ARTIFICIAL COSMETIC IRIS - POTENTIAL RISK OF VISUAL IMPAIRMENT. A CASE REPORT.

In this paper, the authors present a case report of a 46-year-old patient with decompensated pigmentary glaucoma and anterior uveitis after unilateral implantation of a BrightOcular artificial cosmetic iris (Stellar Devices, New York, USA). Postoperatively, there was a decrease of endothelial cells (ECD) down to 1216 cells/mm2, a uveal reaction in the anterior chamber and a significant decompensation of intraocular pressure (IOP). During the first examination at our clinic, the explantation of the artificial cosmetic iris was indicated. However, despite all warnings, the patient repeatedly refused this procedure. The patient later decided to undergo the artificial cosmetic iris explantation due to persistent elevation of IOP with intense eye pain. The cosmetic iris implant was removed almost five months after its implantation. Postoperatively, the anterior uveitis resolved, but there was a further decrease in ECD of 130 cells/mm2 and also an increase in IOP, despite maximal antiglaucoma therapy. Nearly one month after removal of the artificial cosmetic iris, the patient underwent implantation of the Express P50 drainage shunt (Alcon Inc, Fort Worth, TX, USA). After the drainage procedure, IOP was normalized and remained within physiological limits during the first year after surgery. Thereafter, there was a recurrence of elevated IOP, which subsided to normal, after initiation of a combination of two antiglaucoma therapies. Four years after surgery the eye was quiescent, ECD stationary, the optic nerve head was stable, and the visual field remained within the physiological norm. This case report highlights a potentially harmful procedure that is presented as a relatively safe alternative for an iris colour change, representing a deceptive marketing strategy for companies trading in these implants.

SPECIFIC CORNEAL PARAMETERS AND VISUAL ACUITY CHANGES AFTER CORNEAL CROSSLINKING TREATMENT FOR PROGRESSIVE KERATOCONUS.

AIM: To evaluate the effect of crosslinking (CXL) therapy on the change in the quality of visual acuity and the change in the topographic properties of the cornea - curvature, pachymetry, and change of astigmatism, coma abberation and CLMIaa (Cone Localisation and Magnitude Index). METHODS: A retrospective analytical study included 29 eyes of 24 patients who had progressed in the last 12 months and were suitable candidates for CXL surgery. The monitored parameters were the steepest, flatest and mean anterior instantaneous curvature (AICS, AICF, AICM) and the steepest, flatest and mean posterior instantaneous curvature (PICS, PICF, PICM) of the cornea, corneal thickness in the centre of the cornea (PACHC) and in the thinnest point of the cornea (PACHT), corneal astigmatism (ASTIG). coma (COMA), Cone Localization and Magnitude Index (CLMIaa) and uncorrected distance visual acuity (UDVA) with corrected distance visual acuity (CDVA). Data were analysed before surgery and 12 months after surgery. The AIC, COMA, CLMIaa and ASTIG parameters were analysed by paired t test. As the parameters of UDVA, CDVA, PIC and PACH did not meet the conditions of normal distribution, the Wilcoxon test was used to investigate the change in these parameters after CXL. RESULTS: Twelve months after the procedure, we recorded an improvement in UDVA (p = 0.371) and CDVA (p = 0.825), an increase in PICS, PICF and PICM (p = 0.902; p = 0.87 and p = 0.555), a decrease in PACHCC (p = 0.294) and a decrease in CLMIaa (p = 0.113) that did not reach statistical significance. The decrease in PACHT (p = 0.027), decrease in COMA (p = 0.037) and decrease in anterior corneal curvature of AICS, AICF and AICM were statistically significant (p = 0.019; p = 0.010 and p = 0.005). The decrease in the value of astigmatism did not show statistical significance, as p = 0.297. CONCLUSION: CXL corneal therapy has been shown to be an effective method to stabilize the cornea in progressive keratoconus, and to improve the higher order of coma. This contributes to the possible improvement of UDVA and CDVA.

Virtiol - Simulation of Quality of Vision with Multifocal and Edof Intraocular Lenses.

Pupose: To experimentally compare the visual acuity and the subjective perception of different types of multifocal intraocular lenses (IOL) using a VirtIOL device/simulator in a group of volunteers with artephakia. MATERIAL AND METHODS: This was an experimental study involving a total of 20 volunteers with artephakia (35 eyes). Each volunteer rated 5 types of IOLs, 4 presbyopia-correcting IOLs - WIOL-CF, Tecnis Symphony ZXR00, Acrysof IQ PanOptix TFNT00, M-flex 630 F, and as a reference lens, we used the monofocal IOL Acrysof SA60AT. The corrected distance visual acuity (CDVA), distance corrected intermediated visual acuity (DCIVA) and distance corrected near visual acuity (DCNVA) were measured. Additionally, volunteers evaluated the quality of vision under normal or changed lighting conditions, and ranked IOL on scale from 1 to 5. RESULTS: The CDVA evaluated using the VirtIOL device was very good for all tested IOLs (0.04-0.09 log MAR) with minimum differences. However, CDVA without simulator (-0.01 logMAR) was statistically significantly better in all cases. DCIVA was also very similar in each of the investigated IOLs, surprisingly even with monofocal IOL (0.21-0.23 logMAR), without using simulator the DCIVA was statistically significantly worse (0.36 logMAR). The DCNVA was the best for PanOptix intraocular lens (0.22 logMAR); M-flex, Symphony and WIOL-CF lenses had comparable results (0.31-0.34 logMAR). Again, surprisingly similar results were obtained with the use of monofocal IOL (0.36 ± 0.14). Subjective perception of vision through the IOLs was best rated for the monofocal control IOL, whereas Symphony, WIOL-CF and M-flex did not show any statistically significant difference either with or without glare. All tested IOLs were statistically significantly better if compared to PanOptix with or without glare. CONCLUSION: Simulation of vision through IOLs using VirtIOL simulator allows to compare different models of multifocal IOLs from the viewpoint of visual acuity and subjective perception. However, some caution should be exercised when evaluating the results, given that in our experiments, the monofocal IOL achieved relatively good results at near distance, which does not correspond to clinical experience. On the contrary, from the comparison of the results of CDVA without and with VirtIOL, it is obvious that visual acuity is slightly adversely affected by added optics.

