Impact of segmented optical axial length on the performance of intraocular lens power calculation formulas.

PURPOSE: To investigate the difference between the segmented axial length (AL) and the composite AL on a swept-source optical coherence tomography biometer and to evaluate the subsequent effects on artificial intelligence intraocular lens (IOL) power calculations: the Kane and Hill-RBF 3.0 formulas compared with established vergence formulas. SETTING: National Hospital Organization, Tokyo Medical Center, Japan. DESIGN: Retrospective case series. METHODS: Consecutive patients undergoing cataract surgery with a single-piece IOL were reviewed. The prediction accuracy of the Barrett Universal II, Haigis, Hill-RBF 3.0, Hoffer Q, Holladay 1, Kane, and SRK/T formulas based on 2 ALs were compared for each formula. The heteroscedastic test was used with the SD of prediction errors as the endpoint for formula performance. RESULTS: The study included 145 eyes of 145 patients. The segmented AL (24.83 ± 1.89) was significantly shorter than the composite AL (24.88 ± 1.96, P < .001). Bland-Altman analysis revealed a negative proportional bias for the differences between the segmented AL and the composite AL. The SD values obtained by Hoffer Q, Holladay 1, and SRK/T formulas based on the segmented AL (0.52 diopters [D], 0.54 D, and 0.50 D, respectively) were significantly lower than those based on the composite AL (0.57 D, 0.60 D, and 0.52 D, respectively, P < .01). CONCLUSIONS: The segmented ALs were longer in short eyes and shorter in long eyes than the composite ALs. The refractive accuracy can be improved in the Hoffer Q, Holladay 1, and SRK/T formulas by changing the composite ALs to the segmented ALs.

Corneal refractive error and astigmatism in patients aged 6 to 18 years with a history of retinopathy of prematurity and birth weight of <1500 g.

PURPOSE: To investigate corneal refractive power (CR) and astigmatism (AS) in 6- to 18-year-old children with a history of retinopathy of prematurity (ROP) and birth weight of <1500 g who either did or did not undergo retinal photocoagulation (PC). STUDY DESIGN: Retrospective study. METHODS: We examined 143 eyes of 77 children in 2021. The children were divided into three groups for evaluation of CR and AS: those with a birth weight of ≥2500 g (normal birth weight [NBW] group, 13 eyes) as controls, those with spontaneously resolved ROP (sr-ROP group, 27 eyes), and those who underwent PC for treatment of ROP (PC-ROP group, 103 eyes). Swept-source anterior segment optical coherence tomography was used to analyze the cornea. RESULTS: The median CR in the NBW, sr-ROP, and PC-ROP groups was 42.2 (41.3, 42.8) diopters (D), 44.5 (43.2, 45.5) D, and 45.2 (43.8, 46.6) D, respectively. The median AS in the NBW, sr-ROP, and PC-ROP groups was 1.2 (1.0, 1.5) D, 1.1 (0.8, 1.6) D, and 2.1 (1.4, 2.7) D. In the PC-ROP group, the with-the-rule astigmatic axis was 97%. In all three groups, a strong positive correlation was found between the mean anterior and posterior CR (NBW: r=0.795, sr-ROP: r=0.842, PC-ROP: r=0.890) and AS (NBW: r=0.883, sr-ROP: r=0.841, PC-ROP: r=0.860). CONCLUSION: CR was significantly higher in the sr-ROP (p=0.013) and PC-ROP (p<0.001) groups than in the NBW group. The PC-ROP group had significantly more AS than the sr-ROP group. There was a strong correlation between the anterior and posterior CR and AS.

Effect of Segmented Optical Axial Length on the Performance of New-Generation Intraocular Lens Power Calculation Formulas in Extremely Long Eyes.

