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Capsular outcomes of anterior/posterior capsulorhexis opening (ACO/PCO) are essential for performing a secondary in-the-bag intraocular lens implantation. To compare the capsular outcomes with different primary capsulorhexis sizes, Thirty-eight eligible patients (45 eyes) were randomly assigned to three groups by anterior capsulorhexis diameter (Group A: 3.0–3.9, Group B: 4.0–5.0 and Group C: 5.1–6.0 mm). The areas of ACO/PCO and posterior capsule opening opacity (PCOO) as primary outcomes, while, the incidence of visual axis opacity (VAO) as secondary outcome were measured at follow-up visits. Among the thirty eyes included in the final analysis, the mean area of the ACO decreased significantly, whereas the PCO enlarged with time. Group A had the highest anterior capsule constriction and percentage reduction, which increased with time. There were significant differences in the percentage reductions at 6 months and 1 year compared to 1 month in Group A and B. Group C had the highest posterior capsule enlargement. The percentage of PCOO to PCO area and the incidence of VAO was highest in Group A and lowest in Group C. Thus, Capsulorhexis diameter of 4.0–5.0 mm may yield better capsular outcomes, considering moderate contraction of ACO, moderate enlargement of PCO and lower percentage of PCOO and VAO.

Purpose To compare capsular bag stability and posterior capsule opacification (PCO) of a plate-haptic intraocular lens (IOL) and a standard three-piece open-loop-haptic IOL of the same acrylic material. Methods In this randomised bilateral patient-masked and examiner-masked study, each patient received a microincision cataract surgery IOL (MICS IOL; Acri.Smart 46S=CT SHERIS 209M) in one eye and a small incision cataract surgery IOL (SICS IOL; AcriLyc 53N = CT 53N, both Carl Zeiss Meditec AG, Germany) as a control in the contralateral eye. Follow-up examinations were performed 1 h, 1 week, 1 month, 1 year and 3 years postoperatively. Anterior chamber depth (ACD) was measured and retroillumination images were performed at all postoperative follow-ups. Furthermore, uncorrected and corrected distance visual acuity, autorefraction and subjective refraction were assessed. Results In total, 50 eyes of 25 patients were included. The ACD difference between the MICS IOL and the SICS IOL was not significant at any time point (p>0.05). Distance-corrected visual acuity at the 3-year follow-up was similar and not significantly different between the groups (p=0.48). Mean AQUA score in the MICS IOL group and in the SICS IOL group at the 3-year follow-up was 2.3 (SD ±2.3) and 2.1 (SD ±2.2), respectively (p=0.79). Conclusions The investigated hydrophilic acrylic plate-haptic MICS IOL with a hydrophobic surface showed comparable results concerning capsular bag stability and PCO rates up to 3 years compared with a SICS IOL of the same material.

Aim To investigate changes in central corneal thickness (CCT) and intraocular pressure (IOP) in children after congenital cataract surgery, as well as risk factors associated with these changes. Methods 37 eyes of 26 children with congenital cataract undergoing surgery were prospectively recruited. IOP and CCT measurements were performed before the surgery and 6, 12, 18, 24 and 36 months after the procedure. Results Among the 37 eyes, 15 became aphakic and 22 pseudophakic. Mean CCT significantly increased from 556.24±44.19 to 585.07±56.45 μm (p=0.003) after 3 years, whereas mean IOP significantly increased from 12.05±2.3 to 13.89±2.96 mm Hg (p=0.037). Aphakic eyes underwent surgery at an early age (15.16±32.02 months) compared with pseudophakic eyes (71.48±53.14 months) (p<0.001). After 3 years, mean CCT change in aphakic eyes (56.10±46.97 μm) was significantly higher than in pseudophakic eyes (12.71±38.41 μm) (p=0.015). Age at the time of surgery was inversely correlated to CCT change (r=−0.34, p=0.04), but not to IOP change (r=−0.18, p=0.27). When surgery was performed between 0 and 1 year of age, mean CCT change at 3 years was 70.11±42.3 μm, compared with 6.27±28.09, −17.0±8.04 and 48.33±34.99 μm when surgeries were performed at 1–5, 5–10 and >10 years old, respectively (p<0.001). IOP change was not correlated to CCT change (r=0.31, p=0.06). Conclusions CCT increases in eyes undergoing congenital cataract surgery, especially when the surgery is performed at an early age.

