A knowledge-enhanced transform-based multimodal classifier for microbial keratitis identification.

Microbial keratitis, a nonviral corneal infection caused by bacteria, fungi, and protozoa, is an urgent condition in ophthalmology requiring prompt treatment in order to prevent severe complications of corneal perforation and vision loss. It is difficult to distinguish between bacterial and fungal keratitis from image unimodal alone, as the characteristics of the sample images themselves are very close. Therefore, this study aims to develop a new deep learning model called knowledge-enhanced transform-based multimodal classifier that exploited the potential of slit-lamp images along with treatment texts to identify bacterial keratitis (BK) and fungal keratitis (FK). The model performance was evaluated in terms of the accuracy, specificity, sensitivity and the area under the curve (AUC). 704 images from 352 patients were divided into training, validation and testing set. In the testing set, our model reached the best accuracy was 93%, sensitivity was 0.97(95% CI [0.84,1]), specificity was 0.92(95% CI [0.76,0.98]) and AUC was 0.94(95% CI [0.92,0.96]), exceeding the benchmark accuracy of 0.86. The diagnostic average accuracies of BK ranged from 81 to 92%, respectively and those for FK were 89-97%. It is the first study to focus on the influence of disease changes and medication interventions on infectious keratitis and our model outperformed the benchmark models and reaching the state-of-the-art performance.

Clinical efficacy of a new surgical technique of oral mucosal epithelial transplantation for severe ocular surface disorders.

BACKGROUND: Severe ocular surface disorders are one of the major blinding diseases, and a paucity of original tissue obscures successful reconstruction. We developed a new surgical technique of direct oral mucosal epithelial transplantation (OMET) to reconstruct severely damaged ocular surfaces in 2011. This study elaborates on the clinical efficacy of OMET. METHODS: A retrospective review of patients with severe ocular surface disorders who underwent OMET from 2011 to 2021 at the Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine was conducted. Patients who were followed up for at least 3 months postoperatively and had sufficient pre or postoperative records were included. Surgical efficacy was evaluated by comparing the best-corrected visual acuity (BCVA), corneal transparency, neovascularization grade, and symblepharon grade. Additionally, postoperative ocular surface impression cytology was used to study the morphology of the newborn epithelial cells. RESULTS: Forty-eight patients (49 eyes; mean age: 42.55 ± 12.40 years, range:12-66 years) were enrolled in the study. The etiology included chemical burns (30 eyes), thermal burns (16 eyes), explosive injuries (1 eye), Stevens-Johnson syndrome (1 eye), and multiple pterygiums (1 eye). The mean follow-up period was 25.97 ± 22.99 months. Postoperatively, 29 eyes (59.18%) showed improved corneal transparency, 26 eyes (53.06%) had improved BCVA, 47 eyes (95.92%) had a stable epithelium until the final follow-up, 44 eyes (89.80%) had a reduced neovascularization grade. Of the 20 eyes with preoperative symblepharon, 15 (75%) were completely resolved, and five (25%) were partially resolved. Impression cytological studies showed no postoperative conjunctival invasion onto the corneal surface. CONCLUSIONS: OMET is a safe and effective surgical technique for reconstruction in severe ocular surface disorder by maintaining a stable epithelium and reducing the neovascularization and symblepharon grade.

[Research progress on etiologic diagnosis of ocular viral diseases].

A large number of viruses have been found to be associated with ocular diseases, including human adenovirus, human herpesvirus (HHV), human T lymphotropic virus type-1 (HTLV-1), and newly emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This group of diseases is prone to be misdiagnosed or missed diagnosis, resulting in serious tissue and visual damage. Etiological diagnosis is a powerful auxiliary mean to diagnose the ocular diseases associated with human adenovirus, herpes simplex virus 1 and varicella-zoster virus, and it provides the leading diagnosis evidence of infections with herpes simplex virus 2, Epstein-Barr virus, cytomegalovirus, HHV-6/7, HHV-8, HTLV-1 and SARS-CoV-2. Virus isolation, immunoassay and genetic diagnosis are usually used for etiologic diagnosis. For genetic diagnosis, the PCR technique is the most important approach because of its advantages of rapid detection, convenient operation, high sensitivity and high specificity.

