To evaluate the changes in central macular thickness measured with optical coherence tomography (... more To evaluate the changes in central macular thickness measured with optical coherence tomography (OCT) after cataract surgery combined with primary posterior continuous curvilinear capsulorhexis (PCCC). Forty-six eyes of 40 consecutive patients who had uneventful phacoemulsification and in-the-bag intraocular lens implantation surgery with primary PCCC, taking place between August 2005 and January 2006 in Beyoglu Eye Training and Research Hospital, were enrolled. Patients with a history of previous ocular surgery, eye trauma, uveitis, or glaucoma, or any systemic disease such as diabetes mellitus, were excluded from the study. None of the cases had macular pathology before surgery. OCT was performed in all patients preoperatively and postoperatively on the first day, first week, and first, third, and sixth months. Significant quantitative changes from the preoperative examination were observed in the postoperative first week, first month, and third month (p<0.05). The difference between the mean preoperative and postoperative sixth month central macular thickness was not statistically significant (p=0.20). The greatest change in mean macular thickness was noted in the first month visit. No patient developed cystoid macular edema. Because primary PCCC does not have an adverse effect on macular integrity, this procedure may be preferred especially in patients with a high risk of posterior capsular opacification.
Our aim was to evaluate the alterations of subfoveal choroidal thickness (SFCT), photoreceptor la... more Our aim was to evaluate the alterations of subfoveal choroidal thickness (SFCT), photoreceptor layer thickness (PRT), and retinal vessel diameter in the dark and light adaptation. Twenty-four eyes of 24 healthy volunteers (12 males, 12 females) were included in this cross-sectional and observational study. The SFCT, PRT, retinal arteriole, and venule caliber measurements were performed with spectral domain optical coherence tomography in the dark (0.0 cd/m(2)) and under light (80 cd/m(2)) adapted conditions. The mean age of the participants was 30.4 ± 4.4 years (range: 22-42). The SFCT increased statistically significantly in dark adaptation (p < 0.001), then returned to baseline values following light adaptation. The PRT, retinal arteriole, and venule caliber measurements were similar in the dark and light (p > 0.05). While SFCT increased, PRT, and retinal vessel diameter did not change following transition from light to dark.
To evaluate the changes in central macular thickness measured with optical coherence tomography (... more To evaluate the changes in central macular thickness measured with optical coherence tomography (OCT) after cataract surgery combined with primary posterior continuous curvilinear capsulorhexis (PCCC). Forty-six eyes of 40 consecutive patients who had uneventful phacoemulsification and in-the-bag intraocular lens implantation surgery with primary PCCC, taking place between August 2005 and January 2006 in Beyoglu Eye Training and Research Hospital, were enrolled. Patients with a history of previous ocular surgery, eye trauma, uveitis, or glaucoma, or any systemic disease such as diabetes mellitus, were excluded from the study. None of the cases had macular pathology before surgery. OCT was performed in all patients preoperatively and postoperatively on the first day, first week, and first, third, and sixth months. Significant quantitative changes from the preoperative examination were observed in the postoperative first week, first month, and third month (p<0.05). The difference b...
