Validation and Reliability of the Cataract-related Visual Function Questionnaire (CVFQ)

Purpose@#To evaluate the reliability and validity of the Cataract-related Visual Function Questionnaire (CVFQ). @*Methods@#A prospective cross-sectional study of 141 cataract patients was conducted from March 2022 to June 2022. The questionnaire was created based on a literature review and advice from an expert panel. This study determined its construct validity, criterion validity, internal consistency, and test-retest reliability. @*Results@#The CVFQ consists of 15 items distributed among five categories: overall visual quality, overall visual function, distance vision, near vision, and glare. In the exploratory factor analysis of validity, the first three principal components explained 77.8% of the variance. The p-values in the Spearman correlation test comparing the pre- and postoperative total CVFQ score and best-corrected visual acuity (BCVA) were 0.006 and 0.004, respectively. In the reliability analysis, Cronbach’s alpha was > 0.9 for internal consistency and the p-values of each subcategory were all significant in the analysis of test-retest reliability. @*Conclusions@#Our results indicate that the CVFQ is useful for measuring the visual quality and visual function of cataract patients in Korea.

Persistent Epithelial Defects Caused by Limbal Deficiency for Various Causes

Purpose@#We report the process of treating persistent corneal epithelial defects due to limbal deficiency in a patient who underwent surgery for ptosis, recurrent pterygium, and senile cataract for 3 weeks.Case summary: A 65‐year‐old male patient underwent cataract surgery 4 months ago and visited this hospital with persistent inflammation of the left cornea that started 2 months ago. The patient underwent blepharoplasty and pterygium surgery at the same time 3 weeks before cataract surgery. At the first visit, severe conjunctival injection and an oval‐shaped corneal epithelial defect with a size of 3 × 5 mm in the center of the cornea were seen. As the result of the eyelid eversion test, fibrotic scar tissue due to the non‐absorbable suture used during the upper eyelid blepharoplasty was observed and surgically removed. The corneal epithelial defect site became smaller, but the atrophy of the corneal stroma was sustained, and the amniotic membrane was tripled and permanent amniotic membrane transplantation was performed. Corneal epithelial defects have improved with postoperative best‐corrected visual acuity of 0.15. @*Conclusions@#Sufficient recovery period between serial multiple surgeries is required to reduce the occurrence of complications like persistent epithelial defects.

Cataract Surgery Practice in the Republic of Korea: A Survey of the Korean Society of Cataract and Refractive Surgery 2020

Purpose@#To describe current cataract surgery practice patterns and trends among Korean ophthalmologists. @*Methods@#A survey was conducted among members of the Korean Society of Cataract and Refractive Surgery in October 2020. Of the 998 questionnaires, 262 (26.3%) were received for analysis. Data were analyzed using descriptive statistics and compared with those of previous surveys. @*Results@#The largest percentage of respondents (39%) had 11 years of practical experience. The average, median, and mode monthly volumes of cataract surgeries performed by the Korean Society of Cataract and Refractive Surgery members were 31, 20, and 10 cases, respectively. Topical anesthesia was administered by 85% of the respondents. For intraocular lens (IOL) calculations, 96% of the respondents used optical biometry. The proportion of surgeons providing femtosecond laser-assisted cataract surgery increased significantly from 5% in 2018 to 29% in 2020. This increase was accompanied by an increase in the multifocal IOLs. Those who implant multifocal IOL for >10% of their cases increased from 16% (2018) to 29% (2020). Topical nonsteroidal anti-inflammatory drugs were prescribed postoperatively by 76% of the respondents. Most respondents (70%) prescribed these anti-inflammatory drugs for 4 weeks. @*Conclusions@#This survey provided a comprehensive update on current cataract surgery practice in the Republic of Korea. The results highlighted the increasing use of premium IOLs, femtosecond laser-assisted cataract surgery, optical biometry, and topical anesthesia to better meet the patients’ needs.

