Visual Improvement Research Articles

Complications of Nd Yag Laser Capsulotomy

Introduction: Aim and objective is to study the intra and post laser complications of Nd yag laser posterior capsulotomy and to find out the incidence of complications. Materials and Methods: This study was conducted in the department of ophthalmology, Ad-Din Women Medical College 2, Bara moghbazar, Dhaka from July 2018 to June 2022. Our study included 206 patients of 220 eyes with significant PCO. Before laser capsulotomy all patients were assess by routine slit lamp examination, IOP measurement and posterior segment examination done for every patient for exclusion of gross posterior segment pathology. Nd yag laser capsulotomy was carried out under topical anesthesia. These patients were assessed for post laser visual acuity and complications in 1st POD after 7 day and 1 month. Every patients with post laser routine medications and as per need of other related eye problems. Result: Total 220 eyes of 208 patients included in our study ,including 93 male (44.71%) and 115 female (55.29%).Range of age were 21yrs to 87 years. Laser capsulotomy were done one eye in 208 patients and both eyes in 14 patients. Range of energy used in our study from 1 to 4.5 mJ. Complications were noted after yag laser capsulotomy In 29 eyes (13.76%) though after taking maximum precaution for avoiding complications including pre laser slit lamp examination, assessment of IOP, proper dilatation of pupil, power setting were minimum as per as possible. Conclusion: The Nd yag laser capsulotomy is an effective, safe procedure for the treatment of opaque posterior capsule which is unique and magical approach for improvement of vision and restoration of effective life style. Every procedure have some adverse effect, Nd yag laser capsulotomy also have some complications .but benefit are tremendous if we can go in proper way. Medicine Today 2023 Vol.35(2): 91-94

Clinical Factors, Treatment Selection, and Outcomes in Postcataract Fungal Endophthalmitis from Contaminated Viscoelastics

To investigate the factors associated with treatment outcomes of postcataract surgery fungal endophthalmitis outbreaks related to contaminated viscoelastics. Retrospective analysis of clinical data from multiple institutions. This study included 228 eyes of 210 patients who were diagnosed with postcataract surgery fungal endophthalmitis related to the use of viscoelastic material (Unial, Unimed Pharmaceutical Inc); they were followed up for 6 months after the diagnosis. Clinical features and causative species were identified and treatment outcomes were analyzed in patients who underwent 6 months of follow-up. Propensity score matching was conducted to elucidate the impact of vitrectomy timing and intraocular lens (IOL) removal on treatment outcomes. Clinical factors and selection of treatment modalities associated with treatment outcomes at 6 months. Baseline visual acuity (P < 0.01), age (P= 0.05), and the presence of corneal edema (P < 0.01) were closely associated with poor best-corrected visual acuity (BCVA) at 6 months. Patients who underwent immediate vitrectomy after diagnosis showed significantly better BCVA at 6 months (mean logarithm of minimum angle of resolution 0.26 ± 0.43 vs. 0.52 ± 0.52, P= 0.03) and greater degree of visual improvement (mean-0.17 ± 0.37 improvement vs. 0.10 ± 0.57 deterioration, P= 0.03) than those who underwent deferred vitrectomy. Patients who underwent IOL removal during vitrectomy required a lower number of intravitreal antifungal agent injections (mean 8.9 ± 9.1 vs. 16.7 ± 12.2, P < 0.01) and showed a lower incidence of repeated vitrectomy (20% vs. 82%, P<0.01) than in those without IOL removal. In postcataract fungal endophthalmitis, prompt vitrectomy at the time of diagnosis resulted in better treatment outcomes, and IOL removal reduced the treatment burden. Prompt and aggressive surgicalintervention should be considered for postcataract fungal endophthalmitis. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

An Electrocoagulation Fixation Technique for One-Piece Intraocular Lens Scleral Flapless Fixation With Sutures Without Knots.

