Clinical features and possible pathogenesis of multiple evanescent white dot syndrome with different retinal diseases and events:a narrative review

●Multiple evanescent white dot syndrome(MEWDS)is a rare fundus disease,characterized by acute vision loss and visual field defects.Many previous studies have explained the possible pathogenesis and clinical features of primary MEWDS.However,as the number of reported cases increases,secondary MEWDS occurs in other related retinal diseases and injuries,exhibiting some special characteristics.The associated retinal diseases include multifocal choroiditis/punctate inner choroidopathy(MFC/PIC),acute zonal occult outer retinopathy,best vitelliform macular dystrophy,pseudoxanthoma elasticum,and ocular toxoplasmosis.The related retinal injury is laser photocoagulation,surgery,and trauma.Although primary MEWDS often have a self-limiting course,secondary MEWDS may require treatment in some cases,according to the severity of concomitant diseases and complications.Notably,MEWDS secondary to MFC/PIC that is prone to forming choroidal neovascularization and focal choroidal excavation,needs positive treatment with corticosteroids.The possible underlying pathogenesis of secondary MEWDS is the exposure of choroidal antigen after the disruption of Bruch’s membrane.The MEWDS-related features in secondary MEWDS are still evanescent under most circumstances.Its prognosis and treatment depend on the severity of complications.Current studies propose that the etiology is associated with immune factors,including viral infection,inflammation in choroid and Bruch’s membrane,and antigen exposure caused by retinal and/or choroidal insults.More pathogenic studies should be conducted in the future.Accurate diagnosis for secondary MEWDS could benefit patients in aspects of management and prognosis.

Surgical outcome comparisons of multifocal IOLs of Lentis Comfort LS-313 MF15 and Tecnis Eyhance DIB00V

AIM:To compare the surgical outcomes of a multifocal intraocular lens(IOL;Lentis Comfort LS-313 MF15)with those of an enhanced monofocal IOL(Tecnis Eyhance DIB00V).METHODS:This retrospective study included patients who underwent cataract surgery with LS-313 MF15 or Eyhance IOL implantation.Data regarding patient demographics,surgical records,and ophthalmic examination before the cataract surgery and one and three months postoperatively were collected.Visual acuities,refractive values,defocus curves,contrast sensitivities and subjective symptoms were evaluated.RESULTS:Among the 71 eyes(47 patients)included in this study,32 eyes(20 patients)underwent LS-313 MF15 IOL implantation,and 39 eyes(27 patients)underwent Eyhance IOL implantation.No significant differences were observed in age,axial length,or refractive error between the two groups preoperatively.Furthermore,the distancecorrected and uncorrected distance visual acuities one month postoperatively did not differ between the groups,and both groups had sufficient visual acuities at the distances of 5,1 m,70,50,and 30 cm.Other ophthalmic data,including subjective symptoms based on the 14-item Visual Function Index Questionnaire,monocular defocus curves,contrast sensitivities,and halo and glare,did not differ between the groups three months postoperatively.Moreover,both groups had good outcomes.The spherical equivalent one month postoperatively was significantly myopic in the LS-313 MF15 group compared with that in the Eyhance group(P=0.033);however,this difference was not observed three months postoperatively(P=0.471).CONCLUSION:Comparison of the surgical outcomes of LS-313 MF15 with those of Eyhance with different optical properties reveal that both IOLs show good postoperative outcomes,with no significant differences being noted between the two IOLs.

Transmissive multifocal laser speckle contrast imaging through thick tissue

Laser speckle contrast imaging(LSCI)is a powerful tool for monitoring blood flow changes in tissue or vessels in vivo,but its applications are limited by shallow penetration depth under reflective imaging configuration.The traditional LSCI setup has been used in transmissive imaging for depth extension up to 2l_(t)–3l_(t)(l_(t)is the transport mean free path),but the blood flow estimation is biased due to the depth uncertainty in large depth of field(DOF)images.In this study,we propose a transmissive multifocal LSCI for depth-resolved blood flow in thick tissue,further extending the transmissive LSCI for tissue thickness up to 12lt.The limited-DOF imaging system is applied to the multifocal acquisition,and the depth of the vessel is estimated using a robust visibility parameter V_(r)in the coherent domain.The accuracy and linearity of depth estimation are tested by Monte Carlo simulations.Based on the proposed method,the model of contrast analysis resolving the depth information is established and verified in a phantom experiment.We demonstrated its effectiveness in acquiring depth-resolved vessel structures and flow dynamics in in vivo imaging of chick embryos.

