Comparative Analysis of Clinical Outcomes after Placement of Enhanced Monofocal, Monofocal, and Trifocal Intraocular Lenses

Purpose@#To compare the clinical outcomes of patients given an enhanced monofocal intraocular lens (IOL) (Isopure; PhysIOL, Liege, Belgium), and monofocal, and trifocal IOLs. @*Methods@#Patients who underwent cataract surgery with bilateral implantation of monofocal Vivinex IOLs, enhanced monofocal Isopure IOLs, and trifocal Panoptix IOLs were included. Three months postoperatively, the uncorrected distance visual acuity (UDVA), intermediate visual acuity (UIVA), and near visual acuity (UNVA), as well as the spherical equivalent (SE) were determined. Photic symptoms were explored via a questionnaire. @*Results@#The postoperative SE and UDVA did not differ significantly among the three groups (p = 0.100 and 0.204 respectively). The mean UIVAs (logMAR) were 0.61 ± 0.14, 0.3 ± 0.1, and 0.14 ± 0.11 in the Vivinex, Isopure, and Panoptix groups respectively. The Isopure group exhibited a significantly better UIVA than the Vivinex group (p < 0.001) and the Panoptix group exhibited a significantly better UIVA than either the Vivinex or Isopure group (p = 0.002 and < 0.001 respectively). The mean UNVAs (logMAR) were 0.68 ± 0.16, 0.57 ± 0.19, and 0.17 ± 0.12 for the Vivinex, Isopure, and Panoptix groups respectively. There was no significant UNVA difference between the Vivinex and Isopure groups (p = 0.185) but the UNVA of the Panoptix group was significantly better than the UNVAs of the Vivinex and Isopure groups (both p < 0.001). There was no significant difference in photic symptoms between the Vivinex and Isopure groups (p = 0.980); however, the Panoptix group evidenced significantly more severe symptoms than did the other two groups (p = 0.021 and 0.042 respectively). @*Conclusions@#Enhanced monofocal Isopure IOL showed superior intermediate vision compared to Vivinex monofocal IOL, and inferior intermediate and near visual acuity compared Panoptix trifocal IOL, but with fewer photic symptoms.

Changes in Intraocular Pressure and Factors that Influence such Changes after FS-LASIK and SMILE

Purpose@#We compared the intraocular pressure (IOP) changes and the relationships thereof with corneal biomechanics after small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). @*Methods@#A total of 234 eyes of 117 patients who underwent FS-LASIK surgery and 244 eyes of 122 patients who underwent SMILE surgery were included in this retrospective study. Data were collected preoperatively, and at 1, 3, and 6 months postoperatively, including IOP measured via non-contract tonometry, central corneal thickness (CCT), and mean keratometry (Km), flat keratometry (Kf), and steep keratometry (Ks) data obtained using a dual Scheimpflug analyzer. Between-group differences were compared. Simple linear regression analysis was used to determine the relationship between changes in the IOP and the various parameters. @*Results@#The IOP changes were 5.41 ± 2.28 mmHg in the FS-LASIK group and 4.77 ± 2.38 mmHg in the SMILE group, thus significantly different (p = 0.004). The IOP did not change significantly from 1 to 6 months after FS-LASIK but increased significantly from 12.07 ± 1.77 mmHg at 3 months postoperatively to 12.77 ± 1.89 mmHg at 6 months postoperatively after SMILE (p = 0.002). All of the preoperative spherical equivalent and IOP, and changes in the Km, Kf, Ks, and CCT, were significantly associated with the IOP changes in both groups. The preoperative IOP evidenced the strongest relationship with the IOP changes in both groups (R2 = 0.414 in the FS-LASIK group, R2 = 0.292 in the SMILE group). @*Conclusions@#The IOP fell significantly after FS-LASIK and SMILE surgery, significantly more so after FS-LASIK than SMILE. The preoperative IOP exhibited the greatest influence on the IOP decreases after both FS-LASIK and SMILE.

