Visual Prognosis after Explantation of Small-Aperture Corneal Inlays in Presbyopic Eyes: A Case Series

The purpose of this study was to report visual prognosis after explantation of a small-aperture corneal inlay used for the treatment of presbyopia. This is a retrospective case series conducted at a single site in Draper, Utah, USA (Hoopes Vision). Medical records of 176 patients who had received a small-aperture corneal inlay (KAMRA™, AcuFocus Inc., Irvine, CA, USA) were reviewed. Patients who had undergone explantation of the device were identified. Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), and manifest refraction spherical equivalent (MRSE) were measured pre-implantation, post-implantation, pre-explantation, and post-explantation of the inlay. Ten eyes from ten patients were included in this study. The explantation rate was 5.7% over 31 months, with blurry vision as the most common complaint. After explantation, six patients achieved pre-implantation UDVA, and six achieved pre-implantation UNVA. Eight of nine patients who underwent final manifest refraction achieved pre-operative CDVA. All patients had residual donut-shaped corneal haze in the stroma at the previous position of the inlay. All patients experienced improvement in haze with 20% experiencing complete resolution. The degree of stromal haze was not related to the duration of implantation. Of the subset of patients who underwent explantation of their small-aperture corneal inlay, there was persistent loss of CDVA in 10%. The majority of patients experienced some level of residual stromal haze, which may contribute to deficits in UNVA and CDVA in few patients. A hyperopic shift induced by the corneal inlay may contribute to the blurry vision these patients experienced; there was a reduction of this shift post-explantation. While this device is removable, patients should expect some post-explantation changes such as residual haze with a small subset experiencing persistent deficits in CDVA

Effects of a changing environment on the aboveground and belowground systems of yellow birch (Betula alleghaniensis Britton) and sugar maple (Acer saccharum Marsh)

The environment is constantly changing. A change in one environmental factor will cause changes in many other environmental factors either simultaneously or sequentially. For example, an increase in available light, due to canopy opening by natural disturbances, may increase soil temperature and moisture on the forest floor. Therefore, a changing environment has interactive effects on the trees. In forest ecological studies, the effects of some single environmental factors on tree growth are known, but there is a lack of knowledge of the interactions between multiple factors. An understanding of the interactive effects of abiotic and biotic factors on trees is critical for an understanding of the growth and survival of understory saplings in a complex changing environment. The aboveground and belowground systems of a tree respond differently to the same abiotic factors, such as light, since these systems grow in differing environments. This thesis will focus on the interactive effects among available light (including canopy gap size), tree size, artificial shading, liming and plant competition on the aboveground and belowground systems of yellow birch and sugar maple growing in the understory in two field experiments and the interactive effects of light, elevated CO 2 and mycorrhizae on seedlings of both species in a phytotron experiment. The three investigations will address several key questions concerning the growth of these two species and the development of their mycorrhizae in a complex changing environment in the present and future