Age-related Clinical Analysis of Bacterial Keratitis in Daejeon and Chungcheong Provinces: a Multicenter Study

Purpose@#The purpose of this study was to investigate the age-related clinical features, risk factors, and prognoses of bacterial keratitis in Daejeon and Chungcheong provinces and the patterns and trends of fluoroquinolone antibiotic susceptibility. @*Methods@#Medical records of 433 patients (433 eyes) who visited one of the five university hospitals in Daejeon and Chungcheong provinces and were diagnosed as culture-positive bacterial keratitis between January 2000 to December 2018 were reviewed retrospectively. The patients were divided into younger and older groups based on an age of 60 years. Predisposing factors, prognostic factors, treatment method, causative organisms, and susceptibility to fluoroquinolone were analyzed. @*Results@#Two hundred seventy three males (63.0%) and 160 females (37.0%) were included. The most common risk factors in the younger group were contact lens wear (27.5%) and trauma and foreign body (27.0%). The most common risk factors in the older group were trauma and foreign body (30.5%). Staphylococcus species was the most common causative Gram-positive bacteria, regardless of age, and Pseudomonas species was the most common among Gram-negative bacteria. The older group tended to have more severe keratitis required more surgical treatment and had a worse visual outcome than the younger group (p 0.05). @*Conclusions@#Bacterial keratitis in Daejeon and Chungcheong provinces indicated more severe clinical aspects and worse prognoses in older patients showing similar results from previous studies. Caution regarding trauma and foreign bodies and managing previous ocular disease is necessary for all age groups. Education regarding adequate contact lens care and hygiene is required for younger (<60 years) patients.

Age-related Clinical Analysis of Bacterial Keratitis in Daejeon and Chungcheong Provinces: a Multicenter Study

Purpose@#The purpose of this study was to investigate the age-related clinical features, risk factors, and prognoses of bacterial keratitis in Daejeon and Chungcheong provinces and the patterns and trends of fluoroquinolone antibiotic susceptibility. @*Methods@#Medical records of 433 patients (433 eyes) who visited one of the five university hospitals in Daejeon and Chungcheong provinces and were diagnosed as culture-positive bacterial keratitis between January 2000 to December 2018 were reviewed retrospectively. The patients were divided into younger and older groups based on an age of 60 years. Predisposing factors, prognostic factors, treatment method, causative organisms, and susceptibility to fluoroquinolone were analyzed. @*Results@#Two hundred seventy three males (63.0%) and 160 females (37.0%) were included. The most common risk factors in the younger group were contact lens wear (27.5%) and trauma and foreign body (27.0%). The most common risk factors in the older group were trauma and foreign body (30.5%). Staphylococcus species was the most common causative Gram-positive bacteria, regardless of age, and Pseudomonas species was the most common among Gram-negative bacteria. The older group tended to have more severe keratitis required more surgical treatment and had a worse visual outcome than the younger group (p 0.05). @*Conclusions@#Bacterial keratitis in Daejeon and Chungcheong provinces indicated more severe clinical aspects and worse prognoses in older patients showing similar results from previous studies. Caution regarding trauma and foreign bodies and managing previous ocular disease is necessary for all age groups. Education regarding adequate contact lens care and hygiene is required for younger (<60 years) patients.

Corneal Iron Lines Observed in the Clinical Practice

PURPOSE: To unveil the etiology, pathogenic mechanism and the clinical significance of the corneal iron line through various clinical aspects of the corneal iron line. METHODS: This study included 45 eyes of 39 patients who visited the Department of Ophthalmology in Chungnam National University Hospital between April 2011 and March 2014. Anterior segment of the eye was photographed during the diagnostic process. The medical history of the patient was investigated and corneal topography was performed to discover the relationship between the position of the corneal iron line and the curvature of the corneal surface. RESULTS: The corneal iron line was identified in various corneal diseases such as herpetic stromal keratitis and; corneal ulcer. The average age of patients was 57.8 years. Corneal topography was performed in 12 patients and a connection was found between the curvature of the corneal surface and the position of corneal iron line at 75%. During the research period, corneal disease progressed and associated corneal iron line became clearer in 2 eyes. However, there was no repositioning or new appearance in different areas. The corneal iron line was not associated with visual acuity and the shape varied in accordance with the accompanying corneal disorder. The location where the tears repeatedly accumulate was associated with corneal surface. CONCLUSIONS: Based on the occurrence location and the shape of the corneal iron line, we could understand that the occurrence of corneal iron line is associated with the past and current corneal surface irregularities, which verified the validity of the tear pooling hypothesis. Therefore, this result can aid in establishing the diagnosis and treatment plan when the corneal iron line is discovered during clinical practice.

