The Influence of Preoperative Meibomian Gland Disease on Dryness after Cataract Surgery

PURPOSE: The aim of this study is to analyze the influence of preoperative meibomian gland disease (MGD) on the postoperative dry eye disease after cataract surgery. METHODS: 100 eyes of 85 patients who had undergone cataract surgery were enrolled. Patients were stratified into three groups by the severity of meibomian gland disease (MGD Grade I, MGD Grade II and MGD Grade III). In each group, we recorded the indexes of dry eye such as Ocular surface disease index, tear breakup time, Schirmer's test and Corneal staining at preoperatively and postoperative week 1, 2, 5, 9. We compared the indexes, preoperatively and postoperatively between three groups. RESULTS: In comparison of the preoperative indexes between groups, the more severe meibomian gland disease the patients have, the higher Ocular surface disease index and the shorter tear breakup time were observed (p < 0.05). In comparison the preoperative with the postoperative indexes, Ocular surface disease index was higher and tear breakup time was shorter at every postoperative moment in MGD Grade (Gr) II and Gr III. In comparison between MGD groups, MGD Gr III showed higher ocular surface disease index than MGD Gr I and Gr II at every follow up point, and shorter tear breakup time than MGD Gr I and Gr II at preoperative and postoperative week 1 and 9 (p < 0.05). CONCLUSIONS: The severity of meibomian gland disease which exist preoperatively can affect the aggravation of dry eye disease after cataract surgery. Therefore, the treatment of meibomian gland disease before cataract surgery can be a therapeutic option to prevent aggravation of dry eye after cataract surgery.

A Giant Pleomorphic Adenoma of Lacrimal Gland Involving the Palpebral Lobe Causing Severe Mechanical Ptosis

PURPOSE: To report a rare case of giant pleomorphic adenoma of the lacrimal gland involving the palpebral lobe causing severe mechanical ptosis and visual field defect, which was removed successfully. CASE SUMMARY: An 82-year-old man visited our clinic with a large protruding mass on his left upper lid that had grown for approximately 10 years causing severe ptosis. Preoperative orbital CT showed a 2.3 x 2.0 cm sized large mass which was suspicious of hemangioma. The mass was completely excised through a lid crease incision. The histopathologic examination showed typical findings of pleomorphic adenoma. After the surgery, preoperative mechanical ptosis was completely resolved and during the 6 months of follow-up, there was no abnormality of tear secretion and evidence of tumor recurrence. CONCLUSIONS: The authors experienced a rare case of giant pleomorphic adenoma of the lacrimal gland involving the palpebral lobe and resolved mechanical ptosis by complete removal of the tumor through a lid crease incision.

Recurrent Alveolar Soft-Part Sarcoma With Concurrent Involvement of the Orbit and Multiple Sites of the Body

PURPOSE: To report a rare case of recurrent alveolar soft-part sarcoma (ASPS) with concurrent involvement of the orbit and multiple sites of the body that was removed successfully by surgery. CASE SUMMARY: A 37-year-old woman presented with diplopia at the left lateral gaze and proptosis of the left eye. Two years earlier, the patient had a mass excision of the right gluteus maximus and the left orbit, and ASPS was histopathologically diagnosed at that time. In addition, the patient had been treated with chemotherapy and radiation therapy. On radiologic examination, recurrent tumor of the left orbit was found and surgically removed. The histopathologic examination showed that tumor cells were arranged in an alveolar pattern divided by fibrous septa and contained abundant granules in the cytoplasm, typically consistent with ASPS. Postoperatively, the symptoms of diplopia and proptosis improved. CONCLUSIONS: ASPS can occur and recur in the orbit as well as systemically. In addition, at the time of surgical removal of ASPS in the orbit, the surgeon should be particularly cautious of massive bleeding.

