Visual performance and patient preference with bilateral implantation of an extended depth of focus or combined implantation of an extended depth of focus/trifocal intraocular lens.

PURPOSE: Evaluate postoperative visual performance in patients with bilaterally implanted AT LARA or AT LARA/AT LISA tri (Carl Zeiss AG, Jena, Germany) intraocular lenses. METHODS: Multicentered, comparative, open-label, retrospective/prospective study. Post-IOL implantation, patients were prospectively enrolled into this study; preoperative patient data were collected retrospectively. Follow-up was at 2-4 and 5-8 months post-surgery. The primary endpoint was binocular best corrected distance visual acuity (CDVA). The study was retrospectively registered on clinicaltrials.gov (#NCT05462067). RESULTS: Seventy-one patients (142 eyes) were enrolled; 67 patients (134 eyes) have 5-8 months data. The mean binocular CDVA at 2-4 months was -0.10 ± 0.06 logMAR in the bilateral AT LARA group ("bilateral") and -0.11 ± 0.09 logMAR in the combined implantation AT LARA/ AT LISA tri group ("combined implantation"); (P = 0.4856). At 5-8 months, mean binocular CDVA was -0.13 ± 0.06 logMAR in the bilateral group and -0.11 ± 0.09 in the combined implantation group (P = 0.4003). At 5-8 months, more eyes in the bilateral group attained 0.2 logMAR or better binocular uncorrected intermediate VA (UIVA; 67 cm) than those in the combined implantation group (100% vs. 94%, respectively). The bilateral group achieved a mean of 0.24 ± 0.11 logMAR in uncorrected near VA (UCNVA), compared to a mean of 0.16 ± 0.12 logMAR in the combined implantation group at 5-8 months (P = 0.0041). CONCLUSIONS: A combined implantation approach (AT LARA in the distance dominant eye/AT LISA tri in the non-dominant eye) produced similar CDVA outcomes but better UCNVA as bilateral implantation with the AT LARA. UIVA was comparable between groups. No new safety concerns were reported.

Oncocytic lesions of the ophthalmic region: a clinicopathological study with emphasis on cytokeratin expression.

PURPOSE: This study aimed to make a nationwide clinicopathological study of oncocytic lesions in the ophthalmic region and to characterize their cytokeratin (CK) expression. METHODS: All histologically diagnosed oncocytic lesions in the ophthalmic region registered in Denmark over a 25-year period were collected and re-evaluated using a monoclonal antimitochondrial antibody (MU213-UC). Clinical data were registered. Immunohistochemical characterization was performed with a panel of anti-CK antibodies. RESULTS: A total of 34 oncocytic lesions were identified and reviewed. The incidence that required surgical intervention in the Danish population could be approximated to 0.3 lesions per million capita per year. Patient ages ranged from 45 years to 89 years, with a peak incidence in the eighth decade. Female patients were twice as common as male. Lesions were typically described as red­brown, cystic and slow-growing. The antimitochondrial antibody MU213-UC produced a distinct and intense immunostaining of all oncocytic lesions and was found to be useful in substantiating oncocytic differentiation. Twenty-six of the lesions originated in the caruncle, three in the conjunctiva, two in the lacrimal sac, one at the semilunar plica, one on the eyelid margin and one peripunctally. Lesions were histologically classified as adenoma (oncocytoma) (26), hyperplasia (4) and metaplasia (4). Fourteen oncocytic lesions representing different locations and differentiation were further evaluated for CK expression. Basal-type oncocytic cells reacted with antibodies against CK 5 / 6, CK 7, CK 8, CK 13, CK 14, CK 17, CK 18 and CK 19, and suprabasal cells with CK 4, CK 7, CK 8, CK 18 and CK 19. Antibodies against CK 1+10 and CK 20 showed no reaction. CONCLUSIONS: Oncocytic lesions of the ophthalmic region most frequently present as caruncular oncocytomas. The CK profile is similar to the lacrimal- and accessory lacrimal gland duct elements and supports the theory that these lesions originate in the lacrimal- and accessory lacrimal glands.

Vogt-Koyanagi-Harada syndrome in a Greenlandic Inuit.

PURPOSE: To report a case of Vogt-Koyanagi-Harada syndrome (VKH) in an Inuit. METHODS: We carried out a medical evaluation and human leucocyte antigen (HLA) genotyping. RESULTS: A 36-year-old male Inuit developed severely decreased vision, intense headache and vertigo over a 3-week period. Ocular examination revealed panuveitis with bilateral serous retinal detachment and optic nerve head oedema. There was no history of ocular trauma or evidence suggestive of other disease entities. The patient responded well to high-dose systemic prednisolone. Vitiligo presented late in the course. CONCLUSIONS: This case report describes the first published case of VKH in a patient of Inuit ancestry. The patient was homozygous for HLA-DR4, a genotype previously associated with VKH.

Synaptic contact between melanopsin-containing retinal ganglion cells and rod bipolar cells.

