To examine the relationship between non-tobacco nicotine product (NTNP) exposure and the risk of cataract development and cataract surgery. A retrospective analysis of aggregated healthcare data within the TriNetX U.S. Collaborative Network METHODS: We identified patients with documented exposure to NTNPs (n=107,462) and control patients (n=2,512,152) without exposure. NTNP exposure was defined as having had a vaping-related or unspecified nicotine dependence diagnosis. Patients with pre-existing lens disorders, ocular trauma, or procedures were excluded. Propensity score matching (1:1) was performed, accounting for demographics, cataract risk factors, and comorbidities. We assessed the risk of developing cataracts and receiving cataract surgery. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. After PSM, the exposure and control groups had mean ages of 50.8±15.7 vs 51.8±16.8 years, 61% vs 62% White, and 50% vs 50% female. Compared to matched controls (n=106,116), patients exposed to NTNPs (n=106,116) had an increased risk of developing cataracts (HR 2.21; 95% CI 2.12-2.31). Of the patients who received a cataract diagnosis, NTNP exposure was associated with higher risk of receiving cataract surgery (HR 2.93; 95% CI 2.77-3.09) within 5 years. NTNP usage may be associated with cataract development. Given their widespread use in recent years, they may pose considerable public health risks, and it would be prudent to further investigate their relationship with cataracts.
The study assesses the 'health-related quality of life' (HRQoL) in patients with cataract and glaucoma, examines its determinants through both generic and vision-specific instruments, and evaluates the degree of agreement between the two HRQoL assessment tools. A facility-based survey was carried out among 541 participants (297 glaucoma patients and 244 cataract patients) in outpatient settings of tertiary facility from January to June 2024. After obtaining informed consent, the participants were interviewed about their sociodemographic characteristics, medical history, and HRQoL. The mean utility value for the 'EuroQol five dimensions five levels' ('EQ-5D-5L') and the composite score for the 'National Eye Institute Visual Function Questionnaire-25' ('NEI-VFQ-25') were calculated. Factors influencing HRQoL were analyzed through a generalized linear regression model. Additionally, Pearson's correlation coefficient was determined to evaluate the correlation between the HRQoL derived through vision-specific and generic measures. The 'EQ-5D-5L' utility values were 0.74 (0.71-0.77) and 0.87 (0.85-0.89) in glaucoma and cataracts, respectively. The 'NEI-VFQ-25' composite score was 74.8 (72.2-77.2) in glaucoma and 79.3 (77.3-81.2) in cataract. Visual acuity was significantly associated with HRQoL in both disorders. 'NEI-VFQ-25' score had a strong and moderate correlation with EQ-5D-5L value in glaucoma and cataract, respectively. The decrement in HRQoL in patients with glaucoma and cataract underscores the need to prioritize policies for improving awareness, early detection, and management of these diseases. While the 'EQ-5D-5L' adequately captures HRQoL in glaucoma, the incorporation of vision-specific bolt-on dimension to the generic instrument in cataract should be explored.
Cataract surgery is usually performed with topical anesthesia and sedation, which may be provided through a number of different care models with or without involvement of a physician anesthesiologist. We sought to describe anesthesiology care for cataract surgery in Ontario, Canada, and examine the association between the model of anesthesiology care and health service and perioperative outcomes after cataract surgery. We conducted a population-based study of patients who underwent cataract surgery in Ontario using linked health administrative data between 2012 and 2021. The primary outcome was a composite of death, acute hospital admission, or emergency department visit up to 7 days postoperatively. We also collected data on health system costs and operative complications (from physician billing codes). We used multilevel, multivariable regression to estimate adjusted associations between anesthesiology care - fee-for-service anesthesiology care (FFS), care from an anesthesiology care team (ACT), or no physician anesthesiologist care - and outcomes. Of 1 271 251 patients who underwent cataract surgery, 670 754 (52.8%) received FFS care, 256 760 (20.2%) received ACT care, and 343 737 (27.0%) had no physician anesthesiologist care. Adjusted analyses estimated slightly lower odds of the primary composite outcome for patients who received FFS care (n = 8682, 1.3%; adjusted odds ratio [OR] 0.93, 95% confidence interval [CI] 0.88 to 0.99) or ACT care (n = 3034, 1.2%; adjusted OR 0.83, 95% CI 0.76 to 0.89) compared with those with no physician anesthesiologist care (n = 5056, 1.5%). Odds of operative complications were lower and overall costs were higher with any type of physician-provided anesthesiology care. Primary results differed by whether care was provided in a teaching or nonteaching hospital. Care provided or overseen by a physician anesthesiologist was associated with significantly lower odds of an emergency department visit, hospital admission, or death; however, effect sizes were small and of limited clinical importance, and costs were higher. Given these findings, the use of physician anesthesiology care for routine cataract surgery should be reconsidered. Open Science Framework identifier https://osf.io/9y3mt/overview.
