論文

Purpose: To evaluate the accuracy of intraocular lens (IOL) power calculations using ray tracing software in eyes after myopic laser in situ keratomileusis (LASIK). Methods: Twenty-four eyes of 17 cataract patients who underwent phacoemulsification and IOL implantation after myopic LASIK were analyzed retrospectively. The IOL power calculation was performed using OKULIX ray tracing software. The axial length was measured using the IOLMaster and keratometry data using TMS2N. The accuracy of the IOL power calculation using OKULIX was compared with those using the Camellin-Calossi, Shammas-PL, Haigis-L formulas and the double-K SRK/T formula using 43.5 diopters (D) for the Kpre. Results: The mean values of the arithmetic and absolute prediction errors were 0.63 ± 0.85 and 0.80 ± 0.68 D, respectively. The arithmetic prediction error by OKULIX was a significant hyperopic shift of the distribution of the postoperative refractive errors compared to the Camellin-Calossi, Shammas-PL and Haigis-L formulas (P < 0.05), and the absolute prediction error showed no significant difference with other formulas. The prediction errors using OKULIX were within ±0.5 D in 10 eyes (41.7 %) and within ±1.0 D in 18 eyes (75.0 %). The percentages of eyes within ±1.0 D using OKULIX were comparable to those obtained using the Camellin-Calossi, the Shammas-PL formulas and the double-K SRK/T formula using 43.5 D for the Kpre, and significantly (P < 0.05) higher than that obtained using the Haigis-L formula. Conclusions: IOL power calculations using OKULIX provided predictable outcomes in eyes that had undergone a previous myopic LASIK. © 2014 Japanese Ophthalmological Society.

Purpose: To evaluate the postoperative outcome of toric intraocular lens (TIOL) implantation for cataract patients with high corneal astigmatism. Methods: This retrospective study included 24 eyes of 22 patients with high corneal astigmatism exceeded-1.50 D who underwent cataract surgery and implantation of TIOL (SN6AT6:12 eyes, SN6AT7:8 eyes, SN6AT8:3 eyes, SN6AT9:1 eye). The mean age of all cases was 68.1 years. Visual acuity, corneal astigmatism, subjective refraction, and rotation error were recorded preoperatively and 1 month postoperatively. Results: The uncorrected and correted distance visual acuities and subjective refraction were significantly (p<0.001) improved after TIOL implantation. There was no significant difference in corneal astigmatism between preoperatively and postoperatively. The mean rotation error was 2.8°. Conclusion: TIOL was effective for cataract patients with high corneal astigmatism.

PURPOSE: In myopia, biometry including the axial length is important, along with the refractive data. We compared the rates of myopic regression 3 years after phakic intraocular lens (pIOL) implantation and laser in situ keratomileusis (LASIK) after matching the preoperative axial length in highly myopic eyes of Japanese patients. METHODS: This retrospective nonrandomized study included 133 eyes of 84 patients with myopia exceeding -6.00 diopters (D) who underwent implantation of two iris-fixated pIOLs (pIOL group, 66 eyes/46 patients) or myopic LASIK (LASIK group, 67 eyes/38 patients) who were followed for more than 3 years postoperatively. The patient age, preoperative refraction, and preoperative axial length were matched between the study groups. RESULTS: There were no significant differences preoperatively between the groups in age, intraocular pressure, refraction, keratometry, or axial length. The mean regression values after 3 years compared with the 1-month postoperative refractions were -0.12 ± 0.47 (SD) D in the pIOL group and -0.82 ± 0.69 D in the LASIK group (p < 0.001). The differences in the mean regression rates between 1 and 12 months, 12 and 24 months, and 24 and 36 months of follow-up were, respectively, 0.09 ± 0.38 D, -0.11 ± 0.35 D, and -0.11 ± 0.30 D in the pIOL group and -0.57 ± 0.84 D, -0.24 ± 0.47 D, and 0.00 ± 0.53 D in the LASIK group (p < 0.001, p = 0.07, p = 0.15, respectively). CONCLUSIONS: There was a significant difference in myopic regression 3 years postoperatively between the groups matched for preoperative axial length in Japanese patients. This result has the potential to elucidate myopia in the future. Copyright © 2014 American Academy of Optometry.