Chickenpox followed streaky multifocal choroiditis with prednison treatment in a girl with asthma

Dear Editor,We report a case of streaky multifocal choroiditis(SMFC)followed by chickenpox in a girl with asthma under prednison treatment.To our knowledge,this is the first case report of an SMFC followed by chickenpox in a patient with asthma.

Multifocal papillary thyroid cancer in Graves’ disease: A case report

BACKGROUND Thyroid cancer is not commonly observed in patients with Graves’disease(GD).The presence of thyroid nodules in GD is not uncommon.However,a link bet-ween these two entities has been reported.Herein,we report the case of a patient with GD and thyroid cancer in Saudi Arabia,which has not been reported previously in our region.CASE SUMMARY A 26-year-old male patient with GD,receiving carbimazole for 2 years,presented to our hospital.His hyperthyroidism was controlled clinically and biochemically.On clinical examination,he was found to have a left-sided thyroid nodule.Ultra-sound revealed a 2.6 cm hypoechoic nodule with high vascularity.He was then referred for fine needle aspiration which showed that the nodule was highly suspicious for malignancy.The patient underwent total thyroidectomy and was diagnosed with multifocal classical micropapillary thyroid cancer.Post thyroid-ectomy he received radioactive iodine ablation along with levothyroxine replace-ment therapy.CONCLUSION Careful preoperative assessment and thyroid gland ultrasound might assist in screening and diagnosing thyroid cancer in patients with GD.

Effects of Comprehensive Rehabilitation on Patients with Progressive Multifocal Leukoencephalopathy Due to Systemic Lupus Erythematosus: A Case Report

Introduction: Little is known about the feasibility and effectiveness of rehabilitative treatment for systemic lupus erythematosus (SLE) in individuals with progressive multifocal leukoencephalopathy (PML). We describe a patient with SLE complicated by PML and ameliorated by comprehensive rehabilitation. We also review the epidemiology, pathology, imaging characteristics, and treatment of PML. Patient Concerns: We found a patient with SLE with PML improved by multidisciplinary rehabilitation techniques. Diagnoses, Interventions, and Outcomes: We diagnosed a PML with a 13-year history of SLE and lupus nephritis after longtime immunosuppressive therapy. The patient underwent a comprehensive, multifaceted rehabilitation program, including drug therapy, integrated physical therapy, occupational therapy, acupuncture, music therapy, computer-aided cognitive rehabilitation training, and behavioral management training. This rehabilitation program improved her motor function and activities of daily living. Conclusions: Her condition improved in the short term through comprehensive rehabilitation, including physical, speech, and cognitive therapy. Therefore, we recommend comprehensive rehabilitation to improve the function and activities of daily living in patients with PML.

Multifocal Tuberculosis Revealed by Facial Paralysis

Introduction: Tuberculosis is a chronic infectious disease that remains a global public health problem. Children, accounting for 10% of cases, are particularly vulnerable to this disease. Based on a case of multifocal tuberculosis in a 14-month-old infant, the authors conducted a literature review on this condition. Observation: The case involved a 14-month-old infant referred from a health center for persistent symptoms including anemia, fever, and lateral deviation of the mouth during crying. Clinical examination revealed an infectious and meningeal syndrome, as well as facial paralysis. The results of brain imaging, cerebrospinal fluid examination, fundus examination, and gastric lavage fluid examination led to the conclusion of multifocal tuberculosis in the infant without association with HIV. Improvement was observed one week after the start of antituberculosis treatment, with complete recovery without sequelae after 12 months. Conclusion: Although rare, multifocal tuberculosis does exists and its diagnosis remains challenging in infants. Early treatment generally leads to favorable outcomes, especially in the absence of HIV coinfection.

