Efficacy of Rebamipide Instillation for Contact Lens Discomfort With Dry Eye.

OBJECTIVE: To examine the effects of rebamipide ophthalmic solution on the symptoms, signs, and cytokine concentrations in tear fluid among soft contact lens (SCL) wearers with Dry eye disease (DED). METHODS: From November 2015 to June 2017, this open-label, single-arm study examined 40 eyes of 20 SCL wearers with DED who had been using daily disposable SCLs for >3 months (mean age, 30.0±8.33 years; range, 20-47 years). Signs, symptoms, and cytokine concentrations were assessed before and 4 weeks after starting 2% rebamipide ophthalmic solution 4 times/day. Dry eye disease was diagnosed according to: compromised tear dynamics (Schirmer test ≤5 mm or tear break-up time (TBUT) ≤5 sec); ocular surface abnormalities (positive vital staining with fluorescein or lissamine green); and presence of symptoms. Touch thresholds using a Cochet-Bonnet anesthesiometer were also determined for the cornea and conjunctivae. Symptoms were assessed using the 12-item Ocular Surface Disease Index questionnaire. Concentrations of cytokines in tear fluid were measured. RESULTS: Significant improvements in signs were seen for TBUT, surface abnormalities, and touch thresholds. Ocular Surface Disease Index scores likewise improved significantly in all the 12 items. Of the cytokines measured, only interleukin-1ß, interleukin-8, and monocyte chemotactic protein-1 were found in ≥60% of tear samples, with no significant differences in concentrations before and after rebamipide use. CONCLUSIONS: Rebamipide significantly improved all signs and symptoms in patients with DED who wore daily disposable SCLs. Rebamipide is effective for DED treatment with SCL wear.

The correlation between plasma osmolarity and tear osmolarity.

PURPOSE: To the correlation between plasma osmolarity (Posm) and tear osmolarity (Tosm) in patients (54 patients, 88 eyes) who underwent cataract surgery was evaluated. METHODS: Before cataract surgery, routine pre-operative biochemical tests were performed, and Posm was determined from blood samples. Also, Tosm was measured using the TearLab system, and objective signs including tear break-up time (BUT), fluorescein staining, lissamine green staining, and Schirmer's test were evaluated. Dry eye (DE) was diagnosed according to the Japanese criteria for DE. RESULTS: Of the 88 eyes, 4 were diagnosed as definite DE, 70 as probable DE, and 14 as normal. Since the number of definite DE was small, the eyes were divided into two groups: normal group (n = 14) and DE group (n = 74), which included definite DE (n = 4) and probable DE (n = 70). There was no correlation between Posm and Tosm, though Posm (293.32 mOsm/L) was significantly higher than Tosm (288.48 mOsm/L; p < 0.001). There was no significant difference in Tosm between the normal group (288.29 mOsm/L) and the DE group (288.51 mOsm/L). No patients had a Tosm higher than 310 mOsm/L even in the DE group. Correlations between Posm/Tosm and each DE sign value were not found. Of 54 patients, 18 were diabetic. Posm was significantly higher in diabetic (295.78 mOsm/L) than in non-diabetic (292.36 mOsm/L; p = 0.014) patients, while there was no significant difference in Tosm between diabetic and non-diabetic patients. CONCLUSIONS: The results suggest that Tosm is independent of Posm, and Tosm elevation in DE occurs by some local mechanisms.

Anti-epileptics alter hypothyroidism of patients with severe motor and intellectual disabilities.

Objective: Anti-epileptic drugs, such as carbamazepine (CBZ) or phenytoin, may induce hypothyroidism in epilepsy patients. We assessed thyroid function of chronic patients with severe motor and intellectual disabilities (SMID) in our hospital. Methods: We examined thyroid-stimulating hormone (TSH), free thyroxine (fT4), and free thyronine (fT3) in 73 patients with SMID (47 men and 26 women, average age 48.4 years, range 30-68 years) without thyroid hormone supplement therapy. We determined the relationship between the thyroid function of patients taking the anti-epileptic drugs CBZ, valproate (VPA), and phenobarbital, other medications including anti-psychotic drugs, and treatments without anti-epileptic or anti-psychotic drugs. Results: TSH levels were not significantly different between the groups taking CBZ (CBZ+med), other anti-epileptic drugs or anti-psychotic drugs (CBZ-med), and only medications without anti-epileptic or anti-psychotic drugs (Non-med). The CBZ+med group had significantly lower fT4 levels than the CBZ-med or Non-med groups. There was a negative correlation between thyroid function level and the phenobarbital groups. TSH levels of the VPA+med group were significantly higher than VPA-med and Non-med group; fT3 and fT4 levels were not significantly different. Conclusions: Our results indicate that hypothyroidism may be present in patients with SMID taking anti-epileptic drugs. This suggests it is important to regularly measure thyroid function in patients with SMID taking anti-epileptic drugs, especially CBZ.

