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Clinical trials and electrophysiologic studies demonstrated increased perceptual sensitivity in patients suffering from migraines. At least, one triggering factor is described in 85% of migraine patients. The aim of this report was to investigate the relationship between contact lens (CL) usage and migraine attacks in two cases. Two patients who were diagnosed with migraine reported that the frequency of migraine attacks increased after they switched to using CL with different base curves (BCs). These two patients, who began using CL with different BCs experienced discomfort and dryness of the eye. The ocular complaints were followed by migraine attacks. CL intolerance was also developed during migraine attack in one of the cases. The frequency of migraine attacks decreased and allodynia relieved significantly when flatter BCs were selected. CL related stimulus could have triggered the migraine attack. CLs should be well fitted in migraine patients with allodynia.

Purpose: To evaluate the success, safety, and complication rates of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with cataract surgery. Methods: A retrospective study was conducted for 32 patients who underwent GATT combined with phacoemulsification and intraocular lens implantation. Patients with primary open-angle glaucoma were enrolled. The primary outcome measures were visual acuity, intraocular pressure (IOP), the number of antiglaucoma medications used, and complications. Results: The average preoperative visual acuity of the patients was logMAR 1.57 +/- 1.2, and the average postoperative visual acuity was logMAR 0.39 +/- 0.38. A significant increase in visual acuity was observed post-surgery (P < 0.05). The average preoperative IOP was 34.2 +/- 10.6 mmHg. In the 3rd postoperative month, the average IOP was 10.5 +/- 2.2 mmHg, and in the 6th postoperative month, the average IOP was 11.2 +/- 2.4 mmHg. In all postoperative follow-ups, IOP was significantly lower than that during the preoperative period (P < 0.05). A decrease of 2.7 +/- 0.6 on average was detected in the number of glaucoma medications used in the postoperative period compared to the preoperative period, and the average decrease in the number of active ingredients post-surgery was 3.5 +/- 0.8. The most frequent complication was hyphaema (31.2%). In only one patient (3.1%), the surgery was considered to have failed due to the development of deep hypotony. Conclusion: Performing GATT in the same session as cataract surgery does not reduce the efficacy of GATT, yet this procedure reduces the incidence of the most frequent complication of GATT, i.e. hyphaema. Therefore, in convenient cases, combined surgery can safely be performed.

AIM: To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure (IOP). METHODS: Description of 'the accordion suture' technique for mitomycin C augmented trabeculectomy. In cases of postoperative high IOP, pulling the loop of the suture helps to lift up the scleral flap by an even pressure on both edges. By means of this technique, the scleral flap opens up in an "accordion'' manner, thus preventing flap obstruction and providing adequate aqueous flow. RESULTS: Our study group consisted of 8 eyes of 8 patients with neovascular glaucoma. Mean age of the subjects was 67.42 +/- 8.21y and female/male ratio was 4/4. Mean preoperative IOP was 37 +/- 7.48 mm Hg. Mitomycin C augmented trabeculectomy was carried out on the subjects without any complications. The scleral flap closure is performed with three separate sutures; initially, our accordion suture through the center of the flap, and two releasable sutures on both corners. All the patients received removal of two side releasable sutures concomitant with pulling the accordion suture, without any complications. The average traction time was 3.5 +/- 0wk postoperatively. The mean postoperative IOP was 11.37 +/- 2.72 mm Hg. No suture related complications were observed. CONCLUSION: This technique can be the suture of choice for filtering glaucoma surgery in experienced hands by its easy learning curve for precisely indicated patients.

Background: Vancomycin is the gold standard in combination therapy for severe and resistant gram-positive keratitis and in particular for Methicillin-resistant Staphylococcus aureus (MRSA) infections. The aim of this study was to report the ocular surface toxicity and scoring in patients whose treatment shifted to topical linezolid/ceftazidime from topical vancomycin/ceftazidime due to their vancomycin intolerance. Methods: A retrospective, interventional case series of bacterial keratitis was treated with topical linezolid (one drop of 0.2% solution per eye), administered hourly until epithelization and then gradually decreased. The number and extent of punctate epithelial erosions were noted across the entire surface of the cornea. Ocular discomfort was assessed by means of (a) patient-reported pain upon instillation of the medication (vancomycin/linezolid), (b) reported burning sensation between doses and (c) reported foreign-body sensation. No ocular surface toxicity related to linezolid use was noted. Patients were followed for at least 2 months after treatment between April and December 2013. Results: Of the seven patients included in the study (age range: 2-88 years; five females, two males), complete epithelization and resolution was achieved in five patients. One patient was treated with linezolid after penetrating keratoplasty. The second culture of another patient with impending perforation despite linezolid/ceftazidime therapy yielded Fusarium spp., so he underwent tectonic keratoplasty. The mean ocular surface score was 9.4 +/- 1.6 during vancomycin treatment and 5.9 +/- 1.3 during linezolid treatment after discontinuation of vancomycin. The topical linezolid score was significantly lower (p = 0.027). Conclusions: Topical linezolid may be better tolerated, according to the mean ocular surface score, than topical vancomycin by some patients and can be considered an alternative for patients who do not well tolerate vancomycin.

