In vitro optical performance of multifocal and extended depth-of-focus intraocular lenses in spherical aberration conditions.

PURPOSE: To evaluate and compare the optical performances of 4 different types of intraocular lenses (IOLs) in various spherical aberration (SA) conditions. SETTING: POSTECH, Pohang, South Korea. DESIGN: In vitro laboratory study. METHODS: A custom optical bench system with adaptive optics was used. A monofocal IOL, a bifocal IOL, a trifocal IOL, and an extended depth-of-focus (EDoF) IOL from Zeiss were evaluated by measuring through-focus modulation transfer function (MTF) as a function of vergence. MTF changes with SA from -0.1 to +0.1 with 0.05 µm step size were analyzed and compared. RESULTS: In aberration-free conditions, the 4 IOLs showed different MTF curves consistent with their designs. In SA conditions, all the IOLs showed MTF value decreases and the decrease rates at the far focus varied from 28% to 38% per 0.1 µm SAs. The trifocal IOL had low MTF values at the intermediate focus in the noise level with ±0.1 µm SAs. CONCLUSIONS: All tested IOLs showed MTF decreases with SA in different levels. The trifocal and EDoF IOLs were the most and least sensitive to SA among the evaluated IOLs. The study results might be useful in the selection of IOLs for cataract patients with SA.

Diffractive multifocal intraocular lens implantation in patients with monofocal intraocular lens in the contralateral eye.

AIM: To evaluate clinical outcomes of unilateral implantation of a diffractive multifocal intraocular lens (IOL) in patients with contralateral monofocal IOL. METHODS: Twenty-two patients who already had implantation of a monofocal IOL in unilateral eye underwent implantation of a diffractive multifocal IOL in contralateral eye were enrolled. After 1, 6, and 12mo, uncorrected and distant corrected distant visual acuity (UCDVA and DCDVA), uncorrected and distant corrected intermediate-visual acuity (UCIVA and DCIVA), uncorrected and distant corrected near visual acuity (UCNVA and DCNVA), and contrast sensitivity were obtained. Halo/glare symptoms, spectacle dependence, and patient satisfaction were also evaluated. RESULTS: The mean age was 67.86±7.25y and the average interval between two IOL implantations was 645.82±878.44d. At 1mo, binocular UCDVA was lower than 0.20 logMAR in 76% of patients (mean 0.12±0.13 logMAR), which increased to 90% by 6 and 12mo. The binocular UCDVA was significantly better than the monocular results (P<0.05) at 1, 6, and 12mo. Additionally, UCNVA was lower than 0.40 logMAR in 82% of patients, increasing to 90% by 6 and 12mo. Mean UCNVA in the multifocal IOL implanted eye was statistically significantly better than that in the monofocal IOL implanted eye (P<0.05) at 1, 6, and 12mo. About 5% of patients at 1 and 6mo, reported "severe glare or halo". Patient satisfaction rates were 95% and 91% at 6 and 12mo, respectively. CONCLUSION: Unilateral implantation of multifocal IOL in patients with a contralateral, monofocal IOL implantation results in high patient satisfaction rate, with low severe glare or halo rate during follow-up. It can represent a good option for patients who have previously had a monofocal IOL implantation regardless of two year interval duration between two IOL implantations.

Fast and sensitive delineation of brain tumor with clinically compatible moxifloxacin labeling and confocal microscopy.

Delineation of brain tumor margins during surgery is critical to maximize tumor removal while preserving normal brain tissue to obtain optimal clinical outcomes. Although various imaging methods have been developed, they have limitations to be used in clinical practice. We developed a high-speed cellular imaging method by using clinically compatible moxifloxacin and confocal microscopy for sensitive brain tumor detection and delineation. Moxifloxacin is a Food and Drug Administration (FDA) approved antibiotic and was used as a cell labeling agent through topical administration. Its strong fluorescence at short visible excitation wavelengths allowed video-rate cellular imaging. Moxifloxacin-based confocal microscopy (MBCM) was characterized in normal mouse brain specimens and visualized their cytoarchitecture clearly. Then, MBCM was applied to both brain tumor murine models and two malignant human brain tumors of glioblastoma and metastatic cancer. MBCM detected tumors in all the specimens by visualizing dense and irregular cell distributions, and tumor margins were easily delineated based on the cytoarchitecture. An image analysis method was developed for automated detection and delineation. MBCM demonstrated sensitive delineation of brain tumors through cytoarchitecture visualization and would have potentials for human applications, such as a surgery-guiding method for tumor removal.

