Technical note: machine milking of sows--lactational milk yield and litter weights.

This study was designed to 1) determine milk yield of sows that were machine milked; 2) assess the effects of pulsation rate, pulsation ratio, and pig removal on milk yield; and 3) assess litter weights. In Exp. 1, four sows were milked daily to 60 d postpartum. There were differences (P < .05) in milk yield among sows, the greatest being 1,898 mL/d. Daily milk yield peaked between 15 and 25 d postpartum. Litter weights were 18.0 +/- 1.0 kg at farrowing and 60.8 +/- 12.1 kg at d 60. In Exp. 2, four sows were milked daily for 28 d. Pulsation rate and ratio (150/min and 28:72, milk:rest, and 60/min and 50:50) were alternated on a daily basis and pigs were isolated for either 0 or 60 min before milking. The higher pulsation rate resulted in more milk per milking (202 +/- 13 vs 168 +/- 13 mL; P < .05). Pig removal resulted in 221 +/- 11 vs 148 +/- 14 mL milk (P < .01). Pig removal times and pulsation characteristics affect the amount of milk obtained, but milk removal from sows has a severe effect on litter weight. This system can be used to harvest sow's milk for pharmaceutical purposes, but supplementation of the pigs is necessary.

Influence of pig substitution on milk yield, litter weights, and milk composition of machine milked sows.

This study was conducted to 1) determine milk yield of sows that were machine milked up to four times daily; 2) determine the effect of pig substitution on milk yield; 3) assess litter weight changes for sows that are milked; and 4) determine milk composition. Eight sows were milked four times daily to d 51 postpartum. Sows either maintained their own litter or had a week-old replacement litter to replace 25-d-old pigs. Individual gland milk yields were obtained on random days throughout lactation, and different diameter and weighted teat cups were rotated so that all glands received all combinations. Composite milk samples were analyzed for fat, protein, and somatic cells. Milk yields peaked at about 19 d postpartum and declined to 45 d postpartum in sows with their own litter, whereas milk yields peaked earlier and had a more dramatic decline after fostering of a younger litter. Litter weights were 17.1 +/- 1.0 kg at farrowing with 13.6 +/- .6 pigs born alive. Final litter weights were 34.4 +/- 11.7 kg for sows with replacement litters and 74.4 +/- 13.5 kg for sows with their own litters, and numbers of pigs weaned were 6.5 +/- 1.3 and 9.7 +/- 1.5, respectively. Milk fat was influenced by route of oxytocin administration (6.53 +/- .12 for i.v. vs 7.21 +/- .19% for i.m. administration; P < .05). Milk fat percentage was highest on d 2 and declined to 13 d postpartum. Milk protein was influenced by time of day of milking (lowest at the fourth milking, 5.57 +/- .11%) and followed a pattern similar to that for milk fat. Milk protein was affected in a linear manner by milk yield, with highest protein associated with lowest milk yields. Somatic cells in milk were influenced by litter replacement (P < .05) and oxytocin administration (P < .01). There was a linear increase in somatic cells from about 8 x 10(6) cells/mL milk at d 2 to more than 12 x 10(6) cells/mL milk at d 51 postpartum. These results show that pig replacement affects the amount of milk obtained. Moreover, milk composition changes throughout lactation. However, milk removal from sows has a severe impact on litter weight gains, and in systems where sow's milk is needed for commercial purposes, pig supplementation is necessary.

Early clinical experience with the Baerveldt implant in complicated glaucomas.

