center dot PURPOSE: To examine the current causes of intraocular lens (IOL) explantation, compare various IOL explanta-tion techniques, and assess the visual outcomes and com-plications.center dot DESIGN: Retrospective comparative case series.center dot PARTICIPANTS: A total of 175 eyes of 160 patients who underwent IOL exchange for a one-piece foldable acrylic IOL between January 2010 and March 2022 were covered by the research. Group 1 included 74 eyes from 69 patients in which the IOL was removed after being grasped, pulled, and refolded inside the main incision. Group 2 consisted of 66 eyes from 60 patients in which the IOL was removed by bisecting it, whereas group 3 in-cluded 35 eyes from 31 patients in which the IOL was removed by enlarging the main incision.center dot MAIN OUTCOMES: Surgical indications, interventions, visual outcomes and refraction, and complications.center dot RESULTS: The mean patient age was 66.1 +/- 10.5 years. The mean time between primary surgery and IOL explan-tation was 57.0 +/- 38.9 months. IOL dislocation (in 85 eyes, 49.5%) was the most common reason for IOL ex -plantation. When the patients were examined in terms of both surgical indication groups and IOL removal tech-niques, corrected-distance visual acuity increased signifi-cantly in all subgroups ( P < .001). The increase in astig-matism after surgery was 0.08 +/- 0.13 diopters (D) in group 1, 0.09 +/- 0.17 D in group 2, and 0.83 +/- 0.29 D in group 3 ( P < .001).center dot CONCLUSIONS: The grasp, pull, and refold technique for IOL explantation provides a simpler surgery, less com-plication, and good visual outcomes. (Am J Ophthal-mol 2024;257: 84-90. (c) 2023 Elsevier Inc. All rights reserved.)

ABSRACT Background It was reported that pseudoexfoliative material deteriorates iris, brain, heart and lung functions. This material is also found in the skin. Aims The purpose of this study was to investigate the possible effects of pseudoexfoliation material on the aging of the facial skin. Study design Cross-sectional study. Methods Forty pseudoexfoliation syndrome (PES) cases and 40 age- and gender-matched controls were evaluated. Job, cigarette use and the presence of any systemic diseases as well as the duration of sun exposure for all the cases were recorded. All of the cases underwent facial skin examination with Wrinkle Assessment Scale as per Lemperle G et al. and Pinch Test. Results Wrinkle Assessment Scale scores of the groups also were compared for all 8 facial locations. There were statistically significant differences found between Wrinkle Assessment Scale scores in PES and Control Group for all 8 locations. Mean Wrinkle Assessment Scale scores of women were 4.12 ± 0.74 in Control Group and 4.75 ± 0.37 in PES group (p = 0.0001). For men, mean Wrinkle Assessment Scale scores were 3.77 ± 0.72 in Control group and 4.54 ± 0.36 in PES group (p = 0.002). Conclusion These results implies that there is quicker progression in aging of facial skin in PES than normals.

Purpose To evaluate the efficacy of preoperative topical brimonidine use to maintain visibility during trabeculectomy and control intraoperative bleeding and postoperative subconjunctival hemorrhage. Methods The first group comprised 35 eyes of 34 patients administered brimonidine tartrate 0.15% (Brimogut, Bilim Ilac, Turkey) eye drops 6 and 3 min before surgery, and 33 eyes of 31 patients who received no medication for vasoconstriction formed the second group. Preoperative and postoperative photographs and operation video images were taken and vision analysis software used. Black-and-white images were obtained to identify the blood vessel and surface hemorrhage areas. The surface area of the hemorrhage was calculated by counting the black pixels with Image J software. Results There was no significant difference between two groups in terms of baseline (preoperative) eye redness (p > 0.05). In the first group, the eye redness values were 344.7 ± 19.5 pixels preoperatively and 244.1 ± 23.3 pixels at the beginning of the surgery, respectively (p < 0.001). However, no significant change was observed in the second group in eye redness (348.2 ± 17.5 pixels preoperatively and 360.7 ± 26.8 pixels at the beginning of the surgery, p > 0.05). Cautery was used for an average of 11.91 ± 1.96 s in the first group and 25.57 ± 4.66 s in the second to control intraoperative bleeding (P < 0.001). Conclusion Preoperative topical brimonidine use in trabeculectomy surgery significantly decreased intraoperative bleeding and postoperative subconjunctival hemorrhage and facilitated bleeding control.

