The Effect of Anti-glaucoma Eyedrops and 0.1% Fluorometholone on Myopic Regression after LASIK or LASEK

PURPOSE: To evaluate the effect of combined medical treatment with anti-glaucoma eyedrops and 0.1% fluorometholone on visual acuity and refractive errors in patients complaining of blurred vision due to myopic regression after laser-assisted in-situ keratomileusis (LASIK) or laser-assisted sub-epithelial keratectomy (LASEK). METHODS: This study comprised 155 patients (155 eyes) who were diagnosed with myopic regression after LASIK or LASEK and received medical treatment from January 2015 to January 2016. The visual acuity and refractive errors were compared before and after medical treatment and evaluated to determine whether the results differ between LASIK and LASEK. RESULTS: The mean time of medical treatment was 64.1 ± 36.8 months after surgery. The responder group whose vision was improved and whose myopic error was decreased after medical treatment was comprised of 63 patients (41%). Their visual acuity in this group improved -0.21 ± 0.11 logMAR, and the amount of myopic error decreased 0.56 ± 0.32 diopters. The full responder group was 24 patients (15%), and the partial responder group was 39 patients (26%). The frequency of response to medical treatment was higher after LASIK than after LASEK, but the difference was not statistically significant. CONCLUSIONS: The combined medical treatment with anti-glaucoma eyedrops and 0.1% fluorometholone was effective in 41% of patients with regard to visual acuity improvement when used for post-LASIK or post-LASEK myopic regression. The medical treatment was effective after both LASIK and LASEK.

The Result of Photorefractive Keratectomy Treated with 0.1% Fluorometholone and Tranilast Eye Drops

PURPOSE: To determine the effectiveness of the method for preventing corneal opacity and minimizing the intraocular pressure (IOP) increase after photorefractive keratectomy treated with 0.1% fluorometholone and tranilast (0.5% tranilast, Krix®, JW pharmaceutical, Seoul, Korea), especially in cases with elevated IOP. METHODS: The patients who underwent photorefractive keratectomy from May 2014 to May 2015 were enrolled in the present study. The data of 49 patients (49 eyes) with elevated IOP at 1 month postoperatively and who used 0.1% fluorometholone and tranilast eye drops (tranilast group) were analyzed and compared with the control group consisting of patients who underwent the same surgery from December 2012 to October 2013 but used only 0.1% fluorometholone. RESULTS: The visual acuity at postoperative 6 months was log MAR -0.08 ± 0.05 and log MAR -0.08 ± 0.04 in the tranilast group and control group, respectively. The eye drops were used postoperatively for 17.7 ± 3.3 weeks in the tranilast group and for 20.5 ± 3.7 weeks in the control group (p < 0.01). Anti-glaucoma eye drops were used for 18.4 ± 3.2 weeks and 20.9 ± 3.7 weeks postoperatively in the tranilast group and control group, respectively (p < 0.01). CONCLUSIONS: Adding tranilast eye drops to patients whose IOP was elevated because of 0.1% fluorometholone use after photorefractive keratectomy is an effective method for preventing corneal haze and minimizing IOP elevation.

The Incidence of Increased Intraocular Pressure when Using 0.1% Fluorometholone after Photorefractive Keratectomy

PURPOSE: To analyze the time and incidence of increased intraocular pressure (IOP) induced by 0.1% fluorometholone used to prevent corneal haze after photorefractive keratectomy (PRK). METHODS: The present study included 826 patients (826 eyes) who underwent PRK between November 2012 and October 2013 and were followed up for more than 6 months. After surgery the patients were treated with 0.1% fluorometholone for 3-6 months according to their corneal conditions. The time and incidence was analyzed with the time and incidence when anti-glaucoma eye drops were used. RESULTS: Anti-glaucoma eye drops were used in 312 eyes (38%). The anti-glaucoma eye drops were started before 4 weeks postoperatively in 105 eyes (13%) and postoperatively at 5-8 weeks in 86 eyes (10%), at 9-12 weeks in 83 eyes (10%), at 13-16 weeks in 25 eyes (3%) and after 17 weeks in 13 eyes (2%). CONCLUSIONS: The overall incidence of increased IOP when treated with 0.1% fluorometholone for 3-6 months after PRK was approximately 38%. The incidence of increased IOP in each month for the first 3 months was almost identical implying that the longer 0.1 fluorometholone was used, the higher incidence of increased IOP occurred. These results can be helpful in educating patients regarding the risk of increased IOP and determining the follow-up period after PRK.

