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PURPOSE: To evaluate refractive outcomes for the Clareon® monofocal IOL in terms of achieved target refraction for the ORA® Intraoperative Wavefront Aberrometry device (Alcon Laboratories,Inc.) and preoperative noncontact biometry.SETTING: University Eye Clinic Maastricht, Maastricht University Medical Center+, the Netherlands.DESIGN: Prospective observational clinical trial.METHODS: Patients with bilateral age-related cataracts undergoing phacoemulsification, either by delayed sequential surgery or on the same day, were included in the study. Exclusion criteria were an increased risk of refractive surprise or complicated surgery. Implanted IOL power was based on noncontact optical biometry data using the Barrett Universal II formula (BU-II), optimized for the Clareon®IOL. Postoperative subjective refraction was measured four to six weeks after surgery. Catquest-9SF questionnaires were completed preoperatively and three months after surgery.RESULTS: One hundred eyes (51 patients) were included. The percentage of eyes within 1.0D, 0.75D, 0.50D and 0.25D of target for ORA vs. BU-II were 84% (84 eyes), 72% (72 eyes), 57% (57 eyes) and 21% (21 eyes) vs. 97% (97 eyes), 88% (88 eyes), 77% (77 eyes) and 53% (53 eyes), respectively. Mean absolute prediction error was significantly higher for ORA vs. preoperative biometry(P<0.001). After global optimization, the prediction accuracy of ORA improved significantly (P<0.001). Catquest-9SF questionnaires showed improved levels of ability at three months after surgery (P<0.001).CONCLUSIONS: This study showed lower percentages of eyes within target refraction for ORA (prior to lens constant optimization) compared to the BU-II formula when implanting the Clareon®IOL. However, prediction accuracy of ORA improved significantly after global optimization. Therefore, further intraoperative measurements, postoperative measurements, and optimization are needed to improve the ORA prediction for

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.

Treatment of glioblastoma xenografts with chloroquine results in macroautophagy/autophagy inhibition, resulting in a reduction of tumor hypoxia and sensitization to radiation. Preclinical data show thatEGFRvIII-expressing glioblastoma may benefit most from chloroquine because of autophagy dependency. This study is the first to explore the safety, pharmacokinetics and maximum tolerated dose of chloroquine in combination with radiotherapy and concurrent daily temozolomide in patients with a newly diagnosed glioblastoma. This study is a single-center, open-label, dose-finding phase I trial. Patients received oral chloroquine daily starting one week before the course of chemoradiation (temozolomide 75 mg/m(2)/d) until the end of radiotherapy (59.4 Gy/33 fractions). Thirteen patients were included in the study (n = 6: 200 mg, n = 3: 300 mg, n = 4: 400 mg chloroquine). A total of 44 adverse events, possibly related to chloroquine, were registered including electrocardiogram QTc prolongation, irreversible blurred vision and nausea/vomiting resulting in cessation of temozolomide or delay of adjuvant cycles. The maximum tolerated dose was 200 mg chloroquine. Median overall survival was 16 months (range 2-32). Median survival was 11.5 months forEGFRvIII- patients and 20 months forEGFRvIII+ patients. A daily dose of 200 mg chloroquine was determined to be the maximum tolerated dose when combined with radiotherapy and concurrent temozolomide for newly diagnosed glioblastoma. Favorable toxicity and promising overall survival support further clinical studies.

PURPOSE: To evaluate refractive outcomes for the Clareon® monofocal IOL in terms of achieved target refraction for the ORA® Intraoperative Wavefront Aberrometry device (Alcon Laboratories,Inc.) and preoperative noncontact biometry.SETTING: University Eye Clinic Maastricht, Maastricht University Medical Center+, the Netherlands.DESIGN: Prospective observational clinical trial.METHODS: Patients with bilateral age-related cataracts undergoing phacoemulsification, either by delayed sequential surgery or on the same day, were included in the study. Exclusion criteria were an increased risk of refractive surprise or complicated surgery. Implanted IOL power was based on noncontact optical biometry data using the Barrett Universal II formula (BU-II), optimized for the Clareon®IOL. Postoperative subjective refraction was measured four to six weeks after surgery. Catquest-9SF questionnaires were completed preoperatively and three months after surgery.RESULTS: One hundred eyes (51 patients) were included. The percentage of eyes within 1.0D, 0.75D, 0.50D and 0.25D of target for ORA vs. BU-II were 84% (84 eyes), 72% (72 eyes), 57% (57 eyes) and 21% (21 eyes) vs. 97% (97 eyes), 88% (88 eyes), 77% (77 eyes) and 53% (53 eyes), respectively. Mean absolute prediction error was significantly higher for ORA vs. preoperative biometry(P<0.001). After global optimization, the prediction accuracy of ORA improved significantly (P<0.001). Catquest-9SF questionnaires showed improved levels of ability at three months after surgery (P<0.001).CONCLUSIONS: This study showed lower percentages of eyes within target refraction for ORA (prior to lens constant optimization) compared to the BU-II formula when implanting the Clareon®IOL. However, prediction accuracy of ORA improved significantly after global optimization. Therefore, further intraoperative measurements, postoperative measurements, and optimization are needed to improve the ORA prediction for

