Comparison of the Accuracies of Intraocular Lens Power Formulae by the Type of Implanted Lens

Purpose@#We compared the accuracies of formulae used to calculate intraocular lens (IOL) powers when predicting postoperative refraction, by the type of lens. @*Methods@#We retrospectively reviewed the medical records of 445 eyes (332 patients) that had undergone phacoemulsification and posterior chamber lens implantation between January 2017 and December 2019. Axial length was measured via optical low-coherence reflectometry (Lenstar LS900; Haag-Streit, Bern, Switzerland). The IOLs implanted were all one-piece acrylic IOLs, thus, the ALCON SN60WF (215 eyes), the TECNIS ZCB00 (139 eyes), and the MBI SAL302AC (91 eyes). The mean absolute errors (MAEs) and mean numerical errors (MNEs) were calculated using the SRK-2, SRK/T, Hoffer Q, Holladay, Olsen, and Barrett formulae 1-2 weeks after surgery. @*Results@#For the ALCON SN60WF, the Hagis formula yielded the lowest power and thus tended to be myopic, but we found no significant difference in the MAE. For the TECNIS ZCB00, the Olsen formula yielded the lowest power and thus tended to be myopic, and the Barrett formula yielded the lowest MAE. For the MBI SAL302AC, all MAEs and MNEs were similar. @*Conclusions@#Depending on the IOL type, the IOL power calculation formulae differed in terms of predicting postoperative refraction.

Comparison of the Accuracies of Intraocular Lens Power Formulae by the Type of Implanted Lens

Purpose@#We compared the accuracies of formulae used to calculate intraocular lens (IOL) powers when predicting postoperative refraction, by the type of lens. @*Methods@#We retrospectively reviewed the medical records of 445 eyes (332 patients) that had undergone phacoemulsification and posterior chamber lens implantation between January 2017 and December 2019. Axial length was measured via optical low-coherence reflectometry (Lenstar LS900; Haag-Streit, Bern, Switzerland). The IOLs implanted were all one-piece acrylic IOLs, thus, the ALCON SN60WF (215 eyes), the TECNIS ZCB00 (139 eyes), and the MBI SAL302AC (91 eyes). The mean absolute errors (MAEs) and mean numerical errors (MNEs) were calculated using the SRK-2, SRK/T, Hoffer Q, Holladay, Olsen, and Barrett formulae 1-2 weeks after surgery. @*Results@#For the ALCON SN60WF, the Hagis formula yielded the lowest power and thus tended to be myopic, but we found no significant difference in the MAE. For the TECNIS ZCB00, the Olsen formula yielded the lowest power and thus tended to be myopic, and the Barrett formula yielded the lowest MAE. For the MBI SAL302AC, all MAEs and MNEs were similar. @*Conclusions@#Depending on the IOL type, the IOL power calculation formulae differed in terms of predicting postoperative refraction.

Influence of Myopia on Size of Optic Nerve Head and Retinal Nerve Fiber Layer Thickness Measured by Spectral Domain Optical Coherence Tomography

PURPOSE: To investigate optic nerve head size and retinal nerve fiber layer (RNFL) thickness according to refractive status and axial length. METHODS: In a cross-sectional study, 252 eyes of 252 healthy volunteers underwent ocular biometry measurement as well as optic nerve head and RNFL imaging by spectral-domain optical coherence tomography. Correlation and linear regression analyses were performed for all subjects. The magnification effect was adjusted by the modified axial length method. RESULTS: Disc area and spherical equivalent were positively correlated (r = 0.225, r² = 0.051, p = 0.000). RNFL thickness showed significant correlations with spherical equivalent (r = 0.359, r² = 0.129, p = 0.000), axial length (r = -0.262, r² = 0.069, p = 0.000), disc radius (r = 0.359, r² = 0.129, p = 0.000), and radius of the scan circle (r = -0.262, r² = 0.069, p = 0.000). After adjustment for the magnification effect, those relationships were reversed; RNFL thickness showed negative correlation with spherical equivalent and disc radius, and positive correlation with axial length and radius of the scan circle. The distance between the disc margin and the scan circle was closely correlated with RNFL thickness (r = -0.359, r² = 0.129, p = 0.000), which showed a negative correlation with axial length (r = -0.262, r² = 0.069, p = 0.000). CONCLUSIONS: Optic disc radius and RNFL thickness decreased in more severely myopic eyes, but they increased after adjustment for magnification effect. The error due to the magnification effect and optic nerve head size difference might be factors that should be considered when interpreting optical coherence tomography results.

