Optical Quality and Visual Performance With Different Toric Contact Lens Designs.

OBJECTIVES: To evaluate the optical quality of different toric contact lens (CL) designs and compare their on-eye visual correction performance. METHODS: Twenty soft CL wearers aged 20 to 39 years were enrolled. Two daily disposable silicone-hydrogel toric CLs were tested: the "Eyelid Stabilized Design" (ESD-CL) and prism-ballast design (PB-CL); a spherical daily disposable silicone hydrogel CL (spherical CL) was used as a control. On-eye performance was compared for corrected distance visual acuity (CDVA), astigmatism, and ocular higher-order aberrations (HOAs); astigmatism and ocular HOAs were measured with a wavefront sensor. The subjective quality of vision, rated for "blurred vision" and "double vision," lens rotation, and fitting were also compared. RESULTS: The ESD-CLs, PB-CL, and no-CL provided better CDVA than spherical CL ( P <0.05). Compared with spherical CL and no CL, PB-CL and ESD-CLs caused significantly lesser astigmatism ( P <0.05). Coma was significantly lesser with ESD-CLs than that with PB-CL ( P <0.05); total HOAs did not differ among the four conditions. The subjective ratings for blurred and double vision were significantly lower with ESD-CLs than those with spherical CL ( P <0.05). CONCLUSIONS: Toric CLs provide a better CDVA than spherical CLs. However, differences in coma and subjective symptoms may occur because of the design of toric CLs.

Case of Primary Intraocular Lymphoma with Extraocular Extension.

PURPOSE: To describe a case of primary intraocular lymphoma (PIOL) with an extension through the sclera that was confirmed to be part of the PIOL by histopathological examinations. CASE: An 89-year-old woman was referred to a local clinic with a 1-year history of persistent blurred vision in her left eye. After 2 years without aggressive treatments, she had a marked reduction of vision and pain in her left eye. The clinical diagnosis was panophthalmitis, and the eye was enucleated and submitted for histopathological study. RESULTS: Light microscope examination showed that atypical lymphocytic cells had infiltrated into both the intraocular and extraocular areas. The anterior chamber angle was blocked by infiltrating tumor cells, which were also detected around the optic nerve. The tumor cells destroyed Bruch's membrane and infiltrated around the perineural and perivascular areas within the sclera. Immunohistochemistry showed that the tumor cells were positive for B-lymphocyte surface antigen (CD20), B-cell antigen receptor complex-associated protein alpha chain (CD79-alpha), and had a high positive rate for anti-Ki-67 antibody. CONCLUSION: The finding in our case indicates that early diagnosis and treatment are important for eyes with PIOL because the tumor can spread and penetrate the sclera and invade extraocular tissues.

Higher-order aberrations of anterior and posterior corneal surfaces in patients with keratectasia after LASIK.

PURPOSE: We investigated higher-order aberrations (HOAs) of the anterior and posterior corneal surfaces in patients with keratectasia after LASIK. METHODS: The subjects comprised four groups: 12 eyes with keratectasia after LASIK, 30 eyes following LASIK without keratectasia, 30 keratoconic eyes, and 30 normal eyes. Corneal HOAs due to the anterior and posterior corneal surfaces for 6-mm pupils (root mean square [µm]) were obtained using a Scheimpflug-based corneal tomographer and compared among the four groups. RESULTS: There were significant differences in total HOAs of the anterior and posterior corneal surfaces (mean ± SD) in the keratectasia (2.49 ± 1.37 and 0.83 ± 0.57), keratoconus (4.50 ± 2.57 and 1.18 ± 0.65), LASIK (0.84 ± 0.25 and 0.14 ± 0.04), and normal (0.52 ± 0.15 and 0.17 ± 0.06) groups except for between keratoconus and keratectasia at the posterior surface. Keratectasia and keratoconus showed similar coma-dominant patterns at both surfaces, and there were no significant differences in the Zernike terms between both groups except for the total HOAs and coma aberration at the anterior surface. CONCLUSIONS: Although flap creation and laser ablation were supposed to center on the primary line of sight in LASIK, keratectasia after LASIK showed coma-dominant HOAs at both corneal surfaces. This suggests that the cornea in keratectasia has optical properties similar to those in keratoconus.

[Higher-order aberrations in eye implanted with aspherical intraocular lenses].

