Cataract Group Research Articles

Evaluation of the ratio of different major and trace elements in the lens of dogs with cataract.

Understanding the elements that support cataract development and searching for available therapeutic methods is essential for scientific and social interest. For that purpose, the role of trace elements has been investigated in this study to better understand the development of cataracts in dogs. The aim of this study was to evaluate the ratio of the major and trace elements by X-ray fluorescence spectrometry in dog cataract lenses to contribute to diagnostic, non-surgical, and ophthalmological preventive data. A single lens with a cataract from each of a total of 88 dogs (cataract group) and a healthy lens from each of 6 dogs (control group) were evaluated. The elements calcium (Ca), iron (Fe), copper (Cu), zinc (Zn), magnesium (Mg), manganese (Mn), and potassium (K) were analyzed by energy dispersive X-ray fluorescence and X-ray microfluorescence. The results indicated an increase of Ca, Fe, Cu, and Zn, in association with the reabsorption mechanism of hypermature cataracts. The ratio of elements Ca, Fe, Cu, and Zn was different in cataract lenses than in healthy lenses, and our results may support the development of therapeutic strategies for cataracts in dogs. The Ca concentrations were distinct in the cataract development stages, and the Fe concentration was relatively higher in males when compared to females. Finally, this research stands out with a particular contribution to the understanding of both cataract formation and prevention.

1266 ASSOCIATION OF MULTIMORBIDITY PATTERNS AND INCIDENT DEPRESSION AMONG OLDER ADULTS IN TAIWAN: ROLE OF SOCIAL PARTICIPATION

Abstract Background Multimorbidity has negative impacts on the health outcomes of older adults. Previous research has discovered different patterns of multimorbidity. However, evidence is scarce for associations between multimorbidity patterns and depression, especially the role of social participation in it. This study aimed to explore the relationship between multimorbidity patterns and depression among older adults in Taiwan and the effect of social participation in different multimorbidity patterns. Methods This population-based cohort study used data from the Taiwan Longitudinal Study on Aging. It included 1,975 older adults (age >50 years) who were followed from 1996 to 2011. The participants’ multimorbidity patterns in1996 were determined by latent class analysis; their incident depression was ascertained in 2011 by using the 10-item CES-D. Multivariate logistic regression was used to analyse the relationship between multimorbidity patterns and depression. Results In 1996, the participants’ average age was 62.1 years. Four multimorbidity patterns were discovered through latent class analysis, as follows: (1) Cardiometabolic group (n = 93), (2) Arthritis–cataract group (n = 105), (3) Multimorbidity group (n = 128), and (4) Relatively healthy group (n = 1649). After multivariate analysis, participants in the Multimorbidity group had a greater risk of incident depression (Odds ratio: 1.62; 95% Confidence interval: 1.02–2.58), compared with the Relatively healthy group. Subgroup analysis showed that participants without social participation in the Arthritis-Cataract and Multimorbidity groups had greater risks of developing depression. Conclusion This 16-year, population-based cohort study showed that distinct multimorbidity patterns among older adults in Taiwan were associated with incident depression during later life, while social participation played a role as protective factor.

Comparison of ultrasound energy consumption between low-energy femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery in patients with different cataract densities.

Femtosecond laser-assisted cataract surgery (FLACS)'s effect on reducing ultrasound energy, accumulated with cumulative dispersed energy (CDE) units, still remains controversial. This study aims to evaluate the effect of low-energy FLACS on CDE with that of conventional phacoemulsification surgery (CPS) in different cataract densities from multiple surgeons. It was a retrospective case-control study. Total 629 eyes receiving either low-energy FLACS (performed with Ziemer LDV Z8 platform) or CPS were divided into two groups according to preoperative grading of Lens Opacity Classification System III (LOCSIII): milder and harder cataract group. The mean CDE were compared in different cataract densities and surgeons. A linear regression analysis was performed to evaluate the effect of using low-energy FLACS on CDE in harder cataract cases. We found overall CDE had no significant difference between two surgeries. However, low-energy FLACS led to a significantly lower CDE in patients with harder cataracts than CPS (18.47 ± 4.32 vs. 12.96 ± 2.34; p < 0.001). Similar results were observed in the three surgeon subgroups and in linear regression analysis and no significant difference of the effect accounting for surgeons. Moreover, low-energy FLACS results in a reduction of energy consumption comparing to CPS and has endothelial sparring effect in patients with harder cataracts. The reduced energy consumption was observed by using low-energy FLACS irrespective of surgeons' experience or the approaches adopted in patients with harder cataracts. Therefore, we can have more confidence to suggest this innovative platform to the patients in such cases.

