Prevalence and associated factors of myopia among rural school students in Chia-Yi, Taiwan.

BACKGROUND: The prevalence of myopia has increased rapidly worldwide over the past few decades. The aim of this study was to evaluate the prevalence and associated risk factors for myopia in elementary and junior high school students in Chia-Yi, Taiwan. METHODS: We included 5417 students in total from Grade 1-6 (n = 4763) and Grade 7-9 (n = 654) from Chia Yi County in this population-based study. The students underwent noncycloplegic autorefractometry and an interview with a structured questionnaire. RESULTS: For this study population, the prevalence of myopia and high myopia was 42.0 and 2.0%, respectively, revealing a statistically significant increase with increasing age (p < 0.05). Junior high school students (aged 13-15) showed a greater prevalence of myopia than elementary school students (aged 7-12) (55.8% vs. 40.1%, respectively, p < 0.001). Multiple logistic regression analysis showed that associated factors of myopia were body height (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.05-1.06), body mass index (OR: 0.98, 95% CI: 0.96-1.00), and ocular alignment (horizontal heterophoria vs. orthophoria, OR: 2.37, 95% CI: 2.08-2.70; tropia vs. orthophoria, OR: 1.94, 95% CI: 1.50-2.52) for elementary school students, whereas in junior high school students, they included body height (OR: 1.02, 95% CI: 1.01-1.04) and ocular alignment (heterophoria vs. orthophoria, OR: 2.20, 95% CI: 1.56-3.10). CONCLUSIONS: This study provided epidemiological data on myopia in rural school students in Chia-Yi, Taiwan, and demonstrated the association between heterophoria and myopia. Correction of refractive errors in the students remained a challenge.

Progress on Range of Motion After Total Knee Replacement by Sensor-Based System.

For total knee replacement (TKR) patients, rehabilitation after the surgery is key toregaining mobility. This study proposes a sensor-based system for effectively monitoringrehabilitation progress after TKR. The system comprises a hardware module consisting of thetriaxial accelerometer and gyroscope, a microcontroller, and a Bluetooth module, and a softwareapp for monitoring the motion of the knee joint. Three indices, namely the number of swings, themaximum knee flexion angle, and the duration of practice each time, were used as metrics tomeasure the knee rehabilitation progress. The proposed sensor device has advantages such asusability without spatiotemporal constraints and accuracy in monitoring the rehabilitation progress.The performance of the proposed system was compared with the measured range of motion of theCybex isokinetic dynamometer (or Cybex) professional rehabilitation equipment, and the resultsrevealed that the average absolute errors of the measured angles were between 1.65° and 3.27° forthe TKR subjects, depending on the swing speed. Experimental results verified that the proposedsystem is effective and comparable with the professional equipment.

Vibrio cholerae non-O1 - the first reported case of keratitis in a healthy patient.

BACKGROUND: Vibrio cholerae non-O1 is a virulent pathogen that causes significant morbidity and mortality in humans. Herein, we report a case of corneal ulcer caused by this pathogen. CASE PRESENTATION: A 59-year-old fisherman with no systemic history was struck in the right eye by a marine shrimp and developed keratitis. Corneal scrapping culture revealed the presence of the V. cholerae non-O1, and its identification was confirmed by Analytical Profile Index 20E system and polymerase chain reaction. He was successfully treated with topical levofloxacin (0.3%) and fortified amikacin (12.5 mg/mL) for 2 weeks. The visual acuity recovered to 20/25 after treatment without complications. CONCLUSIONS: This is the first case report of keratitis caused by V. cholerae non-O1 strain. Ocular injury by marine creatures and contaminated seawater can contribute to severe corneal ulcer. Early diagnosis can be achieved by meticulous history taking and a comprehensive laboratory workup. Simultaneously, an effective antibiotic therapy can lead to a positive outcome.

Herpetic Corneal Keratopathy Management Using Ipsilateral Supratrochlear Nerve Transfer for Corneal Neurotization.

