High-speed measurement of retinal arterial blood flow in the living human eye with adaptive optics ophthalmoscopy.

We present a technique to measure the rapid blood velocity in large retinal vessels with high spatiotemporal resolution. Red blood cell motion traces in the vessels were non-invasively imaged using an adaptive optics near-confocal scanning ophthalmoscope at a frame rate of 200 fps. We developed software to measure blood velocity automatically. We demonstrated the ability to measure the spatiotemporal profiles of the pulsatile blood flow with a maximum velocity of 95-156 mm/s in retinal arterioles with a diameter >100 µm. High-speed and high-resolution imaging increased the dynamic range, enhanced sensitivity, and improved the accuracy when studying retinal hemodynamics.

Analysis of the sustained release ability of bevacizumab-loaded tetra-PEG gel.

Multiple intravitreal injections, which are painful and costly, are often required in the treatment of retinal disorders. Therefore, a novel drug delivery system using hydrogels is currently being evaluated as an alternative. This study aimed to evaluate the ability of tetra-armed polyethylene glycol (tetra-PEG) gel for sustained release in vitro. Bevacizumab-loaded tetra-PEG gel and 5-Carboxyfluorescein N-succinimidyl ester (FAM-NHS)-labeled IgG-loaded tetra-PEG gel were prepared by mixing tetra-PEG with thiol termini (tetra-PEG-SH) solution, maleimide termini (tetra-PEG-MA) solution, and bevacizumab or FAM-NHS labeled IgG. The gels were prepared with three different polymer concentrations of 1.5%, 5%, and 10%, then an in vitro release study performed to assess the sustained release ability of the drug-loaded tetra-PEG gels. High performance liquid chromatography (HPLC) was used to test the structural stability of the bevacizumab released from the tetra-PEG gel. The binding of bevacizumab to tetra-PEG-SH or MA was assessed using SDS-polyacrylamide gel electrophoresis (PAGE). The bioactivity of released bevacizumab was tested using KDR/NFAT-RE HEK293 cells. In addition, in vitro degradation and swelling studies were also performed. The in vitro release analysis showed that the release of bevacizumab was slower in the 5% and 10% tetra-PEG gels than that of 1.5% tetra-PEG gels. Similarly, the release of FAM-NHS-labeled IgG was slowest in the 1.5%, 5%, and 10% tetra-PEG gels, in that order. The 5% and 10% tetra-PEG gels released bevacizumab and FAM-NHS-labeled IgG over a period of 1-2 weeks. Both bevacizumab and FAM-NHS-labeled IgG were not fully released in 2 weeks. HPLC analysis showed that the retention time of the samples released from the bevacizumab-loaded tetra-PEG gel was similar to that of the bevacizumab standard. The SDS-PAGE analysis showed that bevacizumab binds to tetra-PEG-MA. The bioactivity assay test revealed no decrease in the bioactivity of the released bevacizumab. In vitro degradation and swelling studies revealed that 1.5%, 5%, and 10% tetra-PEG gels expanded by approximately 1.4-, 2-, and 3-fold, respectively. Based on the results of the release and swelling tests, 5% tetra-PEG gels are considered good candidates for controlled release systems for therapeutic antibodies such as bevacizumab. The binding of PEG to the therapeutic antibodies may reduce the availability of therapeutic antibodies that can be released.

Comparison of 5-year safety and efficacy of laser photocoagulation and intravitreal bevacizumab injection in retinopathy of prematurity.

PURPOSE: To compare laser photocoagulation and intravitreal injection of bevacizumab (IVB) treatment for retinopathy of prematurity (ROP). METHODS: The study included 52 eyes of 26 patients after ROP treatment who were observed up to 5 years of age. Twenty-eight eyes received laser photocoagulation as the initial treatment (laser group), and twenty-four eyes underwent IVB (IVB group). We collected data on gestational age, birth weight, 1- and 5-min Apgar scores, zone and stage at the time of treatment, recurrence of ROP and best-corrected visual acuity (BCVA) (logMAR), equivalent spherical value (SE), ocular complications, and developmental delay at the age of 5. RESULTS: More zone I low-stage eyes were treated with IVB than laser. There was no difference in BCVA (p = 0.836). Although the mean SE was not different between the groups (p = 0.280), the prevalence of myopia was significantly higher in the laser group (p = 0.020). Developmental delay was observed in 3 of 14 and 3 of 12 cases in the laser and IVB groups, respectively (p = 0.596). Retinal holes were observed in 2 eyes in the IVB group, with 1 developing localized retinal detachment. There were no significant differences between the groups in the other factors. CONCLUSIONS: Compared to laser for ROP, IVB was not inferior in neurodevelopment or visual outcome and was superior in refractive error. As cases in the IVB group showed retinal holes, long-term follow-up with fundus examination is recommended after IVB.

