Pupil size measurements with a multifunctional aberrometer/coherence interferometer/tomographer and two infrared based pupillometers.

PURPOSE: To compare precision of pupil size measurements of a multifunctional device (Pentacam AXL Wave (OCULUS; abbreviated as Pentacam) and two infrared based pupillometers (PupilX (Albomed), Colvard (Oasis medical)) and to compare repeatability of Pentacam and PupilX. SETTING: Department of Ophthalmology, Goethe-University, Frankfurt, Germany. DESIGN: Prospective, comparative trial. METHODS: Pupil diameter of healthy eyes was measured with Colvard once and Pentacam without (WO) and with glare (WG), PupilX in 0, 1 and 16 lux three times each. In a second series measurements with Pentacam WO and PupilX in 0.06 and 0.12 lux were assessed. RESULTS: 36 eyes of participants aged 21-63 years were included. Mean pupil diameter was 6.05 mm with Colvard, 5.79 mm (1st series), 5.50 mm (2nd series) with Pentacam WO, 3.42 mm WG, 7.26 mm PupilX in 0, 4.67 mm 1, 3.66 mm 16, 6.82 mm in 0.06 and 6.39 mm in 0.12 lux. Measurements with Pentacam WO were significantly different to PupilX in 0, 0.06, 0.12 and 1 lux (all p<0.001), but not to Colvard (p=0.086). Pupil size measured with Pentacam WG and PupilX in 16 lux was not significantly different (p=0.647). Consecutive measurements with Pentacam WO and WG had mean standard deviation of 0.23 and 0.20 mm respectively and with PupilX 0.11 in 0, 0.24 1 and 0.20 mm in 16 lux. CONCLUSIONS: Pentacam provided good assessment of pupil size, but was not equivalent to PupilX in low lighting conditions. Repeatability was more favourable for Pentacam.

Paternal bonding is influenced by prenatal paternal depression and trait-anxiety.

BACKGROUND: Even though the development of an emotional bond to the child involves both parents, studies on the development of paternal bonding and the influencing factors are scarce. This pilot study examines the quality of paternal postnatal bonding in association with paternal depressive and anxiety symptoms before and after birth. Methods: Expecting parents (n = 81) were recruited from maternity services in Frankfurt, Germany. At recruitment and 3 months postpartum (pp) mothers and fathers completed an interview including sociodemographic and pregnancy data. Depressive and anxiety symptoms were screened using the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. At 3-month pp, fathers also completed the Postpartum Bonding Questionnaire for the assessment of bonding difficulties. A total of 63 couples, from whom data were available for both time points, were included in the final study group. RESULTS: Depressive and anxiety symptoms before birth are the best predictors for the quality of paternal bonding pp (Total score R2 .402 p = .001; Impaired bonding R2 .299 p = .019; Rejection and Anger R2 .353 p = .005; Anxiety about care R2 .457 p = .000). Maternal depression and sociodemographic variables were not significantly associated. LIMITATIONS: High selected small study group. CONCLUSIONS: Paternal depressive and anxiety symptoms during pregnancy are highly predictive for the quality of bonding as well as for the presence of depressive and anxiety symptoms 3 month pp. It is necessary to identify these symptoms as soon as possible in order to prevent later negative impacts on parental mental health and on child developmental outcomes.

The impact of perinatal brain injury on retinal nerve fiber layer thickness and optic nerve head parameters of premature children.

