Assessment for Macular Thickness after Uncomplicated Phacoemulsification Using Optical Coherence Tomography.

PURPOSE: Macular edema including cystoid macular edema is one of the main causes of unfavorable visual outcomes after cataract surgery. The macular thickness and the occurrence of macular edema after uncomplicated cataract surgery was evaluated using optical coherence tomography (OCT) in this study. METHODS: Macular map images were taken by OCT before surgery and at 1 week, 1 month, and 2 months postsurgery. The subjects were classified into two groups (group 1, patients with no macular edema; group 2, patients with macular edema). Group 2 was defined as increase in central macular thickness (CMT) by 30% compared with that before surgery. The risk factors for macular edema were evaluated. Group 2 was divided into two subgroups: subclinical macular edema (group 2A) and cystoid macular edema (group 2B) and they were assessed in terms of the clinical course of best-corrected visual acuity and CMT. RESULTS: A total of 376 patients were enrolled in this study, of which 36 (9.57%, group 2) showed macular edema measured by OCT after the surgery. Univariate analysis for group 1 and 2 revealed that intracameral injection of epinephrine during phacoemulsification was associated with the development of macular edema. In group 2, five patients (1.33%) developed cystoid macular edema. Statistically significant differences in the clinical course of CMT were observed at 2 months (201.2 ± 23.1, 250.0 ± 29.8, and 371.0 ± 160.3 in group 1, group 2A, and group 2B, respectively; p < 0.001) and 1 month postoperatively (198.5 ± 23.6, 237.8 ± 40.9, and 314.0 ± 104.5 in group 1, group 2A, and group 2B, respectively; p < 0.001). Group 2B required additional treatment and eventually achieved best-corrected visual acuity of >0.2 with CMT in the normal range. CONCLUSIONS: The intracameral injection of epinephrine may cause macular edema after uncomplicated cataract surgery. Examination of CMT using OCT is recommended for the early detection of macular edema.

Assessment of Optical Quality at Different Contrast Levels in Pseudophakic Eyes.

Purpose. To assess visual function using Optical Quality Analysis System (OQAS) at varying levels of contrast in pseudophakic eyes. Methods. The study included patients admitted to Seoul St. Mary's Hospital between January and February 2012: 143 pseudophakic eyes with one of five intraocular lens types, examined 2-6 months after cataract surgery, and 93 normal eyes (enhanced visual acuity (VA) < 0.1 logMAR) in age-matched controls. Subjects were examined at three contrast levels using the OQAS. Results. At 100%, 20%, and 9% contrast, simulated mean VA was 0.16 ± 0.18 logMAR, 0.30 ± 0.18 logMAR, and 0.52 ± 0.17 logMAR, in normal eyes, and 0.16 ± 0.12 logMAR, 0.33 ± 0.20 logMAR, and 0.56 ± 0.21 logMAR, respectively, in pseudophakic eyes. Simulated VA decreased significantly when contrast was reduced, regardless of ocular status, age group, and lens type (p < 0.05). There were no significant differences between normal and pseudophakic eyes among subjects aged 50-69 (p > 0.05). Among subjects aged 70-79, pseudophakic eyes showed improved simulated VA (p = 0.000) and objective scattering index values (p = 0.008). Conclusions. Patients with intraocular lenses have similar or superior visual function when compared to those with normal eyes at 2-6 months after cataract surgery, even under low-contrast conditions.

Assessment of Lens Center Using Optical Coherence Tomography, Magnetic Resonance Imaging, and Photographs of the Anterior Segment of the Eye.

PURPOSE: To determine the nearest marker for evaluating the center of the crystalline lens using optical coherence tomography (OCT), magnetic resonance imaging (MRI), and photographs. METHODS: Optical coherence tomography scans of human eyes were obtained in vivo during femtosecond laser-assisted cataract surgery. From axial and sagittal images, the distance of the angle center (AC) and pupil center (PC) from the scanned capsule center (SCC) was calculated. From pre- and postoperative photographs, the distance of the PC and limbal center (LC) from the intraocular lens (IOL) center was calculated, and distance between each center on the lens equatorial plane was compared. After combination of pre- and postoperative images, we arranged the centers in order of distance from the IOL center. High-resolution MRI was performed in pig eyes ex vivo to confirm the exact location of the lens center relative to other centers. RESULTS: In human OCT scans and photographs (n = 76), the IOL center to AC distance was 0.22 ± 0.13 mm, the IOL center to SCC distance was 0.22 ± 0.12 mm, the IOL center to PC distance was 0.25 ± 0.17 mm, and the IOL center to LC distance was 0.30 ± 0.18 mm. The AC and SCC were significantly closer to the IOL center than the PC or LC. In MRI (n = 54 images), the lens center to AC distance was 0.90 ± 0.58 mm, and the lens center to PC distance was 1.53 ± 0.87 mm (Δ distance = 0.63 ± 0.69 mm, P = 0.000). CONCLUSIONS: Optical coherence tomography, MRI, and photographs of the anterior segment revealed that the AC is the nearest marker to the center of the lens equator.

