Temporal multiplexing to simulate multifocal intraocular lenses: theoretical considerations

PubMed Central

Akondi, Vyas; Dorronsoro, Carlos; Gambra, Enrique; Marcos, Susana

2017-01-01

Fast tunable lenses allow an effective design of a portable simultaneous vision simulator (SimVis) of multifocal corrections. A novel method of evaluating the temporal profile of a tunable lens in simulating different multifocal intraocular lenses (M-IOLs) is presented. The proposed method involves the characteristic fitting of the through-focus (TF) optical quality of the multifocal component of a given M-IOL to a linear combination of TF optical quality of monofocal lenses viable with a tunable lens. Three different types of M-IOL designs are tested, namely: segmented refractive, diffractive and refractive extended depth of focus. The metric used for the optical evaluation of the temporal profile is the visual Strehl (VS) ratio. It is shown that the time profiles generated with the VS ratio as a metric in SimVis resulted in TF VS ratio and TF simulated images that closely matched the TF VS ratio and TF simulated images predicted with the M-IOL. The effects of temporal sampling, varying pupil size, monochromatic aberrations, longitudinal chromatic aberrations and temporal dynamics on SimVis are discussed. PMID:28717577

Comparative visual performance with monofocal and multifocal intraocular lenses

PubMed Central

Gundersen, Kjell Gunnar; Potvin, Richard

2013-01-01

Background To compare near, intermediate, and distance vision, and quality of vision using appropriate subjective questionnaires, when monofocal or apodized diffractive multifocal intraocular lenses (IOLs) are binocularly implanted. Methods Patients with different binocular IOLs implanted were recruited after surgery and had their visual acuity tested, and quality of vision evaluated, at a single diagnostic visit between 3 and 8 months after second-eye surgery. Lenses tested included an aspheric monofocal and two apodized diffractive multifocal IOLs with slightly different design parameters. A total of 94 patients were evaluated. Results Subjects with the ReSTOR® +2.5 D IOL had better near and intermediate vision than those subjects with a monofocal IOL. Intermediate vision was similar to, and near vision slightly lower than, that of subjects with a ReSTOR® +3.0 D IOL implanted. The preferred reading distance was slightly farther out for the +2.5 D relative to the +3.0 D lens, and farthest for the monofocal. Visual acuity at the preferred reading distance was equal with the two multifocal IOLs and significantly worse with the monofocal IOL. Quality of vision measures were highest with the monofocal IOL and similar between the two multifocal IOLs. Conclusion The data indicate that the ReSTOR +2.5 D IOL provided good intermediate and functional near vision for patients who did not want to accept a higher potential for visual disturbances associated with the ReSTOR +3.0 D IOL, but wanted more near vision than a monofocal IOL generally provides. Quality of vision was not significantly different between the multifocal IOLs, but patient self-selection for each lens type may have been a factor. PMID:24143064

Bilateral implantation of +3.0 D multifocal toric intraocular lenses: results of a US Food and Drug Administration clinical trial.

PubMed

Lehmann, Robert; Modi, Satish; Fisher, Bret; Michna, Magda; Snyder, Michael

2017-01-01

The purpose of this study was to evaluate the clinical outcomes of apodized diffractive +3.0 D multifocal toric intraocular lens (IOL) implantations in subjects with preoperative corneal astigmatism. This was a prospective cohort study conducted at 21 US sites. The study population consisted of 574 subjects, aged ≥21 years, with preoperative astigmatism 0.75-2.82 D, and potential postoperative visual acuity (VA) ≥0.2 logMAR, undergoing bilateral cataract removal by phacoemulsification. The intervention was bilateral implantation of aspheric apodized diffractive +3.0 D multifocal toric or spherical multifocal nontoric IOLs. The main outcome measures were monocular uncorrected near and distance VA and safety at 12 months. A total of 373/386 and 182/188 subjects implanted with multifocal toric and nontoric IOLs, respectively, completed 12-month follow-up after the second implantation. Toric IOLs were nonin-ferior in monocular uncorrected distance (4 m) and near (40 cm) VA but had >1 line better binocular uncorrected intermediate VA (50, 60, and 70 cm) than nontoric IOLs. Toric IOLs reduced cylinder to within 0.50 D and 1.0 D of target in 278 (74.5%) and 351 (94.1%) subjects, respectively. Mean ± standard deviation (SD) differences between intended and achieved axis orientation in the first and second implanted eyes were 5.0°±6.1° and 4.7°±4.0°, respectively. Mean ± SD 12-month IOL rotations in the first and second implanted eyes were 2.7°±5.8° and 2.2°±2.7°, respectively. No subject receiving toric IOLs required secondary surgical intervention due to optical lens properties. Multifocal toric IOLs were noninferior to multifocal nontoric IOLs in uncorrected distance and near VAs in subjects with preexisting corneal astigmatism and effectively corrected astigmatism of 0.75-2.82 D.

Visual Results Following Implantation of a Refractive Multifocal Intraocular Lens in One Eye and a Diffractive in the Contralateral Eye

PubMed Central

Yıldırım Karabağ, Revan; Günenç, Üzeyir; Aydın, Rukiye; Arıkan, Gül; Aslankara, Hüseyin

2018-01-01

Objectives To assess the visual outcomes in patients who underwent cataract surgery with multifocal intraocular lens (IOL) implantation using a “mix and match” approach. Materials and Methods Twenty patients (40 eyes) were involved in this prospective, nonrandomized study. Refractive multifocal IOLs (ReZoom NXG1) were implanted in patients’ dominant eyes and diffractive multifocal IOLs (Tecnis ZMA00) were implanted in their non-dominant eyes. Monocular and binocular uncorrected distance, intermediate and near visual acuity (logMAR), and contrast sensitivity levels were measured at 1, 3, and 6 months after cataract surgery. Defocus curves, reading speeds, patient satisfaction, spectacle dependence, and halo and glare symptoms were also evaluated at 6 months after the surgery. Postoperative quality of life was assessed with the Turkish version of National Eye Institute Visual Function Questionnaire-25. Results The study group comprised 8 females and 12 males with a mean age of 69.45±10.76 years (range, 31-86 years). The uncorrected distance and intermediate visual acuity levels were significantly better in the ReZoom-implanted eyes at postoperative 6 months (p=0.026 and p=0.037, respectively). There was no statistically significant difference in uncorrected near visual acuity (p>0.05). There was no statistically significant difference in contrast sensitivity, reading speed, halos, or glare between the groups (p<0.05). Mild glare/halo was reported by 40% of the subjects. The mean patient satisfaction was 95% and all patients were spectacle independent. Conclusion Mixing and matching multifocal IOLs in selected cataract patients provides excellent visual outcome, a high level of patient satisfaction, and spectacle independency. PMID:29576891

Comparative analysis of visual outcomes with 4 intraocular lenses: Monofocal, multifocal, and extended range of vision.

PubMed

Pedrotti, Emilio; Carones, Francesco; Aiello, Francesco; Mastropasqua, Rodolfo; Bruni, Enrico; Bonacci, Erika; Talli, Pietro; Nucci, Carlo; Mariotti, Cesare; Marchini, Giorgio

2018-02-01

To compare the visual acuity, refractive outcomes, and quality of vision in patients with bilateral implantation of 4 intraocular lenses (IOLs). Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, and Carones Ophthalmology Center, Milano, Italy. Prospective case series. The study included patients who had bilateral cataract surgery with the implantation of 1 of 4 IOLs as follows: Tecnis 1-piece monofocal (monofocal IOL), Tecnis Symfony extended range of vision (extended-range-of-vision IOL), Restor +2.5 diopter (D) (+2.5 D multifocal IOL), and Restor +3.0 D (+3.0 D multifocal IOL). Visual acuity, refractive outcome, defocus curve, objective optical quality, contrast sensitivity, spectacle independence, and glare perception were evaluated 6 months after surgery. The study comprised 185 patients. The extended-range-of-vision IOL (55 patients) showed better distance visual outcomes than the monofocal IOL (30 patients) and high-addition apodized diffractive-refractive multifocal IOLs (P ≤ .002). The +3.0 D multifocal IOL (50 patients) showed the best near visual outcomes (P < .001). The +2.5 D multifocal IOL (50 patients) and extended-range-of-vision IOL provided significantly better intermediate visual outcomes than the other 2 IOLs, with significantly better vision for a defocus level of -1.5 D (P < .001). Better spectacle independence was shown for the +2.5 D multifocal IOL and extended-range-of-vision IOL (P < .001). The extended-range-of-vision IOL and +2.5 D multifocal IOL provided significantly better intermediate visual restoration after cataract surgery than the monofocal IOL and +3.0 D multifocal IOL, with significantly better quality of vision with the extended-range-of-vision IOL. Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Visual performance after bilateral implantation of 2 new presbyopia-correcting intraocular lenses: Trifocal versus extended range of vision.

PubMed

Monaco, Gaspare; Gari, Mariangela; Di Censo, Fabio; Poscia, Andrea; Ruggi, Giada; Scialdone, Antonio

2017-06-01

To compare the visual outcomes and quality of vision of 2 new diffractive multifocal intraocular lenses (IOLs) with those of a monofocal IOL. Fatebenefratelli e Oftalmico Hospital, Milan, Italy. Prospective case series. Patients had bilateral cataract surgery with implantation of a trifocal IOL (Panoptix), an extended-range-of-vision IOL (Symfony), or a monofocal IOL (SN60WF). Postoperative examinations included assessing distance, intermediate, and near visual acuity; binocular defocus; intraocular and total aberrations; point-spread function (PSF); modulation transfer function (MTF); retinal straylight; and quality-of-vision (QoV) and spectacle-dependence questionnaires. Seventy-six patients (152 eyes) were assessed for study eligibility. Twenty patients (40 eyes) in each arm of the study (60 patients, 120 eyes) completed the outcome assessment. At the 4-month follow-up, the trifocal group had significantly better near visual acuity than the extended-range-of-vision group (P = .005). The defocus curve showed the trifocal IOL had better intermediate/near performance than the extended-range-of-vision IOL and both multifocal IOLs performed better than the monofocal IOL. Intragroup comparison of the total higher-order aberrations, PSF, MTF, and retinal straylight were not statistically different. The QoV questionnaire results showed no differences in dysphotopsia between the multifocal IOL groups; however, the results were significantly higher than in the monofocal IOL group. Both multifocal IOLs seemed to be good options for patients with intermediate-vision requirements, whereas the trifocal IOL might be better for patients with near-vision requirements. The significant perception of visual side effects indicates that patients still must be counseled about these effects before a multifocal IOL is implanted. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

[Influence of different multifocal intraocular lens concepts on retinal stray light parameters].

PubMed

Ehmer, A; Rabsilber, T M; Mannsfeld, A; Sanchez, M J; Holzer, M P; Auffarth, G U

2011-10-01

Multifocal intraocular lenses (MIOL) are known to induce various photic phenomena depending on the optical principle. The aim of this study was to investigate the correlation between stray light measurements performed with the C-Quant (Oculus, Germany) and the results of a subjective patient questionnaire. In this study three different MIOLs were compared: AMO ReZoom (refractive design, n=10), AMO ZM900 (diffractive design, n=10) and Oculentis Mplus (near segment design, n=10). Cataract and refractive patients were enrolled in the study. Functional results were evaluated at least 3 months postoperatively followed by stray light measurements and a subjective questionnaire. Surgery was performed for all patients without complications. The three groups were matched for age, IOL power and corrected distance visual acuity (CDVA). Significantly different stray light (median) values log(s) were found (Kruskal-Wallis test, p<0.05): 1.12 log (refractive), 1.13 log (segment) and 1.28 log (diffractive). The subjective questionnaire did not show differences in glare perception but refractive MIOL patients noticed more halos surrounding light sources than the diffractive and segment MIOL patients. Stray light and subjective photopic phenomena do not show any basic correlation. Measurements in patients with refractive MIOLs showed less stray light than near segment or diffractive MIOLs. However, refractive MIOLs induced more halos compared to the other groups analyzed.

Light-distortion analysis as a possible indicator of visual quality after refractive lens exchange with diffractive multifocal intraocular lenses.

PubMed

Brito, Pedro; Salgado-Borges, José; Neves, Helena; Gonzalez-Meijome, José; Monteiro, Manuel

2015-03-01

To study the perception of light distortion after refractive lens exchange (RLE) with diffractive multifocal intraocular lenses (IOLs). Clínica Oftalmológica das Antas, Porto, Portugal. Retrospective comparative study. Refractive lens exchange was performed with implantation of an AT Lisa 839M (trifocal) or 909MP (bifocal toric) IOL, the latter if corneal astigmatism was more than 0.75 diopter (D). The postoperative visual and refractive outcomes were evaluated. A prototype light-distortion analyzer was used to quantify the postoperative light-distortion indices. A control group of eyes in which a Tecnis ZCB00 1-piece monofocal IOL was implanted had the same examinations. A trifocal or bifocal toric IOL was implanted in 66 eyes. The control IOL was implanted in 18 eyes. All 3 groups obtained a significant improvement in uncorrected distance visual acuity (UDVA) (P < .001) and corrected distance visual acuity (CDVA) (P = .001). The mean uncorrected near visual acuity (UNVA) was 0.123 logMAR with the trifocal IOL and 0.130 logMAR with the bifocal toric IOL. The residual refractive cylinder was less than 1.00 D in 86.7% of cases with the toric IOL. The mean light-distortion index was significantly higher in the multifocal IOL groups than in the monofocal group (P < .001), although no correlation was found between the light-distortion index and CDVA. The multifocal IOLs provided excellent UDVA and functional UNVA despite increased light-distortion indices. The light-distortion analyzer reliably quantified a subjective component of vision distinct from visual acuity; it may become a useful adjunct in the evaluation of visual quality obtained with multifocal IOLs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Combining zonal refractive and diffractive aspheric multifocal intraocular lenses.

PubMed

Muñoz, Gonzalo; Albarrán-Diego, César; Javaloy, Jaime; Sakla, Hani F; Cerviño, Alejandro

2012-03-01

To assess visual performance with the combination of a zonal refractive aspheric multifocal intraocular lens (MIOL) (Lentis Mplus, Oculentis GmbH) and a diffractive aspheric MIOL (Acri.Lisa 366, Acri.Tech GmbH). This prospective interventional cohort study comprised 80 eyes from 40 cataract patients (mean age: 65.5±7.3 years) who underwent implantation of the Lentis Mplus MIOL in one eye and Acri.Lisa 366 MIOL in the fellow eye. The main outcome measures were refraction; monocular and binocular uncorrected and corrected distance, intermediate, and near visual acuities; monocular and binocular defocus curves; binocular photopic contrast sensitivity function compared to a monofocal intraocular lens (IOL) control group (40 age-matched pseudophakic patients implanted with the AR-40e [Abbott Medical Optics]); and quality of vision questionnaire. Binocular uncorrected visual acuities were 0.12 logMAR (0.76 decimal) or better at all distances measured between 6 m and 33 cm. The Lentis Mplus provided statistically significant better vision than the Acri.Lisa at distances between 2 m and 40 cm, and the Acri.Lisa provided statistically significant better vision than the Lentis Mplus at 33 cm. Binocular defocus curve showed little drop-off at intermediate distances. Photopic contrast sensitivity function for distance and near were similar to the monofocal IOL control group except for higher frequencies. Moderate glare (15%), night vision problems (12.5%), and halos (10%) were reported. Complete independence of spectacles was achieved by 92.5% of patients. The combination of zonal refractive aspheric and diffractive aspheric MIOLs resulted in excellent uncorrected binocular distance, intermediate, and near vision, with low incidence of significant photic phenomena and high patient satisfaction. Copyright 2012, SLACK Incorporated.

[Multifocal intraocular lenses. A review].

PubMed

Auffarth, G U; Dick, H B

2001-02-01

Modern cataract surgery has developed tremendously during the past 10-15 years. Improved surgical techniques, as well as improved implant materials and designs, have enlarged patient profiles and indications for cataract surgery. This also created much higher expectations from the patients' site. The loss of accommodation is loss of quality of life for presbyopic and especially young pseudophakic patients. Therefore cataract surgery with multifocal IOL implantation is not only of academic interest, but reflects demands and expectations of our patients. Multifocal IOLs have been implanted since 1986, starting with 2-3 zone refractive and diffractive designs. Due to surgical techniques of that time MIOL decentration and surgically induced astigmatism were possible complications. In addition reduced contrast sensitivity and increased glare were common problems of MIOL because of their optical principles. New developments in this field in recent years such as the multizonal, progressive refractive MIOL in combination with improved surgical techniques have overcome those initial problems. Therefore, modern multifocal IOLs can be considered not only for correction of aphakia but also for refractive purposes.

Clinical outcomes and surgeon assessment after implantation of a new diffractive multifocal toric intraocular lens.

PubMed

Kretz, Florian T A; Bastelica, Antoine; Carreras, Humberto; Ferreira, Tiago; Müller, Matthias; Gerl, Matthias; Gerl, Ralf; Saeed, Manzar; Schmickler, Stefanie; Auffarth, Gerd U

2015-03-01

To evaluate the clinical outcome in eyes with significant corneal astigmatism after cataract surgery with implantation of a new diffractive multifocal toric intraocular lens (IOL). Prospective, non-randomised multicentre clinical study including 57 eyes of 38 consecutive patients with an age between 37 and 84 years that underwent cataract surgery with implantation of the toric multifocal IOL Tecnis ZMT (Abbott Medical Optics, Santa Ana, California, USA). Changes in uncorrected and corrected logMAR distance, intermediate and near visual acuity ((uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), corrected near visual acuity) and manifest refraction were evaluated during a 2-4 month follow-up. Additionally, patients were asked about photic phenomena and spectacle dependence. The surgeons subjectively assessed various aspects of the surgery. A significant improvement in CDVA was observed postoperatively (p<0.01), with a significant reduction in manifest cylinder (p<0.01). Mean postoperative binocular UDVA and UNVA were 0.04±0.10 and 0.06±0.12, respectively. Monocular UDVA and UNVA was 0.20 or better in 85.4% and 87.0% of eyes, respectively. Mean binocular logMAR UIVA was 0.21±0.20. Only 10.5% of patients required postoperative correction for near or intermediate distance. The incidence of moderate to severe photic phenomena was limited. Surgeons defined the IOL implantation in most cases as easy or very easy, with a satisfaction rate with the procedure of 84%. The implantation of the multifocal toric IOL is a safe procedure that provides a very good visual rehabilitation in eyes with corneal astigmatism. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Energy balance in apodized diffractive multifocal intaocular lenses

NASA Astrophysics Data System (ADS)

Alba-Bueno, Francisco; Vega, Fidel; Millán, María S.

2011-08-01

The energy distribution between the distance and near images formed in a model eye by three different apodized diffractive multifocal intraocular lenses (IOLs) is experimentally determined in an optical bench. The model eye has an artificial cornea with positive spherical aberration (SA) similar to human cornea. The level of SA upon the IOL, which is pupil size dependent, is controlled using a Hartmann-Shack wave sensor. The energy of the distance and near images as a function of the pupil size is experimentally obtained from image analysis. All three IOLs have the same base refractive power (20D) but different designs (aspheric, spherical) and add powers (+4.0 D, +3.0 D). The results show that in all the cases, the energy efficiency of the distance image decreases for large pupils, in contrast with the theoretical and simulated results that only consider the diffractive profile of the lens. As for the near image, since the diffractive zone responsible for the formation of this image has the same apodization factor in the spherical and aspheric lenses and the apertures involved are small (and so the level of SA), the results turn out to be similar for all the three IOL designs.

An implantation of multifocal lenses LS-313 MF30, Mplus and MplusX models, during and after posterior vitrectomy in patients treated for various diseases of the retina.

PubMed

Cywinski, Adam; Piwonska-Lobermajer, Anna; Penter, Sandra

2016-08-01

A retrospective analysis of visual function and postoperative complaints in patients after posterior vitrectomy and multifocal Mplus or MplusX intraocular lens implantation. 14 patients (14 eyes) were enrolled in the study. All patients underwent posterior vitrectomy due to underlying retinal pathologies. A combined procedure of phacovitrectomy was performed in some patients, whereas others underwent a separate cataract extraction as a second stage of treatment. The Mplus or MplusX intraocular lenses were implanted in all cases and the postoperative visual function and patient complaints were analysed. Multifocal lens explantation was not necessary in any case. Good uncorrected distance and near visual acuity was achieved in most cases. When implanted prior to vitrectomy, the intraocular lenses did not limit the view into the posterior segment, so precise manipulations within the macula and peripheral retina were feasible. The right choice between Mplus and MplusX minimises the rate of postoperative complaints. Conslusions: The multifocal Mplus and MplusX intraocular lenses offer a good alternative for patients who need posterior vitrectomy and still want to achieve good uncorrected distance and near visual acuity.

Visual performance after the implantation of a new trifocal intraocular lens

PubMed Central

Vryghem, Jérôme C; Heireman, Steven

2013-01-01

Purpose To evaluate the subjective and objective visual results after the implantation of a new trifocal diffractive intraocular lens. Methods A new trifocal diffractive intraocular lens was designed combining two superimposed diffractive profiles: one with +1.75 diopters (D) addition for intermediate vision and the other with +3.50 D addition for near vision. Fifty eyes of 25 patients that were operated on by one surgeon are included in this study. The uncorrected and best distance-corrected monocular and binocular, near, intermediate, and distance visual acuities, contrast sensitivity, and defocus curves were measured 6 months postoperatively. In addition to the standard clinical follow-up, a questionnaire evaluating individual satisfaction and quality of life was submitted to the patients. Results The mean age of patients at the time of surgery was 70 ± 10 years. The mean uncorrected and corrected monocular distance visual acuity (VA) were LogMAR 0.06 ± 0.10 and LogMAR 0.00 ± 0.08, respectively. The outcomes for the binocular uncorrected distance visual acuity were almost the same (LogMAR −0.04 ± 0.09). LogMAR −010 ± 0.15 and 0.02 ± 0.06 were measured for the binocular uncorrected intermediate and near VA, respectively. The distance-corrected visual acuity was maintained in mesopic conditions. The contrast sensitivity was similar to that obtained after implantation of a bifocal intraocular lens and did not decrease in mesopic conditions. The binocular defocus curve confirms good VA even in the intermediate distance range, with a moderate decrease of less than LogMAR 0.2 at −1.5 D, with respect to the best distance VA at 0 D defocus. Patient satisfaction was high. No discrepancy between the objective and subjective outcomes was evidenced. Conclusion The introduction of a third focus in diffractive multifocal intraocular lenses improves the intermediate vision with minimal visual discomfort for the patient. PMID:24124348

Comparative analysis of the visual and refractive outcomes of an aspheric diffractive intraocular lens with and without toricity.

PubMed

Frieling-Reuss, Elisabeth H

2013-10-01

To analyze and compare the postoperative visual and refractive outcomes and patients' visual satisfaction after implantation of an aspheric or an aspheric toric multifocal diffractive intraocular lens (IOL) in eyes with equivalent biometric characteristics. Private clinic, Munich, Germany. Comparative case series. Patients having cataract surgery were assigned to 1 of 2 groups: aspheric, which had AT Lisa 809M IOL implantation, and aspheric toric, which had AT Lisa 909M IOL implantation (corneal toricity ≥0.75 diopter [D]). Visual and refractive postoperative outcomes were evaluated, as was the patient's ability to perform daily tasks related to vision and the incidence of photic phenomena. The aspheric group comprised 77 eyes (42 patients) and the aspheric toric group, 26 eyes (17 patients). A significant improvement in corrected distance and near visual acuity was observed postoperatively in both groups, as was a significant reduction in the astigmatic component J0 (P<.01). The aspheric toric group had significantly better uncorrected intermediate visual acuity (P=.01). In both groups, the postoperative astigmatic power vectors and spherical equivalent were within ±0.50 D in 100% of eyes and in more than 88% of eyes, respectively. No statistically significant differences were found in any subjective patient questionnaire item. There was no difference in the incidence of photic phenomena between the groups (P≥0.16). The addition of a toric surface to the aspheric diffractive multifocal platform resulted in a comparable visual performance and ability to perform visual tasks. The author has no financial or proprietary interest in any material or method mentioned. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Food and Drug Administration study update. One-year results from 671 patients with the 3M multifocal intraocular lens.

PubMed

Lindstrom, R L

1993-01-01

The clinical evaluation of the Food and Drug Administration study of the 3M diffractive multifocal intraocular lens (IOL) is presented here to demonstrate the results of 1-year postoperative data accumulated for 671 patients, the first of whom received the implant in 1987. Patients were selected for study if they had absence of preoperative pathology, were at least 60 years of age, and had a reasonable postoperative prognosis. Extensive evaluations took place at 4 to 6 months and 12 to 14 months after surgery, including five different visual acuity measurements and contrast sensitivity. All testing was completed on both eyes. Data from the fellow eye served as a control when implanted with a monofocal IOL. Overall uncorrected distance visual acuity at 1 year after surgery shows 57% patients with 20/40 or better acuity. In this same group, 78% achieved J3 or better near vision, which improved to 82% in the best case group. Uncorrected visual acuity of 20/40 or better and J3 or better was achieved by 50% of best case multifocal IOL patients, compared with 26% of the monofocal best case comparison group. Measurements of contrast sensitivity consistently document a small loss, which is considered clinically insignificant. Statistical analysis of satisfaction ratings shows that predictors of satisfaction include uncorrected distance acuity, final near acuity, and fellow eye spherical equivalent. This multifocal lens appears to work very well for most patients, with more than half having functional uncorrected distance and near vision. The study showed several considerations that are important for optimizing clinical performance and patient satisfaction: patient selection, realistic expectations, accurate biometry, and adequate control of surgical procedures.

Comparison of visual outcomes after bilateral implantation of a diffractive trifocal intraocular lens and blended implantation of an extended depth of focus intraocular lens with a diffractive bifocal intraocular lens

PubMed Central

de Medeiros, André Lins; de Araújo Rolim, André Gustavo; Motta, Antonio Francisco Pimenta; Ventura, Bruna Vieira; Vilar, César; Chaves, Mário Augusto Pereira Dias; Carricondo, Pedro Carlos; Hida, Wilson Takashi

2017-01-01

Purpose The purpose of this study was to compare the visual outcomes and subjective visual quality between bilateral implantation of a diffractive trifocal intraocular lens, Alcon Acrysof IQ® PanOptix® TNFT00 (group A), and blended implantation of an extended depth of focus lens, J&J Tecnis Symfony® ZXR00 with a diffractive bifocal intraocular lens, J&J Vision Tecnis® ZMB00 (group B). Methods This prospective, nonrandomized, consecutive, comparative study included the assessment of 40 eyes in 20 patients implanted with multifocal intraocular lens. Exclusion criteria were existence of any corneal, retina, or optic nerve disease, previous eye surgery, illiteracy, previous refractive surgery, high axial myopia, expected postoperative corneal astigmatism of >1.00 cylindrical diopter (D), and intraoperative or postoperative complications. Binocular visual acuity was tested in all cases. Ophthalmological evaluation included the measurement of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), and uncorrected intermediate visual acuity (UIVA), with the analysis of contrast sensitivity (CS), and visual defocus curve. Results Postoperative UDVA was 0.01 and −0.096 logMAR (p<0.01) in groups A and B, respectively; postoperative CDVA was −0.07 and −0.16 logMAR (p<0.01) in groups A and B, respectively; UIVA was 0.14 and 0.20 logMAR (p<0.01) in groups A and B, respectively; UNVA was −0.03 and 0.11 logMAR (p<0.01) in groups A and B, respectively. Under photopic conditions group B had better CS at low frequencies with and without glare. Conclusion Both groups promoted good quality of vision for long, intermediate, and short distances. Group B exhibited a better performance for very short distances and for intermediate and long distances ≥−1.50 D of vergence. Group A exhibited a better performance for UIVA at 60 cm and for UNVA at 40 cm. PMID:29138533

Bilateral implantation of +2.5 D multifocal intraocular lens and contralateral implantation of +2.5 D and +3.0 D multifocal intraocular lenses: Clinical outcomes.

PubMed

Nuijts, Rudy M M A; Jonker, Soraya M R; Kaufer, Robert A; Lapid-Gortzak, Ruth; Mendicute, Javier; Martinez, Cristina Peris; Schmickler, Stefanie; Kohnen, Thomas

2016-02-01

To assess the clinical visual outcomes of bilateral implantation of Restor +2.5 diopter (D) multifocal intraocular lenses (IOLs) and contralateral implantation of a Restor +2.5 D multifocal IOL in the dominant eye and Restor +3.0 D multifocal IOL in the fellow eye. Multicenter study at 8 investigative sites. Prospective randomized parallel-group patient-masked 2-arm study. This study comprised adults requiring bilateral cataract extraction followed by multifocal IOL implantation. The primary endpoint was corrected intermediate visual acuity (CIVA) at 60 cm, and the secondary endpoint was corrected near visual acuity (CNVA) at 40 cm. Both endpoints were measured 3 months after implantation with a noninferiority margin of Δ = 0.1 logMAR. In total, 103 patients completed the study (53 bilateral, 50 contralateral). At 3 months, the mean CIVA at 60 cm was 0.13 logMAR and 0.10 logMAR in the bilateral group and contralateral group, respectively (difference 0.04 logMAR), achieving noninferiority. Noninferiority was not attained for CNVA at 40 cm; mean values at 3 months for bilateral and contralateral implantation were 0.26 logMAR and 0.11 logMAR, respectively (difference 0.15 logMAR). Binocular defocus curves suggested similar performance in distance vision between the 2 groups. Treatment-emergent ocular adverse events rates were similar between the groups. Bilateral implantation of the +2.5 D multifocal IOL resulted in similar distance as contralateral implantation of the +2.5 D multifocal IOL and +3.0 D multifocal IOL for intermediate vision (60 cm), while noninferiority was not achieved for near distances (40 cm). Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Rotationally asymmetric multifocal IOL implantation with and without capsular tension ring: refractive and visual outcomes and intraocular optical performance.

PubMed

Alió, Jorge L; Plaza-Puche, Ana B; Piñero, David P

2012-04-01

To ascertain whether the refractive, visual, and intraocular optical quality outcomes of a rotationally asymmetric multifocal intraocular lens (IOL) are enhanced by the use of a capsular tension ring. Ninety consecutive eyes from 53 patients (age range: 36 to 82 years) were divided into two groups: the no ring group comprised 43 eyes implanted with the multifocal rotationally asymmetric Lentis Mplus LS-312 (Oculentis GmbH) without a capsular tension ring; and the ring group comprised 47 eyes with the same IOL with a capsular tension ring. Distance and near visual acuity and refractive outcomes were evaluated pre- and postoperatively. Contrast sensitivity, intraocular aberrations, and defocus curve were evaluated postoperatively. Significant postoperative differences between groups were found in sphere, spherical equivalent refraction, and near addition (P<.02). Regarding defocus curve, significantly better visual acuity was present in eyes with the capsular tension ring for intermediate vision conditions (P<.05). Intraocular aberrometry did not differ significantly between groups (P<.09). Refractive predictability and intermediate visual outcomes with the Lentis Mplus LS-312 IOL improved significantly when implanted in combination with a capsular tension ring. Copyright 2012, SLACK Incorporated.

Clinical evaluation of a new pupil independent diffractive multifocal intraocular lens with a +2.75 D near addition: a European multicentre study.

PubMed

Kretz, Florian T A; Gerl, Matthias; Gerl, Ralf; Müller, Matthias; Auffarth, Gerd U

2015-12-01

To evaluate the clinical outcomes after cataract surgery with implantation of a new diffractive multifocal intraocular lens (IOL) with a lower near addition (+2.75 D.). 143 eyes of 85 patients aged between 40 years and 83 years that underwent cataract surgery with implantation of the multifocal IOL (MIOL) Tecnis ZKB00 (Abbott Medical Optics,Santa Ana, California, USA) were evaluated. Changes in uncorrected (uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity) and corrected (corrected distance visual acuity, corrected near visual acuity) logMAR distance, intermediate visual acuity and near visual acuity, as well as manifest refraction were evaluated during a 3-month follow-up. Additionally, patients were asked about photic phenomena and spectacle dependence. Postoperative spherical equivalent was within ±0.50 D and ±1.00 D of emmetropia in 78.1% and 98.4% of eyes, respectively. Postoperative mean monocular uncorrected distance visual acuity, uncorrected near visual acuity and uncorrected intermediate visual acuity was 0.20 LogMAR or better in 73.7%, 81.1% and 83.9% of eyes, respectively. All eyes achieved monocular corrected distance visual acuity of 0.30 LogMAR or better. A total of 100% of patients referred to be at least moderately happy with the outcomes of the surgery. Only 15.3% of patients required the use of spectacles for some daily activities postoperatively. The introduction of low add MIOLs follows a trend to increase intermediate visual acuity. In this study a near add of +2.75 D still reaches satisfying near results and leads to high patient satisfaction for intermediate visual acuity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

[Refraction after Implantation of Multifocal and Presbyopia-Correcting Intraocular Lenses].

PubMed

Kretz, F T A; Linz, K; Mueller, M; Gerl, M; Koss, M J; Gerl, R H; Auffarth, G U

2015-08-01

Nowadays, further developments in the field of intraocular lenses offer a higher level of spectacle independence for our patients. As light gets scattered on different focal points a wider range of defocus is created. This greater defocus area makes it more difficult for us to determine the objective or subjective refraction. This contribution is concerned with the difficulties of measuring visual acuity in different intraocular lens designs and different measurement distances. Measuring refraction after implantation of a multifocal intraocular lens is a complex procedure and the experience of the examiner plays a crucial role. Retinoscopy, keratometry and the defocus curve are reliable methods for testing, while the auto refractometer, bichromatic testing and the cross-cylinder have limitations. Georg Thieme Verlag KG Stuttgart · New York.

Correlation of visual performance with quality of life and intraocular aberrometric profile in patients implanted with rotationally asymmetric multifocal IOLs.

PubMed

Ramón, María L; Piñero, David P; Pérez-Cambrodí, Rafael J

2012-02-01

To examine the visual performance of a rotationally asymmetric multifocal intraocular lens (IOL) by correlating the defocus curve of the IOL-implanted eye with the intraocular aberrometric profile and impact on the quality of life. A prospective, consecutive, case series study including 26 eyes from 13 patients aged between 50 and 83 years (mean: 65.54±7.59 years) was conducted. All patients underwent bilateral cataract surgery with implantation of a rotationally asymmetric multifocal IOL (Lentis Mplus LS-312 MF30, Oculentis GmbH). Distance and near visual acuity outcomes, intraocular aberrations, defocus curve, and quality of life (assessed using the National Eye Institute Visual Functioning Questionnaire-25) were evaluated postoperatively (mean follow-up: 6.42±2.24 months). A significant improvement in distance visual acuity was found postoperatively (P<.01). Mean postoperative logMAR distance-corrected near visual acuity was 0.19±0.12 (∼20/30). Corrected distance visual acuity and near visual acuity of 20/20 or better were achieved by 30.8% and 7.7% of eyes, respectively. Of all eyes, 96.2% had a postoperative addition between 0 and 1.00 diopter (D). The defocus curve showed two peaks of maximum visual acuity (0 and 3.00 D of defocus), with an acceptable range of intermediate vision. LogMAR visual acuity corresponding to near defocus was directly correlated with some higher order intraocular aberrations (r⩾0.44, P⩽.04). Some difficulties evaluated with the quality of life test correlated directly with near and intermediate visual acuity (r⩾0.50, P⩽.01). The Lentis Mplus multifocal IOL provides good distance, intermediate, and near visual outcomes; however, the induced intraocular aberrometric profile may limit the potential visual benefit. Copyright 2012, SLACK Incorporated.

Multifocal intraocular lenses: Types, outcomes, complications and how to solve them

PubMed Central

Salerno, Liberdade C.; Tiveron, Mauro C.; Alió, Jorge L.

2017-01-01

The multifocal intraocular lenses (IOLs) available are often able to restore visual function and allow spectacle independence after their implantation with great levels of patient satisfaction. The factors associated with the postoperatory success include the careful selection of the patient, the knowledge about the IOLs’ design, and their visual performance added to the proper surgical technique and management of possible complications as demonstrated by the evidence available. PMID:29296549

Design of a Test Bench for Intraocular Lens Optical Characterization

NASA Astrophysics Data System (ADS)

Alba-Bueno, Francisco; Vega, Fidel; Millán, María S.

2011-01-01

The crystalline lens is the responsible for focusing at different distances (accommodation) in the human eye. This organ grows throughout life increasing in size and rigidity. Moreover, due this growth it loses transparency through life, and becomes gradually opacified causing what is known as cataracts. Cataract is the most common cause of visual loss in the world. At present, this visual loss is recoverable by surgery in which the opacified lens is destroyed (phacoemulsification) and replaced by the implantation of an intraocular lens (IOL). If the IOL implanted is mono-focal the patient loses its natural capacity of accommodation, and as a consequence they would depend on an external optic correction to focus at different distances. In order to avoid this dependency, multifocal IOLs designs have been developed. The multi-focality can be achieved by using either, a refractive surface with different radii of curvature (refractive IOLs) or incorporating a diffractive surface (diffractive IOLs). To analyze the optical quality of IOLs it is necessary to test them in an optical bench that agrees with the ISO119679-2 1999 standard (Ophthalmic implants. Intraocular lenses. Part 2. Optical Properties and Test Methods). In addition to analyze the IOLs according to the ISO standard, we have designed an optical bench that allows us to simulate the conditions of a real human eye. To do that, we will use artificial corneas with different amounts of optical aberrations and several illumination sources with different spectral distributions. Moreover, the design of the test bench includes the possibility of testing the IOLs under off-axis conditions as well as in the presence of decentration and/or tilt. Finally, the optical imaging quality of the IOLs is assessed by using common metrics like the Modulation Transfer Function (MTF), the Point Spread Function (PSF) and/or the Strehl ratio (SR), or via registration of the IOL's wavefront with a Hartmann-Shack sensor and its analysis through expansion in Zernike polynomials.

Comparison of Visual Performance of Multifocal Intraocular Lenses with Same Material Monofocal Intraocular Lenses

PubMed Central

Yamauchi, Tomofusa; Tabuchi, Hitoshi; Takase, Kosuke; Ohsugi, Hideharu; Ohara, Zaigen; Kiuchi, Yoshiaki

2013-01-01

Purpose To compare the visual performance of multifocal intraocular lenses (IOLs) and monofocal IOLs made of the same material. Methods The subjects included patients implanted with either Tecnis® monofocal IOLs (ZA9003 or ZCB00) or Tecnis® multifocal IOLs (ZMA00 or ZMB00) bilaterally. We conducted a retrospective study comparing the two types of IOLs. The multifocal group included 46 patients who were implanted with Tecnis® multifocal IOLs bilaterally. The monofocal group was an age- and sex-matched control group, and included 85 patients who were implanted with Tecnis® monofocal IOLs bilaterally. Lens opacity grading, the radius of corneal curvature, corneal astigmatism, axial length and the refractive status were measured preoperatively. Pupil size, ocular aberrometry, distance, intermediate and near visual acuity, contrast sensitivity with and without glare and the responses to a quality-of-vision questionnaire were evaluated pre- and postoperatively. Results The uncorrected near visual acuity was significantly better in the multifocal group, whereas both the corrected intermediate and near visual acuity were better in the monofocal group. Contrast sensitivity (with and without glare) was significantly better in the monofocal group. The rate of spectacle dependency was significantly lower in the multifocal group. There were no significant differences between the two groups regarding most items of the postoperative quality-of-vision questionnaire (VFQ-25), with the exception that the patients in the monofocal group reported fewer problems with nighttime driving. Conclusions The multifocal IOLs used in this study reduced spectacle dependency more so than monofocal IOLs and did not compromise the subjective visual function, with the exception of nighttime driving. PMID:23840836

Exploring the optimum step size for defocus curves.

PubMed

Wolffsohn, James S; Jinabhai, Amit N; Kingsnorth, Alec; Sheppard, Amy L; Naroo, Shehzad A; Shah, Sunil; Buckhurst, Phillip; Hall, Lee A; Young, Graeme

2013-06-01

To evaluate the effect of reducing the number of visual acuity measurements made in a defocus curve on the quality of data quantified. Midland Eye, Solihull, United Kingdom. Evaluation of a technique. Defocus curves were constructed by measuring visual acuity on a distance logMAR letter chart, randomizing the test letters between lens presentations. The lens powers evaluated ranged between +1.50 diopters (D) and -5.00 D in 0.50 D steps, which were also presented in a randomized order. Defocus curves were measured binocularly with the Tecnis diffractive, Rezoom refractive, Lentis rotationally asymmetric segmented (+3.00 D addition [add]), and Finevision trifocal multifocal intraocular lenses (IOLs) implanted bilaterally, and also for the diffractive IOL and refractive or rotationally asymmetric segmented (+3.00 D and +1.50 D adds) multifocal IOLs implanted contralaterally. Relative and absolute range of clear-focus metrics and area metrics were calculated for curves fitted using 0.50 D, 1.00 D, and 1.50 D steps and a near add-specific profile (ie, distance, half the near add, and the full near-add powers). A significant difference in simulated results was found in at least 1 of the relative or absolute range of clear-focus or area metrics for each of the multifocal designs examined when the defocus-curve step size was increased (P<.05). Faster methods of capturing defocus curves from multifocal IOL designs appear to distort the metric results and are therefore not valid. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Pseudolentogenic astigmatic effect of multifocal intraocular lenses: non-corneal ocular residual astigmatism (N-CORA) as a new parameter in astigmatic change analysis.

PubMed

Frings, Andreas; Steinberg, Johannes; Druchkiv, Vasyl; Linke, Stephan J; Katz, Toam

2017-08-01

This study was initiated to introduce the term non-corneal ocular residual astigmatism (N-CORA) as a new parameter in astigmatic change analysis after implantation of two different types of non-toric, multifocal intraocular lenses (MIOL). Seventy-two eyes from 72 consecutive patients after MIOL surgery were studied in terms of a retrospective, cross-sectional data analysis. Two types of spherical MIOL were used. Surgical technique in all patients was a 2.4-mm incision phacoemulsification, performed by one surgeon. To investigate the magnitude and axis of astigmatic changes, the true corneal astigmatism and Alpins vector method were applied. There were no statistically significant between-group differences related to the preoperative refraction or ocular residual astigmatism (ORA). After surgery, the mean refractive surgically induced astigmatism (RSIA) and the topographic SIA (TSIA) did not differ significantly between the lenses. The magnitude and orientation of ORA and N-CORA changed after surgery. There are no statistically significant differences in postoperative ORA in magnitude or axis when implanting different types of MIOL. The similarity of N-CORA between both MIOL types shows that both diffractive and refractive asymmetric MIOLs with plate haptics have the same pseudolentogenic astigmatic effect which could be presented in terms of the newly introduced parameter N-CORA.

Foot clearance and variability in mono- and multifocal intraocular lens users during stair navigation.

PubMed

Renz, Erik; Hackney, Madeleine; Hall, Courtney

2016-01-01

Intraocular lenses (IOLs) provide distance and near refraction and are becoming the standard for cataract surgery. Multifocal glasses increase variability of toe clearance in older adults navigating stairs and increase fall risk; however, little is known about the biomechanics of stair navigation in individuals with multifocal IOLs. This study compared clearance while ascending and descending stairs in individuals with monofocal versus multifocal IOLs. Eight participants with multifocal IOLs (4 men, 4 women; mean age = 66.5 yr, standard deviation [SD] = 6.26) and fifteen male participants with monofocal IOLs (mean age = 69.9 yr, SD = 6.9) underwent vision and mobility testing. Motion analysis recorded kinematic and custom software-calculated clearances in three-dimensional space. No significant differences were found between groups on minimum clearance or variability. Clearance differed for ascending versus descending stairs: the first step onto the stair had the greatest toe clearance during ascent, whereas the final step to the floor had the greatest heel clearance during descent. This preliminary study indicates that multifocal IOLs have similar biomechanic characteristics to monofocal IOLs. Given that step characteristics are related to fall risk, we can tentatively speculate that multifocal IOLs may carry no additional fall risk.

Binocular function to increase visual outcome in patients implanted with a diffractive trifocal intraocular lens.

PubMed

Kretz, Florian T A; Müller, Matthias; Gerl, Matthias; Gerl, Ralf H; Auffarth, Gerd U

2015-08-21

To evaluate binocular visual outcome for near, intermediate and distance compared to monocular visual outcome at the same distances in patients implanted with a diffractive trifocal intraocular lens (IOL). The study comprised of 100 eyes of 50 patients that underwent bilateral refractive lens exchange or cataract surgery with implantation of a multifocal diffractive IOL (AT LISA tri 839MP, Carl Zeiss Meditech, Germany). A complete ophthalmological examination was performed preoperatively and 3 month postoperatively. The main outcome measures were monocular and binocular uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), and uncorrected near visual acuities (UNVA), keratometry, and manifest refraction. The mean age was 59.28 years ± 9.6 [SD] (range 44-79 years), repectively. There was significant improvement in UDVA, UIVA, UNVA and CDVA. Comparing the monocular results to the binocular results there was a statistical significant better binocular outcome in all distances (UDVA p = 0.036; UIVA p < 0.0001; UNVA p = 0.001). The postoperative manifest refraction was in 86 % of patients within ± 0.50 [D]. The trifocal IOL improved near, intermediate, and distance vision compared to preoperatively. In addition a statistical significant increase for binocular visual function in all distances could be found. German Clinical Trials Register (DRKS) DRKS00007837.

Distance and near visual acuity improvement after implantation of multifocal intraocular lenses in cataract patients with presbyopia: a systematic review.

PubMed

Agresta, Blaise; Knorz, Michael C; Kohnen, Thomas; Donatti, Christina; Jackson, Daniel

2012-06-01

To evaluate uncorrected distance visual acuity (UDVA) as well as uncorrected near visual acuity (UNVA) as outcomes in treating presbyopic cataract patients to assist clinicians and ophthalmologists in their decision-making process regarding available interventions. Medline, Embase, and Evidence Based Medicine Reviews were systematically reviewed to identify studies reporting changes in UDVA and UNVA after cataract surgery in presbyopic patients. Strict inclusion/exclusion criteria were used to exclude any studies not reporting uncorrected visual acuity in a presbyopic population with cataracts implanted with multifocal intraocular lenses (IOLs). Relevant outcomes (UDVA and UNVA) were identified from the studies retrieved through the systematic review process. Twenty-nine studies were identified that reported uncorrected visual acuities, including one study that reported uncorrected intermediate visual acuity. Nine brands of multifocal IOLs were identified in the search. All studies identified in the literature search reported improvements in UDVA and UNVA following multifocal IOL implantation. The largest improvements in visual acuity were reported using the Rayner M-Flex lens (Rayner Intraocular Lenses Ltd) (UDVA, binocular: 1.05 logMAR, monocular: 0.92 logMAR; UNVA, binocular and monocular: 0.83 logMAR) and the smallest improvements were reported using the Acri.LISA lens (Carl Zeiss Meditec) (UDVA, 0.21 decimal; UNVA, 0.51 decimal). The results of this systematic review show the aggregate of studies reporting a beneficial increase in UDVA and UNVA with the use of multifocal IOLs in cataract patients with presbyopia, hence providing evidence to support the hypothesis that multifocal IOLs increase UDVA and UNVA in cataract patients. Copyright 2012, SLACK Incorporated.

Visual Outcomes, Quality of Vision, and Quality of Life of Diffractive Multifocal Intraocular Lens Implantation after Myopic Laser In Situ Keratomileusis: A Prospective, Observational Case Series

PubMed Central

2017-01-01

Purpose. To report visual performance and quality of life after implantation of a bifocal diffractive multifocal intraocular lens (MIOL) in postmyopic laser in situ keratomileusis (LASIK) patients. Methods. Prospective, observational case series. Patients with prior myopic LASIK who had implantation of Tecnis ZMA00/ZMB00 MIOL (Abbott Medical Optics) at Hong Kong Sanatorium and Hospital were included. Postoperative examinations included monocular and binocular distance, intermediate and near visual acuity (VA), and contrast sensitivity; visual symptoms (0–5); satisfaction (1–5); spectacle independence rate; and quality of life. Results. Twenty-three patients (27 eyes) were included. No intraoperative complications developed. Mean monocular uncorrected VA at distance, intermediate, and near were 0.13 ± 0.15 (standard deviation), 0.22 ± 0.15, and 0.16 ± 0.15, respectively. Corresponding mean values for binocular uncorrected VA were 0.00 ± 0.10, 0.08 ± 0.13, and 0.13 ± 0.10, respectively. No eyes lost >1 line of corrected distance VA. Contrast sensitivity at different spatial frequencies between operated and unoperated eyes did not differ significantly (all P > 0.05). Mean score for halos, night glare, starbursts, and satisfaction were 1.46 ± 1.62, 1.85 ± 1.69, 0.78 ± 1.31, and 3.50 ± 1.02, respectively. Eighteen patients (78%) reported complete spectacle independence. Mean composite score of the quality-of-life questionnaire was 90.31 ± 8.50 out of 100. Conclusions. Implantation of the MIOL after myopic LASIK was safe and achieved good visual performance. PMID:28133543

Visual Outcomes, Quality of Vision, and Quality of Life of Diffractive Multifocal Intraocular Lens Implantation after Myopic Laser In Situ Keratomileusis: A Prospective, Observational Case Series.

PubMed

Chang, John S M; Ng, Jack C M; Chan, Vincent K C; Law, Antony K P

2017-01-01

Purpose . To report visual performance and quality of life after implantation of a bifocal diffractive multifocal intraocular lens (MIOL) in postmyopic laser in situ keratomileusis (LASIK) patients. Methods . Prospective, observational case series. Patients with prior myopic LASIK who had implantation of Tecnis ZMA00/ZMB00 MIOL (Abbott Medical Optics) at Hong Kong Sanatorium and Hospital were included. Postoperative examinations included monocular and binocular distance, intermediate and near visual acuity (VA), and contrast sensitivity; visual symptoms (0-5); satisfaction (1-5); spectacle independence rate; and quality of life. Results . Twenty-three patients (27 eyes) were included. No intraoperative complications developed. Mean monocular uncorrected VA at distance, intermediate, and near were 0.13 ± 0.15 (standard deviation), 0.22 ± 0.15, and 0.16 ± 0.15, respectively. Corresponding mean values for binocular uncorrected VA were 0.00 ± 0.10, 0.08 ± 0.13, and 0.13 ± 0.10, respectively. No eyes lost >1 line of corrected distance VA. Contrast sensitivity at different spatial frequencies between operated and unoperated eyes did not differ significantly (all P > 0.05). Mean score for halos, night glare, starbursts, and satisfaction were 1.46 ± 1.62, 1.85 ± 1.69, 0.78 ± 1.31, and 3.50 ± 1.02, respectively. Eighteen patients (78%) reported complete spectacle independence. Mean composite score of the quality-of-life questionnaire was 90.31 ± 8.50 out of 100. Conclusions . Implantation of the MIOL after myopic LASIK was safe and achieved good visual performance.

Piggyback intraocular lens implantation to correct pseudophakic refractive error after segmental multifocal intraocular lens implantation.

PubMed

Venter, Jan A; Oberholster, Andre; Schallhorn, Steven C; Pelouskova, Martina

2014-04-01

To evaluate refractive and visual outcomes of secondary piggyback intraocular lens implantation in patients diagnosed as having residual ametropia following segmental multifocal lens implantation. Data of 80 pseudophakic eyes with ametropia that underwent Sulcoflex aspheric 653L intraocular lens implantation (Rayner Intraocular Lenses Ltd., East Sussex, United Kingdom) to correct residual refractive error were analyzed. All eyes previously had in-the-bag zonal refractive multifocal intraocular lens implantation (Lentis Mplus MF30, models LS-312 and LS-313; Oculentis GmbH, Berlin, Germany) and required residual refractive error correction. Outcome measurements included uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, distance-corrected near visual acuity, manifest refraction, and complications. One-year data are presented in this study. The mean spherical equivalent ranged from -1.75 to +3.25 diopters (D) preoperatively (mean: +0.58 ± 1.15 D) and reduced to -1.25 to +0.50 D (mean: -0.14 ± 0.28 D; P < .01). Postoperatively, 93.8% of eyes were within ±0.50 D and 98.8% were within ±1.00 D of emmetropia. The mean uncorrected distance visual acuity improved significantly from 0.28 ± 0.16 to 0.01 ± 0.10 logMAR and 78.8% of eyes achieved 6/6 (Snellen 20/20) or better postoperatively. The mean uncorrected near visual acuity changed from 0.43 ± 0.28 to 0.19 ± 0.15 logMAR. There was no significant change in corrected distance visual acuity or distance-corrected near visual acuity. No serious intraoperative or postoperative complications requiring secondary intraocular lens removal occurred. Sulcoflex lenses proved to be a predictable and safe option for correcting residual refractive error in patients diagnosed as having pseudophakia. Copyright 2014, SLACK Incorporated.

Optimizing outcomes with multifocal intraocular lenses

PubMed Central

Sachdev, Gitansha Shreyas; Sachdev, Mahipal

2017-01-01

Modern day cataract surgery is evolving from a visual restorative to a refractive procedure. The advent of multifocal intraocular lenses (MFIOLs) allows greater spectacle independence and increased quality of life postoperatively. Since the inception in 1980s, MFIOLs have undergone various technical advancements including trifocal and extended depth of vision implants more recently. A thorough preoperative workup including the patients’ visual needs and inherent ocular anatomy allows us to achieve superior outcomes. This review offers a comprehensive overview of the various types of MFIOLs and principles of optimizing outcomes through a comprehensive preoperative screening and management of postoperative complications. PMID:29208809

Toric multifocal intraocular lens implantation in a case of bilateral anterior and posterior lenticonus in Alport syndrome

PubMed Central

Ladi, Jeevan S; Shah, Nitant A

2016-01-01

We report the first case of toric multifocal intraocular lens (IOL) implantation in both the eyes of a young patient of Alport syndrome with anterior and posterior lenticonus with a successful outcome. An 18-year-old female patient presented with progressively blurred vision in both eyes since 4–5 years not improving with glasses. Refraction showed high myopia with astigmatism; however, the vision did not improve beyond 6/60 with glasses correction. Clinical examination on slit lamp showed anterior and posterior lenticonus bilaterally with a classical oil droplet appearance. We performed clear lens extraction by phacoemulsification with toric multifocal IOL implantation in both eyes. Postoperatively, the patient achieved an excellent refractive outcome with the unaided vision of 6/9, N6 in both eyes. PMID:27958211

Small-Gauge Pars Plana Vitrectomy for the Management of Symptomatic Posterior Vitreous Detachment after Phacoemulsification and Multifocal Intraocular Lens Implantation: A Pilot Study from the Pan-American Collaborative Retina Study Group

PubMed Central

Navarro, Rodrigo M.; Machado, Leonardo M.; Maia, Ossires; Wu, Lihteh; Farah, Michel E.; Magalhaes, Octaviano; Arevalo, J. Fernando; Maia, Mauricio

2015-01-01

Purpose. To determine the efficacy of 23-gauge pars plana vitrectomy (PPV) for symptomatic posterior vitreous detachment (PVD) on visual acuity (VA) and quality after multifocal intraocular lenses (IOLs). Methods. In this prospective case series, patients who developed symptomatic PVD and were not satisfied with visual quality due to floaters and halos after multifocal IOL implantation underwent PPV. Examinations included LogMAR uncorrected visual acuity (UCVA), intraocular pressure, biomicroscopy, and indirect ophthalmoscopy at baseline and 1, 7, 30, and 180 days postoperatively. Ultrasonography and aberrometry were performed. The Visual Functioning Questionnaire 25 (VFQ-25) was administered preoperatively and at 30 days postoperatively. Both the postoperative UCVA and questionnaire results were compared to preoperative findings using the Wilcoxon test. Results. Sixteen eyes of 8 patients were included. VA significantly improved from 0.17 to 0.09 postoperatively (P = 0.017). All patients reported improvement of halos, glare, and floaters. VFQ-25 scores significantly improved in general vision (P = 0.023), near activities (P = 0.043), distance activities (P = 0.041), mental health (P = 0.011), role difficulties (P = 0.042), and driving (P = 0.016). Conclusion. PPV may increase UCVA and quality of vision in patients with bilateral multifocal IOLs and symptomatic PVD. Larger studies are advised. PMID:26504590

[Clinical results after implantation of a new segmental refractive multifocal intraocular lens].

PubMed

Thomas, B C; Auffarth, G U; Philips, R; Novák, J; Blazek, J; Adamkova, H; Rabsilber, T M

2013-11-01

The aim of the study was a clinical evaluation of an intraocular lens (IOL) with a segmental multifocal optic design and near addition of + 3.0 D as part of a CE approval study. In a multicenter study the LENTIS Mplus LS-312 MF IOL (Oculentis) was implanted in 134 eyes of 79 patients with a mean age of 68 ± 12 years. The multifocality is achieved by implementation of a distance part and a segmented near sector. Three months after surgery, uncorrected and best corrected distance visual acuity (UCDVA and BCDVA, respectively), near visual acuity (UCNVA and BCNVA, respectively), contrast vision and patient satisfaction (questionnaire) were evaluated. The IOLs were implanted uneventfully either unilaterally or bilaterally and 3 months postoperatively (n = 86 eyes) the following mean visual acuities were obtained (logMAR): UCDVA = 0.05, BCDVA = - 0.01, UCNVA = 0.09 and BCNVA = 0.02. Contrast sensitivity (n = 25 eyes) was within normal limits. Of the 66 questioned patients 10.6% spontaneously reported halos and 3% glare. This new innovative multifocal IOL concept showed very good functional results as well as high patient satisfaction.

Reading ability with pseudophakic monovision and with refractive multifocal intraocular lenses: comparative study.

PubMed

Ito, Misae; Shimizu, Kimiya

2009-09-01

To the compare the reading ability after bilateral cataract surgery in patients who had pseudophakic monovision achieved by monofocal intraocular lens (IOL) implantation and patients who had refractive multifocal IOL implantation. Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. This study evaluated patients who had bilateral cataract surgery using the monovision method with monofocal IOL implantation to correct presbyopia (monovision group) or who had bilateral cataract surgery with refractive multifocal IOL implantation (multifocal group). In the monovision group, the dominant eye was corrected for distance vision and the nondominant eye for near vision. The maximum reading speed, critical character size, and reading acuity were measured binocularly without refractive correction using MNREAD-J acuity charts. The monovision group comprised 38 patients and the multifocal group, 22 patients. The mean maximum reading speed was 350.5 characters per minute (cpm) +/- 62.3 (SD) in the monovision group and 355.0 +/- 53.3 cpm in the multifocal group; the difference was not statistically significant. The mean critical character size was 0.24 +/- 0.12 logMAR and 0.40 +/- 0.16 logMAR, respectively (P<.05). The mean reading acuity was 0.05 +/- 0.12 logMAR and 0.19 +/- 0.11 logMAR, respectively (P<.01). The monovision group had better critical character size and reading acuity results. The monovision method group had better reading ability; however, careful patient selection is essential.

Reduction in mean deviation values in automated perimetry in eyes with multifocal compared to monofocal intraocular lens implants.

PubMed

Farid, Marjan; Chak, Garrick; Garg, Sumit; Steinert, Roger F

2014-08-01

To evaluate differences in mean deviation values in automated perimetry in healthy eyes with multifocal compared to monofocal intraocular lens (IOL) implants. Prospective, age-matched, comparative analysis. Single-center, tertiary referral academic practice. A total of 37 healthy eyes in 37 patients with bilateral multifocal (n=22) or monofocal (n=15) IOL implants were studied. INTERVENTION/OBSERVATION PROCEDURE: Humphrey Visual Field 10-2 testing was performed on all patients. Mean deviation (MD) and pattern standard deviation (PSD) numerical values were evaluated and compared between groups. The average MD was -2.84 dB (SD 2.32) for the multifocal IOL group and -0.97 dB (SD 1.58) for the monofocal IOL group (P=.006). There was no significant difference in PSD between the 2 groups (P=.99). Eyes that had the visual field 10-2 testing≥6 months from time of IOL placement showed no improvement in MD when compared to eyes that were tested within 6 months from IOL placement. Multifocal IOL implants cause significant nonspecific reduction in MD values on Humphrey Visual Field 10-2 testing that does not improve with time or neuroadaptation. Multifocal IOL implants may be inadvisable in patients where central visual field reduction may not be tolerated, such as macular degeneration, retinal pigment epithelium changes, and glaucoma. Copyright © 2014 Elsevier Inc. All rights reserved.

Functional Magnetic Resonance Imaging to Assess the Neurobehavioral Impact of Dysphotopsia with Multifocal Intraocular Lenses.

PubMed

Rosa, Andreia M; Miranda, Ângela C; Patrício, Miguel; McAlinden, Colm; Silva, Fátima L; Murta, Joaquim N; Castelo-Branco, Miguel

2017-09-01

To investigate the association between dysphotopsia and neural responses in visual and higher-level cortical regions in patients who recently received multifocal intraocular lens (IOL) implants. Cross-sectional study. Thirty patients 3 to 4 weeks after bilateral cataract surgery with diffractive IOL implantation and 15 age- and gender-matched control subjects. Functional magnetic resonance imaging (fMRI) was performed when participants viewed low-contrast grating stimuli. A light source surrounded the stimuli in half of the runs to induce disability glare. Visual acuity, wavefront analysis, Quality of Vision (QoV) questionnaire, and psychophysical assessment were performed. Cortical activity (blood oxygen level dependent [BOLD] signal) in the primary visual cortex and in higher-level brain areas, including the attention network. When viewing low-contrast stimuli under glare, patients showed significant activation of the effort-related attention network in the early postoperative period, involving the frontal, middle frontal, parietal frontal, and postcentral gyrus (multisubject random-effects general linear model (GLM), P < 0.03). In contrast, controls showed only relative deactivation (due to lower visibility) of visual areas (occipital lobe and middle occipital gyrus, P < 0.03). Patients also had relatively stronger recruitment of cortical areas involved in learning (anterior cingulate gyrus), task planning, and solving (caudate body). Patients reporting greater symptoms induced by dysphotic symptoms showed significantly increased activity in several regions in frontoparietal circuits, as well as cingulate gyrus and caudate nucleus (q < 0.05). We found no correlation between QoV questionnaire scores and optical properties (total and higher order aberration, modulation transfer function, and Strehl ratio). This study shows the association between patient-reported subjective difficulties and fMRI outcomes, independent of optical parameters and psychophysical performance. The increased activity of cortical areas dedicated to attention (frontoparietal circuits), to learning and cognitive control (cingulate), and to task goals (caudate) likely represents the beginning of the neuroadaptation process to multifocal IOLs. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

New trends in intraocular lens imaging

NASA Astrophysics Data System (ADS)

Millán, María S.; Alba-Bueno, Francisco; Vega, Fidel

2011-08-01

As a result of modern technological advances, cataract surgery can be seen as not only a rehabilitative operation, but a customized procedure to compensate for important sources of image degradation in the visual system of a patient, such as defocus and some aberrations. With the development of new materials, instruments and surgical techniques in ophthalmology, great progress has been achieved in the imaging capability of a pseudophakic eye implanted with an intraocular lens (IOL). From the very beginning, optical design has played an essential role in this progress. New IOL designs need, on the one hand, theoretical eye models able to predict optical imaging performance and on the other hand, testing methods, verification through in vitro and in vivo measurements, and clinical validation. The implant of an IOL requires a precise biometry of the eye, a prior calculation from physiological data, and an accurate position inside the eye. Otherwise, the effects of IOL calculation errors or misplacements degrade the image very quickly. The incorporation of wavefront aberrometry into clinical ophthalmology practice has motivated new designs of IOLs to compensate for high order aberrations in some extent. Thus, for instance, IOLs with an aspheric design have the potential to improve optical performance and contrast sensitivity by reducing the positive spherical aberration of human cornea. Monofocal IOLs cause a complete loss of accommodation that requires further correction for either distance or near vision. Multifocal IOLs address this limitation using the principle of simultaneous vision. Some multifocal IOLs include a diffractive zone that covers the aperture in part or totally. Reduced image contrast and undesired visual phenomena, such as halos and glare, have been associated to the performance of multifocal IOLs. Based on a different principle, accommodating IOLs rely on the effort of the ciliary body to increase the effective power of the optical system of the eye in near vision. Finally, we present a theoretical approach that considers the modification of less conventional ocular parameters to compensate for possible refractive errors after the IOL implant.

Validity of automated refraction after segmented refractive multifocal intraocular lens implantation

PubMed Central

Albarrán-Diego, César; Muñoz, Gonzalo; Rohrweck, Stephanie; García-Lázaro, Santiago; Albero, José Ricardo

2017-01-01

AIM To evaluate the clinical utility of automated refraction (AR) and keratometry (KR) compared with subjective or manifest refraction (MR) after cataract or refractive lens exchange surgery with implantation of Lentis Mplus X (Oculentis GmbH) refractive multifocal intraocular lens (IOL). METHODS Eighty-six eyes implanted with the Lentis Mplus X multifocal IOL were included. MR was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up. RESULTS Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D) for sphere. Astigmatism showed better correlation between KR and MR. CONCLUSION We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a Lentis Mplus X multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected. PMID:29181318

Validity of automated refraction after segmented refractive multifocal intraocular lens implantation.

PubMed

Albarrán-Diego, César; Muñoz, Gonzalo; Rohrweck, Stephanie; García-Lázaro, Santiago; Albero, José Ricardo

2017-01-01

To evaluate the clinical utility of automated refraction (AR) and keratometry (KR) compared with subjective or manifest refraction (MR) after cataract or refractive lens exchange surgery with implantation of Lentis Mplus X (Oculentis GmbH) refractive multifocal intraocular lens (IOL). Eighty-six eyes implanted with the Lentis Mplus X multifocal IOL were included. MR was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up. Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D) for sphere. Astigmatism showed better correlation between KR and MR. We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a Lentis Mplus X multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected.

Evaluation of rotation and visual outcomes after implantation of monofocal and multifocal toric intraocular lenses.

PubMed

Garzón, Nuria; Poyales, Francisco; de Zárate, Begoña Ortíz; Ruiz-García, Jose Luis; Quiroga, Juan Antonio

2015-02-01

To evaluate rotational stability and its influence on postoperative visual acuity of different monofocal and multifocal toric intraocular lenses (IOLs). A prospective interventional study was designed. Ninety-one patients with a mean age of 71.65 ± 11.82 years were implanted with toric IOLs after phacoemulsification. Three monofocal toric IOLs (the Lentis LT [Oculentis, Berlin, Germany], enVista [Bausch & Lomb, Rochester, NY], and AcrySof IQ [Alcon Laboratories, Inc., Fort Worth, TX]) and one multifocal toric IOL (AcrySof IQ ReSTOR; Alcon Laboratories, Inc.) were implanted. Preoperative and postoperative images were taken to calculate the misalignment due to the marking method. To evaluate rotation in the different follow-up visits, another photograph was taken 1 hour and 1, 7 and 30 days postoperatively. Refraction, uncorrected distance visual acuity (UDVA), and corrected distance visual acuity were measured 30 days postoperatively. Postoperative UDVA was 0.1 logMAR or better in 64.6% of eyes implanted with monofocal IOLs and 46.4% of eyes implanted with multifocal IOLs. The enVista toric IOL showed the best UDVA compared to the other monofocal IOLs, with 81% of eyes with 0.1 logMAR or better. The mean misalignment in the total group studied was 0.07° ± 0.60°; 69.6% of monofocal IOLs and 67.9% of multifocal IOLs showed less than 5° of rotation. A correlation was found between postoperative UDVA and rotation in the monofocal and multifocal IOLs implanted (r = 0.439 [P < .011] and = 0.787 [P = .001], respectively). At 1 month postoperatively, UDVA was slightly more affected by IOL rotation in multifocal than monofocal toric IOLs. The marking method was also effective. Copyright 2015, SLACK Incorporated.

Implantation of a Multifocal Toric Intraocular Lens after Radial Keratotomy and Cross-Linking with Hyperopia and Astigmatism Residues: A Case Report.

PubMed

Nuzzi, Raffaele; Monteu, Francesca; Tridico, Federico

2017-01-01

Radial keratotomy is a refractive surgical technique, widely used in the 80s and early 90s to correct myopia and astigmatism, but now overcome by more recent laser techniques. Important consequences, often in patients with more than 45 years of age, are progressive hyperopic shift and/or an increase in corneal astigmatism, whose main cause seems to be an increase in the curvature radius of the central portion of the cornea. This seems to be due to radial keratotomy incisions - with the consequent need for cross-linking - intraocular pressure, and corneal biomechanical parameters. The authors propose phacoemulsification with a customized multifocal toric intraocular lens implantation to correct the induced shift and hyperopic astigmatism. A decent postoperative visual acuity was observed with good patient satisfaction. A specific protocol must be applied to optimize the correct diagnosis, presurgical evaluation and postsurgical outcomes that are to be maintained over time, without regressions.

Refractive outcomes after multifocal intraocular lens exchange.

PubMed

Kim, Eric J; Sajjad, Ahmar; Montes de Oca, Ildamaris; Koch, Douglas D; Wang, Li; Weikert, Mitchell P; Al-Mohtaseb, Zaina N

2017-06-01

To evaluate the refractive outcomes after multifocal intraocular lens (IOL) exchange. Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Retrospective case series. Patients had multifocal IOL explantation followed by IOL implantation. Outcome measures included type of IOL, surgical indication, corrected distance visual acuity (CDVA), and refractive prediction error. The study comprised 29 patients (35 eyes). The types of IOLs implanted after multifocal IOL explantation included in-the-bag IOLs (74%), iris-sutured IOLs (6%), sulcus-fixated IOLs with optic capture (9%), sulcus-fixated IOLs without optic capture (9%), and anterior chamber IOLs (3%). The surgical indication for exchange included blurred vision (60%), photic phenomena (57%), photophobia (9%), loss of contrast sensitivity (3%), and multiple complaints (29%). The CDVA was 20/40 or better in 94% of eyes before the exchange and 100% of eyes after the exchange (P = .12). The mean refractive prediction error significantly decreased from 0.22 ± 0.81 diopter (D) before the exchange to -0.09 ± 0.53 D after the exchange (P < .05). The median absolute refractive prediction error significantly decreased from 0.43 D before the exchange to 0.23 D after the exchange (P < .05). Multifocal IOL exchange can be performed safely with good visual outcomes using different types of IOLs. A lower refractive prediction error and a higher likelihood of 20/40 or better vision can be achieved with the implantation of the second IOL compared with the original multifocal IOL, regardless of the final IOL position. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Clinical and optical intraocular performance of rotationally asymmetric multifocal IOL plate-haptic design versus C-loop haptic design.

PubMed

Alió, Jorge L; Plaza-Puche, Ana B; Javaloy, Jaime; Ayala, María José; Vega-Estrada, Alfredo

2013-04-01

To compare the visual and intraocular optical quality outcomes with different designs of the refractive rotationally asymmetric multifocal intraocular lens (MFIOL) (Lentis Mplus; Oculentis GmbH, Berlin, Germany) with or without capsular tension ring (CTR) implantation. One hundred thirty-five consecutive eyes of 78 patients with cataract (ages 36 to 82 years) were divided into three groups: 43 eyes implanted with the C-Loop haptic design without CTR (C-Loop haptic only group); 47 eyes implanted with the C-Loop haptic design with CTR (C-Loop haptic with CTR group); and 45 eyes implanted with the plate-haptic design (plate-haptic group). Visual acuity, contrast sensitivity, defocus curve, and ocular and intraocular optical quality were evaluated at 3 months postoperatively. Significant differences in the postoperative sphere were found (P = .01), with a more myopic postoperative refraction for the C-Loop haptic only group. No significant differences were detected in photopic and scotopic contrast sensitivity among groups (P ⩾ .05). Significantly better visual acuities were present in the C-Loop haptic with CTR group for the defocus levels of -2.0, -1.5, -1.0, and -0.50 D (P ⩽.03). Statistically significant differences among groups were found in total intraocular root mean square (RMS), high-order intraocular RMS, and intraocular coma-like RMS aberrations (P ⩽.04), with lower values from the plate-haptic group. The plate-haptic design and the C-Loop haptic design with CTR implantation both allow good visual rehabilitation. However, better refractive predictability and intraocular optical quality was obtained with the plate-haptic design without CTR implantation. The plate-haptic design seems to be a better design to support rotational asymmetric MFIOL optics. Copyright 2013, SLACK Incorporated.

[Meta-analysis of clinical randomized controlled trials comparing refractive with diffractive multifocal intraocular lenses in cataract surgery].

PubMed

Shao, Dewang; He, Shouzhi

2014-02-01

To systematic review the effectiveness of refractive multifocal intraocular lens (MIOL) versus diffractive MIOL in the treatment of cataract. Randomized controlled trials comparing refractive MIOL with diffractive MIOL were identified by searching PubMed (1966 to May, 2013), EMbase (1980 to May, 2013), Medline (1966 to May, 2013), and The Cochrane Library (Issue 1, 2013). We also hand-searched related journals. All the searches were restricted in English or Chinese. Methodological quality of randomized controlled trials (RCT) was evaluated by simple evaluate method that recommended by the Cochrane Collaboration. Data extracted by two reviewers with designed extraction form. RevMan software (release 5.2) was used for data management and analysis. A total of 11 trials (1460 eyes) were included for systematic review. Subgroup analyses were used according to different model comparison of MIOL. The results showed a significant difference in the mean of the uncorrected distance visual acuity (UCDVA) and the uncorrected intermediate visual acuity (UCIVA) in the refractive MIOL group with WMD -0.04, 95%CI -0.06 to -0.03 (P < 0.01) and WMD -0.05, 95%CI -0.09 to -0.02 (P = 0.001). It showed a significantly difference in the mean of the uncorrected near visual acuity (UCNVA), complete spectacle independent rate, halo rate and glare rate in the diffractive MIOL group with WMD 0.11, 95%CI 0.08 to 0.15 (P < 0.01), WMD 2.98, 95%CI 2.17 to 4.09 (P < 0.01), WMD 1.52, 95%CI 1.14 to 2.04 (P = 0.004) and WMD 1.27, 95%CI 1.07 to 1.50 (P = 0.005). There was no significant difference between the two groups in the mean of the best corrected distance visual acuity (BCDVA), the best distance corrected intermediate visual acuity (BDCIVA), the best distance corrected near visual acuity (BDCNVA) and the best corrected near visual acuity (BCNVA) with WMD -0.01, 95%CI -0.03 to 0.01 (P = 0.45), WMD -0.06, 95%CI -0.15 to 0.03 (P = 0.18), WMD 0.08, 95%CI -0.01 to 0.17 (P = 0.09) and WMD -0.02, 95%CI -0.26 to 0.23 (P = 0.88). Patients implanted with refractive MIOL show better uncorrected distance and intermediate visual acuity; patients implanted with diffractive MIOL show better uncorrected near visual acuity with less likely to appear light halo, glare and other visual adverse reactions. As for spectacles correction cases, patients implanted with diffractive or refractive MIOL have considerable performances in the far, middle, near visual acuity.

Multifocal Intraocular Lens Results in Correcting Presbyopia in Eyes After Radial Keratotomy.

PubMed

Kim, Kyeong Hwan; Seok, Kyung-Won; Kim, Wan Soo

2017-11-01

To report results of multifocal intraocular lens (IOL) implantation in 2 patients with refractive error and presbyopia after previous radial keratotomy (RK). A refractive multifocal IOL with rotational asymmetry (LS313-MF30; Oculentis, Berlin, Germany) was implanted. The first patient was a 60-year-old man with myopia who underwent unilateral RK 20 years before. His uncorrected distance visual acuity (UDVA) was 20/400, and his distance corrected near vision was J9 in both eyes. Six months after bilateral surgery, his binocular UDVA and uncorrected near visual acuity (UNVA) improved to 20/20 and J1, respectively, although he experienced diurnal fluctuation. The second patient was a 55-year-old woman with hyperopia who underwent bilateral RK 18 years before. Uncorrected distance visual acuity was 20/25 in both eyes, but UNVA was between J9 and J10. Three months after unilateral surgery, UDVA and UNVA of the postsurgical eye improved to 20/20 and J1, respectively. Neither patient reported any significant photic phenomena, and both were satisfied with the results of treatment. The desirable clinical outcomes and levels of satisfaction expressed by these patients indicate that surgery using this particular multifocal IOL may benefit presbyopic patients with previous RK.

All-distance visual acuity and contrast visual acuity in eyes with a refractive multifocal intraocular lens with minimal added power.

PubMed

Hayashi, Ken; Yoshida, Motoaki; Hayashi, Hideyuki

2009-03-01

To compare visual acuity (VA) from far to near distances, photopic and mesopic contrast VA, and contrast VA in the presence of a glare source (glare VA), between eyes with a new refractive multifocal intraocular lens (IOL) with added power of only +3.0 diopters and those with a monofocal IOL. Comparative, nonrandomized, interventional study. Forty-four eyes of 22 patients who were scheduled for implantation of a refractive multifocal IOL (Hoya SFX MV1; Tokyo, Japan) and 44 eyes of 22 patients scheduled for implantation of a monofocal IOL. All patients underwent phacoemulsification with bilateral implantation of either multifocal or monofocal IOLs. At approximately 3 months after surgery, monocular and binocular VA from far to near distances was measured using the all-distance vision tester (Kowa AS-15; Tokyo, Japan), whereas photopic and mesopic contrast VA and glare VA were examined using the Contrast Sensitivity Accurate Tester (Menicon CAT-2000, Nagoya, Japan). Pupillary diameter and the degree of IOL decentration and tilt were correlated with VA at all distances. Mean VA in both the multifocal and monofocal IOL groups decreased gradually from far to near distances. When comparing the 2 groups, however, both uncorrected and best distance-corrected intermediate VA at 0.5 m and near VA at 0.3 m in the multifocal IOL group were significantly better than those in the monofocal IOL group (P

Eye growth in the second decade of life: implications for the implantation of a multifocal intraocular lens.

PubMed

Wilson, M Edward; Trivedi, Rupal H; Burger, Berdine M

2009-12-01

There is a growing interest in multifocal intraocular lens (IOL) implantation in children because they lose accommodation when a cataract is removed. Many have assumed that very little, if any, eye growth occurs in the second decade of life. Multifocal IOL implantation requires precise biometry to arrive at the correct IOL power for spectacle independence. If the eye grows and the refraction becomes myopic, spectacle dependence may return. Therefore, knowing when the eye has completed its growth is critical to the decision of when to implant a multifocal IOL. Ninety-eight eyes were analyzed retrospectively. Each had at least two axial length (AL) measurements using immersion A-scan ultrasound in the second decade of life. Globe AL was 23.36 +/- 1.52 mm at initial measurement and 23.89 +/- 1.64 mm at last measurement. Measurement data show variable growth throughout the second decade of life. Based on our data, a theoretical patient was constructed with an AL at age 10 of 23.11 mm, who would need an IOL power of 21.5 for emmetropia. That same patient would have an AL of 23.76 mm (IOL power of 19.5) at age 15 and 24.41 mm (IOL power of 17.5) at age 20. That is a 4-diopter change in the IOL power need. Axial eye growth continues throughout the second decade of life, at least to age 20. These data have important implications for the use of multifocal IOLs in the preteen and teenage years.

Influence of Near-Segment Positioning in a Rotationally Asymmetric Multifocal Intraocular Lens.

PubMed

Song, In Seok; Yoon, Sam Young; Kim, Jae Yong; Kim, Myoung Joon; Tchah, Hungwon

2016-04-01

To compare visual performance and higher order aberrations (HOAs) based on the position of the near segment in eyes with rotationally asymmetric multifocal intraocular lenses (IOLs). Asymmetric multifocal IOLs (Lentis Mplus LS-313; Oculentis Optikgeräte GmbH, Wetzlar, Germany) were implanted with the near segment positioned either inferiorly, superiorly, or temporally. Uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity, corrected distance visual acuity (CDVA), and distance-corrected intermediate (DCIVA) and near (DCNVA) visual acuity, contrast sensitivity, HOAs, and subjective symptom questionnaires were compared at 1 month postoperatively. Forty-five eyes from 45 patients were evaluated (n = 25, 9, and 11 eyes in the inferior, superior, and temporal groups, respectively). No significant differences in UDVA, UIVA, UNVA, CDVA, DCIVA, or DCNVA were found between the three groups (P > .05). The temporal group showed the best results in UDVA, CDVA, and DCNVA, but the inferior group showed the best results in DCIVA and UNVA and the superior group showed the best results in UIVA. Contrast sensitivity and the subjective symptom questionnaire also did not demonstrate any significant differences (P > .05). Total HOA and spherical aberration did not demonstrate any statistically significant differences (P > .05), but vertical coma and horizontal coma demonstrated significant differences based on near segment position (P < .001). The position of the near segment in eyes with rotationally asymmetric multifocal IOLs demonstrates no significant effect on visual performance. Copyright 2016, SLACK Incorporated.

