Rotational stability and clinical outcomes of a new one piece toric intraocular lens with anchor-wing haptics

Background To evaluate the safety and efficacy of a new toric intraocular lens (IOL) with anchor-wing haptics. Methods The new toric IOL with anchor-wing haptics (NS60YT, NIDEK Co., Ltd.) was implanted in eligible patients with age-related cataracts with preoperative corneal astigmatism of 1.0 D or greater at a university hospital and two private hospitals in Japan. The following IOL cylinder powers were evaluated: 1.50 D (NS60YT3), 2.25 D (NS60YT4), 3.00 D (NS60YT5) and 4.50 D (NS60YT7). All patients were assessed out to 12 months postoperatively. The primary endpoint was visual acuity (VA) with spherical addition at 6 months postoperatively, and the primary analysis calculated the proportion of eyes with VA with spherical addition of 0.1 logMAR or better. The magnitude of rotation was compared to the intended axis of IOL implantation at each postoperative examination. Adverse events were evaluated for the safety analysis. Results This study enrolled 64 eyes of 53 patients. At 6 months postoperatively, for all IOL powers, VA with spherical addition of 0.1 logMAR or better was achieved in 90% [95% confidence interval (CI): 80–96] of eyes. The mean IOL rotation was 5.3 ± 4.3° at 12 months postoperatively. The mean magnitude of rotation ranged from 1.9° to 2.5° between each postoperative examination from 1 day to 12 months. There were no vision-threatening intraoperative or postoperative complications for the duration of the study. Conclusions The NS60YT IOL remained stable after implantation and was efficacious for treating 1.00 D or greater astigmatism in patients with senile cataracts. Trial registration This study was registered at ClinicalTrials.gov (NCT03242486) on August 8, 2017 - Retrospectively registered.

Two-stage treatment of ametropia in patients with keratoconus and cataracts

Keratoconus (KC) is a progressive degenerative corneal disease, leads to the aberration of biomechanical and optical properties and thinning of the cornea, causes astigmatism and decreases visual acuity.Materials and methods. 33 patients (35 eyes) with stages II–III of non-progressive keratoconus and concomitant cataracts of various stages of maturity were operated on. The average age of the patients was 46.5 ± 2.7 (41–63) years old. The operations were performed according to our proposed two-stage method of treating ametropia in patients with KC and cataracts (Patent of the Russian Federation No. 2748634 of 28.05.2021). The first stage was the implantation of FERRARA intrastromal corneal ring segments (ICRS) with thickness from 150 to 350 μm. To correct residual refractive error in 5–7 months after stage 1, patients underwent stage 2: cloudy lens was removed and replaced with toric posterior chamber intraocular lens (TIOL) – AcrySof IQ Toric (Alcon, USA), T-fl ex Toric RayOne (Rayner, UK).Results and discussion. After stage 1 of the operation (ICRS implantation), the uncorrected visual acuity (NCVA) was 0.2 ± 0.03, the best corrected visual acuity (BCVA) was 0.4 ± 0.02. In 1 month after stage 2 (phacoemulsifi cation + TIOL) NCVA was 0.64 ± 0.11 and BCVA was 0.74 ± 0.12. During the entire follow-up period after the surgery visual functions, refraction, and rotational stability of TIOL were stable.Conclusions. Conducting a two-stage surgical intervention in patients with keratoconus and cataracts allows to stop the progression of the disease and effectively correct the ametropia concomitant with keratoconus.

Rotational Stability of Proximally Unlocked Retrograde Femoral Nail In Damage Control Surgery – Biomechanical Study

BACKGROUND: This biomechanical study was performed to look into the rotational stability of retrograde femoral intramedullary nail when it is used without proximal locking as a damage control device for management of femoral shaft fractures in emergency situations. This study compares this technique with the accepted methods for femoral shaft fixations in damage control surgeries. An alternative technique of using lateral compression screw to provide additional rotational stability is described.METHODS: Experiments were divided into four different sets. Distally locked retrograde nail was passed across the fracture without any proximal fixation in set 1, a compression screw passed from lateral cortex in set 2, a proximal locking screw fixation in set 3. In set 4, Saw bone was fixed with external fixator.The lateral compression screw group was further sub divided into three subgroups based on the amount of torque applied manually.The torsion test was applied to create an rotational displacement of 10 degrees and the maximum load required to create the rotational displacement was noted.RESULTS: Application of a compression screw improved the rotational stability significantly in comparison to no proximal locking. In the subgroup III of lateral compression screw application, the rotational stability was found to be equivalent to stability achieved with Nail with proximal locking and was found to be greater in comparison to external fixator application.CONCLUSION: This study shows that the addition of a lateral compression screw significantly improves rotational stability and has the potential to be used in emergency lifesaving procedures.