To analyze anterior segment optical coherence tomography (AS-OCT)-derived risk factors for endothelial keratoplasty (EK) after cataract surgery in patients with Fuchs endothelial corneal dystrophy (FECD). Retrospective observational study. We included 73 eyes from 55 consecutive patients with FECD who underwent cataract surgery at three tertiary care institutions between March 2017 and July 2023. We explored the association between preoperative factors (age, sex, incision site, central corneal thickness, anterior chamber depth, components for the anterior and posterior corneal surfaces by Fourier analysis, and signal intensity by AS-OCT) and the requirement for EK within 12 months after cataract surgery. We performed univariate and multivariate regression analyses to calculate the area under the receiver operating characteristic curve (AUC). Of the 73 eyes, 27 (37.0%) required EK. In the univariate analysis, the higher order irregularity component of the 6 mm posterior corneal surface by Fourier analysis yielded the highest AUC of 0.86 (sensitivity: 0.85; specificity: 0.74). In the multivariate analysis, the asymmetry component of the 3 mm anterior corneal surface by Fourier analysis yielded the highest AUC of 0.94, in addition to age, sex, incision site, and anterior chamber depth (sensitivity: 0.93; specificity: 0.85). Thus, we developed a novel logistic regression model incorporating fully quantitative imaging biomarkers from AS-OCT to estimate the probability of requiring EK. The multiple regression model might provide a practical framework for optimizing surgical planning in patients with FECD undergoing cataract surgery, including deciding for either cataract surgery alone or combined EK.
Anxiety, which involves feelings of tension, worry, and physiological changes in the body, can have significant impacts on patients, including an increased risk of mortality. In ophthalmic surgeries, particularly cataract procedures, anxiety levels tend to be high, often stemming from fears of blindness or surgical failure. This study aimed to determine the best and most effective interventions to reduce anxiety in patients undergoing cataract surgery. Systematic reviews, with or without meta-analysis. Additionally, selected studies were required to meet two mandatory criteria from the Database of Abstracts of Reviewers of Effects and be English-language review articles published between January 2010 and 2025 that met these criteria and focused on anxiety reduction strategies in patients undergoing cataract surgery. Finally, out of 75 relevant papers, 5 review studies with 9638 patients were eligible and included in the study. (1) Non-pharmacological interventions (educational videos, patient education, aromatherapy, relaxation techniques, etc.) significantly reduced mean preoperative anxiety compared to the control group. (SMD: -2.14, 95% CI: -3.48 to -0.79; p < 0.001). (2) Nursing techniques could reduce pain and anxiety during the operation (SMD = - 1.19; 95% (CI): -1.96 to -0.43; p = 0.002). (3) The use of anxiolytics (melatonin) could reduce postoperative anxiety in cataract patients. (SMD = - 0.55; 95% CI: -0.95 to -0.15; p = 0.007). (4) Music therapy. This review study identified techniques and strategies to reduce stress in patients undergoing cataract surgery. These strategies, tailored to patient needs, can be implemented individually or in combination, and prioritizing individual patient needs to enhance patient well-being and lead to several positive clinical outcomes and potentially decrease healthcare costs. Future clinical trials are essential to the integration of new technologies and identifying the most effective methods for widespread implementation.
