Image-guided system versus manual marking for toric intraocular lens alignment in cataract surgery

Purpose To compare the accuracy of toric intraocular lens (IOL) alignment using the Verion Image-Guided System versus a conventional manual ink-marking procedure. Setting University Eye Clinic Maastricht, Maastricht, the Netherlands. Design Prospective randomized clinical trial. Methods Eyes with regular corneal astigmatism of at least 1.25 diopters (D) that required cataract surgery and toric IOL implantation (Acrysof SN6AT3-T9) were randomly assigned to the image-guided group or the manual-marking group. The primary outcome was the alignment of the toric IOL based on preoperative images and images taken immediately after surgery. Secondary outcome measures were residual astigmatism, uncorrected distance visual acuity (UDVA), and complications. Results The study enrolled 36 eyes (24 patients). The mean toric IOL misalignment was significantly less in the image-guided group than in the manual group 1 hour (1.3 degrees ± 1.6 [SD] versus 2.8 ± 1.8 degrees; P =.02) and 3 months (1.7 ± 1.5 degrees versus 3.1 ± 2.1 degrees; P &lt;.05) postoperatively. The mean residual refractive cylinder was −0.36 ± 0.32 D and −0.47 ± 0.28 D in the image-guided group and manual group, respectively (P &gt;.05). The mean UDVA was 0.03 ± 0.10 logarithm of minimum angle of resolution (logMAR) and 0.04 ± 0.09 logMAR, respectively (both P &gt;.05). No intraoperative complications occurred during any surgery. Conclusion The IOL misalignment was significantly less with digital marking than with manual marking; this did not result in a better UDVA or lower residual refractive astigmatism.</p

Long-term endothelial cell loss in patients with artisan myopia and artisan toric phakic intraocular lenses 5- and 10-year results

Purpose: To evaluate the long-term change in endothelial cell density (ECD) after the implantation of 2 types of rigid iris-fixated phakic intraocular lenses (pIOLs) for the treatment of myopia and astigmatism. Design: Prospective, clinical cohort study. Participants: A total of 507 eyes of 289 patients receiving the Artisan Myopia or Artisan Toric (Ophtec B.V., Groningen, The Netherlands) iris-fixated pIOL for the treatment of myopia or astigmatism at the University Eye Clinic Maastricht as of January 1998. Methods: A total of 381 myopic and 126 toric pIOLs were implanted. Five- and 10-year follow-ups were completed by 193 and 127 eyes implanted with the myopic pIOL and by 40 and 20 eyes implanted with the toric pIOL, respectively. Main Outcome Measures: Chronic endothelial cell (EC) loss, percentage of eyes with a decrease of ≥25% in ECD, and percentage of eyes with an ECD <1500 cells/mm 2. Results: Chronic EC loss was calculated from 6 months postoperatively to the end of follow-up and showed an annual ECD decline of 48 cells/mm 2 (standard error, 3.14) and 61 cells/mm 2 (standard error, 6.30) in the myopic (P < 0.001) and toric (P < 0.001) groups, respectively, resulting in a total EC loss of 16.6% and 21.5% from 6 months to 10 years postoperatively, respectively. Ten years after implantation, ECD had decreased by ≥25% in 7.9% and 6.3%, whereas ECD was <1500 cells/mm 2 in 3.9% and 4.0% in the myopic and toric groups, respectively. Explantation of the pIOL occurred in 6.0% in the myopic group and 4.8% in the toric group. Risk factors for increased EC loss were a shallow anterior chamber depth (ACD) (P ≤ 0.005) and a smaller distance between the central and peripheral pIOL edge to the endothelium (P ≤ 0.005). Conclusions: A significant linear chronic EC loss was reported after implantation with myopic or toric iris-fixated pIOLs. A smaller ACD and smaller distance between pIOL edge and endothelium were risk factors for EC loss. Modification of preoperative age-related ECD thresholds is indicated to maintain an ECD that warrants safe future combined pIOL explantation and cataract surgery

Biallelic Variants in the COLGALT1 Gene Causes Severe Congenital Porencephaly: A Case Report

Contains fulltext : 231725.pdf (publisher's version ) (Open Access)OBJECTIVE: We describe a third patient with brain small vessel disease 3 (BSVD3), being the first with a homozygous essential splice site variant in the COLGALT1 gene, with a more severe phenotype than the 2 children reported earlier. METHODS: Analysis of whole exome sequencing (WES) data of the child and parents was performed. We validated the missplicing of the homozygous variant using reverse transcription PCR and Sanger sequencing of the mRNA in a lymphocyte culture. RESULTS: The patient presented antenatally with porencephaly on ultrasound and MRI. Postnatally, he showed a severe developmental delay, refractory epilepsy, spastic quadriplegia, and a progressive hydrocephalus. WES revealed a homozygous canonical splice site variant NM_024656.3:c.625-2A>C. PCR and Sanger sequencing of the mRNA demonstrated that 2 cryptic splice sites are activated, causing a frameshift in the major transcript and in-frame deletion in a minor transcript. CONCLUSIONS: We report a third patient with biallelic pathogenic variants in COLGALT1, confirming the role of this gene in autosomal recessive BSVD3

