Repeatability and reproducibility of anterior chamber volume measurements using 3-dimensional corneal and anterior segment optical coherence tomography.

PURPOSE: To evaluate the repeatability and reproducibility of anterior chamber volume (ACV) measurements using swept-source 3-dimensional corneal and anterior segment optical coherence tomography (CAS-OCT) and dual Scheimpflug imaging. SETTING: Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan. DESIGN: Nonrandomized clinical trial. METHODS: Measurements were taken in normal eyes (subject group) and in eyes with primary angle closure (PAC) (patient group). In the subject group, the entire ACV and the central 8.0 mm diameter ACV were measured using CAS-OCT and dual Scheimpflug imaging. In the patient group, the entire ACV and 8.0 mm ACV were measured using CAS-OCT. The coefficient of variation and intraclass correlation coefficient (ICC) were calculated to evaluate repeatability and reproducibility, and the correlation between the 2 devices was assessed. RESULTS: In the subject group, the mean 8.0 mm ACV was 110.14 mm(3) ± 12.57 (SD) using CAS-OCT and 114.51 ± 14.69 mm(3) using Scheimpflug imaging; there was a significant linear correlation (r = 0.878, P < .0001). The mean entire ACV on CAS-OCT was 165.15 ± 29.29 mm(3). The ICCs of the 8.0 mm and entire ACV measurements were greater than 0.94. The coefficients of repeatability and reproducibility of the 8.0 mm ACV and entire ACV measurements were less than 5%. In the patient group, the 8.0 mm and entire ACV measurements showed good reproducibility and repeatability. CONCLUSIONS: The CAS-OCT method allowed noninvasive measurement of the entire ACV with sufficient repeatability and reproducibility. The 8.0 mm ACV measurements with CAS-OCT and Scheimpflug imaging were comparable.

Wound architecture of clear corneal incision with or without stromal hydration observed with 3-dimensional optical coherence tomography.

PURPOSE: To evaluate wound architectures of a clear corneal incision and the duration of stromal edema caused by intentional hydration in cataract surgery using 3-dimensional (3-D) cornea and anterior segment optical coherence tomography (OCT). DESIGN: Prospective, randomized study. METHODS: On 30 eyes of 23 patients, cataract surgery was performed through a clear corneal incision created with a 2.4-mm blade. After confirming the water tightness of the clear corneal incision at the end of surgery, 15 randomly selected eyes received stromal hydration, and the remaining 15 eyes did not. Using the 3-D cornea and anterior segment optical coherence tomography, wound architecture was assessed 1 day, 1 week, and 2 weeks after surgery. RESULTS: There was a statistically significant difference in corneal thickness at the clear corneal incision between eyes with and without stromal hydration 1 day and 1 week after surgery (P < .001 and P < .05, Mann-Whitney U test), but not at 2 weeks after surgery. On day 1, gaping at the epithelial side was seen in 6.7% (2 eyes), gaping at the endothelial side in 30% (9 eyes), misalignment of the roof and floor of incision in 40% (12 eyes), and local detachment of Descemet membrane in 36.7% (11 eyes). These imperfections improved with time. CONCLUSIONS: Using the 3-D cornea and anterior segment optical coherence tomography, detailed architectures of the clear corneal incision were investigated. It was found that the effect of stromal hydration lasted for at least 1 week after surgery.

Repeatability and reproducibility of anterior ocular biometric measurements with 2-dimensional and 3-dimensional optical coherence tomography.

