Efficacy of a 0.05% cyclosporine a topical nanoemulsion in dry eyes with obstructive meibomian gland dysfunction.

PURPOSE: To evaluate the efficacy of topical cyclosporin A (CsA) in obstructive meibomian gland dysfunction (MGD). STUDY DESIGN: Prospective, randomized, single-blinded, controlled clinical study. METHODS: Fifty-one patients with obstructive MGD were randomly assigned to one of two groups. The CsA group received 0.05% CsA topical nanoemulsion (Cyporin N®; Taejoon Pharm) twice daily, 0.15% hyaluronic acid eye drops four times daily, and 10 min of warm compress placement on the eyelids twice daily. In the control group, 0.15% hyaluronic acid eye drops were administered six times daily and warm compress was conducted twice daily for 10 min. The ocular surface disease index (OSDI), Schirmer 1 test, tear film break-up time (TBUT), corneal and conjunctival surface staining using fluorescein, eyelid debris and eyelid redness/swelling, upper and lower meibomian gland (MG) secretion scores, and upper and lower MG loss were assessed at the three-month visits. RESULTS: There were no significant differences in observed parameters between the two groups at baseline. At the three-month evaluation, the CsA group showed significantly better improvements in the TBUT, eyelid debris, eyelid redness/swelling, and lower MG secretion score (P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). There was no improvement in upper or lower MG loss in either group. CONCLUSION: Treatment with 0.05% CsA nanoemulsion in combination with warm compress twice daily alleviated signs of dry eyes with obstructive MGD. However, although MG secretion was improved, glandular loss could not be restored with three months of CsA nanoemulsion treatment.

Eyelid squinting improves near vision in against-the-rule and distance vision in with-the-rule astigmatism in pseudophakic eyes: an eye model experimental study.

BACKGROUND: To elucidate whether eyelid squinting improves near and distance vision in against-the-rule (ATR) and with-the-rule (WTR) simple myopic astigmatism in pseudophakic eyes. METHODS: A refraction-model eye was mounted on a wavefront analyzer. The eyelid fissure was simulated using a slit placed horizontally in front of the model eye. Four different refractive statuses [- 1.50 diopters (D) and - 3.00 D of both WTR and ATR simple myopic astigmatism] were set using cylindrical lenses. For each refractive status (emmetropia, - 1.50 D WTR, - 1.50 D ATR, - 3.00 D WTR, and - 3.00 D ATR astigmatism), wavefront aberrations were measured, both with and without the slit, 40 times each. RESULTS: The 2 mm horizontal slit caused a hyperopic focus shift (+ 6.69 µm) in - 1.50 D WTR astigmatism, whereas, in - 1.50 D ATR astigmatism, it caused a myopic focus shift (- 2.01 µm). The astigmatism was decreased in the ATR astigmatism groups and increased in the emmetropia and WTR astigmatism groups, respectively. Total aberrations were decreased in the emmetropia and WTR astigmatism groups and increased in the ATR astigmatism groups. When the reference plane was set to the near plane, total aberrations were decreased in the ATR astigmatism groups. CONCLUSION: As the horizontal slit was placed in front of the model eye, the focus moves nearer in ATR astigmatism and farther in WTR astigmatism. These effects of eyelid cause improvement of near vision of pseudophakic eyes with ATR astigmatism.

Glistening Formation on a Single-Piece Prehydrated Hydrophobic Acrylic Intraocular Lens in a Diabetic Patient.

PURPOSE: To report a case of intraocular lens (IOL) glistening after uneventful cataract surgery and in-the-bag implantation of an enVista MX60 IOL (Bausch & Lomb, Rochester, NY) in a patient with uncontrolled diabetes mellitus. METHODS: Case report. RESULTS: A 76-year-old woman with non-insulin-dependent diabetes mellitus underwent uncomplicated phacoemulsification with in-the-bag implantation of an enVista MX60 IOL. After 6 months, glistening formation within the IOL optic was observed. In the fellow pseudophakic eye, an acrylic hydrophilic Akreos Adapt AO IOL (Bausch & Lomb) was implanted without complications. CONCLUSIONS: IOL glistening can develop with the enVista MX60 IOL, even after uneventful cataract surgeries in certain situations (eg, uncontrolled diabetes mellitus). Increased vascular permeability due to uncontrolled diabetes mellitus might have been responsible for the postoperative IOL glistening formation. [J Refract Surg. 2016;32(10):710-712.].