Microincision, aspiration cutter-assisted multifocal iris biopsy for melanoma.

PubMed

Finger, Paul T; Milman, Tatyana

2017-01-19

To describe a minimally invasive method to create multifocal full-thickness surgical iridectomy biopsies. Seven patients suspected to have diffuse iris melanoma underwent multifocal surgical iridectomy biopsy through a single 1.0-mm clear corneal incision. A 25-G inked trocar was used to create one visible corneal portal, through which the anterior chamber was filled with sodium hyaluronate 1%. Then, a 25-G aspiration cutter probe was introduced through the corneal incision such that the aspiration portal was occluded by the iris biopsy sites. Then aspiration (600 mm Hg) cutting (300 cuts per minute) was used to create full- and partial-thickness surgical iridectomy biopsies at multiple locations. After each biopsy the probe was removed, and its contents aspirated into a separate 3-mL syringe (marked by clock hour location). The sodium hyaluronate 1% was removed and wound checked for leakage. Diagnostic specimens were obtained in all cases. Five were found to be diffuse iris melanomas and 2 were indeterminate iris melanocytic proliferations. No patients developed a secondary increase in intraocular pressure, hyphema, infection, cataract, or vision loss. No cases of intraocular tumor dissemination were observed. No patient complained of glare or monocular diplopia. Three of 7 corneal wounds were self-sealing. Multifocal surgical iridectomy biopsy can be minimally invasive and effective allowing for partial- and full-thickness iris biopsy. Use of a 25-G aspiration cutting probe allowed for small incision surgery, rapid rehabilitation, and no significant complications.

Effect of Nd:YAG laser capsulotomy on refraction in multifocal apodized diffractive pseudophakia.

PubMed

Vrijman, Violette; van der Linden, Jan Willem; Nieuwendaal, Carla P; van der Meulen, Ivanka J E; Mourits, Maarten P; Lapid-Gortzak, Ruth

2012-08-01

To evaluate the effect on refraction of neodymium:YAG (Nd:YAG) laser posterior capsulotomy for posterior capsule opacification (PCO), and to evaluate the correlation between automated and subjective refraction in multifocal apodized diffractive pseudophakia. A retrospective study of 75 pseudophakic eyes (50 patients) with multifocal apodized diffractive pseudophakia, treated for PCO with Nd:YAG laser posterior capsulotomy, was performed. Pre- and postintervention values of refractive and visual parameters were compared. The outcomes of autorefraction and subjective refraction were also compared. Uncorrected and corrected distance visual acuity improved significantly after Nd:YAG capsulotomy (P<.001). No significant changes were noted in defocus equivalent, astigmatic power vectors J(0) and J(45), and overall blurring strength in subjective refraction and autorefraction. Spherical equivalent changed significantly in autorefraction (P=.008), but not in subjective refraction. Autorefraction and subjective refraction were highly correlated in spherical equivalent, defocus equivalent, and blurring strength (r(2)>0.59). In approximately 7% of eyes, a change of more than 0.50 diopters in spherical equivalent in subjective refraction occurred. In most cases, Nd:YAG laser capsulotomy in patients with multifocal pseudophakia did not result in a change in refraction. However, 7% of eyes experienced a significant change in subjective refraction. Autorefraction correlated well with subjective refraction in apodized diffractive multifocal IOLs. Copyright 2012, SLACK Incorporated.

Comparison of two laboratory-based systems for evaluation of halos in intraocular lenses

PubMed Central

Alexander, Elsinore; Wei, Xin; Lee, Shinwook

2018-01-01

Purpose Multifocal intraocular lenses (IOLs) can be associated with unwanted visual phenomena, including halos. Predicting potential for halos is desirable when designing new multifocal IOLs. Halo images from 6 IOL models were compared using the Optikos modulation transfer function bench system and a new high dynamic range (HDR) system. Materials and methods One monofocal, 1 extended depth of focus, and 4 multifocal IOLs were evaluated. An off-the-shelf optical bench was used to simulate a distant (>50 m) car headlight and record images. A custom HDR system was constructed using an imaging photometer to simulate headlight images and to measure quantitative halo luminance data. A metric was developed to characterize halo luminance properties. Clinical relevance was investigated by correlating halo measurements to visual outcomes questionnaire data. Results The Optikos system produced halo images useful for visual comparisons; however, measurements were relative and not quantitative. The HDR halo system provided objective and quantitative measurements used to create a metric from the area under the curve (AUC) of the logarithmic normalized halo profile. This proposed metric differentiated between IOL models, and linear regression analysis found strong correlations between AUC and subjective clinical ratings of halos. Conclusion The HDR system produced quantitative, preclinical metrics that correlated to patients’ subjective perception of halos. PMID:29503526

History and development of the apodized diffractive intraocular lens.

PubMed

Davison, James A; Simpson, Michael J

2006-05-01

The ReSTOR intraocular lens presents a unique apodized diffractive design within a refractive foldable acrylic optic, which makes an unprecedented level of mulifocal optical performance available. We describe the history and principles of diffractive optics used in the development of this refractive-diffractive IOL.

[Halos and multifocal intraocular lenses: origin and interpretation].

PubMed

Alba-Bueno, F; Vega, F; Millán, M S

2014-10-01

To present the theoretical and experimental characterization of the halo in multifocal intraocular lenses (MIOL). The origin of the halo in a MIOL is the overlaying of 2 or more images. Using geometrical optics, it can be demonstrated that the diameter of each halo depends on the addition of the lens (ΔP), the base power (P(d)), and the diameter of the IOL that contributes to the «non-focused» focus. In the image plane that corresponds to the distance focus, the halo diameter (δH(d)) is given by: δH(d)=d(pn) ΔP/P(d), where d(pn) is the diameter of the IOL that contributes to the near focus. Analogously, in the near image plane the halo diameter (δH(n)) is: δH(n)=d(pd) ΔP/P(d), where d(pd) is the diameter of the IOL that contributes to the distance focus. Patients perceive halos when they see bright objects over a relatively dark background. In vitro, the halo can be characterized by analyzing the intensity profile of the image of a pinhole that is focused by each of the foci of a MIOL. A comparison has been made between the halos induced by different MIOL of the same base power (20D) in an optical bench. As predicted by theory, the larger the addition of the MIOL, the larger the halo diameter. For large pupils and with MIOL with similar aspheric designs and addition (SN6AD3 vs ZMA00), the apodized MIOL has a smaller halo diameter than a non-apodized one in distance vision, while in near vision the size is very similar, but the relative intensity is higher in the apodized MIOL. When comparing lenses with the same diffractive design, but with different spherical-aspheric base design (SN60D3 vs SN6AD3), the halo in distance vision of the spherical MIOL is larger, while in near vision the spherical IOL induces a smaller halo, but with higher intensity due to the spherical aberration of the distance focus in the near image. In the case of a trifocal-diffractive IOL (AT LISA 839MP) the most noticeable characteristic is the double-halo formation due to the 2 non-focused powers. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

Efficacy and safety of multifocal intraocular lenses following cataract and refractive lens exchange: Metaanalysis of peer-reviewed publications.

PubMed

Rosen, Emanuel; Alió, Jorge L; Dick, H Burkhard; Dell, Steven; Slade, Stephen

2016-02-01

We performed a metaanaysis of peer-reviewed studies involving implantation of a multifocal intraocular lens (IOL) in presbyopic patients with cataract or having refractive lens exchange (RLE). Previous reviews have considered the use of multifocal IOLs after cataract surgery but not after RLE, whereas greater insight might be gained from examining the full range of studies. Selected studies were examined to collate outcomes with monocular and binocular uncorrected distance, intermediate, and near visual acuity; spectacle independence; contrast sensitivity; visual symptoms; adverse events; and patient satisfaction. In 8797 eyes, the mean postoperative monocular uncorrected distance visual acuity (UDVA) was 0.05 logMAR ± 0.006 (SD) (Snellen equivalent 20/20(-3)). In 6334 patients, the mean binocular UDVA was 0.04 ± 0.00 logMAR (Snellen equivalent 20/20(-2)), with a mean spectacle independence of 80.1%. Monocular mean UDVA did not differ significantly between those who had a cataract procedure and those who had an RLE procedure. Neural adaptation to multifocality may vary among patients. Dr. Alió is a clinical research investigator for Hanita Lenses, Carl Zeiss Meditec AG, Topcon Medical Systems, Inc., Oculentis GmbH, and Akkolens International BV. Dr. Dell is a consultant to Bausch & Lomb and Abbott Medical Optics, Inc. Dr. Slade is a consultant to Alcon Surgical, Inc., Carl Zeiss Meditec AG, and Bausch & Lomb. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Pupil Influence on the Visual Outcomes of a New-Generation Multifocal Toric Intraocular Lens With a Surface-Embedded Near Segment.

PubMed

Wang, Mengmeng; Corpuz, Christine Carole C; Huseynova, Tukezban; Tomita, Minoru

2016-02-01

To evaluate the influences of preoperative pupil parameters on the visual outcomes of a new-generation multifocal toric intraocular lens (IOL) model with a surface-embedded near segment. In this prospective study, patients with cataract had phacoemulsification and implantation of Lentis Mplus toric LU-313 30TY IOLs (Oculentis GmbH, Berlin, Germany). The visual and optical outcomes were measured and compared preoperatively and postoperatively. The correlations between preoperative pupil parameters (diameter and decentration) and 3-month postoperative visual outcomes were evaluated using the Spearman's rank-order correlation coefficient (Rs) for the nonparametric data. A total of 27 eyes (16 patients) were enrolled into the current study. Statistically significant improvements in visual and refractive performances were found after the implantation of Lentis Mplus toric LU-313 30TY IOLs (P < .05). Statistically significant correlations were present between preoperative pupil diameters and postoperative visual acuities (Rs > 0; P < .05). Patients with a larger pupil always have better postoperative visual acuities. Meanwhile, there was no statistically significant correlation between pupil decentration and visual acuities (P > .05). Lentis Mplus toric LU-313 30TY IOLs provided excellent visual and optical performances during the 3-month follow-up. The preoperative pupil size is an important parameter when this toric multifocal IOL model is contemplated for surgery. Copyright 2016, SLACK Incorporated.

Autorefraction versus subjective refraction in a radially asymmetric multifocal intraocular lens.

PubMed

van der Linden, Jan Willem; Vrijman, Violette; Al-Saady, Rana; El-Saady, Rana; van der Meulen, Ivanka J; Mourits, Maarten P; Lapid-Gortzak, Ruth

2014-12-01

To evaluate whether the automated refraction (AR) correlates with subjective manifest (MR) refraction in eyes implanted with radially asymmetric multifocal intraocular lens (IOLs). This retrospective study evaluated 52 eyes (52 patients) implanted with a radially asymmetric multifocal IOL (LS-312 MF30, Oculentis, Germany). At 3 months postoperatively, the AR and MR values were compared to determine the correlation between the sphere (S), the spherical equivalent (SE) and the astigmatic components J0 and J45. The difference of mean spherical measurement was +0.98D ± 0.62, with the AR measuring more myopic. The difference of the mean spherical equivalent was +1.11D ± 0.57, again with AR being more myopic. Both these differences were statistically significant (p < 0.001). The astigmatic components showed less differences, with the mean difference of the J0 being -0.09D ± 0.43, and the J45 of +0.04D ± 0.47, which were both not statistically significant (p = 0.123 and p = 0.531, respectively). Correlation analysis of the refractive parameters showed r(2) = 0.067, r(2) = 0.078, r(2) = 0.018 and r(2) = 0.015, respectively, all of which point to a low correlation between the AR and the MR. Autorefraction shows poor correlation to manifest subjective refraction with these radially asymmetric multifocal IOLs. The autorefraction systematically underestimates the spherical and spherical equivalent power, while the correlation between the astigmatic components was also low. Autorefraction seems not a valid starting point for manifest subjective refraction with these types of lenses, unless a corrective factor of about +1 dioptre is used. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Clinical Evaluation of Reading Performance Using the Salzburg Reading Desk With a Refractive Rotational Asymmetric Multifocal Intraocular Lens.

PubMed

Linz, Katharina; Attia, Mary S A; Khoramnia, Ramin; Tandogan, Tamer; Kretz, Florian T; Auffarth, Gerd Uwe

2016-08-01

To evaluate functional results and reading performance using the Salzburg Reading Desk after implantation of a sector-shaped near-embedded, rotational asymmetrical multifocal intraocular lens (IOL) and a multifocal toric IOL with a +3.00 diopter (D) near addition. In a prospective study, the LentisMplus and Mplus toric IOLs (Oculentis GmbH, Berlin, Germany) were implanted in 34 eyes of 18 patients at the University Eye Hospital of Heidelberg. Uncorrected and corrected distance visual acuity (UDVA, CDVA) and uncorrected and corrected near visual acuity (UNVA, CNVA) were evaluated using standardized visual acuity charts (ETDRS). The Salzburg Reading Desk was used to analyze unilateral and bilateral uncorrected and corrected reading acuity, reading distance, reading speed, and the smallest log-scaled print size that could be read effectively at a set (40 cm/80 cm) and subjective chosen near and intermediate distance. Postoperatively, the median UDVA was 0.08 logMAR (20/25 Snellen) and the median CDVA was 0.01 logMAR (20/20 Snellen). The median UNVA was 0.12 logMAR (20/25 Snellen) and the median CNVA was 0.03 logMAR (20/20 Snellen). The median uncorrected reading acuity measured with the Salzburg Reading Desk for near distance at 40 cm was 0.18 logMAR (20/32 Snellen). The subjectively preferred near distance was 39 cm and revealed similar visual acuity results. The best reading acuity for intermediate distance with a median of 0.22 logMAR (20/32 Snellen) was achieved at a median distance of 62 cm. Reading performance of the multifocal IOL corresponded for near standardized and individual distance, whereas reading function was better at the patient's preferred intermediate distance. [J Refract Surg. 2016;32(8):526-532.]. Copyright 2016, SLACK Incorporated.

UV solid state laser ablation of intraocular lenses

NASA Astrophysics Data System (ADS)

Apostolopoulos, A.; Lagiou, D. P.; Evangelatos, Ch.; Spyratou, E.; Bacharis, C.; Makropoulou, M.; Serafetinides, A. A.

2013-06-01

Commercially available intraocular lenses (IOLs) are manufactured from silicone and acrylic, both rigid (e.g. PMMA) and foldable (hydrophobic or hydrophilic acrylic biomaterials), behaving different mechanical and optical properties. Recently, the use of apodizing technology to design new diffractive-refractive multifocals improved the refractive outcome of these intraocular lenses, providing good distant and near vision. There is also a major ongoing effort to refine laser refractive surgery to correct other defects besides conventional refractive errors. Using phakic IOLs to treat high myopia potentially provides better predictability and optical quality than corneal-based refractive surgery. The aim of this work was to investigate the effect of laser ablation on IOL surface shaping, by drilling circular arrays of holes, with a homemade motorized rotation stage, and scattered holes on the polymer surface. In material science, the most popular lasers used for polymer machining are the UV lasers, and, therefore, we tried in this work the 3rd and the 5th harmonic of a Q-switched Nd:YAG laser (λ=355 nm and λ=213 nm respectively). The morphology of the ablated IOL surface was examined with a scanning electron microscope (SEM, Fei - Innova Nanoscope) at various laser parameters. Quantitative measurements were performed with a contact profilometer (Dektak-150), in which a mechanical stylus scanned across the surface of gold-coated IOLs (after SEM imaging) to measure variations in surface height and, finally, the ablation rates were also mathematically simulated for depicting the possible laser ablation mechanism(s). The experimental results and the theoretical modelling of UV laser interaction with polymeric IOLs are discussed in relation with the physical (optical, mechanical and thermal) properties of the material, in addition to laser radiation parameters (laser energy fluence, number of pulses). The qualitative aspects of laser ablation at λ=213 nm reveal a smooth optical surface on the intraocular lens with no irregularities, observed with other wavelengths.

Creation of diffraction-limited non-Airy multifocal arrays using a spatially shifted vortex beam

NASA Astrophysics Data System (ADS)

Lin, Han; Gu, Min

2013-02-01

Diffraction-limited non-Airy multifocal arrays are created by focusing a phase-modulated vortex beam through a high numerical-aperture objective. The modulated phase at the back aperture of the objective resulting from the superposition of two concentric phase-modulated vortex beams allows for the generation of a multifocal array of cylindrically polarized non-Airy patterns. Furthermore, we shift the spatial positions of the phase vortices to manipulate the intensity distribution at each focal spot, leading to the creation of a multifocal array of split-ring patterns. Our method is experimentally validated by generating the predicted phase modulation through a spatial light modulator. Consequently, the spatially shifted circularly polarized vortex beam adopted in a dynamic laser direct writing system facilitates the fabrication of a split-ring microstructure array in a polymer material by a single exposure of a femtosecond laser beam.

Metastatic intraocular hemangiopericytoma in a dog

PubMed Central

Pucket, Jonathan D.; Allbaugh, Rachel A.; Higginbotham, Mary L.; Rankin, Amy J.; Teixeira, Leandro

2017-01-01

A 10-year-old Labrador Retriever who had been undergoing therapy for a recurrent hemangiopericytoma of the right flank presented to the Kansas State University Ophthalmology service for evaluation of a painful left eye. Examination revealed secondary glaucoma and irreversible blindness of the affected eye and multifocal chorioretinal lesions in the fellow eye. Therapeutic and diagnostic enucleation of the left eye was performed and histopathologic examination demonstrated the presence of a presumed metastatic spindle cell sarcoma. Further immunohistochemical staining confirmed the intraocular neoplasia to be metastatic spread from the previously removed flank mass. Rapid progression in size and number of chorioretinal lesions in the right eye was noted in the post-operative period until the patient was euthanized one month after surgery. This case report is the first to document intraocular metastasis of hemangiopericytoma in a veterinary patient. PMID:28652979

Metastatic intraocular hemangiopericytoma in a dog.

PubMed

Pucket, Jonathan D; Allbaugh, Rachel A; Higginbotham, Mary L; Rankin, Amy J; Teixeira, Leandro

2017-01-01

A 10-year-old Labrador Retriever who had been undergoing therapy for a recurrent hemangiopericytoma of the right flank presented to the Kansas State University Ophthalmology service for evaluation of a painful left eye. Examination revealed secondary glaucoma and irreversible blindness of the affected eye and multifocal chorioretinal lesions in the fellow eye. Therapeutic and diagnostic enucleation of the left eye was performed and histopathologic examination demonstrated the presence of a presumed metastatic spindle cell sarcoma. Further immunohistochemical staining confirmed the intraocular neoplasia to be metastatic spread from the previously removed flank mass. Rapid progression in size and number of chorioretinal lesions in the right eye was noted in the post-operative period until the patient was euthanized one month after surgery. This case report is the first to document intraocular metastasis of hemangiopericytoma in a veterinary patient.

Refractive Lens Exchange with Multifocal Intraocular Lens for Treatment of Chronic Intermittent Spasm of the Near Reflex

PubMed Central

Sallet, Guy

2017-01-01

We report the case of an emmetropic 32-year-old female with decreased uncorrected visual acuity and diplopia due to intermittent episodes of spasm of the near reflex. Neurologic, general, and ophthalmic examination could not find an organic cause. Attempts at spontaneous recovery, psychogenic therapy, and cycloplegic therapy were unsuccessful and the symptoms persisted for almost 5 years, leading to psychogenic distress. Final treatment with refractive lens exchange and implantation of a toric trifocal intraocular lens resolved the spasm of the near reflex, resulting in an uncorrected distance and near visual acuity of 20/20. PMID:29422856

Influence of the effective lens position, as predicted by axial length and keratometry, on the near add power of multifocal intraocular lenses.

PubMed

Savini, Giacomo; Hoffer, Kenneth J; Lombardo, Marco; Serrao, Sebastiano; Schiano-Lomoriello, Domenico; Ducoli, Pietro

2016-01-01

To calculate the near focal distance of different multifocal intraocular lenses (IOLs) as a function of the 2 parameters that are measured before cataract surgery; that is, axial length (AL) and refractive corneal power (keratometry [K]). GB Bietti Foundation IRCCS, Rome, Italy. Noninterventional theoretical study. The IOL power for emmetropia was first calculated in an eye model with the AL ranging from 20 to 30 mm and K from 38 to 48 diopters (D). Then, the predicted myopic refraction for any given IOL add power (from +1.5 to +4.0 D) was calculated, and from this value the near focal distance was obtained. Calculations were also performed for the average eye (K = 43.81 D; AL = 23.65 mm). The near focal distance increased with increasing values of K and AL for each near power add. The near focal distance ranged between 53 cm and 72 cm (21 inches and 28 inches) for a multifocal IOL with +2.50 D, between 44 cm and 60 cm (17 inches and 24 inches) for a multifocal IOL with +3.00 D add, and between 33 cm and 44 cm (13 inches and 18 inches) for a multifocal IOL with +4.00 D add. In the average eye, the near focal distance ranges between 36 cm (near add power = 4.00 D) and 99 cm (near add power = 1.5 D). Longer eyes with steeper corneas showed the longest near focal distance and could experience more difficulties in focusing near objects after surgery. The opposite was true for short hyperopic eyes. Dr. Hoffer receives licensing fees for the commercial use of the registered trademark Hoffer from all biometry manufacturers using the Hoffer Q formula to ensure that it is programmed correctly and book royalties from Slack, Inc., for the textbook IOL Power. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Can the accuracy of multifocal intraocular lens power calculation be improved to make patients spectacle free?

PubMed

Ramji, Hasnain; Moore, Johnny; Moore, C B Tara; Shah, Sunil

2016-04-01

To optimise intraocular lens (IOL) power calculation techniques for a segmental multifocal IOL, LENTIS™ MPlus(®) (Oculentis GmbH, Berlin, Germany) and assess outcomes. A retrospective consecutive non-randomised case series of patients receiving the MPlus(®) IOL following cataract surgery or clear lens extraction was performed at a privately owned ophthalmic hospital, Midland Eye, Solihull, UK. Analysis was undertaken of 116 eyes, with uncomplicated lens replacement surgery using the LENTIS™ MPlus(®) lenses. Pre-operative biometry data were stratified into short (<22.00 mm) and long axial lengths (ALs) (≥22.00 mm). IOL power predictions were calculated with SRK/T, Holladay I, Hoffer Q, Holladay II and Haigis formulae and compared to the final manifest refraction. These were compared with the OKULIX ray tracing method and the stratification technique suggested by the Royal College of Ophthalmologists (RCOphth). Using SRK/T for long eyes and Hoffer Q for short eyes, 64% achieved postoperative subjective refractions of ≤±0.25 D, 83%≤±0.50 D and 93%≤±0.75 D, with a maximum predictive error of 1.25D. No specific calculation method performed best across all ALs; however for ALs under 22 mm Hoffer Q and Holliday I methods performed best. Excellent but equivalent overall refractive results were found between all biometry methods used in this multifocal IOL study. For eyes with ALs under 22 mm Hoffer Q and Holliday I performed best. Current techniques mean that patients are still likely to need top up glasses for certain situations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Evaluation of the True Wavefront Aberrations in Eyes Implanted With a Rotationally Asymmetric Multifocal Intraocular Lens.

PubMed

Akondi, Vyas; Pérez-Merino, Pablo; Martinez-Enriquez, Eduardo; Dorronsoro, Carlos; Alejandre, Nicolás; Jiménez-Alfaro, Ignacio; Marcos, Susana

2017-04-01

Standard evaluation of aberrations from wavefront slope measurements in patients implanted with a rotationally asymmetric multifocal intraocular lens (IOL), the Lentis Mplus (Oculentis GmbH, Berlin, Germany), results in large magnitude primary vertical coma, which is attributed to the intrinsic IOL design. The new proposed method analyzes aberrometry data, allowing disentangling the IOL power pupillary distribution from the true higher order aberrations of the eye. The new method of wavefront reconstruction uses retinal spots obtained at both the near and far foci. The method was tested using ray tracing optical simulations in a computer eye model virtually implanted with the Lentis Mplus IOL, with a generic cornea or with anterior segment geometry obtained from custom quantitative spectral-domain optical coherence tomography in a real patient. The method was applied to laser ray tracing aberrometry data at near and far fixation obtained in a patient implanted with the Lentis Mplus IOL. Higher order aberrations evaluated from simulated and real retinal spot diagrams following the new reconstruction approach matched the nominal aberrations (approximately 98%). Previously reported primary vertical coma in patients implanted with this IOL lost significance with the application of the proposed reconstruction. Custom analysis of ray tracing-based retinal spot diagrams allowed decoupling of the true higher order aberrations of the patient's eye from the power pupillary distribution of a rotationally asymmetric multifocal IOL, therefore providing the appropriate phase map to accurately evaluate through-focus optical quality. [J Refract Surg. 2017;33(4):257-265.]. Copyright 2017, SLACK Incorporated.

Predictive factors for photic phenomena after refractive, rotationally asymmetric, multifocal intraocular lens implantation

PubMed Central

Tchah, Hungwon; Nam, Kiyeun; Yoo, Aeri

2017-01-01

AIM To investigate the independent factors associated with photic phenomena in patients implanted with refractive, rotationally asymmetric, multifocal intraocular lenses (MIOLs). METHODS Thirty-four eyes of 34 patients who underwent unilateral cataract surgery, followed by implantation of rotationally asymmetric MIOLs were included. Distance and near visual acuity outcomes, intraocular aberrations, preferred reading distances, preoperative and postoperative refractive errors, mesopic and photopic pupil diameters, and the mesopic and photopic kappa angles were assessed. Patients were also administered a satisfaction survey. Photic phenomena were graded by questionnaire. Independent-related factors were identified by correlation and bivariate logistic regression analyses. RESULTS The distance from the photopic to the mesopic pupil center (pupil center shift) was significantly associated with glare/halo symptoms [odds ratio (OR)=2.065, 95% confidence interval (CI)=0.916-4.679, P=0.006] and night vision problems (OR=1.832, 95% CI=0.721-2.158, P=0.007). The preoperative photopic angle kappa was significantly associated with glare/halo symptoms (OR=2.155, 95% CI=1.065-4.362, P=0.041). The photopic angle kappa was also significantly associated with glare/halo symptoms (OR=2.155, 95% CI=1.065-4.362, P=0.041) and with night vision problems (OR=1.832, 95% CI=0.721-2.158, P=0.007) in patients implanted with rotationally asymmetric MIOLs. CONCLUSION A large pupil center shift and misalignment between the visual and pupillary axis (angle kappa) may play a role in the occurrence of photic phenomena after implantation of rotationally asymmetric MIOLs. PMID:28251083

Refractive versus diffractive multifocal intraocular lenses in cataract surgery: a meta-analysis of randomized controlled trials.

PubMed

Xu, Xian; Zhu, Ming-Ming; Zou, Hai-Dong

2014-09-01

Data sources, including PubMed, Medline, Embase, and the Cochrane Controlled Trials Register, were used to identify potentially relevant randomized controlled trials. Eight qualified studies incorporating 1,242 eyes of 621 patients were analyzed using Rev- Manager version 5.2 software (The Cochrane Collaboration, Oxford, England). The primary measures included uncorrected distance, intermediate, and near visual acuity. Reading ability, spectacle independence, and occurrence of photic phenomena were also addressed. The refractive MIOL group exhibited better uncorrected distance visual acuity than the diffractive MIOL group (weighted mean difference [WMD] = -0.04, 95% confidence interval [CI]: -0.06 to -0.02, P < .01). However, the diffractive MIOL group performed better than the refractive MIOL group in uncorrected near visual acuity, reading acuity, reading speed, smallest print size, spectacle independence, halo, and glare rate (WMD = 0.13, 95% CI: 0.10 to 0.17, P < .01; WMD = 0.14, 95% CI: 0.08 to 0.19, P < .01; WMD = -24.14, 95% CI: -43.56 to -4.72, P = .01; WMD = 0.56, 95% CI: 0.43 to 0.69, P < .01; WMD = 0.56, 95% CI: 0.45 to 0.70, P < .01; WMD = 1.50, 95% CI: 1.16 to 1.93, P = .002; WMD = 1.39, 95% CI: 1.10 to 1.75, P = .006, respectively). There was no significant difference between the two groups in uncorrected intermediate visual acuity (WMD = -0.04, 95% CI: -0.09 to 0.00, P = .05). Refractive MIOLs can provide better distance vision, whereas diffractive MIOLs provide better near vision, reading ability, and equivalent intermediate vision, reduce unwanted photic phenomena, and allow greater spectacle independence.

Error induced by the estimation of the corneal power and the effective lens position with a rotationally asymmetric refractive multifocal intraocular lens

PubMed Central

Piñero, David P.; Camps, Vicente J.; Ramón, María L.; Mateo, Verónica; Pérez-Cambrodí, Rafael J.

2015-01-01

AIM To evaluate the prediction error in intraocular lens (IOL) power calculation for a rotationally asymmetric refractive multifocal IOL and the impact on this error of the optimization of the keratometric estimation of the corneal power and the prediction of the effective lens position (ELP). METHODS Retrospective study including a total of 25 eyes of 13 patients (age, 50 to 83y) with previous cataract surgery with implantation of the Lentis Mplus LS-312 IOL (Oculentis GmbH, Germany). In all cases, an adjusted IOL power (PIOLadj) was calculated based on Gaussian optics using a variable keratometric index value (nkadj) for the estimation of the corneal power (Pkadj) and on a new value for ELP (ELPadj) obtained by multiple regression analysis. This PIOLadj was compared with the IOL power implanted (PIOLReal) and the value proposed by three conventional formulas (Haigis, Hoffer Q and Holladay I). RESULTS PIOLReal was not significantly different than PIOLadj and Holladay IOL power (P>0.05). In the Bland and Altman analysis, PIOLadj showed lower mean difference (-0.07 D) and limits of agreement (of 1.47 and -1.61 D) when compared to PIOLReal than the IOL power value obtained with the Holladay formula. Furthermore, ELPadj was significantly lower than ELP calculated with other conventional formulas (P<0.01) and was found to be dependent on axial length, anterior chamber depth and Pkadj. CONCLUSION Refractive outcomes after cataract surgery with implantation of the multifocal IOL Lentis Mplus LS-312 can be optimized by minimizing the keratometric error and by estimating ELP using a mathematical expression dependent on anatomical factors. PMID:26085998

Error induced by the estimation of the corneal power and the effective lens position with a rotationally asymmetric refractive multifocal intraocular lens.

PubMed

Piñero, David P; Camps, Vicente J; Ramón, María L; Mateo, Verónica; Pérez-Cambrodí, Rafael J

2015-01-01

To evaluate the prediction error in intraocular lens (IOL) power calculation for a rotationally asymmetric refractive multifocal IOL and the impact on this error of the optimization of the keratometric estimation of the corneal power and the prediction of the effective lens position (ELP). Retrospective study including a total of 25 eyes of 13 patients (age, 50 to 83y) with previous cataract surgery with implantation of the Lentis Mplus LS-312 IOL (Oculentis GmbH, Germany). In all cases, an adjusted IOL power (PIOLadj) was calculated based on Gaussian optics using a variable keratometric index value (nkadj) for the estimation of the corneal power (Pkadj) and on a new value for ELP (ELPadj) obtained by multiple regression analysis. This PIOLadj was compared with the IOL power implanted (PIOLReal) and the value proposed by three conventional formulas (Haigis, Hoffer Q and Holladay I). PIOLReal was not significantly different than PIOLadj and Holladay IOL power (P>0.05). In the Bland and Altman analysis, PIOLadj showed lower mean difference (-0.07 D) and limits of agreement (of 1.47 and -1.61 D) when compared to PIOLReal than the IOL power value obtained with the Holladay formula. Furthermore, ELPadj was significantly lower than ELP calculated with other conventional formulas (P<0.01) and was found to be dependent on axial length, anterior chamber depth and Pkadj. Refractive outcomes after cataract surgery with implantation of the multifocal IOL Lentis Mplus LS-312 can be optimized by minimizing the keratometric error and by estimating ELP using a mathematical expression dependent on anatomical factors.

Implantation of refractive multifocal intraocular lens with a surface-embedded near section for cataract eyes complicated with a coexisting ocular pathology

PubMed Central

Ouchi, M; Kinoshita, S

2015-01-01

Purpose To evaluate the postoperative outcomes of cataract eyes complicated with coexisting ocular pathologies that underwent implantation of a refractive multifocal intraocular lens (MIOL) with a surface-embedded near section. Methods LENTIS MPlus (Oculentis GmbH) refractive MIOLs were implanted in 15 eyes with ocular pathologies other than cataract (ie, six high-myopia eyes with an axial length longer than 28 mm, two fundus albipunctatus eyes, two branch retinal-vein occlusion eyes, four glaucoma eyes (one with high myopia), and two keratoconus eyes). Uncorrected or corrected distance and near visual acuity (VA) (UDVA, UNVA, CDVA, and CNVA), contrast sensitivity, and defocus curve were measured at 1 day and 6 months postoperatively, and each patient completed a 6-month postoperative questionnaire regarding vision quality and eyeglass use. Results Thirteen eyes (87%) registered 0 or better in CDVA and 12 eyes (73%) registered better than 0 in CNVA. Contrast sensitivity in the eyes of all patients was comparable to that of normal healthy subjects. No patient required eyeglasses for distance vision, but three patients (20%) required them for near vision. No patient reported poor or very poor vision quality. Conclusion With careful case selection, sectorial refractive MIOL implantation is effective for treating cataract eyes complicated with ocular pathologies. PMID:25744442

Implantation of refractive multifocal intraocular lens with a surface-embedded near section for cataract eyes complicated with a coexisting ocular pathology.

PubMed

Ouchi, M; Kinoshita, S

2015-05-01

To evaluate the postoperative outcomes of cataract eyes complicated with coexisting ocular pathologies that underwent implantation of a refractive multifocal intraocular lens (MIOL) with a surface-embedded near section. LENTIS MPlus (Oculentis GmbH) refractive MIOLs were implanted in 15 eyes with ocular pathologies other than cataract (ie, six high-myopia eyes with an axial length longer than 28 mm, two fundus albipunctatus eyes, two branch retinal-vein occlusion eyes, four glaucoma eyes (one with high myopia), and two keratoconus eyes). Uncorrected or corrected distance and near visual acuity (VA) (UDVA, UNVA, CDVA, and CNVA), contrast sensitivity, and defocus curve were measured at 1 day and 6 months postoperatively, and each patient completed a 6-month postoperative questionnaire regarding vision quality and eyeglass use. Thirteen eyes (87%) registered 0 or better in CDVA and 12 eyes (73%) registered better than 0 in CNVA. Contrast sensitivity in the eyes of all patients was comparable to that of normal healthy subjects. No patient required eyeglasses for distance vision, but three patients (20%) required them for near vision. No patient reported poor or very poor vision quality. With careful case selection, sectorial refractive MIOL implantation is effective for treating cataract eyes complicated with ocular pathologies.

Implantation of a multifocal toric intraocular lens with a surface-embedded near segment after repeated LASIK treatments.

PubMed

Khoramnia, Ramin; Auffarth, Gerd U; Rabsilber, Tanja M; Holzer, Mike P

2012-11-01

We report a 66-year-old patient who presented with increasing hyperopia, astigmatism, and presbyopia in both eyes 8 years after bilateral laser in situ keratomileusis (LASIK) and LASIK enhancement in the left eye aiming for spectacle independence. Bilateral multifocal toric Lentis Mplus intraocular lenses (IOLs) with an embedded near segment and individually customized cylinder correction were implanted uneventfully following phacoemulsification. The Haigis-L formula after previous hyperopia correction was chosen for IOL power calculation and provided reliable results. Emmetropia was targeted and achieved. Three months postoperatively, the uncorrected distance visual acuity had increased from 0.40 logMAR to 0.10 logMAR in the right eye and from 0.20 logMAR to 0.00 logMAR in the left eye. The patient gained 6 lines of uncorrected near visual acuity: 0.20 logMAR in the right eye and 0.10 logMAR in the left eye. This case shows that customized premium IOL implantation can provide accurate results even in challenging cases. The International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany, has received research grants, lecture fees, and travel reimbursement from Oculentis GmbH. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Experimental characterization of the imaging properties of multifocal intraocular lenses

NASA Astrophysics Data System (ADS)

Gobbi, Pier Giorgio; Fasce, Francesco; Bozza, Stefano; Brancato, Rosario

2003-07-01

Many different types of intraocular lenses (IOL) are currently available for implantation, both as crystalline lens replacements and as phakic refractive elements. Their optical design is increasingly sophisticated, including aspherical surface profiles and multi-zone multifocal structures, however a quantitative and comparative characterization of their imaging properties is lacking. Also a qualitative visualization of their properties would be very useful for patients in the lens choice process. To this end an experimental eye model has been developed to allow for simulated in-vivo testing of IOLs. The model cornea is made of PMMA with a dioptric power of 43 D, and it has an aspherical profile designed to minimize spherical aberration across the visible spectrum. The eye model has a variable iris and a mechanical support to accomodate IOLs, immersed in physiological solution. The eye length is variable and the retina is replaced by a glass plate. The image formed on this "retina" is optically conjugated to a CCD camera, with a suitable magnification in order to mimic the human fovea resolution, and displayed onto a monitor. With such an opto-mechanical eye model, two types of images have been used to characterize IOLs: letter charts and variable contrast gratings, in order to directly simulate human visual acuity and contrast sensitivity.

Multifocal versus monofocal intraocular lenses after cataract extraction.

PubMed

de Silva, Samantha R; Evans, Jennifer R; Kirthi, Varo; Ziaei, Mohammed; Leyland, Martin

2016-12-12

Good unaided distance visual acuity (VA) is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation. Near vision, however, still requires additional refractive power, usually in the form of reading glasses. Multiple optic (multifocal) IOLs are available which claim to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal IOLs. To assess the visual effects of multifocal IOLs in comparison with the current standard treatment of monofocal lens implantation. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2016), Embase (January 1980 to June 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 June 2016. All randomised controlled trials comparing a multifocal IOL of any type with a monofocal IOL as control were included. Both unilateral and bilateral implantation trials were included. We also considered trials comparing multifocal IOLs with "monovision" whereby one eye is corrected for distance vision and one eye corrected for near vision. We used standard methodological procedures expected by Cochrane. We assessed the 'certainty' of the evidence using GRADE. We found 20 eligible trials that enrolled 2230 people with data available on 2061 people (3194 eyes). These trials were conducted in Europe (13), China (three), USA (one), Middle East (one), India (one) and one multicentre study in Europe and the USA. Most of these trials compared multifocal with monofocal lenses; two trials compared multifocal lenses with monovision. There was considerable variety in the make and model of lenses implanted. Overall we considered the trials at risk of performance and detection bias because it was difficult to mask participants and outcome assessors. It was also difficult to assess the role of reporting bias.There was moderate-certainty evidence that the distance acuity achieved with multifocal lenses was not different to that achieved with monofocal lenses (unaided VA worse than 6/6: pooled RR 0.96, 95% confidence interval (CI) 0.89 to 1.03; eyes = 682; studies = 8). People receiving multifocal lenses may achieve better near vision (RR for unaided near VA worse than J3/J4 was 0.20, 95% CI 0.07 to 0.58; eyes = 782; studies = 8). We judged this to be low-certainty evidence because of risk of bias in the included studies and high heterogeneity (I 2 = 93%) although all included studies favoured multifocal lenses with respect to this outcome.People receiving multifocal lenses may be less spectacle dependent (RR 0.63, 95% CI 0.55 to 0.73; eyes = 1000; studies = 10). We judged this to be low-certainty evidence because of risk of bias and evidence of publication bias (skewed funnel plot). There was also high heterogeneity (I 2 = 67%) but all studies favoured multifocal lenses. We did not additionally downgrade for this.Adverse subjective visual phenomena were more prevalent and more troublesome in participants with a multifocal IOL compared with monofocals (RR for glare 1.41, 95% CI 1.03 to 1.93; eyes = 544; studies = 7, low-certainty evidence and RR for haloes 3.58, 95% CI 1.99 to 6.46; eyes = 662; studies = 7; moderate-certainty evidence).Two studies compared multifocal lenses with monovision. There was no evidence for any important differences in distance VA between the groups (mean difference (MD) 0.02 logMAR, 95% CI -0.02 to 0.06; eyes = 186; studies = 1), unaided intermediate VA (MD 0.07 logMAR, 95% CI 0.04 to 0.10; eyes = 181; studies = 1) and unaided near VA (MD -0.04, 95% CI -0.08 to 0.00; eyes = 186; studies = 1) compared with people receiving monovision. People receiving multifocal lenses were less likely to be spectacle dependent (RR 0.40, 95% CI 0.30 to 0.53; eyes = 262; studies = 2) but more likely to report problems with glare (RR 1.41, 95% CI 1.14 to 1.73; eyes = 187; studies = 1) compared with people receiving monovision. In one study, the investigators noted that more people in the multifocal group underwent IOL exchange in the first year after surgery (6 participants with multifocal vs 0 participants with monovision). Multifocal IOLs are effective at improving near vision relative to monofocal IOLs although there is uncertainty as to the size of the effect. Whether that improvement outweighs the adverse effects of multifocal IOLs, such as glare and haloes, will vary between people. Motivation to achieve spectacle independence is likely to be the deciding factor.

Liquid Crystal Spatial Light Modulators for Simulating Zonal Multifocal Lenses.

PubMed

Li, Yiyu; Bradley, Arthur; Xu, Renfeng; Kollbaum, Pete S

2017-09-01

To maximize efficiency of the normally lengthy and costly multizone lens design and testing process, it is advantageous to evaluate the potential efficacy of a design as thoroughly as possible prior to lens fabrication and on-eye testing. The current work describes an ex vivo approach of optical design testing. The aim of this study was to describe a system capable of examining the optical characteristics of multizone bifocal and multifocal optics by subaperture stitching using liquid crystal technologies. A liquid crystal spatial light modulator (SLM) was incorporated in each of two channels to generate complementary subapertures by amplitude modulation. Additional trial lenses and phase plates were placed in pupil conjugate planes of either channel to integrate the desired bifocal and multifocal optics once the two optical paths were recombined. A high-resolution Shack-Hartmann aberrometer was integrated to measure the optics of the dual-channel system. Power and wavefront error maps as well as point spread functions were measured and computed for each of three multizone multifocal designs. High transmission modulation was achieved by introducing half-wavelength optical path differences to create two- and five-zone bifocal apertures. Dual-channel stitching revealed classic annular rings in the point spread functions generated from two-zone designs when the outer annular optic was defocused. However, low efficiency of the SLM prevented us from simultaneously measuring the eye + simulator aberrations, and the higher-order diffraction patterns generated by the cellular structure of the liquid crystal arrays limited the visual field to ±0.45 degrees. The system successfully simulated bifocal and multifocal simultaneous lenses allowing for future evaluation of both objective and subjective evaluation of complex optical designs. However, low efficiency and diffraction phenomena of the SLM limit the utility of this technology for simulating multizone and multifocal optics.

A study of patient satisfaction after cataract surgery with implantation of different types of intraocular lenses

PubMed Central

2012-01-01

Background The implementation of capitated payment has driven medical institutions through developing balance billing for medical services. By exploring the patients’ decision-making factors on different self-pay items, a reference for the pricing and sales strategy for the related products can be formed. The major purposes of this study were to analyze the determinants of preoperative selection and postoperative satisfaction with implantation of different types of intraocular lenses in cataract surgery. Methods This cross-sectional study consisted of 127 patients that were 50 years of age and older, and who had phacoemulsification with intraocular lens implantation in both eyes. Data were collected by using a structured questionnaire. The following parameters were measured: access to medical care, attitude towards receiving medical products at one’s own expense, overall patient satisfaction and postoperative visual clarity. Results The results showed that the patient’s gender, educational level and economic status influenced the type of intraocular lens chosen. Patients in the insurance group cared about access to medical care, and patients in the balance billing group cared about product differentiation. ANOVA results showed no statistically significant differences in the overall satisfaction of the patients among the groups with different types of intraocular lenses. Patients that received cataract surgery with implantation of multifocal intraocular lenses had better vision when trying to view smaller objects and when looking at objects under strong light. Conclusions Manufacturers should increase the number of differences between their products, and health care providers can then recommend the appropriate intraocular lens in accordance with the needs or demands of their patients, and also by keeping in mind the financial constraints of their patients. PMID:23107001

A study of patient satisfaction after cataract surgery with implantation of different types of intraocular lenses.

PubMed

Wei, Ching-Kuo; Wang, Shun-Mu; Lin, Jen-Chieh

2012-10-29

The implementation of capitated payment has driven medical institutions through developing balance billing for medical services. By exploring the patients' decision-making factors on different self-pay items, a reference for the pricing and sales strategy for the related products can be formed. The major purposes of this study were to analyze the determinants of preoperative selection and postoperative satisfaction with implantation of different types of intraocular lenses in cataract surgery. This cross-sectional study consisted of 127 patients that were 50 years of age and older, and who had phacoemulsification with intraocular lens implantation in both eyes. Data were collected by using a structured questionnaire. The following parameters were measured: access to medical care, attitude towards receiving medical products at one's own expense, overall patient satisfaction and postoperative visual clarity. The results showed that the patient's gender, educational level and economic status influenced the type of intraocular lens chosen. Patients in the insurance group cared about access to medical care, and patients in the balance billing group cared about product differentiation. ANOVA results showed no statistically significant differences in the overall satisfaction of the patients among the groups with different types of intraocular lenses. Patients that received cataract surgery with implantation of multifocal intraocular lenses had better vision when trying to view smaller objects and when looking at objects under strong light. Manufacturers should increase the number of differences between their products, and health care providers can then recommend the appropriate intraocular lens in accordance with the needs or demands of their patients, and also by keeping in mind the financial constraints of their patients.

[Multifocal phakic intraocular lens implant to correct presbyopia].

PubMed

Baikoff, G; Matach, G; Fontaine, A; Ferraz, C; Spera, C

2005-03-01

Presbyopic surgery is considered as the new frontier in refractive surgery. Different solutions are proposed: myopization of one eye, insertion of an accommodative crystalline lens, scleral surgery, the effects of which are still unknown, and finally multifocal phakic implants. We therefore decided to undertake a prospective study under the Huriet law to determine its efficacy and specify the conditions required for an anterior chamber multifocal phakic implant. Fifty-five eyes of 33 patients received an anterior chamber foldable multifocal phakic implant. Twenty-one females and 12 males underwent surgery. Initial refraction was between -5D and +5D. The implant's single addition was +2.50. Recuperating a distant uncorrected visual acuity of 0.6 or better and near uncorrected vision of Parinaud 3 or better can be considered a very good postoperative result. Average follow-up was 42.6+/-18 weeks. Mean postoperative refraction was -0.12+/-0.51 D. Mean postoperative uncorrected visual acuity was 0.78+/-0.20. Postoperative uncorrected visual acuity was Parinaud 2.3+/-0.6. Eighty-four percent of eyes operated on recuperated 0.6 or better without correction and Parinaud 3 or better without correction. Lenses in four eyes were explanted for different reasons, essentially optical, and no severe anatomical complications were observed. Placing an anterior chamber multifocal phakic implant to correct presbyopia is an effective technique with good predictability and has the advantage of being reversible in case of intolerance, optical parasite effects or undesired complications. Considering the particularity of this surgery, it is imperative to respect very strict inclusion criteria: anterior chamber depth equal to or above 3.1 mm, open angle, endothelial cell count equal to or above 2000 cells/mm2, absence of an incipient cataract or the slightest evidence of macular alteration.

Broadband diffractive lens or imaging element

DOEpatents

Ceglio, Natale M.; Hawryluk, Andrew M.; London, Richard A.; Seppala, Lynn G.

1991-01-01

A broadband diffractive lens or imaging element produces a sharp focus and/or a high resolution image with broad bandwidth illuminating radiation. The diffractive lens is sectored or segmented into regions, each of which focuses or images a distinct narrowband of radiation but all of which have a common focal length. Alternatively, a serial stack of minus filters, each with a diffraction pattern which focuses or images a distinct narrowband of radiation but all of which have a common focal length, is used. The two approaches can be combined. Multifocal broadband diffractive elements can also be formed.

Temporal multiplexing with adaptive optics for simultaneous vision

PubMed Central

Papadatou, Eleni; Del Águila-Carrasco, Antonio J.; Marín-Franch, Iván; López-Gil, Norberto

2016-01-01

We present and test a methodology for generating simultaneous vision with a deformable mirror that changed shape at 50 Hz between two vergences: 0 D (far vision) and −2.5 D (near vision). Different bifocal designs, including toric and combinations of spherical aberration, were simulated and assessed objectively. We found that typical corneal aberrations of a 60-year-old subject changes the shape of objective through-focus curves of a perfect bifocal lens. This methodology can be used to investigate subjective visual performance for different multifocal contact or intraocular lens designs. PMID:27867718

Broadband diffractive lens or imaging element

DOEpatents

Ceglio, Natale M.; Hawryluk, Andrew M.; London, Richard A.; Seppala, Lynn G.

1993-01-01

A broadband diffractive lens or imaging element produces a sharp focus and/or a high resolution image with broad bandwidth illuminating radiation. The diffractive lens is sectored or segmented into regions, each of which focuses or images a distinct narrowband of radiation but all of which have a common focal length. Alternatively, a serial stack of minus filters, each with a diffraction pattern which focuses or images a distinct narrowband of radiation but all of which have a common focal length, is used. The two approaches can be combined. Multifocal broadband diffractive elements can also be formed. Thin film embodiments are described.

Broadband diffractive lens or imaging element

DOEpatents

Ceglio, N.M.; Hawryluk, A.M.; London, R.A.; Seppala, L.G.

1993-10-26

A broadband diffractive lens or imaging element produces a sharp focus and/or a high resolution image with broad bandwidth illuminating radiation. The diffractive lens is sectored or segmented into regions, each of which focuses or images a distinct narrowband of radiation but all of which have a common focal length. Alternatively, a serial stack of minus filters, each with a diffraction pattern which focuses or images a distinct narrowband of radiation but all of which have a common focal length, is used. The two approaches can be combined. Multifocal broadband diffractive elements can also be formed. Thin film embodiments are described. 21 figures.

Extended depth of focus intraocular lens: Chromatic performance

PubMed Central

Millán, Maria S.; Vega, Fidel

2017-01-01

We describe a first-and-second-diffractive-order intraocular lens ((1st,2nd)DIOL) within the class of hybrid refractive-diffractive designs for intraocular lenses (IOLs) and analyse its properties of focus extension and compensation of longitudinal chromatic aberration (LCA), particularly for lenses with low addition. Power, energy efficiency and their wavelength dependence are extended from monofocal IOL and conventional bifocal zeroth-and-first-diffractive-order IOL ((0th,1st)DIOL) to (1st,2nd)DIOL of low addition. Compensation of LCA is experimentally assessed in optical bench through the through-focus energy efficiency of three Tecnis IOLs with red, green and blue illuminations: ZA9003 (monofocal), ZKB00 (bifocal (0th,1st)DIOL with + 2.75 D add) and Symfony ZXR00. We prove Tecnis Symfony ZXR00 IOL can be considered an example of (1st,2nd)DIOL design of low addition, with LCA compensation in both the distance and intermediate foci, whereas the bifocal (0th,1st)DIOL does not compensate in the distance focus. However, the energy efficiency of (1st,2nd)DIOL for wavelengths other than the design wavelength is markedly more asymmetric. PMID:28966865

Clinical outcome and higher order aberrations after bilateral implantation of an extended depth of focus intraocular lens.

PubMed

Pilger, Daniel; Homburg, David; Brockmann, Tobias; Torun, Necip; Bertelmann, Eckart; von Sonnleithner, Christoph

2018-04-01

The purpose of this study was to assess the clinical outcome after a bilateral implantation of an extended depth of focus intraocular lens in comparison to a monofocal intraocular lens. Department of Ophthalmology, Charité-Medical University Berlin, Germany. A total of 60 eyes of 30 patients were enrolled in this prospective, single-center study. The cataract patients underwent phacoemulsification with bilateral implantation of a TECNIS ® Symfony (Abbott Medical Optics, Santa Ana, CA, USA, 15 patients) or a TECNIS Monofocal ZCB00 (Abbott Medical Optics, Santa Ana, CA, USA, 15 patients). Postoperative evaluations were performed after 1 and 3 months, including visual acuities at far, intermediate, and near distance. Mesopic, scotopic vision, and contrast sensitivity were investigated. Aberrometry was performed using an iTrace aberrometer with a pupil scan size of 5.0 mm. After 3 months, the TECNIS Symfony group reached an uncorrected visual acuity at far distance of -0.02 logMAR compared to -0.06 logMAR in the TECNIS Monofocal group ( p = 0.03). Regarding the uncorrected vision at intermediate and near distance the following values were obtained: intermediate visual acuity -0.13 versus 0.0 logMAR (TECNIS Symfony vs TECNIS Monofocal, p = 0.001) and near visual acuity 0.11 versus 0.26 logMAR (TECNIS Symfony vs TECNIS Monofocal, p = 0.001). Low-contrast visual acuities were 0.27 versus 0.20 logMar (TECNIS Symfony vs TECNIS Monofocal, p = 0.023). The TECNIS Symfony intraocular lens can be considered an appropriate alternative to multifocal intraocular lenses because of good visual results at far, intermediate, and near distance as well as in low-contrast vision.

[Intramuscular depot steroids : Possible treatment of postsurgical cystoid macula edema with steroid response?

PubMed

Seuthe, A-M; Szurman, P; Boden, K T

2017-11-01

We report on a patient with postsurgical cystoid macular edema (CME) after phacoemulsification and multifocal intraocular lens (MIOL) implantation. At first, there was a very good reaction to intravitreal triamcinolone, inducing complete regression of the edema without increasing intraocular pressure (IOP). One year later the patient suffered from retinal detachment and was treated with vitrectomy, laser, and gas tamponade. Afterward, he developed macular pucker with edema. After surgical treatment with pucker peeling and intravitreal triamcinolone, the patient showed a steroid response and an increase IOP. Postoperatively, there was a recurrence of CME. A coincidental administration of a steroid injection intramuscularly by the general practitioner achieved a prompt reduction of the CME without increasing IOP. This case shows that an initially good reaction to triamcinolone without increasing IOP does not rule out a future steroid response, and that a potential treatment option for CME in patients with a known steroid response could consist of intramuscularly injected steroids.

Optical bench performance of a novel trifocal intraocular lens compared with a multifocal intraocular lens

PubMed Central

Lee, Shinwook; Choi, Myoung; Xu, Zaiwei; Zhao, Zeyu; Alexander, Elsinore; Liu, Yueai

2016-01-01

Purpose The purpose of this study is to compare the optical characteristics of the novel PanOptix presbyopia-correcting trifocal intraocular lens (IOL) and the multifocal ReSTOR +3.0 D IOL, through in vitro bench investigations. Methods The optical characteristics of AcrySof® IQ PanOptix™ (PanOptix) and AcrySof® IQ ReSTOR +3.0 D (ReSTOR +3.0 D) IOLs were evaluated by through-focus Badal images, simulated headlight images, and modulation transfer function (MTF) measurements which determine resolution, photic phenomena, and image quality. Through-focus Badal images of an Early Treatment of Diabetic Retinopathy Study chart were recorded at both photopic and mesopic pupil sizes. Simulated headlight images were taken on an MTF bench with a 50-μm pinhole target and a 5.0 mm pupil at the distance focus of the IOL. MTF curves were measured with a 3.0 mm pupil, and spatial frequencies equivalent to 20/40 and 20/20 visual acuities were recorded to illustrate the through-focus MTF curves. Far-, intermediate-, and near-focus MTF values were obtained. Results Bench Badal image testing and MTF measurements showed that PanOptix has a near focus at a distance of 42 cm and an additional intermediate focus at a distance of about 60 cm. The near focus for ReSTOR +3.0 D is at 45 cm. PanOptix and ReSTOR +3.0 D have comparable photopic distances and near MTF values. Additionally, PanOptix provided a substantial continuous range of vision from distance to intermediate and to near compared with ReSTOR +3.0 D. The halo propensity for PanOptix was slightly higher than that for ReSTOR +3.0 D. Conclusion Laboratory-based in vitro simulations showed that PanOptix trifocal IOL has comparable resolution and image quality performance in distance and near foci compared with ReSTOR +3.0 D IOL. PanOptix showed better resolution and image quality performance at the intermediate focus than ReSTOR +3.0 D IOL. PMID:27330273

Impact of personality characteristics on patient satisfaction after multifocal intraocular lens implantation: results from the "happy patient study".

PubMed

Mester, Ulrich; Vaterrodt, Thomas; Goes, Frank; Huetz, Werner; Neuhann, Irmingard; Schmickler, Stefanie; Szurman, Peter; Gekeler, Katrin

2014-10-01

This prospective multicenter study assessed personality characteristics that may influence patient satisfaction after implantation of multifocal intraocular lenses (MIOLs). One hundred eighty-three patients who underwent bilateral implantation of different MIOLs were enrolled. Uncorrected and corrected distance visual acuity for distance and near (ie, UDVA, UNVA, CDVA, and CNVA) were assessed preoperatively and 3 and 6 months after implantation. Before surgery, personality characteristics were evaluated using a questionnaire based on the NEO Personality Inventory Test and the Compulsiveness Inventory Test. At the 3- and 6-month postoperative visits, patients answered a questionnaire concerning overall satisfaction, need for spectacles at different distances, visual function at different distances and lighting conditions, photic phenomena, and ease of performing daily activities. Three months after surgery (n = 163), mean CDVA was 0.03 ± 0.09 logMAR, UDVA was 0.05 ± 0.09 logMAR, and UNVA was 0.04 ± 0.11 logMAR. At the 6-month visit (n = 131), mean CDVA was 0.02 ± 0.07 logMAR, UDVA was 0.06 ± 0.09 logMAR, and UNVA was 0.05 ± 0.01 logMAR. Most patients (82.2%) would opt for an MIOL again, 3.7% would not, and 14.1% were uncertain. Overall satisfaction with the procedure was correlated to low astigmatism, good visual function, low spectacle dependence, and less halos or glare. The personality characteristics of compulsive checking, orderliness, competence, and dutifulness were statistically significantly correlated to subjective disturbance by glare and halos. Postoperative patient satisfaction after MIOL implantation is correlated to visual performance, spectacle independence, and less photic phenomena. Personality characteristics have an impact on subjective disturbance by photic phenomena and thus are important for patient satisfaction. Copyright 2014, SLACK Incorporated.

Clinical Evaluation of Functional Vision of +1.5 Diopters near Addition, Aspheric, Rotational Asymmetric Multifocal Intraocular Lens

PubMed Central

Khoramnia, Rahmin; Attia, Mary Safwat; Koss, Michael Janusz; Linz, Katharina; Auffarth, Gerd Uwe

2016-01-01

Purpose To evaluate postoperative outcomes and visual performance in intermediate distance after implantation of a +1.5 diopters (D) addition, aspheric, rotational asymmetric multifocal intraocular lens (MIOL). Methods Patients underwent bilateral cataract surgery with implantation of an aspheric, asymmetric MIOL with +1.5 D near addition. A complete ophthalmological examination was performed preoperatively and 3 months postoperatively. The main outcome measures were monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), distance corrected intermediate visual acuity (DCIVA), uncorrected near visual acuity (UNVA) and distance corrected keratometry, and manifest refraction. The Salzburg Reading Desk was used to analyze unilateral and bilateral functional vision with uncorrected and corrected reading acuity, reading distance, reading speed, and the smallest log-scaled print size that could be read effectively at near and intermediate distances. Results The study comprised 60 eyes of 30 patients (mean age, 68.30 ± 9.26 years; range, 34 to 80 years). There was significant improvement in UDVA and CDVA. Mean UIVA was 0.01 ± 0.09 logarithm of the minimum angle of resolution (logMAR) and mean DCIVA was -0.02 ± 0.11 logMAR. In Salzburg Reading Desk analysis for UIVA, the mean subjective intermediate distance was 67.58 ± 8.59 cm with mean UIVA of -0.02 ± 0.09 logMAR and mean word count of 96.38 ± 28.32 words/min. Conclusions The new aspheric, asymmetric, +1.5 D near addition MIOL offers good results for distance visual function in combination with good performance for intermediate distances and functional results for near distance. PMID:27729759

Clinical Evaluation of Functional Vision of +1.5 Diopters near Addition, Aspheric, Rotational Asymmetric Multifocal Intraocular Lens.

PubMed

Kretz, Florian Tobias Alwin; Khoramnia, Rahmin; Attia, Mary Safwat; Koss, Michael Janusz; Linz, Katharina; Auffarth, Gerd Uwe

2016-10-01

To evaluate postoperative outcomes and visual performance in intermediate distance after implantation of a +1.5 diopters (D) addition, aspheric, rotational asymmetric multifocal intraocular lens (MIOL). Patients underwent bilateral cataract surgery with implantation of an aspheric, asymmetric MIOL with +1.5 D near addition. A complete ophthalmological examination was performed preoperatively and 3 months postoperatively. The main outcome measures were monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), distance corrected intermediate visual acuity (DCIVA), uncorrected near visual acuity (UNVA) and distance corrected keratometry, and manifest refraction. The Salzburg Reading Desk was used to analyze unilateral and bilateral functional vision with uncorrected and corrected reading acuity, reading distance, reading speed, and the smallest log-scaled print size that could be read effectively at near and intermediate distances. The study comprised 60 eyes of 30 patients (mean age, 68.30 ± 9.26 years; range, 34 to 80 years). There was significant improvement in UDVA and CDVA. Mean UIVA was 0.01 ± 0.09 logarithm of the minimum angle of resolution (logMAR) and mean DCIVA was -0.02 ± 0.11 logMAR. In Salzburg Reading Desk analysis for UIVA, the mean subjective intermediate distance was 67.58 ± 8.59 cm with mean UIVA of -0.02 ± 0.09 logMAR and mean word count of 96.38 ± 28.32 words/min. The new aspheric, asymmetric, +1.5 D near addition MIOL offers good results for distance visual function in combination with good performance for intermediate distances and functional results for near distance.

Clinical Outcomes after Binocular Implantation of a New Trifocal Diffractive Intraocular Lens

PubMed Central

Kretz, Florian T. A.; Breyer, Detlev; Diakonis, Vasilios F.; Klabe, Karsten; Henke, Franziska; Auffarth, Gerd U.; Kaymak, Hakan

2015-01-01

Purpose. To evaluate visual, refractive, and contrast sensitivity outcomes, as well as the incidence of pseudophakic photic phenomena and patient satisfaction after bilateral diffractive trifocal intraocular lens (IOL) implantation. Methods. This prospective nonrandomized study included consecutive patients undergoing cataract surgery with bilateral implantation of a diffractive trifocal IOL (AT LISA tri 839MP, Carl Zeiss Meditec). Distance, intermediate, and near visual outcomes were evaluated as well as the defocus curve and the refractive outcomes 3 months after surgery. Photopic and mesopic contrast sensitivity, patient satisfaction, and halo perception were also evaluated. Results. Seventy-six eyes of 38 patients were included; 90% of eyes showed a spherical equivalent within ±0.50 diopters 3 months after surgery. All patients had a binocular uncorrected distance visual acuity of 0.00 LogMAR or better and a binocular uncorrected intermediate visual acuity of 0.10 LogMAR or better, 3 months after surgery. Furthermore, 85% of patients achieved a binocular uncorrected near visual acuity of 0.10 LogMAR or better. Conclusions. Trifocal diffractive IOL implantation seems to provide an effective restoration of visual function for far, intermediate, and near distances, providing high levels of visual quality and patient satisfaction. PMID:26301104

Candida Endophthalmitis After Descemet Stripping Automated Endothelial Keratoplasty With Grafts From Both Eyes of a Donor With Possible Systemic Candidiasis.

PubMed

Palioura, Sotiria; Sivaraman, Kavitha; Joag, Madhura; Sise, Adam; Batlle, Juan F; Miller, Darlene; Espana, Edgar M; Amescua, Guillermo; Yoo, Sonia H; Galor, Anat; Karp, Carol L

2018-04-01

To report 2 cases with late postoperative Candida albicans interface keratitis and endophthalmitis after Descemet stripping automated endothelial keratoplasty (DSAEK) with corneal grafts originating from a single donor with a history of presumed pulmonary candidiasis. Two patients underwent uncomplicated DSAEK by 2 corneal surgeons at different surgery centers but with tissue from the same donor and were referred to the Bascom Palmer Eye Institute with multifocal infiltrates at the graft-host cornea interface 6 to 8 weeks later, and anterior chamber cultures that were positive for the same genetic strain of C. albicans. Immediate explantation of DSAEK lenticules and daily intracameral and instrastromal voriconazole and amphotericin injections failed to control the infection. Thus, both patients underwent therapeutic penetrating keratoplasty with intraocular lens explantation, pars plana vitrectomy, and serial postoperative intraocular antifungal injection. Both patients are doing well at 2 years postoperatively with best-corrected vision of 20/20 and 20/30+ with rigid gas permeable lenses. One patient required repeat optical penetrating keratoplasty and glaucoma tube implantation 1 year after the original surgery. Literature review reveals that donor lenticule explantation and intraocular antifungals are often inadequate to control fungal interface keratitis, and a therapeutic graft is commonly needed. Interface fungal keratitis and endophthalmitis due to infected donor corneal tissue is difficult to treat, and both recipients of grafts originating from the same donor are at risk of developing this challenging condition.

Lifetime costs and effectiveness of ReSTOR compared with a monofocal IOL and Array-SA40 in the Netherlands.

PubMed

De Vries, N E; Laurendeau, C; Lafuma, A; Berdeaux, G; Nuijts, R M M A

2010-04-01

To estimate the lifetime cost consequences for society and the National Health Service (NHS) of bilateral monofocal (SI40NB) or multifocal (ReSTOR or Array-SA40) intraocular lense (IOL) implantation after cataract surgery. Public hospital in the Netherlands. A Markov model simulated three cohorts of patients followed 69 until 100 years of age, or death. Spectacle independence rates for each IOL were adjusted to the results of a randomized clinical trial that compared monofocal and multifocal Array-SA40 IOL implants, together with a prospective cohort of patients implanted with ReSTOR. Adjustment was performed using the propensity score method in a multivariate analysis. Resource consumption was estimated from a dedicated Dutch survey. Dutch unit costs were applied to spectacles, cataract surgery, IOLs, visits to ophthalmologists, optometrists, transport, and spectacle cleaning materials. Cost discounted at 4% and undiscounted economic results were calculated. Spectacle independence rates were 86.0% for ReSTOR, 8.7% for monofocal IOLs, and 8.5% for Array-SA40. Patients lived without needing spectacles for 12.9 years after ReSTOR, for 1.4 years after monofocal IOLs, and 1.3 years after Array-SA40. ReSTOR patients bought 6.4 fewer pairs of spectacles than monofocal patients. Lifetime discounted cost consequences for the society were ReSTOR euro3969, monofocal IOLs euro4123, and Array-SA40 euro5326. Corresponding costs for the NHS were euro2415, euro2555, and euro2556, respectively. ReSTOR IOLs provided higher levels of spectacle independence than monofocal SI40NB or multifocal Array-SA40 IOLs resulting in savings, compared to a monofocal, over the period modelled of euro315 for society and euro140 for the NHS.

Fibonacci-like zone plate

NASA Astrophysics Data System (ADS)

Cheng, Shubo; Liu, Mengsi; Xia, Tian; Tao, Shaohua

2018-06-01

We present a new family of diffractive lenses, Fibonacci-like zone plates, generated with a modified Fibonacci sequence. The focusing properties and the evolution of transverse diffraction pattern for the Fibonacci-like zone plates have been analytically investigated both theoretically and experimentally and compared with the corresponding Fresnel zone plates of the same resolution. The results demonstrate that the Fibonacci-like zone plates possess the self-similar property and the multifocal behavior. Furthermore, the Fibonacci-like zone plate beams are found to possess the self-reconstruction property, and would be promising for 3D optical tweezers, laser machining, and optical imaging.

[Spectral transmission in blue filter intraocular lenses].

PubMed

Schrage, N

2012-02-01

There is uncertainty in ophthalmology concerning the quality and spectral transmission of light of so-called blue filter intraocular lenses (IOL). Clinical users have noticed that such IOL's appear to have different color intensities. The discussion on medical changes by means of such IOL's is dependent on the real light transmission of these IOL's. To add some objective data we compared these IOL's by systematic transmission measurements and observed technical differences of diffraction and geometry as well as transmission differences. The result gives objective indications that differences between blue filter IOL's from different manufacturers are important and are detailed in this paper.

Highly uniform parallel microfabrication using a large numerical aperture system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Zi-Yu; Su, Ya-Hui, E-mail: ustcsyh@ahu.edu.cn, E-mail: dongwu@ustc.edu.cn; Zhang, Chen-Chu

In this letter, we report an improved algorithm to produce accurate phase patterns for generating highly uniform diffraction-limited multifocal arrays in a large numerical aperture objective system. It is shown that based on the original diffraction integral, the uniformity of the diffraction-limited focal arrays can be improved from ∼75% to >97%, owing to the critical consideration of the aperture function and apodization effect associated with a large numerical aperture objective. The experimental results, e.g., 3 × 3 arrays of square and triangle, seven microlens arrays with high uniformity, further verify the advantage of the improved algorithm. This algorithm enables the laser parallelmore » processing technology to realize uniform microstructures and functional devices in the microfabrication system with a large numerical aperture objective.« less

Time-Dependent Decline in Multifocal Electroretinogram Requires Faster Recording Procedures in Anesthetized Pigs

PubMed Central

Sørensen, Nina Buus; Christiansen, Anders Tolstrup; Kjær, Troels Wesenberg; Klemp, Kristian; la Cour, Morten; Kiilgaard, Jens Folke

2017-01-01

Purpose The time-dependent effect of anesthetics on the retinal function is debated. We hypothesize that in anesthetized animals there is a time-dependent decline that requires optimized multifocal electroretinogram (mfERG) recording procedures. Methods Conventional and four-frame global-flash mfERG recordings were obtained approximately 15, 60, and 150 minutes after the induction of propofol anesthesia (20 pigs) and isoflurane anesthesia (nine pigs). In six of the propofol-anesthetized pigs, the mfERG recordings were split in 3-minute segments. Two to 4 weeks after initial recordings, an intraocular injection of tetrodotoxin (TTX) was given and the mfERG was rerecorded as described above. Data were analyzed using mixed models in SAS statistical software. Results Propofol significantly decreases the conventional and global-flash amplitudes over time. The only significant effect of isoflurane is a decrease in the global-flash amplitudes. At 15 minutes after TTX injection several of the mfERG amplitudes are significantly decreased. There is a linear correlation between the conventional P1 and the global-flash DR mfERG-amplitude (R2 = 0.82, slope = 0.72, P < 0.0001). There is no significant difference between the 3-minute and the prolonged mfERG recordings for conventional amplitudes and the global-flash direct response. The global flash–induced component significantly decreases with prolonged mfERG recordings. Conclusions A 3-minute mfERG recording and a single stimulation protocol is sufficient in anesthetized pigs. Recordings should be obtained immediately after the induction of anesthesia. The effect of TTX is significant 15 minutes after injection, but is contaminated by the effect of anesthesia 90 minutes after injection. Therefore, the quality of mfERG recordings can be further improved by determining the necessary time-of-delay from intraocular injection of a drug to full effect. Translational Relevance General anesthesia is a possible source of error in mfERG recordings. Therefore, it is important to investigate the translational relevance of the results to mfERG recordings in children in general anesthesia. PMID:28377845

Influence on Visual Quality of Intraoperative Orientation of Asymmetric Intraocular Lenses.

PubMed

Bonaque-González, Sergio; Ríos, Susana; Amigó, Alfredo; López-Gil, Norberto

2015-10-01

To evaluate visual quality when changing the intraocular orientation of the Lentis Mplus LS-312MF nonrotational symmetric +3.00 diopters aspheric multifocal intraocular lens ([IOL] Oculentis GmbH, Berlin, Germany) in normal eyes. An artificial eye was used to measure the in vitro wavefront of the IOL. The corneal topography of 20 healthy patients was obtained. For each eye, a computational analysis simulated the implantation of the IOL. The modulation transfer function (MTF) and an image quality parameter (visually modulated transfer function [VSMTF] metric) were calculated for a 5.0-mm pupil and for three conditions: distance, intermediate, and near vision. The procedure was repeated for each eye after a rotation of the IOL with respect to the cornea from 0° to 360° in 1° steps. Statistical analysis showed significant differences in mean VSMTF values between orientations for distance vision. Optimal orientation of the IOL (different for each eye) showed a mean improvement of 58% ± 19% (range: 20% to 121%) in VSMTF values with respect to the worst possible orientation. For these orientations, intermediate and near vision quality were statistically indistinguishable. The MTFs were different between orientations, showing a mean difference of approximately 5 cycles per degree in the maximum spatial frequencies that can be transferred between the best and the worst orientations for distance vision. The results suggest that implantation of this nonrotational symmetric IOL should improve visual outcomes if it is oriented to coincide with a customized meridian. A simple, practical method is proposed to find an approximation to the angle that an Mplus IOL should be inserted. Copyright 2015, SLACK Incorporated.

Image quality comparison of two multifocal IOLs: influence of the pupil.

PubMed

García-Domene, Mari Carmen; Felipe, Adelina; Peris-Martínez, Cristina; Navea, Amparo; Artigas, Jose M; Pons, Álvaro M

2015-04-01

To evaluate the effect of pupil size on image quality of a sectorial multifocal intraocular lens (IOL), the Lentis Mplus (Oculentis GmbH, Berlin, Germany), and the Acri.LISA IOL (Carl Zeiss Meditec, Jena, Germany). The authors measured the MTFs of the Lentis Mplus LS-312 IOL and the Acri.LISA 366D IOL with three different sizes of pupil diameters: 3, 4, and 5 mm. The MTF was calculated from the cross-line spread function recorded with the OPAL Vector System (Image Science Ltd., Oxford, UK) by using fast Fourier-transform techniques. In distance focus, the image quality provided by the Lentis Mplus IOL was better than that of the Acri. LISA IOL with all pupil diameters. In near focus, the MTF of the Acri.LISA IOL was better with a 3-mm pupil, but poor with larger pupils. The aberration effect was equal in both IOLs in distance focus, but in near focus and with a 3-mm pupil, the Acri.LISA IOL was less affected by the aberration than the Lentis Mplus IOL. The Lentis Mplus IOL provides better distance image quality than the Acri.LISA IOL, whereas the near image quality of the Acri.LISA IOL is better with small-pupil diameter. The sectorial design makes this IOL more suitable for patients with a pupil diameter greater than 3 mm. Copyright 2015, SLACK Incorporated.

Intraocular camera for retinal prostheses: Refractive and diffractive lens systems

NASA Astrophysics Data System (ADS)

Hauer, Michelle Christine

The focus of this thesis is on the design and analysis of refractive, diffractive, and hybrid refractive/diffractive lens systems for a miniaturized camera that can be surgically implanted in the crystalline lens sac and is designed to work in conjunction with current and future generation retinal prostheses. The development of such an intraocular camera (IOC) would eliminate the need for an external head-mounted or eyeglass-mounted camera. Placing the camera inside the eye would allow subjects to use their natural eye movements for foveation (attention) instead of more cumbersome head tracking, would notably aid in personal navigation and mobility, and would also be significantly more psychologically appealing from the standpoint of personal appearances. The capability for accommodation with no moving parts or feedback control is incorporated by employing camera designs that exhibit nearly infinite depth of field. Such an ultracompact optical imaging system requires a unique combination of refractive and diffractive optical elements and relaxed system constraints derived from human psychophysics. This configuration necessitates an extremely compact, short focal-length lens system with an f-number close to unity. Initially, these constraints appear highly aggressive from an optical design perspective. However, after careful analysis of the unique imaging requirements of a camera intended to work in conjunction with the relatively low pixellation levels of a retinal microstimulator array, it becomes clear that such a design is not only feasible, but could possibly be implemented with a single lens system.

Is the Capsular Bag Perimeter Round or Elliptical?

PubMed Central

Amigó, Alfredo; Bonaque-González, Sergio

2016-01-01

Purpose: To report findings that could suggest an elliptical shape of the capsular bag. Methods: Five eyes of three patients with axial length greater than 24 mm underwent phacoemulsification cataract surgery with plate-haptic multifocal toric intraocular lens (IOL) implantation oriented in the vertical meridian. Results: In all cases, correct orientation of the IOLs was verified 30 minutes after surgery. After 24 hours, all eyes demonstrated unwanted rotation of the IOLs ranging from 15 to 45 degrees. The IOLs remained stable in the new position in all cases until adhesion of the capsular bag took place. Conclusion: These observations could suggest that the perimeter of the capsular bag has an elliptical shape. Therefore, the IOL tends to become fixated in a meridian of the capsular bag that best fits the diagonal diameter of the IOL. PMID:27413495

Current perspectives of herpesviral retinitis and choroiditis.

PubMed

Madhavan, H N; Priya, K; Biswas, J

2004-10-01

Vision-threatening viral retinitis are primarily caused by members of the herpesvirus family. The biology and molecular characterization of herpesviruses, clinical presentations of retinopathies, pathology and pathogenesis including the host responses, epidemiology and the laboratory methods of aetiological diagnosis of these diseases are described. Clinical syndromes are acute retinal necrosis (ARN), progressive outer retinal necrosis (PORN), cytomegalovirus (CMV) retinitis, multifocal choroiditis and serpiginous choroiditis besides other viral retinopathies. Herpes simplex virus (HSV) retinitis is more common in immunocompetent persons while varicella zoster virus (VZV) affects both immunocompetent and immunosuppressed patients equally. CMV retinitis is most common among patients with AIDS. The currently employed laboratory methods of antigen detection, virus isolation and antibody detection by enzyme linked immuno-sorbent assay (ELISA) have low sensitivity. Polymerase chain reaction (PCR) has increased the value of diagnosis due to its high clinical sensitivity and absolute specificity in detection of herpesviruses in intraocular specimens.

Ocular residual astigmatism (ORA) in pre-cataract eyes prior to and after refractive lens exchange.

PubMed

Katz, Toam; Steinberg, Johannes; Druchkiv, Vasyl; Linke, Stephan J; Frings, Andreas

2017-08-01

The purpose of this study was to analyze ocular residual astigmatism (ORA) before and after implantation of two different optical types of non-toric multifocal intraocular lenses (MIOL) in pre-cataract patients. This retrospective cohort study analyzed 72 eyes from 72 consecutive patients after MIOL surgery . To investigate magnitude and axis of astigmatic changes, the concepts of true corneal astigmatism and Alpins vector method were applied. There were no statistically significant between-group differences prior to surgery. The mean refractive surgically induced astigmatism (RSIA) (P = 0.063) and the topographic SIA (TSIA) (P = 0.828) did not differ significantly between the lenses, and the summated vector mean for ORA was reduced in terms of magnitude by approximately 0.30 Diopter. ORA in pseudophakic eyes mainly results from the posterior corneal surface and less from IOL tilting, postoperative posterior capsule shrinkage, or secondary cataract.

