Predicting Factor of Visual Outcome in Unilateral Idiopathic Cataract Surgery in Patients Aged 3 to 10 Years

PURPOSE: To report the surgical results of unilateral pediatric cataracts from uncertain causes in relatively older children and to identify factors related to better visual outcomes. METHODS: We retrospectively evaluated the medical records of 39 patients who underwent surgery between the ages of 3 and 10 years for unilateral pediatric cataracts of no known cause. All patients underwent primary intraocular lens implantation and postoperative amblyopia treatment. A postoperative final visual acuity better than 20 / 30 was considered to be a good visual outcome. RESULTS: The mean age of patients was 6.0 ± 1.8 years at the time of surgery. The mean preoperative visual acuity was 1.07 ± 0.71 logarithm of the minimum angle of resolution (range, 0.15 to 3.00), while the mean final postoperative visual acuity was 0.47 ± 0.54 logarithm of the minimum angle of resolution (range, 0.00 to 2.00). Of 39 patients, 18 (46.2%) achieved a good visual outcome. Only the preoperative visual acuity maintained a significant association with a good visual outcome according to our multivariate analysis (p = 0.040). A preoperative visual acuity of 20 / 100 or better was found to increase the chance of achieving a good visual outcome by 13.79-fold (95% confidence interval, 1.13 to 167.58). CONCLUSIONS: The visual outcome of unilateral pediatric cataract surgery for cataracts with no specific cause identified in patients after three years of age could be satisfactory, especially with a preoperative visual acuity of 20 / 100 or better.

Changes in Tear Volume after 3% Diquafosol Treatment in Patients with Dry Eye Syndrome: An Anterior Segment Spectral-domain Optical Coherence Tomography Study

PURPOSE: To evaluate changes in the tear meniscus area and tear meniscus height over time in patients with dry eye syndrome, using anterior segment spectral-domain optical coherence tomography after the instillation of 3% diquafosol ophthalmic solution. METHODS: Sixty eyes from 30 patients with mild to moderate dry eye syndrome were included. Tear meniscus images acquired by anterior segment spectral-domain optical coherence tomography were analyzed using National Institutes of Health's image-analysis software (ImageJ 1.44p). Tear meniscus area and tear meniscus height were measured at baseline, 5 minutes, 10 minutes, and 30 minutes after instillation of a drop of diquafosol in one eye and normal saline in the other eye. Changes in ocular surface disease index score, tear film break-up time, corneal staining score by Oxford schema, and meibomian expressibility were also evaluated at baseline, and after 1 week and 1 month of a diquafosol daily regimen. RESULTS: Sixty eyes from 30 subjects (mean age, 29.3 years; 8 men and 22 women) were included. In eyes receiving diquafosol, tear volume was increased at 5 and 10 minutes compared with baseline. It was also higher than saline instilled eyes at 5, 10, and 30 minutes. Changes in tear volume with respect to baseline were not statistically different after the use of diquafosol for 1 month. Ocular surface disease index score, tear film break-up time, and Oxford cornea stain score were significantly improved after 1 week and 1 month of daily diquafosol instillation, but meibomian expressibility did not change. CONCLUSIONS: Topical diquafosol ophthalmic solution effectively increased tear volume for up to 30 minutes, compared to normal saline in patients with dry eye syndrome.

A Case of Acute Angle Closure Caused by Dislocation of Accommodative Intraocular Lens

PURPOSE: To report a case of acute angle closure after cataract surgery using an accommodative intraocular lens (IOL), WIOL-CF® (GELMED, Praha, Czech). CASE SUMMARY: A 46-year-old male patient underwent phacoemulsification and implantation of WIOL-CF® into the capsular bag. Seven months after the surgery, a sudden increase in intraocular pressure (IOP) associated with angle closure was observed. Ultrabiomicroscopy revealed a dislocated WIOL-CF® that was pushing the peripheral iris anteriorly. Despite the use of IOP-lowering medication and peripheral laser iridotomy, IOP was not controlled. After the use of cycloplegics, the angle was widened and IOP decreased; however, after nine days, the WIOL-CF® was completely dislocated into the anterior chamber and so was removed. CONCLUSIONS: When performing cataract surgery using WIOL-CF®, a possibility of dislocation of IOL and subsequent angle closure should be considered.

