Surgical time and efficacy of illuminated chopper-assisted cataract surgery involving miosis after femtosecond laser pretreatment.

PURPOSE: To evaluate the efficacy of the illuminated chopper-assisted cataract surgery in terms of shortening the surgical time in eyes with miosis after femtosecond laser pretreatment. METHODS: As retrospective study, three hundred thirty-six eyes of 336 consecutive patients who underwent the femtosecond laser and illuminated chopper-assisted cataract surgery were included. Cases with pupil less than 6 mm after femtosecond laser pretreatment were included in the miosis group. Pupil diameter, surgical time, and improved efficacy (100/surgical time×pupil size) were compared between eyes with and without miosis. RESULTS: Of 336 eyes, 20 were included in the miosis group (6.0%). Pupil diameter was smaller in eyes with miosis than in those without miosis (5.23 ± 0.38 mm vs 7.35 ± 0.64 mm, p < 0.001); however, surgical time was not different (6.86 ± 0.73 min vs 6.60 ± 1.27 min, p = 0.071) between the two groups. Mechanical pupil dilations were not needed in any cases. As a result, improved efficacy was calculated to be higher in patients with miosis (2.83 vs 2.14, p < 0.001). CONCLUSION: In terms of surgical time and improved efficacy, using the illuminated chopper simplified cataract surgery involving miosis after femtosecond laser pretreatment. The use of an illuminated chopper is expected to be a good solution for femtosecond laser-assisted cataract surgeries.

Refractive corneal inlay for presbyopia in emmetropic patients in Asia: 6-month clinical outcomes.

BACKGROUND: To evaluate the 6-month clinical outcomes of Flexivue Microlens refractive corneal inlay in emmetropic patients in Asia for the surgical compensation of presbyopia. METHODS: In this retrospective study, corneal inlay implantation was done using a femtosecond laser. The follow-up period was 6 months. Near/intermediate/distant visual acuities, refraction, keratometry, defocus curve, wavefront aberrations, contrast sensitivity, Scheimpflug corneal scanning, endothelial cell density, dry eye test, confocal microscopy scanning, and patient questionnaires were evaluated. RESULTS: The inlay implantation was performed in 21 eyes from June 2015 to April 2017. 6 months after surgery, the uncorrected near visual acuity of the operated eyes increased significantly from 0.55 ± 0.22 logMAR preoperatively to 0.25 ± 0.15 logMAR (p < 0.05) but mean bilateral uncorrected distant visual acuity did not change significantly (p = 0.90). Total higher-order aberration and spherical aberration increased, and the contrast sensitivity of the operated eyes decreased. Endothelial cell density and central corneal thickness did not change from preoperative values. Patient satisfaction for near vision was increased 6 months after implantation, and 50.0% of patients were independent of near spectacles. Explantation was done in 2 cases. CONCLUSION: The Flexivue Microlens refractive corneal inlay was effective for improving near visual acuity at 6 months follow-up But proportion of spectacle independency and patient satisfaction were lower in this Korean population than in previous reports. Further study with a longer follow-up period is needed.

Development of distraction osteogenesis model of the inferior mandibular border and alveolar bone.

The aims of this study were to establish an experimental rat model for distraction osteogenesis of the mandible and alveolar bone for the investigation of histologic and radiographic analysis and to develop the device for various distraction models. For osteotomy location and distraction device design, micro-computed tomographic analysis of the structure of rat mandible was performed. Twenty mandibles of Sprawl-Dawley rats were osteotomized based on the analysis, and newly developed custom-made devices were applied with bone screws. After a 5-day latency period, a distraction of 0.2 mm at a single session, and a 4-week consolidation period, animals were killed for histologic samples. The rat distraction osteogenesis model for the inferior mandibular border and alveolar bone was successfully established based on the protocols used in this study. New bone formation occurred at both body and alveolar bones of the mandible by the combination of 2 modes: intramembranous ossification was predominant at the end of distraction period, whereas endochondral ossification was observed at the center of the distraction gap at the end of the 4-week consolidation period. This model can be applied to various conditions related to distraction osteogenesis and provide information for the development of improvements in clinical treatments using distraction osteogenesis.

Effect of volume used in sub-Tenon's anesthesia on efficacy and intraocular pressure in vitreoretinal surgery.

PURPOSE: To compare the effect of volumes used in sub- Tenon's anesthesia on efficacy and intraocular pressure (IOP) in vitreoretinal surgery. METHODS: A prospective clinical trial was conducted on patients undergoing sub-Tenon's anesthesia for vitreoretinal surgery. Patients were randomized to receive either 3-, 5- or 7-ml volumes of anesthetic solution. IOP were measured immediately prior to injection, immediately after injection and at 2, 5 and 10 min after injection. Pain scores were assigned using a numerical visual analogue scale immediately after surgery, and again on postoperative day 1. RESULTS: A total of 108 patients (119 eyes) were studied, including 35 eyes in the 3-ml group, 48 eyes in the 5-ml group, and 36 eyes in the 7-ml group. There were significant elevations in mean IOP following injection in all groups, and a trend for larger rises in IOP with larger volumes of anesthesia (p < 0.01). Mean IOP were elevated after injection, and reduced at all time intervals. However, the reduction in the 3-ml group took levels to preinjection amounts. There were no significant differences in patient-reported pain scores among the groups when assessed immediately after surgery or on postoperative day 1. The incidence of chemosis and high IOP elevations (>or=40 mm Hg) were more frequent in the 7-ml group (p < 0.05). CONCLUSIONS: Sub-Tenon's anesthesia is effective in vitreoretinal surgery. It would appear that a 3-5-ml volume of anesthetic is safe, when considering the associated complications.

