Possible Risk Factors Affecting Successful Femtosecond Laser-assisted Cataract Surgery

PURPOSE: To determine the risk factors of intraoperative complications in femtosecond laser-assisted cataract surgery. METHODS: This study included 598 eyes of 337 patients who underwent femtosecond laser-assisted cataract surgery (FLACS) between July, 2012 and January, 2017. All eyes had corneal incisions, anterior capsulotomy, nuclear fragmentation, and limbal relaxing incisions (if required). Intraoperative complications were analyzed by watching videos, and the related factors of each complication were retrospectively reviewed alongside the medical records. RESULTS: The mean age of the patients was 62.1 ± 11.9 years. Among the study group, 18 eyes required manual creation of corneal incisions; because the corneal incisions could not be made due to corneal central opacity, corneal peripheral degeneration, ptreygium, conjunctival chalasis, or idiopathic. The anterior capsulotomy was incomplete in 43 cases and manual capsulorrhexis was required for completion. These cases were associated with various conditions, including hypermature cataract, anterior polar or subcapsular cataract, corneal central opacity, pupillary abnormality, lens subluxation, poor pupil dilation, and idiopathic. Overall, 22 eyes had difficulties with nuclear fragmentation, with either mature cataract, lens subluxation, corneal central opacity, anterior polar or subcapsular cataract, or pupillary abnormality. Using the Laser SoftFit™ patient interface decreased the incidences of incomplete corneal incision (from 3.56% to 2.24%, p = 0.367), anterior capsulotomy (from 9.31% to 4.03%, p < 0.05), and nuclear fragmentation (from 5.20% to 1.34%, p < 0.05). The incidences of complications in the experienced group was statistically lower compared with the novice group (p < 0.05 for all comparisons). CONCLUSIONS: The femtosecond laser platform was effective and safe for cataract surgery. However, in the presence of related factors, use of this platform might need to be re-assessed and should be considered for intraoperative complications. Additionally, with the Laser SoftFit™ patient interface and improved surgeon experience, better intraoperative results can be expected for FLACS surgery.

Comparison of Refractive Power and Astigmatism between Digital Keratometer and Autorefractor

PURPOSE: To compare the corneal refraction, astigmatism, and corneal marking for toric intraocular lens measured with a VERION® Image Guided System and an autorefractor in order to precisely determine the toric intraocular lens target. METHODS: The medical records of 29 eyes of 29 patients were retrospectively reviewed to compare the corneal refraction, axis, and amount of astigmatism measured with a VERION® Image Guided System and an autorefractor. We compared the difference in marked axis for toric intraocular lenses as measured by a VERION Digital Marker and a manual marker. RESULTS: The average corneal refraction and amount of astigmatism were greater with the VERION® Image Guided System than with the autorefractor. The average difference in axis of astigmatism was 9.62°. The difference in axis of astigmatism in patients with more than 1.0 D of astigmatism (18 eyes) was 2.82 ± 2.27°, while that in patients with less than 1.0 D of astigmatism (11 eyes) was 20.27 ± 28.14°. The average difference in marked axis for toric intraocular lens measured by the VERION® Digital Marker and manual marker was 2.50° (0°-9.27°). CONCLUSIONS: The corneal refraction and amount of astigmatism were significantly higher with the VERION® Image Guided System, so careful concern and comparison of surgical outcomes between the two devices is needed in biometry.