To evaluate the safety and efficacy of a new microwave thermokeratoplasty procedure combined with... more To evaluate the safety and efficacy of a new microwave thermokeratoplasty procedure combined with accelerated corneal collagen crosslinking (CXL) to improve visual function in patients with keratoconus. Cornea and refractive surgery department, Istanbul, Turkey. Prospective clinical trial. Patients with keratoconus who had the combined procedure were evaluated over 12 months postoperatively. The main outcome measures were changes in logMAR uncorrected (UDVA) and corrected (CDVA) distance visual acuities and in keratometry (K) values. The study enrolled 24 eyes of 24 patients aged 18 to 45 years. The attempted corrections ranged from -1.60 to -6.50 diopters (D). The mean preoperative UDVA of 0.66 logMAR ± 0.26 (SD) significantly improved to 0.39 ± 0.21 logMAR 1 month postoperatively. However by 6 months, the mean UDVA had regressed to 0.58 ± 0.21 logMAR. At 12 months, the mean UDVA was 0.62 ± 0.17 logMAR. The mean K value was 49.11 ± 2.43 D preoperatively, 43.50 ± 3.04 D 1 month postoperatively, 47.52 ± 2.99 D at 6 months, and 48.37 ± 3.00 D at 12 months. There were no cases of significant endothelial cell loss or loss of CDVA lines at 12 months. The new thermokeratoplasty procedure followed by accelerated CXL produced the desired reduction in K values and improvement in postoperative UDVA without significant side effects. However, the early and complete regression of the thermokeratoplasty effect shows the need for further advancement of this technology. Drs. Yilmaz and Marshall are paid consultants to Avedro, Inc. Dr. Muller is president and CEO of Avedro. No other author has a financial or proprietary interest in any material or method mentioned.
Abstract Purpose: To evaluate the differences in corneal biomechanical properties between healthy... more Abstract Purpose: To evaluate the differences in corneal biomechanical properties between healthy subjects and patients with pseudoexfoliation syndrome (PEX) and pseudoexfoliative glaucoma (PEXG) using the ocular response analyzer (ORA). Materials and methods: One hundred eighteen eyes of 45 healthy, 43 PEX and 30 PEXG eyes were included in to the study. Corneal biomechanical parameters measurements were obtained using ORA. The main parameters assessed were corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated pressure measurement (IOPg) and corneal compensated intraocular pressure (IOPcc). Ultrasound pachymetry was used for measurement of central corneal thickness (CCT). Results: In healthy subjects, PEX and PEXG eyes&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; mean CH values were 10.3 ± 1.4, 8.2 ± 1.4 and 6.8 ± 1.7 mmHg, respectively. The difference in mean CH between the PEXG and other two groups were statistically significant (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Mean CRF values were 10.3 ± 0.7, 7.9 ± 1.6 and 7.9 ± 1.9 mmHg, in healthy subjects PEX and PEXG, respectively. The difference in mean CRF between the PEX and PEXG was not statistically significant (p = 0.630), however the mean CRF was significantly higher in healthy subjects, compared to other two groups. Mean CCT were 546.3 ± 28, 525.5 ± 35 and 509 ± 36 μ, in healthy subjects, PEX and PEXG, respectively. The differences on CCT were also significant among the three groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Conclusion: In this study, the corneal biomechanical features of subjects with PEX were found to be changed as compared to healthy controls. In these patients; CH, CRF and CCT were decreased which was more obvious in patients with PEXG in comparison to PEX patients.
To compare the topographic and biomechanical properties of corneas in the eyes of patients with o... more To compare the topographic and biomechanical properties of corneas in the eyes of patients with ocular rosacea (OR) with those of healthy individuals. Thirty-four healthy individuals (control group) and 34 patients with OR (study group) were evaluated in this study. Topographic measurements including keratometry values, irregularity, and surface asymmetry index in the right eye of each participant were obtained using a Scheimpflug camera with a Placido disc topographer (Sirius). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOP), and Goldmann-related IOP were measured using the Reichert Ocular Response Analyzer. Central corneal thickness was also measured using ultrasonic pachymetry and the Sirius corneal topography system. Topographic parameters were not significantly different between the groups (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Mean CH and CRF were significantly lower in patients with OR (P = 0.003 and 0.001, respectively). Central corneal thickness was significantly lower in patients with OR compared with healthy controls (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Mean Goldmann-related IOP and corneal-compensated IOP were not significantly different between the groups (P = 0.09 and 0.13, respectively). This study demonstrated that although the eyes of patients with OR had corneal topographic findings similar to those of healthy controls, corneal biomechanical measurements (CH and CRF) were significantly lower in patients with OR. These results need to be considered when planning corneal refractive surgery in patients with OR.
