Histopathological analysis of the association between mucosal epithelial changes and the lamina propria vascular network in irritation fibroma.

OBJECTIVES: Irritation fibroma in the oral cavity causes atrophy or squamous epithelium thickening with respect to external injury-associated factors. However, ulcers do not occur in most cases. This study aimed to elucidate the mechanism by which ulcers do not form, focusing on the vascular network in the mucosal epithelium of irritation fibroma. METHODS: Immunostaining was performed using an enzyme antibody method with primary antibodies against CD31 and Ki-67 in 17 cases of irritation fibroma in the buccal mucosa. One section was taken at three points from the margin and three points from just above the lesion for measurement. The number of blood vessels in the superficial and deep lamina propria at the measurement site were determined, and the area per blood vessel was measured. RESULTS: The number and area of blood vessels in the superficial lamina propria just below the lesion epithelium were smaller than those in the margin. No difference was observed in the number and area of blood vessels in the deep lamina propria between the margins and lesions. CONCLUSIONS: Our results suggest that the vascular network in the deep lamina propria is maintained and compensates for the nutrient supply to the covering epithelium.

Association between Sarcopenia/Lower Muscle Mass and Short-Term Regression of Deep Vein Thrombosis Using Direct Oral Anticoagulants.

Advanced age, obesity, and muscle weakness are independent factors in the onset of deep vein thrombosis (DVT). Recently, an association between sarcopenia and DVT has been reported. We hypothesized that sarcopenia related factors, observed by ultrasonography, are associated with the regression effect on the thrombus following anticoagulation therapy. The present study focused on gastrocnemius muscle (GCM) thickness and the GCM's internal echogenic brightness. We examined the association with DVT regression following direct oral anticoagulants (DOACs) treatment.The prospective cohort study period was between October 2017 and August 2018. We enrolled 46 patients diagnosed with DVT by ultrasonography, who were aged >60 years old and treated with DOACs. Sarcopenia was evaluated using the Asian Working Group for Sarcopenia flowchart. The average DOACs treatment period was 94 days, and 29 patients exhibited thrombus regression. On univariate logistic regression analysis, sarcopenia, average GCM diameter index, and gastrocnemius integrated backscatter index were significantly associated with thrombus regression. In a multivariate model, only the average GCM diameter index correlated with thrombus regression.The average GCM diameter index is associated with DVT regression treated with DOACs. Considering the GCM diameter during DVT treatment can be a marker to make a decision for the treatment of DVT.

Updated Left Ventricular Diastolic Function Recommendations and Cardiovascular Events in Patients with Heart Failure Hospitalization.

BACKGROUND: Evaluation of diastolic dysfunction is crucial in determining elevated left atrial pressure. However, a validation of the long-term prognostic value of the newly proposed algorithm updated in 2016 has not been performed. The aim of the present study was to investigate the relative value of the updated 2016 diastolic dysfunction grading system for the incidence of readmission in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). METHODS: Two hundred thirty-two patients hospitalized with HF were retrospectively evaluated. Subjects were divided into two subgroups: those with HFrEF (n = 127) and those with HFpEF (n = 105). Readmission risk scores were calculated using the Yale Center for Outcomes Research and Evaluation HF, LACE index, and HOSPITAL scores. The primary end point was readmission following HF and cardiac death. RESULTS: Over a period of 24 months, 86 patients were either readmitted or died. Multivariate Cox analysis was performed on both the HFrEF and HFpEF groups. In the HFrEF group, both the 2009 and 2016 algorithms had superior incremental value for the association of the primary end point to several readmission risk scores. In the HFpEF group, only the 2016 algorithm led to significant improvement in association with the primary end point. The 2016 algorithm had incremental value over several readmission risk scores alone. CONCLUSIONS: The recommendations of the 2016 algorithm can be useful for readmission and cardiac mortality risk assessment in patients with HFrEF and HFpEF. The use of echocardiography to estimate elevated left atrial pressure appears to identify a higher risk group and may allow a more tailored approach to therapy.

Effect of Saxagliptin on Endothelial Function in Patients with Type 2 Diabetes: A Prospective Multicenter Study.

