Published papers

Purpose: To evaluate the effect of age on anterior chamber depth (ACD) and anterior chamber volume (ACV) after laser in situ keratomileusis (LASIK) for myopia. Setting: Department of Ophthalmology, Keio University School of Medicine, and a private clinic, Tokyo, Japan. Methods: In this retrospective study, patients who had uneventful LASIK for myopia or myopic astigmatism were divided into 2 groups: younger (younger than 40 years) and older (40 years and older). Central corneal thickness, central corneal true net power, ACV, and central ACD were measured using a rotating Scheimpflug camera preoperatively and 1 month postoperatively. These parameters were compared between the 2 groups. Results: The study evaluated 161 eyes of 83 patients (mean age 34.5 years ± 8.3 [SD]). The decreases in central ACD and ACV after LASIK were statistically significant in the younger group (P<.0001 and P = .0050, respectively) but not in the older group. Conclusion: Central ACD and the ACV decreased significantly after LASIK in younger patients (<40 years) but not in older patients, indicating that age influences changes in ACD and ACV after LASIK. © 2009 ASCRS and ESCRS.

Purpose: To evaluate the feasibility of correcting spherical aberration with aspheric intraocular lenses (IOLs) in cataract surgery based on individual pupil diameter. Setting: Keio University Hospital, Tokyo, Japan. Methods: In this prospective study, eyes having cataract surgery were divided into 4 groups based on IOL type: aspheric SN (AcrySof SN60WF), aspheric ZA (Tecnis ZA9003), aspheric PY (Hoya PY-60 AD), and spherical (AcrySof Natural SN60AT). Postoperative higher-order aberrations (HOAs) of the cornea and whole eye and the pupil diameter under photopic and mesopic conditions were measured. The HOA was calculated using the individual pupil diameter. The correlation between corneal and ocular spherical aberrations and pupil diameter was evaluated. Results: Each group comprised 30 eyes. Ocular spherical aberrations were significantly lower than corneal spherical aberrations under mesopic conditions in the aspheric SN group, the aspheric ZA group, and the aspheric PY group (P<.05); there was no significant difference between the aberrations in the spherical group. Linear regression showed significant correlations between postoperative corneal and ocular spherical aberrations (β = 0.39, aspheric SN; β = 0.38, aspheric ZA; β = 0.58, aspheric PY; β = 0.79, spherical). The differences in corneal and ocular spherical aberrations were significantly correlated with pupil diameter in the aspheric IOL groups but not in the spherical IOL group. Conclusions: The amount of spherical aberration correction by aspheric IOLs varied depending on IOL type and individual pupil diameter. The linear regression equation in this study may make it possible to customize postoperative ocular spherical aberration after cataract surgery. © 2009 ASCRS and ESCRS.

Purpose: To evaluate the status of periglandular inflammation, ocular surface and tear function alterations in patients with obstructive meibomian gland disease (OMGD) by in vivo confocal microscopy before and after anti-inflammatory treatment, and to compare the results with patients receiving only topical non-preserved artificial tears and sodium hyaluronate eye drops without anti-inflammatory agents. Methods: Thirty-two eyes of 16 OMGD patients receiving anti-inflammatory treatment (treatment group) and 22 eyes of 11 OMGD patients receiving only topical non-preserved artificial tears and sodium hyaluronate eye drops (control group) were recruited in this prospective study. All subjects underwent slit-lamp examinations, tear film break-up time (BUT) measurements, fluorescein and Rose-Bengal stainings, Schirmer test I without anesthesia, transillumination of the lids (meibography), and in vivo laser confocal microscopy of the lids (HRTII-RCM). Results: The mean BUT, fluorescein staining scores, and inflammatory cell densities observed by in vivo confocal microscopy improved significantly in the group receiving anti-inflammatory treatment (p<0.05), whereas no significant alterations of these parameters were observed in the group not receiving anti-inflammatory agents (p>0.05). Conclusions: In vivo confocal microscopy was able to effectively demonstrate the treatment responses in patients with OMGD. Inflammatory cell density calculation seems to be a promising new parameter of in vivo confocal microscopy in the evaluation of treatment responses. © Springer-Verlag 2008.