Preoperative aniseikonia is a prognostic factor for postoperative stereopsis in patients with unilateral epiretinal membrane.

PURPOSE: To investigate stereopsis and other visual functions in patients with unilateral epiretinal membrane (ERM) and to identify vision-related parameters affecting stereopsis. METHODS: This prospective study included 63 consecutive patients who were scheduled to undergo vitrectomy for unilateral idiopathic ERM. We examined stereopsis (Titmus Stereo Test, TST; TNO stereotest, TNO), best-corrected visual acuity (BCVA), letter contrast sensitivity, severity of metamorphopsia, and degree of aniseikonia preoperatively and 6 months postoperatively. RESULTS: Preoperatively, we observed significant correlation between TST scores and other vision-related parameters except severity of metamorphopsia and between TNO score and all the vision-related parameters. Multiple regression analysis showed that preoperative TST and TNO scores were significantly associated with the degree of aniseikonia (both P < 0.01). ERM surgery significantly improved stereopsis, BCVA, contrast sensitivity, and metamorphopsia, but not aniseikonia. Postoperatively, TST was significantly associated with BCVA, and TNO showed association with BCVA and aniseikonia. Postoperative TST and TNO scores showed significant correlation with preoperative aniseikonia (P < 0.005 and P < 0.001, respectively). CONCLUSIONS: Impairment of stereopsis in patients with unilateral ERM was considered to be due to retinally induced aniseikonia. Aniseikonia did not improve by surgery, and preoperative aniseikonia can be a prognostic factor for postoperative stereopsis.

Patching retinal breaks with polyethylene glycol-based synthetic hydrogel sealant for retinal detachment in rabbits.

The purpose of this study was to evaluate absorbable polyethylene glycol (PEG)-based synthetic hydrogel as a sealant for retinal breaks in rhegmatogenous retinal detachment (RD). A three-port, 25-gauge vitrectomy was performed on nine Dutch pigmented rabbit eyes. Subsequently, RD was induced by creating a retinal break. The retina was then reattached by fluid-air exchange. In six of nine eyes (RD-PEG group), PEG sealant was applied to completely cover the retinal breaks, and then photopolymerized with light; thereafter, intravitreous air was replaced with balanced salt solution (BSS). In the remaining three eyes (RD group), PEG sealant was not applied, but the intravitreous air was replaced with BSS. Ophthalmological examinations and intraocular pressure measurements were conducted preoperatively, and at 1 and 7 days, and 1, 3, and 6 months postoperatively. Histological examinations of the eyes were performed after 6 postoperative months. At surgery, retinal reattachment with PEG sealant was achieved in all eyes in the RD-PEG group. Fundoscopic and optical coherence tomographic examinations revealed that the retina remained attached in all the eyes of the RD-PEG group throughout the 6-month observation period. Histological examination revealed no signs of damage in the retinal layers at the edges of the retinal breaks that were in contact with the sealant. In the RD group, the retinas detached in all eyes within 7 days postoperatively. The PEG sealant closed the retinal breaks and maintained retinal reattachment. Intraocular tamponade was not necessary.

Functional visual acuity in patients with successfully treated amblyopia: a pilot study.

