Far and Near Contrast Sensitivity and Quality of Vision with Six Presbyopia Correcting Intraocular Lenses.

The objective of this prospective, randomized, double-masked study was to compare the contrast sensitivity and quality of vision of patients bilaterally implanted with the following six different presbyopia correcting intraocular lenses (IOLs): SV25T0 (n = 19), ATLISA 809M (n = 18), ATLISA TRI 839MP (n = 19), ZKB00 (n = 20), ZLB00 (n = 20) and Symfony ZXR00 (n = 20). For comparison purposes, 36 patients were implanted with a monofocal lens (ZA9003). Contrast sensitivity was assessed binocularly at distance under photopic, mesopic and mesopic plus glare conditions, and at near under photopic conditions. Quality of vision was explored in terms of photic phenomena and spectacle independence. Overall, the monofocal lens offered better contrast sensitivity, under all illumination conditions, and less occurrence and intensity of photic phenomena. Amongst the multifocal IOL (MIOL) designs, the extended depth of focus Symfony ZXR00 provided better contrast sensitivity than the other MIOLs, particularly at intermediate and high spatial frequencies. Up to 40% and 50% of patients implanted with MIOLs reported glare and halos, respectively. The SV25T0 resulted in less occurrence and intensity of halos. The evaluation of photic phenomena and contrast sensitivity under different illumination conditions may reflect real-life, visually challenging situations, and thus provide insightful information to assist ophthalmic surgeons when selecting the best intraocular lens for their patients.

Visual acuity and defocus curves with six multifocal intraocular lenses.

PURPOSE: The purpose of this prospective, randomized, double-masked, study was to compare the visual performance of patients after bilateral implantation of six different IOLs. METHODS: The following IOLs were used in the study: SV25T0 (n = 19), ATLISA 809M (n = 18), ATLISA Tri 839MP (n = 19), ZKB00 (n = 20), ZLB00 (n = 20) and Symfony ZXR00 (n = 20). Visual performance was assessed by the monocular distance-corrected visual acuity at 4 m (CDVA), distance-corrected intermediate visual acuity (DCIVA) at 60 cm and distance-corrected near visual acuity (DCNVA) at 40 cm. Binocular defocus curves were obtained for a range of defocus from + 1.50 D to - 4.50 D, in 0.50 D steps. Quality of life was assessed with the VF-14 questionnaire. RESULTS: CDVA was better with the Symfony ZXR00 than with the SV25T0 (p = 0.032), ATLISA Tri 839MP (p = 0.032) and ATLISA 809M (p = 0.018). The Symfony ZXR00 offered the best DCIVA, followed by the ZKB00. The best and worst DCNVA results corresponded to the ZLB00, and the SV25T0 and Symfony ZXR00, respectively. Defocus curves at distance were good in all groups, although the Symfony had a wider range of clear vision (- 1.50 D to + 0.50 D), with no decay. For intermediate vision, only the Symfony obtained sharp visual acuity. The ATLISA 809M, ATLISA Tri 839MP and ZLB00 were superior at near distance. CONCLUSIONS: The extended depth of focus of the Symfony ZXR00 offers a superior range of clear vision at far and intermediate distances than other multifocal designs, with worse results at near distance. Visual outcomes reflect the particular optical, geometrical and power distribution characteristics of each IOL.

Progression of retinal pigmentation mimicking unilateral retinitis pigmentosa after bilateral pars planitis: a case report.

BACKGROUND: To report our findings in a young patient with unilateral retinitis pigmentosa (RP)-like appearance who developed pigmentary changes in his left retina after an episode of bilateral pars planitis. CASE PRESENTATION: A 17-year-old man presented with 6 months of blurry vision in both eyes. He was diagnosed with bilateral pars planitis. Progressive, intraretinal bone crepuscule pigmentation developed in his left retina during the following three months. An electroretinogram showed subnormal response only in the left eye, suggesting the diagnosis of unilateral pseudoRP. CONCLUSION: An inflammatory disease like pars planitis can accelerate the pigmentation of the retina and mimic a RP in young patients. Causes of pseudoRP may be considered, especially in those rare cases with unilateral affection.

Visual acuity and image quality in 5 diffractive intraocular lenses.

