Combined Ethylenediaminetetraacetic Acid Chelation, Phototherapeutic Keratectomy and Amniotic Membrane Transplantation for Treatment of Band Keratopathy

PURPOSE: The objective of this study is to evaluate the therapeutic efficacy of ethylenediaminetetraacetic acid (EDTA) chelation and excimer laser phototherapeutic keratectomy (PTK) combined with amniotic membrane transplantation (AMT) for the treatment of band keratopathy (BK). METHODS: Eleven eyes in ten patients with BK received combined PTK (ablation zone of central 7.0-7.5 mm, depth of 50 microm), EDTA chelation (0.05 M, 3 minutes), and amniotic membrane transplantation using fibrin glue. Preand postoperative best corrected visual acuities, symptom changes, reepithelialization time, cosmesis, recurrence, and complications were analyzed. RESULTS: Visual acuity improved in three eyes (27.3%) and did not change in eight eyes (72.7%). Symptoms improved in all patients, and the mean reepithelialization time was 10.6+/-5.3 days. The cosmetic results were good in eight eyes (72.7%) and were fair in three eyes (27.3%). During the mean follow-up period of 11.4+/-6.1 months (range, 6 to 23 months), no postoperative complications or recurrences were observed. CONCLUSIONS: The combination of EDTA chelation, PTK, and AMT is safe and effective for the treatment of band keratopathy.

The Changes in Tear Film After Dacryocystorhinostomy

PURPOSE: This study was performed to evaluate the changes in tear film and ocular surface after dacryocystorhinostomy (DCR) in patients with primary acquired nasolacrimal duct obstruction. METHODS: Forty subjects who showed successful results at three months after endoscopic DCR were investigated. The changes in tear breakup time (BUT), basal secretion test (BST), corneal sensitivity test (CST), tear clearance rate (TCR) and keratoepitheliopathy (KEP) were evaluated. RESULTS: The mean age was 57.4+/-13.2 years (29~77 years). Preoperative BST and BUT in eyes which underwent DCR were 13.21+/-3.79 mm and 8.20+/-2.30 seconds, respectively. Three months after the operation, the respective values were 9.13+/-3.77 mm (p=0.01) and 6.27+/-2.20 seconds (p=0.03). Preoperative CST, TCR and KEP in eyes which underwent DCR were 57.89+/-4.18 mm, 3.26+/-0.91 and 0.12+/-0.53, respectively. Three months after the operation, the respective values were 57.75+/-3.55 mm (p=0.32), 3.04+/-0.87 (p=0.08) and 0.13+/-0.54 (p=0.08). No changes were observed between the preoperative and postoperative tear parameters in fellow eyes. CONCLUSIONS: The changes in tear film parameters including BST and BUT should be considered in patients who receive endoscopic DCR.

Comparison of Clinical Results Between Two Spherical Aberraion-Free Intraocular Lenses

PURPOSE: To compare the postoperative outcomes between Akreos MI60 and Akreos AO intraocular lens (IOLs) after cataract surgery. METHODS: A prospective analysis among 55 eyes of 55 patients who had undergone microcoaxial phacoemulsification and implantation of aspheric IOLs (Akreos MI60, 30 eyes; Akreos Adapt-AO, 25 eyes) was performed. The best corrected visual acuity (BCVA), spherical equivalent, intraocular pressure (IOP), corneal thickness, endothelial cell density (ECD), surgically induced astigmatism (SIA), predictability of postoperative spherical equivalent, higher order aberrations, and contrast sensitivity test were evaluated during the follow-up period of 3 months. RESULTS: There were no significant differences in BCVA, spherical equivalent, IOP, corneal thickness, ECD, SIA, higher order aberrations and contrast sensitivity test (p>0.05). The predictability of postoperative spherical equivalent in the Akreos Adapt-AO (-0.57+/-0.22D) represented statistically significant myopic shift compared with the Akreos MI60 group (-0.05+/-0.69D) (p=0.02). CONCLUSIONS: Both the Akreos MI60 and the Akreos Adapt-AO implantation groups performed similiarly, following cataract surgery, showed similar visual function.

