Clinical Outcomes of Intraocular Lenses Produced in the Republic of Korea

PURPOSE@#To evaluate the clinical outcomes of aspheric hydrophilic acrylic EYELIKE® (Koryo Eyetech Co., Seoul, Korea) intraocular lenses (IOLs).@*METHODS@#We conducted a retrospective study of 176 consecutive eyes of 160 patients who underwent cataract surgery with implantation of aspheric EYELIKE® IOLs. The following preoperative measurements were collected: slit-lamp examination, uncorrected distance visual acuity (UCDVA), corrected distance visual acuity (CDVA), intraocular pressure (IOP), automatic and manual keratometry, fundus examination, corneal topography, and specular microscopy. The UCDVA, CDVA, IOP, refraction, and slit-lamp examination were evaluated postoperatively at 1 week and at 1, 3, and 6 months. Specular microscopy was also postoperatively conducted at 1 month.@*RESULTS@#At the 6-month postoperative visit, the mean UCDVA was 0.15 ± 0.23, and the mean CDVA was 0.03 ± 0.07 logarithm of minimal angle of resolution (logMAR). No statistically significant differences were observed among the four groups (postoperative 1 week, postoperative 1 month, postoperative 3 months, and postoperative 6 months) in the manifest spherical equivalent. In total, 74% of IOL Master700 and 54% of A-scan measurements were within ± 0.5 diopters (D) difference from the target refraction, and 95% and 77%, respectively, were within ± 1.0 D from the target refraction. With regard to complications, one case of CME and posterior capsule opacification with decreased visual acuity was detected at month 3 postoperatively; in this case, the CDVA recovered to 0 logMAR with conventional treatment and yttrium aluminium garnetlaser posterior capsulotomy after postoperative 6 months.@*CONCLUSIONS@#Domestically produced EYELIKE® IOLs had high refraction predictability and stability.

Clinical Outcomes of Diffractive Aspheric Trifocal Intraocular Lens Implantation

PURPOSE: To evaluate the clinical outcomes of patients with diffractive aspheric trifocal intraocular lens FineVision Pod F IOL (PhysIOL, Liège, Belgium) implantation. METHODS: Thirty eight eyes received phacoemulsification and implantation of FineVision Pod F IOL. Uncorrected distant visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), refractive values, and defocus curve were evaluated at postoperative 1 month and 3 months. Optical quality was evaluated with the contrast sensitivity test, OQAS® (Optical Quality Analysis System, Visiometrics, Cerdanyola del Vallès, Spain) and questionnaire. RESULTS: At the 3-month postoperative follow-up, the mean spherical equivalent was 0.01 ± 0.31 D and the mean UDVA, UIVA and UNVA were 0.04 ± 0.07, 0.19 ± 0.12, and 0.04 ± 0.07, respectively. Mean contrast sensitivities at 0.75, 1.5, 3, 6, 12, and 18 cycles per degrees were 2.00 ± 1.54, 2.16 ± 1.60, 2.25 ± 1.76, 2.16 ± 1.83, 1.52 ± 1.47 and 1.03 ± 0.95 respectively and mean objective scatter index by OQAS® (Optical Quality Analysis System, Visiometrics) was 1.54 ± 0.74. In satisfaction analysis, general satisfaction with surgery was 89% and spectacle independence were 89% at far, 78% at intermediate and 83% at near distance. Postoperative dissatisfaction factors were dryness (36%), glare at night (32%), halo (18%). CONCLUSIONS: The FineVision Pod F IOL showed excellent distant and near visual acuities with an effective intermediate visual acuity. The eyes with FineVision Pod F IOL expected to achieve the favorable visual outcome and patient satisfaction.

