Predictability of combined cataract surgery and trabeculectomy using Barrett Universal â ¡ formula.

PURPOSE: To compare the predictability of intraocular lens (IOL) power calculation using the Barrett Universal II and the SRK/T formulas in eyes undergoing combined cataract surgery and trabeculectomy. METHODS: We retrospectively reviewed the clinical charts of 56 consecutive eyes undergoing cataract surgery and trabeculectomy. IOL power calculations were performed using the Barrett Universal II and SRK/T formulas. We compared the prediction error, the absolute error, and the percentages within ± 0.5 D and ±1.0 D of the targeted refraction, 3 months postoperatively, and also investigated the relationship of the prediction error with the keratometric readings and axial length, using the two formulas. RESULTS: The prediction error using the SRK/T formula was significantly more myopic than that using the Barrett Universal II formula (paired t-test, p<0.001). The absolute error using the Barrett Universal II formula was significantly smaller than that using the SRK/T formula (p = 0.039). We found significant correlations of the prediction error with the axial length (Pearson correlation coefficient, r = 0.273, p = 0.042), and the keratometric readings (r = -0.317, p = 0.017), using SRK/T formula, but no significant correlations between them (r = 0.219, p = 0.167, and r = -0.023, p = 0.870), using the Barrett Universal II formula. CONCLUSIONS: The Barrett Universal II formula provides a better predictability of IOL power calculation and is less susceptible to the effect of the axial length and the corneal shape, than the SRK/T formula. The Barrett Universal formula, rather than the SRK/T formula, may be clinically helpful for improving the refractive accuracy in such eyes.

Comparison of Laser Iridotomy and Lensectomy Outcomes for Acute Primary Angle Closure.

Purpose: To compare the clinical outcomes of the different treatments for acute primary angle closure (APAC). Methods: We retrospectively reviewed the clinical charts of 87 eyes of 87 patients undergoing treatment for APAC. We investigated the best spectacle-corrected visual acuity (BSCVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and secondary interventions after each treatment. Results: The pretreated IOP was 56.4 ± 9.0 mmHg. As the first treatment for APAC, all eyes underwent topical 2% pilocarpine and systemic mannitol administration. Subsequent laser iridotomy (LI) and lensectomy were necessary in 29 eyes (33%) and 35 eyes (40%), respectively. Bullous keratopathy developed in 1 eye (1%), and following glaucoma surgery was required in 7 eyes (8%). The BSCVA at the final follow-up was 0.16 ± 0.53 and 0.01 ± 0.20 logMAR (Mann-Whitney U test, p=0.149), the IOP was 12.8 ± 2.6, and 12.6 ± 2.9 mmHg (p=0.860), and the ECD was 2295.9 ± 658.2 and 2244.1 ± 622.0 cells/mm2 (p=0.735) in the LI and lensectomy groups, respectively. Conclusions: Approximately 26% of eyes with APAC were resolved after the initial medical treatment, and subsequent surgical treatments, such as LI and lensectomy, were required in 33% and 40% of eyes, respectively. We found no significant differences in the BSCVA, the IOP, or the ECD among LI and lensectomy treatment groups.

Comparison of Visual Performance and Patient Satisfaction After Multifocal Intraocular Lens Implantation and During Multifocal Contact Lens Wear After Monofocal Intraocular Lens Implantation: A Pilot Study.

