Shuya Hara

Posterior chamber phakic implantable collamer lens: changes in vault during 1 year.

PURPOSE To evaluate the changes in vault over time after Implantable Collamer Lens (ICL; STAAR Surgical) posterior chamber phakic intraocular lens implantation. METHODS A total of 36 eyes of 19 patients who underwent ICL implantation were enrolled in the study. Vault (the distance between the back surface of the ICL and the front surface of the crystalline lens) was measured postoperatively using anterior optical coherence tomography. Patients were divided into three groups based on vault (low < or =0.25 mm, moderate >0.25 to <0.75 mm, or high > or =0.75 mm). RESULTS Mean vault at 1 year postoperative was 0.53+/-0.25 mm. The percentages of eyes in the low, moderate, and high vault groups were 13.9%, 72.2%, and 13.9%, respectively. A significant decrease in vault was noted up to 1 month, after which the value stabilized (P<.0001). High vault showed a gradual decrease up to 3 months (P<.0001), after which the value stabilized. A statistically significant correlation was present between the change noted for vault values during the 1-year follow-up period and those measured for the initial vault on postoperative day 1 (P<.0001, r(2)=0.6393). CONCLUSIONS Although values for low and moderate vault exhibited little change after ICL implantation, high vault tended to decrease over time and became stable at 3 months after surgery.

Retropupillary Fixation of Iris-claw Intraocular Lens Versus Transscleral Suturing Fixation for Aphakic Eyes Without Capsular Support

PURPOSE Retropupillary fixation of an iris-claw intraocular lens (IOL) (Verisyse, Abbott Medical Optics) was performed for aphakic eyes without sufficient capsular support, and safety and recovery of the procedure were compared with transscleral suturing fixation. METHODS This interventional case series comprised 11 eyes of 10 aphakic patients without capsular support undergoing retropupillary fixation of the Verisyse, and 21 eyes of 20 patients undergoing transscleral suturing fixation of foldable acrylic IOLs (15 eyes of 14 patients, SuperFlex620H [Rayner Intraocular Lenses Ltd]) and polymethylmethacrylate IOLs (6 eyes of 6 patients, CP60NS [CORNEAL Laboratoire]). Surgical time was measured. Corrected distance visual acuity (CDVA) and intraocular pressure (IOP) were examined preoperatively and 1 day, 1 and 2 weeks, and 1 and 6 months postoperatively. RESULTS No complications occurred in the Verisyse group, whereas complications were reported in seven eyes in the transscleral suturing fixation group throughout follow-up. Mean CDVA (logMAR) in the transscleral suturing group 1 day after surgery was significantly worse than preoperative CDVA (P<.05). In the Verisyse group, no significant changes in CDVA were noted at any time point. Mean IOP at postoperative day 1 in the transscleral suturing fixation group was significantly higher than that in the Verisyse group (P=.0126). Mean surgical time of Verisyse implantation (20.0 ± 8.9 min) was significantly shorter than transscleral suturing fixation (49.7 ± 18.9 min) (P<.0001). CONCLUSIONS Retropupillary fixation of an iris-claw IOL provides early visual recovery, has a low risk of postoperative increase in IOP, and is a time-saving method compared with transscleral suturing fixation for aphakic eyes without sufficient capsular support.

Topical tranilast for treatment of the early stage of mild dry eye associated with chronic GVHD.

Fibrosis and excessive extracellular matrix production are characteristic features of lacrimal gland chronic GVHD (cGVHD). Tranilast (n-[3,4-anthoranilic acid]), used for fibrotic skin disease, inhibits transforming growth factor-β-induced matrix production. We conducted a non-randomized study comparing 8 patients (five men, three women; median age, 47 years) given topical tranilast with 10 patients (three men, seven women; median age, 37 years) receiving therapy with topical artificial tears, sodium hyaluronate and vitamin A for mild ocular cGVHD. The tranilast group instilled topical tranilast and artificial tears q.i.d., beginning the day of dry eye diagnosis. The ocular surface and tear dynamics of each patient were evaluated before hematopoietic stem cell transplant, at the onset of dry eye and after 3 months of treatment. At 3 months, the scores of the Rose Bengal test and Schirmer test with nasal stimulation had significantly improved in the tranilast group compared with that in the control group (P<0.05). Furthermore, although five control patients (50%) developed severe dry eye within the treatment period, only one tranilast-treated patient (12.5%) did; the rest still had mild dry eye (P<0.05). These results suggest the hypothesis that topical tranilast may effectively retard the progression of mild dry eye associated with cGVHD.

