In Vivo Human Lacrimal Gland Imaging Using an Ultrasound Biomicroscopy.

Purpose: In the present study, we introduce human lacrimal gland imaging using an ultrasound biomicroscopy (UBM) with a soft cover and show their findings. Methods: The representative UBM findings of palpebral lobes in seven subjects (4 with non-Sjögren dry eye syndrome, 1 with Sjögren syndrome, and 2 healthy subjects) were described in this study. To prolapse the palpebral lobe, the examiner pulled the temporal part of the upper eyelid in the superotemporal direction and directed the subject to look in the inferonasal direction. We scanned the palpebral lobes longitudinally and transversely using UBM. We used an Aviso UBM (Quantel Medical, Clermont-Ferrand, France) with a 50 MHz linear probe and ClearScan. Results: In UBM of two healthy subjects, the echogenicity of the lacrimal gland was lower than that of the sclera and homogeneous. But, the parenchyma of a patient with Sjögren dry eye syndrome was quite inhomogeneous compared to the healthy subjects. In two patients with dry eye syndrome, we were able to observe some lobules in the parenchyma. We could find excretory ducts running parallel at the surface of the longitudinal section in some subjects. In the longitudinal UBM scan of a subject, we observed a tubular structure at a depth of 1500 µm that was considered a blood vessel. It ran from the superonasal to the inferotemporal direction. In a subject, we observed a large cyst beneath the conjunctiva. Conclusions: Lacrimal gland imaging using UBM has both advantages of OCT and sonography, and could be useful for evaluating dry eye syndrome.

One-year Outcomes of Ultrathin Descemet Stripping Automated Endothelial Keratoplasty Combined with Cataract Surgery in the Korean Population.

PURPOSE: To evaluate the refractive outcomes after ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) combined with phacoemulsification and intraocular lens implantation (triple procedure) in the South Korean population. METHODS: This retrospective observational study included 37 eyes of 36 patients who underwent the UT-DSAEK triple procedure between 2012 and 2021 in a single tertiary hospital. Preoperative and postoperative refractive outcomes and endothelial parameters at 1, 3, 6, and 12 months were observed. RESULTS: At the final postoperative 12-month period, the average best-corrected visual acuity was 0.4 ± 0.5 in logarithm of the minimum angle of resolution. The mean endothelial cell density at 12 months was 1,841.92 ± 731.24 cells/mm2, indicating no significant endothelial cell loss compared to the baseline (p = 0.128). The mean postoperative central corneal thickness at 12 months was 597.41 ± 86.26 µm. The postoperative mean absolute error at 12 months was 0.96 ± 0.89 diopters (D) and mean error was 0.89 ± 0.97 D. CONCLUSIONS: The results of our South Korean cohort study on UT-DSAEK triple surgery showed favorable and safe outcomes. Regardless of graft thickness, it should be noted that a hyperopic shift of 1.00 to 2.00 D needs to be considered in the case of UT-DSAEK triple surgery.

Retrospective Analysis of a New Intrastromal Dissection Technique Using the Retinal Reflex for Deep Anterior Lamellar Keratoplasty.

PURPOSE: The purpose of this study was to describe a new surgical technique for deep anterior lamellar keratoplasty. METHODS: All pupils in the recipient eyes were dilated preoperatively. Vertical grooving was performed using a crescent blade with a width of 5 mm and a depth of one-third to half corneal thickness on the temporal side of the limbus. Stromal dissection was performed as close as possible to Descemet membrane by observing the gap between the gold line by retinal reflex and the front edge of the crescent blade. Lamellar dissection was performed along the lamellar plane using corneal dissectors. The ophthalmic viscoelastic device was injected into the intrastromal pocket to separate the anterior and posterior stroma and an anterior corneal lamella was excised. A donor cornea was sutured into the recipient bed. RESULTS: In 18 eyes, none of the patients had Descemet membrane rupture during surgery. The mean postoperative residual stromal thickness was 80 ± 31 µm. The mean central corneal thickness after surgery was 660 ± 69 µm. At the last follow-up, the cornea was cleared in all 18 eyes on slit-lamp examination. CONCLUSIONS: We estimated the residual stromal thickness based on the gap between the gold line by the retinal reflex and crescent blade, and intrastromal lamellar dissection was performed using a smooth corneal dissector. Consequently, the surface of stromal dissection was smooth, and the residual stromal thickness was even.

