Buoyancy affects stranding rate and dispersal distance of floating litter entering the sea from river mouths.

Rivers are a major source of litter entering the sea but our understanding of the transport and fate of plastics in estuarine environments is poor. Marked blocks of varying buoyancy were released at three river mouths in South Africa. Of the 1400 blocks released, 80% were recovered on nearby beaches, with a higher recovery rate for more buoyant blocks. Dispersal distances increased with decreasing buoyancy at all sites; median dispersal distance of stranded items ranged from 20 to 90 m for expanded polystyrene (EPS) to 70-90 m for wood and 60-1042 m for high density polyethylene (HDPE) blocks. Floating litter in estuaries is subject to bidirectional flow and export is largely controlled by hydrodynamic conditions such as tides, winds, and wave action, as well as coastal structure and vegetation. Cleaning beaches around river mouths will help to reduce leakage of plastic and other litter into the sea.

Localized calcification of hydrophilic acrylic intraocular lenses after posterior segment procedures.

PURPOSE: To describe the clinical and laboratory findings in a series of cases of hydrophilic acrylic intraocular lens (IOL) opacification after posterior segment procedures. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, USA. DESIGN: Experimental study. METHODS: Thirty hydrophilic acrylic IOLs were explanted after various posterior segment procedures (pars plana vitrectomy, intravitreal anti-vascular endothelial growth factor injections) because of localized central anterior surface and subsurface optic opacification associated with decreased visual function. Once received by the laboratory in the dry state or in fixative by the explanting surgeons, microscopic, histochemical (alizarin red), and surface analysis (scanning electron microscopy [SEM], energy-dispersive X-ray spectroscopy [EDS]) evaluations were performed on the IOLs. The surgeons were sent a questionnaire to obtain information pertinent to each case. RESULTS: Of the 30 explanted IOLs, 9 hydrophilic acrylic designs from 7 different manufacturers were identified. Gross microscopy and light microscopy showed granular deposits in a dense round pattern of distribution within the margins of the capsulorhexis or pupil on the anterior surface/subsurface of the IOLs. The granules stained positive for calcium with alizarin red. On SEM coupled with EDS, the granular deposits were found to comprise calcium and phosphate. CONCLUSIONS: A localized pattern of anterior surface/subsurface calcification was seen on hydrophilic acrylic IOLs from various manufacturers. The calcification resembled the pattern seen on calcified IOLs after anterior segment procedures using intracameral injections of air or gas. This calcification of hydrophilic acrylic IOLs is likely the result of blood-aqueous barrier breakdown from repeated intraocular procedures.

Treatment of central serous chorioretinopathy with topical NSAIDs.

PURPOSE: Central serous chorioretinopathy (CSCR) is a common retinopathy that is often observed until resolution. The purpose of this study is to evaluate the effects of topical nonsteroidal anti-inflammatory drugs (NSAIDs) on timing of CSCR recovery. METHODS: An IRB-approved retrospective review was conducted on patients that had been diagnosed with a new-onset, symptomatic case of CSCR. Patients were either observed only (13 untreated eyes) or treated with topical bromfenac or nepafenac (14 eyes) over an average of about a 4-5 week follow-up period. RESULTS: There was no statistical significance between central macular thickness (CMT) and visual acuity of treatment and control groups at the initial presentation. However, at the follow-up visit, CMT reductions in the treatment group were significantly higher than in the control group (p<0.006). CONCLUSION: Use of topical NSAIDs in the treatment of acute CSCR leads to a faster rate of reduction in the subretinal fluid volume over a follow-up period of a few weeks.

Vellus Hair Cyst of the Orbit.

Eruptive vellus hair cysts are a developmental abnormality of vellus hair follicles that result in small cystic papules occurring most frequently on the chest and proximal extremities. Lesions of the ocular adnexa are extremely rare, and to the best of the authors knowledge, involvement of the orbit has never been reported. The authors describe a patient with an eruptive vellus hair cyst involving the orbit.

Microscopic analysis of an opacified OFT CRYL® hydrophilic acrylic intraocular lens.