Factors Affecting Compliance With 0.05% Cyclosporine Emulsion in Patients With Dry Eye Syndrome

PURPOSE: To evaluate the factors affecting compliance with the use of 0.05% cyclosporine emulsion in patients with dry eye syndrome. METHODS: A total of 148 patients using 0.05% cyclosporine emulsion for dry eye were divided into two groups (compliant vs. non-compliant). The compliant group included the patients who used 0.05% cyclosporine emulsion more than 50% of frequency as they had been prescribed. We analyzed factors affecting compliance, including age, gender, severity of symptoms, side effects, use of topical steroid, socioeconomic status, associated systemic disease, number of eyedrops, visit interval, and detailed instruction about 0.05% cyclosporine emulsion. RESULTS: The compliant group included 124 patients (83.8%), and the non-compliant group included 24 patients (16.2%). Multivariate analysis showed that the factors associated with low compliance were severe symptoms, longer visit interval, side effects, lower socioeconomic status, and poor detailed instruction (P<0.05). In contrast, gender, associated systemic disease, and number of eyedrops did not affect the compliance for use of 0.05% cyclosporine emulsion. CONCLUSIONS: Special attention should be given to patients with the above risk factors to improve compliance with the use of 0.05% cyclosporine emulsion.

Corneal Perforation with Preseptal Cellulitis in a Patient with Acute Lymphocytic Leukemia

We report a case of corneal perforation with preseptal cellulitis in a patient with acute lymphocytic leukemia (ALL). A 17-yr-old female patient who was undergoing combination chemotherapy for ALL was referred due to upper lid swelling and pain in the right eye for 2 days. Visual acuity in the right eye was 20/20. Initial examination showed no abnormal findings, other than swelling of the right upper eyelid. Computed tomography showed a finding of preseptal cellulitis. Microbiologic study of bloody and purulent discharge revealed Serratia marcescens. Corneal melting and perforation with iris prolapse were detected in the right eye on the 16th day. Emergent tectonic keratoplasty was performed. Seven months after surgery, visual acuity in the right eye was 20/300, and the corneal graft was stable.

Comparison of Visual Function Between Two Aspheric Intraocular Lenses After Microcoaxial Cataract Surgery

PURPOSE: To compare the visual function and postoperative refraction between two aspheric intraocular lenses (IOLs) after microcoaxial cataract surgery. METHODS: A prospective analysis of 60 eyes of 58 patients who had undergone microcoaxial phacoemulsification and implantation of aspheric IOLs (AcrySof IQ, 30 eyes; Akreos MI60, 30 eyes) was performed. The best corrected visual acuity (BCVA), spherical equivalent, intraocular pressure (IOP), corneal thickness, endothelial cell density (ECD), predictability of postoperative spherical equivalent, higher order aberrations, contrast sensitivity test, satisfaction, and glare were evaluated during the follow-up period of three months. RESULTS: There were no significant differences in BCVA, spherical equivalent, IOP, corneal thickness, or ECD (p>0.05). The predictability of the postoperative spherical equivalent in the AcrySof IQ and Akreos MI60 IOL groups was not significantly different (p=0.59), and the two groups showed good anterior-posterior stability during the postoperative three months. There were no significant differences in higher order aberrations, contrast sensitivity test, satisfaction or glare (p>0.05). CONCLUSIONS: Both AcrySof IQ and Akreos MI60 implantation groups showed similar visual functions and postoperative spherical equivalents after microcoaxial cataract surgery.

The Clinical Effect of Endonasal Dacryocystorhinostomy in the Treatment of Acute Dacryocystitis

PURPOSE: To evaluate the clinical effect of endonasal dacryocystorhinostomy as a primary treatment of acute dacryocystitis with lacrimal sac abscess formation. METHODS: The study comprised 14 patients with acute dacryocystitis and lacrimal sac abscess formation who underwent endonasal dacryocystorhinostomy as a primary treatment. Postoperative evaluations included symptoms of acute dacryocystitis, physical examination, and lacrimal irrigation. Success was defined as the absence of epiphora and good lacrimal irrigation at the last follow-up. RESULTS Of the patients, two were male and twelve were female. The mean age was 54.7 years and mean follow-up period was 8.3 months. Resolution of symptoms and signs of acute dacryocystitis occurred in all patients. In one patient, recurrence of acute dacryocystitis occurred 6 months after surgery. At last follow-up, epiphora and failure of lacrimal irrigation had developed in two patients. CONCLUSIONS: Endonasal dacryocystorhinostomy is considered a safe and effective primary treatment of acute dacryocystitis with lacrimal sac abscess formation.

