Phacoemulsification in posterior polar cataract.

PURPOSE: To evaluate the results and complications of phacoemulsification surgery in eyes with posterior polar cataracts and compare the techniques of viscodissection and hydrodissection. METHODS: The medical records of 29 consecutive patients (16 males, 13 females) with posterior polar cataracts (44 eyes) who had undergone cataract surgery were retrospectively reviewed. Patients were divided into two groups according to the technique used; viscodissection was applied to the experimental group (group 1) and hydrodissection to the control group (group 2). RESULTS: The postoperative best corrected visual acuity (BCVA) was 0.19 ± 0.22 logMAR (mean ± standard deviation) (range 0.00-0.70) in group 1 and 0.25 ± 0.18 logMAR (range 0.00-0.70) in group 2. Although the mean postoperative BCVA in group 1 was greater than that in group 2, the difference was not statistically significant (p=0.165). The mean postoperative BCVA was significantly greater than the mean preoperative BCVA in both groups (p=0.00). Intraoperatively, posterior capsular rupture occurred during the removal of the cortex in three eyes (13%) of group 1 patients, with vitreous loss and anterior vitrectomy in one eye only. In group 2, six eyes (28.5%) presented posterior capsular rupture, and anterior vitrectomy was performed because of vitreous loss in three eyes. Although the percentage of posterior capsular rupture was greater in group 2, the difference was not statistically significant (p=0.207). CONCLUSIONS: Complications in posterior polar cataract surgeries can be overcome by being careful throughout the surgery and using proper techniques. Viscodissection may be better for avoiding posterior capsular rupture than hydrodissection.

Phacoemulsification in posterior polar cataract / Facoemulsificação na catarata polar posterior

ABSTRACT Purpose: To evaluate the results and complications of phacoemulsification surgery in eyes with posterior polar cataracts and compare the techniques of viscodissection and hydrodissection. Methods: The medical records of 29 consecutive patients (16 males, 13 females) with posterior polar cataracts (44 eyes) who had undergone cataract surgery were retrospectively reviewed. Patients were divided into two groups according to the technique used; viscodissection was applied to the experimental group (group 1) and hydrodissection to the control group (group 2). Results: The postoperative best corrected visual acuity (BCVA) was 0.19 ± 0.22 logMAR (mean ± standard deviation) (range 0.00-0.70) in group 1 and 0.25 ± 0.18 logMAR (range 0.00-0.70) in group 2. Although the mean postoperative BCVA in group 1 was greater than that in group 2, the difference was not statistically significant (p=0.165). The mean postoperative BCVA was significantly greater than the mean preoperative BCVA in both groups (p=0.00). Intraoperatively, posterior capsular rupture occurred during the removal of the cortex in three eyes (13%) of group 1 patients, with vitreous loss and anterior vitrectomy in one eye only. In group 2, six eyes (28.5%) presented posterior capsular rupture, and anterior vitrectomy was performed because of vitreous loss in three eyes. Although the percentage of posterior capsular rupture was greater in group 2, the difference was not statistically significant (p=0.207). Conclusions: Complications in posterior polar cataract surgeries can be overcome by being careful throughout the surgery and using proper techniques. Viscodissection may be better for avoiding posterior capsular rupture than hydrodissection.

RESUMO Objetivo: Avaliar os resultados e complicações da cirurgia de facoemulsificação em olhos com catarata polar posterior e comparar as técnicas de viscodissecção e hidrodissecção. Métodos: Os prontuários de 29 pacientes consecutivos (16 homens, 13 mulheres) com posterior cataratas polares (44 olhos), que haviam sido submetidos a cirurgia de catarata foram analisados retrospectivamente. Os pacientes foram divididos em dois grupos de acordo com a técnica utilizada; viscodissecção foi aplicada ao grupo experimental (grupo 1) e hidrodissecção para o grupo de controle (grupo 2). Resultados: No pós-operatório, a melhor acuidade visual corrigida (BCVA) foi 0,19 ± 0,22 logMAR (média ± desvio padrão) (variação 0,00-0,70) no grupo 1 e 0,25 ± 0,18 (0,00-0,70) logMAR no grupo 2. Embora a média da BCVA pós-operatória do grupo 1 tenha sido maior do que a do grupo 2, a diferença não foi estatisticamente significativa (p=0,165). A melhor acuidade visual corrigida pós-operatória foi significativamente melhor do que no pré-operatório, em ambos os grupos (p=0,00). No grupo 1, houve ruptura capsular posterior durante a remoção do córtex em três olhos (13%); houve perda vítrea e necessidade de vitrectomia anterior mas apenas em destes olhos. No grupo 2, a ruptura da cápsula posterior ocorreu em seis olhos (28,5%); vitrectomia anterior foi necessária após a perda vítrea em três destes olhos. Embora a porcentagem de ruptura da cápsula posterior tenha sido maior no grupo 2, a diferença não foi estatisticamente significativa (p=0,207). Conclusões: As complicações em cirurgias de catarata polar posterior podem ser superadas com cautela durante toda a cirurgia e usando técnicas adequadas. Viscodissecção é melhor para evitar a posterior ruptura capsular do que hidrodissecção.