Anti-fibrosis potential of pirarubicin via inducing apoptotic and autophagic cell death in rabbit conjunctiva.

This study investigated the potential efficacy of pirarubicin (THP) in modulating rabbit conjunctival fibrosis both in vitro and in vivo and characterized the underlying mechanisms. Primary rabbit conjunctival fibroblasts (RCF) were cultured and treated with THP or mitomycin C (MMC) for 5 min, followed by assaying for cell viability, cell cycle distribution, apoptotic and autophagic pathways. The production of reactive oxygen species (ROS) and chemotaxis of macrophages by RCF were evaluated using 2',7'-dichlorofluorescein diacetate (DCFH-DA) labeling and transwell migration assay, respectively. Limbal stem cell excision in combination with alkali burn was performed on the rabbits to establish a model of limbal deficiency and conjunctival fibro-vascular invasion. After three months, the modeled fibro-vascular tissue was excised combined with topical subconjunctival 5-min exposure to THP compared with MMC intraoperatively. The recurrence of postoperative fibrosis and the expression of apoptosis, autophagy, and inflammation markers were evaluated by immunohistochemistry. All modeled rabbits developed conjunctival fibro-vascular lesions, which were similar to human recurrent pterygium (HRP). Both THP and MMC inhibited RCF proliferation and arrested cell cycle at the G0/G1 phase. In particular, 7.5 µmol/L THP remarkably promoted RCF autophagy by upregulating the levels of Beclin 1, Atg 5/12 conjugate, and LC3B, whereas, 15 µmol/L THP significantly triggered a cascade of mitochondrial-associated RCF apoptosis. THP induced the production of ROS and enhanced the chemoattraction of macrophages by RCF. Similar to 600 µmol/L MMC, both 7.5 µmol/L and 15 µmol/L THP attenuated postoperative conjunctival fibrosis in the models; 7.5 µmol/L THP preferentially enhanced autophagy while causing fewer side effects. THP exerted its antifibrotic action by modulating autophagy in RCF, inducing cell cycle arrest, and mitochondrial-mediated apoptosis. THP at the dose of 7.5 µmol/L prevented postoperative conjunctival fibrosis in an animal model.

Smart Amphiphilic Random Copolymer-Coated Sponge with pH-Switchable Wettability for On-Demand Oil/Water Separation.

To prepare intelligent controllable oil/water separation materials with high mechanical stability and good recyclability, we fabricated a novel pH-controlled wettability melamine sponge by using a facile dip-coating method. The coated sponge exhibits reversibly switchable wettability between superhydrophilicity-superoleophobicity through acidic surrounding and superhydrophobicity-superoleophilicity under neutral or alkaline conditions. The as-prepared sponge possesses excellent absorption capacity (46.06-122.81 g/g) and oil/water separation efficiency (above 98%). The coated sponge also has good mechanical stability and recyclability which means it can be reused for absorption and oil/water separation. This smart porous material, which can flexibly transform wettability on demand, has great application prospects in oil/water separation.

Eyelid margin cleaning using Deep Cleaning Device for the treatment of meibomian gland dysfunction-associated dry eye: a preliminary investigation.