PURPOSE: To evaluate the performance of traditional vergence formulas with segmented axial length (AL) compared to traditional composite AL in extremely long eyes, and to determine whether the segmented AL can be extended to the new-generation formulas, including the Barrett Universal II, Emmetropia Verifying Optical 2.0 (EVO2), Hill-RBF 3.0 (Hill3), Kane, and Ladas Super formula (LSF) formulas in extremely long eyes. SETTING: National Hospital. Organization, Tokyo Medical Center, Japan. DESIGN: Retrospective case series. METHODS: Consecutive patients who underwent uncomplicated cataract surgery implanted with a three-piece intraocular lens between December 2015 and March 2021 were retrospectively reviewed. The composite AL was measured with a swept-source optical coherence tomography (SS-OCT) biometer using a mean refractive index. The segmented AL was calculated by summing the geometric lengths of the ocular segments (cornea, aqueous, lens, and vitreous) using multiple specific refractive indices based on the data obtained by the SS-OCT-based biometer. When refraction was measured at three months postoperatively, the median absolute errors (MedAEs) were calculated with two ALs for each formula. RESULTS: The study included 31 eyes of 22 patients. The segmented AL (30.45 ± 1.23 mm) was significantly shorter than the composite AL (30.71 ± 1.28 mm, p < 0.001). The MedAEs were significantly reduced when using segmented AL for SRK/T, Haigis, Hill3, and LSF, compared to those obtained using composite AL (0.38 vs. 0.62, 0.48 vs. 0.79, 0.50 vs. 0.90, 0.34 vs. 0.61, p < 0.001 for all formulas, respectively). On the contrary, the MedAE obtained by Kane with segmented AL was significantly worse compared to the one with composite AL (0.35 vs. 0.27, p = 0.03). CONCLUSION: In extremely high myopic eyes, the segmented AL improves the performance of SRK/T, Haigis, Hill3, and LSF formulas compared to the composite AL, while the segmented AL worsens the prediction accuracy of the Kane formula.

Comparison of two one-piece acrylic foldable intraocular lenses: Short-term change in axial movement after cataract surgery and its effect on refraction.

PURPOSE: To compare the change in intraocular lens (IOL) axial movement, corneal power, and postoperative refraction of eyes implanted with two different single-piece, open loop, acrylic foldable IOLs with planar-haptic design: one IOL with hinges vs. one IOL without hinges. The role of IOL axial movement on short-term refractive shift after cataract surgery was also evaluated. METHODS: This retrospective comparative study enrolled consecutive patients who had phacoemulsification with aspheric IOL implantation. The IOL depth (the distance from corneal endothelium to IOL surface) and corneal power were measured via anterior-segment optical coherence tomography at 4 days and 1 month postoperatively. The changes in axial movement of the IOL, corneal power, and manifest refractive spherical equivalent (MRSE) were compared among groups, and the correlations between each lens were evaluated. RESULTS: IOL with hinges was implanted in 42 eyes of 42 patients and IOL without hinges was implanted in 42 eyes of 42 patients. The change in axial movement between 4 days and 1 month was significantly smaller in the IOL with hinges group than in the IOL without hinges group (p < 0.001). The axial movement of IOL with hinges did not correlate with the MRSE change; however, the forward shift of IOL without hinges correlated with the myopic refractive change (Pearson r = 0.62, p < 0.001). CONCLUSION: The postoperative axial movement of IOL was more stable in the IOL with hinges group than the IOL without hinges group between 4 days and 1 month after cataract surgery. Even though the two study IOLs with planar-haptic design are made of similar acrylic materials, other characteristics such as hinge structure may affect IOL stability in the bag.

Preliminary demonstration of a novel intraocular lens power calculation: the O formula.

PURPOSE: To evaluate the performance of a new formula of intraocular lens (IOL) power calculation (the O formula) based on ray tracing without commonly used parameters, including ultrasound-compatible axial length, keratometry readings, and A-constant. SETTING: Tokyo Medical Center, Tokyo, Japan. DESIGN: Retrospective consecutive case series. METHODS: 423 eyes (423 patients) implanted with a single-piece, L-loop, acrylic IOL were enrolled. All biometric data for the O formula were obtained by anterior segment swept-source optical coherence tomography (SS-OCT) and SS-OCT-based biometer. The performance of the O formula was compared with those of the Barrett Universal II (BUII) and Kane formulas at 1 month postoperatively. Statistical analysis was applied according to a heteroscedastic test with SD of prediction errors as the main parameter for formula performance. RESULTS: The SD of the O formula (0.426) was statistically significantly lower than that of the BUII formula (0.464, P = .034) but not statistically significantly different from that of the Kane formula (0.433, P = .601). The percentages of patients with refractive prediction errors within ±0.50 diopter (D) and ±1.00 D of the O, BUII, and Kane formulas were 75.4% and 98.6%, 77.1% and 97.9%, and 76.6% and 98.1%, respectively. CONCLUSIONS: The O formula, based on ray tracing using SS-OCT-based devices, is one of the promising approaches for IOL power calculation, although additional larger scale studies are needed. It may be used as an alternative in IOL power calculation because of its independence from commonly used parameters.

