Joo Youn Shin

Comparison of higher order aberrations after implantable Collamer Lens implantation and wavefront-guided LASEK in high myopia

PURPOSE To compare changes in ocular higher order aberrations (HOAs) after Visian Implantable Collamer Lens (ICL, STAAR Surgical Co) implantation and wavefront-guided laser epithelial keratomileusis (WFG-LASEK) to correct high myopia. METHODS This prospective case series comprised 30 eyes (18 patients) that underwent ICL implantation (ICL group) and 33 eyes (18 patients) that underwent WFG-LASEK (WFG-LASEK group). All eyes had spherical equivalent of -6.00 to -9.00 diopters. Entire ocular, internal optic, and corneal HOAs were measured before surgery and 3 months after surgery using a laser ray tracing aberrometer. Contrast sensitivity testing was performed in 10 eyes from each group at a photopic light level of 85 cd/m(2) and a mesopic level of 3 cd/m(2) 3 months after surgery. RESULTS In the ICL group, HOAs changed for the entire ocular trefoil-y, spherical aberration, internal optic spherical aberration, and corneal trefoil-y. In the WFG-LASEK group, increased HOAs were observed for total HOAs, entire ocular and corneal spherical aberration, secondary astigmatism, and tetrafoil. The ICL group had lower induced aberration values of entire ocular and corneal HOAs compared with the WFG-LASEK group. No significant differences in contrast sensitivity values between groups at the photopic level were noted; however, contrast sensitivity values were significantly lower for 3 (P=.01) and 6 cycles per degree (P<.001) in the WFG-LASEK group at the mesopic level. At the mesopic level, total HOAs, trefoil-y, spherical aberration, and secondary astigmatism were higher in the WFG-LASEK group. CONCLUSIONS Implantable Collamer Lens implantation induced fewer ocular and corneal HOAs and resulted in better contrast sensitivity at mesopic levels than WFG-LASEK in eyes with high myopia.

Association between choroidal thickness and the response to intravitreal ranibizumab injection in age‐related macular degeneration

To investigate the relationship between the choroidal thicknesses of eyes of patients with age‐related macular degeneration (AMD) and the outcomes of intravitreal ranibizumab injection.

Anti–Vascular Endothelial Growth Factor With or Without Pneumatic Displacement for Submacular Hemorrhage

PURPOSE To compare the treatment outcomes of a combination of pneumatic displacement and intravitreal anti-vascular endothelial growth factor, and anti-vascular endothelial growth factor monotherapy for submacular hemorrhage resulting from exudative age-related macular degeneration. DESIGN Retrospective, comparative, interventional case series. METHODS Forty eyes treated with a combination therapy and 42 eyes treated with monotherapy for submacular hemorrhage resulting from exudative age-related macular degeneration with no significant difference in baseline central foveal thickness were compared. Central foveal thickness and best-corrected visual acuity (BCVA) at baseline, 1, 3, and 6 months after initial treatment were measured and compared between the 2 groups after adjustment of baseline central foveal thickness. RESULTS Central foveal thickness (P < .0001) and BCVA (combination, P < .0001; monotherapy, P = .022) were improved after both treatments. Combination therapy showed more rapid improvement of central foveal thickness (P = .009) and BCVA (P = .007) within 1 month than monotherapy, but there was no difference at 6 months (P = .385 and P = .303, respectively). In eyes with subretinal hemorrhage thicker than 450 μm, visual outcome at 6 months was better in the combination therapy group than in the monotherapy group (P = .021), whereas BCVA showed no significant difference between groups in eyes with subretinal hemorrhage less than 450 μm (P = .930). CONCLUSIONS Both treatments are useful options for submacular hemorrhage resulting from exudative age-related macular degeneration. Combination therapy may yield a better treatment outcome than monotherapy in eyes with thick subretinal hemorrhage. Nevertheless, the potential for adverse events resulting from pneumatic displacement should be considered.

Modified Siepser sliding knot technique for scleral fixation of subluxated posterior chamber intraocular lens.

UNLABELLED We describe a new technique of scleral fixation for the management of dislocated intraocular lenses (IOL). A suture is tied inside the eye around the dislocated haptic to prevent slippage of the IOL after surgery. The technique, which is safe and less invasive than previous methods, was used in 3 patients and the results are presented. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.