The dipeptidyl peptidase-4 inhibitor saxagliptin is a widely used antihyperglycemic agent in patients with type 2 diabetes. The purpose of this study was to evaluate the effects of saxagliptin on endothelial function in patients with type 2 diabetes. This was a prospective, multicenter, interventional study. A total of 34 patients with type 2 diabetes were enrolled at four university hospitals in Japan. Treatment of patients was initially started with saxagliptin at a dose of 5 mg daily. Assessment of endothelial function assessed by flow-mediated vasodilation (FMD) and measurement of stromal cell-derived factor-1α (SDF-1α) were conducted at baseline and at 3 months after treatment with saxagliptin. A total of 31 patients with type 2 diabetes were included in the analysis. Saxagliptin significantly increased FMD from 3.1 ± 3.1% to 4.2 ± 2.4% (P = 0.032) and significantly decreased total cholesterol from 190 ± 24 mg/dL to 181 ± 25 mg/dL (P = 0.002), glucose from 160 ± 53 mg/dL to 133 ± 25 mg/dL (P < 0.001), HbA1c from 7.5 ± 0.6% to 7.0 ± 0.6% (P < 0.001), urine albumin-to-creatinine ratio from 63.8 ± 134.2 mg/g to 40.9 ± 83.0 mg/g (P = 0.043), and total SDF-1α from 2108 ± 243 pg/mL to 1284 ± 345 pg/mL (P < 0.001). These findings suggest that saxagliptin is effective for improving endothelial function.

Edoxaban improves acute venous thromboembolism while preserving protein C and protein S levels.

BACKGROUND: It is well known that warfarin inhibits the synthesis of vitamin K-dependent anticoagulants, including thrombin, protein C and S, and factor Xa, leading, paradoxically, to an initial hypercoagulable state. Edoxaban, a direct inhibitor of activated factor X is widely used for the treatment of acute venous thromboembolism (VTE). However, the effect of edoxaban on circulating coagulation factors, in patients with acute VTE, remains unknown. METHODS AND RESULTS: We enrolled 57 patients with acute VTE with/without pulmonary embolism treated with edoxaban (n=37) or warfarin (n=20) in a clinical setting. Before treatment and 2 weeks after treatment, we evaluated thrombotic burden using ultrasound or computed tomography angiography. We also evaluated thrombin generation, represented by prothrombin fragment F1+2; thrombus degradation, represented by D-dimer; and levels of anticoagulants, including protein C, protein S, and antithrombin III. Both edoxaban and warfarin treatment improved thrombotic burden and decreased prothrombin fragment F1+2, and D-dimer. Edoxaban treatment preserved protein C and protein S levels. In contrast, warfarin decreased protein C and protein S levels. Neither treatment affected antithrombin III. CONCLUSIONS: Edoxaban improves VTE while preserving protein C and protein S levels, thereby indicating that edoxaban improves thrombotic burden while maintaining levels of anticoagulants.

Effect of sitagliptin on the echocardiographic parameters of left ventricular diastolic function in patients with type 2 diabetes: a subgroup analysis of the PROLOGUE study.

BACKGROUND: Diabetes is associated closely with an increased risk of cardiovascular events, including diastolic dysfunction and heart failure that leads to a shortening of life expectancy. It is therefore extremely valuable to evaluate the impact of antidiabetic agents on cardiac function. However, the influence of dipeptidyl peptidase 4 inhibitors on cardiac function is controversial and a major matter of clinical concern. We therefore evaluated the effect of sitagliptin on echocardiographic parameters of diastolic function in patients with type 2 diabetes as a sub-analysis of the PROLOGUE study. METHODS: Patients in the PROLOGUE study were assigned randomly to either add-on sitagliptin treatment or conventional antidiabetic treatment. Of the 463 patients in the overall study, 115 patients (55 in the sitagliptin group and 60 in the conventional group) who had complete echocardiographic data of the ratio of peak early diastolic transmitral flow velocity (E) to peak early diastolic mitral annular velocity (e') at baseline and after 12 and 24 months were included in this study. The primary endpoint of this post hoc sub-analysis was a comparison of the changes in the ratio of E to e' (E/e') between the two groups from baseline to 24 months. RESULTS: The baseline-adjusted change in E/e' during 24 months was significantly lower in the sitagliptin group than in the conventional group (-0.18 ± 0.55 vs. 1.91 ± 0.53, p = 0.008), irrespective of a higher E/e' value at baseline in the sitagliptin group. In analysis of covariance, sitagliptin treatment was significantly associated with change in E/e' over 24 months (ß = -9.959, p = 0.001), independent of other clinical variables at baseline such as blood pressure, HbA1c, and medications for diabetes. Changes in other clinical variables including blood pressure and glycemic parameters, and echocardiographic parameters, such as cardiac structure and systolic function, were comparable between the two groups. There was also no significant difference in the serum levels of N-terminal-pro brain natriuretic peptide and high-sensitive C-reactive protein between the two groups during the study period. CONCLUSIONS: Adding sitagliptin to conventional antidiabetic regimens in patients with T2DM for 24 months attenuated the annual exacerbation in the echocardiographic parameter of diastolic dysfunction (E/e') independent of other clinical variables such as blood pressure and glycemic control. Trial registration UMIN000004490 (University Hospital Medical Information Network Clinical Trials). https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000005356 ; registered November 1, 2010.

