Farklı Keratorefraktif Yöntemlerle Düzeltilen Benzer Kırma Kusurlarının Keratometrik Deger Üzerine Etkileri

AMAÇ:Fotorefraktif keratektomi (PRK) ve laser in-situ keratomileusis (LASIK) gibi farklı keratorefraktif yöntemlerle düzeltilen benzer büyüklükteki miyopik ve birleşik miyop astigmatik kırma kusurunun, korneal keratometrik güç üzerindeki etkilerinin benzer olup olmadığının araştırılmasıdır. GEREÇ:Bu geriye dönük, randomize olmayan, karşılaştırmalı klinik araştırma Ocak 2018 ve Haziran 2019 tarihleri arasında TOBB ETÜ Hastanesi’nde gerçekleştirilmiştir. Uygulanan cerrahiye göre olgular PRK (n=100) ve LASIK (n=76) olarak 2 gruba ayrılmıştır ve her bir hastanın sağ gözü çalışmaya dahil edilmiştir. Olguların cerrahi öncesi ve cerrahi sonrası 6. aydaki klinik verileri göz önünde bulundurularak sferik eşdeğerindeki (SE) azalma ile SEfark ve ortalama keratometrideki (Km) değişim ile Kfark değerleri hesaplanmıştır. SEfark/Kfark hesaplaması ile birim SE değişiminin Km üzerindeki etkileri araştırılmış ve gruplar arasında karşılaştırma yapılmıştır. BULGULAR:PRK ve LASIK grupları arasında cinsiyet (p=0,348) ve yaş (p=0,768) bakımından anlamlı fark yoktu. SEfark değeri PRK grubunda -3,36 ± 1,46 D (-0,88 ile -6,50 D) iken LASIK grubunda -3,26 ± 1,41 D (-1 ile -6,13 D) idi ve gruplar arasında anlamlı fark yoktu (p=0,206). SEfark/Kfark parametresi PRK grubunda 0,78 ± 0,46 (-2,66 ile -0,86) iken LASIK grubunda -1,21 ± 0,39 (-3,10 ile -0,30) idi ve gruplar arasında anlamlı fark yoktu (p=0,184). SONUÇ:Benzer büyüklükteki miyopik veya birleşik miyop astigmatik kırma kusuru düzeltmesinde uygulanan PRK ve LASIK cerrahilerinin Km değerindeki cerrahi ile elde edilen değişim üzerine olan etkileri benzerdir

Transepitelyal ve Konvansiyonel Alkol Destekli Fotorefraktif Keratektomi Sonrası Yüksek Sıralı Aberasyonların Karşılaştırılması

Objectives: To compare the asphericity and higher-order aberration (HOA) outcomes of single-step transepithelial photorefractive keratectomy (tPRK) and conventional alcohol-assisted PRK (aaPRK) in patients with myopia and myopic astigmatism. Materials and Methods: Of the 108 eyes of 54 patients enrolled in the study, tPRK was performed on 54 (50%) eyes and aaPRK was performed on 54 (50%) eyes. The following parameters were compared: corrected distance visual acuity (CDVA), spherical equivalent (SE), flat and steep keratometry, intraocular pressure, central corneal thickness, asphericity, and HOAs including horizontal and vertical coma, horizontal and vertical trefoil, spherical aberration, second-order vertical coma, and aberration coefficient. Results: The demographic and baseline characteristics were similar between the two groups (p>0.05, for all). The aberration coefficient value was significantly lower in patients treated with aaPRK compared to patients treated with tPRK at postoperative 3 months, 6 months, and 1 year (p=0.022, p=0.019, and p=0.017, respectively). Differences in the other variables were statistically insignificant (p>0.05 for all). Conclusion: Both tPRK and aaPRK procedures obtain similar postoperative CDVA, SE, asphericity, and HOA outcomes, except the aberration coefficient value.Amaç: Miyop ve miyopik astigmatizmalı hastalarda tek aşamalı transepitelyal fotorefraktif keratektomi (tFRK) ve konvansiyonel alkol yardımlı FRK (aFRK) sonrası asferiklik ve yüksek sıralı aberasyon (YSA) sonuçlarını karşılaştırmak. Gereç ve Yöntem: Çalışmaya 54 hastanın 108 gözü dahil edildi. Elli dört (%50) göze tFRK, 54 (%50) göze aFRK uygulandı. Aşağıdaki parametreler karşılaştırıldı: En iyi düzeltilmiş görme keskinliği (EİDGK), sferik eşdeğer (SE), düz ve dik keratometri, göz içi basıncı, merkezi kornea kalınlığı, asferiklik ve horizontal ve vertikal koma, horizontal ve vertikal trefoil, sferik aberasyon, ikinci sıra vertikal koma ve aberasyon katsayısı. Bulgular: Demografik ve başlangıç klinik özellikler iki grup arasında benzerdi (hepsi için p>0,05). Aberasyon katsayısı değeri, aFRK ile tedavi edilen hastalarda ameliyat sonrası 3. ayda, 6. ayda ve 1. yılda tFRK ile tedavi edilen hastalara göre istatistiksel olarak anlamlı derecede düşük bulundu (sırasıyla p=0,022, p=0,019 ve p=0,017). Diğer değişkenler istatistiksel olarak anlamlı değildi (p>0,05, hepsi için). Sonuç:Hem tFRK hem aFRK prosedürleri ile, aberasyon katsayısı değeri hariç, benzer postoperatif EİDGK, SE, asferiklik ve YSA sonuçları elde edilmektedir

