Comparison of Ocular Biometric Measurements Using New Swept-source Optical-coherence Tomography, Low-coherence Reflectometry, A-Scan Biometry, and Autokeratometry

Purpose@#We compared optical biometric measurements made using new swept-source optical-coherence tomography, low-coherence reflectometry, autokeratometry, and A-scan biometry. @*Methods@#In total, 86 eyes of 47 patients were included. Axial length, lens thickness, central corneal thickness, anterior chamber depth, and corneal curvature were measured using the Anterion® (Heidelberg Engineering, inc., Heidelberg, Germany) and Lenstar LS 900® (Haag-Streit AG, Koeniz, Switzerland) platforms. Corneal curvature and axial length were measured using the Essilor AKR 750® (Essilor instruments, France, Charenton-le-Pont) and PacScan 300A® (Sonomed Inc., Chicago, IL, USA) platforms, respectively. The evaluated biometric parameters were compared and verified; intraclass correlation coefficients and Bland-Altman plots were used to analyze statistical agreement. @*Results@#The differences between the Anterion® and Lenstar LS 900® platforms in terms of axial length, lens thickness, central corneal thickness, anterior chamber depth, and white-to-white diameter were -0.02 ± 0.08, 0.08 ± 0.13, -2.66 ± 11.12, 0.05 ± 0.12, and 0.08 ± 0.26, respectively. All values were statistically significant. The mean corneal curvature between Anterion® and Lenstar LS 900® had a statistically significant difference of -0.08 ± 0.47, while the difference between the Anterion® and AKR 750® platforms was not significant. Biometric parameters measured using an Anterion® and other devices showed a strong positive correlation when assessed using Pearson’s correlation analysis; there was good agreement between the results when analyzed using intraclass correlation coefficients and Bland-Altman plots. @*Conclusions@#Optical biometric measurements made using the Anterion® platform were not significantly different from those obtained using other devices, but there were significant differences compared to the Lenstar LS 900® platform. Since these significant differences could influence decision making during intraocular lens selection for cataract surgery, the values are clinically useful for reference.

Comparison of Myopic Progression before and after Orthokeratology Lens Treatment

PURPOSE: To compare the myopic progression before and after wearing an orthokeratology lens (OK). METHODS: Twenty-six patients (49 eyes) with at least 6 months of myopia prior to OK treatment were evaluated. Changes in the spherical equivalent (SE) refractive error and axial length were compared before and after OK use. Changes in the SE and axial length were also compared between two groups according to the myopic progression before baseline: Group 1 with myopic progression 1 D/year. RESULTS: The myopic progression rate decreased from −1.1 to −0.3 D/year after OK treatment (p < 0.001). Greater increases in axial length were observed in patients who were younger and had less myopia at baseline, a higher rate of myopia progression before baseline, and a shorter axial length at baseline (p < 0.001, p < 0.004, p < 0.007, and p < 0.001, respectively). The increase in axial length was significantly greater in the group with greater myopic progression before baseline (0.2 mm/year) than in the group with less myopic progression (0.1 mm/year) (p = 0.001). CONCLUSIONS: Myopic progression was reduced significantly after OK treatment.

Comparision of Corneal Refractive Power Measured with Opitcal Low-coherence Reflectometry, Autokeratometer, and Topography in Children

PURPOSE: To compare the keratometry obtained from optical low-coherence reflectometry (Lenstar LS900®), autokeratometer (KR-8100®), and topography (Medmont E300®) in children. METHODS: A retrospective study was performed in 316 eyes of 160 subjects. Subjects were divided into 3 groups according to age. Group 1 was younger than 10 years, group 2 was older than 10 years and younger than 18 years, and group 3 was older than 18 years. Subjects were tested using the Lenstar LS900®, KR-8100®, and Medmont E300®. Comparisons were made for steep K, flat K, mean K, and astigmatism among three groups. Agreement among the 3 devices was examined using the Bland-Altman method. RESULTS: The keratometry measured by Medmont E300® was highest, followed by that of Lenstar LS900® and KR-8100® in all 3 groups. Almost all keratometry was significantly different among the 3 devices except for the flat K measured by LS900® and KR-8100® in all 3 groups and flat K measured by KR-8100® and Medmont E300® in Group 3 (p < 0.05). With regard to mean K, the agreement between Lenstar LS900® and KR-8100® was better than that between the other two pairs in both Groups 1 and 2, while agreement between Lenstar LS900® and Medmont E300® was better in Group 3. The agreement between KR-8100® and Medmont E300® was worse than that between the other two pairs in Groups 1 and 3, while the agreement between Lenstar LS900® and Medmont E300® was worse in Group 2. CONCLUSIONS: There were significant differences in keratometry among the 3 devices in all 3 groups. In children, Medmont E300® showed relatively less agreement compared with the other two devices. In adults, however, the agreement between 2 devices showed variable results. Consideration of the keratometry measurement from Lenstar LS900®, KR-8100®, and Medmont E300® might be helpful to estimate accurate corneal keratometry in children.