Impaired pupillary dynamics are a well-recognized feature of pseudoexfoliation syndrome (PXF), yet little is known about how cataract surgery influences postoperative iris function in these eyes. This study aimed to determine the longitudinal effects of cataract surgery on static pupil diameters and dilation velocity in eyes with pseudoexfoliation syndrome compared with age-matched controls. This longitudinal study included 166 eyes of 166 patients undergoing cataract surgery, comprising 91 eyes with pseudoexfoliation syndrome and 75 control eyes without pseudoexfoliation. Pupillary parameters were measured preoperatively and at six months postoperatively using automated pupillometry. Static pupil diameters were assessed under scotopic (0.04 lx), mesopic (4 lx), and photopic (40 lx) illumination conditions. Dynamic pupillary function was evaluated by measuring dilation velocity (DVel, mm/s) following a standardized light stimulus. Postoperative changes (Δ) were calculated as the difference between preoperative and postoperative measurements. Static pupil diameters remained stable in the PXF group across all illumination conditions (p > 0.05). In contrast, the control group demonstrated a significant reduction in scotopic pupil diameter after surgery (p = 0.008), while mesopic and photopic diameters remained unchanged. The most notable finding was observed in pupillary kinetics: dilation velocity significantly increased in the PXF group from 0.13 ± 0.04 mm/s to 0.17 ± 0.05 mm/s (p < 0.001), whereas no significant change was detected in the control group. Between-group comparison showed a significantly greater improvement in dilation velocity in PXF eyes (p < 0.001). Cataract morphology was not associated with postoperative pupillary changes. These findings suggest that cataract surgery may be associated with measurable changes in dynamic pupillary behavior in PXF eyes, particularly in dilation velocity, while static pupil diameter remains largely unchanged.
To evaluate the intraoperative complications of cataract surgeries, identify their independent risk factors, and determine how complication rates evolve over time by reviewing surgical videos, considering both the surgeon's experience and baseline patient characteristics. This retrospective, cross-sectional study evaluated 523 high-quality cataract surgery videos (selected from 1770) performed by a single surgeon with over five years of baseline experience. Videos were divided into group 1 (2010-2017, n = 274) and group 2 (2018-2022, n = 249). Patient cooperation, intraoperative complications, and specific preceding surgical steps were analyzed via video. Cataract grading and pupil diameter were obtained from patient files and video recordings. Univariate and multivariate logistic regression analyses were performed. Univariate analysis showed complication rates (p = 0.026), cataract hardness (p = 0.002), and accompanying ocular findings (p = 0.009) were significantly higher in group 1. Patient cooperation was significantly lower in eyes with complications in group 1 (p = 0.003). Multivariate regression analysis revealed that only poor patient cooperation (OR = 4.862, 95% CI 741-13.579, p = 0.003) and higher nucleus grade (OR = 5.510, 95% CI 1.258-24.134, p = 0.024) were significant independent predictors of intraoperative complications. Patient cooperation and cataract hardness are the primary independent predictors of surgical safety. It is crucial that high-risk cases are carefully pre-assessed and operated on by experienced surgeons equipped with advanced crisis management strategies. High-quality surgical video recordings provide analytically indispensable insights, proving highly beneficial for both postoperative case review and the training of resident physicians.
To provide the first reliability analysis of swept-source optical coherence tomography (SS-OCT) biometry-derived corneal optical quality metrics that may impact intraocular lens design selection in refractive cataract surgery. This was a retrospective instrument evaluation study at the Department of Ophthalmology, Hanusch Hospital, Vienna, Austria. Three consecutive preoperative single-operator scans of patients with cataract were analyzed using the updated wavefront analysis software of a SSOCT biometer (ANTERION; Heidelberg Engineering). Corneal higher order aberrations (HOAs) were quantified as paired polar Zernike magnitudes, dioptric vector components, individual signed Zernike coefficients, and root mean square (RMS) values. For each metric, pooled within-subject standard deviation (Sw), coefficient of variation, and intraclass correlation coefficient (ICC) were calculated. Primary analysis was done at a 4-mm optical zone, with additional 3- and 5-mm assessments to evaluate zone-dependent consistency. Fifty-six eyes of 56 patients with cataract were included. All anterior, posterior, and total HOAs revealed repeatability limits (R = 2.77 × Sw) below 0.10 µm with ICCs of 0.76 to 0.97 and coefficients of variation less than 25% at 4 mm. For the total cornea, RMS HOA and spherical aberration showed repeatability limits of 0.07 µm (ICC: 0.89) and 0.03 µm (ICC: 0.84), respectively. Test-retest variance scaled with zone size (photopic to scotopic) and interindividual variation. Corneal optical quality can be reliably characterized from a SS-OCT biometer at optical zones relevant to refractive cataract surgery. Because measurement uncertainty can impair clinical decision-making, repeatability limits should be considered if wavefront metrics are employed to inform intraocular lens design selection or outcome-based research.