Clinical and Pathological Classification of Eyelid and Conjunctival Tumors: a Retrospective Analysis of Korean Patients

Purpose@#To investigate the clinical and pathological classification of eyelid and conjunctival tumors in Korean patients. @*Methods@#We retrospectively reviewed the medical records of 284 patients with eyelid skin tumors and 158 with conjunctival tumors between January 2011 and June 2020. Demographic, clinical, and histopathological data were analyzed. @*Results@#In total, 260 (91.5%) and 24 (8.5%) patients had benign and premalignant/malignant eyelid tumors, respectively. The mean age was 54.7 ± 20.1 and 72.0 ± 13.5 years, respectively and the most common benign and malignant tumors were intradermal nevus (21.5%) and basal cell carcinoma (4.2%), respectively. The second most common malignant tumor was sebaceous gland carcinoma (1.4%). The conjunctival tumors included 133 (84.2%) benign tumors and 25 (15.8%) premalignant/malignant tumors, in patients with an average age of 47.9 ± 22.2 and 60.7 ± 18.3 years, respectively. The most common benign and malignant conjunctival tumors were subepithelial nevus (13.3%) and lymphoma (10.1%), respectively. The patients with premalignant/ malignant eyelid tumors were significantly older than those with premalignant/malignant conjunctival tumors (p = 0.01). @*Conclusions@#The incidence of sebaceous gland carcinoma was higher in our study than in Western ones, which showed similar results to other East Asian studies. The most common conjunctival malignant tumor was lymphoma in our study and malignant melanoma in Western studies. It is necessary to consider the possibility of lymphoma when the tumor is in the palpebral conjunctiva, where mucosal lymphoid tissue is abundant. This study provides useful data on the incidence and characteristics of eyelid and conjunctival tumors in Korean patients. Further investigations in larger patient populations are required to better understand the epidemiology of eyelid and conjunctival tumors.

Cataract Surgery Practice in the Republic of Korea: A Survey of the Korean Society of Cataract and Refractive Surgery 2020

Purpose@#To describe current cataract surgery practice patterns and trends among Korean ophthalmologists. @*Methods@#A survey was conducted among members of the Korean Society of Cataract and Refractive Surgery in October 2020. Of the 998 questionnaires, 262 (26.3%) were received for analysis. Data were analyzed using descriptive statistics and compared with those of previous surveys. @*Results@#The largest percentage of respondents (39%) had 11 years of practical experience. The average, median, and mode monthly volumes of cataract surgeries performed by the Korean Society of Cataract and Refractive Surgery members were 31, 20, and 10 cases, respectively. Topical anesthesia was administered by 85% of the respondents. For intraocular lens (IOL) calculations, 96% of the respondents used optical biometry. The proportion of surgeons providing femtosecond laser-assisted cataract surgery increased significantly from 5% in 2018 to 29% in 2020. This increase was accompanied by an increase in the multifocal IOLs. Those who implant multifocal IOL for >10% of their cases increased from 16% (2018) to 29% (2020). Topical nonsteroidal anti-inflammatory drugs were prescribed postoperatively by 76% of the respondents. Most respondents (70%) prescribed these anti-inflammatory drugs for 4 weeks. @*Conclusions@#This survey provided a comprehensive update on current cataract surgery practice in the Republic of Korea. The results highlighted the increasing use of premium IOLs, femtosecond laser-assisted cataract surgery, optical biometry, and topical anesthesia to better meet the patients’ needs.

Clinical and Pathological Classification of Eyelid and Conjunctival Tumors: a Retrospective Analysis of Korean Patients

Purpose@#To investigate the clinical and pathological classification of eyelid and conjunctival tumors in Korean patients. @*Methods@#We retrospectively reviewed the medical records of 284 patients with eyelid skin tumors and 158 with conjunctival tumors between January 2011 and June 2020. Demographic, clinical, and histopathological data were analyzed. @*Results@#In total, 260 (91.5%) and 24 (8.5%) patients had benign and premalignant/malignant eyelid tumors, respectively. The mean age was 54.7 ± 20.1 and 72.0 ± 13.5 years, respectively and the most common benign and malignant tumors were intradermal nevus (21.5%) and basal cell carcinoma (4.2%), respectively. The second most common malignant tumor was sebaceous gland carcinoma (1.4%). The conjunctival tumors included 133 (84.2%) benign tumors and 25 (15.8%) premalignant/malignant tumors, in patients with an average age of 47.9 ± 22.2 and 60.7 ± 18.3 years, respectively. The most common benign and malignant conjunctival tumors were subepithelial nevus (13.3%) and lymphoma (10.1%), respectively. The patients with premalignant/ malignant eyelid tumors were significantly older than those with premalignant/malignant conjunctival tumors (p = 0.01). @*Conclusions@#The incidence of sebaceous gland carcinoma was higher in our study than in Western ones, which showed similar results to other East Asian studies. The most common conjunctival malignant tumor was lymphoma in our study and malignant melanoma in Western studies. It is necessary to consider the possibility of lymphoma when the tumor is in the palpebral conjunctiva, where mucosal lymphoid tissue is abundant. This study provides useful data on the incidence and characteristics of eyelid and conjunctival tumors in Korean patients. Further investigations in larger patient populations are required to better understand the epidemiology of eyelid and conjunctival tumors.

