Bias of near-infrared light in evaluation of patients implanted with multifocal intraocular lenses

PURPOSE

To compare visual quality between subjective tests and optical devices using near-infrared (NIR) light in patients implanted with monofocal, multifocal and enlarged depth-of-focus (EDoF) intraocular lenses (IOLs).

METHODS

Cross-sectional study enrolling patients aged between 55 and 75 (axial length between 22 and 25 mm) bilaterally implanted with Tecnis IOLs (Johnson & Johnson) four months previously: 40 patients (80 eyes) with monofocal ZCB00, 41 patients (82 eyes) with bifocal diffractive ZMB00 and 48 patients (96 eyes) with EDoF Symfony. They were examined using subjective and objective tests. The subjective tests comprised visual acuity (VA) with ETDRS charts, contrast sensitivity (CS) with Pelli-Robson and CSV-1000E tests, and clear vision range (CVR). The objective tests using NIR light were performed with the KR-1 W wavefront analyzer and the OQAS.

RESULTS

In the subjective tests, the monofocal group achieved the best outcomes in some of the VA and CS sections, while the bifocal group obtained the worst outcomes in some of the CS sections. In the objective tests, the bifocal group achieved the best results for VA and CS. Discrepancies between pseudoaccommodation range and CVR were found in the bifocal and EDoF groups.

CONCLUSIONS

Assessment of visual quality using NIR light implies greater bias for diffractive lenses than for EDoF lenses. This bias may be even greater with devices using longer light wavelengths or Hartmann-Shack technology. The difference in wavelength between NIR and visible light leads to dimming of near-vision focus and magnification of distance focus.

Comparison of posterior capsule opacification between Clareon CNA0T0 and Tecnis ZCB00 intraocular lenses

INTRODUCTION

The purpose is to compare posterior capsule opacification (PCO) and its impact on vision between Clareon CNA0T0 (Alcon) and Tecnis ZCB00 intraocular lenses (IOLs) (Johnson&Johnson) 1, 6, and 12 months after implantation.

METHODS

A prospective observational study was performed at the Nuestra Señora de Gracia Hospital (Zaragoza, Spain). Fifty eyes (50 patients) with Tecnis IOL (group 1) and 60 eyes (60 patients) with Clareon IOL (group 2) were enrolled. One, 6, and 12 months after age-related cataract surgery by five different surgeons, the following tests were performed: mesopic corrected distance visual acuity (CDVA), CSV1000-E test, KR-1W wavefront analyzer, OQAS II, Catquest-9SF questionnaire and mydriatic slit-lamp pictures. PCO intensity was quantified and the area of opacification was measured using ImageJ (NIH).

RESULTS

Mean age was 71.20 ± 6.79 years in group 1, and 71.73 ± 8.17 years in group 2 (p = 0.72); mean axial length was 23.46 ± 1.14 and 23.53 ± 0.91 mm, respectively (p = 0.72); mean IOL power was 21.69 ± 2.26 D and 21.28 ± 2.44 D, respectively (p = 0.37). One month after surgery there were differences in intensity of PCO (0.73 ± 0.60 and 1.05 ± 0.71, respectively, p = 0.02). Six months after surgery statistical differences were found in VA with 20% CS in mydriatic conditions (0.26 ± 0.21 logMAR (20/36) and 0.18 ± 0.17 logMAR (20/30), respectively, p = 0.04). Twelve months after surgery, no differences were detected between groups. As for the evolution of PCO within the Clareon group, high order aberrations (p < 0.05) and the Strehl ratio (p = 0.02) decreased.

CONCLUSION

There are no differences in slit-lamp pictures or visual function between both IOLs during the first 12 months after implantation.

Optical aberrations in three different intraocular lens designs of a same platform

PURPOSE:

To compare internal optical aberrations between three different intraocular lenses (IOL) of the same Tecnis platform: monofocal ZCB00, multifocal ZMB00, and enlarged depth-of-focus (EDoF) Symfony ZXR00.

