Bekir Sitki Aslan

Primary viscocanalostomy versus trabeculectomy for primary open-angle glaucoma Three-year prospective randomized clinical trial

Purpose: To compare the efficacy and safety of viscocanalostomy and trabeculectomy in patients with primary open‐angle glaucoma (POAG). Setting: Department of Ophthalmology, Ankara Education and Research Hospital, Ankara, Turkey. Methods: In this prospective randomized trial, 50 eyes of 50 patients with medically uncontrolled POAG were randomized to have a trabeculectomy (25 eyes) or a viscocanalostomy (25 eyes). Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before surgery and 1 day, 1 week, 1, 3, and 6 months, and 1, 2, and 3 years postoperatively. Results: At 3 years, the mean IOP was 16.0 mm Hg ± 7.07 (SD) in the trabeculectomy group and 17.8 ± 4.6 mm Hg in the viscocanalostomy group (P = .694). Complete success (IOP 6 to 21 mm Hg without medication) was achieved in 66.2% of eyes at 6 months and 55.1% at 3 years in the trabeculectomy group and in 52.9% and 35.3%, respectively, in the viscocanalostomy group (P>.05). Qualified success (IOP 6 to 21 mm Hg with medication) was achieved in 95.8% of eyes at 6 months and 79.2% at 3 years in the trabeculectomy group and in 90.7% and 73.9%, respectively, in the viscocanalostomy group (P>.05). Postoperative hypotony and cataract formation occurred more frequently in the trabeculectomy group than in the viscocanalostomy group (P = .002). Conclusions: Primary trabeculectomy lowered IOP more than viscocanalostomy in POAG patients. However, the complication rate was lower in the viscocanalostomy group.

Limbal relaxing incisions in congenital astigmatism: 6 month follow-up

Purpose: To evaluate the effectiveness of limbal relaxing incisions (LRIs) for correcting naturally occurring astigmatism. Setting: Ankara Hospital, Ankara, Turkey. Methods: This prospective analysis of the results of the first LRIs in 22 eyes of 13 patients with congenital astigmatism was done using a modified Gills nomogram and was based on preoperative refractive astigmatism determined by manifest and cycloplegic refractions. There were no adjustments based on sex or age. Results: An absolute decrease of 0.91 diopter (D) (44%) in mean astigmatism was achieved after 6 months in 22 eyes. The mean uncorrected visual acuity (logMAR) increased from 0.42 to 0.26 from preoperatively to 6 months postoperatively. No patient lost best corrected visual acuity. Most regression occurred in eyes with more than 3.50 D of astigmatism and between the first and third postoperative months. Conclusion: Limbal relaxing incisions are a practical, simple, and forgiving approach for the correction of lower degrees of astigmatism.

Acute endophthalmitis outbreak after cataract surgery.

Purpose: To evaluate the source of organisms causing an epidemic of postoperative endophthalmitis and to emphasize the importance of prompt intervention with an early diagnosis. Setting: S.B. Ankara Hospital Eye Department, Ankara, Turkey. Methods: Thirteen patients who had surgery on the same day and developed acute postoperative endophthalmitis were evaluated. Clinical patterns were observed and intraocular cultures and stains performed in 10 eyes. Broad‐spectrum intravitreal antibiotics were injected on an empirical basis. Results: Intravitreal cultures showed Pseudomonas aeruginosa in four cases and coaguIase‐negative staphylococci in three cases; three cases were culture negative. P. aeruginosa were also isolated from irrigation solutions used on the same day. Two patients with P. aeruginosa had a visual acuity of 20/200 and 20/300, respectively. Conclusion: The different culture results were probably related to the amount of inoculation, individual risk factors, and the subconjunctival antibiotic injection given at the end of surgery. That one patient with P. aeruginosa endophthalmitis retained a visual acuity of 20/200 shows the importance of rapid intravitreal antibiotic treatment.

Outcome of Complex Retinal Detachment Surgery after Silicone Oil Removal

Background and objective: To evaluate anatomical prognosis after silicone oil removal.Patients and methods: Sixty-eight eyes which underwent silicone oil removal were enrolled into the study. The underlying ocular pathology for pars plana vitrectomy, surgical methods, and time of silicone oil removal were analysed.Results: Sixteen of 68 eyes (23.5%) redetached following the removal of silicone oil. According to etiology redetachment rates: PVR C 9.5% (2/21), PVR D 25% (4/16), trauma without intraocular foreign body 27.3% (3/11), with intraocular foreign body 33.3% (2/6), giant retinal tear 37.5% (3/8), and proliferative diabetic retinopathy with tractional retinal detachment 33.3% (2/6). The rate of redetachment was 22% in patients with encircling band and 27.8% without encircling band. Retina was redetached in the first 10 days in 81.3% of patients after silicone oil removal.Conclusion: The residual vitreoretinal traction especially at the vitreous base is the most likely reason for retinal redetachment after silicone oil removal, which is most commonly seen during the first 10 days.

