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Descemet's membrane detachment (DMD) is one of the rare complications seen during or after cataract surgery. It can cause permanent corneal decompensation if untreated or not reattached spontaneously. A patient with an extensive DMD (involving approximately upper two-thirds of the cornea) during uncomplicated phacoemulsification surgery is reported. After the aspiration of cortical remnants, Descemet's membrane was detached progressively from the clear corneal incision. Descemet's membrane was reattached at the end of the procedure using an air bubble injection. However, DMD was observed again the day after surgery. It was successfully treated with intracameral injection of 0.2 mL volume of 14% perfluoropropane (C(3)F(8)) gas with resultant immediate resolution of his corneal edema. It is believed that early surgical intervention (if possible intraoperatively) with intracameral injection of 14% isoexpansile mixture of C(3)F(8) is a safe and efficient treatment modality for DMD. Appropriate and prompt management may prevent the complications and visual loss.

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BACKGROUND: To evaluate the effect of the Valsalva maneuver (VM) on short-term variations of intraocular pressure (IOP) and ocular pulse amplitude (OPA) values in healthy, young, male subjects. METHODS: IOP and OPA values were measured before and during VM by Pascal dynamic contour tonometer (DCT) in 55 eyes of 55 healthy male volunteers aged 20 through 27 years. RESULTS: Mean IOP before VM was 17.2 +/- 2.9 mmHg and during the VM was 19.8 +/- 4 mmHg. The increase in mean IOP during the VM was found to be statistically significant (p = 0.001). The IOP increased in 46 (83.6%) of 55 eyes. However, in nine eyes (16.4%), IOP decreased during the VM. Mean OPA value before VM was 3.6 +/- 1.4 mmHg and during the VM was 3.6 +/- 1.3 mmHg. The change in mean OPA value was found to be statistically insignificant (p = 0.9). CONCLUSIONS: The IOP significantly increases during VM, whereas OPA remains stable. Strong autoregulatory mechanisms may provide consistent ocular perfusion in healthy subjects during VM.

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PURPOSE: To report shortwave autofluorescence (SW-AF) and near infrared autofluorescence (NIR-AF) findings in a case of Vogt-Koyanagi-Harada (VKH) disease. METHODS: A 22-year-old man presented with a 2-week history of headache, moderate hearing loss, discolored hair, and bilateral gradually decreased vision (20/800 bilaterally). Ophthalmologic examinations revealed bilateral granulomatous anterior uveitis and multiple patchy bullous retinal detachments. Fundus fluorescein angiography (FFA), SW-AF, and NIR-AF imaging were performed with a confocal scanning laser ophthalmoscope at the beginning and after resolution. The patient responded well to systemic prednisolone treatment. Visual acuity and hearing loss improved quickly (visual acuity 16/20 bilaterally). RESULTS: Multilobular dye pooling with a dark rim was observed in serous detached retinal areas on late-phase FFA. These areas were observed as hypoAF in SW-AF and NIR-AF mode due to the blockage. After resolution of serous detachment, numerous hypoAF granular dots were observed scattered over the previously serous detached areas in SW-AF and NIR-AF mode. These hypoAF granular dots were seen as window defect lesion in FFA and interpreted as retinal pigment epithelial damage or atrophy. CONCLUSIONS: SW-AF and NIR-AF imaging confirmed granular retinal pigment epithelium atrophy which corresponds to FFA findings. SW-AF and NIR-AF imaging methods are noninvasive and useful techniques for documentation of fundus changes in VKH disease.

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The authors describe a technique for performing a safe and controlled continuous curvilinear capsulorhexis (CCC) in white cataracts using the contrast-enhancing effect of green light from an endoillumination probe. After attaching a green filter to the endoillumination unit of the vitrectomy set, a CCC was performed under the green light of the endoillumination probe, which was placed on the periphery of the cornea in a manner that followed the tearing edge of the capsulorhexis. This technique may be an alternative to capsular dyes in performing a safe and controlled CCC in white cataracts.

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This article describes two patients with recalcitrant ocular hypertension persisting 6 and 4 months, respectively, after periocular injection of methylprednisolone acetate despite maximum medical therapy. White sub-Tenon's plaques of residual methylprednisolone acetate were excised surgically and analyzed for steroid activity using spectrophotometry. In both cases, intraocular pressure was normalized promptly after surgical removal of visible steroid. In both instances, biochemical analysis of the excised samples revealed residual steroid. Surgical removal of a residual methylprednisolone depot is an effective management choice in patients developing persistent intraocular pressure elevation after periocular injection.