To evaluate the agreement among three different optical methods in measuring anterior chamber dep... more To evaluate the agreement among three different optical methods in measuring anterior chamber depth (ACD), central corneal thickness (CCT), and pupil diameter. One hundred eyes of 50 healthy patients (25 men, 25 women) were enrolled in the study. Mean patient age was 25 years (range: 21 to 32 years). Exclusion criteria were history of any intraocular or corneal surgery, contact lens wear, corneal anomalies, and spherical refraction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5.00 diopters (D) or cylindrical refraction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;2.00 D. All measurements were done by the same operator under mesopic light conditions and repeated using three different optical methods: Visante optical coherence tomography (OCT) (Carl Zeiss Meditec), Orbscan (Bausch &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Lomb), and Pentacam (Oculus Optikgeräte GmbH). Mean CCT as measured by Visante OCT, Orbscan, and Pentacam was 529+/-30.5 microm, 554+/-32.7 microm, and 552+/-29.3 microm, respectively. Mean ACD values were 2.94+/-0.34 mm, 2.84+/-0.33 mm, and 2.98+/-0.33 mm, respectively. Mean pupil diameter measurements were 4.87+/-1.09 mm, 4.0+/-0.67 mm, and 3.05+/-0.59 mm, respectively. The Visante OCT measured CCT thinner and Orbscan measured ACD shallower than the other two methods. All three methods measured pupil diameters significantly different. This study found some statistically significant but clinically insignificant differences among the optical methods assessed. The differences are small and do not influence decisions for refractive surgery in clinical practice.
To evaluate the long-term visual results of Acufocus ACI-7000 (now Kamra) intracorneal inlay impl... more To evaluate the long-term visual results of Acufocus ACI-7000 (now Kamra) intracorneal inlay implantation in presbyopic phakic patients. Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey. Clinical trial. This study comprised patients with emmetropic or post-laser in situ keratomileusis (LASIK) presbyopia. Patients had an uncorrected near visual acuity (UNVA) of 20/40 or worse, correctable to 20/25 or better at distance. The inlay was implanted on the stromal bed after the LASIK flap was relifted or a flap created. The inlay was centered on the presurgical position of the first Purkinje reflex. The main outcome measures were distance and near vision and the complication rate. The study enrolled 39 patients aged 45 to 60 years. At the 4-year follow-up, all patients (N = 22) had 2 or more lines of improvement in UNVA with no significant loss in distance vision. The mean final UNVA was 20/20 (Jaeger [J1]); 96% of patients could read J3 or better. The uncorrected distance acuity was 20/40 or better in all eyes. Five patients had cataract progression, and 2 had a change in refractive status. No eye with an intracorneal inlay had intraoperative complications during cataract extraction. Four inlays were explanted during the study. There were no severe corneal complications that affected final vision. Intracorneal inlay implantation was an effective, safe, and reversible procedure for the long-term surgical treatment of presbyopia.
To assess the safety, predictability, and stability of a new microwave thermokeratoplasty procedu... more To assess the safety, predictability, and stability of a new microwave thermokeratoplasty procedure to correct myopia. Cornea and refractive surgery subspecialty. Prospective clinical trial. Thermokeratoplasty was performed in myopic eyes at a single center in Turkey from June 2009 to June 2010. The attempted corrections ranged from -1.25 to -5.75 diopters (D). The main outcome measures were changes in logMAR uncorrected distance visual acuity (UDVA) and in keratometry (K) values. The procedure was performed in 33 eyes (patients aged 20 to 45 years). The mean preoperative logMAR UDVA (0.76 ± 0.24 [SD]) significantly improved to 0.19 ± 0.20 at 1 month, postoperatively. By 3 months, the mean UDVA had markedly regressed to 0.59 ± 0.29; however, the residual improvement remained statistically significant. At 12 months, the mean logMAR UDVA was 0.72 ± 0.26. The mean K values were 43.9 ± 1.36 D preoperatively, 41.25 ± 2.63 D at 1 month, 43.4 ± 1.69 D at 3 months, and 44.1 ± 1.09 D at 12 months. The mean endothelial cell density was 2836 ± 342 cells/mm(2) preoperatively and were statistically unchanged 12 months postoperatively (2732 ± 353 cell/mm(2)). No patient lost lines of corrected distance visual acuity by 12 months postoperatively. The new thermokeratoplasty procedure produced the desired reduction in myopia and improvement in postoperative UDVA 1 month postoperatively without significant side effects. However, early and complete regression shows the need for further development of this technique. Drs. Yilmaz and Marshall are paid consultants to Avedro, Inc., and Dr. Muller is president and CEO of Avedro, Inc. No other author has a financial or proprietary interest in any material or method mentioned.