Occlusion of Multiple Branches of the Ophthalmic Artery after Injection of Triamcinolone into the Nasal Septum

Purpose@#We report a case of visual loss caused by occlusion of multiple branches of the ophthalmic artery after triamcinolone injection into the nasal septum.Case summary: A 62-year-old male was referred to our ophthalmology clinic because of marked loss of vision in the right eye immediately after triamcinolone injection into the nasal septum. His corrected visual acuity was hand motion in the right eye and the intraocular pressure was 20 mmHg. His pupil was mid-dilated, fixed, and did not respond to light. Fundus examination revealed multiple, white steroidal emboli in the terminal retinal artery and capillaries. Fundus photography revealed macular edema, ischemic retinal whitening, and a cherry-red spot in the posterior pole of the retina. Optical coherence tomography (OCT) revealed inner-layer whitening and swelling and OCT-angiography revealed reduced numbers of terminal capillaries and a low vascular density. Anterior chamber paracentesis and ocular massage were immediately performed. Wide fluorescein angiography revealed diffuse choroidal hypofluorescence in the early phase and fluorescein leakage around the posterior pole in the late phase. Visual acuity improved to 1.0, but retinal whitening was still evident below the macula on fundus examination 3 months after symptom onset. @*Conclusions@#Multiple branches of the ophthalmic artery may become occluded after an intranasal, septal triamcinolone injection. The condition improves with immediate management.

Clinical Features of Patients with Opacification of Hydrophilic Acrylic Intraocular Lens in Neovascular Glaucoma

Purpose@#To report the clinical features of patients with opacification of hydrophilic acrylic intraocular lens (IOL) after cataract surgery in neovascular glaucoma. @*Methods@#This retrospective case series included 11 eyes of 10 patients with IOL opacification and neovascular glaucoma (NVG) between January 2006 and December 2010. We included and analyzed cases with opacification of hydrophilic acrylic IOL. An IOL exchange was performed in three cases, and the explanted IOLs were examined grossly and evaluated by light microscopy. Sagittal sections of the optics of the IOLs were evaluated by Von Kossa staining, scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDX). @*Results@#All 11 eyes of 10 patients were implanted with hydrophilic acrylic IOLs. In addition, there were no cases of hydrophobic acrylic IOL opacification. Nine patients of the 10 patients had diabetic retinopathy and one patient had central retinal artery occlusion. The mean period of IOL opacification after IOL implantation was 19.45 ± 8.52 months and the mean period of IOL opacification after the occurrence of NVG was 14.37 ± 8.51 months. The deposits of the explanted IOLs were shown to consist of calcium by von Kossa staining. The explanted IOLs showed fine whitish irregular granular deposits on the entire anterior surface of the optics by SEM and the presence of calcium deposition was confirmed by EDX analysis. @*Conclusions@#Care is required when using hydrophilic acrylic IOLs in patients with risk of neovascular glaucoma, such as those with diabetic retinopathy or central retinal artery occlusion.