Hemorrhagic descemet’s membrane detachment after viscocanalostomy

We report a case of hemorrhagic detachment of Descemets membrane after viscocanalostomy. A 60-year-old man with pseudoexfoliative glaucoma had an uneventful viscocanalostomy in the right eye. On the first postoperative day, a 5.0 mm x 5.0 mm Descemets membrane detachment was present in the superior nasal quadrant. The space between Descemets membrane and the stroma was filled with a hemorrhage. The hemorrhage resorbed by 6 months postoperatively, and Descemets membrane completely reattached without surgical manipulation. The final visual acuity dropped from 20/40 to 20/100, final intraocular pressure was 20 mm Hg with 1 medication, and a paracentral fibrinoid scar persisted 18 months after surgery. Hemorrhagic detachment of Descemets membrane can cause visual acuity deterioration and should be recognized as a rare complication of viscocanalostomy.

Penetrating keratoplasty in patients with corneal scarring due to trachoma.

BACKGROUND AND OBJECTIVE Trachoma remains the leading cause of preventable corneal blindness. The outcome of penetrating keratoplasty (PK) in these patients is usually poor because of the extensive corneal vascularization, adnexal and ocular surface problems. We evaluated the long-term results of PK in patients with corneal scarring due to trachoma. PATIENTS AND METHODS The fiels of 16 eyes of 13 patients who underwent PK due to late sequel of trachoma were reviewed. RESULTS Preoperative visual acuity ranged from light perception to finger counting levels. Preoperatively, dry-eyes, meibomian gland dysfunction, trichiasis and cicatricial entropion were treated. Over a mean postoperative follow-up of 26.1 +/- 15.6 months (range of 14-61 months), eyes required redrafting due to graft rejection and failure, and corneal ulceration (12.5%). Fourteen eyes remained clear grafts (87.5%), and 13 eyes (81.3%) achieved 0.1 or better visual acuity. CONCLUSIONS These results suggest that although patients with corneal scarring due to trachoma are at high risk, PK may be helpful for visual rehabilitation.

Intraocular intrusion of a scleral sponge implant

A patient with intrusion of a scleral sponge implant after retinal reattachment surgery is described. Retinal incarceration occurred during primary retinal reattachment surgery and the patient underwent additional cryopexy and radial sponge implant. However, the retina remained detached and pars plana vitrectomy was performed with silicone oil endotamponade to reattach the retina. The interval between placement of the sderal buckle and development of intrusion was 3 months. The buckle was sutured to the sclera with mattress sutures. During the postoperative follow-up period, the intraocular pressure was elevated and controlled with topical antiglaucomatous medication. The encircling band was cut but left in place to avoid perforation, and the retina remained attached. Intrusion of a buckle after retinal reattachment surgery is a rare complication that usually does not require surgical intervention. Cutting the silicone band without removing it may be a treatment option.

Vitrectorhexis versus forceps capsulorhexis for anterior and posterior capsulotomy in congenital cataract surgery.

PURPOSE To compare the results of anterior and posterior continuous curvilinear capsulorhexis created using forceps with those created using vitrector in eyes suffering from congenital cataract. METHODS Twenty-eight eyes with congenital cataract were included in the study. The anterior and posterior continuous curvilinear capsulorhexes were created using microforceps in 17 eyes or through a vitrector in 11 eyes. RESULTS Corneal edema (P = .56) and anterior chamber flare (P = 1.0) were comparable in both groups. In addition, the time for optical axis clarity was also similar between the groups (P = .98). CONCLUSION The current results suggest that the use of both techniques appears to be equally safe and effective for the achievement of anterior and posterior capsulorhexis.

Phacoemulsification and Intraocular Lens Implantation in a Patient With Mooren's Ulcer

A 61-year-old man with progressive, bilateral Moorens ulcer had subjective symptoms of pain, discomfort, and blurred vision. Biomicroscopic examination showed 360 degrees of peripheral ulceration of the cornea. There were 1+ cells in the anterior chamber, and nuclear sclerosis of the lens was present. He was treated with topical and systemic steroids, perilimbal conjunctival resection, and systemic cyclophosphamide therapy. After the complete control of inflammation, the patient remained in remission for 14 months. When a cataract developed in the right eye, reducing the visual acuity to light perception, the authors performed a scleral tunnel incision and phacoemulsification with intraocular lens implantation. After 18 months of postoperative follow-up, the vision improved to 20/30, and the eye was stable. Phacoemulsification and scleral tunnel incision with intraocular lens implantation can be successfully performed after the complete control of inflammation with medical therapy.

Comparison of peristaltic and Venturi pumps in bimanual microincisional cataract surgery

Comparison of peristaltic and Venturi pumps in bimanual microincision phacoemulsification on the success of the cataract surgery by using sleeveless phaco tip. Bimanual microincision phacoemulsification was done in 49 eyes using a 1.4-mm temporal clear corneal incision. A peristaltic pump was used in 23 eyes, and a Venturi pump was used in 26 eyes for phacoemulsification. Intraoperative complications, anterior chamber stability, and mean duration of surgery were recorded. Duration of surgery was shorter in the Venturi pump group. Anterior chamber stability could not be established in 17 eyes in the peristaltic pump group; it was established in all eyes in the Venturi pump group. Corneal burns were observed in two eyes in the peristaltic pump group and no eyes in the Venturi pump group. Use of a Venturi pump system and a vented gas-forced infusion system can significantly shorten surgery time and reduce risk of thermal burns.