Eyelid splitting with follicular extirpation using a monopolar cautery for the treatment of trichiasis and distichiasis.

PURPOSE: To assess the efficacy of eyelid splitting coupled with follicular extirpation via monopolar cautery in the treatment of trichiasis and distichiasis. METHODS: Between March 2000 and October 2003, this surgery was performed on 52 eyelids from 45 patients, with a mean follow-up period of 14.3 months (ranging from 12.3 to 17.6 months) . Under local anesthesia and a surgical microscope, a chalazion clamp is positioned on the eyelid, and a no. 11 scalpel is employed to make an incision located immediately anterior and parallel to the abnormal eyelash line. Each of the abnormal hair follicles is then removed via cautery with a monopolar needle. No sutures are involved in this procedure. RESULTS: Forty-four eyelids of 40 patients (84.6%) were successfully treated without recurrence or any residual symptoms. Repeat surgery was then performed on eight eyelids, with successful results in six cases. The cumulative success rate for this procedure was 96.1%. No complications were noted in the treated area, including lid deformities, granuloma formation, infections, and others. CONCLUSIONS: Eyelid splitting coupled with follicular extirpation via cautery with a monopolar needle, a procedure which requires no sutures, constitutes a simple and effective method for the treatment of both trichiasis and distichiasis and is associated with favorable functional and cosmetic results.

Visual improvement in high myopic amblyopic adult eyes following phakic anterior chamber intraocular lens implantation.

PURPOSE: To evaluate the efficacy and safety of angle-supported phakic anterior chamber intraocular lenses in amblyopic adult eyes with very high myopia. METHODS: We evaluated 12 eyes in nine patients with very high myopic amblyopia who received angle-supported phakic intraocular lenses (Phakic 6H) and followed them for more than six months. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and complications were evaluated. A satisfaction score was rated by patients using a 5-point (1-5) numeric scale. RESULTS: The mean age of patients was 37.3 +/- 9.4 years, ranging from 29 to 59 years old. The preoperative mean refraction (spherical equivalent, SE) was -20.10 +/- 5.41 diopters (D). The postoperative mean refraction (SE) was -1.75 +/- 0.76 D at six months. The postoperative BCVA improved an average 3.92 +/- 1.24 lines over preoperative values, and mean endothelial cell loss was 8.9% at six months. Development of cataracts, glaucoma, and pupil abnormalities were not demonstrated in any case during the study. The patients were all very satisfied, as the average satisfaction score was 4.3. CONCLUSIONS: This study indicates that angle-supported phakic anterior chamber intraocular lens implantation may be an effective surgical alternative for the correction of amblyopic adult eyes with very high myopia. However, long-term evaluation is necessary to assess possible complications and long-term safety.

A case of alveolar rhabdomyosarcoma of the ethmoid sinus invading the orbit in an adult.

PURPOSE: A case study and literature review of alveolar rhabdomyosarcoma (RMS) in an adult. METHODS: A 48-year-old male patient presented at our clinic complaining of proptosis that had persisted for 2 weeks in his left eye. A computed tomography (CT) scan revealed a destructive soft-tissue mass in the left ethmoid sinus with invasion of the left orbit and compression of the medial rectus muscle. Endoscopic intranasal biopsy revealed alveolar RMS. Conservative debulking and orbital wall decompression were performed. RESULTS: Immunohistochemical testing was positive for desmin, S-100, and smooth muscle actin (SMA), supporting the diagnosis of RMS. Since ipsilateral cervical and spinal metastasis was detected, systemic treatment was administered simultaneously. CONCLUSIONS: Although rarely found in adults, RMS should be considered in the differential diagnosis of orbital tumors. Immunohistochemical analysis plays an important role in the definitive diagnosis of RMS.

Pupillary capture of implantable contact lens after blunt trauma.

A 33-year-old woman visited our clinic with blurry vision and periorbital swelling after experiencing blunt trauma to left eye. Ten months earlier, she had implantable contact lens (ICL) implantation in the left eye. Biomicroscopic examination showed that that 1 footplate of the ICL was entrapped in the pupillary aperture at the 7 o'clock position and the ICL was placed vertically. The patient had limited ocular movement in lateral gaze, and the computed tomography showed a medial orbital wall fracture. Pupillary capture of the ICL was surgically corrected with an iris manipulator under topical anesthesia. After the ICL was repositioned, the patient's uncorrected visual acuity was restored to 20/32, as before the injury. Pupillary capture of the ICL may occur after blunt ocular trauma.

Solitary infantile myofibroma of the orbital bone.

Infantile myofibroma of the orbit is an extremely rare condition. Only a few instances of this condition have ever been reported. A 3-year-old boy visited our clinic with lateral lower eyelid swelling and a palpable mass in the left eye, which had apparently persisted for 2 months. A computed tomography scan revealed a well-circumscribed mass in the inferolateral orbital portion of the zygomatic bone, coupled with erosion of bone and orbital extension with reactive hyperostosis. Immunohistochemical stains proved positive for smooth muscle actin, supporting the diagnosis of solitary infantile myofibroma of the orbital bone (zygoma). Although rarely found in the orbit, solitary infantile myofibroma can display more aggressive or malignant neoplasm. Immunohistochemistry is integral to the differential diagnosis and a systemic evaluation for multicentric myofibroma is essential.