Evaluation of new approach to enhance visualization performance in cataract surgery: 3D visualization system with coaxial illumination.

PURPOSE: To evaluate the visualization performance of different approaches, including the 3D visualization system with coaxial illumination and the 3D system or microscope with standard illumination. SETTING: Fuzhou Eye Hospital, Fuzhou City, China. DESIGN: Cross-sectional study. METHODS: This 2-part performance assessment for visualization composed of an objective analysis using surgical video images and a subjective survey collecting feedback from surgeons. Data of each eye were obtained with 3 approaches: standard operating microscope with standard illumination (SOM-S), 3D visualization system with standard illumination (3D-S), and 3D visualization system with coaxial illumination (3D-C). RESULTS: 112 eyes (107 cases) and 6 cataract surgeons were involved. The red reflex value was markedly greater in the 3D-C approach compared with other 2 approaches ( P < .001). Compared with the SOM-S approach, the red reflex increased by 55%, 57%, and 53% in the 3D-C approach, corresponding to nuclear grades of II, III, and IV, respectively. In the questionnaire survey, red reflex scores were consistently significantly higher in the 3D-C approach than those in the others ( P < .001). Depth of field was enhanced in both 3D approaches compared with the SOM-S approach ( P < .05). The only minor advantage of the SOM system over the 3D-C approach was in the surrounding field clarity score, and the difference was not statistically significant ( P = 1.000). CONCLUSIONS: The 3D-C approach significantly increased the red reflex in both objective and subjective assessments. Surgeon responses also showed a superior performance for the 3D-C approach.

Direct Costs of Second Aqueous Shunt Implant Versus Transscleral Cyclophotocoagulation (The Assists Trial).

PRCIS: The cost of cyclophotocoagulation is less than the cost of a second glaucoma drainage device. PURPOSE: To compare the total direct costs of implantation of a second glaucoma drainage device (SGDD) with transscleral cyclophotocoagulation (CPC) for patients with inadequately controlled intraocular pressure (IOP) reduction, despite the presence of a preexisting glaucoma drainage device in the ASSISTS clinical trial. METHODS: We compared the total direct cost per patient, including the initial study procedure, medications, additional procedures, and clinic visits during the study period. The relative costs for each procedure during the 90-day global period and the entire study period were compared. The cost of the procedure, including facility fees and anesthesia costs, were determined using the 2021 Medicare fee schedule. Average wholesale prices for self-administered medications were obtained from AmerisourceBergen.com. The Wilcoxon rank sum test was used to compare costs between procedures. RESULTS: Forty-two eyes of 42 participants were randomized to SGDD (n=22) or CPC (n=20). One CPC eye was lost to follow-up after initial treatment and was excluded. The mean (±SD, median) duration of follow-up was 17.1 (±12.8, 11.7) months and 20.3 (±11.4, 15.1) months for SGDD and CPC, respectively ( P =0.42, 2 sample t test). The mean total direct costs (±SD, median) per patient during the study period were $8790 (±$3421, $6805 for the SGDD group) and $4090 (±$1424, $3566) for the CPC group ( P <0.001). Similarly, the global period cost was higher in the SGDD group than in the CPC group [$6173 (±$830, $5861) vs. $2569 (±$652, $2628); P <0.001]. The monthly cost after the 90-day global period was $215 (±$314, $100) for SGDD and $103 (±$74, $86) for CPC ( P =0.31). The cost of IOP-lowering medications was not significantly different between groups during the global period ( P =0.19) or after the global period ( P =0.23). CONCLUSION: The total direct cost in the SGDD group was more than double that in the CPC group, driven largely by the cost of the study procedure. The costs of IOP-lowering medications were not significantly different between groups. When considering treatment options for patients with a failed primary GDD, clinicians should be aware of differences in costs between these treatment strategies.

Total keratometry for toric intraocular lens calculation: comparison from two swept-source optical coherence tomography biometers.

Purpose: To compare the astigmatism prediction accuracy of total keratometry (TK) from the IOLMaster 700 and total corneal power (TCP) from Anterion based on swept-source optical coherence tomography (SS-OCT) technology in toric intraocular lens (toric IOL) calculation. Design: A retrospective observational study. Methods: Total corneal astigmatism (TCA) were obtained using IOLMaster 700 and Anterion. Z CALC 2.0 was used to calculate the expected postoperative refractive astigmatism in conjunction with TCA. Prediction errors (PE) in refractive outcomes was analyzed 1 month postoperatively using the vector analysis by the Holladay method, including the mean vector PE magnitude, percentage of cases with vector PE in certain intervals, and the centroid PE. Results: A total of 56 eyes from 56 patients were enrolled in the study with an insertion of an AT TORBI 709 toric IOL. The difference in mean vector PE of postoperative refractive astigmatism between TK and TCP was not statistically significant (0.48D versus 0.46D, P = 0.281). TK and TCP yielded 27.3 and 40.0% of eyes with vector PE ≤ 0.25D, and 58.2 and 63.6% with vector PE ≤ 0.5D (both P > 0.05), respectively. TK and TCP resulted in similar ATR centroid PE of 0.10D@35° ± 0.60D and 0.15D@22° ± 0.57D, respectively, and there were no significant differences between x-PE component and y-PE component. Conclusion: IOLMaster 700 and Anterion provided comparable astigmatic predictability in toric IOL implantation using total keratometry and Z CALC 2.0.