Efficacy of Topical Cyclosporine Nanoemulsion 0.05% Compared with Topical Cyclosporine Emulsion 0.05% and Diquafosol 3% in Dry Eye

PURPOSE: To evaluate the efficacy and safety of cyclosporine nanoemulsion 0.05% compared to cyclosporine emulsion 0.05% and diquafosol sodium 3%. METHODS: This was a multicenter, randomized, evaluator-masked, active control, parallel, phase IV study. A total of 227 patients were randomly allocated to instill cyclosporine nanoemulsion 0.05% (CN) twice daily, cyclosporine emulsion 0.05% (CE) twice daily, or diquafosol sodium 3% (DQ) six times daily. Non-inferiority of CN was analyzed by primary endpoint (cornea and conjunctival staining scores at week 12). The secondary endpoints were scores of corneal staining, conjunctival staining, tear break-up time, Schirmer test, and Ocular Surface Disease Index at weeks 4 and 12. RESULTS: Primary endpoints showed statistically significant improvements in all groups. Primary endpoints were −6.60 for the CN group, −5.28 for the CE group, and −6.63 for the DQ group (National Eye Institute scale from 0 to 33), verifying the non-inferiority of CN compared to CE (95% confidence interval, −0.15 to 2.80, Δ>−2.88). In intergroup comparison between CN and CE groups, the CN group had significantly more decreased conjunctival staining score at week 12. Intergroup comparison between CN and DQ groups showed consistent statistically significant improvements in TBUT and Schirmer test in the CN group. In the DQ group, TBUT showed late statistically significant improvement at week 12 and Schirmer test showed relatively short-term statistically significant improvement at week 4. CONCLUSIONS: Cyclosporine nanoemulsion 0.05% was equivalently efficient compared to cyclosporine emulsion 0.05% and diquafosol sodium 3%. In addition, CN showed significant improvements in several parameters for treatment of dry eyes.

Anti-apoptotic effects of autophagy via ROS regulation in microtubule-targeted and PDGF-stimulated vascular smooth muscle cells

Autophagy has been studied as a therapeutic strategy for cardiovascular diseases. However, insufficient studies have been reported concerning the influence of vascular smooth muscle cells (VSMCs) through autophagy regulation. The aim of the present study was to determine the effects of VSMCs on the regulation of autophagy under in vitro conditions similar to vascular status of the equipped microtubule target agent-eluting stent and increased release of platelet-derived growth factor-BB (PDGF-BB). Cell viability and proliferation were measured using MTT and cell counting assays. Immunofluorescence using an anti-α-tubulin antibody was performed to determine microtubule dynamic formation. Cell apoptosis was measured by cleavage of caspase-3 using western blot analysis, and by nuclear fragmentation using a fluorescence assay. Autophagy activity was assessed by microtubule-associated protein light chain 3-II (LC-II) using western blot analysis. Levels of intracellular reactive oxygen species (ROS) were measured using H₂DCFDA. The proliferation and viability of VSMCs were inhibited by microtubule regulation. Additionally, microtubule-regulated and PDGF-BB-stimulated VSMCs increased the cleavage of caspase-3 more than only the microtubule-regulated condition, similar to that of LC3-II, implying autophagy. Inhibitory autophagy of microtubule-regulated and PDGF-BB-stimulated VSMCs resulted in low viability. However, enhancement of autophagy maintained survival through the reduction of ROS. These results suggest that the apoptosis of conditioned VSMCs is decreased by the blocking generation of ROS via the promotion of autophagy, and proliferation is also inhibited. Thus, promoting autophagy as a therapeutic target for vascular restenosis and atherosclerosis may be a good strategy.

A Case of Congenital Lacrimal Ductule Fistula on Lateral Skin to the Right Upper Eyelid

PURPOSE: To present a rare case of tear drainage since birth from a lacrimal ductule fistula, which is the first report in the Republic of Korea. CASE SUMMARY: 3-month-old female who presented with discharge of clear fluid from a small skin opening lateral to the right upper eyelid since birth visited the outpatient clinic. The patient was healthy and was receiving no medication. She was born on gestation age 35 weeks and 3 days. No other specific history or other ophthalmic abnormality was found. On examination, a small skin orifice approximately 2 mm diameter and no sign of infection or discoloration was observed. To relieve this symptom, the patient underwent a fistulectomy under general anesthesia. Histopathological examination of the surgical specimen was performed. The patient's symptom subsided postoperatively without recurrence. CONCLUSIONS: This is the first report in the Republic of Korea of tears draining from a lacrimal ductule fistula since birth and the subsequent clinical treatment procedures.