Review of Static Approaches to Surgical Correction of Presbyopia

PubMed Central

Zare Mehrjerdi, Mohammad Ali; Mohebbi, Masomeh; Zandian, Mehdi

2017-01-01

Presbyopia is the primary cause of reduction in the quality of life of people in their 40s, due to dependence on spectacles. Therefore, presbyopia correction has become an evolving and rapidly progressive field in refractive surgery. There are two primary options for presbyopia correction: the dynamic approach uses the residual accommodative capacity of the eye, and the static approach attempts to enhance the depth of focus of the optical system. The dynamic approach attempts to reverse suspected pathophysiologic changes. Dynamic approaches such as accommodative intraocular lenses (IOLs), scleral expansion techniques, refilling, and photodisruption of the crystalline lens have attracted less clinical interest due to inconsistent results and the complexity of the techniques. We have reviewed the most popular static techniques in presbyopia surgery, including multifocal IOLs, PresbyLASIK, and corneal inlays, but we should emphasize that these techniques are very different from the physiologic status of an untouched eye. A systematic PubMed search for the keywords “presbylasik”, “multifocal IOL”, and “presbyopic corneal inlay” revealed 634 articles; 124 were controlled clinical trials, 95 were published in the previous 10 years, and 78 were English with available full text. We reviewed the abstracts and rejected the unrelated articles; other references were included as needed. This narrative review compares different treatments according to available information on the optical basis of each treatment modality, including the clinical outcomes such as near, intermediate, and far visual acuity, spectacles independence, quality of vision, and dysphotopic phenomena. PMID:29090052

Patient-reported benefit of ReSTOR® multi-focal intraocular lenses after cataract surgery: Results of Principal Component Analysis on clinical trial data

PubMed Central

Berdeaux, Gilles; Viala, Muriel; Roborel de Climens, Aude; Arnould, Benoit

2008-01-01

Background Restoration of functional distance and near vision independently of additional correction remains a goal for cataract surgery. ReSTOR®, a new multi-focal intraocular lens (IOL) addresses this issue with an improvement in both distance and near vision, often without need for glasses. This analysis attempted to discuss the patient-reported benefit of ReSTOR® using a full but organised representation of data. Methods Two non-randomised, open-label clinical trials conducted in Europe and the United-States were conducted to compare the efficacy of ReSTOR® to AcrySof® mono-focal IOLs. A total of 710 patients in need of bilateral cataract extraction were included in the pooled study. The TyPE, a patient questionnaire, was fully completed by 672 of them before and after each eye surgery. The TyPE, composed of 67 items measuring overall visual functioning in both conditions (with and without wearing glasses), evaluates limitations, troubles and satisfaction in distance and near vision. A principal component analysis (PCA) of the TyPE questionnaire was performed on pooled data from baseline and post-surgery observations in order to fully represent the change in the TyPE data over time. ReSTOR® and mono-focal groups were used as illustrative variables. The coordinates of the first 2 factors were compared between visits and between IOLs (ReSTOR® vs. mono-focal), using paired t-tests and t-tests, respectively. Results The first factor of the PCA explained 55% of the variance and represented 'visual functioning and patient satisfaction'. The second factor explained 6% of the variance and was interpreted as 'independence from glasses'. An overall difference in factorial coordinates in both factors was seen between baseline and the first eye surgery, and between the first and the second eye surgery. No difference between ReSTOR® and mono-focal IOL groups was observed at baseline. After surgery, ReSTOR® treated-patients had higher coordinates on both "visual functioning and satisfaction" and "independence from glasses" factors. Findings observed on the factorial plan were supported by statistical comparisons of factorial coordinates. Conclusion Both mono-focal and ReSTOR®-implanted patients improved their visual functioning after bilateral cataract surgery. Moreover, ReSTOR® patients reported an additional benefit in independence from glasses as well as in visual functioning and patient satisfaction. PMID:18218068

Patient-reported benefit of ReSTOR multi-focal intraocular lenses after cataract surgery: results of principal component analysis on clinical trial data.

PubMed

Berdeaux, Gilles; Viala, Muriel; Roborel de Climens, Aude; Arnould, Benoit

2008-01-24

Restoration of functional distance and near vision independently of additional correction remains a goal for cataract surgery. ReSTOR, a new multi-focal intraocular lens (IOL) addresses this issue with an improvement in both distance and near vision, often without need for glasses. This analysis attempted to discuss the patient-reported benefit of ReSTOR using a full but organised representation of data. Two non-randomised, open-label clinical trials conducted in Europe and the United-States were conducted to compare the efficacy of ReSTOR to AcrySof mono-focal IOLs. A total of 710 patients in need of bilateral cataract extraction were included in the pooled study. The TyPE, a patient questionnaire, was fully completed by 672 of them before and after each eye surgery. The TyPE, composed of 67 items measuring overall visual functioning in both conditions (with and without wearing glasses), evaluates limitations, troubles and satisfaction in distance and near vision. A principal component analysis (PCA) of the TyPE questionnaire was performed on pooled data from baseline and post-surgery observations in order to fully represent the change in the TyPE data over time. ReSTOR and mono-focal groups were used as illustrative variables. The coordinates of the first 2 factors were compared between visits and between IOLs (ReSTOR vs. mono-focal), using paired t-tests and t-tests, respectively. The first factor of the PCA explained 55% of the variance and represented 'visual functioning and patient satisfaction'. The second factor explained 6% of the variance and was interpreted as 'independence from glasses'. An overall difference in factorial coordinates in both factors was seen between baseline and the first eye surgery, and between the first and the second eye surgery. No difference between ReSTOR and mono-focal IOL groups was observed at baseline. After surgery, ReSTOR treated-patients had higher coordinates on both "visual functioning and satisfaction" and "independence from glasses" factors. Findings observed on the factorial plan were supported by statistical comparisons of factorial coordinates. Both mono-focal and ReSTOR-implanted patients improved their visual functioning after bilateral cataract surgery. Moreover, ReSTOR patients reported an additional benefit in independence from glasses as well as in visual functioning and patient satisfaction.

Energy Efficiency of a New Trifocal Intraocular Lens

NASA Astrophysics Data System (ADS)

Vega, F.; Alba-Bueno, F.; Millán, M. S.

2014-01-01

The light distribution among the far, intermediate and near foci of a new trifocal intraocular lens (IOL) is experimentally determined, as a function of the pupil size, from image analysis. The concept of focus energy efficiency is introduced because, in addition to the theoretical diffraction efficiency of the focus, it accounts for other factors that are naturally presented in the human eye such as the level of spherical aberration (SA) upon the IOL, light scattering at the diffractive steps or the depth of focus. The trifocal IOL is tested in-vitro in two eye models: the aberration-free ISO model, and a so called modified-ISO one that uses an artificial cornea with positive spherical SA in instead. The SA upon the IOL is measured with a Hartmann-Shack sensor and compared to the values of theoretical eye models. The results show, for large pupils, a notorious reduction of the energy efficiency of the far and near foci of the trifocal IOL due to two facts: the level of SA upon the IOL is larger than the value the lens is able to compensate for and there is significant light scattering at the diffractive steps. On the other hand, the energy efficiency of the intermediate focus for small pupils is enhanced by the contribution of the extended depth of focus of the near and far foci. Thus, while IOLs manufacturers tend to provide just the theoretical diffraction efficiency of the foci to show which would be the performance of the lens in terms of light distribution among the foci, our results put into evidence that this is better described by using the energy efficiency of the foci.

Wavefront shaping to correct intraocular scattering

NASA Astrophysics Data System (ADS)

Artal, Pablo; Arias, Augusto; Fernández, Enrique

2018-02-01

Cataracts is a common ocular pathology that increases the amount of intraocular scattering. It degrades the quality of vision by both blur and contrast reduction of the retinal images. In this work, we propose a non-invasive method, based on wavefront shaping (WS), to minimize cataract effects. For the experimental demonstration of the method, a liquid crystal on silicon (LCoS) spatial light modulator was used for both reproduction and reduction of the realistic cataracts effects. The LCoS area was separated in two halves conjugated with the eye's pupil by a telescope with unitary magnification. Thus, while the phase maps that induced programmable amounts of intraocular scattering (related to cataract severity) were displayed in a one half of the LCoS, sequentially testing wavefronts were displayed in the second one. Results of the imaging improvements were visually evaluated by subjects with no known ocular pathology seeing through the instrument. The diffracted intensity of exit pupil is analyzed for the feedback of the implemented algorithms in search for the optimum wavefront. Numerical and experimental results of the imaging improvements are presented and discussed.

Patient-centered and visual quality outcomes of premium cataract surgery: a systematic review.

PubMed

Wang, Sophia Y; Stem, Maxwell S; Oren, Gale; Shtein, Roni; Lichter, Paul R

2017-06-26

Over 8 million cataract surgeries are performed in the United States and the European Union annually, with many patients choosing to pay out of pocket for premium options including premium intraocular lens implants (IOLs) or laser-assisted cataract surgery (LACS). This report provides a systematic review evaluating patient-centered and visual quality outcomes comparing standard monofocal IOLs to premium cataract surgery options. PubMed and EMBASE were searched for publications published between January 1, 1980, and September 18, 2016, on multifocal, accommodative, and toric IOLs, monovision, and LACS, which reported on 1) dysphotopsias, 2) contrast sensitivity, 3) spectacle independence, 4) vision-related quality of life or patient satisfaction, and 5) IOL exchange. Multifocal lenses achieved higher rates of spectacle independence compared to monofocal lenses but also had higher reported frequency of dysphotopsia and worse contrast sensitivity, especially with low light or glare. Accommodative lenses were not associated with reduced contrast sensitivity or more dysphotopsia but had only modest improvements in spectacle independence compared to monofocal lenses. Studies of monovision did not target a sufficiently myopic outcome in the near-vision eye to achieve the full potential for spectacle independence. Patients reported high levels of overall satisfaction regardless of implanted IOL. No studies correlated patient-reported outcomes with patient expectations. Studies are needed to thoroughly compare patient-reported outcomes with concomitant patient expectations. In light of the substantial patient costs for premium options, patients and their surgeons will benefit from a better understanding of which surgical options best meet patients' expectations and how those expectations can be impacted by premium versus monofocal-including monovision-options.

Evaluation of multifocal visual evoked potentials in patients with Graves' orbitopathy and subclinical optic nerve involvement.

PubMed

Pérez-Rico, Consuelo; Rodríguez-González, Natividad; Arévalo-Serrano, Juan; Blanco, Román

2012-08-01

Dysthyroid optic neuropathy is the most serious, although infrequent (8-10 %) complication in Graves' orbitopathy (GO). It is known that early stages of compressive optic neuropathy may produce reversible visual field defects, suggesting axoplasmic stasis rather than ganglion cell death. This observational, cross-sectional, case-control study assessed 34 consecutive patients (65 eyes) with Graves' hyperthyroidism and longstanding GO and 31 age-matched control subjects. The patients' multifocal visual evoked potentials (mfVEP) were compared to their clinical and psychophysical (standard automated perimetry [SAP]) and structural (optic coherence tomography [OCT]) diagnostic test data. Abnormal cluster defects were found in 12.3 % and 3.1 % of eyes on the interocular and monocular amplitude analysis mfVEP probability plots, respectively. As well, mfVEP latencies delays were found in 13.8 and 20 % of eyes on the interocular and monocular analysis probability plots, respectively. Interestingly, 19 % of patients with GO had ocular hypertension, and a strong correlation between intraocular pressure measured at upgaze and mfVEP latency was found. MfVEP amplitudes and visual acuity were significantly related to each other (P < 0.05), but not with the latencies delays. However, relationships between the interocular or monocular mfVEP amplitudes and latencies analysis and SAP indices or OCT data were not statistically significant. One-third of our patients with GO showed changes in the mfVEP, indicating significant subclinical optic nerve dysfunction. In this sense, the mfVEP may be a useful diagnostic tool in the clinic for early diagnosis and monitoring of optic nerve function abnormalities in patients with GO.

Transferring diffractive optics from research to commercial applications: Part II - size estimations for selected markets

NASA Astrophysics Data System (ADS)

Brunner, Robert

2014-04-01

In a series of two contributions, decisive business-related aspects of the current process status to transfer research results on diffractive optical elements (DOEs) into commercial solutions are discussed. In part I, the focus was on the patent landscape. Here, in part II, market estimations concerning DOEs for selected applications are presented, comprising classical spectroscopic gratings, security features on banknotes, DOEs for high-end applications, e.g., for the semiconductor manufacturing market and diffractive intra-ocular lenses. The derived market sizes are referred to the optical elements, itself, rather than to the enabled instruments. The estimated market volumes are mainly addressed to scientifically and technologically oriented optical engineers to serve as a rough classification of the commercial dimensions of DOEs in the different market segments and do not claim to be exhaustive.

Actinomyces bowdenii ulcerative keratitis in a dog.

PubMed

Sherman, Amanda; Daniels, Joshua B; Wilkie, David A; Lutz, Elizabeth

2013-09-01

A 5-year-old spayed female diabetic mixed-breed dog underwent phacoemulsification and intraocular lens implantation to correct bilateral hypermature cataracts. Two months postsurgery, the patient presented with ulcerative keratitis and multifocal stromal abscessation OD, which was controlled, but never resolved, with topical fluoroquinolone therapy. The patient re-presented 2 months later with a new, raised, white gritty corneal opacity associated with hyperemia, chemosis, and blepharospasm OD. Cytology of the right cornea revealed filamentous bacteria, suggestive of Actinomyces spp. Actinomyces bowdenii was subsequently isolated in pure culture and identified via 16s rDNA sequencing. Actinomyces bowdenii has never before been described as a cause of ocular infection. An immunosuppressed corneal environment likely contributed to this opportunistic Actinomycosis. The infection was not controlled with fluoroquinolone therapy, and the isolate, in vitro, was resistant to three fluoroquinolones (ciprofloxacin, ofloxacin, and levofloxacin), which also has not been previously reported for this species of Actinomyces. A superficial keratectomy with conjunctival graft was employed to successfully manage the infection. © 2012 American College of Veterinary Ophthalmologists.

Bilateral uveal metastasis of a subcutaneous fibrosarcoma in a cat.

PubMed

Mowat, Freya M; Langohr, Ingeborg M; Bilyk, Olenka; Koterbay, Amy; Pierce, Kenneth E; Petersen-Jones, Simon M

2012-11-01

A 6-year-old neutered male domestic short-haired cat was presented to the Comparative Ophthalmology service at Michigan State University with a 3-week history of decreased appetite and redness of the left eye. The left forelimb had been removed 15 months previously because of the presence of a subcutaneous fibrosarcoma. In the left globe, a large iridal mass was associated with increased intraocular pressure and retinal detachment. A smaller mass involving the right iris was also present. Imaging revealed a 2-cm mass in the left caudodorsal lung lobe, and abdominal ultrasound showed multifocal bilateral renal masses. Aspirates of these masses were nondiagnostic. The left globe was removed for palliative reasons, and histopathology showed that fibrosarcoma was infiltrating the iris, choroid, and optic nerve. Despite systemic chemotherapy with doxorubicin, the animal died 4 months after initial presentation. Histopathology confirmed highly angioinvasive metastatic fibrosarcoma also in the right uveal tract, the lungs, and both kidneys. © 2012 American College of Veterinary Ophthalmologists.

Metastatic iridociliary adenocarcinoma in a labrador retriever.

PubMed

Zarfoss, M K; Dubielzig, R R

2007-09-01

An enucleated left eye from a 15-year-old female spayed Labrador Retriever was received by the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW) for histopathologic evaluation. Routine histologic preparation included staining with hematoxylin and eosin, and with alcian blue periodic acid-Schiff (PAS). At necropsy 9 months later, all grossly abnormal tissues (ipsilateral orbit and lung) were submitted to the COPLOW for histopathologic evaluation. Histopathologic evaluation of the globe revealed extensive invasion of the uvea and sclera by a pleomorphic cell population that formed disorganized cords and exhibited PAS-positive basement membrane material. Necropsy revealed a morphologically similar tumor in the ipsilateral orbit and lung. On immunohistochemical examination, the intraocular tumor stained diffusely immunopositive for vimentin, S-100, and neuron-specific enolase and multifocally, sparsely immunopositive for cytokeratin AE1/AE3. The orbital and thoracic tumors stained positively for vimentin but negatively for cytokeratin AE1/AE3. There are few reports of canine metastatic iridociliary adenocarcinoma in the literature; this is the first with immunohistochemical analysis.

Detecting early functional damage in glaucoma suspect and ocular hypertensive patients with the multifocal VEP technique.

PubMed

Thienprasiddhi, Phamornsak; Greenstein, Vivienne C; Chu, David H; Xu, Li; Liebmann, Jeffrey M; Ritch, Robert; Hood, Donald C

2006-08-01

To determine whether the multifocal visual evoked potential (mfVEP) technique can detect early functional damage in ocular hypertensive (OHT) and glaucoma suspect (GS) patients with normal standard achromatic automated perimetry (SAP) results. Twenty-five GS patients (25 eyes), 25 patients with OHT (25 eyes), and 50 normal controls (50 eyes) were enrolled in this study. All GS, OHT and normal control eyes had normal SAP as defined by a pattern standard deviation and mean deviation within the 95% confidence interval and a glaucoma hemifield test within normal limits on the Humphrey visual field 24-2 program. Eyes with GS had optic disc changes consistent with glaucoma with or without raised intraocular pressure (IOP), and eyes with OHT showed no evidence of glaucomatous optic neuropathy and IOPs >or=22 mm Hg. Monocular mfVEPs were obtained from both eyes of each subject using a pattern-reversal dartboard array with 60 sectors. The entire display had a radius of 22.3 degrees. The mfVEPs, for each eye, were defined as abnormal when either the monocular or interocular probability plot had a cluster of 3 or more contiguous points with P<0.05 and at least 2 of these points with P<0.01. The mfVEP results were abnormal in 4% of the eyes from normal subjects. Abnormal mfVEPs were detected in 20% of the eyes of GS patients and 16% of the eyes of OHT patients. Significantly more mfVEP abnormalities were detected in GS patients than in normal controls. However, there was no significant difference in mfVEP results between OHT patients and normal controls. The mfVEP technique can detect visual field deficits in a minority of eyes with glaucomatous optic disks and normal SAP results.

Measuring benefits and patients' satisfaction when glasses are not needed after cataract and presbyopia surgery: scoring and psychometric validation of the Freedom from Glasses Value Scale (FGVS).

PubMed

Berdeaux, Gilles; Meunier, Juliette; Arnould, Benoit; Viala-Danten, Muriel

2010-05-24

The purpose of this study was to reduce the number of items, create a scoring method and assess the psychometric properties of the Freedom from Glasses Value Scale (FGVS), which measures benefits of freedom from glasses perceived by cataract and presbyopic patients after multifocal intraocular lens (IOL) surgery. The 21-item FGVS, developed simultaneously in French and Spanish, was administered by phone during an observational study to 152 French and 152 Spanish patients who had undergone cataract or presbyopia surgery at least 1 year before the study. Reduction of items and creation of the scoring method employed statistical methods (principal component analysis, multitrait analysis) and content analysis. Psychometric properties (validation of the structure, internal consistency reliability, and known-group validity) of the resulting version were assessed in the pooled population and per country. One item was deleted and 3 were kept but not aggregated in a dimension. The other 17 items were grouped into 2 dimensions ('global evaluation', 9 items; 'advantages', 8 items) and divided into 5 sub-dimensions, with higher scores indicating higher benefit of surgery. The structure was validated (good item convergent and discriminant validity). Internal consistency reliability was good for all dimensions and sub-dimensions (Cronbach's alphas above 0.70). The FGVS was able to discriminate between patients wearing glasses or not after surgery (higher scores for patients not wearing glasses). FGVS scores were significantly higher in Spain than France; however, the measure had similar psychometric performances in both countries. The FGVS is a valid and reliable instrument measuring benefits of freedom from glasses perceived by cataract and presbyopic patients after multifocal IOL surgery.

Measuring benefits and patients' satisfaction when glasses are not needed after cataract and presbyopia surgery: scoring and psychometric validation of the Freedom from Glasses Value Scale (FGVS©)

PubMed Central

2010-01-01

Background The purpose of this study was to reduce the number of items, create a scoring method and assess the psychometric properties of the Freedom from Glasses Value Scale (FGVS), which measures benefits of freedom from glasses perceived by cataract and presbyopic patients after multifocal intraocular lens (IOL) surgery. Methods The 21-item FGVS, developed simultaneously in French and Spanish, was administered by phone during an observational study to 152 French and 152 Spanish patients who had undergone cataract or presbyopia surgery at least 1 year before the study. Reduction of items and creation of the scoring method employed statistical methods (principal component analysis, multitrait analysis) and content analysis. Psychometric properties (validation of the structure, internal consistency reliability, and known-group validity) of the resulting version were assessed in the pooled population and per country. Results One item was deleted and 3 were kept but not aggregated in a dimension. The other 17 items were grouped into 2 dimensions ('global evaluation', 9 items; 'advantages', 8 items) and divided into 5 sub-dimensions, with higher scores indicating higher benefit of surgery. The structure was validated (good item convergent and discriminant validity). Internal consistency reliability was good for all dimensions and sub-dimensions (Cronbach's alphas above 0.70). The FGVS was able to discriminate between patients wearing glasses or not after surgery (higher scores for patients not wearing glasses). FGVS scores were significantly higher in Spain than France; however, the measure had similar psychometric performances in both countries. Conclusions The FGVS is a valid and reliable instrument measuring benefits of freedom from glasses perceived by cataract and presbyopic patients after multifocal IOL surgery. PMID:20497555

The number of seizures needed in the EMU.

PubMed

Struck, Aaron F; Cole, Andrew J; Cash, Sydney S; Westover, M Brandon

2015-11-01

The purpose of this study was to develop a quantitative framework to estimate the likelihood of multifocal epilepsy based on the number of unifocal seizures observed in the epilepsy monitoring unit (EMU). Patient records from the EMU at Massachusetts General Hospital (MGH) from 2012 to 2014 were assessed for the presence of multifocal seizures as well the presence of multifocal interictal discharges and multifocal structural imaging abnormalities during the course of the EMU admission. Risk factors for multifocal seizures were assessed using sensitivity and specificity analysis. A Kaplan-Meier survival analysis was used to estimate the risk of multifocal epilepsy for a given number of consecutive seizures. To overcome the limits of the Kaplan-Meier analysis, a parametric survival function was fit to the EMU subjects with multifocal seizures and this was used to develop a Bayesian model to estimate the risk of multifocal seizures during an EMU admission. Multifocal interictal discharges were a significant predictor of multifocal seizures within an EMU admission with a p < 0.01, albeit with only modest sensitivity 0.74 and specificity 0.69. Multifocal potentially epileptogenic lesions on MRI were not a significant predictor p = 0.44. Kaplan-Meier analysis was limited by wide confidence intervals secondary to significant patient dropout and concern for informative censoring. The Bayesian framework provided estimates for the number of unifocal seizures needed to predict absence of multifocal seizures. To achieve 90% confidence for the absence of multifocal seizure, three seizures are needed when the pretest probability for multifocal epilepsy is 20%, seven seizures for a pretest probability of 50%, and nine seizures for a pretest probability of 80%. These results provide a framework to assist clinicians in determining the utility of trying to capture a specific number of seizures in EMU evaluations of candidates for epilepsy surgery. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

The number of seizures needed in the EMU

PubMed Central

Struck, Aaron F.; Cole, Andrew J.; Cash, Sydney S.; Westover, M. Brandon

2016-01-01

Summary Objective The purpose of this study was to develop a quantitative framework to estimate the likelihood of multifocal epilepsy based on the number of unifocal seizures observed in the epilepsy monitoring unit (EMU). Methods Patient records from the EMU at Massachusetts General Hospital (MGH) from 2012 to 2014 were assessed for the presence of multifocal seizures as well the presence of multifocal interictal discharges and multifocal structural imaging abnormalities during the course of the EMU admission. Risk factors for multifocal seizures were assessed using sensitivity and specificity analysis. A Kaplan-Meier survival analysis was used to estimate the risk of multifocal epilepsy for a given number of consecutive seizures. To overcome the limits of the Kaplan-Meier analysis, a parametric survival function was fit to the EMU subjects with multifocal seizures and this was used to develop a Bayesian model to estimate the risk of multifocal seizures during an EMU admission. Results Multifocal interictal discharges were a significant predictor of multifocal seizures within an EMU admission with a p < 0.01, albeit with only modest sensitivity 0.74 and specificity 0.69. Multifocal potentially epileptogenic lesions on MRI were not a significant predictor p = 0.44. Kaplan-Meier analysis was limited by wide confidence intervals secondary to significant patient dropout and concern for informative censoring. The Bayesian framework provided estimates for the number of unifocal seizures needed to predict absence of multifocal seizures. To achieve 90% confidence for the absence of multifocal seizure, three seizures are needed when the pretest probability for multifocal epilepsy is 20%, seven seizures for a pretest probability of 50%, and nine seizures for a pretest probability of 80%. Significance These results provide a framework to assist clinicians in determining the utility of trying to capture a specific number of seizures in EMU evaluations of candidates for epilepsy surgery. PMID:26222350

Correlating optical bench performance with clinical defocus curves in varifocal and trifocal intraocular lenses.

PubMed

Plaza-Puche, Ana B; Alió, Jorge L; MacRae, Scott; Zheleznyak, Len; Sala, Esperanza; Yoon, Geunyoung

2015-05-01

To investigate the correlations existing between a trifocal intraocular lens (IOL) and a varifocal IOL using the "ex vivo" optical bench through-focus image quality analysis and the clinical visual performance in real patients by study of the defocus curves. This prospective, consecutive, nonrandomized, comparative study included a total of 64 eyes of 42 patients. Three groups of eyes were differentiated according to the IOL implanted: 22 eyes implanted with the varifocal Lentis Mplus LS-313 IOL (Oculentis GmbH, Berlin, Germany); 22 eyes implanted with the trifocal FineVision IOL (Physiol, Liege, Belgium), and 20 eyes implanted with the monofocal Acrysof SA60AT IOL (Alcon Laboratories, Inc., Fort Worth, TX). Visual outcomes and defocus curve were evaluated postoperatively. Optical bench through-focus performance was quantified by computing an image quality metric and the cross-correlation coefficient between an unaberrated reference image and captured retinal images from a model eye with a 3.0-mm artificial pupil. Statistically significant differences among defocus curves of different IOLs were detected for the levels of defocus from -4.00 to -1.00 diopters (D) (P < .01). Significant correlations were found between the optical bench image quality metric results and logMAR visual acuity scale in all groups (Lentis Mplus group: r = -0.97, P < .01; FineVision group: r = -0.82, P < .01; Acrys of group: r = -0.99, P < .01). Linear predicting models were obtained. Significant correlations were found between logMAR visual acuity and image quality metric for the multifocal and monofocal IOLs analyzed. This finding enables surgeons to predict visual outcomes from the optical bench analysis. Copyright 2015, SLACK Incorporated.

Intraocular Lenses for the Treatment of Age-Related Cataracts

PubMed Central

2009-01-01

Executive Summary Objective The objective of the report is to examine the comparative effectiveness and cost-effectiveness of various intraocular lenses (IOLs) for the treatment of age-related cataracts. Clinical Need: Target Population and Condition A cataract is a hardening and clouding of the normally transparent crystalline lens that may result in a progressive loss of vision depending on its size, location and density. The condition is typically bilateral, seriously compromises visual acuity and contrast sensitivity and increases glare. Cataracts can also affect people at any age, however, they usually occur as a part of the natural aging process. The occurrence of cataracts increases with age from about 12% at age 50 years, to 60% at age 70. In general, approximately 50% of people 65 year of age or older have cataracts. Mild cataracts can be treated with a change in prescription glasses, while more serious symptoms are treated by surgical removal of the cataract and implantation of an IOL. In Ontario, the estimated prevalence of cataracts increased from 697,000 in 1992 to 947,000 in 2004 (35.9% increase, 2.4% annual increase). The number of cataract surgeries per 1,000 individuals at risk of cataract increased from 64.6 in 1992 to 140.4 in 1997 (61.9% increase, 10.1% annual increase) and continued to steadily increase to 115.7 in 2004 (10.7% increase, 5.2% increase per year). Description of Technology/Therapy IOLs are classified either as monofocal, multifocal, or accommodative. Traditionally, monofocal (i.e.. fixed focusing power) IOLs are available as replacement lenses but their implantation can cause a loss of the eye’s accommodative capability (which allows variable focusing). Patients thus usually require eyeglasses after surgery for reading and near vision tasks. Multifocal IOLs aim to improve near and distant vision and obviate the need for glasses. Potential disadvantages include reduced contrast sensitivity, halos around lights and glare. Accommodating IOLs are designed to move with ciliary body contraction during accommodation and, therefore, offer a continuous range of vision (i.e. near, intermediate and distant vision) without the need for glasses. Purported advantages over multifocal IOLs include the avoidance of haloes and no reduction in contrast sensitivity. Polymethyl methacrylate (PMMA) was the first material used in the fabrication of IOLs and has inherent ultraviolet blocking abilities. PMMA IOLs are inflexible, however, and require a larger incision for implantation compared with newer foldable silicone (hydrophobic) and acrylic (hydrophobic or hydrophilic) lenses. IOLs can be further sub-classified as being either aspheric or spheric, blue/violet filtered or non-filtered or 1- or 3-piece. Methods of Evidence-Based Analysis A literature search was conducted from January 2003 to January 2009 that included OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), The Cochrane Library, and the International Agency for Health Technology Assessment/Centre for Review and Dissemination. Inclusion Criteria Exclusion Criteria adult patients with age-related cataractssystematic reviews, randomized controlled trials (RCTs)primary outcomes: distance visual acuity (best corrected distance visual acuity), near visual acuity (best distance corrected near visual acuity)secondary outcomes: contrast sensitivity, depth of field, glare, quality of life, visual function, spectacle dependence, posterior capsule opacification. studies with fewer than 20 eyesIOLs for non-age related cataractsIOLs for presbyopiastudies with a mean follow-up <6monthsstudies reporting insufficient data for analysis Comparisons of Interest The primary comparison of interest was accommodative vs. multifocal vs. monofocal lenses. Secondary comparisons of interest included: tinted vs. non-tinted lenses aspheric vs. spheric lenses multipiece vs. single piece lenses biomaterial A (e.g. acrylic) vs. biomaterial B (e.g. silicone) lenses sharp vs. round edged lenses The quality of the studies was examined according to the GRADE Working Group criteria for grading quality of evidence for interventional procedures. Summary of Findings The conclusions of the systematic review of IOLs for age-related cataracts are summarized in Executive Summary Table 1. Considerations for the Ontario Health System Procedures for crystalline lens removal and IOL insertion are insured and listed in the Ontario Schedule of Benefits. If a particular lens is determined to be medically necessary for a patient, the cost of the lens is covered by the hospital budget. If the patient chooses a lens that has enhanced features, then the hospital may choose to charge an additional amount above the cost of the usual lens offered. An IOL manufacturer stated that monofocal lenses comprise approximately 95% of IOL sales in Ontario and premium lenses (e.g., multifocal/accomodative) consist of about 5% of IOL sales. A medical consultant stated that all types of lenses are currently being used in Ontario (e.g., multifocal, monofocal, accommodative, tinted, nontinted, spheric, and aspheric). Nonfoldable lenses, rarely used in routine cases, are primarily used for complicated cataract implantation situations. ES Table 1: Conclusions for the Systematic Review of IOLs for Age-Related Cataracts Comparison Conclusion GRADE Quality Multifocal vs. monofocal Objective OutcomesSignificant improvement in BDCUNVANo significant difference in BCDVAInconclusive evidence for contrast sensitivityInconclusive evidence for glareSubjective OutcomesInconclusive evidence for visual satisfactionSignificant increase in glare/halosSignificant increase in freedom from spectacles moderatemoderatelowvery lowlowlow/moderatelow/moderate Accommodative vs. multifocal/monofocal Inconclusive due to Insufficient limited evidence for any effectiveness outcome very low Hydrophilic acrylic vs. other materials (hydrophobic acrylic, silicone) Significant increase in PCO score Low Sharp edged compared to round edged Significant reduction in PCO score Low One piece compared to three piece No significant difference in PCO score low Hydrophobic acrylic compared to silicone No significant difference in PCO score moderate Aspherical modified prolate anterior surface compared to spherical No significant difference in VASignificant reduction in contrast sensitivity very lowvery low Blue light filtering compared to non blue-light filtering No significant difference in BCDVANo significant difference in contrast sensitivityNo significant difference in HRQL lowlowhigh/moderate BCDVA refers to best corrected distance visual acuity; BDCUNVA, best distance corrected unaided near visual acuity; HRQL, health related quality of life; PCO, posterior capsule opacification; VA, visual acuity. PMID:23074519

Extreme depth-of-field intraocular lenses

NASA Astrophysics Data System (ADS)

Baker, Kenneth M.

1996-05-01

A new technology brings the full aperture single vision pseudophakic eye's effective hyperfocal distance within the half-meter range. A modulated index IOL containing a subsurface zeroth order coherent microlenticular mosaic defined by an index gradient adds a normalizing function to the vergences or parallactic angles of incoming light rays subtended from field object points and redirects them, in the case of near-field images, to that of far-field images. Along with a scalar reduction of the IOL's linear focal range, this results in an extreme depth of field with a narrow depth of focus and avoids the focal split-up, halo, and inherent reduction in contrast of multifocal IOLs. A high microlenticular spatial frequency, which, while still retaining an anisotropic medium, results in a nearly total zeroth order propagation throughout the visible spectrum. The curved lens surfaces still provide most of the refractive power of the IOL, and the unique holographic fabrication technology is especially suitable not only for IOLs but also for contact lenses, artificial corneas, and miniature lens elements for cameras and other optical devices.

Evaluation of Hydroxychloroquine Retinopathy With Multifocal Electroretinography

PubMed Central

So, Scott C.; Hedges, Thomas R.; Schuman, Joel S.; Quireza, Maria Luz Amaro

2007-01-01

BACKGROUND AND OBJECTIVE To describe the changes revealed by multifocal electroretinography (ERG) in patients taking hydroxychloroquine. PATIENTS AND METHODS Six patients being treated for various inflammatory conditions with hydroxychloroquine for periods ranging from 8 months to 7 years were consecutively evaluated. Each examination included measurement of Snellen visual acuities, Amsler grid assessment, and automated visual field testing. In some cases, funduscopic examinations were complimented by photography and fluorescein angiography. Multifocal ERG was performed for all patients. RESULTS Three patients (six eyes) were found to have distinctive abnormalities on multifocal ERG consisting of pericentral depression of ERG signals. The abnormalities on multifocal ERG corresponded with the patients’ subjective descriptions and the visual field depiction of their pericentral scotomas. All affected patients had been taking hydroxychloroquine for at least 7 years. One patient with generalized depression on multifocal ERG had possible hydroxychloroquine retinopathy. Two patients (three eyes) had relatively normal results on multifocal ERG. CONCLUSION Multifocal ERG objectively demonstrates depression of signals in the perifoveal region in visually symptomatic patients with long-term hydroxychloroquine use. Even patients with normal visual acuity and no fundus abnormalities can have abnormal results. Although we have not yet identified patients with abnormalities on multifocal ERG before the onset of symptoms, multifocal ERG may be useful in monitoring patients at risk and may provide an earlier opportunity to identify maculopathy. PMID:12757106

Characterisation of multifocal breast cancer using the 70-gene signature in clinical low-risk patients enrolled in the EORTC 10041/BIG 03-04 MINDACT trial.

PubMed

Aalders, K C; Kuijer, A; Straver, M E; Slaets, L; Litiere, S; Viale, G; Van't Veer, L J; Glas, A M; Delorenzi, M; van Dalen, T; Tryfonidis, K; Piccart, M J; Cardoso, F; Rutgers, E J

2017-07-01

In multifocal breast cancer, guidelines recommend basing adjuvant systemic treatment decisions on characteristics of the largest lesion, disregarding multifocality as an independent prognosticator. We assessed the association between multifocal disease and both the 70-gene signature (70-GS), and distant metastasis-free survival (DMFS) in clinical low-risk breast cancer patients enrolled in the European Organisation for Research and Treatment of Cancer 10041/BIG 03-04 Microarray In Node-negative and 1 to 3 positive lymph node Disease may Avoid ChemoTherapy (MINDACT) trial. The analysed population consisted of enrolled patients in the MINDACT trial with clinical low-risk disease, defined by a modified Adjuvant! Online cut-off for the 10-year risk of recurrent disease or death. Eligibility criteria of MINDACT dictate that patients with multifocal disease could be included if the different lesions had similar pathological characteristics. The presence of multifocal disease was deducted from the case report form (CRF)-question for sum of diameter for all invasive tumour foci. Clinicopathological characteristics and gene expression of patients with unifocal and multifocal (largest lesion) disease were compared. Subsequently, the association between multifocal disease and the 70-GS was evaluated as well as the association between multifocality and 5-year DMFS. The study included 3090 clinical low-risk patients with unifocal and 238 patients with multifocal disease. Apart from a higher prevalence of lobular tumours (21.8% versus 10.8%, by local pathology), we did not observe differences in baseline characteristics between multifocal and unifocal tumours. Patients with multifocal tumours were more likely to be at high genomic risk as compared to patients with unifocal tumours (22.7% versus 17.3%, odds ratio [OR] 1.45, 95% confidence interval [CI] 1.02-2.07, P = 0.038). We did not find a significant association between tumour focality and DMFS (97.1% for unifocal versus 96.9% for multifocal, hazard ratio [HR] = 1.55, 95% CI 0.68-3.46, P = 0.172), nor a signal for a potential interaction between the prognostic effect of the 70-GS and focality of the tumour regarding DMFS. In the group of clinical low-risk MINDACT patients, multifocal tumours were more likely to have a high-risk 70-GS profile compared to unifocal tumours. We did not observe a significant interaction between multifocality and the 70-GS with respect to survival without distant metastasis in these patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

Comparison between bilateral implantation of a trifocal intraocular lens and blended implantation of two bifocal intraocular lenses

PubMed Central

Vilar, César; Hida, Wilson Takashi; de Medeiros, André Lins; Magalhães, Klayny Rafaella Pereira; de Moraes Tzelikis, Patrick Frensel; Chaves, Mario Augusto Pereira Dias; Motta, Antônio Francisco Pimenta; Carricondo, Pedro Carlos; Alves, Milton Ruiz; Nosé, Walton

2017-01-01

Purpose To compare visual outcomes and performance between bilateral implantation of a diffractive trifocal intraocular lens (IOL) Acrysof®PanOptix® TFNT00 and blended implantation of two different near add power bifocal IOLs: Acrysof® Restor® SV25T0 in dominant eye and Acrysof® Restor® SN6AD1 in the nondominant eye. Methods This prospective, nonrandomized, consecutive and comparative study assessed 20 patients (40 eyes) who had bilateral cataract surgery performed using the IOLs described. Patients were divided into groups, bilateral trifocal implant and blended implant. Evaluation included measurement of binocular uncorrected and corrected distance visual acuity at 4 m (UDVA, CDVA) and uncorrected intermediate (60 cm) and near (at 40 cm) visual acuity; contrast sensitivity (CS) and visual defocus curve. Results Postoperative CDVA comparison showed no statistical significance between groups. UDVA was significantly better in the trifocal groups. Under photopic conditions, the trifocal group had better CS in higher frequencies with and without glare. The binocular defocus curve demonstrated a trifocal behavior in both groups, with the bilateral trifocal group exhibiting better performance for intermediate vision. Conclusion Both lens combinations were able to provide good near, intermediate and distance vision, with the trifocal group showing significantly better performance at intermediate distances and better CS under photopic conditions. PMID:28814826

MULTIMODAL IMAGING OF SYPHILITIC MULTIFOCAL RETINITIS.

PubMed

Curi, Andre L; Sarraf, David; Cunningham, Emmett T

2015-01-01

To describe multimodal imaging of syphilitic multifocal retinitis. Observational case series. Two patients developed multifocal retinitis after treatment of unrecognized syphilitic uveitis with systemic corticosteroids in the absence of appropriate antibiotic therapy. Multimodal imaging localized the foci of retinitis within the retina in contrast to superficial retinal precipitates that accumulate on the surface of the retina in eyes with untreated syphilitic uveitis. Although the retinitis resolved after treatment with systemic penicillin in both cases, vision remained poor in the patient with multifocal retinitis involving the macula. Treatment of unrecognized syphilitic uveitis with corticosteroids in the absence of antitreponemal treatment can lead to the development of multifocal retinitis. Multimodal imaging, and optical coherence tomography in particular, can be used to distinguish multifocal retinitis from superficial retinal precipitates or accumulations.

Three-dimensional vectorial multifocal arrays created by pseudo-period encoding

NASA Astrophysics Data System (ADS)

Zeng, Tingting; Chang, Chenliang; Chen, Zhaozhong; Wang, Hui-Tian; Ding, Jianping

2018-06-01

Multifocal arrays have been attracting considerable attention recently owing to their potential applications in parallel optical tweezers, parallel single-molecule orientation determination, parallel recording and multifocal multiphoton microscopy. However, the generation of vectorial multifocal arrays with a tailorable structure and polarization state remains a great challenge, and reports on multifocal arrays have hitherto been restricted either to scalar focal spots without polarization versatility or to regular arrays with fixed spacing. In this work, we propose a specific pseudo-period encoding technique to create three-dimensional (3D) vectorial multifocal arrays with the ability to manipulate the position, polarization state and intensity of each focal spot. We experimentally validated the flexibility of our approach in the generation of 3D vectorial multiple spots with polarization multiplicity and position tunability.

[In Vitro Evaluation of the Optical Quality of Segmental Refractive Multifocal Intraocular Lenses].

PubMed

Yildirim, Timur Mert; Auffarth, Gerd Uwe; Tandogan, Tamer; Liebing, Stephanie; Labuz, Grzegorz; Choi, Chul Young; Khoramnia, Ramin

2017-11-08

In customised patient care, it is important to know the optical quality of different intraocular lenses (IOL). In this study, the optical quality of three segmental intraocular lenses were compared. The LENTIS Comfort LS-313 MF15, LENTIS Mplus X LS-313 MF30 and LENTIS High Add IOL LS-313 MF80 (Oculentis, Berlin, Germany) with a far power of + 21 D were analysed at the optical bench OptiSpheric IOL PRO (Trioptics GmbH, Wedel, Germany). The lenses have almost the same optical design but differ in the power of the near segment. The MF15 has a + 1.5 D addition to improve vision in intermediate distances, the MF30 has a near addition of + 3 D and the MF80 has a near addition of + 8 D. The modulation transfer function area (MTFa) and the Strehl ratio were examined for apertures of 3 mm (photopic) and 4.5 mm (mesopic). The MTFa values for the far focus are 33.34/30.80/51.53 (MF15/MF30/MF80) with an aperture of 3 mm and 25.38/22.52/43.15 for 4.5 mm. The MTFa values for the intermediate focus are 29.85/16.21/6.25 for a 3 mm aperture and 23.92/8.05/3.08 for 4.5 mm. The MTFa values for the near focus are 9.75/21.49/33.12 for an aperture of 3 mm and 4.95/22.70/31.68 for 4.5 mm. The Strehl ratio of the far focus is 0.34/0.30/0.52 for an aperture of 3 mm and 0.24/0.22/0.43 for 4.5 mm. For the intermediate focus, the Strehl ratio is 0.30/0.17/0.07 for an aperture of 3 mm and 0.24/0.08/0.03 for 4.5 mm. The Strehl ratio of the near focus is 0.10/0.22/0.33 for an aperture of 3 mm and 0.05/0.23/0.32 for 4.5 mm. We confirmed that the addition influences the optical quality of segmental bifocal intraocular lenses. For the far focus, the results of the MF15 and MF30 are similar. In intermediate distances, the MF15 achieves the best results. For near distances, the MF30 achieves better optical values than the MF15. The lens MF80, which has been designed for patients with maculopathies, achieves good results for far and near distances. Georg Thieme Verlag KG Stuttgart · New York.

A rare case of a medullary, multifocal lesion in the distal radius

PubMed Central

Aktas, Birol; Ozturan, Burak; Kilic, Bulent; Ozkan, Korhan

2017-01-01

In multifocal findings, the possibility of multifocal osteoid osteomas should be considered and this case helps us to be attentive for the unusual radiographical presentation of osteoid osteoma. PMID:28748099

Chorioretinal Lesions Presumed Secondary to Zika Virus Infection in an Immunocompromised Adult.

PubMed

Henry, Christopher R; Al-Attar, Luma; Cruz-Chacón, Alexis M; Davis, Janet L

2017-04-01

Zika virus has spread rapidly throughout the Americas since 2015. The public health implications of Zika virus infection lend special importance to identifying the virus in unsuspected hosts. To describe relevant imaging studies and clinical features of chorioretinal lesions that are presumably associated with Zika virus and that share analogous features with chorioretinal lesions reported in cases of Dengue fever and West Nile virus. This is a case report from an academic referral center in Miami, Florida, of a woman in her 60s from Guaynabo, Puerto Rico, who presented with reduced visual acuity and bilateral diffuse, subretinal, confluent, placoid, and multifocal chorioretinal lesions. The patient was observed over a 5-month period. Visual acuity, clinical course, and multimodal imaging study results. Fluorescein angiography revealed early hypofluorescence and late staining of the chorioretinal lesions. Optical coherence tomography demonstrated outer retinal disruption in the placoid macular lesions. Zika RNA was detected in a plasma sample by real-time reverse transcription polymerase chain reaction testing and was suspected to be the cause of chorioretinal lesions after other viral and infectious causes were ruled out. Three weeks after the onset of symptoms, the patient's visual acuity had improved to 20/60 OD and 20/25 OS, with intraocular pressures of 18 mm Hg OD and 19 mm Hg OS. In 6 weeks, the chorioretinal lesions had healed and visual acuity had improved to 20/25 OD and 20/20 OS. Follow-up optical coherence tomography demonstrated interval recovery of the outer retina and photoreceptors. Acute-onset, self-resolving, placoid, or multifocal nonnecrotizing chorioretinal lesions may be a feature of active Zika virus chorioretinitis, as reported in other Flavivirus infections in adults. Similar findings in potentially exposed adults suggest that clinicians should consider IgM antibody or polymerase chain reaction testing for Zika virus as well as diagnostic testing for Dengue fever and West Nile virus.

Multifocal interferometric synthetic aperture microscopy

PubMed Central

Xu, Yang; Chng, Xiong Kai Benjamin; Adie, Steven G.; Boppart, Stephen A.; Scott Carney, P.

2014-01-01

There is an inherent trade-off between transverse resolution and depth of field (DOF) in optical coherence tomography (OCT) which becomes a limiting factor for certain applications. Multifocal OCT and interferometric synthetic aperture microscopy (ISAM) each provide a distinct solution to the trade-off through modification to the experiment or via post-processing, respectively. In this paper, we have solved the inverse problem of multifocal OCT and present a general algorithm for combining multiple ISAM datasets. Multifocal ISAM (MISAM) uses a regularized combination of the resampled datasets to bring advantages of both multifocal OCT and ISAM to achieve optimal transverse resolution, extended effective DOF and improved signal-to-noise ratio. We present theory, simulation and experimental results. PMID:24977909

Direct laser interference patterning of ophthalmic polydimethylsiloxane (PDMS) polymers

NASA Astrophysics Data System (ADS)

Sola, D.; Lavieja, C.; Orera, A.; Clemente, M. J.

2018-07-01

The inscription of diffractive elements in ophthalmic polymers and ocular tissues to induce refractive index changes is of great interest in the fields of Optics and Ophthalmology. In this work fabrication of linear periodic patterns in polydimethylsiloxane (PDMS) intraocular lenses by means of the direct laser interference patterning (DLIP) technique was studied. A Q-Switch Nd:YAG laser coupled to second and third harmonic modules emitting linearly polarized 4 ns pulses at 355 nm with 20 Hz repetition rate was used as the laser source. Laser processing parameters were modified to produce the linear patterns. Processed samples were characterized by means of optical confocal microscopy, Scanning Electron Microscopy SEM, Energy Dispersive X-ray Spectroscopy EDX, Attenuated Total Reflectance-Infrared Spectroscopy ATR-FTIR, and Raman Spectroscopy. Depending on the laser parameters both photo-thermal and photo-chemical damage were observed in the DLIP irradiated areas. Finally, diffractive techniques were used to characterize the diffraction gratings inscribed in the samples resulting in a refractive index change of 1.9 × 10-2 under illumination of a 632.8 nm He-Ne laser.

Contactin-1 and Neurofascin-155/-186 Are Not Targets of Auto-Antibodies in Multifocal Motor Neuropathy.

PubMed

Doppler, Kathrin; Appeltshauser, Luise; Krämer, Heidrun H; Ng, Judy King Man; Meinl, Edgar; Villmann, Carmen; Brophy, Peter; Dib-Hajj, Sulayman D; Waxman, Stephen G; Weishaupt, Andreas; Sommer, Claudia

2015-01-01

Multifocal motor neuropathy is an immune mediated disease presenting with multifocal muscle weakness and conduction block. IgM auto-antibodies against the ganglioside GM1 are detectable in about 50% of the patients. Auto-antibodies against the paranodal proteins contactin-1 and neurofascin-155 and the nodal protein neurofascin-186 have been detected in subgroups of patients with chronic inflammatory demyelinating polyneuropathy. Recently, auto-antibodies against neurofascin-186 and gliomedin were described in more than 60% of patients with multifocal motor neuropathy. In the current study, we aimed to validate this finding, using a combination of different assays for auto-antibody detection. In addition we intended to detect further auto-antibodies against paranodal proteins, specifically contactin-1 and neurofascin-155 in multifocal motor neuropathy patients' sera. We analyzed sera of 33 patients with well-characterized multifocal motor neuropathy for IgM or IgG anti-contactin-1, anti-neurofascin-155 or -186 antibodies using enzyme-linked immunosorbent assay, binding assays with transfected human embryonic kidney 293 cells and murine teased fibers. We did not detect any IgM or IgG auto-antibodies against contactin-1, neurofascin-155 or -186 in any of our multifocal motor neuropathy patients. We conclude that auto-antibodies against contactin-1, neurofascin-155 and -186 do not play a relevant role in the pathogenesis in this cohort with multifocal motor neuropathy.

Multifocal necrotising fasciitis: an overlooked entity?

PubMed

El-Khani, Ussamah; Nehme, Jean; Darwish, Ammar; Jamnadas-Khoda, Benjamin; Scerri, Godwin; Heppell, Simon; Bennett, Nicholas

2012-04-01

The aim of the study is to report a case of multi-focal necrotising fasciitis, review research on this subject to identify common aetiological factors and highlight suggestions to improve management. Necrotising fasciitis is a severe, life-threatening soft tissue infection that typically arises from a single area, usually secondary to a minor penetrating injury. Multi-focal necrotising fasciitis, where there is more than one non-contiguous area of necrosis, is much less commonly reported. There are no guidelines specific to the management of multi-focal necrotising fasciitis, and its under-reporting may lead to missed management opportunities. A systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. A search of MEDLINE, OLD MEDLINE and the Cochrane Collaboration was performed from 1966 to March 2011 using 16 search terms. All articles were screened for genuine non-contiguous multi-focal necrotising fasciitis. Of the papers that met this criterion, data on patient demographics, likely inciting injury, presentation time-line, microbial agents, sites affected, objective assessment scores, treatment and outcome were extracted. A total of 31 studies met our inclusion criteria and 33 individual cases of multi-focal necrotising fasciitis were included in the quantitative analysis. About half (52%) of cases were type II necrotising fasciitis; 42% of cases had identifiable inciting injuries; 21% of cases developed multi-focal lesions non-synchronously, of which 86% were type II. Nearly all (94%) of cases had incomplete objective assessment scores. One case identified inflammatory imaging findings prior to clinical necrosis. Multifocality in necrotising fasciitis is likely to be associated with type II disease. We postulate that validated objective tools will aid necrotising fasciitis management pathways that will identify high-risk groups for multifocality and advise early pre-emptive imaging. We recommend the adoption of regional multi-focal necrotising fasciitis registers. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Radial optic neurotomy for ischaemic central vein occlusion

PubMed Central

Martínez-Jardón, C S; Meza-de Regil, A; Dalma-Weiszhausz, J; Leizaola-Fernández, C; Morales-Cantón, V; Guerrero-Naranjo, J L; Quiroz-Mercado, H

2005-01-01

Background/aims: Ischaemic central retinal vein occlusion (CRVO) accounts for 20–50% of all CRVO. No treatment has been proved to be effective. The efficacy of radial optic neurotomy (RON) was evaluated in eyes with ischaemic CRVO. Methods: 10 patients with ischaemic CRVO underwent RON. After pars plana vitrectomy, a microvitreoretinal blade was used to incise the scleral ring, cribriform plate, and adjacent sclera at the nasal edge of the optic disc. Best corrected visual acuity (BCVA), intraocular pressure (IOP), fluorescein angiography (FA), multifocal electroretinography (mfERG), and optical coherence tomography (OCT) were measured preoperatively and at 1, 3, and 6 months postoperatively. Results: No visual improvement was noted in the eyes that underwent RON. FA and mfERG showed no increase in retinal perfusion or retinal function postoperatively. Mean macular central thickness changed from 841 (SD 170) μm preoperatively to 162 (SD 34) μm at the sixth postoperative month. One patient had retinal central artery perforation intraoperatively. One patient developed neovascular glaucoma. Conclusion: RON in ischaemic CRVO did not improve visual function (by mfERG) or visual acuity although macular thickness did improve. This technique may be associated with potential risks. Randomised studies are needed to corroborate these results. PMID:15834084

Transient Retinal Dysfunctions after Acute Cannabis Use.

PubMed

Schwitzer, Thomas; Robert, Matthieu P; Giersch, Anne; Angioi-Duprez, Karine; Ingster-Moati, Isabelle; Pon-Monnier, Amandine; Schwan, Raymund; Laprevote, Vincent

2016-01-01

Although cannabis is very widespread worldwide, the impact of cannabis on visual function remains poorly understood. This is partly due to numerous difficulties met in developing clinical studies in cannabis users. Here, we report the first documented case of neuroretinal dysfunction after acute cannabis smoking. This observation was favored by the need of an annual ophthalmic evaluation in the context of a chloroquine intake for a systemic lupus erythematosus in a 47-year-old heavy cannabis user. A complete ophthalmic evaluation including visual acuity tests, intraocular pressure, fundoscopic examination, automated 10° central visual field, full-field electroretinogram (ERG) and multifocal ERG was performed twice - 30 min and 5 h after cannabis smoking. A strong decrease (up to 48%) in the a-wave amplitude of the full-field ERG was measured 30 min after cannabis smoking for all scotopic responses compared with the responses 5 h after smoking. Other tests showed reproducible results between the 2 series of measurements. This clinical case suggests that acute inhalation of cannabis affects the photoreceptors functioning. This rare situation suggests further investigations are required on the impact of cannabis on retinal processing, especially since cannabis has been incriminated in car injuries. © 2016 S. Karger AG, Basel.

[Multifocal visual electrophysiology in visual function evaluation].

PubMed

Peng, Shu-Ya; Chen, Jie-Min; Liu, Rui-Jue; Zhou, Shu; Liu, Dong-Mei; Xia, Wen-Tao

2013-08-01

Multifocal visual electrophysiology, consisting of multifocal electroretinography (mfERG) and multifocal visual evoked potential (mfVEP), can objectively evaluate retina function and retina-cortical conduction pathway status by stimulating many local retinal regions and obtaining each local response simultaneously. Having many advantages such as short testing time and high sensitivity, it has been widely used in clinical ophthalmology, especially in the diagnosis of retinal disease and glaucoma. It is a new objective technique in clinical forensic medicine involving visual function evaluation of ocular trauma in particular. This article summarizes the way of stimulation, the position of electrodes, the way of analysis, the visual function evaluation of mfERG and mfVEP, and discussed the value of multifocal visual electrophysiology in forensic medicine.

Multifocal lymphangioendotheliomatosis with devastating intracranial hemorrhage.

PubMed

Huang, Christina; Rizk, Elias; Iantosca, Mark; Zaenglein, Andrea L; Helm, Klaus F; Choudhary, Arabinda K; Dias, Mark S

2013-11-01

An in utero female was found to have a small hemorrhage at the foramen of Monro, hydrocephalus, and what was originally interpreted as a Dandy-Walker variant. At birth she had macrocephaly and numerous cutaneous, multifocal, red-pink blanchable macules. Postnatal MRI demonstrated a hemorrhagic soft-tissue mass involving the upper brainstem, thalamus, and basal ganglia most consistent with in utero complex multifocal intracranial hemorrhage. The skin lesions were thought to be consistent with multifocal lymphangioendotheliomatosis with thrombocytopenia (MLT). The size and location of the hemorrhage precluded operative intervention, although the hydrocephalus was treated with a ventricular shunt. The child continues to have severe developmental delays. Multifocal lymphangioendotheliomatosis with thrombocytopenia is a multifocal vascular disorder most commonly involving the skin and gastrointestinal tract. Intracranial hemorrhages are rare in this context. This case is the third reported instance of MLT with associated intracranial hemorrhage and the only case described in the neurosurgical literature. The authors review the presenting features and pathophysiology of this condition.

Programmable diffractive optical elements for extending the depth of focus in ophthalmic optics

NASA Astrophysics Data System (ADS)

Romero, Lenny A.; Millán, María. S.; Jaroszewicz, Zbigniew; Kołodziejczyk, Andrzej

2015-01-01

The depth of focus (DOF) defines the axial range of high lateral resolution in the image space for object position. Optical devices with a traditional lens system typically have a limited DOF. However, there are applications such as in ophthalmology, which require a large DOF in comparison to a traditional optical system, this is commonly known as extended DOF (EDOF). In this paper we explore Programmable Diffractive Optical Elements (PDOEs), with EDOF, as an alternative solution to visual impairments, especially presbyopia. These DOEs were written onto a reflective liquid cystal on silicon (LCoS) spatial light modulator (SLM). Several designs of the elements are analyzed: the Forward Logarithmic Axicon (FLAX), the Axilens (AXL), the Light sword Optical Element (LSOE), the Peacock Eye Optical Element (PE) and Double Peacock Eye Optical Element (DPE). These elements focus an incident plane wave into a segment of the optical axis. The performances of the PDOEs are compared with those of multifocal lenses. In all cases, we obtained the point spread function and the image of an extended object. The results are presented and discussed.

Multifocal systemic tuberculosis: the many faces of an old nemesis.

PubMed

Al-Tawfiq, Jaffar A

2007-04-01

Tuberculosis continues to be a major health problem, where an estimated 7-8 million new cases are diagnosed each year. Multifocal tuberculosis is characterized by the presence of large multifocal tuberculous areas in the same or different organs. Difficulty in diagnosis of multifocal tuberculosis and consideration of other diseases may lead to a delay in diagnosing this entity. Here the clinical features and characteristics of three patients with multifocal systemic tuberculosis are described. During the period of 1999-2005, a total of 128 confirmed cases of tuberculosis were identified. Three (2.3%) patients had multifocal systemic tuberculosis. The first case had involvement of the lung, psoas muscle, and the vertebral bodies. The second patient had multiple brain lesions with mediastinal and retroperitoneal lymphadenopathy. The third patient had multiple brain lesions, lymphadenopathy, and colonic lesions initially mimicking a metastatic disease. Mycobacterium tuberculosis was grown from pleural fluid in one patient and from lymph node biopsies in another patient. The third patient had histopathologic evidence of tuberculosis. All patients received standard anti-tuberculous treatment, resulting in a full recovery in two patients, while the third patient had residual weakness. Multifocal systemic tuberculosis may pose a diagnostic challenge and may occur in immunocompetent hosts, in whom this entity generally has a good outcome.

PRETEXT II-III multifocal hepatoblastoma: significance of resection of satellite lesions irrespective of their disappearance after chemotherapy.

PubMed

Qureshi, Sajid S; Bhagat, Monica; Kembhavi, Seema; Vora, Tushar; Ramadwar, Mukta; Talole, Sanjay

2015-06-01

To determine the outcomes of resection of satellite lesions in PRE-treatment Tumor EXTension (PRETEXT) II and III multifocal hepatoblastoma irrespective of their disappearance after chemotherapy. To compare the overall outcomes of multifocal and unifocal hepatoblastoma. Fourteen patients with PRETEXT II (n = 7) and III (n = 7) multifocal hepatoblastoma treated between April 2006 and July 2014 were analyzed and their outcomes were compared with PRETEXT II and III unifocal hepatoblastoma treated in the similar period. Satellite lesion or the affected segments with disappeared satellite lesions were resected in 11 patients. Amongst them, all relapses were distant except one in the liver. In contrast, two of three patients developed liver relapse when the affected segments were not resected. None of the patients receiving intensive chemotherapy based on SIOPEL-3 guidelines developed a relapse. The 3-year event-free and overall survival were 38.6 and 42.9% in multifocal hepatoblastoma and 86.4 and 92.4% in unifocal hepatoblastoma (p = 0.001). Multifocality (p = 0.002) and AFP >10,000 after induction chemotherapy significantly affected event-free survival (p = 0.01). Multifocal hepatoblastoma is associated with poor outcomes as compared to unifocal hepatoblastoma. These preliminary observations of relapse and the role of chemotherapy intensification deserve further study in a multicenter controlled trial setting.

Immediate sequential bilateral cataract surgery: A 5-year retrospective analysis of 2470 eyes from a tertiary care eye center in South India

PubMed Central

Ganesh, Sri; Brar, Sheetal; Sreenath, Rohit

2017-01-01

Purpose: The purpose of this study is to evaluate the safety and benefits of immediate sequential bilateral cataract surgery. Patients and Methods: Retrospective data analysis of patients who underwent immediate sequential bilateral phacoemulsification with foldable intraocular lens (IOL) implantation under topical anesthesia from January 2011 to September 2016 was performed. Patients with visually significant bilateral cataract within the axial length range of 21.0–26.5 mm were included in the study. Intraoperative and postoperative complications were evaluated. Results: Two thousand four hundred and seventy eyes from 1235 patients with a mean age of 68.34 years (range: 4–90 years) were analyzed. Best-corrected visual acuity improved from 0.40 ± 0.17 to 0.08 ± 0.10 (logarithm of the minimum angle of resolution). Nearly 92.05% eyes achieved a target postoperative refraction of ± 0.5 D spherical equivalent. Main complications observed were prolonged postoperative inflammation in 25% (n = 31), posterior capsular tears in 0.45% (n = 11), and unilateral cystoid macular edema in 0.08% (n = 2) eyes. No sight-threatening complications such as endophthalmitis, retinal detachment, corneal decompensation and intraocular hemorrhage occurred in any of the eyes. Out of the 288 (23.2%) patients who underwent bilateral multifocal IOL implantation, 23 patients (46 eyes) had femtolaser-assisted cataract surgery procedure. Two pediatric and one Downs syndrome patient underwent bilateral cataract surgery under general anesthesia and intravenous sedation, respectively. Conclusion: IBSCS may be considered as a preferred practice in eligible cases considering significant patient benefits such as early visual rehabilitation, time and cost-effectiveness, and better compliance with postoperative medications. In debilitated patients and special situations, such as pediatric cataract and Downs syndrome requiring general anesthesia it may be the ideal procedure. PMID:28573990

Re-evaluating the concept of "dominant/index tumor nodule" in multifocal prostate cancer.

PubMed

Huang, Cheng Cheng; Deng, Fang-Ming; Kong, Max X; Ren, Qinhu; Melamed, Jonathan; Zhou, Ming

2014-05-01

Prostate cancer (PCa) often presents as a multifocal disease with heterogeneity in Gleason score (GS) and genetic alterations. Dominant/index tumor nodule (DN), the largest nodule in a multifocal disease, is presumed to harbor the most aggressive biological behavior and therefore dictate the overall clinical behavior of PCa. In this study, we examined the pathological features of DN and re-evaluated the validity of the "DN" concept in multifocal PCa. A total of 201 consecutive radical prostatectomy specimens were totally submitted and examined. All independent cancer foci were recorded with prognostically important pathological parameters. Unifocal and multifocal disease was present in 25 (12.4 %) and 176 (87.6 %) cases, respectively. In 20 (11.3 %) multifocal cases, the highest GS, the largest tumor volume (TV), and extraprostatic extension (EPE) did not concur in the same tumor nodules. Non-DNs had a higher GS and EPE in 13 cases each and had both the highest GS and EPE in 5 cases. In the majority of multifocal prostate cancer (88.7 %), DNs have the highest GS and EPE. In these cases, DN is still a valid concept and can be used for assigning overall GS and procuring tissue for research. However, in a significant number of cases (11.3 %), the largest TV, the highest GS, and EPE did not concur in the same tumor nodules. In these cases, pathologists should de-emphasize the concept of DN. Instead, they should place the emphasis on the multifocal nature of the disease and document the pathological features of all independent tumor foci that have the largest TV, the highest GS, and EPE.

Taxonomy of multi-focal nematode image stacks by a CNN based image fusion approach.

PubMed

Liu, Min; Wang, Xueping; Zhang, Hongzhong

2018-03-01

In the biomedical field, digital multi-focal images are very important for documentation and communication of specimen data, because the morphological information for a transparent specimen can be captured in form of a stack of high-quality images. Given biomedical image stacks containing multi-focal images, how to efficiently extract effective features from all layers to classify the image stacks is still an open question. We present to use a deep convolutional neural network (CNN) image fusion based multilinear approach for the taxonomy of multi-focal image stacks. A deep CNN based image fusion technique is used to combine relevant information of multi-focal images within a given image stack into a single image, which is more informative and complete than any single image in the given stack. Besides, multi-focal images within a stack are fused along 3 orthogonal directions, and multiple features extracted from the fused images along different directions are combined by canonical correlation analysis (CCA). Because multi-focal image stacks represent the effect of different factors - texture, shape, different instances within the same class and different classes of objects, we embed the deep CNN based image fusion method within a multilinear framework to propose an image fusion based multilinear classifier. The experimental results on nematode multi-focal image stacks demonstrated that the deep CNN image fusion based multilinear classifier can reach a higher classification rate (95.7%) than that by the previous multilinear based approach (88.7%), even we only use the texture feature instead of the combination of texture and shape features as in the previous work. The proposed deep CNN image fusion based multilinear approach shows great potential in building an automated nematode taxonomy system for nematologists. It is effective to classify multi-focal image stacks. Copyright © 2018 Elsevier B.V. All rights reserved.

Multifocality and Bilaterality of Papillary Thyroid Microcarcinoma

PubMed Central

So, Yoon Kyoung; Kim, Myung Woo

2015-01-01

Objectives Papillary thyroid carcinomas frequently occur as two or more separate foci within the thyroid gland (18%-87%). However, those multifocal tumors are easy to be undetected by preoperative radiologic evaluations, which lead to remnant disease after initial surgery. We aimed to study the incidence of multifocal papillary thyroid microcarcinomas (PTMCs), diagnostic accuracy of preoperative radiologic evaluation, predictive factors, and the chance of bilateral tumors. Methods Two hundred and seventy-seven patients with PTMC were included in this study. All patients underwent total thyroidectomy as an initial treatment. Medical records, pathologic reports, and radiological reports were reviewed for analysis. Results Multifocal PTMCs were detected in 100 of 277 patients (36.1%). The mean number of tumors in each patient was 1.6±1.1, ranging from 1 to 10. The additional tumor foci were significantly smaller (0.32±0.18 cm) than the primary tumors (0.63±0.22 cm) (P<0.001). There was no significant relationship between primary tumor size and the presence of contralateral tumors. With more tumors detected in one lobe, there was greater chance of contralateral tumors; 18.8% with single tumor focus, 30.2% with 2 tumor foci, and 46.2% with 3 or more tumor foci in one lobe. Sensitivity of preoperative sonography was 42.7% for multifocal tumors and 49.0% for bilateral tumors. With multivariate analysis, nodular hyperplasia was the only significant factor for multifocal tumors. Conclusion In cases of PTMCs, the incidence of multifocal tumors is high. However, additional tumor foci are too small to be diagnosed preoperatively, especially under the recent guidelines on radiologic screening tests for papillary thyroid carcinoma. Multifocal PTMCs have high risk of bilateral tumors, necessitating more extensive surgery or more thorough follow-up. PMID:26045918

Metachronous multifocal myxoid liposarcoma involving the gastrointestinal tract. Management and literature review.

PubMed

Salemis, Nikolaos S; Seretis, Charalambos; Seretis, Fotios; Christofyllakis, Charalambos; Karalis, Georgios

2014-01-01

Multifocal soft tissue sarcoma is a rare clinical entity occurring in 1% of patients with extremity soft tissue sarcoma and in 4.5% of patients with liposarcoma. Multifocal disease may arise either synchronously or metachronously and has been associated with poor prognosis. Herein, we have described a rare case of metachronous multifocal myxoid liposarcoma involving the gastrointestinal tract that developed 14 months after the resection of a myxoid buttock liposarcoma. Diagnostic evaluation and management of the patient are discussed along with a review of the relevant literature. We conclude that multifocal myxoid liposarcoma is a rare clinical entity that usually represents metastatic disease with poor prognosis. A thorough imaging and careful physical examination are essential in the preoperative evaluation and postoperative follow-up of patients with myxoid extremity liposarcomas, as these tumors are known to have a tendency to spread toward extrapulmonary sites, frequently without pulmonary metastases.

Metachronous multifocal myxoid liposarcoma involving the gastrointestinal tract. Management and literature review

PubMed Central

Salemis, Nikolaos S.; Seretis, Charalambos; Seretis, Fotios; Christofyllakis, Charalambos; Karalis, Georgios

2014-01-01

Multifocal soft tissue sarcoma is a rare clinical entity occurring in 1% of patients with extremity soft tissue sarcoma and in 4.5% of patients with liposarcoma. Multifocal disease may arise either synchronously or metachronously and has been associated with poor prognosis. Herein, we have described a rare case of metachronous multifocal myxoid liposarcoma involving the gastrointestinal tract that developed 14 months after the resection of a myxoid buttock liposarcoma. Diagnostic evaluation and management of the patient are discussed along with a review of the relevant literature. We conclude that multifocal myxoid liposarcoma is a rare clinical entity that usually represents metastatic disease with poor prognosis. A thorough imaging and careful physical examination are essential in the preoperative evaluation and postoperative follow-up of patients with myxoid extremity liposarcomas, as these tumors are known to have a tendency to spread toward extrapulmonary sites, frequently without pulmonary metastases. PMID:24678225

Multifocal sensory demyelinating neuropathy: Report of a case.

PubMed

Oh, Shin J

2017-10-01

Multifocal sensory demyelinating neuropathy has not been adequately reported in the literature. A 42-year-old man with numbness of the left hand for 3 years and of the right hand for 6 months had a pure multifocal sensory neuropathy involving both hands, most prominently affecting 2-point discrimination, number writing, and object recognition of the left hand. Near-nerve needle sensory and mixed nerve conduction studies were performed on the left ulnar nerve. Studies of the left ulnar nerve documented a demyelinating neuropathy characterized by temporal dispersion and marked decrease in the amplitudes of the sensory and mixed compound nerve potentials in the above-elbow-axilla segment. With intravenous immunoglobulin treatment, there was improvement in his neuropathic condition. In this study I describe a case of multifocal sensory demyelinating neuropathy as a counterpart of multifocal motor neuropathy. Muscle Nerve 56: 825-828, 2017. © 2016 Wiley Periodicals, Inc.

MULTIFOCAL CHOROIDITIS IN DISSEMINATED SPOROTRICHOSIS IN PATIENTS WITH HIV/AIDS.

PubMed

Biancardi, Ana L; Freitas, Dayvison F S; Valviesse, Vitor R G de A; Andrade, Hugo B; de Oliveira, Manoel M E; do Valle, Antonio C F; Zancope-Oliveira, Rosely M; Galhardo, Maria C G; Curi, Andre L L

2017-01-01

In this article, the authors describe multifocal choroiditis related to disseminated sporotrichosis in patients with HIV/AIDS. We conducted a retrospective observational study of three patients infected with HIV who presented with disseminated sporotrichosis characterized by cutaneous lesions, multifocal choroiditis, and other manifestations, including osteomyelitis and involvement of the bone marrow, larynx, pharynx, and nasal and oral mucosa. Five eyes of three patients with HIV/AIDS showed multifocal choroiditis related to disseminated sporotrichosis. The CD4 counts ranged from 25 to 53 mm. All patients were asymptomatic visually. The ocular disease was bilateral in two patients. The lesion size ranged from 1/3 to 2 disc diameters. None of the patients had vitritis. Of the 12 lesions, 9 were localized in the posterior pole (Zone 1) and 3 were localized in the mild periphery (Zone 2). Multifocal choroiditis due to disseminated sporotrichosis can occur in profoundly immunosuppressed patients with HIV/AIDS.

The multifocal electroretinogram in X-linked juvenile retinoschisis.

PubMed

Huang, Shizhou; Wu, Dezheng; Jiang, Futian; Luo, Guangwei; Liang, Jiongji; Wen, Feng; Yu, Minzhong; Long, Shixian; Wu, Lezheng

2003-05-01

To measure and compare the multifocal electroretinography in normal control and X-linked juvenile retinoschisis, 13 cases (13 right eyes) of normal control and nine cases (17 eyes) of X-linked juvenile retinoschisis were measured with VERIS Science 4.0. Four cases (eight eyes) out of the nine retinoschisis cases were tested with Ganzfeld ERG at the same day. The results showed statistically significant difference of average response densities and latencies in six ring retinal regions between the normal control and retinoschisis. The trace array and 3-D topography of multifocal ERG showed multi-area amplitude decrease with absence or reduction of central peak amplitude in patients with retinoschisis. The P1/N1 ratio of multifocal ERG average response densities in six ring retinal regions was different from the b/a ratio of Ganzfeld ERG. The multifocal ERG and Ganzfeld ERG each had its advantage in the diagnosis of retinoschisis.

Multifocal Congenital Hemangiopericytoma.

PubMed

Robl, Renata; Carvalho, Vânia Oliveira; Abagge, Kerstin Taniguchi; Uber, Marjorie; Lichtvan, Leniza Costa Lima; Werner, Betina; Mehrdad Nadji, Mehrdad

2017-01-01

Congenital hemangiopericytoma (HPC) is a rare mesenchymal tumor with less aggressive behavior and a more favorable prognosis than similar tumors in adults. Multifocal presentation is even less common than isolated HPC and hence its clinical and histologic recognition may be challenging. A newborn infant with multifocal congenital HPC causing severe deformity but with a favorable outcome after chemotherapy and surgical removal is reported. © 2016 Wiley Periodicals, Inc.

MULTIFOCAL RETINAL INFILTRATES WITH PHLEBITIS AND OPTIC NEUROPATHY IN AN HIV-POSITIVE PEDIATRIC PATIENT.

PubMed

Kasi, Sundeep K; Vora, Robin A; Martin, Taliva; Cunningham, Emmett T

2015-01-01

To describe an unusual presentation of bilateral HIV-associated multifocal retinal infiltrates with phlebitis and optic neuropathy in a pediatric patient from Zimbabwe, Africa. Retrospective case report of a 15-year-old boy from Zimbabwe, Africa. The patient was found to have bilateral vitritis, multifocal retinitis with phlebitis, and optic neuropathy in the setting of previously unrecognized HIV infection. Vision improved and the clinical findings resolved after treatment with intravenous corticosteroids and highly active retroviral therapy (HAART). The authors describe the occurrence and treatment of bilateral, HIV-associated multifocal retinal infiltrates with phlebitis and HIV-associated optic neuropathy in a pediatric patient from Zimbabwe, Africa.

Prevalence of Multifocal Primary Hyperhidrosis and Symptom Severity Over Time: Results of a Targeted Survey.

PubMed

Glaser, Dee Anna; Ballard, Angela M; Hunt, Niquette L; Pieretti, Lisa J; Pariser, David M

2016-12-01

There is a paucity of data on the prevalence of multifocal primary hyperhidrosis and changes in hyperhidrosis severity over time. The goal of this study was to better understand multifocal primary hyperhidrosis, prevalence and distribution of hyperhidrosis by focal site, age of onset of symptoms by focal area, and change in hyperhidrosis severity over time and with seasons. The International Hyperhidrosis Society, through an unrestricted research grant from Revance Therapeutics, conducted an online survey of registered visitors to its Web site. Participants identified as having "excessive sweating" and opted to participate in the survey (23 questions) after an e-mail invitation. The survey data illustrate that multifocal primary hyperhidrosis is more common than previously believed and that multifocal hyperhidrosis is more common than singular focal hyperhidrosis (81% of patients reported 3 or more focal hyperhidrotic sites). The data also show that sweating symptom severity does not improve with age but stays the same or gets worse and is "bothersome" throughout the year. Recognition of the chronic and multifocal nature of primary hyperhidrosis is useful for treating hyperhidrosis patients long term and illustrates a need for treatments or treatment combinations that are effective for multiple body areas.

Adjuvant Sunitinib or Valproic Acid in High-Risk Patients With Uveal Melanoma

ClinicalTrials.gov

2017-10-25

Ciliary Body and Choroid Melanoma, Medium/Large Size; Ciliary Body and Choroid Melanoma, Small Size; Iris Melanoma; Stage I Intraocular Melanoma; Stage IIA Intraocular Melanoma; Stage IIB Intraocular Melanoma; Stage IIIA Intraocular Melanoma; Stage IIIB Intraocular Melanoma; Stage IIIC Intraocular Melanoma

Is multifocality a prognostic factor in childhood hepatoblastoma?

PubMed

Saettini, Francesco; Conter, Valentino; Provenzi, Massimo; Rota, Matteo; Giraldi, Eugenia; Foglia, Carlo; Cavalleri, Laura; D'Antiga, Lorenzo

2014-09-01

The aim of this study was to assess the prognostic value of multifocality and the effectiveness of two different therapeutic strategies in patients with newly diagnosed hepatoblastoma. Between 1998 and 2011, 31 patients diagnosed with hepatoblastoma were referred to Ospedale Papa Giovanni XXIII, Bergamo, Italy. Patients were stratified according to SIOPEL protocols into high-risk (HR if AFP <100 ng/mL and/or PRETEXT IV and/or vascular invasion and/or extra-hepatic intra-abdominal disease and/or metastases) and standard-risk (SR, all others). The patient data we evaluated were: multifocality; patient age; gender; platelet count; AFP level at diagnosis, during treatment and follow-up; histotype; gestational age; birth weight; surgery (either resection or transplantation) and chemotherapy regimen adopted before and after surgery. The outcome measures were event free survival (EFS) and overall survival (OS); survival curves were estimated according to Kaplan-Meier. EFS and OS were associated significantly with multifocality (3-year EFS 40% vs. 95%, P = 0.006; 3-year OS 42% vs. 95%, P = 0.004). Multivariate analysis demonstrated that multifocality predicts lower EFS (hazard ratio 10.01, P = 0.007). Other factors at diagnosis did not reach statistical significance. A marked treatment dependent improvement was associated with intensive chemotherapy given both before and after liver transplantation (P = 0.06). Patients diagnosed with multifocal tumors had lower EFS levels. Multifocality should be taken into account for future stratification and further studied to assess genetic profile, immunochemistry and prognostic role. © 2014 Wiley Periodicals, Inc.

Axitinib in Treating Patients With Melanoma That is Metastatic or Cannot Be Removed by Surgery

ClinicalTrials.gov

2018-05-08

Extraocular Extension Melanoma; Metastatic Intraocular Melanoma; Recurrent Intraocular Melanoma; Recurrent Melanoma; Stage IIIA Intraocular Melanoma; Stage IIIA Melanoma; Stage IIIB Intraocular Melanoma; Stage IIIB Melanoma; Stage IIIC Intraocular Melanoma; Stage IIIC Melanoma; Stage IV Intraocular Melanoma; Stage IV Melanoma

Double peacock eye optical element for extended focal depth imaging with ophthalmic applications.

PubMed

Romero, Lenny A; Millán, María S; Jaroszewicz, Zbigniew; Kolodziejczyk, Andrzej

2012-04-01

The aged human eye is commonly affected by presbyopia, and therefore, it gradually loses its capability to form images of objects placed at different distances. Extended depth of focus (EDOF) imaging elements can overcome this inability, despite the introduction of a certain amount of aberration. This paper evaluates the EDOF imaging performance of the so-called peacock eye phase diffractive element, which focuses an incident plane wave into a segment of the optical axis and explores the element's potential use for ophthalmic presbyopia compensation optics. Two designs of the element are analyzed: the single peacock eye, which produces one focal segment along the axis, and the double peacock eye, which is a spatially multiplexed element that produces two focal segments with partial overlapping along the axis. The performances of the peacock eye elements are compared with those of multifocal lenses through numerical simulations as well as optical experiments in the image space. The results demonstrate that the peacock eye elements form sharper images along the focal segment than the multifocal lenses and, therefore, are more suitable for presbyopia compensation. The extreme points of the depth of field in the object space, which represent the remote and the near object points, have been experimentally obtained for both the single and the double peacock eye optical elements. The double peacock eye element has better imaging quality for relatively short and intermediate distances than the single peacock eye, whereas the latter seems better for far distance vision.

