Changes in Optic Nerve Head Blood Flow During Horizontal Ocular Duction

Purpose

In this study, we aimed to compare blood flow changes in the optic nerve head (ONH) during horizontal ocular duction among normal, primary open-angle glaucoma (POAG), and normal-tension glaucoma (NTG) eyes.

Methods

In this cross-sectional study, we included 90 eyes from 90 participants (30 control eyes, 30 POAG eyes, and 30 NTG eyes). ONH blood flow was measured with laser speckle flowgraphy using an external fixation light to induce central gaze, abduction, and adduction at 30 degrees for each eye. The mean blur rate (MBR) of the entire ONH area (MA), vascular region (MV), and tissue region (MT), and the change ratio were analyzed. The change ratio was defined as abduction or adduction value/central gaze value.

Results

In the control group, MA significantly decreased during adduction (22.9 ± 3.7) compared with that during central gaze (23.6 ± 3.9, P < 0.05). In the POAG group, MA (adduction = 17.4 ± 3.8 and abduction = 17.3 ± 3.6) and MV (adduction = 37.9 ± 5.6 and abduction = 38.0 ± 5.6) significantly decreased during adduction and abduction compared with those during central gaze (18.0 ± 4.1 and 39.5 ± 6.3, respectively, P < 0.05). In the NTG group, MA significantly decreased during adduction (17.4 ± 4.2) compared with that during central gaze (18.1 ± 4.6) and abduction (18.1 ± 4.8, P < 0.05). The change ratio did not differ between the glaucoma and control groups.

Conclusions

ONH blood flow decreased during horizontal ocular duction regardless of normal or glaucoma states; however, the change ratio was comparable between the normal and glaucoma groups.

Accuracy of pattern deviation in estimating the glaucomatous damage in the central 10° visual field in eyes with glaucoma and cataract

BACKGROUND/AIMS

The accuracy of pattern deviation (PD) in estimating the damage to the glaucomatous visual field (VF) in the central 10° in eyes with glaucoma and cataract is unclear.

METHODS

This retrospective study includes 63 eyes of 52 glaucoma patients who successfully underwent cataract surgery or cataract surgery plus iStent implantation. Using the Humphrey Field Analyser 10-2 test, VF was measured within 6 months preoperatively and postoperatively (VFpre and VFpost, respectively). The mean total deviation values in VFpost (mTDpost) indicates glaucomatous damage without cataract and the difference between this value and mean PD values in VFpre (mPDpre) was evaluated (εmPD). The effect of cataract was then evaluated as the difference between mTDpost and mTDpre (ΔmTD), while the effects of mTDpost and ΔmTD on εmPD were also assessed. In addition, based on preoperative visual acuity (VApre) and VFpre, the optimal model for predicting mTDpost was identified. The error of this method (εOptimalModel) was estimated as the difference against mTDpost, which was compared with εmPD.

RESULTS

Compared with mTDpre, there was a significant improvement in mTDpost (p=0.028). A significant difference was observed between mPDpre and mTDpost (p<0.001). Further, εmPD significantly increased with the increase of mTDpost or ΔmTD (p<0.001 and p=0.0444, respectively). The absolute εOptimalModel was significantly smaller than the absolute εmPD (p<0.001).

CONCLUSIONS

This study warns clinicians that PD of the central 10° VF might underestimate the glaucomatous VF damage with the progression of glaucoma and overestimate it as a cataract progresses.

Changes in the preoperative ocular surface flora with an increase in patient age: A surveillance analysis of bacterial diversity and resistance to fluoroquinolone

PURPOSE

This study analyzed the relationship between patient age and the prevalence and fluoroquinolone susceptibility of gram-positive cocci from the ocular surface flora before ophthalmic surgery.

METHODS

This surveillance study included scraped samples from the conjunctival sac of 8923 eyes of 5490 patients (70.0 ± 13.7 years) without ocular infection before ophthalmologic surgery between August 2018 and December 2020. A review of microbiological records regarding patient age was used to determine the number of isolates and gram-positive species obtained, as well as their fluoroquinolone susceptibility. Fluoroquinolone susceptibility was determined using the Clinical and Laboratory Standards Institute protocols of broth microdilution. Statistical analysis was performed using a generalized additive model and a log-linear model.

RESULTS

In total, 9,894 bacterial isolates obtained from scraped samples from the patients were analyzed. The detected species were Staphylococcus epidermidis (31.0%), Staphylococcus aureus (6.1%), Staphylococcus lugdunensis (3.9%), Enterococcus faecalis (5.8%), Corynebacterium species (31.7%), and Cutibacterium acnes (7.5%) and others. The number of species isolated from the ocular surface was increased at the rate of 1.018 per 10 years of age (p < 0.0001). S. epidermidis, S. lugdunensis, E. faecalis, and Corynebacterium species were isolated more often with an increase in patient age. The levofloxacin resistance ratio of methicillin-sensitive S. epidermidis and Corynebacterium species increased at the rate of 1.204 and 1.087 respectively with a 10-year increase in age (both p < 0.0001).

CONCLUSION

Gram-positive bacteria in the ocular surface flora (OSF) exhibited gradual changes in diversity and fluoroquinolone resistance with an increase in patient age. It is important to monitor the OSF of the patients before ophthalmologic surgery to prevent refractory ocular postoperative infection.

Comparison of Short-term Visual Acuity Changes After Trabeculotomy ab Interno Using Trabectome and Trabeculectomy ab Externo

PURPOSE

To compare short-term visual acuity (VA) changes after trabeculotomy ab interno (TAI) using trabectome and trabeculectomy ab externo (TAE) performed on pseudophakic eyes.

DESIGN

A single-center retrospective study.

PARTICIPANTS

Patients with pseudophakic eyes who had primary open-angle glaucoma or exfoliation glaucoma and underwent TAI or TAE alone.

METHODS

Changes in intraocular pressure (IOP), medication score, Snellen VA, and the number of eyes with vision loss (loss of ≥ 2 Snellen lines) were evaluated at baseline, week 1, and months 1, 3, and 6. The risk factors for vision loss at 6 months postoperatively were analyzed in both groups.

MAIN OUTCOME MEASURES

Visual acuity changes.

RESULTS

A total of 112 eyes of 112 patients were examined: 46 in the TAI group and 66 in the TAE group. Intraocular pressure was significantly lower in both groups at each visit than at baseline. The TAI group had a significantly higher mean postoperative IOP than the TAE group. Medication scores in the TAI group were significantly different after 3 months compared with baseline; however, decreased significantly at all study visits in the TAE group. The mean VA in the TAI group did not decrease significantly at each visit. In the TAE group, it decreased significantly up to 3 months but was not significantly different at 6 months. At all study visits, the number of eyes with vision loss was significantly lower in the TAI group than in the TAE group. Only 2 eyes in the TAI group (4.3%) had vision loss at 6 months, which was caused by macular edema. In the TAE group, 13 eyes (19.7%) experienced vision loss at 6 months. In all cases, the presence of preoperative split fixation [odds ratio = 7.30, P < 0.05] and the occurrence of hypotony-related complications [odds ratio = 6.76, P < 0.05] within 6 months were risk factors for vision loss.

CONCLUSIONS

TAI lowered IOP less than TAE; however, there was less vision loss with TAI. For eyes with a target IOP in the mid-teens, TAI can be recommended as initial surgery.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosuremay be found in the Footnotes and Disclosures at the end of this article.

Human T-cell Leukemia Virus Type 1 (HTLV-1)-induced Uveitis

Human T-cell leukemia virus type 1 (HTLV-1) is a human retrovirus that causes T-cell malignant diseases (adult T-cell leukemia/lymphoma) and HTLV-1-related non-malignant inflammatory diseases, such as HTLV-1 uveitis. Although the symptoms and signs of HTLV-1 uveitis are nonspecific, intermediate uveitis with various degrees of vitreous opacity is the most common clinical presentation. It can occur in one or both eyes and its onset is acute or subacute. Intraocular inflammation can be managed with topical and/or systemic corticosteroids; however, recurrence of uveitis is common. The visual prognosis is generally favorable, but a certain proportion of patients have a poor visual prognosis. Systemic complications of patients with HTLV-1 uveitis include Graves' disease and HTLV-1-associated myelopathy/tropical spastic paraparesis. This review describes the clinical characteristics, diagnosis, ocular manifestations, management, and immunopathogenic mechanisms of HTLV-1 uveitis.

Early postoperative visual acuity changes after trabeculectomy and factors affecting visual acuity

PURPOSE

To investigate the early visual acuity (VA) changes that occur after trabeculectomy and their reversal with recovery.

METHOD

Two hundred ninety-two eyes of 292 patients after initial trabeculectomy as a standalone procedure fulfilling the following conditions were included: 1) patients with a postoperative follow-up of at least 3 months; 2) patients with preoperative corrected VA less than 0.5 logMAR equivalent; 3) patients with reliable results of visual field; and 4) patients who had open angle glaucoma. VA and intraocular pressure (IOP) changes during the first 3 months after surgery and factors affecting VA postoperatively at 3 months were investigated.

RESULTS

The mean IOPs (mmHg) after trabeculectomy were significantly lower than preoperatively during the entire period (P < 0.0001). The mean corrected VA for all patients was 0.06 ± 0.17, 0.24 ± 0.38, 0.19 ± 0.26, and 0.14 ± 0.27 preoperatively and at 1 week, 1 month, and 3 months postoperatively, respectively, showing a significant decrease from the preoperative period at all time points (P < 0.0001). VA loss of two or more levels was observed in 13 eyes (4.45%) at 3 months postoperatively. Foveal threshold (FT), shallow anterior chamber (SAC), and choroidal detachment (CD) affected the change in VA before and at 3 months after surgery (P < 0.0001, P = 0.0002, P = 0.0004, respectively). The factors that had significant effects on VA change were FT, SAC, and CD in POAG, FT and hypotonic maculopathy in NTG, and FT in XFG (p < 0.05).