PURPOSE: The aim of this study was to use conventional visual acuity measurements to quantify the functional visual acuity (FVA) in eyes with successfully treated amblyopia, and to compare the findings with those for contralateral normal eyes. METHODS: Nineteen patients (7 boys, 12 girls; age 7.5 ± 2.2 years) with successfully treated unilateral amblyopia and the same conventional decimal visual acuity in both eyes (better than 1.0) were enrolled. FVA, the visual maintenance ratio (VMR), maximum and minimum visual acuity, and the average response time were recorded for both eyes of all patients using an FVA measurement system. The differences in FVA values between eyes were analyzed. RESULTS: The mean LogMAR FVA scores, VMR (p < 0.001 for both), and the LogMAR maximum (p < 0.005) and minimum visual acuity (p < 0.001) were significantly poorer for the eyes with treated amblyopia than for the contralateral normal eyes. There was no significant difference in the average response time. CONCLUSIONS: Our results indicate that FVA and VMR were poorer for eyes with treated amblyopia than for normal eyes, even though the treatment for amblyopia was considered successful on the basis of conventional visual acuity measurements. These results suggest that visual function is impaired in eyes with amblyopia, regardless of treatment success, and that FVA measurements can provide highly valuable diagnosis and treatment information that is not readily provided by conventional visual acuity measurements.

In vivo retinal and choroidal hypoxia imaging using a novel activatable hypoxia-selective near-infrared fluorescent probe.

PURPOSE: Retinal hypoxia plays a crucial role in ocular neovascular diseases, such as diabetic retinopathy, retinopathy of prematurity, and retinal vascular occlusion. Fluorescein angiography is useful for identifying the hypoxia extent by detecting non-perfusion areas or neovascularization, but its ability to detect early stages of hypoxia is limited. Recently, in vivo fluorescent probes for detecting hypoxia have been developed; however, these have not been extensively applied in ophthalmology. We evaluated whether a novel donor-excited photo-induced electron transfer (d-PeT) system based on an activatable hypoxia-selective near-infrared fluorescent (NIRF) probe (GPU-327) responds to both mild and severe hypoxia in various ocular ischemic diseases animal models. METHODS: The ocular fundus examination offers unique opportunities for direct observation of the retina through the transparent cornea and lens. After injection of GPU-327 in various ocular hypoxic diseases of mouse and rabbit models, NIRF imaging in the ocular fundus can be performed noninvasively and easily by using commercially available fundus cameras. To investigate the safety of GPU-327, electroretinograms were also recorded after GPU-327 and PBS injection. RESULT: Fluorescence of GPU-327 increased under mild hypoxic conditions in vitro. GPU-327 also yielded excellent signal-to-noise ratio without washing out in vivo experiments. By using near-infrared region, GPU-327 enables imaging of deeper ischemia, such as choroidal circulation. Additionally, from an electroretinogram, GPU-327 did not cause neurotoxicity. CONCLUSIONS: GPU-327 identified hypoxic area both in vivo and in vitro.

Stereopsis after successful surgery for rhegmatogenous retinal detachment.

BACKGROUND: To evaluate stereopsis after successful surgery for unilateral rhegmatogenous retinal detachment (RD), and to investigate the relationship between stereopsis and clinical factors. METHODS: In 75 patients after RD surgery and 28 age-matched normal subjects, stereopsis was measured using the Titmus Stereo Test (TST) and TNO stereotest. Clinical data were collected, including age, gender, circumferential dimension of retinal tears, area and duration of RD, macular status, surgical procedures, postoperative spherical equivalent, and logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA), low-contrast visual acuity, postoperative lens status (phakia/pseudophakia), and presence of postoperative epiretinal membrane (ERM), to determine the factors related to stereopsis. RESULTS: Stereopsis in patients after surgery was significantly worse than normal subjects (p < 0.0001). Stereopsis in TST was significantly correlated with the area of RD (p < 0.005), difference of postoperative spherical equivalent between two eyes (p < 0.05), postoperative logMAR BCVA (p < 0.005), difference of postoperative logMAR BCVA between two eyes (p < 0.01), and low-contrast visual acuity (p < 0.05). Stereopsis in TNO stereotest showed significant association with postoperative logMAR BCVA (p < 0.05). Stereopsis in both stereotests were significantly worse in patients with macula-off RD than macula-on RD (p < 0.005, p < 0.01 respectively). No significant relationship was found between stereopsis and other factors. Multiple regression analysis revealed that macular status (on/off) had a significant correlation with both stereopsis in TST and TNO stereotest (p = 0.028, p = 0.019 respectively), whereas other clinical parameters were not relevant. CONCLUSIONS: Stereopsis is significantly deteriorated in patients after RD surgery than in normal subjects. Stereopsis was associated with the difference in refraction between two eyes, postoperative visual acuity and contrast sensitivity, and preoperative macular status.

