Accuracy of intraocular lens power formulas in eyes with keratoconus: Multi-center study in Japan.

PURPOSE: To assess the accuracy of intraocular lens (IOL) power formulas, namely, SRK/T, Haigis, Barrett Universal II, Barrett True-K for keratoconus, Kane formula, and Kane formula for keratoconus, for cataract with keratoconus in Japanese eyes. SETTING: Five surgical sites in Japan. DESIGN: A retrospective case series. METHODS: Eyes with keratoconus undergoing cataract surgery were included. Postoperative refraction was compared with the prediction by the formulas. Visual acuity, manifest spherical equivalent, prediction error (PE), and mean absolute errors (MAEs) were determined 1 month postoperatively. The PE within 0.50 diopter (D), 1.00 D, and 2.00 D were compared between IOL formulas. Subgroup analysis based on the steepest keratometry (stage 1, ≤ 48 D; stage 2, > 48 D and ≤ 53 D; and stage 3, > 53 D) was performed. The relationship between PE and preoperative biometric data were assessed. RESULTS: Fifty eyes were included. The MAE of the Barrett True-K for keratoconus, Kane keratoconus, and Kane formulas were significantly lower than that of Haigis. A statistically significant difference in the prediction accuracy within ± 0.50 D was found between Kane keratoconus and Haigis. The prediction accuracy of the Barrett True-K for keratoconus, SRK/T, and Kane within ± 1.00 D was statistically significant compared with that of Haigis. In stage 3, the Barrett True-K for keratoconus had a significantly lower MAE than SRK/T and Haigis. CONCLUSION: Keratoconus-specific formulas were more accurate than existing formulas in Japanese eyes. The Barrett True-K formula for keratoconus had higher prediction accuracy in severe keratoconus.

Prospective assessment of plate-haptic rotationally asymmetric multifocal toric intraocular lens with near addition of + 1.5 diopters.

BACKGROUND: To prospectively evaluate surgical results following implantation of rotationally asymmetric, plate-haptic, refractive segmented multifocal toric intraocular lenses (IOLs) with near addition of + 1.5 diopters (D) (Lentis Comfort LS-313 MF15T, Oculentis GmbH). METHODS: In 59 eyes of 41 patients, ocular examinations were conducted before and 1 day, 1 week, 1, 3, and 6 months after surgery. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity at 70 cm, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity at 30 cm were tested. A defocus curve was drawn, and the degree of disturbing photic phenomena were questioned. RESULTS: The IOL showed excellent rotational stability; the average absolute rotation was 1.66 ± 1.17 degrees from 1 day 1 to 6 months postoperatively, and 98.1 and 100% of eyes yielded rotation of less than 5 and 10 degrees, respectively. Postoperative distance and intermediate visual acuity were highly satisfactory; UDVA, CDVA, UIVA, and DCIVA were about 20/20, 20/16, 20/25, 20/25, respectively. Near visual acuity was suboptimal; UNVA and DCNVA were at approximately 20/60. The defocus curve analysis showed that 20/25 and 20/40 uncorrected visual acuity was attained at as close as 60 and 40 cm, respectively. Contrast sensitivity was within a normal range, and subjective photic phenomena were minimum. CONCLUSIONS: The refractive segmented, rotationally asymmetric multifocal toric IOLs with + 1.5 D near addition showed superb rotational stability and highly satisfactory distance and intermediate vision. Contrast sensitivity was high and incidence of photic symptoms was very low. TRIAL REGISTRATION: This study was registered at JAPIC Clinical Trials Information, ID: JapicCTI-183,877, https://www.clinicaltrials.jp/cti-user/trial/Search.jsp (February 5, 2018).

Topographic changes after excision surgery of primary pterygia and the effect of pterygium size on topograpic restoration.

