Yaşar Küçüksümer

Capsular tension ring implantation after capsulorhexis in phacoemulsification of cataracts associated with pseudoexfoliation syndrome intraoperative complications and early postoperative findings

Purpose: To evaluate the effect of an endocapsular tension ring in preventing zonular complications during phacoemulsification of cataracts associated with pseudoexfoliation syndrome. Setting: Eye Clinic of Beyoğlu Education and Research Hospital, Istanbul, Turkey. Methods: A prospective randomized study comprised 78 eyes with cataract and pseudoexfoliation syndrome that were randomly divided into 2 groups. The age, sex, cataract density, iridodonesis, axial length, anterior chamber depth, best corrected visual acuity (BCVA), and intraocular pressure (IOP) were matched between groups. In 39 eyes, a capsular tension ring (CTR) was implanted after capsulorhexis and hydrodissection but before nucleus emulsification. Thirty‐nine eyes that did not have a CTR implanted served as a control. The main outcome measures were the rates of intraoperative zonular separation and capsular fixation of a foldable intraocular lens (IOL). Posterior capsule rupture without zonular dialysis, vitreous loss, corneal edema, fibrin in the anterior chamber, BCVA, and IOP in the immediate postoperative period were also compared between the 2 groups. Results: Five eyes (12.8%) in the control group and no eye in the CTR group had intraoperative zonular separation (P = .02). Posterior capsule rupture without zonular separation occurred in 3 eyes (7.7%) in the control group and 2 (5.2%) in the CTR group. Capsular IOL fixation was achieved in 37 eyes (94.9%) in the CTR group and 31 eyes (74.3%) in the control group (P = .012). The difference in BCVA was not statistically significant between the 2 groups (P = .44); however, uncorrected visual acuity (UCVA) was significantly better in the CTR group (P = .026). Conclusion: In cases of cataract associated with pseudoexfoliation syndrome, implanting a CTR before phacoemulsification of the nucleus reduced intraoperative zonular separation, increased the rate of capsular IOL fixation, and improved UCVA.

Posterior capsule opacification 3 years after implantation of an AcrySof and a MemoryLens in fellow eyes

PURPOSE To compare the rates of lens epithelial cell (LEC) migration and posterior capsule opacification (PCO) 1 and 3 years after sutureless small incision phacoemulsification and in-the-bag implantation of 2 acrylic polymer intraocular lenses (IOLs)-the AcrySof and MemoryLens-in fellow eyes of patients. SETTING Eye Clinic, Beyoğlu Education and Research Hospital, Istanbul, Turkey. METHODS Fifty patients with no systemic or ocular problems that would interfere with postoperative visual acuity were included in this prospective study. Each patient had in-the-bag implantation of an AcrySof IOL in 1 eye and a MemoryLens in the fellow eye in a randomized fashion after uneventful phacoemulsification through a sutureless clear corneal incision. RESULTS At 1 year (n = 32 patients), there was no significant difference between fellow eyes in postoperative best corrected visual acuity (BCVA) and contrast sensitivity. In the MemoryLens group, 10 eyes (31.3%) had PCO and 9 (28.1%), LEC migration. In the AcrySof group, no eye had PCO and 2 eyes (6.3%) had LEC migration (P <.001). At 3 years (n = 21 patients), 1 eye (4.7%) in the AcrySof group had PCO and 3 eyes (14.4%) had LEC migration without PCO. In the MemoryLens group, 1 eye (4.7%) had a clear posterior capsule, 11 eyes (52.4%) had LEC migration, and 9 eyes (42.9%) had PCO (P <.001). A neodymium:YAG capsulotomy was required in 4 eyes (19.0%) in the MemoryLens group but no eye in the AcrySof group. At 3 years, BCVA was lower in the MemoryLens group than in the AcrySof group (P <.05). CONCLUSION The 3 year clinical data of fellow eyes indicate that the AcrySof IOL causes less PCO than the MemoryLens.

Primary 25-gauge sutureless vitrectomy with oblique sclerotomies in pseudophakic retinal detachment.

Purpose: To evaluate the anatomic and functional outcomes of 25-gauge sutureless vitrectomy in primary treatment of noncomplex pseudophakic rhegmatogenous retinal detachments (RRD). Methods: Prospective interventional institutional case series. Twenty-two eyes with pseudophakic RRD with proliferative vitreoretinopathy grade A or B underwent primary 25-gauge vitrectomy with oblique sclerotomies and gas endotamponade. Eyes with minimum follow-up of 6 months were evaluated. Main outcome measures were reattachment rate with single surgery, reoperation, complication rates, and changes in visual acuity (VA). Results: Mean duration of visual loss was 14.68 ± 12.87 days. Seventeen (77.27%) eyes had macular detachment. In all eyes 25-gauge sutureless vitrectomy was completed without complications. The mean follow-up period was 10.40 ± 5.77 months. Retinal attachment was achieved in 21 (95.45%) eyes with single surgery and in all (100%) eyes with second vitrectomy. Mean preoperative VA of 1.61 ± 1.18 improved to 0.50 ± 0.53 at the last visit (P < 0.001). Transient hypotony was detected in 2 (9.09%) eyes with spontaneous resolution. No other postoperative complication was observed. Conclusions: Twenty-five-gauge sutureless vitrectomy with oblique sclerotomies in primary treatment of noncomplex pseudophakic RRDs resulted in reattachment in 95.45% with single surgery, and in 100% with reoperation in one eye, accompanied by an increase in visual acuity in 86% of eyes.

