postoperatively. The ophthalmologists and/or optometrists should be careful while examining these types of patients.

Resumo Objetivo: Avaliar retrospectivamente seis diferentes LIOs premium em relação à refração subjetiva e objetiva após operação de catarata. Métodos: Quinhentos e setenta (570) olhos de 285 pacientes com catarata bilateral submetidos a facoemulsificação e operação de implantação de LIO entre fevereiro de 2017 e setembro de 2018 foram incluídos neste estudo. A média de idade dos pacientes foi de 57,78 ± 7,49 (41-71) anos. Dos 285 pacientes, 137 eram do sexo masculino (48,07%) e 148, do sexo feminino (51,93%). As seguintes IOLs foram utilizadas: RayOne Trifocal (Rayner, Worthing, Reino Unido), Lucidis (Swiss Advanced Vision, Neuchâtel, Suíça), PanOptix (Alcon, Fort Worth, EUA), LentisMplus (Oculentis, Berlim, Alemanha), TecnisSymfony (Abbott, Illinois, EUA) e Acriva Trinova (VSY Biotechnology, Istambul, Turquia). Resultados: Não houve diferenças significativas entre os grupos em relação à idade, sexo, comprimento axial, média da acuidade visual não corrigida pré e pós-operatória (AVNC), melhor acuidade visual corrigida (MAVC), equivalente esférico pré-operatório médio (EE) e EE pós-operatório médio (medição subjetiva) (P > 0,05). As refrações pós-operatórias medidas com autorefratômetro foram mais míopes do que as refrações subjetivas em todos os pacientes, exceto naqueles que usavam LIO PanOptix. No décimo segundo mês pós-operatório, a AVNC média chegou a 0,00 logMAR em 405 olhos (78,48%); no entanto, a medição autorefractométrica média foi de -1,28 ± 1,02 (0,00_-2,75) D. Conclusão: As medições autorefractométricas de todos os pacientes que usavam LIOs premium, exceto LIO PanOptix, não foram coerentes com suas acuidades visuais no pós-operatório. Oftalmologistas e/ou optometristas devem ter cuidado ao examinar pacientes com esses perfis.

The Results of Preoperative Topical Brimonidine Usage in Pterygium Surgery.

Purpose: To evaluate the reduction of conjunctival and episcleral hyperemia and bleeding in pterygium surgery following the use of topical brimonidine preoperatively. Methods: In this study, 45 patients who had undergone pterygium surgery under topical anesthesia were enrolled. Brominidine tartrate 0.15% eye drops were applied topically to 25 eyes of 25 patients at the sixth and third minutes preoperatively, and no drops were applied to 20 eyes of 20 patients for vasoconstriction. Preoperative and postoperative photographs and video images were taken. Results: Vasoconstriction effects of topical brimonidine tartrate on surface vessels were observed. The surface area of blood vessels was reduced 60% within 5 min; this effect was observed with the help of Photoshop and ImageJ programs and it lasted for ∼20 min. The surgery lasts for 7 min, on average, so the conjunctival whitening formed by brimonidine tartrate provides a safe and comfortable operative area throughout the surgery. Conclusion: We recommend applying brimonidine tartrate before pterygium surgery due to its conjunctival whitening effect to provide a safe and comfortable operative area throughout the surgery.

Flattened flanged intrascleral intraocular lens fixation technique.