Causes and outcomes of implantable collamer lens explantation in patients with corneal endothelial cell loss.

PURPOSE: To investigate the correlated factors of corneal endothelial cell density (ECD) loss and ECD change in implantable collamer lens (ICL) explantation patients. SETTING: Seoul St. Mary's Hospital, Seoul, South Korea. DESIGN: Retrospective analysis. METHODS: The study cohort consisted of 93 eyes from 50 patients who underwent ICL explantation. Correlation analysis was performed to assess the ocular parameters associated with ECD loss, while percentage of ECD change (ΔECD%) was monitored up to 6 months postoperatively. Receiver operating characteristic (ROC) curve was used to set cutoff values of ocular parameters to prevent ECD loss after explantation. RESULTS: In multiple regression analysis, high vaulting, high vaulting/anterior chamber depth (ACD), low anterior chamber angle (ACA), and high iris pigmentations are the significant factors of ECD loss. At postoperative 6 months, 14 eyes (15.1%) had decrease (10.5% loss), 47 eyes (51.0%) were stationary, and 32 eyes (34.4%) had increase (12.7% gain) of ECD. The ROC curve analysis showed that vaulting had the highest area under the curve (AUC = 0.822), followed by vaulting/ACD (AUC = 0.821), ECD (AUC = 0.753), and ACA (AUC = 0.723) (all P < .01). Preoperative ECD showed a sensitivity of 77.6% and specificity of 86.7% in preventing ECD loss after explantation, with a cutoff value of 1722 cells/mm 2 , as determined by ROC curve analysis. CONCLUSIONS: Our study demonstrated that high vaulting is a significant factor in ECD loss among ICL-inserted patients. To prevent continuous ECD loss in ICL patients, close monitoring of ECD and making appropriate decisions regarding explantation may be necessary.

Standard- and large-sized eggs of Trichuris trichiura in the feces of schoolchildren in the Yangon Region, Myanmar: Morphological and molecular analyses.

Standard- and large-sized eggs of Trichuris trichiura were found in the feces of schoolchildren in Yangon, Myanmar during epidemiological surveys and mass deworming with albendazole in 2017-2019. The standard-sized eggs were identified as those of T. trichiura, but it was necessary to exclude the possibility of the large-sized eggs belonging to Trichuris vulpis, a dog whipworm. We conducted morphological and molecular studies to determine the species of the 2 types of Trichuris eggs. Individual eggs of both sizes were isolated from Kato-Katz fecal smears (n=20) and mechanically destroyed using a 23G injection needle. Nuclear DNA was extracted, and the 18S rRNA region was sequenced in 15 standard-sized eggs and 15 large-sized eggs. The average size of standard-sized eggs (T. trichiura) was 55.2×26.1 µm (range: 51.7-57.6×21.3-28.0 µm; n=97), whereas the size of large-sized eggs was 69.3×32.0 µm (range: 65.1-76.4×30.1-34.5 µm; n=20), slightly smaller than the known size of T. vulpis. Regarding standard-sized eggs, the 18S rRNA nucleotide sequences exhibited 100% homology with T. trichiura deposited in GenBank and 88.6-90.5% homology with T. vulpis. Regarding large-sized eggs, the nucleotide sequences showed 99.8-100% homology with T. trichiura in GenBank and 89.6-90.7% homology with T. vulpis. Both standard- and large-sized eggs of Trichuris spp. found in Myanmar schoolchildren during 2017-2019 were morphologically and molecularly confirmed to belong to T. trichiura. The conversion of eggs from smaller to large sizes might be due to anthelmintic treatments with albendazole.

Genome-Wide Integrative Transcriptional Profiling Identifies Age-Associated Signatures in Dogs.

