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Background@#Surgical correction of aphakia without capsular support continues to be a challenge. Improvements in the technology of cataract surgery have provided advancements in techniques in surgical management of aphakia. Locally, we have limited data on the outcomes of the different intraocular lenses used in aphakia.@*Objective@#This study aimed to determine visual outcomes and complications associated with different techniques of intraocular lens implantation in the absence of capsular support.@*Methods@#We reviewed the medical charts of 207 patients who underwent intraocular lens implantation without capsular support. Excluded were patients with incomplete follow up, pediatric patients, and lost records. Best corrected visual acuity at day 1, 1st month, 3rd month and 6th month postoperatively, and the complications were noted.@*Results@#Mean age was 60 and 51% (n=105) were females. The mean follow-up time was 9.33 ± 0.71 months. Loss of capsular support was most frequently caused by intraoperative complication (n=146, 70%) and trauma. Retropupillary fixation iris claw intraocular lens was frequently used (n=93, 44.9%). Across all patients, visual acuities showed excellent outcomes with 20/50 or better. Across IOL types, the most frequent postoperative complication was increase in IOP. Statistically significant results were set at P <0.05. @*Conclusion@#There is a notable preference towards iris claw retropupillary lenses through time. Iris claw lenses showed the shortest operative time. All intraocular lenses used in aphakia showed comparably good postoperative visual acuities, except for the superior visual acuity trend seen among retropupillary iris claw and anterior chamber IOL groups. Complications included elevated intraocular pressures, corneal edema, and pigment dispersion.
Subject(s)
Aphakia , PhilippinesABSTRACT
Objetivo: explorar os mecanismos envolvidos no desencadeamento e progressão da Doença de Alzheimer (DA) de forma a embasar a sugestão da planta Uncaria Tomentosa (Wild.) como mais uma possiblidade terapêutica coadjuvante para prevenção e tratamento da DA. Método: Trata-se de uma revisão narrativa da literatura realizada com busca de artigos publicados em bases indexadas e diretamente nas revistas de interesse, utilizando-se como descritores "Uncária Tomentosa", "Doença de Alzheimer", e os respectivos termos em inglês. Resultados: com os avanços para a compreensão dos mecanismos moleculares que desencadeiam os efeitos apresentados no desenvolvimento da DA, os diversos mecanismos dos fitocompostos presentes na planta sugerem sua utilização como neuroprotetor, por mecanismos anti-inflamatórios, imunomoduladores e antioxidantes, cujas evidências em literatura são apresentadas para defesa de sua utilização nesta patologia. Conclusão: foram encontradas evidências para sugerir a inclusão da Uncaria tomentosa (Wild.) como possível terapêutica complementar no tratamento da DA. Sua utilização deve ser melhor explorada para aplicação como tratamento complementar as terapêuticas convencionais para a DA
Objective: to explore the mechanisms involved in the triggering and progression of Alzheimer's disease (AD) in order to support the suggestion of the Uncaria Tomentosa (Wild.) plant as another adjuvant therapeutic possibility for the prevention and treatment of AD. Method: This is a narrative review of the literature conducted with a search for articles published on indexed bases and directly in the journals of interest, using as descriptors "Uncária Tomentosa", "Alzheimer's disease", and the respective terms in English. Results: with advances to understand the molecular mechanisms that trigger the effects presented in the development of AD, the various mechanisms of phytocompounds present in the plant suggest its use as neuroprotector, by anti-inflammatory, immunomodulatory and antioxidant mechanisms, whose evidence in the literature is presented to defend its use in this pathology. Conclusion: evidence was found to suggest the inclusion of Uncaria tomentosa (Wild.) as a possible complementary therapy in the treatment of AD. Its use should be better explored for application as a complementary treatment to conventional therapies for AD.
