Combined cataract-glaucoma operations. Extracapsular extraction and trabeculectomy versus phacoemulsification and trabeculectomy

This retrospective study was conducted to evaluate the results of Combined Surgery of Cataract and Glaucoma (triple procedure). The procedure of combined surgery were trabeculectomy and extracapsular extraction (14 eyes) versus trabeculectomy and phacoemulsification (15 eyes). The follow-up of both groups was at least 9 months and up to 16 months (mean: 12 months). The mean decrease of IOP was 12.4 mmHg and 8.9 mm Hg in the first and second group respectively. Instillation of Beta-blockers twelve months after surgery were more frequent in the first group (64.3%) than in the second (26.7%). Finally, the IOP values one year after surgery were equivalent in both groups (less than 19 mmHg in 93% of cases). The mean features to emphasize the delay of recuperation of the best corrected visual acuity: one month for phacotrabeculectomy, and three months for extracapsular with trabeculectomy. The frequency of complications was low in both groups. We observed more hyphemas but less secondary cataracts in the phacotrabeculectomy group. Phacotrabeculectomy could become a reference procedure for combined glaucoma and cataract surgery.     

Fornix-based trabeculectomy with mitomycin-C

BACKGROUND AND OBJECTIVE: Mitomycin-C (MMC) has been shown to improve the surgical success of trabeculectomy; however, the advantages of MMC have been evaluated almost entirely as an adjunct to limbal-based trabeculectomy. This study evaluated the efficacy and safety of fornix-based trabeculectomy with MMC for glaucomatous patients. PATIENTS AND METHODS: Between January 1993 and April 1995, 71 patients underwent fornix-based trabeculectomy with topical application of 0.4 mg/ml of MMC for 3 minutes. The conjunctiva-Tenon's capsule flap was spread over the limbus and sutured in order to create a visible crease with a water-tight closure. The mean follow-up time was 14.5 months. RESULTS: The mean intraocular pressure (IOP) before surgery was 32.4 +/- 9.7 mm Hg. The average postoperative IOP was 14.04 +/- 9.57 mm Hg. An IOP of 20 mm Hg or less was observed in 57 eyes (80%). Postoperatively, 37 eyes (52%) required no additional medical therapy. One month after surgery, only 2 patients had wound leakage with hypotony and choroidal detachment. Two eyes (3%) had suprachoroidal hemorrhage with loss of vision. A conjunctival "buttonhole" occurred in 2 eyes (3%), but only 1 persisted more than a month. CONCLUSIONS: Fornix-based trabeculectomy using intraoperative application of 0.4 mg/ml of MMC for 3 minutes was found to be as safe and effective as limbal-based trabeculectomy with MMC.     

The use of ultrasound biomicroscopy following trabeculectomy

In the current milieu of monumental change in medicine and the health sciences, effective leadership is needed from within the health care profession to address various challenges. A leader needs to be visionary, and must possess the ability to share this vision with others through effective communication. The leader should be fair, trustworthy, sincere, truthful, honest, courageous, and compassionate. He or she should be strong and resolute and be able to lead through persuasion rather than coercion. The leader should possess the attributes and skills to mold organizational change in the desired direction and to deal with reactions of individuals going through the change process. The democratic style of leadership appears to be the most effective, although the autocratic style may be needed occasionally to accomplish a specific task. The noncentered, laissez-faire style of leadership is generally not effective and results in significant frustration among subordinates. The most desirable type of power a leader can exercise over subordinates results from deep trust and effective communication, which make people follow the leader willingly. The health care profession needs to solicit the help of experienced members who have shown leadership to help guide various activities and to serve as mentors for the less experienced individuals. Special courses should be designed and implemented to develop specific leadership skills, which are applicable to various health care disciplines. Practical teaching models, including individuals from various disciplines working together in teams, with opportunities for leadership, should be implemented. Also, an appropriate culture that recognizes and rewards effective leadership in academe needs to be established within academic institutions.     