To assess accelerated corneal collagen crosslinking (CXL) applied concurrently with laser in situ... more To assess accelerated corneal collagen crosslinking (CXL) applied concurrently with laser in situ keratomileusis (LASIK) in a small group of patients. Beyoglu Eye Research and Training Hospital, Istanbul, Turkey. Prospective pilot interventional case series. In May 2010, patients had LASIK with concurrent accelerated CXL in 1 eye and LASIK only in the fellow eye to treat myopia or myopic astigmatism. The follow-up was 12 months. The attempted correction (spherical equivalent) ranged from -5.00 to -8.50 diopters (D) in the LASIK-CXL group and from -3.00 to -7.25 D in the LASIK-only group. Main outcome measures were manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, and the endothelial cell count. Eight eyes of 3 women and 1 man (age 22 to 39 years old) were enrolled. At the 12-month follow-up, the LASIK-CXL group had a UDVA and manifest refraction equal to or better than those in the LASIK-only group. No eye lost 1 or more lines of CDVA at the final visit. The endothelial cell loss in the LASIK-CXL eye was not greater than in the fellow eye. No side effects were associated with either procedure. Laser in situ keratomileusis with accelerated CXL appears to be a promising modality for future applications to prevent corneal ectasia after LASIK treatment. The results in this pilot series suggest that evaluation of a larger study cohort is warranted. Drs. Yilmaz and Marshall are paid consultants to Avedro, Inc. No other author has a financial or proprietary interest in any material or method mentioned.
To evaluate the efficacy of intravitreal dexamethasone implant (IDI) for the treatment of persist... more To evaluate the efficacy of intravitreal dexamethasone implant (IDI) for the treatment of persistent diabetic macular edema (DME) in a subgroup of pseudophakic and nonglaucomatous eyes over a 12-month follow-up period. This was a retrospective, interventional study. Patients with persistent DME who were pseudophakic and did not have a glaucoma or ocular hypertension history, or a family history of glaucoma, were included. After an initial IDI injection, reinjections were performed on an as-needed basis. Changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), intraocular pressure (IOP), and number of injections at month 12 were evaluated. The study included 50 eyes of 43 patients. Mean BCVA at baseline and at months 1, 3, 6, 9, and 12 were 0.22 ± 0.17, 0.31 ± 0.21, 0.25 ± 0.17, 0.25 ± 0.17, and 0.29 ± 0.19 Snellen equivalent, respectively (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05 for all). Mean CRT at baseline and at months 1, 3, 6, 9, and 12 were 606 ± 202 μm, 330 ± 97 μm, 347 ± 104 μm, 405 ± 149 μm, 383 ± 129 μm, and 397 ± 144 μm, respectively (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001 for all). Seven of the 50 eyes (14 %) showed an increase in IOP of ≥10 mm Hg and only 2 of them (4%) needed chronic antiglaucoma medication. The mean number of injections at month 12 was 2.04 ± 0.5. In pseudophakic and nonglaucomatous eyes with DME, IDI was found to be beneficial in regard to visual and anatomic success and seemed safe in this selected group of patients.
