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Purpose: This study presents a novel sutureless closure approach for sclerotomies following pars plana vitrectomy (PPV) and assesses its efficacy and safety. Methods: A total of 142 eyes were included in the study. PPV procedures were performed using 23-gauge (23 G) or 25-gauge (25 G) systems. Preoperative characteristics, intraoperative findings, and postoperative outcomes were documented. Results: The cohort included 80 males and 62 females (mean age: 60.4 ± 12 years), primarily undergoing surgery for retinal detachment (59%). Among the patients, 87% underwent 25 G PPV (35% three-port, 52% four-port), while 13% underwent 23 G PPV (12% three-port, 1% four-port). Gas tamponade was administered in all cases, with perfluoropropane used in 45.7% of instances, sulfur hexafluoride in 29.5%, and air in 24.6%. Spontaneous closure was observed in 9.4% (47 of 501) of sclerotomies, autologous-fibrin induction approach successfully closed 75.8% (380 of 501) of the sclerotomies (83.7% of leaking sclerotomies) and 14.7% (74 of 501) of sclerotomies needed sutures. Visual acuity improved postoperatively, and first-day hypotony rate was 6.3%. Importantly, no serious complications such as choroidal detachment or endophthalmitis were observed during the postoperative period. Conclusion: The autologous-fibrin induction offers a simple, cost-efficient, and reliable approach for sutureless sclerotomy closure in PPV, with promising outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to compare the clinical outcomes of deep sclerectomy and trabeculectomy surgeries, both utilizing 5-fluorouracil. Methods: In this study, 11 eyes of 10 patients (14.3%) in the deep sclerectomy group and 66 eyes of 61 patients (85.7%) in the trabeculectomy group were retrospectively examined. Success in intraocular pressure (IOP) was defined as being below 21 mmHg without medication, partially successful if achieved below 21 mmHg with a single molecule, considered less successful with two to four molecules for maintaining IOP below 21 mmHg, and deemed unsuccessful if IOP exceeded 21 mmHg. Results: The deep sclerectomy group showed a success rate of 81.8% on post-operative day 1, with 18.2% considered unsuccessful; at post-operative 6 months, the success rate was 12.5%, with 50% partially successful and 37.5% less successful. In the trabeculectomy group, the success rate was 97% on post-operative day 1, with 3% considered unsuccessful; at post-operative 6 months, the success rate was 60.8%, with 15.7% partially successful, 13.7% less successful, and 9.8% unsuccessful. Trabeculectomy patients experienced complications such as choroidal detachment (6.1%), shallow anterior chamber (4.5%), tight suturing (3%), internal ostium occlusion (3%), posterior synechia (3%), bleb failure (1.5%), cyclodialysis/iridodialysis (1.5%), and hyphema (1.5%). In the deep sclerectomy group, tight suturing (36.3%), and dellen (9.09%) were observed, with no other complications reported. Conclusion: Trabeculectomy surgery has been observed to be superior to deep sclerectomy in follow-ups up to 48 months postoperatively. However, it is noted that there is a higher risk of post-operative complications. [ABSTRACT FROM AUTHOR]