Comparison of Ocular Biometry Using New Swept-source Optical Coherence Tomography-based Optical Biometer with Other Devices

PURPOSE: To evaluate the agreement between optical biometry with swept-source optical coherence tomography-based optical biometry (IOLMaster 700) and other devices. METHODS: A total of 137 eyes (78 patients) with cataracts were included in this retrospective study. Axial length (AL), anterior chamber depth (ACD), keratometry, and white-to-white (WTW) distance measured using IOLMaster 700 were compared with results for the following five different biometers: IOLMaster 500, A-scan, automated refractor, manual keratometry, and Galilei G4. Differences and correlations among the devices were assessed using the Bland-Altman plot and intraclass correlation coefficient (ICC). RESULTS: For AL values, the IOLMaster 700, IOLMaster 500, and A-scan measurements showed excellent agreement (all ICC >0.99). For ACD values, ICC of IOLMaster 700 and Galilei G4 was 0.965 but A-scan was poorly correlated with either IOLMaster 700 or Galilei G4. The ICCs of IOLMaster 700 and other devices were all greater than 0.9 for average keratometry, but those of the mean cylinder keratometry were all between 0.7 and 0.8. The mean difference in the WTW distance between the IOLMaster 700 and Galilei G4 was 0.029 mm, but the ICC was 0.525. AL measurements were not possible for 10 eyes with the IOLMaster 500 but were obtained in all eyes with the IOLMaster 700. CONCLUSIONS: In clinical practice, AL, ACD, and average keratometry values of IOLMaster 700 can be used interchangeably with those of the other devices tested. However, the ACD value between IOLMaster 700 and A-scan or the WTW distance between IOLMaster 700 and Galilei G4 are not interchangeable because of clinical and statistical differences in measurements between the devices.

Comparison of Reading Speed after Bilateral Bifocal and Trifocal Intraocular Lens Implantation

PURPOSE: To evaluate and compare visual acuity and reading speed for Korean language between a diffractive bifocal and trifocal intraocular lens (IOL) of the same material and haptic design. METHODS: We reviewed the medical records of the patients who had undergone bilateral cataract surgery with bifocal IOLs (AT LISA 801) on the both eyes (bifocal group) and trifocal IOLs (AT LISA tri 839 MP, trifocal group). The main outcome measures were the uncorrected distance, intermediate, and near visual acuity (uncorrected distance visual acuity [UCDVA], uncorrected intermediate visual acuity [UCIVA], and uncorrected near visual acuity [UCNVA]) and corrected distance, near, and distance-corrected intermediate visual acuity (corrected distance visual acuity [CDVA], corrected near visual acuity [CNVA], and distance-corrected intermediate visual acuity [DCIVA]) at last postoperative follow-up month. Reading speeds for Korean language were measured to check near visual function. RESULTS: Fourteen eyes (7 patients) were included in the bifocal group and 32 eyes of 16 patients in the trifocal group. There were no statistical differences between the two groups with respect to UCDVA, UCNVA, CDVA, and CNVA. However, UCIVA (0.35 vs. 0.22 logarithm of the minimum angle of resolution [logMAR], p < 0.01) and DCIVA (0.34 vs. 0.20 logMAR, p < 0.01) were significantly better in the trifocal group than in the bifocal group. The mean reading speed for logMAR 0.5 optotype (point 10) was 86.50 words per minute (wpm) in the bifocal group and 81.48 wpm in the trifocal group without a significant difference (p = 0.70). CONCLUSIONS: Trifocal IOLs provided the same level of distance and near visual acuity and reading speed as that of bifocal IOLs with better intermediate visual acuity.

Comparison between Active and Gravity-based Phacoemulsification Fluidics Systems in Immediate Sequential Bilateral Cataract Surgery