A New Classification for Retinitis Pigmentosa Including Multifocal Electroretinography to Evaluate the Disease Severity

Aim: To establish a useful and objective classification for retinitis pigmentosa (RP) to evaluate the disease severity. Methods: This is a retrospective cross-sectional study. Visual acuity (VA), visual field (VF) width, ellipsoid zone width on optic cohorence tomography (OCT) and multifocal electroretinography (mf ERG) values were obtained from medical records of patients with RP. A scoring criterion was developed wherein each variable was assigned a score from 0 to 5 depending on its distribution. The cumulative score (from 0 to 20) was used to classify disease severity from grade 0 to 5. The scores were correlated with each other and the final grade. Results: Data of 152 eyes of 92 patients who had the results of all tests were reviewed. The mean age was 41.2 years. The mean VA of the patients was 0.13 ± 0.16 Snellen lines. The majority of patients had a VA less than 20/40 (88.6%), a visual field smaller than 20˚ (78%), and an ellipsoid zone width smaller than 7˚ (84.4%). The majority of the patients (85.4%) were in advanced stage of the disease (Grade 4 and 5). Conclusions: We present a simple, objective and easy to use disease severity classification for RP which can be used to categorize patients and to evaluate and compare treatment results.

Clinical and Paraclinical Epidemiological Aspects of Multifocal Fractures of the Mandible in Chuo

Introduction: Multifocal fractures of the mandible are responsible for the modification of anatomy with functional and aesthetic repercussions. The aim of our work is to determine the clinical and paraclinical epidemiological aspects of multifocal mandible fractures. Materials and Methods: Retrospective, descriptive study conducted at the Department of Stomatology and Maxillofacial Surgery of the University Hospital of Owendo, from January 2018 to January 2021. All mandibular multifocal fractures with radiological images were included, while all incomplete records and monofocal fractures were not included. Data collection was done on a form from patient records. Age, sex, mode of transport, periodicity, mechanisms, etiologies, soft tissue lesions, dental joint disorder, sensitivity disorder, dental damage, radiological examination, the number and location of fracture features, and associated lesions were the variables studied. Results: 49 files collected;the average age of 28 ± 8.4 years;male predominance at 75.5%. Personal transport was used at 53%, November was the most accident-prone month, road accident was the dominant etiology at 59%, and direct mechanism at 88%. Stomatoragia predominated at 98%, and hypoaesthesia predominated at 30%. The lesional association with the facial massif was 20%. The CT scan was performed at 61%. The bifocal fracture was the most common at 84%. Discussion: According to Alexander violent assaults are the main cause but for Mala it is MVA. The dental panoramic is the basic examination. For Rocton and Mala, the bifocal fracture is the most frequent of the multifocal fractures. Conclusion: Multifocal fractures are the prerogative of the young subject and road accident is the dominant etiology.

Pontocerebellar Progressive Multifocal Leukoencephalopathy. Radiological, Clinical, Histological and Immunohistochemical Findings in a Hematological Patient

Objective: To describe the radiological, histological and immunohistochemical findings in a case of Progressive Multifocal Leukoencephalopathy (PML) affecting the cerebellar peduncles in a patient with chronic lymphocytic leukemia. Patient and Methods: Magnetic Resonance Imaging (MRI), histological picture (H.E., Kluver-Barrera) and immunohistochemical picture (GFAP, neurofilaments, CD68, JC virus) were obtained. Results: 1) Magnetic resonance imaging: Asymmetric and progressive lesions on middle cerebellar peduncles, that were hyperintense in T2/FLAIR, extended towards the pons, had no mass effect and were unmodified after intravenous contrast. 2) Histology: Marked reactive gliosis with cytopathic changes suggesting viral infection, plus demyelination areas with axonal preservation. 3) Immunohistochemistry: Marked positivity for viral (polyoma and JC virus) markers in glial cells showing cytopathic changes. Conclusions: The importance of histological and immunohistochemical diagnosis in everyday assistance;of the collaboration between clinicians, radiologists and pathologists;and the validity of postmortem studies as a key element for research and clinical quality assessment must be stressed.

