Author Correction: Inter-ocular and inter-visit differences in ocular biometry and refractive outcomes after cataract surgery.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Inter-ocular and inter-visit differences in ocular biometry and refractive outcomes after cataract surgery.

This study aimed to determine whether inter-ocular differences in axial length (AL), corneal power (K), and adjusted emmetropic intraocular lens power (EIOLP) and inter-visit differences in these ocular biometric values, measured on different days, are related to refractive outcomes after cataract surgery. We retrospectively reviewed 279 patients who underwent phacoemulsification. Patients underwent ocular biometry twice (1-4 weeks before and on the day of surgery). Patients were divided into three groups: group S (similar inter-ocular biometry in different measurements; n = 201), group P (inter-ocular differences persisted in the second measurement; n = 37), and group D (inter-ocular difference diminished in the second measurement; n = 41). Postoperative refractive outcomes (mean absolute errors [MAEs]) were compared among the groups. Postoperative MAE2, based on second measurement with reduced inter-ocular biometry difference, was smaller than that calculated using the first measurement (MAE1) with borderline significance in group D (MAE1, 0.49 ± 0.45 diopters vs. MAE2, 0.41 ± 0.33 diopters, p = 0.062). Postoperative MAE2 was greater in group P compared to the other two groups (p = 0.034). Large inter-ocular biometry differences were associated with poor refractive outcomes after cataract surgery. These results indicate that measurements with smaller inter-ocular differences were associated with better refractive outcomes in cases with inter-visit biometry differences.

O-GlcNAc Signaling Augmentation Protects Human Corneal Endothelial Cells from Oxidative Stress via AKT Pathway Activation.

Purpose: To investigate the effect of inhibitor of O-glycosylation on human corneal endothelial cells (HCECs) under oxidative stress.Methods: HCECs were cultured and treated with 10 mM tert-butyl hydroperoxide (tBHP) with or without PUGNAc, a known inhibitor of OGA. Cell viability was assessed. Mitochondrial membrane potential (ΔΨm) was measured. Intracellular Ca2+ levels and mitochondrial Ca2+ levels were measured. Intracellular reactive oxygen species formation was measured. Levels of O-linked ß-N-acetylglucosamine (O-GlcNAc), AKT, and pAKT were evaluated by Western blotting.Results: O-GlcNAc augmentation by PUGNAc increased cell viability, attenuated the loss of ΔΨm, and intracellular ROS against tBHP-induced oxidative stress (p < .05). O-GlcNAc augmentation reduced tBHP-induced mitochondrial calcium overload (p < .05) while it did not have any effect on intracellular calcium overload with tBHP. Furthermore, AKT signaling was activated in the cells with O-GlcNAc augmentation.Conclusions: O-GlcNAc signaling augmentation protects HCECs from oxidative stress via activation of AKT pathways.

Correction: Safety and efficacy of tacrolimus-coated silicone plates as an alternative to mitomycin C in a rabbit model of conjunctival fibrosis.

[This corrects the article DOI: 10.1371/journal.pone.0219194.].

Safety and efficacy of tacrolimus-coated silicone plates as an alternative to mitomycin C in a rabbit model of conjunctival fibrosis.

PURPOSE: To find safer and more effective drugs than mitomycin C to prevent conjunctival fibrosis in a rabbit model. METHODS: Twenty-four rabbits were involved and randomly divided into four groups. Limbus-based peritomy was performed at the superior cornea, and normal saline (NS group), mitomycin C (MMC group), SR (SR group), or TC (TC group)-coated silicone plate was inserted at the sub-Tenon's space in each group. Conjunctival congestion was evaluated at 1 and 4 weeks postoperatively. At 4 weeks, the numbers of inflammatory cells, fibroblasts, myofibroblasts, blood vessels, and goblet cells were counted in the conjunctiva and Tenon's capsule around the silicone plate. RESULTS: At 4 weeks, conjunctival congestion was significantly less than that observed at 1 week in the SR and TC groups (p < 0.05), whereas the number of myofibroblasts was significantly lower in the MMC and TC groups (p < 0.05). The conjunctiva was significantly less congested in the TC group versus the other groups at 1 week and 4 weeks (p < 0.05). The TC group had the lowest number of inflammatory cells and MMC group had the lowest number of goblet cells among all groups (p < 0.05). CONCLUSIONS: The TC-coated silicone plate was more effective in inhibiting inflammation and fibrosis versus the MMC-coated silicone plate and was associated with fewer adverse effects in the rabbit model.

