Keiichiro Minami

Comparison of postoperative surface light scattering of different intraocular lenses

Aims: This retrospective study was conducted to compare postoperative surface scattering of four kinds of intraocular lens (IOL). Methods: Sixty-seven eyes of 67 patients who had undergone cataract surgery were enrolled in this study. One of four IOLs was used in the patients; MA60BM in 17 patients (MA group), SA60AT in 17 patients (SA group), AR40 in 16 patents (AR group) and ClariFlex in 17 patients (CL group). Measurement of scattering from the anterior surface of the IOL was measured with area densitometry using a Scheimpflug camera (EAS-1000, Nidek, Aichi) for 3 years after the surgery. Results: The density of IOL surface scattering increased starting 1 year after surgery and throughout the 3-year period in the MA group and starting at 6 months through 3 years in the SA group, whereas the density was stable in the AR and CL groups. The density of surface scattering in the MA and SA groups at 3 years after surgery was significantly higher than in the AR and CL groups. Conclusion: The surface scattering of MA60BM and SA60AT is higher than that of AR40 and ClariFlex. The grades of surface scattering differ among the manufacturers, even with the same acrylic material.

Effect on visual acuity of increased surface light scattering in intraocular lenses.

PURPOSE: To assess the long‐term increase in surface light scattering of foldable hydrophobic acrylic intraocular lenses (IOLs) and to evaluate its effect on visual acuity. SETTING: Miyata Eye Hospital, Miyazaki, Japan. DESIGN: Cross‐sectional study. METHODS: The clinical records of patients who received an Acrysof IOL (study group) or a Sensar AR40 or AR40e IOL (control group) were reviewed retrospectively. Surface light scattering of IOLs was measured 1 year postoperatively or later. The corrected distance visual acuity (CDVA) at the surface‐light‐scattering examination was compared with the CDVA 1 month after IOL implantation. The changes in CDVA over time were compared with the increase in surface light scattering. RESULTS: The study evaluated 466 eyes of 337 patients. Surface light scattering in the study group continued to increase up to 15 years postoperatively. The light scattering was higher on the anterior IOL surface after 4.5 years. Increased surface light scattering had no significant impact on CDVA; however, there were more cases with decreased CDVA when the surface light scattering exceeded 50 computer‐compatible tape steps. CONCLUSION: Surface light scattering with the implanted foldable hydrophobic acrylic IOL continuously increased during the postoperative years and was a risk for decreased visual acuity. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Long-term Effect of Bak-free Travoprost on Ocular Surface and Intraocular Pressure in Glaucoma Patients After Transition From Latanoprost

PurposeTo assess the efficacy and tolerability of benzalkonium chloride (BAK)-free travoprost after transition from BAK-preserved latanoprost. MethodsThis was a prospective, open-label, multicenter study in patients with open-angle glaucoma or ocular hypertension who had been treated with latanoprost monotherapy for at least 3 months. The main outcome measures were superficial punctate keratopathy (SPK), hyperemia, and intraocular pressure (IOP). At baseline, 1, 3, and 12 months, hyperemia, SPK, and IOP were consecutively assessed. Hyperemia was assessed using a 4-grade scale. SPK was assessed by fluorescence staining observed by Area-Density classification. The IOP was measured by Goldmann applanation tonometry. ResultsOne hundred and fourteen patients participated in this study. Twenty-eight patients discontinued medications by 1 month. Sixty-seven patients completed the study. Transition from latanoprost to BAK-free travoprost showed no significant effect on hyperemia at 1 month, but showed significant decreases at 3 and 12 months compared with baseline (P<0.05). The prevalence of SPK, especially its severity score, at all points were significantly reduced compared with baseline (P<0.05). The IOP at baseline and at 12 months after transition was 14.9±3.4 and 14.3±3.3 mm Hg, indicating a significant reduction after the change in regimen compared with baseline (P<0.05). ConclusionsTreatment for 12 months with BAK-free travoprost after BAK-preserved latanoprost resulted in fewer ocular surface complications, as indicated by the reduced prevalence of SPK and decreased hyperemia, and no clinically relevant changes in IOP. BAK-free travoprost may have beneficial effects on the ocular surface while showing IOP-lowering efficacy comparable with BAK-preserved eye drops.

