Evaluation of the Accuracy of Intraocular Lens Power Calculation Formulas in Phacovitrectomy.

INTRODUCTION: The aim of this study was to evaluate the refractive error in patients undergoing combined phacovitrectomy with and without gas tamponade. METHODS: This was a retrospective chart review including patients undergoing phacoemulsification alone (Group 1), combined phacovitrectomy for epiretinal membrane (Group 2), and combined phacovitrectomy with gas tamponade for rhegmatogenous retinal detachment (RRD) (Group 3). Axial length and keratometry were measured using an optical biometric system (Argos, Alcon Laboratories. Inc.), and a three-piece intraocular lens (IOL; NX-70S) was implanted in all groups. In each group, the prediction error at 3 months was calculated using IOL power calculation formulas (SRK/T, Hill-RBF, Kane, and Barrett Universal II) for each eye. Outcome measures included the mean prediction error (MPE), its standard deviation (SD), and the mean absolute error (MAE). The change in IOL position at 3 months was also assessed using anterior segment optical coherence tomography. RESULTS: A total of 104 eyes were included (Group 1: 30; Group 2: 34; Group 3: 40 eyes). The MPE was -0.08 ± 0.37 diopters (D), -0.26 ± 0.32 D, and -0.59 ± 0.34 D in Group 1, Group 2, and Group 3, respectively, using the Barrett Universal II formula (P < 0.01, ANOVA). The movement forward in the IOL position was 0.95 ± 0.16 mm, 0.94 ± 0.12 mm, and 1.07 ± 0.20 mm in Group 1, Group 2, and Group 3, respectively (P < 0.01). No significant difference was shown in MPE among the four formulas after combined phacovitrectomy with gas (P = 0.531). CONCLUSIONS: Phacovitrectomy in RRD induced a significant myopic shift using any of the clinically available formulas. This suggests that myopic shift should be taken into consideration for better refractive outcomes in phacovitrectomy with gas tamponade in RRD.

Influence of cataract surgery for the first or second eye on vision-related quality of life (VR-QOL) and the predictive factors of VR-QOL improvement.

PURPOSE: To assess improvements in vision-related quality of life (VR-QOL) in patients undergoing their first or second eye cataract surgery, as well as clinical factors related to VR-QOL. STUDY DESIGN: Prospective case series. METHODS: We examined 282 patients undergoing their first (222) or second (60) eye cataract surgery. VR-QOL was evaluated before and after surgery using the 25-item National Eye Institute visual function questionnaire (VFQ-25), along with the best-corrected visual acuity (BCVA), uncorrected visual acuity, and the lens opacities classification system III (LOCSIII). The resulting VFQ-25 subscale scores were compared between patients undergoing their first or second eye cataract surgery, including multiple regression analysis. RESULTS: The mean VFQ-25 composite score (CS) was 71.5 ± 14.2 before and 84.0 ± 10.2 after the first eye cataract surgery and 73.5 ± 12.7 before and 85.4 ± 10.2 after the second eye cataract surgery. VFQ-25 scores improved significantly, with reduced disparity among patients after surgery in both groups. Preoperative CS was related to the preoperative sum of the BCVA (standardized partial regression coefficient (ß) = - 0.254, P < 0.001). Improvement in the CS was related to a preoperative poor BCVA (ß = 0.203, P < 0.001), low CS (ß = - 0.693, P < 0.001), and high general health score (ß = 0.118, P = 0.025). CONCLUSIONS: VR-QOL improved after the first and second eye surgery. Many VFQ-25 subscales were related to the BCVA or LOCSIII scores. Low preoperative VR-QOL and BCVA were related to an improved postoperative VR-QOL.

Intrascleral fixation of intraocular lens haptics: histological advantages in a comparison with scleral suture fixation in rabbits.

PURPOSE: To disclose histological advantages of intrascleral fixation of intraocular lens haptics, in comparison with scleral suture fixation, in a study with rabbits. METHODS: Ten white rabbits, 10 weeks of age, were used in this experimental histopathological study. After unilateral lensectomy and anterior vitrectomy, an intraocular lens haptic was inserted into one eye of each rabbit. Intrascleral fixation was performed in five rabbits, whereas scleral suture fixation was performed in the others. At postoperative 1 week, the globe was enucleated in two rabbits in each group; at postoperative 8 weeks, the globe was enucleated in the remaining three rabbits in each group. Sections of the sclera around haptics and sutures were evaluated with haematoxylin and eosin and immunohistochemical staining methods. We assessed severity of inflammation on histopathological photos, taken near the haptic or suture in the sclera, by counting white blood cells. The Mann-Whitney U test was performed to analyse differences in the severity of inflammation between the groups. RESULTS: Samples in the intrascleral fixation group demonstrated reduced irregularity of collagen fibres; reduced infiltration of fibroblasts, giant cells, lymphocytes, neovascular cells, neutrophils and eosinophils and weaker staining for fibronectin (indicating tissue repair) and heat shock protein 70 (indicating cell damage). In addition, reduced white blood cell infiltration was observed in the intrascleral fixation samples at 8 weeks in both shallow sclera (p = 0.001) and deep sclera (p = 0.002). CONCLUSIONS: Histological analysis showed that intrascleral fixation caused fewer inflammatory changes than scleral suture fixation, with reduced fibroblast migration and production of cytotoxic factors.