Moxifloxacin Labeling-Based Multiphoton Microscopy of Skin Cancers in Asians.

BACKGROUND AND OBJECTIVES: Although multiphoton microscopy (MPM) can visualize both cell and extracellular matrix (ECM) structures of the skin in high-contrast without exogenous labeling, label-free MPM is usually too slow to image clinically relevant large regions. A high-speed MPM method would be beneficial for evaluating clinical skin specimens by increasing the imaging area. In this study, moxifloxacin labeling-based MPM (moxifloxacin MPM) was characterized in various human skin cancer specimens. STUDY DESIGN/MATERIALS AND METHODS: Moxifloxacin ophthalmic solution was used for cell-labeling and MPM imaging was conducted afterwards. Moxifloxacin MPM was characterized in ex vivo normal human skin and skin cancer specimens in comparison with the label-free MPM and fluorescence confocal microscopy (FCM) using acridine orange as a labeling agent. Then, moxifloxacin MPM was applied to various ex vivo human skin cancer specimens including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), dermatofibrosarcoma protuberans (DFSP). Results of moxifloxacin MPM were compared with bright-field clinical and histopathologic findings. RESULTS: Moxifloxacin MPM imaged both cells and collagen in the skin, similarly to label-free MPM, but with enhanced fluorescence intensities in cells and enhanced imaging speeds. Moxifloxacin MPM imaged cells in the skin similarly to acridine orange-based FCM. Moxifloxacin MPM of various human skin cancer specimens imaged their specific cellular features. The microscopic features detected in moxifloxacin MPM were confirmed with histological images. CONCLUSIONS: This observational pilot study demonstrated that moxifloxacin MPM could detect specific cellular features of various skin cancers in good correlation with histopathological images in Asian patients at the higher imaging speed than label-free MPM. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

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.

Analysis of Positional Relationships of Various Centers in Cataract Surgery.

PURPOSE: To analyze the positional relationships of various centers in patients undergoing femtosecond laser-assisted cataract surgery (FLACS). METHODS: The locations of the pupil center (PC), limbal center (LC) and lens center were analyzed in each patient using optical coherence tomography during FLACS in 35 eyes of 35 patients. Using the preoperative corneal aberrometry device, angle kappa and the location of the visual axis (VA) were calculated. After acquiring the relative horizontal and vertical coordinates of each center, the distance and location among each center were compared. The relative location and distance of each center were statistically evaluated. RESULTS: The distance from the PC to the lens center was 0.147 ± 0.103 mm, that from the LC to the lens center was 0.205 ± 0.104 mm, and that from the VA to the lens center was 0.296 ± 0.198 mm. The distance from the PC to the VA was 0.283 ± 0.161 mm, that from the LC to the VA was 0.362 ± 0.153 mm, and that from the lens center to the VA was 0.296 ± 0.198 mm. Among the various centers, the PC was the closest to the lens center, whereas the LC and VA were the farthest. Based on the location of the lens center, the PC, LC, and VA exhibited differences in the X and Y coordinate positions (vertical p = 0.004, horizontal p < 0.001). Among them, the LC was significantly inferior and temporal compared to the PC (vertical p = 0.026, horizontal p = 0.023). Based on the location of the VA, the respective locations of the PC, LC and lens center in two dimensions did not significantly differ (vertical p = 0.310, horizontal p = 0.926). CONCLUSIONS: This study demonstrated the positional and locational relationships between the centers regarding FLACS. The locations of the PC, LC, and VA were different from the lens center with the PC being the closest. Surgeons should be aware of these positional relationships, especially in FLACS.

Femtosecond laser-assisted cataract surgery versus conventional phacoemulsification: Refractive and aberrometric outcomes with a diffractive multifocal intraocular lens.

