Nuclear Sclerosis Research Articles

All in All Anterior to Posterior Segment Ocular Diseases in a Single Individual

Significance: Anterior to posterior ocular diseases in the eye is possible, although rare. Visual disturbances and ocular discomfort may contribute to several factors. Purpose: The purpose of this case report was to describe the possibility of multiple ocular diseases that may present in the eye, making it imperative for optometrists to perform a comprehensive eye examination daily. Case report: A 57-year-old, female presented with a severe gritty sensation in the right eye. The patient underwent Laser Assisted In-situ Keratomileusis (LASIK) 30 years ago and her medical history reveals newly diagnosed Hypertension. The patient has mild bilateral blepharoptosis, and on slit lamp examination with fluorescein staining, the ocular surface reveals multiple Superficial Punctate Keratitis (SPK) possibly due to Post-LASIK. Further, mild clouding of the crystalline lenses was noted suggestive of Nuclear Sclerosis (NS). Dilated eye examination, reveals tiny multiple yellowish-white reflecting particles which were Asteroid Hyalosis (AH) and flame-shaped hemorrhages extended from the optic disc to the macula that is suggestive of Central Retinal Vein Occlusion (CRVO). All in all anterior to posterior segment ocular diseases in this patient were managed accordingly by Optometrist and Ophthalmologist. The diagnosis made were bilateral aponeurotic ptosis, severe dry eyes, NS, AH, and CRVO. The patient was treated with topical cyclosporine and Anti-vasular endothelial growth factor (anti-VEGF) scheduled. Conclusion: This case demonstrates the role of patient history, clinical findings, diagnosis, and treatment of blepharoptosis, chronic dry eye, NS, AH, and CRVO. It emphasizes the importance of evaluating the anterior to posterior segment ocular structures and managing such cases requires close collaboration and teamwork with ophthalmologists. Careful examination and systemic evaluation are vital in such a scenario. It is important to educate patients that any sudden vision loss is not normal and they should consult an eye care professional immediately.

Age-related cataract - Prevalence, epidemiological pattern and emerging risk factors in a cross-sectional study from Central India

Purpose: To study the epidemiological pattern, prevalence, types, and correlates of age-related cataracts in a tertiary care center in central India. Methods: This hospital-based single-center cross-sectional study was conducted on 2,621 patients diagnosed with cataracts for 3 years. Data pertaining to demography, socio-economic profile, cataract grading, cataract types, and associated risk factors were evaluated. Statistical analysis using unadjusted odds ratio (OR) and multivariate logistic regression was performed, with P-value <0.05 considered significant with the power of the study being 95%. Results: The commonest age group affected was 60–79 years, closely followed by the 40–59 years age group. The prevalence of nuclear sclerosis (NS), cortical (CC), and posterior subcapsular cataract (PSC) was found to be 65.2% (3,418), 24.6% (1,289), and 43.4% (2,276), respectively. Among mixed cataracts, (NS + PSC) had the highest prevalence of 39.8%. Smokers were found to have 1.17 times higher odds of developing NS than non-smokers. Diabetics had 1.12 times higher odds of developing NS cataracts and 1.04 times higher odds of developing CC. Patients with hypertension showed 1.27 times higher odds of developing NS and 1.32 times higher odds of developing CC. Conclusion: The prevalence of cataracts in the pre-senile age group (<60 years) was found to have increased significantly (35.7%). A higher prevalence of PSC (43.4%) was found in studied subjects, as compared to the data of previous studies. Smoking, diabetes, and hypertension were found to have a positive association with a higher prevalence of cataracts.

Commentary: Leap forward in presbyopia management - Correcting beyond spectacles.

Commentary: Leap forward in presbyopia management - Correcting beyond spectacles.