Changes of the Meibomian Gland According to Age in the Normal Korean Population

PURPOSE: To examine the changes in meibomian glands associated with aging in a normal Korean population and to estimate the differences between the upper and lower eyelid in each age group. METHODS: We performed meibography on adult subjects using an infrared charge-coupled device (CCD) camera. Each eyelid was scored based on the loss of meibomian glands, and the meiboscores of the upper and lower eyelids were summed to obtain a score for each eye. Meiboscores were evaluated according to age, sex, and upper and lower eyelid meiboscores in each age group. RESULTS: One hundred seventeen eyes of 117 people were enrolled in this study. The study subjects had an average age of 50.4 +/- 19.1 years (range, 20-92; male, 56; female, 61). There was a significant positive correlation between age and total meiboscore, upper and lower eyelid meiboscore (r = 0.578, p < 0.001; r = 0.550, p < 0.001; r = 0.524, p < 0.001). There were no significant differences in the meiboscores of the upper and lower eyelids in any age group, though meiboscores were significantly higher since 40 year-old group than 20 year-old group (p < 0.001, p < 0.001, p < 0.001, p < 0.001). CONCLUSIONS: Based on noncontact meibography in normal adult eyes, the authors concluded that prevalence of changes in the meibomian glands was about 60% and changes in meibomian glands increase with age.

Comparison of Intraocular Pressures According to Position Using Icare Rebound Tonometer

PURPOSE: To evaluate changes in intraocular pressure (IOP) according to position using a portable rebound tonometer. METHODS: We measured the IOP values of 20 healthy volunteers (40 eyes) in the sitting, supine, right lateral decubitus and left decubitus positions with a portable rebound tonometer, and then analyzed using the Wilcoxon signed rank test. IOP in sitting position was also measured with a non-contact tonometer and a Goldmann applanation tonometer, and analyzed with Kruskal-Wallis test and Spearman correlation analysis. Agreement among the 3 tonometers was calculated using the Bland-Altman method. RESULTS: The IOP measured with rebound tonometer in the supine position was significantly higher than in the sitting position (p = 0.002). However, there was no significant difference in IOP between the supine and decubitus positions. In the decubitus position, there was no significant difference in IOP between the dependent and non-dependent eyes. IOP measurement using the rebound tonometer showed positive correlation with that of the noncontact and Goldmann applanation tonometers. CONCLUSIONS: In normal subjects, IOP measurement obtained with a rebound tonometer in the supine position was significantly higher than in the sitting position, but there was no significant difference in IOP between the supine and decubitus positions. A rebound tonometer may be useful for patients whose intraocular pressure measurement with Goldmann applanation tonometer or non-contact tonometer is impossible. When using a portable rebound tonometer in bed-ridden or pediatric patients, we should pay attention to the interpretation of IOP in the supine position.

Research on the Quality of Life of Glaucoma Patients

PURPOSE: To compare subjective quality of life (QOL) of a glaucoma group with a control group. METHODS: The Korean version of the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) was completed by 105 glaucoma clinic patients including 54 glaucoma group and 56 control group. We compared questionnaire scores and previous performed visual field parameters between a glaucoma group and a control group. RESULTS: The glaucoma group results were: Mean age: 55.73 +/- 15.17 years; mean best corrected visual acuity (BCVA; log MAR) 0.05 +/- 0.09 in better eyes and 0.06 +/- 0.09 in worse eyes; and mean intraocular pressure (IOP) 15.94 +/- 2.93 mm Hg in better eyes and 15.49 +/- 3.18 mm Hg in worse eyes. Control group scores were: Mean age: 51.85 +/- 11.36 years; mean BCVA (log MAR) 0.04 +/- 0.07 in better eyes and 0.06 +/- 0.08 in worse eyes; and mean IOP 16.40 +/- 2.50 mm Hg in better eyes and 16.13 +/- 2.16 mm Hg in worse eyes. Age, BCVA, and IOP were not significantly different between groups, but visual field index (VFI) score and visual function questionnaire (NEI-VFQ-25) total score were significantly lower in the glaucoma group (p < 0.01). Additionally, visual field parameters and QOL had a significant relationship in the glaucoma group, especially in better eyes. CONCLUSIONS: The QOL of glaucoma patients was lower than that of normal controls regardless of visual acuity. The degree of visual field loss in the better eye may affect QOL more significantly.