Whole-cell observation of ZIO-stained Golgi apparatus in rat hepatocytes with serial block-face scanning electron microscope, SBF-SEM.

The Golgi apparatus, which plays a role in various biosynthetic pathways, is usually identified in electron microscopy by the morphological criteria of lamellae. A 3-dimensional analyses with serial block-face scanning electron microscope (SBF-SEM), a volume-SEM proficient in obtaining large volumes of data at the whole-cell level, could be a promising technique for understanding the precise distribution and complex ultrastructure of Golgi apparatus, although optimal methods for such analyses remain unclear since the observation can be hampered with sample charging and low image contrast, and manual segmentation often requires significant manpower. The present study attempted the whole-cell observation and semi-automatic classification and segmentation of the Golgi apparatus in rat hepatocytes for the first time by SBF-SEM via ZIO staining, a classical osmium impregnation. The staining electron-densely visualized individual Golgi lamellae, and their ultrastructure could stably be observed without any noticeable charging. The simple thresholding of the serial images enabled the efficient reconstruction of the labeled Golgi apparatus, which revealed plural Golgi apparatus in one hepatocyte. The combination of the heavy metal-based histochemistry of zinc, iodine and osmium (ZIO) staining and SBF-SEM was useful in the 3-dimensional observation of the Golgi apparatus at the whole-cell level because of two technical advantages: (i) visualization of the Golgi apparatus without any heavy metal staining and efficient acquisition of the block-face images without additional conductive staining or any devices for eliminating charging; (ii) easy identification of the staining and hassle-free, semi-automatic classification and segmentation by simple thresholding of the images. This novel approach could elucidate the topographic characteristics of the Golgi apparatus in hepatocytes.

RETINAL SURFACE WRINKLING AS AN INDICATOR FOR INTERNAL LIMITING MEMBRANE PEELING DURING VITRECTOMY FOR RETINAL DETACHMENT.

PURPOSE: To assess the validity of retinal surface wrinkling (RSW) as an indicator to select patients relevant for internal limiting membrane peeling during vitrectomy for rhegmatogenous retinal detachment, to prevent postoperative visual decline due to epiretinal membrane growth. METHODS: This was a prospective, interventional case series of 78 consecutive eyes that underwent initial vitrectomy to repair rhegmatogenous retinal detachments and were followed for 6 months. The presence/absence of RSW was evaluated presurgically on en face optical coherence tomographic images. The internal limiting membrane was peeled if RSW was identified. The main outcome measure was the prevalence of postsurgical epiretinal membrane growth that caused a visual decline of 0.2 or more in logarithm of the minimum angle of resolution unit. RESULTS: The internal limiting membrane was peeled for RSW appearance in 22 eyes (28.2%). Mild epiretinal membranes developed in 8 of the 56 internal limiting membrane-unpeeled eyes (10.3% of total, 6 eyes at stage 1 in the classification of Govetto); however, visual decline occurred in none of them with the mean visual acuity of these 8 eyes maintained at -0.08 ± 0.11 in logarithm of the minimum angle of resolution (≈20/16). CONCLUSION: Visual decline due to epiretinal membrane growth after rhegmatogenous retinal detachment repair was entirely prevented by peeling the internal limiting membrane in about 30% of cases selected for the presence of RSW.

Binding of Gtf2i-ß/δ transcription factors to the ARMS2 gene leads to increased circulating HTRA1 in AMD patients and in vitro.

