Comparative Spectrophotometer Analysis of Ultraviolet-light Filtering, Blue-light Filtering, and Violet-light Filtering Intraocular Lenses

Purpose@#To compare the light transmittance property of seven currently used intraocular lens (IOL) models by spectrophotometer data. @*Methods@#Light transmission spectra of seven IOL models were assessed with a spectrophotometer. The transmittance properties were analyzed in 1 nm units from 350 nm wavelength to 800 nm. @*Results@#Three ultraviolet filtering IOL models (ZCB00, XC1-SP, and AT LISA 809M) showed nearly full transmittance of the light from 400 to 500 nm, while steeply attenuating light with shorter wavelengths in various degrees. Three blue-light filtering IOLs (yellow-tinted IOLs; XY1, SN60WF, and TNFT00) showed a slow-sloped increase of light transmission between 400 to 500nm. Among the three, XY1 showed different degree of inclination, showing a steeper slope than SN60WF and TNFT00. The violet-light filtering IOL (ZFR00V) showed a rapid increase of the transmission at around 435 nm wavelength, which is similar to ultraviolet filtering IOLs. @*Conclusions@#The seven different IOLs measured showed different characteristics of light transmission depending on the properties of each material and color. Blue-light filtering IOLs tend to blocked a wide range of wavelength up to 500 nm, but rather were not effective at the range of 400 to 430 nm. Violet-light filtering IOL showed advantages in filtering the high-energy wavelength, around 430 nm, having a potential risk to retina and allowing the transmission of useful blue and green wavelength which is necessary for a better scotopic contrast sensitivity.

Evaluation of Subconjunctival Remnant Particles after High-frequency Radio-wave Electrosurgery for Conjunctivochalasis

PURPOSE: To investigate the clinical manifestations and properties of remnant particles in the subconjunctival space after high-frequency radio-wave electrosurgery for conjunctivochalasis. METHODS: We performed a retrospective, observational case series with in vitro experimental imaging in nine eyes from eight patients who presented with small dark-gray lesions during follow-up after high-frequency radio-wave electrosurgery for conjunctivochalasis. General examination including slit-lamp examination and visual acuity testing was performed preoperatively and postoperatively. During follow-up, we evaluated remnant particles and any other complications including granuloma or conjunctival injection with slit-lamp photography and anterior optical coherence tomography. Coagulation tips were investigated with scanning electron microscope and energy dispersive X-ray spectroscopy to analyze the insulating electrode and assess changes to tips after repeated use. RESULTS: None of the patients included in this study experienced any change in visual acuity or major complications postoperatively. Small dark-gray lesions (0.3 to 0.5 mm in size) were observed in the inferior bulbar sub-conjunctival space in the location where high-frequency radio-wave electrosurgery had been performed. Cirrus high-definition optical coherence tomography images revealed focal hyper-reflection with a posterior shadow, suggesting foreign particles. Scanning electron microscopy and energy dispersive X-ray spectroscopy imaging analysis revealed peaks of carbon and fluorine complexes, consistent with the polytetrafluoroethylene coating on the electrode. CONCLUSIONS: There were no instances of inflammatory reaction, particle migration, or major complications due to particles. Physicians should be aware of the possibility of remnant polytetrafluoroethylene particles in subconjunctival tissue when using insulated coagulation tips subjected to repeat sterilization.

Efficacy of Topical Cyclosporine Nanoemulsion 0.05% Compared with Topical Cyclosporine Emulsion 0.05% and Diquafosol 3% in Dry Eye