Research on the Quality of Life of Glaucoma Patients

PURPOSE: To compare subjective quality of life (QOL) of a glaucoma group with a control group. METHODS: The Korean version of the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) was completed by 105 glaucoma clinic patients including 54 glaucoma group and 56 control group. We compared questionnaire scores and previous performed visual field parameters between a glaucoma group and a control group. RESULTS: The glaucoma group results were: Mean age: 55.73 +/- 15.17 years; mean best corrected visual acuity (BCVA; log MAR) 0.05 +/- 0.09 in better eyes and 0.06 +/- 0.09 in worse eyes; and mean intraocular pressure (IOP) 15.94 +/- 2.93 mm Hg in better eyes and 15.49 +/- 3.18 mm Hg in worse eyes. Control group scores were: Mean age: 51.85 +/- 11.36 years; mean BCVA (log MAR) 0.04 +/- 0.07 in better eyes and 0.06 +/- 0.08 in worse eyes; and mean IOP 16.40 +/- 2.50 mm Hg in better eyes and 16.13 +/- 2.16 mm Hg in worse eyes. Age, BCVA, and IOP were not significantly different between groups, but visual field index (VFI) score and visual function questionnaire (NEI-VFQ-25) total score were significantly lower in the glaucoma group (p < 0.01). Additionally, visual field parameters and QOL had a significant relationship in the glaucoma group, especially in better eyes. CONCLUSIONS: The QOL of glaucoma patients was lower than that of normal controls regardless of visual acuity. The degree of visual field loss in the better eye may affect QOL more significantly.

Analysis of Retinal Nerve Fiber Layer Thickness of Superior Segmental Optic Hypoplasia and Normal-Tension Glaucoma

PURPOSE: To analyze the peripapillary retinal nerve fiber layer (RNFL) in superior segmental optic hypoplasia (SSOH) patients and normal tension glaucoma (NTG) patients with inferior visual field defects using optical coherence tomography (OCT). METHODS: Ten eyes of 10 patients with SSOH and 10 eyes of 10 patients with NTG were evaluated. The peripapillary RNFL thickness measured by OCT was compared between the 2 groups. RESULTS: The mean RNFL thickness was not significantly different between SSOH patients (79.60 +/- 12.54 micrometer) and NTG patients (77.10 +/- 8.52 micrometer) (p = 0.089). Among the quadrant parameters, there were no significant differences between the 2 groups (p > 0.05). In a clock-hour analysis, the peripapillary RNFL thickness of the NTG group was significantly thicker than the SSOH group in 12, 1, and 2 o'clock (p = 0.029, 0.007, 0.043, respectively). In contrast, the peripapillary RNFL thickness of the SSOH group was significantly thicker than the SSOH group in 6, and 7 o'clock (p = 0.029, 0.007, respectively). CONCLUSIONS: Peripapillary RNFL thickness in patients with SSOH was thinner than in those with NTG in the superonasal region, but thicker in the inferotemporal region indicating a different retinal nerve fiber defect pattern between the 2 diseases.

Comparison of Intraocular Pressure after Cataract Surgery According to Incisional Techniques

PURPOSE: In the present study we compared the intraocular pressure (IOP) after cataract surgery according to incisional techniques. METHODS: Patients who underwent phacoemulsification with intraocular lens implantation were divided into 2 groups: clear corneal incision group (CC group), and scleral tunnel incision group (ST group). All complicated cases were excluded. IOP was measured preoperatively and at 1 week, 1, 3, 6, 12, 18 and 24 months after surgery. RESULTS: Seventy-seven patients (100 eyes) were enrolled in the present study; CC group (28 patients, 33 eyes), ST group (49 patients 67 eyes). Preoperative IOPs in both groups were not significantly different (p = 0.908, student's t-test). IOP in the CC group at 1 week after surgery significantly decreased 2.22 +/- 2.57 mm Hg compared to preoperative IOP (p < 0.001, repeated-measures ANOVA with post hoc analysis), and the IOP of the ST group decreased 2.11 +/- 2.50 mm Hg (p < 0.001, repeated-measures ANOVA with post hoc analysis). The lowered IOP was maintained for 24 months postoperatively. There was no significant difference in IOP change after surgery depending on incisional techniques (p = 0.848, repeated measures ANOVA). CONCLUSIONS: There may be no difference in IOP lowering effect after surgery depending on incisional techniques.

