Pregabalin as a probable cause of central serous chorioretinopathy: Two case reports.

Pregabalin is commonly used for the treatment of neuropathic pain and is attributed to adverse effects of peripheral vasodilation and peripheral edema. Central serous chorioretinopathy (CSCR) is characterized by choroidal fluid leaks from choroidal vessels under the retina, causing focal retinal detachment with macular vision loss. Herein, we report two cases admitted to our clinic with vision loss while under pregabalin treatment. Upon eye examination, both patients were diagnosed with acute CSCR. Pregabalin treatment was discontinued upon the diagnosis of CSCR. We consider that the use of pregabalin in the presented two cases may be the causal effect of the CSCR diagnosis, as pathophysiology of CSCR is in parallel with the edema-related adverse effects of pregabalin.

Evaluation of the Relationship Between Age-related Macular Degeneration and Refractive Error, Socio-demographic Features, and Biochemical Variables in a Turkish Population.

OBJECTIVES: To investigate the relationship between age-related macular degeneration (AMD) and refractive error and axial length, as well as the socio-demographic characteristics and biochemical variables that may affect this relationship. MATERIALS AND METHODS: A total of 196 eyes of 98 patients over 50 years of age who were diagnosed with AMD at our clinic were included in this cross-sectional study. Early and late AMD findings were categorized according to the age-related eye disease study grading scale. Objective refractive error was measured by autorefractometer, confirmed by subjective examination, and spherical equivalent was calculated. Refractive errors of -0.50 D to 0.50 D were classified as emmetropia, <-0.50 D as myopia, and >0.50 D as hyperopia. Axial length was measured by ultrasonic biometry and values ≤23.00 mm were classified as short, >23.00 and <24.00 mm as normal, and ≥24.00 mm as long axial length. Demographic, systemic, and biochemical parameters of all patients were also investigated. RESULTS: Hypermetropic refractive error and shorter axial length were significantly more common than the other groups (p<0.01). No differences were observed between early and late stage groups in terms of refractive error and axial length. Patients with myopia had significantly lower values for total cholesterol, triglyceride, fasting blood glucose, and proportion of smokers. Rates of oral nutritional supplement use and fish consumption were significantly higher in the early AMD group. The most common comorbidity among the AMD patients in our study was essential hypertension. CONCLUSION: Hyperopic refractive error and shorter axial length were found to be associated with AMD. Longitudinal studies including larger patient numbers are needed to elucidate the causal and temporal relationship between hyperopic refractive error and AMD.

Comparison of ranibizumab and subthreshold micropulse laser in treatment of macular edema secondary to branch retinal vein occlusion.

PURPOSE:: To compare the effects of intravitreal ranibizumab injection and yellow (577 nm) subthreshold micropulse laser treatment in patients with macular edema following non-ischemic branch retinal vein occlusion. METHODS:: The medical records of 51 patients who underwent intravitreal ranibizumab (0.5 mg) injection or subthreshold micropulse laser for the treatment of macular edema due to branch retinal vein occlusion were retrospectively reviewed. Subthreshold micropulse laser was administered with a 10% duty cycle, 100 µm spot diameter, 200 ms exposure time. The patients received an injection or laser treatment at baseline and were, then, retreated as needed and were followed for 12 months. The mean best corrected visual acuity changes over the follow-up and the decrease in the mean central macular thickness were evaluated. RESULTS:: A total of 27 and 24 patients were assigned to intravitreal ranibizumab and subthreshold micropulse laser subgroups, respectively. The mean number of treatment was 3.81 of intravitreal ranibizumab group and 1.5 of subthreshold micropulse laser group (p < 0.05). The subgroups were similar with regard to the mean score of best corrected visual acuity at baseline, at 1, 6, and 12 months (p > 0.05). The decrease in the mean central macular thickness was significant in both intravitreal ranibizumab and subthreshold micropulse laser groups at 1, 6, and 12 months than that of values at baseline (p < 0.05). No new ocular or systemic adverse events were observed. CONCLUSION:: Our study results showed that intravitreal ranibizumab or yellow subthreshold micropulse laser treatment for macular edema due to branch retinal vein occlusion was not found to be superior to each other for reducing macular thickness and increasing visual acuity for 1-year period. Based on these results, subthreshold micropulse laser may be a useful alternative approach in the treatment of macular edema secondary to branch retinal vein occlusion.

Effects of long-term computer use on eye dryness.

