Penetrating Keratoplasty in Congenital Glaucoma.

BACKGROUND: Childhood glaucoma is one of the most common causes of corneal opacity in childhood and is associated with various pathological corneal changes, including corneal enlargement, corneal clouding, and edema. Congenital glaucoma (CG) may cause a decrease in vision outcomes due to corneal opacity or clouding, which is often associated with stimulus deprivation amblyopia. Therefore, to create a balance between preventing amblyopia and sustaining corneal clearance, patients with CG can be managed with early penetrating corneal transplantation surgery along with advanced glaucoma management. AIM: To investigate the graft survival rate and factors affecting graft survival in patients with congenital glaucoma who underwent penetrating keratoplasty (PKP). STUDY DESIGN: Cross-sectional. MATERIALS AND METHODS: Patients with congenital glaucoma who underwent PKP were retrospectively evaluated. The associations between age, corneal diameter, presence of ocular comorbidities, concurrent ocular surgeries with corneal graft, and visual outcomes were assessed. RESULTS: Among the 30 eyes enrolled in the study, 6 (20%) had aniridia, 6 (20%) had Axenfeld-Rieger syndrome, and 18 (60%) were diagnosed with primary congenital glaucoma. Graft survival rates were 66.6% and 63.33% at 12 and 24 months, respectively. At the end of the follow-up, the overall graft survival rate was 60%. Statistical significance was observed between patient age at the time of surgery and graft failure (p = 0.02). Graft failure was associated with a younger patient age. Functional vision was achieved in 53.3% of patients. CONCLUSIONS: The management of congenital glaucoma and its corneal complications is a delicate issue that requires great effort. PKP in congenital glaucoma was moderately successful in the present study. To provide functional vision, PKP could be the treatment of choice.

Efficacy comparison of combined trabeculectomy with MMC and gonioscopy-assisted transluminal trabeculotomy.

PURPOSE: To compare the efficacy of gonioscopy-assisted transluminal trabeculotomy combined with cataract surgery (PGATT) and trabeculectomy combined with cataract surgery (PTRAB) in open-angle glaucoma patients. METHODS: A multi-centered, retrospective, non-randomized study included 67 PGATT patients and 70 PTRAB patients. We compared preoperative intraocular pressure (IOP), best-corrected visual acuity (BCVA) compared with early and final IOP, medication numbers, and BCVA levels. Success was determined as IOP reduction > 20% from baseline, IOP between 5 and 21 mmHg, preoperative IOP of higher than 21 mmHg with medication and postoperative IOP of less than 21 mmHg without medication for surgeries performed for intolerance to medication, postoperative IOP < 21 mmHg as well as < 18 mmHg separately without medications, and no need for further glaucoma surgery. RESULTS: Preoperative IOP values were 28.61 ± 6.02 mmHg in PTRAB group and 23.99 ± 8.00 mmHg in PGATT group (P < 0.0001). Early postoperative IOP values were found lower in PTRAB group as 12.19 ± 3.41 mmHg and as 15.69 ± 4.67 mmHg in PGATT group (P < 0.0001). Last follow-up IOP reading were lower in PGATT group (P = 0.009). IOP difference values were found higher both in early and last postoperative periods in PTRAB group (respectively, P < 0.0001, P = 0.018). Success rates were found higher in both at lower than 21 and 18 mmHg levels in PGATT group (respectively, P = 0.014, P = 0.010). CONCLUSION: We found the PGATT combined procedure to be a well-tolerated, effective procedure that can lower IOP both early and late in the postoperative period with different rates of IOP success compared with the combined PTRAB procedure.

The efficacy of gonioscopy-assisted transluminal trabeculectomy combined with phacoemulsification.

