Comparison of Pericardial Patch Graft Thickness for Glaucoma Implant, Using Anterior Segment Optical Coherence Tomography

Purpose@#To compare the thickness of the processed pericardial patch graft for glaucoma implant tube coverage using anterior segment optical coherence tomography (AS-OCT). @*Methods@#Thicknesses of seven samples of two pericardial patch grafts (Tutoplast pericardium, IOP Inc, Costa Mesa, CA, USA; pericardium LYO, DCI Donor Services, Inc., Nashville, TN, USA) were measured using AS-OCT (CASIA2, Tomey Corporation, Nagoya, Japan). The thickness of each sample was measured at the center and eight points with 45-degree angular distance, 2 mm from the center. The thickness was measured using AS-OCT program tools. @*Results@#The median thicknesses were 219 μm for Tutoplast pericardium and 157 μm for pericardium LYO. Tutoplast pericardium was significantly thicker than pericardium LYO (p = 0.001); pericardium LYO had a wider interquartile range within each sample, compared to Tutoplast pericardium (p = 0.017). @*Conclusions@#The thickness of the Tutoplast pericardium was greater and less variable than that of the pericardium LYO. These findings should be considered when choosing processed pericardium for coverage of glaucoma implants.

Influence of Axial Length on Recurrence of Wet Age-related Macular Degeneration after Initial Treatment

PURPOSE: To evaluate the influence of axial length on the recurrence of wet age-related macular degeneration (AMD) after anti-vascular endothelial growth factor therapy. METHODS: A retrospective review of the medical records for 45 eyes of 45 patients, who were diagnosed with neovascular AMD and treated with three ranibizumab injections per month, was performed. Axial length was compared between eyes with (recurrence group) and without (no recurrence group) recurrence of fluid during a 12-month follow-up period. In eyes with recurrence, the association between axial length and the time between the third injection and the first recurrence was also evaluated. RESULTS: The axial length was measured at a mean of 20.6 ± 10.1 months after the diagnosis of neovascular AMD. The mean axial length at that time was 23.33 ± 0.90 mm. The mean axial length was 23.29 ± 0.96 mm in the recurrence group (n = 30) and 23.40 ± 0.79 mm in the no-recurrence group (n = 15). There was no difference in the axial length between the two groups (p = 0.709). In the recurrence group, the period between the third injection and the first recurrence was not associated with axial length (p =0.582). CONCLUSIONS: There was no significant difference in axial length between eyes with and without recurrence after initial treatment for wet AMD. In addition, the time to first recurrence was not significantly associated with axial length. Because the present study was retrospective and the sample size was small, further prospective studies with a better design are needed to more accurately assess the influence of axial length.

Clinical and Demographic Characteristics of Blepharoptosis in Korea: A 24-year Experience including 2,328 Patients

PURPOSE: To describe the demographics, relative incidence of subtypes, and clinical characteristics of blepharoptosis in Korean patients. METHODS: This is a retrospective, observational case series consisting of 2,328 patients who underwent ptosis surgery from 1991 to 2014 at a tertiary referral hospital in Korea. The patients were classified according to the type of ptosis and the evaluation of clinical characteristics including levator muscle function (LF) and degree of ptosis. RESULTS: Of the 2,328 patients, 1,815 (78%) had congenital ptosis and 513 (22%) had acquired ptosis. Simple congenital ptosis is the most common type overall (73.7%), and aponeurotic ptosis is the most common acquired type. More than three-quarters of eyes with congenital ptosis were affected in a moderate (34.4%) to severe degree (41.3%), and most of these eyes had fair (33.7%) to poor LF (60.1%). Among eyes with acquired ptosis, approximately three-quarters were affected in a mild (33.3%) to moderate degree (41.0%), with 63.3% of these eyes having good LF. The most widely used surgical technique was frontalis suspension (55.1%), followed by levator resection (29.0%) and aponeurosis repair (14.8%). At 3 years after the first surgery, 15.7% of patients with congenital ptosis and 10.4% of patients with acquired ptosis underwent reoperation. CONCLUSIONS: Although the prevalence has decreased from previous years, the proportion of cases with congenital ptosis was higher in this study than has been shown in research conducted in the West. The majority of eyes with congenital ptosis was affected to a severe degree and had poor LF, while those with acquired ptosis were affected to a moderate degree and had good LF. More cases with acquired ptosis presented with fair to poor LF, and frontalis suspension surgery was performed more commonly compared to previous studies. The reoperation rate was higher in congenital ptosis compared to acquired ptosis.

Predicting Factor of Visual Outcome in Unilateral Idiopathic Cataract Surgery in Patients Aged 3 to 10 Years

PURPOSE: To report the surgical results of unilateral pediatric cataracts from uncertain causes in relatively older children and to identify factors related to better visual outcomes. METHODS: We retrospectively evaluated the medical records of 39 patients who underwent surgery between the ages of 3 and 10 years for unilateral pediatric cataracts of no known cause. All patients underwent primary intraocular lens implantation and postoperative amblyopia treatment. A postoperative final visual acuity better than 20 / 30 was considered to be a good visual outcome. RESULTS: The mean age of patients was 6.0 ± 1.8 years at the time of surgery. The mean preoperative visual acuity was 1.07 ± 0.71 logarithm of the minimum angle of resolution (range, 0.15 to 3.00), while the mean final postoperative visual acuity was 0.47 ± 0.54 logarithm of the minimum angle of resolution (range, 0.00 to 2.00). Of 39 patients, 18 (46.2%) achieved a good visual outcome. Only the preoperative visual acuity maintained a significant association with a good visual outcome according to our multivariate analysis (p = 0.040). A preoperative visual acuity of 20 / 100 or better was found to increase the chance of achieving a good visual outcome by 13.79-fold (95% confidence interval, 1.13 to 167.58). CONCLUSIONS: The visual outcome of unilateral pediatric cataract surgery for cataracts with no specific cause identified in patients after three years of age could be satisfactory, especially with a preoperative visual acuity of 20 / 100 or better.

