Firat Helvacioglu

Evaluation of intrastromal corneal ring segments for treatment of post-LASIK ectasia patients with a mechanical implantation technique.

Aim: To evaluate the clinical outcomes of Keraring segment implantation in patients with post- laser-assisted in situ keratomileusis (LASIK) ectasia, using a mechanical implantation technique. Materials and Methods: Twelve eyes of 10 patients with post-LASIK ectasia were enrolled. Intracorneal ring segments (ICRS) were implanted after dissection of the tunnel using Tuncs specially designed dissector under suction. A complete ophthalmic examination was performed, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent, keratometric (K) readings, inferosuperior asymmetry index (ISAI), and ultrasound pachymetry. All 3, 6, and 12-month follow-ups were completed, and statistical analysis was performed. Results: The mean preoperative UDVA for all eyes was 1.28 ± 0.59 logMAR. At 12 months, the mean UDVA was 0.36 ± 0.19 logarithm of the Minimum Angle of Resolution (logMAR) (P=0.002), and the mean preoperative CDVA was 0.58 ± 0.3 logMAR, which improved to 0.15 ± 0.12 (P=0.002) at 1 year. There was a significant reduction in cylindrical refractive and spherical equivalent refractive error from –5.29 ± 2.47 diopters (D) and –5.54 ± 5.04 D preoperatively to –1.47 ± 0.71 D and –0.74 ± 1.07 D (P=0.001, P=0.002), respectively, at 1 year. In the same period, the mean K- readings improved from 47.93 ± 4.84 D to 40.87 ± 2.36 D (P=0.002), and the mean ISAI improved from 5.34 ± 3.05 to 2.37 ± 1.68 (P=0.003). No significant changes in mean central corneal thickness were observed postoperatively. There were no major complications during or after surgery. Conclusion: ICRS implantation using a unique mechanical dissection technique is a safe and effective treatment for post-LASIK ectasia. All parameters showed improvement at 1-year follow-up.

Outcomes of torsional microcoaxial phacoemulsification using tips with 30-degree and 45-degree aperture angles

Purpose To compare the safety and efficacy of Ozil Intelligent Phaco torsional microcoaxial phacoemulsification surgeries performed using 30‐degree and 45‐degree aperture angled tips. Setting Maltepe University School of Medicine Department of Ophthalmology, Istanbul, Turkey. Design Comparative case series. Methods Eyes were assigned to 2.2 mm microcoaxial phacoemulsification using the torsional mode with a 45‐degree (Group 1) or 30‐degree (Group 2) aperture angled tip. A quick‐chop surgical technique was used. The primary outcome measures were ultrasound time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound (US) amplitudes, mean surgical time, mean balanced salt solution volume used, and mean central corneal thickness (CCT) changes. Results The mean UST, CDE, and longitudinal and torsional US amplitudes were 58.21 seconds ± 33.81 (SD), 7.74 ± 6.23, 0.45 ± 0.30, and 26.30 ± 12.60 in Group 1 and 63.83 ± 23.42 seconds, 12.36 ± 6.75, 0.23 ± 0.26, and 44.65 ± 14.38 in Group 2, respectively. The mean CDE and torsional amplitudes were significantly lower in Group 1 (P=.002 and P=.001, respectively). The mean balanced salt solution volume was 73.30 ± 19.87 cc in Group 1 and 74.30 ± 19.44 cc in Group 2 (P=.821). The mean CCT change was 52.40 ± 38.08 &mgr;m and 99.35 ± 47.14 &mgr;m, respectively (P<.001). Conclusion Torsional phacoemulsification performed with a 45‐degree aperture angled tip provided more effective lens removal with a lower CDE and less CCT change than a 30‐degree aperture angled tip. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Outcomes of torsional microcoaxial phacoemulsification performed by 12-degree and 22-degree bent tips.

Purpose To compare the safety and efficacy of Ozil Intelligent Phaco torsional microcoaxial phacoemulsification surgeries performed with 12‐degree and 22‐degree bent tips using the Infiniti Vision System. Setting Maltepe University School of Medicine Department of Ophthalmology, Istanbul, Turkey. Design Comparative case series. Methods Eyes were assigned to 2.2 mm microcoaxial phacoemulsification using the torsional mode with a 22‐degree bent tip (Group 1) or a 12‐degree bent tip (Group 2). The primary outcome measures were ultrasound time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound (US) amplitudes, mean surgical time, mean volume of balanced salt solution used, and surgical complications. Results Both groups included 45 eyes. The mean UST, CDE, longitudinal US amplitude, and torsional US amplitude were 65 seconds ± 27.23 (SD), 11.53 ± 6.99, 0.22 ± 0.26, and 42.86 ± 15.64, respectively, in Group 1 and 84 ± 45.04 seconds, 16.68 ± 10.66, 0.48 ± 0.68, and 46.27 ± 14.74, respectively, in Group 2. The mean UST, CDE, and longitudinal amplitudes were significantly lower in Group 1 (P=.003, P=.008, and P=.022, respectively). The mean volume of balanced salt solution was 73.33 ± 28.58 cc in Group 1 and 82.08 ± 26.21 cc in Group 2 (P=.134). Conclusion Torsional phacoemulsification performed with 22‐degree bent tips provided more effective lens removal than 12‐degree bent tips, with a lower UST and CDE. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Comparison of Two Different Ultrasound Methods of Phacoemulsification

