Triple Procedure: A Stepwise Combination of Deep Anterior Lamellar Keratoplasty and Cataract Surgery.

PURPOSE: The aim of this study was to evaluate clinical outcomes of the combined surgery (triple procedure) of deep anterior lamellar keratoplasty (DALK), phacoemulsification, and intraocular lens (IOL) implantation using a new surgical strategy. METHODS: The study included 43 eyes of 43 patients who underwent a triple procedure. Twenty-six eyes with good visibility through the cornea underwent phacoemulsification before the stromal dissection. Seventeen eyes with bad visibility underwent the DALK procedure first until achieving enough visibility to perform the lensectomy. IOL power calculation was performed for a postoperative estimated flat keratometry of 43.5 and aiming to avoid hyperopic postoperative refraction. The postoperative visual examination included uncorrected and corrected distance visual acuity (CDVA) measurements and manifest refraction. RESULTS: The mean follow-up time after suture removal was 3.06 ± 2.14 years. Mean CDVA significantly changed from 0.86 ± 0.56 logMAR preoperatively to 0.37 ± 0.28 logMAR in the last visit ( P < 0.0001). The percentage of eyes with CDVA ≤0.3 logMAR changed from 6.9% preoperatively to 62.8%. No eyes lost lines of vision after surgery, and 80% experienced an improvement of 2 or more lines. The safety index was 2.2. The mean postoperative refractive sphere was +0.13 ± 2.04 D, and the postoperative refractive cylinder was -4.02 ± 2.24 D. Only 2 cases (4.65%) obtained postoperative hyperopic astigmatism. No intraoperative complications were found. CONCLUSIONS: Combined surgery of DALK, phacoemulsification, and IOL implantation is an effective and safe procedure. Depending on the corneal transparency, different surgical strategies can be established to provide more efficacy and safety.

Protector Role of Intraocular Lenses under Artificial Light Conditions.

INTRODUCTION: The aim of this work was to analyze, in an in vitro model, the possible protective effects of ultraviolet- (UV-) or UV/blue-filtering intraocular lens (IOL) under light-emitting diode (LED) lighting conditions. METHODS: Ten models of IOLs were evaluated. Light transmission spectrum was recorded from 300 to 800 nm, in steps of 1 nm. Photodamage in vitro model was induced in ARPE-19 cells by blue LED light (465-475 nm). Changes in cell viability and oxidative stress variables were studied to assess the protective effect of IOLs. RESULTS: UV/blue-filtering IOLs models block blue light spectrum in different proportion and UV-filtering IOLs blocking wavelength below 400 nm. However, in vitro study under blue LED light exposure does not show protective effects related with mitochondrial dysfunction and oxidative stress of UV/blue-filtering IOLs. CONCLUSIONS: The current in vitro study suggests that UV/blue filtering IOLs are not useful in terms of photoprotection in artificial light conditions. The results obtained indicate that it is needed to give attention to other IOL parameters besides the type of filter, as it seems they could have influence on the protective role.

Plasma Rich in Growth Factors Promotes Autophagy in ARPE19 Cells in Response to Oxidative Stress Induced by Blue Light.

Age-related macular degeneration (AMD) causes the degeneration of photoreceptors and retinal cells leading to vision loss in older subjects. Among possible exogenous risk factors, it has been recently proposed that long-term exposure to blue light could aggravate the course of AMD. In the search for therapeutic options, plasma rich in growth factors (PRGF) has been shown to enhance cell antioxidant pathways and protect photoreceptors against the harm produced by blue light, although its mechanism of action remains unknown. One possible mechanism, autophagy, is one of the most conservative cell renewal systems used in eukaryotes to destroy cellular components that have been damaged by some kind of insult. The oxidative stress of exposure to blue light is known to induce cell autophagy. In this study, we examined the combined effects on autophagy of blue light and PRGF in a retinal cell line, ARPE19. In response to treatment with both PRGF and blue light, we detected the modulated expression of autophagy markers such as NF-kB, p62/sqstm1, Atg5, LC3 and Beclin1, and inflammatory markers such as IL1B and IL18. Our findings suggest that PRGF promotes cell autophagy in response to exposure to blue light.