BACKGROUND: Neurotrophic keratopathy (NK) is a potentially sight-threatening condition caused by impairment in the trigeminal corneal innervations with decrease or loss of corneal sensitivity. This prospective study aimed to evaluate the outcomes of surgical neurotization of the cornea using ipsilateral supratrochlear nerve transfer in patients with herpes-induced NK. METHODS: An ophthalmologist and a plastic surgeon performed an interdisciplinary corneal neurotization in 13 eyes of 13 patients after preoperative exclusion of forehead sensation impairment. A 3-cm supra-eyebrow incision allowed for microsurgical supratrochlear nerve dissection, and a subconjunctival tunneling was performed for the nerve transfer. Neurotrophic keratopathy was assessed preoperatively and every 3 months postoperatively using slit-lamp microscopy, the corneal sensitivity test, specular microscopy, and in vivo confocal microscopy. RESULTS: The surgeries had no major complications. The average disease duration from cornea denervation to surgery was 15.2 years. The mean follow-up duration was 18.5 ± 6 months. The symptoms exhibited subjectively improved visual acuity, and objectively improved visual analog scale and NK grading. The subepithelial corneal nerve plexus was found at 9 months postoperatively. The corneal thickness decreased and the corneal endothelial count increased postoperatively. CONCLUSIONS: This is the largest series of corneal neurotization using direct ipsilateral supratrochlear nerve transfer. It is a minimally invasive method to restore corneal sensitivity and treat NK successfully within 1 year without a sural nerve graft. A long-term follow-up is needed for further assessment.

Effect of Extracorporeal Shockwave Therapy on Passive Ankle Stiffness in Patients With Plantar Fasciopathy.

Plantar fasciopathy (PF) is the most common cause of heel pain. Extracorporeal shockwave therapy (ESWT) improves the gait pattern in patients with PF. However, the effects of ESWT on the biomechanics of the ankle in these patients remains unclear. Sixteen participants were included in the present study. Of the 16 participants, 8 patients with PF were assigned to receive extracorporeal shockwave therapy, and 8 healthy participants served as an external control group. ESWT was applied to the PF group for 1500 pulses at an energy flux of 0.26 mJ/mm2 every 3 weeks for 3 sessions. The biomechanics of the ankle joints were then assessed using an isokinetic dynamometer, and a health-related quality of life questionnaire was administered at baseline and at the final follow-up session 12 weeks after the initial treatment. Passive stiffness was calculated and compared between the foot affected with PF, the opposite foot, and both feet of those in the healthy control group. The Kruskal-Wallis 1-way analysis of variance with repeated measures was performed, and statistical significance was considered present at the 5% (p ≤ .05) level. Ankle dorsiflexion in the affected limb increased from 14° ± 3° to 17° ± 2° after ESWT (p < .05). No statistically significant differences were noted in the strength of dorsiflexion or plantarflexion at baseline and after ESWT. However, a statistically significant increase in the ratio of strength in ankle dorsiflexion versus plantarflexion was found after ESWT (p < .05). No differences in the passive stiffness of the ankle joint were demonstrated. Patients reported an improved physical function score after ESWT (p < .05). An increased dorsiflexion/plantarflexion torque ratio and maximal dorsiflexion associated with decreased pain might contribute to the improved physical function after ESWT for PF.

Anti-angiogenic effect of hexahydrocurcumin in rat corneal neovascularization.

AIM: This study was to investigate the anti-angiogenic effect of hexahydrocurcumin (HHC) to evaluate gene (p-basic fibroblast growth factor (bFGF)-SAINT-18 & p-vascular endothelial growth factor (VEGF)-SAINT-18 complex)-induced corneal neovascularization (CorNV) in rats. METHODS: CorNV was induced in 24 eyes of 24 rats. Four groups (Group A: 0 µg, B: 0.01 µg, C: 0.1 µg, and D: 1 µg) of HHC were prepared and implanted into the rat subconjunctival substantia propria 1.5 mm from the limbus at temporal side. The 1 µg of p-bFGF-SAINT-18 & p-VEGF-SAINT-18 complex were prepared and implanted into the rat corneal stroma 1.5 mm from the limbus at the same side. Inhibition of CorNV was observed and quantified from day 1 to day 60. bFGF and VEGF protein expression were analyzed by biomicroscopic examination, western blot analysis, and immunohistochemistry. RESULTS: Subconjunctival injection by 1 µg HHC successfully inhibited gene-induced CorNV in rats. bFGF and VEGF protein expression were reduced after 6 days. Meanwhile, the reduction of HLA-DR expression was detected. CONCLUSIONS: Our study showed that the HHC might provide an important anti-angiogenesis factor to inhibit CorNV development at the corneal experimental angiogenesis model.

Early detection of unhealthy behaviors, the prevalence and receipt of antiviral treatment for disabled adult hepatitis B and C carriers.