Evaluation of the peripapillary retinal nerve fiber layer and ganglion cell-inner plexiform layer measurements in patients with iron deficiency anemia with optical coherence tomography.

OBJECTIVE: To evaluate the thickness of the peripapillary retinal fiber layer (RNFL) and macula ganglion cell-inner plexiform layer (GCL+) using optical coherence tomography (OCT) in patients with iron deficiency (ID) anemia. METHODS: This study included 73 eyes of 39 patients with ID anemia and 68 eyes of 34 age- and sex-matched healthy subjects. The measurements included the peripapillary RNFL thicknesses as average, 4 quadrant and 12 clock-hour (CH) based and macula GCL+ thicknesses as average and 6 quadrant based. All measurements were completed with Cirrus HD-OCT and the results were compared between the groups. RESULTS: A total of 73 eyes of 39 patients with ID anemia and 68 eyes of 34 healthy subjects were included to the study. Regarding peripapillary RNFL thicknesses of the study and control patients, the values of average and quadrants revealed no significant differences between the groups. In CH sectors comparison, peripapillary RNFL thicknesses were significantly decreased only in CH4 (68.7 ± 14.5 µm in study versus 72.0 ± 13.4 µm in control patients, p = 0.049) and CH5 (93.4 ± 20.0µm in study versus 102.2 ± 20.1 µm in control patients, p = 0.01) sectors. All measured quadrants were statistically similar, when macula GCL+ thicknesses were compared between the groups. When the correlations between peripapillary RNFL and macula GCL+ thicknesses and serum hemoglobin and ferritin levels of study and control patients were calculated, the only statistically significant parameter was the correlation of peripapillary RNFL thickness in CH10 sector with serum ferritin level (p = 0.032, Spearman correlation coefficient: 0.369). CONCLUSION: The study revealed that peripapillary RNFL is thinner in nasal-inferior quadrant in patients with ID anemia. The measurements of macula GCL+ thicknesses were similar between the groups. Analyzing the retinal layers using OCT may provide valuable information in neurodegenerative events.

The effect of phacoemulsification surgery on intraocular pressure and anterior segment anatomy of the patients with cataract and ocular hypertension.

We evaluated the effect of phacoemulsification surgery on intraocular pressure (IOP), anterior chamber depth (ACD), iridocorneal angle (ICA), and central corneal thickness (CCT) of the patients with cataract and ocular hypertension. The decrease in IO P values of the 1 st week, 1 st month, 3 rd month, 6 th month, and 1 st year was statistically significant, but that of the 2 nd year was not significant. The increase in ACD and ICA values of the 1 st week, 1 st month, 3 rd month, 6 th month, and 1 st year was statistically significant, but that of the 2 nd year was not significant. The increase in CCT values of 1 st week and 1 st month was statistically significant, but those of 3 rd month, 6 th month, 1 st year, and 2 nd year were not significant. In conclusion, phacoemulsification surgery decreases IOP and increases ACD and ICA in the short-term. However, in the long-term it does not cause any significant changes.

Phacoemulsification in eyes with cataract and high myopia.