CONCLUSION

The frequency of serious vision loss was 4.45% for two or more levels of vision loss, and early postoperative VA changes after trabeculectomy may not be reversed even 3 months later. VA loss is influenced by preoperative FT, postoperative SAC and CD, but the impact of postoperative complications vary with disease type.

Prevalence of Accommodative Microfluctuations in Eyes after Cataract Surgery

BACKGROUND

We aimed to evaluate the existence of accommodative microfluctuations in eyes after cataract surgery.

METHODS

This retrospective observational cohort study included 1160 eyes of 713 patients (mean age: 72.5 ± 8.3 years) who underwent phacoemulsification, intraocular lens insertion, and an evaluation of accommodative microfluctuations with an autorefractometer. Patients with posterior segment disorders resulting in visual acuity impairment and those with unavailable medical information were excluded. High-frequency components (HFCs), between 1.0-2.3 Hz, based on fast Fourier transform analysis of the accommodative microfluctuation data were examined at postoperative 2-3 (2 M) and 6 months (6 M). The relationships between the HFCs and patient age, manifest refraction, and axial length were analyzed.

RESULTS

Increased HFC values (>65) were observed at a constant rate after cataract surgery, with prevalence rates of 33.4% at 2 M and 34.7% at 6 M. Postoperatively, at 2 M, increased HFC values were significantly more common for eyes with axial length ≥26 mm than for those with axial length <26 mm (p = 0.0056). However, they were not significantly correlated to age or postoperative manifest refraction.

CONCLUSIONS

At 2 M postoperatively, increased HFC values presented more frequently in eyes with a greater axial length; hence, the precise detection and understanding of postoperative accommodative spasms in high myopia patients is important.

Measurement of Aniseikonia Tolerance in Binocular Fusion

SIGNIFICANCE

The determination of aniseikonia tolerance may aid in developing optimal treatment plans for cataract surgery, refractive surgery, and refractive correction with glasses and contact lenses.

PURPOSE

This study aimed to measure aniseikonia tolerance.

METHODS

We included 33 patients (mean age ± standard deviation, 28.9 ± 6.4 years; male/female, 12:21) with anisometropia ≤1.0 D and best spectacle-corrected visual acuity of 20/20 or more in both eyes, with no ophthalmologic disease other than refractive errors and no history of ocular surgery. The exclusion criteria were anisometropia >1.0 D, axial length difference >0.5 mm, corneal refractive power difference >0.5 D, astigmatism >3.0 D, stereoacuity threshold >100 arcsec according to the Titmus Stereo Test, and >0% aniseikonia according to the New Aniseikonia Test. Aniseikonia tolerance was assessed using Eyemark Hello, a haploscope using gaze detection technology. Although the optotype of one eye was enlarged or reduced at a speed of 2%/s, the patients were instructed to press a button on the controller to indicate blurring, flickering, and diplopia. The value at which the patient responded was considered the aniseikonia tolerance value and assessed thrice per eye, five times if the values were highly variable, and then averaged.

RESULTS

The mean aniseikonia tolerance was approximately 3%; the median value was approximately 2% (range, 1.0 to 11.5%; dominant eye, 3.3 ± 2.6%; nondominant eye, 2.9 ± 1.8%). No significant difference in aniseikonia tolerance between the dominant and nondominant eyes was observed for the enlarged optotypes. No case showed changes in the ocular alignment before discomfort occurred. No significant correlation was observed between aniseikonia tolerance and anisometropia, axial length difference, corneal power difference, and ocular deviation.

CONCLUSIONS

Aniseikonia should be maintained at <2% for a comfortable visual environment. Aniseikonia tolerance may be an important indicator for cataract surgery, refractive surgery, and spectacle correction.

Navigated direct photocoagulation with a 30-ms short-pulse laser for treating microaneurysms in diabetic macular edema exhibits a high closure rate

This study carried out direct photocoagulation for treating microaneurysms (MAs) in diabetic macular edema (DME) using a navigation laser system with a 30-ms pulse duration. The MA closure rate after 3 months was investigated using pre and postoperative fluorescein angiography images. MAs primarily inside the edematous area based on optical coherence tomography (OCT) maps were selected for treatment, and leaking MAs (n = 1151) were analyzed in 11 eyes (eight patients). The total MA closure rate was 90.1% (1034/1151), and the mean MA closure rate in each eye was 86.5 ± 8.4%. Mean central retinal thickness (CRT) decreased from 471.9 ± 73.0 μm to 420.0 ± 87.5 μm (P = 0.049), and there was a correlation between the MA closure rate and the CRT reduction rate (r = 0.63, P = 0.037). There was no difference in the MA closure rate depending on the degree of edema thickness based on a false-color topographic OCT map image. Direct photocoagulation for DME with a short pulse using the navigated photocoagulator resulted in a high MA closure rate in just 3 months and a corresponding improvement in retinal thickness. These findings encourage the use of a new therapeutic approach for DME.

Degree of loss in the tissue thickness, microvascular density, specific perimetry and standard perimetry in early glaucoma

Objective

To identify the degree of loss of the circumpapillary retinal nerve fibre layer (cpRNFL), the layer from the macular RNFL to the inner plexiform layer (mGCL++), circumpapillary (cpVD) and macular vascular density (mVD), Pulsar perimetry and standard perimetry in early glaucoma.

Methods

In this cross-sectional study, one eye from each of 96 healthy controls and 90 eyes with open-angle glaucoma were measured with cpRNFL, mGCL++, cpVD, mVD, Pulsar perimetry with Octopus P32 test (Pulsar) and standard perimetry with Humphrey field analyser 24-2 test (HFA). For direct comparison, all parameters were converted to relative change values adjusted in both their dynamic range and age-corrected normal value.

Results

The degree of loss in mGCL++ (−24.7%) and cpRNFL (−25.8%) was greater than that in mVD (−17.3%), cpVD (−14.9%), Pulsar (−10.1%) and HFA (−5.9%) (each p<0.01); the degree of loss in mVD and cpVD was greater than that in Pulsar and HFA (each p<0.01); and the degree of loss in Pulsar was greater than that in HFA (p<0.01). The discrimination ability between glaucomatous and healthy eyes (area under the curve) was higher for mGCL++ (0.90) and cpRNFL (0.93) than for mVD (0.78), cpVD (0.78), Pulsar (0.78) and HFA (0.79).

Conclusion

The degree of loss of cpRNFL and mGCL++ thickness preceded by approximately 7%–10% and 15%–20% compared with the micro-VD and visual fields in early glaucoma, respectively.

Trial registration number

UMIN Clinical Trials Registry (http://www.umin.ac.jp/; R000046076 UMIN000040372).

Comparing the structure-function relationship between the visual fields measured with variational Bayes linear regression and SITA standard

PURPOSE

We recently constructed an algorithm to measure visual field (VF) using the variational Bayes linear regression (VBLR). This algorithm enabled a faster VF measurement than the Swedish interactive thresholding algorithm (SITA) standard while maintaining the test-retest reproducibility (Murata H, et al. Br J Ophthalmol 2021). The current study aimed to compare the structure-function relationship between the SITA standard and VBLR.

METHOD

In 78 eyes of 56 patients with primary open-angle glaucoma, VF measurements were conducted using both SITA standard and VBLR VF, as well as spectral-domain optical coherence tomography. The structure-function relationship was investigated between visual sensitivity and circumpapillary retinal nerve fiber layer in the whole VF. This analysis was repeated for each of the 12 sectors (30 degrees). The strength of the structure-function relationship was evaluated using the second-order bias-corrected Akaike Information Criterion (AICc) index.

RESULT

In the whole VF, AICc values of SITA standard and VBLR were 601.6 and 597.3, respectively. The relative likelihood that VBLR had a better structure-function relationship than the SITA standard was 88.2% (when the entire field was averaged) or 99.9% (when all test points were analyzed in the pointwise manner). With the sector-wise analysis, SITA standard had a better structure-function relationship than VBLR in 1 sector (Superior sector in the retina), whereas VBLR had a better structure-function relationship than SITA standard in 4 sectors (Supero-Nasal, Infero-Nasal, Inferior, and Infero-Temporal sectors) with >95% relative likelihood.

CONCLUSION

Although it depends on locations and similar between SITA standard and VBLR-VF, but VBLR-VF had a better structure-function relationship than the SITA standard overall.

Microperimetric analysis of diabetic macular edema after navigated direct photocoagulation with short-pulse laser for microaneurysms

BACKGROUND

Focal laser photocoagulation is an important treatment option for diabetic macular edema (DME). This study aimed to examine the retinal sensitivity (RS) and morphological changes at the coagulated site after direct photocoagulation of microaneurysms (MAs) in patients with DME using a navigated laser photocoagulator with a short-pulse duration of 30 ms.

METHODS

Images of early-phase fluorescein angiography were merged with images from the optical coherence tomography (OCT) map with 9 Early Treatment Diabetic Retinopathy Study grid circles, and MAs inside the edema area were selected for direct photocoagulation. The best-corrected visual acuity (BCVA), parameters of the OCT map including central retinal thickness and retinal thickness in edema range, central RS, and RS in the edema area were assessed at 1 and 3 months after the laser treatment. The RS points that overlapped with the laser spots were identified by merging the Navilas' digital treatment reports and the microperimetry images.