To present an electrocoagulation fixation technique for one-piece intraocular lens (IOL) scleral flapless fixation with sutures without knots. First of all, after repeated tests and comparisons, we chose 8-0 polypropylene suture as the material for electrocoagulation fixation of one-piece IOL haptics because of its proper elasticity and size. A transscleral tunnel puncture at the pars plana was performed using an arc-shaped needle with 8-0 polypropylene suture. The suture was subsequently guided out of the corneal incision by a 1-mL syringe needle and then guided by the needle into the inferior haptics of the IOL. The suture was cut off and heated into a shape of a probe with a spherical tip using a monopolar coagulation device to prevent slippage from the haptics. In the end, 10 eyes underwent our new surgical procedures, and the average operation time was 42.5 ± 12.4 minutes. At the 6-month follow-up, seven of 10 eyes achieved significant vision improvement and nine of 10 kept the implanted one-piece IOL stable in the ciliary sulcus. No serious intraoperative/postoperative complications were observed. The electrocoagulation fixation was a safe and effective alternative technique for previously implanted one-piece IOL scleral flapless fixation with sutures without knots.

Current use of real-time three-dimensional transthoracic echocardiography in animals

This review includes 36 studies of transthoracic real-time three-dimensional echocardiography (RT3DE) in animals. Most of these studies concern cardiac chamber quantification of the left atrium and left ventricle, in dogs. Comparisons of RT3DE and different two-dimensional echocardiographic (2DE) methods have been reported in dogs with myxomatous mitral valve disease (MMVD), dilated cardiomyopathy, and in healthy control dogs. Comparisons of RT3DE and standard reference methods have been reported in healthy control dogs. In dogs with MMVD, volumetric RT3DE measurements of left atrium do not appear to provide superior prognostic value compared with 2DE methods using Simpson's method of discs in dogs with MMVD. The major advantages of RT3DE compared to 2DE include improvements in visualization of the complex morphology of the mitral valve, the estimation of mitral valve regurgitation, and improved visualization of complex congenital cardiac abnormalities.

NCMP-08. TREATMENT OF PITUITARY METASTASIS: A SINGLE CENTER EXPERIENCE AND SYSTEMATIC LITERATURE REVIEW

Abstract PURPOSE To understand the natural history and optimal treatment strategy for pituitary gland metastasis. METHODS We performed both a retrospective chart review of patients treated at our institution and a scoping review of the topic. RESULTS The retrospective review identified seven patients with an average age of 59.6. Primary histologies included breast cancer (4), melanoma (1), renal carcinoma (1), and sarcoma (1). Two patients had anterior pituitary endocrine dysfunction, one of whom was the only patient with visual symptoms. All patients were treated with radiosurgery and two also underwent surgical resection. Overall survival ranged from 6.5 – 117 months. We identified 166 patients from 71 studies in our literature review. The most common primary cancer was lung (27.7%), followed by breast (18.7%) and renal (14.5%) cancer. 107 presented with endocrine dysfunction; with 41 cases of diabetes insipidus and 55 cases of hypopituitarism. 110 presented with visual compromise. 107 patients received radiotherapy, 96 underwent surgical resection and 44 received systemic chemotherapy/immunotherapy. Surgery was significantly associated with an increased likelihood of vision improvement and a decreased likelihood of endocrine normalization. Radiographic regression predicted visual improvement. Median overall survival was 9.9 months (range: 0.2 – 96). CONCLUSIONS Our scoping review showed that both radiosurgery and surgical resection have been frequently used to treat pituitary metastases with good response. Vision improvement is more likely to happen following surgical resection. Despite treatment and radiographic response, patient survival remains less than a year.

An Intelligent Fashion Object Classification Using CNN

Every year the count of visually impaired people is increasing drastically around the world. At present time, approximately 2.2 billion people are suffering from visual impairment. One of the major areas where our model will affect public life is the area of house assistance for specially-abled persons. Because of visual improvement, these people face lots of issues. Hence for this group of people, there is a high need for an assistance system in terms of object recognition. For specially-abled people sometimes it becomes really difficult to identify clothing-related items from one another because of high similarity. For better object classification we use a model which includes computer vision and CNN. Computer vision is the area of AI that helps to identify visual objects. Here a CNN-based model is used for better classification of clothing and fashion items. Another model known as Lenet is used which has a stronger architectural structure. Lenet is a multi-layer convolution neural network that is mainly used for image classification tasks. For model building and validation MNIST fashion dataset is used.

Treatment of persistent flap closure with fluid gas exchange after inverted internal limiting membrane flap technique for idiopathic macular hole.

