Evaluation of the MGDRx eyebag treatment in young and older subjects with dry eye symptoms.

OBJECTIVES: This study aims to evaluate the relationship between application of the MGDRx thermal eyebag and dry eye signs and symptoms in young and older subjects and to compare the results between the two groups. METHODS: Thirty young, healthily volunteers between 18 and 31 years of age (23.95±3.94 years) and thirty older subjects between 61 and 90 years of age (77.97±8.11 years) participated in this study. Ocular surface parameters were assessed using the Oculus Keratograph 5M, following the guidelines of the Tear Film and Ocular Surface Dry Eye Workshop II Diagnostic Methodology report. Only subjects with a positive score on at least one questionnaire and an initial Non-Invasive Keratograph Break-Up Time (NIKBUT) under 10seconds were included in the study. After thermal bag self-application in both eyes every day for 2 weeks, the protocol was carried out again. Lid massage was performed after lid warming. Compliance and degree of improvement were also assessed. MAIN RESULTS: The young volunteer group showed an improvement in NIKBUT, lipid layer score, upper eyelid gland drop-out percentage and dry eye symptoms over the two week treatment period. Improvements in meibum quality, gland obstruction, telangiectasia scores, and dry eye symptoms were found in the older subjects. Mixed ANOVA revealed better NIKBUT and lipid layer values in the young subjects. Despite the treatment compliance being statistically higher in the older group than in the younger subjects (P=0.002), there were no significant differences in subjective improvement between groups (P=0.097). CONCLUSION: Dry eye-related symptoms were improved after thermal bag application, while NIKBUT and lipid layer thickness were improved only in the younger subjects.

Neural regeneration dynamics of Xenopus laevis olfactory epithelium after zinc sulfate-induced damage.

Neural stem cells (NSCs) of the olfactory epithelium (OE) are responsible for tissue maintenance and the neural regeneration after severe damage of the tissue. In the normal OE, NSCs are located in the basal layer, olfactory receptor neurons (ORNs) mainly in the middle layer, and sustentacular (SUS) cells in the most apical olfactory layer. In this work, we induced severe damage of the OE through treatment with a zinc sulfate (ZnSO4) solution directly in the medium, which resulted in the loss of ORNs and SUS cells, but retention of the basal layer. During recovery following injury, the OE exhibited increased proliferation of NSCs and rapid neural regeneration. After 24h of recovery, new ORNs and SUS cells were observed. Normal morphology and olfactory function were reached after 168h (7 days) of recovery after ZnSO4 treatment. Taken together, these data support the hypothesis that NSCs in the basal layer activate after OE injury and that these are sufficient for complete neural regeneration and olfactory function restoration. Our analysis provides histological and functional insights into the dynamics between olfactory neurogenesis and the neuronal integration into the neuronal circuitry of the olfactory bulb that restores the function of the olfactory system.

Comparison of Macular Thickness in Patients with Keratoconus and Control Subjects Using the Cirrus HD-OCT.

PURPOSE: The aim of the present study was to compare macular thickness in patients with keratoconus (KC) with macular thickness in healthy subjects. SUBJECTS AND METHODS: Twenty-six patients with KC and 52 control subjects were included. The macular structure was evaluated using a Zeiss Cirrus HD-OCT. The scan pattern used was 512 × 128, which covers an area of approximately 6 × 6 mm of the retina. The cube volume was assessed as well as macular thickness in each of the 9 sectors defined by the software. RESULTS: The mean signal strength was significantly lower in the KC group (mean 8.4, range 6-10) compared with the control group (mean 9.7, range 7-10), P < 0.0001 (unpaired t-test). There were no significant differences in cube volume (unpaired t-test), cube average thickness, or macular thickness between the KC group and the control subjects in any of the retinal locations (one-way ANOVA). CONCLUSION: Macular structure as measured by OCT in KC subjects should be expected to lie within the range of age and sex matched controls.

Evaluation of the anterior chamber angle in keratoconus and normal subjects.