PURPOSE: To evaluate the repeatability and reproducibility of central corneal thickness (CCT), anterior chamber depth (ACD), and anterior chamber width (ACW) measurements using 3-dimensional (3-D) corneal and anterior segment optical coherence tomography (CAS-OCT) and 2-dimensional (2-D) anterior segment OCT (AS-OCT). SETTING: Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan. DESIGN: Nonrandomized clinical trial. METHODS: The CCT, ACD, and ACW were measured in normal eyes using a prototype 3-D swept-source CAS-OCT device and a 2-D time-domain AS-OCT device (Visante). The coefficient of repeatability and reproducibility and the intraclass correlation coefficient (ICC) were calculated to evaluate the repeatability and reproducibility of the measurements. RESULTS: Eighty-five eyes (85 subjects) were evaluated. The mean CCT measurement was 557.5 µm ± 40.5 (SD) with CAS-OCT and 556.4 ± 39.4 µm with AS-OCT; the mean ACD measurement, 3.13 ± 0.40 mm and 3.16 ± 0.39 mm, respectively; and the mean ACW, 11.80 ± 0.47 mm and 11.79 ± 0.49 mm, respectively. There was no statistically significant difference in CCT or ACW measurements between the 2 devices (P>.05, Wilcoxon signed rank test). Although the ACD measurements were significantly different (P<.0001), the difference was small (0.03 mm). Significant linear correlations were found between the measurements of the 2 devices (P<.0001). The ICC was greater than 0.99 for CAS-OCT and greater than 0.96 for AS-OCT. CONCLUSION: Corneal and anterior segment OCT and AS-OCT provided comparable and well-correlated anterior ocular biometric measurements, with sufficient repeatability and reproducibility.

Visibility of trabecular meshwork by standard and polarization-sensitive optical coherence tomography.

Polarization-sensitive optical coherence tomography (PS-OCT) is known to be advantageous because of its additional tissue-specific contrast of the anterior eye. So far, this advantage has been shown only qualitatively. We evaluate the improved visibility afforded by 3-D PS corneal and anterior eye segment OCT (PS-CAS-OCT) in visualizing the trabecular meshwork (TM) based on statistical evidences. A total of 31 normal subjects participated in this study. The anterior eye segments of both the eyes of the subjects are scanned using a custom-made PS-CAS-OCT and the standard-scattering OCT (S-OCT) and polarization-sensitive phase-retardation OCT (P-OCT) images are obtained. Three graders grade the visibility of the TM using a four-leveled grading system. The intergrader agreement, intermodality differences, and interquadrant dependence of visibility are statistically examined. All three of three combinations of graders show substantial agreement in visibility with P-OCT (ρ = 0.74, 0.70, and 0.68, Spearman's correlation), while only one of three shows substantial agreement with S-OCT (ρ = 0.72). Significant dependence of the visibility on the modality (S-OCT versus P-OCT) and quadrants are found by the analysis of variance. A subsequent Wilcoxon signed-rank test reveals significantly improved visibility. PS-CAS-OCT may become a useful tool for screening angle-closure glaucoma.

Tissue discrimination in anterior eye using three optical parameters obtained by polarization sensitive optical coherence tomography.

We developed a tissue discrimination algorithm of polarization sensitive optical coherence tomography (PS-OCT) based on the optical properties of tissues. We calculated the three-dimensional (3D) feature vector from the parameters intensity, extinction coefficient, birefringence, which were obtained by PS-OCT. The tissue type of each pixel was determined according to the position of the feature vector in the 3D feature space. The algorithm was applied for discriminating tissues of the human anterior eye segment. The conjunctiva, sclera, trabecular meshwork (TM), cornea, and uvea were well separated in the 3D feature space, and we observed them with good contrast. The TM line can be observed in the 3D discriminated volume, as observed by gonioscopy.We validated our method by applying our algorithm and histological data to porcine eyes. A marker was injected into sub-Tenon's space and the tissues that were anterior to the marker and posterior to the marker were successfully segmented by our algorithm.

Investigation of multifocal choroiditis with panuveitis by three-dimensional high-penetration optical coherence tomography.

A single case of multifocal choroiditis with panuveitis (MFCPU) was investigated by a three-dimensional (3-D) high-penetration optical coherence tomography. The HP-OCT is based on a swept-source OCT technology, uses a probe beam with a center wavelength of 1060 nm, and possesses a depth resolution of 10.4 micromin tissue. Two eyes of an MFCPU patient were involved in this study. The eyes were also examined by color fundus photograph, fluorescein angiography (FA), and indocyanine green angiography (ICGA). Findings in these four modalities are comparatively discussed. The OCT scans revealed the following characteristic properties of the lesion sites. Thinning of the retina, destructuring of the retinal layers, and disappearance of the junction of the inner and outer segments of the photoreceptor (IS/OS). Due to the high penetration of this OCT system, the following characteristic properties of the lesions were also observed: localized thinning of the choroid, occlusion of the choroidal vessels, and localized hyper-reflectivity that may represent hyper-pigmentation of the choroid.