We evaluated the results of fluid-gas exchange (FGE) for long-term flap closure of idiopathic macular holes (MH) using the inverted internal limiting (ILM) flap technique. We retrospectively included eyes showing flap closure without complete MH closure and connection of separate macular tissue 1 month postoperatively after the inverted ILM flap technique was detected by ocular coherence tomography at follow-up. Eyes remained flap closure at 2 months after surgery further underwent in-office FGE with 16% C3F8. Of the 153 eyes using the inverted ILM flap technique for idiopathic MH between June 2015 and November 2018, 10 eyes (6.99%) remained flap closure at 1 month postoperatively. Among 10 eyes, 5 eyes (50%) showed flap closure at 2 months postoperatively further underwent FGE for complete MH closure, while the remaining 5 eyes (50%) progressed directly to normal macular structures at 2 months postoperatively. Improvement in vision of all flap closure from baseline was significant (P = .015), with a mean baseline vision of 1.19 [Snellen equivalent (SE), 20/307] ± 0.52 logMAR and the mean final vision of 0.63 (SE, 20/85) ± 0.38 logMAR. The group that underwent FGE showed better final vision of 0.45 (SE, 20/75) ± 0.23 logMAR than the group that did not undergo FGE (0.81 [SE, 20/128] ± 0.44 logMAR). All eyes achieved complete MH closure, including the eyes that underwent FGE in a mean period of 5.60 months (range 3-10 months) after the inverted ILM flap technique. Eyes that underwent FGE achieved a higher rate of foveal restoration [complete external limiting membrane 80%; complete ellipsoid zone (EZ) 60%] than those that did not receive FGE (complete external limiting membrane: 40%; complete EZ: 10%). Eyes with persistent flap closure for more than 2 months postoperatively that underwent FGE showed accelerated complete MH closure, better final vision, and foveal restoration.

Strategic combination of cultivated oral mucosal epithelial transplantation and postoperative limbal-rigid contact lens-wear for end-stage ocular surface disease: a retrospective cohort study

PurposeTo provide the long-term outcome of patients with end-stage severe ocular surface disease (OSD) consecutively treated with cultivated oral mucosal epithelial transplantation (COMET) followed by limbal-rigid contact lens (CL)-wear therapy.DesignRetrospective...

Endoscopic Transpterygoid Corridor for Petroclival Tumors: Case Series and Technical Nuances.

The petroclival area is a technically challenging region to operate owing to the proximity of the internal carotid artery (ICA) and the need to obtain gross total excision of tumors in this area as they are often resistant to radiotherapy. We present our experience with the endonasal endoscopic transpterygoid approach in managing tumors of the petroclival region and discuss various operative nuances for safer resection. A retrospective study of all consecutive cases of lesions occupying the petroclival region that were operated via endonasal endoscopic transpterygoid approach at our center between January 2016 and December 2021 was performed. The study included 14 cases of lesions occupying the petroclival region. Gross total resection by intraoperative observation was achieved in 10 patients, near total decompression was performed in two patients, and the remaining two patients underwent marsupialization of lesion. Postoperatively, one patient had right Lower motor neuron (LMN) facial nerve palsy and one patient required surgery for Cerebrospinal fluid (CSF) rhinorrhea on postoperative day 8. The mean duration of follow-up was 13.8 ± 16.6 months (range: 2-59 months). Four of six patients with visual symptoms on presentation reported improvement in vision, and the other two patients had a stable vision on follow-up. Two patients received radiotherapy postsurgery. No mortality was noted. The extended endonasal endoscopic transpterygoid approach can be safely and efficiently used for petroclival lesions. Very sound knowledge of anatomical relationship, use of intraoperative image guidance to avoid injury to ICA, and multilayer reconstruction with a vascularized nasoseptal flap are required to optimize the clinical outcome.

Treatment of serpiginous choroiditis with sub-tenon triamcinolone in conjunction with systemic steroids case report.

To report two cases of serpiginous choroiditis which were treated with sub-Tenon's triamcinolone in conjunction with systemic steroids to control acute and chronic disease progression. Increased success of disease remission has been postulated for sub-Tenon's triamcinolone therapy in conjunct with systemic steroids. Retrospective chart review of two serpiginous choroiditis patients who presented at an eye center. Both patients received sub-Tenon's triamcinolone and systemic steroids. Visual acuity and disease course are reported. Both cases of serpiginous choroiditis received sub-Tenon's triamcinolone on presentation and were hospitalized for intravenous corticosteroids and systemic work up. The first patient had been on oral corticosteroids before presentation. Both patients reported same day visual improvement after sub-Tenon's triamcinolone was administered. These two case reports describe unique clinical scenarios in which sub-Tenon's triamcinolone was used in both the acute and chronic phases of serpiginous choroiditis. Local steroid therapy can be a useful adjunctive therapy when systemic steroids are delayed, contraindicated or intolerable.