Two Cases of Photodynamic Therapy with Verteporfin in Patients with Corneal Neovascularization

PURPOSE: To evaluate the clinical effect of photodynamic therapy (PDT) with verteporfin (Visudyne(R), Novartis Ophthalmics AG, Hettingen, Switzerland) in the treatment of corneal neovascularization. METHODS: We performed photodynamic therapy on one eye with corneal neovascularization associated with lipid keratopathy, and on another eye with corneal neovascularization after corneal perforation. Verteporfin was administrated intravenously for 10 minutes at a dose of 6 mg/m2 of body surface area. Fifteen minutes after the start of administration, a 689 nm nonthermal laser light (Opal photoactivator, Coherent Inc., USA) was delivered directly over the neovascular network for 83 seconds with a spot size of 4000 micrometer. The patients were followed up at 3 days, 1 week, 1 month, and 6 months after treatment. RESULTS: In both cases, new vessels were successfully occluded after the photodynamic therapy. No recanalization of new vessels was observed at last follow-up and no complications were observed. CONCLUSIONS: PDT with verteporfin is considered to be a safe and effective procedure to regress corneal neovascularization.

Tear Film and Ocular Surface Changes after Umbilical Cord Serum Therapy in Dry Eye Syndrome

PURPOSE: To evaluate the changes of tear film and ocular surface after umbilical cord serum therapy in patients with severe dry eye syndrome. METHODS: Forty-one eyes of 25 patients with severe dry eye syndrome were treated with umbilical cord serum eyedrops. Before and after treatment, symptom score, tear film break-up time (BUT), Schirmer test, corneal sensitivity, keratoepitheliopathy score, and impression cytology were performed. RESULTS: Before treatment, symptom score, BUT, Schirmer test, corneal sensitivity, and keratoepitheliopathy score were 3.18 +/- 0.50, 3.50 +/- 1.27 sec, 3.24 +/- 0.94 mm, 51.63 +/- 9.29 mm, and 6.13 +/- 2.85, respectively. Two months after treatment, the respective parameters were 1.03 +/- 0.53 (P<0.001), 5.42 +/- 2.79 sec (P<0.001), 3.42 +/- 1.16 mm (P=0.067), 52.87 +/- 7.92 mm (0.071), and 2.10 +/- 1.98 (P<0.001). In impression cytology, the grade of squamous metaplasia and goblet cell density were 2.44 +/- 0.71 and 75.05 +/- 41.81 cells/mm2 before treatment, and 1.47 +/- 0.62 and 165.48 +/- 39.19 cells/mm2 at 2 months after treatment, respectively (P<0.001). CONCLUSIONS: Umbilical cord serum treatment is clinically applicable and effective in patients with severe dry eye syndrome.

Inhibition of Corneal Neovascularization by Subconjunctival Injection of alphaVbeta5 Integrin Antibody in Rabbit

PURPOSE: To investigate the efficacy of a subconjunctival injection of alphaVbeta5 integrin antibody on corneal angiogenesis induced by chemical epithelial denudation in a rabbit eye model. METHODS: One week after debridement by heptanol, rabbits were treated with a subconjunctival injection of alphaVbeta5 integrin antibody or control immunoglobulin G weekly for 2 weeks. Rabbits that did not receive injection after debridement served as the untreated group. The percentage of neovascularized corneal area was calculated by biomicroscopy, and the sectioned area and number of new vessels were calculated by histological examinations. RESULTS: At 7 days after the first injection, alphaVbeta5 integrin antibody-treated eyes had 9.5% (P=0.02) and 6.8% (P=0.03) less neovascularized corneal area than vector-treated eyes and untreated eyes, respectively. At 7 days after the second injection, alphaVbeta5 integrin antibody-treated eyes had 21.1% (P=0.02) and 18.3% (P=0.02) less neovascularized corneal area than vector-treated eyes and untreated eyes, respectively. Light microscopic examination showed a smaller neovascularized corneal area and a reduced number of new vessels in the alphaVbeta5 integrin antibody-treated eyes compared to the control eyes. CONCLUSIONS: Subconjunctival injection of alphaVbeta5 integrin antibody effectively reduces experimental corneal neovascularization induced by chemical injury, and could be used as a corneal angiogenesis inhibitor in the future.

