Pupil-size alterations induced by photodisruption during femtosecond laser-assisted cataract surgery.

PURPOSE: To measure miosis after femtosecond laser pretreatment of cataract surgery and determine correlative factors. SETTING: Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, and Catholic University of Korea, Seoul, South Korea. DESIGN: Cross-sectional study. METHODS: Images extracted from surgical videos of femtosecond laser pretreatment and phacoemulsification were used to measure the pupil area. Quantitative analysis of pupil constriction was performed by comparing consecutive images obtained at the initiation of each procedure. Potential factors related to pupil constriction were examined, including laser parameters and anatomic measurements. RESULTS: The study enrolled 56 eyes. The mean pupil area decreased by 29.7% during the time it took to shift between procedures (shifting time). The total laser treatment duration was highly correlated with the reduction in the pupil area (r = -0.433, P = .001). The amount of intraoperative miosis was significantly correlated with the duration of lens fragmentation by the femtosecond laser (r = -0.416, P = .001) and of primary incision creation (r = -0.289, P = .031). Pupil constriction was correlated with patient age (r = -0.398, P = .002) and the laser capsulotomy-pupil margin distance (r = 0.395, P = .003), but not with suction-on time (r = -0.012, P = .930) or shifting time (r = -0.091, P = .506). CONCLUSIONS: The pupil area decreased significantly after femtosecond laser pretreatment of cataract surgery. Intraoperative miosis was most significantly correlated with laser pretreatment duration and patient age. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Nd:YAG Capsulotomy after Phacoemulsification in Vitrectomized Eyes: Effects of Pars Plana Vitrectomy on Posterior Capsule Opacification.

To compare the progression of posterior capsule opacification (PCO) in patients who required Nd:YAG laser capsulotomy following either combined cataract surgery with pars plana vitrectomy (PPV; C-CV), sequential cataract surgery after PPV (S-CV), or cataract surgery alone (CA). The medical records of 321 patients (408 eyes) who underwent Nd:YAG capsulotomy were retrospectively evaluated. The CA group had a significantly longer time interval from cataract surgery to capsulotomy than that of both the CV group (P = 0.006) and the S-CV (P = 0.013) and C-CV (P = 0.042) subgroups when age-matched comparisons were used. CV patients who implanted a hydrophobic acrylic IOL had shorter time intervals than those of CA patients (P = 0.028). CV patients had larger hazard of earlier capsulotomy than CA patients (hazard ratio (HR) = 1.337; 95% confidence interval (CI) 1.100-1.625; P = 0.004). C-CV and S-CV patients both had larger hazard than CA patients in earlier capsulotomy (HR = 1.304; 95% CI = 1.007-1.688; P = 0.044, HR = 1.361; 95% CI = 1.084-1.709; P = 0.008, resp.). PCO progresses more rapidly in patients undergoing combined or sequential cataract surgery and PPV than in patients undergoing CA.

Experimental lens capsular bag model for posterior capsule opacification.

An in vitro culture model enabling posterior capsule opacification (PCO) to be investigated was developed and established by using low-melting-point (LMP)-agarose gel to support the capsular bag. After removal of the cornea from rodent and porcine eyeballs, the lens zonules were dissected. Whole lens explants were embedded into 2 % (37 °C) LMP-agarose gel solution. As performed routinely in cataract surgery, capsulotomy and lens fiber removal were carried out in the solidified LMP-agarose gel as sham cataract surgery. The LMP-agarose-gel-supported capsular bag/lens epithelial cell (CB-LEC) complexes were maintained in Dulbecco's modified Eagle medium supplemented with 10 % fetal bovine serum in an anterior face-down position. The proliferation and migration of LECs into the posterior capsule were observed every 12 h by phase-contrast microscopy. Epithelial cells were observed at the central portion of the CB-LEC complexes after 56.57 ± 16.56 h (n = 7) and 106 ± 14.03 h (n = 6) of culture, for rodent and porcine lenses, respectively. The solidified gel allowed clear microscopic observations and whole-mount immunostaining evaluations of the whole area of the capsular bag. Histological examinations revealed the proliferation, migration, and transdifferentiation of LECs related to posterior capsule opacification. This new in vitro culture model provides experimental benefits by maintaining the natural contour of the capsule without implants inside or outside of the capsule. In addition, this model system allows pharmacological and histological evaluations of the cultured CB-LEC complexes without additional manipulations.

