Vision-related Quality of Life after Bilateral Implantation of Monofocal and Multifocal Intraocular Lenses

Purpose

To evaluate vision-related quality of life in two sets of patients after routine cataract surgery implanting with traditional versus multifocal intraocular lens (IOLs).

Methods

In a cross-sectional prospective study, 58 and 33 candidates for cataract surgery were divided into traditional (Acrysof SN60WF, Alcon Laboratories, Inc) and multifocal IOL (AcrySof IQ PanOptix IOL TFNT00, Alcon Laboratories, Inc.) groups, respectively. The primary outcome was VFQ-25 scores. The secondary outcomes were making comparisons between the two IOL types in the near vision and the driving items.

Results

mean patients' age in traditional and multifocal IOL groups was 60.85 ± 7.40 (55% female) and 59.85 ± 8.95 (36% female) years, respectively. The mean VFQ-25 total scores in traditional and multifocal IOL groups before and after surgery were 63.69 ± 4.95 and 72.15 ± 9.66, and 98.08 ± 0.70 and 95.70 ± 1.30, respectively (P = 0.001 & 0.001). The mean scores of night driving in traditional and multifocal IOL groups were 38.79 ± 20.50 and 44.35 ± 21.12 (P = 0.1) before surgery which improved to 97.41 ± 7.68 and 56.45 ± 11.12 after surgery, respectively (P = 0.001). The mean scores of near vision in traditional and multifocal IOL groups were 46.83 ± 10.56 and 50.53 ± 8.58 (P = 0.2) before surgery which improved to 89.94 ± 4.87 and 100.00 ± 0.00 after surgery, respectively (P = 0.001).

Conclusion

Vision-related quality of life after cataract surgery with either type of traditional or multifocal (PanOptix) IOLs improved to an excellent level. Traditional IOLs provided more satisfaction in nighttime driving while multifocal IOLs provided increased satisfaction in near and intermediate vision.

Comparison between bilateral implantation of a trifocal intraocular lens (Alcon Acrysof IQ® PanOptix) and extended depth of focus lens (Tecnis® Symfony® ZXR00 lens)

PURPOSE

To compare the visual performance outcomes following bilateral cataract surgery using trifocal intraocular lens (Alcon Acrysof IQ® PanOptix) and extended depth of focus lens (Tecnis® Symfony® ZXR00 lens).

METHODS

In this prospective, non-randomized, comparative trial, a total of 40 subjects (80 eyes) were divided into two different groups and submitted to bilateral cataract surgery and implantation of the two different IOLs, Alcon Acrysof IQ® PanOptix® TNFT00 in group A and Tecnis® Symfony® ZXR00 lens (Johnson & Johnson Vision) in group B, was assessed. The uncorrected and corrected near (33 cm), intermediate (60 cm), and far (4 m) binocular visual acuity was measured, and visual binocular defocus curves were also measured in the photopic condition with a long-distance visual acuity and the qualitative visual function was assessed by NEI VFQ-25.

RESULTS

Group A comprised 20 patients; 11 women (55%) and 9 men (45%) with a mean age of 62.1 ± 5.4. In group B 20 patients were recruited; 12 women (60%) and 8 men (40%) with a mean age of 63.2 ± 6.1. The postoperatively calculated mean sphere was + 0.35 ± 0.12 D and - 0.14 ± 0.13 D in groups A and B, respectively. The postoperative uncorrected distance visual acuity (UDVA) as well as uncorrected intermediate visual acuity (UIVA) were statistically equal in both groups (P = 0.12, P = 0.17); meanwhile, the postoperative uncorrected near visual acuity (UNVA) was significantly better in patients with PanOptix IOL implantation (P = 0.01) compared to the binocular defocus curve; the results of the PanOptix group were better than the Symfony group in intermediate and near distance (P = 0.089, P = 0.001) and according to the VFQ-25 questionnaire, then ear vision score as well as sum score turned out to be significantly higher in groups A than B (P = 0.001 and P = 0.015, respectively).