PURPOSE: To investigate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) with or without cataract extraction (CE) in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEX) patients. METHODS: A retrospective, non-randomized study included 108 eyes of 108 patients, with a mean age of 65.96 ± 14.84 years, who underwent GATT to treat open-angle glaucoma. We have compared two groups, GATT alone or GATT combined with CE and followed-up minimum for 12 months. Preoperative intraocular pressure (IOP), best-corrected visual acuity (BCVA) compared with final IOP, medication numbers, and BCVA levels. Surgical success was determined as IOP reduction > 20% from baseline, IOP between 5-21 mmHg, if surgery was done for intolerance to medications, preoperative < 21 mmHg with medications, postoperatively < 21 mmHg without medications, and no need for further glaucoma surgery. Also, we defined success with medications and success without medications. High success is defined as IOP < 16 mmHg without medications. RESULTS: Success percentiles were found 87.5% for GATT and 83.8% for GATT with CE group (P = 0.811). IOP percentile changes were - 44.25 ± 21.32 in GATT group, - 32.29 ± 23.41 in GATT with CE group, statistically higher change observed in GATT group (P = 0.009). Final IOP levels were found statistically indifferent for comparing GATT and GATT with CE groups and between PEX and POAG groups (respectively, P = 0.412, P = 0.335). CONCLUSION: We observed GATT alone has a superior lowering effect on IOP than combined surgery. Final IOP values and success percentiles show us combined surgery is also effective.

Refractive, Topographic, and Aberrometric Results at 2-Year Follow-Up for Accelerated Corneal Cross-Link for Progressive Keratoconus.

Purpose. To report the visual, refractive, and corneal topography and wavefront aberration results of accelerated corneal cross-linking (CXL) during a 24-month follow-up. Methods. Forty-seven eyes underwent riboflavin-ultraviolet A-induced accelerated CXL treatment (30 mW/cm2 with a total dose of 7.2 joules/cm2). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical values, keratometry (K) measurements (Ksteep, Kflat, Kavg, and Kapex), central corneal thickness, and anterior corneal aberrometric analyses including total wavefront error (WFE), total high order aberration (HOA), astigmatism, trefoil, coma, quadrafoil, secondary astigmatism, and spherical aberration were evaluated. Results. The mean UDVA and CDVA were significantly improved at 1 (p = 0.003 and p = 0.004, resp.) and 2 years after treatment (p = 0.001 and p = 0.001, resp.). The mean Ksteep, Kflat, Kaverage, and Kapex values were significantly lower than baseline at 12 months (p = 0.008, p = 0.024, p = 0.001, and p = 0.014, resp.) and 24 months (p = 0.014, p = 0.017, p = 0.001, and p = 0.012, resp.). Corneal thickness showed a significant decrease at 1 month. Total HOA and coma decreased significantly at the 12-month (p = 0.001 and p = 0.009, resp.) and 24-month visits (p = 0.001 and p = 0.007, resp.). Conclusion. Accelerated CXL (30 mW/cm2) was found to be effective in improving UDVA, CDVA, corneal topography readings, total HOA, and coma aberrations during the 24-month follow-up.

Accelerated (18 mW/cm(2)) Corneal Cross-Linking for Progressive Keratoconus: 18-Month Results.

PURPOSE: The aim of this study is to report the results of 18 months of follow-up after treatment with accelerated (18 mW/cm(2)) corneal cross-linking in patients with progressive keratoconus. METHODS: Forty-two eyes of 42 patients with progressive keratoconus were included in this retrospective study. All patients underwent accelerated corneal cross-linking at an irradiance of 18 mW/cm(2) for 5 min (total surface dose 5.4 J/cm(2)). Visual acuity, topographic findings (Kflat, Ksteep, Kaverage, and apical keratometry), and central corneal thickness were evaluated during the 18-month follow-up period. RESULTS: The mean ± standard deviation age of the 16 female and 26 male patients was 24.28 ± 6.32 years (range 14-36). Uncorrected distance visual acuity improved clinically significant from 0.52 ± 0.31 to 0.44 ± 0.25 logMAR (P = 0.031), and corrected distance visual acuity improved clinically significant from 0.34 ± 0.21 to 0.28 ± 0.19 logMAR (P = 0.018). At the last examination during the follow-up period, the flat keratometry (Kflat) decreased from a baseline of 45.65 ± 2.71 to 45.41 ± 2.72 diopters (D) (P = 0.001), the steep keratometry (Ksteep) decreased from 49.20 ± 3.54 to 48.96 ± 3.43 D (P = 0.023), and apical keratometry decreased from 56.62 ± 6.43 to 55.19 ± 5.69 D (P = 0.001), all of them were clinically significant at the 18-month visit. The preoperative values of central corneal thickness changed from 458.95 ± 38.79 to 461.85 ± 41.36 µm 18 months after the operation (P = 0.476). CONCLUSION: The accelerated corneal cross-linking was found to be effective for the stabilization of progressive keratoconus during the 18 months of follow-up visits.

