Presbyopia correction using the monocular bi-aspheric ablation profile in myopic eyes.

PURPOSE: To analyze the 6-month outcomes of the treatment combination of the monocular bi-aspheric ablation profile (PresbyMAX) and contralateral aspheric monofocal laser in situ keratomileusis (LASIK) ablation profile for correction of myopia and presbyopia. SETTING: Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea. DESIGN: Retrospective case series. METHODS: This was a retrospective case review of 92 patients (184 eyes) diagnosed with myopia who underwent uneventful simultaneous bi-aspheric ablation in the nondominant eye and aspheric monofocal regular LASIK in the dominant eye to correct myopia and presbyopia between January 2017 and August 2020. Monocular and binocular uncorrected distance visual acuity (UDVA) and near visual acuity (UNVA), and corrected distance visual acuity and near visual acuity were analyzed postoperatively. RESULTS: At 6 months postoperatively, the mean UDVAs (logMAR) in the dominant and nondominant eyes were 0.01 ± 0.02 and 0.26 ± 0.15, respectively. Furthermore, all treated dominant eyes achieved 20/20 or better monocular UDVA, and 84% achieved 20/16 or better monocular UDVA. In the nondominant treated eyes, 89% achieved 20/50 or better monocular UDVA, 78% achieved 20/40 or better, and 34% achieved 20/32 or better. The binocular cumulative UDVA at 6 months postoperatively was 20/20 or better in all patients. All patients achieved J2 or better in binocular cumulative UNVA, and 83% achieved J1. CONCLUSIONS: Presbyopia correction using the combination of PresbyMAX in the near eye and aspheric monofocal regular LASIK in the distant eye is a safe and effective treatment for presbyopia in patients with myopia.

Removal of lymphangiectasis using high-frequency radio wave electrosurgery.

PURPOSE: To describe a novel technique using high-frequency radio wave electrosurgery (Ellman Surgitron Dual Frequency RF; Ellman International, Inc) for the management of lymphangiectasis. METHODS: Ablations were performed at the lowest power setting of 1 (of 100) in the cutting mode, producing the least amount of lateral heat. To prevent conjunctival hemorrhage, ablation was initiated immediately before introducing the tip of a needle electrode into the subconjunctival tissue under the target area. After the tip of the electrode reached the target area, ablation was maintained for 1 to 2 seconds on the surrounding area and for a longer time on the dilated lymphatic vessels, until the target conjunctiva blanched. These ablations were performed cautiously with the fine electrode to avoid thermal injury to the adjacent scleral tissue. RESULTS: Persistent lymphangiectasis accompanied by accumulated fluid was successively treated with high-frequency radio wave electrosurgery. Surgical time was less than 5 minutes. There were no intraoperative complications. Fourier domain optical coherence tomography revealed resolution of the accumulated fluid and a decrease of dilated lymphatic vessels. Postoperatively, no notable complications, such as charring, scarring of Tenon capsule, or symblepharon resulting from excessive cauterization, were observed. CONCLUSION: High-frequency radio wave electrosurgery may be a safe, quick, and effective modality for the treatment of symptomatic lymphangiectasis patients.

Conjunctival flap surgery for calcified scleromalacia after cosmetic conjunctivectomy.

PURPOSE: To investigate the long-term clinical course of scleromalacia with calcified plaque as a complication of cosmetic conjunctivectomy with topical mitomycin C (MMC) application and to introduce a surgical method for this complication using calcified plaque removal and/or conjunctival flap surgery. METHODS: Eleven patients (15 eyes, 17 lesions) were included in this retrospective study. The calcified plaque was removed with forceps and pterygium knife, and the thinned scleral lesion was covered with a conjunctival flap from an intact superior or inferior conjunctiva. RESULTS: There were no cases of scleral thinning or calcified plaque recurrence in patients who underwent conjunctival flap surgery. The mean interval between previous cosmetic conjunctivectomy with postsurgical topical MMC and the first surgical treatment for complications was 20.0 ± 6.4 months. The mean postoperative follow-up duration after last conjunctival flap surgery or calcified plaque removal was 11.6 ± 4.0 months. CONCLUSIONS: Scleral calcification and thinning progress as time passes after cosmetic conjunctivectomy with postsurgical topical MMC. Calcified plaque removal with conjunctival flap surgery can be an effective surgical management for this complication, returning blood supply to a thinned sclera.

Lens epithelial cell death and reduction of anti-apoptotic protein Bcl-2 in human anterior polar cataracts.

PURPOSE: In light of the growing body of data implicating apoptosis in cataractogenesis, and in particular, the reported detection of apoptosis in posterior capsular opacification, the purported etiology of which, like that of anterior polar cataracts, is an aberrant transdifferentiation of lens epithelial cells into myofibroblastic cells, we hypothesized that apoptosis could also occur in anterior polar cataracts. Here we sought to examine whether apoptotic cell death occurs in lens epithelial cells from patients with anterior polar cataracts. METHODS: Cell death of lens epithelial cells from anterior polar cataracts, nuclear cataracts, and non-cataractous clear lenses was measured by TUNEL assay and DNA fragmentation assay. The expression of Bcl-2 and Bax was examined using reverse transcription-polymerase chain reaction and Western blot analysis. RESULTS: Cell death was detected in specimen from patients with anterior polar cataracts by TUNEL assay. DNA fragmentation assay showed the characteristic laddering pattern from the genomic DNA from anterior polar cataracts. The expression of Bcl-2 mRNA and its protein was markedly decreased in lens epithelial cells from patients with anterior polar cataracts. CONCLUSIONS: This study suggests that apoptotic cell death might occur in lens epithelial cells from anterior polar cataracts and decreased expression of Bcl-2 might play a role in the pathologic cellular mechanism of anterior polar cataracts.

Non-tuberculous mycobacterial keratitis at the interface after laser in situ keratomileusis.

PURPOSE: To describe two cases of bacterial keratitis with atypical mycobacteria after laser in situ keratomileusis (LASIK). METHODS: Two cases of non-tuberculous mycobacterial keratitis occurred in the interface between the stromal bed and flap, 20 days and 14 days after LASIK. The keratitis progressed slowly and worsened after attempts were made to remove the colonies. Mycobacterium fortuitum was confirmed 2 months after initial presentation following culture of the excised flap tissue in one case, and Mycobacterium chelonae was identified by culture of removed material and by RT-PCR with primers in the other case. The patients were treated medically and by surgical flap removal. RESULTS: In the first case, the keratitis was controlled only after removal of the partially melted flap and intensive medical treatment. In the second case, the lesion cleared after 2 months of antibiotics, but after tapering of antibiotics, the infiltrate progressed. Eventually, the keratitis was controlled after removal of the flap. CONCLUSIONS: Non-tuberculous Mycobacterium should be considered as one of the causes of keratitis when presenting as white colonies in the lamellar bed after LASIK. Treatment for 2 months may not be enough to eradicate the infection and excision of the flap may be necessary.