Modeling Human Macular Cone Photoreceptor Spatial Distribution.

Purpose: The purpose of this study was to investigate the spatial distribution of human cone photoreceptors and examine cone density differences between the retinal meridians and quadrants. Method: Using adaptive optics scanning laser ophthalmoscopy, the maculae were imaged in 17 eyes of 11 subjects with normal chorioretinal health aged 54 to 72 years. We measured cone density at 325 points within the central 10 degrees radius of the retina. Cone density spatial distributions along the primary retinal meridians and in four macular quadrants (superior-nasal, superior-temporal, inferior-temporal, and inferior-nasal) were analytically modeled using the polynomial function to assess the meridional and quadrantal difference. Results: The mean and 95% confidence interval for the prediction of cone density along the primary retinal meridians was modeled with a 7-degree one-variable polynomial (R2 = 0.9761, root mean squared error [RMSE] = 0.0585). In the 4 retinal quadrants, cone density distribution was described by a 2-variable polynomial with X degree 3 and Y degree 4 (R² = 0.9834, RMSE = 0.0377). The models suggest no statistically significant difference between medians and between quadrants. However, cone density difference at corresponding spatial locations in different areas can be up to 25.6%. The superior-nasal region has more areas with high cone density, followed by quadrants of inferior-nasal, inferior-temporal, and superior-temporal. Conclusions: Analytical modeling provides comprehensive knowledge of cone distribution across the entire macula. Although modeling analysis suggests no statistically significant difference between medians and between quadrants, the remarkable cone density discrepancies in certain regions should be accounted for in applications requiring sensitive detection of cone variation.

Substrip-based registration and automatic montaging of adaptive optics retinal images.

Precise registration and montage are critical for high-resolution adaptive optics retinal image analysis but are challenged by rapid eye movement. We present a substrip-based method to improve image registration and facilitate the automatic montaging of adaptive optics scanning laser ophthalmoscopy (AOSLO). The program first batches the consecutive images into groups based on a translation threshold and selects an image with minimal distortion within each group as the reference. Within each group, the software divides each image into multiple strips and calculates the Normalized Cross-Correlation with the reference frame using two substrips at both ends of the whole strip to estimate the strip translation, producing a registered image. Then, the software aligns the registered images of all groups also using a substrip based registration, thereby generating a montage with cell-for-cell precision in the overlapping areas of adjacent frames. The algorithm was evaluated with AOSLO images acquired in human subjects with normal macular health and patients with age-related macular degeneration (AMD). Images with a motion amplitude of up to 448 pixels in the fast scanner direction over a frame of 512 × 512 pixels can be precisely registered. Automatic montage spanning up to 22.6 degrees on the retina was achieved on a cell-to-cell precision with a low misplacement rate of 0.07% (11/16,501 frames) in normal eyes and 0.51% (149/29,051 frames) in eyes with AMD. Substrip based registration significantly improved AOSLO registration accuracy.

Robust and Objective Evaluation of Superficial Punctate Keratopathy in a Murine Dry Eye Model.

Purpose: To establish a robust and objective method to evaluate (SPK) superficial punctate keratopathy in a murine dry eye model by developing a reliable photographic system. Design: Experimental study. Subjects: A murine dry eye model was generated by exorbital lacrimal gland excision. Sham-operated mice were used as healthy controls. For the sham operation, an incision was made without touching the gland. Methods: A photographic system was constructed, consisting of an LED lamp and a digital camera fitted with a zoom lens and sharp cut filter. SPK was detected by applying fluorescein solution. To validate the system, SPK was compared between dry eye mice and healthy control mice, and diquafosol (DIQUAS ophthalmic solution 3%; Santen Pharmaceutical Co., Ltd.) or cyclosporine (PAPILOCK Mini ophthalmic solution 0.1%; Santen Pharmaceutical Co., Ltd.) was used to dry eye mice. Main Outcome Measures: SPK was evaluated using the parameters of fluorescence score and fluorescein-stained area. Results: The photographs clearly indicated SPK in dry eye mice. A fluorescence score of 0 to 9 could be easily assessed, and the fluorescein-stained area was quantifiable. The fluorescein-stained area correlated with fluorescence score (correlation coefficient: 0.98), with good interobserver reliability (intraclass correlation coefficient: 0.999). The fluorescein-stained area increased significantly in dry eye mice compared with that of healthy controls (P < 0.0001). Both types of therapeutic eye drops decreased the fluorescein-stained area relative to saline-treated mice (P < 0.05 in diquafosol vs. saline; P < 0.01 in cyclosporine vs. saline). Conclusions: This newly developed system is a robust alternative for quantitative evaluation of SPK in a murine dry eye model. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Detection of Nocturnal Elevation in Intraocular Pressure Using a Home Tonometer in a Patient With Iridocorneal Endothelial Syndrome.

