Corneal Endothelial Cell Loss after Phacoemulsification in Eyes with a Prior Acute Angle-closure Attack

Purpose@#To evaluate endothelial damage after cataract surgery in eyes affected by an angle-closure attack (ACA) and compare it to that in the unaffected fellow eyes (FEs) of patients with ACA and normal eyes (NEs). @*Methods@#The medical data of eyes affected by ACA, FEs (with no history of acute glaucoma attack), and NEs of patients who underwent cataract surgery with simultaneous intraocular lens implantation were retrospectively reviewed. Endothelial cell density (ECD) and central corneal thickness (CCT) measured before surgery and at 1 week, 1 month, and 3 months after surgery were analyzed, and the percentages of loss in ECD and increase in CCT of the three groups were compared. @*Results@#The study enrolled 140 eyes from 100 patients (50 eyes in the ACA group, 40 eyes in the FE group, and 50 eyes in the NE group). The mean ECD was significantly lower in the ACA group than in the other groups (p 0.05). None of the eyes developed corneal edema at 3 months postoperatively. Moreover, the CCTs of the three groups were similar throughout the follow-up period (p > 0.05). @*Conclusions@#Phacoemulsification was not associated with greater endothelial cell loss in the ACA group than in the NE and FE groups. This finding shows that ACA history may not contribute to the exacerbation of corneal endothelial damage in cataract surgery.

A Comparison of Retinal Thickness Changes According to Initial Optic Disc Edema in Optic Neuritis Patients

Purpose@#To compare early changes in the macular retinal nerve fiber layer (mRNFL) and ganglion cell-inner plexiform layer (mGCIPL) thicknesses according to the severity of initial optic disc edema in optic neuritis patients using swept-source optical coherence tomography (SS-OCT). @*Methods@#We retrospectively reviewed 18 eyes of patients diagnosed with naïve optic neuritis along with optic disc edema who underwent SS-OCT. The central thickness of the optic nerve head and the peripapillary retinal thickness were measured at the initial visit. To quantitate the degree of initial optic disc edema, we calculated the difference of each measurement between the affected eye and the normal fellow eye. The mRNFL and mGCIPL thicknesses were measured at the initial visit and at the 1 month follow-up. The association between changes in mRNFL and mGCIPL thicknesses at the 1 month follow-up and the severity of initial optic disc edema were evaluated. @*Results@#In the affected eye, the mGCIPL thickness was reduced at 1 month. The central thickness of the optic nerve head at the initial visit correlated with the reduction in the temporal mGCIPL at 1 month (R = 0.648, p = 0.045). Furthermore, thicker nasal peripapillary retinal thickness at the initial visit correlated with a reduction in nasal (R = 0.659, p = 0.038) and temporal (R = 0.774, p = 0.009) mGCIPL at 1 month. Thicker temporal peripapillary retinal thickness at the initial visit correlated with reduction in the nasal (R = 0.646, p = 0.044) and temporal (R = 0.760, p = 0.011) mGCIPL at 1 month. @*Conclusions@#In optic neuritis patients with optic disc edema, severe optic disc edema, evaluated by peripapillary retinal thickness and central thickness of the optic nerve at the initial visit was associated with a reduced temporal mGCIPL thickness at 1 month. This study suggested that initially severe optic disc edema in optic neuritis patients can predict a rapid decline in the mGCIPL.

Corneal Endothelial Cell Loss after Phacoemulsification in Eyes with a Prior Acute Angle-closure Attack

Purpose@#To evaluate endothelial damage after cataract surgery in eyes affected by an angle-closure attack (ACA) and compare it to that in the unaffected fellow eyes (FEs) of patients with ACA and normal eyes (NEs). @*Methods@#The medical data of eyes affected by ACA, FEs (with no history of acute glaucoma attack), and NEs of patients who underwent cataract surgery with simultaneous intraocular lens implantation were retrospectively reviewed. Endothelial cell density (ECD) and central corneal thickness (CCT) measured before surgery and at 1 week, 1 month, and 3 months after surgery were analyzed, and the percentages of loss in ECD and increase in CCT of the three groups were compared. @*Results@#The study enrolled 140 eyes from 100 patients (50 eyes in the ACA group, 40 eyes in the FE group, and 50 eyes in the NE group). The mean ECD was significantly lower in the ACA group than in the other groups (p 0.05). None of the eyes developed corneal edema at 3 months postoperatively. Moreover, the CCTs of the three groups were similar throughout the follow-up period (p > 0.05). @*Conclusions@#Phacoemulsification was not associated with greater endothelial cell loss in the ACA group than in the NE and FE groups. This finding shows that ACA history may not contribute to the exacerbation of corneal endothelial damage in cataract surgery.

