Chikako Suto

Adjusting intraocular lens power for sulcus fixation

Purpose: To determine the appropriate correction of predicted intraocular lens (IOL) power for sulcus fixation and to prospectively assess the validity of the obtained correction value in patients having sulcus fixation. Setting: Department of Ophthalmology, Saiseikai Kurihashi Hospital, Saitama, Japan. Methods: The postoperative refraction, virtual in‐the‐bag IOL power for the same postoperative refraction, predicted refraction with an increase in in‐the‐bag IOL power by 0.50 to 2.00 diopters (D), and effective lens position (ELP) in 30 eyes with a normal axial length after sulcus fixation were retrospectively evaluated. The results were confirmed prospectively in 16 other eyes requiring sulcus fixation. Results: A significant myopic shift (mean 0.78 D ± 0.47 [SD]) from the predicted refraction occurred after sulcus fixation (P<.0001). The mean virtual IOL power was 1.11 ± 0.67 D higher than that of the actual sulcus‐fixated IOL. The difference between the predicted refraction and the refraction after sulcus fixation was less when the difference in IOL power was 1.00 D. The ELP of the IOLs was 0.75 mm shorter using A‐mode measurement and 0.62 mm shorter using back calculation from the theoretical formula with sulcus fixation than with in‐the‐bag fixation. In the prospective study, there was a small refractive error (mean −0.06 ± 0.19 D) when the planned IOL power was reduced by 1.00 D for sulcus fixation. Conclusion: For sulcus fixation in eyes with a normal axial length, the IOL power should be 1.00 D less than the power for in‐the‐bag fixation.

Conjunctival sac bacterial flora isolated prior to cataract surgery

Objective To determine the trends of conjunctival sac bacterial flora isolated from patients prior to cataract surgery. Subjects and methods The study comprised 579 patients (579 eyes) who underwent cataract surgery. Specimens were collected by lightly rubbing the inferior palpebral conjunctival sac with a sterile cotton swab 2 weeks before surgery, and then cultured for isolation of bacteria and antimicrobial sensitivity testing. The bacterial isolates and percentage of drug-resistant isolates were compared among age groups and according to whether or not patients had diabetes mellitus, hyperlipidemia, dialysis therapy, oral steroid use, dry eye syndrome, or allergic conjunctivitis. Results The bacterial isolation rate was 39.2%. There were 191 strains of Gram-positive cocci, accounting for the majority of all isolates (67.0%), among which methicillin-sensitive coagulase-negative staphylococci was the most frequent (127 strains, 44.5%), followed by methicillin-resistant coagulase-negative staphylococci (37 strains, 12.7%). All 76 Gram-positive bacillary isolates (26.7%) were from the genus Corynebacterium. Among the 16 Gram-negative bacillary isolates (5.9%), the most frequent was Escherichia coli (1.0%). The bacterial isolation rate was higher in patients >60 years old, and was lower in patients with dry eye syndrome, patients under topical treatment for other ocular disorders, and patients with hyperlipidemia. There was no significant difference in bacterial isolation rate with respect to the presence/absence of diabetes mellitus, steroid therapy, dialysis, or a history of allergic conjunctivitis. Methicillin-resistant coagulase-negative staphylococci showed a significantly higher detection rate in diabetic patients than nondiabetic patients (20.3% versus 7.0%, P < 0.05). The percentage of all isolates resistant to levofloxacin, cefmenoxime, and tobramycin was 14.0%, 15.2%, and 17.9%, respectively, with no significant differences among these drugs. Conclusion The high bacterial isolation rate in patients >60 years old and the high methicillin-resistant coagulase-negative staphylococci isolation rate in patients with diabetes are important to consider for prevention of perioperative infections.

