Clinical Outcomes of an Optimized Prolate Ablation Procedure for Correcting Residual Refractive Errors Following Laser Surgery

PURPOSE: The purpose of this study was to investigate the clinical efficacy of an optimized prolate ablation procedure for correcting residual refractive errors following laser surgery. METHODS: We analyzed 24 eyes of 15 patients who underwent an optimized prolate ablation procedure for the correction of residual refractive errors following laser in situ keratomileusis, laser-assisted subepithelial keratectomy, or photorefractive keratectomy surgeries. Preoperative ophthalmic examinations were performed, and uncorrected distance visual acuity, corrected distance visual acuity, manifest refraction values (sphere, cylinder, and spherical equivalent), point spread function, modulation transfer function, corneal asphericity (Q value), ocular aberrations, and corneal haze measurements were obtained postoperatively at 1, 3, and 6 months. RESULTS: Uncorrected distance visual acuity improved and refractive errors decreased significantly at 1, 3, and 6 months postoperatively. Total coma aberration increased at 3 and 6 months postoperatively, while changes in all other aberrations were not statistically significant. Similarly, no significant changes in point spread function were detected, but modulation transfer function increased significantly at the postoperative time points measured. CONCLUSIONS: The optimized prolate ablation procedure was effective in terms of improving visual acuity and objective visual performance for the correction of persistent refractive errors following laser surgery.

The Effect of Machine Aging on the Measurements of Optical Coherency Tomography

PURPOSE: To evaluate the effect of instrument aging on optical coherence tomography (OCT) measurements. METHODS: Single eyes of 60 healthy participants (60 eyes) aged 20-30 years were examined twice using a 5-year-old OCT instrument and a new OCT instrument (Carl Zeiss Meditec, Dublin, CA, USA). The measurements and changes in signal strength were investigated using both instruments. RESULTS: The signal strengths of the new and aged instruments were 8.6 ± 0.8 and 5.0 ± 1.0, respectively, which was a statistically significant difference (p < 0.001). In addition, the central macular thicknesses (CMT) of the new and aged instruments were 201.1 ± 16.1 µm and 210.3 ± 16.0 µm, respectively. The thickness was significantly greater using the aged instrument (p < 0.001). Repeated measurements within the same eye were compared, and the difference in CMT was 3.2 using the new instrument and 10.5 using the aged instrument (p < 0.05). The intraclass correlation coefficient (ICC) was compared to evaluate the reproducibility of each instrument. The ICC values of nine areas of Early Treatment Diabetic Retinopathy Study in the aged instrument were 0.371-0.872, indicating low reproducibility. However, the new instrument showed high reproducibility with values of 0.806-0.947. CONCLUSIONS: Higher signal strength and lower CMT were observed using the new instrument compared to the aged instrument. Additionally, there were no differences in signal strength errors between the instruments. However, the error in CMT measured using the new instrument was significantly smaller compared to that using the aged instrument. Therefore, the effect of instrument aging should be accounted for in analyses of OCT measurements.

Anterior Ischemic Optic Neuropathy Associated with Udenafil

We report a case of anterior ischemic optic neuropathy associated with udenafil. A 54-year-old male presented with an acute onset visual field defect of the right eye after udenafil use. Examination revealed a relative afferent pupillary defect and a swollen disc. Automated visual fields revealed an enlarged blind spot and a narrowed visual field. Fluorescein angiography revealed both an inferior choroidal filling delay and an inferior sector filling delay of the optic disc in the arteriovenous phase as well as diffuse leakage of the optic disc in the late phase. Optical coherent tomography revealed increased thickness of the retinal nerve fiber layer, especially in the area of the inferior disc. The patient was counseled to discontinue the use of udenafil and to monitor his blood pressure regularly. The disc swelling was resolved with residual optic atrophy one month after discontinuing the use of udenafil.

