Early postoperative visual acuity changes after trabeculectomy and factors affecting visual acuity.

PURPOSE: To investigate the early visual acuity (VA) changes that occur after trabeculectomy and their reversal with recovery. METHOD: Two hundred ninety-two eyes of 292 patients after initial trabeculectomy as a standalone procedure fulfilling the following conditions were included: 1) patients with a postoperative follow-up of at least 3 months; 2) patients with preoperative corrected VA less than 0.5 logMAR equivalent; 3) patients with reliable results of visual field; and 4) patients who had open angle glaucoma. VA and intraocular pressure (IOP) changes during the first 3 months after surgery and factors affecting VA postoperatively at 3 months were investigated. RESULTS: The mean IOPs (mmHg) after trabeculectomy were significantly lower than preoperatively during the entire period (P < 0.0001). The mean corrected VA for all patients was 0.06 ± 0.17, 0.24 ± 0.38, 0.19 ± 0.26, and 0.14 ± 0.27 preoperatively and at 1 week, 1 month, and 3 months postoperatively, respectively, showing a significant decrease from the preoperative period at all time points (P < 0.0001). VA loss of two or more levels was observed in 13 eyes (4.45%) at 3 months postoperatively. Foveal threshold (FT), shallow anterior chamber (SAC), and choroidal detachment (CD) affected the change in VA before and at 3 months after surgery (P < 0.0001, P = 0.0002, P = 0.0004, respectively). The factors that had significant effects on VA change were FT, SAC, and CD in POAG, FT and hypotonic maculopathy in NTG, and FT in XFG (p < 0.05). CONCLUSION: The frequency of serious vision loss was 4.45% for two or more levels of vision loss, and early postoperative VA changes after trabeculectomy may not be reversed even 3 months later. VA loss is influenced by preoperative FT, postoperative SAC and CD, but the impact of postoperative complications vary with disease type.

Changes in the preoperative ocular surface flora with an increase in patient age: A surveillance analysis of bacterial diversity and resistance to fluoroquinolone.

PURPOSE: This study analyzed the relationship between patient age and the prevalence and fluoroquinolone susceptibility of gram-positive cocci from the ocular surface flora before ophthalmic surgery. METHODS: This surveillance study included scraped samples from the conjunctival sac of 8923 eyes of 5490 patients (70.0 ± 13.7 years) without ocular infection before ophthalmologic surgery between August 2018 and December 2020. A review of microbiological records regarding patient age was used to determine the number of isolates and gram-positive species obtained, as well as their fluoroquinolone susceptibility. Fluoroquinolone susceptibility was determined using the Clinical and Laboratory Standards Institute protocols of broth microdilution. Statistical analysis was performed using a generalized additive model and a log-linear model. RESULTS: In total, 9,894 bacterial isolates obtained from scraped samples from the patients were analyzed. The detected species were Staphylococcus epidermidis (31.0%), Staphylococcus aureus (6.1%), Staphylococcus lugdunensis (3.9%), Enterococcus faecalis (5.8%), Corynebacterium species (31.7%), and Cutibacterium acnes (7.5%) and others. The number of species isolated from the ocular surface was increased at the rate of 1.018 per 10 years of age (p < 0.0001). S. epidermidis, S. lugdunensis, E. faecalis, and Corynebacterium species were isolated more often with an increase in patient age. The levofloxacin resistance ratio of methicillin-sensitive S. epidermidis and Corynebacterium species increased at the rate of 1.204 and 1.087 respectively with a 10-year increase in age (both p < 0.0001). CONCLUSION: Gram-positive bacteria in the ocular surface flora (OSF) exhibited gradual changes in diversity and fluoroquinolone resistance with an increase in patient age. It is important to monitor the OSF of the patients before ophthalmologic surgery to prevent refractory ocular postoperative infection.

Measurement of Aniseikonia Tolerance in Binocular Fusion.