Comparison of Effective Phacoemulsification Time between Femtosecond Laser-Assisted Cataract Surgery and Conventional Cataract Surgery

PURPOSE: To compare the effect of femtosecond laser-assisted cataract surgery with conventional cataract surgery on effective phacoemulsification time (EPT). METHODS: This study included 66 patients 100 eyes who underwent femtosecond laser-assisted cataract surgery and 68 patients 100 eyes who underwent conventional cataract surgery. Both groups underwent phacoemulsification using pulsed ultrasound energy and EPT was evaluated. The groups were further analyzed according to preoperative Lens opacities classification system (LOCS) III grading. Patients who had femtosecond laser-assisted cataract surgery underwent lens fragmentation with quadrant, hybrid, or grid pattern and the EPT was respectively evaluated. RESULTS: The mean EPT was 5.85 +/- 4.31 seconds in the femtosecond laser-assisted cataract surgery group and 10.34 +/- 6.61 seconds in the conventional group. Overall, EPT was statistically significantly lower in the femtosecond laser-assisted cataract surgery group compared to the conventional group. When the groups were analyzed according to LOCS III grading, this result was consistent for all cataract grades and the reduction in EPT was increased with the higher LOCS III grade. When the groups were analyzed according to lens fragmentation patterns, the mean EPT was lower with 350 microm grid pattern than the quadrant or hybrid pattern. CONCLUSIONS: The femtosecond laser-assisted system in cataract surgery can be an efficient cataract surgery using lower EPT compared to the conventional procedure. Additionally, significant differences were observed in the mean EPT of cataract surgery using the femtosecond laser-assisted system among the 3 lens fragmentation pattern groups.

Iris-trabecular Contact Index Change after Cataract Surgery in Acute Angle Closure Glaucoma

PURPOSE: To evaluate the change of iris-trabecular contact index (ITC index) after cataract surgery in acute angle closure glaucoma. METHODS: Twelve patients (17 eyes) who had a history of acute angle closure glaucoma underwent swept source optical coherence tomography before and after cataract surgery. Correlations between lens vault (LV), ITC index and intraocular pressure (IOP), anterior chamber depth (ACD), anterior chamber volume (ACV), and angle parameters were analyzed before and after cataract surgery. RESULTS: IOP (p = 0.007), ACD (p < 0.001), ACV (p < 0.001), angle parameters (p = 0.001), and ITC index (p = 0.012) were improved after cataract surgery. ITC index decreased from 88.42 ± 23.59% to 48.91 ± 35.13% after cataract surgery (p = 0.012). There was no correlation between LV and ACD (p = 0.075), ACV (p = 0.864), angle parameter (p = 0.112-0.707), or ITC index (p = 0.288) before cataract surgery. The correlations between ITC index and IOP (p = 0.021), ACD (p = 0.002), ACV (p < 0.001), and angle parameter (p = 0.001-0.030) were statistically significant before surgery but not statistically significant (p = 0.223/0.206/0.761/ 0.096-0.819) after surgery. CONCLUSIONS: ITC index significantly improved after cataract surgery, but part of angle closure was not resolved in some cases of acute angle closure glaucoma.

Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery

PURPOSE: To evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantation after myopic refractive surgery. METHODS: Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR(R) SN6AD1, the aspheric DMIOL after myopic refractive surgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assisted subepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction were measured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer in dilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass system under mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively. RESULTS: Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 +/- 0.19, and 0.19 +/- 0.12 (log MAR), respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within +/-0.50 diopters (D) and all eyes were within +/-1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were 0.08 +/- 0.08 and 0.07 +/- 0.07 (microm), respectively. Objective scatter index was 3.42 +/- 1.71 and modulation transfer function (MTF) cut-off value was 21.03 +/- 12.37 cpd. General satisfaction score was 3.52 +/- 0.96 points out of 5, and 8 patients (11 eyes) were not satisfied with DMIOL implantation. CONCLUSIONS: After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to the target D, but optical qualities and patient satisfaction were poor.

Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery

PURPOSE: To evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantation after myopic refractive surgery. METHODS: Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR(R) SN6AD1, the aspheric DMIOL after myopic refractive surgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assisted subepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction were measured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer in dilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass system under mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively. RESULTS: Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 +/- 0.19, and 0.19 +/- 0.12 (log MAR), respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within +/-0.50 diopters (D) and all eyes were within +/-1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were 0.08 +/- 0.08 and 0.07 +/- 0.07 (microm), respectively. Objective scatter index was 3.42 +/- 1.71 and modulation transfer function (MTF) cut-off value was 21.03 +/- 12.37 cpd. General satisfaction score was 3.52 +/- 0.96 points out of 5, and 8 patients (11 eyes) were not satisfied with DMIOL implantation. CONCLUSIONS: After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to the target D, but optical qualities and patient satisfaction were poor.