AIM: To evaluate the visual outcomes of the patients who had undergone sutureless scleral fixated IOL implantation operation in which a new modified Yamane technique called flattened flanged intrascleral intraocular lens fixation technique was applied. MATERIALS AND METHODS: Forty-two eyes of 42 patients who had undergone scleral IOL fixation operation with Yamane technique comprised Group 1. The mean age of this group was 60.24 ± 14.3 (20-77) years. Out of 42 patients, 25 of them (60%) were males and 17 of them (40%) were females. Forty-three eyes of 43 patients who had undergone scleral IOL fixation operation with flattened flange technique comprised Group 2. The mean age of this group was 55.35 ± 15.77 (18-79) years. Out of 43 patients, 23 (53.4%) of them were males and 20 (46.6%) were females. RESULTS: There were no significant differences between two groups in respect to mean preoperative UCVA, postoperative UCVA, preoperative BCVA, and postoperative BCVA (p values 0.35, 0.11, 0.28, and 0.16, respectively). The mean postoperative UCVA and preoperative BCVA were significantly higher than those of preoperative values in both groups (p < 0.05). Intraoperative haptic sliding occurred in three eyes (7%) in the first group, and there was no intraoperative haptic sliding in the second group (0%) (p = 0.05). Postoperative IOL dislocation occurred in one eye (2.5%) in the first group, and there was no postoperative IOL dislocation in the second group (0%) (p = 0.32). CONCLUSION: In conclusion, this technique does not require sutures, decreases intraoperative haptic sliding, may provide more IOL stability and less tilt, and facilitates the implantation of the second haptic. For long-term results, further studies should be conducted.

Influence of Incision Size on Dry Eye Symptoms in the Small Incision Lenticule Extraction Procedure.

PURPOSE: To evaluate the influence of incision size on dry eye symptoms in the small incision lenticule extraction (SMILE) procedure. METHODS: Ninety-four eyes of 47 patients with myopia and/or myopic astigmatism who had undergone the SMILE procedure were enrolled in this study. The patients were divided into 3 groups according to the incision size (2, 3, and 4 mm) applied during the SMILE procedure. RESULTS: There were no significant differences among the groups in respect to age and sex (P values 0.251 and 0.974, respectively) and in respect to preoperative, postoperative first day, first week, first month, third month, and sixth month values of the Ocular Surface Disease Index score, tear break-up time, ST1, and staining grades. CONCLUSIONS: There was no difference in dry eye symptoms with 2-, 3-, and 4-mm incisions. In the learning period of SMILE surgery, larger incision sites can be used to make the procedure easier.

Phacoemulsification in posterior polar cataract.

PURPOSE: To evaluate the results and complications of phacoemulsification surgery in eyes with posterior polar cataracts and compare the techniques of viscodissection and hydrodissection. METHODS: The medical records of 29 consecutive patients (16 males, 13 females) with posterior polar cataracts (44 eyes) who had undergone cataract surgery were retrospectively reviewed. Patients were divided into two groups according to the technique used; viscodissection was applied to the experimental group (group 1) and hydrodissection to the control group (group 2). RESULTS: The postoperative best corrected visual acuity (BCVA) was 0.19 ± 0.22 logMAR (mean ± standard deviation) (range 0.00-0.70) in group 1 and 0.25 ± 0.18 logMAR (range 0.00-0.70) in group 2. Although the mean postoperative BCVA in group 1 was greater than that in group 2, the difference was not statistically significant (p=0.165). The mean postoperative BCVA was significantly greater than the mean preoperative BCVA in both groups (p=0.00). Intraoperatively, posterior capsular rupture occurred during the removal of the cortex in three eyes (13%) of group 1 patients, with vitreous loss and anterior vitrectomy in one eye only. In group 2, six eyes (28.5%) presented posterior capsular rupture, and anterior vitrectomy was performed because of vitreous loss in three eyes. Although the percentage of posterior capsular rupture was greater in group 2, the difference was not statistically significant (p=0.207). CONCLUSIONS: Complications in posterior polar cataract surgeries can be overcome by being careful throughout the surgery and using proper techniques. Viscodissection may be better for avoiding posterior capsular rupture than hydrodissection.