Objetivo: explorar los mecanismos implicados en el desencadenamiento y progresión de la enfermedad de Alzheimer (EA) con el fin de apoyar la sugerencia de la planta Uncaria Tomentosa (silvestre) como otra posibilidad terapéutica adyuvante para la prevención y tratamiento de la EA. Método: Se trata de una revisión narrativa de la literatura realizada con una búsqueda de artículos publicados en bases indexadas y directamente en las revistas de interés, utilizando como descriptores "Uncária Tomentosa", "Alzheimer's disease", y los términos respectivos en inglés. Resultados: con los avances para comprender los mecanismos moleculares que desencadenan los efectos presentados en el desarrollo de la EA, los diversos mecanismos de fitocompuestos presentes en la planta sugieren su uso como neuroprotector, por mecanismos antiinflamatorios, inmunomoduladores y antioxidantes, cuya evidencia en la literatura se presenta para defender su uso en esta patología. Conclusión: se encontró evidencia que sugiere la inclusión de Uncaria tomentosa (Silvestre) como una posible terapia complementaria en el tratamiento de la EA. Su uso debe explorarse mejor para su aplicación como tratamiento complementario a las terapias convencionales para la EA.
Subject(s)
Uncaria , Cat's Claw , Alzheimer DiseaseABSTRACT
Purpose: To assess different approaches in the management of aphakia in adults in Indian ophthalmologists via an online survey. Methods: A survey-monkey based online questionnaire was fielded to Indian ophthalmologists in accordance with the CHERRIES guidelines. We recorded participants’ demographics, practice settings, and preferred surgical options including the type of intraocular lens (IOL) preferred when encountering a case of aphakia in adults with and without adequate capsular support. Differences between anterior segment (AS) surgeons and vitreoretinal (VR) surgeons as well as differences between surgeons with more or less than 10 years of surgical experience were evaluated using analytic statistics. Results: Of the 481 surgeons who responded to the survey, 369 (77%) were AS surgeons and the remaining 112 (23%) were VR surgeons and represented all regions of India. When encountering posterior capsular rent during cataract surgery, a three-piece IOL in the ciliary sulcus was the most preferred (n = 275, 57%) when there was adequate capsular support, while a retrofixated iris-claw IOL (n = 91, 19%) was the commonest choice in eyes without adequate capsular support. With associated nucleus drop, 85% of surgeons preferred to refer the patient to a VR surgeon and left the eye aphakic. Multivariable logistic regression showed that VR surgeons were more than six times likely to prefer a scleral fixated intraocular lens (SFIOLs) [odds ratio (OR) = 6.5, 95% confidence interval (CI) = 3.4–12.5, P < 0.001] and surgeons with >10 years of experience were also twice more likely to prefer an SFIOL (OR = 2.4, 95% CI = 1.2–4.9, P = 0.02). Conclusion: The choice of IOL in absence of capsular support in adult eyes differs between AS and VR surgeons and is also influenced by the surgeon’s experience.
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@#AIM: To analyze the efficacy of iris-claw intraocular lens(ICIOL)and scleral-fixator intraocular lens(SFIOL)in terms of visual outcomes, surgical time, and postoperative complications in the aphakic patients.<p>METHODS: This study was a prospective study with 60 aphakic eyes of 60 patients who attended our outpatient department from October 2018 to February 2020. These patients were divided into two groups and each with 30 patients. Patients in Group I were underwent ICIOL whereas patients in Group II underwent SFIOL implantation. Patients with pre-existing ocular pathologies, previous history of retinal surgery of the eye were excluded. The preoperative and postoperative evaluation was done for the follow up period of 9mo.<p>RESULTS: Twenty-six(87%)patients in the ICIOL group and 24(80%)patients in SFIOL group had best corrected visual acuity(BCVA,LogMAR)with 0.50-0.00 after 9mo follow up. The mean of BCVA(LogMAR)was comparable in both the groups. The surgical time in ICIOL was significantly less than the SFIOL group(<i>P</i><0.01). Complications related to sutures were significantly more in the SFIOL group. Complications found in the ICIOL group were very mild and harmless. <p>CONCLUSION: The visual outcome was comparable in both groups. ICIOL with fewer complications and requiring less surgical time was found to be a better alternative to SFIOL in the correction of aphakia.