TUBULOINTERSTITIAL NEPHRITIS AND UVEITIS SYNDROME WITH A PRIMARY PRESENTATION OF ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY.

PubMed

Lee, Andrew R; Sharma, Sumit; Mahmoud, Tamer H

2017-01-01

To report a case of tubulointerstitial nephritis and uveitis syndrome with a primary presentation of acute posterior multifocal placoid pigment epitheliopathy after use of lamotrigine. Retrospective case report with ultra-widefield fundus imaging, optical coherence tomography, and fluorescein angiography. A 19-year-old woman presented with decreased visual acuity and acute renal failure after starting lamotrigine. Her examination demonstrated 1+ anterior chamber cell and numerous white deep retinal plaque-like lesions predominantly in the macula in both eyes. After extensive ophthalmic and systemic evaluation, the patient was diagnosed with tubulointerstitial nephritis and uveitis syndrome with a primary presentation of acute posterior multifocal placoid pigment epitheliopathy. She had excellent visual recovery with topical and systemic steroids. Acute posterior multifocal placoid pigment epitheliopathy is a rare but important clinical presentation of tubulointerstitial nephritis and uveitis syndrome. Oral corticosteroid treatment can be considered for tubulointerstitial nephritis but is generally not necessary for acute posterior multifocal placoid pigment epitheliopathy.

What Is the Risk of Progressive Multifocal Leukoencephalopathy in Patients With Ulcerative Colitis or Crohn's Disease Treated With Vedolizumab?

PubMed

Card, Timothy; Xu, Jing; Liang, Huifang; Bhayat, Fatima

2018-04-23

Progressive multifocal leukoencephalopathy is a serious condition linked to certain diseases and immunosuppressant therapies, including the α4 integrin antagonist natalizumab. No cases have been reported to date with vedolizumab, a selective antagonist of the α4β7 integrin expressed on gut-homing lymphocytes. This analysis aimed to describe the current and future expected occurrence of progressive multifocal leukoencephalopathy with vedolizumab use, were the risk the same as in other populations in which this disease has been studied. The expected number of vedolizumab-associated progressive multifocal leukoencephalopathy cases was estimated up to May 19, 2016, and modeled up to 2034. These estimates were based on the cumulative exposure to the drug, assuming an equivalent risk to that of patients treated with natalizumab or those from other reference populations where progressive multifocal leukoencephalopathy has been examined. Future cases were modeled based on similar risks and projected sales. The cumulative vedolizumab exposure was estimated at 54,619 patient-years, with a 95% confidence interval of 0.0 to 6.75 cases per 100,000 patient-years. An estimated 30.2 (95% confidence interval, 19.4-40.9) cases of progressive multifocal leukoencephalopathy would have occurred if vedolizumab had the same risk as that of natalizumab. There would be a 50% chance of the first case occurring by 2018, assuming an equivalent risk to the general population. These analyses indicate that the risk of progressive multifocal leukoencephalopathy with vedolizumab is small, and unlikely to be above 6.75 cases per 100,000 patient-years.

Vaccine Therapy in Treating Patients With Stage IIC-IV Melanoma

ClinicalTrials.gov

2014-05-20

Ciliary Body and Choroid Melanoma, Medium/Large Size; Ciliary Body and Choroid Melanoma, Small Size; Extraocular Extension Melanoma; Iris Melanoma; Metastatic Intraocular Melanoma; Mucosal Melanoma; Recurrent Intraocular Melanoma; Recurrent Melanoma; Stage IIC Melanoma; Stage IIIA Intraocular Melanoma; Stage IIIA Melanoma; Stage IIIB Intraocular Melanoma; Stage IIIB Melanoma; Stage IIIC Intraocular Melanoma; Stage IIIC Melanoma; Stage IV Intraocular Melanoma; Stage IV Melanoma

First in vivo animal studies on intraocular nanosurgery and multiphoton tomography with low-energy 80-MHz near-infrared femtosecond laser pulses

NASA Astrophysics Data System (ADS)

Konig, Karsten; Wang, Bagui; Krauss, Oliver; Riemann, Iris; Schubert, Harald; Kirste, Sigrun; Fischer, Peter

2004-07-01

We report on a method for refractive laser surgery based on low-energy femtosecond laser pulses provided by ultracompact turn-key non-amplified laser systems. An additional excimer laser is not required for ablation of the stroma. The novel method has the potential to be used for (i) optical flap creation as well as stroma ablation and (ii) for non-invasive flap-free intrastromal ablation. In addition, 3D multiphoton imaging of the cornea can be performed. In particular, we used sub-nanojoule near infrared 80 MHz femtosecond laser pulses for multiphoton imaging of corneal structures with ultrahigh resolution (< 1μm) as well as for highly precise intraocular refractive surgery. Imaging based on two-photon excited cellular autofluorescence and SHG formation in collagen structures was performed at GW/cm2 intensities, whereas destructive optical breakdown for nanoprocessing occurred at TW/cm2 light intensities. These high intensities were realized with sub-nJ pulses within a subfemtoliter intrastromal volume by diffraction-limited focussing with high NA objectives and beam scanning 50 to 140 μm below the epithelial surface. Multiphoton tomography of the cornea was used to determine the target of interest and to visualize intraocular post-laser effects. Histological examination with light- and electron microscopes of laser-exposed porcine and rabbit eyes reveal a minimum intratissue cut size below 1 μm without destructive effects to surrounding collagen structures. LASIK flaps and intracorneal cavities could be realized with high precision using 200 fs, 80 MHz, sub-nanojoule pulses at 800 nm. First studies on 80 MHz femtosecond laser surgery on living rabbits have been performed.

[Correlation of intraocular pressure variation after visual field examination with 24-hour intraocular pressure variations in primary open-angle glaucoma].

PubMed

Noro, Takahiko; Nakamoto, Kenji; Sato, Makoto; Yasuda, Noriko; Ito, Yoshinori; Ogawa, Shumpei; Nakano, Tadashi; Tsuneoka, Hiroshi

2014-10-01

We retrospectively examined intraocular pressure variations after visual field examination in primary open angle glaucoma (POAG), together with its influencing factors and its association with 24-hour intraocular pressure variations. Subjects were 94 eyes (52 POAG patients) subjected to measurements of 24-hour intraocular pressure and of changes in intraocular pressure after visual field examination using a Humphrey Visual Field Analyzer. Subjects were classified into three groups according to the magnitude of variation (large, intermediate and small), and 24-hour intraocular pressure variations were compared among the three groups. Factors influencing intraocular pressure variations after visual field examination and those associated with the large variation group were investigated. Average intraocular pressure variation after visual field examination was -0.28 ± 1.90 (range - 6.0(-) + 5.0) mmHg. No significant influencing factors were identified. The intraocular pressure at 3 a.m. was significantly higher in the large variation group than other two groups (p < 0.001). Central corneal thickness was correlated with the large variation group (odds ratio = 1.04; 95% confidence interval, 1.01-1.07 ; p = 0.02). No particular tendencies in intraocular pressure variations were found after visual field examination. Increases in intraocular pressure during the night might be associated with large intraocular pressure variations after visual field examination.

Intraocular pressure reduction and regulation system

NASA Technical Reports Server (NTRS)

Baehr, E. F.; Burnett, J. E.; Felder, S. F.; Mcgannon, W. J.

1979-01-01

An intraocular pressure reduction and regulation system is described and data are presented covering performance in: (1) reducing intraocular pressure to a preselected value, (2) maintaining a set minimum intraocular pressure, and (3) reducing the dynamic increases in intraocular pressure resulting from external loads applied to the eye.

[Relevance of the sentinel lymph node biopsy in breast multifocal and multicentric cancer].

PubMed

Mosbah, R; Raimond, E; Pelissier, A; Hocedez, C; Graesslin, O

2015-05-01

The sentinel lymph node biopsy is a gold standard in the management of breast cancer. Its role in multifocal or multicentric tumors is still evolving. The aim of this study is to assess the feasibility and pertinence of sentinel lymph node biopsy in multifocal and multicentric tumors based on a systematic review of literature. A systematic review was conducted searching in the following electronic databases PubMed using "sentinel lymph node biopsy", "breast cancer", "multifocal tumor", "multicentric tumor" and "multiple tumor" as keywords. We included original articles published between 2000 and 2014, both French and English, studying feasibility of sentinel lymph node biopsy in invasive breast cancer, multicentric and/or multifocal tumors. The first end point was success rate and false negative rate. Twenty-six articles were included in this literature review, with 2212 cases (782 multifocal, 737 multicentric and 693 multiple tumors). Percentage of tumors whose stage was higher than stage T2 ranged from 0 to 86.3%. Success rate average was 83.1%. False negative average was 8.2%. False negative rate was less than 10% in 15 articles. Mean of sentinel lymph node biopsy was 2 (1-9). The average rate of sentinel lymph node positive was 50.6%. Axillary recurrence rate was 0.5%. Despite the methodological biases of the studies included in this review of literature, the false negative rate of sentinel node biopsy in multifocal and multicentric breast cancers are less than 10% with a low rate of axillary recurrence. Despite the lack of randomized study, this procedure can be routinely performed in accordance with rigorous technical process. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Visible light focusing flat lenses based on hybrid dielectric-metal metasurface reflector-arrays

PubMed Central

Fan, Qingbin; Huo, Pengcheng; Wang, Daopeng; Liang, Yuzhang; Yan, Feng; Xu, Ting

2017-01-01

Conventional metasurface reflector-arrays based on metallic resonant nanoantenna to control the wavefront of light for focusing always suffer from strong ohmic loss at optical frequencies. Here, we overcome this challenge by constructing a non-resonant, hybrid dielectric-metal configuration consisting of TiO2 nanofins associated with an Ag reflector substrate that provides a broadband response and high polarization conversion efficiency in the visible range. A reflective flat lens based on this configuration shows an excellent focusing performance with the spot size close to the diffraction limit. Furthermore, by employing the superimposed phase distribution design to manipulate the wavefront of the reflected light, various functionalities, such as multifocal and achromatic focusing, are demonstrated for the flat lenses. Such a reflective flat lens will find various applications in visible light imaging and sensing systems. PMID:28332611

Phakic Intraocular Lenses

MedlinePlus

... Implants and Prosthetics Phakic Intraocular Lenses Phakic Intraocular Lenses Share Tweet Linkedin Pin it More sharing options Linkedin Pin it Email Print Phakic intraocular lenses are new devices used to correct nearsightedness. These ...

Upper Extremity Multifocal Neuropathy in a 10-Year-Old Boy Associated With NS6S Disaccharide Antibodies.

PubMed

Edelman, Frederick; Naddaf, Elie; Waclawik, Andrew J

2015-06-01

We present a 10-year-old boy with a predominantly motor multifocal neuropathy with demyelinating and axonal changes with sensory involvement, affecting only one upper extremity. Laboratory studies revealed an elevated titer of immunoglobulin M (IgM) antibodies against the NS6S antigen. He responded to treatment with high dose intravenous immunoglobulins. Focal or multifocal immune-mediated neuropathies are not common in children and may be underdiagnosed. © The Author(s) 2014.

Intraocular (Eye) Melanoma—Health Professional Version

Cancer.gov

Intraocular (uveal) melanoma of the uveal tract (iris, ciliary body, and choroid), though rare, is the most common primary intraocular malignancy in adults. Find evidence-based information on intraocular melanoma treatment.

Case report: multifocal subchondral stress fractures of the femoral heads and tibial condyles in a young military recruit.

PubMed

Yoon, Pil Whan; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

2012-03-01

Subchondral stress fractures of the femoral head may be either of the insufficiency-type with poor quality bone or the fatigue-type with normal quality bone but subject to high repetitive stresses. Unlike osteonecrosis, multiple site involvement rarely has been reported for subchondral stress fractures. We describe a case of multifocal subchondral stress fractures involving femoral heads and medial tibial condyles bilaterally within 2 weeks. A 27-year-old military recruit began having left knee pain after 2 weeks of basic training, without any injury. Subsequently, right knee, right hip, and left hip pain developed sequentially within 2 weeks. The diagnosis of multifocal subchondral stress fracture was confirmed by plain radiographs and MR images. Nonoperative treatment of the subchondral stress fractures of both medial tibial condyles and the left uncollapsed femoral head resulted in resolution of symptoms. The collapsed right femoral head was treated with a fibular strut allograft to restore congruity and healed without further collapse. There has been one case report in which an insufficiency-type subchondral stress fracture of the femoral head and medial femoral condyle occurred within a 2-year interval. Because the incidence of bilateral subchondral stress fractures of the femoral head is low and multifocal involvement has not been reported, multifocal subchondral stress fractures can be confused with multifocal osteonecrosis. Our case shows that subchondral stress fractures can occur in multiple sites almost simultaneously.

Comparison of clinical outcomes and genomic characteristics of single focus and multifocal glioblastoma

PubMed Central

Paulsson, Anna K.; Holmes, Jordan A.; Peiffer, Ann M.; Miller, Lance D.; Liu, Wennuan; Xu, Jianfeng; Hinson, William H.; Lesser, Glenn J.; Laxton, Adrian W.; Tatter, Stephen B.; Debinski, Waldemar

2014-01-01

We investigate the differences in molecular signature and clinical outcomes between multiple lesion glioblastoma (GBM) and single focus GBM in the modern treatment era. Between August 2000 and May 2010, 161 patients with GBM were treated with modern radiotherapy techniques. Of this group, 33 were considered to have multiple lesion GBM (25 multifocal and 8 multicentric). Patterns of failure, time to progression and overall survival were compared based on whether the tumor was considered a single focus or multiple lesion GBM. Genomic groupings and methylation status were also investigated as a possible predictor of multifocality in a cohort of 41 patients with available tissue for analysis. There was no statistically significant difference in overall survival (p < 0.3) between the multiple lesion tumors (8.2 months) and single focus GBM (11 months). Progression free survival was superior in the single focus tumors (7.1 months) as compared to multi-focal (5.6 months, p = 0.02). For patients with single focus, multifocal and multicentric GBM, 81, 76 and 88 % of treatment failures occurred in the 60 Gy volume (p < 0.5), while 54, 72, and 38 % of treatment failures occurred in the 46 Gy volume (p < 0.4). Out of field failures were rare in both single focus and multiple foci GBM (7 vs 3 %). Genomic groupings and methylation status were not found to predict for multifocality. Patterns of failure, survival and genomic signatures for multiple lesion GBM do not appreciably differ when compared to single focus tumors. PMID:24990827

Comparison of T stage, N stage, multifocality, and bilaterality in papillary thyroid carcinoma patients according to the presence of coexisting lymphocytic thyroiditis.

PubMed

Park, Jin Young; Kim, Dong Wook; Park, Ha Kyung; Ha, Tae Kwun; Jung, Soo Jin; Kim, Do Hun; Bae, Sang Kyun

2015-01-01

This study aimed to assess the relationship between coexisting lymphocytic thyroiditis and T-N stages of papillary thyroid carcinoma (PTC) by histopathological analysis. The study included 653 patients who underwent thyroid surgery for PTC at our hospital. Each case was classified as either Hashimoto's thyroiditis (HT), non-Hashimoto type of lymphocytic thyroiditis (NHLT), or normal according to the histopathology of thyroid parenchyma. Patient age, gender, surgical modality, location, T stage, N stage, multifocality and bilaterality were compared according to the histopathology. The prevalence of coexisting lymphocytic thyroiditis was 25.8% (169/653); HT (7.5%, 49/653) and NHLT (18.3%, 120/653). There were no significant differences in T stage, N stage, multifocality and bilaterality with regard to coexisting lymphocytic thyroiditis, regardless of whether HT and NHLT were considered collectively or discretely. Primary tumor size (p < 0.0001), location (p = 0.0011), N stage (p < 0.0001), multifocality (p < 0.0001) and bilaterality (p < 0.0001) differed significantly according to T stage, and gender (p = 0.0193), primary tumor size (p < 0.0001), T stage (p < 0.0001), multifocality (p < 0.0001) and bilaterality (p < 0.0001) differed significantly according to N stage. PTC patients with coexisting lymphocytic thyroiditis did not differ from those with normal parenchyma in terms of T stage, N stage, multifocality and bilaterality.

A common humoral background of intraocular and arterial blood pressure dysregulation.

PubMed

Skrzypecki, Janusz; Grabska-Liberek, Iwona; Przybek, Joanna; Ufnal, Marcin

2018-03-01

It has been postulated that intraocular pressure, an important glaucoma risk factor, correlates positively with arterial blood pressure (blood pressure). However, results of experimental and clinical studies are often contradictory. It is hypothesized that, in some hypertensive patients, disturbances in intraocular pressure regulation may depend on biological effects of blood borne hormones underlying a particular type of hypertension, rather than on blood pressure level itself. This review compares the effects of hormones on blood pressure and intraocular pressure, in order to identify a hormonal profile of hypertensive patients with an increased risk of intraocular pressure surge. The PUBMED database was searched to identify pre-clinical and clinical studies investigating the role of angiotensin II, vasopressin, adrenaline, noradrenaline, prostaglandins, and gaseous transmitters in the regulation of blood pressure and intraocular pressure. Studies included in the review suggest that intraocular and blood pressures often follow a different pattern of response to the same hormone. For example, vasopressin increases blood pressure, but decreases intraocular pressure. In contrast, high level of nitric oxide decreases blood pressure, but increases intraocular pressure. Arterial hypertension is associated with altered levels of blood borne hormones. Contradicting results of studies on the relationship between arterial hypertension and intraocular pressure might be partially explained by diverse effects of hormones on arterial and intraocular pressures. Further studies are needed to evaluate if hormonal profiling may help to identify glaucoma-prone patients.

Early evolution of multifocal optics for well-focused colour vision in vertebrates.

PubMed

Gustafsson, O S E; Collin, S P; Kröger, R H H

2008-05-01

Jawless fishes (Agnatha; lampreys and hagfishes) most closely resemble the earliest stage in vertebrate evolution and lamprey-like animals already existed in the Lower Cambrian [about 540 million years ago (MYA)]. Agnathans are thought to have separated from the main vertebrate lineage at least 500 MYA. Hagfishes have primitive eyes, but the eyes of adult lampreys are well-developed. The southern hemisphere lamprey, Geotria australis, possesses five types of opsin genes, three of which are clearly orthologous to the opsin genes of jawed vertebrates. This suggests that the last common ancestor of all vertebrate lineages possessed a complex colour vision system. In the eyes of many bony fishes and tetrapods, well-focused colour images are created by multifocal crystalline lenses that compensate for longitudinal chromatic aberration. To trace the evolutionary origins of multifocal lenses, we studied the optical properties of the lenses in four species of lamprey (Geotria australis, Mordacia praecox, Lampetra fluviatilis and Petromyzon marinus), with representatives from all three of the extant lamprey families. Multifocal lenses are present in all lampreys studied. This suggests that the ability to create well-focused colour images with multifocal optical systems also evolved very early.

Unusually high incidence of multifocal epithelial hyperplasia in children of the Nahuatl population of Mexico.

PubMed

Ledesma-Montes, Constantino; Mendez-Mendoza, Amilcar

2017-01-01

Multifocal epithelial hyperplasia is an uncommon disease of the oral mucosa caused by the human papilloma virus. To study the clinical and pathological findings of multifocal epithelial hyperplasia detected during an oral examination of 343 Mexican Nahuatl children from a single primary school in El Paso de Cupilco, Mexico. A thorough oral examination was performed in all children and clinical data (age, gender, location and number of lesions) were documented and analyzed. Multifocal epithelial hyperplasia was diagnosed in 110 of the 343 children (32.3%). The ages of the children varied from 5 to 15 years, and of these, 56.3% were girls. The lesions were asymptomatic, 0.2 to 3.0 cm in diameter, soft, round to oval, smooth surfaced, sessile papulonodules, similar in colour to that of the surrounding mucosa. The lesions were commonly seen on the buccal mucosa and tongue, and most affected children (85%) had less than 5 lesions. Children in the 7 to 10 years age group were most often affected. Human papillomavirus typing was not done owing to a lack of facilities. There is a high incidence of multifocal epithelial hyperplasia in Nahuatl children with a predilection for females.

Analysis of Rapid Multi-Focal Zone ARFI Imaging

PubMed Central

Rosenzweig, Stephen; Palmeri, Mark; Nightingale, Kathryn

2015-01-01

Acoustic radiation force impulse (ARFI) imaging has shown promise for visualizing structure and pathology within multiple organs; however, because the contrast depends on the push beam excitation width, image quality suffers outside of the region of excitation. Multi-focal zone ARFI imaging has previously been used to extend the region of excitation (ROE), but the increased acquisition duration and acoustic exposure have limited its utility. Supersonic shear wave imaging has previously demonstrated that through technological improvements in ultrasound scanners and power supplies, it is possible to rapidly push at multiple locations prior to tracking displacements, facilitating extended depth of field shear wave sources. Similarly, ARFI imaging can utilize these same radiation force excitations to achieve tight pushing beams with a large depth of field. Finite element method simulations and experimental data are presented demonstrating that single- and rapid multi-focal zone ARFI have comparable image quality (less than 20% loss in contrast), but the multi-focal zone approach has an extended axial region of excitation. Additionally, as compared to single push sequences, the rapid multi-focal zone acquisitions improve the contrast to noise ratio by up to 40% in an example 4 mm diameter lesion. PMID:25643078

Visual Outcomes, Patient Satisfaction and Spectacle Independence with a Trifocal Diffractive Intraocular Lens.

PubMed

Kretz, Florian Tobias Alwin; Choi, Chul Young; Müller, Matthias; Gerl, Matthias; Gerl, Ralf Helmar; Auffarth, Gerd Uwe

2016-06-01

To evaluate visual outcomes following implantation of a trifocal diffractive intraocular lens (IOL) and to analyze their correlation with patient satisfaction and ease of performing daily tasks. This was a prospective study enrolling 100 eyes of 50 patients undergoing cataract surgery with implantation of trifocal IOL AT LISA tri 839MP. Visual and refractive outcomes were evaluated during a 3-month follow-up. Postoperatively, a questionnaire was used to evaluate patient satisfaction with regard to surgical outcome, spectacle independence, perception of photic phenomena, and ease of performing some vision-related activities. A total of 91%, 87%, and 79% of eyes achieved a monocular uncorrected distance, near, and intermediate visual acuity of 0.1 logarithm of the minimum angle of resolution or better, respectively. After the surgery, 96% of the patients could perform their daily activities without problems. The mean spectacle independence scores for reading, doing computer work, and for distance were 10.33 ± 12.47, 5.71 ± 11.90, and 3.92 ± 9.77, respectively (scale: 0 = no spectacles needed; 40 = spectacles always needed). No correlation was found between spectacle independence and visual outcome (-0.101 ≤ r ≤ 0.244, p ≥ 0.087). Mean scores (0 = no symptoms; 40 = strong symptoms) for glare at night, ghost images, and halos were 15.15 ± 12.02, 4.49 ± 7.92, and 13.34 ± 10.82, respectively. No correlation was found between photic phenomena and visual outcome (-0.199 ≤ r ≤ 0.209, p ≥ 0.150). A total of 80% of patients reported satisfaction with the surgery outcome, and 86% would recommend the surgery to friends and family. Implantation of the AT LISA tri 839MP IOL after cataract surgery provides effective visual restoration associated with a minimal level of photic phenomena, a positive impact on the performance of vision-related daily activities, and a high level of postoperative patient satisfaction.

Visual Outcomes, Patient Satisfaction and Spectacle Independence with a Trifocal Diffractive Intraocular Lens

PubMed Central

Kretz, Florian Tobias Alwin; Choi, Chul Young; Müller, Matthias; Gerl, Matthias; Gerl, Ralf Helmar

2016-01-01

Purpose To evaluate visual outcomes following implantation of a trifocal diffractive intraocular lens (IOL) and to analyze their correlation with patient satisfaction and ease of performing daily tasks. Methods This was a prospective study enrolling 100 eyes of 50 patients undergoing cataract surgery with implantation of trifocal IOL AT LISA tri 839MP. Visual and refractive outcomes were evaluated during a 3-month follow-up. Postoperatively, a questionnaire was used to evaluate patient satisfaction with regard to surgical outcome, spectacle independence, perception of photic phenomena, and ease of performing some vision-related activities. Results A total of 91%, 87%, and 79% of eyes achieved a monocular uncorrected distance, near, and intermediate visual acuity of 0.1 logarithm of the minimum angle of resolution or better, respectively. After the surgery, 96% of the patients could perform their daily activities without problems. The mean spectacle independence scores for reading, doing computer work, and for distance were 10.33 ± 12.47, 5.71 ± 11.90, and 3.92 ± 9.77, respectively (scale: 0 = no spectacles needed; 40 = spectacles always needed). No correlation was found between spectacle independence and visual outcome (-0.101 ≤ r ≤ 0.244, p ≥ 0.087). Mean scores (0 = no symptoms; 40 = strong symptoms) for glare at night, ghost images, and halos were 15.15 ± 12.02, 4.49 ± 7.92, and 13.34 ± 10.82, respectively. No correlation was found between photic phenomena and visual outcome (-0.199 ≤ r ≤ 0.209, p ≥ 0.150). A total of 80% of patients reported satisfaction with the surgery outcome, and 86% would recommend the surgery to friends and family. Conclusions Implantation of the AT LISA tri 839MP IOL after cataract surgery provides effective visual restoration associated with a minimal level of photic phenomena, a positive impact on the performance of vision-related daily activities, and a high level of postoperative patient satisfaction. PMID:27247517

Multifocal tuberculous osteomyelitis in a 3-year-old child.

PubMed

Dewan, Pooja; Tandon, Anupama; Rohatgi, Smriti; Qureshi, Shuaib

2017-05-01

Multifocal skeletal tuberculosis accounts for less than 1% of all tuberculous lesions in children. A 3-year-old unimmunised child presented with painless symmetrical swelling of both arms, pallor and hepatosplenomegaly. A skeletal survey demonstrated lytic lesions of the metadiaphysis of both humeri, a rib and the sacrum. The possibility of Langerhans cell histiocytosis or multifocal fibrous dysplasia was considered; however, acid-fast bacilli were detected in the biopsy specimen and real-time polymerase chain reaction confirmed Mycobacterium tuberculosis infection. Culture for M. tuberculosis was negative. The patient responded to anti-tuberculous therapy.

Unusual multifocal granulomatous disease caused by actinomycetous bacteria in a nestling Derbyan parrot (Psittacula derbiana).

PubMed

Park, F J; Jaensch, S

2009-01-01

A nestling Derbyan parrot (Psittacula derbiana) was presented with unusual subcutaneous swellings of the thigh regions, and poor growth. Histological examination revealed actinomycetous bacteria associated with multifocal systemic granulomas. The clinical and pathological findings of the case are presented, and some relevant aspects of actinomycetous bacterial infections in mammals and birds are discussed. Although granulomatous disease is encountered at times in avian species, the actinomycetous bacteria (Nocardia and Actinomyces spp.) have rarely been reported in association with multifocal granulomatous disease in birds.

Clear cell papillary renal cell carcinoma as part of histologically discordant multifocal renal cell carcinoma: A case report and review of literature.

PubMed

Shao, Tiffany; Yousef, Peter; Shipilova, Irina; Saleeb, Rola; Lee, Jason Y; Krizova, Adriana

2016-03-01

Multifocal renal cell carcinoma of different histological subtypes within a single kidney is rare. We report a recently classified clear cell (tubulo) papillary renal cell carcinoma as part of an unusual case of multifocal renal cell carcinoma of discordant histological subtypes. A 57 year-old-man was found to have multiple renal tumors and cysts on imaging and underwent a laparoscopic left radical nephrectomy. Pathological review showed multifocal renal cell carcinoma (clear cell (tubulo) papillary, clear cell and papillary renal cell carcinomas and papillary adenomas). Morphology of clear cell papillary renal cell carcinoma was supported by immunohistochemical profile (CK7+, HMWK+, CAIX+, AMACR-, CD10-, TFE3-). This is the first report of clear cell papillary renal cell carcinoma as part of multifocal renal cell carcinoma of different histological subtypes. Related lineage of clear cell renal cell carcinoma and papillary renal cell carcinoma is supported by the highest prevalence of their combination within multifocal renal cell carcinoma of different histological subtypes along with their molecular interconnection. Clear cell papillary renal cell carcinoma may be uniquely placed between clear cell and papillary renal cell carcinomas since it shows morphological features intermediate between clear cell and papillary renal cell carcinoma along with overlapping but unique immunohistochemical profile. Clear cell papillary renal cell carcinoma may be molecularly related to clear cell and papillary renal cell carcinomas since the tumors overexpress markers of HIF pathway activation with normal/elevated VHL mRNA expression and some tumors show losses of chromosome 3. Due to the overlapping morphology, it is possible that cases of clear cell papillary renal cell carcinoma may have been misclassified as papillary or clear cell renal cell carcinoma in the literature, incorrectly increasing their reported prevalence. Identification of multifocal RCCs may be related to the extent of pathological sampling. Copyright © 2016 Elsevier GmbH. All rights reserved.

Magnetic Resonance Enterography to Assess Multifocal and Multicentric Bowel Endometriosis.

PubMed

Nyangoh Timoh, Krystel; Stewart, Zelda; Benjoar, Mikhael; Beldjord, Selma; Ballester, Marcos; Bazot, Marc; Thomassin-Naggara, Isabelle; Darai, Emile

To prospectively determine the accuracy of magnetic resonance enterography (MRE) compared with conventional magnetic resonance imaging (MRI) for multifocal (i.e., multiple lesions affecting the same digestive segment) and multicentric (i.e., multiple lesions affecting several digestive segments) bowel endometriosis. A prospective study (Canadian Task Force classification II-2). Tenon University Hospital, Paris, France. Patients with MRI-suspected colorectal endometriosis scheduled for colorectal resection from April 2014 to February 2016 were included. Patients underwent both 1.5-Tesla MRI and MRE as well as laparoscopically assisted and open colorectal resections. The diagnostic performance of MRI and MRE was evaluated for sensitivity, specificity, positive and negative predictive values, accuracy, and positive and negative likelihood ratios (LRs). The interobserver variability of the experienced and junior radiologists was quantified using weighted statistics. Forty-seven patients were included. Twenty-two (46.8%) patients had unifocal lesions, 14 (30%) had multifocal lesions, and 11 (23.4%) had multicentric lesions. The sensitivity, specificity, positive LR, and negative LR for the diagnosis of multifocal lesions were 0.29 (6/21), 1.00 (23/24), 15.36, and 0.71 for MRI and 0.57 (12/21), 0.89 (23/25), 4.95, and 0.58 for MRE. The sensitivity, specificity, positive LR, and negative LR for the diagnosis of multicentric lesions were 0.18 (1/11), 1.00 (1/1), 15, and 0.80 for MRI and 0.46 (5/11), 0.92 (33/36), 5.45, and 0.60 for MRE. Lower accuracies for MRI compared with MRE to diagnose multicentric (p = .01) and multifocal lesions (p = .004) were noted. The interobserver agreement for MRE was good for both multifocality (κ = 0.80) and multicentricity (κ = 0.61). MRE has better accuracy for diagnosing multifocal and multicentric bowel endometriosis than conventional MRI. Copyright © 2018. Published by Elsevier Inc.

Multifocal tenosynovial giant cell tumors in a child with Noonan syndrome.

PubMed

Meyers, Arthur B; Awomolo, Agboola O; Szabo, Sara

2017-03-01

Noonan syndrome is a genetic disorder with variable expression of distinctive facial features, webbed neck, chest deformity, short stature, cryptorchidism and congenital heart disease. The association of Noonan syndrome and giant cell granulomas of the mandible is widely reported. However, Noonan syndrome may also be associated with single or multifocal tenosynovial giant cell tumors, also referred to as pigmented villonodular synovitis. We report a child with Noonan syndrome, giant cell granulomas of the mandible and synovial and tenosynovial giant cell tumors involving multiple joints and tendon sheaths who was initially misdiagnosed with juvenile idiopathic arthritis. It is important for radiologists to be aware of the association of Noonan syndrome and multifocal giant cell lesions, which can range from the more commonly described giant cell granulomas of the mandible to isolated or multifocal intra- or extra-articular tenosynovial giant cell tumors or a combination of all of these lesions.

Power profiles of single vision and multifocal soft contact lenses.

PubMed

Wagner, Sandra; Conrad, Fabian; Bakaraju, Ravi C; Fedtke, Cathleen; Ehrmann, Klaus; Holden, Brien A

2015-02-01

The purpose of this study was to investigate the optical zone power profile of the most commonly prescribed soft contact lenses to assess their potential impact on peripheral refractive error and hence myopia progression. The optical power profiles of six single vision and ten multifocal contact lenses of five manufacturers in the powers -1.00 D, -3.00 D, and -6.00 D were measured using the SHSOphthalmic (Optocraft GmbH, Erlangen, Germany). Instrument repeatability was also investigated. Instrument repeatability was dependent on the distance from the optical centre, manifesting unreliable data for the central 1mm of the optic zone. Single vision contact lens measurements of -6.00 D lenses revealed omafilcon A having the most negative spherical aberration, lotrafilcon A having the least. Somofilcon A had the highest minus power and lotrafilcon A the biggest deviation in positive direction, relative to their respective labelled powers. Negative spherical aberration occurred for almost all of the multifocal contact lenses, including the centre-distance designs etafilcon A bifocal and omafilcon A multifocal. Lotrafilcon B and balafilcon A seem to rely predominantly on the spherical aberration component to provide multifocality. Power profiles of single vision soft contact lenses varied greatly, many having a negative spherical aberration profile that would exacerbate myopia. Some lens types and powers are affected by large intra-batch variability or power offsets of more than 0.25 dioptres. Evaluation of power profiles of multifocal lenses was derived that provides helpful information for prescribing lenses for presbyopes and progressing myopes. Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

[New trends of customizing intraocular lens choice].

PubMed

He, Shou-zhi

2006-05-01

Definition and basic principle of customizing intraocular lens choice are described. The importance of the choicing intraocular lens for individual patient is illustrated. The review emphasizes that it is surgeon's responsibility to choice the appropriate intraocular lens for the best postoperative outcome and patient's satisfaction.

Effects of angiotensin, vasopressin and atrial natriuretic peptide on intraocular pressure in anesthetized rats

NASA Technical Reports Server (NTRS)

Palm, D. E.; Shue, S. G.; Keil, L. C.; Balaban, C. D.; Severs, W. B.

1995-01-01

The effects of atrial natriuretic peptide (ANP), vasopressin (AVP) and angiotensin (ANG) on blood and intraocular pressures of pentobarbital anesthetized rats were evaluated following intravenous, intracerebroventricular or anterior chamber routes of administration. Central injections did not affect intraocular pressure. Equipressor intravenous infusions of ANG raised, whereas AVP decreased, intraocular pressure. Direct infusions of a balanced salt solution (0.175 microliter/min) raised intraocular pressure between 30 and 60 min. Adding ANG or ANP slightly reduced this solvent effect but AVP was markedly inhibitory. An AVP-V1 receptor antagonist reversed the blunting of the solvent-induced rise by the peptide, indicating receptor specificity. Acetazolamide pretreatment lowered intraocular pressure, but the solvent-induced rise in intraocular pressure and inhibition by AVP still occurred without altering the temporal pattern. Thus, these effects appear unrelated to aqueous humor synthesis rate. The data support the possibility of intraocular pressure regulation by peptides acting from the blood and aqueous humor.

Treatment of Exudative and Vasogenic Chorioretinal Diseases Including Variants of AMD and Other CNV Related Maculopathy

ClinicalTrials.gov

2012-10-24

Coats' Disease; Idiopathic Retinal Telangiectasia; Retinal Angiomatous Proliferation; Polypoidal Choroidal Vasculopathy; Pseudoxanthoma Elasticum; Pathological Myopia; Multi-focal Choroiditis; Rubeosis Iridis; Von Hippel Lindau Disease; BEST VITELLIFORM MACULAR DYSTROPHY, MULTIFOCAL (Disorder)

Multifocal meningiomas in a patient with a constitutional ring chromosome 22.

PubMed Central

Arinami, T; Kondo, I; Hamaguchi, H; Nakajima, S

1986-01-01

We report a patient with a constitutional ring chromosome 22, in whom multifocal meningiomas were confirmed at necropsy, and discuss the relationship between the constitutional chromosome change and tumourigenesis of meningiomas in this patient. Images PMID:3712397

Multifocal multi-site Warthin tumour.

PubMed

Hilton, Jennifer M; Phillips, John S; Hellquist, Henrik B; Premachandra, Don J

2008-12-01

The unique case of a 55-year-old man with multifocal adenolymphoma (Warthin's tumour) of both parotid glands, the neck and post-nasal space is presented. Warthin tumour is almost exclusively a parotid tumour but is known to be bilateral in 7-10% of cases and multifocal in 2% of cases. Most extraglandular Warthin tumours have been located in neck lymph nodes and only a few cases have been reported from other sites. The presented case is unique in having synchronous and metachronous Warthin tumours, as well as one of the tumours being neither truly parotid, nor within a lymph node.

Objective assessment of the effect of pupil size upon the power distribution of multifocal contact lenses.

PubMed

Papadatou, Eleni; Del Águila-Carrasco, Antonio J; Esteve-Taboada, José J; Madrid-Costa, David; Cerviño-Expósito, Alejandro

2017-01-01

To analytically assess the effect of pupil size upon the refractive power distributions of different designs of multifocal contact lenses. Two multifocal contact lenses of center-near design and one multifocal contact lens of center-distance design were used in this study. Their power profiles were measured using the NIMO TR1504 device (LAMBDA-X, Belgium). Based on their power profiles, the power distribution was assessed as a function of pupil size. For the high addition lenses, the resulting refractive power as a function of viewing distance (far, intermediate, and near) and pupil size was also analyzed. The power distribution of the lenses was affected by pupil size differently. One of the lenses showed a significant spread in refractive power distribution, from about -3 D to 0 D. Generally, the power distribution of the lenses expanded as the pupil diameter became greater. The surface of the lens dedicated for each distance varied substantially with the design of the lens. In an experimental basis, our results show how the lenses power distribution is affected by the pupil size and underlined the necessity of careful evaluation of the patient's visual needs and the optical properties of a multifocal contact lens for achieving the optimal visual outcome.

21 CFR 886.4300 - Intraocular lens guide.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Intraocular lens guide. 886.4300 Section 886.4300...) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4300 Intraocular lens guide. (a) Identification. An intraocular lens guide is a device intended to be inserted into the eye during surgery to direct...

21 CFR 886.3600 - Intraocular lens.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Intraocular lens. 886.3600 Section 886.3600 Food... DEVICES OPHTHALMIC DEVICES Prosthetic Devices § 886.3600 Intraocular lens. (a) Identification. An intraocular lens is a device made of materials such as glass or plastic intended to be implanted to replace...

Visual performance of four simultaneous-image multifocal contact lenses under dim and glare conditions.

PubMed

García-Lázaro, Santiago; Ferrer-Blasco, Teresa; Madrid-Costa, David; Albarrán-Diego, César; Montés-Micó, Robert

2015-01-01

To assess and compare the effects of four simultaneous-image multifocal contact lenses (SIMCLs), and those with distant-vision-only contact lenses on visual performance in early presbyopes, under dim conditions, including the effects of induced glare. In this double-masked crossover study design, 28 presbyopic subjects aged 40 to 46 years were included. All participants were fitted with the four different SIMCLs (Air Optix Aqua Multifocal [AOAM; Alcon], PureVision Multifocal [PM; Bausch & Lomb], Acuvue Oasys for Presbyopia [AOP; Johnson & Johnson Vision], and Biofinity Multifocal [BM; CooperVision]) and with monofocal contact lenses (Air Optix Aqua, Alcon). After 1 month of daily contact lens wearing, each subject's binocular distance visual acuity (BDVA) and binocular distance contrast sensitivity (BDCS) were measured using the Functional Visual Analyzer (Stereo Optical Co., Inc.) under mesopic conditions (3 candela [cd]/m) both with no glare and under the 2 levels of induced glare: 1.0 lux (glare 1) and 28 lux (glare 2). Among the SIMCLs, in terms of BDVA, AOAM and PM outperformed BM and AOP. All contact lenses performed better at level without glare, followed by Glare 1, and with the worst results obtained under glare 2. Binocular distance contrast sensitivity revealed statistically significant differences for 12 cycles per degree (cpd). Among the SIMCLs, post hoc multiple comparison testing revealed that AOAM and PM provided the best BDCS at the three luminance levels. In both cases, BDVA and BDCS at 12 cpd, monofocal contact lenses outperformed all SIMCL ones at all lighting conditions. Air Optix Aqua Multifocal and PM provided better visual performance than BM and AOP for distance vision with low addition and under dim conditions, but they all provide worse performance than monofocal contact lenses.

Multifocal Visual Evoked Potential in Eyes With Temporal Hemianopia From Chiasmal Compression: Correlation With Standard Automated Perimetry and OCT Findings.

PubMed

Sousa, Rafael M; Oyamada, Maria K; Cunha, Leonardo P; Monteiro, Mário L R

2017-09-01

To verify whether multifocal visual evoked potential (mfVEP) can differentiate eyes with temporal hemianopia due to chiasmal compression from healthy controls. To assess the relationship between mfVEP, standard automated perimetry (SAP), and Fourier domain-optical coherence tomography (FD-OCT) macular and peripapillary retinal nerve fiber layer (RNFL) thickness measurements. Twenty-seven eyes with permanent temporal visual field (VF) defects from chiasmal compression on SAP and 43 eyes of healthy controls were submitted to mfVEP and FD-OCT scanning. Multifocal visual evoked potential was elicited using a stimulus pattern of 60 sectors and the responses were averaged for the four quadrants and two hemifields. Optical coherence tomography macular measurements were averaged in quadrants and halves, while peripapillary RNFL thickness was averaged in four sectors around the disc. Visual field loss was estimated in four quadrants and each half of the 24-2 strategy test points. Multifocal visual evoked potential measurements in the two groups were compared using generalized estimated equations, and the correlations between mfVEP, VF, and OCT findings were quantified. Multifocal visual evoked potential-measured temporal P1 and N2 amplitudes were significantly smaller in patients than in controls. No significant difference in amplitude was observed for nasal parameters. A significant correlation was found between mfVEP amplitudes and temporal VF loss, and between mfVEP amplitudes and the corresponding OCT-measured macular and RNFL thickness parameters. Multifocal visual evoked potential amplitude parameters were able to differentiate eyes with temporal hemianopia from controls and were significantly correlated with VF and OCT findings, suggesting mfVEP is a useful tool for the detection of visual abnormalities in patients with chiasmal compression.

Pulmonary sporotrichosis: case series and systematic analysis of literature on clinico-radiological patterns and management outcomes.

PubMed

Aung, Ar Kar; Teh, Bing Mei; McGrath, Christopher; Thompson, Philip J

2013-07-01

Pulmonary infections by Sporothrix spp. manifest radiologically as cavitary or non-cavitary disease depending on whether the infection is primary pulmonary or multifocal sporotrichosis. Despite current guidelines, the optimal management for pulmonary sporotrichosis remains unclear. In order to clarify this, we present two cases of pulmonary sporotrichosis, as well as the results of a comprehensive literature review of treatment outcomes based on clinico-radiological presentation patterns of the disease. A literature search of all case reports in English language over the last 50 years (1960-2010) was conducted. Data on patient characteristics, risk factors, clinico-radiological patterns, treatment modalities and outcomes were collected and analyzed. A total of 86 cases were identified, i.e., 64 (74.4%) primary pulmonary and 22 (25.6%) multifocal sporotrichosis. Radiologically, primary pulmonary disease was commonly characterized by cavity formation which was lacking in multifocal infections (P = 0.0001). Immunosuppressant use was more common in multifocal sporotrichosis (P = 0.0001), while hemoptysis was more common in primary pulmonary form (P = 0.01). No other differences in patient characteristics or risk factors were noted. Extra-pulmonary multifocal sporotrichosis most commonly involved skin (81.8%) and joints (45.4%). For patients with cavitary primary pulmonary sporotrichosis, outcomes from medical therapy alone were inferior to surgical intervention (P = 0.02). However, for both primary pulmonary and multifocal sporotrichosis with non-cavitary disease, medical therapy alone provided good outcomes. Only 12 (16.7%) cases were treated with itraconazole. Treatment of pulmonary sporotrichosis should be guided by the clinico-radiological patterns of presentation. Medical therapy alone is likely sufficient for non-cavitary disease while early surgery should be considered for cavitary primary pulmonary sporotrichosis. The experience in treating cavitary disease with itraconazole alone is limited and further data are required.

Optical design of soft multifocal contact lens with uniform optical power in center-distance zone with optimized NURBS.

PubMed

Vu, Lien T; Chen, Chao-Chang A; Yu, Chia-Wei

2018-02-05

This study aims to develop a new optical design method of soft multifocal contact lens (CLs) to obtain uniform optical power in large center-distance zone with optimized Non-Uniform Rational B-spline (NURBS). For the anterior surface profiles of CLs, the NURBS design curves are optimized to match given optical power distributions. Then, the NURBS in the center-distance zones are fitted in the corresponding spherical/aspheric curves for both data points and their centers of curvature to achieve the uniform power. Four cases of soft CLs have been manufactured by casting in shell molds by injection molding and then measured to verify the design specifications. Results of power profiles of these CLs are concord with the given clinical requirements of uniform powers in larger center-distance zone. The developed optical design method has been verified for multifocal CLs design and can be further applied for production of soft multifocal CLs.

N-3 Polyunsaturated Fatty Acids of Marine Origin and Multifocality in Human Breast Cancer.

PubMed

Ouldamer, Lobna; Goupille, Caroline; Vildé, Anne; Arbion, Flavie; Body, Gilles; Chevalier, Stephan; Cottier, Jean Philippe; Bougnoux, Philippe

2016-01-01

The microenvironment of breast epithelial tissue may contribute to the clinical expression of breast cancer. Breast epithelial tissue, whether healthy or tumoral, is directly in contact with fat cells, which in turn could influence tumor multifocality. In this pilot study we investigated whether the fatty acid composition of breast adipose tissue differed according to breast cancer focality. Twenty-three consecutive women presenting with non-metastatic breast cancer underwent breast-imaging procedures including Magnetic Resonance Imaging prior to treatment. Breast adipose tissue specimens were collected during breast surgery. We established a biochemical profile of adipose tissue fatty acids by gas chromatography. We assessed whether there were differences according to breast cancer focality. We found that decreased levels in breast adipose tissue of docosahexaenoic and eicosapentaenoic acids, the two main polyunsaturated n-3 fatty acids of marine origin, were associated with multifocality. These differences in lipid content may contribute to mechanisms through which peritumoral adipose tissue fuels breast cancer multifocality.

[The Clinical and Molecular Characteristics of Adenocarcinoma Presented 
by Multi-focal GGO].

PubMed

Song, Yang; Liang, Naixin; Li, Shanqing

2018-03-20

Due to emphasis on early screening for lung cancer, the detection rate of multiple ground glass opacities (GGOs) on computed tomography (CT) image increases in recent years, and research on multifocal adenocarcinomas presented by GGOs has been thriving. It is more common in women and non-smokers and has excellent prognosis both in patients with natural history and after surgery. These clinical features suggest that it is likely to be a distinct disease entity. From the perspective of molecular genetics, lesions in the same individual are likely to have distinct clonal features. Therefore, genetic heterogeneity is the most prominent feature of multifocal pulmonary adenocarcinomas with GGOs. The genetic heterogeneity is expected to assist the diagnosis of multifocal pulmonary adenocarcinoma and intrapulmonary metastasis, and also suggests that genetic testing of the GGO lesions is of great therapeutic significance. Some GGO lesions may harvest the similar clonal feature, which provide new evidence for the theory of spread through air spaces (STAS).
.

Accommodation and Phoria in Children Wearing Multifocal Contact Lenses

PubMed Central

Gong, Celia R; Troilo, David; Richdale, Kathryn

2017-01-01

Purpose To determine the effect of multifocal contact lenses on accommodation and phoria in children. Methods This was a prospective, non-dispensing, randomized, crossover, single visit study. Myopic children with normal accommodation and binocularity and no history of myopia control treatment were enrolled and fitted with Coopervision Biofinity single vision (SV) and multifocal (MF, +2.50D center distance add) contact lenses. Accommodative responses (photorefraction) and phorias (Modified Thorington) were measured at 4 distances (>3m, 100cm, 40cm, 25cm). Secondary measures included high and low contrast logMAR acuity, accommodative amplitude and facility. Differences between contact lens designs were analyzed using repeated measures regression and paired t-tests. Results A total of 16 subjects, aged 10-15 years, completed the study. There was a small decrease in high (SV: -0.08, MF: +0.01) and low illumination (SV:-0.03, MF: +0.08) (both p<0.01) visual acuity, and contrast sensitivity (SV: 2.0, MF: 1.9 log units, p=0.015) with multifocals. Subjects were more exophoric at 40 cm (SV: -0.41, MF: -2.06 Δ) and 25cm (SV: -0.83, MF: -4.30 Δ) (both p<0.01). With multifocals, subjects had decreased accommodative responses at distance (SV: -0.04; MF: -0.37 D, p=0.02), 100 cm (SV: +0.37; MF: -0.35 D, p<0.01), 40 cm (SV: +1.82; MF: +0.62 D, p<0.01), and 25 cm (SV: +3.38; MF: +1.75 D, p<0.01). There were no significant differences in accommodative amplitude (p=0.66) or facility (p=0.54). Conclusions Children wearing multifocal contact lenses exhibited reduced accommodative responses and more exophoria at increasingly higher accommodative demands than with single vision contact lenses. This suggests that children may be relaxing their accommodation and using the positive addition or increased depth of focus from added spherical aberration of the multifocals. Further studies are needed to evaluate other lens designs, different amounts of positive addition and aberrations, and long-term adaptation to lenses. PMID:28027276

Comparison of vision through surface modulated and spatial light modulated multifocal optics.

PubMed

Vinas, Maria; Dorronsoro, Carlos; Radhakrishnan, Aiswaryah; Benedi-Garcia, Clara; LaVilla, Edward Anthony; Schwiegerling, Jim; Marcos, Susana

2017-04-01

Spatial-light-modulators (SLM) are increasingly used as active elements in adaptive optics (AO) systems to simulate optical corrections, in particular multifocal presbyopic corrections. In this study, we compared vision with lathe-manufactured multi-zone (2-4) multifocal, angularly and radially, segmented surfaces and through the same corrections simulated with a SLM in a custom-developed two-active-element AO visual simulator. We found that perceived visual quality measured through real manufactured surfaces and SLM-simulated phase maps corresponded highly. Optical simulations predicted differences in perceived visual quality across different designs at Far distance, but showed some discrepancies at intermediate and near.

Comparison of vision through surface modulated and spatial light modulated multifocal optics

PubMed Central

Vinas, Maria; Dorronsoro, Carlos; Radhakrishnan, Aiswaryah; Benedi-Garcia, Clara; LaVilla, Edward Anthony; Schwiegerling, Jim; Marcos, Susana

2017-01-01

Spatial-light-modulators (SLM) are increasingly used as active elements in adaptive optics (AO) systems to simulate optical corrections, in particular multifocal presbyopic corrections. In this study, we compared vision with lathe-manufactured multi-zone (2-4) multifocal, angularly and radially, segmented surfaces and through the same corrections simulated with a SLM in a custom-developed two-active-element AO visual simulator. We found that perceived visual quality measured through real manufactured surfaces and SLM-simulated phase maps corresponded highly. Optical simulations predicted differences in perceived visual quality across different designs at Far distance, but showed some discrepancies at intermediate and near. PMID:28736655

[Multifocal tubulopapillary tumors of the kidney. Morphologic features and prognosis. Three cases].

PubMed

Abdelmoula, N B; Boudawara, T; Bahloul, A; Hmida, M B; Hachicha, J; Rebai, T; Mhiri, N; Jlidi, R

1999-01-01

Tubulopapillary tumors of the kidney represent a particular group of renal tumors characterized by their less aggressive behavior. These tumors are distinguished from non papillary tumors by their morphologic, cytochemical and genotypic features. They correspond to a continuous spectrum of tumors ranging from papillary renal cell adenoma to papillary renal cell carcinoma. These TTPR show multifocal, bilateral development and chronic lesions of the kidney parenchyma in nearly all cases. The authors report three cases of multifocal TTPR, including one bilateral case. Based on analysis of these cases and a review of the literature, they discuss the histogenetic features and prognosis of TTPR.

Objective perimetry using a four-channel multifocal VEP system: correlation with conventional perimetry and thickness of the retinal nerve fibre layer.

PubMed

Horn, Folkert K; Kaltwasser, Christoph; Jünemann, Anselm G; Kremers, Jan; Tornow, Ralf P

2012-04-01

There is evidence that multifocal visual evoked potentials (VEPs) can be used as an objective tool to detect visual field loss. The aim of this study was to correlate multifocal VEP amplitudes with standard perimetry data and retinal nerve fibre layer (RNFL) thickness. Multifocal VEP recordings were performed with a four-channel electrode array using 58 stimulus fields (pattern reversal dartboard). For each field, the recording from the channel with maximal signal-to-noise ratio (SNR) was retained, resulting in an SNR optimised virtual recording. Correlation with RNFL thickness, measured with spectral domain optical coherence tomography and with standard perimetry, was performed for nerve fibre bundle related areas. The mean amplitudes in nerve fibre related areas were smaller in glaucoma patients than in normal subjects. The differences between both groups were most significant in mid-peripheral areas. Amplitudes in these areas were significantly correlated with corresponding RNFL thickness (Spearman R=0.76) and with standard perimetry (R=0.71). The multifocal VEP amplitude was correlated with perimetric visual field data and the RNFL thickness of the corresponding regions. This method of SNR optimisation is useful for extracting data from recordings and may be appropriate for objective assessment of visual function at different locations. This study has been registered at http://www.clinicaltrials.gov (NCT00494923).

Effect of multizone refractive multifocal contact lenses on standard automated perimetry.

PubMed

Madrid-Costa, David; Ruiz-Alcocer, Javier; García-Lázaro, Santiago; Albarrán-Diego, César; Ferrer-Blasco, Teresa

2012-09-01

The aim of this study was to evaluate whether the creation of 2 foci (distance and near) provided by multizone refractive multifocal contact lenses (CLs) for presbyopia correction affects the measurements on Humphreys 24-2 Swedish interactive threshold algorithm (SITA) standard automated perimetry (SAP). In this crossover study, 30 subjects were fitted in random order with either a multifocal CL or a monofocal CL. After 1 month, a Humphrey 24-2 SITA standard strategy was performed. The visual field global indices (the mean deviation [MD] and pattern standard deviation [PSD]), reliability indices, test duration, and number of depressed points deviating at P<5%, P<2%, P<1%, and P<0.5% on pattern deviation probability plots were determined and compared between multifocal and monofocal CLs. Thirty eyes of 30 subjects were included in this study. There were no statistically significant differences in reliability indices or test duration. There was a statistically significant reduction in the MD with the multifocal CL compared with monfocal CL (P=0.001). Differences were not found in PSD nor in the number of depressed points deviating at P<5%, P<2%, P<1%, and P<0.5% in the pattern deviation probability maps studied. The results of this study suggest that the multizone refractive lens produces a generalized depression in threshold sensitivity as measured by the Humphreys 24-2 SITA SAP.

Epigenetics, microbiota, and intraocular inflammation: New paradigms of immune regulation in the eye.

PubMed

Wen, Xiaofeng; Hu, Xiao; Miao, Li; Ge, Xiaofei; Deng, Yuhua; Bible, Paul W; Wei, Lai

2018-05-01

Sight threatening immune responses that damage the eye characterize intraocular inflammatory diseases. These diseases including uveitis and age-related macular degeneration are worryingly common and quality of life shattering. Genetic studies in past decades significantly advanced our understanding of the etiology of these devastating diseases. Unfortunately, patient genetics alone failed to adequately explain disease origin, susceptibility, and progression. Non-genetic factors such as the epigenetic regulation of ocular diseases and the environmental factors triggering intraocular inflammation offer new insight into intraocular inflammatory disorders. Importantly, mounting evidence is signaling that dysbiosis of human microbiota leads to rapid epigenomic reprograming of host cells and results in the onset of many diseases. In this review, we discuss how epigenetic mechanisms and microbiota may cooperate to initiate and perpetuate ocular inflammation. Lastly, we propose that the discovery of intraocular microbiota presents a significant shift in thought affecting current approaches to the diagnosis, treatment, and prevention of intraocular inflammatory diseases such as uveitis and age-related macular degeneration. The geographical and genetic background difference in both disease presentation and genetic association of intraocular inflammatory diseases may be due to the variation of intraocular microbiota. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

78 FR 33098 - Prospective Grant of Co-Exclusive Licenses: Multi-Focal Structured Illumination Microscopy...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-03

...-Exclusive Licenses: Multi-Focal Structured Illumination Microscopy Systems and Methods AGENCY: National... pertains to a system and method for digital confocal microscopy that rapidly processes enhanced images. In particular, the invention is a method for digital confocal microscopy that includes a digital mirror device...

Impact of contact lens zone geometry and ocular optics on bifocal retinal image quality

PubMed Central

Bradley, Arthur; Nam, Jayoung; Xu, Renfeng; Harman, Leslie; Thibos, Larry

2014-01-01

Purpose To examine the separate and combined influences of zone geometry, pupil size, diffraction, apodisation and spherical aberration on the optical performance of concentric zonal bifocals. Methods Zonal bifocal pupil functions representing eye + ophthalmic correction were defined by interleaving wavefronts from separate optical zones of the bifocal. A two-zone design (a central circular inner zone surrounded by an annular outer-zone which is bounded by the pupil) and a five-zone design (a central small circular zone surrounded by four concentric annuli) were configured with programmable zone geometry, wavefront phase and pupil transmission characteristics. Using computational methods, we examined the effects of diffraction, Stiles Crawford apodisation, pupil size and spherical aberration on optical transfer functions for different target distances. Results Apodisation alters the relative weighting of each zone, and thus the balance of near and distance optical quality. When spherical aberration is included, the effective distance correction, add power and image quality depend on zone-geometry and Stiles Crawford Effect apodisation. When the outer zone width is narrow, diffraction limits the available image contrast when focused, but as pupil dilates and outer zone width increases, aberrations will limit the best achievable image quality. With two-zone designs, balancing near and distance image quality is not achieved with equal area inner and outer zones. With significant levels of spherical aberration, multi-zone designs effectively become multifocals. Conclusion Wave optics and pupil varying ocular optics significantly affect the imaging capabilities of different optical zones of concentric bifocals. With two-zone bifocal designs, diffraction, pupil apodisation spherical aberration, and zone size influence both the effective add power and the pupil size required to balance near and distance image quality. Five-zone bifocal designs achieve a high degree of pupil size independence, and thus will provide more consistent performance as pupil size varies with light level and convergence amplitude. PMID:24588552

Intermediate-term and long-term outcome of piggyback drainage: connecting glaucoma drainage device to a device in-situ for improved intraocular pressure control.

PubMed

Dervan, Edward; Lee, Edward; Giubilato, Antonio; Khanam, Tina; Maghsoudlou, Panayiotis; Morgan, William H

2017-11-01

This study provides results of a treatment option for patients with failed primary glaucoma drainage device. The study aimed to describe and evaluate the long-term intraocular pressure control and complications of a new technique joining a second glaucoma drainage device directly to an existing glaucoma drainage device termed 'piggyback drainage'. This is a retrospective, interventional cohort study. Eighteen eyes of 17 patients who underwent piggyback drainage between 2004 and 2013 inclusive have been studied. All patients had prior glaucoma drainage device with uncontrolled intraocular pressure. The piggyback technique involved suturing a Baerveldt (250 or 350 mm) or Molteno3 glaucoma drainage device to an unused scleral quadrant and connecting the silicone tube to the primary plate bleb. Failure of intraocular pressure control defined as an intraocular pressure greater than 21 mmHg on maximal therapy on two separate occasions or further intervention to control intraocular pressure. The intraocular pressure was controlled in seven eyes (39%) at last follow-up with a mean follow-up time of 74.2 months. The mean preoperative intraocular pressure was 27.1 mmHg (95% confidence interval 23.8-30.3) compared with 18.4 mmHg (95% confidence interval 13.9-22.8) at last follow-up. The mean time to failure was 57.1 months (95% confidence interval 32.2-82), and the mean time to further surgery was 72.3 months (95% confidence interval 49.9-94.7). Lower preoperative intraocular pressure was associated with longer duration of intraocular pressure control (P = 0.048). If the intraocular pressure was controlled over 2 years, it continued to be controlled over the long term. Two eyes (11%) experienced corneal decompensation. Piggyback drainage represents a viable surgical alternative for the treatment of patients with severe glaucoma with failing primary glaucoma drainage device, particularly in those at high risk of corneal decompensation. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

Role of light and the circadian clock in the rhythmic oscillation of intraocular pressure: Studies in VPAC2 receptor and PACAP deficient mice.

PubMed

Fahrenkrug, Jan; Georg, Birgitte; Hannibal, Jens; Jørgensen, Henrik Løvendahl

2018-04-01

The intraocular pressure of mice displays a daily rhythmicity being highest during the dark period. The present study was performed to elucidate the role of the circadian clock and light in the diurnal and the circadian variations in intraocular pressure in mice, by using animals with disrupted clock function (VPAC2 receptor knockout mice) or impaired light information to the clock (PACAP knockout mice). In wildtype mice, intraocular pressure measured under light/dark conditions showed a statistically significant 24 h sinusoidal rhythm with nadir during the light phase and peak during the dark phase. After transfer of the wildtype mice into constant darkness, the intraocular pressure increased, but the rhythmic changes in intraocular pressure continued with a pattern identical to that obtained during the light/dark cycle. The intraocular pressure in VPAC2 receptor deficient mice during light/dark conditions also showed a sinusoidal pattern with significant changes as a function of a 24 h cycle. However, transfer of the VPAC2 receptor knockout mice into constant darkness completely abolished the rhythmic changes in intraocular pressure. The intraocular pressure in PACAP deficient mice oscillated significantly during both 24 h light and darkness and during constant darkness. During LD conditions, the amplitude of PACAP deficient was significantly lower compared to wildtype mice, resulting in higher daytime and lower nighttime values. In conclusion, by studying the VPAC2 receptor knockout mouse which lacks circadian control and the PACAP knockout mouse which displays impaired light signaling, we provided evidence that the daily intraocular pressure rhythms are primarily generated by the circadian master clock and to a lesser extent by environmental light and darkness. Copyright © 2018 Elsevier Ltd. All rights reserved.

Water Drinking Test: Intraocular Pressure Changes after Tube Surgery and Trabeculectomy.

PubMed

Razeghinejad, Mohammad Reza; Tajbakhsh, Zahra; Nowroozzadeh, Mohammad Hossein; Masoumpour, Masoumeh

2017-01-01

To study the effects of filtration surgeries (tube and trabeculectomy) on changes in intraocular pressure after a water-drinking test. In this prospective, non-randomized, comparative clinical study, 30 patients who had tube surgery and 30 age- and sex-matched trabeculectomy patients underwent a water-drinking test. Only one eye of each patient was included. The baseline intraocular pressure was ≤21 mmHg in all enrolled eyes with or without adjunctive topical medications. After the water-drinking test, the intraocular pressure was measured and recorded at 15, 30, 45, and 60 minutes and the results were compared between the two groups. In both groups, intraocular pressure significantly increased from baseline at all measured time-points ( P < 0.001). In the trabeculectomy group, the average intraocular pressure increased from 14.8 ± 2.9 to 18.8 ± 4.7 mmHg at 30 minutes, but decreased at 60 min (18.0 ± 5.2 mmHg). In the Tube group, intraocular pressure increased incrementally until the last measurement (14.2 ± 3.9, 18.8 ± 5.6, and 19.7 ± 6.0 mmHg at baseline, 30, and 60 minutes, respectively). The end-pressure difference (intraocular pressure at 60 minutes vs. baseline) was significantly greater in the tube group (5.6 ± 3.6 mmHg; 41% change) than in the trabeculectomy group (3.2 ± 4.7; 23% change; P = 0.03). Intraocular pressure significantly increased after the water-drinking test in both the groups. Intraocular pressure started to decline 30 minutes after the water-drinking test in the trabeculectomy group, while it continued to increase up to 60 minutes in the Tube group. This finding may have implications regarding the efficacy or safety of the procedures in advanced glaucoma patients.

Effects of hyperbaric exposure on eyes with intraocular gas bubbles.

PubMed

Jackman, S V; Thompson, J T

1995-01-01

Air travel is known to be potentially hazardous for patients with intraocular gas bubbles, and the external pressure changes associated with hyperbaric oxygen therapy and scuba diving could be similarly dangerous. Rabbits with a perfluoropropane/air gas mixture filling approximately 60% of the vitreous cavity of the right eye were exposed to 3 different hyperbaric pressure profiles to an equivalent depth of 33 feet. The first group were a control group and were not exposed to hyperbaric pressures. The second group remained at an equivalent depth of 33 feet for 30 minutes, and the third group remained at 33 feet for 1 minute. Both groups ascended to normal atmospheric pressure at a rate of 1 foot per minute. The fourth group remained at 33 feet for 1 minute and then ascended at a rate of 0.2 feet per minute. In all eyes with an intraocular gas bubble, intraocular pressure dropped to zero when the atmospheric pressure was increased, and rose to more than 50 mmHg when the atmospheric pressure was returned to normal. Pressures in excess of 50 mmHg were sustained for 10 minutes or longer in each rabbit exposed to one of the hyperbaric profiles. No significant intraocular pressure changes were observed in eyes without an intraocular gas bubble or eyes not exposed to hyperbaric pressure. Marked elevation in intraocular pressure occurs as a result of hyperbaric exposure in eyes with an intraocular gas bubble. Hyperbaric exposure is therefore not advisable for patients with intraocular gas bubbles.

Noninvasive photoacoustic detecting intraocular foreign bodies with an annular transducer array.

PubMed

Yang, Diwu; Zeng, Lvming; Pan, Changning; Zhao, Xuehui; Ji, Xuanrong

2013-01-14

We present a fast photoacoustic imaging system based on an annular transducer array for detection of intraocular foreign bodies. An eight-channel data acquisition system is applied to capture the photoacoustic signals using multiplexing and the total time of data acquisition and transferring is within 3 s. A limited-view filtered back projection algorithm is used to reconstruct the photoacoustic images. Experimental models of intraocular metal and glass foreign bodies were constructed on ex vivo pig's eyes and clear photoacoustic images of intraocular foreign bodies were obtained. Experimental results demonstrate the photoacoustic imaging system holds the potential for in clinic detecting the intraocular foreign bodies.

Intraocular (Eye) Melanoma Treatment (PDQ®)—Health Professional Version

Cancer.gov

Intraocular (uveal) melanoma treatment options include observation, surgery, radiation therapy, and transpupillary thermotherapy. Get detailed information about the diagnosis and treatment of newly diagnosed and recurrent intraocular melanoma in this summary for clinicians.

Multifocal bacterial osteomyelitis after varicella infection: a rare but dreaded complication of chickenpox.

PubMed

Gallach Sanchis, David; Doñate Pérez, Francisco; Jiménez Ortega, Plácido

2014-06-01

Chickenpox is an infectious disease common in children, which in most cases is benign toward the self-limited resolution. There are, however, serious systemic and musculoskeletal complications, especially in patients with immunosuppression. We report a case of multifocal skeletal muscle involvement, as a complication of chickenpox by Streptococcus pyogenes.

Bochum ultrasound score allows distinction of chronic inflammatory from multifocal acquired demyelinating polyneuropathies.

PubMed

Kerasnoudis, A; Pitarokoili, K; Gold, R; Yoon, M-S

2015-01-15

The aim of this observational study was to evaluate the applicability of a recently introduced ultrasound score (Bochum ultrasound score; BUS) in distinguishing the chronic inflammatory demyelinating polyneuropathy (CIDP) from the multifocal motor neuropathy (MMN) or the multifocal acquired demyelinating sensory and motor neuropathy (MADSAM). The BUS underwent prospective evaluation of its applicability in a group of 13 patients (mean age 47.2, SD ± 13.7, 9 women), who were referred to our department between January 2012 and August 2013 with the clinical picture of a chronic symmetrical or asymmetrical sensory/sensorimotor neuropathy. The cut-off value of ≥ 2 points in the "Bochum ultrasound score" showed a sensitivity of 80% and specificity of 87.5% (PPV=80%, NPV=87.5%) in distinguishing CIDP from MMN or MADSAM. The BUS seems to allow a reliable distinction of CIDP from multifocal acquired demyelinating polyneuropathies causing predominantly motor nerve dysfunction, such as MMN or MADSAM. Our ultrasound findings indicate a stronger relationship of MADSAM to MMN, than to CIDP. Copyright © 2014 Elsevier B.V. All rights reserved.

Sturgeons, sharks, and rays have multifocal crystalline lenses and similar lens suspension apparatuses.

PubMed

Gustafsson, Ola S E; Ekström, Peter; Kröger, Ronald H H

2012-07-01

Crystalline lenses with multiple focal lengths in monochromatic light (multifocal lenses) are present in many vertebrate groups. These lenses compensate for chromatic aberration and create well-focused color images. Stabilization of the lens within the eye and the ability to adjust focus are further requirements for vision in high detail. We investigated the occurrence of multifocal lenses by photorefractometry and lens suspension structures by light and electron microscopy in sturgeons (Acipenseriformes, Chondrostei) as well as sharks and rays (Elasmobranchii, Chondrichthyes). Multifocal lenses were found in two more major vertebrate groups, the Chondrostei represented by Acipenseriformes and Chondrichthyes represented by Elasmobranchii. The lens suspension structures of sturgeons, sharks, and rays are more complex than described previously. The lens is suspended by many delicate suspensory fibers in association with a ventral papilla in all groups studied. The arrangements of the suspensory fibers are most similar between sturgeons and sharks. In rays, the lens is suspended by a smaller ventral papilla and the suspensory fibers are arranged more concentrically to the lens. Copyright © 2012 Wiley Periodicals, Inc.

Towards multifocal ultrasonic neural stimulation: pattern generation algorithms

NASA Astrophysics Data System (ADS)

Hertzberg, Yoni; Naor, Omer; Volovick, Alexander; Shoham, Shy

2010-10-01

Focused ultrasound (FUS) waves directed onto neural structures have been shown to dynamically modulate neural activity and excitability, opening up a range of possible systems and applications where the non-invasiveness, safety, mm-range resolution and other characteristics of FUS are advantageous. As in other neuro-stimulation and modulation modalities, the highly distributed and parallel nature of neural systems and neural information processing call for the development of appropriately patterned stimulation strategies which could simultaneously address multiple sites in flexible patterns. Here, we study the generation of sparse multi-focal ultrasonic distributions using phase-only modulation in ultrasonic phased arrays. We analyse the relative performance of an existing algorithm for generating multifocal ultrasonic distributions and new algorithms that we adapt from the field of optical digital holography, and find that generally the weighted Gerchberg-Saxton algorithm leads to overall superior efficiency and uniformity in the focal spots, without significantly increasing the computational burden. By combining phased-array FUS and magnetic-resonance thermometry we experimentally demonstrate the simultaneous generation of tightly focused multifocal distributions in a tissue phantom, a first step towards patterned FUS neuro-modulation systems and devices.

Scleral and intraocular amoebic dissemination in Acanthamoeba keratitis.

PubMed

Arnalich-Montiel, Francisco; Jaumandreu, Laia; Leal, Marina; Valladares, Basilio; Lorenzo-Morales, Jacob

2013-12-01

To review an Acanthamoeba keratitis case series for the documented extracorneal spread of the amoeba. A retrospective review of an observational case series from a single institution. Three patients with 4 instances of microbiologically confirmed extracorneal amoebic spread were identified. Patient 1 had nodular scleritis after undergoing penetrating keratoplasty and was treated successfully with double freeze-thaw cryotherapy; patient 2 had intraocular dissemination of the amoeba detected in a retrocorneal membrane; and patient 3 had, after undergoing tectonic keratoplasty, intraocular dissemination of the amoeba that was treated successfully with intraocular and systemic voriconazole and, afterwards, a nodular scleritis treated with double freeze-thaw cryotherapy and a large-diameter corneal graft to treat corneal recurrence. Acanthamoeba can migrate to the sclera or to the intraocular tissues in some instances, such as in long-standing disease or in penetrating keratoplasty. A prompt biopsy for microbiological analysis and early treatment are required, if this is suspected. Voriconazole can be effective for intraocular invasion when used orally and intraocularly. Scleral involvement might require a surgical approach with double freeze-thaw cryotherapy to treat the localized disease.

Retrospective Analysis of Radiological Recurrence Patterns in Glioblastoma, Their Prognostic Value And Association to Postoperative Infarct Volume.

PubMed

Bette, Stefanie; Barz, Melanie; Huber, Thomas; Straube, Christoph; Schmidt-Graf, Friederike; Combs, Stephanie E; Delbridge, Claire; Gerhardt, Julia; Zimmer, Claus; Meyer, Bernhard; Kirschke, Jan S; Boeckh-Behrens, Tobias; Wiestler, Benedikt; Gempt, Jens

2018-03-14

Recent studies suggested that postoperative hypoxia might trigger invasive tumor growth, resulting in diffuse/multifocal recurrence patterns. Aim of this study was to analyze distinct recurrence patterns and their association to postoperative infarct volume and outcome. 526 consecutive glioblastoma patients were analyzed, of which 129 met our inclusion criteria: initial tumor diagnosis, surgery, postoperative diffusion-weighted imaging and tumor recurrence during follow-up. Distinct patterns of contrast-enhancement at initial diagnosis and at first tumor recurrence (multifocal growth/progression, contact to dura/ventricle, ependymal spread, local/distant recurrence) were recorded by two blinded neuroradiologists. The association of radiological patterns to survival and postoperative infarct volume was analyzed by uni-/multivariate survival analyses and binary logistic regression analysis. With increasing postoperative infarct volume, patients were significantly more likely to develop multifocal recurrence, recurrence with contact to ventricle and contact to dura. Patients with multifocal recurrence (Hazard Ratio (HR) 1.99, P = 0.010) had significantly shorter OS, patients with recurrent tumor with contact to ventricle (HR 1.85, P = 0.036), ependymal spread (HR 2.97, P = 0.004) and distant recurrence (HR 1.75, P = 0.019) significantly shorter post-progression survival in multivariate analyses including well-established prognostic factors like age, Karnofsky Performance Score (KPS), therapy, extent of resection and patterns of primary tumors. Postoperative infarct volume might initiate hypoxia-mediated aggressive tumor growth resulting in multifocal and diffuse recurrence patterns and impaired survival.

Effect of Unifocal versus Multifocal Lenses on Cervical Spine Posture in Patients with Presbyopia.

PubMed

Abbas, Rami L; Houri, Mohamad T; Rayyan, Mohammad M; Hamada, Hamada Ahmad; Saab, Ibtissam M

2018-04-04

There are many environmental considerations which may or may not lead to the development of faulty cervical mechanics. The design of near vision lenses could contribute to the development of such cervical dysfunction and consequently neck pain. Decision making regarding proper type of lens prescription seems important for presbyopic individuals. To investigate the effect of unifocal and multifocal lenses on cervical posture. Thirty subjects (18 females and 12 males) participated in the study with an age range from 40 to 64 years. Each subject wore consequently both unifocal and multifocal lenses randomly while reading. Then lateral cervical spine X-ray films were taken for each subject during each lens wearing. X-ray films were analyzed with digital software (Autocad software, 2 D) to measure segmental angles of the cervical vertebrae (Occiput/C1, C1/C2, C2/C3, C3/C4, C4/C5, C5/C6, C6/C7, C3/C7, C0/C3, and occiput/C7). Higher significant extension angle in the segments C0/C7, C1/C2, C5/C6, C6/C7, and C3/C7 (p<0.05) during multifocal lenses wearing were observed in contrast with higher flexion angle between C3/C4 and C4/C5 (p<0.05) with unifocal lenses wear. Multifocal lens spectacles produces increased extension in the cervical vertebrae angles when compared with the use of unifocal lenses.

Locoregional disease patterns in well-differentiated and dedifferentiated retroperitoneal liposarcoma: implications for the extent of resection?

PubMed

Tseng, William W; Madewell, John E; Wei, Wei; Somaiah, Neeta; Lazar, Alexander J; Ghadimi, Markus P; Hoffman, Aviad; Pisters, Peter W T; Lev, Dina C; Pollock, Raphael E

2014-07-01

Well-differentiated (WD)/dedifferentiated (DD) liposarcoma is the most common soft tissue sarcoma of the retroperitoneum. The frequency of distant metastasis is low and the major burden of disease is locoregional. We sought to define the patterns of locoregional disease to help guide surgical decision making. Data were collected from 247 patients with de novo or recurrent tumors treated at our institution from 1993 to early 2012. The number and location of tumors at both initial presentation and subsequent locoregional recurrence were determined by combined analysis of operative dictations and radiologic imaging. Thirty-four percent of patients had multifocal locoregional disease (two or more tumors) at initial presentation to our institution, including 9 % who had tumors at synchronous remote retroperitoneal sites. The impact of multifocal disease on overall survival was dependent on histologic subtype (WD vs. DD) and disease presentation (de novo vs. recurrence) at the time of resection. Among patients with initial unifocal disease, 57 % progressed to multifocal locoregional disease with subsequent recurrence, including 11 % with new tumors outside of the original resection field. No clinicopathologic or treatment-related variable, including the type or extent of resection, was predictive of either multifocal or 'outside field' progression. Multifocal disease is common in patients with WD/DD retroperitoneal liposarcoma, and tumors can also develop at remote, locoregional sites. Surgical resection remains the primary method of locoregional control in this disease; however, the aggressiveness of resection should be individualized, with consideration of both tumor and patient-related factors.

Preventing falls in older multifocal glasses wearers by providing single-lens distance glasses: the protocol for the VISIBLE randomised controlled trial

PubMed Central

Haran, Mark J; Lord, Stephen R; Cameron, Ian D; Ivers, Rebecca Q; Simpson, Judy M; Lee, Bonsan B; Porwal, Mamta; Kwan, Marcella MS; Severino, Connie

2009-01-01

Background Recent research has shown that wearing multifocal glasses increases the risk of trips and falls in older people. The aim of this study is to determine whether the provision of single-lens distance glasses to older multifocal glasses wearers, with recommendations for wearing them for walking and outdoor activities, can prevent falls. We will also measure the effect of the intervention on health status, lifestyle activities and fear of falling, as well as the extent of adherence to the program. Methods/Design Approximately 580 older people who are regular wearers of multifocal glasses people will be recruited. Participants will be randomly allocated to either an intervention group (provision of single lens glasses, with counselling and advice about appropriate use) or a control group (usual care). The primary outcome measure will be falls (measured with 13 monthly calendars). Secondary measures will be quality of life, falls efficacy, physical activity levels and adverse events. Discussions The study will determine the impact of providing single-lens glasses, with advice about appropriate use, on preventing falls in older regular wearers of multifocal glasses. This pragmatic intervention, if found to be effective, will guide practitioners with regard to recommending appropriate glasses for minimising the risk of falls in older people. Trial Registration The protocol for this study was registered with the Clinical Trials.gov Protocol Registration System on June 7th 2006 (#350855). PMID:19321012

[Hormonal homeostasis and intraocular pressure in chronic emotional stress caused by influences acting on the amygdala].