The Effect of Adjuvant Intracameral Triamcinolone Acetonide on the Surgical Results of Trabeculectomy with Mitomycin C.

OBJECTIVES: To evaluate the effect of adjuvant intracameral triamcinolone acetonide (TA) on the surgical results of trabeculectomy with mitomycin C. MATERIALS AND METHODS: All consecutive trabeculectomy cases performed in the glaucoma clinic between July 2012 and December 2013 were retrospectively reviewed from the patient charts. Only those with follow-up of 12 months or longer were included. Patients with intraoperative intracameral TA (study group, n=19) were compared to those without TA (control group, n=21) in terms of surgical success, intraocular pressure (IOP) change, medication use and complications. RESULTS: Forty eyes of 31 patients (21 male/10 female, mean age 64.2±13.8 years) were included in the study. The mean follow-up period was 20.9±5.1 months and 20.7±6.7 months in the study and control groups, respectively (p=0.830). Baseline IOP was 26.4±9.9 and 25.2±7.6 mmHg (p=0.979), and final IOP was 12.7±2.6 and 13.6±3 mmHg in both groups respectively (p=0.226). At the final follow-up, complete success was observed in 68.4% and 52.4% of the study and control groups (p=0.349) and anti-glaucoma medication was used by 31.6% (mean number of medications: 0.79±1.2) and 47.6% (mean number of medications: 1.33±1.7), respectively (p>0.05). Bleb encapsulation, leakage, suture-lysis and hypotony rates were similar in both groups (for all, p>0.05). Cataract progression was noted in six (35.3%) and in five (26.3%) of the phakic eyes in the study and control groups, respectively (p=0.720). CONCLUSION: When used intracamerally, TA did not increase the complication rate in trabeculectomy surgery. Although the group that received TA showed lower IOP levels, use of fewer medications and fewer eyes requiring medication, the differences did not reach significance.

Evaluation of subbasal nerve morphology and corneal sensation after accelerated corneal collagen cross-linking treatment on keratoconus.

PURPOSE: The aim of this study was to report on the evaluation of corneal nerve fiber density and corneal sensation after accelerated corneal collagen cross-linking on keratoconus patients. METHODS: The study was performed on 30 keratoconus eyes (30 participants: 16 M, 14 F; 17-32 years old) treated with accelerated collagen cross-linking for disease stabilization. Mean outcome measures were corneal sensation evaluation by Cochet-Bonnet esthesiometry and subbasal nerve fiber density assessment by corneal in vivo confocal microscopy. All corneal measurements were performed using scanning slit confocal microscopy (ConfoScan 4, Nidek Technologies, Padova, Italy). RESULTS: The accelerated corneal collagen cross-linking procedure was performed on 30 eyes of 30 patients (19 right, 63.3%; 11 left, 27.7%). The mean age was 23.93 ± 4. The preoperative mean keratometry, apex keratometry and pachymetry values were 47.19 ± 2.82 D, 56.79 ± 5.39 and 426.1 ± 25.6 µm, respectively. Preoperative mean corneal sensation was 56.3 ± 5.4 mm (with a range from 40 to 60 mm), it was significantly decreased at 1st and 3rd month visit and increased to preoperative values after 6th month visit. Preoperative mean of subbasal nerve fiber density measurements was 22.8 ± 9.7 nerve fiber/mm(2) (with a range of 5-45 mm), it was not still at the preoperative values at 6th month (p = 0.0001), however reached to the preoperative values at 12th month (p = 0.914). CONCLUSIONS: Subbasal nerve fibers could reach the preoperative values at the 12th month after accelerated corneal collagen cross-linking treatment although the corneal sensation was improved at 6th month. These findings imply that the subjective healing process is faster than the objective evaluation of the keratoconus patients' cornea treated with accelerated corneal collagen cross-linking.