Anterior Segment Parameters Using Pentacam and Prediction of Corneal Endothelial Cell Loss after Cataract Surgery

PURPOSE: We evaluated various preoperative anterior segment parameters measured with a Pentacam rotating Scheimpflug camera and compared them with those of conventional methods. We also evaluated the effect of different parameters on corneal endothelial cells after cataract surgery. METHODS: Pentacam examination was performed in 88 eyes from 88 patients to evaluate central anterior chamber depth (ACD(pentacam)), nuclear density (Densitometry(pentacam)), anterior chamber volume (ACV), and lens thickness (LT(pentacam)). We compared values of ACD(pentacam) with those of ultrasound (ACD(sono)) and also compared Densitometry(pentacam) values with those of Lens Opacities Classification System (LOCS III) classification. We evaluated the effect of the following preoperative values measured with Pentacam on postoperative endothelial cell loss: pupil size measured both preoperatively and before capsulorrhexsis (Pupil(CCC)), amount of viscoelastics, and LT measured by ultrasound (LT(sono)). RESULTS: A significant concordance was found between the two grading methods of nuclear opacity: Densitometry(pentacam) and LOCS III classification (tau(b) = 0.414, p = 0.000). We also found a positive correlation between ACD(pentacam) and ACD(sono) (r = 0.823, p = 0.000) and between ACD(pentacam) and ACV (r = 0.650, p = 0.000). There were significant differences between the results of LT(pentacam) and LT(sono). The final regression model identified Densitometry(pentacam), viscoelastics and Pupil(CCC) as independent predictors of decreased postoperative corneal endothelial cell density (CD) at postoperative day 3, and Densitometry(pentacam), viscoelastics, and ACV as independent predictors of decreased CD two months postoperatively (p<0.05). CONCLUSIONS: Good agreement was found between all results obtained with the Pentacam and conventional methods except LT. Analyzing anterior chamber parameters preoperatively using Pentacam could be helpful to predict postoperative endothelial cell loss.

Levels of Severity in Dry Eye Syndrome According to Delphi Panel Classification

PURPOSE: To investigate levels of severity in dry eye syndrome according to Delphi panel classification. METHODS: Three hundred and twenty-two eyes of 166 patients with dry eye syndrome that did not have coexisting lid margin disease or altered tear distribution and clearance were categorized into 1 of 4 levels of severity, according to the symptoms and signs in the Delphi panel classification. A symptom score was proposed depending on the frequency and impact on the quality of life. Degree of corneal staining using Lissamin green was categorized using the Oxford Scheme. In addition, measurement of the tear film break-up time (BUT) and Schirmer test were performed. RESULTS: According to the levels of severity in the Delphi panel classification, 120 eyes (37.26%) were categorized as level1, 166 eyes (51.55%) as level 2, 30 eyes (9.31%) as level 3, and 6 eyes (1.86%) as level 4. Negative correlations were observed between the levels of severity, BUT, and measurements of the Schirmer test (p<0.001). CONCLUSIONS: Of the 166 eyes with dry eye syndrome that did not have coexisting lid margin disease and altered tear distribution and clearance, 51.55% of eyes were classified as level 2, and 88.81% of eyes were classified as level 1 and level 2.

Risk Factors for Endothelial Cell Loss after Phacoemulsification: Comparison in Different Anterior Chamber Depth Groups

PURPOSE: To assess the risk factors for endothelial cell loss after phacoemulsification with implantation of intraocular lens according to anterior chamber depth (ACD). METHODS: This prospective study included 94 eyes of 94 patients undergoing phacoemulsification cataract surgery. To assess the risk factors for corneal endothelial cell loss, we examined seven variables at 1 day, 1 week, 6 weeks, and 12 weeks postoperatively in each ACD-stratified group. RESULTS: Multiple linear regression analysis showed that the only variable influencing the percentage decrease in corneal endothelial cell density throughout the postoperative follow-up period in the long ACD group (ACD III) was nucleosclerosis. The variables influencing the percentage decrease in corneal endothelial cell density in the short ACD group (ACD I) at one day and one week postoperatively were corneal incisional tunnel length and nucleosclerosis. CONCLUSIONS: Risk factors for endothelial cell loss after phaoemulsification were different according to ACD. Long corneal tunnel length can be one of the risk factors for endothelial cell loss in short ACD eyes.

