Intracorneal implantation of a misdirected foldable intraocular lens during phacoemulsification surgery: a case report / Implantação intracorneana de uma lente intraocular dobrável direcionada incorretamente durante cirurgia de facoemulsificação: relato de caso

ABSTRACT A 59-year-old man presented with a unilateral blurring of vision in his left eye. His left eye's visual acuity was hand movements level. He underwent phacoemulsification surgery, and an intrastromal posterior chamber intraocular lens was implanted. The intrastromal intraocular lens was extracted and a new intraocular lens was implanted. Usinge the Snellen chart, the final best-corrected visual acuity was 20/40. With this case report, we wish to emphasize that a single stepwise clear corneal incision merged with wound-assisted intraocular lens injections can result in intraocular lens misdirection into the corneal stroma. As a result, while performing a misdirected intraocular lens removal, we recommend that the wound be carefully constructed.

RESUMO Um homem de 59 anos apresentou embaçamento visual unilateral no olho esquerdo. Sua acuidade visual nesse olho era no nível de movimentos da mão. O paciente havia se submetido a uma cirurgia de facoemulsificação em que foi feita a implantação intraestromal de uma lente intraocular de câmara posterior. Foi feita a extração dessa lente intraestromal intraocular e uma nova lente intraocular foi implantada. A melhor acuidade visual corrigida final foi de 20/40 pela tabela de Snellen. Com este relato de caso, os autores desejam apontar que uma incisão de degrau único em córnea clara, quando combinada com a injeção de uma lente ocular através da incisão, pode levar a um direcionamento incorreto da lente intraocular para dentro do estroma corneano. Portanto, recomenda-se uma construção cuidadosa da incisão ao se remover uma lente intraocular direcionada incorretamente.

Intracorneal implantation of a misdirected foldable intraocular lens during phacoemulsification surgery: a case report.

A 59-year-old man presented with a unilateral blurring of vision in his left eye. His left eye's visual acuity was hand movements level. He underwent phacoemulsification surgery, and an intrastromal posterior chamber intraocular lens was implanted. The intrastromal intraocular lens was extracted and a new intraocular lens was implanted. Usinge the Snellen chart, the final best-corrected visual acuity was 20/40. With this case report, we wish to emphasize that a single stepwise clear corneal incision merged with wound-assisted intraocular lens injections can result in intraocular lens misdirection into the corneal stroma. As a result, while performing a misdirected intraocular lens removal, we recommend that the wound be carefully constructed.

Comparison of Outcomes of External Dacryocystorhinostomy and Transcanalicular Laser-Assisted Dacryocystorhinostomy in Patients with Primary Acquired Nasolacrimal Duct Obstruction.

PURPOSE: This study aimed to compare anatomical and functional outcomes of external dacryocystorhinostomy (EX-DCR) and transcanalicular multidiode laser dacryocystorhinostomy (TDL-DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO). METHODS: This study was conducted on 60 eyes of 60 patients with PANDO. The study subjects were randomly divided into two groups. Group 1 included 30 patients who underwent EX-DCR, and group 2 included 30 patients who underwent TDL-DCR. Surgery success rates were determined by patency of the neo-ostium, with free saline flow on irrigation and the absence of epiphora. RESULTS: There were 23 women (76.7%) and 7 men (23.3%) with a mean age of 47.33 ± 12.44 years in group 1, and 18 women (60%) and 12 men (40%) with a mean age of 46.2 ± 19.4 years in group 2. There was no significant difference between groups 1 and 2 with respect to age or gender (p = 0.801, p = 0.267, respectively). The mean duration of symptoms was 3.2 years, ranging from 1.5 to 5 years. The mean postoperative follow-up was 12.3 ± 2.44 months. At the end of the follow-up period, the surgery success rates were 96.7% (29/30 eyes) in group 1, and 90% (27/30 eyes) in group 2. There was no statistical difference in the surgery success rates between groups (p = 0.612). CONCLUSION: TDL-DCR is a minimally invasive and safe procedure. The lack of bleeding and incision scar and shorter operation time suggest that TDL-DCR can be a good alternative in PANDO patients.

The Usefulness of Monocyte-to-High Density Lipoprotein and Neutrophil-to-Lymphocyte Ratio in Diabetic Macular Edema Prediction and Early anti-VEGF Treatment Response.