Evaluation of pachymetric measurements with scheimpflug photography-based system and optical coherence tomography pachymetry at different stages of keratoconus.

The aim of this study was to compare the central and peripheral pachymetric measurements determined with Sirius system and Visante OCT and evaluate the agreement between them at different stages of keratoconus. Measurements were not significantly different in all patients and subgroups and showed high correlation for the corneal thicknesses of the entire cornea in different stages of keratoconus.

Pain, wound healing and refractive comparison of mechanical and transepithelial debridement in photorefractive keratectomy for myopia: results of 1 year follow-up.

PURPOSE: To compare the efficacy, safety and postoperative pain of mechanical versus transepithelial photorefractive keratectomy (PRK) techniques. SETTING: Cornea and refractive surgery subspecialty. DESIGN: Prospective clinical trial. METHODS: This prospective comparative study included 84 eyes of 42 patients with myopia who received mechanical PRK (m-PRK) in 1 eye and transepithelial PRK (t-PRK) in the contralateral eye. The mean patient age was 28.5±6.3 years (range 20-46 years). Postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refractions, postoperative epithelial healing time, surgical time, postoperative pain rating and corneal haze were recorded. RESULTS: At week 1, statistically the UDVA was significantly better in the t-PRK eyes; however, at 3 months, similar refractive stability was achieved in both groups. The mean spherical equivalent (SE) decreased from -2.44±1.00D (m-PRK eyes) and -2.88±1.24D (t-PRK eyes) at baseline to -0.19±0.38D and -0.30±0.40D, respectively, after 1 year. Surgical time was 98.6±9.8s in m-PRK eyes and 58.0±6.4s in t-PRK eyes. On postoperative days 1 and 3, using the global assessment rating, 81% of mPRK eyes that had pain, reported more pain than that reported for the tPRK eyes. In addition, m-PRK treated eyes demonstrated higher mean pain scores based on the 11-point numerical rating scale and Visual Analogue Scale (VAS). The mean time to complete epithelial healing was 2.19±0.39 days (t-PRK) and 3.76±0.43 days (m-PRK). CONCLUSION: t-PRK for mild-to-moderate myopia was more comfortable than conventional m-PRK; patients had less pain, and faster healing time.

Comparison of conjunctival graft thickness after primary and recurrent pterygium surgery: anterior segment optical coherence tomography study.

OBJECTIVE: The objective of the following study is to compare the conjunctival graft thickness measured with anterior segment optical coherence tomography (OCT) after primary and recurrent pterygium excision. DESIGN: Prospective, interventional and comparative study. PARTICIPANTS: A total of 20 eyes of 20 patients with primary pterygium (primary group) and 20 eyes of 20 patients with recurrent pterygium (recurrent group) were enrolled. MATERIALS AND METHODS: All patients underwent pterygium excision with conjunctival autograft transplantation. Conjunctival graft thickness was measured at 1 week, 1 month and 3 months after surgery using the Visante-OCT (Carl-Zeiss Meditec, Dublin, CA, USA). Main outcome measure was the mean conjunctival thickness determined as the mean of three measurements at 1, 2 and 3 mm posterior to the scleral spur. RESULTS: There were no statistically significant differences in age, sex, or laterality between the groups. Mean thickness of the graft in primary and recurrent groups, respectively, was 430 ± 127 µm and 461 ± 178 µm at 1 week after surgery (P = 0.587), 114 ± 19 µm and 162 ± 48 µm at 1 month after surgery (P = 0.001) and 109 ± 15 µm and 107 ± 18 µm at 3 months after surgery (P = 0.726). CONCLUSION: The findings revealed that conjunctival thickness after primary or recurrent pterygium excision was greatest at 1 week after surgery and continued to decrease for up to 3 months. Mean graft thickness differed significantly between the two groups only at 1 month after surgery.

Obesity and obstructive sleep apnea in patients with keratoconus in a Turkish population.