PURPOSE: To evaluate the anterior chamber angle in keratoconus eyes by use of the Visante™ OCT and Orbscan™ II. METHODS: Anterior chamber angle was measured with the Visante™ OCT and Orbscan™ II in 52 subjects, 26 KC subjects and 26 age and control subjects. RESULTS: When comparing the nasal and temporal angles obtained with the two techniques no correlation was found (R(2) always below 0.01) in either the control subjects or in the KC subjects. Despite this, there was an overall statistically significant difference in mean anterior chamber angles (p<0.001) between Visante™ OCT and Orbscan™ II. There was no statistical difference (p>0.05) between nasal and temporal anterior chamber angles when comparing controls and KC subjects with either of the two instruments. In general, the Visante™ OCT gave a smaller estimate of the anterior chamber angle. CONCLUSION: The values from the Visante™ OCT and Orbscan™ II cannot be interchanged since the difference in measurement of the anterior chamber angle was significantly different between the two instruments.

Optical quality of the diabetic eye: a review.

Diabetes mellitus is a metabolic disorder characterized by the presence of chronic hyperglycaemia. Several structural, morphological, and physiological changes in each of ocular component have been described in detail during the past decades. Due to these abnormalities, the diabetic patient undergoes a degradation of the retinal image by an increase of higher ocular aberrations and ocular scattering coming from mainly tear film, cornea, and crystalline lens. This review aims to provide an overview of current knowledge about the effects of diabetes mellitus in these optical phenomena and its consequence on the visual quality of the diabetic patient.

The posterior chamber phakic refractive lens (PRL): a review.

Implantation of phakic intraocular lenses (pIOLs) is a reversible refractive procedure, preserving the patient's accommodative function with minimal induction of higher order aberrations compared with corneal photoablative procedures. Despite this, as an intraocular procedure, it has potential risks such as cataracts, chronic uveitis, pupil ovalization, corneal endothelial cell loss, pigmentary dispersion syndrome, pupillary block glaucoma, astigmatism, or endophthalmitis. Currently, only two models of posterior chamber pIOLs are commercially available, the implantable collammer lens (STAAR Surgical Co.) and the phakic refractive lens (PRL; Zeiss Meditec). The number of published reports on the latter is very low, and some concerns still remain about its long-term safety. The present article reviews the published literature on the outcomes after PRL implantation in order to provide a general overview and evaluate its real potential as a surgical refractive option.

Comparison of 18F-FDG positron emission tomography/computed tomography and computed tomography in patients with already-treated breast cancer: diagnostic and prognostic implications.

AIM: The purpose of the study was to assess the comparison of 18F-FDG PET/CT and CT in patients with breast cancer (BC) already treated with primary therapy, in evaluating the diagnostic and prognostic values. METHODS: We retrospectively studied 190 patients (187 women and 3 men, mean age 61±11 years) with previous BC (all stages) after surgery and other primary treatments. They underwent within three months CT and 18F-FDG PET/CT examinations for the evaluation of disease status. Disease relapse was confirmed by clinical evaluation and/or radiological findings. Survival curves of disease-free survival (DFS) and overall survival (OS) were computed using Kaplan-Meier method. Cox analysis regression was used to determine predictive factors of DFS and OS. RESULTS: Of the overall 190 patients, 82 (43%) had evidence of clinical and/or imaging disease relapse, while 108 (57%) did not. Sensitivity, specificity, negative predictive and positive predictive values for disease relapse or progression were of 89% vs. 77%, 73% vs. 53%, 90% vs. 75% and 72% vs. 55%, respectively for PET/CT and CT. DFS curves were significantly different in patients with both negative and positive PET/CT and CT (log-rank test 33.6; P<0.0001 and 12.7; P=0.003, respectively). OS curves were similar in patients with positive/negative PET/CT and CT (P=NS). By both univariate and multivariate Cox regression analysis positive PET/CT was found to be related to the disease recurrence (HR 0.18 and 0.20, both P<0.0001, respectively). CONCLUSION: PET/CT is more accurate than CT in identification of disease relapse in a large population of BC patients. In women at high-risk of recurrence, PET/CT imaging can provide the early detection of BC metastases, tailoring a proper treatment.