OBJECTIVE: To assess the effect of pterygium size on time-course change of corneal topography after excision surgery of primary pterygium. METHODS: Retrospective case series included eyes that underwent excisions of primary pterygium. Pterygium size was graded according to the advancing edge position: less than one third of corneal diameter (grade 1), outside the pupil (grade 2), and within the pupillary area (grade 3). Time-course changes in corneal refractive power, astigmatism, and irregularity (surface regularity and asymmetry indices) in corneal topographies over 12 months postoperatively were compared between the pterygium size grades. RESULTS: Pterygium excision was performed on 562 eyes, consisting of 119, 338, and 105 eyes with grades 1 to 3, respectively. Grade 1 did not change in corneal irregularity, and there was no difference between grades 1 and 2, except for corneal astigmatism at 6 months. Grade 3 showed significantly higher corneal refractive power and irregularity than grade 1 until 3 and 6 months, respectively, whereas corneal astigmatism was higher over 12 months. CONCLUSIONS: Topographic changes after primary pterygium excision were associated with pterygium size. Pterygium advancing over the pupillary area required 6 to 12 months for corneal topography restoration, resulting in slow recovery of visual acuity.

The evaluation study for social cognition measures in Japan: Psychometric properties, relationships with social function, and recommendations.

AIM: Patients with schizophrenia can have significant subjective difficulties in social cognition, but few undergo testing or treatment for social cognition. The Social Cognition Psychometric Evaluation (SCOPE) study recommends six social cognitive measures; however, the reliability and validity of these measures in different cultural and linguistic areas has not been adequately examined. We examined the psychometric properties of nine social cognitive measures and the relationship to social function, with the aim of determining the level of recommendation for social cognitive measures in clinical practice in Japan. METHODS: For our test battery, an expert panel previously selected nine measures: the Bell Lysaker Emotion Recognition Task (BLERT); Facial Emotion Selection Test (FEST); Hinting Task (Hinting); Metaphor and Sarcasm Scenario Test (MSST); Intentionality Bias Task (IBT); Ambiguous Intentions and Hostility Questionnaire (AIHQ); Social Attribution Task-Multiple Choice (SAT-MC); SAT-MCII; and Biological Motion (BM) task. In total, 121 outpatients with schizophrenia and 70 healthy controls were included in the analysis, and the results were provided to an expert panel to determine the recommendations for each measure. The quantitative psychological indices of each measure were evaluated for practicality, tolerability, test-retest reliability, correlation with social function, and the incremental validity of social function. RESULTS: Hinting and FEST received the highest recommendations for use in screening, severity assessment, and longitudinal assessment, followed by BLERT, MSST AIHQ, SAT-MC, and SAT-MCII, with IBT and BM receiving the lowest recommendations. CONCLUSION: This study provides a uniform assessment tool that can be used in future international clinical trials for social cognitive impairment.

Altered expression of enzymes regulating the activity of endothelin-1 in the lower segment of the human amnion during labor.

The level of endothelin (ET)-1, a uterotonin, increases in amniotic fluid during labor. The known metallopeptidases include ET-converting enzyme (ECE), which converts inactive precursor to potent ET-1, and neutral endopeptidase (NEP), which inactivates ET-1. These enzymes are present in fetal membranes, and the aims of this study were to establish the protein expression of the enzymes within the amnion of human fetal membranes. Expressions were compared between amnions obtained before and after term labor using a Western blot analysis and enzyme-linked immunosorbent assay, respectively. The localization of these enzymes was determined using immunohistochemistry. The protein expression of the enzymes and output of bioactive ET-1 in human amnion epithelial cells (HAECs) and mesenchymal cells (HAMCs) were investigated with and without proinflammatory cytokines, oxytocin, and prostaglandin treatment. The effects of sphingosine-1-phosphate (S1P), a bioactive lipid, were also examined. The protein expression of ECE-1 was significantly increased (P < 0.01), whereas that of NEP was significantly decreased, followed by increased ET-1 (P < 0.01), in the amnion obtained after labor (P < 0.01). HAECs and HAMCs primarily expressed ECE-1 and NEP, respectively. The protein expression of ECE-1 was significantly induced (P < 0.01). However, the NEP levels were significantly reduced (P < 0.05) by treatment with TNFalpha and IL1beta followed by the 7.5-fold and 6.5-fold increase of ET-1 (P < 0.01), respectively, in the HAECs. ET-1 was increased 2-fold by S1P (P < 0.01). These results suggest that the altered expression of enzymes regulating the activity of ET-1 during parturition is controlled by inflammatory cytokines.