Intraocular Pressure and Central Corneal Thickness in Premature Infants

PURPOSE: To evaluate of the range and relationship between intraocular pressure (IOP), and central corneal thickness (CCT) in premature infants. METHODS: To investigate the correlation of IOP and CCT with gestational age and body weight, 58 premature infants 37 weeks-old or younger were examined. Under topical anesthesia, IOP was measured with Tono-Pen(R) XL (Medtronic Solan, Jacksonville, FL) and the CCT with pachymeter (SP-2000, TOMEY(R), Japan). The fundus was examined in infants with a risk of retinopathy of prematurity (ROP). RESULTS: Average gestational age of the subjects was 33 weeks and 6 days and body weight was 1506+/-520 grams (mean+/-standard deviation). Forty-five subjects had oxygen therapy, and 10 patients were found to have any one of the stages of ROP. Average IOP was 15.14+/-4.64 mmHg in the right eye and 15.29+/-3.70 mmHg in the left eye. CCT was 594.72+/-74.87 micrometer in the right eye and 599.78+/-74.17 micrometer in the left eye. No statistically significant correlation was found between IOP or CCT and gestational age or body weight. CONCLUSIONS: Gestational age and body weight did not appear to affect IOP or CCT in the gestational age between 26 and 37 weeks. The maturing eye in the neonate is known for fast development in the first year after birth. There are, however, few reports in the literature regarding the changes in dimensions of ocular structures in the premature neonate. These normative values may aid ophthalmologists in assessing IOP and CCT in premature infants.

Intraocular Pressure and Central Corneal Thickness in Premature Infants

PURPOSE: To evaluate of the range and relationship between intraocular pressure (IOP), and central corneal thickness (CCT) in premature infants. METHODS: To investigate the correlation of IOP and CCT with gestational age and body weight, 58 premature infants 37 weeks-old or younger were examined. Under topical anesthesia, IOP was measured with Tono-Pen(R) XL (Medtronic Solan, Jacksonville, FL) and the CCT with pachymeter (SP-2000, TOMEY(R), Japan). The fundus was examined in infants with a risk of retinopathy of prematurity (ROP). RESULTS: Average gestational age of the subjects was 33 weeks and 6 days and body weight was 1506+/-520 grams (mean+/-standard deviation). Forty-five subjects had oxygen therapy, and 10 patients were found to have any one of the stages of ROP. Average IOP was 15.14+/-4.64 mmHg in the right eye and 15.29+/-3.70 mmHg in the left eye. CCT was 594.72+/-74.87 micrometer in the right eye and 599.78+/-74.17 micrometer in the left eye. No statistically significant correlation was found between IOP or CCT and gestational age or body weight. CONCLUSIONS: Gestational age and body weight did not appear to affect IOP or CCT in the gestational age between 26 and 37 weeks. The maturing eye in the neonate is known for fast development in the first year after birth. There are, however, few reports in the literature regarding the changes in dimensions of ocular structures in the premature neonate. These normative values may aid ophthalmologists in assessing IOP and CCT in premature infants.

Effects of Induced Anisometropia by Refractive Surgery on Binocular Vision

PURPOSE: To evaluate the effects of induced anisometropia by refractive surgery on binocular vision and to determine the usefulness of screening tools. CASE SUMMARY: Anisometropia was induced in 7 patients by photorefractive keratectomy (PRK). Binocular vision was determined with the Titmus stereo test, Worth 4-dot test, 4 prism diopter base-out test and Bagolini striated lens test. Each test was performed before surgery, after PRK of one eye and after PRK of both eyes. After PRK of one eye, mean stereopsis by the Titmus stereo test was 1877.14 seconds of arc and after surgery of both eyes, 40 seconds of arc. After surgery of one eye, 6 patients (86.7%) showed suppression with the Worth 4 dot test at distance fixation and one patient (14.3%) at near fixation. After surgery of both eyes, all patients showed fusion with the Worth 4 dot test. After surgery of one eye, 3 patients (42.9%) showed suppression with the 4 prism diopter base-out test and after surgery of both eyes, 2 of the patients showed fusion. All patients showed fusion with the Bagolini striated lens test after surgery of one or both eyes. CONCLUSIONS: Most cases showed decreased binocular vision by the Titmus stereo test at near fixation and the Worth 4 dot test at distance fixation. The changes of binocular vision determined by each tool were variable. Therefore, improved results in evaluating binocular vision will be obtained with a combination of various tools including the Bagolini striated lens test and 4 prism base-out test.

