Visual Outcomes after Bilateral Implantation of an Extended Depth of Focus Intraocular Lens: A Multicenter Study

Purpose@#To evaluate visual performance after bilateral implantation of an extended depth of focus (EDOF) intraocular lens (IOL). @*Methods@#This multicenter, prospective, observational study included 100 patients who underwent bilateral cataract surgery with a toric or non-toric EDOF IOL (Tecnis Symfony), and 96 patients completed the final assessment at 4 to 6 months. Binocular corrected distance visual acuity and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA), spectacle independence, visual symptoms, and patient satisfaction were evaluated. @*Results@#Mean decimal visual acuity results showed a binocular corrected distance visual acuity of 1.10 ± 0.18, UDVA of 1.04 ± 0.17, UIVA of 0.96 ± 0.16, and UNVA of 0.68 ± 0.18. Binocular UDVA and UIVA were 0.8 (decimal) or better in 98% and 94% of patients, respectively. Binocular UNVA was 0.63 (decimal) or better in 76% of patients. Overall, 76% of the patients achieved spectacle independence across all distances, and more than 85% reported no or mild dysphotoptic phenomena. On a scale of 0 to 10, the median patient satisfaction score was 9 for far, 9.5 for intermediate, and 8 for near vision. @*Conclusions@#The Symfony EDOF IOL provided excellent distance, intermediate visual outcome, and functional near visual acuity. The visual results were associated with prominent levels of spectacle independence and patient satisfaction.

Visual Outcomes after Bilateral Implantation of an Extended Depth of Focus Intraocular Lens: A Multicenter Study

Purpose@#To evaluate visual performance after bilateral implantation of an extended depth of focus (EDOF) intraocular lens (IOL). @*Methods@#This multicenter, prospective, observational study included 100 patients who underwent bilateral cataract surgery with a toric or non-toric EDOF IOL (Tecnis Symfony), and 96 patients completed the final assessment at 4 to 6 months. Binocular corrected distance visual acuity and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA), spectacle independence, visual symptoms, and patient satisfaction were evaluated. @*Results@#Mean decimal visual acuity results showed a binocular corrected distance visual acuity of 1.10 ± 0.18, UDVA of 1.04 ± 0.17, UIVA of 0.96 ± 0.16, and UNVA of 0.68 ± 0.18. Binocular UDVA and UIVA were 0.8 (decimal) or better in 98% and 94% of patients, respectively. Binocular UNVA was 0.63 (decimal) or better in 76% of patients. Overall, 76% of the patients achieved spectacle independence across all distances, and more than 85% reported no or mild dysphotoptic phenomena. On a scale of 0 to 10, the median patient satisfaction score was 9 for far, 9.5 for intermediate, and 8 for near vision. @*Conclusions@#The Symfony EDOF IOL provided excellent distance, intermediate visual outcome, and functional near visual acuity. The visual results were associated with prominent levels of spectacle independence and patient satisfaction.

Morphological Changes in Extraocular Muscle of Rabbit Eye Produced by Subtenon's Botulinum A Toxin Chemodenervation

PURPOSE: Currently, when injecting botulinum a toxin into the extraocular muscle, EMG (Electromyography) is used for accurate location. In this study, we examined the effects of subtenon botulinum toxin injection without EMG guidance by quantifying the morphological changes of the extraocular muscle fibers in rabbits. METHODS: Using 10 New Zealand white rabbits, 10 units of botulinum a toxin in 0.1 ml of normal saline was injected into the subtenon space of the superior rectus muscles, 5 mm from the muscle insertion in right eyes. As a control, 0.1 ml of normal saline was injected into the subtenon space of the superior rectus muscles in left eyes. At 3 weeks after injections, the bilateral superior rectus muscles of each rabbit were carefully dissected from the globe. Cross-sections of 5 micrometer thickness were obtained at the site, 5 mm from the insertion of each superior rectus muscle. Sections were stained with Masson's trichrome and observed by light microscopy. Using Image-Pro Plus software, the diameter of the orbital layer myofibers was measured and statistical analysis was done using the Kruskal-Wallis test. RESULTS: The average diameter of the orbital layer fiber cells after botulinum toxin injection was 11.5+/-2.26 micrometer at 3 weeks, whereas that of the control was 14.4+/-3.77 micrometer. The difference was statistically significant (p<0.01). CONCLUSIONS: The diameter of myofibers in the orbital layer was reduced after subtenon botulinum a toxin injection. Further studies on the duration of botulium toxin in subtenon space and the change in the size of myofibers depending on the dosage of botulinum toxin will be necessary.

