Baha Attract Implantation Using a Small Incision: Initial Report of Surgical Technique and Surveillance

Objectives@#. To determine the appropriate anatomical borders of implantation on the temporal bone in a cadaver study, and to develop a simplified surgical technique for Baha Attract implantation through a small incision along the hairline using anatomical evidence and a navigation system. @*Methods@#. In a cadaver study, 20 human adult dry skulls were used to find flat areas of the temporal bone for Baha Attract magnet implantation. Four borders of the “optimal surgical site” were defined: Asterion line, occipitomastoid suture line, sigmoid sinus line, and digastric groove line. In three patients, we implanted the Baha Attract according to the newly developed surgical procedure and validated the feasibility of this technique with a navigation system. @*Results@#. We identified the appropriate position of the implant on the temporal bone, suggesting a simplified surgical technique for Baha Attract with a small incision. We determined the spot of implantation, and the implants were inserted through a small surgical incision (<2.5 cm) under local anesthesia; the procedure lasted approximately 30 minutes. @*Conclusion@#. The optimal surgical site of the temporal bone is a safe and easily accessible location for implantation of the Baha Attract.

A Comparative Study of Gene Array of Cell Cycle Modulators in Human Corneal Epithelial Cells Stimulated with Epidermal Growth Factor(EGF), Hepatocyte Growth Factor(HGF), or Keratinocyte Growth Factor(KGF)

PURPOSE: To identify and differentiate genes that are up-regulated or down-regulated in human corneal epithelial cells in response to epidermal growth factor(EGF), hepatocyte growth factor(HGF) or keratinocyte growth factor(KGF). METHODS: Primary cultures of human corneal epithelial cell(HCE) were treated with 25 ng/ml of EGF, 25 ng/ml HGF, 25 ng/ml KGF, or vehicle in serum-free medium for 8 hours. Total RNA was isolated with TRIZOL(GIBCO, NY), and treated with DNAse I.P 32-labeled complementary DNA(cDNA) probes were synthesized using 6 ug of total RNA made from HCE cells. Equivalent counts of P 32-labeled cDNA probes were hybridized with the membrane of Atlas human cell cycle array at 68degreesC overnight. After sequential washing, the membranes were exposed to X-ray film for three days. These results were analyzed using Atlas Image TM 1.1 Software. RNAse protection assay was used to confirm one of known genes on the array, which was up-regulated by EGF, KGF, and HGF in the human corneal epithelial cells. RESULTS: Autoradiographic analysis showed that out of 111 genes analyzed, 22 were up- or down-regulated in EGF, 26 in HGF and 7 in KGF compared to untreated corneal epithelial cell. After different signal intensity was normalized more than 2000 by Atlas Image TM 1.1 Software, 12 genes were up-regulated and 10 genes down-regulated in EGF. HGF have 6 up-regulated genes and 1 down-regulated gene and KGF had all up-regulated 7 genes. EGF, HGF and KGF all up-regulated the expression of cyclin D1(BCL-1 oncogene) and serine/threonine-protein kinase PITALRE in the primary cultured human corneal epithelial cells. EGF and KGF both up-regulated E2F-1 pRB-binding protein gene. HGF and KGF up-regulated cyclin D2 gene. Proto-oncogene raf was down-regulated by EGF and HGF. CONCLUSIONS: The three growth factors seemed to have similar effects on the genes that contribute to cell cycle control. Studies to analyze the significance of the differences among these growth factors are ongoing.

Phacoemulsification Combined with Transpupillary Silicone Oil Removal Through Posterior Continuous Curvilinear Capsulorhexis

Silicone oil has been used successfully in vitreoretinal surgery for many years. But complications from the use of silicone oil as a long-acting internal tamponade may develop. They include glaucoma, keratopathy, oil emulsification, and cataract. For patients requiring silicone oil removal and cataract surgery, both operations can be performed in a combined procedure. After phacoemulsification, a posterior continuous curvilinear capsulorhexis(PCCC) is performed, followed by irrigation of balanced salt solution(BSS)into vitreous cavity allowing flow out of silicone oil through the PCCC and intraocular lens(IOL)is implanted into remaining capsular bag. This technique offers faster visual rehabilitation, shorter operation time and reduces the risk of peripheral retinal defect, vitreous hemorrhage that may be caused by traditional oil removal through sclerostomy.

Clinical analysis of Superior Oblique Plication Procedure

The purpose of this study is to evaluate retrospectively the surgical results and complications in the patients with unilateral superior oblique palsy using superior oblique plication(SO plication) only or SO plication combined with inferior oblique weakening. Among 22 patients with unilateral superior oblique palsy, there were 13 patients(59.1%) in type III, 5 patients(22.7%) in type IV, 2 patients(9.1%) in type II and 2 patients(9.1%) in type V according to Knapps classification. The mean amount of hypertropia was 18 prism diopters(PD) and 18 of 22 patients(81.8%) showed abnormal head posture(AHP). Nineteen patients (86.4%) showed horizontal strabismus and exotropia was most common. The methods of oblique and vertical rectus operation were SO plication, SO plication combined with inferior oblique weakening, combined with resection of inferior rectus, and combined with recession of contralateral inferior rectus, inferior oblique weakening, and superior rectus weakening. We performed corrective surgery on the patients with horizontal deviation more than 14 PD. Postoperatively the mean amount of hypertropia was 2.6PD. In 7 patients with superior oblique plication only the mean amount of correction in plication was 8.4PD, and hypertropia was corrected 1.2PD per mm. Thirteen of 18 patients(72.2%) with AHP and 15 of 19 patients (78.9%) with horizontal strabismus were corrected after operation. Postoperative complications were residual hypertropia in 7 patients(31.8%) and Brown syndrome in one. We conclude that plication of the superior oblique may be one of the effective procedures for correction of superior oblique palsy and possible its complications may be postoperative undercorrection and Brown syndrom.