Comparison of Optical Coherence Tomography Characteristics among Three Subtypes of Exudative Age-related Macular Degeneration

PURPOSE: To compare the characteristics of optical coherence tomography in eyes with treatment-naïve typical neovascular age-related macular degeneration (typical nAMD), polypoidal choroidal vasculopathy (PCV), and retinal angiomatous proliferation (RAP). METHODS: One hundred fifty-three eyes newly diagnosed with exudative AMD were retrospectively collected. All study eyes were classified into three subtypes: typical nAMD, PCV, and RAP. Subfoveal choroidal thickness (SFCT) was measured using enhanced depth imaging optical coherence tomography (EDI-OCT). Central macular thickness (CMT) and other OCT features including intraretinal cystoid fluid and subretinal fluid were also evaluated in all eyes. SFCT, CMT and other OCT features were compared among the three subtypes of exudative AMD. RESULTS: Seventy-four eyes with typical nAMD, 55 eyes with PCV, and 24 eyes with RAP were included. SFCT was significantly thickest in PCV and thinnest in RAP (p < 0.001). RAP showed the thickest CMT and the highest frequency of intraretinal cystoid fluid (p = 0.004, p < 0.001, respectively). CONCLUSIONS: In patients with exudative AMD, different characteristics of OCT were observed according to the three subtypes. Identification of OCT characteristics could help differentiate the subtypes of exudative AMD.

Comparison of Effective Phacoemulsification Time between Femtosecond Laser-Assisted Cataract Surgery and Conventional Cataract Surgery

PURPOSE: To compare the effect of femtosecond laser-assisted cataract surgery with conventional cataract surgery on effective phacoemulsification time (EPT). METHODS: This study included 66 patients 100 eyes who underwent femtosecond laser-assisted cataract surgery and 68 patients 100 eyes who underwent conventional cataract surgery. Both groups underwent phacoemulsification using pulsed ultrasound energy and EPT was evaluated. The groups were further analyzed according to preoperative Lens opacities classification system (LOCS) III grading. Patients who had femtosecond laser-assisted cataract surgery underwent lens fragmentation with quadrant, hybrid, or grid pattern and the EPT was respectively evaluated. RESULTS: The mean EPT was 5.85 +/- 4.31 seconds in the femtosecond laser-assisted cataract surgery group and 10.34 +/- 6.61 seconds in the conventional group. Overall, EPT was statistically significantly lower in the femtosecond laser-assisted cataract surgery group compared to the conventional group. When the groups were analyzed according to LOCS III grading, this result was consistent for all cataract grades and the reduction in EPT was increased with the higher LOCS III grade. When the groups were analyzed according to lens fragmentation patterns, the mean EPT was lower with 350 microm grid pattern than the quadrant or hybrid pattern. CONCLUSIONS: The femtosecond laser-assisted system in cataract surgery can be an efficient cataract surgery using lower EPT compared to the conventional procedure. Additionally, significant differences were observed in the mean EPT of cataract surgery using the femtosecond laser-assisted system among the 3 lens fragmentation pattern groups.

Surgical Outcomes of Endonasal Revision Surgery for Failed DCR According to Number of Silicone Tubes

PURPOSE: To evaluate the causes of failed dacryocystorhinostomy (DCR) and the effects of transcanalicular diode laser-assisted endonasal revision surgery according to the number of silicone tubes. METHODS: Sixty-seven patients (70 eyes) who underwent revision surgery using transcanalicular diode laser for failed primary endonasal DCR at Sungmo Eye Hospital between March 2007 and December 2012 were studied retrospectively. The causes of failed DCR and the time of recurrence were evaluated. The revision surgeries were endoscopic removal of granuloma and membrane and synechiolysis with intubation of 1 or 2 silicone tubes. We compared the results of revision surgery with 1 silicone tube and 2 silicone tube intubations. RESULTS: Recurrence occurred after a mean duration of 4.6 months following the first DCR. The causes of surgical failure were granuloma (35 eyes), membranous obstruction (23 eyes), synechia (7 eyes), and functional obstruction (5 eyes). We performed revision surgery with 1 silicone tube intubation in 45 eyes (group A) and 2 silicone tube intubations in 25 eyes (group B). The final success rates in groups A and B were 75.6% (34/45) and 84% (21/25), respectively (chi-square test, p = 0.828). CONCLUSIONS: Transcanalicular diode laser-assisted endonasal revision surgery with 2 silicone tubes is not recommended.

Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery

PURPOSE: To evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantation after myopic refractive surgery. METHODS: Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR(R) SN6AD1, the aspheric DMIOL after myopic refractive surgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assisted subepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction were measured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer in dilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass system under mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively. RESULTS: Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 +/- 0.19, and 0.19 +/- 0.12 (log MAR), respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within +/-0.50 diopters (D) and all eyes were within +/-1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were 0.08 +/- 0.08 and 0.07 +/- 0.07 (microm), respectively. Objective scatter index was 3.42 +/- 1.71 and modulation transfer function (MTF) cut-off value was 21.03 +/- 12.37 cpd. General satisfaction score was 3.52 +/- 0.96 points out of 5, and 8 patients (11 eyes) were not satisfied with DMIOL implantation. CONCLUSIONS: After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to the target D, but optical qualities and patient satisfaction were poor.

Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery

PURPOSE: To evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantation after myopic refractive surgery. METHODS: Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR(R) SN6AD1, the aspheric DMIOL after myopic refractive surgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assisted subepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction were measured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer in dilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass system under mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively. RESULTS: Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 +/- 0.19, and 0.19 +/- 0.12 (log MAR), respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within +/-0.50 diopters (D) and all eyes were within +/-1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were 0.08 +/- 0.08 and 0.07 +/- 0.07 (microm), respectively. Objective scatter index was 3.42 +/- 1.71 and modulation transfer function (MTF) cut-off value was 21.03 +/- 12.37 cpd. General satisfaction score was 3.52 +/- 0.96 points out of 5, and 8 patients (11 eyes) were not satisfied with DMIOL implantation. CONCLUSIONS: After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to the target D, but optical qualities and patient satisfaction were poor.

Evaluation of Each Retinal Layer Thickness According to Preoperative OCT Patterns after Idiopathic ERM Removal

PURPOSE: To evaluate the changes in each retinal layer thickness according to preoperative optical coherence tomography (OCT) patterns after idiopathic epiretinal membrane (ERM) removal and to investigate the correlation between retinal layer thickness and visual improvement. METHODS: The medical records of 63 patients (63 eyes) who underwent vitrectomy with internal limiting membrane (ILM) peeling for idiopathic ERM and followed for more than 6 months were retrospectively reviewed. The OCT images of preoperative idiopathic ERM were classified into 3 patterns being flat, convex, and concave. Then, the changes of each retinal layer thickness were compared among OCT patterns and the correlations between retinal layer thickness and visual improvement were analyzed. RESULTS: Improvement in visual acuity was measured in the following order: concave, flat, and convex patterns. The patients with the convex pattern only showed significant improvement of visual acuity. Ganglion cell layer plus inner plexiform layer (GCL + IPL), inner nuclear layer (INL), and outer plexiform layer (OPL) thicknesses were significantly larger in preoperative ERM patients than in normal controls in the following order: convex, concave, and flat patterns. Retinal layer thickness decreased significantly in GCL + IPL and INL after surgery in convex, flat, and concave patterns, in that order. Generally, preoperative retinal layer thickness and postoperative visual acuity were not correlated. However, improvement of visual acuity was significantly related to GCL + IPL and INL thicknesses in the convex pattern and IPL thickness in the flat pattern. CONCLUSIONS: In patients with idiopathic ERM, preoperative difference in each retinal layer thickness according to preoperative OCT patterns was observed. After ERM removal, reduction of each retinal layer thickness and specific retinal layer related to visual improvement was different according to preoperative OCT patterns.

The Evaluation of Prognostic Factors after Vitrectomy for Lamellar Macular Hole Using Optical Coherence Tomography

PURPOSE: To evaluate the prognostic factors that predict visual outcome after vitrectomy for lamellar macular hole using optical coherence tomography (OCT). METHODS: This study included 26 eyes that underwent pars plana vitrectomy, epiretinal membrane removal, and internal limiting membrane peeling for lamellar macular hole. The maximum parafoveal thickness, maximum height and diameter of lamellar macular hole, maximum height and diameter of intraretinal splitting, thinnest foveal floor thickness, and inner segment/outer segment disruption length on preoperative OCT image were investigated for prognostic factors that predict visual outcome. RESULTS: The mean follow-up period was 32.2 months and the mean best corrected visual acuity improved significantly after vitrectomy from log MAR 0.47 +/- 0.32 to log MAR 0.23 +/- 0.23. The postoperative visual acuity correlated significantly with preoperative visual acuity, thinnest foveal floor thickness and inner segment/outer segment disruption length, but not with maximum parafoveal thickness, maximum height and diameter of lamellar macular hole and maximum height and diameter of intraretinal splitting. CONCLUSIONS: The thinnest foveal floor thickness and inner segment/outer segment disruption length on preoperative OCT image were significant prognostic factors.