PURPOSE: The aim of this study was to compare the frequency of occurrence of obesity and high risk of developing obstructive sleep apnea (OSA) in a keratoconus population with that of a control group. METHODS: This prospective, case-controlled multicenter study was performed on patients with keratoconus and age- and gender-matched control subjects. One hundred forty-six patients were included in each group, and the Berlin Questionnaire was used for classifying patients as having a high risk or low risk of developing OSA. The patients' demographic and clinical characteristics were compared with the Mann-Whitney U test for continuous variables and with the χ test for categorical variables. RESULTS: The keratoconus (85 male/61 female) and control (79 male/67 female) groups' median ages were 25 (8-65) and 24 (9-60) years, respectively. Of the 146 patients in each group, 11 (7.5%) patients were determined to be at a high risk of developing OSA in the keratoconus group, and 8 (5.5%) patients were determined to be at a high risk of developing OSA in the control group. There was no significant difference between the groups (P = 0.477). The keratoconus and control groups' median body mass index values were found to be within normal ranges of 23.2 and 23.4, respectively. CONCLUSIONS: In this study, the mean body mass index value of the keratoconus group was determined to be within normal limits. In a Turkish population, the ratio of a high risk of developing OSA was not found to be significantly different between the keratoconus and control groups.

Comparison of corneal hysteresis and corneal resistance factor after small incision lenticule extraction and femtosecond laser-assisted LASIK: a prospective fellow eye study.

PURPOSE: To compare corneal hysteresis (CH) and corneal resistance factor (CRF) between eyes treated with small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (femto-LASIK). SETTING: Beyoglu Eye Training and Research Hospital. DESIGN: Prospective comparative case series. METHODS: Sixty eyes from 30 patients with bilateral myopia or myopic astigmatism were studied. Inclusion criteria were spherical equivalent of subjective manifest refraction (SE) <10diopters (D) and a difference ≤0.50D between the SEs of both eyes. One eye of each patient was treated with SMILE, and the fellow eye underwent femto-LASIK. Randomization was performed using a sealed envelope system. The main outcome measures were CH and CRF measured preoperatively and postoperatively (1 and 6 months). RESULTS: Preoperative SE was similar in both groups (p=0.852). CH and CRF values were reduced postoperatively in both groups compared to their corresponding preoperative values (p<0.001). At the 6-month follow-up visit, the mean CH values in the SMILE and femto-LASIK groups were 8.95±1.47 and 9.02±1.27, respectively (p=0.852), and the mean CRF values were 7.77±1.37 and 8.07±1.26, respectively (p=0.380). CONCLUSION: CH and CRF decreased after SMILE. There were no differences between SMILE and femto-LASIK treatments in postoperative CH or CRF values.

Measurements of anterior segment parameters using three different non-contact optical devices in keratoconus patients.

AIM: To evaluate the measurements of anterior segment parameters using three different non-contact optical devices in keratoconus patients. METHODS: A hundred and one eyes of 55 keratoconus patients were enrolled in this study. The mean age was 26.2±8.9 years. The inclusion criteria were keratoconus stage I to III according to the Amsler-Krumeich keratoconus classification. All the measurements were done by the same operator, under the mesopic light condition and repeated with three different optical methods; Visante, Orbscan and Pentacam. The evaluated anterior segment parameters were anterior chamber depth (ACD), central and thinnest corneal thickness (CCT and TCT) and pupil diameter (PD). RESULTS: THE MEAN CCT MEASURED BY VISANTE, ORBSCAN AND PENTACAM WERE AS FOLLOWS: 462.0±48.1µm, 463.9±60.9µm, 476.5±45.3µm, respectively (P=0.873). The mean ACD values were 3.34±0.33mm, 3.26±0.33mm, 3.49±0.40mm, respectively (P=0.118). The mean PD measurements were 5.11±1.14mm, 4.80±0.85mm, 3.80±1.38mm, respectively (P<0.001). The mean TCT measurements of Visante, Orbscan and Pentacam were 437.9±48.2µm, 447.6±60.6µm and 459.9±44.0µm, respectively (P=0.214). The Visante and Orbscan measured CCT similarly, while Pentacam measured CCT thicker than the other two. The Visante measured TCT thinner than the other two devices. In ACD measurements, Orbscan was the one giving the lowest values. PD was measured differently by the devices. CONCLUSION: Although TCT, CCT and ACD measurements acquired by Visante, Orbscan and Pentacam in keratoconus patients are similar, PD measurements show large differences among the devices.