PURPOSE: To assess the performance of a novel keratometer based on reflections of colored light-emitting diodes (LEDs) and compare it with devices based on Placido rings, monochromatic LEDs, and Scheimpflug images. METHODS: Sixty-three eyes of 63 patients with virgin corneas underwent keratometry with color-LED corneal topography (Cassini; i-Optics, The Hague, The Netherlands) and with devices based on Placido ring reflections (Keratron; Optikon, Rome, Italy), monochromatic LED reflections (Lenstar; Haag-Streit, Koeniz, Switzerland), and Scheimpflug imaging (Pentacam; Oculus Optikgeräte, Wetzlar, Germany). Three repeated measurements were performed with each device. Comparability and repeatability of corneal power and cylinder measurements were assessed. The Bonferroni-corrected α-threshold for statistical significance was 0.016. RESULTS: Corneal power measurements with the Cassini topographer were not statistically significantly different from those with the Pentacam (Corneal power measurements with the Cassini topographer were not statistically significantly different from those with the Pentacam ( P = .64). They were statistically significantly lower than those with the Keratron and Lenstar ( P < .01), but the differences were of negligible clinical relevance. Cylinder measurements with the Cassini topographer were not statistically significantly different from those with any other device ( P = .46). Repeatability of Cassini corneal power measurements was not statistically significantly different from that of the Keratron ( P = .02), but was statistically significantly lower than that of the Lenstar and Pentacam ( P < .001). Repeatability of Cassini cylinder measurements was statistically significantly higher than that of the Pentacam and Keratron ( P < .001), but was not statistically significantly different from that of the Lenstar ( P > .05). CONCLUSIONS: Corneal power and cylinder measurements with color-LED corneal topography yielded values that were comparable to those of other commonly used devices. Repeatability of corneal power measurements was lower compared to some devices, but repeatability of cylinder measurements was relatively high. This may be of particular interest when using toric intraocular lenses. [[ J Refract Surg. 2015;31(4):249–256.]

Exploring the genetic basis of congenital cataracts in two families identifies a molecule, lanosterol, which prevents intracellular protein aggregation of various cataract-causing mutant crystallins, and which can reduce cataract severity and increase lens transparency in vivo in dogs. Lanosterol counters cataract formation In a study of the genetic basis of congenital cataract formation in two families, Kang Zhang and colleagues demonstrate that lanosterol, a sterol present naturally in the lens, can prevent intracellular aggregation of various cataract-causing mutant crystallin proteins. The mutations identified in the genetic study impair the function of lanosterol synthase, an enzyme for synthesizing lanosterol. In dogs with naturally occurring cataracts, the application of eye drops containing lanosterol for six weeks reduced cataract severity and increased lens transparency, suggesting that lanosterol or molecules with similar activity might provide an alternative to surgery for the management of cataracts. The human lens is comprised largely of crystallin proteins assembled into a highly ordered, interactive macro-structure essential for lens transparency and refractive index. Any disruption of intra- or inter-protein interactions will alter this delicate structure, exposing hydrophobic surfaces, with consequent protein aggregation and cataract formation. Cataracts are the most common cause of blindness worldwide, affecting tens of millions of people 1 , and currently the only treatment is surgical removal of cataractous lenses. The precise mechanisms by which lens proteins both prevent aggregation and maintain lens transparency are largely unknown. Lanosterol is an amphipathic molecule enriched in the lens. It is synthesized by lanosterol synthase (LSS) in a key cyclization reaction of a cholesterol synthesis pathway. Here we identify two distinct homozygous LSS missense mutations (W581R and G588S) in two families with extensive congenital cataracts. Both of these mutations affect highly conserved amino acid residues and impair key catalytic functions of LSS. Engineered expression of wild-type, but not mutant, LSS prevents intracellular protein aggregation of various cataract-causing mutant crystallins. Treatment by lanosterol, but not cholesterol, significantly decreased preformed protein aggregates both in vitro and in cell-transfection experiments. We further show that lanosterol treatment could reduce cataract severity and increase transparency in dissected rabbit cataractous lenses in vitro and cataract severity in vivo in dogs. Our study identifies lanosterol as a key molecule in the prevention of lens protein aggregation and points to a novel strategy for cataract prevention and treatment.