Chronic Recurrent Methicillin Resistant Staphylococcus Hemolyticus Endophthalmitis after Cataract Surgery

PURPOSE: To report a case of recurrent endophthalmitis due to methicillin resistant Staphylococcus hemolyticus after phacoemulsification and posterior chamber intraocular lens (IOL) implantation. CASE SUMMARY: A 76-year-old female visited our outpatient clinic with decreased vision 40 days after uncomplicated cataract surgery in her right eye. At the visit, anterior chamber inflammation and cloudy fluid between the posterior capsule and IOL were observed. Uveitis due to residual cortex of lens or capsular block syndrome was suspected, so YAG laser capsulotomy and subconjunctival injection of dexamethasone were performed. Two days later, hypopyon and vitreous opacity were seen. The patient underwent an emergency vitrectomy and intravitreal antibiotic injection with suspicion of bacterial endophthalmitis. The culture was negative. Twenty days after the vitrectomy, anterior chamber inflammation and vitreous opacity developed. The recurrence of endophthalmitis was suspected due to infection by bacteria in the surrounding tissue of the IOL, so the patient underwent an IOL and lens capsule removal with intravitreal antibiotic injection. At this time, the culture revealed methicillin resistant staphylococcus hemolyticus. Systemic and topical vancomycin was then administered, resulting in decreased inflammation. Twenty days after the IOL removal, decreased vision, anterior chamber inflammation, and vitreous opacity developed. Endophthalmitis was decreased by intravitreal antibiotic injection and topical antibiotic treatment. CONCLUSIONS: Methicillin resistant staphylococcus hemolyticus should be considered in the differential diagnosis of chronic recurrent endophthalmitis after cataract surgery.

Evaluation of the Relationship between Incision Location and Change of Posterior Corneal Astigmatism

PURPOSE: To determine if there is a difference in surgically induced astigmatism (SIA) of the posterior corneal surface between superior and temporal incision and its effect on total corneal power in patients who underwent clear corneal incision cataract surgery. METHODS: A retrospective study of 81 patients (84 eyes) who underwent clear corneal incision phacoemulsification by one surgeon. Patients were divided into two groups according to the steep axis: the temporal and superior groups. Anterior, posterior and total corneal SIA (simulated keratometry [Sm K], posterior keratometry [PK] and total corneal power [TCP] respectively) were measured using autorefractive keratometry (ARK) and dual Scheimpflug imaging before and after surgery. RESULTS: There were 61 eyes with temporal incision and 23 eyes with superior incision. The mean SIA was larger in the superior incision group than in the temporal incision group according to ARK, Sm K, PK and TCP (p < 0.05). There were no significant cylindrical changes in ARK in the temporal incision group, however, there was a significant decrease in the superior incision group before and after the operation (p < 0.05). Change in the amount and axis of PK before and after operation were not significantly different, for both incision groups. There was a significant correlation between post-operative TCP and both pre-operative ARK and Sm K for both groups. However, there was no correlation between post-operative TCP and pre-operative PK. In all patients, when pre-operative PK was more than 0.5 D, SIA-ARK, SIA-Sm K and SIA-TCP were all significantly larger than when pre-operative PK was less than 0.5 D, whereas SIA-PK was not. When pre-operative PK was more than 0.5 D, there were no significant differences in SIA-ARK, SIA-Sm K, SIA-PK or SIA-TCP in the temporal incision group. However, SIA-ARK was significantly larger in the superior incision group. CONCLUSIONS: There was no significant cylindrical change in PK before and after operation in both the temporal and superior incision groups. Therefore, when predicting post-operative TCP, it might be meaningful to consider SIA-ARK and SIA-Sm K.

