Green laser induced foveal cyst sustained in a recreational laser light show.

We report the case of a 9-year-old boy complained of visual loss in his right eye after watching green laser light show being hit by a ray of a laser at shopping center before five days ago. The laser had a maximum power rating of 30 mW (US Food and Drug Administration class IIIB). Best-corrected visual acuity in his right eye was 0.2 with Snellen at 5 days after the injury. Dilated fundoscopic examination demonstrated a macular hole appearance in the right eye. Spectral domain optical coherence tomography (OCT, Spectralis, Heidelberg Engineering, Heidelberg, Germany) demonstrates a steep fovea contour, a thickening of the macular edges, intraretinal cysts, disruption of the photoreceptor inner segment/outer segment layer and macular pseudohole formation. Central foveal thickness (515 µm) was increased. Two months after the injury, the patient's visual acuity improved to 0.9 in the right eye without any ocular treatment. Spectral domain OCT revealed the closure of the macular hole with the resolution of the cystic spaces. At 6-months follow-up, visual function had fully recovered and macular assessment was normal.

Tear osmolarity and ocular surface parameters in patients with psoriasis / Parâmetros de osmolaridade lacrimal e da superfície ocular em pacientes com psoríase

ABSTRACT Purpose: The aim of this study was to evaluate tear osmolarity, tear film function, and ocular surface changes in patients with psoriasis. Methods: At a single center, 30 eyes of 30 patients with psoriasis (group 1) and 30 eyes of 30 healthy individuals (group 2) were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT) test, scoring of ocular surface fluorescein staining using a modified Oxford scale, and tear osmolarity measurement. Results: Tear osmolarity values, OSDI, and Oxford scale scores were significantly higher in group 1 (309.8 ± 9.4 mOsm, 38.9 ± 1.1, and 0.7 ± 1.1, respectively) than in group 2 (292.7 ± 7.7 mOsm, 4.2 ± 0.3, and 0.1 ± 0.3, respectively; p<0.01 for all). TBUT was significantly lower in group 1 (8.7 ± 3.6 s) than in group 2 (18.1 ± 2.8 s; p<0.001). No significant differences were detected in Schirmer I test values between the groups (16.2 ± 2.5 mm in group 1 and 16.6 ± 2.3 mm in group 2; p=0.629). Conclusions: The results of this study showed that psoriasis may influence tear osmolarity and tear film function. Patients with psoriasis showed tear hyperosmolarity and tear film dysfunction.

RESUMO Objetivo: O objetivo deste estudo foi avaliar a osmolaridade da lágrima, função do filme lacrimal e alterações da superfície ocular em pacientes com psoríase. Método: Em um único centro, 30 olhos de 30 pacientes com psoríase (grupo 1) e 30 olhos de 30 indivíduos saudáveis (grupo 2) foram avaliados pelo questionário do Índice de Doença da Superfície Ocular (OSDI), teste de Schirmer tipo I, tempo de ruptura do filme lacrimal (TBUT), coloração por fluoresceína da superfície ocular utilizando a escala de Oxford modificada e osmolaridade lacrimal. Resultados: Os valores de osmolaridade lacrimal, OSDI e escores da escala de Oxford foram significativamente maiores no grupo 1 (309,8 ± 9,4 mOsm, 38,9 ± 1,1 e 0,7 ± 1,1, respectivamente) em comparação com o grupo 2 (292,7 ± 7,7 mOsm, 4,2 ± 0,3 e 0,1 ± 0,3, respectivamente) (p<0,01 para todos). TBUT no grupo 1 (8,7 ± 3,6 s) foi significativamente menor em comparação com o grupo 2 (18,1 ± 2,8 s) (p<0,001). Não foram detectadas diferenças significativas nos valores de teste de Schirmer (16,2 ± 2,5 mm no grupo 1 e 16,6 ± 2,3 mm no grupo 2, p=0,629). Conclusões: Este estudo mostrou que a psoríase pode influenciar osmolaridade lágrima e função do filme lacrimal. Os pacientes com psoríase apresentaram hiperosmolaridade lágrima e disfunção do filme lacrimal.

Efficacy of adjunctive mitomycin C in transcanalicular diode laser dacryocystorhinostomy.

