Koray Karadayi

The effect of capsulorhexis size on development of posterior capsule opacification: Small (4.5 to 5.0 mm) versus large (6.0 to 7.0 mm)

Purpose The most common surgically related cause of reduced vision after extracapsular cataract extraction is posterior capsule opacification (PCO), which occurs in up to 50% of eyes following cataract extraction. This study examined whether small capsulorhexes of 4.5 to 5.0 mm, which lie completely on the 5.5 mm intraocular lens (IOL), and large capsulorhexes of 6.0 to 7.0 mm, which lie completely off the lens optic, are effective in preventing PCO development. Methods In this prospective study, 496 eyes of 367 patients underwent standardized phacoemulsification with capsulorhexis and capsular bag foldable acrylic IOL implantation. The patients were randomly assigned to receive either a small capsulorhexis of 4.5 to 5 mm to lie completely on the IOL optic or a large capsulorhexis of 6 to 7 mm to lie completely off the lens optic. Retroillumination photographs were taken at 6 months and then yearly. Results Throughout the follow-up, there was less PCO in the small capsulorhexis group than in the large capsulorhexis group. Conclusions Small capsulorhexes were associated with less wrinkling of the posterior capsule and less PCO than were large capsulorhexes. PCO after IOL implantation has a multi-factored pathogenesis. Small (4.5 to 5.0 mm) capsulorhexis and capsular bag implantation of 5.5 mm acrylic IOL are likely to reduce the PCO incidence when compared with the 6.0 to 7.0 mm capsulorhexis. The significance of the IOL optic diameter in association with the capsulorhexis size should also be documented by further studies.

Increase in central corneal thickness in dry and normal eyes with application of artificial tears: a new diagnostic and follow‐up criterion for dry eye

Aims:  To investigate the effect of artificial tear application on central corneal thickness (CCT) in dry and normal eyes.

Long-term outcomes of combined penetrating keratoplasty with iris-sutured intraocular lens implantation.

PURPOSE To evaluate the long-term outcomes of combined penetrating keratoplasty with iris-sutured posterior chamber intraocular lens implantation. PARTICIPANTS Patients (264 eyes) with aphakic and pseudophakic bullous keratopathy. DESIGN Retrospective case series. INTERVENTION Penetrating keratoplasty combined with implantation of an iris-sutured posterior chamber intraocular lens performed by a single surgeon. METHODS Data were gathered from the institutional database during a period of 10 years (1989-1999) and analyzed using customized software. MAIN OUTCOME MEASURES Graft survival rate, visual acuity, and intraoperative and postoperative complications. RESULTS Two-hundred fifty-two consecutive patients (264 eyes) were operated. Graft survival rates were 95% at 1 year, 89% at 2 years, and 81% at 5 years and were comparable to the results of previous corneal transplant studies. Among 180 patients (191 eyes) with a follow-up of at least 2 years (range, 2-11 years; mean, 5 years), the visual acuity at final follow-up visit, compared with preoperative visual acuity was improved in 72% of eyes (mean preoperative visual acuity, 20/250; mean postoperative visual acuity, 20/60). No intraoperative complications were encountered. CONCLUSIONS Combined penetrating keratoplasty with iris-sutured posterior chamber intraocular lens implantation offers significant vision benefits in this patient group.

The relationship between soluble L-selectin and the development of diabetic retinopathy

Diabetic retinopathy is a leading cause of adult vision loss and blindness. Earlier studies have shown that polymorphonuclear neutrophils play an important role in the pathogenesis of diabetic vascular complications. Stimulation of these cells is associated with the desquamation of L-selectin. The aim of the study was to evaluate the relationship between the serum concentration of L-selectin and the development of retinopathy in Type 2 diabetic patients. The study comprised 51 Type 2 diabetic patients, aged 65.2 ± 7.5 years, with a diabetes duration of 10.1 ± 8.9 years and HbA 1c of 8.2 ± 1.4. The study subjects were divided into two groups: Group A diabetic patients with retinopathy (n = 28) and Group B diabetic patients without retinopathy (n = 23). Twenty age- and sex-matched nondiabetic healthy subjects were enrolled as the control group. Patients with any inflammatory disease were excluded. Retinopathy was assessed by centrally graded retinal photographs. The serum concentration of sL-selectin was estimated using an ELISA test. We observed significantly higher serum concentrations of sL-selectin in Type 2 diabetic patients with retinopathy than in healthy subjects (36.5 ± 18.1 vs. 11.4 ± 7.5 ng/ml, p < 0.001). There was also a significant difference between Group A and Group B (36.5 ± 18.1 vs. 24.2 ± 13.5 ng/ml, p < 0.05) as well as between Group B and the controls (24.2 ± 13.5 vs. 11.4 ± 7.5 ng/ml, p < 0.01) with regard to sL-selectin levels. sL-selectin was significantly correlated with HbA 1c (r = 0.93, p < 0.001) and with diabetes duration (r = 0.44, p < 0.001). These results suggest that there was a strong relationship between sL-selectin and diabetic retinopathy. The strong correlation between sL-selectin and HbA 1c levels supports the concept that the sL-selectin level is increased with poor glycemic control, which may affect endothelial cell activity and cause subsequent microvascular complications.

The efficacy of hyperbaric oxygen for the treatment of experimental uveitis induced in rabbits.

