Clinical Course of Pseudophakic Cystoid Macular Edema Treated with Nepafenac

Background: To evaluate the clinical course of pseudophakic cystoid macular edema (PCME) treated with topical non-steroidal anti-inflammatory drugs (NSAIDs). Methods: An analysis of the clinical course of PCME consisting of 536 eyes of 536 patients from five consecutive randomized clinical trials aimed at the optimization of anti-inflammatory medication in patients undergoing routine cataract surgery. PCME was classified as (i) grade 0a; no macular thickening, (ii) grade 0b; macular thickening (central subfield macular thickness (CSMT) increase of at least 10%) without signs of macular edema, (iii) grade I; subclinical PCME, (iv) grade II; acute PCME, (v) grade III; long-standing PCME. Eyes with PCME classification from grade I onwards were treated with nepafenac 1 mg/mL t.i.d. for two months. Results: CSMT increase of at least 10% at any postoperative timepoint with cystoid changes—a criterion for PCME—was found in 19 of 536 eyes (total incidence 3.5%). Of these 19 eyes, 13 eyes (total incidence 2.4%) had clinically significant PCME. PCME was considered clinically significant when both of the following visual acuity criteria were fulfilled. At any timepoint after the cataract surgery both the corrected distance visual acuity (CDVA) gain was less than 0.4 decimals from that of preoperative CDVA, and the absolute CDVA level remained below 0.8 decimals. Only one of the 19 eyes with criteria for PCME (total incidence 0.2%, incidence of PCME eyes 5.3%) showed no macular edema resolution within 2 months after topical nepafenac administration. Conclusions: PCME in most cases is self-limiting using topical nepafenac without any further need for intravitreal treatment

Decoherence in Quantum Walks on the Hypercube

We study a natural notion of decoherence on quantum random walks over the hypercube. We prove that in this model there is a decoherence threshold beneath which the essential properties of the hypercubic quantum walk, such as linear mixing times, are preserved. Beyond the threshold, we prove that the walks behave like their classical counterparts.Comment: 7 pages, 3 figures; v2:corrected typos in references; v3:clarified section 2.1; v4:added references, expanded introduction; v5: final journal versio

Uneventful Cataract Surgery : Cataract Surgery Training and Effect on Intraoperative Complications : Association Between Aqueous Flare and Pseudophakic Cystoid Macular Edema