OBJECTIVE: To evaluate the effects of long-term computer use on tear production and evaporation. METHODS: In this study, 30 eyes of 30 people using computer for 8 hours a day were taken as the study group. In the control group, 30 eyes of 30 healthy individuals who did not spend 1 hour using computer on a daily basis were evaluated. The cases were examined at 8 am and 5 pm. The Schirmer test, tear break-up time (TBUT), and ocular surface disease index (OSDI) were evaluated. RESULTS: There was no significant difference between the groups in terms of age and gender. The Schirmer test results, which measure the parameters of tear production, were 16.80±2.04 and 15.50±2.06 mm (p>0.05) in the study group, and 17.28±1.52 and 17.16±2.53 in the control group. The TBUT measurements were 9.15±2.93 and 6.80±1.11 sec in the study group. It was observed that the evening TBUT decreased (p<0.05). The TBUT measurements were 15.80±3.15 sec and 15.20±1.92 sec (p>0.05) in the control group. The OSDI scores were 26.7±3.36 and 28.3±1.19 in the study group, and 25.0±4.48 and 27.3±2.27 in the control group. CONCLUSION: As a result, it was found that a long-term computer use did not change the Schirmer test results significantly, but there were statistically significant changes in the tear break-up time (TBUT) results of the evaporative type eye dryness. According the our study results, long-term computer usage may cause an evaporative-type dry eye disease.

Topography and Higher Order Corneal Aberrations of the Fellow Eye in Unilateral Keratoconus.

OBJECTIVES: Comparison of topography and corneal higher order aberrations (HOA) data of fellow normal eyes of unilateral keratoconus patients with keratoconus eyes and control group. MATERIALS AND METHODS: The records of 196 patients with keratoconus were reviewed. Twenty patients were identified as unilateral keratoconus. The best corrected visual acuity (BCVA), topography and aberration data of the unilateral keratoconus patients' normal eyes were compared with their contralateral keratoconus eyes and with control group eyes. For statistical analysis, flat and steep keratometry values, average corneal power, cylindrical power, surface regularity index (SRI), surface asymmetry index (SAI), inferior-superior ratio (I-S), keratoconus prediction index, and elevation-depression power (EDP) and diameter (EDD) topography indices were selected. RESULTS: Mean age of the unilateral keratoconus patients was 26.05±4.73 years and that of the control group was 23.6±8.53 years (p>0.05). There was no statistical difference in BCVA between normal and control eyes (p=0.108), whereas BCVA values were significantly lower in eyes with keratoconus (p=0.001). Comparison of quantitative topographic indices between the groups showed that all indices except the I-S ratio were significantly higher in the normal group than in the control group (p<0.05). The most obvious differences were in the SRI, SAI, EDP, and EDD values. All topographic indices were higher in the keratoconus eyes compared to the normal fellow eyes. There was no difference between normal eyes and the control group in terms of spherical aberration, while coma, trefoil, irregular astigmatism, and total HOA values were higher in the normal eyes of unilateral keratoconus patients (p<0.05). All HOA values were higher in keratoconus eyes than in the control group. CONCLUSION: According to our study, SRI, SAI, EDP, EDD values, and HOA other than spherical aberration were higher in the clinically and topographically normal fellow eyes of unilateral keratoconus patients when compared to a control group. This finding may be due to the mild asymmetric and morphologic changes in the subclinical stage of keratoconus leading to deterioration in the indicators of corneal irregularity and elevation changes. Therefore, these eyes may be exhibiting the early form of the disease.

Differences in pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification.

The purpose of this study is to compare pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification in both eyes, using sub-Tenon's local anesthesia without sedation. In this study, 268 patients with bilateral senile cataracts were recruited. All operations were performed without sedation, using a clear corneal phacoemulsification technique and sub-Tenon's local anesthesia, by one of four surgeons. The first surgery was performed on the eye with the higher grade cataract. The other eye was operated on within 3 months by the same surgeon (mean interval 1.9 ± 1.1 months). All patients were asked to grade their pain experience during induction and maintenance of anesthesia and also during the phacoemulsification surgery, using a visual analogue scale (VAS) from 0 (no pain) to 10 (unbearable pain) administered after the surgery. The cooperation of the patient was graded from 0 (no event) to 3 (markedeye and head movement and lid squeezing) by the attending surgeon. The VAS scores and cooperation scores of the patients were the outcome measurements. The mean pain score was 2.11 ± 0.79 in the first eye and 3.33 ± 0.80 in the second eye during the administration of sub-Tenon's anesthesia, and 1.50 ± 0.60 in the first eye and 2.10 ± 0.57 in the second eye during the phacoemulsification surgery. The patient cooperation score was 1.60 ± 0.75 in the first surgery and 2.08 ± 0.72 in the second surgery. The differences between the first and second surgeries were statistically significant for all outcome measures (p < 0.01). Patients who previously underwent phaco surgery in one eye experienced more pain and showed worse cooperation during the phaco surgery in the second eye, especially if there was a short time between the surgeries, viz., less than 3 months. Therefore, if the surgeon has difficulty in the first operation gaining the patient's cooperation, the surgeon must be careful: if contralateral eye surgery is required, the addition of sedation/analgesia should be considered or the surgery postponed for a while to abolish the influence of recent memory on the patient's subsequent pain experience.

