PURPOSE: To compare the efficacy, predictability, stability and safety of excimer laser photorefracive keratectomy(PRK) for mypia and photoastigmatic refractive keratectomy(PARK) for compound myopic astigmatism. METHODS: Two-hundred-three eyes(118 eyes <-7D spherical equivalent, 85 eyes> or =-7D spherical equivalent) received excimer laser correction for compound myopic astigmatism and 152 eyes(116 eyes <-7D, 36 eyes > or =-7D) for simple myopia. A VISX 20/20B VisionKeyTM excimer laser was used to perform either PARK or PRK. Visual acuity with and without correction, refraction, IOP, corneal haze, and topography were evaluated at 1, 3, 6, and 12 months postoperatively. All patients were followed up for more than 12 months. RESULTS: Postoperative refraction were generally stable after 3 months without significant early overcorrection. At 12 months, 110(94.8%) eyes that underwent PRK and 104(88.1%) eyes that underwent PARK achieved UCVA of 20/30 or better in the group who had lower than -7D correction. For eyes treated with -7D or more, these figures were 31(86.1%) eyes after PRK and 57(67.1%) eyes after PARK. The incidence of within 1D of plano refraction at 1 year follow-up were 97.4% after PRK and 93.2% after PARK in group who had lower than -7D correction. For eyes treated with -7D or more, there figures were 80.6% after PRK and 70.6% after PARK. CONCLUSIONS: Myopia with or without astigmatism was successfully treated in most of the eyes using PRK or PARK with VISX 20/20B VisionKeyTM excimer laser. The predictability and stability of the postoperative refraction during the first 12 months seem to be quite reliable. Futher improvement of excimer laser system and software should increase the clinical outcomes and safety of refractive procedures.
Astigmatism* ; Follow-Up Studies ; Humans ; Incidence ; Lasers, Excimer* ; Myopia* ; Photorefractive Keratectomy ; Visual Acuity

PURPOSE: To evaluate the effect of rotary epithelial scrubber and post-laser corneal chilling on clinical outcomes of excimer laser PRK (VISX 20/20B VisionKeyTM) METHODS: PRK with a rotary epithelial scrubber and post-laser chilled BSS irrigation was performed in 231 eyes of 141 patients (Group I: -4.33+/-0.98 D, July 1997~July 1999). Conventional PRK with mechanical epithelial removal was performed in 282 eyes of 181 patients (Group II: -4.33+/-0.99 D, September 1994~April 1997). A retrospective clinical data of two different PRK procedures was compared. RESULTS: Mean epithelial removal time was significantly short in group I (8.6+/-3.4 sec) than in group II (29.8+/-12.8 sec) (p<0.05). More rapid epithelial healing was achieved in group I (2.6+/-0.7 days) than in group II (2.8+/-0.7 days) (p<0.05). At 12 months, UCVA was 0.7 or better in 99.4% (162/163 eyes) of group I and 92.8% (77/88 eyes) of group II (p<0.05). At 12 months, 98.8% (161/163 eyes) in group I and 95.2% (79/83 eyes) in group II were within +/-1.0 D of emmetropia (p<0.05). After 2 years follow-up, there were no cases showing corneal haze worse than grade 1 in group I. CONCLUSIONS: Excimer laser PRK after precise removal of the epithelium with a rotary scrubber and post-laser corneal chilling provided more rapid epithelialization and visual recovery than conventional PRK. There was statistically significant improvement in clinical outcomes and occurrence of corneal haze in group I comparing with group II. We think that this excimer laser PRK technique be more ideal for the correction of mild to moderate myopia to avoid the serious flap complication of LASIK.
Emmetropia ; Epithelium ; Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ ; Lasers, Excimer* ; Myopia ; Photorefractive Keratectomy* ; Retrospective Studies

PURPOSE: To compare the clinical results, recurrence rates, and recurrence-related risk factors of permanent amniotic membrane transplantation (PAMT, group 1) and temporary amniotic membrane patch (TAMP, group 2) after excision of primary pterygium. METHODS: Recurrence grades were evaluated for 66 eyes (T1, T2, and T3; 0, 32, and 34 eyes, respectively) in group 1 and 73 eyes (T1, T2, and T3; 2, 42, and 29 eyes, respectively) in group 2. Surgical results were classified into surgical success (G0 or G1), conjunctival recurrence (G2), and corneal recurrence (G3). Recurrence rates were analyzed based on gender, age, Tan's preoperative grading system, horizontal and vertical length of the preoperative pterygium, the corneal involvement size of the preoperative pterygium, and epithelial healing time. RESULTS: In the postoperative grading, 3 eyes (4.5%) and 1 eye (1.5%) in group 1, and 4 eyes (5.5%) and 2 eyes (2.7%) in group 2 were graded as clinically recurrence-occurred G2 and G3, respectively. There was no statistically significant difference in recurrence-occurred G2 and G3 cases between the two groups (p = 0.62). No risk factors of clinically significant G2 and G3 recurrence were identified in either group by Cox proportional hazards survival regression analysis. CONCLUSIONS: The results of the present study suggest that PAMT tends to lower the recurrence rate compared to TAMP because the PAMT group had more T3 eyes than the TAMP group, although the two groups showed no statistically significant difference in clinically significant recurrence after pterygium excision.
Amnion ; Eye ; Pterygium ; Recurrence ; Risk Factors ; Transplants