Clinical and laboratory studies on the effects of capsular tension ring on surgical outcomes of trifocal intraocular lens implantation.

PURPOSE: To assess the influence of capsular tension ring (CTR) on surgical outcomes of trifocal intraocular lens (IOL) implantation in femtosecond laser-assisted cataract surgery. SETTING: Sugita Eye Clinic, Tokyo, and University of Tsukuba, Ibaraki, Japan. DESIGN: Prospective, randomized, paired-eye clinical study and laboratory study. METHODS: In the clinical study involving 44 eyes of 22 patients with no risk of zonular instability, 1 eye received IOL alone and the contralateral eye received IOL with CTR. Preoperative capsular bag diameter and postoperative IOL tilt/decentration were measured using anterior segment optical coherence tomography. In the laboratory study, IOL and CTR were implanted into an artificial capsular bag of 10 mm in diameter, and IOL centration was evaluated. RESULTS: Throughout the 12-month follow-up period, there was no significant difference in refractive and visual outcomes between groups. The amount of IOL decentration was significantly larger in eyes with CTR than in eyes without CTR at 12 months postoperatively (P = .037). There was a significant negative correlation between capsular bag diameter and the amount of IOL decentration in eyes with CTR (P = .038), but not in eyes without CTR (P = .873). The laboratory study indicated that interference between CTR eyelets and IOL haptics significantly increased IOL decentration (P < .001). CONCLUSIONS: The use of CTR did not affect refractive and visual outcomes of trifocal IOL implantation in eyes without the risk of zonular weakness. CTR coimplantation increased IOL decentration possibly due to the interference between CTR eyelets and IOL haptics.

Time course of changes in aqueous flare intensity after vitrectomy for rhegmatogenous retinal detachment.

PURPOSE: To investigate the time course of changes in aqueous flare intensity after vitrectomy for rhegmatogenous retinal detachment (RD) and to determine the clinical factors related to an increase in aqueous flare. METHODS: The present study included 22 unilateral patients with RD undergoing primary 20-gauge vitrectomy. Aqueous flare intensity was measured preoperatively and at 1 week, 2 weeks, 1 month, and 3, 6, and 12 months postoperatively using the laser flare meter. RESULTS: Before vitrectomy, aqueous flare intensity was significantly higher in eyes with RD than in contralateral normal eyes. Vitrectomy increased aqueous flare intensity, and the peak was observed at the first postoperative week. Aqueous flare intensity decreased to a stable level at 3 months postoperatively but remained significantly higher than that of contralateral and preoperative eyes throughout the observation period. Clinical factors that were found to be significantly correlated with an increase in aqueous flare intensity included 1) before the surgical procedure: extent of RD and intraocular pressure, and 2) 3 months postoperatively: size of retinal breaks, number of laser photocoagulation spots, operation time, and performance of combined cataract surgery. Multiple regression analysis revealed that aqueous flare intensity at 3 months postoperatively had significant correlation with the size of retinal breaks (P < 0.005) and the number of laser photocoagulation spots (P < 0.05). CONCLUSION: Aqueous flare intensity after vitrectomy for RD decreased to a stable level at 3 months postoperatively but remained significantly higher than the normal level. The size of retinal breaks and the degree of surgical invasion were associated with the increase in aqueous flare.

Type of residual astigmatism and uncorrected visual acuity in pseudophakic eyes.

It is difficult to assess the pure impact of the type of residual astigmatism (with-the-rule; WTR, against-the-rule; ATR, and oblique astigmatism) on uncorrected distance visual acuity (UDVA) in pseudophakic eyes due to different age distribution of patients between those subgroups. We conducted the current study to investigate the association between astigmatism type and UDVA in eyes after cataract surgery with consideration for various confounding factors such as age. Data were retrospectively collected from 1535 pseudophakic eyes with corrected distance visual acuity (CDVA) of 20/20 or better, and spherical equivalent between - 0.125 D and 0.0 D. They were classified based on the pattern of residual refractive astigmatism into four groups; minimum astigmatism (< 0.5 D), WTR, ATR, and oblique astigmatism groups. The stepwise multivariate regression analysis showed that the magnitude of residual refractive astigmatism (standardized partial regression coefficient ß = 0.559, p < 0.001), CDVA (ß = 0.381, p < 0.001), minimum astigmatism group (ß = - 0.188, p < 0.001), and WTR astigmatism group (ß = - 0.058, p < 0.001) were significantly associated with UDVA (r2 = 0.795). Variables excluded from the multivariate regression model include age, preoperative corneal astigmatism, axial length, anterior chamber depth, intraocular lens power, and postoperative spherical equivalent. These results indicate that UDVA is significantly better in eyes with minimum and WTR astigmatism than in those with ATR and oblique astigmatism, after adjustment for confounding parameters. In pseudophakic eyes, oblique and ATR astigmatism exerts a greater impact on UDVA than WTR astigmatism does, even after controlling for age.