A Case of Syphilitic Scleritis Initially Misdiagnosed as Noninfectious Nodular or Fungal Scleritis

PURPOSE: To report a case of syphilitic scleritis initially misdiagnosed as noninfectious nodular or fungal scleritis. CASE SUMMARY: A 63-year-old female, who had severe headaches and ocular pain in her left eye despite treatment with topical and oral NSAIDs for the past 4 months, was transferred from a local clinic. The patient had a history of pterygium excision in the same eye 4 years prior. Upon presentation, she had a scleromalacia with calcified plaque at the nasal conjunctiva. An erythematous nodular elevated lesion was observed in the superonasal sclera. Microbiological smear and cultures were performed to exclude infectious scleritis. Under the suspicion of noninfectious nodular scleritis, the patient was prescribed topical oral steroid and oral NSAIDs. Candida parapsilosis was identified by the microbiological culture. Under the suspicion of fungal scleritis, oral fluconazole and topical amphotericin B were administered, but the lesions did not improve. On the 23rd day of treatment, we discovered the patient had a history of syphilis. The serology test was negative for RPR and FTA-ABS IgM but positive for FTA-ABS IgG. Under the suspicion of syphilitic scleritis, oral doxycycline (200 mg bid) was administered and benzathine penicillin M (2.4 million units) was injected intramuscularly 3 times at 1-week intervals. After the doxycycline and benzathine penicillin therapy, the pain and nodular erythematous lesions were completely resolved. CONCLUSIONS: As shown in this case, syphilitic scleritis should be considered when the patient is resistant to other conventional treatments and shows positive serological tests for syphilis. This is important because syphilitic scleritis is usually aggravated by steroid treatment but can be cured by proper anti-syphilitic chemotherapy.

Comparison of Anterior Segment Measurements Using Scanning-Slit Topography and Optical Low-Coherence Reflectometry (OLCR) Biometry

PURPOSE: To compare the results of anterior segment biometry including white-to-white (WTW) between scanning-slit topography (ORBscan IIz(R), Bausch & Lomb), optical low-coherence reflectometry (OLCR) biometry (Lenstar(R), Haag-Streit), and Castroviejo calipers. METHODS: Measurements on 72 eyes of 36 patients that underwent refractive surgery were measured using ORBscan(R), Lenstar(R), and calipers and compared. Ocular biometry parameters used in this study included the WTW, central corneal thickness, anterior chamber depth (ACD), keratometry, and pupil size. RESULTS: The WTW measurements using ORBscan(R) and calipers (11.57 +/- 0.35 mm and 11.58 +/- 0.34 mm, respectively) were statistically similar. However, the measurement using Lenstar(R) (12.05 +/- 0.40 mm) was significantly greater than with the other methods (p < 0.001). Central corneal thickness and keratometry measurements using ORBscan(R) were greater than when using Lenstar(R) (p = 0.01 for both). ACD and pupil size measurement using Lenstar(R) were greater than when using ORBscan(R) (p < 0.001 for both). CONCLUSIONS: Because WTW and ACD measurements using Lenstar(R) were greater than when using ORBscan(R) and calipers, unexpected high-vaulting may be observed due to the selection of a larger-sized posterior chamber phakic intraocular lens. Therefore, the differences in measurements obtained when using these methods should be considered.

Comparison of Anterior Segment Measurements Using Scanning-Slit Topography and Optical Low-Coherence Reflectometry (OLCR) Biometry

PURPOSE: To compare the results of anterior segment biometry including white-to-white (WTW) between scanning-slit topography (ORBscan IIz(R), Bausch & Lomb), optical low-coherence reflectometry (OLCR) biometry (Lenstar(R), Haag-Streit), and Castroviejo calipers. METHODS: Measurements on 72 eyes of 36 patients that underwent refractive surgery were measured using ORBscan(R), Lenstar(R), and calipers and compared. Ocular biometry parameters used in this study included the WTW, central corneal thickness, anterior chamber depth (ACD), keratometry, and pupil size. RESULTS: The WTW measurements using ORBscan(R) and calipers (11.57 +/- 0.35 mm and 11.58 +/- 0.34 mm, respectively) were statistically similar. However, the measurement using Lenstar(R) (12.05 +/- 0.40 mm) was significantly greater than with the other methods (p < 0.001). Central corneal thickness and keratometry measurements using ORBscan(R) were greater than when using Lenstar(R) (p = 0.01 for both). ACD and pupil size measurement using Lenstar(R) were greater than when using ORBscan(R) (p < 0.001 for both). CONCLUSIONS: Because WTW and ACD measurements using Lenstar(R) were greater than when using ORBscan(R) and calipers, unexpected high-vaulting may be observed due to the selection of a larger-sized posterior chamber phakic intraocular lens. Therefore, the differences in measurements obtained when using these methods should be considered.