PURPOSE: To evaluate our early experience with the Baerveldt implant in patients with complicated glaucoma. METHODS: We reviewed the charts of all patients with more than six months of follow-up after placement of a Baerveldt implant at LSU Eye Center. Surgery was considered a success if intraocular pressure was 21 mm Hg or less (with or without antiglaucoma medications) at the last postoperative visit, except when further glaucoma surgery had been performed or when loss of light perception occurred. RESULTS: Fifty eyes (50 patients) were divided into six diagnostic groups, with mean follow-up times of 16.1 to 19.2 months. Success was achieved in 36 of 50 patients (72%): 26 of 35 (74%) patients with aphakia or pseudophakia, nine of 12 (75%) patients with previously failed filtering surgery, three of seven patients with neovascular glaucoma, all three patients under the age of 13 years, nine of 13 (69%) patients who underwent penetrating keratoplasty, and four of five phakic patients. Overall, visual acuity improved or remained within one line of the preoperative acuity in 32 (64%) patients. The most frequently observed short- and long-term complications were serous choroidal effusion associated with hypotony in 13 (26%) patients and corneal graft failure in six of 13 (46%) corneal transplant patients, respectively. CONCLUSION: Within the study follow-up time, the Baerveldt implant appeared to be safe and effective, with success rates for intraocular pressure control similar to those reported in a recent retrospective study of the Molteno implant.

A comparison of the efficacy of various metipranolol-pilocarpine combinations in patients with ocular hypertension and primary open-angle glaucoma.

We compared the ocular hypotensive effects of four fixed-dose metipranolol-pilocarpine combinations in nineteen ocular hypertensive subjects and glaucoma patients. Each patient was tested with all of the study medications: vehicle alone, 0.1% metipranolol HCl + 2% pilocarpine HCl, 0.1% metipranolol HCl + 4% pilocarpine HCl, 0.3% metipranolol HCl + 2% pilocarpine HCl, and 0.3% metipranolol HCl + 4% pilocarpine HCl, in a single dose, randomized, double-masked, cross-over placebo-controlled trial. In addition, another eight age and baseline intraocular pressure (IOP)-matched subjects received 0.1% or 0.3% metipranolol HCl, while a similar group of 14 volunteers received 2% or 4% pilocarpine HCl. A two week washout period was instituted between the various groups of treatments. All four metipranolol-pilocarpine combinations were more effective than placebo or either medication alone in reducing the average IOP for up to 8 hours (p < 0.05 for each treatment group). Metipranolol HCl 0.3%, regardless of the pilocarpine concentration, demonstrated the most significant IOP lowering effect, reducing the IOP by 4.9 mm Hg or about 20% from baseline. However, 0.1% metipranolol HCl in combination with 4% pilocarpine HCl was found almost as effective with a 18.5% reduction in IOP from baseline, but a shorter duration of action. In conclusion, all metipranolol-pilocarpine combinations were more efficacious than either medication alone in a single-dose trial. Additional multiple-dose studies are needed to determine the long-term effectiveness and tolerance of combining 0.3% metipranolol HCl with either 2% or 4% pilocarpine HCl.

Delayed sustained increase in intraocular pressure secondary to the use of polyacrylamide gel (Orcolon) in the anterior chamber.

Orcolon, a new viscoelastic substance, was withdrawn from the market in the United States by the manufacturer (Optical Radiation Corporation [ORC], Azusa, Calif) because of reports of delayed sustained increases in intraocular pressure (IOP) observed in patients who had undergone anterior segment surgery involving the use of this product. We examined the charts of 118 cases of anterior segment surgery involving Orcolon at our institution and found delayed IOP spikes in 20 of the 116 cases that had at least 3 months of follow up. Procedures included cataract extraction, penetrating keratoplasty, secondary intraocular lens implantation, and glaucoma surgery. Response to maximal medical therapy was poor; 11 patients underwent procedures for IOP control, an additional 4 required new or increased medications, and 3 developed persistent iritis, which required steroids. Four patients lost two or more lines of Snellen line chart visual acuity, and one went from counts fingers to light perception. The cause may be related to the presence of small particles of viscoelastic, which could lead to decreased aqueous outflow, particularly in eyes with an already compromised trabecular meshwork.

Cost of beta-adrenergic receptor blocking agents for ocular hypertension.