Direct visualization of aqueous tear secretion from lacrimal gland.

PURPOSE: To introduce a new method for direct observation of tear secretion from the palpebral lobes of the main lacrimal glands and Wolfring glands using fluorescein dye. METHODS: Twenty-six patients with dry eye and 26 healthy subjects were included in the study. Fluorescein was applied to the conjunctiva overlaying the palpebral lobe of the main lacrimal glands. Under cobalt blue light, we captured tear secretion from the glands in movies. We compared the number of excretory openings, the location and tear flow rate between the dry eye and healthy-subject groups. To observe tear secretion from the Wolfring glands, we everted the upper lids and applied fluorescein dye to the upper margin of the tarsus. RESULTS: Mean number of excretory openings on the palpebral lobe was 2.5 in the dry eye group and 3.4 in the healthy-subject group (p = 0.031). Most of the openings were observed at the ridge, the most protruding portion of the palpebral lobe. Mean flow rate from the palpebral lobe was 0.45 µl/min in the dry eye group and 0.91 µl/min in the healthy-subject group (p = 0.046). Mean flow rate from the Wolfring glands was 0.007 µl/min in the dry eye group and 0.009 µl/min in the healthy-subject group (p = 0.615). CONCLUSION: This visualization method allowed us to directly observe tear secretion from the palpebral lobe of the main lacrimal glands and Wolfring glands, and to quantitatively measure the tear flow rate from the lacrimal glands.

Influence of Near-Segment Positioning in a Rotationally Asymmetric Multifocal Intraocular Lens.

PURPOSE: To compare visual performance and higher order aberrations (HOAs) based on the position of the near segment in eyes with rotationally asymmetric multifocal intraocular lenses (IOLs). METHODS: Asymmetric multifocal IOLs (Lentis Mplus LS-313; Oculentis Optikgeräte GmbH, Wetzlar, Germany) were implanted with the near segment positioned either inferiorly, superiorly, or temporally. Uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity, corrected distance visual acuity (CDVA), and distance-corrected intermediate (DCIVA) and near (DCNVA) visual acuity, contrast sensitivity, HOAs, and subjective symptom questionnaires were compared at 1 month postoperatively. RESULTS: Forty-five eyes from 45 patients were evaluated (n = 25, 9, and 11 eyes in the inferior, superior, and temporal groups, respectively). No significant differences in UDVA, UIVA, UNVA, CDVA, DCIVA, or DCNVA were found between the three groups (P > .05). The temporal group showed the best results in UDVA, CDVA, and DCNVA, but the inferior group showed the best results in DCIVA and UNVA and the superior group showed the best results in UIVA. Contrast sensitivity and the subjective symptom questionnaire also did not demonstrate any significant differences (P > .05). Total HOA and spherical aberration did not demonstrate any statistically significant differences (P > .05), but vertical coma and horizontal coma demonstrated significant differences based on near segment position (P < .001). CONCLUSIONS: The position of the near segment in eyes with rotationally asymmetric multifocal IOLs demonstrates no significant effect on visual performance.

Effectiveness and Optical Quality of Topical 3.0% Diquafosol versus 0.05% Cyclosporine A in Dry Eye Patients following Cataract Surgery.