PURPOSE: Evidence indicates that the melanopsin-containing intrinsically photosensitive retinal ganglion cells (ipRGCs) receive input from rods and cones, which are thought to modulate the irradiance detecting system driving entrainment of the circadian system and pupillomotor control. This study was performed to identify retinal cells that have synaptic contact with ipRGCs. METHODS: Immunohistochemistry and high-power confocal microscopy were used to generate stacks of digital images of sections stained with antibodies against melanopsin, protein kinase C (PKCalpha), tyrosine hydroxylase (TH), presynaptic terminal markers (C-terminal binding protein 2 [CtBP2], vesicular monoamine transporter 2 [VMAT2] and postsynaptic marker (glutamate receptor subunit 4 [GluR4]). Results were analyzed in a computer-based three-dimensional reconstruction program for cellular contacts. RESULTS: Markers and melanopsin rod bipolar processes were found to have axosomatic and axodendritic contact with melanopsin-containing RGCs. Typically, three to four contacts were found on the soma of the melanopsin-containing RGCs, together with contacts on proximal dendrites. Contacts visualized by only CtBP2 immunoreactivity could also be demonstrated on melanopsin cell bodies and processes representing contacts with other types of bipolar cells. At the border of the inner plexiform layer (IPL) and inner nuclear layer (INL), where melanopsin processes stratify, contacts between melanopsin and TH or VMAT2 immunoreactivity processes were observed. CONCLUSIONS: Through confocal microscopy and computer-based three-dimensional analyses, this study demonstrates that melanopsin-containing RGCs have synaptic contact with PKC/CtBP2-containing rod bipolar cells and TH/VMAT2-immunoreactive amacrine cells through axodendritic and axosomatic contact, supporting electrophysiological observations that rods and cones signal to the melanopsin-containing intrinsically photosensitive RGCs.

Caruncular lesions in Denmark 1978-2002: a histopathological study with correlation to clinical referral diagnosis.

PURPOSE: To carry out a retrospective clinicopathological evaluation of caruncular lesions. METHODS: Data were collected from all surgically removed and histopathologically evaluated caruncular lesions registered by Danish pathology departments during the 25-year period 1978-2002. RESULTS: A total of 574 caruncular lesions were identified. The number of caruncular lesions increased significantly during the 25-year period. This was due to an increase in the number of benign lesions, whereas the number of premalignant and malignant lesions remained constant. A total of 550 (96%) of the lesions were benign. Naevus (n = 248, 43%) and papilloma (n = 131, 23%) were the most common neoplasms. Premalignant lesions (n = 10, 1.7%) were dominated by primary acquired melanosis (PAM) with atypia and epithelial dysplasia. Malignant lesions constituted a total of 14 neoplasms (2.4%), with basal cell carcinoma (n = 4, 0.7%) and lymphoma (n = 4, 0.7%) being the most frequent. The preoperative clinical diagnosis was correct in 286 (50%) of cases. CONCLUSION: Caruncular lesions are predominately benign but the lesions are rare and diverse, making clinical diagnosis difficult. Referral of excised lesions for pathological examination is recommended.

Primary basal cell carcinoma of the caruncle with seeding to the conjunctiva.

BACKGROUND: To report the clinical and histopathological characteristics of a patient with a primary basal cell carcinoma (BCC) of the caruncle with seeding of the tumour to the conjunctiva. METHODS: Surgical excision and histological examination. RESULTS: A 60-year-old female presented with a lesion of the caruncle. Clinical examination revealed a pale lobulated tumour without skin involvement. Computer tomography scans showed orbital invasion. The tumour was excised. Three years later a small polypoid tumour developed in the inferior fornix of the same eye. Two and a half years later, the patient developed an orbital recurrence. Microscopically, both neoplasms were composed of infiltrative islands of basaloid tumour cells, scattered mitoses and peripheral palisading consistent with the diagnosis of BCC. CONCLUSION: This case describes a primary BCC of the caruncle with seeding to the conjunctiva.

Melanopsin is expressed in PACAP-containing retinal ganglion cells of the human retinohypothalamic tract.

PURPOSE: The putative circadian photoreceptor melanopsin is found in rodents in a subpopulation of intrinsic light-sensitive retinal ganglion cells (RGCs) constituting the retinohypothalamic tract (RHT). The study was conducted to determine whether melanopsin is expressed in the human retina and costored with the neuropeptide pituitary adenylate cyclase activating polypeptide (PACAP), a marker for the RHT, projecting to the suprachiasmatic nucleus (SCN). Furthermore, whether melanopsin expression is conserved in retinas of blind patients with severe retinal degeneration was investigated. METHODS: In situ hybridization and immunohistochemistry was used to demonstrate melanopsin synthesis in human eyes of 17 donors and two postmortem hypothalami containing the SCN. The coexistence of melanopsin and PACAP in elements of the retinohypothalamic tract was studied by dual-labeling immunocytochemistry. RESULTS: Melanopsin expression was found in a subpopulation of RGCs located in the ganglion cell layer and displaced in the inner nuclear cell layer. Melanopsin-containing cells comprised approximately 0. 8% of all RGCs, with a distinct morphology characterized by two to four dendritic processes constituting a panretinal network. Melanopsin immunoreactivity was primary present at perikaryal boundaries and neuronal processes and to some extent also in the cytoplasm. PACAP and melanopsin were colocalized in the RGCs and PACAP-containing nerve fibers, seemingly innervating the retinorecipient part of the SCN. Melanopsin-expressing RGCs were conserved in retinas of blind patients with severe degeneration of the outer and/or inner layers. CONCLUSIONS: Given the expression of melanopsin in PACAP-containing RGCs of the human RHT, this photoreceptor is a likely first base in the chain of events leading to photoentrainment of both normal and blind people.