Optimization of an Implantable Collamer Lens Sizing Method Using High-Frequency Ultrasound Biomicroscopy

PURPOSE To develop and evaluate a new implantable collamer lens (ICL) sizing method that uses high-frequency ultrasound biomicroscopy (UBM). DESIGN Interventional case series. METHODS ICL were implanted in 47 eyes of 25 patients (8 male, 17 female, mean age 34.7±6.8 years). At 3 months after ICL surgery, the vault (distance between ICL and crystalline lens) was measured using anterior optical coherence tomography (OCT). Stepwise multiple regression analysis was performed in order to determine the optimal ICL size that will be expected to achieve a 0.5-mm vault, and the regression equation was calculated. Mean keratometric power, axial length, anterior chamber depth, sulcus-to-sulcus (STS) diameter, and distance between STS plane and crystalline lens were applied as candidates for explanatory variables. Subsequently, the equation was applied to a new group of patients (81 eyes of 43 patients, 20 male and 23 female, mean age 35.6±7.2 years) in order to decide the ICL size. Postoperative vault was evaluated at 3 months after surgery. Main outcome measures were mean postoperative vault and percentages of eyes that achieved moderate vault. RESULTS The regression equation was determined using 3 explanatory variables: anterior chamber depth (ACD), STS diameter, and distance between STS plane and anterior crystalline lens surface (STSL). The mean vault error (postoperative vault-predicted vault) was -0.06±0.29 mm. Of the total number of eyes, 88.9% had a vault between 0.15 and 1.0 mm. None of the eyes had a low vault (<0.15 mm). Nine eyes (11.1%) had a high vault (>1.0 mm). CONCLUSION A novel ICL sizing equation was developed and shown to be an effective method for calculation of the optimal ICL size in order to achieve an appropriate vault.

Evaluation of tear stability after surgery for conjunctivochalasis

Purpose. To evaluate the efficacy of surgical treatment for conjunctivochalasis using the Tear Film Stability Analysis System. Methods. Fifteen eyes of 15 patients (74.5 ± 4.8 years; 14 females and 1 male) who had surgical reconstruction of the tear meniscus for conjunctivochalasis underwent evaluation with a symptom questionnaire, Schirmer I test, fluorescein tear film break-up time (FBUT), and break-up time index (BUI) measurement by Tear Film Stability Analysis System examinations that were performed preoperatively and 3 months after the surgery. Changes of these tear parameters were statistically analyzed using the paired t test. Results. After the surgery, the mean FBUT and BUI values significantly improved from 5.7 ± 3.2 s and 42.8 ± 18.7, respectively, to 8.4 ± 2.5 s and 60.7 ± 16.5, respectively (FBUT, p = 0.0438; BUI, p = 0.0036). The mean Schirmer test value showed no significant changes before and after surgery (p = 0.9064). Fourteen eyes (93.3%) had improvement of ocular symptoms after surgery. One eye (6.7%) with no improvement of ocular symptoms, FBUT, and BUI after surgery appeared to have aqueous tear deficiency. Conclusions. Surgical treatment for conjunctivochalasis was associated with improvement of tear stability and clinical dry eye symptoms.

Correction of Residual Refractive Error in Pseudophakic Eyes with the Use of a Secondary Piggyback Toric Implantable Collamer Lens

PURPOSE To evaluate the feasibility of piggyback insertion with a toric Implantable Collamer Lens (ICL, STAAR Surgical). METHODS This study investigated eight pseudophakic eyes of five patients who underwent piggyback insertion of a toric ICL to correct residual refractive error. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refractive sphere and astigmatism were measured before and 6 months after surgery. RESULTS Pre- and 6-month postoperative logMAR UDVA were 0.759±0.430 and 0.201±0.458, respectively. All eyes were corrected within ±0.50 diopters (D) of intended spherical equivalent refraction. The manifest refractive astigmatism was within ±0.50 D in five (62.5%) eyes and ±1.00 D in seven (87.5%) eyes. No eyes lost more than one line of CDVA. Pupillary block occurred in one eye on postoperative day 1. CONCLUSIONS Piggyback insertion of a toric ICL appears to be effective and predictable in correcting refractive error in pseudophakic eyes.

New Compact Accommodometer to Measure Accommodation Amplitude as a Biomarker.

PurposeThis study aimed to evaluate a newly designed compact accommodometer (CA) and compare this with a conventional accommodometer for measuring accommodation as a biomarker for aging and lifestyle. DesignThis is an observational case series. MethodsAccommodative amplitude was measured using 2 different accommodometers in 114 patients. We obtained the data of the near-point accommodation amplitude. Subsequently, we used smoking habit as an example of lifestyle-related factor to evaluate its effect on the accommodative power. ResultsThe first part of the study included 60 eyes of 60 men and 54 eyes of 54 women, with a mean (SD) age of 43.8 (12.9) years (range, 18–58 years). There was a consistency within each measuring method despite a significant difference between the 2 devices (P < 0.01). Measuring accommodation by CA was significantly faster than by conventional modality (190.9 ± 58.1 seconds for CA and 371.8 ± 123.6 seconds for D’ACOMO, P < 0.0001, paired t test). In the second part of the study, we found a significant correlation between age and accommodative amplitude both in smokers and in nonsmokers. The accommodative amplitude of the smoker group was significantly lower than that of the nonsmoker group (P < 0.001). ConclusionsCompact accommodometer may work as an alternative and convenient method in place of the conventional accommodometer for measuring accommodative amplitude as an aging biomarker. Lifestyle factors can affect the magnitude of accommodation, which can be measured by this newly developed CA.