Üzeyir Günenç

Effects on visual function of glistenings and folding marks in AcrySof intraocular lenses.

Purpose: To study the effects on visual function of glistenings and folding marks in AcrySof® (Alcon) intraocular lenses (IOLs). Setting: Department of Ophthalmology, Dokuz Eylül University, School of Medicine, Izmir, Turkey. Methods: This study included 91 eyes that had phacoemulsification and in‐the‐bag AcrySof IOL implantation. Slitlamp, visual acuity, and contrast sensitivity evaluations were used to assess all cases. Observations of folding marks and glistenings in the IOL optic were noted. The glistenings were graded from 0 to +4. Eyes with coexisting pathology that could affect visual acuity (n = 15) were excluded from the study. After the exclusion, the visual acuity and contrast sensitivity in 28 eyes with glistenings were compared with those in 48 eyes without glistenings. Results: Localized folding marks away from the central visual axis of the IOL were identified in 25 eyes (27.4%). Glistenings were observed in 34 eyes (37.1%), 6 of which were excluded for coexisting pathology. There was no statistically significant difference in visual acuity and contrast sensitivity at low or medium spatial frequencies between eyes with glistenings and those without (P gt; .05); however, a statistically significant difference was noted at the high spatial frequency (P < .01). There was no difference in visual acuity or contrast sensitivity between eyes with folding marks and those without (P gt; .05). Conclusion: Although glistenings and folding marks were observed after the implantation of AcrySof IOLs, they did not significantly affect visual function.

Posterior capsule opacification after phacoemulsification: foldable acrylic versus poly(methyl methacrylate) intraocular lenses

PURPOSE To study the effects of foldable acrylic and poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation on posterior capsule opacification (PCO). SETTING Department of Ophthalmology, Dokuz Eylül University School of Medicine, Izmir, Turkey. METHODS This consecutive series comprised 157 eyes having phacoemulsification with implantation of a foldable acrylic IOL with rectangular optic edges and a 5.5 mm optic (AcrySof) (n = 80 eyes) or a PMMA IOL with rounded optic edges and 5.5 mm optic (n = 77). Evaluated were incidence, location, and degree of PCO. Mean postoperative follow-up was 17.8 months +/- 1.7 (SD) (range 16 to 22 months). RESULTS Posterior capsule opacification occurred in 8.7% of eyes in the foldable acrylic IOL group and in 24.7% of eyes in the PMMA IOL group. The difference between the 2 groups was statistically significant (P < .01). Centrally located PCO was significantly lower in the acrylic group (P < .01). There were 3 eyes with severe PCO in the PMMA group and none in the acrylic group. Anterior capsule contraction and fibrosis were present in 4 eyes in the PMMA group but none in the acrylic group. Soemmerings ring cataract formation was detected in 3 eyes, all with the AcrySof IOL. CONCLUSION In addition to its optic material and rectangular optic edges, the AcrySof IOL provides additional advantages in lowering the incidence of PCO compared with rounded-edge PMMA IOLs.

Magnetic resonance imaging and computed tomography in the detection and localization of intraocular foreign bodies

In this experimental study, various foreign bodies were inserted into fresh bovine eyes, in different localizations. Twenty-one magnetic and non-magnetic foreign bodies, dimensions of which varied from 1.5 × 1.5 × 2 mm to 3.5 × 6 × 7 mm, were tried to detect by computed tomography (CT) and magnetic resonance imaging (MRI) scanning. In addition, further dissections were applied to check the ocular damage attributable to movement of the foreign bodies. Ferromagnetic foreign bodies have been shown to move in the eye and the risk of torsional forces being applied to the ferromagnetic foreign body seemed to cause intraocular complications during MRI scanning. All of the foreign bodies that were implanted in bovine eyes were recognized on CT scanning, except intraocular lenses. As a general rule, metallic foreign bodies produced beamhardening artifacts, but these artifacts did not cause any problem in detecting the localizations of foreign bodies.

Staining of intraocular lenses with various dyes: a study of digital image analysis.