The impact of different anti-vascular endothelial growth factor treatment regimens on reducing burden for caregivers and patients with wet age-related macular degeneration in a single-center real-world Japanese setting.

OBJECTIVE: To describe the burden associated with different anti-vascular endothelial growth factor (VEGF) treatment strategies for wet age-related macular degeneration (wAMD) in a real-word setting in Japan. METHODS: Single-center, cross-sectional survey of caregivers of patients with wAMD performed in a hospital in Mito-City, a rural area in Japan. Caregiver burden was evaluated using the Burden Index of Caregivers (BIC-11), and depressive symptoms were assessed by the Center for Epidemiologic Studies Depression scale. Retrospective medical chart review was conducted to monitor resource use and visual acuity outcomes in patients. The productivity loss of caregivers accompanying patients on hospital visits was estimated using the human capital method. RESULTS: Seventy-one patient-caregiver pairs were included. Most caregivers were female (74.6%), spouse/partner (54.9%), employed (46.5%), and the primary caregiver (85.9%). Patients received anti-VEGF treatment as follows: treat-and-extend (T&E; n = 42), switch (from as-needed [PRN] to T&E; n = 18), PRN (n = 10), and other (n = 1). Caregiver-related burden (total BIC-11 scores) were 4.29 (T&E) 4.60 (PRN), and 5.33 (switch) (p = NS). The mean number of hospital visits was lower with T&E than PRN (7.88 vs. 14.0 [p = 0.00674] in year 1 and 5.68 vs. 9.0 in year 2). For patients who switched from PRN to T&E, the mean number of hospital visits decreased from 13.21 to 7.43 (p<0.0001) in the first year after switch. The productivity loss associated with accompanying patients to the hospital was lower for caregivers of patients receiving T&E than PRN (mean differences: 74,456.04 JPY [p = 0.00284] in year 1 and 40843.14 JPY in year 2), and was also reduced for caregivers of patients who switched from PRN to T&E. CONCLUSION: wAMD treatment with anti-VEGF agents via T&E reduced hospital visits compared with PRN, where associated monitoring visits are necessary to provide good patient outcomes. T&E was associated with a reduction trend in caregiver burden, including time and costs.

Objective classification of zonular weakness based on lens movement at the start of capsulorhexis.

PURPOSE: To quantify zonular weakness based on lens movement at the start of continuous curvilinear capsulorhexis (CCC) and establish a classification system for it. SETTING: Kozawa Eye Hospital and Diabetes Center, Mito, Japan. DESIGN: Retrospective interventional case series. METHODS: We examined 402 consecutive eyes of 316 patients who underwent CCC, phacoemulsification and aspiration (PEA), and intraocular lens (IOL) implantation. The movement of the lens capsule was measured using images from video recordings of the CCC procedure. Zonular weakness was classified based on the shifted distance: Grade I, less than 0.20 mm; Grade II, 0.20-0.39 mm; and Grade III, greater than 0.40 mm. For each of these grades, we examined the use of the capsule stabilization device during PEA, the surgical procedure for lens removal, and IOL fixation. RESULTS: We classified 276 eyes (68.6%) as Grade I, 102 eyes (25.4%) as Grade II, and 24 eyes (6.0%) as Grade III. As the grade increased, the use of the capsule stabilization device in PEA and scleral suture fixation of IOL increased. CONCLUSIONS: Zonular weakness was quantified by measuring the movement of the lens capsule. An objective classification of zonular weakness based on lens movement may be useful for selecting the appropriate device and procedure during cataract surgery.

Modified capsule expander implantation to reposition and fixate the capsular bag in eyes with subluxated cataractous lenses and phacodonesis: intermediate-term results.