BACKGROUND: Evidence indicates that hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the leading causes of liver cirrhosis and hepatocellular carcinoma. Antiviral treatments have recently been reported as successful cures. However, the prevalence rates of HBV or HCV infection, unhealthy behaviors and receipt of adequate treatment in disabled adults have not been described. The aim of this study was to examine the prevalence of HBV or HCV carriers, receipt of antiviral treatment, and early detection of unhealthy behaviors in disabled adults in Taiwan. METHODS: A population-based, cross-sectional study was conducted between July and December 2013 with 845 community-dwelling adults with disabilities aged >20 years. Statistical analyses included descriptive statistics, Chi-squared tests, and stepwise regression analysis. RESULTS: The prevalence of HBV and HCV infections was 12.9 and 14.1 %, respectively. HCV carriers tended to be older (p < 0.001) and with a lower education (p < 0.001). The majority of HBV/HCV carriers did not know the type of hepatitis infection and did not receive adequate antiviral treatment. After adjusting for potential confounding variables, regression analysis showed that the factors significantly associated with elevated liver function were HCV infection (p < 0.001), HBV infection (p = 0.001), high fasting blood glucose levels (p = 0.001), overweight (p = 0.003), older age (p = 0.027), and alcohol drinking (p = 0.028). CONCLUSIONS: There was a high prevalence of HCV infection among adults with disabilities; few received adequate antiviral treatment or early detection of unhealthy behaviors for the prevention of liver cancer. Clinicians can provide health education to help the participants and caregivers better understand the relationships between specific risk factors and liver health and can encourage HBV and HCV carriers to undergo annual physical check-ups and receive adequate treatment, as covered by the national health insurance.

Cladosporium keratitis - a case report and literature review.

BACKGROUND: Fungal keratitis is one of the major causes of infectious keratitis in tropical countries. Symptoms of fungal keratitis consist of blurred vision, redness, tearing, photophobia, pain and foreign body sensation. If not treated effectively, it could lead to blindness. Common causes include Candida spp., Fusarium spp. and Aspergillus spp.. With the limited choices of topical antifungal agents, we were faced with Cladosporium keratitis, a rare cause of fungal keratitis. CASE PRESENTATION: A 62-year-old Asian male construction worker came to us with intense ocular pain, injection of the conjunctiva, blurred vision, and foreign body sensation in his left eye. His visual acuity was 20/40 OD and 20/400 OS. Slit-lamp exam revealed a corneal ulcer with feathery margin and Descemet's membrane folding. The culture yielded Cladosporium species.. The patient did not show improvements after applying topical natamycin (5 %), topical amphotericin B (1mg/ml), topical fluconazole (2mg/ml) and oral ketoconazole (200mg). After shifting the medical regimen to voriconazole via topical and systemic routes (1mg/ml and 200mg respectively), the keratitis was controlled. CONCLUSIONS: Fungal keratitis remains a challenge for ophthalmologists as there is no evidence suggesting any particular drug or combination of drugs is more effective than another. A review of common topical antifungal agents was done. Voriconazole could be a good choice for treating corneal infection by Cladosporium species.

Development and validation of the short-form Adolescent Health Promotion Scale.

BACKGROUND: Health-promoting lifestyle choices of adolescents are closely related to current and subsequent health status. However, parsimonious yet reliable and valid screening tools are scarce. The original 40-item adolescent health promotion (AHP) scale was developed by our research team and has been applied to measure adolescent health-promoting behaviors worldwide. The aim of our study was to examine the psychometric properties of a newly developed short-form version of the AHP (AHP-SF) including tests of its reliability and validity. METHODS: The study was conducted in nine middle and high schools in southern Taiwan. Participants were 814 adolescents randomly divided into two subgroups with equal size and homogeneity of baseline characteristics. The first subsample (calibration sample) was used to modify and shorten the factorial model while the second subsample (validation sample) was utilized to validate the result obtained from the first one. The psychometric testing of the AHP-SF included internal reliability of McDonald's omega and Cronbach's alpha, convergent validity, discriminant validity, and construct validity with confirmatory factor analysis (CFA). RESULTS: The results of the CFA supported a six-factor model and 21 items were retained in the AHP-SF with acceptable model fit. For the discriminant validity test, results indicated that adolescents with lower AHP-SF scores were more likely to be overweight or obese, skip breakfast, and spend more time watching TV and playing computer games. The AHP-SF also showed excellent internal consistency with a McDonald's omega of 0.904 (Cronbach's alpha 0.905) in the calibration group. CONCLUSION: The current findings suggest that the AHP-SF is a valid and reliable instrument for the evaluation of adolescent health-promoting behaviors. Primary health care providers and clinicians can use the AHP-SF to assess these behaviors and evaluate the outcome of health promotion programs in the adolescent population.

