The Effects of Conjunctival Shield on Pain Alleviation During Cataract Surgery in Conjunctivochalasis Patients

PURPOSE: To evaluate the effect of conjunctival shield on pain alleviation during cataract surgery in conjunctivochalasis patients for conjunctiva drawn into speculum suction holes during cataract surgery. METHODS: Forty patients with conjunctivochalasis undergoing cataract surgery using un aspirating speculum were evaluated in the present study. A thin piece of surgical wipe (conjunctival shield) was inserted between the lid and bulbar conjunctiva to shield the conjunctiva from the suction hole and thereby prevent it from being sucked into the hole. Additionally, patients were asked to rank pain following speculum placement both before and after conjunctiva shield insertion by visual analogue scale. RESULTS: The pain scores were 2.50 +/- 0.78 points before conjunctival shield insertion, and 1.25 +/- 0.66 points after conjunctival shield insertion, which was a significant decrease (p = 0.01). In addition, the results showed a 70% reduction in pain following shield insertion. CONCLUSIONS: Conjunctivochalasis causes pain during cataract surgery when using an aspirating speculum. The conjunctival shield insertion is a safe and simple method for pain-free cataract surgery in conjunctivochalasis patients.

The Effect of Bevacizumab versus Ranibizumab in the Treatment of Corneal Neovascularization: A Preliminary Study

PURPOSE: To compare the short term effects of bevacizumab and ranibizumab injections on the regression of corneal neovascularization (NV). METHODS: Sixteen eyes of 16 patients with corneal NV were randomly assigned for an injection with 2.5 mg of bevacizumab (group 1, n = 8) or 1 mg of ranibizumab (group 2, n = 8) through subconjunctival and intrastromal routes. The patients were prospectively followed-up for one month after the injections. Corneal NV areas, as shown on corneal slit-lamp photographs stored in JPEG format, were calculated using Image J software before the injection, one week after the injection, and one month after the injection. The corneal NV areas were compared before and after the injections. RESULTS: Seven women and nine men, with an average age of 51 years, presented with corneal NV secondary to herpetic keratitis (7 cases), graft rejection (6), chemical burn (1), pemphigoid (1), and recurrent ulcer (1). In group I, the preoperative corneal NV area (8.75 +/- 4.33%) was significantly decreased to 5.62 +/- 3.86% one week after the injection and to 6.35 +/- 3.02% one month after the injection (p = 0.012, 0.012, respectively). The corneal NV area in group 2 also exhibited a significant change, from 7.37 +/- 4.33% to 6.72 +/- 4.16% one week after the injection (p = 0.012). However, no significant change was observed one month after the injection. The mean decrease in corneal NV area one month after injection in group 1 (28.4 +/- 9.01%) was significantly higher than in group 2 (4.51 +/- 11.64%, p = 0.001). CONCLUSIONS: Bevacizumab injection resulted in a more effective and stable regression of corneal NV compared to the ranibizumab injection. The potency and dose of these two drugs for the regression of corneal NV require further investigation.

Anterior Uveitis and Keratitis in Takayasu's Arteritis

PURPOSE: To report a rare case of simultaneous uveitis and keratitis in Takayasu's arteritis. CASE SUMMARY: A 22-year-old woman presented with complaints of redness and decrease in vision in both eyes. The patient was diagnosed a decade earlier as having Takayasu's arteritis. No other systemic or ophthalmic abnormalities were found. She complained of ophthalmic symptom aggravation during an upper respiratory infections and before menstruation. Bilateral corneal edema, conjunctival injection, and anterior uveitis were observed on slit-lamp examination. Concurrent treatments were started in consultation with an internist. Steroid eye drop and steroid systemic administration relieved the ocular pain and symptoms. CONCLUSIONS: When a patient presents with recurrent red eyes and visual disturbances with Takayasu's ateritis, simultaneous uveitis and keratitis due to Takayasu's arteritis should be considered as a possible diagnosis.

Wavefront Analysis of Successful Treatment of Monocular Triplopia After Cataract Extraction: Report of 2 Cases

PURPOSE: To report wavefront analysis of successful treatment of monocular triplopia after cataract extraction. CASE SUMMARY: (Case 1) A 59-year-old man visited our clinic for a monocular triplopia in his left eye of five years in duration. The best spectacle-corrected visual acuity (BSCVA) was 1.0 in the left eye, and the patient had a mild cortical cataract. The ocular spherical aberration (0.126 micrometer for the 4-mm pupil, 0.351 micrometer for the 6-mm pupil) measured by a Hartmann-Shack aberrometer increased preoperatively, while the corneal spherical aberration was normal. After cataract surgery, the monocular triplopia disappeared, and the ocular spherical aberration decreased. (Case 2) A 38-year-old man visited our clinic for a monocular triplopia in his left eye of a two-year duration. The best spectacle-corrected visual acuity (BSCVA) was 0.3 in the left eye, and the patient had a mild nuclear cataract. The ocular spherical aberration (-0.356 micrometer, -1.343 micrometer) and trefoil aberration (0.199 micrometer, 0.252 micrometer) increased preoperatively, while the corneal spherical and trefoil aberrations were normal. After cataract surgery, the monocular triplopia disappeared and the ocular spherical and trefoil aberrations decreased.