Influence of Biometric Variables on Refractive Outcomes after Cataract Surgery in Angle-closure Glaucoma Patients

PURPOSE: To evaluate the influence of biometric variables on refractive outcomes after cataract surgery in angle-closure glaucoma (ACG) patients. METHODS: In this case-control study, 42 ACG patients, 40 open-angle glaucoma (OAG) patients, and 35 controls without glaucoma who had undergone conventional cataract surgery were enrolled consecutively. Electronic medical records, including preoperative biometric variables (keratometric diopter, axial length, anterior chamber depth, and lens thickness), the refractive change (RC), and the absolute value of refractive change (ARC) were reviewed. RESULTS: In the control and OAG patients, the anterior chamber depth was negatively correlated with the ARC (r = -0.344, p = 0.043 and r = -0.431, p = 0.006, respectively), whereas there was no correlation in the ACG patients. Lens thickness was positively correlated with the RC, but not with the ARC, in the control and OAG groups (r = 0.391, p = 0.020 and r = 0.501, p = 0.001, respectively). In contrast, lens thickness in the ACG group was not correlated with the RC but was positively correlated with the ARC (r = 0.331, p = 0.032). CONCLUSIONS: In contrast with the anterior chamber depth, preoperatively measured lens thickness may be a useful predictor of the direction of the RC after cataract surgery in control and OAG patients. However, in ACG patients, a thicker lens was correlated with a larger RC, regardless of the direction of the shift (hyperopic or myopic).

Long-Term Results of Descemet's Stripping Automated Endothelial Keratoplasty in Korea

PURPOSE: To evaluate the long-term results of Descemet's stripping automated endothelial keratoplasty in Korea (DSAEK). METHODS: Seven patients with bullous keratopathy who underwent DSAEK and who were followed-up for more than 18 months were reviewed retrospectively. Best corrected visual acuity, refraction, corneal thickness, and endothelial cell count were examined before and after surgery. RESULTS: The mean follow-up period was 19.9 +/- 2.9 months (18 to 24 months), and the mean age was 61.42 +/- 10.13 years (46 to 76 years). Six patients (85.7%) showed successful results after surgery. Best corrected visual acuity (logMAR) was significantly improved from 1.62 (median) to 1.15 (median) (p = 0.027) at one month after surgery and was maintained until the final follow-up period. There were no statistical differences in spherical ametropia or astigmatism before or 18 months after the operation. Graft failure was observed in one case, in which penetrating keratoplasty was performed 12 months after DSAEK. CONCLUSIONS: Long term results of DSAEK showed fast visual recovery, low ametropia and astigmatism. DSAEK may be a good option for the surgical management of corneal endothelial disease.

Refractive Change Caused Silicone Oil Adhesion to the Intraocular Lens Following Nd:YAG Posterior Capsulotomy

A 32-year-old female who had undergone the silicone oil removal procedure presented with visual disturbance in her left eye. Several months previous, she had cataract surgery in a private clinic, and a month later she had a Nd:YAG laser procedure for posterior capsulotomy. The slit-lamp examination revealed silicone oil droplets that had adhered to the intraocular lens where the posterior capsulotomy was performed. She had experienced high myopia as a manifestation of the resulting refractive changes. We replaced the previous intraocular lens with a new acrylic intraocular lens with resulting improvement to her vision. Here we report the case of a female patient with a history of silicone oil removal surgery where the resulting silicone bubbles had not been removed thoroughly and remained in the vitreous cavity. These bubbles subsequently adhered to the intraocular lens following YAG laser posterior capsulotomy, resulting in refractive changes. We recommend that implanting a silicone intraocular lens in anyone with a history of the silicone oil removal procedure or who has a possible history of silicone oil use should be avoided.

Change of Refractive Error in Patients with Refractive Accommodative Esotropia

PURPOSE: To evaluate the degree and change in refractive error and the relation of refractive error, the angle of deviation and amblyopia in patient with refractive accommodative esotropia. METHODS: Children with refractive accommodative esotropia were retrospectively included in the study. The factor studied were sex, age at the first visit, ocular alignment, refractive error and amblyopia. RESULTS: The average age at the first visit was 4.01+/-1.86 years. And, the average angle of esodeviation was 22.23+/-13.74PD for the near and 21.51+/-12.01PD for the distant. The average manifest and cycloplegic refraction measured at patient's first visit were +2.35+/-2.87D and +4.87+/-1.77D respectively. The difference between cycloplegic and manifest refraction decreased gradually. After 3 years, the average manifest and cycloplegic refraction were +3.42+/-1.80PD and +4.33+/-1.77D. The refractive error didn't significantly affect the degree of esodeviation (r=0.051). Twenty-three of patients were amblyopia. The refraction of amblyopic and non amblyopic patient was +5.07+/-1.85D and +4.50+/-2.47D, respectively. However, this difference was not statistically significant. CONCLUSIONS: Mean cycloplegic refraction decreased significantly over a 3-year period. After full correction with glasses, the difference between cycloplegic and manifest refraction decreased. The refractive error was not associated with the degree of deviation anlge, amblyopia occurrence and treatment success.