Comparison of Continuous Curvilinear Capsulorhexis Parameters between Femtosecond Laser and Conventional Cataract Surgery

PURPOSE: To compare parameters of femtosecond laser and manual continuous curvilinear capsulorhexis (CCC) using anterior segment optical coherence tomography (AS-OCT). METHODS: Femtosecond laser cataract surgery was performed in 30 eyes of 30 patients, and conventional cataract surgery with a manual CCC in 30 eyes of 30 patients. One month after surgery, CCC diameters, circularity of capsulotomy, and distance between the CCC and pupil center were analyzed using the AS-OCT. RESULTS: Mean maximal CCC diameter was 4.96 +/- 0.23 mm in the femtosecond laser group, and 4.70 +/- 0.82 mm in the manual CCC group. Mean minimal CCC diameter was 4.91 +/- 0.23 mm in the femtosecond group, and 4.48 +/- 0.64 mm in the manual CCC group showing significant difference between the two groups (p = 0.000). Circularity of capsulotomy was 0.99 +/- 0.01 in the femtosecond group and 0.91 +/- 0.13 in the manual CCC group and was statistically different between the 2 groups (p = 0.000). The distance from the CCC center to the pupil center was 0.18 +/- 0.09 mm in the femtosecond group and 0.26 +/- 0.17 mm in the manual CCC group. The CCC center was closer to the pupil center in the femtosecond than in the manual CCC group (p = 0.038). CONCLUSIONS: Properly sized and shaped capsulotomy can be expected in femtosecond laser CCC compared with manual CCC.

Comparison of Continuous Curvilinear Capsulorhexis Parameters between Femtosecond Laser and Conventional Cataract Surgery

PURPOSE: To compare parameters of femtosecond laser and manual continuous curvilinear capsulorhexis (CCC) using anterior segment optical coherence tomography (AS-OCT). METHODS: Femtosecond laser cataract surgery was performed in 30 eyes of 30 patients, and conventional cataract surgery with a manual CCC in 30 eyes of 30 patients. One month after surgery, CCC diameters, circularity of capsulotomy, and distance between the CCC and pupil center were analyzed using the AS-OCT. RESULTS: Mean maximal CCC diameter was 4.96 +/- 0.23 mm in the femtosecond laser group, and 4.70 +/- 0.82 mm in the manual CCC group. Mean minimal CCC diameter was 4.91 +/- 0.23 mm in the femtosecond group, and 4.48 +/- 0.64 mm in the manual CCC group showing significant difference between the two groups (p = 0.000). Circularity of capsulotomy was 0.99 +/- 0.01 in the femtosecond group and 0.91 +/- 0.13 in the manual CCC group and was statistically different between the 2 groups (p = 0.000). The distance from the CCC center to the pupil center was 0.18 +/- 0.09 mm in the femtosecond group and 0.26 +/- 0.17 mm in the manual CCC group. The CCC center was closer to the pupil center in the femtosecond than in the manual CCC group (p = 0.038). CONCLUSIONS: Properly sized and shaped capsulotomy can be expected in femtosecond laser CCC compared with manual CCC.