A 51-year-old patient underwent posterior vitrectomy with perfluoropropane gas injection, phacoemulsification, and implantation of an Oft Cryl® hydrophilic acrylic intraocular lens (IOL) because of traumatic retinal detachment and cataract in the right eye. On the first postoperative day, gas was filling the anterior chamber because of patient's non-compliance in terms of head positioning, and was reabsorbed within one week. Eight months later, the patient returned complaining of a significant decrease in vision. IOL opacification was noticed by slit-lamp examination. The lens was explanted to undergo gross and light microscopic analysis. The lens was also stained with the alizarin red method for calcium identification. Light microscopic analysis confirmed the presence of granular deposits, densely distributed in an overall circular pattern in the central part of the lens optic. The granules stained positive for calcium. This is the first case of the opacification of this type of hydrophilic lens. Surgeons should be aware of this potential postoperative complication, and the use of hydrophilic IOLs should be avoided in procedures involving intracameral gas because of the risk of IOL opacification.

Microscopic analysis of an opacified OFT CRYL® hydrophilic acrylic intraocular lens / Análise microscópica de uma lente intraocular acrílica hidrofílica OFT CRYL® opacificada

ABSTRACT A 51-year-old patient underwent posterior vitrectomy with perfluoropropane gas injection, phacoemulsification, and implantation of an Oft Cryl® hydrophilic acrylic intraocular lens (IOL) because of traumatic retinal detachment and cataract in the right eye. On the first postoperative day, gas was filling the anterior chamber because of patient's non-compliance in terms of head positioning, and was reabsorbed within one week. Eight months later, the patient returned complaining of a significant decrease in vision. IOL opacification was noticed by slit-lamp examination. The lens was explanted to undergo gross and light microscopic analysis. The lens was also stained with the alizarin red method for calcium identification. Light microscopic analysis confirmed the presence of granular deposits, densely distributed in an overall circular pattern in the central part of the lens optic. The granules stained positive for calcium. This is the first case of the opacification of this type of hydrophilic lens. Surgeons should be aware of this potential postoperative complication, and the use of hydrophilic IOLs should be avoided in procedures involving intracameral gas because of the risk of IOL opacification.

RESUMO Uma paciente de 51 anos foi submetida à vitrectomia posterior com injeção de gás perfluoropropano, facoemulsificação e implante de lente intraocular (LIO) acrílica hidrofílica Oft cryl® devido a descolamento traumático da retina e catarata. No primeiro dia pós-operatório, o gás estava ocupando a câmara anterior pois a paciente não manteve o decúbito ventral restrito, tendo sido absorvido ao longo de uma semana. Oito meses depois, a paciente retornou com baixa da acuidade visual. Ao exame foi evidenciado opacificação da lente intraocular. A lente foi explantada e submetida à análise macroscópica e sob microscopia óptica. Também, foi corada pelo método de vermelho de alizarina, que identifica cálcio. A análise sob microscopia óptica evidenciou depósitos granulares, densamente distribuídos em padrão circular na parte central da óptica da lente intraocular, que coraram positivo para cálcio. Esse é o primeiro relato de opacificação dessa lente hidrofílica. Os cirurgiões devem estar atentos para esta potencial complicação pós-operatória.

Optic replacement in a novel modular intraocular lens system.

PURPOSE: The purpose of the study is to evaluate the stability and ease of replacement of a new modular intraocular lens (IOL) system consisting of a hydrophobic acrylic base unit and a hydrophobic acrylic optic in the rabbit model. METHODS: Five New Zealand white rabbits were utilized. Bilateral phacoemulsification was performed; one eye received the test IOL (ClarVista Harmoni Modular IOL System) and the other, a commercially available hydrophobic acrylic control IOL (Alcon AcrySof SA60AT). Slit-lamp examinations were performed weekly during postoperative weeks 1 to 6. IOL replacement procedures were performed at weeks 2 and 6 using standard instruments. The rabbits were sacrificed at the end of the study (week 6), with all globes analyzed grossly using the Miyake-Apple technique and sectioned and processed for histopathologic examination. RESULTS: The base component and the optic of the Harmoni IOL system remained stable and centred throughout the clinical follow up. Disengagement of the optic component from the base and replacement of the optic were safely and easily accomplished at 2 and 6 weeks postoperatively. Explantation of the control lens required posterior synechiolysis and capsular bag manipulation due to the position of the loops at the periphery of the bag, thus causing zonular stress. CONCLUSIONS: Replacement of the Harmoni optic was found to be safe and efficient compared with the control IOL, as manipulation of the capsular bag to remove haptic components is not necessary with the modular design. The base component of the modular system remained stable and centred throughout the study.