The combination of phacoemulsification surgery and intravitreal triamcinolone injection in patients with cataract and diabetic macular edema.

PURPOSE: To assess the safety and efficiency of combined phacoemulsification (PHACO) surgery and intravitreal triamcinolone (IVTA) injection with or without macular grid laser photocoagulation in patients with cataract and diabetic macular edema. MATERIAL AND METHODS: This prospective study included 41 eyes of 36 diabetic patients with cataract and coexisting clinically significant macular edema (CSME). After PHACO and IVTA injection eyes were divided into two groups: the laser and IVTA group (Group 1) and only IVTA group (Group 2). Preoperative and postoperative best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were recorded. Paired sample t-test was used to compare data in the groups and C square test for qualitative variables. RESULTS: Postoperative BCVA was significantly higher than the initial BCVA during the follow-up period in both groups (p < 0.01). The BCVA 6 months after surgery was significantly higher in group 1 than in group 2 (p < 0.01). There was no statistically significant difference in IOP between two groups preoperatively and postoperatively during the follow-up period (p > 0.05). There was no statistically significant difference between both groups in mean CMT preoperatively and 2nd week, 2nd month and 3rd month after surgery (p > 0.05). The mean CMT 6 months after surgery was statistically significantly lower in group 1 than in group 2 (p < 0.01). CONCLUSIONS: PHACO surgery combined with IVTA injection improves BCVA and provides a decrease in CMT in diabetic patients with CSME. Additional macular grid laser photocoagulation after surgery helps to preserve this improvement in BCVA and decrease in CMT.

Persistent Symblepharon in an Infant Following Epidemic Keratoconjunctivitis.

Epidemic keratoconjunctivitis (EKC), caused by certain species D human adenoviruses (Ads), is a highly contagious severe disease involving both the conjunctiva and cornea. The hallmark of this disease is the subepithelial infiltration of leukocytes, which results in corneal opacities that may persist for months or even years. In this case, of a 6-month-old infant, we report a symblepharon formation, a relatively rare outcome of EKC. In this condition, the palpebral conjunctiva adheres tightly to the bulbar conjunctiva of the eyeball. Our report is the first documentation of a symblepharon formation in an infant. Only two similar cases have been reported to date; therefore, a detailed description is of considerable interest to ophthalmologists. This is particularly interesting since a previous publication has associated symblepharon formation with an adenovirus infection, which is not usually involved in EKC. The development of a symblepharon following EKC is rare in infants. Since topical treatment cannot be applied due to severe eyelid edema, oral steroid therapy can be administered with pediatric consultation and meticulous monitoring.

Posterior Subtenon's Capsule Triamcinolone Acetonide Injection for the Treatment of Diabetic Macular Edema.