Phacoemulsification in posterior polar cataract / Facoemulsificação na catarata polar posterior

ABSTRACT Purpose: To evaluate the results and complications of phacoemulsification surgery in eyes with posterior polar cataracts and compare the techniques of viscodissection and hydrodissection. Methods: The medical records of 29 consecutive patients (16 males, 13 females) with posterior polar cataracts (44 eyes) who had undergone cataract surgery were retrospectively reviewed. Patients were divided into two groups according to the technique used; viscodissection was applied to the experimental group (group 1) and hydrodissection to the control group (group 2). Results: The postoperative best corrected visual acuity (BCVA) was 0.19 ± 0.22 logMAR (mean ± standard deviation) (range 0.00-0.70) in group 1 and 0.25 ± 0.18 logMAR (range 0.00-0.70) in group 2. Although the mean postoperative BCVA in group 1 was greater than that in group 2, the difference was not statistically significant (p=0.165). The mean postoperative BCVA was significantly greater than the mean preoperative BCVA in both groups (p=0.00). Intraoperatively, posterior capsular rupture occurred during the removal of the cortex in three eyes (13%) of group 1 patients, with vitreous loss and anterior vitrectomy in one eye only. In group 2, six eyes (28.5%) presented posterior capsular rupture, and anterior vitrectomy was performed because of vitreous loss in three eyes. Although the percentage of posterior capsular rupture was greater in group 2, the difference was not statistically significant (p=0.207). Conclusions: Complications in posterior polar cataract surgeries can be overcome by being careful throughout the surgery and using proper techniques. Viscodissection may be better for avoiding posterior capsular rupture than hydrodissection.

RESUMO Objetivo: Avaliar os resultados e complicações da cirurgia de facoemulsificação em olhos com catarata polar posterior e comparar as técnicas de viscodissecção e hidrodissecção. Métodos: Os prontuários de 29 pacientes consecutivos (16 homens, 13 mulheres) com posterior cataratas polares (44 olhos), que haviam sido submetidos a cirurgia de catarata foram analisados retrospectivamente. Os pacientes foram divididos em dois grupos de acordo com a técnica utilizada; viscodissecção foi aplicada ao grupo experimental (grupo 1) e hidrodissecção para o grupo de controle (grupo 2). Resultados: No pós-operatório, a melhor acuidade visual corrigida (BCVA) foi 0,19 ± 0,22 logMAR (média ± desvio padrão) (variação 0,00-0,70) no grupo 1 e 0,25 ± 0,18 (0,00-0,70) logMAR no grupo 2. Embora a média da BCVA pós-operatória do grupo 1 tenha sido maior do que a do grupo 2, a diferença não foi estatisticamente significativa (p=0,165). A melhor acuidade visual corrigida pós-operatória foi significativamente melhor do que no pré-operatório, em ambos os grupos (p=0,00). No grupo 1, houve ruptura capsular posterior durante a remoção do córtex em três olhos (13%); houve perda vítrea e necessidade de vitrectomia anterior mas apenas em destes olhos. No grupo 2, a ruptura da cápsula posterior ocorreu em seis olhos (28,5%); vitrectomia anterior foi necessária após a perda vítrea em três destes olhos. Embora a porcentagem de ruptura da cápsula posterior tenha sido maior no grupo 2, a diferença não foi estatisticamente significativa (p=0,207). Conclusões: As complicações em cirurgias de catarata polar posterior podem ser superadas com cautela durante toda a cirurgia e usando técnicas adequadas. Viscodissecção é melhor para evitar a posterior ruptura capsular do que hidrodissecção.

The effect of phacoemulsification surgery on intraocular pressure and anterior segment anatomy of the patients with cataract and ocular hypertension.

We evaluated the effect of phacoemulsification surgery on intraocular pressure (IOP), anterior chamber depth (ACD), iridocorneal angle (ICA), and central corneal thickness (CCT) of the patients with cataract and ocular hypertension. The decrease in IO P values of the 1 st week, 1 st month, 3 rd month, 6 th month, and 1 st year was statistically significant, but that of the 2 nd year was not significant. The increase in ACD and ICA values of the 1 st week, 1 st month, 3 rd month, 6 th month, and 1 st year was statistically significant, but that of the 2 nd year was not significant. The increase in CCT values of 1 st week and 1 st month was statistically significant, but those of 3 rd month, 6 th month, 1 st year, and 2 nd year were not significant. In conclusion, phacoemulsification surgery decreases IOP and increases ACD and ICA in the short-term. However, in the long-term it does not cause any significant changes.

