Comparison of the Effects of 0.05% and 0.1% Cyclosporine for Dry Eye Syndrome Patients after Cataract Surgery

Purpose@#We compared the effects of 0.05% and 0.1% cyclosporine on dry eye symptoms following cataract surgery. @*Methods@#We retrospectively reviewed the medical records of patients with dry eye syndrome who underwent cataract surgery. The patients were separated into 0.05% and 0.1% cyclosporine groups. Each group had been treated with their routine eye drops for 3 months after cataract surgery. We evaluated dry eye symptoms and signs using the Schirmer test, tear film breakup time (TBUT), corneal and conjunctival staining score, ocular surface disease index (OSDI), and matrix metalloproteinase 9 (MMP-9) testing of the tear film preoperatively and at 2 weeks, 1 month, and 3 months postoperatively. We also compared dry eye symptoms between the groups by dividing all patients according to dry eye severity. @*Results@#The study included 84 eyes (84 patients). The 0.05% cyclosporine group had an increase in the Schirmer test and improved corneal and conjunctival staining scores at 3 months postoperatively. The 0.1% cyclosporine group had improved corneal and conjunctival staining scores at 1 and 3 months postoperatively. The OSDI and MMP-9 results indicated a significant decrease in both groups at 2 weeks, 1 month and 3 months postoperatively. There were no significant differences in the change in dry eye symptoms after cataract surgery between the 0.05% and 0.1% cyclosporine groups. In the patients with level II dry eye syndrome, the 0.05% cyclosporine group showed a significant increase in the Schirmer test compared to the 0.1% cyclosporine group at 3 months postoperatively. The 0.1% cyclosporine group showed a significant improvement in TBUT compared to the 0.05% cyclosporine group at 3 months postoperatively. @*Conclusions@#Both 0.05% and 0.1% cyclosporine are effective treatments for improving dry eye symptoms and ocular surface inflammation after cataract surgery. Both eye drops are considered to have similar effectiveness.

Analysis of Refractive Error after Cataract Surgery According to the Haptic Shape of Intraocular Lens

Purpose@#To analyze and compare changes in refractive error according to different haptic intraocular lenses after cataract surgery. @*Methods@#We retrospectively reviewed the medical records of 508 eyes of 254 patients who underwent cataract surgery in both eyes, with the MBI® SAL302AC (C loop haptic intraocular lens [IOL]) used in one eye and the Zeiss® CT ASPHINA509M (plate haptic IOL) in the other. Using the Barrett Universal II formula, prediction errors were calculated at 1 week, 2 weeks, 1 month, 2 months, and 6 months after surgery.Result: In the C loop group, prediction error was -0.26 ± 0.42 diopter (D) and -0.17 ± 0.45 D at weeks 1 and 2 postoperatively, respectively. Hyperopic shift, which reduced myopia, progressed until 2 weeks postoperatively (p < 0.001), after which there was no significant further shift. In the plate group, prediction error was -0.37 ± 0.45 D at 1 week postoperatively, -0.25 ± 0.44 D at 2 weeks postoperatively, -0.11 ± 0.44 D at 1 month postoperatively, and -0.04 ± 0.44 D at 2 months postoperatively. Hyperopic shift progressed at 2 weeks (p < 0.001), 1 month (p < 0.001), and 2 months (p = 0.02), after which there was no significant further shift. There were no significant differences in the mean or median absolute error at 2 months postoperatively. @*Conclusions@#In both the C loop and plate groups, refraction was myopic at 1 week postoperatively, and then the C loop group progressed to hyperopic shift until 2 weeks postoperatively, and the plate group progressed to hyperopic shift until 2 months postoperatively. At 2 months postoperatively, prediction error of the plate group showed a hyperopic tendency compared to the C loop group, but there was no difference in accuracy based on the absolute error using the Barrett Universal II formula.