Longitudinal decline in autopsy-defined frontotemporal lobar degeneration.

BACKGROUND: The natural history of patients with pathologically proven frontotemporal lobar degeneration (FTLD) is important from clinical and biologic perspectives, but is not well documented quantitatively. METHODS: We examine longitudinal decline in cognitive functioning in an autopsy-proven cohort of patients with the clinical diagnosis of a FTLD spectrum disorder or FTLD pathology using a panel of neuropsychological measures. Patients are categorized according to findings at autopsy into tau-positive FTLD, tau-negative FTLD, and frontal variant-Alzheimer disease (fvAD) subgroups. RESULTS: Patients decline significantly over time on all neuropsychological measures. Moreover, several measures differentiate between histopathologically distinct subgroups throughout the course of the disease process. This includes a significant double dissociation involving relative difficulty on a visual constructional measure in tau-positive patients compared to relatively impaired visual confrontation naming in tau-negative patients. Longitudinal measures of FAS naming fluency and animal naming fluency also distinguish tau-positive patients and tau-negative patients with FTLD from patients with fvAD. Other measures show significant decline but do not distinguish between histopathologic groups longitudinally. CONCLUSION: Our findings suggest different longitudinal patterns of cognitive decline in pathologically defined subgroups of patients. Measures consistently distinguishing between patient subgroups can be used to bolster diagnostic accuracy throughout the course of these diseases, while measures demonstrating undifferentiated longitudinal decline may serve as useful endpoints in treatment trials.

A survey of anthelmintic resistance in Slovakia.

A survey of prevalence of anthelmintic resistant nematode strains was carried out in 77 sheep farms in the Slovak Republic. An egg hatch assay was used for the detection of resistance to the benzimidazole group of anthelmintics. Results could not be obtained from five farms because of low egg counts in faecal samples. On 64 farms, the effective dose (ED50) values were under 0.1 microgram ml-1 while on six farms, trichostrongylid populations with resistance to benzimidazoles were found. Their ED50 values ranged from 0.10 to 0.12 microgram ml-1.

[Anthelmintic control of multiresistant nematodes in the gastrointestinal tract of imported goats]. / Antihelmintické ovplyvnenie polyrezistentných nematódov gastrointestinálneho traktu u importovaných kôz.

Multiple resistant strains of Ostertagia and Trichostrongylus were detected in a flock of cashmere and angora goats imported from New Zealand. The ED50 values detected by in vitro EHA test were from 0.27 to 0.36 micrograms/ml (while the reference value of sensitivity is 0.10 microgram/ml TBZ). Multiple resistance to all the types of currently used anthelmintics was confirmed by in vivo FECRT, when the efficacy of recommended doses was lower than 90% (albendazole 74%, levamisole 86%, ivermectin 83%). Two control schemes were investigated. In the simultaneous application of anthelmintics in the double or triple of recommended doses (0.4 mg/kg ivermectin s.c., 30 mg/kg levamisole and 20 mg/kg albendazole p.o.) was effective. Examination of goats 7 and 8 months after treatment revealed the repeated presence of multiple resistant gastrointestinal nematodes. It is the first published case of intercontinental transfer of resistant strains of nematodes when importing small ruminants.

Effect of a controlled-release albendazole capsule on parasitism and productivity of sheep.

The efficacy of intraruminal albendazole (ABZ) capsules (Profitril-Captec) and the effect of treatment on productivity were studied in 300 ewes infected with gastrointestinal nematodes and the trematode Dicrocoelium dendriticum. Coprological tests revealed that treated animals remained negative for 10 weeks after the administration of capsules. Contamination of pasture with nematode larvae was significantly reduced during the whole experiment. Necropsy of 14 animals (seven treated and seven untreated) showed 96.9-99.2% efficacy against the nematodes Nematodirus spp., Oesophagostomum spp., Cooperia spp., Trichostrongylus spp. and Trichuris ovis, while efficacy was 88.5% against D. dendriticum. During the 6 month pasture season (May-October 1989), treated ewes produced on average 2.56 kg cheese and 0.6 kg wool per ewe more than untreated controls. Our study confirms the reliability of the ABZ slow-release capsules over 90 days and the positive effect of treatment on nematode contamination of pasture and ewe productivity.

Combined nasal intermittent positive-pressure ventilation and rocking bed in chronic respiratory insufficiency. Nocturnal ventilatory support of a disabled person at home.

The use of intermittent positive-pressure ventilation via nasal mask with a rocking bed provided the necessary ventilatory support for a person with quadriplegia living at home. This option was required to maintain an independent life-style of choice. The combination of techniques and the linkage of devices demonstrated an effective use of simple available technology for respiratory care at home and the adaptation of the respiratory prescription to the total needs of each person: medical, social, and financial. The further use of nasal mask ventilation in selected cases is encouraged by clinical research protocol.

Some considerations with regard to the first results about volatile nitrosamine contents in some Cuban foods.

The volatile nitrosamine contents in some samples of Cuban beer and canned meat products are reported. Only dimethylnitrosamine in very low concentrations was detected. The significance of these results and the relative necessity to extend research works in this field are discussed.