CONCLUSION

Both strategies were able to provide good vision for far, intermediate and near distances.

The Argus-II Retinal Prosthesis Implantation; From the Global to Local Successful Experience

Over the past few years, visual prostheses (namely, Argus II retinal implant) and gene therapy have obtained FDA approval in treating blindness resulting from retinitis pigmentosa. Compared to gene therapy; Argus II is less costly with a demonstrated favorable outcome, though the vision is yet artificial. To obtain better results, expectation counseling and preoperative retinal assessment are critical. The global experience with Argus II has enrolled no more than 300 cases so far. The first Argus II retinal prosthesis in Iran was successfully implanted in Shiraz (October 2017). To date, Argus II artificial retina is implanted in four patients in Iran. Beside successful surgery and post-operative care, rehabilitation efforts with validated outcome measures including visual rehabilitation together with neurovisual, visuo-constructive and cognitive rehabilitation/empowerment approaches are expected to boost the functional outcome. A multidisciplinary approach within a cross-functional team would optimize strategies toward better patient outcomes. As such, establishing a collaborative network will foster organized research efforts to better define outcome assessment and rehabilitation strategies. This technology report paper has been an attempt to provide an overview of Argus-II retinal implant global experience as well as the clinical outcome of the so far cases in Iran. Insights from this report were communicated during the first “Brain Engineering and Computational Neuroscience Conference,” 31 January-2 February 2018 in Tehran.

Outcomes of Light Silicone Oil Tamponade for Failed Idiopathic Macular Hole Surgery

Purpose:

To study the outcomes of redo macular hole surgery using light silicone oil tamponade.

Methods:

In this study, medical charts of consecutive patients who underwent redo pars plana vitrectomy, extended dye-assisted internal limiting membrane peel, and light silicone oil tamponade for failed previous macular hole surgery (from January 2010 to June 2014) were retrospectively reviewed. Best spectacle corrected visual acuity and anatomical closure rates were regarded as outcome measures.

Results:

Overall, data from 13 patients was recorded and analyzed. The mean (±SD) age of patients was 66 ± 7 years, and four (30.7%) were male. Mean interval between the primary and redo surgeries was 3.7 ± 2.0 months (range, 1 to 8 months). During redo surgeries, 11 (84.6%) subjects underwent additional internal limiting membrane peeling. Mean interval between the redo surgery and silicone oil removal was 5.9 ± 2.1 months (range, 3 to 10 months). After silicone oil removal, patients were followed for 21.8 ± 14.2 months (range, 3 to 51 months). Mean best spectacle corrected visual acuity improved from 20/452 before redo surgery to 20/121 in the last follow-up examination (P < 0.001). Anatomical success was achieved in 11 (84.6%) patients: nine (69.2%) macular holes were closed and two (15.4%) were flat-open.

Conclusions:

Redo pars plana vitrectomy with light silicone oil tamponade is an effective method for restoration of macular anatomy and function in patients with persistent macular holes.

Outcomes of photorefractive keratectomy in patients with atypical topography

Background

Photorefractive keratectomy (PRK) is at risk of serious complications such as corneal ectasia, which can reduce corrected distance visual acuity. The rate of complications of PRK is higher in patients with atypical topography.

Objective

To determine the outcomes of photorefractive keratectomy in patients with atypical topography.

Methods

This cross-sectional study was done in 2015 in Shiraz in Iran. We included 85 eyes in this study. The samples were selected using a simple random sampling method. All patients were under evaluation for uncorrected distance visual acuity, corrected distance visual acuity, manifest refraction, corneal topography, central corneal thickness using pentacam, slit-lamp microscopy, and detailed fondus evaluation. The postoperative examination was done 1–7 years after surgery. Data were analyzed using IBM SPSS 21.0 version. To analyze the data, descriptive statistics (frequency, percentage, mean, and standard deviation), chi-square, and independent samples t-test were used.