The conjunctival sensitivity in soft contact lens wearers.

We determined the influence of soft contact lenses (SCLs) on conjunctival sensitivity. A total of 26 volunteers (11 males, 15 females; mean age 28.3 ± 4.6 years; range 22-39 years) without dry eye were enrolled in the study. Subjects with a low corneal touch threshold, atopic keratoconjunctivitis, or vernal keratoconjunctivitis were excluded. In 26 participants, 12 were disposable SCL wearers. Touch thresholds were determined using a Cochet-Bonnet esthesiometer with a 0-60 mm nylon monofilament in 5 mm increments. The length (mm) was converted to tension (g/mm(2)). Mean touch sense thresholds in the SCL wearers (n = 12) and non-wearers (n = 14) were 10.7 ± 2.57 and 24.6 ± 7.3 g/mm(2) in the whole conjunctiva, and 9.07 ± 3.02 and 19.2 ± 7.8 g/mm(2) in the upper palpebral conjunctiva, respectively. Significant differences were observed in all locations (p < 0.01). The enhanced conjunctival sensitivity associated with SCL use may contribute to the dry eye-like symptoms in SCL users who do not have dry eye.

Comparison of Distance-Based Uncorrected Visual Acuity Based on the Optical Profile of Same Platform IOLs.

Purpose: To compare and evaluate uncorrected visual acuity (UCVA) from far to near distance for four different optical designs of intraocular lenses (IOLs), developed on the same IOL platform. Patients and Methods: In a cohort of 121 patients, who underwent uncomplicated cataract surgery in Zengyo Suzuki Eye Clinic, Japan, between June 2018 and November 2023, and who received a single-piece TECNIS OptiBlue™ platform series IOL, the following four groups were established based on the IOL implant type: ZCB00V (TE), ZXR00V (SF), DFR00V (SG), and DIB00V (EH). UCVA at 5 m, 1 m, 70 cm, 50 cm, 40 cm, and 30 cm, as well as contrast sensitivity (with and without glare), was compared at one month post-operation. Results: Regarding diffractive IOLs, patients in the SG group demonstrated significantly improved visual acuity at 5 m, 50 cm, 40 cm, and 30 cm, while those in SF group performed significantly better at 1 m. Among non-diffractive IOLs, patients in the EH group demonstrated significantly improved visual acuity scores at 1 m, 70 cm, 40 cm, and 30 cm, compared to individuals in the TE group, with comparable results between the two groups at 5 m and 50 cm. Patients in the SF and EH groups achieved similar results for visual acuity and contrast sensitivity, while those in the SG group exhibited a distinctive decrease in contrast sensitivity (with glare) relative to the other three groups. Conclusion: DFR00V seemingly provides excellent UCVA from near to far distances, aiming for spectacle independence, although at the potential cost of decreased contrast sensitivity compared to the other three IOL types. Furthermore, although ZXR00V and DIB00V differ lens structures, they may nonetheless provide similar visual quality and spectacle independence in daily life.

The study focused on the TECNIS platform, specifically the OptiBlue lens, which is available primarily in Japan. Uncorrected visual acuity (UCVA) from far to near distance was compared and evaluated among four optical designs of intraocular lenses (IOLs), developed on the same IOL platform.

Ergonomic benefit using heads-up display compared to conventional surgical microscope in Japanese ophthalmologists.

