Visual Performance and Optical Quality after Implantation of a New Generation Monofocal Intraocular Lens

Purpose@#To evaluate the performance of two intraocular lenses (IOLs). The new monofocal IOL using a higher-order aspheric optic (Tecnis Eyhance ICB00) was compared to a standard monofocal IOL (Tecnis monofocal ZCB00) of the identical platform and material. @*Methods@#The medical records of the patients who had undergone cataract surgery with implantation of either the ZCB00 or the ICB00 in the dominant eye from March 2020 to August 2020 and with available data from the 3-month visit were reviewed. Subjects with ocular comorbidities or corneal astigmatism greater than 1.00 diopters were excluded. The uncorrected near, intermediate, distance visual acuity and corrected distance visual acuity were the main outcome measures. Optical quality parameters measured using an optical quality analysis system, clinical records including age, sex, laterality, ocular dominance, and information related to refractory errors was also collected. Parameters related to the refractory errors were all uniformly based on the Barrett Universal II formula. @*Results@#Of the 197 recruited patients, 111 and 86 were implanted with the ICB00 and ZCB00, respectively. No statistically significant differences in baseline parameters were observed between the two groups. While no statistically significant differences in distance visual acuity or optical quality were found between the two groups, compared to the ZCB00 group, the ICB00 group showed significantly higher intermediate visual acuity (p @*Conclusions@#ICB00 provided superior intermediate vision and comparable distance performance and photic phenomena compared to a standard monofocal IOL.

Visual Performance and Optical Quality after Implantation of a New Generation Monofocal Intraocular Lens

Purpose@#To evaluate the performance of two intraocular lenses (IOLs). The new monofocal IOL using a higher-order aspheric optic (Tecnis Eyhance ICB00) was compared to a standard monofocal IOL (Tecnis monofocal ZCB00) of the identical platform and material. @*Methods@#The medical records of the patients who had undergone cataract surgery with implantation of either the ZCB00 or the ICB00 in the dominant eye from March 2020 to August 2020 and with available data from the 3-month visit were reviewed. Subjects with ocular comorbidities or corneal astigmatism greater than 1.00 diopters were excluded. The uncorrected near, intermediate, distance visual acuity and corrected distance visual acuity were the main outcome measures. Optical quality parameters measured using an optical quality analysis system, clinical records including age, sex, laterality, ocular dominance, and information related to refractory errors was also collected. Parameters related to the refractory errors were all uniformly based on the Barrett Universal II formula. @*Results@#Of the 197 recruited patients, 111 and 86 were implanted with the ICB00 and ZCB00, respectively. No statistically significant differences in baseline parameters were observed between the two groups. While no statistically significant differences in distance visual acuity or optical quality were found between the two groups, compared to the ZCB00 group, the ICB00 group showed significantly higher intermediate visual acuity (p @*Conclusions@#ICB00 provided superior intermediate vision and comparable distance performance and photic phenomena compared to a standard monofocal IOL.

Combined Phototherapeutic Keratectomy and Peripheral Anterior Stromal Puncture for the Treatment of Recurrent Corneal Erosion Syndrome

Purpose@#To investigate the efficacy of the combined phototherapeutic keratectomy (PTK) and peripheral anterior stromal puncture (ASP) compared with that of PTK alone in patients with recurrent corneal erosion syndrome (RCES). @*Methods@#The medical records of 25 patients (25 eyes) who underwent combined treatment of PTK and peripheral ASP for RCES from March 2016 to May 2017 were retrospectively reviewed. Twenty-three patients (23 eyes) treated with PTK alone from March 2015 to February 2016 served as a control group. All surgeries were performed by a single surgeon. This retrospective clinical study comprised 48 patients (48 eyes) who were followed up for more than 18 months. Clinical records of age, sex, laterality, etiology of RCES, and history of recurrence after treatment were evaluated. @*Results@#Twenty-five eyes were treated with combined PTK and ASP, and 23 eyes were treated with PTK only. The mean follow-up period was 19.63 ± 2.97 and 19.75 ± 6.83 months, respectively. There were no differences in baseline parameters between the groups. In the combined treatment group, one patient experienced recurrence 6 months after the surgery. In the single treatment group, five patients showed recurrence at 4, 7, 8, 11, and 13 months after the surgery, respectively.Compared to the single treatment group, the combined treatment group showed significantly lower recurrence rate (p < 0.05).All recurred patients required no additional treatment except temporary therapeutic contact lenses and topical lubricants. @*Conclusions@#Our findings suggest that combined treatment of PTK and peripheral ASP is effective in alleviation of symptoms and prevention of recurrence in refractory RCES compared with treatment using PTK alone.

