OBJECTIVE

To compare the refractive absolute error when axial length (AL), anterior chamber depth (ACD) and keratometry (K) are sourced from different measuring devices (IOL Master vs a combination of automated keratometer and A-scan) and inputted into the Barrett Universal II or SRK/T formula.

This was a retrospective study. Medical charts of eyes that underwent uncomplicated phacoemulsification with in-the-bag implantation of Envista or multifocal FineVision IOL were reviewed. The results of manifest refraction at 1 month after surgery were collected. The predicted refraction corresponding to the IOL power implanted was collected from 4 IOL sheets: using the SRK/T with AL, ACD, and K from IOL Master (Group A); SRK/T formula with AL and ACD from A-scan and K from the automated keratometer (Group B); Barrett formula with AL, ACD and K from IOL Master (Group C); and Barrett formula using with AL, ACD from A-scan and K from automated keratometer. For each group, the absolute error, prediction error, and variances of prediction error were computed.

A total of 132 eyes were included in the study: 56 in the monofocal group and 76 in the multifocal group. The means of manifest refraction spherical equivalent (MRSE) were 0.06 ± 0.38 D and –0.08 ± 0.31 D in the monofocal and multifocal groups, respectively. When AL and K were obtained from various sources and entered into the Barrett formula, the mean absolute error difference in both the monofocal (p = 0.70) and multifocal (p = 0.10) groups did not reach statistical significance. If the SRK/T formula was used, similar outcomes were observed (monofocal p = 0.97; multifocal p = 0.37). When compared to A-scan groups, the prediction error variances are significantly smaller in the groups that used the IOL Master as their data source. Among the four groups, the Barrett group using IOL Master as the data source showed the lowest overall variation of prediction error (monofocal F = 0.04; multifocal F = 0.03).

Though the refractive outcomes may not be statistically different, using the IOL Master as the source of AL and K makes the refractive outcomes more consistent and predictable. Combining the AL and K from the IOL Master with the Barrett Universal II formula further increases the predictability of refractive outcomes.

PURPOSE: To report a case of retinal toxicity after an intravitreal ganciclovir injection to treat acute retinal necrosis in an eye filled with silicone oil.CASE SUMMARY: A 56-year-old male presented with ocular pain and visual loss in his right eye. His best-corrected visual acuity was 20/25, inflammatory cells in the anterior chamber, multiple retinitis lesions and retinal vessel occlusions in the peripheral retina and vitreous opacity were showed. Acute retinal necrosis was suspected, anterior chamber polymerase chain reaction (PCR) test was done. Aciclovir 2,400 mg/day intravenously and ganciclovir 2.0 mg were administered by intravitreal injection. After 4 days, retinitis was worsened and PCR test was positive for varicella zoster virus. Ganciclovir intravitreal injections were increased twice a week. After 16 days, retinal detachment occurred, so scleral encircling, vitrectomy, laser photocoagulation, and silicone oil tamponade were conducted. Ganciclovir 1.0 mg was injected at the end of surgery. The patient's visual acuity decreased to hand motion, and multiple crystal deposits with multiple retinal hemorrhages were observed in the right eye the next day. Visual acuity did not recover and optical coherent tomography showed that the macula was thinned.CONCLUSIONS: Visual loss seemed to be related with the retinal toxicity of ganciclovir. The increased local concentration due to the silicone oil tamponade is thought to have caused the toxicity.
Acyclovir ; Anterior Chamber ; Ganciclovir ; Hand ; Herpesvirus 3, Human ; Humans ; Intravitreal Injections ; Light Coagulation ; Male ; Middle Aged ; Polymerase Chain Reaction ; Retina ; Retinal Detachment ; Retinal Hemorrhage ; Retinal Necrosis Syndrome, Acute ; Retinal Vessels ; Retinaldehyde ; Retinitis ; Silicon ; Silicones ; Visual Acuity ; Vitrectomy