Plasma Rich in Growth Factors Enhances Cell Survival after in Situ Retinal Degeneration.

PURPOSE: The purpose of this study was to examine the effect of plasma rich in growth factors (PRGFs) under blue light conditions in an in vivo model of retinal degeneration. METHODS: Male Wistar rats were exposed to dark/blue light conditions for 9 days. On day 7, right eyes were injected with saline and left eyes with PRGF. Electroretinography (ERG) and intraocular pressure (IoP) measurements were performed before and after the experiment. After sacrifice, retinal samples were collected. Hematoxylin and eosin staining was performed to analyze the structure of retinal sections. Immunofluorescence for brain-specific homeobox/POU domain protein 3A (Brn3a), choline acetyltransferase (ChAT), rhodopsin, heme oxygenase-1 (HO-1), and glial fibrillary acidic protein (GFAP) was performed to study the retinal conditions. RESULTS: Retinal signaling measured by ERG was reduced by blue light and recovered with PRGF; however, IoP measurements did not show significant differences among treatments. Blue light reduced the expression for Brn3a, ChAT, and rhodopsin. Treatment with PRGF showed a recovery in their expressions. HO-1 and GFAP results showed that blue light increased their expression but the use of PRGF reduced the effect of light. CONCLUSIONS: Blue light causes retinal degeneration. PRGF mitigated the injury, restoring the functionality of these cells and maintaining the tissue integrity.

Antioxidant Role of PRGF on RPE Cells after Blue Light Insult as a Therapy for Neurodegenerative Diseases.

Oxidative stress has a strong impact on the development of retinal diseases such as age-related macular degeneration (AMD). Plasma rich in growth factors (PRGF) is a novel therapeutic approach in ophthalmological pathologies. The aim of this study was to analyze the antioxidant effect of PRGF in retinal epithelial cells (EPR) in in vitro and ex vivo retinal phototoxicity models. In vitro analyses were performed on ARPE19 human cell line. Viability and mitochondrial status were assessed in order to test the primary effects of PRGF. GSH level, and protein and gene expression of the main antioxidant pathway (Keap1, Nrf2, GCL, HO-1, and NQO1) were also studied. Ex vivo analyses were performed on rat RPE, and HO-1 and Nrf2 gene and protein expression were evaluated. The results show that PRGF reduces light insult by stimulating the cell response against oxidative damage and modulates the antioxidant pathway. We conclude that PRGF's protective effect could prove useful as a new therapy for treating neurodegenerative disorders such as AMD.

Visual Function after Implantation of a Presbyopia-Correcting Trifocal Intraocular Lens.

PURPOSE: To evaluate distance, intermediate, and near visual performance in patients implanted with a trifocal aspheric presbyopia-correcting intraocular lens (IOL). METHODS: Forty patients were bilaterally implanted with the AcrySofIQ PanOptix IOL after femtosecond laser-assisted lens surgery. Binocular best corrected distance visual acuity (CDVA) (4 m), best distance-corrected near visual acuity (DCNVA) (40 and 30 cm), best corrected distance intermediate visual acuity (DCIVA) (70, 60, and 50 cm), binocular distance contrast sensitivity under photopic conditions (85 cd/m2), and defocus curves were evaluated at 6-months. RESULTS: Six months postoperatively, the mean binocular Snellen decimal CDVA and DCNVA were 0.94 ± 0.10 (ranging from 0.70 to 1.25) and 0.85 ± 0.13 (ranging from 0.63 to 1.00), respectively. At a distance, all patients showed a cumulative binocular distance-corrected visual acuity of 0.8 or better, and about 80% (n = 31) of the patients had a value of 1.0 (20/20). At near and intermediate distances, all patients showed a cumulative distance-corrected visual acuity of 0.5 (20/40) or better at 30, 40, 50, 60, and 70 cm. Specifically, 50 cm showed the highest percentage of patients with larger values of visual acuity (60% [n = 26] with 20/20). Defocus curve showed a wide range of useful vision with two peaks of best visual acuity at distance and at 50 cm, and the binocular distance contrast sensitivity was within normal limits. CONCLUSIONS: The outcomes of the present study show that the visual performance obtained with bilateral implantation of the trifocal aspheric AcrySofIQ PanOptix IOL is good at far, intermediate, and near distances.

