Foldable Lens Explantation and Exchange：The Reason and Solution

Objective: To report the explantation and exchange of Hydrophilic Acrylic foldableintraocular lens (IOL) on 14 patients who had visual disturbances caused by the changeof transparence on optic.Methods: Sixteen Hydrophilic Acrylic foldable intraocular lenses from 14 patients whopresented with decreased visual acuity from 6 months to 1 year after normalphacoemulsification and IOL implantation associated with extensive transparent changeon optic of the lens. The lenses were explanted with the bisection technique. All the eyeswere reinserted with Acrysof foldable lenses.Results: Sixteen lenses were removed successfully and exchanged with the new lens inthe capsule. The posterior capsular rupture and vitreous loss were found in the first twocases. One of them had the zonulysis due to the radial tear of the anterior capsule duringthe enlargement of the capsular opening. The anterior vitrectomy was performed with IOLfixed on the ciliary sulcus. The visual acuity of all the patients improved obvi     

Sunlight and ultraviolet radiation—pertinent retinal implications and current management

Unprotected and prolonged exposure to ultraviolet (UV) light from sunlight, lasers, and arc welding leads to outer retinal damage. The photoreceptors and retinal pigment epithelium located in the posterior pole are particularly susceptible to this radiation. Classically known as solar retinopathy, this disorder frequently affects young individuals who have clear lenses and a propensity toward observing solar eclipses. Various imaging techniques aid the clinician in diagnosis, even if patients cannot recall an exposure event. By far the most utilized technique is optical coherence tomography that, in tandem with fluorescein angiography, and fundus autofluorescence, is crucial in ruling out other conditions. Fortunately, the prognosis of acute UV retinopathy is favorable, as most cases fully recover; however, a significant percentage of patients suffer from chronic sequelae: reduced acuity and lifelong central/paracentral scotomas. Thus, education toward understanding UV exposure risks, coupled with either abstinence or proper eye protection, is critical in preventing macular damage. We outline the various etiologies responsible for UV-induced retinopathy, describe the limited treatments available, and provide recommendations to minimize the potential devastating ophthalmic consequences as our society increases its reliance on UV-emitting technology and further engages in solar eclipse viewing.     

【In Press】 Preloaded and non-preloaded intraocular lens delivery system and characteristics: human and porcine eyes trial

AIM: To compare characteristics of preloaded and non-preloaded intraocular lens (IOL) delivery systems during IOL delivery procedures. METHODS: Total 101 human eyes were included in this prospective observational case series. Delivery characteristics of 5 types of IOLs including iSert250 NC60 (NC60), EnVista MX60 (MX60), AcryS of IQ SN60WF (SN60WF), TECNIS ZCB00 (ZCB00), and TECNIS PCB00 (PCB00) were investigated. NC60 and PCB00 were injected via preloaded delivery systems and other IOLs were injected via non-preloaded systems. In the human trial, time taken from IOL loading to completion of implantation was measured in all eyes undergoing conventional cataract surgery. Using 4 excised porcine eyes, dynamics of ophthalmic viscosurgical device (OVD) between an IOL injector and a porcine eye was analyzed using fluorescein sodium-stained OVD. RESULTS: The average time for IOL implantation was 22.0s for NC60, 43.2s for MX60, 32.3 seconds for SN60WF, 41.4s for ZCB00, and 14.6s for PCB00 respectively. The number of cases with IOL manipulation with a second instrument was 6 for MX60, 2 for ZCB00, 0 for SN60WF, NC60, and PCB00. Amount of OVD pushed into a porcine eye was smaller with a preloaded system than with non-preloaded systems. CONCLUSION: IOL delivery with preloaded systems is faster and more predictable. Moreover, a preloaded delivery system shows relatively less OVD pushed into a porcine eye than non-preloaded systems.     

Determination of Intraocular Lens Tilt and Decentration Using Simple and Rapid Method

Purpose: To determine the tilt and decentration of implanted intraocular lens (IOL) in vivo one year postoperatively.Methods : A retrospective study was performed on 67 eyes by the method introduced by Guy-ton using the third and fourth Purkinje imagesm through undilated pupil. Results : The average decentration of implanted IOL was 0.68 mm, and the average tilt was 6.03°. The result was similar to the histopadiological study in postmortem eyes and the measurement in vivo.Linear-regression analysis showed there was no relationship between the tilt and decentration and the residual astigmatism ,axial length ,IOL power,etc. Conclusion: The result is similar to the other methods. The method using the third and fourth Purkinje images is simple and easy to perform. It can be used for determining the IOL position through undilated pupil and does not require special apparatus. Eye Science 1998; 14: 13 - 16.     