PURPOSE: To evaluate the effect of rotary epithelial scrubber, cold BSS(R) irrigation, and bandage contact lens on the clinical outcome of excimer laser PRK. METHODS: This updated PRK was performed in 90 eyes (Group I: -4.54 +/- 0.91 D). Conventional PRK with mechanical epithelial removal using Beaver(R) blade and patch dressing was performed in 181 eyes (Group II: -4.30 +/- 0.97 D). Clinical outcome was compared between group I and group II retrospectively. RESULTS: Mean epithelial removal time was significantly shorter in group I (6.6 +/- 0.9 sec) than in group II (33.2 +/- 11.2 sec) (p<0.05). Mean epithelial healing time showed more rapid epithelial healing in group I (2.0 +/- 0.3 days) than in group II (3.0 +/- 1.0 days) (p<0.05). At 1 week and 24 months, UCVA of 0.7 or better was achieved in 91.1%, 97.8% in group I and in 71.8%, 88.2% in group II (p<0.05). At 6 and 24 months, spherical equivalent within 0.5 D of emmetropia was in 91.1%, 91.3% in group I and in 80.7%, 56.9% in group II (p<0.05). After 1 year follow-up, no eye in group I showed either corneal haze worse than grade 1 or loss of 2 or more lines of BSCVA. CONCLUSIONS: Updated PRK provided more rapid epithelialization than conventional PRK. And there was significant improvement in clinical outcome and safety in group I compared with group II. We suggested that updated PRK should be used for the correction of mild to moderate myopia.
Bandages* ; Emmetropia ; Follow-Up Studies ; Lasers, Excimer ; Myopia ; Retrospective Studies

PURPOSE: To evaluate the repeatability of non-invasive tear film break-up time and identify its relationships with dry eye parameters. METHODS: A total of 100 participants (50 with dry eye, and 50 in the control group) were enrolled prospectively. Non-invasive keratograph first (NIKf-BUT) and average (NIKav-BUT) break-up times were evaluated 2 times using Keratograph 4 (Oculus, Wetzler, Germany), and then tear film break-up time with fluorescein (FBUT) was measured. The correlation analyses were performed between non-invasive parameters (NIKf-BUT and NIKav-BUT) and FBUT. Intra-observer agreements of NIKf-BUT and NIKav-BUT were assessed using intraclass correlation coefficients (ICC). The receiver operating characteristic (ROC) curve technique was used to evaluate the non-invasive method in the diagnosis of dry eye. RESULTS: The correlation analyses revealed positive correlation between NIKav-BUT and FBUT in both groups (dry eye; r = 0.66, p < 0.001 and control group; r = 0.77, p < 0.001). The ICCs of NIKf-BUT and NIKav-BUT were 0.72 and 0.94 in the dry eye, respectively, and 0.70 and 0.91 in the control group. NIKav-BUT was not different from FBUT in either group. The areas under the ROC curves of NIKf-BUT and NIKav-BUT were 0.917 and 0.980, respectively. CONCLUSIONS: The high ICCs verified the repeatability of NIKf-BUT and NIKav-BUT. NIKav-BUT showed no difference from FBUT and positive correlation with FBUT. NIK-BUT showed high diagnostic power and can be considered a new parameter to evaluate dry eye syndrome.
Diagnosis ; Dry Eye Syndromes ; Fluorescein ; Methods ; Prospective Studies ; ROC Curve ; Tears*

