Predictable Factors of Postoperative Pain Following LASEK

PURPOSE: To determine predictable factors of postoperative pain and cut-off values following LASEK eye surgery. METHODS: Thirty-three eyes of 17 patients who underwent LASEK from May to December 2008 were reviewed. For evaluation of predictive factors, patients' anxiety level was converted to APAIS, HADS, STAI, and VAS preoperatively. Substance P and prostaglandin E2 levels in tears, blood pressure, heart rate, and history of any previous surgery were determined before the procedure. Thirty minutes and 1 day after LASEK, the subjective degree of pain was scored. RESULTS: Patients with high Amsterdam preoperative anxiety scale (APAIS) and Visual analogue scale (VAS) scores showed more postoperative pain (p=0.04, p<0.001). Higher substance P and prostaglandin E2 levels were significantly related with more severe pain after LASEK (p<0.001, p<0.001). Postoperative pain increased significantly, according to cut-off values (p<0.05), APAIS and VAS scores greater than 6, substance P greater than 631.84 pg/ml, and prostaglandin E2 greater than 783.90 pg/ml. CONCLUSIONS: The level of pain after LASEK surgery varies individually, and many factors, including physical and psychological variances, can affect the pain. With higher APAIS/VAS scores and higher concentrations of substance P, prostaglandin E2 portends more severe pain following LASEK.

Spheric, Aspheric ReSTOR Intraocular Lens: Three-month Results and Preoperative Clinical Factors Influencing Patient's Satisfaction

PURPOSE: To evaluate results at three months postoperatively on patient satisfaction and preoperative clinical factors affecting patient satisfaction after implantation of an AcrySof ReSTOR intraocular lens (IOL). METHODS: Thirty-three eyes of 33 patients who underwent implantation of spheric/aspheric AcrySof ReSTOR IOL at the Samsung Medical Center of Korea were enrolled in the present study. The uncorrected distance visual acuity (UCDVA), best corrected distance visual acuity (BCDVA), and refractive error were recorded preoperatively and three months after surgery. A questionnaire to assess patient satisfaction was created (score range: 1-5, 5 being the maximum score). Patient age, preoperative UCDVA, BCDVA, corneal astigmatism, and asphericity of IOL were selected as preoperative factors influencing patient satisfaction. RESULTS: One hundred percent and 93.9% of the patients achieved UCDVA and BCDVA of 20/25 or better, respectively. The overall patient satisfaction score was 3.9+/-1.0/4.5+/-0.7 (p=0.073) and the score of intent to recommend ReSTOR IOL to others was 3.7+/-1.0/4.5+/-0.6 (p=0.013) with the spheric/aspheric IOL, respectively. The age of patients was negatively correlated with the score of overall satisfaction and the intent to recommend the procedure to others (p=0.024, 0.031). The overall patient satisfaction and intent to recommend of the patients who were less than 55 years old were significantly higher than those of the older patients (p=0.032, 0.039). CONCLUSIONS: High UCDVA and BCDVA resulted from the implantation of ReSTOR IOL. The younger the patients were, the higher the resulting patient satisfaction. Implantation of ReSTOR IOL in young patients is recommended.

Clinical Outcomes of Surgical Techniques in Congenital Cataracts

PURPOSE: To investigate the general clinical features of congenital cataracts and to determine their relationship to visual prognosis and surgical complications according to age at operation and surgical procedure adopted. METHOD: We retrospectively evaluated 92 eyes in 61 patients with congenital cataracts who underwent cataract surgery between January 1996 and December 2006. The demographic data, surgical technique, post-operative complications, and final visual prognosis were evaluated. RESULTS: The average age at surgery was 3.17 years (range 1 month to 11 years), and the mean follow-up was 40.02 months (range 6 to 46 months). Of the 56 eyes that could be checked for visual acuity after cataract extraction, 29 (51.7%) had a BCVA of > or =0.5 at last visit. Unilateral congenital cataracts (p=0.025) and congenital cataracts with strabismus (p=0.019) showed significantly poorer visual outcomes. Patients with nystagmus also experienced a poor visual outcome; 6 patients (67%) had a BCVA of <0.1. Posterior cataracts had the worst visual prognosis (p=0.004). No statistically significant differences in posterior capsular opacity (p=0.901) or synechia formation (p=0.449) were observed between surgical techniques, but children younger than one year showed a higher tendency for PCO and synechia formation. CONCLUSIONS: Anterior vitrectomy did not reduce postoperative complications. Higher rates of complications (PCO, posterior synechia) developed in children younger than one year of age.

