The CINCA syndrome is an inflammatory disease characterised by persistent rash and chronic aseptic meningitis, with extensive infiltration of polymorphonuclear and macrophage cells at the sites of inflammation. The CINCA syndrome belongs to the group of systemic autoinflammatory diseases characterised by episodic or fluctuating degrees of inflammation, without evidence of high-titre autoantibodies or antigen-specific T cells. The disease is caused by mutations in the CIAS1 gene that encodes a protein cryopyrin, NALP3 or PYPAF1. Mutations in cryopyrin have a profound pro-inflammatory effect. Cryopyrin is a caspase 1 activator, which in turn causes the activation of interleukin (IL)1ß. The activating mutations of cryopyrin induce an excessive activation of IL1ß, which causes an influx of macrophages and polymorphonuclear cells to the site of inflammation, in our patient, in his eye.
Purpose: To measure visual acuity at three different defocus planes in pseudophakic subjects with varying levels of spherical aberration induced by an adaptive optics visual simulator. The study aimed to simulate Extended Depth of Focus (EDOF) intraocular lenses (IOLs). Setting: Private hospital (IMO, Barcelona, Spain) Design: Observational case series; modelling theory. Methods: Through-focus visual acuity was measured in 26 pseudophakic subjects (age 63 ± 10 years old) with an adaptive optics visual simulator optimized for clinical use (VAO, Voptica SL, Murcia, Spain). Measurements were made under five different conditions of induced negative spherical aberration: 0, -0.07, -0.15, -0.23 and -0.30 μm (pupil diameter: 4.5 mm). Results were also modelled using ray tracing simulations. Results: On average, depth of focus was extended when spherical aberration increased from -0.07 to -0.15 μm (4.5 mm pupil diameter). Some indivisuals (27%) experienced improved depth of focus with higher magnitudes of spherical aberration, while others (23%) exhibited no benefit from increased (negative) SA, as visual acuity dropped below acceptable levels. Depth of focus calculations based on ray tracing showed general agreement with the measurements. Conclusions: The visual conditions of EDOF IOLs were artificially recreated in a population of pseudophakic patients implanted with a monofocal IOL. The variability seen across subjects in visual acuity at different defocus planes suggests that visual simulators might be capable of screening subjects for suitability and tolerability of these advanced technology lenses.
The introduction of viscoelastics in human ocular surgery dates back to 1972.Subsequntly, several substances were proposed as adjuvants, particularly for cataract surgery; however, the rheologic properties of ophthalmic viscosurgical devices (OVDs), such as viscosity, pseudoplasticity, and coatability led to their employment also in vitreoretinal surgery. OVDs can be used to separate tissues and create space, to break adhesions, to allow space for surgical manipulation, and to contain hemorrhage by dampening capillary oozing. We focus on the principles and clinical results of several viscosurgery techniques, such as viscodissection and viscodelamination for the management of proliferative vitreoretinopathy and diabetic retinopathy and suprachoroidal buckling for primary retinal detachment. Furthermore, we analyze the techniques in which OVDs served as adjuvants in macular hole surgery, particularly in the handling of the internal limiting membrane, and as volumetric substances against hypotony. Finally, we analyze recent perspectives on vitreous humor biochemical features. Preclinical research led to the belief that hyaluronic acid-based hydrogels could become ideal vitreous substitutes, thanks to their viscoelasticity, porosity, optical properties, and biocompatibility; however, although promising, long-term toxicity issues have limited studies on human subjects.
PURPOSE:To evaluate the 6-month effectiveness and safety of a new foldable multifocal iris-fixated phakic intraocular lens (pIOL) for presbyopia correction. SETTING:Multicenter study at 7 sites. DESIGN:Nonrandomized prospective clinical trial. METHODS:Presbyopic patients without cataracts undergoing bilateral multifocal pIOL implantation (Ophtec ArtiPlus) were studied. The primary outcome for efficacy was the visual acuity at distance, intermediate, and near. Secondary outcomes included endothelial cell density (ECD), postoperative refraction, binocular defocus curve, vision quality, spectacle independence, and patient satisfaction. RESULTS:49 subjects (98 eyes) were included. At 6 months, the mean binocular uncorrected distance intermediate, and near visual acuity was -0.05 ± 0.09 logMAR, -0.02 ± 0.07 logMAR, and 0.02 ± 0.08 logMAR, respectively. The ECD remained stable with a mean value of 2771 ± 289 cells/mm 2 at 6 months postoperatively. The mean spherical equivalent was -0.42 ± 0.33 diopters (D), with 95% eyes having a prediction error within ±1.0 D and 77% within ±0.5 D. The binocular distance-corrected defocus curve showed a visual acuity of 0.20 logMAR or better over a range of +1.0 to -3.5 D. Patient satisfaction was high, with a mean score of 3.5 on a 4-point scale, and 83% of the patients reported spectacle independence. 47%, 35%, and 96% of patients reported experiencing glare, halos, and starbursts at well-tolerated levels, respectively. Notably, only 2% of patients found halos and starbursts to be very bothersome. CONCLUSIONS:Bilateral ArtiPlus multifocal pIOL implantation demonstrated good visual acuity from distant to near and maintained stable ECD over 6 months. Patients reported high levels of satisfaction and spectacle independence, despite some optical disturbances.
Purpose To characterize sequential pattern of fluid progression in optic disc pit maculopathy (ODP-M), identify threshold values for fluid migration between retinal layers, and determine the prognostic significance of optical coherence tomography (OCT) biomarkers. Design Multicenter, retrospective interventional case series. Methods Forty-two eyes with ODP-M underwent surgical treatment with follow-up ≥12 months (mean 38.5 ± 30.6 months). OCT parameters including intraretinal fluid (IRF) height, foveal detachment (FD), intrapapillary proliferation (IPP), ellipsoid zone (EZ) integrity, and retinal pigment epithelium (RPE) disruption were analyzed preoperatively and at 1, 6, 12, and 24 months postoperatively. Visual and anatomical outcomes were evaluated using multivariate regression and Kaplan-Meier survival analysis. Results IRF followed a distinct progression pattern, sequentially involving the outer nuclear layer (ONL), inner nuclear layer (INL), and nerve fiber layer (NFL). Resolution after surgery occurred in reverse order (NFL→INL→ONL) with median resolution times of 3, 6, and 12 months, respectively. Surgical success rate after first intervention was 66.7%, with complete final fluid resolution in 72.2% of cases. ROC analysis identified threshold values for ONL→INL progression (152 µm, AUC = 0.84) and for INL→NFL progression (178 µm, AUC = 0.79). In multivariate analysis, independent predictors of final visual acuity included preoperative visual acuity (OR: 4.73, p < .001), absence of FD (OR: 0.31, p = .03), EZ visibility (OR: 0.42, p = .04), and absence of IPP (OR: 0.45, p = .05). Conclusions ODP-M demonstrates a predictable pattern of fluid accumulation and resolution, with specific threshold values for fluid progression between retinal layers that may guide intervention timing and preoperative OCT biomarkers providing valuable prognostic information for visual outcomes.