The objective of the study was to compare the success rate of transcanalicular laser dacryocystorhinostomy (TCL-DCR) with or without the use of adjunctive mitomycin C (MMC) in cases with primary nasolacrimal duct obstruction (NLDO). This retrospective study was comprised of 68 patients with uncomplicated primary NLDO. There were two groups in the study: the Group 1 (n = 35) patients underwent TCL-DCR surgery with MMC and the Group 2 (n = 33) patients underwent TCL-DCR surgery without MMC. All patients had bicanalicular silicone tube intubation. The main outcome measures were patent osteotomy as visualized endoscopically and patent nasolacrimal irrigation. The follow-up period was 12 months. All patients had unilateral TCL-DCR with silicone tube intubation. Six months following surgery, the silicone tubes were removed. At the final evaluation, success rates were 80 % in Group 1 and 78.8 % in Group 2. There was no statistically significant difference between the two groups (p = 0.52). No complications related to MMC usage were recorded during the study period. Intraoperative use of MMC has no beneficial effect on the success rate in TCL-DCR.

Anterior Segment Optical Coherence Tomography Assessment After Laser Capsulotomy in Pseudophakic Eyes With Pseudoexfoliation.

PURPOSE: To assess changes in anterior-chamber depth (ACD) and angle width after neodymium:yttrium aluminum garnet (Nd:YAG) laser capsulotomy pseudophakia in eyes with pseudoexfoliation (PEX). METHODS: This prospective and interventional case series study included 25 pseudophakic eyes of 25 patients with PEX and 26 pseudophakic eyes of 26 patients without PEX scheduled for Nd:YAG laser capsulotomy in a single institution. Anterior-chamber depth and angle width were measured with anterior segment optical coherence tomography before and three days after Nd:YAG laser capsulotomy. Preoperative and postoperative measurements of ACD and angle width included the angle opening distance (AOD), measured as the perpendicular distance from the trabecular meshwork at 500 and 750 mm anterior to the scleral spur to the anterior iris surface (AOD500 and AOD750, respectively) and anterior-chamber angle (ACA) in the nasal and temporal quadrants. Main outcome measures were the changes in ACD and angle width parameters. RESULTS: The mean ACD, AOD500, AOD750, and ACA (nasal and temporal) measurements were 3.67±0.12 mm, 0.63±0.05 mm and 0.65±0.05 mm, 0.67±0.06 mm and 0.77±0.04 mm, 35.25±1.69° and 35.37±1.68° in eyes with PEX and 3.73±0.11 mm, 0.6±0.05 mm and 0.63±0.05 mm, 0.66±0.06 mm and 0.74±0.06 mm, 34.24±1.6° and 34.6±1.47° in control eyes, respectively (P>0.05 for all). After Nd:YAG laser capsulotomy, mean ACD, AOD500, AOD750, and ACA (nasal and temporal) measurements were 3.76±0.09 mm, 0.73±0.05 mm and 0.76±0.05 mm, 0.75±0.06 mm and 0.87±0.04 mm, 36.82±1.46° and 35.06±1.52° in eyes with PEX and 3.77±0.1 mm, 0.68±0.06 mm and 0.72±0.06 mm, 0.72±0.05 mm and 0.84±0.06 mm, 34.95±1.4° and 35.79±1.36° in control eyes, respectively (P=0.811, P=0.019, P=0.021, P=0.109, P=0.126, P=0.001, and P=0.01, respectively). CONCLUSIONS: The depth and width of the anterior chamber in eyes with PEX and in control eyes increased significantly after Nd:YAG laser capsulotomy. The change in the width of the anterior chamber in eyes PEX was statistically significant comparing control eyes.

Serum and Aqueous Concentrations of Inflammatory Markers in Diabetic Macular Edema.

