PURPOSE: To investigate the effects of Anti-TNF-alpha (infliximab, Remicade(R), Shering-Plough) on refractory uveitis. METHODS: A retrospective observational survey was conducted on 12 eyes of 10 patients with refractory uveitis. These patients had no response to immunosuppresants or systemic steroid therapy and were intolerable due to drug toxicity. After an intravenous injection of Anti-TNF-alpha, best corrected visulal acuity was measured. Improvement in inflammation was then observed at the first, third and last month of follow-up. RESULTS: Patients were observed for a mean period of 15 months. They received anti-TNF-alpha intravenously, ranging from one to eleven infusions. After infusion with Anti-TNF-alpha, remission of intraocular inflammation was evident in all patients within 9.7 days. Best corrected visual acuity also improved at the first, third, and last month of follow-up. Two patients were infected by tuberculosis and mumps respectively. CONCLUSIONS: There was an effect on refractory uveitis with anti-TNF-alpha therapy. Many participants may also require further evaluation after treatment.
Drug-Related Side Effects and Adverse Reactions ; Follow-Up Studies ; Humans ; Inflammation ; Injections, Intravenous ; Mumps ; Retrospective Studies ; Tuberculosis ; Uveitis* ; Visual Acuity

PURPOSE: To evaluate the effect of strabismus surgery on proptosis in thyroid-related orbitopathy METHODS: The medical records of 22 consecutive patients (38 eyes) undergoing strabismus surgery were reviewed. Data pertaining to number of muscles operated, the length of muscle recession, prior orbital decompression, and exophthalmometry (by either Hertel or Naugle devices) were evaluated. RESULTS: Thirty-eight eyes in 22 patients with thyroid-related orbitopathy were studied before and after the muscle surgery. The mean change in exophthalmometry for all eyes was an increase of 0.6 mm (p<0.01). Eyes with prior decompression averaged a 0.9 mm increase following strabismus surgery (p<0.01); those without decompression averaged a 0.2 mm decrease, although not statistically significant. For eyes with multiple muscles operated on a given eye averaged 1.2 mm increase; in those with one muscle operated the average increase was 0.2 mm. In cases where the inferior rectus muscle was operated on, the average increase was 0.9 mm. When the total length of muscle recession was less than or equal to 5 mm, the mean exophthalmometric change was a increase of 0.3 mm. If more than 5 mm, the mean was an increase of 0.8 mm. CONCLUSIONS: Strabismus surgery on patients with thyroid-related orbitopathy can worsen proptosis, especially those with prior decompression. When planning for orbital decompression, the surgeon should consider this effect. Patients should be made aware of possible changes to their appearance.
Decompression ; Exophthalmos* ; Humans ; Medical Records ; Muscles ; Orbit ; Strabismus

PURPOSE: To compare the clinical visual results and complications of laser-assisted subepithelial keratectomy (LASEK) and epipolis laser in situ keratomileusis (Epi-LASIK). METHODS: A retrospective analysis of a case series of eyes treated with LASEK or Epi-LASIK with a follow-up of six months was performed. Twenty-two eyes were treated with LASEK, and 20 eyes were treated using Epi-LASIK. The main outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and manifest refraction at one week, one month, three months, and six months after refractive surgery, and the presence of any complications. RESULTS: There was no significant difference of UCVA and mean postoperative spherical equivalent (SE) between the eyes treated with LASEK or Epi-LASIK at one week, three months, and six months. However at one month there was significant difference of UCVA. Additionally, in a comparison between moderate and serve myopia, there was no significant difference of UCVA and mean postoperative spherical equivalent (SE) between groups treated with LASEK or Epi-LASIK at one week, one month, three months, and six months. Seven eyes treated with LASEK and two eyes treated with Epi-LASIK showed persistent epithelial erosion less than one week. Two eyes treated with LASEK exhibited newly-developed corneal opacity, which persisted-through the last visit. CONCLUSIONS: Epi-LASIK showed clinical visual results and complications comparable to LASEK and showed better epithelial healing.
Corneal Opacity ; Follow-Up Studies ; Keratectomy, Subepithelial, Laser-Assisted ; Keratomileusis, Laser In Situ ; Myopia* ; Outcome Assessment (Health Care) ; Refractive Surgical Procedures ; Retrospective Studies ; Visual Acuity