Early surgical displacement of submacular hemorrhage without tissue plasminogen activator use: one-year outcomes

ObjectifLa présente étude se penchait sur l’évolution de la meilleure acuité visuelle (AV) corrigée et la résolution de l'hémorragie sous-maculaire (HSM) à la suite d'un seul déplacement pneumatique de l'hémorragie sous-rétinienne réalisé rapidement qui comprenait l'administration sous-rétinienne d'une solution saline équilibrée et d'air stérile sans recours à un activateur tissulaire du plasminogène (tPA, pour tissue plasminogen activator). NatureAnalyse d'intervention comparative rétrospective. ParticipantsAinsi, 26 yeux présentant une HSM abondante qui ont subi une vitrectomie par la pars plana et un déplacement pneumatique de l'hémorragie sous-rétinienne sans administration de tPA entre 2015 et 2021 et pour lesquels on disposait d'un suivi d'au moins 1 an. MéthodesL'intervention chirurgicale reposait sur la vitrectomie par la pars plana standard réalisée à l'aide d'une aiguille de petit calibre s'accompagnant d'un déplacement pneumatique sous-rétinien obtenu par l'injection sous-rétinienne d'une solution saline équilibrée et d'air stérile suivie d'un échange liquide-gaz/air partiel. Au nombre des principaux paramètres de mesure, mentionnons le degré de déplacement de l'HSM sous-fovéale, les meilleures AV et les AV postopératoires finales de même que les effets indésirables. L'AV mesurée sur l’échelle de Snellen a été convertie en logMAR en vue de l'analyse statistique. RésultatsL’étiologie la plus fréquente de l'HSM abondante (92,3 %) était la dégénérescence maculaire liée à l'âge de type néovasculaire. Ainsi, 1 mois après la chirurgie, on a noté un déplacement complet de l'hémorragie sous-fovéale chez 21 patients (80,8 %). La plupart des interventions visant à déplacer l'HSM ont eu lieu dans la semaine suivant l'apparition des symptômes. La durée moyenne de l'HSM avant l'intervention était de 3,60 ± 2,78 jours (fourchette : 1–12 jours). La meilleure AV corrigée en logMAR est passée de 1,63 ± 0,58 (équivalent de 20/800 sur l’échelle de Snellen au départ) à 0,90 ± 0,42 lettre (équivalent de 20/160 sur l’échelle de Snellen) lors du dernier suivi (p = 0,001). L'amélioration de l'AV enregistrée dans le cadre de la présente étude est comparable à celle d’études antérieures qui incluaient l'administration de tPA. Les complications postopératoires hâtives comprenaient 1 cas de décollement de rétine, 1 cas d'hémorragie du vitré et 1 cas de trou maculaire. ConclusionL'intervention rapide reposant sur l'injection sous-rétinienne d'une solution saline équilibrée et d'air stérile sans administration de tPA permet le déplacement efficace d'une HSM abondante, le tout donnant lieu à une amélioration de la fonction rétinienne, de l'AV et de (l'orthokératologie.)

Simultaneous Topography-guided Custom Ablation With Corneal Cross-linking for Keratoconus: 10-Year Prospective Outcomes

Purpose: To assess 10-year visual and tomographic outcomes of topography-guided custom ablation (T-CAT) with corneal cross-linking (CXL) in eyes with keratoconus. Methods: T-CAT with CXL was performed in 600 eyes (522 patients). Based on the T-CAT ablation plan, the theoretical maximum ablation depth was 50 µm after epithelium removal. After ablation, accelerated corneal cross-linking (CXL) was performed in the central 8-mm zone (9 mW/cm 2 for 10 minutes in “epi-off” mode). The visual acuity and tomography were assessed. Results: There was significant improvement in uncorrected ( P = .001) and corrected ( P = .001) distance visual acuity after the procedure. Keratometry, root mean square lower order aberrations and higher order aberrations, defocus, coma 90°, and spherical aberration reduced significantly after surgery at 10 years of follow-up ( P &lt; .005). All Pentacam (Oculus Optikgerate GmbH) tomographic variables showed significant changes indicating regularization after T-CAT ( P &lt; .005). Flattening of greater than 5.00 diopters in maximum keratometry was noted in 6 eyes (1%). Two of 600 eyes progressed postoperatively and required repeat CXL. Conclusions: T-CAT plus CXL is a safe and effective technique even in the long term for regularizing the anterior corneal surface with significant visual improvement and reduction in higher order corneal aberrations. [ J Refract Surg . 2023;39(11):759–766.]