Evaluation of corneal microstructure in keratoconus: a confocal microscopy study.

PURPOSE: To compare the corneal microstructure in patients with manifest keratoconus (KCN), subclinical KCN, and topographically normal relatives of patients with KCN and in healthy controls. DESIGN: Prospective and cross-sectional study. METHODS: We enrolled 145 subjects in the study. The participants were divided into 4 groups, based on clinical and topographical evaluation: the manifest KCN group (n = 30), the subclinical KCN group (n = 32), the KCN relatives group (n = 53), and the control group (n = 30). Corneal microstructure was assessed by corneal in vivo confocal microscopy in all of the individuals. Mean outcome measures were basal epithelial cell density, endothelial cell density, anterior keratocyte density, posterior keratocyte density, sub-basal nerve density, sub-basal nerve diameter, and stromal nerve diameter. RESULTS: The mean basal epithelial cell density, endothelial cell density, and sub-basal nerve diameter were not significantly different among the 4 groups (P = 0.057, P = 0.592, and P = 0.393, respectively). The mean anterior and posterior stromal keratocyte densities were significantly lower in the manifest group, in the subclinical group, and in the relatives group when compared with the control group (for both parameters; P < 0.001, P < 0.001, and P< 0.001, respectively). The mean stromal nerve diameter in the manifest group, subclinical group, and relatives group was significantly higher than in the control group (P = 0.001, P = 0.049, and P = 0.004, respectively). CONCLUSION: The anterior and posterior stromal keratocyte densities were statistically lower and stromal nerve diameter was statistically higher in patients with manifest KCN, subclinical KCN, and topographically normal KCN relatives compared with controls. Confocal microscopy may be useful for the determination of early corneal microstructural changes before manifestation of typical or subtle topographic signs.

Intraocular lens implantation procedures in aphakic eyes with insufficient capsular support associated with previous cataract surgery.

PURPOSE: The aim was to evaluate the results of three different secondary intraocular lens implantation (IOL) procedures in aphakic eyes without capsular support METHODS: In this retrospective comparative case series, 90 eyes of 90 patients who underwent secondary IOL implantation for correction of aphakia were enrolled. Patients were divided into three groups based on the secondary IOL implantation procedure: anterior chamber iris-fixated IOL (AC-IFIOL), retropupillary iris-fixated IOL (RP-IFIOL), and scleral-fixated posterior chamber IOL (SF-PCIOL). The efficacy and safety of each procedure were assessed at follow-up. RESULTS: All eyes had aphakia caused by a previous cataract surgery. A final corrected distance visual acuity of 20/40 or better was achieved in 22 eyes (62.9%) implanted with an AC-IFIOL, in 12 eyes (50%) with an RP-IFIOL, and 18 eyes (58.1%) with an SF-PCIOL. At final visit, mean postoperative endothelial cell loss was 175 cells/mm(2) (7.2%) in the AC-IFIOL group, 255 cells/mm(2) (11.4%) in the RP-IFIOL group, and 135 cells/mm(2) (5.9%) in the AC-IFIOL group (P > 0.05). CONCLUSIONS: The study showed that AC-IFIOL, RP-IFIOL, and SF-PCIOL implantation had similar visual outcomes and mean corneal endothelial cell loss.

Corneal sensation after corneal refractive surgery with small incision lenticule extraction.

