Measurement of Corneal Power and Astigmatism Using Placido-based Videokeratography and Comparison with Other Keratometers

PURPOSE: In the present study, the repeatability and reproducibility of the corneal power and astigmatism measurements using placido-based video keratography were evaluated and the agreement with other keratometers were compared. METHODS: This prospective study included 45 patients (45 eyes) scheduled to undergo cataract surgery between November 2015 and January 2016. Three sets of corneal power and astigmatism were measured using placido-based video keratometer (Keratograph® 5M), automatic keratometer (KR-8900®), manual keratometer (B×L manual keratometer®), Placido-scanning-slit keratometer (ORBscan II®), Scheimpflug keratometer (Pentacam®), and low coherence interferometry (Lenstar LS900®). Reliability of each device was analyzed using the coefficient of variation, standard deviation and intraclass correlation coefficient. Repeated measures analysis of variance was used to analyze the interdevice comparison of mean absolute difference. The agreement between the devices was evaluated with 95% limits of agreement (LoA) and Bland-Altman plots. RESULTS: The mean corneal power, astigmatism and power vector analysis (J₀, J₄₅) were not significantly different among devices (p > 0.05). In the Bland-Altman plot analysis, the 95% LoA of corneal power, J₀, and J45 when comparing Keratograph® 5M with others ranged from -0.78 to 0.55 D, from -0.42 to 0.45 D, and from -0.39 to 0.47 D, respectively. CONCLUSIONS: Keratograph® 5M showed good repeatability and reproducibility of corneal power and astigmatism measurements and was interchangeable with other keratometers.

Clinical Manifestations and Prognosis of Traumatic Wound Dehiscence after Penetrating Keratoplasty

PURPOSE: To investigate clinical manifestations and prognosis of traumatic wound dehiscence after penetrating keratoplasty (PKP). METHODS: This is a retrospective study of patients with traumatic wound dehiscence after penetrating keratoplasty performed between January 2004 and July 2014. All patients underwent primary repair of wound dehiscence. Main outcome measurements included pre- and post-injury best corrected visual acuity (BCVA), mechanism of injury, indication of PKP, time interval from PKP to injury, time interval from injury to primary repair, extent of dehiscence, type of suture, presence of suture, prolapse of intraocular tissue, secondary operation, BCVA and graft state at 6 months after primary repair. RESULTS: The incidence of traumatic wound dehiscence after PKP was 3.96% (12/303). Mean post-injury BCVA and BCVA at 6 months after primary repair (log MAR) were 2.58 ± 0.95 and 2.50 ± 1.05, respectively, and visual acuity did not show significant improvement (p = 1.000). After primary repair, graft failure developed in 9 patients (75%) and evisceration in 2 patients; re-PKP was performed in 3 patients. Pars plana vitrectomy was performed in 1 patient due to retinal detachment. Visual prognosis was poor in patients with wound dehiscence greater than 180° than those with wound dehiscence less than 180° (3.24 ± 0.13 vs. 1.97 ± 1.11, p = 0.030), and in patients with iris prolapse than those without iris prolapse (3.17 ± 0.16 vs. 1.56 ± 1.05, p = 0.048). CONCLUSIONS: The prognosis of traumatic wound dehiscence after PKP was poor, and the visual prognosis was less favorable in cases with wound dehiscence greater than 180° and iris prolapse. Therefore, prevention of ocular trauma should be emphasized in all patients who undergo PKP.

Clinical Manifestations and Prognosis of Traumatic Wound Dehiscence after Penetrating Keratoplasty

PURPOSE: To investigate clinical manifestations and prognosis of traumatic wound dehiscence after penetrating keratoplasty (PKP). METHODS: This is a retrospective study of patients with traumatic wound dehiscence after penetrating keratoplasty performed between January 2004 and July 2014. All patients underwent primary repair of wound dehiscence. Main outcome measurements included pre- and post-injury best corrected visual acuity (BCVA), mechanism of injury, indication of PKP, time interval from PKP to injury, time interval from injury to primary repair, extent of dehiscence, type of suture, presence of suture, prolapse of intraocular tissue, secondary operation, BCVA and graft state at 6 months after primary repair. RESULTS: The incidence of traumatic wound dehiscence after PKP was 3.96% (12/303). Mean post-injury BCVA and BCVA at 6 months after primary repair (log MAR) were 2.58 ± 0.95 and 2.50 ± 1.05, respectively, and visual acuity did not show significant improvement (p = 1.000). After primary repair, graft failure developed in 9 patients (75%) and evisceration in 2 patients; re-PKP was performed in 3 patients. Pars plana vitrectomy was performed in 1 patient due to retinal detachment. Visual prognosis was poor in patients with wound dehiscence greater than 180° than those with wound dehiscence less than 180° (3.24 ± 0.13 vs. 1.97 ± 1.11, p = 0.030), and in patients with iris prolapse than those without iris prolapse (3.17 ± 0.16 vs. 1.56 ± 1.05, p = 0.048). CONCLUSIONS: The prognosis of traumatic wound dehiscence after PKP was poor, and the visual prognosis was less favorable in cases with wound dehiscence greater than 180° and iris prolapse. Therefore, prevention of ocular trauma should be emphasized in all patients who undergo PKP.

