Hanefi Cakir

Intracorneal inlay to correct presbyopia: Long-term results

PURPOSE: To evaluate the long‐term visual results of Acufocus ACI‐7000 (now Kamra) intracorneal inlay implantation in presbyopic phakic patients. SETTING: Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey. DESIGN: Clinical trial. METHODS: This study comprised patients with emmetropic or post‐laser in situ keratomileusis (LASIK) presbyopia. Patients had an uncorrected near visual acuity (UNVA) of 20/40 or worse, correctable to 20/25 or better at distance. The inlay was implanted on the stromal bed after the LASIK flap was relifted or a flap created. The inlay was centered on the presurgical position of the first Purkinje reflex. The main outcome measures were distance and near vision and the complication rate. RESULTS: The study enrolled 39 patients aged 45 to 60 years. At the 4‐year follow‐up, all patients (N = 22) had 2 or more lines of improvement in UNVA with no significant loss in distance vision. The mean final UNVA was 20/20 (Jaeger [J1]); 96% of patients could read J3 or better. The uncorrected distance acuity was 20/40 or better in all eyes. Five patients had cataract progression, and 2 had a change in refractive status. No eye with an intracorneal inlay had intraoperative complications during cataract extraction. Four inlays were explanted during the study. There were no severe corneal complications that affected final vision. CONCLUSION: Intracorneal inlay implantation was an effective, safe, and reversible procedure for the long‐term surgical treatment of presbyopia. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.

Comparison of anterior chamber depth measurements taken with the Pentacam, Orbscan IIz and IOLMaster in myopic and emmetropic eyes

Purpose:  This study determined to assess the degree of agreement between anterior chamber depth (ACD) measurements obtained using three different devices and to analyse the relationship between ACD and spherical equivalent (SE) refraction.

Complicated Flap Creation With Femtosecond Laser After Radial Keratotomy

Purpose: To report a case of laser in situ keratomileusis (LASIK) that used the Intralase femtosecond laser 14 years after radial keratotomy (RK) for residual myopic astigmatism. Methods: A 39 year-old male patient had undergone a bilateral RK operation for myopic correction. The manifest refraction was −1.25 −3.00 × 175 D, with uncorrected visual acuity (UCVA) of 20/50 and best-corrected visual acuity (BCVA) of 20/20. The central and thinnest pachymetry measurements were 582 and 576 μm, respectively, by Orbscan II. Results: Intralase was used for LASIK, and initially, a loss of suction was seen during flap formation. The flap could be created again at the same intracorneal plane. During flap lifting, the RK incisions were separated, and one of the RK incisions progressed to the corneal center with the force applied by the blunt spatula. No piece was separated completely from the flap. Excimer laser treatment and flap repositioning could be done without any problems. At the fifth postoperative month, his UCVA was 20/20. All RK incisions seemed well aligned. There was no haze or epithelial ingrowth. Conclusions: This case showed that the Intralase femtosecond laser not only has no unique benefit as opposed to the mechanical keratome for post-RK eyes but also can lead to serious complications. We recommend that femtosecond laser flap formation not be used in post-RK eyes.

Comparison of intrastromal corneal ring segment implantation only and in combination with collagen crosslinking for keratoconus.

Purpose To compare visual outcomes, corneal astigmatism, and keratometric readings in patients with progressive keratoconus undergoing intrastromal corneal ring implantation (ICRSI) only and in combination with ultraviolet A riboflavin mediated corneal collagen crosslinking (CXL). Methods In this retrospective comparative study, there were 2 groups of keratoconus patients. Group 1 consisted of only ICRSI patients. Group 2 consisted of combined ICRSI-CXL patients. Preoperative and postoperative uncorrected distance visual acuity (UCDVA) and best-corrected distance visual acuity (BCDVA), spherical error, cylindrical error, and mean keratometry were compared. Results The study evaluated 166 eyes of 121 patients with a mean age of 24.74 years. The UCDVA improved from 0.24 to 0.37 in group 1 and from 0.24 to 0.42 in group 2 at the last visit. The BCDVA improved from 0.34 to 0.62 in group 1 and from 0.31 to 0.67 in group 2. Spherical error decreased from −5.05 D to −1.65 D in group 1 and from −4.82 D to −1.52 D in group 2. Cylindrical error decreased from −6.06 D to −3.47 D in group 1 and from −5.66 D to −3.20 D in group 2. Mean keratometry values decreased from 51.89 D to 47.96 D in group 1 and from 50.89 D to 46.91 D in group 2. p Value was ≥0.05 in group comparisons. Ring explantation due to corneal melting was applied in 3 eyes. Conclusions Both combined ICRSI-CXL and ICRSI-only groups experienced favorable outcomes, without statistical difference in any studied effect of both treatment strategies.

