Effectiveness of multifocal and monofocal intraocular lenses for cataract surgery and lens replacement: a systematic review and meta-analysis.

PURPOSE: Multifocal intraocular lenses (IOLs) offer the possibility of spectacle-free vision following cataract surgery compared to standard IOLs. Existing systematic reviews have generally concluded that multifocal IOLs result in better uncorrected near vision and greater spectacle independence, but more unwanted visual phenomena such as glare and halos, compared to monofocal IOLs. However, the certainty of evidence has been low for most outcomes, and pooled analyses have grouped together technologically obsolete lenses with newer lenses, potentially obscuring differences in performance across different lens types. METHODS: We performed a systematic review searching for RCTs of a multifocal IOL to a standard IOL or monovision that reported spectacle independence, visual acuity, or quality of life. Databases were searched from 1/1/2006-4/30/2017. Existing reviews were used to identify older studies. Title/abstract screening and data extraction were done in duplicate. Where possible, random effects meta-analysis was performed to synthesize results. In addition to comparing multifocal IOLs as a group to monofocal IOLs, we also compared newer diffractive lenses to obsolete or refractive lenses. RESULTS: Twenty-five eligible studies were identified. There was no difference in pooled estimates of corrected or uncorrected distance vision between multifocal and standard IOLs. Compared to monofocal IOLs, multifocal IOLs had statistically significantly better pooled results for the outcome of near vision (10 studies, 1025 patients, mean difference in logMAR of -0.26 (95% CI -0.37, -0.15)); spectacle dependence (12 studies, 1237 patients, relative risk of 0.27 (95% CI 0.20, 0.38)) and borderline significantly better quality of vision (6 studies, 596 patients, standardized mean difference of -0.54, (95% CI -1.12, 0.04)). Compared to monofocal IOLs, multifocal IOLs had statistically significantly worse pooled results for the outcomes of glare (9 studies, 847 patients, risk ratio of 1.36 (95% CI 1.15, 1.61) and halos (7 studies, 754 patients, risk ratio of 3.14 (95% CI 1.63, 6.08). Newer multifocal lenses had statistically significantly better outcomes than older diffractive lenses or refractive lenses, when compared to monofocal IOLs, in near vision, quality of vision, and risk of halos. CONCLUSIONS: Multifocal IOLs compared to standard IOLs or monovision result in better uncorrected near vision and a higher proportion of patients who achieve spectacle independence, but greater risk of unwanted visual phenomena. Newer diffractive lenses may be better than refractive lenses in near vision and quality of vision outcomes, with less risk of halos than older diffractive lenses and refractive lenses. (PROSPERO registration CRD42017069949).

Long-Term Task- and Dopamine-Dependent Dynamics of Subthalamic Local Field Potentials in Parkinson's Disease.

Subthalamic nucleus (STN) local field potentials (LFP) are neural signals that have been shown to reveal motor and language behavior, as well as pathological parkinsonian states. We use a research-grade implantable neurostimulator (INS) with data collection capabilities to record STN-LFP outside the operating room to determine the reliability of the signals over time and assess their dynamics with respect to behavior and dopaminergic medication. Seven subjects were implanted with the recording augmented deep brain stimulation (DBS) system, and bilateral STN-LFP recordings were collected in the clinic over twelve months. Subjects were cued to perform voluntary motor and language behaviors in on and off medication states. The STN-LFP recorded with the INS demonstrated behavior-modulated desynchronization of beta frequency (13-30 Hz) and synchronization of low gamma frequency (35-70 Hz) oscillations. Dopaminergic medication did not diminish the relative beta frequency oscillatory desynchronization with movement. However, movement-related gamma frequency oscillatory synchronization was only observed in the medication on state. We observed significant inter-subject variability, but observed consistent STN-LFP activity across recording systems and over a one-year period for each subject. These findings demonstrate that an INS system can provide robust STN-LFP recordings in ambulatory patients, allowing for these signals to be recorded in settings that better represent natural environments in which patients are in a variety of medication states.

Development of a nomogram for femtosecond laser astigmatic keratotomy for astigmatism after keratoplasty.

PURPOSE: To develop a nomogram for femtosecond laser astigmatic keratotomy (AK) to treat post-keratoplasty astigmatism. SETTING: Three academic medical centers. DESIGN: Retrospective interventional case series. METHODS: A review of post-keratoplasty femtosecond laser AK was performed. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, and keratometry were recorded preoperatively and 1, 3, 6, and 12 months postoperatively. The location, length, depth, and diameter of the AK incisions were recorded, and the surgically induced astigmatic correction was related to these variables using regression analysis. RESULTS: One hundred forty femtosecond laser AK procedures were performed after penetrating keratoplasty (PKP) (n = 129) or deep anterior lamellar keratoplasty (DALK) (n =11), with 89 procedures (80 PKP, 9 DALK) included in the analysis. The mean CDVA improved from 20/59 (0.47 logMAR ± 0.38 [SD]) preoperatively to 20/45 (0.35 ± 0.31 logMAR) postoperatively (P = .013) (n = 46). The mean keratometric astigmatism decreased from 8.26 ± 2.90 diopters (D) preoperatively to 3.62 ± 2.59 D postoperatively (P < .0001) (n = 89). The mean refractive cylinder decreased from 6.77 ± 2.80 D preoperatively to 2.85 ± 2.57 D postoperatively (P < .0001) (n = 69). A nomogram for femtosecond laser AK to treat post-keratoplasty astigmatism was generated using regression analysis. CONCLUSIONS: Femtosecond laser AK significantly improved UDVA and CDVA and significantly reduced keratometric astigmatism and refractive cylinder after keratoplasty. The nomogram generated should improve the accuracy of post-keratoplasty femtosecond laser AK. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Creating the feedback loop: closed-loop neurostimulation.