Approach to a spontaneously ruptured posterior polar cataract

A 61-year-old man presented with gradual blurring of vision and glare in both eyes for a couple of years, with worsening of the vision in his right eye over the past 2 months. He had no medical history of note. On clinical examination, his visual acuities were 20/80 in the right eye and 20/30 in the left eye, uncorrected. The cornea was clear, and the anterior chamber (AC) was deep in both eyes. He had bilateral mild nuclear sclerosis with round central onion-ring-like posterior opacities. The opacities measured approximately 2 mm in diameter and were marginally larger in the right eye than in the left eye (Figure 1JOURNAL/jcrs/04.03/02158034-202305000-00018/figure1/v/2023-04-20T184543Z/r/image-tiff). In addition, there were 2 curvilinear lines across the right posterior capsule (PC), one of which passed across the lens opacity (Figure 2JOURNAL/jcrs/04.03/02158034-202305000-00018/figure2/v/2023-04-20T184543Z/r/image-tiff). Fundus examination was normal in both eyes, and the vitreous was clear. Optical coherence tomography (OCT) of the macular and optic nerve in both eyes was normal. The endothelial cell count in both eyes exceeded 2000 cells/mm2. He had been told by a previous ophthalmologist to have bilateral cataracts and was now keen for surgery starting with the right eye. He works as a manager in a large company and is an avid golf player. He is emmetropic and wears spectacles for near work. Optical biometry using predicated posterior corneal astigmatism did not recommend a toric intraocular lens (IOL). He had done his internet research on IOL options and requested trifocal IOLs. What is your surgical plan for right cataract removal? Explain which IOL you would choose to implant.

Evaluation of eye diseases in cats and dogs: a retrospective study: 200 cases (2021-2022)

In this study, the incidence of eye diseases in cats and dogs brought to Burdur Mehmet Akif Ersoy University Animal Hospital Surgery Clinic between 2021-2022 was investigated. The material of the study consisted of 200 patients (103 dogs and 97 cats). Eye pathology was diagnosed in 35.05% of the examined cats and 35.92% of the examined dogs. The most common cat breed with eye pathologies was mixed breeds with a rate of 29.8%, and the most common dog breed was Golden Retrievers with a rate of 82.3%. When the anatomical localization of the pathologies encountered in the cats and dogs included in the study was evaluated, it was seen that the most common anatomical region with pathologies in cats was the cornea, and the most common anatomical region with pathologies in dogs was the lens. According to the data recorded during the study, the most common eye pathologies were corneal damage 14.7% for cats and senile nuclear sclerosis 36.75% for dogs. In conclusion, with this study, it was aimed to help veterinarians to approach eye diseases by identifying the most common eye diseases in cats and dogs brought to Burdur Mehmet Akif Ersoy University Animal Hospital Surgery Clinic.

Visual function and retinal morphological changes after single suprachoroidal delivery of fluocinolone acetonide (Iluvien®) implant in eyes with chronic diabetic macular edema

BackgroundTo assess the efficacy and safety of supra-choroidal (SC) Iluvien in the management of chronic diabetic macular edema (DME).MethodsA retrospective interventional non-comparative consecutive case series including patients with chronic DME who received an SC Iluvien implant. All patients had persistent central macular thickness (CMT) ≥ 300µ after previous treatment with anti-vascular endothelial growth factor (VEGF) agents or laser photocoagulation. The main outcome measures were improvement of best-corrected visual acuity (BCVA), reduction of CMT, and detection of ocular hypertension/glaucoma or cataract formation. Friedman’s two-way ANOVA was used to analyze BCVA, intraocular pressure (IOP), and DME across different time points. P-value = 0.05.ResultsThe study included 12 eyes of 12 patients. Six patients (50%) were males. The median age was 58 years (range 52–76 years). The median duration of DM was 13 years (range 8–20 years). Ten patients (83.3%) were phakic and 2 patients (17%) were pseudophakic. The median pre-operative BCVA was 0.07 (range 0.05–0.8). The median pre-operative CMT was 544µ (range 354–745µ). The median pre-operative IOP was 17 mmHg (range 14-21mmHg). The median follow-up period was 12 months, range (12–42). Post-operatively, the median final BCVA was 0.15 (range 0.03-1), p 0.02, the median CMT was 404µ (range 213–747), p 0.4 and the median IOP was 19.5 mmHg (range 15–22), p 1. Two out of 10 phakic patients (20%) developed nuclear sclerosis grade I by 12 months. Six patients (50%) developed a transient rise in IOP < 10 mmHg from the baseline that resolved within 3 weeks with antiglaucoma drops.ConclusionSC Iluvien is potentially effective in improving visual function, reducing macular edema, and reducing the incidence of steroid-induced cataracts and glaucoma.

