Risk factors for posterior capsule rupture in mature cataract surgery: A study of 1302 cases.

Purpose: To identify the risk factors predisposing posterior capsule rupture (PCR) during mature cataract surgery. Methods: A total of 1302 consecutive mature cataract cases were included in this retrospective study. A detailed examination was performed for each patient and risk factors including age, gender, systemic diseases, ocular comorbidities, surgeon, and surgery method were recorded. Cases with PCR during surgery were classified as complicated. Multivariate logistic regression analysis with a generalized estimating equations method was applied for statistical analysis. Results: The overall rate of PCR was 7.30% (n=95 eyes). After adjusting for confounders, factors that remained significant on multivariate analysis were strabismus (odds ratio [OR]: 5.70, 95% confidence interval [CI]: 2.17-14.97; P < 0.001), phacodonesis (OR: 4.62, 95% CI: 2.59-8.22; P < 0.001), history of trauma (OR: 4.46, 95% CI: 1.64-12.12; P = 0.003), surgery method (extracapsular cataract extraction/phacoemulsification) (OR: 2.61, 95% CI: 1.60-4.26; P < 0.001), and pseudoexfoliation (OR: 1.94, 95% CI: 1.20-3.16; P = 0. 007). Conclusion: Strabismus, phacodonesis, history of trauma, extracapsular cataract extraction method, and pseudoexfoliation were found to be important risk factors for developing PCR. Appropriate preoperative and perioperative precautions for these higher-risk cases can reduce complications.

Corneal Effect of Air Bubble After Phacoemulsification.

Objectives: The aim of the study was to investigate the effect of air bubble on the cornea at the end of the cataract surgery with phacoemulsification. Methods: This prospective and case-control study included 71 patients with air bubble injected into the anterior chamber at the end of the operation and 63 age-sex-matched control patients without air bubble. Endothelial cell density (ECD), coefficient of variation (CV), hexagonality rate (HEX), and central corneal thickness (CCT) measurements were taken using non-contact specular microscopy preoperatively and at 1-day, 1-week, and 1-month postoperatively. Results: No significant difference was determined between the groups preoperatively in respect of mean visual acuity, anterior chamber depth, ECD, CV, HEX, and CCT values (p>0.05). The intraoperative average ultrasound power, effective phaco time, and ultrasound time values were similar (p>0.05). The CCT value was lower in the study group than in the control group on post-operative day 1 (p=0.012), but similar at 1 week and 1 month (p=0.102, p=0.330, respectively). No significant difference was determined between the groups in mean visual acuity, anterior chamber reaction, ECD, CV, and HEX values at 1-day, 1-week, and 1-month postoperatively (p>0.05). Conclusion: Air bubble may be used as an alternative method to reduce corneal edema on the 1st post-operative day. According to the results, although air bubble has no detrimental effect, there is also seen to be no protective effect on the corneal endothelium.

Metallurgical characterisation and torsional resistance of blue thermomechanically treated nickel titanium instruments after simulated ex vivo retreatment procedure.

To compare used and unused Reciproc Blue and Reciproc after retreatment, the instruments were used in the mesiobuccal canals of maxillary molars with curvature. The torsional resistances were tested and then unused instruments were subjected to XRD, DSC and microhardness tests. Student's t, ANOVA and Tukey's tests were performed (α-level 0.05). The torsional strength of used Reciproc Blue was not significantly different than unused ones (P > .05), while torsional strength of Reciproc decreased significantly (P < .05). DSC and XRD indicated that Reciproc Blue exhibited prominent transformation peaks corresponding austenite to R-phase. Microhardness of Reciproc was significantly higher (P < .05). A second reuse of Reciproc Blue for retreatment could be considered safe in terms of torsional strength. Blue treatment also decreased surface microhardness of the instrument and changed phase composition by increasing the R-phase.

Evaluation of surface roughness after root resection: An optical profilometer study.

The aim of this study was to evaluate the roughness of the apical surface after apical resection performed by six different methods with an optical profilometer. Sixty human single root premolar teeth were used in this in vitro study. After root canal preparation, root canals were filled with gutta-percha and AH Plus root canal sealers by lateral condensation technique. The teeth were randomly divided into six groups according to the apical resection method: steel fissure bur, tungsten carbide fissure bur, Lindeman bur, diamond fissure bur, laser, and ultrasonic surgical piezo with a diamond tip. The root ends were resected 3 mm away from the root apex and at a 90° angle. The time required for apicectomy was recorded for each group. After apical resection, the root surfaces were analyzed by an optical profilometer. The Kruskal-Wallis method was used to analyze the differences between groups. The significance level was set at 5%. The roughest surfaces were obtained by laser (25.54 ± 9.01 µm) and Lindeman bur (17.35 ± 6.03 µm), respectively. The longest mean resection times were recorded in piezosurgery and laser surgery (57 ± 14.39 s and 50.9 ± 16.86 s), respectively. Although the diamond-tipped piezo surgical cutting time is long, it has the best results in terms of surface roughness (5.50 ± 1.73 µm). The optical profilometer is a more convenient tool for evaluating the surface after apical surgery, as it provides an opportunity to evaluate objectively with both visual and numerical data.