Lensectomy after radial keratotomy: 1-year follow-up.

PURPOSE: To report visual and refractive results in radial keratotomy (RK) patients that underwent a cataract surgery with a monofocal intraocular lens (IOL) implantation with 1 year of follow-up. METHODS: Twenty-eight eyes of 15 patients with cataract and the previous RK were included. All eyes underwent phacoemulsification and monofocal IOL implantation. IOL power calculation was done using the Double-K formula of Aramberri. The preoperative versus postoperative corrected distance visual acuity (CDVA) and the uncorrected distance visual acuity (UDVA) values were used to assess the efficacy and safety of the surgery; meanwhile, the achieved versus the expected refractive outcomes postoperatively were used to assess the predictability. RESULTS: Phacoemulsification and IOL implantation was performed successfully in all eyes, and no intra- and postoperative problems occurred. The mean logMAR UDVA significantly improved from 0.7 ± 0.3 to 0.4 ± 0.2 at 6 months, and 0.3 ± 0.2 at 12 months postoperatively. By the end of the follow-up period, about 60% of the eyes achieved 20/25 or better CDVA, 25% of the eyes gained three or more lines of visual acuity, and two eyes had lost one or more lines of visual acuity. The mean spherical equivalent improved from - 1 ± 6.00 to - 0.75 ± 1.1 D by the end of the follow-up, and about 60% of the eyes were within ± 1 D at 12 months after the surgery. No intra- and postoperative problems occurred. CONCLUSIONS: Pseudophakic monofocal IOL implantation offers good visual acuity recovery and acceptable refractive correction in RK patients after 1-year follow-up.

Five-Year Follow-up of Correction of Myopia: Posterior Chamber Phakic Intraocular Lens With a Central Port Design.

PURPOSE: To assess the long-term correction of moderate to high myopia using a posterior chamber phakic intraocular lens with a central port design. METHODS: Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, intraocular pressure (IOP), endothelial cell density (ECD), vault, and adverse events over a 5-year period were evaluated retrospectively. RESULTS: A total of 147 eyes (83 patients) were evaluated. Mean postoperative UDVA and CDVA were 0.05 ± 0.11 and 0.02 ± 0.08 logMAR at 1 year and 0.13 ± 0.18 and 0.02 ± 0.09 logMAR at 5 years, respectively. More than 95% of eyes achieved CDVA of 20/25 or better at both follow-up periods. CDVA was unchanged or improved from one to three or more lines in all eyes. Preoperatively, mean spherical equivalent (SE) was -9.20 ± 3.02 diopters (D). At 1 year, the mean SE was -0.17 ± 0.26 D, with 91.53% of eyes within ±0.50 D and 100% of eyes within ±1.00 D of the target. At 5 years, the mean SE was -0.44 ± 0.47 D, with 67.4% of eyes within ±0.50 D and 90.1% of eyes within ±1.00 D of the target. Mean IOP was 12.74 ± 1.65 and 13.0 ± 2.03 mm Hg, at 1 and 5 years, respectively. No significant rise in IOP (> 20 mm Hg) occurred during the follow-up period. Mean ECD was 2,696 ± 358 and 2,645 ± 359 cells/mm2 at 1 and 5 years, respectively, representing a non-significant loss of 0.43% from preoperative values (P = .304). Mean vault changed significantly from 398 ± 187 µm at 1 year to 340 ± 163 µm at 5 years (P < .001). No intraoperative or postoperative complications or adverse events occurred during the follow-up period. CONCLUSIONS: The good long-term outcomes found in this study support the use of this lens with a central port design for the correction of moderate to high myopia. [J Refract Surg. 2019;35(3):169-176.].