Corneal Iron Lines Observed in the Clinical Practice

PURPOSE: To unveil the etiology, pathogenic mechanism and the clinical significance of the corneal iron line through various clinical aspects of the corneal iron line. METHODS: This study included 45 eyes of 39 patients who visited the Department of Ophthalmology in Chungnam National University Hospital between April 2011 and March 2014. Anterior segment of the eye was photographed during the diagnostic process. The medical history of the patient was investigated and corneal topography was performed to discover the relationship between the position of the corneal iron line and the curvature of the corneal surface. RESULTS: The corneal iron line was identified in various corneal diseases such as herpetic stromal keratitis and; corneal ulcer. The average age of patients was 57.8 years. Corneal topography was performed in 12 patients and a connection was found between the curvature of the corneal surface and the position of corneal iron line at 75%. During the research period, corneal disease progressed and associated corneal iron line became clearer in 2 eyes. However, there was no repositioning or new appearance in different areas. The corneal iron line was not associated with visual acuity and the shape varied in accordance with the accompanying corneal disorder. The location where the tears repeatedly accumulate was associated with corneal surface. CONCLUSIONS: Based on the occurrence location and the shape of the corneal iron line, we could understand that the occurrence of corneal iron line is associated with the past and current corneal surface irregularities, which verified the validity of the tear pooling hypothesis. Therefore, this result can aid in establishing the diagnosis and treatment plan when the corneal iron line is discovered during clinical practice.

Changes of Higher Order Aberration Analyzed by Continuous Measurement after Phacoemulsification

PURPOSE: To analyze the changes of higher order aberration (HOA) measured serially by KR-1W(R) wavefront at every second for 10 seconds between, before, and after phacoemulsification and to evaluate the relationships between HOA and the ocular surface indicators (Schirmer test, tear break-up time, superficial punctate keratitis). METHODS: Corneal HOA was measured in 47 eyes of 30 patients pre- and postoperatively at 2, 4, 6, and 8 weeks by KR-1W(R) using the continuous measurement mode. The patients were divided into 2 groups according to their Schirmer test (above 10 mm or under 10 mm), tear break-up time (above 5 seconds or less than 5 seconds), and superficial punctate keratitis (any keratitis, none) for analysis of relationships between HOA and ocular surface indicators, and we also analyzed the correlation coefficient. RESULTS: Short-term follow up after phacoemulsification revealed that corneal HOA rapidly increased at 2 weeks and recovered to the preoperative level 8 weeks after surgery. Corneal HOA values showed increasing tendency depending on time at preop and 8 weeks after phacoemulsification, and the differences were statistically significant (preop: p < 0.001, 8 weeks: p = 0.027). There were no significant differences of HOA between the 2 groups divided according to their ocular surface indicators, and there were no significant correlations between HOA and ocular surface indicators at any time point. CONCLUSIONS: The HOA of the cornea was restored to its preoperative values at 8 weeks after surgery. Preoperative ocular surface indicators are not significantly influenced on postoperative corneal HOA. The surgical factors are more significant in postoperative corneal HOA than preoperative ocular surface indicators.

