Clinical Ophthalmology
This study compares the effect of topical diclofenac with that of betamethasone against postoperative increase of intraocular pressure (IOP) after cataract surgery in normal patients, and also investigated the risk factors for postoperative increase of IOP in each group.... Fifty consecutive patients without systemic disease who have bilateral and symmetrical cataracts underwent uncomplicated cataract surgery in both eyes (100 eyes in total). Postoperatively, topical diclofenac was applied 4 times daily to one eye, and topical betamethasone to the other eye in each patient. IOP and best corrected logMAR visual acuity (BCVA) in each eye were measured up to 8 weeks. Total surgery time and effective phacoemulsification time (EPT) for each case was recorded.... BCVA in both diclofenac- and betamethasone-treated eyes significantly improved after the cataract surgery; however, no statistical difference in VA was noted between the diclofenac- and betamethasone-treated eyes throughout the observation period. IOP in the diclofenac-treated eyes decreased with time, in contrast to the IOP in the betamethasone-treated eyes, which showed a slight increase. At 4 and 8 weeks postoperatively, there was significant difference between these two eye groups. Multiple regression analysis revealed that postoperative increase in IOP at 8 weeks in the betamethasone-treated eyes was closely correlated with total surgery time and EPT, but the IOP in the diclofenac-treated eyes showed no correlation with any surgical or clinical parameters.
Conclusions: Postoperative increase in IOP after cataract surgery was affected by total surgery time and EPT in the betamethasone-treated eye. The time for surgery and EPT is longer in complicated cases including patients with a hard nucleus or small pupils, and also longer for beginning surgeons and in older patients. In these cases, diclofenac in place of betamethasone as a postoperative topical antiinflammatory drug is recommended for the prevention of postoperative increase in IOP.
Sunday, November 16, 2008
Sunday, November 9, 2008
Acute onset of retinal detachment after posterior chamber phakic intraocular lens implantation
Clinical Ophthalmology
Case report: A 34-year-old man with severe myopia, presented with acute visual loss in his right eye. This occurred 3 hours after a posterior chamber phakic (PCP) intraocular lens (IOL) implantation, and was associated with a rhegmatogenous retinal detachment. Retinal retachment surgery was performed without complications, with the outcome showing good anatomical and functional results during a 2-year follow-up period.
Discussion: Despite the fact that several authors have described retinal detachments following PCP IOL implantation in highly myopic patients, there is no evidence that this procedure increases the risk of retinal detachment in these patients. The occurrence of the retinal detachment immediately after the phakic IOL implantation supports the hypothesis that the surgical procedure could induce iatrogenic changes in patients with high myopia, which could increase the incidence of retinal detachment. In contrast to other reports, the interval between the PCP IOL implantation and the retinal detachment was only 3 hours in our patient. We believe this demonstrates the importance of performing a complete preoperative vitreoretinal examination in patients with severe myopia.
Case report: A 34-year-old man with severe myopia, presented with acute visual loss in his right eye. This occurred 3 hours after a posterior chamber phakic (PCP) intraocular lens (IOL) implantation, and was associated with a rhegmatogenous retinal detachment. Retinal retachment surgery was performed without complications, with the outcome showing good anatomical and functional results during a 2-year follow-up period.
Discussion: Despite the fact that several authors have described retinal detachments following PCP IOL implantation in highly myopic patients, there is no evidence that this procedure increases the risk of retinal detachment in these patients. The occurrence of the retinal detachment immediately after the phakic IOL implantation supports the hypothesis that the surgical procedure could induce iatrogenic changes in patients with high myopia, which could increase the incidence of retinal detachment. In contrast to other reports, the interval between the PCP IOL implantation and the retinal detachment was only 3 hours in our patient. We believe this demonstrates the importance of performing a complete preoperative vitreoretinal examination in patients with severe myopia.
Cataract Surgery and the Risk of Aging Macula Disorder
(Investigative Ophthalmology and Visual Science. 2008;49:4795-4800.)