Evaluation of Multimodal Biometric Parameters for Diagnosing Acute Angle Closure Secondary to Lens Subluxation.

To evaluate the clinical characteristics and multimodal biometric parameters from ultrasound biomicroscopy (UBM) and IOL Master biometry of patients with acute secondary angle-closure due to lens subluxation (ASAC-LS), acute primary angle-closure (APAC), and cataract. This retrospective study included 22 eyes with ASAC-LS, 27 eyes with APAC, and 39 eyes with cataract. Gender, age, affected eye, best corrected visual acuity, axial length, central corneal thickness, and anterior chamber depth (ACD) assessed by UBM and IOL Master were measured and compared between the three groups. In addition, we compared the ratio of ACD (ACD ratio) and the difference of ACD (ACD difference) measured by the two instruments. Logistic regression analysis was conducted to evaluate the predictive factors for lens subluxation. Receiver operating characteristic (ROC) curves were plotted to obtain a suitable cutoff value of biometric parameters to separate ASAC-LS cases from APAC and cataract cases. In the ASAC-LS group, the median (interquartile range [IQR]) ACD measured by IOL Master was 2.47 (IQR 1.85-2.92) mm while the median ACD measured by UBM was 3.11 (IQR 2.60-3.76) mm. The difference of ACD measured by the two instruments was statistically significant in the ASAC-LS group (P < 0.001) whereas the differences were not statistically significant in the APAC group (P = 0.521) and cataract group (P = 0.204). Subsequent pairwise comparison revealed that only the ACD difference (0.40 [IQR 0.22-1.08] mm) and ACD ratio (1.18 [IQR 1.07-1.40]) in the ASAC-LS group were significantly different from those in the APAC group (ACD difference 0.02 [IQR 0.01-0.07] mm; ACD ratio 1.01 [IQR 1.00-1.04]) and cataract group (ACD difference 0.09 [IQR 0.01-0.14] mm; ACD ratio 1.03 [IQR 1.00-1.04]) (all P < 0.001). The ACD difference and ACD ratio were significantly associated with lens subluxation in the multivariate logistic regression analysis (P < 0.001 and P = 0.001, respectively). Additionally, the ROC curve analysis showed that the ACD difference at 0.235mm and the ACD ratio at 1.080 were the respective cut-off values for lens subluxation, with a sensitivity of 77.3% and specificity of 100.0%. Our findings provide a new option for identifying lens subluxation. Specifically, combining the ACD from UBM and IOL Master may be helpful for differential diagnosis of ASAC-LS.

A Novel Biomarker in Primary Glaucoma: Aqueous Humor and Serum Levels of Ischemia Modified Albumin (IMA).

To analyze ischemia-modified albumin (IMA) levels in aqueous humor and serum, and their correlation to RNFL thinning in primary glaucoma patients. Cross-sectional study. Patients were divided into the control and glaucoma groups. The control group was patients with senile cataracts. The glaucoma group consisted of patients diagnosed for the first time as primary open-angle glaucoma (POAG) or primary angle closure glaucoma (PACG). Exclusion criteria were secondary glaucoma and patients with systemic disease. A complete cataract examination was done for all patients, and glaucoma examinations for the glaucoma group. In both groups, the IMA aqueous humor was obtained during cataract and glaucoma procedure. Serum levels of IMA, malondialdehyde (MDA), and tumor necrosis factor alpha (TNF-α) were examined during preoperative examinations. Control group comprised 33 participants, and glaucoma group 41 patients (21 PACG and 20 POAG). Mean IMA aqueous humor (AQH) levels found in cataract group 6.039±3.16 ng/mL, glaucoma group 14.89±6.08 ng/mL, PACG group 12.69±6.25 ng/mL and POAG group 17.33±4.988 mg/mL. Mean IMA serum levels in cataract group 14.75±6.53 ng/mL, glaucoma group 13.89±6.53 ng/mL, PACG group 12.79±6.46 ng/mL± and POAG group 14.93±10.74 ng/mL. Glaucoma group had significant higher level of IMA in aqueous humor compared to control group, but opposite findings in serum IMA levels between groups. POAG patients had a higher aqueous IMA level compared to PACG group and correlated significantly with IOP. IMA AQH also negatively correlated to the RNFL thickness in both POAG and PACG group. Cut off 9.5 ng/mL was considered as a normal limit value to differentiate between control and glaucoma group. Primary glaucoma patients showed a significantly increased level of IMA AQH as a local ischemic biomarker compared to the control group. Systemic oxidative activity is not a representation of local ocular oxidative stress in both cataract and glaucoma group.

