Scharioth Macula Lens for patients with high myopia: a novel approach to achieve spectacle independence (binocular trifocal monovision).

We aimed to test a novel concept based on multiple IOL-implantation, targeting spectacle independence for patients with high and excessive myopia (26.0 mm < axial length; 6.0 D < refractive error). Therefore, we introduced the first results of five patients with high myopia. After clear lens extraction, one eye was targeted to emmetropia, and the other to mild myopia by implanting monofocal capsular bag IOLs with appropriate refractive powers in each case. The emmetropic eye was aimed to result in magnification and improved distance vision, while the mild myopic eye was supposed to ensure good intermediate vision. Thereafter, a Scharioth Macula Lens (SML) was implanted into the emmetropic eye in order to achieve sharp near vision. Visual acuity curves and defocus curves were plotted postoperatively. According to our results, this new concept seems to be an efficient approach of achieving appropriate uncorrected vision at all distances, by creating binocular trifocal monovision.

Canaloplasty in the spotlight: surgical alternatives and future perspectives.

The modern glaucoma surgeon is faced with many surgical alternatives for the management of glaucoma. In recent years, numerous techniques that make Schlemm's canal (SC) more accessible for surgery by being less invasive and surgically less challenging were introduced. Since its first introduction, canaloplasty has become a well-established method of glaucoma surgery. The aim of this paper was to present an overview of canaloplasty and its modifications, and to highlight their strong points and potential drawbacks based on available data on the effectiveness of each technique. Furthermore, it offered an overview of the development of canaloplasty over time and the clinical aspects that should be considered in patient selection. Abbreviations: ABiC = Canaloplasty ab interno, AH = aqueous humour, CSD = Canaloplasty with suprachoroidal drainage, IOP = intraocular pressure, MIGS = minimally invasive glaucoma surgery, OAG = open angle glaucoma, PEXG = pseudoexfoliation glaucoma, SC = Schlemm's canal, TDM = trabeculo-Descemet's membrane.

Does low infusion pressure microincision cataract surgery (LIPMICS) reduce frequency of post-occlusion breaks?

Objective: To compare the number of surge events and efficacy of phacoemulsification using a near-physiological intraocular pressure (IOP) setting and a standard IOP setting. Materials and methods: The surgical data of patients who underwent phacoemulsification with IOL implantation using the CENTURION Vision System's Active Fluidics setting and Active Sentry Handpiece (Alcon Laboratories, USA) were analyzed. Results: The study included 181 patients (204 eyes). In Group 1, the IOP was set at 20 mmHg (n=102, 50%), and in Group 2, the IOP was set at 60 mmHg (n=102, 50%). Total case time was significantly lower (p=.036) in Group 1 (0:03:17.20 ± 0:00:34.55 vs. 0:03:28.71 ± 0:00:43.03). There was no statistically significant difference between the mean cumulative dissipated energy (CDE) (7.06 ± 3.20 vs. 7.59 ± 3.26) and mean ultrasound (UJS) time (0:00:36 ± 0:00:12 vs. 0:00:38 ± 0:00:13) between the two groups (p=0.24 and p=0.31, respectively). Active sentry (AS) engaged less often (p<0.001) in Group 1. There was no statistically significant correlation between the CDE and AS activation in Group 1 (p=0.96). A strong statistically significant correlation between the CDE and AS activation (p<0.0001, r=0.61, CI (0.47 to 0.72)) was observed in group 2. Conclusion: During phacoemulsification, surge events are more likely to occur when operating at high IOP settings. Abbreviations: LIPMICS = low infusion pressure microincision cataract surgery, IOP = intraocular pressure, CDE = cumulative dissipated energy, UJS = mean ultrasound time, AS = Active sentry, LOCS = Lens Opacities Classification System, NO = nuclear opalescence, AFR = aspiration flow rate.

Solid pseudopapillary neoplasm of pancreas: Two case reports.

RATIONALE: About 8384 cases of solid pseudopapillary neoplasms (SPN) of pancreas have been published in English literature, from 1933 to 2018. This is a low-grade tumor that usually occurs in children but is rare in adults and, in exceptional cases, can show extrapancreatic localization. In this paper we present 2 unusual cases of SPNs, 1 with retroperitoneal location (case 1) and 1 that was firstly diagnosed as a G1 neuroendocrine tumor (NET) and showed hepatic metastases after 13 years (case 2). PATIENT CONCERNS: No symptoms in first case. The tumor was incidentally diagnosed, during ultrasound examination. In the second case, the metastasis was observed during regular follow-up. DIAGNOSES: The diagnosis was established based on the histological features and immunohistochemical profile that showed positivity for vimentin, nuclear ß-catenin, cyclin D1, CD10, and SRY-related high-mobility group box 11 and negativity for maspin. INTERVENTIONS: Surgical excision, in both cases. OUTCOMES: No recurrences in first case, at 5 months after diagnosis. Hepatic metastases in the second case, at 13 years after diagnosis, with portal invasion after another 15 months. LESSONS: Without a complex immunoprofile, SPN can be misdiagnosed as NET. SPN can be a low-grade tumor but long-time follow-up is mandatory to detect delayed metastases. A correct diagnosis is necessary for a proper therapeutic management.

The epithelial-mesenchymal transition induces aggressivity of mucinous cystic neoplasm of the pancreas with neuroendocrine component: An immunohistochemistry study.

BACKGROUND: Pancreatic mucinous cystic neoplasms (MCN) are rare tumors that are usually diagnosed in females. MATERIALS AND METHODS: In our department, only four of the 109 consecutive cases of pancreatic tumors (3.67%) were diagnosed as MCNs. In this report, we present the characteristics of these four specific cases which also showed unusual HER-2 positivity and neuroendocrine differentiation. RESULTS: The four MCNs were diagnosed in patients with ages between 46 and 75 years. Other clinical particularities were the following: one benign case, splenic rupture as result of a giant cystic tumor on the tail of the pancreas directly invading the spleen in the second one, metastases in the accessory spleen in the third one and invasion of the abdominal vessels in the fourth case. In all of these cases, the ovarian-like stroma tested positivity for calretinin, progesterone receptor (PR) and, in cases 2 and 3, for AE1/AE3 keratin. The malignant tumor cells were marked by carcinoembryonic antigen, HER-2, maspin, PR and the neuroendocrine markers synaptophysin, CD56, and neuron-specific enolase. CONCLUSIONS: These cases highlight the unusually aggressive behavior of pancreatic MCN with invasive carcinomas that share mixed exo- and endocrine components and show epithelial-mesenchymal transition.