Decentration of pseudoaccommodating IOLs accounted for 14% of all IOL exchanges. Vitreous loss necessitating anterior vitrectomy was strongly correlated with preoperative Nd:YAG laser capsulotomy. Postoperative visual acuity improved in all cases without preoperative ocular comorbidity.

Research Methods and Procedures:The performance of a wide range of fasting-based index estimates of insulin sensitivity was compared by receiver operating characteristic analysis (area under curves and their 95% confidence intervals) against the M value from euglycemic insulin clamp studies collected in the San Antonio (non-Hispanic whites and Hispanic residents of San Antonio, TX) and European Group for the Study of Insulin Resistance (non-diabetic white Europeans) databases (n ϭ 638). Results: Insulin resistance differed substantially between lean (BMI Ͻ 25 kg/m 2 ), overweight or obese (BMI Ն 25 kg/m 2 ), and type 2 diabetic individuals. Estimates of insulin resistance were, therefore, assessed in each group separately. In the overweight and obese subgroup (n ϭ 302), the receiver operating characteristic performance of fastingbased indices varied from 0.72 (0.62 to 0.82), in the case of the insulin/glucose ratio, to 0.80 (0.72 to 0.88) in the case of Belfiore free fatty acids. One superior method could not be identified; the confidence intervals overlapped, and no statistically significant differences emerged. All indices performed better when using the whole study population, with fasting plasma insulin, homeostatic model assessment , insulin/glucose ratio, quantitative insulin sensitivity check index, glucose/insulin ratio, Belfiore glycemia, revised quantitative insulin sensitivity check index, McAuley index, and Belfiore free fatty acids showing area under curves of 0. 83, 0.90, 0.66, 0.90, 0.66, 0.90, 0.85, 0.83, and 0.86, respectively, because of the inclusion of very insulin sensitive (lean) and very insulin resistant cases (diabetic subjects). Discussion: In conclusion, a superior fasting-based index estimate to distinguish between the presence and absence of insulin resistance in overweight and obesity could not be identified despite the use of the large datasets.

. Purpose:  Our purpose was to evaluate the surgical outcome after intra‐ocular lens exchange in patients who presented impairing visual complaints after primary multifocal intra‐ocular lens (MIOL) implantation. In particular, the study was undertaken to look at the number of eyes that could be equipped with the bag‐in‐the‐lens (BIL) IOL after MIOL exchange. Methods:  This series consisted of 30 eyes of 21 consecutive patients scheduled for MIOL exchange. In 15 out of the 30 eyes, IOL misalignment was measured on slit lamp anterior segment photo’s after defining the mathematical centres of the IOL optic, pupil and limbus. Results:  Diffractive MIOL was more frequently explanted (25; 83%) when compared with refractive MIOL (4; 13%) and progressive optic IOL (1; 4%). In 21 out of the 30 eyes (70%) a bag‐in‐the‐lens could be implanted. In 7 out of the 30 eyes (23%), the capsule was not considered sufficiently stable to accommodate an IOL. An iris‐fixated IOL or a sulcus‐fixated IOL was then implanted. In 2 out of the 30 eyes (6%) the remaining capsular bag could accommodate a traditional lens‐in‐the‐bag only. Eyes that underwent Nd:YAG laser capsulotomy prior to the MIOL exchange needed anterior vitrectomy peroperatively (11 eyes; 37%). Visual acuity improved postoperatively in 13 out of the 30 eyes and remained stable in 17 out of the 30 eyes. Conclusions:  Since the BIL technique requires a very well‐preserved capsular bag for the purpose of the IOL implantation, the success rate of BIL implantation after MIOL is a good indicator to evaluate the degree of difficulty to exchange MIOL.