Treatment of keratoacanthoma: Is intralesional methotrexate an option?

BACKGROUND: Keratoacanthomas (KAs) are a variant of squamous cell carcinomas. Some KAs have shown aggressive behaviour, leading to metastasis and death. Surgical excision is the treatment of choice for most KA patients. Intralesional methotrexate (MTX) may also be a potential treatment option for KAs. OBJECTIVE: To evaluate intralesional MTX as a treatment modality for KA. METHODS: A retrospective chart review of nine patients with KAs treated with intralesional MTX was performed. Each patient had biopsy-proven KA. The lesion was initially debulked, and MTX was injected at the base. Patients were seen weekly in the office, and reinjected with intralesional MTX depending on the response of the lesion. Each patient was evaluated for their response to the intralesional MTX injections, the number of injections required and complications. RESULTS: Patients required approximately two to four intralesional injections (12.5 mg to 25 mg per injection) before KA resolution. Eight of nine (88.9%) patients experienced complete resolution of their tumours. One patient experienced treatment failure, and underwent surgical excision of the KA. The average follow-up period was 2.8 years, and there were no recurrences. CONCLUSION: The results from the present retrospective study show that intralesional MTX injection is an effective treatment option for KAs. The authors propose that intralesional MTX injection with initial debulking of the KA should be used as a first line of treatment when KAs present on the extremities, in cosmetically sensitive areas and in elderly patients with multiple comorbities.

Keloid treatment: is there a role for acellular human dermis (Alloderm)?

BACKGROUND: Keloid management is faced with high recurrence rates. Keloid fibroblasts lack the normal negative feedback mechanism resulting in an exuberant scar formation. Alloderm doesn't undergo the same proliferative process as keloidal scar dermis. OBJECTIVE: To evaluate Alloderm as a treatment modality for keloids METHODS: A retrospective chart review of six patients with a total of eight large recurrent keloids was performed. Patients were treated with excision of the keloid followed by placement of Alloderm. Each patient was evaluated for recurrence and complications. RESULTS: During follow-up ranging from 1 month to 4(1/2) years there were 0% recurrences. Two out of 8 (25%) had residual induration. one of the two patients with residual induration, required an intralesional injection of kenalog at 6 months post-op. CONCLUSION: Our results from this small study show that with the use of Alloderm after keloid excision, recurrence is low. Further study is warranted.

Performance of the compensation comparison method for retinal straylight measurement: effect of patient's age on repeatability.

AIM: The assessment of repeatability and reproducibility of retinal straylight measurements with the C-Quant straylight meter (Oculus AG, Germany) and the effect of patient's age on the instrument performance are tested with a series of experiments. METHODS: First, 20 eyes from 20 subjects (mean age 26.9 (SD 2.7) years, mean refractive error -1.34 (2.72) D) were examined with the C-Quant straylightmeter, taking 10 consecutive readings. Five subjects were also examined on five consecutive days to assess reproducibility. Additionally, repeated measures of straylight from 84 subjects of ages ranging from 19 to 86 years (mean (SD): 42.4 (24.0) years) were retrospectively analysed to assess the effect of patient's age on repeatability. RESULTS: The results failed to show significant differences between the readings taken within the same session (mean (0.07), p>0.05) or between sessions (mean (0.05), p>0.05). Variability of intrasession measurements was not significant for subjects of different age (p = 0.094). CONCLUSION: It may be concluded that the C-Quant straylightmeter is repeatable and reliable for the assessment of retinal straylight in human eyes. Age of the patient does not decrease repeatability, even though they feel more insecure about their ability to perform the test.

[Corneal asphericity in a young adult population. Clinical implications]. / Asfericidad corneal en una población de adultos jóvenes. Implicaciones clínicas.