The Correlation between Cognitive Function and Glaucoma

PURPOSE: To compare mini-mental state examination (MMSE) score between glaucoma group and normal control group and to evaluate the correlation between MMSE score and spectral domain-optical coherence tomography (SD-OCT) values in both groups. METHODS: This prospective study includes thirty glaucoma patients (eleven primary open angle glaucoma and nineteen normal tension glaucoma) and thirty normal controls. Retinal nerve fiber layer (RNFL) and Ganglion cell-inner plexiform layer (GC-IPL) thickness were measured with SD-OCT, and the average values of both eyes were used. The cognitive function was evaluated with MMSE by a single examiner. RESULTS: The mean MMSE scores of glaucoma group and normal group were 26.07 ± 2.95, and 27.00 ± 1.68 respectively (p = 0.137). MMSE score of less than 24 only showed in glaucoma group. MMSE score and RNFL thickness showed statistically no signifance in correlation (R² = 0.236; p = 0.070), however, MMSE score and GC-IPL showed statistically significant correlation (R² = 0.256; p = 0.048). CONCLUSIONS: Glaucoma patients tend to show low cognitive function even though the correlation between glaucoma patient and low cognitive function was not statistically significant. Therefore, the aspect of cognitive depression should be concerned, when facing glaucoma patients.

Depressive Symptoms and Quality of Life in Age-related Macular Degeneration Based on Korea National Health and Nutrition Examination Survey (KNHANES)

PURPOSE: This study was conducted to investigate the depressive symptoms and quality of life (QOL) in patients with age-related macular degeneration (AMD) using data obtained from the Korea National Health and Nutritional Examination Survey V-2 (KNHANES V-2) conducted in 2011. METHODS: This was a population-based, cross-sectional study that selected 329 participants from the fifth KNHANES (2011) who were diagnosed with AMD by an ophthalmologist based on fundus photography. The prevalence of depressive symptoms and the health-related QOL (using EuroQol indices) in this cohort were also estimated. Factors associated with depressive symptoms, including socioeconomic status, QOL indices, and associated chronic diseases, were investigated using multivariate regression models. RESULTS: Depressive symptoms were observed more frequently in AMD patients than in non-AMD controls (p = 0.013). Among the total 329 AMD participants, 65 (19.8%) had depressive symptoms. There were 16 males (24.6%) and 49 females (75.4%). Upon multivariate analysis, significant factors found to be associated with depressive symptoms were female gender (odds ratio [OR], 2.082; 95% confidence interval [CI], 1.001 to 4.330), being in the “dependent” group for activities of daily living (OR, 4.638; 95% CI, 2.061 to 10.435), and having “some problems” in the “anxiety-depression” dimension of the EQ-5D (OR, 7.704; 95% CI, 1.890 to 31.408). CONCLUSIONS: Female gender and being dependent on others for activities of daily living increased the association of depressive symptoms in this cohort of AMD participants. Screening for depressive symptoms in East Asian AMD patients with these characteristics should be an important component of their care.

The Effect of Intravitreal Injection on the Corneal Endothelium

PURPOSE: To evaluate the effect of intravitreal injection on the corneal endothelium according to the injected drug. METHODS: The present study included 118 eyes of 113 patients who received intravitreal injection. Before each injection and 1 month after the injection, specular microscopy was performed to evaluate the corneal endothelial changes and central corneal thickness. We classified the patients according to the injected drug (bevacizumab 21 eyes, ranibizumab 20 eyes, aflibercept 47 eyes, dexamathasone implant 30 eyes), phakic or pseudophakic eyes, single or multiple injections and analyzed them retrospectively. RESULTS: The mean corneal endothelial cell density was 2,693.2 ± 298.2 cells/mm² before injection and 2,686.8 ± 288.7 cells/mm² 1 month after injection, and there was no statistically significant difference (p = 0.731). According to the kind of drug, the mean corneal endothelial cell density and central corneal thickness were not significantly different before and 1 month after injection in any of the 4 groups. CONCLUSIONS: There were no significant changes in corneal endothelium before and 1 month after intravitreal injection of the various drugs.

