Comparison of Reading Speed after Bilateral Bifocal and Trifocal Intraocular Lens Implantation

PURPOSE: To evaluate and compare visual acuity and reading speed for Korean language between a diffractive bifocal and trifocal intraocular lens (IOL) of the same material and haptic design. METHODS: We reviewed the medical records of the patients who had undergone bilateral cataract surgery with bifocal IOLs (AT LISA 801) on the both eyes (bifocal group) and trifocal IOLs (AT LISA tri 839 MP, trifocal group). The main outcome measures were the uncorrected distance, intermediate, and near visual acuity (uncorrected distance visual acuity [UCDVA], uncorrected intermediate visual acuity [UCIVA], and uncorrected near visual acuity [UCNVA]) and corrected distance, near, and distance-corrected intermediate visual acuity (corrected distance visual acuity [CDVA], corrected near visual acuity [CNVA], and distance-corrected intermediate visual acuity [DCIVA]) at last postoperative follow-up month. Reading speeds for Korean language were measured to check near visual function. RESULTS: Fourteen eyes (7 patients) were included in the bifocal group and 32 eyes of 16 patients in the trifocal group. There were no statistical differences between the two groups with respect to UCDVA, UCNVA, CDVA, and CNVA. However, UCIVA (0.35 vs. 0.22 logarithm of the minimum angle of resolution [logMAR], p < 0.01) and DCIVA (0.34 vs. 0.20 logMAR, p < 0.01) were significantly better in the trifocal group than in the bifocal group. The mean reading speed for logMAR 0.5 optotype (point 10) was 86.50 words per minute (wpm) in the bifocal group and 81.48 wpm in the trifocal group without a significant difference (p = 0.70). CONCLUSIONS: Trifocal IOLs provided the same level of distance and near visual acuity and reading speed as that of bifocal IOLs with better intermediate visual acuity.

Korean Version Self-testing Application for Reading Speed

PURPOSE: This study introduces a reading chart application for the iPad tablet in the Korean language and investigates the reading speed in a normal-sighted population according to age group. METHODS: Sixty-three Korean sentences were selected from textbooks for second grade elementary school students. A commonly used typeface in everyday printed material, “BatangChe,” was used. Letter size was presented in logarithm of the minimum angle of resolution (logMAR) 0.0 to 1.0 at 0.1 logMAR steps at a reading distance of 40 cm. A third generation retina display iPad was used to present the chart, and the sentences were presented randomly for each size of letter. The subjects repeated the test silently (reading only) and out loud (reading and speaking) to prevent them from skipping reading words. Pilot testing followed in 65 normal vision adults under 60 years of age. RESULTS: The mean reading only speed for logMAR 0.5 optotype (point 10) was 121.1 ± 47.2 words per minute (wpm) for people in their 20s (n=21), 116.5 ± 38.3 in their 30s (n=27), 93.8 ± 12.6 in their 40s (n=9), and 56.5 ± 42.7 (n=8) in their 50s. There was a significant correlation between age and reading and speaking speed (r=−0.48, p<0.001). The mean reading only speed for logMAR 0.5 optotype (point 10) was 202.3 ± 88.4 wpm and the mean reading and speaking speed was 129.7 ± 25.9 wpm, with significantly different (p<0.001). CONCLUSIONS: This Korean reading chart application could present a new standard when checking reading speed according to age groups.

Comparison of Results after Daily Patching and Alternate-Day Patching to Treat Amblyopia

PURPOSE: We compared the results of daily patching and alternate-day patching to treat amblyopia. METHODS: Patients with difference in the visual acuity (VA) between the eyes of at least two lines were prescribed spectacles according to the result of cycloplegic refraction. After 4 months, 45 patients with confirmed amblyopia were randomly assigned to daily patching or alternate-day patching group. Patients were patched daily in the daily patching group (n = 24), and patched every other day in another group. The patching time was 2-6 hours according to the VA of the amblyopic eye. The parents were asked to mark on a calendar whether their child performed occlusion or not. The main outcome measure was the mean VA of amblyopic eye and compliance of occlusion after 1, 3, 6 and 9 months. The success of treatment was defined if difference of VA between the eyes was less than or equal to 1 line. RESULTS: There was no significant difference between the two groups in age, type of amblyopia, VA of the amblyopic eye and total treatment duration. VA of the amblyopic eye was significantly improved at 1 month after occlusion in both groups. At the final visit in both groups, the number of improved VA lines in the amblyopic eye (3.8 lines:3.7 lines, p = 0.754), the final success rate (50.0%:81.0%, p = 0.060) and the compliance of occlusion (94.5%:96.3%, p = 0.803) were not different significantly, but VA of the amblyopic eye (0.2 log MAR:0.1 log MAR, p = 0.042) was better in the alternate-day patching group than that in another group. CONCLUSIONS: There was no difference in the number of improved VA lines in the amblyopic eye, nor were there differences in success rate and compliance of occlusion between the two groups. The final VA was better in the alternate-day patching group than another group. Therefore, the alternate-day patching method is another possible option for the treatment of amblyopia.