PURPOSE: To compare the outcomes of conventional phacoemulsification and femtosecond laser-assisted cataract surgery followed by multifocal intraocular lens (IOL) implantation. SETTING: Asan Medical Center, Seoul, South Korea. DESIGN: Retrospective case series. METHODS: Depending on their preference, patients had femtosecond laser-assisted cataract surgery or conventional phacoemulsification. Patients in the femtosecond group with corneal astigmatism greater than 0.75 diopter also had arcuate keratotomy. All eyes had multifocal IOL implantation. One month after treatment, the uncorrected distance and near visual acuities, spherical equivalent, corneal and refractive astigmatism, aberrometry results, and questionnaire results were compared between groups. Correlations between target-induced astigmatism (TIA) and surgically induced astigmatism (SIA) were also compared between the groups. RESULTS: The femtosecond group comprised 17 patients (23 eyes), with arcuate keratotomy performed in 14 eyes. The conventional phacoemulsification group comprised 22 patients (26 eyes). In the femtosecond group, the difference in corneal astigmatism between preoperatively and postoperatively was statistically significant. The correlation between TIA and SIA was greater in the femtosecond group. Corneal root-mean-square higher-order aberrations (RMS HOAs) (P < .01) and total trefoil (P = .043) were significantly higher in the femtosecond laser group. However, internal total RMS (P = .05), tilt (P = .041), and RMS HOAs (P = .047) were significantly lower in the femtosecond group. Satisfaction scores were significantly higher in the femtosecond group. CONCLUSIONS: Astigmatic change was more predictable in the femtosecond laser-assisted cataract surgery group. Internal aberrations, including total RMS, tilt, and RMS HOAs, were lower in the femtosecond group, and patients in that group were more satisfied.

Two-photon microscopy of Paneth cells in the small intestine of live mice.

Paneth cells are one of the principal epithelial cell types in the small intestine, located at the base of intestinal crypts. Paneth cells play key roles in intestinal host-microbe homeostasis via granule secretion, and their dysfunction is implicated in pathogenesis of several diseases including Crohn's disease. Despite their physiological importance, study of Paneth cells has been hampered by the limited accessibility and lack of labeling methods. In this study, we developed a simple in vivo imaging method of Paneth cells in the intact mouse small intestine by using moxifloxacin and two-photon microscopy (TPM). Moxifloxacin, an FDA-approved antibiotic, was used for labeling cells and its fluorescence was strongly observed in Paneth cell granules by TPM. Moxifloxacin labeling of Paneth cell granules was confirmed by molecular counterstaining. Comparison of Paneth cells in wild type, genetically obese (ob/ob), and germ-free (GF) mice showed different granule distribution. Furthermore, Paneth cell degranulation was observed in vivo. Our study suggests that TPM with moxifloxacin labeling can serve as a useful tool for studying Paneth cell biology and related diseases.

Myopic Shift after Implantation of a Novel Diffractive Trifocal Intraocular Lens in Korean Eyes.

PURPOSE: To evaluate the clinical outcomes of cataract surgery using novel diffractive trifocal intraocular lenses (IOLs) in Koreans. METHODS: This was a retrospective, consecutive, interventional study of cataract surgery using POD FineVision IOL implantation. Complete ophthalmologic examinations were performed preoperatively and postoperatively. Defocus curves were assessed over a range of +1.5 to -4.0 diopters in 0.5-diopter steps at one month postoperatively. Uncorrected distant visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distant visual acuity, distant-corrected intermediate visual acuity, and distant-corrected near visual acuity were assessed one month postoperatively, and manifest refraction was performed during every visit. RESULTS: The study analyzed 31 eyes in 20 patients. There were statistically significant improvements in uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distance visual acuity, distance-corrected intermediate visual acuity, and distance-corrected near visual acuity (p < 0.001). The final postoperative refractive outcomes showed statistically significant myopic shifts compared to the target refraction based on SRK/T, SRK-II, Haigis, and Hoffer Q formulas (p < 0.001). CONCLUSIONS: POD FineVision IOLs provide stable visual restoration with improvements of near and intermediate vision in presbyopic eyes. POD FineVision IOLs show myopic shift in a Korean population; therefore, surgeons should be cautious when selecting IOL power in such patients.

Comparison of Topical Low-Molecular-Weight Heparin-Taurocholate and Bevacizumab for Treatment and Prevention of Corneal Neovascularization.

