Effect of 0.05% Cyclosporine A on the Ocular Surface after Photorefractive Keratectomy

PURPOSE: To evaluate the effect of 0.05% cyclosporine A on the ocular surface after photorefractive keratectomy (PRK). METHODS: This retrospective study included 50 patients who underwent PRK. Patients were divided into two groups: 25 patients in group I were treated with topical 0.05% cyclosporine A with conventional medication, and 25 patients in group II were treated with conventional medication. Visual acuity (VA), tear break-up time (BUT), fluorescein staining score (F-stain), Schirmer I test, and ocular surface disease index (OSDI) were evaluated before surgery and 2 weeks, 1 month, 2 months, and 3 months after surgery. RESULTS: F-stain was significantly lower in group I than in group II at 2 weeks and 1 month (p < 0.05). There was no significant difference in uncorrected VA, BUT, Schirmer I test, or OSDI between the groups. However, group I showed a more effective pattern in dry eye. CONCLUSIONS: Combination treatment with 0.05% cyclosporine A was helpful for early ocular surface stability in patients with dry eye after PRK.

Clinical Outcomes of Diffractive Multifocal Toric Intraocular Lens Implantation

PURPOSE: To evaluate the clinical outcomes of patients with diffractive multifocal toric intraocular lens (IOL) implantation. METHODS: Thirty-four eyes of 26 patients underwent diffractive multifocal toric IOL. Uncorrected visual acuity (UCVA) at distant, intermediate and near and residual refractive astigmatism were measured on the first day, at 2 weeks, and 1, 3 and 6 months postoperatively. Optical quality obtained using the Optical Quality Analysis System II (OQAS II), high-order aberrations (HOA) and patient satisfaction questionnaire were evaluated 3 months postoperatively. RESULTS: At the 6 month postoperative visit, the mean UCVA at distant, intermediate (63 cm, 100 cm) and near were 0.06 +/- 0.07, 0.18 +/- 0.11, 0.16 +/- 0.12 and 0.03 +/- 0.06 (log MAR), respectively. The refractive astigmatism decreased significantly from -1.66 +/- 1.04 D to -0.54 +/- 0.32 D at 6 months postoperatively (p < 0.01). The means of objective scatter index, modulation transfer function (MTF) cut-off value, Strehl ratio and pseudo-accommodation range measured by OQAS II were 1.33 +/- 0.67, 37.24 +/- 9.67 cdp, 0.22 +/- 0.09 and 3.08 +/- 0.53 D, respectively. HOA scores for 5 mm and 6 mm were 0.30 +/- 0.09 and 0.49 +/- 0.15, respectively; 82.3% of the patients were satisfied with the postoperative results, 79.4% of the patients reported they would recommend the procedure to others, and 14.7% of patients reported moderate or severe visual disturbance at night. CONCLUSIONS: Implantation of a diffractive multifocal toric IOL in patients with cataract and corneal astigmatism provided excellent distant, intermediate, and near visual outcomes, good optical quality and high patient satisfaction.

The Clinical Results of Intacs(R) Ring Implantation by Manual Tunnel Creation in Patients with Keratoconus

PURPOSE: To report the clinical results after the implantation of intrastromal corneal ring segments (Intacs(R)) by manual tunnel creation for the correction of keratoconus. METHODS: This retrospective case series was comprised of 10 eyes of 8 consecutive keratoconic patients. Visual acuity, refractive outcome, keratometric values, anterior chamber depth, central corneal thickness, and endothelial cell density were evaluated before and at 1 month, 3 months, and 6 months postoperatively. In addition, the implanted ring segment depth was measured by anterior segment optical coherence tomography at postoperative 6 months. Any postoperative complications were also recorded. RESULTS: Visual acuity was improved in 9 out of 10 eyes. Spherical equivalent and keratometric values were decreased in all eyes. There was no significant difference in central corneal thickness, but endothelial cell density and anterior chamber depth were slightly decreased. The depth of ring segments was almost constant at superior, middle, and inferior. There was a single case of descented implanted ring segments and 6 cases of stromal infiltration around ring segments, but visual acuity was unaffected. In addition, 1 case showed implanted ring exposure, thus the superior ring segment was removed at postoperative 4 months. CONCLUSIONS: Intrastromal corneal ring segment implantation (Intacs(R)) by manual tunnel creation appears to be effective in improving the visual acuity and stabilizing corneal refractive power in keratoconic patients.