Mammals experience similar stages of embryonic development, birth, infancy, youth, adolescence, maturity, and senescence. While embryonic developmental processes have been extensively researched, many molecular mechanisms regulating the different life stages after birth, such as aging, remain unresolved. We investigated the conserved and global molecular transitions in transcriptional remodeling with age in dogs of 15 breeds, which revealed that genes underlying hormone level regulation and developmental programs were differentially regulated during aging. Subsequently, we show that the candidate genes associated with tumorigenesis also exhibit age-dependent DNA methylation patterns, which might have contributed to the tumor state through inhibiting the plasticity of cell differentiation processes during aging, and ultimately suggesting the molecular events that link the processes of aging and cancer. These results highlight that the rate of age-related transcriptional remodeling is influenced not only by the lifespan, but also by the timing of critical physiological milestones.

Diquafosol ophthalmic solution enhances mucin expression via ERK activation in human conjunctival epithelial cells with hyperosmotic stress.

Purpose: To evaluate the effect of diquafosol tetrasodium on the expression of secretory and membrane-associated mucins in multi-layered cultures of primary human conjunctival epithelial cells (HCEC) using intracellular extracellular signal regulated kinase (ERK) signaling. Methods: HCECs were treated with hyperosmotic stress (400 mOsm/l) for 24 h after air-liquid interface cell culture followed by treatment with diquafosol. HCECs were stimulated for 1 h with or without PD98059, an ERK inhibitor, then treated with diquafosol for 6 h and 24 h. Mucin 1 (MUC1), mucin 16 (MUC16), and MUC5AC mRNA and protein expression levels were analyzed, and cell viability was detected using an MTT assay. Western blot analysis was used to examine p44/42 MAPK (Erk1/2) and phosphorylated p44/42 MAPK (Erk1/2) expression. Results: Hyperosmotic stressed HCECs demonstrated increased MUC5AC secretion and gene expression when treated with diquafosol. MUC1 mRNA levels increased significantly at 24 h (p<0.01), and expression of MUC16 mRNA levels increased at 6 h and were maintained until 24 h (p<0.05).There was no significant difference in cell viability compared to the control group. Immunostaining results for MUC1, MUC16, and MUC5AC in diquafosol tetrasodium-treated HCECs at 24 h showed more positive cells than in the control group. Phosphorylation of p44/42 MAPK (Erk1/2) signaling molecules significantly increased from 5 min to 60 min (p<0.05). The effects of diquafosol on mucin expressions in hyperosmotic stressed HCECs were significantly inhibited by PD98059, an ERK inhibitor, at 6 h and 24 h. Conclusions: ERK signaling may regulate the expression levels of MUC1, MUC16, and MUC5AC induced by diquafosol in hyperosmotic stressed HCECs.

In vitro culture of hematopoietic stem cell niche using angiopoietin-1-coupled alginate hydrogel.

Stem cells exist and maintain their quiescence and pluripotency in stem cell niche. Here, we hypothesized that regulation of cell-cell interactions using a polymeric scaffold as synthetic extracellular matrix (ECM) could be critical in creating a hematopoietic stem cell (HSC) niche in vitro. Angiopoietin-1 (Ang1) binds to the tyrosine kinase receptor (Tie2), and regulation of the Tie2/Ang1 interaction is important in maintaining the quiescence of HSCs in vivo. Alginate hydrogel was thus modified with Ang1 as a synthetic ECM to mimic the HSC niche. Long-term HSCs (CD34-, CD135-, and CD150+) were isolated from mouse femurs and cultured on Ang1-modified alginate hydrogel. The percentage of LT-HSCs in G0 phase was 46.8 ± 1.8%, which was comparable to that of LT-HSCs co-cultured with osteoblasts (46.8 ± 2.1%). Ang1-coupled alginate gels were useful to provide a niche for HSC quiescence without a co-culture system. Polymeric scaffolds containing biomimetic and cell-instructive characteristics for stem cell phenotype regulation might help create HSC niches in vitro and be useful to engineer tissues and transplant stem cells.

