Rotational stability and clinical outcomes of a new one piece toric intraocular lens with anchor-wing haptics.

BACKGROUND: To evaluate the safety and efficacy of a new toric intraocular lens (IOL) with anchor-wing haptics. METHODS: The new toric IOL with anchor-wing haptics (NS60YT, NIDEK Co., Ltd.) was implanted in eligible patients with age-related cataracts with preoperative corneal astigmatism of 1.0 D or greater at a university hospital and two private hospitals in Japan. The following IOL cylinder powers were evaluated: 1.50 D (NS60YT3), 2.25 D (NS60YT4), 3.00 D (NS60YT5) and 4.50 D (NS60YT7). All patients were assessed out to 12 months postoperatively. The primary endpoint was visual acuity (VA) with spherical addition at 6 months postoperatively, and the primary analysis calculated the proportion of eyes with VA with spherical addition of 0.1 logMAR or better. The magnitude of rotation was compared to the intended axis of IOL implantation at each postoperative examination. Adverse events were evaluated for the safety analysis. RESULTS: This study enrolled 64 eyes of 53 patients. At 6 months postoperatively, for all IOL powers, VA with spherical addition of 0.1 logMAR or better was achieved in 90% [95% confidence interval (CI): 80-96] of eyes. The mean IOL rotation was 5.3 ± 4.3° at 12 months postoperatively. The mean magnitude of rotation ranged from 1.9° to 2.5° between each postoperative examination from 1 day to 12 months. There were no vision-threatening intraoperative or postoperative complications for the duration of the study. CONCLUSIONS: The NS60YT IOL remained stable after implantation and was efficacious for treating 1.00 D or greater astigmatism in patients with senile cataracts. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov ( NCT03242486 ) on August 8, 2017 - Retrospectively registered.

Posture-related ocular cyclotorsion during cataract surgery with an ocular registration system.

Ocular cyclotorsion when a patient changes from seated to supine position in cataract surgery and factors predicting the amount of cyclotorsion were investigated using VERION system. Variables analyzed were age, gender, preoperative visual acuity, axial length, laterality of eyes, operative duration, and the direction and degree of cyclotorsion. The mean cyclotorsion of 107 eyes of 93 cataract patients was 0.98 ± 4.85 degrees (median, 1 degree; range, -11 to 12 degrees), and the median absolute value was 4 degrees (mean, 4.05 ± 2.82 degrees; range, 0 to 12 degrees). Cyclotorsion was ≥3 degrees in 68 (63.6%) eyes. Excyclotorsion occurred more frequently than incyclotorsion (50.5% vs. 43.0%). There was no cyclotorsion in seven (6.5%). Multiple regression analysis showed that gender was a significant predictive factor for the absolute value of cyclotorsion (ß = 1.06, P = 0.041); however, the other variables had no effect on cyclotorsion. The absolute value of cyclotorsion was significantly larger in female than in male patients [median, 4 degrees and 3 degrees, respectively; mean, 4.66 ± 3.02 degrees and 3.44 ± 2.52 degrees, respectively (P = 0.039)]. In conclusion, cataract patients had significant posture-related ocular cyclotorsion. The amount of cyclotorsion was larger for female than male patients.

Normal tension glaucoma-like degeneration of the visual system in aged marmosets.

The common marmoset (Callithrix jacchus) is a non-human primate that provides valuable models for neuroscience and aging research due to its anatomical similarities to humans and relatively short lifespan. This study was carried out to examine whether aged marmosets develop glaucoma, as seen in humans. We found that 11% of the aged marmosets presented with glaucoma-like characteristics; this incident rate is very similar to that in humans. Magnetic resonance imaging showed a significant volume loss in the visual cortex, and histological analyses confirmed the degeneration of the lateral geniculate nuclei and visual cortex in the affected marmosets. These marmosets did not have elevated intraocular pressure, but showed an increased oxidative stress level, low cerebrospinal fluid (CSF) pressure, and low brain-derived neurotrophic factor (BDNF) and TrkB expression in the retina, optic nerve head and CSF. Our findings suggest that marmosets have potential to provide useful information for the research of eye and the visual system.