We compared the cost per drop and cost per year of therapy for five commercially available ocular beta-blockers (Timoptic, Betagan, Betoptic, Betoptic S, and Optipranolol) based on retail prices in Philadelphia, Pa; New Orleans, La; and San Francisco, Calif. Variations in bottle volumes and drop size combined to yield up to a 48% differential in number of drops per bottle. Average retail price variations were 28% within brands (between pharmacies), 29% between brands, and 29% between regions. Yearly costs were consistently less with larger bottles. Factoring drops-per-bottle, cost of brand, and cost by pharmacy, the cost of a year's supply of beta-blocker in 5-mL bottles in the least expensive region (New Orleans) ranged from $52.25 for Optipranolol to $278.91 for Betagan (534% of the price for Optipranolol). The marked differential in yearly cost among antiglaucoma medications should perhaps be a factor in the recommendations made by physicians and health-care providers.

Nevus of Ota with glaucoma: report of three cases.

We report three cases of unilateral open-angle glaucoma associated with ipsilateral nevus of Ota. All three occurred in black patients and were associated with ipsilateral melanocytic infiltration of the outflow tracts. Glaucoma probably is associated with nevus of Ota in blacks more frequently than has been reported. All patients with nevus of Ota should be examined regularly to screen for glaucoma.

Glaucoma in Hansen's disease.

Glaucoma is considered to be an uncommon complication of Hansen's disease (leprosy). This study determined the prevalence and characteristics of glaucoma in a large institutionalised leprosy population. All 193 patients currently residing at the Gillis W Long Hansen's Disease Center received a complete ophthalmic examination and review of their records. All had been previously treated with dapsone and/or clofazimine. Based on the strict definition of a recorded intraocular pressure greater than or equal to 22 mm Hg and characteristic optic nerve pathology, 19 patients (10%) were found to have glaucoma. Glaucoma secondary to uveitis was noted in 11 of these patients. These findings suggest that the chronic inflammatory process of Hansen's disease, even when treated, may be followed by secondary glaucoma. We recommend that all patients with Hansen's disease receive regular periodic examinations, including slit-lamp biomicroscopy to detect low-grade iridocyclitis and measurement of intraocular pressure.

Pupillary block glaucoma following pediatric cataract extraction.

We present a case of pupillary block glaucoma that developed after cataract extraction in a pediatric patient. To prevent pupillary block and secondary glaucoma after cataract surgery we recommend that all pediatric cataract patients be given a prophylactic peripheral iridectomy.

Molteno rip-cord suture hypopyon.

Seven of 27 eyes developed hypopyons following removal of a 4-0 chromic suture that had been placed intraoperatively in the lumen of the tube of a Molteno implant as a temporary occlusion device. The hypopyons were sterile to anterior chamber tap and in six of seven cases resolved with only routine antibiotic coverage. Surgeons contemplating using an internal chromic suture occlusion in Molteno implants, however, should be aware of this potential problem and adopt a conservative, noninvasive approach.

Pigmentary glaucoma in the black population.

The pigment dispersion syndrome is associated with a secondary open-angle glaucoma most commonly found in young, myopic, white males. We studied 20 cases (38 eyes) of pigment dispersion syndrome in black individuals as defined by heavy deposition on the corneal endothelium and trabecular meshwork with increased intraocular pressure but no other ocular abnormalities. The 20 patients were a homogeneous group that was typified by older age distribution (average, 73 years), a preponderance of hyperopia (median refraction, +2.15 diopters spherical equivalent), female gender (19 women, one man), no iris transillumination defects (zero of 38 eyes), and flatter iris insertion into the ciliary body. We believe that this homogeneous group of black individuals with pigment dispersion and atypical features represents a pigment dispersion syndrome associated with older age, hyperopia, and female sex preponderance, in the black race.

Filtering bleb encapsulation increased by steroid injection.

