Evaluation effectiveness of 0.1% nepafenac on injection-related pain in patients undergoing intravitreal Ozurdex injection.

PURPOSE: To evaluate the analgesic effect of topical 0.1% nepafenac solution during intravitreal Ozurdex injection. METHODS: This prospective, randomized, double-blind placebo-controlled study included 59 patients who were diagnosed with retinal vein occlusion or pseudophakic cystoid macular edema and were selected to receive intravitreal Ozurdex injection. The patients were divided into two groups. Group 1, consisting of 31 eyes of 31 patients, received topical 0.1% nepafenac with topical anesthesia (0.5% proparacaine HCl, Alcaine; Alcon, TX, USA), and group 2, consisting of 28 eyes of 28 patients, received placebo with topical anesthesia. RESULTS: There were 14 (45.2%) men and 17 (54.8%) women in group 1 and 16 (57.1%) men and 12 (42.9%) women in group 2. The mean age of the subjects was 64.42 ± 5.51 years in group 1 and 62.32 ± 7.54 years in group 2. The median visual analog scale pain score was 2 (1-3) in group 1 and 4 (1-6) in group 2. The visual analog scale pain score was significantly lower in group 1 than in group 2 (p < 0.001). CONCLUSION: Topical 0.1% nepafenac has an additive analgesic effect when combined with topical anesthesia for intravitreal Ozurdex injection.

Comparison of the Neodymium-doped Yttrium Aluminum Garnet Capsulotomy Rate with Viscoimplantation and the Hydroimplantation Intraocular Lens Technique.

PURPOSE: To investigate the rate of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy in the hydroimplantation intraocular lens (IOL) technique. METHODS: This retrospective study was comprised of 6,192 eyes in 3,790 patients who underwent surgery from January 2013 to September 2017 and then were followed up for at least 1 year. The eyes of these patients were divided into two groups: either viscoimplantation or hydroimplantation. The follow-up examinations were carried out on the 1st day, 4th day, 1st month, and 3 months to 1 year postoperatively. The Nd:YAG capsulotomy rates were evaluated by the different IOL implantation techniques and IOL materials. RESULTS: The mean follow-up duration of the patients was in the viscoimplantation group 14.85 ± 2.43 and 15.05 ± 1.93 months in the hydroimplantation group. The Nd:YAG capsulotomy rate was significantly lower in the hydroimplantation group compared with the viscoimplantation group for the entire hydrophilic IOL model (p < 0.001). In addition, the Nd:YAG rate was lower in the hydroimplantation group that used a hydrophilic IOL than it was in the viscoimplantation group, which used a hydrophobic IOL. CONCLUSIONS: The hydroimplantation technique reduced the Nd:YAG capsulotomy rate.

Evaluation of Retinol Palmitate Treatment of Photokeratitis in Rat Eyes Exposed to Ultraviolet B Radiation.

OBJECTIVES: Acute exposure to ultraviolet B radiation can cause photokeratitis. Retinol palmitate (RP) is known to have antioxidant properties and improve corneal healing. The aim of this study was to evaluate the effect of topical RP against phototoxic keratitis in rats. METHODS: A total of 14 male Wistar Albino rats were exposed to 1 J/cm2 dose of 311 nm ultraviolet B radiation. The subjects were then divided into 4 study groups using the right and left eye: The RP-5 group (n=7) received topical 250 IU/g RP ointment and the Sham-5 group (n=7) received only the vehicle base component of the ointment 5 minutes after the exposure. The RP-120 group (n=7) received topical RP and the Sham-120 group (n=7) received the vehicle alone 120 minutes after the exposure. The eyes were enucleated 24 hours after the exposure and stained with hematoxylin and eosin for histopathological examination and a terminal deoxynucleotidyl transferase dUTP nick end labeling assay to test for apoptosis. RESULTS: There was no statistically significant difference between the mean corneal epithelial thickness of the RP-5 group and the Sham-5 group (p=0.369). Furthermore, there was no significant difference between the RP-120 and the Sham-120 groups (p=0.765). The timing of the administration of RP resulted in no significant difference in the mean corneal epithelial thickness (p=0.608). Apoptotic cell count scores were not significantly different between corneas that received RP and those who received only the vehicle (p=0.530, p=0.107). CONCLUSION: Topical administration of a single dose of RP was not superior to the use of the vehicle base alone in a photokeratitis model produced using 1 J/cm2 of narrowband ultraviolet radiation in rats.