PURPOSE: To report the changes in functional visual acuity in cataract surgery patients with good pre- and postoperative visual acuity. METHODS: Functional visual acuity was evaluated in 13 eyes of 10 patients before and 1 month after phacoemulsification with implantation of acrylic intraocular lenses. Pre- and postoperative best spectacle-corrected visual acuities (BSCVA) were better than 20/25 in all patients. Low contrast visual acuity and Schirmer tests were also performed before and after surgery. RESULTS: Mean pre- and postoperative logMAR BSCVA were -0.02±0.06 and -0.05±0.04, respectively (P>.05). Mean preoperative logMAR functional visual acuity improved from 0.29±0.17 to 0.092±0.13 post-operatively (P<.05). The visual maintenance ratio in functional visual acuity and low contrast visual acuity also improved significantly after cataract surgery (P<.05). CONCLUSIONS: Measurement of functional visual acuity seems to be useful in the evaluation of timing of surgery, visual quality, and changes in kinetic vision after phacoemulsification surgery.

Purpose: To evaluate irregularity of the anterior and posterior cornea before and after Descemet-stripping endothelial keratoplasty (DSEK) and its effect on visual acuity. Setting: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. Methods: Corneal data were acquired using a rotating Scheimpflug camera before and 1 month and 3 months after DSEK. Anterior and posterior corneal elevation data were decomposed into a set of Zernike polynomials up to the 8th order within a 4.0 mm diameter region. Total higher-order root mean square (HO-RMS) and RMS from the 3rd to 8th order were calculated. The effects of anterior and posterior surface irregularity on visual acuity were evaluated. Results: This clinical study comprised 13 consecutive eyes of 12 bullous keratopathy patients. The mean best corrected visual acuity (BCVA) was 1.11 logMAR ± 0.5 (SD) preoperatively, 0.49 ± 0.49 logMAR 1 month postoperatively, and 0.27 ± 0.32 logMAR at 3 months. The HO-RMS of the anterior surface 1 month (P = .040) and 3 months (P = .048) postoperatively was significantly lower than preoperatively. There were no significant differences in posterior surface HO-RMS between preoperatively and 1 month (P = .45) and 3 months (P = .054). The postoperative BCVA was significantly correlated with HO-RMS (P<.001), but not with posterior surface HO-RMS, at 3 months (P = .354). Conclusion: Postoperative BCVA correlated with irregularity of the anterior surface but not the posterior surface. In addition to corneal transparency, regularity of the anterior surface is an important factor in visual acuity after DSEK. © 2009 ASCRS and ESCRS.

PURPOSE: To evaluate the factors affecting postoperative visual function in eyes with Artisan phakic intraocular lenses (PIOLs). METHODS: This study examined a retrospective noncomparative case series. Phakic IOLs were implanted in 60 eyes of 36 patients with high myopia. Contrast sensitivity for spatial frequencies of 1.1, 1.7, 2.6, 4.2, 6.6, and 10:4 cycles per degree with and without glare and wavefront aberrations were measured before and 3 months after surgery. The area under the log contrast sensitivity function (AULCSF) was calculated from the contrast sensitivity. Stepwise regression analysis was used to assess the factors that affected the postoperative AULCSF. RESULTS: No significant difference was noted between the preoperative AULCSF without glare and the postoperative AULCSF without glare (P=.886). The mean AULCSF with glare improved significantly after surgery (P=.018). The variables affecting the postoperative AULCSF without glare were axial length (partial regression coefficient B=-0.101, P=.0002) and age (B=-0.008, P=.0063). The variables affecting the postoperative AULCSF with glare were axial length (B=-0.127, P<.0001) and age (B=-0.012, P=.0294). The preoperative refraction showed multicollinearity with the axial length, and coma-like aberration and spherical aberration showed multicollinearity with age. CONCLUSIONS: Contrast sensitivity without glare was the same before and after surgery and contrast sensitivity with glare improved after surgery. Longer axial length and older age predispose patients to degradation of the postoperative visual function in eyes with Artisan PIOLs.