We report the case of a 70-year-old female patient who developed corneal edema and iris discoloration following the inadvertent use of 1% methylene blue instead of 0.025% trypan blue to stain the anterior capsule during cataract phacoemulsification surgery. Copious irrigation was performed upon realization of incorrect dye use. Corneal edema and iris discoloration developed during the early postoperative period and persisted at 24-months follow-up. However, keratoplasty was not required. The intracameral use of 1% methylene blue has a cytotoxic effect on the corneal endothelium and iris epithelium. Copious irrigation for at least 30 min using an anterior chamber maintainer may improve outcomes. RESUMO Paciente do sexo feminino com 70 anos de idade desenvolveu edema da córnea e descoloração da íris após o uso inadvertido de 1% de azul de metileno em vez de 0,025% de azul tripano para corar a cápsula anterior do cristalino durante a cirurgia de catarata por facoemulsificação. Foi realizada irrigação abundante quando detectou-se que o corante incorreto tinha sido usado. Edema da córnea e descoloração íris que ocorreu no período pós-operatório precoce persistiu durante 24 meses de seguimento; no entanto, a ceratoplastia não foi necessária. O uso intracameral de 1% de azul de metileno tem efeitos citotóxicos sobre o endotélio da córnea e epitélio da íris. A irrigação abundante durante pelo menos 30 minutos, utilizando um mantenedor de câmara anterior pode resultar em um prognóstico melhor.

Localized unilateral hyperhidrosis (LUH) is an uncommon but well-defined special form of localized hyperhidrosis with diverse causes. It often occurs within a sharply demarcated area on the face or upper extremities. Here, we report a case of LUH in a 16-year-old male with neurofibromatosis type 1 (NF1) and review related data in the literature. The association of this rare entity and NF1 has not yet been described. Subcutaneous botulinum toxin A injection provided a good clinical response with symptomatic relief.

* BACKGROUND AND OBJECTIVE: The results and complications of posterior chamber intraocular lens (IOL) implantation by a 4-point scierai fixation technique are described. * PATIENTS AND METHODS: Fifty eyes of 47 patients who underwent scleral-fixated IOL implantation were retrospectively evaluated. Twenty-one (42%) eyes had a history of trauma and 29 (58%) eyes had previously undergone cataract surgery. In all cases, IOL implantation by 4-point scierai fixation was performed and the knots of fixation sutures were rotated and buried in the globe. The IOL position was adjusted by suture rotation for best centration. * RESULTS: The mean follow-up time was 7 ± 4 months. Four (8%) eyes had minimal corneal edema preoperatively. Cystoid macular edema was noted in 2 (6.8%) eyes in the cataract surgery group and 8 (38%) eyes in the posttraumatic group. Two (9.5%) eyes in the posttraumatic group had atrophie macular changes and 1 (4.7%) had cornea! scarring, which impaired vision. No complications such as knot exposure, tilting of the IOL, decentralization, or endophthalmitis were noted postoperatively. Postoperative mean corrected visual acuity was 0.4 ± 0.3 in the posttraumatic group and 0.4 ± 0.2 in the cataract surgery group. * CONCLUSION: The 4-point scierai fixation technique resulted in no serious postoperative complications such as suture exposure and endophthalmitis. Because the knot can be rotated and buried in the globe, knot exposure is less likely to occur. This procedure is more effective than other techniques regarding IOL centralization. [Ophthalmic Surg Lasers Imaging 2004;35:379-382.]