SIGNIFICANCE: The determination of aniseikonia tolerance may aid in developing optimal treatment plans for cataract surgery, refractive surgery, and refractive correction with glasses and contact lenses. PURPOSE: This study aimed to measure aniseikonia tolerance. METHODS: We included 33 patients (mean age ± standard deviation, 28.9 ± 6.4 years; male/female, 12:21) with anisometropia ≤1.0 D and best spectacle-corrected visual acuity of 20/20 or more in both eyes, with no ophthalmologic disease other than refractive errors and no history of ocular surgery. The exclusion criteria were anisometropia >1.0 D, axial length difference >0.5 mm, corneal refractive power difference >0.5 D, astigmatism >3.0 D, stereoacuity threshold >100 arcsec according to the Titmus Stereo Test, and >0% aniseikonia according to the New Aniseikonia Test. Aniseikonia tolerance was assessed using Eyemark Hello, a haploscope using gaze detection technology. Although the optotype of one eye was enlarged or reduced at a speed of 2%/s, the patients were instructed to press a button on the controller to indicate blurring, flickering, and diplopia. The value at which the patient responded was considered the aniseikonia tolerance value and assessed thrice per eye, five times if the values were highly variable, and then averaged. RESULTS: The mean aniseikonia tolerance was approximately 3%; the median value was approximately 2% (range, 1.0 to 11.5%; dominant eye, 3.3 ± 2.6%; nondominant eye, 2.9 ± 1.8%). No significant difference in aniseikonia tolerance between the dominant and nondominant eyes was observed for the enlarged optotypes. No case showed changes in the ocular alignment before discomfort occurred. No significant correlation was observed between aniseikonia tolerance and anisometropia, axial length difference, corneal power difference, and ocular deviation. CONCLUSIONS: Aniseikonia should be maintained at <2% for a comfortable visual environment. Aniseikonia tolerance may be an important indicator for cataract surgery, refractive surgery, and spectacle correction.

Characteristics of glaucoma patients with intraocular pressure elevation early after trabectome surgery.

PURPOSE: To analyze the rate and time of occurrence of intraocular pressure (IOP) elevation early after trabectome surgery (TOM) and the characteristics of glaucoma patients recovering from IOP elevation. METHOD: Four hundred sixty eyes of 460 glaucoma (191 primary and 269 secondary open-angle glaucoma) patients who underwent TOM were evaluated. IOP elevation early after TOM was diagnosed when IOP increased by more than 5 mmHg over baseline within 1 week to 3 months. If the IOP decreased with the administration of anti-glaucoma eye drops alone, patients were classified as recovered. If the IOP did not decrease despite additional anti-glaucoma eye drop use, patients were classified as non-recovered. The rate and time of occurrence of IOP elevation early after TOM were investigated. Demographic and ocular variables related to recovery and non-recovery were identified by multivariate logistic regression analysis. RESULTS: Of the 460 patients, IOP elevation early after TOM occurred in 102 (22.2%). IOP elevation occurred most frequently at postoperative week 1. Of the 102 patients with IOP elevation, 55 (53.9%) recovered and 47 (46.1%) did not. A large hyphema size the day after surgery was associated with increased likelihood of recovery from IOP elevation (odds ratio [OR], 6.6). A history of past selective laser trabeculoplasty (SLT; OR, 0.10) and high baseline IOP (OR, 0.86) were associated with reduced likelihood of recovery from IOP elevation. CONCLUSION: IOP elevation early after TOM occurred most frequently at postoperative week 1. Patients with a large hyphema size, no history of SLT, and a lower baseline IOP recovered from IOP elevation early after TOM. A large hyphema the day after surgery suggested an increased likelihood of recovery from IOP elevation.

Morphological Changes and Potential Mechanisms of Intraocular Pressure Reduction after Micropulse Transscleral Cyclophotocoagulation in Rabbits.