Pharmacological interventions for social cognitive impairments in schizophrenia: A protocol for a systematic review and network meta-analysis.

Background: Social cognitive impairments adversely affect social functioning (e.g., employment status) in patients with schizophrenia. Although pharmacological interventions have been suggested to provide some benefits on social cognition, little information is available on the comparative efficacy of pharmacotherapy. Thus, the aim of this planned systematic review and network meta-analysis is to perform a quantitative comparison of the effects of various psychotropic drugs, including supplements, on social cognition disturbances of schizophrenia. Methods: The literature search will be carried out using the PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, ClinicalTrials.gov, and International Clinical Trials Registry Platform databases from inception onward. Randomized controlled trials that examined the efficacy of drugs in social cognitive disturbances will be included, based on the most recent studies and the broader literature than previously searched. This protocol defines a priori the methods that will be used for study selection, data collection, quality assessment, and statistical syntheses. Discussion: The findings this work are expected to help promote the development of better therapeutics of social cognitive impairments in schizophrenia and related psychiatric conditions. Systematic Review Registration: [www.crd.york.ac.uk/prospero], identifier [CRD42021293224].

[A case of choroidal osteoma detected by high-penetration optical coherence tomography].

BACKGROUND: Choroidal osteoma is a rare intraocular tumor, composed of mature bone tissue. We performed high-penetration optical coherence tomography (HP-OCT) on a patient with choroidal osteoma with serous retinal detachment(SRD). CASE: A 49-year-old woman complained of visual loss OD. Best corrected visual acuity OD was 0.4. The right eye showed a yellowish white subfoveal lesion of 3 disc diameters in size. As computed tomography of the tumor showed choroidal calcification, the diagnosis of choroidal osteoma was made. HP-OCT demonstrated the structure of the tumor clearly, but normal choroidal vessels were not depicted. In addition, HP-OCT showed strong signals in the lamina choroidocapillaris, and no choroidal vessels were found in the parafoveal area of the left eye. CONCLUSION: A case of choroidal osteoma is presented. HP-OCT can detect structural changes in the choroidal lesions at an early stage of the disease.

Influence of posterior corneal astigmatism on the outcomes of toric intraocular lens implantation in eyes with oblique astigmatism.

PURPOSE: To assess whether the outcomes of toric intraocular lens (IOL) implantation in eyes with oblique astigmatism can be improved by direct measurements of posterior corneal astigmatism using anterior segment optical coherence tomography (AS-OCT) instead of by using anterior corneal measurements alone. STUDY DESIGN: Retrospective case series. METHODS: Two toric IOL power calculation methods were compared: anterior corneal astigmatism was used in the keratometry group, whilst total corneal astigmatism determined by ray tracing through the measured anterior and posterior corneal surfaces was used in the AS-OCT group. In a total of 279 eyes of 232 patients, subgroup analysis was conducted for with-the-rule (WTR) (85 eyes in the keratometry group and 34 eyes in the AS-OCT group), against-the-rule (ATR) (73/29 eyes), and oblique (26/32 eyes) astigmatism. RESULTS: In the WTR and ATR astigmatism groups, the uncorrected distance visual acuity (UDVA) was significantly better in the AS-OCT group than in the keratometry group (P = 0.012 and P < 0.001, Mann-Whitney test), and the residual astigmatism was significantly smaller in the AS-OCT group than in the keratometry group (P = 0.037 and P < 0.001). In eyes with oblique astigmatism, the UDVA (P = 0.299) and residual astigmatism (P = 0.373) of the keratometry and AS-OCT groups did not differ. CONCLUSION: Incorporation of posterior corneal astigmatism measured with AS-OCT can significantly improve the outcomes of toric IOL implantation in eyes with WTR and ATR astigmatism, but not in eyes with oblique astigmatism.