PURPOSE: Occupational musculoskeletal disorders are prevalent in ophthalmic surgeons and can impact surgeons' well-being and productivity. Heads-up displays may reduce ergonomic stress compared to conventional microscopes. This cross-sectional, non-interventional study compared ergonomic experience between heads-up display and conventional ocular microscopes. METHODS: The study protocol was approved by the independent ethics committee and nonprofit organization MINS Institutional Review Board. An online questionnaire was distributed to a sample of ophthalmic surgeons in Japan with experience operating with heads-up display. The questionnaire captured surgeon-specific variables, the standardized Nordic Musculoskeletal Questionnaire, and custom questions to compare heads-up display and conventional microscope and understand long-term impacts of musculoskeletal disorders. RESULTS: Analysis was conducted on responses from 67 surgeons with a mean 25 years of practice and 2.7 years using heads-up display. Many surgeons agreed or strongly agreed that heads-up display reduced the severity (40%) and frequency (40%) of pain and discomfort, improved posture (61%), and improved overall comfort (61%). Of respondents who experienced asthenopia (n = 59) or pain/discomfort during operation (n = 61), 54% reported improvement in asthenopia and 72% reported feeling less pain/discomfort since using heads-up display. Overall, 69% reported preference for heads-up display. CONCLUSION: This study provides novel data on musculoskeletal disorders and the long-term impacts of ergonomic strain reported by ophthalmologists building on existing literature demonstrating ergonomic and other advantages of heads-up display. Future studies with objective ergonomic assessment are warranted to validate these findings.

Effect of a new phacoemulsification and aspiration handpiece on anterior chamber stability.

PURPOSE: To evaluate the responsiveness of 3 phacoemulsification and aspiration (PEA) systems and a new handpiece to occlusion break by measuring anterior chamber depth (ACD) and intraocular pressure (IOP). SETTING: Zengyo Suzuki Eye Clinic, Kanagawa, Japan. DESIGN: Experimental study. METHODS: ACD change during intentional occlusion breaks was observed and evaluated using the slit side view (SSV) method and IOP measurement with the Centurion Vision System (Group 1), Centurion Vision System with Active Sentry (Group 2), Infiniti Vision System (Group 3), and Constellation Vision System (Group 4). 5 eyes were included per group. Occlusion breaks were triggered at IOP of 30 mm Hg, vacuum limits of 550 mm Hg, and aspiration rate of 40 mL/min. ACD change ratio, surge duration, and surge volume were analyzed from videos of SSV and IOP measurement. RESULTS: The smallest ACD change was observed in Group 2 with SSV. ACD change ratios in Groups 1 to 4 were 17.5% ± 3.9%, 7.3% ± 1.2%, 35.7% ± 9.5%, and 74.1 ± 7.7%, respectively. Surge duration and surge volume were calculated only for Groups 1 and 2 and were significantly lower in Group 2 than in Group 1 (0.32 ± 0.03 vs 1.17 ± 0.07 seconds; 18.91 ± 4.70 vs 45.70 ± 0.83 µL). In these 2 groups, ACD change ratio correlated with surge volume. CONCLUSIONS: This study evaluated the responsiveness of 3 PEA systems and a new handpiece to occlusion breaks by measuring IOP and ACD. The Active Sentry system was useful for maintaining the ACD even during occlusion breaks.

Clinical Performance of a Hydrophobic Acrylic Diffractive Trifocal Intraocular Lens in a Japanese Population.

INTRODUCTION: In this study, clinical performance of a hydrophobic acrylic diffractive trifocal intraocular lens (IOL) with double C-loop haptics was evaluated in Japanese cataract eyes. METHODS: Twenty-three patients had bilateral cataract surgery with the implantation of a trifocal IOL with double C-loop haptics. Postoperative examinations at 6 months included assessing uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) at 5 m, uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA) at 80 cm, uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA) at 40 cm. Binocular defocus, contrast sensitivity, spectacle independence, symptoms of photic phenomena and quality of vision (QOV) were also observed. RESULTS: Twenty-three patients received 46 IOLs binocularly. Manifest refraction spherical equivalent was - 0.227 ± 0.385 D (mean ± standard deviation) at 6 months postoperatively. Binocular UDVA, binocular UIVA and binocular UNVA were - 0.101 ± 0.065, - 0.021 ± 0.079 and 0.022 ± 0.095 logMAR units, respectively. Binocular CDVA, binocular DCIVA and binocular DCNVA were - 0.151 ± 0.044, - 0.042 ± 0.067 and - 0.011 ± 0.080 logMAR, respectively. Binocular CDVA of 0.00 logMAR or better was obtained in the defocus from - 3.0 D until + 0.5 D. Only 8.7% of patients required the use of spectacles postoperatively. There were no symptoms of glare, halo and light disturbance in 78.3%, 56.5% and 69.6% of patients, respectively. QOV scores significantly improved postoperatively (P < 0.0001). CONCLUSION: The hydrophobic acrylic trifocal IOL with double C-loop haptics provides good visual performance at all distances and produces high spectacle independence rate and patient satisfaction. TRIAL REGISTRATION NUMBER: NCT04699266 (Clinicaltrials.gov).