BIOELECTRONICS RETINA MATHEMATICAL OPTIMIZATION-SIMULATION FOR INTEGRATE MODEL WITH BRAIN EVOLUTIONARY PRE-HYPOTHESES

Constrained evolutionary optimization algorithms for Integrate and Fire (IAF) classical retina model are programmed. The techniques applied are Pareto-Multiobjective (PMO) methods. Genetic Algorithm (GA) software is developed based on literature neuro-bioelectronics experimental dataset. Results take in handle subroutines functions and matrix-algebra method for setting constraints. Results show PMO 2D imaging charts and numerical values for IAF model, with optimal values for IS Input Current (IC) parameter. Bioelectronics applications for human vision improvements and extrapolation to life-origin pre-hypotheses are briefed.

Single fraction and hypofractionated radiosurgery for perioptic meningiomas-tumor control and visual outcomes: a systematic review and meta-analysis.

Perioptic meningiomas, defined as those that are less than 3mm from the optic apparatus, are challenging to treat with stereotactic radiosurgery (SRS). Tumor control must be weighed against the risk of radiation-induced optic neuropathy (RION), as both tumor progression and RION can lead to visual decline. We performed a systematic review and meta-analysis of single fraction SRS and hypofractionated radiosurgery (hfRS) for perioptic meningiomas, evaluating tumor control and visual preservation rates. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed articles published between 1968 and December 8, 2022. We retained 5 studies reporting 865 patients, 438 cases treated in single fraction, while 427 with hfRS. For single fraction SRS, the overall rate of tumor control was 95.1%, with actuarial rates at 5 and 10years of 96% and 89%, respectively; tumor progression was 7.7%. The rate of visual stability was 90.4%, including visual improvement in 29.3%. The rate of visual decline was 9.6%, including blindness in 1.2%. For hfRS, the overall rate of tumor control was 95.6% (range 92.1-99.1, p < 0.001); tumor progression was 4.4% (range 0.9-7.9, p = 0.01). Overall rate of visual stability was 94.9% (range 90.9-98.9, p < 0.001), including visual improvement in 22.7% (range 5.0-40.3, p = 0.01); visual decline was 5.1% (range 1.1-9.1, p = 0.013). SRS is an effective and safe treatment option for perioptic meningiomas. Both hypofractionated regimens and single fraction SRS can be considered.

FEATURES OF NEUROPROTECTIVE TREATMENT OF CHILDREN WITH PRIMARY CONGENITAL GLAUCOMA

Normalization of intraocular pressure is an indispensable condition, but it does not guarantee stabilization of the glaucomatous process. Neuroprotective therapy aimed at maintaining the active function of axons of ganglion cells is of great importance. The aim of the study was to study the eff ectiveness of the neuroprotective eff ect of the Cortexin drug in congenital glaucoma.Material and methods. Thirty-two (64 eyes) children with congenital glaucoma in the compensation stage were includedin the study. Of these, 18 children (36 eyes) were included in the main group that received the neuroprotectant Cortexin. The remaining 14 children (28 eyes) were included in the control group and received standard treatment. Research methods: Visometry, ophthalmoscopy, perimetry, tonometry, tonography, ocular ultrasound, gonioscopy.Results. All patients underwent antiglaucomatous surgery and, in the absence of negative dynamics during the year, neuroprotective treatment with Cortexin was performed every three months. To study visual acuity in young children, a computer program was developed and used to determine visual acuity. The computer program «Scale for assessment of visual functions» was certifi ed (No. DGU 11841). Next, the parents of the child were explained how to score. After 1 month and after 3 months of treatment, the parents fi lled in the table and deducted points. After completion of neuroprotective treatment within one year, we collected data from the questionnaire fi lled out by the parents and analyzed visual acuity. Data analysis in the main group showed an increase in visual acuity in all stages of glaucoma except the fi nal stage. In children in the control group, visual acuity before surgery was identical to that in the main group. After one year of observation, the increase in visual acuity in the control group was much less than in the main group.Conclusion. Thus, the dynamics of visual acuity improvement was signifi cantly more pronounced in the main group, whichindicates the usefulness of including drugs with neuroprotective eff ect in the complex treatment of glaucomatous neuropathy.

