A comparison of clinical outcomes and optical performance between monofocal and new monofocal with enhanced intermediate function intraocular lenses: a case-control study.

BACKGROUND: To compare clinical outcomes and optical performance of a new monofocal with enhanced intermediate function intraocular lenses (IOLs) with that of conventional monofocal IOLs. METHODS: Sixty eyes of 30 patients who underwent phacoemulsification with bilateral implantation of the ICB00 (15 patients) or ZCB00 (15 patients) IOLs were enrolled. Binocular corrected distance visual acuity (CDVA), distance corrected near visual acuity (DCNVA), and distance corrected intermediate visual acuity (DCIVA) were measured at 4 weeks after surgery. Patient satisfaction for overall, near, intermediate, and distance vision were assessed. The binocular defocus curves were measured. The root mean square of modulation transfer function (MTFRMS) was measured in the optical bench study. RESULTS: The mean binocular DCIVA was significantly better in the ICB00 group (0.01 logMAR) compared to the ZCB00 group (0.13 logMAR), but CDVA and DCNVA were not. The patient satisfaction for near and intermediate vision was significantly higher in the ICB00 group compared to the ZCB00. However, there was no difference in patient satisfaction for overall and distance vision between two groups. The defocus curves showed that mean visual acuity of the ICB00 group was significantly better than that of the ZCB00 group at between - 1.00 D to - 3.00 D of defocus. The ICB00 IOL had higher MTFRMS values at between - 0.50 D to - 2.00 D of defocus compared to the ZCB00 IOL. CONCLUSIONS: The ICB00 IOL provides better binocular intermediate vision and higher satisfaction for near and intermediate vision than the ZCB00 IOL while maintaining excellent distance vision.

Self-sealing hyaluronic acid-coated 30-gauge intravitreal injection needles for preventing vitreous and drug reflux through needle passage.

Self-sealing hyaluronic acid (HA)-coated self-sealing 30-gauge needles exhibiting instant leakage prevention of intravitreal humor and injected drug were developed in this study. Ninety New Zealand rabbits were used in this study. We assessed dye regurgitation in intravitreal ICG dye injections using HA-coated needles (HA needle group) and conventional needles (control group). Vitreous humor levels of anti-vascular endothelial growth factor (VEGF) were compared between groups one, three, and seven days after intravitreal bevacizumab (0.016 mL) injections. Expression levels of inflammatory cytokines in the aqueous humor and vitreous humor, including prostaglandin E2 (PGE2), interferon-γ, tumor necrosis factor-α, interleukin (IL)-1ß, IL-4, IL-6, IL-17, and IL-8, were compared between HA needle, control, and normal (in which intravitreal injection was not performed) groups following 12 intravitreal injections over a period of one week. In the HA needle group, HA remained at the injection site and blocked the hole after intravitreal injection. Dye regurgitation occurred significantly less frequently in the HA needle group (16.7%) than the control group (55.6%) after intravitreal ICG dye injection. Meanwhile, vitreous anti-VEGF levels were markedly higher in the HA needle group than the control group one and three days after intravitreal bevacizumab injections. After 12 intravitreal injections, expression levels of aqueous and vitreous IL-8 significantly increased in the control group compared to the HA needle and normal groups. Conversely, there were no significant differences in the expression of the other seven cytokines among the three groups. Intravitreal injections using HA-coated self-sealing 30-gauge needles can block the outflow of vitreous humor and drugs through the needle passage.

Intraocular lens power calculation using adjusted corneal power in eyes with prior myopic laser vision correction.

