Repeatability and Agreement of Chord Mu between Scheimpflug Tomography and Swept-Source Optical Coherence Tomography

Purpose@#To evaluate repeatability and agreement of chord mu between Scheimpflug tomography (Pentacam HR) and sweptsource optical coherence tomography–based optical biometer (IOLMaster 700). @*Methods@#In this retrospective study, 63 eyes from 33 patients were included. Chord mu, X and Y Cartesian distances between the corneal vertex and the pupil center (Px and Py), and the pupil diameter were compared using two instruments. Repeatability was evaluated using intraclass correlation coefficient (ICC), coefficient of variation (CoV), and within-subject standard deviation (Sw). Interdevice agreement was evaluated using paired t-tests and Bland-Altman plots. @*Results@#Although Sw values for all parameters were similar between the two devices, CoV values of chord mu and pupil diameter were lower, and ICC values of those parameters were higher, in the IOLMaster 700 than in the Pentacam HR. Chord mu and pupil diameter values were higher in IOLMaster 700 than Pentacam HR (p < 0.01). The width of the 95% limit of agreement was wide for all parameters. @*Conclusions@#IOLMaster 700 showed better repeatability than Pentacam HR in chord mu, Px, Py, and pupil diameter values. Because there were statistically significant differences and a low level of agreement in chord mu and pupil diameter values between the two devices, they cannot be used interchangeably.

Comparison of Horizontal White-to-white Diameter Measured Using Four Devices

Purpose@#To compare the horizontal white-to-white (WTW) diameter measured using four devices. @*Methods@#We measured the horizontal WTW diameter of 52 eyes of 52 patients using the IOL Master 500, ANTERION, OA-2000, and Pentacam HR devices. Repeated-measures analysis of variance was used to compare the measurements. Correlations between the measurements were evaluated using the Pearson correlation test. Agreement between measurements obtained using different instruments was confirmed using a Bland-Altman plot. @*Results@#The mean horizontal WTW diameters obtained using IOL Master 500, ANTERION, OA-2000, and Pentacam HR were 11.65 ± 0.39, 11.52 ± 0.44, 11.51 ± 0.52, and 11.28 ± 0.41 mm, respectively. The horizontal WTW diameters obtained using IOL Master 500 and Pentacam HR were the largest and smallest, respectively. There was a statistically significant difference in mean diameter between IOL Master 500 and ANTERION (p = 0.03), as well as between Pentacam HR and the remaining three devices (all p 0.6, p < 0.001). The 95% limits of agreement between the measurements were 0.808-1.619 mm. @*Conclusions@#There were statistically significant differences in horizontal WTW diameter between IOL Master 500 and ANTERION, and between IOL Master 500 and Pentacam HR, but not between IOL Master 500 and OA-2000. Measurements obtained using IOL Master 500 and the remaining three devices are not interchangeable because of their low level of agreement.

Agreement between Two Swept-Source Optical Coherence Tomography Biometers and a Partial Coherence Interferometer

Purpose@#To evaluate the level of agreement between ANTERION (Heidelberg Engineering, Heidelberg, Germany), OA-2000 (Tomey, Nagoya, Japan), and IOLMaster 500 (Carl Zeiss AG, Jena, Germany). @*Methods@#Fifty-one eyes of 51 patients were included in the study. Flat keratometry (K) and steep K, vector component of astigmatism (Jackson cross-cylinder at 0° and 90° [J0] and Jackson cross-cylinder at 45° and 135° [J45]), anterior chamber depth, and axial length were compared using the three devices. Repeated measures analysis of variance was conducted to compare the mean values of the biometrics. Pearson correlation test was conducted to analyze the correlations of the measured values, and a Bland-Altman plot was used to assess the agreement between the three devices. The predicted intraocular lens power of each device was compared to the others using the SRK/T, Haigis, Barrett Universal II, and Kane formulas. @*Results@#All K values measured using ANTERION were flatter than those of other instruments. However, good agreement was observed for flat K (ANTERION - OA-2000; 95% limits of agreement [LoA], 0.86 diopters [D]) and steep K (ANTERION - OA2000; 95% LoA, 0.93 D) and OA-2000 - IOLMaster 500 (95% LoA, 0.93 D). J0 and J45 vector components of astigmatism were not statistically different; however, the agreements were poor between the devices (95% LoA ≥1.97 D). Anterior chamber depth values of ANTERION and OA-2000 were interchangeable (95% LoA, 0.15 mm). The axial length showed a high agreement (95% LoA ≤0.17 mm) among the three devices. The predicted intraocular lens powers of the three devices were not interchangeable regardless of formulas (95% LoA ≥1.04 D). @*Conclusions@#Significant differences in ocular biometrics were observed between ANTERION and the other two devices. This study demonstrated that only axial length showed good agreement among devices.