METHODS:

We included in this study 236 eyes of 118 patients who had been bilaterally implanted either with the monofocal, the multifocal, or the EDoF IOL. They were examined with the K1-RW wavefront analyzer (Topcon Medical Systems) 2 months after surgery. Patients with any ocular pathology were excluded from the study. Only high-order aberrations (HOA) of the third and fourth orders of the Zernike polynomials were considered.

RESULTS:

Forty-three patients (86 eyes) were implanted with the monofocal IOL, 45 patients (90 eyes) with the ZMB00 IOL, and 30 patients (60 eyes) with the EDoF Symfony IOL. Mean age was 62.42 ± 7.38, 63.60 ± 6.01, and 64.74 ± 5.84 years, respectively. Mean axial length was 23.37 ± 1.00, 23.49 ± 1.00, and 23.54 ± 0.73 mm, respectively. For a 6-mm pupil, internal total HOA in the monofocal group was 1.01 ± 1.75 μm; in the bifocal group was 1.35 ± 2.12 μm; and in the Symfony group was 0.72 ± 0.63 μm. No optical aberration differences were found among the three groups (P > 0.05).

CONCLUSION:

There are no differences regarding internal optical aberrations between these three IOLs when analyzing them with optical aberrometry. Patients’ pupil size should be considered for the selection of the most appropriate IOL to be implanted, because despite a same optical platform, every IOL implies a different increase of HOA with larger pupil sizes.

Face recognition impairment in small for gestational age and preterm children

BACKGROUND

Infants born prematurely or with low birth weight are at increased risk of visual perceptual impairment. Face recognition is a high-order visual ability important for social development, which has been rarely assessed in premature or low birth weight children.

AIMS

To evaluate the influence of prematurity and low birth weight on face recognition skills.

METHODS

Seventy-seven children were evaluated as part of a prospective cohort study. They were divided into premature and term birth cohorts. Children with a birth weight below the 10th centile were considered small for gestational age. All children underwent a full ophthalmologic assessment and evaluation of face recognition skills using the Facial Memory subtest from the Test of Memory and Learning.

RESULTS

Premature infants scored worse on immediate face recognition compared to term infants. However, after adjusting for birth weight, prematurity was not associated with worse outcomes. Independent of gestational age, outcomes of low birth weight children were worse than those of appropriate birth weight children, for immediate face recognition (odds ratio [OR], 5.14; 95% confidence interval [CI], 1.32-21.74) and for face memory (OR, 4.48; 95% CI, 1.14-16.95).

CONCLUSIONS

Being born small for gestational age is associated with suboptimal face recognition skills, even in children without major neurodevelopmental problems.

Effect of prematurity and low birth weight in visual abilities and school performance

BACKGROUND

Prematurity and low birth weight are known risk factors for cognitive and developmental impairments, and school failure. Visual perceptual and visual motor skills seem to be among the most affected cognitive domains in these children.

AIMS

To assess the influence of prematurity and low birth weight in visual cognitive skills and school performance.

METHODS

We performed a prospective cohort study, which included 80 boys and girls in an age range from 5 to 13. Subjects were grouped by gestational age at birth (preterm, <37 weeks; term, 37-42 weeks) and birth weight (small for gestational age (SGA), <10th centile; appropriate weight for gestational age (AGA), ≥10th centile). Each child underwent full ophthalmologic assessment and standardized testing of visual cognitive abilities (Test of Visual Perceptual Skills and Test of Visual Analysis Skills). Parents completed a questionnaire on school performance in children.

RESULTS

Figure-ground skill and visual motor integration were significantly decreased in the preterm birth group, compared with term control subjects (figure-ground: 45.7 vs 66.5, p=0.012; visual motor integration, TVAS: (9.9 vs 11.8, p=0.018), while outcomes of visual memory (29.0 vs 47.7, p=0.012), form constancy (33.3 vs 52.8, p=0.019), figure-ground (37.4 vs 65.6, p=0.001), and visual closure (43.7 vs 62.6 p=0.016) testing were lower in the SGA (vs AGA) group. Visual cognitive difficulties corresponded with worse performance in mathematics (r=0.414, p=0.004) and reading (r=0.343, p=0.018).

CONCLUSION

Specific patterns of visual perceptual and visual motor deficits are displayed by children born preterm or SGA, which hinder mathematics and reading performance.