Successful Management of Intraoperative Toxic Endothelial Cell Destruction During Routine Manual Small-incision Cataract Surgery

Cataract surgery is one of the most commonly performed ophthalmic surgeries worldwide. Stromal hydration is done to improve the integrity of the wound, reform the anterior chamber at the end of the surgery and obtain a water-tight wound closure to reduce the risk of endophthalmitis. At the completion of the surgery, subconjunctival injections of antibiotics and steroids are commonly given to reduce the risk of endophthalmitis. Intracameral injection of antibiotics is the delivery of drugs to prevent endophthalmitis, but if a wrong drug is injected in the anterior chamber, it can result in endothelial and anterior chamber toxicity. Here we report a rare and interesting case of a 60-year-old female who underwent manual small-incision cataract surgery (MSICS) for nuclear sclerosis grade 3. All the steps of the surgery were uneventful. At the end of the surgery, side port stromal hydration was performed, and while injecting intracameral moxifloxacin wrongly, gentamicin and dexamethasone were injected into the stroma and anterior chamber. The patient developed 3 + striate keratopathy postoperatively, which was managed with tapering doses of topical steroids, hypertonic saline, and adjuvant drugs. The endothelial cell toxicity resolved within three weeks, and the patient’s vision returned to 6/6. This case signifies that an intraoperatively wrong drug can be injected intracamerally, resulting in transient endothelial cell toxicity, which, if managed correctly, can give an excellent outcome.

Re-inventing the straight incision with a single central suture in manual small-incision cataract surgery to minimize surgically induced astigmatism.

To calculate the surgically induced astigmatism (SIA) in MSICS through a superiorly placed straight scleral incision closed with a single, central, perpendicular 10-0 polyamide suture and to document any suture-related complaints and complications. A retrospective, hospital-based study was carried out in 50 cases of uncomplicated senile cataract (&gt;50 year) with nuclear sclerosis ≥ grade 4, "with the rule" astigmatism who underwent MSICS through a superior, straight incision with a single, central, perpendicular 10-0 nylon suture. Patients with "against the rule" astigmatism, keratoconus, pre-existing corneal opacity, astigmatism &gt;2D, distorted or oblique mires, and previous ocular surgeries and unwilling to participate were excluded. The mean age of the patients was 64.81 + 2.824 years, with a male: female ratio of 1.38:1. The mean SIA at day 7, week 6, and 12 weeks was 0.539 + 0.118, 0.529 + 0.134, and 0.524 + 0.129, respectively. Only 6 patients (12%) complained of foreign body sensation. No patient developed any suture-related complications. SIA is significantly reduced in straight incision by applying a single, central, and perpendicular 10-0 polyamide suture, as compared to a straight incision without a suture.

Comparative study between conventional and 4 mm manual small-incision cataract surgery.

Comparative study of intraoperative and postoperative complications, visual outcomes, and cost-effectiveness between conventional and 4-mm manual small-incision cataract surgery with MVR blade. In total, 600 patients having nuclear sclerosis grade I-IV were operated under peribulbar anesthesia and were divided into two groups of 300 each. In group A (300), conventional small-incision cataract surgery was done, whereas in group B (300), 4-mm manual small-incision cataract surgery was performed through a 4-mm sclerocorneal tunnel. A wire vectis was passed through the 4-mm incision below the nucleus to stabilize it, and a 20-G MVR blade was introduced from 11o'clock limbus and nucleus was bisected into two halves, which were removed through main incision. Cortical wash was given, and foldable IOL was implanted. Intraoperative and postoperative complications between the two groups were compared. Postoperative visual outcome and surgically induced astigmatism between the two groups was studied. The most common intraoperative complication was hyphema (11.33%) and irido-dialysis (8.00%), whereas postoperatively, striate keratopathy (36.33%) and hyphema (19.33%) were common. Short-term complications such as striate keratopathy, hyphema, and irido-dialysis were significantly more in group B, and long-term results in terms of visual outcome and surgically induced astigmatism were significantly less in group B. Although intraoperative and short-term postoperative complications were observed more in 4-mm manual small-incision cataract surgery, it was found to be more effective in terms of surgically induced astigmatism and final visual outcome. In addition, it is cost-effective as compared to phacoemulsification.

Comparison of surgically induced astigmatism in chevron, straight, and frown incisions in manual small-incision cataract surgery.