Decreased Retinal Nerve Fiber Thickness in Asymptomatic Carotid Stenosis

Purpose@#To investigate the relationship between retinal nerve fiber layer (RNFL) thickness and carotid artery stenosis (CAS). @*Methods@#We retrospectively reviewed the medical records of 106 patients who underwent both optical coherence tomography to determine RNFL and carotid artery sonography within 1 year. The RNFL was divided into four quadrants, and each quadrant’s RNFL thickness and average thickness were compared with the artery endothelial thickness, the presence of plaque, and the degree of CAS. A multiple regression analysis was performed to assess the relationship between RNFL and CAS. @*Results@#The presence of carotid artery plaque had a significant association with a decrease in the average RNFL thickness (p = 0.039). There was no statistically significant difference in age or risk factors associated with vascular disease, with the exception of carotid endothelial thickness and the total cholesterol level in the two groups, depending on the presence of total carotid plaque. RNFL thickness was confirmed to be related to age and total cholesterol levels using linear univariate regression analysis. In a multivariable linear regression analysis, with age and total cholesterol levels controlled, the presence of carotid artery plaque was significantly associated with a decrease in average RNFL thickness (p = 0.026). @*Conclusions@#Asymptomatic CAS may be associated with a decrease in average RNFL thickness. In patients with decreased RNFL thickness without any ophthalmic diseases, carotid artery examination should be considered.

Comparison of Anterior Segment Features between Groups with or without Glaucoma in Pseudoexfoliation Syndrome

PURPOSE: To investigate the factors associated with glaucoma in patients with pseudoexfoliation syndrome by comparing features of the anterior segments and ocular biometry according to the presence or absence of open-angle glaucoma in pseudoexfoliation syndrome. METHODS: We analyzed 96 patients (115 eyes) diagnosed as having pseudoexfoliation syndrome in this study. The patients were divided into two groups of simple pseudoexfoliation syndrome (64 patients, 76 eyes) and pseudoexfoliation glaucoma (32 patients, 39 eyes). We compared the age, sex, underlying disease, location of pseudoexfoliative material, iris change, degree of nuclear cataract, pupil dilatation, corneal endothelial cell counts, central corneal thickness, anterior chamber depth, axial length, corneal curvature, and intraocular pressure (IOP). RESULTS: There were no significant differences between the two groups in terms of age (p = 0.694), sex (p = 0.161), diabetes (p = 0.440), hypertension (p = 0.238), pseudoexfoliative material observed in anterior capsule (p = 0.700), pupillary margin (p = 0.210), iris depigmentation (p = 0.526), pupillary ruff loss (p = 0.708), degree of nuclear cataract (p = 0.617), pupil dilatation (p = 0.526), central corneal thickness (p = 0.097), anterior chamber depth (p = 0.283), axial length (p = 0.095), or horizontal and vertical corneal curvature (p = 0.066 and 0.306, respectively). In pseudoexfoliation glaucoma, significantly higher IOP (p = 0.026), a high frequency of membrane formation (p = 0.047), and decreased corneal endothelial cell counts (p = 0.048) were observed. CONCLUSIONS: Pseudoexfoliation syndrome with open-angle glaucoma was shown to be associated with high IOP, decreased corneal endothelial cell counts, and a high frequency of membrane formation. Therefore, when such changes are observed in pseudoexfoliation syndrome patients, a higher risk of open-angle glaucoma should be recognized, and careful attentionis required accordingly.

A Comparative Study of Topical Mitomycin C, Cyclosporine, and Bevacizumab after Primary Pterygium Surgery

PURPOSE: To compare the recurrence rates and complications associated with instillation of topical mitomycin C, cyclosporine, and bevacizumab after primary pterygium surgery. METHODS: Between July 2013 and June 2014, we performed surgery using the bare sclera method on 132 eyes (132 patients) with primary pterygium. We randomly selected 33 eyes (33 patients) and treated them with artificial tears four times a day for three months, 29 eyes (29 patients) were treated with topical 0.02% mitomycin C four times a day for five days, 34 eyes (34 patients) were treated with topical 0.05% cyclosporine four times a day for three months, and 36 eyes (36 patients) were treated with topical 2.5% bevacizumab four times a day for three months after surgery. We prospectively determined the recurrence rates of pterygium and complications at the six-month follow-up examination. RESULTS: At six months after surgery, the recurrence rates in each group were as follows: 45.5% (15 eyes) in the control group, 10.3% (three eyes) in the mitomycin C group, 20.6% (seven eyes) in the cyclosporine group, and 41.7% (15 eyes) in the bevacizumab group (p = 0.004). No serious complications, except subconjunctival hemorrhages, were observed in any group. CONCLUSIONS: Groups receiving topical 0.02% mitomycin C and 0.05% cyclosporine after surgery showed lower recurrence rates than the control group; however, no difference in recurrence rate was observed between the control group and the group receiving topical 2.5% bevacizumab after surgery.

