Evaluation of the Relationship between Incision Location and Change of Posterior Corneal Astigmatism

PURPOSE: To determine if there is a difference in surgically induced astigmatism (SIA) of the posterior corneal surface between superior and temporal incision and its effect on total corneal power in patients who underwent clear corneal incision cataract surgery. METHODS: A retrospective study of 81 patients (84 eyes) who underwent clear corneal incision phacoemulsification by one surgeon. Patients were divided into two groups according to the steep axis: the temporal and superior groups. Anterior, posterior and total corneal SIA (simulated keratometry [Sm K], posterior keratometry [PK] and total corneal power [TCP] respectively) were measured using autorefractive keratometry (ARK) and dual Scheimpflug imaging before and after surgery. RESULTS: There were 61 eyes with temporal incision and 23 eyes with superior incision. The mean SIA was larger in the superior incision group than in the temporal incision group according to ARK, Sm K, PK and TCP (p < 0.05). There were no significant cylindrical changes in ARK in the temporal incision group, however, there was a significant decrease in the superior incision group before and after the operation (p < 0.05). Change in the amount and axis of PK before and after operation were not significantly different, for both incision groups. There was a significant correlation between post-operative TCP and both pre-operative ARK and Sm K for both groups. However, there was no correlation between post-operative TCP and pre-operative PK. In all patients, when pre-operative PK was more than 0.5 D, SIA-ARK, SIA-Sm K and SIA-TCP were all significantly larger than when pre-operative PK was less than 0.5 D, whereas SIA-PK was not. When pre-operative PK was more than 0.5 D, there were no significant differences in SIA-ARK, SIA-Sm K, SIA-PK or SIA-TCP in the temporal incision group. However, SIA-ARK was significantly larger in the superior incision group. CONCLUSIONS: There was no significant cylindrical change in PK before and after operation in both the temporal and superior incision groups. Therefore, when predicting post-operative TCP, it might be meaningful to consider SIA-ARK and SIA-Sm K.

Bilateral Simultaneous Central Retinal Vein Occlusion in a Patient with Waldenstrom's Macroglobulinemia

PURPOSE: The authors report a case of bilateral simultaneous central retinal vein occlusion caused by Waldenstrom's macroglobulinemia. CASE SUMMARY: A 65-year-old man presented to our department complaining of decreased visual acuity for the duration of about 6 months. On his initial visit, best-corrected visual acuity was 0.02 in the right eye and 0.06 in the left eye. Based on the findings of a funduscopic examination, the patient had bilateral diffuse retinal hemorrhages, dilated tortuous veins, and macular edema. He had experienced recurrent spontaneous epistaxis 6 months previously and had undergone treatments such as intravitreal bevacizumab injection and intravitreal dexamethasone implantation at another hospital. Laboratory tests at that hospital showed anemia and hyperproteinemia, for which he was referred to our hemato-oncology department. Bone marrow biopsy was consistent with Waldenstrom's macroglobulinemia/lymphoplasmacytoid lymphoma, and he was treated with systemic chemotherapy. One year after the systemic chemotherapy, his best-corrected visual acuity was 0.15 in the right eye and 0.6 in the left eye. Funduscopy showed decreased bilateral retinal hemorrhages and macular edema. CONCLUSIONS: When simultaneous bilateral central retinal vein occlusion occurs in a patient with no other underlying disease such as hypertension or diabetes, it might be a sign of serum hyperviscosity, and there should be a very high level of suspicion for presence or progression of systemic disease. If such a disease is properly and timely diagnosed, effective early systemic evaluation and therapy can be administered, and it is important to have initial general treatment as well as ophthalmic treatment.

The Long-Term Observation of Intraocular Pressure after Intravitreal Injections of Bevacizumab, Triamcinolone, and Combination of Both

PURPOSE: The present study investigates the onset and frequency of increased intraocular pressure (IOP) after injections of intravitreal Bevacizumab, Triamcinolone, and a combination of both drugs. METHODS: Patients were classified into three groups: Bevacizumab group (group A), Triamcinolone group (group B), and combined drug group (group C), irrespective of the underlying causes. The IOP was measured 30 minutes prior to followed by one day, one week, one month, two months, three months, six months, and one year after injection. The measured IOP at each time point was compared with the pre-injection IOP and the differences in IOP among the three groups were statistically analyzed. The relationships between various factors possible of increasing IOP were also analyzed. RESULTS: A total of 259 subjects were enrolled in the present study. An IOP increase of more than 5 mm Hg was observed in 25 eyes (15%) in group A, 34 eyes (40%) in group B, and 40 eyes (50%) in group C. There was no statistically significant mean IOP change after injection in group A, but in groups B and C there was an increase in mean IOP up until two and three months after injection, respectively. However, eyes in group A with a history of glaucoma showed statistically significant increases in IOP. CONCLUSIONS: The onsets and frequencies of increased IOP were different with the different drugs. Proper follow-up for increased IOP after injection is necessary based on the type of drug used.