Comparison of Colvardpupillometer, ORBScan II and Sirius in Determining Pupil Size for Refractive Surgery

PURPOSE: To compare pupil size measured by Colvard(R)pupillometer, ORBScan II(R), Sirius(R) and analyze correlation between pupil size and night vision disturbance after refractive surgery according to measuring methods. METHODS: Two hundred eyes of one hundred patients who underwent refractive surgery were retrospectively evaluated. Pupil size was measured with Colvard(R)pupillometer, Sirius(R) in the scotopic light condition and with ORBScan II(R), Sirius(R) in the photopic light condition. Patients filled out questionnaire about night vision disturbance at postoperative three months. Correlation between pupil size according to measuring methods and night vision disturbance was evaluated. RESULTS: The mean age of patient was 26 years and number of male patients was 36. In scotopic light condition, pupil size measured with Colvard(R)pupillometer (6.76 mm) was significantly larger than that of Sirius(R) (6.53 mm) (p < 0.001). In photopic light condition, pupil size measured with ORBScan II(R) (3.98 mm) was significantly smaller than that of Sirius(R) (4.41 mm) (p < 0.001). Night vision disturbance were correlated with pupil size and Sirius(R) in the scotopic light condition had strongest correlation among three measuring method (r = 0.44). CONCLUSIONS: Sirius(R) tends to measure pupil size smaller than Colvard(R)pupillometer in the scotopic light condition. The correlation between night vision disturbance and pupil size was highest in Sirius(R).

Clinical Usefulness of a Thermal-Massaging System for Treatment of Dry Eye with Meibomian Gland Dysfunction

PURPOSE: To evaluate the clinical usefulness of KCL 990(R) for the treatment of dry eye with meibomian gland dysfunction (MGD). METHODS: Patients (n = 54 eyes, 27 subjects) diagnosed with dry eye with MGD were recruited for a prospective, one-month clinical trial. Patients received a twice-a-day 15-minute treatment using the KCL 990(R). Effectiveness parameters included patient symptom scores using the Ocular Surface Disease Index (OSDI) questionnaires, tear osmolarity measured with TearLab(R) (TearLab Corporation, San Diego, CA, USA), classical tear break-up time (TBUT), and objective TBUT value using an Optical Quality Analysis System (OQAS(R), Visiometrics, Castelldefels, Spain). Data are presented for pre-treatment (baseline) and at 1 week and 1 month post-treatment. An objective TBUT value was estimated in each eye when the optical scattering index (OSI) started to increase consistently, and data were obtained at pretreatment (baseline) and at 1 month post-treatment. RESULTS: The symptom scores on OSDI questionnaires, tear osmolarity, and tear break-up time improved significantly from baseline to one week (p < 0.05). This improvement was maintained with no significant regression at 1 month (p < 0.05). The objective TBUT value decreased significantly at 1 month (p < 0.05). CONCLUSIONS: KCL 990(R) contributed to improve not only signs and symptoms of dry eye with MGD, but also the function of the tear film and ocular surface.

Accuracy of Biometry and Intraocular Lens Power Calculation With Partial Coherence Interferometry in High Myopia

PURPOSE: To investigate the accuracy of biometry and intraocular lens (IOL) power calculation using partial coherence interferometry (IOL Master(R)) in highly myopic patients with axial lengths of 26 mm or greater. METHODS: Patients with axial lengths equal to or greater than 26 mm who had undergone cataract surgery were enrolled. IOL power was calculated using IOL Master and/or applanation ultrasonography with the SRK/T formula. Twenty-seven eyes using both IOL Master and applanation ultrasonography were included in a paired group, and forty-eight eyes using the IOL Master only and twenty-five eyes using applanation ultrasonography only were included in unpaired groups. The differences between the predicted refraction and the actual refraction were compared and analyzed. RESULTS: In the paired study, the axial lengths in patients using IOL Master (29.14+/-2.32 mm) were significantly longer than those of patients using applanation ultrasonography (28.57+/-2.23 mm) (p0.05). In the unpaired study, the MAEs of the IOL Master and applanation ultrasonography groups were 0.61+/-0.61D and 0.65+/-0.63D, respectively. CONCLUSIONS: In eyes with axial lengths of 26.0 mm or greater, the accuracy of IOL power calculation with IOL Master using the SRK/T formula was comparable to that with applanation ultrasonography.

