Astigmatic correction with implantation of a light adjustable vs monofocal lens: a single site analysis of a randomized controlled trial

AIM: To evaluate the light adjustable lens (LAL) vs a standard monofocal lens in achieving target astigmatic refraction and improving postoperative uncorrected distance visual acuity (UDVA).METHODS: This randomized controlled clinical trial included 40 patients with pre-existing astigmatism and visually significant cataract. Twenty-eight patients received the LAL and 12 control patients received a monofocal intraocular lens (IOL) after cataract extraction at a single institution. The patients with the LAL underwent adjustment by ultraviolet (UV) light postoperatively plus subsequent lock-in procedures and all patients returned to clinic for follow up of study parameters at 6, 9, and 12mo. Manifest refraction, distance visual acuity, and adverse events were recorded at each visit. RESULTS: The mean cylinder before adjustment in eyes with the LAL was -0.89±0.58 D (-2.00 to 0.00 D) and -0.34±0.34 D (-1.25 to 0.00 D) after lock-in (P=1.68×10^-8). The mean cylinder in patients with the monofocal lens was -1.00±0.32 D (-1.50 to -0.50 D) at 17-21d postoperatively, which was statistically different from the LAL cylinder post lock-in (P=1.43×10^-6). UDVA in the LAL group was 20/20 or better in 79% of patients post lock-in with good stability over 12mo compared with 33% of the control patients with UDVA of 20/20 or better.CONCLUSION: These results demonstrate that the LAL is more effective in achieving target refractions and improving postoperative UDVA in patients with pre-existing corneal astigmatism than a standard monofocal lens.

Syndecan-4 functionalization of tissue regeneration scaffolds improves interaction with endothelial progenitor cells

Key to most implanted cell free scaffolds for tissue regeneration is the ability to sequester and retain undifferentiated mesenchymal stem cells at the repair site.In this report,syndecan-4,a heparan sulfate containing proteoglycan,was investigated as a unique molecule for use in scaffold functionalization.An electrospun hybrid scaffold comprised of poly(glycerol)sebacate(PGS),silk fibroin and type I collagen(PFC)was used as a model scaffold to develop a procedure and test the hypothesis that functionalization would result in increased scaffold binding of endothelial progenitor cells(EPCs).For these studies both Syndecan-4 and stromal derived factor-1a(SDF-1a)were used in functionalization PFC.Syndecan-4 functionalized PFC bound 4.8 fold more SDF-1a compared to nonfunctionalized PFC.Binding was specific as determined by heparin displacement studies.After culture for 7 days,significantly,more EPCs were detected on PFC scaffolds having both syndecan-4 and SDF-1a compared to scaffolds of PFC with only syndecan-4,or PFC adsorbed with SDF-1a,or PFC alone.Taken together,this study demonstrates that EPCs can be bound to and significantly expanded on PFC material through syndecan-4 mediated growth factor binding.Syndecan-4 with a multiplicity of binding sites has the potential to functionalize and expand stem cells on a variety of scaffold materials for use in tissue regeneration.