INTRODUCTION: Micropulse transscleral cyclophotocoagulation (MP-TSCPC) is a method for intraocular pressure (IOP) reduction in patients with glaucoma; however, the specific mechanisms underlying its ability to reduce IOP remain unclear. We therefore investigated the morphological changes and mechanisms of IOP reduction after MP-TSCPC. METHODS: The right eyes of 4 pigmented rabbits were treated with MP-TSCPC with power setting corresponding to those used in glaucoma patients (1 power: 2,000 mW; time: 160 s; duty cycle: 31.3%). Power settings of 1, 1/8, 1/16, and 1/32 power were applied to the right eyes. The left eyes were used as controls. A light microscope and electron microscope were used to observe morphological findings after 1 week of MP-TSCPC. IOP and IOP reduction rate were compared before and after MP-TSCPC application on days 1, 3, and 5, and at 1 week. RESULTS: In the pre-MP-TSCPC, IOP was 16.7 ± 0.6 mm Hg. The IOP of rabbit treated with the 1 power was 3 mm Hg, with an IOP reduction rate of 80%; however, the eyes developed phthisis bulbi. The IOP was 7.0 ± 0.0 mm Hg 1 week after MP-TSCPC (IOP reduction rate: 59%) in rabbit treated with the 1/8 power. Reduction in IOP was observed, but there was significant tissue invasion to the ciliary body. The IOP was 10.3 ± 0.6 mm Hg (IOP reduction rate: 40%) 1 week after MP-TSCPC in rabbit treated with the 1/16 power, which was more effective to reduce IOP than that with the 1/8 power. Tissue invasion to the ciliary body was negligible, nonpigmented epithelial cells of the pars plicata were damaged, basal infoldings were destroyed, and repair was accompanied by proliferating tissue. No IOP reduction or tissue change was observed in rabbit treated with the 1/32 power. CONCLUSION: A potential mechanism for IOP reduction in pigmented rabbits is aqueous humor transport dysfunction due to damage to the nonpigmented epithelial cells of the pars plicata and destruction of basal infoldings. The power of MP-TSCPC was consistent with both morphological changes and IOP reduction.

Standard coronal orbital magnetic resonance imaging is an effective technique for diagnosing sagging eye syndrome.

PURPOSE: The aim of this study was to determine the importance and efficacy of the standard coronal magnetic resonance imaging (MRI) analysis method for the correct clinical diagnosis of the sagging eye syndrome. METHODS: This retrospective study evaluated the standard coronal MRI efficacy by comparing the positions of the orbital pulleys and extraocular muscles in patients with sagging eye syndrome as well as controls. The participants included 50 patients with sagging eye syndrome (aged 73.3 ± 6.7 years) and 17 age-matched control patients (aged 70.9 ± 4.3 years) that presented optic neuritis. The participants were classified into groups of age-related distance esotropia and cyclo-vertical strabismus. Lateral rectus-superior rectus band condition, lateral rectus vertical angle, lateral rectus tilting angle, and superior rectus-lateral rectus displacement angle were examined. RESULTS: The lateral rectus-superior rectus band was more frequently disordered in the two groups than that in the control. The lateral rectus vertical and tilt angle examinations exhibited a significant difference in the age-related distance esotropia [(- 13.3 ± 10.9°, p < 0.05) and (- 24.1 ± 9.5°, p < 0.01)] and cyclo-vertical strabismus [(- 11.9 ± 6.9°, p < 0.05) and (- 20.8 ± 9.3°, p < 0.01)] groups compared with those in the control group [(- 7.5 ± 5.1°) and (- 12.2 ± 9.1°)]. The superior rectus-lateral rectus displacement angle did not present a significant difference between the patients and control groups. CONCLUSIONS: Patients with sagging eye syndrome exhibited disordered orbital pulley and extraocular muscle malposition, as determined by standard coronal magnetic resonance imaging, indicating the effectiveness of the procedure for diagnosing sagging eye syndrome.