Corneal Endothelial Changes After ICL (Implantable Collamer Lens) Insertion

PURPOSE: To evaluate the stability of corneal endothelial cells after ICL (implantable contact lens) implantation. METHODS: Retrospective review of 50 eyes were subjected to implantation of ICL by one surgeon from December 2003 to April 2008. During the follow-up period, the number of eyes with regular follow-up decreased and remained at 18 eyes at the time of a three-year follow-up. Patients were examined preoperatively and at one, three, and six months and one, two, and three years postoperatively. The main outcome measures were the change in corneal endothelial cell density (CD), coefficient of variation (CV), and hexagonality (HA). This analysis was done in all eyes and especially in the 18 eyes with regular follow-up for three years and 11 eyes with changes in CV and HA corresponding to the normal endothelial wound healing process for three years. RESULTS: Corneal endothelial CD, CV, and HA were not significantly changed compared with their preoperative values throughout the three-year follow-up period for all eyes. In the early postoperative period, there was a slight decrease in CD, but it increased after the second year of follow-up (range: -3.12%~+2.84%); there was a slight increase in CV, but it decreased after the six-month follow-up (-6.63%~+5.56%); and there was a slight decrease in HA, but it increased after the three-month follow-up (range: -0.88%~10.64%). Similarly, there were no significant changes in corneal endothelial cell density in the 18 eyes with regular follow-up or the 11 eyes with changes in CV and HA corresponding to normal endothelial wound healing process for three years. CONCLUSIONS: The results show stability of corneal endothelial cells after ICL implantation.

Perioperative Modulating Factors on Astigmatism in Sutured Cataract Surgery

PURPOSE: To evaluate the factors that affect postoperative astigmatism and post-suture removal astigmatism, and to evaluate the risk factors associated with astigmatism axis shift. METHODS: We performed a retrospective chart review of 130 eyes that had undergone uneventful phacoemulsification cataract surgery. Preoperative astigmatism was divided into four groups (Groups I, II, III, and IV) according to the differences between the axis of preoperative astigmatism (flattest axis) and the incision axis (105 degrees). We analyzed the magnitude and axis of the induced astigmatism after the operation and after suture removal in each group. We also analyzed the factors which affected the postoperative astigmatism and post-suture removal astigmatism in each sub-group of Groups I, II, III, and IV, excluding postoperative or post-suture removal axis shift (specifically, Group I(WAS), II(WAS), III(WAS), and IV(WAS)). We identified the variables associated with the prevalence of postoperative astigmatism axis shift and those associated with the prevalence of post-suture removal axis shift. RESULTS: An increase in the magnitude of postoperative astigmatism was associated with an increase in the preoperative magnitude of astigmatism in Groups I(WAS), II(WAS), and III(WAS) (p<0.05), and with an increase in the corneal tunnel length in Group I(WAS). A decrease in the magnitude of postoperative astigmatism was associated with an increase in the corneal tunnel length in Groups III(WAS) and IV(WAS) (p<0.05). An increase in the magnitude of post-suture removal astigmatism was associated with an increase in the magnitude of postoperative astigmatism in Groups I(WAS) and IV(WAS) (p<0.05), and with late suture removal in Group IV(WAS) (p<0.05). A decrease in the magnitude of post-suture removal astigmatism was associated with late suture removal in Groups I(WAS) and II(WAS). A logistic regression analysis showed that the prevalence of post-suture removal astigmatism axis shift was associated with increased corneal tunnel length, decreased magnitude of postoperative astigmatism, and early suture removal. CONCLUSIONS: In order to reduce postoperative and post-suture removal astigmatism, we recommend a short corneal tunnel length and late suture removal in patients with Group I(WAS) characteristics, late suture removal in Group II(WAS)-like patients, long corneal tunnel length in Group III(WAS)-like patients, and long corneal tunnel length and early suture removal in patients with characteristics of Group IV(WAS).