Analysis of Miscorrection after Implantation of the Toric Intraocular Lens

PURPOSE: To evaluate the efficacy and stability of AcrySof Toric intraocular lens (IOL) implants and to analyze the miscorrection that resulted after implantation. METHODS: This retrospective study included 422 eyes of 348 patients who underwent cataract surgery with implantation of the AcrySof toric IOL between December 2011 and June 2013. We evaluated uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), keratometry and refraction preoperatively and 3 months postoperatively. The axis of implanted AcrySof Toric IOL was measured using the KR-1W aberrometer before mydriasis. At 3 months postoperatively, patients with a residual cylindrical power of 0.50 diopters (D) or more, and having an IOL rotation of 10 degrees (degrees) or more were considered having miscorrection. RESULTS: UCVA (log MAR) improved from 0.58 +/- 0.35 to 0.18 +/- 0.26. Preoperative corneal astigmatism was 1.46 +/- 0.72 D and postoperative refractive cylindrical power was 0.45 +/- 0.30 D. The postoperative miscorrection was 50.5% in the T3 group, 35.7% in the T4 group, and 27.2% in the T5 group. The incidence of overcorrection was significantly higher in the T3 group than in the T4 and T5 group. In eyes with with-the-rule (WTR) astigmatism, overcorrection was found in 36.4% (32/88 eyes), while in eyes with against-the-rule (ATR) astigmatism, undercorrection was found in 37.6% of cases (44/117 eyes). There were five cases of IOL rotation at 3 months postoperatively. CONCLUSIONS: AcrySof Toric IOL was effective in correcting corneal astigmatism and had good rotational stability. However, the incidence of miscorrection, especially for overcorrection, was higher with lower power toric IOL. Patients with WTR astigmatism tend to have overcorrection, while those with ATR show a tendency toward undercorrection, suggesting that these changes considered at the time of cataract surgery.

The Effects of Overnight Orthokeratology Lens Wear on Ocular Scatter

PURPOSE: To evaluate the change of visual quality after wearing orthokeratology lenses overnight. METHODS: This study included 13 patients (24 eyes) who wore orthokeratology lenses for the first time. Visual quality was assessed with the optical quality analysis system (OQAS) using the double-pass technique. The value of modulation transfer function (MTF) cutoff, Strehl ratio, and objective scatter index (OSI) were measured at baseline and 4 weeks after wearing the lenses. RESULTS: The mean spherical equivalent decreased from -2.70 +/- 1.03 diopters (D) to 0.03 +/- 0.36 D after 4 weeks of wearing orthokeratology lenses and uncorrected visual acuity improved from log MAR 0.88 +/- 0.17 to log MAR 0.03 +/- 0.04. The MTF cutoff decreased from 38.20 +/- 11.01 to 34.79 +/- 10.30 and the Strehl ratio decreased from 0.24 +/- 0.07 to 0.21 +/- 0.07 but without statistical significance. The OSI significantly increased from 0.38 +/- 0.19 to 0.72 +/- 0.40 after wearing orthokeratology lenses. CONCLUSIONS: Orthokeratology lenses were effective for correction of myopia and astigmatism. The OSI increased after wearing the lenses, but MFT cutoff and Strehl ratios were not affected.

Comparison of Four Systems of IOL Calculation after Keratorefractive Surgery in Eyes Requiring Cataract Surgery

PURPOSE: To report the evaluation and comparison of true corneal power after corneal refractive surgery through ARK, Orbscan II(R), Pentacam and IOL master. METHODS: Target IOL (Intraocular lens) power calculated with the SRK/T formula using SMK (Sungmo Eye Hospital keratometry), which is a new method for measuring corneal refractive power, was compared with the back-calculated ideal IOL power after cataract surgery for 30 eyes that required cataract surgery and had previously undergone refractive surgery. Target IOL powers calculated using 4 systems were compared with IOL power calculated using the clinical history method for 64 eyes that had undergone refractive surgery. RESULTS: Using SMK with the SRK/T formula, the actual refraction was within +/-0.5 diopter (D) of the intended refraction for 63.8% of eyes and within +/-1.0 D for 90.9% of eyes. Compared with target IOL power calculated with the clinical history method, target IOL power calculated by SMK with the SRK/T formula had a difference of 1.95 +/- 0.86 D, which was similar to the results calculated by the Haigis-L formula and by TNP with Haigis. CONCLUSIONS: The method of IOL calculation using SMK with the SRK/T formula showed the best predictability in patients after corneal refractive surgery. Comparatively accurate results were produced in IOL power calculations using the Haigis-L formula, and the TNP with Haigis method.