Long-term clinical results of trabectome surgery in patients with open-angle glaucoma.

PURPOSE: To evaluate the 72-month clinical results of trabectome surgery (TOM) in patients with primary open-angle glaucoma (POAG), secondary OAG and childhood glaucoma. METHOD: A total of 305 eyes from 249 glaucoma patients were analyzed in the current retrospective single-center study. Kaplan-Meier analysis was performed using three criteria: criterion A (postoperative intraocular pressure [IOP] ≤ 21 mmHg and ≥ 20% reduction from baseline IOP); criterion B (postoperative IOP ≤ 18 mmHg and ≥ 20% reduction from baseline IOP); and criterion C (postoperative IOP ≤ 16 mmHg and ≥ 20% reduction from baseline IOP). The changes in IOP, medication score, success probability, results of the multivariate analysis for success and failure risk factors, and complications were analyzed. RESULTS: The baseline IOP in all glaucoma patients decreased from 29.2 ± 9.8 mmHg with a 5.3 ± 1.7 medication score to 16.4 ± 5.8 mmHg (- 43.8%) with a 4.2 ± 1.5 medication score at 72 months (p < 0.01). The success probabilities in all cases for 72 months based on criterion A, B, and C were 44%, 35%, and 17%, respectively. For criterion A, no significant differences were found in the success probability according to the glaucoma subtype for 72 months. The combined surgical procedure significantly decreased the failure risk (hazard ratio [HR]: 0.59). On the other hand, the presence of POAG (HR: 1.6) and a history of past selective laser trabeculoplasty (HR: 2.2) significantly increased failure risk. One patient (0.3%) demonstrated endophthalmitis after TOM but recovered through appropriate treatment. CONCLUSION: At the 72-month time point, approximately half of the glaucoma patients maintained an IOP ≤ 21 mmHg with ≥ 20% IOP reduction. TOM is a safe surgery but may not yield sufficient IOP reduction in patients who have received SLT or have POAG.

Effect of corneal cross-linking on endothelial cell density and morphology in the peripheral cornea.

BACKGROUND: To compare the endothelial cell density and morphology in the peripheral cornea before and after corneal cross-linking (CXL). METHODS: This study evaluated thirty-one eyes of 31 patients who were treated with standard CXL for progressive keratoconus. Preoperatively and 6 months postoperatively, we compared the corneal endothelial cell density (ECD), the coefficient of variation in cell size (CV), and the percentage of hexagonal cells (HEX), in the peripheral regions of the cornea, using a non-contact specular microscope (EM-3000, Tomey). RESULTS: All keratoconic eyes in this series were measurable in the peripheral regions. No significant differences were found in the peripheral ECD preoperatively and 6 months postoperatively at each point (Wilcoxon signed-rank test, superior, p = 0.16, nasal superior, p = 0.12, temporal superior, p = 0.17, inferior, p = 0.37, nasal inferior, p = 0.28, temporal inferior, p = 0.17). The mean percentage of the ECD loss was 1.3, 1.3, 1.0, 1.4, 0.7, and 1.4%, respectively. No significant differences in the peripheral CV or HEX were found preoperatively and 6 months postoperatively at each point. CONCLUSIONS: Standard CXL does not cause significant changes in endothelial cell density, polymegethism, or polymorphism, in the peripheral regions of the cornea. It is suggested that CXL is a minimally invasive surgical approach for progressive keratoconus, even in terms of peripheral endothelial cells. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry (000031162).

Compressive Lesions of the Optic Chiasm: Subjective Symptoms and Visual Field Diagnostic Criteria.

We investigated the diagnostic ability of a new criterion (simple temporal depression) for compressive lesions of the optic chiasm. The subjects were 124 eyes with compressive lesions of the optic chiasm. The controls were 84 eyes. The Humphrey (Carl Zeiss) visual field test was used for visual field testing. The simple temporal depression index was calculated as the ratio of the sums of the thresholds for one line on the nasal side and temporal side of the vertical meridian. The result of new index was 87% sensitivity and 99% specificity. This result suggested that our new criterion will assist the diagnosis in the future.