Dry Eye After Cataract Surgery and Associated Intraoperative Risk Factors

PURPOSE: To investigate changes in dry eye symptoms and diagnostic test values after cataract surgery and to address factors that might influence those symptoms and test results. METHODS: Twenty-eight eyes from 14 patients with preoperative dry eye (dry eye group) and 70 eyes from 35 patients without preoperative dry eye (non-dry eye group) were studied prospectively. In each group, we measured values such as tear break-up time (tBUT), Schirmer I test (ST-I), tear meniscus height (TMH), and subjective dry eye symptoms (Sx), and evaluated the postoperative changes in these values. We also evaluated the influence of corneal incision location and shape on these values. The correlations between these values and microscopic light exposure time and phacoemulsification energy were investigated. RESULTS: In the dry eye group, there were significant aggravations in Sx at 2 months postoperatively and in TMH at 3 days, 10 days, 1 month, and 2 months postoperatively, compared with preoperative values. All dry eye test values were significantly worse after cataract surgery in the non-dry eye group. With regard to incision location, there was no difference in tBUT, Sx, ST-I, or TMH in either the dry eye group or the non-dry eye group at any postoperative time point. Regarding incision shape, there was no difference in tBUT, Sx, ST-I or TMH at any postoperative time point in the dry eye group. In the superior incision sub-group of the non-dry eye group, tBUT and Sx were worse in the grooved incision group at day 1. In the temporal incision sub-group of the non-dry eye group, Sx were worse in the grooved incision group at 1 day, 3 days, and 10 days postoperatively. In both groups, significant correlations were noted between microscopic light exposure time and dry eye test values, but no correlation was noted between phacoemulsification energy and dry eye test values. CONCLUSIONS: Cataract surgery may lead to dry eye. A grooved incision can aggravate the symptoms during the early postoperative period in patients without dry eye preoperatively. Long microscopic light exposure times can have an adverse effect on dry eye test values.

The Surgical Result of Phacoemulsification after Penetrating Keratoplasty

PURPOSE: To evaluate the factors that affect visual outcome and transplanted corneal endothelial cell density in eyes that have undergone cataract surgery after penetrating keratoplasty, and to compare surgical outcomes with those of a control group. METHODS: We conducted a retrospective review of case records of 20 eyes that had undergone cataract surgery between January 2003 and April 2006 after previous penetrating keratoplasty (group I) and 20 eyes that had undergone cataract surgery alone with low cornea endothelial cell density (group II). RESULTS: For both groups, the grade of nucleosclerosis affected postoperative best corrected visual acuity (BCVA) and the total phaco energy (phaco power X time) did not affect either BCVA or endothelial cell density. In group I, the factor that most affected change in corneal endothelial cell density after cataract surgery was the time interval between keratoplasty and phacoemulsification. Comparison of the surgical results showed an increase in BCVA for both groups, and the difference between the two groups was not statistically significant. However, group I showed a significantly greater decrease in corneal endothelial cell density than did group II. CONCLUSIONS: Our results suggest that the corneal endothelial cells of the eye having previously undergone penertrating keratoplasty are vulnerable to surgical insult occurring in procedures such as cataract surgery, and that the time interval between the two procedures can affect the change in endothelial cell density.