We report on a patient with iridocorneal endothelial (ICE) syndrome in whom intraocular pressure (IOP) elevation during the night was detected using a home tonometer. A 44-year-old woman was diagnosed with ICE syndrome in the left eye. Angle-closure attack-like symptoms, including blurred vision and headache, appeared and spontaneously resolved irregularly at bedtime. Daytime examination indicated normal IOP and no obvious signs of glaucoma such as visual field defects or fundus abnormalities. However, nocturnal IOP measurements using a home tonometer revealed temporary high IOP at the time of symptom onset. A home tonometer may be a useful tool to detect transient IOP elevation at night, even if the IOP is normal during daytime examinations.

Time course of changes in aqueous flare intensity after vitrectomy for rhegmatogenous retinal detachment.

PURPOSE: To investigate the time course of changes in aqueous flare intensity after vitrectomy for rhegmatogenous retinal detachment (RD) and to determine the clinical factors related to an increase in aqueous flare. METHODS: The present study included 22 unilateral patients with RD undergoing primary 20-gauge vitrectomy. Aqueous flare intensity was measured preoperatively and at 1 week, 2 weeks, 1 month, and 3, 6, and 12 months postoperatively using the laser flare meter. RESULTS: Before vitrectomy, aqueous flare intensity was significantly higher in eyes with RD than in contralateral normal eyes. Vitrectomy increased aqueous flare intensity, and the peak was observed at the first postoperative week. Aqueous flare intensity decreased to a stable level at 3 months postoperatively but remained significantly higher than that of contralateral and preoperative eyes throughout the observation period. Clinical factors that were found to be significantly correlated with an increase in aqueous flare intensity included 1) before the surgical procedure: extent of RD and intraocular pressure, and 2) 3 months postoperatively: size of retinal breaks, number of laser photocoagulation spots, operation time, and performance of combined cataract surgery. Multiple regression analysis revealed that aqueous flare intensity at 3 months postoperatively had significant correlation with the size of retinal breaks (P < 0.005) and the number of laser photocoagulation spots (P < 0.05). CONCLUSION: Aqueous flare intensity after vitrectomy for RD decreased to a stable level at 3 months postoperatively but remained significantly higher than the normal level. The size of retinal breaks and the degree of surgical invasion were associated with the increase in aqueous flare.

Improvement in Dacryoendoscopic Visibility after Image Processing Using Comb-Removal and Image-Sharpening Algorithms.

Recently, a minimally invasive treatment for lacrimal passage diseases was developed using dacryoendoscopy. Good visibility of the lacrimal passage is important for examination and treatment. This study aimed to investigate whether image processing can improve the dacryoendoscopic visibility using comb-removal and image-sharpening algorithms. We processed 20 dacryoendoscopic images (original images) using comb-removal and image-sharpening algorithms. Overall, 40 images (20 original and 20 post-processing) were randomly presented to the evaluators, who scored each image on a 10-point scale. The scores of the original and post-processing images were compared statistically. Additionally, in vitro experiments were performed using a test chart to examine whether image processing could improve the dacryoendoscopic visibility in a turbid fluid. The visual score (estimate ± standard error) of the images significantly improved from 3.52 ± 0.26 (original images) to 5.77 ± 0.28 (post-processing images; p < 0.001, linear mixed-effects model). The in vitro experiments revealed that the contrast and resolution of images in the turbid fluid improved after image processing. Image processing with our comb-removal and image-sharpening algorithms improved dacryoendoscopic visibility. The techniques used in this study are applicable for real-time processing and can be easily introduced in clinical practice.