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@#AIM: To compare the curative effect of retropupillary iris claw intraocular lens(IOL)implantation and posterior chamber ciliary scleral suture fixed IOL in the aphakic eyes without capsular support.<p>METHODS: The present retrospective study included 70 aphakic eyes without capsular support. According to the different surgical methods, the patients were divided into two groups, including group A(35 eyes)with treatment of retropupillary iris claw IOL implantation, group B(35 eyes)with treatment of posterior chamber ciliary scleral suture fixed IOL. The uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), intraocular pressure(IOP)and corneal endothelial cell density(CECD)of the two groups were documented and compared before operation and 3d, 1, 3, 6mo and 1a after operation. Furthermore, the stability of IOL in both groups, as well as the intraoperative and postoperative complications were recorded.<p>RESULTS: The patients in the present study were followed up for 12 to 14mo. 3d after surgery, UCVA in group A was significantly improved compared with that before surgery(<i>P</i><0.01), while BCVA had no difference compared with that before surgery(<i>P</i>=0.073).UCVA in group B showed no difference(<i>P</i>=0.097), while BCVA was worse(<i>P</i>=0.002). UCVA and BCVA in both groups were significantly elevated 1mo after surgery(<i>P</i><0.05), and remained stable 6, 3mo later,respectively. Furthermore, IOP in both groups remained in normal level during the follow up period, 0.7% and 2.3% reduction of CECD in A group and B gruop was observed at 1a after operation respectively(<i>P</i><0.05). Both IOP and CECD between the two groups have no significant differenc at each time point during the follow up period(<i>P</i>>0.05).There was no significant difference between whole eye astigmatism and corneal astigmatism in A group and B gruop at 1 and 6mo after operation(<i>P</i>>0.05). Additionally, There was 1 case of IOL dislocation in each group after operation, which was further recovered by operation. Significant tilt and deviation of IOL were not observed in the rest of the patients during the follow up period. The other postoperative complications were mild with no difference in complications between the two groups(<i>P</i>>0.05).<p>CONCLUSION: For aphakic eyes without capsular support, both retropupillary iris claw IOL implantation and posterior chamber ciliary scleral suture fixed IOL are safe and effective surgical methods. Retropupillary iris claw IOL implantation has relatively simple operation, lower damage to the eyeball tissue, the shorter operation time, and the quicker recovery of postoperative visual acuity, which is one of the effective clinical treatments.
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Among 20 million cataract surgeries being performed worldwide every year, approximately 5% are being complicated by posterior capsule rent or zonular dialysis. Intraocular lens (IOL) implantation in such cases with intraoperative complications is quite challenging. Our next course of action is to place the IOL in the ciliary sulcus, however, there is a risk of IOL drop into the vitreous in cases of inadequate support. We have described a novel idea of using a suture material through the dialling hole of a three-piece rigid IOL which can be used as a leash to reduce the risk of IOL drop during implantation in such cases. This technique could also be used during sutureless scleral fixated IOL and retro-pupillary iris claw lens implantation. We found that in 90 consecutive patients where this technique was used, there was no incidence of IOL drop or retinal detachment.
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Purpose: To evaluate the outcomes of implantation of an iris-claw intraocular lens (IC-IOL) in retropupillary position in aphakic patients. Methods: We conducted a prospective interventional study, including 36 aphakic eyes with inadequate capsular support. The postoperative examination included best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, central corneal thickness (CCT), and anterior segment examination with emphasis on the anterior chamber reaction and shape of pupil. Follow-up was done for 3 months. Results: Thirty-six eyes of 34 patients, including 22 right eyes and 14 left eyes were included. Indications for surgery were complicated cataract surgery in 38.9% (n = 14), aphakia in 27.8% (n = 10), pseudophakic bullous keratopathy in 16.7% (n = 6), dislocated posterior chamber IOL (PCIOL) in 11.1% (n = 4), IC drop in 2.8% (n = 1), and subluxated PCIOL in 2.8% (n = 1). Postoperatively, the visual acuity improved by at least two lines in 32 (88.9%) and worsened in four (11.1%) eyes at the end of three months. Mean postoperative IOP at the end of the third month was 12.42 mmHg (standard deviation [SD] 2.57; range 11.55�.29 mmHg). The mean postoperative CCT at the end of the third month was 542.42 microns (SD 13.77; range 537.76�7.07 microns). Sixteen eyes (44.4%) had horizontally oval pupil, eleven eyes (30.6%) had round pupil, and nine eyes (25%) had irregular pupil. Twenty-three eyes (63.9%) presented with significant anterior chamber reaction and seven eyes (19.4%) had corneal stromal edema on postoperative day 1. Conclusion: Our study demonstrated that retropupillary IC-IOL implantation in eyes without adequate capsular support is an effective and safe procedure with a good visual outcome and fewer complications.