Objective Parameters Associated with Subjective Symptom Severity in Dry Eye Syndrome Patients

PURPOSE: To evaluate the correlation between the ocular surface disease index (OSDI score) and objectively quantifiable parameters in dry eye syndrome patients, and to assess environmental and lifestyle risk factors in severe OSDI patients. METHODS: The present study was retrograde and included 30 patients (30 eyes) diagnosed with dry eye syndrome at Ilsan Paik Hospital for the first time. Shirmer's test, corneal staining, and conjunctiva staining were assessed, and tear break-up time, meibum quality, and OSDI questionnaires were performed. We measured the lipid layer thickness in tear meniscus and counted the amount of partial eyelid blinking using Lipiview®. Moreover, we modified images of the lower lid meibography and calculated the percentage of meibomian glands outside the lower tarsal plate using the ImageJ® software. We analyzed the Pearson's correlation and performed a multiple linear regression analysis between the test values and OSDI. In addition, logistic regression analysis was used to determine the risk factors of the severe OSDI group, such as insomnia, level of computer use, and exposure to fully air-conditioned indoor environments. RESULTS: According to the Pearson's correlation analysis, quality of the meibum showed the highest statistically significant correlation with OSDI, followed by age, conjunctiva staining score, counts of partial blinking, and corneal staining score. The multiple linear regression analysis revealed that quality of the meibum and age were statistically significant factors affecting the OSDI score. Based on the logistic regression analysis, using a computer for more than 4 hours at a time exhibited a 7.43-fold odds ratio for severe OSDI (p-value = 0.029). CONCLUSIONS: Meibomian gland dysfunction and age should be considered to be important factors, especially in treating dry eye syndrome patients who complain severely. Moreover, we should also consider environmental factors such as long-term computer use for the treatment of dry eye syndrome patients with severe symptoms.

Incidence of Posterior Capsular Opacification Based on Low and High Fluid-dynamic Parameters

PURPOSE: To compare the incidence of posterior capsular opacification (PCO) based on low and high fluid-dynamic parameters during cataract surgery and evaluate the importance of these findings. METHODS: This retrospective study included 125 eyes in 73 patients with senile cataract who received a cataract surgery between September 2013 and March 2014. Patients were divided into 2 groups: those with low (vacuum: 180 mm Hg, aspiration flow: 18 mL/min, bottle height: 55 cm) and high (vacuum: 400 mm Hg, aspiration flow: 22 mL/min, bottle height: 90 cm) fluidic parameters during the nucleus was removal. We measured the total surgery time, ultrasound time, and balanced salt solution consumption during phacoemulsification. Best corrected visual acuity (BCVA), PCO score, PCO percentage and severity were measured at 3, 6 and 12 months postoperatively. Endothelial cell density (ECD) was measured preoperatively and 12 months postoperatively. RESULTS: The study included 20 eyes of 13 patients with low parameters and 20 eyes of 15 patients with high parameters. There was no statistically significant difference in the mean total surgery time, ultrasound time or fluid consumption between the two groups. BCVA and ECD were not significantly different between the two groups during the postoperative follow-up. PCO score, percentage and severity were higher in the low parameter group at 3, 6 and 12 months postoperatively. CONCLUSIONS: Surgery with low fluid-dynamic parameters is equally effective as with high parameters in terms of surgical time and postoperative BCVA. However, the incidence of PCO was higher in the low fluid-dynamic parameter group up to 12 months. Surgical efforts to reduce remnant lens epithelial cells are needed during low fluidic-dynamic parameter surgery.

Successful Treatment with Chronic Conjunctivitis: Removal of Tarsoconjunctival Crypt

No abstract available.

