Evaluation of changes in retinal and choroidal thickness using spectral domain optical coherence tomography in unilateral non granulomatous acute anterior uveitis.

PURPOSE: To assess retinal and choroidal thickness changes in eyes with a first episode of unilateral non granulomatous acute anterior uveitis (AU). METHODS: Thirty-one patients with acute unilateral non granulomatous AU who had undergone spectral domain optical coherence tomography (SD-OCT) of both eyes were included in this retrospective study. Retinal thickness (RT) as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) and subfoveal choroidal thickness (SFCT) obtained by SD-OCT were recorded. Healthy fellow eyes of the patients served as the control. RESULTS: A significant thickening in 1mm of ETDRS subfield and in subfoveal choroid was observed in eyes with acute AU when compared with the unaffected fellow eyes (P=0.005 and P<0.00001, respectively). RT and SFCT of affected eyes did not show a significant difference in terms of HLA-B27 antigen presence or absence (P>0.05, for all). CONCLUSIONS: Significant posterior segment changes were detected in eyes with acute unilateral non granulomatous AU.

Efficacy and safety of pneumatic trabeculoplasty versus timolol added to latanoprost in primary open angle glaucoma.

BACKGROUND: To compare the safety and short-term additive hypotensive effect of pneumatic trabeculoplasty (PNT) versus timolol among patients receiving topical latanoprost for primary open angle glaucoma (POAG). PATIENTS AND METHODS: This study prospectively evaluated 30 eyes of 30 patients with POAG receiving latanoprost monotherapy. We randomly assigned 15 eyes to PNT plus latanoprost (Group A), and 15 eyes to latanoprost/timolol fixed combination therapy (Group B). PNT treatment was performed at days 0, 7, and 90. Follow-up visits occurred at day 1, week 1, and months 1 and 3. RESULTS: Compared to baseline values, both treatments significantly lowered IOP (p ≤ 0.001).The mean IOP for Group A was 21.13 ± 1.6 mmHg at baseline and 18.7 ± 1.5 mmHg at three months (p ≤ 0.001). For Group B, mean IOP was 20.8 ± 1.9 mmHg at baseline and 18.9 ± 0.8 mmHg at three months (p ≤ 0.001). Transient conjunctival hyperaemia, the only adverse effect occurring after PNT, was observed in all patients in Group A. CONCLUSION: The additive IOP-lowering effect of PNT was similar to timolol in patients with POAG receiving latanoprost.

Transcanalicular revision surgery for failed dacryocystorhinostomy.

AIM: To evaluate the effectiveness of transcanalicular multi diode laser in revision dacryocystorhinostomy and to determine the outcomes. MATERIALS AND METHODS: Fifty-three consecutive patients (19 males, 44 females) who were referred for recurrent dacryostenosis with epiphora after a failed primary dacryocystorhinostomy (DCR) operation were included in the study. Patients were assigned to two separate groups on the basis of primary DCR operation: either endonasal dacryocystorhinostomy (END-DCR) or transcanalicular multi diode laser dacryocystorhinostomy (TC-MDL DCR). TC-MDL DCR technique was used for revision surgeries in both groups. The mean age of the patients was 46.5 ± 13.1 (Range, 15 -71) and the average follow-up duration was 12 months. RESULTS: The success rate was 62% (18/29) in the primarily TC-MDL DCR operated group, and 85.2% (29/34) in the primarily END-DCR operated group respectively. The occlusion of internal ostium with granulation tissue was the leading etiology of unsuccessful surgical outcome in both group 1 and group 2 (42.8% and 28.5% respectively). CONCLUSIONS: TC-MDL DCR is a minimally invasive surgical method with relatively high success and low complication rates in patients with failed primary DCR requiring revision.

Surgical outcome of coaxial phacoemulsification with torsional ultrasound after a 2.4 mm versus 3.2 mm clear corneal temporal incision.

PURPOSE: This study aimed to evaluate and compare outcomes of phacoemulsification surgery with purely torsional ultrasound in coaxial small incision procedures. METHODS: This study was a prospective observational series of 50 eyes of 50 patients with age-related cataracts. There were two groups each with 25 eyes. Group 1 eyes were treated with microcoaxial phacoemulsification using a 2.4 mm temporal clear corneal incision; group 2 eyes were treated with phacoemulsification using a 3.2 mm temporal clear corneal incision. Both groups underwent a standardised surgical procedure using purely torsional ultrasound. Outcome measures were best corrected visual acuity, percentage increase in postoperative corneal thickness, and surgically-induced astigmatism assessed at day 1, week 1, month 1 and month 3 postoperatively. RESULTS: Both groups were comparable with respect to age, cataract grading and intraoperative parameters such as cumulative dissipated energy and irrigation volume. The only statistically significant outcome difference was surgically induced astigmatism at postoperative day 1 (higher in group 2). Intraoperative and early postoperative complications were similar in both groups. CONCLUSIONS: Coaxial phacoemulsification with purely torsional ultrasound produced satisfactory results for 2.4 mm and 3.2 mm incisions. There were no differences in outcomes between groups.

