Clinical outcomes and optical performance of four differentmultifocal intraocular lenses

Background/aim: The purpose of the present study was to evaluate clinical outcomes and optical performance of 4 different multifocal intraocular lenses (IOLs). Materials and methods: Ninety eyes of 51 patients who received Reviol MFM 611, Reviol MFM 625, Acri.LISA, and ReSTOR SN6AD3 multifocal IOLs after cataract surgery were retrospectively evaluated. The patients were similar in terms of age, sex, cataract hardness and axial length. The mean outcome measures were uncorrected and corrected distance visual acuity (UDVA, CDVA), distance-corrected intermediate and near visual acuity (DCIVA, DCNVA), intra or postoperative complications, and contrast sensitivity (CS) results under mesopic conditions. The mean follow up period was 10.5 months (range: 6 12 months). Results: All cases were within ± 0.75 D of emmetropia. Postoperative increase in UDVA and DCNVA was statistically significant in all groups. The Acri.LISA group showed slightly lower DCIVA compared with the other IOLs. CS was clinically similar between the groups. None of the patients developed any early or late postoperative complication or neuroadaptation problem, which necessitated explantation of the lens. Conclusion: All four multifocal lens designs provided satisfactory visual functions and CS results in patients who fulfilled the criteria for multifocal lens implantation

Toxic Anterior Segment Syndrome After Phacoemulsification

Toxic anterior segment syndrome (TASS) caused by non-infectious agents is a sterile inflammation which occurs after anterior segment surgery and results in toxic damage to the intraocular tissues. Occurring within 12-48 hours after surgery, the most common symptoms and signs are blurred vision, corneal edema and inflammation. There are many agents accused in the etiology such as: irrigation fluids, improper sterilization of surgical instruments, ocular medications, and intraocular lens. Postoperative endophthalmitis is important in the differential diagnosis. In this article, a case of TASS seen after phacoemulsification surgery is discussed in terms of diagnosis, differential diagnosis, and treatment modality. (Turk J Ophthalmol 2013; 43: 377-80

Nodular Scleritis and Sweet Syndrome

Sweet’s syndrome (Acute febrile neutrophilic dermatosis) is a rare skin disorder characterized by fever, neutrophilic leucocytosis, and erythematous skin nodules. Patients are usually middle-aged women presenting with painful skin lesions. This syndrome is known to have extra-cutaneous manifestations involving the joints, kidneys, liver, and lungs. In this article, the authors aim to present a case of Sweet’s syndrome with ocular involvement. (Turk J Ophthalmol 2013; 43: 286-8

Comparison of combined phacoemulsification-non-penetrating deep sclerectomy and phacoemulsification-trabeculectomy

AIM: To compare the outcomes of combined phacoemulsification and non-penetrating deep sclerectomy(P-DS)with combined phacoemulsification and trabeculectomy(P-T)in patients who have cataract and moderate-to-severe primary open angle glaucoma(POAG)or pseudoexfoliative glaucoma(PXG).<p>METHODS: In this prospective randomized study 40 eyes of 40 patients with cataract and POAG or PXG were evaluated. Complete eye examination and glaucoma tests were performed in all patients. Combined P-DS and P-T were performed under local anesthesia in 20 eyes in each group. Visual acuity(VA), intraocular pressure(IOP)and number of glaucoma medications were all recorded preoperatively and postoperative on 10d, 1, 3, 6 and 12mo. Complications, laser goniopuncture in P-DS group and needling in P-T group were also recorded.<p>RESULTS: The age(P-DS, 66.3±11.0 and P-T, 70.2±9.3y)and sex distribution(P-DS, 7 female and 13 male, P-T, 9 female and 11 male)were similar in both groups(<i>P</i>>0.05). Number of POAG and PXG patients were 12 and 8, and 13 and 7 in P-DS and P-T groups, respectively(<i>P</i>>0.05). There was no difference between groups in terms of preoperative VA(P-DS, 0.69±0.22 and P-T, 0.76±0.22 logMAR), IOP(P-DS, 17.9±1.6 and P-T, 18.1±1.9 mm Hg)and number of medications(P-DS: 2.7±0.7 and P-T: 2.9±0.8),(<i>P</i>>0.05). VA increased, IOP and number of medications decreased in both groups postoperatively(<i>P</i><0.01). Postoperative IOPs were 15.0±1.7 and 14.5±1.6 mm Hg in P-DS and P-T groups respectively(<i>P</i>=0.472). Postoperative number of medications were slightly better in P-T group(0.5±0.7)than in P-DS group(0.8±0.9)(<i>P</i>=0.307). There were no complications in both groups. Laser goniopuncture was applied in 7 eyes(once in 5 eyes and twice in 2 eyes)in P-DS group. Needling was performed in 1 eye in P-T group. <p>CONCLUSION: In patients with coexisting cataract and glaucoma, both combined P-DS and P-T may be performed safely. Reliability and efficacy were similar in both groups. Follow-up of P-DS should be done cautiously and when necessary laser goniopuncture should be performed