Changes in Tear Volume after 3% Diquafosol Treatment in Patients with Dry Eye Syndrome: An Anterior Segment Spectral-domain Optical Coherence Tomography Study

PURPOSE: To evaluate changes in the tear meniscus area and tear meniscus height over time in patients with dry eye syndrome, using anterior segment spectral-domain optical coherence tomography after the instillation of 3% diquafosol ophthalmic solution. METHODS: Sixty eyes from 30 patients with mild to moderate dry eye syndrome were included. Tear meniscus images acquired by anterior segment spectral-domain optical coherence tomography were analyzed using National Institutes of Health's image-analysis software (ImageJ 1.44p). Tear meniscus area and tear meniscus height were measured at baseline, 5 minutes, 10 minutes, and 30 minutes after instillation of a drop of diquafosol in one eye and normal saline in the other eye. Changes in ocular surface disease index score, tear film break-up time, corneal staining score by Oxford schema, and meibomian expressibility were also evaluated at baseline, and after 1 week and 1 month of a diquafosol daily regimen. RESULTS: Sixty eyes from 30 subjects (mean age, 29.3 years; 8 men and 22 women) were included. In eyes receiving diquafosol, tear volume was increased at 5 and 10 minutes compared with baseline. It was also higher than saline instilled eyes at 5, 10, and 30 minutes. Changes in tear volume with respect to baseline were not statistically different after the use of diquafosol for 1 month. Ocular surface disease index score, tear film break-up time, and Oxford cornea stain score were significantly improved after 1 week and 1 month of daily diquafosol instillation, but meibomian expressibility did not change. CONCLUSIONS: Topical diquafosol ophthalmic solution effectively increased tear volume for up to 30 minutes, compared to normal saline in patients with dry eye syndrome.

Comparison of Anterior Segment Measurements Using Scanning-Slit Topography and Optical Low-Coherence Reflectometry (OLCR) Biometry

PURPOSE: To compare the results of anterior segment biometry including white-to-white (WTW) between scanning-slit topography (ORBscan IIz(R), Bausch & Lomb), optical low-coherence reflectometry (OLCR) biometry (Lenstar(R), Haag-Streit), and Castroviejo calipers. METHODS: Measurements on 72 eyes of 36 patients that underwent refractive surgery were measured using ORBscan(R), Lenstar(R), and calipers and compared. Ocular biometry parameters used in this study included the WTW, central corneal thickness, anterior chamber depth (ACD), keratometry, and pupil size. RESULTS: The WTW measurements using ORBscan(R) and calipers (11.57 +/- 0.35 mm and 11.58 +/- 0.34 mm, respectively) were statistically similar. However, the measurement using Lenstar(R) (12.05 +/- 0.40 mm) was significantly greater than with the other methods (p < 0.001). Central corneal thickness and keratometry measurements using ORBscan(R) were greater than when using Lenstar(R) (p = 0.01 for both). ACD and pupil size measurement using Lenstar(R) were greater than when using ORBscan(R) (p < 0.001 for both). CONCLUSIONS: Because WTW and ACD measurements using Lenstar(R) were greater than when using ORBscan(R) and calipers, unexpected high-vaulting may be observed due to the selection of a larger-sized posterior chamber phakic intraocular lens. Therefore, the differences in measurements obtained when using these methods should be considered.

Comparison of Anterior Segment Measurements Using Scanning-Slit Topography and Optical Low-Coherence Reflectometry (OLCR) Biometry