Effect of Scattering and Aberrations on Visual Acuity for Band Keratopathy.

SIGNIFICANCE: The progressive accumulation of the calcification may deteriorate corneal transparency, especially in the interpalpebral area, and subsequent visual performance for patients with band keratopathy. However, the detailed quantitative analysis of light scattering or higher-order aberrations on visual performance for these patients so far has not been elucidated. PURPOSE: The aim of this study was to assess the relationship of intraocular forward scattering, corneal backward scattering, and corneal higher-order aberrations with visual acuity in eyes with band keratopathy. METHODS: This prospective study comprised 27 eyes of 27 consecutive patients who were diagnosed as having band keratopathy and age-matched 27 eyes of 27 healthy subjects. We quantitatively assessed objective scattering index using the double-pass instrument (Optical Quality Analysis System II; Visiometrics, Terrassa, Spain), corneal densitometry using the Scheimpflug rotating camera (Pentacam HR; Oculus, Wetzlar, Germany), and corneal higher-order aberrations using the Hartmann-Shack aberrometry (KR-9000; Topcon, Tokyo, Japan). RESULTS: The mean objective scattering index, corneal densitometry, corneal higher-order aberrations, and logarithm of the minimal angle of resolution (logMAR) visual acuity in eyes with band keratopathy were 5.14 ± 3.11, 36.42 ± 10.55 gray-scale units, 0.33 ± 0.10 µm, and 0.03 ± 0.11 logMAR, respectively. These parameters were significantly larger in the band keratopathy group than in those in the control group (Mann-Whitney U test, P < .001). We found significant correlations of visual acuity with the objective scattering index (Spearman correlation coefficient, r = 0.465, P = .015), but no significant association with the corneal densitometry (r = 0.082, P = .683) or with corneal higher-order aberrations (r = -0.073, P = .718), in eyes having band keratopathy. CONCLUSIONS: Intraocular forward scattering, corneal backward scattering, and corneal higher-order aberrations in eyes with band keratopathy were significantly higher than those in normal eyes. Visual acuity was significantly correlated with intraocular forward scattering, but not with corneal backward scattering or corneal aberrations in the band keratopathy group, suggesting that intraocular forward scattering plays a vital role in visual performance in eyes with band keratopathy.

Swedish Interactive Threshold Algorithm for central visual field defects unrelated to nerve fiber layer.

PURPOSE: To evaluate the characteristic appearance of induced central visual field defects unrelated to the nerve fiber layer on standard automated perimetry using the Swedish Interactive Threshold Algorithm (SITA), and to compare the findings to the appearance on existing Full Threshold (FT) and FASTPAC (FP) algorithms. METHODS: Thirty right eyes of 30 healthy young participants were examined using four Humphrey 24-2 program algorithms: FT, FP, SITA-Standard (SS), and SITA-Fast (SF). Central visual field defects were induced using a high-density white opacity filter centered on a plano lens. The test duration, fovea threshold, mean sensitivity (MS), mean deviation (MD), pattern standard deviation (PSD), visual field index (VFI), and defect size and depth were compared among all algorithms. RESULTS: The mean test duration was 21 % to 71 % shorter (p < 0.01), the fovea threshold 0.9 to 2.6 dB higher (p < 0.05), MS 1.1 to 1.7 dB higher (p < 0.05), MD 0.84 to 1.48 dB higher, PSD 0.33 to 0.60 lower, and VFI 2 % higher (p < 0.05) on SS and SF than on FT and FP. The defect size was approximately four points larger and the defect depth 127 to 156 dB shallower on SS and SF than on FT and FP (p < 0.01). CONCLUSIONS: Central visual field defects unrelated to the nerve fiber layer were wider and shallower and global indices were higher on SITA than on conventional FT and FP. These findings indicate that careful attention is required when converting from FT and FP to SITA.