The thesis studies uneventful cataract surgery and some of its most common complications. The data is based upon retrospective clinical trials performed in the Kymenlaakso Central Hospital, Kotka, Finland. In the first study learning curve of beginning surgeon´s is evaluated and advances in training and equipment analyzed. A common intra-operative complication, posterior capsule rupture with or without vitreous loss (PCR) was designated as the end-point. With appropriate training and equipment, incidence of complications can be reduced and training made safer. In the second study the incidence of late post operative complication pseudophakic cystoid macular edema (PCME) was analyzed and the current treatment protocol was compared with international publications. PCME can result in permanent visual deficiency, even if the surgical procedure was performed without complications. Ocular inflammation has been presumed to increase the risk for PCME development. In the third study the association between aqueous flare, a marker for ocular inflammation, and development with PCME was established by using a laser flare meter. The fourth study analyzes the cost-consequence in intraocular lense (IOL) selection with respect to development of common late complication called posterior Capsular Opacification (PCO) or secondary cataract. Different IOLs have different PCO incidence profiles. PCO requires laser therapy. By preferring IOLs with lower PCO incidence, the public sector can benefit considerably.Väitöskirjassa tutkitaan tavanomaisesti suoritetun kaihileikkauksen myöhäisiä jälkikomplikaatioita, sekä aloittavien kirurgien oppimiskäyrää ja komplikaatioiden esiintymistä. Aineisto perustuu kliinisiin tutkimuksiin, jotka on tehty Kymenlaakson keskussairaalassa, Kotkassa. Ensimmäisessä tutkimuksessa tarkasteltiin kuinka paljon kaihileikkauksessa usein esiintyvää takakapselirepeämää esiintyy aloittelevilla kirurgeilla. Tämän kehitystä tarkasteltiin erilaisten opetusmetodien ja teknologisten saavutusten valossa. Tutkimus osoittaa, että suunniteltu koulutustekniikka ja teknologinen kehitys ovat vähentäneet aloittelevien kirurgien komplikaatioiden määrää. Toisessa tutkimuksessa tarkastelimme tavanomaisen kaihileikkauksen myöhäisvaikutuksena kehittyvää verkkokalvon turvotusta. Verkkokalvon turvotus voi kroonistua ja pysyvästi heikentää näköä, vaikka leikkauksessa ei olisi tapahtunut mitään poikkeavaa. Tutkimuksessa tarkasteltiin Kymenlaaksossa tapahtuvan verkkokalvoturvotuksen insidenssiä, hoitostrategiaa ja vertailtiin tätä kansainvälisten julkaisujen kanssa. Tutkimus osoittaa, että insidenssi Kotkassa vastaa kansainvälistä tasoa ja hoito on hyvää. Okulaarisen inflammaation oletetaan toimivan merkittävänä riskitekijänä verkkokalvon turpoamisen kehitykselle. Kolmas tutkimus pyrkii havaitsemaan onko olemassa silmän etuosan tulehduksen tasoa, joka voidaan yhdistää verkkokalvon turvotuksen kehittymiseen. Silmän etuosan tulehdusta mitattiin laserin läpivalolla ja tutkimustulokset antavat ymmärtää, että tulehduksella ja verkkokalvon turvotuksella on yhteys. Neljännessä tutkimuksessa tarkastellaan eri silmänsisäisten linssien jälkikaihen esiintyvyyttä. Jälkikaihi vaatii laserilla tehtävän toimenpiteen, jotta potilaan näkökyky palautuu. Koska eri silmänsisäisillä linsseillä on suuretkin erot jälkikaihen esiintyvyydessä, valitsemalla parempi silmänsisäinen linssi, voidaan tehdä merkittäviä kustannus- ja resurssisäästöjä

Preoperative anti-inflammatory treatment of diabetic patients does not improve recovery from cataract surgery when postoperatively treated with a combination of prednisolone acetate and nepafenac

Purpose To examine preoperative anti-inflammatory treatment on recovery from cataract surgery in eyes of diabetic patients. Methods A Prospective randomized clinical trial. One hundred and three eyes of 103 patients with diabetes undergoing routine cataract surgery were randomized (1:1) not to receive any preoperative anti-inflammatory medication or to receive preoperative topical anti-inflammatory medication with a combination of prednisolone acetate (10 mg/ml) and nepafenac (1 mg/ml). All eyes received postoperative anti-inflammatory combination therapy for 3 weeks. Recovery from surgery was recorded by a structured home questionnaire. Clinical outcome parameters were recorded at 28 days and 3 months. Results Patient age and gender distribution, and all baseline ophthalmic and systemic parameters were comparable between the study groups. After surgery, conjunctival injection lasted 2.4 +/- 1.7 days (mean +/- SD) and irritation of the eye 3.3 +/- 3.9 days in eyes without preoperative treatment, when compared to 1.6 +/- 1.6 days (p = 0.067) and 2.4 +/- 4.0 days (p = 0.431), respectively, in eyes with preoperative treatment. At 28 days, central subfield macular thickness (CSMT) increased 2.2 +/- 20.2 mu m in eyes without preoperative treatment, when compared 0.1 +/- 25.2 mu m (p = 0.670) in eyes with preoperative treatment. At 3 months, the respective CSMT change from baseline was -1.5 +/- 26.9 mu m and -3.4 +/- 26.2 mu m (p = 0.762). None of the eyes were reported with pseudophakic cystoid macular oedema (PCME) in either group. Conclusion Lack of preoperative anti-inflammatory treatment does not impair recovery from surgery or predispose diabetic patients to increased risk of PCME in eyes postoperatively treated with combination therapy of prednisolone acetate and nepafenac.Peer reviewe