To investigate still-controversial associations between prior cataract surgery and aging macula disorder (AMD) in a general population..... After adjusting for age, sex, follow-up time, and the correlation between eyes, a history of cataract surgery was associated with incident dry late AMD (OR, 3.43; 95% CI, 1.82–6.49). This association remained significant after additional adjustment for smoking status and AMD stage at baseline (OR, 3.44; 95% CI, 1.68–7.08). No statistically significant association was found between prior cataract surgery and the incidence of wet late AMD or early AMD. Homozygous CFH Y402H carriers had higher risks for all types of AMD compared to heterozygotes and noncarriers after cataract surgery, particularly for dry AMD.
CONCLUSIONS. The findings imply that cataract surgery increases the risk of dry AMD, particularly in homozygous CFH Y402H carriers. The risk of AMD progression should be considered before recommending cataract surgery to patients with cataract and early AMD.
To investigate still-controversial associations between prior cataract surgery and aging macula disorder (AMD) in a general population..... After adjusting for age, sex, follow-up time, and the correlation between eyes, a history of cataract surgery was associated with incident dry late AMD (OR, 3.43; 95% CI, 1.82–6.49). This association remained significant after additional adjustment for smoking status and AMD stage at baseline (OR, 3.44; 95% CI, 1.68–7.08). No statistically significant association was found between prior cataract surgery and the incidence of wet late AMD or early AMD. Homozygous CFH Y402H carriers had higher risks for all types of AMD compared to heterozygotes and noncarriers after cataract surgery, particularly for dry AMD.
CONCLUSIONS. The findings imply that cataract surgery increases the risk of dry AMD, particularly in homozygous CFH Y402H carriers. The risk of AMD progression should be considered before recommending cataract surgery to patients with cataract and early AMD.
Friday, November 7, 2008
Central corneal thickness measured by the Orbscan II system, contact ultrasound pachymetry, and the Artemis 2 system
Journal of Cataract & Refractive SurgeryVolume 34, Issue 11, November 2008, Pages 1906-1912
To compare central corneal thickness (CCT) measurements by the Orbscan II device, contact ultrasound (US) pachymetry, and the noncontact Artemis 2 scanning US system.The CCT in 40 eyes (20 normal subjects) was measured by the Orbscan II followed by contact US pachymetry and then the Artemis 2. Results were compared using analysis of variance (ANOVA), paired t tests, and Bland-Altman plots.
Conclusions Ultrasound pachymetry and Artemis 2 CCT measurements were highly correlated; the 11 μm mean difference in measurements may be attributed to decentration, oblique incidence of the probe to the cornea, or possibly the effect of topical anesthesia with contact pachymetry. Although the mean difference between Orbscan II and Artemis 2 values was 7.5 μm, Orbscan values were less correlated than Artemis 2 values with contact US pachymetry and were prone to underestimation of the CCT in thinner corneas
To compare central corneal thickness (CCT) measurements by the Orbscan II device, contact ultrasound (US) pachymetry, and the noncontact Artemis 2 scanning US system.The CCT in 40 eyes (20 normal subjects) was measured by the Orbscan II followed by contact US pachymetry and then the Artemis 2. Results were compared using analysis of variance (ANOVA), paired t tests, and Bland-Altman plots.