Embryo and larva development in common dentex (Dentex dentex), a pelagophil teleost: the quantitative composition of egg-free amino acids and their interrelations

Free amino acids (FAAs) play a key role in the physiology of marine teleosts (eggs, embryos, and larvae). However, the relationship between the egg FAAs content and the production of viable embryos and larvae (at different developmental stages) in batch spawner pelagophils has not yet comprehensively been investigated. Viable eggs of common dentex, Dentex dentex, were obtained from captive broodstocks. Egg wet weight (WW), dry weight (DW), and water content (%W) and viability parameters, or VPs (egg floating rate [FR], hatching rate [HR], and larval survival rate [SR] at days 0 to 5 posthatch) were determined for 45 egg batches. The egg batches were classified according to their HR magnitude. Twelve egg batches with the same WW, DW, and %W were taken from the same broodstock and at the same developmental stage to determine the qualitative and quantitative composition of FAAs. The total FAA (TFAA) content, glutamic acid (Glu), asparagine (Asn), glutamine (Gln), and arginine (Arg) were correlated with VPs. The Glu was significantly correlated with HR and SR at 0 day posthatch (dph), the Asn with SR at 1 dph, and the Gln and Arg with FR and HR. Of the 361 ratios made based on the absolute concentrations of FAAs, 24 ratios were correlated with VPs (P<0.005) through 42 simple regression models (R(2)=0.641 to 0.846). Of the 42 significant relationships found approximately 10%, approximately 28%, approximately 12%, approximately 30%, approximately 8%, approximately 4%, approximately 2%, approximately 2%, and approximately 2% of the models show the relations of the egg FAAs ratios with FR, HR, SR at days 1 to 5 posthatch, and %W, respectively. A path coefficient in combination with a Pearson's correlation coefficient provided a series of statistical evidences to show the effects of the egg FAAs interrelations on the relationships found between quantitative composition of a FAA and a VP.

Cell-based assay coupled with chromatographic fractioning: a strategy for marine toxins detection in natural samples

Cell-based assays (CBA) have been proposed for the evaluation of toxicity caused by marine toxins in natural samples (fish, shellfish and microalgae). However, their application has been hindered due to the interferences present in biological matrices that may cause cellular response and interfere in toxicity evaluation. This work reviews in an extensive introduction the use of CBA for toxicity evaluation of marine toxins. Afterwards, the coupling of chromatographic fractioning with neuroblastoma Neuro-2a CBA is presented to enhance the applicability of CBA for complex matrices. Examples of application are provided for mussel samples (Mytilus galloprovincialis) and microalgae (Gambierdiscus sp.), and the results demonstrated the great potential of the combined strategy for reliable toxicological evaluation without ethical concern. Fractioning of an equivalent of 72 mg eq mL(-1) of mussel sample allowed the identification of non-toxic and toxic fractions whereas only 2.5mg eq mL(-1) of non-purified mussel sample was responsible for 20% of cell mortality. Furthermore, the application of CBA allowed selectively distinguishing between ciguatoxin-like and other unspecific toxicity in Gambierdiscus sp. extract.

Prevalence and phenotypic distribution of dyslipidemia in type 1 diabetes mellitus: effect of glycemic control

BACKGROUND

Data on the prevalence of dyslipidemia in type 1 diabetes mellitus are scarce and are based on total triglyceride and total cholesterol concentrations alone.

OBJECTIVE

To assess the effect of glycemic optimization on the prevalence of dyslipidemia and low-density lipoprotein cholesterol (LDL-C) concentrations requiring intervention in patients with type 1 diabetes.

PATIENTS

A total of 334 adults with type 1 diabetes and 803 nondiabetic control subjects.

METHODS

Levels of glycosylated hemoglobin, total cholesterol, total triglyceride, high-density lipoprotein cholesterol (HDL-C), and LDL-C were assessed at baseline and after 3 to 6 months of intensive therapy with multiple insulin doses.

