Management of acquired punctal stenosis with perforated punctal plugs.

PURPOSE: To evaluate the efficiency of perforated punctal plug in acquired punctal stenosis. MATERIALS AND METHODS: Forty-five eyes of 33 patients who had epiphora due to punctal stenosis were included in this study. After biomicroscopic examination and lacrimal dilatation punctal stenosis was managed with the perforated punctal plugs in all patients. In the following period epiphora, plug tolerance, lacrimal drainage were evaluated and graded. Lacrimal drainage was evaluated with fluorescein dye disappearing test. RESULTS: The age of the patients ranged between 31 and 80 (mean 55.78 ± 13.11). Preoperatively punctal dilatation and lacrimal system irrigations were performed on all patients. Lacrimal system irrigation was positive in all patients. Perforated punctal plugs were placed in the inferior puncti in all patients. The plugs were explanted 6 months after operation. The follow-up period ranged between 6 and 24 months. Plug tolerance was good in 97.8% of the eyes in the 1st month visit. Epiphora decreased remarkably in 88.9% of the patients 1 month after plug implantation, except one whose plug dropped off spontaneously in 2 weeks. Fluorescein disappearing times were found under 3 min in 97.8% of the eyes after plug explanations. CONCLUSION: Punctum stenosis is one of the several disorders that cause lacrimal drainage obstruction. Perforated punctal plugs are found convenient and effective in managing punctal stenosis.

Foldable iris-fixated phakic intraocular lens implantation for the correction of myopia: two years of follow-up.

PURPOSE: To evaluate the safety, efficacy and potential risks of Artiflex foldable iris-fixated phakic intraocular lens (pIOL) implantation for the management of myopia. MATERIALS AND METHODS: Seventy-eight eyes of 40 consecutive patients with a mean spherical refraction of -11.70 ± 3.77 diopters (D; range -5.50 to -17.5 D) were included in this prospective, noncomparative, interventional case series. Main parameters assessed were uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), corneal topography (Orbscan II, BauchandLomb, Rochester, NY, USA), manifest and cycloplegic refractive errors, endothelial cell density (ECD) and applanation tonometry. RESULTS: After 2 years, BSCVA was 20/40 or better in 82% of the eyes and UCVA was 20/40 or better in 84% of the eyes. After 1 month, 1 year, and 2 years, 51.3% (37 of 72 eyes), 58.9% (46 of 78 eyes) and 76.0% (38 of 50 eyes) of eyes gained 1 line or more of BSCVA, respectively. Compared to preoperative values, the mean endothelial cell loss was 2.6% at 1 month, 4.9% at 1 year and 7.4% at 2 years. Pigmented or non-pigmented precipitates were observed in 17 eyes (21.7%) which were treated with topical corticosteroids. At the second postoperative year, pigmented precipitates persisted in nine eyes. However, this was not associated with a loss of BSCVA. CONCLUSION: The implantation of Artiflex pIOL is an effective surgical option for the management of high myopia. The most common complication observed within 2 years of follow-up was accumulation of pigmented precipitates with no effect on the final BSCVA.

Phakic anterior chamber lenses in very high myopia: an 18-month follow up.

BACKGROUND: To evaluate the efficacy and tolerance of two different foldable anterior chamber phakic intraocular lenses for high myopia. DESIGN: A prospective interventional case series at the Eye Clinic, Kartal Training and Research Hospital, Istanbul, Turkey. PARTICIPANTS: Sixty-two eyes of 31 patients received iris-claw lens (group 1) (Artiflex AC 401, Ophtec), and 43 eyes of 22 patients received angle-supported lens (group 2) (I-Care, Corneal). METHODS: The mean preoperative spherical equivalents for group 1 and group 2 were -12.13 D and -18.95 D, respectively. Endothelial cell density was measured at day 1 and at 1, 3, 6, 12 and 18 months for follow ups. MAIN OUTCOME MEASURES: Percentage change in endothelial cell density and improvement in visual acuity. RESULTS: At the 18-months follow up, uncorrected visual acuity improved to logMAR 0.37 ± 0.23 from 1.60 ± 0.10 in group 1, and logMAR 0.47 ± 0.14 from 0.70 ± 0.20 in group 2; best spectacle corrected visual acuity improved to logMAR 0.23 ± 0.22 from logMAR 0.36 ± 0.14) in group 1, and logMAR 0.29 ± 0.18 from logMAR 0.50 ± 0.20) in group 2 (P<0.001, in both groups). Mean decreased endothelial cell density was 241 cells/mm(2) (8.61%) and 223 cells/mm(2) (8.42%) at 18 months follow up in group 1 and 2, respectively (P=0.17) but significant in comparison to preoperative values for both groups (P<0.001). CONCLUSIONS: Although both iris-claw and angle-supported lenses offer good refractive outcomes significant endothelial cell density was observed at 18 months follow up.

Cicatricial upper and lower eyelid ectropion in an ichthyosis patient. Surgical correction.