PURPOSE: To evaluate the factors affecting postoperative visual function in eyes with Artisan phakic intraocular lenses (PIOLs). METHODS: This study examined a retrospective non-comparative case series. Phakic IOLs were implanted in 60 eyes of 36 patients with high myopia. Contrast sensitivity for spatial frequencies of 1.1, 1.7, 2.6, 4.2, 6.6, and 10.4 cycles per degree with and without glare and wavefront aberrations were measured before and 3 months after surgery. The area under the log contrast sensitivity function (AULCSF) was calculated from the contrast sensitivity. Stepwise regression analysis was used to assess the factors that affected the postoperative AULCSF. RESULTS: No significant difference was noted between the preoperative AULCSF without glare and the postoperative AULCSF without glare (P=.886). The mean AULCSF with glare improved significantly after surgery (P=.018). The variables affecting the postoperative AULCSF without glare were axial length (partial regression coefficient B = -0.101, P=.0002) and age (B = -0.008, P=.0063). The variables affecting the postoperative AULCSF with glare were axial length (B=-0.127, P<.0001) and age (B = -0.012, P=.0294). The preoperative refraction showed multi- collinearity with the axial length, and coma-like aberration and spherical aberration showed multicollinearity with age. CONCLUSIONS: Contrast sensitivity without glare was the same before and after surgery and contrast sensitivity with glare improved after surgery. Longer axial length and older age predispose patients to degradation of the postoperative visual function in eyes with Artisan PIOLs. [J Refract Surg. 2009;25:25-32.].

Purpose: To evaluate the effect of spherical aberration on visual function under natural pupil conditions after cataract surgery. Setting: Keio University Hospital, Tokyo, Japan. Methods: This study comprised cataract patients who had cataract extraction with implantation of an acrylic intraocular lens. Preoperative and postoperative visual acuity, higher-order aberration in the whole eye, contrast sensitivity function, and pupil diameter under photopic and mesopic conditions 1 month after surgery were measured. The area under log contrast sensitivity function (AULCSF) and spherical aberration corresponding to the individual pupil diameter under photopic and mesopic conditions were evaluated. Results: One hundred seven eyes of 79 patients (30 men, 49 women; mean age 68.0 years ± 9.6 [SD]) were evaluated. The mean pupil diameter was 2.9 ± 0.50 mm under photopic conditions and 3.6 ± 0.57 mm under mesopic conditions. The mean spherical aberration was 0.03 ± 0.04 μm (range -0.12 to 0.34 μm) under photopic conditions and 0.05 ± 0.10 μm (range -0.14 to 0.55 μm) under mesopic conditions. The postoperative AULCSF without glare under photopic conditions was significantly negatively correlated with spherical aberration (P = .014). The postoperative AULCSF with and without glare under mesopic conditions was significantly negatively correlated with spherical aberration (P<.001 and P = .01, respectively). Conclusions: Postoperative spherical aberration had a significant effect on visual function under photopic and mesopic conditions. This result indicates that reduced postoperative spherical aberration improves postoperative visual function under photopic and mesopic conditions. © 2009 ASCRS and ESCRS.

