Incidence, risk factors, and treatment of retroprosthetic membranes following Boston keratoprosthesis eyes and the impact of glaucoma surgery.

PURPOSE: To assess incidence, risk factors, and treatment of retroprosthetic membrane (RPM) formation in eyes following Boston keratoprosthesis (Kpro) implantation and their correlation with glaucoma drainage device placement (GDD). METHODS: A retrospective review was performed on eyes that underwent Kpro type I or II implantation between 2005 and 2020 at a tertiary academic center. Multiple variables were collected including preoperative characteristics, presence of RPM, management of RPM, and outcomes including corrected visual acuity (VA). A Fischer's exact test was used to evaluate the significance of risk factors of RPM formation and an odds ratio was calculated for each possible risk factor. A Mann-Whitney U test was used to evaluate comparisons between outcomes and qualitative analyses. RESULTS: Of the 87 eyes identified, 37 (43%) developed an RPM within an average of 1.5 years (range, 31 days-7.5 years) following Kpro implantation. Mean follow-up duration was 4.3 years. Eyes that developed RPM had significantly worse preoperative VA compared to those that did not (logMAR 2.55 vs. 2.28, p = 0.022). The mean number of prior penetrating keratoplasty procedures trended higher in eyes that developed RPM (2.46 vs. 2.18, p = 0.44) but was not significant. GDD placement after Kpro implantation was associated with an increased risk of RPM formation (RR = 1.69 p = 0.026). Of the 37 eyes that developed an RPM following Kpro, 17 (47%) were treated with Nd:YAG laser, and four of those 17 (21%) also underwent pars plana vitrectomy (PPV). Seven of 37 eyes (19%) underwent PPV without Nd:YAG. Comparisons between RPM occurrence and final VA were not significant. CONCLUSIONS: The incidence of RPM formation following Kpro implantation was 43%. Eyes that developed RPM had significantly worse preoperative VA. GDD placement after Kpro implantation increased the risk of developing RPM. Final VA and occurrence of RPM were not significantly different between the Nd:YAG and PPV treatment groups.

Automated Eye Tracking Enables Saccade Performance Evaluation of Patients with Concussion History.

SIGNIFICANCE: Automated eye tracking could be used to evaluate saccade performance of patients with concussion history, providing quantitative insights about the degree of oculomotor impairment and potential vision rehabilitation strategies for this patient population. PURPOSE: To evaluate the saccade performance of patients with concussion history based on automated eye-tracking test results. METHODS: We conducted a retrospective study of patients with concussion history, primarily from sports participation, who underwent oculomotor testing based on an eye-tracking technology at the Duke Eye Center vision rehabilitation clinic between June 30, 2017, and January 10, 2022. Patients' saccade test results were reviewed, including saccade fixation and saccade speed/accuracy ratio. The outcomes were compared with age-matched normative population data derived from healthy individuals. Multiple linear regression analyses were performed to identify factors associated with saccade performance among patients with concussion history. RESULTS: On hundred fifteen patients with concussion history were included in the study. Patients with concussion, on average, had fewer fixations on self-paced horizontal and vertical saccade tests and lower horizontal and vertical saccade speed/accuracy ratios compared with normative ranges. Among patients with concussion history, multiple linear regression analyses showed that older age was associated with fewer fixations on horizontal and vertical saccade tests, whereas male sex was associated with more fixations on horizontal and vertical saccade tests (all P < .01). In addition, older age was associated with lower horizontal saccade speed/accuracy ratio, after adjusting for sex, number of concussion(s), and time from most recent concussion to oculomotor testing ( P < .001). CONCLUSIONS: Patients with concussion history had lower saccade performance based on eye tracking compared with healthy individuals. We additionally identified risk factors for lower saccade performance among patients with concussion history. These findings support the use of saccade test results as biomarkers for concussion and have implications for post-concussion rehabilitation strategies.

Affect, Belief, and the Arts.