Purpose: To report a case who received implantation of piggyback intraocular lens (IOL) for residual refractive error after cataract surgery. Case: A 70-year-old man presented to our clinic complaining of decreased visual acuity in his both eyes. Both eyes had received radial keratotomy 23 years before and photorefractive keratectomy 12 years before. Findings: Visual acuity was 0.5 right and 0.4 left without correction, and 0.9 right and 1.0 left with correction. Under diagnosis of age-related cataract, both eyes received phacoemulsification-aspiration with IOL implantation. Visual acuity was 0.5 in either eye without correction and 1.2 right and 1.0 left with correction one year later. The left eye had refraction of +3.00D()cyl-2.00D 65°. By request of the patient, monofocal piggyback IOL was implanted into the left eye. Six months after surgery, left visual acuity was 0.63 without and 1.0 with correction. There has been no complication throughout. Conclusion: Implantation of piggyback IOL can be a therapeutic option for residual refractive error after cataract surgery.

PURPOSE: To evaluate surgically induced changes in corneal, internal, and ocular higher-order aberrations (HOAs) after phakic intraocular lens (PIOL) implantation and compare them between two PIOLs with different pupillary diameters. METHODS: Twenty-three eyes with an Artisan PIOL (Ophtec BV, Groningen, The Netherlands) (Artisan group) and 30 eyes with an Artiflex PIOL (Ophtec BV) (Artiflex group) were retrospectively evaluated. The corneal, internal, and ocular HOAs and refractive data were recorded preoperatively and 6 months postoperatively. The root mean squares (RMSs) of the total HOAs from the third- to sixth-order Zernike coefficients were calculated. The RMSs of the third- and fourth-order coefficients represented coma-like aberrations (S3) and spherical-like aberrations (S4), respectively. The main outcome measures were the differences in the parameters among the groups with different pupillary diameters. RESULTS: The mean postoperative spherical equivalents decreased from -11.84 ± 4.90 to -0.16 ± 0.40 diopters and -9.78 ± 3.20 to -0.09 ± 0.26 diopters in the Artisan and Artiflex groups, respectively. With the 4- and 5-mm pupillary diameters, the postoperative internal and ocular spherical aberrations (Z40) were significantly lower in the Artiflex group than in the Artisan group (4 mm, P = .002, .024; 5 mm, P = .004, .022, respectively). With the 6-mm pupillary diameter, there were no significant postoperative differences in any parameter measured between groups; both groups had positive spherical aberration values. CONCLUSIONS: The postoperative ocular spherical aberrations were positive after Artisan and Artiflex implantation. The postoperative ocular spherical aberration was greater in the Artisan group, possibly due to differences in the SAs of both PIOLs. Copyright © SLACK Incorporated.

Purpose: To propose the central-peripheral (C-P) method, which requires no data history to calculate intraocular lens (IOL) powers for eyes that underwent laser in situ keratomileusis (LASIK), and compare the accuracy of the C-P method with other IOL formulas for eyes after LASIK. Methods: Sixteen patients with cataract (25 eyes) who underwent myopic LASIK were analysed retrospectively. The C-P method is a modified double-K method using the SRK/T formula, in which the estimated pre-LASIK keratometric power calculated from the post-LASIK peripheral anterior sagittal power (also called the axial power) is used for the Kpre in the double-K method using the SRK/T formula, and the post-LASIK anterior sagittal power is used for the Kpost. We compared the accuracy of the C-P method with other popular IOL calculation formulas for use in eyes after LASIK. Results: The median values of the arithmetic and absolute prediction errors with the C-P method were 0.11 diopter (D) (range, -1.67 to 1.97 D) and 0.55 D (range, 0.02-1.97 D), respectively. The prediction error using the C-P method was within ±0.5 D in 48% of eyes, within -1.0 to +0.5 D in 60% of eyes, and within ±1.0 D in 68% of eyes. The C-P method resulted in a significantly higher percentage of eyes within ±0.5 D than the BESSt formula, Shammas-PL formula, true net power method, double-K method using 43.5 D for Kpre, and Feiz-Mannis method. Conclusion: The C-P method may be a good option for calculating IOL powers in eyes undergoing cataract surgery after LASIK when the preoperative LASIK data are unavailable. © 2013 The Authors Acta Ophthalmologica © 2013 Acta Ophthalmologica Scandinavica Foundation.