PURPOSE: To compare the results of anterior segment biometry including white-to-white (WTW) between scanning-slit topography (ORBscan IIz(R), Bausch & Lomb), optical low-coherence reflectometry (OLCR) biometry (Lenstar(R), Haag-Streit), and Castroviejo calipers. METHODS: Measurements on 72 eyes of 36 patients that underwent refractive surgery were measured using ORBscan(R), Lenstar(R), and calipers and compared. Ocular biometry parameters used in this study included the WTW, central corneal thickness, anterior chamber depth (ACD), keratometry, and pupil size. RESULTS: The WTW measurements using ORBscan(R) and calipers (11.57 +/- 0.35 mm and 11.58 +/- 0.34 mm, respectively) were statistically similar. However, the measurement using Lenstar(R) (12.05 +/- 0.40 mm) was significantly greater than with the other methods (p < 0.001). Central corneal thickness and keratometry measurements using ORBscan(R) were greater than when using Lenstar(R) (p = 0.01 for both). ACD and pupil size measurement using Lenstar(R) were greater than when using ORBscan(R) (p < 0.001 for both). CONCLUSIONS: Because WTW and ACD measurements using Lenstar(R) were greater than when using ORBscan(R) and calipers, unexpected high-vaulting may be observed due to the selection of a larger-sized posterior chamber phakic intraocular lens. Therefore, the differences in measurements obtained when using these methods should be considered.

A Case of Syphilitic Scleritis Initially Misdiagnosed as Noninfectious Nodular or Fungal Scleritis

PURPOSE: To report a case of syphilitic scleritis initially misdiagnosed as noninfectious nodular or fungal scleritis. CASE SUMMARY: A 63-year-old female, who had severe headaches and ocular pain in her left eye despite treatment with topical and oral NSAIDs for the past 4 months, was transferred from a local clinic. The patient had a history of pterygium excision in the same eye 4 years prior. Upon presentation, she had a scleromalacia with calcified plaque at the nasal conjunctiva. An erythematous nodular elevated lesion was observed in the superonasal sclera. Microbiological smear and cultures were performed to exclude infectious scleritis. Under the suspicion of noninfectious nodular scleritis, the patient was prescribed topical oral steroid and oral NSAIDs. Candida parapsilosis was identified by the microbiological culture. Under the suspicion of fungal scleritis, oral fluconazole and topical amphotericin B were administered, but the lesions did not improve. On the 23rd day of treatment, we discovered the patient had a history of syphilis. The serology test was negative for RPR and FTA-ABS IgM but positive for FTA-ABS IgG. Under the suspicion of syphilitic scleritis, oral doxycycline (200 mg bid) was administered and benzathine penicillin M (2.4 million units) was injected intramuscularly 3 times at 1-week intervals. After the doxycycline and benzathine penicillin therapy, the pain and nodular erythematous lesions were completely resolved. CONCLUSIONS: As shown in this case, syphilitic scleritis should be considered when the patient is resistant to other conventional treatments and shows positive serological tests for syphilis. This is important because syphilitic scleritis is usually aggravated by steroid treatment but can be cured by proper anti-syphilitic chemotherapy.

Clinical Usefulness of a Thermal-Massaging System for Treatment of Dry Eye with Meibomian Gland Dysfunction

PURPOSE: To evaluate the clinical usefulness of KCL 990(R) for the treatment of dry eye with meibomian gland dysfunction (MGD). METHODS: Patients (n = 54 eyes, 27 subjects) diagnosed with dry eye with MGD were recruited for a prospective, one-month clinical trial. Patients received a twice-a-day 15-minute treatment using the KCL 990(R). Effectiveness parameters included patient symptom scores using the Ocular Surface Disease Index (OSDI) questionnaires, tear osmolarity measured with TearLab(R) (TearLab Corporation, San Diego, CA, USA), classical tear break-up time (TBUT), and objective TBUT value using an Optical Quality Analysis System (OQAS(R), Visiometrics, Castelldefels, Spain). Data are presented for pre-treatment (baseline) and at 1 week and 1 month post-treatment. An objective TBUT value was estimated in each eye when the optical scattering index (OSI) started to increase consistently, and data were obtained at pretreatment (baseline) and at 1 month post-treatment. RESULTS: The symptom scores on OSDI questionnaires, tear osmolarity, and tear break-up time improved significantly from baseline to one week (p < 0.05). This improvement was maintained with no significant regression at 1 month (p < 0.05). The objective TBUT value decreased significantly at 1 month (p < 0.05). CONCLUSIONS: KCL 990(R) contributed to improve not only signs and symptoms of dry eye with MGD, but also the function of the tear film and ocular surface.