Phacoemulsification in eyes with cataract and high myopia.

PURPOSE: To evaluate the outcomes and complications following phacoemulsification surgery in eyes with cataract and high myopia. METHODS: We retrospectively evaluated the data of 43 eyes of 28 consecutive patients (12 males, 16 females) with cataract and high myopia who had undergone phacoemulsification and intraocular lens (IOL) implantation. The mean [± standard deviation (range)] age of the patients was 59.20 ± 11.08 (39-77) years. RESULTS: The frequency of nuclear cataract was significantly higher than that of other cataract types (P=0.003). The mean axial length was 28.97 ± 1.99 (26-33) mm and the mean IOL power was 5.09 ± 4.78 (-3.0 to +14.0) diopters (D). The mean preoperative spherical equivalent (SE) was -16.48 ± 5.23 (-8.00 to -25.00) D and the mean postoperative SE was -1.46 ± 0.93 (0.00 to -3.00) D (P=0.00). The mean preoperative best-corrected visual acuity (BCVA) was 0.91 ± 0.37 (0.30 to -1.50) logMAR and the mean postoperative BCVA was 0.29 ± 0.25 (0.00-1.00) logMAR (P=0.00). Twenty-two eyes (51.2%) achieved the target postoperative refraction (±1.0 D). The eyes were divided into 3 groups according to the axial length. The mean biometric error was significantly higher in the group with the greatest axial length than in the other groups (P=0.007). Preoperative argon laser photocoagulation was performed in 7 eyes (16%) on account of retinal tears, retinal holes, or lattice degeneration. Postoperatively, retinal tears developed in 2 eyes (4%) and were treated with photocoagulation. One eye (2%) developed retinal detachment postoperatively, with the patient consequently referred for retinal surgery. Postoperatively, posterior capsule opacities developed in 11 eyes (25%), with all cases treated by laser capsulotomy. CONCLUSIONS: Good postoperative outcomes following phacoemulsification surgery were observed in patients with cataract and high myopia. However, clinicians should be aware of the risk of postoperative retinal tears and rhegmatogenous retinal detachment. Preoperative prophylactic argon laser photocoagulation treatment should be considered where necessary.

Phacoemulsificatıon in eyes wıth cataract and high myopia / Facoemulsificação em olhos com catarata e alta miopia

ABSTRACTPurpose:To evaluate the outcomes and complications following phacoemulsification surgery in eyes with cataract and high myopia.Methods:We retrospectively evaluated the data of 43 eyes of 28 consecutive patients (12 males, 16 females) with cataract and high myopia who had undergone phacoemulsification and intraocular lens (IOL) implantation. The mean [± standard deviation (range)] age of the patients was 59.20 ± 11.08 (39-77) years.Results:The frequency of nuclear cataract was significantly higher than that of other cataract types (P=0.003). The mean axial length was 28.97 ± 1.99 (26-33) mm and the mean IOL power was 5.09 ± 4.78 (-3.0 to +14.0) diopters (D). The mean preoperative spherical equivalent (SE) was -16.48 ± 5.23 (-8.00 to -25.00) D and the mean postoperative SE was -1.46 ± 0.93 (0.00 to -3.00) D (P=0.00). The mean preoperative best-corrected visual acuity (BCVA) was 0.91 ± 0.37 (0.30 to -1.50) logMAR and the mean postoperative BCVA was 0.29 ± 0.25 (0.00-1.00) logMAR (P=0.00). Twenty-two eyes (51.2%) achieved the target postoperative refraction (±1.0 D). The eyes were divided into 3 groups according to the axial length. The mean biometric error was significantly higher in the group with the greatest axial length than in the other groups (P=0.007). Preoperative argon laser photocoagulation was performed in 7 eyes (16%) on account of retinal tears, retinal holes, or lattice degeneration. Postoperatively, retinal tears developed in 2 eyes (4%) and were treated with photocoagulation. One eye (2%) developed retinal detachment postoperatively, with the patient consequently referred for retinal surgery. Postoperatively, posterior capsule opacities developed in 11 eyes (25%), with all cases treated by laser capsulotomy.Conclusions:Good postoperative outcomes following phacoemulsification surgery were observed in patients with cataract and high myopia. However, clinicians should be aware of the risk of postoperative retinal tears and rhegmatogenous retinal detachment. Preoperative prophylactic argon laser photocoagulation treatment should be considered where necessary.