Abstract Purpose: To assess the effects of nepafenac ophthalmic suspension 0.1% for the control of pain experienced after dexamethasone intravitreal implant (Ozurdex) injections.Methods: This randomized, double-masked, placebo-controlled study included 68 adults receiving Ozurdex injection. Patients were randomly assigned to receive nepafenac ophthalmic suspension 0.1% or balanced salt solution placebo. They were asked to assess the level of pain using a visual analog scale (VAS) for pain, at 1, 6 and 24 hours following the injection. Results: At 1 hour after the injection, there was a course toward less pain scores in the nepafenac group; however, statistical significance was not reached. At 6 and 24 hours, the nepafenac group had significantly lower pain scores than those receiving placebo.Conclusion: Nepafenac ophthalmic suspension 0.1% is effective in reducing pain experienced after Ozurdex injections.

OBJECTIVES:This study was a prospective evaluation of changes in the results of visual field tests taken before and after pterygium excision. METHODS:This was a prospective, single-center study. Seventy-five eyes of 75 patients who had undergone pterygium excision with autograft implantation were enrolled. All of the patients had stage III pterygium according to the Johnston classification. The mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI) global index changes after pterygium excision were compared to evaluate the effect of pterygium on visual field analysis. RESULTS:The mean preoperative MD value was -3.04±2.63 dB (range: -14.84-0.62 dB) and the mean postoperative MD value was -1.83±2.09 dB (range: -13.82-1.74 dB) (p<0.001). The mean preoperative PSD value was 2.59±1.92 dB (range: 1.16-12.76 dB) and the mean postoperative PSD value was 2.41±1.62 dB (1.15-13.29 dB) (p>0.05). The mean preoperative VFI value was 96.01±4.46% (range: 68-100%) and the mean postoperative VFI value was 96.28±4.18% (range: 70-100%) (p>0.05). CONCLUSION:After pterygium excision, the MD improved significantly. However, the PSD and VFI did not change significantly. The significant change in MD value was related to the reduction in corneal light scattering, contrast sensitivity, aberrations, and blockage on the optic axis.

OBJECTIVES:The aim of this study was to evaluate the effectiveness of selective laser trabeculoplasty (SLT) at lowering intraocular pressure (IOP) as initial or adjunctive treatment in patients with primary open-angle glaucoma (POAG).METHODS:This was a prospective, comparative study. A total of 162 eyes of 81 patients with bilateral POAG were evaluated. The patients were categorized into 2 groups. SLT was performed as an adjunctive treatment in 42 POAG patients (Group 1, 84 eyes) and as initial treatment in 39 POAG patients (Group 2, 78 eyes).RESULTS:The mean baseline IOP and post-SLT IOP for the entire study group was 23.3±4.8 mm Hg and 14.6±2.7 mm Hg, respectively. The mean percentage reduction of IOP post-SLT at the final visit was 34.5% in Group 1 and 40.5% in Group 2. The number of medications used in the Group 1 before SLT was 2.11±0.88 (range: 1-4), while after SLT, medication use decreased to 0.9 ±0.15 (range: 0-3). The mean length of follow-up was 49.85±8.2 weeks (range: 24-78 weeks).CONCLUSION:SLT can be used effectively as a primary or an adjunctive therapy for the treatment of POAG. It was also effective at reducing the quantity of medications used. The reduction in IOP was similar in the primary and adjunctive group for up to 1 year of follow-up.

Objectives: This study was an examination of the long-term results of transcanalicular laser (TCL) and external (EX) dacryocystorhinostomy (DCR). Methods: Patients who had undergone TCL-DCR or EX-DCR between 2009 and 2013 were invited for long-term follow-up in 2019. All of the patients who responded had an ophthalmic examination and were assessed using lacrimal irrigation. An intranasal evaluation was performed when the irrigation test had non-patent results. TCL procedures were performed with a diode laser (980 nm). Ostium cleansing with a suction unit and a nasal endoscope was performed in the first week. In EX-DCR procedures, an anterior flap was created and tented to the orbicularis oculi muscle. A silicon tube was implanted in both methods and removed at 4-6 months. Results: A total of 74 EX-DCR patients were assessed. The lacrimal irrigation test was negative in 5 cases. The functional success rate was 93.2% with a follow-up of 8 years. A total of 63 patients who had undergone TCL-DCR were evaluated and the irrigation test was negative in 9 patients. The functional success rate was 85.7% with a follow-up of 7 years. The difference in the success rate was statistically insignificant with a p value of 0.09. Conclusion: The long-term success rates of both EX-DCR and TCL-DCR were high.