A Novel Intraocular Lens Simulator that Allows Patients to Experience the World Through Multifocal Intraocular Lenses Before Surgeries.

Purpose: The purpose of this study was to investigate whether the intraocular lens (IOL) simulator can simulate how the world appears to patients with multifocal IOLs by allowing the patients to see far and near objects through the IOL simulator. Methods: Twenty eyes from 20 patients (age = 50-70 years old) were included in the study. The IOL simulator we developed consists of a trial lens frame adapter, a lens tube, a concave lens, a spacer, a wet cell, and an IOL. We used two IOLs: Tecnis monofocal and Tecnis bifocal IOL (add +3.25 diopter [D]). Patients wore a trial lens frame with an IOL simulator on distant corrected trial lenses and underwent the following tests: defocus curve, satisfaction with distance and near vision, halo around the light, and near point accommodation (NPA). To check how the world appears to the patients through this simulator, a machine vision lens and a scientific camera were attached to the simulator, and far and near objects were photographed. Results: In the defocus curve of multifocal IOL, the visual acuity showed the second peak at -4 D. Compared to monofocal IOL, satisfaction with distant vision was slightly worse, more halos were felt, satisfaction with near vision was higher, and the NPA was shorter in multifocal IOL. In the scientific camera test, through the multifocal IOL, the waiting room was blurry, the halo around the ceiling light was prominent, and the characteristics on the near visual acuity chart were clear. Conclusion: Subjects could experience the functions of multifocal IOLs with our newly developed IOL simulator. Translational Relevance: This IOL simulator using geometric optics allows patients to experience the function of multifocal IOLs before cataract surgery.

Comparison of a preservative-free nonsteroidal anti-inflammatory drug and preservative-free corticosteroid after uneventful cataract surgery: multicenter, randomized, evaluator-blinded clinical trial.

PURPOSE: To compare the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) and steroidal eyedrops for inflammation management after cataract surgery using slitlamp indicators. SETTING: 11 eye centers in South Korea. DESIGN: Randomized prospective multicenter study with a blinded evaluator. METHOD: In 125 (250 eyes) patients who underwent cataract surgery, bromfenac sodium hydrate 0.1% (NSAID group) was applied twice a day in 1 eye, whereas the other eye was treated with fluorometholone 0.1% (steroid group), 4 times a day for 4 weeks postoperatively. The primary efficacy outcome was the presence of anterior chamber cells and flare at 1 week postoperatively. Anterior chamber cells and flare at 4 to 8 weeks, corrected distance visual acuity, central corneal thickness, conjunctival hyperemia, dry eye parameters, foveal thickness, and ocular and visual discomfort were evaluated as secondary outcomes. RESULTS: At week 1, residual anterior chamber inflammation was not statistically significantly different between the groups (-1.03 ± 1.27 vs -0.95 ± 1.24, P = .4850). However, the NSAID group recovered from conjunctival hyperemia more rapidly than the steroid group (0.30 ± 0.52 vs 0.44 ± 0.81, P = .0144 at week 1). The increase in central corneal thickness in the NSAID group was less than that in the steroid group 1 week postoperatively (7.87 ± 22.46 vs 29.47 ± 46.60 µm, P < .0001). The change in foveal thickness in the NSAID group was significantly less than that in the steroid group (18.11 ± 68.19 vs 22.25 ± 42.37 µm, P = .0002). Lower levels of postoperative ocular and visual discomfort were reported in the NSAID group than in the steroid group under treatment. CONCLUSIONS: Preservative-free bromfenac was as effective as preservative-free fluorometholone eyedrops in anterior chamber inflammation control and showed better signs and symptoms after cataract surgery.

Comparative Accuracy of Barrett Toric Calculator With and Without Posterior Corneal Astigmatism Measurements and the Kane Toric Formula.

