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    Comparison of Two Different Ultrasound Methods of Phacoemulsification
    (ELSEVIER SCIENCE INC, 2014) Helvacioglu, Firat; Yeter, Celal; Sencan, Sadik; Tunc, Zeki; Uyar, O. Murat
    PURPOSE: To compare the safety and efficacy of micro-coaxial phacoemulsification surgeries performed with the OZil Intelligent Phaco torsional mode (Alcon Laboratories, Inc., Fort Worth, USA) and combined torsional/longitudinal ultrasound mode using 45 degree aperture angled tips. DESIGN: Prospective randomized clinical trial. METHODS: SETTING: Maltepe University, Istanbul. PATIENT POPULATION: Eighty eyes of 80 cataract patients were randomly assigned to 2.2 mm microcowdal phacoemulsification using the OZil Intelligent Phaco torsional mode (Group 1) or combined torsional/longitudinal ultrasound mode (Group 2). OBSERVATION PROCEDURE: Intraoperative fluid and energy usage and postoperative examinations were evaluated. MAIN OUTCOME MEASURES: Ultrasound time, cumulative dissipated energy, longitudinal and torsional ultrasound amplitudes, mean operation time, mean volume of fluid used, and surgical complications. RESULTS: Both groups included 40 eyes. Mean ultrasound time, cumulative dissipated energy, and longitudinal and torsional ultrasound amplitudes in Group 1 were 58.21 +/- 33.81 seconds, 7.74 +/- 6.23, 0.45 +/- 0.30, and 26.30 +/- 12.60%, respectively, and these parameters in Group 2 were 64.75 +/- 30.23 seconds, 12.61 +/- 6.21, 26.32 +/- 5.85, and 40.98 +/- 8.33%, respectively. Cumulative dissipated energy and longitudinal and torsional amplitudes were found to be significantly lower in Group 1 (P = .001, P < .001, P < .001). Mean volumes of fluid used in Groups 1 and 2 were 73.30 +/- 19.87 cc and 107.07 +/- 21.82 cc, respectively (P < .001). CONCLUSION: With the aid of a 45 degree aperture angled tip, the OZil Intelligent Phaco torsional mode provided more effective lens removal than the combined torsional/longitudinal ultrasound mode, with a lower cumulative dissipated energy and volume of fluid used. (C) 2014 by Elsevier Inc. All rights reserved.
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    Evaluation of intrastromal corneal ring segments for treatment of keratoconus with a mechanical implantation technique
    (WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2013) Tunc, Zeki; Helvacioglu, Firat; Sencan, Sadik
    Purpose: To evaluate the clinical outcomes of intrastromal corneal ring segment (ICRS) implantation in patients with keratoconus using a mechanical implantation technique. Materials and Methods: Thirty eyes of 17 patients with keratoconus were enrolled. ICRSs (Keraring) were implanted after dissection of the tunnel using Tunc's specially designed dissector under suction. A complete ophthalmic examination was performed, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent, keratometric readings, inferosuperior asymmetry index (ISAI), and ultrasound pachymetry. All 3-, 6-, and 12-month follow-ups were completed, and statistical analysis was performed. Results: The mean preoperative UDVA for all eyes was 1.36 +/- 0.64 logMAR. At 12 months, the mean UDVA was 0.51 +/- 0.28 logMAR (P = 0.001), and the mean preoperative CDVA was 0.57 +/- 0.29 logMAR, which improved to 0.23 +/- 0.18 (P = 0.001) at 1 year. There was a significant reduction in spherical equivalent refractive error from -6.42 +/- 4.69 diopters (D) preoperatively to -1.26 +/- 1.45 D (P = 0.001) at 1 year. In the same period, the mean K-readings improved from 49.38 +/- 3.72 D to 44.43 +/- 3.13 D (P = 0.001), and the mean ISAI improved from 7.92 +/- 3.12 to 4.21 +/- 1.96 (P = 0.003). No significant changes in mean central corneal thickness were observed postoperatively. There were no major complications during and or after surgery. Conclusion: ICRS implantation using a unique mechanical dissection technique is a safe and effective treatment for keratoconus. All parameters improved by the 1-year follow-up.