Meibomian Gland Dysfunction Associated with Bortezomib in a Multiple Myeloma Patient

Purpose@#This study reports a case of meibomian gland dysfunction associated with bortezomib, which is a treatment of choice for multiple myeloma.Case summary: A 59‐year‐old female patient presented to our hospital with a complaint of dryness that had worsened for 2 months and eye discharges that were difficult to remove even after washing her face. The patient had been diagnosed with multiple myeloma 5 months prior and had undergone four cycles of bortezomib therapy. Slit‐lamp microscopy revealed a number of pouting of the meibomian gland (MG) orifices in both eyes. Meibography revealed that more than one‐third and less than twothirds of the total MG area of both upper lids were lost and more than two‐thirds of the total MG area of both lower lids were lost. No clinically significant improvements were noted at 8 months despite thorough eyelid hygiene therapy, including warm compresses, topical antibiotics, steroids, and artificial tears. However, when the patient revisited our clinic 2 months after completing bortezomib treatment, the subjective symptoms had improved and all of the pouting of MG orifices had disappeared. There was no significant difference in the MG dropout area for either eye compared with the observations from a previous visit during bortezomib treatment. @*Conclusions@#Clinicians should be aware that MG dysfunction may occur or worsen in patients receiving bortezomib treatment and should consider this when establishing a treatment plan for meibomian dysfunction or when educating patients.

Use of Topical Cyclosporin and Tacrolimus for Recurrent Subepithelial Infiltrates after Epidemic Keratoconjunctivitis

Purpose@#To report a case of recurrent subepithelial infiltrates (SEIs) after epidemic keratoconjunctivitis (EKC), which improved with the use of topical cyclosporin and tacrolimus.Case summary: A 33‐year‐old female patient with bilateral EKC developed multiple SEIs, which were worse in the left eye, after applying topical antibiotics and steroid for 3 weeks. She was administered 0.5% loteprednol etabonate every 2 hours, which was gradually tapered to once a day, and 0.1% cyclosporine once daily. However, the SEIs recurred. Therefore, 0.1% cyclosporine was administered twice a day in both eyes and the frequency of administration of steroid eye drops was increased. The dose of steroid eye drops was reduced, but two attempts to taper the dose failed. SEIs in the right eye improved with the use of 0.1% cyclosporine. However, SEIs in the left eye recurred on tapering the steroid dose. Therefore, topical 0.02% tacrolimus ointment was administered once daily in the left eye. After 2 weeks of using tacrolimus, the topical steroids were discontinued. SEIs were well‐controlled for 6 months with 0.1% cyclosporine administered 1‐2 times/day in the right eye and 0.02% tacrolimus administered 1 time/3 days in the left eye. @*Conclusions@#Topical cyclosporine and tacrolimus can minimize the requirement for steroids, and treat chronic and recurrent SEIs after EKC.

Agreement between Scheimpflug Camera and the Swept-source Optical Coherence Tomography Measurements in Keratometry and Higher-order Aberrations

Purpose@#To evaluate the compatibility of corneal curvature and astigmatism, and higher-order aberrations (HOAs) measured by the Scheimpflug camera Pentacam HR and the swept-source optical coherence tomography ANTERION. @*Methods@#This prospective study included normal subjects with no ophthalmic history. Steep keratometry (K), flat K, astigmatism and its axis of the anterior and posterior surfaces, total corneal power, and HOAs using the two instruments were compared. To compare the mean values of the measurements, a paired t-test was used. Bland-Altman analysis was applied to assess the agreement between the two devices. @*Results@#Fifty-three eyes of 53 subjects were evaluated. There were statistically significant differences for steep K, astigmatism, and vector J0, J45 in the anterior surface and total corneal power between the two devices (p 0.81, p 0.78, p 0.37, p < 0.05). Most HOAs, except for the horizontal trefoil, showed clinically acceptable agreements. The total root mean square of HOAs was not significantly different between the two devices (p = 0.122). @*Conclusions@#Most of the keratometric values cannot be used interchangeably. However, the vectoral component of astigmatism showed clinically good agreement. Several HOAs have statistically significant differences; however, almost all HOAs showed acceptable agreements, except for the horizontal trefoil.

