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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.

Amaç: Birincil veya ikincil olarak iris arkasına iris kıskaçlı lens (İKL) implantasyonu uygulanan hastaların klinik ve cerrahi sonuçlarının değerlendirilmesi.Gereç ve Yöntem: Çalışmaya Uludağ Üniversitesi Göz Kliniğinde Kasım 2008-Aralık 2015 arasında iris arkasına İKL implantasyonu uygulanan 99 hastanın 101 gözü dahil edildi. Dosyalar geriye dönük olarak incelendi, eksik veri kaydı olan hastalar çalışma dışı bırakıldı. Olguların yaşı, cinsiyeti, ameliyat endikasyonları, travma öyküsü, uygulanan cerrahi işlem, ameliyat öncesi (AÖ) ve sonrası (AS) sferik eşdeğer (SE), en iyi düzeltilmiş görme keskinliği (EİDGK), göz içi basınç (GİB), biyomikroskopik bulguları kaydedildi. 38 hastanın 40 gözünde, 44,6 ay sonra santral kornea kalınlığı (SKK) ve endotel sayısı (ES) ölçümleri değerlendirildi.Sonuçlar: Olguların ortalama yaşı 66,9±19,7; 39'u (%39,4) kadın, 60'ı (%60,6) erkekti. AÖ'ne göre AS 1.ayda SE'de anlamlı düzelme (p=0,007) ve AS 1.hafta ve 1.ayda EİDGK'de anlamlı artış saptandı (p=0,001). 1.ayda tüm gözlerde ve 44,6 ay sonra 40 gözde İKL fikse ve santralizeydi, 9 hastada lokalize iris atrofisi, 2 hastada pigment dispersiyonu mevcuttu. Bu hastaların İKL implantasyonu uygulanan gözünün ES değerleri aynı hastanın fakik (n=21) olan diğer gözleri ile karşılaştırıldığında anlamlı olarak düşük (p=0,003), psödofakik (n=15) olan diğer gözleri ile karşılaştırıldığında daha düşük olmakla birlikte bu farkın anlamlı olmadığı (p=0,520) görüldü.Tartışma: İKL implantasyonu, tecrübeye bağımlı olarak, cerrahi sürenin kısa, komplikasyonların az olması nedeniyle sık tercih edilen güvenli ve etkili bir yöntemdir. Klasik iris önüne implantasyon ile kıyaslandığında iris arkasına implantasyon daha zor olmakla birlikte, lensin daha anatomik yerleşimi nedeniyle ikincil GİL seçiminde ilk tercihimizdir.Anahtar kelimeler: İkincil iris kıskaçlı lens, görme keskinliği, endotel sayısı. Purpose: To evaluate clinical and surgical outcomes of primary and secondary iris-claw lens (ICL) implantation.Materials and Methods: Onehundred and one eyes of 99 patients who underwent ICL implantation in Uludag University Ophthalmology Department between November 2008-December 2015, were included in this retrospective study. Data recorded for each subject consisted of age, gender, surgical indications, trauma history, surgical procedure, preoperative and postoperative spherical equivalent (SE), best corrected visual acuity (BCVA), intraocular pressure (IOP) and biomicroscopy examination findings. Central corneal thickness (CCT) and endothelial cell count (ECC) values were recorded for 40 eyes of 38 patients with followed-up period of 44,6 months.Results: The subjects were %39,4 female, %60,6 male and the mean age was 66,9±19,7 years. With compare to preoperative values, SE at first month was significantly improved (p=0,007); BCVA at first week and first month were significantly increased (p=0,001). Iris-claw lenses were centralized in all eyes at first month and in 40 eyes after 44,6 months; localized iris atrophy was seen in 9 patients and pigment dispersion in 2 patients. Endothelial cell count values in ICL implantated eyes were significantly lower (p=0,003) when compared to the fellow phakic eyes of the same patients (n=21). Although ECC values in ICL implantated eyes were lower than pseudophakic eyes of the same patients (n=15), it was not statistically significant (p=0,520).Conclusion: Iris-claw lens implantation is a safe, effective method that is frequently preferred due to its shorter surgery time and low complication rates. Although retropupillary ICL implantation might be seen as a challenging procedure than anterior chamber ICL implantation, it is our first choice due to its more adequate anatomic positioning.Key words: Secondary iris claw lens, best corrected visual acuity, endothelial cell count. 38

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.

* 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 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.