Diagnostic Importance of OCT Pachymetry in Keratoconus.

AIMS: To demonstrate changes in distance and near fusional vergence measured with prism bars, while compensating for present heterophoria using current ametropia correction. In addition, to determine the differences in values of the AC/A ratio determined by the heterophoric (calculation) and gradient methods. MATERIAL AND METHODS: The basic sample includes 19 subjects with a mean age of 21.5 ±3.0 years (min. 18, max. 27). We used the Von Graefe technique for examination of distance and near phoria, and prism bars for examination of fusion vergences measured in prism diopters. We divided the basic cohort into six research sets according to the size of distance and near heterophoria. This was a cohort of patients with distance (D OR) and near orthophoria (N OR), a cohort of patients with distance (D EX) and near exophoria (N EX) and a set of patients with distance (D ES) and near esophoria (N ES). RESULTS: In the case of both groups with exophoria (distance, near) we found a statistically significant result only for negative fusion vergence (NFV). There was a statistically significant increase in NFV in the sample with distance and near exophoria (D EX, p = 0.01 and B EX, p = 0.02, respectively). In our study, we also demonstrated a statistically significant difference (p < 0.001) in the values of the AC/A ratio measured by the gradient and heterophoric methods. The values determined by the gradient method are lower (3.0 ±1.1 pD/D versus 5.8 ±0.9 pD/D) than by the heterophoric method. CONCLUSION: By comparing fusion vergence values in patients with exophoria and orthophoria, we demonstrated that in the presence of distance or near exophoria there is an increase in ipsilateral fusion vergence. In the case of an increase in ipsilateral fusion vergence, the finding was statistically significant both distance and near (p = 0.01 and p = 0.02, respectively). By contrast, we were unable to prove this fact in the group of patients with esophoria. In our study, we also demonstrated a statistically significant difference (p < 0.001) in the values of the AC/A ratio measured by the gradient and heterophoric methods. The values determined by the gradient method are lower (3.0 ±1.1 pD/D versus 5.8 ±0.9 pD/D) than by the heterophoric method.

Virtual Reality Visual Training in an Adult Patient with Anisometropic Amblyopia: Visual and Functional Magnetic Resonance Outcomes.

A case of an adult with anisometropic amblyopia who underwent a successful vision therapy program playing videogames in a virtual reality environment is described, reporting changes in conventional visual clinical data, as well as in brain activity. The patient was a 22 year old man on baseline examination that never previously wore correction for his anisometropia. After prescribing contact lens correction for the anisometropia and after 44 h of virtual reality-based vision therapy over a period of 1.5 years, the best corrected distance visual acuity (BCDVA) in the amblyopic eye improved from 0.05 to 0.5 (Sloan chart). One year after finishing the visual training, the BCDVA experienced a slight decrease to 0.4 (Sloan chart). Through the visual training, the patient gradually developed stereopsis. Likewise, changes were also detected after visual therapy on functional magnetic resonance imaging while the patient was viewing 2D and 3D stimuli. The preliminary results of this case show the potential of using virtual reality-based visual training as a treatment for adult amblyopia.

Presbyopic lens exchange (PRELEX) cataract surgery outcomes with implantation of a rotationally asymmetric refractive multifocal intraocular lens: femtosecond laser-assisted versus manual phacoemulsification.

PURPOSE: To compare the visual and refractive outcomes obtained with the implantation of a rotationally asymmetric refractive multifocal IOL after femtosecond laser-assisted cataract surgery (FLACS) and conventional lens extraction (CLE). METHODS: A total of 78 eyes of 58 patients that had undergone conventional phacoemulsification (36 eyes, CLE group) or FLACS (37 eyes, FLACS group) with the implantation of the toric multifocal IOL LU-313 MF30T (Oculentis, Germany) were enrolled in this retrospective study. Mean age was 57.0 years at the time of surgery, ranging from 44 to 69 years. Visual and refractive outcomes were evaluated during a 12-month follow-up. Likewise, contrast sensitivity was assessed at the end of the follow-up. RESULTS: Significant improvements were observed in both groups in uncorrected distance (UDVA) and near visual acuity (UNVA) at 1 month postoperatively (p < 0.001). Differences between groups in these parameters as well as in sphere and cylinder did not reach statistical significance during the whole follow-up (p ≥ 0.079), except for UNVA only at 12 months postoperatively (p = 0.018). Concerning corrected near visual acuity, only significant differences between groups were found preoperatively (p = 0.020). Furthermore, only a minimal but significant difference between groups was found at 12 months postoperatively in contrast sensitivity for the spatial frequency of 18 cycles/° (p = 0.029). CONCLUSIONS: The rotationally asymmetric toric multifocal IOL LU-313 MF 30T provides good visual rehabilitation for near and distance vision after presbyopic lens extraction in eyes with preexisting astigmatism, independently whether the cataract surgery is performed with the FLACS or conventional technique.