Comparison of Tricuspid Annular Plane Systolic Excursion in Patients With Atrial Fibrillation Versus Sinus Rhythm.

Echocardiography now plays a central guiding role in the management of patients with atrial fibrillation (AF). However, the current guidelines mention little about the presence AF during the assessment of echocardiographic variables in the clinical setting. AF itself may impact on tricuspid annular plane systolic excursion (TAPSE) as a right ventricular systolic function compared with sinus rhythm (SR). The aim of this study was to compare and assess the echocardiographic parameters including TAPSE in patients with AF and SR. From January 1, 2013, to September 30, 2014, patients with AF without any cardiovascular disease were retrospectively evaluated using echocardiography. Age-, gender-, and left ventricular ejection fraction-matched patients with SR were selected from our database on the basis of a comprehensive history, physical examination, and echocardiographic findings. During the study period, we identified 239 patients with AF (74 ± 9 years; 65% men) and without any cardiac disease who underwent echocardiography. We also included 281 patients in the SR group (74 ± 8 years; 67% men). In all study subjects, TAPSE in AF was smaller than in SR regardless of age (17 ± 3 vs 20 ± 3 mm, p <0.001). In the stepwise multiple regression model, TAPSE was strongly associated with the presence of AF (standardized ß = -0.362, p <0.001) and stroke volume index (standardized ß = 0.173, p <0.001) after adjustment for age, gender, heart rate, left ventricular ejection fraction, and tricuspid regurgitant grade. In conclusions, patients with AF had lower TAPSE than those with SR regardless of age. When we assess TAPSE in the clinical setting, we must pay attention to the presence of AF.

Clinical Utility of Measuring Epicardial Adipose Tissue Thickness with Echocardiography Using a High-Frequency Linear Probe in Patients with Coronary Artery Disease.

BACKGROUND: The relationship between epicardial adipose tissue (EAT) and coronary artery disease (CAD) has recently attracted a great deal of attention in the medical community. The objective of this study was to determine whether measuring EAT thickness in the anterior interventricular groove (AIG) using echocardiography is feasible and whether this index can be a marker of CAD. METHODS: A total of 311 patients (mean age, 67 ± 11 years; 208 men) who underwent coronary angiography between December 2011 and December 2013 were prospectively enrolled. EAT-AIG thickness and EAT thickness on the free wall of the right ventricle (RV) were measured in systole using a high-frequency linear probe. Seventy-one patients who underwent multidetector-row computed tomography were enrolled to validate the method for measuring EAT thickness using echocardiography. Subjects were divided into two groups, those with and without significant coronary stenosis, on the basis of findings on coronary angiography (≥ 75% luminal narrowing). RESULTS: EAT-AIG thickness measured using echocardiography was validated by computed tomography. EAT-AIG thickness was strongly correlated with EAT volume (r = 0.714, P < .001). The CAD group had thicker EAT-AIG than the non-CAD group (8.3 ± 3.0 vs 6.3 ± 2.5 mm, P < .001). EAT-RV thickness was greater in the CAD group than in the non-CAD group (5.0 ± 2.1 vs 4.4 ± 2.3 mm, P = .009) as well. The area under the curve on receiver operating characteristic curve analysis of EAT-AIG thickness for predicting CAD was 0.704, which was higher than the EAT-RV thickness. CONCLUSIONS: Measuring EAT thickness using echocardiography with a high-frequency linear probe was validated with computed tomography. EAT-AIG was thicker in the CAD group than in the non-CAD group, as was EAT-RV thickness. This noninvasive index may have potential as a diagnostic marker for predicting coronary atherosclerosis.

