Outcomes of Small Incision Lenticule Extraction: Mild to Moderate Myopia versus High Myopia

PURPOSE: To evaluate the refractive outcomes of small incision lenticule extraction (SMILE) in high myopia patients compared with mild to moderate myopia patients. METHODS: This study included 332 eyes of 166 myopic patients treated with SMILE using Visumax 500 kHz femtosecond laser. Treated eyes were divided into 2 groups according to preoperative spherical equivalent (SE): mild to moderate myopia (A group, or =-6.0 D). Follow-up visits were at 1 day, 1 week, 1 month, 3 months, and 6 months. The outcome measures included uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BDVA), postoperative SE, efficacy index, safety index and predictability. RESULTS: Preoperative SE was -4.85 +/- 0.86 D in the A group and -7.70 +/- 1.0 D in the B group. No differences were observed between -0.04 +/- 0.29 D in the A group and -0.30 +/- 0.37 D in the B group at 6 months postoperatively (p = 0.062). At 6 months postoperatively, 98.3% and 97.3% had UDVA of 20/25 or better in the A group and B group, respectively. In the A group, 97.3% and 100% were within +/-0.5 D and +/-1.0 D of intended correction and in the B group, 91.7% and 96.9% were within +/-0.5 D and +/-1.0 D, respectively. Efficacy indices were 1.02 +/- 0.19 in the A group and 0.99 +/- 0.18 in the B group. Safety indices were 1.16 +/- 0.16 in the A group and 1.14 +/- 0.16 in the B group. The efficacy and safety indices were not significantly different between the A and B groups at 6 months postoperatively (p = 0.09, p = 0.695, respectively). CONCLUSIONS: This study showed that SMILE is effective and safe for correcting high myopia as well as mild to moderate myopia.

Risk Factors for Dry Eye in Thyroid-Associated Ophthalmopathy

PURPOSE: To investigate the risk factors for dry eye in thyroid-associated ophthalmopathy patients. METHODS: The present retrospective study was conducted on 78 eyes in 39 patients diagnosed with thyroid-associated ophthalmopathy. The risk factors for dry eye in thyroid-associated ophthalmopathy patients were examined by analyzing data including tear break-up time, Schirmer's test, age, gender, thyroid function status, palpebral fissure width, lagophthalmos, eyelid retraction, and exophthalmos through multiple logistic regression analysis. RESULTS: The risk factors for dry eye disease were palpebral fissure width (OR = 3.422, p = 0.022) and lagophthalmos (OR = 13.068, p = 0.049). Age, gender, thyroid hormone status, eyelid retraction and exophthalmos did not show significant association with dry eye in multiple logistic regression analysis. The only risk factor for tear film break-up time less than 10 seconds was palpebral fissure width (OR = 2.787, p = 0.045), and none of the risk factors for Schirmer's test less than 10 mm at 5 minutes were statistically significant. CONCLUSIONS: Risk factors for dry eye in thyroid ophthalmopathy patients were palpebral fissure width and lagophthalmos.

The Preoperative Prognostic Factors for Outcome After LASEK Using the MEL60

PURPOSE: To investigate the preoperative clinical factors affecting the refractive outcome after laser-assisted subepithelial keratomileusis (LASEK). METHODS: This retrospective study was conducted on 58 patients (116 eyes) who underwent bilateral LASEK using the MEL60. The outcome efficacy and predictability of LASEK was examined by analyzing data including age, gender, preoperative uncorrected visual acuity, preoperative refraction (spherical equivalent and cylindrical diopter), central corneal thickness, tear breakup time, and Schirmer test through multiple logistic regression analysis. RESULTS: The preoperative factor associated with postoperative uncorrected visual acuity was the amount of preoperative spherical equivalent. Greater preoperative spherical equivalent was associated with decreased efficacy. Predictability was also associated with the amount of preoperative spherical equivalent. Greater preoperative spherical equivalent was associated with decreased predictability. The other preoperative factors including sex, age, preoperative uncorrected visual acuity, amount of preoperative cylinder diopter, intraocular pressure, tear breakup time, Schirmer test and central corneal thickness did not show any association with efficacy or predictability. CONCLUSIONS: The preoperative spherical equivalent was determined as the most important prognosis factor in LASEK, as it is in PRK or LASIK.

Treatment of Hypotony Maculopathy Caused by Silicone Oil Removal With Gas Tamponade

PURPOSE: To report a case of hypotony maculopathy after silicon oil removal treated by intravitreal gas injection. CASE SUMMARY: A 35-year-old women presented with decreased visual acuity of the right eye for two weeks. Retinal detachment with peripheral retinal tears was observed in the patient's right eye. Pars plana vitrectomy including lensectomy, endolaser photo-coagulation and silicone oil injection was performed. Silicone oil removal was performed to improve patient's visual acuity two months after the operation. After the silicone oil removal, visual acuity was decreased to hand motion, and intraocular pressure was decreased below 3 mmHg while observing chorioretinal folding in fundus for two months. Intraviteal C3F8 gas injections were performed three times in the two months after silicone oil removal. After three gas injections, gradual reduction of chorioretinal folding was observed. Visual acuity was improved to 0.2 and IOP was maintained at 8 to 10 mmHg for 18 months after the last gas injection. CONCLUSIONS: Intravitreal gas injection offers a safe and effective method for treating hypotony retinopathy after silicon oil removal.

A Case of Combination Therapy for Subretinal Neovascularization in Bilateral Acquired Parafoveal Telangiectasis

PURPOSE: To evaluate the clinical results of a case of subretinal neovascularization (SRN) in bilateral acquired parafoveal telangiectasis, performed combination therapy of intravitreal bevacizumab (1.25 mg/0.05ml) and photodynamic therapy (PDT). CASE SUMMARY: A 46-year-old female presented with a decrease invisual acuity. Her best-corrected visual acuity (BCVA) was 1.0 in the right eye and 0.1 in the left eye. On ophthalmic examination, she was diagnosed with bilateral acquired parafoveal telangiectasis combined with SRN in the left eye. Intravitreal bevacizumab was injected, and then photodynamic therapy was performed 4 days later. Three months after the combination therapy, her BCVA improved to 0.5, a regression of SRN was observed and vascular leakage was markedly decreased. However, her BCVA decreased to 0.1 and SRN recurred 9 months later. CONCLUSIONS: The combined treatment of intravitreal bevacizumab and photodynamic therapy may be used as a selective alternative treatment modality for SRN in bilateral acquired parafoveal telangiectasis, although its effect is short-term.