To evaluate the changes in central macular thickness measured with optical coherence tomography (... more To evaluate the changes in central macular thickness measured with optical coherence tomography (OCT) after cataract surgery combined with primary posterior continuous curvilinear capsulorhexis (PCCC). Forty-six eyes of 40 consecutive patients who had uneventful phacoemulsification and in-the-bag intraocular lens implantation surgery with primary PCCC, taking place between August 2005 and January 2006 in Beyoglu Eye Training and Research Hospital, were enrolled. Patients with a history of previous ocular surgery, eye trauma, uveitis, or glaucoma, or any systemic disease such as diabetes mellitus, were excluded from the study. None of the cases had macular pathology before surgery. OCT was performed in all patients preoperatively and postoperatively on the first day, first week, and first, third, and sixth months. Significant quantitative changes from the preoperative examination were observed in the postoperative first week, first month, and third month (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). The difference between the mean preoperative and postoperative sixth month central macular thickness was not statistically significant (p=0.20). The greatest change in mean macular thickness was noted in the first month visit. No patient developed cystoid macular edema. Because primary PCCC does not have an adverse effect on macular integrity, this procedure may be preferred especially in patients with a high risk of posterior capsular opacification.
Our aim was to evaluate the alterations of subfoveal choroidal thickness (SFCT), photoreceptor la... more Our aim was to evaluate the alterations of subfoveal choroidal thickness (SFCT), photoreceptor layer thickness (PRT), and retinal vessel diameter in the dark and light adaptation. Twenty-four eyes of 24 healthy volunteers (12 males, 12 females) were included in this cross-sectional and observational study. The SFCT, PRT, retinal arteriole, and venule caliber measurements were performed with spectral domain optical coherence tomography in the dark (0.0 cd/m(2)) and under light (80 cd/m(2)) adapted conditions. The mean age of the participants was 30.4 ± 4.4 years (range: 22-42). The SFCT increased statistically significantly in dark adaptation (p &amp;amp;amp;amp;lt; 0.001), then returned to baseline values following light adaptation. The PRT, retinal arteriole, and venule caliber measurements were similar in the dark and light (p &amp;amp;amp;amp;gt; 0.05). While SFCT increased, PRT, and retinal vessel diameter did not change following transition from light to dark.
To evaluate the changes in central macular thickness measured with optical coherence tomography (... more To evaluate the changes in central macular thickness measured with optical coherence tomography (OCT) after cataract surgery combined with primary posterior continuous curvilinear capsulorhexis (PCCC). Forty-six eyes of 40 consecutive patients who had uneventful phacoemulsification and in-the-bag intraocular lens implantation surgery with primary PCCC, taking place between August 2005 and January 2006 in Beyoglu Eye Training and Research Hospital, were enrolled. Patients with a history of previous ocular surgery, eye trauma, uveitis, or glaucoma, or any systemic disease such as diabetes mellitus, were excluded from the study. None of the cases had macular pathology before surgery. OCT was performed in all patients preoperatively and postoperatively on the first day, first week, and first, third, and sixth months. Significant quantitative changes from the preoperative examination were observed in the postoperative first week, first month, and third month (p<0.05). The difference b...