Subclinical Carotid Atherosclerosis Burden in the Japanese: Comparison between Okinawa and Nagano Residents.

AIM: The prevalence of overweight and a change in atherosclerotic lipid profiles may be linked to region-specific differences in atherosclerotic diseases. We evaluated whether the lipid phenotype could be linked to region- and sex-specific differences in the degree of atherosclerosis. METHODS: Non-diabetic subjects included Okinawa (n=1674) and Nagano (n=1392) residents aged 30-75 years who underwent carotid ultrasonography for the measurement of maximum intima-media thickness (max IMT). RESULTS: Average max IMT was higher in Okinawa men and women, and the increase in max IMT with age was enhanced in men. Multiple regression analysis showed that in addition to age and systolic blood pressure, low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol were IMT determinants only in men for both Okinawa and Nagano. Meanwhile, HDL-cholesterol was a determinant for Okinawa men and women, but not for Nagano men and women. CONCLUSIONS: This is the first report to show region- and sex-specific differences in the determinants for max IMT in a Japanese population. The evaluation of the relationship between lipid profile patterns and region- and sex-specific differences in carotid atherosclerosis burden may be required.

Comparison of carotid plaque tissue characteristics in patients with acute coronary syndrome or stable angina pectoris: assessment by iPlaque, transcutaneous carotid ultrasonography with integrated backscatter analysis.

BACKGROUND: The association of the tissue characteristics of carotid plaques with coronary artery disease has attracted interest. The present study compared the tissue characteristics of carotid plaques in patients with acute coronary syndrome (ACS) with those in patients with stable angina pectoris (SAP) using the iPlaque system, which is based on ultrasound integrated backscatter. METHODS AND RESULTS: Carotid ultrasound examinations were performed in 26 patients with ACS, and 38 age- and gender-matched patients with SAP. Neither plaque area nor maximal intima-media thickness differed significantly between the two groups. However, the average integrated backscatter value within the plaque was greater in the ACS patients than in the SAP patients. iPlaque analysis revealed that the percentage blue area (lipid pool) was greater in the ACS patients than in the SAP patients (43.4 ± 11.2 vs 18.3 ± 10.3%, p < 0.0001), and that the percentage green area (fibrosis) was lower in the ACS than in the SAP patients (7.5 ± 7.5% vs 20.7 ± 11.7%, p < 0.0001). CONCLUSIONS: The lipid component of carotid plaques is greater in ACS patients than in SAP patients. Our iPlaque system provides a useful and feasible method for the tissue characterization of carotid plaques in the clinical setting.

Long-term clinical outcomes of toric intraocular lens implantation in cataract cases with preexisting astigmatism.

PURPOSE: To evaluate the long-term clinical outcomes and rotational stability of toric intraocular lenses (IOLs) to correct preexisting astigmatism in cataract patients. SETTING: Kitasato University Hospital, Kanagawa, Japan. DESIGN: Prospective observational study. METHODS: Phacoemulsification with implantation of a toric IOL (Acrysof IQ toric SN6AT) was performed in cataract patients with corneal astigmatism. The postoperative follow-up was up to 2 years. RESULTS: This study enrolled 378 eyes of 302 patients with a mean age of 63.4 years ± 16.9 (SD). The corrected distance visual acuity 3 months postoperatively was 20/25 or better in 94.7% of eyes. The mean refractive cylinder was -1.92 ± 1.45 diopters (D) preoperatively, -0.59 ± 0.62 D 3 months postoperatively (322 eyes), and -0.67 ± 0.90 D at 2 years (73 eyes). There were statistically significant differences between the preoperative and 3-month postoperative measurements (P<.001, Wilcoxon signed-rank test). The mean IOL misalignment was 4.1 ± 3.0 degrees 2 years postoperatively. The mean IOL rotation was 4.5 ± 4.9 degrees within 1 day postoperatively. The rotation was more than 20 degrees in 6 eyes, all of which had an axial length (AL) of more than 25.0 mm. All rotations occurred within 10 days postoperatively. CONCLUSIONS: Toric IOLs were effective in reducing preexisting corneal astigmatism and had overall good rotational stability. A large degree of IOL rotation might occur in eyes with a relatively long AL, especially during the early postoperative period. The 6 rotated IOLs were implanted to correct with-the-rule astigmatism. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Binocular function in patients with pseudophakic monovision.