Comparison of Anterior Chamber Depth and Central Corneal Thickness Measured Using Different Devices

PURPOSE: To compare the accuracy and clinical usefulness of different devices by measuring anterior chamber depth (ACD) with three devices and central corneal thickness (CCT) with four devices. METHODS: In 180 eyes of 90 healthy subjects, ACD was measured using A-scan, Lenstar LS900®, Pentacam®, and CCT was measured using ultrasound pachymetry (USP), Lenstar LS900®, Pentacam®, and anterior segment optical coherence tomography (OCT). RESULTS: The average ACT measurements using Lenstar LS900®, A-scan, and Pentacam® were 3.27 ± 0.35 mm, 3.26 ± 0.36 mm, and 3.25 ± 0.36 mm, respectively. The measurements were significantly correlated (p < 0.001) but without statistically significant difference (p = 0.017). The Bland-Altman plots showed a low degree of agreement. The average CCT measurements using Pentacam®, USP, Lenstar LS900®, and OCT were 553.31 ± 25.23 µm, 547.26 ± 23.83 µm, 541.38 ± 24.49 µm, and 531.40 ± 22.33 µm, respectively. The measurements were significantly correlated (p < 0.001) and statistically significantly different (p < 0.05). The Bland-Altman plots showed a low degree of agreement. CONCLUSIONS: ACD and CCT measured using different devices were highly correlated, but the ACD measurements were not statistically different; however, the CCT measurements were statistically different, and agreement was low between both measurements.

Comparison of Biometric Measurements and Refractive Results between Applanation Ultrasonography and Three Different Interferometries

PURPOSE: To compare ocular biometry and refractive results measured using conventional applanation ultrasonography and 3 different optical interferometries, Lenstar LS900(R), AL-Scan(R) and OA-2000(R). METHODS: The biometries of 31 cataractous eyes were measured using ultrasonography, Lenstar LS900(R), AL-Scan(R) or OA-2000(R). The axial length, anterior chamber depth and keratometry were measured. The SRK/T formula was used to calculate intraocular lens power. Two months after cataract surgery, the refractive outcome was determined and results from the 4 different biometry methods were compared. RESULTS: Axial lengths were 23.39 +/- 0.95 mm, 23.42 +/- 0.98 mm, 23.43 +/- 0.98 mm and 23.44 +/- 0.98 mm measured using ultrasonography, Lenstar LS900(R), AL-Scan(R) and OA-2000(R), respectively with no statistically significant differences observed (p = 0.996). The anterior chamber depth and keratometry were 3.14 +/- 0.41 mm, 3.10 +/- 0.38 mm and 3.13 +/- 0.39 mm (p = 0.936) and 44.41 +/- 1.52 D, 44.54 +/- 1.57 D and 44.44 +/- 1.52 D (p = 0.937) for Lenstar LS900(R), AL-Scan(R) and OA-2000(R) respectively. There were no statistically significant differences between the 3 optical devices. The mean absolute error of the 4 different devices were not statistically significant (p = 0.722). CONCLUSIONS: The ocular biometric measurements and prediction of postoperative refraction using ultrasonography, Lenstar LS900(R), AL-Scan(R) or OA-2000(R) showed no significant differences.

Short-Term Clinical Results and Safety of Ultra Q Laser Treatment for Vitreous Floaters

PURPOSE: To evaluate the short-term clinical results and safety of Ultra Q neodymium-doped yttrium aluminium garnet (Nd:YAG) laser treatment for vitreous floaters. METHODS: The present study included 31 eyes of 31 patients with symptomatic floaters lasting more than 3 months. The vitreous floaters were photodisrupted using Ultra Q Nd:YAG laser. Preoperative and postoperative best corrected visual activity (BCVA) and intraocular pressure, change of the floater, patient satisfaction and postoperative complications were analyzed prospectively. RESULTS: There was no significant difference between preoperative and postoperative BCVA and intraocular pressure (p > 0.05). Vitreous floaters were not found in 9 eyes (29.03%), decreased floaters were observed in 19 eyes (61.29%) and definite change of floaters was not observed in 3 eyes (9.68%). Patient satisfaction after the laser treatment was very satisfied in 11 eyes (35.48%) and satisfied in 20 eyes (64.58%). Satisfaction in Weiss ring type of the floater was the highest, very satisfied in 6 of the 8 eyes (75%) and vitreous floaters were not observed in 7 of the 8 eyes (87.50%). Postoperative complications were not observed during a follow-up period of at least 3 months. CONCLUSIONS: Ultra Q Nd:YAG laser was an effective and safe treatment for the vitreous floaters in this short-term study.