Thymic Origin Neuroendocrine Carcinoma Metastasizing to the Orbit in an Otherwise Asymptomatic Patient.

A 39-year-old man without a significant medical history developed headaches, OS swelling, and limited left-sided ocular motility. An ultrasound of the left orbit and head MRI revealed a retro-orbital mass. A partial left anterior orbitotomy with partial resection was performed, and histopathologic examination of the resected tumor portion was suggestive of a neuroendocrine carcinoma. A large, anterior mediastinal mass was found on chest imaging, and the patient was diagnosed with a primary thymic neuroendocrine tumor. To the authors' knowledge, this is the first report of an otherwise healthy patient presenting with the mass effects of a thymic neuroendocrine carcinoma metastasis to the orbital tissues before detection of the primary thymic malignancy.

Fracture and dislocation of a glass intraocular lens optic as a complication of neodymium:YAG laser posterior capsulotomy: Case report and literature review.

UNLABELLED: An 83-year-old man presented with a 1-year history of blurry vision in his left eye. Bilateral cataract surgery and ciliary sulcus posterior chamber intraocular lens (IOL) implantation had been performed 11 years earlier. The corrected distance visual acuity (CDVA) was 20/60 in the left eye. Slitlamp examination revealed moderate posterior capsule opacification. Neodymium:YAG laser posterior capsulotomy was performed and complicated by IOL fracture and immediate dislocation of optic fragments into the anterior chamber. An IOL exchange was performed, and the damaged IOL was removed in 7 pieces. A 3-piece acrylic IOL was suture fixated to the posterior iris. Pathologic analysis showed that the damaged IOL was made of glass supported by a polyimide frame. Twelve months after the IOL exchange, the CDVA was 20/60. FINANCIAL DISCLOSURE: Dr. Ahmed is a consultant to Alcon Laboratories, Inc., Abbott Medical Optics, Inc., and Bausch & Lomb. Dr. Mamalis is a consultant to Anew Optics, Inc., and Medennium, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Evaluation of stability and capsular bag opacification with a foldable intraocular lens coupled with a protective membrane in the rabbit model.

PURPOSE: To evaluate the stability and capsular bag opacification of a smooth or a patterned silicone protective membrane implanted in the bag with secondary placement of an intraocular lens (IOL). SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN: Experimental study. METHODS: Twelve New Zealand rabbits had bilateral implantation of a protective membrane and an IOL or an IOL alone. Three groups of 8 eyes each received the IOL and the smooth protective membrane, the IOL and the patterned membrane, or the IOL alone. Slitlamp examination was performed weekly for 4 weeks. The rabbits were then humanely killed and their globes enucleated. Capsular bag opacification was scored based on the Miyake-Apple view, and the eyes underwent histopathology. RESULTS: At 4 weeks, the mean central posterior capsule opacification (PCO) score was 0.28 ± 0.32 (SD) in all eyes with a protective membrane and 2.08 ± 1.28 in eyes with the IOL alone (P < .00001, Student t test). Peripheral PCO and Soemmerring ring formation were also significantly less in eyes with the protective membrane. Histopathologically, the posterior capsules were relatively clear in most IOLs with the protective membrane. The smooth and patterned protective membranes showed a significant difference in overall capsular bag opacification formation compared with the IOLs without the membrane. CONCLUSIONS: The circular geometry of the protective membrane led to expansion of the capsular bag and appeared to prevent capsular bag opacification. Further studies are warranted to assess whether the pattern on the device's posterior surface further enhances this effect. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Calcification of hydrophilic acrylic intraocular lenses associated with intracameral air injection following DMEK.

UNLABELLED: We present 2 cases of localized calcification on the anterior surface/subsurface of hydrophilic acrylic intraocular lenses (IOLs) following procedures involving intracameral injection of air. Although this phenomenon has been reported in hydrophilic acrylic IOLs, to our knowledge it has not been reported in the IOLs described in our cases, one a sulcus-fixated supplementary IOL and the other a hydrophilic acrylic IOL with a hydrophobic surface. Centralized opacity of the IOLs was first noted months after Descemet membrane endothelial keratoplasty had been performed in both cases; explantation was required. Laboratory analysis of the IOLs confirmed calcification of the anterior surfaces in a localized pattern in the area of the capsulorhexis or pupil. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Evaluation of stability and capsular bag opacification of a new foldable adjustable intraocular lens.