Conclusions Ultrasound pachymetry and Artemis 2 CCT measurements were highly correlated; the 11 μm mean difference in measurements may be attributed to decentration, oblique incidence of the probe to the cornea, or possibly the effect of topical anesthesia with contact pachymetry. Although the mean difference between Orbscan II and Artemis 2 values was 7.5 μm, Orbscan values were less correlated than Artemis 2 values with contact US pachymetry and were prone to underestimation of the CCT in thinner corneas
Corneal biomechanical measurements before and after laser in situ keratomileusis
Journal of Cataract & Refractive SurgeryVolume 34, Issue 11, November 2008, Pages 1886-1891
To study the correlation between corneal biomechanical properties and surgical parameters in myopic patients before and after laser in situ keratomileusis (LASIK).....In 43 eyesof 43 patients, the Ocular Response Analyzer was used to measure corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc) before and 1 month after LASIK. Manifest refraction spherical equivalent (MRSE), preoperative central corneal thickness (CCT), flap thickness (FT), and ablation depth (AD) were also recorded. Changes in these parameters after LASIK were calculated and the correlations between the change in CH (ΔCH), change in CRF (ΔCRF) and the AD, change in MRSE (ΔMRSE), and CCT were examined. The relationship between ΔCRF and ΔMRSE was examined by linear regression analysis....The preoperative mean CH and mean CRF (11.52 mm Hg ± 1.28 [SD] and 11.68 ± 1.40 mm Hg, respectively) were significantly higher than postoperative values (9.48 ± 1.24 mm Hg and 8.47 ± 1.53 mm Hg, respectively) (P<.0001). A higher attempted correction was correlated with a larger ΔCH and ΔCRF (AD, r = 0.47 and r = 0.65, respectively; ΔMRSE, r = 0.51 and r = 0.66, respectively). No correlation was found between ΔCH, ΔCRF, and preoperative CCT. Conclusions Changes in CH and CRF after LASIK suggest alteration in corneal biomechanics correlating with attempted correction. The CRF parameter may be more useful than the CH parameter in assessing biomechanical changes resulting from LASIK
To study the correlation between corneal biomechanical properties and surgical parameters in myopic patients before and after laser in situ keratomileusis (LASIK).....In 43 eyesof 43 patients, the Ocular Response Analyzer was used to measure corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc) before and 1 month after LASIK. Manifest refraction spherical equivalent (MRSE), preoperative central corneal thickness (CCT), flap thickness (FT), and ablation depth (AD) were also recorded. Changes in these parameters after LASIK were calculated and the correlations between the change in CH (ΔCH), change in CRF (ΔCRF) and the AD, change in MRSE (ΔMRSE), and CCT were examined. The relationship between ΔCRF and ΔMRSE was examined by linear regression analysis....The preoperative mean CH and mean CRF (11.52 mm Hg ± 1.28 [SD] and 11.68 ± 1.40 mm Hg, respectively) were significantly higher than postoperative values (9.48 ± 1.24 mm Hg and 8.47 ± 1.53 mm Hg, respectively) (P<.0001). A higher attempted correction was correlated with a larger ΔCH and ΔCRF (AD, r = 0.47 and r = 0.65, respectively; ΔMRSE, r = 0.51 and r = 0.66, respectively). No correlation was found between ΔCH, ΔCRF, and preoperative CCT. Conclusions Changes in CH and CRF after LASIK suggest alteration in corneal biomechanics correlating with attempted correction. The CRF parameter may be more useful than the CH parameter in assessing biomechanical changes resulting from LASIK
Visual quality after diffractive intraocular lens implantation in eyes with previous myopic laser in situ keratomileusis
Journal of Cataract & Refractive Surgery
Volume 34, Issue 11, November 2008, Pages 1848-1854
To evaluate distance, intermediate, and near visual quality in eyes having diffractive intraocular lens (IOL) implantation after previous myopic laser in situ keratomileusis (LASIK)....Best corrected distance visual acuity at 12.5%, 25%, and 100% contrasts under photopic and mesopic conditions, best distance-corrected near visual acuity, defocus curve, and corneal higher-order aberrations (HOAs) were measured in eyes with a spherical AcrySof ReSTOR SNA60D3 IOL or aspherical Acri.LISA 366D IOL after myopic LASIK and in phakic eyes after myopic LASIK (control group).....Under photopic conditions at 100% contrast, best corrected distance acuity was 0.1 logMAR or better in all groups. At 25% and 12.5%, there were no statistically significant differences between the Acri.LISA and AcrySof ReSTOR groups or the Acri.LISA and control groups (P >.01). The control group had better best corrected distance acuity than the AcrySof ReSTOR group (P = .0002 and P<.0001 at 25% and 12.5%, respectively). Under mesopic conditions, the Acri.LISA group had better best corrected distance acuity than the AcrySof ReSTOR group at all contrasts (P >.01). The best distance-corrected near acuity was comparable in the 2 IOL groups (P<.01). Intermediate visual acuity was statistically significantly better in the Acri.LISA group than in the AcrySof ReSTOR group (P<.01). There were no statistically significant differences in HOAs between the 3 groups (P >.01).Conclusions:Both multifocal IOLs provided good and comparable visual acuity at distance and near. However, the aspherical Acri.LISA IOL gave better intermediate visual acuity than the spherical AcrySof ReSTOR IOL.