Astigmatic Correlation between the Automated Refractometry and Dual Scheimpflug Analyzer in Pseudophakic Eyes

PURPOSE: To examine the relationship between the refractive astigmatism by automated refractometry and the corneal astigmatism by a dual Scheimpflug analyzer in pseudophakic eyes. METHODS: Prospectively, 75 patients (100 eyes) were enrolled in the present study. Refractive astigmatism was obtained by automated refraction. Corneal astigmatism was obtained using automated keratometry (ARK-530A®) and dual Scheimpflug scanning analysis (Galilei G4®). All refractive values were converted to the power vector components J0 and J45 for comparison and regression analysis of refractive versus corneal astigmatism. Bland-Altman plots were created to estimate the agreement between measurements. RESULTS: The average astigmatism from each measurement was -1.11 ± 1.44 D (refractive astigmatism from automated refraction), -0.77 ± 1.06 D (corneal astigmatism from automated keratometry), -0.93 ± 1.02 D (simulated K from Galilei G4®), and -1.11 ± 1.48 D (total corneal power from Galilei G4®). Refractive J0 and keratometric J0 were significantly correlated (r = 0.557, p ≤ 0.001), as well as the corresponding J45 values (r = 0.655, p = 0.025). Refractive astigmatism and total corneal power components were also significantly correlated (J0: r = 0.618, p ≤ 0.001; J45: r = 0.608, p = 0.04). In the Bland-Altman plots, keratometric J0 and total corneal power J0 showed the best agreement. CONCLUSIONS: The accuracy of measurements for corneal refraction and astigmatism in pseudophakic eyes is higher using the dual Scheimpflug analyzer, especially for total corneal power. This value of astigmatism can take into account the refractive astigmatism of pseudophakic eyes and can be used in evaluating postoperative corneal astigmatism.

Retinal Nerve Fiber Layer Volume Measurements in Normal Children Using Spectral Domain Optical Coherence Tomography

PURPOSE: To measure retinal nerve fiber layer (RNFL) volume in normal children using spectral domain optical coherence tomography (SD-OCT). METHODS: This study included 79 eyes of 54 normal children between 4 and 15 years of age evaluated from February 2012 to November 2012. All participants underwent ocular examination and 3D-disc scanning using SD-OCT. RNFL volume was calculated between 2.5 and 5 mm diameter circles using the length, width, and height of each pixel derived from the RNFL thickness map with Matlab software. The relationship between RNFL volume and thickness was analyzed. RESULTS: The RNFL volumes of the mean total, superior, nasal, inferior, and temporal areas were 1.48 ± 0.09 mm3, 0.45 ± 0.04 mm3, 0.29 ± 0.04 mm3, 0.46 ± 0.03 mm3, and 0.29 ± 0.04 mm3, respectively. Comparing RNFL volume and conventional circumpapillary RNFL thickness measured using built-in software, a strong correlation between mean total, superior, and inferior areas (R = 0.980, 0.953 and 0.932, respectively) and a moderate correlation between the nasal and temporal areas were observed (R = 0.545 and 0.514, respectively). The negative correlations between RNFL thickness and RNFL volumes of the mean total, superior, nasal, inferior, and temporal areas and age were not significant (p > 0.05). CONCLUSIONS: This study reports RNFL volume measured from RNFL thickness map analysis in normal children. These data regarding RNFL volume of normal children may provide useful information for diagnosis and monitoring of pediatric glaucoma.

Treatment of Acute Retinal Necrosis with Acute Kidney Injury after Intravenous Antiviral Injection

PURPOSE: In the present study, a case of acute retinal necrosis with acute renal injury due to high-dose intravenous antiviral injection which was treated by intravitreal ganciclovir injection is reported. CASE SUMMARY: A 46-year-old female visited our clinic complaining of red eye and decreased vision in the right eye. At the first visit, her corrected visual acuity was finger count in the right eye, and 20/20 in the left eye. Fundus examination of the right eye revealed multiple peripheral arterial occlusion, papilledema, and whitish necrotic infiltration at the periphery. Clinically diagnosed as acute retinal necrosis, the patient was started on intravenous acyclovir. Two days after injection, her serum creatinine level increased, therefore, intravenous acyclovir was discontinued and she was started on intravitreal ganciclovir. Five days after the intravenous injection was discontinued, the serum creatinine level returned to normal range. Four months after the first visit, visual acuity was 20/100 and no recurrence was observed. CONCLUSIONS: Intravitreal ganciclovir injection can be an effective alternative in patients with acute retinal necrosis and poor kidney function.