PURPOSE: To compare efficacy of aspherical intraocular lenses (IOLs) with spherical IOLs by measuring the ocular and internal higher-order aberrations. METHODS: Two hundred four eyes of 145 patients were evaluated at Kozaki eye clinic after phacoemulsification with implantation of 2 aspherical IOLs (45 eyes with the Hoya FY60AD, and 43 eyes with the Nidek N4-18YG); or 3 spherical IOLs (38 eyes with the Hoya YA60BBR, 32 eyes with the Kowa AU6K and 46 eyes with the Alcon MZ30BD). The 3rd and 4th higher-order aberrations (HOAs) were measured with KR9000PW for a 6-mm-diameter pupil, and then the ocular and internal HOAs were compared between the groups. RESULTS: The mean internal spherical aberrations at 1 month after surgery were significantly lower in the FY60AD (-0.14 +/- 0.07 microm) and the N4-18YG (-0.23 +/- 0.08 microm) than in the MZ30BD (0.17 +/- 0.10 microm), the YA60BBR (0.16 +/- 0.08 microm) and the AU6K (0.04 +/- 0.06 microm). The mean ocular HOAs were significantly lower in the FY60AD and the N4-18YG than in the other spherical IOLs. The negative correlation between IOL power and spherical aberrations after surgery was significant for both the aspherical IOL groups of FY60AD and N4-18YG. CONCLUSIONS: The correlation between the IOL power and spherical aberrations, and the HOAs after surgery varied depending on the type of IOL.

Effect of NIDEK optimized aspheric transition zone ablation profile on higher order aberrations during LASIK for myopia.

PURPOSE: To investigate the effect of the Optimized Aspheric Transition zone profile (OATz) that was devised to minimize the "red ring" in corneal topography on ocular higher order aberrations following LASIK for myopia. METHODS: Laser in situ keratomileusis with OATz using the Nidek Advanced Vision Excimer Laser Platform (NAVEX) was performed on 22 eyes with a 4.5-mm optical zone and 8.0-mm transition zone (OATz group). Conventional LASIK was performed on 11 eyes with a 6.0-mm optical zone and 7.0-mm transition zone as a control (conventional group). The higher order aberrations for the central 6-mm diameter were measured at 1 month postoperatively using a Hartmann-Shack wavefront sensor. In addition to the spherical aberration, the magnitude and orientation of trefoil, coma, tetrafoil, and secondary astigmatism were compared between two groups using Zernike vector analysis. RESULTS: The mean magnitude (root-mean-square) of the total higher order aberrations in the conventional group (0.70 +/- 0.28 microm) was significantly higher than that in the OATz group (0.51 +/- 0.15 microm, P < .05, unpaired t test). For spherical aberration, the OATz group had significantly lower values (0.22 +/- 0.17 microm) than the conventional group (0.38 +/- 0.23 pm, P < .05). The magnitude of coma in the conventional group was also higher than that in the OATz group (P < .05), and the mean axis of coma was 8.6 degrees in the conventional group and 64.3 degrees in the OATz group. No statistically significant differences were noted in the magnitude and axes of trefoil, tetrafoil, or secondary astigmatism between the two groups. CONCLUSIONS: The OATz profile may decrease the surgically induced increase of higher order aberrations, especially spherical aberration, following LASIK. However, a study with equivalent treatment groups and larger sample sizes is required for a definitive conclusion.

Higher-order aberrations due to the posterior corneal surface in patients with keratoconus.

PURPOSE: This study was designed to investigate higher-order aberrations (HOAs) due to the posterior corneal surface in keratoconic eyes compared with normal eyes. METHODS: We studied 24 normal and 28 keratoconic eyes. The anterior/posterior corneal heights and pachymetric data were obtained with a rotating Scheimpflug camera. HOAs for 6 mm pupils were calculated from the differences between the height data and the best-fit sphere, using an original program for each corneal surface. The reference axes of the measurements were aligned with the primary line of sight. The HOAs were expanded with normalized Zernike polynomials. For each pair of standard Zernike terms for trefoil, coma, tetrafoil, and secondary astigmatism, one value for the magnitude and axis was calculated by Zernike vector analysis. RESULTS: The mean total corneal HOAs (root mean square [microm]) from the anterior/posterior surfaces were significantly (P < 0.001) higher in keratoconic (4.34/1.09, respectively) than in control eyes (0.46/0.15). The mean magnitude of each Zernike vector terms for trefoil, coma, and spherical aberration from the anterior/posterior surfaces was significantly (P < 0.001) higher in keratoconic (0.77/0.19, 3.57/0.87, -0.44/0.17) than control eyes (0.09/0.04, 0.33/0.07, 0.25/-0.07), respectively. The mean axes by vector calculation for coma due to the anterior (63.6 degrees ) and posterior surfaces (241.9 degrees ) were in opposite directions. CONCLUSIONS: Corneal HOAs on both corneal surfaces in keratoconic eyes were higher than in control eyes. Coma from the posterior surface compensated partly for that from the anterior surface. Residual irregular astigmatism in patients with keratoconus wearing rigid gas permeable contact lenses can be estimated by measuring the HOA from the posterior corneal surface.

Characteristics of ocular higher-order aberrations in patients with pellucid marginal corneal degeneration.

