Secondary intraocular lenses in eyes with aphakia or dislocated IOL: impact of suture fixation on early and late complications

BACKGROUND: Secondary intraocular lens (IOL) implantation is exposed to an increased risk of complications, including endophthalmitis and retinal detachment. The present analysis compares the outcomes and complications experienced in our own series of patients. PATIENTS AND METHODS: We retrospectively reviewed a consecutive series of secondary posterior chamber IOL implantations performed in a single centre, two surgeon setting over a period of 8 years and with a follow up-time of at least 4 months. RESULTS: Between 1997 and 2005, 75 patients received a sulcus-supported secondary IOL without suture fixation, whereas suture fixation was required in 137 instances. Visual acuity improved in both groups (group 1: from 0.36 +/- 0.39 (0.01-1.2) to 0.73 +/- 0.33 (0.02-1.0; p = 0.18); group 2: from 0.33 +/- 0.34 (0.02-1.0) to 0.46 +/- 0.33 (0.01-1.0; p = 0.006), but more pronounced in eyes not requiring suture fixation (p = 0.012). IOL placement was more likely to be combined with endophacoemulsification in the not suture-fixed IOLs (12.7 vs. 5.3 %). In contrast, retinal tears (10.6 vs. 8.6 %, respectively) and retinal detachment (5.3 vs. 2.2 %, respectively) were equally distributed. In the early postoperative phase, IOP was lower in suture-fixed eyes, which showed a higher incidence of minor intraocular haemorrhages and cystoid macular edema (5.3 vs. 8.0 %); late complications up to 5 years postoperatively were equally distributed. CONCLUSION: A preoperatively less complicated anterior segment situation and a lower incidence of postoperative macular edema may account for a better visual outcome after placement of a sulcus supported IOLs without suturing. If required, suture fixation may be performed without exposing the eye to an increased risk of late postoperative complications.

Montana In the 1970’s: Seen Through a Reporter’s Eyes -- Chuck Johnson “In the Crucible of Change”

It has been said that “journalism is the first rough draft of history.” If that be the case, much of Montana’s history since 1970 was first written by Chuck Johnson. He has covered the activities of 20 regular sessions of the Legislature plus an untold number of Special Sessions, the Constitutional Convention, nine Governors, eight US Senators and seven US Congressmen. Primary elections, general elections, state and national Party Conventions have been seen by Montanans through Johnson’s prism. Big and little news about policy, insights about politics, and a sense of the people behind the news (and history) has flowed from Chuck Johnson’s pen. Johnson’s first decade as a journalist coincides substantially with the period of “In the Crucible of Change.” Having been one of those who wrote the first draft of much of the history in the series “In the Crucible of Change,” and as “Dean of Montana’s Capitol Reporters,” Chuck’s reflections and insights about the period are conveyed in this film with a maturity and understanding that can only come from one who has spent decades honing is craft to perfection. Chuck Johnson is a journalist who has covered Montana state government and politics since 1970. Since 1992, he has been bureau chief of the Lee Newspapers State Bureau in Helena, writing for the Lee daily newspapers: the Billings Gazette, The Montana Standard (Butte), Helena Independent Record, The Missoulian, and the Ravalli Republic (Hamilton). Johnson, a Great Falls native raised in Helena, was exposed to politics early on when he was taken up to the Legislature one night to watch the debate on the raging issue of the day--whether stores should be allowed to give trading stamps to customers. He received a B.A. in journalism and an M.A. history from the University of Montana. Johnson spent a year studying politics and economics at Oxford University in England on a Rotary Foundation scholarship. He previously was chief of the Great Falls Tribune Capitol Bureau and worked for the Associated Press, Missoulian and Helena Independent Record. Chuck and his wife Pat reside in Helena.

The Eyes Have It: Regulatory and Structural Changes Both Underlie Cichlid Visual Pigment Diversity

A major goal of evolutionary biology is to unravel the molecular genetic mechanisms that underlie functional diversification and adaptation. We investigated how changes in gene regulation and coding sequence contribute to sensory diversification in two replicate radiations of cichlid fishes. In the clear waters of Lake Malawi, differential opsin expression generates diverse visual systems, with sensitivities extending from the ultraviolet to the red regions of the spectrum. These sensitivities fall into three distinct clusters and are correlated with foraging habits. In the turbid waters of Lake Victoria, visual sensitivity is constrained to longer wavelengths, and opsin expression is correlated with ambient light. In addition to regulatory changes, we found that the opsins coding for the shortest-and longest-wavelength visual pigments have elevated numbers of potentially functional substitutions. Thus, we present a model of sensory evolution in which both molecular genetic mechanisms work in concert. Changes in gene expression generate large shifts in visual pigment sensitivity across the collective opsin spectral range, but changes in coding sequence appear to fine-tune visual pigment sensitivity at the short-and long-wavelength ends of this range, where differential opsin expression can no longer extend visual pigment sensitivity.