The MRSA Keratitis in Premature Infant

PURPOSE: Methicillin resistant staphylococcus aureus (MRSA) keratitis is hard to treat because it has a tendency to increase resistance to almost every antibiotics. Because neonates, especially premature infants are a particulary vulnerable population, prompt diagnosis and treatment is needed. We report a case of MRSA keratitis in a premature infant, which resulted in severe corneal opacity with neovascularization. METHODS: We treated MRSA keratitis in a premature baby whose birth history is 29(+5) weeks-1.6Kg-C/S delivery. RESULTS: Conventional treatment with intravenous administration of antibiotics and topical antibiotics did not improve the corneal inflammation. Culture proven diagnosis of MRSA keratitis was made and vancomycin was started. one week after vancomycin treatment, corneal inflammation began to decrease slowly. But there remained severe corneal opacity with neovascularization. Penetrating keratoplasty and amblyopia treatment may be required in the future.

The Effect of Minor Components and Growth Factor Added to Corneal Storage Medium on the Viability of Corneal Endothelium

PURPOSE: This study has been conducted to evaluate morphologic and functional changes of cat corneal endothelium preserved in Likorol , locally prepared medium and locally prepared medium with growth factor, respectively. METHODS: To know the morphologic change of the dornea, cat corneal endothelia stored in three different medium are examined by specular microscopy and the change of central corneal thickness was measured by light microscopy from the distance of between epithelum and endothelium. We also examined the corneal endothelium of each group by scanning electronmicroscopy. To know the functional change of the cornea, alkaline phosphatase released to each preservation medium was measured with biochemical analyzer. RESULTS: The change of corneal thickness was remarkable in locally prepared medium (group LL)up to 4 days of preservation and specular microscopic change of endothelial cell density, polymegathism and pleomorphism was significantly notable in locally prepared medium (group LL). The morphologic change examined by scanning electron microscopy was significantly notable in locally prepared medium with growth factor (group LLG). The alkaline phosphatase activity at the 6th preservation day was higher in locally prepared medium with growth factor (group LLG) than in Likorol (group L). CONCLUSIONS: The viability of corneal endothelium in corneal storage medium with minor components and growth factor is significantly higher than that without minor components and growth factor.

The Influence of Axial Myopia on Diabetic Retinopathy

PURPOSE: To investigate the association of axial myopia with the incidence and progression of diabeticretinopathy. METHODS: One hundred eyes of diabetic group and one hundred eyes of non-diabetic group were included. We divided one hundred eyes of diabetic group into 5 groups according to their axial length, compared the incidence and progression of diabetic retinopathy at first hospital visit and after three year follow up. RESULTS: In severe myopic eye(axial length>28mm), the grade of diabetic retinopathy incidencence at the first visit is 1.23(near mild non proliferative diabetic retinopthy) and the grade of diabetic retinopathy progression is 1.17(nearly no change between the first hospital visit and after three year follow up). We found that axial length is inversely related with incidence and progression of diabetic retinopathy. CONCLUSION: From this result, we knew that axial myopia is protective for the development of diabetic retinopathy and we suggest there'll be association with decrease in ocular perfusion pressure and axial myopia patients with diabetic retinopathy.

Etiological Factors of the Ptosis After Cataract Surgery

To investigate the change in upper eye lid position after cataract operation with retrobulbar anesthesia and bridle suture, we studied 60 eyes of 60 patients randomized into 3 groups, group I received retrobulbar anesthesia and bridle suture, group II received retrobulbar anesthesia and group III received topical anesthesia.The measurement of interpalpebral fissure, levator function were taken at pre-op, post-op 1 week, post-op 4 weeks.The post operative mean palpebral fissure height and mean levator function decreased compared with those of the preoperative state but there were improvement of their ptosis with times.The incidence of ptosis at post operative 4 weeks was highest in group I with both retrobulbar anesthesia and bridle suture and lowest in group III with topical anesthesia (p=0.035).The result of this study indicate that ptosis after cataract surgery can be induced by various our operative techniques including retrobulbar anesthesia and bridle suture.We found there'll be many other causes of ptosis from the result of variant ptosis in group III with topical anesthesia.