Comparison of intraoperative complications of phacoemulsification between sequential and combined procedures of pars plana vitrectomy and cataract surgery.

PURPOSE: To compare intraoperative complications during phacoemulsification between sequential and combined procedures of vitrectomy and cataract surgery. METHODS: We retrospectively reviewed the medical records of 54 patients who underwent cataract surgery in a previously vitrectomized eye (sequential group) and 311 patients who underwent combined vitrectomy and cataract surgery (combined group). Primary outcome measures were intraoperative complications during phacoemulsification. Secondary measures were preoperative and intraoperative cataract gradings. RESULTS: The most common complication during phacoemulsification was posterior capsule rupture. The rate of posterior capsule rupture was higher in the sequential group (6 eyes, 11.4%) than in the combined group (14 eyes 4.5%, P = 0.049). Preoperative lens density (nuclear color and posterior subcapsular scores) was higher in the sequential group (P < 0.001). Intraoperative nuclear grading was higher compared with the preoperative one in the sequential group, but the two gradings did not differ in the combined group. CONCLUSION: Phacoemulsification in a vitrectomized eye is associated with a higher rate of posterior capsule rupture than the one in combined vitrectomy. These results may have been caused by hard nucleus cataract in a vitrectomized eye.

Lash ptosis and associated factors in Asians.

Lash ptosis (LP) is one of the important factors to be considered in blepharoplasty or correction of ptosis, but LP is an often overlooked symptom. We evaluate normal variations in the degree of LP to analyze the relationship between LP and its associated factors in Asians. One-hundred and sixty patients without ptosis and 16 patients with acquired ptosis were included in this study. We measured the degree of LP, marginal reflex distance 1, levator function, and presence or absence of a double fold. A significant difference was observed in LP rating between the nonptosis and acquired ptosis groups (P = 0.00), along with a significant correlation between LP rating and marginal reflex distance 1 (r = -0.272, P < 0.01), levator function (r = -0.170, P < 0.01), and absence or presence of double fold (r = -0.233, P < 0.01). Our results may be beneficial in the design of a basic plan for Asian patients with LP at the time of upper eyelid surgery, such as blepharoplasty or correction of ptosis.

Correlation between ciliary sulcus diameter measured by 35 MHz ultrasound biomicroscopy and other ocular measurements.

PURPOSE: To measure horizontal ciliary sulcus diameters by 35 MHz ultrasound biomicroscopy (UBM) and evaluate correlations between these and other ocular measurements. SETTING: Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea. METHODS: A pilot group comprising 20 eyes of 10 patients was enrolled in a prospective trial. Horizontal sulcus diameter was measured using a 35 MHz UBM unit; other ocular measurements (eg, corneal curvature, refractive error, white-to-white [WTW] distance, anterior chamber depth [ACD]) were also taken in all patients. Linear regression analysis was used to evaluate the correlation between horizontal sulcus diameter and the other measurements. A regression equation was determined as a result of the analysis and applied to a second validation group (14 eyes). RESULTS: The mean horizontal diameter of the ciliary sulcus in the pilot group was 11.56 mm +/- 0.64 (SD). The mean corneal curvature was significantly and negatively correlated with the horizontal sulcus diameter (P<.001). Refractive error, ACD, and horizontal WTW diameter were not correlated with the horizontal sulcus diameter by multiple regression analysis. In the validation group, sulcus diameters estimated using the regression equation were significantly correlated with actual values, and these 2 sets of values were not statistically different. CONCLUSIONS: Mean corneal curvature was significantly and negatively correlated with horizontal sulcus diameter. The derived regression formula based on mean corneal curvature measurements may help predict sulcus diameters for proper sizing of posterior chamber phakic intraocular lenses.

Short-term influence of aspirating speculum use on dry eye after cataract surgery: a prospective study.

PURPOSE: The aim of this study was to investigate the short-term influence of the use of an aspirating speculum on dry eye after performing cataract surgery. METHODS: This study was conducted using a prospective, consecutive, comparative, interventional case series of 58 eyes of 58 patients who underwent clear corneal cataract surgery; 29 eyes were treated using an aspirating speculum, and 29 eyes were treated without using a nonaspirating speculum. The main outcome measures were sequential changes of dry eye parameters including conjunctival staining, tear film break-up time (tBUT), conjunctivochalasis grades, and ocular surface disease index (OSDI). RESULTS: In the nonaspirating speculum group, tBUT and conjunctivochalasis grades were aggravated on day 1 postoperatively (P < 0.001), but conjunctival staining and OSDI did not show any significant change during the follow-up. In the aspirating speculum group, significant aggravation was observed by conjunctival staining on day 1 postoperatively (P = 0.001), tBUT and conjunctivochalasis grades were evaluated on day 1 and day 7 postoperatively (P < 0.001), and the OSDI was evaluated on day 7 postoperatively (P = 0.011). CONCLUSIONS: The use of an aspirating speculum aggravated dry eye parameters during the early postoperative period. Although these parameters returned to their preoperative values at 1 month postoperatively, the use of an aspirating speculum has the potential to aggravate dry eyes after cataract surgery is performed.