Toric Intraocular Lens Calculations Using Ratio of Anterior to Posterior Corneal Cylinder Power.

PURPOSE: To evaluate the accuracy of toric intraocular lens (IOL) calculation using estimated total corneal astigmatism based on the anterior-to-posterior corneal cylinder power ratio according to the axis orientation of anterior corneal astigmatism. DESIGN: Retrospective cross-sectional study. METHODS: Nine hundred twenty-eight eyes of 928 reference subjects and 20 cataract patients (20 eyes) implanted with a toric IOL were enrolled. Linear regression analysis parameters (ß0 and ß1) of relationship between the simulated keratometry cylinder (CylSimK) and posterior corneal cylinder power of reference subjects were used to calculate the estimated posterior corneal astigmatism (-[ß1 × CylSimK + ß0] @ 90). When regression analysis was not significant, estimated posterior corneal astigmatism was defined as the negative value of the mean posterior corneal cylinder power @ 90. Estimated total corneal astigmatism was defined as the vectorial sum of anterior corneal astigmatism and estimated posterior corneal astigmatism. Residual astigmatism error, predicted using SimK, was compared with that predicted using estimated total corneal astigmatism. RESULTS: Estimated posterior corneal astigmatism was determined to be -(0.15 × CylSimK + 0.22) @ 90 in eyes with with-the-rule astigmatism, -(0.05 × CylSimK + 0.27) @ 90 in oblique astigmatism, and -0.27 @ 90 in against-the-rule astigmatism. The median magnitude of the predicted residual astigmatism error calculated using estimated total corneal astigmatism (0.30 cylinder diopters) was significantly smaller than that calculated with SimK (0.50 cylinder diopters). CONCLUSIONS: Toric IOL calculations using estimated total corneal astigmatism based on the anterior-to-posterior corneal cylinder power ratio provided a more appropriate toric IOL cylinder power than calculations using SimK astigmatism.

A simple method to shorten the unfolding time of prehydrated hydrophobic intraocular lens.

OBJECTIVE: To evaluate the effect of warm ophthalmic viscosurgical devices (OVDs) on the unfolding time of prehydrated hydrophobic acrylic intraocular lenses (IOLs). DESIGN: Experimental study and human trial. PARTICIPANTS: Three foldable hydrophobic acrylic IOLs (enVista MX60, AcrySof SN60AT, and Tecnis 1 ZCB00). METHODS: The unfolding times of 3 kinds of IOLs were measured according to temperature from 26°C to 32°C in a transparent container filled with a mixture of OVDs and balanced salt solution. The unfolding time of each IOL was measured 4 times for each temperature. Unfolding time was defined as the time required for the folded IOL to recover ≥ 90% of its overall optic diameter before folding. In human trials, the unfolding time of the MX60 in a capsular bag filled with 30°C OVDs was compared with that filled with room temperature OVDs for 4 cases in each group. RESULTS: The unfolding time of the MX60 (215 ± 25 seconds) was significantly longer than that of the SN60AT (28 ± 7 seconds) and the ZCB00 (29 ± 7 seconds) at 26°C (p = 0.013). However, there were no differences in the unfolding time of 3 IOLs at 32°C. In human trials, the unfolding time of the MX60 was shorter in a capsular bag filled with 30°C OVDs (32 ± 13 seconds) than if filled with OVDs kept at room temperature (127 ± 27 seconds; p = 0.029). CONCLUSIONS: When fast and complete unfolding characteristics are needed, filling the anterior chamber and capsular bag with OVDs warmed to 30°C before IOL implantation is recommended.