Infliximab induces remission in cryptogenic multifocal ulcerous stenosing enteritis:First case

We present the case of a 29-year-old patient with a history of abdominal pain and vomiting.Based on wireless video capsule findings he was previously diagnosed with ileal Crohn's disease at a different institution,although the clinical and radiological picture was not typical and the response to corticosteroids was poor.We performed a single-balloon enteroscopy showing a short,ulcerous stenosis 50 cm proximal from Bauhin's valve.The endoscopic and clinical histopathological findings were compatible with cryptogenic multifocal ulcerous stenosing enteritis(CMUSE).High dose corticosteroids were again started,without effect.The monoclonal tumor necrosis factor-α(TNF-α) antibody infliximab was added to the medical therapy.After induction therapy,both clinical and endoscopic amelioration was obtained.Larger case studies are needed to confirm the efficacy of TNF-α inhibition in steroid refractory CMUSE.

Predictive factors for photic phenomena after refractive,rotationally asymmetric,multifocal intraocular lens implantation

AIM： To investigate the independent factors associated with photic phenomena in patients implanted with refractive,rotationally asymmetric,multifocal intraocular lenses（MIOLs）.METHODS： Thirty-four eyes of 34 patients who underwent unilateral cataract surgery,followed by implantation of rotationally asymmetric MIOLs were included.Distance and near visual acuity outcomes,intraocular aberrations,preferred reading distances,preoperative and postoperative refractive errors,mesopic and photopic pupil diameters,and the mesopic and photopic kappa angles were assessed.Patients were also administered a satisfaction survey.Photic phenomena were graded by questionnaire.Independent-related factors were identified by correlation and bivariate logistic regression analyses.RESULTS： The distance from the photopic to the mesopic pupil center（pupil center shift） was significantly associated with glare/halo symptoms [odds ratio（OR）=2.065,95% confidence interval（CI）=0.916-4.679,P=0.006] and night vision problems（OR=1.832,95% CI=0.721-2.158,P=0.007）.The preoperative photopic angle kappa was significantly associated with glare/halo symptoms（OR=2.155,95% CI=1.065-4.362,P=0.041）.The photopic angle kappa was also significantly associated with glare/halo symptoms（OR=2.155,95% CI=1.065-4.362,P=0.041） and with night vision problems（OR=1.832,95% CI=0.721-2.158,P=0.007） in patients implanted with rotationally asymmetric MIOLs.CONCLUSION： A large pupil center shift and misalignment between the visual and pupillary axis（angle kappa）may play a role in the occurrence of photic phenomena after implantation of rotationally asymmetric MIOLs.

Visual function and higher order aberration after implantation of aspheric and spherical multifocal intraocular lenses:a meta-analysis

AIMTo assess the visual outcomes of aspheric multifocal intraocular lenses (IOLs) compared with spherical multifocal IOL after cataract surgery.

慢性复发性多病灶性骨髓炎的诊疗进展

慢性复发性多病灶性骨髓炎（chronic recurrent multifocal osteomyelitis,CRMO）,也叫慢性无菌性骨髓炎,是一种以复发性的全身多处炎症性骨痛为特点的疾病。目前CRMO被认为是一种自身炎症性疾病（auto-inflammatory disease）,且常常与牛皮癣（psoriasis）及克罗恩病（Crohn disease）等伴发[1]。作为一种发病率较低的疾病,

Generation of super-resolved optical needle and multifocal array using graphene oxide metalenses

Ultrathin flat metalenses have emerged as promising alternatives to conventional diffractive lenses,offering new possibilities for myriads of miniaturization and interfacial applications.Graphene-based materials can achieve both phase and amplitude modulations simultaneously at a single position due to the modification of the complex refractive index and thickness by laser conversion from graphene oxide into graphene like materials.In this work,we develop graphene oxide metalenses to precisely control phase and amplitude modulations and to achieve a holistic and systematic lens design based on a graphene-based material system.We experimentally validate our strategies via demonstrations of two graphene oxide metalenses:one with an ultra-long(~16λ)optical needle,and the other with axial multifocal spots,at the wavelength of 632.8 nm with a 200 nm thin film.Our proposed graphene oxide metalenses unfold unprecedented opportunities for accurately designing graphene-based ultrathin integratable devices for broad applications.