To report a case who received exchange of intraocular lens (IOP) for impaired vision due to glistening and whitening. Case: A 78-year-old woman presented with impaired vision in her right eye. She had received cataract surgery with implantation of IOL 6 years before. She had had reportedly visual acuity of 0.8 immediately after surgery. Findings: Corrected visual acuity was 0.4 in the right eye. Slitlamp examination showed glistening and whitening of IOP. Funduscopy showed slight chorioretinal atrophy which was the same as immediately after surgery. She received exchange of IOL resulting in corrected visual acuity of 0.8. Conclusion: This case illustrates that glistening and whitening of IOL may result in impaired visual function. Exchange of IOL may be useful in such a situation.

PURPOSE: To study the effect of pupil size on the relationship between refractive astigmatism and uncorrected distance visual acuity (UDVA) and pseudoaccommodation in pseudophakic eyes. METHODS: Thirty-six eyes from 36 patients who underwent phacoemulsifi cation and intraocular lens (IOL) implantation were included. All eyes were divided into two groups based on the presence of postoperative with-therule astigmatism or against-the-rule astigmatism. Uncorrected and corrected distance visual acuity (CDVA), refractive astigmatism, subjective accommodation amplitude, and pupil sizes under photopic and mesopic conditions were measured 1 month postoperatively. The effects of pupil size on the relationship between refractive astigmatism and UDVA were investigated. RESULTS: Against-the-rule astigmatism had a moderate but signifi cant negative linear correlation with UDVA irrespective of the pupil size (R2=0.60, P<.01). A moderate but signifi cant negative linear correlation was found when the pupil diameter exceeded 2.9 mm in eyes with with-the-rule astigmatism (R2=0.46, P=.04). Refractive astigmatism was not signifi cantly correlated with pseudoaccommodation regardless of the pupil diameter in either group. CONCLUSIONS: The results of the current study suggest that pupil size may have an impact on postoperative UDVA in eyes having against the-rule astigmatism and in eyes with a large pupil diameter and with-the-rule astigmatism. Copyright © SLACK Incorporated.

PURPOSE: To report the changes in functional visual acuity (FVA) in eyes with experimentally induced astigmatism. METHODS: This study included 26 right eyes from 26 healthy participants (mean age: 27.0±4.4 years). After confi rming best correction under cycloplegia, the cylinder power ×90° and ×180° (against-the-rule [ATR] and with-the-rule [WTR] astigmatism, respectively) were added with 0.50-diopter (D) steps, from 0.50 to 2.50 D. Conventional visual acuity (VA), FVA as measured by the FVA Measurement System (NIDEK Co Ltd), and 10% low-contrast visual acuity (LCVA) were measured with 3-mm artifi cial pupil under each condition. RESULTS: The mean corrected logMAR VA, FVA, LCVA were -0.18±0.00 (20/13), -0.10±0.08 (20/16), and 0.06±0.06 (20/23), respectively. The VA, FVA, and LCVA had a signifi cant linear negative correlation with the addition of cylinder irrespective of the axes. A significant decrease in FVA was noted on addition of ≥0.50 D WTR astigmatism and ≥1.00 D ATR astigmatism. With the addition of 1.00 D of cylindrical lens, 96% of eyes with WTR and ATR astigmatism could maintain 20/20 in VA testing, whereas only 50% and 62% of eyes with WTR and ATR astigmatism, respectively, could maintain 20/20 in FVA testing. CONCLUSIONS: Astigmatism may be associated with deterioration of visual function even when conventional VA of 20/20 is attained. Functional VA testing seems to be useful in evaluating the masked astigmatic visual impairment that cannot be detected by conventional VA testing. Copyright © SLACK Incorporated.