PURPOSE: To determine the relevance of the different ocular optical components in the refractive state of young adults, paying special attention to the corneal topography represented by the asphericity value. SUBJECTS AND METHODS: Corneal topographies and ultrasonic biometries were obtained from 109 university students with different refractive errors (spherical equivalent range: +3.25 D to -11.00 D). A regression study was performed in order to establish the relationships between corneal asphericity and refractive error, as well as other ocular optical components related to the emmetropization mechanism of the eye. RESULTS: The mean asphericity values were -0.23 (SD 0.08, range: -0.42 to -0.03). All the values correspond to the mathematical description of the prolate ellipse, most commonly accepted for the normal human cornea. The statistical correlation between asphericity and equivalent refractive error was not significant, but a significant correlation was found for the asphericity with respect to the radius of curvature, vitreous chamber depth and axial length. CONCLUSIONS: 1) The asphericity values support the generalised morphology of the prolate cornea as the standard. The influence of this configuration on the contact lens fit, refractive surgery or the visual performance of the eye are discussed. 2) Results suggest that, although a relationship between axial length and corneal topography actually exists, it is not likely that the latter has implications for the emmetropization mechanisms which determine the refractive state of the adult eye.

Influence of corneal asymmetry on the phakometric measurement of ocular surface alignment.

Phakometric measurements of corneal and crystalline lens surface alignment are influenced by corneal asymmetry in which the corneal apex does not coincide with the limbal centre. The purpose of this study was to determine the horizontal separation (e) between these corneal landmarks. Measurements were made in 60 normal eyes (30 subjects) using the Orbscan IIz corneal analysis workstation. Our results show that both corneal landmarks typically coincide, so that e = 0, but that inter-subject variations of about +/-1 mm can be expected (so that the corneal apex may fall nasal or temporal to the visual axis). This suggests that no correction for corneal asymmetry is required when estimating average amounts of ocular alignment from samples of eyes but that the measurement of e is strongly recommended for measurements in individual eyes.

[Changes in axial length/corneal radius ratio (AL/CR) according to refractive state of the eye. Relationship with ocular components]. / Variación de la ratio longitud axial/radio corneal (LA/RC) con el estado refractivo ocular. Relación con los componentes oculares.

PURPOSE: Determination of the role of the axial length/corneal radius ratio (AL/CR) in the refractive state and investigation of its relationship with the ocular optical components: AL, CR, anterior chamber depth (ACD), crystalline lens thickness (CT) and vitreous chamber depth (VCD). METHODS: The RE (right eye) of 193 University students 22.27 (SD 3.24) years, with different refractive errors (spherical equivalent range: +3.00 D to -11.00 D), being divided into: emmetropes, hyperopes and myopes (low, moderate and high). The ACE, the CT, the VCD and the AL were measured by ultrasonography (unidimensional echography); and the mean CR by videokeratoscopy. RESULTS: The value of AL/CR obtained was 2.98 (SD 0.69) for emmetropes, 2.89 (SD 0.87) for hyperopes, 3.01 (SD 0.07) in low myopias, 3.10 (SD 0.11) in moderate myopias and 3.23 (SD 0.12) in high myopias. The AL/CR ratio showed a higher correlation with the refractive error. Besides, all the refractive groups were observed to have lower CE values as the AL/CR increased. This tendency is statistically significant in hyperopes, emmetropes and low myopes; and is not in moderate and high myopias. All the study groups could be observed to have a positive and statistically significant correlation between AL/CR and ACD. CONCLUSION: The ratio AL/CR is the most important parameter and the best predictor of the refractive state of the human eye. It provides important information on how best to determine the degree of emmetropization given by the crystalline, decreasing its power and the ACD in concordance with the LA. A value for the ratio AL/CR above 3.00 could be considered as a risk factor for the development of myopia in emmetropic eyes.

Accuracy and precision of EyeSys and Orbscan systems on calibrated spherical test surfaces.