PURPOSE: To determine the association of monocyte-to-high-density lipoprotein ratio (MHR) and neutrophil-to-lymphocyte ratio (NLR) with diabetic macular edema (DME) and early anti-VEGF treatment response. MATERIAL METHODS: This was a retrospective and cross-sectional study conducted with 143 patients with diabetes mellitus (53 diabetic retinopathy with DME, 38 diabetic retinopathy without DME, and 52 without diabetic retinopathy). RESULTS: 13.9 was the best cutoff value to predict DME for MHR, and 2 was for NLR (59% and 75% sensitivity and 81% and 59% specificity, respectively). Logistic regression analysis showed that NLR≥2 and MHR≥13.9 were significantly associated with DME prediction. However, neither NLR≥2 nor MHR≥13.9 was associated with central retinal thickness(CRT) or best corrected visual acuity(BCVA) outcomes after anti-VEGF treatment. On the other hand, increased NLR was associated with inferior CRT outcomes. CONCLUSION: MHR and NLR were simple and cost-effective biomarkers to predict DME. Moreover, higher NLR may contribute to poor CRT outcomes.

Evaluation of inner and outer retinal thickness in patients receiving intravitreal ranibizumab injections for diabetic macular edema.

PURPOSE: To measure inner and outer retinal thickness with optical coherence tomography (OCT) in patients in whom intravitreal ranibizumab was administered due to diabetic macular edema (DME) and to investigate its relation to the visual prognosis. METHODS: In this retrospective case series, there were 60 consecutive eyes with DME in which intravitreal ranibizumab injection was performed for 3 times in 1-month intervals. All patients underwent full ophthalmic examination and spectral-domain OCT (SD-OCT). The total retinal thickness, the inner thickness, and the outer thickness in 4 parafoveal subfields were measured. The correlation between the retinal thickness and logMAR best-corrected visual acuity (BCVA) was investigated. RESULTS: No significant correlation was found between the total retinal thickness in the central and other subfields and either the baseline or final visit logMAR BCVA values (p>0.05). There was a significant positive correlation between the final visit logMAR BCVA values and pretreatment inner retinal thickness in the nasal and inferior subfields (r = 0.270, p = 0.037, and r = 0.410, p = 0.001, respectively). There was significant negative correlation between the final visit logMAR BCVA values and pretreatment outer retinal thickness in nasal and temporal parafoveal subfields (r = -0.297, p = 0.021, and r = -0.268, p = 0.038, respectively). CONCLUSIONS: It could be beneficial to use inner and outer retinal thickness instead of total retinal thickness in determination of short-term prognosis in patients who had intravitreal ranibizumab injection for DME.

Aqueous humour levels of ghrelin in exfoliation syndrome and exfoliation glaucoma patients.

PURPOSE: To investigate levels of ghrelin in the aqueous humour (AqH) of patients with exfoliation syndrome and exfoliation glaucoma and compare them to levels of ghrelin in control subjects. METHODS: This cross-sectional study involved 15 patients with exfoliation syndrome, 8 with exfoliation glaucoma and 12 control subjects for whom cataract surgery was indicated. The AqH was aspirated from the anterior chamber with a 27-G needle under sterile conditions prior to tissue manipulation. Ghrelin levels were quantified using radioimmunassay kits. RESULTS: Levels of ghrelin in the AqH were 187.87 ± 80.1 pg/mL in the eyes exhibiting exfoliation syndrome, 98.53 ± 50.9 pg/mL in the eyes exhibiting exfoliation glaucoma and 111.40 ± 77.5 pg/mL in the controls. Ghrelin level of patients with exfoliation syndrome were significantly higher than those of patients with exfoliation glaucoma and the controls (P < 0.05). Ghrelin levels of patients with exfoliation glaucoma were lower than those of the controls but were not reach statistically significant (P > 0.05). Age, gender and IOP did not have a significant effect on ghrelin levels in patients with exfoliation syndrome and exfoliation glaucoma. CONCLUSION: This study is the first to report elevated levels of ghrelin in the AqH in eyes exhibiting exfoliation syndrome. Findings suggest ghrelin might play role in the etiopathogenesis of exfoliation syndrome to exfoliation glaucoma.

Apoptotic effects of topical antiglaucoma medications on conjunctival epithelium in glaucoma patients.

PURPOSE: In this study, we aimed to investigate the apoptotic effects of topical antiglaucoma medications on the conjunctival epithelium. METHODS: A total of 65 patients were included in the study. Thirty patients were included in the first group who had received antiglaucomatous therapy before trabeculectomy. In the second group, 20 patients who had received no drugs before trabeculectomy were included, while the third group underwent only cataract surgery as control. During the surgery, 2 x 4 mm conjunctival samples were harvested from the upper bulbar conjunctiva. The mean apoptosis rate was calculated by determining apoptosis at conjunctival epithelium using the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) method. RESULTS: The mean apoptosis rate was 0.537 ± 0.369 (0.026 ± 0.962) in group 1, 0.139 ± 0.162 (0.005 ± 0.676) in group 2, and 0.078 ± 0.035 (0.035 ± 0.142) in the control group (group 3). The mean apoptosis rate was significantly higher in the first group than the other 2 groups (p = 0.0001). CONCLUSION: Apoptotic effects of topical antiglaucoma drugs on the conjunctival epithelial cells were found. However, our results revealed that the number of medications, duration of medication, and type of glaucoma had no effect on the apoptotic effect.