PURPOSE: In this study, we evaluated changes in the anterior chamber structure and lens position before and after phacoemulsification in eyes grouped by axial length (AL).METHODS: This study included 65 eyes (16 short eyes [AL < 22.5 mm], 33 normal eyes [22.5 mm < AL < 25.0 mm], and 16 long eyes [AL > 25.5 mm]) that underwent cataract surgery. Pre- and postoperative anterior chamber depth (ACD) was measured using Pentacam® and IOL Master®,. In addition, we evaluated the anterior chamber angle (ACA), anterior chamber volume (ACV), epithelium-iris distance, and iris-lens (intraocular lens [IOL]) distance.RESULTS: The change in ACD was significantly smaller in long eyes (Pentacam®,, p = 0.000; IOL Master®,, p = 0.001). The change in ACA was significantly larger in short eyes (p = 0.000), and the change in ACV was significantly smaller in long eyes (p = 0.000). The change in the epithelium–iris distance was significantly smaller in long eyes (p = 0.000), and the change in the iris-lens (IOL) distance was significantly smaller in short eyes (p = 0.000).CONCLUSIONS: In short eyes, changes in ACD, ACA, and ACV were found to be larger than those of other groups as the iris moved backward. In long eyes, greater backward movement of the IOL was observed. Therefore, the appropriate IOL power should be chosen, considering the postoperative position of the IOL during cataract surgery of short and long eyes.
Anterior Chamber ; Cataract ; Iris ; Lenses, Intraocular ; Phacoemulsification

PURPOSE: To report a patient with a pseudophakic bullous keratopathy (PBK) who underwent Descemet's membrane stripping endothelial keratoplasty (DSEK) with manual preparation of the donor corneal graft.CASE SUMMARY: A 61-year-old female presented with visual disturbance in her right eye. Five months prior, she was treated with phacoemulsification and intraocular lens exchange surgery of the right eye, and a very severe corneal edema was revealed by slit-lamp examination. We diagnosed PBK and planned DSEK with manual preparation of a donor corneal graft because of the non-availability of a microkeratome or a femtosecond laser. After making the corneal graft using an artificial anterior chamber, crescent knife and cornea dissector, the keratoplasty proceeded using the graft. Three months after surgery, her graft was well-maintained on the right eye. The patient's visual acuity was 0.3, and the corneal endothelial cell count was 1,844/mm².CONCLUSIONS: Manual preparation of the donor corneal graft for DSEK is suitable as a second choice treatment method when the availability of surgical devices is limited.
Anterior Chamber ; Cornea ; Corneal Edema ; Corneal Transplantation ; Descemet Membrane ; Endothelial Cells ; Female ; Humans ; Lenses, Intraocular ; Methods ; Middle Aged ; Phacoemulsification ; Tissue Donors ; Transplants ; Visual Acuity

PURPOSE: To report a case of Epstein-Barr virus-related corneal endotheliitis accompanied by secondary glaucoma.CASE SUMMARY: A 73-year-old male presented with blurred vision in his right eye. In the ophthalmic evaluation, there were dispersed keratic precipitates overlying corneal edema. The anterior chamber showed trace ~1+ graded inflammation and an endothelial density decrease. His best-corrected visual acuity and intraocular pressure in the right eye were 0.2 and 34 mmHg, respectively. Paracentesis was performed on the anterior chamber of the right eye to confirm the diagnosis under the suspicion of corneal endotheliitis with trabeculectomy for the intraocular pressure control. Epstein-Barr virus was confirmed using a multiplex polymerase chain reaction (PCR), and oral and eye drops of Acyclovir were used to treat the patient. There was no evidence of a recurrence over 2 years and his intraocular pressure was 12 mmHg and best-corrected visual acuity was maintained at 0.5.CONCLUSIONS: A case of Epstein-Barr virus-related corneal endotheliitis was diagnosed using PCR of the aqueous humor. The patient was treated with an oral antiviral agent and eyedrops without a recurrence.
Acyclovir ; Aged ; Anterior Chamber ; Aqueous Humor ; Corneal Edema ; Diagnosis ; Glaucoma ; Herpesvirus 4, Human ; Humans ; Inflammation ; Intraocular Pressure ; Male ; Multiplex Polymerase Chain Reaction ; Ophthalmic Solutions ; Paracentesis ; Polymerase Chain Reaction ; Recurrence ; Trabeculectomy ; Visual Acuity