Phakic intraocular lenses (pIOLs) are a common solution for the surgical correction of high myopia and myopia in thin corneas. Global trends result in increasing rates of patients with high myopia which will result in increased rates of pIOL implantation. Three types of lenses can be distinguished: anterior chamber angle-supported, anterior chamber iris-fixated, and posterior chamber phakic IOLs. The efficacy of phakic intraocular lenses is generally very good, but pIOLs have undergone many changes over the years to improve the safety profile and decrease pIOL-related complications such as endothelial cell loss, corneal decompensation and cataract formation. This article describes the efficacy and safety profiles of the most recent pIOLs, as well as suggests gaps of knowledge that are deserve additional research to optimize the results of pIOLs.

PURPOSE: To compare visual outcomes, reading ability, and visual quality between the Symfony extended depth-of-focus intraocular lens (IOL) and the trifocal AT LISA tri 839MP IOL.SETTING: University Eye Clinic Maastricht, The Netherlands.DESIGN: Prospective randomized controlled trial.METHODS: Patients were randomly assigned to bilateral Symfony IOL or AT LISA tri 839MP IOL implantation. The primary outcome measure was uncorrected intermediate visual acuity (UIVA measured at 66 cm). Secondary outcomes included uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), reading ability, and comparison of defocus curves, contrast sensitivity, optical adverse effects, and quality of vision.RESULTS: The study enrolled 60 eyes of 30 patients. The mean UIVA was -0.02 ± 0.03 (SD) vs 0.01 ± 0.03 logarithm of the minimal angle of resolution (logMAR) in the Symfony and AT LISA tri 839MP groups, respectively (P = .047). The UDVA was 0.01 ± 0.12 and -0.05 ± 0.07 logMAR (P = .11) and the UNVA was 0.09 ± 0.05 and 0.04 ± 0.07 logMAR (P = .052) in the Symfony and AT LISA tri 839MP groups, respectively. Reading ability was similar in both groups at 40 cm and 66 cm (P = .87 and P = .14, respectively). Less than 10% of patients in both groups experienced disabling glare. Patients experienced disabling halos in the AT LISA tri 839 MP group compared to the Symfony group in 39% and 21% of cases, respectively (P = .12). The mean score for visual functioning was 88.0 ± 14.1 n the trifocal group and 88.2 ± 10.9 for the EDOF group (P = .96).CONCLUSIONS: The UIVA was better in the Symfony group than in the AT LISA tri 839MP group. No significant differences were seen in the binocular UNVA and UDVA, contrast sensitivity, reading ability, incidence of photopic phenomena, and patient satisfaction.

Purpose: To evaluate the cost-effectiveness of toric versus monofocal intraocular lens (100 implantation in cataract patients with bilateral corneal astigmatism.Setting: Two ophthalmology clinics in the Netherlands.Design: Prospective cost-effectiveness analysis.Methods: Resource-use data were collected over a 6-month postoperative period. Consecutive patients with bilateral age-related cataract and 1.25 diopters or more of corneal astigmatism were included in the economic evaluation. Patients were randomized to phacoemulsification with bilateral toric or monofocal IOL implantation. All relevant resources were included in the cost analysis. The base-case analysis was performed from a societal perspective based on quality-adjusted life years (QALYs). The main outcome was the incremental cost-effectiveness ratio.Results: The analysis comprised 77 consecutive patients (33 toric IOL; 44 monofocal IOL). Societal costs were higher in the toric IOL group ((sic)3203 [$3864]) than in the monofocal IOL group ((sic)2796 [US$3373]). QALYs were slightly lower in the toric IOL group (0.30 versus 0.31; P = .75). Toric IOLs were therefore inferior to monofocal IOLs from a cost-effectiveness perspective. The cost-effectiveness probability ranged from 1% to 15%, assuming a ceiling ratio for the incremental cost-effectiveness ratio of (sic)2500 to (sic)20 000 per QALY.Conclusions: From a societal perspective, bilateral toric IOL implantation in cataract patients with corneal astigmatism was not cost-effective compared with monofocal IOL implantation. Copayment by patients should therefore be considered. (C) 2018 ASCRS and ESCRS