The Incidence of Increased Intraocular Pressure when Using 0.1% Fluorometholone after Photorefractive Keratectomy

PURPOSE: To analyze the time and incidence of increased intraocular pressure (IOP) induced by 0.1% fluorometholone used to prevent corneal haze after photorefractive keratectomy (PRK). METHODS: The present study included 826 patients (826 eyes) who underwent PRK between November 2012 and October 2013 and were followed up for more than 6 months. After surgery the patients were treated with 0.1% fluorometholone for 3-6 months according to their corneal conditions. The time and incidence was analyzed with the time and incidence when anti-glaucoma eye drops were used. RESULTS: Anti-glaucoma eye drops were used in 312 eyes (38%). The anti-glaucoma eye drops were started before 4 weeks postoperatively in 105 eyes (13%) and postoperatively at 5-8 weeks in 86 eyes (10%), at 9-12 weeks in 83 eyes (10%), at 13-16 weeks in 25 eyes (3%) and after 17 weeks in 13 eyes (2%). CONCLUSIONS: The overall incidence of increased IOP when treated with 0.1% fluorometholone for 3-6 months after PRK was approximately 38%. The incidence of increased IOP in each month for the first 3 months was almost identical implying that the longer 0.1 fluorometholone was used, the higher incidence of increased IOP occurred. These results can be helpful in educating patients regarding the risk of increased IOP and determining the follow-up period after PRK.

Analysis of Postoperative Intraocular Pressure Underestimation Measured with Non Contact Tonometry after Corneal Refractive Surgery

PURPOSE: To analyze the postoperative intraocular pressure (IOP) underestimation measured with non-contact tonometry after corneal refractive surgery. METHODS: The postoperative IOP decrease measured with non-contact tonometry (NCT), regarded as IOP underestimation, was calculated in 253 LASIK patients and 281 LASEK patients. Multiple regression analysis was performed to determine the preoperative factors which affect postoperative IOP underestimation. The right eye results were reported in this paper. RESULTS: The postoperative IOP decrease was affected by age (r = -0.0420, p = 0.03), corneal ablation depth (r = 0.0466, p < 0.01), and operation method (LASIK or LASEK) (r = 0.6006, p < 0.01). For every 100 microm decrease of corneal thickness by LASIK, the IOP decreased 6.29 +/- 2.40 mm Hg in patients under 26 years of age and 6.12 +/- 2.53 mm Hg in patients above 26 years of age (p = 0.05). For every 100 microm decrease of corneal thickness by LASEK, the IOP decreased 5.77 +/- 2.37 mm Hg in patients under 26 years of age and 5.44 +/- 2.62 mm Hg in patients above 26 years of age (p = 0.05). CONCLUSIONS: The postoperative IOP underestimation measured with NCT was more prominent in younger-aged patients after LASIK than LASEK with deeper ablation depth.

Analysis of Enhancement Rate According to Age after Refractive Surgery with Schwind Amaris

PURPOSE: To evaluate the clinical effects of an automatic energy-lowering system in patients over the age of 28 years with Schwind Amaris laser platform by analyzing the enhancement operation rate according to age. METHODS: A total of 20448 eyes from 10224 patients who received a bilateral LASIK or LASEK operation with the Schwind Amaris laser platform between August 2007 and April 2011 in our clinic were included in the present study. The rate of enhance operation due to undercorrection was analyzed to determine whether the age affects the enhancement operation rate. RESULTS: There were a total of 17 enhancement operations. Fifteen out of 17 eyes who received the enhanced operation were above the age of 28 years (p=0.005). In multivariate analysis, patient age over 28 years (OR=6.75, CI 1.54-29.60, p=0.011), preoperative higher spherical equivalent (OR=0.56, CI 0.41-0.77, p=0.0004) and preoperative higher mean keratometric value (OR=1.38, CI 1.01-1.88, p=0.043) were significantly associated with a higher enhancement operation rate. CONCLUSIONS: Surgeons should be aware that the amount of laser energy from Schwind Amaris laser platform is automatically reduced in patients above the age of 28 years. Therefore, the nomogram should be adjusted to reduce the enhancement operation rate for a specific age group, especially in patients with higher preoperative myopic errors and steeper cornea.