Influence of irrigation dynamic pressure-assisted hydrodissection on intraocular pressure and the posterior chamber-anterior hyaloid membrane barrier during cataract surgery.

PURPOSE: To evaluate the effects of irrigation dynamic pressure-assisted hydrodissection (irrigation-hydro: iH) on intraocular pressure (IOP) and the posterior chamber-anterior hyaloid membrane (PC-AHM) barrier in porcine eyes. STUDY DESIGN: Experimental. METHODS: In Experiment 1, IOP was recorded while irrigating the anterior chamber (AC), during iH, and during phacoemulsification and aspiration in 20 porcine eyes using bottle heights of 50, 70, and 90 cm. Under the same conditions, IOP was recorded during conventional manual cortical cleaving hydrodissection (manual hydro: mH) in 20 porcine eyes. In Experiment 2, after iH, ACs were perfused for 5 seconds with balanced salt solution containing 1.0-µm fluorescein beads in 20 porcine eyes using bottle heights of 70, 118, and 169 cm. PC-AHM barrier staining grade was evaluated by the Miyake-Apple view. RESULTS: iH proved successful in all cases. In Experiment 1, IOP during iH was relatively stable and peak IOP was below the baseline bottle height-dependent pressure. No eyes showed a peak IOP > 75 mmHg during iH, but 8 eyes showed a peak IOP > 75 mmHg during mH. In Experiment 2, neither AHT nor ruptured capsules were observed at any bottle height. CONCLUSION: Unlike mH, IOP during iH was relatively stable without any high peak IOP. Thus, iH offers a simple technique for reducing peak IOP and avoiding disturbance of the PC-AHM barrier.

The safety and efficacy of phaco-sleeve irrigation-assisted hydrodissection during femtosecond laser-assisted cataract surgery.

Femtosecond laser-assisted cataract surgery (FLACS) changes the intraoperative environment due to the generation of intracapsular gas that induces a high intracapsular volume. Manual hydrodissection (mH) may induce high intracapsular pressure (ICP) and additional intracapsular volume, thereby leading to capsular block syndrome (CBS). Since the phaco-sleeve irrigation-assisted hydrodissection (iH) technique is used to initially groove and split the lens and remove the intracapsular gas, this can reduce the intracapsular volume while bypassing the intracapsular lens prior to the hydrodissection. As iH uses the phaco tip to intentionally vacuum the intraocular fluid for use in inducing the irrigation jet from the sleeve side holes, the ICP cannot surpass the set irrigation pressure, thereby avoiding CBS. Using this technique, we performed FLACS without CBS in 310 cataract eyes. Our findings suggest that the iH technique may be beneficial for patients by preventing CBS during FLACS.

Age-related macular degeneration affects the optic radiation white matter projecting to locations of retinal damage.

We investigated the impact of age-related macular degeneration (AMD) on visual acuity and the visual white matter. We combined an adaptive cortical atlas and diffusion-weighted magnetic resonance imaging (dMRI) and tractography to separate optic radiation (OR) projections to different retinal eccentricities in human primary visual cortex. We exploited the known anatomical organization of the OR and clinically relevant data to segment the OR into three primary components projecting to fovea, mid- and far-periphery. We measured white matter tissue properties-fractional anisotropy, linearity, planarity, sphericity-along the aforementioned three components of the optic radiation to compare AMD patients and controls. We found differences in white matter properties specific to OR white matter fascicles projecting to primary visual cortex locations corresponding to the location of retinal damage (fovea). Additionally, we show that the magnitude of white matter properties in AMD patients' correlates with visual acuity. In sum, we demonstrate a specific relation between visual loss, anatomical location of retinal damage and white matter damage in AMD patients. Importantly, we demonstrate that these changes are so profound that can be detected using magnetic resonance imaging data with clinical resolution. The conserved mapping between retinal and white matter damage suggests that retinal neurodegeneration might be a primary cause of white matter degeneration in AMD patients. The results highlight the impact of eye disease on brain tissue, a process that may become an important target to monitor during the course of treatment.