Statistical Analysis of Factors Affecting Surgically Induced Astigmatism Following Trabeculectomy.

Purpose: To objectively evaluate surgically induced astigmatism (SIA) after trabeculectomy with mitomycin C and investigate the relationships between SIA and various factors. Patients and Methods: This retrospective study included the right eyes of 66 consecutive patients who underwent standard trabeculectomy performed in the superior temporal quadrant for the first time by a single surgeon. Keratometry recordings made before surgery and 3 months after surgery were collected to calculate the SIA in each patient. The arithmetic mean of SIA (M-SIA) and the centroid of SIA (C-SIA) were determined using vector analysis. The relationships between the magnitude of SIA and the following possible related factors were assessed: age, sex, pre-operative corneal astigmatism, pre-operative intraocular pressure (IOP), 3-month postoperative IOP, pre-operative best-corrected visual acuity (BCVA), 3-month postoperative BCVA, the number of total scleral flap sutures (T-SFS), the number of leftover scleral flap sutures without laser suture lysis at 3 months postoperatively (L-SFS), shape of the scleral flap (triangle or trapezoid), and incision type of the conjunctival flap (fornix- or limbal-based). Results: The mean (± standard deviation) M-SIA was 1.00 ± 0.85 D, and the mean C-SIA was 0.34 ± 1.28 D at 104°. The direction of C-SIA showed a trend of corneal steepening to the superior temporal location, in the direction of the scleral flap location. There were significant correlations of the magnitudes of SIA with the number of T-SFS (P = 0.001) and the number of L-SFS (P < 0.001). Conclusion: Trabeculectomy induced SIA in the direction of the scleral flap location, and scleral sutures are significantly associated with the SIA. The scleral suture may play a key role in steepening the cornea toward the scleral flap direction in post-trabeculectomy patients.

Changes in Tear Osmolarity after Cataract Surgery.

BACKGROUND: The purpose of this study was to examine changes in the ocular surface before and after phacoemulsification with small incisions and to examine the changes in tear osmolarity. METHODS: This was a prospective, observational study involving 55 eyes of 39 patients (19 male, 20 female patients; average age 72.0±7.3 years) who had cataract surgery at a Nippon Medical School Hospital between December 2013 and June 2018. Compromised tear dynamics were determined by the Schirmer test or the tear break-up time (BUT). An abnormal ocular surface was identified by positive vital staining with fluorescein or lissamine green. Moreover, tear osmolarity (Tosm) and corneal sensitivity were measured. All assessments were done preoperatively and 1 and 4 weeks (P1W and P4W) after the surgery. RESULTS: None of the operations had any complications. Operating time was 17.8±9.3 minutes. BUT was significantly decreased at P1W, and it recovered at P4W. The Schirmer test did not change significantly. The fluorescein staining score (FSS) increased significantly at P1W and recovered at P4W. The Lissamine green score (LSS) did not change significantly. Tear osmolarity increased significantly at P1W and did not recover at P4W. Corneal sensitivity decreased significantly at P1W and recovered at P4W. CONCLUSION: In the present study, there were temporary changes in dry eye-related examinations including tear osmolarity after cataract surgery. In particular, tear osmolarity increased significantly 4 weeks after surgery compared to before surgery, and it showed long-term changes, unlike other factors. After cataract surgery, tear osmolarity, BUT, and FSS increase, resulting in dry eye symptoms. Therefore, it is necessary to pay attention to discomfortable eye symptoms of patients after cataract surgery.

Serum Brain-Derived Neurotrophic Factor in Glaucoma Patients in Japan: An Observational Study.

