Modified in situ perfusion of the kidney using balloon catheters

Experiences with the in situ hypotherme perfusion in the operative treatment of calculus in kidneys and calices are reported. A modified technique is presented using an inflatable Swan-Ganz-ballon catheter for simultaneous blocking of renal blood flow and perfusion.     

Exfoliative syndrome and phacoemulsification

PURPOSE: Exfoliation syndrome (ES) is often considered as a poor indication for phacoemulsification because of zonular weakness, capsular weakness and poor pupil dilatation. METHODS: We evaluated from January 1992 to December 1992 a series of 107 consecutive eyes with ES and undergoing cataract surgery or combined cataract-glaucoma surgery. The pupil was surgically enlarged if the diameter was < or = 5 mm. RESULTS: During surgery, only one case of zonular dialysis without vitreous loss was observed. The incidence of postoperative complications was low (6 hyphemas and 8 inflammatory reactions) and visual results were satisfactory. CONCLUSION: Phacoemulsification can be used routinely in eyes with ES if a careful peroperative protocol is followed: pupillary dilatation, wide capsulorhexis, total nucleus hydrodisection.     

The initial complication rate of phacoemulsification in India

PURPOSE: This study was designed to investigate the feasibility of teaching experienced surgeons to perform phacoemulsification in India, a cataract-endemic area. Complications occurring during surgery and the first postoperative day were documented and evaluated. METHODS: During a 1-month period, at the Aravind Eye Hospital in Madurai, India, the first 100 consecutive cataract operations performed by each of three experienced surgeons (a total of 300 cases), using phacoemulsification were prospectively evaluated. Multiple logistic regression was used to identify factors associated with intraoperative and postoperative complications. RESULTS: The mean age of patients was 57.4+/-9.3 years. The median best corrected preoperative visual acuity was 20/80. Mean surgical and phacoemulsification times were 15.8+/-3.7 minutes and 2.2+/-1.5 minutes, respectively. Complications occurred in 65 (21.7%) eyes. The most common was a rent in the posterior capsule, occurring in 40 (13.3%) eyes. There were significant variations in complication rate and in surgical time among the surgeons. The risk of experiencing a complication decreased as the number of phacoemulsifications performed increased. An increased risk of complications was associated with worse preoperative visual acuity and increasing patient age. CONCLUSIONS: With each successive case, the chances of experiencing a complication decreased 1%. Acceptable results were obtained within 1 month of performing the first phacoemulsification.     

Corneal endothelial damage associated with phacoemulsification

Ergonovine maleate (EM) is a powerful stimulant of human tubal motility. It has been therefore thought that EM could interfere with normal ovum transport and serve as a contraceptive. The tube activating effects of EM and methyl EM were evaluated in 14 women and results confirmed that both are powerful stimulants of the human Fallopian tube. EM immediately post coitus significantly reduces the conception rate.     

Unusual presentation of phacoanaphylaxis following phacoemulsification

A case of phacoanaphylaxis following phacoemulsification is presented. The unusual features of the disease included the markedly delayed onset and the clinical appearance of the hypopyon. Emphasis is placed on the cytologic examination of anterior chamber aspirate in such cases.     

Retinal detachment following phacoemulsification in highly myopic cataract patients

OBJECTIVE: To compare trifluridine eyedrops, cidofovir eyedrops, and penciclovir ophthalmic ointment for the treatment of herpes simplex virus type 1 keratitis. METHODS: New Zealand white rabbits were infected with the McKrae strain of herpes simplex virus type 1. Three days after viral inoculation, the rabbits were randomly assigned to treatment with 1% trifluridine, 0.2% cidofovir, 3% penciclovir ointment, or phosphate-buffered saline (for control) on various schedules. The severity of keratitis was graded in a masked manner. RESULTS: Treatment with any of the antiviral drugs resulted in significantly less severe keratitis than treatment with phosphate-buffered saline. There was no statistically significant difference between eyes given trifluridine 2, 4, or 7 times a day and eyes given cidofovir 2 times a day (P=.06, P=.43, and P=.19, respectively, using the F test of the analysis of variance). Cidofovir given twice a day was significantly more effective than penciclovir given either 2 or 4 times a day (P<.001 and P=.002, respectively). Even with once-a-day dosage, all 3 drugs were significantly more effective than phosphate-buffered saline (P<.001 for all). There was no significant difference between once-a-day trifluridine and cidofovir treatments (P=.17). Trifluridine administered 5 times a day was as effective as 1% cidofovir. A similar degree of punctate keratitis was seen after 4 to 5 days in eyes treated with trifluridine at the highest frequency, 1% cidofovir, or penciclovir ointment. CONCLUSION: Trifluridine treatment was highly effective in this rabbit model, even when given only once a day. Treatment with cidofovir was as effective as that with trifluridine. CLINICAL RELEVANCE: Cidofovir and penciclovir treatments may prove to be effective against epithelial keratitis. Clinical trials of trifluridine, cidofovir, and penciclovir with lower treatment frequencies appear to be warranted.     