Volume 34, Issue 11, November 2008, Pages 1848-1854
To evaluate distance, intermediate, and near visual quality in eyes having diffractive intraocular lens (IOL) implantation after previous myopic laser in situ keratomileusis (LASIK)....Best corrected distance visual acuity at 12.5%, 25%, and 100% contrasts under photopic and mesopic conditions, best distance-corrected near visual acuity, defocus curve, and corneal higher-order aberrations (HOAs) were measured in eyes with a spherical AcrySof ReSTOR SNA60D3 IOL or aspherical Acri.LISA 366D IOL after myopic LASIK and in phakic eyes after myopic LASIK (control group).....Under photopic conditions at 100% contrast, best corrected distance acuity was 0.1 logMAR or better in all groups. At 25% and 12.5%, there were no statistically significant differences between the Acri.LISA and AcrySof ReSTOR groups or the Acri.LISA and control groups (P >.01). The control group had better best corrected distance acuity than the AcrySof ReSTOR group (P = .0002 and P<.0001 at 25% and 12.5%, respectively). Under mesopic conditions, the Acri.LISA group had better best corrected distance acuity than the AcrySof ReSTOR group at all contrasts (P >.01). The best distance-corrected near acuity was comparable in the 2 IOL groups (P<.01). Intermediate visual acuity was statistically significantly better in the Acri.LISA group than in the AcrySof ReSTOR group (P<.01). There were no statistically significant differences in HOAs between the 3 groups (P >.01).Conclusions:Both multifocal IOLs provided good and comparable visual acuity at distance and near. However, the aspherical Acri.LISA IOL gave better intermediate visual acuity than the spherical AcrySof ReSTOR IOL.
Monday, November 3, 2008
Topical Cyclosporine A in the Prevention of Pterygium RecurrenceOzlem
To investigate the efficacy and safety of postoperative topical cyclosporine A 0.05% (tCsA) (Restasis®, Allergan Pharmaceutical) eye drops in preventing the recurrence of pterygium. Methods: 31 patients with bilateral pterygium were examined between January 2006 and February 2007. During a 1-year follow-up, the right eyes of the patients assigned as the treatment group were treated by tCsA and the left eyes were considered as the control group. Results: The pterygium recurred in 4 (12.9%) of 31 right eyes in the treatment group and in 14 (45.2%) of 31 left eyes in the control group (p = 0.005). The mean follow-up ± SD was 9.39 ± 4.14 months (range, 1 to 12 months). The control group had a 7.37 times higher risk of recurrence in pterygium compared with the treatment group (OR = 0.1357, p = 0.0051). A statistically significant difference in recurrence-free probabilities was found for the treatment and control groups (log-rank test; p = 0.006). A multivariate Cox regression model showed that age (p = 0.0093) and tCsA (p = 0.0103) were independent statistically significant impacts on recurrence-free time for pterygium. Conclusion: This study suggests that primary excision of pterygium with postoperative instillation of 0.05% cyclosporine is both safe and efficient
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