A Case of Successful Endoscopic Dacryocystorhinostomy in Nasolacrimal Duct Obstruction with Wegener Granulomatosis

PURPOSE: To report a case of nasolacrimal duct obstruction occurring in a patient with Wegener granulomatosis treated successfully with endoscopic dacryocystorhinostomy. CASE SUMMARY: A 36-year-old female diagnosed with Wegener's granulomatosis 3 years prior and treated with rituximab and currently taking azathioprine 100 mg presented with a 1-year history of left epiphora and mucus in the left eye. Her left tear meniscus was higher than the right and was a hard stop with lacrimal probe when a lacrimal probing test was performed. Mucus was regurgitated during lacrimal irrigation and middle turbinate was not observed due to granuloma in the nasal cavity. Dacryocystography showed proximal nasolacrimal duct obstruction and a well-defined dacryocystocele 6 x 5 x 6 mm in size was observed on the left lacrimal fossa on facial 3D computed tomography. After synechiolysis for a granuloma in the nasal cavity, endoscopic dacryocystorhinostomy was performed and silastic sheet sutured on the nasal septum to prevent resynechia. After 2 weeks and 4 months, the silastic sheet and silicon tube were removed, respectively. The patient was asymptomatic following surgery and there was no regurgitation during lacrimal irrigation test. The ostium was patent at 5 months after surgery using the endoscopic dye test. CONCLUSIONS: Nasolacrimal duct obstruction occurring in a patient with Wegener's granulomatosis can be treated effectively with endoscopic dacryocystorhinostomy even if the nasal cavity is narrow due to granuloma.

Influences on Astigmatism and Corneal Endothelium Using Two Different Incision Sizes and Mode of Phacoemulsification

PURPOSE: To compare surgically induced astigmatism and influences on the corneal endothelium in phacoemulsification by Ozil(R) and Hyperpulse mode of Infiniti(R) using 2 different corneal incision lengths of 2.2 mm and 2.8 mm. METHODS: The patients were grouped by the mode of phacoemulsification and incision size as follows: Ozil(R) mode with 2.2 mm incision group (n = 29), and 2.8 mm incision group (n = 30); Hyperpulse mode with 2.2 mm incision group (n = 29), and 2.8 mm incision group (n = 30). The surgically induced astigmatism, central corneal thickness and endothelial cell density were measured up to 2 months after surgery and the efficiency of 2 modes compared by measuring average phacoemulsification times. RESULTS: There was no significant difference in the surgically induced astigmatism, central corneal thickness, endothelial cell density, best corrected visual acuity and average phaco power among 4 groups. The cumulated dissipated energy (CDE) using Ozil(R) mode was lower than Hyperpulse mode in the group of nuclear sclerosis grade 1 and 2. CONCLUSIONS: Two different modes of phacoemulsification using Ozil(R) and Hyperpulse mode, and different incision sizes of 2.2 mm and 2.8 mm in Infiniti(R) showed no significant difference in the endothelial cell density or the surgically induced astigmatism up to 2 months after surgery. Phacoemulsification using Ozil(R) mode is considered more efficient in low grade nuclear sclerosis cataract.

Changes in Higher Order Aberration According to Tear-Film Instability Analyzed by Continuous Measurement Using Wavefront

PURPOSE: To evaluate the changes of higher order aberration according to tear-film instability measured serially by KR-1W wavefront every second for 10 seconds. The present study also analyzed the relationship between higher order aberration and the tear-film break-up time, Schirmer test, and superficial punctate keratitis. METHODS: The 228 eyes of 114 patients randomly selected from patients who visited hospital were measured once every second for 10 seconds after eye blinking by continuous measurement using wavefront. RESULTS: Higher order aberration increased overtime, and the higher order aberration value measured at the tenth second subtracted from the value of the first second was statistically significant (p = 0.004). In addition, the increment in higher order aberration between 9 seconds and 10 seconds was statistically significant (p = 0.01). The group of patients with a tear-film break-up time less than 6 seconds showed the greatest changes when measuring the higher order aberration difference value between the tenth and first seconds, which was statistically significant (p = 0.002). The group of patients where the Schirmer test results were longer than 10 millimeters and who had superficial punctate keratitis showed the greatest statistically significant changes when measuring the difference in higher order aberration values between the tenth and first seconds (p = 0.008, p = 0.005, respectively). CONCLUSIONS: Analysis of higher order aberration by wavefront could be useful in cases of decreased optical quality, diagnosis and evaluation of treatment in dry eye syndrome.

