High-addition segmented refractive bifocal intraocular lens in inactive age-related macular degeneration: A multicenter pilot study.

This multicenter, open-label study aimed to determine the safety and functional outcome of a high-addition segmented refractive bifocal intraocular lens (IOL) in late inactive age-related macular degeneration (AMD). Twenty eyes of 20 patients were enrolled and followed until 12 months after the intervention. Patients underwent cataract surgery with implantation of a LS-313 MF80 segmented refractive bifocal intraocular lens with a near addition of +8.0 D (Teleon Surgical Vertriebs GmbH, Berlin, Germany). The main outcome measures were distance corrected near visual acuity (DCNVA) and safety as determined by intra- and post-operative complications. Secondary outcomes included distance corrected visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), the need for magnification to read newspaper, preferred reading distance, speed and performance (logRAD), as well as patient satisfaction. Mean DCNVA improved from 0.95 (±0.19) to 0.74 (±0.35) logMAR, until 6 months after surgery, P<0.05. CDVA improved from 0.70 (±0.23) to 0.59 (±0.30) logMAR, UDVA from 0.94 (±0.25) to 0.69 (±0.34) logMAR, UNVA from 1.08 (±0.19) to 0.87 (±0.43) logMAR. The mean need for magnification decreased from 2.9- to 2.3-fold, preferred reading distance from 23 to 20 cm. No intraoperative complications occurred during any of the surgeries. One patient lost > 2 lines of CDVA between 6 and 12 months, in another case, the study IOL was exchanged for a monofocal one due to dysphotopsia and decreased CDVA. Implantation of a segmented refractive bifocal IOL with +8.0 D addition improves near and distance vision in patients with late AMD and has a satisfactory safety profile.

Outcomes of combining a trifocal and a low-addition bifocal intraocular lens in patients seeking spectacle independence at all distances.

PURPOSE: To assess the visual and refractive outcomes and patient satisfaction after cataract surgery in patients with a diffractive multifocal intraocular lens (IOL) with a low addition (add) power (+2.75 diopters [D]) (Tecnis ZKB00) in the dominant eye and a diffractive trifocal IOL (AT LISA tri 839MP) in the nondominant eye. SETTING: Augenärzte Gerl, Kretz, and Kollegen, Head Office, Ahaus, Germany. DESIGN: Prospective case series. METHODS: All patients had implantation of the low-add multifocal IOL in the dominant eye and a trifocal IOL in the fellow eye. Patients were evaluated preoperatively and 3 months postoperatively for monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity, intermediate and near visual acuities, the binocular defocus curve, and manifest refraction. Dysphotopic phenomena were objectively evaluated and subjective patient satisfaction questionnaires administered. RESULTS: The study included 42 patients (84 eyes). The mean postoperative spherical equivalent was -0.06 D ± 0.57 (SD). The binocular visual acuities were 0.00 ± 0.05 logarithm of the minimum angle of resolution (logMAR) (UDVA), 0.19 ± 0.11 logMAR (uncorrected intermediate visual acuity at 80 cm), 0.16 ± 0.10 logMAR (distance-corrected intermediate visual acuity at 80 cm), 0.11 ± 0.09 logMAR (uncorrected near visual acuity at 40 cm), and 0.08 ± 0.09 logMAR (distance-corrected near visual acuity at 40 cm). The binocular defocus curve showed a visual acuity of 0.20 logMAR or better between +0.50 D and -3.00 D. Of the patients, 92%, 92%, and 75% reported never wearing spectacles for distance, intermediate, or near distance, respectively. CONCLUSION: The mix-and-match approach seemed to provide functional visual performance at all distances while achieving spectacles independence in the majority of patients.

SURGICAL AND FUNCTIONAL RESULTS OF 27-GAUGE VITRECTOMY COMBINED WITH COAXIAL 1.8 MM MICROINCISION CATARACT SURGERY: A Consecutive Case Series.