Results

We studied 85 eyes. Among the patients, 23 (27.1%) were male and 62 (72.9%) were female. Mean age of the participants was 28.25±5.55 years. Mean postoperative refraction was – 0.37±0.55 diopters. Keratoconus or corneal ectasia was not reported in any patient in this study. There was no statistically significant difference between SI index before and after operation (p=0.736). Mean preoperative refraction was −3.84 ± 1.46 diopters in males and −4.20±1.96 diopters in females; thus there was not statistically significant difference (p = 0.435).

Conclusion

PRK is a safe and efficient photorefractive surgery and is associated with low complication rate in patients with atypical topography.

The Association of Serum Leptin Level and Anthropometric Measures With the Severity of Diabetic Retinopathy in Type 2 Diabetes Mellitus

This study was performed to determine the association amongst serum leptin level and anthropometric measures with the severity of Diabetic Retinopathy (DR) in subjects with type 2 Diabetes Mellitus (DM). This case-controlled study was conducted within a one-year period, during year 2016, at outpatient retina ophthalmology clinics of Shiraz, southern Iran. Eighty-three patients with type 2 DM, referring for ophthalmoscopy evaluation, were included. Anthropometric measures, serum leptin level, and baseline laboratory assessment was performed for all subjects. Patients were categorized as group 1, consisting of patients with severe Non-Proliferative Diabetic Retinopathy (severe NPDR) and Proliferative Diabetic Retinopathy (PDR) (n = 44), and group 2, consisting of patients without Diabetic Retinopathy (no DR) or mild/moderate NPDR (n = 39). The serum leptin level and anthropometric measures were compared between the two study groups. The correlation between these variables was also assessed. The mean age of the participants was 59.3 ± 6.9 years old. The two study groups were comparable regarding baseline characteristics. Cases of group 1 had significantly higher Erythrocyte Sedimentation Rate (ESR) (P = 0.049) and Systolic Blood Pressure (P = 0.025) when compared with those of group 2. The serum level of leptin was found to be significantly higher in cases of group 1 when compared to those of group 2 (P = 0.003). However, anthropometric measures, including Body Mass Index (BMI) (P = 0.167), Body Adiposity Index (BAI) (P = 0.061), and Waist to Hip Ratio (WHR) (P = 0.220) were comparable between the two study groups. Serum leptin level was positively correlated with BMI (r = 0.819; P < 0.001) and BAI (r = 0.630; P < 0.001) in group 1. Increased serum levels of leptin were associated with advanced stages of DR in subjects with type 2 DM. Serum leptin level might be a better indicator of the effects of obesity on DR, compared to anthropometric measures (BAI or BMI).

Long-term effects of intravitreal infliximab for treatment of sight-threatening chronic noninfectious uveitis

PURPOSE

This study aimed to evaluate the safety and long-term effects of infliximab on chronic noninfectious uveitis with measuring best corrected visual acuity (BCVA) and central macular thickness (CMT).

METHOD

Ten eyes of 7 patients were included in this prospective case series. All the patients had noninfectious anterior and posterior uveitis that was unresponsive to conventional treatments for 3 months. About 1.5 mg of infliximab in 0.15 cc was injected intravitreally and the patients were followed for 6 months. BCVA was measured by Snellen chart and grading of vitritis was measured according to binocular indirect ophthalmoscope score before injection, 4 weeks, 3 months, and 6 months after the injection. CMT was measured 1 day before injection and compared with the same factors 4 weeks and 6 months after the injection.

RESULTS

Mean of LogMAR before injection was 1.37±0.43 that changed to 0.67±0.55 and 1.38±0.36 one month and 6 months after the injection, respectively. Mean CMT before injection was 673.2±338.39 that changed to 456.4±317.46 and 659.3±342.48, 4 weeks and 6 months after the injection, respectively. Mean vitreous haziness grade before injection, 4 weeks, 3 months, and 6 months after the injection was 2.7, 0.95, 2.3, and 2.6, respectively.

CONCLUSIONS

Intravitreal Infliximab may be used in treatment of noninfectious uveitis. It probably improves the vision and decreases the macular edema but its effect is temporary and repeated injections may be needed to achieve the best therapeutic goal.