Anterior capsule coverage and rotational stability of an acrylic toric intraocular lens.

PURPOSE: To investigate factors related to the rotational stability of an acrylic toric intraocular lens (IOL). SETTING: Four ophthalmic surgical sites in Japan. DESIGN: Prospective case series. METHODS: The study included 120 eyes of 120 patients undergoing phacoemulsification and implantation of a toric IOL (AcrySof IQ, Alcon Laboratories, Inc.). At 1 hour postoperatively, the area of continuous curvilinear capsulorhexis (CCC) was measured, and the state of anterior capsule coverage on the IOL optic (total on or partial on) was recorded. The toric IOL axis orientation was assessed at the end of surgery and at 1 hour, 1 week, 1 month, and 6 months postoperatively. Multiple regression analysis was performed to explore any clinical factors relevant to IOL rotation from the end of surgery to 6 months postoperatively. The explanatory variables included age, anterior chamber depth preoperatively, axial length, type of corneal astigmatism (with-the-rule, against-the-rule, or oblique astigmatism), area of CCC, state of anterior capsule overlap on IOL optic (total coverage vs partial coverage), and surgical sites (surgeons). RESULTS: The multiple regression analysis in 110 eyes of 110 patients indicated that anterior capsule overlap on the IOL optic was the only variable associated with IOL rotation at 6 months postoperatively (P = .0482). The mean absolute rotation at 6 months was 1.96 ± 1.81 degrees in the total on group and 3.79 ± 3.12 degrees in the partial on group (P = .0004). CONCLUSIONS: Rotational stability of a single-piece, acrylic toric IOL was better in eyes with total anterior capsule coverage than that in those with partial anterior capsule coverage on the IOL optic.

Facilitative Effects of Transcranial Direct Current Stimulation on Semantic Memory Examined by Text-Mining Analysis in Patients With Schizophrenia.

Background: Beneficial effects of transcranial direct current stimulation (tDCS) are relevant to cognition and functional capacity, in addition to psychiatric symptoms in patients with schizophrenia. However, whether tDCS would improve higher-order cognition, e.g., semantic memory organization, has remained unclear. Recently, text-mining analyses have been shown to reveal semantic memory. The purpose of the current study was to determine whether tDCS would improve semantic memory, as evaluated by text-mining analyses of category fluency data, in patients with schizophrenia. Methods: Twenty-eight patients entered the study. Cognitive assessment including the category fluency task was conducted at baseline (before tDCS treatment) and 1 month after t administration of tDCS (2 mA × 20 min, twice per day) for 5 days, according to our previous study. The category fluency data were also obtained from 335 healthy control subjects. The verbal outputs (i.e., animal names) from the category fluency task were submitted to singular valued decomposition (SVD) analysis. Semantic memory structures were estimated by calculating inter-item cosines (i.e., similarities) among animal names frequently produced in the category fluency task. Data were analyzed longitudinally and cross-sectionally to compare the semantic structure within the patient group (i.e., baseline vs. follow-up) and between groups (patients vs. healthy controls). In the former, semantic associations for frequent items were compared in the form of cosine profiles, while in the latter, the difference in the magnitude of the correlations for inter-item cosines between healthy controls and patients (baseline, follow-up) was examined. Results: Cosine profiles in the patient group became more cluster-based (i.e., pet, carnivores, and herbivores) at follow-up compared to those at baseline, yielding higher cosines within subcategories. The correlational coefficient of inter-item cosines between healthy controls and patients was significantly greater at follow-up compared to baseline; semantic associations in patients approached the normality status after multi-session tDCS. Conclusions: To our knowledge, this is the first study to demonstrate the facilitative effect of tDCS on semantic memory organization in patients with schizophrenia. Text-mining analysis was indicated to effectively evaluate semantic memory structures in patients with psychiatric disorders.