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    Evaluation of intrastromal corneal ring segments for treatment of post-LASIK ectasia patients with a mechanical implantation technique
    (WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2011) Tunc, Zeki; Helvacioglu, Firat; Sencan, Sadik
    Aim: To evaluate the clinical outcomes of Keraring segment implantation in patients with post-laser-assisted in situ keratomileusis (LASIK) ectasia, using a mechanical implantation technique. Materials and Methods: Twelve eyes of 10 patients with post-LASIK ectasia were enrolled. Intracorneal ring segments (ICRS) were implanted aft er dissection of the tunnel using Tunc's specially designed dissector under suction. A complete ophthalmic examination was performed, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent, keratometric (K) readings, inferosuperior asymmetry index (ISAI), and ultrasound pachymetry. All 3, 6, and 12-month follow-ups were completed, and statistical analysis was performed. Results: The mean preoperative UDVA for all eyes was 1.28 +/- 0.59 logMAR. At 12 months, the mean UDVA was 0.36 +/- 0.19 logarithm of the Minimum Angle of Resolution (logMAR) (P=0.002), and the mean preoperative CDVA was 0.58 +/- 0.3 logMAR, which improved to 0.15 +/- 0.12 (P=0.002) at 1 year. There was a significant reduction in cylindrical refractive and spherical equivalent refractive error from -5.29 +/- 2.47 diopters (D) and -5.54 +/- 5.04 D preoperatively to -1.47 +/- 0.71 D and -0.74 +/- 1.07 D (P=0.001, P=0.002), respectively, at 1 year. In the same period, the mean K-readings improved from 47.93 +/- 4.84 D to 40.87 +/- 2.36 D (P=0.002), and the mean ISAI improved from 5.34 +/- 3.05 to 2.37 +/- 1.68 (P=0.003). No significant changes in mean central corneal thickness were observed postoperatively. There were no major complications during or aft er surgery. Conclusion: ICRS implantation using a unique mechanical dissection technique is a safe and effective treatment for post-LASIK ectasia. All parameters showed improvement at 1-year follow-up.
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    Outcomes of torsional microcoaxial phacoemulsification performed by 12-degree and 22-degree bent tips
    (ELSEVIER SCIENCE INC, 2013) Helvacioglu, Firat; Yeter, Celal; Tunc, Zeki; Sencan, Sadik
    PURPOSE: To compare the safety and efficacy of Ozil Intelligent Phaco torsional microcoaxial phacoemulsification surgeries performed with 12-degree and 22-degree bent tips using the Infiniti Vision System. SETTING: Maltepe University School of Medicine Department of Ophthalmology, Istanbul, Turkey. DESIGN: Comparative case series. METHODS: Eyes were assigned to 2.2 mm microcoaxial phacoemulsification using the torsional mode with a 22-degree bent tip (Group 1) or a 12-degree bent tip (Group 2). The primary outcome measures were ultrasound time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound (US) amplitudes, mean surgical time, mean volume of balanced salt solution used, and surgical complications. RESULTS: Both groups included 45 eyes. The mean UST, CDE, longitudinal US amplitude, and torsional US amplitude were 65 seconds +/- 27.23 (SD), 11.53 +/- 6.99, 0.22 +/- 0.26, and 42.86 +/- 15.64, respectively, in Group 1 and 84 +/- 45.04 seconds, 16.68 +/- 10.66, 0.48 +/- 0.68, and 46.27 +/- 14.74, respectively, in Group 2. The mean UST, CDE, and longitudinal amplitudes were significantly lower in Group 1 (P=.003, P=.008, and P=.022, respectively). The mean volume of balanced salt solution was 73.33 +/- 28.58 cc in Group 1 and 82.08 +/- 26.21 cc in Group 2 (P=.134). CONCLUSION: Torsional phacoemulsification performed with 22-degree bent tips provided more effective lens removal than 12-degree bent tips, with a lower UST and CDE.
