Orbital Lymphangioma: Characteristics and Treatment Outcomes of 12 Cases.

PURPOSE: To report the patient characteristics and treatment outcomes in 12 cases of orbital lymphangioma. METHODS: In this study, orbital lymphangioma was diagnosed based on clinical, radiologic (computed tomography, magnetic resonance imaging), and histologic findings when possible. Patients whose vision was not compromised by orbital lymphangioma, or that did not have increased intraocular pressure (IOP), received oral corticosteroids. Orbital lymphangioma that affected vision or increased IOP was treated by surgery, which included aspiration of blood or partial resection with or without injection of a sclerosant. RESULTS: Four patients without compromised vision responded well to oral corticosteroids. Eight patients with compromised vision underwent some form of surgery. Bleeding recurred in three patients after aspiration of blood and in two after partial resection and intralesional injection of a sclerosant. Overall, five patients were treated successfully by aspiration of blood, intralesional injection of a sclerosant, and application of continuous negative pressure by appropriate drainage. Partial resection was successful in two patients with organized hematoma. CONCLUSIONS: Orbital lymphangioma that does not compromise vision can be treated medically using oral corticosteroids. Patients with threatened vision or elevated IOP due to acute hemorrhage should be treated by aspiration of blood, intralesional injection of a sclerosant, and application of continuous negative pressure. Partial resection may be effective only in patients with organized hematoma.

Evaluation of optical quality parameters and ocular aberrations in multifocal intraocular lens implanted eyes.

PURPOSE: We investigated the correlations between optical quality parameters obtained from the double-pass system and ocular aberrations obtained from the ray-tracing aberrometer in multifocal intraocular lens (IOL) implanted eyes. MATERIALS AND METHODS: Twenty eyes from 20 patients were enrolled in this study. Modulation transfer function cutoff frequency, The Strehl ratio, objective scatter index, and objective pseudo-accommodation obtained from the double-pass system were compared with root mean square (RMS) total aberration, RMS higher-order aberration, and spherical aberration obtained from the ray-tracing aberrometer. Additionally, parameters of the double-pass system and ray-tracing aberrometer were compared with manifested refraction values and subjective visual acuity, respectively. RESULTS: There was no statistically significant correlation between optical quality parameters obtained from the double-pass system and ocular aberrations, except between the Strehl ratio and RMS total aberration (r=-0.566, p=0.018). No significant correlations were found between the parameters of both devices, and manifested refraction values or subjective visual acuity. CONCLUSION: Optical quality parameters, especially the Strehl ratio, in multifocal IOL implanted eyes were affected by RMS total aberration. Further studies based on accurate measurements of ocular aberrations and additional optical quality parameters are needed to delineate relationships between optical quality parameters and ocular aberrations in multifocal IOL implanted eyes.

Double-pass system assessing the optical quality of pseudophakic eyes.

PURPOSE: To compare the optical quality measurements obtained from the double-pass system and ocular aberrations, subjective visual acuity, and contrast sensitivity score in pseudophakic eyes. METHODS: Three months after cataract surgery, modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scatter index, and objective pseudoaccommodation obtained from the double-pass system were compared with total aberration, higher-order aberration, and spherical aberration obtained from ray-tracing aberrometer. In addition, parameters of the double-pass system were compared with subjective visual acuity and the contrast sensitivity score. RESULTS: Forty eyes of 40 patients were included. The MTF cutoff frequency and Strehl ratio were negatively correlated with total aberration (r = -0.503, p = 0.003; r = -0.509, p = 0.003, respectively) and subjective visual acuity (r = -0.453, p = 0.007; r = -0.354, p = 0.040, respectively). The objective scatter index was positively correlated with total aberration (r = 0.451, p = 0.024) and subjective visual acuity (r = 0.516, p = 0.008). The MTF cutoff frequency showed a correlation with contrast sensitivity score under photopic and mesopic conditions. CONCLUSIONS: Optical quality parameters obtained from the double-pass system were correlated with ocular aberrations, subjective visual acuity, and contrast sensitivity score in pseudophakic eyes.