The One-Way Communication Complexity of Group Membership

This paper studies the one-way communication complexity of the subgroup membership problem, a classical problem closely related to basic questions in quantum computing. Here Alice receives, as input, a subgroup $H$ of a finite group $G$; Bob receives an element $x \in G$. Alice is permitted to send a single message to Bob, after which he must decide if his input $x$ is an element of $H$. We prove the following upper bounds on the classical communication complexity of this problem in the bounded-error setting: (1) The problem can be solved with $O(\log |G|)$ communication, provided the subgroup $H$ is normal; (2) The problem can be solved with $O(d_{\max} \cdot \log |G|)$ communication, where $d_{\max}$ is the maximum of the dimensions of the irreducible complex representations of $G$; (3) For any prime $p$ not dividing $|G|$, the problem can be solved with $O(d_{\max} \cdot \log p)$ communication, where $d_{\max}$ is the maximum of the dimensions of the irreducible \F_p-representations of $G$

Cataract complications study : an analysis of adverse effects among 14,520 eyes in relation to surgical experience

Background: To evaluate the learning-curve in performing cataract surgery with respect to developments in technology and different teaching strategies by comparing the incidence of capsular bag-related complications to operator experience. Methods: A review of the registry of 14,520 cataract surgeries carried out at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland, from August 8, 2009 to July 31, 2017. Results: We identified 144 cases with posterior capsule rupture and/or loss of capsular bag support (incidence 0.99% of all surgeries). The mean age of patients was 76.99.1 years and gender distribution ratio 29:71 male:female. Pseudoexfoliation syndrome (PXF; incidence 21%) and small pupil (incidence 14%) were over-represented in complication eyes, especially at the beginning of the study. Capsular bag-related complication rates were reported in 0.36% of surgeries for senior and 7.03% for resident surgeons at the beginning of the study, compared to 0.32% and 1.32%, respectively, at the end of the study. Best-corrected visual acuity at the final post-operative visit was 0.61 +/- 0.16 decimals at the beginning of the study, and 0.81 +/- 0.19 decimals at the end of the study. The mean number of post-operative visits was 4.3 +/- 2.7 and did not show trend over the study period. Conclusions: Real-world evidence suggests PXF and small pupil as significant risk factors in cataract surgery. A gradual decline in the rate complications was noted with increasing surgical experience, also among residents over the follow-up period.Peer reviewe

Cataract complications study: an analysis of adverse effects among 14,520 eyes in relation to surgical experience

Background: To evaluate the learning-curve in performing cataract surgery with respect to developments in technology and different teaching strategies by comparing the incidence of capsular bag-related complications to operator experience.Methods: A review of the registry of 14,520 cataract surgeries carried out at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland, from August 8, 2009 to July 31, 2017.Results: We identified 144 cases with posterior capsule rupture and/or loss of capsular bag support (incidence 0.99% of all surgeries). The mean age of patients was 76.99.1 years and gender distribution ratio 29:71 male:female. Pseudoexfoliation syndrome (PXF; incidence 21%) and small pupil (incidence 14%) were over-represented in complication eyes, especially at the beginning of the study. Capsular bag-related complication rates were reported in 0.36% of surgeries for senior and 7.03% for resident surgeons at the beginning of the study, compared to 0.32% and 1.32%, respectively, at the end of the study. Best-corrected visual acuity at the final post-operative visit was 0.61 +/- 0.16 decimals at the beginning of the study, and 0.81 +/- 0.19 decimals at the end of the study. The mean number of post-operative visits was 4.3 +/- 2.7 and did not show trend over the study period.Conclusions: Real-world evidence suggests PXF and small pupil as significant risk factors in cataract surgery. A gradual decline in the rate complications was noted with increasing surgical experience, also among residents over the follow-up period

