Cornea opacity, uveitis with iris atrophy and lens damage following cosmetic high-intensity ultrasound of the eyelid: a case report

BACKGROUND

High-intensity focused ultrasound (HIFU) is a cosmetic procedure that aims to tone the skin through thermal collagen coagulation. The energy is delivered in the deep layers of the skin, and because of these characteristics, the risks of severe damage to adjacent tissue and the ocular surface may be underestimated. Previous reports have demonstrated superficial corneal opacities, cataracts, increased intraocular pressure, or ocular refractive changes in different patients following HIFU. In this case, we report deep stromal opacities associated with anterior uveitis, iris atrophy and lens opacity formation following a single HIFU superior eyelid application.

CASE PRESENTATION

A 47-year-old female presented to the ophthalmic emergency department complaining of pain, hyperemia and photophobia in the right eye following a HIFU application to the superior right eyelid. A slit lamp examination showed three temporal-inferior corneal infiltrates with edema and severe anterior uveitis. The patient was treated with topical corticosteroids, and six months later, there was residual corneal opacity, iris atrophy and peripherical cataract formation. No surgical procedure was needed, and the final vision was Snellen 20/20 (1.0).

CONCLUSION

The risk of severe impairment to the ocular surface and ocular tissues may be underestimated. Cosmetic surgeons and ophthalmologists must be aware of the complications, and the long-term follow-up of these changes needs further investigation and discussion. Safety protocols of the HIFU intensity threshold for thermal lesions in the eye and the use of protective eye devices should be better evaluated.

Low-dose ionizing radiation: Effects on the proliferation and migration of lens epithelial cells via activation of the Wnt/β-catenin pathway

Eye lens opacification (cataract) induced by ionizing radiation is an important concern for radiation protection. Human lens epithelial cells (HLE-B3) were irradiated with γ-rays and radiation effects, including cell proliferation, cell migration, cell cycle distribution, and other changes related to the β-catenin pathway, were determined after 8-72 h and 7 d. In an in vivo model, mice were irradiated; DNA damage (γH2AX foci) in the cell nucleus of the anterior capsule of the lens was detected within 1 h, and radiation effects on the anterior and posterior lens capsules were observed after 3 months. Low-dose ionizing radiation promoted cell proliferation and migration. The expression levels of β-catenin, cyclin D1, and c-Myc were significantly increased in HLE-B3 cells after irradiation and β-catenin was translocated into the cell nucleus (activation of the Wnt/β-catenin pathway). In C57BL/6 J mouse lens, even a very low irradiation dose (0.05 Gy) induced the formation of γH2AX foci, 1 h after irradiation. At 3 months, migratory cells were found in the posterior capsule; expression of β-catenin was increased and it was clustered at the nucleus in the epithelial cells of the lens anterior capsule. The Wnt/β-catenin signaling pathway may an important role in promoting abnormal proliferation and migration of lens epithelial cells after low-dose irradiation.

Astigmatism profile in the elderly population: Tehran Geriatric Eye Study

PURPOSE

To determine the prevalence of astigmatism and its associated factors and examine astigmatism symmetry patterns in an elderly population.

STUDY DESIGN

Population based cross-sectional study.

METHODS

The present population-based cross-sectional study was conducted on an elderly population above 60 years of age in Tehran, Iran in 2019. The sampling was done using the stratified multistage random cluster sampling method. All study participants underwent a complete optometric examination and slit-lamp biomicroscopy.

RESULTS

The prevalence of astigmatism higher than -0.50, -1.00, and -2.00 D was 83% (95% CI: 81 -84), 52 % (95% CI: 50 -54), and 19% (95% CI: 17-20), respectively. These prevalence was 79%(95% CI: 77-81), 46(95% CI: 44-49) and 14(95% CI: 13-16) in subjects without a history of ocular surgery, respectively. Based on cylinder power worse than -1.00 D, 10% (95% CI: 9-12), 20% (95% CI: 18-22), and 21% (95% CI:19-23) of study participants had with the rule, against the rule, and oblique astigmatism, respectively. According to the results of the multiple regression model, male gender, older age, low education level, pure posterior subcapsular cataract, pseudophakia, and myopia were independent factors associated with astigmatism. The prevalence of anisorule astigmatism was 57 % (95% CI: 56-59), the most common anisorule astigmatism was against the rule-oblique type with a prevalence of 36% (95% CI: 34-38).