PURPOSE: To report wavefront analysis of successful treatment of monocular triplopia after cataract extraction. CASE SUMMARY: (Case 1) A 59-year-old man visited our clinic for a monocular triplopia in his left eye of five years in duration. The best spectacle-corrected visual acuity (BSCVA) was 1.0 in the left eye, and the patient had a mild cortical cataract. The ocular spherical aberration (0.126 micrometer for the 4-mm pupil, 0.351 micrometer for the 6-mm pupil) measured by a Hartmann-Shack aberrometer increased preoperatively, while the corneal spherical aberration was normal. After cataract surgery, the monocular triplopia disappeared, and the ocular spherical aberration decreased. (Case 2) A 38-year-old man visited our clinic for a monocular triplopia in his left eye of a two-year duration. The best spectacle-corrected visual acuity (BSCVA) was 0.3 in the left eye, and the patient had a mild nuclear cataract. The ocular spherical aberration (-0.356 micrometer, -1.343 micrometer) and trefoil aberration (0.199 micrometer, 0.252 micrometer) increased preoperatively, while the corneal spherical and trefoil aberrations were normal. After cataract surgery, the monocular triplopia disappeared and the ocular spherical and trefoil aberrations decreased.
Adult ; Cataract ; Cataract Extraction ; Eye ; Humans ; Lotus ; Middle Aged ; Pupil ; Visual Acuity

PURPOSE: To compare ocular higher order aberrations measured by two different aberrometers in a sample of normal eyes. METHODS: We included 41 normal eyes of Koreans in this study. Ocular aberration data were obtained through three measurements per eye using Zywave and OPD-Scan devices. Spherical equivalent and higher order aberrations calculated in the central 6 mm zone and expressed as root mean square (RMS) values were analyzed. RESULTS: A comparison of measurements between the Zywave and OPD-Scan devices demonstrated no statistically significant differences in the RMS values of total higher order aberration (p=0.11), but significant differences were detected in the RMS values of total spherical aberration, total coma and total trefoil (p<0.01). CONCLUSIONS: The two different aberrometers that we tested are suitable for taking repeated measurements and are internally consistent, but not interchangeable.
Coma ; Eye ; Lotus

PURPOSE: To investigate the effect of intravitreal injection of triamcinolone acetonide (4 mg) on refractory uveitis with cystoid macular edema (CME). METHODS: A retrospective observation survey was conducted on 21 eyes of 15 patients with refractory uveitis that had no response to immunosuppresants or systemic steroid therapy. Seven eyes were injected with triamcinolone acetonide intravitreally only, and fourteen eyes were injected during pars plana vitrectomy. At 3 and 12 months after triamcinolone acetonide injection, best corrected visual acuity and thickness of macula were measured by OCT. RESULTS: The average pre-treatment best corrected visual acuity was 0.18+/-0.08, and the average macular thickness was 534+/-132 micrometer. At 3 months after injection, the results for the same parameters were 0.45+/-0.18, 345+/-125 micrometer respectively. At 12 months after injection, they were 0.30+/-0.09, 498+/-133 micrometer respectively. Thus, best corrected visual acuity had improved and macular thickness had decreased at 3 months post-injection for the groups with intravitreal injection of triamcinolone acetonide and intravitreal injection during pars plana vitrectomy. However, these changes in best corrected visual acuity and macular thickness were not observed 12 months after injection. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide had a temporary effect on refractory uveitis with cystoid macular edema (CME). However, a study that includes more participants will be necessary for conclusive evaluation.
Humans ; Intravitreal Injections* ; Macular Edema ; Retrospective Studies ; Triamcinolone Acetonide* ; Triamcinolone* ; Uveitis* ; Visual Acuity ; Vitrectomy

PURPOSE: To evaluate the clinical results of intrastromal ring segment (Keraring(R)) implantation using a femtosecond laser in patients with keratectasia. METHODS: Twenty eyes of 19 keratectatic patients (15 eyes of keratoconus and five eyes of post-LASIK keratectasia) who completed at least three months of postoperative follow-up were included in this study. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent, keratometric value, corneal astigmatism, corneal higher order aberrations (HOA) and specular microscopy were determined or performed before and after surgery. In addition, intraoperative and postoperative adverse complications were recorded. RESULTS: UCVA improved in 13 out of 20 eyes (65%), and BSCVA improved in 16 out of 20 eyes (80%). At the postoperative examination there was no statistically significant reduction in the spherical equivalent with that observed at the examination before implantation. Conversely, there were statistically significant reductions in topographic mean K value and Sim K astigmatism, corneal total and coma-like HOA (p<0.05). On specular microscopy, there was no statistically significant difference between preoperative and postoperative endothelial cell density. There was one case of partial Descemet membrane detachment and one case of microperforation as a complication during surgery, which recovered over time without any treatment. CONCLUSION: Keraring(R) implantation appears to be an effective and safe procedure for improving visual acuity and stabilizing corneal refractive power in keratectactic patients.
Aniline Compounds ; Astigmatism ; Descemet Membrane ; Endothelial Cells ; Eye ; Follow-Up Studies ; Humans ; Keratoconus ; Microscopy ; Visual Acuity