Laser Treatment for Recurrent Secondary Iris Cyst

PURPOSE: To report two cases of recurrent iris cyst, that were treated with argon laser photocoagulation and Nd: YAG laser cystotomy. METHODS: A 56 year-old woman with a history of cataract surgery and trabeculectomy in the right eye 15 months ago was presented with ocular irritation and decreased vision, and a 34 year-old man with a history of ocular trauma in the right eye 10 years ago was presented with photopsia and decreased vision. The recurrent secondary iris cyst was diagnosed in both patients. Argon laser photocoagulation and Nd: YAG laser cystotomy used to coagulate the cysts under the topical anesthesia. After 15 months, recurrent iris cyst developed at the same site of the second patient. The argon laser photocoagulation and Nd: YAG laser cystotomy were repeated. RESULTS: The treatment with argon laser photocoagulation and Nd: YAG laser was effective for the resolution of the recurrent secondary iris cysts.

The Results of Cyanoacrylate Glue Application for Corneal Perforation and Impending Perforation

PURPOSE: To investigate the effectiveness of cyanoacrylate glue application in cases of corneal perforation or impending perforation due to refractory keratitis. METHODS: Cyanoacrylate glue was applied on 6 cases of fungal keratitis, 3 cases of herpetic keratitis, and 3 cases of bacterial keratitis from July 1998 to June 2002. 2 cases were corneal perforations and 10 were impending perforations. Cyanoacrylate glue was applied on stromal melting area including normal epithelium. When fibrovascular tissue grew beneath the glue sufficiently, glue was removed. When glue was sloughed off spontaneously or fibrovascular tissue was found to be insufficient, glue was reapplied. RESULTS: After average follow up of 25 weeks, the corneal surface was stabilized in 11 eyes except 1 case of fungal keratitis that had broad area of stromal melting(5.4mm). After use of glue, process of stromal melting was found to be discontinued. As fibrovascular tissue grew up beneath the glue, corneal surface became stable. Average diameter of stromal melting area and of glue application area was 4.0mm and 4.4mm respectively. Average duration of glue application was 17 weeks. CONCLUSIONS: Cyanoacrylate glue application appears to be an effective and convenient method in cases of corneal perforations and impending perforations associated with advanced and extensive fungal, bacterial, and herpetic keratitis with active keratolysis.

Prognosis and Survival Rate of Penetrating Keratoplasty in Corneal Dystrophy and Corneal Degeneration

PURPOSE: To investigate the prognosis, survival rate and curve on the eyes for corneal dystrophy and corneal degeneration, we performed statistical analysis. METHODS: Forty-one recipients (62 eyes) have received penetrating keratoplasty for corneal dystrophy and corneal degeneration for about 14 years from April 1984 to October 1997. We analyzed survival rate and curve on sex, age and type of corneal dystrophy and corneal degeneration. RESULTS: Mean age was 35 years and sex distribution of recipient was predominant in female patients (M: 16 recipients, 19 eyes, F: 25 recipients, 43 eyes). In the causative disease of first keratoplasty, corneal dystrophy and corneal degeneration were 46 eyes and 16 eyes. Granular type was the most common type of keratoplasty. In 62 grafts, graft rejection was developed in 19 eyes (30.6%). Graft rejection periods ranged from 53 days to 10 years and 3 months. Mean graft rejection time was 2 years and 8 months. In this study, 5 years survival rate developed in 75% of corneal dystrophy and developed in 31% of corneal degeneration. The statistical analysis showed significant relationship between survival rate and disease type (p=0.0032, p0.05). CONCLUSIONS: This result suggests that corneal dystrophy was higher than corneal degeneration in survival rate with statistically significant difference. But sex and age did not have influence on survival rate.