The Effect of Immunologically Safe Plasma Rich in Growth Factor Eye Drops in Patients with Sjögren Syndrome.

PURPOSE: The objective was to provide preliminary information about the efficacy and safety of immunologically safe plasma rich in growth factor (immunosafe PRGF) eye drops in the treatment of moderate to severe dry eye in patients with primary and secondary Sjögren's syndrome (SS) and to analyze the influence of several variables on treatment outcomes. METHODS: This retrospective study included patients with SS. All patients were treated with previously immunosafe PRGF eye drops to reduce the immunologic component contents. Ocular Surface Disease Index (OSDI) scale, best-corrected visual acuity (BCVA), visual analog scale (VAS) frequency, and VAS severity outcome measures were evaluated before and after treatment with immunosafe PRGF. The potential influence of some patient clinical variables on results was also assessed. Safety assessment was also performed reporting all adverse events. RESULTS: Twenty-six patients (12 patients with primary SS, and 14 patients suffering secondary SS) with a total of 52 affected eyes were included and evaluated. Immunosafe PRGF treatment showed a significant reduction (P < 0.05) in OSDI scale (41.86%), in BCVA (62.97%), in VAS frequency (34.75%), and in VAS severity (41.50%). BCVA and VAS frequency scores improved significantly (P < 0.05) after concomitant treatment of PRGF with corticosteroids. Only 2 adverse events were reported in 2 patients (7.7% of patients). CONCLUSIONS: Signs and symptoms of dry eye syndrome in patients with SS were reduced after treatment with PRGF-Endoret eye drops. Immunosafe PRGF-Endoret is safe and effective for treating patients with primary and secondary SS.

Sequential intrastromal corneal ring segment and monofocal intraocular lens implantation for keratoconus and cataract: Long-term follow-up.

PURPOSE: To evaluate the efficacy, safety, predictability, and stability of sequential Ferrara intrastromal corneal ring segment (ICRS) and intraocular lens (IOL) implantation in patients with keratoconus and cataract. SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. DESIGN: Retrospective case series. METHODS: This study comprised patients with keratoconus and cataract who had ICRS implantation followed 6 months later by IOL implantation. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities and residual refractive errors, analyzed using vector analysis, were recorded preoperatively, 6 months after ICRS implantation, 6 months after IOL implantation, and 3 years and 5 years thereafter. RESULTS: Seventy eyes of 47 patients were studied. The mean UDVA was 1.08 logMAR ± 0.24 (SD) preoperatively, 0.95 ± 0.31 logMAR 6 months after ICRS implantation (P = .03), and 0.44 ± 0.29 logMAR 6 months after IOL implantation (P < .0001). The mean CDVA changed from 0.35 ± 0.23 logMAR before surgery to 0.28 ± 0.22 logMAR 6 months after ICRS implantation (P < .0001) and to 0.11 ± 0.16 logMAR 6 months after IOL implantation (P < .0001). The UDVA and CDVA were stable over the period after the second procedure (P > .05). The spherical equivalent (SE) and the refractive cylinder declined steeply after IOL implantation (P < .001) and then were stable (P > .05). CONCLUSION: Sequential ICRS and IOL implantation provided good visual and refractive outcomes and was an effective, safe, predictable, and stable procedure for the treatment of patients with keratoconus and cataract.

Safety and Efficacy of Autologous Plasma Rich in Growth Factors Eye Drops for the Treatment of Evaporative Dry Eye.

