The Impact of Angle Lambda on Patient Satisfaction after Optiflex Trio Trifocal Intraocular Lens Implantation.

Purpose: To evaluate the vision-related quality of life (QOL), visual acuities, and refractive outcomes of patients with different angle lambda (λ) after a trifocal intraocular lens (IOL) implantation at Veni Vidi Eye Hospital, Istanbul, Turkey. Methods: This retrospective, nonrandomized, and noncomparative case series included patients who had phacoemulsification bilaterally with the implantation of a trifocal IOL (Optiflex Trio) and responded to a vision-related QOL questionnaire measuring patient satisfaction. The patients were divided into two groups according to the angle λ with a cutoff value of 0.5 mm. Evaluations were conducted to examine the monocular visual acuities, spherical equivalents, corneal astigmatism measured 3 months after surgery, and outcomes of the QOL questionnaire in the two groups. Results: The study examined 130 eyes from 65 patients aged from 41 to 78 years old. There were no statistically significant differences between the two groups at 3 months after surgery in terms of uncorrected distance visual acuity (UDVA), monocular uncorrected intermediate visual acuity (UIVA), monocular uncorrected near visual acuity (UNVA), spherical equivalent, and corneal astigmatism (P > 0.05). Patients with a greater angle λ had significantly more difficulty going out to see movies, plays, or sporting events (P=0.02), driving at night (P=0.002), and driving in difficult conditions (P < 0.001) than patients with a lower angle λ. Conclusions: The Optiflex Trio showed good results in terms of visual acuity at all distances, positive refractive outcomes, and high patient satisfaction in daily life according to the QOL questionnaire. An angle λ greater than 0.5 mm may potentially cause dysphotopsia symptoms, especially during nighttime activities.

Comparison of fibrin glue and suture technique in pterygium surgery performed with limbal autograft / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft.METHODS: A prospective randomised clinical trial was carried out in 58 eyes of 58 patients operated for primary nasal pterygium. Autologous conjunctival graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision. In 29 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive (Beriplast P) and in 29 eyes with 8- 0 Virgin silk sutures. The Mann-Whitney U test was used for statistical analysis. Postoperative patient discomfort (pain, stinging, watering) and biomicroscopic findings (hyperemia, edema) were graded. Patients were followed up at least for six months.RESULTS: Subconjunctival hemorrhage occured under the graft in one patient in group 1. In seven cases of group 2, sutures were removed at the 15th day because of granulomatous tissue reaction. Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in one case of group 1, and 2 cases of group 2. Average surgery cost was higher (P<0.05) and surgery time was shorter (P<0.05) in fibrin group. CONCLUSION: Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.

Lymphoma of the nasal cavity and paranasal sinuses: treatment and outcome of early-stage disease.

The records of 23 patients diagnosed and treated at the Massachusetts General Hospital for extranodal non-Hodgkin's lymphoma of the paranasal sinus and nasal cavity were reviewed. The majority of patients were Ann Arbor stage I and approximately evenly divided in T1 or T2 (n = 10) and T3 or T4 (n = 13). Eight patients had nasal-type NK/T cell and 15 patients had diffuse large B-cell lymphoma (DLBCL). The patients with nasal-type NK/T cell lymphoma predominately involved the nasal cavity (5/8), whereas the DLBCL more often had the paranasal sinuses as the primary site (12/15). All patients received radiation as part of their treatment. Only three patients received chemotherapy as part of their initial treatment for three cycles using a cyclophosphamide, doxorubicin, vincristine, and prednisone-based regimen. By coincidence, the estimated overall survival (OS) and disease-free survival rates for both 5 and 10 years were all the same for all analyses. The OS for the entire group at 10 years was 78%. Significant prognostic factors were Ann Arbor stage IEA versus IIEA ( p = 0.0001) and T stage with (T1 or T2) versus (T3 or T4) (p = 0.0243). Combining Ann Arbor stage and T stage created a highly significant prognostic variable (IEA & [T1 or T2], IEA & [T3 or T4], IIEA & [T1 or T2], IIEA & [T3 or T4]) at p = 0.0001, regardless of site or histology. Patients with local-regional disease appear to be well controlled with radiation alone, but distant failure remains a problem. A combined-modality approach with local-regional radiation and systemic chemotherapy is recommended for these patients.

Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts.

BACKGROUND: Stents provide effective treatment for stenotic saphenous venous aorto-coronary bypass grafts, but their placement carries a 20% incidence of procedure-related complications, which potentially are related to the distal embolization of atherosclerotic debris. We report the first multicenter randomized trial to evaluate use of a distal embolic protection device during stenting of such lesions. METHODS AND RESULTS: Of 801 eligible patients, 406 were randomly assigned to stent placement over the shaft of the distal protection device, and 395 were assigned to stent placement over a conventional 0.014-inch angioplasty guidewire (control group). The primary end point-a composite of death, myocardial infarction, emergency bypass, or target lesion revascularization by 30 days-was observed in 65 patients (16.5%) assigned to the control group and 39 patients (9.6%) assigned to the embolic protection device (P=0.004). This 42% relative reduction in major adverse cardiac events was driven by myocardial infarction (8.6% versus 14.7%, P=0.008) and "no-reflow" phenomenon (3% versus 9%, P=0.02). Clinical benefit was seen even when platelet glycoprotein IIb/IIIa receptor blockers were administered (61% of patients), with composite end points occurring in 10.7% of protection device patients versus 19.4% of control patients (P=0.008). CONCLUSIONS: Use of this distal protection device during stenting of stenotic venous grafts was associated with a highly significant reduction in major adverse events compared with stenting over a conventional angioplasty guidewire. This demonstrates the importance of distal embolization in causing major adverse cardiac events and the value of embolic protection devices in preventing such complications.