Imbalance between myopic shift and the minimum amplitude of accommodation: a hypothesis for the pathogenesis of ocular hypertension secondary to drug-induced bilateral acute ciliochoroidal effusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report 5 cases with drug-induced bilateral acute ciliochoroidal effusion(DBACE)and myopic shift, with or without ocular hypertension(OHT), summarize patients' clinical characteristics and recovery process of DBACE, and investigate the possible pathophysiological mechanism.METHODS:A retrospective observational case study conducted from June 2017 to February 2021. The included patients were subjected to a series of ocular examinations listed as follows: 1)best corrected visual acuity; 2)intraocular pressure(IOP); 3)slit-lamp microscopy; 4)fundus photography; 5)ultrasound biomicroscopy(UBM); 6)subjective optometry; 7)axial length and anterior chamber depth. All patients were followed up every 2d until the diopters were completely restored to the state before the disease onset.RESULTS:In total, 5 patients aged 10-45 years old, including 3 female and 2 male patients, were enrolled in this study. All patients were bilaterally involved(5/5), and had myopic shift(5/5), of whom 3 patients had OHT(3/5). With the increase of age, myopic shift decreased, while OHT increased. Based on OHT, the dynamic aggravation process of DBACE was subdivided into 2 stages, stage 1(myopic shift without OHT)and stage 2(myopic shift with OHT). With the deterioration of DBACE, when myopic shift approached or exceeded the minimum amplitude of accommodation(MAA), IOP gradually rose, and DBACE progressed from stage 1 to stage 2. With the recovery of DBACE after discontinuing the suspicious drugs, DBACE in stage 2 first returned to stage 1, and then returned to normal.CONCLUSION:Pathophysiological mechanism of DBACE was subdivided into 2 stages, including stage 1(myopic shift without OHT)and stage 2(myopic shift with OHT). The transition between the two stages depends on the imbalance between myopic shift and MAA.

Refractive changes during off-the-axis retinoscopy in myopia

Purpose: To analyze the refractive shift during off?the?axis retinoscopy under cycloplegic drugs in myopic patients during ocular examination. Methods: Prospective cross?sectional study was carried out among 10 myopic patients having refractive errors of ?3.00 D or less. All the subjects underwent cycloplegic refraction by a single examiner at 0°, 10°, and 20°. Descriptive data were analyzed as mean and standard deviation. Paired t?test was used to compare the mean differences between on?axis (0°) and off?axis (10° and 20°) retinoscopy. Result: The mean spherical equivalent refraction of 10 myopic patients showed an increase in myopic shift with approximately 7% and 18% for 10° and 20° of eccentricity, respectively. Similarly, the mean spherical equivalent measure on axis (0°) and off axis (10° and 20°) were ?2.5495, ?2.737, and ?3.0265, respectively. The mean spherical equivalent differences between on?axis (0°) and off?axis (10° and 20°) showed statistically significant differences with P < 0.05. Conclusion: This study concluded that a greater degree of eccentricity will induce a greater amount of errors in retinoscopy

A comparative study of knotless versus knotted transscleral suture-fixated intraocular lens implantation