Background: To evaluate the results of pars plana vitrectomy with peeling of the internal limiting membrane (ILM) in eyes with chronic macular oedema. Methods: PPV with indocyanine green (ICG) assisted peeling of the ILM was performed in 33 eyes with diabetic (21 eyes) or,non-diabetic (12 eyes) macular oedema. Postoperatively, resolution of macular oedema, improvement of visual acuity (VA) and complications were documented. The peeled membranes were submitted for light and transmission electron microscopic evaluation. Results: The mean follow-up time was 12.2 months. The macular oedema decreased or was resolved in 17 (81%) eyes in the diabetic group and in 11 (92%) eyes in the non-diabetic group. VA improved by at least 2 lines in 11 (52%) eyes in the diabetic group and in 7 (58%) eyes in the non-diabetic group. The difference between visual acuity improvements of the two groups was not statistically significant (P>0.05). However, in the diabetic group the difference of visual improvement between cystoid and diffuse type of macular oedema eyes was statistically significant (14% versus 71%, P=0.02). Light and transmission electron microscopy showed the presence of ILM in all specimens. During the follow-up period no recurrence of macular oedema or epiretinal membrane formation was observed. Conclusion: Pars plana vitrectomy with peeling of the ILM and epiretinal membrane leads to the resolution of macular oedema in the majority of eyes. This however, is not always associated with VA improvement. In diabetic eyes, cystoid type of macular oedema appears to be a poor prognostic factor for improved VA.

Purpose: To investigate the refractive outcomes after arcuate keratotomy for astigmatism. Setting: Uludag University, Faculty of Medicine, Department of Ophthalmology, Bursa, Turkey. Method. Sixteen eyes of 11 patients with astigmatism had arcuate keratotomy using the Terry astigmatome. The mean age of the patients was 36 years +/- 10 (SD). All patients received preoperative and postoperative ophthalmic examinations consisting of best spectacle-corrected (BSCVA) and uncorrected (UCVA) visual acuities, corneal topography, and ultrasonic pachymetry. Surgery was performed using topical anesthesia of oxybuprocaine 0.1% eyedrops. The Terry astigmatome was selected by the mean paracentral (estimated incision area) corneal thickness. All patients received topical ofloxacin 0.3% and topical diclofenac 0.1% eyedrops postoperatively. Results: The mean corneal astigmatism was -4.0 +/- 1.1 diopters (D) (range -2.2 to -6.0 D) preoperatively and -1.8 +/- 0.8 D (range -0.6 to -3.0 D) postoperatively. The mean surgically induced corneal astigmatism was 2.5 +/- 0.6 D. The mean UCVA (logMAR) was 0.74 +/- 0.25 preoperatively and 0.18 +/- 0.23 1 week postoperatively, and the mean BSCVA (logMAR) was 0.19 +/- 0.24 and 0.19 +/- 0.23, respectively. There were no intraoperative or postoperative complications. Conclusion: Arcuate keratotomy using the Terry astigmatome was a safe and reliable treatment for corneal astigmatism.

Background and Objective: To compare the intraocular pressures (IOP) obtained with dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) and to determine the dependency of both devices on corneal structure. Patients and Methods: One hundred forty eyes of 70 patients were included. Cases with corneal pathologies, former glaucoma diagnosis, and systemic diseases were excluded. All eyes underwent measurements of central corneal thickness (CCT) and corneal curvature. IOP measurements were obtained with GAT and DCT. The agreement of measurements was statistically analyzed. Results: The correlation of IOP values obtained with DCT and GAT was statistically significant. The mean DCT values were 0.46 ± 2.55 mm Hg higher than those of GAT, but this difference was statistically insignificant. Bland–Altman plots showed reasonable inter-method agreement between DCT and GAT measurements. GAT readings were significantly affected by CCT, but DCT measurements were affected by age and corneal curvature. Conclusion: DCT is a reliable method of assessing IOP and is less dependent on central corneal thickness. This new technology may be a promising step forward in the management of glaucoma. Further studies are required to validate these observations.

Purpose To present a novel technique for the implantation of phakic iris-claw intraocular lenses (IOL) in highly myopic cases. Methods Twelve cases, under the age of 40, with high myopia were included in this retrospective study. The mean follow-up span was 14.4±5.8 months. Phakic iris-claw IOL implantation was performed, through a 5.5 or 6.5 mm self sealing scleral tunnel with Bursa technique. No suturing and opening a peripheral iridectomy or iridotomy was required in our study. Pre- and postoperative patient evaluation included manifest and cycloplegic refractions, uncorrected visual acuity, best-corrected visual acuity (BCVA), induced astigmatism, and intraocular pressure (IOP) assessments. Results All eyes gained one to nine lines of BCVA of the Snellen chart. The vector analysis revealed an induced astigmatism of 0.63 D. No significant IOP change was detected throughout the follow-up. Conclusions The data suggest that nonfoldable iris fixated phakic IOL implantation, through a self-sealing incision with Bursa technique, is safe and requires no iridectomy or iridotomy in cases with deep anterior chambers.