Foveal threshold and photoreceptor integrity for prediction of visual acuity after intravitreal aflibercept on age-related macular degeneration.

PURPOSE: To determine whether baseline foveal threshold and photoreceptor integrity can predict best-corrected visual acuity (BCVA) at 12 months after intravitreal aflibercept (IVA) therapy in eyes with neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS: We evaluated 25 eyes of 25 patients with treatment-naïve neovascular AMD who received IVA once a month for 3 months, followed by once every 2 months for 8 months. BCVA, integrity of the external limiting membrane (ELM) or the ellipsoid zone (EZ) of the photoreceptors, and retinal sensitivity were determined before (baseline) and at 6 and 12 months after initial IVA. The average threshold foveal sensitivity and mean deviation within the central 10° were determined by Humphrey central 10-2 perimetry. Correlations between BCVA at 12 months and integrity of the ELM or EZ, foveal threshold, and mean deviation at each visit were determined. RESULTS: At 12 months, BCVA improved significantly from 0.20±0.23 to 0.10±0.22 logMAR (logarithm of the minimum angle of resolution) units, and foveal threshold and mean deviation improved significantly from 29.0±5.1 and -3.38±3.10 dB to 32.6±3.2 and -1.64±2.10 dB, respectively (P=0.0009 and P=0.0021). At baseline, both foveal threshold and integrity of the ELM were significantly correlated with BCVA at 12 months (P=0.0428 and P=0.0275). CONCLUSION: These results indicate that both integrity of the ELM and foveal threshold at baseline can predict BCVA after treatment for neovascular AMD. There is a possibility that these parameters can predict the efficacy of IVA in each case.

Transcutaneous aponeurotic repair with small detachment of the levator aponeurosis for aponeurotic blepharoptosis in Japanese patients.

PURPOSE: To examine the surgical outcomes of a modified transcutaneous aponeurotic repair for aponeurotic blepharoptosis in a Japanese population. METHODS: This retrospective study included 75 eyelids of 45 patients with aponeurotic blepharoptosis who had undergone a modified transcutaneous aponeurotic repair. This procedure included a long skin incision for securing a wide surgical field, creation of a double eyelid crease, and a small extent of detachment of the levator aponeurosis from the tarsal surface. Functional success was defined as a postoperative margin reflex distance-1 of 2-5 mm without serious complications at 3 months postoperatively. Cosmetic success was judged by achieving a ≤ 1-mm laterality of eyelid height, a ≤ 2-mm laterality of pretarsal show, and symmetry of the eyelid contour at 3 months postoperatively. RESULTS: The functional success rate was 70.7% among all patients, with 84.4%, 86.7%, and 88.9% of patients showing cosmetic success regarding symmetry of eyelid height, pretarsal show, and eyelid contour, respectively. After applying functional and all 3 cosmetic criteria simultaneously, 28 patients (62.2%) were satisfied in this study. No serious complications occurred during the follow-up period. CONCLUSIONS: This modified procedure provided good functional and cosmetic outcomes for aponeurotic blepharoptosis, indicating an acceptable blepharoptosis repair for East Asian patients.

Heterozygous deletion of the OPA1 gene in patients with dominant optic atrophy.