CONCLUSION

The prevalence of astigmatism was high in the elderly population of Tehran. More than half of the participants in this study had anisorule astigmatism, and against the rule-oblique combination was more prevalent than other types. A posterior subcapsular cataract, a history of cataract surgery, and myopia were the associated factors of astigmatism in this study.

[Analysis of lens status of 4452 medical radiation workers in a city]

Objective: To understand the lens condition of radiation workers in a city, explore the factors affecting lens opacity, and provide basis for strengthening the radiation protection management of radiation workers. Methods: In December 2020, according to the national radiation health monitoring project, the occupational health examination data of radiation workers in an occupational health examination institution in a city from December 2018 to November 2020 were collected, including the basic information of radiation workers and ophthalmic examination results. The lens conditions of radiation workers in different subgroups were analyzed, and the influencing factors of lens opacity were analyzed by multifactor logistic regression. Results: A total of 4452 radiation workers were included, of which 439 (9.9%) had lens opacity. The lens opacity rate of male radiation workers was higher than that of female radiation workers (P<0.05) . With the increase of age and length of service, the lens abnormalities of radiation workers increased (r(s)=0.269, 0.212, P<0.01) . The lens opacity rate of radiation workers engaged in nuclear medicine was high (12.7%, 9/71) . The rate of lens opacity in off-the-job medical examination radiation workers was high (18.3%, 26/142) . By multivariate logistic regression analysis, the risk of lens opacification in the age ≤30-year-old group and the >30-<50-year-old group were 0.087 times (95%CI: 0.058-0.132) and 0.076 times (95%CI: 0.054-0.107) that in the age ≥50-year-old group, respectively. The risk of lens opacification in the age ≤10-year-old group, >10-<20-year-old group and 20-30-year-old group were 0.293 (95%CI: 0.189-0.456) , 0.413 (95%CI: 0.256-0.666) and 0.318 (95%CI: 0.204-0.497) times, respectively. Conclusion: The lens opacity rate of radiation workers is related to age and working age.Attention should be paid to high-age and long-term radiation workers to ensure their health.

The protective mechanism of Grx2 in ultraviolet-B (UVB)-induced cataract formation

OBJECTIVE

We established a mouse cataract model by irradiating Grx2 knockout (KO) and knock-in (KI) genetically modified mice with UVB to explore the protective mechanism of Grx2 against UVB lens damage.

METHODS

After irradiating Grx2 KO and Grx2 KI mice with UVB lamps, we observed and recorded the general physiological conditions and lens opacity of the mice. The crystalline grading system of the University of Oxford was used to classify the opacity of the lens. Lens reactive oxygen species (ROS) contents were detected using a microplate reader, western blot, and enzyme-linked immunosorbent assay (ELISA) to detect antioxidant and antioxidant enzyme contents. Statistical analysis of the recorded data was performed by using SPSS 19.0 software.

RESULTS

After UVB irradiation, the weight of Grx2 KO mice was slightly lower than that of wild-type (WT) mice of the same age. Compared to WT mice, the lens opacity of Grx2 KO mice appeared earlier, the nucleus density of the lens increased, and the opacity increased in the first week after UVB irradiation. Meanwhile, the lenses of Grx2 KI mice remained transparent. The experiment showed that the content of ROS increased, the level of glutathione (GSH) decreased, the content of 8-OHdG increased, and the expression of BCL2 decreased after UVB irradiation. Compared to WT mice, these changes were more significant in Grx2 KO mice.

CONCLUSION

This experiment found that knocking out the Grx2 gene accelerated the occurrence and development of UVB-induced cataracts in mice and that Grx2 plays an important role in the oxidative damage caused by UVB radiation by repairing the antioxidant enzymes of the lens. This study provides a new animal model and research ideas for the study of cataract pathogenesis.