The Association between Diabetic Retinopathy and Levels of Ischemia-Modified Albumin, Total Thiol, Total Antioxidant Capacity, and Total Oxidative Stress in Serum and Aqueous Humor.

Purpose. To investigate the oxidant and antioxidant status of patients with type 2 diabetes mellitus and nonproliferative diabetic retinopathy (DRP). Methods. Forty-four patients who had cataract surgery were enrolled in the study. We included 22 patients with DRP in one group and 22 patients in the control group. Samples of aqueous humor and serum were taken from all patients. Serum and aqueous ischemia-modified albumin (IMA), total thiol, total antioxidant capacity (TAC), and total oxidative stress (TOS) levels were compared in two groups. Results. Median serum IMA levels were 44.80 absorbance units in the DRP group and 40.15 absorbance units in the control group (P = 0.031). Median serum total thiol levels in the DRP group were significantly less than those in the control group (3051.13 and 3910.12, resp., P = 0.004). Mean TOS levels in the serum were 2.93 ± 0.19 in the DRP group and 2.61 ± 0.26 in the control group (P = 0.039). The differences in mean total thiol, TAC, and TOS levels in the aqueous humor and mean TAC levels in the serum were not statistically significant. Conclusion. IMA, total thiol, and TOS levels in the serum might be useful markers in monitoring the risk of DRP development.

Effect of latanoprost/timolol and dorzolamide/tiomolol on intraocular pressure after phacoemulsification surgery.

AIM: To evalaute the effect of fixed-combination latanoprost 0.005%/timolol maleate 0.5% and dorzolamide hydrochloride 2%/timolol maleate 0.5% on postoperative intraocular pressure after phacoemulsification cataract surgery. METHODS: This study is a prospective, randomized, double-masked and placebo-controlled. The study included 90 eyes of 90 patients which were scheduled to have phacoemulsification surgery. Patients were randomly assigned preoperatively to 1 of 3 groups (30 eyes of 30 patients). Two hour before surgery, the patients received one drop latanoprost/timolol (group 1), dorzolamide/timolol (group 2) and placebo (group 3, control group). The IOPs were measured at preoperative and postoperative 4, 8, and 24 hours. RESULTS: The preoperative mean intraocular pressure was not statistically significant between both drug groups and control group. In group 1 and 2, the postoperative mean IOP [group1: (14.03±3.15)mmHg and group 2: (14.16±4.43)mmHg] at 24 hours were significantly lower than the control group [(16.93±3.70)mmHg, (P<0.05)]. In addition, the postoperative mean IOP of group 1 [(14.90±3.69)mmHg] at 8 hours was significantly lower than the control group [(17.70±3.89)mmHg, (P<0.05)], but there was no significant difference between group 2 [(16.16±5.23)mmHg] and control group at 8 hours (P>0.05). CONCLUSION: When compared with placebo, the use of preoperative fixed combination of latanoprost/timolol and dorzolamide/timolol is an effective method for preventing intraocular pressure elevation in 24 hours after phacoemulsification surgery, but did not completely prevent IOP spikes.

Gyrate atrophy of the choroid and retina with hyperornithinemia, cystinuria and lysinuria responsive to vitamin B6.

In this report, an 8-year-old girl is presented with the complaint of progressive night blindness. The authors have performed eye funduscopy, which showed chorioretinal atrophy in gyrate shape. A high level of plasma ornithine was determined. Urinary excretion of ornithine as well as lysine and cystine were increased. Patient was treated with high dose pyridoxine supplement (500 mg/dl). The night blindness condition of the patient improved. After 1 month of pyridoxine therapy ornithine level of her plasma was successfully reduced and blindness improved.

The effects of different doses of remifentanil on intraocular pressure after tracheal intubation: a randomized, double-blind and prospective study.

We investigated the effects of alfentanil and different doses of remifentanil on intraocular pressure (IOP) and hemodynamic responses during laryngoscopy and endotracheal intubation in 60 patients. IOP values decreased significantly from 30 seconds before the intubation to 5 minutes after intubation measurements compared to baseline values in all the groups. However, a significant increase in IOP was recorded in the 0.5-microg remifentanil group after tracheal intubation.

Conjunctival impression cytology in pseudoexfoliative glaucoma and pseudoexfoliation syndrome.