Despite recommendation of surgery in both eyes in patients with bilateral cataract, there is little evidence about the benefits of second-eye surgery. The objective of this study was to compare the benefits of cataract surgery in both eyes with those of surgery in one eye only. Two-arm randomized controlled trial involving 296 patients with bilateral cataracts of two public teaching hospitals. Patients were randomly assigned to receive surgery in one eye only (control group) or surgery in both eyes, one eye at a time (intervention group). The main outcome measures were binocular visual acuity, binocular contrast sensitivity, stereopsis, and patient-reported visual disability (VF-14), measured 4–6 months postoperatively. A total of 135 (91.2%) and 139 (93.9%) patients completed the trial in the control and intervention groups, respectively. Postoperatively, intervention group presented a better visual acuity (difference of 0.07; 95% CI = 0.03, 0.12), stereopsis (0.62 log sec arc; 95% CI = 0.45, 0.79), and VF-14 (8.2 points; 95% CI = 4.4, 12.4). No significant differences were found for contrast sensitivity. Bilateral cataract patients should have surgery in both eyes. Including stereopsis and patient-reported visual disability in the assessment of cataract patients, especially after first-eye surgery, will improve the evaluation of effectiveness.

Gap junctions consist of arrays of intercellular channels that enable adjacent cells to communicate both electrically and metabolically. Gap junctions have a wide diversity of physiological functions, playing critical roles in both excitable and non-excitable tissues. Gap junction channels are formed by integral membrane proteins called connexins. Inherited or acquired alterations in connexins are associated with numerous diseases, including heart failure, neuropathologies, deafness, skin disorders, cataracts and cancer. Gap junctions are highly dynamic structures and by modulating the turnover rate of connexins, cells can rapidly alter the number of gap junction channels at the plasma membrane in response to extracellular or intracellular cues. Increasing evidence suggests that ubiquitination has important roles in the regulation of endoplasmic reticulum-associated degradation of connexins as well as in the modulation of gap junction endocytosis and post-endocytic sorting of connexins to lysosomes. In recent years, researchers have also started to provide insights into the physiological roles of connexin ubiquitination in specific tissue types. This review provides an overview of the advances made in understanding the roles of connexin ubiquitination in the regulation of gap junction intercellular communication and discusses the emerging physiological and pathophysiological implications of these processes.