Long-term Clinical Outcomes of Implantable Collamer Lens

Purpose@#To evaluate the long-term clinical outcomes of implantable collamer lens (ICL) implantation in myopic patients. @*Methods@#This retrospective study included 129 eyes of 68 patients who underwent ICL implantation for correction of myopia with a 10-year follow-up. @*Results@#Ten years after ICL implantation, the mean uncorrected and corrected distance visual acuities (LogMAR) were 0.03 ± 0.13 and -0.07 ± 0.06, respectively. Ten years postoperatively, 52.7% and 84.5% of the eyes were within ± 0.5 and ± 1.0 diopters, respectively. The mean efficacy and safety indices were 0.91 ± 0.22 and 1.07 ± 0.19, respectively. There was no significant difference between mean preoperative (13.52 ± 2.88 mmHg) and postoperative (13.59 ± 3.55 mmHg) intraocular pressures. The endothelial cell density decreased from before surgery to 10 years after surgery (3,074 ± 365 cells/mm2, 2,812 ± 406 cells/mm2, respectively; mean decrease: 8.5 ± 10.8%; p = 0.011). Eight eyes (6.2%) developed cataract during follow-up, which was symptomatic in three eyes (2.3%) and treated with ICL explantation and phacoemulsification. Rhegmatogenous retinal detachment occurred in one eye (0.8%) and was treated with vitrectomy. @*Conclusions@#ICL implantation for the correction of myopia had good efficacy and safety outcomes during long-term follow-up of 10 years. However, patients should be closely monitored for complications such as cataract formation, endothelial cell loss, and retinal detachment.

Long-term Clinical Outcomes of Implantable Collamer Lens

Purpose@#To evaluate the long-term clinical outcomes of implantable collamer lens (ICL) implantation in myopic patients. @*Methods@#This retrospective study included 129 eyes of 68 patients who underwent ICL implantation for correction of myopia with a 10-year follow-up. @*Results@#Ten years after ICL implantation, the mean uncorrected and corrected distance visual acuities (LogMAR) were 0.03 ± 0.13 and -0.07 ± 0.06, respectively. Ten years postoperatively, 52.7% and 84.5% of the eyes were within ± 0.5 and ± 1.0 diopters, respectively. The mean efficacy and safety indices were 0.91 ± 0.22 and 1.07 ± 0.19, respectively. There was no significant difference between mean preoperative (13.52 ± 2.88 mmHg) and postoperative (13.59 ± 3.55 mmHg) intraocular pressures. The endothelial cell density decreased from before surgery to 10 years after surgery (3,074 ± 365 cells/mm2, 2,812 ± 406 cells/mm2, respectively; mean decrease: 8.5 ± 10.8%; p = 0.011). Eight eyes (6.2%) developed cataract during follow-up, which was symptomatic in three eyes (2.3%) and treated with ICL explantation and phacoemulsification. Rhegmatogenous retinal detachment occurred in one eye (0.8%) and was treated with vitrectomy. @*Conclusions@#ICL implantation for the correction of myopia had good efficacy and safety outcomes during long-term follow-up of 10 years. However, patients should be closely monitored for complications such as cataract formation, endothelial cell loss, and retinal detachment.

Clinical Outcomes of Combined Procedure of Astigmatic Keratotomy and Laser in situ Keratomileusis