Effects of Induced Anisometropia by Refractive Surgery on Binocular Vision

PURPOSE: To evaluate the effects of induced anisometropia by refractive surgery on binocular vision and to determine the usefulness of screening tools. CASE SUMMARY: Anisometropia was induced in 7 patients by photorefractive keratectomy (PRK). Binocular vision was determined with the Titmus stereo test, Worth 4-dot test, 4 prism diopter base-out test and Bagolini striated lens test. Each test was performed before surgery, after PRK of one eye and after PRK of both eyes. After PRK of one eye, mean stereopsis by the Titmus stereo test was 1877.14 seconds of arc and after surgery of both eyes, 40 seconds of arc. After surgery of one eye, 6 patients (86.7%) showed suppression with the Worth 4 dot test at distance fixation and one patient (14.3%) at near fixation. After surgery of both eyes, all patients showed fusion with the Worth 4 dot test. After surgery of one eye, 3 patients (42.9%) showed suppression with the 4 prism diopter base-out test and after surgery of both eyes, 2 of the patients showed fusion. All patients showed fusion with the Bagolini striated lens test after surgery of one or both eyes. CONCLUSIONS: Most cases showed decreased binocular vision by the Titmus stereo test at near fixation and the Worth 4 dot test at distance fixation. The changes of binocular vision determined by each tool were variable. Therefore, improved results in evaluating binocular vision will be obtained with a combination of various tools including the Bagolini striated lens test and 4 prism base-out test.

Intraocular Pressure Elevation after Intravitreal Triamcinolone Acetonide Injection

PURPOSE: This study investigated firstly the change of intraocular pressure (IOP) after injection of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema and secondly the factors that influence these changes. METHODS: A prospective, non-comparative study was performed in 60 patients at Kangnam Sacred Heart Hospital from October 2003 to September 2004. All the patients received 4-mg IVTA injection. RESULTS: Mean IOP was elevated from the day after injection and peaked at 20.5 mmHg after 2 months (p=0.000). Twenty-six eyes (43.3%) showed significant IOP elevation. IOP was not controlled despite full glaucoma medication in 7 (11.7%) eyes. Two eyes underwent filtering surgery. Younger age was a statistically significant predictive factor for IOP elevation (p=0.009). CONCLUSIONS: In this study, patients who needed filtering surgery developed an IOP spike within one week after the injection. Therefore, clinicians should consider checking IOP at the end of the first week. Furthermore, greater cautions is mandatory with relatively younger patients.

Scanning Electron Microscopic Observations of Sequential Alterations of Type 1 HSV Keratitis in Rabbits

PURPOSE: This study aimed to investigate the microscopic findings of characteristic epithelial herpes simplex keratitis (HSK) and the changes of those findings over time. METHODS: Sixteen rabbits were inoculated with the Kos-stain of herpes simplex virus (HSV) type 1 in both eyes. Two rabbits each were enucleated on the 2nd, 3rd, 4th, 5th, 6th, 7th, and 9th day after viral inoculation and were observed with a scanning electron microscope (S-2380n, Hitachi, Japan). RESULTS: Corneas showed dendritic epithelial desquamation, changes in epithelial microvilli, and changes in intercellular adhesion. With progression, the basement membrane and basal cells were exposed, intercellular spaces were broadened, and the adhesion of basal cells to basement membrane and the intercellular adhesion were loosened. Later, infiltrations of some inflammatory cells were found. Until the last day there was no destruction of basement membrane or an exposure of stroma. CONCLUSIONS: Though it was impossible to follow up a lesion throughout the experiment because of the necessity of enucleation, and in addition, the findings could not be generalized to all the strains, this study provides a better understanding of HSK. Further studies on various manifestations of HSK from other strains of HSV are needed in the future.