Purpose: Evaluation of anterior segment parameters using the Scheimpflug corneal topography 1 year after surgery in patients who underwent sutureless scleral fixation intraocular lens (SFIOL) implantation using the modified Yamane technique and retropupillary iris-claw intraocular lens (RPIOL) implantation. Methods: A total of 60 eyes from 57 patients who underwent sutureless SFIOL implantation and 57 eyes from 52 patients who underwent RPIOL implantation were included. Anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), anterior–posterior corneal astigmatism, and keratometric values were assessed using the Scheimpflug corneal topography (Pentacam HR, Germany). Results: There was no statistically significant difference in postoperative UCVA and BCVA between the sutureless SFIOL and the RPIOL group (p = 0.236, p = 0.293, respectively). While there was no statistically significant difference in postoperative IOP between the two groups (p = 0.223), a statistically significant decrease in IOP was observed in both groups (p < 0.001). While there was no statistical difference between the sutureless SFIOL group and the RPIOL group in terms of spherical value (p = 0.441) and spherical equivalence (p = 0.237), there was a statistically significant difference in cylindrical value (p < 0.001). While there was a statistical difference in anterior astigmatism (p < 0.001), there was no statistical difference in posterior astigmatism (p = 0.405). There was no statistical difference in terms of ACV, ACD, and ACA between the sutureless SFIOL and the RPIOL group (p = 0.812, p = 0.770, p = 0.401, respectively). Conclusion: In this study, although there was a statistical difference in cylindrical value and anterior corneal astigmatism between the sutureless SFIOL and RPIOL groups, vision was not affected. According to this study, sutureless SFIOL and RPIOL are two successful methods in terms of visual acuity, anterior segment, and keratometry outcomes in aphakic patients after phacoemulsification. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of commercial tattoo inks used in corneal tattooing on conjunctival microbiota. This prospective case control study consisted of 125 participants divided in the following three groups: 35 patients with corneal tattoos, 40 patients with corneal leukoma, and 50 healthy subjects. Corneal tattooing was performed in all the cases in this study using a tattoo pen machine and commercial tattoo ink. A total of 500 cultures were taken from 250 eyes of 125 individuals on chocolate and sheep blood agar. Bacteriological samples were taken from the inferior eyelid conjunctiva using a sterile cotton swab. Without any contact elsewhere, the swabs were smeared on bedside chocolate agars and 5% sheep blood agar. In tattooed eyes, bacterial growth was detected in 42.9% of the chocolate and sheep blood agar samples. In other healthy eyes of patients with corneal tattoos, 54.5% bacterial growth on chocolate agar and 57.1% on sheep blood agar were detected. No statistical difference was detected in the conjunctival microbiota of chocolate and sheep blood agar (p = 0.254, p = 0.134, respectively) in the tattooed eyes compared to the other eye of the individual. No statistically significant difference was found in terms of bacterial growth in tattooed, leukoma, or healthy eyes on chocolate and sheep blood agar (p = 0.408, p = 0.349). The growth rate of Staphylococcus epidermidis decreased by 33.3% (from 12 to 8) on chocolate agar in 35 tattooed eyes, and it decreased by 28.5% (from 14 to 10) on sheep blood agar, while gram-negative bacteria Brevundimonas diminuta, Acinetobacter lwoffii, and Psychrobacter faecalis were detected in three patients. Corneal tattooing using commercial dye does not affect conjunctival microbiota. In the past 3 years, 120 patients have been tattooed with commercial tattoo ink in Istanbul Medeniyet University Göztepe Training and Research Hospital. No complications related to infection were found in the 3-year follow-up. The gram-negative bacteria detected in the healthy control group and tattooed eyes were bacteria found on normal skin or in the respiratory tract. Although some gram-negative bacteria do not cause infection, careful eye examination, follow-up, and culture are required in suspicious cases. [ABSTRACT FROM AUTHOR]

Purpose: This article aims to present the corneal tattooing method and how using a tattoo pen machine can improve aesthetic appearance in patients with corneal leukoma. Methods: In this study, 42 patients were evaluated who had no visual potential and who had undergone colored corneal tattooing using an automatic tattoo pen machine for aesthetic purposes. The procedure was conducted according to the principles of the Declaration of Helsinki. The commercially available tattoo ink that has traditionally been used on human skin (brown, green, and black) for years was used for all the patients in this study, and 252 corneal photographs (with a Topcon slit lamp imaging device at 16 magnifications, i.e., 16 ×) taken within the last 2 years were evaluated retrospectively. Red, green, and blue (RGB) and hue, saturation, and lightness (HSL) values of the tattooed areas, such as pupils and iris, in corneal photographs were determined online using the Color Code Finder program. The RGB and HSL values of the pupil and iris were compared before surgery on the first day and first week, first month, third month, and twelfth month after surgery. Results: In the first postoperative month, the mean pupil lightness (L) and iris L values were found to have increased by 10.7% and 5.7%, respectively. Between the first month and the first year, the L value of the mean pupil and that of the iris increased by 1.7% and 5.2%, respectively. The increase in the RGB value of the mean pupil in the first month was statistically significant (p = 0.02). The highest increase in RGB values of the iris was observed in the first week and first month (p = 0.113). This result shows that the majority of fading occurred in the first month. After the first month, the increase in the L value in the black-colored pupil was less than that in the brown- or green-colored iris. These results show that light colors fade faster and more. Conclusion: Esthetically, corneal leukoma causes severe psychological problems. Many patients are unable to use prosthetic contact lenses. Evisceration surgery has many complications, and limbal stem cells are used in evisceration surgery. Corneal tattooing using a tattoo pen machine is an easy, practical, and repeatable method used for aesthetic purposes. Successful results require the use of appropriate methods, ink, and ophthalmologist's experience. All patients in this study had a more aesthetic appearance than the preoperative white eye. Further studies are needed to develop a colored aesthetic tattooing method with a tattoo pen machine. [ABSTRACT FROM AUTHOR]

