In this retrospective case series, we investigated factors associated with posterior capsule aperture (PCA) reclosure following neodymium-yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy. The study encompassed patients who underwent cataract surgery with intraocular lens (IOL) implantation or a combined vitrectomy, cataract surgery, and IOL implantation between 2009 and 2022. PCA reclosure was observed in 22 eyes of 17 patients: 45% (10 eyes) underwent the triple procedure, and 55% (12 eyes) received cataract surgery with IOL implantation. In our clinic, 14% of patients were given IOLs with a 4% water content, while 73% (13 eyes) of those experiencing PCA reclosure had IOLs with a 4% water content. The mean interval between Nd:YAG capsulotomies was notably shorter than that between the initial cataract surgery and the first Nd:YAG laser capsulotomy. We also identified five stages of PCA reclosure progression. In conclusion, IOL water content may be linked to PCA reclosure, and the time to recurrence is shorter with each successive reclosure. Further research is needed to verify these findings and uncover additional contributing factors.
Purpose. To demonstrate the importance of ultrasonographic biomicroscopy for following the clinical course of an intracorneal hematoma of unknown origin. Methods. A 64-year-old woman was referred to the Nagoya University Hospital because of a decrease in vision in her left eye. Her visual acuity was 20/70 (uncorrectable) in the left eye and the slit-lamp biomicroscopic examination showed a dark red-colored intracorneal hematoma in the central area of the left eye at the pre-Descemet's membrane level. Because the hematoma was small without any epithelial involvement and ultrasonographic biomicroscopy (UBM) and slit-lamp biomicroscopy showed a low risk of a pupillary block, she was followed without surgical treatment. Results. The hematoma turned yellow and grew smaller, and UBM images showed an internal liquified cyst 10 months after her initial visit. The cystic legion was detected as a low-echoic cavity by UBM 2 months before it was observed by slit-lamp biomicroscopy. The hematoma was almost resolved 2.5 years after the onset, and the visual acuity OS improved to 20/30. Conclusion. The intracorneal hematoma occurred without any obvious cause and should be classified as spontaneous. UBM combined with slit-lamp biomicroscopy was useful in estimating the extent of the hematoma and thus the risk of pupillary block. It was also helpful in deciding whether surgical treatment was necessary.
In this study, the hypothesis that increased intraocular levels of iron cause oxidative damage to the retina was tested.Adult C57BL/6 mice were given an intravitreous injection of saline or 0.10, 0.25, or 0.50 mM FeSO(4). Scotopic electroretinograms (ERGs) were performed 3, 7, and 14 days after injection, and photopic ERGs were performed on day 14. Hydroethidine was used to identify superoxide radicals and lipid peroxidation was visualized by staining for hydroxynonenal (HNE). Retinal cell death was evaluated by TUNEL and measurement of inner nuclear layer (INL) and outer nuclear layer (ONL) thickness. Levels of rhodopsin and cone-opsin mRNA were measured by quantitative real time RT-PCR. Cone density was assessed by peanut agglutinin staining and confocal microscopy.Compared with retinas in saline-injected eyes, retinas from eyes injected with FeSO(4) showed greater fluorescence after intravenous injection of hydroethidine due to superoxide radicals in photoreceptors, greater photoreceptor staining for HNE, a marker of lipid peroxidation, and increased expression of Heme oxygenase 1, an indicator of oxidative stress. ERG b-wave amplitudes were reduced (photopic > scotopic) in FeSO(4)-injected eyes compared with those in saline-injected eyes. Numerous TUNEL-stained nuclei were seen along the outer border of the ONL, the location of cone cell nuclei, at 1 and 2 days after injection of FeSO(4). In FeSO(4)-injected eyes, the thickness of the ONL, but not the INL, was significantly reduced, and 17 days after injection, there were 3.8- and 2.6-fold reductions in the mRNAs for M-cone and S-cone opsin, respectively, whereas there was no significant difference in rhodopsin mRNA. Confocal microscopy of peanut agglutinin-stained sections showed dose-dependent FeSO(4)-induced cone drop out.Increased intraocular levels of FeSO(4) cause oxidative damage to photoreceptors with greater damage to cones than rods. This finding suggests that the oxidative defense system of cones differs from that of rods and other retinal cells, and that cones are more susceptible to damage from the type of oxidative stress imposed by iron.
To describe four cases of functional visual loss which challenge the theory that its causes are different in children and adults (i.e., that financial gain is the primary cause in adults while in children it is an involuntary response to psychosocial problems). Rather, we will show a similar etiology of functional visual loss in children and adults. We also describe diagnostic testing and therapeutic approaches that are useful in both children and adults with functional visual loss.Two children (5 and 15 years old) and two adults (54 and 73 years old) with presumed functional visual loss and whose visual functions were assessed with verbal assurance, Starlight Test, Flicker Test, and trial glasses or contact lenses.Normal visual function was elicited in all four cases. In both pediatric patients we were able to elicit normal vision using verbal assurance and trial glasses or contact lenses. In both adult patients, we elicited dramatic improvements in vision with verbal assurance and discussion of the patients' psychosocial situation.Children and adults present with similar etiologies (psychosocial problems) of functional visual loss. In these cases we believe the children were motivated by their desire to wear glasses or contacts and the adults were involuntarily responding to psychosocial problems. These cases show that we cannot, as has been proposed, clearly categorize patients with functional visual loss based upon age.