PURPOSE: To provide preliminary information about the safety and efficacy of plasma rich in growth factors (PRGF) in the treatment of evaporative dry eye (EDE) and analyze the influence of certain variables on treatment outcomes. METHODS: This retrospective study included patients with EDE treated between January 2011 and December 2013. Outcome measures including signs and symptoms of the disease were evaluated before and after treatment. The influence of some of the patient's clinical variables on results was assessed. Safety assessment was also performed. RESULTS: Eighty-three patients with a total of 156 eyes were evaluated. Statistically significant reductions in the Ocular Surface Disease Index (38.2%), best-corrected visual acuity (27.4%), Visual Analogue Scale scores for frequency (32%) and severity (34%), and a significant improvement in the Schirmer test scores (177.5%) were observed (p < 0.05). The results were stratified according to the identified potential effect modifiers. Only four adverse events were reported. All of them were mild and resolved within a few days. CONCLUSIONS: Results suggest that PRGF eye drops could be a safe and effective treatment in reducing EDE signs and symptoms. When treating patients, the possible influence of some clinical variables must be taken into account.

Visual function after implantation of a diffractive aspheric trifocal intraocular lens.

PURPOSE: To evaluate distance, intermediate, and near vision after bilateral implantation of a diffractive aspheric trifocal intraocular lens (IOL). METHODS: This study enrolled 204 eyes of 102 patients who had bilateral implantation of the AT LISA tri 839MP IOL. Monocular and binocular uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) (4 meters), monocular and binocular uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA) (30, 40 centimeters), binocular uncorrected intermediate visual acuity (UIVA) and distance-corrected intermediate visual acuity (DCIVA) (50, 60, 70 centimeters), the defocus curve, and binocular photopic and mesopic contrast sensitivity with and without glare were evaluated over 6 months. RESULTS: No statistically significant differences in visual acuity outcomes between follow-up visits were found at any distance evaluated (p>0.05). Six months postoperatively, the mean monocular UDVA and UNVA were comparable to preoperative CDVA and DCNVA, respectively. All patients achieved a binocular CDVA of 20/25 or better. The mean binocular DCIVA ranged from 0.11 ± 0.11 (70 cm) to 0.07 ± 0.11 logMAR (50 cm). The mean binocular DCNVA was 20/25 or better in nearly 87% of patients. The defocus curve showed a wide range of useful vision, with no statistically significant differences in visual acuity at intermediate distances (p = 0.151). Mesopic contrast sensitivity was lower than under photopic conditions, particularly at medium and high spatial frequencies (p<0.001). CONCLUSIONS: Bilateral implantation of this trifocal IOL provides good visual outcomes at far, intermediate, and near distances, being an effective solution to reduce spectacle dependence after lensectomy.

Autologous Plasma Rich in Growth Factors Eyedrops in Refractory Cases of Ocular Surface Disorders.

PURPOSE: Preliminary information about the safety and efficacy of plasma rich in growth factors (PRGF) eyedrops in the treatment of refractory cases of diverse ocular surface disorders (OSDs) is presented here. MATERIAL AND METHODS: This retrospective cohort study included cases with OSDs refractory to previous treatment with conventional treatments or autologous serum or cyclosporine, and treated with PRGF eyedrops. The signs and symptoms of ocular surface disorders [using the ocular surface disease index (OSDI), best-corrected visual acuity (BCVA), visual analog scale (VAS) frequency and VAS severity] were evaluated before and after treatment with PRGF. A safety assessment was also performed reporting all adverse events or complications. RESULTS: Forty-one patients with a total of 80 treated eyes were evaluated. Statistically significant reductions in the OSDI scale (39.27%), VAS frequency (38.9%) and VAS severity (40.3%), and a significant improvement in BCVA (54.86%) were all observed (p < 0.05). The results were stratified according to the identified potential effect modifiers. There were only two adverse events (eye redness and eyelid inflammation), which were reported as mild and resolved in a few days. CONCLUSIONS: PRGF eyedrops could be a safe and effective treatment option for refractory cases of OSDs. When treating patients the possible influence on the results of some clinical variables must be taken into account.

LOXL1 gene variants and their association with pseudoexfoliation glaucoma (XFG) in Spanish patients.