Central macular thickness and subfoveal choroidal thickness changes on spectral domain optical coherence tomography after cataract surgery in pediatric population.

To evaluate the central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) changes on spectral domain optical coherence tomography (SD-OCT) after cataract surgery with intraocular lens (IOL) implantation in a pediatric population. This was a longitudinal, prospective, interventional study which included 90 pediatric patients who underwent cataract extraction with IOL implantation. Serial SD-OCT scans were done at postoperative day 1, 1-month, and 3-month follow-up. CMT and SFCT were measured at each visit. A statistically significant increase in CMT was noted at 1 month (from 199.3 μm to 210.04 μm) post surgery, which declined over a 3-month period (202.70 μm, P = 0.0001). In case of SFCT, a constant increase was observed for over 3 months of follow-up (baseline: 296.52 μm; 1 month: 309.04 μm; and 3 months: 319.03 μm, P = 0.0001). The traumatic cataract group showed more pronounced changes in CMT and SFCT than the non-traumatic cataract group. No significant difference was observed regarding these parameters between those who underwent primary posterior capsulotomy (PPC) versus those who did not. None of the patients in the study group developed cystoid macular edema. These posterior segment-related anatomical changes did not affect the final visual outcomes. Cataract surgery induces potential inflammatory changes in the macula and choroid in pediatric patients. Such changes are more pronounced in trauma-related cases; however, they are not significant enough to affect the visual outcomes. Similarly, the additional surgical step of PPC does not induce significant anatomical or functional changes.

Association of cognitive function with Neurofilament light chain in the aqueous humor of human eye.

To evaluate the predictive clinical role of neurofilament light chain (NfL), amyloid-β (Aβ), glial fibrillary acidic protein (GFAP), and phosphorylated tau at threonine 181 (p-tau181) proteins in human aqueous humor (AH) and quantify the retinal macular microvascular parameters by optical coherence tomography angiography (OCTA) as early diagnostic markers of Alzheimer's disease (AD). This prospective, single-site, cross-sectional, cohort study enrolled 55 participants, including 38 patients with neovascular age-related macular degeneration (nAMD) and 17 individuals with senile cataracts. The single-molecule array platform was used to quantitatively measure the levels of AH NfL, Aβ40, Aβ42, GFAP, and p-tau181 proteins in AH. The mini-mental state examination (MMSE) score was used to assess the global cognitive function. OCTA scan with 6 × 6 mm macular area was used to quantify the retinal thickness and microvascular densities of superficial retinal capillary plexuses and deep retinal capillary plexuses. NfL, Aβ40, Aβ42, GFAP, and p-tau181 were detected in all AH samples by Simoa platform. Individuals with cataract had higher concentrations of NfL and p-tau181 but lower Aβ40 and Aβ42 and similar GFAP compared to those with nAMD. Lower MMSE scores showed a negative correlation with NfL concentration of AH not only in the nAMD group (p = 0.043), but also in the cataract group (p = 0.032). However, the MMSE scores were not associated with the levels of Aβ40, Aβ42, GFAP, or p-Tau181. Further analysis found that the Aβ40 and Aβ42 concentrations showed a strong positive correlation (p < 0.0001). In addition, the NfL concentration showed a mild positive correlation with that of GFAP in the cataract group (p = 0.021). Although it has not reached statistical significance, there was a correlation between the levels of NfL and Aβ42 in the nAMD group (p = 0.051). Moreover, the macular superficial vessel density values had a negative correlation with the concentration of NfL (p = 0.004) but a positive correlation with MMSE scores (p = 0.045). The macular deep vessel density values were negatively correlated with the concentration of p-tau181 (p = 0.031) and positively correlated with MMSE scores (p = 0.020). The examination of AD-related biomarkers in human AH and OCTA may improve the ocular-based AD detection methods and contribute to forestalling the progression of preclinical AD.