RESULTS

Seventeen eyes from 14 patients were studied. The mean retinal thickness in the edema range decreased at 3 months compared with pretreatment (P = 0.042), but the BCVA, central retinal thickness, central RS, and RS in the edema area remained unchanged. Overall, 32 of 400 sensitivity points overlapped with the laser-coagulated spots. The mean RS at these spots were 22.4 ± 5.3 dB at 1 month and 22.5 ± 4.8 dB at 3 months, with no significant change from the baseline of 22.7 ± 3.5 dB.

CONCLUSIONS

Retinal thickness improved in the coagulated edema area without a decrease in RS after direct photocoagulation of MAs with a short 30-ms pulse using Navilas. This promising therapeutic strategy for DME is effective and minimally invasive.

The Japan Glaucoma Society guidelines for glaucoma 5th edition

We are pleased to bring you the 5th edition of the Glaucoma Clinical Practice Guidelines. Clinical practice guidelines are based on evidence (scientific grounds). It is a document that presents the treatment that is the most appropriate for the patient. "Glaucoma Clinical Guidelines" was first published in 2003. This was the first guideline for glaucoma treatment in Japan. The principle of glaucoma treatment is to lower intraocular pressure. Means for lowering intraocular pressure includes drugs, lasers, and surgery; Glaucoma is a disease that should be considered as a complex syndrome rather than a single condition. Therefore, the actual medical treatment is not as simple as one word. This time we set the Clinical Questionnaire with a focus on glaucoma treatment. We hope that you will take advantage of the 5th edition.

Effects of General Anesthesia on Ocular Refraction

PURPOSE

General anesthesia alters the autonomic nervous system. This study aimed to investigate the effects of general anesthesia on objective ocular refraction.

METHODS

A total of 57 patients (112 eyes) under 15 years of age who underwent strabismus surgery under general anesthesia were included in this study. Objective refraction values, corneal refraction values, and pupil diameter were measured using a HandyRef-K, a hand-held refractive keratometer, in the operating room before and during general anesthesia before strabismus surgery.

RESULTS

The spherical power of the myopic eye increased from -0.75 D to -2.29 D (diopter); the cylindrical power increased from -0.90 D to -1.39 D (p < .01 for all). The corneal refractive power decreased by an average of 0.25 D (p < .01). The spherical refractive power was negatively correlated with the age and the amount of change between cycloplegia before general anesthesia and during general anesthesia (r = -0.32, p < .05).

CONCLUSIONS

General anesthesia resulted in manifestation of myopia as noted by the objective refraction values. Corneal refractive values flatten under the same conditions, suggesting that the contraction of the ciliary muscles was the main cause of myopia. We speculate that this change was due to parasympathetic dominance and contraction of the ciliary muscles during general anesthesia.

Predictability of combined cataract surgery and trabeculectomy using Barrett Universal Ⅱ formula

Purpose

To compare the predictability of intraocular lens (IOL) power calculation using the Barrett Universal II and the SRK/T formulas in eyes undergoing combined cataract surgery and trabeculectomy.

Methods

We retrospectively reviewed the clinical charts of 56 consecutive eyes undergoing cataract surgery and trabeculectomy. IOL power calculations were performed using the Barrett Universal II and SRK/T formulas. We compared the prediction error, the absolute error, and the percentages within ± 0.5 D and ±1.0 D of the targeted refraction, 3 months postoperatively, and also investigated the relationship of the prediction error with the keratometric readings and axial length, using the two formulas.

Results

The prediction error using the SRK/T formula was significantly more myopic than that using the Barrett Universal II formula (paired t-test, p<0.001). The absolute error using the Barrett Universal II formula was significantly smaller than that using the SRK/T formula (p = 0.039). We found significant correlations of the prediction error with the axial length (Pearson correlation coefficient, r = 0.273, p = 0.042), and the keratometric readings (r = -0.317, p = 0.017), using SRK/T formula, but no significant correlations between them (r = 0.219, p = 0.167, and r = -0.023, p = 0.870), using the Barrett Universal II formula.

Conclusions

The Barrett Universal II formula provides a better predictability of IOL power calculation and is less susceptible to the effect of the axial length and the corneal shape, than the SRK/T formula. The Barrett Universal formula, rather than the SRK/T formula, may be clinically helpful for improving the refractive accuracy in such eyes.

iStent inject® and cataract surgery for mild-to-moderate primary open angle glaucoma in Japan: a cost-utility analysis

AIM: To evaluate the cost-utility of iStent inject® with cataract surgery vs cataract surgery alone in patients with mild-to-moderate primary open angle glaucoma (POAG) in the Japanese setting from a public payer's perspective. METHODS: A Markov model was adapted to estimate the cost-utility of iStent inject® plus cataract surgery vs cataract surgery alone in one eye in patients with mild-to-moderate POAG over lifetime horizon from the perspective of Japanese public payer. Japanese sources were used for patients' characteristics, clinical data, utility, and costs whenever available. Non-Japanese data were validated by Japanese clinical experts. RESULTS: In the probabilistic base case analysis, iStent inject® with cataract surgery was found to be cost-effective compared with cataract surgery alone over a lifetime horizon when using the ¥5 000 000/quality-adjusted life year (QALY) willingness-to-pay threshold. The incremental cost-utility ratio (ICUR) was estimated to be ¥1 430 647/QALY gained and the incremental cost-utility ratio (ICER) was estimated to be ¥12 845 154/blind eye avoided. iStent inject® with cataract surgery vs cataract surgery alone was found to increase costs (¥1 025 785 vs ¥933 759, respectively) but was more effective in increasing QALYs (12.80 vs 12.74) and avoiding blinded eyes (0.133 vs 0.141). The differences in costs were mainly driven by costs of primary surgery (¥279 903 vs ¥121 349). In the scenario analysis from a societal perspective, which included caregiver burden, iStent inject® with cataract surgery was found to dominate cataract surgery alone. CONCLUSION: The iStent inject® with cataract surgery is a cost-effective strategy over cataract surgery alone from the public payer's perspective and cost-saving from the societal perspective in patients with mild-to-moderate POAG in Japan.

Structure–Function Relationships and Glaucoma Detection with Magnification Correction of OCT Angiography

Purpose

To investigate the effects of adjusting the ocular magnification during OCT-based angiography imaging on structure–function relationships and glaucoma detection.

Design

Cross-sectional study.

Participants

A total of 96 healthy control participants and 90 patients with open-angle glaucoma were included.

Methods

One eye of each patient in the control group and the patient group was evaluated. The layers comprising the macula vascular density (VD) and circumpapillary VD were derived from swept-source OCT angiography imaging. The mean sensitivity (MS) of the standard automated perimetry was measured using the Humphrey 24-2 test. Structure–function relationships were evaluated with simple and partial correlation coefficients. A receiver operating characteristic analysis was performed to evaluate the diagnostic accuracy for glaucoma using the area under the receiver operating characteristic curve (AUC). Ocular magnification was adjusted using Littmann’s formula modified by Bennett.

Main Outcome Measures

The association between the axial length and VD, structure–function relationships, and glaucoma detection with and without magnification correction.

Results

The superficial layer of the macular region was not significantly correlated to the axial length without magnification correction (r = 0.0011; P = 0.99); however, it was negatively correlated to the axial length with magnification correction (r = –0.22; P = 0.028). Regarding the nerve head layer in the circumpapillary region, a negative correlation to the axial length without magnification correction was observed (r = –0.22; P = 0.031); however, this significant correlation disappeared with magnification correction. The superficial layer of the macula and the nerve head layer of the circumpapillary region were significantly correlated to Humphrey 24-2 MS values without magnification correction (r = 0.22 and r = 0.32, respectively); however, these correlations did not improve after magnification correction (r = 0.20 and r = 0.33, respectively). Glaucoma diagnostic accuracy in the superficial layer (AUC, 0.63) and nerve head layer (AUC, 0.70) without magnification correction did not improve after magnification correction (AUC, 0.62 and 0.69, respectively).

Conclusions

Adjustment of the ocular magnification is important for accurate VD measurements; however, it may not significantly impact structure–function relationships and glaucoma detection.

Hyperopia-Correcting Phototherapeutic Keratectomy and Its Comparison With Conventional Phototherapeutic Keratectomy

Purpose

To evaluate hyperopia-correcting phototherapeutic keratectomy (HC-PTK) and to compare the visual and refractive outcomes of HC-PTK and conventional PTK.

Methods

This study comprised a total of 72 eyes of 72 consecutive patients who underwent HC-PTK and conventional PTK for granular corneal dystrophy or band-shaped keratopathy. Preoperatively and 6 months postoperatively, we assessed visual acuity, manifest refraction, and mean keratometry, as well as postoperative corneal higher-order aberrations and adverse events in each PTK group, and compared these metrics between the two groups.

Results

LogMAR BSCVA significantly improved from 0.43 ± 0.47 preoperatively to 0.21 ± 0.38 postoperatively in the HC-PTK group (Wilcoxon signed-rank test, p < 0.001). It was also significantly improved from 0.22 ± 0.21 preoperatively to 0.15 ± 0.12 postoperatively in the conventional PTK group (p = 0.031). Mean refraction significantly changed from 0.27 ± 1.55 diopter (D) preoperatively to 0.50 ± 1.77 D postoperatively, in the HC-PTK group (p = 0.313). By contrast, it was significantly hyperopic from −0.15 ± 2.41 D preoperatively to 1.45 ± 2.46 D postoperatively, in the conventional PTK group (p < 0.001). No significant complications occurred in any case during the follow-up period.

