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Pur po se: To report the results of phacoemulsification and toric intraocular lens (IOL) implantation in patients with cataract and high astigmatism. Ma te ri al and Met hod: Medical records of 21 eyes of 17 patients (6 men, 11 women) with 1,5 diopter (D) or more corneal astigmatism who underwent phacoemulsification and foldable hydrophobic acrylic toric intraocular lens implantation at Başkent University, Department of Ophthalmology between 2008 and 2011 were reviewed. Preoperative and postoperative 1-month data were recorded and compared for best corrected log Mar visual acuity (BCVA), and corneal and refractive cylinder powers. Toric IOL axis shift was also evaluated at postoperative 3 months. Re sults: The average age of the patients was 63.0±6.9 years. The mean follow-up duration was 17.9±4.8 months (range, 12-28). The mean preoperative BCVA and refractive cylinder were 0.47±0.3 (range, 0.3-2.0, log-Mar) and 3.11±1.32 D, respectively. Postoperative BCVA increased to a mean of 0.14±0.27 (range, 0.1-1.0, log-Mar), while refractive cylinder power decreased to a mean of 1.00±0.98 at the end of follow-up. Dis cus si on: Toric IOL implantation is an effective surgical alternative in patients with high astigmatism and cataract. It is possible to correct preexisting astigmatism and to achieve visual recovery with toric IOL implantation with a good preoperative planning and proper surgical technique. [ABSTRACT FROM AUTHOR]

Aim To compare the aqueous humour penetration of moxifloxacin 0.5% and gatifloxacin 0.3% eye drops administered in two different dosing regimens during phacoemulsification surgery. Methods This prospective, randomised study included 97 patients. The patients were randomly divided into two treatment groups to receive either moxifloxacin or gatifloxacin. All patients received the topical antibiotics four times per day for 2 days prior to surgery. Patients in each group were further subdivided to receive additional doses of antibiotic drops as two drops 30 min apart (subgroup 1) versus four drops 10 min apart (subgroup 2) 1 h prior to the surgery. At the beginning of surgery, 0.1 ml of aqueous humour was aspirated, and the concentrations of moxifloxacin and gatifloxacin were analysed by high-performance liquid chromatography. Results The mean concentrations of moxifloxacin and gatifloxacin in the aqueous humour were 0.7260.40 mg/ml and 0.4760.29 mg/ml, respectively, in the first subgroup, and 1.9561.05 mg/ml and 0.7760.52 mg/ml, respectively, in the second subgroup. Both the inter-group (p=0.006 and p=0.000, respectively) and the intra-group (p=0.000 and p=0.035, respectively) differences between the aqueous humour concentrations of moxifloxacin and gatifloxacin subgroups were statistically significant. Conclusion Moxifloxacin, given in the same dosage, penetrated the aqueous humour better then gatifloxacin during cataract surgery. The penetration of both antibiotics increased significantly when the dosage of the agent was doubled. [ABSTRACT FROM AUTHOR]