The cultural project is a therapeutic melding of emotion, symbols, and knowledge. In this paper, I describe how spiritual emotions engendered through encounters in imaginative culture enable fixation of metaphysical beliefs. Evolved affective systems are domesticated through the social practices of imaginative culture so as to adapt people to live in culturally defined cooperative groups. Conditioning, as well as tertiary-level cognitive capacities such as symbols and language are enlisted to bond groups through the imaginative formats of myth and participatory ritual. These cultural materializations can be shared by communities both synchronically and diachronically in works of art. Art is thus a form of self-knowledge that equips us with a motivated understanding of ourselves in the world. In the sacred state produced through the arts and in religious acts, the sense of meaning becomes noetically distinct because affect infuses the experience of immanence, and one's memory of it, with salience. The quality imbued thereby makes humans attentive to subtle signs and broad "truths." Saturated by emotions and the experience of alterity in the immanent encounter of imaginative culture, information made salient in the sacred experience can become the basis for belief fixation. Using examples drawn from mimetic arts and arts of immanence, I put forward a theory about how sensible affective knowledge is mediated through affective systems, direct perception, and the imagination.

Review of Vitreopapillary Traction Syndrome.

Vitreopapillary traction (VPT) syndrome is a potentially visually significant disorder of the vitreopapillary interface characterised by an incomplete posterior vitreous detachment with the persistently adherent vitreous exerting tractional pull on the optic disc and resulting in morphologic alterations and a consequent decline of visual function. It is most commonly unilateral but bilateral reports have also been described. The cause of the condition may be unknown or idiopathic, although the histology of traction shows proliferation of fibrous astrocytes, myofibroblasts, fibrocytes, and retinal pigment epithelial cells. It is theorised that VPT may induce a congested optic disc with neuronal dysfunction as well as decreased prelaminar flow. The present study reviews and summarises the features, diagnosis, and management of VPT.

Acute transaminitis after initial days of starting haloperidol.

Haloperidol is a first-generation antipsychotic butyrophenone that is lipophilic, readily absorbed, and extensively metabolized in the liver. The occurrence of elevated liver enzymes with haloperidol is reported to be 2.4% with cases generally occurring in the setting of chronic use. In this case, we present a patient who developed elevated liver enzymes 1-2 days after starting haloperidol treatment on two separate occasions and in the context of negative hepatic viral and autoimmune serology. Liver enzymes consistently had alanine transaminase > aspartate transaminase and peaked at 288 U/L prior to discontinuation of the medication. The patient was taken off haloperidol after serology resulted and clozapine regimen started. He was able to tolerate clozapine well with recovery of his transaminitis and psychiatric stabilization.

Effects of Brimonidine on Retinal Pigment Epithelial Cells and Müller Cells Exposed to Amyloid-Beta 1-42 Peptide In Vitro.

BACKGROUND AND OBJECTIVE: To evaluate whether brimonidine can prevent cytotoxicity in human retinal pigment epithelial (RPE) and Müller (MIO) cells after exposure to amyloid-beta 1-42 (Aß42). MATERIALS AND METHODS: An in vitro model of geographic atrophy (GA), which is an end-stage complication of age-related macular degeneration (AMD), simulated with the application of Aß42 in cell culture. RPE and MIO cells were pretreated with brimonidine for 6 hours, then exposed to 10µM Aß42 for 24 hours. Several concentrations (one time [1×], two times [2×], and five times [5×]) of brimonidine were used to assess for a dose-related effect. Assays were immediately run following the treatment period. 2',7'-Dichlorofluorescein diacetate was used to assess reactive oxygen species production, the MTT assay was used to assess cell viability, and the JC-1 dye assay was used to assess mitochondrial membrane potential. The main outcome measures were reactive oxygen species (ROS) production, cell viability, and mitochondrial membrane potential (ΔΨm) of RPE and MIO cells following the treatment phase. RESULTS: High-dose (5×) brimonidine was capable of reducing ROS production in RPE and MIO cells with exposure to Aß42. The application of Aß42 alone did not trigger a rise in ROS production. Brimonidine was unable to rescue cell viability and ΔΨm after exposure to Aß42 in both cell cultures. Instead, high-dose (5×) brimonidine appeared to increase the toxicity to cell viability and ΔΨm in cultures exposed to Aß42. However, this was not due to medication toxicity alone, because high-dose (5×) brimonidine without exposure to Aß42 did not affect the cell viability in both cell types. CONCLUSION: Brimonidine may have a role in preventing oxidative cellular injury in AMD. However, this role does not appear to translate into protection against some of the cytotoxic effects observed from this in vitro model of GA. In this cellular model of GA, brimonidine is able to reduce oxidative stress but is unable to rescue cell viability or prevent mitochondrial dysfunction. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:S23-S28.].