RNFL and Ganglion Cell Complex Thickness in Normal Hemifield According to the Severity of Glaucoma

PURPOSE: To analyze the thickness of the circumpapillary retinal nerve fiber layer (cRNFL) and macular ganglion cell complex (mGCC) in apparently normal hemifield areas of glaucomatous eyes with superior or inferior visual hemifield defects according to their severity compared with the same hemifield of normal eyes using Topcon 3D spectral-domain optical coherence tomography (SD-OCT). METHODS: The present study included 90 normal eyes and 90 glaucomatous eyes with superior or inferior visual hemifield defects that underwent cRNFL and mGCC imaging using 3D SD-OCT. The cRNFL and mGCC parameters were compared between normal hemifield in glaucomatous eyes and the same hemifield in normal eyes. The mean deviation (MD) parameters (Mild: MD > -6 dB, 54 eyes; Moderate: -6 dB ≥ MD ≥ -12 dB, 60 eyes; Severe: MD < -12 dB, 30 eyes) in glaucomatous eyes were also compared between the 3 severity groups. RESULTS: The average hemifield cRNFL thickness was 93.6 ± 24.2 µm and 118.1 ± 14.1 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 107.8 ± 19.1 µm and 124.9 ± 17.1 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively. mGCC thickness was 95.8 ± 5.9 µm and 103.5 ± 7.7 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 93.4 ± 8.2 µm and 104.5 ± 8.2 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively (all p < 0.05). The thickness parameters were decreased in normal hemifield of glaucomatous eyes, which significantly decreased according to the severity (MD) of visual field defect (all p < 0.01). CONCLUSIONS: The measurement of cRNFL and mGCC thickness in normal hemifield of glaucomatous eyes using SD-OCT is useful in detecting structural glaucomatous changes before visual field defects appear.

RNFL and Ganglion Cell Complex Thickness in Normal Hemifield According to the Severity of Glaucoma

PURPOSE: To analyze the thickness of the circumpapillary retinal nerve fiber layer (cRNFL) and macular ganglion cell complex (mGCC) in apparently normal hemifield areas of glaucomatous eyes with superior or inferior visual hemifield defects according to their severity compared with the same hemifield of normal eyes using Topcon 3D spectral-domain optical coherence tomography (SD-OCT). METHODS: The present study included 90 normal eyes and 90 glaucomatous eyes with superior or inferior visual hemifield defects that underwent cRNFL and mGCC imaging using 3D SD-OCT. The cRNFL and mGCC parameters were compared between normal hemifield in glaucomatous eyes and the same hemifield in normal eyes. The mean deviation (MD) parameters (Mild: MD > -6 dB, 54 eyes; Moderate: -6 dB ≥ MD ≥ -12 dB, 60 eyes; Severe: MD < -12 dB, 30 eyes) in glaucomatous eyes were also compared between the 3 severity groups. RESULTS: The average hemifield cRNFL thickness was 93.6 ± 24.2 µm and 118.1 ± 14.1 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 107.8 ± 19.1 µm and 124.9 ± 17.1 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively. mGCC thickness was 95.8 ± 5.9 µm and 103.5 ± 7.7 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 93.4 ± 8.2 µm and 104.5 ± 8.2 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively (all p < 0.05). The thickness parameters were decreased in normal hemifield of glaucomatous eyes, which significantly decreased according to the severity (MD) of visual field defect (all p < 0.01). CONCLUSIONS: The measurement of cRNFL and mGCC thickness in normal hemifield of glaucomatous eyes using SD-OCT is useful in detecting structural glaucomatous changes before visual field defects appear.

Bilateral Simultaneous Central Retinal Vein Occlusion in a Patient with Waldenstrom's Macroglobulinemia

PURPOSE: The authors report a case of bilateral simultaneous central retinal vein occlusion caused by Waldenstrom's macroglobulinemia. CASE SUMMARY: A 65-year-old man presented to our department complaining of decreased visual acuity for the duration of about 6 months. On his initial visit, best-corrected visual acuity was 0.02 in the right eye and 0.06 in the left eye. Based on the findings of a funduscopic examination, the patient had bilateral diffuse retinal hemorrhages, dilated tortuous veins, and macular edema. He had experienced recurrent spontaneous epistaxis 6 months previously and had undergone treatments such as intravitreal bevacizumab injection and intravitreal dexamethasone implantation at another hospital. Laboratory tests at that hospital showed anemia and hyperproteinemia, for which he was referred to our hemato-oncology department. Bone marrow biopsy was consistent with Waldenstrom's macroglobulinemia/lymphoplasmacytoid lymphoma, and he was treated with systemic chemotherapy. One year after the systemic chemotherapy, his best-corrected visual acuity was 0.15 in the right eye and 0.6 in the left eye. Funduscopy showed decreased bilateral retinal hemorrhages and macular edema. CONCLUSIONS: When simultaneous bilateral central retinal vein occlusion occurs in a patient with no other underlying disease such as hypertension or diabetes, it might be a sign of serum hyperviscosity, and there should be a very high level of suspicion for presence or progression of systemic disease. If such a disease is properly and timely diagnosed, effective early systemic evaluation and therapy can be administered, and it is important to have initial general treatment as well as ophthalmic treatment.

