Effects of Cataract on Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer Thickness on Swept Source Optical Coherence Tomography

Purpose@#To evaluate the changes in peripapillary retinal nerve fiber layer (pRNFL) thickness and macular ganglion cell-inner plexiform layer (mGC-IPL) thickness measured by swept source optical coherence tomography (SS-OCT) following cataract surgery in patients with glaucoma. @*Methods@#We included 42 glaucoma eyes and 42 case-matched normal eyes that underwent cataract surgery without complications. One matching set included one glaucoma eye and one case-matched normal eye. The age, sex, and cataract subtype scores were similar for each group. Before and within 3 months of surgery, we measured the pRNFL thickness and mGCIPL thickness by SS-OCT. @*Results@#Following cataract surgery, the image quality (IQ) of SS-OCT improved in both groups. The thickness of the pRNFL and mGC-IPL increased in the mean values and all areas, except for pRNFL from 1 to 4 o’clock in the glaucoma group and at 1 o’clock in the normal group. Posterior subcapsular cataract was related to the change in IQ following surgery. The glaucoma and normal group showed greater pRNFL thickness change due to lesser preoperative pRNFL thickness. Furthermore, the mGC-IPL thickness change was greater in the glaucoma group because of lesser preoperative mGC-IPL thickness. By contrast, the normal group demonstrated greater mGC-IPL thickness change due to higher cortical cataract scores. @*Conclusions@#Cataracts caused the deterioration of the IQ in SS-OCT, thereby resulting in an undermeasurement of the pRNFL and mGC-IPL thickness. Preoperative pRNFL and mGC-IPL were negatively associated with postoperative pRNFL and mGCIPL thickness change in the glaucoma and normal groups. Therefore, ophthalmologists should particularly consider the effect of cataract while diagnosing glaucoma using SS-OCT.

Stereopsis before and after Inferior Oblique Weakening Surgery

PURPOSE: To analyze stereopsis change before and after inferior oblique weakening surgery. METHODS: We retrospectively reviewed the medical records of 31 patients who had undergone inferior oblique weakening surgery. The factors analyzed included sex, age at surgery, preoperative and postoperative visual acuity (VA), time from first detection to surgery, degree of inferior oblique overaction (IOOA), primary/secondary IOOA, exotropia/hypertropia, bilaterality, and type of surgery. RESULTS: Eighteen patients with a mean age 7.3 ± 3.1 years exhibited stereopsis of 60 arc seconds or better before surgery and 17 had stereopsis better than 60 arc seconds after surgery. Postoperatively, stereopsis improved in 13 patients and deteriorated in 9. Better preoperative VA and the absence of superior oblique underaction were associated with better preoperative stereopsis. Better preoperative VA, postoperative VA, and the presence of head tilt were associated with better postoperative stereopsis. Unilateral inferior oblique weakening surgery and accompanying hypertropia were associated with improved stereopsis, while the absence of hypertropia was associated with deteriorated stereopsis. CONCLUSIONS: In this retrospective study, 58.1% of patients tended to have bifoveal fixation. When a vertical deviation is present in the primary position due to unilateral IOOA, IO weakening surgery can be expected to improve binocular function.

Fixation of the Eyeball to the Periosteum Over the Posterior Lacrimal Crest in Inveterate Exotropia

PURPOSE: To report the results obtained after fixation of the eyeball to the periosteum over the posterior lacrimal crest in 5 cases of inveterate exotropia. METHODS: From September 2011 to January 2013, 5 patients with inveterate exotropia and a history of surgery for exotropia underwent fixation of the eyeball to the periosteum over the posterior lacrimal crest. RESULTS: The mean preoperative exotropia of 35 +/- 10.61 PD changed to esotropia of 5.8 +/- 17.28 PD at the one week postoperative visit and exotropia of 13.2 +/- 11.34 PD at the final postoperative visit (mean, 6.05 months after surgery). At the final postoperative visit, 2 patients who had ocular adhesion due to trauma showed 25 PD exotropia. None of the patients showed injuries to the lacrimal system, but 2 patients showed conjunctival granuloma. CONCLUSIONS: Fixation of the eyeball to the periosteum over the posterior lacrimal crest is an effective approach for the management of inveterate exotropia, except in cases of exotropia combined with ocular adhesion.

A Case of Meibomian Gland Dysfunction after Cosmetic Eyelid Tattooing Procedure

PURPOSE: To report a case of meibomian gland dysfunction as a chronic complication of eyelid tattooing and the corneal epithelial defect as an acute complication of eyelid tattooing well healed with proper treatment. CASE SUMMARY: A 31-year-old woman presented with severe eye pain, irritation and epiphora in both eyes. The patient underwent an eyelid tattooing procedure 2 hours before and dark pigments were placed on the inner eyelid margin. Slit lamp examination showed conjunctival injection and inferior corneal epithelial defect in both eyes. After 2 months, dry eye symptom still remained although the cornea was completely epithelialized. After 1 year, the patient improved completely, but still showed decreased tear film breakup time (TBUT). CONCLUSIONS: Due to the increased number of people who undergo cosmetic eyelid tattooing procedures, the number of reports associated with complications has increased and acute complications such as corneal epithelial defect can occur. Moreover, chronic discomfort associated with dry eye syndrome can occur when pigmentation is placed on the eyelid inner margin and lead to the destruction of meibomian glands. Thus, eyelid tattooing should be performed after careful consideration of possible complications.