Comparison of Efficacy and Sensation of Instillation between 0.05% Cyclosporine Nanoemulsion and Microemulsion Type

PURPOSE: To evaluate and compare the efficacy and sensation of instillation between 0.05% cyclosporine nanoemulsion group and microemulsion group. METHODS: This is a double-blind, prospective randomized clinical trial. Patients had 2 weeks of wash-out period before the study. They were randomly assigned to either nanoemulsion group or microemulsion group and treated with each group's cyclosporine eye drop. Artificial eye drop and topical steroid were used together according to severity of dryness of cornea. We checked every patient's Break-up time (BUT), Schirmer test, Staining Score and Ocular surface disease index (OSDI) on baseline, 1 month and 3 months after. Patients also self-checked frequency of use of artificial eye drop and topical steroid. Sensation of instillation was also checked. RESULTS: Both nanoemulsion eye-drop and microemulsion eye-drop improved BUT, Schirmer test, Staining Score and OSDI throughout 12 weeks. The nanoemulsion type reduced OSDI significantly compared to the microemulsion type. The mean frequency of use of artificial tear and topical steroid was similar in both groups. Foreign body sense score was higher in microemulsion group. CONCLUSIONS: 0.05% cyclosporine nanoemulsion type has simillar efficacy and subjectively less foreign body sensation.

Bilateral Cataract after Taking Oxcarbazepine

PURPOSE: To report a case of bilateral posterior subcapsular cataract after taking oxcarbazepine (Trileptal®, Novartis, Basel, Swiss). CASE SUMMARY: A 19-year-old female visited our clinic with decreased vision in both eyes. Her best-corrected visual acuity was 0.3 in the right eye and 0.5 in the left eye, and slit-lamp examination revealed a bilateral cortical opacity and subcapsular cataract. She had been taking oxcarbazepine for epilepsy for 10 years, which was discontinued 3 years ago. Her mother had undergone cataract surgeries when she was approximately 46 years of age. No other risk factors for cataract were present. CONCLUSIONS: In the present case, bilateral cortical opacity and subcapsular cataract were assumed to be associated with the use of oxcarbazepine. We suggest that oxcarbazepine could induce a cataract and recommend a regular follow-up by a qualified ophthalmologist.

Comparison of Intraocular Lens Power Calculation Methods Following Myopic Laser Refractive Surgery: New Options Using a Rotating Scheimpflug Camera

PURPOSE: To evaluate and compare published methods of calculating intraocular lens (IOL) power following myopic laser refractive surgery. METHODS: We performed a retrospective review of the medical records of 69 patients (69 eyes) who had undergone myopic laser refractive surgery previously and subsequently underwent cataract surgery at Samsung Medical Center in Seoul, South Korea from January 2010 to June 2016. None of the patients had pre-refractive surgery biometric data available. The Haigis-L, Shammas, Barrett True-K (no history), Wang-Koch-Maloney, Scheimpflug total corneal refractive power (TCRP) 3 and 4 mm (SRK-T and Haigis), Scheimpflug true net power, and Scheimpflug true refractive power (TRP) 3 mm, 4 mm, and 5 mm (SRK-T and Haigis) methods were employed. IOL power required for target refraction was back-calculated using stable post-cataract surgery manifest refraction, and implanted IOL power and formula accuracy were subsequently compared among calculation methods. RESULTS: Haigis-L, Shammas, Barrett True-K (no history), Wang-Koch-Maloney, Scheimpflug TCRP 4 mm (Haigis), Scheimpflug true net power 4 mm (Haigis), and Scheimpflug TRP 4 mm (Haigis) formulae showed high predictability, with mean arithmetic prediction errors and standard deviations of −0.25 ± 0.59, −0.05 ± 1.19, 0.00 ± 0.88, −0.26 ± 1.17, 0.00 ± 1.09, −0.71 ± 1.20, and 0.03 ± 1.25 diopters, respectively. CONCLUSIONS: Visual outcomes within 1.0 diopter of target refraction were achieved in 85% of eyes using the calculation methods listed above. Haigis-L, Barrett True-K (no history), and Scheimpflug TCRP 4 mm (Haigis) and TRP 4 mm (Haigis) methods showed comparably low prediction errors, despite the absence of historical patient information.

