Intraocular Lens Power Calculations Using Dual Scheimpflug Analyzer

PURPOSE: To investigate the accuracy of intraocular lens power calculations using simulated keratometry (simK) of dual Scheimpflug analyzer and 5 types of formulas in cataract patients. METHODS: The keratometry (K), axial length (AXL) and anterior chamber depth (ACD) were measured using ultrasound biometry (USB) combined with auto-keratometry (Auto-K), parital coherence interferometry (PCI; IOL master®) and dual Scheimpflug analyzer (DSA; Galilei®) in 39 eyes of 39 patients. Predicted refraction was calculated using Auto-K, mean K of PCI, and simK and total corneal power (TCP) of DSA in the Sanders-Retzlaff-Kraff (SRK-T) formula. The SRK-II, SRK-T, Holladay II, Haigis, and Hoffer-Q formula were used to calculate predicted refraction with the simK of DSA and AXL of USB. Manifest refraction, mean numerical error (MNE) and mean absolute error were evaluated 1, 3 and 6 months after cataract surgery. RESULTS: TCP of DSA was lower compared with other keratometric values (p < 0.05). The MNE was not different among Auto-K, mean K and simK. The MNE using TCP was larger compared with Auto-K, mean K and simK at 1 month after surgery (p < 0.05). There was a difference in MNE between simK and TCP of DSA at 6 months after surgery (p < 0.05). The MNE of SRK-T formula was the smallest in the intraocular lens (IOL) power calculation using the simK of DSA. CONCLUSIONS: We suggest using IOL power calculations with simK of DSA and SRK-T formula rather than TCP of DSA in cataract patients with normal corneas.

Research on the Perceptions of Low Vision Rehabilitation

PURPOSE: To evaluate the understanding of low vision and awareness of low vision rehabilitation of non-health care providers and health care providers using a survey. METHODS: The present survey included 304 individuals; 137 non-health care providers (25 low vision patients, 38 non-low vision patients, and 74 normal controls) and 167 health care providers (51 ophthalmologists, 56 non-ophthalmic physicians, 24 nurses, and 36 medical technicians). The questionnaire used in the survey consisted of 10 items pertaining to the definition of low vision (3 items), assistance of low vision patients (3 items), awareness of the difficulties of low vision patients in daily life (3 items), and the understanding of low vision aids (1 item). RESULTS: The majority of participants, except ophthalmologists, were unaware of low vision rehabilitation. The perceptions of low vision rehabilitation between non-health care providers and health care providers except ophthalmologists were not different. The ophthalmologists showed a better understanding of low vision and awareness of low vision rehabilitation than other health care provider groups. However, no difference was found in the degree of understanding regarding low vision aids. Low vision patients showed the lowest rate of satisfaction with the environment around them and most experienced the greatest difficulties in public transportation and outside activities. CONCLUSIONS: Although ophthalmologists showed a better understanding of low vision rehabilitation, their understanding of low vision aids was poor. Thus, there should be an effort to improve the ophthalmologists' understanding regarding low vision care. To enhance low vision rehabilitation awareness, promotion of low vision services and education campaigns is necessary and a strategy concerning social welfare to improve the environment for low vision patients should be implemented.

Internal Lens Signal Measured by Dual Scheimpflug Anterior Segment Analyzer

PURPOSE: To investigate the clinical significance of the internal lens signal measured using dual Scheimpflug anterior segment analyzer (Galilei(TM), Ziemer, Switzerland) in patients receiving cataract surgery. METHODS: The present study included 151 eyes of 148 patients who received surgery for senile cataracts from February 2012 to January 2013. Preoperative internal lens signals were measured preoperatively. The depth of anterior chamber and anterior angles were measured using dual Scheimpflug anterior segment analyzer preoperatively and 1 month postoperatively. Preoperative and postoperative best-corrected visual acuities (BCVAs) were measured. The relationships between preoperative internal lens signal and the changes in BCVA or anterior angles were evaluated. RESULTS: Internal lens signal and preoperative BCVA (log MAR) or preoperative anterior chamber depth were highly correlated (r = 0.287, p = 0.001 and r = -0.271, p = 0.004, respectively). Anterior angles increased 1 month after surgery compared with the preoperative values (p < 0.001). The amount of change between preoperative and postoperative anterior angles correlated with preoperative anterior angles (p < 0.001). However, no statistically significant correlation was observed between internal lens signal and preoperative anterior angles or postoperative BCVA. Internal lens signal correlated with changes in postoperative anterior angles (p < 0.001). CONCLUSIONS: Internal lens signal correlated with preoperative visual acuity and may help evaluate the cataract severity quantitatively and objectively. Internal lens signal may aid in understanding the structure of anterior segments by predicting the lens volume. Knowing the effect of visual impairment due to cataracts and predicting visual improvement after cataract surgery is necessary.