Visual Outcomes of Secondary Lens Implants in Children with Different Etiologies

Aim: This study investigated visual outcomes and factors that impact vision in children receiving secondary Intraocular Lens (IOL) implants. Methods: Children who had traumatic or congenital cataracts and underwent secondary lens implantation for aphakia at Drashti Netralaya between 2000 and 2019 were retrospectively examined. We included all the eyes with secondary implants for aphakia correction with placement either in the bag or sulcus or through scleral fixation. We obtained data from electronic medical records and analyzed using SPSS 22 through descriptive analysis, cross tabulation and t test. We evaluated visual outcomes among different patients. Results: Our cohort consisted of 84 eyes (mean age: 7.88 ± 6.07 years). Of the 84 eyes, 24 (28.6%) and 60 (71.4%) were female and male patients, respectively and 32 (38.1%) had traumatic cataract. We observed significant improvements in vision following lens implantation (p=0.000). Those with nontraumatic cataracts exhibited better outcomes that did the traumatic cataract group (p=0.004). Corneal opacity caused comorbidities in the traumatic group (14/52, 14.29%). Visual outcomes significantly improved in young patients and were not affected by other variables. Conclusion: Secondary lens implantation significantly improved vision in aphakic children. Young patients and those with nontraumatic cataracts demonstrated more favorable visual outcomes.

TGF-β2 levels in the aqueous humor are elevated in the second eye of high myopia within two weeks after sequential cataract surgery

Transforming growth factor-β (TGF-β) is the critical regulator of physiological and pathological conditions in lens. The TGF-β signaling pathway is closely associated with high myopia patients. Thirty eyes from fifteen patients with high myopia who received sequential cataract surgery were enrolled in this prospective study. Ten cataract patients with non-myopia were chosen as a control group. Aqueous humor (AH) samples were used to detect the levels of TGF-β1, TGF-β2, and TGF-β3 in both groups. Compared with the non-myopic cataracts patient group, the highly myopic cataracts group had a significantly higher TGF-β2 (P = 0.019). Besides, the level of TGF-β2 of the second eye was significantly higher than that in the first eye in high myopia cataract patients group (P = 0.037). And TGF-β1 showed significant differences with age and axial length of high myopia cataract patients. Therefore, TGF-β2 may contribute to the development of high myopia and cataract surgery increased the expression of TGF-β2.

Evaluations of aqueous humor protein markers in different types of glaucoma.

To compare the concentrations of protein markers in aqueous humor (AH) of patients with primary open-angle glaucoma (POAG), chronic angle-closure glaucoma (CACG), acute primary angle closure (APAC), and cataract without glaucoma as the control group.AH samples were collected at the beginning of surgery from 82 eyes of 82 patients who were divided into POAG (n = 23), CACG (n = 21), APAC (n = 19), and cataract groups (n = 19). The expression levels of interferon-gamma (IFN-γ), interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-17A (IL-17A), lymphotoxin-alpha (LT-α), monocyte chemotactic protein-1 (MCP-1), matrix metalloproteinase-2 (MMP-2), brain derived neurotrophic factor (BDNF), basic fibroblast growth factor (bFGF), platelet-derived growth factor-AA (PDGF-AA), vascular endothelial growth factor (VEGF), tissue inhibitor of metalloproteinases-1 (TIMP-1), and tumor necrosis factor-alpha (TNF-α) in AH were detected using a microsphere-based immunoassay.The AH levels of TNF-α, MMP-2, MCP-1, IFN-γ, and TIMP-1 in the APAC and CACG groups were significantly higher than those in control eyes. Additionally, the AH levels of interleukin-6 (IL-6) and VEGF in the APAC group were significantly higher than those in the control group (CG). The interleukin-8 (IL-8) levels in patients with POAG were significantly higher than those in control eyes, whereas the LT-α levels were significantly lower than those in control eyes. IL-6 levels were significantly correlated with the coefficient of variation (CV), whereas IL-6 levels were significantly negatively correlated with the frequency of hexagonal cells (HEX) and corneal endothelial cell density (CD).The levels of TNF-α, MMP-2, MCP-1, IFN-γ, TIMP-1, IL-6, IL-8, VEGF, and LT-α were different among the three types of glaucoma. These different types of glaucoma may be caused by various pathogeneses, which opens avenues for further investigation into the pathogenesis of glaucoma and discoveries new targets and pathways for the treatment of glaucoma.

