for the Spanish Multicenter Group on AMD IMPORTANCE Identification of the genetic risk factors that contribute to geographic atrophy (GA) could lead to advancements in interventional trials and/or therapeutic approaches for combating vision loss.OBJECTIVE To investigate whether single-nucleotide polymorphisms (SNPs) are associated with the presence and progression of established GA in age-related macular degeneration (AMD). DESIGN, SETTING, AND PARTICIPANTS Prospective, controlled, multicenter study of 154 patients with GA/AMD and 141 age-matched control participants at 8 Spanish hospitals. MAIN OUTCOMES AND MEASURESSamples of DNA were collected to analyze SNPs within AMD-related genes (CFH, CFB, C3, FHR1-3, and ARMS2). Fundus autofluorescence imaging was used to evaluate GA progression during a 2-year period in 73 patients with GA/AMD. Finally, logistic regression was used to analyze the associations of SNPs, age, body mass index, and cigarette smoking with the rate of progression and relative growth of GA.RESULTS This case-control analysis revealed a significant (P < .05) association between the presence of GA and SNPs within CFH, ARMS2, and FHR1-3. Moreover, logistic regression analysis identified significant associations of the rate of progression with genetic polymorphisms (CFH-402His [P = .04] and CFH-62Ile [P = .04]) and demographic factors (sex [P = .02] and age [P = .02]), whereas relative growth was associated with 1 polymorphism (CFB-32Gln [P = .04]).CONCLUSIONS AND RELEVANCE Taken together, our findings confirm that genetic risk factors related to the presence of GA are not identical to those associated with GA progression. In fact, we demonstrate that gene variants of CFH and CFB, as well as demographic risk factors, confer significant risk for GA progression (both rate of progression and relative growth) within a Spanish population.

Purpose To compare the intraocular pressures (IOPs) obtained with the IOPen rebound tonometer, Goldmann applanation tonometer (GAT) and the ocular response analyzer (ORA) and investigate the effects of corneal biomechanical properties on IOPen measurements. Methods A total of 198 normal eyes were included in this cross-sectional and randomized study. Three measurements were taken using IOPen. Agreement between tonometers was calculated using the Bland and Altman limits of agreement (LoA) analysis. Results The median IOPen IOP was 3 mm Hg below the GAT (Po0.001), 3 mm Hg below the ORA IOP similar to Goldmann (IOPg), and 3 mm Hg below the ORA IOP corrected using corneal parameters (IOPcc)(Po0.01). The LoA width between the IOPen and GAT IOPs varied between 13.92 (mean IOPen IOP) and 15.99 mm Hg (third IOPen measurement). The central corneal thickness (CCT) was unrelated to IOPen measurements (P40.05). Corneal hysteresis (CH) and corneal rigidity factor (CRF) were correlated with IOPen and GAT. Conclusions IOPen underestimated the IOP compared with GAT and ORA. The effect of measurement quality or measurement order on IOPen was low. CCT did not affect the IOPen, but the CH and CRF did. The LoA width between the IOPen and GAT IOPs was higher than between the ORA IOPg or ORA IOPcc and GAT IOPs.

An 82-year-old man had uneventful phacoemulsification with bilateral implantation of a hydrophilic acrylic, single-piece intraocular lens (IOL) (ACR6D SE, Laboratoires Cornéal). Five years later, simultaneous and bilateral IOL subluxations occurred. In both eyes, the subluxation was situated on the side of one haptic that had moved forward (temporal area in the right eye and superior area in the left eye). In the right eye, the haptic-capsular bag was entrapped by the pupil and produced endothelial damage. A transscleral suture was placed over and under the subluxated haptic through the anterior and posterior capsules to capture the haptic. The haptic was then sutured to the sclera. No postoperative complications developed. We hypothesize that 10-degree angulated and broad haptic junctions can lead to zonular damage and IOL subluxation.

Cionni ring (CR) implantation is a procedure to correct limited lens subluxation in cases with Marfan syndrome, homocystinuria, Weill-Marchesani syndrome, and trauma. [1][2][3][4] Although capsular tension ring implantation may be the solution for zonular weakness, it does not correct capsular bag decentration. 5 Cionni ring implantation centers the intraocular lens (IOL), protects the capsular bag, and has few significant intraoperative and postoperative complications 1 year after surgery. 6,7 However, in a series of 90 eyes with CRs, Cionni et al. 8 report an incidence of broken CR suture in 10% of eyes after a median follow-up of 18 months; 5 eyes required resuturing to recenter the IOL. Before this report, we had published our first 7 cases of phacoemulsification and CR implantation. 6 One of our cases (case 3) has recently been checked, and a rupture of the suture was observed. The hook of this CR was entrapped by the pupil. To our knowledge, no similar CR complication has been reported. CASE REPORTA 14-year-old boy was operated on for lens subluxation in 2000. The patient had Marfan syndrome with a 140-degree inferotemporal subluxation in both eyes and significant aortic disease related to the syndrome. The best corrected visual acuity (BCVA) was 20/125 in both eyes. Phacoemulsification with CR implantation was performed. The patient had myopia, and MA60BM AcrySof IOLs of C5.0 diopters (D) in the right eye and C9.0 D in the left eye were implanted. The CR was sutured to the sulcus near the limbus in the inferotemporal area using a 10-0 polypropylene (Prolene) suture. One year after surgery, the BCVA was 20/25 in both eyes. The CR provided excellent IOL centration and positioning in both eyes. However, posterior capsule opacification and slight pseudophacodonesis were observed in the left eye ( Figure 1). The iris in this eye had been gently pushed by the hook without pigment dispersion or chronic uveitis.Fourteen months after surgery, a neodymium:YAG laser posterior capsulotomy was performed in the left eye. No other intraocular complications were observed in the next 5 years. However, 7 years after surgery (2007), in a routine checkup and after pupil dilation, a rupture of the CR hook suture was observed in the left eye. The CR hook was entrapped by the pupil, and no remnants of the Prolene suture in the eyelet were found (Figure 2). The IOL was centered, and the BCVA was 20/25. The patient denied any previous trauma. With the patient face up, drops of pilocarpine were instilled to reverse the entrapment but the entrapment was maintained. The patient was told that the CR suture was broken, but he decided not to have another surgery to resuture the CR hook because the BCVA was similar to what it had been in previous years and the IOL was centered. No corneal endothelial damage was found. Currently, the patient is being checked every 6 months for possible IOL displacement or other secondary problems. DISCUSSIONThis case demonstrates that late complications may occur with CR implantation. If the CR hook sutur...