F. Hakan Öner

Effects on visual function of glistenings and folding marks in AcrySof intraocular lenses.

Purpose: To study the effects on visual function of glistenings and folding marks in AcrySof® (Alcon) intraocular lenses (IOLs). Setting: Department of Ophthalmology, Dokuz Eylül University, School of Medicine, Izmir, Turkey. Methods: This study included 91 eyes that had phacoemulsification and in‐the‐bag AcrySof IOL implantation. Slitlamp, visual acuity, and contrast sensitivity evaluations were used to assess all cases. Observations of folding marks and glistenings in the IOL optic were noted. The glistenings were graded from 0 to +4. Eyes with coexisting pathology that could affect visual acuity (n = 15) were excluded from the study. After the exclusion, the visual acuity and contrast sensitivity in 28 eyes with glistenings were compared with those in 48 eyes without glistenings. Results: Localized folding marks away from the central visual axis of the IOL were identified in 25 eyes (27.4%). Glistenings were observed in 34 eyes (37.1%), 6 of which were excluded for coexisting pathology. There was no statistically significant difference in visual acuity and contrast sensitivity at low or medium spatial frequencies between eyes with glistenings and those without (P gt; .05); however, a statistically significant difference was noted at the high spatial frequency (P < .01). There was no difference in visual acuity or contrast sensitivity between eyes with folding marks and those without (P gt; .05). Conclusion: Although glistenings and folding marks were observed after the implantation of AcrySof IOLs, they did not significantly affect visual function.

Posterior capsule opacification after phacoemulsification: foldable acrylic versus poly(methyl methacrylate) intraocular lenses

PURPOSE To study the effects of foldable acrylic and poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation on posterior capsule opacification (PCO). SETTING Department of Ophthalmology, Dokuz Eylül University School of Medicine, Izmir, Turkey. METHODS This consecutive series comprised 157 eyes having phacoemulsification with implantation of a foldable acrylic IOL with rectangular optic edges and a 5.5 mm optic (AcrySof) (n = 80 eyes) or a PMMA IOL with rounded optic edges and 5.5 mm optic (n = 77). Evaluated were incidence, location, and degree of PCO. Mean postoperative follow-up was 17.8 months +/- 1.7 (SD) (range 16 to 22 months). RESULTS Posterior capsule opacification occurred in 8.7% of eyes in the foldable acrylic IOL group and in 24.7% of eyes in the PMMA IOL group. The difference between the 2 groups was statistically significant (P < .01). Centrally located PCO was significantly lower in the acrylic group (P < .01). There were 3 eyes with severe PCO in the PMMA group and none in the acrylic group. Anterior capsule contraction and fibrosis were present in 4 eyes in the PMMA group but none in the acrylic group. Soemmerings ring cataract formation was detected in 3 eyes, all with the AcrySof IOL. CONCLUSION In addition to its optic material and rectangular optic edges, the AcrySof IOL provides additional advantages in lowering the incidence of PCO compared with rounded-edge PMMA IOLs.

Early postoperative capsular block syndrome

Purpose: To report the results of early postoperative capsular block syndrome (CBS) after phacoemulsification and intraocular lens (IOL) implantation. Setting: Department of Ophthalmology, Dokuz Eylül University School of Medicine, Idot;zmir, Turkey. Methods: Thirteen eyes of 13 patients with CBS who had uneventful phacoemulsification were included in the study. Twelve patients had in‐the‐bag implantation of a foldable IOL, and 1 had implantation of a poly(methyl methacrylate) IOL in the ciliary sulcus. Continuous curvilinear capsulorhexis was performed in all eyes, and sodium hyaluronate 1.4% (Healon GV®) was used during all steps of surgery. The patients were closely followed without intervention during the first month after surgery. If resolution did not occur during follow‐up, a neodymium:YAG (Nd:YAG) laser peripheral anterior capsulotomy was performed first, followed by posterior capsulotomy if the anterior capsulotomy was not successful. Results: The CBS resolved without intervention in 2 eyes by 1 month postoperatively. A small Nd:YAG laser peripheral anterior capsulotomy was attempted in 10 cases after 1 month but could not be performed in 2 eyes because of inadequate pupil dilation. Peripheral anterior capsulotomy was successful in 5 of 8 eyes, with resolution of CBS in a few days. The Nd:YAG laser posterior capsulotomy was successful in 5 cases after the failure of the anterior capsulotomy. One patient chose to postpone treatment for 11 months, at which time posterior capsulotomy was performed successfully and the CBS resolved. Conclusions: Resolution of CBS occurred spontaneously in only a small percentage of cases during the first month after phacoemulsification with IOL implantation. Neodymium:YAG laser peripheral anterior capsulotomy and posterior capsulotomy were successful in treating CBS.