Detecting Subclinical Corneal Edema Using Corneal Thickness Mapping in Patients Presenting Fuchs Endothelial Corneal Dystrophy

To determine whether local corneal thickness changes observed with optical coherence tomography (OCT) can detect subclinical corneal edema in Fuchs endothelial corneal dystrophy (FECD). Retrospective cohort study. A series of patients presenting FECD who underwent cataract surgery alone (45 eyes) or with concomitant Descemet membrane endothelial keratoplasty (triple procedure; 117 eyes). The study reviewed medical records, collected the preoperative corneal thickness map and calculated the differences and ratio of corneal thickness measured at 5, 7, and 9 mm from the central corneal thickness. Area under the receiver operating characteristic curves (AUCs) were calculated and thresholds were selected to obtain a specificity of 90%. The median difference between 5- and 2-mm corneal thickness in the supra-nasal quadrant (∆5-2mmSN) was 38 µm (interquartile range 34-46) in the cataract group and 17 µm (2-38) in the triple procedure group (P < .001). The corneal thickness ratios of supra-nasal 5- to 2-mm (R5/2mmSN) and 7- to 2-mm (R7/2mmSN) were 1.07 (1.06-1.08) and 1.15 (1.13-1.17)] in the cataract group and 1.03 (1.00-1.06) and 1.09 (1.06-1.14) in the triple procedure group (P < .001). The probability of corneal edema was increased 7-fold with ∆5-2mm SN < 27 µm (AUC=0.76) and 9.4- and 7.4-fold with R5/2mmSN and R7/2mmSN < 1.045 (AUC=0.77) and 1.118 (AUC=0.76), respectively. Local changes in corneal thickness may be useful in detecting preclinical corneal edema, especially in patients with FECD undergoing cataract surgery.

17β-Estradiol Inhibits Oxidative Damage in Cataracts Rats via NOTCH1 Signaling

This study assesses the effect of 17β-estradiol on oxidative damage and NOTCH1 levels in cataract rats. 45 SD rats, aged 8–12 weeks old and weighted 225–312 g were assigned into healthy group, cataract group, and treatment group with n = 15 in each group followed by analysis of the pathological morphology of rat lens by HE staining, cell apoptosis by flow cytometry, and the degree of turbidity under a microscope. Meanwhile, MDA and SOD levels were measured and NOTCH1, p53 and BAX expressions was detected by PT-PCR. The Healthy group rats showed complete and orderly lens structure, whereas, the cataract group showed disorganized and distributed loosely lens, with the formation of vacuoles and the rupture and degradation of fibrocells. In the treatment group, the lens epithelial cells were orderly and evenly distributed, and the vacuoles were significantly reduced. The apoptotic rate of lens epithelial cells in healthy group (1.79±0.11)% was significantly lower than that in cataract group (15.22±1.17)% (P &lt; 0.05), which showed significantly higher apoptotic rate than treatment group (6.31±1.12)% (P &lt; 0.05). The degree of eye turbidity was increased in cataract group and reduced in treatment group compared with that in healthy group (P &lt; 0.05). In addition, cataract group showed significantly reduced SOD and increased MDA level groups along with upregulated Notch1, p53 and Bax (P &lt; 0.05). However, treatment group showed significantly increased SOD, decreased MDA and downregulated Notch1, p53 and Bax. In conclusion, 17β-estradiol reduces the apoptosis rate of lens epithelial cells in cataract rats by reducing NOTCH1 level, thereby enhancing the ability to resist oxidative damage.

Frequency of Dry Eyes after Cataract Surgery and Effect of Gender, Duration of Cataract and Age on Dry Eye Symptoms after Phacoemulsification

Purpose: To determine the frequency of dry eyes in patients after cataract surgery and to find out the effect of gender, duration of cataract and age on dry eye symptoms after phacoemulsification. Study Design: Descriptive Observational study. Place and Duration of Study: Layton Rehmatulla Benevolent Trust Free Eye and Cancer Hospital, Lahore from October 2015 to April 2016. Methods: One hundred and twenty patients between 40-80 years of age and suffering from cataract were included. Past medical history and current medical information was recorded. To control bias, only one experienced surgeon carried out the procedures. Follow-up was done at 1st post-operative day, one week, one month and 3 months. Tear film break up time was noted at each visit. Quantitative variables like age and tear film break-up time (TBUT) were presented as mean ± SD. The Qualitative variables were presented as frequency and percentages. Data was stratified according to age, gender and duration of cataract. Post-stratification Chi-square test was applied and p-value ≤0.05 was considered significant. Results: Out of 120 patients, there were 47 (39%) males and 73 (61%) females. A total of 35 (29.2%) patients had dry eyes. Mean age was 59.11 ± 12.358 years while mean TBUT was 11.27 ± 2.582 seconds. There was no relation of dry eye with gender, duration of cataract and different age groups (p &gt; 0.05). Conclusion: Frequency of Dry eyes after cataract surgery was 29.2% (n = 35). There was no effect of gender, duration of cataract and age of the patient on the post-operative TBUT after phacoemulsification.