OBJECTIVE: To evaluate the safety and effectiveness of eyelid margin cleaning using Deep Cleaning Device for the treatment of meibomian gland dysfunction-associated dry eye. METHODS: This was a prospective, randomized, open-label, investigator-masked, and self-controlled study. We randomly assigned one eye of patients with meibomian gland dysfunction-associated dry eye to the treatment group, and the other eye to the control group. Both groups received artificial tears and lid warming; the treatment group received an additional one-time in-office eyelid margin cleaning using Deep Cleaning Device. Non-invasive tear break-up time (NITBUT) and tear meniscus height (TMH) of each eye, and Standard Patient Evaluation for Eye Dryness II (SPEED II) score of each patient were evaluated before and at one week after treatment. RESULTS: Thirty eyes of 15 patients were enrolled. No adverse effects occurred during the treatment. Compared with the baseline values, the SPEED score decreased significantly at one week after treatment (mean±95% confidence interval, 11.00±0.99 vs. 5.67±1.67, P<0.0001), the NITBUT-first in the treatment group increased significantly at one week after treatment ((4.74±1.27) s vs. (7.49±2.22) s, P=0.01). The NITBUT-first was significantly longer in the treatment group ((7.49±2.22) s) than in the control group ((5.17±0.91) s) at one week after treatment (P=0.042). No significant differences were found in other tear film parameters between the two groups. CONCLUSIONS: Eyelid margin cleaning using the novel Deep Cleaning Device is a convenient, effective, and safe treatment for patients with meibomian gland dysfunction-associated dry eye.

Effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty.

OBJECTIVE: To investigate the effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty (FBDALK). METHODS: This is a retrospective analysis of patients who were diagnosed with advanced keratoconus between 2011 and 2014 in our hospital. The base of the cone in all patients did not exceed the central cornea at a 6-mm range. The FBDALK was performed by a same surgeon. All patients had a complete corneal suture removal and the follow-up records were intact. Patients who had graft-bed misalignment or who were complicated with a cataract or glaucoma were excluded. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and Pentacam examination data were recorded at two years postoperatively. The recorded data included the superior-inferior (S-I) and nasal-temporal (N-T) corneal thickness differences in 2, 4, 6, and 8 mm diameter concentric circles with the corneal apex as the center (S-I2 mm, S-I4 mm, S-I6 mm, S-I8 mm, N-T2 mm, N-T4 mm, N-T6 mm, and N-T8 mm), the linear, X-axis, and Y-axis distance between the corneal pupillary center and the cornea apex, total corneal astigmatism at a zone of 3 mm diameter from the corneal apex (TA3 mm), the astigmatic vector values J0 and J45, and the corneal total higher-order aberration for 3 and 6 mm pupil diameters (HOA3 mm and HOA6 mm). Statistical analysis was performed by SPSS 15.0. RESULTS: A total of 47 eyes of 46 patients met the criteria and were included in this study. The mean follow-up time was (28±7) months. The mean UCVA was 0.45±0.23 (logMAR) (MAR: minimum angle of resolution) and the mean BSCVA was 0.19±0.15 (logMAR), which were all significantly positively correlated with postoperative TA3 mm and HOA3 mm. The mean S-I corneal thickness differences were (44.62±37.74) µm, and the mean N-T was (38.57±32.29) µm. S-I2 mm was significantly positively correlated with J0 (r=0.31), J45 (r=0.42), HOA3 mm (r=0.37), and HOA6 mm (r=0.48). S-I4 mm and S-I8 mm were significantly positively correlated with HOA3 mm (r=0.30, r=0.40) and HOA6 mm (r=0.46, r=0.35). The X-axis distance between corneal pupillary center and corneal apex was significantly positively correlated with J45 (r=0.29). CONCLUSIONS: In patients with advanced keratoconus after FBDALK, the unevenly distributed thickness at corneal pupillary area and the misalignment of corneal apex and pupillary center might cause significant regular and irregular astigmatism, which affected the postoperative visual quality.

Assessment of Tear Film and Bulbar Redness by Keratograph 5M in Pediatric Patients After Orthokeratology.