Elevated Tear Human Neutrophil Peptides 1-3, Human Beta Defensin-2 Levels and Conjunctival Cathelicidin LL-37 Gene Expression in Ocular Rosacea.

Purpose: To investigate the role of innate immunity in ocular rosacea. Methods: Thirty-two patients with ocular rosacea patients (group-1) and 28 healthy volunteers (group-2) who served as controls were enrolled in the study. Tear function parameters were assessed, conjunctival impression cytology was performed and tear samples were collected. Human-neutrophil-peptides (HNP) 1-3 and human-beta-defensin-2 (hBD-2) levels were measured in tears by using ELISA tests. Cathelicidin leucin-leucin-37 (LL-37), hBD-2, human-beta-defensin-9 (hBD-9) gene expression levels were measured in the conjunctival impression cytology samples using real-time polymerase chain reaction. Results: Tear HNP1-3 (p = 0.024), hBD-2 (p < 0.001), conjunctival LL-37 gene expression rate (p = 0.014) and ocular surface disease index scores (p = 0.001) were higher and the tear break-up time was lower (p = 0.003) in group-1. No other differences were found between the groups. Conclusion: The results of this study suggest the role of abnormal innate immunity in the pathophysiology of ocular rosacea by revealing elevated antimicrobial peptide levels.

0.1% Nepafenac reduces pain and increases patient comfort during cataract surgery.

PURPOSE: To evaluates analgesic effectiveness of 0.1% nepafenac during cataract surgery. METHODS: This prospective randomized randomized double-masked, placebo-controlled study comprised 80 eyes of 40 consecutive patients who underwent bilateral cataract surgery and implantation of foldable intraocular lens with topical anesthesia with and without topical nepafenac drops. Each eye of patients was assigned to group 1 and group 2. Topical anesthesia combined with 0.1% nepafenac used three times a day the day before the surgery and once half an hour just before the surgery was group 1, consisting of 40 eyes, and topical anesthesia with using placebo was group 2 consisting of 40 eyes. Patients were asked to score their pain using a visual analog scale (VAS) and verbal pain scale (VPS) immediately following the surgery. When the patient moved or squeeze the eye during surgery, the surgical comfort was evaluated as bad and otherwise, it was evaluated as good. RESULTS: When the intensity of pain during the surgery was evaluated, the percentage of patients reporting mild or no pain in group 1 was %825 and in group 2 was %45. Mean VAS pain score and mean VPS pain score in group 1 was significantly lower than that in group 2(p = 0.024, p < 0.001). Surgical comfort in group 1 was %825 and in group 2%65(P = 0.075). CONCLUSION: 0.1% nepafenac reduces pain of patients who undergone routine clear corneal phacoemulsification with topical anesthesia and may increase patient comfort during the surgery when used preoperatively.

Safety of hydroimplantation in cataract surgery in patients with pseudoexfoliation syndrome.

AIM: To evaluate the safety of hydroimplantation in cataract surgery in patients with pseudoexfoliation syndrome. METHODS: This prospective randomized study comprised 100 eyes of 100 consecutive patients who underwent cataract surgery and implantation of foldable intraocular lens (IOL). Each eye was assigned to group 1 or group 2. Hydroimplantation without using viscoelastic agent as group 1 (n=50), and hydroxypropylmethylcellulose (Eyevisc, Biotech, India) was used in group 2 (n=50). RESULTS: There were no statistically significant differences in central corneal thickness (CCT) and corneal endothelial cell count (ECC) between both groups at each visit and percentage change in CCT and ECC (P>0.05). The mean intraocular pressure (IOP) at postoperative 5h increased statistically significantly in group 2 (P<0.001). There was no statistically significant difference in IOP between two groups, before and after surgery excluding the 24h postoperative IOP, but patients in group 2 had higher IOP than that in the group 1 at 24h after surgery (P=0.035). No case in either group experienced posterior capsular rupture, or zonular dialysis. Fixation of the globe during IOL implantation was better in group 1 than that in group 2. CONCLUSION: Hydroimplantation has advantages in terms of IOP changes and duration of the surgery and seems to be safe in patients with pseudoexfoliation syndrome.

Endophthalmitis after tooth extraction in a patient with previous perforating eye injury.