PURPOSE: To report a case of corneal collagen cross-linking for corneal ulcer caused by the Moraxella group.CASE SUMMARY: A 77-year-old male had decreased visual acuity for several days in his right eye. The patient showed severe stromal ring infiltrates with a corneal epithelial defect measuring (5.0 × 7.0 mm), a corneal endothelial plaque, and a hypopyon measuring less than 1.0 mm in height in the anterior chamber of the right eye. There was no abnormal finding in the right eye using B-scan ultrasonography. Before starting treatment, a corneal culture was conducted. The culture tests showed the presence of the Moraxella group. Because the patient was diagnosed with a corneal ulcer caused by the Moraxella group, corneal collagen cross-linking (CXL) was performed. The antimicrobial susceptibility test confirmed that this Moraxella group was sensitive to ceftazidime, so the patient was treated with 5% ceftazidime eye drops and 0.5% moxifloxacin eye drops every 2 hours for 9 months after corneal collagen CXL. The uncorrected visual acuity was 0.1 in the right eye, and there was almost no corneal stromal melting on anterior segment optical coherence tomography.CONCLUSIONS: This is the first known case of a corneal ulcer, in the Republic of Korea, caused by the Moraxella group and treated with corneal collagen CXL. Corneal collagen CXL should be considered as a surgical treatment for patients who have an impending corneal perforation due to a corneal ulcer because it is a simple procedure and causes fewer serious complications than other treatments.
Aged ; Anterior Chamber ; Ceftazidime ; Collagen ; Cornea ; Corneal Perforation ; Corneal Ulcer ; Freezing ; Humans ; Male ; Moraxella ; Ophthalmic Solutions ; Republic of Korea ; Tomography, Optical Coherence ; Ultrasonography ; Visual Acuity

PURPOSE: To report a case of macular edema and retinal vasculitis treated with intravitreal dexamethasone implantation in a Behcet's disease patient after cataract surgery. CASE SUMMARY: A 26-year-old male with Behcet's disease, without recurrence of uveitis for 3 months, underwent phacoemulsification and posterior chamber intraocular lens implantation for a cataract in the left eye. The preoperative best corrected visual acuity (BCVA) of the left eye was 0.15. At day 1 after surgery, his BCVA was 0.4, and slit lamp examination of his left eye revealed a mild anterior chamber reaction. At 1 week after surgery, he presented with left vision impairment, his BCVA was 0.04, and mild inflammation was observed in both the anterior chamber and the vitreous in his left eye. Unilateral macular edema was confirmed with optical coherence tomography, and fluorescein angiography revealed retinal vasculitis on the fovea and peripheral retina. Intravitreal dexamethasone implantation was performed in his left eye, 1 month after treatment, the macular edema and retinal vasculitis had improved, and the BCVA of his left eye was 0.8. CONCLUSIONS: In patients with Behcet's disease, intravitreal dexamethasone implantation can be an effective treatment option for macular edema and retinal vasculitis after cataract surgery.
Adult ; Anterior Chamber ; Behcet Syndrome ; Cataract ; Dexamethasone ; Fluorescein Angiography ; Humans ; Inflammation ; Lens Implantation, Intraocular ; Macular Edema ; Male ; Phacoemulsification ; Recurrence ; Retina ; Retinal Vasculitis ; Slit Lamp ; Tomography, Optical Coherence ; Uveitis ; Vasculitis ; Visual Acuity

PURPOSE: We report a case of toxic keratoconjunctivitis resulting from the self-application of human breast milk as a traditional folk remedy for allergic conjunctivitis. CASE SUMMARY: An 82-year-old woman presented with pain and conjunctival hyperemia in the right eye that had been worsening for three days. Two months previously, she was treated with antiallergic eye drops for allergic conjunctivitis at another eye clinic. However, the symptoms did not improve. She applied her daughter-in-law's breast milk into her right eye as a folk remedy for three days. The pain and conjunctival hyperemia worsened. At the initial visit, her corrected visual acuity was 0.3 in the right eye. Slit lamp examination demonstrated conjunctival hyperemia, punctate epithelial erosion at the central cornea, corneal keratic precipitates and white-colored deposits in the peripheral cornea combined with irregularly shaped small nodules. There was no anterior chamber inflammation. There was no medical history of rheumatoid arthritis or tuberculosis. Blood tests for serum and other infectious and inflammatory levels for infection and inflammatory markers were performed followed by application of topical steroids and antibiotics with artificial tears. After 3 weeks of treatment, conjunctival hyperemia and corneal deposits had almost resolved and best-corrected visual acuity improved to 1.0. CONCLUSIONS: The self-application of human breast milk may cause toxic keratoconjunctivitis. Therefore, efforts should be made, actively, to inform and educate the elderly in rural areas not to use human breast milk as a folk remedy.
Aged ; Aged, 80 and over ; Anterior Chamber ; Anti-Bacterial Agents ; Arthritis, Rheumatoid ; Breast ; Conjunctivitis, Allergic ; Cornea ; Female ; Hematologic Tests ; Humans ; Hyperemia ; Inflammation ; Keratoconjunctivitis ; Lubricant Eye Drops ; Medicine, Traditional ; Milk, Human ; Ophthalmic Solutions ; Slit Lamp ; Steroids ; Tuberculosis ; Visual Acuity