Conclusion

Both HC-PTK and conventional PTK showed a significant improvement of BSCVA and no vision-threatening complications at any time in this series. HC-PTK significantly reduced a hyperopic shift in refraction compared with conventional PTK, suggesting its viability for patients requiring PTK, especially in consideration of preventing this hyperopic issue.

Faster algorithms to measure visual field using the variational Bayes linear regression model in glaucoma: comparison with SITA-Fast

AIMS

To compare the visual field (VF) test results measured with the Swedish Interactive Threshold Algorithm Fast (SITA-Fast) and newly developed variational Bayes linear regression visual field (VBLR-VF) Fast or VBLR-VF Fast+.

METHOD

Of 65 patients with glaucoma, 31 eyes of 31 patients performed VBLR-VF Fast and SITA-Fast, and 34 eyes of 34 patients performed VBLR-VF Fast+ and SITA-Fast on the same day and iterated the same procedures within 6 months using the 24-2 test grid in the current prospective study. Global index (mean deviation and pattern SD), pointwise retinal sensitivity, test duration and reliability index (fixation loss, false positive and false negative) were compared between SITA-Fast and VBLR-VF Fast or VBLR-VF Fast+.

RESULTS

Global indices were not significantly different between SITA-Fast and VBLR-VF Fast or VBLR-VF Fast+. There was no significant difference in the pointwise retinal sensitivity between the SITA-Fast and VBLR-VF Fast algorithms at the first visit, while the VBLR-VF Fast algorithm was approximately 1 dB higher compared to the SITA-Fast algorithm at the second visit. Test duration was reduced by approximately 30 s (10%) with VBLR-VF Fast and by approximately 80 s (30%) with VBLR-VF Fast+ compared with to SITA-Fast (p<0.05). Most cases showed good reliability index values; however, a marginal but significant difference was observed between the VBLR-VF and SITA-Fast algorithms.

CONCLUSION

Both VBLR-VF Fast and VBLR-VF Fast+ considerably reduced the test durations. Although there was a marginal difference in the pointwise retinal sensitivities, global indices were almost interchangeable between the VBLR-VF Fast and SITA-Fast.

Clinical evaluation of flat peripheral curve design with aspherical-curve and multi-curve hard contact lenses for keratoconus

Aspherical- and multi-curve rigid gas-permeable hard contact lenses (HCLs) have a flattened curve in the peripheral zone and are mostly used for patients with keratoconus who cannot wear glasses, soft contact lenses, or spherical HCLs. In this retrospective study, a total of 95 eyes of 77 patients who used aspherical- or multi-curve HCLs (mean age: 40.0 ± 11.0 years) were evaluated. This study examined the types of aspherical- and multi-curve HCLs, best-corrected visual acuity (BCVA) values before and after wearing HCLs, the association with the Amsler-Krumeich classification, duration of wear, corneal/conjunctival disorder, and the frequency of changing HCLs. There were 78 eyes that used aspherical-curve HCLs and 17 that used multi-curve HCLs. BCVA significantly improved from 0.42 logMAR to 0.06 logMAR after wearing either form of HCL. The Amsler-Krumeich classification showed that aspherical-curve HCLs were commonly used for patients with stage 2 keratoconus, and multi-curve HCLs were commonly used for stage 4 patients. The BCVA values were worse when the disease stage was more severe (stages 3 and 4) regardless of HCL type. The mean base curve of the lenses was steeper in multi-curve HCLs than in aspherical-curve HCLs. The more severe the disease stage, the steeper the base curve in both aspherical- and multi-curve HCLs. The duration of wear significantly improved from 2.1 h to 10.2 h, and corneal/conjunctival disorder similarly improved. The mean frequency of changing HCL types was 1.1 times. This study suggests that a flat peripheral curve design with aspherical- and multi-curve HCLs is useful for patients with keratoconus.

Vertically Fixated Posterior Chamber Phakic Intraocular Lens Implantation Through a Superior Corneal Incision

Introduction

To assess the 1-year outcomes of vertically fixated posterior chamber phakic intraocular lens implantation through a superior corneal incision.

Methods

This pilot study comprised 78 eyes of 53 consecutive patients undergoing vertically fixated implantable collamer lens (ICL) implantation through a superior corneal incision to correct moderate to high myopia and myopic astigmatism. We prospectively determined the safety, efficacy, predictability, stability, and adverse events preoperatively, and at 1 week and 1, 3, and 12 months postoperatively.

Results

The mean follow-up period was 10.4 ± 5.4 months. Uncorrected and corrected visual acuity were −0.20 ± 0.10 and −0.25 ± 0.07 logMAR, respectively, at 1 year postoperatively. At 1 year postoperatively, 98% and 100% of eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. A nonsignificant change in manifest refraction of −0.01 ± 0.08 D occurred from 1 week to 1 year. The manifest astigmatism decreased significantly, from 0.69 ± 0.73 D preoperatively to 0.21 ± 0.27 D at 1 year postoperatively (Mann–Whitney U test, p < 0.001). No vision-threatening complications occurred at any time in this series.

Conclusions

According to our experience, the vertically fixated ICL through a superior incision achieved good results, without significant complications. Considering that younger patients requiring ICL surgery tend to have with-the-rule astigmatism, this surgical technique may be a viable option for reducing astigmatism without using toric ICLs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40123-022-00470-6.

Eight-Year Outcomes of Implantation of Posterior Chamber Phakic Intraocular Lens With a Central Port for Moderate to High Ametropia

Purpose: To assess the 8-year clinical outcomes of implantation of an implantable collamer lens (ICL) with a central port (KS-Aquaport; EVO-ICL) for moderate to high myopia and myopic astigmatism. Methods: This retrospective study comprised a total of 177 eyes of 106 patients with spherical equivalents of -7.99 ± 3.33 D [mean ± standard deviation], who underwent EVO-ICL implantation. We evaluated the safety, efficacy, predictability, stability, and adverse events of the surgery, at 1 month, and 1, 2, 4, 6, and 8 years postoperatively. Results: The logarithm of the minimal angle of resolution (LogMAR) uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were -0.07 ± 0.17 and -0.20 ± 0.09, respectively, at 8 years postoperatively. The safety and efficacy indices were 1.18 ± 0.24 and 0.89 ± 0.28, respectively. At 8 years, 83 and 93% eyes were within ± 0.5 D and ± 1.0 D of the targeted correction, respectively. Change in manifest refraction from 1 month to 8 years postoperatively was -0.13 ± 0.30 D. Three eyes (1.7%) that developed cataracts had a slight pre-existing peripheral anterior subcapsular cataract formation required simultaneous ICL extraction and cataract surgery at 2 or 3 years or ICL size change (1 size up) at 7 years postoperatively. We found that neither significant intraocular pressure (IOP) rise (including pupillary block) nor significant endothelial cell loss occurred in any case throughout the 8-year observation period. Conclusions: Current ICL implantation with central port technology offered good continuous outcomes for all measures of safety, efficacy, predictability, and stability for correcting moderate to high myopic errors over a long period, thereby suggesting its long-term viability as a surgical approach for the treatment of such eyes.

Effect of Trabeculectomy on Mean and Centroid Surgically Induced Astigmatism

This study aimed to investigate the arithmetic mean of surgically induced astigmatism (M-SIA) and the centroid of surgically induced astigmatism (C-SIA) after standard trabeculectomy. We comprised 185 eyes of 143 consecutive patients (mean age ± standard deviation, 67.7 ± 11.6 years) who underwent trabeculectomy and completed at least a 3-month routine follow-up. In all cases, the scleral flap was made at the nasal-superior location. Corneal astigmatism was measured with an automated keratometer. We calculated the M-SIA and the C-SIA using vector analysis and applied the astigmatism double angle plot. The magnitude of corneal astigmatism increased significantly, from 1.17 ± 0.92 D preoperatively to 1.77 ± 1.05 D postoperatively (paired t-test, p < 0.001). The M-SIA was 1.12 ± 0.55 D, and the C-SIA was 0.73 D @64° ± 1.02 D in the right eye group, and the M-SIA was 1.08 ± 0.48 D and the C-SIA was 0.60 D @117° ± 1.03 D in the left eye group. The C-SIA showed an astigmatic shift toward the nasal-superior location of the scleral flap creation. Our results revealed that trabeculectomy induced the SIA in the direction of the scleral flap location and that the C-SIA was much lower than the M-SIA in eyes undergoing trabeculectomy.

Diagnosability of Keratoconus Using Deep Learning With Placido Disk-Based Corneal Topography

Purpose: Placido disk-based corneal topography is still most commonly used in daily practice. This study was aimed to evaluate the diagnosability of keratoconus using deep learning of a color-coded map with Placido disk-based corneal topography.

Methods: We retrospectively examined 179 keratoconic eyes [Grade 1 (54 eyes), 2 (52 eyes), 3 (23 eyes), and 4 (50 eyes), according to the Amsler-Krumeich classification], and 170 age-matched healthy eyes, with good quality images of corneal topography measured with a Placido disk corneal topographer (TMS-4^TM, Tomey). Using deep learning of a color-coded map, we evaluated the diagnostic accuracy, sensitivity, and specificity, for keratoconus screening and staging tests, in these eyes.

Results: Deep learning of color-coded maps exhibited an accuracy of 0.966 (sensitivity 0.988, specificity 0.944) in discriminating keratoconus from normal eyes. It also exhibited an accuracy of 0.785 (0.911 for Grade 1, 0.868 for Grade 2, 0.920 for Grade 3, and 0.905 for Grade 4) in classifying the stage. The area under the curve value was 0.997, 0.955, 0.899, 0.888, and 0.943 as Grade 0 (normal) to 4 grading tests, respectively.