The aim of this stuty is to describe a case of endophthalmitis after tooth extraction in a patient with previous perforating eye injury. 50 years old male patient attempted to our clinic with complaints of sudden severe pain, reduced vision, light sensitivity and redness in the right eye. The patient stated that severe pain in his eye began approximately 12 hours following tooth extraction. The patient's ocular examination revealed a visual acuity of hand motion in the right eye. Anterior segment examination of the right eye showed intense conjunctival hyperemia, chemosis, a fine keraticprespitat and corneal edema. Dental procedures of the patients who had recently underwent ocular surgery or trauma should be done in a more controlled manner under anti -infective therapy or should be postponed in elective procedures.

Intraocular pressure lowering effect of orbital decompression is related to increased venous outflow in Graves orbitopathy.

PURPOSE: To investigate the effects of combined orbital bone and fat decompression on intraocular pressure (IOP) and superior ophthalmic vein blood flow velocity (SOV-BFV), and their association with the clinical features of Graves orbitopathy (GO). METHODS: During the 2002-2008 period, 72 eyes of 36 GO cases demonstrating moderate to severe orbitopathy were evaluated according to their clinical features as: cases with or without dysthyroid optic neuropathy (DON), and underwent orbital decompression. A control group comprised 40 eyes of 20 healthy subjects. In both groups, a full ophthalmic examination including IOP and Hertel measurements was performed, and SOV-BFV was analyzed with color Doppler imaging. Examinations were repeated after orbital decompression in GO patients. RESULTS: All the cases demonstrated clinical features of inactive disease. Among the patients 24 of 72 eyes (33.3%) showed clinical features of DON. After surgery, the mean decrease in Hertel values was 6.2 ± 1.8 mm (p = 0.001). The mean decrease in IOP was 3.0 ± 1.7 mmHg (from 17.3 ± 2.7 to 14.3 ± 2.0 mmHg) after orbital decompression where the post-operative values were comparable with the control group (12.9 ± 1.4 mmHg, p = 0.36). The mean increase in SOV-BFV achieved with decompression was 1.2 ± 0.6 cm/s (from 4.8 ± 1.7 to 6.0 ± 1.8 cm/s) and post-operative SOV-BFV values were also comparable with the control group (6.6 ± 1.3 cm/s, p = 0.26). The increase in SOV-BFV in cases with DON did not differ from cases without DON (p = 0.32), however, post-operative SOV-BFV of cases with DON was stil lower than cases without DON (p = 0.035). CONCLUSIONS: Combined orbital bone and fat decompression significantly reduced the IOP levels and increased the SOV-BFV in GO. This could be the confirmative finding of prediction that elevated IOP in GO is associated with increased episcleral venous pressure. The post-operative changes in IOP and SOV-BFV show differences regarding the clinical features of disease.

Hyaluronic acid viscoelastic medium as an aid for microsurgical venous anastomoses.

The thin-walled structure of veins leads them to stay collapsed during anastomoses, thereby the incidence of technical failures is more common than arterial anastomoses. In order to overcome this problem, we are introducing the use of viscoelastic material based on our experience on rats. Six rats were used in order to study the technical feasibility of the viscoelastic material during microsurgical vein anastomosis. End-to-end anastomoses were performed on rat jugular veins using 0.5-1 mL of the viscoelastic medium applied to the ends of the veins and surgical field under ×30 operating microscope magnification. Then 1.8% (n:3) and 3.0% (n:3) hyaluronic acid was used as a viscous medium in order to keep the vein lumens open during anastomosis. In conclusion, we have found that 3.0% hyaluronic acid viscoelastic medium facilitates microvenous anastomosis in rat. Studies involving human practice are needed for further evaluation of this technical refinement.

Effect of 1% brinzolamide and 0.5% timolol fixed combination on intraocular pressure after cataract surgery with phacoemulsification.

AIM: To evaluate the effect of brinzolamide-timolol fixed combination on intraocular pressure (IOP) after cataract surgery. METHODS: The study included 92 eyes of 87 patients who underwent cataract surgery and intraocular lens implantation. Patients scheduled for phacoemulsification were assigned to 1 of 2 groups. The treatment group received 1 drop of brinzolamide-timolol fixed combination immediately after surgery, and the control group received no treatment. The IOP was measured preoperatively and at 2h and 24h postoperatively. RESULTS: The mean IOP change was lower in the treatment group than in the control group at 2h postoperatively. The difference between the mean IOP values of the two groups at 2h postoperatively was found to be statistically significant. Twenty-four hours after the surgery, the mean IOP change was still higher in the control group when compared to the treatment group. CONCLUSION: The fixed combination brinzolamide-timolol can effectively reduce IOP after cataract surgery.