Stratus OCT image analysis with spectral-domain OCT (Topcon 3D OCT Viewer).

AIMS: To assess the accuracy of the Topcon 3D OCT Viewer in analysing Stratus OCT data. METHODS: Randomly selected fast macular thickness map protocol optical coherence tomography (OCT) raw data were exported from the Stratus OCT database and imported into and analysed with the Topcon 3D OCT Viewer. The segmentation error (SE) rates and scores were compared between the two programs. Differences in the retinal thickness between the two programs were measured in both the SE (-) group and the SE (+) group. RESULTS: 356 eyes were analysed. The SE rate and mean SE score were significantly lower with the Topcon 3D OCT Viewer than with Stratus OCT ((30.9% (110/356) vs 38.2% (136/356), p=0.011; 0.33 ± 0.59 vs 0.48 ± 0.96, p=0.003), respectively). In the SE (-) group, the mean of the differences between the two programs was -2.79 µm (p<0.001) in the central 1 mm zone of the nine ETDRS areas and 1.49 µm (p=0.152) for the automated centre point thickness. CONCLUSIONS: The Topcon 3D OCT Viewer analysed Stratus OCT data very well and displayed better segmentation performance. The Topcon 3D OCT Viewer program can be used interchangeably for the measurement of macular thickness, but careful interpretation by a clinician is needed.

Risk factors for the development of transient hypotony after silicone oil removal.

PURPOSE: The purpose of the study was to determine the incidence, duration, and risk factors for postoperative transient hypotony after pars plana silicone oil removal. METHODS: This was a retrospective, noncomparative, interventional case series. The records of 89 eyes of 89 patients who underwent pars plana silicone oil removal with at least 6 months of follow-up were reviewed. Postoperative transient hypotony was defined as an intraocular pressure of <6 mmHg occurring within 1 week of surgery, which recovered within 4 months after surgery. RESULTS: Transient hypotony occurred in 35 of 89 eyes (39.3%). Thirty-three eyes recovered within 1 week after surgery. The logistic regression model, including age, number of previous pars plana vitrectomies, number of intraoperative endolaser applications, extent of remaining posterior proliferative vitreoretinopathy and the degree of proliferative vitreoretinopathy removal, number of preoperative antiglaucoma ophthalmic solutions, duration of postoperative anterior chamber inflammation, axial length, preoperative intraocular pressure, and duration of oil tamponade, showed that only axial length was significantly associated with the development of postoperative transient hypotony (odds ratio = 1.385, P = 0.023). CONCLUSION: Transient hypotony frequently developed after silicone oil removal, and most cases recovered within 1 week postoperatively. Patients with a long axial length had increased odds of developing transient hypotony after silicone oil removal.

A case of acquired Brown syndrome after surgical repair of a medial orbital wall fracture.

A case of acquired Brown syndrome caused by surgical repair of medial orbital wall fracture is reported in the present paper. A 23-year-old man presented at the hospital with right periorbital trauma. Although the patient did not complain of any diplopia, the imaging study revealed a blow-out fracture of the medial orbital wall. Surgical repair with a calvarial bone autograft was performed at the department of plastic surgery. The patient was referred to the ophthalmologic department due to diplopia that newly developed after surgery. The prism cover test at distant fixation showed hypotropia of the right eye, which was 4 prism diopters (PD) in primary gaze, 20 PD in left gaze, while orthophoric in right gaze. Eye movement of the right eye was markedly limited on elevation in adduction with normal elevation in abduction with intorsion in the right eye present. Forced duction test of the right eye showed restricted elevation in adduction. Computerized tomography scan of the orbits showed the right superior oblique muscle was entrapped between the autografted bone fragment and posterior margin of the fracture. When repairing medial orbital wall fracture that causes Brown syndrome, surgeons should always be careful of entrapment of the superior oblique muscle if the implant is inserted without identifying the superior and posterior margin of the orbital fracture site.