PURPOSE: To compare the visual performance and patient satisfaction in multifocal intraocular lens (IOL)-implanted eyes and multifocal contact lens (CL)-wearing eyes undergoing monofocal IOL implantation. METHODS: We retrospectively assessed visual acuity at all distances (0.3, 0.5, 0.7, 1, and 5 m), contrast sensitivity function, patient satisfaction score, and the rate of spectacle independence in the multifocal IOL and multifocal CL groups. RESULTS: Binocular visual acuity at 0.3, 0.5, 0.7, 1, and 5 m was 0.05 ± 0.11, - 0.02 ± 0.09, - 0.02 ± 0.09, - 0.02 ± 0.09, and - 0.04 ± 0.07, respectively, in the multifocal IOL group and 0.25 ± 0.13, 0.04 ± 0.10, 0.01 ± 0.09, - 0.01 ± 0.07, and 0.00 ± 0.08, respectively, in the multifocal CL group. We found significant differences in visual acuity at all distances. The area under the log contrast sensitivity function was 1.32 ± 0.14 and 1.33 ± 0.16 in the multifocal IOL and CL groups, respectively (p = 0.444). The patient satisfaction score for overall vision was 80.2 ± 20.6 and 82.9 ± 10.5 (p = 0.889), and the rate of spectacle independence was 23.4% and 41.7% in the multifocal IOL and CL groups, respectively (p = 0.277). CONCLUSIONS: According to our experience, both multifocal IOLs and CLs provided good near-to-distance binocular vision and subsequent high patient satisfaction in daily activities with acceptable contrast sensitivity, suggesting their viability for presbyopic correction in elderly subjects.

Comparison of Mean and Centroid of Surgically Induced Astigmatism After Standard Cataract Surgery.

Purpose: To compare the arithmetic mean of surgically induced astigmatism (M-SIA) and the centroid of surgically induced astigmatism (C-SIA) after standard cataract surgery. Methods: We retrospectively examined 200 eyes of 100 consecutive patients undergoing bilateral cataract surgery through a 2.8 mm temporal clear corneal incision. We quantitatively measured the magnitude and axis of corneal astigmatism preoperatively and 3 months postoperatively using an automated keratometer (TONOREFF-II, Nidek). We assessed the M-SIA, the C-SIA, and the double angle plots for the display of the individual SIA distributions. Results: For bilateral data analysis, the magnitude of corneal astigmatism significantly increased from 0.66 ± 0.39 D preoperatively to 0.74 ± 0.46 D postoperatively (paired t-test, p = 0.012). The M-SIA was 0.50 ± 0.36 D. On the other hand, the C-SIA was 0.18 ± 0.60 D at an axis of 97°. For unilateral analysis, we obtained similar outcomes between the right and left eye groups. Conclusions: According to our experience, standard cataract surgery induces the M-SIA by approximately 0.5 D. The magnitude of the C-SIA largely decreased to approximately 40% of the M-SIA, and the direction of the C-SIA showed a tendency toward with-the-rule astigmatism. It should be noted that the M-SIA was considerably different from the C-SIA, especially when selecting the appropriate toric IOL model and power.

Regional comparison of preoperative biometry for cataract surgery between two domestic institutions.

PURPOSE: Regional variations of the preoperative biometry can affect the refractive accuracy of cataract surgery. We aimed to compare the preoperative biometric data for cataract surgery between two domestic institutions. METHODS: We retrospectively reviewed the preoperative biometric data of 673 consecutive eyes undergoing standard cataract surgery at Miyata Eye Hospital (Miyazaki; M group) and Kitasato University Hospital (Kanagawa; K group), and compared these data between the two groups. RESULTS: We found significant differences in the mean keratometric readings (44.39 ± 1.56 D vs. 44.09 ± 1.74 D) (unpaired t test, p = 0.034), the anterior chamber depth (3.14 ± 0.43 mm vs. 3.46 ± 0.62 mm) (p < 0.001), the axial length (23.98 ± 1.62 mm vs. 24.59 ± 1.82 mm) (p < 0.001), and the lens thickness (4.64 ± 0.48 mm vs. 4.37 ± 0.62 mm) (p < 0.001), in the M and K groups, respectively. Otherwise, we found no significant differences in corneal astigmatism (p = 0.104), or central corneal thickness (p = 0.480) between the two groups. For subgroup analysis, the prediction error (0.06 ± 0.47 D) in the M group was significantly more hyperopic than that (- 0.09 ± 0.54 D) in the K group (p = 0.006). CONCLUSIONS: There were significant differences in the mean keratometric readings, the anterior chamber depth, the axial length, and the lens thickness, by approximately 0.3 D, 0.3 mm, 0.6 mm, and 0.3 mm, respectively. Regional variations of the preoperative biometry did exist to some extent, and were not clinically negligible, in consideration of the precise IOL power calculation and the subsequent refractive accuracy of cataract surgery. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry (000037994).