Middle cerebellar peduncles:Magnetic resonance imaging and pathophysiologic correlate

We describe common and less common diseases that can cause magnetic resonance signal abnormalities of middle cerebellar peduncles(MCP), offering a systematicapproach correlating imaging findings with clinical clues and pathologic mechanisms. Myelin abnormalities, different types of edema or neurodegenerative processes, can cause areas of abnormal T2 signal, variable enhancement, and patterns of diffusivity of MCP. Pathologies such as demyelinating disorders or certain neurodegenerative entities(e.g., multiple system atrophy or fragile X-associated tremor-ataxia syndrome) appear to have predilection for MCP. Careful evaluation of concomitant imaging findings in the brain or brainstem; and focused correlation with key clinical findings such as immunosuppression for progressive multifocal leukoencephalopahty; hypertension, post-transplant status or high dose chemotherapy for posterior reversible encephalopathy; electrolyte disorders for myelinolysis or suspected toxic-drug related encephalopathy; would yield an appropriate and accurate differential diagnosis in the majority of cases.

Visual outcome and optical quality after bilateral implantation of aspheric diffractive multifocal, aspheric monofocal and spherical monofocal intraocular lenses: a prospective comparison

·AIM: To evaluate the visual function after bilateral implantation of aspheric diffractive multifocal Tecnis ZMA00, aspheric monofocal ZA9003 versus spherical monofocal Akreos Adapt intraocular lenses (IOLs). ·METHODS: Tecnis ZMA00, Tecnis ZA9003 or Akreos Adapt IOLs were bilaterally implanted in 180 eyes from 90 patients. The following parameters were assessed 3 months postoperatively: monocular and binocular uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) for distance, intermediate and near, spherical aberration (SA), contrast and glare sensitivity, near point refractive power, uncorrected and best corrected near stereoscopic acuity (NSA). Patient satisfaction was assessed by a questionnaire. ·RESULTS:Threemonthspostoperatively,themonocular and binocular UCVA and DCVA at near of Tecnis ZMA00 were significantly better than other two groups. The mean SA for 5.0mm optical zone in Tecnis ZMA00 and Tecnis ZA9003 was significantly lower than that in Akreos Adapt. Mean contrast sensitivity and glare sensitivity were better for Tecnis ZA9003 group than for other two groups. Patients with Tecnis ZMA00 had higher monocular and binocular near point refractive power and uncorrected NSA than monofocal groups. The patients in Tecnis ZMA00 had higher mean values for halo compared with other two groups. ·CONCLUSION: Tecnis ZMA00 provided better near VA and uncorrected NSA and higher near point refractive power than monofocal IOLs and patients were spectacle independent. The IOLs with Tecnis aspheric design improved contrast and glare sensitivity. Patients with Tecnis ZMA00 reported more disturbances on visual phenomena of halo. ·

Visual performance of four types of diffractive multifocal intraocular lenses and a review of articles