Characteristics of Patients Older than 90 Years Diagnosed with Neovascular Age-related Macular Degeneration

PURPOSE: To evaluate the characteristics of patients aged ≥ 90 years who were diagnosed with neovascular age-related macular degeneration (AMD). METHODS: A retrospective review of medical records was performed for 44 patients aged ≥ 90 years diagnosed with neovascular AMD. History of cerebrovascular or cardiovascular disorder and visual acuity at diagnosis were assessed. Fellow eye visual acuity data were also collected. When the fellow eye visual acuity was worse than 0.5, the primary reason for the visual deterioration was identified. RESULTS: The mean patient age was 91.5 ± 1.5 years (range: 90–95 years). Ten (22.7%) patients had histories of cerebrovascular or cardiovascular disorders. The mean logarithm of the minimal angle of resolution (logMAR) of visual acuity was 1.11 ± 0.51 and the visual acuity was worse than 0.1 in 20 eyes (45.5%). The fellow eye visual acuity was worse than 0.5 in 26 eyes (59.1%). The primary reason was neovascular or atrophic AMD in 23 eyes (88.5%). CONCLUSIONS: The incidence of cerebrovascular or cardiovascular disorders was relatively high in patients aged ≥ 90 years. Patients also had poor visual acuity at diagnosis and a high incidence of fellow eye visual deterioration. These systemic conditions should be considered when treating these patients. Additionally, a regular ophthalmic examination is recommended for the early detection of these disorders.

Correlations among Refractive Error, Axial Length, and Corneal Power in Childhood

PURPOSE: To investigate sexual differences and correlations among refractive error, axial length (AL), and corneal power. METHODS: A retrospective review of the medical records for 2,006 eyes of children aged 5–16 years was conducted. Cycloplegic refraction and AL measurements were performed on all eyes. Sexual differences in corneal power and AL were investigated in emmetropic eyes and after adjustment for the spherical equivalent (SE). The distribution of AL with every 1 diopter (D) interval was determined. Quantitative correlations among SE, corneal power, and AL were analyzed using multiple regression analyses. RESULTS: The mean age of the subjects was 7.62 years and the mean SE was −0.10 D. Males had a longer AL and lower corneal power than females both in emmetropic eyes and in all subjects after adjustment for the SE. The AL increased 0.40 mm for every −1 D change of the SE. When compared to a 1 D interval of the SE, the AL difference between the upper and lower values of a 95% confidence interval was 2.98 mm, which showed the variability of the AL distribution. Eyes with a long AL had lower corneal power (p < 0.001). Every 1 mm change of AL resulted in a −2.1 D change in the SE, and every 1 D change of corneal power resulted in a −0.8 D change in the SE (p < 0.001). CONCLUSIONS: The distribution of the AL and corneal power was variable, even in eyes with the same refractive error. The AL and corneal power differed by sex. Quantitative correlations between the SE, AL, and corneal power can be clinically used in the estimation of these parameters.

A Comparison of Retinal Nerve Fiber Layer Thickness Measured Using Five Different Optical Coherence Tomography Devices

PURPOSE: To compare circumpapillary retinal nerve fiber layer (RNFL) thicknesses as measured using five different optical coherence tomography (OCT) devices. METHODS: RNFL thickness was measured in 32 healthy eyes of 32 subjects using a Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA, USA), Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany), Topcon DRI OCT (Topcon, Tokyo, Japan), RS-3000 Advance OCT (NIDEK, Aichi, Japan), and RTVue-100 (Optovue, Fremont, CA, USA). Global and quadrant (superior, nasal, inferior, and temporal) RNFL thicknesses were compared using repeated measures analysis of variance, and the agreement among devices was determined using Bland-Altman analyses. RESULTS: The global RNFL thickness was greatest when measured using the Topcon DRI OCT, with a mean value of 107.5 µm. The mean global RNFL thicknesses measured using the RTVue-100, RS-3000 Advance OCT, and Spectralis OCT were 104.9 ± 8.4, 104.4 ± 9.4, 102.5 ± 8.9 µm, respectively. The Cirrus HD-OCT presented the thinnest RNFL measurement, with a mean value of 97.7 ± 8.7 µm (p < 0.01). A similar pattern was found for the quadrant RNFL thicknesses (p < 0.01). Differences in the global RNFL thicknesses among the devices ranged from 0.5 to 9.9 µm. The limits of agreement of the global RNFL thicknesses evaluated by Bland-Altman analyses ranged from 6.8 to 19.6 µm. CONCLUSIONS: RNFL thicknesses measured using five different OCT devices were not interchangeable and there was a wide limit of agreement. When interpreting RNFL thickness values determined by different devices, caution is advised.