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PURPOSE To examine the long-term refractive changes after stabilization of surgically induced changes (SICs) subsequent to cataract surgery. SETTING Private hospital. DESIGN Case-control study. METHODS Manifest refraction of 300 eyes of 300 patients that underwent phacoemulsification and 300 eyes of 300 age- and sex-matched patients without surgery was examined the day on which SICs stabilized (baseline) and ≥7 years postbaseline using an autorefractometer. Refraction was divided into 3 components: spherical power (M), vertical/horizontal astigmatism (J0), and oblique astigmatism (J45) using power vector analysis, and the components were compared between the 2 time-points and between groups. RESULTS In the surgery group, the mean M and J45 did not change significantly between baseline and ≥7 years postbaseline, but the J0 significantly decreased between the 2 time-points (P < .001), indicating an against-the-rule (ATR) shift. In the non-surgery group, the mean M significantly increased and J0 significantly decreased between the time-points (P < .001), whereas J45 did not change significantly. The mean change in M between the 2 time-points was significantly smaller in the surgery group (P < .001), whereas the changes in J0 and J45 did not differ significantly between the time-points. CONCLUSION Spherical power did not change and refractive astigmatism significantly changed toward ATR astigmatism during the more than 7-year follow-up after stabilization of SICs in pseudophakic eyes, while hyperopic and ATR shifts occurred in phakic eyes, and the astigmatic changes were comparable between pseudophakic and phakic eyes.

Purpose To examine whether intraocular pressure (IOP) increases immediately after cataract surgery in eyes with pseudoexfoliation (PXF) syndrome and to assess whether orally administered acetazolamide can prevent the IOP elevation. Setting Hayashi Eye Hospital, Fukuoka, Japan. Design Prospective case series. Methods Patients with PXF syndrome scheduled for phacoemulsification were randomly assigned to 1 of 3 groups: (1) oral acetazolamide administered 1 hour preoperatively (preoperative administration group), (2) administered 3 hours postoperatively (postoperative administration group), and (3) not administered (no administration group). The IOP was measured using a rebound tonometer 1 hour preoperatively, upon completion of surgery, and at 1, 3, 5, 7, and 24 hours postoperatively. Results The study comprised 96 patients (96 eyes). The mean IOP increased at 3, 5, and 7 hours postoperatively in all groups. At 1 hour and 3 hours postoperatively, the IOP was significantly lower in the preoperative administration group than in the postoperative group and no administration group (P ≤ .001). At 5, 7, and 24 hours postoperatively, the IOP was significantly lower in the preoperative group and postoperative administration group than in the no administration group (P ≤. 045). An IOP spike higher than 25 mm Hg occurred less frequently in the preoperative administration group than in the postoperative administration group and the no administration group (P = .038). Conclusions Intraocular pressure increased at 3, 5, and 7 hours after cataract surgery in eyes with PXF syndrome. Oral acetazolamide administered 1 hour preoperatively reduced the IOP elevation throughout the 24-hour follow-up; acetazolamide administered 3 hours postoperatively reduced the elevation at 5 hours postoperatively and thereafter.

To compare changes in the shape and astigmatism of the total, anterior, and posterior cornea between eyes with long-length clear corneal incisions (CCIs) and eyes with short-length CCIs in cataract surgery.Hayashi Eye Hospital, Fukuoka, Japan.Prospective case series.Both eyes of patients having phacoemulsification with temporal CCIs were randomized to have a long-length (≥1.75 mm) or short-length (1.75 mm) CCI. Corneal astigmatic changes were decomposed to vertical/horizontal (Jackson cross-cylinder, axes at 180 degrees and 90 degrees [J0]) and oblique changes (Jackson cross-cylinder, axes at 45 degrees and 135 degrees [J45]) using power vector analysis. Corneal shape changes were assessed using the average of the difference map on videokeratography 2 days and 2, 4, and 8 weeks postoperatively.The mean J0 and J45 values of the total cornea in the 120 eyes evaluated were significantly greater in the long CCI group than in the short CCI group at all follow-ups (P ≤ .0290). The videokeratography showed a wedge-shaped flattening in the total and anterior cornea and a steepening in the posterior cornea around the CCI 2 days postoperatively in both groups. This wound-related flattening of the total and anterior cornea rapidly reduced but persisted until 8 weeks, whereas the steepening of the posterior cornea disappeared within 4 weeks. These changes extended closer to the central cornea in the long CCI group than in the short CCI group.Corneal astigmatic changes were significantly greater after long CCI than after short CCI. The wound-related shape changes occurred immediately postoperatively but rapidly diminished.