Relationship Between RR Intervals and Early Diastolic Mitral Annulus Velocities in Atrial Fibrillation Patients Who do not Have Significant Valvular Diseases

BACKGROUND AND OBJECTIVES: Irregular RR intervals in atrial fibrillation (AF) results in beat to beat changes in hemodynamical parameters. Early diastolic mitral annulus velocity (E') is one of the parameters that represent diastolic function of the left ventricle (LV). In this study, we have investigated the effects of continuous changes of systolic functions in AF on the diastolic functions of the LV. SUBJECTS AND METHODS: E' (35-40 beats) was recorded in 31 AF patients that did not have significant valvular heart diseases. The relationships between preceding RR intervals (RR-1) or pre-preceding RR intervals (RR-2) and E's were obtained using a logarithmic function. RESULTS: Slopes between RR-1 and E' varied from -1.62 to 1.04 in total coordinates. In the logistic regression analysis patients with negative slopes were found to have a larger left atrial size than patients with positive slopes (5.5+/-0.67 cm vs. 4.9+/-0.56 cm, p=0.02). Slopes were negatively related with mean RR intervals in the Pearson correlation analysis (r=-0.40, p=0.028). Slopes between RR-2 and E' were also variable and were not associated with other parameters. CONCLUSION: Beat to beat changes in systolic functions derived from irregular RR intervals in AF had variable effects on diastolic functions among patients. The relationship between RR-1 and E' was associated with LA sizes and mean RR intervals.

Association of New Parameters Derived from Relation between RR intervals and Left Ventricular Performances with Heart Failure in Patients with Atrial Fibrillation and Normal Systolic Function

BACKGROUND AND OBJECTIVES: Heart failure (HF) may occur in atrial fibrillation (AF) patients with a normal left ventricular (LV) systolic function if the diastolic function is impaired. The association of new parameters from the relationship between the preceding RR interval (RR-1) and LV outflow peak ejection velocity (Vpe) with systolic function has been reported. The aim of this study was to observe whether these parameters were associated with HF in AF patients with a normal systolic function. SUBJECTS AND METHODS: AF patients with a normal systolic function were divided into two groups according to the presence (n=16) or absence (n=30) of a history of HF. From the logarithmic equation between RR-1 and Vpe, the slope, Vpe at RR-1 second (Vpe-1), and Slope/Vpe-1 were calculated. RESULTS: Patients with a history of HF were older (p=0.037) and tended to more frequently have hypertension (p=0.063) than those with no history of HF. The ejection fractions were similar between the two groups. In the coordinates with RR-1 from 0.6 to 1 second, the slope tended to be steeper (p=0.074) and slope/Vpe-1 was higher in patients with a history of HF (p=0.011). The Vpe-1 was similar between the two groups (p=0.66). A multiple forward logistic regression analysis showed that slope/Vpe-1 was the only independent variable associated with the occurrence of HF. Slope/Vpe-1 was related with aortic regurgitation, HF history, and the interventricular septal thickness in a multiple stepwise regression analysis. CONCLUSION: New parameters from the relationship between the RR intervals and LV performances were associated with the occurrence of HF in AF patients with a normal systolic function. This finding suggests that these parameters may be related with the LV diastolic function.