Comparison of sulcus implantation of single-piece hydrophilic foldable acrylic and polymethylmethacrylate intraocular lenses in eyes with posterior capsule tear during phacoemulsification surgery.

PURPOSE: To compare the results of sulcus implantation of acrylic and poly(methylmethacrylate) (PMMA) intraocular lens (IOL) in eyes with posterior capsule tear during phacoemulsification surgery. METHODS: In all eyes a posterior capsule tear developed during phacoemulsification surgery and an IOL to the ciliary sulcus was implanted primarily. A total of 89 eyes of 88 patients received hydrophilic foldable acrylic IOL (acrylic group). A total of 72 eyes of 72 patients received PMMA IOL (PMMA group). The mean age was 67.1 years and 68.1 years and postoperative follow-up period was 19.2 months and 17.9 months in acrylic and PMMA groups, respectively. RESULTS: Temporary corneal edema appeared in 33 eyes and 26 eyes, elevation of intraocular pressure in 17 eyes and 12 eyes, anterior chamber inflammatory reaction in 5 eyes and 5 eyes, clinical cystoid macular edema in 7 eyes and 12 eyes, and decentered IOL in 4 eyes and 3 eyes in acrylic and PMMA groups, respectively. Late postoperative endophthalmitis developed in two eyes of the PMMA group. Rhegmatogenous retinal detachment developed in one eye in each group. Final best-corrected visual acuities were 5/10 and above in 73 eyes (82.02%) in the acrylic group and 5/10 and above in 42 eyes (58.33%) in the PMMA group. Postoperative final induced astigmatism was 0.5+/-0.5 D (SD) in the acrylic group and 1.11+/-0.65 D (SD) in the PMMA group (p=0.0001) (independent samples t-test). CONCLUSIONS: Increased astigmatism is more frequently seen in the PMMA group. The implantation of foldable acrylic IOL in the sulcus after posterior capsule tear maintains the advantages of small incision surgery.

[Calcification of hydrophilic acrylic intraocular lenses: clinical and pathological aspects]. / Calcification postopératoire des lentilles intraoculaires acryliques hydrophiles: aspects cliniques et pathologiques.

PURPOSE: The aim of this study was to evaluate the clinical aspects of ten eyes with calcified hydrophilic acrylic intraocular lenses and pathological data obtained from seven explanted lenses. MATERIAL AND METHODS: Forty-seven eyes of 40 patients received the same implant in the first 6-month period of 2001. Ten eyes showed intraocular lens opacification detected 6-18 months after the operation: seven lenses were explanted and three were left in place because they were not causing a decrease in visual acuity or glare at light. Five of ten eyes were diabetic. The explanted lenses were examined under the light microscope and the electron microscope. The elemental analysis of the lens surfaces was made by energy dispersive spectrometry. RESULTS: The light microscopy showed an irregular surface covered by a gray-white opacity. The electron microscopy detected multiple granulations on the front and back surfaces of the lenses including some portions of the haptics. The size and density of these granulations were smaller on the back surface. The energy dispersive spectrometry showed the presence of calcium and phosphate on both surfaces. The spikes of calcium and phosphate were smaller for the back surface of the lenses. DISCUSSION: Calcification was predominantly seen on the surfaces that were in contact with aqueous not covered with anterior capsule. Half (5/10) of the cases were diabetic even though 18% of all patients receiving this lens were diabetic. The presence of diabetes is very common in other series. These data suggest the role of a metabolic factor influencing the milieu of the lens in this calcification process. CONCLUSION: Calcification of the hydrophilic acrylic lenses is a relatively serious complication, but the conditions leading to its appearance and the physiopathology have not yet been fully elucidated. The surgeon should be very careful in the choice of the intraocular lens to implant, and even more so if the patient is diabetic.

[Cataract surgery by phacoemulsification in Werner's syndrome]. / La chirurgie de la cataracte par phakoéation dans le syndrome de Werner.

We report two cases of Werner's syndrome, a sister and a brother of 32 and 28 years, respectively, who were operated on for cataracts in both eyes. This hereditary syndrome, also called the adult progeria, is characterized by several manifestations of premature aging. Cataract surgery in this syndrome often predisposes to complications such as wound dehiscence and bullous keratopathy. The 4 eyes of the two patients were operated on using the phacoemulsification technique. The operations were successful, and we did not observe any serious complications during the 2-year follow-up period: cystoid macular edema in the brother's right eye was easily cured by topical indomethacin. This experience with these two patients showed that Werner's syndrome cataracts can be safely managed with the current phacoemulsification and small-incision surgery techniques.