Visual Outcomes of a Second-Generation, Enhanced UV Protected Light Adjustable Lens in Cataract Patients with Previous LASIK and/or PRK.

Purpose: To report on the visual outcomes of the second-generation (ActivShieldTM) Light Adjustable Lens (LAL) used in cataract surgery for patients with a history of laser refractive surgery (LASIK and/or photorefractive keratectomy [PRK]) using a co-managed, open-access methodology. Patients and Methods: This retrospective case series of consecutive patients with history of laser refractive surgery implanted with the second-generation LAL with an emmetropic target were included in the study. Following surgery, all patients received their ultraviolet (UV) light treatments at a separate open-access facility through a co-managed arrangement. Uncorrected distance visual acuity (UDVA), spherical equivalent (SE), and residual cylinder for eyes with an emmetropic refractive target were the primary outcome measures as documented at the patient's final, stable, refractive postoperative exam. Results: Thirty-three patients (34 eyes) with a history of laser refractive surgery were included in the study and implanted with the second-generation LAL with a postoperative emmetropic refractive target. Twenty-eight (82.4%) saw 20/20 or better and 9 (26.5%) saw 20/15 or better. The mean SE was 0.01 ± 0.31 D and 33 (97.1%) were within ±0.50 D SE of plano. The mean residual cylinder was -0.28 ± 0.32 D and 30 (88.2%) were within ±0.50 D. Conclusion: Use of the second-generation LAL was efficacious in cataract surgical patients with a history of LASIK and/or PRK using a co-managed, open-access methodology.

Visual Outcomes of an Enhanced UV Protected Light Adjustable Lens Using a Novel Co-Managed, Open-Access Methodology.

Purpose: To report on the safety and visual acuity (VA) outcomes using a co-managed, open-access methodology with a second-generation (ActivShieldTM) Light Adjustable Lens (LAL 2.0). Patients and Methods: This retrospective observational case series of consecutive patients implanted with the LAL 2.0 choosing an emmetropic target in at least one eye were included in the study. All patients were co-managed with light treatments occurring at an open-access facility. Exclusion criteria included pathology of the macula and/or cornea with reduced best corrected visual acuity (BCVA). The primary outcome measures were uncorrected distance visual acuity (UDVA), spherical equivalent (SE), and residual cylinder for emmetropic goal eyes at the final 3- to 9-month postoperative visit. Results: Thirty-three patients (62 eyes) were included in the study and implanted with the LAL 2.0. Thirty-three (53.2%) eyes had previous corneal refractive treatment(s) with 22 (66.7%) having no original historical refractive records available. Thirty-six (58.1%) total eyes and 20 (32.3%) postrefractive eyes had an emmetropic refractive target. Of all the emmetropic goal eyes, 35 (97.2%) saw 20/20 or better and 36 (100%) were within ±0.50 D SE of plano and had a mean cylinder of -0.15 ± 0.26 D. Of the postrefractive emmetropic goal eyes, 19 (95%) saw 20/20 or better, 20 (100%) were within ±0.50 D SE of plano and had a mean cylinder of -0.17 ± 0.28 D. Conclusion: A co-managed, open-access methodology using the LAL 2.0 was safe and efficacious even in challenging postrefractive clinical scenarios.

Neodymium:YAG laser anterior capsulectomy: surgical option in the management of negative dysphotopsia.

UNLABELLED: This report describes 6 cases in which neodymium:YAG (Nd:YAG) laser anterior capsulectomy achieved limited success in treating negative dysphotopsia. In 5 eyes with the Akreos AO MI60L posterior chamber intraocular lens (PC IOL), the dysphotopsia symptoms resolved completely (3 eyes) and partially (2 eyes) depending on the extent of the Nd:YAG laser anterior capsulectomy. In 1 eye with the Acrysof IQ toric PC IOL, the symptoms did not improve. Success with this procedure in patients with the Akreos AO MI60L PC IOL supports the role of the anterior capsule in the etiology and mechanism of negative dysphotopsia. Because the anterior capsulectomy did not resolve the symptoms in the patient with the Acrysof IQ toric PC IOL, the anterior capsule should be considered an optical risk factor for negative dysphotopsia and important in the manifestation of symptoms in only some patients. Other primary optical factors that have been described can presumably manifest negative dysphotopsia symptoms independent of light scatter from the anterior capsule. FINANCIAL DISCLOSURE: The author has no financial or proprietary interest in any material or method mentioned.

Use of cobalt blue light in grading cataract and estimating vision loss.

