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.

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.

Comparison of Four Systems of IOL Calculation after Keratorefractive Surgery in Eyes Requiring Cataract Surgery

PURPOSE: To report the evaluation and comparison of true corneal power after corneal refractive surgery through ARK, Orbscan II(R), Pentacam and IOL master. METHODS: Target IOL (Intraocular lens) power calculated with the SRK/T formula using SMK (Sungmo Eye Hospital keratometry), which is a new method for measuring corneal refractive power, was compared with the back-calculated ideal IOL power after cataract surgery for 30 eyes that required cataract surgery and had previously undergone refractive surgery. Target IOL powers calculated using 4 systems were compared with IOL power calculated using the clinical history method for 64 eyes that had undergone refractive surgery. RESULTS: Using SMK with the SRK/T formula, the actual refraction was within +/-0.5 diopter (D) of the intended refraction for 63.8% of eyes and within +/-1.0 D for 90.9% of eyes. Compared with target IOL power calculated with the clinical history method, target IOL power calculated by SMK with the SRK/T formula had a difference of 1.95 +/- 0.86 D, which was similar to the results calculated by the Haigis-L formula and by TNP with Haigis. CONCLUSIONS: The method of IOL calculation using SMK with the SRK/T formula showed the best predictability in patients after corneal refractive surgery. Comparatively accurate results were produced in IOL power calculations using the Haigis-L formula, and the TNP with Haigis method.

Intravitreal Bevacizumab for Macular Edema Secondary to Ruptured Retinal Arterial Macroaneurysm

PURPOSE: To study the short-term effect of intravitreal injection of bevacizumab in the treatment of macular edema secondary to retinal macroaneurysm. METHODS: Eight eyes of 9 patients who underwent consecutive intravitreal bevacizumab injections for macular edema secondary to retinal macroaneurysm were prospectively evaluated. Complete eye examination including the best corrected visual acuity (BCVA), fundus examination and optical coherence tomography (OCT) were performed at baseline and follow-up visits at 2, 4 and 6 months. RESULTS: The mean age was 73.6 +/- 6.9 years, and the mean study period was 7.3 +/- 2.6 months. At the final visit, BCVA improved from log MAR 1.92 +/- 0.67 to log MAR 0.87 +/- 0.57. The mean central macular thickness on OCT image decreased from 388 +/- 168 microm at the initial visit to 200 +/- 39 microm at the final visit. Three eyes without subretinal hemorrhage presented better visual outcome than eyes with subretinal hemorrhage. All eyes showed some decrease in angiographic leakage. No adverse side effects were observed following the injections. CONCLUSIONS: Intravitreal bevacizumab injection can be used as a selective alternative treatment modality for macular edema secondary to retinal macroaneurysm.

Visual and Surgical Outcomes of Lamellar Macular Hole

PURPOSE: To investigate the visual and anatomical results of surgical treatment for symptomatic lamellar macular hole. METHODS: Ten eyes of ten patients with decreased visual acuity and lamellar macular hole were diagnosed using optical coherence tomography (OCT). Pars plana vitrectomy, epiretinal membrane removal, internal limiting membrane peeling, and gas tamponade (5 eyes) were performed for the treatment of lamellar hole. The resolution of the lamellar hole was assessed in relation to each OCT image at baseline. RESULTS: The mean postoperative follow-up duration was 7.5 months, and best corrected visual acuity improved from log MAR 0.67 +/- 0.38 to log MAR 0.30 +/- 0.28. Central foveal thickness decreased from 441 +/- 184 microm to 291 +/- 64 microm. The OCT of all eyes demonstrated improvement in macular contour. However, retinal detachment in one eye occurred at two months after the operation and was reattached with gas tamponade and photocoagulation. CONCLUSIONS: Vitrectomy, epiretinal membrane removal and internal limiting membrane peeling showed benefit in the treatment of symptomatic lamellar macular hole. However, large and prospective studies are necessary regarding the surgical indication, time and procedure for lamella macular hole.

Induced Astigmatism and High-Order Aberrations after 1.8-mm, 2.2-mm and 3.0-mm Coaxial Phacoemulsification Incisions