Analys of multifocal and toric extended depth of focus intraocular lenses implantation

Purpose. Analysis of the functional results of new IOL with an extended depth of focus implantation a in the short-term (6 months) follow-up period. Material and methods. The prospective study included 27 patients (40 eyes) after bilateral (n=12) or monolateral (n=15) implantation of EDOF IOL Tecnis Symfony with an average follow-up period of 6.5±0.2 (6-7) months. In all cases, IOL implantation was preceded by cataract phacoemulsification or removal of the transparent lens for refractive purposes. The age range was from 39 to 78 (60.6±10.1) years. EDOF IOL Tecnis Symfony ZXR00 was implanted in 30 eyes, and toric EDOF IOL Tecnis Symfony ZXT100, ZXT150, ZTX225, and ZXT300 were implanted in 10 eyes in the presence of clinically significant astigmatism. Results. An increase in UCNVA from 0.18±0.04 to 0.79±0.11, UCIVA from 0.21±0.07 to 0.89±0.10, UCDVA from 0.24±0.06 to 0.95±0.16, BCNVA from 0.61±0.05 to 0.80±0.03, BCIVA from 0.58±0.10 to 0.97±0.19, and BCDVA from 0.65±0.08 to 1.0±0.06 (p<0.05 in all cases). The spherical equivalent of refraction decreased from -4.5±1.8 in the preoperative period to -0.18±0.92 in the follow-up period of 6 months after implantation of the Tecnis Symfony ZXR00 IOL. In the group with toric IOLs, a decrease in the cylindrical component of refraction was shown from 1.33±1.02 (modulo) to 0.61±0.44 (modulo) during the maximum observation period. In all cases, the rotational stability of the implanted IOLs was noted. In 9 patients out of 24 (37.5%), permanent or periodic optical phenomena were detected, of which 4 patients (16.7%) had halos, 3 (12.5%) had glare, and 2 (8.3%) had difficulty driving in the dark. These side effects did not affect the overall patient satisfaction – 22 patients (91.7%) rated the result of the operation as "excellent", and 2 patients (8.3%) – as "good". Conclusion. The paper presents an analysis of the first experience in the Russian Federation of implantation of new multifocal and toric IOLs with extended depth of focus in 27 patients. Data on the effectiveness of this IOL for vision correction at all distances, low frequency of side optical phenomena, and high patient satisfaction are presented. Further comparative studies with other multifocal IOLs are needed. Key words: cataract; presbyopia; multifocal IOL; IOL with extended depth of focus; EDOF; Symphony.

The Level of the Functional Movement Screen Among Traditional Dancers

Movement assessments are commonly used to assess athlete&rsquo;s risk of injury as well as basic and specific skill movement patterns; however, dance is identified to be differing from sports because the average dancer&rsquo;s training load is higher than the athletes. This study aims to identify the difference in the Functional Movement Screen (FMS) level among traditional dancers in Malaysia. A quasi-experimental study design was adopted, which involved 66 dancers (M = 33; F = 33). The study comprised traditional dancers from three ethnic backgrounds, namely, Malay, Chinese and Indian. The descriptive analysis described the level of the dancers&rsquo; FMS, as follows: Malay (M = 16.18, SD = 2.062), Chinese (M = 18.50, SD = 1.102), Indian (M = 18.23, SD = 1.445). The ANOVA analysis found a significant difference in the FMS scores among all three groups of dancers, F (2,63) = 14.026, p &gt;.000. The deep squat, hurdle step, shoulder mobility, active straight leg raise and trunk stability tests for push-up indicated a significant difference, whereas the inline lunges test and rotational stability tests showed no significance difference. However, the Post Hoc analysis showed no significant difference between the Chinese and Indian dancers. It can be concluded that there is a difference in FMS scores between Malay, Chinese and Indian dancers. FMS may be a useful tool to help identify dancers about the risk of injury and improve their movement quality.