PURPOSE: To evaluate the clinical outcomes of a combined procedure of astigmatic keratotomy (AK) and laser in situ keratomileusis (LASIK) for the correction of high astigmatism. METHODS: Thirty-five eyes of 19 patients who had astigmatic keratotomy were studied. The patients had a secondary procedure, LASIK, to correct the residual refractive error. Follow-up visits were at 1 week, 1 month, 3 months, and 6 months. The outcome measures included uncorrected distance visual acuity, refractive error, efficacy, safety, and predictability. We compared preoperative and post-AK expected corneal ablation depth using an Amaris Ablation depth table. RESULTS: After astigmatic keratotomy, astigmatism was reduced by 61.43 ± 14.62%, and after LASIK, astigmatism was reduced by 91.65 ± 8.68%. Expected corneal ablation depth was reduced by 18.72 ± 11.77% after astigmatic keratotomy. The proportion of eyes with spherical equivalent 0.5 D or less was 85.71% at 6 months after the combined procedure of astigmatic keratotomy and LASIK. No intraoperative or postoperative complications were observed. CONCLUSIONS: This study showed the combined procedure of astigmatic keratotomy and LASIK is effective for visual acuity, refraction, and reduction in corneal ablation depth.

A Case of Suction Loss During SMILE and a Switch to LASIK

PURPOSE: To report a case of suction loss during small incision lenticule extraction (SMILE) and a good visual outcome after switching to femtosecond laser-assisted in-situ keratomileusis (LASIK). CASE SUMMARY: A 20-year-old female was admitted to receive refractive surgery. During SMILE in the left eye, suction loss occurred at 65% of posterior cut completion. We switched to LASIK and SMILE was performed in the right eye as planned. The uncorrected distance visual acuity was 1.2 with a manifest refraction of +0.25 Dsph with 0 Dcyl. The patient had no complications at 3 months postoperatively. CONCLUSIONS: Suction loss during SMILE is a rare complication. Good visual outcome was achieved by switching to LASIK.

Clinical Outcomes of Beveled, Full Thickness Astigmatic Keratotomy

PURPOSE: To evaluate the beveled, full thickness astigmatic keratotomy. METHODS: This study included 185 eyes of 112 patients treated with beveled, full thickness astigmatic keratotomy. Treated eyes were divided into 3 groups: beveled, full thickness astigmatic keratotomy after implantable collamer lens (ICL) implantation (group A), beveled, full thickness astigmatic keratotomy after cataract surgery (group B) and beveled, full thickness astigmatic keratotomy alone (group C). Follow-up visits were at 1 week, 1 month, 3 months and 6 months. The outcome measures included uncorrected distance visual acuity, astigmatism, efficacy, safety and predictability. RESULTS: At 6 months postoperatively, astigmatism was significantly reduced: 68.9 +/- 18.24% in total, 69.24 +/- 20.76%, in the group A, 67.84 +/- 17.56% in the group B and 67.82 +/- 13.97% in the group C. The proportion of eyes with astigmatism 1.0 or less was 88.65% in total, 91.49% in the group A, 87.5% in the group B and 70.0% in the group C. Mean improvement in corrected distance visual acuity (CDVA) was 0.56 lines; no eyes lost 2 lines of CDVA after 6 months postoperatively. Postoperative complications were not observed. CONCLUSIONS: This study showed the beveled, full thickness astigmatic keratotomy is effective and safe for correcting astigmatism alone as well as correcting astigmatism after ICL implantation or cataract surgery.

Outcomes of Small Incision Lenticule Extraction: Mild to Moderate Myopia versus High Myopia

PURPOSE: To evaluate the refractive outcomes of small incision lenticule extraction (SMILE) in high myopia patients compared with mild to moderate myopia patients. METHODS: This study included 332 eyes of 166 myopic patients treated with SMILE using Visumax 500 kHz femtosecond laser. Treated eyes were divided into 2 groups according to preoperative spherical equivalent (SE): mild to moderate myopia (A group, or =-6.0 D). Follow-up visits were at 1 day, 1 week, 1 month, 3 months, and 6 months. The outcome measures included uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BDVA), postoperative SE, efficacy index, safety index and predictability. RESULTS: Preoperative SE was -4.85 +/- 0.86 D in the A group and -7.70 +/- 1.0 D in the B group. No differences were observed between -0.04 +/- 0.29 D in the A group and -0.30 +/- 0.37 D in the B group at 6 months postoperatively (p = 0.062). At 6 months postoperatively, 98.3% and 97.3% had UDVA of 20/25 or better in the A group and B group, respectively. In the A group, 97.3% and 100% were within +/-0.5 D and +/-1.0 D of intended correction and in the B group, 91.7% and 96.9% were within +/-0.5 D and +/-1.0 D, respectively. Efficacy indices were 1.02 +/- 0.19 in the A group and 0.99 +/- 0.18 in the B group. Safety indices were 1.16 +/- 0.16 in the A group and 1.14 +/- 0.16 in the B group. The efficacy and safety indices were not significantly different between the A and B groups at 6 months postoperatively (p = 0.09, p = 0.695, respectively). CONCLUSIONS: This study showed that SMILE is effective and safe for correcting high myopia as well as mild to moderate myopia.