Purpose: To describe a new method of alignment of toric intraocular lenses (IOLs) and evaluation of their rotation errors using anterior segment optical coherence tomography (AS-OCT). Methods: Twenty-nine eyes of 22 patients who had cataract extraction and implantation of an acrylic toric IOL were included. The new AS-OCT method was used for the alignment of toric IOLs and evaluation of their rotation errors. These rotation errors were evaluated and compared with those measured using the internal map of a wavefront aberrometer. Results: The mean rotation error ± standard deviation (SD) of the toric IOLs evaluated by AS-OCT was 3.2 ± 2.2° and 3.2 ± 2.4° at 1 week and 1 month after surgery, respectively. The mean difference in the reference axis between the visits was 1.8 ± 2.1°. The mean difference between the rotation errors of the alignment axes measured by AS-OCT and the internal map was 2.5 ± 1.9° (P = 0.037). Conclusion: The current method is clinically useful not only for the accurate alignment of toric IOLs but also for evaluating their rotation errors. © Japanese Ophthalmological Society 2011.

Purpose : To report two cases who had received LASIK previously and who underwent cataract surgery with implantation of multifocal intraocular lens (IOL). Cases and Findings : Both were males aged 47 and 55 years respectively. LASIK had been performed 6 years and 2 years before respectively. Both cases were diagnosed with cataract in the right eye. Corrected visual acuity was 1.2 and 0.7 respectively. The affected eye was treated by cataract surgery and implantation of diffractive multifocal IOL. After surgery, near and far visual acuity with the naked eye was 1.2 and 1.0 in one case and 1.0 each in the other. Both patients expressed satisfaction with the outcome. Contrast sensitivity was at the lower limit of normal range in both cases. Conclusion : These two cases illustrate that refractive error and impaired visual function may result following implantation of multifocal IOL after LASIK. We advocate due explanation to obtain informed consent in such cases.

Purpose: To evaluate the predictability of total postoperative spherical aberration after aspheric intraocular lens (IOL) implantation using preoperative corneal spherical aberration. Setting: Keio University Hospital, Tokyo, Japan. Methods: Corneal and ocular higher-order aberrations (HOAs) were analyzed preoperatively and postoperatively in eyes having cataract extraction with aspheric IOL implantation. The predicted postoperative total spherical aberration Z(4,0) was calculated by adding the preoperative corneal spherical aberration and the labeled spherical aberration of the IOL. The prediction error of the postoperative total spherical aberration was calculated by subtracting the predicted postoperative total spherical aberration from the postoperative total spherical aberration. Surgically induced corneal spherical aberration was calculated by subtracting the postoperative from the preoperative corneal spherical aberration. Results: There were no statistically significant differences between preoperative and postoperative corneal spherical aberration, 3rd-order aberration, or HOAs. The prediction error of the postoperative total spherical aberration was within ±0.05 μm in 9 (24.3%) of the 37 eyes evaluated and within ±0.10 μm in 18 eyes (48.6%). Statistically significantly correlations were found between the surgically induced corneal spherical aberration and prediction error of postoperative total spherical aberration, the preoperative corneal spherical aberration and surgically induced corneal spherical aberration, and the preoperative corneal spherical aberration and prediction error of postoperative total spherical aberration. Conclusions: Predictability of postoperative ocular spherical aberration after cataract surgery with aspheric IOL implantation was insufficient because of the surgically induced corneal spherical aberration. Considering surgically induced corneal spherical aberration could improve the predictability of postoperative ocular spherical aberration. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2010 ASCRS and ESCRS.

Purpose : To report two cases who received replacement of multifocal intraocular lens (IOL) by monofocal IOL due to postoperative dissatisfaction. Cases : A 75-year-old male received bilateral cataract surgery with implantation of diffractive multifocal IOL. Asthenopia and photophobia became worse after surgery. In accordance to his wish, the multifocal IOL was replaced by monofocal IOL 4 months later. His subjective complaints persisted but improved after treatment for essential blepharospasm. Another 52-year-old female received similar bilateral cataract surgery with implantation of refractive multifocal IOL. The lens was replaced by monofocal one due to photophobia 4 months later. Her subjective complaints persisted. Conclusion : These cases illustrate that replacement of multifocal by monofocal IOL due to dissatisfaction of patients need careful considerations.