PURPOSE: To compare the accuracy of the Barrett toric calculator with and without posterior corneal astigmatism and the Kane toric calculator. DESIGN: Retrospective cross-sectional study. METHODS: The study included a total of 79 eyes of 79 patients who underwent toric intraocular lens (IOL) insertion during uncomplicated cataract surgery by a single surgeon. Using vector analysis, the mean absolute prediction error, the standard deviation of the prediction error, and the percentage of eyes with a prediction error within ±0.50 diopter (D), ± 0.75 D, and ± 1.00 D were calculated. The IOL Master 700 (Carl Zeiss Meditec AG, Jena, Germany) was used for measuring biometry including posterior corneal astigmatism. The main analysis was designed to provide the clinical outcomes with each formula using the postoperative keratometry values and the measured postoperative IOL axis. Real-world analysis was performed using the preoperative keratometry values and the intended IOL axis. RESULTS: There was no significant difference in mean absolute prediction errors calculated with 2 versions of the Barrett toric formula (predicted posterior corneal astigmatism and measured posterior corneal astigmatism) and the Kane toric formula (P > .05). The Barrett toric calculator with predicted and measured posterior corneal astigmatism yielded the best results, with 60.8% <0.50 D prediction error in the main analysis. In the real-world analysis, the Barrett toric calculator with predicted posterior corneal astigmatism showed the best result, with 53.2% <0.50 D prediction error. CONCLUSION: The Barrett toric formula with and without posterior corneal astigmatism measurements using the IOL Master 700 and the Kane toric formula yielded accurate and comparable outcomes in this single-surgeon analysis. Am J Ophthalmol 2021;221:•••-•••. © 2021 Elsevier Inc. All rights reserved.

Clinical differences between toric intraocular lens (IOL) and monofocal intraocular lens (IOL) implantation when myopia is determined as target refraction.

BACKGROUND: The aim of this study is to analyze and compare the clinical results of toric intraocular lens (IOL) and monofocal IOL implantation when the target refraction value is -3 diopter (D) in cataract patients with corneal astigmatism > 1.5 diopters (D). METHODS: We performed a retrospective chart review for patients with corneal astigmatism > 1.5D who underwent cataract surgery and their target refraction is -3D. 100 eyes (100 patients; monofocal IOL, 60; toric IOL, 40) were enrolled in the current study. Near and distant uncorrected visual acuity (UCVA), corrected VA, spherical equivalent and refractive, corneal astigmatism were evaluated before and after surgery. RESULTS: The near UCVA of the toric IOL group (0.26 ± 0.33) after cataract surgery was significantly better than that of the monofocal IOL group (0.48 ± 0.32) (p = 0.030). The distant UCVA of the toric IOL group (0.38 ± 0.14) was also significantly better than that of the monofocal IOL group (0.55 ± 0.22) (p = 0.026). Best-corrected visual acuity (p = 0.710) and mean spherical equivalent (p = 0.465) did not show significant differences between the toric IOL group and the monofocal IOL group. In the toric IOL group, postoperative refractive astigmatism was - 0.80 ± 0.46D and postoperative corneal astigmatism was - 1.50 ± 0.62D, whereas the corresponding values in the monofocal IOL group were - 1.65 ± 0.77D and - 1.45 ± 0.64D; residual refractive astigmatism was significantly lower with toric IOL implantation compared with monofocal IOL implantation (p = 0.001). There were no postoperative complications. CONCLUSIONS: When myopic refraction such as -3D was determined as the target power in patients with corneal astigmatism, toric IOL implantation led to excellent improvement in both near and distant UCVA.

Ocular surface inflammation induces de novo expression of substance P in the trigeminal primary afferents with large cell bodies.