Purpose: To evaluate anterior chamber angle alterations after phakic intraocular lens (pIOL) implantation using the Pentacam rotating Scheimpflug camera (Oculus) and the effect on intraocular pressure (IOP) and anterior chamber inflammation. Setting: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. Methods: Twenty eyes of 11 patients with high myopia who had implantation of pIOLs (Artisan/Verisyse, model 204, Ophtec BV) were included. All pIOLs were fixated on the iris near the 3 o'clock and 9 o'clock positions. Angles at the 2, 3, 4, 8, 9, and 10 o'clock positions, IOP, and postoperative flare were evaluated retrospectively. Results: The mean angle degree at 2, 3, 4, 8, 9, and 10 o'clock was 40.3 degrees ± 3.3 (SD) preoperatively and 36.5 ± 5.8 degrees postoperatively; the postoperative angles were significantly narrower than the preoperative angles (P<.001). The mean angles at 3 o'clock and 9 o'clock were 39.8 ± 3.7 degrees and 40.6 ± 3.5 degrees, respectively, preoperatively and 32.7 ± 6.0 degrees and 31.3 ± 5.4 degrees, respectively, postoperatively. The postoperative angles at 3 o'clock and 9 o'clock were narrower than the preoperative angles (P<.001). There was no significant difference between preoperative IOP and postoperative IOP (P = .22). The flare at 1 month (r = 0.573, P = .0071) and 1 year (r = 0.700, P = .004) was significantly correlated with the angle change. Conclusion: Partial localized narrowing of anterior chamber angles that occurred after pIOL implantation induced acute and chronic anterior chamber inflammation in patients with large angle alterations. © 2008 ASCRS and ESCRS.

PURPOSE: To report steroid-induced glaucoma after photorefractive keratectomy (PRK). METHODS: A 50-year-old Japanese woman was referred for end-stage glaucoma 9 months after PRK. Topical fluorometholone 0.1% was administered for corneal subepithelial haze in both eyes for 9 months after PRK. Pneumatic non-contact tonometry values of intraocular pressure (IOP) remained normal (range: 11 to 17 mmHg), until she was diagnosed with end-stage steroid-induced glaucoma with extensive restriction in visual fields. At the patient's initial examination in our hospital, IOP measured by Goldmann applanation tonometry was 34 mmHg in the right eye and 32 mmHg in the left eye, but the estimated IOP as corrected by central corneal thickness measurement was >40 mmHg in both eyes. RESULTS: The patient underwent uneventful bilateral trabeculectomies, resulting in reduction of IOP to <10 mmHg in both eyes. CONCLUSIONS: The underestimation of IOP after PRK led to advanced visual field loss. Careful evaluation of IOP, optic disc, and visual field tests are indispensable to avoid such a devastating outcome after PRK.

Purpose: To report short-term outcome of epipolis LASIK for refractive anomaly. Cases: This retrospective study was made on 28 eyes of 14 cases who received epipolis LASIK for myopia with or without astigmatism. The series comprised 6 males and 8 females. The age averaged 32.6 ± 7.2 years. All had myopia ranging from - 2.25D to -9.63 diopters. Astigmatism ranged from 0 to 2.5 diopters. Uncorrected visual acuity ranged from 0.032 to 0.2. All the eyes had corrected visual acuity of 1.0 or over. Results: Three months after treatment, the refraction was within 0.5 diopter from the target value in 20 eyes (71%) and within 1.0 diopter in 27 eyes (96%). Safety index was 1.07 and efficacy index was 0.85. As intraoperative complication, free flap and incomplete flap developed in one eye each. Two eyes had temporary haze after surgery. There was no serious postoperative complication. Conclusion: Judging from 3-month results, epipolis LASIK appears to be safe and effective. Improvement of nomogram may contribute to better outcome.

Purpose: To study the effect of higher-order aberrations (HOAs) on visual function in keratoconus with a rigid gas permeable (RGP) contact lens (CLs). Design: Retrospective nonrandomized study. Methods: Thirteen eyes of 10 subjects with keratoconus who wore a RGP CLs (KC-RGP group), 15 eyes of nine normal subjects (normal group), and 14 eyes of nine subjects who wore a RGP CLs (RGP group) who had no ocular diseases except for refractive errors and had 20/20 or better-corrected visual acuity were included in this study. The root-mean-square (RMS) of the third-, fourth-, fifth-, and sixth-order Zernike coefficients (total HOAs), the RMS of the third-order Zernike coefficients (S3) (coma-like aberration), the RMS of the fourth-order coefficients (S4) (spherical-like aberrations), and the area under the log contrast sensitivity function (AULCSF) were evaluated. Results: The AULCSF in the KC-RGP group was significantly lower than in the other two groups. The total HOAs, S3, and S4 in the KC-RGP group were significantly higher than in the other two groups. There were significant negative correlations between the area under the log contrast sensitivity function and the total HOAs, S3, and S4. Conclusions: The visual performance in a keratoconic eye with a RGP CLs degrades compared with normal eyes with and without RGP CLs, even if the corrected VA is good. The degradation is assumed to be related to residual HOAs in a keratoconic eye with a RGP CLs. © 2007 Elsevier Inc. All rights reserved.

