Time-related variations in viability of random pattern skin flaps: An experimental study in rats.

Chronobiological variations are in the fabric of life. The first ideas regarding the possible effects of circadian rhythm on surgical outcomes were published in the early 2000s. Some studies support and oppose this idea. The lack of experimental evidence in a controlled setting has led to this study. This study aimed to explore the chronobiological implications of surgical outcomes. The rats were divided into four groups. A random pattern dorsal skin flaps were elevated in all groups at six h intervals. Flap necrosis rates and melatonin, oxidant, and antioxidant factors were studied. Flap survival was better in the 06:00 h group. The flap necrosis was higher in the 18:00 h group. Some of the biochemical parameters displayed circadian variations. As an independent variable, the time of surgical intervention changed the flap survival rates. It should be noted that the study was held in a nocturnal animal model thus the pattern of flap survival can be in reversed fashion in a clinical scenario. This study is the first experimental evidence for "Chronosurgery" in a controlled setting. Further studies in all aspects of surgical disciplines are required.

Eye patching as a treatment for amblyopia in children aged 10-16 years.

PURPOSE: To investigate the effects of full-time patching regimen on the treatment of amblyopia in children aged 10-16 years. METHODS: Forty-seven patients with a mean age of 12.09 ± 1.65 years were included in this study. All of the patients received eye patching for the entire day, 6 days a week, during the first 3 months. The patients who achieved visual acuity of 0.00 logMAR at the third month were provided with additional patching treatment (4-6 h/day). On the other hand, the patients who showed no change in their visual acuity or an increase of less than 0.00 logMAR at the third month had 3 more months of eye patching for the entire day, 6 days a week. RESULTS: Prior to treatment, the best mean visual acuity of the amblyopic eyes was 0.48 ± 0.25 (range 1.00-0.15) logMAR. After follow-up, the visual acuity of the amblyopic eyes was 0.20 ± 0.22 (range 1.00-0.00) logMAR. Thus, visual acuity in the amblyopic eyes improved by 0.2 log unit or more in 38 of 47 patients (81%). CONCLUSIONS: The present results show that patching in older children with amblyopia improves visual acuity with no serious complications. The use of patching in children to improve amblyopia seems promising.

Concise review: induced pluripotent stem cells and lineage reprogramming: prospects for bone regeneration.

Bone tissue for transplantation therapies is in high demand in clinics. Osteodegenerative diseases, in particular, osteoporosis and osteoarthritis, represent serious public health issues affecting a respectable proportion of the elderly population. Furthermore, congenital indispositions from the spectrum of craniofacial malformations such as cleft palates and systemic disorders including osteogenesis imperfecta are further increasing the need for bone tissue. Additionally, the reconstruction of fractured bone elements after accidents and the consumption of bone parts during surgical tumor excisions represent frequent clinical situations with deficient availability of healthy bone tissue for therapeutic transplantations. Epigenetic reprogramming represents a powerful technology for the generation of healthy patient-specific cells to replace or repair diseased or damaged tissue. The recent generation of induced pluripotent stem cells (iPSCs) is probably the most promising among these approaches dominating the literature of current stem cell research. It allows the generation of pluripotent stem cells from adult human skin cells from which potentially all cell types of the human body could be obtained. Another technique to produce clinically interesting cell types is direct lineage reprogramming (LR) with the additional advantage that it can be applied directly in vivo to reconstitute a damaged organ. Here, we want to present the two technologies of iPSCs and LR, to outline the current states of research, and to discuss possible strategies for their implementation in bone regeneration.

Penetration of topically applied diclofenac and ketorolac into the aqueous humour and subretinal fluid: randomized clinical trial.