Evaluation of lens opacity due to inhibition of cholesterol biosynthesis using rat lens explant cultures

Drug-induced lens opacity has the potential to cause blindness and is of concern in drug development. Inhibition of cholesterol biosynthesis is one of the causes of lens opacity. Lens opacity is only observed after chronic administration in in vivo nonclinical studies in drug development. Thus, to save resources (e.g., time and cost) and to reduce burden on animals, it is required to develop in vitro evaluation systems that can predict and avoid the risk of lens opacity earlier and easier. In this study, we investigated whether rat lens explant cultures could be useful for the evaluation of drug-induced lens opacity via inhibition of cholesterol biosynthesis. Nineteen drugs, including statins, allylamine, thiocarbamate, azole, and morpholine, which inhibit cholesterol biosynthesis, as well as a negative control (acetaminophen, rosiglitazone and troglitazone), were used. Rat lens explants were treated with drugs for 13 days at concentrations close to IC50 values or higher against cholesterol biosynthesis, and lens opacity (severity and region) was evaluated. In most cases, region-specific lens opacity limited in the equator to posterior pole, as observed in vivo was observed at IC50 values or higher concentrations. The severity of opacity was likely to be related to the inhibitory potency toward cholesterol biosynthesis, concentration of drugs distributed in the lens, or time of exposure. Furthermore, GSH levels were also involved in the deterioration of lens opacity. In conclusion, we demonstrated that rat lens explant cultures can be useful to assess the potential drug-induced lens opacity associated with inhibition of cholesterol biosynthesis and to elucidate the mechanisms of lens opacity.

ATM and TP53 Polymorphisms Modified Susceptibility to Radiation-Induced Lens Opacity in Natural High Background Radiation Area, China

Purpose: A population-based case-control study was conducted in Yangjiang and Enping areas in South China to assess whether the risk of lens opacity induced by natural high background radiation exposure is modulated by polymorphisms of ATM and TP53.Materials and methods: A total of 133 cases who were diagnosed with cortical and posterior subcapsular (PSC) opacity were recruited, and 419 healthy controls were selected through counter-matching in terms of radiation status. Genomic DNA from all the participants was genotyped with the Illumina platform for four single nucleotide polymorphisms of ATM (rs189037, rs373759, and rs4585) and TP53 (rs1042522). The cumulative lens dose received during the entire life was estimated based on annual indoor and outdoor radiation doses and gender- and age-specific occupancy factors. Non-conditional logistic regression was performed to calculate odds ratio (OR) and 95% confidence intervals (95% CI).Results: ATM rs189037 and TP53 rs1042522 were significantly related to cortical and PSC opacity. The risk of opacity was higher when individuals carried the A allele of ATM rs189037 and C allele of TP53 rs1042522, compared with GG genotype. ATM rs189037 A allele carriers (AG/AA) and TP53 rs1042522 C allele carriers (CG/CC) combined with a cumulative lens dose of 100 mGy or higher showed statistically significant opacity risks (OR =5.51, 95% CI: 1.47-20.66; OR =2.69, 95% CI: 1.10-6.60).Conclusion: The A allele of ATM rs189037 and C allele of TP53 rs1042522 increase the risk of lens opacity induced by radiation. These polymorphisms in ATM and TP53 might modify the risk of cortical and PSC opacity induced by chronic and prolonged low-dose radiation.

[25-Gauge macular surgery: comparison with and without combined phacoemulsification and artificial lens implantation]

BACKGROUND

With the surgical methods continuously developed in recent years, macular surgery has become an increasingly less traumatic procedure for the eye. For patients with additional lens opacification, a 1-stage procedure with combined cataract surgery is recommended.

OBJECTIVE

The aim of this retrospective study was to record the functional results and complications after elective macular surgery with and without combined phacoemulsification and artificial lens implantation.

MATERIAL AND METHODS

The retrospective study included all patients who were operated on with a pars plana vitrectomy (ppV; 25 gauge) for epiretinal membrane, macular hole or vitreoretinal traction between 2010 and 2016 and who had a follow-up period of at least 3 months. The functional results and possible risk factors as well as complications that occurred were then recorded.