Effect of Cysteamine on Human Peripheral Blood Mononuclear Cells-Chemically Injured Keratocytes Reaction

PURPOSE: To investigate the effect of cysteamine on mixed peripheral blood mononuclear cells (PBMCs)-chemically injured keratocytes reaction (mixed lymphocyte-keratocyte reaction; MLKR). METHODS: PBMC stimulation assay was performed after keratocytes were chemically injured with 0.05 N NaOH for 60 seconds. MLKR was treated with various concentrations of cysteamine (0-10 mM). Intracellular reactive oxygen species (ROS) formation was measured using the oxidation-sensitive fluorescent probe, 2'7'-dichlorofluorescein diacetate (DCF-DA). Proliferation rate of PBMCs stimulated by NaOH-treated keratocytes and secretion profiles of matrix metalloprotease-9 (MMP-9), transforming growth factor-beta1 (TGF-beta1), interleukin-6 (IL-6), and macrophage migration inhibitory factor (MIF) were determined using the bromodeoxyuridine proliferation assay and enzyme-linked immunosorbent assay, respectively. RESULTS: Proliferation rate of PMBCs was suppressed by cysteamine in a dose-dependent manner (p = 0.019). Fluorescence of DCF-DA decreased depending on cysteamine concentration (p < 0.001). MMP-9, IL-6 and TGF-beta1 levels were suppressed by cysteamine in a dose-dependent manner (p < 0.05), whereas MIF levels increased with cysteamine concentration of 0.5-10 mM (p = 0.008). CONCLUSIONS: These study results indicate that cysteamine induced the ROS-mediated inhibition of inflammatory cytokine release and proliferation of PBMCs stimulated by chemically injured keratocytes. Thus, cysteamine can be used in the treatment of chemical corneal burns.

Corneal Thickness Measured by Dual Scheimpflug, Anterior Segment Optical Coherence Tomography, and Ultrasound Pachymetry

PURPOSE: To compare central corneal thickness (CCT) as measured by dual rotating Scheimpflug camera (Galilei), anterior segment optical coherence tomography (AS-OCT), and ultrasound pachymetry (USP). METHODS: The measurements of CCT using a dual rotating Scheimpflug camera, AS-OCT, and USP in 40 eyes of 20 healthy subjects were compared. RESULTS: The average measurements of CCT by dual rotating Scheimpflug camera, AS-OCT, and USP were 538.10 +/- 31.36 microm, 536.20 +/- 31.21 microm, and 541.93 +/- 34.93 microm, respectively. The CCT measurement by USP was statistically significantly thicker than by the dual rotating Scheimpflug camera and AS-OCT (p = 0.017, p = 0.001, respectively). There was no significant difference between the dual rotating Scheimpflug camera and AS-OCT (p = 0.054). A significant linear correlation was observed between the dual rotating Scheimpflug camera, the AS-OCT, and the USP (r > 0.900, p < 0.001). CONCLUSIONS: The results of the 3 methods have significant correlation with each other, but the measurement by USP was significantly thicker than the dual rotating Scheimpflug camera and AS-OCT. Therefore, CCT should be interpreted in the context of the instrument used.

Intraocular Pressure Change After Secondary Intravitreal Triamcinolone Acetonide Injection

PURPOSE: To evaluate the change of intraocular pressure (IOP) after first and second injection of intravitreal triamcinolone acetonide for the treatment of macular edema and the factors that influence these changes. METHODS: A prospective, non-comparative study was performed in 41 eyes at Kangnam Sacred Heart Hospital from October 2003 to November 2005. All of the patients received injection of intravitreal triamcinolone acetonide (4 mg) twice. The IOPs before and after triamcinolone injection were measured with non-contact tonometer and Goldmann applanation tonometer. RESULTS: Mean IOP after the first and second injections were elevated from the day after injection and peaked after 3 months. Younger age (p=0.042), male (p=0.050) and the history of IOP elevation after first injection (p=0.004) were a statistically significant predictive factor for IOP elevation after second injection. Younger age (p=0.000) and male (p=0.010) were a significant predictive factor for IOP elevation after first and second injection. CONCLUSIONS: Clinicians should consider checking IOP especially for the patients who with the history of IOP elevation after first injection, male and relatively younger age.