We evaluated the changes in substance P (SP)-expressing trigeminal neurons (TNs) innervating the cornea following ocular surface inflammation. Ocular surface inflammation was induced in Sprague-Dawley rats using 0.1% benzalkonium chloride (BAK). The corneal staining score, corneal epithelial apoptosis, conjunctival goblet cells, and density of corneal subbasal nerve plexus (SNP) were assessed, and the mRNA levels of SP, interleukin (IL)-1ß, IL-6, and tumour necrosis factor-α were measured in corneas and ipsilateral trigeminal ganglia (TG). SP-immunoreactivity (IR) was measured in corneal intraepithelial nerves and TNs. The cell size of corneal TNs in the TG was calculated. All parameters were observed immediately (BAK group), at 1 week (1 w group), and 2 months (2 m group) after 2 weeks of BAK application. BAK caused an increase in the corneal staining score and the number of apoptotic cells, loss of conjunctival goblet cells, reduced density of corneal SNP, and upregulated expression of SP and inflammatory cytokines in both the cornea and TG in the BAK group but those changes were not observed in the 2 m group. On the other hand, SP-IR% and mean cell size of corneal TNs increased significantly in the BAK, 1 w, and 2 m groups, compared to the control. Our data suggest that following ocular surface inflammation, large-sized corneal TNs which normally do not express SP, expressed it and this phenotype switching lasted even after the inflammation disappeared. Long-lasting phenotypic switch, as well as changes in the expression level of certain molecules should be addressed in future studies on the mechanism of corneal neuropathic pain.

Clinical efficacy of eyelid hygiene in blepharitis and meibomian gland dysfunction after cataract surgery: a randomized controlled pilot trial.

The purpose of this randomized clinical trial is to evaluate the effect of eyelid hygiene on subjective symptoms, anterior blepharitis, and meibomian gland dysfunction (MGD) after cataract surgery. Subjects with obstructive MGD who underwent cataract surgery were randomly divided into two groups. In the eyelid hygiene group, eyelid hygiene was performed twice a day for 10 days from 3 days before to 1 week after cataract surgery. The control group did not perform eyelid hygiene. A subjective symptom questionnaire of SPEED, anterior blepharitis grade, and meibum quality and quantity was evaluated at baseline and at postoperative 1 and 4 weeks. The eyelid hygiene group (n = 36) showed decreased SPEED score after cataract surgery and the control group (n = 33) did not. Anterior blepharitis grade was worse 1 week after surgery in the control group but not in the eyelid hygiene group. The control group had significantly decreased meibum quality and quantity in both the upper and lower eyelids after cataract surgery, but the eyelid hygiene group did not. Eyelid hygiene before/after cataract surgery improved postoperative subjective symptoms and prevented postoperative exacerbation of anterior blepharitis and MGD. Thus, perioperative eyelid hygiene is recommended for patients with obstructive MGD who undergo cataract surgery.

New IOL formula using anterior segment three-dimensional optical coherence tomography.

This retrospective study was aimed to compare prediction errors from various combinations of biometric data generated using optical coherence tomography (OCT) and develop a new intraocular lens (IOL) formula using biometric data. 145 eyes from 145 patients who underwent femtosecond laser-assisted cataract surgery (FLACS) were enrolled to the present study and they were divided into a training set (n = 92) and a test set (n = 53). Preoperative axial length (AL) and corneal radius were measured using partial coherence interferometry. The anterior chamber depth (ACD), lens meridian parameter (LMP), lens thickness (LT), thickness of anterior and posterior parts of the crystalline lens (aLT and pLT), and anterior segment length were measured by OCT. From a training set, we developed eight regression equations and analyzed the predictive accuracy. The regression equation using AL, LMP, and pLT (-1.143 + 0.148*AL + 0.428*LMP + 0.254*pLT) showed the strongest correlation with effective lens position (ELP) and smallest standard deviation of ELP prediction error. IOL formula generated using AL, LMP, and pLT yielded the highest predictive accuracy. In a test set, the new IOL formula also produced narrowest range of prediction error, smallest median absolute error, and highest percentages within ±0.25, ±0.50 than existing IOL formulas. The IOL formula considering AL, LMP and pLT will help to improve predictive accuracy in FLACS.

How does the world appear to patients with multifocal intraocular lenses?: a mobile model eye experiment.