Effect of hole size on fluid dynamics of a posterior-chamber phakic intraocular lens with a central perforation by using computational fluid dynamics.

BACKGROUND: A modified implantable collamer lens (ICL) with a central hole with a diameter of 0.36 mm, referred to as a hole-ICL, was created to improve aqueous humour circulation. The aim of this study is to investigate the ideal hole size in a hole-ICL from the standpoint of the fluid dynamic characteristics of the aqueous humour using computational fluid dynamics. METHODS: Fluid dynamics simulation using an ICL was performed with thermal-hydraulic analysis software FloEFD V 12.2 (Mentor Graphics Corp.). In the simulation, three-dimensional eye models based on a modified Liou-Brennan model eye with a conventional ICL (Model ICM, Staar Surgical) and a hole-ICL were used. The hole-ICL was -9.0 dioptres (D) and 12.0 mm in length, with an optic zone of 5.5 mm. The vaulting was 0.50 mm. The quantity of aqueous humour produced by the ciliary body was set at 2.80 µL/min. Flow distribution between the anterior surface of the crystalline lens and the posterior surface of the ICL was calculated, and trajectory analysis was performed. RESULTS: With an increase in the central hole size, the velocity of the aqueous humour increased, with the peak velocity occurring at a diameter of approximately 0.4 mm. Once the diameter had increased above 0.4 mm, the velocity then decreased. The velocity difference between the cases of a central hole size of 0.1 mm and 0.2 mm was significant. CONCLUSION: The desirable central hole size was 0.2 mm or larger in terms of flow dynamics. The current model, based on a central hole size of 0.36 mm, was close to ideal. The optimisation of the hole size should be performed based on results from a long-term clinical study so as to analyse the incidence rate of secondary cataract and optical performance.

[Epidemiological Study of Poor Visual Acuity among Schoolchildren in Bonin Islands].

PURPOSE: To investigate the change in uncorrected visual acuity (UCVA) among schoolchildren in Bonin Islands. SUBJECTS AND METHODS: UCVA of schoolchildren aged 6 to 14 years, was collected from reports of School Health Examination Surveys conducted from 1981 to 2012. The proportion of schoolchildren with poor UCVA in the Bonin Islands was compared with those in metropolitan Tokyo. The results in Bonin Islands were also divided into two groups, before- and after-1996 when terrestrial television broadcasting service has been started, and the data of those two groups were compared. RESULTS: The proportion of schoolchildren with poor UCVA in Bonin Islands was lower than that in Tokyo. Among the residents of Bonin Islands, the proportion of schoolchildren with UCVA of < 1.0 was higher in the after-1996 group than in the before- 1996 group, with a clear increase in schoolchildren with poor UCVA after 1996 (p < 0.01, Fisher's exact test), examined among the 4th grade of elementary school or above. After 1996, 26.6% of first graders at a public junior high school had poor UCVA of < 0.7, whereas before 1996 no such case could be detected. CONCLUSION: The present study revealed that the proportions of schoolchildren with poor UCVA in Bonin Islands was lower than that in Tokyo; but in the residents of Bonin Islands after 1996, the proportion of the schoolchildren with poor UCVA increased.

Bilateral Concurrent Eye Examination with a Head-Mounted Perimeter for Diagnosing Functional Visual Loss.

The authors here report a case series where bilateral concurrent eye examination, using a head-mounted perimeter (imo®), was employed to facilitate diagnosis of functional visual loss, as regular ophthalmological tests were ineffective. Subjects (11-year-old female, 15-year-old male, and 24-year-old male) were diagnosed with unilateral functional visual loss by using the imo®, at the Kitasato University hospital. The results of the imo® and those of Goldmann perimetry or Humphrey Field Analyzer II differed for all subjects, which is indicative of potential functional visual loss. Bilateral concurrent examination with the imo® may become a standard for future diagnosis of unilateral functional visual loss.