Comparison of Colvardpupillometer, ORBScan II and Sirius in Determining Pupil Size for Refractive Surgery

PURPOSE: To compare pupil size measured by Colvard(R)pupillometer, ORBScan II(R), Sirius(R) and analyze correlation between pupil size and night vision disturbance after refractive surgery according to measuring methods. METHODS: Two hundred eyes of one hundred patients who underwent refractive surgery were retrospectively evaluated. Pupil size was measured with Colvard(R)pupillometer, Sirius(R) in the scotopic light condition and with ORBScan II(R), Sirius(R) in the photopic light condition. Patients filled out questionnaire about night vision disturbance at postoperative three months. Correlation between pupil size according to measuring methods and night vision disturbance was evaluated. RESULTS: The mean age of patient was 26 years and number of male patients was 36. In scotopic light condition, pupil size measured with Colvard(R)pupillometer (6.76 mm) was significantly larger than that of Sirius(R) (6.53 mm) (p < 0.001). In photopic light condition, pupil size measured with ORBScan II(R) (3.98 mm) was significantly smaller than that of Sirius(R) (4.41 mm) (p < 0.001). Night vision disturbance were correlated with pupil size and Sirius(R) in the scotopic light condition had strongest correlation among three measuring method (r = 0.44). CONCLUSIONS: Sirius(R) tends to measure pupil size smaller than Colvard(R)pupillometer in the scotopic light condition. The correlation between night vision disturbance and pupil size was highest in Sirius(R).

Development of EKC after Eximer Laser Photorefractive Surgery and Subsequent Recurrence of EKC-like Keratitis

This research focuses on four cases of patients having undergone eximer laser photorefractive surgery who were diagnosed with adenoviral keratoconjunctivitis during the postoperative period and who later developed epidemic keratoconjunctivitis (EKC)-like keratitis. Two of the patients had undergone laser-assisted subepithelial keratectomy (LASEK), one had undergone laser in situ keratomileusis and one had photorefractive keratectomy. After the surgery adenoviral keratoconjunctivitis and recurrent late-developing EKC-like keratitis were observed in the patients. Recurrent late-developing EKC-like keratitis occurred in one of the patients, who had received LASEK as many as three times. The others had only one or two episodes.The corneal infiltrates of keratitis mainly occurred in the central cornea. Successful resolution of recurrent late-developing EKC-like keratitis was achieved through the use of topical steroids without sequelae and the final best-corrected visual acuity was as good as the base line. These keratitis infiltrates have been presumed to represent an immune response to the suspected adenoviral antigens deposited in corneal stroma during the primary adenoviral infection. Previous reports argued that patients with a history of adenoviral ketatoconjunctivitis were succeptible to adenoviral keratoconjunctivitis becoming reactivated; however, in our research, our patients had their first adenoviral infections after the eximer laser photorefractive surgery and reactivation was confirmed. We recommend that attention be paid to adenoviral infection after laser refractive operations, because these patients seem to have more frequent recurrences.

Success Rates According to the Shape of Rhinostomy After Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the success rates according to the shape of rhinostomy after endonasal dacryocystorhinostomy. METHODS: We analyzed 131 patients (188 cases) who had undergone endonasal dacryocystorhinostomy with a minimum follow-up of 6 months. After surgery, all cases were classified into flat, alcove, concave, or concealed concave types according to Jane's rhinostomy classification. Patency to irrigation and improved symptoms were considered indicative of a successful outcome. RESULTS: There were 81 flat type patients (125 cases), 31 alcove type patients (42 cases), 19 concave type patients (21 cases), and no cases were classified as concealed concave type. The success rates were 75.2%, 85.7%, 81.0% respectively, and the most common cause of failure was the formation of granulation within the ostium. The success rates did not significantly vary according to the shape of rhinostomy (p=0.144). CONCLUSIONS: The success rates after endonasal dacryocystorhinostomy of flat, alcove, and concave types in turn were 75.2%, 85.7%, and 81.0%.

Bilateral Spontaneous Anterior Lens Dislocation in a Retinitis Pigmentosa Patient

PURPOSE: To report a case of bilateral spontaneous anterior lens dislocation associated with retinitis pigmentosa (RP). METHODS: A 45-year-old male with RP presented with elevated intraocular pressure (IOP) in the right eye and was treated with laser iridotomy (LI). After LI, complete crystalline lens dislocation into the anterior chamber occurred. Surgical intervention, including anterior vitrectomy, intracapsular cataract extraction (ICCE), and IOL scleral fixation was performed. Two years later, the same episode occurred in his left eye and a similar treatment was done. RESULTS: Surgery was successful in both eyes. CONCLUSIONS: This is the first report of bilateral spontaneous anterior lens dislocation in a RP patient.