OBJECTIVES: To assess the tear meniscus height (TMH), noninvasive tear breakup time (NITBUT), and bulbar redness in pediatric patients after orthokeratology (OK). METHODS: Pediatric patients who underwent overnight OK between December 2014 and November 2017 were retrospectively investigated. According to the time of wearing, subjects were divided into three groups: 1-week, 1-month, and over 1-year. Age-matched subjects were recruited as a control group. Keratograph 5M was used to assess TMH, NITBUT-first, NITBUT-average, and bulbar redness score. RESULTS: A total of 106 subjects aged from 7 to 15 years were included. Compared with control group, NITBUT-first was significantly lower in 1-week group (P=0.036) and NITBUT-average was significantly lower in 1-month group (P=0.019). Compared with over 1-year group, NITBUT-first was significantly lower in 1-week and 1-month groups (P=0.014, P=0.035, respectively), and NITBUT-average was significantly lower in 1-month group (P=0.022). Bulbar redness score was significantly lower in 1-month group than 1-week group (P=0.004). No significant difference in TMH was found between all groups. Significant correlation was found between NITBUT-first and NITBUT-average in all subjects (R=0.812, P<0.001). No other significant correlations were found between variables included TMH, NITBUT, bulbar redness score, or target correction. CONCLUSIONS: As a noninvasive method, Keratograph 5M was easily to be applied on pediatric patients. The OK lens did not induce significant tear deficiency or bulbar redness, but might affect tear film stability in a short term after wearing.

Assessments of tear meniscus height, tear film thickness, and corneal epithelial thickness after deep anterior lamellar keratoplasty.

OBJECTIVE: To assess the lower tear meniscus height (LTMH), central tear film thickness (CTFT), and central corneal epithelial thickness (CCET) after deep anterior lamellar keratoplasty (DALK). METHODS: This was a retrospective cross-sectional study of 20 patients who had DALK in one eye over a three-month period. LTMH, CTFT, and CCET of the operated eyes and the unoperated fellow eyes were measured using high-definition optical coherence tomography (HD-OCT). Correlations between three OCT assessments and age, time following surgery, graft size, bed size, and the number of residual sutures were analyzed. RESULTS: Compared to patients with keratoconus, patients with other corneal conditions had significantly higher CCET in the fellow eye (P=0.024). For all patients, CCET in the operated eye was significantly negatively correlated with the number of residual sutures (R=-0.579, P=0.008), and was significantly positively correlated with time following surgery (R=0.636, P=0.003). In the fellow eye, a significant positive correlation was found between age and CCET (R=0.551, P=0.012), and a significant negative correlation between age and CTFT (R=-0.491, P=0.028). LTMH was found to be significantly correlated between operated and fellow eyes (R=0.554, P=0.011). There was no significant correlation between LTMH and age, bed/graft size, time following surgery, or residual sutures (all possible correlations, P>0.05). CONCLUSIONS: Patients with keratoconus tend to have a thinner central corneal epithelium. Corneal epithelium keeps regenerating over time after DALK. DALK did not induce a significant change in tear volume compared with the fellow eye. Postoperative tear function might depend on an individual's general condition, rather than on age, gender, bed/graft size, time following surgery, or residual sutures.

Case Report: Acute Hydrops with Descemet Membrane Schisis in Corneal Ectasia after Radial Keratotomy.

SIGNIFICANCE: As patients with previous radial keratotomy (RK) are still occasionally encountered, recognition of the anatomy of post-RK corneas and management of their complications remain relevant. High-definition anterior segment optical coherence tomography (AS-OCT) is a very useful tool to assess these postsurgical corneas. PURPOSE: To describe a case of acute corneal hydrops with Descemet membrane schisis after RK with observation by AS-OCT. CASE REPORT: A 43-year-old woman presented with a 9-day history of sudden vision loss, foreign body sensation, and photophobia in her left eye. She had undergone bilateral RK 25 years ago at her local hospital. Slit-lamp examination revealed marked corneal edema and stromal clefts in the central cornea along with radial surgical scars in her left eye. Pentacam imaging showed the typical pattern of a post-RK cornea with ectasia in her right eye. Multiple dilacerations of collagen lamellae and fluid-filled intrastromal cysts together with epithelial edema were observed in her left eye using AS-OCT. A Descemet membrane detachment with schisis was also shown by AS-OCT. After 5 months of medication with topical 0.1% fluorometholone eye drops four times daily together with 3% ofloxacin eye ointment once daily, the corneal edema, Descemet membrane detachment, and Descemet membrane schisis had completely resolved resulting in pan-stromal scarring. CONCLUSIONS: This report describes acute corneal hydrops with Descemet membrane schisis after RK imaged using high-definition AS-OCT. The acute hydrops was possibly caused by corneal ectasia or underlying keratoconus, which was aggravated by RK. High-definition AS-OCT is a useful tool to demonstrate the details of different corneal layers and to observe the resolving process of acute hydrops. Topical medications consisting of antibiotic, lubrication, and corticosteroid can be used to treat the acute event effectively.