The effectiveness of a community-based health promotion program for rural elders: a quasi-experimental design.

OBJECTIVES: A community-based health promotion program (CBHP) might be beneficial for the elderly, but evidence is limited. We therefore examined the effect of a CBHP on change of lifestyle, physiological indicators and depression score among seniors in 2 rural areas. METHODS: A prospective quasi-experimental design involved a total of 520 senior participants living in 6 rural villages, who were clustered and conveniently assigned to 2 intervention groups. Senior nursing students were the interveners for group 1 and community peer supporters for group 2. The primary outcome measure was the change in health-related behavior measured on the geriatric health promotion scale (GHPS). The secondary outcome comprised changes in the short form of the Chinese geriatric depression scale (CGDS-15), fasting blood sugar, total cholesterol, waist circumference and blood pressure. Paired-t test and analysis of covariance were used for statistical inspection. RESULTS: Most of the participants were retired farmers or fishermen >75years of age who had little education. The total scores and all subscales of GHPS, along with some physiological indicators, improved significantly between pretest and post-test in both groups. After adjustment for confounders, intervention in group 1 was more effective than that in group 2 regarding self-protection behaviors. Systolic and diastolic blood pressure was significantly lower in group 2. CONCLUSIONS: CBHP programs are valuable for improving healthy lifestyle, fasting blood sugar, blood pressure and depression score among seniors. The low cost and effectiveness of incorporating multidisciplinary resources to help rural elders to maintain a healthy status and a healthier lifestyle.

The role of cross sectional imaging in the management of acute pyogenic inguinal abscess - extrapelvic versus intrapelvic origin.

BACKGROUND: Abscesses involving the inguinal region as manifestations of complex soft-tissue infections are rare, and the infectious route is usually unclear. The purpose of this study was to ascertain the importance of imaging study and whether the clinical presentations differ between the extrapelvic and intrapelvic origin. METHODS: Patients who presented with inguinal abscess between January 2003 and December 2010 were evaluated retrospectively. All patients received broad-spectrum antibiotic therapy and debridement. Imaging studies, including computed tomography or magnetic resonance imaging, were performed in all patients to elucidate the origin and extent of infectious disease, and the results were reviewed. Clinical data, laboratory examination findings, and culture results were analyzed. RESULTS: Twenty-eight patients were enrolled in the study: 13 patients whose infections were of extrapelvic origin (Group 1) and 15 patients of intrapelvic origin (Group 2). Imaging studies yielded information that helped guiding the treatment. Gram-positive coccus infection was more frequent in Group 1 (p < 0.001), while mixed pathogen and anaerobic bacterial infection were more frequent in Group 2 (p = 0.002 and p = 0.006, respectively). Group 2 had a higher incidence of history of malignancy and chronic renal failure (p = 0.044 and p = 0.038, respectively). CONCLUSIONS: Computed tomography and magnetic resonance imaging are helpful in diagnosing cases of inguinal abscess and determining the extent of infection. In patients presenting with acute pyogenic inguinal abscess, a higher prevalence of chronic renal failure and history of malignancy were found in those with an intrapelvic, as compared with an extrapelvic, origin of infection.

Inhibition of corneal neovascularization with the combination of bevacizumab and plasmid pigment epithelium-derived factor-synthetic amphiphile INTeraction-18 (p-PEDF-SAINT-18) vector in a rat corneal experimental angiogenesis model.