This study aims to assess whether an individual's chronotype (i.e. morningness versus eveningness) has an impact on tear film. Eighty-six dry eye patients not having any underlying systemic or metabolic diseases and either a morning or evening chronotype were included in the study. Tear film break-up time (BUT) and Schirmer tests are common objective tests that are used to diagnose the eye dryness. Using multivariate analysis of covariance (MANCOVA), we investigated the interaction effect of chronotype x sex on insomnia, Schirmer (mm) and BUT (sec) measurements after adjusting for age. We found that the participants who were more prone to evening chronotype characteristics reported to have more severe dry eye signs which monitor with the aid of the Schirmer and tear film break-up time test. In addition, those with higher scores in insomnia severity index had lower Schirmer test and tear film break-up time scores. These findings suggest that chronobiological factors may play a crucial role in the dry eye symptom severity.

Aim: To evaluate the outcome of the modified technique of external dacryocystorhinostomy (EDCR) with a "U"-shaped single flap that was fixed on to the orbicularis muscle with combined silicone tube in dacriostenosis. In cases with decreased visibility because of excessive bleeding during surgery, a small sac size, and difficulty of mutual suturing between nasal mucosal and sac flaps related to distance.Methods: This retrospective study included 118 patients with a nasolacrimal duct obstruction who underwent the modified technique of EDCR. The modified EDCR procedure envisions the creation of anastomosis of the single anterior "U"-shaped flaps suturing anterior flaps of the lacrimal sac and nasal mucosa. The sutured flap was fixed on to the orbicularis muscle. The silicone tube intubation was performed on all patients.Results: The average age of the patients was 39 +/- 19.2 (9-70) years, including 94 women and 24 men. The average follow-up time was 18 +/- 4.5 (9-36) months. Total 112 eyes (94.9%) showed a patent lacrimal system to irrigation, whereas 6 eyes (5.1%) had recurrence of epiphora and not patent lacrimal system to irrigation by the end of the first surgeries. The same surgery was planned for these patients. The patent lacrimal system was achieved in 3 of these 6 eyes. The overall success rate of the surgical procedure used in this study was 97.4%.Conclusions: This modified technique of EDCR with a "U"-shaped single anterior flaps that was fixed on to the orbicularis muscle with combined silicone tube simplifies the surgical procedure and is effective in the management of nasolacrimal duct obstruction.

Objective: To assess the effects of nepafenac ophthalmic suspension 0.1% for control of pain in patients undergoing pterygium surgery. Methods: This randomized, double-masked placebo-controlled study included 62 adults undergoing pterygium surgery. Patients were randomly assigned to receive nepafenac ophthalmic suspension 0.1% or balanced salt solution placebo. They were asked to assess the level of pain using an 11-point numeric rating scale at 6, 12, 24, 48, and 72 hr after surgery. Patients also were evaluated daily for the progression of corneal epithelial healing until complete closure was observed. Results: Except at 72 hr after surgery, the patients reported significantly less pain in eyes receiving nepafenac than in eyes receiving placebo. There was no statistical difference between the two groups in corneal epithelial healing. Conclusions: Treatment with nepafenac ophthalmic suspension 0.1% significantly reduced postoperative pain compared with placebo after pterygium surgery.