PubMed

Isakova, L S; Danilov, G E; Egorkina, S B; Butolin, E G

1989-01-01

Changes in intraocular pressure, eye hydrodynamics and the amount of hypophyseal, thyroid, adrenal and pancreatic hormones were studied during continuous stimulation of amygdaloid complex or after administration of angiotensin II into the structure in rabbits. The effects involved changes in hormonal homeostasis and elevation of intraocular pressure due to a hypersecretion of intraocular fluid. The administration of angiotensin II during the amygdala stimulation enhanced the changes.

Genetics of Primary Intraocular Tumors

PubMed Central

Nagarkatti-Gude, Nisha; Wang, Yujuan; Ali, Mohammad Javed; Honavar, Santosh G.; Jager, Martine J.; Chan, Chi-Chao

2012-01-01

Primary intraocular neoplasms are tumors that originate within the eye. The most common malignant primary intraocular tumor in adults is uveal melanoma and the second is primary intraocular lymphoma or vitreoretinal (intraocular) lymphoma. The most common malignant intraocular tumor in children is retinoblastoma. Genetics plays a vital role in the diagnosis and detection of ocular tumors. In uveal melanoma, monosomy 3 is the most common genetic alteration and somatic mutations of BAP1, a tumor suppressor gene, have been reported in nearly 50% of primary uveal melanomas. The retinoblastoma gene RB1 is the prototype tumor suppressor gene—mutations in RB1 alleles lead to inactivated RB protein and the development of retinoblastoma. Immunoglobulin heavy chain (IgH) or T-cell receptor (TCR) gene rearrangement is observed in B-cell or T-cell primary vitreoretinal lymphoma, respectively. Other factors related to the genetics of these three common malignancies in the eye are discussed and reviewed. PMID:22834783

Pigment dispersion syndrome associated with intraocular lens implantation: a new surgical technique.

PubMed

Canut Jordana, M Isabel; Pérez Formigó, Daniel; Abreu González, Rodrigo; Nadal Reus, Jeroni

2010-11-11

We report the case of a myopic patient who, after intraocular lens transplant in the posterior chamber, suffered elevated intraocular pressure due to pigment dispersion, with recurrent episodes of blurred vision. The patient was treated with a new surgical technique that can avoid potential iridolenticular contact. Complete ophthalmologic examination and optical coherence tomography (OCT) of the anterior segment were performed. Contact between the pigmentary epithelium and the iris with an intraocular lens was revealed by utrasound biomicroscopy and OCT. In this case, Nd:YAG laser iridotomy and laser iridoplasty were not effective for iridolenticular separation and control of the pigment dispersion. We propose a new technique: stitches on the surface of the iris to obtain good iridolenticular separation and good intraocular pressure control. Stitches on the iris surface should be considered as optional therapy in pigmentary glaucoma secondary to intraocular lens implantation. This surgical technique can avoid potential iridolenticular contacts more definitively.

In Vitro Aberrometric Assessment of a Multifocal Intraocular Lens and Two Extended Depth of Focus IOLs

PubMed Central

Tolosa, Angel; de Fez, Dolores; Caballero, María T.; Miret, Juan J.

2017-01-01

Purpose To analyze the “in vitro” aberrometric pattern of a refractive IOL and two extended depth of focus IOLs. Methods A special optical bench with a Shack-Hartmann wavefront sensor (SH) was designed for the measurement. Three presbyopia correction IOLs were analyzed: Mini WELL (MW), TECNIS Symfony ZXR00 (SYM), and Lentis Mplus X LS-313 MF30 (MP). Three different pupil sizes were used for the comparison: 3, 4, and 4.7 mm. Results MW generated negative primary and positive secondary spherical aberrations (SA) for the apertures of 3 mm (−0.13 and +0.12 μm), 4 mm (−0.12 and +0.08 μm), and 4.7 mm (−0.11 and +0.08 μm), while the SYM only generated negative primary SA for 4 and 4.7 mm apertures (−0.12 μm and −0.20 μm, resp.). The MP induced coma and trefoil for all pupils and showed significant HOAs for apertures of 4 and 4.7 mm. Conclusions In an optical bench, the MW induces negative primary and positive secondary SA for all pupils. The SYM aberrations seem to be pupil dependent; it does not produce negative primary SA for 3 mm but increases for higher pupils. Meanwhile, the HOAs for the MW and SYM were not significant. The MP showed in all cases the highest HOAs. PMID:29318040

In Vitro Aberrometric Assessment of a Multifocal Intraocular Lens and Two Extended Depth of Focus IOLs.

PubMed

Camps, Vicente J; Tolosa, Angel; Piñero, David P; de Fez, Dolores; Caballero, María T; Miret, Juan J

2017-01-01

To analyze the "in vitro" aberrometric pattern of a refractive IOL and two extended depth of focus IOLs. A special optical bench with a Shack-Hartmann wavefront sensor (SH) was designed for the measurement. Three presbyopia correction IOLs were analyzed: Mini WELL (MW), TECNIS Symfony ZXR00 (SYM), and Lentis Mplus X LS-313 MF30 (MP). Three different pupil sizes were used for the comparison: 3, 4, and 4.7 mm. MW generated negative primary and positive secondary spherical aberrations (SA) for the apertures of 3 mm (-0.13 and +0.12  μ m), 4 mm (-0.12 and +0.08  μ m), and 4.7 mm (-0.11 and +0.08  μ m), while the SYM only generated negative primary SA for 4 and 4.7 mm apertures (-0.12  μ m and -0.20  μ m, resp.). The MP induced coma and trefoil for all pupils and showed significant HOAs for apertures of 4 and 4.7 mm. In an optical bench, the MW induces negative primary and positive secondary SA for all pupils. The SYM aberrations seem to be pupil dependent; it does not produce negative primary SA for 3 mm but increases for higher pupils. Meanwhile, the HOAs for the MW and SYM were not significant. The MP showed in all cases the highest HOAs.

Survey of Intraocular Antibiotics Prophylaxis Practice after Open Globe Injury in China.

PubMed

Lou, Bingsheng; Lin, Lixia; Tan, Junlian; Yang, Yao; Yuan, Zhaohui; Lin, Xiaofeng

2016-01-01

To elucidate the Chinese practice of intraocular antibiotics administration for prophylaxis after open globe injury. A cross-sectional questionnaire survey was performed online by scanning a Quickmark (QR) code with smartphones at the 20th Chinese National Conference of Ocular Trauma in November 2014. A total of 153 (30.6%) of all participators at the conference responded. Of the respondents, 20.9% were routinely administered with prophylactic intraocular injection of antibiotics at the conclusion of the primary eye repair, and 56.9% were used only in cases with high risk of endophthalmitis development. The intraocular route of delivery was mainly included with intracameral injection (47.9%) and intravitreal injection (42.0%). Cephalosporins (53.8%) and vancomycin (42.0%) were the main choices of antibiotic agents, followed by fluoroquinolones (24.3%), and aminoglycosides (13.4%). Only 21.9% preferred a combination of two or more two drugs routinely. In addition, significantly more respondents from the referral eye hospital (92.7%) replied using intraocular antibiotics injection for prophylaxis compared to those respondents from the primary hospital (69.4%) (p = 0.001, Fisher's exact test). Intraocular antibiotics injection for post-traumatic endophthalmitis prophylaxis is widely used in China. However, the choice of antibiotic agents and the intraocular route of delivery vary. A well-designed clinical trial is needed to establish a standardized protocol of intraocular antibiotics administration for post-traumatic endophthalmitis prophylaxis.

HMB-45 negative multifocal malignant perivascular epithelioid cell tumor of the soft tissue responding to sirolimus: First case report from India.

PubMed

Kapoor, Akhil; Beniwal, Surender; Singhal, Mukesh Kumar; Kumar, Narender; Kumar, Vanita; Kumar, Harvindra Singh

2015-01-01

Perivascular epithelioid cell tumor (PEComa) is a group of sarcomas that exhibit a myomelanocytic phenotype and possess a unique cell type in the perivascular epithelioid cell. Traditionally HMB-45 immunoreactivity is the first criteria required to consider a tumor to be PEComa. We report a case of multifocal PEComa with negative HMB-45 marker. The patient presented with three big ulceroproliferative lesions; two over right thigh and one over the scalp in the right frontal region. The patient was prescribed with oral sirolimus to which good response was seen. To the best of our knowledge, this is the first case of HMB-45 negative multifocal malignant PEComa from India.

Multifocal hyperfunctioning thyroid carcinoma without metastases.

PubMed

Nishida, Akiko T; Hirano, Shigeru; Asato, Ryo; Tanaka, Shinzo; Kitani, Yoshiharu; Honda, Nobumitsu; Fujiki, Nobuya; Miyata, Kouji; Fukushima, Hideyuki; Ito, Juichi

2008-09-01

Hyperthyroidism due to thyroid carcinoma is rare, and most cases are caused by hyperfunctioning metastatic thyroid carcinoma rather than primary carcinoma. Among primary hyperfunctioning thyroid carcinoma, multifocal thyroid carcinoma is exceedingly rare, with the only one case being reported in the literature. Here, we describe the case of a 62-year-old woman with multifocal functioning thyroid carcinoma. Technetium-99m (99m Tc) scintigraphic imaging showed four hot areas in the thyroid gland. Histopathological examination of all four nodules revealed papillary carcinoma, corresponding to hot areas in the 99m Tc scintigram. DNA sequencing of the thyrotropin receptor (TSH-R) gene from all nodules revealed no mutation, indicating that activation of TSH-R was unlikely in the pathophysiogenesis of hyperfunctioning thyroid carcinoma in the present case.

Water Drinking Test: Intraocular Pressure Changes after Tube Surgery and Trabeculectomy

PubMed Central

Razeghinejad, Mohammad Reza; Tajbakhsh, Zahra; Nowroozzadeh, Mohammad Hossein; Masoumpour, Masoumeh

2017-01-01

Purpose: To study the effects of filtration surgeries (tube and trabeculectomy) on changes in intraocular pressure after a water-drinking test. Methods: In this prospective, non-randomized, comparative clinical study, 30 patients who had tube surgery and 30 age- and sex-matched trabeculectomy patients underwent a water-drinking test. Only one eye of each patient was included. The baseline intraocular pressure was ≤21 mmHg in all enrolled eyes with or without adjunctive topical medications. After the water-drinking test, the intraocular pressure was measured and recorded at 15, 30, 45, and 60 minutes and the results were compared between the two groups. Results: In both groups, intraocular pressure significantly increased from baseline at all measured time-points (P < 0.001). In the trabeculectomy group, the average intraocular pressure increased from 14.8 ± 2.9 to 18.8 ± 4.7 mmHg at 30 minutes, but decreased at 60 min (18.0 ± 5.2 mmHg). In the Tube group, intraocular pressure increased incrementally until the last measurement (14.2 ± 3.9, 18.8 ± 5.6, and 19.7 ± 6.0 mmHg at baseline, 30, and 60 minutes, respectively). The end-pressure difference (intraocular pressure at 60 minutes vs. baseline) was significantly greater in the tube group (5.6 ± 3.6 mmHg; 41% change) than in the trabeculectomy group (3.2 ± 4.7; 23% change; P = 0.03). Conclusion: Intraocular pressure significantly increased after the water-drinking test in both the groups. Intraocular pressure started to decline 30 minutes after the water-drinking test in the trabeculectomy group, while it continued to increase up to 60 minutes in the Tube group. This finding may have implications regarding the efficacy or safety of the procedures in advanced glaucoma patients. PMID:29090048

A high speed multifocal multiphoton fluorescence lifetime imaging microscope for live-cell FRET imaging

PubMed Central

Poland, Simon P.; Krstajić, Nikola; Monypenny, James; Coelho, Simao; Tyndall, David; Walker, Richard J.; Devauges, Viviane; Richardson, Justin; Dutton, Neale; Barber, Paul; Li, David Day-Uei; Suhling, Klaus; Ng, Tony; Henderson, Robert K.; Ameer-Beg, Simon M.

2015-01-01

We demonstrate diffraction limited multiphoton imaging in a massively parallel, fully addressable time-resolved multi-beam multiphoton microscope capable of producing fluorescence lifetime images with sub-50ps temporal resolution. This imaging platform offers a significant improvement in acquisition speed over single-beam laser scanning FLIM by a factor of 64 without compromising in either the temporal or spatial resolutions of the system. We demonstrate FLIM acquisition at 500 ms with live cells expressing green fluorescent protein. The applicability of the technique to imaging protein-protein interactions in live cells is exemplified by observation of time-dependent FRET between the epidermal growth factor receptor (EGFR) and the adapter protein Grb2 following stimulation with the receptor ligand. Furthermore, ligand-dependent association of HER2-HER3 receptor tyrosine kinases was observed on a similar timescale and involved the internalisation and accumulation or receptor heterodimers within endosomes. These data demonstrate the broad applicability of this novel FLIM technique to the spatio-temporal dynamics of protein-protein interaction. PMID:25780724

Light refocusing with up-scalable resonant waveguide gratings in confocal prolate spheroid arrangements

NASA Astrophysics Data System (ADS)

Quaranta, Giorgio; Basset, Guillaume; Benes, Zdenek; Martin, Olivier J. F.; Gallinet, Benjamin

2018-01-01

Resonant waveguide gratings (RWGs) are thin-film structures, where coupled modes interfere with the diffracted incoming wave and produce strong angular and spectral filtering. The combination of two finite-length and impedance matched RWGs allows the creation of a passive beam steering element, which is compatible with up-scalable fabrication processes. Here, we propose a design method to create large patterns of such elements able to filter, steer, and focus the light from one point source to another. The method is based on ellipsoidal mirrors to choose a system of confocal prolate spheroids where the two focal points are the source point and observation point, respectively. It allows finding the proper orientation and position of each RWG element of the pattern, such that the phase is constructively preserved at the observation point. The design techniques presented here could be implemented in a variety of systems, where large-scale patterns are needed, such as optical security, multifocal or monochromatic lenses, biosensors, and see-through optical combiners for near-eye displays.

Intraocular (Eye) Melanoma—Patient Version

Cancer.gov

Intraocular (uveal) melanoma is a rare cancer that forms in the eye. It usually has no early signs or symptoms. As with melanoma of the skin, risk factors include having fair skin and light-colored eyes. Start here to find information on intraocular melanoma treatment.

Intraocular cysts of toxoplasma gondii in patients with necrotizing retinitis following periocular/intraocular triamcinolone injection.

PubMed

Nijhawan, Raje; Bansal, Reema; Gupta, Nalini; Beke, Nikhil; Kulkarni, Pandurang; Gupta, Amod

2013-10-01

To report the detection of Toxoplasma gondii cysts in intraocular aspirates of patients with necrotizing retinitis following periocular/intraocular corticosteroid injection. Case report. Two patients (2 eyes) with widespread necrotizing retinitis in a steroid-exposed eye posed a diagnostic challenge and underwent pars plana vitrectomy (PPV). Intraocular samples (vitreous fluid, retinal tissue, and subretinal aspirate in case 1, and vitreous fluid in case 2) were subjected to cytological examination. The subretinal aspirate (case 1) revealed encysted bradyzoites of Toxoplasma gondii. Vitreous fluid (case 2) tested positive for anti-toxoplasma antibodies and the smear showed encysted forms of Toxoplasma gondii on cytology. CONCLUSION. Toxoplasma gondii cysts were detected in eyes with necrotizing retinitis that developed secondary to injudicious use of corticosteroids.

Evaluation of sentinel lymph node biopsy prior to axillary lymph node dissection: the role of isolated tumor cells/micrometastases and multifocality/multicentricity-a retrospective study of 1214 breast cancer patients.

PubMed

Schröder, Lars; Fricker, Roland; Stein, Roland Gregor; Rink, Thomas; Fitz, Hartmut; Blasius, Sebastian; Wöckel, Achim; Müller, Thomas

2018-06-01

Sentinel lymph node biopsy (SLNB) alone has thus become an accepted surgical approach for patients with limited axillary metastatic disease. We investigated to what extent isolated tumor cells (ITC) or micrometastasis in SLNBs is associated with proven tumor cells or metastasis in non-sentinel lymph nodes. Furthermore, we investigated the feasibility of SLNB in multifocal and multicentric tumors as both entities have been considered a contraindication for this technique. 1214 women suffering from T1 and T2 invasive breast cancer, with clinically and sonographically insuspect axillary status and undergoing primary breast cancer surgery including SLNB and axillary staging in case of SLN (sentinel lymph node) metastases, were recruited into this multicentered study. ITC and micrometastases were found in 2.01 and 21.4% of patients with SLN metastases (n = 299). Among patients with sentinel micrometastases, 4.7% showed further axillary micrometastases, while only two patients (3.1%) had two axillary macrometastases. Multifocal and multicentric tumors were diagnosed in 9.3 and 2.6% of our patients who at least had one SLN resected, respectively. Detection rates of SLNs did not differ between the cohorts suffering from unicentric and multifocal or multicentric disease. Moreover, the portion of tumor-free SLNs, the number of SLNs with metastasis as well as the mean number of resected SLNs did not differ. No patient with sentinel node micrometastases showed more than two axillary macrometastases. Multifocal and multicentric disease is no contraindication for SLNB.

Primary scattered multifocal melanocytomas in spinal canal mimicking neurofibromatosis.

PubMed

Yang, Chenlong; Fang, Jingyi; Li, Guang; Yang, Jun; Xu, Yulun

2016-08-01

Meningeal melanocytoma is an extremely rare pigmented tumor derived from leptomeningeal melanocytes. By and large, it is considered to be a well-differentiated and slow-growing benign lesion. Generally, meningeal melanocytomas are solitary lesions, and the occurrence of the primary multifocal form in the central nervous system is exceedingly rare; it has been previously reported in only six cases. The present report illustrates a 41-year-old woman with primary multifocal meningeal melanocytoma in the spinal canal. Contrary to earlier reports, the tumors presented with a scattered appearance mimicking neurofibromatosis. This study is a case report and review of literature. On admission, the cerebral magnetic resonance images of the patient were normal, whereas the spinal magnetic resonance images showed scattered multifocal nodules mimicking neurofibromatosis. Surgical resection of the responsible lesions was scheduled. In addition to this case presentation, relevant previous reports were reviewed, and the challenging diagnosis, management, and prognosis of meningeal melanocytoma are discussed. Gross total resection of the two largest lesions was achieved, and histopathological examinations confirmed the diagnosis. Despite the benign histopathological findings, the patient had an aggressive clinical course. On follow-up at 18 months after surgery, she succumbed to the disease. Clinicians should be alert to a potential aggressive clinical course of meningeal melanocytoma, despite its benign histopathological nature. Of particular note is multifocality and diffuse leptomeningeal hyperpigmentation, which may suggest a poor prognosis. A combined treatment including surgical resection and adjuvant radiotherapy should be considered, and long-term close follow-up is necessary. Copyright © 2016. Published by Elsevier Inc.

Postmenopausal frontal fibrosing alopecia: a frontal variant of lichen planopilaris.

PubMed

Kossard, S; Lee, M S; Wilkinson, B

1997-01-01

Lichen planopilaris usually produces multifocal areas of scarring alopecia. Recently, a condition in postmenopausal women characterized by progressive frontal hairline recession associated with scarring has been described. Our purpose was to study the clinical and histopathologic features and results of treatment in a group of women with the frontal variant of lichen planopilaris and to compare the immunohistochemical profile of scalp biopsy specimens from this subset with that found in the multifocal variant of lichen planopilaris. The clinical data as well as the histopathologic findings in 16 women with frontal fibrosing alopecia were collated. The immunohistochemical profile of six scalp biopsy specimens from the frontal hairline were compared with six specimens from women with multifocal lichen planopilaris. In addition to the progressive frontal fibrosing alopecia in all 16 women, total loss or a marked decrease of the eyebrows was observed in 13. No evidence of lichen planus was observed at other sites. In one patient multifocal areas of lichen planopilaris developed in the scalp. The frontal fibrosing alopecia was slowly progressive but has stabilized in five patients. Biopsy specimens from the frontal hairline showed histologic changes identical to lichen planopilaris. Immunophenotyping failed to reveal any significant differences between the frontal and multifocal variants. No effective treatments emerged although oral steroids and antimalarials may temporarily slow the course. Hormone replacement therapy did not appear to influence the course of the alopecia. Progressive frontal fibrosing alopecia is a clinically distinct variant of lichen planopilaris that affects in particular elderly women and frequently involves the eyebrows. The basis for this lichenoid tissue reaction targeting frontal scalp follicles and eyebrows is unknown.

Randomized Crossover Trial of Silicone Hydrogel Presbyopic Contact Lenses.

PubMed

Sivardeen, Ahmed; Laughton, Deborah; Wolffsohn, James S

2016-02-01

To assess the performance of four commercially available silicone hydrogel multifocal monthly contact lens designs against monovision. A double-masked randomized crossover trial of Air Optix Aqua multifocal, PureVision 2 for Presbyopia, Acuvue OASYS for Presbyopia, Biofinity multifocal, and monovision with Biofinity contact lenses was conducted on 35 presbyopes (54.3 ± 6.2 years). After 4 weeks of wear, visual performance was quantified by high- and low-contrast visual acuity under photopic and mesopic conditions, reading speed, defocus curves, stereopsis, halometry, aberrometry, Near Activity Visual Questionnaire rating, and subjective quality of vision scoring. Bulbar, limbal, and palpebral hyperemia and corneal staining were graded to monitor the impact of each contact lens on ocular physiology. High-contrast photopic visual acuity (p = 0.102), reading speed (F = 1.082, p = 0.368), and aberrometry (F = 0.855, p = 0.493) were not significantly different between presbyopic lens options. Defocus curve profiles (p < 0.001), stereopsis (p < 0.001), halometry (F = 4.101, p = 0.004), Near Activity Visual Questionnaire (F = 3.730, p = 0.007), quality of vision (p = 0.002), bulbar hyperemia (p = 0.020), and palpebral hyperemia (p = 0.012) differed significantly between lens types, with the Biofinity multifocal lens design principal (center-distance lens was fitted to the dominant eye and a center-near lens to the nondominant eye) typically outperforming the other lenses. Although ocular aberration variation between individuals largely masks the differences in optics between current multifocal contact lens designs, certain design strategies can outperform monovision, even in early presbyopes.

Changes in accommodation and ocular aberration with simultaneous vision multifocal contact lenses.

PubMed

Ruiz-Alcocer, Javier; Madrid-Costa, David; Radhakrishnan, Hema; Ferrer-Blasco, Teresa; Montés-Micó, Robert

2012-09-01

The aim of this study was to evaluate ocular aberration changes through different simultaneous vision multifocal contact lenses (CLs). Eighteen young-adult subjects with a mean age of 29.8±2.11 years took part. Changes in accommodative response, spherical aberration (C(4)(0)), horizontal coma (C(3)(1)), vertical coma (C(3)(-1)), and root mean square (RMS) of higher-order aberrations (HOAs, third to sixth orders) were evaluated. Measurements were obtained with a distance-single vision CL and 2 aspheric multifocal CLs of simultaneous focus center-near design (PureVision Low Add and PureVision High Add) for 2 accommodative stimuli (-2.50 and -4.00 D). All measurements were performed monocularly with a Hartmann-Shack aberrometer (IRX-3; Imagine Eyes, Orsay, France). No statistically significant differences were found in accommodative responses to -2.50- and -4.00-D stimuli between the single vision CL and the 2 multifocal CLs. Spherical aberration was found to decrease and become more negative with accommodation for both stimuli with all three CLs. Horizontal coma decreased significantly with accommodation (-2.5- and -4.00-D stimuli) for the distance-single vision CLs (P=0.002 and P=0.003). No differences were found in vertical coma Zernike coefficients. The RMS of HOAs was found to decrease only with the single vision CLs for both stimuli (P<0.01). Data obtained in this study suggest that in young subjects, the multifocal CLs studied do not induce large changes in accommodative response compared with the distance-single vision CLs. Spherical aberration reduced significantly with accommodation.

Occurrence of intraocular air bubbles during intravitreal injections for retinopathy of prematurity.

PubMed

Sukgen, Emine Alyamac; Gunay, Murat; Kocluk, Yusuf

2017-02-01

This study aims to present five cases with retinopathy of prematurity (ROP) who were found to have intraocular air bubbles after intravitreal injection (IVI) treatment. The medical records of 148 infants who underwent IVI for ROP were retrospectively reviewed and the ones who demonstrated post-injection intraocular air bubble formation were recruited. Of the 148 patients (31 babies received ranibizumab, 20 babies received aflibercept, 97 babies received bevacizumab), five were found to have intraocular air bubbles right after the IVI. Two infants received intravitreal ranibizumab and three received intravitreal bevacizumab injections. Although intraocular pressure increased temporarily, no intraocular sterile or infective reactions were observed in the postoperative period. The air bubble was found to resorb spontaneously within 72 h. The occurrence rate of the intravitreal air bubbles in our series was 3.37 % despite previously not been reported in the literature. Due to the intravitreal air injection risk, it is important to be more careful while preparing the intravitreal medication before treatment in premature babies.

Multifocal Epithelial Hyperplasia.

PubMed

Agnew, Caitlin; Alexander, Sherene; Prabhu, Neeta

2017-01-15

Multifocal epithelial hyperplasia is a rare disease associated with human papilloma virus types 13 and 32. Diagnosis is based on clinical and histopathological findings, and most lesions are asymptomatic and regress spontaneously with time. The purpose of this paper is to describe a five-year-old girl who presented with multiple intraoral lesions on the buccal mucosa and tongue, which regressed spontaneously in 15 months.

Association of abnormal plasma bilirubin with aggressive HCC phenotype

PubMed Central

Carr, Brian I.; Guerra, Vito; Giannini, Edoardo G.; Farinati, Fabio; Ciccarese, Francesca; Rapaccini, Gian Ludovico; Marco, Maria Di; Benvegnù, Luisa; Zoli, Marco; Borzio, Franco; Caturelli, Eugenio; Chiaramonte, Maria; Trevisani, Franco

2014-01-01

Background Cirrhosis-related abnormal liver function is associated with predisposition to HCC, features in several HCC classification systems and is an HCC prognostic factor. Aims To examine the phenotypic tumor differences in HCC patients with normal or abnormal plasma bilirubin levels. Methods A 2,416 patient HCC cohort was studied and dichotomized into normal and abnormal plasma bilirubin groups. Their HCC characteristics were compared for tumor aggressiveness features, namely blood AFP levels, tumor size, presence of PVT and tumor multifocality. Results In the total cohort, elevated bilirubin levels were associated with higher AFP levels, increased PVT and multifocality and lower survival, despite similar tumor sizes. When different tumor size terciles were compared, similar results were found, even for small tumor size patients. A multiple logistic regression model for PVT or tumor multifocality showed increased OddsRatios for elevated levels of GGTP, bilirubin and AFP and for larger tumor sizes. Conclusions HCC patients with abnormal bilirubin levels had worse prognosis than patients with normal bilirubin. They also had increased incidence of PVT and tumor multifocality and higher AFP levels, in patients with both small and larger tumors. The results show an association between bilirubin levels and indices of HCC aggressiveness. PMID:24787296

Outcomes in multifocal neuroblastoma as part of the neurocristopathy syndrome.

PubMed

Williams, Phoebe; Wegner, Eva; Ziegler, David S

2014-08-01

The neurocristopathy syndrome occurs because of a germline mutation of the paired-like homeobox 2b (PHOX2B) gene at 4p12, a neurogenesis regulator gene. The result is abnormal neural crest cell development resulting in congenital central hypoventilation syndrome, Hirschsprung disease, and neuroblastoma (NB), which is often multifocal and disseminated in its presentation. Previously, such widespread disease was regarded as highly aggressive and treated either with palliative intent or, conversely, with very intense, high-dose chemotherapy. We now present a patient who had neurocristopathy syndrome who had multifocal NB associated with an underlying germline PHOX2B mutation. He was treated conservatively with surgery and low-dose chemotherapy. After treatment he had extensive residual disease that has continued to mature despite no further treatment. A literature review identified 26 similar patients presenting with multifocal NB as part of the neurocristopathy syndrome. In all cases the NB behaved in an indolent manner with no deaths from tumor reported when patients received appropriate treatment. These provocative findings suggest for the first time that children who have neurocristopathy-associated NB should be treated conservatively, despite the aggressive appearance of their disease. Copyright © 2014 by the American Academy of Pediatrics.

Professor Peter Choyce: an early pioneer of intraocular lenses and corneal/refractive surgery.

PubMed

Pandey, Suresh K; Apple, David J

2005-06-01

Professor Peter Choyce, FRCS, DOMS, MS, was one of the pioneers of intraocular lens implant surgery. He developed an interest in artificial lens implantation following cataract surgery, a procedure that was widely criticized by the ophthalmic establishment in the UK, Europe, North America and other countries. Owing to the opposition to the intraocular lenses, Peter Choyce together with Sir Harold Ridley co-founded the International Intraocular Implant Club in 1966, which was responsible for the gradual acceptance of artificial lens implantation. Peter Choyce developed several models of intraocular lens, but did not patent the majority of them. The Choyce Mark IX, manufactured by Rayner Intraocular Lenses, became the first US Food and Drug Administration-approved intraocular lens in 1981. A review of Peter Choyce's record confirms a significant number of original innovations in the field of anterior segment surgery, including many procedures taken for granted today, but not associated with his name. These include early work on both kerato- and intraocular lens-refractive procedures, keratoprosthesis, pioneering paediatric implant procedures and others. Unfortunately his tenacious adherence to anterior chamber lens technology, while in general clinically sound, caused many to question his influence and hence he remained poorly understood even until after his death. He passed away on 8 August 2001 after a long fight with colon cancer. In this article, we provide evidence and elaborate Peter Choyce's accomplishments, which places him as one of the most innovative ophthalmologist in his surgical field in the twentieth century.

Multifocal choroiditis - an unusual finding in Crohns disease.

PubMed

Vianna, R N G; Ozdal, P C; Deschnes, J

To report a patient with Crohns disease and acute decreased vision in one eye secondary to multifocal choroiditis and serous retinal detachment. A complete ocular examination, including fluorescein angiography, was performed. Fundus biomicroscopy disclosed multifocal, deep, discretely elevated yellowish lesions at the posterior pole of the affected eye. Fluorescein angiographic study of these lesions revealed early hypofluorescence followed by late yperfluorescence. Subtenonian injection of corticosteroids rapidly induced remission of the choroidal lesions. Chorioretinal involvement in patients with Crohns disease may or may not be related to reactivation of this disorder. Therefore, even patients without gastrointestinal symptoms who present with posterior segment inflammation must be informed of this. The chorioretinal inflammatory lesions do seem to respond promptly to periocular injection of corticosteroids. (Eur J Ophthalmol 2004; 14: 345-9).

Multifocal Neuropathy: Expanding the Scope of Double Crush Syndrome.

PubMed

Cohen, Brian H; Gaspar, Michael P; Daniels, Alan H; Akelman, Edward; Kane, Patrick M

2016-12-01

Double crush syndrome (DCS), as it is classically defined, is a clinical condition composed of neurological dysfunction due to compressive pathology at multiple sites along a single peripheral nerve. The traditional definition of DCS is narrow in scope because many systemic pathologic processes, such as diabetes mellitus, drug-induced neuropathy, vascular disease and autoimmune neuronal damage, can have deleterious effects on nerve function. Multifocal neuropathy is a more appropriate term describing the multiple etiologies (including compressive lesions) that may synergistically contribute to nerve dysfunction and clinical symptoms. This paper examines the history of DCS and multifocal neuropathy, including the epidemiology and pathophysiology in addition to principles of evaluation and management. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Intraocular (Uveal) Melanoma Symptoms, Tests, Prognosis, and Stages (PDQ®)—Patient Version

Cancer.gov

Intraocular melanoma is a rare cancer that forms from cells that make melanin in the eye. It is the most common eye cancer in adults and may not cause early signs or symptoms. Find out risk factors, tests to diagnose, prognosis, and staging for intraocular melanoma.

21 CFR 886.4270 - Intraocular gas.

Code of Federal Regulations, 2010 CFR

2010-04-01

... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4270 Intraocular gas. (a) Identification. An intraocular gas is a device consisting of a gaseous fluid intended to be introduced into the eye to place pressure... required. As of May 28, 1976, an approval under section 515 of the act is required before this device may...

21 CFR 886.4300 - Intraocular lens guide.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4300 Intraocular lens guide. (a) Identification. An intraocular lens guide is a device intended to be inserted into the eye during surgery to direct... lenses, the device is exempt from the premarket notification procedures in subpart E of part 807 of this...

Severe pigment dispersion after iris-claw phakic intraocular lens implantation.

PubMed

Galvis, Virgilio; Carreño, Néstor I; Tello, Alejandro; Laiton, Andrea N

2017-12-01

A 23-year-old female patient presented 3 months after the implantation of an Artisan® phakic intraocular lens with a severe depigmentation of the iris and peripheral anterior synechiae. Explantation of the intraocular lens and goniosynechialysis were performed. Eleven months after the explantation appearance of the iris significantly improved. There was no loss of lines of corrected distance visual acuity. Severe pigment dispersion after the implantation of an Artisan® phakic intraocular lens may happen and may require explantation of the lens. Iris depigmentation may improve with time.

Topical tissue plasminogen activator appears ineffective for the clearance of intraocular fibrin.

PubMed

Zwaan, J; Latimer, W B

1998-06-01

To determine the efficacy of topical tissue plasminogen activator (tPA) for the resolution of postoperative or inflammatory intraocular fibrinous exudates. Each treatment consisted of drops of 1 mg/ml tPA given 9 times 5 minutes apart. Records were reviewed and the results at 24 and 48 hours were recorded. Sixty-two patients had a total of 94 treatments. Fibrin exudates following intraocular surgery in 34 patients were treated 44 times. In 6 patients there was a positive result. Fibrin associated with intraocular infection was treated in 9 patients. None showed clear improvement. Nineteen patients had a total of 34 treatments for poorly controlled intraocular pressure (IOP) after glaucoma surgery. Five patients showed adequate control of the IOP, 12 did not change, and 2 had a questionable improvement. Eleven patients had adequate IOP control after additional treatment. Seven required suture lysis, 2 ab interno bleb revision, and 2 YAG capsulotomy or iridotomy to reduce the IOP to an acceptable level. Within the limits of this retrospective study and taking into account that fibrin may resolve spontaneously, it appears that topical tPA drops are not effective for the liquefaction of intraocular fibrin after surgery or in association with intraocular inflammation. They did not improve IOP control after glaucoma surgery.

The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators.

PubMed

2000-10-01

To investigate the association between control of intraocular pressure after surgical intervention for glaucoma and visual field deterioration. In the Advanced Glaucoma Intervention Study, eyes were randomly assigned to one of two sequences of glaucoma surgery, one beginning with argon laser trabeculoplasty and the other trabeculectomy. In the present article we examine the relationship between intraocular pressure and progression of visual field damage over 6 or more years of follow-up. In the first analysis, designated Predictive Analysis, we categorize 738 eyes into three groups based on intraocular pressure determinations over the first three 6-month follow-up visits. In the second analysis, designated Associative Analysis, we categorize 586 eyes into four groups based on the percent of 6-month visits over the first 6 follow-up years in which eyes presented with intraocular pressure less than 18 mm Hg. The outcome measure in both analyses is change from baseline in follow-up visual field defect score (range, 0 to 20 units). In the Predictive Analysis, eyes with early average intraocular pressure greater than 17.5 mm Hg had an estimated worsening during subsequent follow-up that was 1 unit of visual field defect score greater than eyes with average intraocular pressure less than 14 mm Hg (P =.002). This amount of worsening was greater at 7 years (1.89 units; P <.001) than at 2 years (0.64 units; P =.071). In the Associative Analysis, eyes with 100% of visits with intraocular pressure less than 18 mm Hg over 6 years had mean changes from baseline in visual field defect score close to zero during follow-up, whereas eyes with less than 50% of visits with intraocular pressure less than 18 mm Hg had an estimated worsening over follow-up of 0.63 units of visual field defect score (P =.083). This amount of worsening was greater at 7 years (1.93 units; P <.001) than at 2 years (0.25 units; P =.572). In both analyses low intraocular pressure is associated with reduced progression of visual field defect, supporting evidence from earlier studies of a protective role for low intraocular pressure in visual field deterioration.

[Multifocal Langerhans cell histiocytosis of bone: late revelation in a 76-year-old woman].

PubMed

Lahiani, D; Hammami, B K; Maâloul, I; Frikha, M; Baklouti, S; Jlidi, R; Ben Jemaâ, M

2008-03-01

Langerhans cell histiocytosis or histiocytosis X has a variable course from a self-limited eosinophilic granuloma to an aggressive disseminated disease. It mainly affects children. We report a 76-year-old woman with multifocal bone histiocytosis X, involving the rachis, an iliac bone and the skull. The diagnosis has been established by histological exam. Outcome was favourable after chemotherapy.

Compensating additional optical power in the central zone of a multifocal contact lens forminimization of the shrinkage error of the shell mold in the injection molding process.

PubMed

Vu, Lien T; Chen, Chao-Chang A; Lee, Chia-Cheng; Yu, Chia-Wei

2018-04-20

This study aims to develop a compensating method to minimize the shrinkage error of the shell mold (SM) in the injection molding (IM) process to obtain uniform optical power in the central optical zone of soft axial symmetric multifocal contact lenses (CL). The Z-shrinkage error along the Z axis or axial axis of the anterior SM corresponding to the anterior surface of a dry contact lens in the IM process can be minimized by optimizing IM process parameters and then by compensating for additional (Add) powers in the central zone of the original lens design. First, the shrinkage error is minimized by optimizing three levels of four IM parameters, including mold temperature, injection velocity, packing pressure, and cooling time in 18 IM simulations based on an orthogonal array L 18 (2 1 ×3 4 ). Then, based on the Z-shrinkage error from IM simulation, three new contact lens designs are obtained by increasing the Add power in the central zone of the original multifocal CL design to compensate for the optical power errors. Results obtained from IM process simulations and the optical simulations show that the new CL design with 0.1 D increasing in Add power has the closest shrinkage profile to the original anterior SM profile with percentage of reduction in absolute Z-shrinkage error of 55% and more uniform power in the central zone than in the other two cases. Moreover, actual experiments of IM of SM for casting soft multifocal CLs have been performed. The final product of wet CLs has been completed for the original design and the new design. Results of the optical performance have verified the improvement of the compensated design of CLs. The feasibility of this compensating method has been proven based on the measurement results of the produced soft multifocal CLs of the new design. Results of this study can be further applied to predict or compensate for the total optical power errors of the soft multifocal CLs.

Multi-focal HIFU reduces cavitation in mild-hyperthermia.

PubMed

Chaplin, Vandiver; Caskey, Charles F

2017-01-01

Mild-hyperthermia therapy (40-45 °C) with high-intensity focused ultrasound (HIFU) is a technique being considered in a number of different treatments such as thermally activated drug delivery, immune-stimulation, and as a chemotherapy adjuvant. Mechanical damage and loss of cell viability associated with HIFU-induced acoustic cavitation may pose a risk during these treatments or may hinder their success. Here we present a method that achieves mild heating and reduces cavitation by using a multi-focused HIFU beam. We quantify cavitation level and temperature rise in multi-focal sonications and compare it to single-focus sonications at the transducer geometric focus. Continuous wave sonications were performed with the Sonalleve V2 transducer in gel phantoms and pork at 5, 10, 20, 40, 60, 80 acoustic watts for 30 s. Cavitation activity was measured with two ultrasound (US) imaging probes, both by computing the raw channel variance and using passive acoustic mapping (PAM). Temperature rise was measured with MR thermometry at 3 T. Cavitation and heating were compared for single- and multi-focal sonication geometries. Multi-focal sonications used four points equally spaced on a ring of either 4 mm or 8 mm diameter. Single-focus sonications were not steered. Multi-focal sonication generated distinct foci that were visible in MRI thermal maps in both phantoms and pork, and visible in PAM images in phantoms only. Cavitation activity (measured by channel variance) and mean PAM image value were highly correlated (r > 0.9). In phantoms, cavitation exponentially decreased over the 30-second sonication, consistent with depletion of cavitation nuclei. In pork, sporadic spikes signaling cavitation were observed with single focusing only. In both materials, the widest beam reduced average and peak cavitation level by a factor of two or more at each power tested when compared to a single focus. The widest beam reduced peak temperature by at least 10 °C at powers above 5 W, and created heating that was more spatially diffuse than single focus, resulting in more voxels in the mild heating (3-8 °C) range. Multi-focal HIFU can be used to achieve mild temperature elevation and reduce cavitation activity.

Population-based Incidence of Intraocular Lens Exchange in Olmsted County, Minnesota.

PubMed

Bothun, Erick D; Cavalcante, Lilian C B; Hodge, David O; Patel, Sanjay V

2018-03-01

To determine the population-based incidence of pseudophakic intraocular lens exchange in Olmsted County, Minnesota. Retrospective review of a population-based cohort. Patients undergoing pseudophakic intraocular lens exchange in Olmsted County, Minnesota, between January 1, 1986 and December 31, 2016 were identified from the Rochester Epidemiology Project medical record linkage system. Indications and outcomes were determined, and the incidence rate was calculated as cases per 1 000 000 person-years. Poisson regression analysis was used to assess changes in incidence over time, and the cumulative probability of needing a lens exchange was estimated by Kaplan-Meier analysis. Eighty cases of intraocular lens exchange were identified, yielding an overall age- and sex-adjusted incidence rate of 28.4 per million (confidence interval [CI], 22.1-34.7), which increased over the study period (P = .04). The 30-year cumulative probability of intraocular lens exchange among patients undergoing cataract surgery was 1.5% (CI, 0.6%-2.4%), increasing at a relatively constant rate. Dislocated lenses accounted for 72.5% of lens exchanges. Unplanned refractive outcome of primary cataract surgery and uveitis-glaucoma-hyphema syndrome from squared-edged haptics emerged as newer indications for intraocular lens exchange. The population-based incidence of pseudophakic intraocular lens exchange has increased over the last 30 years, and can be explained by the increase in incidence rate of cataract surgery over the same period. Surgeons should be aware of emerging indications of intraocular lens exchange, which reflect changes in lens design and increasing expectations of refractive outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

The intraocular pressure response to dehydration: a pilot study.

PubMed

Hunt, Andrew P; Feigl, Beatrix; Stewart, Ian B

2012-05-01

The aim of this study was to determine the intraocular pressure response to differing levels of dehydration. Seven males participated in 90 min of treadmill walking (5 km h(-1) and 1% grade) in both temperate (22 °C) and hot (43 °C) conditions. At baseline and 30 min intervals intraocular pressure, nude body mass, body temperature and heart rate were recorded. Statistically significant interactions (p < 0.05) were observed for intraocular pressure (hot condition: baseline 17.0 ± 2.9, 30 min 15.6 ± 3.5, 60 min 14.5 ± 3.7 and 90 min 13.6 ± 2.9 mmHg; temperate condition: baseline 16.8 ± 2.7, 30 min 16.5 ± 2.6, 60 min 15.8 ± 2.5 and 90 min 15.7 ± 1.8 mmHg) and body mass loss (hot condition: 30 min -1.07 ± 0.35, 60 min -2.17 ± 0.55 and 90 min -3.13 ± 0.74%; temperate condition: 30 min -0.15 ± 0.11, 60 min -0.47 ± 0.18 and 90 min -0.78 ± 0.25%). Significant linear regressions (p < 0.05) were observed for intraocular pressure and body mass loss (adjusted r(2) = 0.24) and intraocular pressure change and body mass loss (adjusted r(2) = 0.51). In conclusion, intraocular pressure was progressively reduced during a period of exercise causing dehydration, but remained relatively stable when hydration was maintained. The present study revealed a moderate relationship between dehydration (body mass loss) and intraocular pressure change.

Reproducibility of intraocular pressure peak and fluctuation of the water-drinking test.

PubMed

Hatanaka, Marcelo; Alencar, Luciana M; De Moraes, Carlos G; Susanna, Remo

2013-01-01

The water-drinking test has been used as a stress test to evaluate the drainage system of the eye. However, in order to be clinically applicable,a test must provide reproducible results with consistent measurements. This study was performed to verify the reproducibility of intraocular pressure peaks and fluctuation detected during the water-drinking test in patients with ocular hypertension and open-angle glaucoma. A prospective analysis of patients in a tertiary care unit for glaucoma treatment. Twenty-four ocular hypertension and 64 open-angle glaucoma patients not under treatment. The water-drinking test was performed in 2 consecutive days by the same examiners in patients not under treatment. Reproducibility was assessed using the intraclass correlation coefficient. Peak and fluctuation of intraocular pressure obtained with the water-drinking test were analysed for reproducibility. Eighty-eight eyes from 24 ocular hypertension and 64 open-angle glaucoma patients not under treatment were evaluated. Test and retest intraocular pressure peak values were 28.38 ± 4.64 and 28.38 ± 4.56 mmHg, respectively (P = 1.00). Test and retest intraocular pressure fluctuation values were 5.75 ± 3.9 and 4.99 ± 2.7 mmHg, respectively (P = 0.06). Based on intraclass coefficient, reproducibility was excellent for peak intraocular pressure (intraclass correlation coefficient = 0.79) and fair for intraocular pressure fluctuation (intraclass correlation coefficient = 0.37). Intraocular pressure peaks detected during the water-drinking test presented excellent reproducibility, whereas the reproducibility of fluctuation was considered fair. © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

Comprehensive molecular characterization of multifocal glioblastoma proves its monoclonal origin and reveals novel insights into clonal evolution and heterogeneity of glioblastomas.

PubMed

Abou-El-Ardat, Khalil; Seifert, Michael; Becker, Kerstin; Eisenreich, Sophie; Lehmann, Matthias; Hackmann, Karl; Rump, Andreas; Meijer, Gerrit; Carvalho, Beatriz; Temme, Achim; Schackert, Gabriele; Schröck, Evelin; Krex, Dietmar; Klink, Barbara

2017-04-01

The evolution of primary glioblastoma (GBM) is poorly understood. Multifocal GBM (ie, multiple synchronous lesions in one patient) could elucidate GBM development. We present the first comprehensive study of 12 GBM foci from 6 patients using array-CGH, spectral karyotyping, gene expression arrays, and next-generation sequencing. Multifocal GBMs genetically resemble primary GBMs. Comparing foci from the same patient proved their monoclonal origin. All tumors harbored alterations in the 3 GBM core pathways: RTK/PI3K, p53, and RB regulatory pathways with aberrations of EGFR and CDKN2A/B in all (100%) patients. This unexpected high frequency reflects a distinct genetic signature of multifocal GBMs and might account for their highly malignant and invasive phenotype. Surprisingly, the types of mutations in these genes/pathways were different in tumor foci from the same patients. For example, we found distinct mutations/aberrations in PTEN, TP53, EGFR, and CDKN2A/B, which therefore must have occurred independently and late during tumor development. We also identified chromothripsis as a late event and in tumors with wild-type TP53. Only 2 events were found to be early in all patients: single copy loss of PTEN and TERT promoter point mutations. Multifocal GBMs develop through parallel genetic evolution. The high frequency of alterations in 3 main pathways suggests that these are essential steps in GBM evolution; however, their late occurrence indicates that they are not founder events but rather subclonal drivers. This might account for the marked genetic heterogeneity seen in primary GBM and therefore has important implications for GBM therapy. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Neuro-Oncology.

Multifocal Motor Neuropathy, Multifocal Acquired Demyelinating Sensory and Motor Neuropathy and Other Chronic Acquired Demyelinating Polyneuropathy Variants

PubMed Central

Barohn, Richard J.; Katz, Jonathan

2014-01-01

Chronic acquired demyelinating neuropathies (CADP) are an important group of immune neuromuscular disorders affecting myelin. These are distinct from chronic inflammatory demyelinating polyneuropathy (CIDP). Classically, CIDP is characterized by proximal and distal weakness, large fiber sensory loss, elevated cerebrospinal fluid (CSF) protein content, demyelinating changes nerve conduction studies or nerve biopsy, and response to immunomodulating treatment. In this chapter we discuss CADP with emphasis on multifocal motor neuropathy (MMN), multifocal acquired demyelinating sensory and motor neuropathy (MADSAM), distal acquired demyelinating symmetric (DADS) neuropathy and conclude with less common variants. While each of these entities has distinctive laboratory and electrodiagnostic features that aid in their diagnosis, clinical characteristics are of paramount importance in diagnosing specific conditions and determining the most appropriate therapies. Unlike CIDP, MMN is typically asymmetric and affects only the motor nerve fibers. MMN is a rare disease that presents chronically, over several years of progression affecting the arms are more commonly than the legs. Men are more likely than women to develop MMN. MADSAM should be suspected in patients who have weakness and loss of sensation in primarily one arm or leg which progresses slowly over several months to years. It is important in patient with multifocal demyelinating clinical presentation to distinguish MMN from MADSAM since corticosteroids are not effective in MMN where the mainstay of therapy is intravenous gammaglobulin (IVIg). DADS can be subdivided into DADS-M (associated woth M-protein) and DADS-I which is idioapthic. While DADS-I patients respond somewhat to immunotherapy, DADS-M patients present with distal predominant sensorimotor demyelinating neuropathy phenotype and are notoriously refractory to immunotherapies regardless of antibodies to myelin-associated glycoprotein (MAG). Our knowledge regarding pathogenesis, diagnosis and management continues to expand, resulting in improved opportunities for identification and treatment. PMID:23642723

Evaluation of refractive correction for standard automated perimetry in eyes wearing multifocal contact lenses

PubMed Central

Hirasawa, Kazunori; Ito, Hikaru; Ohori, Yukari; Takano, Yui; Shoji, Nobuyuki

2017-01-01

AIM To evaluate the refractive correction for standard automated perimetry (SAP) in eyes with refractive multifocal contact lenses (CL) in healthy young participants. METHODS Twenty-nine eyes of 29 participants were included. Accommodation was paralyzed in all participants with 1% cyclopentolate hydrochloride. SAP was performed using the Humphrey SITA-standard 24-2 and 10-2 protocol under three refractive conditions: monofocal CL corrected for near distance (baseline); multifocal CL corrected for distance (mCL-D); and mCL-D corrected for near vision using a spectacle lens (mCL-N). Primary outcome measures were the foveal threshold, mean deviation (MD), and pattern standard deviation (PSD). RESULTS The foveal threshold of mCL-N with both the 24-2 and 10-2 protocols significantly decreased by 2.2-2.5 dB (P<0.001), while that of mCL-D with the 24-2 protocol significantly decreased by 1.5 dB (P=0.0427), as compared with that of baseline. Although there was no significant difference between the MD of baseline and mCL-D with the 24-2 and 10-2 protocols, the MD of mCL-N was significantly decreased by 1.0-1.3 dB (P<0.001) as compared with that of both baseline and mCL-D, with both 24-2 and 10-2 protocols. There was no significant difference in the PSD among the three refractive conditions with both the 24-2 and 10-2 protocols. CONCLUSION Despite the induced mydriasis and the optical design of the multifocal lens used in this study, our results indicated that, when the dome-shaped visual field test is performed with eyes with large pupils and wearing refractive multifocal CLs, distance correction without additional near correction is to be recommended. PMID:29062776

Evaluation of refractive correction for standard automated perimetry in eyes wearing multifocal contact lenses.

PubMed

Hirasawa, Kazunori; Ito, Hikaru; Ohori, Yukari; Takano, Yui; Shoji, Nobuyuki

2017-01-01

To evaluate the refractive correction for standard automated perimetry (SAP) in eyes with refractive multifocal contact lenses (CL) in healthy young participants. Twenty-nine eyes of 29 participants were included. Accommodation was paralyzed in all participants with 1% cyclopentolate hydrochloride. SAP was performed using the Humphrey SITA-standard 24-2 and 10-2 protocol under three refractive conditions: monofocal CL corrected for near distance (baseline); multifocal CL corrected for distance (mCL-D); and mCL-D corrected for near vision using a spectacle lens (mCL-N). Primary outcome measures were the foveal threshold, mean deviation (MD), and pattern standard deviation (PSD). The foveal threshold of mCL-N with both the 24-2 and 10-2 protocols significantly decreased by 2.2-2.5 dB ( P <0.001), while that of mCL-D with the 24-2 protocol significantly decreased by 1.5 dB ( P =0.0427), as compared with that of baseline. Although there was no significant difference between the MD of baseline and mCL-D with the 24-2 and 10-2 protocols, the MD of mCL-N was significantly decreased by 1.0-1.3 dB ( P <0.001) as compared with that of both baseline and mCL-D, with both 24-2 and 10-2 protocols. There was no significant difference in the PSD among the three refractive conditions with both the 24-2 and 10-2 protocols. Despite the induced mydriasis and the optical design of the multifocal lens used in this study, our results indicated that, when the dome-shaped visual field test is performed with eyes with large pupils and wearing refractive multifocal CLs, distance correction without additional near correction is to be recommended.

The effect of multifocal soft contact lenses on peripheral refraction.

PubMed

Kang, Pauline; Fan, Yvonne; Oh, Kelly; Trac, Kevin; Zhang, Frank; Swarbrick, Helen A

2013-07-01

To compare changes in peripheral refraction with single-vision (SV) and multifocal (MF) correction of distance central refraction with commercially available SV and MF soft contact lenses (SCLs) in young myopic adults. Thirty-four myopic adult subjects were fitted with Proclear Sphere and Proclear Multifocal SCLs to correct their manifest central refractive error. Central and peripheral refraction were measured with no lens wear and subsequently with the two different types of SCL correction. At baseline, refraction was myopic at all locations along the horizontal meridian. Peripheral refraction was relatively hyperopic compared with center at 30 and 35 degrees in the temporal visual field (VF) in low myopes, and at 30 and 35 degrees in the temporal VF, and 10, 30, and 35 degrees in the nasal VF in moderate myopes. Single-vision and MF distance correction with Proclear Sphere and Proclear Multifocal SCLs, respectively, caused a hyperopic shift in refraction at all locations in the horizontal VF. Compared with SV correction, MF SCL correction caused a significant relative myopic shift at all locations in the nasal VF in both low and moderate myopes and also at 35 degrees in the temporal VF in moderate myopes. Correction of central refractive error with SV and MF SCLs caused a hyperopic shift in both central and peripheral refraction at all positions in the horizontal meridian. Single-vision SCL correction caused the peripheral retina, which initially experienced absolute myopic defocus at baseline with no correction to experience an absolute hyperopic defocus. Multifocal SCL correction resulted in a relative myopic shift in peripheral refraction compared with SV SCL correction. This myopic shift may explain recent reports of reduced myopia progression rates with MF SCL correction.

Overcoming Presbyopia by Manipulating the Eyes' Optics

NASA Astrophysics Data System (ADS)

Zheleznyak, Leonard A.

Presbyopia, the age-related loss of accommodation, is a visual condition affecting all adults over the age of 45 years. In presbyopia, individuals lose the ability to focus on nearby objects, due to a lifelong growth and stiffening of the eye's crystalline lens. This leads to poor near visual performance and affects patients' quality of life. The objective of this thesis is aimed towards the correction of presbyopia and can be divided into four aims. First, we examined the characteristics and limitations of currently available strategies for the correction of presbyopia. A natural-view wavefront sensor was used to objectively measure the accommodative ability of patients implanted with an accommodative intraocular lens (IOL). Although these patients had little accommodative ability based on changes in power, pupil miosis and higher order aberrations led to an improvement in through-focus retinal image quality in some cases. To quantify the through-focus retinal image quality of accommodative and multifocal IOLs directly, an adaptive optics (AO) IOL metrology system was developed. Using this system, the impact of corneal aberrations in regard to presbyopia-correcting IOLs was assessed, providing an objective measure of through-focus retinal image quality and practical guidelines for patient selection. To improve upon existing multifocal designs, we investigated retinal image quality metrics for the prediction of through-focus visual performance. The preferred metric was based on the fidelity of an image convolved with an aberrated point spread function. Using this metric, we investigated the potential of higher order aberrations and pupil amplitude apodization to increase the depth of focus of the presbyopic eye. Thirdly, we investigated modified monovision, a novel binocular approach to presbyopia correction using a binocular AO vision simulator. In modified monovision, different magnitudes of defocus and spherical aberration are introduced to each eye, thereby taking advantage of the binocular visual system. Several experiments using the binocular AO vision simulator found modified monovision led to significant improvements in through-focus visual performance, binocular summation and stereoacuity, as compared to traditional monovision. Finally, we addressed neural factors, affecting visual performance in modified monovision, such as ocular dominance and neural plasticity. We found that pairing modified monovision with a vision training regimen may further improve visual performance beyond the limits set by optics via neural plasticity. This opens the door to an exciting new avenue of vision correction to accompany optical interventions. The research presented in this thesis offers important guidelines for the clinical and scientific communities. Furthermore, the techniques described herein may be applied to other fields of ophthalmology, such as childhood myopia progression.

Ocular Onchocerciasis in the Yanomami Communities from Brazilian Amazon: Effects on Intraocular Pressure

PubMed Central

Herzog-Neto, Guilherme; Jaegger, Karen; do Nascimento, Erika S.; Marchon-Silva, Verônica; Banic, Dalma M.; Maia-Herzog, Marilza

2014-01-01

To determine the influence of onchocercal eye disease on the intraocular pressure of the Yanomami Tribe Aratha-ú of Roraima State, Brazil, considered endemic for onchocerciasis, a total of 86 patients were submitted to an ophthalmologic exam that included external examination, slit lamp examination, intraocular pressure measurement, and a fundus ophthalmoscope examination. A high prevalence of onchocerciasis-related eye lesions was encountered in 68.6% of the patients. Punctate keratitis and microfilariae in the anterior chamber were found in ∼28%. The mean of intraocular eye pressure found was 10.47 mm of Hg. PMID:24297812

Ocular onchocerciasis in the Yanomami communities from Brazilian Amazon: effects on intraocular pressure.

PubMed

Herzog-Neto, Guilherme; Jaegger, Karen; Nascimento, Erika S do; Marchon-Silva, Verônica; Banic, Dalma M; Maia-Herzog, Marilza

2014-01-01

To determine the influence of onchocercal eye disease on the intraocular pressure of the Yanomami Tribe Aratha-ú of Roraima State, Brazil, considered endemic for onchocerciasis, a total of 86 patients were submitted to an ophthalmologic exam that included external examination, slit lamp examination, intraocular pressure measurement, and a fundus ophthalmoscope examination. A high prevalence of onchocerciasis-related eye lesions was encountered in 68.6% of the patients. Punctate keratitis and microfilariae in the anterior chamber were found in ∼28%. The mean of intraocular eye pressure found was 10.47 mm of Hg.

Evaluation of the Goldmann-Witmer coefficient in the immunological diagnosis of ocular toxocariasis.

PubMed

Wang, Zhu Jian; Zhou, Min; Cao, Wen Jun; Ji, Jian; Bi, Ying Wen; Huang, Xin; Xu, Ge Zhi

2016-06-01

Ocular toxocariasis (OT) is a zoonotic parasitic infection mainly caused by the intraocular tissue invasion of second-stage Toxocara canis or Toxocara cati larva. Measuring specific anti-T. canis antibodies in the intraocular fluid (IF) can increase OT diagnosis accuracy using Goldmann-Witmer coefficient (GWC). However, there is no systemic evaluation of GWC application in the immunological diagnosis of OT. To assess GWC for the immunodiagnosis of ocular toxocariasis, paired IF and serum samples from 72 patients diagnosed with OT were retrospectively analyzed for specific anti-T. canis IgG by enzyme linked immunosorbent assay (ELISA). GWC values were calculated to determine intraocular specific IgG production. Clinical features and other laboratory data were recorded, and their correlations with GWC evaluated. Of the 72 OT patients, 60 (83.33%) showed intraocular specific IgG production confirmed by GWC, while intraocular nonspecific IgE production was found in 64/69 (92.75%) cases. No significant correlation was found among clinical features and IF specific IgG production. Values for peripheral blood samples were lower than those of intraocular fluid regarding OT screening, and vitreous humor samples showed increased local specific IgG and nonspecific IgE production compared with aqueous humor samples. Overall, our results indicate that GWC and intraocular IgE production have referential values in diagnosing ocular toxocariasis. Copyright © 2016 Elsevier B.V. All rights reserved.

EX VIVO MODEL FOR THE CHARACTERIZATION AND IDENTIFICATION OF DRYWALL INTRAOCULAR FOREIGN BODIES ON COMPUTED TOMOGRAPHY.

PubMed

Syed, Reema; Kim, Sung-Hye; Palacio, Agustina; Nunery, William R; Schaal, Shlomit

2017-06-06

The study was inspired after the authors encountered a patient with a penetrating globe injury due to drywall, who had retained intraocular drywall foreign body. Computed tomography (CT) was read as normal in this patient. Open globe injury with drywall has never been reported previously in the literature and there are no previous studies describing its radiographic features. The case report is described in detail elsewhere. This was an experimental study. An ex vivo model of 15 porcine eyes with 1 mm to 5 mm fragments of implanted drywall, 2 vitreous only samples with drywall and 3 control eyes were used. Eyes and vitreous samples were CT scanned on Days 0, 1, and 3 postimplantation. Computed ocular images were analyzed by masked observers. Size and radiodensity of intraocular drywall were measured using Hounsfield units (HUs) over time. Intraocular drywall was hyperdense on CT. All sizes studied were detectable on Day 0 of scanning. Mean intraocular drywall foreign body density was 171 ± 52 Hounsfield units (70-237) depending on fragment size. Intraocular drywall foreign body decreased in size whereas Hounsfield unit intensity increased over time. Drywall dissolves in the eye and becomes denser over time as air in the drywall is replaced by fluid. This study identified Hounsfield Units specific to intraocular drywall foreign body over time.

Multifocal recurrent periostitis. Report of two cases.

PubMed

Kozlowski, K; Anderson, R; Tink, A

1981-11-01

Two case reports of recurrent multifocal periostitis in two girls aged 15 and 6 are added to the eight cases already reported in the literature. The disease is characterized clinically by recurrent mesomelic swelling of the extremities and radiologically by periosteal thickening and sclerosis of underlying bone. Hyperglobulinaemia is the most constant biochemical finding. The bone biopsy shows no typical features. The possibility of a viral etiology is discussed.

Multifocal recurrent periostitis responsive to colchicine.

PubMed

Festen, J J; Kuipers, F C; Schaars, A H

1985-01-01

A brother and sister with multifocal recurrent periostitis are presented. Their disease started at an early age and manifested itself as an episodic migrating arthropathy. At roentgenography, reversible solid periosteal reactions were visible along large tubular bones. Scintigraphic and histological investigations revealed a sterile osteitis and thickened periosteum, but there was no indication of a viral infection. The girl experienced spontaneous amelioration after puberty; the boy improved markedly on colchicine.

Childhood-Onset Multifocal Motor Neuropathy With Immunoglobulin M Antibodies to Gangliosides GM1 and GM2: A Case Report and Review of the Literature.

PubMed

Ishigaki, Hidetoshi; Hiraide, Takuya; Miyagi, Yoshifumi; Hayashi, Taiju; Matsubayashi, Tomoko; Shimoda, Ayumi; Kusunoki, Susumu; Fukuda, Tokiko

2016-09-01

Multifocal motor neuropathy is a rare immune-mediated neuropathy characterized by progressive asymmetric weakness and atrophy without sensory abnormalities. Although disease onset is usually in adulthood, a few childhood-onset cases have been reported. Here, we report the case of an 8-year-old boy with multifocal motor neuropathy who presented with a slowly progressive left and distal upper limb weakness without sensory loss. The initial high-dose intravenous immunoglobulin treatment significantly improved left upper limb muscle weakness. Continued monthly intravenous immunoglobulin treatment gradually improved muscle strength for several months initially. While the muscle strength decreased slightly after 8 months of therapy, it was better than that before intravenous immunoglobulin treatment. One year and eight months after the initiation of treatment, serum testing for IgM antibodies to gangliosides, GM1 and GM2, was negative. This is the first pediatric report of the serum IgM autoantibodies positive to GM1 and GM2. The clinical course is similar to that of partial intravenous immunoglobulin responders among patients with adulthood-onset multifocal motor neuropathy. Since the symptoms plateaued after the initial intravenous immunoglobulin therapy, prognosis appears to be determined by the patient's initial response to intravenous immunoglobulin treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

[Multifocal Electroretinography in Patients with Poppers Maculopathy].

PubMed

Pahlitzsch, Milena; Salchow, Daniel; Rossel, Mirjam; Bergholz, Richard

2017-10-12

Background Maculopathy is a potential side effect of amyl nitrite or "poppers" abuse. It is characterized by a sudden, painless decrease in visual acuity. While the funduscopic changes are subtle, optical coherence tomography shows alterations of the outer retinal layers in the fovea. However, the extent of retinal dysfunction remains poorly understood. Materials/Methods We compared the multifocal electroretinogram of 6 patients with poppers maculopathy to that of a control group consisting of 6 healthy subjects. Response densities and implicit times of N1 and P1 were analyzed. Results Response densities and implicit times of both N1 and P1 were lower in the patients with poppers maculopathy than in the control group, particularly in ring 1 and rings 4 and 5. The only statistically significant finding, however, was a reduced N1 response density of one hexagon in the patient group. No significant differences were found considering the sum response or the averaged rings 1 to 5. Conclusion Compared to a healthy control group, the multifocal electroretinogram of patients with poppers maculopathy shows no relevant impairment. This contrasts the marked effect of the disease on visual acuity. In clinical practice, poppers maculopathy cannot be diagnosed by multifocal electroretinography. Georg Thieme Verlag KG Stuttgart · New York.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY SHOWS INNER CHOROIDAL ISCHEMIA IN ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY.

PubMed

Dolz-Marco, Rosa; Sarraf, David; Giovinazzo, Vincent; Freund, K Bailey

2017-01-01

To describe multimodal imaging findings of an evolving case of acute posterior multifocal placoid pigment epitheliopathy occurring in a young healthy male. Case report of a patient with acute posterior multifocal placoid pigment epitheliopathy including comprehensive systemic and ocular examinations. Ultra-widefield autofluorescence, fluorescein angiography, indocyanine green angiography, and serial optical coherence tomography angiography were performed. A 34-year-old male presented with acute vision loss in his left eye for 2 weeks. His best-corrected visual acuity was 20/20 in his right eye and 20/200 in his left eye. Dilated funduscopic examination revealed multiple creamy white deep retinal lesions showing macular involvement of the left eye with a diffuse area of pigmentary changes. The presence of multiple areas of hypoperfusion of the inner choroid were demonstrated with fluorescein and indocyanine green angiography. Serial optical coherence tomography angiography showed multiple evolving areas of decreased flow at the level of the inner choroid. Although the pathogenesis of acute posterior multifocal placoid pigment epitheliopathy remains unknown, there is growing evidence of a primary choroidal involvement with secondary damage to the overlying retinal pigment epithelium and the outer retinal layers. Optical coherence tomography angiography may provide valuable information for the diagnosis and follow-up of this condition avoiding invasive angiographic procedures.

Topical 5% 5-fluorouracil in the treatment of multifocal basal cell carcinoma of the face: A novel chemotherapeutic approach.

PubMed

Naik, Mayuresh P; Mehta, Anuj; Abrol, Sangeeta; Kumar, Sandeep; Gupta, Vishnu S

2016-12-01

To determine the safety and efficacy of topical 5-fluorouracil (5-FU) 5% ointment in treatment of non-syndromic multifocal basal cell carcinoma. A 55-year-old male patient, with 8 hours of daily sun exposure, having histologically proven and radiologically non-syndromic, multifocal basal cell carcinoma with involvement of 6 sites on the face, was treated with topical 5-FU 5% ointment twice daily over all sites except the site involving lid margin to prevent corneal toxicity. Left lid lesion underwent wide surgical excision with 5-mm clear margins and reconstruction with nasal septal mucoperichondrium and local skin mobilization. Pharmacologic effects first appeared at 4 weeks and by 8 weeks, the lesions had scabbed and had fallen off with no induration but residual mild perilesional erythema. Patient had post-op histopathological clear margins and recovered uneventfully. No recurrence in 6 months. A topical 5-FU 5% ointment represents a paradigm shift in the treatment of BCC from invasive and disfiguring options (surgery and chemoradiotherapy) to cheap, convenient, effective, non-invasive, non-disfiguring topical chemotherapy. Topical 5% 5-FU is a safe and effective modality of treatment of superficial spreading multifocal basal carcinoma, especially lesions larger than 10 mm, where margins cannot be identified clearly and recurrent lesions.

Frontoethmoidal mucocele associated with bilateral increased intraocular pressure and proptosis.

PubMed

Chandra, Aman; Lim, Mingyann; Scott, Elizabeth; Morsman, David

2007-02-01

We describe the case of a 53-year-old man presenting with bilateral proptosis and raised intraocular pressure. Computed tomography imaging revealed these signs to be secondary to a frontoethmoidal mucocele with bilateral orbital invasion. Bilateral increased intraocular pressure is unusual in cases of frontoethmoidal mucoceles, but prompt imaging and treatment can prevent permanent visual loss.

Comparison of hydrophobic and hydrophilic intraocular lens in preventing posterior capsule opacification after cataract surgery: An updated meta-analysis.

PubMed

Zhao, Yang; Yang, Ke; Li, Jiaxin; Huang, Yang; Zhu, Siquan

2017-11-01

Posterior capsular opacification (PCO) is a common long-term complication of cataract surgery. Intraocular lens design and material have been implicated in influencing the development of PCO. This study evaluated the association of hydrophobic and hydrophilic intraocular lenses on preventing PCO. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until August 3, 2016, using the following search terms: cataract, posterior capsule opacification, and intraocular lens. Eligible studies included randomized controlled trials (RCTs), retrospective, and cohort studies. Eleven studies were included in the study with a total of 889 eyes/patients. The overall analysis revealed that hydrophobic intraocular lenses were associated with lower Nd:YAG laser capsulotomy rates than hydrophilic lenses [odds ratio (OR) = 0.38, 95% confidence interval (95% CI) = 0.16-0.91, P = .029]. Hydrophobic intraocular lenses were also associated with lower subjective PCO score (diff. in means: -1.32, 95% CI = -2.39 to -0.25, P = .015) and estimated PCO score (diff. in means: -2.23; 95% CI, -3.80 to -0.68, P = .005) as compared with hydrophilic lenses. Objective PCO score was similar between lens types. (diff. in means: -0.075; 95% CI, -0.18 to 0.035; P = .182). Pooled analysis found that visual acuity was similar between hydrophobic and hydrophilic intraocular lenses (diff. in means: -0.016; 95% CI, -0.041 to 0.009, P = .208). In general, PCO scores and the rate of Nd:YAG laser capsulotomy were influenced by intraocular lens biomaterial. Lens made of hydrophobic biomaterial were overall superior in lowering the PCO score and the Nd:YAG laser capsulotomy rate, but not visual acuity.

Comparison of hydrophobic and hydrophilic intraocular lens in preventing posterior capsule opacification after cataract surgery

PubMed Central

Zhao, Yang; Yang, Ke; Li, Jiaxin; Huang, Yang; Zhu, Siquan

2017-01-01

Abstract Background: Posterior capsular opacification (PCO) is a common long-term complication of cataract surgery. Intraocular lens design and material have been implicated in influencing the development of PCO. This study evaluated the association of hydrophobic and hydrophilic intraocular lenses on preventing PCO. Methods: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until August 3, 2016, using the following search terms: cataract, posterior capsule opacification, and intraocular lens. Eligible studies included randomized controlled trials (RCTs), retrospective, and cohort studies. Results: Eleven studies were included in the study with a total of 889 eyes/patients. The overall analysis revealed that hydrophobic intraocular lenses were associated with lower Nd:YAG laser capsulotomy rates than hydrophilic lenses [odds ratio (OR) = 0.38, 95% confidence interval (95% CI) = 0.16–0.91, P = .029]. Hydrophobic intraocular lenses were also associated with lower subjective PCO score (diff. in means: −1.32, 95% CI = −2.39 to −0.25, P = .015) and estimated PCO score (diff. in means: −2.23; 95% CI, −3.80 to −0.68, P = .005) as compared with hydrophilic lenses. Objective PCO score was similar between lens types. (diff. in means: −0.075; 95% CI, −0.18 to 0.035; P = .182). Pooled analysis found that visual acuity was similar between hydrophobic and hydrophilic intraocular lenses (diff. in means: −0.016; 95% CI, −0.041 to 0.009, P = .208). Conclusion: In general, PCO scores and the rate of Nd:YAG laser capsulotomy were influenced by intraocular lens biomaterial. Lens made of hydrophobic biomaterial were overall superior in lowering the PCO score and the Nd:YAG laser capsulotomy rate, but not visual acuity. PMID:29095259

Vitrectomy with complete posterior hyaloid removal for ischemic central retinal vein occlusion: Series of cases

PubMed Central

Leizaola-Fernández, Carlos; Suárez-Tatá, Luis; Quiroz-Mercado, Hugo; Colina-Luquez, Juner; Fromow-Guerra, J; Jiménez-Sierra, Juan M; Guerrero-Naranjo, Jose L; Morales-Cantón, Virgilio

2005-01-01

Background Central retinal vein occlusion (CRVO) is a common retinal vascular disorder with potentially complications: (1) persistent macular edema and (2) neovascular glaucoma. No safe treatment exists that promotes the return of lost vision. Eyes with CRVO may be predisposed to vitreous degeneration. It has been suggested that if the vitreous remains attached to the macula owing to a firm vitreomacular adhesion, the resultant vitreous traction can cause inflammation with retinal capillary dilation, leakage and subsequent edema6. The roll of vitrectomy in ischemic CRVO surgical procedures has not been evaluated. Case presentation This is a non comparative, prospective, longitudinal, experimental and descriptive series of cases. Ten eyes with ischemic CRVO. Vitrectomy with complete posterior hyaloid removal was performed. VA, rubeosis, intraocular pressure (IOP), and macular edema were evaluated clinically. Multifocal ERG (m-ERG), fluorescein angiography (FAG) and optic coherence tomography (OCT) were performed. Follow-up was at least 6 months. Moderate improvement of visual acuity was observed in 60% eyes and stabilized in 40%. IOP changed from 15.7 ± 3.05 mmHg to 14.9 ± 2.69 mmHg post-operative and macular edema from 976 ± 196 μm to 640 ± 191 μm to six month. The P1 wave amplitude changed from 25.46 ± 12.4 mV to 20.54 ± 11.2 mV. Conclusion A solo PPV with posterior hyaloid removal may help to improve anatomic and functional retina conditions in some cases. These results should be considered when analyzing other surgical maneuvers. PMID:15943889

Cataract surgery practices in the United States Veterans Health Administration.

PubMed

Havnaer, Annika G; Greenberg, Paul B; Cockerham, Glenn C; Clark, Melissa A; Chomsky, Amy

2017-04-01

To describe current cataract surgery practices within the United States Veterans Health Administration (VHA). Veterans Health Administration hospitals in the U.S. Retrospective data analysis. An initial e-mail containing a link to an anonymous 32-question survey of cataract surgery practices was sent to participants in May 2016. Two reminder e-mails were sent to nonresponders 1 week and 2 weeks after the initial survey was sent; the remaining nonresponders were called twice over a 2-week period. The data were analyzed using descriptive statistics. The response rate was 75% (67/89). Cataract surgeons routinely ordered preoperative testing in 29 (45%) of 65 sections and preoperative consultations in 26 (39%) of 66 sections. In 22 (33%) of 66 sections, cataract surgeons administered intracameral antibiotics. In 61 (92%) of 66 sections, cataract surgeons used toric intraocular lenses (IOLs). In 20 (30%) of 66 sections, cataract surgeons used multifocal IOLs. Cataract surgeons in 6 (9%) of 66 sections performed femtosecond laser-assisted cataract surgery. In 6 (9%) of 66 sections, cataract surgeons performed immediate sequential bilateral cataract surgery. Forty-nine (74%) ophthalmology chiefs reported a high level of satisfaction with Veterans Affairs ophthalmology. The survey results indicate that in cataract surgery in the VHA, routine preoperative testing is commonly performed and emerging practices, such as femtosecond laser-assisted cataract surgery and immediate sequential bilateral cataract surgery, have limited roles. The results of this survey could benchmark future trends in U.S. cataract surgery practices, especially in teaching hospital settings. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Intraocular laser surgical probe for membrane disruption by laser-induced breakdown.

PubMed

Hammer, D X; Noojin, G D; Thomas, R J; Clary, C E; Rockwell, B A; Toth, C A; Roach, W P

1997-03-01

A fiber probe has been designed as a surgical aid to cut intraocular membranes with laser-induced breakdown as the mechanism. The design of the intraocular laser surgical probe is discussed. A preliminary retinal damage distance has been calculated with breakdown threshold, spot size, and shielding measurements. Collateral mechanical-damage effects caused by shock wave and cavitation are discussed.

PENETRATING OCULAR INJURY WITH RETAINED INTRAOCULAR FOREIGN BODY FROM DRYWALL.

PubMed

Syed, Reema; Kim, Sung-Hye; Palacio, Agustina; Nunery, William R; Schaal, Shlomit

2018-03-23

To present a case of open globe injury and retained intraocular foreign body secondary to drywall. Interventional case report. A 21-year-old man presented with corneal laceration, iris defect, and vitreous hemorrhage after hammering drywall. Computed tomography scan was negative for intraocular foreign body, but a drywall intraretinal foreign body was found on 25-gauge vitrectomy. Intraoperative findings and 6-month follow-up are presented. Intraocular foreign body must always be suspected in all cases of penetrating ocular trauma. Although magnetic resonance imaging is ideal in diagnosing nonmetallic foreign bodies, computed tomography scan with Hounsfield units should be used in an emergency setting.

Bilateral intraocular calcification in necrotizing cytomegalovirus retinitis.

PubMed

Tuncer, Samuray; Oray, Merih; Yildirim, Yeliz; Camcioglu, Yildiz; Tugal-Tutkun, Ilknur

2014-10-01

We report a unique case of bilateral intraocular calcification due to necrotizing cytomegalovirus (CMV) retinitis associated with congenital CMV infection. A 7-month-old boy with a history of congenital CMV infection showed bilateral intraocular calcific plaques on computed tomography (CT) and ultrasonography. We reviewed the patient's medical files for the purpose of this report. The patient had a prior medical history of hospitalization for fever and swelling in the neck at 3 months of age. Systemic findings (anemia, neutropenia, hepatosplenomegaly, and reactive lymphadenomegaly) in association with a low CD4 count, high blood CMV viral load, and positivity for urine CMV DNA by polymerase chain reaction led to the diagnosis of bone marrow suppression and congenital CMV infection. At 7 months, he developed horizontal nystagmus and bilateral leukocoria over 20 days. Cranial CT and ultrasonography revealed bilateral intraocular calcific plaques and the patient was referred to rule out retinoblastoma. Fundoscopy was consistent with bilateral hemorrhagic, necrotizing CMV retinitis. Significant resolution of the retinal infiltrations occurred 2 weeks after initiation of systemic treatment with ganciclovir. Intraocular calcification may be a sign of active CMV retinitis. To our knowledge this is the first report of bilateral intraocular calcification serving as the presenting clinical manifestation of necrotizing CMV retinitis.

Variations in retinal nerve fiber layer measurements on optical coherence tomography after implantation of trifocal intraocular lens.

PubMed

García-Bella, Javier; Martínez de la Casa, José M; Talavero González, Paula; Fernández-Vigo, José I; Valcarce Rial, Laura; García-Feijóo, Julián

2018-01-01

To establish the changes produced after implantation of a trifocal intraocular lens (IOL) on retinal nerve fiber layer measurements performed with Fourier-domain optical coherence tomography (OCT). This prospective study included 100 eyes of 50 patients with bilateral cataract in surgical range, no other associated ocular involvement, refractive errors between +5 and -5 spherical diopters, and less than 1.5 D of corneal astigmatism. The eyes were operated by phacoemulsification with implantation of 2 different trifocal IOLs (FineVision and AT LISA tri 839MP) in randomized equal groups. Cirrus OCT and Spectralis OCT were performed before surgery and 3 months later. Both analyzed the thickness of the nerve fiber layer and thickness divided by quadrants (6 in case of Spectralis and 4 in case of Cirrus HD). The mean age of patients was 67.5 ± 5.8 years. The global nerve fiber layer thickness measured with Spectralis OCT was 96.77 μm before surgery and 99.55 μm after. With Cirrus OCT, the global thickness was 85.29 μm before surgery and 89.77 μm after. Statistically significant differences in global thickness measurements between preimplantation and postimplantation of the IOL were found with both OCT in the 2 groups. Statistically significant differences were also found in temporal and superior quadrants. The implantation of a diffractive trifocal IOL alters the results of the optic nerve fiber layer on Fourier-domain OCT in these patients, which should be taken into account in the posterior study of these patients.