Transscleral fixation of foldable intraocular lenses

Purpose: To report the results of transscleral implantation of foldable intraocular lenses (IOLs). Setting: Department of Ophthalmology Dokuz Eylül University School of Medicine, Izmir, Turkey. Methods: Twenty eyes of 20 patients had transscleral fixation of a foldable IOL combined with conventional 3‐port pars plana vitrectomy or anterior vitrectomy. Twelve eyes had lens luxation, 8 traumatic and 4 idiopathic. Six eyes were aphakic, 3 after extracapsular cataract extraction and 3 as a result of complicated phacoemulsification. One patient with a mature cataract and pseudoexfoliation had a wide zonular dialysis during phacoemulsification. One patient had an opacified hydrophilic acrylic IOL. Results: The mean age of the patients was 52.9 years (range 17 to 80 years). The mean preoperative best corrected visual acuity (BCVA) was 20/63 (range counting fingers to 20/25). The mean preoperative refraction was +10.8 diopters (D) (range +10 to +13 D) and the mean preoperative astigmatism, 1.8 D (range 1.0 to 5.5 D). Sixteen IOLs were hydrophobic acrylic, 14 of which were 3‐piece AcrySof® MA60BM (Alcon) and 2 of which were Sensar® AR40 (Allergan). Four IOLs, all VisaAcryl® (Staar), were hydrophilic acrylic. The mean power of the IOLs was +22.0 D (range 19.0 to 26.0 D). The mean follow‐up was 12 months (range 1 to 18 months). The postoperative BCVA ranged between 20/100 and 20/20, and the mean postoperative astigmatism was 1.1 D (range 0.5 to 4.0 D) at the last follow‐up visit. The difference was statistically significant (P<.05). Suture exposure and cystoid macular edema were the only complications, each occurring in 2 eyes. Conclusion: Transscleral fixation of foldable IOLs takes less time and results in fewer complications and better visual outcomes.

Long-Term Results of Various Anterior Capsulotomies and Radial Tears on Intraocular Lens Centration

BACKGROUND AND OBJECTIVE To evaluate the long-term effects of various anterior capsulotomies and radial tears on intraocular lens (IOL) centration. MATERIALS AND METHODS Ninety-five eyes of 87 senile cataract patients operated with extracapsular technique were evaluated in IOL tilt and decentration with a new method of measurement. According to the type of anterior capsulotomy and number of radial tears, five groups were constituted as, can opener, envelope, continous curvilinear capsulorrhexis (CCC), CCC with one radial tear (relaxing incision at quadrant 12), and CCC with two relaxing incisions (relaxing incisions at quadrants 6 and 12), respectively. RESULTS Early decentration and tilt in groups CCC and CCC with one radial tear were significantly lower than the other groups (P < 0.05). Late decentration and tilt in the CCC group were significantly lower than the other groups (P < 0.01). Highest values of tilt and decentration were determined in envelope capsulotomy. Additional symmetric relaxing incision at quadrant 6 revealed no effect on the prevention of decentration and tilt compared to one relaxing incision. CONCLUSION CCC with one radial tear is not ideal but sufficient for IOL centration. All other anterior capsulotomy techniques, other than intact CCC, do not guarantee the IOL centration.

Staining of vitreous with triamcinolone acetonide in retained lens surgery with phacofragmentation

PURPOSE: To evaluate the beneficial effects of triamcinolone‐assisted vitrectomy during management of retained nuclei with phacofragmentation. SETTING: Dokuz Eylul University, Medical Faculty, Ophthalmology Department, and Retina Eye Center, Izmir, Turkey. METHODS: Twelve eyes of 12 patients were operated on between January 2002 and September 2003. Eleven patients were referred because of nucleus drop during phacoemulsification surgery. Six of these patients had mature white cataracts, and in 5 cases total nucleus luxation into vitreous cavity had occurred. In 1 case, approximately half of the nucleus was luxated. Five of the referred patients had pseudoexfoliation (PEX), 3 of whom also had phacodonesis. All of these patients had luxated nucleus segments of more than half. One patient was referred with an intraocular lens (IOL) implanted in the sulcus region. One patient who was not referred also had PEX, iridodonesis, and phacodonesis; total drop of nucleus had occurred in this case. All patients were treated with pars plana vitrectomy with triamcinolone acetonide staining of the vitreous material and phacofragmentation of the dropped nucleus segments. In 2 cases, transscleral foldable IOL fixation surgery was combined simultaneously. One patient already had an IOL at the time of referral. Nine patients were left aphakic for secondary procedures. RESULTS: All patients except 1 with subretinal neovascular membrane achieved best corrected visual acuities of equal or better than 0.5. No intraoperative or postoperative retinal complications were observed after 9 to 15 months of follow‐up. CONCLUSION: Staining of the vitreous material with triamcinolone acetonide during vitrectomy and phacofragmentation surgery for luxated nuclei helped in total removal of the vitreous body, thus preventing the aspiration of peripheral vitreous fibrils by the phaco tip, which might induce retinal detachment intraoperatively or postoperatively.