RESULTS

A total of 781 eyes were identified of which 517 (66%) had a phacoemulsification and artificial lens implantation with a 25-gauge vitrectomy, membranectomy, ILM peeling and SF6 gas or air tamponade. The mean follow-up time was 17 months. The mean logMAR visual acuity was 0.59 preoperatively and 0.4 postoperatively. From 64 phacic eyes which did not receive a combined phacoemulsification and artificial lens implantation 40 (62.5%) required phacoemulsification and artificial lens implantation within 13.6 months due to complicated cataract, 18 even within 6 months. In terms of complications, there were comparable results between ppV alone and the combined operation, particularly with respect to an IOL dislocation or iris capture.

CONCLUSION

Overall elective macular surgery is a procedure with few complications both without and above all with combined phacoemulsification and artificial lens implantation. Therefore, a combined operation makes sense in terms of surgical management and postoperative rehabilitation, especially in times of a pandemic with limited surgical resources.

Lens-specific conditional knockout of tropomyosin 1 gene in mice causes abnormal fiber differentiation and lens opacity

Tropomyosin (Tpm) 1 and 2 are important in the epithelial mesenchymal transition of lens epithelial cells; however, the effect of Tpm1 depletion during aging remains obscure. We analyzed the age-related changes in the crystalline lens of Tpm1- conditional knockout mice (Tpm1-CKO). Floxed alleles of Tpm1 were conditionally deleted in the lens, using Pax6-cre transgenic mice. Lenses of embryonic day (ED) 14, postnatal 1-, 11-, and 48-week-old Tpm1-CKO and wild type mice were dissected to prepare paraffin sections, which subsequently underwent histological and immunohistochemical analysis. Tpm1 and α smooth muscle actin (αSMA) mRNA expression were assessed using RT-PCR. The homozygous Tpm1-CKO (Tpm1^-/-) lenses displayed a dramatic reduction in Tpm1 transcript, with no change to αSMA mRNA expression. Tpm1^-/- mice had small lenses with disorganized, vesiculated fiber cells, and loss of epithelial cells. The lenses of Tpm1^-/- mice had abnormal and disordered lens fiber cells with cortical and peri-nuclear liquefaction. Expression of filamentous-actin was reduced in the equator region of lenses derived from ED14, 1-, 11-, and 48-week-old Tpm1^-/- mice. Therefore, Tpm1 plays an integral role in mediating the integrity and fate of lens fiber differentiation and lens homeostasis during aging. Age-related Tpm1 dysregulation or deficiency may induce cataract formation.

Outcomes of effective goniosynechialysis under an endoscopic view combined with phacoemulsification in residual angle-closure glaucoma with lens opacity: 6-month results

PURPOSE

We aimed to evaluate the efficacy and safety of effective goniosynechialysis (GSL) under an endoscopic view combined with phacoemulsification in residual angle-closure glaucoma with lens opacity.

METHODS

This was a retrospective study. Patients with residual angle-closure glaucoma, lens opacity, and uncontrolled intraocular pressure (IOP) who were receiving anti-glaucoma medications were selected to undergo effective GSL under an endoscopic view combined with phacoemulsification. Follow-up examinations were conducted until 6 months postoperatively.

RESULTS

Twenty-five eyes of 24 patients diagnosed with residual angle-closure glaucoma and lens opacity and peripheral anterior synechiae (PAS) at least ≥ 270° were included. Their mean age was 61.32 ± 6.11 years. Preoperatively, the mean (standard error) IOP was 29.69 (11.22) mmHg, and the median number of IOP-lowering medications used was 3.0. The decreases in the rates of IOP of the patients were 44.29%, 52.17%, 46.95%, 48.37%, and 47.29% at 1 day, 1 week, 1 month, 2.5 months, and 6 months after the surgery, respectively. At 6 months, the median number of IOP-lowering medications used decreased from 3 to 0 and the range of PAS compared to the baseline decreased from 312° to 107° (P < 0.001). We also found that 21/25 eyes achieved improved or stable visual acuity after surgery. Postoperative complications included transiently elevated IOP (12.0%), exudation (8.0%), and hyphema (4.0%).