BACKGROUND: In this study, ocular surface changes and tear film functions in patients with pseudoexfoliative glaucoma (PEXG) and pseudoexfoliation (PEX) syndrome were evaluated. METHODS: This study is a randomized, double-blind and prospective study. Conjunctival impression cytology, tear film break-up time (TFBUT) test and basal Schirmer test (BST) were performed on 45 eyes of 45 subjects with PEXG (group I), 48 eyes of 48 subjects with PEX syndrome (group 2) and 50 eyes of 50 normal subjects (group 3). Impression cytology was graded 0-III based on the shape, eosinophilic-staining cytoplasm and nucleocytoplasmic ratio of the epithelial cells, and the shape, quantity and Periodic Acid Schiff-positive cytoplasm of the goblet cells. RESULTS: Impression cytology grading scores were 6.7% grade 0, 15.6% grade I, 37.7% grade II and 40% grade III in group 1, 6.3%, 18.7%, 43.8% and 31.2% in group 2 and 38%, 36.0%, 20% and 6% in group 3, respectively. The scores in groups 1 and 2 were significantly higher than in group 3 (P = 0.001, chi(2) = 39.84). The mean values of TFBUT of groups 1, 2 and 3 were 5.91 +/- 3.27, 7.39 +/- 4.82, 10.96 +/- 3.81 s and the mean values of BST were 7.82 +/- 3.56, 9.04 +/- 4.60 and 12.50 +/- 5.25 mm/5 min, respectively. The values of TFBUT and BST were lower in groups 1 and 2 than in group 3 (P = 0.001). CONCLUSION: The conjunctival changes in PEX and PEXG patients recorded in this study may explain the existence of tear film abnormalities in these patients. It has been shown that PEXG and PEX syndrome cause conjunctival surface changes and reduction of tear film functions.

The effect of latanoprost, bimatoprost, and travoprost on intraocular pressure after cataract surgery.

PURPOSE: The aim of this study was to evaluate the effect of preoperative topical latanoprost, bimatoprost, and travoprost administration on postoperative intraocular pressure (IOP) after phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation. METHODS: This prospective, randomized, double-masked study included 120 eyes of 120 consecutive, normotensive, uncomplicated cataract patients having phacoemulsification surgery with PC IOL implantation. They were randomized into 1 of 4 treatment groups, each of which had 30 patients. Two (2) h before the surgery, the patients received 0.005% latanoprost (Group 1), 0.004% bimatoprost (Group 2), 0.03% travoprost (Group 3), or placebo (Group 4, artificial tears). IOP was measured at preoperative, 4, 8, and 24 h postoperative with a Goldmann applanation tonometer. The anterior chamber was examined postoperatively 24 h for levels of cell and flare using slit-lamp biomicroscopy. RESULTS: The preoperative mean IOP was not statistically significant different among the four groups. In Groups 1 and 3, the mean IOP at 4, 8 and 24 h were significantly lower than the control (Group 4; P < 0.05). However, in Group 2, there was no significant difference in IOP during the study period, compared to the control (Group 4; P > 0.05). In addition, the mean postoperative IOP at 24 h in Groups 1 and 3 were significantly lower than the preoperative IOP (P < 0.05). No severe anterior chamber reaction was observed in any group. CONCLUSIONS: Our findings show that a single-dose topical of latanoprost and travoprost can prevent early postoperative IOP elevation after phacoemulsification surgery without any sideeffects.

Bilateral -14.0 diopters index myopia successfully treated with cataract surgery: a case report.

We report a 60-year-old man with bilateral nuclear cataract and -14.0 diopters index myopia. Following uncomplicated phacoemulsifications and posterior chamber intraocular lens implantations on both eyes, right and left axial lengths were 22.58 and 22.60 mm with otobiomeric A-scan ultrasound, respectively. Three-month corrected visual acuity was 20/20 in the right eye with a -1.00 x 130 degrees cylinder and 20/20 in the left eye with -0.50 spheres and -1.00 x 100 degrees cylinders.

Sneddon's syndrome: clinical and laboratory analysis of 10 cases.

Sneddon's syndrome is characterized by livedo reticularis and cerebrovascular lesions. We report the cases of women (mean age, 36.2 +/- 8.1 years) diagnosed with Sneddon's syndrome based on the presence of livedo reticularis and characteristic cerebrovascular findings. Seven of these patients had cerebral infarcts on cranial computed tomography scan. Antiphospholipid antibodies were positive in 6 of these cases. Three cases had abnormal levels of antithrombin III. Analyses of chromosome 6 revealed no abnormalities. In 3 of the cases, investigation of the pedigrees revealed autosomal dominant traits. Two cases had epilepsy, and 3 had migraine. One case with migraine also had myasthenia gravis. In addition, we detected inferior altudinal hemianopia in 2 cases, cognitive functional disorder in 3 and depression in 2. Based on these findings, the entire vascular, haematologic, neurologic, and dermatologic systems should be evaluated in patients diagnosed with Sneddon's syndrome.