RESUMOObjetivo:Avaliação dos resultados e complicações associadas à cirurgia de facoemulsificação em olhos com catarata e miopia alta.Método:Quarenta e três olhos de 28 pacientes (12 homens, 16 mulheres) consecutivos com catarata e alta miopia, que haviam sido submetidos a facoemulsificação e implante de lentes intraoculares (LIO), foram avaliados retrospectivamente. A idade foi de 59,20 ± 11,08, (39-77) anos [média ± desvio padrão, (variação)].Resultados:A frequência de catarata nuclear foi significativamente maior do que os outros tipos (p=0,003). O comprimento axial foi 28,97 ± 1,99, (26-33) mm e o poder da LIO foi 5,09 ± 4,78, (-3,0 a 14,0) dioptrias (D). O equivalente esférico pré-operatório (SE) foi de -16,48 ± 5,23, (-25,00 a -8,00) D e o SE pós-operatório foi -1,46 ± 0,93, (0,00 a -3,00) D, (P=0,00). A melhor acuidade visual corrigida pré-operatória (BCVA) foi de 0,91 ± 0,37, (0,30 -1,50) logMAR e a BCVA pós-operatória foi de 0,29 ± 0,25, (0,00-1,00) logMAR, (P=0,00). Vinte e dois olhos (51,2%) estavam dentro de refração alvo pós-operatória (± 1,0 D). Os olhos foram divididos em três grupos, de acordo com o comprimento axial. O erro biométrico foi significativamente maior no terceiro grupo, em comparação com os outros grupos (p=0,007). Fotocoagulação pré-operatória por laser de argônio foi realizada em 7 olhos (16%) devido a roturas retinianas, buracos de retina ou degeneração látice. No pós-operatório, as roturas da retina ocorreram em dois olhos (4%); tratados com fotocoagulação. Um olho (2%) desenvolveu descolamento de retina no pós-operatório e foi encaminhado para cirurgia de retina. No pós-operatório, opacidades da cápsula posterior ocorreram em 11 olhos (25%) e estes foram tratados com capsulotomia a laser.Conclusões:A cirurgia de facoemulsificação permite bons resultados em pacientes com catarata e miopia alta. No entanto, devemos estar atentos para a possibilidade de roturas da retina pós-operatórias e para o descolamento de retina regmatogênico. Se necessário, devemos usar o tratamento profilático de fotocoagulação a laser antes da cirurgia.

The influence of size and shape of Nd:YAG capsulotomy on visual acuity and refraction.

PURPOSE: To evaluate the influence of size and shape of neodymium:yttrium aluminum- Garnet (Nd:YAG) laser capsulotomy on visual acuity and refraction. METHODS: We retrospectively evaluated 85 eyes of 67 patients treated with Nd:YAG laser posterior capsulotomy for posterior capsule opacification (PCO). The mean age of included patients was 57.57 ± 9.26 (mean ± standard deviation, 38-75 years). The mean interval between surgery and Nd:YAG laser capsulotomy was 26.09 ± 7.08 (10-38) months. Patients were divided into four groups according to the shape and size of capsulotomy. Groups comprised patients with cruciate shape capsulotomies with openings of less than or equal to 3.5 mm (Group 1) or greater (Group 2) and patients with circular shape capsulotomies with openings of less than or equal to 3.5 mm (Group 3) or greater (Group 4). RESULTS: The mean number and energy of laser firings were significantly higher in Group 4 (p=0.00), and significantly lower in Group 1 (p=0.00), compared with that in other groups. Pre-procedural and post-procedural mean spherical equivalent (SE) values were significantly higher in Group 1 (p=0.026 and p=0.011, respectively). No statistical difference in best-corrected visual acuities (BCVA) or intraocular pressures (IOP) were observed between groups before (p=0.44 and p=0.452, respectively) or after capsulotomy (p=0.108 and p=0.125, respectively). A significantly higher number of patients in Group 4 (p=0.001), and a significantly lower number of patients in Group 1 (p=0.001), reported floating bodies compared with that in other groups. No significant changes in SE or intraocular pressure were observed after capsulotomy in any group (p=0.074 and p=0.856, respectively). Best-corrected visual acuity was significantly improved following capsulotomy in all groups (p<0.01). CONCLUSION: Cruciate shape capsulotomy with an opening of 3.5 mm or less provides the greatest improvement in visual function with minimal complications.