To compare endothelial toxicity and efficacy of two local steroid injections (intracameral triamcinolone acetonide and subconjunctival dexamethasone) in controlling postoperative inflammation following pars plana vitrectomy (PPV) combined with phacoemulsification cataract surgery. This cohort included 54 patients that underwent combined surgery and received either intracameral triamcinolone acetonide injections (n = 27, IC-TA group) or subconjunctival dexamethasone (n = 27, Sc-Dex group) injections at the end of the surgery. All participants had at least 4 months or longer follow-up. A detailed ophthalmologic examination including intraocular pressure (IOP) measurement and specular microscopy was performed at every visit. Endothelial cell density (ECD) reduced significantly in IC-TA group postoperatively (2418 vs. 2249, p = 0.019), while it did not change significantly in Sc-Dex group (2541 vs. 2492, p = 0.247). Postoperative ECD was also significantly lower in IC-TA group compared to Sc-Dex group (p = 0.011). Preoperative and postoperative IOP values remained unchanged both in IC-TA and Sc-Dex groups (p = 0.424 and p = 0.523, respectively). However, 4 patients in IC-TA group and 5 patients in the Sc-Dex group needed glaucoma medications. The postoperative need for glaucoma medications was similar between the groups (p = 0.347). Postoperative inflammation was well controlled in both groups and none of the patients developed fibrin membrane or synechiae postoperatively. Both treatments were effective in controlling postoperative inflammation, but patients in IC-TA group experienced significantly higher endothelial loss. Sc-Dex injections are safer in terms of endothelial loss and preferable to control postoperative inflammation following complex intraocular surgeries. [ABSTRACT FROM AUTHOR]

Objectives: Iris-claw intraocular lens (IC-IOL) implantation and sutureless scleral fixation of intraocular lenses (SSF-IOL) are two commonly preferred surgical approaches for the management of aphakic patients without sufficient capsular support. The aim of this study was to compare the outcomes of IC-IOL implantation and trocar-assisted SSF-IOL implantation. Methods: The medical records of secondary IOL implantation patients were retrospectively reviewed. All patients had a detailed ophthalmological examination, including LogMAR best-corrected distance visual acuity (CDVA), intraocular pressure (IOP), and endothelial cell density (ECD) preoperatively and postoperatively. SPSS 21.0 software was used for the statistical analysis. Results: There were 15 patients in the IC-IOL group and 12 patients in the SSF-IOL group. Age and gender distributions were similar between the groups (p=0.456 and p=0.398, respectively). Similarly, patients in both groups had similar CDVA preoperatively and postoperatively (p=0.51, p=0.48, respectively). Both IC-IOL and SSF-IOL implantation significantly increased CDVA (p=0.001 and p=0.005, respectively). IOP remained unchanged in both groups. However, ECD reduced significantly following both IC-IOL and SSF-IOL implantation (p=0.001 and p=0.005, respectively) and trocar-assisted SSFIOL implantation resulted in significantly more endothelial loss compared to IC-IOL implantation (439.5±89 vs. 164.4±53, p=0.013). Conclusion: Both surgical approaches increased CDVA significantly and at similar levels. However, trocar-assisted SSF-IOL implantation resulted in significantly more endothelial loss compared to IC-IOL implantation. None of the patients developed bullous keratopathy, but this difference should be kept in mind, especially in patients with critically low ECD. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This article evaluates the effects of unilateral and bilateral inferior oblique myectomy (IOM) on fundus torsion in primary and secondary inferior oblique overaction (IOOA). METHODS: This study analyzed 230 OCT images of 53 eyes of 32 patients who had undergone IOM by a single surgeon in the last two years. The disc-foveal angle (DFA) was calculated by digitally measuring the angle between the horizontal line passing through the geometric center of the optic disc and the curved line connecting the fovea to the geometric center of the optic disc. DFA was classified into intorsion, normal torsion, and extortion. The DFA was measured from the OCT images before the operation in the first week, first month, third month, and sixth month. RESULTS: When all the patients in our study were evaluated together, IOM statistically reduced the mean DFA in the third month (p=0.00). The DFA was higher in the secondary IOOA group than in the primary IOOA group (p=0.24). Bilateral IOM statistically significantly reduced DFA in the third month (p=0.00) and decreased the DFA difference between the two eyes in the third month (p=0.583). Unilateral IOM increased the DFA, rather than decreasing it, in the first week in operated eyes (p=0594) and increased the DFA difference between the two eyes after surgery (p=0.477). When we evaluated the localization of the macula as an intorsion, normal intorsion, or extortion, the extortion decreased from 36 to nine in the third month after bilateral IOM, and intorsion was seen in only two. Unilateral surgery did not significantly change fundus torsion in primary IOOA, and it caused intorsion in 3 of 6 (50%) operated eyes in secondary IOOA. CONCLUSION: Although unilateral IOM provides a clinical improvement in secondary IOOA, it increases the difference in DFA between both eyes and causes intorsion in 50% of patients. Masked IOOA was detected in 3 of 11 (27.3%) patients who underwent unilateral IOM. When deciding on unilateral surgery, the possibility of increased DFA difference between both eyes, intorsion in the operated eye, and masked IOOA in the other eye should be considered. [ABSTRACT FROM AUTHOR]

