Radial keratotomy for the optical rehabilitation of mild to moderate keratoconus: more than 5 years' experience.

PURPOSE: To present the authors' long-term experience of radial keratotomy (RK) for the optical rehabilitation of patients with mild to moderate keratoconus--central corneal thickness of greater than 400 microm and without apical scarring. METHODS: In this observational, noncomparative series of cases, all consecutive patients with mild or moderate keratoconus, treated by RK between 1990 and 2002, with at least 1 year follow-up were included. A total of 170 eyes of 96 patients were investigated. Mean follow-up was 42.08 +/- 28.14 months. Visual acuity, refraction, corneal curvature, central corneal thickness, and complications were evaluated. RESULTS: In all of the control visits, mean uncorrected and best spectacle corrected visual acuities were better than preoperative values (p<0.0001). Preoperative myopic spherical refraction decreased significantly (p<0.0001), and remained relatively unchanged throughout the follow-up (p=0.43). A small but statistically significant decrease from baseline was ob-served in astigmatism (p=0.038), which almost disappeared 1 year after the surgery (p=0.47). The surgery produced a statistically significant flattening of the corneal curvature (p<0.0001). Central corneal thickness did not change significantly (p>0.05) in either control visit. In 33 eyes (19.4%), re-deepening of the incisions was required. In 3 eyes (1.8%) penetrating keratoplasty was performed, due to disease progression in 2 eyes (1.2%) and acute traumatic hydrops in 1 eye (0.6%). In 4 eyes (2.2%) microperforation, in 2 eyes (1.2%) macroperforation, in 1 eye (0.6%) infectious keratitis, and in 1 eye (0.6%) hyperopic shift occurred. CONCLUSIONS: RK surgery was found to be a reasonable option for the rehabilitation of a selected group of keratoconus patients in the early or moderate stages.

Capsular tension ring implantation after capsulorhexis in phacoemulsification of cataracts associated with pseudoexfoliation syndrome. Intraoperative complications and early postoperative findings.

PURPOSE: To evaluate the effect of an endocapsular tension ring in preventing zonular complications during phacoemulsification of cataracts associated with pseudoexfoliation syndrome. SETTING: Eye Clinic of Beyoglu Education and Research Hospital, Istanbul, Turkey. METHODS: A prospective randomized study comprised 78 eyes with cataract and pseudoexfoliation syndrome that were randomly divided into 2 groups. The age, sex, cataract density, iridodonesis, axial length, anterior chamber depth, best corrected visual acuity (BCVA), and intraocular pressure (IOP) were matched between groups. In 39 eyes, a capsular tension ring (CTR) was implanted after capsulorhexis and hydrodissection but before nucleus emulsification. Thirty-nine eyes that did not have a CTR implanted served as a control. The main outcome measures were the rates of intraoperative zonular separation and capsular fixation of a foldable intraocular lens (IOL). Posterior capsule rupture without zonular dialysis, vitreous loss, corneal edema, fibrin in the anterior chamber, BCVA, and IOP in the immediate postoperative period were also compared between the 2 groups. RESULTS: Five eyes (12.8%) in the control group and no eye in the CTR group had intraoperative zonular separation (P =.02). Posterior capsule rupture without zonular separation occurred in 3 eyes (7.7%) in the control group and 2 (5.2%) in the CTR group. Capsular IOL fixation was achieved in 37 eyes (94.9%) in the CTR group and 31 eyes (74.3%) in the control group (P =.012). The difference in BCVA was not statistically significant between the 2 groups (P =.44); however, uncorrected visual acuity (UCVA) was significantly better in the CTR group (P =.026). CONCLUSION: In cases of cataract associated with pseudoexfoliation syndrome, implanting a CTR before phacoemulsification of the nucleus reduced intraoperative zonular separation, increased the rate of capsular IOL fixation, and improved UCVA.

Posterior capsule opacification 3 years after implantation of an AcrySof and a MemoryLens in fellow eyes.

PURPOSE: To compare the rates of lens epithelial cell (LEC) migration and posterior capsule opacification (PCO) 1 and 3 years after sutureless small incision phacoemulsification and in-the-bag implantation of 2 acrylic polymer intraocular lenses (IOLs)-the AcrySof and MemoryLens-in fellow eyes of patients. SETTING: Eye Clinic, Beyoglu Education and Research Hospital, Istanbul, Turkey. METHODS: Fifty patients with no systemic or ocular problems that would interfere with postoperative visual acuity were included in this prospective study. Each patient had in-the-bag implantation of an AcrySof IOL in 1 eye and a MemoryLens in the fellow eye in a randomized fashion after uneventful phacoemulsification through a sutureless clear corneal incision. RESULTS: At 1 year (n = 32 patients), there was no significant difference between fellow eyes in postoperative best corrected visual acuity (BCVA) and contrast sensitivity. In the MemoryLens group, 10 eyes (31.3%) had PCO and 9 (28.1%), LEC migration. In the AcrySof group, no eye had PCO and 2 eyes (6.3%) had LEC migration (P <.001). At 3 years (n = 21 patients), 1 eye (4.7%) in the AcrySof group had PCO and 3 eyes (14.4%) had LEC migration without PCO. In the MemoryLens group, 1 eye (4.7%) had a clear posterior capsule, 11 eyes (52.4%) had LEC migration, and 9 eyes (42.9%) had PCO (P <.001). A neodymium:YAG capsulotomy was required in 4 eyes (19.0%) in the MemoryLens group but no eye in the AcrySof group. At 3 years, BCVA was lower in the MemoryLens group than in the AcrySof group (P <.05). CONCLUSION: The 3 year clinical data of fellow eyes indicate that the AcrySof IOL causes less PCO than the MemoryLens.

Radial keratotomy for the optical rehabilitation of mild to moderate keratoconus: More than 5 years experience.

PURPOSE: To present the authors long-term experience of radial keratotomy (RK) for the optical rehabilitation of patients with mild to moderate keratoconus central corneal thickness of greater than 400 m and without apical scarring. METHODS: In this observational, noncomparative series of cases, all consecutive patients with mild or moderate keratoconus, treated by RK between 1990 and 2002, with at least 1 year follow-up were included. A total of 170 eyes of 96 patients were investigated. Mean follow-up was 42.08 28.14 months. Visual acuity, refraction, corneal curvature, central corneal thickness, and complications were evaluated. RESULTS: In all of the control visits, mean uncorrected and best spectacle corrected visual acuities were better than preoperative values (p<0.0001). Preoperative myopic spherical refraction decreased significantly (p<0.0001), and remained relatively unchanged throughout the follow-up (p=0.43). A small but statistically significant decrease from baseline was ob-served in astigmatism (p=0.038), which almost disappeared 1 year after the surgery (p=0.47). The surgery produced a statistically significant flattening of the corneal curvature (p<0.0001). Central corneal thickness did not change significantly (p>0.05) in either control visit. In 33 eyes (19.4%), re-deepening of the incisions was required. In 3 eyes (1.8%) penetrating keratoplasty was performed, due to disease progression in 2 eyes (1.2%) and acute traumatic hydrops in 1 eye (0.6%). In 4 eyes (2.2%) microperforation, in 2 eyes (1.2%) macroperforation, in 1 eye (0.6%) infectious keratitis, and in 1 eye (0.6%) hyperopic shift occurred. CONCLUSIONS: RK surgery was found to be a reasonable option for the rehabilitation of a selected group of keratoconus patients in the early or moderate stages.