Metabolomic study of eyeball rupture and patients with cataracts in aqueous humor.

The purpose of the present study was to identify metabolic biomarkers and study the metabolic changes in relation to cataracts and eyeball rupture in human aqueous humor. This case-control study included 3 patients with traumatic ocular rupture treated by surgery as the control group, 10 patients with severe cataracts as the severe cataracts group and 10 patients with mild cataracts as the mild cataracts group. The present study used liquid chromatography-mass spectrometry to analyze the metabolomics of aqueous humor samples. Databases including the Kyoto Encyclopedia of Genes and Genomes and MetaboAnalyst were used to find potential pathways for metabolites. Aqueous humor metabolic spectrum can competently distinguish patients with different degrees of cataracts from the control group. A total of 34 metabolites were identified as potential biomarkers that could distinguish patients with different degrees of cataracts; 36 metabolites were identified as potential biomarkers that could distinguish patients with severe cataracts from the control group; 34 metabolites were identified as potential biomarkers that could distinguish patients with mild cataracts from controls. In pathway analysis, glycerolphospholipid metabolism was highly affected, which meant that these metabolic markers serve an important role in the regulation of this pathway. The present study identified valuable metabolic biomarkers and pathways, which is helpful for an improved understanding of the pathogenesis of cataracts. This discovery has transformation value for the development of new treatment methods for cataracts.

Active Learning to Characterize the Full Contrast Sensitivity Function in Cataracts.

BackgroundTo characterize contrast sensitivity function (CSF) in cataractous and pseudophakic eyes compared to healthy control eyes using a novel quantitative CSF test with active learning algorithms.MethodsThis is a prospective observational study at an academic medical center. CSF was measured in eyes with visually significant cataract, at least 2+ nuclear sclerosis (NS) and visual acuity (VA) ≥ 20/50, in pseudophakic eyes and in healthy controls with no more than 1+ NS and no visual complaints, using the Manifold Contrast Vision Meter. Outcomes included Area under the Log CSF (AULCSF) and CS thresholds at 1, 1.5, 3, 6, 12, and 18 cycles per degree (cpd). A subgroup analysis as performed on cataract eyes with VA ≥ 20/25.ResultsA total of 167 eyes were included, 58 eyes in the cataract group, 77 controls, and 32 pseudophakic eyes with respective median AULCSF of 1.053 (0.352) vs 1.228 (0.318) vs 1.256 (0.360). In our multivariate regression model, cataract was associated with significantly reduced AULCSF (P= 0.04, β= −0.11) and contrast threshold at 6 cpd (P= 0.01, β= −0.16) compared to controls. Contrast threshold at 6 cpd was significantly reduced even in the subgroup of cataractous eyes with VA ≥ 20/25 (P=0.02, β=−0.16).ConclusionThe novel qCSF test detected disproportionate significant contrast deficits at 6 cpd in cataract eyes; this remained significant even in the cataractous eyes with VA ≥ 20/25. CSF testing may enhance cataract evaluation and surgical decision-making, particularly in patients with subjective visual complaints despite good VA.

Phakic intraocular lens explantation: series of 175 surgeries.

To evaluate the indications for pIOL explantation, pIOL survival time, and visual outcomes and access endothelial cell loss (ECL) after explantation. Ophthalmology Department, Centro Hospitalar Universitário do Porto, Portugal. Retrospective longitudinal study. A chart review was performed for all consecutive patients who underwent pIOL explantation from January 2010 to December 2019 in a single center. This study included 175 eyes of 112 patients (77% women). The mean pIOL survival was 12.9 ± 4.8 (3.7 to 28.6) years, and the mean follow-up period after explantation was 4.1 ± 3.0 (0.3 to 9.9) years. The most frequent causes for explantation were cataract formation (44.0%, n = 77) and ECL (50.3%, n = 88). During the follow-up period after explantation, the mean ECL rate was 2.27 ± 9.32%/year in the cataract group and -2.14 ± 10.24%/year in the ECL group, reflecting a positive change in cell density in the latter. 8 eyes (4.6%) required a corneal transplant during the follow-up. The mean corrected distance visual acuity was 0.17 ± 0.24 logMAR at the last visit. This study demonstrated that pIOL explantation, after a mean survival time of 13 years, was a safe procedure. The main causes for explantation were cataract formation and ECL. Most patients showed a sustained improvement in visual acuity and endothelial cell density after pIOL explantation, and yet its timing should be ideal to avoid irreversible complications.