Purpose. To evaluate the effectiveness and optical quality of 3.0% topical diquafosol versus 0.05% cyclosporine A in dry eye patients following cataract surgery. Methods. In total, 40 eyes of 40 patients newly diagnosed with dry eye syndrome 1 week after cataract surgery were randomized to receive either 3.0% diquafosol ophthalmic solution six times daily or 0.05% cyclosporine A twice daily for 3 months. Outcome measures were tear film break-up time (TBUT), results on Schirmer 1 test, ocular surface staining score, the ocular surface disease index (OSDI) score, and higher-order aberrations (HOAs). Measurements were taken at baseline and at 1, 2, and 3 months. Results. In the diquafosol group, TBUT showed higher outcomes than the cyclosporine A group at 1 and 3 months. Both groups showed increased scores on Schirmer 1 test. The ocular surface staining score decreased in all periods in both groups. Vertical coma and total HOAs decreased more in the cyclosporine A group than in the diquafosol group at 3 months. Conclusion. Both 3.0% diquafosol and 0.05% cyclosporine A were effective in treating dry eye after cataract surgery. Diquafosol was more effective in increasing the tear secretion, but cyclosporine A was more effective in improving optical aberrations.

Low Serum 25-Hydroxyvitamin D Levels Are Associated with Dry Eye Syndrome.

BACKGROUND: Dry eye syndrome (DES) is a common tear film and ocular surface disease that results in discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. Systemic diseases associated with DES include diabetes mellitus, rheumatoid arthritis, depression, anxiety, thyroid disease, allergic diseases, irritable bowel syndrome, chronic pain syndrome, and hyperlipidemia. Interestingly, it has been found that most of these are associated with low levels of serum 25-hydroxyvitamin D (25(OH)D) or inadequate sunlight exposure. METHODS: In this cross-sectional data analysis, noninstitutionalized adults aged ≥19 years (N = 17,542) who participated in Korean National Health and Nutrition Examination Survey 2010-2012 were included. Information regarding duration of sunlight exposure was collected from the survey participants. Serum 25(OH)D and zinc levels were measured. The confounding variables were age, gender, sunlight exposure time, region of residence, obesity, serum 25(OH)D level, diabetes mellitus, rheumatoid arthritis, depression, thyroid disorder, atopic dermatitis, history of ocular surgery, regular exercise, and walking exercise. RESULTS: Mean serum 25(OH)D levels of subjects with and without DES were 16.90 ± 6.0 and 17.52 ± 6.07 (p<0.001). Inadequate sunlight exposure time (odds ratio [OR], 1.554; 95% confidence interval [CI], 1.307-1.848), urban residence (OR, 1.669; 95% CI, 1.456-1.913), indoor occupation (OR, 1.578; 95% CI, 1.389-1.814), and low serum 25(OH)D level (OR, 1.158; 95% CI, 1.026-1.308) were the risk factors for DES. After adjusting for age, sex, obesity, diabetes mellitus, rheumatoid arthritis, depression, thyroid disorder, atopic dermatitis, history of ocular surgery, regular exercise, and occupation, low serum 25(OH)D level (OR, 1.178; 95% CI, 1.010-1.372) and deficient sunlight exposure time (OR, 1.383; 95% CI, 1.094-1.749) were the risk factors for diagnosed DES. CONCLUSION: Low serum 25(OH)D levels and inadequate sunlight exposure are associated with DES in Korean adults. These results suggest that sufficient sunlight exposure or vitamin D supplementation may be useful in DES treatment.

Corneal coma and trefoil changes associated with incision location in cataract surgery.

PURPOSE: To investigate changes in corneal higher-order aberrations (HOAs) associated with the incision location in cataract surgery. SETTING: Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. DESIGN: Observational case series. METHODS: Eyes were divided into 3 groups according to the different axes of incision location: superior, temporal, and nasal. Preoperative and 1-month postoperative corneal coma, trefoil, and spherical aberrations were compared. RESULTS: The study evaluated 119 eyes that had uneventful cataract surgery with a 2.2 mm limbal incision. The superior incision group showed significant changes in the vertical coma (amount of change: -0.119 µm ± 0.153 [SD]; P < .001) and vertical trefoil (amount of change: 0.185 ± 0.260 µm, P = .001). The nasal incision group showed a significant change in oblique trefoil (amount of change: 0.176 ± 0.207 µm; P < .001). The temporal incision group did not show significant changes in HOAs. CONCLUSION: The superior incision in 2.2 mm phacoemulsification cataract surgery caused a change in the corneal vertical coma in a negative direction. Corneal trefoil changes were dependent on the incision location. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Higher-order aberrations associated with better near visual acuity in eyes with aspheric monofocal IOLs.