Treatment of ocular rosacea:comparative study of topical cyclosporine and oral doxycycline

<b>AIM:</b>To compare the effectiveness of topical cyclosporine A emulsion with that of oral doxycycline for rosacea associated ocular changes and dry eye complaints.<b>METHODS:</b>One hundred and ten patients with rosacea were screened. Thirty-eight patients having rosacea associated eyelid and ocular surface changes and dry eye complaints were included in the study. Patients were randomly divided into two groups:nineteen patients were given topical cyclosporine twice daily and nineteen patients were given oral doxycycline 100 mg twice daily for the first month and once daily for the following two months. Symptom and sign scores, ocular surface disease index questionnarie and tear function tests were evaluated at baseline and monthly for 3mo. Three months after results were compared with that of baseline.<b>RESULTS:</b>Mean values of symptom, eyelid sign and corneal/conjunctival sign scores of each treatment group at baseline and 3mo after treatments were compared and both drugs were found to be effective on rosacea associated ocular changes (<i>P</i>&lt;0.001). Cyclosporine was more effective in symptomatic relief and in the treatment of eyelid signs (<i>P</i>=0.01). There was statistically significant increase in the mean Schirmer score with anesthesia and tear break up time scores in the cyclosporine treatment group compared to the doxycycline treatment group (<i>P</i>&lt;0.05).<b>CONCLUSION</b>:Cyclosporine as a topical drug can be used in the treatment of rosacea associated ocular complications because it is more effective than doxycycline. In addition ocular rosacea as a chronic disease requires long term treatment and doxycycline has various side effects limiting its long term usage

Relationship Between Peripapillary Atrophy and Optic Disc Parameters in Eyes with Primary Open-Angle Glaucoma

Pur po se: To evaluate the relationship between peripapillary atrophy and optic disc parameters measured by Heidelberg Retina Tomography (HRT) and visual field findings in eyes with primary open-angle glaucoma. Methods: Thirty eyes of 30 patients with primary open-angle glaucoma were included in this study. In addition to routine ophthalmic examination, optic disc parameters were evaluated with HRT and visual field was evaluated with Humphrey Visual Field Analyzer. Peripapillary atrophy area was measured by drawing contour of the border of the peripapillary atrophy (Beta zone: chorioretinal atrophy area in which sclera and big choroid blood vessels were seen) in HRT. The relationship between this atrophy area and both visual field findings and optic disc parameters was evaluated. Pearson’s correlation coefficient and statistical significance were calculated. Results: The mean age of the patients was 61.4±8.9 years. Measured beta zone area was 0.65±0.40 mm2. Mean deviation measured with Humphrey Visual Field Analyzer was -8.6±8.2 dB and pattern standard deviation was 6.4±4.6. Statistically significant correlation between peripapillary atrophy area and age (PC=0.495, p=0.005), mean deviation (PC=-0.554, p=0.001), cup area (PC=0.382, p=0.037), cup/disc area ratio (PC=0.562, p=0.001), linear cup/disc area ratio (PC=0.422, p=0.020) and mean retinal nerve fiber layer thickness (PC=-0.360, p=0.047) was found. There was not a significant relationship between other optic disc parameters and peripapillary atrophy area (p>0.05). Conclusion: Significant correlation was seen between peripapillary beta zone atrophy area and some important optic disk parameters in primary open-angle glaucoma patients. More meaningful information would have been obtained if sectoral investigation of the optic disc was performed. (Turk J Ophthalmol 2011; 41: 291-4