PURPOSE: To investigate outcomes after coaxial 1.8 mm microincision cataract surgery combined with 27-gauge vitrectomy (MICVIT) in eyes with vitreoretinal disease and age-related cataract. METHODS: A single-center, retrospective case series study of 62 subjects (62 eyes) with a mean age of 70 years who underwent combined microincision phacoemulsification, intraocular lens implantation, and 27-gauge vitrectomy during the 12-month period to January 2015. Intraoperative and postoperative complications, and visual results were the main outcome measures. RESULTS: The mean follow-up period was 6 months (range 2-10 months). Intraoperative findings were retinal break (9.7%) and one posterior capsule tear (1.6%). No cases required corneal or scleral suture, or conversion to larger-gauge vitrectomy. Postoperative complications consisted of posterior capsule opacification (8%), elevated intraocular pressure >30 mmHg (6.4%), retinal detachment (1.6%), and fibrin reaction (1.6%). There were no cases of hypotony (<9 mmHg), intraocular lens decentration, or postoperative endophthalmitis. Visual acuity improved 3 Early Treatment of Diabetic Retinopathy Study (EDTRS) score lines from 0.48 ± 0.4 logMAR (20/60) preoperatively to 0.17 ± 0.23 logMAR (20/30) at final postoperative visit (P = 0.001). CONCLUSION: Findings suggest 27-gauge vitrectomy combined with microincision phacoemulsification and intraocular lens implantation is feasible, safe, and effective as a 1-step surgical procedure for the management of vitreoretinal pathologies and concurrent cataract.

Surgical and Functional Results of Hybrid 25-27-Gauge Vitrectomy Combined with Coaxial 2.2 mm Small Incision Cataract Surgery.

Purpose. To investigate outcomes after coaxial 2.2 mm small incision cataract surgery combined with hybrid 25-27-gauge vitrectomy in eyes with vitreoretinal disease and age-related cataract. Methods. A single-center, retrospective case series study of 55 subjects (55 eyes) with a mean age of 70 years who underwent combined small incision phacoemulsification, intraocular lens (IOL) implantation, and hybrid 25-27-gauge vitrectomy during the 12-month period to December 2014. Intraoperative and postoperative complications and visual results were the main outcome measures. Results. The mean follow-up period was 6 months (range: 2-18 months). Intraoperative findings were 3 retinal breaks (5.5%). No cases required corneal or scleral suture or conversion to larger-gauge vitrectomy. Postoperative complications consisted of posterior capsule opacification (12.7%), elevated intraocular pressure >30 mmHg (1.8%), and fibrin reaction (5.5%). There were no cases of hypotony (<7 mmHg), IOL decentration, or postoperative endophthalmitis. Visual acuity (mean ± SD) improved from 0.52 ± 0.6 logMAR preoperatively to 0.22 ± 0.46 logMAR at final postoperative visit (P < 0.0001). Conclusion. Surgical and visual outcomes suggest hybrid 25-27-gauge vitrectomy combined with small incision phacoemulsification and IOL implantation is feasible, safe, and effective as a one-step surgical procedure for the management of vitreoretinal pathologies and concurrent cataract.

Portable single port 23-gauge vitrectomy in postoperative endophthalmitis.

AIM: To evaluate the safety and effectiveness of the Intrector(®) for treating postoperative endophthalmitis. MATERIALS AND METHODS: In a retrospective multicenter study, patients who received a single port 23-gauge core pars plana vitrectomy and isovolumetric injection of vancomycin, ceftazidime, and dexamethasone/amphotericin B using the Intrector(®) for postoperative endophthalmitis of intermediate severity (grade II or III vitreous inflammation and best-corrected visual acuity between hand movements and 0.3 logMAR [logarithm of the minimum angle of resolution]) were evaluated. Improvement in visual acuity, resolution of intraocular inflammation, the need for additional surgical procedures, and the development of complications were evaluated at a 1-month follow-up examination. RESULTS: Fifteen patients (mean age 55.6±7.2 years) underwent treatment with the Intrector(®). The mean vitreous volume aspirated was 0.78±0.22 mL. The vitreous samples indicated positive microorganism culture results in six of the 15 cases, but the samples were positive when analyzed by real-time polymerase chain reaction in all cases (15/15). The mean best-corrected visual acuity improved significantly (P=0.01) from 0.88±0.29 (logMAR) to 0.32±0.28. Each patient demonstrated at least three lines of visual improvement. No additional medical or surgical interventions were required, and the complete resolution of intraocular inflammation was noted in all patients at the 1-month follow-up examination. No procedure-related complications were observed. CONCLUSION: The Intrector(®) may be a safe and effective treatment option for infectious postoperative endophthalmitis. Larger studies comparing the outcomes of the Intrector(®) to the traditional treatments for postoperative endophthalmitis need to be conducted before its role in the treatment of postoperative endophthalmitis can be properly defined.

