Visual performance of the intraindividual implantation of a trifocal intraocular lens in the bag and a +4.0 D bifocal intraocular lens in the sulcus with optic capture created by femtosecond laser-assisted cataract surgery.

At present, only one design is available for trifocal intraocular lens (IOL); unfortunately, this particular design is not suitable for implantation in the sulcus with optic capture when posterior capsule rupture (PCR) occurs. Although three-piece bifocal IOLs can be implanted in the sulcus, this form of IOL can be vulnerable to tilt and decentration, thus causing aberration and photopic phenomena, such as halos and glares. However, visual axis centered optic capture using femtosecond laser-assisted cataract surgery (FLACS) is able to manage such complex operations. In the present study, we implanted a three-piece +4.0 D bifocal IOL into the sulcus of a patient who experienced PCR using optic capture and FLACS following the straightforward implantation of a one-piece trifocal IOL in the other eye. Defocus curves showed that the weakness of the trifocal IOL (nearest distances) was compensated for by the strength of the +4.0 D bifocal IOL, whereas the weakness of the +4.0 D bifocal IOL (middle distance) was compensated for by the strength of the trifocal IOL. Therefore, this combination provided the patient with a wider range of depth of focus. The contrast sensitivity in both eyes was within the normal range. Photopic phenomena were comparable with the bilateral implantation of the trifocal IOL. Anterior segment optical coherence tomography showed that tilt and decentration in the trifocal IOL implanted in the bag was significantly higher than the +4.0 D bifocal IOL implanted in the visual axis centered optic capture. This case showed that the intraindividual implantation of a single-piece trifocal IOL in the bag and a three-piece +4.0 D bifocal IOL in the sulcus, using a combination of optic capture and FLACS, is promising particularly in cases of PCR and can provide a wider range of vision without losing visual quality.

[A Case of Choroidal and Brain Metastases from Castration-Resistant Prostate Cancer].

Choroidal and central nervous system metastases from prostate cancer are extremely rare. We report a case of choroidal and brain metastases from castration-resistant prostate cancer (CRPC). A 75-year-old male patient with metastatic CRPC presented with a 1-week history of a decrease in visual acuity in his left eye. An ophthalmoscopic examination revealed a choroidal tumor, 4 disc diameters across with serious retinal detachment. He was diagnosed with metastatic choroidal tumor from examination and patient's background. The external beam radiation therapy of total 30 Gy was successful and his visual acuity was improved. Three courses of chemotherapy with docetaxel (55 mg/m2) were performed, but finally he was found to have multiple brain metastases 4 months later. His headache disappeared after palliative whole brain radiotherapy, but he died 3 months after diagnosis of brain metastases. Although choroidal and brain metastases from prostate cancer are very rare, it is important for urologists to listen to the patient's complaints and consider the possibility of these rare metastases in patients with advanced cancer.

Multicoated contact lens for bimanual vitreous surgery without endoillumination.

We developed a new multicoated contact lens for use with the bimanual vitrectomy technique. The new lens is made of quartz, and its multicoated surface has properties that decrease light reflection and increase light absorption. The lens is placed on the cornea, and the coaxial light from the operating microscope alone enables surgeons to obtain a clear image of the retinal surface. This new vitrectomy contact lens is very useful for the treatment of eyes with proliferative membranes and allows surgeons to perform vitrectomy by using both hands.

Absorption of short wavelengths of endoillumination in indocyanine green solution: implications for internal limiting membrane removal.

PURPOSE: To measure the absorption coefficients of short wavelengths, irradiated by a light source used for vitreous surgery, in indocyanine green (ICG) solution and balanced salt solution (BSS), and to determine the implications of these absorption coefficients on retinal phototoxicity caused by ICG-assisted internal limiting membrane removal. METHODS: The absorption coefficients of short wavelengths irradiated by a commercially available light source used for vitreous surgery were measured in ICG solution and BSS using a dual-beam spectroradiometer. RESULTS: The absorption coefficient of wavelengths irradiated by the endoillumination light source in ICG solution was almost the same as that obtained in BSS. The absorbance coefficients of the ICG solutions were 0.18 cm(-1) at 400 nm and 0.03 cm(-1) at 450 nm. In BSS, the absorption coefficients were 0.17 cm(-1) at 400 nm and 0.015 cm(-1) at 450 nm. No significant difference in absorbance was seen between 400 nm and 450 nm ( P>0.05). CONCLUSIONS: The absorption of wavelengths is not greater in ICG solution than in BSS. ICG solution during intravitreal use probably does not enhance retinal photochemical injury during ICG-assisted internal limiting membrane removal.

Measured visual acuity of fellow eyes as a prognostic factor in macular hole surgery.

PURPOSE: To investigate the effect of the vision of the fellow eye on the visual acuity of eyes after successful macular hole surgery. DESIGN: Prospective consecutive series. METHODS: A consecutive series of eyes with successful macular hole closure were studied and assigned to one of two groups according to the visual acuity of the fellow eye; a group with visual acuity less than 20/200 and a group with visual acuity of 20/200 or better. Preoperative and postoperative visual acuity in the two groups was measured based on the logarithm of the minimal angle of resolution (LogMAR), and postoperative visual acuity was also determined by using the multiple-letter visual acuity chart, which permitted measurement of visual acuity at an extrafoveal point. RESULTS: Group 1 (<20/200) consisted of 19 eyes and group 2 (>20/200) consisted of 51 eyes. LogMAR visual acuity at 6 months postoperatively was significantly better in group 1 than in group 2 (0.21 vs 0.41, P <.01). The logMAR change 6 months after surgery was significantly greater in group 1 than in group 2 (0.49 vs 0.23, P <.01). There was no significant difference between two groups in logMAR visual acuity at 6 months postoperatively determined with the multiple-letter visual acuity chart (0.20 vs 0.29, P >.05). CONCLUSIONS: Visual recovery after successful macular hole surgery is inversely correlated with vision in the fellow eye. Learning to use eccentric fixation may contribute to visual improvement after macular hole surgery.