CONCLUSIONS

Phacoemulsification combined with effective GSL under an endoscopic view may reopen residual angle-closure glaucoma and reduce the number of IOP-lowering medications for up to 6 months. It is an effective and safe method for patients with residual angle-closure glaucoma and lens opacity.

Evaluation of factors related to Anaesthesia-induced Lens opacity in experimental mice

To investigate conditions that cause temporal lens opacity, we tested chemical and physical factors, such as anaesthesia dose, ocular surface dryness, and infrared (IR) light exposure in anaesthetised C57BL/6 N mice. Mice were anaesthetised with a low (80%; tiletamine/zolazepam 32 mg/kg and xylazine 8 mg/kg, intraperitoneal injection) or high (120%; 48 mg/kg and 12 mg/kg) dose of anaesthetic and examined every 5 min from 10 to 30 min after anaesthesia was induced. Lens opacity levels were assessed and graded (1-6) using the standard classification system. Regardless of the anaesthetic dose, lens opacity grade was 1-2 in moisturised eyes with application of 0.5% carboxymethylcellulose, and 5-6 in dry ocular surface conditions. Lens opacity in mice with high-dose anaesthetic in the dry ocular surface condition was not different from that of mice with low-dose anaesthetic. Lens opacity grade 1-2 was noted in eyes in the wet ocular surface condition, regardless of IR light exposure. During IR light exposure in eyes in the dry ocular surface condition, lens opacity (grade 6) in mice with high-dose anaesthetic was not different from that (grade 6) in mice with low-dose anaesthetic. We demonstrated that ocular surface dryness might be a relevant factor for the formation and progression of lens opacity in anesthetized C57BL/6 N mice. Anaesthesia dose and IR light exposure did not strongly influence lens opacity formation. Furthermore, eyes with corneal dryness-induced lens opacity recovered to normal status without additional intervention.

[Analysis of lens of 1720 medical application radiology workers in Hangzhou]

Objective: To analyze the lens opacity of some hospitals in Hangzhou to provide evidence for further improvement of radiation protection. Methods: Physical examination data of 1720 radiological workers who underwent occupational disease physical examination in our hospital on January1, 2016and December 31, 2017 were collected. Lens turbidity, gender, age, type of work, radiological working age and other influencing factors were statistically analyzed, and logistic regression analysis was used for multipactor analysis. Results: A total of 112 cases of lens turbidity (turbidity rate 6.51%) , after lens turbidity, subcapsular majority (64 cases (57.14%) ) ; lens turbidity increased with age, and showed an increasing trend of radiation working age; the lens turbidity rate was different in different types of work, including nuclear medicine (23.33%) 、radiology (6.76%) 、interventional radiology (6.06%) 、dental radiology (4.26%) and radiotherapy (4.21%) . Type of work、age and length of service are risk factors for lens opacity; Age and type of work were independent risk factors for lens opacity. Conclusion: The turbidity of lens of radiologcial workers is related to age and workering age. Radiological workers engaged in nuclear medicine should strictly strengthen radiation protection.

Bone and ocular safety of budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler in COPD: a 52-week randomized study

Background

Long-term use of inhaled corticosteroids (ICSs) has been associated with increased risk of bone and ocular comorbidities. We evaluated the effects of the triple fixed-dose combination budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler (BGF MDI), formulated using co-suspension delivery technology, on bone mineral density (BMD) and ocular safety in patients with moderate-to-very severe chronic obstructive pulmonary disease (COPD).

Methods

In this extension study, a subset of patients from the 24-week, phase III, randomized, double-blind KRONOS study (NCT02497001) continued treatment (BGF MDI 320/18/9.6 μg, budesonide/formoterol fumarate [BFF] MDI 320/9.6 μg or glycopyrrolate/formoterol fumarate [GFF] MDI 18/9.6 μg, as a non-steroidal comparator) for an additional 28 weeks. Primary endpoints were percentage change from baseline in lumbar spine BMD and change from baseline in lens opacities classification system III posterior subcapsular cataract (P) score, both at Week 52. Adverse events were also assessed.