Conclusions: Deep learning using color-coded maps with conventional corneal topography effectively distinguishes between keratoconus and normal eyes and classifies the grade of the disease, indicating that this will become an aid for enhancing the diagnosis and staging ability of keratoconus in a clinical setting.

Prediction of keratoconus progression using deep learning of anterior segment optical coherence tomography maps

Background

To predict keratoconus progression using deep learning of the color-coded maps measured with a swept-source anterior segment optical coherence tomography (As-OCT) device.

Methods

We enrolled 218 keratoconic eyes with and without disease progression. Using deep learning of the 6 color-coded maps (anterior elevation, anterior curvature, posterior elevation, posterior curvature, total refractive power, and pachymetry map) obtained by the As-OCT (CASIA, Tomey), we assessed the accuracy, sensitivity, and specificity of prediction of keratoconus progression in such eyes.

Results

Deep learning of the 6 color-coded maps exhibited an accuracy of 0.794 in discriminating keratoconus with and without progression. For a single map analysis, posterior elevation map (0.798) showed the highest accuracy, followed by anterior curvature map (0.775), posterior corneal curvature map (0.757), anterior elevation map (0.752), total refractive power map (0.729), and pachymetry map (0.720), in distinguishing between progressive and non-progressive keratoconus. The use of the adjusted algorithm by age subgroups improved to an accuracy of 0.849.

Conclusions

Deep learning of the As-OCT color-coded maps effectively discriminates progressive keratoconus from non-progressive keratoconus with an accuracy of approximately 85% using the adjusted age algorithm, indicating that it will become an aid for predicting the progression of the disease, which is clinically beneficial for decision-making of the surgical indication of corneal cross-linking (CXL).

Comparison of magnitude and summated vector mean of surgically induced astigmatism vector according to incision site after phakic intraocular lens implantation

Background

To compare the arithmetic mean (M-SIA) and the summated vector mean of surgically induced astigmatism (SVM-SIA) according to the incision site after phakic intraocular lens (Visian implantable collamer lens (ICL), STAAR Surgical) implantation.

Methods

This study comprised 121 eyes of 121 consecutive patients undergoing ICL surgery through a 3.0-mm temporal or superior clear corneal incision. The magnitude and the axis of corneal astigmatism preoperatively and 3 months postoperatively were measured using an automated keratometer. The M-SIA and the SVM-SIA were determined according to the incision site.

Results

The magnitude of corneal astigmatism significantly increased from 1.23 ± 0.59 D preoperatively to 1.46 ± 0.72 D postoperatively in the temporal incision group (Wilcoxon signed-rank test, P < 0.001), but it significantly decreased from 1.09 ± 0.36 D preoperatively to 0.86 ± 0.41 D postoperatively in the superior incision group (P < 0.001). The M-SIA was 0.48 ± 0.30 D, and the SVM-SIA was 0.23 ± 0.52 D at a meridian of 82° in the temporal incision group. The M-SIA was 0.57 ± 0.30 D, and the SVM-SIA was 0.47 ± 0.45 D at a meridian of 1° in the superior incision group.

Conclusions

ICL implantation induces the M-SIA by approximately 0.5 D, but the SVM-SIA decreased to 50% and 80% of the M-SIA in magnitude through temporal and superior incisions, respectively. The direction of the SVM-SIA showed a tendency toward corneal flattening to the incisional site. It should be noted that the M-SIA is somewhat different from the SVM-SIA according to the incision site.

Trial registration University Hospital Medical Information Network Clinical Trial Registry (000044269)

Comparison of Mean and Centroid of Surgically Induced Astigmatism After Standard Cataract Surgery

Purpose: To compare the arithmetic mean of surgically induced astigmatism (M-SIA) and the centroid of surgically induced astigmatism (C-SIA) after standard cataract surgery.

Methods: We retrospectively examined 200 eyes of 100 consecutive patients undergoing bilateral cataract surgery through a 2.8 mm temporal clear corneal incision. We quantitatively measured the magnitude and axis of corneal astigmatism preoperatively and 3 months postoperatively using an automated keratometer (TONOREFF-II, Nidek). We assessed the M-SIA, the C-SIA, and the double angle plots for the display of the individual SIA distributions.

Results: For bilateral data analysis, the magnitude of corneal astigmatism significantly increased from 0.66 ± 0.39 D preoperatively to 0.74 ± 0.46 D postoperatively (paired t-test, p = 0.012). The M-SIA was 0.50 ± 0.36 D. On the other hand, the C-SIA was 0.18 ± 0.60 D at an axis of 97°. For unilateral analysis, we obtained similar outcomes between the right and left eye groups.

Conclusions: According to our experience, standard cataract surgery induces the M-SIA by approximately 0.5 D. The magnitude of the C-SIA largely decreased to approximately 40% of the M-SIA, and the direction of the C-SIA showed a tendency toward with-the-rule astigmatism. It should be noted that the M-SIA was considerably different from the C-SIA, especially when selecting the appropriate toric IOL model and power.

Prediction of Phakic Intraocular Lens Vault Using Machine Learning of Anterior Segment Optical Coherence Tomography Metrics

PURPOSE

To compare the achieved vault using the conventional manufacturer's nomogram and the predicted vault using machine learning, in a large cohort of eyes undergoing posterior chamber phakic intraocular lens (EVO implantable collamer lens [ICL]; STAAR Surgical) implantation.

DESIGN

Reliability and validity assessment and comparison.

METHODS

Our study comprised a total of 1,745 eyes of 1,745 consecutive patients (mean age ± standard deviation, 26.2 ± 6.8 years) undergoing ICL implantation. At 1 month postoperatively, we quantitatively measured the actual vault, and compared it with the predicted vault using machine leaning of anterior segment optical coherence tomography metrics.

RESULTS

All machine learning methods, such as support vector regressor (SVR), gradient boost regressor (GBR), random forest regressor (RFR), and linear regressor (LR), showed significantly less mean absolute error and higher percentages of eyes within 50-200 µm of the targeted ICL vault than the conventional nomogram (P < .001). The RFR provided the lowest mean absolute errors and the highest percentages of eyes within 50 to 200 µm, followed by the GBR, the LR, and the SVR (P < .01).

CONCLUSIONS

Machine learning of the preoperative anterior segment optical coherence tomography metrics, especially the RFR, provided significantly higher predictability of the ICL vault than the conventional manufacturer's nomogram, suggesting that it will become an aid for predicting the ICL vault and subsequently selecting the proper ICL size in daily practice.

Clinical outcomes of simultaneous phototherapeutic keratectomy and photoastigmatic keratectomy

This study was aimed to assess the outcomes of simultaneous phototherapeutic keratectomy (PTK) and photoastigmatic keratectomy (PAK), with special attention to astigmatic correction. We comprised 70 eyes of 70 patients who underwent simultaneous PTK and PAK in patients having granular corneal dystrophy and band keratopathy with refractive astigmatism of 1 diopter (D) or more. Preoperatively and 6 months postoperatively, we assessed corrected uncorrected distance visual acuity (UDVA), distance visual acuity (CDVA), manifest spherical equivalent, refractive astigmatism, corneal astigmatism, and higher-order aberrations (HOAs). LogMAR CDVA significantly improved, from 0.27 ± 0.27 preoperatively, to 0.13 ± 0.21 postoperatively (Paired t test, p < 0.001). LogMAR UDVA also significantly improved, from 0.70 ± 0.32 preoperatively, to 0.57 ± 0.41 postoperatively (p = 0.043). Refractive astigmatism significantly decreased, from 2.12 ± 0.95 D preoperatively, to 0.89 ± 0.81 D postoperatively (p < 0.001). Corneal astigmatism also significantly decreased, from 2.17 ± 0.90 D preoperatively, to 1.08 ± 0.71 D postoperatively (p < 0.001). Corneal HOAs did not significantly change, from 0.54 ± 0.30 µm preoperatively, to 0.48 ± 0.20 µm postoperatively (p = 0.140). No significant complications occurred in any eye. Simultaneous PTK and PAK treatment is effective not only for improving visual acuity, but also for reducing astigmatism.

Characterization of the position of the extraocular muscles and orbit in acquired esotropia both at distance and near using orbital magnetic resonance imaging

PURPOSE

Age-related distance esotropia (ARDE) involves acquired esotropia at distance and phoria at near. However, distance-independent esotropia (DIE) exists esotropia both at distance and near. Thus, we examined the orbital magnetic resonance imaging (MRI) findings for DIE to assess differences in its characteristics.

METHODS

This study was a retrospective case-control study. We evaluated the efficacy of the standard coronal MRI in patients with acquired esotropia and control patients with optic neuritis. Cases with strabismus in the control group were excluded. DIE was defined as having esotropia both at distance and near, and an angle of more than 10 prism diopters at near. The condition of the lateral rectus-superior rectus band, position of rectus muscles, and the volume ratio of the globe to the whole orbit (G/WO) were examined.

RESULTS

The DIE group consisted of 12 eyes of 6 patients (77.3±7.7 years); ARDE group, 38 eyes of 19 patients (73.1±6.8 years); and control group, 34 eyes of 17 patients (70.9±4.3 years). The ratio of abnormality of the lateral rectus-superior rectus bands was higher in the DIE and ARDE groups than in the control group (p<0.01). The vertical angle of the lateral rectus deviated downwards in the control (-7.5±5.1°), ARDE (-12.2±9.1°), and DIE groups (-18.8±5.7°) (p<0.05). The tilting angle of the lateral rectus was tilted temporally in the control (-12.2±9.1°), ARDE (-20.0±8.6°) and DIE groups (-28.6±5.4°) (p<0.01). G/WO was higher in the DIE (0.28±0.01) and ARDE groups (0.27±0.02) compared to the control (0.25±0.03) group (p<0.01).