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PURPOSE: To compare the efficacy and complication rates of laser suture lysis (LSL) or releasable sutures techniques after trabeculectomy. MATERIALS AND METHODS: Forty-eight eyes of 43 consecutive patients with uncomplicated glaucoma who were recruited for primary trabeculectomy with mitomycin-C were divided into 2 groups. Group 1 and group 2 comprised 27 and 21 eyes that were randomly assigned to a standard surgery and releasable suture groups, respectively. A target intraocular pressure (IOP) had been determined on the basis of the severity of the glaucoma and was called a complete success, qualified success, or failure. RESULTS: In group 1, the mean change in IOP after LSL was 7.31+/-1.98 mm Hg, 6.1+/-1.1 mm Hg, and 3.9+/-1.5 mm Hg when sutures were lysed on the first, second, and third months. In group 2, the mean change in IOP after releasable suture removed was 8.20+/-2.74 mm Hg, 5.12+/-1.65 mm Hg, and 4.4+/-1.0 mm Hg when sutures were released at the first, second, and third months. At the end of 6 months, the success (complete and qualified success) rates were 92% and 90% for LSL and releasable suture groups, respectively. There was no statistically significant differences in success (P>0.05) and complication (P>0.05) rates between groups. CONCLUSIONS: We observed an effective IOP reduction in eyes that had suture release both in the early and late postoperative periods after LSL and suture release. We believe that both the laserable and releasable suture techniques can be preferred to permanent sutures for closing scleral flaps in primary trabeculectomy with mitomycin-C in uncomplicated glaucoma.

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AIMS: To investigate the effect of artificial tear application on central corneal thickness (CCT) in dry and normal eyes. METHODS: Forty eyes of 40 patients with symptomatic dry eyes and 20 eyes of 20 controls were included in the study. A combination artificial tear therapy was given to both groups for 1 week. The CCT was measured with ultrasonic pachymetry before and after the therapy. In addition, at the beginning of the study, 11 dry eye patients and eight control patients were evaluated separately as a subgroup: they received artificial tears every 10 min for an hour to determine whether this might constitute a diagnostic criterion. Results were analysed with a Wilcoxon test, accepting p < 0.01 as significant. RESULTS: The mean CCT in the dry eye group before and after 1-week therapy was 531.5 +/- 16.5 and 559.6 +/- 26.1 microm, respectively (p < 0.0001); thus yielding an average CCT increase of 28.1 +/- 9.4 microm (=5.30%: 1.65% minimum; 7.03% maximum) from baseline. The mean CCT in the control group before and after 1-week therapy was 549.2 +/- 37.8 and 552.3 +/- 39.8 microm, respectively (p = 0.001); thus, yielding an average CCT increase of 3.1 +/- 1.9 microm (=0.56%: 0.00% minimum; 1.18% maximum) from baseline. When the subgroup was evaluated separately, the average increase from baseline in 11 dry eye patients was 10.4 +/- 4.0 microm (=1.89%: 0.60% minimum; 4.26% maximum) after 1 h of artificial tear application, while it was 2.9 +/- 2.0 microm (=0.51%: 0.00% minimum; 0.58% maximum) in eight control patients (p < 0.0001). CONCLUSION: The CCT in dry eyes increases rapidly and significantly compared to normal eyes after application of artificial tears. It is suggested that this increase could be used as a criterion in the diagnosis and follow up of dry eyes, and that this increase in thickness should be considered in intra-ocular pressure measurements as well as in refractive surgical procedures.

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PURPOSE: To explore the relationship between the refractive state of the eye and high blood pressure in a representative population. DESIGN: Case-control study. METHODS: Three hundred twenty-one patients with essential hypertension (mean age 53.9 +/- 15.5 years) and 188 age-matched and sex-matched healthy control subjects (mean age 50.9 +/- 7.3 years) from the same regional Health Maintenance Organization were consecutively included for the study (P > .05 for age and sex). The refractive state of the eyes was identified objectively by an autorefractometer and retinoscopic examination, recording the autorefractometer values. Spherical equivalents between -0.50 (included) and +0.50 (included) diopters were regarded as emmetropia. Values below or above this interval were regarded as either myopia or hypermetropia. Mean spherical equivalents of the groups were compared using independent samples t test; distributions of refraction were compared with chi(2) test. RESULTS: The mean spherical equivalent of the patients with essential hypertension was +0.88 +/- 1.34 diopters (range -3.75 to +6.38 diopters), whereas the mean spherical equivalent of the control subjects was -0.26 +/- 1.12 diopters (range -5.00 to +3.38 diopters) (P < .0001). Whereas 61.4% of hypertensive patients were hypermetropic, 18.1% of normotensive patients were hypermetropic (P < .0001). CONCLUSIONS: There is a strong association of essential arterial hypertension with hypermetropia, which has not been previously reported. Given the findings of this study, we recommend that patients who have hypermetropia and have had no recent systemic examination should at least have their blood pressure checked.

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