Evaluation of Each Retinal Layer Thickness According to Preoperative OCT Patterns after Idiopathic ERM Removal

PURPOSE: To evaluate the changes in each retinal layer thickness according to preoperative optical coherence tomography (OCT) patterns after idiopathic epiretinal membrane (ERM) removal and to investigate the correlation between retinal layer thickness and visual improvement. METHODS: The medical records of 63 patients (63 eyes) who underwent vitrectomy with internal limiting membrane (ILM) peeling for idiopathic ERM and followed for more than 6 months were retrospectively reviewed. The OCT images of preoperative idiopathic ERM were classified into 3 patterns being flat, convex, and concave. Then, the changes of each retinal layer thickness were compared among OCT patterns and the correlations between retinal layer thickness and visual improvement were analyzed. RESULTS: Improvement in visual acuity was measured in the following order: concave, flat, and convex patterns. The patients with the convex pattern only showed significant improvement of visual acuity. Ganglion cell layer plus inner plexiform layer (GCL + IPL), inner nuclear layer (INL), and outer plexiform layer (OPL) thicknesses were significantly larger in preoperative ERM patients than in normal controls in the following order: convex, concave, and flat patterns. Retinal layer thickness decreased significantly in GCL + IPL and INL after surgery in convex, flat, and concave patterns, in that order. Generally, preoperative retinal layer thickness and postoperative visual acuity were not correlated. However, improvement of visual acuity was significantly related to GCL + IPL and INL thicknesses in the convex pattern and IPL thickness in the flat pattern. CONCLUSIONS: In patients with idiopathic ERM, preoperative difference in each retinal layer thickness according to preoperative OCT patterns was observed. After ERM removal, reduction of each retinal layer thickness and specific retinal layer related to visual improvement was different according to preoperative OCT patterns.

The Evaluation of Prognostic Factors after Vitrectomy for Lamellar Macular Hole Using Optical Coherence Tomography

PURPOSE: To evaluate the prognostic factors that predict visual outcome after vitrectomy for lamellar macular hole using optical coherence tomography (OCT). METHODS: This study included 26 eyes that underwent pars plana vitrectomy, epiretinal membrane removal, and internal limiting membrane peeling for lamellar macular hole. The maximum parafoveal thickness, maximum height and diameter of lamellar macular hole, maximum height and diameter of intraretinal splitting, thinnest foveal floor thickness, and inner segment/outer segment disruption length on preoperative OCT image were investigated for prognostic factors that predict visual outcome. RESULTS: The mean follow-up period was 32.2 months and the mean best corrected visual acuity improved significantly after vitrectomy from log MAR 0.47 +/- 0.32 to log MAR 0.23 +/- 0.23. The postoperative visual acuity correlated significantly with preoperative visual acuity, thinnest foveal floor thickness and inner segment/outer segment disruption length, but not with maximum parafoveal thickness, maximum height and diameter of lamellar macular hole and maximum height and diameter of intraretinal splitting. CONCLUSIONS: The thinnest foveal floor thickness and inner segment/outer segment disruption length on preoperative OCT image were significant prognostic factors.

The Effects of Overnight Orthokeratology Lens Wear on Ocular Scatter

PURPOSE: To evaluate the change of visual quality after wearing orthokeratology lenses overnight. METHODS: This study included 13 patients (24 eyes) who wore orthokeratology lenses for the first time. Visual quality was assessed with the optical quality analysis system (OQAS) using the double-pass technique. The value of modulation transfer function (MTF) cutoff, Strehl ratio, and objective scatter index (OSI) were measured at baseline and 4 weeks after wearing the lenses. RESULTS: The mean spherical equivalent decreased from -2.70 +/- 1.03 diopters (D) to 0.03 +/- 0.36 D after 4 weeks of wearing orthokeratology lenses and uncorrected visual acuity improved from log MAR 0.88 +/- 0.17 to log MAR 0.03 +/- 0.04. The MTF cutoff decreased from 38.20 +/- 11.01 to 34.79 +/- 10.30 and the Strehl ratio decreased from 0.24 +/- 0.07 to 0.21 +/- 0.07 but without statistical significance. The OSI significantly increased from 0.38 +/- 0.19 to 0.72 +/- 0.40 after wearing orthokeratology lenses. CONCLUSIONS: Orthokeratology lenses were effective for correction of myopia and astigmatism. The OSI increased after wearing the lenses, but MFT cutoff and Strehl ratios were not affected.