A Case of Femoral Neck Insufficiency Fracture due to Tumor-Induced Osteomalacia

Tumor-induced osteomalacia (TIO) is a rare skeletal disease caused by hypersecretion of fibroblast growth factor 23 (FGF-23) from neoplasms of mesenchymal origin; patients with TIO present with insufficiency fractures, progressive bone pain, and delayed fracture unions. Herein, we report the case of a 48-year-old man with an insufficiency fracture in his left femoral neck associated with TIO. The causative tumor located in the patient’s maxillary sinus had been resected; however, complete resection was impossible due to the location of the tumor. Therefore, the patient’s osteomalacia persisted, and he experienced a left femoral neck fracture in the absence of severe trauma. Because delayed fracture union was anticipated in this patient, we performed an internal fixation using an implant with a lateral plate for angular stability and multiple screws for rotational stability. Although fracture union took 15 months, the patient’s postoperative course was uneventful, and he could walk without any symptoms or assistance at his most recent follow-up 30 months after surgery. In TIO, hypersecretion of FGF-23 leads to increased renal excretion of phosphorus, increased bone resorption of calcium and phosphorus, decreased osteoblastic bone mineralization, and decreased gastrointestinal absorption of calcium and phosphorus, leading to insufficiency fractures and delayed fracture unions. Diagnosis of TIO is often delayed due to its rarity and vague symptoms. Total resection of the causative tumor is the optimal treatment; however, in cases wherein complete tumor resection is impossible, drug therapy may be insufficient, and the underlying TIO pathology, including bone fragility, may persist. Early diagnosis of TIO is important for preventing insufficiency fractures; however, when fractures are unavoidable, the surgical treatment of femoral neck fractures in patients with osteomalacia should account for a longer time frame for complete fracture union and therefore utilize implants with sufficient stability.

First Experience of Multifocal and Toric Extended Depth of Focus Intraocular Lenses Implantation (Short-Term Analysis)

Aim. Analysis of the functional results of new IOL with an extended depth of focus implantation a in the short-term (6 months) follow-up period.Patients and methods. The prospective study included 27 patients (40 eyes) after bilateral (n = 12) or monolateral (n = 15) implantation of EDOF IOL Tecnis Symfony with an average follow-up period of 6.5 ± 0.2 (6–7) months. In all cases, IOL implantation was preceded by cataract phacoemulsification or removal of the transparent lens for refractive purposes. The age range was from 39 to 78 (60.6 ± 10.1) years. EDOF IOL Tecnis Symfony ZXR00 was implanted in 30 eyes, and toric EDOF IOL Tecnis Symfony ZXT100, ZXT150, ZTX225, and ZXT300 were implanted in 10 eyes in the presence of clinically significant astigmatism.Results. An increase in UCNVA from 0.18 ± 0.04 to 0.79 ± 0.11, UCIVA from 0.21 ± 0.07 to 0.89 ± 0.10, UCDVA from 0.24 ± 0.06 to 0.95 ± 0.16, BCNVA from 0.61 ± 0.05 to 0.80 ± 0.03, BCIVA from 0.58 ± 0.10 to 0.97 ± 0.19, and BCDVA from 0.65 ± 0.08 to 1.0 ± 0.06 (p < 0.05 in all cases). The spherical equivalent of refraction decreased from –4.5 ± 1.8 in the preoperative period to –0.18 ± 0.92 in the follow-up period of 6 months after implantation of the Tecnis Symfony ZXR00 IOL. In the group with toric IOLs, a decrease in the cylindrical component of refraction was shown from 1.33 ± 1.02 (modulo) to 0.61 ± 0.44 (modulo) during the maximum observation period. In all cases, the rotational stability of the implanted IOLs was noted. In 9 patients out of 24 (37.5 %), permanent or periodic optical phenomena were detected, of which 4 patients (16.7 %) had halos, 3 (12.5 %) had glare, and 2 (8.3 %) had difficulty driving in the dark. These side effects did not affect the overall patient satisfaction — 22 patients (91.7 %) rated the result of the operation as “excellent”, and 2 patients (8.3 %) — as “good”.Conclusion. The paper presents an analysis of the first experience in the Russian Federation of implantation of new IOLs with extended depth of focus and their toric version in 27 patients. Data on the effectiveness of this IOL for vision correction at all distances, low frequency of side optical phenomena, and high patient satisfaction are presented. Further comparative studies with other multifocal IOLs are needed.