Satisfactory clinical outcome following delayed repositioning of a traumatic post-LASIK flap with dislocation and shrinkage managed by irrigation, stretching, and debridement.

OBJECTIVE: To report surgical management and favorable outcome in a case with delayed repair of traumatic laser in situ keratomileusis (LASIK) flap dislocation with shrinkage and folds. METHODS: A 30-year-old man with a five-year history of bilateral LASIK experienced blunt trauma to his right eye followed by decreased vision for 5 weeks. The surgical management included initially softening the flap by irrigation with balanced salt solution (BSS). The shrinkage folds were carefully and gently stretched by scraping with a 26-gauge cannula accompanied by BSS irrigation. All of the epithelial ingrowth on the flap inner surface and on the bed was thoroughly debrided by scraping and irrigation. After the flap was repositioned to match its original margin, a soft bandage contact lens was placed. RESULTS: At his initial visit, slit-lamp microscopy and optical coherence tomography (OCT) showed shrinkage of the LASIK flap with an elevated margin approximately 3 mm above the original position. The flap covered half of the pupil and had multiple horizontal folds. Two months after surgery, the flap remained well positioned with only faint streaks in the anterior stroma. The uncorrected visual acuity of the right eye was 20/20 with a manifest refraction of Plano. CONCLUSIONS: For delayed repair of traumatically dislocated LASIK flaps, sufficient softening by BSS, stretching the shrinkage folds, and thorough debridement of ingrowth epithelium enable resetting the flap and provide satisfactory results.

Descemet's Membrane Detachment with Schisis Induced by Phacoemulsification.

PURPOSE: To describe a case of Descemet's membrane detachment and schisis (Descemet's membrane separated into multiple layers) with confirmation by high-definition anterior segment optical coherence tomography (AS-OCT) after phacoemulsification and intraocular lens implantation. CASE REPORT: A 72-year-old woman presented with persistent corneal edema after phacoemulsification. She was diagnosed with herpes simplex keratitis and had been unsuccessfully treated for 60 days in her local hospital. Slit-lamp examination revealed moderate conjunctival injection, disciform-like stromal edema, and diffuse superficial punctate epithelial erosions. Descemet's membrane schisis and detachment with an interlayer tear were verified by high-definition AS-OCT. After 2 weeks of medication with topical 0.1% fluorometholone eye drops four times daily together with 3% ofloxacin eye ointment twice daily, Descemet's membrane was reattached with complete resolution of conjunctival injection, corneal edema, and epithelial erosions. CONCLUSIONS: This is a report of Descemet's membrane schisis in vivo that is documented and confirmed by high-definition AS-OCT. Descemet's membrane detachment and schisis caused by phacoemulsification can be misdiagnosed as herpetic keratitis due to stromal edema and epithelial erosion. Topical steroid and lubrication may help reattach Descemet's membrane to its original position.

Treatment of corneal perforation with lenticules from small incision lenticule extraction surgery: a preliminary study of 6 patients.

PURPOSE: To evaluate the use of lenticules extracted using small incision lenticule extraction (SMILE) surgery as a surgical alternative for wound closure in corneal perforation. METHODS: Corneal lenticules obtained through SMILE surgery with central thickness >100 µm were fixed over corneal perforation sites using 10-0 nylon interrupted stitches. Patients were monitored for a minimum of 1 year and were assessed using slit-lamp microscopy, fluorescein, digital tonometry, and best spectacle-corrected visual acuity (BSCVA) measurements. Postoperative complications throughout the study period were recorded. RESULTS: Corneal perforations were successfully sealed in all 6 patients; 3 patients (50%) exhibited improved postoperative BSCVA. Between 3 and 4 weeks after the operation, part of the lenticules became incorporated into the corneal stroma and complete reepithelialization was achieved. During the follow-up period of 12 months, no evidence of infection, relapse, or perforation was detected in any patient. CONCLUSIONS: These preliminary findings suggest that the use of corneal lenticules may be a safe and effective surgical alternative for corneal perforation closure, with potential clinical application as relatively simple and inexpensive temporary measures to improve the condition of the cornea for further definitive interventions.