BACKGROUND: It is important to know how well the surface topography can be measured with current devices for corneal topographic analysis. There are several applications that need an accurate and precise method to measure corneal shape and variations, such as the effect of contact lens wear and the different refractive surgery techniques. PURPOSE: The aim of this study is to compare the accuracy and reproducibility of the measurement of the central curvature on calibrated steel balls using the EyeSys videokeratoscope and the Orbscan corneal topography system. METHODS: The videokeratoscope (EyeSys Corneal Analysis System 2000, version 3.1) and the Orbscan corneal topography system (Orbscan II version 3.0) were used by four trained investigators to measure a series of five uniform and calibrated test surfaces with known radius of curvature ranging from 6.13 to 9.00 mm. RESULT: No statistically significant difference was found between the videokeratoscope and Orbscan systems in relation to accuracy or precision. The 95% confidence limits showed a close agreement between both instruments. The mean bias was less than +/-0.05 mm for both devices. The precision of the instruments was found to be similar. CONCLUSION: The EyeSys seems to measure more accurately, but the accuracy of the Orbscan was also acceptable, suggesting that both instruments are accurate and precise enough for research and clinical purposes. However, further studies of accuracy and repeatability of topographical measurements on human eyes generated by different topographers are necessary.

Variación de la ratio longitud axial/radio corneal (LA/RC) con el estado refractivo ocular: Relación con los componentes oculares / Canges in axial lenght/corneal radius ratio (AL/CR) according to refractive state of the eye. Relationship with ocular componets

Objetivo: Determinación del papel de la ratio longitud axial/radio corneal (LA/RC) en el estado refractivo e investigación de su relación con los componentes ópticos oculares: LA, RC, profundidad de cámara anterior (PCA), espesor del cristalino (EC) y profundidad de cámara vítrea (PCV). Métodos: Se ha examinado el ojo derecho (OD) en 193 estudiantes universitarios de 22,27 (DE 3,24) años, con diversas formas de error refractivo (rango equivalente esférico: +3,00 D a –11,00 D), dividiéndose en emétropes, hipermétropes y miopes (bajos, moderados y altos). La PCA, el EC, la PCV y la LA se han medido por ultrasonografía (ecografía unidimensional); y, el RC promedio por videoqueratoscopía. Resultados: El valor de LA/RC resultó ser 2,98 (DE 0,69) para emétropes, 2,89 (DE 0,87) para hipermétropes, 3,01 (DE 0,07) en miopías bajas, 3,10 (DE 0,11) en miopías moderadas y 3,23 (DE 0,12) en miopías altas. La ratio LA / RC presentaba la más alta correlación con el error refractivo. Además, en todos los grupos refractivos se observó que a medida que aumentaba el valor de LA / RC, el EC tendía a disminuir. Esta tendencia es estadísticamente significativa en hipermétropes, emétropes y miopes bajos; no siéndolo en miopías moderadas y altas. En todos los grupos de estudio se observa una correlación positiva y estadísticamente significativa entre LA/RC y PCA. Conclusión: La ratio LA/RC es el parámetro más determinante y el mejor predictor del estado refractivo del ojo humano. Proporciona información importante para determinar el grado de emetropización que aporta el cristalino, reduciendo su potencia y, la PCA en concordancia con la LA. Una ratio LA/RC superior a 3,00 podría considerarse un factor de riesgo para el desarrollo de miopía en ojos emétropes(AU)

Purpose: Determination of the role of the axial length/corneal radius ratio (AL/CR) in the refractive state and investigation of its relationship with the ocular optical components: AL, CR, anterior chamber depth (ACD), crystalline lens thickness (CT) and vitreous chamber depth (VCD). Methods: The RE (right eye) of 193 University students 22.27 (SD 3.24) years, with different refractive errors (spherical equivalent range: +3.00 D to –11.00 D), being divided into: emmetropes, hyperopes and myopes (low, moderate and high). The ACE, the CT, the VCD and the AL were measured by ultrasonography (unidimensional echography); and the mean CR by videokeratoscopy. Results: The value of AL/CR obtained was 2.98 (SD 0.69) for emmetropes, 2.89 (SD 0.87) for hyperopes, 3.01 (SD 0.07) in low myopias, 3.10 (SD 0.11) in moderate myopias and 3.23 (SD 0.12) in high myopias. The AL/CR ratio showed a higher correlation with the refractive error. Besides, all the refractive groups were observed to have lower CE values as the AL/CR increased. This tendency is statistically significant in hyperopes, emmetropes and low myopes; and is not in moderate and high myopias. All the study groups could be observed to have a positive and statistically significant correlation between AL/CR and ACD. Conclusion: The ratio AL/CR is the most important parameter and the best predictor of the refractive state of the human eye. It provides important information on how best to determine the degree of emmetropization given by the crystalline, decreasing its power and the ACD in concordance with the LA. A value for the ratio AL/CR above 3.00 could be considered as a risk factor for the development of myopia in emmetropic eyes(AU)

Necrotizing fasciitis: Diagnosis and management of an occult infective focus.

