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.

Incidence of and risk factors for increased intraocular pressure after penetrating keratoplasty.

PURPOSE: To identify the incidence of and risk factors associated with the development of glaucoma after penetrating keratoplasty. METHODS: A retrospective study was carried out between September 1996 and January 2007 with 729 patients' 749 eyes, which underwent penetrating keratoplasty at the 1st Eye Clinic at Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul. Six attending surgeons performed all the surgeries at the same center. Age, sex, preoperative diagnosis, the presence of preoperative glaucoma, the status of the lenses, and additional surgery performed during keratoplasty, which may affect the postoperative intraocular pressure, were evaluated. RESULTS: The patients' ages ranged from 5 to 86 years (with a mean of 40.9 +/- 20.4 years). Two hundred seventy-seven (61.9%) of the patients were female and 452 (38.1%) were male. Intraocular pressure increases in the early postoperative period occurred in 41 (5.5%) eyes and chronically elevated intraocular pressure was found in 124 (16.6%) eyes. Preoperative diagnosis of inflammatory diseases such as graft thinning (relative risk [RR] = 4.96), traumatic scar formation (RR = 2.66), graft abscess (RR = 2.62), graft rejection (RR = 2.61), bullous keratopathy (RR = 2.59), and corneal abscess (RR = 1.52) were found to be risk factors for the development of glaucoma. Also, the following were significantly associated with an increased risk of glaucoma: peripheral anterior synechia (P = 0.019), preoperative glaucoma (P = 0.0001), and additional surgery combined with penetrating keratoplasty (P = 0.0001). The average period between surgery and the first intraocular pressure elevation was 5.0 +/- 6.5 months for all eyes. The mean intraocular pressure value of eyes that developed glaucoma after penetrating keratoplasty was 27.9 +/- 5.8 mmHg. CONCLUSIONS: Increased intraocular pressure after penetrating keratoplasty is a common clinical problem, and the risk factors are preoperative diagnosis of inflammatory diseases, peripheral anterior synechia, preoperative glaucoma, and additional surgery combined with penetrating keratoplasty.

Treatment of primary pterygium.

PURPOSE: To compare preserved human amniotic membrane transplantation and conjunctival autografts for treatment of primary pterygium. METHODS: Thirty-seven eyes of 35 patients with primary pterygium underwent surgical excision. In group A, 25 eyes were treated with conjunctival autografts. In group B, 12 eyes were treated with preserved human amniotic membrane transplantation. These two groups were compared in terms of complications, recurrence, and final appearance, prospectively. RESULTS: We observed two cases of recurrence in group A and five cases of recurrence in group B. The onset of recurrence was about 5.5 months in both groups. We observed two eyes with Dellen ulcer and one case with a Tenon's cyst in the superior temporal quadrant in group A and one case of Dellen ulcer and granulation tissue of one eye in group B. CONCLUSIONS: We suggest that free conjunctival autografting is a more effective technique in primary pterygium in terms of lowering recurrences compared with the amniotic membrane transplantation technique.

Effect of heparin in the intraocular irrigating solution on postoperative inflammation in the pediatric cataract surgery.

PURPOSE: To evaluate the influence of irrigation of the anterior chamber with heparin sodium on postoperative inflammation after pediatric cataract surgery. SETTING: Kartal Training and Research Hospital, First Eye Clinic, Istanbul, Turkey. DESIGN: Randomized prospective double-blind study. METHODS: Fourteen consecutive eyes from 14 patients aged 8.9 +/- 5.9 years, (range 3-18 years) (group 1) and 19 eyes from 19 patients aged 9.1 +/- 5.2 (range 1.5-18 years) (group 2) underwent pediatric cataract surgery. Five patients in group 1 were between three and five years old. One patient was 1.5 years old and six patients in group 2 were between three and five years old. During the procedure, group 1 received anterior chamber irrigation with heparin sodium (5 IU/cc) and 1 ml of heparin sodium (concentration 10 IU/ml) added to the irrigating balanced salt solution (BSS Plus; Alcon Laboratories, Inc., Fort Worth, TX, USA) while group 2 received BSS without heparin sodium only. Cases aged under three years received anterior vitrectomy in addition to posterior capsulorrhexis. One eye received anterior vitrectomy in group 1 and two eyes received anterior vitrectomy in group 2. Cases with preoperative complications were not included in the study. Early and late postoperative inflammatory complications, including fibrin formation, anterior and posterior synechia, cyclitic and pupillary membrane formation were recorded and compared. RESULTS: Mild anterior chamber reaction was observed in three patients in Group 1, while nine cases in group 2 experienced marked anterior chamber reaction. In four of nine patients from group 2, anterior chamber reaction was severe and resulted in pupillary membrane and synechia despite treatment in the postoperative 7th day, while in all three cases in group 1, reaction disappeared by the 7th day. CONCLUSION: Anterior chamber irrigation with heparin during pediatric cataract surgery may minimize early inflammatory reaction and decrease the number of postoperative inflammatory related complications.