Comparison of Predictability Using Barrett Universal II and SRK/T Formulas according to Keratometry.

PURPOSE: To compare the predictability of intraocular lens (IOL) power calculation using the Barrett Universal II and the SRK/T formulas, according to the keratometry. METHODS: We retrospectively reviewed the clinical charts of 335 consecutive eyes undergoing standard cataract surgery. IOL power calculations were performed using the Barrett Universal II and the SRK/T formulas. We compared the prediction error, the absolute error, and the percentages within ±0.25, ±0.5, and ±1.0 D of the targeted refraction, 1 month postoperatively, and also investigated the relationship of these outcomes with the keratometric readings, using the two formulas. RESULTS: The prediction error using the SRK/T formula was significantly more myopic than that using the Barrett Universal II formula (the paired t-test, p < 0.001). The absolute error using the SRK/T formula was significantly larger than that using the Barrett Universal II formula (p=0.006). We found a significant correlation between the prediction error and the keratometric readings using the SRK/T formula (Pearson correlation coefficient, r = -0.522, p < 0.001), but there was no significant correlation between them using the Barrett Universal II formula (r = -0.031, p=0.576). CONCLUSIONS: The Barrett Universal II formula provides a better predictability of IOL power calculation and is less susceptible to the effect of the corneal shape, than the SRK/T formula. The Barrett Universal formula, instead of the SRK/T formula, may be clinically helpful for improving the refractive accuracy, especially in eyes with steep or flat corneas.

Visual performance and patient satisfaction of multifocal contact lenses in eyes undergoing monofocal intraocular Lens implantation.

PURPOSE: To assess visual performance and patient satisfaction of multifocal contact lenses in eyes having monofocal intraocular lens (IOL) implantation. METHODS: We prospectively assessed uncorrected visual acuity at all distances (0.3, 0.4, 0.5, 0.7, 1, and 5 m), higher-order aberrations (HOAs), objective scattering index (OSI), contrast sensitivity, and patient satisfaction, before and during multifocal contact lenses wear in IOL-implanted eyes. RESULTS: Visual acuity at 0.3, 0.4, 0.5, 0.7, 1, and 5 m during wearing multifocal contact lenses was 0.21 ± 0.08, 0.11 ± 0.06, 0.01 ± 0.08, -0.02 ± 0.10, -0.02 ± 0.08, and -0.01 ± 0.07, respectively. We found a significant improvement at near to intermediate distances (30, 40, and 50 cm), but no significant change at intermediate to far distances (70 cm, 1 m, and 5 m). Log contrast sensitivity significantly decreased at 6 and 12 cycles/degrees, but did not significantly change at 1.5, 3, and 18 cycles/degrees. Third-order aberrations significantly increased after CL treatment, but fourth-order aberrations or total higher-order aberrations did not significantly change during CL treatment. The OSI and log(s) did not significantly change during CL treatment. The patient satisfaction score for overall vision significantly improved during CL treatment. CONCLUSIONS: Multifocal contact lenses significantly improved visual acuity at near to intermediate distances, and subsequent patient satisfaction, even though contrast sensitivity function slightly decreased, suggesting its viability of presbyopic correction in monofocal IOL-implanted eyes.

Predictability of intraocular lens power calculation in eyes after phototherapeutic keratectomy.