PURPOSE: To evaluate the efficacy and safety of cyclosporine nanoemulsion 0.05% compared to cyclosporine emulsion 0.05% and diquafosol sodium 3%. METHODS: This was a multicenter, randomized, evaluator-masked, active control, parallel, phase IV study. A total of 227 patients were randomly allocated to instill cyclosporine nanoemulsion 0.05% (CN) twice daily, cyclosporine emulsion 0.05% (CE) twice daily, or diquafosol sodium 3% (DQ) six times daily. Non-inferiority of CN was analyzed by primary endpoint (cornea and conjunctival staining scores at week 12). The secondary endpoints were scores of corneal staining, conjunctival staining, tear break-up time, Schirmer test, and Ocular Surface Disease Index at weeks 4 and 12. RESULTS: Primary endpoints showed statistically significant improvements in all groups. Primary endpoints were −6.60 for the CN group, −5.28 for the CE group, and −6.63 for the DQ group (National Eye Institute scale from 0 to 33), verifying the non-inferiority of CN compared to CE (95% confidence interval, −0.15 to 2.80, Δ>−2.88). In intergroup comparison between CN and CE groups, the CN group had significantly more decreased conjunctival staining score at week 12. Intergroup comparison between CN and DQ groups showed consistent statistically significant improvements in TBUT and Schirmer test in the CN group. In the DQ group, TBUT showed late statistically significant improvement at week 12 and Schirmer test showed relatively short-term statistically significant improvement at week 4. CONCLUSIONS: Cyclosporine nanoemulsion 0.05% was equivalently efficient compared to cyclosporine emulsion 0.05% and diquafosol sodium 3%. In addition, CN showed significant improvements in several parameters for treatment of dry eyes.

Reduction of Blue Light Emission in Internet-protocol Television and Its Effect on Ocular Fatigue

PURPOSE: The blue light emitted from electronic devices may be harmful to the eye. We investigated whether internet-protocol television (TV) with lowered blue light emission reduced ocular fatigue. METHODS: A total of 98 healthy subjects were recruited. They watched an animated movie (A) and an identical version except for reduced blue light (B), sequentially for 1 hour in random order. Before and after watching the movies, we measured the distance and near refraction and tear break-up time objectively. Ocular discomfort score and the earliest onset time of the ocular fatigue symptoms were also measured using our specially designed subjective ocular discomfort scale. RESULTS: The median age of the participants was 28.5 years, and there were 56 females out of 98 total participants. Both distance and near refraction were not significantly different before versus after watching the movies, nor between viewing movies A and B. However, the accommodative amplitude measured by subtracting the near refraction from the distance refraction was found to be greater after watching movie B compared with movie A in a subset of subjects with hyperopia [1.92 vs. 1.72 diopters (D) for the right eye and 2.14 vs. 1.83 D for the left eye; p = 0.04 and p < 0.01, respectively]. The ocular discomfort score was lower (15.40 vs. 12.85; p = 0.10), but not significantly, and the earliest ocular fatigue onset time was significantly delayed (23.48 vs. 34.51 minutes; p < 0.01), after watching movie B. CONCLUSIONS: Reduction of blue light emission alleviated ocular fatigue caused by TV displays. Watching TV with lower blue light may provide benefits to hyperopic individuals by reducing eye strain and improving the accommodative amplitude.

Visual Outcomes, Patient Satisfaction and Spectacle Independence with a Trifocal Diffractive Intraocular Lens

PURPOSE: To evaluate visual outcomes following implantation of a trifocal diffractive intraocular lens (IOL) and to analyze their correlation with patient satisfaction and ease of performing daily tasks. METHODS: This was a prospective study enrolling 100 eyes of 50 patients undergoing cataract surgery with implantation of trifocal IOL AT LISA tri 839MP. Visual and refractive outcomes were evaluated during a 3-month follow-up. Postoperatively, a questionnaire was used to evaluate patient satisfaction with regard to surgical outcome, spectacle independence, perception of photic phenomena, and ease of performing some vision-related activities. RESULTS: A total of 91%, 87%, and 79% of eyes achieved a monocular uncorrected distance, near, and intermediate visual acuity of 0.1 logarithm of the minimum angle of resolution or better, respectively. After the surgery, 96% of the patients could perform their daily activities without problems. The mean spectacle independence scores for reading, doing computer work, and for distance were 10.33 ± 12.47, 5.71 ± 11.90, and 3.92 ± 9.77, respectively (scale: 0 = no spectacles needed; 40 = spectacles always needed). No correlation was found between spectacle independence and visual outcome (-0.101 ≤ r ≤ 0.244, p ≥ 0.087). Mean scores (0 = no symptoms; 40 = strong symptoms) for glare at night, ghost images, and halos were 15.15 ± 12.02, 4.49 ± 7.92, and 13.34 ± 10.82, respectively. No correlation was found between photic phenomena and visual outcome (-0.199 ≤ r ≤ 0.209, p ≥ 0.150). A total of 80% of patients reported satisfaction with the surgery outcome, and 86% would recommend the surgery to friends and family. CONCLUSIONS: Implantation of the AT LISA tri 839MP IOL after cataract surgery provides effective visual restoration associated with a minimal level of photic phenomena, a positive impact on the performance of vision-related daily activities, and a high level of postoperative patient satisfaction.