Chest wall resection for multifocal osseous haemangioma.

PubMed

Weinandt, Marthe; Legras, Antoine; Mordant, Pierre; Le Pimpec Barthes, Françoise

2016-02-01

Intraosseous haemangioma is a rare and benign primary tumour of the bone. We report the case of a 76-year old woman who presented the exceptional condition of multifocal cavernous haemangiomas involving the spine and the ribs, requiring spinal and chest wall resections to confirm the diagnosis and treat the symptoms. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

[Bronchoalveolar carcinoma].

PubMed

Wislez, Marie; Cadranel, Jacques; Milleron, Bernard

2003-04-01

Bronchoalveolar carcinoma is one of the four histologic subtypes of adenocarcinoma and its incidence is increasing. It grows in a lepidic fashion along the alveolar septa without invasive growth. The lack of invasive growth is an essential criterion based on data indicating that patients may be curable by surgical resection. The revised definition seems to be suitable for its solitary nodular form but less for multifocal or pneumonic-type form. High-resolution lung CT-scan is necessary to evaluate pulmonary involvement because of the high frequency of multifocal disease at initial presentation and because of the presence of ground glass opacity that could be one of the first manifestation of cancer bronchiolo-alvéolaireon CT. Therapeutic management does not differ from the one of non small cell lung cancer. Solitary nodules are treated by surgical resection with a good prognosis while multifocal and/or pneumonic forms are treated by systemic chemotherapy with a worse prognosis.

Multifocal oral melanoacanthoma associated with Addison's disease and hyperthyroidism: a case report.

PubMed

Dantas, Thinali Sousa; Nascimento, Isabelly Vidal do; Verde, Maria Elisa Quezado Lima; Alves, Ana Paula Negreiros Nunes; Sousa, Fabrício Bitu; Mota, Mário Rogério Lima

2017-01-01

Oral melanoacanthoma is a mucocutaneous, pigmented, rare, benign, and probably reactive lesion. This paper reports for the first time in the literature a case of multifocal oral melanoacanthoma in a patient diagnosed with Addison's disease and concomitant Graves' disease with hyperthyroidism. The patient presented with oral pigmented lesions, which were hypothesized to be mucosal pigmentation associated with Addison's disease. Due to their unusual clinical pattern, these oral lesions were biopsied and diagnosed as oral melanoacanthoma on histopathology and immunohistochemistry for HMB-45. At the moment of this report, the patient was being treated for her systemic conditions, but the lesions had not regressed. Reactive hyperpigmentation of the skin and mucous membranes may be found in Addison's disease and hyperthyroidism. This case reinforces the hypothesis of a reactive nature for oral melanoacanthoma and highlights the need for investigation of endocrine disorders in patients with multifocal oral melanoacanthoma.

[Follow-up on MEWDS by fundus perimetry and multifocal ERG with the SLO].

PubMed

Bültmann, S; Martin, M; Rohrschneider, K

2002-09-01

Most conventional techniques for examination such as perimetry or ERG may not be sensitive enough to detect functional alterations due to MEWDS precisely. We report on a follow-up performed by fundus perimetry and the new technique of multifocal ERG using the scanning laser ophthalmoscope. A 24-year-old female patient (VA 0.2/0.8) was followed up for 7 weeks with these techniques as well as Octopus perimetry, fluorescence angiography, Ganzfeld ERG and biomicroscopy. Multifocal ERG stimulation (mfERG, Retiscan) was performed with the SLO. Visual acuity improved from 0.2 to 0.8 and the central relative scotoma disappeared while a relevant increase of P1-wave amplitudes in mfERG could be observed. Combining objective measurements from the fundus controlled SLO-mfERG and results from fundus perimetry enable good correlation of morphology and results, even for minor alterations of the macula only accessible by few established clinical examinations.

Central diabetes insipidus as a very late relapse limited to the pituitary stalk in Langerhans cell histiocytosis.

PubMed

Nakagawa, Shunsuke; Shinkoda, Yuichi; Hazeki, Daisuke; Imamura, Mari; Okamoto, Yasuhiro; Kawakami, Kiyoshi; Kawano, Yoshifumi

2016-07-01

Central diabetes insipidus (CDI) and relapse are frequently seen in multifocal Langerhans cell histiocytosis (LCH). We present two females with multifocal LCH who developed CDI 9 and 5 years after the initial diagnosis, respectively, as a relapse limited to the pituitary stalk. Combination chemotherapy with cytarabine reduced the mass in the pituitary stalk. Although CDI did not improve, there has been no anterior pituitary hormone deficiency (APHD), neurodegenerative disease in the central nervous system (ND-CNS) or additional relapse for 2 years after therapy. It was difficult to predict the development of CDI in these cases. CDI might develop very late in patients with multifocal LCH, and therefore strict follow-up is necessary, especially with regard to symptoms of CDI such as polydipsia and polyuria. For new-onset CDI with LCH, chemotherapy with cytarabine might be useful for preventing APHD and ND-CNS.

Multifocal visual evoked potentials for early glaucoma detection.

PubMed

Weizer, Jennifer S; Musch, David C; Niziol, Leslie M; Khan, Naheed W

2012-07-01

To compare multifocal visual evoked potentials (mfVEP) with other detection methods in early open-angle glaucoma. Ten patients with suspected glaucoma and 5 with early open-angle glaucoma underwent mfVEP, standard automated perimetry (SAP), short-wave automated perimetry, frequency-doubling technology perimetry, and nerve fiber layer optical coherence tomography. Nineteen healthy control subjects underwent mfVEP and SAP for comparison. Comparisons between groups involving continuous variables were made using independent t tests; for categorical variables, Fisher's exact test was used. Monocular mfVEP cluster defects were associated with an increased SAP pattern standard deviation (P = .0195). Visual fields that showed interocular mfVEP cluster defects were more likely to also show superior quadrant nerve fiber layer thinning by OCT (P = .0152). Multifocal visual evoked potential cluster defects are associated with a functional and an anatomic measure that both relate to glaucomatous optic neuropathy. Copyright 2012, SLACK Incorporated.

An intraocular micro light-emitting diode device for endo-illumination during pars plana vitrectomy.

PubMed

Koelbl, Philipp S; Lingenfelder, Christian; Spraul, Christoph W; Kampmeier, Juergen; Koch, Frank Hj; Kim, Yong Keun; Hessling, Martin

2018-03-01

Development of a new, fiber-free, single-use endo-illuminator for pars plana vitrectomy as a replacement for fiber-based systems with external light sources. The hand-guided intraocularly placed white micro light-emitting diode is evaluated for its illumination properties and potential photochemical and thermal hazards. A micro light-emitting diode was used to develop a single-use intraocular illumination system. The light-source-on-tip device was implemented in a prototype with 23G trocar compatible outer diameter of 0.6 mm. The experimental testing was performed on porcine eyes. All calculations of possible photochemical and thermal hazards during the application of the intraocular micro light-emitting diode were calculated according to DIN EN ISO 15007-2: 2014. The endo-illuminator generated a homogeneous and bright illumination of the intraocular space. The color impression was physiologic and natural. Contrary to initial apprehension, the possible risk caused by inserting a light-emitting diode into the intraocular vitreous was much smaller when compared to conventional fiber-based illumination systems. The photochemical and thermal hazards allowed a continuous exposure time to the retina of at least 4.7 h. This first intraocular light source showed that a light-emitting diode can be introduced into the eye. The system can be built as single-use illumination system. This light-source-on-tip light-emitting diode-endo-illumination combines a chandelier wide-angle illumination with an adjustable endo-illuminator.

The Effect of Altitude on Intraocular Pressure in Vitrectomized Eyes with Sulfur Hexafluoride Tamponade by the Friedenwald Method: Rabbit Animal Model

PubMed Central

Fromow-Guerra, Jans; Solís-Vivanco, Adriana; Perez-Reguera, Adriana; Quiroz-Mercado, Hugo; Meza-de Regil, Armando; Papa-Oliva, Gabriela; Morales-Cantón, Virgilio

2016-01-01

The aim of this study is to assess the change in intraocular pressure after a road trip, in eyes with different levels of filling with gas tamponade. Five rabbit eyes were subject to pars plana vitrectomy and gas tamponade (filling percentage: 25%, 50%, and 100% of nonexpansile SF6, 100% saline solution, and 100% room air). A sixth eye was injected with 0.35 cc of undiluted SF6 without vitrectomy. Guided by global positioning system, they were driven to the highest point of the highway connecting Mexico City with Puebla city and back, stopping every 300 m to assess intraocular pressure. The rabbit's scleral rigidity and estimation for human eyes were done by using the Friedenwald nomogram. Maximum altitude was 3209 m (Δ949 m). There were significant differences in intraocular pressure on the rabbit eyes filled with SF6 at 100%, 50%, 25%, and 100% room air. Per every 100 m of altitude rise, the intraocular pressure increased by 1.53, 1.0046, 0.971, and 0.97 mmHg, respectively. Using the human Friedenwald rigidity coefficient, the human eye estimate for intraocular pressure change was 2.1, 1.8, 1.4, and 1.1 mmHg per every 100 m of attitude rise. Altitude changes have a significant impact on intraocular pressure. The final effect depends on the percentage of vitreous cavity fill and scleral rigidity. PMID:27957500

The Effect of Altitude on Intraocular Pressure in Vitrectomized Eyes with Sulfur Hexafluoride Tamponade by the Friedenwald Method: Rabbit Animal Model.

PubMed

Fromow-Guerra, Jans; Solís-Vivanco, Adriana; Velez-Montoya, Raul; Perez-Reguera, Adriana; Quiroz-Mercado, Hugo; Meza-de Regil, Armando; Papa-Oliva, Gabriela; Morales-Cantón, Virgilio

2016-01-01

The aim of this study is to assess the change in intraocular pressure after a road trip, in eyes with different levels of filling with gas tamponade. Five rabbit eyes were subject to pars plana vitrectomy and gas tamponade (filling percentage: 25%, 50%, and 100% of nonexpansile SF 6 , 100% saline solution, and 100% room air). A sixth eye was injected with 0.35 cc of undiluted SF 6 without vitrectomy. Guided by global positioning system, they were driven to the highest point of the highway connecting Mexico City with Puebla city and back, stopping every 300 m to assess intraocular pressure. The rabbit's scleral rigidity and estimation for human eyes were done by using the Friedenwald nomogram. Maximum altitude was 3209 m (Δ949 m). There were significant differences in intraocular pressure on the rabbit eyes filled with SF 6 at 100%, 50%, 25%, and 100% room air. Per every 100 m of altitude rise, the intraocular pressure increased by 1.53, 1.0046, 0.971, and 0.97 mmHg, respectively. Using the human Friedenwald rigidity coefficient, the human eye estimate for intraocular pressure change was 2.1, 1.8, 1.4, and 1.1 mmHg per every 100 m of attitude rise. Altitude changes have a significant impact on intraocular pressure. The final effect depends on the percentage of vitreous cavity fill and scleral rigidity.

Repeated intraocular crystallization of ganciclovir in one eye after bilateral intravitreal injections: a case report.

PubMed

Iu, Lawrence P L; Fan, Michelle C Y; Lam, Wai-Ching; Wong, Ian Y H

2018-02-09

Cytomegalovirus (CMV) retinitis is an opportunistic infection that primarily affects immunocompromised individuals. Intravitreal ganciclovir injection monotherapy or in combination with systemic anti-CMV therapy are effective treatments for CMV retinitis. Crystallization of ganciclovir after intravitreal injection is extremely rare. Only two cases had been reported in literature. Crystallization in only one eye after bilateral injections had not been reported before. We hereby report a case of intraocular ganciclovir crystallization in one eye after bilateral intravitreal injections, and repeated crystallization in the same eye after repeated injections. A 79-year-old patient had bilateral cytomegalovirus retinitis and received bilateral intravitreal ganciclovir injections of 2.5 mg in 0.05 ml sterile water. Fundus examination after injection showed formation of needle-shaped, golden-yellow crystals in the vitreous of right eye but not in left eye. The crystals dissolved spontaneously. Repeated bilateral intravitreal ganciclovir injections 4 days later resulted in repeated crystallization of ganciclovir in right eye but not in left eye. The crystals dissolved spontaneously and completely after 5 minutes. Visual acuity remained unchanged and intraocular pressure was normal. Intraocular ganciclovir crystallization could occur after intravitreal injections. It is important to perform fundus examination after injection. The crystals may dissolve rapidly and vitrectomy may not be necessary. Our case suggested intraocular ganciclovir crystallization is an idiosyncratic phenomenon, subjects to distinctive intraocular environment which could be different between two eyes of the same patient. The susceptible intraocular environment could be persistent leading to repeated crystallization.

Steroid-induced ocular hypertension in the pediatric age group.

PubMed

Al Hanaineh, Abeer T; Hassanein, Dina H; Abdelbaky, Sameh H; El Zawahry, Omar M

2018-03-01

Comparing the effects of topical Rimexolone versus Dexamethasone and Rimexolone versus Fluorometholone on the intraocular pressure in children <13 years. A total of 40 patients (80 eyes) undergoing bilateral recession strabismus surgery were divided into two groups. Group A included 20 children (40 eyes); for each, one eye was randomized to receive 1% Rimexolone and the fellow eye received 0.1% Dexamethasone. Group B included 20 children (40 eyes); for each, one eye was randomized to receive 1% Rimexolone and the fellow eye received 0.1% Fluorometholone. Patients received eye drops for two consecutive weeks. Preoperative and postoperative intraocular pressure values for weeks 1, 2, 3, 4, and 6 were measured. The ocular-hypertensive response of all patients was categorized as either high, intermediate or low (Armaly-Becker Classification). After a 2-week treatment for both groups, peak and maximal intraocular pressure changes were reached. Changes were significantly higher in the Dexamethasone-treated eyes than in the Rimexolone- and Fluorometholone-treated eyes, which had a comparable change. (Week 2 intraocular pressure Group A: 14.15 ± 3.23 mmHg vs 17.95 ± 4.27 mmHg; Group B: 15.1 ± 2.27 mmHg vs 15.2 ± 2.73 mmHg). In both groups, the increase was statistically significant compared to the baseline intraocular pressure (preoperative intraocular pressure Group A: 13.2 ± 3.53 mmHg vs 13.1 ± 3.43 mmHg; Group B: 12.55 ± 2.98 mmHg vs 12.15 ± 3.31 mmHg). Intraocular pressure returned to near preoperative values over the following four consecutive weeks (Week 6 intraocular pressure Group A: 12.25 ± 2.67 mmHg vs 12.55 ± 2.95 mmHg; Group B: 12.15 ± 2.8 mmHg vs 12.00 ± 2.75 mmHg). None of the patients were high responders. Dexamethasone caused a higher elevation in intraocular pressure than Rimexolone and Fluorometholone in children. The ocular-hypertensive response was transient after the 2-week course.

Combining primary and piggyback intraocular lenses to treat extreme myopic astigmatism in stable keratoconus following cataract surgery.

PubMed

Goh, Yi Wei; Misra, Stuti; Patel, Dipika V; McGhee, Charles N J

2013-03-01

The majority of those with keratoconus can maximise visual acuity with spectacle or contact lens correction as they age; however, as subjects enter their sixties, cataracts may supervene and contact lens tolerance diminishes with consequent reduction in visual acuity. Following cataract extraction, the complex refractive error associated with keratoconus may not be readily corrected by an intraocular lens alone. This report highlights the planned implantation of a primary posterior chamber toric intraocular lens with a secondary piggyback, sulcus-based, intraocular lens in advanced but stable keratoconus with extreme myopic astigmatism and cataract. © 2013 The Authors. Clinical and Experimental Optometry © 2013 Optometrists Association Australia.

[Intraocular osteosarcoma in a dog].

PubMed

Wiesner, L; Schröder, S; Gralla, S; Goeck, D; Kramer, M; Ondreka, N

2014-01-01

The present case describes the diagnostic and therapeutic procedure of a dog with an intraocular osteosarcoma. According to the results of the diagnostic imaging studies, the tentative diagnosis of an intraocular neoplasm with perforation of the globe and orbital invasion of the tumour was made and an orbital exenteration was performed. The histopathological diagnosis of the extracted organ implied an intraocular, extraskeletal osteosarcoma. Seventy-seven days later the patient displayed an acute paraparesis. Clinical and diagnostic reevaluation using magnetic resonance imaging (MRI) was performed and the dog was euthanized at the owner's request. By means of MRI and necropsy, an additional axial osteosarcoma of the 6th lumbar vertebra and a malignant melanoma of the right tonsil were diagnosed.

Treatment of pseudobulbar affect with citalopram in a patient with progressive multifocal leukoencephalopthy.

PubMed

King, R R; Reiss, J P

2012-01-01

Pseudobulbar affect (PBA) manifests in a variety of neurologic illnesses suggesting a heterogeneous pathophysiology with common underpinnings. We report successful treatment of PBA with a selective serotonin reuptake inhibitor (SSRI) in a 54-year-old woman following progressive multifocal leukoencephalopathy (PML). In light of recent focus on dextromethorphan/quinidine (DM/Q) for the treatment of PBA, the clinician is reminded of the effectiveness of SSRIs. Copyright © 2011 Elsevier Ltd. All rights reserved.

Recurrent multifocal cutaneous Kaposiform hemangioendothelioma: A rare vascular tumor of infancy and childhood.

PubMed

Atla, Bhagyalakshmi; Sudhakar, P V; Rao, Nagarjun; Prasad, Uma

2016-01-01

Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular tumor of childhood although cases occurring in adulthood are also described. The features overlap with juvenile capillary hemangioma and Kaposi sarcoma. We report a rare case of recurrent, multifocal (nose and chin) cutaneous KHE initially occurring in a 3-year-old female child, uncomplicated by Kasabach-Merritt syndrome. Recurrences occurred over the next 6 years and resulted in complete distortion of the nose, requiring plastic repair.

Atypical multifocal Dravet syndrome lacks generalized seizures and may show later cognitive decline.

PubMed

Kim, Young Ok; Bellows, Susannah; McMahon, Jacinta M; Iona, Xenia; Damiano, John; Dibbens, Leanne; Kelley, Kent; Gill, Deepak; Cross, J Helen; Berkovic, Samuel F; Scheffer, Ingrid E

2014-01-01

To show that atypical multifocal Dravet syndrome is a recognizable, electroclinical syndrome associated with sodium channel gene (SCN1A) mutations that readily escapes diagnosis owing to later cognitive decline and tonic seizures. Eight patients underwent electroclinical characterization. SCN1A was sequenced and copy number variations sought by multiplex ligation-dependent probe amplification. All patients were female (age range at assessment 5-26y) with median seizure onset at 6.5 months (range 4-19mo). The initial seizure was brief in seven and status epilepticus only occurred in one; three were febrile. Focal seizures occurred in four patients and bilateral convulsion in the other four. All patients developed multiple focal seizure types and bilateral convulsions, with seizure clusters in six. The most common focal seizure semiology (six out of eight) comprised unilateral clonic activity. Five also had focal or asymmetric tonic seizures. Rare or transient myoclonic seizures occurred in six individuals, often triggered by specific antiepileptic drugs. Developmental slowing occurred in all: six between 3 years and 8 years, and two around 1 year 6 months. Cognitive outcome varied from severe to mild intellectual disability. Multifocal epileptiform discharges were seen on electroencephalography. Seven out of eight patients had SCN1A mutations. Atypical, multifocal Dravet syndrome with SCN1A mutations may not be recognized because of later cognitive decline and frequent tonic seizures. © 2013 Mac Keith Press.

Concordant and Discordant EGFR Mutations in Patients with Multifocal Adenocarcinomas: Implications for EGFR Targeted Therapy

PubMed Central

Chuang, Jody C.; Shrager, Joseph B.; Wakelee, Heather A.; Neal, Joel W.

2016-01-01

Purpose Adenocarcinoma remains the most common subtype of lung cancer in the United States. Most patients present with tumors that are invasive and often metastatic, but some patients develop multiple precursor in-situ or minimally invasive adenocarcinoma tumors which can be synchronous and metachronous. These precursor lesions harbor the same spectrum of genetic mutations found in pure-invasive adenocarcinomas, such as EGFR, KRAS and p53 mutations. It is less clear, however, if separate lesions in patients who present with multifocal disease share common underlying genetic driver mutations. Methods Here we review the relevant literature on molecular driver alterations in adenocarcinoma precursor lesions. We then report four cases with multifocal EGFR mutant adenocarcinomas in whom we performed molecular testing on 2 separate lesions. Findings In two of these patients, the mutations are concordant, and in two cases the mutations are discordant. A review of the literature demonstrates increasing evidence that lesions with discordant mutations may confer a more favorable prognosis, since they are unlikely to represent metastases. Implications Our findings suggest that the emergence of the dominant EGFR driver alteration is often independent between lesions in patients with multifocal adenocarcinomas, and thus the same targeted therapy may not be effective for all lesions. However, genetic testing of multiple lesions can help distinguish separate primary tumors from metastatic disease. PMID:27368115

The interaction between intracranial pressure, intraocular pressure and lamina cribrosal compression in glaucoma.

PubMed

McMonnies, Charles W

2016-05-01

This review examines some of the biomechanical consequences associated with the opposing intraocular and intracranial forces. These forces compress the lamina cribrosa and are a potential source of glaucomatous pathology. A difference between them creates a displacement force on the lamina cribrosa. Increasing intraocular pressure and/or decreasing intracranial pressure will increase the trans-lamina cribrosa pressure difference and the risk of its posterior displacement, canal expansion and the formation of pathological cupping. Both intraocular pressure and intracranial pressure can be elevated during a Valsalva manoeuvre with associated increases in both anterior and posterior lamina cribrosa loading as well as its compression. Any resulting thinning of or damage to the lamina cribrosa and/or retinal ganglion cell axons and/or astrocyte and glial cells attached to the matrix of the lamina cribrosa and/or reduction in blood flow to the lamina cribrosa may contribute to glaucomatous neuropathy. Thinning of the lamina cribrosa reduces its stiffness and increases the risk of its posterior displacement. Optic nerve head posterior displacement warrants medical or surgical lowering of intraocular pressure; however, compared to intraocular pressure, the trans-lamina cribrosa pressure difference may be more important in pressure-related pathology of the optic nerve head region. Similarly important could be increased compression loading of the lamina cribrosa. Reducing participation in activities which elevate intraocular and intracranial pressure will decrease lamina cribrosa compression exposure and may contribute to glaucoma management and may have prognostic significance for glaucoma suspects. © 2016 The Authors. Clinical and Experimental Optometry © 2016 Optometry Australia.

Relationship of the actual thick intraocular lens optic to the thin lens equivalent.

PubMed

Holladay, J T; Maverick, K J

1998-09-01

To theoretically derive and empirically validate the relationship between the actual thick intraocular lens and the thin lens equivalent. Included in the study were 12 consecutive adult patients ranging in age from 54 to 84 years (mean +/- SD, 73.5 +/- 9.4 years) with best-corrected visual acuity better than 20/40 in each eye. Each patient had bilateral intraocular lens implants of the same style, placed in the same location (bag or sulcus) by the same surgeon. Preoperatively, axial length, keratometry, refraction, and vertex distance were measured. Postoperatively, keratometry, refraction, vertex distance, and the distance from the vertex of the cornea to the anterior vertex of the intraocular lens (AV(PC1)) were measured. Alternatively, the distance (AV(PC1)) was then back-calculated from the vergence formula used for intraocular lens power calculations. The average (+/-SD) of the absolute difference in the two methods was 0.23 +/- 0.18 mm, which would translate to approximately 0.46 diopters. There was no statistical difference between the measured and calculated values; the Pearson product-moment correlation coefficient from linear regression was 0.85 (r2 = .72, F = 56). The average intereye difference was -0.030 mm (SD, 0.141 mm; SEM, 0.043 mm) using the measurement method and +0.124 mm (SD, 0.412 mm; SEM, 0.124 mm) using the calculation method. The relationship between the actual thick intraocular lens and the thin lens equivalent has been determined theoretically and demonstrated empirically. This validation provides the manufacturer and surgeon additional confidence and utility for lens constants used in intraocular lens power calculations.

[Association between two different types of strangling and intraocular pressure variation in jiu-jitsu athletes].

PubMed

Scarpi, Marinho Jorge; Conte, Marcelo; Rossin, Reginaldo Alexandre; Skubs, Renato; Lenk, Rudolf Eberhard; Brant, Rodrigo

2009-01-01

To verify the association between two different types of strangling with intraocular pressure variation in jiu-jitsu athletes. An observational study was performed on 9 athletes of jiu-jitsu, with at least 6 month of training, male, aged 20 to 30 years, without any physical and eyeball lesions. Associations between intraocular pressure and Cross Choke from the guard strangling (E1), and E2 - Cross Choke from mount strangling were gotten. Intraocular pressure was determined by using Perkins tonometer, at first in the absence of physical exercise over the last 24 hours and after each strangling. Then it was carried out the intraocular pressure measure at each 3 minutes, during 12 minutes of exercise recovery (R1, R2, R3, and R4) keeping the athletes lied down. Statistical analysis was done using ANOVA test and Bonferroni post-test. Meaningful reduction of both eyes intraocular pressure occurred at the E2 situation comparing to the E1 situation at all exercise recovery measures: R1 (OD: 8.22 +/- 1.39 vs.11.33 +/- 2.00 / OE: 8.55 +/- 1.23 vs. 11.88 +/- 1.90), R2 (OD: 8.44 +/- 1.87 vs.10.22 +/- 2.53 / OE: 9.00 +/- 1.80 vs. 10.44 +/- 2.35), R3 (OD: 8.44 +/- 1.74 vs.9.78 +/- 2.54 / OE: 8.55 +/- 1.42 vs. 10.33 +/- 1.93) all with p<0,01 e R4 (OD: 8.88 +/- 2.08 vs.9.55 +/- 2.87 / OE: 9.11 +/- 1.53 vs. 10.44 +/- 2.18) with p<0.05. Meaningful IOP reduction (p<0.05) was observed at the R1 moment of E2 strangling (OD: 10.77 +/- 1.92 vs.8.22 +/- 1.39 / OE: 11.44 +/- 1.94 vs. 8.55 +/- 1.23). There is association between intraocular pressure and jiu-jitsu strangling exercises, with intraocular pressure reduction.

Water-drinking test in primary angle-closure suspect before and after laser peripheral iridotomy.

PubMed

Waisbourd, Michael; Savant, Shravan V; Sun, Yi; Martinez, Patricia; Myers, Jonathan S

2016-03-01

This study aimed to investigate whether performing a laser peripheral iridotomy in primary angle-closure suspects had an effect on the intraocular pressure response during the water-drinking test. Prospective study in a hospital setting. Primary angle-closure suspects scheduled for a laser peripheral iridotomy. Primary angle-closure suspects were evaluated before the laser peripheral iridotomy and 2 weeks after. On each visit, subjects underwent the water-drinking test. Intraocular pressure was measured every 15 min within a 1-h period. Intraocular pressure fluctuations during the water drinking test. Twenty patients were enrolled. The mean age was 58.1 years (±10.2 SD), predominantly female (n = 14, 70%). Average intraocular pressure range (maximum-minimum) during the water-drinking test increased significantly from 2.6 ± 1.1 mmHg before the laser peripheral iridotomy to 3.5 ± 1.5 mmHg after (P = 0.04). The mean difference between peak and last intraocular pressure measurements increased after the laser peripheral iridotomy was performed, from 2.5 mmHg (±1.27 SD) to 3.3 mmHg (±1.66 SD), (P = 0.057). There was no change in mean peak intraocular pressure (maximum-baseline) before and after the laser peripheral iridotomy (P = 0.87). Primary angle-closure suspects who underwent the water-drinking test had a slightly more pronounced recovery of intraocular pressure after the laser peripheral iridotomy was performed, which may be attributed to increase in the area of exposed trabecular meshwork following treatment. Differences in intraocular pressure curves before and after laser peripheral iridotomy were minimal, and therefore, the water-drinking test had limited value as a provocative test in this patient population. © 2015 Royal Australian and New Zealand College of Ophthalmologists.

Delineation of the vitreous and posterior hyaloid using bromophenol blue.

PubMed

Haritoglou, Christos; Strauss, Rupert; Priglinger, Siegfried G; Kreutzer, Thomas; Kampik, Anselm

2008-02-01

To describe visualization of the vitreous and the posterior hyaloid membrane using bromophenol blue during vitrectomy for macular hole and retinal detachment. Six patients with macular holes and four with retinal detachments were included in the study. Before and after surgery, complete clinical examination, including funduscopy and measurements of best-corrected visual acuity and intraocular pressure, was performed. Additional functional tests, such as fluorescein angiography, optical coherence tomography (Stratus OCT; Carl Zeiss Meditec, Jena, Germany, Germany), Goldmann perimetry, and multifocal electroretinography as well as photography of the posterior pole, were performed for macular hole patients. Bromophenol blue was used in concentrations of 0.2%. During macular hole surgery, the dye was injected into the air-filled globe, while during surgery for retinal detachment, the globe was partially filled with perfluorocarbon before dye injection after induction of a posterior vitreous detachment to stain the vitreous peripherally. Bromophenol blue provided sufficient staining of the attached posterior hyaloid membrane and vitreous remnants in the periphery. This was especially helpful for patients in whom a posterior vitreous detachment could not be induced mechanically by suction using the vitrectomy probe alone, as seen in three of six interventions for a macular hole in this series. In addition, staining of the vitreous or vitreous remnants in the periphery and at the vitreous base was seen in all patients and helped to completely remove the vitreous in a controlled fashion. After macular hole surgery, increase of visual acuity from 20/100 (mean) to 20/40 was seen during follow-up up to 6 months. In one case, the hole persisted and required a second operation. Finally, closure of the hole was achieved in all patients. After retinal detachment surgery, reattachment was achieved in all cases. No dye-related adverse events were seen during follow-up as shown by the functional tests (visual acuity measurement, electroretinography, and perimetry) applied. Delineation of the vitreous and the posterior hyaloid using bromophenol blue staining greatly facilitates vitreoretinal procedures. Bromophenol blue appeared to be a very helpful and safe tool to visualize the posterior hyaloid membrane in macular hole surgery and assured its complete separation from the retinal surface. The dye also helped to remove vitreous at the vitreous base during retinal detachment surgery. Therefore, bromophenol blue appears as a very good alternative to triamcinolone, which has been used for this purpose, because the dye has no pharmacological properties and no side effects are likely to occur such as cataract formation and increase in intraocular pressure. Further studies including larger numbers of patients are mandatory.

A Randomized Trial of Soft Multifocal Contact Lenses for Myopia Control: Baseline Data and Methods.

PubMed

Walline, Jeffrey J; Gaume Giannoni, Amber; Sinnott, Loraine T; Chandler, Moriah A; Huang, Juan; Mutti, Donald O; Jones-Jordan, Lisa A; Berntsen, David A

2017-09-01

The Bifocal Lenses In Nearsighted Kids (BLINK) study is the first soft multifocal contact lens myopia control study to compare add powers and measure peripheral refractive error in the vertical meridian, so it will provide important information about the potential mechanism of myopia control. The BLINK study is a National Eye Institute-sponsored, double-masked, randomized clinical trial to investigate the effects of soft multifocal contact lenses on myopia progression. This article describes the subjects' baseline characteristics and study methods. Subjects were 7 to 11 years old, had -0.75 to -5.00 spherical component and less than 1.00 diopter (D) astigmatism, and had 20/25 or better logMAR distance visual acuity with manifest refraction in each eye and with +2.50-D add soft bifocal contact lenses on both eyes. Children were randomly assigned to wear Biofinity single-vision, Biofinity Multifocal "D" with a +1.50-D add power, or Biofinity Multifocal "D" with a +2.50-D add power contact lenses. We examined 443 subjects at the baseline visits, and 294 (66.4%) subjects were enrolled. Of the enrolled subjects, 177 (60.2%) were female, and 200 (68%) were white. The mean (± SD) age was 10.3 ± 1.2 years, and 117 (39.8%) of the eligible subjects were younger than 10 years. The mean spherical equivalent refractive error, measured by cycloplegic autorefraction was -2.39 ± 1.00 D. The best-corrected binocular logMAR visual acuity with glasses was +0.01 ± 0.06 (20/21) at distance and -0.03 ± 0.08 (20/18) at near. The BLINK study subjects are similar to patients who would routinely be eligible for myopia control in practice, so the results will provide clinical information about soft bifocal contact lens myopia control as well as information about the mechanism of the treatment effect, if one occurs.

Multifocal fibrosing thyroiditis: report of 55 cases of a poorly recognized entity.

PubMed

Fellegara, Giovanni; Rosai, Juan

2015-03-01

During the course of our consultation activity, we have recognized a peculiar form of thyroiditis in which multiple foci of fibrosis, most of which were associated with reactive atypia of the surrounding follicles, are present. We have referred to this condition, both in our consultation reports and in the third series of A.F.I.P. Fascicle on Tumors of the Thyroid Gland, as "multifocal fibrosing thyroiditis" or (less frequently) "multifocal sclerosing thyroiditis," which are descriptive terms that highlight the benign/inflammatory nature of the process, its multiplicity, and its unknown pathogenesis. The aim of this study is to better define the morphologic features of this process and correlate it with some clinical data. With this purpose, the consultation files of one of the authors (J.R.) were searched for cases coded as multifocal fibrosing thyroiditis or multifocal sclerosing thyroiditis in a 20-year period ranging from January 1989 to December 2009. A total of 55 cases were identified that displayed the above-listed features. There were 51 (93%) female and 4 (7%) male patients (F/M=12.75), with ages ranging between 15 and 71 years (mean age, 47.03 y; median age, 44.5 y). Microscopically, multiple foci of fibrosis were identified in all cases, their number ranging from 2 to 51 per case (mean number, 16), with a mean diameter of 3 mm (range: 0.36 to 15.1 mm). Although heterogenous in shape and size, the individual foci were rather similar to each other in composition, being characterized by a fibrotic poorly cellular center that merged with a cellular peripheral zone. Some of the follicular structures present at the periphery of the scar and-to a lesser extent-those entrapped inside it underwent complex reactive and regenerative (atypical) changes that simulated malignancy. We discuss the differential diagnosis with other benign and malignant thyroid conditions and speculate about its pathogenesis and possible relationship with papillary thyroid microcarcinoma.

Intraocular Pressure Increases After Intraarticular Knee Injection With Triamcinolone but Not Hyaluronic Acid.

PubMed

Taliaferro, Kevin; Crawford, Alexander; Jabara, Justin; Lynch, Jonathan; Jung, Edward; Zvirbulis, Raimonds; Banka, Trevor

2018-07-01

Intraarticular steroid injections are a common first-line therapy for severe osteoarthritis, which affects an estimated 27 million people in the United States. Although topical, oral, intranasal, and inhalational steroids are known to increase intraocular pressure in some patients, the effect of intraarticular steroid injections on intraocular pressure has not been investigated, to the best of our knowledge. If elevated intraocular pressure is sustained for long periods of time or is of sufficient magnitude acutely, permanent loss of the visual field can occur. How does intraocular pressure change 1 week after an intraarticular knee injection either with triamcinolone acetonide or hyaluronic acid? A nonrandomized, nonblinded prospective cohort study was conducted at an outpatient, ambulatory orthopaedic clinic. This study compared intraocular pressure elevation before and 1 week after intraarticular knee injection of triamcinolone acetonide versus hyaluronic acid for management of primary osteoarthritis of the knee. Patients self-selected to be injected in their knee with either triamcinolone acetonide or hyaluronic acid before being informed of the study. The primary endpoint was intraocular pressure elevation of ≥ 7 mm Hg 1 week after injection. This cutoff is determined as the minimum significant pressure change in the ophthalmology literature recognized as an intermediate responder to steroids. Intraocular pressure was measured using a handheld Tono-Pen® applanation device. This device is frequently used in intraocular pressure measurement in clinical and research settings; 10 sequential measurements are obtained and averaged with a confidence interval. Only measurements with a 95% confidence interval were used. Over a 6-month period, a total of 96 patients were approached to enroll in the study. Sixty-two patients out of 96 approached (65%) agreed. Thirty-one (50%) were injected with triamcinolone and 31 (50%) were injected with hyaluronic acid. Patients with osteoarthritis of the knee who were suitable candidates for either a steroid injection or hyaluronic acid injection were included in the study. Exclusion criteria included previous glaucoma surgery, previous corneal injury precluding use of a Tono-Pen, current acute or chronic steroid use, and diagnosis of glaucoma other than primary open-angle. Patients with elevated intraocular pressure at the 1-week timepoint were invited to return at 1 month for repeat measurement; however, only five of nine (55.6%) were able to do so. The mean age of the total population was 64.1 ± 11.65 years. There were 46 (74%) women and 16 men. Patient in the hyaluronic acid injection group were younger than the triamcinolone group, 59.5 ± 11.7 versus 68.7 ± 9.7 years of age (p < 0.003). The mean intraocular pressure increased by 2.79 mm Hg 1 week after treatment with triamcinolone, but it did not change among those patients treated with hyaluronic acid (2.79 ± 9.9 mm Hg versus -0.14 ± 2.96 mm Hg; mean difference 2.93 mm Hg; 95% confidence interval, -0.71 to 6.57 mm Hg; p = 0.12). More patients who received triamcinolone injections developed an increase in intraocular pressure > 7 mm than did those who received hyaluronic acid (29% [nine of 29] versus 0% [zero of 31]; p = 0.002). Of the nine patients who developed elevated intraocular pressure after a triamcinolone injection, five returned for reevaluation 1 month later, and four of them had pressures that remained elevated > 7 mm Hg from baseline. There appears to be an associated intraocular pressure elevation found in patients who have undergone a triamcinolone injection of the knee. Further larger scale randomized investigations are warranted to determine the longevity of this pressure elevation as well as long-term clinical implications, including optic nerve damage and visual field loss. Level II, therapeutic study.

STS-41 crewmembers conduct DSO 0472 Intraocular Pressure on OV-103's middeck

NASA Image and Video Library

1990-10-10

STS-41 crewmembers conduct Detailed Supplementary Objective (DSO) 0472 Intraocular Pressure on the middeck of Discovery, Orbiter Vehicle (OV) 103. Mission Specialist (MS) William M. Shepherd rests his head on the stowed treadmill while Pilot Robert D. Cabana, holding Shepherd's eye open, prepares to measure Shepherd's intraocular pressure using a tono pen (in his right hand). Objectives include: establishing a database of changes in intraocular pressures that can be used to evaluate crew health; validating ten degree head down bedrest as a model for cephalad fluid shifts in microgravity; facilitating the interpretation of data by providing a quantative measure of microgravity induced cephalad fluid shifts; and validating the tono pen as an effective tool for diagnostic and scientific data collection.

A Cerebellar Tremor in a Patient with Human Immunodeficiency Virus-1 Associated with Progressive Multifocal Leukoencephalopathy

PubMed Central

Kim, Hee-Jin; Lee, Jae-Jung; Lee, Phil Hyu

2009-01-01

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system (CNS) caused by JC virus infection in oligodendrocytes, especially in patients with acquired immunodeficiency syndrome (AIDS). Movement disorders associated with PML are very rare. Here, we report a case of PML in an AIDS patient who presented with a cerebellar tremor, caused by lesions in the cerebellar outflow tract. A cerebellar tremor can be a rare clinical manifestation in patients with PML. PMID:24868366

Progressive multifocal leukoence--phalopathy presenting as homonymous hemianopia in a patient with acquired immunodeficiency syndrome.

PubMed

Pandey, Amit; Bandivdekar, Karishma; Ramchandani, Suresh; Ramchandani, Sushama

2012-01-01

We present a case of a Human Immunodeficiency Virus (HIV) positive patient who was referred for retinal evaluation to rule out ophthalmic manifestations of Acquired Immunodeficiency Syndrome (AIDS). She complained of some disturbance in vision in both eyes. Fundus examination showed no abnormality. Perimetry, done to rule out optic nerve pathology, showed a left homonymous hemianopia. Magnetic Resonance Imaging (MRI) scan showed features of Progressive Multifocal Leukoencephalopathy (PML). She had no other neurological symptoms or signs.

Infantile Hepatic Hemangioendothelioma: An Uncommon Cause of Persistent Pulmonary Hypertension in a Newborn Infant.

PubMed

Chatmethakul, Trassanee; Bhat, Ramachandra; Alkaabi, Maryam; Siddiqui, Abdul; Peevy, Keith; Zayek, Michael

2016-07-01

Multifocal and diffuse infantile hepatic hemangioendotheliomas commonly present with signs of high-output congestive heart failure. In addition, prolonged persistent pulmonary overcirculation eventually leads to the development of pulmonary hypertension at a later age. We report a 2-day old, full-term infant with multifocal, large infantile hepatic hemangioendothelioma, who presented with an early onset of pulmonary hypertension, managed successfully with supportive care and systemic therapy directed toward the involution of infantile hepatic hemangioendothelioma.

Multifocal amelanotic conjunctival melanoma and acquired melanosis sine pigmento.

PubMed Central

Paridaens, A D; McCartney, A C; Hungerford, J L

1992-01-01

Clinical and histopathological features of four cases of multifocal amelanotic malignant melanoma of the conjunctiva in association with 'acquired melanosis sine pigmento' are reported. The absence of conjunctival pigmentation in this extremely rare combination of lesions prevented early diagnosis and clinical monitoring. As a result orbital exenteration was required in three cases. This multicentric non-pigmented variety of conjunctival malignant melanoma tends to present later than pigmented forms and may require exenteration of the orbit as a primary procedure. Images PMID:1540561

Multifocal amelanotic conjunctival melanoma and acquired melanosis sine pigmento.

PubMed

Paridaens, A D; McCartney, A C; Hungerford, J L

1992-03-01

Clinical and histopathological features of four cases of multifocal amelanotic malignant melanoma of the conjunctiva in association with 'acquired melanosis sine pigmento' are reported. The absence of conjunctival pigmentation in this extremely rare combination of lesions prevented early diagnosis and clinical monitoring. As a result orbital exenteration was required in three cases. This multicentric non-pigmented variety of conjunctival malignant melanoma tends to present later than pigmented forms and may require exenteration of the orbit as a primary procedure.

Unique Case of Disseminated Plague With Multifocal Osteomyelitis.

PubMed

Tovar Padua, Leidy; Kamali, Amanda; Kim, Hannah; Green, Nicole M; Civen, Rachel; Schwartz, Benjamin; Krogstad, Paul; Deville, Jaime; Yeganeh, Nava; Lugo, Debra; Baker, Amira; Soni, Priya; Cho, Catherine; Svircic, Natalia; Dry, Sarah; Seeger, Leanne; Lloyd, Jessica; Deukmedjian, Grace; Bowen, Richard; Hale, Gillian; Zaki, Sherif R; Mead, Paul; Nielsen-Saines, Karin

2017-09-01

Plague is a disease caused by Yersinia pestis. Septicemic and pneumonic plague have a high mortality rate if untreated. Here we describe the challenges of accurately diagnosing a nonfatal pediatric case of septicemic plague with involvement of multiple organs; to our knowledge, the first documented case of multifocal plague osteomyelitis. © The Author 2017. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Comparison of evening and morning dosing of travoprost 0.004%/timolol 0.5% fixed combination in 6 month period.

PubMed

Suić, Smiljka Popović; Laus, Katia Novak; Dosen, Vukosava Maricic; Ekert, Miroslav; Mandić, Zdravko; Bojić, Lovro

2010-09-01

An open label, multi-center, 6 months observational study of new fixed combination (travoprost 0.004%/timolol 0.5%), in order to evaluate both efficacy (intraocular pressure lowering) and tolerability (patient and investigator satisfaction) of two dosing regimens--evening (PM) and morning (AM). After screening for enrollment, to 40 patients (79 eyes with primary open angle glaucoma or ocular hypertension), new fixed combination travoprost 0.004%/timolol 0.5% was prescribed once a day in the evening (PM). Patients were enrolled according to each investigator decision on indication for travoprost 0.004%/timolol 0.5% fixed combination once a day, without washout period after previous medication. Intraocular pressure was measured at 9 AM at all time control points: at baseline, after 1 month, after 3 months and after 6 month. After 1 month, screening for nonresponders (criteria: 20% intraocular pressure lowering) and subjects with major side effects was performed. At second control visit, after 3 months PM dosing, intraocular pressure was measured and patients were instructed to continue once a day the same medication, but in the morning (AM) for consequent 3 months. After 1 month, reduction in mean intraocular pressure value was 21.66%. At the visit after 3 month, the mean intraocular pressure was 15.67 +/- 2.17 mm Hg (reduction 21.14%). 3 month after dosing regimen changed to AM (6 month after beginning of travoprost 0.004%/timolol 0.5% combination therapy), reduction in intraocular pressure value was 19.86%. The differences (mean +/- standard deviation) in intraocular pressure values after 1, 3 and 6 month were all highly statistically significant compared to baseline values. The tolerability was evaluated in five steps (Likert scale) ranging from unsatisfactory to excellent by both patient and investigator--taken at 3 and 6 month control visit. 95% of patients and 100% of investigators were satisfied with the possibility of choosing dosing regimen for travoprost 0.004%/timolol 0.5% fixed combination. Travoprost 0.004%/timolol 0.5% fixed combination proved sufficient intraocular pressure control dosed either PM or AM with no statistically significant difference between two dosing regimens. Possibility to choose between two dosing regimens gives each practitioner additional reassurance that glaucoma therapy will be individualised to needs of each patient.

Intraocular osteosarcoma in a dog.

PubMed

van de Sandt, R R O M; Boevé, M H; Stades, F C; Kik, M J L; Kirpensteijn, J

2004-07-01

A 10-year-old German shepherd dog was presented with unilateral uveitis and hyphaema. Treatment was unsuccessful and the eye was enucleated. Intraocular osteosarcoma was diagnosed by histological examination.

Corn silk aqueous extracts and intraocular pressure of systemic and non-systemic hypertensive subjects.

PubMed

George, Gladys O; Idu, Faustina K

2015-03-01

Hypotensive properties have been attributed to the stigma/style of Zea mays L (corn silk). Although the effect of corn silk extract on blood pressure has been documented in animal studies, we are not aware of any study on its effect on human blood pressure and intraocular pressure. A randomised study was carried out on the effect of water only, masked doses of corn silk aqueous extract (60, 130, 192.5 and 260 mg/kg body weight) on intraocular pressure and blood pressure of 20 systemic and 20 non-systemic hypertensive subjects. Intraocular pressure and blood pressure were measured at baseline and every hour for eight hours after administering water or a masked dose of corn silk aqueous extract. Each dose was administered at two-week intervals to each subject in the two study groups. The results showed that the last three doses of corn silk aqueous extract gave a statistically significant reduction (p < 0.001) in mean intraocular pressure and blood pressure within eight hours of administration. The peak effect on intraocular pressure was observed after four hours and this was preceded by the peak effect on blood pressure, which occurred after three hours of administration. The hypotensive effect was dose-dependent in the two groups. Corn silk aqueous extract has a lowering effect on intraocular pressure in systemic and non-systemic hypertensive subjects. This may have resulted from the fall in blood pressure that is due to potassium-induced natriuresis and diuresis caused by the high potassium content in the high doses of the corn silk extract. © 2015 The Authors. Clinical and Experimental Optometry © 2015 Optometry Australia.

Central Corneal Thickness and its Relationship to Intra-Ocular and Epidmiological Determinants.

PubMed

Tayyab, Ali; Masrur, Amena; Afzal, Farooq; Iqbal, Fyza; Naseem, Kamran

2016-06-01

To measure central corneal thickness in Pakistani population and determine its relationship to intra-ocular pressure, age, gender and ethnicity. Cross-sectional observation study. Pakistan Institute of Medical Sciences, Islamabad, Pakistan, between December 2013 and February 2015. The right eyes of 1000 cases (496 males and 504 females) were recruited for this study. Inclusion criteria were Pashtun or Punjabi ethnicity, intra-ocular pressure < 22 mmHg, gonioscopically open angles, cup-disk-ratio < 0.5, and age matched normal visual fields. Cases with prior ocular surgery, contact lens use, corneal pathologies, myopia or hypermetropia > ±3.0 diopters, astigmatism of > ±1.0 diopters were excluded. Central corneal thickness was measured using a TopCon non-contact specular microscope. Intra-ocular pressure was measured using Goldmann applanation tonometer. Frequency distribution, test of significance, and regression analysis was carried out using Statistical Package for Social Sciences version 20.0. Mean age was 47.31 ±11.78 years. Ethnic composition was 51.6% (n=516) Pashtun and 48.4% (n=484) Punjabi. The mean central corneal thickness was 503.96 (±12.47) µm, while the mean intra-ocular pressure was 15.61 (±2.68) mmHg. Regression analysis showed a significant association between central corneal thickness and intra-ocular pressure (p=0.00) and age (p=0.00). A±100 µchange in central corneal thickness was associated with change in IOPof ±3.30 mmHg, whereas central corneal thickness decreased by 0.12 µm per year. No significant association could be established between central corneal thickness and ethnicity (p=0.19). Central corneal thickness of the studied races was comparable to non-Caucasians which affects intra-ocular pressure measurements, and decreases with increasing age. No relationship was observed between central corneal thickness and ethnicity or gender.

Influence of macular pigment optical density spatial distribution on intraocular scatter.

PubMed

Putnam, Christopher M; Bland, Pauline J; Bassi, Carl J

This study evaluated the summed measures of macular pigment optical density (MPOD) spatial distribution and their effects on intraocular scatter using a commercially available device (C-Quant, Oculus, USA). A customized heterochromatic flicker photometer (cHFP) device was used to measure MPOD spatial distribution across the central 16° using a 1° stimulus. MPOD was calculated as a discrete measure and summed measures across the central 1°, 3.3°, 10° and 16° diameters. Intraocular scatter was determined as a mean of 5 trials in which reliability and repeatability measures were met using the C-Quant. MPOD spatial distribution maps were constructed and the effects of both discrete and summed values on intraocular scatter were examined. Spatial mapping identified mean values for discrete MPOD [0.32 (s.d.=0.08)], MPOD summed across central 1° [0.37 (s.d.=0.11)], MPOD summed across central 3.3° [0.85 (s.d.=0.20)], MPOD summed across central 10° [1.60 (s.d.=0.35)] and MPOD summed across central 16° [1.78 (s.d.=0.39)]. Mean intraocular scatter was 0.83 (s.d.=0.16) log units. While there were consistent trends for an inverse relationship between MPOD and scatter, these relationships were not statistically significant. Correlations between the highest and lowest quartiles of MPOD within the central 1° were near significance. While there was an overall trend of decreased intraocular forward scatter with increased MPOD consistent with selective short wavelength visible light attenuation, neither discrete nor summed values of MPOD significantly influence intraocular scatter as measured by the C-Quant device. Published by Elsevier España, S.L.U.

Comparison between intraocular pressure spikes with water loading and postural change.

PubMed

Chong, Calum Wk; Wang, Sarah B; Jain, Neeranjali S; Bank, Cassandra S; Singh, Ravjit; Bank, Allan; Francis, Ian C; Agar, Ashish

2016-12-01

To compare the agreement between peak intraocular pressures measured through the water drinking test and the supine test, in patients with primary open angle glaucoma. Consecutive, prospective, blinded. Twenty-one patients from the Glaucoma Unit, Prince of Wales Hospital, Sydney, Australia. For the supine test, intraocular pressure was recorded immediately after the patient had lain down and at 20 and 40 min. At the second evaluation, intraocular pressure was measured in each patient after drinking 10 mL/kg body weight of water for the water drinking test. Again, all patients had their intraocular pressure measured at 20 and 40 min (t = 20 and t = 40, respectively). Patients were excluded from the study if they had pre-existing cardiac, renal or pulmonary complications or had concurrent ocular disease or an anatomical abnormality (including angle recession, peripheral anterior synechiae and developmental anomalies of the angle) that may have influenced intraocular pressure. Bland-Altman analysis. Bland-Altman analysis indicated an overall excellent agreement in terms of mean difference between methods (1.0, -1.0 and -0.90 mmHg, at 0, 20 and 40 min, respectively). Further, with the exception of t = 40, all measured time points had 95% confidence intervals within 6.5 mmHg of their mean difference on the Bland-Altman plot. There was close agreement between the intraocular pressure values of the supine test and water drinking test. However, as the water drinking test may be uncomfortable and potentially hazardous, there is potential that the supine test may be a safer and more comfortable alternative. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

[Magnetic resonance imaging and ultrasonography in dogs and cats with ocular and orbital diseases. Part 1: Ocular diseases].

PubMed

von Krosigk, F; Steinmetz, A; Ellenberger, C; Oechtering, G

2012-01-01

This two-part study describes the clinical usefulness and value of ultrasound and magnetic resonance imaging (MRI) in dogs and cats with ocular (n=30) and orbital diseases (n=31). MRI and ultrasonography characteristics are described in single cases with ocular and orbital disease. Ultrasonography and MRI were performed in 15 dogs and 15 cats with intraocular neoplasia or intraocular inflammatory disease. In all patients with intraocular neoplasia, sonography revealed masses with increased echogenicity and fairly uniform echotexture, thus allowing the tentative diagnosis of an intraocular tumour. In these cases, MRI often proved to be a valuable diagnostic tool in showing the complete extent of intraocular lesion. An additional benefit of MRI was seen in the tissue characterization of tumours based on MRI signal characteristics and pattern of contrast enhancement. Discreet intraocular inflammatory alterations, in particular to the anterior and posterior segment of the eyeball, were more clearly shown by ultrasound than by MRI. Neoplasia could be excluded and inflammatory disease was successfully diagnosed using MRI due to the different image sequences with or without contrast medium administration. Traumatic ruptures of the lens capsule and the globe after trauma were depicted more clearly with MRI. When opacity of the anterior eye segment is present, various intraocular changes can be quickly diagnosed by ultrasound with high accuracy, without requiring anaesthesia of the patient. MRI of the globe allows differentiation of diverse pathologies, gives detailed information of infiltration in orbital structures and the exact degree of ocular lesions after trauma. This additional evidence often makes it easier to predict the correct prognosis and choose the best therapy.

Multifocal electroretinography in patients with Stargardt's macular dystrophy

PubMed Central

Kretschmann, U; Seeliger, M; Ruether, K; Usui, T; Apfelstedt-Sylla, E; Zrenner, E

1998-01-01

AIMS—To describe the topography of multifocal electroretinograms (ERGs) and to explore its diagnostic value in patients with Stargardt's macular dystrophy (SMD).
METHODS—51 patients with SMD were examined by means of the m-sequence technique to characterise the topography of electroretinographic responses in the central visual field. The results were compared with data from 30 normal volunteers.
RESULTS—In 49 of 51 patients with SMD, macular electroretinographic activity was markedly diminished or non-detectable. Towards more peripheral areas, ERG responses of the SMD patients approached those of normals. Implicit times were not markedly delayed at any eccentricity.
CONCLUSION—In contrast with Ganzfeld electroretinography, multifocal electroretinography is useful to detect foveal dysfunction in SMD. Areas of dysfunction were found to be usually larger than expected from psychophysical measurements and morphological alteration. In early stages of the disease it was possible to detect foveal dysfunction, even in patients lacking morphological fundus changes and with good visual acuity.

 Keywords: Stargardt's macular dystrophy; fundus flavimaculatus; electroretinography PMID:9602623

Predictability of uncontrollable multifocal seizures - towards new treatment options

NASA Astrophysics Data System (ADS)

Lehnertz, Klaus; Dickten, Henning; Porz, Stephan; Helmstaedter, Christoph; Elger, Christian E.

2016-04-01

Drug-resistant, multifocal, non-resectable epilepsies are among the most difficult epileptic disorders to manage. An approach to control previously uncontrollable seizures in epilepsy patients would consist of identifying seizure precursors in critical brain areas combined with delivering a counteracting influence to prevent seizure generation. Predictability of seizures with acceptable levels of sensitivity and specificity, even in an ambulatory setting, has been repeatedly shown, however, in patients with a single seizure focus only. We did a study to assess feasibility of state-of-the-art, electroencephalogram-based seizure-prediction techniques in patients with uncontrollable multifocal seizures. We obtained significant predictive information about upcoming seizures in more than two thirds of patients. Unexpectedly, the emergence of seizure precursors was confined to non-affected brain areas. Our findings clearly indicate that epileptic networks, spanning lobes and hemispheres, underlie generation of seizures. Our proof-of-concept study is an important milestone towards new therapeutic strategies based on seizure-prediction techniques for clinical practice.

Evolving paradigms in multifocal breast cancer.

PubMed

Salgado, Roberto; Aftimos, Philippe; Sotiriou, Christos; Desmedt, Christine

2015-04-01

The 7th edition of the TNM defines multifocal breast cancer as multiple simultaneous ipsilateral and synchronous breast cancer lesions, provided they are macroscopically distinct and measurable using current traditional pathological and clinical tools. According to the College of American Pathologists (CAP), the characterization of only the largest lesion is considered sufficient, unless the grade and/or histology are different between the lesions. Here, we review three potentially clinically relevant aspects of multifocal breast cancers: first, the importance of a different intrinsic breast cancer subtype of the various lesions; second, the emerging awareness of inter-lesion heterogeneity; and last but not least, the potential introduction of bias in clinical trials due to the unrecognized biological diversity of these cancers. Although the current strategy to assess the lesion with the largest diameter has clearly its advantages in terms of costs and feasibility, this recommendation may not be sustainable in time and might need to be adapted to be compliant with new evolving paradigms in breast cancer. Copyright © 2014 Elsevier Ltd. All rights reserved.

Multifocal canalicular adenoma of the minor labial salivary glands

PubMed Central

Samar, María Elena; Avila, Rodolfo Esteban; Fonseca, Ismael Bernardo; Anderson, William; Fonseca, Gabriel M; Cantín, Mario

2014-01-01

Canalicular adenoma (CA) is an uncommon benign neoplasia of salivary glands which is clinically difficult to recognise. Despite having an excellent prognosis, the histological diagnosis and clinical management of this entity can be troublesome. While the main differential diagnosis to consider is basal cell adenoma (BCA), similar histological patterns and multifocality have been observed in adenoid cystic carcinoma (ACC) and polymorphous low-grade adenocarcinoma (PLGA), both locally-aggressive malignancies which require radically different treatment to CA. An emphasis has been placed on the value of immunohistochemistry in avoiding diagnostic and surgical errors. CA is positive for AE1/AE3, CD117 and S-100 protein, and negative for p63, α-SMA, Ki 67 and vimentin. Here we discuss the case of a 61-year-old female with CA in her right upper lip, showing multifocal growth histologically. The differential diagnosis with other adenomas is discussed in addition to the role of immunohistochemical studies that can confirm the clinical and surgical findings. PMID:25550873

Progressive Multifocal Leukoencephalopathy: Endemic Viruses and Lethal Brain Disease.

PubMed

Haley, Sheila A; Atwood, Walter J

2017-09-29

In 1971, the first human polyomavirus was isolated from the brain of a patient who died from a rapidly progressing demyelinating disease known as progressive multifocal leukoencephalopathy. The virus was named JC virus after the initials of the patient. In that same year a second human polyomavirus was discovered in the urine of a kidney transplant patient and named BK virus. In the intervening years it became clear that both viruses were widespread in the human population but only rarely caused disease. The past decade has witnessed the discovery of eleven new human polyomaviruses, two of which cause unusual and rare cancers. We present an overview of the history of these viruses and the evolution of JC polyomavirus-induced progressive multifocal leukoencephalopathy over three different epochs. We review what is currently known about JC polyomavirus, what is suspected, and what remains to be done to understand the biology of how this mostly harmless endemic virus gives rise to lethal disease.

[Research on antibodies anti toxoplasma gondii in intraocular fluids (Aqueous and vitreous humor) from patients with ocular toxoplasmosis, in the City of Belém, Pará State].

PubMed

Carmo, Ediclei Lima do; Almeida, Edmundo Frota; Bichara, Cléa Nazaré; Póvoa, Marinete Marins

2005-01-01

Tests were performed for antibodies IgG, IgM and IgA anti-Toxoplasma gondii antibodies in serum and intraocular fluids (Aqueous and vitreous humor) from patients with ocular toxoplasmosis. By the results obtained, it was verified that intraocular IgG and IgA anti-Toxoplasma gondii antibodies can be important markers for the diagnosis of ocular toxoplasmosis.

Solid intraocular xanthogranuloma in three Miniature Schnauzer dogs.

PubMed

Zarfoss, Mitzi K; Dubielzig, Richard R

2007-01-01

Macrophages that contain abundant intracytoplasmic lipid are called 'foam cells'. In four canine globes submitted to the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW), foam cells formed a solid intraocular mass. The purpose of this study was to describe the histopathologic findings in these cases. The electronic COPLOW database (1993-2006) was searched for the diagnosis of 'foam cell tumor'. Clinical history, gross pathology and histopathology (5-micron sections, hematoxylin and eosin and Alcian blue periodic acid Schiff) were reviewed in all cases. Cases were included if the globe was grossly filled by a solid mass and if all intraocular structures were effaced by lipid-laden foam cell macrophages admixed with birefringent, Alcian blue-positive crystals oriented in stellate patterns. All three patients (four globes) satisfying the selection criteria were Miniature Schnauzers. In all cases the clinical history included diabetes mellitus, hyperlipidemia and chronic bilateral uveitis that was interpreted to be lens-induced. All globes were enucleated because of glaucoma. The term solid intraocular xanthogranuloma was used to describe these cases because the intraocular contents were effaced by a solid mass of foam cells and birefringent crystals. The cases in this report suggest that diabetic Miniature Schnauzers with hyperlipidemia are at risk for lipid and macrophage-rich uveitis, which may in some cases form a solid inflammatory intraocular mass, precipitate glaucoma, and lead to enucleation.

An Intraocular Camera for Retinal Prostheses: Restoring Sight to the Blind

NASA Astrophysics Data System (ADS)

Stiles, Noelle R. B.; McIntosh, Benjamin P.; Nasiatka, Patrick J.; Hauer, Michelle C.; Weiland, James D.; Humayun, Mark S.; Tanguay, Armand R., Jr.

Implantation of an intraocular retinal prosthesis represents one possible approach to the restoration of sight in those with minimal light perception due to photoreceptor degenerating diseases such as retinitis pigmentosa and age-related macular degeneration. In such an intraocular retinal prosthesis, a microstimulator array attached to the retina is used to electrically stimulate still-viable retinal ganglion cells that transmit retinotopic image information to the visual cortex by means of the optic nerve, thereby creating an image percept. We describe herein an intraocular camera that is designed to be implanted in the crystalline lens sac and connected to the microstimulator array. Replacement of an extraocular (head-mounted) camera with the intraocular camera restores the natural coupling of head and eye motion associated with foveation, thereby enhancing visual acquisition, navigation, and mobility tasks. This research is in no small part inspired by the unique scientific style and research methodologies that many of us have learned from Prof. Richard K. Chang of Yale University, and is included herein as an example of the extent and breadth of his impact and legacy.

Evaluating the risk of eye injuries: intraocular pressure during high speed projectile impacts.

PubMed

Duma, Stefan M; Bisplinghoff, Jill A; Senge, Danielle M; McNally, Craig; Alphonse, Vanessa D

2012-01-01

To evaluate the risk of eye injuries by determining intraocular pressure during high speed projectile impacts. A pneumatic cannon was used to impact eyes with a variety of projectiles at multiple velocities. Intraocular pressure was measured with a small pressure sensor inserted through the optic nerve. A total of 36 tests were performed on 12 porcine eyes with a range of velocities between 6.2 m/s and 66.5 m/s. Projectiles selected for the test series included a 6.35  mm diameter metal ball, a 9.25  mm diameter aluminum rod, and an 11.16  mm diameter aluminum rod. Experiments were designed with velocities in the range of projectile consumer products such as toy guns. A range of intraocular pressures ranged between 2017 mmHg to 26,426 mmHg (39 psi-511 psi). Four of the 36 impacts resulted in globe rupture. Intraocular pressures dramatically above normal physiological pressure were observed for high speed projectile impacts. These pressure data provide critical insight to chronic ocular injuries and long-term complications such as glaucoma and cataracts.

[Clinico-pathological features of papillary thyroid cancer coexistent with Hashimoto's thyroiditis].

PubMed

Molnár, Sarolta; Győry, Ferenc; Nagy, Endre; Méhes, Gábor; Molnár, Csaba

2017-02-01

Former studies suggest the frequent coexistence of Hashimoto's thyreoditis with papillary thyroid cancer, frequently featured by multifocal carcinogenesis but lower clinical stages compared to thyroid cancers lacking thyroiditis. We examined the clinico-pathological correlations between Hashimoto's thyroditis and papillary thyroid cancer in our region in the North-Eastern part of Hungary. We included a total of 230 patients with papillary thyroid cancer who underwent thyroid surgery at the Surgical Department of the University of Debrecen. Patients' sex, age, multifocality of thyroid cancer and clinical stage were evaluated. Cases included 40 patients (17.4%) with (4 male, 36 female) and 190 (82.6%) patients without HT (44 male, 146 female). Hashimoto's thyroiditis related thyroid cancer was almost exclusively associated with the papillary histological type. Multifocality of papillary cancer was significantly more frequent with coexisting Hashimoto's thyroiditis (16/40; 40.0%) compared to cases uninvolved (45/190; 23.7%; p = 0.034). In contrast, lymph node metastasis was significantly less frequent among patients with Hashimoto's thyroiditis (4 pN1 [36.4%]; 7 pN0 [63.6%]) then without it (34 pN1 [82.9%]; 7 pN0 [17.1%]; p = 0.002). Higher frequency and multifocality of papillary thyroid cancer might be the consequence of preexisting Hashimoto's thyroiditis to be considered as a preneoplastic stimulus supporting carcinogenesis, though the exact pathomechanism of this correlation is not clear yet. Orv. Hetil., 2017, 158(5), 178-182.

European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of multifocal motor neuropathy.

PubMed

van Schaik, I N; Bouche, P; Illa, I; Léger, J-M; Van den Bergh, P; Cornblath, D R; Evers, E M A; Hadden, R D M; Hughes, R A C; Koski, C L; Nobile-Orazio, E; Pollard, J; Sommer, C; van Doorn, P A

2006-08-01

Several diagnostic criteria for multifocal motor neuropathy have been proposed in recent years and a beneficial effect of intravenous immunoglobulin (IVIg) and various other immunomodulatory drugs has been suggested in several trials and uncontrolled studies. The objectives were to prepare consensus guidelines on the definition, investigation and treatment of multifocal motor neuropathy. Disease experts and a patient representative considered references retrieved from MEDLINE and the Cochrane Library in July 2004 and prepared statements which were agreed in an iterative fashion. The Task Force agreed good practice points to define clinical and electrophysiological diagnostic criteria for multifocal motor neuropathy and investigations to be considered. The principal recommendations and good practice points were: (i) IVIg (2 g/kg given over 2-5 days) should be considered as the first line treatment (level A recommendation) when disability is sufficiently severe to warrant treatment. (ii) Corticosteroids are not recommended (good practice point). (iii) If initial treatment with IVIg is effective, repeated IVIg treatment should be considered (level C recommendation). The frequency of IVIg maintenance therapy should be guided by the individual response (good practice point). Typical treatment regimens are 1 g/kg every 2-4 weeks or 2 g/kg every 4-8 weeks (good practice point). (iv) If IVIg is not or not sufficiently effective then immunosuppressive treatment may be considered. Cyclophosphamide, ciclosporin, azathioprine, interferon beta1a, or rituximab are possible agents (good practice point). (v) Toxicity makes cyclophosphamide a less desirable option (good practice point).

Multifocal demyelinating motor neuropathy and hamartoma syndrome associated with a de novo PTEN mutation

PubMed Central

Bansagi, Boglarka; Phan, Vietxuan; Baker, Mark R.; O'Sullivan, Julia; Jennings, Matthew J.; Whittaker, Roger G.; Müller, Juliane S.; Duff, Jennifer; Griffin, Helen; Miller, James A.L.; Gorman, Grainne S.; Lochmüller, Hanns; Chinnery, Patrick F.; Roos, Andreas; Swan, Laura E.

2018-01-01

Objective To describe a patient with a multifocal demyelinating motor neuropathy with onset in childhood and a mutation in phosphatase and tensin homolog (PTEN), a tumor suppressor gene associated with inherited tumor susceptibility conditions, macrocephaly, autism, ataxia, tremor, and epilepsy. Functional implications of this protein have been investigated in Parkinson and Alzheimer diseases. Methods We performed whole-exome sequencing in the patient's genomic DNA validated by Sanger sequencing. Immunoblotting, in vitro enzymatic assay, and label-free shotgun proteomic profiling were performed in the patient's fibroblasts. Results The predominant clinical presentation of the patient was a childhood onset, asymmetric progressive multifocal motor neuropathy. In addition, he presented with macrocephaly, autism spectrum disorder, and skin hamartomas, considered as clinical criteria for PTEN-related hamartoma tumor syndrome. Extensive tumor screening did not detect any malignancies. We detected a novel de novo heterozygous c.269T>C, p.(Phe90Ser) PTEN variant, which was absent in both parents. The pathogenicity of the variant is supported by altered expression of several PTEN-associated proteins involved in tumorigenesis. Moreover, fibroblasts showed a defect in catalytic activity of PTEN against the secondary substrate, phosphatidylinositol 3,4-trisphosphate. In support of our findings, focal hypermyelination leading to peripheral neuropathy has been reported in PTEN-deficient mice. Conclusion We describe a novel phenotype, PTEN-associated multifocal demyelinating motor neuropathy with a skin hamartoma syndrome. A similar mechanism may potentially underlie other forms of Charcot-Marie-Tooth disease with involvement of the phosphatidylinositol pathway. PMID:29720545

Multifocal humeral fractures.

PubMed

Maresca, A; Pascarella, R; Bettuzzi, C; Amendola, L; Politano, R; Fantasia, R; Del Torto, M

2014-02-01

Multifocal humeral fractures are extremely rare. These may affect the neck and the shaft, the shaft alone, or the diaphysis and the distal humerus. There is no classification of these fractures in the literature. From 2004 to 2010, 717 patients with humeral fracture were treated surgically at our department. Thirty-five patients presented with an associated fracture of the proximal and diaphyseal humerus: synthesis was performed with plate and screws in 34 patients, and the remaining patient had an open fracture that was treated with an external fixator. Mean follow-up was 3 years and 3 months. A classification is proposed in which type A fractures are those affecting the proximal and the humeral shaft, type B the diaphysis alone, and type C the diaphysis in association with the distal humerus. Type A fractures are then divided into three subgroups: A-I, undisplaced fracture of the proximal humerus and displaced shaft fracture; A-II: displaced fracture of the proximal and humeral shaft; and A-III: multifragmentary fracture affecting the proximal humerus and extending to the diaphysis. Multifocal humeral fractures are very rare and little described in the literature, both for classification and treatment. The AO classification describes bifocal fracture of the humeral diaphysis, type B and C. The classification suggested in this article mainly concerns fractures involving the proximal and humeral shaft. A simple classification of multifocal fractures is suggested to help the surgeon choose the most suitable type of synthesis for surgical treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.

Management of metastatic retroperitoneal sarcoma: a consensus approach from the Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG).

PubMed

2018-04-01

Retroperitoneal sarcoma (RPS) is a rare disease accounting for 0.1%-0.2% of all malignancies. Management of RPS is complex and requires multidisciplinary, tailored treatment strategies at all stages, but especially in the context of metastatic or multifocal recurrent disease. Due to the rarity and heterogeneity of this family of diseases, the literature to guide management is limited. The Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaboration of sarcoma experts from all disciplines convened in an effort to overcome these limitations. The TARPSWG has compiled the available evidence surrounding metastatic and multifocally recurrent RPS along with expert opinion in an iterative process to generate a consensus document regarding the complex management of this disease. The objective of this document is to guide sarcoma specialists from all disciplines in the diagnosis and treatment of multifocal recurrent or metastatic RPS. All aspects of patient assessment, diagnostic processes, local and systemic treatments, and palliation are reviewed in this document, and consensus recommendations provided accordingly. Recommendations were guided by available evidence, in conjunction with expert opinion where evidence was lacking. This consensus document combines the available literature regarding the management of multifocally recurrent or metastastic RPS with the practical expertise of high-volume sarcoma centers from multiple countries. It is designed as a tool for decision making in the complex multidisciplinary management of this condition and is expected to standardize management across centers, thereby ensuring that patients receive the highest quality care.

Heterogeneity of DNA methylation in multifocal prostate cancer.

PubMed

Serenaite, Inga; Daniunaite, Kristina; Jankevicius, Feliksas; Laurinavicius, Arvydas; Petroska, Donatas; Lazutka, Juozas R; Jarmalaite, Sonata

2015-01-01

Most prostate cancer (PCa) cases are multifocal, and separate foci display histological and molecular heterogeneity. DNA hypermethylation is a frequent alteration in PCa, but interfocal heterogeneity of these changes has not been extensively investigated. Ten pairs of foci from multifocal PCa and 15 benign prostatic hyperplasia (BPH) samples were obtained from prostatectomy specimens, resulting altogether in 35 samples. Methylation-specific PCR (MSP) was used to evaluate methylation status of nine tumor suppressor genes (TSGs), and a set of selected TSGs was quantitatively analyzed for methylation intensity by pyrosequencing. Promoter sequences of the RASSF1 and ESR1 genes were methylated in all paired PCa foci, and frequent (≥75 %) DNA methylation was detected in RARB, GSTP1, and ABCB1 genes. MSP revealed different methylation status of at least one gene in separate foci in 8 out of 10 multifocal tumors. The mean methylation level of ESR1, GSTP1, RASSF1, and RARB differed between the paired foci of all PCa cases. The intensity of DNA methylation in these TSGs was significantly higher in PCa cases than in BPH (p < 0.001). Hierarchical cluster analysis revealed a divergent methylation profile of paired PCa foci, while the foci from separate cases with biochemical recurrence showed similar methylation profile and the highest mean levels of DNA methylation. Our findings suggest that PCa tissue is heterogeneous, as between paired foci differences in DNA methylation status were found. Common epigenetic profile of recurrent tumors can be inferred from our data.

Psychophysical Vision Simulation of Diffractive Bifocal and Trifocal Intraocular Lenses

PubMed Central

Brezna, Wolfgang; Lux, Kirsten; Dragostinoff, Nikolaus; Krutzler, Christian; Plank, Nicole; Tobisch, Rainer; Boltz, Agnes; Garhöfer, Gerhard; Told, Reinhard; Witkowska, Katarzyna; Schmetterer, Leopold

2016-01-01

Purpose The visual performance of monofocal, bifocal, and trifocal intraocular lenses was evaluated by human individuals using a vision simulator device. This allowed investigation of the visual impression after cataract surgery, without the need actually to implant the lenses. Methods The randomized, double-masked, three-way cross-over study was conducted on 60 healthy male and female subjects aged between 18 and 35 years. Visual acuity (Early Treatment Diabetic Retinopathy Study; ETDRS) and contrast sensitivity tests (Pelli-Robson) under different lighting conditions (luminosities from 0.14–55 cd/m2, mesopic to photopic) were performed at different distances. Results Visual acuity tests showed no difference for corrected distance visual acuity data of bi- and trifocal lens prototypes (P = 0.851), but better results for the trifocal than for the bifocal lenses at distance corrected intermediate (P = 0.021) and distance corrected near visual acuity (P = 0.044). Contrast sensitivity showed no differences between bifocal and trifocal lenses at the distant (P = 0.984) and at the near position (P = 0.925), but better results for the trifocal lens at the intermediate position (P = 0.043). Visual acuity and contrast sensitivity showed a strong dependence on luminosity (P < 0.001). Conclusions At all investigated distances and all lighting conditions, the trifocal lens prototype often performed better, but never worse than the bifocal lens prototype. Translational Relevance The vision simulator can fill the gap between preclinical lens development and implantation studies by providing information of the perceived vision quality after cataract surgery without implantation. This can reduce implantation risks and promotes the development of new lens concepts due to the cost effective test procedure. PMID:27777828

Importance of intraocular pressure in glaucoma

NASA Astrophysics Data System (ADS)

Joos, Karen M.

1999-06-01

Glaucoma results in permanent vision loss and affects the peripheral vision initially. It is presented in 22.5 million people worldwide and is the 3rd cause of blindness. Present tonometers are not ideal for intraocular pressure measurements in all eyes. Of concern, PRK and LASIK may result in lower intraocular pressure readings. A challenges now exists for the development of a tonometer which can easily compensate for corneas with many parameters to avoid a future increase in normal-tension glaucoma or glaucoma which is advanced.

Suturing technique for scleral fixation of toric intraocular lens in the traumatic aphakic eye with corneal astigmatism.

PubMed

Pan, Qintuo; Yang, Zhengwei; Chen, Xiaomeng; Wei, Wenlong; Ke, Zhisheng; Chen, Ding; Huang, Fang; Cai, Junyong; Zhao, Zhenquan

2018-04-01

To describe the clinical outcomes of traumatic aphakic eyes with corneal astigmatism after using a novel technique for toric intraocular lens suture fixation. In total, 12 eyes of 12 patients who underwent a new scleral suture fixation technique of one-piece toric intraocular lens (SN6AT series, Alcon Inc., TX, USA) were included in our retrospective study. Preoperative patient status, postoperative visual acuity and refractive outcomes, postoperative intraocular lens rotation, tilt, decentration, and complications were analyzed. The mean follow-up was 11.6 ± 1.0 months. The mean preoperative best-corrected visual acuity was 0.55 ± 0.32 in the logarithm of minimum angle of resolution equivalent; the postoperative best-corrected visual acuity was 0.45 ± 0.34. The mean preoperative total corneal astigmatism was 2.51 ± 1.67 D. The mean postoperative residual astigmatism was 0.77 ± 0.54 D. The mean intraocular lens rotation was 3.33° ± 1.37° (range, 1°-6°). The mean intraocular lens tilt in horizontal direction was 3.64° ± 1.02° (range, 2.6°-6.3°) and in vertical direction it was 3.19° ± 1.07 ° (range, 1.6°-5.2°). The mean intraocular lens decentration in horizontal direction was 0.14 ± 0.03 mm (range, 0.089-0.192 mm) and in vertical direction it was 0.15 ± 0.02 mm (range, 0.113-0.181 mm). One patient had mild vitreous hemorrhage and two other patients had high postoperative residual sphere and astigmatism, respectively. But no other serious complications were observed. Scleral suture fixation of foldable toric intraocular lens to correct corneal astigmatism can be a safe and effective alternative technique to manage traumatic aphakic eyes that lack adequate capsular support.