An Overview of Ophthalmologic Survey Methodology in the 2008-2015 Korean National Health and Nutrition Examination Surveys

The Korea National Health and Nutrition Examination Survey (KNHANES) is a national program designed to assess the health and nutritional status of the noninstitutionalized population of South Korea. The KNHANES was initiated in 1998 and has been conducted annually since 2007. Starting in the latter half of 2008, ophthalmologic examinations were included in the survey in order to investigate the prevalence and risk factors of common eye diseases such as visual impairment, refractive errors, strabismus, blepharoptosis, cataract, pterygium, diabetic retinopathy, age-related macular degeneration, glaucoma, dry eye disease, and color vision deficiency. The measurements included in the ophthalmic questionnaire and examination methods were modified in the KNHANES IV, V, and VI. In this article, we provide detailed information about the methodology of the ophthalmic examinations in KNHANES in order to aid in further investigations related to major eye diseases in South Korea.

A Case of Corneal Burn During Phacoemulsification

PURPOSE: To report a case of severe corneal burn during phacoemulsification that was successfully managed with a second operation and medical treatment. CASE SUMMARY: An 89-year-old female had phacoemulsification of a mature cataract in her right eye, and was transferred to our outpatient clinic after development of a thermal burn at the corneal incision site. On initial examination, visual acuity was light perception and slit-lamp examination revealed diffuse, severe corneal edema, and a 3.0 x 3.0 mm-sized epithelial defect with severe stromal opacity around the incision site. Extracapsular cataract extraction through superior scleral incision was performed with posterior chamber implantation of a 3-piece hydrophobic acrylic intraocular lens (IOL). Topical steroids as well as hypertonic saline were used to manage corneal edema postoperatively. One month postoperatively, her best corrected visual acuity was 0.06 and slit-lamp examination showed markedly decreased corneal edema and epithelial defect. Three months postoperatively, her best corrected visual acuity was 0.2, the IOL was centered in the capsular bag, and corneal edema nearly disappeared with remnant moderate corneal opacities. CONCLUSIONS: We report successful treatment of severe corneal burn during phacoemulsification managed with extracapsular cataract extraction through scleral incision and medical treatment.

Change in the mGC-IPL in Patients with a History of APAC According to SD-OCT

PURPOSE: This study was conducted to measure macular ganglion cell-inner plexiform layer (mGC-IPL) thickness in patients with a history of unilateral single attack of acute primary angle closure (APAC) and to compare it with that of unaffected fellow eyes 8 weeks after resolution using spectrum domain optical coherence tomography (SD-OCT). METHODS: Medical records of 24 patients with history of first episode of unilateral APAC were reviewed retrospectively. Eight weeks after APAC, mGC-IPL thickness and peripapillary retinal nerve fiber layer thickness were measured with SD-OCT and analyzed in eyes affected by APAC (group 1) and fellow eyes (group 2). RESULTS: There were no significant differences between the groups with regard to best corrected visual acuity, spherical equivalent, central corneal thickness, or axial length (p > 0.05). There were no significant differences in mGC-IPL thickness in the superotemporal, superior, or superonasal sectors (p > 0.05). However, average, inferonasal, inferior, and inferotemporal sectors of group 1 were significantly thinner than those of group 2 (p = 0.002, 0.002, 0.001, 0.001, respectively). In addition, average mGC-IPL difference between affected eyes and fellow eyes showed a statistically significant correlation with attack duration (correlation coefficient = 0.249, p = 0.019). CONCLUSIONS: Normalization of elevated intraocular pressure as soon as possible after APAC onset is recommended in order to reduce mGC-IPL loss, and measurements of mGC-IPL thickness can be helpful for follow-up of APAC patients.