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Background: Japanese encephalitis (JE) vaccination in India started in 2006 with SA-14-14-2 live attenuated JE vaccine (JEV) following large outbreaks of JE in some districts of Eastern Uttar Pradesh and Bihar in 2005. Age groups 1-15 yrs are first vaccinated with a single dose of JEV in a campaign mode followed by integration of this vaccine in routine immunization. It is beyond doubt that added to vaccination campaigns, proper awareness on JE can play significant role in controlling the disease.Methods: An observational study with cross sectional design was conducted in Kolkata Medical College and Hospital, Kolkata during JE Vaccination campaign during January, 2018 among 85 respondents, to assess the awareness on JE, among care-givers who brought their children for vaccination at the immunization clinic.Results: It was found that only 37.6% the respondents attending the campaign knew the name of the disease; 17.6% respondents were aware about disease transmission, and 5.9% could state two or more clinical features that might be associated with Japanese Encephalitis. 69.4% had no knowledge of up to what age JE vaccines can be administered; 23.5% said it can be administered till the beneficiaries attain fifteen years of age.Conclusions: IEC activities during JE vaccination campaign was not able raise awareness on JE to the desired level. However beneficiaries were informed about service availability and could be mobilised to come for vaccination.
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Purpose: To compare the visual outcome and complications of retropupillary fixated iris claw intraocular lens (IOL) and sutureless intrascleral IOL fixation using the flanged fixation technique at 1 year. Methods: In this retrospective study, eyes that underwent either iris claw or flanged SFIOL from January 2016 to July 2017 with a minimum of 1-year follow-up were enrolled. Improvement in visual acuity, intraocular pressure measurements, endothelial cell count, central macular thickness, and complications were compared between and within groups at 6 weeks, 3 months, and 1 year postoperatively. Results: Data from 150 eyes were analyzed (n = 90 in the iris claw group and n = 60 in the flanged SFIOL group). Posterior capsular rent was the most common indication for IOL implantation (n = 51, 34%). The iris claw and SFIOL groups were comparable in terms of demographics and baseline characteristics. There was significant improvement in uncorrected distance visual acuity (UCDVA) at 6 weeks in both groups (P = 0.77), and at 1 year, the UCDVA was comparable between groups (0.36 ± 0.32 in the iris claw group and 0.30 ± 0.28 in the SFIOL, P= 0.75). Transient elevation of intraocular pressure was seen slightly more in eyes with SFIOL (17%), while ovalization of the pupil was the main sequelae seen in the iris claw group (20%). Conclusion: Both iris claw IOL fixation and SFIOL using flange are viable options for surgical correction of aphakia. Visual outcomes are excellent at 6 weeks and are maintained till 1-year follow-up, and complication rates are acceptably low, although ovalization of pupil is common with iris claw IOLs.
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Purpose: To compare the visual outcomes and complications between the eyes receiving retropupillary iris claw intraocular lens (IOL) and scleral-fixated IOL (SFIOL) for post-cataract aphakia. Methods: Medical records of consecutive patients who had iris claw IOL and SFIOL surgery from January 2010 to March 2015, with > 1 year of follow up were retrospectively analyzed. The surgical technique was based on individual surgeon preference. The best-corrected distance visual acuity (BCDVA), previous surgery, surgical technique, and complications were analyzed. Results: Retropupillary iris claw IOL was fixated in 48 eyes (46%) and SFIOL was performed in 56 eyes. Iris claw was performed more frequently at the time of primary cataract surgery (56%) compared to SFIOL (14%) (P < 0.001). At 1 month postoperative, BCDVA was significantly better in the SFIOL group [0.7 ± 0.5 logarithm of minimum angle of resolution (logMAR) in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P < 0.001] but this difference did not persist at 1 year (0.4 ± 0.4 logMAR in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P = 0.56). Eyes with iris claw IOL experienced significantly more postoperative iritis (17%), intraocular pressure spikes (10%), and ovalization of the pupil (16%). Conclusion: Retropupillary iris claw IOL fixation is as safe as SFIOL for visual rehabilitation of post-cataract aphakia. Visual rehabilitation following iris claw IOL might take longer than SFIOL. Ovalization of the pupil is the commonest adverse effect reported with this type of IOL design.