Survey of Japanese ophthalmic surgeons regarding perioperative disinfection and antibiotic prophylaxis in cataract surgery

Purpose To elucidate Japanese trends for perioperative disinfection and antibiotic selection during cataract surgeries. Methods Perioperative iodine use and antibiotic prophylaxis for cataract surgery were surveyed in eight regions in Japan by mail or through interviews from February 1 to March 1, 2014. Results We surveyed 572 surgeons, of whom 386 (67%) responded. Most of the surgeons (94%) used iodine compounds before surgery for periocular skin disinfection (povidone–iodine [PI]: 79%; polyvinyl alcohol-iodine [PAI]: 15%) or conjunctival disinfection (85%; PI: 36%; PAI: 49%). Preoperative conjunctival iodine was primarily used as an eye wash (irrigation: 95%) and less often as an eye drop (5%). It was determined that 31% of surgeons waited 30 seconds or more between periocular disinfection and conjunctival disinfection. During surgery, 14% of surgeons used iodine several times, including immediately before intraocular lens insertion, and 7% used the Shimada technique (repeated iodine irrigation). Preoperative antibiotic eye drops were used by 99% of surgeons, and antibiotics were added to the irrigation bottle by 22%. The surgeons reported use of subconjunctival antibiotic injections (23%), antibiotic ointments (79%), and intracameral antibiotics (7%: 22 moxifloxacin; 6 levofloxacin). All surgeons prescribed postoperative eye drops, with 10% initiating the drops on the day of surgery. Conclusion Iodine compounds are commonly used preoperatively, but few institutions use iodine compounds intraoperatively, particularly with repeated application. The selection of antibiotic administration and disinfection technique has to be at the surgeon’s discretion. However, intracameral antibiotic and intraoperative iodine compound use are techniques that should be widely recognized.

Evaluation of Axial Length Measurement of the Eye Using Partial Coherence Interferometry and Ultrasound in Cases of Macular Disease

PURPOSE The present study evaluated the accuracy of using partial coherence interferometry (PCI) and ultrasound (US) to measure axial length in eyes with macular disease, the nature of the double peak (DP) in PCI measurements, and the applicability of intraocular lens (IOL) power calculation. DESIGN Retrospective noncomparative case series. PARTICIPANTS We studied 132 eyes with macular edema, epiretinal membrane, and macular hole in 132 patients who underwent combined cataract and vitrectomy surgery. METHODS Axial length was measured using PCI and US. If a DP was observed in the PCI measurement, the posterior peak was used for the IOL calculation. The central retinal thickness (CRT) was measured using optical coherence tomography. MAIN OUTCOME MEASURES Measurements were made of the frequency of DP observation in PCI measurement and the postoperative refractive errors when either PCI or US measurements were applied. RESULTS A DP was observed in 25 (18.7%) of 132 eyes in the axial length measurement using PCI. There was a significant correlation between the interpeak distance and the CRT (P<0.001, r(2)=0.3869). The 6-month postoperative refractive errors in the DP and single peak (SP) groups were predicted correctly within +/-0.5 diopters in 56.0% (DP) and 61.7% (SP) of the cases and within +/-1.0 diopters in 92.0% (DP) and 92.2% (SP) of the cases. The accuracy of the axial length measurement was similar between PCI and US. CONCLUSIONS Our results suggest that the longer axial length of the DP observed in PCI represents retinal pigment epithelium. If a DP was observed in PCI measurement, application of the longer peak for the IOL calculation resulted in a refractive error similar to that in the SP group.