The disease-initiating molecular events for age-related macular degeneration (AMD), a multifactorial retinal disease affecting many millions of elderly individuals worldwide, are still unknown. Of the over 30 risk and protective loci so far associated with AMD through whole genome-wide association studies (GWAS), the Age-Related Maculopathy Susceptibility 2 (ARMS2) gene locus represents one of the most highly associated risk regions for AMD. A unique insertion/deletion (in/del) sequence located immediately upstream of the High Temperature Requirement A1 (HTRA1) gene in this region confers high risk for AMD. Using electrophoretic mobility shift assay (EMSA), we identified that two Gtf2i-ß/δ transcription factor isoforms bind to the cis-element 5'- ATTAATAACC-3' contained in this in/del sequence. The binding of these transcription factors leads to enhanced upregulation of transcription of the secretory serine protease HTRA1 in transfected cells and AMD patient-derived induced pluripotent stem cells (iPSCs). Overexpression of Htra1 in mice using a CAG-promoter demonstrated increased blood concentration of Htra1 protein, caused upregulation of vascular endothelial growth factor (VEGF), and produced a choroidal neovascularization (CNV)-like phenotype. Finally, a comparison of 478 AMD patients to 481 healthy, age-matched controls from Japan, India, Australia, and the USA showed a statistically increased level of secreted HTRA1 blood concentration in AMD patients compared with age-matched controls. Taken together, these results suggest a common mechanism across ethnicities whereby increased systemic blood circulation of secreted serine protease HTRA1 leads to subsequent degradation of Bruch's membrane and eventual CNV in AMD.

Suicidal attempt with caffeine overdose treated with dexmedetomidine: a case report.

BACKGROUND: Caffeine is a widely used dietary stimulant, and cases of caffeine overdoses, sometimes leading to death, are increasing. We encountered a case of caffeine intoxication resolved with administration of the sedative agent dexmedetomidine. CASE PRESENTATION: We administered dexmedetomidine for sedation and to suppress sympathetic nerve stimulation in the case of an 18-year-old Japanese male who ingested a massive dose of caffeine with the intention of committing suicide. The patient was in an excited state and had hypertension, sinus tachycardia, and hypokalemia with prominent QT prolongation. After dexmedetomidine administration, the patient's mental state, hemodynamics, and electrolyte levels were improved immediately. He was discharged without any sequelae 3 days later. CONCLUSION: Cases of acute caffeine intoxication with agitation, sympathetic overactivity and adverse cardiac events would benefit with dexmedetomidine treatment.

VALIDITY AND EFFICACY OF INTERNAL LIMITING MEMBRANE PEELING DURING INITIAL VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT: VISUAL OUTCOMES IN MACULA-SPARING CASES.

PURPOSE: To compare the visual outcomes and prevalence of epiretinal membrane (ERM) growth postoperatively between eyes treated with and without internal limiting membrane peeling during vitrectomy for macula-sparing rhegmatogenous retinal detachment. METHODS: Fifty-five consecutive cases who underwent vitrectomy for macula-sparing rhegmatogenous retinal detachment were reviewed retrospectively. The inclusion criteria were a minimal 6-month follow-up postoperatively and spectral domain optical coherence tomographic images available at follow-up. Cases with any pre-existing macular condition possibly affecting the visual prognosis were excluded. All cases were divided into two groups: 22 cases without internal limiting membrane peeling (Group 1) and 33 cases with internal limiting membrane peeling (Group 2). The two groups were compared using the Mann-Whitney U test and Fisher exact test in terms of the best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution) before vitrectomy, postoperative BCVA, and the presence of postoperative ERM growth. Postoperative BCVA and ERM growth were determined at 6 months, 12 months, and the last visit. The visual outcomes were also analyzed between cases with and without postoperative symptomatic ERM growth, which caused visual impairment and required surgical removal. RESULTS: The mean postoperative BCVAs were 0.00, -0.08, and -0.08 logarithm of the minimum angle of resolution in Group 1, and -0.08, -0.08, and -0.08 logarithm of the minimum angle of resolution in Group 2 at 6 months, 12 months, and the last visit, respectively, and did not differ significantly between the 2 groups at each time point except for at 12 months (P = 0.027). An ERM developed in 14 cases in Group 1, 7 of which were symptomatic. No cases in Group 2 had ERM growth. The prevalence of ERM growth was significantly (P < 0.001) higher in Group 1 than Group 2. The BCVA was significantly worse at 6 months (P = 0.011), 12 months (P = 0.003), and the last visit (P = 0.019) in 7 cases with symptomatic ERMs (median, 0.30, 0.15, and 0.10 logarithm of the minimum angle of resolution, respectively) than in 48 cases without symptomatic ERMs (median, -0.08, -0.08, and -0.08 logarithm of the minimum angle of resolution, respectively). CONCLUSION: Internal limiting membrane peeling did not result in decreased visual acuity postoperatively in cases with a macula-sparing rhegmatogenous retinal detachment, and the procedure significantly prevented postsurgical ERM growth. Symptomatic ERMs led to decreased visual acuity even after surgical removal. These results support the validity and efficacy of internal limiting membrane peeling for preventing ERM growth after rhegmatogenous retinal detachment repair.

