Episodic Angle Closure after Visian™ Implantable Collamer Lens Implantation in a Patient Using Adderall®.

Introduction: Amphetamine-based medications such as Adderall®, used for the treatment of attention deficit-hyperactivity disorder (ADHD), may theoretically elicit angle closure through their adrenergic mechanisms. The relationship between the use of implantable collamer lenses (ICLs) and angle closure has been extensively investigated based on appropriate vault and lens sizing and postoperative changes in the anterior chamber angle (ACA) and corneal morphology. This case reflects a synergistic impact from both Adderall® use and ICL implantation for the proposed mechanism of angle closure. Case Presentation: A 36-year-old myopic female with ADHD controlled with Adderall® underwent toric ICL implantation in the right eye after undergoing preoperative laser peripheral iridotomy. Shortly after, the patient developed episodic angle closure in the right eye, with episodes mainly occurring after taking an additional dose of Adderall® in a dimly lit environment. The patient later had an ICL exchange with a smaller sized EVO+ toric ICL in the right eye and remained asymptomatic after. Conclusion: Additive mechanisms from both the ICL and Adderall® were present in our patient. The ICL caused crowding of the ACA through a pseudophacomorphic mechanism, and the Adderall® caused increased iridotrabecular contact secondary to pharmacologic mydriasis. This resulted in episodic angle closure with subsequent spikes in the intraocular pressure. There are no current reports or studies in the current literature describing the combined mechanisms of ICL implantation and Adderall® use in the potential development of angle closure. Further studies may be done to assess interactions of such medications in patients after ICL implantation.

Complex Cardiovascular Morbidities in Prader-Willi Syndrome: A Multidisciplinary Approach.

This case emphasizes the complexity of Prader-Willi syndrome (PWS), the need for a collaborative approach from specialists, and a closer look at the various cardiovascular complexities associated with this syndrome. While current treatments focus on managing symptoms, ongoing genetic research offers hope for more favorable outcomes. Further studies are crucial to gauge the effectiveness of these treatments for PWS patients. We detail a patient with a complex medical history of PWS, further complicated by congenital heart disease with Eisenmenger's syndrome, diabetes mellitus, pulmonary hypertension, venous insufficiency, hypothyroidism, and hyperlipidemia. Reported in this study is a compilation of clinical data as well as suggestions from several medical specialists in applying a multifaceted approach to treatment, significantly emphasizing the need for interdisciplinary care and management of patients experiencing a combination of various medical issues with an emphasis on cardiovascular complications.

LASIK Versus PRK Based on Increased Risk of Corneal Haze: Assessing Current Decision-Making Capabilities of Six Artificial Intelligence Models in Refractive Surgery.

PURPOSE: To investigate the current decision-making capabilities of 6 different artificial intelligence (AI) models by assessing their refractive surgery recommendations (laser in-situ keratomileusis [LASIK] or photorefractive keratectomy [PRK]) for a theoretical patient with a history of keloid formation. METHODS: Claude-2 (Anthropic, 2023), GPT-4 (OpenAI, 2023), GPT-3.5 (OpenAI, 2022), Gemini 1.0 (Google DeepMind, 2023), Microsoft Copilot (Microsoft AI, 2023), and Google-PaLM (Google AI, 2022) underwent three systematic queries to determine the most appropriate surgical plan (LASIK or PRK) for a theoretical patient with an increasing manifest refraction of -3.50, -5.00, and -7.00 diopters (D) in both eyes, an uncomplicated ocular examination, and history of keloid formation. They were then tasked with providing published scientific references to support their responses. The AI models' recommendations were compared to those of a group of 6 experienced ophthalmologists, serving as a benchmark. RESULTS: The group of ophthalmologists unanimously recommended LASIK (6/6 ophthalmologists), in contrast to the unanimous initial recommendation for PRK from the AI models (6/6 models). Of the 42 references provided by the AI models, 55% were fictitious and 45% were authentic. Only 1 of the 6 models altered its initial recommendation to LASIK when presented with the same patient with a history of keloid formation but with increasing severity of myopia (-3.50 to 5.00 to 7.00 D). DISCUSSION: It is evident that current AI models lack the critical-thinking abilities required to accurately analyze and assess apparent risk factors in clinical scenarios, such as the risk of corneal haze after PRK at higher levels of myopia, particularly in cases with a history of keloid formation. [J Refract Surg. 2024;40(8):e533-e538.].

Precision in IOL Calculation for Cataract Patients with Prior History of Combined RK and LASIK Histories.