PURPOSE To compare the safety and efficacy of microcoaxial phacoemulsification surgeries performed with the OZil Intelligent Phaco torsional mode (Alcon Laboratories, Inc., Fort Worth, USA) and combined torsional/longitudinal ultrasound mode using 45 degree aperture angled tips. DESIGN Prospective randomized clinical trial. METHODS setting: Maltepe University, Istanbul. patient population: Eighty eyes of 80 cataract patients were randomly assigned to 2.2 mm microcoaxial phacoemulsification using the OZil Intelligent Phaco torsional mode (Group 1) or combined torsional/longitudinal ultrasound mode (Group 2). observation procedure: Intraoperative fluid and energy usage and postoperative examinations were evaluated. main outcome measures: Ultrasound time, cumulative dissipated energy, longitudinal and torsional ultrasound amplitudes, mean operation time, mean volume of fluid used, and surgical complications. RESULTS Both groups included 40 eyes. Mean ultrasound time, cumulative dissipated energy, and longitudinal and torsional ultrasound amplitudes in Group 1 were 58.21±33.81 seconds, 7.74±6.23, 0.45±0.30, and 26.30±12.60%, respectively, and these parameters in Group 2 were 64.75±30.23 seconds, 12.61±6.21, 26.32±5.85, and 40.98±8.33%, respectively. Cumulative dissipated energy and longitudinal and torsional amplitudes were found to be significantly lower in Group 1 (P=.001, P<.001, P<.001). Mean volumes of fluid used in Groups 1 and 2 were 73.30±19.87 cc and 107.07±21.82 cc, respectively (P<.001). CONCLUSION With the aid of a 45 degree aperture angled tip, the OZil Intelligent Phaco torsional mode provided more effective lens removal than the combined torsional/longitudinal ultrasound mode, with a lower cumulative dissipated energy and volume of fluid used.

Ozil IP torsional mode versus combined torsional/longitudinal microcoaxial phacoemulsification.

Purpose. To compare the safety and efficacy of microcoaxial phacoemulsification surgeries performed with the Ozil Intelligent Phaco (IP) torsional mode and combined torsional/longitudinal ultrasound (US) mode using the Infiniti Vision System (Alcon Laboratories). Methods. In this prospective randomized comparative study, 60 eyes were assigned to 2.2-mm microcoaxial phacoemulsification using the Ozil IP torsional mode (group 1) or combined torsional/longitudinal US mode (group 2). The primary outcome measures were US time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound amplitudes, mean operation time, mean volume of balanced salt solution (BSS) used, and surgical complications. Results Both groups included 30 eyes. Mean UST, CDE, and longitudinal and torsional ultrasound amplitudes in group 1 were 1 minute 15±34.33 seconds, 8.74±5.64, 0.43±0.74, and 25.56±8.56, respectively, and these parameters in group 2 were 1 minute 40±51.44 seconds, 9.28±5.99, 3.64±1.55, and 3.71±1.34, respectively. UST and longitudinal amplitudes were found to be significantly low in group 1 (p<0.001, p<0.001), whereas torsional amplitude was found to be significantly high in this group (p=0.001). Mean volumes of BSS used in groups 1 and 2 were 63.30±18.00 cc and 84.50±28.65 cc, respectively (p=0.001). Conclusions. The Ozil IP torsional mode may provide more effective lens removal than the combined torsional/longitudinal US mode with a lower UST and volume of BSS used.

Evaluation of intrastromal corneal ring segments for treatment of keratoconus with a mechanical implantation technique

Purpose: To evaluate the clinical outcomes of intrastromal corneal ring segment (ICRS) implantation in patients with keratoconus using a mechanical implantation technique. Materials and Methods: Thirty eyes of 17 patients with keratoconus were enrolled. ICRSs (Keraring) were implanted after dissection of the tunnel using Tuncs specially designed dissector under suction. A complete ophthalmic examination was performed, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent, keratometric readings, inferosuperior asymmetry index (ISAI), and ultrasound pachymetry. All 3-, 6-, and 12-month follow-ups were completed, and statistical analysis was performed. Results: The mean preoperative UDVA for all eyes was 1.36 ± 0.64 logMAR. At 12 months, the mean UDVA was 0.51 ± 0.28 logMAR (P = 0.001), and the mean preoperative CDVA was 0.57 ± 0.29 logMAR, which improved to 0.23 ± 0.18 (P = 0.001) at 1 year. There was a significant reduction in spherical equivalent refractive error from –6.42 ± 4.69 diopters (D) preoperatively to –1.26 ± 1.45 D (P = 0.001) at 1 year. In the same period, the mean K-readings improved from 49.38 ± 3.72 D to 44.43 ± 3.13 D (P = 0.001), and the mean ISAI improved from 7.92 ± 3.12 to 4.21 ± 1.96 (P = 0.003). No significant changes in mean central corneal thickness were observed postoperatively. There were no major complications during and or after surgery. Conclusion: ICRS implantation using a unique mechanical dissection technique is a safe and effective treatment for keratoconus. All parameters improved by the 1-year follow-up.

