Murat Aslankurt

Pain and cooperation in patients having dominant-side or nondominant-side phacoemulsification

Purpose To evaluate the relationship between laterality and perceived pain and cooperation during phacoemulsification under combined topical and intracameral anesthesia. Setting University ophthalmology clinic and eye hospital, Kahramanmaraş, Turkey. Design Cohort study. Methods Seventy‐eight patients with senile cataracts who had ocular surgery were included prospectively. The dominant side was determined with the Edinburg Handedness Inventory. Phacoemulsification and intraocular lens implantation were performed. The surgeon graded the patient’s cooperation from 0 (best) to 3 (worst). The duration of surgery was recorded. Another researcher rated perceived pain from 0 (no pain) to 10 (unbearable pain) using a visual analogue scale (VAS). Pain scores and the degree of cooperation for dominant‐side and nondominant‐side surgery were the primary outcomes. Results Forty‐six patients had surgery in the dominant eye and 32 in the nondominant eye. The 2 groups were similar in age, sex, and severity and type of cataract. The mean VAS score was significantly higher in patients having dominant‐side surgery than in those having nondominant‐side surgery (P<.01). Similarly, the mean cooperation score was significantly poorer in the patients having dominant‐side surgery (P<.05). Visual analogue scores were correlated with patient cooperation (r = 0.890, P<.0001). Conclusion Pain scores were higher in dominant‐side surgery for cataract under topical and intracameral anesthesia, which should be kept in mind when selecting anesthesia and in studies in which pain is scored. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

The pain experience and cooperation of patients in consecutive cataract surgery.

Purpose The aim of this study was to investigate the pain experience and the cooperation of patients during consecutive cataract surgery. Methods In this prospective, randomized study, 60 consecutive adult patients with bilateral senile cataracts were recruited. All operations were performed with clear corneal phacoemulsification (phaco) technique under topical and intracameral anesthesia without sedation. The first surgery was performed in the eye with high-grade cataract. The other eye was operated within 3 months. Every patient was graded using a visual analogue scale (VAS) from 0 (no pain) to 10 (unbearable pain) after the surgery. The cooperation of the patient was graded from 0 (no event) to 3 (marked eye and head movement and lid squeezing) by the surgeon. The VAS scores and cooperation of patients were the main outcome measurements. Results The mean VAS score was 1.50± 0.81 in the first surgery and 2.15±0.79 in the other eye surgery (p<0.001). The patient cooperation score was 1.50±0.81 in the first surgery and 2.18±0.77 in the other eye surgery (p<0.001). The VAS and patient cooperation scores were positively correlated (r=0.633, p<0.001) in the study group. The VAS and patient cooperation scores were similar based on sex and laterality. Conclusions Patients who previously underwent phaco surgery in one eye experience more pain and have worse cooperation during the other eye phaco surgery.

Corneal thickness measured by Scheimpflug imaging in children with Down syndrome.

PURPOSEnTo measure corneal thickness via the use of a Scheimpflug imaging system (OCULUS Optikgeräte GmbH, Wetzlar, Germany) in children with Down syndrome.nnnMETHODSnThis prospective, nonrandomized, clinical trial included children with Down syndrome and age- and sex-matched healthy controls. All subjects received a complete ophthalmologic examination. Corneal topography measurements were acquired by means of Scheimpflug imaging. Central corneal thickness (CCT), thinnest point of cornea (TP), and corneal volume (CV) were analyzed.nnnRESULTSnA total of 27 children with Down syndrome and 37 control subjects were included in the study. In children with Down syndrome, the mean CCT was 494.27 ± 47 μm, the mean TP was 487 ± 49 μm, and the mean CV was 56.2 ± 6. In the controls, the mean CCT was 539.3 ± 40 μm, the mean TP was 538.0 ± 40.8 μm, and the mean CV was 61.3 ± 4. For all 3 parameters, the difference was statistically significant (P < 0.001). In the Down syndrome group, the CCT was <500 μm in 16 subjects (59.2%) and <450 μm in 5 (18.5%). In the control group, the CCT was <500 μm in 14 subjects (37.8%) and <450 μm in 2 (5.4%).nnnCONCLUSIONSnIn this study, corneal thickness was less in children with Down syndrome than in healthy control subjects. Decreased corneal thickness may be an early sign of a degenerative corneal disease such as keratoconus in children with Down syndrome.