Purpose: To evaluate structural changes in the cornea and anterior chamber (AC) after LASIK for myopia. Design: Retrospective nonrandomized study. Participants: One hundred sixty-one eyes of 83 patients (mean age, 34.5±8.3 years) who underwent uneventful LASIK for myopia and myopic astigmatism. The preoperative refractive error (spherical equivalent) and corneal thickness were -6.02±2.10 diopters (D) and 549.9±29.3 μm, respectively. Methods: The AC volume (ACV), AC depth (ACD), corneal thickness, central corneal true net power, and posterior corneal tangential curvature were measured using a rotating Scheimpflug camera before and 1 week and 1 month after surgery. In 84 eyes of 42 cases, anterior and posterior corneal elevations and corneal thicknesses also were measured by scanning-slit topography before and 1 month after surgery. Main Outcome Measures: Time course of the ACV, ACD (central, midperiphery, periphery), corneal thickness, central corneal true net power, posterior corneal tangential curvature using the Scheimpflug camera, and amount of forward shifting of the posterior corneal surface at the center of the difference map using scanning-slit topography. Results: Preoperative and 1-month postoperative mean ACVs were 198.1 mm3 and 196.4 mm3, respectively, and preoperative and postoperative mean ACDs (center, midperiphery, periphery) were 3.24, 2.65, and 1.89 mm, and 3.21, 2.63, and 1.87 mm, respectively. The corneal thickness within the optical zone, subjective refraction, and central corneal true net power significantly changed by tissue subtraction after LASIK (P<0.0001). There were no significant differences in the ACV, ACDs (center, midperiphery, periphery), peripheral corneal thickness, and posterior corneal tangential curvature from preoperatively to 1 month after LASIK. However, using scanning-slit topography, the posterior corneal surface displayed a mean forward shift of 29.0±19.0 μm 1 month after surgery. Conclusion: The posterior corneal curvature, peripheral corneal thickness, ACDs, and ACV were consistent. These observations indicated that neither forward shifting of the central posterior corneal surface (bulging) nor backward shifting of the peripheral posterior corneal surface due to corneal swelling after ablation occurred after LASIK. © 2007 American Academy of Ophthalmology.

Purpose: To evaluate optical function in cataractous and pseudophakic eyes using the new point spread function (PSF) analysis system in a clinical setting. Methods: We applied this new analysis system in the study of two cataractous eyes and one pseudophakic eye of two patients. Using a PSF analyzer, double-pass PSF was measured directly for each subject, and the single-pass modulation transfer function (MTF) and single-pass PSF were calculated. The simulated retinal images of various sizes of Landolt's rings and their contrast characteristics were also calculated by the PSF analyzer. Results: The MTF and the contrast of the simulated retinal images degraded in cataractous eyes were compared with data for normal eyes; the degradation pattern depended on the opacification pattern. The MTF and the contrast of the simulated retinal images in the pseudophakic eye improved significantly compared with the cataractous eyes, although both values were lower in the pseudophakic eye than in young normal eyes. Conclusions: Our data showed degradation of optical function in cataractous and pseudophakic eyes in comparison with optical function in young normal eyes. If further accumulations of PSF data are made, it may be possible to establish an objective standard by which to measure the progression of cataract, as well as an objective indication for treatment in the future. © Japanese Ophthalmological Society 2006.