BACKGROUND: To show how the world appear to patients with multifocal intraocular lens (IOL) using a novel mobile model eye. METHODS: The mobile model eye was composed of an artificial cornea, IOL, IOL chamber, and a camera. A monofocal IOL (Tecnis monofocal IOL) and two diffractive multifocal IOL (ReSTOR, Tecnis multifocal IOL) were used in the study. We went outside to take a picture of the scenery. At night, we stood on a road and took pictures to see how the traffic lights and headlights of cars looked. For an indoor analysis, we approached the Early Treatment Diabetic Retinopathy Study (ETDRS) chart to the model eye from a distance of 95 cm to check the multifocal function of the lenses. In the car, we took pictures of the street and a cell phone in turn to check the multifocal function of the lenses. RESULTS: Two multifocal IOLs showed definite multifocal function. Far objects appeared either similarly clear or slightly hazier (depending on the IOL model) than those with the monofocal IOL. In the night vision, there was a mild or severe halo around light sources compared to those with the monofocal IOL. CONCLUSION: We believe that this mobile model eye can be used to evaluate how the real world appear to a patient with a multifocal IOL, to explain multifocal function of the IOLs, and possible complications in the patients, before performing a surgery.

Influence of corneal spherical aberration on prediction error of the Haigis-L formula.

The purpose of this study is to investigate the relationships between corneal asphericity and Haigis-L formula prediction errors in routine cataract surgery after refractive surgery for myopic correction. This retrospective study included 102 patients (102 eyes) with a history of previous PRK or LASIK and cataract surgery. Axial length, anterior chamber depth, and central corneal power were measured using the optical biometer. On the anterior corneal surface, Q-value, spherical aberration, and ecentricity at 6.0 and 8.0 mm were measured using a rotating Scheimpflug camera. The postoperative refractive outcome at 6 months, mean error, and mean absolute error were determined. Correlation tests were performed to determine the associations between pre-cataract surgery data and the prediction error. The Q-values for 6.0 and 8.0 mm corneal diameter were 1.57 ± 0.70 (range: 0.03~3.44), and 0.82 ± 0.5 (range: -0.10~-2.66). The spherical aberration for 6.0 and 8.0 mm diameter was 1.16 ± 0.39 µm (range: 0.24~2.08 µm), and 3.69 ± 0.87 µm (range: 0.91~5.91 µm). eccentricity for 6.0 and 8.0 mm diameter was -1.22 ± 0.31 (range: -1.85 to -0.17), and -0.82 ± 0.39 (range: -1.63 to 0.32). The spherical aberration for 8.0 mm cornea diameter showed the highest correlations with the predicion error (r = 0.750; p < 0.001). When the modified Haigis-L formula considering spherical aberration for 8.0 mm produced smaller values in standard deviation of mean error (0.45D versus 0.68D), mean absolute error (0.35D versus 0.55D), and median absolute error (0.31D versus 0.51D) than the Haigis formula. Corneal asphericity influences the predictive accuracy of the Haigis-L formula. The accuracy was enhanced by taking into consideration the corneal spherical aberration for the 8.0 mm zone at pre-cataract surgery state.

Toric intraocular lens implantation in cataract patients with corneal opacity.

BACKGROUND: To evaluate the effect of toric intraocular lens implantation in cataract patient with corneal opacity and high astigmatism. METHODS: Thirty-one eyes of 31 patients who underwent cataract surgery with toric intraocular lens implantation were included. All patients had corneal opacity with astigmatism. Preoperative total corneal astigmatism was determined considering posterior astigmatism using a rotating Scheimpflug camera (Pentacam®: Oculus, Wetzlar, Germany). At 2 months after toric intraocular lens implantation, we evaluated residual astigmatism, uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA). RESULTS: Postoperative UCVA and BCVA (0.30 ± 0.17, 0.22 ± 0.16LogMAR) were statistically improved compared to preoperative UCVA and BCVA (1.2 ± 0.34, 1.1 ± 0.30LogMAR, respectively) (P < 0.01). Postoperative residual refractive astigmatism (1.2 ± 0.35D) was statistically reduced compared to preoperative refractive astigmatism (2.4 ± 0.65D) (P < 0.05). Preoperative and postoperative total corneal astigmatism values were not statistically different. All eyes achieved postoperative visual acuity as good as or better than preoperative one. The size of corneal opacity covering pupil had significant negative correlation with postoperative UCVA and BCVA (logMAR) (R = 0.91 P < 0.05 and R = 0.92 P < 0.05, respectively). CONCLUSION: Toric intraocular lens implantation can improve UCVA, BCVA, and refractive astigmatism in cataract patient with corneal opacity. The size of corneal opacity covering pupil is the major prognostic factor for postoperative visual improvement. Therefore, toric intraocular lens implantation should be considered for cataract patients who have corneal opacity with high astigmatism.