PURPOSE: To evaluate the outcomes and complications following phacoemulsification surgery in eyes with cataract and high myopia. METHODS: We retrospectively evaluated the data of 43 eyes of 28 consecutive patients (12 males, 16 females) with cataract and high myopia who had undergone phacoemulsification and intraocular lens (IOL) implantation. The mean [± standard deviation (range)] age of the patients was 59.20 ± 11.08 (39-77) years. RESULTS: The frequency of nuclear cataract was significantly higher than that of other cataract types (P=0.003). The mean axial length was 28.97 ± 1.99 (26-33) mm and the mean IOL power was 5.09 ± 4.78 (-3.0 to +14.0) diopters (D). The mean preoperative spherical equivalent (SE) was -16.48 ± 5.23 (-8.00 to -25.00) D and the mean postoperative SE was -1.46 ± 0.93 (0.00 to -3.00) D (P=0.00). The mean preoperative best-corrected visual acuity (BCVA) was 0.91 ± 0.37 (0.30 to -1.50) logMAR and the mean postoperative BCVA was 0.29 ± 0.25 (0.00-1.00) logMAR (P=0.00). Twenty-two eyes (51.2%) achieved the target postoperative refraction (±1.0 D). The eyes were divided into 3 groups according to the axial length. The mean biometric error was significantly higher in the group with the greatest axial length than in the other groups (P=0.007). Preoperative argon laser photocoagulation was performed in 7 eyes (16%) on account of retinal tears, retinal holes, or lattice degeneration. Postoperatively, retinal tears developed in 2 eyes (4%) and were treated with photocoagulation. One eye (2%) developed retinal detachment postoperatively, with the patient consequently referred for retinal surgery. Postoperatively, posterior capsule opacities developed in 11 eyes (25%), with all cases treated by laser capsulotomy. CONCLUSIONS: Good postoperative outcomes following phacoemulsification surgery were observed in patients with cataract and high myopia. However, clinicians should be aware of the risk of postoperative retinal tears and rhegmatogenous retinal detachment. Preoperative prophylactic argon laser photocoagulation treatment should be considered where necessary.

Phacoemulsificatıon in eyes wıth cataract and high myopia / Facoemulsificação em olhos com catarata e alta miopia

ABSTRACTPurpose:To evaluate the outcomes and complications following phacoemulsification surgery in eyes with cataract and high myopia.Methods:We retrospectively evaluated the data of 43 eyes of 28 consecutive patients (12 males, 16 females) with cataract and high myopia who had undergone phacoemulsification and intraocular lens (IOL) implantation. The mean [± standard deviation (range)] age of the patients was 59.20 ± 11.08 (39-77) years.Results:The frequency of nuclear cataract was significantly higher than that of other cataract types (P=0.003). The mean axial length was 28.97 ± 1.99 (26-33) mm and the mean IOL power was 5.09 ± 4.78 (-3.0 to +14.0) diopters (D). The mean preoperative spherical equivalent (SE) was -16.48 ± 5.23 (-8.00 to -25.00) D and the mean postoperative SE was -1.46 ± 0.93 (0.00 to -3.00) D (P=0.00). The mean preoperative best-corrected visual acuity (BCVA) was 0.91 ± 0.37 (0.30 to -1.50) logMAR and the mean postoperative BCVA was 0.29 ± 0.25 (0.00-1.00) logMAR (P=0.00). Twenty-two eyes (51.2%) achieved the target postoperative refraction (±1.0 D). The eyes were divided into 3 groups according to the axial length. The mean biometric error was significantly higher in the group with the greatest axial length than in the other groups (P=0.007). Preoperative argon laser photocoagulation was performed in 7 eyes (16%) on account of retinal tears, retinal holes, or lattice degeneration. Postoperatively, retinal tears developed in 2 eyes (4%) and were treated with photocoagulation. One eye (2%) developed retinal detachment postoperatively, with the patient consequently referred for retinal surgery. Postoperatively, posterior capsule opacities developed in 11 eyes (25%), with all cases treated by laser capsulotomy.Conclusions:Good postoperative outcomes following phacoemulsification surgery were observed in patients with cataract and high myopia. However, clinicians should be aware of the risk of postoperative retinal tears and rhegmatogenous retinal detachment. Preoperative prophylactic argon laser photocoagulation treatment should be considered where necessary.