Optical Coherence Tomography Pachymetry Mapping in Diagnosis of Keratoconus

Purpose: To evaluate abnormal corneal thinning using optical coherence tomography (OCT) pachymetry mapping in keratoconus patients. Material and Method: In this prospective study, 57 eyes of 33 keratoconus patients and 50 eyes of 25 control subjects without ocular pathology were compared. After routine ophthalmologic examination, corneal topography and corneal pachymetry mapping by OCT with anterior segment module were performed in all subjects. Central corneal thickness (CCT), minimum corneal thickness (Min), superior-inferior (S-I), minimum-median (Min-Med), superonasal-inferotemporal (SN-IT), superotemporal-inferonasal (ST-IN), minimum-maximum (MinMax) and minimum corneal vertical localization(MCVL) parameters were evaluated from the OCT pachymetric maps. Measurements were performed three times in all patients, and the means of these data were used for statistical analysis and comparisons. Cut-off values were determined for all OCT-derived parameters. Sensitivity, specificity, and area under the receiver operating characteristic (AROC) curve were also calculated for these parameters. Results: Keratoconic corneas were thinner. Minimum corneal thickness was 425±63 µm in the keratoconus group, and 513.7±3 µm in the control group (p<0.001). The thinnest corneal location was inferiorly displaced in the keratoconus group. MCVL value was -845.6±427.9 µm in the keratoconus group and -419.6±240.1 µm in the control group (p<0.001). Min-med was -46.3±23.8 µm and 18.4±16.3 µm in keratoconus and control groups, respectively. Corneal thinning was more asymmetric in the keratoconus group ( S-I, SN-IT, ST-IN parameters were statistically different between the groups, p<0.001). Sensitivity, specificity, and AROC values of the OCT pachymetric parameters were within the range of 82-92%, 54-89%, and 0.674-0.922, respectively. Discussion: OCT pachymetry maps have high sensitivity and specificity for keratoconus diagnosis. OCT provides additional information in patients whose corneal topography was inconsistent with clinical signs and interpretation of both devices together would be more valuable in the diagnosis of keratoconus. (Turk J Ophthalmol 2013; 43: 236-4

The Long-Term Effects of Silicone Hydrogel Contact Lens Wear on Corneal Morphology

Pur po se: To evaluate the effects of silicone hydrogel contact lenses (SHCL) on central corneal thickness (CCT), corneal endothelial cell morphology, and tear functions. Ma te ri al and Met hod: Fifty-five eyes of 28 SHCL wearers (Group 1) and 52 eyes of 26 healthy subjects (Group 2) were included in this study’. According to their contact lens wearing time, the contact lens wearing subjects were divided into 2 groups: Group 1a - wearing time less than 1 year and Group 1b - wearing time more than 1 year. CCT, epithelial thickness, corneal endothelial cell morphology, ocular surface disease index score (OSDI), and tear break-up time (TBUT) were evaluated. Re sults: In Group 1 and Group 2, the mean CCT was 561.85±39.98 µm and 537.25±27.12 µm, respectively (p: 0.001).The epithelial thickness was 50.38±5.41 µm and 55.64±5.32 µm, respectively (p: 0.001). In Group 1a and Group1 b, the mean CCT was 573.39±33.86 µm and 546.96±42.98 µm (p: 0.014) and the epithelial thickness was 49.51±4.78 µm and 51.50±6.04 µm (p>0.05), respectively. In Group 1, the percentage of endothelial cells larger than 700µ was low, while the percentage of endothelial cells between 200 and 400µ was high (p<0,05). Dis cus si on: With SHCL wear, the corneal morphology is more affected in the short-term period. During long-term contact lens wear, the cornea enters an adaptation period and shows near-normal morphology. Tear functions are not affected by short- or long-term SHCL wear. (Turk J Ophthalmol 2012; 42: 91-6

