Purpose:Keratoplasty had a higher risk for rejection with the recipient's corneal neovascularization. Bacterial corneal ulcers have more neovascular area than fungal, however there was no comparison. This study compared tear fluid vascular endothelial growth factor (VEGF-A) and corneal neovascularization between bacterial and fungal corneal ulcers. Method:Corneal photographs and tear fluid of corneal ulcer patients at the first visit and after four weeks were studied. The corneal neovascularization area was measured using ImageJ® software. VEGF-A concentration was measured using enzyme-linked immunosorbent assay. Results:Twelve bacterial corneal ulcer patients and 10 fungal corneal ulcer patients showed a mean age of 37 years old. The most common bacteria was Pseudomonas aeruginosa and the most common fungi was Fusarium sp. The neovascular area was similar among the groups at the first visit (bacterial 10,3% (2,3-37,5) vs fungal 8,0% (3,7-22,8), p = 0,262), however, the bacterial group showed a larger neovascularization area at the fourth week (bacterial 21,6% (2,3-58,0) vs fungal 11,0% (5,4-22,5), which reached statistical significance after multivariate adjustment for potential confounders p=0,033). VEGF-A was similar at the first visit (bacterial 215,6 pg/ml (58,0-1111,6) vs fungal 339,3 pg/ml (22,7-1313,0), p=0,391) and the fourth week (bacterial 399,7 pg/ml (181,9-1496,3) vs fungal 743,8 pg/ml (78,7-1416,5), p=0,792). No significant correlation was found between VEGF-A and corneal neovascular area (first visit r -0,28, p=0,212, fourth week r -0,04 p=0,855). Conclusion:Bacterial keratitis showed larger corneal neovascularization than fungal keratitis. However, this study found no significant difference in tear fluid VEGF-A concentration between the two groups. No significant correlation was found between VEGF-A and corneal neovascular area. Further study is needed to measure additional mediators alongside VEGF-A to evaluate bacterial and fungal angiogenic factor.
Purpose:To identify clinical factors associated with stereoacuity impairment in patients with intermittent exotropia (IXT), with an emphasis on perinatal, refractive, motor, and sensory parameters. Methods:This nationwide cross-sectional study analyzed 5,385 Korean patients with IXT from the Korean Intermittent Exotropia Multicenter Study (KIEMS). Stereoacuity was assessed using Titmus and Randot stereotests, and patients were classified into good or poor stereoacuity groups. Multivariable logistic regression was performed to identify independent predictors, including anisometropia (≥1.5 D) and refined Worth 4 Dot (W4D) categories (fusion, suppression, diplopia). Results:Among 3,723 patients with Titmus and 952 with Randot results, anisometropia ≥1.5 D was strongly associated with poor Titmus stereoacuity (OR=4.707, p=0.0002). Good distance and near fusion control were protective factors in the Titmus model. An initial surgical plan was also linked to better Titmus stereoacuity. No variables remained significant in the Randot model. Neither prematurity nor low birth weight was independently associated with stereoacuity after adjustment. Conclusions:Anisometropia and fusion control are key predictors of stereoacuity in IXT, whereas prematurity and low birth weight have limited independent effects. Early detection and correction of anisometropia and preservation of fusion control should be prioritized to maintain binocular visual function.
This review discusses the role of Corneal Allograft Intrastromal Ring Segments (CAIRSs) in the treatment of keratoconus and ectatic corneal disease, covering their mechanisms, techniques, outcomes, and prospects. The technique was developed in 2018 by reviewing protocols, surgical methods, customization, and combined approaches such as cross-linking. The review covers all aspects of CAIRS, including tissue selection, preparation, tunnel creation, and insertion technique. Clinical results show that CAIRS significantly improves visual acuity, corneal topography, and refractive stability, with success using both laser and manual techniques, especially with customization for asymmetric cones. Combining CAIRS with cross-linking enhances biomechanical stability and delays keratoplasty. Although uncommon, complications include graft rejection, extrusion, and refractive issues, and their overall safety is high. The ability to adjust segments postoperatively is advantageous over the use of artificial devices. Limitations include surgeon skill, cost, and tissue availability. AI technology promises to improve accuracy and outcomes. CAIRS is a minimally invasive option for keratoconus and ectatic disease, offering optical and structural benefits. Whether CAIRS will reduce the future role of deep anterior lamellar keratoplasty remains to be determined as direct head-to-head comparative studies between the two procedures are currently lacking. Current evidence supports its use as an effective treatment with the potential for broader adoption as technology advances.