PURPOSE. The aim of the study was to evaluate the safety and effectiveness of a new technique, two-site bimanual microincisional cataract surgery combined with viscocanalostomy plus deeper sclerectomy (two-site bimanual MICS-VC-DS), in patients with cataract and glaucoma. METHODS. Noncomparative, interventional case series. From December 2005 to October 2007, a consecutive series of 12 patients (12 eyes) with uncontrolled primary open angle glaucoma (POAG) and cataract have undergone two-site bimanual MICS-VC-DS. Postoperative evaluation included visual acuity (VA), intraocular pressure (IOP), average retinal nerve fiber layer (RNFL) thickness measurement, and gonioscopic, biomicroscopic, and funduscopic examination. Paired-samples t test was used. A p value of

Purpose To evaluate the technique, efficacy, and safety of posterior iris fixation of iris-claw intraocular lens (IOLs) implantation through a scleral tunnel incision for aphakia correction. Design Noncomparative, interventional case series. Methods A secondary posterior iris fixation of the Artisan iris-claw IOL (Ophthec BV, Groningen, The Netherlands) was implanted for aphakia correction in the authors’ clinical practice. Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), astigmatism, manifest refraction, lens position, pigment dispersion, and intraocular pressure (IOP) were evaluated in 32 consecutive eyes of 32 patients. Results BSCVA was 20/40 or better in 28 eyes (87.50%) during the mean follow-up time (nine months). Mean postoperative spherical equivalent was −0.70 diopters (D; standard deviation [SD], 0.47 D) at six months after surgery. Mean prediction error was −0.13 D (SD, 0.28 D), and mean absolute prediction error was 0.26 D (SD, 0.15 D). Preoperative mean astigmatism was −1.08 D (SD, 0.55 D; range, 0.0 to −2.0 D). At six months after surgery, mean astigmatism was −2.1 D (SD, 0.81 D; range, −0.75 to −3.75 D). There was no significant postoperative IOP increase. Lens position, evaluated by Oculus Pentacam (Pentacam 70700: Oculus, Wetzlar, Germany) and ultrasound biomicroscopy [UBM] (Ophthalmic Technologies Inc, Toronto, Ontario, Canada), was parallel to the iris plane. Conclusions Posterior iris fixation of the iris-claw IOL implantation through a scleral tunnel incision is a safe procedure and an effective option for aphakic eyes without capsule support.

PURPOSE. To compare the amount of ultrasound (US) energy and balanced solution (BS) re- quired for burst mode and pulse mode during bimanual phacoemulsification surgery. METHODS. One hundred cases were divided into two groups (the pulse mode Group 1 (50 eyes), the burst mode Group 2 (50 eyes)). One surgeon (M.B.) performed phaco - emulsification procedures using topical anesthesia with the AMO Sovereign in all patients. The technique was based on the nuclear hardness and surgeon's criteria and performed bi- manually. The surgery time, total ultrasound time (UST) and effective US power (USP), and used balanced solution (BS) were retrospectively compared. RESULTS. The mean surgery time, mean UST, and mean used BS volume were not statisti- cally different in both groups (p>0.05). The mean EPT was statistically highly different in both groups (p>0.001). There was a slight tendency toward more surgery time in Group 2 than in Group 1, although the difference was not significant (p=0.146). Statistically signif- icant higher results (Group 1: r=0,889, p

PURPOSE. To evaluate the effect of anterior chamber continuous infusion maintainer system on the contamination of anterior chamber in phacoemulsification surgery. METHODS. Clear corneal phacoemulsification surgery was performed in 132 eyes of 132 randomly selected patients with cataract who were divided into two groups of 66 eyes according to the use of an anterior chamber maintainer (ACM) system. The fluid specimens were taken from anterior chamber in the beginning and at the end of the surgery. They were transferred under anaerobic conditions and investigated by culturing onto blood agar and thiogluconate broth media. Differences between the two groups with respect to contamination of the specimens were investigated. RESULTS. The mean age of the group undergoing surgery without a maintainer system (Group A) was 63 +/- 10 years (min = 41, max = 80) versus 59 +/- 10 years (min = 33, max = 80) in the other group (Group B) in which the maintainer was used during surgery. In the postoperative specimen, Micrococcus species were isolated from one eye (1.5%) in Group A and S. pyogenes in one eye (1.5%) from Group B. Mean follow-up interval was 12 +/- 6 (min = 4, max 28) months. CONCLUSIONS. The use of ACM system in clear corneal phacoemulsification surgery carries no additional risks as far as contamination is concerned.

The end of a scleral fixation suture may erode through the conjunctiva and become exposed. To avoid this, a scleral flap, autologous cornea, dura mater, or fascia lata patches have been used to cover the ends, and rotation of the knot into the tissue has been reported. An alternative technique to bury the end of the suture is described.