Objective Accommodation Measurements In Different Ages By Using An Autorefractometer

Introduction: To measure accommodation amplitude (AA) at different ages by using Tonoref 3 (NIDEK CO., LTD.) and to investigate a possible correlation with pupil diameter. Material and Methods: AA was measured in both eyes of 125 subjects between 25 and 69 years of age by using Tonoref 3. Pupil diameter was also measured at the same time with AA measurement. All measurements were repeated 3 times and for test–retest reliability, the same protocol was repeated on 3 additional days as well as twice on the same day in the young adults and the average values were collected for statistical analysis. Subjects were grouped into 10-year bins, and a descriptive univariate analysis of the data performed. Results: The mean age was 37.82 years ±1.72 (SD). The mean AA was 1.6682±0.1841 (range 0.14-8.06). In order to investigate the relationship between age and AA, the age data is divided into three groups as 30 and under, 30-39, 40 and above. A significant difference was found between 30 and 40 age above groups and 30-39 and 40 age and above (p=0.000, for each). A negative correlation was found between age and AA. In addition, a weak correlation was found between pupil diameter and AA. Conclusions: The accommodative responses measured with Tonoref 3 were significantly suitable for objective measurement of accommodation with varying ages. Pupil diameter has a weak effect on the measurement of AA

Comparison of 9.0 and 9.2 mm Flap Diameter Options of Femtosecond Laser In-Situ Keratomileusis for Hypermetropia and Hypermetropic Astigmatism

Aim. To compare the postoperative one-year outcomes of asphericity (Q) and high order aberration (HOA) values of 9.0 and 9.2 mm diameter flap groups in hypermetropia and hypermetropic astigmatism subjects who underwent femtosecond laser in-situ keratomileusis (LASIK). Materials and Methods. The study included 68 eyes of 34 patients. A femtosecond laser platform (Allegrato Wave, Wavelight AG, Erlangen, Germany) was used for flap cutting. Corneal stroma was ablated using Wavelight EX500 with wavefront-optimized profile (WaveLight GmbH, Erlangen, Germany). 9.0 mm flap diameter was randomly chosen for one eye, and 9.2 mm flap diameter was chosen for the fellow eye. Two eyes of the patients who used two different flap diameters were enrolled into two different groups. Corneal stroma was ablated using Wavelight EX500 with wavefront-optimized profile (WaveLight GmbH, Erlangen, Germany). Postoperative one-year outcomes of Q and HOA values of 9.0 and 9.2 mm diameter flap groups were compared statistically. Results. The preoperative manifest refraction spherical equivalents of the 9.0 and 9.2 mm diameter flap groups were 1.86 +/- 1.81 D and 1.69 +/- 1.99 D (p=0.754). No intraoperative or postoperative complications were observed. At postoperative one-year, Q values were 0.98 +/- 0.13 D and 0.91 +/- 0.15 D (p=0.029). HOAs including horizontal and vertical coma, horizontal and vertical trefoil, spherical aberration, and second order vertical coma were not significantly different (p>0.05 for all). Total HOA values were 1.62 +/- 0.14 and 1.40 +/- 0.16, in the 9.0 and 9.2 mm diameter flap groups, respectively (p<0.001). Conclusion. Both the 9.0 and 9.2 mm diameter flap options in femtosecond LASIK are equally safe and effective. Many of the HOA values are similar in both options, and better results were provided in terms of total HOA and Q values with the 9.2 mm diameter flap option. This study was registered with trial registration number 118-011