Objective: The aim of the present study was to examine the efficacy of hyperbaric oxygen (HBO) therapy in the treatment of experimental uveitis induced in rabbits. It was hypothesized that HBO therapy improves the regression of experimental uveitis induced in rabbits. Research design and methods: An experimental animal study was conducted on 48 rabbits (48 right eyes of these rabbits) to evaluate the effects of HBO therapy on endotoxin-induced acute anterior uveitis in rabbits. To induce acute anterior uveitis, Salmonella typhimurium lipopolysaccharide endotoxin (LPS) was intravitreally injected into the right eyes of the rabbits. The animals were randomly assigned to five groups. No treatment was given to the rabbits in Group A. Prednisolone acetate was topically administered to the rabbits in Group B. Methylprednisolone acetate was administered by anterior subtenon injection to the rabbits in Group C four hours after LPS application. HBO therapy was administered to the rabbits in Group D. Both HBO therapy and anterior subtenon injection of methylprednisolone therapy were administered to the rabbits in Group E. To compare the effects of the different therapies on the progression of endotoxin-induced uveitis, examinations including clinical scoring of anterior uveitis, microscopic examination of aspirated aqueous humor for inflammatory responses, and aqueous protein level assessment were performed once a day after LPS injection. Results: There was a statistically significant difference between the control group (Group A) and other groups (Groups B–E) with respect to the number of inflammatory cells and protein levels in the aqueous one and three days after LPS injection (p < 0.05), indicating that the treatments resulted in less inflammation in Groups B–E compared to Group A. Moreover, there was no statistically significant difference between Groups B and C, Groups B and D, Groups B and E, Groups C and D, and Groups C and E with regard to the number of inflammatory cells in the aqueous at Day 1 after LPS injection (p > 0.05). In addition, Groups B and C and Groups B and D were comparable with regard to cell counts at Day 3 (p > 0.05), showing that HBO was comparable to corticosteroids in reducing inflammation. The differences between Groups B and E and Groups C and E were significant with regard to aqueous cell counts at Day 3 (p < 0.05), showing that HBO plus steroid was more effective than steroids alone. Conclusion: The intensity of ocular inflammation in the group receiving HBO therapy combined with anterior subtenon injection of methylprednisolone therapy was lower than in the other groups. We also demonstrated that HBO therapy was an effective therapeutic modality for the treatment of experimental uveitis induced in rabbits with an efficacy comparable to that of corticosteroids. Moreover, HBO plus steroid was superior to steroids alone in reducing inflammation.

The effects of artificial tear application on contrast sensitivity in dry and normal eyes

Purpose To investigate the effects of artificial tear application on contrast sensitivity in dry and normal eyes. Methods A total of 55 patients with normal (10/10) corrected or uncorrected visual acuity referring to GATA Gulhane Military Medical Academy Haydarpasa Ophthalmology Outpatient Clinic were evaluated in regard to dry eye diagnostic criteria, and assigned into the dry eye group (Group 1; 35 patients) and the control group (Group 2; 20 patients). All patients were given a contrast sensitivity testing at low and high spatial frequencies using the gradual contrast sensitivity chart before and at 5 minutes after application of artificial tears, and the two groups were compared. Wilcoxon test was used in statistical analysis, accepting a p value of <0.05 as significant. Results In the dry eye group, there was a statistically significant increase in contrast sensitivity scores both at low and high frequencies after application of artificial tears (p<0.05). In the control group, although there was a significant increase in low frequency scores after artificial tear application (p< 0.05), there was not a significant change in high frequency scores (p>0.05). Conclusions The decreased contrast sensitivity in dry eyes improves with application of artificial tears. Therefore, the impeded quality of vision seen in dry eye patients could be restored closer to normal with artificial tear therapy. Besides, contrast sensitivity testing could be used in the follow-up of artificial tear therapy.

Capsulorhexis in White Cataract Using a Green-Light Endoillumination Probe

BACKGROUND AND OBJECTIVE To compare the effectiveness of augmented superior oblique Z-tenotomy (SOZT) with fixed standard SOZT in canceling preoperative superior oblique overaction associated with A pattern anisotropia or V pattern in Browns syndrome. PATIENTS AND METHODS Sixteen consecutive patients with superior oblique overaction or Browns syndrome were treated by removal of a triangular piece of the superior oblique tendon near its insertion (augmented SOZT). Outcome was compared with 20 consecutive historical controls after standard SOZT. RESULTS The decrease in superior oblique overaction in the right and left eyes and fundus intorsion and the collapse of A pattern anisotropia were more significant for patients with superior oblique overaction (P = .003, P = .007, P = .05, P = .0015, respectively) and patients with Browns syndrome (P = .025, P = .03, and P = .05, respectively). No study patient with superior oblique overaction and A pattern anisotropia required reoperation compared with 5 of 14 controls (37.5%); rates for patients with Browns syndrome were 0 for the study group and 3 of 6 (50%) for the control group. CONCLUSIONS Augmented SOZT is superior to standard SOZT for correcting superior oblique overaction, intorsion, A or V pattern, and stereopsis. It is not associated with complications or reoperation. The size of the Z-tenotomy can be modified according to the intraoperative assessment to achieve symmetric results.

Re: "the lift and fill lower blepharoplasty".

1. Harris GJ, Sakol PJ, Beatty RL. Relaxed skin tension line incision for dacryocystorhinostomy. Am J Ophthalmol 1989;108:742–3. 2. Putterman AM. Eyelid incision approach to dacryocystorhinostomy facilitated with a mechanical retraction system. Am J Ophthalmol 1994;118:672–4. 3. Kim JH, Woo KI, Chang HR. Eyelid incision for dacryocystorhinostomy in Asians. Korean J Ophthalmol 2005;19:243–6. 4. Akaishi PM, Mano JB, Pereira IC, et al. Functional and cosmetic results of a lower eyelid crease approach for external dacryocystorhinostomy. Arq Bras Oftalmol 2011;74:283–5. Tarjani V. dave, m.d. mohammad Javed ali, m.d., f.r.c.s. P. sravani, b.ophth. milind N. Naik, m.d.