PURPOSE: This study analyzed clinical characteristics of Staphylococcus aureus keratitis according to methicillin-resistance. METHODS: The authors performed a retrospective chart review of 46 isolates in 46 eyes with Staphylococcus aureus keratitis that were followed up for more than 2 months between January 1998 and December 2014. Comparative analyses of the epidemiology, predisposing factors, initial clinical manifestations, antibiotics susceptibility and clinical outcome between methicillin-resistant Staphylococcus aureus (MRSA) keratitis and methicillin-sensitive Staphylococcus aureus (MSSA) keratitis were performed. Risk factors of poor visual outcome were analyzed using logistic regression analysis. RESULTS: Among 46 eyes, MRSA was present in 15 eyes (33%) and MSSA in 31 eyes (67%). Male (61%) and older than 60 year-old group (48%) were common. Ocular surface disease/ocular surgery history and trauma were more common as a predisposing factor. Vancomycin was 100% sensitive to both the MRSA and MSSA groups. Antibiotics susceptibility to MRSA was significantly low in the oxacillin (0%), gentamicin (13.3%) and trimethoprim/sulfamethoxazole (53.3%) groups. Sensitivity to fluoroquinolone was 81.3% (MRSA 64.3% vs. MSSA 94.4%; p = 0.064). There were no differences in early corneal findings between the groups. The ratio of BCVA 0.5 or more was 24.4% initially and increased to 44.4% after treatment among all eyes (p = 0.046). Risk factors for poor visual outcomes included a BCVA less than 0.1 at initial evaluation (p = 0.033). CONCLUSIONS: Among eyes with Staphylococcus aureus keratitis, 33% were MRSA. The ratio of BCVA 0.5 or more increased after treatment among all eyes. There were no differences between MRSA and MSSA eyes in terms of epidemiology, predisposing factors, initial clinical manifestations or clinical outcome, except for antibiotic susceptibility. For positive patient outcomes, a treatment approach considering methicillin-resistance as well as various factors affecting clinical course is recommended.
Anti-Bacterial Agents ; Causality ; Epidemiology ; Gentamicins ; Humans ; Keratitis* ; Logistic Models ; Male ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Retrospective Studies ; Risk Factors ; Staphylococcus aureus* ; Staphylococcus* ; Vancomycin

PURPOSE: To investigate the clinical results, recurrence rates, and recurrence-related risk factors of temporary amniotic membrane patch (TAMP) after excision of primary pterygium. METHODS: Recurrence grade was evaluated for 73 eyes with a mean follow-up of 15.5 months (range 9 to 56 months). Surgical results were classified into surgical success (G0/G1), conjunctival recurrence (G2), and corneal recurrence (G3). Recurrence rates were analyzed based on gender, age, Tan's preoperative grading system, horizontal and vertical length of the preoperative pterygium, the corneal involvement size of the preoperative pterygium, planned or unplanned removal of amniotic membrane, and epithelial healing time. Using Kaplan-Meier survival analysis, the cumulative proportion of integrated G0/G1 was evaluated. RESULTS: In the postoperative grading, 58 (79.5%) and 9 (12.3%) eyes were graded as clinically recurrence-free G0 and G1, respectively; 4 (5.5%) and 2 (2.7%) eyes were graded as clinically recurrence-occurred G2 and G3, respectively. The cumulative proportion of integrated recurrence-free G0/G1 at 24 months after surgery was 0.83 +/- 0.08. T3 of Tan's preoperative grading system was identified as the only risk factor for recurrence above G1 through multivariate logistic regression analysis (p = 0.02). CONCLUSIONS: The recurrence rate of the present TAMP study showed better results in comparison with 9.1 to 56.1% of recurrence rates in other studies. The TAMP has advantages of surgical procedure with ease, low complications, and low recurrence rates. Therefore, after surgical excision of primary pterygium, the authors concluded the TAMP is highly recommended for good clinical outcomes and low recurrence rates.
Amnion ; Eye ; Follow-Up Studies ; Logistic Models ; Pterygium ; Recurrence ; Risk Factors

PURPOSE: To investigate the shifting trends of pathogenic organisms, antibiotic resistance, and clinical characteristics of patients with Gram-positive bacterial keratitis and to elucidate the prognostic factors. METHODS: We performed a retrospective chart review of 152 isolates in 146 eyes with Gram-positive bacterial keratitis between January 1998 and December 2012. The study was divided into 5 periods for analysis of the bacteriological profiles and in vitro antibiotic resistance. The epidemiological and clinical characteristics were compared according to bacterial isolates. Logistic regression analysis was performed to determine the risk factors. RESULTS: Gram-positive bacterial keratitis tended to decrease and significant change in the distribution of isolates was not observed. Commonly isolated organisms were S. epidermidis (48.7%), S. aureus (25.0%), and S. pneumoniae (7.2%) in order of frequency. The resistance to fluoroquinolone tended to increase (p = 0.104) and resistance to gentamicin was significantly decreased (p = 0.01). S. epidermidis had the shortest corneal epithelium healing time (p = 0.035) and the most favorable visual outcome after treatment (p = 0.035) compared with the other species. Risk factors for poor visual outcomes included a best corrected visual acuity less than 0.1 at initial evaluation and an epithelial healing time greater than 10 days. CONCLUSIONS: Gram-positive bacterial keratitis tended to decrease and S. epidermidis was the most common isolate. The clinical prognosis was most favorable in S. epidermidis. The BCVA less than 0.1 at initial evaluation was an important risk factor for poor visual outcome and surgical treatment in Gram-positive bacterial keratitis.
Drug Resistance, Microbial ; Epithelium, Corneal ; Gentamicins ; Humans ; Keratitis* ; Logistic Models ; Pneumonia ; Prognosis ; Retrospective Studies ; Risk Factors ; Staphylococcus aureus ; Staphylococcus epidermidis ; Visual Acuity