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OBJECTIVE@#To observe the difference in clinical efficacy between chicken-claw needling at Shangbaxie (Extra) and Hegu (LI 4) combined with acupuncture at Houxi (SI 3) and the conventional acupuncture at the 3 points for the treatment of hand dysfunction after stroke.@*METHODS@#Forty-two patients were divided into an observation group and a control group according to the random number table, 21 cases in each one. The chicken-claw needling was used at Shangbaxie (Extra) and Hegu (LI 4) on the affected side combined with acupuncture at Houxi (SI 3) in the observation group. The conventional acupuncture was performed at the same point as the observation group in the control group, once a day, 6 days for a course, 1 day of interval after a course, and the therapeutic effect was observed after 5 courses. The simplifying Fugl-Meyer Motor Function Rating Scale (FMA), the modified Barthel index and the Brunnstrom grading criteria were used to evaluate the hand function of the two groups before and after treatment.@*RESULTS@#The FMA score, Barthel index and Brunnstrom grade were improved after treatment in the two groups (all <0.05), and the FMA score, Barthel index and Brunnstrom grade in the observation group were better than those in the control group (all <0.05).@*CONCLUSION@#Chicken-claw needling at Shangbaxie (Extra) and Hegu (LI 4) combined with acupuncture at Houxi (SI 3) can effectively treat hand dysfunction after stroke, and the curative effect is better than the conventional acupuncture at the 3 points.
Subject(s)
Humans , Acupuncture Therapy , Hand , Needles , Stroke , Treatment OutcomeABSTRACT
Objective To compare.the therapeutic effect of claw-type bone plates and anatomical plates in fixation of traumatic multiple rib fractures.Methods Clinical data of 70 patients with traumatic multiple rib fractures between January 2016 and November 2017 was analyzed retrospectively.Based on the treatnents,patients were assigned to two groups:the claw-type bone plates fixation group (n0=33) and anatomical plates fixation group (n =37).The variables including operation time,intraoperative blooding,postoperative thoracic hemorrhage rate,wound drainage,plate loosening and breakage,postoperative chest pain were compared.Data were analyzed using SPSS17.0 statistical software.Student's t test and rank sum test were used to compare the measurement data,and x2test was used to compare the counting data.Results The operation time after the full exposure of fractures were recorded.Operation time for each fracture [(11.04± 1.81)min vs (12.30±0.47) min],intraoperative bleeding [(120.76±7.19) mL vs (110.00±7.45) mL] and wound drainage [(114.06±7.24) mL vs (107.98±7.23) mL] in the claw-type rib bone plates fixation group were statistically significant different compared with the anatomical plates fixation group (P＜0.05).There were lcase of screw abscission in the anatomical plates fixation group (suffering trom osteoporosis) and 2 cases in the claw-type bone plates fixation group (without osteoporosis and other complications).Two cases suffered from chest pain and 2 cases suffered from massive hemorrhage in the chest in the claw-type bone plates fixation group,with secondary operation removing internal fixations.Conclusions The two kinds of internal fixation have their own advantages and disadvantages.The claw-type bone plates fixation is cheaper,easier to shape and has shorter operation time,which is especially suitable for comminuted fracture.Although the anatomical plates fixation is more expensive than claw-type bone plates fixation,the anatomical plates fixation on multiple fractured ribs has less postoperative blood loss,lower postoperative thoracic hemorrhage rate,plate loosening,chest pain,which significantly reduces second operation and possesses a higher clinical application value.
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Removal of intraocular foreign body (IOFB) from the posterior segment of the eye is challenging. In addition to surgical skill, it requires specific instrumentation to grasp and remove the IOFB. Small metallic IOFB can be removed using intraocular rare earth magnets but metallic IOFB larger than 3 mm and nonmetallic IOFBs like shot gun pellets, stones, or large glass fragments require specialized IOFB grasping forceps for removal. We describe the design and case-based clinical applications of a novel IOFB removal forceps, “the claw” that consists of a titanium handle and a 27-mm, 19-G metallic shaft that houses four retractable prongs made of nitinol wire. When completely extended, the prongs measure 14 mm in length and open up to 8–8.5 mm in the widest extent. The four prongs offer a very secure grip without crushing or splintering the IOFB leading to minimal chances of IOFB slippage and inadvertent retinal trauma.