PURPOSE: To compare the predictability of intraocular lens (IOL) power calculation using several corneal power measurements in eyes that underwent phototherapeutic keratectomy (PTK). STUDY DESIGN: Retrospective case series. METHODS: We reviewed the clinical charts of 42 eyes of 25 consecutive patients who underwent cataract surgery after PTK for granular corneal dystrophy or band keratopathy. IOL power calculations were performed using the SRK/T formula with four corneal power measurements [automated keratometry (AK) measured with a partial coherence interferometer, simulated keratometry (Sim K), true net power (TNP), and total corneal refractive power (TCRP) measured with a rotating Scheimpflug camera]; we determined the prediction error, absolute error, and percentage within ± 1.0 D of the targeted refraction, 1 month postoperatively. RESULTS: The prediction error in the TCRP group was significantly better than those in the AK, Sim K, and TNP groups. The absolute error was also significantly better than those in the AK and Sim K groups, but not significantly different from that in the TNP group. The percentages of within ± 0.5 and 1.0 D in the TCRP group were significantly higher than those in the AK and Sim K groups, but not significantly different from that in the TNP group. CONCLUSIONS: The TCRP provides the highest predictability of IOL power calculation in post-PTK eyes. This result suggests that the use of the TCRP, rather than of conventional anterior keratometry, may be clinically helpful for improving the refractive accuracy of post-PTK eyes.

Predictability of Intraocular Lens Power Calculation for Cataract with Keratoconus: A Multicenter Study.

This study was aimed to assess the predictability of intraocular lens (IOL) power calculation after cataract surgery for keratoconus. We retrospectively reviewed the clinical charts of 102 eyes of 71 consecutive keratoconic patients who developed cataract. We determined manifest spherical equivalent, prediction errors, and absolute errors, 1 month postoperatively. The achieved refraction was significantly more hyperopic than the targeted refraction, when keratometric readings were used (p = 0.001). At 1 month, 36% and 63% of the eyes were within ±0.5 and ±1.0 D, respectively, of the targeted correction. We found a significant correlation between the prediction error and the mean keratometry (Pearson correlation coefficient r =-0.545, p < 0.001). No vision-threatening complications occurred in any case. The achieved refraction was significantly more myopic than the targeted refraction, when total corneal refractive power was used (p = 0.013). Phacoemulsification with IOL implantation appeared to be safe and effective, and the accuracy was also good in mild keratoconus, but not in severe keratoconus. It should be noted that that a large amount of hyperopic shift occurred especially in advanced keratoconic patients, when keratometric readings were used for IOL power calculation, and that a slight, but significant, myopic shift occurred, when total corneal refractive power was used.

Predictability of Intraocular Lens Power Calculation After Simultaneous Pterygium Excision and Cataract Surgery.

This study was aimed to assess the predictability of intraocular lens (IOL) power calculation after simultaneous pterygium excision and phacoemulsification with IOL implantation. We retrospectively reviewed the clinical charts of 60 eyes of 60 consecutive patients (mean age ±â€Šstandard deviation, 73.5 ±â€Š7.0 years) who developed pterygium and cataract. We determined visual acuity (logMAR), manifest spherical equivalent, manifest astigmatism, corneal astigmatism, and mean keratometry, preoperatively and 3 months postoperatively. Corrected visual acuity was significantly improved from 0.19 ±â€Š0.20 preoperatively to -0.06 ±â€Š0.07 postoperatively (P < 0.001, Wilcoxon signed-rank test). Uncorrected visual acuity was also significantly improved from 0.62 ±â€Š0.33 preoperatively to 0.31 ±â€Š0.32 postoperatively (P < 0.001). At 3 months, 48% and 82% of the eyes were within ±â€Š0.5 and ±â€Š1.0 D, respectively, of the targeted correction. We found significant correlations of the prediction errors with the changes in the mean keratometry (Spearman signed-rank test, r = -0.535, P < 0.001) and with the pterygium size (r = -0.378, P = 0.033). Simultaneous pterygium and cataract surgery was safe and effective, and the accuracy was moderately predictable. However, it should be noted that a significant myopic shift occurred postoperatively, possibly resulting from the steepening of the cornea after pterygium removal, especially when the size of pterygium was large.

Demographics of patients having cataract surgery after laser in situ keratomileusis.