Study of the Level of Pro- and Antiangiogenic Growth Factors in Vitreous Fluid in Neovascular Age-Related Macular Degeneration on the Background of Treatment

Purpose: to study the level of pro- and antiangiogenic growth factors in the vitreous fluid of the eyes with the neovascular form of agerelated macular degeneration (nAMD) against the background of antiangiogenic therapy.Patients and methods. The concentration of proangiogenic (IL-8, angiogenin, TNF-α, VEGF, bFGF) and antiangiogenic (IFN-α, TGF-β IFN-γ) growth factors in the vitreous fluid of nAMD patients was determined by multiplex flow cytometry. Patients with senile cataracts without signs of AMD and cataract patients burdened with naïve (untreated) nAMD were in the comparison groups.Results. Compared with senile cataracts, proangiogenic cytokines TNF-α were present more frequently and at a higher level in the vitreous fluid of the eyes with treated nVMD (75 % vs. 47.5 %, p &lt; 0.05; Msr ± m: 2.4 ± 0.5 vs. 1.4 ± 0.3 pg/ml, p &lt; 0.05), IL-8 (100 % vs. 75 %, p &lt; 0.01; 492.9 ± 75.7 vs. 8.5 ± 1.5 pg/ml, p &lt; 0.01), angiogenin (3822.4 ± 498.6 vs. 2820.2 ± 319.3, p &lt; 0.01) and FGFb (58.3 % vs. 26.7 %, p &lt; 0.05; 10.1 ± 5.9 vs. 2.7 ± 1.0, p &lt; 0.01). In both groups of patients, antiangiogenic factors IFN-γ and TGF-β were practically not detected, but the concentration of IFN-α was significantly higher (6.4 ± 1.7 versus 4.4 ± 0.4, p &lt; 0.01). VEGF levels in both nosological groups were almost identical: 17.5 ± 14.0 (with nAMD) versus 18.4 ± 3.2 (n/a), while VEGF was found in vitreous fluid in the cataract group significantly more often (68.2 % vs. 17 %, p &lt; 0.01). By way of explanation, the authors suggested that since patients with nAMD had previously been administered the anti-angiogenic drug Ranibizumab, it is possible that the VEGF production was under the control of the drug, that is, suppressed or blocked.Conclusion. Elevated levels of proangiogenic growth factors IL-8, angiogenin, TNF-α and bFGF in vitreous fluid with nAMD against the background of antiangiogenic therapy with ranibizumab suggest the presence of other, independent of VEGF, acting mechanisms for stimulating angiogenesis. The absence of antiangiogenic growth factors IFN-γ and TGF-β in the vitreous fluid allows us to think about the presence of a defect in the control and regulation of angiogenesis in nAMD. The rare detection of VEGF in combination with a significant decrease in its concentration compared to senile cataracts against the background of treatment with ranibizumab of the eyes with nAMD demonstrates targeted inhibition in practice. Against the background of treatment with angiostatic drugs, an inversion of the angiogenic phenotype occurs with the formation of new workarounds of angiogenesis, which apparently dictates the connection of drugs with other mechanisms of action.

A study of incidence of dry eye after manual small incision cataract surgery and phacoemulsification

To compare incidence of dry eye between phacoemulsification and manual small incision cataract surgery. This observational study included two groups. Group A consisted of 30 patients who had undergone manual small incision cataract surgery and Group B consisted of 30 patients who had undergone phacoemulsification. A detailed history was taken from all paricipants before they underwent a complete systemic and ocular examination which included best corrected visual acuity, slit lamp examination, intraocular pressure, and dilated fundus examination. Tests for dry eyes likes Schirmer’s test 1, tear film break up time (TBUT), tear meniscus height (TMH) was done postoperatively at 1 week, 3 weeks and 1 month postoperative. One test positive out of three was considered as a dry eye.The values of various tear film tests schirmer’s test, tear film break up time and tear meniscus height showed no significant difference between both groups (Chi square test P Value = 0.605,0.832, 1). There was no significant difference in incidence of dry eye in manual small incision cataract surgery and phacoemulsification (Chi square test p value = 0.317). On comparing the data with respect to age and sex, no significant difference in incidence of dry eye was seen between both groups or between male and female. There is high incidence of dry eye 33.33⸓ seen in diabetic patients. (Chi square test P Value = 0.0371).There is no significant difference in incidence of dry eye between manual small incision cataract surgery and phacoemulsification. We also found out high incidence of dry eye in diabetic patients.

