PURPOSE: To compare the short term effects of bevacizumab and ranibizumab injections on the regression of corneal neovascularization (NV). METHODS: Sixteen eyes of 16 patients with corneal NV were randomly assigned for an injection with 2.5 mg of bevacizumab (group 1, n = 8) or 1 mg of ranibizumab (group 2, n = 8) through subconjunctival and intrastromal routes. The patients were prospectively followed-up for one month after the injections. Corneal NV areas, as shown on corneal slit-lamp photographs stored in JPEG format, were calculated using Image J software before the injection, one week after the injection, and one month after the injection. The corneal NV areas were compared before and after the injections. RESULTS: Seven women and nine men, with an average age of 51 years, presented with corneal NV secondary to herpetic keratitis (7 cases), graft rejection (6), chemical burn (1), pemphigoid (1), and recurrent ulcer (1). In group I, the preoperative corneal NV area (8.75 +/- 4.33%) was significantly decreased to 5.62 +/- 3.86% one week after the injection and to 6.35 +/- 3.02% one month after the injection (p = 0.012, 0.012, respectively). The corneal NV area in group 2 also exhibited a significant change, from 7.37 +/- 4.33% to 6.72 +/- 4.16% one week after the injection (p = 0.012). However, no significant change was observed one month after the injection. The mean decrease in corneal NV area one month after injection in group 1 (28.4 +/- 9.01%) was significantly higher than in group 2 (4.51 +/- 11.64%, p = 0.001). CONCLUSIONS: Bevacizumab injection resulted in a more effective and stable regression of corneal NV compared to the ranibizumab injection. The potency and dose of these two drugs for the regression of corneal NV require further investigation.
Adult ; Aged ; Aged, 80 and over ; Angiogenesis Inhibitors/*therapeutic use ; Antibodies, Monoclonal, Humanized/*therapeutic use ; Corneal Neovascularization/*drug therapy ; Female ; Humans ; Male ; Middle Aged ; Pilot Projects ; Prospective Studies ; Treatment Outcome ; Young Adult

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 evaluate the changes in higher-order aberrations (HOAs) after implantation of an ICL (implantable contact lens). METHODS: Twenty-six eyes that had undergone ICL implantation between February 2008 and October 2009 were included. Ocular higher-order aberrations of all the eyes were measured using the Hartmann-Shack aberrometer (KR9000PW). Examinations were performed preoperatively, as well as one week, one month, and three months after ICL implantation. Changes in ocular total higher-order aberrations, total spherical aberration, coma aberration, trefoil aberration, and S3 and S4 calculated in the central 4-mm zone and expressed as root mean square (RMS) values were analyzed. RESULTS: The mean patient age was 25.4 years, and the mean preoperative spherical equivalent was -6.40 diopters(D). The mean postoperative spherical equivalents were 0.00 +/- 0.13D, 0.03 +/- 0.21D, -0.013 +/- 0.12D at one week, one month,and three months, respectively. There were no statistically significant differences in ocular higher-order aberration RMS,including spherical, coma, or trefoil aberration, at one week, one month, or three months postoperative or between preoperative and postoperative measurements. CONCLUSIONS: There is no significant change of ocular higher order aberration in the central 4-mm zone after ICL implantation.
Coma ; Eye ; Humans ; Lenses, Intraocular ; Lotus

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 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

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 compare surgically induced astigmatism (SIA) and some corneal higher order aberrations in patients who underwent microcoaxial cataract surgery (MCCS) or conventional cataract surgery. METHODS: A prospective randomized study included 60 eyes of 55 patients. Thirty eyes received MCCS using a 2.2mm clear corneal incision (group 1), and 30 eyes received conventional cataract surgery using a 2.8 mm clear corneal incision (group 2). SIA and corneal higher order aberrations were measured with a Keratometer (Humphrey, Zeiss) and i-Trace (Tracey Technologies) preoperatively, and at 1 and 3 months after cataract surgery. SIA was analyzed vectorially using the Alpins method. RESULTS: There was no significant difference in preoperative UCVA or BCVA between the two groups. At 1 month and 3 months after surgery, SIA in group 1 was less than that in group 2, but this difference was not significant. There was no statistically significant difference in postoperative change of corneal higher order aberrations in each group at 1 month or 3 months after surgery, and there was no statistically significant difference in corneal higher order aberrations between the two groups preoperatively, at 1 month, or 3 months after surgery. CONCLUSIONS: There was no significant difference in SIA and corneal higher order aberrations between the two groups.
Astigmatism ; Cataract ; Eye ; Humans ; Prospective Studies

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 report three cases of Urrets-Zavalia syndrome after deep lamellar keratoplasty. CASE SUMMARY: A retrospective chart analysis of two men who underwent deep lamellar keraplasty after corneal chemical burns and one woman who was treated with deep lamellar keratoplasty due to lattice dystrophy was performed. To maintain the anterior chamber depth and prevent formation of a double anterior chamber after deep lamellar keratoplasty, air or gas (C3F8) was injected into the anterior chamber for all three cases. After injections of air or gas (C3F8) into the anterior chamber, pupillary blocks occurred and intraocular pressures increased. Afterwards, intraocular pressures were well-controlled, but the pupil remained irreversibly fixed and dilated despite the use of miotics. CONCLUSIONS: Urrets-Zavalia syndrome, a postoperative complication, was first reported in a patient who underwent penetrating keratoplasty for keratoconus. This syndrome can also occur after deep lamellar keratoplasty on rare occasions.
Anterior Chamber ; Burns, Chemical ; Corneal Transplantation ; Female ; Humans ; Intraocular Pressure ; Keratoconus ; Keratoplasty, Penetrating ; Male ; Miotics ; Postoperative Complications ; Pupil ; Retrospective Studies