Changes in Human Tear Proteome Following Topical Treatment of Dry Eye Disease: Cyclosporine A Versus Diquafosol Tetrasodium.

Purpose: To compare the changes in human tear proteome and clinical effects following topical cyclosporine A (CsA) 0.05% or diquafosol tetrasodium (DQS) 3% treatment of dry eye disease (DED), and to identify biomarkers for determining disease severity and treatment effectiveness in DED. Methods: A total of 18 patients were diagnosed with non-Sjögren DED. Nine patients in each group were treated with topical CsA 0.05% or DQS 3% for 4 weeks. Tear samples were collected after evaluation of tear breakup time, corneal and conjunctival erosion staining, and results of Schirmer's test 1 before and after treatment. Proteomes were characterized using liquid chromatography mass spectrometry, and proteins exhibiting a fold change >1.5 or <0.67 (P < 0.05) were considered differentially expressed (DEP). Results: A total of 794 proteins were identified, with no significant difference observed between pretreatment and posttreatment conditions. Proteomic analysis identified 54 and 106 DEPs between treatment groups (CsA and DQS, respectively), with gene ontology analysis indicating that both treatments enhanced innate and adaptive immune responses and cellular detoxification. Protein-network analysis showed that inflammation associated with the immune response was primarily responsible for the therapeutic process in both groups. Conclusions: These results provide insight into the broad scope of changes at the ocular surface in DED and indicated that although both drugs improved the clinical parameters, the activated tear-specific biomarkers differed significantly between treatments. Our findings suggest that the DEPs identified here and those correlated with the clinical parameters might represent candidate biomarkers for DED.

Preoperative biometric measurements with anterior segment optical coherence tomography and prediction of postoperative intraocular lens position.

The purpose of this study is to evaluate the biometric parameters of crystalline lens components and to find effective factors for predicting postoperative intraocular lens (IOL) position. This retrospective study included 97 eyes from 97 patients with a mean age of 63.00 ± 12.38 (SD) years. The biometric measurements were performed by means of a 3-dimensional optical coherence tomography (3D-OCT) device. Specifically, anterior chamber depth (ACD), aqueous depth (AD), lens thickness (LT), lens meridian parameter (LMP), white-to-white diameters (WTW), anterior segment length (ASL), the anterior part of lens (aLT), and the posterior part of lens (pLT) were measured. Additionally, axial length (AL) and corneal radius (CR) were measured by the partial coherence interferometry. Ninety-seven eyes were divided into thin lens group (LT < 4.5 mm) and thick lens group (LT ≥ 4.5 mm). The differences between the above two groups were also analyzed. Postoperative IOL position was measured by 3D-OCT at 3 months postoperatively and regression formulas for predicting postoperative IOL position were developed by various combinations of preoperative factors. As lens thickened, ACD and AD became shallow (all P < .001). AD, ACD, ASL, aLT, and pLT showed statistically significant differences between two subgroups classified on the basis of LT (all P < .001). Meanwhile, the value obtained by subtracting aLT from pLT did not show any association with the other biometric measurements. The combination of ACD, aLT, pLT, AL, CR, and WTW showed the highest correlation with postoperative IOL position (R = 0.536, P < .001). In conclusion, pLT-aLT was an independent factor not affected by any other variables and did not show significant difference between thin lens group and thick lens group. The subdivision of the lens structure using 3D-OCT helps to predict postoperative IOL position.