Risk Factors for Fluoroquinolone Resistance in Ocular Cultures

PURPOSE: To identify the risk factors associated with fluoroquinolone resistance in patients undergoing cataract surgery. METHODS: A total of 1,125 patients (1,125 eyes) who underwent cataract surgery at Veterans Health Service Medical Center from May 2011 to July 2012 were enrolled in this study. Conjunctival cultures were obtained from the patients on the day of surgery before instillation of any ophthalmic solutions. The medical records of patients with positive coagulase negative staphylococcus (CNS) and Staphylococcus aureus (S. aureus) cultures were reviewed to determine factors associated with fluoroquinolone resistance. RESULTS: Of 734 CNS and S. aureus cultures, 175 (23.8%) were resistant to ciprofloxacin, levofloxacin, gatifloxacin, or moxifloxacin. Use of fluoroquinolone within 3 months and within 1 year before surgery, topical antibiotic use other than fluoroquinolone, systemic antibiotic use, recent hospitalization, ocular surgery, intravitreal injection and use of eyedrops containing benzalkonium chloride were significantly more frequent in resistant isolates than in susceptible isolates. In multivariable logistic regression analysis, ocular surgery (odds ratio [OR], 8.457), recent hospitalization (OR, 6.646) and use of fluoroquinolone within 3 months before surgery (OR, 4.918) were significant predictors of fluoroquinolone resistance, along with intravitreal injection (OR, 2.976), systemic antibiotic use (OR, 2.665), use of eyedrops containing benzalkonium chloride (OR, 2.323), use of fluoroquinolone within 1 year before surgery (OR, 1.943) and topical antibiotic use other than fluoroquinolone (OR, 1.673). CONCLUSIONS: Recent topical fluoroquinolone use, hospitalization and ocular surgery were significantly associated with fluoroquinolone resistance in CNS and S. aureus isolates from ocular culture.

Incidence and Risk Factors of Intraoperative Floppy Iris Syndrome During Cataract Surgery

PURPOSE: To determine the incidence and risk factors of intraoperative floppy iris syndrome (IFIS) in patients undergoing cataract surgery. METHODS: The present study included 981 eyes of 655 patients who underwent cataract surgery and development and grade of IFIS were recorded. Correlation analysis was performed to determine the relationship between the IFIS and risk factors such as alpha1-adrenergic antagonist (tamsulosin, terazosin, alfuzosin), benzodiazepine, 5-alpha-reductase inhibitor, age, gender, hypertension, diabetes and glaucoma. RESULTS: IFIS developed in 178 eyes (18.1%) out of 981 eyes. There was a correlation between the development of the IFIS and alpha1-adrenergic antagonist and benzodiazepine and male gender; however, there was no correlation with 5-alpha-reductase inhibitor, age, gender, hypertension, diabetes and glaucoma. IFIS grade tended to be higher as the cumulative dosage of the alpha1-adrenergic antagonist increased. Odds ratio of the patients using tamsulosin was the highest among the other risk factors, which was 3.8 times higher than the patients using terazosin, 9.0 times higher than the patients using alfuzosin and 11.1 times higher than the patients using benzodiazepine. Among patients who underwent cataract surgery on both eyes and who were confirmed with IFIS in 1 or both eyes, no significant grade differences between the 2 eyes were noted. CONCLUSIONS: Alpha 1-adrenergic antagonist and benzodiazepine were risk factors for the development of the IFIS, and as the cumulative dosage of the alpha1-adrenergic antagonist increased, the probability of developing a higher grade of IFIS increased. Therefore, predicting and preparing for potential IFIS in patients who have the above-mentioned risk factors are necessary before planning cataract surgery. Additionally, the IFIS aspect of the first eye could be utilized as a predictive value for developing IFIS profile of the fellow eye.