Comparison of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty for Keratoconus

PURPOSE: To compare the therapeutic outcomes after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) in patients with keratoconus. METHODS: We retrospectively reviewed the clinical records of 57 patients diagnosed with keratoconus who had undergone DALK (19 eyes of 19 patients) and PKP (38 eyes of 38 patients) in Samsung medical center between January 1995 and January 2006. RESULTS: The 19 and 38 patients with keratoconus who underwent DALK and PKP had mean ages of 25.3 (range: 17-46) and 26.2 (range: 12-51) years, respectively. These groups were followed up for mean times of 16.7 (range: 6-34) and 45.7 (range: 6-115) months after surgery, respectively. The DALK group showed significantly higher values of refractive power, central corneal thickness, and endothelial cell density, while two eyes (10.5%) in the DALK group developed stromal rejection, which resolved after steroid therapy. In the PKP group, eight eyes (21%) developed endothelial rejection, among whom one eye (2.6%) resulted in a graft failure of a patient who underwent re-PKP, and two eyes (5.3%) in the PKP group developed secondary glaucoma. CONCLUSIONS: DALK should be considered as the primary surgical technique in keratoconus, because the visual outcome is comparable with PKP and it reduces severe complications such as secondary glaucoma and the risk of graft failure by preserving the corneal endothelium compared to PKP.

Swan Syndrome

PURPOSE: Swan syndrome, one of the chronic postoperative complications following cataract surgery produces recurrent hyphema from new vessels of the anterior chamber and thereby increases intraocular pressure (IOP). We report the first Korean case of "Swan syndrome". METHODS: A 66-year-old male complained of loss of vision and red eye two months after unplanned extracapsular cataract extraction in the right eye. At our glaucoma clinic, hyphema of 1 mm in height was noticed through a slit lamp. IOP was 33 mmHg. A new vessel at the inlet of the previous scleral tunnel incision was noticed through gonioscopic examination. We diagnosed this case with Swan syndrome. RESULTS: To remove the hyphema, anterior chamber irrigation was performed. However, the hyphema recurred. Therefore argon laser photocoagulation was performed with permanent non-recurrence of the hyphema and IOP was maintained within the normal range. CONCLUSIONS: Swan syndrome which produces recurrent hyphema with resultant blurred vision is associated with neovascularization originated from episcleral vessels. In this case, argon laser photocoagulation was effective in the eradication of the new vessel.

Clinical Manifestations of Cyclodialysis Cleft and Prognostic Factors Associated with Direct Cyclopexy

PURPOSE: To evaluate the clinical manifestations and the factors associated with prognosis of the traumatic cyclodialysis patients who underwent direct cyclopexy. METHODS: The authors retrospectively analyzed the data of 23 eyes of 22 patients who underwent consecutive direct cyclopexy for the hypotonous cyclodialysis between 1997 and 2002 at the authors' institution. Perioperative A-scan and ultrabiomicroscopy were performed to evalaute correlation between the parameters and postoperative visual prognosis. RESULTS: Postoperatively, the mean increase of intraocular pressure was 11.1mmHg and the mean improvement of visual acuity was four lines of Han's Korean visual acuity chart. As the preoperative hypotony period was shorter, postoperative visual prognosis was better (p<0.05). Anterior chamber depth (p<0.0001), axial length (p<0.01), spherical equivalent (p<0.05), and intraocular pressure (p<0.0001) were increased, whereas lens thickness (p<0.0001) was decreased postoperatively. Transient postoperative ocular hypertension was controlled by adequate medication, and the patients' intraocular pressure were controlled below 20 mmHg without medications at the average of 19 days after the cyclopexy. Post-operative visual acuity was not significantly correlated with pre-operative intraocular pressure, pre-operative visual acuity, age, or sex. Preoperative extent of cyclodialysis was not significantly correlated with visual prognosis, postoperative development of cataract, intraocular pressure, or the cause of trauma. CONCLUSIONS: Direct cyclopexy is one of a successful method for the treatment of the hypotonous cyclodialysis cleft, and the early diagnosis and treatment are thought to be necessary for the improvement of visual prognosis.