Objective Accommodation Amplitude Measurements Using a New Autorefractometer Device

Objectives: To measure the value of objective accommodation amplitude (AA) in patients using the new autorefractometer device and to evaluate the effects of age, refraction errors, pupil diameter on objective AA measurements. Methods: Three hundred subjects who were divided into five groups according to age were enrolled in this study. AA and pupil diameter were measured three times from both eyes using Tonoref III (NIDEK Co., Ltd.). Results: The mean AA was 1.6325±0.061 Diopter (D) (0.13-9.11 D). The mean AA values were statistically significantly different between the groups (p=0.000). It was not observed gender effect on AA (p=0.115). Although there was no significant difference between emmetropic and myopic groups, there were significant differences between emmetropic and hyperopic groups and also between myopic and hyperopic groups concerning AA (p=0.000, for both). A statistically significant difference was found for the mean AA between the groups with and without refractive surgery (p=0.028). Correlation analysis revealed that AA is increased as the mean pupil diameter increases (p=0.000, r=0.202) and the mean pupil diameter decreases with increasing age (p=0.000, r=-0.308). When the AA obtained from the patients in group 1 were compared with the AA values obtained by subjective accommodation tests, the AA values obtained by autorefractometer device were found to be correlated with push up, push down and minus lens tests (r=0.577, r=0.682, r=0.427) AA values obtained by autorefractometer device were found to be statistically significantly lower than other subjective tests (p< 0.001). Conclusion: The Tonoref III device seems to provide objective AA measurements in presbyopic or non-presbyopic individuals. Age, refractive error, pupil diameter and history of refractive surgery were effective on AA values, while the gender was not effective

Effects of Cyclotorsion Orientation and Magnitude in Eyes with Compound Myopic Astigmatism on the Compensation Capacity of WaveLight EX500 Photorefractive Keratectomy

Purpose To investigate the clinical effects of different orientation and magnitude of cyclotorsion on the compensation capacity of the WaveLight EX500 photorefractive keratectomy (PRK) platform. Methods This retrospective study comprised 400 eyes of 200 patients who underwent bilateral simultaneous PRK due to compound myopic astigmatism. The subjects were separated according to the orientation of cyclotorsion into incyclotorsion and excyclotorsion groups, and by the magnitude of cyclotorsion into group 1 (0.50 to 2.50 degrees), group 2 (3.00 to 5.00 degrees), group 3 (5.50 to 7.50 degrees), and group 4 (8.00 to 9.50 degrees). Results The mean magnitude of cyclotorsion was 3.50 ± 2.4 degrees (0.50 to 9.50 degrees) in the incyclotorsion group and 3.32 ± 2.3 degrees (0.50 to 9.50 degrees) in the excyclotorsion group (p = 0.617). The postoperative refractive outcomes of the incyclotorsion and excyclotorsion groups were similar (p > 0.05 for all). The postoperative mean cylindrical refractive error was −0.32 ± 0.3 diopters (D, −1.25 to 0.00 D) in group 1, −0.47 ± 0.2 D (−2.00 to 0.00 D) in group 2, −0.62 ± 0.2 D (−1.00 to −0.25 D) in group 3, and −0.91 ± 0.2 D (−1.50 to −0.50 D) in group 4 (p < 0.001). Preoperative cylindrical refractive error was positively correlated with magnitude of cyclotorsion (r = 0.125 and p = 0.013), which was also positively correlated with postoperative cylindrical refractive error (r = 0.600 and p < 0.001). Conclusions Incyclotorsion and excyclotorsion can be equally compensable in the WaveLight EX500 PRK platform for compound myopic astigmatism. A value of ≤2.50 degrees cyclotorsion magnitude was observed to be more compensable than higher degrees of cyclotorsion magnitude. Preoperative high astigmatism was associated with high cyclotorsion magnitude, which was also associated with a high degree of postoperative astigmatism

Miadında Doğan Türk Bebeklerde Refraktif Kusurların Taşınabilir Otorefraktometre ile Taranması