Effects of mydriasis and miosis on kinetic perimetry findings in normal participants.

PURPOSE: To evaluate the effects of pharmacologically induced mydriasis and miosis on kinetic perimetry findings in normal participants. METHODS: Thirty-eight eyes of 38 healthy young participants underwent kinetic perimetry (Octopus 900 perimeter) with III4e, I4e, I3e, I2e, and I1e stimuli. For each participant, 24 predetermined meridians with 15° intervals were automatically tested with a velocity of 3°/s under normal, mydriatic, and miotic conditions. Mydriasis and miosis were induced by one drop of 0.4 % tropicamide and 2 % pilocarpine hydrochloride, respectively. The isopter area and kinetic sensitivity were compared between the three pupil conditions. RESULTS: The average pupil size in the normal condition was 5.6 ± 0.9 mm, and it significantly increased to 8.5 ± 0.7 mm after mydriasis (p < 0.01) and decreased to 3.4 ± 0.8 mm after miosis (p < 0.01). Compared to the normal pupil, the isopter area of the dilated pupil was not significantly different under the III4e stimulus; however, it significantly decreased under the I4e, I3e, I2e, and I1e stimuli (p < 0.01). Compared to the normal pupil, the isopter area of the constricted pupil significantly decreased (p < 0.01) with the III4e stimulus and significantly increased with the I3e and I2e stimuli (p < 0.05). CONCLUSIONS: For both pupil conditions, kinetic sensitivity at each meridian showed a similar trend to the isopter area under each stimulus. The isopter area of the dilated pupil generally decreased, whereas the isopter area of the constricted pupil showed various findings. Therefore, careful attention should be paid to changes in the isopter area associated with changes in the pupil size.

Changes in Optic Nerve Head Blood Flow During Horizontal Ocular Duction.

Purpose: In this study, we aimed to compare blood flow changes in the optic nerve head (ONH) during horizontal ocular duction among normal, primary open-angle glaucoma (POAG), and normal-tension glaucoma (NTG) eyes. Methods: In this cross-sectional study, we included 90 eyes from 90 participants (30 control eyes, 30 POAG eyes, and 30 NTG eyes). ONH blood flow was measured with laser speckle flowgraphy using an external fixation light to induce central gaze, abduction, and adduction at 30 degrees for each eye. The mean blur rate (MBR) of the entire ONH area (MA), vascular region (MV), and tissue region (MT), and the change ratio were analyzed. The change ratio was defined as abduction or adduction value/central gaze value. Results: In the control group, MA significantly decreased during adduction (22.9 ± 3.7) compared with that during central gaze (23.6 ± 3.9, P < 0.05). In the POAG group, MA (adduction = 17.4 ± 3.8 and abduction = 17.3 ± 3.6) and MV (adduction = 37.9 ± 5.6 and abduction = 38.0 ± 5.6) significantly decreased during adduction and abduction compared with those during central gaze (18.0 ± 4.1 and 39.5 ± 6.3, respectively, P < 0.05). In the NTG group, MA significantly decreased during adduction (17.4 ± 4.2) compared with that during central gaze (18.1 ± 4.6) and abduction (18.1 ± 4.8, P < 0.05). The change ratio did not differ between the glaucoma and control groups. Conclusions: ONH blood flow decreased during horizontal ocular duction regardless of normal or glaucoma states; however, the change ratio was comparable between the normal and glaucoma groups.

Evaluation of the Accuracy of Intraocular Lens Power Calculation Formulas in Phacovitrectomy.