PURPOSE: To compare the clinical outcomes during phacoemulsification when using active fluidics (Centurion®) and gravity-based fluidics (Infiniti®) in immediate sequential bilateral cataract surgery. METHODS: From January 2015 to September 2015, 68 eyes of 34 patients with bilateral cataract were assigned to receive immediate sequential bilateral cataract surgery by Centurion® in one eye and Infiniti® in the other eye. We measured and compared intraoperative factors, including cumulative dissipated energy (CDE), ultrasound time, mean amount of balanced salt solution (BSS) used, and pain using a scale. Best corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) were also evaluated preoperatively and 1 month postoperatively. RESULTS: Intraoperative measurements showed significantly less CDE (5.05 ± 2.18 vs. 7.05 ± 3.82), ultrasound time (24.65 ± 9.68 vs. 34.95 ± 17.95 seconds), and mean amount of BSS used (37.06 ± 10.25 vs. 44.88 ± 16.38 mL) in the Centurion® group than in the Infiniti® group (p = 0.011, p = 0.005, p = 0.021, respectively). The intraoperative pain scale was 0.26 ± 0.51 in the Centurion® group and 0.50 ± 0.71 in the Infiniti® group, and was not significantly different (p = 0.121). BCVA, increase of CCT and decrease of ECD were not significantly different between the two groups at 1 month postoperatively. CONCLUSIONS: The efficacy of phacoemulsification in the Centurion® group was superior to that in the Infiniti® group. The level of intraoperative pain and clinical outcomes 1 month after surgery were not significantly different between the two groups.

Korean Version Self-testing Application for Reading Speed

PURPOSE: This study introduces a reading chart application for the iPad tablet in the Korean language and investigates the reading speed in a normal-sighted population according to age group. METHODS: Sixty-three Korean sentences were selected from textbooks for second grade elementary school students. A commonly used typeface in everyday printed material, “BatangChe,” was used. Letter size was presented in logarithm of the minimum angle of resolution (logMAR) 0.0 to 1.0 at 0.1 logMAR steps at a reading distance of 40 cm. A third generation retina display iPad was used to present the chart, and the sentences were presented randomly for each size of letter. The subjects repeated the test silently (reading only) and out loud (reading and speaking) to prevent them from skipping reading words. Pilot testing followed in 65 normal vision adults under 60 years of age. RESULTS: The mean reading only speed for logMAR 0.5 optotype (point 10) was 121.1 ± 47.2 words per minute (wpm) for people in their 20s (n=21), 116.5 ± 38.3 in their 30s (n=27), 93.8 ± 12.6 in their 40s (n=9), and 56.5 ± 42.7 (n=8) in their 50s. There was a significant correlation between age and reading and speaking speed (r=−0.48, p<0.001). The mean reading only speed for logMAR 0.5 optotype (point 10) was 202.3 ± 88.4 wpm and the mean reading and speaking speed was 129.7 ± 25.9 wpm, with significantly different (p<0.001). CONCLUSIONS: This Korean reading chart application could present a new standard when checking reading speed according to age groups.

Comparison of Clinical Outcomes between Laser Blended Vision and Monovision Laser Refractive Surgery for Presbyopia

PURPOSE: To compare the efficacy and safety of Laser Blended Vision (LBV) and monovision laser refractive surgery (monovision) for presbyopia correction in patients with myopia. METHODS: This retrospective comparative study included 42 eyes of 21 patients with LBV and 50 eyes of 25 patients with monovision. Monocular and binocular distance, intermediate and near visual acuity, and refractive changes were evaluated preoperatively and 3 months after the surgery and compared. The patients in the LBV group underwent further evaluation of spherical aberration 3 months after the surgery and treatment satisfaction 3-6 months after the surgery. RESULTS: The mean age of the patients was 47.9 years in the LBV group and 41.7 years in the monovision group. Three months after surgery, the spherical equivalents were +0.11 ± 0.17 D in the dominant eye and -1.52 ± 0.36 D in the non-dominant eye in the LBV group. In contrast, the spherical equivalents were +0.23 ± 0.26 D in the dominant eye and -0.82 ± 0.28 D in the non-dominant eye in the monovision group. All patients achieved a binocular uncorrected distance visual acuity of 0.10 (log MAR) or better, and 86% of the LBV group and 100% of the monovision group achieved a binocular uncorrected intermediate visual acuity of better than 0.10. Moreover, 95% of the LBV group and 100% of the monovision group achieved a binocular uncorrected near visual acuity of better than 0.18. In the LBV group, mean spherical aberration increased after surgery than before, but it was not statistically significant. Complications such as corneal opacity that could decrease visual acuity were absent in both groups. Overall patient satisfaction after surgery was 80% in the LBV group. CONCLUSIONS: Despite the relatively higher mean age of the LBV group, both groups showed similar results regarding presbyopia correction in patients with myopia.

