A Nationwide Multicenter Study on 1-Year Outcomes of Posterior Chamber Phakic Intraocular Lens Implantation for Low Myopia.

Purpose: To assess the nationwide multicenter outcomes of posterior chamber phakic intraocular lens implantation with a central hole (EVO-ICL, STAAR Surgical) for patients with low myopia. Methods: This multicenter study comprised 172 eyes of 111 consecutive patients undergoing hole ICL implantation to correct low myopia and myopic astigmatism [manifest spherical equivalent (MSE);-3 diopters (D) or less] at seven nationwide major surgical facilities. We retrospectively determined safety, efficacy, predictability, stability, and adverse events at 1 week, 1, 3, 6, and 12 months postoperatively, and at the final visit. Results: The mean follow-up period was 1.4 ± 1.0 years. Uncorrected and corrected visual acuities at 1 year postoperatively were -0.17 ± 0.12 and -0.24 ± 0.07 logarithm of the minimal angle of resolution (logMAR), respectively. At 1 year postoperatively, 91% and 100% of eyes were within 0.5 and 1.0 D of the target correction, respectively. No significant manifest refraction changes of -0.07 ± 0.26 D occurred from 1 week to 1 year. No vision-threatening complications occurred at any time in this series. Conclusions: According to our experience, the EVO-ICL performed well without significant complications throughout the 1-year observation period, even for the correction of low myopia. It is suggested that current ICL implantation is one of the viable surgical options for correcting low myopia.

Posterior chamber phakic intraocular lens implantation after laser in situ keratomileusis.

BACKGROUND: To assess the multicenter outcomes of posterior chamber phakic intraocular lens implantation with a central hole (EVO-ICL, STAAR Surgical) for patients undergoing previous laser in situ keratomileusis (LASIK). METHODS: This case series enrolled 31 eyes of 21 consecutive patients undergoing EVO-ICL implantation to correct residual refractive errors after LASIK at 7 nationwide major surgical sites. We investigated safety, efficacy, predictability, stability, and adverse events at 1 week, 1, 3, and 6 months postoperatively, and at the final visit. RESULTS: The mean observation period was 1.6 ± 1.8 years. Uncorrected and corrected visual acuities were - 0.14 ± 0.11 and - 0.22 ± 0.09 logMAR at 6 months postoperatively. At 6 months postoperatively, 81% and 100% of eyes were within ± 0.5 D and ± 1.0 D, respectively, of the targeted correction. We found neither significant manifest refraction changes of 0.05 ± 0.38 D from 1 week to 6 months nor apparent intraoperative or postoperative complications in any case. CONCLUSIONS: Our multicenter study confirmed that the EVO-ICL provided good outcomes in safety, efficacy, predictability, and stability, even in post-LASIK eyes. Therefore, EVO-ICL implantation may be a viable surgical option, even for correcting residual refractive errors after LASIK. Trial registration University Hospital Medical Information Network Clinical Trial Registry (000045295).

Possible involvement of Enterococcus infection in the pathogenesis of chronic pancreatitis and cancer.

(Aim) Bacterial infection underlies the pathogenesis of many human diseases, including acute and chronic inflammation. Here, we investigated a possible role for bacterial infection in the progression of chronic pancreatitis. (Materials and Methods) Pancreatic juice was obtained from patients with pancreatic cancer (n = 20) or duodenal cancer/bile duct cancer (n = 16) and subjected to PCR using universal primers for the bacterial 16S ribosomal RNA gene. Bacterial species were identified by PCR using bile samples from four pancreatic cancer patients. PCR products were subcloned into T-vectors, and the sequences were then analyzed. Immunohistochemical and serologic analyses for Enterococcus faecalis infection were performed on a large cohort of healthy volunteers and patients with chronic pancreatitis or pancreatic cancer and on mice with caerulein-induced chronic pancreatitis. The effect of E. faecalis antigens on cytokine secretion by pancreatic cancer cells was also investigated. (Results) We found that 29 of 36 pancreatic juice samples were positive for bacterial DNA. Enterococcus and Enterobacter species were detected primarily in bile, which is thought to be a pathway for bacterial infection of the pancreas. Enterococcus faecalis was also detected in pancreatic tissue from chronic pancreatitis and pancreatic cancer patients; antibodies to E. faecalis capsular polysaccharide were elevated in serum from chronic pancreatitis patients. Enterococcus-specific antibodies and pancreatic tissue-associated E. faecalis were detected in mice with caerulein-induced chronic pancreatitis. Addition of Enterococcus lipoteichoic acid and heat-killed bacteria induced expression of pro-fibrotic cytokines by pancreatic cancer cells in vitro. (Conclusion) Infection with E. faecalis may be involved in chronic pancreatitis progression, ultimately leading to development of pancreatic cancer.