Experimental observation of intraocular pressure changes during microkeratome suctioning in laser in situ keratomileusis

Purpose: To observe changes in intraocular pressure (IOP), the manner in which the eye is suctioned, and the effect of the number of suction ports. Setting: Department of Ophthalmology, Tokyo Dental College, Suidobashi Hospital, Tokyo, Japan. Methods: Suction rings with single or dual ports were made of transparent acrylic acid resin to facilitate observation with a digital video camera. The IOP and the duration of the IOP increase (time to reach 90% of the maximum IOP) were measured in 6 porcine eyes with an intra‐vein pressure‐sensor catheter in the vitreous cavity. The IOP changes were recorded using a personal computer. Results: Suctioning with single‐ and dual‐port suction rings was similar. The IOP increases with single‐ and dual‐port suction rings were similar (99.1 mm Hg ± 6.1 [SD] and 99.0 ± 6.5 mm Hg, respectively) (P = .987). The duration of the IOP increase was also similar (4.21 ± 0.24 seconds and 4.12 ± 0.33 seconds, respectively) (P = .190). Conclusions: The number of ports did not affect suctioning and changes in IOP. This technique is useful in developing the ideal shape and setting of the suction ring.

Ray-tracing intraocular lens power calculation using anterior segment optical coherence tomography measurements

PURPOSE: To assess the efficiency of ray‐tracing intraocular lens (IOL) power calculation with anterior segment optical coherence tomography (AS‐OCT) in normal eyes with cataract. SETTING: Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan. DESIGN: Case series. METHODS: The study comprised consecutive patients who had cataract surgery and obtained a corrected visual acuity of 0.15 logMAR or better postoperatively. Preoperatively, Placido topography and AS‐OCT measurements were taken during a routine examination. The predicted postoperative refractions were obtained using 3 methods: the SRK/T formula with autokeratometry, ray‐tracing calculation with Placido topography data, and ray‐tracing calculations with AS‐OCT measurement of both corneal surfaces. The refractive errors from the manifest refraction spherical equivalent were compared 1 month postoperatively, and the effects of corneal eccentricity and posterior corneal curvature were evaluated. RESULTS: Seventy patients (102 eyes) were enrolled. There was no significant difference in refractive errors (P=.89). The refractive error with the SRK/T formula was correlated significantly with corneal eccentricity (P=.0017); the ray‐tracing calculations were unaffected. There was a weak correlation with the posterior corneal curvature in the ray‐tracing calculations performed with Placido topography (P<.0002). CONCLUSION: The accuracy of the ray‐tracing IOL power calculations using AS‐OCT data was comparable to that of the conventional formula and minimized the effect of corneal eccentricity and posterior corneal curvature. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

One-year prospective intrapatient comparison of aspherical and spherical intraocular lenses in patients with bilateral cataract.

PURPOSE To conduct longitudinal, intrapatient comparisons of aspherical and spherical silicone intraocular lenses (IOL) of the same material and platform in patients undergoing bilateral cataract surgery. DESIGN Prospective, randomized study. METHODS Sixty-two eyes of 31 patients were randomized to receive a silicone aspherical IOL (Tecnis Z9000; AMO Inc, Santa Ana, California, USA) in 1 eye and a silicone spherical IOL (CeeOn 911A; AMO Inc) in the other eye. Best spectacle-corrected visual acuity (BSCVA); corneal and ocular wavefront aberrations; contrast sensitivity under photopic (180 lux), intermediate (75 lux), and scotopic (15 lux) illumination; amount of IOL decentration and tilt; and degree of posterior capsular opacification were measured at 1, 3, 6, and 12 months after surgery. All-distance visual acuity (VA) was measured 3 months after surgery. RESULTS There were no significant differences between IOLs with regard to BSCVA, amount of IOL decentration and tilt, degree of posterior capsule opacification, and all-distance VA at any point after surgery. Regarding corneal wavefront aberrations, there was no difference in third- and fourth-order root mean square (RMS). In ocular wavefront aberrations, aspherical IOLs showed significantly lower fourth-order RMS (P < .001) than spherical IOLs throughout the study, but not in third-order RMS. Contrast sensitivity under photopic and mesopic conditions was not different between IOLs, but contrast sensitivity under scotopic conditions was significantly better with aspherical IOLs than with spherical IOLs (P < .01) at all measurement points. CONCLUSIONS The silicone aspherical IOL (Tecnis Z9000; AMO Inc) significantly reduced ocular spherical aberration and improved scotopic contrast sensitivity, and these results were consistent through the 1-year follow-up.

Effect of diquafosol tetrasodium eye drop for persistent dry eye after laser in situ keratomileusis.