Müller cell and neuronal remodeling in retinal detachment and reattachment and their potential consequences for visual recovery: a review and reconsideration of recent data

Recent evidence suggests that the adult mammalian retina is far more plastic than was previously thought. Retinal detachment induces changes beyond the degeneration of outer segments (OS). Changes in photoreceptor synapses, second- and even third-order neurons may all contribute to imperfect visual recovery that can occur after successful reattachment. Changes that occur in Müller cells have obvious effects through subretinal fibrosis and proliferative vitreoretinopathy, but other unidentified effects seem likely as well. Reattachment of the retina induces its own set of responses aside from OS re-growth. Reattachment halts the growth of Müller cell processes into the subretinal space, but induces their growth on the vitreal surface. It also induces the outgrowth of rod axons into the inner retina.     

Retinoma and Phthisis Bulbi of Retinoblastoma 1.Clinical and Genetic Analysis

Retinoma and phthisis bulbi of retinoblastoma are rare entitiesfound in retinoblastoma patients and their relatives.Eleven cases of phthisisbulbi of retinoblastoma and 9 cases of retinoma were identified from 1966 to1991 in our center.The clinic data show that retinoma and phthisis bulbi areclosely related to the retinoblastoma gene.Enucleation should be carried outas soon as possible without hesitation for the phthisis of eyes with retinoblas-toma.Genetic counseling and frequent observation should be paid attention toretinoma patients and their offspring.The mechanism of retinoma developed isdiscussed.We propose that the diversity of second mutation might be thecause of retinoma.Eye Science 1992;8:117-121.     

Hypoxia and the expression of HIF-1α and HIF-2α in the retina of streptozotocin-injected mice and rats

Decreases in retinal blood flow in diabetics could render the retina hypoxic. In mouse and rat models of diabetes, a decrease in retinal blood flow occurs early, within 3-4 weeks of the induction of hyperglycemia, although information is scarce on whether this early decrease in flow induces hypoxia. The purpose of the current study was to determine whether hypoxia-inducible factor (HIF) levels increase following 4 and/or 12 weeks of hyperglycemia in streptozotocin (STZ)-injected mouse (C57BL/6) and rat (Wistar) retinas. Additionally, retinal tissue hypoxia was measured with pimonidazole following 12 weeks of hyperglycemia. These aims were accomplished via immunostaining of cross-sections from enucleated eyes. In mice, staining for HIF-1α and HIF-2α showed a contrasting pattern, with HIF-1α higher in the inner retina than outer, but HIF-2α higher in the outer retina than inner. However, in rats, staining for both HIF-1α and HIF-2α was more intense in the inner retina. The HIF-1α staining intensities and patterns were similar between diabetic animals and their non-diabetic counterparts following 4 and 12 weeks of hyperglycemia. The same was true for HIF-2α except for a trend toward an increase following 12 weeks of hyperglycemia in mice. Pimonidazole staining showed significant decreases throughout all layers of the central retina and most layers of the peripheral retina of rats (but not mice), following 12 weeks of hyperglycemia. In summary, despite early decreases in flow in rats and mice, retinal HIF-1α and HIF-2α were not found to be increased, and the extent of hypoxia may even decrease after 12 weeks of hyperglycemia in rats.     

Pupil size and Perimetry—a pharmacological model using increment and decrement stimuli

Background To assess the influence of natural and pharmacologically induced pupil size fluctuations on differential luminance sensitivity threshold (DLS) using bright (increment) and dark (decrement) stimuli. Methods Twelve healthy volunteers (20–30 years) were examined under the effect of phenylephrine 2%, dapiprazole 0.5%, and placebo. Pupil size was recorded by infra-red video camera in sessions without and with visual field examination (Tübingen Computer Campimeter). DLS was estimated at 9 locations within the central 20° visual field, using bright and dark 26 min-of-arc-stimuli (10 cd/m² background, 4-2-1 dB thresholding strategy, four reversals). Results There were substantial inter-individual differences in pupil size and pupil size fluctuations. Intra-individual differences were small. Independently of medication, pupil size fluctuations were reduced by more than one-third when a subject was undergoing perimetric examination. Pupil size affected DLS on its own (slope 0.21 dB/mm; 95% CI: 0.09–0.33 dB/mm), differently at different stimulus locations, and to a greater extent with increment than with decrement stimuli (slope difference 0.13 dB/mm; 95% CI: 0.00–0.26 dB/mm). Conclusions Campimetric examinations have a stabilising effect on pupil size fluctuations. Pupil size affects DLS with bright stimuli more than with dark stimuli; in normal young subjects this effect is not relevant for clinical or normative studies.     