Changes in Hypermetropic Spectacle Correction after Surgery in Partially Accommodative Esotropia

PURPOSE: To investigate the characteristics of successfully weaning patients off of glasses and the change in hypermetropic spectacle correction required for maintaining orthotropia using an analysis of surgery results of patients with partially accommodative esotropia. METHODS: We reviewed the medical records of 104 patients who underwent standard surgery for correcting partially accommodative esotropia. In total, 64 patients who had follow-up periods of at least 2 years were included. The patients were divided into 2 groups: 28 patients who were asked to discontinue their hyperopic glasses (glasses-discontinued group) and 36 patients who still needed hyperopic glasses (glasses-maintained group). We investigated the age at first visit and at surgery, total angle of deviation and residual angle of deviation with correction before surgery, weaning time of hyperopic glasses, follow-up period, and the time at which the hyperopic glasses were discontinued in the glasses-discontinued group. RESULTS: There were no statistically significant differences in the age at first visit and at surgery as well as the duration of postoperative follow-up between both groups. The total esodeviated angle without hyperopic correction of the glasses-discontinued group was significantly lower than that of glasses-maintained group (37.4PD:46.7PD, p < 0.05); there were no significant differences in the remaining esotropic angle after hyperopic correction. The average hyperopic degree in the glasses-discontinued group was significantly lower than that in the glasses-maintained group (+3.0D:+4.7D, p < 0.05), there were no significant differences in the weaning time of hyperopic glasses between both groups. CONCLUSIONS: The esodeviated angle without hyperopic correction was smaller and hyperopic degree was lower in the glasses-discontinued group than in the glasses-maintained group after surgery for partially accommodative esotropia. Therefore, it might be helpful to predict the postoperative possibility to discontinue glasses in the patients with partially accommodative esotropia.

Result Comparison after Reoperation in Recurrent Exotropia According to the Type of First Operation

PURPOSE: To investigate and compare the clinical courses and surgical success rates of secondary operations in recurrent exotropia according to the type of first operation for correction of exotropia. METHODS: A retrospective chart review was performed for all patients with recurrent exotropia of the basic or pseudodivergence excess types. In group A (36 patients), bilateral lateral rectus (LR) recession was performed as the first operation and uni- or bilateral medial rectus (MR) resection was performed as the second operation. In group B (19 patients), unilateral LR recession-MR resection (R&R) was performed as the first operation and LR recession or R&R in contralateral eye as the second operation. RESULTS: There were no significant differences between the 2 groups when considering age at each operation, frequency of the amblyopia, prescription of prism, time interval for recurrence and reoperation and the final and cumulative success rates. No postoperative complications were observed in either group. The mean number of used muscles for the first and second operation was 3.9 +/- 0.4 in group A, and 3.4 +/- 0.5 in group B (p = 0.001). Mean time interval for occurrence of postoperative orthophoria was 3.7 +/- 6.2 months in group A and 6.5 +/- 16.2 in group B (p = 0.047). In group B, the incidence of esodeviation tended to increase after postoperative 1 month. CONCLUSIONS: The final success rates of reoperation between the 2 types of the first operation in recurrent exotropia were similar. Mean time between postoperative overcorrection of orthophoria was shorter in the group with bilateral LR recession followed by secondary MR resection than in the other group. Unilateral R&R followed by LR recession or R&R in contralateral eye may be more helpful to decrease the number of used muscles than in the bilateral LR recession followed by secondary MR resection.