Purpose: To evaluate the interaction of various intraocular lens (IOL) materials with commonly used dyes. Materials and Methods: One IOL of each of the five groups (polymethylmethacrylate, silicone, three-piece hydrophobic acrylic, single-piece hydrophobic acrylic and single-piece hydrophilic acrylic) was bathed in trypan blue 0.1%, fluorescein sodium 2% and indocyanine green (ICG) 0.5% for 15 min. Digital photographs of the IOLs were obtained prior to bathing and after the 15-min bath in each dye. The same IOLs were immersed in the same dye for another 15 min and digital images were reobtained to depict the 30-min dye uptake. New IOLs from the group that exhibited visible colour change after the 15-min bath were then bathed in twofold dilution and if there was still visible dye uptake, fourfold dilution was performed, repeating the 15-min bath and digital photography. The images were then processed using Adobe Photoshop 5.1 to get mean luminosity and red-green-blue values. These values were compared between the groups and the undyed control. Also, dye washout was observed in serum-containing vials. Results: None of the polymethylmethacrylate, silicone and hydrophobic acrylic IOLs were stained with the dyes used. The only IOL material that changed colour was hydrophilic acrylic and did so with all dyes. The most marked colour change was with fluorescein sodium 2%, the least was with trypan blue 0.05%. Twofold dilution of trypan blue and fourfold dilutions of fluorescein sodium and ICG still stained the hydrophilic acrylic IOL; however, fourfold dilution of trypan blue did not cause a significant colour change. Trypan blue washed out within 6 h, while the IOL stained with ICG remained stained for longer than 24 h. Comment: Hydrophilic acrylic IOLs should be used with caution together with dyes since this material demonstrates marked dye uptake and washout may also take some time.

Penetration of amikacin into aqueous humor of rabbits.

Amikacin is an aminoglycoside antibiotic that has poor corneal penetration due to its hydrophilic properties. The purpose of this study was to compare and evaluate the penetration of amikacin sulfate into aqueous humor of the rabbit eye when applied by different routes and concentrations, namely 100 or 250 mg/ml topical fortified amikacin eye drops, 100 or 250 mg/ml amikacin-embedded soft contact lenses and 25 mg subconjunctival amikacin injection. One hour after application, amikacin was not detectable in any of the 100 mg/ml concentration groups. High levels of amikacin above the minimum inhibitory concentration for susceptible bacteria were detected when applied subconjunctivally and by 250 mg/ml topical fortified routes. Topical fortified amikacin 250 mg/ml reached the highest value in the aqueous (p < 0.05). Our results point out the poor corneal penetration of amikacin in standard concentrations from the intact rabbit cornea and that subconjunctival injections might provide satisfactory penetration.

Monoscleral fixated lens implantation in eyes with partial loss of capsular or zonular support.

Abstract A technique is described in which a posterior chamber intraocular lens (IOL) is implanted in eyes with partial loss of posterior capsule or zonular support. The IOL’s inferior haptic is placed over the residual capsule and the superior haptic is fixated to the ciliary sulcus with a polypropylene suture. In 17 eyes that had surgery using this technique, mean postoperative visual acuity was 20/25; complications included irregular pupil, iris capture, pupil block, hyphema, localized peripheral anterior synechia, IOL tilt, suture exposure, and cystoid macular edema.

Corneal Biomechanical Properties in Patients With Arcus Senilis.