Intravitreal infliximab in experimental endotoxin-induced uveitis

PURPOSE

Tumor necrosis factor-alpha (TNF-alpha) plays a central role in the pathogenesis of ocular inflammation and the level of TNF-alpha is increased in ocular fluids of patients with uveitis. Intravenous infliximab, a monoclonal antibody against TNF-alpha, has been used for the treatment of uveitis with promising preliminary results. The aim of this study was to evaluate the effect of intravitreal injection of infliximab on experimental uveitis.

METHODS

Thirty-three white New Zealand rabbits were divided randomly into three groups. Group 1 (n=5) received intravitreal injection of 1 mg/0.1 cc infliximab plus 0.1 cc normal saline, group 2 (n=14) received intravitreal injection of 2 microg Salmonella typhimurium endotoxin plus 1 mg/0.1 cc infliximab, and group 3 (n=14) animals received intravitreal endotoxin 2 microg/0.1 cc plus normal saline 0.1 cc. Inflammation was evaluated by clinical examinations on days 1, 3, 5, and 7 after the injections; measuring the protein concentration and inflammatory cell content of the aqueous humor; and histopathologic examination.

RESULTS

No inflammation occurred in group 1 animals. There was a statistically significant difference between group 2 and 3 animals with regard to clinical examination on the third, fifth, and seventh postinjection days. The differences between groups 2 and 3 were significant with regard to aqueous cell counts and protein content at day 7 (p=0.02 and p=0.001, respectively). Histopathologic examination results showed less inflammation in group 2 animals compared to group 3 animals (p=0.009).

CONCLUSIONS

The results provide evidence that intravitreal injection of infliximab suppresses ocular inflammation in a rabbit model of severe endotoxin-induced uveitis.

Ultrasonographic pictures of intravitreal triamcinolone acetonide

PURPOSE

To evaluate ultrasonographic pictures of intravitreal triamcinolone acetonide (IVTA).

METHODS

Twenty-eight eyes from 28 patients who needed intravitreal injection of triamcinolone acetonide (4 mg/0.1 mL) were included in this study. A baseline ocular B-scan ultrasound examination was performed in all eyes before IVTA injection. Subsequent examinations were scheduled about 1 hour, 1 day, and 1 week after the injection and thereafter weekly up to complete sonographic disappearance of triamcinolone acetonide. Ultrasonographic pictures of IVTA and disappearance time of the medication were evaluated.

RESULTS

In all the eyes, IVTA was seen as multiple inhomogeneous markedly hyperechoic areas with various size and shape and nonuniform distribution through the vitreous cavity. Common pictures included localized bright hyper-reflective area, diffuse bright point-like echo sources, membranous surfaces, and subhyaloid opacities. IVTA deposited along acoustic interfaces and changed their ultrasonographic characteristics. IVTA facilitated visualization of posterior vitreous surface in seven patients. Opacities due to IVTA gradually cleared over a 3- to 7-week period.

CONCLUSIONS

The findings indicate that IVTA has a bright hyper-reflective ultrasonic image and should be considered as a differential diagnosis for vitreous opacity. IVTA can change the ultrasonographic pattern of the vitreous cavity and highlight membranous surfaces.

Triamcinolone-assisted neodymium:YAG laser vitreolysis

Triamcinolone acetonide was injected into the vitreous cavity to treat a case of cystoid macular edema. After the injection, slit-lamp examination was performed and the vitreous strands adhered to the remaining edge of the posterior capsule were clearly visualized. The strands were dissected with neodymium:YAG (Nd:YAG) laser shots. A technique that can be used to facilitate diagnosis and Nd:YAG laser dissection of vitreous strands in cases with complications of adhesion of vitreous strands into anterior segment structures is described.

Inferior turbinate fracture and congenital nasolacrimal duct obstruction

PURPOSE

To evaluate the success rate of probing combined with inferior turbinate fracture in comparison with simple probing as a first attempt in the treatment of congenital nasolacrimal duct obstruction in children.