Interaction of Intraocular Lenses with Various Concentrations of Silicone Oil: An Experimental Study

The aim of this study was to evaluate the interaction between various widely used intraocular lenses (IOLs) and silicone oils of different viscosities. Four groups of IOLs, including monoblock foldable hydrophilic acrylic IOLs (Morcher, type 92s); monoblock hydrophobic acrylic IOLs (Acrysof®-SA60AT, Alcon); single-piece rigid polymethylmethacrylate (PMMA) IOLs (Intraocular Optical International-IOI-65130) and a three-piece foldable silicone optic IOL (CeeOn® Edge 911A, Pharmacia UpJohn) were analyzed in vitro to determine the percentage adherence 1,000-centistoke, 1,300-centistoke or 5,000-centistokes silicone oil on the IOL optic. For each IOL type, there was no statistically significant difference in the mean silicone oil coverage (MSC) of the IOL optics for the different viscosities of silicone oil. Silicone IOLs had the highest MSC percentage (79.9%) whereas hydrophilic acrylic IOLs were the least silicone-covered IOLs (7.8%) compared to the other IOL types tested in this study. It is not the concentration of silicone oil that affects silicone oil coverage. When performing small-incision cataract surgery in patients who may require silicone oil injection, foldable hydrophilic acrylic or hydrophobic acrylic lenses should be preferred over standard foldable silicone lenses.

Surgical management of postoperative endophthalmitis: Comparison of 2 techniques

Purpose: To evaluate the results of 2 surgical techniques in eyes with postoperative endophthalmitis. Setting: Department of Ophthalmology, Dokuz Eylul University, School of Medicine, İzmir, Turkey. Methods: Twenty‐four eyes with endophthalmitis after cataract surgery had vitrectomy as an initial procedure according to the Endophthalmitis Vitrectomy Study (EVS) criteria (Group 1, n = 24). These eyes were compared with 28 eyes that had total pars plana vitrectomy with an encircling band, silicone tamponade, and endolaser (Group 2, n = 28). The visual and anatomical outcomes and the need for additional procedures (repeat vitrectomy) were evaluated in the 2 groups. Results: In Group 1, 6 eyes (25.0%) had an additional procedure, 3 eyes (12.5%) had phthisis, and 21 eyes (87.5%) had successful surgery. In Group 2, no eye had an additional procedure, 1 eye (3.5%) had phthisis, and 27 eyes (96.4%) had successful surgery. The number of additional procedures was significantly less and the rate of surgical success was significantly higher in Group 2 than in Group 1 (P<.01). Conclusion: Despite the poor visual prognosis of endophthalmitis surgery, more radical intervention can increase the chance of surgical success and decrease the number of additional procedures in eyes with postoperative endophthalmitis.

Bilateral massive choroidal hemorrhage secondary to Glanzmann's syndrome

Characteristics of intraocular bleeding and its management in association with blood dyscrasias are discussed. We present a patient with massive bilateral choroidal hemorrhage secondary to Glanzmanns syndrome. Magnetic resonance imaging and ultrasonographic findings were ordered. During the clinical course, bilateral intravitreal hemorrhage and tractional retinal detachment occurred. Left pars plana vitrectomy was performed under general anaesthesia. The procedure was unsuccessful because of intraoperative uncontrolled bleeding.

Indocyanine green angiography in Biettils crystalline retinopathy

Abstract Background: To our knowledge, the indocyanine green (ICG) angiographic features of Biettis crystalline retinopathy have been described in a single case only. We report the ICG angiographic findings in four patients with Biettis crystalline retinopathy and compare them with the fluorescein angiographic findings. Methods: Review of the records of four patients with Biettis crystalline retinopathy, three of whom were from a single consanguineous family. Fluorescein and ICG angiography were performed with the Heidelberg scanning laser ophthalmoscope. Results: The ICG angiographic findings varied according to the stage of the disease. In the early stages no retinal pigment epithelium (RPE) alterations or choriocapillaris loss were noted. In advanced cases there was extensive chorioretinal atrophy. Most notably, intraretinal crystals did not exhibit fluorescence/cyanescence and had no masking effect on fluorescein or ICG angiography. In all cases angiography showed hypofluorescent/hypocyanescent dots, most likely corresponding to RPE alterations adjacent to atrophic areas. Interpretation: ICG angiography does not give additional information in Biettis crystalline retinopathy and probably is not superior to fluorescein angiography. However, it delineates the atrophic areas slightly better than does fluorescein angiography.