PURPOSE: Several OPA1 variants cause dominant optic atrophy (DOA), the most common hereditary optic atrophy. Here, we describe a newly discovered OPA1 deletion in 3 patients with DOA. METHODS: A female proband, her brother, and her mother underwent complete ophthalmologic examinations that included optical coherence tomography and visual field assessments using a Humphrey Field Analyzer with both standard automated perimetry (SAP) and short-wavelength automated perimetry (SWAP). Genomic DNA from each patient was examined to detect genomic rearrangements involving OPA1; the genetic analysis involved both multiplex ligation probe amplification and conventional Sanger sequencing. RESULTS: Each patient had temporal optic disc pallor and significant thinning of the retinal nerve fiber layer in both eyes, although there was phenotypic variability among the patients that ranged from asymptomatic to moderately decreased visual acuity. For the affected brother and mother, the mean deviation values from SAP were within the normal range, whereas those from SWAP were significantly below the normal range (P < .05). The genetic analysis identified a newly discovered heterozygous deletion that encompasses exons 9-14 and revealed a breakpoint junction that directly connects intron 8 to intron 14. CONCLUSIONS: This newly described deletion is likely to lead to loss of function in the functionally important GTPase domain encoded by exons 9-16, and the heterozygosity suggested that haploinsufficiency caused the phenotypes. The deletion may be associated with mild DOA phenotypes ranging from asymptomatic to moderately decreased visual acuity.

Effects of photodynamic therapy plus intravitreal aflibercept with subtenon triamcinolone injections for aflibercept-resistant polypoidal choroidal vasculopathy.

PURPOSE: To evaluate the outcome of triple therapy of photodynamic therapy combined with injections of intravitreal aflibercept (IVA) and subtenon triamcinolone acetonide for polypoidal choroidal vasculopathy (PCV) resistant to IVA. METHODS: A retrospective chart review at a single institution was conducted to identify patients with PCV resistant to treatment with IVA who were switched to treatment with triple therapy. In total, 13 eyes from 13 patients were included in the study. Demographic data, visual acuities, central retinal thickness (CRT) and height of pigment epithelial detachment (PED) on optical coherence tomography (OCT), complications, and number of injections were reviewed. RESULTS: The patients had a mean age of 68 years (range 53-83). The number of prior injections with IVA ranged from 5 to 10. At 12 months follow-up after triple therapy, there was a significant improvement in visual acuity (P = 0.0039), a significant decrease in CRT (P = 0.003), and a significant reduction of the height of PED (P = 0.015). Only one patient had retinal pigment epithelium tear. CONCLUSIONS: Triple therapy improved visual and anatomical outcomes in patients with PCV with recurrent or resistant retinal fluid and PED after multiple injections with IVA.

Conjunctival Chemosis Caused by Exposure of the Lacrimal Caruncle: A Case Report.

An 84-year-old woman presented with a 3-month history of conjunctival chemosis in the left eye. At the first examination, the chemosis neighbored the lacrimal caruncle and was localized in the inferomedial region of the conjunctiva. During eyelid closure, only the left lacrimal caruncle was exposed. One month later, the chemosis further extended to the inferolateral region. We debulked the lacrimal caruncle to prevent the exposure of the caruncle. One month after the surgery, conjunctival chemosis had resolved completely. At the postoperative 6-month follow-up, the patient showed no recurrence of chemosis.

Perioperative changes of the intraocular pressure during the treatment of epiretinal membrane by using 25- or 27-gauge sutureless vitrectomy without gas tamponade.

PURPOSE: The purpose of this study was to compare perioperative intraocular pressures (IOPs) in 25- or 27-gauge microincision vitrectomy surgery (MIVS) and to evaluate the stability of postoperative sclerotomy closure. MATERIALS AND METHODS: This is a retrospective review of 147 eyes treated for epiretinal membrane by using 25- or 27-gauge MIVS as the initial vitrectomy (25-gauge phacovitrectomy [25-P group]: 73 eyes, 25-gauge vitrectomy alone [25-A group]: 15 eyes, 27-gauge phacovitrectomy [27-P group]: 47 eyes, and 27-gauge vitrectomy alone [27-A group]: 12 eyes). Statistical analyses of perioperative IOPs on preoperative day (PreOp), postoperative day (POD)1, POD2, postoperative week 1, and postoperative month 1 were performed. RESULTS: All self-sealing sclerotomies were obtained without gas tamponade at the end of surgery. Also, no significant differences were noted in the age and axial length among the 4 groups and in the surgical time between 25-P and 27-P groups and between 25-A and 27-A groups. Significant decreases in IOP were found at POD1 and POD2 in the 25-P, 25-A, and 27-P groups compared with PreOP, but not in the 27-A group. CONCLUSION: Even though surgeons confirm that there is no leakage from sutureless sclerotomy and that a normal IOP is preserved at the end of 25- or 27-gauge MIVS, there is a possibility of postoperative sclerotomy leakage on the day of the surgery. Furthermore, postoperative sclerotomy self-sealing of the MIVS in previous intraocular lens implantation cases is considered to be acquired easily than that in phacovitrectomy.

