Visual Outcomes after Bilateral Implantation of an Extended Depth of Focus Intraocular Lens: A Multicenter Study

Purpose@#To evaluate visual performance after bilateral implantation of an extended depth of focus (EDOF) intraocular lens (IOL). @*Methods@#This multicenter, prospective, observational study included 100 patients who underwent bilateral cataract surgery with a toric or non-toric EDOF IOL (Tecnis Symfony), and 96 patients completed the final assessment at 4 to 6 months. Binocular corrected distance visual acuity and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA), spectacle independence, visual symptoms, and patient satisfaction were evaluated. @*Results@#Mean decimal visual acuity results showed a binocular corrected distance visual acuity of 1.10 ± 0.18, UDVA of 1.04 ± 0.17, UIVA of 0.96 ± 0.16, and UNVA of 0.68 ± 0.18. Binocular UDVA and UIVA were 0.8 (decimal) or better in 98% and 94% of patients, respectively. Binocular UNVA was 0.63 (decimal) or better in 76% of patients. Overall, 76% of the patients achieved spectacle independence across all distances, and more than 85% reported no or mild dysphotoptic phenomena. On a scale of 0 to 10, the median patient satisfaction score was 9 for far, 9.5 for intermediate, and 8 for near vision. @*Conclusions@#The Symfony EDOF IOL provided excellent distance, intermediate visual outcome, and functional near visual acuity. The visual results were associated with prominent levels of spectacle independence and patient satisfaction.

Visual Outcomes after Bilateral Implantation of an Extended Depth of Focus Intraocular Lens: A Multicenter Study

Purpose@#To evaluate visual performance after bilateral implantation of an extended depth of focus (EDOF) intraocular lens (IOL). @*Methods@#This multicenter, prospective, observational study included 100 patients who underwent bilateral cataract surgery with a toric or non-toric EDOF IOL (Tecnis Symfony), and 96 patients completed the final assessment at 4 to 6 months. Binocular corrected distance visual acuity and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA), spectacle independence, visual symptoms, and patient satisfaction were evaluated. @*Results@#Mean decimal visual acuity results showed a binocular corrected distance visual acuity of 1.10 ± 0.18, UDVA of 1.04 ± 0.17, UIVA of 0.96 ± 0.16, and UNVA of 0.68 ± 0.18. Binocular UDVA and UIVA were 0.8 (decimal) or better in 98% and 94% of patients, respectively. Binocular UNVA was 0.63 (decimal) or better in 76% of patients. Overall, 76% of the patients achieved spectacle independence across all distances, and more than 85% reported no or mild dysphotoptic phenomena. On a scale of 0 to 10, the median patient satisfaction score was 9 for far, 9.5 for intermediate, and 8 for near vision. @*Conclusions@#The Symfony EDOF IOL provided excellent distance, intermediate visual outcome, and functional near visual acuity. The visual results were associated with prominent levels of spectacle independence and patient satisfaction.

The Effectiveness of Mitomycin C on Pterygium Surgery with Amniotic Membrane Transplantation

PURPOSE: To compare postoperative recurrence rates of pterygium surgery with amniotic membrane transplantation with and without mitomycin C. METHODS: A retrospective analysis of 45 eyes of 43 patients who underwent pterygium surgery with amniotic membrane transplantation with a minimum of six months of follow-up. Nineteen eyes underwent mitomycin C application, while the remaining 26 eyes did not. Recurrence rates and complications were evaluated. RESULTS: With a minimum of six months of follow-up, fibrovascular tissue in the excised area not invading the cornea (conjunctival recurrence) was noted in two eyes (10.5%), and fibrovascular tissue invading the cornea (corneal recurrence) was noted in one eye (5.4%) in the amniotic membrane transplantation with mitomycin C group. Conjunctival recurrence was noted in six eyes (23.1%) and corneal recurrence in three eyes (11.5%) in the amniotic membrane transplantation without mitomycin C group. Recurrence rate in the amniotic membrane transplantation with mitomycin C group (15.9%) was significantly lower (p = 0.014) than that in the amniotic membrane transplantation without mitomycin C group (34.6%). Complications included sub-amniotic membrane hemorrhage in two eyes, granuloma in one eye, and wound dehiscence in one eye in each group. There were no specific complications related to usage of mitomycin C. CONCLUSIONS: In pterygium surgery with amniotic membrane transplantation, application of mitomycin C is an effective method to reduce recurrence rates, especially conjunctival recurrences that are related to cosmetic problems. This method may also be helpful to reduce patient discomfort.