PURPOSE: To compare objective image quality at distant, intermediate, and near foci with the corresponding visual acuity (VA) in patients symmetrically implanted with 5 different diffractive multifocal intraocular lenses (IOLs) (ReSTOR SV25T0, Tecnis ZKB00, Tecnis ZLB00, AT LISA 809, and AT LISA Tri 839MP) and a monofocal lens (Tecnis ZA9003) 3 months after cataract intervention. METHODS: Objective image quality, measured as the area under the modulation transfer function curve (AMTF), was tested in vitro in an eye model. In addition, corrected distance visual acuity and distance-corrected intermediate and near visual acuities (DCIVA and DCNVA) were assessed in a group of 79 patients, randomly implanted with one of the lenses. RESULTS: Image quality and VA at the distant focus was good for all lens designs, but was similarly compromised at the intermediate focus, where the best DCIVA corresponded to the low add ZKB00. At the near focus, the monofocal lens and the distance dominant SV25T0 had the worst AMTF values, with the ZLB00 presenting the best DCNVA. The relationship between AMTF and VA was found not to be linear, with VA being similarly good for AMTF values over a certain threshold. CONCLUSIONS: Visual acuity of pseudophakic patients reflected the optical quality of the specific IOL design within a certain range of measurements, beyond which maximum VA is limited by other ocular, optical, and neuropsychophysical factors.

Incidence and distribution of paravascular lamellar holes and their relationship with macular retinoschisis in highly myopic eyes using spectral-domain oct.

The purpose of the study is to determine the incidence and distribution of paravascular lamellar holes (PLH) around retinal vessels in highly myopic eyes and their relationship with macular retinoschisis (MR). We examined 306 eyes of 178 patients with high myopia, performing multiple scans of the posterior pole within the retinal vascular arcades using spectral-domain OCT. Type of staphyloma was determined. PLH were divided into three groups: holes only (group 1), holes extending below vessels (group 2), and holes in an area of paravascular retinoschisis (group 3). OCT showed that 96/306 eyes (31.4 %) had PLH mainly along the infero-temporal arcade (39.9 %). Type V and IX staphylomas had a higher proportion of PLH in the infero-temporal arcade than other staphylomas. Group 3 eyes presented higher rates of myopia and staphyloma. MR was detected in 10/27 eyes (37 %) in Group 3, but only in 2/33 eyes (6.1 %) in Group 1. No MR was found in Group 2. PLH are relatively common in highly myopic eyes and mainly distributed in the inferior temporal arcade. Findings from this descriptive study suggest that distribution of PLH might be related to the type of staphyloma. Further studies are needed to evaluate the relevance of PLH in the pathogenesis of MR.

Halo and Through-Focus Performance of Four Diffractive Multifocal Intraocular Lenses.

PURPOSE: To compare, as a function of pupil size, the through-focus performance and halo features of four diffractive intraocular lenses (IOLs). METHODS: Three diffractive bifocal IOLs (ReSTOR +2.5 D SV25T0, Tecnis +2.75 D ZKB00, and AT LISA +3.75 D 809M) and a diffractive trifocal IOL (AT LISA tri +3.33 D, +1.66 D 839MP) were tested in vitro in a modified International Organization for Standardization eye model. The modulation transfer function (MTF) at the IOLs' foci was obtained with pupils ranging from 2.0 to 5.0 mm. Through-focus MTF curves (at 50 cycles/mm) were compared among all the IOLs. The halo formation and characteristics were obtained from image analysis. RESULTS: The multifocal IOLs studied in this work showed, at their foci, secondary out-of-focus images, which originate halos and whose characteristics depend on the lens design and pupil size. The smallest halo occurred for the distance focus of the SV25T0. The distance and near foci of the SV25T0 yielded, respectively, the best and lowest optical quality among the studied IOLs. The distance focus of the ZKB00, AT LISA, and AT LISA tri were of similar quality, but the near focus of the ZKB00 outperformed the near foci of the rest of the IOLs. The IOLs' optical performance gradually deteriorates as pupil increases. CONCLUSIONS: Differences in the design of the diffractive IOLs translate into differences in optical quality at their foci, through-focus performance, and halo features, which can offer further information to surgeons when selecting which IOL to implant.

Next generation sequencing uncovers a missense mutation in COL4A1 as the cause of familial retinal arteriolar tortuosity.