A Case of Holmium: YAG Laser Thermal Keratoplasty to Correct Hyperopia Induced by LASIK

PURPOSE: To report a case of noncontact Ho: YAG laser thermal keratoplasty (LTK) treatment for hyperopia induced by laser in situ keratomilieusis (LASIK). METHODS: Following LASIK in a 32-year-old man with -11.0, consecutive hyperopia of +5.25D was seen at 7 months postoperatively. Ho: YAG LTK was applied to the eye with hyperopia after LASIK, and uncorrected/best-corrected visual acuity (UCVA/BCVA), refraction, central keratometric value were measured at 1day, 2 weeks, 3 months, 5 months, and 15 months after Ho: YAG LTK. RESULTS: UCVA was improved to 0.9, and no clinically significant complication occurred until 5 months after Ho: YAG LTK. Although mild hyperopic regression was detected 15 months postoperatively, the patient was satisfied with result of Ho: YAG LTK. CONCLUSIONS: Noncontact Ho: YAG LTK might be considered as a safe and effective measure in correcting LASIK induced hyperopia. Further evaluation is needed to know long-term stabilities of correcting effect.

Clinical Evaluationnof Monovision Induced by Laser Thermal Keratoplasty (LTK)

PURPOSE: To evaluate clinical effects of laser thermal keratoplasty (LTK), LTK was performed in patients with presbyopia or hyperopia. METHODS: LTK was performed in 38 patients who was older than 45 between May and December 2001. Preoperative contact lens fitting and wearing for patients to experience the monovision was tried in all patients for one week. With LTK, we intended patients used dominant eyes for distance vision and nondominant eyes for near vision. Patients' satisfaction, refractive change and near visual acuity were evaluated for least 3 months after surgery. RESULTS: The mean improvement of near vision was 5.16 lines by test with Korean near vision chart. 79% (30 of 38) of patients were satisfied with the results of LTK. CONCLUSIONS: Monovision with LTK is thought to be a good option in patients with presbyopia.

Reverse Modified Hughes Procedure for Reconstruction of Upper Eyelid

PURPOSE: The purpose of this article is to describe reverse modified Hughes procedure to reconstruct extensive full-thickness defect developed on over 75% of the upper eyelid. METHODS: We performed upper eyelid reconstruction on 4 patiets with extensive full-thickness upper eyelid defect more than 80% due to tumor resection. A tarsoconjunctival flap from a donor lower eyelid reconstituted the posterior lamella, orbicularis oculi muscle was mobilized over the tarsoconjunctival flap, and an advanced redundant cutaneous flap adjacent to the eyelid defect were used to reconstruct the anterior lamella. Tarsoconjunctival flap splitting was performed 6 weeks later. Follow up ranges from 6 months to 5 years. RESULTS: We obtained satisfactory results on all 4 patients both clinically and cosmetically. There have been no complications such as ectropion, lower-lid necrosis. CONCLUSIONS: Reverse modified Hughes procedure is an ideal option for reconstruction of extensive fullthickness upper eyelid defect.

Lamellar Sclerokeratoplasty for Limbal Dermoids

PURPOSE: To evalute the surgical outcome of patients with limbal dermoid choristomata treated lay lamellar sclerokeratoplasty. METHODS: We performed lamellar sclerokeratoplasty on 13 patients with limbal dermoid in 14 eyes. Lamellar corneoscleral graft was used in this operation. We evaluated cosmetic effect, refractive change and graft survival/integrity after a follow up period of at least 3 months. RESULTS: All patients who underwent lamellar sclerokeratoplasty had good or excellent cometic result with good sclerocorneal alignment. There were no significant refractive changes following the surgery. Most (13 of 14) eyes had good graft integrity and survival without graft rejection. One of 14 eyes showed graft rejection sign, but it was subsided with systemic cyclosporine therapy. CONCLUSION: Lamellar sclerokeratoplasty is thought to be a good option for the primary surgery for limbal dermoid.