PURPOSE: To evaluate the relationship between ocular deviation and stereopsis and fusion in patients who had pseudophakic monovision surgery. SETTING: Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. DESIGN: Retrospective comparative case series. METHODS: Patients had surgical monovision correction with monofocal intraocular lens placement followed by routine postoperative examinations. The alternate prism cover test was used to measure motor alignment. Sensory tests for binocularity included sensory fusion determinations using the Worth 4-dot test, near stereopsis test, and fusion amplitude measured with a prism bar. Patients with monovision were categorized as having small-angle exophoria (≤10.0 prism diopters [Δ]) or moderate-angle exophoria (>10.0 Δ). RESULTS: This study comprised 60 patients with a mean age of 70.2 years ± 7.7 (SD). The difference in the mean stereopsis values between patients with small-angle exophoria and patients with moderate-angle exophoria was statistically significant (P<.001). In the moderate-angle exophoria group, 10 patients (62.5%) developed intermittent exotropia after surgery; however, no serious ocular deviation problems were observed. The fusion amplitudes in patients with pseudophakic monovision were approximately similar to normal values. Patients with moderate-angle exophoria were more likely to fail the Worth 4-dot test than those with small-angle exophoria. CONCLUSIONS: In patients with pseudophakic monovision having a near exophoria angle of more than 10.0 Δ, the possibility of changes in ocular deviation and stereopsis after surgery is a concern. Moreover, the application of monovision in patients with a previous moderate-angle exophoria should be carefully considered. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Five-year follow-up of ocular deviation in bilaterally pseudophakic patients.

PURPOSE: To investigate long-term ocular deviation in patients who had undergone implantation of a monofocal intraocular lens (IOL) in both eyes. METHODS: Eighty-eight patients with exophoria (average age, 68 ± 8 years; average axial length, 23.9 ± 0.9 mm) scheduled for bilateral phacoemulsification and monofocal IOL implantation were recruited. Before surgery and at 1, 3, and 6 months and 1, 2, 3, 4, and 5 years after surgery, we assessed ocular deviation near stereopsis in patients wearing their normal spectacles. RESULTS: At 5 years after surgery, near stereopsis had a median value of 50 arcsec and the mean stereopsis was 85.8 ± 101.8 arcsec; 85 patients (85%) had good stereopsis (ie, ≥100 arcsec). Of the total patients, 12.5% shifted from exophoria to intermittent strabismus or exotropia at near vision, and near stereopsis decreased. Most of them had a preoperative near exophoria angle of more than 12 prism diopters. CONCLUSION: In bilaterally pseudophakic patients with a near exophoria angle of more than 12 prism diopters, we should be concerned about the possibility of variations in ocular deviation and stereopsis after cataract surgery.

Five-year clinical study of patients with pseudophakic monovision.

PURPOSE: To assess the long-term clinical outcomes and acceptability of pseudophakic monovision. SETTING: Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. DESIGN: Case series. METHODS: Patients who had surgery using the monovision method with monofocal intraocular lenses had routine postoperative examinations. Assessed were visual acuity, near stereopsis, ocular deviation, patient satisfaction, and the rate of spectacle dependence preoperatively and 1, 3, and 6 months and 1, 2, 3, 4, and 5 years postoperatively. RESULTS: The study enrolled 54 patients with a mean age of 74.7 years ± 7.9 (SD). The mean difference in the spherical equivalent refractive error between eyes of each patient was 2.13 diopters. The binocular uncorrected distance visual acuity was at least 0.10 logMAR in 98% of patients, with 76% achieving Jaeger 2 or better binocular uncorrected near visual acuity. Near stereopsis in patients who shifted from exophoria to intermittent exotropia decreased, although no serious problems were observed. The rate of spectacle dependence was 88% preoperatively, 41% at 1 year, and 22% at 5 years. Patient satisfaction improved gradually during the follow-up. CONCLUSION: Pseudophakic monovision was an effective approach for correcting presbyopia throughout the 5-year observation period; however, a longer follow-up, including further studies is necessary to allow selection of appropriate patients. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

[Corneal astigmatism before cataract surgery].