Purpose: To evaluate the long-term refractive and visual, anterior chamber depth, and axial length (AL) changes and complications after rigid iris-fixated phakic intraocular lens (pIOL) implantation to treat myopia or astigmatism.Setting: University Eye Clinic Maastricht, Maastricht UMC + , the Netherlands.Design: Prospective case series.Methods: The study evaluated patients who had implantation of an Artisan myopic or toric iris-fixated pIOL as of January 1998. Changes were measured annually and reported after 1, 5, and 10 years postoperatively.Results: The study comprised 460 eyes (250 patients; mean age 41.1 years +/- 10.7 [SD]). Over 10 years, the mean myopization was -0.79 diopters (D) (P <.001), with 52% of eyes within +/- 1.0 D of target. The mean increase in the logarithm of the minimum angle of resolution (logMAR) corrected distance visual acuity (CDVA) over 10 years was 0.05 (P <.001); 95% of eyes had a CDVA of 20/40 or more and 7% lost 2 or more lines of CDVA. The mean logMAR uncorrected visual acuity (UDVA) increased by 0.14 over 10 years (P <.001); 96% had a UDVA 20/40 or better. The AL increased by 1.14 mm over 10 years (P = .009). Ten percent of pIOLs were explanted because of cataract formation after a mean of 97.9 +/- 34.9 months. A higher preoperative age (hazard ratio [HR], 1.08; P <.001) and longer AL (HR, 1.34; P <.001) were risk factors for shorter survival because of cataract formation.Conclusion: Ten years after rigid iris-fixated pIOL implantation, the CDVA and UDVA decreased significantly as a result of significant myopization caused by an increased AL unrelated to the pIOL. (C) 2019 ASCRS and ESCRS

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 <.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 > .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 > .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. (C) 2017 ASCRS and ESCRS

Anand Vinekar,1 Chaitra Jayadev,1 Siddesh Kumar,2 Shwetha Mangalesh,1,3 Mangat Ram Dogra,4 Noel J Bauer,5 Bhujang Shetty6 1Department of Pediatric Retina, Narayana Nethralaya Eye Hospital, Bangalore, 2Raichur Institute of Medical Sciences, Raichur, Karnataka, India; 3Department of Ophthalmology, Duke University, Durham, NC, USA; 4Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India; 5Department of Ophthalmology, Maastricht University of Health Sciences, Maastricht, the Netherlands; 6Department of Ophthalmology, Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India Purpose: To report the reduction in the incidence and severity of retinopathy of prematurity (ROP) in rural India over a 4-year period following the introduction of improved neonatal care practices. Methods: The Karnataka Internet Diagnosis of Retinopathy of Prematurity program (KIDROP), is a tele-medicine network that screens for ROP in different zones of Karnataka state in rural India. North Karnataka is the most underdeveloped and remote zone of this program and did not have any ROP screening programs before the intervention of the KIDROP in 2011. Six government and eleven private neonatal centers in this zone were screened weekly. Specific neonatal guidelines for ROP were developed and introduced in these centers. They included awareness about risk factors, oxygen regulation protocols, use of pulse oxymetry, monitoring postnatal weight gain, nutritional best practices, and management of sepsis. The incidence and severity of ROP were compared before the guidelines were introduced (Jan 2011 to Dec 2012) and after the guidelines were introduced (July 2013 to June 2015). Results: During this 4-year period, 4,167 infants were screened over 11,390 imaging sessions. The number of enrolled infants increased from 1,825 to 2,342 between the two periods (P<0.001). The overall incidence of any stage ROP reduced significantly from 26.8% to 2