Amblyopia treatment of adults with dichoptic training using the virtual reality oculus rift head mounted display: preliminary results.

BACKGROUND: The gold standard treatments in amblyopia are penalizing therapies, such as patching or blurring vision with atropine that are aimed at forcing the use of the amblyopic eye. However, in the last years, new therapies are being developed and validated, such as dichoptic visual training, aimed at stimulating the amblyopic eye and eliminating the interocular supression. PURPOSE: To evaluate the effect of dichoptic visual training using a virtual reality head mounted display in a sample of anisometropic amblyopic adults and to evaluate the potential usefulness of this option of treatment. METHODS: A total of 17 subjects (10 men, 7 women) with a mean age of 31.2 years (range, 17-69 year) and anisometropic amblyopia were enrolled. Best corrected visual acuity (BCVA) and stereoacuity (Stereo Randot graded circle test) changes were evaluated after 8 sessions (40 min per session) of dichoptic training with the computer game Diplopia Game (Vivid Vision) run in the Oculus Rift OC DK2 virtual reality head mounted display (Oculus VR). RESULTS: Mean BCVA in amblyopic eye improved significantly from a logMAR value of 0.58 ± 0.35 before training to a post-training value of 0.43 ± 0.38 (p < 0.01). Forty-seven percent of the participants achieved BCVA of 20/40 or better after the training as compared to 30% before the training. Mean stereoacuity changed from a value of 263.3 ± 135.1 before dichoptic training to a value of 176.7 ± 152.4 s of arc after training (p < 0.01). A total of 8 patients (47.1%) before dichoptic treatment had unmeasurable stereoacuity while this only occurred in 2 patients (11.8%) after training. CONCLUSIONS: Dichoptic training using a virtual reality head mounted display seems to be an effective option of treatment in adults with anisometropic amblyopia. Future clinical trials are needed to confirm this preliminary evidence. TRIAL REGISTRATION: Trial ID: ISRCTN62086471 . Date registered: 13/06/2017. Retrospectively registered.

Toll-like receptor 4 contributes to the inhibitory effect of morphine on colonic motility in vitro and in vivo.

Opioids rank among the most potent analgesic drugs but gastrointestinal side effects, especially constipation, limit their therapeutic utility. The adverse effects of opioids have been attributed to stimulation of opioid receptors, but emerging evidence suggests that opioids interact with the innate immune receptor Toll-like receptor 4 (TLR4) and its signalling pathway. As TLR4 signalling affects gastrointestinal motility, we examined the involvement of TLR4 in morphine-induced depression of peristaltic motility in the guinea-pig intestine in vitro and male C57BL/6N mice in vivo. While the TLR4 antagonist TAK-242 (0.1 µM and 1 µM) did not alter the morphine-induced inhibition of peristalsis in the isolated guinea-pig small intestine, the morphine-induced decrease in pellet propulsion velocity in colonic segments was attenuated by TAK-242 (0.1 µM). The ability of TAK-242 (4 mg/kg) to mitigate the morphine-induced suppression of colonic motility was replicated in mice in vivo by measuring the expulsion time of beads inserted in the distal colon. The inhibition of upper gastrointestinal transit of mice by morphine was not affected by pre-treatment with TAK-242 (4 mg/kg) in vivo. This is the first report that morphine-induced inhibition of colonic peristalsis is alleviated by TLR4 antagonism. We therefore conclude that TLR4 may contribute to opioid-induced constipation.