Purpose: To explore the efficacy, safety and tolerability of 1 mg intracameral triamcinolone acetonide (TA) in controlling ocular inflammation in patients undergoing cataract surgery. Methods: Sixty eyes of 60 patients undergoing cataract extraction with phacoemulsification at the Department of Ophthalmology, Baskent University School of Medicine were randomized into two groups. After surgery, eyes in group A were injected with 1 mg/0.1 ml TA into the anterior chamber, but eyes in group B were not. Postoperatively; in group B, topical prednisolone acetate 1% eyedrops were administered six times per day for 7 days, then four times per day for 15 days, to control postoperative inflammation. In group A, topical corticosteroids were not used. To evaluate the efficacy of intracameral TA, anterior chamber cells, anterior chamber flare and conjunctival hyperaemia were measured on postoperative days 1, 7 and 30 by slit-lamp biomicroscopy. The safety of intracameral TA was evaluated by visual acuity measurements, intraocular pressure values and fundus examination. Tolerance variables were assessed by the degree of burning, stinging and blurred vision. Results: Both treatments were equally effective in controlling postoperative inflammation following phacoemulsification. No statistically significant differences between groups were observed for the efficacy, safety and tolerance variables, and no serious adverse events were observed. Conclusions: Intracameral TA of 1 mg can effectively be used to control postoperative inflammation after uncomplicated cataract surgery with phacoemulsification. This makes it possible to decrease the dosage and duration of topical prednisolone acetate. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effectiveness of brinzolamide 1% (Azopt®) and brimonidine 0.2% (Alphagan®) with a placebo in preventing an early increase in intraocular pressure (IOP) after phacoemulsification.Setting: Department of Ophthalmology, Baskent University, School of Medicine, Ankara, Turkey.Methods: In this prospective double-masked study, 90 eyes of 90 patients having clear corneal phacoemulsification were randomly divided into 3 groups of 30 eyes each. One hour before surgery, 1 group received 1 drop of brinzolamide 1%, another received 1 drop of brimonidine 0.2%, and the third received 1 drop of a balanced saline solution (placebo). The IOP was measured preoperatively and 3 and 16 to 20 hours postoperatively.Results: Three hours postoperatively, the mean IOP increased by 4.2 mm Hg ± 7.0 (SD), 3.2 ± 6.4 mm Hg, and 5.3 ± 4.2 mm Hg in the brinzolamide, brimonidine, and placebo groups, respectively. The IOP increase from baseline was significant in all 3 groups (all P<.01), with no difference between the groups (P>.05). The change in IOP at 16 to 20 hours was 0.2 ± 2.8 mm Hg, 0.2 ± 2.4 mm Hg, and –0.8 ± 2.4 mm Hg, respectively. The changes were not significant compared to baseline (all P>.05). Six eyes (20%) in the brinzolamide group, 5 eyes (16.7%) in the brimonidine group, and 7 eyes (23.3%) in the placebo group had an IOP higher than 25 mm Hg 3 hours postoperatively; the difference between groups was not significant (P = .8).Conclusion: Prophylactic use of 1 drop of brinzolamide or brimonidine was not more effective than a placebo in controlling early postoperative IOP elevations after clear corneal phacoemulsification. [Copyright &y& Elsevier]