Vitreous levels of vascular endothelial growth factor, stromal cell-derived factor-1α, and angiopoietin-like protein 2 in patients with active proliferative diabetic retinopathy.

PURPOSE: To determine the vitreous levels of vascular endothelial growth factor (VEGF), stromal cell-derived factor-1α (SDF-1α) and angiopoietin-like protein 2 (ANGPTL2) in patients with active proliferative diabetic retinopathy (PDR), and to ascertain their contribution on different clinical presentation of active PDR. METHODS: This case-control study included 31 eyes with active PDR and 10 eyes with idiopathic macular hole (MH) (control group). Eyes with active PDR were divided into three subgroups: vitreous hemorrhage (VH), tractional retinal detachment (TRD) caused by active fibrovascular membrane (FVM), and coexistence of VH and TRD with FVM. Vitreous samples obtained during vitrectomy were analyzed for concentrations of VEGF, SDF-1α, and ANGPTL2. RESULTS: Vitreous level of VEGF (2021 (168-6550) pg/ml vs 110.1 (74.5-236) pg/ml), SDF-1α (517 (194-1044) pg/ml vs 388 (320-535) pg/ml), and ANGPTL2 (725 (131-1590) ng/ml vs 196 (75.9-437) ng/ml) were significantly higher in eyes with active PDR than in control group (p < 0.001, p = 0.002, and p < 0.001, respectively). The concentrations of these meaditors in each active PDR subgroups were also significantly higher than control group (p < 0.05). The vitreous level of ANGPTL2 was significantly higher in eyes with TRD caused by FVM (1033 ± 401 ng/ml) than in eyes with VH (561 ± 237 ng/ml; p = 0.008). CONCLUSION: High levels of SDF-1α, ANGPTL2 and particularly VEGF seem to be associated with PDR. Since the vitreous levels of ANGPTL2 tend to be higher in eyes with active fibrovascular tractional detachment, vitreous levels of this chemokine seem to be affected by the clinical presentation of vascularly active PDR eyes.

Comparison of cyclic fatigue resistance of Rotate instrument with reciprocating and continuous rotary nickel-titanium instruments at body temperature in relation to their transformation temperatures.

OBJECTIVE: The aim of this study was to compare the cyclic fatigue resistance at body temperature and phase transformation behaviors of novel Rotate instrument (25.06) with rotating Mtwo (25.06) and reciprocating Reciproc Blue (25.08) and Reciproc (25.08) instruments. MATERIALS AND METHODS: The Rotate, Reciproc Blue, Reciproc, and Mtwo instruments free of visible deformations were collected and tested in a static cyclic fatigue test method, which has a ceramic block containing an artificial canal with 60° angle of curvature and a 5-mm radius of curvature at 37 °C (n = 16). All instruments were operated until fracture occurred, and both time to fracture (TF) and the lengths of the fractured fragments were recorded. TF data was analyzed with one-way ANOVA followed by post hoc Tukey tests and Weibull analysis, and fractured fragment length data were subjected to one-way ANOVA and post hoc Tukey tests (P < 0.05). Two unused instruments from each brand were also subjected to differential scanning calorimetry (DSC) analysis to determine their phase transformation temperatures. RESULTS: The Reciproc Blue instruments showed significantly higher TF values and reliability than the other groups (P < 0.05). Rotate instruments exhibited greater cyclic fatigue resistance than the Reciproc and Mtwo instruments (P < 0.05). No significant difference was detected among the fractured fragment lengths (P > 0.05). The lowest austenite finish temperature was exhibited by the Mtwo, which presented a single transformation peak, followed by the Rotate, Reciproc Blue, and Reciproc instruments which all presented two peaks during transformation. CONCLUSIONS: Cyclic fatigue resistance of instruments manufactured from thermally treated Blue wire instruments was superior to those of the Mtwo and Reciproc, whereas reciprocating the Blue wire showed the highest resistance. CLINICAL RELEVANCE: The present study compared the cyclic fatigue resistance of the novel Rotate instrument with similar instruments manufactured from conventional nickel-titanium, m-wire, and Blue wire at body temperature and reported that Blue-treated instruments exhibited superior cyclic fatigue resistance.

Aqueous Humor Levels of Vascular Endothelial Growth Factor and Stromal Cell-Derived Factor-1α in Age-Related Macular Degeneration.