OBJECTIVE: To determine the level of intraocular penetration of diclofenac sodium and ketorolac tromethamine into the aqueous humour and subretinal fluid. DESIGN: Prospective randomized clinical trial. PARTICIPANTS: Twenty eyes scheduled for retinal detachment surgery and 17 eyes scheduled for cataract surgery. METHODS: Patients with retinal detachment were randomly assigned to receive either topical ketorolac (n = 11) or topical diclofenac (n = 9). Subretinal fluid samples were collected 30-60 minutes after the administration of the last dose. In addition, 17 patients with cataract were randomly assigned to receive topical ketorolac (n = 9) or topical diclofenac (n = 8). The aqueous humour samples were collected 30 minutes after the administration of the last dose. Drug concentrations were determined by high-performance liquid chromatography fluorescence. RESULTS: The mean diclofenac concentration in the subretinal fluid was 42.31 (SD 24.89) ng/µL. Ketorolac was undetectable in the subretinal fluid in all patients who received it because ketorolac tromethamine levels were under the limit of detection. In the aqueous humour, mean diclofenac concentration was 4.98 (SD 4.56) ng/µL, and mean ketorolac concentration was 20.17 (SD 12.21) ng/µL. Topical administration of diclofenac sodium yielded 8.4 times greater drug concentration in the subretinal fluid than in the aqueous humour. Aqueous humour concentrations of ketorolac were higher than those of diclofenac (p = 0.019). CONCLUSIONS: The concentration in the subretinal fluid of topically applied diclofenac was higher than that of ketorolac; and topical ketorolac penetrated into the aqueous humour better than diclofenac did. This suggests that diclofenac can be used more effectively in events related to posterior segment and ketorolac in anterior segment events.

Focal posterior pole viral retinitis.

PURPOSE: To describe the clinical features of an atypical form of viral retinitis in immunocompetent patients. METHODS: This was a retrospective noncomparative case series. The charts of 8 patients diagnosed with and treated for focal posterior viral retinitis were reviewed. Clinical and demographic features were evaluated. All the patients had extensive laboratory tests, fundus fluorescein angiography, optical coherence tomography of macula, and polymerase chain reaction of vitreous. RESULTS: All the patients were referred to our Uveitis Service from other hospitals, as their uveitis symptoms deteriorated in spite of treatment. The mean age of 4 male and 4 female patients was 32.1 years (range, 22-42 years). The mean follow-up period was 10 months (range, 6-18 months). All of the patients had unilateral disease. Polymerase chain reaction analysis of vitreous specimen was positive for herpes simplex virus-1 in 5 patients and varicella zoster virus in 3 patients. Retinitis resolved after systemic acyclovir treatment in all patients. CONCLUSIONS: Viral etiology must be borne in mind in the differential diagnosis of atypical retinitis. It can be a milder form of viral retinitis like focal viral retinitis, as mentioned in this study. The prognosis of this disease is better than the other forms of necrotizing retinopathies involving a larger area of retina.

Duration of renal failure as risk factor for conjunctival squamous metaplasia.

OBJECTIVE: To assess ocular surface changes in patients with chronic renal failure (CRF), to compare the results with the duration of illness. STUDY DESIGN: Impression cytology from 48 patients with CRF on regular hemodialysis and 16 age- and sex-matched control subjects were studied. Specimens were taken from the temporal bulbar conjunctiva using cellulose acetate filter paper. RESULTS: Among the patients with CRF who were ill for 0-10 years, 25 patients (78.1%) disclosed grade 0-1, and 7 patients (21.9%) disclosed grade 2-3 cytologic changes, whereas in those with the duration of CRF > 10 years, 9 patients (56.2%) had grade 0-1 and 7 patients (43.8%) had grade 2-3 changes. Specimens from the control group revealed 93.8% grade 0-1 and 6.2% grade 2-3 changes (p < 0.05). CONCLUSION: The ocular surfaces of patients with CRF differ significantly from those of normal individuals, and the severity of conjunctival changes is related to the duration of CRF.

Decompression retinopathy after Ahmed glaucoma valve implantation in a patient with congenital aniridia and pseudophakia.

We present the case of a 16-year-old adolescent boy with congenital aniridia and pseudophakia who developed decompression retinopathy in a glaucomatous eye after Ahmed glaucoma valve implantation combined with anterior vitrectomy. On the first postoperative day, dot and blot-shaped hemorrhages scattered in the posterior pole were observed. The hemorrhages resolved over 6 months, and the visual acuity returned to the preoperative level. Severe deterioration of the visual field was not observed in the late postoperative period. Despite the sudden visual acuity decrease postoperatively, decompression retinopathy is a benign condition and resolution of hemorrhages without sequelae is the natural course.