Protective Effect of Preoperative Intraocular Pressure Reduction on Corneal Endothelium in Cataract Surgery

PURPOSE: To evaluate whether intraocular pressure reduction by intravenous injection of mannitol before phacoemulsification-cataract surgery can have a protective effect on corneal endothelium. METHODS: Patients undergoing sequential bilateral cataract surgery were divided into 2 groups, 36 eyes with anterior chamber depth (ACD) or = 2.50 mm (group B). In each group, preoperative intravenous injection of mannitol was performed in 1 randomly selected eye of the patient. The specular microscopic examination including cell density (ECD), coefficient of variation (CV), hexagonality (HA) of corneal endothelium, and corneal thickness was performed on postoperative 1 day, 2 weeks, and 5 weeks. In each group, the parameters were compared between the eyes with mannitolization and the contralateral eyes without mannitolization. RESULTS: In group A, eyes with preoperative mannitolization showed significantly higher ECD at postoperative 1 day and 5 weeks and showed a significantly thinner cornea at postoperative 1 day than those without mannitolization (all p < 0.05). However, in group B, there was no significant difference of ECD, CV, HA, and corneal thickness between the eyes with and without mannitolization. CONCLUSIONS: Preoperative intraocular pressure reduction by mannitolization before phacoemulsification can protect the corneal endothelial cells and recover the early postoperative period visual acuity in eyes with shallow anterior chamber.

Refractive Change after Transscleral Fixation of Intraocular Lens

PURPOSE: To evaluate the anterior chamber depth (ACD), extent of intraocular lens (IOL) tilt, and decentration and refractive error after transscleral fixation of IOL. METHODS: We retrospectively reviewed the medical records of 17 cases with transscleral fixation of IOL (6 with aphakia, 5 with IOL dislocation, and 6 with lens subluxation). The acrylic IOL (MN60AC(R)) was fixated in 12 eyes and the polymethylmethacrylate IOL (CZ70BD(R)) was fixated in 5 eyes at 1.0 mm posterior from the limbus. We analyzed the ACD, extent of IOL tilt and decentration, manifest refraction, refractive error, higher order aberration, and corneal endothelium at 2 weeks, 1 month and 2 months postoperatively. RESULTS: The mean ACD was 3.36 +/- 0.11 mm, 3.30 +/- 0.12 mm, and 3.27 +/- 0.13 mm, the mean extent of IOL tilt was 4.61 +/- 0.12degrees, 4.65 +/- 0.14degrees, and 4.60 +/- 0.12degrees and the mean extent of IOL decentration was 0.43 +/- 0.01 mm, 0.45 +/- 0.01 mm, and 0.45 +/- 0.01 mm at 2 weeks, 1 month and 2 months postoperatively, respectively in eyes with transscleral fixation of IOL. The ACD was shallower and the extent of IOL tilt and decentration was greater than with IOL in-the-bag insertion patients. The mean refractive errors were -0.55 +/- 0.27 D, -0.63 +/- 0.24 D, and -0.69 +/- 0.19 D at the same period, respectively. CONCLUSIONS: Although postoperative refractive error is influenced by surgeon factors such as incision size, distance of fixation suture from limbus, and tightness of suture material, according to our results, an IOL 0.75 D more hyperopic than predicted should be selected in transscleral fixation of IOL at 1.0 mm posterior from the limbus. Additionally, each surgeon should assess their specific results and modify the lens calculations accordingly.

A Case of Melanocytoma Originating from the Iris

PURPOSE: To report a case of melanocytoma originating from the iris observed for the first time in Korea. CASE SUMMARY: A 53-year-old female with an unexpected iris mass was referred to our clinic. A round, 2.5 mm x 3.5 mm-sized iris mass was found on slit lamp examination in the 12 o'clock area of the patient's left eye. The mass was densely pigmented and had a smooth surface. Gonioscopy showed the mass had reached the peripheral cornea frontward and the lens backward. An excisional biopsy was performed for diagnosis. After the operation, a gonioscopic examination showed an intact ciliary body behind the surgical margin of the iris. A melancytoma of the iris was observed on subsequent histopathological examination. The patient has remained symptom-free with no iris mass recurrence since the operation. CONCLUSIONS: A few cases of iris melanocytomas have been reported worldwide but not in Korea. We confirmed a case of melanocytoma originating from the iris for the first time in Korea.

Corneal Perforation in Phlyctenular Keratitis

PURPOSE: Corneal perforation from phlyctenular keratoconjunctivitis is rarely reported worldwide and no case has been reported in Korea. We report a case of corneal perforation in a patient with phlyctenular keratoconjunctivitis along with a literature review. CASE SUMMARY: A 15-year-old female presented to our clinic with repetitive tears, conjunctival injection, and discomfort in her right eye for several months. Slit-lamp examination revealed oily plugs at the meibomian gland orifices with collarettes, conjunctival injection and a round, whitish elevated lesion accompanying neovascularization of the inferotemporal side of the cornea. As an initial treatment, topical antibiotic was given but no signs of improvement were observed. Hence, topical steroid was applied on suspicion of phlyctenular keratitis and the patient's symptoms and corneal lesion improved. Two months later, the patient's symptoms relapsed and the lesion was found progressing towards the central cornea. The treatment was restarted and the symptoms improved but the corneal lesion continuously progressed towards the center, thinning the central cornea. Seventeen months from the time of initial diagnosis, the patient revisited prior to the scheduled appointment complaining of abrupt tears in her right eye. Slit-lamp examination revealed a corneal perforation at the center of the thinned cornea. Hence, we performed an emergent tectonic corneal patch graft. After the operation, opacity remained covering the visual axis at the central cornea, thus penetrating keratoplasty was performed 10 months later. Henceforth, the patient has remained free of symptoms and visual acuity has been recovered. CONCLUSIONS: Usually phlyctenular keratoconjunctivitis responds well to treatment and does not have a significant influence on vision. However, occasionally phlyctenular keratoconjunctivitis may not respond to treatment and may spread to the central cornea causing loss of visual acuity and even corneal perforation in rare occasions. Therefore, in order to prevent such complications, prompt diagnosis and treatment are essential.