14N NQR and proton NMR study of ferroelectric phase transition and proton exchange in organic ferroelectric (H2-TPPZ)(Hca)2.

The complete (14)N nuclear quadrupole resonance spectrum has been measured in ferroelectric (H(2)-TPPZ)(Hca)(2) using nuclear quadrupole double resonance. The quadrupole coupling tensors are assigned to various nitrogen positions in the crystal structure. Two types of asymmetric N-H(+)...N hydrogen bonds are observed in the ferroelectric phase. A slow dynamics influencing the (14)N NQR spectrum and relaxation has been observed in the paraelectric phase. The analysis of the (14)N NQR spectra in the paraelectric phase shows that above T(c) each hydrogen bond exchanges between the two types observed in the ferroelectric phase. The change of the type of hydrogen bond is associated with the transfer of protons within the bond.

Effects of astigmatic defocus on binocular contrast sensitivity.

PURPOSE: To determine the effects of astigmatism on contrast sensitivity (CS). METHODS: Eighteen normal volunteers (30.5 ± 6.0 [mean ± SD] years) were recruited. After correcting each refractive error by spectacles, against-the-rule (ATR) or with-the-rule (WTR) astigmatism of +1.00, +2.00 and +3.00 D was intentionally produced in both eyes, and then binocular CS was measured. The cylindrical addition of different powers (+1.00-+3.00 D) was compensated with spherical lenses so that the spherical equivalent refraction became zero in each eye. Subsequently, the above cylindrical addition was monocularly induced, and binocular CS was measured again. The relation between CS and astigmatic power, axis, and monocular or binocular astigmatism was investigated. RESULTS: With binocular ATR and WTR astigmatism, increases in astigmatic power significantly correlated with decreases in the area under the log contrast sensitivity function (AULCSF). With monocular astigmatic defocus, astigmatic power addition did not affect AULCSF. With binocular astigmatic defocus of high-power (+2.00 and +3.00 D), ATR astigmatism deteriorated AULCSF more than WTR astigmatism. In a comparison between binocular and monocular astigmatic defocus, CS was significantly worse with binocular astigmatic defocus than with monocular astigmatic defocus at higher spatial frequencies regardless of astigmatic power. CONCLUSIONS: Binocular astigmatic defocus deteriorates CS depending on the amount of astigmatic power. ATR astigmatism reduces CS more than WTR astigmatism dose. In addition, binocular astigmatic defocus affects CS more severely than monocular astigmatic defocus especially at high spatial frequencies.

Risk factors for corneal endothelial cell loss by cataract surgery in eyes with pseudoexfoliation syndrome.

PURPOSE: The aim of this study was to investigate the factors associated with decreases in corneal endothelial cell density (ECD) resulting from cataract surgery in eyes with pseudoexfoliation syndrome (PEX). METHODS: The clinical records of 78 eyes of 78 patients with PEX who had undergone cataract surgery were reviewed. ECD was measured preoperatively and at 3 months postoperatively with specular microscopy. Multiple regression analysis was used to assess the factors that were significantly related to the rate of ECD loss. Explanatory variables included age, preoperative ECD, pupil diameter, cataract grade, concomitance of glaucoma or diabetes mellitus, preoperative anterior chamber depth, surgery time, total time and power of ultrasound, performance of intraoperative pupillary enlargement manipulation, and postoperative aqueous flare intensity at 1 week and 1 month. RESULTS: ECD before and after surgery was 2,464±337 cells/mm(2) and 2,400±347 cells/mm(2), respectively, with an ECD loss rate of 2.6%±5.1% (mean ± SD). Multiple regression analysis revealed that ECD loss was significantly associated with the cataract grade (P=0.019) and preoperative anterior chamber depth (P=0.023). CONCLUSION: With modern small incision cataract surgery, the ECD loss varied with surgical invasions due to severe cataract and shallow anterior chamber, and the presence of PEX was least affected.

Intraocular pressure elevation after vitrectomy for various vitreoretinal disorders.