Long Term Incidence Rate of Glaucoma after Pars Plana Vitrectomy

PURPOSE: To evaluate the incidence rate of postoperative glaucoma after pars plana vitrectomy (PPV) and to compare incidence rate of glaucoma between phakic and pseudophakic eyes. METHODS: Retrospective chart review of patients who underwent PPV between January 2007 and May 2014. The outcome measure was the presence or absence of postoperative glaucoma, defined as definitive loss of neuro-retinal rim defect on fundus exam or showing glaucomatous change on a visual field test that warranted maintenance of ocular hypotensive therapy. RESULTS: There were 333 patients average age 57.09 +/- 13.43 included this study. Patients were followed for an average of 56.23 +/- 10.85 months. There was no significant difference in mean intra ocular pressure (IOP) between the vitretomized eyes with unoperative eyes, except in mean IOP at one day postoperatively (p = 0.012). In unoperative eyes, 10 of 315 (3.1%) were newly diagnosed as postoperative glaucoma. For the vitrectomized eyes, 69 of the 351 (19.6%) were newly diagnosed as postoperative glaucoma. There was a significant difference in incidence rate of glaucoma between the two groups (p < 0.001, chi-square test). There was a significantly higher IOP in glaucoma eyes compared with normal eyes (p < 0.001, Repeated Measures Analysis of variance [RM-ANOVA]). A possible risk factor for the development of glaucoma after PPV was cataract surgery (p = 0.0497, chi-square test). CONCLUSIONS: The incidence of glaucoma in patients with PPV is higher than in normal eyes. The incidence seems to increase particularly in those who have a pesudophakic eye. Patients who underwent PPV, especially in the pseudophakic state, need to have their IOP monitored carefully and managed properly by an ophthalmologist.

A Case of Successful Treatment Using Topical Colistin in Multidrug-resistant Pseudomonas aeruginosa Bacterial Ulcer

PURPOSE: To report a successful case of corneal ulcer caused by multidrug-resistant Pseudomonas aeruginosa using topical colistin in an immobilized patient who was hospitalized for a long period. CASE SUMMARY: An immobilized 58-year-old female who was admitted for a long stay due to cerebral aneurysm hemorrhage presented with left ocular discharge and hyperemia, and was referred to our clinic. The patient was treated at a local clinic with topical antibiotics, but showed no improvement. At initial visit, she had difficulty communicating with the medical team and taking ophthalmic examination, and she had severe chemosis and corneal infiltration, corneal opacity, and hypopyon on her left eye with a portable slit lamp. Gram staining, bacterial and fungal cultures, and an antibiotic sensitivity test were performed from a corneal scrape. The cultures revealed growth of Pseudomonas aeruginosa, which is resistant to all antibiotics except colistin. As soon as we were aware of the results of the antibiotic sensitivity test, she was treated with topical colistin 0.19% every 1 hour on her left eye, starting immediately. After 28 days of treatment, the infection was resolved except for the remaining corneal opacity. She had a persisted stable corneal lesion at 1-year-follow up after colistin treatment, which indicated no recurrence. CONCLUSIONS: Due to gait disturbance, the patient almost missed appropriate ophthalmic examination or treatment. However, as we started immediate topical colistin treatment, we report a successful therapy of corneal ulcer induced by multidrug-resistant Pseudomonas aeruginosa without severe complications, such as perforation.

Primary Neuroendocrine Carcinoma of the Breast with Clinical Features of Inflammatory Breast Carcinoma: A Case Report and Literature Review / 한국유방암학회지

Primary neuroendocrine carcinoma of the breast (NECB) is a very rare type of invasive breast carcinoma. Most NECBs appear on breast imaging as solid masses of varied shapes and margins, and have worse clinical outcomes than does invasive ductal carcinoma, not otherwise specified. However, there have been no reports to date regarding NECB with features of inflammatory breast carcinoma. Here, we describe the clinical, radiol-ogic, and pathologic findings of the first reported case of primary NECB presenting as inflammatory breast carcinoma. The patient complained of diffuse right breast enlargement and erythema. Mammography identified severe breast edema and axillary lymphadenopathy. Ultrasound detected an irregular, angular, hypoechoic mass with dermal lymphatic dilatation. On magnetic resonance imaging, the mass had rim enhancement and the entire right breast showed heterogeneous enhancement with malignant kinetic features. Pathology identified the mass as a primary NECB with positive for synaptophysin, CD56, estrogen and progesterone receptors.