Clinical Effects of Intracameral Voriconazole Injection in Patients with Fungal Keratitis Refractory to Conventional Treatment

PURPOSE: To evaluate clinical effects of intracameral voriconazole injection in fungal keratitis refractory to conventional therapy. METHODS: Thirty-eight eyes of 38 patients with fungal keratitis were included in this study. The patients were divided into 3 groups: 13 patients with intracameral voriconazole injection (50 microg/0.1 ml; group A), 11 patients with intracameral amphotericin B injection (10 microg/0.1 ml; group B), and 14 patients with conventional therapy only (group C). Clinical factors including treatment success rate and time to successful treatment were evaluated. RESULTS: Treatment success was accomplished in 12 eyes in group A (92.3%), 10 eyes in group B (90.9%), and 12 eyes in group C (85.7%). Time to treatment success in group A, B, and C was 36.1 +/- 10.4 days (p = 0.04), 34.2 +/- 7.8 days (p = 0.03), and 49.5 +/- 16.7 days, respectively. Patients who had received intracameral voriconazole injection or amphotericin B showed faster fungal keratitis improvement than patients who received conventional treatment. Time to re-epithelialization and time to disappearance of hypopyon showed a similar clinical course. CONCLUSIONS: Intracameral voriconazole injection, which has a similar therapeutic effect as intracameral amphotericin B injection in the management of fungal keratitis, can be helpful in the treatment of intractable fungal keratitis.

Phototherapeutic Keratectomy with or without Amniotic Membrane Transplantation for Symptomatic Bullous Keratopathy

PURPOSE: We evaluated the therapeutic effects of phototherapeutic keratectomy (PTK) with or without amniotic membrane transplantation (AMT) in patients who had symptomatic bullous keratopathy with poor visual potential. METHODS: Twenty-five eyes of 25 patients with bullous keratopathy were reviewed retrospectively. Ten eyes (group A) were treated with PTK, and the other 15 eyes (group B) were treated with combined PTK and AMT. Changes of vision and symptoms, re-epithelization time, recurrence of bulla, central corneal thickness measured by anterior segment optical coherence tomography, and postoperative complications were analyzed. RESULTS: At post-operative 3 months, visual acuity improved in 2 patients in both A and B groups. Nine patients in group A (90%) and 13 patients in group B (86.7%) showed symptom improvement. Mean re-epithelization time was 12.40 +/- 4.33 days in group A and 8.13 +/- 1.19 days in group B (p > 0.05). In both groups, central corneal thickness decreased postoperatively without statistically significant difference between groups. At the final follow-up visit, epithelial bulla had not recurred in 7 eyes (70.0%) in group A and 12 eyes (80.0%) in group B. No postoperative complication was detected. CONCLUSIONS: PTK alone appears comparable to the combined treatment of PTK and AMT in terms of symptom improvement, re-epithelization time and recurrence rate.

The Effect of Melatonin on Retinal Ganglion Cell Survival in Ischemic Retina / 전남의대학술지

Our objective was to determine whether melatonin increases retinal ganglion cell (RGC) survival in ischemic mouse retina. Transient retinal ischemia was induced by an acute elevation of intraocular pressure in C57BL/6 mice. To evaluate the effect of melatonin on retinal ischemia, an equal amount of either melatonin or vehicle was intraperitoneally injected into the mice 1 hour before ischemia, at the time of ischemia, and 1 hour after ischemia. Hypoxia inducible factor 1alpha (HIF-1alpha) and glial fibrillary acidic protein (GFAP) expression were assessed 6, 12, and 24 hours after ischemia-reperfusion by Western blot. RGC survival was measured 2 weeks after ischemia-reperfusion. The expression of HIF-1alpha and GFAP peaked 24 hours after ischemia-reperfusion in ischemic retina. The treatment of ischemic retina with melatonin resulted in the inhibition of increased expression of HIF-1alpha and GFAP. RGC survival was greater in retinas treated with melatonin than in retinas treated with vehicle 2 weeks after ischemia-reperfusion. On the basis of our results, we suggest that melatonin treatment increased RGC survival in ischemic mouse retina. The neuroprotective effect of melatonin is mediated by the inhibition of HIF-1alpha stabilization and reduced activity of glial cells in ischemic mouse retina.