Bevacizumab, a 149-kDa protein, is a recombinant humanized monoclonal antibody to VEGF. PEDF, a 50-kDa glycoprotein, has demonstrated anti-vasopermeability properties. In this study, we demonstrated that the combination of bevacizumab and plasmid pigment epithelium-derived factor-synthetic amphiphile INTeraction-18(p-PEDF-SAINT-18) has a favorable antiangiogenic effect on corneal NV. Four groups(Group A: 0 µg + 0 µg, B: 0.1 µg + 0.1 µg, C: 1 µg + 1 µg, and D: 10 µg + 10 µg) of bevacizumab + p-PEDF-SAINT-18 were prepared and implanted into the rat subconjunctival substantia propria 1.5 mm from the limbus on the temporal side. Then, 1 µgof p-bFGF-SAINT-18 was prepared and implanted into the rat corneal stroma 1.5 mm from the limbus on the same side. The inhibition of NV was observed and quantified from days 1 to 60. Biomicroscopic examination, western blot analysis and immunohistochemistry were used to analyze the 18-kDa bFGF, 50-kDa PEDF and VEGF protein expression. No inhibition activity for normal limbal vessels was noted. Subconjunctival injection with the combination of bevacizumab and p-PEDF-SAINT-18 successfully inhibited corneal NV.The bFGF and PEDF genes were successfully expressed as shown by western blot analysis,and a mild immune response to HLA-DR was shown by immunohistochemistry. We concluded that the combination of bevacizumab and p-PEDF-SAINT-18 may have more potent and prolonged antiangiogenic effects, making it possible to reduce the frequency of subconjunctival bevacizumab administration combined with a relatively safe profile and low toxicity.

Physiological exophoria did not increase the incidence of myopia in rural school children in Taiwan.

ABSTRACT: This study evaluated the incidence rate and risk factors for developing myopia in elementary school students in Chiayi, Taiwan. This prospective cohort study comprised 1816 students without myopia (grades 1 to 5 in Chiayi County). The students underwent a noncycloplegic ocular alignment examinations using an autorefractometer and completed a questionnaires at baseline and at a 1-year follow-up. A univariate logistic regression was used to assess the effects of the categorical variables on new cases of myopia. A multinomial logistic regression was then conducted. A chi-squared test was used to compare new cases of myopia in terms of ocular alignment. A Cox hazard ratio model was then used to validate factors associated with changes in ocular alignment. A P value of <.05 was considered significant. In 370 participants with new cases of myopia out of 1816 participants, a spherical error of -1.51 ±â€Š0.6 diopters was noted at follow-up. The baseline ocular alignment was not a significant risk factor for developing myopia (exophoria vs orthophoria: OR 1.26, 95% CI 0.97-1.62; other vs. orthophoria: OR 1.15, 95% CI 0.73-1.82). However, new cases of myopia (HR 1.36, 95% CI 1.14-1.61), and baseline ocular alignment (exophoria vs orthophoria: HR 3.76, 95% CI 3.20-4.42; other vs orthophoria: HR 3.02, 95% CI 2.05-4.45) were associated with exophoria at follow-up. This study provided epidemiological data on the incidence of myopia in elementary school students in Chiayi, Taiwan. It also demonstrated that physiological exophoria does not predispose patients to developing myopia.

Portable rotating grating stimulation for anisometropic amblyopia with 6 months training.

Treatment of grating stimulation has been used in amblyopia for decades, but high dropout rate and inconvenience for daily practice occur in previous studies. We developed a home-based portable system with rotating grating stimulation on a tablet. Thirty anisometropic amblyopic children were randomly allocated into the control or Grating group. They drew contour of the picture under patch of a better eye for 6 months. Best-corrected visual acuity (BCVA), grating acuity (GA), and contrast sensitivity (CS) were assessed at the baseline, 1st, 2nd, 3rd, and 6th months of training. All participants completed the 6-month training. Patched eyes of both groups exhibited no difference. Trained eyes of the control group had significantly slight improvement in BCVA and GA. In particular, the Grating group exhibited significantly higher BCVA, GA, and CS compared with those of the control group at the 3rd and 6th months of training. Moreover, percentage of the Grating group with great improvement (BCVA ≥ 0.3 or CS ≥ 0.3) was significantly larger than those of the control group at the 3rd or 6th months of training. The portable grating stimulation system demonstrates its trainability by no dropout and effectiveness by significant improvements in all assessments through a well experimental design.Trial Registration: ClinicalTrials.gov NCT04213066, registered 30/12/2019, https://clinicaltrials.gov/ct2/show/NCT04213066 .

Mycoplasma infection and ocular surface diseases: a nationwide cohort study.

Whether patients with Mycoplasma infection have an increased risk of ocular surface ulcers. Using a nation-wide database, we identified patients with a new diagnosis of Mycoplasma infection between 1997 and 2013, and compared them with age-, sex-, and index year-matched subjects without the infection. Cox proportional regression was performed to compare the risk of corneal diseases between the two cohorts. The incidence of corneal diseases was significantly higher in the 4223 patients with Mycoplasma infection than in the 16,892 patients without (7.28 vs. 5.94 per 1000 person-years, P < 0.01). The adjusted hazard ratio for the risk of corneal diseases in the study cohort was 1.21 times higher (95% CI 1.02-1.44) than that in the comparison cohort. Mycoplasma infection might be a predisposing factor for patients with keratitis.