A Case of Conjunctival Lithiasis with Clinical Manifestations of Superior Limbic Keratoconjunctivitis

PURPOSE: To report a case of conjunctival lithiasis with clinical manifestations of superior limbic keratoconjunctivitis. CASE SUMMARY: A 40-year-old male complained of pain, foreign body sensation and injection in the left eye lasting 1 month. The slit-lamp examination revealed injection of the superior bulbar conjunctiva, linear corneal band opacity, fine punctate staining and epithelial defect in the superior cornea area. After eversion of the left upper eyelid, there were many various-sized conjunctional concretions and inflammation in the superior tarsal conjunctiva. Therefore, we considered conjunctival lithiasis-induced clinical manifestations of superior limbic keratoconjunctivitis and then removed the conjunctival concretions using a 30-gauge needle. After the procedures, artificial tears, antibiotic eye drops, steroid eye drops and a therapeutic contact lens were applied. After 1 week, all symptoms and signs improved and there was no recurrence for 4 months. CONCLUSIONS: Mechanical stimulation by severe conjunctival lithiasis can induce clinical manifestations of superior limbic keratoconjunctivitis. Therefore, in patients with clinical manifestations of superior limbic keratoconjunctivitis, conjunctival lithiasis should be considered by observing the superior tarsal conjunctiva more closely.

The Clinical Outcome of Silicone Tube Intubation According to the Site Resistant to Lacrimal Duct Probing

PURPOSE: To evaluate clinical outcomes of silicone tube intubation according to the site of resistance to lacrimal duct probing in complete or partial nasolacrimal duct obstruction patients. METHODS: This study included 102 eyes of 72 patients who were diagnosed with complete or partial nasolacrimal duct obstruction and who underwent silicone tube intubation. According to the site of resistant to nasolacrimal duct probing, eyes were divided into proximal resistance (Group I), distal resistance (Group II) and both side resistance (Group III). The success rate was estimated based on functional (symptom relief) and anatomical (normalization of tear meniscus) success. RESULTS: The success rates in Group I, Group II, and Group III were 53.1%, 78.8%, and 27.0%, respectively, showing that Group II attained the highest success rate (Pearson chi-square test, p = 0.001). CONCLUSIONS: In cases of only distal resistance to lacrimal probing without dacryocystography, silicone tube intubation should be performed with expectation of good clinical outcomes, even if complete nasolacrimal obstruction was suspected on syringing.

The Clinical Outcome of Silicone Tube Intubation According to the Site Resistant to Lacrimal Duct Probing

PURPOSE: To evaluate clinical outcomes of silicone tube intubation according to the site of resistance to lacrimal duct probing in complete or partial nasolacrimal duct obstruction patients. METHODS: This study included 102 eyes of 72 patients who were diagnosed with complete or partial nasolacrimal duct obstruction and who underwent silicone tube intubation. According to the site of resistant to nasolacrimal duct probing, eyes were divided into proximal resistance (Group I), distal resistance (Group II) and both side resistance (Group III). The success rate was estimated based on functional (symptom relief) and anatomical (normalization of tear meniscus) success. RESULTS: The success rates in Group I, Group II, and Group III were 53.1%, 78.8%, and 27.0%, respectively, showing that Group II attained the highest success rate (Pearson chi-square test, p = 0.001). CONCLUSIONS: In cases of only distal resistance to lacrimal probing without dacryocystography, silicone tube intubation should be performed with expectation of good clinical outcomes, even if complete nasolacrimal obstruction was suspected on syringing.

A Case of Optic Neuropathy Caused by Fungal Ball in an Onodi Cell

PURPOSE: To report a rare case of optic neuropathy caused by a fungal ball in an Onodi cell. CASE SUMMARY: A 63-year-old female was referred to our clinic with relapsed visual loss and ocular pain in the right eye. She had been diagnosed as optic neuritis 14 days before and given pulse steroid therapy. She recovered to normal but relapsed 7 days before. In medical referral there was no suspected multiple sclerosis but only a few inflammation in the paranasal sinuses. On our initial examination, best corrected visual acuity was counting finger at 10 cm in the right eye, and 1.0 in the left eye, along with relative afferent pupillary defect in the right eye. The fundoscopic examinations disclosed disc swelling; nearly total visual field defect was observed on visual field examination and visual evoked potential test revealed decreased amplitude at P100 wave in the right eye. Clinical impression was relapsed optic neuritis. After the administration of pulse steroid therapy, her disc swelling was decreased and visual acuity was recovered to 0.6, however, visual acuity was exacerbated to 0.4 in 2 weeks. We checked outside brain magnetic resonance imaging (MRI) and the result showed optic neuropathy caused by a fungal ball in an Onodi cell. The patient was referred to otorhinolaryngologist and fungal ball was removed by endoscopic sinus surgery. 3 weeks after surgery the patient's visual acuity was 0.9, no disc swelling was found and visual evoked potential was recovered to normal. CONCLUSIONS: An Onodi cell lesion should be considered in the differential diagnosis of optic neuritis, identified by imaging studies and promptly removed by surgery for visual recovery.