Encephalocraniocutaneous Lipomatosis without Neurologic Anomalies

No abstract available.

Effect of Amniotic Membrane on Epithelial Thickness and Formation of Hemidesmosomes after Corneal Stromal Wound

PURPOSE: To investigate the effects of an amniotic membrane patch on corneal epithelial thickness and formation of hemidesmosomes during corneal stromal wound healing. METHODS: A stromal wound 9 mm in diameter and 130 microm in depth was created on rabbit cornea using a microkeratome. The changes in corneal epithelial thickness and hemidesmosome formations were compared between the amniotic membrane, contact lens, and control groups. Changes in the corneal epithelium were examined using H&E staining and hemidesmosome formation was examined using an electron microscope at 2 and 4 weeks after flap removal. RESULTS: Two weeks after treatment, the corneal epithelial thickness was 95.3 +/- 6.3 microm in the amniotic membrane group being significantly thicker than 76.4 +/- 5.1 microm in the contact lens group and 68.3 +/- 6.1 microm in the control group. Furthermore, more hemidesmosome formations were observed in the amniotic membrane group compared to the other 2 groups. However, there were no significant differences in corneal epithelial thickness or hemidesmosome formation among the 3 groups at week 4. CONCLUSIONS: The amniotic membrane group showed a thicker corneal epithelium and more hemidesmosome formation than the other 2 groups 2 weeks after flap removal. Thus, the use of an amniotic membrane patch appears to be effective in the early stages of corneal stromal wound healing.

Comparison of Ocular Biometry Measured by Ultrasound and Two Kinds of Partial Coherence Interferometers

PURPOSE: To evaluate the reproducibility and repeatibility of biometry in cataractous eyes, pseudophakic eyes and eyes having undergone refractive surgery. The OcuScan(R)RxP, LENSTAR(R) and IOL Master(R) instruments were compared, as were. The accuracies of the refractive results after cataract surgery. METHODS: The biometries of 45 cataractous eyes, 31 pseudophakic eyes, and 32 eyes having undergone refractive surgery were measured by two practitioners using OcuScan(R)RxP, LENSTAR(R) and IOL Master(R) instruments. The paired t-test was used to compare the reproducibilities in the three groups. RESULTS: There were no differences in axial length among the groups when using any of the instruments. There was no significant difference in the repeatibility regardless of the instrument used, although. In the cataractous eyes, pseudophakic eyes and eyes with refractive surgery, OcuScan(R)RxP showed the highest repeatability. However, we knew that all three instruments were excellent in the repeatability because the difference was less than 1.5%. The Prediction error of the instruments with regard to refractive results could not be determined after cataract surgery. In some patients with severe cataract, measurement was impossible for both the LENSTAR(R) and IOL Master(R) instruments. CONCLUSIONS: In all groups, OcuScan(R)RxP, LENSTAR(R) and IOL Master(R) showed no significant differences with regard to reproducibility or prediction of refractive power after surgery. Among three groups, the repeatability was rather high in the existing ultrasound method than in the partial coherence interferometers. In some patients with severe cataract, measurement was impossible for both the LENSTAR(R) and IOL Master(R) instruments.

Comparison of Clinical Results between Ellips and Ozil Modes in Phacoemulsification