Is Obesity a Risk or Protective Factor for Open-Angle Glaucoma in Adults? A Two-Database, Asian, Matched-Cohort Study.

Obesity contributes to multiple systemic disorders; however, extensive discussion regarding obesity and open-angle glaucoma (OAG) remains limited, and conclusions in the existing literature diverge. This study aims to analyze the risk of OAG among obese adults in Taiwan. In this study, adults (aged ≥18 years) with a diagnostic code of obesity or morbid obesity registered in the Longitudinal Health Insurance Database (LHID) 2000 and LHID2005 from 1 January 2001 to 31 December 2010 were included. All adults were traced until the diagnosis of OAG, the occurrence of death, or 31 December 2013. Risk of OAG was significantly higher in obese adults than in non-obese adults after multivariable adjustment (adjusted hazard ratio (aHR): 1.43 (95% confidence interval (CI) 1.11-1.84)/aHR: 1.54 (95% CI 1.23-1.94) in the LHID2000/LHID2005). Both databases demonstrated that young obese adults (aged ≤40 years) had a remarkably increased risk of OAG compared with young non-obese adults (aHR 3.08 (95% CI 1.82-5.21)/aHR 3.81 (95% CI 2.26-6.42) in the LHID2000/LHID2005). This two-database matched-cohort study suggests that obese adults have an increased risk of OAG. In young adults, in particular, obesity could be a potential risk factor of OAG.

Correction of Myopic Astigmatism with Topography-Guided Laser In Situ Keratomileusis (TOPOLINK).

We aim to assess the feasibility of topography-guided laser in situ keratomileusis (TOPOLINK) for correcting pre-existing and surgical-induced astigmatism. A retrospective, single center cohort study was conducted. Patients with pre-existing irregular myopic astigmatism were recruited into the primary group and those with irregular myopic astigmatism following laser in situ keratomileusis (LASIK) were recruited into the enhancement group. The changes in uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), maximum astigmatism, spherical equivalent (SE) and patient satisfaction were recorded. The Chi-square test, Mann-Whitney U test and Generalized Linear Mixed Model were utilized for the analysis in the current study. A total of 18 eyes were studied in the primary group and 14 eyes were examined in the enhancement group. One year postoperatively, the UCVA, BCVA, maximum astigmatism and SE improved significantly in both the primary and the enhancement groups (all p < 0.05). The UCVA (p = 0.046) and SE (p = 0.003) were worse in the primary group preoperatively but became similar in both groups postoperatively, while the BCVA and maximum astigmatism remained identical between groups throughout the study period (all p < 0.05). In addition, the rate of high and moderate satisfaction reached 90.0% in the primary and the enhancement groups, without significant differences (p = 0.871). In conclusion, the TOPOLINK showed high predictability and will contribute to similar outcomes between primary and postoperative irregular myopic astigmatism concerning visual acuity, refractive status and subject satisfaction.

A Novel Sequential Docking Technique: Use of Femtosecond Arcuate Keratotomy and Femtosecond Assisted Cataract Surgery Using a Pupil Expansion Ring on a Patient with Intraoperative Floppy Iris Syndrome.

PURPOSE: The purpose of this study was to evaluate the efficacy of a novel double-docking technique, incorporating the use of femtosecond laser arcuate keratotomy (FSAK) in correcting low-degree astigmatism and Malyugin ring, in a patient with intraoperative floppy iris syndrome (IFIS). METHODS: A case report of a 72-year-old man with grade 4 cataract, low-degree astigmatism (<2D), and IFIS (pupil size <4 mm, intraoperatively) is presented. The patient underwent cataract surgery using a femtosecond laser to treat low-degree astigmatism because the patient requested for the use of a multifocal  intraocular lens (IOL). The first docking was performed to complete arcuate keratotomy, produce the mainparacentesis incisions, and create clear corneal incisions. Insertion of the Malyugin ring was performed after the first docking, whereas the second one was executed to complete continuous curvilinear capsulotomy and lens fragmentation. The patient's uncorrected visual acuity (UCVA) was measured pre- and post-operatively. The complications were evaluated post-operatively and 3 months later during the follow-up visit. RESULTS: The patient's UCVA for distance improved from 0.3 (6/12 Snellen equivalent) to 0 (6/6 Snellen equivalent) logMAR post-operatively. During the follow-up visit, the patient's uncorrected near visual acuity was at J2. His corneal astigmatism changed from -1.0 Diopter @177° pre-operative to -0.12 D @173° post-operative. No other intraoperative or post-operative complications were observed. CONCLUSION: The double-docking technique, with the use of FSAK, and Malyugin ring produced successful surgical outcomes for the patient. The benefits of this technique allow surgeons to avoid changing the shape of the patient's cornea from the injection of the viscoelastic device into the anterior chamber, which could lower the femtosecond laser's precision and docking location.