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.

Aim: To present a patient who developed bilateral endogenous endophthalmitis secondary to Streptococcus pneumoniae meningitis. Methods: A 44-year-old man who was unconscious because of bacterial meningitis was referred to us for conjunctival hyperemia and decreased pupillary light reflexes. Ophthalmoscopy revealed inflammation in the anterior chamber and vitreous opacities in both eyes. He was diagnosed as having endogenous endophthalmitis associated with the meningitis. Ceftazidime and vancomycin hydrochloride were injected intravitreally and subconjunctivally repeatedly in both eyes. Results: Vision improved to 20/200 in the left eye 1 month later, but the right eye became hypotonic and blind. Vision deteriorated to light perception in the left eye due to a retinal detachment with proliferative vitreoretinopathy, and vitreous surgery successfully reattached the retina. Vision recovered to 20/80, and the retina has remained attached for 1 year. Conclusions: We recommend that endogenous endophthalmitis be suspected in cases of meningitis, and if present, intravitreal and subconjunctival antibiotics should be promptly given to preserve vision. Copyright © 2008 S. Karger AG.

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.

目的:房水内代謝産物を非侵襲的に測定するための足掛かりとして,可視光域のレーザー光を網膜側へ直接入らないように,前房内へ横向きに透過させる機構を構築すること.また,臨床的に房水透過レーザーのシグナル検出と安全性を検討すること.方法:光学シミュレータLightTools(Synopsys社)を用いて,角膜屈折率や非球面形状を考慮したヒトの眼球モデルを独自に作成し,光線追跡シミュレーションを行った.シミュレーションの結果をもとに測定装置を開発し,健常男性3名3眼(平均年齢28.3歳)を対象に,前房内の透過レーザー光を検出した.複数回測定し,断続的に6秒間27点で透過光を得た.結果:独自の眼球モデルで光線追跡のシミュレーションを実施したところ,空気・角膜間では安定した光路の確立がほとんど不可能で,房水に近い屈折率である生理食塩液で角膜周囲を満たす必要性を明らかにした.生理食塩液格納容器と光透過機構,研究対象者の顔を固定する独自の装置を開発し,臨床的に房水透過レーザー光シグナル(n=2,322)を得た.変動係数が0.15未満の累積相対度数は67%であり,変動係数の最頻値は最小階級の0～0.05であることから,システムとして妥当であると考えられた.また,研究対象者に有害事象は認められなかった.結論:本研究では,可視光域のレーザー光を前房内へ横向きに透過させ,非侵襲的にシグナルを概ね検出できた.また,first-in-human試験として安全性を確認でき,臨床応用の可能性を見出すことができた.(著者抄録)

日本人の学童にみられる0.01%アトロピン点眼剤治療完遂後の近視進行の有無を検討した。近視を呈する小児167例を対象とした無作為化対照試験のデータを解析し、2年間のアトロピン点眼剤終了後1ヵ月、12ヵ月における等価球面度数(SE)と軸長を測定した。アトロピン投与群が84例(男児38例、女児46例、平均8.99±1.44歳)、プラセボ投与群が83例(男児35例、女児48例、平均9.00±1.49歳)であり、投与中止1ヵ月後の評価が可能であったのは計149例、12ヵ月後の評価が可能であったのは計51例であった。1ヵ月後におけるSEの最小2乗(LS)平均差は0.18D、軸長のLS平均差は-0.10mmであり、アトロピンによる近視進行抑制効果は維持されていた。12ヵ月後の評価では、SEのLS平均差は0.11Dとアトロピン群とプラセボ群との間に有意差はみられなかったが、軸長のLS平均差は-0.14mmを示しており有意差が認められた。アトロピン投与中止の12ヵ月後における軸延長はプラセボ投与群と比較して少なく、近視進行抑制効果が維持されているものと考えられた。