Background: In order to improve the quality of life of newborns, it is important to detect the earliest visual problems. This study aimed to determine the refractive status in healthy term babies and to investigate whether there is a correlation between refractive status and birth weight Materials and Methods: Two hundred and three healthy full-term babies at an age of postnatal 8 weeks were included in the study. In order to evaluate refractive status handheld autorefractometer device was used in all subjects. The types of refractive errors were analyzed both in right and left eyes separately. Measurements taken under cycloplegic condition were analyzed for spherical equivalent, astigmatism and anisometropia. Results: Hypermetropia was found as the most common refractive error among the participants (65% in right eyes, 62% in left eyes). With the rule astigmatism is found to be the most common astigmatic pattern in both eyes (75% in right eyes, 70% in left eyes). Anisometropia incidence was found to be 8%. No correlation between refractive status and birth weight (p=0.105 r=-0.280) Conclusion: Hypermetropia and with the rule astigmatism is the most common refractive error in term babies and there is no relationship between refractive status and birth weight in healthy infants born in term.Amaç: Yenidoğanların yaşam kalitesini arttırmak için en erken görsel problemleri tespit etmek önemlidir. Bu çalışmada sağlıklı term bebeklerde refraktif durumun belirlenmesi ve refraktif durum ile doğum ağırlığı arasında bir korelasyon olup olmadığı araştırıldı. Gereç ve Yöntem: Çalışmaya doğum sonrası 8 haftalık term doğan iki yüz üç sağlıklı bebek alındı. Kırılma durumunu değerlendirmek için tüm olgularda el otorefraktometre cihazı kullanıldı. Kırılma kusurları hem sağ hem de sol gözde ayrı ayrı analiz edildi. Sikloplejik koşullar altında yapılan ölçümler, sferik eşdeğer, astigmatizma ve anizometropi açısından analiz edildi. Bulgular: Hipermetropi, katılımcılar arasında en sık kırılma kusuru olarak saptadı(sağ gözlerde % 65, sol gözlerde % 62). Kurala uygun astigmatizma her iki gözde de en sık rastlanan astigmatik patern tespit edildi (sağ gözlerde % 75, sol gözlerde % 70). Anizometri insidansı% 8 olarak bulundu. Kırılma durumu ile doğum ağırlığı arasında korelasyon bulunmadı (p = 0.105 r = -0.280). Sonuç: Hipermetropi ve kurala uygun astigmatizma term doğan sağlıklı türk bebeklerde en sık görülen kırma kusuru olup, bu bebeklerde kırılma kusuru ile doğum ağırlığı arasında bir ilişki yoktur

Femtosaniye Lazer Destekli LASIK Cerrahisi Sonrası Erken Dönemde Retinal Ganglion Hücre Tabakası Kalınlığının Değerlendirilmesi

Objectives: To evaluate the early effects of femtosecond laser-assisted in situ keratomileusis (LASIK) surgery on retinal ganglion cell thickness (GCT), peripapillary retinal nerve fiber thickness (NFT), and central macular thickness (CMT) obtained by spectral domain optical coherence tomography (SD-OCT) in a healthy population. Materials and Methods: This case-control study included data from the right eye of 40 subjects without any disease other than refractive error and who had undergone femtosecond LASIK surgery. The preoperative, postoperative 1-hour, and postoperative 3-week GCT, NFT, and CMT values obtained by SD-OCT were compared. Results: The mean age was 27.54±5.99 years (18-45 years). GCT, NFT, and CMT were 18.43±6.03 µm, 107.90±9.01, and 234.3±21.2 ?m preoperatively; 18.05±5.93 µm, 108.08±8.92 ?m, and 230.1±22.6 µm at postoperative 1 hour; and 17.86±5.27 µm, 107.98±10.13, and 236.3±25.1 ?m at postoperative 3 weeks (p=0.159, 0.85, and 0.254, respectively). Conclusion: There were no changes in GCT, NFT, and CMT values evaluated with SD-OCT in the early period after femtosecond LASIK surgery