Detection of Mycoplasma conjunctivae in the eyes of healthy, free-ranging Alpine ibex: possible involvement of Alpine ibex as carriers for the main causing agent of infectious keratoconjunctivitis in wild Caprinae

Mycoplasma conjunctivae is considered the major cause of infectious keratoconjunctivitis (IKC) in Alpine ibex (Capra i. ibex) and chamois (Rupicapra r. rupicapra). While it is known that domestic sheep can act as healthy carriers for M. conjunctivae, this question has not been addressed in wild ungulates so far. In this study, bacteriological investigations and field observations were performed to assess whether free-ranging Alpine ibex can be healthy carriers of M. conjunctivae. Among 136 ibex without clinical signs of IKC, M. conjunctivae was identified 26 times (19.1%) by TaqMan PCR. To assess the potential pathogenicity of M. conjunctivae strains isolated from asymptomatic eyes, strains from three healthy ibex and from 15 IKC-ibex and IKC-chamois were analysed genetically by DNA sequence analysis of the variable part of the lppS gene. No significant differences were observed between strains from asymptomatic and clinically affected animals, reflecting the assumption that healthy ibex may act as carriers for M. conjunctivae strains that may be pathogenic for other individuals. Our results further indicate that development of IKC is associated with M. conjunctivae load in the eyes. In addition, a questionnaire survey revealed that IKC is generally less common in ibex than chamois and that infection in wild ungulates is not necessarily linked to the presence of sheep. These data support the hypothesis that apparently healthy ibex may be important in the epizootiology of IKC and indicate that host predilection may play a role in IKC development.

All eyes on me?! Social anxiety and self-directed perception of eye gaze

To date, only little is known about the self-directed perception and processing of subtle gaze cues in social anxiety that might however contribute to excessive feelings of being looked at by others. Using a web-based approach, participants (n=174) were asked whether or not briefly (300 ms) presented facial expressions modulated in gaze direction (0°, 2°, 4°, 6°, 8°) and valence (angry, fearful, happy, neutral) were directed at them. The results demonstrate a positive, linear relationship between self-reported social anxiety and stronger self-directed perception of others' gaze directions, particularly for negative (angry, fearful) and neutral expressions. Furthermore, faster responding was found for gaze more clearly directed at socially anxious individuals (0°, 2°, and 4°) suggesting a tendency to avoid direct gaze. In sum, the results illustrate an altered self-directed perception of subtle gaze cues. The possibly amplifying effects of social stress on biased self-directed perception of eye gaze are discussed.

Functional and anatomical outcome of eyes with neovascular age-related macular degeneration treated with intravitreal ranibizumab following an exit strategy regimen.

AIMS To assess the functional and morphological outcome of eyes with neovascular AMD treated with intravitreal ranbizumab following an exit strategy treatment regime. METHODS The Bern treatment regime for neovascular AMD has a fixed injection schedule, even in the non-active stage of the disease. The regimen has been adapted from the PIER study treatment protocol. Eyes with non-active AMD will receive 4 injections in the first year, and 2 injections in the second year of follow-up before treatment stops. Patients that received ranibizumab for treatment and reached the exit criteria were identified, and charts were reviewed to assess functional and morphological outcome. RESULTS Only 2.6% of all patients (15 out of 575 patients) reached the exit criteria. Mean change in best corrected ETDRS visual acuity (VA) was 4.5±16.9 letters when comparing baseline VA to 4 weeks after the last injection (p=0.32). OCT mean foveal thickness was significantly thinner after last treatment (247.9±43.0 µm) compared to baseline (332.5±83.1 µm, p=0.002). The mean total number of ranibizumab injections was 15.6±8.0, and the mean total treatment period was 40.9±18.3 months. Twenty percent of eyes had geographic atrophy present at baseline versus 46.6% at the end of treatment. CONCLUSIONS Even with a fixed treatment regime and a defined treatment exit strategy, only a small percentage of patients reach exit criteria. Retinal thickness has been significantly reduced by repeated intravitreal ranibizumab injections, and geographic atrophy became more frequent.