Anterior ocular biometry using 3-dimensional optical coherence tomography.

PURPOSE: To evaluate anterior ocular biometry by comparing the measurements of central corneal thickness (CCT) and anterior chamber depth (ACD) with 3-dimensional corneal and anterior segment optical coherence tomography (CAS-OCT) and other methods. DESIGN: Cross-sectional study. PARTICIPANTS: Forty eyes of 40 normal subjects. METHODS: The CCT was measured by 4 methods (CAS-OCT, Scheimpflug camera, scanning-slit topography, and ultrasonic pachymetry), and the ACD was measured by 3 methods (CAS-OCT, Scheimpflug camera, and scanning-slit topography). The anterior chamber volume (ACV) was calculated with CAS-OCT. Repeatability and reproducibility of CAS-OCT measurements were evaluated. MAIN OUTCOME MEASUREMENTS: The CCT and ACD were measured and compared between devices. The ACV was calculated with CAS-OCT. Coefficient of variation and intraclass correlation coefficient (ICC) were calculated to evaluate repeatability and reproducibility of CAS-OCT measurements. RESULTS: The mean CCT was 547.0+/-39.0, 590.0+/-39.8, 525.0+/-45.0, and 545.0+/-40.3 microm with CAS-OCT, Scheimpflug camera, scanning-slit topography, and ultrasonic pachymetry, respectively. Significant differences were observed among the 4 methods (P<0.0001; 1-way analysis of variance [ANOVA]). The CCT measured with Scheimpflug camera was significantly larger than those measured with the other methods (P<0.0001; Bonferroni multiple comparison), but there was no significant difference among the other 3 methods. The mean ACD was 3.01+/-0.47, 3.04+/-0.52, and 2.88+/-0.50 mm with CAS-OCT, Scheimpflug camera, and scanning-slit topography, respectively. There was no significant difference among the 3 methods (P = 0.678; 1-way ANOVA). A significant linear correlation in CCT and ACD were observed between CAS-OCT and other methods (all P<0.0001). The mean ACV calculated with CAS-OCT was 169.7+/-23.1 mm(3). The coefficient of repeatability and reproducibility of CCT and ACD measurements were <5% and ICCs were >0.98. CONCLUSIONS: The CCT measurements were comparable among CAS-OCT, ultrasonic pachymetry, and scanning-slit topography, but Scheimpflug camera yielded a significantly higher CCT value. There was no significant difference in ACD measurements among CAS-OCT, Scheimpflug camera, and scanning-slit topography. The ACV was noninvasively measured by CAS-OCT. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

Investigation of post-glaucoma-surgery structures by three-dimensional and polarization sensitive anterior eye segment optical coherence tomography.

A sequential case series of post-glaucoma-surgery structures examined by three-dimensional corneal and anterior eye segment optical coherence tomography (3D-CASOCT) and 3D polarization sensitive CASOCT (PS-CASOCT) is presented. A total of 5 patients who underwent glaucoma surgery were included in this study. Of these, 1, 1, and 3 patient underwent trabeculotomy, laser iridotomy, and trabeculectomy respectively. One patient each who had undergone trabeculotomy or laser iridotomy was examined using a prototype 3D-CASOCT. This prototype is based on swept-source OCT technology, uses a probe beam with a center wavelength of 1.31 microm, and has an axial resolution of 11.6 microm and a scanning speed of 20,000 A lines/s. All 3 patients who underwent trabeculectomy were examined by PS-CASOCT, which has similar specifications to those of 3DCASOCT, measures the depth-resolved birefringence of a specimen, and yields conventional OCT images. Detailed 3D visualization of the incision site of trabeculotomy and the ablation site of laser iridotomy was achieved using 3D-CASOCT. PS-CASOCT revealed, in addition to the structural details, the birefringent properties of the tissues of the trabeculectomy bleb. Some blebs showed abnormal birefringence in the conjunctiva and in a remnant fluid pool. This may indicate the existence of fibrosis in these regions. Both 3D-CASOCT and PS-CASOCT provide clinically significant information for the postoperative assessment of structures created during glaucoma surgery. Interactive 3D datasets of all cases are provided for interactive clinical review. Complex raw 3D OCT volumes are also provided as a reference dataset for the development of PS-OCT algorithms.