OBJECTIVES: Our aim was to determine the molecular cause of autosomal dominant familial retinal arteriolar tortuosity (FRAT) in a family with three affected subjects. MATERIAL AND METHODS: Ophthalmologic evaluation included determination of best-corrected visual acuity (BCVA), slit-lamp and dilated fundus inspection, applanation tonometry, fundus photography, and fluorescein retinal angiography (FA). Molecular methods included whole exome sequencing analysis and Sanger sequencing validation of putative causal mutation in DNA from affected individuals. RESULTS: Typical signs of familial retinal arteriolar tortuosity were observed in all three patients. Exome sequencing identified a heterozygous c.1528G > A (p. Gly510Arg) mutation in COL4A1. Sanger sequencing confirmed that all three patients harbored the same pathogenetic mutation in COL4A1. The p. Gly510Arg variant in COL4A1 was absent in DNA from an available unaffected daughter, from a set of control alleles, and from publicly available databases. CONCLUSIONS: The molecular basis of familial retinal arteriolar tortuosity was identified for the first time, thus expanding the human phenotypes linked to COL4A1 mutations. Interestingly, the COL4A1 p.Gly510Arg mutation has been previously identified in a family with HANAC (Hereditary Angiopathy with Nephropathy, Aneurysm and Cramps), a multisystemic disease featuring retinal arteriolar tortuosity. No cerebral, neurologic, renal, cardiac or vascular anomalies were recognized in the pedigree described here. These data indicate that identical mutations in COL4A1 can originate both eye-restricted and systemic phenotypes.

Stereo-acuity in patients implanted with multifocal intraocular lenses: is the choice of stereotest relevant?

PURPOSE: A randomized and double-blinded study design was implemented to assess the stereo-acuity in patients symmetrically implanted with four types of multifocal intraocular lenses (MIOLs), compared to a monofocal lens (control group). In addition, the influence of the type of test employed for the evaluation of stereo-acuity was explored. MATERIALS AND METHODS: Six months after cataract intervention, stereo-acuity was measured with the Titmus and TNO stereotests in 143 patients implanted with one of the following MIOL lens types: hybrid spherical SN60D3, hybrid aspheric SN6AD1, diffractive aspheric ZMA00 and refractive spherical NXG1. A control group implanted with the monofocal aspheric ZA9003 (in which stereo-acuity was measured with a near addition) was also included in the study. RESULTS: Statistically significant better stereo-acuity was found in the monofocal group with both stereotests (except for the SN60D3 group with the Titmus test) (all p < 0.001). No significant differences in stereo-acuity between MIOLs were found using the Titmus test. However, with the TNO, patients implanted with hybrid diffractive MIOLs exhibited statistically significant worse stereo-acuity than those with the refractive design (SN60D3, p < 0.001; SN6AD1, p = 0.006). CONCLUSIONS: Patients implanted with MIOLs have worse stereo-acuity than those implanted with monofocal IOLs due to the decrease in retinal image contrast originating in the simultaneous presence of two images. A wavelength-based stereotest such as the TNO induces large differences in image contrast between fellow eyes implanted with diffractive-based MIOLs, which may result in an underestimation of the real stereo-acuity of the patient.

An aggressive primary orbital natural killer/T-cell lymphoma case: poor response to chemotherapy.

Natural killer/T-cell lymphoma (NKTCL) and its presentation with extranodal orbital involvement as a single lesion are extremely rare. The aim of this article was to describe the presentation, diagnosis, and systemic treatment of a primary orbital NKTCL. A 67-year-old Caucasian woman presented with left exophthalmos, pain, periorbital swelling, and limited extrinsic ocular motility. Orbital cellulitis was suspected, but finally orbital biopsy was performed due to no response to initial antibiotic and anti-inflammatory standard treatment. The pathologic diagnosis was NKTCL. Systemic evaluations were negative. CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy was initiated, but after 2 cycles of treatment, tumoral progression was observed. SMILE (dexamethasone, methotrexate, ifosfamide, L-asparaginase, etoposide) rescue chemotherapy was then administered. Lymphoma progression was inevitable. She died 10 months later. Although more nasal NKTCL cases have been described, the nonnasal primary orbital NKTCL is an uncommon neoplasm with high mortality rate, despite the recent use of more potent chemotherapy regimens.

Comparison of far and near contrast sensitivity in patients symmetrically implanted with multifocal and monofocal IOLs.