Administrative contracts in the doctrine and system of sources of administrative law of Germany and Ukraine

The article is devoted to the analysis of the doctrinal concept and legislative definition of the administrative contract in the legal systems of Germany and Ukraine, as well as the place of this institution in the system of sources of administrative law of Ukraine. It has been established that recently the influence of the legal doctrine of the Federal Republic of Germany on the administrative law of Ukraine has significantly increased, and it no longer sees “power relations” in the relations between subjects of state power and citizens, and therefore, the concept of proportionality acquires a wider meaning. Under such conditions, an administrative contract is not inferior to an administrative act in its rule of law value. The two-level model of legal regulation of administrative contracts in the Federal Republic of Germany is analyzed, as well as the legal position of the Federal Supreme Court on the applicability of civil law norms in the public sphere. The importance of the place of the public-law contract and its administrative procedure in the Law “On Administrative Procedures” of the Federal Republic of Germany is revealed. A description of the ontological, subject, and methodological criteria for the identification of administrative contracts in the domestic doctrine of administrative law is given. It is proved that the problem of legal regulation of an administrative contract in the Ukrainian legal field should be considered through the prism of three main models of systematization of administrative and procedural legislation, which are used in the legal systems of different countries of the world. Corresponding improvements in legal regulation and own vision of the prospects for the codification of legislation on administrative contracts in the legal field of Ukraine are proposed.

Pituitary macroadenoma apoplexy as a rare complication of Bruton tyrosine kinase inhibitor in chronic lymphoid leukaemia

BackgroundPituitary apoplexy is a neurosurgical emergency and is a known yet rare complication of pituitary macroadenoma. Patients typically present with visual field defects, headache and altered sensorium. There are multiple risk factors for this complication and a thorough drug history is essential to exclude iatrogenic causes of disease. We present an extremely rare case of newly diagnosed pituitary insufficiency unveiled by ibrutinib therapy (a Bruton tyrosine kinase inhibitor). Furthermore, after initial withdrawal of ibrutinib because of the erroneous diagnosis of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), its re-administration led to the development of classical pituitary apoplexy 4 months after treatment was restarted.Case presentationA male patient in his 60s with a background of chronic lymphocytic leukaemia (CLL) on ibrutinib and venetoclax presents with acute confusion and deranged electrolytes. He is found to be hyponatraemic and is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) and treated with fluid restriction. He represents again 3 weeks later with hyponatraemia and further investigations reveal pituitary insufficiency and macroadenoma. He was restarted on ibrutinib and venetoclax at the time of discharge.Four months later, he presents with sudden retro-orbital headache associated with vomiting. Clinical findings include cranial nerve III, IV and XI palsy. Humphrey’s visual field examination revealed a left visual field index (VFI) of only 1% while the right was 64% with temporal hemianopia. Both pupils were mid-dilated and poorly reactive to light. MRI pituitary with contrast showed features of pituitary apoplexy and optic nerve compression. He was urgently referred to the neurosurgical team and underwent an emergency trans-sphenoidal hypophysectomy with circumferential excision of the macroadenoma. Post-operative recovery was uneventful with marked improvement in vision bilaterally.The patient was restarted on ibrutinib and venetoclax 2 weeks post-operatively. Approximately 1 year post-treatment, he remains in radiological, clinical and biochemical remission from CLL and all medications have been withdrawn.ConclusionsThis is a unique and rare case of pituitary macroadenoma apoplexy following the commencement of ibrutinib for CLL. Central nervous system haemorrhage is a rare side effect of ibrutinib due to its platelet dysfunction effects. A thorough assessment is required to assess the risks and benefits of using ibrutinib in patients with pituitary macroadenoma to avoid serious complications.