Clinical Outcome of Small Incision Lenticule Extraction including Visual Quality Analysis

PURPOSE: To present the clinical outcomes of small incision lenticule extraction (SMILE) including visual quality analysis in Korean patients with myopia METHODS: The medical records of 228 eyes of 116 patients who underwent SMILE in HanGil Eye Hospital LASIK Center from May 2014 to Feb 2015 and were followed-up for at least 3 months was analyzed retrospectively. The patients were followed up at 1 day, 1 week, 1 month, and 3 months after the operation. Refractive value, visual acuity, intraocular pressure, and visual quality were measured at each visit RESULTS: Preoperatively, uncorrected distant visual acuity was 0.01 ± 0.02 in log MAR, spherical equivalent was -5.03 ± 1.72 diopters, intraocular pressure was 15.85 ± 2.85 mm Hg, and the objective scattering index (OSI) value was 0.68 ± 0.49. The postoperative uncorrected distant visual acuity was 0.13 ± 0.10, 0.05 ± 0.08, 0.04 ± 0.09, and 0.02 ± 0.04 and OSI was 2.16 ± 1.89, 1.25 ± 0.64, 1.14 ± 0.69, and 0.81 ± 0.36 at 1 day, 1 week, 1 month, and 3 months after the operation, respectively. The postoperative intraocular pressure was 12.55 ± 3.74 mm Hg, 13.03 ± 4.35 mm Hg, 11.65 ± 2.49 mm Hg at 1 week, 1 month, and 3 months after the operation. The efficacy of refractive surgery 3 months after the operation was 0.97 ± 0.11, the safety was 0.99 ± 0.10, and predictability was 99.56% and 100.00% at the range of ±0.5 diopters and ± 1.0 diopter, respectively. CONCLUSIONS: The SMILE operation showed comparable clinical outcomes with conventional refractive surgery in terms of efficacy, safety, and predictability. Intraocular pressure and visual quality normalized gradually throughout the 3-month postoperative period.

Clinical Outcome of Small Incision Lenticule Extraction including Visual Quality Analysis

PURPOSE: To present the clinical outcomes of small incision lenticule extraction (SMILE) including visual quality analysis in Korean patients with myopia METHODS: The medical records of 228 eyes of 116 patients who underwent SMILE in HanGil Eye Hospital LASIK Center from May 2014 to Feb 2015 and were followed-up for at least 3 months was analyzed retrospectively. The patients were followed up at 1 day, 1 week, 1 month, and 3 months after the operation. Refractive value, visual acuity, intraocular pressure, and visual quality were measured at each visit RESULTS: Preoperatively, uncorrected distant visual acuity was 0.01 ± 0.02 in log MAR, spherical equivalent was -5.03 ± 1.72 diopters, intraocular pressure was 15.85 ± 2.85 mm Hg, and the objective scattering index (OSI) value was 0.68 ± 0.49. The postoperative uncorrected distant visual acuity was 0.13 ± 0.10, 0.05 ± 0.08, 0.04 ± 0.09, and 0.02 ± 0.04 and OSI was 2.16 ± 1.89, 1.25 ± 0.64, 1.14 ± 0.69, and 0.81 ± 0.36 at 1 day, 1 week, 1 month, and 3 months after the operation, respectively. The postoperative intraocular pressure was 12.55 ± 3.74 mm Hg, 13.03 ± 4.35 mm Hg, 11.65 ± 2.49 mm Hg at 1 week, 1 month, and 3 months after the operation. The efficacy of refractive surgery 3 months after the operation was 0.97 ± 0.11, the safety was 0.99 ± 0.10, and predictability was 99.56% and 100.00% at the range of ±0.5 diopters and ± 1.0 diopter, respectively. CONCLUSIONS: The SMILE operation showed comparable clinical outcomes with conventional refractive surgery in terms of efficacy, safety, and predictability. Intraocular pressure and visual quality normalized gradually throughout the 3-month postoperative period.

