The purpose of this study is to compare pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification in both eyes, using sub-Tenon's local anesthesia without sedation. In this study, 268 patients with bilateral senile cataracts were recruited. All operations were performed without sedation, using a clear corneal phacoemulsification technique and sub-Tenon's local anesthesia, by one of four surgeons. The first surgery was performed on the eye with the higher grade cataract. The other eye was operated on within 3 months by the same surgeon (mean interval 1.9 ± 1.1 months). All patients were asked to grade their pain experience during induction and maintenance of anesthesia and also during the phacoemulsification surgery, using a visual analogue scale (VAS) from 0 (no pain) to 10 (unbearable pain) administered after the surgery. The cooperation of the patient was graded from 0 (no event) to 3 (markedeye and head movement and lid squeezing) by the attending surgeon. The VAS scores and cooperation scores of the patients were the outcome measurements. The mean pain score was 2.11 ± 0.79 in the first eye and 3.33 ± 0.80 in the second eye during the administration of sub-Tenon's anesthesia, and 1.50 ± 0.60 in the first eye and 2.10 ± 0.57 in the second eye during the phacoemulsification surgery. The patient cooperation score was 1.60 ± 0.75 in the first surgery and 2.08 ± 0.72 in the second surgery. The differences between the first and second surgeries were statistically significant for all outcome measures (p < 0.01). Patients who previously underwent phaco surgery in one eye experienced more pain and showed worse cooperation during the phaco surgery in the second eye, especially if there was a short time between the surgeries, viz., less than 3 months. Therefore, if the surgeon has difficulty in the first operation gaining the patient's cooperation, the surgeon must be careful: if contralateral eye surgery is required, the addition of sedation/analgesia should be considered or the surgery postponed for a while to abolish the influence of recent memory on the patient's subsequent pain experience.

We report a case of unilateral transient mydriasis and ptosis after botulinum toxin injection applied by a medical doctor for a cosmetic procedure. A 36-year-old nurse was referred to our eye clinic with unilateral mydriasis and ptosis in the right eye 3 days after botulinum toxin injection for a cosmetic procedure. Botulinum toxin was applied to her eye by a doctor at her hospital who was not an ophthalmologist. She was treated with topical apraclonidine 0.5% ophthalmic solution. Her ptosis decreased to 2 mm with apraclonidine and her visual axis improved. Mydriasis was present for 3 weeks and then disappeared. Mild ptosis continued for 3 months, then resolved completely. Patients seeking treatment with botulinum toxin A for cosmetic purposes should be warned about the possibility of ptosis and mydriasis after injection. If these side effects are seen, the patient must be referred to an ophthalmologist for appropriate management.

Objectives:To investigate the relationship between age-related macular degeneration (AMD) and refractive error and axial length, as well as the socio-demographic characteristics and biochemical variables that may affect this relationship.Materials and Methods:A total of 196 eyes of 98 patients over 50 years of age who were diagnosed with AMD at our clinic were included in this cross-sectional study. Early and late AMD findings were categorized according to the age-related eye disease study grading scale. Objective refractive error was measured by autorefractometer, confirmed by subjective examination, and spherical equivalent was calculated. Refractive errors of -0.50 D to 0.50 D were classified as emmetropia, <-0.50 D as myopia, and >0.50 D as hyperopia. Axial length was measured by ultrasonic biometry and values ≤23.00 mm were classified as short, >23.00 and <24.00 mm as normal, and ≥24.00 mm as long axial length. Demographic, systemic, and biochemical parameters of all patients were also investigated.Results:Hypermetropic refractive error and shorter axial length were significantly more common than the other groups (p<0.01). No differences were observed between early and late stage groups in terms of refractive error and axial length. Patients with myopia had significantly lower values for total cholesterol, triglyceride, fasting blood glucose, and proportion of smokers. Rates of oral nutritional supplement use and fish consumption were significantly higher in the early AMD group. The most common comorbidity among the AMD patients in our study was essential hypertension.Conclusion:Hyperopic refractive error and shorter axial length were found to be associated with AMD. Longitudinal studies including larger patient numbers are needed to elucidate the causal and temporal relationship between hyperopic refractive error and AMD.