A Case of Herpetic Simplex Keratitis after Application of 0.015% Tafluprost Eye Drops

PURPOSE: To report a single case of herpes simplex keratitis after application of 0.015% tafluprost eye drops. CASE SUMMARY: A 68-year-old male presented with left eye discomfort, epiphora, decreased visual acuity and hyperemia. The patient was diagnosed with glaucoma 6 weeks prior and started on 0.015% tafluprost eye drops in left eye and 0.15% brimonidine in both eyes. On slit lamp examination dendritic epithelial defect was observed and the patient was diagnosed with herpes simplex keratitis. The 0.015% tafluprost treatment was discontinued and 0.15% brimonidine was applied in both eyes twice a day. The herpetic keratitis in his left eye resolved completely in 2 weeks with acyclovir ointment and oral antiviral agent. No further recurrence was observed in the following 3 months.

The Effect of Conjunctivochalasis Surgery Using a High-Frequency Radio-Wave Electrosurgical Unit

PURPOSE: To evaluate the effects of conjunctivochalasis surgery using a high-frequency radio-wave electrosurgical unit. METHODS: Twenty-seven eyes of 14 patients with conjuctivochalasis who received surgeries with shrinkage of the inferior bulbar conjunctiva using a high-frequency radio-wave electrosurgical unit (Ellman surgitron(R)) were evaluated. Conjuctivochalasis grade, the ocular symptoms, Ocular Surface Disease Index (OSDI), tear film break-up time (BUT), Schirmer test, and corneal staining with fluorescein were measured preoperatively, at 3 months postoperatively, and analyzed prospectively. RESULTS: Three months after the surgery, all patients' conjunctivochalasis became grade 0, and the ocular symptoms, OSDI score, BUT, and corneal staining with fluorerscein were also improved. Additionally, there were no specific complications during the follow-up period. CONCLUSIONS: Conjunctivochalasis surgery using a high-frequency radio-wave electrosurgical unit produced an effective improvement in conjuctivochalasis grade and symptoms and appeared to be a simple and safe procedure.

Reactivation of Herpetic Keratitis in a Patient after Using Two Different Prostaglandin Analogues

PURPOSE: To report a case of herpetic keratitis after administration of two different prostaglandin analogues. CASE SUMMARY: A 68-year-old female with a history of herpetic keratitis in her right eye after using latanoprost seven years previous presented with redness, mild ocular pain and tearing in the same eye. She had also been prescribed travoprost eye drops for both eyes for uncontrolled glaucoma one month earlier. The cornea in her right eye showed a dendritic epithelial defect with focal epithelial erosions. Travoprost treatment was discontinued, and the herpetic keratitis recovered completely in ten days with acyclovir ointment and oral agent. No further recurrence was observed in the following six months.

Refractive Predictability of Partial Coherence Interferometry and Factors that can Affect It

PURPOSE: To evaluate the refractive predictability of a partial coherence interferometry (PCI) biometry device (IOL Master(R)) for cataract surgery and to investigate factors that may affect it. METHODS: Retrospective review of 209 eyes from 151 patients that had undergone preoperative PCI biometry and an uneventful phacoemulsification cataract surgery with posterior chamber intraocular lens (IOL) implantation was conducted. Prediction error defined as the intended refraction minus the postoperative refraction in spherical equivalent (SE) and the absolute error were analyzed according to IOL calculation formulas, patient characteristics, preoperative visual acuity (VA) and refraction, posterior subcapsular cataract (PSC), signal-to-noise ratio (SNR), and axial length (AL). RESULTS: The overall refractive predictability of the PCI device was good. Generally, the SRK/T formula performed better than the SRK-II formula. Refractive predictability was slightly worse in eyes with > or =+2.0 diopters (D) of preoperative SE (with both SRK-II and SRK/T) and in eyes with an AL or =+2.0D was related to a significantly greater hyperopic shift in postoperative refraction. With proper verification of measured data and a suitable IOL calculation formula, good refractive predictability is expected from PCI biometry regardless of patient characteristics, preoperative VA, SNR, PSC, and AL.