Purpose:This study aimed to identify risk factors for visual field (VF) progression in glaucoma patients who underwent Ahmed Glaucoma Valve (AGV) implantation and achieved adequate intraocular pressure (IOP) reduction. Understanding these factors is vital for improving long-term outcomes. Methods:A retrospective observational study was conducted at XX Hospital, including glaucoma patients who underwent AGV implantation between October 2012 and January 2022. Patients were eligible if they achieved IOP <18 mmHg with up to two anti-glaucoma medications and had at least three follow-up VF tests. Logistic regression was used to identify factors associated with VF progression. Results:Among the 33 patients, 42.4% (14 eyes) showed VF progression. There was no significant difference in postoperative IOP between the progression and non-progression groups. Smoking was strongly associated with VF progression. Current smokers had a significantly higher risk (odds ratio [OR] = 9.333, 95% confidence interval [CI]: 1.653-52.685, P = 0.011), and past smokers also showed a significant association (P = 0.045). Conclusion:Smoking is a significant risk factor for VF progression in glaucoma patients after AGV implantation, even with adequate IOP control. Clinicians should assess smoking history and encourage smoking cessation to improve patient long-term outcomes. Further research with larger cohorts is needed to confirm these findings and explore additional risk factors.
Purpose:To evaluate changes at mounth-1, in corneal densitometry, corneal optical aberrations, best-corrected visual acuity, central corneal thickness, keratometric parameters, and intraocular pressure after neodymium yttrium aluminum garnet laser posterior capsulotomy. Methods:This retrospective self-controlled observational study included pseudophakic patients with visually significant posterior capsule opacification who underwent laser posterior capsulotomy. Preoperative and postoperative month-1 examinations included best-corrected visual acuity, intraocular pressure, keratometry, central corneal thickness, Scheimpflug-based corneal densitometry, and corneal aberration analysis. Densitometry was assessed in the 0-2, 2-6, 6-10, and 10-12 mm annular zones and in the anterior, central, posterior, and total corneal layers. Results:Forty-five eyes of 45 patients were analyzed. The mean age was 60 ± 18 years, and 23 patients (51.1%) were female. Best-corrected visual acuity improved significantly at postoperative month 1 (p < 0.001). Keratometric values, central corneal thickness, intraocular pressure, total root mean square, higher-order aberrations, spherical aberration, and coma values did not change significantly. Corneal densitometry did not show significant postoperative differences in the 0-2, 2-6, or 10-12 mm zones. However, significant increases were observed in the anterior, central, posterior, and total layers within the 6-10 mm zone (all p < 0.05). No intraoperative or postoperative complications occurred. Conclusions:Laser posterior capsulotomy was associated with a localized short-term increase in peripheral corneal densitometry in the 6-10 mm zone, without significant changes in central corneal thickness, keratometry, intraocular pressure, or corneal aberrations at 1 month. The clinical relevance and persistence of this subtle densitometric change require prospective evaluation.