Korean Guidelines for the Diagnosis and Management of Dry Eye: Development and Validation of Clinical Efficacy

PURPOSE: To evaluate the clinical efficacy of newly developed guidelines for the diagnosis and management of dry eye. METHODS: This retrospective, multi-center, non-randomized, observational study included a total of 1,612 patients with dry eye disease who initially visited the clinics from March 2010 to August 2010. Korean guidelines for the diagnosis and management of dry eye were newly developed from concise, expert-consensus recommendations. Severity levels at initial and final visits were determined using the guidelines in patients with 90 +/- 7 days of follow-up visits (n = 526). Groups with different clinical outcomes were compared with respect to clinical parameters, treatment modalities, and guideline compliance. Main outcome measures were ocular and visual symptoms, ocular surface disease index, global assessment by patient and physician, tear film break-up time, Schirmer-1 test score, ocular surface staining score at initial and final visits, clinical outcome after three months of treatment, and guideline compliance. RESULTS: Severity level was reduced in 47.37% of patients treated as recommended by the guidelines. Younger age (odd ratio [OR], 0.984; p = 0.044), higher severity level at initial visit, compliance to treatment recommendation (OR, 1.832; p = 0.047), and use of topical cyclosporine (OR, 1.838; p = 0.011) were significantly associated with improved clinical outcomes. CONCLUSIONS: Korean guidelines for the diagnosis and management of dry eye can be used as a valid and effective tool for the treatment of dry eye disease.

The Effect of Fixed Combination of Brinzolamide 1% and Timolol 0.5% in Normal-Tension Glaucoma

PURPOSE: We conducted a study to evaluate the effects of brinzolamide/timolol fixed combination (BTFC) in normal-tension glaucoma (NTG) patients. METHODS: We reviewed the records of 33 normal-tension glaucoma patients treated with BTFC in the unilateral eye. We measured intraocular pressure (IOP) every 2 and 1/2 hours between 09:00 am and 04:30 pm. After using BTFC at 8:00 am and 8:00 pm for 6 months, we measured the IOP at the same time period. We analyzed and compared the IOP of eyes treated with BTFC and contralateral eyes. RESULTS: The mean reduction in IOP was -2.85 +/- 1.43 mm Hg (-18.36 +/- 8.58%) in the eyes treated with BTFC and -2.21 +/- 1.73 mm Hg (-13.90 +/- 10.66%) in the contralateral eyes. The IOP lowering effect was greater in the eyes treated with BTFC than in the contralateral eyes. After 6 months of BTFC instillation, the changes in IOP measurements were the lowest at 11:30 am and increased at each time point afterwards. The greatest reduction in IOP was observed at 1 month; however, significant IOP reduction was observed at 3 and 6 months in both BTFC and contralateral eyes. There was no serious adverse event causing ocular damage. CONCLUSIONS: BTFC provided a significant IOP reduction in both BTFC and contralateral eyes in NTG patients.