Relationship Between Prolonged Intraocular Inflammation and Macular Edema After Cataract Surgery

PurposeTo assess whether aqueous flare is related to an increased risk of pseudophakic cystoid macular edema (PCME) following uneventful cataract surgery in nondiabetic and diabetic patients.MethodsA post hoc analysis of five consecutive randomized clinical trials in the Department of Ophthalmology, Kymenlaakso Central Hospital, Finland. Aqueous flare levels were recorded in 448 eyes of 448 patients before surgery, and after the course of topical anti-inflammatory treatment 28 days and three months after cataract surgery.ResultsAqueous flare increase of ConclusionsAt 28 days, aqueous flare increase was associated with macular thickening. A 100% cutoff value could potentially be used when studying anti-inflammatory efficacy of different treatment protocols. Flare values exceeding this cutoff value could be considered as an indication for extending anti-inflammatory therapy.Translational RelevanceA 100% increase in aqueous flare at 28 days after cataract surgery from baseline predicted macular thickening up to three months postoperatively. Identifying a correlation between increased aqueous flare levels and pseudophakic cystoid macular edema may allow recognition of the most vulnerable patients, development of prophylactic treatment strategies and reduction of the number and severity of postoperative complications.</p

Comparison of Evaluations for Heart Transplant Before Durable Left Ventricular Assist Device and Subsequent Receipt of Transplant at Transplant vs Nontransplant Centers

IMPORTANCE: In 2020, the Centers for Medicare & Medicaid Services revised its national coverage determination, removing the requirement to obtain review from a Medicare-approved heart transplant center to implant a durable left ventricular assist device (LVAD) for bridge-to-transplant (BTT) intent at an LVAD-only center. The association between center-level transplant availability and access to heart transplant, the gold-standard therapy for advanced heart failure (HF), is unknown. OBJECTIVE: To investigate the association of center transplant availability with LVAD implant strategies and subsequent heart transplant following LVAD implant before the Centers for Medicare & Medicaid Services policy change. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of the Society of Thoracic Surgeons Intermacs multicenter US registry database was conducted from April 1, 2012, to June 30, 2020. The population included patients with HF receiving a primary durable LVAD. EXPOSURES: LVAD center transplant availability (LVAD/transplant vs LVAD only). MAIN OUTCOMES AND MEASURES: The primary outcomes were implant strategy as BTT and subsequent transplant by 2 years. Covariates that might affect listing strategy and outcomes were included (eg, patient demographic characteristics, comorbidities) in multivariable models. Parameters for BTT listing were estimated using logistic regression with center-level random effects and for receipt of a transplant using a Cox proportional hazards regression model with death as a competing event. RESULTS: The sample included 22 221 LVAD recipients with a median age of 59.0 (IQR, 50.0-67.0) years, of whom 17 420 (78.4%) were male and 3156 (14.2%) received implants at LVAD-only centers. Receiving an LVAD at an LVAD/transplant center was associated with a 79% increased adjusted odds of BTT LVAD designation (odds ratio, 1.79; 95% CI, 1.35-2.38; P \u3c .001). The 2-year transplant rate following LVAD implant was 25.6% at LVAD/transplant centers and 11.9% at LVAD-only centers. There was an associated 33% increased rate of transplant at LVAD/transplant centers compared with LVAD-only centers (adjusted hazard ratio, 1.33; 95% CI, 1.17-1.51) with a similar hazard for death at 2 years (adjusted hazard ratio, 0.99; 95% CI, 0.90-1.08). CONCLUSIONS AND RELEVANCE: Receiving an LVAD at an LVAD-transplant center was associated with increased odds of BTT intent at implant and subsequent transplant receipt for patients at 2 years. The findings of this study suggest that Centers for Medicare & Medicaid Services policy change may have the unintended consequence of further increasing inequities in access to transplant among patients at LVAD-only centers