Twenty-Four-Hour Variation of Intraocular Pressure in Primary Open-Angle Glaucoma Treated with Triple Eye Drops.

Objectives. To evaluate 24-hour intraocular pressure (IOP) variation in patients with primary open-angle glaucoma (POAG) treated with triple eye drops. Subjects and Methods. The IOP was measured in 74 eyes in 74 POAG patients (seated) on triple therapy (PG analogue, ß-blocker, carbonic anhydrase inhibitor) at about every 3 hours. Results. The peak IOP was 13.5 ± 3.1 at 1:00, and the trough IOP was at 12.6 ± 2.4 mmHg at 7:00. The IOP at 7:00 was significantly lower than that at 10:00, 1:00, and 3:00 (p < 0.05). Based on the time of the peak IOP, we classified the patients into two groups: diurnal (28 eyes) and nocturnal types (37 eyes). There was significant difference at the spherical equivalent between diurnal and nocturnal types (p = 0.014). To assess the influence of reflective error, we conducted subanalysis for two groups: high myopic (26 eyes, ≤-6D) and low/nonmyopic (24 eyes, ≥-2D) groups. In the low/nonmyopia group, the IOP was significantly higher at 1:00 and 3:00 than at 13:00, 16:00, and 7: 00 (p < 0.05). Conclusion. The mean of IOP elevated outside of clinic hour in the POAG patients on triple therapy. The low/nonmyopia patient should be carefully treated because the IOP of the patients at night elevated significantly.

Prewound assisted technique for hydrophobic foldable intraocular lens implantation.

PURPOSE: To describe a technique for intraocular lens (IOL) implantation that lessens the degree of surgical invasiveness by implanting a tightly rolled IOL through a small incision without touching the eye with the cartridge tip. METHODS: An IOL was inserted through an incision by first allowing the leading haptic to protrude slightly from the cartridge tip. It was then injected through the incision without allowing any part of the cartridge to touch the eye during IOL implantation. In one eye, the entire circumference of the beveled portion of the cartridge tip was inserted into the anterior chamber to implant the IOL, whereas in the other eye, the IOL was inserted through the incision by first allowing the leading haptic to protrude slightly from the cartridge tip. It was then injected through the incision without allowing any part of the cartridge to touch the eye during IOL implantation. We analyzed the incision width before and after IOL implantation and the degree of surgically induced astigmatism on the day after surgery and at 1 and 3 months after surgery. RESULTS: Using our technique, both the amount by which the wound was enlarged and the hydration rate were significantly lower compared with conventional IOL implantation. Our method enables IOL implantation to be carried out through a small incision at a width that was only previously possible with forcible insertion. CONCLUSIONS: Our IOL implantation technique can be performed using both hands with no need to immobilize the eyeball.

Irrigation dynamic pressure-assisted hydrodissection during cataract surgery.