OBJECTIVES: This study investigated the contribution of vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1α (SDF-1α) angiogenic mediators in eyes with age-related macular degeneration (AMD). METHODS: Aqueous humor specimens taken during cataract surgery in 7 cases of intermediate stage (nonexudative) AMD and 7 cases of late stage (exudative) AMD were evaluated using chemiluminescent immunoassay testing in this prospective case-control study. Mediator levels were compared with the normal reference values of 7 patients without any disease other than cataract. RESULTS: The groups were similar in terms of age and gender (p>0.05). The aqueous humor levels of VEGF in both the intermediate AMD (median: 224.3 pg/mL, range: 44.8-380.4 pg/mL) and late-stage AMD (median: 108.7 pg/mL, range: 61.9-223.5 pg/mL) patients were similar to those of the control group (median: 121.1 pg/mL, range: 24.9-156.6 pg/mL) (p=0.256). Moreover, there was no significant difference in the SDF-1α concentrations between the intermediate AMD (median: 160.9 pg/mL, range 130-166.3 pg/mL), late AMD (median: 161 pg/mL, range: 154.1.9-171.6 pg/mL), and control group values (median: 161 pg/mL, range: 155.2-219 pg/mL) (p=0.763). CONCLUSION: The aqueous humor levels of VEGF and SDF-1α were within the normal range in patients with intermediate and late-stage AMD.

Temperature and time variations during apical resection.

OBJECTIVE: The aim of this study was to investigate temperature and time variations during root-end resection. MATERIAL AND METHODS: Sixty human premolars were selected. The root canals were enlarged up to ProTaper X3 rotary instrument. A thermocouple was placed into the root canal 1 mm behind the resection line. The teeth were randomly divided into six groups according to the apical resection method: steel bur, tungsten carbide bur, Lindeman bur, diamond bur, laser and ultrasonic surgical piezo with a diamond tip. The root ends were resected 3 mm away from the root apex. The temperature of the root dentine during resection was recorded as maximum temperature, mean temperature and temperature change. The time required for apicectomy was recorded for each group. The Kruskal-Wallis method was used to analyse the differences between temperature changes during apical resections. The significance level was set at 5%. RESULTS: There was no significant difference between bur groups in terms of temperature increase. The maximum temperature in piezo surgery was significantly higher than the Lindeman, tungsten and steel burs (p < .001). In addition, the maximum temperature in laser surgery was higher than the Lindeman bur (p < .05). An increase in the temperature was mostly seen in piezo surgery and the least temperature change occurred in the Lindeman bur. Mean time stayed under 1 min in each group. CONCLUSIONS: Although piezo caused the highest temperature increase, the measured temperature increase was within physiological limits in all tested techniques.

Autogenous Tooth Bone Graft and Simvastatin Combination Effect on Bone Healing.

OBJECTIVE: Autogenous tooth bone grafts (ATGM) are materials prepared from extracted teeth and have been used for bone augmentation. These graft materials are known to have similar structures and components to bone grafts. In this sense, this study aimed to evaluate all the tooth layers mixed with simvastatin without any demineralization process effect on bone formation. METHODS: In 60 Wistar albino rats, a standardized 6.0 m-diameter critical size bone defect was created in their calvarium. The study consists of 1 control and 4 experimental groups. In the control group (12 rats), the defects were left empty. The defects were grafted only with ATGM in Group 1, with ATGM mixed with simvastatin in Group 2, autogenous bone graft mixed with simvastatin in Group 3, and with xenogenic bone graft mixed with simvastatin in Group 4. The animals were sacrificed at the 7th and 28th days after operation. RESULTS: PCR, micro CT and histological results show that bone formation was enhanced in the experimental groups in comparison to the control group. Group 1 and Group 2 had similar bone formation rate when compared to Group 3 and Group 4 at the 28th day after operation. CONCLUSION: This study concludes that mineralized teeth may be used for defect reconstruction without any demineralization process. Autogenous mineralized tooth bone graft should be mixed with simvastatin for bone regeneration like other grafts.

Septo-optic dysplasia with fovea plana: A case report.

Septo-optic dysplasia (SOD) is characterized by optic nerve hypoplasia, pituitary gland hypoplasia, and midline abnormalities of the brain. The phenotype of SOD is highly heterogeneous, and the existence of at least two features is considered sufficient for diagnosis. Fovea plana is the absence of a foveal pit in the central fovea, and despite being a developmental abnormality of the fovea, good visual acuity may be retained in some individuals. In this case, a 12-year-old female presented to the ophthalmology clinic with the complaint of blurred vision in her right eye. In dilated fundus examination, optic disc hypoplasia and no foveal light reflex were seen. Magnetic resonance imaging and optical coherence tomography revealed optic nerve, brain midline, and foveal abnormalities. The patient was diagnosed as having SOD with optic nerve hypoplasia and septum pellucidum agenesis, and fovea plana. Both SOD and fovea plana are rare conditions, and there are several reports in the literature that separately describe their clinical features. The most important aspect of this case report is to reveal the unusual co-existence of SOD and fovea plana in a young patient.