Evaluation of trabeculectomy blebs using 3-dimensional cornea and anterior segment optical coherence tomography.

OBJECTIVE: To investigate the internal structures of trabeculectomy blebs using 3-dimensional cornea and anterior segment optical coherence tomography (3-D CAS OCT). DESIGN: Observational case series. PARTICIPANTS: Thirty-eight filtering blebs in 31 patients who had undergone trabeculectomy examined retrospectively. METHODS: Intrableb structures were examined using 3-D CAS OCT. The blebs were classified clinically as successful (intraocular pressure [IOP] <18 mmHg without glaucoma medication) or failed. MAIN OUTCOME MEASURES: Bleb structures were assessed in terms of the visibility of the drainage route, scleral flap, and microcysts. The length and height of the internal fluid-filled cavity, maximum and minimum bleb wall thickness, total bleb height, volumes of the internal fluid-filled cavity and hyporeflective area, and number of microcysts were analyzed. RESULTS: Intrableb drainage route, scleral flap, and microcysts were observed in 92.1%, 94.7%, and 86.8% eyes, respectively. The IOP showed a significant negative correlation with horizontal and vertical length of the fluid-filled cavity (Spearman correlation coefficient [r(s)] = -0.634; P<0.0001; and r(s) = -0.539; P = 0.0008, respectively), height of the fluid-filled cavity (r(s) = -0.334; P = 0.031), maximum bleb wall thickness (r(s) = -0.491; P = 0.0023), total bleb height (r(s) = -0.629; P<0.0001), volume of the internal fluid-filled cavity (r(s) = -0.480; P = 0.0029), volume of hyporeflective area (r(s) = -0.443; P = 0.0056), and number of microcysts (r(s) = -0.451; P = 0.0045). There were 26 successful (64.8%) and 12 failed (31.6%) blebs. Significant differences were observed between these groups in IOP (P<0.0001), horizontal and vertical length of the fluid-filled cavity (P<0.0001 and P = 0.0019, respectively), height of the fluid-filled cavity (P = 0.0046), maximum bleb wall thickness (P = 0.0029), total bleb height (P = 0.0003), volume of the internal fluid-filled cavity (P = 0.0006), volume of hyporeflective area (P = 0.0020), and number of microcysts (P = 0.0025). CONCLUSIONS: The internal aqueous humor outflow channel and scleral flap could be visualized, and the 3-D volume of the intrableb cavity was calculated using 3-D CAS OCT. The successful blebs exhibited a large internal fluid-filled cavity, an extensive hyporeflective area, and thicker bleb walls with more microcysts. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Visualization of sub-retinal pigment epithelium morphologies of exudative macular diseases by high-penetration optical coherence tomography.

PURPOSE: To evaluate the clinical significance of the newly developed long-wavelength probe optical coherence tomography (LP-OCT) for the diagnosis of exudative macular diseases. METHODS: Fourteen eyes of 13 participants were prospectively enrolled in the study. There were seven type I and five type II choroidal neovascularization (CNV) cases associated with age-related macular degeneration and idiopathic neovascularization and one case of polypoidal choroidal vasculopathy (PCV). A custom-built LP-OCT based on swept-source OCT (SS-OCT) technology was used. This new OCT uses a probe beam with a wavelength of 1060 nm that provides deeper penetration into the choroid and higher image contrast to the structures beneath the retinal pigment epithelium (RPE) and pathologic tissues than does conventional OCT. The depth resolution is 10.4 microm in tissue and the measurement speed is 28,000 depth scans/s. All the eyes were also examined by standard short wavelength probe OCT (SP-OCT). The image contrasts of the LP- and SP-OCT were qualitatively evaluated and analyzed by Wilcoxon's paired signed rank test and Spearman's rank correlation test. RESULTS: In 10 of 14 eyes, high-contrast visualization of the diseases beneath the RPE, CNV, or fibrin was attained. These diseases were almost invisible in the SP-OCT images. The LP-OCT of the remaining eyes also revealed significant improvement in the image contrasts beneath the RPE and CNV. Qualitative evaluation of the image contrasts and subsequent statistical test indicated statistically significant improvement in the image penetration to the choroid of LP-OCT to that of SP-OCT. CONCLUSIONS: LP-OCT provided significant improvement in the image contrast of exudative macular diseases.