Increased Tear TNF-alpha and MMP-9 in Patients with Necrotizing Scleritis after Pterygium Excision

PURPOSE: We collected tear or scleral tissues of necrotizing scleritis after pterygium excision, and evaluated them for tumor necrosis factor (TNF)-alpha and matrix metalloproteinase (MMP)-9 to elucidate the molecular basis and seek for treatment of this disease. METHODS: Three patients with necrotizing scleritis after pterygium excision were evaluated for MMP-9 and TNF-alpha in tear and scleral tissue by Western blot analysis. RESULTS: Before treatment with corticosteroid, the patients' tear samples showed increased expression of TNF-alpha and MMP-9 compared to those of the contralateral eye. After treatment, the expression of TNF-alpha and MMP-9 was decreased compared to those of the pre-treated tear samples. The patients' sclera showed increased expression of MMP-9 compared to that of the donors' sclera and the patients' conjunctiva. CONCLUSIONS: Our results suggest that cytokine-related inflammation plays a role in the pathophysiology of necrotizing scleritis and strongly supports, under the guarantee of negative microbiological culture, the prompt use of corticosteroid and immunosuppressive agents to help suppress the progression of this disease.

Bilateral optic neuritis as first manifestation of systemic lupus erythematosus

A 21-year-old woman presented with bilateral optic neuritis, combined with central retinal vein occlusion. General physical examination and neurologic consultation revealed no other findings. Laboratory investigation yielded an elevated erythrocyte sedimentation rate, positive LE preparation, elevated ANA titer, and elevated blood urea nitrogen and creatinine levels. Diagnosis of systemic lupus erythematosus (SLE) was made. Renal failure developed quickly and she was treated with hemodialysis, transfusion and subsequently systemic corticosteroid. Anti-phospholipid antibody was positive to lupus anti-coagulant and the titer was normalized after 2-month steroid therapy at which time the visual outcome differed between the eyes. The right eye showed improvement in visual acuity and visual field, but the left eye was not improved and retained a central scotoma. SLE needs to be considered in young women with optic neuritis when other causes of optic neuritis have been excluded, and serologic tests including anti-phospholipid antibody should be conducted.

Collateral vessels in branch retinal vein occlusion

Experiments show that collaterals that develop and maturate in branch retinal vein occlusion (BRVO) are helpful in the drainage of blood from a blocked area to an adjacent area. Laser treatment on the nonperfusion area can reduce the retinal blood inflow that can impair the formation of collateral vessels. Furthermore, if collaterals were accidentally destroyed by laser photocoagulation, leakage and neovascularization would increase. Forty-five patients with BRVO were reviewed retrospectively. Collateral vessels were noted from angiographic analysis in 27 of 45 (60%) patients. Good visual prognosis was noted in the patients with collaterals. Cases with neovascularization underwent laser treatment. In one case, laser photocoagulation was applied to the collateral vessels accidentally, after which the leakage significantly increased on fluorescein angiography. In conclusion, collateral vessels in BRVO have a favorable effect on visual prognosis. Careful laser treatment is recommended to avoid destroying collaterals in BRVO.

The Complications Developed after Repeated Botulinum Toxin Injection

PURPOSE: To investigate the incidence of complication associated with repeated botulinum toxin chemodenervation in extraocular muscle. METHODS: 47 patients who had taken botulinum toxin chemodenervation from 1996 to November 2001 were reviewed retrospectively. 10 patients had taken repeated injection. Saline diluted botulinum toxin was directly injected into the extraocular muscle through the Teflon coated needle. RESULTS: In 10 patients, 5 patients had complications which were 2 cases of hypertropia, 2 cases of ptosis and 1 case of retrobulbar hemorrhage who was 44 year old woman taken 5 times of botulinum toxin injection. She was successfully treated with lateral canthotomy and cantholysis. CONCLUSIONS: Rate of complication in repeated botulinum toxin chemodenervation was not different from that of single procedure. We experienced one case of retrobulbar hemorrhage in 10 patients with repeated botulinum injection.