Small-incision lenticule extraction for myopia: results of a 12-month prospective study.

PURPOSE: To analyze the safety, efficacy, stability, and predictability of small-incision lenticule extraction to correct myopia. METHODS: Patients were evaluated preoperatively and then at 1 day, at 2 weeks, and at 1, 3, 6, and 12 months postoperatively. Safety, efficacy, stability, predictability, and surgical complications were assessed. Changes in higher-order aberrations, intraocular pressure, central corneal thickness, dry eye signs, contrast sensitivity, and subjective glare symptoms were evaluated. RESULTS: All 52 myopic patients in the initial treatment group completed the final 12-month follow-up. At 12 months, 90.4% of eyes were within ±0.5 diopters (D) of the intended refractive target. The mean (±SD) change in manifest refraction from 1 day to 12 months was -0.06 (±0.37) D. The uncorrected visual acuity was better than or equal to 20/20 in 83% of eyes; 98% of eyes had a best-corrected visual acuity of better than or equal to 20/20. No eye lost two or more Snellen lines. There was an increase in higher-order aberrations, spherical aberration, and coma postoperatively. No significant increase in intraocular pressure occurred. The tear breakup time decreased significantly after surgery and did not return to preoperative levels within 12 months. The log contrast sensitivity value with glare of 6.3, 4.0, 2.5, and 1.6 degrees of visual angle at 1 month was statistically significantly reduced but recovered to preoperative levels after 3 months. Twenty-seven percent of patients complained of mild or moderate glare postoperatively, but the symptoms disappeared during the 12-month follow-up period with no influence on daily life. No vision-threatening complications occurred. CONCLUSION: Small-incision lenticule extraction is a promising corneal refractive procedure to correct myopia.

Comparison of the visual results after SMILE and femtosecond laser-assisted LASIK for myopia.

PURPOSE: To perform a comparative clinical analysis of the safety, efficacy, and predictability of two surgical procedures (ie, small incision lenticule extraction [SMILE] and femtosecond laser-assisted LASIK [FS-LASIK]) to correct myopia. METHODS: Sixty eyes of 31 patients with a mean spherical equivalent of -5.13 ± 1.75 diopters underwent myopia correction with the SMILE procedure. Fifty-one eyes of 27 patients with a mean spherical equivalent of -5.58 ± 2.41 diopters were treated with the FS-LASIK procedure. Postoperative uncorrected and corrected distance visual acuity, manifest refraction, and higher-order aberrations were analyzed statistically at 1 and 3 months postoperatively. RESULTS: No statistically significant differences were found at 1 and 3 months in parameters that included the percentage of eyes with an uncorrected distance visual acuity of 20/20 or better (P = .556, .920) and mean spherical equivalent refraction (P = .055, .335). At 1 month, 4 SMILE-treated eyes and 1 FS-LASIK-treated eye lost one or more line of visual acuity (P = .214, chi-square test). At 3 months, 2 SMILE-treated eyes lost one or more line of visual acuity, whereas all FS-LASIK-treated eyes had an unchanged or corrected distance visual acuity. Higher-order aberrations and spherical aberration were significantly lower in the SMILE group than the FS-LASIK group at 1 (P = .007, .000) and 3 (P = .006, .000) months of follow-up. CONCLUSIONS: SMILE and FS-LASIK are safe, effective, and predictable surgical procedures to treat myopia. SMILE has a lower induction rate of higher-order aberrations and spherical aberration than the FS-LASIK procedure.

Dry eye after small incision lenticule extraction and LASIK for myopia.