PURPOSE: To investigate the distribution of corneal astigmatism, and the relationship of astigmatism to the patients' age in a large number of pre-cataract surgery patients. MATERIALS AND METHOD: We retrospectively examined 12428 eyes of 7187 patients (5396 eyes of men, 7032 eyes of women) who underwent cataract surgery at Kitasato University Hospital from April, 2002 to September, 2009. The mean patients' age at the time of surgery was 69.9 +/- 12.1 years. We determined corneal astigmatism using an Auto Refract Keratometer ARK-700A, a RKT-7700 (Nidek), a RK-F1 (Canon) and a Retinomax K-plus2(Righton). We carried out these measurements at least three times for each patient, and the average values were used for analysis. RESULTS: The mean corneal astigmatism was 1.02 +/- 0.81 D (0 to 14.75 D). The percentage of 1 D or less of corneal astigmatism was 63.6%, that of more than 1 D and 1.5 D or less was 20.9%, that of more than 1.5 D and 2 D or less was 7.4%, that of more than 2 D and 2.5 D or less was 3.8% and that of more than 2.5 D and 3 D or less was 1.8%. Neither significant laterality nor age difference in corneal astigmatism were found. The prevalence of with-the-rule astigmatism (WTR) was common in young population, whereas the prevalence of against-the-rule astigmatism(ATR) increased in the older population, whereas the prevalence of oblique astigmatism remains unchanged. CONCLUSIONS: Approximately two thirds of the preoperative patients had 1 D or less corneal astigmatism, and the remaining one third had over 1 D corneal astigmatism. The frequency of WTR was greater at a younger age, and that of ATR, at an older age.

Evaluation of corneal biomechanical parameters after simultaneous phacoemulsification with intraocular lens implantation and limbal relaxing incisions.

PURPOSE: To determine whether alterations in architecture cause corneal biomechanical changes after simultaneous cataract surgery and limbal relaxing incisions (LRIs). SETTING: Department of Ophthalmology, Kitasato University, Kanagawa, Japan. DESIGN: Observational case series. METHODS: This study longitudinally assessed corneal hysteresis (CH) and the corneal resistance factor (CRF) using the Ocular Response Analyzer in eyes having cataract surgery with LRIs. The relationship between these biomechanical parameters and central corneal thickness (CCT), measured using an ultrasound pachymeter, was also assessed. RESULTS: The mean CH was 10.0 mm Hg ± 1.2 (SD) preoperatively, 9.0 ± 1.6 mm Hg 1 day postoperatively, 9.7 ± 1.4 mm Hg at 1 week, 9.6 ± 1.4 mm Hg at 1 month, and 10.2 ± 1.3 mm Hg at 3 months. The mean CRF was 10.0 ± 1.5 mm Hg, 8.9 ± 1.6 mm Hg, 9.5 ± 1.5 mm Hg, 9.5 ± 1.4 mm Hg, and 9.5 ± 1.4 mm Hg, respectively. There were significant differences between preoperative and 1-day postoperative measurements (P=.005, CH; P=.004, CRF). The CH and CRF were significantly correlated with CCT (r = 0.33, P=.04 and r = 0.40, P=.01, respectively) 3 months postoperatively. CONCLUSIONS: The CH and CRF values decreased 1 day after simultaneous cataract surgery with LRIs but soon recovered to preoperative levels, suggesting there were no significant changes in corneal biomechanical factors after 1 day. Corneal thickness may play a role in biomechanical factors even in such eyes.

Time course of corneal biomechanical parameters after phacoemulsification with intraocular lens implantation.

