Heat Treatment Enhances the Neuroprotective Effects of Crude Ginseng Saponin by Increasing Minor Ginsenosides.

Ginsenoside is the primary active substance of ginseng and has many pharmacological effects, such as anti-cancer, immune, regulating sugar and lipid metabolism, and antioxidant effects. It also protects the nervous and cardiovascular systems. This study analyzes the effects of thermal processing on the bioactivities of crude ginseng saponin. Heat treatment increased the contents of minor ginsenosides in crude saponins, such as Rg3, and heat-treated crude ginseng saponin (HGS) had better neuroprotective effects than non-treated crude saponin (NGS). HGS reduced glutamate-induced apoptosis and reactive oxygen species generation in pheochromocytoma 12 (PC12) cells, significantly more than NGS. HGS protected PC12 cells against glutamate-induced oxidative stress by upregulating Nrf2-mediated antioxidant signaling and downregulating MAPK-mediated apoptotic signaling. HGS has the potential for the prevention and treatment of neurodegenerative disorders, such as Alzheimer's and Parkinson's disease.

Therapeutic Effects of Aloe saponaria against Ulcerative Colitis Induced by Dextran Sulfate Sodium.

Aloe vera (A. vera) has been studied as a treatment option for ulcerative colitis (UC), but there is a lack of scientific evidence showing whether treatment with Aloe saponaria (A. saponaria) can also be beneficial. To investigate the therapeutic potential of A. saponaria as a treatment for UC, clinical symptoms, histopathological characteristics of the colon, inflammatory response, and toxicity were analyzed in dextran sulfate sodium (DSS)-induced UC mice after administration of aqueous extracts of A. saponaria (AAS) for 7 days. The total polyphenol and tannin content of AAS was 272 µg/g and 163 µg/g, respectively. AAS exhibited significant antioxidant activity. Several clinical symptoms, including body weight, colon length, and hematochezia, remarkably improved in the DSS+AAS treated group compared to the DSS+Vehicle-treated group. In addition, similar improvements were detected in the histopathological characteristics and mucin-secreting ability in the colon of DSS-induced UC mice after the administration of AAS. The levels of infiltrated inflammatory cells and cytokine expression were significantly decreased in a dose-dependent manner in the colon of the DSS+AAS-treated group. These alterations in inflammatory response were accompanied by a significant recovery of the protein kinase C/extracellular signal-regulated kinase (PKC/ERK) and phosphatidylinositol-3-kinase/serine-threonine protein kinase (PI3K/Akt) signaling pathways. However, the levels of key markers for hepatotoxicity and nephrotoxicity consistently remained between those of the DSS+AAS-treated and the No groups. Therefore, the results of the present study provide novel evidence that AAS may improve the clinical symptoms and attenuate the inflammatory response in DSS-induced UC mice and does not have any significant hepatotoxicity or nephrotoxicity.

Seasonal Dynamics of Methanotrophic Bacteria in a Boreal Oil Sands End Pit Lake.

Base Mine Lake (BML) is the first full-scale demonstration end pit lake for the oil sands mining industry in Canada. We examined aerobic methanotrophic bacteria over all seasons for 5 years in this dimictic lake. Methanotrophs comprised up to 58% of all bacterial reads in 16S rRNA gene amplicon sequencing analyses (median 2.8%), and up to 2.7 × 104 cells mL-1 of water (median 0.5 × 103) based on qPCR of pmoA genes. Methanotrophic activity and populations in the lake water were highest during fall turnover and remained high through the winter ice-covered period into spring turnover. They declined during summer stratification, especially in the epilimnion. Three methanotroph genera (Methylobacter, Methylovulum, and Methyloparacoccus) cycled seasonally, based on both relative and absolute abundance measurements. Methylobacter and Methylovulum populations peaked in winter/spring, when methane oxidation activity was psychrophilic. Methyloparacoccus populations increased in the water column through summer and fall, when methane oxidation was mesophilic, and also predominated in the underlying tailings sediment. Other, less abundant genera grew primarily during summer, possibly due to distinct CH4/O2 microniches created during thermal stratification. These data are consistent with temporal and spatial niche differentiation based on temperature, CH4 and O2. This pit lake displays methane cycling and methanotroph population dynamics similar to natural boreal lakes. IMPORTANCE The study examined methanotrophic bacteria in an industrial end pit lake, combining molecular DNA methods (both quantitative and descriptive) with biogeochemical measurements. The lake was sampled over 5 years, in all four seasons, as often as weekly, and included sub-ice samples. The resulting multiseason and multiyear data set is unique in its size and intensity, and allowed us to document clear and consistent seasonal patterns of growth and decline of three methanotroph genera (Methylobacter, Methylovulum, and Methyloparacoccus). Laboratory experiments suggested that one major control of this succession was niche partitioning based on temperature. The study helps to understand microbial dynamics in engineered end pit lakes, but we propose that the dynamics are typical of boreal stratified lakes and widely applicable in microbial ecology and limnology. Methane-oxidizing bacteria are important model organisms in microbial ecology and have implications for global climate change.