PURPOSE: To compare the therapeutic and preventive effects of topically administered 7-taurocholic acid-conjugated low-molecular-weight heparin (LHT7) and bevacizumab in experimentally induced corneal neovascularization (CoNV). METHODS: CoNV was induced using sutures in the right eyes of 24 mice. To investigate the therapeutic effects, CoNV was allowed to develop for 1 week before treatment. To ascertain the preventive effects, the treatments were applied immediately after the suture. In each experiment, 12 eyes were divided into 3 groups and treated topically using bevacizumab (bevacizumab group), LHT7 (LHT7 group), and normal saline (control group). The treatments were instilled 3 times daily for 2 weeks. The CoNV area was measured before instillation and after 1 and 2 weeks after instillation. RESULTS: In the investigation of therapeutic effects, the CoNV area had decreased significantly 1 week after treatment in the bevacizumab group (1.58-0.75 mm; P = 0.036) and LHT7 group (1.38-0.74 mm; P = 0.018). Two weeks after treatment, the CoNV area was significantly smaller in the bevacizumab groups (0.60 mm; P = 0.005) and LHT7 group (0.64 mm; P = 0.015) than in the control group (1.68 mm), but the bevacizumab group did not differ significantly from the LHT7 group. In the experiment addressing the preventive effects, CoNV was less developed in the bevacizumab group (0.70 mm; P = 0.003) and LHT7 group (0.54 mm; P = 0.003) than in the control group (1.75 mm), and the CoNV area was smaller in the LHT7 group than in the bevacizumab group (P = 0.021). CONCLUSIONS: The effects of LHT7 on CoNV regression are comparable to those of bevacizumab. Topical administration of LHT7 prevents CoNV more effectively than bevacizumab.

Comparison of visual function after implantation of inferior sector-shaped intraocular lenses: low-add +1.5 D vs +3.0 D.

PURPOSE: To compare visual function after implantation of multifocal Lentis comfort LS-313 MF 15 (group 1) or Lentis M plus LS-313 MF 30 (group 2) intraocular lenses (IOLs). METHODS: Patients between 49 and 76 years of age who received monocular cataract surgery with multifocal IOL implantation were analyzed. Patients were evaluated preoperatively and for 5 months postoperatively for distance, intermediate, and near visual acuities, and static photopic and mesopic contrast sensitivity. A satisfaction questionnaire was administered 5 months after surgery. RESULTS: Group 1 comprised 21 eyes and group 2 contained 34 eyes. Both groups had a statistically significant improvement in uncorrected and corrected distance visual acuities postoperatively (p<0.01). Uncorrected visual near acuity at 40 cm was better in group 2 (1 month: p = 0.013; 5 months: p = 0.051). Uncorrected intermediate visual acuity at 70 cm was better in group 1 (1 month: p = 0.060; 5 months: p = 0.044). No significant differences in contrast sensitivity were observed between the groups. Glare and halo symptoms were better in group 1 (glare: p = 0.044; halo: p = 0.029). CONCLUSIONS: Inferior sector-shaped, near-addition IOLs with lower add powers (+1.5 D) provide good vision over longer working distances and show fewer glare and halo symptoms.

Influence of Near-Segment Positioning in a Rotationally Asymmetric Multifocal Intraocular Lens.

PURPOSE: To compare visual performance and higher order aberrations (HOAs) based on the position of the near segment in eyes with rotationally asymmetric multifocal intraocular lenses (IOLs). METHODS: Asymmetric multifocal IOLs (Lentis Mplus LS-313; Oculentis Optikgeräte GmbH, Wetzlar, Germany) were implanted with the near segment positioned either inferiorly, superiorly, or temporally. Uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity, corrected distance visual acuity (CDVA), and distance-corrected intermediate (DCIVA) and near (DCNVA) visual acuity, contrast sensitivity, HOAs, and subjective symptom questionnaires were compared at 1 month postoperatively. RESULTS: Forty-five eyes from 45 patients were evaluated (n = 25, 9, and 11 eyes in the inferior, superior, and temporal groups, respectively). No significant differences in UDVA, UIVA, UNVA, CDVA, DCIVA, or DCNVA were found between the three groups (P > .05). The temporal group showed the best results in UDVA, CDVA, and DCNVA, but the inferior group showed the best results in DCIVA and UNVA and the superior group showed the best results in UIVA. Contrast sensitivity and the subjective symptom questionnaire also did not demonstrate any significant differences (P > .05). Total HOA and spherical aberration did not demonstrate any statistically significant differences (P > .05), but vertical coma and horizontal coma demonstrated significant differences based on near segment position (P < .001). CONCLUSIONS: The position of the near segment in eyes with rotationally asymmetric multifocal IOLs demonstrates no significant effect on visual performance.