Изучение уровня про- и антиангиогенных факторов роста в стекловидной жидкости при неоваскулярной возрастной макулярной дегенерации

Aim: to study the level of pro- and antiangiogenic growth factors in vitreous fluid in neovascular AMD. Methods. The concentration of proangiogenic (IL-8, angiogenin, TNFα, VEGF, bFGF) and antiangiogenic (IFNα, TGFβ, IFNγ) growth factors in the vitreous fluid of 24 patients with the neovascular form of age-related macular degeneration (nAMD) was determined by multiplex flow cytometry; 38 patients with senile cataracts without signs of AMD served as a matching group. Results. In nAMD compared to senile cataracts, proangiogenic cytokines TNFα were present more often and at a higher level in the vitreous fluid (75 vs. 47.5 %, p &lt; 0.05; M±m: 2.36±0.46 vs. 1.35±0.30 pg / ml, p &lt; 0.05), IL-8 (100 vs. 75 %, p &lt; 0.01; 492.87±75.7 vs. 8.48±1.5 pg/ml, p &lt; 0.01), angiogenin (3822.4±498.57 vs. 2820.15±319.27, p &lt; 0.01) and FGFb (58.3 vs. 26.7 %, p &lt; 0.05; M±m: 10.05±5.93 vs. 2.72±1.04, p &lt; 0.01). In both groups of patients, antiangiogenic factors IFNγ and TGFβ were practically not detected, but the concentration of IFNα was significantly higher (6.42±1.71 versus 4.42±0.41, p &lt; 0.01). VeGF levels in both nosological groups were almost identical: M±m: 17.48±13.97 (with nAMD) versus 18.44±3.23 (n/s), while the frequency of its detection in the cataract group was significantly higher (68.2 % vs. 17 %, p &lt; 0.01). By way of explanation, it can be assumed that since patients with nAMD had previously been administered the anti-angiogenic drug ranibizumab, it is possible that the VEGF production was under the control of the drug (suppressed). Conclusions. 1. Elevated levels of proangiogenic growth factors IL-8, angiogenin, TNFα and bFGF in vitreous fluid in nAMD against the background of antiangiogenic therapy with Lucentis suggest the presence of other, non-VEGF-independent mechanisms for stimulating angiogenesis. 2. The absence of antiangiogenic growth factors IFNγ and TGFβ in the vitreous fluid allows to think about the presence of a defect in the control and regulation of angiogenesis in nAMD. 3. Rare detection of VEGF in combination with a significant decrease in its concentration compared to senile cataracts against the background of treatment with ranibizumab of the eyes with nAMD demonstrates targeted inhibition in practice. Key words: age-related macular degeneration; growth factors; vitreous fluid; angiogenesis; antiangiogenic therapy

Influence of combined phacovitrectomy without tamponade on intraocular lens displacement and postoperative refraction.

To compare phacoemulsification versus phacovitrectomy regarding postoperative intraocular lens (IOL) shift and refraction. This prospective bilateral comparison study included 40 eyes of 20 patients. Inclusion criteria were combined phacovitrectomy without gas/air tamponade in one eye and cataract surgery in the contralateral eye with implantation of the same IOL. Postoperative anterior chamber depth (ACD) was compared between both groups 1-5 hr, 1 day and 8 weeks after surgery. Postoperative refraction was compared after 8 weeks using the Holladay I, HofferQ, SRK/T, Haigis and Barrett formulae. There were no intergroup differences in ACD (8 weeks: 0.02 mm absolute difference, SD 0.22, range -0.36 to 0.65, p = 0.401), mean absolute refractive error (8 weeks: Holladay I p = 0.452; HofferQ p = 0.475; SRK/T p = 0.498; Haigis p = 0.869; and Barrett p = 0.352) or percentages within the 0.5 D and 1.0 D range at any time-point. All formulae were optimized for the phacovitrectomy and the cataract groups. There was no correlation of macular thickness change and refractive error (cataract group r2 = -0.13, p = 0.58; phacovitrectomy group r2 = -0.10, p = 0.68). Combined phacovitrectomy without air/ gas tamponade caused neither ACD displacement nor refractive shifts compared to phacoemulsification alone. Surgically induced macular thickness change had no significant influence on postoperative refraction in this study. All five IOL formulae showed comparable postoperative refractive outcomes.