Anti-inflammatory activity of a new cyclic peptide, citrusin XI, isolated from the fruits of Citrus unshiu.

ETHNOPHARMACOLOGICAL RELEVANCE: Citrus unshiu (Rutaceae) is an easy-peeling citrus fruit, which has been used as a traditional Korean medicine for improving skin elasticity, relieving fatigue and cough, and preventing bronchitis, flu, and various cancers. However, its active components associated with anti-inflammation and underlying mechanisms remain unknown. In this study, we investigated the active constituents from the fruits of Citrus unshiu and evaluated the anti-inflammatory activity in order to support the traditional usage of Citrus unshiu. MATERIAL AND METHODS: Repeated column chromatography, together with a semi-preparative HPLC purification was used to separate the bioactive constituent from the EtOAc soluble fraction of the EtOH extract of Citrus unshiu fruits. Anti-inflammatory effects of the isolated compounds on lipopolysaccharide (LPS)-induced production of pro-inflammatory mediators were examined using RAW264.7 macrophage cells. RESULTS: A new cyclic peptide, citrusin XI (1), was isolated and identified from the fruits of Citrus unshiu. The structure of compound 1 was elucidated by spectroscopic analysis, including 1D and 2D nuclear magnetic resonance (NMR) ((1)H, (13)C, COSY, HMQC and HMBC experiments), and high resolution (HR)-mass spectrometry, and its absolute configurations were further confirmed by the Marfey׳s method. Compound 1 decreased NO production in LPS-stimulated RAW264.7 cells in a dose-dependent manner with an IC50 value of 70µM. Compound 1 suppressed NO production by decreasing iNOS expression but COX-2 expression was slightly associated with the reduction by compound 1 in LPS-induced RAW264.7 cells. Furthermore, compound 1 inhibited NF-κB activation by blocking IκBα degradation and NF-κB phosphorylation in LPS-stimulated RAW264.7 cells. CONCLUSIONS: These results indicate that a new cyclic peptide, citrusin XI, from Citrus unshiu fruits has anti-inflammatory properties that inhibit the release of pro-inflammatory mediators. Compound 1 decreases NO production by decreasing iNOS expression and NF-κB activation associated with IκBα degradation and NF-κB phosphorylation in LPS-induced RAW264.7 cells. This is the first study to clarify the underlying mechanism of the anti-inflammatory effect exerted by a pure isolated compound from Citrus unshiu in LPS-stimulated RAW264.7 macrophage cells. The phytochemical, citrusin XI of Citrus unshiu may serve as lead compound in the design of new agents for preventing and treating inflammatory diseases.

Power prediction for one-piece and three-piece intraocular lens implantation after cataract surgery in patients with chronic angle-closure glaucoma: a prospective, randomized clinical trial.