Central corneal thickness in patients with mild to moderate rosacea.

OBJECTIVE: We aimed to evaluate central corneal thickness (CCT) in patients with rosacea in comparison to a healthy control group and to investigate any correlations by using the Schirmer test, tear break-up time (TBUT), and disease severity. DESIGN: Prospective nonrandomized study. PARTICIPANTS: Patients with mild to moderate rosacea (n = 51) and a group of healthy individuals (n = 51) were included. METHOD: Patients were evaluated by a dermatologist; disease severity was determined and total rosacea severity score was calculated for each patient. CCT measurements were performed using ultrasonic pachymetry. Tear function tests, including Schirmer and TBUT, were also performed. RESULTS: The mean CCT value was significantly lower in patients with rosacea than in the control group (544.91 ± 29.41 µm vs 559.40 ± 24.18 µm, p = 0.003). The mean Schirmer test value was significantly lower in patients than in controls (10.54 ± 6.09 mm vs 19.13 ± 4.24 mm, p < 0.0001), and the mean TBUT was shorter in the group with rosacea than in the controls (8.32 ± 3.50 s vs 16.67 ± 5.76 s, p < 0.0001). CCT values were found to be correlated with the Schirmer test values in the rosacea group (r = 0.33, p = 0.01). CONCLUSIONS: Patients with rosacea have thinner corneas, which could be attributed to the observed deteriorated tear function parameters. Candidates for corneal photoablation surgery should be evaluated regarding rosacea disease because the postoperative period could be complicated by decreased ocular wetting and corneal thinning, even in overlooked mild forms.

Refractory cystoid macular oedema due to intraocular lens haptic perforating the iris.

Cystoid macular oedema is a well-known complication of cataract surgery associated with intraocular lens decentration or dislocation. A 55-year-old man, who had undergone a phacoemulsification and intraocular lens implantation surgery two months previously was referred because of reduced vision in the right eye. Ocular examination revealed that one of the haptics had perforated the iris at 6 o'clock. There was cystoid macular oedema of the right eye. A topical non-steroid anti-inflammatory drug, followed by intravitreal injections did not produce a significant regression. Finally, the haptic was repositioned surgically and the macular oedema dramatically resolved. Correct placement of the intraocular lens might avoid post-operative complications including cystoid macular oedema.

Simultaneous reconstruction of medial canthal area and both eyelids with a single transverse split forehead island flap.

In this report, we are presenting a case in which we have split the paramedian forehead flap, thus providing 2 axially perfused skin flaps for simultaneous reconstruction of the upper and lower lid structures after resection of basal cell carcinoma from the left medial canthal area. We found that split forehead flap seems to be a favorable option for simultaneous reconstruction of the upper and lower eyelid defects by enabling nicely vascularized and abundant amount of regional skin.

Enophthalmos due to atelectasis of the maxillary sinus: silent sinus syndrome.

Silent sinus syndrome is a clinical entity with the constellation of progressive enophthalmos and hypoglobus due to gradual collapse of the orbital floor with opacification of the maxillary sinus, in the presence of subclinical maxillary sinusitis. It occurs secondary to maxillary sinus hypoventilation due to obstruction of the ostiomeatal unit. In this paper, a 35-year-old woman with a complaint of asymmetry in her left eye and denting of upper eyelid was reported. In the left eye, upper sulcus was deepened and there was 3-mm hypoglobus. There was no diplopia or restriction of eye movements in any gaze positions. Hertel exophthalmometry revealed a 4-mm enophthalmos on the left eye. Computed tomographic scan of the orbita and paranasal sinuses showed left maxillary sinusitis, air-fluid level, and collapse of left maxillary sinus walls. In addition, inferior bulging in the left orbital floor was also reported. The treatment was a 2-stage operation. In the first stage, she underwent endoscopic septoplasty plus left maxillary antrostomy, and in the second stage, she underwent a subciliary orbital floor repair of the iliac bone resulting in the improvement of the enophthalmos and her cosmetic appearance. Regarding this case, the literature is also reviewed in detail.

Schwannoma of the lower eyelid in a 13-year-old girl.

A 13-year-old girl presented with a history of a slowly enlarging, mobile, right lower eyelid mass of 2 years' duration. Excisional biopsy revealed the characteristic histopathologic features of a schwannoma. After complete excision, there was no recurrence at 1-year follow-up. Schwannoma is a rare eyelid tumor, appearing sporadically and in a solitary form, which should be considered in the differential diagnosis of eyelid tumors in children.