Efficacy and Safety of Immediate Sequential Bilateral Cataract Surgery

PURPOSE: To evaluate the efficacy and safety of immediate sequential bilateral cataract surgery with respect to patient outcomes and complication rates. METHODS: From January 2010 to December 2014, we conducted a retrospective study of patients who had immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) with an interval of one to two months between the first and the fellow eye operations. The changes in visual acuity, manifest spherical equivalent, and refractive error of 140 eyes of 70 patients of both groups were compared postoperatively at one month. The incidence of endophthalmitis was investigated during the same period. RESULTS: At one month postoperatively, log MAR best corrected visual acuity were measured to be 0.06 +/- 0.72 in the ISBCS group and 0.09 +/- 0.66 in the DSBCS group, and that of the fellow eyes were 0.07 +/- 0.64 and 0.07 +/- 0.18, respectively (p = 0.331, p = 0.781, respectively). The postoperative spherical equivalents were -0.18 +/- 0.23 D in the ISBCS group and -0.19 +/- 0.25 D in the DSCBS group, and that of the fellow eyes were -0.15 +/- 0.18 D and -0.16 +/- 0.21 D, respectively. There were no significant statistical differences between the two groups (p = 0.835, p = 0.676, respectively). The postoperative refractive error was -0.20 +/- 0.21 D in the ISCBS group and -0.18 +/- 0.13 D in the DSBCS group, and that of the fellow eyes were -0.14 +/- 0.22 D and -0.19 +/- 0.22 D, respectively (p = 0.482, p = 0.237, respectively). A total of 21,140 eyes had cataract surgery performed, and only 10 eyes (0.05%) developed endophthalmitis. Endophthalmitis did not occur in the ISBCS group. CONCLUSIONS: In experienced hands, with stringent patient selection criteria and with a strict aseptic protocol, ISBCS can safely provide comparable visual outcome and better satisfaction of the patient with good efficacy.

Comparison of Clinical Outcomes in Implantable Collamer Lens Implantation between AQUA ICL(R) and Conventional ICL

PURPOSE: To compare the clinical outcomes between AQUA ICL(R) (V4C) and conventional implantable collamer lens (ICL, V4B) in patients with high myopia. METHODS: We compared preoperative and postoperative visual acuities, spherical equivalent, intraocular pressure, postoperative vault and visual quality assessed using optical quality analyzing system (OQAS(R)) between 20 eyes implanted with ICL (V4B) and 22 eyes implanted with AQUA ICL(R) (V4C). RESULTS: Visual acuity (log MAR) and spherical equivalent at postoperative 3 months were 0.06 +/- 0.09 and -0.26 +/- 0.17 D in the V4B group and 0.03 +/- 0.03 and -0.23 +/- 0.19 D in the V4C group, respectively. There was no statistical difference in visual acuity and spherical equivalent between the 2 groups (p > 0.05). Postoperative intraocular pressure (IOP) elevated significantly in both groups until 6 hours after the operation (p 0.05). V4C resulted in lower IOP than V4B 6 hours postoperatively. In ICL (V4B) and AQUA ICL(R) (V4C) groups, the objective scattering index (OSI) was 1.29 +/- 0.90 and 1.36 +/- 0.68, modulation transfer function (MTF) cut off value was 29.62 +/- 11.31 c/deg and 29.61 +/- 9.56 c/deg and Sterhl ratio was 0.18 +/- 0.07 and 0.17 +/- 0.04, respectively, 3 months postoperatively. None of these values were significantly different between the 2 groups. CONCLUSIONS: AQUA ICL(R) (V4C) implantation is an effective, convenient and safe surgery for myopia correction and yields better outcome than ICL (V4B) in terms of early postoperative IOP.