Vitrectomy for retained lens fragments after phacoemulsification

PURPOSE: Posterior lens fragments after phacoemulsification can be a serious complication of cataract surgery. This study is designed to evaluate the clinical features of eyes after pars plana vitrectomy has been performed to remove posteriorly dislocated lens fragments after phacoemulsification. METHODS: The authors performed a retrospective chart review of 126 consecutive eyes of 126 patients with dislocated lens fragments after phacoemulsification, managed with pars plana vitrectomy at Associated Retinal Consultants of Michigan. These eyes were operated on from January 1986 through January 1996. RESULTS: The relation of the intervals between cataract surgery and vitrectomy to various postoperative clinical parameters was studied. Clinical features at presentation included elevated intraocular pressure (IOP over 25 mmHg) in 52.4% of the eyes, uveitis in 69.6%, and corneal edema in 50.8%. Initial visual acuity was 20/400 or worse in 73.8% of the eyes. The mean preoperative visual acuity was 20/278 (median, 20/400), whereas the mean final visual acuity was 20/40 (median, 20/50) after a mean follow-up of 18.9 months. Retinal detachments were found in 20 eyes: 7 before vitrectomy and 13 during or after it. After surgery, 44% of eyes achieved a final visual acuity of 20/40 or better and 90% were 20/400 or better. The distribution of best-corrected final visual acuities among the eyes showed statistically significant differences based on the type of intraocular lens (IOL) used, with posterior chamber IOL greater than anterior chamber IOL, and anterior chamber IOL greater than aphakia. Reasons for a poor visual outcome included persistent corneal edema (four eyes), retinal detachment (two eyes), central retinal vein occlusion (two eyes), age-related macular degeneration (two eyes) glaucoma (one year), and endophthalmitis (one eye). CONCLUSIONS: There were no statistically significant differences between early (< 7 days) and delayed (8 days or more) vitrectomy when increased IOP, corneal edema, choroidal effusions, cystoid macular edema, and visual acuity were analyzed. The use of vitrectomy to remove posteriorly dislocated lens fragments has been shown to be an effective treatment method that significantly reduces the inflammatory response and hastens visual recovery.     

Triple procedure with phacoemulsification prior to grafting

OBJECTIVE: To evaluate the value of transesophageal color Doppler echocardiography in the diagnosis of intrathoracic masses. METHODS: Twenty patients with intrathoracic masses were examined by transesophageal echocardiography (TEE), including 12 patients with central lung masses and 8 with mediastinal masses. The neoplasms were explored by two-dimensional realtime ultrasonography, Doppler color flow imaging (DCFI) and pulsed Doppler (PD). The results were compared with computed tomography (CT), operative and pathological examination findings. RESULTS: We were able to identify the size, structure (solid or cystic), anatomic relationship, metastatic lymph nodes and venous carcinoembolus of the masses. Furthermore, the hemodynamic data in the vasculature inside the masses were detected. CONCLUSIONS: As a new method, TEE with Doppler technique is not only valuable in differentiating malignant and benign neoplasms but also useful for preoperative evaluation of the mass resectability in patients with intrathoracic neoplasms.     

Corneal opacification occurring after phacoemulsification and phacofragmentation

Four patients developed progressive corneal opacification five to eight months after ultrasonic cataract extraction. Transmission electron microscopy was performed in all patients. Scanning electron microscopy, performed in only one patient, showed radiating folds of Descemet's membrane with pits on its posterior surface as well as focal traumatic disruption probably caused by probe contact. Bullous keratopathy was present in one patient. Two other patients had folds of Descemet's membrane and a thin retrocorneal fibrous layer. All four tumor specimens showed secondary epithelial and stromal changes. The common denominator was the total or partial absence of endothelium or marked alterations of its remnants.     

不同切口超声乳化白内障吸除术临床应用研究

目的:探讨透明角膜缘隧道切口和角膜隧道切口超声乳化白内障吸除术治疗老年性白内障的临床效果.方法:将行白内障超声乳化吸除人工晶体植入术的患者80例96眼,随机分为观察组40例(49眼)和对照组各40例(47炎),观察组采用透明角膜缘隧道切口,对照组采用角膜隧道切口,比较两组患者术后裸眼视力、角膜散光和手术并发症发生情况.结果:观察组患者术后裸眼视力、角膜散光值均优于对照组,差异存在统计学意义(P＜0.05);两组患者并发症发生率相似,无统计学差异(P＞0.05).结论:采用透明角膜隧道切口超声乳化白内障吸除术治疗老年性白内障,有利于术后视力恢复,降低角膜散光程度,值得临床推广应用.     

Simplified anesthesia technique for scleral tunnel phacoemulsification

A simplified anesthesia technique for sutureless scleral tunnel, small incision, one-port phacoemulsification is described. Step 1: Mild intravenous sedation is achieved with 1 mg of midazolam and 10 mg of propofol. Step 2: A tetracaine- or preservative-free-lidocaine-soaked Weck cell sponge is applied to the superior bulbar conjunctiva and the superior episcleral tissue for localized anesthesia. Step 3: Preservative-free lidocaine 1%, 0.75 cc, is injected into the anterior chamber for intraocular anesthesia. This technique can be used in the presence of all types of cataracts, requires about 10 seconds to complete, and can be used with all phacoemulsification techniques. Results of the technique in a study population are reported.     