The influence of size and shape of Nd:YAG capsulotomy on visual acuity and refraction / A influência do tamanho e forma da capsulotomia por laser de Nd:YAG sobre a acuidade visual e refração

ABSTRACTPurpose:To evaluate the influence of size and shape of neodymium:yttrium aluminum- Garnet (Nd:YAG) laser capsulotomy on visual acuity and refraction.Methods:We retrospectively evaluated 85 eyes of 67 patients treated with Nd:YAG laser posterior capsulotomy for posterior capsule opacification (PCO). The mean age of included patients was 57.57 ± 9.26 (mean ± standard deviation, 38-75 years). The mean interval between surgery and Nd:YAG laser capsulotomy was 26.09 ± 7.08 (10-38) months. Patients were divided into four groups according to the shape and size of capsulotomy. Groups comprised patients with cruciate shape capsulotomies with openings of less than or equal to 3.5 mm (Group 1) or greater (Group 2) and patients with circular shape capsulotomies with openings of less than or equal to 3.5 mm (Group 3) or greater (Group 4).Results:The mean number and energy of laser firings were significantly higher in Group 4 (p=0.00), and significantly lower in Group 1 (p=0.00), compared with that in other groups. Pre-procedural and post-procedural mean spherical equivalent (SE) values were significantly higher in Group 1 (p=0.026 and p=0.011, respectively). No statistical difference in best-corrected visual acuities (BCVA) or intraocular pressures (IOP) were observed between groups before (p=0.44 and p=0.452, respectively) or after capsulotomy (p=0.108 and p=0.125, respectively). A significantly higher number of patients in Group 4 (p=0.001), and a significantly lower number of patients in Group 1 (p=0.001), reported floating bodies compared with that in other groups. No significant changes in SE or intraocular pressure were observed after capsulotomy in any group (p=0.074 and p=0.856, respectively). Best-corrected visual acuity was significantly improved following capsulotomy in all groups (p<0.01).Conclusion:Cruciate shape capsulotomy with an opening of 3.5 mm or less provides the greatest improvement in visual function with minimal complications.

RESUMOObjetivo:Avaliar a influência do tamanho e forma da capsulotomia a laser de Neodímio: Ítrio-Alumínio-Granada (Nd:YAG) na acuidade visual e refração.Métodos:Oitenta e cinco olhos de 67 pacientes, com opacificação de cápsula posterior (PCO), que tinham sido submetidos a capsulotomia por laser de Nd:YAG, foram avaliadas retrospectivamente. A idade foi 57,57 ± 9,26 (média ± desvio padrão), variação 38-75 anos. O intervalo médio entre a cirurgia e a capsulotomia a laser de Nd:YAG foi 26,09 ± 7,08 (variação 10-38) meses. Os pacientes foram divididos em 4 grupos de acordo com a forma e o tamanho da capsulotomia. O grupo 1 incluiu pacientes com forma cruzada e tamanho igual ou menor do que 3,5 mm de abertura capsulotomia, Grupo 2, forma cruzada e tamanho maior do que 3,5 mm, Grupo 3, forma circular e tamanho igual ou menor do que 3,5 mm e Grupo 4, forma circular e tamanho superior a 3,5 mm.Resultados:A quantidade média de energia utilizada e tiros aplicadas foram significativamente maiores no Grupo 4 (p=0,00) e significativamente menores no grupo 1 (p=0,00). O equivalente esférico (SE), antes e após o procedimento, foi significativamente mais elevado no Grupo 1 (p=0,026, p=0,011). Não houve diferença estatística entre os grupos em relação à acuidade visual melhor corrigida (BCVA) e pressão intraocular (IOP) antes do procedimento (p=0,44, p=0,452) e após o procedimento (p=0,108, p=0,125). O número de pacientes com sintomas de moscas volantes foi significativamente maior no grupo 4 (P=0,001) e significativamente inferior no grupo 1 (p=0,001). SE e IOP após o procedimento não foram estatisticamente diferentes daqueles antes do procedimento (p=0,074, p=0,856, respectivamente) em todos os grupos. BCVA após o procedimento foi significativamente melhor do que antes do procedimento (p=0,00) em todos os grupos.Conclusões:Em conclusão, para complicações mínimas e máximas funções visuais, o tamanho ótimo capsulotomia deve ser igual a ou menor do que 3,5 mm e deve ser em forma cruzada.