Functional and anatomical results after a single intravitreal Ozurdex injection in retinal vein occlusion: a 6-month follow-up -- the SOLO study.

PURPOSE: To evaluate the efficacy of intravitreal dexamethasone implants in eyes with cystoid macular oedema (CME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) in the clinical everyday practice, examine the effects of early retreatment and compare the results with the GENEVA study. METHODS: The charts of 102 patients (102 eyes) with CME secondary to BRVO (n = 54) or CRVO (n = 48) treated with Ozurdex at 8 centres were retrospectively reviewed. The patients were examined monthly over a 24-week period. Slit-lamp biomicroscopy, measurement of best-corrected visual acuity (BCVA) and measurement of the central retinal thickness (CRT) with spectral-domain optical coherence tomography (SD-OCT) were performed at baseline and at every follow-up examination. With progression of the disease (loss of one line or increased central retinal thickness (CRT) of 150 µm), a reinjection of Ozurdex or anti-VEGF was offered. Additional supplementing sectorial or panretinal laser photocoagulation was considered based on the individual status of the retina. RESULTS: In the BRVO group, the median BCVA was 0.6 logMAR (Snellen equivalent of 0.25) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.3 logMAR (Snellen equivalent of 0.50) after 8 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 12 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 16 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 20 weeks and 0.45 logMAR (Snellen equivalent of 0.35) after 24 weeks. The mean CRT was 559 ± (SD) 209 µm at baseline and it decreased to 335 ± 148 µm after 4 weeks, 316 ± 137 µm after 8 weeks, 369 ± 126 µm after 12 weeks, 407 ± 161 µm after 16 weeks, 399 ± 191 µm after 20 weeks and 419 ± 196 µm after 24 weeks. In the CRVO group, the median BCVA was 0.7 logMAR (Snellen equivalent of 0.20) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 8 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 12 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 16 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 20 weeks and 0.52 logMAR (Snellen equivalent of 0.30) after 24 weeks. The mean CRT at baseline was 740 ± 351 µm and it decreased to 419 ± 315 µm after 4 weeks, 352 ± 261 µm after 8 weeks, 455 ± 251 µm after 12 weeks, 497 ± 280 µm after 16 weeks, 468 ± 301 µm after 20 weeks and 395 ± 234 µm after 24 weeks. The BCVA improvement was statistically significantly better (p < 0.05) compared with baseline in both groups at every follow-up visit. The mean CRT maintained significantly better when compared with baseline in both groups at all follow-up visits. Early reinjection was indicated in BRVO in 40.7% after 17.5 ± 4.2 weeks and in CRVO in 50% after 17.68 ± 4.2. Six eyes (11%) with BRVO received a sectorial laser photocoagulation at a mean interval of 22 ± 5.0 weeks. Seven eyes (15%) with CRVO received a panretinal laser photocoagulation after a mean interval of 18 ± 7.0 weeks. The BCVA improvement and the mean CRT reduction were statistically significant (p < 0.05) compared with baseline in both groups at every follow-up visit. CONCLUSIONS: Dexamethasone intravitreal implant resulted in a significant improvement of the BCVA and reduction of CME in patients with BRVO or CRVO. Early retreatment after 16 weeks instead of 24 weeks, like in the GENEVA study, was indicated in 50% to stabilize the improved functional and anatomical results.

Acute D2 receptor blockade induces rapid, reversible remodeling in human cortical-striatal circuits.

Structural remodeling has been observed in the human brain over periods of weeks to months, but the molecular mechanisms governing this process remain incompletely characterized. Using multimodal pharmaco-neuroimaging, we found that acute D2 receptor blockade induced reversible striatal volume changes and structural-functional decoupling in motor circuits within hours; these alterations predicted acute extrapyramidal motor symptoms with high precision. Our findings suggest a role for D2 receptors in short-term neural plasticity and identify a potential biomarker for neuroleptic side effects in humans.

Impact of injection techniques on intraocular pressure (IOP) increase after intravitreal ranibizumab application.