Prospective assessment of plate-haptic rotationally asymmetric multifocal toric intraocular lens with near addition of + 1.5 diopters.

BACKGROUND: To prospectively evaluate surgical results following implantation of rotationally asymmetric, plate-haptic, refractive segmented multifocal toric intraocular lenses (IOLs) with near addition of + 1.5 diopters (D) (Lentis Comfort LS-313 MF15T, Oculentis GmbH). METHODS: In 59 eyes of 41 patients, ocular examinations were conducted before and 1 day, 1 week, 1, 3, and 6 months after surgery. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity at 70 cm, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity at 30 cm were tested. A defocus curve was drawn, and the degree of disturbing photic phenomena were questioned. RESULTS: The IOL showed excellent rotational stability; the average absolute rotation was 1.66 ± 1.17 degrees from 1 day 1 to 6 months postoperatively, and 98.1 and 100% of eyes yielded rotation of less than 5 and 10 degrees, respectively. Postoperative distance and intermediate visual acuity were highly satisfactory; UDVA, CDVA, UIVA, and DCIVA were about 20/20, 20/16, 20/25, 20/25, respectively. Near visual acuity was suboptimal; UNVA and DCNVA were at approximately 20/60. The defocus curve analysis showed that 20/25 and 20/40 uncorrected visual acuity was attained at as close as 60 and 40 cm, respectively. Contrast sensitivity was within a normal range, and subjective photic phenomena were minimum. CONCLUSIONS: The refractive segmented, rotationally asymmetric multifocal toric IOLs with + 1.5 D near addition showed superb rotational stability and highly satisfactory distance and intermediate vision. Contrast sensitivity was high and incidence of photic symptoms was very low. TRIAL REGISTRATION: This study was registered at JAPIC Clinical Trials Information, ID: JapicCTI-183,877, https://www.clinicaltrials.jp/cti-user/trial/Search.jsp (February 5, 2018).

Refractive state and visual acuity of children with extremely low birth weight at 3 years old in Japan.

PURPOSE: To investigate the refractive status and visual acuity of 3-year-old children with extremely low birth weight (ELBW). STUDY DESIGN: Retrospective cohort study. METHODS: We examined 161 children born between January 2009 and December 2014. The children were divided into five groups for evaluation of visual acuity and refraction: no retinopathy of prematurity (ROP), reverse ROP, photocoagulation (PC) zone II (ZII), PC (ZI), and PC (ZI + lens-sparing vitrectomy [vit]). RESULTS: Median (1st quartile, 3rd quartile) gestational age was 25 (24, 26) weeks. Median birth weight was 738 (588, 846) g. Spherical equivalence (SE) was +0.38 (-0.06, +0.75) diopters (D) in no ROP, +0.63 (-0.25, +1.34) D in reverse ROP, +0.38 (-0.75, +1.31) D in PC (ZII), -3.31 (-8.06, +0.16) D in PC (ZI), and -12.00 (-13.50, -4.50) D in PC (ZI+ vit) children. Best corrected visual acuity (BCVA) in log MAR was 0.15 (0.07, 0.26) in no ROP, 0.17 (0.10, 0.30) in reverse ROP, 0.22 (0.10, 0.38) in PC (ZII), 0.45 (0.22, 0.55) in PC (ZI), and 1.10 (0.82, 1.30) in PC (ZI+ vit) children. There was a significant correlation between SE and BCVA (r = -0.43, p < 0.0001). CONCLUSION: The no ROP, reverse ROP, and PC (ZII) groups showed no significant differences in SE or BCVA, accounting for 79.5% of ELBW children. SE and BCVA in the PC (ZI) and PC (ZI+ vit) groups were worse than in the other groups. The current results reveal a correlation between SE and BCVA.