Council Votes on Duke Elder, Francois and Gonin Medals and Pathology Award

At its meeting in Florence, the Council voted to award the three historic ICO medals as follows:·Gonin Medal to Al Sommer, MD ·International Duke Elder Medal to Bradley R. Straatsma, MD, JD. ·Jules Francois Medal to Bruce Spivey, MD. See the criteria and process defined for awarding each medal.The Council also voted to present the new ICO Ophthalmic Pathology Award, which it approved in October 2004, to Thaddeus P. Dryja, MD, Director of the Cogan Eye Pathology Laboratory …     

Tissue Plasminogen Activator and Glaucoma

Ⅰ.Introduction Tissue Plasminogen Activator (tPA) is a new clot-specific fibrinolytic agent, developed through gene cloning. It is a 70,000 dalton serine protease with 527 amino acids and 3 saccharic chains. The tPA- fibrin complex specifically activates plasminogen into plasmin, which in turn degrades fibrin into solube split products. Because of its selectivity for fibrin-bound plasminogen, tPA promotes local lysis, instead of the systemic fibrinolytic state promoted by streptokinase and urokinase.     

Relationship between socioeconomic and lifestyle factors and cataracts in Koreans: The Korea National Health and Nutrition Examination Survey 2008–2011

Purpose

Cataracts are the leading cause of visual impairment and blindness, and therefore early identification and modification of the risk factors for cataracts are meaningful. This study aimed to investigate the relationship between socioeconomic status (SES) and lifestyle factors, and age-related cataracts in South Korea.

Methods

This cross-sectional study was based on data collected in the 2008–2011 Korea National Health and Nutrition Examination Survey. A total of 15 866 subjects, aged ≥40 years, were included. SES was defined using household income and education level. Sociodemographic, lifestyle, and other associated factors were assessed by health interviews and examinations. Cataracts were diagnosed via slit-lamp examination using the Lens Opacities Classification System III.

Results

The prevalence of any cataract was 38.9% in men and 42.3% in women (P<0.001). In women, the risk of cataracts increased with decreases in household income (P-value for trend=0.016 and 0.041 in any, and cortical cataract, respectively) and education level (P-value for trend=0.009, 0.027, and 0.016 in any, nuclear, and cortical cataract, respectively) after adjusting for confounding factors. Current smoking was correlated with nuclear cataracts in men (OR 1.21; 95% CI: 1.00, 1.46 in age-adjusted analysis) and cataract surgery in women (OR 2.25; 95% CI: 1.00, 5.04 in multivariate-adjusted analysis).

Conclusions

Socioeconomic disparities in cataract prevalence were observed in women; current smoking increased the risk of nuclear cataracts in men and surgery in women. Public health interventions focusing on gender differences are warranted to prevent and treat cataracts.     

Orbital infantile haemangioma: radiological features and treatment – case series and literature review

Aim: The aim of this study is to report a retrospective case series on orbital infantile haemangiomas (OIH). Radiological features and treatment with oral propranolol (OP) are illustrated along with an updated literature review. Methods: A retrospective chart review of six children, diagnosed with OIH from November 2015 to October 2016, was carried out. Only children with deep documented orbital involvement were included. All patients underwent magnetic resonance imaging (MRI) under general anaesthesia. OP was administered to the infants according to the Nottingham Children's Hospital guideline. As per the guideline, a preliminary paediatric assessment was performed and a 1 mg/kg test dose was administered, followed by definitive treatment at a dosage of 2 mg/kg in three divided doses.Results: Average age at presentation was within the first 3 weeks of life. T1 hypointensity, T2 hyperintensity, avid enhancement with contrast, and the presence of flow-voids appear a fixed pattern of OIH on MRI. Response to treatment was noticed within 4 weeks in all children, and two of them (33.3%) responded within the first 7 days. In two children (33.3%), the haemangioma became clinically undetectable by the seventh month of treatment, while the other four (66.6%) experienced an almost complete regression of the OIH by the last follow-up. No complications were found.Conclusions: Our series strengthens the understanding that MRI is the preferred imaging modality in the investigation of OIH, showing vascular features, detailed orbital extension, and possible associated malformations. OP is the treatment of choice for OIH, and our study confirms its safety and effectiveness.     

Spatial distortions and processing latencies in the onset repulsion and Fröhlich effects

In the Fr?hlich illusion, the first position of a moving target is mis-localized in the direction of motion. In the onset repulsion effect, the opposite error occurs. To reconcile these conflicting error patterns, we improved previous methods by using natural pointing movements and a large range of target velocities. Displacement was found to increase in the direction of motion, but the linear function relating velocity and displacement was shifted opposite to the direction of target motion. The results suggest that onset localization may be determined by two independent factors: first, an (attentional) delay that accounts for the increase of displacement in the direction of motion with increasing velocity. This delay is visible in motor and probe judgments and explains the Fr?hlich illusion. Second, motor judgments are offset opposite to the direction of target motion. This bias is unique to motor judgments (pointing) and may be partially explained by attentional repulsion.     

Glaucoma and cataract: combined operation or trabeculectomy first and cataract extraction later?