PURPOSE: To examine the influence of different intravitreous injection techniques on the short-term intraocular pressure (IOP) in patients with exudative age-related macular degeneration (AMD) receiving 0.05 ml ranibizumab (Lucentis) in the supine position. METHODS: Forty-five eyes (45 patients, 16 male, 29 female, mean age: 78 years) received intravitreal ranibizumab injections for treatment of exudative AMD (0.05 ml = 0.5 mg). A total of 31 patients received a standard straight scleral incision, and 14 were injected using the tunneled sclera technique. IOP was measured by Schiøtz tonometry immediately pre-and postoperatively, and the amount of subconjunctival reflux was documented using a semi-quantitative scale. Twenty-three eyes were phakic, and the remaining 22 were pseudophakic. No history of glaucoma was present. The Wilcoxon matched-pairs test was used for comparisons. RESULTS: The mean preoperative IOP was 22.4 +/- 5.5 mmHg in the supine position. Immediately after the injection, the IOP increased to 47.9 +/- 15.1 (range 23-82). The mean difference between preoperative IOP and immediately after the injection was 25.5 +/- 13.6 mmHg. The mean IOP increase in eyes receiving a standard straight scleral incision was 21.9 +/- 14.2 mmHg (median 22.3) versus 33.5 +/- 7.2 mmHg (median 34.7) in the tunneled scleral incision group (p = 0.001). CONCLUSIONS: IOP increased significantly in a considerable number of patients after receiving 0.05-ml intravitreal ranibizumab injections. This increase was dependent on the intravitreal injection technique and was significantly higher if a tunneled scleral injection was performed.

Course of intraocular pressure after intravitreal injection of 0.05 mL ranibizumab (Lucentis).

PURPOSE: This prospective study examines the changes in short-term intraocular pressure (IOP) in patients with wet age-related macular degeneration (AMD) receiving intravitreal injections of 0.05 mL ranibizumab (Lucentis) in a supine position. METHODS: A total of 45 eyes (45 patients, 16 M, 29 F, mean age: 78 y) received intravitreal ranibizumab injections for treatment of wet AMD (0.05 mL = 0.5 mg). The IOP was measured by Schiötz tonometry immediately preoperatively and postoperatively, and also after 3 and 10 minutes in a supine position. No history of glaucoma was present. RESULT: The mean preoperative IOP was 22.4+/-5.5 mmHg in supine position. Immediately after the injection, IOP increased to 47.9+/-15.1 (range 23-82, p<0.001), with 32 eyes (71.1%) >40 and 19 eyes (42.2%) >50 mmHg. The mean difference between preoperative IOP and immediately after the injection was +25.5+/-13.6 mmHg. IOP decreased spontaneously by the first 3 minutes after operation by 12.6+/-6.0 mmHg and after 10 minutes by 21+/-9.4 mmHg. The mean difference between preoperative IOP and 10 minutes postoperatively was +4.6+/-7.0 mmHg (range: -9.3 to +25.9 mmHg, p<0.001). Eyes without a subconjunctival reflux had a higher increase in IOP than eyes with any reflux (p<0.001). CONCLUSIONS: IOP increased significantly in a considerable number of patients after intravitreal ranibizumab injections. A rapid and spontaneous decline was observed in the majority of cases. If there is no subconjunctival reflux after the injection, the increase in IOP is higher than in eyes with any backflow under the conjunctiva.

Incidence of posterior vitreous detachment after cataract surgery.