Agreement between Scheimpflug Camera and the Swept-source Optical Coherence Tomography Measurements in Keratometry and Higher-order Aberrations

Purpose@#To evaluate the compatibility of corneal curvature and astigmatism, and higher-order aberrations (HOAs) measured by the Scheimpflug camera Pentacam HR and the swept-source optical coherence tomography ANTERION. @*Methods@#This prospective study included normal subjects with no ophthalmic history. Steep keratometry (K), flat K, astigmatism and its axis of the anterior and posterior surfaces, total corneal power, and HOAs using the two instruments were compared. To compare the mean values of the measurements, a paired t-test was used. Bland-Altman analysis was applied to assess the agreement between the two devices. @*Results@#Fifty-three eyes of 53 subjects were evaluated. There were statistically significant differences for steep K, astigmatism, and vector J0, J45 in the anterior surface and total corneal power between the two devices (p 0.81, p 0.78, p 0.37, p < 0.05). Most HOAs, except for the horizontal trefoil, showed clinically acceptable agreements. The total root mean square of HOAs was not significantly different between the two devices (p = 0.122). @*Conclusions@#Most of the keratometric values cannot be used interchangeably. However, the vectoral component of astigmatism showed clinically good agreement. Several HOAs have statistically significant differences; however, almost all HOAs showed acceptable agreements, except for the horizontal trefoil.

Clinical Characteristics of Corneal Hyperalgesia in Patients with Dry Eye Symptoms

Purpose@#We analyzed the clinical characteristics of corneal hyperalgesia patients with dry eye symptoms. @*Methods@#Sixty-nine eyes of 69 adults (aged ≥ 20 years) who visited the hospital due to dry eye symptoms were analyzed. Using a Cochet-Bonnet esthesiometer, patients with ≥ 40 mm corneal sensitivity were designated as the corneal hyperalgesia group, and those with < 40 mm were designated as the control group. All patients were tested by slit lamp biomicroscopy. The tear film break-up time (TFBUT), tear secretion, meibography, tear lipid layer thickness, eye blink pattern and Ocular Surface Disease Index were assessed. The eye blink pattern was divided into four types, flat, uphill, downhill, and mixed, and the rate of partial eye blink was recorded. @*Results@#We compared the 38 eyes in the corneal hyperalgesia group with the 31 eyes in the control group. The pain sensitivity was 51.18 ± 7.66 and 21.61 ± 9.25 mm in the corneal hyperalgesia and control groups, respectively. Tactile sensitivity was higher in the hyperalgesia group (59.21 ± 1.85 mm) than the control group (54.84 ± 10.12 mm) (p = 0.048), and the TFBUT in the hyperalgesia group (3.47 ± 0.80 seconds) was significantly shorter than the control group (4.10 ± 1.16 seconds) (p = 0.036). There was a significant difference in the proportions of the four eye blink patterns between the hyperalgesia and control groups (p = 0.023). In the hyperalgesia group, 35.1% were uphill types and 32.4% were flat types, while in the control group, 43.8% were downhill types. The other tests showed no significant group differences. @*Conclusions@#The TFBUT was shorter in patients with dry eye symptoms than controls, and the proportions of the four eye blink patterns also differed between the groups.

Investigation of Tear Lipid Layer Patterns According to Blinking Among Dry Eye Patients

Purpose@#To investigate tear lipid layer patterns according to blinking using an interferometer for dry eye patients. @*Methods@#We retrospectively reviewed the medical records of 132 patients who underwent dry eye disease-related evaluation, including LipiView®, between August 2018 and January 2020. Data including past history, slit-lamp examination, tear film break-up time, Schirmer, Oxford score grading, lipid layer thickness (LLT), number of blinks, and tear lipid layer patterns according to blinking were collected. We subdivided dry eye as meibomian gland dysfunction (MGD), aqueous deficiency dry eye (ADDE), and combined ADDE/MGD (Combine); we also classified the tear lipid layer patterns as uphill, flat, downhill, and mix. @*Results@#The numbers of patients in each tear lipid film pattern were as follows; uphill 45, flat 16, downhill 53, and mix 18. The statistically significant clinical characteristics among the four patterns were Oxford score (p = 0.001), LLT (p = 0.019), number of blinks (p = 0.001), number of partial blinks (p = 0.013), and the partial/total blinks ratio (p = 0.001). The most common pattern for MGD was downhill 44.7%; for Combine, downhill 40.7% and uphill 35.8%; and for ADDE, uphill 38.5%. @*Conclusions@#The tear lipid layer graph patterns according to blinking using LipiView® were associated with the number of blinks, the partial/total blink ratio, and LLT.