Purpose:To evaluate postoperative dry eye outcomes associated with adjunctive topical 0.1% cyclosporine A (CsA) combined with early steroid tapering in patients undergoing combined pars plana vitrectomy (PPV) and cataract surgery for idiopathic epiretinal membrane (ERM). Methods:This retrospective study included 40 eyes of 40 patients who underwent combined 25-gauge PPV with ERM peeling and cataract surgery. Patients were managed with one of two postoperative regimens according to routine clinical practice: Group 1 received topical 0.1% CsA with early tapering and discontinuation of topical prednisolone acetate at 5 weeks, whereas Group 2 received prolonged topical prednisolone acetate monotherapy for 2 months. Ocular Surface Disease Index (OSDI), non-invasive tear breakup time (NIBUT), lipid layer thickness (LLT), tear meniscus height (TMH), partial blink ratio, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and central macular thickness (CMT) were evaluated preoperatively and postoperatively. Results:Significant changes over time were observed for BCVA (p = 0.002), OSDI (p = 0.005), and CMT (p = 0.016). A significant time-by-group interaction was observed for OSDI (p = 0.012). Post-hoc analysis showed that OSDI changes differed significantly between groups during the 1- to 2-month postoperative interval (p = 0.002) and from baseline to 2 months (p = 0.015). The between-group difference in OSDI change from baseline to 2 months was -14.9 points (95% confidence interval, -26.9 to -2.9). No significant between-group differences were observed in NIBUT, LLT, TMH, partial blink ratio, or CMT trends during follow-up. No severe postoperative complications were observed. Conclusions:Early steroid tapering combined with adjunctive topical 0.1% CsA may represent a potential postoperative management strategy for ocular discomfort in selected patients undergoing combined surgery for idiopathic ERM. Further prospective studies are required to validate these findings.
Purpose: This study aimed to identify the predominant adenoviral genotypes responsible for epidemic keratoconjunctivitis in South Korea and to evaluate genotype distribution and associated clinical manifestations based on molecular confirmation.Methods: Sixty-seven conjunctival swabs were obtained from patients clinically suspected of epidemic keratoconjunctivitis between October 2016 and December 2019. Viral nucleic acids were extracted using the QIAamp Viral Mini kit and processed via the QIAcube platform. Adenoviral genotypes were molecularly confirmed using polymerase chain reaction and sequencing of the hexon gene.Results: Of the 67 specimens, 45 (67.2%) showed positive genotyping results. Adenovirus types D8 (42.2%) and D37 (31.1%) were the predominant genotypes identified. From 2016 to 2018, D8 was the dominant genotype, whereas in 2019, additional genotypes, including B3, D53, D64, and E4, were newly detected during the study period. All patients with confirmed genotypes exhibited conjunctival hyperemia and follicular reaction. Pseudomembrane formation was observed in 68.4% of D8 cases and 57.1% of D37 cases. Corneal involvement, including epithelial defects and subepithelial infiltration, was frequently observed in genotypes D8, D37, D53, and D64, whereas genotypes B3 and E4 showed no corneal involvement, indicating potential trends toward genotype-associated clinical features.Conclusions: Adenoviral genotypes D8 and D37 were the predominant causes of epidemic keratoconjunctivitis in South Korea. In 2019, additional genotypes, including B3, D53, D64, and E4, were newly detected, suggesting temporal changes in genotype distribution during the study period. Corneal involvement was more frequently observed in D8, D37, D53, and D64, whereas B3 and E4 showed no corneal involvement. These findings provide descriptive epidemiologic data on adenoviral genotypes in South Korea and may serve as baseline information for future studies of genotype-associated clinical manifestations.
Purpose:To investigate the effect of higher cylindrical power and axis misalignment of toric SCL in mild and moderate astigmatism on visual acuity, contrast sensitivity, visual satisfaction, and vision acceptability. Methods:20 astigmatic participants underwent randomized experimental trial for the following conditions on different days: full cylinder power, higher cylindrical power by 0.5D, and higher cylindrical power by 1.0DC. Axis was also misaligned by -10 and +10degree for each cylinder power alteration. Baseline and outcome variables were assessed using: Snellen chart for visual acuity, Pelli-Robson Chart for contrast sensitivity, and VAS scale for visual clarity, satisfaction and vision acceptability. Results:Overcorrecting cylinder power resulted in significant effect (p<0.05) on all variables. Overall, higher cylindrical power by 1.0DC had stronger statistical evidence (p<0.01) than 0.5DC. There was no significant difference between the mild and moderate astigmatism groups, except for the visual acuity when higher cylindrical power by 0.5 D was implemented. Misalignment by both +10° and -10° had a significant effect on all variables, except contrast sensitivity. Conclusion:Toric SCL with higher cylindrical power by 0.5DC and 1.0DC as well as misalignment of 10° had a significant effect on visual acuity, contrast sensitivity, clarity, satisfaction, and vision acceptability in patients with mild to moderate astigmatism.