Purpose: To compare functional outcomes and complication rates of two scleral fixated intraocular lens implantation (SFIOL) techniques. Methods: In this retrospective study, there were 30 eyes of 30 patients who underwent SFIOL implantation for dislocation of the IOL or crystalline lens. Group 1 (n = 17) comprised patients who received scleral?fixated polymethylmethacrylate (PMMA) IOL implantation through a self?sealing sclerocorneal tunnel with the suture burial technique, and group 2 (n = 13) comprised patients who received scleral?fixated foldable acrylic IOL implantation with a cartridge using a self?sealing clear corneal incision (CCI) with knotless Z?suture technique between 2014 and 2019. Surgical outcomes concerning safety, efficiency, visual function, induced astigmatism with vector analysis, and complications were compared. Results: The indications were dislocated crystalline lens (n = 5/30), dislocated IOL (n = 17/30), and dropped nucleus (n = 8/30). The mean follow?up time was 50.65 ± 14.02 months in group 1 and 15.69 ± 3.71 months in group 2 (P < 0.001). The postoperative visual acuity improvement was statistically significant in both groups (P < 0.001). Surgically induced astigmatism was significantly higher in group 1 (2.68 ± 1.04 D) compared with group 2 (1.6 ± 1.0 D) at month 12 (P = 0.001). Postoperative complications included suture exposure (n = 1 in group 1) and cystoid macular edema (n = 1 in group 1; n = 1 in group 2). Conclusion: Both SFIOL techniques are safe and effective in the absence of adequate capsular support. However, the knotless Z?suture technique appears to be superior to the suture burial technique with regard to suture exposure?related complications. In addition, self?sealing CCI appears to be superior to self?sealing sclerocorneal tunnel with regard to surgically induced astigmatism

Short Term Visual and Refractive Outcome following Surgical Intervention forPosterior Capsule Opacification (PCO) in Children in a Tertiary Eye Hospital

BACKGROUND: PCO occurs commonly postoperatively followingcataract extraction in children, obscuring vision as did the initialcataract. It may require a second surgical procedure when it is dense.It is expected that this results in restoration of vision and it is importantto ascertain that this is the case as well as to examine any significantchanges in refraction thereafter.M ETHODS: A retrospective observational study extractingdemographic and clinical information from case notes of patients whohad membranectomy and/or capsule polishing between October 2017and September 2018.RESULTS: 57 eyes of 51 patients were enrolled. There was a 2:1male: female ratio. Mean age at cataract surgery was 6.33 3.59yearswhilst that for PCO surgery was 9.68 3.89years. Postoperativevisual acuity (by WHO definition) was good (between 6/6 and 6/18)in 33.3%, compared to 8.8% preoperatively. Whereas presenting visualacuity was poor (<6/60) in 61.4% preoperatively, this reduced to30% postoperatively. Visual outcome was influenced by age at cataractsurgery, age at PCO surgery, interval between cataract and PCO surgeryand type of cataract. Children >8 years of age at time of PCO surgeryhad a greater proportion of good post-operative best corrected visualacuity (BCVA) (52.6%), whilst 75% of children younger than 8yearsat time of surgery turned out with poor BCVA after surgery.Developmental cataracts proportionately had the best outcome ofvisual acuity. There was a range of refractive shift of +0.25D to ­5.25D with a mean myopic shift of ­1.51D following membranectomy. CONCLUSION: There was a good proportion of children withsignificant improvement in visual acuity on the short term,and a mildmyopic shift following membranectomy.

Long-term results of in-the-bag primary intraocular lens implantation in children younger than 24 months / Resultados a longo prazo de implante primário de lente intraocular no saco capsular em crianças menores que 24 meses

ABSTRACT Purpose: The purpose of this study was to analyze the safety of primary intraocular lens implantation in a large number of eyes in children aged <24 months. Methods: The medical records of patients aged 5-24 months, who underwent primary intraocular lens implantation in the capsular bag, were reviewed. A foldable three-piece acrylic intraocular lens was implanted by the same surgeon using a single surgical technique. Patients who had <1 year of follow-up after the surgery were excluded. The main outcome measurements included visual acuity, myopic shift, follow-up complications, and additional surgeries. Results: Sixty-eight patients (93 eyes) were analyzed. The mean age of the patients at the time of surgery was 15.06 ± 6.19 months (range: 5-24 months), and the spherical equivalent 1 month after surgery was 3.62 ± 2.32 D. After 5.67 ± 3.10 years, the spherical equivalent was -0.09 ± 3.22 D, and the corrected distance visual acuity was 0.33 ± 0.33 and 0.64 ± 0.43 logMAR in bilateral and unilateral cases, respectively (p=0.000). The highest myopic shift was observed in infants who underwent surgery at ages 5 and 6 months. The most frequent complications included visual axis opacification and corectopia. Glaucoma and retinal detachment were not reported. Conclusion: Primary in-the-bag intraocular lens implantation in children aged 5-24 months is safe, and is associated with low rates of adverse events and additional surgery.