The irrigation dynamic pressure-assisted hydrodissection technique (irrigation-hydro [iH]) does not require performing manual hydrodissection using a syringe and cannula to achieve cortical-capsular cleavage during cataract surgery. Since the iH technique uses the phaco tip to intentionally vacuum the intraocular fluid in order to induce the irrigation dynamic pressure for cortical-capsular cleavage, there is a reduction in the intraocular pressure (IOP) from the bottle-height-dependent hydrostatic pressure. Thus, since the peak irrigation pressure derived from the phaco tip sleeve will be limited by the height of the irrigation fluid bottle, this is advantageous in helping to avoid excessively high IOP during cortical-capsular hydrodissection. Using this technique, we were able to effectively perform phacoemulsification without complications in 607 of 609 cataract eyes. Our findings show that utilization of the iH technique would be of benefit to patients, as it prevents high-pressure hydrodissection-related complications, such as capsular block syndrome and tears in the anterior hyaloid membrane during cataract surgery.

Early postoperative evaluation of retinal function by electroretinography after vitreous surgery for idiopathic epimacular membrane.

PURPOSE: In this study, we used the PuREC to carry out electroretinography (ERG) measurements using skin electrodes to assess changes before and after microincision vitreous surgery (MIVS) for epiretinal membrane (ERM) and evaluate the stress on retinal function soon after MIVS. METHODS: The study subjects were 18 eyes of 18 patients who underwent MIVS for ERM simultaneously with cataract surgery. ERG measurements were performed using a skin electrode on the day before vitreous surgery, on the day after surgery, and 1 week later. The amplitude and implicit time of each waveform were measured, and the changes between preoperative results and those 1 day and 1 week postoperatively were investigated. RESULTS: Preoperatively, the dark-adapted (DA) 0.01 ERG, the DA 3.0 ERG a-wave amplitude, and the light-adapted (LA) 3.0 ERG b-wave amplitude were significantly smaller in affected eyes compared with their fellow eyes (P < 0.05, Wilcoxon's signed-rank test). The day after surgery, all-wave amplitude showed no significant difference compared to preoperatively (repeated-measures analysis of variance (ANOVA) post hoc test). One week after surgery, the LA 3.0 ERG for b-waves and flicker ERG amplitude had improved from the value on the day after surgery (P < 0.05, ANOVA post hoc test). CONCLUSIONS: Cone ERG components have improved within 1 week after surgery by MIVS for ERM.

Combination Surgery With Transcorneal Microincision Vitrectomy Surgery and Intrascleral Intraocular Lens Fixation for Spontaneous Intraocular Lens Luxation.

To present a combination technique for two cases of in-the-bag intraocular lens (IOL) luxation into the vitreous cavity. Vitrectomy was performed via a cornea microincision vitrectomy system, and the luxated IOL was fixed into the sclera. IOL fixation is simple from no trocar cannulas and less disrupted conjunctiva. Postoperative corneal endothelial cell density in Case 1 and Case 2 were reduced by -2.1% and -5.1%, respectively. Postoperative frequency of hexagon was decreased in Case 1 but maintained in Case 2. The authors concluded that combination surgery has distinct benefits for IOL luxation; however, long-term corneal changes need to be further assessed. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:267-271.].

A case of traction retinal detachment in a patient with Gaucher disease.

BACKGROUND: This is the first report of vitreous surgery for traction retinal detachment in a patient with type III Gaucher disease with multiple vitreous opacities. MATERIALS AND METHODS: A 16-year-old boy who was diagnosed with Gaucher disease at age two and was undergoing enzyme replacement therapy presented with numerous white opacities of varying sizes in the vitreous bodies of both eyes. Visual acuity was 20/40 in the right eye and 20/2000 in the left eye. The retina of the left eye was completely detached, and vitreous surgery was performed. RESULTS: Liquefaction of the vitreous body was advanced, and the central part of the vitreous cavity contained almost no vitreous humor. The macular region was successfully aspirated with a vitreous cutter to form a posterior vitreous detachment. From the optic disk to the nasal side, however, posterior vitreous detachment formation was prevented by strong adhesions between the retina and the vitreous body. The traction retinal detachment of the posterior fundus improved after vitreous body resection alone. CONCLUSIONS: Traction retinal detachment may occur as a result of severe vitreous liquefaction in cases of Gaucher disease with numerous vitreous opacities.