Purpose:This study investigates the relationship between retinal changes in proliferative diabetic retinopathy (PDR) patients and the severity of internal carotid artery (ICA) stenosis, using optical coherence tomography angiography (OCTA). The goal is to explore potential correlations between ICA stenosis and specific retinal parameters, aiding in risk factor identification. Methods:A retrospective analysis was conducted on 73 PDR patients (146 eyes), assessing carotid artery stenosis (CAS) severity via neck CT angiography and carotid doppler ultrasonography. Patients were divided into two groups based on ICA stenosis: normal to mild (Group I) and moderate or above (Group II). Retinal parameters, including the foveal avascular zone (FAZ) area and vessel density in both superficial and deep capillary plexuses, were analyzed using OCTA and Image J software. Statistical adjustments were made for age differences between the groups, and appropriate statistical methods were employed to account for the non-independence of eyes within the same patient and small sample size in Group II. Results:The average age was 64.84±9.4 years. Group II patients were on average about 5 years older than Group I, and this age difference was significant. After adjusting for age, significant differences remained between the groups in macular vessel density of the superficial plexus and FAZ area, with Group II showing decreased vessel density and increased FAZ area in severe ICA stenosis cases. However, deep capillary plexus vessel density showed no significant variation. Conclusions:OCTA demonstrates that increased ICA stenosis in PDR patients correlates with decreased macular vessel density and expanded FAZ area, underscoring the need for carotid assessments. Early microvascular changes detectable by OCTA, even at mild NPDR stages, may indicate disease progression, positioning OCTA as a crucial non-invasive monitoring tool.
Purpose:To compare the clinical outcomes of sutureless scleral-fixated posterior chamber intraocular lens (SFIOL) implantation performed with fibrin glue versus without fibrin glue in eyes with inadequate posterior capsular support. Methods:This prospective, randomized, comparative clinical study included 40 eyes of 40 patients requiring secondary intraocular lens implantation. Patients were randomly allocated into two groups: Group A (n = 20) underwent glued sutureless SFIOL implantation using fibrin glue, and Group B (n = 20) underwent non-glued sutureless SFIOL implantation. Preoperative evaluation included visual acuity, intraocular pressure (IOP), anterior segment assessment, corneal pachymetry, specular microscopy, and posterior segment examination. Outcome measures included surgical time, intra-operative complications, postoperative visual acuity, anterior segment parameters, IOP changes, scleral flap healing, pupillary abnormalities, and IOL centration. Patients were followed for a minimum of six months. Results:Both groups demonstrated significant improvement in best-corrected visual acuity postoperatively (p < 0.001), with no significant intergroup difference at final follow-up (p = 0.853). Mean surgical time was longer in the glued IOL group but was not statistically significant (p = 0.361). A statistically significant postoperative rise in IOP was observed only in the glued IOL group (p = 0.049). Endothelial cell loss, corneal clarity, anterior chamber depth changes, and IOL centration were comparable between the two groups. Intra-operative and postoperative complications were generally mild and manageable. Conclusion:Both glued and non-glued sutureless scleral-fixated IOL techniques provide comparable visual and anatomical outcomes in eyes lacking capsular support. The non-glued technique offers a cost-effective alternative without compromising safety or efficacy and may be particularly advantageous in resource-limited settings.
