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OBJECTIVES: This paper presents the design and construction of a viable pupillometer system and demonstrates its merits with extensive validation tests. MATERIALS AND METHODS: A web camera was modified by removing its infrared filter and mounted on a chin rest. Light emitting diodes (LEDs) operating at infrared and visible spectra were integrated to provide background and light stimulus, respectively. The LEDs were controlled by a microprocessor board. Stimulation was presented using a periodic paradigm with variable period and duty cycle. Videos of both pupils were recorded at 30 frames/second and processed offline using software developed in-house. The overall system was validated with data gathered from individuals with healthy vision under different stimulation paradigms. Temporal variations in pupil size were determined and analyzed statistically. RESULTS: The analysis revealed that the pupil sizes were accurately measured from the video frames provided that reflections from both infrared and visible lights remain outside the pupil. The system achieved moderate to excellent repeatability scores (87.8 and 86.8% for short 1 second and long 2 second pulses, respectively), which demonstrated its effectiveness and confirmed that it can be used reliably as a pupillometer. CONCLUSION: The proposed pupillometer system produces useful, quantitative data characterizing pupillary light response. However, further development and implementation are needed to potentially turn it into a low-cost alternative for other studies involving the autonomic nervous system, cognitive function, drug metabolism, pain response, psychology, fatigue, and sleep disorders.

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PURPOSE: To evaluate the result of using intraoperative botulinum toxin A (BTA) as an adjunct to monocular recession-resection surgery in the management of large-angle sensory strabismus. METHODS: The medical records of patients diagnosed with sensory strabismus with constant large-angle strabismus were reviewed retrospectively to identify those who underwent monocular recession-resection surgery combined with 5 units of BTA injection into the recessed muscle of the nonfixating eye. Surgical outcome was considered successful if the final deviation was within the range of 0Δ-10Δ. RESULTS: A total of 13 patients (mean age, 31.04 ± 18.5 years) were included, 8 with exotropia and 5 with esotropia. The mean follow-up period was 52.77 ± 10.9 months. The mean preoperative deviation was 66Δ ± 16Δ in the esodeviation group and 56Δ ± 5Δ in the exodeviation group. The final postoperative mean deviation was 6Δ ± 7Δ in the esodeviation group and 6Δ ± 8Δ in the exodeviation group. There were 7 patients (87.5%) with final deviation of ≤10Δ in the exodeviaton group and 4 (80%) in the esodeviation group. CONCLUSIONS: Adjunctive usage of BTA with conventional surgery appears to enhance surgical outcomes by increasing the amount of expected correction. The combined use of BTA with monocular recession-resection rectus muscle surgery may be a good alternative in the treatment of large-angle sensory strabismus with the advantage of less risk of potential complications compared to supramaximal surgery or surgery in the "good" eye.

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BACKGROUND: In this retrospective study, we evaluated our surgical outcomes of transscleral intraocular lens (IOL) fixation and introduced a simple, quick, and effective method to fixate and bury the sutures in the sclera to avoid suture exposure. METHODS: Eyes were divided into 3 groups according to surgical technique. Half-thickness scleral flaps were prepared, and polypropylene suture ends were cut short in group 1 (12 eyes). Suture ends were left long without flaps in group 2 (47 eyes) and were buried into the scleral tunnel in group 3 (21 eyes). RESULTS: The suture exposure rate was significantly lower in group 3 (0%) compared with group 2 (p = 0.006) and group 1 (p = 0.040). There was no significant difference in group 1 (25%) compared with group 2 (27.6%) (p = 1.000). INTERPRETATION: Burying the suture ends into the scleral tunnel is a simple, safe, and effective technique for avoiding suture exposure in scleral-fixated IOL implantation.

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PURPOSE: To investigate the effects of intravenous (IV) patient-controlled sedation/analgesia with fentanyl during phacoemulsification surgery under topical anesthesia. SETTING: Adnan Menderes University Medical School, Departments of Ophthalmology and Anesthesiology and Reanimation, Aydin, Turkey. METHODS: In this double-blind randomized study, 68 patients were randomly allocated to 2 groups. In the fentanyl group comprising 34 patients, fentanyl was administered by patient-controlled analgesia (PCA) equipment in 5 microg bolus doses with a lockout period of 5 minutes after an IV loading dose of 0.7 microg/kg in 2 mL balanced salt solution. In the control group comprising 34 patients, a balanced salt solution was given without an analgesic drug by PCA equipment. Verbal pain scale (VPS) and sedation scores were recorded preoperatively and 5, 10, 15, 20, and 30 minutes after the start of surgery. Patient comfort and surgeon satisfaction were assessed postoperatively. RESULTS: The sedation score was higher in the fentanyl group than in the control group at 5 and 10 minutes (P =.006 and P =.012, respectively). The VPS scores were higher in the control group than in the fentanyl group at 15 and 20 minutes (P =.02 and P =.016, respectively). Patients pressed the button for additional analgesia 2.6 times +/- 3.9 (SD) in the control group and 0.9 +/- 1.6 times in the fentanyl group (P =.025). Patient and surgeon satisfaction were higher in the fentanyl group than the control group (P =.023 and P =.018, respectively). CONCLUSIONS: The results of this study suggest that IV PCA with fentanyl has supplemental effects on analgesia and sedation during cataract surgery under topical anesthesia and increases patient comfort and surgeon satisfaction.

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PURPOSE: One of the possible etiologies of proptosis in patients with thyroid-associated eye disease is stated to be passive orbital venous congestion caused by the occlusive and constrictive changes of the superior ophthalmic vein (SOV). In an attempt to clarify the validity of this claim, quantitative information on the flow velocity of the SOV was obtained by colour Doppler imaging in 24 patients with thyroid-associated eye disease and compared with data from the control group. METHODS: On clinical examination, ocular motility, proptosis, soft tissue involvement, and the presence of optic neuropathy were evaluated. The interaction of these signs with the flow velocity of the SOV was investigated in conjunction with computed tomographic (CT) findings such as extraocular muscle enlargement, dilatation of the SOV, and apical crowding of the orbit. RESULTS: The mean blood flow velocity was significantly decreased in patients compared to the control group (P <.05). The CT measures that contributed to significant decreases in SOV blood flow velocity were apical crowding (P <.05) and the coexistence of horizontal and vertical extraocular muscle involvement (P <.05). Among the clinical measures, significant decreases could be attributed to soft tissue findings (P <.01) and to optic neuropathy (P <.05). CONCLUSIONS: External compression of the SOV may contribute to the SOV blood flow decrease in orbits afflicted with thyroid eye disease, but proptosis is not relevant to the SOV blood flow decrease.

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