PURPOSE: To investigate the relationship between the serum and aqueous levels of inflammatory markers and diabetic macular edema (DME). METHODS: The study included four patient groups: the healthy control group (n = 23 eyes); the diabetic control group (n = 22 eyes); the groups with and without DME (n = 20 eyes and n = 22 eyes, respectively). The patients were evaluated based on their serum levels of HbA1c, C-reactive protein (CRP) and serum and aqueous levels of tumor necrosis factor-alpha (TNF-α). RESULTS: Statistically significant differences were present for the serum CRP levels and for the aqueous TNF-α levels between the healthy control group and the group with DME (p = 0.004 and p = 0.03, respectively); for the serum TNF-α levels between the healthy control group and the groups without and with DME (p = 0.009 and p = 0.001, respectively). CONCLUSIONS: Increased serum levels of CRP and serum and aqueous levels of TNF-α in DME suggest that inflammation is involved in the pathogenesis of DME.

Changes in Anterior Chamber Depth after Combined Phacovitrectomy.

OBJECTIVES: To evaluate changes in anterior chamber depth (ACD) and postoperative refractive outcomes after combined phacovitrectomy. MATERIALS AND METHODS: This study included 10 eyes of 10 patients that underwent combined phacovitrectomy (study group) and 14 eyes of 14 patients that underwent phacoemulsification surgery (control group) at Istanbul Medipol University Ophthalmology Department. Preoperative and 3-month postoperative best corrected visual acuity (BCVA), ACD, change in ACD and refractive outcomes were compared between the two groups. RESULTS: Preoperative ACD, postoperative ACD at 3 months and change in ACD were similar between two groups (p=0.403, p=0.886, p=0.841). Postoperative mean refractive outcomes were 0.22±0.51 diopter in the phacovitrectomy group and -0.39±0.53 diopter in the phacoemulsification group (p=0.019). BCVA was increased in both groups (p=0.001). CONCLUSION: Postoperative refractive outcomes in eyes that underwent combined phacovitrectomy are different from those in eyes that underwent only phacoemulsification surgery. This is important in determining preoperative intraocular lens power before combined phacovitrectomy.

Tear Osmolarity and Tear Film Parameters in Patients With Ocular Rosacea.

OBJECTIVES: The aim of this study was to evaluate tear osmolarity and tear film parameters in patients with ocular rosacea. METHODS: In a single center, 25 eyes of 25 patients with ocular rosacea (group 1), 25 eyes of 25 patients with rosacea without ocular involvement (group 2), and 20 eyes of 20 healthy individuals (group 3) were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT), scoring of ocular surface fluorescein staining using modified Oxford scale, and tear osmolarity. RESULTS: Tear osmolarity values, OSDI and Oxford scale scores were significantly higher in group 1 than in groups 2 and 3 (P<0.001 for all). Schirmer I test and TBUT in group 1 were significantly lower than in groups 2 and 3 (P<0.001 for all). There were no significant differences in OSDI, Schirmer I test, TBUT, Oxford scores, or tear osmolarity between groups 2 and 3 (P=0.629, P=0.175, P=0.713, P=865, and P=0.388, respectively). CONCLUSIONS: This study showed that ocular rosacea is associated with tear hyperosmolarity and tear film dysfunction.

Compare the effects of two silicone-hydrogel bandage contact lenses on epithelial healing after photorefractive keratectomy with anterior segment optical coherence tomography.

PURPOSE: To evaluate the efficacy of two silicone hydrogel bandage lenses (SiHy) on epithelial healing following photorefractive keratectomy (PRK) with anterior segment optical coherence tomography (AS-OCT). METHODS: Forty-two eyes of 21 patients who underwent PRK were included in a contralateral eye comparison study. At the end of the procedure, one eye of each patient was fitted with a Lotrafilcon B contact lens whereas the fellow eye was fitted with a Comfilicon A lens. Patients were examined on the day of surgery and at days 1-5 postoperatively. Main outcome measures were number of reepithelialized eyes, epithelial defect size, patient discomfort score and average complete reepithelization time. RESULTS: The number of mean reepithelialized eyes was showed no statistical significance between both groups during the follow up. Average epithelial defect size for Comfilcon A and Lotrafilcon B was 32.7±12.2mm(2) vs. 33.3±12mm(2) at day 1 (p=0.279) and 13.1±6mm(2) vs. 14.5±9mm(2) at day 3 postoperatively (p=0.018). Average re-epithelialization time was 3.1 days for Comfilcon A and 3.6 days for Lotrafilcon B (p=0.03). Mean subjective discomfort score was 2.25±0.96 in eyes with Lotrafilcon B and 1.64±0.67 in eyes with Comfilcon A on the first exam the day after surgery and until third day the differences were statistically significant (p=0.011 and p=0.012, respectively). CONCLUSIONS: AS-OCT is a reliable and noncontact method for assessment of reepithelialization under contact lenses after PRK. Eyes with Comfilcon A showed a statistically significant better discomfort score and faster reepithelialization time.