Purpose To examine how corneal astigmatism changes with age over 20 years after cataract surgery and to assess whether the changes differ from those in eyes that did not have surgery. Setting Hayashi Eye Hospital, Fukuoka, Japan. Design Retrospective case study. Methods Using an autokeratometer, corneal astigmatism was measured preoperatively, at baseline (the day the surgically induced astigmatism stabilized), and 10 years and 20 years after baseline. The change in corneal astigmatism between baseline and 10 years, 10 years and 20 years, and baseline and 20 years was determined using power vector analysis and compared between the time intervals and between groups. Results The study assessed 74 eyes that had phacoemulsification with a horizontal scleral incision more than 21 years ago (surgery group) and 68 eyes that did not have surgery (no-surgery group). The mean vertical/horizontal change in corneal astigmatism (J0) between baseline and 20 years was −0.64 diopter (D) in the surgery group and −0.49 D in the no-surgery group. The oblique change (J45) was −0.03 D in the surgery group and 0.07 D in the no-surgery group. Using multivariate comparison, the mean J0 and J45 values were not significantly different between baseline and 10 years or between 10 years and 20 years in both groups (P ≥ .2350). The J0 and J45 values were not significantly different between the 2 groups at any time interval (P ≥ .1331). Conclusions Corneal astigmatism continues to change toward against-the-rule astigmatism over 20 years after cataract surgery. This change was similar in eyes that did not have surgery.

Purpose To compare corneal astigmatism and shape between male and female eyes in relationship to age. Setting Hayashi Eye Hospital, Fukuoka, Japan. Design Prospective case series. Methods Eyes of men and women in 5 age groups (40 to 49 years, 50 to 59 years, 60 to 69 years, 70 to 79 years, and ≥80 years) had videokeratographic evaluations using a Placido-Scheimpflug system. Corneal astigmatism decomposed to vertical–horizontal (J0) and oblique (J45) astigmatism components was compared between male and female eyes, and corneal shape changes were compared using videokeratography maps. Results The study comprised 1000 eyes (100 eyes of male patients and 100 eyes of female patients in each of the 5 age groups). The mean J0 of the total and anterior cornea were significantly smaller in male eyes than in female eyes in all age groups (P ≤ .0269) with no significant difference in the J45 between sexes, indicating greater against-the-rule (ATR) astigmatism in male eyes. The mean J0 of the posterior cornea did not differ significantly between sexes except in the 50 to 59 years group (P = .0105). The ATR astigmatic change per decade did not differ significantly between men and women. Videokeratography maps revealed that the total and anterior corneal shape changed to ATR astigmatism with age in both sexes, and that this ATR change began at a younger age in male eyes than in female eyes. The posterior corneal shape did not differ between sexes at any age. Conclusion Against-the-rule corneal astigmatism was greater and the ATR astigmatic change with age began earlier in the male eyes than in the female eyes, suggesting that target astigmatism should be determined separately for men and women when performing astigmatism correction.

Purpose To compare changes in intraocular pressure (IOP) immediately after clear corneal incision (CCI) cataract surgery between eyes in which IOP was adjusted to a high or normal range at the conclusion of surgery. Setting Hayashi Eye Hospital, Fukuoka, Japan. Design Comparative case series. Methods Either eye of patients scheduled for phacoemulsification was randomized to 1 of 2 groups as follows: eyes that were to be adjusted to (1) high IOP (22 to 40 mm Hg) or (2) normal IOP (10 to 21 mm Hg). The IOP was measured using a rebound tonometer preoperatively; at the conclusion of surgery; and 15, 30, 60, 120, and 180 minutes and 24 hours postoperatively. The Seidel test and anterior segment optical coherence tomography (AS-OCT) were performed. Results The mean IOP at the conclusion of surgery was 31.3 mm Hg in the high IOP group and 17.1 mm Hg in the normal IOP group. The IOP decreased to approximately 15 mm Hg by 15 minutes and did not change until 60 minutes in either group. The mean IOP did not differ significantly between groups throughout the observation period (P≥.0634). Hypotony of 5 mm Hg or less was not detected in any eye. The Seidel test was negative and based on AS-OCT, the wound was closed at 60 minutes in all eyes. Conclusions After adjusting IOP to a high or normal range, the IOP normalized within 15 minutes postoperatively and was stable for 24 hours. The wound was closed within 60 minutes postoperatively. Financial Disclosure The Hayashi Eye Hospital (Drs. Hayashi, Yoshida, Manabe, and Yoshimura) received a research grant for clinical trials of materials outside the submitted work sponsored by Alcon Japan Ltd., Santen Pharmaceutical Inc., Senjyu Pharmaceutical Ltd., Hoya Corp., Pfizer Japan, Inc., Novartis Pharma K.K., Wakamoto Pharmaceutical Ltd., Nitten Pharmaceutical Ltd., Japan Association of Health Service, and EBMs Ltd. Dr. Hayashi received lecture fees with or without travel expenses for materials outside the submitted work from Santen Pharmaceutical, Inc., Alcon Japan Ltd., and Pfizer Japan, Inc. No author has a financial or proprietary interest in any material or method mentioned.