BACKGROUND: LOXL1 gene is the most important genetic risk factor known so far for pseudoexfoliation glaucoma (XFG). Our purpose was to evaluate the potential association of individual genetic variants of the lysyl oxidase-like 1 (LOXL1) gene and haplotypes with XFG in Spanish patients. METHODS: Blood samples were collected from a total of 105 Spanish patients with XFG and 200 healthy controls. The entire LOXL1 gene along with the promoter, coding and non-coding regions including the 5'- and 3'-untranslated regions, were sequenced using next-generation sequencing in 99 XFG patients. SNPs rs16958477 (promoter), rs1048661 (exon 1), rs3825942 (exon 1), rs2165241 (intron 1) and rs3522 (exon 7) in LOXL1 were genotyped by restriction fragment-length polymorphism (RFLP) in all Spanish control participants and in six additional XFG patients, and a case-control association study was performed. Comparisons of the allelic and genotypic frequencies were performed using standard χ(2) test with Bonferroni and Pearson corrections. Logistic regression analyses were permormed using Sigmaplot v11. Haplotypes frequencies were performed using HaploView 4.0. RESULTS: Sequencing of the LOXL1 gene in XFG participants identified a total of 212 SNPs, of which 49 exhibited allelic frequencies with significant differences between cases and controls, and 66 were not previously described. The allele frequencies of SNPs rs16958477, rs1048661, rs3825942, rs2165241, were significantly associated with an increased risk for XFG, however the SNP rs3522 was not. The haplotype frequencies of SNPs rs16958477, rs1048661, rs3825942 and rs2165241 and their association with XFG indicated that the CGGT haplotype, containing all four risk alleles, and the AGGT haplotype, which carries the protective allele of rs16958477 and three risk alleles of the other three SNPs, were significantly associated with XFG (p = 4.5×10(-6), and p = 8.8×10(-6)), conferring more than 2-fold increased disease susceptibility. CONCLUSIONS: SNPs of the LOXL1 gene are associated with XFG in the Spanish population. This information adds new support to the distinct risk association frequencies of LOXL1 alleles with XFG in Western European and Asian populations. Identification and validation of additional SNPs along the entire LOXL1 gene of XFG cases may provide insightful information on their potential role in the pathogenesis of this disease.

CFH polymorphisms in a Northern Spanish population with neovascular and dry forms of age-related macular degeneration.

PURPOSE: To elucidate the potential role of single-nucleotide polymorphisms (SNPs) in complement factor H (CFH) gene in Northern Spanish patients with age-related macular degeneration (AMD). METHODS: A case-control study of 130 unrelated native Northern Spanish diagnosed with AMD (46 dry, 35 neovascular and 49 mixed) and 96 healthy controls matched by age and ethnicity were enrolled. DNA was isolated from peripheral blood and genotyped for AMD-associated SNPs (rs3753394, rs529825, rs800292, rs3766404, rs203674, rs10671170, rs3753396 and rs1065489) using TaqMan probes and restriction fragment length polymorphism (RFLP). The association study was performed using the HaploView 4.0 software. RESULTS: The allelic frequency analysis revealed that rs529825, rs800292, rs203674 and rs10671170 were significantly associated with an increased risk for AMD. The haplotypes CGG (rs3753394, rs529825 and rs800292) and GCAG (rs203674, rs1061170, rs3753396 and rs1065489) were significantly associated with AMD while the haplotypes CAA (rs3753394, rs529825 and rs800292) and TTAG (rs203674, rs1061170, rs3753396 and rs1065489) were found to be protective. Small differ-ences in allelic frequencies were found between dry and neovascular cases; however, these differences were not significant and did not distinguish one form the other. CONCLUSIONS: This study found significant association of SNPs rs529825, rs800292, rs203674 and rs1061170 in the CFH gene with susceptibility to AMD. We identified haplotypes that confer protection or increased risk of AMD but not specific genetic variants in CFH capable to distinguish the different clinical forms of AMD in this cohort. Collectively, our results confirmed that CFH represents a strong genetic risk factor for this disease in the Northern Spanish population.