METHODS

In a prospective interventional case-control study, 86 eyes from 61 children older than 6 months with congenital nasolacrimal duct obstruction underwent surgical intervention. Forty-two eyes of 33 patients underwent probing combined with infracturing of the inferior turbinate and 44 eyes of 28 patients underwent simple probing. The outcome evaluation included a standard ophthalmologic examination plus a dye disappearance test 2 months after the surgical intervention.

RESULTS

In the case group (probing + infracture of the inferior turbinate), the results were good in 22 (66.7%) patients, fair in 8 (24.2%), and poor in 3 (9.1%). In the control group (simple probing), the results were good in 20 (71.4%) patients, fair in 3 (10.7%), and poor in 5 (17.9%) (p=0.9). Success rates were 91% and 82% in the case and control groups, respectively (p=0.4).

CONCLUSIONS

Based on the results of this study, infracturing of the inferior turbinate does not increase the success rate of simple probing as a first attempt.

Focus on triamcinolone acetonide as an adjunct to glaucoma filtration surgery

Glaucoma is one of the most common causes of irreversible blindness worldwide. Despite continued advances in medical and laser therapy, incisional surgery still appears to be an important and for many cases the only option by which intraocular pressure is controlled. Unlike many other types of surgery in which complete healing of tissue would be a desirable outcome, glaucoma surgery seeks to achieve incomplete healing to allow aqueous humor to escape the eye. Pharmacologic modulation of wound healing is a hot topic in glaucoma filtration surgery. Although routine antifibrotic medications are associated with good results in modulating wound healing in glaucoma surgery, they carry with them the possibility for significant morbidity due to the adverse effects of treatment. Challenge continues to be to find a safe and effective agent for this purpose. Because of beneficial effects of triamcinolone acetonide in some conditions which are associated with secondary glaucoma and also potential effects of this agent in modulating wound healing process, we propose it as a useful adjunct to glaucoma filtration surgery. This approach may allow modulation of wound healing with less of the toxicity associated with commonly used antifibrotics (5-FU and mitomycin C).

LASIK after retinal detachment surgery

PURPOSE

To compare, in the same individuals, the safety and efficacy of laser in situ keratomileusis (LASIK) in eyes with and without previous retinal detachment surgery.

METHODS

In a prospective clinical trial, seven myopic patients who had previously undergone scleral buckling surgery in one eye underwent conventional LASIK surgery in both eyes. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, Orbscan topography and pachymetry were recorded before and 1, 3, 6 and 12 months after surgery. The eyes were divided into two groups: group 1 consisted of eyes that had undergone previous surgery for retinal detachment, and group 2 consisted of the fellow eyes of the same patients, which had not undergone any previous ocular surgery. Student's t-test for match-paired data was used to evaluate the significance of differences.

RESULTS

LASIK was performed successfully in all patients. The UCVA improved in all eyes in both groups. The mean change in the spherical equivalent between 1 and 12 months after LASIK surgery was 1.7 +/- 1.1 and 0.6 +/- 0.5 diopter in groups 1 and 2, respectively (p = 0.019).

CONCLUSION

LASIK may be considered for treatment of myopia in eyes that have had previous surgery for retinal detachment. However, the risk of regression may be higher in such eyes than in eyes with no previous scleral buckling surgery.

Potential role of uric acid in the molecular pathogenesis of age-related macular degeneration

Age-related macular degeneration (ARMD) is the foremost cause of blindness among the elderly population in industrialised countries. Currently, there is no effective treatment for the majority of patients. To develop new and effective modes of therapy, understanding of the molecular basis of the disease is mandatory. Many age-related pathologies have been attributed to cumulative oxidative damage caused by reactive oxygen intermediates. There is growing evidence that uric acid has antioxidant properties and it is a naturally occurring antioxidant. Based on antioxidant role in pathogenesis of ARMD and antioxidant properties of uric acid we conclude that altered uric acid metabolism could play a role in ARMD damage and pathogenesis. Future research needs to evaluate uric acid metabolism in ARMD patients.