PURPOSE: To evaluate the prediction accuracy of the intraocular lens (IOL) power calculation using adjusted corneal power according to the posterior/anterior corneal curvature radii ratio in the Haigis formula (Haigis-E) in patients with a history of prior myopic laser vision correction. METHODS: Seventy eyes from 70 cataract patients who underwent cataract surgery and had a history of myopic laser vision correction were enrolled. The adjusted corneal power obtained with conventional keratometry (K) was calculated using the posterior/anterior corneal curvature radii ratio measured by a single Scheimpflug camera. In eyes longer than 25.0 mm, half of the Wang-Koch (WK) adjustment was applied. The median absolute error (MedAE) and the percentage of eyes that achieved a postoperative refractive prediction error within ± 0.50 diopters (D) based on the Haigis-E method was compared with those in the Shammas, Haigis-L, and Barrett True-K no-history methods. RESULTS: The MedAE predicted using the Haigis-E (0.33 D) was significantly smaller than that obtained using the Shammas (0.44 D), Haigis-L (0.43 D), and Barrett True-K (0.44 D) methods (P < 0.001, P = 0.001, and P = 0.014, respectively). The percentage of eyes within ± 0.50 D of refractive prediction error using the Haigis-E (78.6%) was significantly greater than that produced using the Shammas (57.1%), Haigis-L (58.6%), and Barrett True-K (61.4%) methods (P = 0.025). CONCLUSION: IOL power calculation using the adjusted corneal power according to the posterior/anterior corneal curvature radii ratio and modified WK adjustment in the Haigis formula could improve the refraction prediction accuracy after cataract surgery in eyes with prior myopic laser vision correction.

Recovery From Suppression With Successful Motor Alignment After Surgery for Intermittent Exotropia.

PURPOSE: To investigate recovery from suppression when the target motor alignment is achieved following surgery for intermittent exotropia. METHODS: The medical records of 237 patients who underwent surgery for exotropia were retrospectively reviewed. The age at surgery, sex, preoperative angle of deviation, suppression status, and near stereopsis were investigated. Suppression status was classified as no, alternate, or constant suppression. Target motor alignment was defined as 10 prism diopters (PD) or less of exodeviation or 2 PD of esodeviation at the final visit. RESULTS: The mean age at surgery was 8.2 ± 3.2 years and 115 (48.5%) patients were male. The preoperative angle of deviation was 26.3 ± 5.9 PD and the follow-up postoperative period was 21.6 ± 7.6 months. The preoperative suppression status included 23 (9.7%), 55 (23.2%), and 159 (67.1%) patients who showed no, alternate, or constant suppression, respectively. Two hundred fifteen (90.7%) patients obtained the target motor alignment by the final visit. Of the 144 patients who demonstrated constant suppression preoperatively but achieved the target motor alignment postoperatively, 12 (8.3%) patients demonstrated residual suppression. All 12 of these patients had a preoperative angle of exotropia of greater than 20 PD. CONCLUSIONS: Most patients undergoing surgery for intermittent exotropia obtained both successful motor alignment and fusion postoperatively. However, successful motor alignment did not guarantee recovery of suppression when the preoperative angle of exotropia was greater than 20 PD. The preoperative factors and functional implications underlying this finding are unclear and merit further study. [J Pediatr Ophthalmol Strabismus. 2020;57(1):21-26.].

Changes in the Matrix Metalloproteinase 9 Point-of-Care Test Positivity According to MMP-9 Concentration and Loading Volume.

PURPOSE: To measure changes in the matrix metalloproteinase 9 (MMP-9) point-of-care test, InflammaDry (Rapid Pathogen Screening, Inc, Sarasota, FL) positivity, based on ocular surface MMP-9 concentrations and loading volume. METHODS: Two different MMP-9 products, preform and active, were analyzed using the InflammaDry test, detecting MMP-9 levels of more than 40 ng/mL of both preform and active MMP-9. Preform MMP-9 (Natural human MMP-9 protein; Abcam, Cambridge, UK) was analyzed at different concentrations (50, 100, 500, 1000, and 1500 ng/mL) and loading volumes (5, 10, and 20 µL). Active MMP-9 (Human MMP-9 protein; Novus Biologicals, Littleton, CO) was also analyzed using the InflammaDry test at different concentrations (50 and 100 ng/mL) and loading volumes (10, 20, and 40 µL). RESULTS: Natural human MMP-9 protein (preform) of 50, 100, and 500 ng/mL exhibited negative results for every loading volume. At 1000 ng/mL, the 20 µL volume was positive, whereas the 5 and 10 µL volumes were negative. At 1500 ng/mL, all loading volumes were positive, but the density of positive bands varied depending on the loading volume; larger loading volumes had higher band density. Human MMP-9 protein (active) of 50 ng/mL was negative for every loading volume. In 100 ng/mL, the 20 and 40 µL volumes showed positive results with similar positive band densities. CONCLUSIONS: The InflammaDry test had a different detection range depending on MMP-9 formulas; higher concentrations of preform MMP-9 protein were needed to yield positive results. In addition, InflammaDry positivity varied based on the loading volumes. Clinicians should be aware of the possibility of false negatives with low tear volumes despite elevated MMP-9 concentrations.

