RESUMEN
OBJECTIVE: To assess residual postoperative refractive astigmatism following bilateral implantation of a trifocal toric intraocular lens (IOL) in a real-world multisurgeon setting. DESIGN: Prospective multisurgeon study (6 surgeons at 2 sites). METHODS: Bilateral implantation of a trifocal toric IOL (AcrySof PanOptix IOL; Alcon Vision LLC, Fort Worth, TX, USA) was performed in 140 eyes of 70 patients. Patients were assessed on day 1 and 3 months postoperatively. The primary outcome measure was residual astigmatism. Secondary endpoints included absolute prediction error, IOL rotation, binocular uncorrected and distance-corrected visual acuities at near (40 cm), intermediate (60 cm), and distance (6 m) and spectacle independence evaluated with the validated Intraocular Lens Satisfaction questionnaire. RESULTS: Mean preoperative cylinder was 1.25 ± 0.72 D and was 0.39 ± 0.28 D at 3 months postoperatively. At 3 months postoperatively, mean residual astigmatism was 0.39 ± 0.28 D (range, 0-1.25 D), and 118 eyes (84.3%) had postoperative astigmatism of 0.5 D or less. Mean absolute prediction error was 0.25 ± 0.21 D (range, 0-1.13 D), and 124 eyes (88.6%) had absolute prediction error of 0.5 D or less. At 3 months postoperatively, mean absolute rotation was 2.0 ± 2.7 degrees compared with baseline (range, 0-15 degrees), and 133 IOLs (95.0%) were within 5 degrees of the implanted axis. Additionally, 55 patients (79%) reported never or rarely using spectacles at near, 66 (94%) at intermediate, and 67 (96%) at distance. CONCLUSIONS: The results of this study demonstrate that implantation with the PanOptix toric IOL can provide excellent refractive and visual outcomes with minimal residual astigmatism.
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BACKGROUND: To construct a patient-based symptom questionnaire to facilitate early referral of thyroid-associated orbitopathy (TAO) in Graves' hyperthyroidism (GH). METHODS: Phase I of our study involved developing a symptomatology-based questionnaire for the self-reporting of TAO symptoms in patients recently diagnosed with GH. Phase II involved administering the questionnaire along with a standard ophthalmic examination to a screening cohort of patients newly diagnosed with GH. Symptoms highly associated with the clinical diagnosis of TAO were used to construct a tool with the highest possible sensitivity. Phase III involved validation of this tool in a new cohort of patients recently diagnosed with GH. For each patient, the diagnosis of TAO was made by both a standardized orbital ophthalmic exam and the questionnaire. Results from the questionnaire were then compared to the clinical examination. RESULTS: The questionnaire was compared to the standardized examination and found to have a sensitivity of 0.76 and a specificity of 0.82 in the validation phase of the study. INTERPRETATION: This questionnaire may be a useful tool in clinical practice to allow identification of patients with TAO secondary to GH. Future studies using this questionnaire are needed to determine whether earlier identification and management of these patients is associated with reduced morbidity from TAO.
Asunto(s)
Oftalmopatía de Graves/diagnóstico , Enfermedades Orbitales/diagnóstico , Encuestas y Cuestionarios , Diagnóstico Precoz , Reacciones Falso Negativas , Enfermedad de Graves/diagnóstico , Humanos , Radioisótopos de Yodo , Valor Predictivo de las Pruebas , Cintigrafía , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Enfermedades de la Tiroides/diagnóstico , Neoplasias de la Tiroides/diagnóstico por imagen , Tirotoxicosis/diagnóstico , Tirotropina/sangre , Imagen de Cuerpo EnteroRESUMEN
PURPOSE: To report novel immunoreactivity in a patient with melanoma-associated retinopathy. DESIGN: Retrospective case report and experimental study. METHODS: A 32-year-old woman with a history of metastatic melanoma presented with bilateral decreased visual acuity. Electroretinography, Goldmann perimetry, immunohistochemistry, and Western blotting of her serum were performed. RESULTS: Electroretinography showed a "negative" B-wave. Paracentral and central scotomas were observed on Goldmann perimetry. Antibodies to a retinal transducin were demonstrated by Western blotting. No immunoreactivity to retinal bipolar cells was detected by immunohistochemistry. CONCLUSION: Melanoma-associated retinopathy can be related to a variety of antiretinal antibodies. Recognition of transducin, a novel melanoma-associated retinopathy antigen, may be important for identifying and treating patients with night blindness and melanoma.