Multifocal and extended depth of focus intraocular lenses

Advances in intraocular lens(IOL)design have rendered cataract surgery a refractive procedure.Newer IOL types include bifocal,trifocal and extended depth of focus(EDOF)IOLs.Their basic difference nestles in the number of focal points that each lens provides,which in turn leads to different visual outcomes.Familiarity of surgeons with the various characteristics of each lens is of utmost importance for accurate IOL selection to match each patient’s needs.In this review,we aim to compare the clinical outcomes after implantation of multifocal and EDOF IOLs in terms of distance,intermediate and near vision,contrast sensitivity,and reading performance.Finally,we discuss the defocus curve and the optical and photic phenomena associated with each type of IOL.

Bilateral benign reactive lymphoid hyperplasia of the conjunctiva: a case treated with oral doxycycline and review of the literature

Background:To report a case of bilateral benign reactive lymphoid hyperplasia(BRLH)of the conjunctiva treated with oral doxycycline and perform review of the literature evaluating the presentation,treatment and risk of transformation to lymphoma.Case presentation:A case report is described and review of the literature from January 1975 to January 2019 was performed.A 30-year-old man presented with bilateral enlarging fleshy pink medial canthal conjunctival lesions.Incisional biopsy revealed BRLH.Oral doxycycline was initiated(100 mg two times a day)for a total of 2 months.Both lesions decreased in size significantly at the patient’s two-month follow up visit.The residual lesion in the right eye was excised along with an adjacent pterygium and the patient has been free of recurrence for the past 1.5 years.The lesion in the left eye has remained stable in size after cessation of the oral doxycycline.A total of 235 cases of conjunctival BRLH were identified in our literature search.The mean age at diagnosis was 35.2 years(range,5 to 91 years).BRLH lesions were unilateral in 75%of patients and bilateral in 25%of them.Seven patients(2.9%)had a concurrent Epstein-Barr virus(EBV)infection at the time of lesion appearance.The most common treatments were surgical excision(155/235 or 65.9%)and corticosteroids(30/235 or 12.7%),while 14%(33/235)of the patients were observed and 4.6%(11/235)received external beam radiotherapy alone.Recurrence occurred in ten patients(10/235 or 4.2%),of whom five had undergone surgical excision alone,two excision followed by external beam radiotherapy,one excision and oral corticosteroids,one radiotherapy alone and one had been treated with topical corticosteroids.Overall,only 2 of the 235 reported cases(0.8%)developed malignancy,one localized to the conjunctiva and one systemic.Conclusions:Benign reactive lymphoid hyperplasia is one of the lymphoproliferative disorders of the conjunctiva and ocular adnexa.Extensive literature review shows that most cases are treated with surgery,steroids or observation.Oral doxycycline may be considered an alternative non-invasive treatment of BRLH conjunctival lesions.BRLH lesions warrant careful follow up as they can rarely transform into conjunctival or systemic lymphoma.