Rie Amano

Assessment of visual performance in pseudophakic monovision

PURPOSE: To assess the visual performance and acceptability of pseudophakic monovision and examine its relationship to age. SETTING: Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. METHODS: This retrospective study examined patients with pseudophakic monovision using monofocal intraocular lenses. Refractive errors, visual acuity at various distances, contrast sensitivity, and near stereopsis were measured. Patient satisfaction with monovision was evaluated using a questionnaire. RESULTS: Eighty‐two patients (age 49 to 87 years) were evaluated. The mean difference in spherical equivalent refractive error between each patients eyes was 2.27 diopters. Most patients had a binocular uncorrected visual acuity of 0.10 logMAR or better at all distances. For contrast sensitivity, binocular summation was observed at 1.5 to 6.0 cycles per degree. Near stereopsis was in the normal range, which was up to 100 seconds of arc. Questionnaire responses showed that 81% of patients (64% <60 years; 87% between 60 years and 70 years; 94% older than 70 years) were satisfied with the results. CONCLUSION: Pseudophakic monovision was an effective approach for managing loss of accommodation after cataract surgery in patients older than 60 years; however, a careful selection process is required.

Long-term clinical outcomes of toric intraocular lens implantation in cataract cases with preexisting astigmatism

Purpose To evaluate the long‐term clinical outcomes and rotational stability of toric intraocular lenses (IOLs) to correct preexisting astigmatism in cataract patients. Setting Kitasato University Hospital, Kanagawa, Japan. Design Prospective observational study. Methods Phacoemulsification with implantation of a toric IOL (Acrysof IQ toric SN6AT) was performed in cataract patients with corneal astigmatism. The postoperative follow‐up was up to 2 years. Results This study enrolled 378 eyes of 302 patients with a mean age of 63.4 years ± 16.9 (SD). The corrected distance visual acuity 3 months postoperatively was 20/25 or better in 94.7% of eyes. The mean refractive cylinder was −1.92 ± 1.45 diopters (D) preoperatively, −0.59 ± 0.62 D 3 months postoperatively (322 eyes), and −0.67 ± 0.90 D at 2 years (73 eyes). There were statistically significant differences between the preoperative and 3‐month postoperative measurements (P<.001, Wilcoxon signed‐rank test). The mean IOL misalignment was 4.1 ± 3.0 degrees 2 years postoperatively. The mean IOL rotation was 4.5 ± 4.9 degrees within 1 day postoperatively. The rotation was more than 20 degrees in 6 eyes, all of which had an axial length (AL) of more than 25.0 mm. All rotations occurred within 10 days postoperatively. Conclusions Toric IOLs were effective in reducing preexisting corneal astigmatism and had overall good rotational stability. A large degree of IOL rotation might occur in eyes with a relatively long AL, especially during the early postoperative period. The 6 rotated IOLs were implanted to correct with‐the‐rule astigmatism. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Five-year clinical study of patients with pseudophakic monovision

PURPOSE: To assess the long‐term clinical outcomes and acceptability of pseudophakic monovision. SETTING: Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. DESIGN: Case series. METHODS: Patients who had surgery using the monovision method with monofocal intraocular lenses had routine postoperative examinations. Assessed were visual acuity, near stereopsis, ocular deviation, patient satisfaction, and the rate of spectacle dependence preoperatively and 1, 3, and 6 months and 1, 2, 3, 4, and 5 years postoperatively. RESULTS: The study enrolled 54 patients with a mean age of 74.7 years ± 7.9 (SD). The mean difference in the spherical equivalent refractive error between eyes of each patient was 2.13 diopters. The binocular uncorrected distance visual acuity was at least 0.10 logMAR in 98% of patients, with 76% achieving Jaeger 2 or better binocular uncorrected near visual acuity. Near stereopsis in patients who shifted from exophoria to intermittent exotropia decreased, although no serious problems were observed. The rate of spectacle dependence was 88% preoperatively, 41% at 1 year, and 22% at 5 years. Patient satisfaction improved gradually during the follow‐up. CONCLUSION: Pseudophakic monovision was an effective approach for correcting presbyopia throughout the 5‐year observation period; however, a longer follow‐up, including further studies is necessary to allow selection of appropriate patients. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Inhibitory effect of histamine on axonal transport in cultured mouse dorsal root ganglion neurons

Histamine is important in mediating peripheral sensory information such as inflammation, allergic hypersensitivity, and itch. In the present study, using video-enhanced microscopy, we investigated the effect of histamine on axonal transport in cultured dorsal root ganglion (DRG) neurons of the mouse. Application of histamine (100 microM) reversibly reduced the number of particles transported within neurites in both anterograde and retrograde directions. The histamine H(1)-receptor agonist 2-thiazolylethylamine (100 microM) and the H(3)-receptor agonist R-alpha-methylhistamine (100 microM) also reduced anterograde and retrograde axonal transport, whereas the histamine H(2)-receptor agonist dimaprit (100-1000 microM) had no effect. The effect of histamine was partially blocked by pretreatment with H(1)-receptor antagonist pyrilamine (1 microM) or the H(3)-receptor antagonist thioperamide (1 microM). Pretreatment with a combination of pyrilamine (1 microM) and thioperamide (1 microM) completely blocked the response to histamine. The H(2)-receptor antagonist cimetidine (1 microM) was ineffective. These results suggest that histamine inhibits axonal transport of cultured mouse DRG neurons via the activation of H(1)- and H(3)-receptors.