Two Cases of Treatment of Extreme Myopia using combined Anterior Chamber Phakic Intraocular Lens and Laser In Situ Keratomileusis

PURPOSE: For patient with extreme myopia outside the suspected limit of single procedure alone, we performed Lasik as a secondary procedure for the correction of residual refractive error following phakic IOL implantation. METHODS: First, we made a corneal flap using ACS(Bauch & Lomb surgical/Chirom vision, Irvine, CA) due to the potential risk of endothelial damage by cornea-IOL contact during the flap dissection. One month later, phakic IOLs, Nuvita MA20 (Bauch & Lomb surgical/Chiron vision, Irvine, CA) implantation were done, and 4 months after IOL implantation, stromal ablation was performed with the eximer laser by using previously formed flap. RESULTS: Preoperative spherical equivalent refraction was -25.0 D of Rt eye, -24.0 D of Lt eye, and preoperative visual acuity was 20/500 (best spectacle corrected visual acuity; BSCVA: 20/50) of Rt eye, 20/200 (BSCVA: 20/40) of Lt eye. Spherical equivalent refraction following phakic IOL implantation was -4.25 D of Rt eye, -3.75 D of Lt eye and refractive cylinder was -1.0 D cyl x90 A, visual acuity was 20/100 (BSCVA: 20/40) of Rt eye, 20/100 (BSCVA: 20/40) of Lt eye. Spherical equivalent refraction at the last examination following LASIK was -0.75 D of Rt eye, -0.5 D of Lt eye and visual acuity was 20/25 (BSCVA: 20/25) of Rt eye, 20/25 (BSCVA: 20/25) of Lt eye. CONCLUSIONS: Bioptics by combined anterior chamber phakic intraocular lens and laser in situ keratomileusis is one of the effective methods for patients with refractive error of extreme myopia outside the suspected limits of single procedure alone. Longer follow-up of large number of cases is needed to fully assess the safety and complications.

Clinical and Histology Findings of Corneal Graft Safety Ring Implanted in Rabbit Cornea

PURPOSE: We developed corneal graft safety ring for improving of penetrating keratoplasty success rate and minimizing the refractive error, and evaluated its stability in the rabbit cornea. METHODS: Following circular corneal incision (depth: 200 microgram, diameter: 7.5 mm) with 7.5 mm Hess-Burg barron vaccum trephine, corneal stroma was dissected toward the corneal center with 6.5 mm diameter. After insertion of the corneal graft safety ring (diameter: 6.0 mm, thickness: 0.15 mm), we examined gross and histologic findings of the rabbit cornea at postoperative 1week, 1month, 3months. RESULTS: The corneal graft safety ring was maintained stable in rabbit cornea for 3months grossly. Histologic finding around corneal graft safety ring showed inflammatory cells and neovascularization which was increased by 1month, and thereafter decreased markedly and maintained stable. CONCLUSIONS: Corneal graft safety ring implantation seemed to be an amenable procedure for improving penetrating keratoplasty outcome.