Change in optical axial length after cataract surgery: segmental method vs composite method.

PURPOSE: To compare the changes in axial length (AL) obtained after cataract surgery by partial coherence interferometry (PCI), swept-source optical coherence tomography with the composite method (SS-OCT/CM), and SS-OCT with the segmental method (SS-OCT/SM). SETTING: National Hospital Organization, Tokyo Medical Center, Japan. DESIGN: Retrospective case series. METHODS: AL was measured preoperatively and 1 month postoperatively by PCI, SS-OCT/CM, and SS-OCT/SM. RESULTS: Two hundred sixty-eight eyes in 139 patients who underwent cataract surgery were included. The mean ALs measured by PCI and SS-OCT/CM decreased significantly from 24.14 ± 1.58 to 24.05 ± 1.58 mm (P < .0001) and from 24.15 ± 1.58 to 24.05 ± 1.59 mm (P < .0001), respectively. The mean differences between the preoperative and postoperative AL were 0.083 ± 0.044 mm (PCI) and 0.096 ± 0.045 mm (SS-OCT/CM), respectively; Bland-Altman analysis revealed fixed bias between the preoperative and postoperative values. The mean preoperative and postoperative ALs measured by SS-OCT/SM were 24.12 ± 1.54 and 24.12 ± 1.54 mm, respectively (P = 0.97). The mean difference between the preoperative and postoperative ALs was 0.00 ± 0.03 mm on SS-OCT/SM; Bland-Altman analysis indicated good agreement between these values. CONCLUSIONS: The difference between preoperative and postoperative ALs is less with SS-OCT/SM than with PCI or SS-OCT/CM. Assuming that AL is not altered by cataract surgery, AL measurement is more accurate by SS-OCT/SM than by PCI or SS-OCT/CM.

Comparison of composite and segmental methods for acquiring optical axial length with swept-source optical coherence tomography.

This study compared the optical axial length (AL) obtained by composite and segmental methods using swept-source optical coherence tomography (SS-OCT) devices, and demonstrated its effects on the post-operative refractive errors (RE) one month after cataract surgery. Conventional AL measured with the composite method used the mean refractive index. The segmented-AL method used individual refractive indices for each ocular medium. The composite AL (24.52 ± 2.03 mm) was significantly longer (P < 0.001) than the segmented AL (24.49 ± 1.97 mm) among a total of 374 eyes of 374 patients. Bland-Altman analysis revealed a negative proportional bias for the differences between composite and segmented ALs. Although there was no significant difference in the RE obtained by the composite and segmental methods (0.42 ± 0.38 D vs 0.41 ± 0.36 D, respectively, P = 0.35), subgroup analysis of extremely long eyes implanted with a low power intraocular lens indicated that predicted RE was significantly smaller with the segmental method (0.45 ± 0.86 D) than that with the composite method (0.80 ± 0.86 D, P < 0.001). Segmented AL with SS-OCT is more accurate than composite AL in eyes with extremely long AL and can improve post-operative hyperopic shifts in such eyes.

Quantitative evaluation of digital-image enhancement during heads-up surgery.