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In this new technique of cataract surgery in patients with iris-fixated phakic intraocular lens with cataract, phakic IOL is explanted at the end of surgery. Phakic IOL remains stable and securely enclaved to the iris during phacoemulsification which is performed through a small 2.2 mm incision. Endothelial protection is provided by viscodispersive OVD above the phakic IOL and space for surgery is created by high molecular weight viscocohesive OVD beneath the phakic IOL. This technique provides significant advantages from the previously described techniques in terms of chamber stability, endothelial protection, iris trauma and surgical ease.
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The histological and molecular analysis of biopsy samples are fundamental steps for the understanding of physiopathology, diagnosis and prognosis of the diseases. However, harvest of tissue biopsies from hoof lamellar tissue is a procedure with limitations due to lack of effective surgical instruments and techniques. The aim of the current study is to develop and test in vivo a surgical instrument with the specific purpose of harvesting lamellar tissue in cattle. A prototype called Falcão-Faleiros' lamellotome (INPIBR102013018765-8) was designed, produced and tested. After sedation, five adult cattle were restrained in lateral recumbency and locally anesthetized in two digits. The stratum corneum was worn down using a rotary tool coupled to a 3/8" high-speed cutter until the soft tissue proximity was reached. Next, the inner edge of the worn area was bounded with a scalpel. The lamellotome was introduced to obtain and hold the sample. The histological specimens of 16mm length by 6mm depth were stained with HE, PAS, Masson's thricome and Shorr. The structures of interest were differentiated in the histological analysis without technical artifacts and a mean number of 85 epidermal laminae per sample were counted. No relevant lameness or wound complication were seen following the procedure. In conclusion the technique using the lamellotme was effective in obtaining lamellar tissue biopsy samples without causing clinical harm in cattle. The procedure showed potential to be used in clinical research or even as a supplementary diagnosis method for routine bovine podiatry.(AU)
A avaliação das propriedades histológicas e da expressão de genes e proteínas em biópsias tem sido determinante para o entendimento da fisiopatologia, o diagnóstico e o prognóstico das enfermidades. Entretanto, a obtenção de biópsias do casco é um procedimento com limitações devido à ausência de técnicas e instrumentos específicos. O objetivo foi desenvolver e testar, na espécie bovina, um instrumento cirúrgico especificamente desenvolvido para realização de biópsias de casco nominado lamelótomo de Falcão-Faleiros (INPI, BR102013018765-8). Utilizaram-se cinco bovinos adultos que foram sedados, contidos em decúbito lateral e tiveram dois dígitos anestesiados. Em seguida, uma serra circular acoplada a uma microretífica foi usada para o desgaste do estrato córneo na parede dorsal até próximo do estrato lamelar. Após incisões retilíneas delimitando a borda interna da área desgastada, utilizou-se o lamelótomo para obtenção da amostra. Os fragmentos de 16mm de comprimento e 6mm de profundidade foram fixados em formalina e processados para histologia com colorações HE, PAS, Shorr e tricrômico de Masson. Nenhum dos animais apresentou claudicação ou complicação relevantes no período pós-opertório. As amostras foram consideradas adequadas quanto à integridade das lâminas e à preservação de sua arquitetura. Obtiveram-se média de 85 lâminas epidérmicas viáveis por biópsia. Conclui-se que o lamelótomo de Falcão-Faleiros é apropriado e seguro para a obtenção de biópsias de casco em bovinos, se mostrando promissor para uso em estudos clínicos e na rotina de diagnóstico de problemas podais em bovinos.(AU)
Subject(s)
Animals , Cattle , Cattle/surgery , Feasibility Studies , Hoof and Claw/abnormalities , Surgical Instruments/statistics & numerical dataABSTRACT