Whole Exome Sequencing Identifies a Novel Predisposing Gene, MAPKAP1, for Familial Mixed Mood Disorder.

Background: Mood disorder is ranked seventh among the worldwide causes of non-fatal disease burden and is generally believed to be a heritable disease. However, there is still a substantial portion of the heritability yet to be discovered, despite the success of genome-wide association studies (GWAS) for mood disorder. A proportion of the missing heritability may be accounted for by rare coding variants segregating in families enriched with mood disorder. Methods: To identify novel variants segregating with mood disorder, we performed whole-exome sequencing on genomic DNA for a multigenerational family with nine members affected with mood disorder. We prioritized potential causal variants within the family based on segregation with mood disorder, predicted functional effects, and prevalence in human populations. In addition, for the top-ranked candidate variant, we conducted validation in vivo to explore the pathogenesis of mood disorder. Results: We identified and ranked 26 candidate variants based on their segregation pattern and functional annotations. The top-ranked variant, rs78809014, is located in intron 7 of the MAPKAP1 gene. The expression levels of MAPKAP1 in peripheral blood of both major depression disorder (MDD) patients and depressive-like mice ventral dentate gyrus were significantly higher than that in the corresponding controls. In addition, the expression level of MAPKAP1 were correlated with antidepressant response. Conclusions: Although the exact mechanisms in the family remain to be elucidated, our data strongly indicate a probable role of the variant, rs78809014, in the regulatory process of the expression of MAPKAP1 and thus in the development of mood disorder in familial mood disorder.

Evaluation of the Repeatability and Reproducibility of Corneal Epithelial Thickness Mapping for a 9-mm Zone Using Optical Coherence Tomography.

PURPOSE: To evaluate the repeatability and between-machine/operator reproducibility of optical coherence tomography (RTVue-XR) for mapping corneal epithelial thickness (ET) and corneal thickness (CT) over a 9-mm zone. METHODS: In 5 groups of eyes (normal, contact lens, dry eye, post-LASIK/PRK, and keratoconus), corneal ET and CT were evaluated in 25 areas in the following 4 regions: 1) 1 central zone within 0 to 2.0 mm diameter, 2) 8 paracentral zones from 2.0 to 5.0 mm diameter, 3) 8 midperipheral zones from 5.0 to 7.0 mm diameter, and 4) 8 peripheral zones from 7.0 to 9.0 mm diameter. Three devices with designated operators were used to obtain 3 scans per device for each eye. The repeatability, reproducibility, and coefficient of variation were calculated. RESULTS: For all areas up to 9 mm diameter, in normal eyes, contact lens eyes, dry eyes, post- LASIK/PRK eyes, and keratoconic eyes, repeatability and reproducibility ranged from 0.7 to 1.5, 1.0 to 2.6, 0.9 to 2.0, 0.7 to 2.5, and 1.1 to 2.3 µm for ET and 1.5 to 8.3, 2.3 to 12.1, 1.7 to 14.2, 1.4 to 13.7, and 6.9 to 18.9 µm for CT, respectively. The ranges of coefficient of variation values were 1.2% to 3.0%, 1.9% to 5.5%, 1.8% to 4.3%, 1.3% to 5.2%, and 2.2% to 4.5% for ET and 0.3% to 1.2%, 0.4% to 1.8%, 0.4% to 2.1%, 0.3% to 2.0%, and 1.2% to 3.0% for CT, respectively. CONCLUSIONS: Optical coherence tomography produced excellent repeatability and reproducibility for corneal ET and CT measurements up to a 9-mm zone in normal eyes and eyes with different corneal conditions. The CT measurements in keratoconic eyes were more variable than those in eyes with other corneal conditions.

Long-term safety of laser in situ keratomileusis in eyes with thin corneas: 5-year follow-up.