Diurnal Intraocular Pressure with Bimatoprost/Timolol Fixed Combination versus Latanoprost/Timolol Fixed Combination in Healthy Subjects

PURPOSE: To evaluate the effects of a bimatoprost/timolol fixed combination (BTFC) and a latanoprost/timolol fixed combination (LTFC) on diurnal intraocular pressure (IOP) and anterior ocular parameters in healthy subjects. METHODS: We enrolled 58 healthy subjects in this prospective clinical study. Thirty subjects were treated with BTFC and 28 subjects were treated with LTFC. IOP was measured every 2 hours except from 01:00 and 05:00. Axial length, corneal curvature, and anterior chamber depth were obtained using the IOL master at baseline and 24 hours later. Adverse events were assessed by patient interview and by slit lamp examination. RESULTS: The largest difference in IOP between treated and untreated eyes 8 hours after instillation was 1.67 mmHg in the BTFC group (p < 0.001). The largest difference in IOP between treated and untreated eyes 10 hours after instillation was 1.93 mmHg in the LTFC group (p < 0.001). For anterior ocular parameters such as axial length, corneal curvature, anterior chamber depth at baseline and 24 hours after instillation, there were no significant differences between the baseline and 24-hour values in either the BTFC or LTFC group. The most frequently occurring adverse event was conjunctival hyperemia, which was found in 33.3% (n = 10) of the BTFC group and 25.0% (n = 7) of the LTFC group (p = 0.486). CONCLUSIONS: BTFC and LTFC provided a significant reduction in IOP from baseline without changing any anterior ocular parameters. Our results provide a reference for monocular trials to assess the effect of eye drops in a clinical condition.

Diurnal Intraocular Pressure with Bimatoprost/Timolol Fixed Combination versus Latanoprost/Timolol Fixed Combination in Healthy Subjects

PURPOSE: To evaluate the effects of a bimatoprost/timolol fixed combination (BTFC) and a latanoprost/timolol fixed combination (LTFC) on diurnal intraocular pressure (IOP) and anterior ocular parameters in healthy subjects. METHODS: We enrolled 58 healthy subjects in this prospective clinical study. Thirty subjects were treated with BTFC and 28 subjects were treated with LTFC. IOP was measured every 2 hours except from 01:00 and 05:00. Axial length, corneal curvature, and anterior chamber depth were obtained using the IOL master at baseline and 24 hours later. Adverse events were assessed by patient interview and by slit lamp examination. RESULTS: The largest difference in IOP between treated and untreated eyes 8 hours after instillation was 1.67 mmHg in the BTFC group (p < 0.001). The largest difference in IOP between treated and untreated eyes 10 hours after instillation was 1.93 mmHg in the LTFC group (p < 0.001). For anterior ocular parameters such as axial length, corneal curvature, anterior chamber depth at baseline and 24 hours after instillation, there were no significant differences between the baseline and 24-hour values in either the BTFC or LTFC group. The most frequently occurring adverse event was conjunctival hyperemia, which was found in 33.3% (n = 10) of the BTFC group and 25.0% (n = 7) of the LTFC group (p = 0.486). CONCLUSIONS: BTFC and LTFC provided a significant reduction in IOP from baseline without changing any anterior ocular parameters. Our results provide a reference for monocular trials to assess the effect of eye drops in a clinical condition.

The Effect of Anthocyanoside and Ginkgo Biloba Extract on Normal-Tension Glaucoma According to Presence of Diabetes

PURPOSE: This study was performed to evaluate the effect of anthocyanoside and ginkgo biloba extract (GBE) in patients with normal tension glaucoma (NTG), according to the presence of diabetes mellitus (DM). METHODS: A chart review of patients with normal tension glaucoma was retrospectively analyzed. All patients underwent a Humphrey visual field (HVF) test and logarithm of the minimal angle of resolution best-corrected visual acuity (log MAR BCVA) was measured over a 6 months period. Changes in mean deviation (MD), pattern standard deviation (PSD) of visual field and log MAR BCVA were compared among anthocyanoside, GBE and no medication (control) groups. Patients were divided according to the presence of DM. RESULTS: A total of 406 NTG patients, including 151 DM patients, were included in the present study. MD was improved in the anthocyanoside and GBE groups, but not in the control group. PSD was not significantly different in all groups. BCVA was improved in the anthocyanoside group, but deteriorated in the control group. The results were similar in patients with or without DM. The generalized linear model demonstrated that systemic medication affected changes in visual indices. CONCLUSIONS: The results from the present study suggest that anthocyanoside and GBE may be helpful for improving visual function in some patients with NTG regardless of their DM status.