Purpose: This comprehensive prospective study aimed to investigate the bacterial contamination of antibiotic steroid eye ointments and drops frequently used by eye patients. Method: In this comprehensive prospective study, a total of 410 multi-use topical eye medications containing 15 different ingredients from 22 pharmaceutical companies used by 185 patients were analyzed. Four groups were formed as follows: group 1: antibiotic ointments (n: 109); group 2: antibiotic drops (n: 103); group 3: steroid ointments (n: 67); and group 4: steroid drops (n: 131). Topical multi-use eye drops and ointments used by patients at home for at least 1 week were randomly collected. The caps and contents were separately bacteriologically examined in a chocolate agar medium. Results: Our study detected bacterial contamination in 23 containers (5.6%) of the total 410 topical drugs. According to the groups, bacterial contamination was detected in 10 of 67 (14.9%) steroid ointments, 6 of 109 (5.5%) antibiotic ointments, 4 of 131(3.1%) steroid drops, and 3 of 103 (2.9%) antibiotic drops. While the bacterial contamination rate in ointments was 9.1%, this rate was 3% in drops. The difference between them was statistically significant (p = 0.015). According to the post-hoc pairwise comparisons, the difference between steroid drops and steroid ointment (p = 0.0023) was statistically significant. Among all drugs, contamination was detected in 12 of the 93 (12.9%) containers used after keratitis, conjunctivitis, and inflammatory conditions. It was determined that preservatives statistically reduced bacterial growth on the cap. The preservatives did not have a statistically significant effect on the bacterial contamination of the contents compared to the caps. While all contaminations were detected in illiterate and primary school graduates, no contamination was seen in the drugs used by any secondary school or university graduate. Conclusion: Our study detected contamination in all topical ophthalmic drug groups. Contamination rates were found to be higher in ointments and steroids. Bacterial contamination was also seen in drugs containing preservatives. We should be careful in the use of topical medications. We do not recommend the bilateral use of ointments and drops in infected eyes, such as those with keratitis, or after intraocular surgeries, such as those for cataracts. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Corneal incision size has influence both on corneal biomechanics and intracameral fluid dynamics during phacoemulsification cataract surgery. The aim of this study was to evaluate the impact of corneal incision size on endothelial cell loss and surgically induced astigmatism (SIA) following phacoemulsification cataract surgery. METHODS: This prospective, randomized, and comparative study included 61 eyes with senile cataracts. The patients were randomly assigned to 2.2 mm and 2.8 mm corneal incision sizes and were operated with the same phacoemulsification system. Phacoemulsifcation energy parameters, pre-operative and post-operative endothelial cell counts and corneal astigmatism values were specifically recorded. SIA was calculated according to Alpins method and the results of both groups were compared. RESULTS: There were 31 eyes in the microincisional (2.2 mm) group and 30 eyes in the standard incision (2.8 mm) group. There was no significant difference between the groups for age and gender distribution (p=0.09 and p=0.18, respectively). Similar levels of cumulative dissipated energy was used during phacoemulsification in both groups (p=0.70). SIA was slightly higher in the standard incision group compared to microincisional group (0.47D at 64° vs. 0.37D at 61°, p=0.30). Pre-operative and post-operative uncorrected visual acuity (UCVA) was similar between the groups (p=0.45 and p=0.27).Endothelial cell loss tended to be slightly higher in the microincisional group compared to standard incision group (174.87±132.27 vs. 160.84±121.58, p=0.75), but this difference was not statistically significant. CONCLUSION: Smaller corneal incisions slightly reduced SIA, but tended to induce more endothelial cell loss. This small difference in SIA did not cause a significant change in the postoperative UCVA. Therefore, the trend in reducing corneal incision sizes below 2.8 mm might not be contributing the surgical outcomes of the patients, especially when we consider potential corneal endothelial changes. [ABSTRACT FROM AUTHOR]