Results

In total, 456 patients were included in the safety population (53.1% male, mean age 62.8 years). Changes from baseline in lumbar spine BMD (least squares mean [LSM] range − 0.12 to 0.38%) and P score (LSM range 0.02–0.15) were small for all treatments. Both BGF MDI and BFF MDI were non-inferior to GFF MDI using margins of −2% (BMD) and 0.5 units (P score). The incidence of treatment-emergent adverse events (TEAEs)  was generally similar among groups. Rates of confirmed pneumonia were low overall (2.4%) and highest in the GFF MDI group (3.4%), followed by BGF MDI (2.1%) and BFF MDI (1.1%). There were no cumulative adverse effects of treatment over time as the incidence and types of TEAEs, were generally similar in the first 24 weeks of the study and after Week 24.

Conclusions

In patients with COPD, both ICS-containing therapies were non-inferior to GFF MDI for the primary BMD and ophthalmological endpoints. Changes from baseline in all three treatment groups over 52 weeks were small and not clinically meaningful. All treatments were well tolerated with no new or unexpected safety findings.

Trial registration

ClinicalTrials.gov NCT02536508. Registered 27 August 2015.

Electronic supplementary material

The online version of this article (10.1186/s12931-019-1126-7) contains supplementary material, which is available to authorized users.

Probucol Slows the Progression of Cataracts in Streptozotocin-Induced Hyperglycemic Rats

We examined the effect of probucol, an antihyperlipidemic drug with potent antioxidant properties, on cataract formation in streptozotocin (STZ)-induced hyperglycemic rats that were given 5% D-glucose as drinking water. Probucol treatment was initiated immediately after the induction of hyperglycemia was confirmed. Using full horizontal-plane lens images captured with an original digital camera system, the opacity of central region of lens was assessed by measuring the opaque area in the region. Central opacities were detected after 3 weeks of hyperglycemia, and progressed in a time-dependent manner. The majority of STZ-induced hyperglycemic rats developed severe cataracts after 9 weeks of hyperglycemia. Probucol slowed the progression of cataracts in a dose-dependent manner. Levels of sorbitol and protein carbonyls in lenses of STZ-induced hyperglycemic rats were higher than those of control rats. Probucol suppressed the increase in protein carbonyls, but not of sorbitol, in lenses of STZ-induced hyperglycemic rats. Probucol had no significant effect on increases in plasma concentrations of glucose, total cholesterol, and triglyceride observed in STZ-induced hyperglycemic rats. These results suggest that probucol slows the progression of sugar cataracts, independent of its lipid-lowering effects. The beneficial effect of probucol on cataracts is partially attributable to the attenuation of oxidative damage to lens proteins.

The current status of eye lens dose measurement in interventional cardiology personnel in Thailand

Workers involved in interventional cardiology procedures receive high eye lens doses if radiation protection tools are not properly utilized. Currently, there is no suitable method for routine measurement of eye dose. In Thailand, the eye lens equivalent doses in terms of Hp(3) of the interventional cardiologists, nurses, and radiographers participating in interventional cardiology procedures have been measured at 12 centers since 2015 in the pilot study. The optically stimulated luminescence (OSL) dosimeter was used for measurement of the occupational exposure and the eye lens dose of 42 interventional cardiology personnel at King Chulalongkorn Memorial Hospital as one of the pilot centers. For all personnel, it is recommended that a first In Light OSL badge is placed at waist level and under the lead apron for determination of Hp(10); a second badge is placed at the collar for determination of Hp(0.07) and estimation of Hp(3). Nano Dots OSL dosimeter has been used as an eye lens dosimeter for 16 interventional cardiology personnel, both with and without lead-glass eyewear. The mean effective dose at the body, equivalent dose at the collar, and estimated eye lens dose were 0.801, 5.88, and 5.70 mSv per year, respectively. The mean eye lens dose measured by the Nano Dots dosimeter was 8.059 mSv per year on the left eye and 3.552 mSv per year on the right eye. Two of 16 interventional cardiologists received annual eye lens doses on the left side without lead glass that were higher than 20 mSv per year, the new eye lens dose limit as recommended by ICRP with the risk of eye lens opacity and cataract.