Effect of fenofibrate on C-reactive protein levels in hypertriglyceridemic patients / 대한내과학회지

BACKGROUND: High levels of C-reactive protein (CRP) are associated with an increased risk for cardiovascular diseases. Most reports on the effect of fibrate on CRP level have inadequate study designs and the results are inconsistent. This study was designed to evaluate the effect of fenofibrate on CRP levels in hypertriglyceridemic patients. METHODS: Patients with triglyceride (TG) level over 200 mg/dL were treated with 200 mg of fenofibrate (Fenofibrate group, n=30) or with general measures (Control group, n=30). Patients with CRP levels >10 mg/L were excluded. Patients with hypercholesterolemia were treated with HMG CoA reductase inhibitor (Statin group, n=30). Lipid and lipoprotein levels were measured before and 2 months after medication. RESULTS: Baseline characteristics were similar in Fenofibrate and Control groups. Baseline CRP levels were independently associated with the presence of diabetes mellitus. Fenofibrate therapy did not change CRP levels (1.67+/-1.60 vs 1.76+/-1.88 mg/L, p=0.79) as did Control group (p=0.46). When both Fenofibrate and Control groups were divided into three subgroups in terms of baseline CRP levels, CRP levels were increased in the lowest group (p=0.019), did not change in the middle and the highest groups (p=0.89 and p=0.47 respectively). In patients with baseline CRP level > or =3 mg/L, CRP levels were decreased (p=0.041). Changes of CRP levels were independently associated with baseline CRP levels. Statin therapy decreased CRP levels (p=0.046). CONCLUSIONS: Fenofibrate did not change CRP levels in hypertriglyceridemic patients. Cardioprotective effects of fibrates may not be associated with anti-inflammatory mechanisms in contrast to those of statins.

Binding of Annexin V to Oxidized Lipid on Oxidatively Damaged Erythrocyte

BACKGROUND AND OBJECTIVES: Annexin V is known to bind to the phosphatidylserine (PS) of damaged cell membranes. We recently demonstrated that annexin V binds to oxidized red blood cells (oxRBC). The aim of this study was to find whether annexin V binds to oxidized lipids or to the PS of oxRBC. MATERIALS AND METHODS: Red blood cells (RBC) were oxidized by the addition of CuSO4, and the degree of oxidation evaluated using the semiquantitative measurement of thiobarbituric acid reactive substance (TBARS). The binding of annexin V to oxRBC was evaluated by flow cytometry. RESULTS: Annexin V was found to bind to oxRBC, but not to native RBC. The percentage of RBC binding to annexin V was closely correlated with the degree of oxidation, as measured using TBARS (r=0.99, p=0.000) in relation to the concentration of CuSO4. The binding of annexin V to oxRBC was attenuated in the presence of oxidized low density lipoprotein (oxLDL), with these phenomena also being dosedependent. The binding was reduced by 71.0+/-3.0% in the presence of 100 microgram/mL oxLDL. LDL had no influence on the binding of annexin V to oxRBC. CONCLUSION: These findings suggest that annexin V may bind to the oxidized lipids of cell membranes. Further studies will be required to evaluate the relative importance between oxidized lipids and PS, and to find the characteristics of oxidized lipids in the binding of annexin V to damaged cell membranes.

Comparison of Surgically Induced Astigmatism between Superior and Temporal Clear Corneal Incision in Sutureless Cataract Surgery

Postoperative changes of keratometric astigmatism were analysed in 137 cases of phacoemulsification and foldable silicone posterior chamber lens implantation using clear corneal incision. The subjects were divided into two groups; Group 1 comprised 36 eyes which underwent surgery using a superior approach, Group 2 comprised 101 eyes which underwent surgery using a temporal approach. Surgically induced keratometric astigmatism in Group 1 was -1.14+/-1.02 diopter(D) at one day, -0.98+/-1.03 D at one week, -0.58+/-0.94 D at two months after operation, and in Group 2 was 0.69+/-0.97 D at one day, 0.96+/-1.08 at one week, 0.63+/-0.68 at two months after operation. The difference of absolute astigmatism between two groups was statistically significant(p<0.05) at one day after operation. But there was no statistically significant difference at one week and two months after operation. Temporal incision induced less astigmatism than superior incision temporarily in cataract surgery using clear corneal incision.