AIM: To investigate the long term (≥5y) efficacy, predictability, and safety of laser in situ keratomileusis (LASIK) in eyes with thin corneas [central corneal thickness (CCT) <500 µm]. METHODS: A total of 339 patients met the criteria of this study. Finally, 175 eyes of 89 patients who had thin corneas and underwent LASIK≥5y ago returned to our clinic and included in this study. Preoperative parameters recorded included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), manifest refraction, CCT and corneal topography. At returning visits, in addition to visual acuity and manifest refraction, ultrasound CCT and corneal topography were performed. Optical coherence tomography was used to measure the CCT, LASIK flap thickness, and residual stromal bed thickness (RSBT). Safety index, efficacy index, percentage of eyes within ±0.5 D and ±1.0 D of refraction, percent tissue altered (PTA), and percentage stromal bed thickness (PSBT) were calculated. RESULTS: The safety index was 1.09 and efficacy index was 0.99. The percentages of eyes within ±0.5 D and ±1.0 D were 71.2% and 87.7%, respectively. The mean PTA was 40%±6% (range 20% to 55%); 76 eyes (43.4%) had PTA <40% and 99 eyes (56.6%) had PTA≥40%. The mean RSBT was 303±27 µm (range 240 to 390 µm), and 2 eyes had RSBT<250 µm. The mean PSBT was 61%±9% (range 51% to 85%). No eyes developed ectasia. CONCLUSION: In this cohort with the PSBT of 50% or more, LASIK is safe with follow-up for at least 5y.

Identify abnormalities in resting-state brain function between first-episode, drug-naive major depressive disorder and remitted individuals: a 3-year retrospective study.

This study aims to identify and characterize neurobiological markers for major depressive disorder (MDD) from resting-state brain functional MRI. We examined the abnormality in the regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) in first-episode, drug-naive major depressive disorder (fMDD), and remitted major depressive disorder (rMDD) and correlated these fluctuations with clinical markers of MDD. We conducted a retrospective study and reviewed the medical records of 43 patients with fMDD. Overall, 13 of the 43 patients who had at least 3 years of follow-up care and the 17-item Hamilton Depression rating scale less than 7 took no antidepressants for more than half a year at the end of the 3-year follow-up. We further chose a group of 14 healthy controls matched for age, sex and education level with patients with rMDD. Multiple comparison analysis was performed for ALFF and ReHo. The statistical significance level was set at P value of less than 0.05. We examined whether there were differences among the three groups in the whole-brain ALFF and ReHo during resting state. Compared with healthy controls, patients with fMDD showed significant decrease of ReHo in the right anterior lobe of cerebellum and significant increase of ReHo in the right inferior temporal gyrus, and significant decrease of ALFF in the left inferior parietal lobule and right caudate nucleus. Compared with patients with rMDD, those with fMDD showed significant increase of ReHo in the right fusiform gyrus and the left middle temporal gyrus, and significant increase of ALFF in the right superior temporal gyrus. Compared with healthy controls, patients with rMDD showed significant increase of ReHo in the right supramarginal and significant decrease of ReHo in the right precuneus, and significant decrease of ALFF in the right lingual gyrus and in the left superior frontal lobe. Only patients with fMDD showed the relatively robust increase in intrinsic activity of temporal gyrus. The temporal gyrus may play a critical role in depressive symptomatology. Abnormal right fusiform gyrus, left middle temporal gyrus, and right superior temporal gyrus alterations were present only in patients with rMDD but not in patients with fMDD, indicating that these alterations may be a therapeutic target for MDD. Abnormal right supramarginal, right precuneus, right lingual gyrus and left superior frontal lobe alterations were present only in patients with rMDD and not in healthy control, and thus may be used as a state marker of MDD.

Comparison of Newer IOL Power Calculation Methods for Eyes With Previous Radial Keratotomy.

PURPOSE: To evaluate the accuracy of the optical coherence tomography-based (OCT formula) and Barrett True K (True K) intraocular lens (IOL) calculation formulas in eyes with previous radial keratotomy (RK). METHODS: In 95 eyes of 65 patients, using the actual refraction following cataract surgery as target refraction, the predicted IOL power for each method was calculated. The IOL prediction error (PE) was obtained by subtracting the predicted IOL power from the implanted IOL power. The arithmetic IOL PE and median refractive PE were calculated and compared. RESULTS: All formulas except the True K produced hyperopic IOL PEs at 1 month, which decreased at ≥4 months (all P < 0.05). For the double-K Holladay 1, OCT formula, True K, and average of these three formulas (Average), the median absolute refractive PEs were, respectively, 0.78 diopters (D), 0.74 D, 0.60 D, and 0.59 D at 1 month; 0.69 D, 0.77 D, 0.77 D, and 0.61 D at 2 to 3 months; and 0.34 D, 0.65 D, 0.69 D, and 0.46 D at ≥4 months. The Average produced significantly smaller refractive PE than did the double-K Holladay 1 at 1 month (P < 0.05). There were no significant differences in refractive PEs among formulas at 4 months. CONCLUSIONS: The OCT formula and True K were comparable to the double-K Holladay 1 method on the ASCRS (American Society of Cataract and Refractive Surgery) calculator. The Average IOL power on the ASCRS calculator may be considered when selecting the IOL power. Further improvements in the accuracy of IOL power calculation in RK eyes are desirable.