High-volume intraocular lens surgery in a rural eye camp in India.

BACKGROUND AND OBJECTIVE: The appropriate surgical treatment for the enormous number of patients in developing nations who are blind due to cataract is a hotly debated issue. The authors objective is to demonstrate that modern surgical techniques (extracapsular cataract extraction and intraocular lens implantation, phacoemulsification and intraocular lens implantation) can be performed in a high-volume, cost effective manner, even in temporary settings. The authors believe that the approach to cataract blindness is not simple intracapsular cataract extraction, but rather the challenge of (1) training all ophthalmic personnel in modern techniques (microsurgery, biometry), (2) training managers in higher levels of organizational skill, and (3) doing these things in the face of limited resources. PATIENTS AND METHODS: A total of 1298 surgeries were performed in a public eye camp in Ganeshpuri, India (50 miles north of Bombay). Of these, 1214 (93.5%) of the patients received intraocular lens (IOL) implants. Ninety-three percent (1032/1108) of the patients who underwent extracapsular cataract extraction (ECCE) and IOL implantation and 89% (83/93) of the patients who underwent phacoemulsification and IOL implantation returned for follow-up. RESULTS: Postoperatively, 48% (498/1032) of the patients who underwent ECCE and IOL implantation achieved corrected vision of 6/12 or better and 65% (671/1032) attained corrected vision of 6/18 or better. Of the patients who underwent phacoemulsification and IOL implantation, 59 of 83 (71%) attained vision of 6/12 or better with correction and 68 of 83 (79%) achieved vision of 6/18 or better with correction. These results are almost identical to those obtained by the authors in their Ganeshpuri 1991 camp. Surgical complication rates were comparable to those reported in hospital-based studies. CONCLUSION: For this type of camp to operate efficiently, there must be standardization of skills among ophthalmic personnel, costs must be contained, and the organizational skills necessary to ensure smooth functioning of the camp must exist. However, on the basis of their data, these authors believe that with suitable organizational and surgical facilities, IOL implantation can be successfully performed in high-volume surgical eye camps.

Intraocular lens implantation in rural India.

We performed 379 extracapsular cataract surgeries with implantation of intraocular lenses (IOLs) in a public eye camp in Ganeshpuri, India (50 miles north of Bombay). Ninety percent (341) of the patients returned for follow up. At 8 weeks postoperatively, 48% of the patients had a visual acuity of 6/18 or better uncorrected; with correction, this figure rises to 71.5%. In general, surgical complications were neither severe nor frequent. More serious difficulties were associated with measuring initial IOL power, obtaining refractive data (including astigmatism), follow up of astigmatism (suture cutting), posterior capsule opacification, and associated preoperative pathology. On the basis of our data, we believe that IOL implantation in public eye camps, under controlled conditions of asepsis and with appropriate instrumentation, is a safe and effective way to provide visual rehabilitation to the rural populations of third-world countries.

Visual outcome of cataract extraction and lens implantation complicated by vitreous loss.

A retrospective study of 62 cases of planned extracapsular cataract extraction with intraocular lens implantation complicated by vitreous loss revealed a visual outcome of 20/20 to 20/40 in 34 eyes (54.8%), 20/50 to 20/80 in 16 eyes (25.8%), 20/100 to 20/400 in six eyes (9.7%), and worse than 20/400 in six eyes (9.7%). If preexisting ocular diseases such as glaucoma and macular degeneration are eliminated, 77.3% achieved a visual acuity of 20/40 or better.

Intraocular lens implant exchange and resolution of cystoid macular edema.

Cystoid macular edema is a recognized complication of cataract extraction and intraocular lens implantation with an incidence of 5.2% to 50.0%. We have recently performed lens implant exchange in an eye with cystoid macular edema which suffered recurrent hyphema (UGH syndrome). In addition to resolution of the patient's recurrent hyphema, we observed the resolution of cystoid macular edema in this eye.

The double implant: alternative management for intraocular lens dislocation.

We describe a new management of posterior dislocation of an intraocular lens implant into the vitreous by means of focal retinal photocoagulation and implantation of a secondary anterior chamber lens to correct subsequent aphakia.

Intraocular lens implantation in acute angle closure glaucoma associated with cataract.

We have performed planned extracapsular cataract extraction and implantation of a posterior chamber intraocular lens in four eyes of three patients undergoing surgery for acute angle closure glaucoma associated with cataract. Three of these four eyes suffered angle closure secondary to intumescent cataract. One suffered primary angle closure upon preoperative pupillary dilation prior to lens extraction. We have found no evidence of corneal decompensation, residual glaucoma, or increased surgical morbidity in our patients. We feel that acute glaucoma associated with cataract is not a contraindication to lens implantation.

Treatment of pseudophakic cystoid macular edema by elevation of intraocular pressure.

We have utilized topical steroid therapy (dexamethasone 0.1%, one drop four times a day) in the treatment of seventeen pseudophakic patients with postoperative cystoid macular edema. Our patients underwent either extracapsular cataract extraction and implantation of a posterior chamber lens or intracapsular cataract extraction and anterior chamber lens placement. All of our patients achieved 20/40 vision after one to three months of therapy. Forty percent attained final visual acuity of 20/20. We attribute resolution of cystoid macular edema to elevation of intraocular pressure induced by topical steroids.

Toxicity of intrapleural Bacillus Calmette-Guérin treatment in animals.

The toxicity of intrapleural Tice strain Bacillus Calmette-Guérin (BCG) infection was tested in hamsters. Doses above 10(6) colony-forming units caused significant systemic infection, which could be controlled with conventional antituberculosis therapy. Living BCG in the pleural space did not prevent the healing of bronchial or vascular closures after pulmonary resection. Prophylactic intrapleural BCG (10(6) colony-forming units) significantly reduced tumor growth in the lungs of mice following i.v. injection of 5 x 10(5) syngeneic sarcoma cells. These animal experiments suggest that intrapleural BCG may be administered in the pleural space after lung resection in limited doses if followed by a complementary course of antimicrobial therapy.

Pyruvate decarboxylase III. Specificity restrictions for thiamine pyrophosphate in the protein association step, sub-unit structure.

Pyruvate decarboxylase dissociates into sub-units of one half the molecular weight at alkaline pH. At the same conditions the cofactors thiamine pyrophosphate and Mg2+ are released and can be separated from the protein. Thiamine pyrophosphate is an obligatory cofactor for reconstitution to the oligomer [1]. In this study the effect of thiamine pyrophosphate derivatives (thiamine monophosphate, thiamine, and thiazole pyrophosphate) upon the reconstitution procedure was evaluated. The complete association of sub-units to form active oligomer was attained only when thiamine pyrophosphate was present. It is concluded that both the pyrimidine ring and the pyrophosphate group are required for productive co-enzyme binding and it is proposed that this interaction effects a conformational change which promotes protomer aggregation to form the enzymatically active holoenzyme. In addition data are presented which indicate that the monomer unit is 60 000 +/- 3000 daltons and that the N-terminal amino acid is histidine. Since the molecular weight of the active oligomer is 230 000 it is proposed that pyruvate decarboxylase is a tetramer comprised of four identical or nearly identical monomer units.