Double peak axial length measurement signal in cataract patients with epiretinal membrane.

PURPOSE: To evaluate the accuracy of axial length (AL) measurement for intraocular lens (IOL) calculation in patients with cataract and epiretinal membrane (ERM). METHODS: This prospective, cross-sectional study was performed in cataract patients with ERM. All subjects were sent for standard optical biometry, prepared for cataract surgery. Signals of AL measurement were detected as double peaks and recorded as AL1 (first peak), and AL2 (second peak). The IOL power was calculated from AL1 and AL2, and reported as IOL1 and IOL2. The IOL2 was chosen for cataract surgery in all cases. Postoperative predictive errors were compared between IOL1 and IOL2. RESULTS: Thirty-seven eyes from 37 patients were included. Mean AL1 was significantly shorter than AL2 (23.13 ± 1.28 vs. 23.60 ± 1.34 mm, p < 0.001), resulting in higher power of IOL1 than IOL2 (mean difference was 1.53 ± 0.96 diopters, p < 0.001). At 3-months post-operation, twenty-nine eyes (78.4%) (95% CI 62.8%-88.6%) showed refractive error within ± 0.5 diopter and all eyes were within ± 1.0 diopter. Postoperative predictive errors including mean arithmetic error (ME) and mean absolute error (MAE) of IOL2 were significantly lower than those of IOL1 (ME: IOL1 vs. IOL2, -0.94 ± 0.91 vs. 0.08 ± 0.51; MAE: 0.97 ± 0.88 vs. 0.39 ± 0.33 diopter, all p < 0.001). CONCLUSIONS: AL measurement in ERM can be detected as a double peak signal during biometric measurement. The IOL power calculated from the first and second peak signals is significantly different. However, the IOL power derived from the second peak signal provides better refractive outcomes. The results suggest that the second peak signal represents an accurate AL measurement.

Efficacy of subtenon 20-mg triamcinolone injection versus 0.1% dexamethasone eye drops for controlling inflammation after phacoemulsification: a randomized controlled trial.

A prospective randomized control trial of 140 eyes from 140 patients, who underwent phacoemulsification, was conducted to compare the efficacy of subtenon corticosteroids injection with corticosteroids eye drops for controlling postoperative intraocular inflammation. Seventy patients received subtenon 20-mg triamcinolone injection (TA group), whereas the other 70 patients received 0.1% dexamethasone eye drops (Dexa group) after the uneventful surgeries. We examined and measured anterior chamber inflammation (ACI) score, laser flare-cell metering, conjunctival redness, pain, discomfort, visual acuity, intraocular pressure, and central foveal thickness on 1, 7, 14, 28 and 90 days postoperatively. At one month after the surgery, full recovery (zero ACI score) was found in 43 patients (63.20%) in the Dexa group versus 47 patients (68.10%) in the TA group (p = 0.55). There were no statistically significant differences in aqueous cells (p = 0.37) and flare (p = 0.86) between the two groups at one month. All participants experienced no serious adverse events. In conclusion, we found no statistically significant difference between subtenon 20-mg triamcinolone injection and 0.1% dexamethasone eye drop to control inflammation postoperatively. A single subtenon 20-mg triamcinolone injection could be an alternative anti-inflammatory treatment for an uneventful phacoemulsification.

Comparison of central corneal thickness measurements in corneal edema using ultrasound pachymetry, Visante anterior-segment optical coherence tomography, Cirrus optical coherence tomography, and Pentacam Scheimpflug camera tomography.

PURPOSE: To compare the central corneal thickness (CCT) measurements in subjects with corneal edema using ultrasound pachymetry, Visante anterior-segment optical coherence tomography (OCT), Cirrus OCT, and Pentacam Scheimpflug camera tomography. METHODS: This prospective cross-sectional study included 46 eyes of 33 patients with corneal edema and a CCT exceeding 550 µm evaluated by ultrasound pachymetry, Visante OCT, Cirrus OCT, and Pentacam. Two observers measured each eye twice. Intraobserver and interobserver reproducibility were determined and agreement among the devices calculated. RESULTS: CCT was measured in 40 eyes of 29 patients. Regardless of the CCT, the measurements obtained using Visante OCT, Cirrus CCT, and ultrasound pachymetry were well correlated. Interobserver and intraobserver reproducibility were high among the three devices. Pentacam overestimated the results compared with the other devices, and ultrasound pachymetry was unmeasurable in six (13%) eyes with very thick and opaque corneas. In eyes with mild corneal edema (CCT 551-650 µm), measurements from the four devices were comparable. CONCLUSION: All devices reliably measured the CCT <650 µm. In eyes with edema exceeding 650 µm, CCT measurements from the Visante OCT, Cirrus OCT, and ultrasound pachymetry devices showed good reproducibility and were well correlated, while the Pentacam overestimated the values compared to the other devices. Pentacam and ultrasound pachymetry should not be used in eyes with extreme corneal edema and opacity.

A 5-year retrospective record review of hospital-based low-vision rehabilitation in Thailand.

PURPOSE: To investigate the quality-of-life-related goals of low-vision patients, the causes of visual impairment, and the low-vision rehabilitation services at a Thai national tertiary referral center. SUBJECTS AND METHODS: A review was conducted on the medical records of patients attending the Low Vision Rehabilitation Clinic, Siriraj Hospital, Bangkok, Thailand, between 2012 and 2016. RESULTS: A total of 992 patient records were included, comprising of 760 adults (aged over 15 years) and 232 children (aged ≤15), with a mean age of 52.2 and 5.4 years, respectively. The retina was the most common anatomic site of visual impairment. Among the adults, the most common ocular condition was retinitis pigmentosa (28.3%), followed by age-related macular degeneration (10.3%), glaucoma (10.0%), and diabetic retinopathy (9.6%). As for the children, the most common ocular conditions were cortical visual impairment (17.7%), optic nerve hypoplasia (13.4%), and retinopathy of prematurity (9.5%). More patients had low vision (a visual acuity of <6/18-3/60) than blindness (a visual acuity below 3/60). The most commonly stated goals among the adults were reading, writing, and performing near tasks (34.7%), and independent mobility (21.3%), whereas for children, the most frequently indicated goal was visual and developmental stimulation (38.4%). The services most often provided for the adults were the prescribing of visual aid devices (51.8%) and orientation and mobility training (40.7%), while the children most often received visual and developmental stimulation provided by a multidisciplinary team (33.8%). The Thai Government's Universal Health Care Coverage scheme was the most commonly used medical insurance. CONCLUSION: Data from this study can be used to improve low-vision patient care and rehabilitation services, and as input to the further development of national health care policies for low-vision patients.