Objectives: The aim of this study was to show at what rate the technological equipment used in cataract surgery by Turkish ophthalmologists and their knowledge are reflected in practice and how up to date they are. Materials and Methods: A questionnaire conducted using SurveyMonkey was used to evaluate the answers to 17 questions from 823 members of the Turkish Ophthalmological Association. Results were evaluated in subgroups according to the participants' age, occupational status, institutions, and whether they conducted relevant academic activities, and the data were compared as inadequate, standard, and contemporary approaches according to the determined criteria. Results: Optical biometry devices were used at rates of 77.7% and 67.3% for intraocular lens (IOL) power calculations and keratometric measurements in preparation for cataract surgery, respectively. For IOL power calculation, third-generation formulas, especially the SRK-T, were used most commonly (46.2%), followed by second-generation formulas (21.9%), and fourth/fifth-generation formulas and multiple evaluations for different axial lengths (31.9%). The most common incision size was 2.8 mm (51.6%), while the percentage of 2.2 mm and shorter incisions considered to be neutral in terms of surgically induced astigmatism was 18.8%. When selecting incision location, approaches to reduce corneal astigmatism were reported by 28.9%, neutral approaches by 26.2%, and insensitive approaches by 44.9%. Additionally, 55.6% of participants never implanted toric IOLs and 50.7% did not use presbyopia-correcting IOLs. The proportion of surgeons who have experience with femtosecond laser-assisted cataract surgery was 10.3% and the rate of intracameral antibiotic injection at the end of the operation was 89.4%. Conclusion: It was seen that Turkish cataract surgeons were able to use high technology for surgical preparation and surgery at high rates, but this was not reflected in practice at same rate in terms of achieving contemporary standards of refractive cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: To determine the tear osmolarity changes in patients who had undergone phacoemulsification surgery. Material and Method: Tear osmolarity measurements were performed in 30 eyes of 30 patients who had undergone cataract surgery without any complication. Measurements were performed before surgery and consecutively at 1st month, 3rd month, and 6th month after the surgery. TearLab osmometer (TearLab Corporation, San Diego, CA, USA) device was used for the measurements and paired ttest was used for statistical analysis. Results: The mean age of the patients was 72.3±3.7 (67-78) years. Thirteen patients were men and 17 patients were women. The mean osmolarity values were 305.8±6.5 mOsm/L before the surgery and 312.3 ±6.4 mOsm/L at 1st month, 307.5±5.1 mOsm/L at 3rd month and 305.1±5.7 at 6th month after the surgery. The difference between the values before surgery and at 1st month was found statistically significant (p=0.001). Discussion: The tear osmolarity increases at the first month after surgery but decreases to the levels measured before surgery at the 3rd month. The increase at the first month may be due to the corneal incisions and medication used after the surgery. We think that we have to take into account this similarity increase in all cataract patients, especially in those who also have dry eye disease. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to analyze the risk factors resulting in high intraocular pressure (IOP), which was accepted as IOP higher than 22 mmHg, following uncomplicated phacoemulsification. Materials and Methods: The records of 812 eyes of 584 patients who underwent uncomplicated phacoemulsification were evaluated. There were 330 men and 254 women ranging between the age of 26 and 89 years (65.4 ± 9.8 years). The preoperative, postoperative first day (day 1), first week (day 7), and first month (day 30) IOP values were analyzed. Data on history of diabetes, glaucoma, pseudoexfoliation (PXF), incision site, capsular staining with trypan blue, and surgeon were recorded. A multinomial regression analysis was performed * to analyse the relationship of the factors with postoperative high IOP. Results: The mean IOP was 15.6 ± 4.3 mmHg preoperatively. Postoperatively that were changed to 19.7 ± 9.0 mmHg at day 1, 12.7 ± 4.5 mmHg at day 7, and 12.8 ± 3.7 mmHg at day 30. The factors such as surgeon, presence of PXF, diabetes, surgical incision site, and trypan blue were not related to the postoperative high IOP (P > 0.05, in all). The only factor that related to high IOP at all visits was glaucoma (P < 0.005). Conclusion: According to our results, preoperative diagnosis of glaucoma seems to be the only factor to affect the postoperative IOP higher than 22 mmHg. [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]

Purpose: To compare a bupivacaine and lidocaine mixture with levobupivacaine and ropivacaine in terms of safety, efficacy and blocking quality in peribulbar anaesthesia for phacoemulsification. Methods: A total of 105 patients scheduled for cataract surgery with peribulbar anaesthesia were randomly allocated into three groups of 35 patients each, to receive 5 ml of, respectively, a 1 : 1 mixture of bupivacaine 0.5% and lidocaine 2% (group 1), levobupivacaine 0.75% (group 2), or ropivacaine 1% (group 3). Ocular movement scores were evaluated at 2, 4, 6, 8 and 10 mins after injection. Intraoperative and postoperative analgesia were evaluated by verbal pain scores. Duration of surgery, need for supplementary anaesthesia, haemodynamic parameters and the incidence of perioperative complications were recorded. Results: The ocular movement score in min 2 was significantly lower in group 1. There was no significant difference between groups 2 and 3. Ocular movement scores at mins 4 and 6 were significantly decreased in group 1 and 2 compared with group 3. There was no significant difference among the groups in ocular movement scores at mins 8 and 10. Verbal pain scores in postoperative hour 4 were highest in group 3, but scores for the intraoperative period and postoperative hours 1 and 2 were similar among the groups. Duration of surgery and haemodynamic parameters did not differ among the groups. Conclusions: All agents were considered to be convenient for clinical use in cataract surgery with peribulbar anaesthesia. Although the ocular movement scores in the ropivacaine group were higher than in the other groups at mins 4 and 6, this did not imply any clinical significance. [ABSTRACT FROM AUTHOR]

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]