PURPOSE: To report the intermediate-term results of capsule stabilization for scleral fixation with implantation of the Yaguchi hook, a modified capsule expander stabilization hook. SETTING: Department of Ophthalmology, School of Medicine, University of Showa, Fujigaoka Rehabilitation Hospital, Yokohama, Japan. DESIGN: Retrospective case series. METHODS: Patients with zonular dialysis and phacodonesis were followed postoperatively for at least 2 years. All eyes had phacoemulsification and aspiration using an ordinary capsule expander and in-the-bag implantation of an intraocular lens (IOL). Capsule expanders were removed after the residual cortex was removed, and the capsular bag was fixated to the scleral wall via the ciliary sulcus using the modified capsule expander stabilization hook. Preoperative findings, intraoperative complications, and postoperative courses were examined. RESULTS: The mean age of the 11 patients (11 eyes) was 72.2 years ± 10.5 (SD); 5 patients were men. The mean postoperative follow-up was 48.6 ± 13.6 months. The zonular dialysis range was 90 to 180 degrees in 1 eye, 180 degrees in 4 eyes, and 180 to 270 degrees in 1 eye. In 5 eyes, severe phacodonesis was observed without obvious zonular dialysis. In all eyes, the capsular bag and IOL were well centered without severe intraoperative or postoperative complications. CONCLUSION: The modified capsule expander stabilization hook provided good centration and stabilization of the capsule-IOL complex in eyes with severely weak zonular fibers. FINANCIAL DISCLOSURE: Dr. Yaguchi, who is the inventor of the modified capsule expander, has received financial support from Handaya, Tokyo, Japan. No other author has a financial or proprietary interest in any material or method mentioned.

Repositioning and scleral fixation of subluxated lenses using a T-shaped capsule stabilization hook.

We describe a T-shaped capsule stabilization hook (modified capsule expander [M-CE]) used for repositioning and scleral fixation of the lens capsule of subluxated lenses. The 5-0 polypropylene device is flexible and attached to a curved needle. The contact portion is bent at 1.25 mm, and the end bifurcates in a T configuration to form a 3.75 mm footpad from which the capsular bag can be suspended. Modified capsule expanders were implanted in 4 eyes of 4 patients with subluxated cataractous lenses and provided excellent support and centration of the intraocular lens (IOL)-capsular bag complex. The IOLs remained well centered and stable. The corrected distance visual acuity improved to at least 20/20 in all patients after surgery. Thus, M-CEs were effective in fixating the lens capsule to the sclera in patients with significant zonular weakness.

Periostin, discovered by nano-flow liquid chromatography and mass spectrometry, is a novel marker of diabetic retinopathy.

Diabetes can lead to serious microvascular complications including proliferative diabetic retinopathy (PDR), the leading cause of blindness in adults. Recent studies using gene array technology have attempted to apply a hypothesis-generating approach to elucidate the pathogenesis of PDR, but these studies rely on mRNA differences, which may or may not be related to significant biological processes. To better understand the basic mechanisms of PDR and to identify potential new biomarkers, we performed shotgun liquid chromatography (LC)/tandem mass spectrometry (MS/MS) analysis on pooled protein extracts from neovascular membranes obtained from PDR specimens and compared the results with those from non-vascular epiretinal membrane (ERM) specimens. We detected 226 distinct proteins in neovascular membranes and 154 in ERM. Among these proteins, 102 were specific to neovascular membranes and 30 were specific to ERM. We identified a candidate marker, periostin, as well as several known PDR markers such as pigment epithelium-derived factor (PEDF). We then performed RT-PCR using these markers. The expression of periostin was significantly up-regulated in proliferative membrane specimens. Periostin induces cell attachment and spreading and plays a role in cell adhesion. Proteomic analysis by LC/MS/MS, which permits accurate quantitative comparison, was useful in identifying new candidates such as periostin potentially involved in the pathogenesis of PDR.

Comparison of the outcomes of limbal-based trabeculectomy with and without anchor sutures.

BACKGROUND AND OBJECTIVE: To retrospectively evaluate the efficacy and safety of limbal-based trabeculectomy with anchor sutures compared to standard limbal-based trabeculectomy. Limbal-based trabeculectomy was performed with a new technique using anchor sutures, which involved tying the conjunctiva to the sclera at a deep fornix incision to prevent bleb localization induced by slippage of the conjunctival suture scar toward the scleral flap. PATIENTS AND METHODS: In this retrospective, comparative, interventional case series, 45 eyes that underwent limbal-based trabeculectomy with anchor sutures and 27 eyes that underwent standard limbal-based trabeculectomy were analyzed (primary surgery). RESULTS: At a target intraocular pressure of 15 mm Hg, the 3-year survival rate using Kaplan-Meier analysis was 76.2% in the limbal-based trabeculectomy with anchor sutures group and 55.6% in the standard limbal-based trabeculectomy group. Bleb morphology analysis using the Moorfields Bleb Grading System showed that blebs in the limbal-based trabeculectomy with anchor sutures group were more diffused than those in the standard limbal-based trabeculectomy group. CONCLUSION: Limbal-based trabeculectomy with anchor sutures appears to be an effective method for decreasing intraocular pressure and improving morphology of blebs.