Clinical Outcomes of Diffractive Aspheric Trifocal Intraocular Lens Implantation

PURPOSE: To evaluate the clinical outcomes of patients with diffractive aspheric trifocal intraocular lens (AT.LISA tri839 MP(R) IOL, Carl Zeiss Meditec, Jena, Germany) implantation. METHODS: Forty eyes of 53 patients received phacoemulsification and implantation of AT.LISA tri839 MP(R) IOL (Carl Zeiss Meditec). Uncorrected distant visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), refractive values, and defocus curve were evaluated at postoperative 1 month and 3 months. Optical quality was evaluated with the Optical Quality Analysis System (OQAS(R), Visiometrics, Castelldefels, Spain). RESULTS: At the 3-month postoperative follow-up, the mean spherical equivalent was 0.01 +/- 0.31 D and the mean UDVA, UIVA and UNVA were 0.023 +/- 0.020, 0.155 +/- 0.091, and 0.139 +/- 0.069, respectively. The means of the objective scatter index, modulation transfer function cut-off value, Strehl ratio measured by OQAS(R) (Visiometrics) were 1.83 +/- 0.52, 33.58 +/- 14.27 cycle per degree and 0.18 +/- 0.11, respectively. Intermediate visual acuity did not fall sharply at defocus curve. CONCLUSIONS: Implantation of the diffractive aspheric trifocal intraocular lens in patients with cataracts provided excellent distant, intermediate and near visual acuities with high visual quality.

The Recovery of Optical Quality after Laser Vision Correction

PURPOSE: To evaluate the optical quality after laser in situ keratomileusis (LASIK) or serial photorefractive keratectomy (PRK) using a double-pass system and to follow the recovery of optical quality after laser vision correction. METHODS: This study measured the visual acuity, manifest refraction and optical quality before and one day, one week, one month, and three months after laser vision correction. Optical quality parameters including the modulation transfer function, Strehl ratio and intraocular scattering were evaluated with a double-pass system. RESULTS: This study included 51 eyes that underwent LASIK and 57 that underwent PRK. The optical quality three months post-surgery did not differ significantly between these laser vision correction techniques. Furthermore, the preoperative and postoperative optical quality did not differ significantly in either group. Optical quality recovered within one week after LASIK but took between one and three months to recover after PRK. The optical quality of patients in the PRK group seemed to recover slightly more slowly than their uncorrected distance visual acuity. CONCLUSIONS: Optical quality recovers to the preoperative level after laser vision correction, so laser vision correction is efficacious for correcting myopia. The double-pass system is a useful tool for clinical assessment of optical quality.

Anterior and Posterior Corneal Spherical Aberration Measured With Pentacam in the Korean

PURPOSE: To evaluate the spherical aberrations of the anterior and posterior surfaces of normal corneas using Pentacam in a Korean sample population and determine their ranges and changes with age. METHODS: We used Pentacam (Oculus Inc.,Germany) to measure the anterior and posterior corneal spherical aberrations of 240 eyes in 240 patients with normal corneas who visited our clinic. The means and ranges of spherical aberrations and their changes with age were determined. We examined both eyes of 90 patients to confirm the inter-ocular symmetry in spherical aberration. RESULTS: The mean age of the 240 patients (M:F=103:137) was 49.8 years (range: 20-79), and the mean spherical aberrations of the anterior and posterior surfaces of the cornea were 0.230+/-0.078 micrometer, and -0.04+/-0.021 micrometer, respectively. The mean total corneal spherical aberration was 0.19+/-0.087 micrometer. There were no differences between males and females, and inter-ocular symmetry was observed in all tested patients. There was a tendency for the values of anterior, posterior and total corneal spherical aberration to increase with age. Ranges of spherical aberrations were from -0.177 micrometer to 0.423 micrometer in the anterior cornea, from -0.083 micrometer to 0.034 micrometer in the posterior cornea, and from -0.238 micrometer to 0.410 micrometer in the total cornea. CONCLUSIONS: In a Korean population, the mean total corneal spherical aberration was 0.19 micrometer, which was shown to increase with age. Some patients were shown to have an extreme value. Based on these results, a preoperative analysis for corneal spherical aberration may be helpful when selecting aspheric intraocular lenses.