PURPOSE: To assess the accuracy of intraocular lens (IOL) power prediction for cataract surgery in chronic angle-closure glaucoma (CACG) patients with different IOLs' implantation. METHODS: This prospective randomized clinical trial included 45 eyes with CACG and 48 eyes with normal controls undergoing cataract surgery. In the CACG group, 23 eyes (51%) had three-piece IOL implantation and 22 eyes (49%) had one-piece IOL implantation. In the normal control group, 25 eyes (52%) had three-piece IOL implantation and 23 eyes (48%) had one-piece IOL implantation. Using the SRK/T formula, the mean difference between the predicted and actual postoperative spherical equivalent [mean absolute error (MAE)] was obtained and converted to natural logarithm (ln) for statistical analysis. The power of the implanted IOL was calculated to predict postoperative SE using three formulas: SRK II, Holladay II and Hoffer Q by post hoc analysis in each group. The predictive accuracy of each formula was analysed by comparing the lnMAE. RESULTS: In the one-piece IOL group, there was no difference in lnMAE between the CACG and normal control group (p = 0.314). In the three-piece IOL group, the lnMAE of the CACG group was larger than that of the normal control group (p < 0.001). The lnMAEs calculated by the SRK/T formula were more accurate than the Holladay II (p = 0.045) and Hoffer Q (p = 0.042) formula in the CACG one-piece IOL group. CONCLUSIONS: Implantation of one-piece IOLs provides similar power prediction accuracy comparable to normal cataract patients; this result may be explained by the IOL haptic configuration or design.

Surgical results of Ahmed valve implantation with intraoperative bevacizumab injection in patients with neovascular glaucoma.

PURPOSE: To investigate the surgical results of Ahmed valve implantation with intraoperative bevacizumab injection in patients with neovascular glaucoma (NVG). METHODS: A retrospective comparative case series review was conducted on 52 eyes with NVG who underwent Ahmed glaucoma valve implantation with or without intraoperative bevacizumab intravitreal injection. In the intraoperative intravitreous bevacizumab injection group (IVB group, 20 eyes), 1.25 mg of bevacizumab was injected into the vitreous cavity during Ahmed valve implantation. In the control group (32 eyes), only Ahmed valve implantation was performed. Surgical failure was defined when (1) the postoperative intraocular pressure was over 21 mm Hg at consecutive clinic visits, (2) the visual acuity became light perception negative, (3) additional antiglaucomatic surgery was required, or (4) devastating operative or postoperative complications were noted. RESULTS: Although the success rate in the IVB group (70.0%) was higher than that in the control group (62.5%) 1 year after operation, the differences were not statistically significant (P=0.828 by log-rank test). Mean intraocular pressures in the IVB group were significantly lower than those of the control group at 12 and 15 months (P<0.05 by the Mann-Whitney U test). Postoperative complications were similar between the 2 groups. Preoperative history of trabeculectomy was a significant risk factor for surgical failure of Ahmed valve implantation in NVG (relative risk=4.618; P=0.018 by Cox regression model). CONCLUSIONS: Intraoperative IVB injection does not seem to be helpful for better surgical outcomes of Ahmed valve implantation in NVG. A history of trabeculectomy is a risk factor for failure after Ahmed valve implantation in patients with NVG.

Influence of cataract on time domain and spectral domain optical coherence tomography retinal nerve fiber layer measurements.

PURPOSE: To assess and compare the influence of cataract on measurements of retinal nerve fiber layer (RNFL) thickness by time domain (TD) optical coherence tomography (OCT) and spectral domain (SD) OCT. METHODS: Patients who underwent uncomplicated cataract surgery were consecutively enrolled in this study. The peripapillary RNFL thickness was measured before and 8 weeks after cataract surgery using TD-OCT and SD-OCT during the same visit. Changes in the RNFL thickness measurement and signal strength (SS) after cataract surgery were evaluated. RESULTS: A total of 54 patients (54 eyes) were included. After excluding 19 eyes owing to poor imaging or low SS (<5), scans of 35 eyes were included in the final analysis. A significant difference was identified between the preoperative and postoperative SS values using SD-OCT, but not TD-OCT (P=0.002 and 0.789, respectively). The changes in RNFL thickness after cataract surgery were more prominent and frequent for SD-OCT than TD-OCT. There was a significant correlation between change in preoperative RNFL thickness and SS changes for both TD-OCT (r=0.410, P<0.001) and SD-OCT (r=0.246, P=0.002). CONCLUSIONS: The presence of cataract significantly affects RNFL thickness measurements by SD-OCT and TD-OCT. SD-OCT, which demonstrated more consistent change of RNFL measurements after cataract extraction, is not necessarily associated with lower RNFL thickness measurement performance in cataract cases, as more participants with cataract were excluded because of poor image quality or low SS, which was more associated with TD-OCT than SD-OCT.

Influence of blue light-filtering intraocular lenses on retinal nerve fiber layer measurements by spectral-domain optical coherence tomography.