The Effect of Eyeliner Tattoo on Meibomian Gland Dysfunction and the Ocular Surface

PURPOSE: To determine whether eyeliner tattoo affects the meibomian gland (MG) and ocular surface.METHODS: The medical charts of an eyeliner tattoo group (16 eyes of 8 patients) and a control group (16 eyes of 18 patients) were retrospectively reviewed. The ocular surface disease index questionnaire, ocular surface staining score, tear film break-up time (TBUT), upper eyelid abnormality, meibum expressibility and quality, and MG loss and tear film lipid layer thickness (LLT) which measured with LipiView® (TearScience, Morrisville, NC, USA) were compared. In the tattoo group, the correlation between the distance from the MG orifice to the tattoo pigment and other indices were analyzed.RESULTS: Compared to controls, the tattoo group had a significantly higher ocular surface disease index (p = 0.002), shorter TBUT (p < 0.001), higher vessel engorgement of the upper lid (p = 0.016), poorer meibum expressibility and quality (p = 0.006 and p < 0.001, respectively), higher MG loss (p < 0.001), and thinner LLT (p = 0.024). In the tattoo group, the closer the tattoo was to the MG orifice, the more the upper lid vessel was engorged and the more MG loss occurred (r(s) = −0.560, p = 0.024; r(s) = −0.563, p = 0.023, respectively), and a thinner LLT was observed (r(s) = 0.567, p = 0.022).CONCLUSIONS: Eyeliner tattoos may be related to changes in the lid margin, loss of the MG, and thinning of the LLT.

Analysis of Medical Litigations Associated with Keratorefractive Surgery in Korea

Purpose@#To analyze the results of court rulings regarding medical litigations involving keratorefractive surgery in Korea. @*Methods@#We collected anonymized judgements involving keratorefractive surgery between 1990 and 2017 and analyzed the causes of medical litigations, the court rulings, reasons for compensation, and the total and average amounts finally awarded. @*Results@#Nineteen of 31 litigations were related to laser in-situ keratomileusis, six to photorefractive keratectomy, and six to laser epithelial keratomileusis surgery. The reasons for litigation were as follows: glaucoma (8), corneal ectasia (7), infectious keratitis (5), retinal disease (2), dissatisfaction in visual outcome (2), photophobia (2), and other (5). Among the 31 cases, 17 (54.8%) litigations were decided in favor of the plaintiff; 14 (45.2%) litigations were decided against. The number of informed consent violations was 15 cases, with 13 cases for the plaintiff and two cases for the defendant, showing a statistically significant difference (p = 0.001). The cause of the lawsuit and injury type did not affect the outcome of the lawsuit. The total amount requested by the plaintiff was KRW 4,846,196,087, and the average amount was KRW 156,328,906. The total amount of damages awarded was KRW 885,804,168, and the average awarded was KRW 52,106,128. Additionally, glaucoma showed the highest total (KRW 393,121,061) and average (KRW 196,560,530) amounts of awarded damages. @*Conclusions@#Nearly half of the lawsuits were handed down in favor of the plaintiff, with more than half involving damages in violation of informed consent. The results of this study are expected to help surgeons understand the reasons for and results of medical lawsuits regarding keratorefractive surgeries, to reduce these types of lawsuits in the future.

Analysis of Medical Litigations Associated with Keratorefractive Surgery in Korea

