Korean journal of ophthalmology : KJO最新文献

Purpose: To compare clinical outcomes between patients with and without intraoperative miosis during femtosecond laser-assisted cataract surgery (FLACS) and to identify risk factors for intraoperative miosis during the initial learning curve in the surgeon's first 300 consecutive cases.

Methods: This retrospective cohort study included the first 300 consecutive FLACS cases performed by a single surgeon at a single center. A 5.0-mm capsulotomy was created in all cases using a femtosecond laser. Eyes were divided into two groups based on pupil diameter after femtosecond laser treatment: miosis group (<5 mm) and mydriasis group (≥5 mm). Clinical outcomes at 3 months were compared. Perioperative variables were analyzed to identify factors associated with intraoperative miosis.

Results: Of the 300 eyes, 52 (17.3%) were in the miosis group and 248 (82.7%) in the mydriasis group. The miosis group had significantly smaller preoperative pupil diameter (p = 0.002), narrower capsulotomy-pupil margin distance (p = 0.002), longer vacuum duration (p < 0.001), longer phacoemulsification time (p = 0.005), and more frequent multiple docking attempts (p = 0.009). The first 150 cases had a higher incidence of multiple docking attempts (p < 0.001) and miosis (p < 0.001) compared to the second 150 cases. At 3 months, the mean corrected distance visual acuity was -0.01 ± 0.03 and 0.00 ± 0.04 in the miosis and mydriasis groups, respectively (p = 0.890), with no significant differences observed in specular microscopy outcomes. No mechanical expanders were used in any case, and no intraoperative complications occurred in either group.

Conclusions: Small preoperative pupil diameter, narrow capsulotomy-pupil margin distance, prolonged vacuum duration, multiple docking, and the surgeon's initial learning curve were associated with intraoperative miosis during FLACS. Although phacoemulsification time was prolonged, it did not lead to a higher rate of intraoperative complications or adversely affect postoperative clinical outcomes.

Purpose: To determine the prevalence of traumatic cataract and factors influencing visual outcomes following cataract extraction in a tertiary center in Malaysia.

Methods: A retrospective review was conducted on patients treated for traumatic cataract at the ophthalmology department between January 2012 and December 2022. Data were retrieved from the Malaysian Cataract Registry. Data of those with history of blunt trauma, secondary cataract surgery, or primary closure with cataract removal after open globe injuries, with a minimum 1-year follow-up after surgery, were extracted from the registry. Their data were retrieved from the medical record unit. The outcome of cataract surgery was based on best-corrected visual acuity (BCVA) ≥6 / 18 as good and <6 / 18 as poor outcome.

Results: A total of 224 patients (113 with open globe injuries and 112 with closed globe injuries) were included, with a mean age of 41.1 ±19.8 years. Men had a 5:1 higher risk. Domestic accidents (34.4%) were the leading cause, followed by agricultural (21.9%) and nonagricultural occupational injuries (21.4%). Preoperatively, 72.8% presented with severe visual impairment. Phacoemulsification was the most common surgical technique (37.1%), and primary intraocular lens (IOL) implantation was performed in 53.1%, while 25.9% remained aphakic. Postoperatively, 46.0% achieved BCVA ≥6 / 18, while 24.1% remained blind (<3 / 60). Those with closed globe injuries were 3.4 times more likely to yield good visual outcomes (p < 0.001). Better preoperative visual acuity, posterior capsule IOL, sulcus- and iris-fixated IOL is associated with favorable outcome. There was significant correlation between preoperative and postoperative visual acuity (r = 0.306, p < 0.001).

Conclusions: Traumatic cataract surgery is not uncommon, but the outcome is unpredictable. Closed globe injuries, better preoperative visual acuity, posterior capsule IOL, and sulcus- and iris-fixated IOL are strong predictors for favorable visual recovery in traumatic cataract surgery. Early intervention, thorough ocular assessment, and tailored surgical planning are crucial for optimal rehabilitation.

Purpose: To evaluate and compare the short-term outcomes of an accelerated corneal cross-linking (CXL) protocol with a total energy dose of 7.2 J/cm2 in pediatric and adult keratoconus patients.

Methods: This study included 113 eyes of 82 keratoconus patients who underwent accelerated epithelium-off CXL (12 mW/cm2 for 10 minutes) at a university hospital. Patients were divided into two groups based on age: <18 years (group 1, 48 eyes; mean age, 15.4 ± 1.6 years) and ≥18 years (group 2, 65 eyes; mean age, 23.4 ± 3.4 years). Preoperative and postoperative (6-month) uncorrected visual acuity, best-corrected visual acuity, keratometric indices, central corneal thickness, and endothelial cell density were analyzed and compared between groups.

Results: Significant improvements in best-corrected visual acuity and reductions in keratometric indices were observed in both groups (p < 0.05). While both groups demonstrated significant visual and structural improvements, group 2 exhibited a greater magnitude of change in most keratometric and refractive parameters. Both groups exhibited significant decreases in central corneal thickness (p < 0.001). Posterior keratometric values showed statistically significant changes in both groups (p < 0.001). Endothelial cell density remained stable, and no severe complications were noted.