PURPOSE: To assess the time course of corneal biomechanical parameters after phacoemulsification with intraocular lens implantation. METHODS: We examined 54 eyes of 33 consecutive patients undergoing cataract surgery. We quantitatively assessed the values of corneal biomechanics characterized by corneal hysteresis (CH) and corneal resistance factor (CRF) using an Ocular Response Analyzer before and 1 day, 1 week, 1 month, and 3 months after surgery. We also investigated the relationship between these biomechanical parameters and central corneal thickness 3 months after surgery. RESULTS: The CH was 9.7 ± 1.1 (mean ± SD) mm Hg preoperatively, and 9.0 ± 1.4, 9.7 ± 1.1, 9.7 ± 1.1, and 9.7 ± 1.3 mm Hg 1 day, 1 week, 1 month, and 3 months postoperatively, respectively. The CRF was 9.5 ± 1.1 mm Hg preoperatively, and 8.8 ± 1.2, 9.2 ± 1.3, 9.1 ± 0.9, and 9.2 ± 1.2 mm Hg 1 day, 1 week, 1 month, and 3 months postoperatively, respectively. Multiple comparisons demonstrated significant differences between measurements made before and 1 day after surgery (P = 0.01 for CH and CRF, Dunnett test). Both CH and CRF were significantly correlated with central corneal thickness (Pearson correlation coefficient r = 0.29; P = 0.03 for CH and r = 0.42; P = 0.002 for CRF). CONCLUSIONS: Both CH and CRF decreased briefly at 1 day after cataract surgery but soon recovered to the preoperative levels, suggesting that cataract surgery does not induce a significant change in corneal biomechanics, except for 1 day postoperatively. The corneal thickness may play some role in corneal biomechanics even in postcataract eyes.

Assessment of visual performance in pseudophakic monovision.

PURPOSE: To assess the visual performance and acceptability of pseudophakic monovision and examine its relationship to age. SETTING: Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. METHODS: This retrospective study examined patients with pseudophakic monovision using monofocal intraocular lenses. Refractive errors, visual acuity at various distances, contrast sensitivity, and near stereopsis were measured. Patient satisfaction with monovision was evaluated using a questionnaire. RESULTS: Eighty-two patients (age 49 to 87 years) were evaluated. The mean difference in spherical equivalent refractive error between each patient's eyes was 2.27 diopters. Most patients had a binocular uncorrected visual acuity of 0.10 logMAR or better at all distances. For contrast sensitivity, binocular summation was observed at 1.5 to 6.0 cycles per degree. Near stereopsis was in the normal range, which was up to 100 seconds of arc. Questionnaire responses showed that 81% of patients (64% <60 years; 87% between 60 years and 70 years; 94% older than 70 years) were satisfied with the results. CONCLUSION: Pseudophakic monovision was an effective approach for managing loss of accommodation after cataract surgery in patients older than 60 years; however, a careful selection process is required.

[Assessment of visual function and satisfaction in pseudophakic monovision].

PURPOSE: To investigate the visual function and acceptability of pseudophakic monovision in relation to age. METHODS: We examined 82 cases (age: 49-87 years) with pseudophakic monovision. All cases were undergone monovision using monofocal intraocular lens (IOLs). The cases were classified into three groups based on their age (A, less than 60 years; B, between 60 to 70 years ; and C, more than 70 years). Refractive error, visual acuity at various distances, contrast sensitivity, and near stereopsis were measured. Using a questionnaire, patient satisfaction before and after cataract surgery was evaluated. RESULT: The mean difference in spherical equivalent refractive error between both eyes was 2.27 D (A, 2.39D; B, 2.30D; and C, 2.20 D). Most cases had a binocular uncorrected visual acuity of 20/25 or better at all distances. For contrast sensitivity, binocular summation was observed at 1.5 to 6 cycles/ degree. Near stereopsis was in the normal range, which was less than or equal to 100 seconds of arc. Moreover, it was found that 82% of the patients were satisfied with the results (A, 68%; B, 86%; and C, 93%). CONCLUSION: Pseudophakic monovision may be an effective approach for managing loss of accommodation after cataract surgery especially in patients over 60 years of age. However, careful selection of patients should be carried out.