PURPOSE: To study theeffect of micro incision (1.8 mm) and small incision (2.2 mm and 2.8 mm) coaxial phacoemulsification on surgically induced astigmatism (SIA) and high-order aberrations (HOA) of anterior and posterior corneal surface. METHODS: The present randomized clinical study included 32 eyes having a 1.8-mm, 38 eyes having a 2.2-mm, and 30 eyes having a 2.8-mm corneal incision. SIAs were measured at 1 and 3 months postoperatively. HOAs included coma, trefoil, and spherical aberration. The coma-root mean square (RMS) and trefoil-RMS were evaluated at 1 month after the cataract operation. RESULTS: Surgically induced astigmatisms were 0.41 +/- 0.30 diopter (D) in the 1.8-mm incision group, 0.47 +/- 0.21 D in 2.2-mm group and 0.71 +/- 0.50 D in the 2.8-mm group. The SIA of the 1.8-mm group was smaller than the other groups (p = 0.002). There was no statistically significant difference in coma, spherical aberration of the corneal anterior surface and trefoil, or spherical aberration of the posterior surface among the 3 groups at 1 month after surgery. CONCLUSIONS: Incision size contributes to postoperative corneal astigmatism. Phacoemulsification cataract surgery with less than 2.8-mm incision does not significantly influence the corneal aberrationsof anterior and posterior corneal surfaces.
Astigmatism ; Cataract ; Coma ; Eye ; Lotus ; Phacoemulsification

PURPOSE: To assess the efficacy of the Toric Implantable Collamer Lens (Toric ICL) to treat moderate to high myopic astigmatism. METHODS: Toric ICL was implanted in 77 eyes of 40 patients with myopia (spherical equivalent [SE] between 3.5 and 18.5 diopters [D]) and astigmatism between 1 and 6 D. The patients were followed up for at least 3 months. Uncorrected visual acuity (UCVA), refraction, best spectacle-corrected visual acuity (BSCVA), adverse events, and postoperative complications were evaluated. RESULTS: At 3months postoperatively, the proportion of eyes with 1.0 or better UCVA (56 eyes out of 77 eyes, 72.7%) was significantly greater than the proportion of eyes with preoperative 1.0 or better BSCVA (38 eyes out of 77 eyes, 49.4%). The mean manifest refractive cylinder dropped from 2.78D (+/-1.05) at baseline to 0.35D (+/-0.34) postoperatively, an 87.4% decrease in astigmatism. Mean manifest refraction SE (MRSE) improved from -9.93D (+/-2.66) preoperatively to 0.15D (+/-0.33) postoperatively. A total of 96.1% of eyes were predicted accurately to within +/-0.75D of predicted MRSE. Mean improvement in BSCVA was 0.79lines; there were no eyes that lost two lines of BSCVA after 3 months postoperatively. CONCLUSIONS: The results support the efficacy and predictability of Toric ICL implantation to treat moderate to high myopic astigmatism.
Astigmatism ; Eye ; Humans ; Myopia ; Postoperative Complications ; Visual Acuity

PURPOSE: To assess the efficacy and safety of selective laser trabeculoplasty (SLT) as initial and adjunctive treatment for ocular hypertension and open angle glaucoma. METHODS: Twenty-four eyes with ocular hypertension and 63 eyes with open angle glaucoma were treated with a frequency-doubled, Q-switched Nd:YAG laser. Intraocular pressure (IOP) was measured prelaser treatment, one week, one, two, three, six, 12, 18, and 24 months after treatment. RESULTS: The average pre-laser IOP of 87 eyes was 21.6 mmHg. The mean IOP percent reductions at 1 week, one, two, three, six, 12, 18, and 24 months were 15.3%, 20.0%, 21.3%, 19.6%, 23.4%, 23.4%, 20.5%, and 20.9%, respectively. The IOP percent reductions in the initial treatment group at one, 12, and 24 months were 21.1%, 24.8%, and 22.8% respectively. The IOP percent reductions in the adjunctive treatment group at 1, 12, and 24 months were 19.6%, 22.9%, and 20.2% respectively. There were no differences in IOP percent reduction between the initial treatment group and the adjunctive treatment group. CONCLUSIONS: Selective laser trabeculoplasty has shown reasonable efficacy in lowering IOP over two-year follow-up period as initial and adjunctive treatment for ocular hypertension and open angle glaucoma.
Eye ; Follow-Up Studies ; Glaucoma, Open-Angle ; Intraocular Pressure ; Ocular Hypertension ; Trabeculectomy