Comparison of the effects of dorzolamide-timolol fixed combination and brimonidine on intraocular pressure after phacoemulsification surgery.

PURPOSE: To compare the effects of dorzolamide-timolol combination and brimonidine on intraocular pressure (IOP) after phacoemulsification surgery. METHODS: This prospective, randomized study included 69 eyes of 43 patients undergoing phacoemulsification and foldable intraocular lens implantation. Twenty-one patients were women and 22 were men. The mean patient age was 69.7+/-12.4 years. Patients were randomly assigned to one of three treatment groups preoperatively. Group A (n=23) received one drop of dorzolamide-timolol fixed combination and group B (n=23) received one drop of brimonidine tartrate 0.2% immediately after surgery. In group C (n=23), patients received no treatment and served as a control group. IOP was measured by Goldmann applanation tonometry 6 hours and 24 hours after surgery. RESULTS: Six hours after surgery, the mean IOP was significantly lower in group A (16.3+/-2.9 mm Hg) than in groups B (20.6+/-2.9 mm Hg) and C (24.6+/-5.4 mm Hg). However, 24 hours after surgery, the mean IOP was higher in group C (19.8+/-4.7 mm Hg) than in the other two groups (14.1+/-2.8 mm Hg in group A and 17.5+/-2.7 mm Hg in group B). CONCLUSIONS: Prophylactic treatment with dorzolamide-timolol fixed combination was more effective than brimonidine in reducing IOP 6 hours and 24 hours after phacoemulsification surgery.

Astigmatism after superonasal and superotemporal clear corneal incisions in phacoemulsification.

PURPOSE: To determine the astigmatism outcomes after cataract surgery performed using superonasal and superotemporal clear corneal incisions. SETTING: Department of Ophthalmology, Kartal Training and Research Hospital, Istanbul, Turkey. METHODS: This prospective study includes consecutive 45 eyes of 34 patients having phacoemulsification with implantation of foldable acrylic intraocular lens through a corneal tunnel incision between January and April 2004. The right eye always had a superotemporal incision while the left eye a superonasal incision. Astigmatism was measured by keratometry readings before surgery and 3rd, 15th, and 45th days postoperatively. The surgically induced astigmatism (SIA) was calculated by the vector analysis using the Holladay-Cravy-Koch method at 3rd day, 2nd and 6th weeks postoperatively. RESULTS: The mean preoperative astigmatism was 0.74 +/- 0.45 diopter (D) in the temporal incision group and 0.69 +/- 0.39 D in the nasal incision group. Fifty-eight percent of eyes had against-the-rule (ATR) astigmatism, 26% had with-the-rule (WTR) astigmatism, and 16% were astigmatically neutral. At 6 weeks, 46% of eyes had ATR astigmatism and 35% had WTR astigmatism. The mean total astigmatism was lower in the temporal incision group than in the nasal incision group at all successive examinations postoperatively. Although the total astigmatism decreased at 6 weeks in both groups, temporal incisions yielded less total and surgically induced astigmatism (P < .05). CONCLUSIONS: Cataract surgery using superotemporal incision induced significantly less SIA in the early postoperative period.

A retrospective case series: use of SoftPerm contact lenses in patients with keratoconus.

PURPOSE: To evaluate the performance of the SoftPerm contact lens in patients with irregular astigmatism caused by keratoconus. METHODS: Twenty-four eyes of 14 patients with keratoconus who had intolerance to rigid gas-permeable contact lenses and were fitted with SoftPerm lenses at Kartal Training and Research Hospital between August 1998 and January 2002 were evaluated retrospectively. The average follow-up time was 23 months. Patients were between the ages of 16 and 39 years. All patients were examined by corneal topography before a SoftPerm contact lens trial. A standard protocol was used to select the initial trial lens on the basis of computer-generated topographic keratometric readings. Final lens selection was based on clinical performance. Visual acuity and complications were analyzed after fitting. RESULTS: Best-corrected spectacle visual acuity of 20/40 or better was noted in 12.5% of eyes before the SoftPerm contact lens trial and increased to 83.3% after the SoftPerm contact lens fitting. Lens damage especially related to separation at the junction was observed in 29.1% of patients, discomfort in 29.1%, giant papillary conjunctivitis in 25%, and peripheral corneal neovascularization in 25%. Discomfort was the most common reason for discontinuation. CONCLUSIONS: SoftPerm lenses can be considered when high astigmatism is encountered in patients with keratoconus who have better visual acuity with SoftPerm lenses than with spectacles and who are intolerant of rigid gas-permeable lenses.