Analysis of new attachment site in medial rectus resection with advancement using anterior segment optical coherence tomography.

OBJECTIVE: To evaluate the surgical outcome of unilateral medial rectus resection with small advancement for recurrent exotropia, ≤30 prism diopters (PD), and verify new attachment site anatomically using anterior segment optical coherence tomography (ASOCT). METHOD: This study is a retrospective chart review of patients who underwent 1.0 mm advancement of unilateral resected medial rectus from original medial rectus (OMR) insertion for recurrent exotropia since 2014. The age at operation, sex, preoperative angle of deviation, near stereopsis, and suppression were evaluated. Success was defined as ≤5 PD of esodeviation or ≤10 PD of exodeviation at the final visit. Preoperative scleral thickness was measured using ASOCT, 1.0 and 0.5 mm anterior to OMR insertion, and at the insertion. RESULTS: A total of 76 patients, including 30 males (40.2%), were reviewed retrospectively. Continuous values were presented as mean ± standard deviation. Age at operation was 11.6 ± 6.6 years. The preoperative deviation was 20.9 ± 3.6 PD, and the amount of resected unilateral medial rectus was 4.5 ± 0.6 mm. The minimum required follow-up period after operation was 12 months after surgery. The postoperative follow-up period was 21.3 ± 8.0 months. A total of 65 patients (87.8%) showed successful outcome at the final visit. Preoperative scleral thickness at 1.0 and 0.5 mm anterior to OMR insertion site, and at OMR insertion site were 0.52 ± 0.05, 0.52 ± 0.06, and 0.43 ± 0.04 mm, respectively. Scleral thickness at OMR insertion site was significantly less compared with 1.0 and 0.5 mm from the OMR insertion site (p = 0.03). CONCLUSION: The scleral thickness 1.0-0.5 mm anterior to OMR insertion site was thicker that than at the OMR insertion site. The new technique of medial rectus resection with small advancement may be safer and more effective than conventional technique.

Measuring nasolacrimal duct volume using computed tomography images in nasolacrimal duct obstruction patients in Korean.

AIM: To investigate nasolacrimal duct (NLD) volume in Korean patients and to examine the correlation between NLD volume and obstruction. METHODS: Of patients who underwent orbital computed tomography from March 2013 to January 2016, patients diagnosed with NLD obstruction were classified into the patient group and patients without obstruction were classified into the control group. The NLD volume was measured using the Image J program, which showed the NLD in axial, coronal, and sagittal images on computed tomography. RESULTS: The average value of men's NLD volume, 265.33±90.57 mm3, was significantly larger than women's, 211.87±68.61 mm3 (P=0.009). In the patient group, the NLD volume of the obstructed eyes, 242.49±82.93 mm3, and the non-obstructed eyes, 225.20±73.20 mm3, were significantly higher than the control group, 217.61±82.04 mm3 (P<0.001, P<0.001). CONCLUSION: The NLD volume is larger in men than in women in Korean adults. If there is NLD obstruction in women, the NLD volume is larger and it is judged that inflammatory reaction caused a chronic change in the bone around the NLD and affect the measurement of NLD volume.

Granulomatous Inflammation of the Upper Eyelid After Autologous Fat Injection.

A 45-year-old female came to the clinic complaining of periorbital swelling and ptosis on the left upper eyelid that had started 6 months previously. She had received an autologous fat injection in the forehead 6 months prior, and there was no other ophthalmologic history. There were no abnormal findings, including pupil, extraocular movement, or fundus examination. There was eyebrow elevation of the left upper eyelid, and the marginal reflex distance 1 was 1 mm on the left eye compared to 4 mm on the right eye. There were a 2-cm-sized round and firm mass on the left upper eyelid that was not accompanied by tenderness. Orbital computed tomography showed heterogeneous infiltration with an ill-defined margin. Excisional biopsy and levator advancement were performed on the left upper eyelid, and histological findings showed chronic granulomatous inflammation with foreign body reaction and fat necrosis.A complete history for patient presentation with autologous fat injection is important when a periorbital mass is encountered clinically because granulomatous inflammation of the eyelid may occur after autologous fat injection in the forehead and can be related to migration of the injected fat.