First generation versus second generation toric calculator for toric IOL implantations

Purpose: To compare the accuracy of predicted postoperative residual refractive astigmatism after toric IOL implantation between a first generation and a second generation toric calculatorMethodA total of 458 eyes underwent cataract extraction and implantation of a toric IOL between 2011 and 2017. A first generation toric calculator (Acrysof Toric Calculator) was used in 323 eyes, whereas a second generation toric calculator (Barrett Toric Calculator) was used in 135 eyes. The primary outcome was to compare the amount of over‐ and undercorrection of pre‐existent astigmatism, using vector analysis.ResultsPreoperative both groups had comparable corneal astigmatism (respectively 2.43 ± 1.10 D and 2.31 ± 1.26 D for the Acrysof and Barrett group, p > 0.05). Postoperatively, no significant differences were seen in terms of misalignment, CDVA, residual refractive astigmatism, and spherical equivalent. A significant better uncorrected visual acuity was seen in the Barrett group compared to the Acrysof group (respectively 0.05 ± 0.12 vs 0.12 ± 0.17 logMar). Vector analyses showed a significantly lower percentage of overcorrection of ≥0.5 D or ≥1.0 D in the Barrett group (respectively 14% and 3%) compared to the Acrysof group (respectively 32% and 8%). A significant higher percentage of undercorrection of ≥0.5 D was seen in the Barrett group compared to the Acrysof group (respectively 7% and 2%). The correction index was significantly closer to the ideal 1.00 in the Barrett group (1.06 ± 0.24) compared to the Acrysof group (1.16 ± 0.24).ConclusionsThe use of a second generation toric calculator significantly reduces overcorrection after toric IOL implantation

Toxinotype A Clostridium perfringens causing septicaemia with intravascular haemolysis: two cases and review of the literature

Background: Septicaemia with intravascular haemolysis is a rare, but often fatal, presentation of Clostridium perfringens infection. C. perfringens is a Gram-positive, anaerobic bacterium that can produce multiple toxins. Toxinotyping is not performed regularly.Methods: This article describes two human cases of C. perfringens infections. Toxinotyping was performed using polymerase chain reaction (PCR). Additionally, a structured review of the literature was performed which searched specifically for cases of C. perfringens infection with haemolysis.Results: Both cases were identified as toxinotype A strains and both cases were fatal. Also, both cases showed marked haemolysis during their clinical course, which is assumed to have played a significant role in their outcome. In total, 83 references were identified describing human C. perfringens infection with haemolysis. Mortality rates have been stable over the last 10 years at 80%. Toxinotyping has been performed in a total of six cases. Of the four cases analysed by PCR, all were identified as toxinotype A.Conclusions: Haemolytic C. perfringens infections are rare but are fatal in most cases. Toxinotyping is performed rarely. The authors advocate increased use of toxinotyping to gain insight into pathophysiology and more effective interventions. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.Molecular basis of bacterial pathogenesis, virulence factors and antibiotic resistanc

Ocular findings in 22q11.2 deletion syndrome: A systematic literature review and results of a Dutch multicenter study

The 22q11.2 deletion syndrome (22q11.2DS) is a multisystem disorder with an estimated prevalence of 1:3000 live births. Manifestations show a marked variability in expression and include speech- and language delay, intellectual disability, and neuropsychiatric disorders. We aim to provide an overview of ocular findings in 22q11.2DS in order to optimize recommendations for ophthalmic screening. We combined results from a systematic literature review with results from a multicenter cross-sectional study of patients with 22q11.2DS who were assessed by an ophthalmologist. Our systematic literature search yielded four articles, describing 270 patients. We included 132 patients in our cross-sectional study (median age 8.9 [range 0-56] years). Most reported ocular findings were retinal vascular tortuosity (32%-78%), posterior embryotoxon (22%-50%), eye lid hooding (20%-67%), strabismus (12%-36%), amblyopia (2%-11%), ptosis (4%-6%), and refractive errors, of which hyperopia (6%-48%) and astigmatism (3%-23%) were most common. Visual acuity was (near) normal in most patients (91%-94%). Refractive errors, strabismus, and amblyopia are treatable conditions that are frequently present in patients with 22q11.2DS and should be corrected at an early stage. Therefore, in 22q11.2DS, we recommend ophthalmic and orthoptic screening at the age of 3 years or at diagnosis, and a low-threshold referral in adults