BACKGROUND: Surgical correction of bilateral cicatricial upper and lower eyelid ectropion in an ichthyosis patient remains a challenge in clinical practice. MAIN OBSERVATIONS: A 24-year-old female patient presented to our clinic with bilateral upper and lower eyelid ectropion. Her skin over her entire body and face was dry and scaly. The diagnosis was cicatricial ectropion related in a patient with ichthyosis. The upper eyelids were treated by retroauricular full thickness skin grafts and upper eyelid lateral tarsal strip procedure. And lower eyelids were treated by cheek transposition grafts and lower eyelid lateral tarsal strip procedure. The upper and lower eyelids were corrected successfully with these surgical procedures. CONCLUSIONS: In patients with ichthyosis skin alterations in the eyelid cause shortening of the anterior lamella, subsequently resulting with ectropion. Successful surgical correction with skin grafts or transposition flaps can be performed to lenghten anterior lamella. Adding lateral tarsal strip procedure to skin grafting helps to maintain a beter lid margin apposition.

Congenital ptosis and amblyopia.

PURPOSE: To investigate the incidence and causes of amblyopia in congenital ptosis. METHODS: The frequency and causes of amblyopia were evaluated in 83 eyes of 72 patients with congenital ptosis. Patient ages ranged between 10 months and 70 years. Amblyopia was defined as best-corrected visual acuity of 0.7 or less. After a complete ophthalmologic examination, the amount of ptosis and levator function was determined and the following amblyogenic factors were identified: ametropia, anisometropia, and strabismus. In cases with no other reason for amblyopia, stimulus deprivation amblyopia due to ptosis was assumed. RESULTS: The amount of ptosis was mild in 5 (6%), moderate in 26 (31%), and severe in 52 (63%) of 83 eyes with congenital ptosis. Strabismus was present in 17 (20%) eyes. Visual acuity could not be determined in 10 of 83 eyes with ptosis in children younger than 4 years. The overall incidence of amblyopia in the remaining 73 eyes was 48%. Of those patients with amblyopia, 54% had refractive errors such as anisometropia or ametropia, 20% had strabismus with or without refractive errors, and 26% had amblyopia solely attributed to ptosis. When all eyes with ptosis were included, the rate of stimulus deprivation amblyopia was 12% and all of these eyes had severe ptosis. CONCLUSION: Early detection and treatment of amblyogenic factors such as refractive errors and strabismus is recommended and, when the pupillary axis is occluded with severe ptotic eyelids, surgery should be performed as soon as possible to prevent stimulus deprivation amblyopia.

Toric intraocular Collamer lens for high myopic astigmatism after penetrating keratoplasty.

A toric intraocular Collamer lens (ICL) was used to correct myopic astigmatism after penetrating keratoplasty. The patient's manifest refraction improved from -8.0 -1.75 x 170 preoperatively, with an uncorrected distance visual acuity (UDVA) of 0.15 and a corrected distance visual acuity (CDVA) of 0.4, to +0.75 -0.50 x 130 postoperatively, with a UDVA of 0.8 and a CDVA of 1.0. No serious complications or refractive changes occurred during the 1-year follow-up. Implantation of a myopic toric ICL in phakic eyes is an option to correct postkeratoplasty anisometropia and astigmatism.

Primary implant placement with evisceration in patients with endophthalmitis.

PURPOSE: We report the results of 25 patients with endophthalmitis treated with evisceration with and without cornea preservation and primary orbital implants. DESIGN: Retrospective observational case series. METHODS: The records of 25 consecutive patients who underwent evisceration for endophthalmitis between June 1999 and November 2005 were reviewed. Ages ranged between three and 90 years (mean 57.6 years). The cause of endophthalmitis and bacterial agents were documented. All the patients were treated with topical, intravitreal, and intravenous antibiotics for endophthalmitis before evisceration. RESULTS: The follow-up period was between two months and 79 months (mean 25.4 months). All patients had relief from their pain and were satisfied with their cosmetic appearance and motility. Implant exposure was noted in three (12%) patients and pyogenic granuloma in one (4%) patient, which were treated successfully. Eighteen of the patients had prosthesis fitting at least eight weeks after operation. Seven patients elected to not have prosthesis. CONCLUSION: Unless the endophthalmitis is secondary to severe devastating trauma in which there is no sclera left, primary orbital implant placement with evisceration in these patients is an acceptable treatment.

Evisceration via superior temporal sclerotomy.

PURPOSE: To describe evisceration via superior temporal equatorial sclerotomy with preservation of the cornea as an alternative technique. DESIGN: Retrospective case series. METHODS: Records of 31 consecutive patients who underwent evisceration via superior temporal equatorial sclerotomy between November 1996 and November 2002 were reviewed. Patient age ranged from 1 to 79 years (mean, 27.93 years). Posterior sclerotomies were performed in 14 eyes (45%). The surgical indications, prior ocular surgeries, complications, cornea alterations, cornea sensitivities, size and material of the implants, and the motility of the globes with and without prosthesis were evaluated. RESULTS: Average follow-up was 31.68 months (range, 5-77 months). No intraoperative complications occurred. One patient had late-term pain due to partial implant extrusion from the melted cornea. All corneas remained clear until the 1st month after surgery. After the 2nd month some corneas became semiopaque (61%) and totally opaque (16%). Seven corneas remained clear (23%). Cornea vascularization started in the second week postsurgery in all patients. It was limited peripherally in six patients and moved forward to the central part in 25 patients. No patient had corneal sensation. In one case, keratitis occurred at month 13 postsurgery; in another, conjunctival dehiscence in the superior temporal region was noted, 26 months after surgery, due to esotropia resulting from pressure exerted on the region by the prosthesis. Globe motility was satisfactory in all patients. CONCLUSIONS: Implant motility is satisfactory and the implant exposure rate is low with this technique.