Supraciliary contraction segments: A new method for the treatment of presbyopia

Background and Objective: To evaluate the safety and effectiveness of supraciliary contraction segment implants (SCSIs) for the treatment of presbyopia. Materials and Methods: This prospective, non-comparative study comprised 10 eyes from five phakic and emmetropic 50-year-old subjects. Preoperative and postoperative near and distance visual acuity, topography, axial length, pachymetry, and intraocular pressure were analyzed. A 5.32-mm long and 0.85-mm thick piece of polymethyl methacrylat (PMMA) and a 5.32-mm long or 0.55-mm thick dried hydrophilic SCSI were placed within the scleral tunnels that were created 2 mm away from the limbus. The 500–550 μm deep tunnels were parallel to the limbus and four segments were implanted per eye. The SCSIs were entirely placed at a depth of approximately 85% in the sclera. Results: The uncorrected distance visual acuity was similar before and after the surgery (0.00 logMAR). The monocular mean uncorrected near visual acuity (UNVA) was 0.5 ± 0.0 before surgery, 0.12 ± 0.10 logMAR at 1 month after surgery, 0.16 ± 0.18 logMAR at 3 months after surgery, and 0.29 ± 0.16 logMAR at the 18-month follow-up. Conclusion: Despite obtaining satisfactory results at 6 months after the surgery, a follow-up of the SCSI intervention at 18 months revealed a regression of the early post-op UNVA improvement caused by a progressive outward movement of SCSIs.

Optical coherence tomography of bilateral nanophthalmos with macular folds and high hyperopia.

Importance. There is a conflict about the content of the macular folds in nanophthalmic eyes in the literature. Our study clearly demonstrated that papillomacular folds seen in nanophthalmos or posterior microphthalmos were only composed of neurosensory retina without involvement of retinal pigment epithelium and choroid. Observations. This is a report of two consecutive nanophthalmic patients with macular folds at Maltepe University School of Medicine, Department of Ophthalmology, from January to June 2012. Anterior segment dimensions were near normal. The axial lengths of the eyes were short with markedly shortened posterior segment. A macular fold extending from the center of the fovea towards the optic nerve head was present in all eyes. Optic coherence tomography clearly demonstrated that folds were only composed of neurosensory retina. Binocular visual acuities and refractive errors of the cases were 0.3, 0.2 and +16.00, +15.75 diopters, respectively. Conclusions and Relevance. Our study proposes a surgical option to treat these folds like serous retinal detachments by showing the true content of the folds, although there is not any surgical operation accepted for this condition yet. Further studies dealing with the surgical interventions of these folds should be performed to support this option.

The Use of Amniotic Membrane in the Management of Strabismus Reoperation Cases

Objective: To describe the use of amniotic membrane (AM) in reoperations to decrease scar formation and to improve ductions. Design: Prospective interventional case series. Participants: Four previously operated cases with restrictive strabismus. Methods: Objective clinical findings were recorded during both pre and post-operative periods. Excision of adhesions and scar tissue, repositioning of extraocular muscles and placement of AM between muscle, sclera and tenon tissue were performed. Results: Orthophoria with no duction deficits was achieved in 2 patients. One patient with fat adherence syndrome had orthophoria with -1 adduction deficit. Only one patient with congenital fibrosis syndrome had 25 PD of esotropia with abduction deficit (-2). Conclusions: We believe that AM placement between the extra ocular muscle, sclera and tenon tissue improves the ductions by inhibiting post-operative scar formation.

Effect of Corneal Incision Enlargement on Surgically Induced Astigmatism in Biaxial Microincision Cataract Surgery

Objectives: To evaluate surgically induced astigmatism (SIA) in biaxial microincision cataract surgery with enlargement of one corneal incision during intraocular lens implantation (IOL). Materials and Methods: Data from 683 eyes with cataract that underwent biaxial microincision cataract surgery and IOL were retrospectively analyzed. The operated eyes were divided into 4 groups defined by final corneal incision length after IOL implantation. There were 83 eyes with 1.6 mm corneal incisions (group 1) and 200 eyes in each of the 2, 2.4, and 2.8 mm corneal incision groups (groups 2, 3 and 4, respectively). SIA was assessed using preoperative and postoperative keratometric values at one month. Results: The mean magnitude of SIA was 0.83±0.4 D in group 1, 0.93±0.5 D in group 2, 1.03±0.6 D in group 3 and 1.04±0.7 D in group 4. The SIA showed statistically significant differences between the four groups (p=0.05). Pairwise group comparisons revealed significant differences between groups 1 and 3 and groups 1 and 4 (p=0.005). Conclusion: Biaxial microincision cataract surgery with an incision size of 1.6 mm resulted in the least SIA. Enlargement of the corneal incision beyond 2.0 mm during IOL implantation led to significant increases in SIA. We believe that with the development and dissemination of IOLs which can be inserted through small corneal incisions, biaxial microincision cataract surgery will be the best choice to prevent SIA and increase visual acuity.