Changes of Tear Film and Ocular Surface in Diabetes Mellitus

This study was performed to investigate the changes of tear film and ocular surface in diabetic patients, as well as the ocular and systemic factors related to these changes. We assessed the scoring of keratoepitheliopathy, corneal sensitivity test, tear film break-up time (BUT), Schirmer test, and conjunctival impression cytology in 94 eyes of 47 patients with noninsulin-dependent diabetes mellitus and in 60 eyes of 30 normal subjects. The degree of keratoepitheliopathy was severe, and the corneal sensitivity, BUT, and tear secretion were significantly reduced in the diabetic patients. Conjunctival impression cytology showed a higher grade of conjunctival squamous metaplasia and lower goblet cell density in the diabetic patients. All parameters were related to the status of metabolic control, diabetic neuropathy, and stage of diabetic retinopathy. We think that diabetic patients with poor metabolic control, neuropathy, and advanced stage of retinopathy should be examined for tear film and ocular surface changes.

Clinical Features and Treatment Results of Conjunctival Lymphoproliferative Lesions

PURPOSE: To investigate the clinical features of conjunctival lymphoproliferative lesions and associated systemic lymphoma, and to determine the recurrence rate and prognosis according to treatment methods. METHODS: Eighteen patients with conjunctival lymphoproliferative lesions were followed up. We retrospectively analyzed data for clinical symptoms, anatomical location, histological type, associated systemic lymphoma, and treatment results. RESULTS: Conjunctival lymphoproliferative lesions were classified according to WHO classification: benign lymphoid hyperplasia in 7 patients, MALT-lymphoma in 7, and small B lymphocytic lymphoma in 4. Systemic lymphoma existed in 2 patients (11.1%). Remission was not achieved in one patients treated by surgical excision and chemotherapy. Complete remission was achieved in 5 patients with conjunctival malignant lymphoma treated by surgical excision, radiotherapy and chemotherapy. CONCLUSIONS: We consider that aggressive treatment using radiotherapy, chemotherapy and surgical excision in conjunctival malignant lymphoma is needful to achieve complete remission and prevent recurrence.

Effects of Bilateral Lateral Rectus Recession and Unilateral Recession-Resection in Large Angle Exotropia

PURPOSE: To evaluate the effect of bilateral lateral rectus recession and of unilateral rectus recession and resection in the patients who showed large angle exotropia. METHODS: Sixty-five patients who underwent either bilateral lateral rectus recession or unilateral recession-resection and who were followed up for more than 1 year between 1996 to 2001 at Chonnam University Hospital, were reviewed. The effect of bilateral lateral recession and unilateral recession-resection was compared according to preoperative angle of deviation. Successful outcome was defined as esotropia

Study of Tear Film and Ocular Surface in Keratoconus

PURPOSE: To evaluate the changes of tear film and ocular surface in keratoconus patients. METHODS: Twenty-eight eyes of 18 patients with keratoconus and 32 eyes of 16 normal subjects were included. We performed corneal sensitivity test, tear film break-up time (BUT), Schirmer test, fluorescein and rose bengal staining, and conjunctival impression cytology, and compared the results between the two groups. According to the central corneal power, we classified the patients into 3 groups and compared these parameters between groups. RESULTS: Corneal sensitivity was 5.56 +/- 0.34 mm and 5.88 +/- 0.25 mm (p<0.001), BUT was 9.64 +/- 2.51 sec and 10.69 +/- 2.89 sec (p=0.008), basal tear secretion was 9.00 +/- 3.06 mm and 10.88 +/- 3.95 mm (p=0.025), fluorescein staining score was 1.43 +/- 1.87 and 0.69 +/- 1.20 (p=0.105), and rose bengal staining score was 0.86 +/- 0.97 and 0.22 +/- 0.55 (p=0.003) in the patients and control subjects, respectively. The degree of conjunctival squamous metaplasia was 1.04 +/- 0.51 and 0.62 +/- 0.43 (p=0.039), and goblet cell density was 762.65 +/- 76.32 cells/mm2 and 880.21 +/- 82.06 cells/mm2 (p=0.041) in the patients and control subjects respectively. All parameters except basal tear secretion and fluorescein staining score were related to the severity of keratoconus. CONCLUSIONS: Tear film and ocular surface changes in patients with keratoconus are composed of decreased corneal sensitivity, decreased quantity and quality of tear film, and damages to corneal and conjunctival epitheliums, which are similar to the findings in keratoconjunctivitis sicca.