Purpose@#To analyze the results of court rulings regarding medical litigations involving keratorefractive surgery in Korea. @*Methods@#We collected anonymized judgements involving keratorefractive surgery between 1990 and 2017 and analyzed the causes of medical litigations, the court rulings, reasons for compensation, and the total and average amounts finally awarded. @*Results@#Nineteen of 31 litigations were related to laser in-situ keratomileusis, six to photorefractive keratectomy, and six to laser epithelial keratomileusis surgery. The reasons for litigation were as follows: glaucoma (8), corneal ectasia (7), infectious keratitis (5), retinal disease (2), dissatisfaction in visual outcome (2), photophobia (2), and other (5). Among the 31 cases, 17 (54.8%) litigations were decided in favor of the plaintiff; 14 (45.2%) litigations were decided against. The number of informed consent violations was 15 cases, with 13 cases for the plaintiff and two cases for the defendant, showing a statistically significant difference (p = 0.001). The cause of the lawsuit and injury type did not affect the outcome of the lawsuit. The total amount requested by the plaintiff was KRW 4,846,196,087, and the average amount was KRW 156,328,906. The total amount of damages awarded was KRW 885,804,168, and the average awarded was KRW 52,106,128. Additionally, glaucoma showed the highest total (KRW 393,121,061) and average (KRW 196,560,530) amounts of awarded damages. @*Conclusions@#Nearly half of the lawsuits were handed down in favor of the plaintiff, with more than half involving damages in violation of informed consent. The results of this study are expected to help surgeons understand the reasons for and results of medical lawsuits regarding keratorefractive surgeries, to reduce these types of lawsuits in the future.

Report of Bilateral Acute Angle-closure Crisis Induced by Serotonin-norepinephrine Reuptake Inhibitors

PURPOSE@#This study reports a case of bilateral acute angle-closure crisis induced by two kinds of serotonin-norepinephrine reuptake inhibitors (SNRIs), duloxetine and tramadol.CASE SUMMARY: A 55-year-old female visited our clinic, complaining of bilateral visual impairment, ocular pain, and headache, which began 2 days after taking several drugs including duloxetine and tramadol for the purpose of back pain relief. On the day of the first visit, her uncorrected visual acuity was 0.04 in the right eye and 0.02 in the left eye, and the intraocular pressure (IOP) was 45 mmHg in the right eye and 51 mmHg in the left eye. The anterior chamber was shallow and the anterior chamber-angle was closed in both eyes on gonioscopy. There was mild nuclear sclerosis of both lenses. Assuming drug-induced bilateral acute angle-closure crisis, all medications were discontinued, and IOP-lowering agents were prescribed. The symptoms, visual acuity, and IOP improved; however, both anterior chambers were still shallow and the iridocorneal angle was still closed in both eyes. Laser iridotomy was tried in the right eye but failed because the pupils were not completely constricted, and iris bleeding occurred. Phacoemulsification and posterior chamber lens insertion were conducted in both eyes, and her visual acuity, IOP, anterior chamber depth, and iridocorneal angle have been stable at 9 months since her first visit.@*CONCLUSIONS@#The combined administration of SNRI may cause bilateral acute angle-closure attacks.

Dry Eye Syndrome and Morphological Changes of Meibomian Glands in Type 2 Diabetic Patients

PURPOSE: To evaluate the morphological changes of meibomian glands and dry eye syndrome in patients with type II diabetes. METHODS: The medical records of 72 diabetic patients referred to the ophthalmology clinic for the evaluation of diabetic retinopathy, who had dry eye symptoms, were retrospectively reviewed. RESULTS: A total of 72 patients, with an age of 56.3 ± 13.3 years, were analyzed. The group with diabetic retinopathy (52 patients) had a significantly lower tear film break-up time (p = 0.046), lower Schirmer's test value (p = 0.005), and higher percentage of upper (p = 0.036) and lower (p = 0.017) meibomian gland area losses than the group without diabetic retinopathy (20 patients). According to multilinear regression analyses considering sex, age, and diabetes-related characteristics, the Schirmer's test value was significantly lower with increasing stage of diabetic retinopathy (β = −1.180, p = 0.016). The percentage of upper meibomian gland area loss was significantly increased with increasing age (β = 0.605, p < 0.001), glycosylated hemoglobin (β = 1.881, p = 0.011), and stage of diabetic retinopathy (β = 4.458, p = 0.001). The percentage of lower meibomian gland loss area was significantly increased with increasing age (β = 0.443, p = 0.001) and stage of diabetic retinopathy (β = 4.879, p = 0.001). CONCLUSIONS: In patients with type 2 diabetes, the more severe the diabetic retinopathy, the more likely the meibomian gland loss will occur, so careful and appropriate treatment should be conducted.

