Influence of frosted haptics on rotational stability of toric intraocular lenses.

We investigated the unfolding property and rotational stability of a new toric intraocular lens (IOL); TECNIS toric II (toric-II, ZCW, Johnson & Johnson) that is an improved version of TECNIS toric IOL (toric-I, ZCV). Both IOLs are based on an identical platform, except for the frosted haptics with toric-II IOL. The study consisted of two parts; experimental study and clinical, retrospective, case series. Experimental study indicated that the overall time from IOL ejection to unfolding to 11 mm was significantly shorter with toricII than toric-I IOLs (p = 0.032), due to the earlier separation of the haptics from the optic with toric-II IOL. Clinical study included 131 eyes of 99 patients who had undergone phacoemulsification and toric IOL implantation. At 3 months postoperatively, toric-II IOL showed significantly better rotational stability than toric-I IOL, including smaller residual manifest astigmatism (p = 0.018), less amount of axis misalignment from the intended axis (p = 0.04), lower incidence of misalignment > 10º (p = 0.0044), and less degree of prediction errors (p = 0.043). Postoperative uncorrected distance visual acuity tended to be better in the toric-II than in the toric-I groups, with marginal statistical difference (p = 0.057). TECNIS toric II IOL with the frosted haptics showed significantly better rotational stability than its predecessor, probably due to quicker unfolding and greater friction with the capsular bag.

Influence of posterior corneal astigmatism on the outcomes of toric intraocular lens implantation in eyes with oblique astigmatism.

PURPOSE: To assess whether the outcomes of toric intraocular lens (IOL) implantation in eyes with oblique astigmatism can be improved by direct measurements of posterior corneal astigmatism using anterior segment optical coherence tomography (AS-OCT) instead of by using anterior corneal measurements alone. STUDY DESIGN: Retrospective case series. METHODS: Two toric IOL power calculation methods were compared: anterior corneal astigmatism was used in the keratometry group, whilst total corneal astigmatism determined by ray tracing through the measured anterior and posterior corneal surfaces was used in the AS-OCT group. In a total of 279 eyes of 232 patients, subgroup analysis was conducted for with-the-rule (WTR) (85 eyes in the keratometry group and 34 eyes in the AS-OCT group), against-the-rule (ATR) (73/29 eyes), and oblique (26/32 eyes) astigmatism. RESULTS: In the WTR and ATR astigmatism groups, the uncorrected distance visual acuity (UDVA) was significantly better in the AS-OCT group than in the keratometry group (P = 0.012 and P < 0.001, Mann-Whitney test), and the residual astigmatism was significantly smaller in the AS-OCT group than in the keratometry group (P = 0.037 and P < 0.001). In eyes with oblique astigmatism, the UDVA (P = 0.299) and residual astigmatism (P = 0.373) of the keratometry and AS-OCT groups did not differ. CONCLUSION: Incorporation of posterior corneal astigmatism measured with AS-OCT can significantly improve the outcomes of toric IOL implantation in eyes with WTR and ATR astigmatism, but not in eyes with oblique astigmatism.

Outcomes of bee sting injury: comparison of hornet and paper wasp.

PURPOSE: To compare the outcomes of ocular injuries of hornets and paper wasps' stings. STUDY DESIGN: Retrospective case series. METHODS: Patients diagnosed with ocular injuries sustained by bee stings at Miyata Eye Hospital (Miyazaki, Japan) between August 2000 and July 2016 were enrolled. Retrospective data regarding type of bee, visual acuity, and treatment were collected from medical records. Outcomes of the hornet and wasp groups were compared. RESULTS: Five eyes of 5 patients (3 men, 2 women; mean age 44.6±21.2 years [range 9-62 years]) were enrolled. The mean follow-up period was 50.6 ± 57.6 months (range 4 days to 121 months). The causative bee was hornet in 3 cases and wasp in 2. The anterior chamber was irrigated in 2 patients, both from the hornet group. The best-corrected visual acuity at the final visit was no light perception, light perception, and (0.02) in the hornet group, (1.5) and (1.2) in the wasp group. CONCLUSIONS: The hornet group exhibited significantly worse prognosis than the wasp group. Identifying the type of bee is important in establishing prognosis.