PURPOSE: We report two cases of uveo-meningeal syndrome involving the retina, uvea, and optic disc in both eyes after viral meningitis. CASE SUMMARY: A 16-year-old female was referred to our department with blurred vision in both eyes. She was hospitalized in the pediatric ward with viral meningitis. She showed a norma best-corrected visual acuity (BCVA) and normal intraocular pressure in both eyes, but had severe inflammation in the anterior chamber on slit lamp examination, and optic disc edema and multiple whitish lesions on fundus examination. She was treated with intravenous antibiotic injections and steroid eye drops. After close observation, inflammation in the anterior chamber, optic disc edema, and the multiple whitish lesions in the retina were improved. A 27-year-old male who was treated for viral meningitis at the neurology department was referred to us with blurred vision in both eyes. His BCVAs were 0.7 (right eye) and 0.6 (left eye). The intraocular pressure was normal in both eyes. Slit lamp examination revealed inflammation in the anterior chamber and optic disc edema, and a fundus examination revealed multiple infiltrations. He received treatment for presumed herpes virus infection. After close observation, inflammation in the anterior chamber, optic disc edema, and multiple infiltrations with hemorrhage in the retina were improved. CONCLUSIONS: Clinicians should consider the possibility of uveo-meningeal syndrome, which can cause inflammation in the uvea,retina, and optic disc simultaneous with viral meningitis accompanying blurred vision.
Adolescent ; Adult ; Anterior Chamber ; Edema ; Female ; Hemorrhage ; Humans ; Inflammation ; Intraocular Pressure ; Male ; Meningitis ; Meningitis, Viral ; Neurology ; Ophthalmic Solutions ; Retina ; Slit Lamp ; Uvea ; Vision Disorders ; Visual Acuity

PURPOSE: To report a patient stung by a bee, who was diagnosed with sterile endopthalmitis and another patient diagnosed with optic neuritis, with decreasing visual acuity, after refined bee venom injection around the orbital tissue. CASE SUMMARY: A 82-year-old female visited our hospital for decreased visual acuity in the right eye and ocular pain due to a bee sting. The bee sting penetrated the sclera into the vitreous. In the anterior segment, severe cornea edema and anterior chamber cells were seen. Using ultrasonography, inflammation was seen around the intravitreal area. After 3 months, intravitreal inflammation regressed but the patient's visual acuity was light perception negative, and corneal opacity, neovascularization, and phthisis bulbi were detected. A 55-year-old male visited our hospital for ocular pain in the right eye and decreasing visual acuity after refined bee venom injection around the orbital tissue. The best-corrected visual acuity in the right eye was 15/100, there was moderate injection on the conjunctiva. A relative afferent pupillary defect, abnormal color vision test results, and a defect in the visual field test were observed. There was no pain during external ocular movement, and other general blood tests, and a brain MRI were normal. Based on these symptoms, methylprednisolone megatherapy was started for treatment of optic neuritis. After treatment, visual acuity of the right eye was 9/10 and all other clinical optic neuritis symptoms regressed. CONCLUSIONS: Based on these two cases, ocular toxicity from bee venom could result from both direct and indirect courses. Treatment using refined bee venom might be harmful, and caution is recommended in its use.
Aged, 80 and over ; Anterior Chamber ; Bee Venoms ; Bees ; Bites and Stings ; Brain ; Color Vision ; Conjunctiva ; Cornea ; Corneal Opacity ; Edema ; Female ; Hematologic Tests ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Male ; Methylprednisolone ; Middle Aged ; Optic Neuritis ; Orbit ; Pupil Disorders ; Sclera ; Ultrasonography ; Visual Acuity ; Visual Field Tests