PURPOSE: This study aims to evaluate the impact of birth weight (BW), gestational age (GA), retinopathy of prematurity (ROP), and perinatal brain injury (PBI) on optic nerve head (ONH) parameters and nerve fiber layer thickness (RNFLT) in preterm children. METHODS: ONH parameters and RNFLT were examined prospectively in 5-15-year-old preterm and full-term children with RTVue-100 OCT (Optovue, USA). The parameters of the two groups were compared and possible influences of BW, GA, ROP, and PBI analyzed in preterm children. RESULTS: In total, 51 full-term and 55 preterm children were included. The mean age was 9.98 ± 3.4 years in full-term and 10.0 ± 2.5 years in preterm children. The mean GA in preterm children was 29.6 ± 3.8 weeks with a BW of 1523 ± 732 g. RNFLT was significantly lower in preterm than in full-term children in all but temporal quadrants. Cup area, volume, cup/disc area ratio, and horizontal cup/disc ratio (CDR) were significantly larger and rim area significantly thinner in preterm children. GA was positively correlated with superior, nasal, and overall RNFLT and negatively correlated with cup area, volume, and horizontal CDR. ROP stage correlated negatively with superior and nasal RNFLT. PBI was the only significant predicting factor for RNFL thinning in all but temporal quadrant in multiple regression analysis. Preterm children with PBI had a significantly larger optic cup (CDR 0.70 ± 0.33 vs. 0.37 ± 0.27) and thinner optic rim. CONCLUSION: PBI correlated strongest with RNFL thinning, a thinner optic rim, and a larger optic cup in preterm children and should be evaluated in each patient to prevent incorrect diagnosis like glaucoma.

Sudden vision loss and neurological deficits after facial hyaluronic acid filler injection.

BACKGROUND: The ongoing expansion of the cosmetic armamentarium of facial rejuvenation fails to uncover the inherent risks of cosmetic interventions. Informed consent to all risks of cosmetic filler injections and potential sequelae, including ocular and neurological complications, should be carefully ensured. We present two cases of complications following facial hyaluronic acid filler injections. CASE PRESENTATIONS: Case 1: A 43-year-old woman presented with monocular vision loss of the left eye, associated ptosis, ophthalmoplegia, periocular pain and nausea, cutaneous changes of the glabella region and forehead, and sensory impairment in the left maxillary branch dermatome (V2) after receiving a hyaluronic acid (HA) filler injection into the left glabellar area. On ophthalmological examination, an ophthalmic artery occlusion (OAO) was diagnosed upon identification of a "cherry-red spot". Magnetic resonance imaging (MRI) revealed a left ischemic optic neuropathy. Supportive therapy and hyaluronidase injections were initiated. A follow-up MRI of the head performed two months after presentation corresponded to stable MRI findings. The patient had irreversible and complete vision loss of the left eye, however, the ptosis resolved. Case 2: A 29-year-old woman was admitted to hospital a few hours after a rhinoplasty and cheek augmentation with hyaluronic acid, presenting with acute monocular vision loss in the right eye, retrobulbar pain, fatigue and vomiting. In addition, the patient presented a harbinger of impending skin necrosis and a complete oculomotor nerve palsy on the right side, choroidal ischemia and vision impairment. Supportive treatment and hyaluronidase injections into the ischemic tissue were initiated. A small scar at the tip of the nose, vision impairment and an irregular pupillary margin on the right side persisted at follow-up. CONCLUSION: These two case reports and the literature review emphasize the pathophysiological mechanisms leading to potentially devastating complications. In order to reduce the risk of vision loss secondary to cosmetic filler injections, practitioners should possess a thorough knowledge of anatomy and preventive strategies.

Ophthalmic artery occlusion after glabellar hyaluronic acid filler injection.