Long-Term Endothelial Cell Changes after Angle-Supported Anterior Chamber Lens Implantation in Phakic Eyes

PURPOSE: To evaluate long-term endothelial cell changes in phakic eyes that underwent implantation of an angle-supported anterior chamber lens to correct myopia. METHODS: A retrospective analysis was performed in 110 eyes of 55 patients who underwent implantation of angle-supported anterior chamber lenses with a follow-up period longer than 5 years. Comparisons were made between preoperative and postoperative endothelial cell density, coefficient of variation, and percentage of hexagonal cells. RESULTS: Mean preoperative corneal endothelial cell density was 2951 +/- 336 cells/mm2 and the percentage of cell loss was 3.8% at year 1, 12.6% at year 3, 13.4% at year 5, 22.5% at year 7, and 22.2% at year 9. Explantation was required in 13 eyes (11.8%) due to the decrease of endothelial cell count to 936 +/- 458 cells/mm2 over 9 years of follow-up. CONCLUSIONS: Continuous endothelial cell loss was observed after implantation of angle-supported anterior chamber lens in the long-term follow-up. A constant decline in the endothelial cell density necessitates periodic ophthalmologic evaluation including specular microscopy.

Effectiveness of Wide Excision of Subconjucntival Fibrovascular Tissue with Conjunctivo-Limbal Autograft in Pterygium Surgery

PURPOSE: To evaluate the efficacy of wide excision of subconjucntival fibrovascular tissue after conjunctivo-limbal autograft of primary and recurrent pterygium. METHODS: Sixty-five eyes of 59 patients underwent pterygium excision with conjunctivo-limbal autograft. Thirty-six eyes of 33 patients had wide excision of pterygium, 29 eyes of 26 patients did not have wide excision of pterygium. All patients underwent follow-up for more than one year. Complications, recurrence rate, and operation time were evaluated. RESULTS: With a minimum of one year of follow-up, there was no recurrence in either group. Six cases (17%) of subconjunctival fibrosis at the donor site, one case (3%) of subconjunctival neovascularization at the donor site, and one case (3%) of wound gapping at the recipient site were noted in the wide excision group. In the non-wide excision group, there were two cases (7%) of subconjunctival fibrosis at the donor site, one case (3%) of granuloma at the donor site, and one case (3%) of retention cyst at the recipient site. Mean operating time in the non-wide excision group (45.2 +/- 6.9 minutes) was significantly shorter than that in the wide excision group (62.4 +/- 6.2 minutes). CONCLUSIONS: Non-wide excision with conjunctivo-limbal autograft in pterygium surgery can be considered an effective treatment with shorter operating time than the wide excision method. Both of these methods show low recurrence rates and few complications for both primary and recurrent pterygia.

A Case of Bulbar Conjunctival Schwannoma

PURPOSE: The schwannoma is a tumor originating from Schwann cell proliferation. Schwannoma is a rare disease, making up only 1% of all the tumors that develop in the orbit. Schwannomas usually arise from the choroids or the ciliary body, and occurrence in the conjunctiva is especially rare. Few cases have been reported worldwide, and no cases have been reported in Korea thus far. We report our case along with a literature review. CASE SUMMARY: A 31-year-old male patient visited our department with a history of discomfort of in his right eye for the past 5 years caused by a bulbar conjunctival mass. On ophthalmologic examination, a 5x3x3 mm, elevated, yellowish mass with a smooth surface was observed on the bulbar conjunctiva adjacent to the superonasal limbus near the 2 o'clock area of the right eye. We performed excision and biopsy for diagnosis and treatment of the bulbar conjunctival mass and confirmed the pathologic report for the diagnosis of schwannoma.