PURPOSE: The aim of this study was to measure serum levels of brain-derived neurotrophic factor (BDNF) in Japanese patients with primary open angle glaucoma (POAG) and normal tension glaucoma (NTG). METHODS: This was a prospective observational study of serum BDNF levels in 78 patients who underwent cataract surgery or trabeculectomy (27 glaucoma patients and 51 non-glaucoma cataract patients as controls). Patient age was 68.8 ± 11.1 years (mean ± standard deviation; range 35-86 years). The numbers of patients with POAG and NTG were 16 and 11, respectively. POAG was diagnosed by intraocular pressure measurement, gonioscopy, optic nerve head change, and presence of a visual field defect. RESULTS: Serum BDNF concentration was significantly lower in the glaucoma group (including both POAG and NTG) than in the control group (7.2 ± 3.6 ng/mL vs. 12.2 ± 9.3 ng/mL, p=0.004). Serum BDNF concentration was lower in early glaucoma than in moderate glaucoma. There was no correlation between serum BDNF concentration and age. When patients with NTG and POAG were compared, serum BDNF concentration was lower in the former. Serum BDNF concentration was not significantly correlated with glaucoma parameters, including optical coherence tomography and visual field defects. CONCLUSION: This is the first study to investigate serum BDNF concentration in glaucoma patients in Japan. Future studies should evaluate the role of BDNF as a potential biomarker of glaucoma.

Brain-derived Neurotrophic Factor in the Aqueous Humor of Glaucoma Patients.

BACKGROUND: Brain-derived neurotrophic factor (BDNF) may be involved in the pathogenesis of glaucoma. BDNF concentrations reported in previous studies have varied widely, and the concentration of BDNF in aqueous humor is unknown. In this study, BDNF concentrations in the aqueous humor of glaucoma patients and control patients were measured with ELISA kits. METHODS: This prospective, observational study examined BDNF levels in aqueous humor in 62 eyes of 43 patients who underwent cataract surgery or trabeculectomy (11 glaucoma patients and 32 non-glaucoma cataract patients as controls). BDNF concentrations were examined by 4 different enzyme-linked immunosorbent assay (ELISA) techniques. RESULTS: The mean ± SD patient age was 72.0 ± 10.1 (range 35 to 87) years. Two of the techniques detected no BDNF in aqueous humor in any samples (n=3 and n=9, respectively); the average value was less than zero. An ultrasensitive ELISA kit did not yield reliable measurements. Finally, in an even more sensitive ELISA (Simoa-HD1), performed by an outside contractor, 25 (54.3%) eyes were below the detection limit, including 20 (55.6%) control and 5 (50%) glaucoma cases. For eyes with detectable BDNF, the overall BDNF concentration was 0.158 pg/mL (n=21): 0.196 pg/mL (n=16) in controls and 0.034 pg/mL (n=5) in glaucoma cases. CONCLUSIONS: BDNF level in aqueous humor varies widely.

Evaluation of the Utility of Capsular Stabilization Devices in a Zonular Fiber Defect Model with the Slit Side View System.

Capsular stabilization devices were evaluated in a zonular fiber defect model using the slit side view (SSV) system to confirm their utility for capsular stabilization during phacoemulsification. A zonular fiber defect model was made by cutting Zinn's zonule under observation with a slit lamp microscope in a porcine eye. Phacoemulsification was performed, and the movement of the lens capsule and the depth of the anterior chamber were observed using the SSV in three groups: control group: no surgical instruments used, CE group: a capsule expander was inserted, and CTR group: a capsular tension ring was inserted. In the control group, the equator of the lens was unstable and was easily suctioned to the port of the ultrasound handpiece. The lens capsule was stable in both in the CE and CTR groups. In the CTR group, the equator responsible for the zonular rupture also returned and closed true to its original position. The utility of the capsular stabilization devices in this zonular fiber defect model was confirmed with the SSV system.

Effects of Hydrogen in Prevention of Corneal Endothelial Damage During Phacoemulsification: A Prospective Randomized Clinical Trial.