CONCLUSION

In comparison with the ARDE and control groups, the DIE group presented with abnormalities of the lateral rectus-superior rectus band, malposition of the lateral rectus, and differences in the G/WO. The DIE group showed a more severe form of ARDE.

Ocular and Systemic Factors Affecting Laser Speckle Flowgraphy Measurements in the Optic Nerve Head

Purpose

To investigate the ocular and systemic factors related to glaucoma and to be adjusted for interindividual comparison of ocular blood flow measurement results by laser speckle flowgraphy (LSFG) obtained from the optic nerve head (ONH) in normal Japanese individuals.

Methods

A multicenter, prospective cross-sectional study was conducted. The ONH tissue-area and vessel-area mean blur rate (MT and MV) were evaluated using LSFG and ONH structural parameters using planimetric methods. Multivariate linear mixed-effects modeled regression analysis was used to identify the contributing factors to the MT and MV. The explanatory variables were age; gender; smoking history; body mass index; mean arterial pressure (MAP); heart rate; intraocular pressure; axial length (AL); disc, rim, cup, and β-peripapillary atrophy (β-PPA) areas; and central retinal artery and vein equivalents.

Results

In total, 195 eyes of 126 healthy individuals with an average age of 48.1 years were included. Multivariate analysis showed that MAP and disc area had a negative (P < 0.001) correlation, whereas β-PPA area had a positive correlation with MT (P = 0.010). Age and AL had a negative correlation (P = 0.001 and P = 0.011, respectively), whereas cup area had a positive correlation (P = 0.012) with MV.

Conclusions

Interindividual comparison of MT or MV must be adjusted for both systemic factors (blood pressure or age) and local ocular factors (AL and disc, cup, or β-PPA area).

Translational Relevance

Our results provided reference data on the LSFG measurement and are important in comparing ocular blood flow between individuals using LSFG.

Comparing the usefulness of a new algorithm to measure visual field using the variational Bayes linear regression in glaucoma patients, in comparison to the Swedish interactive thresholding algorithm

Background/aims

We previously reported that the visual field (VF) prediction model using the variational Bayes linear regression (VBLR) is useful for accurately predicting VF progression in glaucoma (Invest Ophthalmol Vis Sci. 2014, 2018). We constructed a VF measurement algorithm using VBLR, and the purpose of this study was to investigate its usefulness.

Method

122 eyes of 73 patients with open-angle glaucoma were included in the current study. VF measurement was performed using the currently proposed VBLR programme with AP-7700 perimetry (KOWA). VF measurements were also conducted using the Swedish interactive thresholding algorithm (SITA) standard programme with Humphrey field analyser. VF measurements were performed using the 24–2 test grid. Visual sensitivities, test–retest reproducibility and measurement duration were compared between the two algorithms.

Result

Mean mean deviation (MD) values with SITA standard were −7.9 and −8.7 dB (first and second measurements), whereas those with VBLR-VF were −8.2 and −8.0 dB, respectively. There were no significant differences across these values. The correlation coefficient of MD values between the 2 algorithms was 0.97 or 0.98. Test–retest reproducibility did not differ between the two algorithms. Mean measurement duration with SITA standard was 6 min and 02 s or 6 min and 00 s (first or second measurement), whereas a significantly shorter duration was associated with VBLR-VF (5 min and 23 s or 5 min and 30 s).

Conclusion

VBLR-VF reduced test duration while maintaining the same accuracy as the SITA-standard.

Comparison of Phakic Intraocular Lens Vault Using Conventional Nomogram and Prediction Formulas

This study aimed to compare the achieved vault using a manufacturer's nomogram and the predicted vault using the currently available prediction formulas after posterior chamber phakic intraocular lens (EVO Implantable Collamer Lens; ICL, STAAR Surgical) implantation. We included 200 eyes of 100 consecutive patients (mean age ± standard deviation, 34.3 ± 7.8 years) undergoing ICL implantation with a central hole. Three months postoperatively, we quantitatively measured the actual vault, and we compared it with the predicted vault using anterior segment optical coherence tomography (CASIA 2, Tomey). The agreement rate of the recommended ICL size using the manufacturer's nomogram, the NK formula, and the KS formula was 50.0%. The achieved vault was 477.1 ± 263.7 µm, which was significantly smaller than the predicted vaults of 551.2 ± 335.1 and 606.4 ± 212.2 µm, using the NK and KS formulas, respectively (Dunnett test, p = 0.014, p < 0.001). The achieved vault was not significantly different from the predicted vault using the NK or KS formula (p = 0.386, p = 0.157) when selecting a 12.1 mm ICL size. It was not significantly different from the predicted vault using the NK formula (p = 0.962), but it was significantly smaller than that using the KS formula (p = 0.033) when selecting a 12.6 mm size. It was significantly smaller than the predicted vault using the NK and KS formulas (p < 0.001) when selecting 13.2 mm size. The total agreement rate of the recommended ICL size was approximately 50%. The predicted ICL vault tended to overestimate the actual ICL vault, especially when selecting a larger ICL size.

Effectiveness and limitations of minimally invasive glaucoma surgery targeting Schlemm's canal

Glaucoma surgery is performed to lower intraocular pressure (IOP); ideally, the IOP reduction is safely maintained for an extended period of time. Although trabeculectomy was considered the gold standard for glaucoma surgery for many years because of its effective IOP reduction, yet now it is considered unsafe because of serious complications. In recent years, minimally invasive glaucoma surgery (MIGS), which emphasizes safety and can be performed rapidly, has become widespread. Because MIGS does not involve conjunctival incisions, patients can undergo future trabeculectomy. If IOP reduction can be maintained safely, the number of anti-glaucoma drops can be reduced and visual function maintained, good outcomes for patients with glaucoma. Currently, many types of MIGS approved in Japan are reported to yield relatively good results, with targets of approximately 15-19 mmHg. However, the IOP-lowering effects of MIGS are limited. In procedures targeting Schlemm's canal, it is difficult to lower IOP beyond episcleral venous pressure. In some instances, a beneficial effect cannot be achieved if function is reduced beyond the collector channel. There are many unclear aspects regarding long-term outcomes following MIGS. Notably, investigation is ongoing to determine which patients are likely to benefit most from surgery. Based on previous reports, this review describes the characteristics and results of MIGS, approved in Japan, as well as underlying factors that affect the preoperative predictions and outcomes of the surgical procedure.

Morphological changes and potential mechanisms of intraocular pressure reduction after micropulse transscleral cyclophotocoagulation in rabbits

INTRODUCTION

Micropulse transscleral cyclophotocoagulation (MP-TSCPC) is a method for intraocular pressure (IOP) reduction in patients with glaucoma; however, the specific mechanisms underlying its ability to reduce IOP remain unclear. We therefore investigated the morphological changes and mechanisms of intraocular pressure (IOP) reduction after MP-TSCPC.

METHODS

The right eyes of four pigmented rabbits were treated with MP-TSCPC with power setting corresponding to those used in glaucoma patients (1 power: 2,000 mW; time: 160 sec; duty cycle: 31.3%). Power settings of 1, 1/8, 1/16, and 1/32 power were applied to the right eyes. The left eyes were used as controls. A light microscope and electron microscope were used to observe morphological findings after 1 week of MP-TSCPC. IOP and IOP reduction rate were compared before and after MP-TSCPC application on days 1, 3, and 5, and at 1 week.

RESULTS

In the pre-MP-TSCPC, IOP was 16.7 ± 0.6 mmHg. The IOP of rabbit treated with the 1 power was 3 mmHg, with an IOP reduction rate of 80%; however, the eyes developed phthisis bulbi. The IOP was 7.0 ± 0.0 mmHg 1 week after MP-TSCPC (IOP reduction rate: 59%) in rabbit treated with the 1/8 power. Reduction in IOP was observed, but there was significant tissue invasion to the ciliary body. The IOP was 10.3 ± 0.6 mmHg (IOP reduction rate: 40%) 1 week after MP-TSCPC in rabbit treated with the 1/16 power, which was more effective to reduce IOP than that with the 1/8 power. Tissue invasion to the ciliary body was negligible, nonpigmented epithelial cells of the pars plicata were damaged, basal infoldings were destroyed, and repair was accompanied by proliferating tissue. No IOP reduction or tissue change was observed in rabbit treated with the 1/32 power.

CONCLUSION

A potential mechanism for IOP reduction in pigmented rabbits is aqueous humor transport dysfunction due to damage to the nonpigmented epithelial cells of the pars plicata and destruction of basal infoldings. The power of MP-TSCPC was consistent with both morphological changes and IOP reduction.

Two cases of epithelial ingrowth after small incision lenticule extraction

Purpose

To report two cases of epithelial ingrowth after small incision lenticule extraction (SMILE) successfully treated without lifting the corneal cap.

Observations

A 34-year-old woman and a 37-year-old man who both had undergone bilateral SMILE procedures earlier at another institution, developed visually significant epithelial ingrowth into the interface pocket with an incisional tear. In both patients, the interface pocket was meticulously irrigated with a balanced salt solution to facilitate separation of the epithelial ingrowth from the interface. After that, the epithelial ingrowth was manually scraped using a blunt spatula, and removed from the pocket using 27-gauge vitreous forceps. 10–0 nylon sutures and soft bandage contact lenses were placed for 1 week. The best spectacle-corrected visual acuity improved to 20/16 or more 1-month postoperatively. No significant complications occurred.

Conclusions and importance

SMILE with incisional tear may cause epithelial ingrowth, resulting in significant visual disturbance. This can be successfully treated with meticulous surgical debridement of the corneal epithelium, even without lifting the corneal cap.