Clinical Efficacy and Complications of Intraocular Lens Exchange for Opacified Intraocular Lenses

PURPOSE: To evaluate the clinical efficacy and complications of intraocular lens (IOL) exchange. METHODS: A review of medical records was performed for 52 eyes that had undergone an IOL exchange due to IOL opacification. Surgical complications and their incidences were analyzed. The mean best corrected visual acuity (BCVA) after the IOL exchange was compared with the mean pre-exchange BCVA and with the mean BCVA after the initial IOL implantation. Prediction error of refraction and biometric data obtained for the IOL exchange were, if available, compared with those obtained for the initial IOL implantation. The prediction error for the IOL exchange, calculated from the biometric data obtained before the IOL exchange, was compared with that calculated from the measurements obtained before the initial IOL implantation. RESULTS: The overall complication rates were low and no serious complications were found. The mean BCVA improved significantly after the IOL exchange and was not significantly different from that obtained after the initial IOL implantation. However, the refractive prediction for the IOL exchange was not as good as it was for the initial IOL implantation, which was thought to be related with difficulties in axial length (AL) measurements. Biometric data taken before the initial IOL implantation was associated with a significantly better refractive prediction than those taken before the IOL exchange. CONCLUSIONS: IOL exchange was both efficacious and safe for visual recovery. However, IOL exchange was related with increased difficulty of predicting postoperative refraction; difficulties in AL measurements are the suggested cause.

The Effects of EMLA on Pain Associated with Retrobulbar Injection

A prospective study was undertaken to assess the efficacy of the anesthetic cream EMLA (Eutectic Mixture of Local Anesthetics)in alleviating the pain of retrobulbar injection in patients undergoing cataract surgery.One-hundred forty-three patients who had undergone cataract surgery under local anesthesia in Korea Veterans Hospital from July 1999 to February 2000 were selected randomly into three groups and each of them had no significant difference in their age, sex and underlying conditions.Fifty-seven patients received the EMLA cream, 43 patients received the placebo and the remaining 43 patients received nothing.Among three groups, the EMLA group and the placebo group were double masked.The pain assessed subjectively by the patient was expressed in 11 scales (0-10).And the reactions of the patients to needle insertion, which had been objectively assessed by the one operator, were graded into 4 scales (0-3).No patient experienced serious side effects in each treatment group.In subjective grading, the EMLA group which had been graded as 2.91 +/-1.93 was proven to be more effective in reducing pain than the placebo group (6.2 +/-2.02)and the not-treated group (6.56 +/-1.64).In objective grading, the EMLA group (0.44 +/-0.63)was superior to the placebo group (0.98+/-0.99)and the no treated group (1.4 +/-0.13).In conclusion, local pretreatment using the EMLA cream to alleviate the pain on retrobulbar injection is one of good methods for enhancing the patient cooperation in cataract surgery with reduced anxiety.

Comparison of Normal Bacterial Flora in the Conjuntival Sac of Normal and Anophthalmic Eyes

A bacterial study of the conjunctival sac of 115 patients with an anophthalmic eye has compared the kinds of normal flora in the conjunctival sac of normal and anophthalmic eyes and investigated the susceptibility of the isolated bacteria to various antibiotics. Detection rate of bacteria were 35.7% and 69.6% in normal and anophthalmic eyes, respectively. In normal eyes S. epidermidis(40.4%) were isolated more frequently than S. aureus(21.3%), but the detection rate for each bacteria in anophthalmic eyes showed no significant differences. The incidence rate in kinds of bacterial flora in both conjunctival sacs of a person who has one anophthalmic eye was 37.5%, lower than that of a person with normal eyes(71.4% to 96.5%). Bacteria isolated from normal and anophthalmic conjunctiva were similarly sensitive to amikacin, cefazolin, erythromycin, oxacillin. and tobramycin and were resistant to ampicillin and penicllin.