PURPOSE: Hydrogen (H2) has been reported to scavenge free radicals, particularly the hydroxyl radical (·OH). Ultrasound oscillation in an aqueous solution produces ·OH. Our recent study demonstrated that H2 dissolved in an irrigation solution prevented corneal endothelial damage during phacoemulsification in an animal model. We examined the effects of H2 during clinical phacoemulsification. DESIGN: A single-center, prospective, randomized, double-masked clinical trial. METHODS: Thirty-two patients who had cataracts of similar nucleus hardness in both eyes (age: 75.4±7.68 years; 17 males, 15 females) were recruited. Phacoemulsification was performed using a solution of dissolved H2 in one eye, and a conventional solution in the contralateral eye. Endothelial cell density (ECD) at the center of the cornea was measured using noncontact specular microscopy preoperatively and at 1 day, 1 week, and 3 weeks postoperatively. RESULTS: Reduction rates of ECD (mean ± standard deviation) were 16.0%±15.7% at 1 day, 15.4%±16.1% at 1 week, and 18.4%±14.9% at 3 weeks in the control group, compared to 6.5%±8.7% at 1 day (P = .003), 9.3%±11.0% at 1 week (P = .039), and 8.5%±10.5% at 3 weeks (P = .004) in the H2 groups. These rates were significantly smaller in the H2 group at all time points. CONCLUSIONS: H2 dissolved in irrigation solution reduced corneal endothelial damage during phacoemulsification. This suggests that a considerable part of the corneal endothelial damage during phacoemulsification is caused by oxidative stress, and that H2 is useful in clinical phacoemulsification.

A Novel "Slit Side View" Method to Evaluate Fluid Dynamics during Phacoemulsification.

Due to recent technical advances in cataract surgeries, there has been a significant improvement in the safety and surgical outcomes of phacoemulsification. However, the corneal endothelium can be damaged during phacoemulsification by multiple factors. Therefore, we used a slit lamp to analyze the fluid dynamics of ophthalmic viscosurgical devices (OVDs) in the anterior chamber during phacoemulsification. In this experimental study, extracted porcine eyes were injected with OVDs stained with fluorescein through a side port of the eye and then fixed on a slit lamp microscope. After inserting a phaco tip, phacoemulsification simulation was then performed on the iris plane. Subsequent movements of OVDs in the anterior chamber were observed during the procedure by using a slit lamp microscope. Aspiration and removal of cohesive OVDs from the inside of the anterior chamber occurred within a few seconds after the ultrasonic vibration. Aspiration of dispersive OVDs occurred gradually, with some of the OVDs remaining on the side of the anterior chamber side in an irregular shape. This shape enabled the OVD to trap the air, thereby preventing the air from directly touching the corneal endothelium. Viscoadaptive OVDs remained inside the anterior chamber as a lump, with the infusion solution flowing between the corneal endothelium and the OVD, thus leading to the eventual aspiration of the OVD. Viscous dispersive OVDs remained as a lump between the corneal endothelium and the phaco tip. However, once the infusion solution flowed between the cornea and the OVD, the OVD detached from the corneal endothelium, indicating that this type would likely be aspirated and removed. This method, termed the "slit side view," enables viewing of the movement of OVDs during surgery, as well as observation of the fluid dynamics in the anterior chamber.

Irrigation port hydration in phacoemulsification surgery.

BACKGROUND: In most cases, hydration is performed by water injection into the stromal tissue with a needle. The technique is simple, however it is sometimes troublesome. PURPOSE: We describe a simple technique for hydrating the corneal stroma in cataract surgery using an irrigation port. PATIENTS AND METHODS: The technique began by pushing the irrigation port against the corneal stroma for a few seconds during phacoemulsification, which generated edema in the corneal incision that subsequently prevented leakage. This procedure is called the hydration using irrigation port (HYUIP) technique. A total of 60 eyes were randomized and placed in two groups, 30 eyes underwent surgeries using the HYUIP technique (HYUIP group) and 30 eyes underwent surgeries without the HYUIP technique (control). The three points evaluated during each surgery included 1) the occurrence of anterior chamber collapse during the pulling out of the I/A tip after inserting the intraocular lens, 2) the need for conventional hydration, and 3) watertight completion at the end stage of surgery. RESULTS: The anterior chamber collapse and the need for conventional hydration were significantly smaller in the HYUIP group compared to the control group. Regarding the self-sealing completion, no significant difference was observed between the two groups. CONCLUSION: The HYUIP technique is an effective method for creating self-sealing wound. In addition, this technique helps to prevent anterior chamber collapse.