Influence of the signal-to-noise ratio on the accuracy of IOLMaster measurements

PURPOSE: To evaluate the relationship between the sound‐to‐noise ratio (SNR) and the reliability of axial length (AL) measurements obtained with the IOLMaster (Carl Zeiss Meditec AG). SETTING: Department of Ophthalmology, Saiseikai Kurihashi Hospital, Saitama, Japan. METHODS: In a clinical prospective study, 216 consecutive eyes of 144 patients scheduled for cataract surgery were evaluated for the type and severity of cataract using the Lens Opacities Classification System III. Preoperative and postoperative AL measurements were performed with the IOLMaster. The preoperative SNR values were used to divide the eyes into 5 groups. The following were compared between the groups: preoperative logMAR best spectacle‐corrected visual acuity (BSCVA), difference in AL between preoperatively and postoperatively, error in the postoperative predicted refraction, and type and severity of cataract. RESULTS: The preoperative logMAR BSCVA was significantly worse in eyes with an SNR <2 (P<.05). The AL was longer preoperatively than postoperatively in all groups, and there was a significant difference in the <2 SNR group and the 2 to <5 group (P<.05). There were no significant differences in the error in postoperative predicted refraction. The percentage of patients with P4 or worse posterior subcapsular cataract (PSC) increased significantly with a decrease in the SNR (P<.01). However, there was no correlation between nuclear color grade and the SNR. CONCLUSION: The SNR value was useful in confirming the good quality of AL readings taken with the IOLMaster, even though the SNR value correlated significantly with the preoperative logMAR BSCVA and PSC severity.

Efficacy of retinol palmitate eye drops for dry eye in rabbits with lacrimal gland resection.

Purpose We examined the efficacy of retinol palmitate (VApal) for dry eyes using dry eye model rabbits whose lacrimal glands were resected. Materials and methods After alkaline injury on keratoconjunctival epithelium, VApal eye drops were administered 6 times a day for 7 days. The efficacy of VApal was also compared with that of 0.1% hyaluronic acid eye drops. Results The fluorescein staining and rose bengal scores showed a significant decrease compared with the score in the vehicle group at 7 days (P < 0.05) in the 1000 IU/mL VApal group and at both 3 days (P < 0.05) and 7 days (P < 0.01) in the 1500 IU/mL VApal group. Histological examination revealed recovery of the corneal epithelium, and PAS staining disclosed the recovery of mucin-producing lower palpebral conjunctival goblet cells after 7 days in the 1500 IU/mL VApal group compared with the vehicle group. Results from impression cytology showed a significant increase in density of conjunctival goblet cells compared with that in the vehicle group after 7 days in the 1000 IU/mL VApal group and after 3 and 7 days in the 1500 IU/mL VApal group. There were no significant changes in tear flow in either group. Topical application of VApal at 1500 IU/mL showed greater improvement than 0.1% hyaluronic acid in both fluorescein and rose bengal score and in the density of conjunctival goblet cells. Conclusion It is suggested that VApal is effective for the improvement of keratoconjunctival epithelial damage associated with tear abnormalities, such as dry eyes.

Effect of long-term treatment with eyedrops for glaucoma on conjunctival bacterial flora.

Objective: The effect of eyedrops for glaucoma on conjunctival bacterial flora was investigated by comparing a group of patients treated with such eyedrops for at least 1 year to a control group that did not use eyedrops. Methods: In both groups, bacterial culture came from scrapings of the conjunctival sac, and the bacterial infection rate and pattern of drug resistance were determined. Findings were analyzed in various subgroups stratified by age, frequency of instillation, and concentration of antiseptic benzalkonium chloride in the eyedrops. Results: The culture-positive rate was significantly lower in the glaucoma eyedrop group (43/119 eyes, 40.3%) than in the control group (19/28 eyes, 67.8%) (P < 0.05). No differences in infection rate were found among the different age groups. The most frequent bacteria in both groups was coagulase-negative staphylococci. Gram-negative bacteria were only detected in the glaucoma eyedrop group. Retrospective evaluation was possible for 86 eyes of patients from the glaucoma eyedrop group, among which 45 eyes (52.3%) showed some corneal epithelium damage. There was no difference in the culture-positive rate of bacteria between patients who used eyedrops containing 0.01% or higher dose of benzalkonium chloride and those containing less than 0.01%. Strains that showed resistance to levofloxacin were significantly less frequent in the glaucoma eyedrop group (six strains, 15.0%) than in the control group (11 strains, 39.3%) (P < 0.05). Conclusion: Patients using eyedrops for glaucoma had a lower culture-positive rate of bacteria in the conjunctival sac, probably due to being washed out by the eyedrops. However, Gram-negative bacteria were detected in the eyedrop group. Bacteria isolated from the eyedrop group had lower resistance to levofloxacin, a finding that may have clinical relevance.