Visual Outcomes at 12 Months in Patients Following Implantation of a Diffractive Multifocal Intraocular

Introduction: The aim of this study was to assess distance, intermediate, and near visual acuity, contrast sensitivity, and patient satisfaction outcomes of a multifocal intraocular lens (IOL). Methods: This multicenter, prospective clinical study was conducted at seven study sites in Turkey. Patients who underwent bilateral cataract removal and implantation of a diffractive, acrylic, hydrophobic, multifocal IOL (Acriva UD Reviol MFB 625; VSY Biotechnology, Istanbul, Turkey) were included. The uncorrected and best corrected distance visual acuities (UCDVA and BCDVA), uncorrected and best corrected intermediate visual acuities (UCIVA and BCIVA), and uncorrected and best corrected near visual acuities (UCNVA and BCNVA) were measured preoperatively and at postoperative 1, 6, and 12 months. Distance and near visual acuity scores (VAS) contrast sensitivities were measured at these time points. Quality of life was evaluated by visual function-14 (VF-14) questionnaire. Results: Two hundred eyes of 100 patients were included. Monocular and binocular visual acuities at all distances showed improvement at postoperative 12 months compared to preoperative measurements (P < 0.001). Monocular and binocular UCIVA and binocular BCIVA at postoperative 12 months were significantly improved compared to measurements at 1 month (P < 0.001). Binocular contrast sensitivity at distance showed significant improvement from postoperative 1 month to postoperative 12 months, except for 3 cycles per degree (cpd; without glare) and 18 cpd (with glare). VAS improved from 75.96 at postoperative 1 month to 76.85 at postoperative 12 months. VF-14 score was 98.2 +/- 4.6. Conclusion: The Acriva UD Reviol MFB 625 appears to provide a good level of distance and near visual acuity, quality of life, and patient satisfaction. Further studies with longer follow-up will provide valuable insight into the long-term stability of these visual outcomes

Effects of hemodialysis on corneal and anterior chamber morphometry and intraocular pressure in patients with end-stage renal disease

<div><p>ABSTRACT Purpose: To evaluate the effects of hemodialysis (HD) on corneal and anterior chamber morphometry, as well as intraocular pressure (IOP) in patients with end-stage renal disease. Methods: Fifty right eyes were examined 30 minutes before and after HD. IOP was measured with a Goldmann applanation tonometer, and Ehlers' formula was used to calculate the corrected IOP values. The central corneal thickness (CCT), corneal volume (CV), keratometric values, anterior chamber depth (ACD), aqueous depth (AQD), anterior chamber volume (ACV), and anterior chamber angle (ACA) in the nasal and temporal quadrants were measured with a Sirius anterior segment analysis system. Blood urea nitrogen levels, body mass, and systolic and diastolic arterial pressure were also measured before and after HD. Results: The mean age was 60.80 ± 13.38 (range: 35-80) years. The mean uncorrected and corrected IOP values decreased from 18.06 ± 3.91 and 18.31 ± 4.83 mmHg to 16.94 ± 3.87 and 16.95 ± 4.74 mmHg after HD, respectively (p=0.011 and p=0.003, respectively). The mean CCT decreased from 536.38 ± 24.73 to 533.18 ± 27.25 µm (p=0.002), and the mean CV decreased from 57.52 ± 3.15 to 55.68 ± 3.55 mm³ (p<0.001) after HD. There were no significant changes in ACD, AQD, ACV, ACA, or the keratometric values (p>0.05 for all values). There were no significant correlations between the ocular and systemic parameters (p>0.05 for all correlations). Conclusions: Uncorrected IOP, corrected IOP, CCT, and CV values decreased after HD, whereas the anterior chamber morphometry values remained similar between the measurements performed before and after HD.</p></div