PURPOSE: To compare the effects of small incision lenticule extraction (SMILE) and LASIK with either femtosecond laser or mechanical microkeratome on dry eye. METHODS: A total of 176 patients (338 eyes) who underwent refractive procedures for myopia were observed in this nonrandomized, interventional, prospective study. To evaluate dry eye, the Schirmer secretion test without anesthesia, tear break-up time, and the McMonnies questionnaire were used preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: In all groups, there was no significant decrease in the results from the Schirmer secretion test without anesthesia after surgery. The value in the LASIK group was significantly lower than any other group at 3 and 6 months postoperatively. In all groups, the tear break-up time decreased significantly after surgery and did not return to preoperative levels within 6 months; the SMILE group time lasted significantly longer than the LASIK group at 1 month. The McMonnies score increased significantly in all groups after surgery. The preoperative levels returned within 6 months in all groups except the LASIK group. The mean McMonnies score in the SMILE group was better than other groups. CONCLUSIONS: Dry eye after corneal refractive surgery usually occurs transiently. The SMILE procedure had better dry eye parameters and relatively fewer subjective symptoms than LASIK.

Changes of tear film and tear secretion after phacoemulsification in diabetic patients.

OBJECTIVE: To evaluate tear film stability and tear secretion in patients with diabetes after phacoemulsification. METHODS: Twenty-five diabetic cataract patients and 20 age-matched non-diabetic cataract patients as control underwent phacoemulsification. Tear film break-up time (TFBUT), Schirmer I test (SIT), corneal fluorescein staining, and dry eye symptoms were measured pre- and postoperatively. RESULTS: Diabetics had a decreased preoperative TFBUT and SIT. TFBUT was reduced on Day 1 and recovered on Day 180 postoperatively in both groups. SIT was increased after phacoemulsification, but returned to preoperative levels by Day 180 in non-diabetics, whereas it was lower than preoperative level in diabetics. Positive corneal fluorescein staining was elevated in both groups, and returned to preoperative levels only in controls. Dry eye symptoms were similar to fluorescein staining in both groups. CONCLUSION: Tear secretion was reduced in diabetic cataract patients after phacoemulsification, which worsened dry eye symptoms and predisposed those patients to ocular damage.

Sensory exotropia subsequent to senile cataract.

To evaluate the phacoemulsification and intraocular lens implantation in patients with sensory exotropia subsequent to senile cataract. The authors prospectively studied the role of phacoemulsification and intraocular lens implantation on 25 patients by observing visual acuity, ocular alignment, binocular vision and diplopia pre-, 1 month post- and 3 months post-operation. The patients underwent follow-up for three months. Postoperatively, one patient had a corrected visual acuity of 20/50, and 24 patients had 20/40 or better. The ocular alignment, binocular vision and diplopia were resolved spontaneously. Phacoemulsification and intraocular lens implantation performed together is effective on sensory exotropia subsequent to senile cataract.

[Anterior corneal topographic changes after scleral buckling surgery].

OBJECTIVE: To investigate corneal refractive changes after scleral buckling surgery. METHODS: In a prospective self-controlled clinical study, we investigated the changes of refractive power, astigmatic power, astigmatic axis, and irregular astigmatic power of anterior corneal surface following scleral buckling surgery for retinal detachment in 30 patients (30 eyes). The corneal shapes were detected by Orbscan II topography at 1 day before surgery, and 1 week, 1 month, and 3 months after surgery. The effects of some surgical factors on the anterior corneal refractive changes were analyzed. RESULTS: After surgery, refractive power on corneal anterior surface decreased significantly in peripheral zone at 1 week (P < 0.01). Astigmatic power increased obviously in central zone. The direction of astigmatic axis matched the direction of the buckle, and changed obviously in central zone after 1 week (P < 0.05). Irregular astigmatic power did not change significantly. There was a significant correlation between the encircling length/the buckle width and the refractive changes of corneal anterior surface. CONCLUSION: Refractive changes of corneal anterior surface following scleral buckling surgery was mainly temporary. Changes in the shape of corneal should be minimized to ensure a favorable postoperative visual acuity.