Uveitis- a rare disease often associated with systemic diseases and infections- a systematic review of 2619 patients

PubMed Central

2012-01-01

Background Uveitis is an autoimmune disease of the eye that refers to any of a number of intraocular inflammatory conditions. Because it is a rare disease, uveitis is often overlooked, and the possible associations between uveitis and extra-ocular disease manifestations are not well known. The aim of this study was to characterize uveitis in a large sample of patients and to evaluate the relationship between uveitis and systemic diseases. Methods The present study is a cross-sectional study of a cohort of patients with uveitis. Records from consecutive uveitis patients who were seen by the Uveitis Service in the Department of Ophthalmology at the Medical University of Vienna between 1995 and 2009 were selected from the clinical databases. The cases were classified according to the Standardization of Uveitis Nomenclature Study Group criteria for Uveitis. Results Data were available for 2619 patients, of whom 59.9% suffered from anterior, 14.8% from intermediate, 18.3% from posterior and 7.0% from panuveitis. 37.2% of all cases showed an association between uveitis and extra-organ diseases; diseases with primarily arthritic manifestations were seen in 10.1% of all cases, non-infectious systemic diseases (i.e., Behçet´s disease, sarcoidosis or multiple sclerosis) in 8.4% and infectious uveitis in 18.7%. 49.4% of subjects suffering from anterior uveitis tested positively for the HLA-B27 antigen. In posterior uveitis cases 29% were caused by ocular toxoplasmosis and 17.7% by multifocal choroiditis. Conclusion Ophthalmologists, rheumatologists, infectiologists, neurologists and general practitioners should be familiar with the differential diagnosis of uveitis. A better interdisciplinary approach could help in tailoring of the work-up, earlier diagnosis of co-existing diseases and management of uveitis patients. PMID:22932001

Intravitreal Autologous Bone Marrow CD34+ Cell Therapy for Ischemic and Degenerative Retinal Disorders: Preliminary Phase 1 Clinical Trial Findings

PubMed Central

Park, Susanna S.; Bauer, Gerhard; Abedi, Mehrdad; Pontow, Suzanne; Panorgias, Athanasios; Jonnal, Ravi; Zawadzki, Robert J.; Werner, John S.; Nolta, Jan

2015-01-01

Purpose. Because human bone marrow (BM) CD34+ stem cells home into damaged tissue and may play an important role in tissue repair, this pilot clinical trial explored the safety and feasibility of intravitreal autologous CD34+ BM cells as potential therapy for ischemic or degenerative retinal conditions. Methods. This prospective study enrolled six subjects (six eyes) with irreversible vision loss from retinal vascular occlusion, hereditary or nonexudative age-related macular degeneration, or retinitis pigmentosa. CD34+ cells were isolated under Good Manufacturing Practice conditions from the mononuclear cellular fraction of the BM aspirate using a CliniMACs magnetic cell sorter. After intravitreal CD34+ cell injection, serial ophthalmic examinations, microperimetry/perimetry, fluorescein angiography, electroretinography (ERG), optical coherence tomography (OCT), and adaptive optics OCT were performed during the 6-month follow-up. Results. A mean of 3.4 million (range, 1–7 million) CD34+ cells were isolated and injected per eye. The therapy was well tolerated with no intraocular inflammation or hyperproliferation. Best-corrected visual acuity and full-field ERG showed no worsening after 6 months. Clinical examination also showed no worsening during follow-up except among age-related macular degeneration subjects in whom mild progression of geographic atrophy was noted in both the study eye and contralateral eye at 6-month follow-up, concurrent with some possible decline on multifocal ERG and microperimetry. Cellular in vivo imaging using adaptive optics OCT showed changes suggestive of new cellular incorporation into the macula of the hereditary macular degeneration study eye. Conclusions. Intravitreal autologous BM CD34+ cell therapy appears feasible and well tolerated in eyes with ischemic or degenerative retinal conditions and merits further exploration. (ClinicalTrials.gov number, NCT01736059.) PMID:25491299

Quality of vision, patient satisfaction and long-term visual function after bilateral implantation of a low addition multifocal intraocular lens.

PubMed

Pedrotti, Emilio; Mastropasqua, Rodolfo; Bonetto, Jacopo; Demasi, Christian; Aiello, Francesco; Nucci, Carlo; Mariotti, Cesare; Marchini, Giorgio

2017-07-17

The aim of the current study was to compare the quality of vision, contrast sensitivity and patient satisfaction with a biaspheric, segmented, rotationally asymmetric IOL (Lentis Comfort LS-313 MF 15-Oculentis GmbH, Berlin, Germany) as opposed to those of a monofocal IOL. This prospective single-blind comparative study included two groups of patients affected by bilateral senile cataract who underwent lens extraction and IOL implantation. The first group received a bilateral implantation of a monofocal IOL, and the second group received a bilateral implantation of the Comfort IOL. Twelve months after surgery uncorrected and corrected visual acuity at different distances (30, 50, 70 cm and 4 m), defocus curve and contrast sensitivity were assessed. Patient's satisfaction and spectacle independence were evaluated by mean of the NEI RQL-42 questionnaire. No significant differences were found between the groups in terms of near vision. The group of patients implanted with a Comfort IOL obtained the best results at intermediate distances (50 and 70 cm P < .001). Both groups showed an excellent uncorrected distance visual acuity (4 m). No statistically significant differences were found in terms of corrected near, intermediate and distance visual acuity. Concerning contrast sensitivity, no statistically significant differences between the groups were observed at any cycles per degree. The NEI RQL-42 questionnaire showed statistically significant differences between the group for "near vision" (P = .015), "dependence on correction" (P = .048) and "suboptimal correction" (P < .001) subscales. Our findings indicated that the Comfort IOL +1.5 D provides a good intermediate spectacle independence together with a high quality of vision, with a low amount of subjective symptoms and a contrast sensitivity similar to those obtained with a monofocal IOL.

Refractive lens exchange in younger and older presbyopes: comparison of complication rates, 3 months clinical and patient-reported outcomes

PubMed Central

Schallhorn, Steven C; Schallhorn, Julie M; Pelouskova, Martina; Venter, Jan A; Hettinger, Keith A; Hannan, Stephen J; Teenan, David

2017-01-01

Purpose To compare refractive and visual outcomes, patient satisfaction, and complication rates among different age categories of patients who underwent refractive lens exchange (RLE). Methods A stratified, simple random sample of patients matched on preoperative sphere and cylinder was selected for four age categories: 45–49 years (group A), 50–54 years (group B), 55–59 years (group C), and 60–65 years (group D). Each group contained 320 patients. All patients underwent RLE with a multifocal intraocular lens at least in one eye. Three months postoperative refractive/visual and patient-reported outcomes are presented. Results The percentage of patients that achieved binocular uncorrected distance visual acuity 20/20 or better was 91.6% (group A), 93.8% (group B), 91.6% (group C), 88.8% (group D), P=0.16. Binocularly, 80.0% of patients in group A, 84.7% in group B, 78.9% in group C, and 77.8% in group D achieved 20/30 or better uncorrected near visual acuity (P=0.13). The proportion of eyes within 0.50 D of emmetropia was 84.4% in group A, 86.8% in group B, 85.7% in group C, and 85.8% in group D (P=0.67). There was no statistically significant difference in postoperative satisfaction, visual phenomena, dry eye symptoms, distance or near vision activities. Apart from higher rate of iritis in the age group 50–55 years, there was no statistically significant difference in postoperative complication rates. Conclusion RLE can be safely performed in younger as well as older presbyopes. No significant difference was found in clinical or patient-reported outcomes. PMID:28894356

Transverse vs torsional ultrasound: prospective randomized contralaterally controlled study comparing two phacoemulsification-system handpieces.

PubMed

Assil, Kerry K; Harris, Lindsay; Cecka, Jeannie

2015-01-01

To compare surgical efficiency and multiple early clinical outcome variables in eyes undergoing phacoemulsification using either transversal or torsional ultrasound systems. Assil Eye Institute, Beverly Hills, CA, USA. Prospective, randomized, clinician-masked, contralaterally controlled single-center evaluation. Patients seeking cataract removal in both eyes with implantation of multifocal intraocular lenses were randomly assigned to one of two treatment rooms for phacoemulsification with either a transverse ultrasound system or torsional handpiece system. The contralateral eye was treated at a later date with the alternate device. A total of 54 eyes of 27 patients having similar degrees of cataract, astigmatism, and visual potential were included. All operative data were collected for analysis, and patients were followed for 3 months after surgery. Similar visual acuity was reported at all postoperative visits between the two groups. Mean phacoemulsification time and total power required were both significantly lower with the transverse system than with the torsional technique (P<0.05 for both). Similarly, mean total balanced salt solution used was significantly less with the transverse system vs torsional (P<0.05). Postoperative safety demonstrated significantly lower endothelial cell loss at 1 day and 1 month (P<0.05) with transverse vs torsional. Macular swelling was less at 1 week, 1 month, and 3 months with transverse vs torsional, although the difference did not achieve significance (P=0.1) at any single time point. Clinically detectable corneal edema was reported less frequently at all postoperative time points with the transverse system. The transverse ultrasound system was found to be possibly associated with less balanced salt-solution use, less phacoemulsification time, and less power required than the torsional phaco system. Postoperative data suggested that improved phaco efficiency may translate to a better overall safety profile for the patient.

Modelling lifetime cost consequences of ReSTOR® in cataract surgery in four European countries

PubMed Central

Lafuma, Antoine; Berdeaux, Gilles

2008-01-01

Background To compare the lifetime costs of liberating patients from spectacles after cataract surgery by implanting the multifocal intraocular lens (IOL) 'ReSTOR®' versus monofocal IOLs in France, Italy, Germany and Spain. Methods A Markov model was created to follow patient cohorts from cataract surgery until death. Prevalence rates of patients not needing spectacles after cataract surgery were obtained from clinical trials. Resource utilisation included implant surgery, IOLs, spectacles, visits to ophthalmologists and eye centres, transport, and time lost by patients. Economic perspectives were those of Society and Sickness Funds (SFs). Results The mean number of spectacles purchased after ReSTOR® was 1.34–1.61 and after monofocal IOLs 6.05–7.27. From the societal perspective, total cost estimates discounted by 3% were between €3,551 and €4,052 with ReSTOR® compared to €3,989 and €5,548 with monofocal IOLs. Undiscounted savings related to ReSTOR® ranged from €815 to €2,164. From the SFs' perspective total cost estimates discounted by 3% were between €2,150 and €2,524 with ReSTOR® compared to €2,324 and €2,610 with monofocal IOLs. Savings related to ReSTOR®, once costs discounted, ranged from €61 to €219. Discount and spectacle freedom prevalence rates were the most sensitive parameters. Conclusion The bulk of the savings related to ReSTOR® were realized outside the SF. From both a societal and SF perspective, savings, after a 3% discounting, achieved by liberating patients from spectacles counterbalanced the initially higher cost of ReSTOR®. ReSTOR® is a cost saving alternative to spectacles for patients requiring cataract surgery. PMID:18627594

Applicability of predictive toxicology methods for monoclonal antibody therapeutics: status Quo and scope.

PubMed

Kizhedath, Arathi; Wilkinson, Simon; Glassey, Jarka

2017-04-01

Biopharmaceuticals, monoclonal antibody (mAb)-based therapeutics in particular, have positively impacted millions of lives. MAbs and related therapeutics are highly desirable from a biopharmaceutical perspective as they are highly target specific and well tolerated within the human system. Nevertheless, several mAbs have been discontinued or withdrawn based either on their inability to demonstrate efficacy and/or due to adverse effects. Approved monoclonal antibodies and derived therapeutics have been associated with adverse effects such as immunogenicity, cytokine release syndrome, progressive multifocal leukoencephalopathy, intravascular haemolysis, cardiac arrhythmias, abnormal liver function, gastrointestinal perforation, bronchospasm, intraocular inflammation, urticaria, nephritis, neuropathy, birth defects, fever and cough to name a few. The advances made in this field are also impeded by a lack of progress in bioprocess development strategies as well as increasing costs owing to attrition, wherein the lack of efficacy and safety accounts for nearly 60 % of all factors contributing to attrition. This reiterates the need for smarter preclinical development using quality by design-based approaches encompassing carefully designed predictive models during early stages of drug development. Different in vitro and in silico methods are extensively used for predicting biological activity as well as toxicity during small molecule drug development; however, their full potential has not been utilized for biological drug development. The scope of in vitro and in silico tools in early developmental stages of monoclonal antibody-based therapeutics production and how it contributes to lower attrition rates leading to faster development of potential drug candidates has been evaluated. The applicability of computational toxicology approaches in this context as well as the pitfalls and promises of extending such techniques to biopharmaceutical development has been highlighted.

Designing multifocal corneal models to correct presbyopia by laser ablation

NASA Astrophysics Data System (ADS)

Alarcón, Aixa; Anera, Rosario G.; Del Barco, Luis Jiménez; Jiménez, José R.

2012-01-01

Two multifocal corneal models and an aspheric model designed to correct presbyopia by corneal photoablation were evaluated. The design of each model was optimized to achieve the best visual quality possible for both near and distance vision. In addition, we evaluated the effect of myosis and pupil decentration on visual quality. The corrected model with the central zone for near vision provides better results since it requires less ablated corneal surface area, permits higher addition values, presents stabler visual quality with pupil-size variations and lower high-order aberrations.

The Benefit of Mirtazapine in the Treatment of Progressive Multifocal Leukoencephalopathy in a Young HIV-positive Patient

PubMed Central

Miranda, Jorge; Sandoval, Hugo; Ramos-Duran, Luis; Tonarelli, Silvina B.

2018-01-01

Highly active antiretroviral therapy is well-established in the treatment of human immunodeficiency virus (HIV)-positive patients. Nonadherence with therapy regimens often leads to the occurrence of opportunistic infections that further complicate treatment and challenge the treating physician. We report a young HIV-positive patient who suffered from progressive multifocal leukoencephalopathy caused by the human John Cunningham virus and showed objective clinical improvement after adding mirtazapine to the treatment regimen, an observation that is supported by the emerging literature. PMID:29497578

Multifocal Tubercular Dactylitis: A Rare Presentation of Skeletal Tuberculosis in an Adult.

PubMed

Thatoi, Pravat; Parida, Manoj; Barik, Rakesh; Das, Bidyut

2017-06-01

Tubercular dactylitis is an uncommon form of osteo-articular tuberculosis seen in children. Multifocal involvement, simultaneously involving hands and feet is extremely uncommon. Here we report an adult patient with tubercular dactylitis involving multiple digits of both hands and second digit of right foot in absence of any risk factors like immunodeficiency or any debilitating condition. The patient was successfully treated with anti-tubercular drugs for six months. Mycobacterium tuberculosis infection of bones and joints can present in an unusual way but early diagnosis and treatment caries a good prognosis.

[Pyomyositis, sacroiliitis and spondylodiscitis caused by Staphylococcus hominis in a immunocompetent woman].

PubMed

Gómez Rodríguez, N; Durán Muñoz, O

2006-12-01

In absence of risk factors, osteoarticular infections by coagulase-negative staphylococci are very infrequent. We described the case of a immunocompetent 73-year-old-woman that suffered pyomyositis, left sacroiliitis and spondylodiscitis involving the first and second thoracic vertebrae by Staphylococcus hominis. This multifocal infection occurred five-weeks after intramuscular administration of NSAI for treatment of low back pain associated with a herniated disc L4-L5. This is the first know case of a multifocal muscle skeletal infection by Staphylococcus hominis in a patient immunocompetent.

Strategy in Regulatory Decision-Making for Management of Progressive Multifocal Leukoencephalopathy.

PubMed

Segec, A; Keller-Stanislawski, B; Vermeer, N S; Macchiarulo, C; Straus, S M; Hidalgo-Simon, A; De Bruin, M L

2015-11-01

Progressive multifocal leukoencephalopathy (PML) has been observed after the use of several medicines, including monoclonal antibodies. As these drugs play important roles in the therapeutic armamentarium, it is important to address the challenges that this severe adverse reaction poses to the safe use of medicines. Considering the need for consistent outcomes of regulatory decisions, the European Medicines Agency Pharmacovigilance Risk Assessment Committee (PRAC) used PML as an example to develop a systematic approach to labeling and risk minimization. © 2015 American Society for Clinical Pharmacology and Therapeutics.

Intraocular pressure reduction and regulation

NASA Technical Reports Server (NTRS)

Baehr, E. F.; Mcgannon, W. J.

1979-01-01

System designed to reduce intraocular pressure hydraulically to any level desired by physician over set time and in controlled manner has number of uses in ophthalmology. Device may be most immediately useful in treatment of glaucoma.

A new surgical technique using steel suture for trans-scleral fixation of posterior chamber intraocular lenses

PubMed Central

Ram, Jagat; Gupta, Nishant; Chaudhary, Manish; Verma, Neelam

2013-01-01

Background: A new emerging complication of trans-scleral fixation of posterior chamber (PC) intraocular lens (IOL) with polypropylene suture is high rates of spontaneous dislocation of the IOL due to disintegration or breakage of suture. Materials: We report a new surgical technique of trans-scleral fixation of posterior chamber intraocular lens (SF PCIOL) with steel suture to eliminate the complication of dislocation of IOL fixed with polypropylene suture in one adult and a child. Results: We successfully achieved stable fixation and good centration of IOL after SF PCIOL with steel suture in these patient having inadequate posterior capsular support. Both eyes achieved best corrected visual acuity 20/40 at 18 months follow-up. Conclusions: Steel suture is a viable option for trans-scleral fixation of posterior chamber intraocular lens. PMID:23619504

Anti-tubercular therapy for intraocular tuberculosis: A systematic review and meta-analysis

PubMed Central

Kee, Ae Ra; Gonzalez-Lopez, Julio J.; Al-Hity, Aws; Gupta, Bhaskar; Lee, Cecilia S.; Gunasekeran, Dinesh Visva; Jayabalan, Nirmal; Grant, Robert; Kon, Onn Min; Gupta, Vishali; Westcott, Mark; Pavesio, Carlos; Agrawal, Rupesh

2016-01-01

Intraocular tuberculosis remains a diagnostic and management conundrum for both ophthalmologists and pulmonologists. We analyze the efficacy and safety of anti-tubercular therapy (ATT) in patients with intraocular tuberculosis and factors associated with favorable outcome. Twenty-eight studies are included in this review, with a total of 1,917 patients. Nonrecurrence of inflammation was observed in pooled estimate of 84% of ATT-treated patients (95% CI 79–89). There was minimal difference in the outcome between patients treated with ATT alone (85% successful outcome; 95% CI 25–100) and those with concomitant systemic corticosteroid (82%; 95% CI 73–90). The use of ATT may be of benefit to patients with suspected intraocular tuberculosis; however, this conclusion is limited by the lack of control group analysis and standardized recruitment and treatment protocols. PMID:26970263

Combined ab interno trabeculotomy and lens extraction: a novel management option for combined uveitic and chronic narrow angle raised intraocular pressure.

PubMed

Lin, Siying; Gupta, Bhaskar; Rossiter, Jonathan

2016-02-01

Minimally invasive glaucoma surgery is a developing area that has the potential to replace traditional glaucoma surgery, with its known risk profile, but at present there are no randomised controlled data to validate its use. We report on a case where sequential bilateral combined ab interno trabeculotomy and lens extraction surgery was performed on a 45-year-old woman with combined uveitic and chronic narrow angle raised intraocular pressure. Maximal medical management alone could not control the intraocular pressure. At 12-month follow-up, the patient had achieved stable intraocular pressure in both eyes on a combination of topical ocular antiglaucomatous and steroid therapies. This case demonstrates the effectiveness of trabecular meshwork ablation via ab interno trabeculotomy in a case of complex mixed mechanism glaucoma. 2016 BMJ Publishing Group Ltd.

Combined ab interno trabeculotomy and lens extraction: a novel management option for combined uveitic and chronic narrow angle raised intraocular pressure

PubMed Central

Lin, Siying; Gupta, Bhaskar; Rossiter, Jonathan

2016-01-01

Minimally invasive glaucoma surgery is a developing area that has the potential to replace traditional glaucoma surgery, with its known risk profile, but at present there are no randomised controlled data to validate its use. We report on a case where sequential bilateral combined ab interno trabeculotomy and lens extraction surgery was performed on a 45-year-old woman with combined uveitic and chronic narrow angle raised intraocular pressure. Maximal medical management alone could not control the intraocular pressure. At 12-month follow-up, the patient had achieved stable intraocular pressure in both eyes on a combination of topical ocular antiglaucomatous and steroid therapies. This case demonstrates the effectiveness of trabecular meshwork ablation via ab interno trabeculotomy in a case of complex mixed mechanism glaucoma. PMID:26833953

Evaluating the Biostability of Yellow and Clear Intraocular Lenses with a System Simulating Natural Intraocular Environment

PubMed Central

Hayashi, Rijo; Hayashi, Shimmin; Arai, Kiyomi; Yoshida, Shinichirou; Chikuda, Makoto; Machida, Shigeki

2016-01-01

Purpose Blue light–filtering intraocular lenses (IOLs) are thought to protect the retina from blue light damage after cataract surgery, and the implantation of yellow-tinted IOLs has been commonly used in cataract surgery. To our knowledge, this is the first investigation measuring the long-term biostability of yellow-tinted IOLs using an in vitro system simulating natural intraocular environment. Methods Six hydrophobic acrylic IOLs, three clear IOLs, and three yellow-tinted IOLs were included in the study. Each yellow-tinted IOL was a matching counterpart of a clear IOL, with the only difference being the lens color. The IOLs were kept in conditions replicating the intraocular environment using a perfusion culture system for 7 months. Resolution, light transmittance rate, and the modulation transfer function (MTF) were measured before and after culturing. Surface roughness of the anterior and posterior surfaces was also measured. Results After culturing for 7 months, there were no changes in the resolution, the light transmittance rate, and MTF. The surface roughness of the anterior and posterior surfaces increased after culturing; however, this increase was clinically insignificant. There were no differences in surface roughness between the clear and yellow-tinted IOLs, either before or after culturing. Conclusions A novel in vitro system replicating intraocular environment was used to investigate the biostability of yellow-tinted IOLs. The surface roughness showed no clinically significant increase after culturing for 7 months. Translational Relevance This system is useful for evaluating the biostability of IOLs. PMID:27933221

Diagnosis of intraocular lymphosarcoma in a dog by use of a polymerase chain reaction assay for antigen receptor rearrangement.

PubMed

Pate, Diana O; Gilger, Brian C; Suter, Steven E; Clode, Alison B

2011-03-01

A 12-year-old castrated male mixed-breed dog was evaluated because of blepharospasm and blindness affecting both eyes. During examination and diagnostic testing of the dog, fine-needle aspirates of splenic nodules were examined microscopically and stage Vb multicentric large-cell lymphosarcoma was identified. Aqueocentesis was performed, and sample analysis revealed intraocular lymphosarcoma; B-cell neoplasia was confirmed by use of a PCR assay for antigen receptor rearrangement (PARR) performed on samples of aqueous humor. Secondary uveitis and glaucoma were detected bilaterally in addition to chronic superficial corneal ulcerations in the left eye. Treatment for abdominal and intraocular lymphosarcoma involving administration of vincristine, l-asparaginase, cyclophosphamide, doxorubicin, and prednisone was initiated. Secondary uveitis and glaucoma were controlled with topical treatment; however, the corneal ulceration did not resolve. Seven weeks following diagnosis, the dog died as a result of complications related to systemic neoplasia and chemotherapy. In the dog of this report, intraocular lymphosarcoma was diagnosed via PARR performed on samples of aqueous humor. Moreover, the immunophenotype of the neoplastic cells was determined by use of that diagnostic technique. Because secondary uveitis is a common finding in dogs and cats with systemic lymphosarcoma, intraocular lymphosarcoma should be considered as a differential diagnosis; furthermore, investigation (eg, PARR performed on aqueous humor samples) to identify the presence of intraocular lymphosarcoma is warranted, thereby allowing targeted interventions to be considered in management of those patients.

Toric Intraocular Lens Outcomes in Patients With Glaucoma.

PubMed

Brown, Reay H; Zhong, Le; Bozeman, Caroline W; Lynch, Mary G

2015-06-01

To report the outcomes of toric intraocular lens implantation in patients with glaucoma and corneal astigmatism. One hundred twenty-six eyes of 87 patients with glaucoma and corneal astigmatism that underwent cataract surgery with an AcrySof toric intraocular lens (Alcon Laboratories, Inc., Fort Worth, TX) implant were selected for this single-center, retrospective case series. Corrected distance visual acuity, intraocular pressure, and refractive astigmatism were measured in each eye preoperatively and postoperatively. Uncorrected distance visual acuity and toric alignment were measured postoperatively. The uncorrected distance visual acuity was 0.04 ± 0.08 logMAR (20/22 Snellen) for all eyes. Ninety-eight percent of all eyes achieved an uncorrected distance visual acuity of 20/40 or better, with 76% achieving 20/25 or better and 47% achieving 20/20. The corrected distance visual acuity for all eyes was 0.01 ± 0.03 logMAR (20/20.5 Snellen) postoperatively. The refractive cylinder improved from 1.47 ± 1.10 diopters preoperatively to 0.31 ± 0.37 diopters postoperatively. The residual refractive cylinder was 1.00 diopter or less in 97% of eyes, 0.75 diopters or less in 90% of eyes, and 0.50 diopters or less in 83% of eyes. Mean misalignment was 4.4° ± 5.1°. Intraocular pressure decreased by a mean of 2.3 ± 3.3 mm Hg following the surgery. Toric intraocular lenses can reliably reduce astigmatism and improve uncorrected vision in eyes with cataract and glaucoma. Copyright 2015, SLACK Incorporated.

The incidence of posterior capsule disruption during phacoemulsification and associated postoperative complication rates in dogs: 244 eyes (1995-2002).

PubMed

Johnstone, Nancy; Ward, Daniel A

2005-01-01

The objective of this retrospective study was to report the incidence of posterior capsule disruption during routine phacoemulsification and to document the postoperative outcomes and complications in eyes with posterior capsule disruption compared with eyes with intact posterior capsules. Records of 143 dogs (244 eyes) were reviewed. Data collected included whether the posterior capsule was disrupted, whether the disruption was planned or accidental, whether an intraocular lens was implanted, and visual outcome. Records were reviewed for postoperative complications. Intraocular lens implantation rates, complication rates, and visual outcomes were compared between intact and disrupted posterior capsule groups using Chi-square analyses. The posterior capsule was disrupted in 33/244 eyes (14%). Planned capsulotomies accounted for 36% of the disruptions. Intraocular lenses were implanted in 76% of eyes without a disruption of the posterior capsule and in 31% of eyes with a posterior capsule disruption. Intraocular lenses were more likely to be implanted in eyes with a planned disruption of the posterior capsule (7/12; 58%) than in eyes with an accidental disruption (3/20; 15%). There were no significant differences in postoperative complications or visual outcome between eyes with posterior capsule disruption and those without. The most significant complication of posterior capsule disruption during phacoemulsification is the inability to implant an intraocular lens. Intraocular lenses are more likely to be placed in eyes with intentional disruptions of the posterior capsule than those with accidental ruptures.

Intraocular robotic interventional surgical system (IRISS): Mechanical design, evaluation, and master-slave manipulation.

PubMed

Wilson, Jason T; Gerber, Matthew J; Prince, Stephen W; Chen, Cheng-Wei; Schwartz, Steven D; Hubschman, Jean-Pierre; Tsao, Tsu-Chin

2018-02-01

Since the advent of robotic-assisted surgery, the value of using robotic systems to assist in surgical procedures has been repeatedly demonstrated. However, existing technologies are unable to perform complete, multi-step procedures from start to finish. Many intraocular surgical steps continue to be manually performed. An intraocular robotic interventional surgical system (IRISS) capable of performing various intraocular surgical procedures was designed, fabricated, and evaluated. Methods were developed to evaluate the performance of the remote centers of motion (RCMs) using a stereo-camera setup and to assess the accuracy and precision of positioning the tool tip using an optical coherence tomography (OCT) system. The IRISS can simultaneously manipulate multiple surgical instruments, change between mounted tools using an onboard tool-change mechanism, and visualize the otherwise invisible RCMs to facilitate alignment of the RCM to the surgical incision. The accuracy of positioning the tool tip was measured to be 0.205±0.003 mm. The IRISS was evaluated by trained surgeons in a remote surgical theatre using post-mortem pig eyes and shown to be effective in completing many key steps in a variety of intraocular surgical procedures as well as being capable of performing an entire cataract extraction from start to finish. The IRISS represents a necessary step towards fully automated intraocular surgery and demonstrated accurate and precise master-slave manipulation for cataract removal and-through visual feedback-retinal vein cannulation. Copyright © 2017 John Wiley & Sons, Ltd.

Severe South American Ocular Toxoplasmosis Is Associated with Decreased Ifn-γ/Il-17a and Increased Il-6/Il-13 Intraocular Levels

PubMed Central

de-la-Torre, Alejandra; Sauer, Arnaud; Pfaff, Alexander W.; Bourcier, Tristan; Brunet, Julie; Speeg-Schatz, Claude; Ballonzoli, Laurent; Villard, Odile; Ajzenberg, Daniel; Sundar, Natarajan; Grigg, Michael E.

2013-01-01

In a cross sectional study, 19 French and 23 Colombian cases of confirmed active ocular toxoplasmosis (OT) were evaluated. The objective was to compare clinical, parasitological and immunological responses and relate them to the infecting strains. A complete ocular examination was performed in each patient. The infecting strain was characterized by genotyping when intraocular Toxoplasma DNA was detectable, as well as by peptide-specific serotyping for each patient. To characterize the immune response, we assessed Toxoplasma protein recognition patterns by intraocular antibodies and the intraocular profile of cytokines, chemokines and growth factors. Significant differences were found for size of active lesions, unilateral macular involvement, unilateral visual impairment, vitreous inflammation, synechiae, and vasculitis, with higher values observed throughout for Colombian patients. Multilocus PCR-DNA sequence genotyping was only successful in three Colombian patients revealing one type I and two atypical strains. The Colombian OT patients possessed heterogeneous atypical serotypes whereas the French were uniformly reactive to type II strain peptides. The protein patterns recognized by intraocular antibodies and the cytokine patterns were strikingly different between the two populations. Intraocular IFN-γ and IL-17 expression was lower, while higher levels of IL-13 and IL-6 were detected in aqueous humor of Colombian patients. Our results are consistent with the hypothesis that South American strains may cause more severe OT due to an inhibition of the protective effect of IFN-γ. PMID:24278490

The role of methotrexate in resolving ocular inflammation after specific therapy for presumed latent syphilitic uveitis and presumed tuberculosis-related uveitis.

PubMed

Sahin, Ozlem; Ziaei, Alireza

2014-07-01

This study was designed to investigate whether the antiinflammatory and antiproliferative activity of oral and intravitreal methotrexate (MTX) suppresses intraocular inflammation in patients with presumed latent syphilitic uveitis and presumed tuberculosis-related uveitis. Interventional prospective study including three cases with presumed latent syphilitic uveitis treated with intravenous penicillin and oral MTX, and two cases with presumed tuberculosis-related uveitis treated with standard antituberculosis therapy and intravitreal MTX injections. Treatment efficacy of all cases was assessed by best-corrected visual acuity, fundus fluorescein angiography, and optical coherence tomography. Four eyes of 3 patients with presumed latent syphilitic uveitis had improved best-corrected visual acuity, suppression of intraocular inflammation, and resolution of cystoid macular edema in 6 months with oral MTX therapy. No recurrence of intraocular inflammation was observed in 6 months to 18 months of follow-up period after cessation of MTX. Two eyes of two patients with presumed tuberculosis-related uveitis showed improved best-corrected visual acuity, suppression of intraocular inflammation, and resolution of cystoid macular edema after intravitreal injections of MTX. No recurrence of intraocular inflammation was observed in 6 months to 8 months of follow-up period after cessation of antituberculous therapy. For the first time in the treatment of presumed latent syphilitic uveitis and presumed tuberculosis-related uveitis, we believe that MTX might have an adjunctive role to suppress intraocular inflammation, reduce uveitic macular edema, and prevent the recurrences of the diseases.

Intraocular inflammation in autoimmune diseases.

PubMed

Pras, Eran; Neumann, Ron; Zandman-Goddard, Gisele; Levy, Yair; Assia, Ehud I; Shoenfeld, Yehuda; Langevitz, Pnina

2004-12-01

The uveal tract represents the vascular organ of the eye. In addition to providing most of the blood supply to the intraocular structures, it acts as a conduit for immune cells, particularly lymphocytes, to enter the eye. Consequently, the uveal tract is represented in many intraocular inflammatory processes. Uveitis is probably a misnomer unless antigens within the uvea are the direct targets of the inflammatory process. A better term of the condition is "intraocular inflammation" (IOI). To review the presence of IOI in autoimmune diseases, the immunopathogenic mechanisms leading to disease, and treatment. We reviewed the English medical literature by using MEDLINE (1984-2003) employing the terms "uveitis," "intraocular inflammation," and "autoimmune diseases." An underlying autoimmune disease was identified in up to 40% of patients with IOI, and included spondyloarthropathies, Behcets disease, sarcoidosis, juvenile chronic arthritis, Vogt-Koyanagi-Harada syndrome (an inflammatory syndrome including uveitis with dermatologic and neurologic manifestations), immune recovery syndrome, and uveitis with tubulointerstitial disease. The immunopathogenesis of IOI involves enhanced T-cell response. Recently, guidelines for the use of immunosuppressive drugs for inflammatory eye disease were established and include: corticosteroids, azathioprine, methotrexate, mycophenolate mofetil, cyclosporine, tacrolimus, cyclophosphamide, and chlorambucil. New therapies with limited experience include the tumor necrosis factor alpha inhibitors, interferon alfa, monoclonal antibodies against lymphocyte surface antigens, intravenous immunoglobulin (IVIG), and the intraocular delivery of immunosuppressive agents. An underlying autoimmune disease was identified in up to 40% of patients with IOI. Immunosuppressive drugs, biologic agents, and IVIG are employed for the treatment of IOI in autoimmune diseases.

The effect of vitrectomy with silicone oil tamponade on intraocular pressure and anterior chamber morphology.

PubMed

Suic, S P; Sikić, J

2001-01-01

We measured the tamponading effect of silicone oil, saline and air after vitrectomy, on intraocular pressure and aqueous humor outflow in 85 patients with highly proliferative retina and vitreous changes. Silicone oil as retinal tamponading agent after vitrectomy was used in 45 patients, and saline or air in 39 patients. The mean intraocular pressure measured at one month after treatment was greatly elevated in patients with silicone oil tamponade as compared to those with saline or air tamponade. At 6 and 12 months examinations, mean intraocular pressures were compared in these two groups of patients. Gonioscopy revealed silicone oil emulsification and presence of emulsified bubbles in the anterior chamber in 22.22% of patients, and narrowing of the chamber angle in several patients with silicone oil tamponade. Intraocular pressure elevation following vitrectomy with silicone oil tamponade was found to be of transient rather than permanent nature, since it regressed after silicone oil removal. This transient elevation was due to silicone oil tendency to emulsify. Silicone oil bubbles changed the morphology of the anterior chamber angle and fine trabecular structures by creating a barrier to aqueous humor outflow.

Weight effect of saline accumulation in surgical drapes.

PubMed

Wiggins, Michael N; Thostenson, Jeff D

2007-10-01

Positive vitreal pressure during phacoemulsification is a known risk factor for posterior capsule rupture. Knowledge of modifiable causes of positive vitreal pressure is imperative to aid in its management intraoperatively. The aim of our study was to determine whether the weight from the accumulation of a large volume of saline in the surgical drapes could have an effect on intraocular pressure in patients. Such an effect could indicate a source of posterior vitreal pressure in patients undergoing prolonged phacoemulsification. In 23 adult patients undergoing phacoemulsification at the Jones Eye Institute at the University of Arkansas for Medical Sciences, intraocular pressure readings were taken before and after the addition of 500 cc of saline to the surgical drapes and taken again after removal of the saline. Statistically significant differences in intraocular pressure were found between the baseline measurement, the measurement with saline, and the measurement after saline removal. No differences in the rise in intraocular pressure were found according to age, race, sex, or which eye was tested. Accumulation of a large volume of saline in surgical drapes has a modest effect on intraocular pressure. This may indicate a contributing cause of posterior vitreal pressure during prolonged phacoemulsification.

Eye Cancer

MedlinePlus

Cancer of the eye is uncommon. It can affect the outer parts of the eye, such as the eyelid, which are made up ... and nerves. If the cancer starts inside the eyeball it's called intraocular cancer. The most common intraocular ...

Light transmission through intraocular lenses with or without yellow chromophore (blue light filter) and its potential influence on functional vision in everyday environmental conditions.

PubMed

Owczarek, Grzegorz; Gralewicz, Grzegorz; Skuza, Natalia; Jurowski, Piotr

2016-01-01

In this research the factors used to evaluate the light transmission through two types of acrylic hydrophobic intraocular lenses, one that contained yellow chromophore that blocks blue light transmission and the other which did not contain that filter, were defined according to various light condition, e.g., daylight and at night. The potential influence of light transmission trough intraocular lenses with or without yellow chromophore on functional vision in everyday environmental conditions was analysed.

Identification of occult tumors by whole-specimen mapping in solitary papillary thyroid carcinoma.

PubMed

Park, Seog Yun; Jung, Yuh-S; Ryu, Chang Hwan; Lee, Chang Yoon; Lee, You Jin; Lee, Eun Kyung; Kim, Seok-Ki; Kim, Tae Sung; Kim, Tae Hyun; Jang, Jeyun; Park, Daeyoon; Dong, Seung Myung; Kang, Jae-Goo; Lee, Jin Soo; Ryu, Junsun

2015-08-01

We undertook this study to estimate an accurate incidence and spread patterns of occult papillary thyroid carcinoma (PTC) in patients with a preoperative diagnosis of solitary PTC by using whole-specimen mapping of all specimens after a total thyroidectomy. Enrolled prospectively in this whole-thyroid mapping study are 82 consecutive patients who underwent a total thyroidectomy under a preoperative diagnosis of solitary PTC. All thyroidectomy specimens were serially sectioned in 2 mm thickness and whole-thyroid mapping was carried out for additional foci of occult PTC. The frequencies of occult lesions detected in the whole and contralateral lobe were determined, and clinicopathologic factors associated with multifocality were assessed. Whole-thyroid mapping revealed 66 occult PTC lesions missed by preoperative ultrasound in 37 (45.1%) of the 82 patients. The great majority (92.5%) of the occult PTC was smaller than 3 mm in size and 25 patients (30.5%) had contralateral lesions. We found that the male sex was an independent predictor of multifocality (odds ratio (OR), 3.00; 95% CI, 1.11-8.14), adjusting for preoperative findings. Analysis with pathologic parameters showed that the male sex (OR, 5.03; 95% CI, 1.68-15.08) and extrathyroidal extensions (OR, 3.03; 95% CI, 1.03-8.95) were associated with multifocal PTC. However, none of the clinicopathologic factors evaluated predicted contralateral PTC. Our study demonstrates the diagnostic limitations of ultrasound for the detection of multifocal PTC and the need to consider the possibility of occult lesions in the management of solitary PTC, especially in male patients. © 2015 Society for Endocrinology.

Fast Confocal Raman Imaging Using a 2-D Multifocal Array for Parallel Hyperspectral Detection.

PubMed

Kong, Lingbo; Navas-Moreno, Maria; Chan, James W

2016-01-19

We present the development of a novel confocal hyperspectral Raman microscope capable of imaging at speeds up to 100 times faster than conventional point-scan Raman microscopy under high noise conditions. The microscope utilizes scanning galvomirrors to generate a two-dimensional (2-D) multifocal array at the sample plane, generating Raman signals simultaneously at each focus of the array pattern. The signals are combined into a single beam and delivered through a confocal pinhole before being focused through the slit of a spectrometer. To separate the signals from each row of the array, a synchronized scan mirror placed in front of the spectrometer slit positions the Raman signals onto different pixel rows of the detector. We devised an approach to deconvolve the superimposed signals and retrieve the individual spectra at each focal position within a given row. The galvomirrors were programmed to scan different focal arrays following Hadamard encoding patterns. A key feature of the Hadamard detection is the reconstruction of individual spectra with improved signal-to-noise ratio. Using polystyrene beads as test samples, we demonstrated not only that our system images faster than a conventional point-scan method but that it is especially advantageous under noisy conditions, such as when the CCD detector operates at fast read-out rates and high temperatures. This is the first demonstration of multifocal confocal Raman imaging in which parallel spectral detection is implemented along both axes of the CCD detector chip. We envision this novel 2-D multifocal spectral detection technique can be used to develop faster imaging spontaneous Raman microscopes with lower cost detectors.

Multifocal demyelinating motor neuropathy and hamartoma syndrome associated with a de novo PTEN mutation.

PubMed

Bansagi, Boglarka; Phan, Vietxuan; Baker, Mark R; O'Sullivan, Julia; Jennings, Matthew J; Whittaker, Roger G; Müller, Juliane S; Duff, Jennifer; Griffin, Helen; Miller, James A L; Gorman, Grainne S; Lochmüller, Hanns; Chinnery, Patrick F; Roos, Andreas; Swan, Laura E; Horvath, Rita

2018-05-22

To describe a patient with a multifocal demyelinating motor neuropathy with onset in childhood and a mutation in phosphatase and tensin homolog ( PTEN ), a tumor suppressor gene associated with inherited tumor susceptibility conditions, macrocephaly, autism, ataxia, tremor, and epilepsy. Functional implications of this protein have been investigated in Parkinson and Alzheimer diseases. We performed whole-exome sequencing in the patient's genomic DNA validated by Sanger sequencing. Immunoblotting, in vitro enzymatic assay, and label-free shotgun proteomic profiling were performed in the patient's fibroblasts. The predominant clinical presentation of the patient was a childhood onset, asymmetric progressive multifocal motor neuropathy. In addition, he presented with macrocephaly, autism spectrum disorder, and skin hamartomas, considered as clinical criteria for PTEN-related hamartoma tumor syndrome. Extensive tumor screening did not detect any malignancies. We detected a novel de novo heterozygous c.269T>C, p.(Phe90Ser) PTEN variant, which was absent in both parents. The pathogenicity of the variant is supported by altered expression of several PTEN-associated proteins involved in tumorigenesis. Moreover, fibroblasts showed a defect in catalytic activity of PTEN against the secondary substrate, phosphatidylinositol 3,4-trisphosphate. In support of our findings, focal hypermyelination leading to peripheral neuropathy has been reported in PTEN-deficient mice. We describe a novel phenotype, PTEN-associated multifocal demyelinating motor neuropathy with a skin hamartoma syndrome. A similar mechanism may potentially underlie other forms of Charcot-Marie-Tooth disease with involvement of the phosphatidylinositol pathway. Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Laminin-5 gamma 2 chain as an invasivity marker for uni- and multifocal lesions in the lower anogenital tract.

PubMed

Nordström, Britta; Einhorn, N; Silfverswärd, C; Sjövall, K; Tryggvason, K; Auer, G

2002-01-01

During recent decades it has become apparent that there are two types of vulvar disease: the classic type found in elderly women with unicentric and unifocal lesions, and the type found in younger women, in which precancerous and invasive changes develop in the anogenital lower tract in a multicentric and multifocal fashion, often over a long period of observation. The laminin-5 gamma 2 chain is an extracellular protein that is a component of the basement membrane. Recently its expression has been recognized as a marker in cervical cancer that permits identification of invasive capacity. The aim of our study was to determine if laminin-5 gamma 2 chain antibody can act as a sensitivity marker of invasive capacity in precancerous and invasive carcinoma in women with uni- and multifocal changes in the anogenital tract. The result showed that all patients in the older group of women with invasive carcinoma of the vulva had moderate to high positive expression of the laminin-5 gamma 2 chain. In the group of younger patients with multifocal precancerous changes observed over long periods, most of the patients with vulva intraepithelial neoplasia (VIN) 3 showed laminin-5 gamma 2 chain positivity already in the precancerous changes, and all of them developed invasivity during the period of observation. Normal epithelium without atypia was mostly negative or of low immunoreactivity of laminin-5. In conclusion, positive laminin-5 gamma 2 chain expression seems to indicate the invasiveness potential of precancerous lesions and is also expressed in all investigated invasive carcinomas of the anogenital tract.

[Sentinel node biopsy in patients with multifocal and multicentric breast cancer: A 5-year follow-up].

PubMed

Blanco Saiz, I; López Carballo, M T; Martínez Fernández, J; Carrión Maldonado, J; Cabrera Pereira, A; Moral Alvarez, S; Santamaría Girón, L; Cantero Cerquella, F; López Secades, A; Díaz González, D; Llaneza Folgueras, A; Aira Delgado, F J

2014-01-01

Sentinel lymph node biopsy (SLNB) as a staging procedure in multiple breast cancer is a controversial issue. We have aimed to evaluate the efficacy of sentinel node (SN) detection in patients with multifocal or multicentric breast cancer as well as the safety of its clinical application after a long follow-up. A prospective descriptive study was performed. Eighty-nine patients diagnosed of multiple breast cancer (73 multifocal; 16 multicentric) underwent SLNB. These patients were compared to those with unifocal neoplasia. Periareolar radiocolloid administration was performed in most of the patients. Evaluation was made at an average of 67.2 months of follow-up (32-126 months). Scintigraphic and surgical SN localization in patients with multiple breast cancer were 95.5% and 92.1%, respectively. A higher percentage of extra-axillary nodes was observed than in the unifocal group (11.7% vs 5.4%) as well as a significantly higher number of SN per patient (1.70 vs 1.38). The rate of SN localization in multicentric cancer was slightly lower than in multifocal cancer (87.5% vs 93.1%), and the finding of extra-axillary drainages was higher (20% vs 10%). Number of SN per patient was significantly higher in multicentric breast cancer (2.33 vs 1.57). No axillary relapses have been demonstrated in the follow-up in multiple breast cancer patients group. SLNB performed by periareolar injection is a reliable and accurate staging procedure of patients with multiple breast cancer, including those with multicentric processes. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

Risk for eye splash injury during administration of intraocular injections: a study of retina specialists and fellows.

PubMed

Bourla, Dan H; Wirthlin, Robert S; Bourla, Nirit; Gupta, Anurag; Stanescu-Segall, Dinu; Schwartz, Steven D; Axer-Siegel, Ruth

2007-06-01

To evaluate the use of eye protection and frequency of eye splash events during intraocular injections as well as infection risk awareness among retina specialists and fellows in training. In a prospective survey of practicing retina specialists and retina fellows, frequency of use and type of eye protection employed during intraocular injections, frequency of eye splash occurrences, description of the eye splash event, number of procedures performed, and awareness of transconjunctival infection risk were investigated. Sixty-four ophthalmologists responded to the questionnaire: 40 retina fellows and 24 retina specialists. The response rate was 100%. Twenty-five percent of the fellows and 33.3% of the specialists reported using eye protection, including corrective glasses, during all intraocular injections. Two of the retina fellows and none of the specialists used special forms of eye protection. Retina fellows had a mean +/- SD of 2.1 +/- 1.3 years experience and the specialists had a mean +/- SD of 10.4 +/- 6.7 years experience in performing intraocular injections. The mean number of injections +/- SD performed by the fellows and specialists was 23 +/- 14.6 and 35 +/- 11.9 per month, respectively. Twelve conjunctival or corneal splash occurrences were reported by six fellows and two retina specialists. Eleven splash events occurred due to reflux of fluid during administration of subconjunctival anesthetic injection, and one event occurred during an anterior chamber tap. Splash events were significantly more likely to occur during procedures performed by fellows, with a relative risk of 8.4 for unprotected procedures (P< 0.001, Fisher exact test). Most (87.5%) of the participants were aware of the risk for transconjunctival viral infection. Special eye protection is seldom used during administration of intraocular injections. Although the risk for eye splash during administration of subconjunctival anesthetic before intraocular injections is relatively small, protective measures may be considered when treating high-risk patients.

[Intraocular pressure after ND: YAG laser capsulotomy in pseudophakic patients with glaucoma].

PubMed

Sesar, Antonio; Petric, Irena; Sesar, Ivanka; Lacmnovic-Loncar, Valentina; Jurisić, Darija; Tomić, Zeljka; Mandić, Zdravko

2006-01-01

The aim of the study was to analyze changes in intraocular pressure after Nd: YAG laser capsulotomy in pseudophakic patients with glaucoma. Intraocular pressure was recorded before, and 1 and 3 hours after YAG laser capsulotomy in 69 pseudophakic patients with glaucoma. Twenty eight patients received no therapy before capsulotomy, 21 patients received topical brimonidine 0.2%, and 20 patients received topical dorzolamide 2% 1 hour before laser capsulotomy. All patients received topical tropicamide 1% and tetracaine 0.5%. Nd: YAG laser posterior capsulotomy was performed using inverted-U technique to make a 3-4 mm diameter capsulotomy. After capsulotomy, all eyes received topical fluorometholone for 10 days. A pressure rise was greater in patients without any therapy before YAG laser capsulotomy. Eight patients with glaucoma showed intraocular pressure rise of 5 mm Hg, and 2 patients pressure rise of 10 mm Hg after laser capsulotomy. A reduction of intraocular pressure rise was found in patients who received dorzolamide 2% or brimonidine 0.2%, only 1 patient in each group developed a pressure rise of 5 mm Hg. In all patients a significant pressure rise developed within the first hour. It is difficult to compare different studies due to different techniques of cataract surgery and different intraocular lense material and design. Barnes showed that 6 of 29 (21%) developed a pressure rise of 5 mm Hg, and 1 of 29 (3%) patients a pressure rise of 10 mm Hg. In our study, 29% of patients had a pressure rise of > or =5 mm Hg, and 7% of patients had a rise of > or =10 mm Hg after laser capsulotomy. These results may be associated with a large proportion of extracapsular cataract extraction (71%) versus phacoemulsification (29%) in our patients. Pretreatment with dorzolamide 2% or brimonidine 0.2% reduce the intraocular pressure rise after Nd: YAG laser capsulotomy in pseudophakic patients with glaucoma.

Chronic post-operative iris prosthesis endophthalmitis in a patient with traumatic aniridia: a case report.

PubMed

Firl, Kevin C; Montezuma, Sandra R

2016-11-09

Post-operative endophthalmitis is a serious complication of intraocular surgery which may present acutely or chronically. Chronic post-operative endophthalmitis is characterized by decreased visual acuity, mild pain, and low-grade uveitis several weeks or months after intraocular surgery which may be responsive to corticosteroids, but recur upon tapering. Low virulence organisms such as Propionibacterium acnes are the most common culprit organisms, and treatment most often consists of both intravitreal antibiotic injections and surgery. Aniridia is a condition defined by total or partial loss of the iris and leads to decreased visual quality marked by glare and photophobia. Treatment of complex or severe cases of traumatic aniridia in which surgical repair is difficult may consist of implantation of iris prostheses, devices designed to reduce symptoms of aniridia. Though chronic, post-operative endophthalmitis has been associated with most intraocular surgeries including intraocular lens implantation after cataract removal, it has never been described in a patient with an iris prosthesis. In this case report, we describe the case of a 49 year old, male construction worker with traumatic aniridia who experienced chronic, recurrent low-grade intraocular inflammation and irritation for months after implantation of the Ophtec 311 prosthetic iris. Symptoms and signs of inflammation improved temporarily with sub-Tenon's capsule triamcinolone injections. Ultimately after more than 2 post-operative years, the iris prosthesis was explanted, and intravitreal cultures showed P. acnes growth after 5 days. Intravitreal antibiotics treated the infection successfully. To our knowledge, this is the first reported case of chronic, post-operative endophthalmitis in a patient with an iris prosthesis. Chronic, post-operative endophthalmitis may be a difficult to identify in the context of traumatic aniridia and iris prosthesis implantation due to other potential etiologies of chronic intraocular inflammation such as implant-induced chafing. Clinicians should suspect chronic, post-operative endophthalmitis in any case of recurrent, low-grade intraocular inflammation.

Optic nerve head blood flow response to reduced ocular perfusion pressure by alteration of either the blood pressure or intraocular pressure.

PubMed

Wang, Lin; Cull, Grant A; Fortune, Brad

2015-04-01

To test the hypothesis that blood flow autoregulation in the optic nerve head has less reserve to maintain normal blood flow in the face of blood pressure-induced ocular perfusion pressure decrease than a similar magnitude intraocular pressure-induced ocular perfusion pressure decrease. Twelve normal non-human primates were anesthetized by continuous intravenous infusion of pentobarbital. Optic nerve blood flow was monitored by laser speckle flowgraphy. In the first group of animals (n = 6), the experimental eye intraocular pressure was maintained at 10 mmHg using a saline reservoir connected to the anterior chamber. The blood pressure was gradually reduced by a slow injection of pentobarbital. In the second group (n = 6), the intraocular pressure was slowly increased from 10 mmHg to 50 mmHg by raising the reservoir. In both experimental groups, optic nerve head blood flow was measured continuously. The blood pressure and intraocular pressure were simultaneously recorded in all experiments. The optic nerve head blood flow showed significant difference between the two groups (p = 0.021, repeat measures analysis of variance). It declined significantly more in the blood pressure group compared to the intraocular pressure group when the ocular perfusion pressure was reduced to 35 mmHg (p < 0.045) and below. There was also a significant interaction between blood flow changes and the ocular perfusion pressure treatment (p = 0.004, adjusted Greenhouse & Geisser univariate test), indicating the gradually enlarged blood flow difference between the two groups was due to the ocular perfusion pressure decrease. The results show that optic nerve head blood flow is more susceptible to an ocular perfusion pressure decrease induced by lowering the blood pressure compared with that induced by increasing the intraocular pressure. This blood flow autoregulation capacity vulnerability to low blood pressure may provide experimental evidence related to the hemodynamic pathophysiology in glaucoma.

Deblurring adaptive optics retinal images using deep convolutional neural networks.

PubMed

Fei, Xiao; Zhao, Junlei; Zhao, Haoxin; Yun, Dai; Zhang, Yudong

2017-12-01

The adaptive optics (AO) can be used to compensate for ocular aberrations to achieve near diffraction limited high-resolution retinal images. However, many factors such as the limited aberration measurement and correction accuracy with AO, intraocular scatter, imaging noise and so on will degrade the quality of retinal images. Image post processing is an indispensable and economical method to make up for the limitation of AO retinal imaging procedure. In this paper, we proposed a deep learning method to restore the degraded retinal images for the first time. The method directly learned an end-to-end mapping between the blurred and restored retinal images. The mapping was represented as a deep convolutional neural network that was trained to output high-quality images directly from blurry inputs without any preprocessing. This network was validated on synthetically generated retinal images as well as real AO retinal images. The assessment of the restored retinal images demonstrated that the image quality had been significantly improved.

Deblurring adaptive optics retinal images using deep convolutional neural networks

PubMed Central

Fei, Xiao; Zhao, Junlei; Zhao, Haoxin; Yun, Dai; Zhang, Yudong

2017-01-01

The adaptive optics (AO) can be used to compensate for ocular aberrations to achieve near diffraction limited high-resolution retinal images. However, many factors such as the limited aberration measurement and correction accuracy with AO, intraocular scatter, imaging noise and so on will degrade the quality of retinal images. Image post processing is an indispensable and economical method to make up for the limitation of AO retinal imaging procedure. In this paper, we proposed a deep learning method to restore the degraded retinal images for the first time. The method directly learned an end-to-end mapping between the blurred and restored retinal images. The mapping was represented as a deep convolutional neural network that was trained to output high-quality images directly from blurry inputs without any preprocessing. This network was validated on synthetically generated retinal images as well as real AO retinal images. The assessment of the restored retinal images demonstrated that the image quality had been significantly improved. PMID:29296496

Intraocular 6-hydroxydopamine prevents the persistent estrus induced by continuous light.

PubMed

Shimizu, K; Hokano, M

1985-01-15

Following the intraocular injection of 6-hydroxydopamine, which can destroy the retinal dopaminergic neurons, female rats showed a normal estrous cycle in LD 12:12 but not a persistent estrus in continuous light.

Intraocular gnathostomiasis: report of a case and review of literature.

PubMed

Pillai, Gopal S; Kumar, Anil; Radhakrishnan, Natasha; Maniyelil, Jayasree; Shafi, Tufela; Dinesh, Kavitha R; Karim, Shamsul

2012-04-01

Intraocular gnathostomiasis is a rare parasitic infection caused by the third-stage larvae of spiruroid nematode Gnanthostoma spp. seen mostly in tropical and subtropical regions. It is a food-borne zoonosis caused by ingestion of raw or undercooked freshwater fish, amphibians, reptiles, birds, and mammals, all of which are known to harbor advanced third-stage larvae of Gnanthostoma spp. To date, 74 cases of intraocular gnathostomiasis have been reported from 12 different countries. Only four countries have reported more than 10 cases each, and India shares the rare distinction of being one of them, with 14 cases. Surprisingly, not a single case of cutaneous gnanthostomiasis has ever been reported from India. We present one such case of intraocular gnathostomiasis in a 41-year-old male who presented with an actively motile worm attached to the iris, and we review the pertinent literature of all such cases reported from India.

Suction-based grasping tool for removal of regular- and irregular-shaped intraocular foreign bodies.

PubMed

Erlanger, Michael S; Velez-Montoya, Raul; Mackenzie, Douglas; Olson, Jeffrey L

2013-01-01

To describe a suction-based grasping tool for the surgical removal of irregular-shaped and nonferromagnetic intraocular foreign bodies. A surgical tool with suction capabilities, consisting of a stainless steel shaft with a plastic handle and a customizable and interchangeable suction tip, was designed in order to better engage and manipulate irregular-shaped in-traocular foreign bodies of various sizes and physical properties. The maximal suction force and surgical capabilities were assessed in the laboratory and on a cadaveric eye vitrectomy model. The suction force of the water-tight seal between the intraocular foreign body and the suction tip was estimated to be approximately 40 MN. During an open-sky vitrectomy in a porcine model, the device was successful in engaging and firmly securing foreign bodies of different sizes and shapes. The suction-based grasping tool enables removal of irregular-shaped and nonferromagnetic foreign bodies. Copyright 2013, SLACK Incorporated.

INTRAOCULAR LENS SCAFFOLD TO PREVENT INTRAOCULAR FOREIGN BODY SLIPPAGE.

PubMed

Agarwal, Amar; Ashok Kumar, Dhivya; Agarwal, Athiya

2017-01-01

To report the application of intraocular lens (IOL) scaffold technique in intraocular foreign body (IOFB) removal. Patient with IOFB in posterior segment is included. The IOFB is retrieved from the posterior segment (pars plana vitrectomy and exteriorization of the IOFB from the retinal surface using an intravitreal forceps via the posterior capsulotomy) and placed on the iris. A three-piece posterior chamber IOL is placed in the sulcus via the clear corneal incision. IOFB is then removed from the anterior chamber over the IOL by forceps. Metallic IOFB of 4 mm × 3 mm has been retrieved by IOL scaffold technique after rescuing it from the posterior segment. There has been no drop or slip of IOFB in the vitreous during removal. Posterior chamber IOL served as scaffold during IOFB removal from anterior chamber. The IOL scaffold maneuver has shown to prevent slippage by acting as a barrier between the IOFB and the vitreous.

Genome-wide association study of intraocular pressure identifies the GLCCI1/ICA1 region as a glaucoma susceptibility locus

PubMed Central

Strange, Amy; Bellenguez, Céline; Sim, Xueling; Luben, Robert; Hysi, Pirro G.; Ramdas, Wishal D.; van Koolwijk, Leonieke M.E.; Freeman, Colin; Pirinen, Matti; Su, Zhan; Band, Gavin; Pearson, Richard; Vukcevic, Damjan; Langford, Cordelia; Deloukas, Panos; Hunt, Sarah; Gray, Emma; Dronov, Serge; Potter, Simon C.; Tashakkori-Ghanbaria, Avazeh; Edkins, Sarah; Bumpstead, Suzannah J.; Blackwell, Jenefer M.; Bramon, Elvira; Brown, Matthew A.; Casas, Juan P.; Corvin, Aiden; Duncanson, Audrey; Jankowski, Janusz A.Z.; Markus, Hugh S.; Mathew, Christopher G.; Palmer, Colin N.A.; Plomin, Robert; Rautanen, Anna; Sawcer, Stephen J.; Trembath, Richard C.; Wood, Nicholas W.; Barroso, Ines; Peltonen, Leena; Healey, Paul; McGuffin, Peter; Topouzis, Fotis; Klaver, Caroline C.W.; van Duijn, Cornelia M.; Mackey, David A.; Young, Terri L.; Hammond, Christopher J.; Khaw, Kay-Tee; Wareham, Nick; Wang, Jie Jin; Wong, Tien Y.; Foster, Paul J.; Mitchell, Paul; Spencer, Chris C.A.; Donnelly, Peter; Viswanathan, Ananth C.

2013-01-01

To discover quantitative trait loci for intraocular pressure, a major risk factor for glaucoma and the only modifiable one, we performed a genome-wide association study on a discovery cohort of 2175 individuals from Sydney, Australia. We found a novel association between intraocular pressure and a common variant at 7p21 near to GLCCI1 and ICA1. The findings in this region were confirmed through two UK replication cohorts totalling 4866 individuals (rs59072263, Pcombined = 1.10 × 10−8). A copy of the G allele at this SNP is associated with an increase in mean IOP of 0.45 mmHg (95%CI = 0.30–0.61 mmHg). These results lend support to the implication of vesicle trafficking and glucocorticoid inducibility pathways in the determination of intraocular pressure and in the pathogenesis of primary open-angle glaucoma. PMID:23836780

Commercial air travel after intraocular gas injection.

PubMed

Houston, Stephen; Graf, Jürgen; Sharkey, James

2012-08-01

Passengers with intraocular gas are at risk of profound visual loss when exposed to reduced absolute pressure within the cabin of a typical commercial airliner. Information provided on the websites of the world's 10 largest airlines offer a considerable range of opinion as to when it might be safe to fly after gas injection. Physicians responsible for clearing pseassengers as 'fit to fly' should be aware modern retinal surgical techniques increasingly employ long-acting gases as vitreous substitutes. The kinetics of long-acting intraocular gases must be considered when deciding how long after surgery it is safe to travel. It is standard practice to advise passengers not to fly in aircraft until the gas is fully resorbed. To achieve this, it may be necessary to delay travel for approximately 2 wk after intraocular injection of sulfur hexafluoride (SF6) and for 6 wk after injection of perfluoropropane (C3F8).

Pigment dispersion and chronic intraocular pressure elevation after sulcus placement of 3-piece acrylic intraocular lens.

PubMed

Almond, M Camille; Wu, Michael C; Chen, Philip P

2009-12-01

A 55-year-old man had phacoemulsification and implantation of a 3-piece acrylic intraocular lens (IOL) (AcrySof MA60AC) in the right eye. One month postoperatively, the intraocular pressure (IOP) was 48 mm Hg and peripheral transillumination defects were noted in the iris circumferentially, with the IOL optic edge visible as a silhouette. Gonioscopy showed dense pigmentation of the trabecular meshwork in the right eye, but in the left eye, only mild trabecular meshwork pigment was seen, along with a concave peripheral iris insertion. At 21 months, the right eye required 3 medications for IOP control. While pigment dispersion has been widely reported after placement of 1-piece acrylic IOLs in the ciliary sulcus, we conclude that in susceptible individuals with a concave peripheral iris insertion, pigment dispersion can occur with sulcus placement of a 3-piece acrylic model despite its thinner optic and angulated haptics.

[A morbidity study of intraocular foreign bodies].

PubMed

Mocanu, C; Bădescu, S

1993-01-01

190 patients presenting intraocular foreign bodies, hospitalized between 1981-1991, are examined. The study of accidents: cases showed a clear prevalence of work accidents--127 cases (66.84%); 86 of these cases occurred in industry (45.26%), the rest of 41 occurred in agriculture (21.58%). The professions most exposed to such accidents are those of locksmith, mechanic in agriculture or automobile industry. The postsurgical evolution and the incidence of complications show that intraocular foreign bodies are wosse-making factors of ocular plagues, because of anatomical structures disorganization, transparency modifications and infectious complications implied, which determined the diminishing of visual acuity in 88.08% of cases. The big percentage of work accidents in the etiology of intraocular foreign bodies emphasize the great importance of foreign the work-protection rules (regarding a especially the wearing of protection glasses) and of introducing of automation in technological processes involving great risks.

Intraocular pressure and retinal vascular changes during transient exposure to microgravity.

PubMed

Mader, T H; Gibson, C R; Caputo, M; Hunter, N; Taylor, G; Charles, J; Meehan, R T

1993-03-15

We measured intraocular pressures and retinal vascular diameters from 11 subjects during 20 seconds of microgravity produced by parabolic flight on board a KC-135 aircraft. Intraocular pressures increased 58% during parabolic flight compared to baseline values (19 +/- 1 mm Hg vs 12 +/- 1 mm Hg, respectively; P < .001). A 4% reduction in the caliber of retinal arteries was also noted during microgravity, but this change did not achieve statistical significance (7.8 +/- 0.3 pixels at zerogravity vs 8.1 +/- 0.3 pixels at 1g; P = .07). The increase in intraocular pressure and trend of arteries to constrict are thought to result from cephalad shifts in intravascular and extravascular body fluids as a result of the absence of the 1g hydrostatic gradient. The results of our study confirm that this fluid shift and its effects on the eye occur rapidly, within 20 seconds of exposure to microgravity.

Multifocal bilateral metatarsal tuberculosis: a rare presentation.

PubMed

Vijay, Vipul; Sud, Alok; Mehtani, Anil

2015-01-01

Tuberculosis, or phthisis (consumption) as it was popularly known in the Greek era, has been endemic in Southeast Asia and Sub-Saharan Africa; however, the human immunodeficiency virus epidemic has seen the re-emergence of this disease in the areas in which it was not very commonly reported. With this, the need for understanding and treatment of rare presentations of tuberculosis has become of paramount importance to achieve the World Health Organization millennium goal of a "reversal of incidence by 2015." Foot involvement has been reported in 0.1% to 0.3% of extrapulmonary cases. Multifocal lesions have an incidence of <10% in osteoarticular tuberculosis. Bilateral feet involvement in multifocal tuberculosis has not yet been reported in either children or adults in published studies. We report a case of tuberculosis with lesions in the bilateral metatarsals, the occurrence of which is very rare. The diagnosis was mainly histopathologic owing to the paucibacillary nature of the disease. Early identification and treatment with antitubercular drugs will normally result in a good cosmetic and functional result. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Synchronous multifocal necrotizing fasciitis prognostic factors: a retrospective case series study in a single center.

PubMed

Lee, Ching-Yu; Li, Yen-Yao; Huang, Tsan-Wen; Huang, Tsung-Yu; Hsu, Wei-Hsiu; Tsai, Yao-Hung; Huang, Jou-Chen; Huang, Kuo-Chin

2016-12-01

No reports have been published on synchronous multifocal necrotizing fasciitis (SMNF), a multifocal presence of necrotizing fasciitis in different extremities. We evaluated the clinical characteristics and outcomes of SMNF. Eighteen patients (14 men, 4 women; mean age: 59 years) diagnosed with SMNF of the extremities between January 2004 to December 2012 were enrolled and evaluated. Vibrio species were the most commonly (78%; n = 14) isolated; others were two cases (11%) of Aeromonas spp., one case (6%) of group A β-hemolytic streptococcus, and one case of coagulase-negative staphylococcus. SMNF was in the bilateral lower limbs (72%; n = 13), bilateral upper limbs (17%; n = 3), and one patient with one upper and one lower limb (11%). Non-surviving patients had more bilateral lower limb involvement and thrombocytopenia. Most patients with SMNF were male and had bilateral lower limb and marine Gram-negative bacteria involvement. The mortality of SMNF remained extremely high in patients with involvement of bilateral lower limb and initial thrombocytopenia.

Locally aggressive and multifocal phosphaturic mesenchymal tumors: two unusual cases of tumor-induced osteomalacia.

PubMed

Higley, Meghan; Beckett, Brooke; Schmahmann, Sandra; Dacey, Elizabeth; Foss, Erik

2015-12-01

Tumor-induced osteomalacia (TIO) has long been recognized as a clinical paraneoplastic syndrome. The identification of a unique histopathologic entity, the phosphaturic mesenchymal tumor (PMT), as a distinct etiology for TIO has been a more recent discovery. The majority of published cases describe a solitary, non-aggressive appearing soft tissue or osseous lesions in patients with osteomalacia; aggressive appearing or multifocal lesions appear to be exceedingly rare. These tumors characteristically secrete fibroblast growth factor 23 (FGF23). Elevated serum levels of FGF23 result in phosphate wasting and osteomalacia. In the majority of cases, laboratory abnormalities and clinical signs and symptoms of osteomalacia precede identification of the causative lesion by years. Following diagnosis, complete resection with wide margins to prevent local recurrence is most often curative. Imaging characteristics of PMT are diverse and remain incompletely defined, as the majority of previous publications are outside of the radiologic literature. We present multiple imaging modalities in two cases of patients with debilitating osteomalacia and unusual appearing PMTs: one with a locally aggressive lesion leading to pathologic fracture, the second presenting with exceedingly rare multifocal PMT.

Multifocal ERG findings in carriers of X-linked retinoschisis

PubMed Central

Kim, Linda S.; Seiple, William; Szlyk, Janet P.

2006-01-01

Purpose To determine whether retinal dysfunction in obligate carriers of X-linked retinoschisis (XLRS) could be observed in local electroretinographic responses obtained with the multifocal electroretinogram (mfERG). Methods Nine obligate carriers of XLRS (mean age, 46.2 years) were examined for the study. Examination of each carrier included an ocular examination and mfERG testing. For the mfERG, we used a 103-scaled hexagonal stimulus array that subtended a retinal area of approximately 40° in diameter. The amplitudes and implicit times in each location for the mfERG were compared with the corresponding values determined for a group of 34 normally-sighted, age-similar control subjects. Results Mapping of 103 local electroretinographic response amplitudes and implicit times within a central 40° area with the mfERG showed regions of reduced mfERG amplitudes and delayed implicit times in two of nine carriers. Conclusions The mfERG demonstrated areas of retinal dysfunction in two carriers of XLRS. When present, retinal dysfunction was evident in the presence of a normal-appearing fundus. Multifocal ERG testing can be useful for identifying some carriers of XLRS. PMID:17180613

Robot-assisted intraocular surgery: development of the IRISS and feasibility studies in an animal model

PubMed Central

Rahimy, E; Wilson, J; Tsao, T-C; Schwartz, S; Hubschman, J-P

2013-01-01

Purpose The aim of this study is to develop a novel robotic surgical platform, the IRISS (Intraocular Robotic Interventional and Surgical System), capable of performing both anterior and posterior segment intraocular surgery, and assess its performance in terms of range of motion, speed of motion, accuracy, and overall capacities. Patients and methods To test the feasibility of performing ‘bimanual' intraocular surgical tasks using the IRISS, we defined four steps out of typical anterior (phacoemulsification) and posterior (pars plana vitrectomy (PPV)) segment surgery. Selected phacoemulsification steps included construction of a continuous curvilinear capsulorhexis and cortex removal in infusion–aspiration (I/A) mode. Vitrectomy steps consisted of performing a core PPV, followed by aspiration of the posterior hyaloid with the vitreous cutter to induce a posterior vitreous detachment (PVD) assisted with triamcinolone, and simulation of the microcannulation of a temporal retinal vein. For each evaluation, the duration and the successful completion of the task with or without complications or involuntary events was assessed. Results Intraocular procedures were successfully performed on 16 porcine eyes. Four eyes underwent creation of a round, curvilinear anterior capsulorhexis without radialization. Four eyes had I/A of lens cortical material completed without posterior capsular tear. Four eyes completed 23-gauge PPV followed by successful PVD induction without any complications. Finally, simulation of microcannulation of a temporal retinal vein was successfully achieved in four eyes without any retinal tears/perforations noted. Conclusion Robotic-assisted intraocular surgery with the IRISS may be technically feasible in humans. Further studies are pending to improve this particular surgical platform. PMID:23722720

Effects of Different Intensities of Exercise on Intraocular Pressure

ERIC Educational Resources Information Center

Rowe, Deryl; And Others

1976-01-01

The decrease in intraocular pressure during exercise and the first few minutes of recovery is related to a decrease in blood pH and an increase in blood lactate concentration, not to the intensity of the exercise. (MB)

VEGF Trap in Treating Patients With Recurrent Stage III or Stage IV Melanoma That Cannot Be Removed by Surgery

ClinicalTrials.gov

2018-04-26

Ciliary Body and Choroid Melanoma, Medium/Large Size; Extraocular Extension Melanoma; Iris Melanoma; Metastatic Intraocular Melanoma; Recurrent Intraocular Melanoma; Recurrent Melanoma; Stage III Melanoma; Stage IV Melanoma

Multifocal fibrosclerosis presenting as Grave's orbitopathy. Bilateral exophthalmos associated with retroperitoneal and sellar fibrosis.

PubMed

van der Pol, R; Nieuwenhuis, M G; Mourits, M P

1999-03-01

Multifocal fibrosclerosis (MF) is a rare disease that may be misdiagnosed as Graves' orbitopathy. The combination of localisations of MF presented here has not been reported before. A 44-year-old man was referred with progressive bilateral exophthalmos. CT of his chest and abdomen revealed an intrathoracic and retroperitoneal peri-aortal soft-tissue process with hydronephrosis. Histological examination of orbital masses showed a fibrous process with low inflammatory activity. Later the sella was found to be involved as well. A diagnosis of MF was made. MF should be considered in the differential diagnosis of bilateral exophthalmos.

The Risk of Progressive Multifocal Leukoencephalopathy in the Biologic Era: Prevention and Management.

PubMed

Molloy, Eamonn S; Calabrese, Cassandra M; Calabrese, Leonard H

2017-02-01

Progressive multifocal leukoencephalopathy (PML) is a rare, typically fatal, demyelinating central nervous system infection caused by reactivation of the John Cunningham virus that generally occurs in immunosuppressed patients. With an evolving understanding of a greater clinical heterogeneity of PML and significant implications for therapy, PML should be considered in the differential diagnosis of neurologic presentations of rheumatic diseases. Increased awareness of PML among rheumatologists is required, as earlier diagnosis and restoration of immune function may improve the otherwise grim prognosis associated with PML. Copyright © 2016 Elsevier Inc. All rights reserved.

The clinical presentation and surgical treatment of verrucous dermatitis lesions in a draught horse.

PubMed

Poore, Luke A B; Else, Rod W; Licka, Theresia L

2012-02-01

Verrucous pastern dermatitis is a progressive inflammatory skin disease commonly involving the palmar or plantar aspects of the pasterns of horses. There are no reports of successful surgical treatment for multifocal circumscribed verrucous masses in the chronic stages of verrucous pastern dermatitis. A combination of sharp dissection and electrocautery was used to resect numerous multifocal circumscribed verrucous masses from the distal hindlimb of an 11-year-old gelding draught horse. There was no evidence of significant regrowth or complications at a 24 month postoperative examination. © 2011 The Authors. Veterinary Dermatology. © 2011 ESVD and ACVD.

Vision and falls in older people: risk factors and intervention strategies.

PubMed

Lord, Stephen R; Smith, Stuart T; Menant, Jasmine C

2010-11-01

Poor vision impairs balance and increases the risk of falls and fractures in older people. Multifocal glasses can add to this risk by impairing contrast sensitivity, depth perception, and ability to negotiate obstacles. Vision assessment and provision of new spectacles may not reduce, and may even increase, the risk of falls. Restriction of the use of multifocal glasses may reduce falls in active older people. Other effective fall prevention strategies include maximizing vision through cataract surgery and occupational therapy interventions in visually impaired older people. Copyright © 2010 Elsevier Inc. All rights reserved.

Multifocal avascular necrosis after liver transplantation: an unusual presentation of the antiphospholipid syndrome.

PubMed

Mundo, J; Peris, P; Monegal, A; Navasa, M; Cervera, R; Guañiabens, N

2006-01-01

We describe the case of a 31-year-old man who presented with an antiphospholipid syndrome (APS), which manifested as multifocal avascular necrosis (AVN) one year after orthotopic liver transplantation. The patient developed multiple AVN affecting hips, left knee, humerus and tarsal bones just after withdrawal of corticosteroid therapy. Three years later when lupus anticoagulant was detected, he began anticoagulant treatment and no further AVN episodes were observed. It is important to be aware of this clinical manifestation of APS, especially in these cases where it can be easily overlooked because of corticosteroid therapy.

Generation of multifocal irradiance patterns by using complex Fresnel holograms.

PubMed

Mendoza-Yero, Omel; Carbonell-Leal, Miguel; Mínguez-Vega, Gladys; Lancis, Jesús

2018-03-01

We experimentally demonstrate Fresnel holograms able to produce multifocal irradiance patterns with micrometric spatial resolution. These holograms are assessed from the coherent sum of multiple Fresnel lenses. The utilized encoded technique guarantees full control over the reconstructed irradiance patterns due to an optimal codification of the amplitude and phase information of the resulting complex field. From a practical point of view, a phase-only spatial light modulator is used in a couple of experiments addressed to obtain two- and three-dimensional distributions of focal points to excite both linear and non-linear optical phenomena.

Simulation study of an X-ray diffraction system for breast tumor detection

NASA Astrophysics Data System (ADS)

Marticke, F.; Montémont, G.; Paulus, C.; Michel, O.; Mars, J. I.; Verger, L.

2017-09-01

X-ray diffraction (XRD) is a powerful technique used to determine the molecular structure of biological tissues. In breast tissues for example, the scattering signatures of dense fibroglandular tissue and carcinoma have been shown to be significantly different. In this study, XRD was used as a second control level when conventional mammography results were unclear, for instance because of overly high breast density. A system optimized for this issue, called multifocal XRD, was developed combining energy dispersive spectral information at different scattering angles. This system allows depth-imaging in one go but needs an x,y-direction scan to image the region conventional mammography identified as suspect. The scan-time for about 10 cm3 with an incident flux of about 4 . 8 ṡ 107 photons per second would be around 2 s. For this study, breast phantoms with and without cancerous nodule were simulated to assess the separation power of the method and to determine the radiation dose required to obtain nearly ideal separation. For tumors situated in the center of the breast, the required dose was only about 0.3 mGy, even for breasts with high density. The tumor position was shown to have a low impact on detectability provided it remained in a zone where the system was sufficiently sensitive. The influence of incident spectrum maximum energy was also studied. The required dose remained very low with any of the incident spectra tested. Finally, an image slice was reconstructed in the x-direction and showed that the system can detect the presence of a small tumor (4 mm). Hence, XRD is a very promising tool to reduce the number of unnecessary invasive breast biopsies.

Snapshot 3D tracking of insulin granules in live cells

NASA Astrophysics Data System (ADS)

Wang, Xiaolei; Huang, Xiang; Gdor, Itay; Daddysman, Matthew; Yi, Hannah; Selewa, Alan; Haunold, Theresa; Hereld, Mark; Scherer, Norbert F.

2018-02-01

Rapid and accurate volumetric imaging remains a challenge, yet has the potential to enhance understanding of cell function. We developed and used a multifocal microscope (MFM) for 3D snapshot imaging to allow 3D tracking of insulin granules labeled with mCherry in MIN6 cells. MFM employs a special diffractive optical element (DOE) to simultaneously image multiple focal planes. This simultaneous acquisition of information determines the 3D location of single objects at a speed only limited by the array detector's frame rate. We validated the accuracy of MFM imaging/tracking with fluorescence beads; the 3D positions and trajectories of single fluorescence beads can be determined accurately over a wide range of spatial and temporal scales. The 3D positions and trajectories of single insulin granules in a 3.2um deep volume were determined with imaging processing that combines 3D decovolution, shift correction, and finally tracking using the Imaris software package. We find that the motion of the granules is superdiffusive, but less so in 3D than 2D for cells grown on coverslip surfaces, suggesting an anisotropy in the cytoskeleton (e.g. microtubules and action).

Eye Cancer

MedlinePlus

... layer of tissue underneath the retina that contains connective tissue and melanocytes, which are pigmented (colored) cells, and nourishes the inside of the eye. The choroid is the most common site for a tumor. Types of intraocular cancer The most common intraocular cancer in adults is ...

Apparatus and method for non-contact, acoustic resonance determination of intraocular pressure

DOEpatents

Sinha, Dipen N.; Wray, William O.

1994-01-01

Apparatus and method for measuring intraocular pressure changes in an eye under investigation by detection of vibrational resonances therein. An ultrasonic transducer operating at its resonant frequency is amplitude modulated and swept over a range of audio frequencies in which human eyes will resonate. The output therefrom is focused onto the eye under investigation, and the resonant vibrations of the eye observed using a fiber-optic reflection vibration sensor. Since the resonant frequency of the eye is dependent on the pressure therein, changes in intraocular pressure may readily be determined after a baseline pressure is established.

Symbolic algebra approach to the calculation of intraocular lens power following cataract surgery

NASA Astrophysics Data System (ADS)

Hjelmstad, David P.; Sayegh, Samir I.

2013-03-01

We present a symbolic approach based on matrix methods that allows for the analysis and computation of intraocular lens power following cataract surgery. We extend the basic matrix approach corresponding to paraxial optics to include astigmatism and other aberrations. The symbolic approach allows for a refined analysis of the potential sources of errors ("refractive surprises"). We demonstrate the computation of lens powers including toric lenses that correct for both defocus (myopia, hyperopia) and astigmatism. A specific implementation in Mathematica allows an elegant and powerful method for the design and analysis of these intraocular lenses.

