Prediction error and myopic shift after intraocular lens implantation in paediatric cataract patients

Aim To determine the amount of myopic shift in children after cataract surgery with intraocular lens (IOL) implantation and to evaluate success in achieving the target refraction. Methods The children were assigned into three groups depending on age at time of surgery: Group A, 0-1 years old; Group B, 1-7 years old; Group C, 7-18 years old. Multiple regression analysis was used to create a formula for expected myopic shift and to find out which variables were associated with a higher absolute prediction error. Results Children less than 12 months of age experienced higher myopic shifts and a larger mean rate of refractive change per year compared with older children. We found higher myopic shifts in younger children at time of surgery and children with unilateral cataract. Absolute prediction error was significantly higher in Group A compared with Groups B and C (p=0.022 and p=0.037, respectively). Multiple regression analysis showed that corneal radius was the only variable significantly associated with absolute prediction error. Conclusion Our data demonstrate the complexity in predicting the postoperative refraction in children under 1 year old and show that age at surgery and laterality are factors to consider when deciding which IOL power to implant in children

Suspected Bacterial Endophthalmitis following Intravitreal Anti-VEGF Injection: Case Series and Literature Review

Aim: To report an up-to-date overview of all patients reported in the literature with suspected bacterial endophthalmitis following anti-VEGF injection. Secondly, to identify specific symptoms and signs to differentiate between infectious and noninfectious endophthalmitis. Methods: A Pubmed search retrieved 12 retrospective case series which had included a total of 118 patients with suspected bacterial endophthalmitis after anti-VEGF injection. Data of 15 patients from the Rotterdam Eye Hospital were added. Patients were divided into three groups: those who did not receive intravitreal antibiotics (group A), patients who received intravitreal antibiotics with biopsy-negative cultures (group B) and those with biopsy-positive cultures (group C). Results: The median time between anti-VEGF injection and presentation with suspected bacterial endophthalmitis was 1 day in group A compared to 3 days in groups B and C. At presentation, patients of group A had a better median visual acuity (logMAR 1.0) compared to those in groups B and C (logMAR 2.1 and 2.5, respectively). Conclusion: This study suggests that patients presenting with a visual acuity of 20/200 (logMAR 1.0) or less and later than 24 h after injection are more likely to have bacterial endophthalmitis. To prevent undertreatment in these patients, the threshold to proceed to vitreous biopsy and empirical intravitreous antibiotics should be low. Copyright (c) 2012 S. Karger AG, Base

Inter- and intra-rater reliability of ultrasound tissue characterization (UTC) in patellar tendons

Purpose Ultrasound tissue characterization (UTC) is used in research and clinical practice to quantify tendon structure of the patellar tendon. This is the first study to investigate the inter- and intra-rater reliability for UTC of the patellar tendon on a large scale. Method Fifty participants (25 patellar tendinopathy, 25 asymptomatic) were recruited. The affected patellar tendons in symptomatic and right tendons in asymptomatic participants were scanned with UTC twice by one researcher and once by another. The same was done for contour marking (needed to analyze a UTC scan) of the tendon. Intraclass correlation coefficient (ICC (2,1)) for echo-types I, II, III, IV, aligned fibrillar structure (echo-types I + II), and disorganized structure (echo-types III + IV) were calculated. This was done for UTC scans as well as solely marking contours. Results Inter-rater reliability showed fair to good ICC values for echo-types I (0.65) and II (0.46) and excellent ICC values for echo-type III (0.81), echo-type IV (0.83), aligned fibrillar structure (0.82), and disorganized structure (0.82). Intra-rater reliability showed excellent ICC values for echo-types I (0.76), III (0.88), IV (0.85), aligned fibrillar structure (0.88), and disorganized fibrillar structure (0.88) and a fair to good value for echo-type II (0.61). Contour marking showed excellent ICC values for all echo-types. Conclusion This study showed that UTC scans for patellar tendons have overall good intra-rater and inter-rater reliability. To optimize reliability of UTC scans of the patellar tendon, using the same rater and using aligned fibrillar structure (echo-types I + II combined) and disorganized structure (echo-types III + IV combined) as outcome measures can be considered

Projecting methods for pension and social security financing Valuation of intergenerational transfers in funded collective pension schemes Valuation of intergenerational transfers in funded collective pension schemes *

Abstract This paper applies contingent claim analysis to value pension contracts for real-life collective pension plans with intergenerational risk sharing and offering DB-like benefits. We rewrite the balance sheet of such a pension fund as an aggregate of embedded generational options. This implies that a pension fund is a zero-sum game in value terms, so any policy change inevitably leads to value transfers between generations. We explore intergenerational value transfers that may arise from a plan redesign or from changes in funding policy and risk sharing rules. We develop a stochastic framework which accounts for time-varying investment opportunities and computes the embedded generational options. Changes in the values of the generational options enable us to evaluate the impact of policy modifications in the pension contract with respect to intergenerational transfers and redistribution. We find that a switch to a less risky asset mix is beneficial to elderly members at the expense of younger members who lose value. A reallocation of risk bearing from a plan with flexible contributions and fixed benefits to a plan with fixed contributions and flexible benefits leads to value redistribution from older plan members to younger ones