Primary posterior capsulotomy and posterior optic buttonholing in eyes with phacovitrectomy and gas tamponade.

Primary Posterior Capsulotomy and Posterior Optic Buttonholing in Eyes With Phacovitrectomy and Gas Tamponade Vitrectomy with intraocular gas tamponade is an established treatment for idiopathic macular hole and retinal detachment. Because nucleosclerosis is a common complication of vitrectomy with gas tamponade, phacovitrectomy combined with pars plana vitrectomy with phacoemulsification and intraocular lens (IOL) implantation is commonly used to treat various diseases. Phacovitrectomy can reduce the number of surgeries and lessen the financial burden and achieve early visual rehabilitation. However, surgeons should consider some possible problems related to the IOL in phacovitrectomy, such as posterior capsular opacity (PCO), posterior synechiae formation, IOL subluxation, and pupillary capture of the IOL optic. Eyes with phacovitrectomy with gas tamponade are more likely to have these complications. Moreover, gas leaking into the anterior chamber or an anterior shift of the IOL can also occur during and after surgery. This can hinder fundus examination and decrease the advantages of the combined operation. The concept of optic capture was used to develop a technique to manage posterior capsule complications, such as tear, and to prevent PCO in pediatric surgery. Various optic capture techniques have been used in challenging or complicated situations. Posterior optic buttonholing (POBH), though a primary posterior continuous curvilinear capsulorhexis (CCC), is a surgical technique primarily designed to prevent PCO. Previous reports have demonstrated significantly reduced postoperative movement of the IOL and few complications in 1,000 consecutive cases of primary posterior CCC with POBH. However, this procedure, the forceps-created posterior CCC with POBH, is technically difficult with a steep learning curve and is rarely used for phacovitrectomy. A study reported that primary posterior capsulotomy using a 25-gauge vitreous cutter in phacovitrectomy can be easily performed, avoiding the complications caused by inexperience. Thus, we considered this primary posterior capsulotomy technique with a 25-gauge vitreous cutter and a POBH technique in eyes with phacovitrectomy and gas tamponade.

Fundus autofluorescence findings in central serous chorioretinopathy using two different confocal scanning laser ophthalmoscopes: correlation with functional and structural status

PurposeTo compare autofluorescence (AF) findings using wide-field (Optomap) and conventional (HRA-AF) confocal scanning laser ophthalmoscopy (cSLO) systems in patients with central serous chorioretinopathy (CSC), and to investigate the correlations between AF findings and functional and anatomical status.MethodsOptical coherence tomography (OCT) and AF images were compared in 73 eyes with serous retinal detachment (SRD) (group A) and 30 eyes without SRD (group B). We evaluated AF findings from the SRD region, atrophic area, and foveola. Correlations between AF findings and outer retinal abnormalities in OCT and visual acuity (VA) were analyzed.ResultsOptomap-AF was more effective than HRA-AF in identifying the margins of a detached area (P = 0.001) in group A, and for monitoring mild outer retinal damage (P = 0.041) in group B. The foveolar AF grades in both instruments were significantly correlated with VA and central foveal thickness (CFT) in both group A (Optomap, VA rs = 0.33, P = 0.012; CFT rs = −0.38, P = 0.002; HRA, VA rs = 0.62, P < 0.001; CFT rs = −0.70, P < 0.001) and group B (Optomap, VA rs = 0.71, P < 0.001, CFT rs = −0.78, P < 0.001; HRA, VA rs = 0.40, P = 0.026, CFT rs = −0.40, P = 0.030).ConclusionsOptomap-AF was found to be advantageous for monitoring subretinal status in eyes with SRD, and more accurately reflected mild outer retinal changes in eyes without SRD. Foveolar AF grades of both imaging modalities were significantly correlated with functional and anatomical status.