To evaluate the safety and efficacy of a new microwave thermokeratoplasty procedure combined with... more To evaluate the safety and efficacy of a new microwave thermokeratoplasty procedure combined with accelerated corneal collagen crosslinking (CXL) to improve visual function in patients with keratoconus. Cornea and refractive surgery department, Istanbul, Turkey. Prospective clinical trial. Patients with keratoconus who had the combined procedure were evaluated over 12 months postoperatively. The main outcome measures were changes in logMAR uncorrected (UDVA) and corrected (CDVA) distance visual acuities and in keratometry (K) values. The study enrolled 24 eyes of 24 patients aged 18 to 45 years. The attempted corrections ranged from -1.60 to -6.50 diopters (D). The mean preoperative UDVA of 0.66 logMAR ± 0.26 (SD) significantly improved to 0.39 ± 0.21 logMAR 1 month postoperatively. However by 6 months, the mean UDVA had regressed to 0.58 ± 0.21 logMAR. At 12 months, the mean UDVA was 0.62 ± 0.17 logMAR. The mean K value was 49.11 ± 2.43 D preoperatively, 43.50 ± 3.04 D 1 month postoperatively, 47.52 ± 2.99 D at 6 months, and 48.37 ± 3.00 D at 12 months. There were no cases of significant endothelial cell loss or loss of CDVA lines at 12 months. The new thermokeratoplasty procedure followed by accelerated CXL produced the desired reduction in K values and improvement in postoperative UDVA without significant side effects. However, the early and complete regression of the thermokeratoplasty effect shows the need for further advancement of this technology. Drs. Yilmaz and Marshall are paid consultants to Avedro, Inc. Dr. Muller is president and CEO of Avedro. No other author has a financial or proprietary interest in any material or method mentioned.
Abstract Purpose: To evaluate the differences in corneal biomechanical properties between healthy... more Abstract Purpose: To evaluate the differences in corneal biomechanical properties between healthy subjects and patients with pseudoexfoliation syndrome (PEX) and pseudoexfoliative glaucoma (PEXG) using the ocular response analyzer (ORA). Materials and methods: One hundred eighteen eyes of 45 healthy, 43 PEX and 30 PEXG eyes were included in to the study. Corneal biomechanical parameters measurements were obtained using ORA. The main parameters assessed were corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated pressure measurement (IOPg) and corneal compensated intraocular pressure (IOPcc). Ultrasound pachymetry was used for measurement of central corneal thickness (CCT). Results: In healthy subjects, PEX and PEXG eyes&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; mean CH values were 10.3 ± 1.4, 8.2 ± 1.4 and 6.8 ± 1.7 mmHg, respectively. The difference in mean CH between the PEXG and other two groups were statistically significant (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Mean CRF values were 10.3 ± 0.7, 7.9 ± 1.6 and 7.9 ± 1.9 mmHg, in healthy subjects PEX and PEXG, respectively. The difference in mean CRF between the PEX and PEXG was not statistically significant (p = 0.630), however the mean CRF was significantly higher in healthy subjects, compared to other two groups. Mean CCT were 546.3 ± 28, 525.5 ± 35 and 509 ± 36 μ, in healthy subjects, PEX and PEXG, respectively. The differences on CCT were also significant among the three groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Conclusion: In this study, the corneal biomechanical features of subjects with PEX were found to be changed as compared to healthy controls. In these patients; CH, CRF and CCT were decreased which was more obvious in patients with PEXG in comparison to PEX patients.
To compare the topographic and biomechanical properties of corneas in the eyes of patients with o... more To compare the topographic and biomechanical properties of corneas in the eyes of patients with ocular rosacea (OR) with those of healthy individuals. Thirty-four healthy individuals (control group) and 34 patients with OR (study group) were evaluated in this study. Topographic measurements including keratometry values, irregularity, and surface asymmetry index in the right eye of each participant were obtained using a Scheimpflug camera with a Placido disc topographer (Sirius). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOP), and Goldmann-related IOP were measured using the Reichert Ocular Response Analyzer. Central corneal thickness was also measured using ultrasonic pachymetry and the Sirius corneal topography system. Topographic parameters were not significantly different between the groups (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Mean CH and CRF were significantly lower in patients with OR (P = 0.003 and 0.001, respectively). Central corneal thickness was significantly lower in patients with OR compared with healthy controls (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Mean Goldmann-related IOP and corneal-compensated IOP were not significantly different between the groups (P = 0.09 and 0.13, respectively). This study demonstrated that although the eyes of patients with OR had corneal topographic findings similar to those of healthy controls, corneal biomechanical measurements (CH and CRF) were significantly lower in patients with OR. These results need to be considered when planning corneal refractive surgery in patients with OR.