The usefulness of the Deep Learning method of variational autoencoder to reduce measurement noise in glaucomatous visual fields

The aim of the study was to investigate the usefulness of processing visual field (VF) using a variational autoencoder (VAE). The training data consisted of 82,433 VFs from 16,836 eyes. Testing dataset 1 consisted of test-retest VFs from 104 eyes with open angle glaucoma. Testing dataset 2 was series of 10 VFs from 638 eyes with open angle glaucoma. A VAE model to reconstruct VF was developed using the training dataset. VFs in the testing dataset 1 were then reconstructed using the trained VAE and the mean total deviation (mTD) was calculated (mTDVAE). In testing dataset 2, the mTD value of the tenth VF was predicted using shorter series of VFs. A similar calculation was carried out using a weighted linear regression where the weights were equal to the absolute difference between mTD and mTDVAE. In testing dataset 1, there was a significant relationship between the difference between mTD and mTDVAE from the first VF and the difference between mTD in the first and second VFs. In testing dataset 2, mean squared prediction errors with the weighted mTD trend analysis were significantly smaller than those form the unweighted mTD trend analysis.

Standard coronal orbital magnetic resonance imaging is an effective technique for diagnosing sagging eye syndrome

PURPOSE

The aim of this study was to determine the importance and efficacy of the standard coronal magnetic resonance imaging (MRI) analysis method for the correct clinical diagnosis of the sagging eye syndrome.

METHODS

This retrospective study evaluated the standard coronal MRI efficacy by comparing the positions of the orbital pulleys and extraocular muscles in patients with sagging eye syndrome as well as controls. The participants included 50 patients with sagging eye syndrome (aged 73.3 ± 6.7 years) and 17 age-matched control patients (aged 70.9 ± 4.3 years) that presented optic neuritis. The participants were classified into groups of age-related distance esotropia and cyclo-vertical strabismus. Lateral rectus-superior rectus band condition, lateral rectus vertical angle, lateral rectus tilting angle, and superior rectus-lateral rectus displacement angle were examined.

RESULTS

The lateral rectus-superior rectus band was more frequently disordered in the two groups than that in the control. The lateral rectus vertical and tilt angle examinations exhibited a significant difference in the age-related distance esotropia [(- 13.3 ± 10.9°, p < 0.05) and (- 24.1 ± 9.5°, p < 0.01)] and cyclo-vertical strabismus [(- 11.9 ± 6.9°, p < 0.05) and (- 20.8 ± 9.3°, p < 0.01)] groups compared with those in the control group [(- 7.5 ± 5.1°) and (- 12.2 ± 9.1°)]. The superior rectus-lateral rectus displacement angle did not present a significant difference between the patients and control groups.

CONCLUSIONS

Patients with sagging eye syndrome exhibited disordered orbital pulley and extraocular muscle malposition, as determined by standard coronal magnetic resonance imaging, indicating the effectiveness of the procedure for diagnosing sagging eye syndrome.

Visual performance and patient satisfaction of multifocal contact lenses in eyes undergoing monofocal intraocular Lens implantation

PURPOSE

To assess visual performance and patient satisfaction of multifocal contact lenses in eyes having monofocal intraocular lens (IOL) implantation.

METHODS

We prospectively assessed uncorrected visual acuity at all distances (0.3, 0.4, 0.5, 0.7, 1, and 5 m), higher-order aberrations (HOAs), objective scattering index (OSI), contrast sensitivity, and patient satisfaction, before and during multifocal contact lenses wear in IOL-implanted eyes.

RESULTS

Visual acuity at 0.3, 0.4, 0.5, 0.7, 1, and 5 m during wearing multifocal contact lenses was 0.21 ± 0.08, 0.11 ± 0.06, 0.01 ± 0.08, -0.02 ± 0.10, -0.02 ± 0.08, and -0.01 ± 0.07, respectively. We found a significant improvement at near to intermediate distances (30, 40, and 50 cm), but no significant change at intermediate to far distances (70 cm, 1 m, and 5 m). Log contrast sensitivity significantly decreased at 6 and 12 cycles/degrees, but did not significantly change at 1.5, 3, and 18 cycles/degrees. Third-order aberrations significantly increased after CL treatment, but fourth-order aberrations or total higher-order aberrations did not significantly change during CL treatment. The OSI and log(s) did not significantly change during CL treatment. The patient satisfaction score for overall vision significantly improved during CL treatment.

CONCLUSIONS

Multifocal contact lenses significantly improved visual acuity at near to intermediate distances, and subsequent patient satisfaction, even though contrast sensitivity function slightly decreased, suggesting its viability of presbyopic correction in monofocal IOL-implanted eyes.

Effect of corneal cross-linking on endothelial cell density and morphology in the peripheral cornea

BACKGROUND

To compare the endothelial cell density and morphology in the peripheral cornea before and after corneal cross-linking (CXL).

METHODS

This study evaluated thirty-one eyes of 31 patients who were treated with standard CXL for progressive keratoconus. Preoperatively and 6 months postoperatively, we compared the corneal endothelial cell density (ECD), the coefficient of variation in cell size (CV), and the percentage of hexagonal cells (HEX), in the peripheral regions of the cornea, using a non-contact specular microscope (EM-3000, Tomey).

RESULTS

All keratoconic eyes in this series were measurable in the peripheral regions. No significant differences were found in the peripheral ECD preoperatively and 6 months postoperatively at each point (Wilcoxon signed-rank test, superior, p = 0.16, nasal superior, p = 0.12, temporal superior, p = 0.17, inferior, p = 0.37, nasal inferior, p = 0.28, temporal inferior, p = 0.17). The mean percentage of the ECD loss was 1.3, 1.3, 1.0, 1.4, 0.7, and 1.4%, respectively. No significant differences in the peripheral CV or HEX were found preoperatively and 6 months postoperatively at each point.

CONCLUSIONS

Standard CXL does not cause significant changes in endothelial cell density, polymegethism, or polymorphism, in the peripheral regions of the cornea. It is suggested that CXL is a minimally invasive surgical approach for progressive keratoconus, even in terms of peripheral endothelial cells.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trial Registry (000031162).

Usefulness of data augmentation for visual field trend analyses in patients with glaucoma

AIM

To investigate the usefulness of data augmentation in visual field (VF) trend analyses in patients with glaucoma.

METHOD

This study included 6380 VFs from 638 eyes of 417 patients with open-angle glaucoma. Various affine transformations were applied to augment the VF data: (1) rotation, (2) scaling, (3) vertical and horizontal shift and (4) a combination of these different transformations. Using pointwise linear regression (PLR), the total deviation (TD) values of a patient's 10th VF were predicted using TD values from shorter VF series (from first to third VFs (VF1-3) to first to ninth VFs (VF1-9)) with and without VF data augmentation, and the root mean squared error (RMSE) was calculated.

RESULTS

With PLR, mean RMSE without VF augmentation averaged from 3.95 (VF1-3) to 19.01 (VF1-9) dB. The RMSE was significantly improved by applying the different transformations: (1) rotation (from VF1-3 to VF1-7), (2) scaling (from VF1-3 to VF1-6), (3) vertical and horizontal shifts (from VF1-3 to VF1-4) and (iv) a combination of these (from VF1-3 to VF1-7). Progression rates in VF1-10 had better agreement with those in shorter VF series when a combination of affine transformation was applied. The differences in rates were between 1.9 (VF1-3) and 0.39 (VF1-9) dB if augmentation was used, which was significantly smaller than that observed when augmentation was not applied (from 2.6 with VF1-3 to 0.26 dB with VF1-9).

CONCLUSION

It is useful to apply VF data augmentation techniques when predicting future VF progression in glaucoma using PLR, especially with short VF series.

Comparison of Humphrey Field Analyzer and imo visual field test results in patients with glaucoma and pseudo-fixation loss

The aim of this cross-sectional study was to evaluate the results of a visual field (VF) test for patients with glaucoma and pseudo-fixation loss. These patients exhibit fixation loss (FL) rates >20% with the Humphrey Field Analyzer (HFA); however, actual fixation stabilizes when a head-mounted perimeter (imo) is used. This device is able to adjust the stimulus presentation point by tracking eye movements. We subjected 54 eyes of 54 patients with glaucoma and pseudo-FL to the HFA 30–2 or 24–2 Swedish Interactive Threshold Algorithm -Standard protocol. All patients also underwent the imo 30–2 or 24–2 Ambient Interactive Zipper Estimated Sequential Testing protocol after HFA measurement. We compared HFA and imo reliability indices [including false-positive (FP) responses, false-negative (FN) responses, and FL rate], global indices [including mean deviation (MD), visual field index (VFI), and pattern standard deviation (PSD)], and retinal sensitivity for each test point. There were no significant differences in MD, VFI, and PSD between HFA and imo, and these measures were strongly correlated (r > 0.96, p < 0.01). There were no significant differences in FP and FN between both devices, while FL measured with HFA (27.5%) was significantly reduced when measured with imo (13.2%) (p < 0.01). There was no correlation in FL and FN between both devices, and a weak correlation for FP (r = 0.29, p = 0.04). At each test point, retinal sensitivity averaged 1.7 dB higher with HFA, compared with imo (p < 0.01). There was no significant variability in global indices in patients with pseudo-FL. The FP response rate might have influenced measures of FL in patients with glaucoma and pseudo-FL.

Predictability of intraocular lens power calculation in eyes after phototherapeutic keratectomy

PURPOSE

To compare the predictability of intraocular lens (IOL) power calculation using several corneal power measurements in eyes that underwent phototherapeutic keratectomy (PTK).

STUDY DESIGN

Retrospective case series.