The repair and regeneration of tissues using endogenous stem cells represents an ultimate goal in regenerative medicine. To our knowledge, human lens regeneration has not yet been demonstrated. Currently, the only treatment for cataracts, the leading cause of blindness worldwide, is to extract the cataractous lens and implant an artificial intraocular lens. However, this procedure poses notable risks of complications. Here we isolate lens epithelial stem/progenitor cells (LECs) in mammals and show that Pax6 and Bmi1 are required for LEC renewal. We design a surgical method of cataract removal that preserves endogenous LECs and achieves functional lens regeneration in rabbits and macaques, as well as in human infants with cataracts. Our method differs conceptually from current practice, as it preserves endogenous LECs and their natural environment maximally, and regenerates lenses with visual function. Our approach demonstrates a novel treatment strategy for cataracts and provides a new paradigm for tissue regeneration using endogenous stem cells. A new procedure for cataract removal that preserves lens epithelial progenitor cells in mammals, which require Pax6 and Bmi1 for their self-renewal, achieves lens regeneration in rabbits, macaques and in infants with cataracts. Sight restoration through cellular regeneration The only current treatment for cataracts, the leading cause of blindness, is to extract the damaged lens surgically and implant an artificial intraocular lens. The technique has its limitations, so there is great interest in the possibility of a regenerative medicine approach. Two papers published in this issue of Nature report advances that could bring that prospect a little closer. Kang Zhang and colleagues isolate mammalian lens epithelial stem/progenitor cells and show that Pax6 and Bmi1 are required for their renewal. They have also developed a removal procedure for cataract-affected tissue that preserves these cells, and achieved lens regeneration in rabbits, macaques and in human infants with cataracts. In the second paper, Kohji Nishida and colleagues describe a protocol for in vitro generation of a self-formed ectodermal autonomous multi-zone (SEAM) from human induced pluripotent stem cells. The SEAM includes distinct cell lineages from the ocular surface ectoderm, lens, neuro-retina, and retinal pigment epithelium. Previous experiments had focused mainly on obtaining one cell type. These authors show that cells from the SEAM can be expanded to form a functional corneal epithelium when transplanted to an animal model of blindness.

Purpose: To determine the effect of a capsular tension ring (CTR) implantation in preventing posterior capsular opacification (PCO) after cataract surgery in patients with high myopia. Materials and Methods: In this prospective single-surgeon standardized-surgical-procedure fellow-eye comparison trial, 34 patients with high myopia had phacoemulsification surgery. Although one eye received an acrylic intraocular lens (IOL) and CTR, other eye received only an IOL as control. PCO, within the capsulorhexis overlap, was documented by standardized digital retroillumination images at least 2 years post-operatively, and the percentage area of PCO was scored (scale 0%-100%) using the POCOman software system. The PCO score and the incidence of neodymium-doped yttrium aluminum garnet (Nd: YAG) capsulotomy of groups, and correlations between PCO score and presence of CTR, age, phaco time, refraction, and axial length (AL) were determined. Results: The mean time interval from surgery to PCO measurement was 43.4 ± 11.2 months for the eyes with a CTR and 43.1 ± 11.6 months for the controls (P = 0.91). The PCO score of the eyes with a CTR was significantly lower than in the controls (5.9 ± 4.3 vs. 22.3 ± 12.2, respectively; P < 0.001). There were statistically insignificant correlations between PCO score and pre-operative refraction (r = 0.02; P = 0.90), AL (r = 0.03; P = 0.80), phaco time (r = 0.11; P = 0.53), and patient′s age (r = 0.23; P = 0.55). No patient with a CTR had a Nd: YAG laser capsulotomy, but it was six in controls (P = 0.025). Conclusions: CTR implantation seems to be effective in reducing the PCO and Nd: YAG laser capsulotomy rates in high myopic eyes.

Cataract is a visible opacity in the lens substance, which, when located on the visual axis, leads to visual loss. Age-related cataract is a cause of blindness on a global scale involving genetic and environmental influences. With ageing, lens proteins undergo non-enzymatic, post-translational modification and the accumulation of fluorescent chromophores, increasing susceptibility to oxidation and cross-linking and increased light-scatter. Because the human lens grows throughout life, the lens core is exposed for a longer period to such influences and the risk of oxidative damage increases in the fourth decade when a barrier to the transport of glutathione forms around the lens nucleus. Consequently, as the lens ages, its transparency falls and the nucleus becomes more rigid, resisting the change in shape necessary for accommodation. This is the basis of presbyopia. In some individuals, the steady accumulation of chromophores and complex, insoluble crystallin aggregates in the lens nucleus leads to the formation of a brown nuclear cataract. The process is homogeneous and the affected lens fibres retain their gross morphology. Cortical opacities are due to changes in membrane permeability and enzyme function and shear-stress damage to lens fibres with continued accommodative effort. Unlike nuclear cataract, progression is intermittent, stepwise and non-uniform.