: The study was conducted to calculate and compare the surgically induced astigmatism (SIA) in chevron, frown, and straight incisions in manual small-incision cataract surgery (MSICS). A prospective, hospital-based study was conducted on 90 patients aged 50 years and above with nuclear sclerosis of grade 4 or more. Each group had 30 patients, divided into Group V (chevron incision), Group S (straight incision), and Group F (frown incision). Patients who had with-the-rule (WTR) astigmatism were operated on through a chevron or straight incision superiorly, while patients who had against-the-rule (ATR) astigmatism underwent MSICS through a temporal frown incision. The patients were followed up post-operatively on days 1, 7, 6 weeks, and 12 weeks, and at each visit, the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and SIA were calculated and compared. The mean age of all the patients was 66.22 ± 8.05 years. BCVA of at least 6/18 or better at 12 weeks post-operatively was achieved in 29 patients (97%) in Group V, 28 patients (93%) in Group F, and 29 patients (97%) in Group S. The mean SIA in Group V was 0.34D ± 0.22D, in Group S was 0.97D ± 0.29D, and in Group F was 0.575D ± 0.25D. SIA by chevron incision is the least followed by the frown incision and straight incision. The superiorly placed chevron incision in WTR astigmatism provided optimal results for the best UCVA and minimal SIA. The temporal frown incision in ATR astigmatism also had good results.

Pattern of Refractive Errors in a Tertiary Hospital in South East, Nigeria

Background: Uncorrected refractive errors (RE) are a major cause of visual impairment. They affect a large proportion of the population globally and have psychological and socio-economic effects on the individual, family and society. They could lead to poor quality of life.&#x0D; Aim: To determine the pattern and predisposing factors of refractive errors among patients seen in the outpatient clinic.&#x0D; Methodology: A cross-sectional, descriptive study involving patients with refractive error that presented to the eye clinic in the year 2017. Data were obtained from patients’ records, entered into and analysed using IBM SPSS version 25.&#x0D; Results: A total of 300 patients with refractive errors were seen in the period of study. This comprised of 93 males and 207 females with mean age of 40.13±17.6 years. The commonest presenting complaint was blurring of both far &amp; near vision (24%), other presenting complaints in decreasing order of frequency were blurring of distant vision, itching, blurring of near vision, eye pain, headache and red eyes in 18%,15%, 9.6%, 5.6%, and 3.2% respectively. Presbyopia was noted in 55.3% while myopia, anisometropia, astigmatism and hypermetropia were noted in 20.7%, 19.3%, 7.0% and 1.3% respectively. Nuclear sclerosis was the commonest co-existing ocular pathology or morbidity.&#x0D; Statistically significant association was found between age of the patients and presence of ocular disease existing with RE (p=0.016).&#x0D; Conclusion: Fifty-one percent of the study population had refractive errors. The commonest refractive error was myopia while hypermetropia was the least common refractive error in this environment.

Occurrence of cystoid macular edema after uneventful phacoemulsification in diabetic patients without retinopathy: A hospital-based comparative study

This study aims to determine the incidence of CME after uneventful phacoemulsification in diabetic patients without any signs of retinopathy and nondiabetic patients in early post-operative periods. The present study was a prospective, comparative, hospital-based study conducted from December 2019 to December 2020 in the Ophthalmology department of a tertiary care referral hospital in Eastern India. All patients aged between 50 to 80 years of either sex with cataract grade nuclear sclerosis II–III with or without cortical cataract and early posterior subcapsular cataract undergoing uncomplicated phacoemulsification surgery by a single surgeon were included in the study. The patients were divided into 2 groups. Group 1 consisted of Type 2 diabetes mellitus patients with cataracts with no retinopathy changes on funduscopy and group 2 included healthy non-diabetic patients with cataracts. Comprehensive baseline evaluation including central retinal thickness (CRT) measurement using optical coherence tomography was done in all cases. Best corrected visual acuity (BCVA) and CRT were assessed 1 week and 6 weeks following surgery. Seventy-four patients were included in the study. Both the groups consisted of 37 cases each. The mean age in group 1 and group 2 was 62.24 ± 6.36 and 63.30 ± 6.39 years respectively. One patient in each group developed clinical CME in the postoperative period. The incidence of CME in our study was 2.7%. Improvement in BCVA was comparable in both groups and statistically insignificant. An increase in CRT was found to be statistically significant (P= 0.047) in group 1 at the 6th week follow-up. Visual outcomes in diabetic patients without retinopathy are similar to normal patients following uncomplicated phacoemulsification surgery.