Current DBS therapy delivers a train of electrical pulses at set stimulation parameters. This open-loop design is effective for movement disorders, but therapy may be further optimized by a closed loop design. The technology to record biosignals has outpaced our understanding of their relationship to the clinical state of the whole person. Neuronal oscillations may represent or facilitate the cooperative functioning of brain ensembles, and may provide critical information to customize neuromodulation therapy. This review addresses advances to date, not of the technology per se, but of the strategies to apply neuronal signals to trigger or modulate stimulation systems.

Diagnosis of prostatic carcinoma on multiparametric magnetic resonance imaging using shearlet transform.

This paper presents a method to diagnose prostate cancer on multiparametric magnetic resonance imaging (Mp-MRI) using the shearlet transform. The objective is classification of benign and malignant regions on transverse relaxation time weighted (T2W), dynamic contrast enhanced (DCE), and apparent diffusion coefficient (ADC) images. Compared with conventional wavelet filters, shearlet has inherent directional sensitivity, which makes it suitable for characterizing small contours of cancer cells. By applying a multi-scale decomposition, the shearlet transform captures visual information provided by edges detected at different orientations and multiple scales in each region of interest (ROI) of the images. ROIs are represented by histograms of shearlet coefficients (HSC) and then used as features in Support Vector Machines (SVM) to classify ROIs as benign or malignant. Experimental results show that our method can recognize carcinoma in T2W, DCE, and ADC with overall sensitivity of 92%, 100%, and 89%, respectively. Hence, application of shearlet transform may further increase utility of Mp-MRI for prostate cancer diagnosis.

Cystoid macular edema without macular thickening: a retrospective optical coherence tomographic study.

BACKGROUND: This is a retrospective observational case series of 37 eyes of 32 patients meeting the inclusion criteria intended to describe the appearance, prevalence, and associated risk factors for cystoid macular edema in eyes with normal foveal thickness and contour as determined by optical coherence tomography (OCT). METHODS: A retrospective review of all patients with macular disease who underwent OCT evaluation at the New England Eye Center from January to March 2007 and met the study inclusion criteria was performed. Optical coherence tomography scans were evaluated for the presence of intraretinal cystic fluid or cystoid macular edema but with normal retinal thickness and foveal contour. Retinal thickness and contour were evaluated using OCT mapping software. The main outcome measures were as follows: OCT-defined entity based on the presence of cystoid spaces within the fovea, "normal" foveal thickness (<252 microm), normal foveal contour, and best-corrected visual acuity on the date of examination. RESULTS: Thirty-seven eyes of 32 patients were determined to have cystoid macular edema with normal foveal thickness and contour on OCT. The overall prevalence within our patient population was 4.9%. Mean foveal thickness (standard deviation) for these patients was 201.4 microm (28.9) compared with normal mean foveal thickness (standard deviation) of 212 microm (20.0). Of the 32 patients, 17 (53.1%) had a primary diagnosis of age-related macular degeneration. The mean visual acuity (Snellen; logarithm of the minimum angle of resolution) was 20/80 (0.60). CONCLUSION: Cystoid macular edema in the setting of normal foveal thickness and contour as determined by OCT has not been extensively described. This entity is not pathognomonic of a single diagnosis and can occur in the setting of several disparate diagnoses as seen in our cohort. Chief among these were age-related macular degeneration and diabetic retinopathy. Acute postcataract cystoid macular edema was absent.

Vernal conjunctivitis.

Vernal conjunctivitis is a bilateral, seasonal, external ocular inflammatory disease of unknown cause. Afflicted patients experience intense itching, tearing, photophobia, and mucous discharge, and usually demonstrate large cobblestone papillae on their superior tarsal conjunctiva and limbal conjunctiva. It primarily affects children, may be related to atopy, and has environmental and racial predilections. Although usually self-limited, vernal conjunctivitis can result in potentially blinding corneal complications. Treatment of chronic forms of ocular allergies may necessitate collaborative efforts between the ophthalmologist and the allergist or immunologist.

Recipients of blood from a donor with multiple HLA antibodies: a lookback study of transfusion-related acute lung injury.

BACKGROUND: The effects of transfusion of HLA antibodies to patients with corresponding antigens are not well known. STUDY DESIGN AND METHODS: Records of patients who received blood from previous donations of a donor implicated in a case of transfusion-related acute lung injury (TRALI) were examined. The donor had multiple HLA antibodies reactive with 96 percent of HLA Class I antigens and 88 percent of HLA Class II antigens. RESULTS: Among 103 patients (40 with a pretransfusion white blood cell [WBC] count of >/=3.5 x 10(9)/L), 1 patient met criteria for TRALI and had clinical evidence for diffuse alveolar hemorrhage. Among the subset of 55 patients (17 with a pretransfusion WBC count of 3.5 x 10(9)/L) with known HLA types, none developed TRALI even though 54 (98%) had one to five corresponding HLA antigens. In a subgroup of patients four of 62 patients with chest radiographs, developed new or worse bilateral infiltrates with implicated but not control units (p = 0.0625). CONCLUSION: Transfusion of HLA antibodies from this donor to nonneutropenic patients did not cause TRALI, but there was a trend of an association with new or worse bilateral pulmonary infiltrates. Further research is needed to determine why transfusion of HLA antibodies to recipients with corresponding antigens causes TRALI in some cases and not in others.