Corneal coma and trefoil changes associated with incision location in cataract surgery.

PURPOSE: To investigate changes in corneal higher-order aberrations (HOAs) associated with the incision location in cataract surgery. SETTING: Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. DESIGN: Observational case series. METHODS: Eyes were divided into 3 groups according to the different axes of incision location: superior, temporal, and nasal. Preoperative and 1-month postoperative corneal coma, trefoil, and spherical aberrations were compared. RESULTS: The study evaluated 119 eyes that had uneventful cataract surgery with a 2.2 mm limbal incision. The superior incision group showed significant changes in the vertical coma (amount of change: -0.119 µm ± 0.153 [SD]; P < .001) and vertical trefoil (amount of change: 0.185 ± 0.260 µm, P = .001). The nasal incision group showed a significant change in oblique trefoil (amount of change: 0.176 ± 0.207 µm; P < .001). The temporal incision group did not show significant changes in HOAs. CONCLUSION: The superior incision in 2.2 mm phacoemulsification cataract surgery caused a change in the corneal vertical coma in a negative direction. Corneal trefoil changes were dependent on the incision location. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

A new multiple noncontinuous puncture (pointage) technique for corneal tattooing.

AIM: To assess the safety and cosmetic efficacy of a new multiple noncontinuous transepithelial puncture technique for tattooing a decompensated cornea. METHODS: It was a non-comparative clinical case series study. The study examines 33 eyes in 33 patients with total corneal opacity due to corneal decompensation, which developed following intraocular surgery. Corneal tattooing was performed using the multiple noncontinuous transepithelial puncture technique (i.e. pointage). The safety of this new surgical strategy was assessed by occurrence of adverse events for the follow-up period. The cosmetic efficacy was determined by the patient's cosmetic satisfaction and independent observer's opinion about patient appearance. RESULTS: Seven women and 26 men were included in the study. The mean age was 46.4±17.5y (range: 7-67). In total, 30 of 33 patients (91%) reported cosmetic satisfaction within the follow-up period. Only 3 patients (9%) required additional tattooing due to cosmetic unsatisfaction. Cosmetic outcomes were analyzed and classified as excellent or good in 13 (39%) and 17 (52%) patients, respectively. No serious adverse events developed, except delayed epithelial healing in 3 cases. CONCLUSION: The cosmetic outcomes of the multiple noncontinuous transepithelial puncture technique for corneal tattooing were good. The safety of this method is higher than conventional procedures. This new procedure also provides improved cost-effectiveness and safety over current corneal tattooing techniques.

Accuracy of an automated refractor using a Hartmann-Shack sensor after corneal refractive surgery and cataract surgery.

PURPOSE: To evaluate the accuracy of a new automated refractor (HRK-8000A) using the Hartmann-Shack sensor in eyes with previous corneal refractive surgery or intraocular lens (IOLs) implantation. SETTING: Asan Medical Center, Seoul, South Korea. DESIGN: Retrospective nonrandomized clinical study. METHODS: Refractive errors were evaluated after more than 1 month postoperatively. Subjective refractive error measurements were obtained by the same practitioner. Refractive error measurements were obtained with the Hartmann-Shack sensor refractor and a conventional refractor (KR 8800). RESULTS: There were 121 eyes (121 patients) with previous corneal refractive surgery and 122 eyes (122 patients) with previous cataract surgery. The results of refractive error measured by the Hartmann-Shack sensor refractor were more similar to subjective refraction than those measured by the conventional refractor in both groups. In both groups, the mean spherical equivalent (SE) for the subjective refraction showed better agreement with the automated refraction measured by the Hartmann-Shack sensor refractor (limits of agreement [LoA], -0.66 to +0.65 diopters [D] and -0.47 to +0.41 D, respectively) than the automated refraction measured by the conventional refractor (LoA, -1.66 to +0.58 D and -1.34 to +0.60 D, respectively). In both groups, the Jackson cross-cylinder at axis 0 degrees and 45 degrees from the automated refraction by the Hartmann-Shack sensor refractor and conventional refractor showed similar agreement with the subjective refraction. CONCLUSION: The Hartmann-Shack sensor automated refractor gave reliable and valid objective refraction results in patients who have had cataract or corneal refractive surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Femtosecond Laser-assisted Arcuate Keratotomy Versus Toric IOL Implantation for Correcting Astigmatism.