RESULTS

Levels of LDL-C greater than 4.13 mmol/L (>160 mg/dL) and total triglyceride greater than 2.25 mmol/L (>200 mg/dL) and low HDL-C levels (<0.9 mmol/L [<35 mg/dL] in men or <1.1 mmol/L [<45 mg/dL] in women) were found in 16%, 5%, and 20% of patients and 13%, 6%, and 9% of controls, respectively (P<.001 for HDL-C). Diabetic women showed more hypercholesterolemia than nondiabetic women (15.6% vs 8.5%; P =.04). After glycemic optimization (mean +/- SD glycosylated hemoglobin decrease, 2.2 +/- 1.96 percentage points), the prevalence of LDL-C levels greater than 4.13 mmol/L (>160 mg/dL) became lower in diabetic men than in nondiabetic men (9.7% vs 17.5%; P =.04), but women showed frequencies of dyslipidemia similar to their nondiabetic counterparts. The proportion of patients with LDL-C concentrations requiring lifestyle (>2.6 mmol/L [>100 mg/dL]) or drug (>3.4 mmol/L [>130 mg/dL]) intervention decreased from 78% and 42% to 66% and 26%, respectively.

CONCLUSIONS

Low HDL-C is the most frequent dyslipidemic disorder in patients with poorly controlled insulin-treated type 1 diabetes, and a high proportion show LDL-C levels requiring intervention. Less favorable lipid profiles could explain the absence of sex protection in diabetic women. The improvement caused by glycemic optimization puts forward intensive therapy as the initial treatment of choice for dyslipidemia in poorly controlled type 1 diabetes.

[Bronchogenic carcinoma in patients with human immunodeficiency virus infection]

The diagnosis of bronchogenic carcinoma (BC) in patients with HIV infection is infrequent. Five cases are described and the existing references reviewed. The incidence, risk factors, clinical manifestations, histology, age of onset, diagnosis and survival in HIV positive patients with BC were analyzed. The clinical histories of 2,586 patients with HIV infection seen in the authors' center were reviewed. Five cases in whom BC was detected were found. Sixty-nine cases published in the international literature were collected in a reference search by the MEDLINE system between 1982-1994. The patients with BC and HIV infection have an early age of presentation (mean age: 42 years) and a lower survival with respect to those without infection. No differences were observed with regard to the smoking habit, procedures for achieving diagnosis or clinical manifestation. The predominant histologic subtype was adenocarcinoma. A higher incidence of BC was observed in patients with HIV infection with respect to the control groups on elimination of the bias for age and risk factors for BC. Given its low incidence, BC should be considered in the differential diagnosis of pulmonary disease in patients with HIV infection in cases presenting a history of smoking, once the most common opportunistic infections have been discarded.

[HIV infection declines among intravenous drug addicts in Barcelona: 1987-1993]

BACKGROUND

The evolution of the prevalence of HIV infection in intravenous drug addicts who initiate hospital detoxication was analyzed.

METHODS

Six hundred fifty intravenous drug addicts (535 males, 115 females) were analyzed for HIV and surveyed in regard to demographic variables and the use of drugs over a period of 7 years (1987-1993): age, sex, year of initiation of intravenous drug addiction, length of the habit and year of admission.

RESULTS

Most of the subjects were men (82%) with a mean age of 19.7 years at the time of initiation to the use of i.v. drugs and an age of 25.9 years on admission to the unit. The mean time of i.v. drug addiction at admission was 74 months. The characteristics of the patients according to the year of admission were homogeneous in regard to age, length of drug addiction and male/female ratio. More than 50% of the subjects had initiated the use of i.v. drugs during the first half of the last decade. The global prevalence of HIV infection was of 66.3% with no differences being observed between sexes. The frequency of infection was shown to have globally decreased from 1987 to 1993 (p = 0.06) although the rates of HIV infection in women did not significantly modify (p = 0.08) in contrast to that of men (p = 0.05).

CONCLUSIONS

The epidemia of HIV infection in intravenous drug addicts may have entered into remission following a decade characterized by a spread in the use of heroin and great diffusion of the disease.

Dopaminergic resistance in a case of invasive macroprolactinoma

Invasive prolactinoma is a relatively infrequent variety of macroprolactinoma characterized by a fast and aggressive growth, with infiltration to adjacent structures, and whose management is frequently difficult. We present the case of a fatal invasive macroprolactinoma in whom resistance to different dopaminergic drugs developed.