Dacryoendoscopic recanalization of lacrimal passage obstruction/stenosis after radioiodine therapy for differentiated thyroid carcinoma.

PURPOSE: Radioiodine therapy, a standard treatment for differentiated thyroid carcinomas, is associated with several adverse events including lacrimal drainage system obstruction. Herein, we describe the first case of duct lumen recanalization using dacryoendoscopy for lacrimal passage obstruction and stenosis after radioiodine therapy. OBSERVATIONS: A 48-year-old female treated with radioiodine therapy for differentiated thyroid carcinoma 5 years prior presented with epiphora in both eyes. Dacryocystography showed nasolacrimal duct stenosis in the right eye and nasolacrimal duct obstruction in the left eye. Dacryoendoscopic examination revealed right common canalicular polyps, fibrosis in the right lacrimal sac, right nasolacrimal duct stenosis, and left upper and common canaliculus stenosis. Lacrimal passage recanalization with the insertion of a nasolacrimal stent tube using dacryoendoscopy was performed on the right eye. This successfully resolved the epiphora. CONCLUSIONS AND IMPORTANCE: Dacryoendoscopic examination for epiphora after radioiodine therapy may help detect early-stage nasolacrimal passage obstruction/stenosis. This condition can be resolved by recanalization and insertion of a lacrimal tube, without the need for a more invasive surgical approach such as dacryocystorhinostomy.

Assessment of conjunctival flora in eyes with lacrimal passage obstruction before and after successful dacryoendoscopic recanalisation.

BACKGROUND: To investigate conjunctival bacterial flora in eyes with lacrimal passage obstruction before and after dacryoendoscopic recanalisation with lacrimal tube intubation. METHODS: One-hundred fifty eyes with lacrimal passage obstruction that were successfully treated by dacryoendoscopic recanalisation were enrolled. Conjunctival sampling was done for each eye before and 4 months after surgery. The lower fornix was rubbed by a sterile cotton swab, and the collected samples were cultured with several agar plates. Colonies were differentiated and enumerated by standard bacteriological laboratory techniques. RESULTS: Positive bacterial growth was detected in 42.0% of all the samples before surgery, and the positivity rate significantly decreased to 26.0% after surgery (p=0.0051). The number of strains detected also decreased from 20 before surgery to 9 after surgery, especially pathogenic microorganisms decreased. In addition, drug-resistant bacteria such as penicillin-resistant Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus were detected in nine eyes before surgery but were detected only in one eye after surgery. Coagulase-negative Staphylococci and Corynebacterium spp., which are common in normal conjunctival flora, accounted for 46.5% of all the isolates before surgery and 80.9% after surgery, showing a significant increase in the rate after surgery (p<0.0001). CONCLUSIONS: This study showed that physiological recanalisation of lacrimal passage after dacryoendoscopic surgery significantly decreased the culture positivity rate of conjunctival sac and the number of microorganism strains detected. It also decreased the number of potentially pathogenic and drug-resistant bacteria and increased the percentages of indigenous bacteria, causing the normalisation of conjunctival flora.

Artificial accommodating intraocular lens powered by an ion polymer-metal composite actuator.

The current method of controlling the focus of an accommodating intraocular lens is based on ciliary muscle contraction and cannot be used in older patients with presbyopia. We aimed to develop a dynamically accommodating intraocular lens powered by a membrane-shaped ion polymer metal composite actuator that is thin enough to be inserted in the eye. This study addresses two key problems identified in our previous accommodating intraocular lens prototype: the lack of repeatability due to the use of swine lenses instead of artificial lenses and the occurrence of a sixth order aberration. Thus, we present a new accommodating intraocular lens design and a method to transfer energy to actuators. To accommodate lens deformation and depth of focus, we used a membrane-shaped ion polymer metal composite actuator, thin enough to be inserted in the eye, and used an artificial silicone lens. To prevent the sixth order aberration, we included a ring between the ion polymer metal composite actuator and the lens. Different voltage patterns were applied to the IPMC actuator and changes in focus were observed. We were able to obtain repeatability and prevent the sixth order aberration. The dioptric power changed to ±0.23 D when ±1.5 V was used; however, at >1.5 V, a large accommodating range occurred, in addition to astigmatic vision. Thus, we have developed a novel prototype that is completely artificial, allowing reproducible and repeatable results. Visual accommodative demands were successfully met; however, although astigmatic vision was lessened, it was not completely eradicated.