PURPOSE: To evaluate the characteristics of higher-order aberrations (HOAs) in eyes with pellucid marginal corneal degeneration (PMCD). SETTING: Department of Ophthalmology, Osaka University Medical School, Osaka, Japan. METHODS: Ocular HOAs were measured by aberrometry in 20 eyes with PMCD (PMCD group), 76 eyes with keratoconus (KC group), and 105 normal eyes (control group) with a 4.0 mm pupil. The magnitudes and axes of trefoil, coma, tetrafoil, and secondary astigmatism and the magnitude of spherical aberration were compared between the 3 groups using vector analysis of Zernike terms. RESULTS: The mean axes of coma in the PMCD group (85.5 degrees) and KC group (82.5 degrees) were opposite the axis in the control group (253.7 degrees). The magnitude of coma was significantly lower in the PMCD group (0.27 microm +/- 0.19 [SD]) than in the KC group (0.70 +/- 0.37 microm) (P < .05). The mean axes of trefoil in the PMCD group (27.1 degrees) and control group (35.4 degrees) were opposite the axis in the KC group (93.8 degrees). The magnitude of spherical aberration was significantly higher in the PMCD group (0.086 +/- 0.10 microm) than in the KC group (-0.030 +/- 0.13 microm) (P < .05); the spherical aberration signs were opposite in the groups. CONCLUSIONS: Although PMCD and KC are categorized as noninflammatory corneal thinning disorders, the HOA patterns in the 2 groups differed, possibly due to differences in the positions of the corneal apex. PMCD and KC may cause distinctively different deterioration in the quality of vision.

Three cases of idiopathic "multiple-parallel-line" endotheliitis.

PURPOSE: To report 3 cases of idiopathic endotheliitis that appeared clinically as multiple parallel lines of keratic precipitates on the corneal endothelium. METHODS: Interventional case reports. RESULTS: Slit-lamp examinations of the 3 patients showed several parallel dotted lines of keratic precipitates on the corneal endothelium. Although all cases were managed successfully by topical steroid in 1 week, corneal endothelial cell damage occurred. No virus (herpes simplex virus 1, varicella zoster virus, or cytomegalovirus) could be detected by reverse transcriptase polymerase chain reaction in the aqueous humor of 1 of the 3 patients. CONCLUSIONS: This series of cases presented a unique type of idiopathic endotheliitis with the clinical appearance of multiple and parallel lines of keratic precipitates. The expression patterns of the keratic precipitates were distinct from those of previously reported linear endotheliitis.

Magnitude and orientation of Zernike terms in patients with keratoconus.

PURPOSE: To measure the magnitude and orientation of the Zernike terms in keratoconic eyes, with and without rigid gas-permeable (RGP) contact lenses. METHODS: A total of 76 eyes with keratoconus, 58 eyes with keratoconus suspect, and 105 normal eyes were studied. To determine the effect of RGP lenses, 19 eyes with keratoconus, 9 eyes with keratoconus suspect, and 17 normal eyes, with and without an RGP lenses, were compared. Ocular higher-order aberrations (HOAs) were measured with a wavefront sensor for a 4-mm-diameter pupil, and the magnitudes, axes of trefoil, and coma were calculated by vector analysis. RESULTS: Zernike vector analysis showed prominent vertical coma with an inferior slow pattern, with mean axes of 82.5 degrees or 91.0 degrees in the patients with keratoconus or keratoconus suspect, respectively. The mean axes of trefoil in patients with keratoconus (93.8 degrees ) and keratoconus suspect (100.6 degrees ) differed from that in normal subjects (35.4 degrees ), indicating that keratoconus has a reverse trefoil pattern from that of normal eyes. Although the total HOAs were significantly (keratoconus and keratoconus suspect, P < 0.001 and P = 0.012, respectively) reduced with an RGP lens, the patterns of the axes of coma and trefoil were reversed with the lens. CONCLUSIONS: In addition to the larger amount of trefoil, coma, tetrafoil, and secondary astigmatism, keratoconic eyes tend to have a reverse coma pattern and reverse trefoil aberrations compared with normal eyes. Although RGP lenses correct the irregular astigmatism, smaller comet-like retinal images in the opposite direction remain due to residual vertical coma.

The use of competitive PCR for quantitation of HSV-1 DNA.

PURPOSE: Polymerase chain reaction (PCR) detects the genomic materials of etiological agents with high specificity and sensitivity. However, in herpes simplex virus type 1 (HSV-1) infection, the clinical significance of the results often poses controversy because of the subclinical viral shedding during latent infection. Quantitative PCR might provide additional information to help clinical evaluation of the results. METHODS: Virus DNA was extracted from high titer stock of human HSV-1 (FK 25) by phenol/chloroform treatment. Construct (p/HSV-1) was made by inserting the glycoprotein D gene obtained from virus DNA into p(GEM-T) vector. Competitor (p/DeltaHSV-1) was made by deleting the inner 40 bp of construct (p/HSV-1) with restriction enzyme. Competitive PCR was performed using primers that amplify the glycoprotein D gene, and a template made of a 1:1 molar mixture of HSV-1 DNA and the competitor. RESULTS: The PCR product reflected the initial template dose from 20 to 30 cycles. Minimum detection level of HSV-1 DNA was 0.01 ng. CONCLUSION: Competitive PCR can quantitate HSV-1 DNA.