RESUMOObjetivo:Avaliação dos resultados e complicações associadas à cirurgia de facoemulsificação em olhos com catarata e miopia alta.Método:Quarenta e três olhos de 28 pacientes (12 homens, 16 mulheres) consecutivos com catarata e alta miopia, que haviam sido submetidos a facoemulsificação e implante de lentes intraoculares (LIO), foram avaliados retrospectivamente. A idade foi de 59,20 ± 11,08, (39-77) anos [média ± desvio padrão, (variação)].Resultados:A frequência de catarata nuclear foi significativamente maior do que os outros tipos (p=0,003). O comprimento axial foi 28,97 ± 1,99, (26-33) mm e o poder da LIO foi 5,09 ± 4,78, (-3,0 a 14,0) dioptrias (D). O equivalente esférico pré-operatório (SE) foi de -16,48 ± 5,23, (-25,00 a -8,00) D e o SE pós-operatório foi -1,46 ± 0,93, (0,00 a -3,00) D, (P=0,00). A melhor acuidade visual corrigida pré-operatória (BCVA) foi de 0,91 ± 0,37, (0,30 -1,50) logMAR e a BCVA pós-operatória foi de 0,29 ± 0,25, (0,00-1,00) logMAR, (P=0,00). Vinte e dois olhos (51,2%) estavam dentro de refração alvo pós-operatória (± 1,0 D). Os olhos foram divididos em três grupos, de acordo com o comprimento axial. O erro biométrico foi significativamente maior no terceiro grupo, em comparação com os outros grupos (p=0,007). Fotocoagulação pré-operatória por laser de argônio foi realizada em 7 olhos (16%) devido a roturas retinianas, buracos de retina ou degeneração látice. No pós-operatório, as roturas da retina ocorreram em dois olhos (4%); tratados com fotocoagulação. Um olho (2%) desenvolveu descolamento de retina no pós-operatório e foi encaminhado para cirurgia de retina. No pós-operatório, opacidades da cápsula posterior ocorreram em 11 olhos (25%) e estes foram tratados com capsulotomia a laser.Conclusões:A cirurgia de facoemulsificação permite bons resultados em pacientes com catarata e miopia alta. No entanto, devemos estar atentos para a possibilidade de roturas da retina pós-operatórias e para o descolamento de retina regmatogênico. Se necessário, devemos usar o tratamento profilático de fotocoagulação a laser antes da cirurgia.

The influence of size and shape of Nd:YAG capsulotomy on visual acuity and refraction.

PURPOSE: To evaluate the influence of size and shape of neodymium:yttrium aluminum- Garnet (Nd:YAG) laser capsulotomy on visual acuity and refraction. METHODS: We retrospectively evaluated 85 eyes of 67 patients treated with Nd:YAG laser posterior capsulotomy for posterior capsule opacification (PCO). The mean age of included patients was 57.57 ± 9.26 (mean ± standard deviation, 38-75 years). The mean interval between surgery and Nd:YAG laser capsulotomy was 26.09 ± 7.08 (10-38) months. Patients were divided into four groups according to the shape and size of capsulotomy. Groups comprised patients with cruciate shape capsulotomies with openings of less than or equal to 3.5 mm (Group 1) or greater (Group 2) and patients with circular shape capsulotomies with openings of less than or equal to 3.5 mm (Group 3) or greater (Group 4). RESULTS: The mean number and energy of laser firings were significantly higher in Group 4 (p=0.00), and significantly lower in Group 1 (p=0.00), compared with that in other groups. Pre-procedural and post-procedural mean spherical equivalent (SE) values were significantly higher in Group 1 (p=0.026 and p=0.011, respectively). No statistical difference in best-corrected visual acuities (BCVA) or intraocular pressures (IOP) were observed between groups before (p=0.44 and p=0.452, respectively) or after capsulotomy (p=0.108 and p=0.125, respectively). A significantly higher number of patients in Group 4 (p=0.001), and a significantly lower number of patients in Group 1 (p=0.001), reported floating bodies compared with that in other groups. No significant changes in SE or intraocular pressure were observed after capsulotomy in any group (p=0.074 and p=0.856, respectively). Best-corrected visual acuity was significantly improved following capsulotomy in all groups (p<0.01). CONCLUSION: Cruciate shape capsulotomy with an opening of 3.5 mm or less provides the greatest improvement in visual function with minimal complications.