Releasable suture in phacotrabeculectomy

An externalized releasable suture in phacotrabeculectomy, does not use scleral flap for trabeculectomy but excised posterior lip of sclera ltunnel incision is use to create a fisutula. This provides early visual rehabilitation, good control of postoperative intraocular pressure, maintenance of chamber depth during early postoperative period and reduction of the extent of tissue dissection which may decrease the stimuleus to wound healing and early filteration failure with few complication. We reviewed the effectiveness of an externalized releasable suture in phacotrabeculectomy using 6mm scleral tunnel incision after 6 months of follow-up in 10 eyes of 8 patients with coexisting cataract and glaucoma. At 6 months after operation, the mean intraocular pressure reduction was 13.2 mmHg postoperatively and the number of glaucoma medication decreased from 2.4 to 0.3. NO medication was needed in 8 eyes postoperatively. The visual acuity improved in all eyes and 7 eyes recoveed to 20/40 or better. The several complications such as partial posterior capsule rupture, transient wound leakage, posterior capsule opacity were noted. NO case of shallow anterior chamber was found. $ eyes had slightly increased IOP in the early postoperative period, and subsequent suture removal reduced IOP. In all cases, depth of anterior chamber was well formed. The releasable suture in combined procedure provides a low incidence of postoperative complication due to overfilteration, and makes it possible to increase the degree of filteration by removal when needed during the early postoperative period. this reduces the incidence of shallow and flat anterior chamber without compromising long-term control of intraocular prssure.

Progressive Iris Atrophy

Progressive iris atrophy is a disease characterized by marked iris atrophy, iris hole, corneal endotherial abnormality, perripheral anterior synechia, and glaucoma. It is considered as a variant of iridocorneal endotherial syndrome with Chandler's syndrome and Cogan-Reese syndrome. We have experianced a 34 year old male patient complaning visual blurring in his left eye. At examination, we found characteristics of progressive iris atrophy. After filerring surgery, associated glaucoma was well controlled. Then we report a case with review of the literatures.

A Prospective Study of Ptosis following Cataract Surgery

A prospective study was investigated to evaluate the effect of local anesthesla, surgical technique of cataract and superior rectus muscle injury on postoperative ptosis. Preoperative and postoperative measurements of palpebral fissure, margi reflex distance(MRD), margin limbal distance(MLD), levator function and photograph were taken. Two hundreds patients were randomized into four groups to study these effect. Group A received a Van Lint eyelid block and a superior rectus bridle suture. Group B received a Van Lint block and an episcleral retraction suture. Group C received an O'Brien eyeli block and a superior rectus bridle suture. Group D received an O'Brien block and an episcleral retraction suture. Postoperative measurements of palpebral fissure, margin reflex distance(MRD), margin limbal distance(MLD), levator functi and photograph were taken at first day and eight weeks postoperatively and ptosis patients of a drop in the lid margin of a 2mm or more were follow up at six months postoperatively. Ptosis patients of a drop in the lid margin of 2mm or more were found in 20% of group A, 18% of group B, 14% of group C, 4% of group D, and 14% of all cases. Postoperative ptosis was statistically reduced in group D at eight weeks postoperatively(compared with group A and D P=0.0091, group B and D P=0.0042, group C and D P=0.0268). It appears that trauma to the superior retus muscle complex is the most critical factor in postoperative ptosis and we could minimize this effect in group D.

Comparison of Corneal Astigmatism According to Varing Incision Location and Suture Method in Phacoemulsification

In order to evaluate the effects of incision location and suture method on induced astigmatism in cataract surgery, three different procedures were applied to 150 eyes which had phacoemulsification through 6 mm incision with 6 mm optic IOLs. The group 1(50 eyes) had posterior limbal incision followed by interrupted radial sutures. The group 2(50 eyes) had posterior limbal incision followed by continuous shoelace sutures. The group 3(50 eys) had scleral pocket incision at 2 - 2.5 mm apart from the surgical limbus followed by sutureless technique. The corneal astigmatism was ana lysed by algebraic and vector methods. Keratometric astigmatic changes with vector analysis on postoperative 1 day were 2.34 diopter(D), 1.41D, 0.74D in the group 1, group 2, gruop 3 respectively. There were statistically significant differences among the three groups(p<0.01). At postoperative 1 week. the keratometric astigmatic change of the group 3 was less than that of the group 1(p<0.01) and the visual acuity of the group 3 was better than that of the group 1(p<0.05). During postoperative 1 to 6 months, there was no statistically significant differences among the three groups in astigmatic changes or visual acuity. It could be concluded that scleral pocket incision with suture less technique showed significantly less astigmatism than other techniques initially, and continuous shoelace suture technique could have more stable and less astigmatism than interrupted radial suture technique.