[A case of intralenticular foreign iron body without any symptoms for 20 years].

BACKGROUND: After penetrating injury an intralenticular foreign body is usually associated with complications such as traumatic cataracts, uveitis, and glaucoma. Under rare conditions, however, a foreign body may remain in the eye without any complications for many years. There have been few reports of persisting intralenticular foreign bodies in Japan, and no report of an intralenticular body of iron which was retained for more than 6 months. We report a case of intralenticular foreign iron body that stayed without any symptoms for 20 years. CASE REPORT: A 65-year-old male with an episode of ocular pain in his right eye 20 years ago presented with blurred vision in the right eye. Slit lamp examination revealed cataract and a intralenticular foreign body in the right eye. Despite the presence of a black foreign body in the middle of the nucleus, damage to the anterior capsule was minimal. He was successfully treated by surgical removal of the foreign body, phacoemulsification, and intraocular lens implantation. In vitro analysis demonstrated that the foreign body was oxidized Fe. CONCLUSION: A foreign body may remain dormant in the crystalline lens for many years depending on the conditions. We reported a patient with an intralenticular foreign iron body without symptoms for 20 years, who was successfully treated with lens surgery.

Three-dimensional anterior segment optical coherence tomography of filtering blebs after trabeculectomy.

PURPOSE: To evaluate trabeculectomy blebs by using 3-dimensional anterior segment optical coherence tomography (OCT). METHODS: We prospectively examined 4 eyes of 4 patients who developed filtering blebs after trabeculectomy. A 1310-nm high-speed OCT prototype was used to image the 3-dimensional structure of the filtering blebs. RESULTS: The 3-dimensional structure of the filtering blebs was clearly observed in the OCT images. Three types of filtering blebs were observed: diffuse blebs in 2 eyes, an encapsulated bleb in 1 eye, and a nonfunctioning cystic bleb in 1 eye. The volume of each bleb was 9.97, 1.10, 0.76, and 0.88 mm3, respectively. En-face OCT images clearly showed the aqueous outflow channels at the margins of the scleral flaps. CONCLUSION: Three-dimensional OCT allows objective and noninvasive assessment of filtering blebs after trabeculectomy.

Indocyanine green staining facilitates detection of bleb leakage during trabeculectomy.

PURPOSE: To report a new technique to visualize bleb leakage using indocyanine green (ICG) staining during trabeculectomy. PATIENTS AND METHODS: The ICG solution was widely applied over the filtering bleb including the conjunctival wound before completion of trabeculectomy. This procedure was performed in 48 eyes of 44 consecutive patients undergoing trabeculectomy between December 2004 and October 2005. RESULTS: Without staining, bleb leakage was not identified by the direct observation under the operating microscope. ICG staining clearly visualized aqueous leakage from the bleb in 5 eyes (10.4%). The bleb leakage in these eyes was easily repaired with 10-0 nylon sutures, and no eyes, including these 5 cases, showed bleb leakage after surgery. There were no intraoperative and postoperative complications related to ICG application. CONCLUSIONS: The application of ICG during trabeculectomy is a simple and useful technique to facilitate detection and repair of the bleb leakage.

Three-dimensional optical coherence tomography of granular corneal dystrophy.

PURPOSE: To describe 3-dimensional optical coherence tomography (OCT) findings in a case of granular corneal dystrophy. METHODS: A 1310-nm high-speed swept-source OCT prototype was used to image the 3-dimensional structures of the cornea of a patient with granular corneal dystrophy. RESULTS: Three-dimensional OCT clearly showed multiple highly reflective lesions, corresponding to the deposits in the cornea. Volume of the deposits within the central 1.5 mm of the cornea was 0.11 mm and occupied 2.98% of the corneal volume. CONCLUSIONS: Three-dimensional OCT allows objective and noninvasive assessment of granular corneal dystrophy.

Prospective intrapatient comparison of 6.0-millimeter optic single-piece and 3-piece hydrophobic acrylic foldable intraocular lenses.

