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.].

Wiedemann-Rautenstrauch Syndrome With Bilateral Tarsal Kink: Three Sutures for Correction.

The authors describe a 5-month-old male infant with Wiedemann-Rautenstrauch syndrome, which is an extremely rare condition. He had tarsal kink in upper eyelids in both eyes. The authors treated bilateral tarsal kink with an everting suture via a transconjunctival approach under local anesthesia.

Epidemiology of Adult Open Globe Injury.

OBJECTIVE: The aim of this study was to evaluate the epidemiology and outcomes of adult open globe injuries (OGI) in the eastern part of Turkey. METHODS: The retrospective study included all the patients who were diagnosed with OGI (436 eyes in 425 patients) at our clinic between 1997 and 2015. The OGI patients aged over 16 years were included into the study. Open globe injuries were classified according to the Ocular Trauma Classification. Age, gender, medical history, time between trauma and hospital admission, and mechanism of injury were recorded for each patient. RESULTS: The incidence of OGI in adults was found to be 3.40/100,000, with 5.00/100,000 in males and 1.67/100,000 in females. Open globe injuries were mostly seen in the age group of 17 to 29 years and in October and November. The patients included 79.5% males and 20.5% females. Intraocular foreign body was detected in 99 (22.7%) eyes. A strong, linear, negative correlation was found between the Ocular Trauma Classification values and final visual LogMAR (rp = -0.602, P = 0.0001). The most common mechanism of injury was occupational accident (38.4%). CONCLUSION: Open globe injuries remain a serious public health problem, resulting in significant vision loss. Open globe injuries are mostly seen in the young, middle-aged, and male working population. Additional preventive measures should be taken for the individuals in these groups.

Intravitreal bevacizumab for treatment of serous macular detachment in central retinal vein occlusion.

PURPOSE: To report the long-term effect of intravitreal bevacizumab on serous macular detachment (SMD) in central retinal vein occlusion (CRVO). METHODS: Retrospective, interventional, noncomparative case series. Nineteen consecutive patients (19 eyes) with SMD secondary to CRVO were included. Primary outcomes were the change of the best-corrected visual acuity (BCVA) and the central foveal thickness (CFT) at final visit. Secondary outcome was the resolution of the SMD. RESULTS: The mean patient age was 65.6 years, and the mean follow-up time 21.6 months. Of the 19 eyes, 15 eyes were non-ischemic. The average number of bevacizumab injections was 5.9 from baseline to the final visit. Mean logMAR BCVA improved from 1.20 ± 0.45 (20/317) to [Formula: see text] and mean CFT decreased from 918 ± 280 µm to [Formula: see text] at the final visit. The SMD resolved in 16 of the 19 eyes completely. No local or systemic complication was observed. CONCLUSION: In this retrospective case series, a significant improvement of the vision and resolution of the SMD was found after bevacizumab treatment for CRVO with SMD. Large case series are necessary to evaluate the role of the intravitreal bevacizumab treatment for CRVO associated with SMD.

Conjunctival Lymphangiectasis.

The authors report the case of a 41-year-old woman presenting with both intermittent conjunctival swelling and dilated conjunctival vessels on ocular examination in the right eye who was diagnosed as having conjunctival lymphangiectasis. This is a rare disease that occurs as the result of a connection between conjunctival lymphatic and blood vessels.

MRI-Induced Migration of Retained Metallic Foreign Body in the Eye.

A 50-year-old man presented to the out-patient clinic because of a sudden pain in his left eye just after lumbal magnetic resonance imaging (MRI) was started. Biomicroscopic examination of the left eye revealed the inferior anterior chamber angle including a foreign body and the superior anterior chamber angle including the iris portion, into which the foreign body had been stuck prior to the MRI examination. His history revealed an accidental penetrating eye trauma of the shotgun pellet of 28 years ago. The foreign body was easily removed using a forceps intraoperatively. The foreign body was defined as a metallic foreign body postoperatively.

Persistant Pupillary Membrane Surgery.

A 21-year-old woman presented with bilateral poor visual acuity due to the bilateral remnants of pupillary membrane in June 2007. The patient underwent excisional removal of pupillary membrane remnant in both the eyes, 1 week apart. Postoperatively, the pupillary area was completely free of any membrane remnant, no complication was observed. Visual acuities were 0.6 right eye and 0.4 left eye.

Conjunctival myxoma: a clinicopathologic report.

A conjunctival myxoma was identified in a specimen obtained from a 45-year-old woman via excisional biopsy. The patient presented with a slowly growing painless epibulbar mass. The paucicellular tumor included stellate and spindle-shaped cells, mast cells, and dilated lymphatic channels embedded in a loose collagenous matrix. The differential diagnosis of conjunctival myxoma should include tumors that have myxoid patterns and richly myxoid malignant neoplasms.

Nd:YAG laser posterior capsulotomy after pediatric and adult cataract surgery.

We evaluated neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy procedure with or without anesthesia in 35 pediatric eyes and 51 adult eyes. We concluded that Nd:YAG laser posterior capsulotomies in children are similar to adults in general aspects and that Nd:YAG laser capsulotomy can be performed safely and effectively in children under topical or no anesthesia.

Reconstruction of lower eyelid defects using a cross upper eyelid flap composited with ear cartilage.

BACKGROUND: Basal cell carcinomas (BCC) most frequently involve the lower eyelid and are treated with total excision. Various techniques have been proposed for reconstruction of the excised eyelid. OBJECTIVE: Because most flaps used in such techniques are bulky, thinner, and aesthetically more favorable, flaps have been sought recently. METHODS: Defects of the lower lid have been closed with a combination of cross-flaps and choncal cartilage prepared from the upper eyelid. RESULTS: Eleven lower lids from 10 patients operated for BCC were reconstructed. All flaps survived. The duration of follow-up was 10 months, and no complications such as relapse, ectropion, or lagophthalmus occurred. CONCLUSIONS: The upper eyelid flap was found to be an appropriate cover for both the skin and the conjunctiva due to its hairless and smooth structure. The outcome in patients followed up for a mean of 10 months was successful, cosmetically and functionally.

