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Purpose: To compare 4 methods for intraoperative pupil dilatation in eyes with pseudoexfoliation syndrome and insufficient pupil size during phacoemulsification.Design: Prospective, randomized, comparative, interventional case series.Participants: Forty eyes of 40 patients with pseudoexfoliation and maximally dilated pupil size smaller than 3.5 mm.Intervention: Mechanical pupil dilatation with iris-retractor hooks (group I), polymethyl methacrylate (PMMA) pupil dilator-ring (Morcher, Stuttgart, Germany) (group II), Beehler pupil dilator (group III), and bimanual stretching (group IV).Main outcome measures: Performance (pupil size achieved), complications, and added surgical time.Results: The mean pupil sizes achieved with the PMMA pupil-dilator ring, Beehler pupil dilator, and bimanual stretching were 5.9±0.6 mm, 5.5±0.8 mm, and 4.9±0.7 mm, respectively. A square-shaped pupil was achieved with iris-retractor hooks, and the mean size of the largest circle that can fit in this square was 5.6±0.6 mm. There were no statistically significant differences in the postdilatation pupil sizes between the 4 study groups (P>0.05). Apart from self-limited intraoperative hemorrhage from pupil margin, iris sphincter rupture was the only observed complication related to mechanical pupil dilatation. This occurred in 4 eyes in groups I and III, 3 eyes in group IV, and 1 eye in group II (P>0.05). The mean added surgical time for placement of iris-retractor hooks and for implantation of a PMMA pupil-dilator ring was 297±51 and 176±54 seconds, respectively. The additional time required for pupil dilatation with the Beehler pupil dilator and bimanual stretching was 65±8 and 55±10 seconds, respectively. The time needed for pupil dilatation in groups I and II is significantly longer than that in groups III and IV (P<0.001).Conclusions: All 4 methods used in this study were effective procedures for the mechanical dilatation of small pupils secondary to pseudoexfoliation syndrome. Iris-retractor hooks and the PMMA pupil-dilator ring are the most time-consuming techniques but have the advantage of a stable pupil size throughout the surgery. The PMMA pupil-dilator ring causes the least iris trauma. The Beehler pupil dilator and bimanual stretching technique were the least time-consuming methods for mechanical pupil dilatation. [Copyright &y& Elsevier]

Purpose: To compare the results of intracameral dexamethasone and intracameral triamcinolone acetonide injection in patients that underwent cataract surgery with phacoemulsification. Materials and Methods: Sixty eyes of 60 patients that underwent cataract surgery with phacoemulsification were randomized into two groups. Preoperative visual acuity of all patients was 0.5 or lower and intraocular pressures were under 21mmHg. After surgery, eyes in group 1 (30 eyes) were injected with 0.4 mg/0.1 ml dexamethasone into the anterior chamber, and eyes in group 2 (30 eyes) were injected with 2 mg/0.05 ml triamcinolone acetonide into the anterior chamber. All eyes received standard postoperative prednisolone acetate and moxifloxacin eye drops. The biomicroscopic evaluation, visual acuity, and intraocular pressure measurements were done at baseline (preoperatively) and on postoperative days 1, 7 and 30. Results: There were no statistically significant differences in mean visual acuity, the amount of anterior cells and flare between the two groups (P ≥ 0.05). Mean intraocular pressure values at postoperative first day were significantly higher in group 2 than in group 1 (P = 0.009). The mean intraocular pressures on days 7 and 30 after surgery were not statistically different between the two groups (P ≥ 0.05). Conclusions: Intracameral dexamethasone and intracameral triamcinolone acetonide were similarly effective in controlling postoperative inflammation following phacoemulsification. However, the intraocular pressures on postoperative first day were higher in patients receiving intracameral triamcinolone acetonide. The highest intraocular pressure in triamcinolone acetonide group was 24 mmHg, and stabilized in a few days, therefore using triamcinolone acetonide may impose a minimal risk to patients. Nevertheless, intracameral dexamethasone seems to be a better alternative to apply at the end of surgery to suppress the inflammation during the first 24 hours. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effectiveness of brinzolamide 1%, brimonidine 0.2%, acetazolamide 250 mg, intracameral acetylcholine, and timolol 0.5% in preventing intraocular pressure (IOP) peaks during the early period after phacoemulsification in which sodium chondroitin sulfate 4%–sodium hyaluronate 3% (Viscoat) was used as the ophthalmic viscosurgical device (OVD). Setting: Department of Ophthalmology, Baskent University Medical Faculty, Ankara, Turkey. Methods: This prospective randomized study comprised 185 eyes of 185 patients with uncomplicated cataract scheduled for phacoemulsification using Viscoat as the OVD. Patients were randomly assigned to 1 of 6 groups: postoperative application of topical brinzolamide 1%, brimonidine 0.2%, oral acetazolamide 250 mg, intracameral acetylcholine, timolol 0.5%, or no ocular hypotensive agent (control group). The IOP was measured at baseline (preoperatively) as well as 6 hours, 20 to 24 hours, and 1 week after surgery. Results: The mean preoperative IOP values were not significantly different between the groups. Six hours and 20 to 24 hours postoperatively, the mean IOP was significantly lower in all groups receiving an ocular hypotensive agent than in the control group (P<.01). Six hours after surgery, the mean IOP significantly increased in all groups but was higher in the control group. At 20 to 24 hours, the mean IOP decreased significantly in all ocular hypotensive agent groups but remained significantly high in the control group. One week after surgery, there were no significant differences between the groups. Conclusion: Brinzolamide, brimonidine, acetazolamide, intracameral acetylcholine, and timolol had similar effects in reducing IOP increases after phacoemulsification performed using Viscoat. [Copyright &y& Elsevier]

Purpose To evaluate the elastic modulus, hardness, and mechanical properties of the anterior lens capsule in different types of cataract and to assess the correlation with age. Setting Baskent University Hospital, Department of Ophthalmology, Ankara, Turkey. Design Prospective comparative study. Methods Patients were divided into 3 groups. Group 1 comprised patients with senile cataract, Group 2 patients had pseudoexfoliation (PXF) syndrome, and Group 3 patients had dye-enhanced cataract surgery. The capsules were analyzed using a nanoindentation device. Young's modulus of elasticity was measured by the Oliver-Pharr method and capsule hardness by the Martens method. Results The study comprised 72 patients, 24 per group. The mean Young's modulus was 7.53 GPa ± 1.07 (SD) in Group 1, 6.01 ± 1.25 GPa in Group 2, and 8.12 ± 0.98 GPa in Group 3. The capsules in Group 2 were more elastic than in Group 1 and Group 3 ( P < .001). The capsules in Group 3 had lower elasticity than in Group 1, although the difference was not significant ( P = .94). The mean capsule stiffness was 326.41 ± 98.40 MPa in Group 1, 210.5 ± 52.32 MPa in Group 2, and 315.54 ± 163.15 MPa in Group 3. The lens capsules in Group 2 were less stiff than those in Group 1 and Group 3 ( P < .001). Conclusions Capsule thickness was positively correlated with increasing age in all groups. The anterior lens capsules of patients with PXF had more elasticity and less stiffness than the other groups. Intracameral trypan blue application had no effect on capsule elasticity and stiffness. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effects of topical loteprednol etabonate 0.5% and prednisolone acetate 1% on postoperative inflammation after cataract surgery. Materials and Methods: Forty eyes of 40 patients who underwent uncomplicated cataract surgery between October 2008 and February 2009 were included in this study. The patients were divided into two groups randomly; loteprednol etabonate 0.5% and prednisolone acetate 1% were used in group 1 and group 2, respectively. Preoperative and postoperative examinations were performed after 1 day, 1 week, and 1 month, and the anterior chamber cells, flare, best-corrected visual acuity (VA), and intraocular pressure (IOP) of the patients were compared statistically. Results: There were no statistically significant differences in mean VA or mean IOP measurements between the two groups at any postoperative visit. Although there were no significant differences in mean anterior chamber cells or flare of the patients between the two groups on postoperative day 1, mean anterior chamber cells and flare were significantly higher in group 1 than in group 2 at the first postoperative week (p=0.03, p=0.02). None of the patients had anterior chamber cells or flare at the first postoperative month in the groups. Fibrin reactions were observed in two patients in group 1 and gentamycine+dexamethasone were applied subconjunctivally for treatment. Conclusion: Loteprednol etabonate 0.5% is effective in controlling postoperative inflammation after cataract surgery, but less effective than prednisolone acetate 1%. Patients who receive loteprednol etabonate 0.5% treatment after uncomplicated cataract surgery must be followed up frequently. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article related to comparing the intracameral dexamethasone and intracameral triamcinolone acetonide injection in cataract surgery with phacoemulsification, published in a previous issue of 2015 and also mentions author response to the article.