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Purpose: To verify the risk factors that influence the intraocular lens (IOL) dislocationMethods: The time to of in-the-bag IOL (242 eyes) dislocation after the initial surgery was examined using patient characteristics and risk factors. The examined risk factors included 11 factors associated with underlying diseases (trauma, pseudoexfoliation syndrome (PE), atopic dermatitis, retinitis pigmentosa, glaucoma attack, glaucoma, short axial length, long axial length, uveitis, scleral buckling, post-pars plana vitrectomy) and two factors associated with the initial surgical findings (zonular weakness [ZW], posterior capsule rupture).In addition, the 242 eyes were classified into four groups (group A, PE+ ZW+; group B, PE− ZW+; group C, PE+ ZW−; group D, PE− ZW−), and the dislocation period was examined.Results: The median patient age was 67 years, and the median time to dislocation after the first cataract surgery was 120 months. Among the risk factors, PE and ZW were significantly associated with the time to dislocation (both p < 0.05). In addition, the time to dislocation was significantly shorter in groups A (12.3 months) and B (83.6 months) than in group D (135.6 months; p < 0.001 and p = 0.007, respectively).Conclusions: The presence of PE and/or ZW increases the risk of IOL dislocation. However, positivity for PE alone may be associated with a lower risk of IOL dislocation, indicating the need to assess ZW in the initial surgery.

We present a semi-crater sculpting and split technique for simple nucleus removal and hydrodissection-free phacoemulsification. In this technique, the crater sculpting is done in half the nucleus only and emulsified before nucleus rotation. The remaining half of the nucleus is freed from the capsule and then rotated to the opposite side of the phaco tip and emulsified. This technique can be easily performed without hydrodissection because emulsifying half the nucleus creates a free space. It was used in 19 198 eyes between 2000 and 2013 and enabled stable phacoemulsification, regardless of the surgeon's experience. The technique prevents hydrodissection-related complications, such as posterior capsule rupture caused by high intraocular pressure changes, and reduces the stress on the zonule during nucleus rotation. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.

For concrete structures exposed to salt environment, the microstructure and cracks play a crucial role in the ingress of chloride ions into concrete. In this study, concrete is simulated on the meso scale as a three-phase composite, i.e., aggregate particles, mortar and the interfacial transition zone (ITZ). Because of the advantages in predicting cracks behavior in concrete, Rigid Body Spring Model (RBSM) is employed to carry out the mechanical analysis to simulate the distribution and width of microcracks. And then, the truss network model is adopted to evaluate the chloride diffusivity of the cracked concrete. On the basis of the statistics analysis of diffusion coefficients of concrete and mortar determined experimentally, the diffusivity of ITZ is analytically clarified. The range of diffusion coefficient of ITZ estimated in this paper is approximately 3-16 times of that of mortar depending on the different assumed thickness, which agrees well with that of the previous experimental results. With the aim to validate the effect of microcracks on the diffusivity of concrete, a series of the chloride ions penetrating analysis is numerically carried out on the concrete specimen under different stress levels. The axial compressive and tensile loading conditions are investigated respectively and the effects of stress level on chloride diffusivity of cracked concrete are examined. Results indicate that the chloride diffusivity is significantly dependent on the stress level, but only considering the effect of cracks predicted by RBSM is not sufficient. So an empirical equation which can account for the microstructure variation of concrete under loading is proposed. With it, a reasonable estimation for chloride diffusivity of cracked concrete is achieved.