Subjective and objective clinical outcomes of a new trifocal toric intraocular lens and effect of femtosecond laser cataract surgery

Purpose: To evaluate the clinical outcomes and quality of life following implantation of PanOptix toric intraocular lens (IOL) and to compare the outcomes following femtosecond laser assisted cataract surgery (FLACS) and standard cataract surgery (SCS). Methods: This comparative retrospective study included 79 eyes of 55 patients underwent cataract or refractive lens exchange surgery between April 2017 and January 2020 in Bayindir Hospital and Kaskaloglu Eye Hospital. Corneal (CA) and refractive astigmatism (RA), uncorrected visual acuities for distant, intermediate, and near (UDVA, UIVA, and UNVA), low contrast distance visual acuity, rotational stability, defocus curves, photopic and mesopic contrast sensitivity (CS), visual function-14 (VF-14) test, presence of dysphotopsia, and need for spectacles were evaluated at postoperative third month. Outcomes were compared between FLACS and SCS group. Results: The mean UDVA, UIVA, and UNVA were 0.05 ± 0.07, 0.08 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. All patients achieved ⩾0.3 logMAR uncorrected visual acuity for all distances. UDVA was found significantly better in FLACS group ( p = 0.03). All eyes had ⩽1 D of subjective postoperative RA. Defocus curve had two peaks at 0 and −1.50 D. Spectacle independence was achieved in 88.7% of patients. Photopic and mesopic CS was within normal range in all patients. The mean VF-14 score was 98 ± 2. The mean IOL axis rotation was 2.1° ± 2.3°. Only one patient reported seeing disturbing halos. Conclusions: This trifocal toric IOL effectively reduced refractive astigmatism and provided excellent visual outcomes with high spectacle independence, patients’ satisfaction, and good rotational stability. FLACS might have an impact on optimal postoperative results.

Development of Oil Based Foam for Pressurized Mud Cap Drilling PMCD Applications

Pressurized Mud Cap Drilling (PMCD) technique is typically applied for drilling formations with natural fractures and large vugs that result in severe or total losses. The density of the drilling fluid used in PMCD is slightly below reservoir pore pressure. In the case of very low reservoir pressures below base oil densities (~6.7 ppg), foam can be an option. This paper presents a methodology to develop an oil-based foam system for a PMCD application. The scope includes the descriptions of a foam PMCD application, functional requirements of foam, the development workflow, testing procedures, and modeling that are necessary to qualify a foam for PMCD application. The development methodology first involves identifying the constraints and well conditions of a given PMCD application; these include wellpath, hole and casing sections, reservoir pressure and temperature, surface pumping pressure limits (typically a rotating control device limit), foam stability requirements, etc. The above constraints drive the performance requirements for the foam. Next comes the design of the foam formulation and evaluating its performance against these requirements through various lab tests and modeling efforts, which can include ambient pressure half-life tests for initial screening, static and rotational stability tests at in-situ well conditions, rheology tests, solubility tests, pressure transmission estimates, gas migration estimates, and hydraulics modeling. Example results from the lab tests and modeling are shown to provide more insights into the development process. The proposed methodology may be used as a guide to design a foam drilling fluid for a PMCD application. The iterative nature of the development method is shown and is driven by the functional requirements that are coupled to each other. For example, a more viscous foam may be more stable but it may not be pumpable. Likewise, a less viscous foam may be pumpable but may not be sufficiently stable. Similarly, a highly compressible foam may not be good at pressure transmission to monitor downhole pressure variations as compared to a less compressible foam. In summary, the methodology described in this paper explains the development of an oil-based foam for a PMCD application that satisfies a set of operational constraints and functional requirements while highlighting the major factors that could impact foam performance. The application of foam to PMCD is a new concept and to our knowledge has not been applied in the field; in significantly depleted reservoirs this may become a viable option.