PURPOSE: To compare the clinical outcomes following phacoemulsification in Ellips (Signature(R)) and Ozil (Infiniti(R)) modes. METHODS: Phacoemulsification was performed using Ellips and Ozil modes in 30 eyes each. The phacoemulsification parameters such as the maximum phaco power, vacuum power, and aspiration rates were consistent between the two modes. Nuclear sclerosis grade, average phaco power, and the total phaco energy were recorded. The best-corrected visual acuity, central corneal thickness, and endothelial cell counts were measured preoperatively and on postoperative day 1 and on week 1, 2, 4, and 8. RESULTS: The average phaco power and total phaco energy were significantly lower in patients with nuclear sclerosis grades 1 and 2 in the Ellips group compared with those in the Ozil group (p 0.05). Two months postoperatively, the changes in central corneal thickness were 8.73 +/- 17.62 and 5.19 +/- 14.42 microm in the Ellips and Ozil groups, and the changes in endothelial cell count were 100.4 +/- 196.5 and 145.7 +/- 323.8 cells/mm2 (p > 0.05), respectively. The differences did not reach statistical significance. CONCLUSIONS: Although the ultrasound energy used in the surgical procedure was significantly lower in the Ellips group compared with that in the Ozil group, especially in patients with nuclear sclerosis grades 1 and 2, there were no significant differences in the best-corrected visual acuity, central corneal thickness, and endothelial cell count between the 2 groups.

Comparison of Influences on the Cornea by the Longitudinal Phacoemulsification Between the Sovereign(R) and Infiniti(R)

PURPOSE: To compare the influences on the corneal endothelium and surgically induced astigmatism following cataract surgery performed with Sovereign(R) and Infiniti(R) using the longitudinal phacoemulsification through the clear corneal incision. METHODS: Patients were operated on with the Sovereign(R) (n=46) and Infiniti(R) (n=45) programmed with the same parameters. Corneal thickness, endothelial cell count, effective phaco time and average phaco power were measured. Surgically induced astigmatism was calculated by keratometric readings. RESULTS: The change in corneal thickness at 1 day and endothelial cell count at 1 month postoperatively was significantly lower in the Infiniti(R) group. However, there were no significant differences in the change in corneal thickness and endothelial cell count at 2 months postoperatively. Surgically induced astigmatism in the 2 groups was consistently similar. Effective phaco time and average phaco power were lower in the Sovereign(R) group. CONCLUSIONS: Using the longitudinal phacoemulsification, early postoperative change of corneal endothelium was lower in the Infiniti(R) group. However, the efficacy of phacoemulsification in the Sovereign(R) group was superior to the Infiniti(R) group.

Intraocular Lens Power Calculation Using Haigis-L Method After Corneal Refractive Surgery

PURPOSE: To evaluate the Haigis-L method of IOL Master that does not require preoperative data for intraocular lens (IOL) power calculations and compare the results with other methods requiring preoperative data. METHODS: Fifty eyes of 25 patients who had undergone laser-assisted subepithelial keratectomy (LASEK) and were followed for 1 month or longer were selected for this study. IOL power was calculated by four different methods: clinical history method, Feiz-Mannis method, modified Masket method, and Haigis-L method. RESULTS: The mean calculated IOL powers showed the following results: clinical history method; 23.65D, Feiz-Mannis method; 24.45D, modified Masket method; 22.89D, and Haigis-L method; 23.80D. Each IOL power differed statistically from others (p=0.000). The difference between each method was analyzed by the Bonferroni test, with the Feiz-Mannis method showing the highest result and the modified Masket method, the lowest. The clinical history method and Haigis-L method presented similar results. CONCLUSIONS: For patients without data prior to corneal refractive surgery, the Haigis-L method is as accurate as the clinical history method. Therefore, comparatively accurate results can be produced in IOL power calculations using the Haigis-L method after corneal refractive surgery.