The Effect of Various Factors on Variability of Retinal Nerve Fiber Layer Thickness Measurements Using Optical Coherence Tomography

PURPOSE: To evaluate the effects of various factors on the variability of retinal nerve fiber layer (RNFL) thickness measurements using the Stratus optical coherence tomography (OCT) in normal and glaucomatous eyes. METHODS: Four hundred seventy-four subjects (103 normal eyes and 371 glaucomatous eyes) were scanned to determine the RNFL thickness measurements using the Stratus OCT. Measurements were obtained twice during the same day. The standard deviation (SD) was used to compare the variability in RNFL thickness measurements of the normal subjects to that of the glaucomatous patients. Multivariate regression analysis was used to evaluate which covariates were independent predictors of SD in overall mean RNFL thickness. RESULTS: The mean SD of all RNFL thickness measurements was larger in the glaucoma group except in one sector. In the multivariate regression analysis, the average signal strength (SS) and the relative SS change (difference in SS between initial and repeat scans, divided by initial SS) were independent predictors of the SD in the RNFL thickness measurements (partial R2 = 0.018, 0.013; p = 0.016, 0.040, respectively). CONCLUSIONS: Glaucomatous eyes tend to be more variable than normal eyes in RNFL thickness measurement using the Straus OCT. The average SS and the relative SS changes appear to correlate with the variability in RNFL thickness measurement. Therefore, the results of the RNFL analysis should not be interpreted independently of these factors.

Low Limit for Effective Signal Strength in the Stratus OCT in Imperative Low Signal Strength Cases

PURPOSE: To determine the lowest limit of signal strength that is still effective for accurate analysis of optic coherence tomography (OCT) values, we investigated the reproducibility of OCT scans by signal strength (SS). METHODS: A total of 668 subjects were scanned for measurements of retinal nerve fiber layer (RNFL) thickness using the Stratus OCT twice on the same day. The variability of overall RNFL thickness parameters obtained at different SS was analyzed and compared by repeated-measures of ANOVA and Spearman's correlation coefficient. Values of the intraclass correlation coefficient (ICC) and variability (standard deviation) of RNFL thickness were obtained. The false positive ratio was analyzed. RESULTS: When SS was 3, the variability of RNFL thickness was significantly different (low ICC, high variability) in comparison to when SS was 4 or greater. Significant negative correlations were observed between variability in RNFL thickness and signal strength. The difference of variability of average RNFL thickness between SS 4 (4.94 microm) and SS 6 (4.41 microm) was 0.53 microm. CONCLUSIONS: Clinically, the difference of variability of average RNFL thickness between SS 4 and SS 6 was quite small. High SS is important, however, when signal strength is low due to uncorrectable factors in patients in need of OCT for glaucoma and retinal disease. Our results suggest that SS 4 is the lowest acceptable limit of signal strength for obtaining reproducible scanning images.

Conventional Epi-LASIK and Lamellar Epithelial Debridement in Myopic Patients with Dermatologic Keloids

We report the outcome of conventional epipolis laser in situ keratomileusis (Epi-LASIK, flap-on) and lamellar epithelial debridement (LED; Epi-LASIK, flap-off) in myopic patients with dermatologic keloids. Three patients, who were all noted to be susceptible to keloid scarring, received conventional Epi-LASIK in their right eyes and LED in their left eyes. The patients were followed-up for 6 to 21 months after their surgeries, and the outcomes were then evaluated. In case 1, the preoperative spherical equivalent (SE) was -6.5 diopters (D) in the right eye (OD) and -6.25 D in the left eye (OS). At 21 months postoperatively, the uncorrected visual acuity (UCVA) was 20 / 12.5 in both eyes. In case 2, the preoperative SE was -5.25 (OD) / -6.00 (OS). After six months, the postoperative UCVA was 20 / 12.5 in both eyes. In case 3, the preoperative SE was -4.5 (OD) / -2.0 (OS). The UCVA at the six-month follow-up was 20 / 12.5 in both eyes. No adverse events, including corneal haze, occurred in any of the patients. All three of our patients reported excellent visual outcomes following both conventional Epi-LASIK and LED, despite their histories of keloid formation. The present cases suggest that both Epi-LASIK and LED may be safe and effective techniques for myopic patients with dermatologic keloids.