PURPOSE: The purpose of this study was to assess the influence of blue light-filtering intraocular lenses (IOL) on peripapillary retinal nerve fiber layer (RNFL) thickness measurements by spectral-domain (SD) optical coherence tomography (OCT). METHODS: This prospective study included 50 eyes of 50 patients. Patients were randomly assigned to receive either a blue light-filtering IOL (acrysof IQ (SN60WF) [Alcon]) or a clear IOL (Tecnis (Z9003) [AMO]). The peripapillary RNFL thickness was measured using a Cirrus SD OCT before and 8 weeks after cataract surgery. Perioperative differences in RNFL thickness measurements and signal strengths (SS) were evaluated and compared in both IOL groups. RESULTS: Thirty-nine eyes of 39 patients were included in the final analysis. There was a significant increase in average RNFL thickness and SS after cataract surgery in both IOL groups. No significant difference in perioperative changes of RNFL measurements was noted between yellow and clear IOL groups. In the multivariable analysis, the factor affecting perioperative differences of RNFL measurements was not IOL type but SS. CONCLUSIONS: Our data suggests that blue-light filtering IOL does not influence RNFL thickness measurements by Cirrus SD-OCT.

COCH transgene expression in cultured human trabecular meshwork cells and its effect on outflow facility in monkey organ cultured anterior segments.

Purpose. To determine the effects of COCH transgene expression on cultured human trabecular meshwork (HTM) cell morphology and on outflow facility (OF) in monkey organ cultured anterior segments (MOCAS). Methods. An adenoviral (Ad) vector expressing both cochlin (COCH) and green fluorescent protein (GFP) (AdCOCHGFP) or GFP alone (AdGFP) was used to transduce cultured HTM cells (multiplicity of transduction, 2.8 and 28). COCH transgene expression in transduced HTM cells and the culture medium was verified by Western blot analysis and immunofluorescence detection 5 days after transduction. MOCAS were used to test the effect of Ad vectors (2.8 x 10(10) viral particles per segment) on OF. The morphology of transduced MOCAS was evaluated by light microscopy. Results. Western blot analysis showed a viral vector dose-dependent expression of cochlin in transduced cells and the culture medium. There was no notable morphologic change in transduced cells. In MOCAS, cochlin expression was detectable in the medium by 3 days after transduction. A 35% decrease in OF in AdCOCHGFP-transduced MOCAS was detected after 3 days, decreasing by 76% after 12 days when compared to control segments injected with AdGFP. Anterior segment pressure (ASP) more than doubled (P < 0.05) in segments injected with AdCOCHGFP at 12 days after transduction. Light microscopy revealed normal angle structures in transduced segments. Conclusions. Ad vector delivery of the COCH transgene resulted in cochlin expression in HTM cells and MOCAS. Cochlin expression was effective in decreasing OF and increasing ASP in MOCAS, suggesting possible involvement of cochlin in IOP elevation in vivo. COCH gene delivery has potential for use in developing a glaucoma model.

Efficacy of brimonidine tartrate 0.2% ophthalmic solution in reducing halos after laser in situ keratomileusis.

PURPOSE: To quantitatively evaluate the effect of brimonidine tartrate 0.2% (Alphagan) on halo and pupil size in patients who had symptomatic night-vision difficulties after laser in situ keratomileusis (LASIK). SETTING: Nune Eye Hospital, Seoul, Korea. METHODS: This study comprised 28 eyes of 14 patients with symptomatic night-vision difficulties after LASIK. Pupil diameter was measured with a Colvard pupillometer (Oasis Medical, Inc.). Quantitative analysis of halos was performed by measuring the area using a new computerized method. Pupil size and halo size were evaluated under scotopic and normal room light conditions. Alphagan was administered, and the effect was measured after 30 minutes and 1, 6, 12, and 24 hours. RESULTS: There was a statistically significant correlation between pupil size and halo size (r = 0.527; P<.0001; slope = 691.6 pixel/mm). Pupil size and halo size decreased significantly 30 minutes after Alphagan instillation under both luminance conditions (all P< .0001). Under normal room light, the pupil and halo remained decreased until the last measurement at 24 hours. Under scotopic conditions, the pupil returned to its preinstillation size at 24 hours while the halo remained decreased. The maximum effect on halos was observed after 6 hours, when the mean reduction over preinstillation size was 28.2% and 29.1% under normal room light conditions and scotopic conditions, respectively. CONCLUSION: Alphagan effectively reduced halo size and pupil size in postoperative LASIK patients with night-vision symptoms.