PURPOSE: To compare postoperative performance and stability of 6.0-mm optic single- and 3-piece acrylic foldable intraocular lenses (IOLs). DESIGN: Prospective, randomized, self-controlled trial. PARTICIPANTS: Eighty eyes of 40 patients with bilateral senile cataracts. INTERVENTION: Phacoemulsification and IOL implantation were performed. One eye of a patient was randomly assigned to the SA60AT single-piece IOL, and the contralateral eye was allocated to the MA60AC 3-piece IOL. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA), spherical equivalent, aqueous flare intensity, anterior chamber depth, amount of IOL decentration and tilt, area of anterior capsule opening, and degree of posterior capsule opacification (PCO) were measured 2 days, 1 week, and 1, 3, 6, and 12 months after surgery. Specular microscopy was performed at 12 months postoperatively. RESULTS: In the SA60AT group, the anterior chamber depth did not show significant changes after surgery (P>0.05; paired t test), and the refraction remained highly stable throughout the 1-year study period. The MA60AC group showed significant shallowing of the anterior chamber (P<0.05) and a myopic shift (P<0.05) up to 1 month after surgery. There were no significant differences between the 2 groups (P>0.05) in BCVA, aqueous flare intensity, the amount of IOL decentration, IOL tilt, area of anterior capsule opening, and degree of PCO throughout the 12-month follow-up period. CONCLUSIONS: Both the SA60AT single-piece and MA60AC 3-piece lenses showed a minimum amount of decentration, tilt, anterior capsule contraction, and PCO. Although the MA60AC showed significant forward shift and myopic refractive changes after surgery, the SA60AT displayed little axial movement associated with highly stable refraction after surgery. This feature of the SA60AT should facilitate earlier spectacle prescription and quicker visual/social rehabilitation of patients after cataract surgery.

Influence of pupil diameter on the relation between ocular higher-order aberration and contrast sensitivity after laser in situ keratomileusis.

PURPOSE: To investigate the influence of pupil diameter on the relation between induced changes in ocular higher-order wavefront aberrations and changes in contrast sensitivity by conventional laser in situ keratomileusis (LASIK) for myopia. METHODS: In 215 eyes of 117 patients (age, 33.2 +/- 8.3 years) undergoing LASIK for myopia of -1.25 to -13.5 D (-5.28 +/- 2.55 D), ocular wavefront aberrations and contrast sensitivity function were determined before and 1 month after surgery. Preoperative photopic pupil diameter was measured with a digital camera. Ocular higher-order aberrations were measured for a 4-mm pupil with a Hartmann-Shack wavefront analyzer. The root-mean-square (RMS) of the third- and fourth-order Zernike coefficients was used to represent coma- and spherical-like aberration, respectively. From the contrast-sensitivity data, the area under the log contrast sensitivity function (AULCSF) was calculated. RESULTS: One hundred five eyes had a photopic pupil diameter of 4 mm or larger, and the remaining 110 had a photopic pupil diameter smaller than 4 mm. There were no statistically significant differences in the background clinical data between these two groups. In the eyes with a photopic pupil diameter of 4 mm or larger, the changes in third-order comalike aberrations did not correlate with the changes in AULCSF (Pearson correlation coefficient, r = -0.037, P = 0.723) and 10% low-contrast visual acuity (r = 0.125, P = 0.224), but fourth-order spherical-like aberrations correlated significantly with the changes in AULCSF (r = -0.229, P = 0.024) and 10% low-contrast visual acuity (r = 0.221, P = 0.038). In the eyes with photopic pupil size smaller than 4 mm, there were significant correlations between the changes in comalike aberrations and the changes in AULCSF (r = -0.487, P < 0.001) and 10% low-contrast visual acuity (r = 0.310, P = 0.003), but spherical-like aberrations showed no correlation with the changes in AULCSF (r = -0.078, P = 0.485) and 10% low-contrast visual acuity (r = 0.208, P = 0.158). CONCLUSIONS: In eyes with larger photopic pupil diameter, increases in spherical-like aberration dominantly affect contrast sensitivity, whereas in eyes with smaller pupil size, changes in coma-like aberration exert greater influence on visual performance.

Inadvertent insertion of an opposite-power intraocular lens.