Long-Term Stability of Minimally Invasive Radial Keratotomy for Mild to Moderate Keratoconus.

PURPOSE: This study aimed to evaluate the long-term stability of minimally invasive radial keratotomy (mini-RK) for eyes with mild to moderate keratoconus. DESIGN: Retrospective observational case series. METHODS: Eleven eyes from 6 patients with hard contact lens (HCL)-intolerant keratoconus underwent mini-RK and were followed up for more than 5 years. The mini-RK consisted of 8 radial incisions with depths of 90% of the thinnest corneal thickness, based on the Lindstrom nomogram. Best-corrected visual acuity (BCVA), keratometry, and corneal endothelial cell density (ECD) were examined preoperatively and for 5 to 10 years postoperatively. Changes in keratometric astigmatism were evaluated using power vector analysis. Severities of keratoconus preoperatively and 1 year postoperatively were graded using the Amsler-Krumeich classification. RESULTS: The postoperative observation periods were from 6 to 10 years (mean, 7.9 years). There were no changes in the BCVA, ECD, and keratometric astigmatism. The mean keratometric refraction significantly decreased from 47.5 diopters (D) preoperatively to 44.0 D at 1 month after mini-RK (P = 0.037) and was stable over 5 years, whereas keratometric astigmatism did not change from preoperatively through the postoperative period (P > 0.59). Keratoconus of grade 2 or higher improved to lower grades. CONCLUSIONS: The mini-RK treatment was safe and effective for HCL-intolerant eyes with mild to moderate keratoconus.

Four-year experience with a silicone refractive multifocal intraocular lens.

PURPOSE: To assess the long-term outcomes after implantation of a foldable silicone refractive multifocal intraocular lens (IOL). SETTING: Private practice, Osaka, Japan. METHODS: This retrospective study evaluated eyes that had implantation of an Array SA40N silicone refractive multifocal IOL with a follow-up of up to 4 years. Outcome measures were refraction, corneal astigmatism, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected (UNVA) and corrected (CNVA) near visual acuities, incidence of glare and halos, patient satisfaction, time to neodymium:YAG (Nd:YAG) laser capsulotomy, and spectacle dependence. RESULTS: The study comprised 41 patients (72 eyes) with a mean age of 48.7 years +/- 13.4 (SD) (range 18 to 71 years) and a mean scotopic pupil size of 5.7 +/- 1.0 mm (range 4.0 to 8.5 mm). The refraction and corneal astigmatism were stable throughout the 4-year follow-up. The mean acuity values 1 month postoperatively were as follows: UDVA, 0.06 logMAR; CDVA, 0.08 logMAR; UNVA, 0.24 logMAR; CNVA, 0.04 logMAR. The change at 4 years was not significant for any visual acuity (P>.64). Patient satisfaction with near vision decreased at 2 years (P = .054). An Nd:YAG laser capsulotomy was performed in 48 eyes (66.7%) a mean 21.7 +/- 16.3 months postoperatively. CONCLUSIONS: The silicone refractive multifocal IOL provided good and stable distance and near visual acuities over the 4-year follow-up, even though it was anticipated that slight posterior capsule opacification would affect near vision. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.