Bu çalışma, 22 Mayıs 2003 tarihleri arasında Miami[Florida]’da düzenlenen 8. Annual Meeting of the International-Ocular-Surface-Society’da bildiri olarak sunulmuştur. Objective: To describe the ocular surface and tear function findings in premature and term babies. Design: Prospective, case-control study. Participants: Forty-eight eyes of 24 premature babies seen at the Department of Ophthalmology of Uludag University School of Medicine, Bursa, Turkey, from March 2002 through September 2002 and 50 eyes of 25 healthy term babies were studied. Intervention: The subjects underwent routine ophthalmic examinations; corneal sensitivity measurements; Schirmer test with anesthesia, with and without nasal stimulation; primary Jones test; fluorescein staining of the ocular surface; and conjunctival impression cytology. Main Outcome Measures: Premature and term babies were compared for corneal sensitivity, lacrimal drainage system patency, tear function and ocular surface staining parameters, goblet cell density, and squamous metaplasia grade. The relation of these parameters to the status of the ocular surface was also investigated. Results: Mean corneal sensitivity scores were 45 +/- 5.0 mm and 55 +/- 4.5 mm in the premature and term babies, respectively (P

In summary, we found that AMT can be helpful for the treatment of epithelial defects and stromal ulcers. We came to learn that cases with total limbal deficiency or extensive ocular surface inflammation may not be cured with AMT alone. AMT provides improvement of corneal sensitivity, tear film stability and impression cytology parameters. However, the entire mechanism of the healing effect of amniotic membrane is still unknown. A recent experimental study revealed that amniotic membrane transplantation vs tarsorraphy in murine HSV-1 stromal keratitis resulted in improvements in substance-P-related corneal nerve fibres in eyes treated with amniotic membrane, but not in eyes treated with tarsorraphy. We think that prospective, controlled, comparative studies of corneal ulcers treated by, for instance, tarsorraphy or other modalities should be performed to investigate whether the beneficial changes of amniotic membrane transplantation are greater or lesser than the changes that might have been observed by an alternative treatment. In this study, we tried to point to the effects of amniotic membrane transplantation on the ocular surface together with the problematic and unresolved issues. Thus, it is our sincere belief that further studies should be carried out along these lines.

Purpose To evaluate the clinical outcome after primary treatment of lens injuries with corneal or corneoscleral trauma. Methods Ten eyes of 10 patients were retrospectively evaluated. There were no foreign bodies in any eye. After primary repair, an anterior chamber maintainer (ACM) was introduced through the inferotemporal corneal quadrant. Sodium hyaluronate 1.4% (Healon GV®) was injected, and the anterior capsule was stained with trypan blue 0.1% vital stain (Vision Blue®) under the viscoelastic substance. After a capsulorhexis was created, the lens material was aspirated. The nucleus was delivered from the scleral tunnel, which was opened from the superior/superotemporal corneal quadrant. A conventional 21.0 diopter poly(methyl methacrylate) intraocular lens (IOL) with a 5.5 mm optic and overall diameter of 12.5 mm (Dr. Schmidth®, Hannan Kibbutz) was implanted through the scleral tunnel. The scleral tunnel was not sutured, and the corneal entry sites were closed with stromal hydration. Results The final best spectacle-corrected visual acuity (BSCVA) was better than 20/100 in all patients, and 6 patients had a BSCVA of 20/20. The IOL was in the capsular bag in all patients at the last follow-up. The mean follow-up was 12.3 months (range 7 to 25 months). The main visually limiting factors were corneal scar, irregular astigmatism, and traumatic maculopathy. Conclusions Primary IOL implantation in carefully selected patients with penetrating corneoscleral lens injury may yield visually rewarding results. The use of a vital stain to increase the visibility of the injured anterior capsule and of a closed scleral tunnel system with an ACM increased the surgical safety.

Bu çalışma, Antalya[Türkiye]'de düzenlenen 34. Türk Oftalmoloji Derneği Ulusal Kongresinde (34th National Congress of the Turkish-Ophthalmology-Society) bildiri olarak sunulmuştur. A healthy 21-year-old man had laser in situ keratomileusis (LASIK) in the right eye for a refractive error of -7.0 diopters. The electrocardiogram findings and heart rate were recorded before LASIK; during eye lid speculum insertion, vacuum application, corneal flap preparation, and excimer laser keratectomy; and after the procedure. The pre-LASIK heart rate was 90 pulses/min. Severe bradycardia of 40 beats/min developed during vacuum application, and the procedure was terminated. Severe bradycardia caused by an oculocardiac reflex may occur during LASIK, and patients should be closely monitored during the procedure. Türk Oftalmoloji Derneği