Comparison of Ocular Biometry and Postoperative Refraction in Cataract Patients between Galilei-G6(R) and IOL Master(R)

PURPOSE: To compare the axial lengths, anterior chamber depths, and keratometric measurements and to predict postoperative refractions of Dual Scheimpflug analyzer Galilei G6(R) and intra ocular lens (IOL) Master(R). METHODS: A total of 50 eyes in 50 patients who received cataract surgery were included in the present study. The axial length, anterior chamber depth, and keratometry were measured using 2 types of partial coherence interferometries (Galilei G6(R) and IOL Master(R)). The SRK/T formula was used to calculate IOL power and the predictive error which subtracts predictive refraction from postoperative refraction was compared between the ocular biometry devices. RESULTS: Axial lengths were 23.36 +/- 0.80 mm and 23.36 +/- 0.90 mm measured by Galilei G6(R) and IOL Master(R), respectively. Axial length measured by Galilei G6(R) was not statistically significant compared with IOL Master(R) (p = 0.321). The anterior chamber depth and keratometry were 3.22 +/- 0.35 mm and 44.29 +/- 1.40 D measured by Galilei G6(R) and 3.11 +/- 0.46 mm and 44.39 +/- 1.41 D measured by IOL Master(R), respectively. The differences of anterior chamber depth and keratometry between the 2 devices were statistically significant (p < 0.001 and p = 0.028, respectively). The mean absolute prediction errors were 0.45 +/- 0.37 D and 0.49 +/- 0.39 D in Galilei G6(R) and IOL Master(R), respectively and was not statistically significantly different (p = 0.423). CONCLUSIONS: The ocular biometric measurements and prediction of postoperative refraction using Galilei G6(R) were as accurate as with IOL Master(R).

Transscleral Fixation of Intraocular Lenses Using Modified Injector

PURPOSE: To evaluate the clinical stability and outcomes of 3-piece intraocular lens (IOL) transscleral fixation surgery using a modified injector. METHODS: We have modified and used the Sapphire unfolder injector system (Allergan(R), USA). This involved, cutting a slit longitudinally at the terminal part of the injector so that a thread could pass through it freely. After a conjunctival peritomy created at 2 and 8 o'clock, a long curved needle with double-armed 10-0 polypropylene is passed through the exposed sclera. Two pieces of suture are withdrawn through the 2.8 mm corneal incision and 1 suture (from 8 o'clock) is passed through the opening of the cartridge and then tied to the leading haptic. Next, the IOL was implanted with the cartridge and then inserted through the corneal incision site. The other suture (from 2 o'clock) is tied to the haptic on the opposite side and inserted. RESULTS: The study included 20 eyes of 20 patients with a mean age of 62.8 years at the initial visit. There were no complications, such as vitreous hemorrhage, retinal detachment, glaucoma, corneal edema, or iris injury. While the knot fixed to the leading haptic of IOL passed by the cartridge, there was no change of position. During the follow-up period, IOL dislocation did not occur and the corrected visual acuity and corneal astigmatism improved significantly. CONCLUSIONS: This technique is an effective procedure for minimizing entangled thread and corneal astigmatism.

Central Corneal Thickness Measured by Noncontact Specular Microscopy, Dual Rotating Scheimpflug Camera and Ultrasound Pachymetry

PURPOSE: To compare central corneal thickness (CCT) as measured using noncontact specular microscopy (NCSM), dual rotating Scheimpflug camera (Galilei(R)), and ultrasound pachymetry (USP). METHODS: The measurements of CCT using NCSM, dual rotating Scheimpflug camera and USP in 70 eyes of 70 healthy subjects were compared. RESULTS: The average measurements of CCT using NCSM, dual rotating Scheimpflug camera, and USP were 567.70 +/- 31.21 microm, 557.84 +/- 26.29 microm, and 553.31 +/- 29.69 microm, respectively. The CCT measurement using NCSM was statistically significantly thicker than when measured using USP (p 0.900, p < 0.001). CONCLUSIONS: The results of the 3 methods were significantly correlated but the measurement using NCSM was significantly thicker than when using USP. CCT measurements of healthy eyes using dual rotating Scheimpflug camera were more correlated with USP than NCSM. The CCT measurements using dual rotating Scheimpflug camera is a better alternative for USP than NCSM.