Results of trabeculectomy combined with phacoemulsification versus trabeculectomy combined with extracapsular cataract extraction in patients with advanced glaucoma

We compared the results of trabeculectomy combined with phacoemulsification (n = 16) with those of trabeculectomy combined with extracapsular cataract extraction (n = 18). There was no significant difference between the two groups in terms of early or chronic postoperative intraocular pressure (IOP) control or in terms of the number of glaucoma medications prescribed postoperatively. However, by 12 weeks postoperatively, bleb height and extent were significantly greater in the phacoemulsification group. There was no significant difference between the groups in terms of postoperative spheroequivalent, astigmatism, or cylindrical axis. The mean final visual acuity, however, was less in the extracapsular group. We conclude that phacoemulsification combined with trabeculectomy offers a safe and effective technique to control postoperative IOP in patients with glaucoma.     

Small incision trabeculectomy avoiding Tenon''s capsule. A new procedure for glaucoma surgery

Plasma ET-1 was measured around the clock on different calendar dates in healthy subjects and in subjects with diabetes and/or with high blood pressure and/or a history of vascular complications (HVDR). A transverse approach, with each subject contributing a single 24-h mean, assessed any about-weekly or half-weekly variation in ET-1. A circasemiseptan component resolved by single cosinor for nondiabetic (but not for diabetic) HVDR subjects (p = 0.010) differs in its timing of overall high values (p < 0.050) from that found in healthy subjects (p = 0.006). The results are aligned with circasemiseptan patterns in other circulatory variables and morbidity/mortality statistics.     

Change in optic disk topography after trabeculectomy

PURPOSE: To investigate the relationship between optic disk topography and intraocular pressure before and after trabeculectomy with confocal scanning laser ophthalmoscopy. METHODS: The eyes of 49 consecutive patients undergoing trabeculectomy at a university-based glaucoma practice underwent preoperative and postoperative imaging using a confocal scanning laser ophthalmoscope (Heidelberg Retina Tomograph). Three images of one eye of each patient were obtained with a 15-degree field of view. Preoperative images were obtained approximately 2 months before surgery (mean +/- SD, 2.4 +/- 1.6 months). Postoperative images were obtained at least 3 months after surgery (mean, 4.5 +/- 2.6 months). RESULTS: Mean preoperative intraocular pressure, postoperative intraocular pressure, and percent change in intraocular pressure respectively were 23.1 +/- 6.8 mm Hg, 12.7 +/- 7.1 mm Hg, and 43.8% +/- 29.9%. A significant association (P < .01) was found between percent decrease in intraocular pressure and decreases in cup area, cup volume, and cup/disk area ratio as well as between percent decrease in intraocular pressure and increases in rim area, rim volume, mean height contour, retinal cross-section area, and height in contour. Between 11.7% and 31.2% of the variability (R2) in these parameters was explained by the percent change in intraocular pressure. Topography changes were more strongly associated with percent change than with mean change in intraocular pressure. We found no association between percent decrease in intraocular pressure and reference plane height or maximum cup depth. CONCLUSIONS: Changes in optic nerve topography were associated with reduction in intraocular pressure after trabeculectomy.     

A histologic study of the placentas of patients with saline- and prostaglandin-induced abortion

A comparative histologic study of plancentas aborted after infusion of hypertonic saline or prostaglandin F2alpha into the amniotic cavity toinduce abortion is presented. Five placentas from spontaneous abortions served as controls. Saline abortion produced edema of the membranes; congested,dilated, thrombotic blood vessels; and subchorionic necrosis. Prostaglandin did not produce edema, but created marked vasospasm as evidenced by thickened vessels without subchorionic necrosis. The absence of serious sepsis and defibrination in prostaglandin-induced abortions is probably related to the absence of tissue necrosis.     

The histologic spectrum of Barrett's esophagus

To define the histology of the columnarlined esophagus, we obtained esophageal biopsies from various levels with manometric control from 11 patients. There were three types of columnar epithelia above the lower esophageal sphincter: atrophic gastric-fundic-type epithelium with parietal and chief cells; junctional-type epithelium with cardiac mucous glands; and distinctive specialized columnar epithelium with a villiform surface, mucous glands and intestinal-type goblet cells. When present, specialized columnar epithelium was always the most proximal, and gastric fundic epithelium the most distal epithelium. Junctional epithelium was interposed between gastric fundic and specialized columnar or squamous epithelium. Four patients had unequivocal esophagitis in squamous epithelium, but its presence and severity did not correlate with inflammation in or length or type of distal columnar epithelium. Histoligic study of the columnar-lined esophagus demonstrated a spectrum of epithelial patterns. This heterogeneity helps to explain prior discrepant reports.     