Functional evaluation of corneal endothelium by combined measurement of corneal volume alteration and cell density after phacoemulsification.

PURPOSE: To assess a new method of functional evaluation of corneal endothelium using combined measurement of corneal volume alteration and cell density (CD) after phacoemulsification. SETTING: Nippon Medical School Hospital, Tokyo, Japan. METHODS: Phacoemulsification was performed in 28 cases. The corneal volume within 3.0 mm and 10.0 mm circles of the cornea was measured using Scheimpflug imaging (Pentacam, Oculus, Inc.) and the cell density, using specular microscopy (Noncon Robo, Konan Medical). The volume stress index (VSI), a parameter for measuring functional evaluation, was calculated by dividing the volume increase within the 3.0 mm circle (preoperative corneal volume - corneal volume at time of measurement) by the central cell density value. The resulting value is indicative of the amount of postoperative increase in corneal volume with which each corneal endothelial cell should be able to cope. RESULTS: Three months after surgery, the 3.0 mm corneal volume returned to preoperative values, while the 10.0 mm corneal volume remained significantly higher than preoperatively. The cell density values did not significantly change throughout the study. The VSI showed a significant decrease by 7 days after surgery followed by a gradual decrease until the end of the study. At 3 months, the VSI value was significantly smaller than at 1 day. CONCLUSION: The corneal volume increase after surgery may be indicative of the degree of the endothelial damage in the area; thus, the VSI may be useful in the functional assessment of the corneal endothelium.

Two cases of true exfoliation of the lens capsule after cataract surgery.

True exfoliation of the lens capsule is known to be associated with glassblower's cataract, which is caused by extended exposure to excessive heat. Furthermore, inflammation and trauma are also considered to be predisposing factors. We report two cases of true exfoliation that were confirmed after cataract surgery. Neither patient exhibited true exfoliation before cataract surgery. In addition, neither patient had a history of occupation with exposure to excessive heat, inflammation or trauma. We observed the anterior lens capsules of these two patients with slit-lamp microscopy before and after cataract surgery. True exfoliation disappeared by adhering to the anterior capsule in both cases, and there were no complications during the observation period.

Quantitative analysis of posterior capsule opacification of hydrophobic acrylic intraocular lenses.

Posterior capsule opacification (PCO) remains a common complication of modern cataract surgery, although both modification of materials used and changes in the intraocular lens (IOL) optic edge design have helped to decrease its incidence slightly. Recently, various kinds of quantitative methods have been developed for measuring PCO. The purpose of this study was to compare the quantitative analysis of PCO between different types of IOL designs. Patients enrolled in the study had age-related cataract and underwent uneventful cataract surgery and implantation of either the AcrySof MA30BA (Alcon) or the Sensor AR40e (AMO), which are differently designed hydrophobic acrylic IOLs with a sharp-edged optic design. Postoperative examination was performed at 6 months. Retroillumination photographs of each eye were obtained, and the degree of PCO was assessed using the Evaluation of Posterior Capsule Opacification (EPCO) system. Grade 1 PCO was noted in both the MA30BA and the AR40e groups. There was no significant difference in the mean PCO score between the MA30BA and AR40e groups. Although the sharp-edged optic designs of both IOLs might similarly inhibit PCO at 6 months, a long-term follow-up period is needed to determine if any PCO differences occur between these 2 hydrophobic acrylic IOLs.

Phacoemulsification associated corneal damage evaluated by corneal volume.

PURPOSE: To determine the usefulness of the Pentacam corneal volume assay in the assessment of corneal endothelial damage caused by phacoemulsification and aspiration (PEA). DESIGN: Prospective, comparative, observational case series. METHODS: PEA was performed in 85 eyes by three surgeons under different conditions. Central cell density (CD) was determined using a specular microscope before and one month after surgery. Pentacam was used before and one day, one week, and one month after surgery to determine 3- and 10-mm corneal volumes. RESULTS: For all surgeons, no significant differences in the 3-mm corneal volumes were noted between the before and one-month after surgery values. However, 10-mm corneal volumes at one month were significantly higher than preoperative levels. No correlation was noted between the increasing rate of the 10-mm corneal volume and decreasing rate of CD. CONCLUSIONS: Pentacam-determined corneal volumes may be useful in assessing PEA-caused corneal damage.