Apparatus and method for non-contact, acoustic resonance determination of intraocular pressure

DOEpatents

Sinha, D.N.; Wray, W.O.

1994-12-27

The apparatus and method for measuring intraocular pressure changes in an eye under investigation by detection of vibrational resonances therein. An ultrasonic transducer operating at its resonant frequency is amplitude modulated and swept over a range of audio frequencies in which human eyes will resonate. The output therefrom is focused onto the eye under investigation, and the resonant vibrations of the eye observed using a fiber-optic reflection vibration sensor. Since the resonant frequency of the eye is dependent on the pressure therein, changes in intraocular pressure may readily be determined after a baseline pressure is established. 3 figures.

[Gases in vitreoretinal surgery].

PubMed

Janco, L; Vida, R; Bartos, M; Villémová, K; Izák, M

2012-02-01

To evaluate the importance and benefits of using gases in vitreoretinal surgery. The gases represent a wide group of substances used in eye surgery for more than 100 years. The role of intraocular gases in vitreoretinal surgery is irreplaceable. Their use is still considered to be the "gold standard". An important step in eye surgery was the introduction of expanding gases--sulfur hexafluoride and perfluorocarbons into routine clinical practice. The most common indications for the use of intraocular gases are: retinal detachment, idiopathic macular hole, complications of vitreoretinal surgery and others. The introduction of intraocular gases into routine clinical practice, along with other modern surgical techniques resulted in significant improvement of postoperative outcomes in a wide range of eye diseases. Understanding the principles of intraocular gases use brings the benefits to the patient and physician as well. Due to their physical and chemical properties they pose far the best and most appropriate variant of intraocular tamponade. Gases also bring some disadvantages, such as difficulties in detailed fundus examination, visual acuity testing, ultrasonographic examination, difficulties in application of intravitreal drugs or reduced possibility of retina laser treatment. The gases significantly change optical system properties of the eye. The use of gases in vitreoretinal surgery has significantly increased success rate of retinal detachment surgery, complicated posterior segment cases, trauma, surgery of the macula and other diseases.

[Correction of aphakia with the implantation of the retropupillary iris clip intraocular artificial lens].

PubMed

Szabó, Antal; Papp, András; Borbándy, Ágnes; D Géhl, Zsuzsanna; Nagy, Zoltán Zsolt; Resch, Miklós

2017-01-01

The correction of aphakia might be a challenge for the surgeon. The aim of this study is to describe the authors' experience with the implantation of the retropupillary iris clip intraocular lens. Patients between January 2014 and December 2015 were included in the retrospective study. Retropupillary implantation of iris clip intraocular lens VRSA 54 (AMO Advanced Medical Optics, USA) was performed in all cases. The minimum follow up period was three months. The stability of the intraocular lens and the intraoperative and postoperative complications and the visual acuity were evaluated. During this time period 11 cases (1 female, 10 males) were included in the study. The mean age at the time of the implantation was 57.7 years (between 25-74 years). In 4 cases the iris clip lens was implanted during the first intervention, in 7 cases during the secondary procedure. In all cases the lens was fixated onto the iris posteriorly. The best corrected visual acuity before the iris clip implantation was 0.43 (0.1-1.0) and postoperatively at the time of the follow up 0.49 (0.04-1.0). With the use of the retropupillary implanted iris clip intraocular lens all of the patients could have been rehabilitated without major complications. Orv. Hetil., 2017, 158(1), 20-24.

A case of scleritis associated rheumatoid arthritis accompanying an intraocular elevated lesion.

PubMed

Kobayashi, Takatoshi; Takai, Nanae; Tada, Rei; Shoda, Hiromi; Kida, Teruyo; Ikeda, Tsunehiko; Ozaki, Takurou; Makino, Shigeki

2018-05-30

Scleritis and/or uveitis sometimes accompanies patients who suffer from rheumatoid arthritis. However, few studies have reported scleritis and/or uveitis accompanying a fundus elevated lesion, such as an intraocular tumor. In this study, we report a case of rheumatoid uveitis associated with an intraocular elevated lesion. A 66-year-old female visited another eye clinic and was diagnosed as bilateral anterior uveitis, and was prescribed steroid eye drops for treatment. She had previously been diagnosed as rheumatoid arthritis at the age of 30 years. Due to vitreous opacity that appeared in her right eye, we increased the instillation of steroid eye drops and the amount of oral prednisolone. Although the inflammation had improved, anterior uveitis relapsed, and an intraocular whitish elevated lesion resembling an intraocular tumor at the superior nasal retina appeared. We speculated this lesion to be a granuloma complicated with rheumatoid arthritis. Thus, we increased the amount of prednisolone administration, and the lesion began to shrink and ultimately fully disappeared. We strongly believe that our case's lesion was a subretinal granuloma related with rheumatoid arthritis, as it disappeared by increased corticosteroid treatment. Our findings show that we should consider rheumatoid arthritis in a differential diagnosis of such types of fundus elevated lesions.

Vertical fixation with fibrin glue-assisted secondary posterior chamber intraocular lens implantation in a case of surgical aphakia

PubMed Central

Ladi, Jeevan S; Shah, Nitant A

2013-01-01

We report the first case of vertical fixation by fibrin glue-assisted secondary posterior chamber intraocular lens implantation in a case of surgical aphakia. Advantages of vertical fixation are discussed. PMID:23514650

42 CFR 416.180 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICARE PROGRAM AMBULATORY SURGICAL SERVICES Adjustment in Payment Amounts for New Technology Intraocular... technology intraocular lenses (IOLs) furnished at ambulatory surgical centers (ASCs). (b) Scope. This subpart sets forth— (1) The process for interested parties to request that CMS review the appropriateness of...

The Fyodorov Sputnik intraocular lens.

PubMed

Kwitko, M L

1979-04-01

The author has implanted 197 Fyodorov intraocular lenses. With careful selection of patients, good surgical judgment, and meticulous surgery, a degree of success can be obtained with this lens, which will equal that of conventional cataract surgery. The surgical technique of implantation will be described.

Multifocal electroretinograms.

PubMed

Creel, Donnell J

2011-12-04

A limitation of traditional full-field electroretinograms (ERG) for the diagnosis of retinopathy is lack of sensitivity. Generally, ERG results are normal unless more than approximately 20% of the retina is affected. In practical terms, a patient might be legally blind as a result of macular degeneration or other scotomas and still appear normal, according to traditional full field ERG. An important development in ERGs is the multifocal ERG (mfERG). Erich Sutter adapted the mathematical sequences called binary m-sequences enabling the isolation from a single electrical signal an electroretinogram representing less than each square millimeter of retina in response to a visual stimulus. Results that are generated by mfERG appear similar to those generated by flash ERG. In contrast to flash ERG, which best generates data appropriate for whole-eye disorders. The basic mfERG result is based on the calculated mathematical average of an approximation of the positive deflection component of traditional ERG response, known as the b-wave. Multifocal ERG programs measure electrical activity from more than a hundred retinal areas per eye, in a few minutes. The enhanced spatial resolution enables scotomas and retinal dysfunction to be mapped and quantified. In the protocol below, we describe the recording of mfERGs using a bipolar speculum contact lens. Components of mfERG systems vary between manufacturers. For the presentation of visible stimulus, some suitable CRT monitors are available but most systems have adopted the use of flat-panel liquid crystal displays (LCD). The visual stimuli depicted here, were produced by a LCD microdisplay subtending 35-40 degrees horizontally and 30-35 degrees vertically of visual field, and calibrated to produce multifocal flash intensities of 2.7 cd s m(-2). Amplification was 50K. Lower and upper bandpass limits were 10 and 300 Hz. The software packages used were VERIS versions 5 and 6.

Peripheral refraction with eye and head rotation with contact lenses.

PubMed

Lopes-Ferreira, Daniela P; Neves, Helena I F; Faria-Ribeiro, Miguel; Queirós, António; Fernandes, Paulo R B; González-Méijome, José M

2015-04-01

To evaluate the impact of eye and head rotation in the measurement of peripheral refraction with an open-field autorefractometer in myopic eyes wearing two different center-distance designs of multifocal contact lenses (MFCLs). Nineteen right eyes from 19 myopic patients (average central M ± SD = -2.67 ± 1.66 D) aged 20-27 years (mean ± SD = 23.2 ± 3.3 years) were evaluated using a Grand-Seiko autorefractometer. Patients were fitted with one multifocal aspheric center-distance contact lens (Biofinity Multifocal D(®)) and with one multi-concentric MFCL (Acuvue Oasys for Presbyopia). Axial and peripheral refraction were evaluated by eye rotation and by head rotation under naked eye condition and with each MFCL fitted randomly and in independent sessions. For the naked eye, refractive pattern (M, J0 and J45) across the central 60° of the horizontal visual field values did not show significant changes measured by rotating the eye or rotating the head (p > 0.05). Similar results were obtained wearing the Biofinity D, for both testing methods, no obtaining significant differences to M, J0 and J45 values (p > 0.05). For Acuvue Oasys for presbyopia, also no differences were found when comparing measurements obtained by eye and head rotation (p > 0.05). Multivariate analysis did not showed a significant interaction between testing method and lens type neither with measuring locations (MANOVA, p > 0.05). There were significant differences in M and J0 values between naked eyes and each MFCL. Measurements of peripheral refraction by rotating the eye or rotating the head in myopic patients wearing dominant design or multi-concentric multifocal silicone hydrogel contact lens are comparable. Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Extended depth of focus contact lenses vs. two commercial multifocals: Part 1. Optical performance evaluation via computed through-focus retinal image quality metrics.

PubMed

Bakaraju, Ravi C; Ehrmann, Klaus; Ho, Arthur

To compare the computed optical performance of prototype lenses designed using deliberate manipulation of higher-order spherical aberrations to extend depth-of-focus (EDOF) with two commercial multifocals. Emmetropic, presbyopic, schematic eyes were coupled with prototype EDOF and commercial multifocal lenses (Acuvue Oasys for presbyopia, AOP, Johnson & Johnson & Air Optix Aqua multifocal, AOMF, Alcon). For each test configuration, the through-focus retinal image quality (TFRIQ) values were computed over 21 vergences, ranging from -0.50 to 2.00D, in 0.125D steps. Analysis was performed considering eyes with three different inherent aberration profiles: five different pupils and five different lens decentration levels. Except the LOW design, the AOP lenses offered 'bifocal' like TFRIQ performance. Lens performance was relatively independent to pupil and aberrations but not centration. Contrastingly, AOMF demonstrated distance centric performance, most dominant in LOW followed by MED and HIGH designs. AOMF lenses were the most sensitive to pupil, aberrations and centration. The prototypes demonstrated a 'lift-off' in the TFRIQ performance, particularly at intermediate and near, without trading performance at distance. When compared with AOP and AOMF, EDOF lenses demonstrated reduced sensitivity to pupil, aberrations and centration. With the through focus retinal image quality as the gauge of optical performance, we demonstrated that the prototype EDOF designs were less susceptible to variations in pupil, inherent ocular aberrations and decentration, compared to the commercial designs. To ascertain whether these incremental improvements translate to a clinically palpable outcome requires investigation through human trials. Copyright © 2017 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

The prevalence of leptospirosis and its association with multifocal interstitial nephritis in swine at slaughter.

PubMed Central

Baker, T F; McEwen, S A; Prescott, J F; Meek, A H

1989-01-01

An abattoir survey was undertaken to determine the prevalence of leptospirosis and its association with lesions of multifocal interstitial nephritis (so-called "white spotted kidneys") in swine at slaughter. Both cross-sectional and case-control study designs were used. Of 197 kidneys from hogs randomly selected at slaughter, 11 (5.6%) had generalized grey-white foci typical of multifocal interstitial nephritis (MFIN). Antibody titers greater than or equal to 1:80 against Leptospira pomona were detected in nine (4.6%) hogs and against L. bratislava in 63 (32%) of these hogs. Leptospira pomona (kennewicki) was detected by immunofluorescence in 5/197 (2.5%) of randomly selected hogs. Leptospires identified as genotype kennewicki were isolated from six (9.8%) of 61 kidneys cultured. Leptospira bratislava was not detected by immunofluorescence or culture. There was a highly significant (p = 0.00) and strong association (odds ratio (OR) = 195) between high L. pomona titer (greater than or equal to 1:80) and the presence of leptospires in the kidneys, as detected by culture. There was also a significant (p = 0.046) and strong (OR = 8.10) association between multifocal interstitial nephritis and the presence of renal leptospires as detected by culture. The association between leptospiral titer and MFIN lesions in the prevalence survey group of animals was statistically significant (p = 0.031), but this association was not significant in the case-control study group (p = 0.071) The failure to identify L. bratislava despite serological evidence of infection suggests that some of these seropositive animals may have been transiently infected at an early age, that serological findings were falsely positive, or that immunofluorescence and isolation attempts failed to detect L. bratislava if they were indeed present in the kidneys.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2766150

An integrated approach to fast and informative morphological vouchering of nematodes for applications in molecular barcoding

PubMed Central

De Ley, Paul; De Ley, Irma Tandingan; Morris, Krystalynne; Abebe, Eyualem; Mundo-Ocampo, Manuel; Yoder, Melissa; Heras, Joseph; Waumann, Dora; Rocha-Olivares, Axayácatl; Jay Burr, A.H; Baldwin, James G; Thomas, W. Kelley

2005-01-01

Molecular surveys of meiofaunal diversity face some interesting methodological challenges when it comes to interstitial nematodes from soils and sediments. Morphology-based surveys are greatly limited in processing speed, while barcoding approaches for nematodes are hampered by difficulties of matching sequence data with traditional taxonomy. Intermediate technology is needed to bridge the gap between both approaches. An example of such technology is video capture and editing microscopy, which consists of the recording of taxonomically informative multifocal series of microscopy images as digital video clips. The integration of multifocal imaging with sequence analysis of the D2D3 region of large subunit (LSU) rDNA is illustrated here in the context of a combined morphological and barcode sequencing survey of marine nematodes from Baja California and California. The resulting video clips and sequence data are made available online in the database NemATOL (http://nematol.unh.edu/). Analyses of 37 barcoded nematodes suggest that these represent at least 32 species, none of which matches available D2D3 sequences in public databases. The recorded multifocal vouchers allowed us to identify most specimens to genus, and will be used to match specimens with subsequent species identifications and descriptions of preserved specimens. Like molecular barcodes, multifocal voucher archives are part of a wider effort at structuring and changing the process of biodiversity discovery. We argue that data-rich surveys and phylogenetic tools for analysis of barcode sequences are an essential component of the exploration of phyla with a high fraction of undiscovered species. Our methods are also directly applicable to other meiofauna such as for example gastrotrichs and tardigrades. PMID:16214752

A naive Bayes algorithm for tissue origin diagnosis (TOD-Bayes) of synchronous multifocal tumors in the hepatobiliary and pancreatic system.

PubMed

Jiang, Weiqin; Shen, Yifei; Ding, Yongfeng; Ye, Chuyu; Zheng, Yi; Zhao, Peng; Liu, Lulu; Tong, Zhou; Zhou, Linfu; Sun, Shuo; Zhang, Xingchen; Teng, Lisong; Timko, Michael P; Fan, Longjiang; Fang, Weijia

2018-01-15

Synchronous multifocal tumors are common in the hepatobiliary and pancreatic system but because of similarities in their histological features, oncologists have difficulty in identifying their precise tissue clonal origin through routine histopathological methods. To address this problem and assist in more precise diagnosis, we developed a computational approach for tissue origin diagnosis based on naive Bayes algorithm (TOD-Bayes) using ubiquitous RNA-Seq data. Massive tissue-specific RNA-Seq data sets were first obtained from The Cancer Genome Atlas (TCGA) and ∼1,000 feature genes were used to train and validate the TOD-Bayes algorithm. The accuracy of the model was >95% based on tenfold cross validation by the data from TCGA. A total of 18 clinical cancer samples (including six negative controls) with definitive tissue origin were subsequently used for external validation and 17 of the 18 samples were classified correctly in our study (94.4%). Furthermore, we included as cases studies seven tumor samples, taken from two individuals who suffered from synchronous multifocal tumors across tissues, where the efforts to make a definitive primary cancer diagnosis by traditional diagnostic methods had failed. Using our TOD-Bayes analysis, the two clinical test cases were successfully diagnosed as pancreatic cancer (PC) and cholangiocarcinoma (CC), respectively, in agreement with their clinical outcomes. Based on our findings, we believe that the TOD-Bayes algorithm is a powerful novel methodology to accurately identify the tissue origin of synchronous multifocal tumors of unknown primary cancers using RNA-Seq data and an important step toward more precision-based medicine in cancer diagnosis and treatment. © 2017 UICC.

Testing vision with angular and radial multifocal designs using Adaptive Optics.

PubMed

Vinas, Maria; Dorronsoro, Carlos; Gonzalez, Veronica; Cortes, Daniel; Radhakrishnan, Aiswaryah; Marcos, Susana

2017-03-01

Multifocal vision corrections are increasingly used solutions for presbyopia. In the current study we have evaluated, optically and psychophysically, the quality provided by multizone radial and angular segmented phase designs. Optical and relative visual quality were evaluated using 8 subjects, testing 6 phase designs. Optical quality was evaluated by means of Visual Strehl-based-metrics (VS). The relative visual quality across designs was obtained through a psychophysical paradigm in which images viewed through 210 pairs of phase patterns were perceptually judged. A custom-developed Adaptive Optics (AO) system, including a Hartmann-Shack sensor and an electromagnetic deformable mirror, to measure and correct the eye's aberrations, and a phase-only reflective Spatial Light Modulator, to simulate the phase designs, was developed for this study. The multizone segmented phase designs had 2-4 zones of progressive power (0 to +3D) in either radial or angular distributions. The response of an "ideal observer" purely responding on optical grounds to the same psychophysical test performed on subjects was calculated from the VS curves, and compared with the relative visual quality results. Optical and psychophysical pattern-comparison tests showed that while 2-zone segmented designs (angular & radial) provided better performance for far and near vision, 3- and 4-zone segmented angular designs performed better for intermediate vision. AO-correction of natural aberrations of the subjects modified the response for the different subjects but general trends remained. The differences in perceived quality across the different multifocal patterns are, in a large extent, explained by optical factors. AO is an excellent tool to simulate multifocal refractions before they are manufactured or delivered to the patient, and to assess the effects of the native optics to their performance. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessment of subjective intraocular forward scattering and quality of vision after posterior chamber phakic intraocular lens with a central hole (Hole ICL) implantation.

PubMed

Iijima, Ayaka; Shimizu, Kimiya; Yamagishi, Mayumi; Kobashi, Hidenaga; Igarashi, Akihito; Kamiya, Kazutaka

2016-12-01

To evaluate the subjective intraocular forward scattering and quality of vision after posterior chamber phakic intraocular lens with a central hole (Hole ICL, STAAR Surgical) implantation. We prospectively examined 29 eyes of 29 consecutive patients (15 men and 14 women; ages, 37.2 ± 8.8 years) undergoing Hole ICL implantation. We assessed the values of the logarithmic straylight value [log (s)] using a straylight meter (C-Quant ™ , Oculus) preoperatively and 3 months postoperatively. The patients completed a questionnaire detailing symptoms on a quantitative grading scale (National Eye Institute Refractive Error Quality of Life Instrument-42; NEI RQL-42) 3 months postoperatively. We compared the preoperative and postoperative values of the log(s) and evaluated the correlation of these values with patient subjective symptoms. The mean log(s) was not significantly changed, from 1.07 ± 0.20 preoperatively, to 1.06 ± 0.17 postoperatively (Wilcoxon signed-rank test, p = 0.641). There was a significant correlation between the preoperative and postoperative log(s) (Spearman's correlation coefficient r = 0.695, p < 0.001). The postoperative log(s) was significantly associated with the scores of glare in the questionnaire (Spearman's correlation coefficient r = -0.575, p = 0.017). According to our experience, Hole ICL implantation does not induce a significant additional change in the subjective intraocular forward scattering. The symptom of glare after Hole ICL implantation was significantly correlated with the postoperative intraocular forward scattering in relation to the preoperative one. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Bartonella and intraocular inflammation: a series of cases and review of literature

PubMed Central

Kalogeropoulos, Chris; Koumpoulis, Ioannis; Mentis, Andreas; Pappa, Chrisavgi; Zafeiropoulos, Paraskevas; Aspiotis, Miltiadis

2011-01-01

Purpose: To present various forms of uveitis and/or retinal vasculitis attributed to Bartonella infection and review the impact of this microorganism in patients with uveitis. Methods: Retrospective case series study. Review of clinical records of patients diagnosed with Bartonella henselae and Bartonella quintana intraocular inflammation from 2001 to 2010 in the Ocular Inflammation Department of the University Eye Clinic, Ioannina, Greece. Presentation of epidemiological and clinical data concerning Bartonella infection was provided by the international literature. Results: Eight patients with the diagnosis of Bartonella henselae and two patients with B. quintana intraocular inflammation were identified. Since four patients experienced bilateral involvement, the affected eyes totaled 14. The mean age was 36.6 years (range 12–62). Uveitic clinical entities that we found included intermediate uveitis in seven eyes (50%), vitritis in two eyes (14.2%), neuroretinitis in one eye (7.1%), focal retinochoroiditis in one eye (7.1%), branch retinal vein occlusion (BRVO) due to vasculitis in one eye (7.1%), disc edema with peripapillary serous retinal detachment in one eye (7.1%), and iridocyclitis in one eye (7.1%). Most of the patients (70%) did not experience systemic symptoms preceding the intraocular inflammation. Antimicrobial treatment was efficient in all cases with the exception of the case with neuroretinitis complicated by anterior ischemic optic neuropathy and tubulointerstitial nephritis. Conclusion: Intraocular involvement caused not only by B. henselae but also by B. quintana is being diagnosed with increasing frequency. A high index of suspicion is needed because the spectrum of Bartonella intraocular inflammation is very large. In our study the most common clinical entity was intermediate uveitis. PMID:21750616

Intraocular biopsy using special forceps: a new instrument and refined surgical technique.

PubMed

Akgul, Harun; Otterbach, Friedrich; Bornfeld, Norbert; Jurklies, Bernhard

2011-01-01

The aim was to investigate the Essen biopsy forceps as a new instrument and surgical approach for biopsy of intraocular tumours. Biopsy is indicated for assessment of any uncertain intraocular process or confirmation for presumed diagnosis before treatment. There is increasing interest for further genetic and immunocytological information in order to characterise the neoplasm, especially grading and prognosis of micrometastasis in uveal melanoma. The authors have developed a new surgical technique using special intraocular biopsy forceps. Twenty patients with uncertain intraocular subretinal tumour underwent biopsies carried out using the special Essen biopsy forceps. Biopsies were obtained through sutureless 23-gauge three-port vitrectomy. A small retinotomy tumour specimen was taken by the forceps branches. For further processing, the specimens were flushed out into a sterile tube and then sent to pathologists. The prebioptical tumour had a mean thickness of 3.48 mm (1.1 to 9.8 mm). In all cases (n=20) biopsies (0.3-2.1 mm in size) were obtained, in 19 cases (95%) allowing precise histological and immunohistochemical typing of the lesions following cytoblock embedding. Uveal melanoma was diagnosed in 50% (n=10), choroidal metastasis in 15% (n=3) and choroidal naevus in 15% (n=3); other diagnoses (n=3) included choroidal haemangioma, B cell lymphoma and old subretinal haemorrhage. Apart from three patients with temporary punctual bleeding on the surface, there were no intra- and postoperative complications. Biopsy using special forceps is a promising new approach and precise surgical procedure. Especially for small intraocular tumours, this technique has the advantage in providing enough tissue for improved histological examination and presenting a low risk for complications.

Optometry-based general population survey of pupil ruff atrophy and ocular hypertension.

PubMed

Ang, Ghee S; Stevenson, Peter J; Sargent, Geoff; Grimmer, Peter; Corbett, Patricia; Jourdain, Erin; Wells, Anthony P

2013-01-01

To evaluate and describe the pupil ruff changes and relationship to intraocular pressure, pseudoexfoliation syndrome and glaucoma status in an optometric population in New Zealand. Prospective cross-sectional survey of an optometric population. Six hundred and twenty subjects over 50 years old routinely attending the participating optometry practices. Exclusion criteria included previous intraocular surgery, ophthalmic laser, uveitis, angle closure and secondary glaucoma. Multicentre study involving 11 optometry practices in the Wellington region, New Zealand. The pupillary ruff and associated gonioscopy findings of study participants were graded based on the previously published Pupil Ruff Atrophy grading system. Parameters evaluated include pupillary ruff absence and abnormality, pseudoexfoliation material and trabecular meshwork pigmentation. Correlations between intereye Pupil Ruff Atrophy grading differences and inter-eye intraocular pressure and cup:disc ratio differences. Six hundred and twenty subjects were included, with a mean age of 62.2 ± 9.1 years and mean intraocular pressure of 14.8 ± 3.4 mmHg. Four hundred and fourteen (66.8%) had bilateral pupil ruff changes and 12 (1.5%) had pseudoexfoliation. Inter-eye intraocular pressure asymmetry was significantly correlated with amount of missing pupillary ruff (r = 0.111; P = 0.022) and trabecular meshwork pigmentation (r = 0.147; P = 0.002). Inter-eye cup:disc ratio asymmetry was not correlated with any of the Pupil Ruff Atrophy grading parameters. Asymmetry of pupillary ruff absence and trabecular meshwork pigmentation was correlated with intraocular pressure asymmetry (but not with cup:disc ratio asymmetry) in a general optometric population setting in New Zealand. © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

AZD2171 in Treating Patients With Recurrent or Stage IV Melanoma

ClinicalTrials.gov

2015-06-01

Acral Lentiginous Malignant Melanoma; Ciliary Body and Choroid Melanoma, Medium/Large Size; Ciliary Body and Choroid Melanoma, Small Size; Extraocular Extension Melanoma; Intraocular Melanoma; Iris Melanoma; Lentigo Maligna Malignant Melanoma; Recurrent Melanoma; Stage, Intraocular Melanoma; Stage IV Melanoma; Superficial Spreading Malignant Melanoma

Postoperative inflammatory reactions to intraocular lense sterilized with ethylene-oxide.

PubMed

Stark, W J; Rosenblum, P; Maumenee, A E; Cowan, C L

1980-05-01

Postoperative inflammatory complications after intraocular lens implantation have increased since we have been using lenses manufactured by American companies and sterilized with ethylene-oxide, as compared with lenses from European companies sterilized by sodium hydroxide. The possible sources of this complication are discussed.

Two cases of intraocular infection with Alaria mesocercaria (Trematoda)

PubMed

McDonald, H R; Kazacos, K R; Schatz, H; Johnson, R N

1994-04-15

We encountered two cases of human intraocular infection with mesocercariae of Alaria (Trematoda), involving unrelated Asian men who had unilateral decreased vision. Both patients had pigmentary tracks in the retina, areas of active or healed retinitis, or both, and other signs of diffuse unilateral subacute neuroretinitis. Similar, nonnematode worms were seen in the patients' retinas and vitreous, respectively, several years after apparent infection. The worm in Case 1 was analyzed from projected fundus photographs and diagnosed as an Alaria mesocercaria on the basis of its shape, size (500 x 150 microns), and movement; it was successfully killed with laser. The worm in Case 2 was removed surgically from the vitreous and identified as A. mesocercaria, 555 x 190 microns, most likely A. americana. The probable source of infection in the patients was ingestion, in local restaurants, of undercooked frogs' legs containing A. mesocercaria. In addition to causing prolonged intraocular infection, A. mesocercaria was found to be a cause of diffuse unilateral subacute neuroretinitis, a condition previously attributed only to intraocular nematode larvae.

In vitro oxygen sensing using intraocular microrobots.

PubMed

Ergeneman, Olgaç; Chatzipirpiridis, George; Pokki, Juho; Marín-Suárez, Marta; Sotiriou, Georgios A; Medina-Rodríguez, Santiago; Sánchez, Jorge F Fernández; Fernández-Gutiérrez, Alberto; Pané, Salvador; Nelson, Bradley J

2012-11-01

We present a luminescence oxygen sensor integrated with a wireless intraocular microrobot for minimally-invasive diagnosis. This microrobot can be accurately controlled in the intraocular cavity by applying magnetic fields. The microrobot consists of a magnetic body susceptible to magnetic fields and a sensor coating. This coating embodies Pt(II) octaethylporphine (PtOEP) dyes as the luminescence material and polystyrene as a supporting matrix, and it can be wirelessly excited and read out by optical means. The sensor works based on quenching of luminescence in the presence of oxygen. The excitation and emission spectrum, response time, and oxygen sensitivity of the sensor were characterized using a spectrometer. A custom device was designed and built to use this sensor for intraocular measurements with the microrobot. Due to the intrinsic nature of luminescence lifetimes, a frequency-domain lifetime measurement approach was used. An alternative sensor design with increased performance was demonstrated by using poly(styrene-co-maleic anhydride) (PS-MA) and PtOEP nanospheres.

Activity of crude cold-water extract of the culinary-medicinal oyster mushroom, Pleurotus ostreatus (Jacq.:Fr.) P.Kumm. (higher Basidiomycetes), and timolol maleate on induced ocular hypertension.

PubMed

Ebigwai, Joseph Kayefor; Edu, Esther Aja; Itam, Edisua Hogan; Mofunanya, Ann Jerry

2012-01-01

Aqueous crude cold-water extract from the fruiting body of the culinary-medicinal oyster mushroom Pleurotus ostreatus was assessed for activity against increased intra-ocular pressure (IOP) in mice. A 0.1% dexamethasone instillation was used to raise the intra-ocular pressure in the animals above the 21-mmHg threshold limit. The extract has intrinsic anti-hypertensive properties that are dose dependent. A comparison analysis indicated that 150 mg/mL of the crude extract produced 57.69% reduction in the intra-ocular pressure, while doses of 100 mg/ mL and 200 mg/mL produced 44.78% and 70.03% IOP reduction, respectively, compared with timolol maleate with 57.69%. The results were significant at 0.05 confidence limit (p < 0.05) when compared to a placebo and therefore support its use for the treatment of increased intra-ocular pressure.

Advanced pigment dispersion glaucoma secondary to phakic intraocular collamer lens implant.

PubMed

Ye, Clara; Patel, Cajal K; Momont, Anna C; Liu, Yao

2018-06-01

We report a case of pigment dispersion glaucoma secondary to uncomplicated phakic intraocular collamer lens (ICL) (Visian ICL™, Staar Inc., Monrovia, CA) implant that resulted in advanced visual field loss. A 50-year-old man presented for routine follow-up status post bilateral phakic intraocular collamer lens (ICL) placement 8 years earlier. He was incidentally found to have a decline in visual acuity from an anterior subcapsular cataract and elevated intraocular pressure (IOP) in the left eye. There were signs of pigment dispersion and no evidence of angle closure. Diffuse optic nerve thinning was consistent with advanced glaucomatous visual field defects. Pigment dispersion was also present in the patient's right eye, but without elevated IOP or visual field defects. The patient was treated with topical glaucoma medications and the phakic ICL in the left eye was removed concurrently with cataract surgery to prevent further visual field loss. Pigment dispersion glaucoma is a serious adverse outcome after phakic ICL implantation and regular post-operative monitoring may prevent advanced visual field loss.

Anti-tubercular therapy for intraocular tuberculosis: A systematic review and meta-analysis.

PubMed

Kee, Ae Ra; Gonzalez-Lopez, Julio J; Al-Hity, Aws; Gupta, Bhaskar; Lee, Cecilia S; Gunasekeran, Dinesh Visva; Jayabalan, Nirmal; Grant, Robert; Kon, Onn Min; Gupta, Vishali; Westcott, Mark; Pavesio, Carlos; Agrawal, Rupesh

2016-01-01

Intraocular tuberculosis remains a diagnostic and management conundrum for both ophthalmologists and pulmonologists. We analyze the efficacy and safety of anti-tubercular therapy (ATT) in patients with intraocular tuberculosis and factors associated with favorable outcome. Twenty-eight studies are included in this review, with a total of 1,917 patients. Nonrecurrence of inflammation was observed in pooled estimate of 84% of ATT-treated patients (95% CI 79-89). There was minimal difference in the outcome between patients treated with ATT alone (85% successful outcome; 95% CI 25-100) and those with concomitant systemic corticosteroid (82%; 95% CI 73-90). The use of ATT may be of benefit to patients with suspected intraocular tuberculosis; however, this conclusion is limited by the lack of control group analysis and standardized recruitment and treatment protocols. We propose further prospective studies to better establish the efficacy of ATT and ascertain the factors associated with favorable treatment outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Development and experimental verification of an intraocular scattering model

NASA Astrophysics Data System (ADS)

Jiang, Chong-Jhih; Jhong, Tian-Siang; Chen, Yi-Chun; Sun, Ching-Cherng

2011-10-01

An intraocular scattering model was constructed in human eye model and experimentally verified. According to the biometric data, the volumetric scattering in crystalline lens and diffusion at retina fundus were developed. The scattering parameters of cornea, including particle size and obscuration ratio, were varied to make the veiling luminance of the eye model matching the CIE disability glare general formula. By replacing the transparent lens with a cataractous lens, the disability glare curve of cataracts was generated and compared with that of transparent lenses. The MTF of the intraocular scattering model showed nice correspondence with the data measured by a double-pass experiment.

[Opacification of an intraocular lens: calcification of hydrophilic intraocular lenses after gas tamponade of the anterior chamber].

PubMed

Schmidinger, G; Pemp, B; Werner, L

2013-11-01

A patient with endothelial dystrophy was treated with Descemet stripping automated endothelial keratoplasty (DSAEK) combined with cataract extraction and implantation of a hydrophilic intraocular lens (IOL, Lentis-L312, Oculentis) but visual acuity dropped from 0.15 logMAR to 0.52 logMAR 18 months later due to calcification of the IOL. With new methods of lamellar corneal transplantation being used more frequently the number of necessary anterior chamber tamponades with air/gas are increasing. In cataract cases in which a gas tamponade and transplantation might be necessary later on (cornea guttata), hydrophilic IOLs should be avoided.

Multifocal necrotising fasciitis and septic shock complicating varicella infection in an adult

PubMed Central

Mifsud, Simon; Schembri, Emma Louise; Mallia Azzopardi, Charles; Zammit, Maria Alessandra

2013-01-01

A 35-year-old woman with a 3-day history of chickenpox, presented to the hospital in septic shock and with multifocal, non-adjacent lesions of necrotising fasciitis. Necrotising fasciitis is a rare yet life-threatening complication of chickenpox. Blood cultures and wound swabs confirmed the presence of Streptococcus pyogenes. The initial emergency management included oxygen, aggressive fluid resuscitation and antimicrobial therapy. Once the patient was stabilised, surgical management ensued. This included debridement and eventual grafting of the necrotic skin lesions. Intensive management and follow-up for 8 weeks were required before the patient was deemed fit for discharge. PMID:24130210

Acute posterior multifocal placoid pigment epitheliopathy associated with cerebral vasculitis.

PubMed

Weinstein, J M; Bresnick, G H; Bell, C L; Roschmann, R A; Brooks, B R; Strother, C M

1988-09-01

Acute multifocal posterior placoid pigment epitheliopathy (APMPPE) is an unusual self-limited retinal disorder that has been associated with various systemic complications. To our knowledge, three prior cases associated with cerebral vasculitis have been described. This article describes a patient with APMPPE and angiographically documented cerebral vasculitis who was notable because of (a) the presence of two different cerebral ischemic events, occurring 1 month apart, and (b) the long latency (3 months) between the onset of ocular symptoms and the second cerebral ischemic event. Recognition of the association between APMPPE and cerebral vasculitis may permit early treatment of CNS involvement and prevention of morbidity.

Hereditary Neuropathy With Liability to Pressure Palsies: Diverse Phenotypes in Childhood.

PubMed

Harada, Yohei; Puwanant, Araya; Herrmann, David N

2016-12-01

Hereditary neuropathy with liability to pressure palsies (HNPP) is a rare autosomal-dominant disorder that most commonly produces recurrent painless focal sensory and motor neuropathies often preceded by minor, mechanical stress, or minor trauma. Herein, we report 2 pediatric cases of HNPP with atypical presentations; isolated muscle cramping and toe walking. Electrophysiologic testing disclosed multifocal sensorimotor polyneuropathy with slowing of sensory conduction velocities in both cases, which prompted PMP 22 gene deletion testing. Multifocal sensorimotor electrophysiologic abnormalities, with slowing of sensory conduction velocities should raise consideration of HNPP in childhood. These case reports emphasize that the diagnosis of HNPP in children requires a high index of suspicion.

Chromatic multifocal pupillometer for objective early diagnosis of mild cognitive impairment

NASA Astrophysics Data System (ADS)

Rotenstreich, Ygal; Ben-Ner, Daniel; Sharvit-Ginon, Inbal; Ravona-Springer, Ramit; Beeri, Michal; Sher, Ifat

2017-02-01

The pupil responses of 15 cognitively normal subjects (ages 60-74) were examined in response to 76 focal red and blue light stimuli using a chromatic multifocal pupillometer (CMP). Subjects with low cognitive scores as determined as by Montreal Cognitive Assessment testing, presented significantly weaker and sluggish pupil responses in peripheral and central locations of the visual field in response to red and blue light. Our findings suggests that the CMP may present a novel objective, non-invasive, low cost technique for early diagnosis of cognitive decline that may serve for Alzheimer Disease prevention and as sensitive outcome measure of therapeutic effects.

Mefloquine improved progressive multifocal leukoencephalopathy in a patient with systemic lupus erythematosus.

PubMed

Beppu, Minako; Kawamoto, Michi; Nukuzuma, Souichi; Kohara, Nobuo

2012-01-01

We describe a case of a 67-year-old man with systemic lupus erythematosus who presented with progressive left hemiplegia. Although the cerebral spinal fluid (CSF) polymerase chain reaction (PCR) for the JC virus was negative, a brain biopsy confirmed the diagnosis of progressive multifocal leukoencephalopathy (PML). The tapering of prednisone and the use of cidofovir could not arrest the disease progression. Administration of mefloquine stopped the extension of the lesion, and resulted in obvious clinical improvement. The CSF nested PCR for the JC virus also became negative. This widely used drug should be tried for the treatment of non-HIV PML.

Multifocal Renal Fungal Abscesses.

PubMed

Cho, Eric Y; Kaplan, Joshua R; Mamone, Linda; Mydlo, Jack H; Reese, Adam C

2016-07-01

We report a case of multiple fungal renal abscesses in a 36-year-old woman with a history of diabetes and intravenous substance use disorder. The patient presented with fever and hematuria, and was found to be bacteremic and fungemic. She was initially managed with broad-spectrum antibiotics and antifungals. She remained febrile and imaging on treatment day 14 showed no improvement of the renal abscesses. Thus, a nephrectomy was performed, after which the patient defervesced and follow-up blood cultures were negative. There is a paucity of literature regarding management of multifocal fungal renal abscesses that fail to respond to medical management. Copyright © 2016 Elsevier Inc. All rights reserved.

Progressive Multifocal Leukoencephalopathy: Recent Advances and a Neuro-Ophthalmological Review.

PubMed

Sudhakar, Padmaja; Bachman, David M; Mark, Alexander S; Berger, Joseph R; Kedar, Sachin

2015-09-01

Progressive multifocal leukoencephalopathy (PML) is a severe often fatal opportunistic infection of the central nervous system caused by reactivation of a ubiquitous polyoma virus, JC virus. Although typically characterized by multifocal asymmetric subcortical white matter lesions, it may be monofocal and affect the cortical gray matter. Among the broad spectrum of clinical manifestations that occurs with PML, visual complaints are common. Combination of representative personally observed cases of PML and comprehensive review of case series of PML from 1958 through 2014. Neuro-ophthalmic signs and symptoms were reported in approximately 20%-50% of patients with PML and can be the presenting manifestation in half of these. A majority of these presentations occur from damage to cerebral visual pathways resulting in visual field defects, cortical blindness, and other disorders of visual association. Given the decreased frequency of infratentorial and cerebellar involvement, ocular motility disorders are less common. Visual complaints occur in patients with PML and are often the presenting sign. Awareness of this condition is helpful in avoiding unnecessary delays in the diagnosis of PML and management of the underlying condition. Recent guidelines have established criteria for diagnosis of PML in the high-risk patient population and strategies to mitigate the risk in these populations.

Protothecal granulomatous meningoencephalitis in a dog.

PubMed

Salvadori, C; Gandini, G; Ballarini, A; Cantile, C

2008-10-01

A case of central nervous system protothecosis in a dog is reported. A three-year-old male Maremma sheepdog was referred with a two month history of diarrhoea associated with progressive tetraparesis, depression and right circling. Stupor, severe proprioceptive deficits, bilateral decreased thoracic limb flexor reflexes and bilateral deficit of the menace reaction were detected on neurological examination and a multi-focal neurological localisation was suspected. Histopathological evaluation revealed multi-focal granulomatous foci in the thalamus, hippocampus and caudal brainstem containing numerous oval-rounded organisms with a thick, periodic acid-Schiff-positive and Gomori's methenamine silver-positive cell wall, a basophilic cytoplasm and one nucleus. Scattered sporangia containing two to four endospores were also observed. Morphological features were consistent with Prototheca species. Ultrastructurally, numerous degenerated algae were present within macrophages mainly lacking nuclei and cytoplasmic organelles. Generally, protothecosis in dogs is characterised by systemic signs because of a multi-organ involvement, and haemorrhagic colitis or ophthalmologic signs are the most frequent presenting signs. However, protothecosis should be added, also in Europe, to the list of the differential diagnoses in adult dogs with a multi-focal neurological localisation even in absence of other clinical signs.

Anatomical constraints on attention: Hemifield independence is a signature of multifocal spatial selection

PubMed Central

Alvarez, George A; Gill, Jonathan; Cavanagh, Patrick

2012-01-01

Previous studies have shown independent attentional selection of targets in the left and right visual hemifields during attentional tracking (Alvarez & Cavanagh, 2005) but not during a visual search (Luck, Hillyard, Mangun, & Gazzaniga, 1989). Here we tested whether multifocal spatial attention is the critical process that operates independently in the two hemifields. It is explicitly required in tracking (attend to a subset of object locations, suppress the others) but not in the standard visual search task (where all items are potential targets). We used a modified visual search task in which observers searched for a target within a subset of display items, where the subset was selected based on location (Experiments 1 and 3A) or based on a salient feature difference (Experiments 2 and 3B). The results show hemifield independence in this subset visual search task with location-based selection but not with feature-based selection; this effect cannot be explained by general difficulty (Experiment 4). Combined, these findings suggest that hemifield independence is a signature of multifocal spatial attention and highlight the need for cognitive and neural theories of attention to account for anatomical constraints on selection mechanisms. PMID:22637710

Perifoveal function in patients with North Carolina macular dystrophy: the importance of accounting for fixation locus.

PubMed

Seiple, William; Szlyk, Janet P; Paliga, Jennifer; Rabb, Maurice F

2006-04-01

To quantify the extent of visual function losses in patients with North Carolina Macular Dystrophy (NCMD) and to demonstrate the importance of accounting for eccentric fixation when making comparisons with normal data. Five patients with NCMD who were from a single family were examined. Multifocal electroretinograms (mfERGs) and psychophysical assessments of acuity and luminance visual field sensitivities were measured throughout the central retina. Comparisons of responses from equivalent retinal areas were accomplished by shifting normal templates to be centered at the locus of fixation for each patient. Losses of psychophysically measured visual function in patients with NCMD extend to areas adjacent to the locations of visible lesions. The multifocal ERG amplitude was reduced only within the area of visible lesion. Multifocal ERG implicit times were delayed throughout the entire central retinal area assessed. ERG timing is a sensitive assay of retinal function, and our results indicate that NCMD has a widespread effect at the level of the mid and outer retina. The findings also demonstrated that it is necessary to account for fixation locus and to ensure that equivalent retinal areas are compared when testing patients with macular disease who have eccentric fixation.

Clinical characteristics of occult macular dystrophy in family with mutation of RP1l1 gene.

PubMed

Tsunoda, Kazushige; Usui, Tomoaki; Hatase, Tetsuhisa; Yamai, Satoshi; Fujinami, Kaoru; Hanazono, Gen; Shinoda, Kei; Ohde, Hisao; Akahori, Masakazu; Iwata, Takeshi; Miyake, Yozo

2012-06-01

To report the clinical characteristics of occult macular dystrophy (OMD) in members of one family with a mutation of the RP1L1 gene. Fourteen members with a p.Arg45Trp mutation in the RP1L1 gene were examined. The visual acuity, visual fields, fundus photographs, fluorescein angiograms, full-field electroretinograms, multifocal electroretinograms, and optical coherence tomographic images were examined. The clinical symptoms and signs and course of the disease were documented. All the members with the RP1L1 mutation except one woman had ocular symptoms and signs of OMD. The fundus was normal in all the patients during the entire follow-up period except in one patient with diabetic retinopathy. Optical coherence tomography detected the early morphologic abnormalities both in the photoreceptor inner/outer segment line and cone outer segment tip line. However, the multifocal electroretinograms were more reliable in detecting minimal macular dysfunction at an early stage of OMD. The abnormalities in the multifocal electroretinograms and optical coherence tomography observed in the OMD patients of different durations strongly support the contribution of RP1L1 mutation to the presence of this disease.

Field observations of display placement requirements and character size for presbyopic and prepresbyopic computer users.

PubMed

Bartha, Michael C; Allie, Paul; Kokot, Douglas; Roe, Cynthia Purvis

2015-01-01

Computer users continue to report eye and upper body discomfort even as workstation flexibility has improved. Research shows a relationship between character size, viewing distance, and reading performance. Few reports exist regarding text height viewed under normal office work conditions and eye discomfort. This paper reports self-selected computer display placement, text characteristics, and subjective comfort for older and younger computer workers under real-world conditions. Computer workers were provided with monitors and adjustable display support(s). In Study 1, older workers wearing progressive-addition lenses (PALs) were observed. In study 2, older workers wearing multifocal lenses and younger workers were observed. Workers wearing PALs experienced less eye and body discomfort with adjustable displays, and less eye and neck discomfort for text visual angles near or greater than ergonomic recommendations. Older workers wearing multifocal correction positioned displays much lower than younger workers. In general, computer users did not adjust character size to ensure that fovial images of text fell within the recommended range. Ergonomic display placement recommendations should be different for computer users wearing multifocal correction for presbyopia. Ergonomic training should emphasize adjusting text size for user comfort.

Intermediate addition multifocals provide safe stair ambulation with adequate 'short-term' reading.

PubMed

Elliott, David B; Hotchkiss, John; Scally, Andrew J; Foster, Richard; Buckley, John G

2016-01-01

A recent randomised controlled trial indicated that providing long-term multifocal wearers with a pair of distance single-vision spectacles for use outside the home reduced falls risk in active older people. However, it also found that participants disliked continually switching between using two pairs of glasses and adherence to the intervention was poor. In this study we determined whether intermediate addition multifocals (which could be worn most of the time inside and outside the home and thus avoid continual switching) could provide similar gait safety on stairs to distance single vision spectacles whilst also providing adequate 'short-term' reading and near vision. Fourteen healthy long-term multifocal wearers completed stair ascent and descent trials over a 3-step staircase wearing intermediate and full addition bifocals and progression-addition lenses (PALs) and single-vision distance spectacles. Gait safety/caution was assessed using foot clearance measurements (toe on ascent, heel on descent) over the step edges and ascent and descent duration. Binocular near visual acuity, critical print size and reading speed were measured using Bailey-Lovie near charts and MNRead charts at 40 cm. Gait safety/caution measures were worse with full addition bifocals and PALs compared to intermediate bifocals and PALs. The intermediate PALs provided similar gait ascent/descent measures to those with distance single-vision spectacles. The intermediate addition PALs also provided good reading ability: Near word acuity and MNRead critical print size were better with the intermediate addition PALs than with the single-vision lenses (p < 0.0001), with a mean near visual acuity of 0.24 ± 0.13 logMAR (~N5.5) which is satisfactory for most near vision tasks when performed for a short period of time. The better ability to 'spot read' with the intermediate addition PALs compared to single-vision spectacles suggests that elderly individuals might better comply with the use of intermediate addition PALs outside the home. A lack of difference in gait parameters for the intermediate addition PALs compared to distance single-vision spectacles suggests they could be usefully used to help prevent falls in older well-adapted full addition PAL wearers. A randomised controlled trial to investigate the usefulness of intermediate multifocals in preventing falls seems warranted. © 2015 The Authors Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.

The Effects of Hashimoto Thyroiditis on Lymph Node Metastases in Unifocal and Multifocal Papillary Thyroid Carcinoma

PubMed Central

Zhu, Feng; Shen, Yi Bin; Li, Fu Qiang; Fang, Yun; Hu, Liang; Wu, Yi Jun

2016-01-01

Abstract The purpose of this study was to investigate the risk factors for central and lateral neck lymph node metastases in papillary thyroid carcinoma (PTC) and multifocal papillary thyroid carcinoma (MPTC), particularly when associated with Hashimoto thyroiditis (HT). A retrospective analysis of 763 consecutive patients who underwent total thyroidectomy with bilateral central neck dissection in the First Affiliated Hospital, College of Medicine, Zhejiang University between October 2011 and October 2014 was conducted. All patients had formal histological diagnoses of HT. Multivariable logistic regression analysis was performed to identify risk factors of neck lymph node metastases. Our study identified 277 PTC patients with HT and showed comparatively low rates of central lymph node metastases (CLNM) compared with the PTC patients without HT (37.2% versus 54.7%, P < 0.001). There were no statistically significant differences in lateral lymph node metastases (LLNM) (P = 0.656). Neck lymph node metastases were histologically proven in 127 (45.8%) patients with PTC with HT, including 103 CLNM and 24 LLNM. There were no significant differences in LLNM between the MPTC-associated HT and classic MPTC cases; however, a significantly reduced risk of CLNM was observed in the MPTC-associated HT compared with the MPTC cases (35.7% versus 72.4%, respectively, P < 0.001). In the multivariate analysis, HT was identified as an independent alleviating factor for CLNM in all PTC patients (odds ratio, 0.369; 95% confidence interval (CI), 0.261 to 0.521; P < 0.001) and in MPTC patients (odds ratio, 0.227; 95% CI, 0.126–0.406; P < 0.001). A cut-off of thyroid peroxidase antibody >140 IU/mL was established as the most sensitive and specific level for the prediction of MPTC based on receiver operating characteristic curve analyses. Thyroid peroxidase antibody, age, tumor size, and multifocality exhibited the ability to predict CLNM in PTC with HT patients with an area under the curve of 81.1% based on a multivariate model. Hashimoto thyroiditis was associated with increased prevalences of multifocality and capsular invasion. In contrast, HT was associated with a reduced risk of CLNM in PTC and MPTC patients, which indicated a potential protective effect. We found that the prognostic prediction model was applicable for predicting multifocality and CLNM in PTC patients with HT. PMID:26871795

The Effects of Hashimoto Thyroiditis on Lymph Node Metastases in Unifocal and Multifocal Papillary Thyroid Carcinoma: A Retrospective Chinese Cohort Study.

PubMed

Zhu, Feng; Shen, Yi Bin; Li, Fu Qiang; Fang, Yun; Hu, Liang; Wu, Yi Jun

2016-02-01

The purpose of this study was to investigate the risk factors for central and lateral neck lymph node metastases in papillary thyroid carcinoma (PTC) and multifocal papillary thyroid carcinoma (MPTC), particularly when associated with Hashimoto thyroiditis (HT).A retrospective analysis of 763 consecutive patients who underwent total thyroidectomy with bilateral central neck dissection in the First Affiliated Hospital, College of Medicine, Zhejiang University between October 2011 and October 2014 was conducted. All patients had formal histological diagnoses of HT. Multivariable logistic regression analysis was performed to identify risk factors of neck lymph node metastases.Our study identified 277 PTC patients with HT and showed comparatively low rates of central lymph node metastases (CLNM) compared with the PTC patients without HT (37.2% versus 54.7%, P < 0.001). There were no statistically significant differences in lateral lymph node metastases (LLNM) (P = 0.656). Neck lymph node metastases were histologically proven in 127 (45.8%) patients with PTC with HT, including 103 CLNM and 24 LLNM. There were no significant differences in LLNM between the MPTC-associated HT and classic MPTC cases; however, a significantly reduced risk of CLNM was observed in the MPTC-associated HT compared with the MPTC cases (35.7% versus 72.4%, respectively, P < 0.001). In the multivariate analysis, HT was identified as an independent alleviating factor for CLNM in all PTC patients (odds ratio, 0.369; 95% confidence interval (CI), 0.261 to 0.521; P < 0.001) and in MPTC patients (odds ratio, 0.227; 95% CI, 0.126-0.406; P < 0.001). A cut-off of thyroid peroxidase antibody >140 IU/mL was established as the most sensitive and specific level for the prediction of MPTC based on receiver operating characteristic curve analyses. Thyroid peroxidase antibody, age, tumor size, and multifocality exhibited the ability to predict CLNM in PTC with HT patients with an area under the curve of 81.1% based on a multivariate model.Hashimoto thyroiditis was associated with increased prevalences of multifocality and capsular invasion. In contrast, HT was associated with a reduced risk of CLNM in PTC and MPTC patients, which indicated a potential protective effect. We found that the prognostic prediction model was applicable for predicting multifocality and CLNM in PTC patients with HT.

Intraocular foreign-body hazard during vitrectomy.

PubMed

Bovino, J A; Marcus, D F

1982-03-01

We noted two instances of forceps-induced fragmentation of the bar used for scleral plug storage during vitreous surgery. The silicone bar material was adherent to the plug in both cases. Because this represents a significant intraocular foreign body hazard, the scleral plug should be carefully inspected before insertion.

STS-44 crewmembers conduct DSO 472, Intraocular Pressure, on OV-104's middeck

NASA Image and Video Library

1991-12-01

STS044-04-001 (24 Nov-1 Dec 1991) --- Astronauts F. Story Musgrave (right) and Mario Runco, Jr., mission specialists, team up for one of the biomedical Detailed Supplementary Objective (DSO) test on the eight-day flight, this one involving intraocular pressure.

Bilateral cataract extraction with posterior chamber intraocular lens implantation simultaneous in pediatric cataracts.

PubMed

Caça, Ihsan; Sakalar, Yildirim Bayezit; Ari, Seyhmus; Alakus, Fuat; Dogan, Eyüp

2008-01-01

We evaluated the results of simultaneous bilateral cataract extraction with intraocular lens (IOL) inplantation 32 pediatric cataract patients. Simultaneous cataract extraction and posterior capsulotomy with anterior vitrectomy and IOL implantation is an effective and safe procedure in bilateral pediatric cataracts treatment.

Fundus autofluorescence patterns in primary intraocular lymphoma.

PubMed

Casady, Megan; Faia, Lisa; Nazemzadeh, Maryam; Nussenblatt, Robert; Chan, Chi-Chao; Sen, H Nida

2014-02-01

To evaluate fundus autofluorescence (FAF) patterns in patients with primary intraocular (vitreoretinal) lymphoma. Records of all patients with primary intraocular lymphoma who underwent FAF imaging at the National Eye Institute were reviewed. Fundus autofluorescence patterns were evaluated with respect to clinical disease status and the findings on fluorescein angiography and spectral-domain optical coherence tomography. There were 18 eyes (10 patients) with primary intraocular lymphoma that underwent FAF imaging. Abnormal autofluorescence in the form of granular hyperautofluorescence and hypoautofluorescence was seen in 11 eyes (61%), and blockage by mass lesion was seen in 2 eyes (11%). All eyes with granular pattern on FAF had active primary intraocular lymphoma at the time of imaging, but there were 5 eyes with unremarkable FAF, which were found to have active lymphoma. The most common pattern on fluorescein angiography was hypofluorescent round spots with a "leopard spot" appearance (43%). These hypofluorescent spots on fluorescein angiography correlated with hyperautofluorescent spots on FAF in 5 eyes (36%) (inversion of FAF). Nodular hyperreflective spots at the level of retinal pigment epithelium on optical coherence tomography were noted in 43% of eyes. The hyperautofluorescent spots on FAF correlated with nodular hyperreflective spots on optical coherence tomography in 6 eyes (43%). Granularity on FAF was associated with active lymphoma in majority of the cases. An inversion of FAF (hyperautofluorescent spots on FAF corresponding to hypofluorescent spots on fluorescein angiography) was observed in less than half of the eyes.

Delayed presentation of retained acrylic intraocular lens (IOL) fragment after uncomplicated cataract surgery.

PubMed

Capitena, Cara E; Gamett, Kevin; Pantcheva, Mina B

2016-10-01

To report a case of delayed presentation of a severed acrylic single-piece intraocular lens (IOL) haptic fragment causing corneal edema after uneventful phacoemulsification surgery. An 85-year-old male presented with inferior corneal decompensation six months after a reportedly uneventful phacoemulsification in his left eye. A distal haptic fragment of an acrylic single-piece posterior chamber intraocular lens was found in the inferior anterior chamber angle. Intraoperative examination revealed that the dislocated fragment originated from the temporal haptic, the remainder of which was adherent to the anterior surface of the capsular bag. The clipped edge of the haptic fragment showed a clean, flat surface, suggesting it was severed by a sharp object. The findings were considered consistent with cutting of the fragment during implantation presumably from improper lens loading, improper implantation technique, or defective implantation devices. This is the first case report of a foldable acrylic intraocular lens severed during routine uncomplicated cataract surgery that was not noted at the time of the surgery or in the immediate postoperative period. Delayed presentation of severed IOL fragments should be considered in cases of late onset corneal edema post-operatively, when other causes have been ruled out. Careful implantation technique and thorough examination of the intraocular lens after implantation to assess for lens damage intraoperatively is essential to avoid such rare complications.

[Music and Glaucoma].

PubMed

Plange, N

2017-02-01

Music may have multiple influences on the human organism. A possible therapeutic effect for patients with glaucoma has been postulated, aside from the known impact of music on the cardiovascular system, psychogenic effects and a short-term improvement in mental performance (Mozart effect). The higher level of mental stress in patients with glaucoma and type-A personality behaviour may be related to higher intraocular pressure in patients with glaucoma. Relaxing music may have a positive impact in these patients, related to a reduction in intraocular pressure or its fluctuations. However, only limited data exist on the effects of music on intraocular pressure. No clinical studies have yet been performed to investigate the effect of music or music therapy on glaucoma progression. The music of Mozart may influence visual field examinations, possibly due to a positive short term effect on mental performance. This factor needs to be addressed in studies dealing with the effect of music in glaucoma. The relevance of intraocular pressure increases in professional wind instrument players is controversial. An increased level of care might be advisable in patients with advanced glaucoma. The influences of music on humans, altered personality profiles in patients with glaucoma and the studies showing some effect of stress on intraocular pressure stress the relevance of psychological support for glaucoma patients, who are confronted with a disease with a high longterm risk of blindness. Georg Thieme Verlag KG Stuttgart · New York.

Intraocular Gnathostoma spinigerum. Clinicopathologic study of two cases with review of literature.

PubMed

Biswas, J; Gopal, L; Sharma, T; Badrinath, S S

1994-01-01

Live intraocular nematode is a rare occurrence that is mostly reported in Southeast Asian countries. Common nematodes that are seen live in the eye are microfilaria, Gnathostoma, and Angiostrongylus. Approximately 12 cases of intraocular gnathostomiasis have been reported in the literature. Two cases of intraocular gnathostoma, removed by vitrectomy in the first case and by paracentesis in the second case, are reported. Morphologic study of the parasites in wet preparation was performed under dissecting microscope and fixed in Karnovosky's fixative. Light microscopic and scanning electron microscopic studies were also performed. The first patient had anterior uveitis, multiple iris holes, and dense vitreous haze with fibrous proliferation over the optic disc. On resolution of the vitreous haze, a live worm was seen in the vitreous cavity. The second patient had anterior uveitis with secondary glaucoma, multiple iris holes, mild vitritis, and focal subretinal haemorrhage with subretinal tracts. Four days later a live worm was seen in the anterior chamber and removed. Microscopic study of the parasites from both patients revealed typical head bulb with four circumferential rows of hooklets, and fine cuticular spines were seen on the surface of the body. Iris holes, uveitis, and subretinal haemorrhage with subretinal tract can be characteristic features of intraocular gnathostomiasis. Identification of this parasite can be made by typical features, which can be identified on light and scanning electron microscopic study.

Concurrent clinical intraocular findings in horses with depigmented punctate chorioretinal foci.

PubMed

Mathes, Rachel L; Burdette, Erin L; Moore, Phillip A; Myrna, Kathern E

2012-03-01

To report concurrent clinical intraocular findings in horses with depigmented punctate chorioretinal foci and to document any correlation with equine recurrent uveitis (ERU). Records of 131 horses (241 eyes) examined at the University of Georgia Veterinary Teaching hospital from 2001 to 2010 were reviewed with either clinically normal fundi or depigmented punctate chorioretinal foci in the absence of other fundic pathology. Data collected included patient signalment, concurrent clinical ocular findings and follow-up information. Sex, presence of no other intraocular findings, presence of ERU, presence of cataracts, and presence of vitreal disease were compared between normal and foci groups using chi-squared analysis. Age and length of follow-up time were compared using a student's t-test. Ninety-one horses (167 eyes) with chorioretinal foci and forty horses (74 eyes) with clinically normal ocular fundi were examined. Fifty-eight (64%) horses with chorioretinal foci and 20 (50%) horses with clinically normal fundi had a normal intraocular examination. There was no significant difference in any of the criteria examined between groups. Horses with depigmented punctate chorioretinal foci, in the absence of other fundic pathology, are not more likely to have intraocular disease or ERU than horses with clinically normal ocular fundi. These findings suggest that depigmented punctate fundic foci in horses are not indicative of or associated with ERU. © 2011 American College of Veterinary Ophthalmologists.

21 CFR 886.3600 - Intraocular lens.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Intraocular lens. 886.3600 Section 886.3600 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... the natural lens of an eye. (b) Classification. Class III. (c) Date PMA or notice of completion of a...

Non-invasive method of measuring cerebral spinal fluid pressure

NASA Technical Reports Server (NTRS)

Borchert, Mark S. (Inventor); Lambert, James L. (Inventor)

2000-01-01

The invention provides a method of non-invasively determining intracranial pressure from measurements of an eye. A parameter of an optic nerve of the eye is determined, along with an intraocular pressure of the eye. The intracranial pressure may be determined from the intraocular pressure and the parameter.

Simple technique to treat pupillary capture after transscleral fixation of intraocular lens.

PubMed

Jürgens, Ignasi; Rey, Amanda

2015-01-01

We describe a simple surgical technique to manage pupillary capture after previous transscleral fixation of an intraocular lens. Neither author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Intra-ocular pressure normalization technique and equipment

NASA Technical Reports Server (NTRS)

Baehr, E. F. (Inventor)

1979-01-01

A method and apparatus is described for safely reducing abnormally high intraocular pressure in an eye during a predetermined time interval. This allows maintenance of normal intraocular pressure during glaucoma surgery. A pressure regulator of the spring-biassed diaphragm type is provided with additional bias by a column of liquid. The hypodermic needle can be safely inserted into the anterior chamber of the eye. Liquid is then bled out of the column to reduce the bias on the diaphragm of the pressure regulator and, consequently, the output pressure of the regulator. This lowering pressure of the regulator also occurs in the eye by means of a small second bleed path provided between the pressure regulator and the hypodermic needle.

Ultrastructural evaluation of explanted opacified Hydroview (H60M) intraocular lenses

PubMed Central

Cartwright, Nathaniel E Knox; Mayer, Eric J; McDonald, Brendan M; Skinner, Andrew; Salter, Chris J; Tole, Derek M; Sparrow, John M; Dick, Andrew D; Group, The Bristol IOL Study; Ferguson, David J P

2007-01-01

Aim To describe the ultrastructural appearance of explanted opacified Hydroview H60M intraocular lenses. Methods 14 explanted lenses were examined by scanning electron microscopy, and their appearance compared with a non‐implanted H60M lens from the same time period. Wavelength‐dispersive x ray spectroscopy (WDX) was performed on two opacified lenses. Results Subsurface deposits were seen in all explanted opacified lenses. These deposits broke only onto the surface of more densely opacified lenses. WDX confirmed that the deposits contained both calcium and phosphorous, consistent with their being calcium apatite. Conclusion These findings challenge the widely accepted opinion that H60M intraocular lens opacification begins on the surface of the optic. PMID:16987894

[Possibility of 3D Printing in Ophthalmology - First Experiences by Stereotactic Radiosurgery Planning Scheme of Intraocular Tumor].

PubMed

Furdová, A; Furdová, Ad; Thurzo, A; Šramka, M; Chorvát, M; Králik, G

Nowadays 3D printing allows us to create physical objects on the basis of digital data. Thanks to its rapid development the use enormously increased in medicine too. Its creations facilitate surgical planning processes, education and research in context of organ transplantation, individualization prostheses, breast forms, and others.Our article describes the wide range of applied 3D printing technology possibilities in ophthalmology. It is focusing on innovative implementation of eye tumors treatment planning in stereotactic radiosurgery irradiation.We analyze our first experience with 3D printing model of the eye in intraocular tumor planning stereotactic radiosurgery. 3D printing, model, Fused Deposition Modelling, stereotactic radiosurgery, prostheses, intraocular tumor.

Branch retinal artery occlusion post-penetrating globe injury with intraocular foreign body.

PubMed

Nagpal, Manish; Chaudhary, Pranita; Jain, Ashish

2018-01-01

Intraocular foreign body (IOFB) in cases of penetrating eye injury accounts for an important indication of vitreoretinal intervention following ocular trauma. Vascular occlusion as a complication of IOFB is rare. Here we present a case of a 34-year-old male with post-traumatic cataract and an intraocular metallic foreign body (IOFB) lodged in the superficial layers of the retina inferotemporal to the disc, causing an inferotemporal branch retinal artery occlusion. The case was managed by lensectomy with pars plana vitrectomy and IOFB removal followed by a second procedure of secondary IOL implantation. Final best-corrected visual acuity improved to 6/24. This case highlights an unusual sequelae following penetrating ocular trauma.

Intraocular gnathostomiasis from coastal part of Maharashtra.

PubMed

Sujata, Dharmshale N; Renu, Bharadwaj S

2013-01-01

Intraocular infestation by live Gnathostoma spinigerum is a rare occurrence in humans. Most of the published reports are from South-East Asia. We report a case of ocular gnathostomiasis from Western Maharashtra, where the worm was removed live from the anterior chamber of the left eye. Identification of the worm was confirmed by light microscopy.

Human Intraocular Filariasis Caused by Dirofilaria sp. Nematode, Brazil

PubMed Central

Diniz, Daniel G.; Dantas-Torres, Filipe; Casiraghi, Maurizio; de Almeida, Izabela N.F.; de Almeida, Luciana N.F.; Nascimento dos Santos, Jeannie; Furtado, Adriano Penha; Sobrinho, Edmundo F. de Almeida; Bain, Odile

2011-01-01

A case of human intraocular dirofilariasis is reported from northern Brazil. The nematode was morphologically and phylogenetically related to Dirofilaria immitis but distinct from reference sequences, including those of D. immitis infesting dogs in the same area. A zoonotic Dirofilaria species infesting wild mammals in Brazil and its implications are discussed. PMID:21529396

Role of intraocular Leptospira infections in the pathogenesis of Equine Recurrent Uveitis in the Southern United States

USDA-ARS?s Scientific Manuscript database

To investigate the role of intraocular leptospiral infections in horses with Equine Recurrent Uveitis (ERU) in the southern United States, blood and ocular fluid samples were collected from horses with a history and ocular findings consistent with ERU. Samples were also obtained from control horses ...

The influence of oxybuprocaine (Novesine) on the intraocular pressure.

PubMed

Leys, M; van Rij, G; de Heer, L J

1986-01-15

Patients with raised intraocular pressure often have lower tension during hospital admissions than on out-patient measurement, even though the therapy is the same. A prospective study on 18 volunteers and 10 glaucoma patients was set up to find out whether oxybuprocaine eyedrops or repeated applanation tonometry could have anything to do with this. The tension was measured at least 3 times a day with the non-contact tonometer (NCT). In the case of the volunteers oxybuprocaine was instilled into the eye 3 times a day for one week. In the case of the patients the tension in one eye was measured with the Goldmann tonometer on several days after the application of oxybuprocaine drops. No reduction in intraocular pressure was found during the observation period, nor was there an obvious difference between the test eyes and the control eyes. In hospital, patients had at 11 o'clock in the morning intraocular pressure which was on the average 2.2 +/- 1.5 mmHg lower than that measured at out-patient checks, in spite of receiving the same therapy.

Intraocular lens power estimation by accurate ray tracing for eyes underwent previous refractive surgeries

NASA Astrophysics Data System (ADS)

Yang, Que; Wang, Shanshan; Wang, Kai; Zhang, Chunyu; Zhang, Lu; Meng, Qingyu; Zhu, Qiudong

2015-08-01

For normal eyes without history of any ocular surgery, traditional equations for calculating intraocular lens (IOL) power, such as SRK-T, Holladay, Higis, SRK-II, et al., all were relativley accurate. However, for eyes underwent refractive surgeries, such as LASIK, or eyes diagnosed as keratoconus, these equations may cause significant postoperative refractive error, which may cause poor satisfaction after cataract surgery. Although some methods have been carried out to solve this problem, such as Hagis-L equation[1], or using preoperative data (data before LASIK) to estimate K value[2], no precise equations were available for these eyes. Here, we introduced a novel intraocular lens power estimation method by accurate ray tracing with optical design software ZEMAX. Instead of using traditional regression formula, we adopted the exact measured corneal elevation distribution, central corneal thickness, anterior chamber depth, axial length, and estimated effective lens plane as the input parameters. The calculation of intraocular lens power for a patient with keratoconus and another LASIK postoperative patient met very well with their visual capacity after cataract surgery.

Validation of the ocular trauma score for intraocular foreign bodies in deadly weapon-related open-globe injuries.

PubMed

Unal, Melih H; Aydin, Ali; Sonmez, Murat; Ayata, Ali; Ersanli, Dilaver

2008-01-01

To evaluate the prognostic value of the Ocular Trauma Score (OTS) in cases of deadly weapon-related open-globe injuries with intraocular foreign bodies. A retrospective, interventional case series included 20 eyes of 20 patients who had deadly weapon-related open-globe injuries with intraocular foreign bodies. The OTS was calculated for each patient by adding the determined numbers of OTS variables at presentation (initial visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment, and afferent pupillary defect). Patients were categorized based on their score (category 1 through 5). Final visual acuities in the OTS categories were calculated and compared to those in OTS study group. No statistically significant difference was found between the categorical distributions of the study patients and those in the OTS study group. No patient in the study was in category 5. The OTS, which was designed to predict visual outcomes of general ocular trauma, may also provide reliable information about the prognosis of deadly weapon-related open-globe injuries with intraocular foreign bodies.

The effect of intraocular gas and fluid volumes on intraocular pressure.

PubMed

Simone, J N; Whitacre, M M

1990-02-01

Large increases in the intraocular pressure (IOP) of postoperative gas-containing eyes may require the removal of gas or fluid to reduce the IOP to the normal range. Application of the ideal gas law to Friedenwald's equation provides a mathematical model of the relationship between IOP, intraocular gas and fluid volumes, and the coefficient of scleral rigidity. This mathematic model shows that removal of a given volume of gas or fluid produces an identical decrease in IOP and that the more gas an eye contains, the greater the volume reduction necessary to reduce the pressure. Application of the model shows that the effective coefficient of scleral rigidity is low (mean K, 0.0021) in eyes with elevated IOP that have undergone vitrectomy and retinal cryopexy and very low (mean K, 0.0013) in eyes with elevated IOP that have undergone placement of a scleral buckle and band. By using the appropriate mean coefficient of rigidity, the volume of material to be aspirated to produce a given decrease in IOP can be predicted with clinically useful accuracy.

Diode laser trabeculoplasty in open angle glaucoma: 50 micron vs. 100 micron spot size.

PubMed

Veljko, Andreić; Miljković, Aleksandar; Babić, Nikola

2011-01-01

The study was aimed at evaluating the efficacy of diode laser trabeculoplsaty in lowering intraocular pressure in patients with both primary open-angle glaucoma and exfoliation glaucoma by using different size of laser spot. This six-month, unmasked, controlled, prospective study included sixty-two patients with the same number of eyes, who were divided into two groups. Trabeculoplasty was performed with 50 micron and 100 micron laser spot size in the group I and group II, respectively. Other laser parameters were the same for both groups: the wave length of 532 nm, 0.1 second single emission with the power of 600-1200 mW was applied on the 180 degrees of the trabeculum. The mean intraocular pressure decrease in the 50 micron group (group 1) on day 7 was 24% from the baseline and after six-month follow-up period the intraocular pressure decrease was 29.8% (p < 0.001). In the 100 micron group (group II), the mean intraocular pressure decrease on day 7 was 26.5% and after six months it was 39% (p < 0.001).

Cataract, phacoemulsification and intraocular pressure: Is the anterior segment anatomy the missing piece of the puzzle?

PubMed

Masis Solano, Marisse; Lin, Shan C

2018-01-29

Cataract extraction is a safe and effective surgery that has a lowering effect on the intraocular pressure. The specific mechanisms for this effect are still unclear. A direct inflammatory effect on the trabecular meshwork, alteration of the blood aqueous barrier, changes in the ciliary body and mechanical changes of the anterior segment anatomy are the key to understand cataract surgery and it's effects on aqueous humor dynamics. Additionally, with the advent of AS OCT, changes in the anterior segment of the eye have been studied and several parameters (such as lens vault, angle opening distance and anterior chamber depth) have been identified as predictors of intraocular pressure change. In eyes with narrow angles there is a greater drop in intraocular pressure after cataract surgery and it is correlated with parameters related to anterior chamber space. It is safe to affirm that cataract surgery is an important part of the modern glaucoma treatment and evidence should be analyzed as part of a bigger picture in order to more accurately understand its clinical relevance. Copyright © 2018. Published by Elsevier Ltd.

Bilateral phacoemulsification and intraocular lens implantation in a great horned owl.

PubMed

Carter, Renee T; Murphy, Christopher J; Stuhr, Charles M; Diehl, Kathryn A

2007-02-15

A great horned owl of estimated age < 1 year that was captured by wildlife rehabilitators was evaluated because of suspected cataracts. Nuclear and incomplete cortical cataracts were evident in both eyes. Ocular ultrasonography revealed no evidence of retinal detachment, and electroretinography revealed normal retinal function. For visual rehabilitation, cataract surgery was planned and intraocular lens design was determined on the basis of values obtained from the schematic eye, which is a mathematical model representing a normal eye for a species. Cataract surgery and intraocular lens placement were performed in both eyes. After surgery, refraction was within -0.75 diopters in the right eye and -0.25 diopters in the left eye. Visual rehabilitation was evident on the basis of improved tracking and feeding behavior, and the owl was eventually released into the wild. In raptors with substantial visual compromise, euthanasia or placement in a teaching facility is a typical outcome because release of such a bird is unacceptable. Successful intraocular lens implantation for visual rehabilitation and successful release into the wild are achievable.

Deformable Surface Accommodating Intraocular Lens: Second Generation Prototype Design Methodology and Testing.

PubMed

McCafferty, Sean J; Schwiegerling, Jim T

2015-04-01

Present an analysis methodology for developing and evaluating accommodating intraocular lenses incorporating a deformable interface. The next generation design of extruded gel interface intraocular lens is presented. A prototype based upon similar previously in vivo proven design was tested with measurements of actuation force, lens power, interface contour, optical transfer function, and visual Strehl ratio. Prototype verified mathematical models were used to optimize optical and mechanical design parameters to maximize the image quality and minimize the required force to accommodate. The prototype lens produced adequate image quality with the available physiologic accommodating force. The iterative mathematical modeling based upon the prototype yielded maximized optical and mechanical performance through maximum allowable gel thickness to extrusion diameter ratio, maximum feasible refractive index change at the interface, and minimum gel material properties in Poisson's ratio and Young's modulus. The design prototype performed well. It operated within the physiologic constraints of the human eye including the force available for full accommodative amplitude using the eye's natural focusing feedback, while maintaining image quality in the space available. The parameters that optimized optical and mechanical performance were delineated as those, which minimize both asphericity and actuation pressure. The design parameters outlined herein can be used as a template to maximize the performance of a deformable interface intraocular lens. The article combines a multidisciplinary basic science approach from biomechanics, optical science, and ophthalmology to optimize an intraocular lens design suitable for preliminary animal trials.

Induction of antibody response in the oral cavity of dogs following intraocular (eye drop) immunization with Porphyromonas gingivalis cell lysate incorporated in pH-sensitive fusogenic polymer-modified liposomes.

PubMed

Shimizu, Yosuke; Iwasaki, Tadashi; Tajima, Tomoko; Yuba, Eiji; Kono, Kenji; Watarai, Shinobu

2017-02-14

Induction of mucosal immune responses against Porphyromonas gingivalis within the oral cavity of dogs was studied by immunizing with pH-sensitive fusogenic polymer (MGluPG)-modified liposome-associated cell lysate. Dogs immunized with P. gingivalis cell lysate-containing MGluPG-modified liposomes by intraocular (eye drop) route displayed significant levels of P. gingivalis cell lysate-specific serum IgG and IgA as well as mucosal IgA antibodies in saliva secretion. Serum and salivary antibodies generated by intraocularly immunized with MGluPG-modified liposome-associated P. gingivalis cell lysate revealed a significant aggregation activity against P. gingivalis, whereas serum and saliva from dogs receiving MGluPG-modified liposomes unentrapping P. gingivalis cell lysate did not show the aggregation activity against P. gingivalis. Furthermore, P. gingivalis-specific antibodies in saliva of immunized dogs inhibited the adherence of P. gingivalis to cultured HeLa cells. More importantly, salivary antibodies induced by intraocular immunization with P. gingivalis cell lysate-containing MGluPG-modified liposomes significantly inhibited the coaggregation of P. gingivalis with Actinomyces naeslundii and the cell damage activity of P. gingivalis against FaDu cells, an oral epithelial cell. These results suggest that intraocularly administered P. gingivalis cell lysate-containing MGluPG-modified liposomes should be an effective mucosal vaccine against P. gingivalis infection in dogs and may be an important tool for the prevention of periodontitis.

Surgical outcome of cats treated for aqueous humor misdirection syndrome: a case series.

PubMed

Atkins, Rosalie M; Armour, Micki D; Hyman, Jennifer A

2016-07-01

To evaluate the clinical outcome of cats treated surgically for aqueous humor misdirection syndrome. A retrospective analysis of cats treated surgically between January 1, 2006, and January 1, 2013, for aqueous humor misdirection syndrome was performed. Signalment, medical therapy, eyes affected, intraocular pressures prior to and after surgery, surgical procedures performed, postoperative complications, and visual status were evaluated. Seven cats (nine eyes) fit the inclusion criteria. Six of seven cats were female, and five of seven cats were diagnosed with bilateral aqueous humor misdirection syndrome. Three surgical approaches were evaluated as follows: (i) phacoemulsification and posterior capsulotomy, (ii) phacoemulsification, posterior capsulotomy and anterior vitrectomy, and (iii) phacoemulsification, posterior capsulotomy, anterior vitrectomy, and endocyclophotocoagulation. The mean age at diagnosis was 12.9 years. Seven of nine eyes had controlled intraocular pressure (≤25 mmHg) during the first 6 months postoperatively. All cats were visual with controlled intraocular inflammation at 1 year postoperatively; however, one eye had an elevated intraocular pressure. All cats were continued on topical antiglaucoma and anti-inflammatory medications following surgery with the mean number of drops per day decreasing from 3.9 drops/day prior to surgery to 2.2 drops/day postoperatively. Surgical management for feline aqueous humor misdirection syndrome may be a viable option to maintain a visual and normotensive status in cats that no longer have successful control of intraocular pressure with medical therapy. © 2016 American College of Veterinary Ophthalmologists.