Effect of laser peripheral iridotomy using argon and neodymium-YAG lasers on corneal endothelial cell density: 7-year longitudinal evaluation.

PURPOSE: To evaluate the changes in corneal endothelial cell density (ECD) over a 7-year period after laser peripheral iridotomy (LPI) using argon and neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers. STUDY DESIGN: Retrospective case series. METHODS: Eyes that underwent prophylactic LPI using argon and Nd:YAG lasers were followed up for 7 years. Central corneal endothelial cells were observed by use of noncontact specular microscopy preoperatively and at 1 and 7 years postoperatively. Changes in ECD and the associations between preoperative ECD and the total energy of the Nd:YAG laser were evaluated. RESULTS: Fifty-one eyes of 51 patients were followed up for 7 years. The ECD significantly decreased after LPI (P < 0.049), and the reduction rate at 1 year after the surgery (1.69 ± 4.80%, 95% CI: 0.34%-3.04%) was significantly higher than the annual reduction rates after 1 year (0.17 ± 0.85%/y, P = 0.036, 95% CI: -0.07% to 0.41%). No association was found between the preoperative ECD and the total laser energy. CONCLUSIONS: Long-term evaluation indicated that the reduction in ECD after argon-Nd:YAG laser LPI was present but small during the initial year and was negligible after 1 year.

Influence of intraocular lens subsurface nanoglistenings on functional visual acuity.

To investigate the influence of intraocular lens subsurface nanoglistenings (SSNGs) on functional visual acuity (FVA), thirty-nine eyes of 29 patients were examined in this study. The SSNG group comprised 19 eyes of 14 patients (75.7± 5.4 years, mean ± standard deviation), and the control group comprised 20 eyes of 15 patients (73.6 ± 6.5 years). The SSNGs were diagnosed on the basis of the typical whitish IOL appearance upon slit-lamp examination and results of densitometry regarding surface light scattering using Scheimpflug images. The FVA measurement system (AS-28; Kowa, Aichi, Japan) was used to examine changes in continuous visual acuity (VA) over time, and visual function parameters such as FVA, visual maintenance ratio (VMR), maximum VA, minimum VA, standard deviation of VA, and number of blinks were assessed. The results were compared between the SSNG and control groups, and correlations of FVA parameters with the intensity of surface light scattering, time after surgery, and age were also evaluated. There were significant differences in VMR (P = 0.035) and standard deviation of VAs (P = 0.031) between the two groups, although no significant differences were found in baseline VA, FVA, maximum VA, minimum VA, and number of blinks. None of the FVA parameters showed any significant correlations with the intensity of surface light scattering, time after surgery, or age. There is a possibility that VA is unstable during a continuous gazing task in patients with SSNGs.

Relationship between metamorphopsia and foveal microstructure in patients with branch retinal vein occlusion and cystoid macular edema.

PURPOSE: We aimed to investigate the relationship between the severity of metamorphopsia and the foveal microstructure measured with spectral-domain optical coherence tomography (SD-OCT) in patients with cystoid macular edema caused by branch retinal vein occlusion (BRVO-CME). METHODS: The study included 30 eyes of 30 patients with BRVO-CME. We examined visual acuity and the severity of metamorphopsia using M-CHARTS. Central foveal thickness, central retinal thickness at the fovea (CRT-1 mm), and macular volume were measured with SD-OCT software. The status of ellipsoid zone (EZ), external limiting membrane (ELM), outer retinal cyst, and inner retinal cyst was also evaluated. RESULTS: The mean metamorphopsia score was 0.77 ± 0.50, with 28 of 30 patients (93 %) having metamorphopsia (metamorphopsia score ≥ 0.2). The vertical metamorphopsia score (0.89 ± 0.54) was significantly higher than the horizontal metamorphopsia score (0.64 ± 0.53) (p < 0.005). The status of EZ and ELM was significantly associated with visual acuity, but not with the mean metamorphopsia score. The mean metamorphopsia score was significantly related to CRT-1 mm (p < 0.05) and the presence of inner retinal cyst (p < 0.05). CONCLUSIONS: The severity of metamorphopsia was significantly associated with central retinal thickness and the presence of inner retinal cyst.