In your eyes only: deficits in executive functioning after frontal TMS reflect in eye movements

This study investigated the roles of the right and left dorsolateral prefrontal (rDLPFC, lDLPFC) and the medial frontal cortex (MFC) in executive functioning using a theta burst transcranial magnetic stimulation (TMS) approach. Healthy subjects solved two visual search tasks: a number search task with low cognitive demands, and a number and letter search task with high cognitive demands. To observe how subjects solved the tasks, we assessed their behavior with and without TMS using eye movements when subjects were confronted with specific executive demands. To observe executive functions, we were particularly interested in TMS-induced changes in visual exploration strategies found to be associated with good or bad performance in a control condition without TMS stimulation. TMS left processing time unchanged in both tasks. Inhibition of the rDLPFC resulted in a decrease in anticipatory fixations in the number search task, i.e., a decrease in a good strategy in this low demand task. This was paired with a decrease in stimulus fixations. Together, these results point to a role of the rDLPFC in planning and response selection. Inhibition of the lDLPFC and the MFC resulted in an increase in anticipatory fixations in the number and letter search task, i.e., an increase in the application of a good strategy in this task. We interpret these results as a compensatory strategy to account for TMS-induced deficits in attentional switching when faced with high switching demands. After inhibition of the lDLPFC, an increase in regressive fixations was found in the number and letter search task. In the context of high working memory demands, this strategy appears to support TMS-induced working memory deficits. Combining an experimental TMS approach with the recording of eye movements proved sensitive to discrete decrements of executive functions and allows pinpointing the functional organization of the frontal lobes.

Pupillometry: the eyes shed fresh light on the mind

Recent studies provide promising methodological advances in the use of pupillometry as on-line measurement of cognitive processes and show that visual attention allocation, mind-wandering, mental imagery, and even rhyme expectations can influence the size of the human pupil.

Imperial Eyes. Van Dycks Porträtmalerei als globale Technologie

Zu Beginn des 17. Jahrhunderts hatte sich die Malerei in Antwerpen vor allem durch Rubens als Medium einer zunehmend global verbundenen Welt etabliert. Doch auch zahlreiche von Van Dycks Porträts sind Zeugnisse eines oft hochgradig ambivalenten Kosmopolitismus. Neben Gemälden von international agierenden Antwerpener Händlern und Gelehrten fertigte der Künstler auch in Genua und England Porträts der adligen Elite an, in welchen sich deren globale Erfahrungen und Ambitionen spiegelten. Van Dyck reagierte in der Inszenierung der Marchesa Elena Grimaldi Cattaneo, mit einem schwarzen Sklaven, wie in der des Earl of Denbigh, zwischen einheimischen und exotischen Elementen, auf spezifische Anforderungen an das repräsentative Porträt im Zeitalter des disenclavement. Diese Anforderungen werden besonders deutlich in dem für eine geplante Expedition nach Madagaskar entstandenen Porträt des Earls of Arundel und dessen Frau Alethea Talbot. Das Gemälde verbindet Elemente herrschaftlicher, merkantilistischer und intellektueller Selbststilisierung mit einer Reduktion auf wenige, innovative Elemente. Die majestätische Inszenierung des Paars ist nur in einem globalen Kontext zu erklären, so dass sich die Frage nach der Funktion des in mehreren Werkstattkopien erhaltenen Gemäldes stellt. Hatte Van Dyck in seiner Komposition eine Lösung gefunden, die im Kontext des englischen Hofes, möglicherweise als Teil eines Festes, wie auch für potentielle Investoren, sowie die verarmte Landbevölkerung, die in der Indentur ihre einzige Hoffnung sah, gleichermaßen überzeugend wirkte? Die Hybris in dem überlebensgroßen Porträts des Paares, das mit leuchtend heller Haut, in kostbar glänzende Stoffe gekleidet und mit modernen Messinstrumenten in den Händen dargestellt ist, lässt es als ideales Medium der globalen Ambitionen des Paars erscheinen.

Watching Eyes - Effekte an Recyclingsammelstellen

Weniger unsachgemässe Abfallentsorgung dank Watching Eyes – dies war die These unseres Feldexperiments. In fünf Gemeinden der Region Bern und Olten wurde während drei Monaten die Wirkung von aufklebbaren Augenpaaren (sog. „Watching Eyes“) auf die unsachgemässe Abfallentsorgung bei Recyclingsammelstellen getestet. Die Menge des Abfalls konnte durch Watching Eyes um bis zu 35 % reduziert werden. Ebenfalls bestätigt wurden die zusätzlichen Erwartungen, dass an Unterflur - Containertypen und an offen einsehbaren Sammelstellen weniger Müll unsachgemäss abgestellt wird. Alle Erkenntnisse passen in die Theorie, dass Benutzer der Sammelstellen sich eher normkonform verhalten, wenn sie sich beobachtet fühlen. Ausserdem macht diese Forschungsarbeit Hoffnung, dass Watching Eyes für ein gesellschaftsrelevantes Problem, die unsachgerechte Abfallentsorgung, Hilfestellung bieten können. Watching Eyes - Aufkleber entfalten ihren grössten Effekt auf soziales Verhalten bei dauerhafter Anwendung. Dieser Effekt vermag die illegal deponierten Müllmengen an Recyclingsammelstellen um rund ein Drittel zu reduzieren. Weiter kann Gemeinden empfohlen werden, in Unterfluranlagen zu investieren und von den alten, traditionellen Containern abzusehen, da dadurch die Menge deponierten Abfalls deutlich reduziert werden kann.