Purpose To report the intermediate-term results of capsule stabilization for scleral fixation with implantation of the Yaguchi hook, a modified capsule expander stabilization hook. Setting Department of Ophthalmology, School of Medicine, University of Showa, Fujigaoka Rehabilitation Hospital, Yokohama, Japan. Design Retrospective case series. Methods Patients with zonular dialysis and phacodonesis were followed postoperatively for at least 2 years. All eyes had phacoemulsification and aspiration using an ordinary capsule expander and in-the-bag implantation of an intraocular lens (IOL). Capsule expanders were removed after the residual cortex was removed, and the capsular bag was fixated to the scleral wall via the ciliary sulcus using the modified capsule expander stabilization hook. Preoperative findings, intraoperative complications, and postoperative courses were examined. Results The mean age of the 11 patients (11 eyes) was 72.2 years ± 10.5 (SD); 5 patients were men. The mean postoperative follow-up was 48.6 ± 13.6 months. The zonular dialysis range was 90 to 180 degrees in 1 eye, 180 degrees in 4 eyes, and 180 to 270 degrees in 1 eye. In 5 eyes, severe phacodonesis was observed without obvious zonular dialysis. In all eyes, the capsular bag and IOL were well centered without severe intraoperative or postoperative complications. Conclusion The modified capsule expander stabilization hook provided good centration and stabilization of the capsule–IOL complex in eyes with severely weak zonular fibers. Financial Disclosure Dr. Yaguchi, who is the inventor of the modified capsule expander, has received financial support from Handaya, Tokyo, Japan. No other author has a financial or proprietary interest in any material or method mentioned.

Aims: To evaluate the influence of decentration on optical performance in multifocal intraocular lenses (IOLs) using eye models. Methods: This study evaluated 4 types of multifocal IOLs (ReSTOR SA60D3, Alcon; TECNIS Multifocal ZM900, AMO; ReZoom, AMO; SFX-MV1, Hoya). The evaluations were based on measurements of the near and far modulation transfer function (MTF) and visualized actual near images (newspaper) using eye models with the IOL horizontally displaced 0, 0.25, 0.5, 0.75 and 1.0 mm from the center. Results: For the diffractive ReSTOR the near MTF decreased with increasing decentration. The near images (newspaper characters) became difficult to distinguish at a decentration of 1.0 mm. For the diffractive ZM900, the near and far MTFs gradually decreased with increasing decentration. For the refractive ReZoom and SFX-MV1, we observed almost no change in the near MTF from a decentration of 0–1.0 mm. However, the far MTF clearly decreased starting at a decentration of 1.0 mm for ReZoom and 0.75 mm for SFX-MV1. Conclusion: The MTFs and near images are affected to a different extent depending on the design of multifocal IOLs; clinically relevant effects are not to be expected up to a decentration of 0.75 mm.

Postoperative vision-threatening corneal edema sometimes occurs after eye surgery, and corneal endothelial damage may be caused or exacerbated by drug toxicity. A range of commercially available antibiotic and anti-inflammatory ophthalmic solutions used postoperatively, namely levofloxacin, moxifloxacin, gatifloxacin, cefmenoxime, diclofenac, bromfenac, pranoprofen, betamethasone, and fluoromethorone, were assessed by using human corneal endothelial cells (HCECs). Propylparaoxybenzoate and methylparaoxybenzoate were also examined. Cell survival after 48 h exposure to the drugs was evaluated using the WST assay. Cefmenoxime and betamethasone were the least toxic antibiotic and anti-inflammatory drug, respectively. Cell survival was concentration dependent and increased markedly to ≥ 80% with dilutions of 100-fold or more. Two preservatives seemed to cause minimal cytotoxicity among those tested. Antibiotic cytotoxicity to HCEC was ranked as cefmenoxime < levofloxacin = gatifloxacin < moxifloxacin, while the toxicity of anti-inflammatory drugs was dependent on benzalkonium chloride and polysorbate. These drugs are unlikely to cause HCEC damage at the concentrations used under the usual conditions. Preservatives are essential ingredients in ophthalmic solutions to control postoperative infection and inflammation and we should be aware of their toxicity as well as efficacy.