Analysis of Optical Coherence Tomographic Patterns and Clinical Courses in Diabetic Macular Edema after Treatment

PURPOSE: To analyze the optical coherence tomographic patterns and clinical courses of patients with diabetic macular edema (DME) after treatment. METHODS: The charts of 65 patients with DME were retrospectively reviewed. Baseline optical coherence tomographic patterns of DME were categorized into the 4 groups: group 1 (9 eyes, 13.8%) showed diffuse retinal thickening, group 2 (21 eyes, 32.3%) had cystoid macular edema (CME), group 3 (13 eyes, 20.0%) demonstrated serous retinal detachment (SRD) and group 4 (22 eyes, 33.9%) had combined CME and SRD. Treatments for DME included intravitreal bevacizumab/triamcinolone injection, focal laser photocoagulation and vitrectomy. During 12 months of follow-up, changes in the patterns of DME were assessed. Additionally, the central retinal thickness (CRT) and best-corrected visual acuity (BCVA) were measured at baseline, 6 and 12 months. RESULTS: During 12 months of follow-up, 21 eyes (32.3%) showed changes in the DME pattern: 2 eyes (22.2%) in group 1, 3 (14.3%) in group 2, 4 (30.8%) in group 3 and 12 (54.5%) in group 4. A significantly greater proportion of eyes with changes in DME pattern underwent vitrectomy compared with those without changes in DME pattern (p = 0.012). There was a significant difference in CRT among the 4 groups; group 4 demonstrated the largest CRT at baseline, 6 and 12 months (p < 0.001, 0.002 and 0.029, respectively). However, there were no significant differences in BCVA among the 4 groups at baseline, 6 or 12 months (p = 0.879, 0.375 and 0.246, respectively). CONCLUSIONS: Clinical courses varied according to the tomographic patterns of DME after treatment, and the poorest anatomic outcome was found in group 4. Change in tomographic pattern of DME was correlated with the treatment of DME, which might suggest a poorer outcome in those patients than in the patients who maintained their DME patterns.

Reliability and Usefulness of Refractive Measurements by PlusoptiX S09 in Children

PURPOSE: To compare the refractive measurements obtained using a photorefractor (PlusoptiX S09, PlusoptiX GmbH, Germany) with those obtained using cycloplegic refraction in children. METHODS: We assessed the refractive status of 268 eyes in 134 children. The values acquired via photorefraction with a PlusoptiX S09 device were compared with those obtained by cycloplegic retinoscopy. Hyperopia (> or =+3.5 D), myopia (> or =-3.0 D), with the rule or against the rule astigmatism (> or =-1.5 D), and oblique astigmatism (> or =-1.0 D) were set as diagnostic criteria for refractive amblyopia risk factors (RARFs). The difference in the detection of RARFs by the two methods was the main outcome measure. RESULTS: The average spherical refractive power was -0.81 +/- 1.68 D for PlusoptiX S09 versus -0.26 +/- 2.00 D for cycloplegic retinoscopy (average difference -0.54 +/- 0.61 D; p < 0.001). The average spherical equivalent was -1.20 +/- 1.62 D for PlusoptiX S09 versus -0.64 +/- 1.94 D for cycloplegic retinoscopy (average difference -0.56 +/- 0.62 D; p < 0.001). The average cylinder power was -0.79 +/- 0.93 D for PlusoptiX S09 versus -0.76 +/- 0.94 D for cycloplegic retinoscopy (average difference -0.03 +/- 0.33 D; p = 0.135). Even though cycloplegic retinoscopy is considered the gold standard, the sensitivity and specificity for detecting RARFs with the PlusoptiX S09 were 88.0% and 96.3%, respectively. CONCLUSIONS: PlusoptiX S09 is a relatively useful method for detecting RARFs, but the device tends toward myopic shift compared to cycloplegic refraction, and hyperopia is underestimated.

Clinical Manifestations and Risk Factors of Ocular Graft-versus-Host Disease (GVHD) after Hematopoietic Stem Cell Transplantation

PURPOSE: To investigate the incidence, clinical manifestations, and risk factors of ocular graft-versus-host disease (GVHD) as well as the survival of the patients after allogeneic hematopoietic stem cell transplantation (HSCT). METHODS: The medical records of 99 patients who visited our clinic and were screened for ocular GVHD after allogeneic HSCT were reviewed retrospectively. Subjects were divided into 2 groups depending on the occurrence of ocular GVHD on slit-lamp biomicroscopy. We compared clinical manifestations and survival between the 2 groups and analyzed the risk factors associated with the development of ocular GVHD. RESULTS: Ocular GVHD was diagnosed in 38 patients (38.38%) at a mean of 315 days after HSCT. Out of the 38 patients who developed ocular GVHD, 22 patients (57.89%) were diagnosed with dry eye only and 16 patients (42.11%) were diagnosed with conjunctival disease. The presence of extraocular GVHD (hazard ratio (HR) 35.76, p < 0.001), the number of extraocular GVHD (HR 3.07, p < 0.001), skin GVHD (HR 2.31, p = 0.029), oral GVHD (HR 8.16, p < 0.001), and gastrointestinal tract GVHD (HR 5.00, p = 0.002) were independent risk factors of ocular GVHD. Comparisons of the survival demonstrated decreased survival of patients with conjunctival disease compared to patients without ocular GVHD and patients with dry eye only, but there was no statistically significant differences (log rank test, p = 0.208). CONCLUSIONS: Ocular GVHD is common after allogeneic HSCT. The majority of ocular GVHD occurs in the chronic stage and is associated with decreased survival. Therefore, more intensive and long-term follow-up with ophthalmic and systemic monitoring is necessary, especially in patients who have extraocular GVHD, for early recognition and proper treatment of ocular GVHD.