Purpose: This study aimed to evaluate the accuracy of 12 intraocular lens (IOL) power calculation formulae for eyes that have undergone both radial keratotomy (RK) and laser assisted in situ keratomileusis (LASIK) surgery to determine the efficacy of various IOL calculations for this unique patient group. Currently, research on this surgical topic is limited. Methods: In this retrospective study, 11 eyes from 7 individuals with a history of RK and LASIK who underwent cataract surgery at Hoopes Vision were analyzed. Preoperative biometric and corneal topographic measurements were performed. Subjective refraction was obtained postoperatively. Twelve different intraocular lens (IOL) power calculations were used: Barrett True K No History, Barrett True K (prior LASIK, Prior RK history), Barrett Universal 2, Camellin-Calossi-Camellin (3C), Double K-Modified Holladay, Haigis-L, Galilei, OCT, PEARL-DGS, Potvin-Hill, Panacea, and Shammas. Results: The rankings of mean arithmetic error (MAE), from least to greatest, were as follows: 3C (0.088), Haigis-L-L (-0.508), Shammas (-0.516), OCT Average (-0.538), Barrett True K (-0.557), OCT RK (-0.563), Galilei (-0.570), IOL Master (-0.571), OCT LASIK (-0.583), Barrett True K No History (-0.597), Pearl-DGS (-0.606), Potvin-Hill SF (-0.770), Potvin-Hill TNP (-0.778), Panacea (-0.876), and Barrett Universal 2 (-1.522). The 3C formula achieved the greatest percentage of eyes within ±0.25 D of target range (91%), while Haigis-L, Shammas, Galilei, Potvin Hill, Barrett True K, IOL Master, PEARL-DGS, and OCT formulae performed similarly, achieving 45% of eyes within ±0.75D of target refraction. Conclusion: This study demonstrates the accuracy of the lesser known 3C formula in IOL calculation, particularly for patients who have undergone both RK and LASIK. Well-known formulae, such as Haigis-L, Shammas, and Galilei, which are used by the American Society of Cataract and Refractive Surgery (ASCRS), are viable options, although 3C formulae should be considered in this patient population. Furthermore, larger studies can confirm the best IOL power formulas for post-RK and LASIK cataract patients.

Comparative Analysis of Corneal Higher-Order Aberrations after Laser-Assisted In Situ Keratomileusis, Photorefractive Keratectomy, and Small Incision Lenticule Extraction with Correlations to Change in Myopic Q-Value and Spherical Equivalent with and without Astigmatism.

Background: This retrospective chart review compared the higher-order aberrations (HOAs) among photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) alongside changes in spherical equivalent (SEQ) and corneal shape (Q-value). Methods: Analyzing 371 myopic eyes, including 154 LASIK, 173 PRK, and 44 SMILE cases, Pentacam imaging was utilized pre-operatively and at one-year post-operative visits. Results: All procedures resulted in 100% of patients achieving an uncorrected distance visual acuity (UDVA) of 20/40 or better, with 87% of LASIK and PRK, and 91% of SMILE patients having 20/20 or better. Significant increases in HOAs were observed across all procedures (p < 0.05), correlating positively with SEQ and Q-value changes (LASIK (0.686, p < 0.05), followed by PRK (0.4503, p < 0.05), and SMILE (0.386, p < 0.05)). Vertical coma and spherical aberration (SA) were the primary factors for heightened aberration magnitude among the procedures (p < 0.05), with the largest contribution in SMILE, which is likely attributed to the centration at the corneal apex. Notably, PRK showed insignificant changes in vertical coma (-0.197 µm ± 0.0168 to -0.192 µm ± 0.0198, p = 0.78), with an increase in oblique trefoil (p < 0.05). Conclusions: These findings underscore differences in HOAs among PRK, LASIK, and SMILE, helping to guide clinicians.

The PLAGL2/MYCN/miR-506-3p interplay regulates neuroblastoma cell fate and associates with neuroblastoma progression.

BACKGROUND: The oncogene MYCN is critical for tumorigenesis of several types of cancers including neuroblastoma. We previously reported that miR-506-3p repressed MYCN expression in neuroblastoma cells. However, the mechanism underlying such regulation was undetermined since there is no miR-506-3p target site in MYCN 3'UTR. METHODS: By a systematic investigation combining microarray, informatics and luciferase reporter assay, we identified that the transcriptional factor pleiomorphic adenoma gene-like 2 (PLAGL2) is a direct target of miR-506-3p that mediates its regulation on MYCN expression. Using CHIP-PCR and luciferase reporter assay, we validated the transcriptional regulation of MYCN by PLAGL2 and we further demonstrated the transcriptional regulation of PLAGL2 by MYCN. We examined the function of PLAGL2 in regulating neuroblastoma cell fate by cell viability assay, colony formation and Western blotting of differentiation markers. We examined the effect of retinoic acid, the differentiation agent used in neuroblastoma therapy, on miR-506-3p, PLAGL2 and MYCN expressions by quantitative PCR and Western blots. We investigated the clinical relevance of PLAGL2 expression by examining the correlation of tumor PLAGL2 mRNA levels with MYCN mRNA expression and patient survival using public neuroblastoma patient datasets. RESULTS: We found that miR-506-3p directly down-regulated PLAGL2 expression, and we validated a PLAGL2 binding site in the MYCN promoter region responsible for promoting MYCN transcription, thereby establishing a mechanism through which miR-506-3p regulates MYCN expression. Conversely, we discovered that MYCN regulated PLAGL2 transcription through five N-Myc-binding E-boxes in the PLAGL2 promoter region. We further confirmed the reciprocal regulation between endogenous PLAGL2 and MYCN in multiple neuroblastoma cell lines. Moreover, we found that PLAGL2 knockdown induced neuroblastoma cell differentiation and reduced cell proliferation, and combined knockdown of PLAGL2 and MYCN showed a synergistic effect. More strikingly, we found that high tumor PLAGL2 mRNA levels were significantly correlated with high MYCN mRNA levels and poor patient survival in neuroblastoma patients. Furthermore, we found that retinoic acid increased expression of miR-506-3p and repressed expression of MYCN and PLAGL2. CONCLUSIONS: Our findings altogether suggest that the interplay network formed by PLAGL2, MYCN and miR-506-3p is an important mechanism in regulating neuroblastoma cell fate, determining neuroblastoma prognosis, and mediating the therapeutic function of retinoic acid.