Spontaneous Corneal Hydrops in Pellucid Marginal Degeneration

To report a case of spontaneous corneal hydrops which is a rare complication in pellucid marginal degeneration. A 69-year-old female pa- tient with history of pellucid marginal degeneration admitted to our clinic with sudden onset of pain and loss of vision in her left eye. In eye examination, acute corneal hydrops was detected in the left eye and corneal perforation was not observed. Corneal topography revealed pel- lucid marginal degeneration in the right eye. Topical moxifloxacin, loteprednol etabonate and 5% sodium chlorure drop treatment was initi- ated on the patient's left eye. There was a significant decrease in pain complaints at the 1 st week follow-up. Acute corneal hydrops can rarely be seen in pellucid marginal degeneration patients.Pellüsid marjinal dejenerasyon hastalığında nadir bir komplikasyon olan spontan korneal hidrops olgusunu ve tedavisini sunmayı amaç- ladık. Pellüsid marjinal dejenerasyon hikayesi olan 69 yaşındaki kadın hasta kliğinimize sol gözünde ani başlayan ağrı ve görme kaybı ile baş- vurdu. Yapılan muayenesinde sol gözde akut korneal hidrops saptandı, perforasyon mevcut değildi. Korneal topografide sağ gözde pellüsid marjinal dejenerasyon saptandı. Hastanın sol gözüne topikal moksifloksasin, loteprednol etabonat ve %5 sodyum klorür damla tedavisi baş- landı ve törapötik kontakt lens uygulandı. 1. hafta kontrollerinde ağrı şikâyetlerinde belirgin azalma mevcuttu. Akut korneal hidrops nadir de olsa pellüsid marjinal dejenerasyon hastalarında görülebilir

Current Approaches in Refractive Surgery

At the most basic level, refractive surgery is any eye surgery performed to improve the refractive error of the eye or to eliminate the patient\'s dependence on glasses or contact lenses and is one of the most common \"cosmetic\" procedures applied worldwide. For many clinicians, refractive surgery usually refers to laser in-situ keratomileusis (LASIK), the most common refractive procedure. However, refractive surgery also includes surface ablation, refractive lens exchange (RLE) and phakic intraocular lens implantation. Laser refractive surgical procedures (such as LASIK, photorefractive keratectomy) are defi ned as highly safe surgeries that provide excellent visual results for patients with low to moderate refractive errors. With the recently developed small incision lenticle extraction (SMILE), the refractive stromal lenticle formed by femtosecond laser can be removed from a small corneal incision to obtain the desired refractive correction. In laser refractive surgical procedures, it has been shown that it is possible to obtain more perfect results with customized treatments such as topography, wavefront guided ablations. Surgical procedures such as phakic intraocular lens implants and refractive lens exchange are also provided by today\'s technology to treat the wider range of refraction defects. While refractive surgery continues to evolve, the long-term results of innovations need to be proven.Refraktif cerrahi, gözün refraksiyon kusurunu iyileştirmek veya hastanın gözlük ya da kontakt lenslere olan bağımlılığını ortadan kaldırmak için uygulanan göz ameliyatıdır ve dünya çapında uygulanan en yaygın \"kozmetik\" prosedürlerden biridir. Birçok klinisyen için, refraktif cerrahi genellikle en sık yapılan refraktif işlem olan laser in-situ keratomileusis (LASİK) anlamına gelir. Fakat refraktif cerrahi ayrıca yüzey ablasyonu, refraktif lens değişimi (RLD) ve fakik göz içi lens implantasyonu gibi daha birçok cerrahi işlemi de kapsamaktadır. Lazer refraktif cerrahi prosedürleri (LASİK, fotorefraktif keratektomi gibi) düşük-orta dereceli refraksiyon kusurları olan hastalar için mükemmel görsel sonuçlar veren oldukça güvenli ameliyatlar olarak tanımlanmaktadır. Son zamanlarda geliştirilen küçük insizyonlu lentikül ekstraksiyonu (SMILE) yönteminde, femtosaniye lazer ile şekillendirilen refraktif stromal lentikül küçük bir korneal kesiden çıkarılarak istenilen refraktif düzeltme elde edilebilmektedir. Lazer refraktif cerrahi prosedürlerinde topografi , wavefront kılavuzlu tedaviler gibi özelleştirilmiş tedaviler ile daha mükemmel sonuçlar elde etmenin mümkün olduğu gösterilmiştir. Daha geniş aralıklardaki refraksiyon kusurlarının tedavisini gerçekleştirmek üzere fakik göziçi lens implantları ve refraktif lens değişimi gibi cerrahi prosedürler de günümüz teknolojisi ile sağlanmaktadır. Refraktif cerrahi gelişmeye devam etmekle birlikte bulunan yeniliklerin uzun vadeli sonuçları da bilimsel çalışmalarla kanıtlanması gerekmektedir