BACKGROUND: The aim of this retrospective study is to evaluate the difference in postoperative intraocular pressure (IOP) control, number of antiglaucoma medications and visual acuity (VA) between combined phacoemulsification and trabeculectomy (Glaucoma triple) surgery and two-stage procedures with trabeculectomy first and cataract extraction later. PATIENTS AND METHODS: Two groups of glaucoma patients were assessed: In group 150 consecutive patients undergoing combined phacoemulsification and trabeculectomy were enrolled. In group two, 51 consecutive patients were included, that had undergone trabeculectomy first and cataract surgery later. The mean interval between the two procedures was 3.2 years, 35/51 patients (71%) underwent conventional extracapsular cataract extraction, the other 16 patients (29%) had phacoemusification via clear cornea incision. RESULTS: One year postoperative both groups revealed a significant IOP reduction. IOP-reduction was significantly better in the two-stage group one year after trabeculectomy (12.8 +/- 4.0 mm Hg) and one year after cataract extraction (14.0 +/- 2.8 mm Hg) as compared to the combined surgery group (15.3 +/- 4.0 mm Hg). Kaplan-Meier survival analysis revealed a 90% success-rate 12 months after trabeculectomy only as compared to 65% success-rate in the combined surgery group. The number of antiglaucoma medications was significantly reduced in both groups. One year after cataract surgery no difference in VA could be seen between the two groups. CONCLUSIONS: If medically uncontrolled glaucoma with advanced optic nerve head changes in patients with coexisting glaucoma and cataracts is the main indication for surgery, a two-stage procedure (i.e. trabeculectomy first, cataract extraction later) yields better long-term IOP control. If glaucoma is medically controlled with a simple regimen, conjunctiva-sparing cataract surgery may be the treatment of choice. In all other cases of coexisting glaucoma and cataract combined phacoemulsification and trabeculectomy (Glaucoma triple) is preferrable, either performed through a single incision or as two separate procedures in the same session (i.e. trabeculectomy from above, phacoemulsifiaction via clear cornea from temporal).     

Color and motion: which is the tortoise and which is the hare?

Recent psychophysical studies have been interpreted to indicate that the perception of motion temporally either lags or is synchronous with the perception of color. These results appear to be at odds with neurophysiological data, which show that the average response-onset latency is shorter in the cortical areas responsible for motion (e.g., MT and MST) than for color processing (e.g., V4). The purpose of this study was to compare the perceptual asynchrony between motion and color on two psychophysical tasks. In the color correspondence task, observers indicated the predominant color of an 18 degrees x 18 degrees field of colored dots when they moved in a specific direction. On each trial, the dots periodically changed color from red to green and moved cyclically at 15, 30 or 60 deg/s in two directions separated by 180 degrees, 135 degrees, 90 degrees or 45 degrees. In the temporal order judgment task, observers indicated whether a change in color occurred before or after a change in motion, within a single cycle of the moving-dot stimulus. In the color correspondence task, we found that the perceptual asynchrony between color and motion depends on the difference in directions within the motion cycle, but does not depend on the dot velocity. In the temporal order judgment task, the perceptual asynchrony is substantially shorter than for the color correspondence task, and does not depend on the change in motion direction or the dot velocity. These findings suggest that it is inappropriate to interpret previous psychophysical results as evidence that motion perception generally lags color perception. We discuss our data in the context of a "two-stage sustained-transient" functional model for the processing of various perceptual attributes.     

Ipilimumab-induced Ocular and Orbital Inflammation—A Case Series and Review of the Literature

Purpose: Ipilimumab, a monoclonal antibody directed against the immune protein cytotoxic T-lymphocyte antigen-4 (CTLA-4), characteristically induces side effects called “immune-related adverse events” (IRAE). Although ophthalmic involvement is rare, we report 7 cases of eye and orbit complications related to ipilimumab therapy.

Methods: We performed a retrospective review of patients with metastatic melanoma who developed ipilimumab-related ocular or orbital inflammation who were seen at our institutions.

Results: Seven patients were identified: 4 patients had orbital inflammation, 2 had uveitis, and 1 had peripheral ulcerative keratitis. Four patients developed inflammation after the second ipilimumab infusion, 2 after the third infusion and 1 after the first infusion. All 4 patients with orbital inflammation were treated with systemic corticosteroids. Two patients with uveitis were treated with topical steroids, but were also treated with systemic corticosteroids for other IRAE, including colitis and hypophysitis. The patient with keratitis was treated with topical corticosteroids alone with resolution of inflammation. All 7 patients discontinued ipilimumab therapy, 5 due to systemic IRAE and 2 due to tumor progression. Five of 7 patients had tumor progression on ipilimumab therapy.

Conclusions: Ocular and orbital inflammation may occur in patients with metastatic melanoma receiving ipilimumab, is frequently accompanied by other IRAEs, and resolves with corticosteroid treatment, often leaving no long-term sequelae.