Phialemonium obovatum keratitis after penetration injury of the cornea.

Phialemonium keratitis is a very rare case and we encountered a case of keratitis caused by Phialemonium obovatum (P. obovatum) after penetrating injury to the cornea. This is the first case report in the existing literature. A 54-year-old male was referred to us after a penetration injury, and prompt primary closure was performed. Two weeks after surgery, an epithelial defect and stromal melting were observed near the laceration site. P. obovatum was identified, and then identified again on repeated cultures. Subsequently, Natacin was administered every two hours. Amniotic membrane transplantation was performed due to a persistent epithelial defect and impending corneal perforation. Three weeks after amniotic membrane transplantation, the epithelial defect had completely healed, but the cornea had turned opaque. Six months after amniotic membrane transplantation, visual acuity was light perception only, and corneal thinning and diffuse corneal opacification remained opaque. Six months after amniotic membrane transplantation, visual acuity was light perception only, and corneal thinning and diffuse corneal opacification remained.

Tectonic deep anterior lamellar keratoplasty in impending corneal perforation using cryopreserved cornea.

We report a case of tectonic corneal transplantation for impending corneal perforation to preserve anatomic integrity using cryopreserved donor tissue. An 82-year-old woman exhibiting impending corneal perforation suffered from moderate ocular pain in the left eye for one week. After abnormal tissues around the impending perforation area were carefully peeled away using a Crescent blade and Vannas scissors, the patient received tectonic deep anterior lamellar keratoplasty using a cryopreserved cornea stored in Optisol GS® solution at -70℃ for four weeks. At six months after surgery, the cornea remained transparent and restored the normal corneal thickness. There were no complications such as corneal haze or scars, graft rejection, recurrent corneal ulcer, and postoperative rise of intraocular pressure. Cryopreserved donor lamellar tissue is an effective substitute in emergency tectonic lamellar keratoplasty, such as impending corneal perforation and severe necrotic corneal keratitis.

Opacification of the optic of an Akreos Adapt intraocular lens.

A 60-year-old diabetic patient transferred to our retina clinic for a regular follow-up for diabetic retinopathy. He had uneventful cataract surgery at the time of pars plana vitrectomy in the right eye due to diabetic retinopathy at a private ophthalmologic hospital. Six months after the surgery, neovascular glaucoma with hyphema developed in the right eye and an Ahmed valve was implanted at our hospital. Ten months after cataract surgery, we found opacification of the intraocular lens (IOL) which was causing significant visual disturbance. At the time, the best corrected visual acuity (BCVA) in the right eye was hand motion. The IOL was explanted 45 months after the operation. Five months after explantation, the BCVA was 0.06. Unfortunately, pathologic analysis was not performed. Patient-related factors such as an anterior chamber reaction caused by hyphema might have been responsible for the opacification. To our knowledge, there are no previous reports of opacification of the Akreos Adapt IOL.

A new method of harvesting descemet membrane-endothelium complex approaching from the suprachoroidal space for descemet membrane endothelial keratoplasty: an experimental animal study.

PURPOSE: To report the study in rabbits of a new method of harvesting Descemet membrane-endothelium complex approaching from the suprachoroidal space for Descemet membrane endothelial keratoplasty. MATERIALS AND METHODS: Twenty-four eyes of 12 rabbits were used for microscopic analysis, whereas 24 eyes of 12 cats were used for gross photographic analysis. The enucleated eyeballs of the rabbits and cats were incised 360 degrees circumferentially along the equator. Manual separation was performed between the sclera and the underlying connective tissue approaching from the suprachoroidal space in the direction of the central cornea step by step in spiral pattern. After complete separation of the stroma from the Descemet membrane-endothelium-iris complex, it was excised from the globe at the outside of the iris root. The synthetic carrier (soft contact lens) was laid down on the punch block, and then the excised complex was brought over the carrier with the endothelium-iris side upward. Two steps of down punch for the designed graft size were performed. The harvested complexes were processed for vital stains and were evaluated through photography taken under a light microscope and gross close-up. The endothelial cell loss rates were calculated by a computer software. RESULTS: The overall harvest success rate was 89.6% (43 of 48). The overall structural cell loss rate was 1.83 +/- 2.34 by microscopic analysis and 4.68% +/- 1.68% by gross photographic analysis. CONCLUSION: The new method of en bloc harvesting Descemet membrane-endothelium complex approaching from the suprachoroidal space could provide minimal damage to the endothelium during harvesting, and it can be carried and passed through an injector.