PURPOSE: To investigate higher-order aberrations (HOAs) related to increased uncorrected near visual acuity in eyes with aspheric monofocal intraocular lenses. METHODS: All patients underwent phacoemulsification followed by implantation of aspheric monofocal intraocular lenses with a negative spherical aberration (Tecnis one-piece, ZCB00; Abbott Medical Optics, Inc., Milpitas, CA). The distance-corrected near visual acuity (DCNVA), corrected near visual acuity, uncorrected near visual acuity, corrected distance visual acuity, uncorrected distance visual acuity, defocus curve, and ocular and corneal HOAs were examined 1 month after surgery. All near visual acuity measurements were taken with a 4-mm external aperture after pharmacologic dilation. Eyes were divided into two groups according to the DCNVA: eyes with DCNVA of 0.4 logMAR (20/50 Snellen) or better (0.4 logMAR or better group) and eyes with DCNVA worse than 0.4 logMAR (0.4 logMAR or worse group). The HOAs for a 4-mm pupil between the two groups were compared. RESULTS: A total of 37 eyes of 36 patients were included. The mean ocular spherical aberration was -0.010 ± 0.033 µm in the 0.4 logMAR or better group and -0.012 ± 0.023 µm in the 0.4 logMAR or worse group (P = .28). Among ocular HOAs, only vertical coma Z3(-1) showed a significant difference between the groups, with a mean ocular vertical coma of -0.038 ± 0.043 µm in the 0.4 logMAR or better group and 0.015 ± 0.061 µm in the 0.4 logMAR or worse group (P = .01). In corneal HOAs, no components showed a significant difference between the groups. CONCLUSIONS: In cases of aspheric intraocular lens implantation, ocular vertical coma may be a major HOA associated with better near visual acuity. Although corneal aberrations are major determinants of ocular aberrations after cataract surgery, aberrations from internal optics may still play an important role in visual performance.

Bilateral mix-and-match versus unilateral multifocal intraocular lens implantation: long-term comparison.

PURPOSE: To compare the visual outcomes and subjective satisfaction levels of patients who had bilateral mix-and-match implantation or monocular implantation of multifocal intraocular lenses (IOLs). SETTING: Asan Medical Center, Seoul, South Korea. DESIGN: Retrospective comparative case series. METHODS: Patients had implantation of a diffractive multifocal IOL (Tecnis ZM900) in 1 eye and a refractive multifocal IOL (Rezoom NXG1) in the other eye via the mix-and-match approach or of a Tecnis ZM900 IOL in 1 eye only. After 1 year, the uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and contrast sensitivity were evaluated. Patient satisfaction, spectacle dependence, and halo and glare symptoms were also evaluated. RESULTS: Twenty-three patients were evaluated. One year postoperatively, the mean values in the bilateral group and unilateral group were, respectively, binocular UDVA, 0.10 logMAR ± 0.18 (SD) and 0.10 ± 0.13 logMAR (P=.574); UIVA, 0.23 ± 0.12 logMAR and 0.29 ± 0.14 logMAR (P=.127); UNVA, 0.25 ± 0.18 logMAR and 0.27 ± 0.25 logMAR (P=.926). Subjective patient satisfaction was slightly higher in the bilateral implantation group (P=.083). There were no significant differences in contrast sensitivity, spectacle dependency, halos, or glare. CONCLUSIONS: There were no significant differences in postoperative visual acuity, subjective patient satisfaction, spectacle independence, or other visual symptoms between patients who had bilateral or unilateral implantation of multifocal IOLs. Unilateral implantation of a multifocal IOL is an option to lower spectacle dependency and increase patient satisfaction.

Subconjunctival injection of low-molecular-weight heparin-taurocholate 7 inhibits corneal neovascularization.