Objective: To evaluate the peripapillary choroidal thickness of patients with chronic obstructive pulmonary disease (COPD) via enhanced depth imaging optical coherence tomography (EDI-OCT).Materials and methods: A total of 80 patients with COPD (80 eyes) and 50 control subjects (50 eyes) were enrolled. Choroidal scans and the retinal nerve fiber layer (RNFL) thickness were obtained for all eyes using OCT.Results: The average peripapillary choroidal thickness measurements of the COPD group (147.5853.53m) were lower than the control group (160.84 +/- 44.73m) (p=0.068). Inferior segment thicknesses were significantly thinner than the other segments (p<0.05). Subfoveal choroidal thickness and RNFL thickness measurements of the COPD group were also lower than those of the control group (p=0.111).Conclusion: Hypoxia in COPD seems to affect the choroidal thickness. Thinning of the choroid may be attributed to increased vascular resistance and reduced blood flow in patients with COPD. The possible effects of the disease to the eye may be clarified through the role of the choroidal vasculature in the blood supply of the anterior optic nerve head.

Abstract Objective: The purpose of this study was to examine the vasoreactivity in retina and choroid of the healthy eyes in response to experimentally altered partial arterial pressure of carbon dioxide (PaCO2) using a non-invasive technique, spectral domain optical coherence tomography (SD-OCT). Materials and methods: The study included non-smoking participants between 18 and 35 years of age, having visual acuity of 20/20 and with no systemic and ocular diseases. At baseline, the participants breathed room air (normocapnia). Hypocapnia was created with the help of hyperventilation; for this, the participants were instructed to draw deep and quick breaths, resulting one breathing cycle per 2 s. To create hypercapnia subjects rebreathed from a 5 l bag at least 3 min. Choroidal thickness and retinal artery diameter were measured at baseline, and hyperventilation and rebreathing conditions by SD-OCT. Results: Twenty eyes of 20 healthy subjects were included in this study. Their mean age was 24.90 ± 5.32 years. Hyperventilation caused a significant reduction in choroidal thickness, compared with baseline, at all points; whereas rebreathing caused no significant change at all points. The mean diameters of the arteries were 151.80 ± 7.88 μm, with a significant decline to 148.90 ± 7.25 μm at hyperventilation condition and a significant increase to 153.50 ± 7.88 μm at rebreathing condition (p = 0.018, p = 0.043, respectively). Conclusion: This study demonstrated that, SD-OCT was a useful tool in measuring the ocular vascular response under hypercapnia and hypocapnia conditions. These findings may be helpful for further understanding the physiological nature of ocular blood flow and this preliminary study provides a basis for future studies.

Objective: To evaluate the histopathological results of cases who presented with an eyelid mass and underwent mass excision. Methods: The histopathological results of 107 cases, who underwent eyelid mass excision between May 2011 and March 2014 were retrospectively analyzed. Age and sex, mass localization, operative technique, and histopathological results were recorded. Results: Of 107 subjects included in the study, 61 were male and 46 were female, with a mean age of 49.44±19.81 years. The distribution of benign eyelid tumors were as follows: 37 (37.8%) squamous papillomas, 19 (19.4%) intradermal nevus, 9 (9.2%) seborrheic keratosis, 7 (7.1%) epidermal inclusion cyst, 6 (6.1%) inflammatory lesions, 5 (5.1%) suderiferous cysts, 5 (5.1%) capillary hemangiomas, 3 (3.1%) xanthelasma, 3 (3.1%) fibromas, 1 (1.0%) moll gland cyst, 1 (1.0%) chondroid syringoma, 1 (1.0%) dermoid cyst, and 1 (1.0%) actinic keratosis. Malignant eyelid tumors included 8 (88.9%) cases of basal cell carcinomas and 1 (11.1%) squamous cell carcinoma. Conclusion: In this study squamous papilloma was the most common benign eyelid tumor followed by intradermal nevus. Basal cell carcinoma was the most common malignant eyelid tumor followed by squamous cell carcinoma.

We evaluated the effect of phacoemulsification surgery on intraocular pressure (IOP), anterior chamber depth (ACD), iridocorneal angle (ICA), and central corneal thickness (CCT) of the patients with cataract and ocular hypertension. The decrease in IOP values of the 1st week, 1st month, 3rd month, 6th month, and 1st year was statistically significant, but that of the 2nd year was not significant. The increase in ACD and ICA values of the 1st week, 1st month, 3rd month, 6th month, and 1st year was statistically significant, but that of the 2nd year was not significant. The increase in CCT values of 1st week and 1st month was statistically significant, but those of 3rd month, 6th month, 1st year, and 2nd year were not significant. In conclusion, phacoemulsification surgery decreases IOP and increases ACD and ICA in the short-term. However, in the long-term it does not cause any significant changes.