Impact of short-term exposure of commercial eyedrops preserved with benzalkonium chloride on precorneal mucin.

PURPOSE: The aim of this study is to investigate the short-term effects of benzalkonium chloride (BAC), a preservative used in many ophthalmic topical solutions, on precorneal mucin in humans. METHODS: Immortalized human corneal-limbal epithelial (HCLE) cells were exposed to eyedrops containing BAC solutions at 0.0025% and 0.01% concentrations for a period of 15 min. Human corneal epithelium was acquired with consent, as a byproduct of elective excimer photorefractive keratectomy procedures after application of Ocuflox eyedrops (0.3% ofloxacin with 0.0025% BAC) for 1 week before surgery. The relative expression of the MUC1 and MUC16 mucin gene was determined by conventional and real-time reverse transcription-polymerase chain reaction (RT-PCR). Monoclonal antibodies for MUC1 (HMFG-1) and MUC16 (OC125) were used in western blot analysis to detect MUC1 and MUC16. Human corneas exposed to 0.01% BAC solutions were examined by transmission electron microscopy. RESULTS: The expression of MUC1 and MUC16 gene transcripts was not changed after exposure to BAC in HCLE cells and human corneal epithelium. However, MUC1 and MUC16 were reduced after exposure to BAC in HCLE cells and human corneal epithelium. Transmission electron microscopy of the anterior corneal surface revealed fixation of the mucous layer after exposure to 0.01% BAC for 5 or 15 min; prolonged exposure (60 min) to 0.01% BAC destroys the mucous layer. CONCLUSIONS: This study demonstrates that short-term exposure to BAC can alter the precorneal mucin.

Amniotic membrane as a biologic pressure patch for treating epithelial ingrowth under a damaged laser in situ keratomileusis flap.

We present 2 patients who had epithelial ingrowth after intraoperative laser in situ keratomileusis (LASIK) complications that created defects in the flap near the visual axis. As an adjuvant to removing the epithelium, an amniotic membrane patch was sutured tightly to the episclera so that it covered the entire cornea. The amniotic membrane overlay was left in place for about 1 week. There was no evidence of recurrent epithelial ingrowth after a minimum of 4 months. Use of an amniotic membrane overlay can be an effective adjuvant therapy to secure a LASIK flap when direct suturing would threaten the visual axis.

Correction of osteoporotic fracture deformities with global sagittal imbalance.

UNLABELLED: Osteoporotic spinal deformities with global sagittal imbalance have devastating effects on patients. However, treatment is difficult and there is a high risk of perioperative medical and mechanical complications. Patients with osteoporotic spinal deformities are not ideal candidates for posterior pedicle subtraction osteotomy; the condition necessitates combined anterior-posterior for corrections of the deformity. We ascertained the complication rates and efficacy of the anterior-posterior surgery and determined the factors influencing the results. To determine complication rates we analyzed a series of patients (n = 32). To evaluate overall results, we analyzed 18 patients with more than 2-years followup. A total of 18 complications occurred in 12 of 32 patients (37.5%) with seven early complications occurring in five patients and 11 delayed complications occurring in seven patients. Three patients needed additional surgery to treat the complications. At 2 years postoperatively, 17 of 18 patients (94%) reported subjective improvement with 54% decrement of Oswestry Disability Index and 70% decrement of the visual analogue scale pain score. The factors associated with clinical improvement was restoration of total lumbopelvic lordosis, C7 plumb, and control of T4-12 thoracic kyphosis. Prevention and aggressive treatment of junctional fractures were important in achieving favorable results. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series, [patients treated one way with no comparison group of patients treated in another way]). See the Guidelines for Authors for a complete description of the levels of evidence.

Effect of postoperative refractive error on visual acuity and patient satisfaction after implantation of the Array multifocal intraocular lens.