COMPARISON OF CHANGES IN ENDOTHELIAL CELL DENSITY AND MORPHOLOGY AFTER MANUAL SMALL INCISION CATARACT SURGERY IN DIABETICS VS. NON-DIABETICS – A PROSPECTIVE STUDY

Purpose: To compare the changes in endothelial cell density (ECD) and morphology after manual small incision cataract surgery (MSICS) in diabetics vs. non-diabetics All consecutive consenting adults Methods: with age related cataract &lt; grade 2 nuclear sclerosis undergoing MSICS were recruited. Specular microscopy was done to document the ECD, coefcient of variation (CoV) and percentage of hexagonality in all eyes before and 1 month after MSICS. The primary outcome measure was the difference in ECD between diabetics and non-diabetics at 1 month compared to baseline. One hundred eyes of 100 Results: patients were recruited in the diabetic (n=50) and non-diabetic (n=50) groups and completed 1 month follow up. There were no differences at baseline, though non-diabetics had marginally higher counts (p=0.07). The mean ECD decreased signicantly in both groups (p&lt;0.001 for both) but this drop was signicantly more in diabetics (566 + 137cells/mm3, 95% CI= 527 to 604) compared to non-diabetics (347 + 94cells/mm3, 95% CI= 320 to 373) (p&lt;0.001). The percentage hexagonality decreased slightly after MSICS in both, although by the same magnitude (-6.4 + 3.7 in diabetics vs. -5.2 + 3.9%, p=0.09) where as the CoV changed more (-5.8 + 5.5 in non-diabetics vs. 2.9 + 2.6, p&lt;0.001) in the diabetic group. Eyes Conclusions: with softer cataracts in diabetics undergoing MSICS experience much greater endothelial cell loss at 1 month, though changes in the morphology such as percentage hexagonality and CoV are not as marked.

Comparing retinal sensitivities on blue-on-yellow and green-on-yellow perimetry in glaucoma suspects.

To compare the retinal sensitivities between the blue-on-yellow perimetry (BYP)/short-wavelength automated perimetry (SWAP) and green-on-yellow perimetry (GYP) among patients with and without nuclear sclerosis among glaucoma suspects. After ophthalmic examination, patients were subjected to two perimetric tests: BYP and GYP. The visual field (VF) parameters were compared between the two perimeters (p < 0.05 was considered significant). Fifty-five eyes of 39 patients with a mean age of 60.53 ± 9.70 years were included in the study. Twenty-one eyes had clear lens or pseudophakia. Twenty-six eyes had lower grades of nuclear sclerosis (NO2NC2, NO3NC3) and eight eyes had higher grades of cataract (NO4NC4, NO5NC5). The mean retinal sensitivity (RS) in BYP was 22.08 ± 5.02 (dB) and in GYP was 23.84 ± 5.50 (dB) (p = 0.08). The mean defect in BYP was -2.56 ± 4.40 (dB) and in GYP was -3.24 ± 5.05 (dB), pattern standard deviation (PSD) in BYP was 3.65 ± 1.91 (dB) and in GYP was 3.83 ± 1.99 (dB), and foveal threshold (FT) was 24.20 ± 4.32 (dB) in BYP and 28.10 ± 4.50 (dB) in GYP. The two perimeters showed good agreement by the Bland-Altman plot for all parameters. Fourteen eyes showed perimetric changes suggestive of glaucoma by BYP. In these, GYP had a sensitivity of 92.86% (95% CI of 66.13% to 99.82%) and specificity of 95.12% (95% CI of 83.47% to 99.40%). BYP and GYP show good agreement. They are comparable in clear media as well as in different grades of nuclear sclerosis. GYP showed good sensitivity and specificity compared to BYP.

Recruitment of Temporal Aqueous Outflow Channels After Bent Needle Ab-Interno Goniectomy Demonstrated by Aqueous Angiography.

To demonstrate the utility of operating on the temporal trabecular meshwork with in vivo - aqueous angiography demonstrating new aqueous outflow channels. In a patient with primary open angle glaucoma, nuclear sclerosis, and medically uncontrolled intraocular pressure, Indocyanine green aqueous angiography (0.5%) was performed to visualize baseline functional aqueous outflow channels. This was followed by 30 degrees bent needle ab-interno goniectomy in the temporal quadrant, where no aqueous outflow channels were initially visualized. Aqueous angiography was repeated using 2% fluorescein to visualize aqueous outflow channels after bent needle ab-interno goniectomy. Prebent needle ab-interno goniectomy, aqueous angiography revealed functional outflow channels in the nasal quadrant although none were visible in the temporal quadrant. Postbent needle ab-interno goniectomy in temporal quadrant aqueous angiography demonstrated 2 new aqueous outflow channels. In a patient with open angle glaucoma, following temporal quadrant ab-interno goniectomy, the recruitment of aqueous outflow channels was demonstrated using aqueous angiography.