To evaluate the agreement among three different optical methods in measuring anterior chamber dep... more To evaluate the agreement among three different optical methods in measuring anterior chamber depth (ACD), central corneal thickness (CCT), and pupil diameter. One hundred eyes of 50 healthy patients (25 men, 25 women) were enrolled in the study. Mean patient age was 25 years (range: 21 to 32 years). Exclusion criteria were history of any intraocular or corneal surgery, contact lens wear, corneal anomalies, and spherical refraction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5.00 diopters (D) or cylindrical refraction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;2.00 D. All measurements were done by the same operator under mesopic light conditions and repeated using three different optical methods: Visante optical coherence tomography (OCT) (Carl Zeiss Meditec), Orbscan (Bausch &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Lomb), and Pentacam (Oculus Optikgeräte GmbH). Mean CCT as measured by Visante OCT, Orbscan, and Pentacam was 529+/-30.5 microm, 554+/-32.7 microm, and 552+/-29.3 microm, respectively. Mean ACD values were 2.94+/-0.34 mm, 2.84+/-0.33 mm, and 2.98+/-0.33 mm, respectively. Mean pupil diameter measurements were 4.87+/-1.09 mm, 4.0+/-0.67 mm, and 3.05+/-0.59 mm, respectively. The Visante OCT measured CCT thinner and Orbscan measured ACD shallower than the other two methods. All three methods measured pupil diameters significantly different. This study found some statistically significant but clinically insignificant differences among the optical methods assessed. The differences are small and do not influence decisions for refractive surgery in clinical practice.
To evaluate the long-term visual results of Acufocus ACI-7000 (now Kamra) intracorneal inlay impl... more To evaluate the long-term visual results of Acufocus ACI-7000 (now Kamra) intracorneal inlay implantation in presbyopic phakic patients. Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey. Clinical trial. This study comprised patients with emmetropic or post-laser in situ keratomileusis (LASIK) presbyopia. Patients had an uncorrected near visual acuity (UNVA) of 20/40 or worse, correctable to 20/25 or better at distance. The inlay was implanted on the stromal bed after the LASIK flap was relifted or a flap created. The inlay was centered on the presurgical position of the first Purkinje reflex. The main outcome measures were distance and near vision and the complication rate. The study enrolled 39 patients aged 45 to 60 years. At the 4-year follow-up, all patients (N = 22) had 2 or more lines of improvement in UNVA with no significant loss in distance vision. The mean final UNVA was 20/20 (Jaeger [J1]); 96% of patients could read J3 or better. The uncorrected distance acuity was 20/40 or better in all eyes. Five patients had cataract progression, and 2 had a change in refractive status. No eye with an intracorneal inlay had intraoperative complications during cataract extraction. Four inlays were explanted during the study. There were no severe corneal complications that affected final vision. Intracorneal inlay implantation was an effective, safe, and reversible procedure for the long-term surgical treatment of presbyopia.
To assess the safety, predictability, and stability of a new microwave thermokeratoplasty procedu... more To assess the safety, predictability, and stability of a new microwave thermokeratoplasty procedure to correct myopia. Cornea and refractive surgery subspecialty. Prospective clinical trial. Thermokeratoplasty was performed in myopic eyes at a single center in Turkey from June 2009 to June 2010. The attempted corrections ranged from -1.25 to -5.75 diopters (D). The main outcome measures were changes in logMAR uncorrected distance visual acuity (UDVA) and in keratometry (K) values. The procedure was performed in 33 eyes (patients aged 20 to 45 years). The mean preoperative logMAR UDVA (0.76 ± 0.24 [SD]) significantly improved to 0.19 ± 0.20 at 1 month, postoperatively. By 3 months, the mean UDVA had markedly regressed to 0.59 ± 0.29; however, the residual improvement remained statistically significant. At 12 months, the mean logMAR UDVA was 0.72 ± 0.26. The mean K values were 43.9 ± 1.36 D preoperatively, 41.25 ± 2.63 D at 1 month, 43.4 ± 1.69 D at 3 months, and 44.1 ± 1.09 D at 12 months. The mean endothelial cell density was 2836 ± 342 cells/mm(2) preoperatively and were statistically unchanged 12 months postoperatively (2732 ± 353 cell/mm(2)). No patient lost lines of corrected distance visual acuity by 12 months postoperatively. The new thermokeratoplasty procedure produced the desired reduction in myopia and improvement in postoperative UDVA 1 month postoperatively without significant side effects. However, early and complete regression shows the need for further development of this technique. Drs. Yilmaz and Marshall are paid consultants to Avedro, Inc., and Dr. Muller is president and CEO of Avedro, Inc. No other author has a financial or proprietary interest in any material or method mentioned.