Clinical Effect of a Mixed Solution of Sodium Hyaluronate and Sodium Carboxymethylcellulose During the Transconjunctival Approach for Orbital Wall Reconstruction / 전남의대학술지

This study aimed to evaluate the anti-adhesive effect of a mixed solution of sodium hyaluronate and sodium carboxymethylcellulose (HACMC, Guardix-sol(R)) during the transconjunctival approach to orbital wall reconstruction. Eighty-seven patients who underwent orbital wall reconstruction by the transconjunctival approach were enrolled in this prospective study. We applied HACMC between the orbicularis oculi muscle and the orbital septum after surgery in 47 patients and did not use it in 40 patients. Lower lid retraction and marginal reflex distance 2 (MRD2) were measured to analyze the degree of postoperative adhesion at 1 week and 1, 3, and 6 months. The degree of MRD2 showed clinically significant differences at postoperative 1 week and 1 month between the HACMC and control groups (p<0.05). Lower lid ectropion developed in two patients (5.0%) in the control group but did not occur in the HACMC group. In orbital wall reconstruction by the transconjunctival approach, the HACMC mixture solution is effective for preventing adhesion and lower lid ectropion during the early postoperative period.

The Effect of Melatonin on Retinal Ganglion Cell Survival in Ischemic Retina / 전남의대학술지

Our objective was to determine whether melatonin increases retinal ganglion cell (RGC) survival in ischemic mouse retina. Transient retinal ischemia was induced by an acute elevation of intraocular pressure in C57BL/6 mice. To evaluate the effect of melatonin on retinal ischemia, an equal amount of either melatonin or vehicle was intraperitoneally injected into the mice 1 hour before ischemia, at the time of ischemia, and 1 hour after ischemia. Hypoxia inducible factor 1alpha (HIF-1alpha) and glial fibrillary acidic protein (GFAP) expression were assessed 6, 12, and 24 hours after ischemia-reperfusion by Western blot. RGC survival was measured 2 weeks after ischemia-reperfusion. The expression of HIF-1alpha and GFAP peaked 24 hours after ischemia-reperfusion in ischemic retina. The treatment of ischemic retina with melatonin resulted in the inhibition of increased expression of HIF-1alpha and GFAP. RGC survival was greater in retinas treated with melatonin than in retinas treated with vehicle 2 weeks after ischemia-reperfusion. On the basis of our results, we suggest that melatonin treatment increased RGC survival in ischemic mouse retina. The neuroprotective effect of melatonin is mediated by the inhibition of HIF-1alpha stabilization and reduced activity of glial cells in ischemic mouse retina.

Clinical Effect of a Mixed Solution of Sodium Hyaluronate and Sodium Carboxymethylcellulose During the Transconjunctival Approach for Orbital Wall Reconstruction / 전남의대학술지

This study aimed to evaluate the anti-adhesive effect of a mixed solution of sodium hyaluronate and sodium carboxymethylcellulose (HACMC, Guardix-sol(R)) during the transconjunctival approach to orbital wall reconstruction. Eighty-seven patients who underwent orbital wall reconstruction by the transconjunctival approach were enrolled in this prospective study. We applied HACMC between the orbicularis oculi muscle and the orbital septum after surgery in 47 patients and did not use it in 40 patients. Lower lid retraction and marginal reflex distance 2 (MRD2) were measured to analyze the degree of postoperative adhesion at 1 week and 1, 3, and 6 months. The degree of MRD2 showed clinically significant differences at postoperative 1 week and 1 month between the HACMC and control groups (p<0.05). Lower lid ectropion developed in two patients (5.0%) in the control group but did not occur in the HACMC group. In orbital wall reconstruction by the transconjunctival approach, the HACMC mixture solution is effective for preventing adhesion and lower lid ectropion during the early postoperative period.

Recent Changes in Prevalence of Hepatitis B Viral Markers in Preschool Children in Seoul,1995

PURPOSE: A nationwide hepatitis B vaccination publicity campaign and program was launched in 1988 in Korea. This survey was designed to evaluate the recent changes of the positive rates of hepatitis B surface antigen and antibody in sampled preschool children living in Seoul, 1995. METHODS: Study population consisted of 218 preschool children aged 2 to 5 years. Most of them had been immunized against hepatitis B in accordance with the schedule in early infancy. Blood samples were tested for HBsAg, HBsAb and HBcAb by radioimmunoassay. RESULTS: Of 218 children, 214(98.2%) had received hepatitis B vaccination. Two of 218(0.9%) was surface antigen positive. The positive rates of HBsAb in age groups were 68.2, 73.6, 71.6, and 66.7% from 2 to 5 years, respectively (mean 70.6%). They showed no significant difference with aging. One(0.6%) of 154 who were HBsAb positive was HBcAb positive. CONCLUSIONS: Most of the children who were HBsAb positive acquired the antibodies by immunization, and vertical transmission is rare recently. Our findings suggest that the effective administration of vaccination with the help of publicity campaign lowers HBV transmission and increases positive rate of HBsAb.