Changes in Tear Film, Cornea and Ocular Surface According to the Duration of Soft Contact Lens Wear

PURPOSE: The present study evaluated the changes in tear film, cornea and ocular surface according to the duration of soft contact lens wear. METHODS: A total 65 patients with 130 eyes were enrolled the present study, and were divided into 4 grous. The control group (group A) was composed of 32 eyes of 16 patients who had not worn soft contact lenses, group B, (34 eyes of 17 patients), had worn soft contact lenses less than 5 years, group C, (32 eyes of 16 patients), had worn soft contact lenses for 5 to 10 years and group D, (32 eyes of 16 patients), had worn soft contact lenses for more than 10 years. The tear break-up time (BUT), Schirmer's test, corneal sensitivity test, central corneal thickness, ocular surface disease index (OSDI), corneal fluorescein staining score, specular microscopy and conjunctival impression cytology were analyzed. The results were compared between the control group and the soft contact lens groups. RESULTS: In group B, BUT significantly decreased, but corneal fluorescein staining score and squamous metaplasia significantly increased (p < 0.05). In group C, OSDI and snake-like chromatin pattern significantly increased, but corneal thickness and goblet cell density significantly decreased (p < 0.05). In group D, the coefficient of variation for endothelium significantly increased, but corneal sensitivity and hexagonality significantly decreased (p < 0.05). CONCLUSIONS: Duration of soft contact lens wear influences changes in tear film, cornea and ocular surface.

Choroidal Thickness Changes According to the Refractive Errors and Axial Length in Korean Myopia Patients

PURPOSE: To investigate the choroidal thickness changes with the Enhanced Depth Imaging (EDI) technique according to refractive errors and axial length in Korean myopia patients. METHODS: A total of 90 eyes from 90 patients with myopia (between the ages of 19 and 39 years) underwent spectral-domain optical coherence tomography (SD-OCT)-EDI evaluations. Spherical equivalent was measured by cycloplegic refraction and axial length was obtained by IOL master(R). The subfoveal choroidal thickness was analyzed according to age, sex, axial length and spherical equivalent by linear correlations. RESULTS: The average age of all subjects was 25.44 years, mean spherical equivalent was -5.06 diopter (D), mean axial length was 25.70 mm, and mean choroidal thickness was 281.47 microm. In a multiple regression model, the patients' age had no statistical effect on subfoveal choroidal thickness. Subfoveal choroidal thickness decreased by 13.58 microm per -1D increase in refractive errors and by 33.99 microm per 1 mm increase in axial length when adjusted for sex and age. In addition, subfoveal choroidal thickness was 59.82 microm thicker in men than in women when adjusted for axial length and spherical equivalent (p < 0.001). CONCLUSIONS: Among young Korean myopia patients, subfoveal choroidal thickness was significantly related with refractive errors and axial length. Moreover, choroidal thickness was thicker in men than women when adjusted for refractive errors and axial length.

Choroidal Thickness Changes According to the Refractive Errors and Axial Length in Korean Myopia Patients

PURPOSE: To investigate the choroidal thickness changes with the Enhanced Depth Imaging (EDI) technique according to refractive errors and axial length in Korean myopia patients. METHODS: A total of 90 eyes from 90 patients with myopia (between the ages of 19 and 39 years) underwent spectral-domain optical coherence tomography (SD-OCT)-EDI evaluations. Spherical equivalent was measured by cycloplegic refraction and axial length was obtained by IOL master(R). The subfoveal choroidal thickness was analyzed according to age, sex, axial length and spherical equivalent by linear correlations. RESULTS: The average age of all subjects was 25.44 years, mean spherical equivalent was -5.06 diopter (D), mean axial length was 25.70 mm, and mean choroidal thickness was 281.47 microm. In a multiple regression model, the patients' age had no statistical effect on subfoveal choroidal thickness. Subfoveal choroidal thickness decreased by 13.58 microm per -1D increase in refractive errors and by 33.99 microm per 1 mm increase in axial length when adjusted for sex and age. In addition, subfoveal choroidal thickness was 59.82 microm thicker in men than in women when adjusted for axial length and spherical equivalent (p < 0.001). CONCLUSIONS: Among young Korean myopia patients, subfoveal choroidal thickness was significantly related with refractive errors and axial length. Moreover, choroidal thickness was thicker in men than women when adjusted for refractive errors and axial length.

A Case of Phentermine Hydrochloride Induced Acute Myopia and Acute Angle Closure

PURPOSE: To describe a case of bilateral acute myopia and acute angle-closure associated with phentermine hydrochloride, a drug used for obesity treatment. CASE SUMMARY: A 25-year-old woman visited our hospital with blurry vision and ocular pain after taking phentermine hydrochloride for three weeks. Manifest refraction accompanied myopic shift in the both eyes, slit-lamp examination showed forward displacement of the lens-iris diaphragm and fundus examination revealed retinal folds. Suspecting phentermine hydrochloride induced acute myopia and acute angle closure, discontinuation of the drug and administration of cycloplegic agents and antiglaucomatic agent successfully resolved the symptoms. CONCLUSIONS: Although the exact mechanism is unknown, phentermine hydrochloride may generate ciliochoroidal effusion and ciliary edema, lead to acute myopia and acute angle closure resulting from forward displacement of the lens-iris diaphragm.