RESUMO Objetivo: O objetivo deste estudo foi analisar a segurança do implante de lente intraocular primária em um grande número de olhos em crianças <24 meses. Métodos: Foram revisados os prontuários de pacientes com idade entre 5-24 meses, submetidos a implante primário de lente intraocular no saco capsular. Uma lente intraocular acrílica de três peças dobrável foi implantada pelo mesmo cirurgião usando uma única técnica cirúrgica. Pacientes que tiveram <1 ano de acompanhamento após a cirurgia foram excluídos. Os principais resultados incluíram medidas de acuidade visual, mudança miópica, complicações pós operatórias e cirurgias adicionais. Resultados: Foram analisados 68 pacientes (93 olhos). A média de idade dos pacientes no momento da cirurgia foi de 15,06 ± 6,19 (5 a 24) meses, e o equivalente esférico 1 mês após a cirurgia foi de 3,62 ± 2,32 D. Após 5,67 ± 3,10 anos, o equivalente esférico foi de -0,09 ± 3,22 D, e a acuidade visual corrigida à distância foi de 0,33 ± 0,33 e 0,64 ± 0,43 logMAR em casos bilaterais e casos unilaterais, respectivamente (p=0,000). A maior mudança míopica foi observado em bebês submetidos à cirurgia aos 5 e 6 meses de idade. As complicações mais frequentes incluíram opacificação do eixo visual e corectopia. Glaucoma e descolamento de retina não foram relatados. Conclusão: O implante primário de lente intraocular no saco capsular em crianças de 5-24 meses é seguro e está associado à baixas taxas de eventos adversos e cirurgias adicional.

Refractive outcomes of a single-step and a two-step approach for silicone oil removal and cataract surgery

Purpose: To compare the intermediate-term refractive outcomes of a single-step and a two-step approach for silicone oil removal (SOR) and cataract surgery. Methods: Case records of patients who had SOR and phacoemulsification (PE) from 2011 to 2013 at a tertiary center in South India were retrospectively analyzed. A total of 135 eyes that underwent ultrasound biometry (UB) were studied. Eighty-seven eyes had SOR and PE at a single surgery (Group A), where as UB was done in a silicone oil (SO) filled eye. Forty-eight eyes had SOR followed by PE later (Group B), where UB was done in a fluid-filled eye. The refractive error (RE) and best-corrected visual acuity (BCVA) at postoperative day 45 (D45) and postoperative month 3 (M3) were compared. Results: Baseline axial length, intraocular lens (IOL) power, and RE in both groups were comparable. A myopic shift (4.18 ± 5.47 diopters [D]) was noted in 92% eyes at M3. Forty-nine percent eyes had a RE of ?±1.5D at M3. RE at D45 and at M3 was significantly lesser in Group B (?1.73 ± 2.04 vs. ?0.64 ± 1.75; P, 0.002). BCVA was significantly lesser in Group A at baseline, at D45, and at M3 (P < 0.01 for all). There was no difference in other baseline characteristics of eyes that had RE ?±1.5D and those that had RE >±1.5D at M3. Conclusion: SO-filled eyes had a myopic shift in refraction after SOR and PE. When UB is used for IOL power calculation, better refractive outcomes are obtained when SOR and PE are performed in a two-step approach.