Active Learning to Characterize the Full Contrast Sensitivity Function in Cataracts.

BackgroundTo characterize contrast sensitivity function (CSF) in cataractous and pseudophakic eyes compared to healthy control eyes using a novel quantitative CSF test with active learning algorithms.MethodsThis is a prospective observational study at an academic medical center. CSF was measured in eyes with visually significant cataract, at least 2+ nuclear sclerosis (NS) and visual acuity (VA) ≥ 20/50, in pseudophakic eyes and in healthy controls with no more than 1+ NS and no visual complaints, using the Manifold Contrast Vision Meter. Outcomes included Area under the Log CSF (AULCSF) and CS thresholds at 1, 1.5, 3, 6, 12, and 18 cycles per degree (cpd). A subgroup analysis as performed on cataract eyes with VA ≥ 20/25.ResultsA total of 167 eyes were included, 58 eyes in the cataract group, 77 controls, and 32 pseudophakic eyes with respective median AULCSF of 1.053 (0.352) vs 1.228 (0.318) vs 1.256 (0.360). In our multivariate regression model, cataract was associated with significantly reduced AULCSF (P= 0.04, β= −0.11) and contrast threshold at 6 cpd (P= 0.01, β= −0.16) compared to controls. Contrast threshold at 6 cpd was significantly reduced even in the subgroup of cataractous eyes with VA ≥ 20/25 (P=0.02, β=−0.16).ConclusionThe novel qCSF test detected disproportionate significant contrast deficits at 6 cpd in cataract eyes; this remained significant even in the cataractous eyes with VA ≥ 20/25. CSF testing may enhance cataract evaluation and surgical decision-making, particularly in patients with subjective visual complaints despite good VA.

Impact on corneal morphology after cataract surgery with intracameral moxifloxacin in neglected hard cataracts.

To evaluate corneal morphology after use of 0.5% intracameral moxifloxacin (ICM) in cataract surgery in patients who presented late with hard cataracts. Cross-sectional study conducted from June-2021 to December-2021 at a tertiary eye-care center. 90 patients over 60 years with high-risk characteristics for Covid-19, who presented late with higher grades of nuclear-sclerosis (NS), were included. They underwent phacoemulsification and 0.5%moxifloxacin (0.1 ml) was injected intracamerally at the end of surgery. Best-corrected visual acuity (BCVA), intraocular pressures (IOP), endothelial cell density (ECD), coefficient of variation in cell-area (CoV), hexagonality (Hex) and central corneal thickness (CCT) were measured preoperatively and postoperatively on day1, day7 and day30. Statistical analysis was done by Anova test. p-value<0.05 was considered significant. Mean age of presentation was 65.26±8.3 years. Mean preoperative BCVA (1/60-to-6/60), IOP (16.7±2.3 mm of Hg), CCT (523.93±39.6µ), ECD (2547±302.08cells/mm2), Hex (47.04±5.7%) and CoV (37.57±3.9) changed to BCVA (6/9-to-6/6), IOP (17.5±2.1 mm of Hg), CCT (538.42±36.9µ), ECD (2388.40±339.25cells/mm2), Hex (44.44±5.6%) and CoV (39.09±4.5) at day30 postoperative. Average rate of change at day30 was increase in CCT (2.89%), ECD loss (6.4%), decrease in Hex (4.9%) and increase in CoV (4.6%), though clinically insignificant. No case of endophthalmitis or toxic-anterior segment syndrome seen. 0.5% moxifloxacin (0.1 ml) is safe as intracameral antibiotic to prevent postoperative infection in high-risk patients. The reported changes in the corneal parameters were within the range of any routine surgeries of hard senile cataracts. No specific effect could be attributed to ICM.