Purpose: To compare bactericidal activities of daptomycin (DAP) and vancomycin (VAN) in an experimental rabbit model of Enterococcus faecalis endophthalmitis.Materials and methods: The right vitreous cavities of 24 New Zealand rabbits were inoculated with 100 colony-forming units of E. faecalis; and after 24 h, rabbits were randomly divided into three groups. DAP group (n = 8, 0.2 mg/0.05 ml intravitreally), VAN group (n = 8, 1 mg/0.05 ml intravitreally) and balanced salt solution group (BSS, n = 8, 0.05 ml intravitreally). Clinical examination scores were recorded, and vitreous aspirates were obtained for microbiological analysis on days 0, 1, 2, 3 and 4. Rabbits were sacrificed, and the eyes were enucleated for histopathological assessment.Results: There was no difference between the DAP, VAN and BSS groups in terms of the clinical grading of endophthalmitis 24 h after the inoculation. The bacterial counts were similar between the VAN and DAP groups except on day 1, where it was significantly lower than those in the VAN group (p = 0.003). On day 4, 62% of the eyes treated with DAP, and 50% of the eyes treated with VAN were sterilized. All of the eyes from the BSS group showed increasing bacterial growth from day 0 to day 4. There was no difference between the DAP and VAN groups in terms of the histopathological and clinical examination scores, while they were significantly lower than those in the BSS group.Conclusions: This study demonstrates evidence of the effectiveness of DAP for the treatment of experimental E. faecalis endophthalmitis.

The aim of this retrospective study was to evaluate the course of dry eye syndrome after phacoemulsification surgery.

PURPOSE To evaluate the outcomes and complications following phacoemulsification surgery in eyes with cataract and high myopia. METHODS We retrospectively evaluated the data of 43 eyes of 28 consecutive patients (12 males, 16 females) with cataract and high myopia who had undergone phacoemulsification and intraocular lens (IOL) implantation. The mean [± standard deviation (range)] age of the patients was 59.20 ± 11.08 (39-77) years. RESULTS The frequency of nuclear cataract was significantly higher than that of other cataract types (P=0.003). The mean axial length was 28.97 ± 1.99 (26-33) mm and the mean IOL power was 5.09 ± 4.78 (-3.0 to +14.0) diopters (D). The mean preoperative spherical equivalent (SE) was -16.48 ± 5.23 (-8.00 to -25.00) D and the mean postoperative SE was -1.46 ± 0.93 (0.00 to -3.00) D (P=0.00). The mean preoperative best-corrected visual acuity (BCVA) was 0.91 ± 0.37 (0.30 to -1.50) logMAR and the mean postoperative BCVA was 0.29 ± 0.25 (0.00-1.00) logMAR (P=0.00). Twenty-two eyes (51.2%) achieved the target postoperative refraction (±1.0 D). The eyes were divided into 3 groups according to the axial length. The mean biometric error was significantly higher in the group with the greatest axial length than in the other groups (P=0.007). Preoperative argon laser photocoagulation was performed in 7 eyes (16%) on account of retinal tears, retinal holes, or lattice degeneration. Postoperatively, retinal tears developed in 2 eyes (4%) and were treated with photocoagulation. One eye (2%) developed retinal detachment postoperatively, with the patient consequently referred for retinal surgery. Postoperatively, posterior capsule opacities developed in 11 eyes (25%), with all cases treated by laser capsulotomy. CONCLUSIONS Good postoperative outcomes following phacoemulsification surgery were observed in patients with cataract and high myopia. However, clinicians should be aware of the risk of postoperative retinal tears and rhegmatogenous retinal detachment. Preoperative prophylactic argon laser photocoagulation treatment should be considered where necessary.