The Effect of Early Topical Steroid Treatment after Trans-Epithelial PRK

PURPOSE: To evaluate the clinical effects of early topical steroid treatment on corneal epithelium healing and postoperative corneal haziness after trans-epithelial photorefractive keratectomy (Trans PRK). METHODS: A total of 400 eyes from 200 patients who received Trans PRK with the Schwind Amaris laser platform (SCHWIND eye-tech solutions, Kleinostheim, Germany) were included in the present study. In 200 eyes (100 patients, early treated group) topical steroid was used from operation day but in the other 200 eyes (100 patients, late treated group) topical steroid was not used until therapeutic contact lenses were removed. The epithelial healing time, corneal haziness and visual acuity at postoperative 3, and 6 months were compared between the 2 groups. RESULTS: The therapeutic contact lenses could be removed at postoperative 3.50 +/- 1.46 days and 3.14 +/- 0.50 days in the early treated group and late treated group, respectively (p < 0.01). Breakdown of the epithelium after removal of therapeutic contact lenses occurred in 8 eyes, which were all in the early treated group. The difference of the visual acuity at postoperative 3 and 6 months between the 2 groups was not statistically significant. However, at postoperative 6 months, the corneal opacity developed in 12 eyes (6%) in the late treated group and 2 eyes (1%) in the early treated group (p = 0.01). CONCLUSIONS: Early treatment with topical steroid can delay corneal epithelial healing, especially the attachment of epithelium to stroma. However, the treatment can reduce the prevalence of corneal opacity after Trans PRK.

The Analysis of Vault Change after Posterior Chamber Phakic Intraocular Lens Size Exchange

PURPOSE: To evaluate the vault change after implantable collamer lens (ICL) size exchange according to the preoperative vault. METHODS: In 14 eyes of 13 patients, the vault change after ICL exchange operation due to unideal vault was compared in 2 groups, the smaller ICL exchanged group and larger ICL exchanged group. RESULTS: In 6 out of 14 eyes, the ICL was exchanged to a 0.5 mm smaller size and the vault was changed from 1.38 mm (1.18-1.70) to 0.71 mm (0.51-0.92) (p = 0.03). In 8 eyes, the ICL was exchanged to a 0.5 mm bigger size and the vault was changed from 0.07 mm (0.03-0.13) to 0.50 mm (0.12-1.01) (p < 0.01). The exchange operation was performed at 3.5 postoperative days (1-6) if the ICL was exchanged to 1 step smaller size, but the exchange operation was performed at 135 postoperative days (90-660) if the ICL was exchanged to 1 step bigger size (p < 0.01). CONCLUSIONS: ICL exchange to 1 step smaller or bigger size is an effective method to correct unideal postoperative vault to a more ideal vault size. The exchange to 1 step smaller size ICL tended to be performed sooner.

The Benefits of One Day, One Eye Surgery in Bilateral ICL Implantation

PURPOSE: To evaluate the benefits of one day, one eye ICL implantation which allows the ICL size of the later-operated eye to be adjusted after evaluating the postoperative vault of the first-operated eye in order to reduce the postoperative ICL size exchange rates of both eyes. METHODS: A total of 426 eyes of 213 patients who received one day, one eye bilateral ICL implantation were included in the present study. The cases where a different ICL size was implanted in the later-operated eye because of high or low postoperative vault of the first-operated eye were analyzed as well as the ICL exchange rates. RESULTS: Among 213 patients, same size ICLs were implanted in both eyes in 188 patients (88%) as planned. However, a different ICL size was implanted in the later-operated eye in 25 patients (12%). Eight eyes of 8 patients out of 25 patients needed their ICL size exchanged during the follow-up period and all 8 eyes were first-operated eyes. This occurred in 8 patients (3.8%) out of 213 patients. CONCLUSIONS: One day, one eye ICL implantation, which can help the size adjustment of the later-operated eye according to the postoperative 1 day vault of the first-operated eye, can reduce the risk of bilateral ICL size exchange operation.