Repeatability and Reproducibility of Tear Meniscus Evaluations Using Two Different Spectral Domain-optical Coherence Tomography

PURPOSE: To evaluate the repeatability and reproducibility of inferior tear meniscus measurements using two different spectral domain-optical coherence tomography (OCT), and to compare the inter-device agreements between these devices. METHODS: Two examiners evaluated the tear meniscus depth (TMD) and tear meniscus height (TMH) of 20 eyes in 20 normal subjects using Cirrus OCT and Spectralis OCT with the examiners calculating the TMD and TMH. We analyzed intra-examiner repeatability, inter-examiner reproducibility, and inter-device agreement. RESULTS: The average TMD measurements using the Cirrus OCT and Spectralis OCT devices were 151.25 ± 41.53 µm and 139.10 ± 40.56 µm by examiner 1, respectively, and 152.03 ± 42.77 µm and 138.35 ± 39.70 µm by examiner 2, respectively. The TMHs were 291.90 ± 100.19 µm and 245.43 ± 66.44 µm by examiner 1, respectively, and 288.25 ± 98.72 µm and 244.23 ± 60.69 µm by examiner 2, respectively. The TMDs and TMHs measured using these OCT devices were not statistically significant for intra-examiner and inter-examiner measurements (all, p > 0.05). These devices showed high repeatability (intraclass correlation coefficient ≥ 0.991) for intra-examiner TMD and TMH measurements and the inter-examiner coefficient of variation ranged from 2.04% to 4.32%. The 95% limits of agreement between the two devices were −66.13 to 91.95 µm for TMD and −127.18 to 217.68 µm for TMH. CONCLUSIONS: Both OCT devices are useful for conducting inferior tear meniscus measurements. The inter-device agreement was poor, and the devices were not interchangeable.

Medical Litigations Associated with Cataract Surgery in Korea

BACKGROUND: To analyze the results of court rulings about medical litigations related to cataract surgery in Korea. METHODS: We collected 50 anonymized judgements regarding cataract surgery between 2000 and 2016 and analyzed the reasons for the medical litigations, the court rulings, the reasons for compensation, and the amount claimed and finally awarded. RESULTS: Forty-eight litigations (96%) resulted from errors in treatment, and the reasons were as follows: endophthalmitis, dissatisfaction of visual outcome or ocular discomfort, bullous keratopathy or corneal opacity, retinal detachment, glaucoma or vitreous hemorrhage due to the progression of an underlying diabetic retinopathy, and others in order. Two litigations (4%) arose due to errors in diagnosis. Among the 50 final cases, 21 litigations (42%) were decided in favor of the plaintiff, and 29 litigations (58%) were decided against the plaintiff and dismissed. Ten cases awarded damages to the plaintiffs because of a violation of duty of care, and 11 cases awarded damages due to a violation of informed consent. When comparing cases with errors in diagnosis to cases with errors in treatment, there was no significant difference in the relative risk of a defendant's verdict (P = 0.503). The total amount of awarded damages was KRW 439,124,496 (USD 399,204), and the average amount was KRW 20,910,690 (USD 19,010). CONCLUSION: Nearly half of the cases were decided in favor of the plaintiff due to the violation of informed consent. This study's results will be helpful in understanding the results of medical litigations regarding cataract surgery and reducing future lawsuits.

Safety of Using Matrix Metalloproteinase Inhibitor in Experimental Glaucoma Filtration Surgery

We evaluated the safety of matrix metalloproteinase (MMP) inhibitor in experimental glaucoma filtration surgery in an animal model. Fifteen New Zealand white rabbits underwent an experimental trabeculectomy and were randomly allocated into 3 groups according to the adjuvant agent: no treatment group (n = 5), 0.02% mitomycin C (MMC) soaking group (n = 5), and MMP inhibitor (ilomastat) subconjunctival injection group (n = 5). Slit lamp examination with Seidel testing, pachymetry, and specular microscopy was performed preoperatively and postoperatively. The conjunctiva and ciliary body toxicity were evaluated with scores according to the pathologic grading systems. Electron microscopy was used to examine the structural changes in cornea, conjunctiva, and ciliary body. In the ilomastat-treated group, there was no statistically significant change in central corneal thickness preoperatively and at 28 days postoperatively (P = 0.655). There were also no significant changes in specular microscopy findings over the duration of the study in the ilomastat-treated group. The conjunctival toxicity score was 1 in the control group, 1.5 in the ilomastat-treated group, and 2 in the MMC-treated group. When assessing ciliary body toxicity scores, the ilomastat-treated group score was 0.5 and the MMC-treated group score was 1.5. Transmission electron microscopy did not show structural changes in the cornea and ciliary body whereas the structural changes were noticed in MMC group. A single subconjunctival injection of MMP inhibitor during the experimental trabeculectomy showed a less toxic affect in the rabbit cornea, conjunctiva, and ciliary body compared to MMC.