Surgically induced astigmatism after 3.0 mm temporal and nasal clear corneal incisions in bilateral cataract surgery.

AIMS: To compare the corneal refractive changes induced after 3.0 mm temporal and nasal corneal incisions in bilateral cataract surgery. MATERIALS AND METHODS: This prospective study comprised a consecutive case series of 60 eyes from 30 patients with bilateral phacoemulsification that were implanted with a 6.0 mm foldable intraocular lens through a 3.0 mm horizontal clear corneal incision (temporal in the right eyes, nasal in the left eyes). The outcome measures were surgically induced astigmatism (SIA) and uncorrected visual acuity (UCVA) 1 and 3 months, post-operatively. RESULTS: At 1 month, the mean SIA was 0.81 diopter (D) for the temporal incisions and 0.92 D for nasal incisions (P = 0.139). At 3 months, the mean SIA were 0.53 D for temporal incisions and 0.62 D for nasal incisions (P = 0.309). The UCVA was similar in the 2 incision groups before surgery, and at 1 and 3 months post-operatively. CONCLUSION: After bilateral cataract surgery using 3.0 mm temporal and nasal horizontal corneal incisions, the induced corneal astigmatic change was similar in both incision groups. Especially in Asian eyes, both temporal and nasal incisions (3.0 mm or less) would be favorable for astigmatism-neutral cataract surgery.

Intracameral illuminator-assisted advanced cataract surgery combined with 23-gauge vitrectomy in eyes with poor red reflex.

PURPOSE: To evaluate the efficacy and outcomes of intracameral illuminator-assisted advanced cataract surgery combined with 23-gauge vitrectomy in eyes with a poor red reflex. SETTING: Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea. DESIGN: Interventional case series. METHODS: Surgeon-controlled intracameral illumination was used for visualization during combined cataract surgery and 23-gauge vitrectomy. The main outcome measures were causes of the poor red reflex, value of the intracameral illuminator in specific cataract steps, and intraoperative and postoperative complications. RESULTS: The study comprised 17 patients (17 eyes). The main causes of a poor red reflex were vitreous hemorrhage in 8 eyes, vitreous opacity in 6 eyes, and corneal opacity, bullous retinal detachment, and globe deviation in 1 eye each. Horizontal or oblique intracameral illumination minimized the amount of corneal scatter and reflection of the illuminating light and provided high-quality intraoperative lens images in most surgical steps. In addition, excellent visibility of the lens capsules facilitated the removal of almost all lens epithelial cells from the capsular bag. In all eyes, completion of the capsulorhexis and in-the-bag implantation of an intraocular lens were accomplished. In 1 eye, a radial anterior capsule tear occurred during irrigation/aspiration. Postoperatively, the rate of anterior capsule opacification was 11.8% (2/17 eyes) and of posterior capsule opacification, 23.5% (4/17 eyes). CONCLUSIONS: Surgeon-controlled intracameral illumination provided excellent imaging and almost 360-degree visualization of the lens capsule structures. This capability can be used for challenging cataract surgery combined with vitrectomy in eyes with a poor red reflex. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Refractive errors and strabismus in Down's syndrome in Korea.