PURPOSE: In this study we investigated pathogenic organisms, antibiotic susceptibility, and clinical characteristics of patients with Gram-negative bacterial keratitis and elucidated risk factors for poor visual outcomes. METHODS: The authors performed a retrospective chart review of 161 eyes (169 isolates) with Gram-negative bacterial keratitis between January 1998 and December 2012 at Yeungnam University Hospital. The study was divided into 5 periods for analysis of the bacteriological profiles and in vitro antibiotic sensitivity. The epidemiological and clinical characteristics were compared according to 3 groups (Pseudomonas species, Enterobacter species, and Serratia marcescens). Additionally, logistic regression analysis was performed to determine the risk factors. RESULTS: The prevalence of Gram-negative organisms increased from 34.7 to 73.2% between the 1st and 5th periods (p < 0.001). Pseudomonas spp. was the most commonly isolated organism (55 eyes, 32.5%) over the total period, followed by Enterobacter spp. (41 eyes, 24.3%) and Serratia marcescens (33 eyes, 19.5%). The effective antibiotics against Gram-negative bacterial pathogens isolated from culture were cefepime (94.5%), levofloxacin (93.4%), ciprofloxacin (93.0%), and amikacin (92.3%). The incidence was higher in the elderly over 60 years of age and in early adulthood patients in their 20s and 30s. The frequent predisposing factors were contact lens wearing and corneal trauma. S. marcescens had the shortest corneal epithelium healing time (p = 0.012) and the most favorable visual outcome after treatment (p = 0.004) compared with the other species. Risk factors for poor visual outcomes included a best corrected visual acuity less than 0.1 at initial evaluation (p < 0.001) and central corneal lesion (p = 0.027). CONCLUSIONS: Gram-negative bacterial keratitis tended to increase and Pseudomonas spp. was the most common isolate. The clinical prognosis was most favorable in S. marcescens. Early diagnosis of Gram-negative bacterial keratitis and appropriate antibiotic selection including cefepime, quinolone, or amikacin are recommended.
Aged ; Amikacin ; Anti-Bacterial Agents ; Causality ; Ciprofloxacin ; Early Diagnosis ; Enterobacter ; Epithelium, Corneal ; Humans ; Incidence ; Keratitis* ; Levofloxacin ; Logistic Models ; Prevalence ; Prognosis ; Pseudomonas ; Retrospective Studies ; Risk Factors ; Serratia ; Serratia marcescens ; Visual Acuity

PURPOSE: To investigate the preoperative characteristics and postoperative change of the higher-order wavefront aberrations (HOAs) in myopic photorefractive keratectomy (PRK). METHODS: Standard PRK was performed in 39 eyes (spherical equivalent -4.71+/-1.56D) using the VISX(R) STAR S4(TM) excimer laser system. Wavefront analysis was performed preoperatively and 6 months postoperatively using the VISX(R) WaveScan(TM) aberrometer. Statistical analysis was performed to assess the preoperative characteristics of the HOAs and the PRK-induced aberrations. RESULTS: The preoperative root mean square (RMS) value of the total HOAs was 0.291 micrometer: coma 0.159 micrometer, trefoil 0.157 micrometer, spherical aberration 0.093 micrometer. Among the 3 HOAs, only the spherical aberration showed moderate magnitude negative correlation with the spherical equivalent (p=0.012) and sphere (p=0.005). The magnitude of all of the HOAs, except trefoil, were significantly increased at postoperative 6 months: total HOAs 183% (0.533 micrometer, p<0.001), spherical aberration 341% (0.317 micrometer, p<0.001), coma 185% (0.294 micrometer, p<0.001), trefoil 104% (0.163 micrometer, p=0.681). In the postoperative correlation analysis, only the PRK-induced spherical aberration showed the increase of magnitude with increasing preoperative spherical equivalent (p=0.036) and sphere (p=0.019). CONCLUSIONS: The HOAs, especially spherical aberration and coma, were increased after PRK. Among the 3 HOAs, the spherical aberration showed the greatest increase of magnitude and percent change; it also showed a positive correlation with increasing preoperative spherical equivalent and sphere. Further software improvements in the wavefront-guided surface ablations need to have a diminution of PRK-induced spherical aberration.
Coma ; Lasers, Excimer ; Lotus ; Photorefractive Keratectomy