Objective@#To explore the methods and the clinical effect of composite skin graft with meshed acellular allogeneic dermal matrix(allo-ADM)and split thickness autogenous skin graft for pediatric claw hand.@*Methods@#From January 2013 to March 2016, acellular allogeneic dermis matrix(allo-ADM)with split thickness autogenous skin graft was applied for 13 cases(20 hands) of burned pediatric claw hands. The size of the wounds ranged from 6cmx6cm to 10cmx17cm, located in the back of the proximal phalanx and hand. The scar was totally excised and hands′deformities were corrected, with allo-ADM and split thickness autogenous skin graft to cover the wounds. Kirschner wire and plaster fixation, graft gauze bag pile were released 2 weeks after surgery, following by wearing a brace and elastic glove for rehabilitative therapy.@*Results@#2 weeks after transplantation the composite skin survival rate was 70%-100%; 10 cases(17 hands) were followed up for 10 months to2 years. The skin graft survival rate was 70% in 2 cases(3 hands), who underwent secondary operation to correct deformity. The composite skin graft survival rate was above 90% in 8 cases(14 hands). Long term follow-up results showed that composite skin graft had satisfactory elasticity and color. According to the active range assessment of joint movement (TAM method), the results were excellent (TAM% equals to 100%) in 4 hands, good (TAM% was greater than 75%) in 11 hands and acceptable (TAM% was equal to 50%) in 2 hands.@*Conclusions@#Composite transplantation of acellular allogeneic dermis matrix with spit thick autogenous skin graft can effectively improve the appearance and function of children′s claw hand, while avoiding the scar formation due to the harvest of full thickness skin.
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Objective To observe the effect of implantation of iris-claw intraocu lax lens combined with pupil reconstruction on aphakic eyes caused by ocular trauma.Methods The clinical data of 17 patients (17 eyes) of aphakic eyes treated with irisclaw intraocular lens implantation and pupil reconstruction were analyzed retrospectively,and the visual acuity,corneal endothelial cell count,intraocular pressure,intraocular lens location,pupil condition and postoperative complications were observed.Results Intraocular lens were implanted and pupils were repaired in all 17 patients (17 eyes) successfully,with no complications of intraocular lens dislocation and corneal decom pensation.The postoperative uncorrected visual acuity (0.52 + 0.17) was better than the preoperative visual acuity (0.04 + 0.02) and preoperative best corrected visual acui ty (0.44 +0.13).The corneal endothelial cell count was (1993.88 + 127.24) mm-2 6 months after operation,which was lower than that of preoperative date (2178.88 + 132.61)mm-2 (P ＜ 0.05).Preoperative intraocular pressure (15.91 + 2.73) mmHg (1 kPa =7.5 mmHg) was not significantly different from postoperative intraocular pressure (16.69 + 2.61) mmHg (1 kPa =7.5 mmHg) (P ＞ 0.05).The postoperative pupil size [(4.4 + 0.2) mm] was smaller than that of preoperative date [(5.5 + 0.3) mm] (P ＜ 0.05).The symptoms of photophobia,glare and diplopia did not occur postoperatively.Conelusion Pupil reconstruction combined with iris-claw intraocular lens implanta tion is a safe and effective method for aphalic eyes combined with absence of capsule support and ruptured iris.
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Objective To observe the effect of implantation of iris-claw intraocu lax lens combined with pupil reconstruction on aphakic eyes caused by ocular trauma.Methods The clinical data of 17 patients (17 eyes) of aphakic eyes treated with irisclaw intraocular lens implantation and pupil reconstruction were analyzed retrospectively,and the visual acuity,corneal endothelial cell count,intraocular pressure,intraocular lens location,pupil condition and postoperative complications were observed.Results Intraocular lens were implanted and pupils were repaired in all 17 patients (17 eyes) successfully,with no complications of intraocular lens dislocation and corneal decom pensation.The postoperative uncorrected visual acuity (0.52 + 0.17) was better than the preoperative visual acuity (0.04 + 0.02) and preoperative best corrected visual acui ty (0.44 +0.13).The corneal endothelial cell count was (1993.88 + 127.24) mm-2 6 months after operation,which was lower than that of preoperative date (2178.88 + 132.61)mm-2 (P ＜ 0.05).Preoperative intraocular pressure (15.91 + 2.73) mmHg (1 kPa =7.5 mmHg) was not significantly different from postoperative intraocular pressure (16.69 + 2.61) mmHg (1 kPa =7.5 mmHg) (P ＞ 0.05).The postoperative pupil size [(4.4 + 0.2) mm] was smaller than that of preoperative date [(5.5 + 0.3) mm] (P ＜ 0.05).The symptoms of photophobia,glare and diplopia did not occur postoperatively.Conelusion Pupil reconstruction combined with iris-claw intraocular lens implanta tion is a safe and effective method for aphalic eyes combined with absence of capsule support and ruptured iris.