Purpose: To compare the corneal biomechanical properties and intraocular pressure (IOP) levels in patients with and without arcus senilis (AS). Methods: Ocular response analyzer measurements were performed on the right eyes of 37 patients with AS (group 1) and 37 control eyes (group 2). Corneal hysteresis, corneal resistance factor, Goldmann-correlated IOP, and corneal compensated IOP were recorded with Ocular response analyzer. Spherical equivalent value of the refractive errors, axial length, central corneal thickness, and IOP measured with Goldmann applanation tonometer were noted for each study eyes. Statistical analyses were performed with Student t, Kruskal–Wallis, and Pearson correlation tests. Results: Mean age was 67.6 ± 9.8 years in group 1 and 65.3 ± 8.1 years in group 2 (P = 0.308). Mean corneal hysteresis and corneal resistance factor readings were 9.8 ± 0.9 versus 10.6 ± 0.8 (P < 0.001) and 10.05 ± 1.07 versus 10.9 ± 0.9 (P < 0.001) in groups 1 and 2, respectively. Mean corneal compensated IOP and Goldmann-correlated IOP values were found as 16.1 ± 3.3 mm Hg versus 15.8 ± 2.6 mm Hg (P = 0.719) and 15.1 ± 3.3 mm Hg versus 15.0 ± 2.6 mm Hg (P = 0.912) in groups 1 and 2, respectively. There was no statistical difference in IOP measured with Goldmann applanation tonometer, central corneal thickness, spherical equivalent value of the refractive error, axial length measurements, and mean keratometry readings between the 2 groups (P = 0.983, P = 0.289, P = 0.938, P = 0.886, P = 0.07, respectively). Conclusions: The mean corneal hysteresis and corneal resistance factor values of eyes with AS were lower when compared with the controls. This study demonstrated that AS may change the corneal biomechanical properties.

Combined transscleral fixation of an artificial iris prosthesis with an intraocular lens

Post-traumatic aniridia combined with aphakia may be seen after globe injury. Aside from esthetic aspects, partial or total loss of the iris tissue may also be related to various degrees of glare and photophobia. Such patients suffer from severe visual impairment secondary to aphakia. Herein we describe a novel surgical technique for the management of an aphakic eye with traumatic aniridia for a patient who underwent transscleral fixation of a custom-tailored artificial iris prosthesis combined with a rigid intraocular lens (IOL). Tight suturing of the IOL haptic eyelets on the silicone iris prosthesis and fixation of such a complex to the scleral wall may provide excellent cosmetic and functional outcomes in aphakic eyes with aniridia.

Surgical management of spontaneous in-the-bag intraocular lens and capsular tension ring complex dislocation

We describe a technique to manage late spontaneous intraocular lens (IOL) and capsular tension ring (CTR) dislocation within the intact capsular bag. The subluxated IOL and CTR complex can be positioned in a closed chamber and fixed to the pars plana at both 3 and 9 o’clock quadrants with the presented ab externo direct scleral suturation technique which provides an easy, safe and effective surgical option for such cases.

Topically applied 1% voriconazole induces dysplastic changes on the ocular surface: animal study

Abstract Purpose: To identify the risk of inducing ocular surface dysplasia following topical administration of 1% voriconazole eye drop. Methods: Fourteen noninflamed healthy eyes of 14 white adult New Zealand rabbits were included in the study. The rabbits were randomly divided into two groups comprised of 7 rabbits each. Group 1 received topical 1% voriconazole and Group 2 received topical saline as the control group. In all animals, right eye was selected for the study. In Group 1 (Voriconazole Group), single drop of voriconazole was instilled every 10 min consecutively for 17 times a day for 60 days. In Group 2 (Control Group), single drop of saline was instilled every 10 min consecutively for 17 times a day for 60 days. At two months, animals were sacrificed and study eyes were enucleated with the eyelids. The specimens were stained with hematoxylin-eosin and histopathologic changes in cornea, bulbar and palpebral conjunctiva were evaluated under light microscope. Results: There were no macroscopically visible lesions on the ocular surface of any rabbits. Histopathological evaluation showed mild to moderate dysplasia localized mainly in the limbus and extending to the adjacent cornea and bulbar conjunctiva in all rabbits in Voriconazole Group. Severe dysplasia or carcinoma in situ was not observed. In the Control Group, dysplasia was not observed, at all. Conclusion: This animal study provides a possible relationship between topically administered 1% voriconazole and ocular surface dysplasia. We recommend ophthalmologists to be aware of the risk of ocular surface dysplasia in patients received voriconazole eye drop.