PURPOSE: To determine the incidence of and risk factors for intraocular pressure (IOP) elevation in the immediate postoperative period after vitrectomy for various vitreoretinal disorders. METHODS: A prospective study was performed in 228 consecutive patients with various vitreoretinal disorders. The IOP was measured before surgery, at the end of surgery, and at 5 hours and 1 day after surgery using Tono-Pen XL. The IOP at the end of surgery was adjusted to 15.0 ± 2.0 mm Hg. RESULTS: Intraocular pressure elevation (>25 mm Hg) was found in 55 (24.1%) and 52 (22.8%) patients at 5 hours and 1 day postoperatively, respectively. The IOP at 5 hours was significantly lower in patients with macular hole (MH) than in those with diabetic macular edema, proliferative diabetic retinopathy (PDR), proliferative vitreoretinopathy, or rhegmatogenous retinal detachment (RD). The IOP at 1 day was significantly higher in patients with PDR and RD than in those with MH and epiretinal membrane. Multiple regression analysis revealed that IOP at 5 hours postoperatively had a significant correlation with the number of laser photocoagulation, preoperative IOP, combined cataract surgery, and 20-gauge vitrectomy. The IOP at 1 day postoperatively was significantly associated with these 4 parameters as well as the severity of postoperative vitreous hemorrhage and use of expanding gas tamponade. CONCLUSIONS: Intraocular pressure elevation was found in approximately one-quarter of cases within 1 day following vitrectomy. The risk factors for IOP elevation included number of laser photocoagulation, combined cataract surgery, severity of postoperative vitreous hemorrhage, and use of expanding gas tamponade.

Effect of preoperative corneal astigmatism orientation on results with a toric intraocular lens.

PURPOSE: To compare the Acrysof IQ toric intraocular lens (IOL) and the Acrysof IQ aspheric nontoric IOL and evaluate the effect of preoperative corneal astigmatism orientation on results. SETTING: Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. DESIGN: Comparative case series. METHODS: This retrospective chart review comprised patients with cataract and preoperative corneal astigmatism between 1.0 diopter (D) and 2.5 D having toric IOL (toric group) or aspheric nontoric IOL (nontoric group) implantation. Eyes were grouped depending on the preoperative axis of corneal astigmatism; that is, with the rule (WTR), against the rule (ATR), and oblique. Preoperative and postoperative analyses included uncorrected (UDVA) and corrected (CDVA) distance visual acuities and cylindrical power preoperatively and 3 months postoperatively. RESULTS: The postoperative CDVA was not significantly different between the 2 IOLs; however, the postoperative UDVA was significantly better in the toric group than in the nontoric group (P<.0001). The postoperative residual cylindrical power was significantly smaller in the toric group (P<.0001). In eyes with ATR and oblique astigmatism, the mean postoperative UDVA was significantly better in the toric group, whereas there were no differences between the 2 groups in patients with WTR astigmatism. CONCLUSIONS: There was significant improvement in postoperative cylinder and UDVA with toric IOLs compared with nontoric IOLs. With a superior corneal incision, the benefits of astigmatism correction with the toric IOL were more significant in patients with ATR and oblique astigmatism than in those with WTR astigmatism.

Intraocular pressure elevation in the early postoperative period after vitrectomy for rhegmatogenous retinal detachment.

PURPOSE: The purpose of this study was to determine the incidence of and risk factors for intraocular pressure (IOP) elevation within 24 h following vitrectomy for rhegmatogenous retinal detachment (RD). METHODS: We assessed 34 eyes of 34 consecutive patients with RD undergoing vitrectomy and 12 eyes of 12 patients with macular hole as controls. IOP was measured using Tonopen XL before surgery, at the end of surgery, and at 5 h and 1 day postoperatively. IOP at the end of surgery was adjusted to 15.0 ± 2.0 mmHg. RESULTS: IOP elevation was found in five RD eyes at 5 h and in 13 1 day postoperatively. IOP in patients with RD at both 5 h and 1 day postoperatively was significantly higher than that of controls. Circumferential dimension of retinal tears and disease duration were significantly associated with IOP elevation at both 5 h and 1 day postoperatively. CONCLUSIONS: IOP elevation in the early postoperative period following vitrectomy for RD is common. The risk factors for IOP elevation include the extent of retinal tears and duration of detachment. Prophylactic treatment may be useful in eyes with higher risks of IOP elevation.