PURPOSE: To evaluate the effects of a subconjunctival injection of low-molecular-weight heparin-taurocholate 7 (LHT7) on corneal neovascularization (CoNV) in rats. METHODS: Twenty-four Sprague-Dawley rats were divided into 4 groups of 6 animals each. Corneal centers were cauterized by the application of a silver/potassium nitrate solution for 8 seconds. Either 0.02 or 0.04 mL of 25 mg/mL of LHT7 (low- and high-LHT7 groups, respectively) was subconjunctivally injected on days 2 and 4 after the cauterization was done; 0.02 mL of 25 mg/mL of bevacizumab was injected into rats in the positive control group, with normal saline (NS) being administered to a negative control group. Digital photographs of the cornea were taken 1 and 2 weeks later to calculate the percentage of CoNV using the area of the neovascularized cornea. To compare the differences in CoNV between weeks 1 and 2, the change in CoNV was calculated by subtracting the percentage of CoNV at 1 week from that at 2 weeks. RESULTS: The percentage of CoNV did not differ among the 4 groups either 1 or 2 weeks after the cauterization (P > 0.05). In all groups except the NS group, the percentage of CoNV significantly decreased at 2 weeks compared with that at 1 week (all P < 0.05). Moreover, the changes of CoNV in the high-LHT7 and bevacizumab groups significantly decreased compared with that in the NS group (all P < 0.05). Two corneal stromal hemorrhages occurred, 1 in each LHT7 group. CONCLUSIONS: Despite complications, including corneal stromal hemorrhage, subconjunctival injection of LHT7 attenuated CoNV after chemical cauterization.

Transconjunctival sutureless vitrectomy for the treatment of vitreoretinal complications in patients with diabetes mellitus.

BACKGROUND AND OBJECTIVE: To compare the safety and effectiveness of 25-gauge transconjunctival sutureless vitrectomy (TSV) with conventional 20-gauge pars plana vitrectomy (PPV) for the treatment of vitreoretinal complications in patients with diabetic retinopathy. PATIENTS AND METHODS: Forty-five eyes of 44 consecutive patients with diabetes mellitus who had undergone 25-gauge TSV for the treatment of vitreous hemorrhage, traction retinal detachment, or diabetic macular edema and 45 control patients with diabetes mellitus who had undergone conventional 20-gauge PPV were studied. RESULTS: The mean duration of surgery in the 25-gauge TSV group was statistically significantly shorter than that in the 20-gauge PPV group. The mean visual acuity at both 1 week and 1 month after surgery was statistically significantly better in the 25-gauge TSV group than in the 20-gauge PPV group. Complications in the 25-gauge TSV group were similar to those in the 20-gauge PPV group. CONCLUSION: A shorter operation time and faster recovery of postoperative visual acuity were the main advantages of using 25-gauge TSV. Despite its limitations, 25-gauge TSV can be safely used for the treatment of vitreoretinal complications in patients with diabetes mellitus.

Comparison between dynamic contour tonometry and Goldmann applanation tonometry.

PURPOSE: To compare the intraocular pressures (IOPs) measured by dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT), and to investigate the association of IOPs on eyes of varying central corneal thickness (CCT). METHODS: In this prospective study, 451 eyes of 233 subjects were enrolled. IOPs were measured by GAT and DCT. CCT was measured three times and the average was calculated. Each eye was classified into one of three groups according to CCT: low CCT (group A, CCT<520 microm, n=146); normal CCT (group B, 520 microm550 microm, n=142). In each group, we investigated the association of CCT with IOP measurement by GAT and DCT. RESULTS: The IOPs measured by GAT and DCT were significantly associated for all eyes (R=0.853, p<0.001, Pearson correlation). CCT was related with both IOP measurement by GAT and DCT with statistical significance (mixed effect model, p<0.001). However, subgroup analysis showed that CCT affected IOP measured by GAT for groups B and C, whereas it affected IOP measured by DCT only for group C. CONCLUSIONS: IOP measured by DCT was not affected by CCT in eyes with low to normal CCT, whereas this measurement was affected in eyes of high CCT range. CCT may have less effect on IOP measurements using DCT than those obtained by GAT, within a specified range of CCT.