PURPOSE: To evaluate and compare the efficacy of posterior subtenon's triamcinolone injections versus grid laser photocoagulation (GLP) combined with posterior subtenon's triamcinolone injection in eyes with diabetic macular edema (DME). METHODS: In this prospective clinical study, 42 eyes with DME that showed a decrease in visual acuity (VA) were included. The first group consisted of 22 eyes that received a posterior subtenon's injection of 40 mg of triamcinolone acetonide under topical anesthesia. The second group of 20 eyes received macular GLP applied 1 month after subtenon's triamcinolone acetonide (STTA) injection. All patients were evaluated at baseline and 1 day; 1, 2, 4, 6, and 8 weeks; and 3 and 6 months after injection. In some patients, injections were repeated after 3 months. The main outcome measures were VA, central macular thickness (CMT), intraocular pressure, cataract progression, and frequency of complications. RESULTS: The mean baseline CMT for Group I was 456.85 ± 56.90 µm. The mean baseline CMT for Group II was 455.66 ± 57 µm. In the first group, mean CMTs for second week, 8th week, 12th week, and 6th month were 258.15, 276.50, 280.05, and 433.30 µm, respectively. In the second group, mean CMTs for second week, 8th week, 12th week, and 6th month were 261.42, 272.76, 284.71, and 291.76 µm, respectively. Before treatment, in the first group, the mean best-corrected visual acuity (BCVA) measured using a Snellen chart was 0.19, while the first week, third, and sixth month BCVA means were 0.59, 0.57, and 0.41, respectively. Before treatment, BCVA in the second group was 0.17, while the first week, third, and sixth month means were 0.61, 0.64, and 0.60, respectively. Treatment complications included cataracts in 4 eyes and glaucoma in 1 eye. CONCLUSION: There is a temporary therapeutic effect of posterior subtenon's triamcinolone injection without laser photocoagulation. GLP improves VA and reduces the risk of recurrent macular edema after posterior STTA injection.

Contact lens visual rehabilitation in keratoconus and corneal keratoplasty.

Keratoconus is the most common corneal distrophy. It's a noninflammatory progressive thinning process that leads to conical ectasia of the cornea, causing high myopia and astigmatism. Many treatment choices include spectacle correction and contact lens wear, collagen cross linking, intracorneal ring segments implantation and finally keratoplasty. Contact lenses are commonly used to reduce astigmatism and increase vision. There are various types of lenses are available. We reviewed soft contact lenses, rigid gas permeable contact lenses, piggyback contact lenses, hybrid contact lenses and scleral-semiscleral contact lenses in keratoconus management. The surgical option is keratoplasty, but even after sutur removal, high astigmatism may stil exists. Therefore, contact lens is an adequate treatment option to correct astigmatism after keratoplasty.

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.

High Dk piggyback contact lens system for contact lens-intolerant keratoconus patients.

BACKGROUND: The aim of the study was to examine the clinical success of high Dk (oxygen permeability) piggyback contact lens (PBCL) systems for the correction of contact lens intolerant keratoconus patients. METHODS: Sixteen patients (29 eyes) who were not able to wear gas-permeable rigid lenses were included in this study. Hyper Dk silicone hydrogel (oxygen transmissibility or Dk/t = 150 units) and fluorosilicone methacrylate copolymer (Dk/t = 100 units) lenses were chosen as the PBCL systems. The clinical examinations included visual acuity and corneal observation by biomicroscopy, keratometer reading, and fluorescein staining before and after fitting the PBCL system. RESULTS: INDICATIONS FOR USING PBCL SYSTEM WERE: lens stabilization and comfort, improving comfort, and adding protection to the cone. Visual acuities increased significantly in all of the patients compared with spectacles (P = 0). Improvement in visual acuity compared with rigid lenses alone was recorded in 89.7% of eyes and no alteration of the visual acuity was observed in 10.3% of the eyes. Wearing time of PBCL systems for most of the patients was limited time (mean 6 months, range 3-12 months); thereafter they tolerated rigid lenses alone except for 2 patients. CONCLUSION: The PBCL system is a safe and effective method to provide centering and corneal protection against mechanical trauma by the rigid lenses for keratoconus patients and may increase contact lens tolerance.

Comparison of burst, pulse, and linear modes used in phacoemulsification surgery.

PURPOSE: To compare different ultrasound modes used in phacoemulsification surgery in terms of their efficacy and outcomes during and after surgery. METHODS: A total of 86 patients with cataract diagnosis who underwent phacoemulsification surgery in Fatih Sultan Mehmet Education and Research Hospital Eye Diseases Clinic between November 2006 and February 2008 were included in the study and were prospectively analyzed. Patients were randomized into 3 groups based on the phacoemulsification mode to be used (burst, pulse, and linear mode). RESULTS: Mean phacoemulsification time was 40.32+/-33.14 seconds, ultrasound time was 19.94+/-9.10 seconds, and effective ultrasound time was 20.16+/-16.57 seconds in Group I; mean phaco time was 79.90+/-65.52 seconds, ultrasound time was 15.30+/-5.74 seconds, and effective ultrasound time was 39.95+/-32.76 seconds in Group II; and mean phaco time was 75.75+/-50.56 seconds, ultrasound time was 11.65+/-2.91 seconds, and effective ultrasound time was 37.87+/-22.89 seconds in Group III. Central corneal thickness measurements with pachymetry were 586.61+/-46.86 microm on day 1, 555.54+/-39.31 microm at week 1, 543.29+/-33.88 microm at month 1, and 543.29+/-33.88 microm at month 3 in Group I; 549.83+/-49.18 microm on day 1, 530.03+/-46.42 microm at week 1, 524.32+/-45.76 microm at month 1, and 521.32+/-45.26 microm at month 3 in Group III; and 572.91+/-39.12 microm on day 1, 545.91+/-32.67 microm at week 1, 537.70+/-29.77 microm at month 1, and 534.04+/-28.64 microm at month 3 in Group III. CONCLUSIONS: Phacoemulsification power should be kept at minimum in order to induce minimal trauma and to achieve early rehabilitation.