Improvement in Contrast Sensitivity Function after Lacrimal Passage Intubation in Eyes with Epiphora.

This prospective case series aimed to investigate the contrast sensitivity function before and after lacrimal passage intubation (LPI) in eyes with epiphora due to lacrimal passage obstruction. We included 58 eyes of 51 patients who underwent LPI for lacrimal passage obstruction. The best-corrected visual acuity (BCVA), contrast sensitivity function, and lower tear meniscus were compared before LPI and one month after lacrimal duct stent removal. The area under the log contrast sensitivity function (AULCSF) was calculated for the analyses. Lower tear meniscus was assessed using anterior segment optical coherence tomography. The BCVA was comparable (p = 0.61) before and after LPI, while AULCSF increased significantly after treatment (before LPI: 1.29 ± 0.17, after LPI: 1.37 ± 0.14, p < 0.0001). Treatment resulted in a significant increase in contrast sensitivity at all spatial frequencies, 3-18 cycles/degree (p < 0.01 for 3, p < 0.01 for 6, p < 0.0005 for 12, p < 0.05 for 18 cycles/degree). The lower tear meniscus parameters improved significantly after treatment (p < 0.005); however, no correlation between the changes in the tear meniscus and those of the AULCSF was found. The contrast sensitivity significantly improved after LPI in eyes with epiphora due to lacrimal passage obstruction.

Deterioration of contrast sensitivity in eyes with epiphora due to lacrimal passage obstruction.

PURPOSE: Epiphora causes deterioration in contrast sensitivity in some eye diseases. This study was conducted to investigate contrast sensitivity in eyes with epiphora caused by lacrimal passage obstruction. METHODS: This single-center, prospective case series enrolled 57 patients with unilateral lacrimal passage obstruction. The best-corrected visual acuity (BCVA), contrast sensitivity function, and lower tear meniscus of the affected and contralateral unaffected eyes were compared. The area under the log contrast sensitivity function (AULCSF) was calculated. RESULTS: The BCVA did not significantly differ between the affected and contralateral eyes, while the AULCSF was significantly lower in the affected eyes than that in the contralateral eyes (median 1.35, interquartile range 1.22-1.44 vs. median 1.36, interquartile range 1.28-1.46, P = 0.032). Lower tear meniscus parameters were significantly higher in the affected eyes than those in the contralateral eyes (P < 0.005). CONCLUSIONS: The contrast sensitivity function is significantly diminished in eyes with epiphora caused by lacrimal passage obstruction.

Stereopsis and retinal microstructures following macular hole surgery.

The aim of this prospective study was to evaluate the changes in stereopsis in patients who underwent vitrectomy for macular hole (MH) and assess the relationship between stereopsis and retinal microstructures. Fifty-two patients who underwent successful vitrectomy for unilateral MH and 20 control participants were recruited. We examined stereopsis using the Titmus Stereo Test (TST) and TNO stereotest (TNO), optical coherence tomography, and best-corrected visual acuity measurements, preoperatively, and at 3, 6, and 12 months postoperatively. As a result, preoperative and postoperative 3, 6, and 12-month values of stereopsis assessed by TST (log) were 2.7, 2.2, 2.2, and 2.2, respectively. TNO (log) were 2.8, 2.5, 2.4, and 2.4, respectively. Stereopsis in MH after surgery was significantly worse than that in normal participants (p < 0.001). Preoperative TST significantly correlated with MH size and defect length of external limiting membrane (ELM). Postoperative TST demonstrated significant correlation with the preoperative ELM defect length, and postoperative TNO was associated with the preoperative interdigitation zone defect length. Vitrectomy for MH significantly improved stereopsis, although not to normal levels. The ELM defect lengths, which approximately correspond to TST circles, are prognostic factors for postoperative stereopsis by TST. The interdigitation zone defect length, similar in size to the TNO index, is a prognostic factor for postoperative stereopsis by TNO.