Draw to shade: A personalized daylighting regulation method through user-involved paintings for enhanced indoor visual comfort and aesthetics experience

The natural lighting plays a pivotal role in people's physical and mental well-being when people stay indoors for a long time. However, due to construction, appearance and attributes differences of built buildings, and various occupants' aesthetic preference, shading design fail to provide adaptive personalized scheme for visual comfort improvement and occupant aesthetics experience. Inspired by the concept of “draw to shade”, this study proposes a user-involved method to generate paintings with opaque and transparent blocks to regulate daylighting indoors by combining multi-objective daylight simulation and occupant-interactive AI creation platform. As a result, the method reduces the daylight glare probability (DGP) with an efficiency of 8.30%–64.2%, while controlling hourly Useful Daylight Illuminance (hUDI) within an acceptable range. We also demonstrate a fabrication via concept of fluid fibers to explore the application space of the method. Overall, the study can inspire more research on daylight regulation, while taking into account performance, aesthetics and application, to enable people improve visual comfort at individual aesthetic will in different spaces.

Quality of life and vision assessment with scleral lenses in keratoconus.

The purpose of the study is to evaluate the visual outcomes and improvement in quality of life (QOL) of patients with keratoconus with scleral lenses. In this prospective study, 14 patients (28 eyes) with bilateral keratoconus were fitted with scleral lenses (McAsfeer 16.00 mm) in Pune city, Maharashtra, India. Uncorrected visual acuity (VA), best spectacle-corrected VA, and VA with scleral lenses were evaluated. The patients were given the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) for judging the QOL, before and after using scleral lenses for 3 months. The mean uncorrected VA of the 14 patients with a mean age of 28.64 ± 6.57 years was 1.18 ± 0.19 logMAR. Best spectacle-corrected high-contrast VA improved from 0.47 ± 0.25 logMAR to 0.03 ± 0.07 logMAR with scleral lenses (P < 0.001). Best spectacle-corrected low-contrast VA improved from 0.68 ± 0.22 logMAR to 00.47 ± 0.10 logMAR with scleral lenses (P < 0.001). Along with the increase in overall median scores on the NEI VFQ-25 from 1735 to 2930 points (P < 0.001), the distance and near activities (P < 0.001), vision-specific mental health (P < 0.002), social functioning (P < 0.004), and driving (P < 0.005) improved after using scleral lenses for 3 months. Scleral lenses can be an effective and safe management option for patients with keratoconus leading to an improved vision and QOL.

Early and Late Complications after Cataract Surgery in Patients with Uveitis.

Background and Objectives: Uveitis, a prevalent eye disorder characterized by inflammatory processes, often leads to cataract formation and significant visual impairment. This study aimed to evaluate preoperative conditions and postoperative outcomes following cataract surgery in uveitis patients. Materials and Methods: A retrospective study was conducted at the University Hospital Center Rebro Zagreb, Croatia, involving uveitis patients who underwent cataract surgery between 2013 and 2022. Eligible patients had uveitic cataracts affecting visual acuity or posterior segment visualization in a "quiet eye" and were disease-inactive for at least three months. Patients with certain pre-existing ocular conditions were excluded. The data collected included patient demographics, uveitis type, preoperative therapy, preexisting lesions, and postoperative outcomes such as visual acuity, intraocular pressure, central macular thickness, and complications. Statistical analysis was performed to identify risk factors associated with complications. Results: This study included 105 patients. The most common uveitis types were idiopathic uveitis, HLA-B27-associated uveitis, and JIA uveitis. After cataract surgery, there was a significant improvement in visual acuity at various time points, with 90% of eyes showing improvement. Intraocular pressure decreased over time. Central macular thickness increased at three months post-surgery but remained stable thereafter. Early and late complications were observed in 52.4% and 63.8% of eyes, respectively. The most common complications were posterior capsular opacification (53.3%), macular edema (26.6%), and epiretinal membrane formation (9.52%). The factors associated with complications varied between early and late stages but included age, age at the onset of uveitis, and the uveitis type. Conclusions: In patients with quiescent uveitis undergoing cataract surgery, significant visual improvement was achieved. This study highlights the importance of careful patient selection, preoperative and postoperative inflammation management, and precise surgical techniques. Although complications were common, the risk of capsular opacification, macular edema, and epiretinal membrane formation after surgery increased. However, future investigations should address this study's limitations and further refine perioperative strategies.