PURPOSE: To retrospectively assess the demographics of patients having cataract surgery in eyes with previous laser in situ keratomileusis (LASIK). SETTING: Department of Ophthalmology, Kitasato University, Kanagawa, and Sanno Hospital, Tokyo, Japan. DESIGN: Retrospective case series. METHODS: This study evaluated eyes of consecutive patients scheduled for cataract surgery after previous LASIK (Group 1). The control groups comprised eyes with axial lengths (ALs) matched with ALS in Group 1 (Group 2) and all eyes scheduled for cataract surgery (Group 3). Assessed were age, sex, corrected distance visual acuity, manifest refraction, keratometry (K) readings, corneal astigmatism, and corneal higher-order aberrations (HOAs). RESULTS: Group 1 comprised 40 eyes of 40 patients; Group 2, 606 eyes of 606 patients; and Group 3, 3642 eyes of 3642 patients. The mean age at cataract surgery of patients in Group 1 was 54.6 years ± 8.1 (SD), which was significantly younger than in Group 2 (by approximately 10 years) and Group 3 (by approximately 15 years) (P < .001, Student t test). In Group 1, 70.0% of patients were men, a significantly higher percentage than in Groups 2 and 3 (P < .05, Fisher exact test). The rate of corneal HOAs was significantly higher in Group 1 than in Groups 2 and 3 (P < .05, Student t test). There were no significant differences in other demographics except in K readings. CONCLUSION: A long AL and an increase in corneal HOAs might contribute to a tendency for cataract surgery to be performed earlier in eyes in which LASIK has been performed. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Comparison of vault after implantation of posterior chamber phakic intraocular lens with and without a central hole.

PURPOSE: To compare the vault after implantation of a posterior chamber phakic intraocular lens (pIOL) (Visian Implantable Collamer Lens) with and without a central artificial hole for moderate to high ametropia. SETTING: Department of Ophthalmology, Kitasato University, Kanagawa, Japan. DESIGN: Retrospective comparative study. METHODS: The study comprised eyes of patients who had central hole pIOL implantation in 1 eye and conventional pIOL implantation in the fellow eye. The time course of the postoperative pIOL vault was quantitatively assessed using a rotating Scheimpflug camera (Pentacam HR). RESULTS: Twenty-three patients (46 eyes) (mean age 31.3 years ± 7.4 [SD]) were enrolled in the study. The amount of vault with the central hole pIOL was 603 ± 276 µm, 552 ± 261 µm, 539 ± 258 µm, 520 ± 240 µm, and 482 ± 245 µm, at 1 week, 1 month, 3 months, 6 months, and 1 year postoperatively, respectively. The amount with the conventional pIOL vault was 585 ± 252 µm, 550 ± 269 µm, 514 ± 253 µm, 485 ± 233 µm, and 459 ± 239 µm, respectively. There was no significant association between the pIOL vault and the refractive accuracy 1 year postoperatively (Spearman correlation coefficient r = 0.18, P = 0.41 for central hole pIOL and r = 0.07, P = .76 for conventional pIOL). CONCLUSIONS: The vault of the new central hole pIOL appeared to be essentially equivalent to the vault of the conventional pIOL, suggesting that the presence of the central hole did not significantly affect the vault or the refractive accuracy. FINANCIAL DISCLOSURE: Dr. Shimizu is a consultant to Staar Surgical Co. and has assisted with the development of patented technologies. No other author has a financial or proprietary interest in any material or method mentioned.

A study of the causes of bilateral optic disc swelling in Japanese patients.

PURPOSE: To investigate the etiology of bilateral disc swelling in Japanese. METHODS: Using Kitasato University's Department of Neuro-Ophthalmology medical records and fundus photographs of the period December 1977 through November 2010, we retrospectively identified 121 outpatients who had been initially confirmed with bilateral disc swelling. RESULTS: The most common cause of the bilateral disc swelling was increased intracranial pressure (ICP) (59%); followed by pseudopapillitis (16%); uveitis (8%); hypertensive retinopathy (5%); bilateral optic neuritis, acute disseminated encephalomyelitis (ADEM) and optic disc drusen (all at 2% each); and leukemia (1%). Unknown etiology accounted for 6% of the cases. CONCLUSION: Although increased ICP is the most common etiology for bilateral disc swelling, it can also be triggered by a variety of other causes. Pseudopapillitis is the most important progenitor of bilateral disc swelling in Japanese.