A Case of Sudden Refractive Change with Intraocular Pressure Change Following Trauma

PURPOSE: To report a case of refractive change with intraocular pressure change following trauma. METHODS: Changes in intraocular pressure, refractive power, lens thickness, depth of anterior chamber, and axial length of an 8-year-old girl were measured. RESULTS: During the early period after trauma, the patient showed low intraocular pressure and shallow anterior chamber depth. The refractive power changed to transient high myopia. With temporary high intraocular pressure, the refractive power changed to hyperopia and the refractive power recovered toward emmetropia as the intraocular pressure fell to the normal level. Refractive alteration is a result of changes in intraocular pressure and depth of the anterior chamber by cyclodialysis cleft and its adhesion is induced by trauma to the eye. Herein, the authors show evidence for a relationship between refractive change and posttraumatic ocular change.

A Case of Sarcoptes Scabiei Infestation of Eye Lid

The infestation caused by itch mite, Sarcoptes scabiei brings about very severe itching aggravated at night, and has a very high transmissibility. The lesions are commonly found on lower abdomen, thigh, axilla, interdigital area, buttocks, and genitalia. But it is rare to find the mite on eye lid. We have experienced a 33 year-old female patient who complained of persistent itching and foreign body sense in upper eyelid, and found a mite there. Then it was removed mechaincally, and the symptoms disappeared without any particular treatment. So we report a case of eye lid infestation by S.scabiei with the review of literatures.

The Effect of Intravitreal and Subconjunctival Ciprfloxacin in the Treatment of S.Aureus Endophthalmitis

To investigate the therapeutic effect of ciprofloxacin for the treatment of endophthalmitis, we used 18 rabbits with Staphylococcus aureus induce dendophthalmitis. The rabbits were assigned into three groups according to the treatment regimen; those who were not given any drug into group I, those who were given 100 microgram/ml ciprofloxacin intrvitreally into group II, and those who were given 2 mg/ml ciprofloxacin subconjunctivaly for 5 days into group III. We assessed clinical score, culture result of vitreous aspirate and pathologic finding of various ocular tissue. We found clinically significant decrease in clinical score in group II, but there were no significant differences in the vitreous culture and in the histologic findings among the study groups. In conclusion, we assume that intravitreal injection of ciprofloxacin may be the better treatment modality to treat endophthalmitis by S.aureus. In addition we still think there ought to be more studies as to the determination the dosage of ciprofloxacin and the use of steroid in combination.

Frontalis Sling Operation Using Preserved Fascia Lata

In this prospective study, 208 cases of ptosis were repaired using dried preserved fascia lata as suspension material for frontalis sling procedure during 1990 to 1996. The average age at operation was 9.2 years with the range of 2 months to 56 years. One hundred forty one patients (91.0%) of the 155 patients with follow-up of more than 3 months and 99 (90.8%) of the 109 patients with follow-up of more than 6 months showed satisfactory results respectively. Among 12 unsatisfactory cases six patients underwent reoperation and achieved satisfactory results. Exposure keratitis was the most common complication (39.4%)but most of them were transient. The authors report frontalis sling operation using preserved fascia lata with 96.3% of success rate with few complications.

The Effect of Excimer Laser Photorefractory Keratectomy on Density of Corneal Endothelial cells

To investigate the effect of 193 nm ArF excimer laser photorefractive keratectomy(PRK) on corneal endothelium, 18 patients(30 eyes), undergone PRK at department of ophthalmology of Seoul National University Hospital from August to December 1994, were analyzed according to their preoperative contact lens use or not, amount of attempted correction (6D over or under) and postoperative topical steroid use or not. The central corneal endothelial cell density was measured before and 1 week, 2 months after PRK. Differences of the central corneal endothelial cell density between contact lens user and nonuser, myopes over 6D and under 6D, and steroid user and non-user were not statistically significant.