Effect of subconjunctival lacrimal gland transplantation in a rabbit dry eye model.

Purpose: The main and accessory lacrimal glands are involved in reflex and basal secretion of tears, respectively, with the glandular tissue anatomy being similar for both glands. We transplanted part of the main lacrimal gland under the palpebral conjunctiva in a rabbit dry eye model and assessed the therapeutic effect of this procedure. Methods: In New Zealand White rabbits, the greater superficial petrosal nerve was cut unilaterally under a microscope. The other eye served as a normal control. For transplantation, approximately 0.07 g of the main lacrimal gland was harvested from the normal side, labeled with octadecylindocarbocyanine, and transplanted under the palpebral conjunctivae of both eyes. At 1 week and 1 month after the transplantation, the eyes were observed, and the Schirmer tear test and histological examination of the palpebral conjunctiva were performed. Results: On the denervated side, tear flow, measured by the Schirmer tear test, recovered at 1 month after the transplantation of the main lacrimal gland compared with that before transplantation. The contralateral control side showed no changes. On the denervated side, the fluorescein score significantly improved at 1 month after transplantation compared with that before transplantation (P < 0.005), whereas the rose bengal score showed no difference. Histological examination revealed that octadecylindocarbocyanine-labeled transplanted main lacrimal gland tissue was present under the palpebral conjunctiva. Conclusions: These results suggest that the partial transplantation of the main lacrimal gland may be effective for treatment of dry eyes.

A Japanese Survey of Perioperative Antibiotic Prophylaxis in Cataract Surgery.

PurposeThe objective of this study was to identify trends in the use of perioperative antibiotic prophylaxis in cataract surgery in Japan. DesignThis was a national survey by mail or interview. MethodsThe use of perioperative antibiotic prophylaxis in cataract surgery was evaluated by conducting a survey in 6 regions within Japan from October 1, 2011, to March 1, 2012. ResultsResponses were received from 285 (75%) of the 387 surgeons who were surveyed. The results revealed that 89% (255/285) administered ophthalmic antibiotic ointment. Forty-seven percent (133/285) used antibiotics in forms other than ophthalmic ointments within 6 hours after surgery, 7% (19/285) used eyedrops, 24% (67/285) used antibiotics via an irrigation bottle, 1% (2/285) used intracameral injections, and 24% (69/285) used subconjunctival injections. ConclusionsAlthough poor intraocular penetration of ophthalmic ointments has been reported, ophthalmic ointments are widely used. The fact that antibiotics should ideally be administered within 6 hours after surgery is not widely recognized. However, intracameral injection, which achieves much higher antibiotic concentration in the anterior chamber than other methods, is a technique that should be widely acknowledged.

Optimal Timing of Cataract Surgery and Panretinal Photocoagulation for Diabetic Retinopathy

The Early Treatment Diabetic Retinopathy Study (ETDRS) concluded that panretinal photocoagulation (PRP) should be performed before cataract surgery in patients with proliferative diabetic retinopathy (1). It is also preferable to perform focal photocoagulation for macular edema before PRP (2). Recently, adoption of minimally invasive cataract surgery has reduced the postoperative progression of retinopathy (3). Patients in the ETDRS (1) were enrolled in the 1980s, however, and the surgical procedures included intracapsular and extracapsular cataract extraction; thus, there was a major difference in surgical invasiveness compared with the small-incision phacoemulsification cataract surgery currently performed. Accordingly, it was necessary to review the optimum timing of PRP (4). Therefore, we conducted this hospital-based retrospective cohort study on the timing …