Effects of Prone Positioning on Critical Distance in Iris-Claw Phakic Intraocular Lens-Implanted Eyes

PURPOSE: To evaluate the effects of prone positioning on the critical distance (CD) in Artiflex (Ophtec BV) foldable anterior iris-claw phakic intraocular lens (pIOL)-implanted eyes. METHODS: Twenty patients with 40 Artiflex-implanted eyes were prospectively enrolled in the present study. The nasal and temporal critical distances (CD) were measured with Visante anterior segment optical coherence tomography (OCT, Carl Zeiss, Dublin, CA) in both the sitting and prone positions. RESULTS: The mean nasal CD was 1.52 +/- 0.15 mm in the sitting position and 1.49 +/- 0.13 mm in the prone position (p = 0.01). The mean temporal CD was 1.63 +/- 0.17 mm in the sitting position and 1.63 +/- 0.16 mm in the prone position (p = 0.67). In a multiple regression analysis, the changes in nasal CD were positively correlated with anterior chamber volume (r = 0.27; p = 0.01) and negatively correlated with pupil size (r = -0.23; p < 0.01). CONCLUSIONS: Prone positioning can induce a decrease in the nasal CD in Artiflex-implanted patients, especially in subjects with small pupils and large anterior chamber volumes.

Effects of Transient Prone Position on Vault and Anterior Chamber Angle in ICL Implanted Patients

PURPOSE: To evaluate the effects of transient prone position on vault and anterior chamber angle parameters in ICL implanted patients. METHODS: 40 eyes of 20 ICL implanted patients with at least 1 month of follow-up were included in the present study. The central ICL vault and anterior chamber parameters including angle opening distance at 500 (AOD500) were measured with the Visante anterior segment optical coherence tomography (OCT) (Carl Zeiss, Dublin, CA) in both the sitting and prone positions by tilting the OCT 90 degrees in the vertical axis and having the patient fixate downwards towards the floor. RESULTS: The mean central vault was 0.55 +/- 0.21 mm (SD) and 0.59 +/- 0.21 mm (SD) in the sitting and prone positions, respectively (p < 0.0001). The nasal and temporal AOD500 were 0.26 +/- 0.11 mm and 0.28 +/- 0.08 mm, respectively in the sitting position, which decreased to 0.24 +/- 0.10 mm and 0.26 +/- 0.08 mm in the prone position, however, both were not statistically significant (p = 0.08, p = 0.09). AOD500 was inversely correlated with vault (r = -0.47; p = 0.0024). There were no significant correlations between increase of vault and anterior chamber depth or white to white nor ICL vault. CONCLUSIONS: Transient prone positioning of ICL implanted patients can induce a significant increase in ICL vault.

The Analysis of AC/A Ratio in Nonrefractive Accommodative Esotropia Treated with Bifocal Glasses

PURPOSE: To report the long term results of bifocal treatment in nonrefractive accommodative esotropia and to analyze the changes of accommodative convergence to accommodation (AC/A) ratio. METHODS: Sixteen patients treated with bifocal glasses for at least 5 years were evaluated retrospectively. Angle of deviation at near and distance, refractive error, and AC/A ratio by the lens gradient method were analyzed. The changes of AC/A ratios were also compared after dividing the patients according to continuation or cessation of bifocal therapy. RESULTS: Six patients (38%; bifocal stop group, BSG) were able to stop using bifocal glasses at an average age of 10.8 years (range, 6.5 to 15.4 years) during their follow-up. However, the other ten patients (62%; bifocal continue group, BCG) had to continue using bifocal glasses until the final visit, which was 13.8 years on average (range, 11.3 to 18.5 years). The AC/A ratio decreased from time of bifocal prescription to the last visit in both groups, from 4.4 to 2.7 in the BSG and from 5.9 to 4.5 in the BCG. AC/A ratios were significantly higher (p = 0.03) in the BCG than that of the BSG from the beginning of bifocal treatment and this difference was persistent until the final visit (p = 0.03). CONCLUSIONS: The AC/A ratio decreased with age in both groups but was significantly higher throughout the entire follow-up period in the BCG. AC/A ratio at bifocal prescription could be an important factor in predicting response to bifocal treatment.