Objective: To evaluate the histopathological results of cases who presented with an eyelid mass and underwent mass excision. Methods:The histopathological results of 107 cases, who underwent eyelid mass excision between May 2011 and March 2014 were retrospectively analyzed.Age and sex, mass localization, operative technique, and histopathological results were recorded. Results:Of 107 subjects included in the study, 61 were male and 46 were female, with a mean age of 49.44±19.81years.The distribution of benign eyelid tumors were as follows: 37 (37.8%)squamous papillomas, 19 (19.4%) intradermal nevus, 9 (9.2%) seborrheic keratosis, 7 (7.1%)epidermal inclusion cyst, 6 (6.1%) inflammatory lesions, 5 (5.1%) suderiferous cysts, 5 (5.1%) capillary hemangiomas, 3 (3.1%)xanthelasma, 3 (3.1%)fibromas, 1 (1.0%) moll gland cyst, 1 (1.0%) chondroid syringoma, 1 (1.0%) dermoid cyst, and 1 (1.0%) actinic keratosis.Malignant eyelid tumors included 8 (88.9%) cases of basal cell carcinomas and 1 (11.1%)squamous cell carcinoma. Conclusion:In this study squamous papilloma was the most common benign eyelid tumor followed by intradermal nevus.Basal cell carcinoma was the most common malignant eyelid tumor followed by squamous cell carcinoma.

Objective: To evaluate the histopathological results of cases who presented with an eyelid mass and underwent mass excision. Methods: The histopathological results of 107 cases, who underwent eyelid mass excision between May 2011 and March 2014 were retrospectively analyzed. Age and sex, mass localization, operative technique, and histopathological results were recorded. Results: Of 107 subjects included in the study, 61 were male and 46 were female, with a mean age of 49.44±19.81 years. The distribution of benign eyelid tumors were as follows: 37 (37.8%) squamous papillomas, 19 (19.4%) intradermal nevus, 9 (9.2%) seborrheic keratosis, 7 (7.1%) epidermal inclusion cyst, 6 (6.1%) inflammatory lesions, 5 (5.1%) suderiferous cysts, 5 (5.1%) capillary hemangiomas, 3 (3.1%) xanthelasma, 3 (3.1%) fibromas, 1 (1.0%) moll gland cyst, 1 (1.0%) chondroid syringoma, 1 (1.0%) dermoid cyst, and 1 (1.0%) actinic keratosis. Malignant eyelid tumors included 8 (88.9%) cases of basal cell carcinomas and 1 (11.1%) squamous cell carcinoma. Conclusion: In this study squamous papilloma was the most common benign eyelid tumor followed by intradermal nevus. Basal cell carcinoma was the most common malignant eyelid tumor followed by squamous cell carcinoma.

PURPOSE:To evaluate the influence of size and shape of neodymium:yttrium aluminum- Garnet (Nd:YAG) laser capsulotomy on visual acuity and refraction.METHODS:We retrospectively evaluated 85 eyes of 67 patients treated with Nd:YAG laser posterior capsulotomy for posterior capsule opacification (PCO). The mean age of included patients was 57.57 ± 9.26 (mean ± standard deviation, 38-75 years). The mean interval between surgery and Nd:YAG laser capsulotomy was 26.09 ± 7.08 (10-38) months. Patients were divided into four groups according to the shape and size of capsulotomy. Groups comprised patients with cruciate shape capsulotomies with openings of less than or equal to 3.5 mm (Group 1) or greater (Group 2) and patients with circular shape capsulotomies with openings of less than or equal to 3.5 mm (Group 3) or greater (Group 4).RESULTS:The mean number and energy of laser firings were significantly higher in Group 4 (p=0.00), and significantly lower in Group 1 (p=0.00), compared with that in other groups. Pre-procedural and post-procedural mean spherical equivalent (SE) values were significantly higher in Group 1 (p=0.026 and p=0.011, respectively). No statistical difference in best-corrected visual acuities (BCVA) or intraocular pressures (IOP) were observed between groups before (p=0.44 and p=0.452, respectively) or after capsulotomy (p=0.108 and p=0.125, respectively). A significantly higher number of patients in Group 4 (p=0.001), and a significantly lower number of patients in Group 1 (p=0.001), reported floating bodies compared with that in other groups. No significant changes in SE or intraocular pressure were observed after capsulotomy in any group (p=0.074 and p=0.856, respectively). Best-corrected visual acuity was significantly improved following capsulotomy in all groups (p<0.01).CONCLUSION:Cruciate shape capsulotomy with an opening of 3.5 mm or less provides the greatest improvement in visual function with minimal complications.