A case of recurrent Schneiderian papilloma of the lacrimal sac invading the nasal cavity.

A 44-year-old man presented with a history of chronic epiphora, discharge from the right eye, and a palpable mass in the medial canthal area. Irrigation of the lacrimal system revealed bloody discharge. Orbital magnetic resonance imaging (MRI) showed a well-defined heterogeneous enhanced mass filling the lacrimal sac and upper nasolacrimal duct (NLD). A wide excision and surgical biopsy were performed. Histopathology showed the tumor to be an exophytic Schneiderian papilloma with moderate to severe dysplasia. Three months later, the mass was found to be invading the nasal cavity through the NLD. Endoscopic histopathological evaluation confirmed that it was identical to the originally identified papilloma.

A case of radiation retinopathy of left eye after radiation therapy of right brain metastasis.

A 37-year-old female, who had received modified radical mastectomy for cancer of her right breast, presented with decreased visual acuity in the left eye after radiation therapy for the management of the metastasis to her right brain 14 months ago. After ocular examination, we diagnosed her as radiation retinopathy. At the time of the first visit, the corrected best visual acuity was 0.4 in the left eye, and fundus examination revealed cotton wool spots and cystoid macular edema (CME). The findings in the right eye were normal except for cotton wool spots in the superior major arch. Fluorescein angiography (FA) showed marked telangiectasia and microaneurysms in her left eye but tiny microaneurysms in her right eye. Subsequent optical coherent tomography (OCT) showed CME. We injected intravitreal triamcinolone acetonide (TA). Two weeks after treatment, the visual acuity was improved to 0.6 and the retinal thickness was decreased. Three months later, the visual acuity in the left eye was dropped to 0.3 due to the recurrence of CME, so we injected intravitreal TA again. Five months later, visual acuity was improved to 0.5 and OCT revealed the improvement of CME. The incidence of radiation retinopathy is higher in the side nearer to radiation, but careful radiation blocking is also required on the opposite side of irradiation site considering the possibility of radiation retinopathy and careful observation is required on both sides of the eyes when performing fundus examination.

Relationship between topographic patterns and corneal astigmatism in Korean adults.

The anterior corneal surface is one of the most important elements determining the optical performance of the eye. Corneal topography provides quantitative data about the anterior corneal surface. We studied the corneal topography of 200 normal corneas in 110 adult subjects. All of the eyes were examined using the Corneal Analysis System (EyeSys 2000, Houston, Texas). The topographic maps were grouped into the following patterns: round, oval, symmetric bow tie, asymmetric bow tie, and irregular. The symmetric and asymmetric bow tie patterns were the most common topographic pattern (33.0%, and 32.5%, respectively) in our study population, followed by oval (14.5%), irregular (12.5%), and round (7.5%) patterns. The mean corneal astigmatism calculated from videokeratographic data was 0.32 D for round, 0.63 D for oval, 1.16 D for symmetric bow tie, 1.21 D for asymmetric bow tie, and 0.43 D for irregular patterns. There were significant differences among the corneal astigmatic values in the topographic patterns (p < 0.01, Gabriel post hoc test). The distributions of symmetric and asymmetric bow tie patterns were skewed toward greater amounts of corneal astigmatism. In conclusion, the results of this study demonstrate the relationship between topographic patterns and corneal astigmatism and should provide one possible normal standard for corneal topography in Korean adults.