The Association between Corneal Biomechanical Properties and Initial Visual Field Defect Pattern in Normal Tension Glaucoma

PURPOSE: To investigate the association between corneal biomechanical properties and initial visual field defect pattern in normal tension glaucoma using an Ocular Response Analyzer (ORA; Reichert Instruments, Depew, NY, USA). METHODS: Forty-one patients with normal tension glaucoma were divided into 2 subgroups, 21 patients with initial paracentral scotomas and 20 patients with initial peripheral scotomas. The corneal biomechanical properties of corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), corneal-compensated IOP (IOPcc) measured by the ORA, central corneal thickness, and Goldmann applanation tonometry were comparatively analyzed between the 2 groups. RESULTS: The patients with initial peripheral scotomas were significantly younger than those with initial paracentral scotomas (49.45 ± 13.33 years vs. 58.14 ± 12.49 years, p = 0.035) and showed more myopia (− 2.42 ± 2.22 diopter vs. − 0.89 ± 2.22 diopter, p = 0.034). The mean CRF was significantly lower in the initial paracentral scotoma group than in the initial peripheral scotoma group. (9.45 ± 1.95 mmHg vs. 10.58 ± 2.05 mmHg; p = 0.041). No significant difference in CH, IOPg, or IOPcc was seen between the groups. CONCLUSIONS: CRF was significantly different between the initial paracentral scotoma group and initial peripheral scotoma group in normal tension glaucoma. Thus, CRF may be useful to predict initial central field loss in normal tension glaucoma.

A Case of Recurrent Scleritis Associated with Menstrual Cycle

PURPOSE: To describe a case of recurrent scleritis associated with a patient's menstrual cycle. CASE SUMMARY: A 27-year-old woman presented to our ophthalmology department with redness and pain in her left eye over 2 days. She received laser-assisted in situ keratomileusis surgery for both eyes 6 years prior and was diagnosed with scleritis in her left eye 3 years prior. She was referred to rheumatologic department to determine if she had auto-immune disease, but the systemic review was negative. She was diagnosed with idiopathic scleritis and was treated with oral Methylprednisolone to provide symptom relief. However, her symptoms exhibited a recurrent pattern. These symptoms regularly affected her during the 2-3 days before menstruation, which had been occurring for more than 10 years, beginning when she was a middle school student. The symptoms affected both eyes and did not improve when treated with topical non-steroid anti-inflammaroty drugs (NSAIDs), topical steroids, or oral NSAIDs. However, her symptoms were relieved when treated with oral steroids. Beginning with her pregnancy and extending through her delivery and breast-feeding periods, follow up had been interrupted, but she noted that recurrence episodes were rare during this time. To this day, her symptoms appear once per month and are controlled through oral steroids. CONCLUSIONS: Literature reviews have revealed no such case reports regarding recurrent scleritis associated with the female menstrual cycle. If cyclic recurrence of scleritis episodes is present in a female patient, a careful history should be taken in order to evaluate any possible associations with the menstrual cycle.

Progression of Visual Field Loss and Body Mass Index in Normal Tension Glaucoma

PURPOSE: To evaluate the association between body mass index (BMI) and visual field (VF) progression in normal tension glaucoma (NTG) patients. METHODS: We reviewed the medical records of 78 eyes of 78 NTG patients who were treated with eye drops for more than 18 months. Age, sex, existence of hypertension (HTN), diabetes mellitus (DM), refractive error, baseline intraocular pressure (IOP), IOP reduction ratio, baseline VF indices including mean deviation (MD) and pattern standard deviation, VF progression rate (MD slope, dB/year), number of eye drops, and BMI were analyzed. The progression of VF was determined by glaucoma change probability analyses (STATPAC 2) using a Humphrey field analyzer. RESULTS: The mean follow-up in consecutive eyes was 4.4 ± 2.7 years. A total of 18 eyes showed progression and 60 eyes did not. The VF progression rate (p 0.05). However, multiple linear regression analyses showed that a lower BMI was significantly associated with faster VF progression in the progression group (β = 0.078; standard error = 0.030; p = 0.027). CONCLUSIONS: In the group in which VF loss progressed despite treatment with eye drops, a lower BMI was associated with progression of VF loss in NTG patients.