Relationship between Early Postoperative Stereoacuity and Surgical Outcome in Intermittent Exotropia

PURPOSE: To identify the correlation between early postoperative stereoacuity and surgical outcome in intermittent exotropia. METHODS: The medical records of 74 patients who underwent unilateral lateral rectus recession or bilateral lateral rectus recession for intermittent exotropia with a minimum postoperative follow-up of 3 years were retrospectively reviewed. Postoperative stereoacuity was measured using the vectogram test and Titmus test at 1 month post-operative. The deviation angle was measured at near and at distance using a prism cover test. Patients were divided into two groups according to post-operative angle deviation, and stereoacuity was analyzed in both groups. RESULTS: Sixty patients showed no suppression at distance at 1 month post-operative follow-up. Of these, 55 patients (85.9%) belonged to the success group and 5 patients (50.0%) belonged to the recurrence group. The post-operative suppression test and the surgical outcome exhibited a significant association (p = 0.017). 53 patients showed normal stereoacuity 1 month after surgery. Of these, 49 patients (76.6%) belonged to the success group and 4 patients (40.0%) belonged to the recurrence group (p = 0.017). Post-operative stereoacuity and surgical outcome exhibited a significant association (p = 0.026). CONCLUSIONS: Post-operative suppression test results at distance and stereoacuity at near may be helpful in predicting surgical outcomes of patients with intermittent exotropia.

The Effect of 3% Diquafosol Tetrasodium on Corneal Wetting Property and Mucin-5AC Concentration in Rabbits

PURPOSE: To evaluate the immediate effects of 3% diquafosol ophthalmic solution on tear MUC5AC concentration and corneal wetting property in rabbit eyes. METHODS: Six New Zealand white rabbits were used in the present study. Fifteen minutes after instilling 50 microL of 3% diquafosol into the right eye of each rabbit and 50 microL of saline into the left eye, corneal wetting property, tear MUC5AC concentrations and the area of periodic acid-Schiff (PAS)-stained conjunctival goblet cells were evaluated under general anesthesia using conjunctival impression cytology. Corneal wetting property was evaluated by measuring the duration from when the image of the microscopic light beam was clear on the corneal surface immediately after blinking to when the image began to blur. RESULTS: The mean time of corneal wetting property was 86.40 (+/- 17.90) seconds in the diquafosol group and 49.00 (+/- 6.35) seconds in the control group. There was a significant difference between the two groups (p = 0.043). The mean concentration of tear MUC5AC was significantly higher in the diquafosol group (18.21 +/- 1.52 ng/mL) than the control group (12.75 +/- 1.82 ng/mL; p = 0.028). Conjunctival impression cytology showed the area of PAS-stained conjunctival goblet cells was significantly lower in the diquafosol group (23.17 +/- 0.05%) than the control group (32.49 +/- 0.08%; p = 0.028). CONCLUSIONS: Immediately after instilling 3% diquafosol, corneal wetting property improved significantly. Also tear MUC5AC concentration, which was released from conjunctival goblet cells increased compared to saline.

Adherence to Preservative-Free Dorzolamide/Timolol Fixed Combination Assessed by Counting the Unused Single-Dose Units

PURPOSE: To investigate the actual adherence to treatment with preservative-free dorzolamide-timolol fixed combination (DTFC) eyedrops of primary open-angle glaucoma (POAG) patients by counting the number of unused single-dose units of DTFC. METHODS: This study included 34 POAG patients newly prescribed with preservative-free DTFC eyedrops (formulated in single-dose units). The enrolled patients were asked to bring the unused DTFC units on their next visit after 2 weeks of treatment with DTFC. On their second visit, they were asked to complete a questionnaire regarding the self-reported adherence and the number of unused DTFC single-dose units was counted. The actual adherence (%) was calculated by dividing the expected number of used DTFC units by the actual number of used DTFC units. The correlation between the self-reported adherence and the measured adherence was assessed. RESULTS: Twenty-nine (93.5%) patients answered they adhered to the medication by more than 90% and 2 (6.5%) answered they instilled the eyedrops at 80-90% of the dosing schedule. However, after counting the unused DTFC single-dose units, 9 (29.0%) patients showed an actual adherence of <90%. Moreover, the actual adherence of 3 (9.7%) patients was <60%. Unexpectedly, 4 (12.9%) patients showed the actual adherence exceeding 100% (196%, 1 patient; 107-132%, 3 patients). CONCLUSIONS: We demonstrated a large difference between the self-reported and the actual adherence to treatment by counting the unused single-dose units of eyedrops. Preservative-free topical anti-glaucoma medications (formulated in single-dose units) provide clinicians an opportunity to assess the actual adherence of glaucoma patients by counting the unused units of eyedrops.