Necrotizing fasciitis is a life-threatening, fulminant disease that is a diagnostic and therapeutic challenge. Presenting with a triad of findings including progressive erythema, severe dermatological edema and severe pain disproportionate to the physical findings, this disease is a surgical emergency. Delayed diagnosis and surgical debridement lead to higher mortality. Early extensive surgical debridement, aggressive antibiotic therapy, invasive monitoring and intensive care management determine the outcome in most cases. In patients who fail to demonstrate clinical improvement, profound sepsis and its sequela -systemic inflammatory response - have frequently been implicated. It is these patients that need to be carefully re-evaluated for 'hidden' foci of infection that may be the real cause of the patient's decline. Once detected, these occult foci can be surgically debrided, resulting in dramatic improvement. Two illustrative cases, one with occult endo- and panophthalmitis and the other with an unusual involvement of deeper muscle planes and the nodal basin, demonstrate this point. This consumptive process gathers momentum at an alarming speed, hence, the treatment must be aggressive and prompt.

La fasciite nécrosante est une maladie fulminante mettant la vie en danger, sans compter que c'est un défi diagnostique et thérapeutique. Se manifestant par une triade d'observations, y compris un érythème évolutif, un œdème dermatologique grave et une douleur marquée disproportionnée par rapport aux observations physiques, cette maladie est une urgence opératoire. Un retard du diagnostic et du débridement chirurgical entraîne un taux de mortalité plus élevé. Dans la plupart des cas, un débridement chirurgical précoce extensif, une antibiothérapie énergique, une surveillance envahissante et une prise en charge en soins intensifs déterminent l'issue. Chez les patients qui n'affichent pas d'amélioration clinique, une septicémie profonde et ses séquelles (une réponse inflammatoire systémique), se produisent souvent. Ce sont ces patients qui ont besoin d'une réévaluation attentive afin de dépister des foyers « cachés ¼ d'infection qui pourraient être la véritable cause du déclin du patient. Une fois dépisté, ces foyers occultes peuvent faire l'objet d'un débridement chirurgical, ce qui entraîne une amélioration remarquable. Deux cas, l'un accompagné d'endophtalmie et de panophtalmie occultes et l'autre, de l'atteinte inhabituelle des plans musculaires plus profonds et du bassin nodal, démontrent ce point. Ce processus consomptif gagne de la vitesse à un rythme alarmant. C'est pourquoi le traitement doit être rapide et dynamique.

Intraoperative acute tissue expansion revisited: a valuable tool for challenging skin defects.

BACKGROUND: The efficacy of acute tissue expansion (ATE) in achieving skin closure has been strongly debated. Proponents maintain that ATE is efficacious, whereas critics have argued for lack of supporting scientific data and that ATE is no more effective than skin undermining in closure of surface defects. OBJECTIVE: To compare and actually quantify gain in skin length after extensive undermining of skin edges alone or in combination with ATE in skin defects. METHODS: Twenty-one consecutive patients undergoing excision and closure of wounds in certain anatomical areas where primary closure is difficult were studied. Actual measurements of the undermined skin before and after ATE were recorded. Immediate problems and long-term follow-up data were analyzed. RESULTS: ATE, in addition to undermining, provides 1:1.61 +/- 0.23 more skin on each margin than undermining used alone. It is effective, easy to perform, inexpensive, and reproducible, with clearly quantifiable increments of skin stretch. Long-term morbidity is minimal with excellent cosmetic results. CONCLUSION: ATE provides a useful tool for closure of skin defects that are resistant to simple primary closure even when deeply undermined. It is simple and easily performed in an office setting without much preparation or special equipment.