Purpose: To compare the correlations between lamina cribrosa (LC) and related structures with Bruch's membrane opening-minimum rim width (BMO-MRW) and retinal nerve fiber layer (RNFL) thickness in pseudoexfoliation syndrome (PXS) and different stages of pseudoexfoliation glaucoma (PXG). Methods: This prospective cross-sectional study included 32 PXS eyes of 24 patients and 94 PXG eyes (early-stage (n: 55) and advanced-stage glaucoma (n: 39) of 78 patients. Global and six sectors of RNFL thicknesses and BMO-MRW parameters were measured with enhanced depth imaging (EDI) mode of SD-OCT. Structural parameters; lamina cribrosa thickness (LCT), lamina cribrosa depth (LCD), prelaminar tissue thickness (PLTT), four quadrants of peripapillary choroidal thicknesses (PPCT), and subfoveal choroidal thickness (SFCT) were measured and statistical relationships between the structural parameters have been laid out. We apply the generalized estimating equations method to take into account dependency of right and left eyes. Results: From PXS to mild and advanced PXG groups LCT and PLTT decrease from 147.29 ± 33.10, 145.62 ± 30.64, 126.30 ± 29.14 and 260.93 ± 185.07, 247.27 ± 142.58, 159.89 ± 86.84, respectively, and LCD varies as 159.89 ± 86.84, 420.88 ± 117.80, and 505.64 ± 183.25. The correlations between LCD, LCT, and PLTT and the stage of the disease are significant. BMO-MRW shows slightly stronger correlations than the RNFL with LC related parameters. SFCT does not exhibit any significant relationship with the stage of the disease. However, PPCT in only the interior quadrant does. The significant correlations between LCD and all quadrants of PPCT is the sign of important anatomic relationship. Conclusion: These findings show that the BMO-MRW parameter may be more sensitive than RNFL and can safely be used in the diagnosis and follow-up in PXS and PXG, but this result should be supported with longer and larger series. [ABSTRACT FROM AUTHOR]

Purpose: Iris claw intraocular lenses (IOLs) were successfully used for the management of aphakia in patients that lack capsular support. The aim of this study was to compare the clinical outcome of prepupillary and retropupillary implantation of these IOLs. Methods: The files of the 26 patients that had an iris claw IOL implantation between 2010 and 2020 were retrospectively reviewed. Detailed ophthalmological examination findings including corrected distance visual acuity (CDVA), intraocular pressure, endothelial cell counts, slit lamp and dilated fundus examination findings were specifically tabulated. Intraoperative and postoperative complications were also specifically recorded. Results: There were 18 patients in the prepupillary implantation group and eight patients in the retropupillary implantation group. Age and gender distribution were similar between the groups. CDVA significantly increased in prepupillary and retropupillary implantation groups (p = 0.001 and p = 0.012, respectively). Median endothelial cell loss was 6.7% in prepupillary group and 7.2% in retropupillary group. The only intraoperative complication was iridodialysis (n = 1). Postoperative complications included retinal detachment (n = 1), cystoid macular edema (n = 2) and IOL tilt (n = 1). All of these complications occurred in the prepupillary implantation group. Conclusion: Prepupillary and retropupillary implantation of iris claw IOLs resulted with similar visual gain and endothelial loss rates in a follow-up time of 6 months. There was an insignificant trend toward a reduced complication rate following retropupillary implantation. [ABSTRACT FROM AUTHOR]

Purpose: Ocular discomfort is a common symptom in central sensitization syndromes. The aim of this study was to evaluate ocular surface discomfort and related corneal changes in patients with irritable bowel syndrome. Methods: Twenty-nine patients with IBS (20 female, 9 male, mean age: 45.3 ± 10.1 years) and 37 healthy control subjects (25 female, 12 male, mean age: 44.95 ± 9.76 years) were included. A detailed ophthalmological examination was performed to all participants including tear break-up time (TBUT) and Schirmer test I with anesthetic (SIT). Ocular discomfort was evaluated using the ocular surface disease index (OSDI) questionnaire and corneal sensation was evaluated with Cochet-Bonnet esthesiometer. Corneal subbasal nerve plexus was evaluated with in vivo corneal confocal microscopy (IVCM). Results: There was no significant difference between the groups for age, gender distribution, and visual acuity. OSDI scores were significantly higher (p = 0.008) and TBUT was significantly reduced in patients with IBS compared to controls (p = 0.001 for right eye, p = 0.014 for left eye). However, there was no significant difference in corneal touch sensation and SIT results between the groups. IVCM revealed that corneal nerve fiber density, corneal nerve branch density, and corneal nerve fiber length were significantly reduced in patients with IBS (p < 0.001, p < 0.001, and p = 0.023, respectively). Conclusion: Patients with IBS have increased dry eye-associated ocular surface complaints and nerve fiber loss in corneal subbasal nerve plexus. IBS should be remembered in the differential diagnosis, when there is discordance between the level of ocular surface discomfort and dry eye disease associated corneal findings. [ABSTRACT FROM AUTHOR]