[Surgical treatment of Eagle syndrome by way of the oropharynx. A case report]

The authors present one case of elongated Styloid process which surgeons was undertaken due to intense symptomatology. Oropharyngeal approach was used and showed to be the election way for resection.

Stability of chitin synthetase in cell-free preparations of a wild-type strain and a 'slime' variant of Neurospora crassa

Chitin synthetase activity in cell-free preparations from a wild-type strain and a 'slime' variant of Neurospora crassa was monitored over many days in samples stored at 0 degrees C. Total activity in whole-cell-free extracts and low-speed supernatants from both organisms was very unstable, losing more than 90% of the initial activity on storage at 0 degrees C for 96 h. Chitin synthetase detection was not masked by chitinase activity present in the preparations. Gel-filtration chromatography of these preparations increased the stability of the activity from the 'slime' variant, whereas removal of particulate structures by high-speed centrifugation stabilized the chitin synthetase activity in the supernatant, particularly in the wild type. These results suggest that factor(s) involved in the regulation of chitin synthetase may be differentially located or altered in 'slime' cells.

Sedimentation properties of chitosomal chitin synthetase from the wild-type strain and the 'slime' variant of Neurospora crassa

Marked differences in the pattern of sedimentation of cellular structures were observed after isopycnic centrifugation of crude cell-free preparations from the Neurospora crassa wall-less 'slime' variant and mycelial wild-type strain. Kinetic studies of particle sedimentation showed that the various types of subcellular components, as revealed by turbidity, UV absorption, polypeptide patterns, and chitin synthetase activity determinations, sediment independently of one another. An important feature was the finding that chitin synthetase from 'slime' peaked at a median specific gravity of 1.1201 +/- 0.0036, whereas that from wild-type strain sedimented at a higher buoyant density (specific gravity 1.1349 +/- 0.0024). Different cultivation conditions or cell breakage procedures (osmotic lysis or ballistic disruption) did not seem to affect this sedimentation behavior. Electron microscopy revealed the presence of chitosomes (microvesicles containing chitin synthetase) in the chitin synthetase activity peaks obtained after isopycnic centrifugation of cell-free extracts from 'slime' and wild-type strains. The discrepancy in buoyant density of chitin synthetases from both N. crassa strains might point to inherent differences in chemical composition of the chitosomal microvesicles. In any case, the lower buoyant density of 'slime' chitosomes appears to be one of several major alterations in sedimentation behavior of subcellular structures. These alterations might be related to the inability of 'slime' to make a cell wall.

[Endemic goiter in school children of Salta Province, Argentina]

The Province of Salta, located in the northwest of Argentina, showed severe endemic goiter-cretinism. The purpose of our work, therefore, was to evaluate the results of the iodized salt prophylaxis measure implemented since 1963. In 1980-1981 the prevalence of goiter was determined in 16,935 school children whose ages ranged from four to 15 years. The urinary iodine/creatinine index was also determined in a subsample of 401 children. Findings revealed that the goiter prevalence in the Province was 16.1%. In 10 Departments of the Province, those with greater socioeconomic development and denser population, the prevalences found were below 10%, limit established as endemic. In the remaining 13 Departments, especially in those less developed--where mountainous regions make their access difficult and hence, their populations consume non-iodized salt obtained from natural salt basins--values exceeded this limit. The average ioduria was 104.0 micrograms I/g Cr, with 4.5% presenting values below 25 micrograms. After 20 years of prophylaxis, endemic goiter has therefore been partially eradicated. It is suggested, however, that consumption of iodized salt and, even the supply of iodized oil in those areas where prevalence is high, be recommended.

[Pancreatic pseudocyst in childhood]

Pancreatic pseudocysts are rare in children, with different etiology and prognosis than adults. We report four cases of post-traumatic pancreatic pseudocysts with their follow-up by echography and CT scan. Spontaneous resolution has been observed in three patients while one case was operated on. The better prognosis of the pancreatic pseudocyst in childhood, confirmed by our clinical observations and literature, lead us to promote a more conservative management and follow-up than in adults.