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Context: Surgical outcome of retropupillary fixation of iris claw lens. Aims: To evaluate the various indications, intra and post‑operative complications, and visual outcome of retropupillary fixation of iris claw lens in aphakic eyes. Settings and Design: The study design is a retrospective study at a tertiary eye care center. Methods: Review of medical records of 61 aphakic eyes of 61 patients, who were rehabilitated with retropupillary fixation of an iris claw lens, with a follow‑up duration of at least 1 year. Statistical Analysis Used: Data analysis was performed using paired t‑test and Chi‑square test. Results: Mean preoperative uncorrected visual acuity was 1.66 ± 0.3 LogMAR and postoperative acuity at 1 year was 0.53 ± 0.5 LogMAR (P = 0.00001). Preoperative distant best‑corrected visual acuity was 0.30 ± 0.48 LogMAR and postoperative acuity at 1 year was 0.27 ± 0.46 LogMAR (P = 0.07). Mean preoperative astigmatism was 1.43 ± 1.94 D and postoperatively was 1.85 ± 2.16 D (P = 0.0127). Mean endothelial cell count was 2353.52 ± 614 cells/mm² preoperatively which decreased to 2200 ± 728 cells/mm² at 1 year follow‑up (P = 0.006). There was no significant difference in central macular thickness and intraocular pressure pre and post-surgery. Complications included ovalization of pupil in 9.83%, hypotony in 1.63%, toxic anterior segment syndrome in 1.63%, cystoid macular edema in 11.47%, epiretinal membrane in 3.27%, and iris atrophy in 6.55%. Conclusion: Iris claw is a safe and an effective method of rehabilitating aphakic eyes.
ABSTRACT
ABSTRACT: The Uncaria tomentosa and Uncaria guianensis species, which are endemic plants in the Amazonian region, are highlighted as medicinal plants mainly because of their anti-inflammatory activity. The vegetal drug and various types of extracts have been commercialized by pharmaceutical industries and distributed in several countries, thus configuring the economic potential of both species. The objective of the present research was to collect agronomical data published in PubMed, SciELO, and Scopus databases and analyze the main subjects that were either investigated or not investigated to enable the production chain of these species. The conclusion is that U. guianensis has been less studied than U. tomentosa under all aspects evaluated. Both species have been exploited in an extractivistic way. However, no report was found on either sustainable management or conservation or domestication strategies or yet large scale production that can continuously attend the global demand of the pharmaceutic industry. Furthermore, the amount currently produced is insufficient to supply the program of the Ministry of Health, which intends to provide herbal drugs from Uncaria to all Brazilian cities.
RESUMO: As espécies Uncaria tomentosa e Uncaria guianensis , plantas endêmicas da Amazônia, destacam-se como plantas medicinais por apresentarem principalmente atividade anti-inflamatória. A droga vegetal e diversos tipos de extratos são comercializadas por indústrias farmacêuticas distribuídas em vários países, configurando o potencial econômico de ambas as espécies. O objetivo deste trabalho foi reunir dados agronômicos publicados nas bases de dados PubMed, SciELO e Scopus para analisar os principais temas que já foram investigados ou que ainda precisam ser abordados para viabilizar a cadeia produtiva dessas espécies. A conclusão é que U. guianensis é menos estudada do que U. tomentosa sob todos os aspectos avaliados. Ambas as espécies são exploradas de forma extrativista. Entretanto, não foram encontrados relatos de manejo sustentável, nem estratégias de conservação ou domesticação, ou ainda plantios em larga escala que possam atender de modo contínuo a demanda mundial da indústria farmacêutica. Além disso, não há quantidade suficiente para abastecer o programa nacional do Ministério da Saúde, que pretende disponibilizar fitoterápicos produzidos a partir de Uncaria a todos os municípios brasileiros.