AIM: To compare the clinical outcomes of a variety of multifocal intraocular lenses(MIOLs) in patients diagnosed with presbyopia or cataracts. METHODS: This clinical trial study included 141 patients(282 eyes) with different MIOLs implantation. The Symfony(60 eyes), the Re STOR(100 eyes), the AT LISAtri(60 eyes), and the Pan Optix(62 eyes) intraocular lenses were evaluated in this prospective interventional study. The near, intermediate, and distant visual acuities, contrast sensitivity, and defocus curve were measured as valid criteria. To statistically analyze the results, we used the Statistical Package for Social Science software, the non-parametric Wilcoxon signed-rank t, the one-way analysis of variance and the Tukey’s post-hoc test in our analysis. Moreover, we conducted a detailed literature search on the Pub Med database in English about MIOLs, in total 59 studies were included in this review article.RESULTS: The four approaches did not show any significant difference in the best-corrected distance visual acuity(P>0.05). The defocus curves at the contrast of 100% showed that trifocal IOLs had better intermediate performance than the bifocal IOL(P<0.05). There were no statistically significant differences between AT LISAtri and Pan Optix lenses for visual acuity at all distances. The eyes with Pan Optix, Symfony, and AT LISAtri IOL showed better contrast sensitivity than those Re STOR at spatial frequencies of 1, 3, and 6 cpd in photopic and mesopic conditions(P<0.001). CONCLUSION: All four groups of the multifocal lenses were satisfying in terms of distance and near vision. Also, the group of trifocal lenses led to satisfactory outcomes in intermediate vision, without degradation in quality of vision.

Accuracy of eight intraocular lens power calculation formulas for segmented multifocal intraocular lens

AIM:To evaluate the accuracy of eight different intraocular lens(IOL)power calculation formulas for a segmented multifocal IOL.METHODS:A total of 53 eyes of 41 adult cataract patients who underwent phacoemulsification and implantation with the SBL-3 segmented multifocal IOL between January 1,2017 and January 31,2019 were included in this retrospective study.Preoperative biometry measurements were obtained using an IOL Master.Manifest refraction was performed at least 4 wk postoperatively.Accuracy of the eight formulas[Barrett Universal II,Emmetropia Verifying Optical(EVO),Haigis,Hill-RBF 2.0,Hoffer Q,Holladay 1,Kane,and SRK/T]was analyzed.RESULTS:Using current lens constants,all formulas exhibited errors of slight myopic shift in refractive prediction.The Barrett Universal II formula had a significantly lower median absolute error(MedAE)than did Holladay 1(P=0.02),Kane(P=0.001)and Hill-RBF 2.0(P<0.001)formulas.The Haigis formula had a lower MedAE value than did the Hill-RBF 2.0 formula(P=0.005).Differences in MedAE values among SRK/T,EVO and Hoffer Q formulas were not significant.After optimizing lens constants,the MedAE values of all formulas were reduced;significant changes were noted for EVO(P=0.022),Haigis(P=0.048);Hill-RBF 2.0(P=0.014),Holladay 1(P=0.045)and Kane(P=0.022)formulas.All formulas performed equally well after optimization of lens constants(P=0.203).CONCLUSION:All eight formulas tend to result in a myopic shift when using current lens constants.Optimized lens constants improve the accuracy of these formulas among adult Chinese patients.

Functional and anatomical evaluation of the effect of nepafenac in prevention of macular edema after phacoemulsification in diabetic patients

AIM: To evaluate the effect of prophylactic administration of nepafenac in prevention of macular edema occurring in diabetic patients after phacoemulsification and to investigate the correlation between optical coherence tomography(OCT) foveal thickness and multifocal electroretinogram(MF-ERG) parameters.METHODS: The study included two groups. Group 1 included 50 diabetic patients with senile cataract(50 eyes, 30 females, 20 males, aged 55±7 y) received nepafenac 0.1% eye drop. Group 2 included another 50 diabetic patients with senile cataract(50 eyes, 22 female, 28 males, aged 53.8±8 y) did not receive nepafenac. All patients were followed up for 3 mo postoperatively. OCT and MF-ERG were done preoperative and at 1 wk, 1, 2 and 3 mo.RESULTS: The mean foveal thickness was statistically significantly lower in Group 1. Five eyes in Group 2 developed clinical cystoid macular oedema(CMO)(10%), and no patients in Group 1 developed central macular thickening more than 50 μm. There were insignificant differences in MF-ERG amplitudes and latencies between the two groups except in the five eyes that developed CMO, there statistically significant reduction of MF-ERG amplitude with increase in foveal thickness. CONCLUSION: Perioperative nepafenac reduces the incidence of CMO following uncomplicated phacoemulsification significantly. Nepafenac has no side effects.