Choriocapillaris flow features and choroidal vasculature in the fellow eyes of patients with acute central serous chorioretinopathy.

PURPOSE: The purpose of the study is to investigate the characteristics of choriocapillaris flow based on the underlying choroidal vasculature in fellow eyes with central serous chorioretinopathy (CSC). METHODS: We included 57 patients with CSC and normal controls. Characteristics of choriocapillaris flow were evaluated using swept-source optical coherence tomography (OCT) angiography. We divided the choroidal layer into the vascular and stromal beds according to the choroid vessels on en-face OCT images. We compared the flow void area and mean vascular density of the choriocapillaris according to the underlying choroidal beds in the CSC and control group. RESULTS: The mean vascular density of the choriocapillaris in the CSC group was not different from that of the control group (P = 0.289). The flow void area was more frequently found in the CSC group (59.6%) than in the control group (29.8%, P = 0.002). The presence of the flow void area in the CSC group was associated with greater macular choroidal thickness (P = 0.004). In the CSC group, the mean flow void area and ratio of the choriocapillaris over the vascular bed were larger than those over the stromal bed (all P < 0.001). CONCLUSIONS: The location of the flow void area of the choriocapillaris was associated with the distribution of the underlying choroidal vessels. This suggests that the underlying choroidal vessels may affect choriocapillaris perfusion in pachychoroid eyes.

Surgical factors affecting oculocardiac reflex during strabismus surgery.

BACKGROUND: To investigate surgical factors associated with the occurrence of oculocardiac reflex (OCR) and changes in heart rate (HR) during strabismus surgery. METHODS: Patients who underwent strabismus surgery under general anesthesia were enrolled in this study. The HR during surgery was measured at baseline, and at the following points during surgery: traction of the muscle, maximal increase after traction (adrenergic phase), and the cutting of the muscle. OCR was defined as an HR reduction of more than 20% at traction of the muscle, when compared to baseline HR. The HR at each stage during the surgery was compared between patients with and without OCR. RESULTS: A total of 162 operated muscles from 99 patients were enrolled. The incidence of OCR was 65% in patients. In patients with two muscle surgeries, there were significantly more OCRs in the first operated muscle than in the second operated muscle (p < 0.01). The difference in the decrease in HR in patients with OCR was significantly lower than that in patients without OCR at traction of the muscle, the adrenergic phase, and the cutting of the muscle (all, p < 0.01). The first operated muscle was a significant risk factor associated with the occurrence of OCR (OR = 3.95, p < 0.01). CONCLUSION: The first operated muscle in patients with two muscle surgeries was a significant risk factor for OCR. Decreased HR at the traction of the muscle during surgery did not fully recover in patients with OCR.

Reconstruction of Large Orbital Posterior Floor Wall Fracture Considering Orbital Floor Slope Using Endoscope.

PURPOSE: Reconstruction of a large orbital fracture extending to the posterior wall of the maxillary sinus is difficult and challenging. In this study, the authors present transconjunctival or transcaruncular approach using endoscopy and layered porous polyethylene barrier sheets to manage large orbital floor wall fracture. METHODS: A retrospective review of all patients who underwent reconstruction of large orbital floor wall fractures between June 2009 and July 2015 was conducted. Patient demographics, degree of enophthalmos, ocular motility and diplopia test results, and surgical complications were reviewed. RESULTS: This study included 53 eyes of 53 patients. The mean time from trauma to surgery was 34.1 days (range, 1-360 days). The average postoperative follow-up period was 6.1 months (range, 3-14 months). The degrees of enophthalmos preoperatively, and 1 week, 1 month, and 3 months postoperatively were -1.98 mm (range, -1.5 to -3 mm), 0.13 mm (range, -1.0 to +1.5 mm), -0.09 mm (range, -2.0 to +1.5 mm), and -0.43 mm (range, -2.0 to +1.0 mm), respectively. The mean improvement in enophthalmos at 3 months postoperation was 1.55 mm (P < 0.001). There was only 1 patient with residual 2 mm enophthalmos at 3 months postoperation. There were no definite surgical complications in any patient. CONCLUSION: Sufficient dissection to the posterior extent of the fracture and reconstruction of the orbital floor slope are the most important surgical factors to prevent residual enophthalmos. The authors believe using an endoscope and layered porous polyethylene are effective techniques in challenging patients with large orbital wall fracture.