Adjustable temporal suture in trabeculectomy with scleral flap

BACKGROUND AND OBJECTIVE: The long-term success of trabeculectomy depends primarily on the degree of scarring that occurs to the artificial filtration route that is created by the procedure. The most serious postoperative complication of trabeculectomy is a persistent shallow anterior chamber or a flat chamber. The objective of this study was to evaluate the effect of a suturing technique on the long-term success of trabeculectomy. PATIENTS AND METHODS: In this study, the authors analyzed a trabeculectomy technique that is based on the application of a suture of variable tightness on the scleral flap. The technique was performed on 11 patients subjected to trabeculectomy. RESULTS: The postoperative complication of shallow anterior chamber was successfully treated with further tightening of the suture for one patient. For each patient, the authors loosened the suture on the fourth postoperative day and removed it completely on the seventh or eighth postoperative day. The patients were observed postoperatively for a minimum of 1 year. During this period the intraocular pressure for each patient was within the normal limits. CONCLUSION: The authors contend that this trabeculectomy technique, in which a suture on the scleral flap can be adjusted for tightness and is later removed, contributes significantly to the treatment of a postoperative shallow anterior chamber or a flat chamber and to the long-term function of an effective filtration fistula.     

A survey of important psychological books.

80 of 100 psychologists who possessed PhDs and were staff members of colleges or universities were randomly selected from the "American Psychological Association 1958 Directory." In order, the highest rated authors were: Freud, James, Hull, Pavlov, Watson, Boring, Skinner, Thorndike, Woodworth, Tolman, Kohler, Lewin, Darwin, Ebbinghaus, Koffka, and Wundt. Books rated with the largest number of points include: James' "Principles of Psychology"; Hull, "Principles of Behavior"; Pavlov, "Conditioned Reflexes"; Freud, "Interpretation of Dreams"; Boring, "History of Experimental Psychology"; and Watson, "Psychology from the Standpoint of a Behaviorist." From Psyc Abstracts 36:02:2AI92W. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of Blastocystis in domestic chickens

The prevalence and morphology of Blastocystis in fresh faecal material from 227 domestic chickens was investigated. A very high prevalence of infection (approximately 95%) was found in chickens from four of the five commercial farms studied. Extremely high numbers of Blastocystis were found in the majority of samples. Blastocystis cells showed considerable variation in size, ranging from approx. 3 microm to approx. 120 microm in diameter. This size range is more extreme than those previously recognised for the organism from chickens. All chickens from one farm appeared free of Blastocystis infection. Most Blastocystis cells appeared to be the vacuolar form, although the shape of the cells and the appearance of the central vacuole contents varied considerably within and among faecal samples. Nuclei showed "spots" of electron-opaque material, generally arranged as a band within the nuclei. Multiple individual cysts within a single outer fibrillar layer were found in addition to single cysts without an encompassing fibrillar layer.     

A telephone survey of day-surgery eye patients

The objective of this research study was to evaluate the nursing care processes and patient satisfaction with the new day-surgery services. Forty-five adult day-surgery eye patients were selected at random to take part in a telephone survey. The response rate was 84.4% (38). Patients were contacted 48 hours post-surgery to obtain their view of the entire surgical experience. The research result found that the majority of the patients were satisfied with the day-surgery services. The main problems experienced by patients were long waiting times to see the doctor during pre-operation assessment, unsatisfactory journeys to and from theatre, and difficulty in remembering verbal advice. Twenty-eight (73.6%) of the day-surgery patients would prefer day-surgery again for a similar operation, but 10 (26.3%) would prefer a longer stay in hospital. The main implications for practice are that realistic assessment time should be allocated to reduce waiting time, verbal advice should be accompanied by written leaflets or audio-tape, and patients should be encouraged to make an informed choice about day or in-patient surgery. A regular survey of day-surgery eye patients should be part of a general audit.