PURPOSE: To evaluate the long-term effectiveness of different surgical procedures according to horizontal eyelid laxity in correcting involutional entropion. METHODS: This retrospective study reviewed 104 eyes of 79 patients with involutional lower eyelid entropion who underwent surgical repair. The 62 eyes with horizontal eyelid laxity were classified as group I. In 17 eyes of group I, we performed the lateral tarsal strip procedure alone (group Ia), while in 45 eyes of group I, we performed the lateral tarsal procedure and Quickert suture (group Ib). The 42 eyes without horizontal eyelid laxity were classified as group II. In 13 eyes of group II, we performed a lower eyelid retractor reinsertion procedure only (group IIa), and in 29 eyes of group II, we performed combined lower eyelid retractor reinsertion and orbicularis resection (group IIb). RESULTS: The recurrence rate in these four surgical subsets (group Ia , group Ib, group IIa, group IIb) was 11.7%, 0%, 15.4%, and 6.9%, respectively, with an average follow-up of 11 months. Six recurrent eyelids and two overcorrected eyelids successfully underwent procedures to correct recurrent entropion and ectropion, respectively. CONCLUSIONS: The lateral tarsal strip procedure is an effective approach for achieving long-lasting correction of involutional entropion with horizontal eyelid laxity, whereas the lower eyelid retractor reinsertion procedure is an effective approach for achieving long-lasting correction for involutional entropion without horizontal eyelid laxity. Use of the Quickert suture reduced the need to repeat the lateral tarsal strip procedure and additional orbicularis resection decreased the need to repeat the lower eyelid retractor reinsertion procedure.
Ectropion ; Entropion ; Eye ; Eyelids ; Follow-Up Studies ; Humans ; Recurrence ; Retrospective Studies ; Sutures

PURPOSE: This study aims to examine the levels of the perception and work performance of patient safety based on the healthcare accreditation criteria among long-term care hospital nurses. METHODS: A cross-sectional study was performed using questionnaires. Out of 205 criteria, 39 items relevant to patient safety were selectively adapted for this study. Data were analyzed with descriptive statistics, t-test, ANOVA, and Pearson correlation coefficient. RESULTS: The mean scores of perception and work performance were 4.36 and 4.24 out of 5, respectively, and the difference between them was significantly different (t=5.78, P<.001). The two variables were both significantly higher among those nurses who were older, married, head nurses, had many nursing experiences, and aware of Healthcare Accreditation than the other nurses. Positive correlations were observed between perception and work performance in all three sub-systems. The relations between these two in the patient care system was the most highly correlated (r=.894, P<.001). The lowest scores of perception and work performances were fire-related criteria (i.e., reporting). CONCLUSION: Overall, subject's perception proves to be higher than their work performance. It is necessary to develop some viable environment and training programs to enhance their work performance up to the level of their perception of patient safety.
Accreditation ; Cross-Sectional Studies ; Delivery of Health Care ; Education ; Humans ; Long-Term Care* ; Nursing ; Nursing, Supervisory ; Patient Care ; Patient Safety* ; Work Performance*

PURPOSE: To investigate long-term visual outcomes and prognostic factors to predict visual outcomes in patients with anatomic success after macular hole surgery. METHODS: Medical records of 36 eyes with successfully repaired stage 3 or 4 idiopathic macular hole and with at least 24 months of follow-up were reviewed. Hole height, stage of macular hole, base diameter, minimum diameter, hole form factor, macular hole index, and hole closure type were measured or calculated, and the correlations of visual outcomes with variables of preoperative optical coherence tomography (OCT) were analyzed. RESULTS: The patients were classified into 3 groups according to the time period necessary to achieve the best corrective visual acuity. The visual acuity of 16 eyes (44.4%) recovered in a mean of 6 months, 13 eyes (36.1%) improved slowly and continuously, and 7 eyes had no improvement despite successful anatomical closure. There were no statistical differences in hole height, base diameter, minimum diameter, hole form factor, macular hole index, or closure type among the 3 groups. CONCLUSIONS: The improvement in visual acuity after successful macular hole surgery persisted at the 24-month follow-up and after. There were no correlations between delayed visual acuity after macular hole surgery and minimum diameter, base diameter, hole height, hole form factor, macular hole index, or closure type.
Eye ; Follow-Up Studies ; Humans ; Medical Records ; Retinal Perforations ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To compare clinical outcomes after intravitreal injection of triamcinolone acetonide or bevacizumab for the treatment of macular edema secondary to branch retinal vein occlusion. METHODS: Sixty-six patients received an intravitreal injection of either triamcinolone acetonide or bevacizumab. Patients were retrospectively reviewed. Thirty-three out of 66 patients were treated with an intravitreal injection of triamcinolone acetonide, while the other 33 patients received a bevacizumab injection. All patients underwent a visual acuity test, optical coherence tomography imaging and ophthalmoscopic examination throughout the follow-up. RESULTS: In the triamcinolone group, central macular thickness (CMT) decreased from 496.69 +/- 153.01 micrometer at baseline to 313.06 +/- 150.14 micrometer at the six-month follow-up visit, while in the bevacizumab group, CMT decreased from 441.30 +/- 185.79 micrometer to 295.67 +/- 188.80 micrometer (p<0.05). In the triamcinolone group, best-corrected visual acuity (BCVA) improved from logMAR 0.92 +/- 0.70 at baseline to logMAR 0.53 +/- 0.43 at the six-month follow-up visit, and in the bevacizumab group, BCVA improved from logMAR 0.74 +/- 0.47 to logMAR 0.34 +/- 0.33 (p<0.05). CONCLUSIONS: The therapeutic effects of intravitreal triamcinolone acetonide showed no significant differences compared with those of intravitreal bevacizumab with regard to anatomical and functional outcomes.
Antibodies, Monoclonal, Humanized ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Macular Edema ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Retrospective Studies ; Tomography, Optical Coherence ; Triamcinolone ; Triamcinolone Acetonide ; Visual Acuity ; Bevacizumab