PURPOSE: To evaluate the clinical efficacy and safety of femtosecond laser-assisted arcuate keratotomy (FS-AK) versus toric intraocular lens (IOL) implantation for correcting astigmatism in patients with cataract. METHODS: A retrospective chart review was performed. All patients had senile cataracts with corneal astigmatism (range: +1.00 to +3.00 diopters [D]) before cataract surgery. Twenty-five patients agreed to undergo toric IOL implantation (the toric IOL group). Twenty-three patients did not agree to undergo toric IOL implantation despite astigmatism; however, these patients were not satisfied with their remaining astigmatism following cataract surgery and requested astigmatism correction using FS-AK (the FS-AK group). Visual acuity and intraocular pressure were evaluated, and automated refraction, keratometry, and slit-lamp examinations were performed at 1 day, 1 week, 1 month, and 5 months after surgery. RESULTS: Refractive astigmatism decreased in both groups. The mean preoperative and postoperative refractive cylinders were 1.71 ± 1.15 and 0.78 ± 1.06 D, respectively, in the FS-AK group (P < .001) and 1.67 ± 0.13 and 0.83 ± 0.097 D, respectively, in the toric IOL group (P < .001). There were no statistically significant differences between groups at any time during the follow-up period. CONCLUSIONS: FS-AK is a fast, customizable, adjustable, precise, and safe procedure for reducing refractive errors in patients with residual astigmatism after cataract surgery. The results of this procedure are comparable to the toric IOL.

Hydrogel Inlay for Presbyopia: Objective and Subjective Visual Outcomes.

PURPOSE: To evaluate changes in visual performance and ocular optical quality after implantation of a corneal hydrogel inlay as a treatment for presbyopia. METHODS: A Raindrop Near Vision Inlay (ReVision Optics, Lake Forest, CA) was implanted monocularly on the stromal bed of a femtosecond laser-assisted generated corneal flap of non-dominant eyes of 22 patients with emmetropic presbyopia (preoperative spherical equivalent range: -0.50 to 1.00 diopters). Efficacy was determined by measuring near and distance visual acuities and ocular aberrations, and satisfaction was assessed by a patient questionnaire. RESULTS: The preoperative monocular uncorrected near visual acuity of the inlay inserted eye was 20/129 ± 1 Snellen (range: 20/135 to 20/61 Snellen) and improved to 20/35 ± 2 Snellen (range: 20/61 to 20/20 Snellen) (P < .01) at 6 months postoperatively. The monocular uncorrected distance visual acuity of the eye receiving the inlay was 20/25 ± 2 Snellen (range: 20/50 to 20/20 Snellen) preoperatively and 20/25 ± 1 Snellen (range: 20/50 to 20/20 Snellen) at 6 months postoperatively (P =.257). According to the questionnaire responses, 82% of patients were satisfied. This was despite near glasses needs remaining in 13.6% of the cohort and the presence of glare and a decrease in night vision in approximately 40% of patients. The primary spherical aberration coefficient Z4(0) changed from positive to negative values in all patients (P < .01). However, the point spread function showed no significant change. CONCLUSIONS: Hydrogel corneal inlays improve uncorrected near visual acuity in patients with presbyopia with only moderate effect on visual quality. However, the satisfaction with this therapy was relatively lower in these Korean patients than that reported previously in Western patients.

Higher-order aberrations associated with better near visual acuity in eyes with aspheric monofocal IOLs.