PURPOSE: The aims of this study were to examine the distribution of refractive errors and clinical characteristics of strabismus in Korean patients with Down's syndrome. METHODS: A total of 41 Korean patients with Down's syndrome were screened for strabismus and refractive errors in 2009. RESULTS: A total of 41 patients with an average age of 11.9 years (range, 2 to 36 years) were screened. Eighteen patients (43.9%) had strabismus. Ten (23.4%) of 18 patients exhibited esotropia and the others had intermittent exotropia. The most frequently detected type of esotropia was acquired non-accommodative esotropia, and that of exotropia was the basic type. Fifteen patients (36.6%) had hypermetropia and 20 (48.8%) had myopia. The patients with esotropia had refractive errors of +4.89 diopters (D, ±3.73) and the patients with exotropia had refractive errors of -0.31 D (±1.78). Six of ten patients with esotropia had an accommodation weakness. Twenty one patients (63.4%) had astigmatism. Eleven (28.6%) of 21 patients had anisometropia and six (14.6%) of those had clinically significant anisometropia. CONCLUSIONS: In Korean patients with Down's syndrome, esotropia was more common than exotropia and hypermetropia more common than myopia. Especially, Down's syndrome patients with esotropia generally exhibit clinically significant hyperopic errors (>+3.00 D) and evidence of under-accommodation. Thus, hypermetropia and accommodation weakness could be possible factors in esotropia when it occurs in Down's syndrome patients. Based on the results of this study, eye examinations of Down's syndrome patients should routinely include a measure of accommodation at near distances, and bifocals should be considered for those with evidence of under-accommodation.

Evisceration with four anterior relaxing incisions and circumferential posterior sclerotomies with porous polyethylene orbital implants: an 8-year study.

PURPOSE: To present long-term follow-up data on eviscerations carried out with scleral modification and placement of spherical porous polyethylene implants. METHODS: We conducted a retrospective, interventional study on eviscerations performed with four anterior relaxing incisions and posterior sclerotomies made circumferentially behind the equator at approximately 330° and placement of porous polyethylene spherical implant, performed between March 2000 and August 2007 by a single surgeon. Patient age, sex, causative diagnosis, axial length, implant size, follow-up duration, complications and treatment were recorded. RESULTS: In total, 92 patients were identified. The mean implant size was 19.46 mm. During the follow-up period (mean: 60 months, range: 19-107 months), there were no cases of implant exposure. In some patients, mild discharge, ptosis and conjunctival cysts developed. CONCLUSIONS: Primary evisceration with four anterior relaxing incisions and posterior sclerotomies made circumferentially behind the equator at approximately 330°, combined with porous polyethylene orbital implant placement, is a useful technique for treating a variety of end-stage eye diseases.

Changes in aqueous concentrations of various cytokines after intravitreal triamcinolone versus bevacizumab for diabetic macular edema.

PURPOSE: To investigate the changes in aqueous inflammatory and angiogenic cytokine levels after intravitreal injection of triamcinolone or bevacizumab for reducing foveal thickness in diabetic macular edema (DME). DESIGN: Prospective, interventional case series. METHODS: Twenty-two eyes of 11 patients with bilateral DME and 6 eyes of 6 patients undergoing cataract surgery participated in this study. In each DME patient, 1 eye received an intravitreal injection of 4 mg triamcinolone acetonide and the other eye received 1.25 mg bevacizumab. Aqueous humor samples were obtained before and 4 weeks after the intravitreal injection in the DME group and before the surgery in the control group. Aqueous concentrations of interleukin (IL)-6, IL-8, interferon-induced protein (IP)-10, monocyte chemotactic protein (MCP)-1, platelet-derived growth factor (PDGF)-AA, and vascular endothelial growth factor (VEGF) were measured by multiplex bead assay. RESULTS: Before the administration of the drugs, aqueous levels of IL-8, IP-10, MCP-1, and VEGF were significantly higher in the DME group than in the control group. After intravitreal injection, foveal thickness was more decreased in the triamcinolone acetonide (IVTA) group compared with the bevacizumab (IVBe) group. IL-6, IP-10, MCP-1, PDGF-AA, and VEGF were significantly decreased in the IVTA group, but only VEGF in the IVBe group. Aqueous levels of VEGF were more decreased in the IVBe group than in the IVTA group. CONCLUSIONS: These findings suggest that the pathogenesis of DME is not only related to VEGF dependency, but also to other mechanisms suppressed by corticosteroids. We suppose that these cytokines would have an important role in both the pathogenesis of DME and the underlying mechanism of intravitreal injections.

Surgeon-controlled-endoillumination-guided irrigation and aspiration during combined 23-gauge sutureless vitrectomy and cataract surgery in eyes with poor fundus reflex.

We describe a surgeon-controlled-endoillumination-guided irrigation and aspiration (I/A) technique that can be used to polish the posterior capsule during combined 23-gauge sutureless vitrectomy and cataract surgery in eyes with a poor red fundus reflex. In a dark room with the microscope light turned off, the surgeon holds and controls a 23-gauge endoilluminator with the left hand to achieve better retroillumination during I/A. Using surgeon-controlled endoillumination, it is possible to follow and guide the posterior capsule area undergoing I/A. The excellent visibility of the posterior capsule facilitates posterior capsule polishing with no intraoperative complications.