The Effect of Lens Thickness to Anterior Chamber Depth on the Vault after ICL Implantation

PURPOSE: To evaluate the crystalline lens thickness/anterior chamber depth (CLT/ACD) ratio as a preoperative factor that affects the vault after implantable contact lens (ICL) implantation. METHODS: A total of 130 eyes of 130 patients who received bilateral ICL implantation were included in the present study. The preoperative CLT/ACD ratio was analyzed to determine if the patients had any correlation with postoperative vault by Visante optical coherence tomography (OCT). RESULTS: The mean vault was 0.58 mm +/- 0.23 at postoperative 2 months. Eight eyes (6.15%) had low vault, 93 eyes (71.53%) had ideal vault and 29 eyes (29.31%) had high vault. The CLT/ACD ratios were 1.04 mm +/- 0.11, 0.96 mm +/- 0.09 and 0.90 mm +/- 0.09 in the low vault group, ideal vault group and high vault group, respectively (p < 0.01). The CLT/ACD ratio showed statistically significant correlations with postoperative vault in univariate analysis (r = -0.4718; p < 0.01) and in multivariate analysis (p < 0.01). CONCLUSIONS: Vaults after ICL implantation have a negative correlation with the preoperative CLT/ACD ratio. The results from the present study may improve the prediction of postoperative vault after ICL implantation.

Two Cases of Mirror-Image Eye Anomalies in Monozygotic Twins

We report two cases of mirror image anomalies in two different pairs of monozygotic twins. In case 1, the twins exhibited mirroring of strabismus and refractive errors. Twin 1 had 35 prism diopters (PD) right intermittent exotropia at distant fixation and myopic anisometropia that was spherical 2.00 diopters more myopic in the right eye. Twin 2 had 35 PD left intermittent exotropia at distant fixation and her left eye was more myopic by - spherical 1.00 diopters. In case 2, the twins were diagnosed with infantile nystagmus with upbeat jerk. Twin 1 exhibited a habitual head turn of 30degrees to the left with dampening of her nystagmus in dextroversion. Twin 2 also exhibited abnormal head position, but in his case the habitual turn was 30degrees to the right. We believe that this is the first report describing mirror imaged intermittent exotropia with anisometropia and infantile nystagmus with opposite abnormal head positions in pairs of monozygotic twins.

Evaluation of Sensitivity and Specificity of DNA Chip for Diagnosis of Granular Corneal Dystrophy II

PURPOSE: To evaluate the sensitivity and specificity of the DNA chip method in diagnosing patients with granular corneal dystrophy type II (GCD II) induced by mutation of the betaigh3 gene. METHODS: Two hundred twenty-seven patients who visited Severance Eye hospital, corneal dystrophy clinic, from 1 July 2006 to 30 September 2007 were included in this study after history taking and review of their medical records. All subjects were examined by slit lamp microscopy, and blood sampling was done. The sampled blood was used in DNA sequencing and the DNA chip method. RESULTS: Among 227 subjects, 125 (54.6%) patients had GCD II and 103 (45.4%) patients showed normal results according to the DNA sequencing method. The sensitivity and specificity of the DNA chip method were both 100%, while the sensitivity of the slit lamp method was 99.19% and the specificity was 100%. CONCLUSIONS: The DNA chip method for diagnosing GCD II is a more simple, time-saving, and accurate method than DNA sequencing method, and the sensitivity and specificity were both 100%.