Proteomic Analysis of Toxoplasma gondii KI-1 Tachyzoites

We studied on the proteomic characteristics of Toxoplasma gondii KI-1 tachyzoites which were originally isolated from a Korean patient, and compared with those of the well-known virulent RH strain using 2-dimensional electrophoresis (2-DE), mass spectrometry, and quantitative real-time PCR. Two-dimensional separation of the total proteins isolated from KI-1 tachyzoites revealed up to 150 spots, of which 121 were consistent with those of RH tachyzoites. Of the remaining 29 spots, 14 showed greater than 5-fold difference in density between the KI-1 and RH tachyzoites at a pH of 5.0-8.0. Among the 14 spots, 5 from the KI-1 isolate and 7 from the RH strain were identified using MALDI-TOF mass spectrometry and database searches. The spots from the KI-1 tachyzoites were dense granule proteins (GRA 2, 3, 6, and 7), hypoxanthine-guanine-xanthine phosphoribosyltransferase (HGRPTase), and uracil phosphoribosyltransferase (UPRTase). The spots from the RH strain were surface antigen 1 (SAG 1), L-lactate dehydrogenase (LDH), actin, chorismate synthase, peroximal catalase, hexokinase, bifunctional dihydrofolate reductase-thymidylate synthase (DHTR-TS), and nucleoside-triphosphatases (NTPases). Quantitative real-time PCR supported our mass spectrometric results by showing the elevated expression of the genes encoding GRA 2, 3, and 6 and UPRTase in the KI-1 tachyzoites and those encoding GRA 7, SAG 1, NTPase, and chorismate synthase in the RH tachyzoites. These observations demonstrate that the protein compositions of KI-1 and RH tachyzoites are similar but differential protein expression is involved in virulence.

Measurement of Anterior Segment Using Visante OCT in Koreans

PURPOSE: To obtain the average values of anterior segment structures of adult Koreans using Visante OCT in relation to age and sex, and to compare the central corneal thickness values with these measurements using an A-scan ultrasonic pachymeter. METHODS: Anterior segment images were obtained in 185 Korean (298 eyes) using Visante OCT. Four different parameters (central corneal thickness, anterior chamber depth, anterior chamber angle, and internal anterior chamber diameter) were measured at four meridians (vertical, horizontal, 45 degrees, and 135 degrees). Afterwards, the same examiner performed A-scan ultrasonic pachymetry to measure central corneal thickness. RESULTS: Central corneal thickness values measured using Visante OCT were significantly less than those obtained using an A-scan ultrasonic pachymeter (p=0.000). Central corneal thickness, anterior chamber angle, and internal anterior chamber diameters were all smaller in females than in males (p<0.05). Anterior chamber depth, anterior chamber angle, and internal anterior chamber diameter showed a significant decrease according to increasing age in both sexes (p<0.05). CONCLUSIONS: Average values and changes of anterior segment structures in relation to age and sex were established using Visante OCT in Korean adults. These results may be useful as standard values in anterior segment surgeries as well as in the diagnosis and follow-up of certain anterior segment diseases.

Determine a Proper Axial Length by Ultrasonic Biometry in Opaque Hydrophilic Acrylic Intraocular Lens

PURPOSE: To investigate the accuracy of measuring ultrasonic axial lengths using A-scan (Ocuscan(R), Alcon, USA) on opaque intraocular lenses after hydrophilic lens (ACRL-160(R), Ophthalmed, USA) implantation. METHODS: We measured axial length through ultrasonic biometry prior to intraocular lens exchange. Twelve eyes of 14 patients who had intraocular lens opacity following hydrophilic acryl lens implantation were examined in a clinical study. We compared pre-cataract operative axial lengths to pre-IOL exchange axial lengths. The pre-IOL exchange axial lengths were measured in aphakic and pseudophakic modes. In the pseudophakic mode, the ultrasound velocity through an IOL was set at a rate ranging between 1,500 m/sec to 2,200 m/sec. RESULTS: The pre-IOL exchange axial lengths in the pseudophakic mode at the rate of 1,600 m/sec in lens velocity were the closest to pre-cataract operative values (p=0.88). CONCLUSIONS: When pre-cataract operative axial length is known with a hydrophilic acrylic intraocular lens, previous values may be used for IOL exchange of an opacity patient. If not, however, the closest values to pre-cataract operative axial lengths may be obtained by setting the velocity in the pseudophakic mode to a lens velocity rate of 1,600 m/sec.