Time course of corneal biomechanical parameters after phacoemulsification with intraocular lens implantation.

Purpose: To assess the time course of corneal biomechanical parameters after phacoemulsification with intraocular lens implantation. Methods: We examined 54 eyes of 33 consecutive patients undergoing cataract surgery. We quantitatively assessed the values of corneal biomechanics characterized by corneal hysteresis (CH) and corneal resistance factor (CRF) using an Ocular Response Analyzer before and 1 day, 1 week, 1 month, and 3 months after surgery. We also investigated the relationship between these biomechanical parameters and central corneal thickness 3 months after surgery. Results: The CH was 9.7 ± 1.1 (mean ± SD) mm Hg preoperatively, and 9.0 ± 1.4, 9.7 ± 1.1, 9.7 ± 1.1, and 9.7 ± 1.3 mm Hg 1 day, 1 week, 1 month, and 3 months postoperatively, respectively. The CRF was 9.5 ± 1.1 mm Hg preoperatively, and 8.8 ± 1.2, 9.2 ± 1.3, 9.1 ± 0.9, and 9.2 ± 1.2 mm Hg 1 day, 1 week, 1 month, and 3 months postoperatively, respectively. Multiple comparisons demonstrated significant differences between measurements made before and 1 day after surgery (P = 0.01 for CH and CRF, Dunnett test). Both CH and CRF were significantly correlated with central corneal thickness (Pearson correlation coefficient r = 0.29; P = 0.03 for CH and r = 0.42; P = 0.002 for CRF). Conclusions: Both CH and CRF decreased briefly at 1 day after cataract surgery but soon recovered to the preoperative levels, suggesting that cataract surgery does not induce a significant change in corneal biomechanics, except for 1 day postoperatively. The corneal thickness may play some role in corneal biomechanics even in postcataract eyes.

Evaluation of corneal biomechanical parameters after simultaneous phacoemulsification with intraocular lens implantation and limbal relaxing incisions

PURPOSE: To determine whether alterations in architecture cause corneal biomechanical changes after simultaneous cataract surgery and limbal relaxing incisions (LRIs). SETTING: Department of Ophthalmology, Kitasato University, Kanagawa, Japan. DESIGN: Observational case series. METHODS: This study longitudinally assessed corneal hysteresis (CH) and the corneal resistance factor (CRF) using the Ocular Response Analyzer in eyes having cataract surgery with LRIs. The relationship between these biomechanical parameters and central corneal thickness (CCT), measured using an ultrasound pachymeter, was also assessed. RESULTS: The mean CH was 10.0 mm Hg ± 1.2 (SD) preoperatively, 9.0 ± 1.6 mm Hg 1 day postoperatively, 9.7 ± 1.4 mm Hg at 1 week, 9.6 ± 1.4 mm Hg at 1 month, and 10.2 ± 1.3 mm Hg at 3 months. The mean CRF was 10.0 ± 1.5 mm Hg, 8.9 ± 1.6 mm Hg, 9.5 ± 1.5 mm Hg, 9.5 ± 1.4 mm Hg, and 9.5 ± 1.4 mm Hg, respectively. There were significant differences between preoperative and 1‐day postoperative measurements (P=.005, CH; P=.004, CRF). The CH and CRF were significantly correlated with CCT (r = 0.33, P=.04 and r = 0.40, P=.01, respectively) 3 months postoperatively. CONCLUSIONS: The CH and CRF values decreased 1 day after simultaneous cataract surgery with LRIs but soon recovered to preoperative levels, suggesting there were no significant changes in corneal biomechanical factors after 1 day. Corneal thickness may play a role in biomechanical factors even in such eyes. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Five-year follow-up of ocular deviation in bilaterally pseudophakic patients.

ABSTRACT Purpose: To investigate long-term ocular deviation in patients who had undergone implantation of a monofocal intraocular lens (IOL) in both eyes. Methods: Eighty-eight patients with exophoria (average age, 68 ± 8 years; average axial length, 23.9 ± 0.9 mm) scheduled for bilateral phacoemulsification and monofocal IOL implantation were recruited. Before surgery and at 1, 3, and 6 months and 1, 2, 3, 4, and 5 years after surgery, we assessed ocular deviation near stereopsis in patients wearing their normal spectacles. Results: At 5 years after surgery, near stereopsis had a median value of 50 arcsec and the mean stereopsis was 85.8 ± 101.8 arcsec; 85 patients (85%) had good stereopsis (ie, ≥100 arcsec). Of the total patients, 12.5% shifted from exophoria to intermittent strabismus or exotropia at near vision, and near stereopsis decreased. Most of them had a preoperative near exophoria angle of more than 12 prism diopters. Conclusion: In bilaterally pseudophakic patients with a near exophoria angle of more than 12 prism diopters, we should be concerned about the possibility of variations in ocular deviation and stereopsis after cataract surgery.

Late-onset Diffuse Lamellar Keratitis

BACKGROUND Diffuse lamellar keratitis (DLK) is marked by the presence of diffuse or multifocal infiltrates confined to the laser in situ keratomileusis(LASIK) interface. These infiltrates are culture-negative, and the etiology is thought to be noninfectious. Most cases of DLK occur within the first week or two following surgery. CASE We describe two cases of diffuse lamellar keratitis that occurred 3 months after LASIK. These patients were treated with intensive topical corticosteroids. RESULTS We treated the patients with topical corticosteroids, with rapid improvement in patient symptoms, visual acuity, and slit-lamp biomicroscopy. CONCLUSION DLK may occur three months after LASIK.