PURPOSE: To report the incidence of posterior vitreous detachment (PVD) after uneventful state-of-the-art small-incision phacoemulsification with implantation of a posterior chamber intraocular lens (PC IOL). SETTING: Department of Ophthalmology, Ludwigshafen Hospital, Ludwigshafen, Germany. METHODS: This prospective study evaluated the vitreous status of eyes by biomicroscopic examination, indirect binocular ophthalmoscopy, and B-scan ultrasonography before planned cataract surgery. Patients with the posterior vitreous attached were included for follow-up and examined 1 week, 1 month, and 1 year after uneventful phacoemulsification with PC IOL implantation. The preoperative prevalence and postoperative incidence of PVD were determined by ultrasonography. RESULTS: The study included 188 eyes of 188 patients (131 women, 57 men) with a mean age of 77.2 years. The mean spherical equivalent was -0.78 diopter (D) (range -8.75 to +6.25 D) and the mean axial length (AL), 23.22 mm (range 20.50 to 26.04 mm). Preoperatively, 130 eyes (69.1%) had PVD and 58 eyes (30.9%) had no PVD. Postoperatively, 12 eyes (20.7%) developed PVD at 1 week, 18 eyes (31%) at 1 month, and 4 eyes (6.9%) at 1 year. The vitreous body remained attached to the retina in 24 eyes (41.4%) 1 year after surgery. No preoperatively measured parameter (eg, age, refraction, AL, effective phacoemulsification time) was predictive of the occurrence of PVD after cataract surgery. CONCLUSION: The occurrence of PVD after modern cataract surgery was frequent in cases in which the posterior hyaloid was attached to the retinal surface preoperatively.

Optical coherence tomography for diagnosis of posterior vitreous detachment at the macular region.

PURPOSE: To assess optical coherence tomography (OCT) for diagnosing posterior vitreous detachment (PVD) at the macular region compared to kinetic B-scan ultrasonography. METHODS: In the present study, the authors prospectively investigated the frequency of PVD at the posterior pole utilizing ocular kinetic B-mode sonography in 315 eyes of 188 patients (113 female, 75 male; mean age, 72.8 years; range, 39-94) prior to cataract surgery. In addition, OCT scans of the macular region were performed in all subjects for detection of PVD at the macula. RESULTS: A total of 130 eyes (41.3%) had no sonographic signs of PVD. In this subset of patients in 36 eyes (27.7%), OCT revealed a flat PVD at the macular region with the distance between the posterior hyaloid and retinal surface being less than 400 microm (mean distance, 234 +/- 112 microm, range, 24-398). When combining both methods, the diagnosis of PVD at the posterior pole was made in 221 of 315 eyes (70.2%). CONCLUSIONS: OCT is a valuable tool for detecting PVD at the macular region, particularly in cases with small distances between the retinal surface and posterior hyaloid. Proof of attachment of the posterior hyaloid can be established only by combining kinetic ultrasonography and OCT.

D2 antidopaminergic modulation of frontal lobe function in healthy human subjects.

BACKGROUND: Although the major principles of dopamine (DA) signaling have been well described previously, its precise modulatory impact on the prefrontal cortex (PFC) in humans is poorly understood. Two major neurophysiological models propose segregated functional circuits on the systems level as well as D(1) and D(2) receptor-dependent processing states on the cellular level (two-state model). METHODS: We examined the predictive validity of these models in 10 healthy male volunteers with a haloperidol challenge (HLP). Cortico-striatal-thalamo-cortical (CSTC) motor loop functions were examined during functional magnetic resonance imaging (fMRI) with a sequential finger opposition task. Neuropsychological implications of the two-state model were evaluated with a test battery of D(1)- or D(2)-sensitive prefrontal measures. RESULTS: Analysis of fMRI data revealed a significant HLP-induced blood oxygen level dependent-signal decrease in the sensorimotor striatum and a lateralized activation loss of ipsilateral higher order motor cortices and contralateral cerebellum. Neuropsychological evaluation demonstrated a preferential impairment of D(2)-sensitive functions, whereas D(1) or non-dopaminergic domains were unaffected. CONCLUSIONS: Our data support the hypothesis that mesocortical D(1) and D(2) receptors exert differential influences in the PFC for cognitive function, but the nigrostriatal CSTC network model for the motor domain could not be confirmed.

Haloperidol challenge in healthy male humans: a functional magnetic resonance imaging study.

Functional magnetic resonance imaging (fMRI) was used to determine the acute blood oxygen level dependent effect (BOLD) of neuroleptic drugs in healthy male subjects. Using a robust simultaneous visuo-acoustic stimulation paradigm fMRI measurements were obtained prior to as well as 1 h and 24 h after intravenous infusion of 5 mg haloperidol to six healthy young men. After the administration, subjects showed significantly reduced BOLD contrast in the middle occipital gyrus while BOLD contrast was increased in the lingual gyrus. This pattern normalised within 24 h. Our results emphasise the necessity to control for interactions through acute medication and confirm fMRI as a non-invasive method for studying cerebral psychopharmacological effects.