PURPOSE: To evaluate the clinical features of subretinal hemorrhage after photodynamic therapy in eyes with exudative age-related macular degeneration. METHODS: We retrospectively reviewed data for 267 eyes of 243 patients who had undergone PDT for the treatment of ARMD between January 2005 and December 2006. Best corrected visual acuity, fundus photography, fluorescein angiography, and ICG angiography were performed before and after treatment. We followed up the patients at 1 week, 1 month, and 3 months after treatment and at 3-month intervals thereafter. RESULTS: Postoperative subretinal hemorrhage was seen in 36 (13.4%) of 267 eyes. The pretreatment and post-treatment mean visual acuities were logMAR 0.80 and logMAR 1.05 respectively, representing a decrease of 2.05 lines. On FAG, two eyes were predominantly classic, four eyes were minimally classic, and 30 eyes were occult. The laser irradiation spot size was under 3,000 micrometer in one case and from 3,000 micrometer to 5,000 micrometer in 19 cases and over 5,000 micrometer in 16 eyes. CONCLUSIONS: Subretinal hemorrhage after PDT for ARMD can be a common complication in patients who have been treated for larger irradiation spot sizes and for pigment epithelial detachment (PED), so doctors should be aware of the risk of serious hemorrhagic complications in such situations.
Angiography ; Eye ; Fluorescein Angiography ; Hemorrhage ; Humans ; Macular Degeneration ; Photochemotherapy ; Photography ; Retrospective Studies ; Triazenes ; Visual Acuity

PURPOSE: To assess macular function before and after vitrectomy and membrane removal in epiretinal membranes by means of multifocal electroretinogram (mfERG). METHODS: The mfERGs (RETIscan(R), Roland, Germany) of 28 consecutive patients (28 eyes) with idiopathic epiretinal membranes were recorded before epiretinal membrane surgery and 3 to 6 months after surgery. The average retinal response density and implicit time of each local response were estimated as anatomic macular areas corresponding roughly to 5 rings. Preoperative and postoperative responses of mfERG were compared. The correlation of the change of retinal response density and postoperative macular configuration on optical coherent tomography (OCT) was statistically analyzed. RESULTS: The postoperative value of P1 amplitude and implicit time were not statistically correlated with the preoperative value (p>0.05). There were no significant correlations between the changes of rings 1 and 2 with regard to the retinal response density of the mfERGs and visual acuity. There was no significant correlation between the change of retinal response density and postoperative macular configuration according to OCT. CONCLUSIONS: The use of mfERGs does not seem useful for predicting clinical prognosis after epiretinal membrane surgery. Further studies of influence of internal limiting membrane removal on mfERG response should be conducted.
Epiretinal Membrane ; Humans ; Membranes ; Prognosis ; Retinaldehyde ; Visual Acuity ; Vitrectomy

PURPOSE: To report the evaluation and comparison of true corneal power after corneal refractive surgery through ARK, Orbscan II(R), Pentacam and IOL master. METHODS: Target IOL (Intraocular lens) power calculated with the SRK/T formula using SMK (Sungmo Eye Hospital keratometry), which is a new method for measuring corneal refractive power, was compared with the back-calculated ideal IOL power after cataract surgery for 30 eyes that required cataract surgery and had previously undergone refractive surgery. Target IOL powers calculated using 4 systems were compared with IOL power calculated using the clinical history method for 64 eyes that had undergone refractive surgery. RESULTS: Using SMK with the SRK/T formula, the actual refraction was within +/-0.5 diopter (D) of the intended refraction for 63.8% of eyes and within +/-1.0 D for 90.9% of eyes. Compared with target IOL power calculated with the clinical history method, target IOL power calculated by SMK with the SRK/T formula had a difference of 1.95 +/- 0.86 D, which was similar to the results calculated by the Haigis-L formula and by TNP with Haigis. CONCLUSIONS: The method of IOL calculation using SMK with the SRK/T formula showed the best predictability in patients after corneal refractive surgery. Comparatively accurate results were produced in IOL power calculations using the Haigis-L formula, and the TNP with Haigis method.
Cataract* ; Humans ; Refractive Surgical Procedures