Prevalence of cataract after collagen copolymer phakic intraocular lens implantation for myopia, hyperopia, and astigmatism.

PURPOSE: To evaluate the prevalence of cataract after Implantable Collamer Lens phakic intraocular lens (pIOL) implantation with different models at different ages and for different refractive powers. SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. DESIGN: Retrospective nonrandomized clinical study. METHODS: The pIOL (models V4, V4b, or V4c) was implanted in all cases. RESULTS: The study included 3420 eyes (1898 patients). The mean patient age at surgery was 31.2 years ± 6.4 (SD) (range 18 to 50 years) and the mean spherical refractive error, -7.27 ± 5.24 diopters (D) (range -26.5 to 12.5 D). Twenty-one eyes (0.61%) of 15 patients had pIOL explantation (all model V4) because cataract developed. The mean age of the patients who had explantation was 39.43 ± 4.57 years; 7 were younger than 40 years, and 8 were 40 years or older. The mean spherical equivalent was -10.1 ± 5.41 D; 3 eyes had a pIOL power less than -10.50 D, 4 eyes between -10.50 D and -13.50 D, and 14 higher than -13.50 D. The mean time between pIOL implantation and cataract surgery was 4.2 ± 1.8 years. No eye with implantation of the latest models (V4b and V4c) developed cataract. The mean vault distance in eyes that developed cataracts was 103 ± 69 µm. CONCLUSIONS: The incidence of cataract was low after pIOL implantation at the 6-year follow-up. The rate of cataract was higher in older patients and in those with high refractive errors. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Collagen copolymer posterior chamber phakic intraocular lens supported by the ciliary sulcus to treat myopia: one-year follow-up.

PURPOSE: To evaluate the predictability, stability, safety, and efficacy of Visian V4b Implantable Collamer Lens phakic intraocular lens (pIOL) implantation to treat varying degrees of myopia. SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. DESIGN: Prospective nonrandomized clinical study. METHODS: The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, pIOL vault, and adverse effects were evaluated 12 months postoperatively. RESULTS: The study enrolled 121 eyes (68 patients). The mean spherical equivalent decreased from -8.61 diopters (D) ± 3.41 (SD) (range -18.75 to -2.25 D) preoperatively to -0.18 ± 0.29 D (range -1.25 to 0.50 D) 12 months postoperatively; 97 eyes (80.2%) were within ±0.25 D of the target refraction and 114 eyes (94.2%) were within ±0.50 D (r(2) = 0.99). The mean Snellen decimal UDVA and CDVA were 0.91 ± 0.17 and 0.97 ± 0.09, respectively. Postoperatively, the UDVA was 20/20 or better in 80 eyes (66.1%) and 20/40 or better in 115 eyes (95.0%). The mean efficacy index was 0.96 ± 0.14. The CDVA was 20/20 or better in 103 eyes (85.1%) and 20/40 or better in all eyes. No eye lost lines of CDVA, and 22 eyes (18.2%) gained 1 or more lines of CDVA. The mean safety index was 1.04 ± 0.10. There were no intraoperative complications. CONCLUSIONS: The predictability, safety, and effectiveness of the pIOL were good throughout the 12-month follow-up and comparable to outcomes reported for previous pIOL models. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Caries dental en adolescentes de una comunidad venezolana / Dental decay in adolescents of a Venezuelan community

Se realizó un estudio descriptivo y transversal de 240 adolescentes de 12-14 años de edad, atendidos en la consulta de Odontología de la comunidad de Palmira, Estado de Táchira, de la República Bolivariana de Venezuela, desde enero hasta septiembre de 2011, para identificar los principales factores de riesgo que favorecieron la aparición de caries. En la serie, la prevalencia de caries fue 83,3 por cada 100 niños examinados y se comprobó que el cepillado deficiente y la ingestión de alimentos ricos en carbohidratos influyeron en que el índice de dientes cariados-obturados y perdidos fuera elevado, de manera que se recomienda realizar acciones educativas para lograr estilos de vida más saludables en este grupo poblacional.