Changes in Axial Length Following Trabeculectomy and Ahmed Glaucoma Valve Implantation

PURPOSE: This study examines the changes in axial length after trabeculectomy and Ahmed glaucoma valve implantation surgery. METHODS: In the forty three eyes of the 42 patients who had the uncontrolled glaucoma, 22 eyes of 21 patients having trabeculectomy and 21 eyes of 21 patients having Ahmed glaucoma valve implantation from October 2004 to September 2005 at Kim's Eye Hospital were analyzed prospectively. These patients had IOP and axial length measurements preoperatively, at 1 week, 1 month, and 3 months after surgery and refractive power measurements preoperatively, at 3 months after surgery. Axial length was measured by IOL Master(R). RESULTS: There was a statistically significant reduction in IOP after 3 months of 26.6+/-11.2 mmHg overall, 22.4+/-8.4 mmHg following trabeculectomy, and 30.9+/-12.3 mmHg after Ahmed glaucoma valve implatation (p<0.001). There was a statistically significant reduction in axial length after 3 months of -0.24+/-0.10 mm overall, -0.21+/-0.1 mm after trabeculectomy and -0.28+/-0.1 mm after Ahmed glaucoma valve implantation. CONCLUSIONS: There was a statistically significant decrease in axial length after both trabeculectomy and Ahmed glaucoma valve implantation. We must consider the influence of axial length change on refraction in planning combined glaucoma and cataract surgery or future IOL implantation.

No association of prion protein gene polymorphisms with Alzheimer's disease in Korean population

The polymorphism at codon 129 (M129V) of the human prion protein gene (PRNP) is a known risk factor for Creutzfeldt-Jakob disease (CJD) in Caucasians. There are few reports of this polymorphism's effect on memory and on the risk of Alzheimer's disease (AD). The M129V genotype distributions among Asians are very different from Caucasians. Another polymorphism, codon 219 (E219K) is not found in Caucasians. We investigated two polymorphisms of PRNP, M129V (rs1799990) and E219K (rs1800014) in 297 Korean AD patients and 217 healthy subjects. The analysis of the genotype and allele distributions showed no significant difference between the AD patients and the controls in both polymorphisms (P=0.19 genotype, P=0.51 allele for M129V; P=0.64 genotype, P=0.50 allele for E219K). Also, the PRNP polymorphisms were not significantly associated with AD when the populations were stratified for the presence or absence of apolipoprotein E-e4 (ApoE-epsilon4) allele. These results suggest that the PRNP genetic variants are not associated with the risk for AD in Korean population.

A Three Month Placebo-Controlled Clinical Trial of INM 176 in the Old Aged Subjects with Memory Impairment / 신경정신의학

OBJECTIVES: We examined the effects of INM 176 (K-1107) compared with placebo on the cognitive functions of 92 old aged subjects with cognitive impairment. METHODS: This was a prospective, 12 week, double-blind, placebo-controlled clinical trial. The elderly who achieved a score of less than 25 points on the K-MMSE or showed a high risk of Alzheimer's disease from the 7-Minute Neurocognitive Screening Battery were considered to have objective impairment and were selected as subjects for this study. The subjects were randomized to placebo or INM 176 group. The outcome measures were from the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog), the Instrumental Activities of Daily Living (IADL) and the Korean Geriatric Depression Scale (KGDS) and two kinds of computerized priming tests. After setting the total error score in the Alzheimer's Disease Assessment Scale-Cognitive section (ADAS-cog) as the repeated measurement factor, an analysis of variance of the combined factor design was done between the placebo and INM 176 group. RESULTS: The interaction effect of time (pre- and post- trial) and group (placebo and INM 176 group) was significant in the analysis of the ADAS-cog's total error score. The INM 176 group's total error score in the ADAS-cog decreased significantly (p<0.01), whereas the placebo group showed a slight increase. The mean changes in IADL and GDS from baseline scores favored in the INM 176 group than in the placebo group. Outcome changes of ADAS-cog, IADL, KGDS scores during the 12 week clinical trail of INM 176 and placebo demonstrated favorable responses in the INM176 administered group. CONCLUSIONS: This is a preliminary clinical trial result of INM176 as a memory pill. Based on these results, INM176 may be a candidate molecule for the improvement of cognitive functions, including memory. Further clinical trial should demonstrate its efficacy.