In an attempt to enhance its pressure-lowering and fibroblast inhibiting effects, we administered 0.15 cc of 24 mg/ml dexamethasone, intra-Tenon's, directly over the fistula site following 16 consecutive filtering surgeries. The encapsulation rate in these eyes was 56% (9/15), as compared with 10% (2/20) in a retrospectively matched group of eyes that had undergone filtering surgery with dexamethasone given subconjunctivally 180 degrees away from the filter site. The effective concentration of dexamethasone achieved by the injections at the filter site apparently did not maintain the fibroblast inhibitory drug level and, in fact, supported fibroblastic growth, resulting in increased encapsulation. Because of the increased encapsulation rate and the lack of any demonstrable benefit associated with it, we do not recommend intralesional dexamethasone in filtering surgery. Commercial topical steroids with their lower concentrations also may act to promote rather than inhibit fibroblast growth. Prolonged steroid use after filtering surgery beyond the inflammatory phase of wound healing (about 2 weeks) may increase fibrosis in the area of the filter, resulting in a thick-walled bleb with few microcysts, one form of which is frank encapsulation. Thus, we recommend that topical steroids routinely be stopped by the third postoperative week if the level of inflammation permits.

The site of operating microscope light-induced injury on the human retina.

We determined the site of the focal illumination from the Zeiss OPMI-6 operating microscope on the retina of the phakic and aphakic human cadaver eye by directly observing the illuminating element image on the posterior scleral surface of the globe. With the eye straight ahead and the operating microscope level, the focal oval area of retinal illumination was located superior to the foveola in both the phakic and aphakic eye. Tilting the operating microscope 10 degrees toward the surgeon displaced the entire illuminating element image 0.50 mm below the foveola in the phakic eye and 0.25 mm below the foveola in the aphakic eye. Rotating the eye inferiorly 10 degrees displaced the entire illuminating element image 1.0 mm below the foveola in the phakic eye and 1.25 mm below the foveola in the aphakic eye. Centering the field of view superiorly (viewing the superior limbus) paradoxically displaced the illuminating element image inferiorly, resulting in central foveal illumination. Foveal light exposure was avoided in most eye positions by tilting the microscope at least 10 degrees toward the surgeon.

Exfoliation syndrome prevalence in the glaucoma population of South Louisiana.

A prospective study was performed to determine the prevalence of exfoliation syndrome in a glaucoma population of South Louisiana. Five hundred consecutive open angle glaucoma patients over 50 years of age (median age 70.6 years) from both indigent clinic and private referral sources were examined for the presence of exfoliation material on the lens capsule. The prevalence in caucasian patients was 2.7%, blacks 0.4%, combined 1.4%. This compares with a reported prevalence of exfoliation syndrome among patients with open angle glaucoma in the United States of 3% to 28%, Denmark of 26%, Ireland of 66%, and Sweden of 75%. This low prevalence may be a reflection of the ethnic origin of the population, but other explanations are considered.

A model for predicting the site of paraxial retinal lesions secondary to "coaxial" operating microscope illumination systems.

We measured a 15 +/- 2-mm displacement of the illuminating element of the coaxial operating microscope from the true optical center of the microscope. We further calculated the displacement of the image of the illuminating element of the operating microscope on the retina of the simplified schematic eye and found that the "coaxial" operating microscope would focus the light between 1.3 and 1.8 mm superior to the fovea of the eye, depending on the theoretical refractive status of the simplified eye. Actual measurements on a simulated retina (35-mm camera) confirmed the calculated displacements. The deviation varied with eye tilt and microscope position. We also found that the maneuvers commonly used by anterior segment surgeons of tilting the microscope and rotating the eye downward tended to displace the image of the illuminating element closer to the fovea, increasing the chance for symptomatic retinal damage. A combination of such maneuvers may reduce the potential for clinically significant retinal phototoxicity by displacing the light further inferior to the fovea.