PURPOSE: A prospective, randomized, double-masked, clinical trial was designed to evaluate distance and near contrast sensitivity (CS) in patients symmetrically, and randomly, implanted with 4 different multifocal intraocular lens (MIOL) designs (ReSTOR SN6AD1, ReSTOR SN60D3, ReZoom NXG, and Tecnis ZMA00) and a monofocal control group (Tecnis ZA9003), 6 months after cataract intervention. METHODS: Photopic, mesopic, and mesopic with glare distance CS, as well as photopic near CS, was evaluated with the CSV-1000 CS test and the Vistech VCTS 6000 system, respectively, in a group of 180 patients attending the ophthalmology department of Sant Pau Hospital, Barcelona, for cataract intervention and lens implantation. RESULTS: Statistically and clinically significant differences were found between the monofocal and multifocal lens groups at all spatial frequencies and illumination conditions, both during distance and near CS evaluation (all p<0.05), with the monofocal lens offering the best performance in all cases. Contrast sensitivity was similarly compromised in all MIOL models at distance, although MIOLs with diffractive optics and aspheric profiles showed a non-statistically significant trend to perform better in mesopic conditions. Near CS was lower for refractive, distance dominant lens designs, particularly at medium to high spatial frequencies. CONCLUSIONS: The present results, which reflect intraocular lens (IOL) characteristics in optics, profile, and add power, may contribute to help surgeons decide on the type of IOL most suitable for each patient by taking into consideration the individual needs for critical distance and near vision, both in terms of visual acuity and contrast sensitivity.

Acute-Onset Endophthalmitis Caused by Alloiococcus otitidis following a Dexamethasone Intravitreal Implant.

PURPOSE: To report the first case of acute endophthalmitis caused by Alloiococcus otitidis after a dexamethasone intravitreal implant. METHODS: A 74-year-old female was treated with intravitreal Ozurdex(®) in her left eye for central retinal vein occlusion (CRVO). Best-corrected visual acuity (BCVA) in the eye was 4/20. Intravitreal injection was uneventful. At 48 h after injection, she developed ocular pain and visual acuity had dropped to light perception. Endophthalmitis associated with intravitreal injection was suspected. RESULTS: The patient did not show a favorable clinical response following systemic, intravitreal, and topical fortified antibiotics. We then performed a vitreous biopsy and removed the Ozurdex implant by pars plana vitrectomy. A vitreous culture was positive for A. otitidis. At the 2-month follow up, no inflammation was observed, but due to CRVO and probably aggravated by endophthalmitis, the fundus showed macular fibrosis. The final BCVA was finger counting at 30 cm in her left eye. CONCLUSIONS: In cases of an intravitreal implant associated with endophthalmitis, we recommend removal of the device because it may act as a permanent reservoir of organisms if it remains in the vitreous cavity.

Visual acuity, contrast sensitivity, subjective quality of vision, and quality of life with 4 different multifocal IOLs.

PURPOSE: This prospective, randomized, double-masked, clinical trial was designed to evaluate visual acuity, contrast sensitivity, subjective quality of vision, and quality of life in 47 patients symmetrically, and randomly, implanted with 4 different IOL designs (SN6AD1, SN60D3, ReZoom NXG1, and Tecnis ZMA00), 3 months after cataract intervention. METHODS: Binocular corrected and uncorrected distance visual acuity, binocular distance corrected (BCNVA) and uncorrected (UCNVA) near visual acuity, binocular distance corrected (BCIVA) and uncorrected (UCIVA) intermediate visual acuity, photopic, mesopic, and mesopic with glare contrast sensitivity, quality of vision, and quality of life were evaluated. RESULTS: Statistically and clinically significant differences were found in BCNVA and UCNVA at 33 cm between high and low add power IOLs, while diffractive SN6AD1 lenses achieved better UCNVA at 40 cm than refractive ReZoom IOLs. Asphericity and low add power were found to improve BCIVA. Contrast sensitivity was similarly compromised in all IOL models, although diffractive optics and aspheric profiles performed better in mesopic conditions. All IOL types received similar overall satisfaction and quality of life scores. Whereas ReZoom patients depended on their spectacles for near tasks, intermediate vision was spectacle independent. Photic phenomena were present in all IOLs, albeit more frequent in ReZoom IOLs. CONCLUSIONS: The present results, which reflect IOL characteristics in optics, profile, and add power, may contribute to help surgeons decide on the type of IOL most suitable for each patient, especially those with high visual demands at near and intermediate distances.