PURPOSE: To test an anecdotally reported cataract grading system predictive of a 20/50 visual threshold in cataract-induced vision loss using cobalt blue light. SETTING: Hennepin County Medical Center, Minneapolis, Minneapolis VA Medical Center, Minneapolis, and Regions Hospital, St. Paul, Minnesota, USA. METHODS: Four observers evaluated pure nuclear cataracts using a standardized cobalt-blue-light protocol. Observers graded a nuclear cataract as positive if the posterior capsule was visualized with cobalt blue light and negative if the posterior capsule was not visualized. Results of the grading were compared with cataract-induced vision loss in an attempt to establish a threshold for lost visual acuity in grading cataracts with cobalt blue light. The study design was prospective observation of a cohort with a visually significant cataract. RESULTS: This study did not show a clear visual acuity threshold for cataract-induced vision loss using a standardized cobalt-blue-light protocol. Overall, 26.3% (95% confidence interval, 13.4-40.2) of all 20/40 or less dense nuclear cataracts had visible posterior capsules using cobalt blue light, with good estimated interobserver agreement. CONCLUSIONS: Although cobalt blue light is selectively absorbed by yellow pigment in an aging nuclear cataract, its ability to predict visual acuity loss due to lens opacity was limited.

Cannulation of the suprachoroidal space: a novel drug delivery methodology to the posterior segment.

PURPOSE: To describe, test, and evaluate the pharmacokinetics of a novel posterior drug delivery system (PDS) by means of microcannulation of the suprachoroidal space in both the primate and pig animal model. DESIGN: Animal study. METHODS: A rhesus macaque (Macaca mulatta) (n = 1) and pig model (n = 93) were used to evaluate the PDS, a microcannula that combines a drug delivery channel with a fiber-optic illumination and optimal transition properties. The surgical technique, safety profile, histopathology, retinal and choroidal blood flow, injection of tracer dyes, and triamcinolone pharmacokinetics were studied. Pre- and postsurgical high-speed video confocal scanning laser ophthalmoscopy (cSLO) that used fluorescein and indocyanine green (ICG) imaging and wide-field fundus imaging studies were performed. Globes were enucleated for either histopathology or pharmacokinetics. RESULTS: Cannulation was performed in 93 of 94 animals. Complications included: endophthalmitis (1/94), choroidal tear (1/94), choroidal blood flow irregularities (4/94), postoperative inflammation (6/94), scleral ectasia (4/94), wound abscess (1/94), and others. Histopathology demonstrated normal anatomy in uncomplicated cases. Triamcinolone remains in the local ocular tissue for at least 120 days, and measurable at very low levels in the systemic circulation. CONCLUSIONS: Accessing the suprachoroidal space by the microcannulation system can be performed in a safe and reproducible manner by using careful surgical technique. Forceful PDS tip impact into connective tissues in the macular and optic nerve regions should be avoided. Triamcinolone pharmacokinetics are unique and suggest long-term local tissue levels with low systemic levels. PDS access to the suprachoroidal space represents a novel drug delivery method, applicable to a wide variety of pharmacotherapies to the macula, optic nerve, and posterior pole.

Malondialdehyde inhibits cardiac contractile function in ventricular myocytes via a p38 mitogen-activated protein kinase-dependent mechanism.

(1) Increased oxidative stress plays a significant role in the etiology of cardiovascular disease. Lipid peroxidation, initiated in the presence of hydroxy radicals resulting in the production of malondialdehyde, directly produces oxidative stress. This study was designed to examine the direct impact of malondialdehyde on ventricular contractile function at the single cardiac myocyte level. Ventricular myocytes from adult rat hearts were stimulated to contract at 0.5 Hz, and mechanical and intracellular Ca(2+) properties were evaluated using an IonOptix Myocam system. Contractile properties analyzed included peak shortening amplitude (PS), time-to-PS (TPS), time-to-90% relengthening (TR(90)), maximal velocity of shortening/relengthening (+/-dLdt), and Ca(2+)-induced intracellular Ca(2+) fluorescence release (CICR) and intracellular Ca(2+) decay (tau). p38 mitogen-activated protein (MAP) kinase phosphorylation was assessed with Western blot. (2) Our results indicated that malondialdehyde directly depressed PS, +/-dLdt and CICR in a concentration-dependent manner and shortened TPS without affecting TR(90) and tau. Interestingly, the malondialdehyde-induced cardiac mechanical effect was abolished by both the p38 MAP kinase inhibitor SB203580 (1 and 10 micro M) and the antioxidant vitamin C (100 micro M). Western blot analysis confirmed direct phosphorylation of p38 MAP kinase by malondialdehyde. (3) These findings revealed a novel role of malondialdehyde and p38 MAP kinase in lipid peroxidation and oxidative stress-associated cardiac dysfunction.