Myopic Shift after Implantation of a Novel Diffractive Trifocal Intraocular Lens in Korean Eyes

PURPOSE: To evaluate the clinical outcomes of cataract surgery using novel diffractive trifocal intraocular lenses (IOLs) in Koreans. METHODS: This was a retrospective, consecutive, interventional study of cataract surgery using POD FineVision IOL implantation. Complete ophthalmologic examinations were performed preoperatively and postoperatively. Defocus curves were assessed over a range of +1.5 to −4.0 diopters in 0.5-diopter steps at one month postoperatively. Uncorrected distant visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distant visual acuity, distant-corrected intermediate visual acuity, and distant-corrected near visual acuity were assessed one month postoperatively, and manifest refraction was performed during every visit. RESULTS: The study analyzed 31 eyes in 20 patients. There were statistically significant improvements in uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distance visual acuity, distance-corrected intermediate visual acuity, and distance-corrected near visual acuity (p < 0.001). The final postoperative refractive outcomes showed statistically significant myopic shifts compared to the target refraction based on SRK/T, SRK-II, Haigis, and Hoffer Q formulas (p < 0.001). CONCLUSIONS: POD FineVision IOLs provide stable visual restoration with improvements of near and intermediate vision in presbyopic eyes. POD FineVision IOLs show myopic shift in a Korean population; therefore, surgeons should be cautious when selecting IOL power in such patients.

Intraocular Lens Power Estimation in Combined Phacoemulsification and Pars Plana Vitrectomy in Eyes with Epiretinal Membranes: A Case-Control Study

PURPOSE: To evaluate the accuracy of postoperative refractive outcomes of combined phacovitrectomy for epiretinal membrane (ERM) in comparison to cataract surgery alone. MATERIALS AND METHODS: Thirty-nine eyes that underwent combined phacovitrectomy with intraocular lens (IOL) implantation for cataract and ERM (combined surgery group) and 39 eyes that received phacoemulsification for cataract (control group) were analyzed, retrospectively. The predicted preoperative refractive aim was compared with the results of postoperative refraction. RESULTS: In the combined surgery group, refractive prediction error by A-scan and IOLMaster were -0.305+/-0.717 diopters (D) and -0.356+/-0.639 D, respectively, compared to 0.215+/-0.541 and 0.077+/-0.529 in the control group, showing significantly more myopic change compared to the control group (p=0.001 and p=0.002, respectively). Within each group, there was no statistically significant difference in refractive prediction error between A-scan and IOLMaster (all p>0.05). IOL power calculation using adjusted A-scan measurement of axial length based on the macular thickness of the normal contralateral eye still resulted in significant postoperative refractive error (all p<0.05). Postoperative refraction calculated with adjusted axial length based on actual postoperative central foveal thickness change showed the closest value to the actual postoperative achieved refraction (p=0.599). CONCLUSION: Combined phacovitrectomy for ERM resulted in significantly more myopic shift of postoperative refraction, compared to the cataract surgery alone, for both A-scan and IOLMaster. To improve the accuracy of IOL power estimation in eyes with cataract and ERM, sequential surgery for ERM and cataract may need to be considered.

Long-term results after primary intraocular lens implantation in children operated less than 2 years of age for congenital cataract.

Purpose: To study the long‑term outcome of cataract surgery with primary intraocular lens (IOL) in children <2 years. Materials and Methods: Retrospective analysis of bilateral cases that were operated before 2 years age for congenital cataract. All underwent primary posterior capsulotomy with anterior vitrectomy and primary IOL implantation. Only those with a follow‑up of at least 8 years were evaluated. Results: Twenty‑six eyes of 13 children with bilateral cataract met the inclusion criteria. Average age at surgery was 14.15 months with a mean follow‑up of 102 months. Average preoperative axial length (AL) was 19.93 mm. There was a refractive shift from a mean spherical equivalent of 1.64 D at 2 weeks after surgery to -1.42 D measured at last follow‑up. Twenty‑four eyes out of 26 (92%) achieved final visual acuity (VA) of 6/18 or more at last follow‑up with 19/26 (73%) having acuity of 6/12 or greater. Raised intraocular pressure was documented in one eye only. Average AL recorded at last follow‑up was 22.21 mm. Conclusion: Primary IOL implantation in children <2 years is a safe surgical procedure with excellent long‑term results. The myopic shift is well‑controlled and final VA achieved is reasonably good.