Structural Analysis of Different Incision Sizes and Stromal Hydration in Cataract Surgery Using Anterior Segment Optical Coherence Tomography

PURPOSE: To analyze healing changes of corneal wounds of different corneal incision sizes with or without stromal hydration in cataract surgery using anterior segment optical coherence tomography. METHODS: Cataract surgeries were performed by a single surgeon and 2.2- and 2.8-mm corneal incisions were made using a diamond blade (ME-759; Meyco, Biel-Bienne, Swiss). Patients were divided into four groups according to incision size (2.2 and 2.8 mm), and with/without stromal hydration. Fifteen eyes were assigned to each group and incision wounds were measured using anterior segment optical coherence tomography at 2 hours, 1 day, 1 week, 1 month, and 3 months postoperatively. Corneal thickness, incision length and incision angle were measured and existence of epithelial, endothelial gaping and Descemet's membrane detachment was evaluated. RESULTS: Incision thickness was greater in the group with stromal hydration than in the group without on operation day (p < 0.05). Stromal hydration exerted greater influence in the 2.2-mm incision group than in the 2.8-mm incision group. Corneal thickness decreased more rapidly in the stromal hydration group than in the group with no hydration (p = 0.022). Endothelial gaping was greater in the 2.2-mm incision group than in the 2.8-mm incision group 1 day, 1 month, and 3 months after surgery (p = 0.035, p = 0.009, and p = 0.008, respectively). No other statistical significance was observed between the two groups (2.2 and 2.8 mm) during follow-up regarding corneal thickness, epithelial gaping and Descemet's membrane detachment. CONCLUSIONS: Corneal wounds with a smaller incision could be more vulnerable to external stimuli such as stromal hydration and are less stable than those with a larger incision.

Clinical Features and Compliance in Patients with Cosmetic Contact Lens-Related Complications

PURPOSE: To investigate the clinical features and compliance of cosmetic contact lens (CL)-related complications compared with soft CL-related complications. METHODS: We performed a retrospective chart review of 97 patients (194 eyes) regarded as having CL-related complications at the outpatient clinic. The portion of complications, gender, age, and chief complaints at the initial visit were analyzed, as was compliance to cosmetic and soft CL-related guidelines for use. RESULTS: A total of 97 patients (49 patients with cosmetic CL-related complications and 43 patients with soft CL-related complications) were evaluated. The mean age of the subjects using cosmetic CL was 19.8 years (14-31 years), and all the patients were female. The chief complaints at the initial visit included ocular pain, injection, blurred vision, dryness, itching and foreign body sensation. The main complications included corneal erosion, sterile corneal infiltrate, allergic disease, neovascularization, corneal ulcer and dry eye syndrome. No statistical difference was found regarding chief complaints or complications. The proportion of patients lost to follow-up was 47% in cosmetic CL-related and 20% in soft CL-related complications, a significant difference (p = 0.015). CONCLUSIONS: Because young females are the most common CL patients and do not always fully comply with the guidelines for use, ophthalmologists need to warn these patients about the risk of serious complications.

The Relationship between the High-Frequency Component of Accommodative Microfluctuation, Accommodative Lag and Accommodative Amplitude in Presbyopic Eyes

PURPOSE: To determine the relationship between the high-frequency component of accommodative microfluctuation (HFC) and accommodative lag in presbyopic eyes and how they affect the subjective accommodation power with other ophthalmic factors, such as pupil diameter and corneal multifocality. METHODS: Forty subjects (80 eyes) were included in this study, and the non-corrected distance and near visual acuity was measured and then converted to log MAR vision. The addition power for 33 cm near visual work was also measured and the accommodative power was measured by the push-up method. The HFC, accommodative lag and pupil size according to accommodative stimuli (-1.0 to -3.0 D) was measured by Speedy-i Autorefractor (Right Mfg Co., Tokyo). The corneal multifocality and corneal astigmatism was measured by corneal topography (TMS-4; Tomey, Erlangen, Germany). RESULTS: The mean age was 60.0 +/- 4.66 years (51-68) and there were 23 male and 17 female subjects (1.35:1). The HFC and pupil size showed no significant change according to accommodation demand, however, the accommodative lag showed a statistically significant increase (p < 0.001 by one-way ANOVA). Accommodative lag (-2.0 D) showed a statistically significant negative correlation with the subjective accommodative power, and the pupil size (0 D) showed a positive correlation with the subjective accommodative power. CONCLUSIONS: In presbyopia patients, the objective accommodative lag and initial pupil size showed a statistically significant relationship with subjective accommodative power. On the other hand, HFC, pupil size and corneal multifocality, alone may not be indicators to predict accommodative power, but these are important components to explain the dynamic aspect of accommodation.