Purpose: Intraocular lens (IOL) implantation with a trocar-assisted sutureless scleral fixation technique is a relatively new IOL implantation approach for aphakic eyes. During this surgery, the intrascleral position of the haptics can change the location of the IOL optic and may alter the refractive outcome. This study aimed to evaluate the refractive outcome of this surgery. Methods: The files of 22 patients who had undergone IOL implantation with the trocar-assisted sutureless scleral fixation technique were retrospectively reviewed, and the patients were invited for final examination. IOL power was calculated with optical biometry (Lenstar LS900). IOL power calculations were performed according to formulas designed for in-the-bag IOL implantation. The final refractive error was determined with an autorefractometer (Topcon KR-1/RM-1). Results: This study included 14 patients (8 male, 6 female, mean age: 62.7 ± 18.7). There were no significant differences between the preoperative and postoperative corneal astigmatism values (p = 0.16). There were also no significant differences between the postoperative corneal and total astigmatism values (p = 0.44), confirming the absence of significant IOL tilt. The difference between the implanted IOLs and the calculated IOL power for emmetropia was 0.09 D ± 0.49 D (p = 0.52). Although emmetropia was targeted, the refractive outcome shifted to hyperopia (+ 0.85 D ± 1.15 D) and was significantly different from the refractive status calculated with optical biometry (p = 0.034). Conclusions: The intrascleral fixation of IOLs results in increased posterior positioning of the IOL optic and can induce approximately 0.85 D of hyperopia if proper adjustments are not performed during IOL power calculations. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The present study aims to describe a novel, low-cost, transconjunctival sutureless bimanual vitrectomy illumination approach and evaluate its surgical outcome. METHODS: Thirty-six eyes of 36 patients who underwent pars plana vitrectomy with the above-mentioned technique were included in this study. Four trocars were placed in superotemporal, inferotemporal, inferonasal and superonasal quadrants. A piece (23 mm) was cut from 30G intravenous cannula and a 30 mm endoillumination probe was placed inside this sleeve. This design limited the entry of the light probe into the vitreous cavity to 7 mm and provided a safe illumination by the assistant without the risk of damaging the retinal tissue. RESULTS: Thirty-six eyes of 36 patients were included (24 male, 12 female, mean age: 58.4±14.3 years) in this study. Thirty patients had rhegmatogenous retinal detachment (six of these patients with coexisting choroidal detachment), four patients had diabetic tractional retinal detachment, one patient had a nucleus drop and one patient had an intraocular foreign body. The mean follow-up time after pars plana vitrectomy (PPV) was 5.05±4.4 months. LogMAR best-corrected visual acuity improved significantly after PPV (p<0.001). Postoperative complications included recurrent detachment in two eyes, hypotony in one eye and endophthalmitis in one eye. The transient rise in intraocular pressure was observed in 19 patients, but there was no significant difference between the preoperative and postoperative mean IOP in the long term follow-up. CONCLUSION: This bimanual vitrectomy system provided favorable outcomes without increasing the cost of standard PPV. The advantage of this system over the chandelier illumination include the reduction in glare, the possibility to change the direction of the light during the surgery to better illuminate the surgical site and the lower cost. This approach can be used in any vitrectomy system (20G, 23G, 25G, and 27G) by changing the size of the IV cannula. [ABSTRACT FROM AUTHOR]

Purpose We describe a scleral suture fixation technique for dislocated plate haptic toric intraocular lens (IOL) implantation. Materials and methods A double-armed 10-0 straight polypropylene suture was passed into the eye from the sclera (2 mm away from the limbus). A suture needle was passed through the hole on the corner of the IOL and pulled out from the paracentesis with a 27-gauge needle. Afterward, the suture needle was reinserted from the same paracentesis and then removed from the eye with the help of a 27-gauge needle entering the eye from a nearby point to the first scleral entrance. The needle was passed through the end of the loop and pulled slightly to initiate the formation of a cow-hitch knot. The same procedure was applied to the other hole on the plate haptic. Both sutures were adjusted and fixed to the sclera with a Z suture. Results No complications were observed and at the follow-up visits, uncorrected visual acuity was 0.8 with decimal. Conclusion Axial, sagittal, and rotational stability rules are taken into consideration, scleral fixation surgery for a dislocated plate haptic foldable toric IOL is an alternative method to eliminate astigmatic refractive error. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the alteration of lower lid configuration and function with anterior transposition surgery of the inferior oblique (IO) muscle.Patients and Methods: A prospective clinical trial was conducted on a consecutive series of patients underwent anterior transposition of the IO as a sole operation. All patients received a thorough ophthalmic examination 1 day before and 3 months after surgery. Output parameters were consisted of palpebral fissure, margin reflex distance 1-2, lower lid function, hertel value, and lower lid crease. The differences of the collected data were calculated for statistical significance by using the Wilcoxon test.Results: A total of 19 eyes of 16 consecutive patients were included. The median preoperative grade of IO overaction was 3.5 (ranging from 3 to 4), which decreased to 0 (ranging from 0 to 2) postoperatively (P < 0.05). No significant change was observed in all parameters 3 months postoperatively (P > 0.05).Conclusion: In this study, no significant effect on lower lid configuration and function was observed following IO anterior transposition in which the disinserted muscle was placed posterior to inferior rectus insertion. [ABSTRACT FROM AUTHOR]