Anterior segment optical coherence tomography documentation of a case of topiramate induced acute angle closure.

We present a case report of a 31-year-old female patient who presented to us with a 1 day history of acute bilateral eye pain, blurred vision and headache. She was found to have a myopic shift, raised intraocular pressure (IOP) and shallow anterior chambers in both eyes. She had been commenced on oral topiramate 1 week previously. A number of investigations, including anterior segment optical coherence tomography (AS-OCT) were done and a diagnosis of topiramate induced bilateral acute angle closure (TiAAC) was made. Topiramate was discontinued and she was managed with topical and oral antiglaucoma medications, topical steroids and cyclopegics. Her symptoms subsided dramatically at the next follow-up. The AS-OCT documentation revealed lucidly the improvement in her anterior chamber depth and anterior chamber angle parameters. Her IOP decreased, her myopic shift showed reversal and her AS-OCT fi ndings revealed gross improvement in all the parameters angle opening distance, trabecular iris space area and scleral spur angle. This case report clearly shows with AS OCT documentation the changes which occur in the anterior segment in a case of TiAAC.

Myopic Shift Following Selective Laser Trabeculoplasty: A Case Report.

Introduction: Selective laser trabeculoplasty (SLT) (Lumenis, Santa Clara, CA) was developed in 1999 as a means to lower IOP in patients with glaucoma. It is a relatively safe procedure. We report a rare side effect of anterior chamber shallowing with myopic following SLT. Case Presentation: A 48 year-old white female who underwent SLT OD developed a 4- diopter myopic shift and anterior chamber shallowing 1 week following SLT. Both the anterior chamber shallowing and the myopic shift resolved within 5 weeks. Conclusion: Anterior chamber shallowing and myopic shift following SLT is a rare side effect but is reversible. Physicians and patients should be aware of this potential side effect of SLT.

Influence of Watching 3D Television on Refractive Error in Children with Exodeviation

PURPOSE: To investigate the effects of watching three-dimensional (3D) television (TV) on the angle of deviation and refractive error in children with exodeviation. METHODS: Twenty-three volunteers with exodeviation, aged 6 to 12 years, without any ocular abnormalities other than refractive error and exodeviation were recruited for this study. The subjects watched 3D TV for 50 minutes at a viewing distance of 2.8 meters. The image disparity of 3D contents was -1 to 1 degree. Refractive errors were measured before and immediately after watching TV and after a 10-minute rest. The changes in angle of deviation were also obtained. Refractive errors and angle of deviation before and after watching 3D TV were compared. RESULTS: The mean age of the subjects was 9.30 +/- 1.58 years. The mean baseline angle of deviation was 13.04 +/- 5.25 (6-30) prism diopters (PD), which did not change significantly immediately after watching 3D TV and after a 10-minute rest (p = 0.452). The mean refractive errors were -2.15 +/- 1.55 D in the right eye and -2.06 +/- 1.55 D in the left eye before and changed to -2.14 +/- 1.57 D and -2.11 +/- 1.45 D, respectively, immediately after watching 3D TV. After a 10 minute rest, the mean refractive errors were 2.14 +/- 1.53 D in the right eye and -2.07 +/- 1.53 D in the left eye. All changes in refractive errors were not statistically significant (p = 0.991 in right eye, 0.495 in left eye). The amount of myopic shift in both eyes immediately after watching 3D TV was correlated with the angle of exodeviation (r = 0.468, p = 0.024). However, the correlation disappeared after a 10-minute rest (r = 0.345, p = 0.107). CONCLUSIONS: Watching properly made 3D contents on 3D TV for 50 minutes at more than 2.8 meters of viewing distance did not affect the refractive error in children with exodeviation. Further studies on the relationship between the amount of myopic shift and the angle of exodeviation are necessary.