Viscoelastic adherence to corneal endothelium following phacoemulsification

OBJECTIVE: The study examined the prevalence and correlates of criminal victimization and the relationship between victimization and client outcomes for homeless clients with mental illness. METHODS: Subjects were clients in community treatment programs participating in the Access to Community Care and Effective Services and Supports (ACCESS) program of the Center for Mental Health Services. Data were obtained through interviews conducted at program entry and at three and 12 months after entry with ACCESS clients in 18 sites during the first year of program operation (N = 1,839). Self-reports of victimization during the past two months as well as data on sociodemographic, health, and social adjustment indicators were obtained at each time point. Multiple regression was used to determine both the correlates of victimization among this population and the effect of recent victimization on client outcomes three and 12 months after program entry. RESULTS: Forty-four percent of the clients were the victims of at least one crime during the two months before entering the program. Women were significantly more likely than men to have been victimized. Multivariate analysis showed that the more severe the client's psychotic symptoms, alcohol abuse, and criminal history, the more likely he or she was to have been victimized. Recent victimization had a significant impact on client outcomes in terms of increased homelessness and decreased quality of life. Victimization shortly before program entry was also the single most important predictor of victimization at both follow-up points. CONCLUSIONS: These findings suggest the critical need for service providers who work with homeless people with serious mental illness to assess the extent to which they have been victims of crime and to address issues of victimization and safety along with psychiatric and social adjustment problems.     

Ductal carcinoma in situ

The incidence of ductal carcinoma in situ (DCIS) has increased significantly in the last 2 decades, due to the diagnosis of asymptomatic cancers by screening mammography. These cancers are usually diagnosed by the presence of calcification on mammography. Histologic classification of these tumors is controversial, and established and proposed classification systems are reviewed. The role of breast conservation in the treatment of many of these lesions is generally accepted, although areas of debate regarding its application in these patients persists.     

Prospective, randomized trial of Microvisc and Healon in routine phacoemulsification

PURPOSE: To compare the safety and efficacy of the new sodium hyaluronate viscoelastic, Microvisc, with those of Healon in routine phacoemulsification. SETTING: York Finch Eye Associates and York Finch General Hospital, Toronto, Ontario, Canada. METHODS: An unmasked, prospective, randomized clinical trial of 100 eyes in 100 patients having routine phacoemulsification and intraocular lens implantation was conducted to compare the safety and efficacy of Microvisc with those of Healon. Visual acuity, corneal thickness, and intraocular pressure were assessed preoperatively and at 6 hours, 1 and 5 days, and 1 and 6 months postoperatively. RESULTS: There were no statistically significant differences between the two treatment groups at any follow-up CONCLUSION: Based on the parameters assessed, both viscoelastic products were safe and provided comparable outcomes.     

The effect of phacoemulsification on aqueous outflow facility

OBJECTIVE: Although control of intraocular pressure (IOP) after cataract extraction may be of critical importance, little is known regarding changes in facility of outflow in the early postoperative period. The effect of phacoemulsification and conjunctival peritomy size on the coefficient of aqueous outflow facility (C) and IOP was studied. DESIGN: Participants were assigned randomly to one of two treatment groups. PARTICIPANTS: Seventy-four patients with cataract and without evidence of glaucoma were studied. INTERVENTION: Patients were randomized to receive either single- or two-quadrant conjunctival peritomy and phacoemulsification. MAIN OUTCOME MEASURES: Tonometry and tonography were assessed before surgery and at 1 day, 1 week, 6 weeks, and 1 year after surgery by a masked observer. RESULTS: Fifty patients with a mean of 11.4 months' (range, 10-13 months) follow-up were analyzed. Patients with reduced preoperative facility of outflow (as defined by C < or = 0.28 microliter/min/mmHg) showed a significant improvement from a mean preoperative value of 0.24 +/- 0.04 microliter/min/mmHg to 0.41 +/- 0.22 microliter/min/mmHg at 1 year (P = 0.002, N = 19). Among all patients, there was no significant change between mean preoperative C and last follow-up (0.39 +/- 0.23 vs. 0.46 +/- 0.38 microliter/min/mmHg, not significant [ns], N = 50). Furthermore, there was no significant change between mean preoperative and final IOP (23.7 +/- 4.1 vs. 23.3 +/- 3.9 mmHg, ns, N = 50). There was a significant elevation of mean IOP on postoperative day 1 to 27 +/- 6.2 mmHg (P = 0.001, N = 50). Patients with IOP elevations greater than 8 mmHg on postoperative day 1 had significantly elevated IOP at 1 year compared to preoperative values (P = 0.02, N = 12). There were no significant differences detected regarding C or IOP between single- or two-quadrant peritomy groups. CONCLUSIONS: Outflow facility improves after phacoemulsification in patients with a reduced preoperative coefficient of aqueous outflow. Postoperative day 1 IOP is significantly elevated after phacoemulsification. Conjunctival peritomy size does not appear to play a role in aqueous outflow facility or IOP after surgery.