PURPOSE: To determine the ideal target refraction to optimize visual acuity (VA) and patient satisfaction after implantation of Array SA40N multifocal intraocular lens (IOL) (AMO). SETTING: Inha University College of Medicine, Incheon, Korea. METHODS: The study prospectively enrolled 188 eyes of 163 patients and assigned them to 1 of 3 groups according to their postoperative refractive status: Group 1 (43 myopic eyes, -0.50 diopter [D] to -1.50 D), Group 2 (114 emmetropic eyes, -0.50 D to +0.50 D) and Group 3 (31 hyperopic eyes, +0.50 D to +1.50 D). Uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), UCDVA under glare conditions, contrast sensitivity, and patient satisfaction were then compared between the 3 groups. RESULTS: Three months postoperatively, UCDVA, UCNVA, UCDVA under glare conditions, and contrast sensitivity were good in all eyes and more than 72% of patients never wore glasses for near vision. In Group 2, UCDVA was significantly better (0.74 +/- 0.20; P<.05) compared with Groups 1 and 3 (0.40 +/- 0.24 and 0.38 +/- 0.30, respectively); UCNVA was also significantly better in Group 2 (0.68 +/- 0.08; P<.05) than in Groups 1 and 3 (0.45 +/- 0.21 and 0.41 +/- 0.17, respectively). However, there were no significant differences in patient satisfaction, contrast sensitivity, and UCDVA under glare conditions between the 3 groups (P>.05). CONCLUSIONS: Aiming for emmetropia rather than myopia when calculating the power for the multifocal intraocular lens may improve visual acuity. However, patients must be considered on an individual basis to meet their expectations and requirements.

Clinical manifestation and pathologic finding of unilateral acute hydrops after bilateral laser in situ keratomileusis.

We present a case of unilateral acute hydrops that developed in 25-year-old man 6 years after bilateral laser in situ keratomileusis (LASIK) for the correction of 2.75 diopters (D) of myopia. Preoperative corneal thickness using ultrasound pachymetry were 556 microm in the right eye and 554 microm in the left eye. Preoperative corneal topography of both eyes showed an asymmetric bow-tie pattern with inferior steepening. Forty-seven months after LASIK, the left eye developed astigmatism and enhancement excimer ablation was performed. Sixteen months after enhancement, a definite sign of keratectasia was detected in the left eye. Twenty-six months after enhancement, acute hydrops occurred in the left eye. The interface of the LASIK wound was separated and filled with aqueous humor. Penetrating keratoplasty was performed to avoid perforation. The keratocytes at the edge between the peripheral flap and remaining stroma showed mixoid degeneration and edematous change suggesting dying cells.

Comparison of higher-order aberrations after LASEK with a 6.0 mm ablation zone and a 6.5 mm ablation zone with blend zone.

PURPOSE: To compare the higher-order aberrations (HOAs) after laser-assisted subepithelial keratectomy (LASEK) using a conventional optical zone and a larger zone with a blend zone. SETTING: Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. METHODS: In this prospective study, 19 patients with a manifest refraction of -3.00 to -8.25 diopters (D) were treated with LASEK using a conventional (6.0 mm) optical zone in 1 eye and a larger (6.5 mm) zone with 8.0 mm blend zone in the other eye. The patients were followed for 3 months. Pupil size, best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), manifest refraction, corneal topography, pachymetry, and wavefront aberration were examined preoperatively; BCVA, UCVA, manifest refraction, and wavefront aberration were measured 1 and 3 months postoperatively. The Hartmann-Shack aberrometer (WaveScan(R), Visx) was used to measure the overall wavefront aberrations in scotopic pupils. RESULTS: There were no significant differences in preoperative pupil size, BCVA, UCVA, and manifest refraction between the 2 groups or in postoperative BCVA, UCVA, and refraction. Higher-order aberrations increased at 1 and 3 months in both eyes compared with preoperatively. At 3 months, in a scotopic pupil, the mean root-mean-square wavefront error of the HOAs was 0.41 +/- 0.14 in the eyes treated with the larger optical zone and 0.61 +/- 0.28 in those treated with the conventional optical zone. There was a significant difference between optical zones (P =.006). The difference was more pronounced in the treatment of myopia greater than -5.0 D (P =.001). CONCLUSIONS: In the scotopic condition, HOAs after LASEK using a large optical zone with blend zone ablation were smaller than those associated with conventional ablation zone treatment. The larger zone with blend zone treatment may be a good surgical alternative for better visual outcomes in scotopic conditions.