The influence of size and shape of Nd:YAG capsulotomy on visual acuity and refraction / A influência do tamanho e forma da capsulotomia por laser de Nd:YAG sobre a acuidade visual e refração

ABSTRACTPurpose:To evaluate the influence of size and shape of neodymium:yttrium aluminum- Garnet (Nd:YAG) laser capsulotomy on visual acuity and refraction.Methods:We retrospectively evaluated 85 eyes of 67 patients treated with Nd:YAG laser posterior capsulotomy for posterior capsule opacification (PCO). The mean age of included patients was 57.57 ± 9.26 (mean ± standard deviation, 38-75 years). The mean interval between surgery and Nd:YAG laser capsulotomy was 26.09 ± 7.08 (10-38) months. Patients were divided into four groups according to the shape and size of capsulotomy. Groups comprised patients with cruciate shape capsulotomies with openings of less than or equal to 3.5 mm (Group 1) or greater (Group 2) and patients with circular shape capsulotomies with openings of less than or equal to 3.5 mm (Group 3) or greater (Group 4).Results:The mean number and energy of laser firings were significantly higher in Group 4 (p=0.00), and significantly lower in Group 1 (p=0.00), compared with that in other groups. Pre-procedural and post-procedural mean spherical equivalent (SE) values were significantly higher in Group 1 (p=0.026 and p=0.011, respectively). No statistical difference in best-corrected visual acuities (BCVA) or intraocular pressures (IOP) were observed between groups before (p=0.44 and p=0.452, respectively) or after capsulotomy (p=0.108 and p=0.125, respectively). A significantly higher number of patients in Group 4 (p=0.001), and a significantly lower number of patients in Group 1 (p=0.001), reported floating bodies compared with that in other groups. No significant changes in SE or intraocular pressure were observed after capsulotomy in any group (p=0.074 and p=0.856, respectively). Best-corrected visual acuity was significantly improved following capsulotomy in all groups (p<0.01).Conclusion:Cruciate shape capsulotomy with an opening of 3.5 mm or less provides the greatest improvement in visual function with minimal complications.

RESUMOObjetivo:Avaliar a influência do tamanho e forma da capsulotomia a laser de Neodímio: Ítrio-Alumínio-Granada (Nd:YAG) na acuidade visual e refração.Métodos:Oitenta e cinco olhos de 67 pacientes, com opacificação de cápsula posterior (PCO), que tinham sido submetidos a capsulotomia por laser de Nd:YAG, foram avaliadas retrospectivamente. A idade foi 57,57 ± 9,26 (média ± desvio padrão), variação 38-75 anos. O intervalo médio entre a cirurgia e a capsulotomia a laser de Nd:YAG foi 26,09 ± 7,08 (variação 10-38) meses. Os pacientes foram divididos em 4 grupos de acordo com a forma e o tamanho da capsulotomia. O grupo 1 incluiu pacientes com forma cruzada e tamanho igual ou menor do que 3,5 mm de abertura capsulotomia, Grupo 2, forma cruzada e tamanho maior do que 3,5 mm, Grupo 3, forma circular e tamanho igual ou menor do que 3,5 mm e Grupo 4, forma circular e tamanho superior a 3,5 mm.Resultados:A quantidade média de energia utilizada e tiros aplicadas foram significativamente maiores no Grupo 4 (p=0,00) e significativamente menores no grupo 1 (p=0,00). O equivalente esférico (SE), antes e após o procedimento, foi significativamente mais elevado no Grupo 1 (p=0,026, p=0,011). Não houve diferença estatística entre os grupos em relação à acuidade visual melhor corrigida (BCVA) e pressão intraocular (IOP) antes do procedimento (p=0,44, p=0,452) e após o procedimento (p=0,108, p=0,125). O número de pacientes com sintomas de moscas volantes foi significativamente maior no grupo 4 (P=0,001) e significativamente inferior no grupo 1 (p=0,001). SE e IOP após o procedimento não foram estatisticamente diferentes daqueles antes do procedimento (p=0,074, p=0,856, respectivamente) em todos os grupos. BCVA após o procedimento foi significativamente melhor do que antes do procedimento (p=0,00) em todos os grupos.Conclusões:Em conclusão, para complicações mínimas e máximas funções visuais, o tamanho ótimo capsulotomia deve ser igual a ou menor do que 3,5 mm e deve ser em forma cruzada.

The course of dry eye after phacoemulsification surgery.