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.

Administration of the fixed combination of latanoprost 0.005% and timolol 0.5% in glaucoma patients with an intraocular pressure over 30 mmHg.

PURPOSE: To evaluate the intraocular pressure (IOP) reducing effect of a fixed combination of 0.005% latanoprost and 0.5% timolol in patients with an IOP of 30 mmHg or higher. DESIGN: Prospective, randomized clinical trial. PARTICIPANTS: Twenty-eight patients. METHODS: Patients had received no prior medical glaucoma treatment. Routine ophthalmic examinations and visual field tests were performed before and after treatment for each patient. RESULTS: Mean IOP was 32.28 +/- 0.92 mmHg before treatment. Mean IOP levels were 18.75 +/- 0.68 for the first day, 17.96 +/- 0.90 for the first week and 17.64 +/- 0.66 for the first month after treatment. CONCLUSION: A fixed combination of latanoprost 0.005% and timolol 0.5% is effective in significantly reducing IOP in glaucoma patients with an IOP greater than 30 mmHg.

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.

Refraction, intraocular pressure and anterior chamber depth changes after Nd:YAG laser treatment for posterior capsular opacification in pseudophakic eyes.

PURPOSE: The aim was to investigate the effect of Nd:YAG capsulotomy on refraction, intraocular pressure and anterior chamber depth changes and complications of Nd:YAG laser treatment for posterior capsular opacification in pseudophakic eyes. METHODS: Our study includes 26 eyes (23 patients) with posterior capsular opacification after uncomplicated phacoemulsification surgery and intraocular lens implantation. Complete ocular examinations were performed for all patients. The visual acuity, intraocular pressure and anterior chamber depth measurements were obtained in all examinations. Nd:YAG capsulotomy was measured in all patients. Eyes received one drop of aproclonidine 0.5 % before and immediately after YAG laser capsulotomy. Data were analysed statistically. RESULTS: Mean patient age was 53.73 +/- 13.53 years. Before Nd:YAG capsulotomy mean anterior chamber depth was 4.03 +/- 0.58 mm and in the first day after capsulotomy the mean value was 4.02 +/- 0.46 mm. Mean spherical equivalent refraction before laser treatment was -0.52 D and on the first day after laser treatment was -0.49 D. An improvement in visual acuity was achieved in all cases. Before Nd:YAG capsulotomy mean visual acuity was 0.38 +/- 0.13 and on the first day after capsulotomy, the mean value was 0.93 +/- 0.11, the difference of which was statistically significant. There were no statistically significant differences between the anterior chamber depth and intraocular pressure measurements before laser capsulotomy and on the first day, first month and third month after laser. CONCLUSION: Nd:YAG laser capsulotomy is an effective and safe method of treatment of posterior capsular opacification.

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.

Rose K contact lens fitting for keratoconus.

PURPOSE: We evaluated the clinical outcome and fitting characteristics with Rose K contact lenses in patients with irregular astigmatism due to keratoconus. METHODS: About 19 patients with keratoconus were fitted with Rose K lens in the Cornea Department at the Fatih Sultan Mehmet Training and Research Hospital between May 2005 and April 2006. Patients were between 19 and 32 years of age. All the patients underwent a complete ophthalmic examination and best-corrected visual acuity measurements were taken with glasses at the baseline visit. During biomicroscopic evaluation, position, and centralization of the contact lens and fluorescein staining were noted. Visual acuity, contact lens comfort, and daily contact lens wearing time after fitting were evaluated. RESULTS: A total of 96% of the patients tolerated the fitting. The mean daily wearing time was 10.7 h. There was a significant increase in visual acuity with Rose K lens compared with best-corrected spectacle visual acuity. CONCLUSION: Rose K lenses are a viable alternative in the visual rehabilitation of patients with keratoconus.