A mediation analysis was applied to determine whether the association between reserve proxies and naming accuracy is dependent on task FC. Results show that naming accuracy depends on the posterior cingulate cortex (PCC) functional decoupling in both younger and older adults but through different pathways. While high-performing older adults rely on the asynchronization of this area from motor speech regions' activity, the best-performing younger adults rely on the functional decoupling with language-related regions. Mediation analysis reveals that the PCC decoupling mediates the relationship between the level of engagement in stimulating activities and naming accuracy in younger adults, but not in older adults. These findings suggest that reserve-related mechanisms may be more critical for naming in early adult life, while older adults' neurofunctional organization may benefit more from a lifetime of acquired knowledge.Endophthalmitis after cat bite has poor outcome particularly those associated with scleral injury. A 33-year-old Caucasian female was seen by her ophthalmologist 4 days after cat bite to her right eye with hand motion vision and obvious signs of acute endophthalmitis. She was treated with exploration and repair of scleral puncture wound, anterior chamber and vitreous cultures and intravitreal injections of vancomycin and ceftazidime. Cultures were positive for alpha hemolytic Streptococcus. She underwent a pars plana vitrectomy, cultures and repeat injection of the same antibiotics and intravitreal dexamethasone 2 days later. Cultures grew Bacillus. Endophthalmitis resolved and she regained 20/20 vision after cataract surgery 3 months later. Successful outcome of acute endophthalmitis following a cat bite to the sclera in this case was most likely due to prompt intravitreal antibiotics and early vitrectomy combined with supplemental intravitreal antibiotics and steroid therapy.Candida dubliniensis is an emerging pathogen implicated in a variety of infections in immunocompromised hosts. A 79-year-old male with autoimmune pancytopenia on chronic oral steroid therapy was admitted for suspected sepsis and started on empirical antibiotics and micafungin. He developed floaters and decreased vision while on this regimen and was diagnosed with bilateral candida endophthalmitis. Blood cultures grew C. dubliniensis.Intravenous therapy was switched to voriconazole and amphotericin B. He also received aggressive intravitreal antifungal therapy consisting of 100 μg/0.1 mL voriconazole (4 OD, 3 OS) and 5 μg/0.1 mL amphotericin B (3 OD, 1 OS) over 2 weeks that resulted in local control of infection. The right eye developed a retinal detachment 1 month after initial presentation that was repaired by 25-gauge pars plana vitrectomy, scleral buckle, laser and silicone oil. At the 15-month follow-up exam, subsequent to silicone oil removal, membrane peel and cataract surgery, OD visual acuity had improved to 20/80. OS was phakic and 20/25. Aggressive intravitreal antifungal therapy combined with intravenous therapy may control endophthalmitis and avoid the risks associated with pars plana vitrectomy during acute infection.In this case series, we report the use of the black Artisan iris-claw intraocular lens (IOL) (Ophtec, The Netherlands) in 6 patients with various visually debilitating symptoms requesting occlusion of one eye. Between 2016 and 2019, 6 (5 female, 1 male) patients underwent implantation of the custom-made black Artisan iris-claw IOL after other management strategies had failed to relieve their symptoms. The black Artisan IOL is an opaque anterior chamber IOL that is fixated to the iris by enclavation. Data were obtained from the electronic patient records (Epic, Verona, WI, USA). All implantation surgeries were uneventful. In terms of outcomes, 4 patients (67%) were satisfied with the result. In 2 patients (33%), the dysphotopic symptoms were not resolved, and these patients opted for either an enucleation or an evisceration. In conclusion, a black Artisan IOL is a valuable and - if needed - reversible option in the management of patients suffering from monocular debilitating visual symptoms leading to disturbances of binocular vision. The clinical presentation leading to the implantation of a pupil-occluding IOL varies and patient satisfaction following implantation is variable. Careful preoperative evaluation of patient factors and expectations, and stepped-care management is recommended to minimize treatment failure. Pupil-occluding lens implantation is often the last step in the treatment of intractable visual complaints in eyes with complex ophthalmologic history, before evisceration or enucleation.Classical clinical findings of multiple evanescent white dot syndrome (MEWDS) include multiple, small white dots scattered throughout the posterior pole, foveal granularity, posterior vitreous cells, and mild optic disc swelling. We describe the case of a 35-year-old man who was admitted to our department with an unusual presentation of MEWDS at the early onset of the disease. A unilateral circumpapillary retinal white spot was observed. Spectral domain optical coherence tomography demonstrated irregularities of the retinal pigment epithelium and disruptions of the outer retinal layers around the optic nerve without other abnormalities. A few days later, the lesion spread centrifugally from the peripapillary region and along the vascular arcades. https://www.selleckchem.com/products/gdc-0068.html This distinctive appearance in an early stage of the disease may suggest a disorder other than MEWDS, which can lead to a misdiagnosis and unnecessary treatment.Transorbital and intra-sphenoidal traumas are relatively uncommon, can be challenging to manage, and are associated with a high risk of complications and potentially fatal outcome. Transorbital and intra-sphenoidal trauma pose a medical challenge due to close relationship to delicate and critical anatomical structures, such as the globe, optic nerve, the ophthalmic internal carotid arteries, and central nervous system. Rapid admission to a level 1 trauma center with a high surgical expertise level is essential to ensure the best possible treatment and outcome. We present a case of a 75-year-old man who had a severe orbital trauma, where a wooden foreign object penetrated the orbit into the sphenoid sinus without penetrating its posterior wall. This case is important because of the rare trauma presentation with a wooden foreign object, which can easily be missed on computed tomography. The case also illustrates the importance of close collaboration between ophthalmologists and rhinologists when challenged with severe orbital sphenoid sinus trauma.