Transient Myopic Shift Due to Increased Latent Accommodation after LASEK

PURPOSE: To investigate accommodation and progress of patients who showed myopia on manifest refraction in the early postoperative period after LASEK. METHODS: Forty-one eyes were included in the present study which had undergone LASEK surgery from February to March 2012. Seven eyes showed myopia over -0.25 D on manifest refraction at 1 month postoperatively, but showed decreased amount of myopia at 2 months postoperatively and were classified as group 1. The other 34 eyes were classified as group 2. The differences between cycloplegic and manifest refraction (CRSE-MRSE) were defined as the amount of latent accommodation and compared between the 2 groups. RESULTS: Amount of latent accommodation was 0.179 +/- 0.426 D in group 1 (7 eyes), 0.265 +/- 0.303 D in group 2 (34 eyes) preoperatively, 1.286 +/- 0.664 D in group 1, 0.368 +/- 0.536 D in group 2 at 1 month postoperatively, and 0.500 +/- 0.520 D in group 1, and 0.489 +/- 0.546 D in group 2 at 2 months postoperatively. The amount of latent accommodation in group 1 was significantly greater than that of group 2 one month postoperatively. As the amount of latent accommodation decreased, the amount of myopic shift decreased gradually over 2 months in group 1 after surgery. CONCLUSIONS: Transient myopic shift due to increased latent accommodation was observed in several patients one month postoperatively and the amount of myopic shift decreased with time without treatment. Thus, surgeons should consider cycloplegic refraction when planning treatment for patients with myopic regression.

Prevalence of myopic shifts among patients seeking cataract surgery / Prevalencia de cambios miópicos en pacientes con catarata

Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males). A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%). The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.

La cirugía moderna de facoemulsificación del cristalino tiene una recuperación muy rápida. La elección correcta del lente intraocular que se coloca en la cirugía permite, muchas veces, anticipar si el paciente va a precisar anteojos luego de la cirugía. Este estudio analiza una muestra de pacientes con catarata, mostrando la frecuencia relativa de cambios miópicos que permiten a los pacientes ver de cerca sin lentes antes de la cirugía. Se estudiaron retrospectivamente una serie de pacientes consecutivos que realizaron cirugía electiva de catarata. El cambio refractivo miópico fue documentado comparando las prescripciones antiguas con la medición subjetiva al momento del estudio. Los sujetos fueron agrupados de acuerdo a la presencia o ausencia de cambios miópicos, y se estudiaron las proporciones con respecto a su grado de opacidad nuclear. La edad promedio de los 229 sujetos estudiados fue de 71.5 ± 10.4 años, 109 (47.6%) varones. Se halló un cambio miópico, definido como un cambio mayor de - 0.5 dioptrías, en 85 (37.1%, IC95%: 30.8-43.4%). El porcentaje de sujetos con cambio miópico fue significativamente mayor en aquellos que tenían mayor opacidad nuclear al tiempo del examen. En este estudio de pacientes no seleccionados que buscaban realizar cirugía de catarata, más de un tercio tuvo cambios miópicos en la refracción. Si el paciente lograba ver bien de cerca antes de la cirugía, esto debería ser tenido en cuenta a la hora de elegir un correcto lente intraocular para que el sujeto no pierda este beneficio de la catarata.

Early Capsular Block Syndrome after Phacoemulsification with Posterior Chamber IOL Insertion Combined with Vitrectomy

PURPOSE: To report early capsular block syndrome (CBS) after phacoemulsification with posterior chamber intraocular lens (IOL) insertion combined with vitrectomy. METHODS: Medical records of 622 eyes of 589 patients who had combined phacoemulsification, IOL implantation and vitrectomy between March 2009 and December 2011 were retrospectively reviewed. Among patients with CBS occurring within 1 month of surgery, the patient's baseline characteristics, type of IOL and ophthalmic viscoelastic devices were analyzed. RESULTS: Nine patients (1.45%) developed CBS with typical capsular bag distension. All CBS occurred within 2 weeks after the surgery. Hydrophilic, large optics and no angulation between optic and haptic were related with the occurrence of CBS. Nd:YAG laser capsulotomy (5 eyes), and surgical capsulectomy (2 eyes) resolved CBS successfully. In 2 eyes with gas tamponade, CBS resolved without intervention with the absorption of gas. CONCLUSIONS: CBS may develop after phacoemulsification with PC IOL insertion combined with vitrectomy and/or vitreous tamponade. Hydrophilic material, large optics and no angulation were risk factors of capsular block by enhancing adhesion between the capsulorrhexis and the optic.