The course of dry eye after phacoemulsification surgery.

BACKGROUND: The aim of this retrospective study was to evaluate the course of dry eye syndrome after phacoemulsification surgery. METHODS: One hundred and ninety-two eyes of 96 patients (30 males, 66 females) with chronic dry eye syndrome and cataract, who had undergone phacoemulsification surgery were enrolled in this study. RESULTS: Their mean age was 68.46 ± 8.14 standard deviation (SD) (range 56-83) years . Thirty of them (31 %) were males and 66 (69 %) were females. Ocular Surface Disease Index (OSDI) questionnaire scores increased postoperatively, but arrived preoperative levels at the end of 3rd month following the surgery. Fluorescein staining patterns according to Oxford Schema got worse postoperatively, however after postoperative 3rd month they got better and resembled preoperative patterns. The mean postoperative 1st day, 1st week and 1st month Break-up Time (BUT) values were significantly lower than preoperative BUT value (P < 0.001, P < 0.001, P < 0.001), however 3rd month, 6th month, 1st year and 2nd year values were not significantly different from preoperative value (P = 0.441, P = 0.078, P = 0.145, P = 0.125). The mean postoperative 1st day, 1st week and 1st month Schirmer Test 1 (ST1) values were significantly lower than preoperative ST1 value (P < 0.001, P < 0.001, P < 0.001), however 3rd month, 6th month, 1st year and 2nd year values were not significantly different from preoperative value (P = 0.748, P = 0.439, P = 0.091, P = 0.214). CONCLUSION: Phacoemulsification surgery may aggravate the signs and symptoms of dry eye and affect dry eye test values in chronic dry eye patients in short-term. However, in long-term, signs and symptoms of dry eye decrease and dry eye test values return to preoperative values.

Toxic anterior-segment syndrome (TASS).

PURPOSE: To evaluate the clinical findings and courses of five patients who developed toxic anterior-segment syndrome (TASS) after cataract surgery and investigate the cause. MATERIALS AND METHODS: In May 2010, on the same day, ten patients were operated on by the same surgeon. Five of these patients developed TASS postoperatively. RESULTS: Patients had blurred-vision complaints on the first day after the operation, but no pain. They had different degrees of diffuse corneal edema, anterior-chamber reaction, fibrin, hypopyon, iris atrophies, and dilated pupils. Their vision decreased significantly, and their intraocular pressures increased. Both anti-inflammatory and antiglaucomatous therapies were commenced. Corneal edema and inflammation resolved in three cases; however, penetrating keratoplasty was needed for two cases and additional trabeculectomy was needed for one case. Although full investigations were undertaken at all steps, we could not find the causative agent. CONCLUSION: TASS is a preventable complication of anterior-segment surgery. Recognition of TASS, differentiating it from endophthalmitis, and starting treatment immediately is important. Controlling all steps in surgery, cleaning and sterilization of the instruments, and training nurses and other operation teams will help us in the prevention of TASS.