Association between Type of Cataract According to LOCS Classification with Diabetes Mellitus

Prevalence of diabetes mellitus has increased over time. DM has several adverse effects on body, out of which cataract is the most common ocular complication. Cataract is found to be more common in patients with diabetes mellitus due to changes in the metabolism of body. Objectives: To determine the association of type of cataract according to LOCS classification with diabetes mellitus. Methods: The age of the patients was in the range of 25-80 years old. The inclusion criteria were the diabetic patients having the diabetic history of more than 8 years. Patients who were older than 80 years old and who had a history of any systemic disease were disqualified from the trial. All of the patients who were included underwent thorough eye examination. Results: 98 patients were included in the study having positive history of diabetes mellitus. The most common kind of cataract in people with diabetes is PSCC. There were 51 participants with posterior sub-capsular cataract (PSCC) (52.0 percent). This was followed by nuclear sclerosis cataract in twenty (20.04%) patients and cortical cataract in twelve (12.2%) individuals. In contrast, diabetic patients only experienced posterior polar cataract in seven (7.1%) patients and nuclear sclerosis and PSCC in the remaining eight (8.1%) patients. Conclusions: Diabetic mellitus patients should be checked for PSCC, which can impair vision, particularly in bright light, or during the day

KATARAKT AMELİYATI SONRASI GEÇ DÖNEMDE FARKEDİLEN DESCEMET MEMBRAN DEKOLMANINA YAKLAŞIM

We aimed to present the differential diagnosis and treatment of Descemet membrane detachment (DMD) in a patient with acute corneal edema after phacoemulsification surgery. A 52-year-old female patient presented to our clinic with acute corneal edema and visual impairment secondary to DMD, which was noticed on the postoperative 16th day after routine phacoemulsification surgery in the left eye. On the 16th day, visual acuity of the case was; 0.8 in the right eye and from 50 cm in the left eye at the level of counting finger. In biomicroscopic examination nuclear sclerosis in the right eye, diffuse corneal edema except the upper temporal region in the left eye was followed. Intraocular pressures were normal in both eyes. On fundus examination, the right eye was normal and the left eye was normal ultrasonographically like the right eye although cannot be evaluated clearly. Anterior segment optical cohorens tomography (ASOCT) was performed with suspicion of DMD. ASOCT images showed a hyperreflective band that was forming a second anterior chamber under corneal epithelial and stromal edema. The patient was being diagnosed with DMD and corneal edema related with this and perfluoropropane (C3F8) injection was made into the anterior chamber. On the third day following the injection, the cornea was transparent except for the paracentral descemet wrinkles, there was gas appearance in the anterior chamber and visual acuity increased to 0.2 level according to snellen. This case shows us that intracameral gas injections can be an effective treatment modality in DMDs exceeding two weeks.

Risk Factors and Treatments of Suprachoroidal Hemorrhage.

Suprachoroidal hemorrhage (SCH) is a rare but serious sight-threatening complication of inner eye surgery. Despite continuous advances in treatment, visual prognosis remains poor. The disease has a more typical clinical presentation, the etiology and pathogenesis are not well defined, and intraoperative ocular and systemic factors may induce fulminant SCH. To investigate risk factors and treatments of SCH-associated intraocular surgeries, summarize diagnosis, characteristics, management, and prevention of SCH developed during and after intraocular surgeries. A retrospective study of SCH occurred in six cases of intraocular surgeries including cataract, glaucoma, pars plana vitrectomy (PPV), and silicone oil removal surgery. Assess baseline systemic and ocular characteristics of SCH eyes. Analyze the second surgery timing and technique, and visual outcomes were measured. SCH occurred in six patients including five eyes during surgeries and one eye after the surgery. Three eyes that underwent cataract surgery had hard nucleuses (nuclear sclerotic 4+). One eye was due to hypotony during the vitrectomy procedure. One eye developed SCH when silicone oil was extracted from the eyeball. One eye developed delayed SCH after glaucoma surgery. Incision closure and anterior chamber deepening were performed. B-scan ultrasonography was used to diagnose SCH, and determine the timing and location of sclerotomy for the second surgery. Vitrectomy and sclerotomy were performed in five eyes. The median follow-up time was six months. The final best-corrected visual acuity (BCVA) was 0.3 in one eye, one eye had light perception with retinal adherence, and four eyes had no light perception with retinal detachment. The results showed that risk factors including advanced age, hypertension, taking anticoagulants, antiplatelet drugs, and cardiovascular drugs were systemic risk factors, and hard nucleus (nuclear sclerosis 4 +) cataract, long-term uncontrolled ocular hypertension glaucoma, vitrectomy, silicone oil removal, high myopia, aphakia, previous intraocular surgery, intraocular pressure during surgery, and others were ocular risk factors. The most important risk factor is a sudden drop in intraocular pressure during or after surgery. The outcome of visual acuity depends on retinal status. Because of the poor prognosis, the prevention of SCH is of utmost importance during intraocular surgery.