Changes in Hypermetropic Spectacle Correction after Surgery in Partially Accommodative Esotropia

PURPOSE: To investigate the characteristics of successfully weaning patients off of glasses and the change in hypermetropic spectacle correction required for maintaining orthotropia using an analysis of surgery results of patients with partially accommodative esotropia. METHODS: We reviewed the medical records of 104 patients who underwent standard surgery for correcting partially accommodative esotropia. In total, 64 patients who had follow-up periods of at least 2 years were included. The patients were divided into 2 groups: 28 patients who were asked to discontinue their hyperopic glasses (glasses-discontinued group) and 36 patients who still needed hyperopic glasses (glasses-maintained group). We investigated the age at first visit and at surgery, total angle of deviation and residual angle of deviation with correction before surgery, weaning time of hyperopic glasses, follow-up period, and the time at which the hyperopic glasses were discontinued in the glasses-discontinued group. RESULTS: There were no statistically significant differences in the age at first visit and at surgery as well as the duration of postoperative follow-up between both groups. The total esodeviated angle without hyperopic correction of the glasses-discontinued group was significantly lower than that of glasses-maintained group (37.4PD:46.7PD, p < 0.05); there were no significant differences in the remaining esotropic angle after hyperopic correction. The average hyperopic degree in the glasses-discontinued group was significantly lower than that in the glasses-maintained group (+3.0D:+4.7D, p < 0.05), there were no significant differences in the weaning time of hyperopic glasses between both groups. CONCLUSIONS: The esodeviated angle without hyperopic correction was smaller and hyperopic degree was lower in the glasses-discontinued group than in the glasses-maintained group after surgery for partially accommodative esotropia. Therefore, it might be helpful to predict the postoperative possibility to discontinue glasses in the patients with partially accommodative esotropia.

Result Comparison after Reoperation in Recurrent Exotropia According to the Type of First Operation

PURPOSE: To investigate and compare the clinical courses and surgical success rates of secondary operations in recurrent exotropia according to the type of first operation for correction of exotropia. METHODS: A retrospective chart review was performed for all patients with recurrent exotropia of the basic or pseudodivergence excess types. In group A (36 patients), bilateral lateral rectus (LR) recession was performed as the first operation and uni- or bilateral medial rectus (MR) resection was performed as the second operation. In group B (19 patients), unilateral LR recession-MR resection (R&R) was performed as the first operation and LR recession or R&R in contralateral eye as the second operation. RESULTS: There were no significant differences between the 2 groups when considering age at each operation, frequency of the amblyopia, prescription of prism, time interval for recurrence and reoperation and the final and cumulative success rates. No postoperative complications were observed in either group. The mean number of used muscles for the first and second operation was 3.9 +/- 0.4 in group A, and 3.4 +/- 0.5 in group B (p = 0.001). Mean time interval for occurrence of postoperative orthophoria was 3.7 +/- 6.2 months in group A and 6.5 +/- 16.2 in group B (p = 0.047). In group B, the incidence of esodeviation tended to increase after postoperative 1 month. CONCLUSIONS: The final success rates of reoperation between the 2 types of the first operation in recurrent exotropia were similar. Mean time between postoperative overcorrection of orthophoria was shorter in the group with bilateral LR recession followed by secondary MR resection than in the other group. Unilateral R&R followed by LR recession or R&R in contralateral eye may be more helpful to decrease the number of used muscles than in the bilateral LR recession followed by secondary MR resection.

Vitreous Web after Pars Plana Vitrectomy and Bevacizumab Injection

PURPOSE: To report a case of vitreous inflammation (vitreous web) after intravitreal bevacizumab injection accompanying pars plana vitrectomy (PPV) for the treatment of proliferative diabetic retinopathy with vitreous hemorrhage. CASE SUMMARY: A 41-year-old female who underwent panretinal photocoagulation for diabetes mellitus (DM) retinopathy presented with decreased visual acuity in her right eye which was caused by vitreous hemorrhage. The patient underwent PPV with intravitreal bevacizumab injection. One day after surgery, the vitreous hemorrhage cleared and there was no inflammation in the anterior segment; however, multiple inflammatory white strands (vitreous web) were found in the vitreous cavity. She was diagnosed with non-infectious endophthalmitis and treated with topical steroid and additional oral steroids, resulting in clearance of the vitreous web on postoperative day 4. One month later, vitreous hemorrhage occurred in the other eye. PPV without bevacizumab injection cleared the vitreous hemorrhage with no evidence of vitreous web. CONCLUSIONS: Vitreous web-like inflammation can occur after intravitreal bevacizumab injection accompanying PPV for the treatment of DM vitreous hemorrhage. After eliminating infectious endophthalmitis based on lack of pain, conjunctival injection, anterior chamber hypopyon, and inflammatory cells, the web can be cleared without invasive intravitreal antibiotics injections.