To assess accelerated corneal collagen crosslinking (CXL) applied concurrently with laser in situ... more To assess accelerated corneal collagen crosslinking (CXL) applied concurrently with laser in situ keratomileusis (LASIK) in a small group of patients. Beyoglu Eye Research and Training Hospital, Istanbul, Turkey. Prospective pilot interventional case series. In May 2010, patients had LASIK with concurrent accelerated CXL in 1 eye and LASIK only in the fellow eye to treat myopia or myopic astigmatism. The follow-up was 12 months. The attempted correction (spherical equivalent) ranged from -5.00 to -8.50 diopters (D) in the LASIK-CXL group and from -3.00 to -7.25 D in the LASIK-only group. Main outcome measures were manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, and the endothelial cell count. Eight eyes of 3 women and 1 man (age 22 to 39 years old) were enrolled. At the 12-month follow-up, the LASIK-CXL group had a UDVA and manifest refraction equal to or better than those in the LASIK-only group. No eye lost 1 or more lines of CDVA at the final visit. The endothelial cell loss in the LASIK-CXL eye was not greater than in the fellow eye. No side effects were associated with either procedure. Laser in situ keratomileusis with accelerated CXL appears to be a promising modality for future applications to prevent corneal ectasia after LASIK treatment. The results in this pilot series suggest that evaluation of a larger study cohort is warranted. Drs. Yilmaz and Marshall are paid consultants to Avedro, Inc. No other author has a financial or proprietary interest in any material or method mentioned.
To evaluate the efficacy of intravitreal dexamethasone implant (IDI) for the treatment of persist... more To evaluate the efficacy of intravitreal dexamethasone implant (IDI) for the treatment of persistent diabetic macular edema (DME) in a subgroup of pseudophakic and nonglaucomatous eyes over a 12-month follow-up period. This was a retrospective, interventional study. Patients with persistent DME who were pseudophakic and did not have a glaucoma or ocular hypertension history, or a family history of glaucoma, were included. After an initial IDI injection, reinjections were performed on an as-needed basis. Changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), intraocular pressure (IOP), and number of injections at month 12 were evaluated. The study included 50 eyes of 43 patients. Mean BCVA at baseline and at months 1, 3, 6, 9, and 12 were 0.22 ± 0.17, 0.31 ± 0.21, 0.25 ± 0.17, 0.25 ± 0.17, and 0.29 ± 0.19 Snellen equivalent, respectively (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05 for all). Mean CRT at baseline and at months 1, 3, 6, 9, and 12 were 606 ± 202 μm, 330 ± 97 μm, 347 ± 104 μm, 405 ± 149 μm, 383 ± 129 μm, and 397 ± 144 μm, respectively (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001 for all). Seven of the 50 eyes (14 %) showed an increase in IOP of ≥10 mm Hg and only 2 of them (4%) needed chronic antiglaucoma medication. The mean number of injections at month 12 was 2.04 ± 0.5. In pseudophakic and nonglaucomatous eyes with DME, IDI was found to be beneficial in regard to visual and anatomic success and seemed safe in this selected group of patients.
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