Purpose To compare binocular visual function in patients with unilateral cataract after monocular implantation of a multifocal intraocular lens (IOL) and after monocular implantation of a monofocal IOL. Setting Hayashi Eye Hospital, Fukuoka, Japan. Design Nonrandomized comparative study. Methods Patients with unilateral cataract scheduled for implantation of a diffractive multifocal IOL and age-matched patients scheduled for implantation of a monofocal IOL were recruited. Three months postoperatively, binocular visual acuity from far to near distances, binocular photopic or mesopic high- to low-contrast visual acuity with and without glare, and stereoacuity were examined. Results The mean binocular uncorrected near visual acuity or corrected near visual acuity at 0.3 m and uncorrected or corrected intermediate visual acuity at 0.5 m were significantly better in the multifocal group than in the monofocal group ( P ≤.0196), although there was no significant difference in uncorrected or corrected visual acuity at other distances. Binocular photopic contrast visual acuity and glare visual acuity at low contrasts and mesopic glare visual acuity were significantly worse in the multifocal group than in the monofocal group ( P ≤.0147). Near stereoacuity was similar between groups. Spectacle independence was significantly better in the multifocal group than in the monofocal group ( P ≤.0006). Conclusion Monocular implantation of a diffractive multifocal IOL in patients with unilateral cataract provided better binocular near and intermediate visual acuity and spectacle independence than monocular implantation of a monofocal IOL, although distance contrast sensitivity was worse with the multifocal IOL. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Purpose To compare the effect of steepest-meridian clear corneal incisions (CCIs) for reducing preexisting corneal astigmatism between a meridian-marking method and a surgeon's-intuition method. Setting Hayashi Eye Hospital, Fukuoka, Japan. Design Randomized controlled trials. Methods Eyes scheduled for phacoemulsification were randomized to 1 of 2 groups: a 2.65 mm steepest-meridian CCI using the meridian-marking method or a 2.65 mm steepest-meridian CCI using the surgeon's intuition. Regular and irregular corneal astigmatism, surgically induced astigmatism (SIA) vector, refractive status, higher-order aberrations (HOAs), uncorrected (UDVA) and corrected (CDVA) distance visual acuities, and physical meridian misalignment of the steepest-meridian CCI measured using anterior segment optical coherence tomography were evaluated preoperatively and 1 month and 3 months postoperatively. Results The mean meridian misalignment of the steepest-meridian CCIs was significantly smaller in the meridian-marking group (4.4 degrees ± 2.8 [SD]) than in the surgeon's-intuition group (8.6 ± 4.4 degrees) ( P ≤.0001). Regular and irregular corneal astigmatism and corneal HOAs did not change significantly postoperatively in either group. No significant difference was found in regular or irregular corneal astigmatism, refractive cylinder, manifest spherical equivalent value, SIA, HOAs, UDVA, or CDVA between the meridian-marking group and the surgeon's-intuition group throughout the follow-up. Conclusion The physical meridian misalignment of steepest-meridian CCI was significantly smaller with the meridian-marking method than with the surgeon's-intuition method; however, the effect of the difference was not large enough to decrease remaining astigmatism and HOAs or to improve the UDVA. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Purpose To compare corneal endothelial cell damage and ocular inflammation after cataract surgery in eyes with and without pseudoexfoliation (PXF). Setting Hayashi Eye Hospital, Fukuoka, Japan. Design Nonrandomized comparative study. Methods This study comprised eyes with PXF (PXF group) and age-matched eyes without PXF (non-PXF group) scheduled for phacoemulsification. Preoperatively and 1 and 3 months postoperatively, corneal endothelial cell density (ECD) and central corneal thickness (CCT) were measured using a specular microscope. Flare intensity was measured using a flare meter, and central macular thickness was measured using optical coherence tomography. Results Each group had 36 eyes. The mean ECD was significantly lower in the PXF group than in the non-PXF group preoperatively and postoperatively (P≤.0250). The percentage of endothelial cell loss was significantly greater in the PXF group than in the non-PXF group (P≤.0216); the percentage was 9.0% in the PXF group and 3.4% in the non-PXF group 3 months postoperatively. The mean CCT was similar between groups throughout the follow-up period; however, the percentage increase in CCT was significantly greater in the PXF group than in the non-PXF group 1 month postoperatively (P=.0152). Flare intensity and foveal thickness did not differ significantly between groups throughout the follow-up period (P≥.3079). Conclusions Corneal endothelial cell loss and a transient increase in CCT were greater after cataract surgery in eyes with PXF than in eyes without PXF. Thus, because the corneal endothelium in eyes with PXF is vulnerable to cataract surgery, careful surgical procedures are necessary. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

A one-year prospective study was conducted in 120 patients to assess the time course of changes in intraocular inflammation after three cataract surgery procedures: planned extracapsular extraction with poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation (11 mm incision group), phacoemulsification with PMMA IOL implantation (7 mm incision group), and phacoemulsification with foldable silicone single-piece IOL implantation (4 mm incision group). Each group was carefully matched for patients' ophthalmologic and systemic backgrounds. Patients with hard nuclei were excluded. The degree of inflammation was evaluated by quantitating aqueous flare intensity and cell count with the laser flare-cell meter. In the early postoperative period, both aqueous flare intensity and cell count were highest in the 11 mm incision group followed, in decreasing order, by the 7 mm and 4 mm incision groups. Significant between-group differences were observed at one, two, and seven postoperative days for flare and one day through one week for cells. Both parameters in each group decreased to a similar level one month after surgery, but flare intensity in all groups remained significantly higher than that of age-matched normal controls up to six months postoperatively.