Combined Kerarings and Artisan/Artiflex IOLs in Keratectasia

PURPOSE:To evaluate the results of combined intracorneal ring (Keraring, Mediphacos Ltd) and anterior chamber, iris-fixated, phakic intraocular lens (pIOL) (Artisan and Artiflex, Ophtec BV) implantation in patients with ectatic corneal conditions and secondary high myopic and astigmatic refractive error. METHODS:Ten eyes of eight consecutive patients with different ectatic corneal diseases underwent sequential intracorneal Keraring and iris-fixated pIOL implantation. Two eyes with keratoconus, one eye with pellucid marginal degeneration, and one eye with iatrogenic corneal ectasia were implanted with the Artisan pIOL; six eyes with keratoconus were implanted with the Artiflex pIOL. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), topographic findings, and complications were recorded. RESULTS:Mean UDVA improved from 0.02+/-0.10 pre-operatively to 0.11+/-0.06 after Keraring implantation and to 0.54+/-0.18 after pIOL implantation (P<.001 for all). Mean CDVA improved from 0.18+/-0.12 preoperatively to 0.39+/-0.13 after Keraring implantation and to 0.66+/-0.18 after pIOL implantation (P<.001 for all). Mean MRSE reduced from -12.50+/-6.31 D preoperatively to +/-12.08+/-5.17 D after Keraring implantation (P=.10) and to -0.10+/-0.84 D after pIOL implantation (P<.001). No intra- or postoperative complications were observed. CONCLUSIONS:Sequential intracorneal Keraring segments and Artisan/Artiflex pIOL implantation resulted in visual and refractive improvements in patients with different corneal ectatic conditions with high myopic refractive errors.

Lift and crack technique for risky cataract cases.

UNLABELLED We describe a technique to manage dense cataract cases. After a capsulorhexis of 6.0 to 7.0 mm diameter has been created, the phaco tip is inserted into the nucleus centrally and high vacuum is used to lift the nucleus and elevate it with a tilt to protrude outside the capsular bag distally. The chopper is used to segment the nucleus centripetally, starting from the lens equator or just behind, without applying stress to the capsular bag or zonules. Further phacoemulsification is maintained by holding the nucleus centrally and chopping it into smaller triangular sectoral pieces. In this horizontal chopping technique, which is done just outside the capsular bag, grasping the nucleus in the center and elevating it with high vacuum instead of depressing one edge of the nucleus to elevate the other edge prevents additional stress to the capsule and zonules. FINANCIAL DISCLOSURE Neither author has a financial or proprietary interest in any material or method mentioned.

Intraoperative complications in intumescent cataract surgery using a phaco capsulotomy technique

Purpose To evaluate intraoperative complications of a modified phaco capsulotomy technique and the ophthalmic viscosurgical device (OVD)–assisted capsulorhexis in eyes with intumescent white cataract. Setting Lütfi Kırdar Kartal Eye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey. Design Comparative randomized case study. Methods Eyes of patients with intumescent white cataract were divided into 2 equal groups. After the anterior capsule was stained with trypan blue, Group 1 received a modified phaco capsulotomy technique and Group 2 received a high‐viscosity OVD–assisted capsulorhexis. The OVD used was sodium hyaluronate 2.0% (Protectalon 2.0%) Main outcomes were the capsulorhexis diameters, the deviations from the target diameter, and intraoperative complications. Results Eighty eyes of 80 patients were enrolled. There was a deviation from the target capsulorhexis diameter in 15 eyes (11 oversized, 4 undersized) in Group 1 and in 20 eyes (16 oversized, 6 undersized) in Group 2. Capsule tears during capsulorhexis were observed in 2 eyes in Group 1, and the surgery was changed to extracapsular cataract extraction (ECCE) in 1 eye. In Group 2, capsule tears during capsulorhexis occurred in 22 eyes and 20 of these were managed with ECCE. Conclusion The modified phaco capsulotomy technique might reduce the risk for capsule tear during capsulorhexis, leading to safe cataract surgery in cases of intumescent cataracts. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.

360-Degree Iris Burns Following Conductive Keratoplasty.

PURPOSE The authors report a case with multiple iris burns after conductive keratoplasty to correct hyperopia. METHODS Case report. RESULTS A 52-year-old woman with hyperopia had a previous conductive keratoplasty procedure and underwent a conductive keratoplasty re-treatment 6 months later. Postoperatively, she presented with 360-degree iris burns in both eyes that were correlated with the corneal conductive keratoplasty scars. In addition, specular microscopy revealed decreased endothelial cell density for both eyes. CONCLUSIONS This is the first reported case of iris burns associated with conductive keratoplasty. [J Refract Surg. 2016;32(11):776-778.].

Intracorneal ring implantation using Intralase ® with partial coverage of the cone in a patient after an alkaline injury

Purpose To report the use of intracorneal ring segment (ICRS) implantation in a case of severe corneal thinning and irregularity secondary to alkali burn. Case report A 33-year-old man who had a history of ocular alkali burn in the right eye was admitted. His best corrected visual acuity was 0.16 with manifest refraction of +5.00 (–7.00 × 180°). Orbscan II® revealed steepening of >53 D superiorly, excessive thinning inferiorly with thinnest pachymetric reading of 269 μm. Two KeraRing® segments, 200 μm thick and 90° arced, were implanted. During intrastromal channel creation by Intralase®, the inferior half of the applanating cone was covered by a gelatinous paper to prevent the penetration of the laser beam into the anterior chamber. In the first year postoperation, best corrected visual acuity was 0.7 with manifest refraction of +1.50 (–3.50 × 35°). Visante® opticial coherence tomography displayed ICRS at a depth of <370 μm. Conclusion ICRS implantation with this novel approach may be an option in eyes with severe corneal irregularity and thinning.