INTRODUCTION: The aim of this study was to evaluate the refractive error in patients undergoing combined phacovitrectomy with and without gas tamponade. METHODS: This was a retrospective chart review including patients undergoing phacoemulsification alone (Group 1), combined phacovitrectomy for epiretinal membrane (Group 2), and combined phacovitrectomy with gas tamponade for rhegmatogenous retinal detachment (RRD) (Group 3). Axial length and keratometry were measured using an optical biometric system (Argos, Alcon Laboratories. Inc.), and a three-piece intraocular lens (IOL; NX-70S) was implanted in all groups. In each group, the prediction error at 3 months was calculated using IOL power calculation formulas (SRK/T, Hill-RBF, Kane, and Barrett Universal II) for each eye. Outcome measures included the mean prediction error (MPE), its standard deviation (SD), and the mean absolute error (MAE). The change in IOL position at 3 months was also assessed using anterior segment optical coherence tomography. RESULTS: A total of 104 eyes were included (Group 1: 30; Group 2: 34; Group 3: 40 eyes). The MPE was -0.08 ± 0.37 diopters (D), -0.26 ± 0.32 D, and -0.59 ± 0.34 D in Group 1, Group 2, and Group 3, respectively, using the Barrett Universal II formula (P < 0.01, ANOVA). The movement forward in the IOL position was 0.95 ± 0.16 mm, 0.94 ± 0.12 mm, and 1.07 ± 0.20 mm in Group 1, Group 2, and Group 3, respectively (P < 0.01). No significant difference was shown in MPE among the four formulas after combined phacovitrectomy with gas (P = 0.531). CONCLUSIONS: Phacovitrectomy in RRD induced a significant myopic shift using any of the clinically available formulas. This suggests that myopic shift should be taken into consideration for better refractive outcomes in phacovitrectomy with gas tamponade in RRD.

A modified glaucoma staging system based on visual field index.

PURPOSE: To describe a modified glaucoma staging system (Modified GSS) based on the visual field index (VFI) and evaluate the performance of the Modified GSS compared with the Bascom Palmer GSS and Enhanced GSS. METHODS: A total of 549 eyes of 549 patients were studied retrospectively. The Modified GSS was used to classify the glaucomatous visual field defects into stage 0 to 5 based on the VFI. The cutoff values for each stage were derived from VFI that were equivalent to mean deviations of -6, -12, -20, and -25 dB by receiver operating characteristic analysis. The staging performances, based on each of three GSSs, were compared with both the Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study (CIGTS) scores. RESULTS: The VFI cutoff values calculated for each stage were 81.5, 62.5, 42.5, and 22.5%, respectively. The correlation coefficient of Modified GSS was greater than that of Bascom Palmer GSS (p < 0.001), and correlation coefficients of Modified GSS and Enhanced GSS were equivalent. However, Enhanced GSS tended to classify moderate to severe AGIS and CIGTS scores into higher stages (p < 0.001). CONCLUSIONS: The Modified GSS is easy to use and accurate, and the staging performance is either equal or superior to existing GSSs.

Human T-cell Leukemia Virus Type 1 (HTLV-1)-induced Uveitis.

Human T-cell leukemia virus type 1 (HTLV-1) is a human retrovirus that causes T-cell malignant diseases (adult T-cell leukemia/lymphoma) and HTLV-1-related non-malignant inflammatory diseases, such as HTLV-1 uveitis. Although the symptoms and signs of HTLV-1 uveitis are nonspecific, intermediate uveitis with various degrees of vitreous opacity is the most common clinical presentation. It can occur in one or both eyes and its onset is acute or subacute. Intraocular inflammation can be managed with topical and/or systemic corticosteroids; however, recurrence of uveitis is common. The visual prognosis is generally favorable, but a certain proportion of patients have a poor visual prognosis. Systemic complications of patients with HTLV-1 uveitis include Graves' disease and HTLV-1-associated myelopathy/tropical spastic paraparesis. This review describes the clinical characteristics, diagnosis, ocular manifestations, management, and immunopathogenic mechanisms of HTLV-1 uveitis.