PURPOSE: Filler injections for aesthetic purposes are very popular, but can have far-reaching and irreversible consequences. This report describes the course of a patient with devastating complications after glabellar hyaluronic acid injection, their pathomechanism, management and outcome. OBSERVATIONS: A healthy, 43-year-old woman underwent her first hyaluronic acid injection in the glabella and went blind on her left eye immediately thereafter. Massaging of the injection area and observation were performed, before she presented with swelling of the left forehead and upper lid, ptosis, complete ophthalmoplegia and blindness in our hospital. Immediate massaging of the globe and systemic therapy including acetylsalicylic acid, tinzaparin sodium and cortisone was initiated and hyaluronidase injections in the injection area were performed. In the further course, the patient developed necrotic and hemorrhagic skin and mucosal lesions, lagophthalmos, anterior and posterior segment ischemia and globe hypotonia with consecutive globe deformation. In the follow-up of 2.5 months, lid swelling, lagophthalmos and ptosis resolved and keratopathy improved but blindness, skin lesions and strabismus with reduced eye motility were still present and madarosis and early enophthalmos were detected. CONCLUSIONS AND IMPORTANCE: The outcome of ophthalmic artery occlusion after hyaluronic acid filler injection is poor. Sufficient knowledge about facial anatomy, the implementation of filler injections and the management of complications is essential for the practitioner. The patient should be clarified about potential and even rare risks of these procedures.

A pilot study of multilevel analysis of BDNF in paternal and maternal perinatal depression.

Depression in the perinatal period is common in mothers worldwide. Emerging research indicates that fathers are also at risk of developing perinatal depression. However, knowledge regarding biological risk factors and pathophysiological mechanisms of perinatal depression is still scarce, particularly in fathers. It has been suggested that the neurotrophin BDNF may play a role in maternal perinatal depression; however, there is currently no data regarding paternal perinatal depression. For this pilot study, 81 expecting parents were recruited and assessed at several time points. We screened for depression using EPDS and MADRS, investigated several psychosocial variables, and took blood samples for BDNF val66met genotyping, epigenetic, and protein analysis. Between pregnancy and 12 months postpartum (pp), we found that 3.7 to 15.7% of fathers screened positive for depression, and 9.6 to 24% of mothers, with at least a twofold increased prevalence in both parents using MADRS compared with EPDS. We also identified several psychosocial factors associated with perinatal depression in both parents. The data revealed a trend that lower BDNF levels correlated with maternal depressive symptoms at 3 months pp. In the fathers, no significant correlations between BDNF and perinatal depression were found. Pregnant women demonstrated lower BDNF methylation and BDNF protein expression compared with men; however, these were found to increase postpartum. Lastly, we identified correlations between depressive symptoms and psychosocial/neurobiological factors. The data suggest that BDNF may play a role in maternal perinatal depression, but not paternal.

Posterior continuous curvilinear capsulorhexis with anterior vitrectomy vs optic capture buttonholing without anterior vitrectomy in pediatric cataract surgery.

PURPOSE: To investigate long-term complications after pediatric cataract surgery with implantation of a heparin-coated polymethyl methacrylate intraocular lens (PMMA IOL) and posterior continuous curvilinear capsulorhexis (PCCC) with anterior vitrectomy vs PCCC without anterior vitrectomy with optic capture buttonholing. SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Prospective randomized clinical trial. METHODS: Eyes with unilateral or bilateral congenital cataract without further pathologies or former surgeries were randomly assigned in 2 groups: cataract removal, IOL implantation, and PCCC with anterior vitrectomy (group A) or posterior optic buttonholing without anterior vitrectomy (group B). The main outcome measures were posterior capsule opacification (PCO), complication rates, and refractive development. RESULTS: 58 eyes of 41 pediatric cataract surgery patients were included. The mean age at the time of operation was 66.05 months (±29.39). In group A (n = 26), 2 eyes required treatment for PCO, whereas the optic axis remained clear in all eyes in group B (n = 30), which was statistically insignificant. In addition, group B had a slightly lower rate of complications. The mean spherical equivalent after a mean postoperative follow-up of 6.5 years was -0.11 ± 2.51 diopters (D) (-5.0 to +4.0 D) in group A and -0.08 ± 2.14 D (-5.0 to +4.0 D) in group B, which was also statistically insignificant. CONCLUSIONS: Optic capture with a heparin-coated PMMA IOL proved to be a safe technique in the prevention of secondary cataract formation without a higher rate of complications and the necessity of vitrectomy.