PURPOSE: To evaluate the effect of conjunctival shield on pain alleviation during cataract surgery in conjunctivochalasis patients for conjunctiva drawn into speculum suction holes during cataract surgery. METHODS: Forty patients with conjunctivochalasis undergoing cataract surgery using un aspirating speculum were evaluated in the present study. A thin piece of surgical wipe (conjunctival shield) was inserted between the lid and bulbar conjunctiva to shield the conjunctiva from the suction hole and thereby prevent it from being sucked into the hole. Additionally, patients were asked to rank pain following speculum placement both before and after conjunctiva shield insertion by visual analogue scale. RESULTS: The pain scores were 2.50 +/- 0.78 points before conjunctival shield insertion, and 1.25 +/- 0.66 points after conjunctival shield insertion, which was a significant decrease (p = 0.01). In addition, the results showed a 70% reduction in pain following shield insertion. CONCLUSIONS: Conjunctivochalasis causes pain during cataract surgery when using an aspirating speculum. The conjunctival shield insertion is a safe and simple method for pain-free cataract surgery in conjunctivochalasis patients.
Cataract* ; Conjunctiva ; Humans ; Suction ; Surgical Instruments ; United Nations

PURPOSE: To describe femtosecond laser-assisted corneal biopsy and its use in assessing the causative organism in a case of fungal keratitis that occurred 8 months after penetrating keratoplasty. CASE SUMMARY: A 27-year-old man who had undergone penetrating keratoplasty 8 months prior showed atypical diffuse corneal haze and erosion. Diagnostic corneal biopsy using a femtosecond laser was performed because of repeated negative test results for an infectious organism and a lack of improvement, despite steroid and empirical antibiotic therapy. A corneal flap 200 micrometer in depth and 3 mm in diameter was obtained. The biopsy showed pseudohyphae, which led to a diagnosis of Candidal keratitis. No complications occurred during the procedure. CONCLUSIONS: Femtosecond laser-assisted corneal biopsy enabled identification of the infectious pathogen. This technique is easy, safe, and rapid, and it yields a biopsy specimen with a uniform depth and precise size. Femtosecond laser-assisted corneal biopsy can be used as an accurate diagnostic method in uncertain cases of corneal ulcers.
Adult ; Biopsy ; Humans ; Keratitis ; Keratoplasty, Penetrating

PURPOSE: To compare corneal pachymetry assessment using four measurement methods in normal and post-femtosecond laserassisted LASIK eyes. METHODS: Central corneal thickness was measured sequentially using Orbscan II, Pentacam, Galilei and ultrasonic pachymetry in 30 normal, non-surgical eyes (Group I), 30 eyes one to six months after femtosecond laser-assisted LASIK (Group II), and 30 eyes six months or longer after femtosecond laser-assisted LASIK (Group III). RESULTS: In Group I, corneal thickness measurements were similar for all four methods (P=0.202, one way ANOVA). In Groups II and III, corneal thickness measurements were significantly different (P=0.000, respectively, one way ANOVA). Compared to the Pentacam, Galilei and ultrasonic pachymetry, Orbscan significantly underestimated the corneal thicknesses in Groups II and III (P<0.005, respectively, one way ANOVA). CONCLUSIONS: Central corneal thicknesses of normal eyes were similar for all four measurements, therefore corneal thickness measurements before refractive surgery using all four measurements is suitable. However measurements obtained with the Orbscan II were thinner than those obtained with the Pentacam, Galilei or ultrasonic pachymetry in post femtosecond laserassisted LASIK eyes. Further studies are needed to determine which instrument is more accurate in measuring central corneal thickness before and after refractive surgery.
Corneal Pachymetry ; Eye ; Keratomileusis, Laser In Situ ; Refractive Surgical Procedures ; Ultrasonics