Prevalence of microbial contamination in donor corneas.

BACKGROUND/PURPOSE: Postoperative infection is the most disastrous complication of penetrating keratoplasty (PK). Corneoscleral rim culture provided information regarding subsequent infections. Our aims were to identify the incidence of microbial contamination in donor corneas and to report the recovery of bacteria with two culture methods, i.e., conventional culture media after aerobic/anaerobic cotton swabs and blood culture media (Fastidious Antibiotic Neutralization [FAN]). MATERIALS AND METHODS: A total of 118 patients underwent PK. Corneoscleral rim cultures were performed using aerobic/anaerobic culture cotton swabs (Transystem™, COPAN, Italia) with subsequent convention media and blood culture media (FAN bottle, BD BACTEC™, USA). The results of the different methods were reported and analyzed. RESULTS: Microorganisms were recovered from 24 in total 118 cases (20.3%, n = 118), 14 from blood culture media (FAN) (11.8%, n = 118), 9 from conventional culture media after aerobic/anaerobic cotton swabs (7.63%, n = 118), and 2 from fungus culture (1.69%, n = 118). The most commonly identified pathogen was coagulase-negative Staphylococcus (CoNS) (n = 13, 54.2%), and more isolates of CoNS and staphylococcus aureus were recovered from blood culture media (FAN) than those from conventional culture media after aerobic/anaerobic cotton swabs (13 vs. 4, P = 0.05). Conversely, more nonfermentative Gram-negative bacilli were recovered from conventional culture media after aerobic/anaerobic cotton swabs. None of the 24 cases with positive corneoscleral rim cultures reported ocular infection for the recipients in at least 6 months' follow-up. CONCLUSION: The conventional culture media after aerobic/anaerobic cotton swabs and blood culture media (FAN) did not yield identical isolates of bacteria. The blood culture media (FAN) could further yield Gram-positive bacteria in addition to those recovered from convention media. It seemed adding gentamicin and streptomycin could achieve bacteriostatic effect instead of the bactericidal effect. The administration of postoperative antibiotic in the recipient was suggested.

Pre-eclampsia/Eclampsia as a Risk Factor of Noninfectious Uveitis Among Postdelivery Women.

PURPOSE: We sought to analyze the incidence and risk of noninfectious uveitis (NIU) among postdelivery women with a history of pre-eclampsia/eclampsia (PEE). DESIGN: Population-based retrospective matched cohort study. METHODS: All participant data were retrieved from the Longitudinal Health Insurance Database 2005. Two thousand seventy-three postdelivery women ≥20 years of age were diagnosed with PEE between January 1, 1997 and December 31, 2012 and were included in the study. We traced the occurrence of NIU during 5 years of follow-up. The primary outcome measure was the occurrence of NIU with the use of anti-inflammatory drugs and adjudication by an ophthalmologist. RESULTS: NIU occurred in 14 of 2073 (0.7%) postdelivery women with PEE. The incidence rate of NIU was 1.5 and 0.5 per 1000 person-years among postdelivery women with and without PEE, respectively (incidence rate ratio 2.96 [95% confidence interval 1.48-5.90]; P = .002). Postdelivery women with PEE demonstrated a significant increase in the cumulative incidence of NIU compared with those without PEE (P = .001). The risk of the occurrence of NIU was significantly higher in the PEE group than in the non-PEE group (adjusted hazard ratio 2.96 [95% CI 1.48-5.92]; P = .002) after adjusting for age, income, urbanization, and comorbidities. CONCLUSIONS: This is the first study to substantiate an association between PEE and NIU. Our results suggest that PEE could be a potential risk factor for the occurrence of NIU among postdelivery women.