Cataracts are one of the most common preventable causes of blindness and severe visual impairment in children worldwide. Early detection and consistent conservative and surgical treatment can significantly improve visual function and quality of life. Knowledge of the different types of cataracts is clinically relevant, as they differ in terms of prognosis and accompanying systemic diseases. Cataract surgery in children is more challenging than surgery for senile cataracts. Special surgical techniques must be used to prevent posterior capsule opacification (PCO). For this purpose, different surgical techniques are available. The choice of surgical technique has implications for the choice of intraocular lenses (IOL) and the postoperative follow-up. Biometry and IOL calculation should account for a myopic shift throughout childhood. To provide a visual benefit to the child, long-term amblyopia treatment with refractive correction and occlusion therapy is crucial, and long-term clinical follow-up should evaluate for late complications such as PCO and secondary glaucoma.
To evaluate morphological characteristics of capsulotomy created using selective laser capsulotomy (SLC) (CAPSULaser device; Excel-Lens, Inc) or femtosecond laser (FSL) (LenSx; Alcon Laboratories, Inc) in white cataract. This was a prospective non-randomized comparative study of 40 patients with white cataract who had phacoemulsification. A 5-mm capsulotomy was planned using SLC (n = 20) or FSL (n = 20). The primary outcome measure was capsulotomy size. Secondary outcomes were capsulotomy circularity, intraocular lens (IOL) coverage, centration, continuity, and residual microadhesions. Follow-up was performed on postoperative days 1 and 30. The mean age of the patients was 65.3 ± 8.8 years (18 men, 22 women). Residual microadhesions were observed in 2 eyes (10%) in the SLC group and 11 eyes (55%) in the FSL group (P = .002). Release of milky fluid did not obscure laser delivery in the SLC group, but hampered laser delivery in the FSL group. On postoperative day 1, mean capsulotomy diameter was 4.45 ± 0.17 mm in the SLC group and 5.03 ± 0.07 mm in the FSL group (P < .001). Circularity index was comparable (SLC group: 0.993 ± 0.01, FSL group: 0.996 ± 0.005; P = .25), with 360° IOL coverage in both groups. Overlap index was 0.66 ± 0.27 in the SLC group and 0.84 ± 0.11 in the FSL group (P = .01). Decentration was significantly greater with SLC (SLC group: 0.37 ± 0.37 mm, FSL group: 0.09 ± 0.07 mm; P = .004). No case had radial tear of capsulotomy or posterior capsule rent. Both FSL and SLC are safe and effective to create circular continuous capsulotomies in white cataract. FSL capsulotomies are more predictable in terms of size and centration. SLC capsulotomies have fewer microadhesions because fast capsulotomy creation does not allow milky cortex to obscure laser delivery.
To evaluate and compare the clinical outcomes of phacoemulsification (PE) combined with trabeculectomy (TB) versus PE combined with goniosynechialysis (GSL) in managing primary angle-closure glaucoma (PACG) coexisting with cataract. This clinical research was designed as a retrospective study, including 71 patients with PACG and cataract who underwent surgical treatment at Zibo Center Hospital between October 2023 and May 2025. Among them, 37 patients (37 eyes) underwent PE and intraocular lens implantation combined with TB (PE+TB group), and 34 patients (34 eyes) underwent PE and intraocular lens implantation combined with goniosynechialysis (PE+GSL group). Patients were followed up for 12 weeks after surgery to assess intraocular pressure (IOP), best-corrected visual acuity (BCVA), central anterior chamber depth (CACD), corneal endothelial cell counts (ECCs), and the incidence of postoperative complications. After surgery, IOP, BCVA, CACD, and ECCs improved significantly from baseline in both groups. However, between-group comparison showed a statistically significant difference only in IOP, which was lower in the PE+TB group than in the PE+GSL group (P<0.05), whereas BCVA, CACD, and ECCs were comparable between groups (all P>0.05). During postoperative follow-up, the incidence of complications in the PE+GSL group was significantly lower than that in the PE+TB group (P<0.05). PE combined with either TB or GSL has its own advantages in the treatment of PACG with cataract: PE+TB results in lower IOP, while PE+GSL leads to fewer complications.