Anterior segment optical coherence tomography evaluation of corneal epithelium healing time after 2 different surface ablation methods.

OBJECTIVES: To compare epithelial healing time following laser epithelial keratomileusis (LASEK) and photorefractive keratectomy (PRK) with anterior segment optic coherence tomography (AS-OCT). METHODS: This prospective interventional case series study comprised 56 eyes of 28 patients that underwent laser refractive surgery in the Department of Ophthalmology, Medipol University Medical Faculty, Istanbul, Turkey, between March 2014 and May 2014. Each patient was randomized to have one eye operated on with PRK, and the other with LASEK. Patients were examined daily for 5 days, and epithelial healing time was assessed by using AS-OCT without removing therapeutic contact lens (TCL). Average discomfort scores were calculated from ratings obtained from questions regarding pain, photophobia, and lacrimation according to a scale of 0 (none) to 5. RESULTS: The mean re-epithelialization time assessed with AS-OCT was 3.07±0.64 days in the PRK group, 3.55±0.54 days in the LASEK group, and the difference was statistically significant (p=0.03). Mean subjective discomfort score was 4.42±0.50 in the PRK eyes, and 2.85±0.44 in the LASEK eyes on the first exam day (p=0.001). The score obtained on the second (p=0.024), and third day (p=0.03) were also statistically significant. The fourth (p=0.069), and fifth days scores (p=0.1) showed no statistically significant difference between groups. CONCLUSION: The PRK showed a statistically significant shorter epithelial healing time, but had a statistically significant higher discomfort score until the postoperative fourth day compared with LASEK.

Ocular surface and tear parameters in patients with chronic hepatitis C at initial stages of hepatic fibrosis.

PURPOSE: The aim of this study was to evaluate changes in ocular surface and tear function parameters in chronic hepatitis C at initial stages of hepatic fibrosis. METHODS: Thirty-one patients with biopsy-proven chronic hepatitis C and 31 age- and sex-matched healthy control subjects without systemic hepatitis C infection were examined with the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I, tear film break-up time, and scoring of ocular surface fluorescein and Rose Bengal staining using modified Oxford and van Bijsterveld scoring systems, respectively. RESULTS: All ocular surface parameters, except OSDI and corneal staining scores, were significantly worse in hepatitis C group. The control group had greater OSDI scores than the hepatitis C group, but there was no statistically important difference. In subgroup analysis, progression of hepatic fibrosis was found to be correlated strongly with decreased Schirmer test I, increased OSDI, lid parallel conjunctival folds, conjunctival, and corneal staining scores. CONCLUSION: Patients with chronic hepatitis C were more likely to exhibit severe ocular surface damage and signs of dry eye.

Intraoperative and early postoperative flap-related complications of laser in situ keratomileusis using two types of Moria microkeratomes.

The purpose of this study is to describe the incidence, management, and visual outcomes of intraoperative and early postoperative flap-related complications of laser in situ keratomileusis (LASIK) surgery using two types of Moria M2 microkeratomes. This retrospective analysis was performed on 806 primary LASIK cases. The intraoperative and early postoperative flap-related complications were identified and categorized according to type of Moria microkeratome. There were 52 intraoperative and early postoperative complications--one case of partial flap (0.124 %), one case of free flap (0.124 %), one case of small flap (0.124 %), 13 cases of epithelial defect (1.61 %), 12 cases of flap striae (1.49 %), 10 cases of diffuse lamellar keratitis (1.24 %), 10 cases of interface debris (1.24 %), three cases of epithelial ingrowth (0.37 %), and one case of microbial infection (0.124 %). The overall incidence of flap complications was 6.45 %. There were 27 right eye (6.73 %) and 25 left eye (6.17 %) complications. The incidence of complications with the Moria automated metallic head 130 microkeratome was 4.22 % and with the Moria single-use head 90 microkeratome was 2.23 %. We observed one culture-negative interface abscess which was cured with surgical cleaning and intensive medical treatment. The most common complication encountered was epithelial defects, followed by flap striae. Our study showed that LASIK with a microkeratome has a relatively low incidence of intraoperative and early postoperative flap complications. The authors have no financial interest in any of the issues contained in this article and have no proprietary interest in the development of marketing of or materials used in this study.