Purpose: To evaluate the effect of diquafosol tetrasodium (DQS) for the treatment of persistent dry eye after laser in situ keratomileusis (LASIK). Setting: Miyata Eye Hospital, Miyazaki, Japan. Design: Noncomparative case series. Methods: This prospective study included 30 eyes of 15 patients in whom dry eye had persisted for over 12 months after LASIK, and the symptoms had not improved with artificial tears and sodium hyaluronate treatment. In addition, treatment with DQS 3% eye drops, 6 times a day, was performed for 12 weeks. Best-corrected visual acuity, tear secretion with the Schirmer test, tear break-up time, and fluorescein and lissamine green staining scores on the cornea and conjunctiva were examined before and at 1, 4, and 12 weeks after the addition. A subjective questionnaire of 14 symptoms was also assessed before and 12 weeks after treatment. Results: The fluorescein and lissamine green staining scores significantly improved over 12 weeks; however, the best-corrected visual acuity and tear secretion did not change. The symptoms of fatigue, dryness, grittiness, discomfort, difficulty in reading, and discomfort within the area of dryness improved after the additional DQS treatment. Conclusions: The DQS treatment improved the subjective and objective symptoms of persistent dry eye after LASIK. Increased mucin production because of the addition of DQS probably improved the tear film stability and reduced the symptoms of dry eye in patients who had persistent dry eye after LASIK.

Limbal relaxing incisions using a reference point and corneal topography for intraoperative identification of the steepest meridian.

PURPOSE To examine the efficacy and safety of topography-based limbal relaxing incision (LRI) surgery. METHODS Forty-four eyes of 36 consecutive patients who underwent cataract surgery more than 1 month previously, had refractive against-the-rule astigmatism of ≥2.00 diopters (D), and were scheduled to undergo LRI surgery were enrolled in the study. Patients were randomized into two groups-a topography-based LRI group (19 eyes of 14 patients) and a conventional LRI group (25 eyes of 22 patients). The topography-based LRI procedure comprised 3 steps: placing a mark on the cornea and conjunctiva, identifying this mark in the topographic image, and performing LRI based on the location of the mark. In the conventional LRI group, the horizontal meridian was marked under a slit lamp and LRIs were made based on the position of the horizontal mark. RESULTS Corneal astigmatism in the topography-based LRI group before and 1 month after surgery was 2.03±0.92 D and 1.33±0.69 D, respectively (P=.014). Corneal astigmatism in the conventional LRI group before and 1 month after surgery was 2.36±0.77 D and 0.93±0.70 D, respectively (P<.0001). Fourier harmonic analysis of the topography data demonstrated that regular astigmatism was significantly decreased in the two groups. The mean regular astigmatism was not significantly different before and after LRI between groups, whereas the variances (mean of the deviation squared from its mean) of regular astigmatism were significantly different between groups 1 month after LRI. CONCLUSIONS Compared with conventional LRI surgery, a topography-based procedure may reduce the deviation of the effect of LRIs.

Autorefraction after implantation of diffractive multifocal intraocular lenses

PURPOSE: To evaluate whether autorefractometry values after implantation of diffractive multifocal intraocular lenses (IOLs) correlate with manifest refraction values. SETTING: Tokyo Dental College Suidobashi Hospital, Tokyo, Japan. METHODS: This retrospective study evaluated eyes that had cataract surgery with implantation of a diffractive multifocal IOL. One month or more postoperatively, the autorefraction values were compared with the manifest refraction values to determine the correlation between the 2 methods in sphere, cylinder, and spherical equivalent (SE). RESULTS: The study evaluated 156 eyes of 84 patients. The mean spherical refraction was 0.13 diopters (D) ± 0.66 by autorefraction and 0.26 ± 0.50 D by manifest refraction. The mean cylinder value was 0.94 ± 0.58 D and 0.61 ± 0.48 D, respectively. The mean SE was −0.34 ± 0.66 D and −0.06 ± 0.48 D, respectively. All 3 measurements by autorefraction and manifest refraction were well correlated (r2 = 0.67, 0.66, 0.64, respectively). CONCLUSION: Findings show that postoperative autorefraction can be used to estimate the manifest refraction in eyes with diffractive multifocal IOLs. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Use of Scheimpflug corneal anterior-posterior imaging in ray-tracing intraocular lens power calculation

Purpose:  To examine improvement with the use of Scheimpflug imaging of the anterior and posterior corneal surfaces in the accuracy of ray‐tracing intraocular lens (IOL) power calculation for normal cataractous eyes.