A descriptive and cross-sectional study of 240 adolescents with 12-14 years, assisted in the Odontology Department of Palmira community, Táchira state, Bolivarian Republic of Venezuela was carried out from January to September, 2011, to identify the main risk factors favoring the cavity was found. In the series, the cavity prevalence was 83.3 every 100 examined children, and it was proven that the scarce brushing and the ingestion of foods rich in carbohydrates influenced on the high index of damaged-filled and lost teeth so that it is recommended to carry out educative actions to achieve healthier lifestyles in this populational group.

Caries dental en adolescentes de una comunidad venezolana / Dental decay in adolescents of a Venezuelan community

Se realizó un estudio descriptivo y transversal de 240 adolescentes de 12-14 años de edad, atendidos en la consulta de Odontología de la comunidad de Palmira, Estado de Táchira, de la República Bolivariana de Venezuela, desde enero hasta septiembre de 2011, para identificar los principales factores de riesgo que favorecieron la aparición de caries. En la serie, la prevalencia de caries fue 83,3 por cada 100 niños examinados y se comprobó que el cepillado deficiente y la ingestión de alimentos ricos en carbohidratos influyeron en que el índice de dientes cariados-obturados y perdidos fuera elevado, de manera que se recomienda realizar acciones educativas para lograr estilos de vida más saludables en este grupo poblacional(AU)

A descriptive and cross-sectional study of 240 adolescents with 12-14 years, assisted in the Odontology Department of Palmira community, Táchira state, Bolivarian Republic of Venezuela was carried out from January to September, 2011, to identify the main risk factors favoring the cavity was found. In the series, the cavity prevalence was 83.3 every 100 examined children, and it was proven that the scarce brushing and the ingestion of foods rich in carbohydrates influenced on the high index of damaged-filled and lost teeth so that it is recommended to carry out educative actions to achieve healthier lifestyles in this populational group(AU)

Comparative proteomic study in serum of patients with primary open-angle glaucoma and pseudoexfoliation glaucoma.

Alterations in the sera proteins between patients with Primary Open-Angle Glaucoma (POAG), Pseudoexfoliation Glaucoma (PEXG), and healthy controls were identified through a proven approach utilizing equalization of high-abundance serum proteins with ProteoMiner™, two-dimensional fluorescent difference gel electrophoresis (2D-DIGE), MALDI-TOF/TOF, and nanoLC-MS-MS. Quantitative immunoassays of the 17 most-differentially-altered proteins identified in this analysis confirmed that they were also over expressed in the intact serum of newly recruited glaucoma patients. Overall, this report identifies a panel of candidates for glaucoma biomarkers and supports their further validation in large population studies. Additionally, functional pathway analysis of these candidate proteins suggested that they are part of a network linked to regulating immune and inflammatory-related processes. The data have been deposited to the ProteomeXchange with identifier PXD000198. BIOLOGICAL SIGNIFICANCE: POAG and PEXG are major causes of age-related blindness in the world; however, treatment can be very effective if they are identified early on in the progression. Genetic linkage studies can only explain a limited number of cases, suggesting that these forms of glaucoma are multigenic in nature. Other important factors, such as modifier genes, epigenetic influences, environmental and dietary agents, and inflammatory and oxidative effects are also believed to affect the development of these diseases. The characterization of metabolic and/or proteins changes, for example in bodily fluids, before the clinical manifestation of glaucoma is of considerable relevance for its early diagnosis. In the present work, identification of over-expressed proteins in serum of glaucoma patients (POAG and PEXG) linked to immune and inflammatory processes supports the finding that changes in these pathways also manifest systemically in patients with these pathologies. This study provides a new basis to validate the identified proteins as biomarkers of glaucoma in a large-scale-multiplexed screening in sera.