BACKGROUND: The aim of this retrospective study was to evaluate the course of dry eye syndrome after phacoemulsification surgery. METHODS: One hundred and ninety-two eyes of 96 patients (30 males, 66 females) with chronic dry eye syndrome and cataract, who had undergone phacoemulsification surgery were enrolled in this study. RESULTS: Their mean age was 68.46 ± 8.14 standard deviation (SD) (range 56-83) years . Thirty of them (31 %) were males and 66 (69 %) were females. Ocular Surface Disease Index (OSDI) questionnaire scores increased postoperatively, but arrived preoperative levels at the end of 3rd month following the surgery. Fluorescein staining patterns according to Oxford Schema got worse postoperatively, however after postoperative 3rd month they got better and resembled preoperative patterns. The mean postoperative 1st day, 1st week and 1st month Break-up Time (BUT) values were significantly lower than preoperative BUT value (P < 0.001, P < 0.001, P < 0.001), however 3rd month, 6th month, 1st year and 2nd year values were not significantly different from preoperative value (P = 0.441, P = 0.078, P = 0.145, P = 0.125). The mean postoperative 1st day, 1st week and 1st month Schirmer Test 1 (ST1) values were significantly lower than preoperative ST1 value (P < 0.001, P < 0.001, P < 0.001), however 3rd month, 6th month, 1st year and 2nd year values were not significantly different from preoperative value (P = 0.748, P = 0.439, P = 0.091, P = 0.214). CONCLUSION: Phacoemulsification surgery may aggravate the signs and symptoms of dry eye and affect dry eye test values in chronic dry eye patients in short-term. However, in long-term, signs and symptoms of dry eye decrease and dry eye test values return to preoperative values.

Self-declaration of diabetes and factors associated with having regular eye examinations among patients with type 2 diabetes in Turkey.

PURPOSE: To assess the awareness of diabetic retinopathy (DR), decided by self-declaration of diabetes, and the factors associated with having regular eye examinations among patients with type 2 diabetes in Turkey. METHODS: Between January and June 2014, 3322 adult patients attending an outpatient ophthalmology clinic were screened and 160 patients with type 2 diabetes with a known duration of at least 5 years were included. All patients were asked for their complaints and self-declaration of diabetes was noted. A questionnaire including questions about demographic characteristics, disease process, and follow-up was applied to responders, and all patients underwent a detailed ophthalmologic examination with dilation. RESULTS: A total of 31.9% of the patients self-declared that they had diabetes and/or requested examination for DR. A total of 29.4% reported that they had regular eye examinations. In regression analyses, factors associated with having regular eye examination were longer duration of diabetes (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.01-5.8; p = 0.049), insulin use (OR 4.45; 95% CI 1.7-10.7; p = 0.001), and self-declaration of diabetes (OR 8.16; 95% CI 3.5-19.2; p<0.001). CONCLUSIONS: The rates of self-declaration of diabetes and having regular eye examinations among patients with type 2 diabetes are low in Turkey. All adults undergoing an eye examination should be questioned for diabetes. Education of both patients with diabetes and the health care stuff dealing with them could improve the rates of patients having regular eye examinations and enhance the early detection of DR.

Toxic anterior-segment syndrome (TASS).

PURPOSE: To evaluate the clinical findings and courses of five patients who developed toxic anterior-segment syndrome (TASS) after cataract surgery and investigate the cause. MATERIALS AND METHODS: In May 2010, on the same day, ten patients were operated on by the same surgeon. Five of these patients developed TASS postoperatively. RESULTS: Patients had blurred-vision complaints on the first day after the operation, but no pain. They had different degrees of diffuse corneal edema, anterior-chamber reaction, fibrin, hypopyon, iris atrophies, and dilated pupils. Their vision decreased significantly, and their intraocular pressures increased. Both anti-inflammatory and antiglaucomatous therapies were commenced. Corneal edema and inflammation resolved in three cases; however, penetrating keratoplasty was needed for two cases and additional trabeculectomy was needed for one case. Although full investigations were undertaken at all steps, we could not find the causative agent. CONCLUSION: TASS is a preventable complication of anterior-segment surgery. Recognition of TASS, differentiating it from endophthalmitis, and starting treatment immediately is important. Controlling all steps in surgery, cleaning and sterilization of the instruments, and training nurses and other operation teams will help us in the prevention of TASS.