Horner's syndrome following a subtotal thyroidectomy for a benign nodular goitre

We present a case of Horners syndrome occurring as a complication of thyroidectomy. A 42-year-old female patient presented with eyelid drop which developed immediately after thyroidectomy for goitre. Ophthalmic examination revealed eyelid ptosis, miosis and anhidrosis. Preoperative ultrasonography showed multiple isohyperechogenic solid nodules in each lobe, consistent with multinodular goitre. Therefore, the patient underwent subtotal thyroidectomy. The ophthalmic findings did not improve at the end of 6u2005months follow-up. Similar cases have been reported related to neck tumours or their surgery, mediastinum-located goitre and retropharyngeal abscess surgeries, but not after benign nodular goitre surgery. Several possible mechanisms have been proposed to explain this phenomenon; anatomical variations making the patient susceptible to damage to the sympathetic chain seem to be most likely in our patient.

Topical proparacaine abuse resulting in evisceration

A 72-year-old man was admitted to our clinic because of pain in the right eye. Corneal oedema, peripheral anterior synechiae formation and intraocular lens were determined in the right eye. The left eye was normal except for nuclear sclerosis. Intraocular pressure was 35u2005mmu2005Hg in the right eye and 14u2005mmu2005Hg in the left eye. The patient was diagnosed as having bullous keratopathy and glaucoma. He was treated with antiglaucoma drugs and artificial tears as an outpatient. Persistent keratopathy was observed at follow-up, despite adequate therapy. In the detailed anamnesis of the patient, we discovered that he had used a topical anaesthetic instead of the prescribed medicine owing to ocular pain. The patient was still using topical anaesthetic eye drops, despite warnings. Finally, evisceration was performed on his right eye because of corneal melting and perforation.

Preventable visual impairment in children with nonprofound intellectual disability.

Purpose To assess the preventable visual impairment in children with nonprofound intellectual disability (ID). Methods A total of 215 children with IDs (90 Down syndrome [DS], 125 nonprofound ID) and 116 age- and sex-matched healthy subjects were enrolled in this study. All participants underwent ophthalmologic examinations including cycloplegic refraction measurements, ocular movement evaluation, screening for strabismus (Hirschberg, Krimsky, or prism cover test), slit-lamp biomicroscopy, funduscopy, and intraocular pressure measurements. All data were recorded for statistical analysis. Results Ocular findings in decreasing prevalence were as follows: refractive errors 55 (61.1%), strabismus 30 (33.2%), cataract 7 (7.8%), and nystagmus 7 (7.8%) in children with DS; refractive errors 57 (45.6%), strabismus 19 (15.2%), cataract 7 (6.4%), nystagmus 5 (4%), and glaucoma 1 (0.8%) in children with other ID; and refractive errors 13 (11.2%) and strabismus 4 (3.5%) in controls. Cataracts, glaucoma, and nystagmus were not observed in the control group. The most common ophthalmic findings in children with DS compared with other ID and controls were with hyperopia (p<0.03 and p<0.001, respectively) and esotropia (p<0.01 and p<0.01, respectively). Conclusions The pediatric population with ID has a high prevalence of preventable visual impairments, refractive errors, strabismus, and cataracts. The prevalence of strabismus and refractive errors was more frequent in children with DS. The importance of further health screenings including ophthalmic examinations should be utilized to implement appropriate care management and improve quality of life.