Regression of late onset choroidal metastasis from a breast carcinoma with letrozole.

We report the case of a 50-year-old woman with a history of diabetes mellitus who underwent left breast lumpectomy and ipsilateral lymphadenectomy in 1994 because of an infiltrating ductal carcinoma. Chemotherapy followed by radiotherapy to the breast and nodal areas were performed. In 2010, in a routine screening for diabetic retinopathy, two choroidal elevated masses above and below the optic nerve associated to serous retinal detachment of her right eye were noted. The patient was asymptomatic. Carcinoma was positive for hormone receptor. Hormone treatment with letrozole was established. Complete regression of the choroidal metastasis was observed 3 months later. Ophthalmologic screening in asymptomatic patients with breast cancer has the advantage of being a noninvasive procedure and enables an early treatment in isolated cases. However, some studies are an argument against the usefulness of eye screening due to the low incidence of asymptomatic choroidal metastasis and the cost that involves performing it routinely in a large number of patients. Aromatase inhibitors are well-tolerated drugs that may be a powerful tool in the management of metastatic breast cancer that express hormone receptors.

Intraocular lens dislocation after whole-body vibration.

We present 2 cases of intraocular lens (IOL) dislocation that appeared shortly after the patients exercised on a vibration platform. The first patient was a 71-year-old woman who presented with lens subluxation in her right eye and a complete posterior IOL dislocation in her left eye. The second case was a 62-year-old woman who presented with unilateral IOL dislocation within the capsular bag in her right eye. Timing from IOL implantation to dislocation was approximately 6 years and 4 years, respectively. Pars plana vitrectomy with removal of the dislocated IOL was performed in both patients. Whole-body vibration training has become increasingly popular as a form of exercise training. It reportedly may provide benefits in physical function and in some diseases, especially in older people. However, evidence-based protocols ensuring safety and efficacy in this population are lacking. We discuss vibration as a cause of late IOL dislocation.

Combined retinal detachment and candida chorioretinitis.

To report a case of slowly progressive traction and rhegmatogenous retinal detachment after successfully managed candida chorioretinitis. A 44-year-old immunocompromised woman was treated with voriconazole for fungal chorioretinitis. Six months after onset she developed a combined retinal detachment. Slow progression of retinal detachment was observed and vitrectomy was performed. The macular area remained attached and visual acuity was maintained. Ophthalmologists should be aware of this unusual complication after the resolution of active candida chorioretinitis.

A case of necrotizing scleritis resulting from Pseudomonas aeruginosa.

PURPOSE: The purpose of this study was to report a case of necrotizing scleritis resulting from Pseudomonas aeruginosa with no corneal infiltrate. RESULTS: A 75-year-old man presented with pain and redness in his left eye accompanied by fever of 3 days' duration. He was receiving chemotherapy for hepatic metastasis of an unknown origin. He presented a necrotizing scleritis with no corneal infiltrate. Scleral cell culture and blood culture were positive for P. aeruginosa. He was treated with oral imipenem and topical fortified ceftazidime. The response was good, but a scleral patch graft was needed to stabilize scleral thinning. CONCLUSION: This is the first case report of infectious scleritis in the context of P. aeruginosa sepsis in the absence of corneal infiltration.

Pupillary block glaucoma in phakic eyes using 5000 centistoke silicone oil.

PURPOSE: To describe pupillary block glaucoma in phakic patients undergoing vitrectomy and 5000 centistoke silicone oil injection. DESIGN: Observational case reports. METHODS: Vitrectomy and higher-viscosity silicone oil injection was performed in two phakic patients with proliferative diabetic retinopathy. RESULTS: Both patients developed a pupillary block in the early postoperative period (1 week and 1 month after surgery). Unnoticed zonulysis during surgery, thought to be the main contributory cause, allowed access of the silicone oil between the iris and the lens. Although higher-viscosity silicone oil was used in both cases, an acute glaucoma developed. An inferior iridotomy was performed, resulting in a temporary resolution of the pupillary block. CONCLUSION: Vitreoretinal surgeons should be aware of silicone-induced pupillary block glaucoma in phakic eyes, even when higher-viscosity silicone oils are used.