A Case of Congenital Idiopathic Microcoria

PURPOSE: To report a case of congenital idiopathic microcoria corrected with pupilloplasty and amblyopia treatment. CASE SUMMARY: A 4-year-old girl was referred for pupillary abnormality of the left eye. Her mother experienced no problems during gestation, and the patient was born at full term. On initial examination, visual acuity was 20/25 in the right eye and counting finger at 50 cm in the left eye. Slit lamp examination revealed that the left pupil was displaced superonasally. A band of fibrous tissue extended across the left pupil and there was no red reflex. There was very slight reaction to mydriatics. Using 23-gauge vitrectomy scissors, a pupilloplasty was performed, and the synechiae are removed. Postoperatively, the pupillary light reflex was brisk, and occlusion therapy was initiated. After 3 months, the visual acuity of the left eye improved to 20/30. CONCLUSIONS: In our case, although microcoria was diagnosed at a relatively old age, the patient's clinical features were consistent with congenital idiopathic microcoria. Therefore, we diagnosed the patient with gradually progressed congenital idiopathic microcoria. In the case of typical congenital idiopathic microcoria, the red-reflex is absent at birth because of the small pupil. However, as in our case, it is possible that the pupil can contract gradually due to movement of the fibrous strand. The point must be considered in such patients.

A Case of Anterior Lens Capsule Rupture from Blunt Ocular Trauma

PURPOSE: To report a case of isolated anterior capsule rupture with cataract after blunt ocular trauma. CASE SUMMARY: A 38-year-old male complained of decreased visual acuity in the right eye after blunt ocular trauma 5 days earlier. The visual acuity was counting fingers at 30 cm in the right eye, and intraocular pressure, measured using an applanation tonometer, was 25 mm Hg. Slit lamp examination showed a white intumescent cataract with anterior lens capsule rupture and cortical lens material extruding into the anterior chamber. Under local anesthesia, removal of the cataract was approached via a clear corneal incision. After removal of the cataract using irrigation and aspiration, the intact posterior capsule was observed. IOL haptic was implanted in the sulcus, and IOL optic was implanted in the bag. Postoperatively, the BCVA improved in the right eye to 0.8 at 1 month, and the intraocular pressure, by the Goldmann applanation tonometer was 13 mm Hg at that time.

Botulinum Toxin for Palliative Treatment of Epiphora in Patients with Nasolacrimal Duct Obstruction

PURPOSE: To describe the use of botulinum toxin injection of the lacrimal gland for palliative treatment of epiphora secondary to nasolacrimal duct obstruction. METHODS: A prospective non-comparative interventional case series study was designed to include 13 patients with nasolacrimal duct obstruction. Under topical anesthesia botulinum toxin A (1-4unit) was injected into the palpebral lobe of the lacrimal gland via a transconjunctival approach. Patients underwent a Schirmer test and a subjective evaluation of their epiphora symptoms was performed at 0 (baseline), 1, 4 and 12 weeks after injection. RESULTS: Subjective epiphora scores improved in 10 out of the 13 patients (76.9%). Schirmer test results showed objective reduction in tearing from baseline but did not strongly correlate with the subjective epiphora scores. Transient ptosis were experienced by two patients. CONCLUSIONS: Botulinum A toxin injection for palliative treatment of epiphora secondary to nasolacrimal duct obstruction is a simple, effective and safe treatment.

Two Cases of Deepening of the Upper Lid Sulcus from Topical Bimatoprost Therapy

PURPOSE: To report two cases of deepening of the upper lid sulcus following bimatoprost. METHODS: A 54-year-old woman who used bimatoprost for one week and a 70-year-old woman who used bimatoprost for 4 months developed deep lid sulcus. Both were using bimatoprost for glaucoma treatment. RESULTS: Both patients also showed improvement of dermatochalasis and widening of the palpebral fissure. One week after discontinuing bimatoprost, the lid sulcus of the 54-year-old returned to baseline and exophthalmometry was unchanged. The orbital CT of the 70-year-old was normal. She did not complain about deepening of the lid sulcus, and she has not discontinued treatment due to this adverse effect.