Carlevale and retropupillary iris-claw Artisan intra-ocular lenses (IOLs) treat aphakia without capsular support, but their relative performance is uncertain. PubMed, Embase and the Cochrane Library were searched to March 2025. Primary outcomes: best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), mean absolute refractive error (MARE) and mean refractive error (MRE). Secondary outcomes: operating time and postoperative complications. Random-effects meta-analysis with I² and incision-type subgroups was performed. Five studies comprising 631 eyes (229 Carlevale, 402 iris-claw) met inclusion criteria. Mean age was 70.1 ± 14.1 years, 61.18
BACKGROUND:Apathy, depression and anhedonia are clinically overlapping constructs, which hinders diagnostic clarity and treatment development. This study aimed to comprehensively characterise these syndromes to identify a core set of non-redundant symptoms that maximally dissociate them and to investigate the psychological nature of key distinguishing features. METHODS:Data from seven datasets (N=4578) of healthy individuals and patients with major depressive disorder were analysed using the Apathy Motivation Index, Beck Depression Inventory and Snaith-Hamilton Pleasure Scale. A machine-learning algorithm identified the most informative, non-redundant items for dissociating 'pure' apathy, depression and anhedonia. The nature of emotional apathy was further investigated with follow-up studies. RESULTS:Although substantial symptom overlap existed, 'pure' syndromes were present. Factor analysis revealed a robust five-factor structure, separating depression, anhedonia and three distinct apathy domains (behavioural, social and emotional). Machine learning identified 10 core symptoms that differentiated the pure syndromes with high accuracy (area under the curve >0.90) and could also identify well the presence of each syndrome in individuals suffering from two or more syndromes. Emotional apathy negatively correlated with depression and was specifically associated with reduced affective empathy and a diminished sensitivity to the intensity of negative facial emotions, rather than with alexithymia or antidepressant-induced emotional blunting. CONCLUSIONS:Apathy, depression and anhedonia are dissociable constructs with distinct symptom signatures. Emotional apathy is a unique dimension which provides a novel target for research. A 10-item Apathy-Depression-Anhedonia Measure developed here provides a pragmatic tool for rapid, precise phenotyping to guide more personalised therapeutic strategies.
INTRODUCTION:Invasive motor cortex stimulation (iMCS) can be a last-resort treatment of chronic neuropathic pain syndromes. There is evidence that iMCS was found to influence pain intensity, quality of life scores, and pain medication intake in clinical practice. Albeit, qualitative studies published over the last years showed that the expectations and experiences of patients have a significant impact on treatment outcomes. This paper focus on these experiences of chronic neuropathic pain patients treated with iMCS. OBJECTIVES:The aim of this interview study was to map the experiences of patients treated with iMCS in order to evaluate the multidimensional effects of iMCS. MATERIALS AND METHODS:Twenty-eight patients with chronic neuropathic pain treated with iMCS between 2005 and 2018 were interviewed individually. All interviews were semi-structured using a predefined topic list. An inductive iterative process was performed during the interviews using the constant comparative method. All interviews were audio-recorded and transcribed verbatim afterwards. Transcripts were coded using direct content analysis. The derived codes were structured into categories and themes. Basic quantitative demographic data were collected, and the decrease in pain intensity after 2 years iMCS was calculated. RESULTS:Content analysis of the interviews revealed ten relevant categories, which could be structured into three themes: 1. Influence of the iMCS procedure on patients' live; 2. Effects of iMCS on quality of life and participation and 3. Acceptance and satisfaction. In total, 32% (8/25) were identified as responders, and 68% (17/25) as non-responders. Most patients (71%, 20/28) indicated they would undergo iMCS again. Three patients deceased before the end of the study. CONCLUSION:This study suggests that the effects of iMCS should be assessed in a more multidimensional way compared to only the effect on pain as patients confided that the true treatment effect and patient satisfaction were based more on improvements of their quality of life, enabling patients to participate again in society in a meaningful way. In clinical practice, this study emphasizes the need for thorough patient education and realistic expectation management prior to implantation, highlighting both potential benefits and limitations to support informed decision-making.