Results of Nuvita Phakic Anterior Chamber Intraocular Lens for High Myopia

PURPOSE: The study was designed to evaluate the clinical results of an anterior chamber intraocular lens implantation (Nuvita MA 20 implantation) on high myopic patients. METHODS: We reviewed the clinical results of Nuvita MA 20 implantation surgery in 6 high myopic patients (11 eyes) with more than -7.0 diopters (D) for a year after the surgery. One patient was male,five patients were female and the mean age was 31.5 years old (25~41 years old). RESULTS: Mean preoperative spherical equivalent was -16.61 4.9 D and mean postoperative spherical equivalent was -0.9+/-0.5 D at 1 week, -1.275+/-1.14 D at 1 month, -1.14+/-1.22 D at 3 months, -1.18+/-1.18 D at 6 months and -1.05+/-1.2 D at 12 months. Mean uncorrected visual acuity preoperatively was 0.03+/-0.06 and postoperatively was 0.6+/-0.25 at 1 week, 0.57+/-0.25 at 1 month, 0.67+/-0.4 at 6 months, 0.8+/-0.32 at 12 months. Postoperative complications included 6 eyes of IOL rotation (55%), 4 eyes of pupil distortion (36%), 1 eye of intraocular pressure elevation (9%), 1 eye of pupillary block (9%), 1 eye of IOL decentration (9%) and 1 eye of nuclear cataract (9%), but serious postoperative complications such as retinal detachment and bullous keratopathy were not found. Mean endothelial cell density was 2677+/-148 (cells/mm2) at preoperative period, 2576+/-167 (cells/mm2) at 1 month, 2546+/-127 (cells/mm2) at 3 months, 2490+/-171 (cells/mm2) at 6 months and 2408+/-133 (cells/mm2) at 12 months. CONCLUSIONS: The implantation of Nuvita MA 20 into anterior chamber is considered to be a safe method of treatment for patients with high myopia.

Gramoxone Poisoning Victims as Corneal Transplantion Donors

PURPOSE: Paraquat (Gramoxone;1,1'dimethyl 4,4'-dipyridilium) is a toxic herbicide. It is ingested accidently or for the purpose of suicide in rural community. Having experienced four patients receiving donor corneas from the victims of Gramoxone poisoning, we report these cases with the review of the literature. METHODS: Four corneas donated by two males who died of Gramoxone intoxication were used in corneal transplantation of 4 patients. RESULTS: At postoperative 12 months, uncorrected visual acuity in each of the 3 patients was 0.1, 0.3 and 0.04, and each cornea maintained transparency. One patient had a retransplantation due to corneal epithelial cell defect and at postoperative 12 months, uncorrected visual acuity was 0.9.

Clinical Results and Complications of LASIK using Technolas 217 C-LASIKTM

We evaluated clinical results and complications of LASIK using Technolas 217 C-LASIKTM excimer laser. This study included 102 patients(203 eyes) who had LASIK from March 1998 to February 1999 and followed up for at least 6months. Preoperative mean spherical equivalent was -3.99+/-1.198(SD), -7.928+/1.138(SD)and -11.92+/-1.060(SD)in each group I, II, III.The results at postoperative 6months were as following: 1. Mean spherical equivalent was -0 .44+/-0.410(SD), -0.34+/-0.500(SD), -0.37+/-0.430(SD)in each group I, II, III. 2. The 70 eyes(65%), 48 eyes(61%), 10 eyes(60%)in each group I, II, III were within+/-0.5D. 3. Mean uncorrected visual acuitywas 1.00+/-0.130(SD), 0.96+/-0.140(SD), 0.86+/-0.150(SD)in each group I, II, III. 4. Loss of best spectacle corrected visual acuity of two or more lines was 6 eyes(3%). Intraoperative complications was thin flap(5 eyes, 2.5%), flap tear(1 eyes, 0.5%)and postoperative complications was night glare and halo(58 eyes, 28.8%), punctate epithelial keratopathy(35 eyes, 12.3%)and interface foreign body(23 eyes, 11.3%). Above results suggests that myopic keratomileusis using Technolas 217 C-LASIKTM is a safe, effective way to correct myopia.