Phototherapeutic keratectomy in diffuse stromal haze in granular corneal dystrophy type 2.

PURPOSE: To determine the minimum depth of phototherapeutic keratectomy (PTK) required for diffuse haze removal in granular corneal dystrophy type 2 and to determine whether Fourier domain optical coherence tomography (FD-OCT) can be an effective technique for predicting the exact required depth of ablation. METHODS: The depth of ablation used for diffuse stromal haze removal was evaluated with the slit lamp and serially taken photographs during the PTK procedure. The depth of diffuse haze was measured preoperatively using FD-OCT. RESULTS: Forty-three eyes of 30 patients were included in this study. The mean age of the patients was 62.0 ± 8.4 years. The mean depth of PTK required was 43.7 ± 6.2 µm (range, 31-59 µm). The mean follow-up period for 29 eyes of 22 patients, who had follow-up periods of more than 6 months, was 21.0 ± 12.0 months. The mean best spectacle-corrected visual acuity of these 29 eyes was 0.43 ± 0.15 preoperatively and 0.71 ± 0.16 (P = 0.022) 1 month postoperatively. Of the 43 eyes of 30 patients, FD-OCT was evaluated in 29 eyes of 22 patients. The mean preoperative depth of diffuse haze using FD-OCT was 44.3 ± 6.4 µm. The mean depth of ablation required to remove diffuse stromal haze was 44.5 ± 5.9 µm. The actual ablated depths correlated well with the depth of haze detected by FD-OCT preoperatively (intraclass correlation coefficient = 0.719). CONCLUSIONS: FD-OCT is an accurate method of predicting the depth of PTK required to remove visually significant diffuse haze in patients with granular corneal dystrophy type 2. We advocate the use of slit-lamp biomicroscopy after the initial 30-µm ablation to determine the necessity for any further ablation.

Three different aspheric treatment algorithms of laser-assisted sub-epithelial keratectomy in patients with high myopia.

PURPOSE: To compare visual outcomes and quality in high myopia patients treated using one of three aspheric treatment algorithms based on the NIDEK Advanced Vision Excimer Laser System. METHODS: Sixty eyes of 60 high myopia patients (>-6 diopter) underwent topography-guided (CATz) (20 eyes), wavefront-guided (OPDCAT) (20 eyes), or topography and wavefront-guided (OPA) (20 eyes) laser-assisted sub-epithelial keratectomy. Visual acuity, manifest refraction spherical equivalent (MRSE), ocular and corneal higher order aberrations, corneal asphericity, point spread function (Strehl ratio) and modulation transfer function (MTF) were compared preoperatively and 1, 3 and 6 months postoperatively. RESULTS: Six months after surgery, logMAR uncorrected visual acuity was 0.02 ± 0.09 in the CATz group, 0.02 ± 0.07 in the OPDCAT group and 0.02 ± 0.08 in the OPA group, and there were no statistically significant differences (P = 0.5355). No statistical differences were found among the three groups in MRSE (P = 0.3541). Induced spherical aberrations and the change of corneal asphericity were less in the OPA group than in the others (P < 0.0001). The MTF was slightly better in the OPA group than in the others. The Strehl ratio showed no statistically significant differences among the three groups. CONCLUSIONS: All three aspheric treatment algorithms were safe and effective in correcting high myopia. Among them, the OPA algorithm maintained optical quality and physiologic cornea longer than the others.

Intraocular lens power calculations for cataract surgery after phototherapeutic keratectomy in granular corneal dystrophy type 2.