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    Outcomes of torsional microcoaxial phacoemulsification using tips with 30-degree and 45-degree aperture angles
    (ELSEVIER SCIENCE INC, 2014) Helvacioglu, Firat; Sencan, Sadik; Yeter, Celal; Tunc, Zeki; Uyar, O. Murat
    PURPOSE: To compare the safety and efficacy of Ozil Intelligent Phaco torsional microcoaxial phacoemulsification surgeries performed using 30-degree and 45-degree aperture angled tips. SETTING: Maltepe University School of Medicine Department of Ophthalmology, Istanbul, Turkey. DESIGN: Comparative case series. METHODS: Eyes were assigned to 2.2 mm microcoaxial phacoemulsification using the torsional mode with a 45-degree (Group 1) or 30-degree (Group 2) aperture angled tip. A quick-chop surgical technique was used. The primary outcome measures were ultrasound time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound (US) amplitudes, mean surgical time, mean balanced salt solution volume used, and mean central corneal thickness (CCT) changes. RESULTS: The mean UST, CDE, and longitudinal and torsional US amplitudes were 58.21 seconds +/- 33.81 (SD), 7.74 +/- 6.23, 0.45 +/- 0.30, and 26.30 +/- 12.60 in Group 1 and 63.83 +/- 23.42 seconds, 12.36 +/- 6.75, 0.23 +/- 0.26, and 44.65 +/- 14.38 in Group 2, respectively. The mean CDE and torsional amplitudes were significantly lower in Group 1 (P=.002 and P=.001, respectively). The mean balanced salt solution volume was 73.30 +/- 19.87 cc in Group 1 and 74.30 +/- 19.44 cc in Group 2 (P=.821). The mean CCT change was 52.40 +/- 38.08 mu m and 99.35 +/- 47.14 mu m, respectively (P<.001). CONCLUSION: Torsional phacoemulsification performed with a 45-degree aperture angled tip provided more effective lens removal with a lower CDE and less CCT change than a 30-degree aperture angled tip.
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    Ozil IP torsional mode versus combined torsional/longitudinal microcoaxial phacoemulsification
    (WICHTIG EDITORE, 2012) Helvacioglu, Firat; Tunc, Zeki; Yeter, Celal; Oguzhan, Hasan; Sencan, Sadik
    PURPOSE. To compare the safety and efficacy of microcoaxial phacoemulsification surgeries performed with the Ozil Intelligent Phaco (IP) torsional mode and combined torsional/longitudinal ultrasound (US) mode using the Infiniti Vision System (Alcon Laboratories). METHODS. In this prospective randomized comparative study, 60 eyes were assigned to 2.2-mm microcoaxial phacoemulsification using the Ozil IP torsional mode (group 1) or combined torsional/longitudinal US mode (group 2). The primary outcome measures were US time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound amplitudes, mean operation time, mean volume of balanced salt solution (BSS) used, and surgical complications. RESULTS. Both groups included 30 eyes. Mean UST, CDE, and longitudinal and torsional ultrasound amplitudes in group 1 were 1 minute 15 +/- 34.33 seconds, 8.74 +/- 5.64, 0.43 +/- 0.74, and 25.56 +/- 8.56, respectively, and these parameters in group 2 were 1 minute 40 +/- 51.44 seconds, 9.28 +/- 5.99, 3.64 +/- 1.55, and 3.71 +/- 1.34, respectively. UST and longitudinal amplitudes were found to be significantly low in group 1 (p<0.001, p<0.001), whereas torsional amplitude was found to be significantly high in this group (p=0.001). Mean volumes of BSS used in groups 1 and 2 were 63.30 +/- 18.00 cc and 84.50 +/- 28.65 cc, respectively (p=0.001). CONCLUSIONS. The Ozil IP torsional mode may provide more effective lens removal than the combined torsional/longitudinal US mode with a lower UST and volume of BSS used.