Repeated bevacizumab injections versus mitomycin C in rotational conjunctival flap for prevention of pterygium recurrence.

AIMS: To evaluate the efficacy of repeated bevacizumab injection in rotational conjunctival flap surgery versus rotational conjunctival flap with adjunctive mitomycin C (MMC) or rotational conjunctival flap alone. MATERIALS AND METHODS: Ninety eyes of 90 patients who underwent primary pterygium surgery with rotational flap were evaluated. Patients were randomly assigned to undergo conjunctival rotational flap alone (Group A) or conjunctival rotational flap with either 0.02% MMC application (Group B) or adjunctive subconjunctival 2.5 mg/0.1 ml bevacizumab injection (Group C). Each group consisted of 30 eyes. Recurrence rates at 9 months were evaluated. RESULTS: There were no statistically significant differences in mean size of the pterygium across the limbus in terms of length (P > 0.5). The recurrence rates at 9 months were 26.6% (n = 8) in Group A, 13.3% (n = 4) in Group B, and 10% (n = 3) in Group C. The recurrence rates in Group B and C were significantly lower than in Group A (P = 0.1806). The recurrence rates were similar in Group B and C (P > 0.05). CONCLUSIONS: Subconjunctival bevacizumab injection may decrease the recurrence rate of primary pterygium surgery with rotational conjunctival flap. Further studies with a larger population and longer follow-up period are needed to supplement this study.

Diode laser-assisted endoscopic dacryocystorhinostomy: a comparison of three different combinations of adjunctive procedures.

Chronic dacryocystitis is a frequently encountered condition which can be corrected by dacryocystorhinostomy. Today, the diode laser is increasingly put to use in such corrective operations. This study aims to answer the questions of which adjunctive procedures and which combinations of such procedures are necessary and effective in securing more successful outcomes in diode laser dacryocystorhinostomy. This prospective randomized study included eighty patients (13 male, 67 female) who underwent dacryocystorhinostomy in our hospital during the 2 year period of January 2009-January 2011. The patients were selected consecutively and were randomly allocated to three groups. Group 1 (30): diode laser + mitomycin C + silicone intubation; Group 2 (27): diode laser + silicone intubation; Group 3 (23): diode laser + mitomycin C. All patients were evaluated postoperatively on day 1, week 1, and on the 1st, 3rd, 6th, 12th, 18th, and 24th months. The postoperative evaluation consisted of preoperative and postoperative ostium measurements, recording postoperative complications, and calculating and comparing success rates and operative times. The mean ages of the patients were 63.4 for Group 1, 60.7 for Group 2, and 61.8 for Group 3. No statistically significant difference was found among the groups regarding pre- and postoperative ostium measurements. The success rates were 84.3, 80, and 76.9 % for Groups 1, 2, and 3, respectively. Complications noted in Group 1 were restenosis (3), premature silicone tube loss (1), development of granulation tissue (3), synechia (2), infection (2), and hemorrhage (3). Those for Group 2 were restenosis (5), premature tube loss (2), granulation (8), synechia (6), infection (3), and hemorrhage (4). Group 3 had 6 cases with stenosis, 5 with granulation, 3 with infection, 6 with synechia, and 5 with hemorrhage. The operative times of the groups were 25.5, 15.3, and 18.1 min, respectively, for Group 1, 2, and 3. All three groups had statistically significant differences regarding the duration of surgery, with p < 0.001, p < 0.001, and p = 0.002 for Group 1 and 2, Group 1 and 3, and Group 2 and 3, respectively. Our study showed that when diode laser DCR was combined with bicanalicular silicone intubation and intraoperative mitomycin C application, those adjunctive procedures, while increasing operative time, enhanced the success rate and diminished complications as compared to diode laser plus intubation and/or diode laser plus mitomycin C.