Early and late effects of pterygium surgery on corneal topography.

BACKGROUND AND OBJECTIVE: The aim of this study was to compare the corneal topographic changes at the early and late postoperative period after pterygium surgery. PATIENTS AND METHODS: Sixteen eyes of 15 patients with primary pterygium were included in the study. All of the pterygia were excised primarily. Computerized corneal topography measurements were taken before surgery and at the second week (postoperative early period) and third month (postoperative late period) after the operation. Keratometric astigmatism, total mean corneal refractive power, and flattened or steepened areas of the cornea were detected at each visit. The topographical changes were evaluated using the analysis of variance. Multiple comparison analyses were made with the Tukey HSD test. RESULTS: Keratometric astigmatism was 2.58 +/- 2.33 diopters (D) at the preoperative period, 1.30 +/- 1.24 D at the postoperative early period, and 0.61 +/- 0.38 D at the postoperative late period (P < .001). The surgically induced corneal astigmatism was 3.23 +/- 2.33 D (range, 0.52 to 8.32 D) at the postoperative early period and 2.70 +/- 2.24 D (range, 0.47 to 7.72 D) at the postoperative late period (P = .287). Astigmatism was 81.25% with-the-rule at the preoperative period, 43.75% oblique and 37.50% against-the-rule at the postoperative early period, and 62.50% with-the-rule at the postoperative late period. Total mean corneal refractive power was 42.51 +/- 1.99 D at the preoperative period, 43.95 +/- 1.58 D at the postoperative early period, and 43.89 +/- 1.80 D at the postoperative late period (P = .014). CONCLUSION: Corneal topographic changes induced by pterygium greatly improve at the postoperative early period. However, normal corneal topography patterns are formed at the postoperative late period.

Nephropathy and retinopathy in type 2 diabetic patients living at moderately high altitude and sea level.

BACKGROUND: High-altitude-induced hypoxia results in various diseases, such as chronic mountain sickness and high altitude retinal edema, and may affect severity and incidence of some cardiovascular diseases. In order to evaluate the effects of moderately high altitude on diabetic nephropathy and retinopathy, a cross-sectional study was planned. MATERIAL METHOD: Long-term type II diabetic residents of sea level (n=75, 38 male, 37 female, mean age 51.9+/-10.5 in Trabzon and Zonguldak cities) and moderately high altitude (h = 1,727 m, n = 73, 28 male, 45 female, mean age 48.3+/-12.1, Van city) were compared. RESULTS: No difference was observed in terms of age, gender, diabetes duration, body mass index, smoking, systolic, diastolic, and mean arterial blood pressure values, serum glucose levels, cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, hemoglobin, HbA1C, hypertension control, or blood pressure medications and retinopathy incidence. Mean 24 h protein excretion (210.0+/-139.9, 127.8+/-112.1 mg; P=0.00), proteinuria prevalence (57.5% versus 33.3%, p=0.003), and serum creatinine levels (1.04+/-0.22 versus 0.84+/-0.21, p = 0.00) were significantly higher in the highlanders, glomerular filtration rate (GFR) was significantly lower in sea level (SL) patients (90.9+/-26.5 versus 83+/-21.1, p=0.05). CONCLUSION: Tendency to diabetic nephropathy as indicated by higher proteinuria and creatinine levels is increased among type 2 diabetic patients living at moderately high altitude. Prospective studies are needed to confirm these findings.

Age-related differences in normal corneal topography.

BACKGROUND AND OBJECTIVE: The aim of this study was to compare age-related differences in the corneal topography of a normal population using a computerized corneal topography system. PATIENTS AND METHODS: The randomized comparative study included 240 eyes of 120 subjects with normal corneas. Subjects were divided into six age groups: 5 to 10 years (group 1), 11 to 20 years (group 2), 21 to 30 years (group 3), 31 to 40 years (group 4), 41 to 50 years (group 5), and 51 years or older (group 6). Average corneal power and corneal astigmatism were examined. An average corneal topography map was constructed and the astigmatism pattern was determined in each age group. RESULTS: Average corneal power values were 41.64 +/- 0.85 diopters (D), 42.35 +/- 0.90 D, 42.63 +/- 0.99 D, 42.94 +/- 0.93 D, 43.38 +/- 0.77 D, and 43.53 +/- 0.88 D in groups 1 to 6, respectively (P < .001). Mean astigmatism values were similar in all age groups (P = .225). Younger subjects had with-the-rule astigmatism, but older subjects showed a shift to oblique or against-the-rule astigmatism. The averaged maps of groups 1 to 3 showed a vertical bow-tie pattern, but the central steep area gradually extended horizontally and it became a round configuration in groups 4 to 6. CONCLUSION: This study suggests that the normal cornea becomes steeper in the horizontal line and superior vertical quadrant and shifts from with-therule to against-the-rule astigmatism, but the amount of physiological corneal astigmatism does not change with age.

A newborn with lipemia rednalis.

Lipemia retinalis is a rare ocular manifestation of certain types of hyperlipidemia. A case of a newborn with lipemia retinalis evaluated by laboratory and dinical findings is described. A creamy white appearance of all retinal blood vessels was demonstrated by color fundus photographs. The patient had elevated levels of triglycerides (29,000 mg/dL) and cholesterol (1,470 mg/dL). Lipid electrophoresis indicated hyperprebetalipoproteinemia. Type IV primary hyperlipoproteinemia was diagnosed.