Masahiko Ayaki1, Atsuo Iwasawa2, Mitsutaka Soda3, Shigeo Yaguchi3, Ryohei Koide41Department of Ophthalmology, Saitama National Hospital, Saitama, Japan; 2Department of Clinical Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan; 3Department of Ophthalmology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan; 4Department of Ophthalmology, Showa University School of Medicine, Tokyo, JapanPurpose: Epithelial disorders after eye surgery can result in visual deterioration and patient discomfort. Such disorders may be caused by drug toxicity. In the present study, we evaluated the toxicity of ophthalmic solutions, with or without benzalkonium chloride (BAK) as the preservative, used for postoperative care.Methods: A range of commercially available antibiotic and anti-inflammatory ophthalmic solutions used postoperatively (ie, levofloxacin, moxifloxacin, gatifloxacin, norfloxacin, tosufloxacin, dibekacin, cefmenoxime, diclofenac, bromfenac, pranoprofen, betamethasone, and fluoromethorone) were assessed in three corneal cell lines and one conjunctival cell line. All antibiotic solutions were BAK free. Cell viability was determined with the 3-(4,5-dimethyl-2 thiazoyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay after cells had been exposed to the drugs for 48 h. The effects of preservatives on cell viability were also determined. Toxicity was compared using the cell viability score (CVS).Results: Based on results of the MTT assay and CVS, the order of cell viability after exposure to the antibiotic solutions was cefmenoxime ≥ tosufloxicin ≥ dibekacin ≥ levofloxacin ≥ norfloxacin = gatifloxacin = moxifloxacin. For the anti-inflammatory solutions, the order of cell viability was betamethasone ≥ betamethasone + fradiomycin > preservative-free diclofenac ≥ preservative-free bromfenac >> 0.02% fluoromethorone ≥ 0.1% fluoromethorone = diclofenac + preservative = bromfenac + preservative = pranoprofen. The anti-inflammatory drugs were more toxic than the antibiotics. The toxicity of antibiotic drugs against ocular surface cells was dependent on the pharmaceutical components of the solution, whereas that of the anti-inflammatory drugs was dependent on both the pharmaceutical components and the preservatives.Conclusion: Postoperative drug-induced epitheliopathy may be caused primarily by anti-inflammatory drugs. CVS is useful in comparing the cytotoxicity of different drugs.Keywords: toxicity, preservative, cornea, eye

To evaluate the detrition of clear corneal incisions (CCIs) after intraocular lens (IOL) implantation using an injector system in porcine eyes.Group A: after CCIs were performed with 1.8, 2.0, 2.2, 2.4, and 2.65 mm wide slit knives, a Y-60 H (HOYA) IOL was implanted in the anterior chamber using an injector system. Group B: after CCIs were performed with 2.4, 2.65, 2.8, 3.0, and 3.2 mm wide slit knives, a PY-60 R (HOYA) IOL was implanted in the anterior chamber using an injector system. Group C: after CCIs were performed with 2.8, 3.0, 3.2, 3.4 mm wide slit knives, a SN 60 AT (Alcon) IOL was implanted in the anterior chamber using an injector system.CCIs were performed with 3.0 mm wide slit knives. Each group used five porcine eyes for each slit knife (Group A 25 eyes; Group B 25 eyes; Group C 20 eyes; CONTROL 5 eyes). The detrition of the CCIs was evaluated on three different aspects using a scanning electron microscope: a) external expansion at both edges of CCIs; b) rupture of the collagen fibers; c) expansion between the collagen fibers. Aspects a, b and c were given a score of 0, 1, and 2, respectively, and the total points were compared statistically between test and control groups.The degree of CCIs detrition was significantly reduced in CCIs with a width of more than 2.4 mm of CCIs width in Group A, more than 3.0 mm in Group B, and more than 3.2 mm in Group C.Minimizing the detrition of corneal incisions after IOL implantation needs a larger than the recommended width of corneal incision.

To observe the retinopathy of the patients who received interferon/ribavirin for treatment of chronic hepatitis C.We observed 6 patients(5 males and 1 female) who received interferon/ribavirin for treatment of chronic hepatitis C. Visual acuity tests and detailed fundus examinations were performed monthly during 6 months of interferon/ribavirin therapy.All patients developed soft retinal exudate and 5 developed retinal blot hemorrhage. None of the patients exhibited visual impairment or subjective symptoms during the treatment period, and the retinopathy disappeared or decreased in all patients. All of the patients in this study developed interferon retinopathy while undergoing interferon/ribavirin combination therapy.Because the combination of ribavirin with interferon may increase the incidence of interferon retinopathy, and cases of severe retinal complications have also been reported, careful fundus examinations should be performed during combination therapy, just as they are performed during conventional interferon therapy.