Secondary iris claw intraocular lens implantation for the correction of aphakia after pars plana vitrectomy.

Purpose: The purpose of this study was to evaluate the safety and efficacy of iris claw intraocular lens implantation for correction of aphakia in vitrectomized eyes without capsular support. Methods: This was a prospective interventional case series. Twelve aphakic vitrectomized eyes without capsular support underwent iris claw intraocular lens implantation. The main outcome measures were changes in uncorrected visual acuity, best-corrected visual acuity, spheric equivalent, corneal endothelial cell density, corneal thickness, central macular thickness, and complications. Results: Mean follow-up was 15.58 ± 3.80 months with no intraoperative complications. Postoperatively, uncorrected visual acuity increased significantly at all follow-up visits (P < 0.05). Mean best-corrected visual acuity increased 10 letters/2 lines at the final follow-up visit (P = 0.023). Mean postoperative spheric equivalent at the last visit was −1.68 ± 063 D, and the spheric equivalent was within ±2.00 D of emmetropia in 9 (75%) eyes. Mean central macular thickness increased only at postoperative Month 3 (P = 0.043). Mean endothelial cell density loss was 23.87% at the last visit. Mean corneal thickness did not change during follow-up (P > 0.05). No corneal edema was observed. Complications were transient intraocular pressure increase (n = 1), cystoid macular edema (n = 1), and haptic dislocation replaced by surgery (n = 1). Retinas remained attached in all eyes. Conclusion: Secondary iris claw intraocular lens implantation is clinically safe and effective to correct aphakia in vitrectomized eyes without capsular support. Larger studies with longer follow-up are warranted.

Visual field changes after laser in situ keratomileusis in myopic eyes

Purpose: To evaluate the effect of acute elevation of intraocular pressure (IOP) during laser in situ keratomileusis (LASIK) on the visual field in myopic eyes. Setting: Istanbul University, Cerrahpassa Medical Faculty, Istanbul, Turkey. Methods: Thirty‐seven eyes of 37 patients were included in the study. The LASIK procedure was performed using the Hansatome® microkeratome (Bausch & Lomb) and the Summit SVS Apex Plus® 193 nm argon–fluoride excimer laser. Visual field testing was performed twice before LASIK and 1 day and 24 months after LASIK. Seventy‐six points, 6 degrees apart, in the central visual field (Central 30‐2) were tested for threshold sensitivity (Humphrey). The mean threshold sensitivity of baseline and post‐LASIK visual field examinations was calculated in each patient. Seventy‐six points of the Central 30‐2 test were divided into 21 clusters corresponding to perimetric nerve‐fiber bundles derived from Peridata software version 6.2a (Interzaag AG). The mean threshold sensitivity of each cluster and the visual field indices (mean deviation [MD] and corrected pattern standard deviation [CPSD]) in baseline and follow‐up visual fields were compared using analysis of variance. Results: The mean age of the 23 men and 14 women was 31.04 years ± 6.55 (SD). The mean spherical equivalent refraction was −4.21 ± 1.66 diopters (D) (range −2.25 to −6.75 D). The mean duration of suction was 42.29 ± 29.06 seconds. The mean visual field sensitivity at baseline and the 2 follow‐up examinations was 25.97 ± 2.04 dB, 25.70 ± 1.99 dB, and 27.17 ± 1.68 dB, respectively (P = .181). There was no difference between preoperative and postoperative visual field clusters except in area 13. In area 13, threshold sensitivity was decreased at 1 day (P = .039) and at the preoperative level at 24 months. The MD of the visual fields was −3.53 ± 1.67 dB, −3.61 ± 2.91 dB, and −2.61 ± 1.66 dB at the preoperative and 2 postoperative examinations, respectively (P = .495). The mean CPSD of the visual fields was 1.76 ± 1.24 dB, 1.42 ± 0.85 dB, and 1.74 ± 0.86 dB, respectively (P = .680). Conclusion: Laser in situ keratomileusis did not cause visual field defects in mild to moderate myopic patients who had no risk factors that might render the optic nerve more vulnerable to damage.

ZB5M Anterior Chamber and Fyodorov's Posterior Chamber Phakic Intraocular Lenses: Long-term Follow-up

PURPOSE To compare the long-term complications of two outdated phakic intraocular lenses (PIOL) implanted in eyes with high myopia to aid development of better PIOL designs. METHODS Sixty-two eyes of 37 patients implanted with the ZB5M anterior chamber PIOL (anterior chamber group) and 22 eyes of 14 patients implanted with Fyodorovs posterior chamber PIOL (posterior chamber group) were examined. Complications were compared after a mean follow-up of 71.15 +/- 32.17 months (range: 24 to 145 months) in the anterior chamber group and 84.14 +/- 26.43 months (range: 24 to 132 months) in the posterior chamber group (P = .07). RESULTS At last follow-up, pupil ovalization was present in 32 (51.6%) eyes in the anterior chamber group and 1 (4.5%) eye in the posterior chamber group (P < .001), and cataract in 5 (8.1%) eyes in the anterior chamber group and 7 (31.8%) eyes in the posterior chamber group (P = .007). Phakic intraocular lens decentration, glaucoma, retinal detachment, corneal decomposition, and monocular diplopia were additional complications encountered in both groups, with no statistically significant difference. CONCLUSIONS Proper understanding of these outdated PIOLs may be helpful in developing better PIOL designs.

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.