The Changes in Macular Thickness after Phacoemulsification in Patients with Non-diabetes and Nonproliferative Diabetic Retinopathy

PURPOSE: To compare the changes in macular thickeness between non-diabetic group and a mild or moderate nonproliferative diabetic retinopathy group after phacoemulsification. METHODS: This study consisted of 32 eyes of 22 patients who underwent phacoemulsification. The non-diabetic group included 20 eyes of 15 patients; the diabetic group (mild or moderate nonproliferative diabetic retinopathy) included 12 eyes of 7 patients. Macular thickness using optical coherence tomography (OCT) and corrected visual acuity were measured before surgery and 1 day, 1 week, 1 month, 2 months, 6 months and 12 months after surgery. RESULTS: In the non-diabetic group, the macular thickness increased by 2.8+/-4.2% at 1 week, 5.9+/-4.5% at 1 month, 4.8+/-3.8% at 2 months, 0.6+/-0.8% at 6 months, and -0.3+/-1.2% at 12 months after surgery, while it increased by 4.8+/-5.0% at 1 week, 11.1+/-5.2% at one month, 9.9+/-6.0% at two months, 8.1+/-4.6% at 6 months, 3.9+/-3.5% at 12 months in the diabetic group. The increased amount of macular thickness was significantly higher in the diabetic group than in the non-diabetic group at 1 month, 2 months, 6 months, and 12 months. Visual acuity was not significantly different between the diabetic and non-diabetic groups. In the non-diabetic group, 2 months after the operation, LogMAR below 0.02 (Snellen 0.95) were remained with best corrected visual acuity. Similarly to non-diabetic patients, diabetic patients needed 12 months to reach best corrected visual acuity. CONCLUSIONS: Macular thickness increased in both diabetic and non-diabetic groups after phacoemulsification, and the increased amount of macular thickness was significantly greater and lasted longer in the diabetic group compared with the non-diabetic group. In cases of mild or moderate nonproliferative diabetic retinopathy, macular thickness change due to cataract surgery did not influence visual acuity.

Acanthamoeba Keratitis Related to Cosmetic Contact Lenses

PURPOSE: To report a rare case of Acanthamoeba keratitis in both eyes related to cosmetic contact lenses. METHODS: A 17-year-old girl with a history of wearing cosmetic contact lenses presented with keratitis. She purchased cosmetic contact lenses on the internet, and used contact lens care system irregularly with tap water. RESULTS: After analysis of the corneal scraping, the contact lenses and the storage solution, the organism Acanthamoeba was identified. The patient was treated with polyhexamethylene biguanide (PHMB) and chlorhexidine for 3 months, and recovered with normal visual acuity. CONCLUSIONS: Poor hygiene and insufficient disinfection may be major risk factors for Acanthameoba keratitis in cosmetic contact lens wearers. The cosmetic contact lens user should receive professional advice before using these lenses, and this precaution must be communicated to the public.

Comparison of Influences on the Cornea between the WhiteStar Mode and Continuous Mode

PURPOSE: To compare the influences on the cornea between the WhiteStar mode and the continuous mode in the Sovereign(R) phacoemulsification unit after cataract surgery using temporal clear corneal incisions. METHODS: This study comprised 46 eyes of 23 patients who had cataracts in both eyes with similar grades of nucleosclerosis. The WhiteStar mode was used in one eye, and the continuous mode was used in the other eye. Pachymetry at the corneal center and 2 mm from the temporal limbus was performed. Topography and specular microscopy were performed, and surgically induced astigmatism was calculated using the Holladay-Cravy-Koch formula by simulated keratometric readings of Humphrey topography. Effective phaco time and average phaco power were recorded. RESULTS: Changes of corneal thickness at the center of the eye and at the incision site were significantly lower in the WhiteStar mode than in the continuous mode at 1 month postoperatively. However, there was no significant difference in corneal thickness at either site and in other parameters measured at 2 months postoperatively. The effective phaco time in the WhiteStar mode was significantly lower than in the continuous mode for cataracts with a high grade of nucleosclerosis. CONCLUSIONS: The early postoperative corneal edema in the WhiteStar mode was less than in the continuous mode. However, there was no remarkable difference in corneal endothelial damage. The effectiveness of phacoemulsification in the WhiteStar mode was superior to that in the continuous mode, especially for dense cataracts.