PURPOSE: To study theeffect of micro incision (1.8 mm) and small incision (2.2 mm and 2.8 mm) coaxial phacoemulsification on surgically induced astigmatism (SIA) and high-order aberrations (HOA) of anterior and posterior corneal surface. METHODS: The present randomized clinical study included 32 eyes having a 1.8-mm, 38 eyes having a 2.2-mm, and 30 eyes having a 2.8-mm corneal incision. SIAs were measured at 1 and 3 months postoperatively. HOAs included coma, trefoil, and spherical aberration. The coma-root mean square (RMS) and trefoil-RMS were evaluated at 1 month after the cataract operation. RESULTS: Surgically induced astigmatisms were 0.41 +/- 0.30 diopter (D) in the 1.8-mm incision group, 0.47 +/- 0.21 D in 2.2-mm group and 0.71 +/- 0.50 D in the 2.8-mm group. The SIA of the 1.8-mm group was smaller than the other groups (p = 0.002). There was no statistically significant difference in coma, spherical aberration of the corneal anterior surface and trefoil, or spherical aberration of the posterior surface among the 3 groups at 1 month after surgery. CONCLUSIONS: Incision size contributes to postoperative corneal astigmatism. Phacoemulsification cataract surgery with less than 2.8-mm incision does not significantly influence the corneal aberrationsof anterior and posterior corneal surfaces.

Long-Term Visual Outcomes and Prognostic Factors for Successful Idiopathic Macular Hole

PURPOSE: To investigate long-term visual outcomes and prognostic factors to predict visual outcomes in patients with anatomic success after macular hole surgery. METHODS: Medical records of 36 eyes with successfully repaired stage 3 or 4 idiopathic macular hole and with at least 24 months of follow-up were reviewed. Hole height, stage of macular hole, base diameter, minimum diameter, hole form factor, macular hole index, and hole closure type were measured or calculated, and the correlations of visual outcomes with variables of preoperative optical coherence tomography (OCT) were analyzed. RESULTS: The patients were classified into 3 groups according to the time period necessary to achieve the best corrective visual acuity. The visual acuity of 16 eyes (44.4%) recovered in a mean of 6 months, 13 eyes (36.1%) improved slowly and continuously, and 7 eyes had no improvement despite successful anatomical closure. There were no statistical differences in hole height, base diameter, minimum diameter, hole form factor, macular hole index, or closure type among the 3 groups. CONCLUSIONS: The improvement in visual acuity after successful macular hole surgery persisted at the 24-month follow-up and after. There were no correlations between delayed visual acuity after macular hole surgery and minimum diameter, base diameter, hole height, hole form factor, macular hole index, or closure type.

Case of Tsutsugamushi Disease With Anterior Uveitis

PURPOSE: To report a single case of tsutsugamushi disease with anterior uveitis and eschars on the upper eyelid. CASE SUMMARY: A 56-year-old female patient complained of ocular pain and gradually decreasing visual acuity in her right eye. On physical examination, lymphadenopathy was palpable on the right side of the neck, and eschars were observed on the forehead and upper eyelid. On slit lamp examination, conjunctival injection, episcleral vessel dilations and severe intraocular inflammatory reaction were observed. Fundus examination showed no abnormal findings. A blood test was submitted for analysis, and tsutsugamushi disease was diagnosed. The patient's ocular manifestations responded well to treatment with steroids. After three weeks, the patient showed improvement on ocular examination, and no problems were observed at the six-month follow-up. CONCLUSIONS: Although ocular manifestation of tsutusgamushi disease with conjunctivitis and limbitis has previously been reported, ocular manifestation of tsutusgamushi disease with anterior uveitis has not been reported. Anterior uveitis may respond satisfactorily to steroid treatment, along with improvement in systemic conditions.

Two-year Follow-up of Selective Laser Trabeculoplasty as Initial and Adjunctive Treatment for Ocular Hypertension and Open Angle Glaucoma

PURPOSE: To assess the efficacy and safety of selective laser trabeculoplasty (SLT) as initial and adjunctive treatment for ocular hypertension and open angle glaucoma. METHODS: Twenty-four eyes with ocular hypertension and 63 eyes with open angle glaucoma were treated with a frequency-doubled, Q-switched Nd:YAG laser. Intraocular pressure (IOP) was measured prelaser treatment, one week, one, two, three, six, 12, 18, and 24 months after treatment. RESULTS: The average pre-laser IOP of 87 eyes was 21.6 mmHg. The mean IOP percent reductions at 1 week, one, two, three, six, 12, 18, and 24 months were 15.3%, 20.0%, 21.3%, 19.6%, 23.4%, 23.4%, 20.5%, and 20.9%, respectively. The IOP percent reductions in the initial treatment group at one, 12, and 24 months were 21.1%, 24.8%, and 22.8% respectively. The IOP percent reductions in the adjunctive treatment group at 1, 12, and 24 months were 19.6%, 22.9%, and 20.2% respectively. There were no differences in IOP percent reduction between the initial treatment group and the adjunctive treatment group. CONCLUSIONS: Selective laser trabeculoplasty has shown reasonable efficacy in lowering IOP over two-year follow-up period as initial and adjunctive treatment for ocular hypertension and open angle glaucoma.