Lens capsule-related problems in patients undergoing phacoemulsification surgery

Purpose This study aimed to compare lens capsule-related problems in mature versus non-mature senile cataracts in patients undergoing phacoemulsification surgery. Methods A total of 295 patients with senile cataract were divided into two groups according to lens maturation: 105 patients with mature senile cataract comprised Group 1 (study group) and the remaining 190 with non-mature senile cataract comprised Group 2 (control group). Prior to surgery, ophthalmological examination was undertaken. Patients’ best-corrected visual acuity and intraocular pressure were measured and a slit-lamp examination and funduscopy performed. All examination data were recorded and any capsule-related problems during surgery were also recorded. Patient files were reviewed retrospectively and compared between groups. Fisher’s exact test was used in the statistical analysis. Results In Group 1, the capsule-related problems found were: inability to complete capsulorhexis (seven eyes [6.6%]), posterior capsular perforation (three eyes [2.8%]), and conversion to extracapsular surgery (one eye [0.9%]). A posterior capsular perforation was seen in one eye (1%) in the control group. An intraocular lens was inserted into the sulcus in six eyes (5.7%) and one anterior chamber (0.9%) in Group 1 and into the sulcus in one eye (0.5%) of Group 2. The lens was inserted into the capsular bag in all other patients. Conclusion Delaying surgery in patients with cataracts creates a high risk for capsule-related surgical complications. Although capsule dyes make capsulorhexis easier, capsulorhexis is the most problematic phase of phacoemulsification in mature cataracts.

Ophthalmic Findings of Acute Mercury Poisoning in Primary School Students

Purpose: To report ophthalmic findings in acute mercury poisoning in the primary school students. Methods: Seventy two children exposed to mercury vapor and 42 healthy controls were enrolled in the study. Full ophthalmologic examination including best corrected visual acuity, external eye examination, a slit-lamp examination, funduscopy, intraocular pressure measurements, Visual Field (VF), Visual Evoked Potential (VEP) and Color Vision (CV) tests were performed at the presentation and after six months. The parametric values of VF, Mean Deviation (MD) and Pattern Standard Deviation (PSD) were compared between groups. nResults: The visual acuity less than two lines in ETDRS chart in 7(9.7%) patients, color vision impairment in 6(8.3%) patients were determined with ophthalmic examination. There were a significant difference in the color confusion index of patients, (p<0.05). The mean parametric VF values of MD and PSD were found statistically, significant difference (p<0.001, p<0,001 respectively), The latency values of VEP were 7% of 20 patients over 100 ms. There were no correlation between ophthalmic findings and mercury levels in urine and blood. nConclusion: While visual acuity minimally affected, advanced visual functions were significantly impaired in a way independent of mercury level. The goal of this paper is to draw attention to the importance of public education on potentially hazardous effects of mercury in terms of preventive community health. In particular, both primary school teachers and students should be trained concerning poisonous gases such as mercury.

A case of secondary ankyloblepharon following bicanalicular silicone tube implantation.

To the Editor: Ankyloblepharon is a disorder in which upper and lower eyelids adhere to each other with skin bands. The adhesion may affect the whole or only part of the eyelids. Most cases of this disorder are caused by congenital or traumatic reasons. To the best of our knowledge, secondary ankyloblepharon following canalicular silicone tube implantation has not been reported previously. An 8-year-old female patient was admitted to our emergency department with bicanalicular lacerations caused by a traffic accident. The patient was treated with bicanalicular silicone tube implantation and primary suture repair under general anesthesia. She was discharged on the postoperative second day. The sutures were removed on the postoperative seventh day. Three months after the surgery, a band formation was detected between the upper and lower eyelids near the medial canthus. This formation was diagnosed as secondary ankyloblepharon. The bands were excised, and the silicon tube was removed under general anesthesia (Fig.). Recurrent ankyloblepharon or epiphora were not seen in the 2-year follow-up period. Acquired ankyloblepharon secondary to infectious diseases, ocular trauma, or autoimmune disorders have been reported. To the best of our knowledge, our patient is the first reported case of secondary ankyloblepharon after the silicon tube implantation.