Complicated Ophthalmopathy in Herpes Zoster Ophthalmicus Including Vitreous Opacity, Retinal Hemorrhage and Optic Neuropathy

PURPOSE: To introduce a case of complicated ophthalmopathy in herpes zoster ophthalmicus including vitreous opacity, retinal hemorrhage and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis. CASE SUMMARY: A 59-year-old man visited our clinic because of visual disturbance in the right eye which occurred after right facial pain and vesicles. There were inflammatory cells in the anterior chamber, retinal hemorrhage in the retina and vitreous opacity was found. Track-like high signal intensity along the right optic nerve was found on T1 MRI. Partial filling defect of optic disc was observed on fluorescein angiography (FAG). The patient was diagnosed with herpes zoster ophthalmicus complicated by anterior uveitis and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis. The patient was started on intravenous acyclovir at a dose of 10 mg/kg every 8 hours for 5 days and Herpesid eye ointment 5 times daily. After the initial treatment, oral acyclovir 400 mg was given 3 times daily for 14 days. Skin symptoms and fundus findings improved but the visual acuity did not improve because of optic atrophy. CONCLUSIONS: Ophthalmopathy including anterior uveitis, vitreous opacity, retinal hemorrhage and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis should be considered in herpes zoster ophthalmicus patients.

Reinsertion of the Anterior Chamber Intraocular Lens with Long-Term Protruded Haptic

PURPOSE: To report a case of anterior chamber intraocular lens (ACL) reposition with the haptic protruded into the subconjunctiva in a patient with a previous ACL implantation. CASE SUMMARY: A 64-year-old man visited our clinic because of visual disturbance and discomfort in his right eye. Approximately 8 years earlier, he had cataract surgery and there was no visual improvement but eye discomfort. The haptic of the ACL protruded into the subconjunctiva at 11-1 o'clock. The visual acuity of the right eye was 0.2 and the intraocular pressure of the right eye was 27 mmHg. The ACL was repositioned because of low cell density (1222 cells/mm2). After 6 months, the visual acuity of the right eye was 0.3, best corrected visual acuity was 0.8, intraocular pressure was 12 mmHg and cell density was 838 cells/mm2. There were no inflammation signs or complications. CONCLUSIONS: Reinserting ACL when the haptic is protruding into the subconjunctiva could be a simple and safe method when a decrease in corneal endothelial cell density is present.

Clinical Manifestation of Retinal Pigment Epithelial Tear after Treatment of Age-Related Macular Degeneration

PURPOSE: To determine the risk factors of retinal pigment epithelial (RPE) tears developed after treatment of exudative age-related macular degeneration (AMD) and to report its clinical manifestations. METHODS: A retrospective, consecutive chart review was performed for all patients with exudative AMD treated with intravitreal anti-vascular endothelial growth factor (VEGF) antibody or photodynamic therapy (PDT) between March 2010 and January 2013. The main outcome measures were the time from first injection to development of the RPE tear and pre- and post-RPE tear visual acuity. The visual acuity conservational interval was defined between the time the RPE tear occurred and the time visual acuity decreased 5 letters or more from pre-RPE tear visual acuity. RESULTS: A total of 219 eyes were treated with intravitreal bevacizumab, ranibizumab or PDT. Ten eyes from 10 patients developed a RPE tear (4.6%); 7 were occult choroidal neovasculization (CNV) and 3 were polypoidal choroidal vasculopathy (PCV). The average age of the RPE tear patients was 75.4 years which is statistically greater than the others (65.7) (p = 0.001). Ninety percent (9/10) of the RPE tears occurred within the first 12 weeks after treatment started. Five patients conserved their visual acuity for approximately 4 months after the RPE tear occurred. However, all 10 patients had poor visual acuity within 1 year of the follow-up period. CONCLUSIONS: RPE tears occur after intravitreal anti-VEGF antibody or PDT treatments for exudative AMD in elderly patients. Visual acuity could be conserved in the early period after a RPE tear occurred but decreased within the next year.