Correlation between Lens Thickness and Anterior Chamber Depth after Cataract Operation

The accuracy of intraocular lens power calculation in cataract surgery depends on three factor :accuracy of the biometric data[axial length, corneal power, predicted pseudophakic anterior chamber depth], accuracy of manufacturer of IOL power quality, and accuracy of the IOL power formulas usedto obtain desired lens power. We retrospectively analyzed 27 patients[40 eyes] who had taken 3.2 millimeterscleral tunnel incision and been implanted with Silicone IOL. We evaluated the correlation between pseudophakic anterior chamber depth and preoperative lens thickness. And, we calculated the ratio of anterior and posterior distance from the central point on the presumption that there is the central point remaining constant despite of thickening of lens. The preoperative mean lens thickness was 4.47 +/-0 .4 9 mm. The change of anterior chamber depth was significantly increased according to the lens thickness at postoperaitve 3months[r=0.57, p<0.01]. The mean ratio of anterior and posterior distance from central point was 0.29:0.71. This result suggests that the postoperative anatomical center of IOL will change more posterior as increasing preoperative lens thickness. And we concluded that we would more exactly predict postoperative pseudophakic anterior chamber depth considering the preoperative lens thickness if the ratio of lens thickening was constant.

Endothelial Cell Changes after Penetrating Keratoplasty

The purpose of this study was to investigate the correlations between endothelial cell loss rate at one week, one month, three months, and six months after penetrating keratoplasty and clinical factors including recipient age, donor age, preoperative endothelial cell densities of the donors and preoperative diagnoses of the recipients. Among the 70 patients who underwent penetrating keratoplasty at Chonbuk University Hospital from December 1996 to January 1999, 30 eyes of 30 patients that showed reasonable endothelial resolution by non-contact specular microscopy during the follow up period of 6 months were chosen and evaluated.The cell density decreased continuously during the observation period. Endothelial cell loss rate averaged 11.5%at one week, 19.0% at one month, 25.0%at three months and 30.0%at six months after penetrating keratoplasty. Endothelial cell loss rate showed no significant correlation with donor age, recipient age, preoperative cell density at any examination period[r+/-0.4, p0.05]. Preoperative endothelial cell density showed significant correlation with postoperative endothelial cell density at each examination period[r0.7, p<0.05]. The rate of endothelial loss in the keratoconus group was significantly lower than those of bullous keratopathy or corneal leukoma groups at three months after penetrating keratoplasty[Wilcoxon test, p<0.05].

The Effect of Intraocular 1% Lidocaine on the Corneal Endothelium during Phacoemulsification

The aim of this study was to evaluate the influence of intraocular 1% lidocaine as an adjunct to topical anesthesia on corneal endothelial cell during phacoemulcification. We evaluated 38 patients(50 eyes). All patients underwent phacoemulsification and PCL implantaion. Twenty five eyes were used intraocular 1% lidocaine and topical anesthesia and others used only topical anesthesia. Endothelial cell density was examind preoperatively, and at 1 day, 1 week, 1 and 2 months postoperatively by specular microscopy. The difference of preoperative endothelial cell density between two groups was not statistically significant. In lidocaine-used group, the average endothelial cell loss was 7. 6%, 9. 2%, 10.4%, 10.6%at 1 day, 1 week, 1 and 2 months. In non used group, the average endothelial cell loss was 7. 4%, 9. 4%, 9. 9%, 11. 7%at 1 day, 1 week, 1 and 2 months. The difference of postoperative endothelial cell density between two groups was not statistically significant(P>0.1). From these results, we conclude that the intraocular lidocaine infusion for anesthesia had little effect on the corneal endothelial cell loss.