Conclusions: Accelerated CXL with a total energy dose of 7.2 J/cm2 demonstrated a favorable safety profile and significant efficacy in stabilizing keratoconus in both pediatric and adult patients over a 6-month period. Notably, adult patients exhibited a greater extent of keratometric and refractive improvement, suggesting a potentially age-dependent biomechanical response. These findings support the utility of this protocol as an early intervention strategy, particularly in young adults with progressive disease.

Purpose: The purpose of this study is to determine which demographic and biometric factors, lens hardness, complications such as pseudoexfoliation syndrome (PEX) and intraoperative floppy iris syndrome (IFIS), and intraoperative metrics have the greatest influence on active surge mitigation (ASM) actuation during phacoemulsification using the Centurion Vision System with the Active Sentry handpiece.

Methods: The preoperative analysis considered age, sex, biometric data (obtained using IOLMaster 700 and the Pentacam), and lens hardness according to the Lens Opacification Classification System (LOCS) III. IFIS and PEX were also assessed. Intra-operative metrics during phacoemulsification included total case time, cumulative dissipated energy, total ultrasound time, and the number of ASM actuations.

Results: Significant positive correlations were found between ASM and both LOCS III grade (p = 0.001) and age (p = 0.017), albeit a significant negative correlation was observed with anterior chamber depth (p = 0.005). No significant differences in the number of ASM actuations were observed between genders or in patients with PEX or IFIS. In multivariate analysis, an ASM of ≥1 significantly predicted higher LOCS III grade (odds ratio, 1.79; 95% confidence interval, 1.04-2.95), whereas greater anterior chamber depth reduced this likelihood (odds ratio, 0.311; 95% confidence interval, 0.100-0.960).

Conclusions: ASM actuation is more frequent with advanced lens hardness and old age, while a deep anterior chamber reduces actuations compared to a shallow one. Lens hardness affects ASM more than anterior chamber depth, and no significant correlation was found between PEX, IFIS, and ASM.

Despite extensive research on clinical characteristics, patient management, and surgical outcomes of intermittent exotropia, there remains significant confusion regarding the nomenclature system for infantile exotropia, which develops before 12 months of age. Additionally, there still is a controversy over whether infantile exotropia represents the phenotypic counterpart of infantile esotropia or early-onset intermittent exotropia. In this article, we critically review the previous nomenclature systems and propose some modifications to the current classifications of infantile exotropia. These include three diagnostic categories: primary infantile exotropia, early-onset intermittent exotropia, and secondary infantile exotropia. Stereopsis is valuable for differentiation between primary infantile exotropia and early-onset intermittent exotropia. However, further research is needed for more precise descriptions of their clinical features, optimal surgical timing, and proper management.

Purpose: To evaluate the 6-month clinical outcomes of accelerated corneal cross-linking (A-CXL) using a total energy dose of 7.2 J/cm2 with a 0.1% dextran-free riboflavin solution containing hydroxypropyl-methylcellulose (HPMC) in patients with progressive keratoconus.

Methods: A total of 42 eyes from 35 patients with progressive keratoconus underwent epithelial removal, followed by the application of 0.1% dextran-free riboflavin solution with HPMC every 30 seconds for 10 minutes. A-CXL was performed using ultraviolet A irradiation at 12 mW/cm2 for 10 minutes, delivering a total energy dose of 7.2 J/cm2. Evaluations included uncorrected distance visual acuity, corrected distance visual acuity, keratometric indices (flat, steep, and maximum keratometry), central corneal thickness, endothelial cell density, corneal astigmatism, and demarcation line depth using anterior-segment optical coherence tomography. Each keratometric index was measured three times, and mean values were recorded.

Results: Corrected distance visual acuity improved significantly from 0.55 ± 0.29 to 0.36 ± 0.23 logarithm of the minimum angle of resolution (p < 0.001). Keratometric indices showed significant reductions, with the mean maximum keratometry decreasing from 57.06 ± 5.7 to 55.4 ± 5.5 diopters (D; p < 0.001). Astigmatism, as represented by cylindrical power, decreased slightly from -3.98 ± 1.98 D preoperatively to -3.75 ± 1.94 D postoperatively; however, this change was not statistically significant (p = 0.122). Central corneal thickness was significantly reduced from 471.6 ± 32.4 to 461.4 ± 31.7 µm (p < 0.001), while uncorrected distance visual acuity remained unchanged (p = 0.070). The mean demarcation line depth was 287.82 ± 39.77 µm. No significant change was observed in endothelial cell density (p = 0.090), and no minor postoperative complications were encountered.

Conclusions: A-CXL using a total energy dose of 7.2 J/cm2 with 0.1% dextran-free riboflavin effectively stabilizes keratoconus progression, significantly improves visual acuity and corneal astigmatism, and preserves endothelial integrity over a 6-month follow-up. Further long-term studies are required to validate these findings.