Kazım Devranoğlu

Phacoemulsification with topical anesthesia: Resident experience

PURPOSE: To compare the intraoperative and postoperative complications and outcomes of phacoemulsification performed by residents using topical and retrobulbar anesthesia. SETTING: Two university ophthalmology departments. METHODS: One hundred fifty phacoemulsification procedures were performed by 3 residents who used retrobulbar anesthesia (retrobulbar group), and 146 phacoemulsification procedures were performed by another 3 residents who used topical anesthesia and who had no experience with retrobulbar or peribulbar anesthesia (topical group). Case notes were prospectively compared. The data analyzed included the ocular history, intraoperative and postoperative complications, and final best spectacle‐corrected visual acuity (BSCVA). RESULTS: There were no differences between the 2 groups in complication rates. Anterior capsule tears occurred in 8 eyes (5.3%) in the retrobulbar group and 7 eyes (4.7%) in topical group. Capsulorhexis was continuous but not curvilinear in 14 eyes (9.3%) and 12 eyes (8.2%), respectively. Capsulorhexis tear or posterior capsule rupture that necessitated conversion to extracapsular cataract extraction occurred in 3 eyes (2.0%) in the retrobulbar group and in 1 eye (0.6%) in the topical group. Posterior capsule rupture with vitreous loss occurred in 10 eyes (6.6%) and 9 eyes (6.1%), respectively. Loss of lens fragments in the vitreous cavity occurred in 3 eyes (2.0%) and 4 eyes (2.7%), respectively. The 63 postoperative complications (41 eyes [27.3%], retrobulbar group; 22 eyes [15.0%], topical group) included cystoid macular edema, intraocular lens decentration, endophthalmitis, bullous keratopathy, transient intraocular pressure elevation, temporary corneal edema, and vitreous hemorrhage. Some cases had more than 1 complication. The BSCVA, including in eyes with preexisting ocular pathology, was 20/40 or better in 86.7% in the retrobulbar group and 84.9% in the topical group. CONCLUSION: When supervised and in selected patients, residents who have no retrobulbar or peribulbar anesthesia experience can safely perform phacoemulsification using topical anesthesia.

Glutathione S transferase M1 and T1 genetic polymorphisms are related to the risk of primary open-angle glaucoma: a study in a Turkish population.

Background: Genetic factors and oxidative damage have been shown to have a role in the development of primary open angle glaucoma (POAG). Aim: To determine the effects of genetic polymorphisms of glutathione S transferase (GST)M1 and GSTT1 on the risk of POAG in a Turkish population. Methods: Using a multiplex polymerase chain reaction (PCR), GSTM1 and GSTT1 gene polymorphisms were analysed in 144 patients with POAG and in 121 otherwise healthy controls of similar age. Results: The GSTM1 positive genotype and the GSTT1 null genotype had an increased risk of developing POAG (p<0.001, OR 2.93, 95% CI 1.66 to 5.20 and OR 4.25, 95% CI 2.30 to 7.80, respectively). The risk of glaucoma also increased significantly in subjects with a combination of GSTM1 positive and GSTT1 null genotypes (p<0.001, OR 3.46, 95% CI 1.64 to 7.38). Conclusion: The GSTM1 positive genotype and GSTT1 null genotype or the combination of both may be associated with the increased risk of development of POAG in the Turkish population.

Determining the lowest trypan blue concentration that satisfactorily stains the anterior capsule