A comparison of endonasal with external dacryocystorhinostomy in revision cases.

The objective is to compare the success rates of revision endonasal dacryocystorhinostomy (END-DCR) with revision external dacryocystorhinostomy (EXT-DCR). The present retrospective study was conducted between January 2002 and July 2009. Seventy-four consecutive patients (17 males, 57 females) who had epiphora or recurrent dacryocystitis after a previous failed EXT-DCR procedure were enrolled in the study. The END-DCR group consisted of 43 patients (10 males, 33 females) who underwent 44 END-DCRs, whereas the EXT-DCR group included 31 patients (7 males, 24 females) who underwent 31 dacryocystorhinostomies (DCRs). Successful DCR was defined as relief of symptoms as demonstrated by saline irrigation at the last post-operative visit. Further nasal surgery was performed in 18 (40.9%) eyes in the END-DCR group. The average follow-up time for the END-DCR and EXT-DCR groups was 11 and 9 months, respectively. The success rate was 77.4% (24/31 DCRs) in the END-DCR group, and 84.1% (37/44 DCRs) in the EXT-DCR group. There was no significant difference between the groups regarding overall success (p = 0.465). END-DCR is as safe and efficient technique as external approach with low complication rates in revision cases. END-DCR yields good esthetic and functional results and has a success rate similar to that of the external approach.

The capsular tension ring in eyes with traumatic subluxated cataracts: a comparative study.

We investigated the results of phacoemulsification surgery with or without capsular tension ring in eyes with traumatic subluxated cataracts with zonular dialysis. Capsular tension ring implantation before nucleus emulsification in subluxated cataracts will reduce various complications.

Phacoemulsification with viscodissection in posterior polar cataract: minimizing risk of posterior capsule tear.

We retrospectively evaluated the efficacy of viscodissection in decreasing the risk of posterior capsule tear during phacoemulsification surgery in 23 eyes with posterior polar cataract. Eyes were randomly assigned to two groups prior to emulsification: cortical viscodissection (Group 1) or non-viscodissection (Group 2). The visual acuities similarly improved in all eyes in the two groups. Posterior capsule tear occurred in one eye in Group 1 and five eyes in Group 2 (p < 0.05). On the basis of these results, the viscodissection technique was safer and more efficient than the non-dissection technique.

Transscleral fixation of a single-piece hydrophilic foldable acrylic intraocular lens.

BACKGROUND: To evaluate the results of transscleral fixation of foldable hydrophilic acrylic intraocular lenses (IOLs). METHODS: Twenty eyes of 16 patients, aphakic after phacoemulsification (PE) surgery and with at least 6 months follow-up, were included in the study. All eyes were implanted with single-piece hydrophilic foldable acrylic lenses by transscleral fixation, either with PE surgery (2 eyes) or secondarily. RESULTS: Follow-up was 11.6 months (SD 4.85, range 6-20 mo). Age was 62.3 years (SD 12.95, range 18-78 y); 10 patients were women. Preoperative best corrected visual acuity (BCVA) was 0.20 (SD 0.14, range 0.1-0.3) in eyes with primary IOL implantation and 0.53 (SD 0.12, range 0.3-0.7) in secondary implantation. Astigmatism was 1.4 D (SD 1.19, range 0.25 to 5.0 D). Postoperatively, transient corneal edema developed in 6 eyes (30%) and transient IOP elevation in 2 eyes (10%). BCVA was 0.69 (SD 0.15, range 0.4-0.9), astigmatism was 0.84 D (SD 0.80, range 0.25 to 3.0 D), both p < 0.01. Spherical refractive error was -0.38 D (SD 0.47, range +0.75 to -1.25 D). Cystoid macular edema was observed in 2 eyes (10%). No IOL decentration was observed on biomicroscopy in any eye with undilated pupil; IOL decentration with no effect on vision was observed in 3 eyes (15%) after pupil dilation. No IOL tilt, retinal detachment, suture exposure, or endophthalmitis was observed. INTERPRETATION: Scleral fixation of foldable IOLs may be preferred in eyes with insufficient zonular and capsular support. This technique reduces surgery time and complications, and it provides early visual rehabilitation.