PURPOSE: To compare effects of small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (F-LASIK) on corneal sensation and dry eye parameters. METHODS: In this prospective, randomized, contralateral-eye study, 28 patients with myopia or myopic astigmatism in both eyes were enrolled. One eye of each patient was treated by SMILE, and the fellow eye was treated by F-LASIK. Mean outcome measures Cochet-Bonnet esthesiometry, Schirmer test with anesthesia, tear breakup time, and tear film osmolarity were evaluated preoperatively as well as 1 week, 1 month, 3 months, and 6 months after surgery. RESULTS: Corneal sensation was reduced after both SMILE and F-LASIK surgeries 1 week, 1 month, and 3 months after surgery (p < 0.05 in both groups). Corneal sensation was significantly lower after F-LASIK than after SMILE at postoperative 1 week, 1 month, and 3 months (p < 0.01 for all points). Dry eye parameters such as tear breakup time, Schirmer test, and tear film osmolarity did not change significantly in any of the procedures and were not significantly different between the procedures at any follow-up visits. CONCLUSIONS: The findings of the study revealed that, although both F-LASIK and SMILE procedures changed the corneal sensation 1 week, 1 month, and 3 months after surgery, they did not affect the dry eye parameters at any point.

Laser in situ keratomileusis in adult patients with anisometropic amblyopia.

AIM: To evaluate the increase in corrected distance visual acuity (CDVA) after laser in situ keratomileusis (LASIK) in adults with anisometropic amblyopia. METHODS: The medical records of consecutive patients diagnosed with anisometropic amblyopia at the time of refractive evaluation who underwent LASIK were retrospectively reviewed. Patients with at least a two-line difference of visual acuity (VA) between the eyes with a spherical refractive error difference of at least 3.00 diopters (D) or an astigmatic difference of at least 2.00D were included. Patients with any other possible reason for amblyopia other than anisometropia or those who had undergone previous amblyopia treatment were excluded. Amblyopic eyes with myopia or myopic astigmatism were considered as group 1, hypermetropia or hypermetropic astigmatism constituted group 2, and mixed astigmatism patients comprised group 3. Uncorrected distance visual acuity (UDVA), subjective manifest refraction, and CDVA were analyzed at 1 week and 1 month, 3, and 6 months. RESULTS: The study included 57 eyes of 57 patients. There were 33 eyes in group 1, 12 eyes in group 2, and 12 eyes in group 3. The preoperative mean values for spherical equivalent of subjective manifest refraction (SE) in groups 1, 2, and 3 were (-4.66±1.97)D, (4.40±1.00)D, and (0.15±1.05)D, respectively. Mean CDVA improved 0.1 log units (1 line LogMAR) at 6 months (P<0.05). Sixteen eyes (28%) exhibited an improvement in CDVA in week 1. Fourteen eyes (25%) experienced two or more lines of CDVA improvement at month 6. There were no statistically significant differences among the groups in terms of CDVA (P>0.05). Moreover, age, the amount of preoperative refractive error, and the levels of preoperative corrected and UDVA had no effect on postoperative CDVA improvement (P>0.05). CONCLUSION: Correction of refractive errors with LASIK produced significant CDVA improvement in adult patients with anisometropic amblyopia and no previous amblyopia treatment.

Photorefractive keratectomy in the correction of astigmatism using Schwind Amaris 750s laser.

AIM: To evaluate the results of three photorefractive keratectomy (PRK) procedures in the treatment of astigmatism. METHODS: In this retrospective comparative case series, 89 eyes of 50 patients who underwent PRK treatment for astigmatism were enrolled. The patients were divided into 3 groups based on the PRK procedure: Group 1: PRK without mitomycin-C (MMC) application, Group 2: PRK with MMC application, and Group 3: Trans-Photorefractive Keratectomy (T-PRK). The efficacy, safety, predictability, and complications of treatment were assessed at 1, 3 and 6 months after the treatment. RESULTS: At postoperative 6 months, the percentage of postoperative uncorrected visual acuity (UCVA) of 20/20 or better was 55.6% (20 eyes) in group 1, 75% (15 eyes) in group 2, and 75.8% (25 eyes) in group 3 (P=0.144). The percentage of postoperative best corrected visual acuity (BCVA) of unchanged or gained ≥1 lines was 80.6% (29 eyes) in group 1, 70% (14 eyes) in group 2, and 90.9% (30 eyes) in group 3 (P=0.151). The percentage of postoperative BCVA of lost ≥2 lines was 11.1% (4 eyes) in group 1, 20% (4 eyes) in group 2, and 6.1% (2 eyes) in group 3. The mean manifest refractive spherical equivalent (MRSE) and mean cylindrical refraction were not significantly different among the each groups (P>0.05). At postoperative 6 months, the percentage of MRSE of within ±0.50 D was 100% (36 eyes) in Group 1, 100% (20 eyes) in Group 2, and 93.9% (31 eyes) in Group 3. At the each follow-up period, there was no significant difference in number of eyes with haze and mean haze score(P>0.05). CONCLUSION: The study showed that PRK without MMC, PRK with MMC and T-PRK appears to have similar effectiveness, safety and predictability in the treatment of astigmatism. The incidence of haze was also similar between the three groups.