Capsular stabilization device to preserve lens capsule integrity during phacoemulsification with a weak zonule.

We describe a new capsular stabilization device for suspending a lens with weak zonular support. It is flexible, 10.0 mm in length, and fashioned from 5-0 nylon. The contact portion is bent at 1.25 mm with an end bifurcating to form a T-shape to minimize stress on the capsular equator. After a continuous curvilinear capsulorhexis is created, the capsular stabilization devices to hook the capsulotomy margin are inserted. The T-shaped end is passed around the anterior capsular flap to fit the curvature of the equator. Phacoemulsification and aspiration using this device was performed in 12 eyes of 9 patients, and the usefulness and complications were analyzed. The capsular stabilization devices suspended the capsule and facilitated safe phacoemulsification in all eyes. Posterior capsule rupture occurred in 2 eyes. None of the cases had notable postoperative complications. This device ensures a stable capsule-iris complex and reduces surgical risks.

Antioxidants and an inhibitor of advanced glycation ameliorate death of retinal microvascular cells in diabetic retinopathy.

BACKGROUND: Pericyte ghosts and acellular capillaries are well known as early histological changes resulting from diabetic retinopathy. These histological changes mean that the cell death of retinal microvessels has accelerated. It was reported that apoptosis of retinal microvascular cells (RMCs) was increased in diabetic patients. Therefore, we investigated apoptosis of RMCs in Goto-Kakizaki (GK) rats, a type 2 diabetic model, and involvement with antioxidants (a combination of vitamins C and E) or a novel inhibitor of advanced glycation, OPB-9195. METHODS: GK rats were treated with the antioxidants combination or OPB-9195 for 36 weeks. We obtained isolated preparations of the vascular network from their retinas by trypsin digestion. Apoptosis of retinal vascular cells was detected with terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. RESULTS: We found that apoptosis of RMCs was increased in the diabetic GK rats. Furthermore, a combination of vitamins C and E and an advanced glycation end-products inhibitor mostly inhibited this increased apoptosis. CONCLUSIONS: We concluded that apoptosis of RMCs was a good marker that indicates the progression of diabetic retinopathy in GK rats. Both oxidative stress and the accumulation of advanced glycation end-products appears to promote the apoptosis of retinal microvascular cells, and antioxidants or advanced glycation end-products inhibitors might ameliorate diabetic retinopathy.

[Influence of cataract and intraocular lens surgery on health-related quality of life].

PURPOSE: To evaluate the vision-related quality of life(QOL) in patients undergoing cataract surgery with the Japanese version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). SUBJECTS AND METHODS: Subjects were 110 patients [70.4 +/- 9.2 (mean +/- standard deviation) years old] undergoing bilateral cataract surgery. Best-corrected visual acuity was 20/30 or worse in both eyes. The VFQ-25 was recorded before and 2 months after phacoemulsification and foldable intraocular lens implantation, and the influence of various clinical parameters was assessed. The VFQ-25 was also recorded in 69 glaucoma patients with visual field defects in both eyes, and in 31 normal subjects. RESULTS: The VFQ-25 scores before cataract surgery were as low as the scores obtained in glaucoma patients. Cataract surgery significantly improved VFQ-25 scores to the level of normal subjects Statistically significant improvements were observed in subscales such as general vision, near activities, distance activities, driving, peripheral vision, color vision, social functioning, dependency, role difficulties, mental health, and total score (p<0.001, paired t-test). The degree of improvement in VFQ-25 scores did not correlate with preoperative or postoperative visual acuity, uncorrected or corrected. The VFQ-25 scores improved more in younger patients, and improvement in the general vision subscale showed a significant negative correlation with age (r= -0.286, p=0.009, Pearson correlation coefficient). The degree of posterior subcapsular cataract in better eyes showed significant correlation with the improvement in subscales, such as distance activity (r =0.413, p<0.001), driving (r= 0.449, p=0.015), social functioning (r=0.308, p= 0.004), mental health (r=0.330, p=0.002), dependency (r=0.323, p=0.003), and total score (r=0.328, p=0.002). Other types of cataract had no correlation. Men tended to show more improvement in VFQ-25 scores by surgery than women, except for the dependency subscale. CONCLUSION: The current study quantitatively demonstrated that vision-related QOL is significantly impaired in patients with cataract, and that cataract surgery dramatically improves patients' QOL.