Changes in Refraction following Pediatric Cataract Surgery

PURPOSE: To evaluate the factors influencing the refractive changes and to predict the ideal intraocular lens powers in children who had undergone cataract surgery. METHODS: The medical records of the pediatric patients with aphakia or pseudophakia who were followed for more than 5 years postoperatively were reviewed retrospectively. They were grouped according to the age at surgery and were followed-up every six months postoperatively. The myopic changes and the factors associated with these changes among the groups were evaluated and compared. RESULTS: The follow-up time was 5 years. In the age-matched subset of patients, no statistically significant difference in the refractive change were found between the aphakic and pseudophakic eyes as well as between the unilateral and bilateral cataracts. Children operated on at 1 month to 1 year of age had a mean myopic shift of -5.58D (range -1.88 to -12.85) and children operated on at 1 to 3 years of age had a shift of -4.25D (range -1.78 to -8.71). The mean myopic shift decreased as the age at operation increased. Children operated on at 10 to 15 years of age had a shift of -1.46D (range 0 to -5.28). CONCLUSIONS: During the first 5 years after surgery, no statistically significant difference in refractive change was observed between the aphakic eyes and pseudophakic eyes as well as between the unilateral and bilateral cataracts. The increasing difficulty in deciding the ideal IOL-power is expected in young children as the refractive change becomes more unpredictable when surgery is performed on younger patients.

Five-year Follow-up of Refractive Error and Visual Acuity in Preschool Children

PURPOSE: The purpose of this study is to evaluate visual acuity and refractive state in preschool children and to find the environmental factors that cause visual acuity and refractive change. METHODS: The initial subjects were 3, 225 preschool children, aged 4 to 6 years old, selected randomly from 15 preschools in Daejeon from August to November, 1997. Among them, 759 (23.5%) children showed 0.6 or less visual acuity or had different visual acuity of more than 2 lines between two eyes. In addition, 537 (70.8%) children who did not showed organic ocular abnormality during the first examination received refraction. Five years later, 120 (22.3%) children were reexamined and enrolled in this study. RESULTS: Uncorrected visual acuity was 0.44 (log MAR -0.36 +/- 0.27) and corrected visual acuity was 0.85 (logMAR -0.07 +/- 0.09) on average in 1997. Generally there was a myopic shift by -1.30 +/- 1.16 diopter (D) for 5 years (p<0.001) and astigmatism was significantly decreased by 0.32 +/- 0.48 D in the hyperopic group (p<0.001). The amount of myopic shift was lower in the children who were wearing eyeglasses than in those who were not in the hyperopic group (p<0.05). Corrected visual acuity was significantly increased by 0.13 (logMAR 0.06 +/- 0.08, p<0.001). The degree of myopic shift was larger in the children whose parents were wearing eyeglasses than in those whose parents were not wearing eyeglasses (p<0.05) but other environmental factors did not influence on visual acuity or refractive change. CONCLUSIONS: Early examination of visual acuity and refractive state, and adequate treatment are important to increase visual function in preschool children.

The Effect of Strabismus Surgery on Refractive Error Measured with Corneal Topography

This study was prospectively performed to assess the corneal refractive changes after strabismus surgery. Seventy patients who were average 12.56 years old were enrolled and the corneal refractive power was measured with corneal topography system[Videokeratoscope, Eye Sys TM laboratories]. The postoperative corneal refractive changes were not observed at apex, 3 mm zone and 5 mm zone in all the patients, but the corneal refractive power increased at 5 mm zone for one week only in resection and recession surgery group. The corneal refractive changes according to the amount of surgery were not observed, but the significant correlation was noted at apex and 3 mm zone for one week, while at 5 mm zone for 8weeks in horizontal muscle recession surgery group. The corneal refractive changes after strabismus surgery were noted at the peripheral cornea and especially in resection and recession surgery group. Further studies of this subject including more patients of various operation methods are expected.

Clinical Results of Silicone Foldable Intraocular Lens Implantation: Diabetics vs Nondiabetics

To evaluate the visual, astigmatic results and incidence of complications in cases of no-stich, small incision cataract surgery with a square sclerocorneal tunnel and silicone flexible intraocular lens we cornpared the resuite of catarct surgery in DM patients with those of non-DM patients. 305 eyes of 284 patients including 21 eyes of 20 patients of diabetes mellitus from October, 1994 to Decernber, 1996 who underwent cataract surgery with silicone foldable intraocular lens were enrolled in this retrospective study. During follow-up examination, the change of visual acuity, astigmatism, the incidence of postoperative complications was evaluated. Early visual rehabilitation because of small surgically induced refractive change during im.mediate postoperative period can be achieved. During 2 months follow-up, no against-the-rule shift of astigmatism detected. The incidence of postoperative complication were nearly the same as previous report : decentration 0.7%, hyphema 2%, uveitis 0.4%, posterior casular opacification 4.2%. In cases of posterior capsular opacification, Nd-YAG laser posterior capsulotomy showed significant increment of vision. The visual acuities in DM patients were comparably as good as those of non-DM patients. The incidence of posterior capsular opacification and corneal edema was relatively high in DM patients. In conclusion, no stitch snaall incision cataract, surgery through which silicone foldable intraocular lens im. planted showed good visual, astigmatic results in uncomplicated and selected cases of cornplicated with DM patients.

Cycloplegic Refraction in Esotropic Children: Cydopentolate versus Atropine

Cycloplegic refraction with 1% cyclopentolate and I % atropine was performed in esotropic children younger than 6 years. The purpose of this study was to find clinical factors related with differencs in refractive changes between cyclopentolate and atropine Additionally, the periodic refractive changes at the first, second and third day during performing traditional atropinization were evaluated. The results were as follows: The refractive state after using 1 % cyclopentolate was + 5.00 diopters in average and that after using 1% atropine was +5.77 diopters in average (p