Cataracts and strabismus associated with hand rearing using artificial milk formulas in Bengal tiger (Panthera tigris spp tigris) cubs

The aim of this investigation is to describe the potential contributing nutritional factors involved in the development of ophthalmic and dermatologic changes in four Bengal tiger (Panthera tigris spp tigris) cubs fed an artificial milk formula. The affected animals were compared with two other tiger cubs that had been nursed by their dam naturally. After the first clinical signs appeared, the tiger cubs underwent ophthalmic evaluation. Severe symmetric generalized alopecia over the trunk, sparing the head and distal portion of the front and rear limbs, bilateral cataracts and strabismus were noticed. Milk and blood from the mother, as well as blood from the healthy and affected cubs were collected in order to evaluate complete blood counts, serum chemistry values, and amino acid levels. The amino acid concentrations in the artificial formula were also evaluated for comparison to the milk from the dam. The concentration of taurine, arginine, phenylalanine, tryptophan and histidine were very low in the artificial formulas as compared to the dam´s milk. The tiger cubs that received the artificial formula had lower levels of the amino acids listed previously as compared to those that nursed from the dam naturally. Taurine, as well as arginine, phenylalanine, tryptophan and histidine deficiency appeared to be possible causes of the development of skin problems, cataracts and strabismus in the tiger cubs fed with these particular artificial milk replacers. In the future, special attention should be given in order to make sure that adequate levels of these amino acids are present in artificial milk for tiger cubs.

[Cataract development after electrical injury]

Cataract development is one of the most common complications of ocular electrical injury. Our patient reported an electrical injury of his face 13 years ago that affected both eyes. Since that time he noticed progressive visual impairment of both eyes. At the time of first presentation in 2014, slit lamp examination showed characteristic opacities within the anterior and posterior subcapsular area of the lens. Cataract surgery led to full recovery of visual acuity.

A test of lens opacity as an indicator of preclinical Alzheimer Disease

Previous studies reported that characteristic lens opacities were present in Alzheimer Disease (AD) patients postmortem. We therefore determined whether cataract grade or lens opacity is related to the risk of Alzheimer dementia in participants who have biomarkers that predict a high risk of developing the disease. AD biomarker status was determined by positron emission tomography-Pittsburgh compound B (PET-PiB) imaging and cerebrospinal fluid (CSF) levels of Aβ42. Cognitively normal participants with a clinical dementia rating of zero (CDR = 0; N = 40) or with slight evidence of dementia (CDR = 0.5; N = 2) were recruited from longitudinal studies of memory and aging at the Washington University Knight Alzheimer's Disease Research Center. The age, sex, race, cataract type and cataract grade of all participants were recorded and an objective measure of lens light scattering was obtained for each eye using a Scheimpflug camera. Twenty-seven participants had no biomarkers of Alzheimer dementia and were CDR = 0. Fifteen participants had biomarkers indicating increased risk of AD, two of which were CDR = 0.5. Participants who were biomarker positive were older than those who were biomarker negative. Biomarker positive participants had more advanced cataracts and increased cortical light scattering, none of which reached statistical significance after adjustment for age. We conclude that cataract grade or lens opacity is unlikely to provide a non-invasive measure of the risk of developing Alzheimer dementia.

The assessment of lens opacity postmortem and its implication in forensics

Visual impairment, mostly due to cataracts, has been demonstrated to be an important factor associated with traffic accidents. Although vision screening is standard procedure during licensing in order to prevent motor vehicle accidents, an eye exam is not typically administered after an accident has already occurred. Postmortem assessment of lens opacity in victims of car accidents would provide helpful information for attesting to the liability of the parties in specific accidents, determining the circumstances of the accident, and developing preventive measures for both drivers and pedestrians alike. In this paper, we explore the use of different methods and their limitations for assessing lens opacity postmortem. We discuss the possible use and benefits of a simple, but as-yet untested method: retrobulbar translucency. The method would be based on the recording of shadows formed by opaque regions of the lens while the eye is illuminated from the back with a rigid source of light. The efficacy and objectivity of the method, its reproducibility, and the inter- and intra-observer error should be tested before implementing such a technique to be regularly used to determine lens opacity in cadavers.