PURPOSE: To investigate the predictability of various intraocular lens (IOL) power calculation methods in granular corneal dystrophy type 2 (GCD2) with prior phototherapeutic keratectomy (PTK) and to suggest the more predictable IOL power calculation method. METHODS: Medical records of 20 eyes from 16 patients with GCD2, all having undergone cataract surgery after PTK, were retrospectively evaluated. Postoperative cataract refractive errors were compared with target diopters (D) using IOL power calculation methods as follows: 1) myopic and 2) hyperopic Haigis-L formula in IOLMaster (Carl Zeiss Meditec); 3) SRK/T formula using 4.5-mm zone Holladay equivalent keratometry readings (EKRs) (single-K Holladay EKRs method); 4) central keratometry power of true net power map in the Pentacam system (Oculus Optikgeräte GmbH); and 5) clinical history, Aramberri double-K, and double-K Holladay EKRs methods. Topographic status of corneal curvature after PTK was evaluated. RESULTS: Fourteen (70%) of 20 eyes showed central island formation after PTK. When central island was present, the mean absolute error (MAE) using the hyperopic Haigis-L formula was 0.25±0.15 D. When central island was not present, the myopic Haigis-L formula showed MAE of 0.33±0.16 D. When central island formation and IOLMaster keratometry underestimation were present, the hyperopic Haigis-L formula showed the least MAE of 0.26±0.08 D when switching the IOL-Master keratometry values equal to 4.5-mm zone Holladay EKRs. CONCLUSIONS: In planning for cataract surgery after PTK in GCD2, topographic analysis for central island formation is necessary. With or without central island formation, the hyperopic or myopic Haigis-L formula can be applied. When IOLMaster keratometry shows underestimation, the Haigis-L formula using 4.5-mm zone Holladay EKRs can be considered.

Univariate and bivariate polar value analysis of corneal astigmatism measurements obtained with 6 instruments.

PURPOSE: To compare the corneal astigmatism measurements from 6 instruments in preoperative assessment for toric intraocular lens (IOL) implantation. SETTING: Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea. DESIGN: Prospective comparative observational study. METHODS: This study included patients with cataract and more than 1.00 diopter (D) of corneal astigmatism. For preoperative evaluation of toric IOL implantation, the net astigmatism was evaluated using manual keratometry, autokeratometry, partial coherence interferometry (PCI) (IOLMaster), corneal topography/ray-tracing aberrometry (iTrace), scanning-slit topography (Orbscan), and Scheimpflug imaging (Pentacam). All net astigmatisms were converted to polar values. Using the astigmatism measurements from manual keratometry as a standard, Bland-Altman analysis, linear mixed-model, and bivariate graphic analysis were performed. RESULTS: The study group comprised 257 eyes of 141 patients. Bland-Altman plots showed good agreement between manual keratometry and each instrument for polar values. There was no significant between-instrument difference in KP(90) and KP(135) in the linear mixed model analysis or in bivariate polar values in bivariate confidence ellipses. CONCLUSION: The corneal astigmatism measurements from autokeratometry, PCI, corneal topography/ray-tracing aberrometry, scanning-slit topography, and Scheimpflug imaging were comparable to those from manual keratometry and can be used interchangeably with manual keratometry to measure corneal astigmatism.

Successful argon laser photocoagulation of diffuse epithelial ingrowth following concomitant persistent pupillary membrane removal and phacoemulsification.

UNLABELLED: A 57-year-old woman had concomitant surgery of persistent pupillary membrane removal and uneventful phacoemulsification through the same temporal clear corneal incision in her left eye. Short axial lengths (right eye, 21.08 mm; left eye, 20.39 mm) with shallow angles were noted bilaterally, and other findings were not remarkable. The patient experienced angle-closure attacks 3 and 7 months postoperatively. At the second angle-closure attack, diffuse epithelial ingrowth was observed. The epithelial ingrowth covered the intraocular lens surface in the interpupillary area, the iris surface surrounding the pupil, and the temporal anterior chamber angle, but did not reach the corneal endothelial incision. After observation of iris blanching with laser photocoagulation, argon laser photocoagulation was applied to the epithelium covering the iris and angle 7 times during the following month. The epithelial ingrowth was completely removed and did not recur during the 36-month follow-up. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.