Stability of Four-Haptic Intraocular Lens in Combined Phacoemulsification and Vitrectomy

PURPOSE: To evaluate the stability of intraocular lenses (IOLs) according to the haptic design in combined surgery (phacoemulsification, intraocular lens insertion, and vitrectomy) by comparing early IOP elevation and the accuracy of IOL power. METHODS: A retrospective study was conducted for 85 eyes of 85 patients who had undergone combined surgery. IOP elevation one week postoperatively and the difference between target refraction and postoperative refraction after two months were evaluated in all patients. All eyes were allocated to either a 2-haptic IOL group or a 4-haptic IOL group, and then each group was divided into three subgroups: gas-filled, silicone oil-filled, or balanced salt solution-filled. RESULTS: In the balanced salt solution-filled group, the early IOP increase was significantly less in the 4-haptic IOL group than it was in the 2-haptic IOL group (3.24 mmHg vs. 6.15 mm Hg, p=0.025). The myopic shifts of the 2-haptic IOL group were significantly greater than those of the 4-haptic IOL group for all of the subgroups (gas subgroup -0.71D vs. -0.31D, p=0.045; balanced salt solution subgroup -0.66D vs. -0.16D, p=0.018). CONCLUSIONS: In combined surgery, 4-haptic IOL implantation showed significantly less early IOP elevation and less myopic shift than those of 2-haptic IOL implantation.

Acute Transient Myopic Shift in a Patient With Fever of Unknown Origin: A Case Report

PURPOSE: To report a case of acute transient myopic shift in a patient with fever of unknown origin. CASE SUMMARY: A 31-year-old woman without a history of any ophthalmic problems presented with a sudden onset of bilateral blurred vision. She was admitted with the diagnosis of fever of unknown origin (FUO). Ophthalmic examination revealed a visual acuity of 0.06 in the right eye and 0.1 in the left eye. A myopic shift of 3.12 diopters (D) and 2.25D was noted in the right and left eyes, respectively. Retinal folds and choroidal thickening accompanied the myopic shift. On the third day after onset, visual acuity had decreased even more. Myopic shift increased to 4.87D in the right eye and 4.50D in the left eye. At the same time, the depth of the anterior chamber maximally decreased and the thickness of the lens was maximally increased. One week later, the myopic shift was normalized to emmetropia. The depth of the anterior chamber and the thickness of the lens also normalized as the fever subsided.

Comparision of the Three Different Hydrophilic Acrylic Intraocular Lenses

PURPOSE: To evaluate the stability of three different hydrophilic acrylic intraocular lenses (IOLs), which have different shapes. IOLs included in this study are three-piece acrylic IOL with PMMA (Polymethylmethacrylate) haptics (Hydroview(R) H60M, Bausch &Lomb, U.S.A), one-piece acrylic IOL with broad optic-haptic junction (Centerflex(R) 570H, RAYNER, UK), and one-piece acrylic IOL with narrow optic-haptic junction (Aquasens, Ophthalmic Innovations International, U.S.A). METHODS: We evaluated 69 patients (100 eyes) who had undergone cataract surgeries and who had hydrophilic acrylic IOLs implanted from September, 2003 to March, 2004. Forty eyes implanted with three-piece acrylic IOL with PMMA haptics, 40 eyes implanted with one-piece acrylic IOL with broad optic-haptic junction, and 20 eyes implanted with one-piece acrylic IOL with narrow optic-haptic junction were included. Slit lamp examination, best corrected visual acuity (BCVA), anterior chamber depth (ACD), refraction, and IOL decentration were evaluated at one week and at one, three, and six months postoperatively. RESULTS: There was no statistically significant difference in BCVA, ACD, mean SE or decentration between patients implanted with three different types of hydrophilic acrylic IOL during the 6 month follow-up period (P>0.05). However, Postoperative myopic shift was discovered in 4 eyes (4/20) with Aquasens. CONCLUSIONS: There were no statistically significant difference in the Stabilities of the 3-different hydrophilic acrylic IOLs. However, patients who were implanted Aquasens shold be observed carefully because Aquasense has the posibilitiy to have myopic shift more than 1 Dioptor.