Comparison of refractive outcomes using five devices for the assessment of preoperative corneal power.

BACKGROUND: To compare keratometric values obtained with a manual keratometer (Topcon), an automated keratometer (Canon), an Orbscan II (Bausch & Lomb), the IOLMaster keratometer (Carl-Zeiss) and the Pentacam rotating Scheimpflug camera (Oculus) in cataract surgery, and to characterize the refractive outcomes generated using each device. DESIGN: Retrospective study conducted at a tertiary university hospital. PARTICIPANTS: Sixty-nine eyes of 69 patients were analysed. METHODS: The keratometric values obtained with different devices (manual keratometer, automated keratometer, corneal topography, IOLMaster keratometer and Scheimpflug camera) were employed for intraocular lens power calculation. Multiple comparisons of averaged keratometric value were conducted, and the averaged keratometric value was used to calculate the predicted refraction. The absolute values of corneal astigmatism were calculated and also compared. MAIN OUTCOME MEASURES: Mean keratometric value, absolute value of astigmatism, mean error and mean absolute error from each device. RESULTS: The mean keratometric values generated by manual keratometer, automated keratometry, corneal topography, IOLMaster keratometer and the Pentacam Scheimpflug system were 43.95 ± 1.39, 43.91 ± 1.39, 44.67 ± 1.53, 44.03 ± 1.41 and 42.96 ± 1.39 diopter, respectively. The absolute value of astigmatism determined via manual keratometer, automated keratometer, corneal topography, IOLMaster keratometer and the Pentacam Scheimpflug system were 0.95 ± 0.60, 0.99 ± 0.69, 1.14 ± 0.74, 1.11 ± 0.65 and 1.03 ± 0.73 diopter, respectively. The corneal topography showed statistically significant differences with other devices and produced the greater value in mean absolute errors (all P < 0.05). CONCLUSION: Keratometric values with standard devices are a good choice for cataract surgery, whereas the corneal topography is not an appropriate method for the assessment of preoperative keratometric values.

Posterior corneal curvature assessment after Epi-LASIK for myopia: comparison of Orbscan II and Pentacam imaging.

PURPOSE: To compare the changes in posterior corneal curvature using scanning slit topography (Orbscan II) and Scheimpflug imaging (Pentacam) before and after Epi-laser in situ keratomileusis (LASIK) for myopia. METHODS: In a prospective observational case-series study, 20 myopic patients having undergone Epi-LASIK were examined serially with two different devices, Orbscan II and Pentacam, preoperatively and one month postoperatively. Posterior central elevation (PCE) and posterior maximal elevation (PME) were compared between the two devices, and the changes in parameters after Epi-LASIK were analyzed using a difference map. RESULTS: All parameters (preoperative and postoperative PCE and preoperative and postoperative PME) that were measured using the Orbscan II were significantly greater compared to those of the Pentacam (for all p < 0.001). PCE and PME were significantly increased one month postoperatively in the Orbscan II measurements (p < 0.05) but were not significantly increased in the Pentacam measurements. Also, ΔPCE and ΔPME, in the difference map obtained by each serial scanning, were significantly greater in the Orbscan II measurements than with the Pentacam (p = 0.012, p = 0.016). CONCLUSIONS: The Pentacam measurements displayed significantly reduced values in all parameters related to posterior corneal elevation compared to those of the Orbscan II. The Pentacam showed no significant change in posterior corneal curvature after Epi-LASIK, based on the difference map.

Synthesis, characterization, and preliminary assessment of anti-Flt1 peptide-hyaluronate conjugate for the treatment of corneal neovascularization.

Anti-Flt1 peptide of GNQWFI has been reported to inhibit vascular endothelial growth factor receptor 1 (VEGFR1) - mediated endothelial cell migration and tube formation. In this work, a protocol to synthesize anti-Flt1 peptide-hyaluronate (HA) conjugate was successfully developed for the treatment of corneal neovascularization. Using tetrabutyl ammonium salt of HA (HA-TBA), water-insoluble anti-Flt1 peptide could be conjugated with HA in dimethyl sulfoxide (DMSO) by the amide bond formation between carboxyl groups of HA and N-terminal amine groups of GGNQWFI. The formation of anti-Flt1 peptide-HA conjugate was confirmed by (1)H NMR and fluorometric analyses. The average number of grafted peptide molecules in anti-Flt1 peptide-HA conjugates could be controlled from 3 to 30 per single HA chain by changing the feeding amount of peptide for the conjugation reaction. According to in vitro biological activity tests, anti-Flt1 peptide-HA conjugate exhibited a significant inhibition effect on the binding of Flt1-Fc to VEGF(165) coated on the well. Furthermore, in vivo biological activity of anti-Flt1 peptide-HA conjugate was confirmed from the inhibitory effect on corneal neovascularization in silver nitrate cauterized corneas of SD rats. The VEGF receptor 2 expression was also reduced after treatment with anti-Flt1 peptide-HA conjugate. The water-soluble anti-Flt1 peptide-HA conjugate was thought to have a potential to be developed as anti-angiogenic therapeutics for the treatment of corneal neovascularization.