To compare the effectiveness of topical nepafenac 0.1% and 0.3% in the management of pseudophakic cystoid macular edema (PCME) following cataract surgery. In this retrospective comparative study, patients with PCME after cataract surgery and a follow-up of at least three months were included. Patients were assigned to two groups according to the topical nepafenac treatment initiated after PCME diagnosis: 0.1% (Group-1) or 0.3% nepafenac (Group-2). Best-corrected visual acuity (BCVA), macular and choroidal parameters assessed by optical coherence tomography (OCT) were evaluated at diagnosis and during follow-up and were compared between the groups. The study included 97 eyes from 78 patients, with a mean age of 71.3 ± 7.1 years. Baseline demographic characteristics and surgical parameters were comparable between the groups. BCVA, macular and choroidal parameters improved in both groups during follow-up. At the third month, Group-1 showed significantly better mean BCVA (0.056 ± 0.082 vs. 0.122 ± 0.135, p = 0.028). At the first month, mean central foveal subfield thickness was significantly thinner in Group-1 (348.0 ± 96.5 vs. 387.9 ± 130.7, p = 0.047). Mean choroidal vascular index (CVI) increased during follow-up in both groups, with a greater increase observed in Group-2 at the first month (0.5 ± 2.7 vs. 2.1 ± 3.7, p = 0.024). Complete anatomical response at the first month was observed more often in Group-1 (60.0% vs. 38.1%, p = 0.033). Topical nepafenac 0.1% and 0.3% were both associated with improvement in PCME. Group-1 showed better early anatomical and later visual outcomes, whereas Group-2 showed a greater early CVI increase. However, these findings do not establish the superiority of either regimen.
High-voltage craniofacial electrical injury may result in delayed cataract without optic nerve damage. Multimodal structural and functional assessment supports accurate prognostication, and when posterior segment integrity is preserved, visual recovery after cataract surgery is typically excellent and sustained.
Investigate the impact of race and specific social determinants of health, including income and insurance status, on visual acuity outcomes for cataract surgery in a Midwest safety net academic medical center. Retrospective chart review. University of Cincinnati Eye Clinic, a safety net academic medical center. Records of first-time unilateral cataract surgeries performed between January 2015 and August 2020 were analyzed, with comparisons between Black and White patients. Statistical analyses included chi-square tests, t tests, analysis of variance, and linear regression models, with a significance threshold of α=.05. Postoperative uncorrected visual acuity (UCVA), postoperative refractive error (cylinder and sphere), and prevalence of comorbid conditions such as glaucoma and diabetic retinopathy. Black patients had lower median incomes (P=.0001), worse postoperative UCVA (P=.014, 95% confidence interval [CI]: .016, .147), higher postoperative cylinder (P=.003, 95% CI: .092, .454), more myopic postoperative sphere (P=.017, 95% CI: -.829, -.083), and higher rates of glaucoma (P=.001) and diabetic retinopathy (P=.001). Adjusting for confounders, race was not independently associated with postoperative UCVA (P=.342). Although Black patients demonstrated worse postoperative UCVA, these disparities were linked to comorbidities and social determinants of health rather than race itself. These findings emphasize the importance of addressing nonracial determinants for improving visual acuity outcomes.
Intraoperative stress can adversely affect surgical performance and trainee well-being, particularly in ophthalmic surgeries where micro-level precision plays a paramount role. This study aimed to evaluate both subjective measures of general perceived stress and objective physiological responses during phacoemulsification cataract surgery among ophthalmology trainees. In this cross-sectional study, 59 ophthalmology residents and fellows were enrolled. Objective physiological responses, including systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and arterial oxygen saturation (SpO2), were recorded before and during key steps of surgery (incision, capsulorhexis, and lens removal with intraocular lens (IOL) implantation) by an ambulatory electrocardiograph (ECG) device. General perceived stress was also assessed during the preoperative resting period using the 14-item perceived stress scale (PSS-14). SBP and HR increased significantly throughout the surgical steps, with the highest values observed during lens removal and IOL implantation (all P < 0.03). In contrast, changes in DBP and SpO2 were not statistically significant (P > 0.05). Less experienced trainees demonstrated higher overall DBP trends compared to more experienced counterparts (P = 0.01). Based on PSS-14 scores, female surgeons and those with lower levels of training reported significantly higher perceived stress (P = 0.04 and P < 0.001, respectively). Pre-operative propranolol use was associated with lower perceived stress (P = 0.02), although it did not significantly affect physiological parameters. Physiological responses in ophthalmology trainees increase during phacoemulsification cataract surgery, which may be translated into higher intra-operative stress. This increase is particularly higher in later stages, and is influenced by experience level and individual factors. As a result, these findings underscore the importance of implementing targeted strategies to enhance ophthalmology trainee well-being and improve surgical training environments, especially for individuals more susceptible to elevated stress levels.