PURPOSE: To investigate higher-order aberrations (HOAs) related to increased uncorrected near visual acuity in eyes with aspheric monofocal intraocular lenses. METHODS: All patients underwent phacoemulsification followed by implantation of aspheric monofocal intraocular lenses with a negative spherical aberration (Tecnis one-piece, ZCB00; Abbott Medical Optics, Inc., Milpitas, CA). The distance-corrected near visual acuity (DCNVA), corrected near visual acuity, uncorrected near visual acuity, corrected distance visual acuity, uncorrected distance visual acuity, defocus curve, and ocular and corneal HOAs were examined 1 month after surgery. All near visual acuity measurements were taken with a 4-mm external aperture after pharmacologic dilation. Eyes were divided into two groups according to the DCNVA: eyes with DCNVA of 0.4 logMAR (20/50 Snellen) or better (0.4 logMAR or better group) and eyes with DCNVA worse than 0.4 logMAR (0.4 logMAR or worse group). The HOAs for a 4-mm pupil between the two groups were compared. RESULTS: A total of 37 eyes of 36 patients were included. The mean ocular spherical aberration was -0.010 ± 0.033 µm in the 0.4 logMAR or better group and -0.012 ± 0.023 µm in the 0.4 logMAR or worse group (P = .28). Among ocular HOAs, only vertical coma Z3(-1) showed a significant difference between the groups, with a mean ocular vertical coma of -0.038 ± 0.043 µm in the 0.4 logMAR or better group and 0.015 ± 0.061 µm in the 0.4 logMAR or worse group (P = .01). In corneal HOAs, no components showed a significant difference between the groups. CONCLUSIONS: In cases of aspheric intraocular lens implantation, ocular vertical coma may be a major HOA associated with better near visual acuity. Although corneal aberrations are major determinants of ocular aberrations after cataract surgery, aberrations from internal optics may still play an important role in visual performance.

Efficacy and safety of combination treatment for oculodermal melanocytosis: surgical reduction and use of 532-nm Q-switched Nd: YAG laser.

PURPOSE: The aim of this study was to evaluate the efficacy and safety of combination treatment using surgical reduction technique and 532-nm Q-switched Nd:YAG laser treatment for the removal of oculodermal melanocytosis. METHODS: We retrospectively reviewed the medical records of patients who underwent combination treatment using surgical reduction and 532-nm Q-switched Nd:YAG laser for the removal of ocular pigmentation in oculodermal melanocytosis at Asan Medical Center (Seoul, Korea) between January 2009 and January 2013. The safety and cosmetic efficacy of this new surgical strategy were assessed by both patients and observers. RESULTS: Fifty eyes of 47 patients with oculodermal melanocytosis were enrolled. Ocular pigmentation was successfully reduced in all patients, and all patients were satisfied with the cosmetic results at the last visit. Preoperative and postoperative corrected visual acuity, keratometry, and refractive errors did not significantly differ. Postoperative intraocular pressure was significantly reduced (mean change, 2.33 ± 3.54 mm Hg; P = 0.03) at 1 month after surgery. During the follow-up period, no serious adverse events developed other than conjunctival neovascularization and conjunctival inclusion cyst in 5 eyes, respectively. CONCLUSIONS: Combination treatment for oculodermal melanocytosis removal seems to be cosmetically satisfactory and safe. This study suggested that combination treatment using surgical technique and 532-nm Q-switched Nd:YAG laser may be helpful for the removal of oculodermal melanocytosis.

Subconjunctival injection of low-molecular-weight heparin-taurocholate 7 inhibits corneal neovascularization.

PURPOSE: To evaluate the effects of a subconjunctival injection of low-molecular-weight heparin-taurocholate 7 (LHT7) on corneal neovascularization (CoNV) in rats. METHODS: Twenty-four Sprague-Dawley rats were divided into 4 groups of 6 animals each. Corneal centers were cauterized by the application of a silver/potassium nitrate solution for 8 seconds. Either 0.02 or 0.04 mL of 25 mg/mL of LHT7 (low- and high-LHT7 groups, respectively) was subconjunctivally injected on days 2 and 4 after the cauterization was done; 0.02 mL of 25 mg/mL of bevacizumab was injected into rats in the positive control group, with normal saline (NS) being administered to a negative control group. Digital photographs of the cornea were taken 1 and 2 weeks later to calculate the percentage of CoNV using the area of the neovascularized cornea. To compare the differences in CoNV between weeks 1 and 2, the change in CoNV was calculated by subtracting the percentage of CoNV at 1 week from that at 2 weeks. RESULTS: The percentage of CoNV did not differ among the 4 groups either 1 or 2 weeks after the cauterization (P > 0.05). In all groups except the NS group, the percentage of CoNV significantly decreased at 2 weeks compared with that at 1 week (all P < 0.05). Moreover, the changes of CoNV in the high-LHT7 and bevacizumab groups significantly decreased compared with that in the NS group (all P < 0.05). Two corneal stromal hemorrhages occurred, 1 in each LHT7 group. CONCLUSIONS: Despite complications, including corneal stromal hemorrhage, subconjunctival injection of LHT7 attenuated CoNV after chemical cauterization.