Argon Laser Photocoagulation Combined With Subconjunctival and Intravitreal Bevacizumab Injections for a Retrocorneal Neovascular Membrane

PURPOSE: To report a case of retrocorneal membrane effectively treated with focal argon laser photocoagulation combined with subconjunctival and intravitreal bevacizumab injections. CASE SUMMARY: A 69-year-old female presented with persistent ocular pain and decreased visual acuity of the right eye following a complicated extracapsular cataract extraction performed nine months earliet. On examination, there was a neovascular retrocorneal membrane covering the superior one-third of the cornea with a sutured wound along the limbus. Following unresponsive conservative treatment, we performed focal argon laser photocoagulation followed by subconjunctival and intravitreal bevacizumab injections (1.25 mg). Two weeks later, markedly regressed neovascularization was noted. Additional argon laser photocoagulation, subconjunctival and intravitreal bavacizumab were performed six weeks later. Four months after the last treatment, the neovascular component substantially decreased and fibrous scar tissue replaced the neovascularization. The retrocorneal membrane showed no progression.

Clinical Outcomes of LASIK Using a 213 nm Solid-State Laser System: 6-month Follow-up

PURPOSE: To present prospective clinical results of laser-assisted in situ keratomileusis (LASIK) using a solid-state laser system for the correction of mild to moderate myopia with or without astigmatism. METHODS: Thirty-eight eyes underwent LASIK using a 213 nm solid-state laser (Pulzar Z1trade mark, CustomVistrade mark, Australia). Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refractive errors, higher order aberrations (HOA) and contrast sensitivity were evaluated preoperatively and postoperatively. RESULTS: The preoperative and postoperative mean spherical and cylindrical refractive errors were -3.27+/-0.85D, +1.04+/-0.69D, -0.36+/-0.7D and +0.14+/-0.2D, respectively. UCVA over 20/25 was obtained in 27 eyes (93%). A result within 1.00D of the desired correction was achieved in 90% of the eyes. There were no decreases in BCVA within the study group. The preoperative and postoperative root-mean-square of HOA at 3 months were 0.196+/-0.092 microm and 0.326+/-0.107 microm respectively. The preoperative and postoperative contrast sensitivity values were similar. CONCLUSIONS: The clinical outcomes of LASIK using a solid-state laser system were comparable to the conventional refractive surgery in mild to moderate myopia. The 213 nm solid state laser may be an alternative option for refractive surgery.

Quantitative Analysis of Aqueous Flare in Diabetic Patients

PURPOSE: We performed quantitative analysis of aqueous flare to evaluate the influence of diabetes mellitus on the flare values reflecting microvascular injuries of the retina. METHODS: We compared aqueous flare values of diabetic patients without diabetic retinopathy (80 patients, 160 eyes), with those of normal control group (21 persons, 42 eyes) and diabetic retinopathy patients (20 patients, 40 eyes). The correlation between flare values and the risk factors of diabetic retinopathy was evaluated in diabetic patients without diabetic retinopathy. RESULTS: Flare values were highest in diabetic retinopathy patients, and higher in diabetic patients without diabetic retinopathy than normal control group with statistical significance (p<0.01). Flare values were not significantly correlated with the risk factors of diabetic retinopathy. CONCLUSIONS: Microvascular injury appears to be developed in diabetic patients without diabetic retinopathy.

Quantitative Analysis of Aqueous Flare in Diabetic Patients

PURPOSE: We performed quantitative analysis of aqueous flare to evaluate the influence of diabetes mellitus on the flare values reflecting microvascular injuries of the retina. METHODS: We compared aqueous flare values of diabetic patients without diabetic retinopathy (80 patients, 160 eyes), with those of normal control group (21 persons, 42 eyes) and diabetic retinopathy patients (20 patients, 40 eyes). The correlation between flare values and the risk factors of diabetic retinopathy was evaluated in diabetic patients without diabetic retinopathy. RESULTS: Flare values were highest in diabetic retinopathy patients, and higher in diabetic patients without diabetic retinopathy than normal control group with statistical significance (p<0.01). Flare values were not significantly correlated with the risk factors of diabetic retinopathy. CONCLUSIONS: Microvascular injury appears to be developed in diabetic patients without diabetic retinopathy.