Macular Buckling Surgery for Retinal Detachment Associated with Macular Hole in High Myopia Eye.

A 68-year-old woman presented to our clinic with a 1-month history of central scotoma and visual loss in her right eye. The best corrected visual acuity (BCVA) was hand motion in her right eye. Fundus examination showed myopic chorioretinal degeneration in association with posterior staphyloma and the retina was slightly elevated throughout the macula. Optical coherence tomography (OCT) revealed retinal detachment involving the posterior pole with a macular hole and staphyloma. The patient underwent pars plana vitrectomy, internal limiting membrane peeling, macular buckling, and perfluoropropane gas tamponade. At 3-month follow-up, her BCVA was improved to counting fingers at 1 meter and flattened retina with closed macular hole was observed by OCT. Myopic macular hole with retinal detachment associated with posterior staphyloma represent a challenge regarding their management and several surgical techniques have been described. Although satisfactory anatomical improvement is achieved in these eyes after surgery, the visual acuity outcomes may be poorer than expected due to the chorioretinal atrophy at the posterior pole.

Fracture Resistance of Endodontically Retreated Roots After Retreatment Using Self-Adjusting File, Passive Ultrasonic Irrigation, Photon-Induced Photoacoustic Streaming, or Laser.

OBJECTIVE: Additional cleaning techniques and devices are required to remove maximum amount of residual filling material, which might limit disinfection of root canal system during retreatment. This study aimed to compare fracture resistance of roots when self-adjusting file (SAF), photon-induced photoacoustic streaming (PIPS), passive ultrasonic irrigation (PUI), erbium-doped yttrium aluminum garnet (Er:YAG), or neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers are applied following the use of retreatment files in endodontics. MATERIALS AND METHODS: A total of 117 human mandibular canine teeth of similar dimensions were selected and divided into nine groups (n = 13). Aside from control, instrumented, and only-prepared groups, 91 teeth were remaining, of which 13 were assigned to the only-filling group and final 78 to retreatment, thus R-Endo file, R-Endo+SAF, R-Endo+PUI, R-Endo+Er:YAG laser, R-Endo+Nd:YAG laser, and R-Endo+PIPS. RESULTS: The fracture strengths of the retreatment groups were lower than control, instrumented, and only-filling groups (p < 0.05). There was no difference between the R-Endo group and additional retreatment procedure groups (p > 0.05). CONCLUSIONS: Further cleaning methods using SAF, PIPS, Er:YAG laser, Nd:YAG laser, or PUI did not decrease the fracture resistance when compared with the R-Endo group.

Use of EndoVac System for Aspiration of Exudates from a Large Periapical Lesion: A Case Report.

Large cyst-like periapical lesions can heal after nonsurgical root canal treatment. Decreasing the hydrostatic pressure within a periapical lesion can be achieved with the aspiration technique by using EndoVac when there is drainage of cystic fluid through the canals. Clinical examination of a 21-year-old male patient revealed a large periapical lesion extending from the distal aspect of tooth #26 and reaching the mesial surface of tooth #22. During root canal treatment of teeth #23, #24, and #26, serous exudate drained from the root canal of tooth #24. The MacroCannula component of EndoVac apical negative pressure irrigation system was used to aspirate the inflammatory fluid. The technique produces a vacuum effect in the periapical region through the root canal, which facilitates evacuation of large amounts of exudate. Two-year clinical and radiographic examinations revealed resolution of the mandibular radiolucency, and the adjacent tooth #25 retained its vitality. The healing of a large periapical lesion can be achieved by the correct diagnosis and the proper treatment approach, without the need for surgery. EndoVac negative irrigation system might be useful for intracanal aspiration of exudates.

Neuro-fuzzy classification of prostate cancer using NEFCLASS-J.

Medical diagnosis has been the most proper area for the implementations of artificial intelligence for approximately 20 years. In this paper, a new approach based on neuro-fuzzy classification (NEFCLASS) tool has been presented to classify prostate cancer. The tool has the features of batch learning, automatic cross validation, automatic determination of the rule base size, and handling of missing values to increase its interpretability. We have investigated how good medical data analysis could be done with NEFCLASS-J, and what effects selected parameters have on classifier performances. Medical data were obtained from patients with real prostate cancer and benign prostatic hyperplasia (BPH). The reason for the selection of these two illnesses was the fact that their symptoms are very similar yet their differentiation is very crucial. The results showed that, for creating high performance of classifier appropriate for the data used, firstly it is necessary to decide well on the membership type and the number of fuzzy sets and then validation procedure. After a good classifier has been found, other parameters should be investigated to improve this classifier. In the light of this study, we can present a foresight for the diagnosis of the patients with prostate cancer or BPH.