Relationship between Middle school Students' Computer using Time and Dry eye

PURPOSE: As computer and Internet are getting widely spread, people who use visual display terminal (VDT) are increasing. Especially as computer and Internet on line games are popular, more people are exposed to VDT than in the past. So we examined to explore the relationship between middle school students' computer using time and dry eye. METHODS: The subjects were 105 middle school male students in the same district. We surveyed them on the time of computer use weekly and ocular discomfort while using computer. We examined anterior segment of the eyes by slit lamp, and checked BUT and Shirmer test. RESULTS: The subjects who frequently use computer showed shorter BUT, dry eye related ocular findings (meniscus floater, corneal erosion.), and symptoms of dry eye. But there was no significant difference in Schirmer test. CONCLUSIONS: Students in middle school age may have symptoms and ocular findings of dry eye owing to increased time of computer use. So proper rest during computer use and adequate education for dry eye are thought to be necessary.

Electron microscopic studies of epithelial adhesion complex of keratoconus

PURPOSE: Keratoconus is a bilateral noninflammatory ecstatic disease of cornea. Clinical manifestations and treatments are well-described , but the exact pathophysiology has many debates. There are many reports on pathologic abnormalities of keratoconus, but few reports on epithelial adhesion complex. The authors investigated the abnormalities in epithelial adhesion complex of keratoconus. METHODS: Using 4 corneas from 4 recipients of penetrating keratoplasty, examination was done with transmission electron microscope (Hitachi-600, Japan) after proper fixation and staining. Central and peripheral portion of each corneal tissues were examined. RESULTS: In two tissues, severe degeneration of basement membrane and Bowman's layer were found. Some degree of abnormalities was found in other tissues, which had minimal change. Some of hemidesmosomes, the most distinct part of adhesion complex, were found only in well-maintained tissue but the distribution was abnormal. CONCLUSIONS: The fact that basal plasma membrane had selectively more degenerations and changes than intercellular plasma membrane implies pathophysiology of keratoconus on adhesion complex, basal plasma membrane, basement membrane and Bowman's layer. Further study on this issue will reveal more information as to its pathophysiology.

The Study of Toxicity of Mitomycin C and Steroid as Eyedrops in Rabbit Cornea

To investigate the drug effect of topical Mitomycin C in various concentrations combined with steroid, we used 30 rabbits whose corneal epitheliums were abraded intentionally. They were divided into 5 groups. Using MMC in various concentrations and steroids, we instilled them into right eyes and saline into left eyes as control. We measured the healing rate at a interval of 12 hours. Three months later, we sacrificed one of them and examined the pathological changes from various ocular tissues. We found many complications such as corneal edema, ulcer, opacity and definite delay of wound healing when the concentration higher than 0.04%MMC was used. There were also decreased fibroblast cells in H-E staining. The steroids seemed not to pose any influence on the effect of MMC. In conclusion, we must take the great care in the use of MMC, and the concentration should be low when used. In addition, we still think there ought to be more studies as to the effect of steroids according to MMC levels.

The Study of Toxicity of Mitomycin C and Steroid as Eyedrops in Rabbit Cornea

To investigate the drug effect of topical Mitomycin C in various concentrations combined with steroid, we used 30 rabbits whose corneal epitheliums were abraded intentionally. They were divided into 5 groups. Using MMC in various concentrations and steroids, we instilled them into right eyes and saline into left eyes as control. We measured the healing rate at a interval of 12 hours. Three months later, we sacrificed one of them and examined the pathological changes from various ocular tissues. We found many complications such as corneal edema, ulcer, opacity and definite delay of wound healing when the concentration higher than 0.04%MMC was used. There were also decreased fibroblast cells in H-E staining. The steroids seemed not to pose any influence on the effect of MMC. In conclusion, we must take the great care in the use of MMC, and the concentration should be low when used. In addition, we still think there ought to be more studies as to the effect of steroids according to MMC levels.

Surgical Correction fo Epiblepharon

Epiblepharon is one of the most common eyelid abnormalities among Asian children. The anatomic defect in epiblepharon is the absence of the adhesion between the lower eyelid retractors and the anterior lamella. We performed a simple surgical technique to correct epiblephron on 131 patients from January 1990 to September 1996. Several burried 8-0 nylon sutures were placed to allow adhesion between the tarsal plate and the subcutaneous tissue of the superior incision and minimal amount of the redundant skin and orbicularis muscle were removed. The average age at operation was 6.7 years. 97 patients (90.7%) showed satisfactory results with 6.7 months of average follow-up period. Ten patients (9.3%) showed recurrence of cilia touch but only 2 patients underwent reoperation with good result. Complications were minimal including 2 suture abscess and 1 wound dehiscence.