Image-processing is an advantage of heads-up surgery and expected to facilitate ophthalmic surgeries. To evaluate image-processing quantitatively, we analyzed the surgical images of twenty eyes that underwent vitrectomy with internal limiting membrane (ILM) peeling assisted by Brilliant Blue G (BBG). Still images of the peeling procedure were obtained from the surgical video, and the color difference was calculated between two adjacent spots inside and outside the ILM-peeling contour, i.e., without and with BBG staining, respectively. The color differences were compared between the two settings with and without image-processing, delivered by an algorithm to enhance the color and contrast. Color differences were calculated using two methods: the Euclidean distance based on RGB values (RGB distance) and the Delta-E00 formula provided by the International Commission on Illumination. In five cases, minimum light intensities required to recognize the contour of ILM-peeling were compared during surgeries between the two settings with and without enhancement. Image-processing increased the mean color difference significantly (P < 0.001) from 15.47 and 4.49 to 34.03 and 8.00, respectively, for the RGB distance and Delta-E00. The minimum light intensity was reduced from 15 to 5 on average by image-enhancement. These results showed image-processing enhances color differences and reduces light intensities during vitrectomy.

One-year clinical evaluation of rotationally asymmetric multifocal intraocular lens with +1.5 diopters near addition.

We conducted a one-year prospective, multicenter study to assess clinical outcomes after implantation of segmented, rotationally asymmetric multifocal intraocular lenses (IOLs) with +1.5 diopters (D) near addition. In this phase III clinical trial, 120 eyes of 65 patients undergoing phacoemulsification and implantation of Lentis Comfort LS-313 MF15 (Oculentis GmbH) were included. The ophthalmological examinations were performed before and 1 day, 1 week, 1, 3, 6, 9, and 12 months after surgery. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity at 70 cm, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity at 30 cm were measured. A defocus curve was obtained and patients were asked about the severity of photic phenomena. Postoperative distance and intermediate visual acuity was excellent, with UDVA, CDVA, UIVA, and DCIVA of approximately 20/20, 20/16, 20/25, 20/25 were attained, respectively. The level of near visual acuity was lower; UNVA and DCNVA remained at around 20/60 and 20/70, respectively. The defocus curve indicated that postoperative uncorrected visual acuity of 20/25 and 20/40 was obtained at as close as 67 cm and 50 cm, respectively. Contrast sensitivity was within the normal range, with a minimal level of subjective symptoms and high patient satisfaction. The rotationally asymmetric multifocal IOLs with +1.5 D near addition provided excellent distance and intermediate vision, but near vision was not enough for reading small prints. Contrast sensitivity was high, with very low incidences of photic phenomena and a high level of patient satisfaction.

Impact of Bedside Tracheostomy on Procalcitonin Kinetics in Critically Ill Patients.

BACKGROUND: Critically ill patients are particularly vulnerable to invasive procedures and complications; however, tracheostomy is frequently performed in the intensive care unit (ICU). We analyzed the effects of tracheostomy on procalcitonin (PCT) kinetics and investigated whether PCT could reliably predict septic complications after tracheostomy. METHODS: We retrospectively identified 134 patients who underwent bedside tracheostomy during their ICU stay at a Japanese university hospital from October 2010 to December 2015. We extracted PCT data from the day of the procedure (day 0) to postoperative day 2 and defined alert PCT as a PCT level ≥0.5 ng/mL, which had not decreased from the previous day. We divided patients into the following groups: nonevent, aseptic complication, and septic complication. RESULTS: Twelve (9.2%) patients developed acute aseptic complications, and 12 (9.2%) patients developed septic complications. In the nonevent group, the PCT value decreased continuously in the initial PCT ≥ 0.5 ng/mL subgroup (P < .001, P <.001 for trend). In contrast, significant changes were not observed in the initial PCT < 0.5 ng/mL subgroup. Significant differences and an upward trend in alert PCT incidence rate existed between the groups (P < .001, P < .001 for trend): nonevent group, 5.5%; aseptic complication group, 41.7%; and septic complication group, 66.7%. In a multivariate linear regression model, septic complications were independently associated with PCT change at postoperative days 1 and 2 (adjusted ß = 3.58, P < .001; adjusted ß = 9.84, P < .001, respectively). Procalcitonin predicted septic complications more accurately than C-reactive protein, with the area under the receiver operating characteristic curves of 0.8 versus 0.63 (P = .058) and 0.91 versus 0.69 (P = .036) at postoperative days 1 and 2, respectively. CONCLUSION: Our results demonstrated that PCT was not elevated after uncomplicated surgical tracheostomy in critically ill patients.