Hormone replacement therapy has been widely used for the prevention of postmenopausal osteoporosis and treatment of climacteric symptoms for many years, but its effect on ocular functions remains unclear. The aim of the study was to evaluate the long-term effects of tibolone on ocular functions in postmenopausal women. A total of 77 healthy women with at least 1 year of spontaneous menopause were enrolled in the study. Forty women were treated with tibolone for 6 months and 37 women were left untreated. All these patients underwent ophthalmic examination including visual acuity, intraocular pressure (IOP), tear functions, blue-on-yellow and white-on-white Humphrey visual field (HVF), visual evoked potentials (VEP) and electroretinography (ERG). There were significant differences in mean deviation of blue-on-yellow HVF, and oscillatory potentials (O1, O2, and O4) in the ERGs of the chronic tibolone users and the control ( P < 0.0001, P = 0.001, P < 0.0001 and 0.05, respectively). However, no significant differences were observed in visual acuity, IOP, tear functions, white-on-white HVF and VEP. We concluded that, although tibolone had no effects on visual acuity, IOP, tear functions and VEP, it might cause some early adverse effects on the electrophysiologic and structural characteristics of the retina, which are detected by these sensitive assays. Randomized placebo-controlled studies with larger groups are needed in future research. [ABSTRACT FROM AUTHOR]

Purpose. Taurolidine is a broad-spectrum, nonantibiotic antimicrobial agent, not previously tested against the common causes of bacterial keratitis. This study, employing an experimental rabbit model of Staphylococcus aureus keratitis, investigated the effectiveness of topical taurolidine in reducing the number of bacteria, and its effectiveness was compared with topical ciprofloxacin, ofloxacin, and 5% cefazolin. Methods. The right corneas of all rabbits were intrastromally injected with 100 colony-forming units of Staphylococcus aureus ATCC strain 25923. The animals were divided into the following seven groups: Group 1 (6 rabbits) received taurolidine, group 2 (6 rabbits) received ciprofloxacin, group 3 (6 rabbits) received ofloxacin, group 4 (6 rabbits) received cefazolin, group 5 (5 rabbits) received polyvinylpyrrolidone (vehicle), group 6 (4 rabbits) received sterile water, and group 7 (4 rabbits) was left untreated (control group). The eyes were topically treated every 30 min with the above-mentioned substances from 4 to 9 h postinjection. One hour after the last drop administration (at 10 h postinjection), signs of inflammation were scored in a masked fashion by slit-lamp examination. Then, their corneas were processed. The number of colony-forming units (cfu) per cornea in all eyes was also determined. Results. All antimicrobial (taurolidine, ciprofloxacin, ofloxacin, and cefazolin) treatments significantly reduced cfu numbers and slit-lamp examination scores compared with untreated eyes, eyes that received the vehicle, or eyes with sterile water (all p values [ABSTRACT FROM AUTHOR]

¸Serefeddin Sabuncuoglu (1385−1468 ad) was a Turkish surgeon who lived in the Ottoman Empire during the fifteenth century, a time of progressive expansion. When in his eighties, he wrote Cerrahiyyetü’l-Haniyye, which means Imperial Surgery. His book is the first example of an illustrated surgical textbook in the Turkish−Islamic medical literature. The importance of his book rests upon the inclusion of colour miniatures of the surgical procedures, incisional techniques and instruments, all drawn by Sabuncuog˘lu himself. Only three hand-written copies exist, two of which were originally written by the author and are currently exhibited in Paris and Istanbul. The book was rediscovered in 1936, but some parts of it are still suspected to be missing. At present, the book consists of three chapters divided into 193 known sections. The sections deal with all fields of surgery including ophthalmology, and cite relevant Greek, Arabic and Persian textbooks. In this historical article the sections of Cerrahiyyetü’l-Haniyye pertinent to ophthalmology are critically reviewed, including a selection of the coloured drawings. [ABSTRACT FROM AUTHOR]

Purpose. Taurolidine is a broad spectrum, non-antibiotic antimicrobial agent, not previously tested against infectious endophthalmitis. The efficacy of intravitreal taurolidine in the treatment of experimental Staphylococcus epidermidis endophthalmitis was evaluated and compared with vancomycin in a rabbit model. Methods. The right eyes of 34 albino rabbits were infected with an intravitreal inoculum of S. epidermidis (105colony-forming units/0.1 ml). The right eyes of four rabbits (group 7) were not infected and served as uninfected controls. 24 hours after inoculation of bacteria the animals were divided into the following treatment groups: group 1 (7 rabbits) received intravitreal taurolidine at 24 hours and group 2 (7 rabbits) received at 48 hours. Group 3 (7 rabbits) received vancomycin at 24 hours and group 4 (7 rabbits) at 48 hours. Group 5 (3 rabbits) received polyvinylpyrrolidone at 24 hours and group 6 (3 rabbits) at 48 hours. Clinical scoring was performed at 24,48 and 72 hours. At 72 hours post inoculation, vitreous samples were collected for quantitative microbiological studies and then, the eyes were enucleated for histopathological scorings. Results. The clinical and histopathological examinations revealed significant amelioration of inflammation in eyes treated with taurolidine and vancomycin when compared with polyvinylpyrrolidone. The eyes treated with taurolidine also had significantly lower colony forming units than the eyes treated with polyvinylpyrrolidone and taurolidine rendered many eyes sterile. Conclusion. Taurolidine is expected to be a potential agent for treatment of S. epidermidis endophthalmitis. [ABSTRACT FROM AUTHOR]