Effect of fluorometholone/tetrahydrozoline fixed combination on conjunctival autograft morphology after primary pterygium excision.

PURPOSE: To evaluate the effect of a fluorometholone/tetrahydrozoline fixed combination on conjunctival graft morphology after primary pterygium excision. METHODS: The patients who underwent pterygium excision with conjunctival autograft transplantation were randomized into three groups based on postoperative medications as the fluorometholone/tetrahydrozoline group, fluorometholone group, and dexamethasone group. Conjunctival graft thickness was measured with anterior segment optical coherence tomography. The conjunctival graft hyperemia was evaluated using a high definition external camera. RESULTS: The mean graft thickness was significantly lower in the fluorometholone/tetrahydrozoline group compared with fluorometholone and dexamethasone groups at 2 weeks (P = 0.002 and P = 0.012, resp.) and at 1 month after surgery (P = 0.003 and P = 0.013, resp.). The conjunctival hyperemia score was significantly lower in the fluorometholone/tetrahydrozoline group compared with fluorometholone and dexamethasone groups at 2 weeks (P = 0.000 and P = 0.000, resp.) and at 1 month (P = 0.039 and P = 0.040, resp.). The graft thickness and conjunctival hyperemia score were similar among the groups at 1 week and 3 months (P > 0.05). CONCLUSION: The findings of the present study revealed that treatment with the fluorometholone/tetrahydrozoline fixed combination may be helpful to decrease graft edema and to achieve better cosmetic appearance at 2 weeks and 1 month after pterygium excision.

Accuracy and precision of cap thickness in small incision lenticule extraction.

AIMS: To report and compare the cap thickness predictability of small incision lenticule extraction (SMILE) and flap thickness of femtosecond laser-assisted in situ keratomileusis (femto-LASIK). SETTINGS AND DESIGN: Beyoglu Eye Training and Research Hospital, Refractive Surgery Department, Istanbul, Turkey. Retrospective pilot study. MATERIALS AND METHODS: Medical records of patients who had SMILE in one eye and femto-LASIK in the other eye were reviewed. Visante corneal Optical Coherence Tomography (OCT) images at 1 week and 1 month post-surgery were analyzed. Both cap and flap thickness at the temporal edge and the nasal edge were measured and compared to each other. STATISTICAL ANALYSES USED: PAWS Statistics 18 and unpaired student t-test were used to compare the groups. RESULTS: The study included 66 eyes of 33 patients (24.7 ± 3.8 years, 20 females and 13 males). Mean flap thickness was 114.88 µm ± 4.96 µm, and mean cap thickness was 114.63 µm ± 5.18 µm. In group 1 (SMILE), cap thickness values were 115.84 µm ± 6.84 µm, 114.75 µm ± 7.36 µm, 113.66 µm ± 6.88 µm, and 114.27 µm ± 6.90 µm in measurement zones 1, 2, 3, and 4, respectively. In group 2 (FemtoLASIK), flap corneal thickness values were 115.96 mmHg ± 7.01 mmHg, 114.72 mmHg ± 7.17 mmHg, 113.54 mmHg ± 6.45 mmHg, and 115.30 mmHg ± 6.64 mmHg in measurement zones 1, 2, 3, and 4, respectively. In both groups, no statistically significant change within the measurement zones was observed. CONCLUSION: The predictability of cap thickness in SMILE surgery does not differ from the femto-LASIK flaps created using the same femtosecond laser platform.