Change of Incision Wound after Folded Intraocular Lens Insertion Through 4.0 and 3.2 mmWidth Scleral Tunnel Incision

Two different scleral tunnel incision widths were studied to determine whether the difference of cornea wound extension existed in each scleral tunnel incision widths(4 mm, 3.2 mm).25 patients in group A undergoing phacoemulsification through approximately 4 mmwidth scleral tunnel and folded silicone IOL implantation were studied with internal incision gauge after initial keratome entry, phacoemulsification, and folded IOL implantation. Same procedure was done in group B patients except 3.2 mmscleral tunnel width was made instead. After completion of phacoemulsification, the incision was further widened by a mean of 0.05 mmin both groups. Forceps insertion of silicone IOL resulted in further incision enlargement by a mean of 0.15 mmin group A, and 0.05 mmin group B. No difference was found between the intraoperative or postoperative wound stabilities between two incisions. Vector analysis calculations of mean postoperative induced astigmatism for 4.0 mmincision versus 3.2 mmincision were -0.33D versus -0.20D at 3 month. Therefore, although 4 mmscleral tunnel incision resulted in larger wound extension and induced astigmatism, it showed same wound stability and easier implantation of IOL relative to 3.2 mmscleral tunnel incision. It is necessary that proper scleral tunnel incision width is selected based on degree of surgical skill and compliance of patients.

Enlargement of Incision During Phacoemulsification and Folded Intraocular Lens Implant Surgery

As a study that the incision size was changed at each step of the surgical procedure but it is different, from the universal assumption that. the incision width initially created by a keratome during cataract extraction remained same size after the end of the surgical procedure, the authors investigated a comparative study between the two studies. We used specially designed instrument for accurate measuring of the incision size in 100 eyes and the incision size was measured after the creation of the initial incision, after the coirlpletion of phacoemulsification, after widening the incision and after the folded IOL insertion. Dividing group A and B in 50 eyes respectively, we designated the incision enlargement with 3.0mm keratome as A and 3.2mm keratome as B. It appeared statistically significant widening of the incision by approximately 0.06mm after the completion of phacoemulsification, 0.19mm after the folded IOL insertion in group A and 0. 05mm, 0.1mm in group B, respectively. Future studies of the surgical techniques and the postoperative healing after small incision cataract surgery must measure the actual incision size to avoid misleading assumption that the keratome size at the beginning of the procedure determines the incision size at. the end of the procedure.

Recovery from Neovascular Glaucoma after Treatment with Ahmed Glaucoma Valve Implantation in Ocular Ischemic Syndrome

Ocular ischemic syndrome is caused by reduction of blood to the eyeball, which can prodece anterior and posterior segment ischemia. Initial symptom include sudden or gradual loss of vision and eyeball pain. Anterir segment findings are conjunctival injection, iris neovascularization(NV), angle NV,peripheralanterior synechiae, and lens opacity. Posterior segmentfindings are pale, cupped of edematous opticdisc, disc NV, retinal NV, retinal hemorrhage, cherry red spot, retinal arterioles attenuation or sclerosis, and centralretinal artery collapse with pressure on globe. We have experienced a patient who had left ophthalmic artery stenosis, right ophthalmic artery narrowing and neovascular glaucoma in both eyes. We report the case of ocular ischemic syndrome that had control of IOP, mild improvement of visual acuity and regression of neovascularization after Ahmed glaucoma valve implantation.

Two Cases of Cataract in Two Sisters with Myotonic Dystrophy

Myotonic dystrophy is a muscular disease that is transmitted in autosomal dominant pattern. Typical features are myotonicity due to defective muscular relaxation after its contraction and muscular dystrophy. Ophthalmologic complications are cataract, retinal degeneration, hypotony, ptosis, extraocular muscle weakness, and saccadic eye movement defect. Cardiomyopathy, abnormal conduction of cardiac muscle, alopecia of frontal head, testicular atrophy, diabetes mellitus, decreased pulmonary function, and mental retardation are complications of other organs in this disease. Authors experienced two cases of cataract in two sisters with myotonic dystrophy.