Clinical Outcomes of LASIK Using a 213 nm Solid-State Laser System: 6-month Follow-up

PURPOSE: To present prospective clinical results of laser-assisted in situ keratomileusis (LASIK) using a solid-state laser system for the correction of mild to moderate myopia with or without astigmatism. METHODS: Thirty-eight eyes underwent LASIK using a 213 nm solid-state laser (Pulzar Z1trade mark, CustomVistrade mark, Australia). Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refractive errors, higher order aberrations (HOA) and contrast sensitivity were evaluated preoperatively and postoperatively. RESULTS: The preoperative and postoperative mean spherical and cylindrical refractive errors were -3.27+/-0.85D, +1.04+/-0.69D, -0.36+/-0.7D and +0.14+/-0.2D, respectively. UCVA over 20/25 was obtained in 27 eyes (93%). A result within 1.00D of the desired correction was achieved in 90% of the eyes. There were no decreases in BCVA within the study group. The preoperative and postoperative root-mean-square of HOA at 3 months were 0.196+/-0.092 microm and 0.326+/-0.107 microm respectively. The preoperative and postoperative contrast sensitivity values were similar. CONCLUSIONS: The clinical outcomes of LASIK using a solid-state laser system were comparable to the conventional refractive surgery in mild to moderate myopia. The 213 nm solid state laser may be an alternative option for refractive surgery.

Corneal Melting and Descemetocele Resulting From Noninfectious Keratitis Related to the Cosmetic Contact Lenses

PURPOSE:To report 2 cases of corneal melting and corneal melting with descemetocele that occurred in users of cosmetic contact lenses. CASE SUMMARY: A-12-year-old and a 13-year-old female who used cosmetic contact lenses were referred to our clinic under the preliminary diagnosis of keratitis and corneal melting. The patients had purchased the lenses from an optician and had worn the lenses for approximately 1 month without being educated on their proper use. The signs and symptoms improved after 2 weeks of treatment with oral steroid and 1% topical prednisolone acetate. However, descemetocele occurred in the 12-year-old patient. Reepithelization of the cornea had been completed within the treatment period. However, corneal thinning with mild opacity remained in the lesions, and the best corrected visual acuities on the Snellen chart were 20/30 in both patients.

The Effect of a New Carbon Stent for Preventing Restenosis-Prospective, Randomized Study for Preventing Metal Allergy

BACKGROUND AND OBJECTIVES: Metal allergy has been reported to be related to stent restenosis. Therefore, we sought to investigate the incidence of metal allergy with new carbon stent with ion implantation technique and its relationship to restenosis. SUBJECTS AND METHODS: Between April 2002 and June 2004, 128 patients (100 male, mean age 60+/-10 years) were included in this study. The clinical diagnoses of the study patients included 64 acute myocardial infarction, 24 unstable angina and 40 stable angina patients. Patients were randomly assigned to receive either an Arthos Inert Stent (the study group) or an Arthos stent (the control group), with follow-up angiography scheduled 6 months later. Three months after stent implantation, skin patch tests, for the detection of metal allergies, were performed with manganese, molybdenum, nickel and chromium. RESULTS: There were no differences between the age, genders, risk factors and multi-vessel involvement between the two groups, as well as no differences in the angiographic parameters and restenosis (p>0.05). There were no differences in the positive rates of the skin tests between the Arthos stent and Arthos Inert stent groups or between the restenosis and no-restenosis groups (p>0.05). CONSLUSION: The new carbon stent, with ion implantation, did not reduce coronary restenosis. An allergic reaction was not related to the stent technology or stent restenosis.