The Prevalence and Predictive Factors of Deterioration in Accommodative Esotropia

PURPOSE: A number of patients with accommodative esotropia who were initially well controlled with their optical correction will deteriorate. This study aims to examine the cautious clinical features of patients with accommodative esotropia during follow-up period by obtaining the prevalence and the predictive factors of deterioration in accommodative esotropia. METHODS: The records of 89 patients with accommodative esotropia whose eyes were aligned with optical correction (including bifocals) to 8 prism diopters (PD) of esotropia or less were reviewed. All patients were followed for a period of at least 2 years. The patients whose alignment was increased to 10PD of esotropia or greater during the follow-up period were included into the deteriorated group. We obtained the rate of deterioration and compared the clinical features of the deteriorated and controlled group. RESULTS: The mean follow-up period was 64.1+/-29.3 months. Seven (7.8%) of 89 patients was deteriorated. The mean interval of deterioration after initial optical correction was 41.8+/-26.9 months. The stereopsis was significantly worse in the deteriorated group (p=0.024). The frequency of high AC/A ratio was also significantly higher in the deteriorated group (p=0.003). CONCLUSIONS: This study indicates that accommodative esotropia with high AC/A ratio or worse sensory status has an increased likelihood of deterioration.

The Prevalence and Predictive Factors of Deterioration in Accommodative Esotropia

PURPOSE: A number of patients with accommodative esotropia who were initially well controlled with their optical correction will deteriorate. This study aims to examine the cautious clinical features of patients with accommodative esotropia during follow-up period by obtaining the prevalence and the predictive factors of deterioration in accommodative esotropia. METHODS: The records of 89 patients with accommodative esotropia whose eyes were aligned with optical correction (including bifocals) to 8 prism diopters (PD) of esotropia or less were reviewed. All patients were followed for a period of at least 2 years. The patients whose alignment was increased to 10PD of esotropia or greater during the follow-up period were included into the deteriorated group. We obtained the rate of deterioration and compared the clinical features of the deteriorated and controlled group. RESULTS: The mean follow-up period was 64.1+/-29.3 months. Seven (7.8%) of 89 patients was deteriorated. The mean interval of deterioration after initial optical correction was 41.8+/-26.9 months. The stereopsis was significantly worse in the deteriorated group (p=0.024). The frequency of high AC/A ratio was also significantly higher in the deteriorated group (p=0.003). CONCLUSIONS: This study indicates that accommodative esotropia with high AC/A ratio or worse sensory status has an increased likelihood of deterioration.

Comparison of Clinical Appearance of Pediatric Ocular Injury, According to Grade Level

PURPOSE: To compare the causes and clinical manifestations of pediatric ocular injuries according to grade level. METHODS: We retrospectively reviewed the medical records of 78 children, 15 years and younger, who had been hospitalized for pediatric ocular injuries, classified them into three groups according to grade level, and compared their clinical manifestations. RESULTS: Eighteen (23.1%) were preschoolers, 39 (50.0%) were elementary school students, and 21 (26.9%) were middle and high school students. The most common causes of injury included toys and household goods at home in the preschool group, toys and sporting activity at home and school in the elementary school group, and sporting activity at school in the middle and high school group. The incidence of ocular injury was higher in the 'without supervision group' (57.7%); however, in the preschool group, it was higher (72.2%) even in the 'supervision group' (P<0.05). In the preschool group, the incidence of perforating ocular injury (P<0.05) and the rate of surgical treatment (P<0.05) were higher than those of other groups. CONCLUSIONS: The causes and clinical manifestations of pediatric ocular injury were different according to school degree. The incidence of pediatric ocular injuries can be decreased more efficiently by recognizing these differences.