BACKGROUND: Incorrect lens power remains one of the most common reasons for intraocular lens explantation/exchange. We evaluated stability and effect on capsular bag opacification of a new foldable modular lens system, with a base component and an optic component in rabbit eyes. METHODS: Bilateral phacoemulsification was performed on six rabbits; one eye received the test lens (Harmoni Modular Lens, ClarVista Medical), whereas the other received a single-piece hydrophobic acrylic control lens (SA60AT, Alcon). Slit-lamp examinations were performed at postoperative weeks 1, 2, 3, 4 and 6. All rabbits were sacrificed at week 6. After enucleation, the eyes were examined grossly from the Miyake-Apple view. Following, all globes were sectioned and processed for histopathological examination. RESULTS: The modular lens was stable in all six rabbits. Uveal biocompatibility was similar to or better in the test eyes when compared with control eyes up to 6 weeks postoperatively. Overall, capsular bag opacification was found to be significantly lower in the test eyes when compared with control eyes. At the 6-week gross examination, central posterior capsule opacification was scored as 0.58 ± 0.73 in the test group, and as 3.00 ± 1.26 in the control group (paired two samples for means t-test; two-tail P = 0.005). CONCLUSIONS: The Harmoni Modular system remains stable within the capsular bag after implantation. Due to the design of the base component featuring long loops, along with peripheral anterior and posterior square edges, the lens appeared to prevent overall capsular bag opacification in the rabbit model.

UR Well Eye Care: a model for medical student ophthalmology education and service in the community.

PURPOSE: To assess medical student ophthalmic educational exposure and service provided through the University of Rochester's UR Well Eye Care (URWEC) program, a student-run initiative in which medical students provide supervised eye care to an uninsured urban population. DESIGN: Retrospective chart review. SUBJECTS: Consecutive patients seen at the student-run URWEC in Rochester, NY, USA between June 2008 and June 2013. METHODS: One hundred and forty-five of 148 charts of consecutive patients seen at URWEC over the 5-year period were identified and reviewed. Data on patient demographics, reason for visit, history, examination, diagnoses, and management were collected into a database. MAIN OUTCOME MEASURES: Main outcome measures included reasons for referral, student performance of ophthalmic examination components, ophthalmic diagnoses, and hours of volunteer service rendered. RESULTS: Patients came from a variety of countries and educational and racial backgrounds. The most common reason for referral to URWEC was diabetic screening eye exams (66/145, 46%). Student volunteers performed the following examination components in 79%-100% of visits under direct supervision of an attending ophthalmologist: visual acuity, pupils, extraocular movements, confrontation visual fields, intraocular pressure, drop administration, slit-lamp examination, and dilated fundoscopic exam. The most common diagnosis other than refractive error was cataract (29/145, 20%). Almost half of patients (66/145, 46%) were diagnosed with potentially vision-threatening conditions. Six hundred and thirty hours of community service were rendered by students and attending ophthalmologists during the 5-year period. CONCLUSION: Student-run eye clinics provide a longitudinal setting where students can receive one-on-one training with attending ophthalmologists, attain a broad clinical exposure, and provide a needed service in their communities.

The in vivo diagnosis of early-stage aortic valve sclerosis using magnetic resonance imaging in a rabbit model.

PURPOSE: To use magnetic resonance imaging (MRI) to identify and monitor early aortic valve sclerosis (AVS) induced by cholesterol feeding in rabbits. AVS is a highly prevalent disease process, affecting more than 25% of the population over age 65. A major obstacle to early stage medical management of AVS has been the lack of an objective noninvasive technique to identify its presence and monitor its progress. MATERIALS AND METHODS: Retrospectively gated CINE fast spoiled gradient echo (fSPGR) images of aortic valve cusps were collected at 3-month intervals starting at 6 months using a 1.5 T MR scanner interfaced with a customized surface radiofrequency coil. At 16 months a subset of animals was sacrificed and excised cusps were examined with both high frequency ultrasound (US) and histopathological techniques to validate the MRI method. RESULTS: MR and US analysis identified significant thickening of diseased AV cusps when compared to control (P < 0.05). Histopathological analysis confirmed the presence of human-like AVS in diseased rabbit valves. CONCLUSION: Early AVS, exemplified by increased valve thickness, can be identified in vivo using high-resolution MRI.