Protection of Cardiomyocytes from Acute Ischemic Injury by Protein Kinase Cepsilon Expression

BACKGROUND AND OBJECTIVES: Ischemic injury is the most common and important cause of myocardial damage. Over past decades, a number of studies have identified a protective mechanism known as ischemic preconditioning, which can block or delay cell death from ischemic injury. Protein kinase C (PKC), especially theepsilonisoform has been proposed as a key factor in the signaling pathway of ischemic preconditioning. However, whether PKCepsilon expression in cardiomyocytes can offer such protection from acute ischemia has not been explored. MATERIALS AND METHODS: To demonstrate a direct effect of PKCepsilon expression, a lentiviral vector system was established. Using the lentiviral vector, PKCepsilon was introduced to neonatal rat ventricular myocytes (NRVM) cultured under ischemic conditions, and also to adult rat myocardium subject to left coronary artery ligation. RESULTS: Compared to control, PKCepsilon expression in cultured NRVM under ischemia resulted in preserved cell density and morphology, and a reduction in cell death (77.6+/-12.8% vs 58.1+/-7.2%, p<0.05). In adult rats, the infarcted area after coronary artery ligation was markedly reduced in myocardium injected with PKCepsilon vector compared to control (11.4+/-5.3% vs 20.5+/-11.3%, p<0.01). CONCLUSION: These results provide direct evidence that PKCepsilon is a central player in protection against cell death from acute ischemia.

Prevalence and predictors of tortuous radial artery in patients undergoing transradialcoronary angiography / 대한내과학회지

BACKGROUND: It is well known that the presence of a tortuous radial artery, in patients undergoing transradial coronary angiography (CAG), may cause undesirable results such as access failure and arterial dissection. Thus, our aim was to investigate the prevalence and predictors of the presence of a tortuous radial artery in patients undergoing transradial CAG. METHODS: We prospectively investigated the tortuosity of the radial artery in 158 consecutive patients. The tortuosity of the radial artery was determined by radial angiography. A tortuous radial artery was defined as one with a maximal angulation of more than 45 degrees. To determine the predictors of a tortuous artery, we examined clinical and intra-procedural characteristics. RESULTS: A right radial angiography was easily performed in 154 patients (97.5%) without any complications. A tortuous radial artery was identified in 34 patients (22%). On the univariate analysis, advanced age, female gender, short stature, underweight, hypertension, and absence of progression of the mini-guide wire were significantly associated with the presence of a tortuous radial artery. Significant independent predictors of a tortuous radial artery by multivariate analysis were: advanced age, absence of progression of the mini-guide wire and hypertension. CONCLUSIONS: These data showed that the presence of a tortuous radial artery could be predicted by advanced age, absence of progression of the mini-guide wire and a history of hypertension. Thus, identification of a tortuous radial artery prior to coronary angiography may be helpful for a safe transradial CAG in patients at high risk for a tortuous radial artery.

Comparisons of the Short-Term Angiographic Outcomes of Cypher and Taxus Stents Implanted in the Same Patient

BACKGROUND AND OBJECTIVES: Drug-eluting stents (DES) have been shown to substantially reduce both angiographic and clinical restenosis. Cypher(R) (sirolimus-eluting stent, Cordis, Johnson and Johnson, Florida, USA) and Taxus(R) (paclitaxel-eluting stent, Boston Scientific, Boston, USA) are the two most widely used DESs, and they both have distinct pharmacological properties and release kinetics. It has been not studied whether these two DESs show different angiographic outcomes when they are simultaneously implanted in the same patient. SUBJECTS AND METHODS: We retrospectively analyzed the angiographic findings of the short-term follow-up in 34 patients (average age: 63 year old, 9 women) in whom both Cypher and Taxus stents were implanted at the same time for the treatment of obstructive coronary lesion. RESULTS: There was no significant difference in the basal angiographic characteristics of the lesions that had two stents deployed in terms of the AHA/ACC classification, reference diameter, the percent diameter stenosis and minimal luminal diameter. The post-procedure results were similar between the two stents. At 6 months follow-up, the Cypher stent displayed significantly less in-stent lumen loss compared with the Taxus stent (0.16+/-0.04 mm vs 0.27+/-0.04 mm; respectively, p=0.040) and a smaller percent diameter stenosis (15.9+/-1.3% vs 19.9+/-2.2%, respectively, p=0.049). CONCLUSION: The Cypher stent showed significantly less luminal loss during short term follow-up compared with the Taxus stent when implanted in the same patient. This result suggests that in a given individual patient, the Cypher stent induces less neointimal proliferation than does the Taxus stent.