The Effect of Pattern Scan Laser Photocoagulation on Peripapillary Retinal Nerve Fiber Layer Thickness and Optic Nerve Morphology in Diabetic Retinopathy

PURPOSE: To evaluate the effect of pattern scan laser (PASCAL) photocoagulation on peripapillary retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and optic nerve morphology in patients with diabetic retinopathy. METHODS: Subjects included 35 eyes for the PASCAL group and 49 eyes for a control group. Peripapillary RNFL thickness, cup-disc area ratio and CMT were measured before PASCAL photocoagulation and at 2 and 6 months after PASCAL photocoagulation in the PASCAL or control groups. RESULTS: The average RNFL thickness had increased by 0.84 microm two months after and decreased by 0.4 microm six months after PASCAL photocoagulation compared to baseline, but these changes were not significant (p = 0.83, 0.39). The cup-disc area ratio was unchanged after PASCAL photocoagulation. CMT increased by 18.11 microm (p = 0.048) at two months compared to baseline thickness, and partially recovered to 11.82 microm (p = 0.11) at six months in the PASCAL group. CONCLUSIONS: PASCAL photocoagulation may not cause significant change in the peripapillary RNFL thickness, CMT, and optic nerve morphology in patients with diabetic retinopathy.

A Prospective Study of Blepharoptosis after Panretinal Photocoagulation Using Ophthalmoscopic Contact Lens

PURPOSE: To investigate the possibility of blepharoptosis as a complication after panretinal photocoagulation using ophthalmoscopic contact lens. METHODS: We prospectively evaluated patients who were diagnosed with diabetic retinopathy and scheduled to be treated with panretinal photocoagulation. Margin reflex distance 1 (MRD1), levator function, palpebral fissure height and width, and tarsal plate height were measured at the day of photocoagulation and 3 months after treatment. RESULTS: MRD1 was decreased in 8 eyes (25.8%), levator function was decreased in 5 eyes (16.1%), and palpebral fissure height was decreased in 6 eyes (19.4%). The decrement of MRD1 and palpebral fissure height after photocoagulation were significant (p = 0.008, p = 0.031, respectively). There was a significant negative correlation between MRD1 decrement and tarsal plate height (p = 0.045). CONCLUSIONS: We identified blepharoptosis after panretinal photocoagulation using contact ophthalmoscopic lens, which was related with low tarsal plate height.

The Changes of Anterior Chamber Depth, Axial Length, Refractive Errors after Combined Vitrectomy

PURPOSE: To evaluate the changes of anterior chamber depth (ACD), Axial length (AXL) after combined vitrectomy and cataract surgery and to analyze the association with refractive errors. METHODS: In 22 eyes who underwent combined vitrectomy and cataract surgery (PPV-Phaco group), 20 eyes who underwent vitrectomy-only (PPV-only group) and 28 eyes who underwent uncomplicated cataract surgery (Phaco-only group), ACD and AXL were measured with IOL master (Carl Zeiss Jena, Germany) preoperatively and 3 months postoperatively. We compared the preoperative desired refraction and postoperative 3 months refraction. RESULTS: ACD were increased in PPV-Phaco group and Phaco-only group (all, p < 0.001) and this change was more prominent in PPV-Phaco group (p = 0.030). In PPV only group, ACD was decreased (p < 0.001). The AXL after surgery was not significant different from the preoperative AXL in PPV-Phaco and PPV only groups (p = 0.612, p = 0.090). But the AXL was decreased in Phaco-only group (p = 0.022). Hyperopic shifting were noticed in PPV-Phaco and phaco-only groups, but myopic shifting was noticed in PPV-only group. However, these changes were not statistically significant (p = 0.292, p = 0.251, p = 0.068). CONCLUSIONS: ACD was increased after combined vitrectomy and cataract surgery. AXL was not changed. The hyperopic shifting was noticed after combined vitrectomy and cataract surgery, but was not statistically significant.