Purpose: To report the association of congenital nasolacrimal duct occlusion and clinical anophthalmos in an eight-year-old girl. Methods: A case report. The patient suffered from epiphora and clinical anophthalmos on the right side since birth. This paper presents the clinical presentation, workup, and surgical approach of the case. Results: The nasolacrimal system of the patient was occluded on irrigation. Computed tomography showed a blockage at the level of the sac-duct junction, an enlarged nasolacrimal duct below the obstruction, and a sclera-like ball of tissue surrounded by extraocular muscles in the right orbit. Treatment included a right, bicanalicular silicon intubation performed under general anesthesia. Conclusion: This case may represent a new association that has not been previously reported. [ABSTRACT FROM AUTHOR]

PURPOSE. The effectiveness of the topical taurolidine was evaluated in eradicating or reducing microorganisms in the normal flora of human eyes in a randomized controlled study and analyzed also the irritating effects of taurolidine on the ocular surface. METHODS. One hundred and twenty eyes of 110 patients awaiting cataract surgery were randomly divided into four groups consisting of 30 eyes each. The first group received 0.05% taurolidine, the second received 0.3% gentamicin, the third received vehicle eyedrops and the fourth received saline to the preoperative eye four times daily for two days. Cultures were obtained from the eyelids and conjunctivas of all subjects prior to the therapy and again at the end of 48 hours. Micro-biological identification and colony counts were performed by standard laboratory methods, and the results were compared. The patients were clinically evaluated for symptoms and signs at the end of therapies. RESULTS. Taurolidine and gentamicin produced a significant decrease from the basal bacteriological state: the number of colonies (p < 0.01 for taurolidine, p < 0.01 for gentamicin) was reduced by both agents. Staphylococcus epidermidis was the most common microorganism isolated before therapy, and the number of its colonies was significantly reduced in taurolidine-treated (p < 0.001) and gentamicin-treated (p < 0.01) subjects. There was no significant difference in terms of the irritating effects for all therapies tested (p > 0.05). CONCLUSIONS. Taurolidine solution with its unique properties is an effective antimicrobial agent for reducing the number of bacteria in the flora of the eye. Taurolidine appears to be well tolerated and offers promise as a potential new antimicrobial drug. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the antibacterial effect of topical anesthetic proparacaine on conjunctival flora. Methods: One hundred and forty-four eyes of 72 patientsawaiting cataract surgery were included in the study. A commercially available solution of proparacaine, preserved with benzalkonium chloride 0.01%, was instilled in one eye of all subjects while the vehicle solution, including the same concentration of preservative in aqueous solution, was administered to the other eye. Conjunctival cultures were taken from all eyes before and 15 minutes after the instillation of proparacaine and the vehicle. Results: Of the 144 eyes, 76 (52.8%) had positive-conjunctival cultures with the most commonly isolated organisms being coagulase-negative staphylococci in each group. Of the 76 culture-positive eyes, 40 (52.6%) received proparacaine and 36 (47.4%) the vehicle preparation. Fifteen minutes after the instillation of proparacaine and the vehicle eyedrops, four eyes (10%) and 12 eyes (33.3%) had culture-positive conjunctival smears, respectively. Proparacaine significantly reduced the number of culture-positive eyes ( p = 0.0003), in contrast to the vehicle ( p = 0.21). Conclusion: A topicalanesthetic, proparacaine, demonstrates antibacterial effects on the conjunctival flora. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "The effect of anterior transposition of the inferior oblique muscle on eyelid configuration and function" in the previous issue is presented.

Presents a letter to the editor regarding the common causes of pediatric uveitis.

A letter to the editor is presented in response to the article "Polyglactin sutures versus nylon sutures for suturing of conjunctival autograft in pterygium surgery," by Victoria W. Y. Wong in the 2007 issue.

The article focuses on risk factors involved in intracameral application of topical anesthetics. These anesthetics have antibacterial effect at a clinical concentration on many pathogens including Staphylococcus epidermidis, which is the most frequently encountered pathogen in bacterial endophthalmitis including postoperative forms. Interestingly, these agents have been proposed as one possible reason for the potential low yield of bacterial cultures due to their antibacterial activity. In light of this knowledge, lignocaine could not actually be a risk factor in post-cataract endophthalmitis.