Presbyopia-correcting intraocular lenses (IOL) are usually implanted bilaterally. A 49-year-old highly myopic female patient with unilateral cataract underwent unilateral implantation of a nondiffractive, presbyopia-correcting IOL. Uncorrected visual acuity from a distance to 40 cm was good 3 months postoperatively, with high patient satisfaction and no relevant dysphotopsia. With careful patient selection, unilateral implantation of modern presbyopia-correcting IOL can be a successful treatment option. HINTERGRUND: Presbyopie-korrigierende Intraokularlinsen (IOL) werden meist bilateral implantiert. Bei einer 49-jährigen hoch myopen Patientin mit einseitiger Katarakt erfolgte die einseitige Implantation einer nichtdiffraktiven, Presbyopie-korrigierenden IOL. Drei Monate postoperativ zeigten sich eine gute unkorrigierte Sehschärfe von der Ferne bis 40 cm mit hoher Patientinnenzufriedenheit ohne relevante Dysphotopsien. Bei sorgfältiger Patientenselektion kann die einseitige Implantation moderner, Presbyopie-korrigierender IOL eine erfolgreiche Option darstellen.
Treatment of glaucoma is directed towards controlling intraocular pressure (IOP) and the options are many, starting from medical therapy to cyclodestructive surgeries. Drainage devices are a treatment option for glaucoma with a visual prognosis and have a major advantage of long-term success in controlling IOP and better tolerability. The Aurolab Aqueous Drainage Implant (AADI) is devised from a prototype Baerveldt implant. Numerous complications have been reported with the AADI; however, chronic inflammation so far is very rare. In our report, significant uveitis was noted in a patient with primary open-angle glaucoma post failed trabeculectomy after implantation of the AADI, resulting in the formation of annular synechiae and neovascularisation of the iris. There was poor compliance with medications and loss to follow-up owing to COVID-19 restrictions for more than a year. The patient was meticulously managed by intracameral anti-VEGF and synechiae release coupled with cataract extraction and intraocular lens implantation under the cover of steroids.Through this case, we want to emphasise the need for patient compliance towards postoperative medications and, to our knowledge, such dense inflammation following implantation of the AADI has not been reported.
Cataract, the leading cause of blindness worldwide, results from age-related misfolding and aggregation of long-lived crystallin proteins in the eye lens. The cytoplasm of fiber cells in the lens core becomes increasingly oxidizing with age, allowing non-native disulfides to drive light-scattering aggregation of γ-crystallins. Despite this vulnerability to non-native disulfides, and despite lacking any native-state disulfides, γ-crystallins are unexpectedly Cys-rich. To understand this paradox, we investigated how replacing all four Cys residues in the aggregation-prone N-terminal domain of γD-crystallin affects its stability and aggregation. Cys removal precludes the disulfide-driven aggregation pathway we reported previously. Here, we characterize two full-length human γD-crystallin variants: C18S/C32S/C41S/C78S ("NCS") and C18T/C32A/C41A/C78A ("NCA/T"). Thermodynamic and kinetic stability measurements indicate the N-terminal domain was greatly destabilized in both variants relative to WT, with NCS more destabilized than NCA/T. Upon mild heating or partial denaturation, both variants formed light-scattering aggregates, which were amorphous by transmission electron microscopy. Surprisingly, the aggregation proceeded exclusively from a dimer of natively folded molecules held together by a C-terminal disulfide bridge. These dimers form readily even in the WT protein, and evidence of them has been found in the lens. Aggregation was strongly suppressed by the lens's native chemical chaperone, myo-inositol. The aggregation rate depended linearly on protein concentration, indicating that the rate limiting step was a transformation of the natively-folded to misfolded molecules within the dimer. We propose that many age-related chemical modifications could destabilize the native fold of human γD-crystallin, favor misfolding within disulfide-bridged dimers, and thereby cause aggregation.
暂无摘要（点击查看详情）
We derive closed-form analytical sensitivities of pseudophakic refraction with respect to corneal power (K), axial length (L), effective lens position (E), and intraocular (IOL) power (P) from a single implicit paraxial vergence equation. Each partial derivative is expressed in both local-vergence and parameter-only forms, with explicit reference-plane conventions (corneal versus spectacle). The axial-length sensitivity scales as T-2, predicting increased vulnerability in short eyes. The effective lens position (ELP) sensitivity admits a factorization explaining the empirical heuristic ΔR≈0.0006(P2+2KP)ΔEmm. The IOL-power adjustment ratio Q=(∂R/∂P)-1 matches a previously published expression, confirming independence from P and L. Clinical application to uncertainty budgeting reveals that the ELP prediction dominates refractive variance in short eyes, while keratometry dominates in long and post-refractive-surgery eyes.