Congenital Aniridia

Aniridia is a very rare disorder the main features of which are congenitally partial or nearly complete absence of the iris and foveal hypoplasia. The authors obseved aniridia in two generations, mother and one daughter. They have cataract, ectopia lentis, nystagmus and foveal hypoplasia as well as aniridia. The lens of daughter was aspirated in both eyes consecutively. Her final best corrected visual acuity was 0.3 with +sph. 13.00D in each eyes.

Preoperative Maximal Mydriasis Test in Cataract Patients

To predict the mydriatic status of the cataract patients preoperatively, we performed maximal mydriasis test with stepwise instillations of 1% tropicamide and 2.5% phenylephrine or 10% phenylephrine to the out-patients who was scheduled to have cataract operation. Among 210 eyes of 113 patients, the pupillary size of 167 eyes was dilated to 8mm or more and the other 43 eyes were insufficiently dilated to less than 8mm diameter. In the insufficiently dilated group, we have observed the presumable causes of insufficient mydriasis as follows: posterior synechiae, diabetic autonomic pupillopathy, age-related miosis and unknown. By this test, we could predict the mydriatic status of the cataract patient preoperatively and could prepare the appropriate operative method and equipment effectively.

Clinical Results of Q-Switchd Nd: YAG Laser Posterior Capsulotomy

From February 1987 to January 1991, We performed posterior capsulotomy on after cataract patients(400 eyes)by using Q-Switched Nd: YAG Laser. The results were as follow; 1. 226 aphakic eyes and 174 pseudophakic eyes(22 anterior chamber IOLs, 152 posterior chamber IOLs) were followed. 2. 335 adult and senile cataracts, 47 traumatic cataracts, and 18 congenital cataracts were followed. 3. The power setting of Nd: YAG Laser ranged from 1.0 to 2.4 mJ in 261 eyes(65.3%); less than 40 pulses were used in 298 eyes(74.5%). 4. Postoperative corrected visual acuity of 0.7 or better was achieved in 207 eyes(51.8%) and 1.0 or better in 112 eyes(28%). 5. Frequent ocular complications were a transient increase of intraocular pressure(15.8%) and vitreous prolapse(l3.5%).

Clinical Experience of Q-switched Nd:YAG Laser Iridotomy 50 cases for Angle Glosure Glaucoma

To evaluate the efficacy and immediate complications of Q-switched Nd:YAG laser iridotomy in the treatment of angle closure glaucoma, Q-switched Nd:YAG laser iridotomy using coherent model 7900(U.S.A.)was performed on 50 eyes, 43 patients with angle closure glaucoma between Feb. 1987 and Mar. 1988. Forty-six eyes of Thirty-nine Patients had been followed up {or more than 2 months. Four eyes were lost to follow-up. Among 50 treated eyes, 46 required a single laser session for patency and four eyes required two sessions. Intraocular pressure was significantly decreased after Q-switched Nd: YAG laser iridotomy and the continuous use of previous glaucoma medications as necessary(p<0.01). Immediate postoperative intraocular pressure elevation was seen in two Nd:YAG-treated eyes. Thirty-five eyes treated with the Nd:YAG laser had minimal bleeding from the iridotomy site. Forty-four Nd:YAG-treated eyes had transient iritis.

A Case of Acute Posterior Multlfocal Placoid Pigment Epithellopathy

Acute posterior multifocal placoid pigment epitheliopathy(APMPPE), first described in 1968 by Gass, is chracterized by rapid loss of central vision secondary to multifocal, yellow-white placoid lesions at the level of the pigment epithelium and choroid and significant visual improvement after spontaneous resolution of the active lesions within several weeks or months. Fluorescein angiography shows chracteristically that the chtoidal fluorescence is not visible at the site of acute lesion in the early arterial and arteriovenous phases and become hyperfluorescent due to staining of the lesions in the late venous phases. We experienced a case of acute multifocal placoid pigment epitheliopathy in 26 years old female patient occurring in both eyes.