METHODS

We reviewed the clinical charts of 42 eyes of 25 consecutive patients who underwent cataract surgery after PTK for granular corneal dystrophy or band keratopathy. IOL power calculations were performed using the SRK/T formula with four corneal power measurements [automated keratometry (AK) measured with a partial coherence interferometer, simulated keratometry (Sim K), true net power (TNP), and total corneal refractive power (TCRP) measured with a rotating Scheimpflug camera]; we determined the prediction error, absolute error, and percentage within ± 1.0 D of the targeted refraction, 1 month postoperatively.

RESULTS

The prediction error in the TCRP group was significantly better than those in the AK, Sim K, and TNP groups. The absolute error was also significantly better than those in the AK and Sim K groups, but not significantly different from that in the TNP group. The percentages of within ± 0.5 and 1.0 D in the TCRP group were significantly higher than those in the AK and Sim K groups, but not significantly different from that in the TNP group.

CONCLUSIONS

The TCRP provides the highest predictability of IOL power calculation in post-PTK eyes. This result suggests that the use of the TCRP, rather than of conventional anterior keratometry, may be clinically helpful for improving the refractive accuracy of post-PTK eyes.

Comparison of angle-to-angle distance using three devices in normal eyes

PURPOSE

To compare the angle-to-angle (ATA) distance, and the repeatability and the reproducibility of these measurements among the three devices.

METHODS

We performed the ATA measurements in 26 healthy subjects using anterior segment optical coherence tomography (CASIA2, Tomey, Japan), the Scheimpflug camera (Pentacam HR, Oculus, Wetzlar, Germany), and the combined Placido-ring corneal topography and Scheimpflug camera (TMS-5, Tomey). We also compared the repeatability and the reproducibility of the ATA measurements among these three devices.

RESULTS

The ATA in the CASIA2 group was significantly larger than that in the Pentacam group (Bonferroni test, p = 0.002), or that in the TMS-5 group (p < 0.001). The coefficient variation of the first and second ATA measurements for a single examiner was 0.44% in the CASIA2 group, followed by 0.84% in the TMS-5 group, and 1.92% in the Pentacam group. The coefficient variation of the ATA measurements for two examiners was 0.61% in the CASIA2 group, followed by 0.97% in the TMS-5 group, and 1.84% in the Pentacam group.

CONCLUSIONS

The ATA distance measured with the CASIA2 was ~0.40 and 0.56 mm larger than that with the Pentacam and the TMS-5, respectively. The CASIA2 provided the highest repeatability and reproducibility of the ATA measurements, followed by the TMS-5, and the Pentacam. These three instruments cannot be used interchangeably in terms of ATA measurements.

Keratoconus detection using deep learning of colour-coded maps with anterior segment optical coherence tomography: a diagnostic accuracy study

OBJECTIVE

To evaluate the diagnostic accuracy of keratoconus using deep learning of the colour-coded maps measured with the swept-source anterior segment optical coherence tomography (AS-OCT).

DESIGN

A diagnostic accuracy study.

SETTING

A single-centre study.

PARTICIPANTS

A total of 304 keratoconic eyes (grade 1 (108 eyes), 2 (75 eyes), 3 (42 eyes) and 4 (79 eyes)) according to the Amsler-Krumeich classification, and 239 age-matched healthy eyes.

MAIN OUTCOME MEASURES

The diagnostic accuracy of keratoconus using deep learning of six colour-coded maps (anterior elevation, anterior curvature, posterior elevation, posterior curvature, total refractive power and pachymetry map).

RESULTS

Deep learning of the arithmetical mean output data of these six maps showed an accuracy of 0.991 in discriminating between normal and keratoconic eyes. For single map analysis, posterior elevation map (0.993) showed the highest accuracy, followed by posterior curvature map (0.991), anterior elevation map (0.983), corneal pachymetry map (0.982), total refractive power map (0.978) and anterior curvature map (0.976), in discriminating between normal and keratoconic eyes. This deep learning also showed an accuracy of 0.874 in classifying the stage of the disease. Posterior curvature map (0.869) showed the highest accuracy, followed by corneal pachymetry map (0.845), anterior curvature map (0.836), total refractive power map (0.836), posterior elevation map (0.829) and anterior elevation map (0.820), in classifying the stage.

CONCLUSIONS

Deep learning using the colour-coded maps obtained by the AS-OCT effectively discriminates keratoconus from normal corneas, and furthermore classifies the grade of the disease. It is suggested that this will become an aid for improving the diagnostic accuracy of keratoconus in daily practice.

CLINICAL TRIAL REGISTRATION NUMBER

000034587.

<p>Challenges to detect glaucomatous visual field loss with pupil perimetry</p>

We evaluated the pattern deviation of pupil fields to differentiate a glaucomatous damage using the head-mounted perimeter “imo”. Thirty-four eyes of 26 glaucoma patients (mean age, 55.1 years) were examined. The pattern deviation (85th percentile) of pupil fields was calculated from the difference between age-matched normal and abnormal percentage pupil constriction. Consequently, glaucomatous damages were remarkably distinguished from the normal pupil fields using the pattern deviation of the imo.

Validating the efficacy of the binomial pointwise linear regression method to detect glaucoma progression with multicentral database

BACKGROUND/AIM

We previously reported the benefit of applying binomial pointwise linear regression (PLR: binomial PLR) to detect 10-2 glaucomatous visual field (VF) progression. The purpose of the current study was to validate the usefulness of the binomial PLR to detect glaucomatous VF progression in the central 24°.

METHODS

Series of 15 VFs (Humphrey Field Analyzer 24-2 SITA-standard) from 341 eyes of 233 patients, obtained over 7.9±2.1 years (mean±SD), were investigated. PLR was performed by regressing the total deviation of all test points. VF progression was determined from the VF test points analyses using the binomial test (one side, p<0.025). The time needed to detect VF progression was compared across the binomial PLR, permutation analysis of PLR (PoPLR) and mean total deviation (mTD) trend analysis.

RESULTS

The binomial PLR was comparable with PoPLR and mTD trend analyses in the positive predictive value (0.18-0.87), the negative predictive value (0.89-0.95) and the false positive rate (0.057-0.35) to evaluate glaucomatous VF progression. The time to classify progression with binomial PLR (5.8±2.8 years) was significantly shorter than those with mTD trend analysis (6.7±2.8 years) and PoPLR (6.6±2.7 years).

CONCLUSIONS

The binomial PLR method, which detected glaucomatous VF progression in the central 24° significantly earlier than PoPLR and mTD trend analyses, shows promise for improving our ability to detect visual field progression for clinical management of glaucoma and in clinical trials of new glaucoma therapies.

Effect of the administration period of perioperative topical levofloxacin on normal conjunctival bacterial flora

PURPOSE

To assess the long-term and short-term effects of post-cataract surgery antibiotic therapy on the drug-resistance profile of normal conjunctival bacterial flora.

SETTING

Miyata Eye Hospital, Miyazaki, Japan.

DESIGN

Randomized prospective clinical trial.

METHODS

Patients aged 20 years or older who had cataract surgery between May and September 2015 were given levofloxacin 1.5% ophthalmic solution for 3 days preoperatively. The patients were randomly assigned to a 1-week postoperative group or a 1-month postoperative group according to postoperative administration duration. Conjunctival sacs were scraped for bacterial culturing before administration, 1 week postoperatively, at the completion of administration, and 1, 3, and 6 months after administration completion. The bacterial culture growth and minimum inhibitory concentrations (MICs) of levofloxacin against recovered strains of Staphylococcus epidermidis were assessed.

RESULTS

The study enrolled 104 patients. The MICs of levofloxacin against S epidermidis increased during levofloxacin administration compared with before administration in both groups and then declined after administration completion. However, by 3 months, the MICs in the 1-month group were approximately twice those in the 1-week group. Antibiotic susceptibility before administration, at completion of administration, and at 3 months was 73.6%, 20.2%, and 38.5%, respectively, in the 1-week group and 63.0%, 0.0%, and 19.3%, respectively, in the 1-month group. The results indicate that from completion of administration to 3 months, the susceptible strains were approximately 20% lower in the 1-month postoperative group than in the 1-week postoperative group.

CONCLUSION

Administration duration of perioperative levofloxacin 1.5% influenced the MICs and susceptibility of S epidermidis isolated from the conjunctival sac.

Visual Performance in Eyes Undergoing Femtosecond Laser-Assisted Keratoplasty for Advanced Keratoconus

This study was aimed to compare visual performance in eyes having femtosecond laser-assisted keratoplasty (FLAK) for grade 4 keratoconus and keratoconic eyes according to the Amsler-Krumeich classification. We comprised 15 eyes of 15 patients undergoing FLAK for grade 4 keratoconus and 69 of 69 keratoconic patients (grade 1; 26 eyes, 2; 17 eyes, 3; 10 eyes, and 4; 16 eyes), and compared best spectacle-corrected visual acuity (BSCVA), corneal astigmatism (CA), corneal densitometry (CD), and corneal higher-order aberrations (CHOAs) using the Scheimpflug rotating camera. BSCVA in the post-FLAK group was significantly better than that in grade 3 or 4 group, but not than that in grade 1 or 2 group. CA was significantly lower than that in grade 3 or 4 group, but not than that in grade 1 or 2 group. CD was significantly higher than that in grade 1, 2, and 3 group, and significantly lower than that in grade 4 group. CHOAs were significantly lower than that in grade 3 or 4 group, but not than that in grade 1 or 2 group. FLAK showed significantly better BSCVA, and less CA and CHOAs, than grade 3 or 4 keratoconus, and showed less CD than grade 4 keratoconus.