An 82-year-old woman with age-related cataract and high myopia had uneventful phacoemulsification and intraocular lens (IOL) implantation. Preoperative visual acuity was 20/60 with -16.00 -3.00 x 70 and axial length was 29.29 mm. An IOL (MA60MA, Alcon) of +5.0 diopters (D) was selected with target refraction of -1.5 D. The next day, visual acuity was 20/15 with +5.50 -2.00 x 60. It was found that an IOL of -5.0 D was inadvertently inserted instead of +5.0 D because of an identical package appearance of the opposite-diopter IOLs except for a small negative sign before the diopter label. The -5.0 D IOL was surgically replaced with +5.0 D IOL, and visual acuity became 20/15 with -0.50 -2.00 x 70. When selecting an IOL for highly myopic patients, attention should be paid to the extreme resemblance of the package of opposite-diopter IOLs.

Ciliary body edema after scleral buckling surgery for rhegmatogenous retinal detachment.

PURPOSE: Choroidal detachment and anterior chamber (AC) shallowing develop in some cases after scleral buckling surgery for rhegmatogenous retinal detachment (RD). Postoperative angle-closure glaucoma has been reported to occur in 4% of cases. It is supposed that compression by the local scleral buckling induces ciliary body edema and angle narrowing. This study aimed to evaluate quantitatively the time course of changes in ciliary body thickness and AC depth (ACD) before and after the scleral buckling procedure using ultrasound biomicroscopy. DESIGN: Prospective consecutive case series. PARTICIPANTS: Forty-six eyes of 44 patients (43.7+/-18.1 years old [mean +/- standard deviation]) undergoing rhegmatogenous RD surgery. METHODS: Ciliary body thickness and ACD were measured before and 3, 7, 14, and 28 days after the procedure. Ultrasound biomicroscopy was used to evaluate ACD and ciliary body thickness. MAIN OUTCOME MEASURE: Time course of changes in ciliary body thickness and ACD. RESULTS: The surgery caused significant increases in ciliary body thickness at 3, 7, and 14 days postoperatively (P<0.0001, Bonferroni multiple comparison). Ciliary body edema reached its peak 3 days after surgery, followed by a gradual decrease thereafter. Ciliary body thickness in the encircling group was statistically greater than in the segmental buckling group at 3 and 7 days postoperatively (P<0.001, Student's t test). The ciliary body was significantly thicker in the direction of buckling than on the opposite side 3 days after surgery (P = 0.0079). In the encircling group, retinal reattachment surgery significantly decreased ACD 3 days after surgery (P = 0.018), whereas no significant fluctuations were found in the buckling group. CONCLUSIONS: Even without apparent choroidal detachment and a shallow AC, subclinical ciliary edema existed in all directions of all eyes for at least 1 month after the scleral buckling procedure. The ciliary body in the direction of scleral buckling showed greater edema than the other areas. Eyes treated with the encircling band showed greater ciliary edema than those treated with segmental buckling alone.

Evaluation of arterial stiffness in patients with branch retinal vein occlusion.

PURPOSE: To assess the arterial stiffness in patients with branch retinal vein occlusion (BRVO). METHODS: Brachial-ankle pulse wave velocity (PWV) and ankle-brachial index were measured in 10 patients with BRVO (mean age 67.9 +/- 7.5 years) and in 18 age-matched controls (mean age 66.9 +/- 6.8 years). The controls were subjects with systemic essential hypertension having no retinal lesions. RESULTS: The PWV in the BRVO group was 1,946 +/- 254 cm/s which was significantly higher than that in the control group (1,688 +/- 274 cm/s; p = 0.014, Wilcoxon rank sum test). The ankle-brachial indexes were 1.16 and 1.15 in BRVO and control groups, respectively. There was no significant difference between the groups (p = 0.944). In the control group, there was a significant positive correlation between PWV and systolic blood pressure (Spearman correlation coefficient r(s) = 0.385, p = 0.043), while no significant correlation was found in the BRVO group (Spearman correlation coefficient r(s) = -0.188, p = 0.603). CONCLUSION: The arterial stiffness is increased in patients with BRVO which was thought to be due to the structural changes of the artery and not dependent on the blood pressure.