Purpose: To determine the lowest concentration of trypan blue that will stain the anterior capsule satisfactorily to perform a safe continuous curvilinear capsulorhexis and to describe a staining technique using a dispersive viscoelastic material. Setting: Cerrahpasa School of Medicine, University of Istanbul, Istanbul, Turkey. Methods: Trypan blue 0.1% (Vision Blue®) was diluted by half by adding an equal volume of balanced salt solution (BSS®) in a stepwise pattern continuously until the concentration failed to stain the anterior capsule satisfactorily. After the dilution, 4 concentrations of the dye were obtained: 0.050%, 0.025%, 0.0125%, and 0.00625%. The volume of dye used for staining was 0.1 cc at all concentrations. Each concentration of the dye was applied using a classic air‐bubble technique or a technique in which the dye was injected under sodium hyaluronate 3.0%‐chondroitin sulfate 4.0% (Viscoat®) onto the anterior lens surface without using an air bubble to reform the anterior chamber. Each diluted concentration was used in 10 eyes by the same surgeon, with 5 eyes having the air‐bubble technique and 5 having the viscoelastic technique. The 0.1% concentration was used in 5 eyes, all having the viscoelastic technique. Results: Trypan blue in concentrations as low as 0.0125% stained the anterior capsule satisfactorily. In addition, staining was possible under the Viscoat. The viscoelastic technique was faster, safer, and easier to perform than the air‐bubble technique. Conclusions: As trypan blue is a potentially carcinogenic vital dye and its possible long‐term side effects are unknown, the lowest effective concentration should be used. A concentration lower than 0.1% was effective in staining the anterior capsule even under dispersive viscoelastic material.

Repair of Descemet’s membrane detachment after viscocanalostomy

We report an alternative descemetopexy technique in a case of Descemets membrane detachment after viscocanalostomy, possibly caused by high-molecular-weight viscoelastic material.

Fungal keratitis after nonpenetrating glaucoma surgery

Purpose. The purpose was to report a case of fungal keratitis that occurred following viscocanalostomy. Methods. A 63-year-old man who underwent viscocanalostomy in his left eye presented with pain, redness, watering, and a decrease in visual acuity. Slit lamp examination showed teardrop-like stromal infiltration of the superior cornea. Corneal and conjunctival scrapings were obtained and a corneal biopsy was performed. Results. Microscopic examination of smears demonstrated no bacteria and fungi. Corneal biopsy revealed dichotomously branching, septate hyphae suggestive of Aspergillus species. Culture identified no microorganism. The patient responded to amphotericin B treatment and the corneal infiltration resolved, leaving a plaquelike corneal scar. Conclusion. Fungal keratitis may occur after viscocanalostomy, but prompt diagnosis and treatment can preserve the eye.

Intraocular lens optic capture in eyes with zonular weakness in cataract patients

&NA; We desribe a technique for managing cataracts in eyes with zonular weakness. The technique is a combination of microhook iris retractors to fixate the capsulorhexis, a capsular tension ring, and intraocular lens optic capture. Results of this technique in 70 eyes after a 13‐month mean follow‐up are reported. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Flap dimensions created with the hansatome microkeratome : Correlation with Orbscan-derived anterior segment data

PURPOSE: To investigate the flap dimensions created by Hansatome microkeratome (Bausch & Lomb Surgical) and their correlation with anterior segment biometric data measured by the Orbscan II (Bausch & Lomb). SETTING: Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. METHODS: Forty‐four myopic eyes of 22 patients (mean age 29 years ± 7 [SD]) that had laser in situ keratomileusis surgery using the Hansatome microkeratome were enrolled in the study. Intraoperative images taken from video recordings of procedures were analyzed with image analysis software to determine flap size and hinge size. White‐to‐white corneal diameter, corneal curvatures (Kmax, Kmin), corneal thickness, and anterior chamber depth were deducted from Orbscan measurement. Correlation analyses between flap dimensions and Orbscan‐derived anterior segment biometric data were done. RESULTS: The mean corneal flap diameter was 9.56 ± 0.28 mm in the right eye and 9.62 ± 0.28 mm in the left eye. There was no difference in flap size between the right and left eyes (P = .43). The mean hinge size was 4.98 ± 0.37 mm in the right eye and 5.07 ± 0.41 mm in the left eye. There was no difference in hinge size between the right and left eyes (P = .46). There was a significant correlation between flap size and preoperative corneal thickness (P<.001, r = 0.487), but there was no correlation between flap size and corneal curvature (P = .40, r = −0.12), white‐to‐white corneal diameter (P = .11, r = 0.47), or anterior chamber depth (P = .52, r = 0.09). There was also no correlation between hinge size and preoperative anterior segment biometric data. CONCLUSION: The Hansatome microkeratome produced a flap whose diameter is close to the intended flap diameter, and preoperative corneal thickness seems to be the important factor in determining flap size.