Macular dysfunction in patients with macula-on rhegmatogenous retinal detachments.

AIMS: To assess macular function in patients with macula-on rhegmatogenous retinal detachments (RRDs) using focal macular electroretinography (FMERG). METHODS: This is a prospective, observational case series of 27 patients diagnosed with a macula-on RRD. Foveal attachment was confirmed on spectral-domain optical coherence tomography. Eyes with any macular disorder, cataract, vitreous opacity or vitreous haemorrhage were excluded. FMERG was recorded in the affected and fellow eyes using a round stimulus 15° in diameter. The status of four retinal factors in the affected eyes was examined, that is, the number of involved quadrants, number of quadrants with retinal breaks, presence of an RRD invading the vascular arcade, and presence of a giant retinal tear. The implicit time and amplitude of the a-wave, b-wave and oscillatory potentials (OPs) were compared between the affected and fellow eyes using Wilcoxon signed-rank test. The influence of the four retinal factors on each FMERG component of the affected eyes was also evaluated using Mann-Whitney U test and Kruskal-Wallis test. RESULTS: Significant reductions in the amplitudes of the a-waves (p=0.001), b-waves (p<0.001) and OPs (p=0.001) were observed in the affected eyes compared with the fellow eyes. There was no significant difference between the affected and fellow eyes in the implicit times of any components. None of the four retinal factors affected the parameters in the affected eyes. CONCLUSION: Altered FMERG responses suggested the presence of macular dysfunction in eyes with macula-on RRDs.

8K ultra-high-definition microscopic camera for ophthalmic surgery.

BACKGROUND: We have developed a new compact lightweight 8K ultra-high-definition (UHD; 7,680×4,320 pixels) camera and started medical application with an ophthalmic surgical microscope which is interchangeable with the conventional high-definition (1,920×1,080 pixels)/4K UHD (3,840×2,160 pixels) microscopic camera. METHODS: We did a feasibility study to apply our 8K UHD microscope in cataract surgery, glaucoma surgery and vitreous surgery using pig cadaver eyes. The 8K UHD microscope comprises a surgical microscope, a camera adaptor with relay lenses, an 8K UHD camera and an 8K UHD LCD to share the 8K UHD images with all surgical staff in real time. RESULTS: In ophthalmic surgeries, higher resolution images than conventional microscopic cameras were obtained with 8K UHD LCD equivalent to the observation through the microscopic eye pieces. CONCLUSION: Based on the results of this feasibility study, clinical trials on human ophthalmic surgery using the new 8K UHD microscopic camera should be conducted in the near future.

Advanced quantitative analysis of the sub-retinal pigment epithelial space in recurrent neovascular age-related macular degeneration.

To quantitatively evaluate changes in the sub-retinal pigment epithelial (RPE) space and determine the association with recurrent neovascular age-related macular degeneration (AMD). Twenty-two eyes treated with intravitreal aflibercept for treatment-naïve neovascular AMD were studied retrospectively. The sub-RPE area, volume, and central retinal thickness (CRT) were evaluated 1 and 2 months after the loading phase using spectral-domain optical coherence tomography. Recurrence was defined as newly detected neovascular activity during the 6 months after the loading phase. In eyes with recurrent AMD, the sub-RPE area increased significantly (P = 0.036) from 1 to 2 months after the loading phase and the sub-RPE volume increased marginally (P = 0.06). Subgroup analysis showed significant (P = 0.008 and P = 0.016, respectively) increases in the sub-RPE area and volume in typical AMD. In eyes with no recurrence, no significant changes occurred in the two parameters. No significant CRT changes occurred in eyes with or without a recurrence. A quantitative analysis demonstrated an increased likelihood of the sub-RPE space shortly after the loading phase in eyes with recurrent AMD; no changes occurred in eyes without a recurrence. These early changes in the sub-RPE space could indicate disease activity and are valuable for predicting recurrences of neovascular AMD.