The Comparison of Central and Mean True-Net Power (Pentacam) in Calculating IOL-Power After Refractive Surgery

Purpose To compare the accuracy of central true net corneal power (cTNP) and mean true net corneal power (mTNP) of the Pentacam system to give a keratometry (K) reading for calculating IOL (intraocular lens) power in eyes following refractive surgery. Methods Refraction, an automated K-reading (Km), cTNP and mTNP were measured for 15 eyes that required cataract surgery and had previously undergone refractive surgery. The difference between postoperative manifest refraction values and target refraction values calculated with the SRK/T formula using cTNP were compared with the one using mTNP. Results The mean deviation from the desired post-cataract refractive outcome was 0.60 diopter (D) ±0.47 (standard deviation) using cTNP; 0.75±0.54 using mTNP (p=0.386). The actual refraction was within ±0.50D of the intended refraction for 60% (cTNP) and 33.3% (mTNP) of eyes, and within ±1.00D for 93% (cTNP) and 66.7% (mTNP) of eyes. Conclusions Although not statistically significant, the cTNP showed better accuracy than mTNP to give a keratometry (K) reading for post-refractive surgery eyes requiring cataract surgery.

Comparison of Preoperative and Postoperative Ocular Biometry in Eyes with Phakic Intraocular Lens Implantations

Purpose To compare preoperative and postoperative ocular biometry in patients with iris-fixated phakic intraocular lens (pIOLs): Artisan and Artiflex. Materials and Methods This study included 40 eyes with Artisan and 36 eyes with Artiflex pIOL implants. Anterior chamber depth (ACD) and axial length (AL) were measured by applanation ultrasonography (A-scan) and partial coherence interferometry (IOLMaster) preoperatively and 3 months after pIOL implantation. Results ACD measurements after Artisan or Artiflex pIOL implantation were smaller than preoperative measurements. Specifically, the difference after Artisan pIOL implantation was -1.07±0.17 mm by A-scan and -0.08±0.08 mm by IOLMaster. The difference after Artiflex pIOL implantation was -1.31±0.15 mm by A-scan and -0.05±0.07 mm by IOLMaster. After Artisan pIOL implantation, differences in AL measurements by A-scan were insignificant (difference: -0.03±0.15 mm), whereas postoperative AL measurements by IOLMaster were significantly longer than preoperative measurements (difference: 0.12±0.07 mm). After Artiflex pIOL implantation, AL measurements by both A-scan and IOLMaster were significantly longer than preoperative measurements (difference: 0.09±0.16 mm by A-scan and 0.07±0.10 mm by IOLMaster). In the Artiflex group, differences in AL measurements by A-scan correlated with the central thickness of the Artiflex pIOL. Conclusion ACD and AL measurements were influenced by iris-fixated phakic IOL implantation.

Anti-Vascular Endothelial Growth Factor with Gas for Submacular Hemorrhage.

Purpose To investigate the treatment outcome of pneumatic displacement and intravitreal anti–vascular endothelial growth factor (VEGF) for submacular hemorrhage (SMH) from exudative age-related macular degeneration (AMD). Methods Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured at baseline and at 1, 3, and 6 months after initial treatment in 72 eyes of 72 patients treated with a combination of pneumatic displacement and anti-VEGF injection for SMH from exudative AMD. Results Best-corrected visual acuity and CFT showed significant improvement from baseline during the 6-month follow-up period (logarithm of the minimum angle of resolution BCVA from 1.80 to 1.00, CFT from 886 to 383 &mgr;m, p < 0.001, respectively). The decrease in subretinal hemorrhage was greater than that in subretinal pigment epithelial hemorrhage at 1 month after initial treatment (p < 0.001). In eyes with symptoms for less than 30 days, higher reflectivity of hemorrhage on optical coherence tomography and higher CFT were associated with lower BCVA after 6 months of treatment (reflectivity B = 0.335, p = 0.007; CFT B = 0.001, p = 0.003). Conclusions The combination of pneumatic displacement and intravitreal anti-VEGF is a useful treatment option for SMH secondary to AMD. Higher baseline CFT and higher reflectivity of hemorrhage were associated with lower BCVA 6 months after initial treatment.

Multiple ocular abnormalities associated with trisomy 4p.

Ocular features associated with trisomy 4p have rarely been described. The authors have experienced multiple ocular abnormalities (bilateral cataracts, posterior synechiae, and posterior segment changes) associated with this chromosomal abnormality. It was presumed that these intraocular findings might be associated with the previous inflammatory process. In the current case, the patient recovered some useful vision after surgical removal of cataracts and intraocular lens implantations in both eyes. A detailed ophthalmic examination for patients with the autosomal imbalance is recom-mended.