Clear Lens Extraction for the Correction of Severe High Myopia: Seven-year Follow-up

PURPOSE: To evaluate the postoperative outcomes and complications 7 years after clear lens extraction (CLE) for the correction of high myopia. METHODS: The medical records of 23 eyes of 15 patients who had undergone CLE to correct myopia higher than -12 diopter and who could be followed up for more than 7 years were reviewed. A scleral tunnel incision and continuous curvilinear capsulorhexis were made, followed by phacoemulsification and posterior chamber intraocular lens implantation. Refractive error, visual acuity and postoperative complications were recorded. RESULTS: Mean follow-up was 98.2 (84~118) months. Posterior capsular opacification developed in 12 eyes (52.2%) and neodymium: YAG laser posterior capsulotomy was performed in 7 eyes. Retinal detachment developed in 3 eyes of 2 patients at 6 months, 34 months, and 9 years after CLE. At 7 years after CLE, the spherical equivalent (SE) of 14 (60.9%) of 20 eyes was within +/- 2 diopter of targeted refractive error. Shift to myopia occurred by 1 diopter compared to SE at 1 year after CLE. Best corrected visual acuity improved by 2 lines in 14 eyes (60.9%) and was 0.5 or better in 17 eyes (73.9%). CONCLUSIONS: CLE for correction of high myopia had good visual outcomes with acceptable predictability. However, long term follow-up revealed gradual increase of serious complications like retinal detachment, posterior capsular opacification, and myopic shift by 1 diopter between 1 year and 7 years after CLE.

Comparison of the Long-term Clinical Results of Hydrophilic and Hydrophobic Acrylic Intraocular Lenses

This study was performed to compare the incidence of posterior capsular opacity (PCO) and refractive errors between hydrophilic (ACR6D, Corneal (R) ) and hydrophobic (MA60BM, AcrySof (R) ) acrylic intraocular lenses (IOLs) over a 3-year follow-up after phacoemulsification surgery. The patients with AcrySof (R) implanted in one eye and Corneal (R) in the other eye were categorized as Group 1 (n=28), while those with one or both eyes implanted with IOLs of the same kind were categorized as Group 2 (AcrySof (R), n=90; Corneal (R), n=95). Refractive errors were evaluated at 3 months and 3 years postoperatively. The incidence of visually significant PCO was investigated 3 years postoperatively. Postoperative refractive values at 3 months were not significantly different between the two groups. However, refractive values at 3 years were significantly different between two IOLs in both groups [AcrySof (R) -0.37 +/- 0.43D, Corneal (R) -0.62 +/- 0.58D in Group 1 (p=0.04) ; AcrySof (R) -0.38 +/- 0.52, Corneal (R) -0.68 +/- 0.54 in Group 2 (p< 0.01) ]. The incidence of visually significant PCO was 14% and 32% in Group 1, and 13% and 28% in Group 2, for the AcrySof (R) and Corneal (R) implants, respectively. The incidence of visually significant PCO of hydrophilic acrylic IOLs was higher than that of hydrophobic acrylic IOLs in the 3-year follow-up. The postoperative 3-year refractive value of Corneal (R) showed myopic shift.