Disruption of ingrown epithelium via Nd:YAG laser or DIEYAG. A retrospective case series of Post-LASIK patients.

PURPOSE: To describe in detail the technique used and results of disruption of ingrown epithelium via Nd:YAG laser (DIEYAG) after LASIK treatment and enhancement. OBSERVATIONS: Epithelial ingrowth following laser in situ keratomileusis (LASIK) enhancement has the potential to cause significant refractive error and discomfort when allowed to progress. This retrospective case series following seven eyes after LASIK enhancement and one eye with flap trauma, assessed the effectiveness and safety of the disruption of ingrown epithelium via Nd:YAG laser. In all cases, we found that the progression of ingrown epithelium was eliminated. Using best spectacle corrected visual acuity and topography as our main outcome measures, we found that refractive error and visual disturbance caused by ingrowth stabilized or improved, with no subsequent complications identified. CONCLUSION AND IMPORTANCE: The disruption of ingrown epithelium via Nd:YAG laser offers a safe and effective alternative to other treatments for epithelial ingrowth after LASIK treatment and enhancement.

Optimization of femtosecond lasers using porcine and human donor corneas before in vivo use.

PURPOSE: To demonstrate a safe and effective method of optimizing a femtosecond laser upon installation or for a new procedure before use on patients. In this case, specifically for optimizing settings for intrastromal corneal pocket creation for the presbyopic small-aperture corneal inlay (Kamra) and deep laser in situ keratomileusis (LASIK) flaps for the presbyopic hydrogel corneal inlay (Raindrop). SETTING: Keil LASIK Vision Center, Grand Rapids, Michigan, USA. DESIGN: Experimental study. METHODS: Human donor corneas were used to optimize femtosecond laser settings after initial optimization with porcine corneas. The laser used was the Femto LDV Z4. RESULTS: Pocket settings optimized for porcine corneas were 12.0 mm/s pocket and tunnel at 105% energy; whereas, settings optimized with human donor corneas were 13.0 mm/s pocket and tunnel at 110% energy. Settings optimized with human donor corneas were subsequently applied in vivo to create pockets for the small-aperture corneal inlay. Further adjustment of settings to 14.0 mm/s pocket at 110% energy was still necessary to optimize pockets. No change in settings was necessary when creating deeper corneal LASIK flaps (ie, the same settings could be used for flaps of 110 µm or 180 µm). CONCLUSIONS: After settings were optimized for porcine corneas, further optimization was necessary before successful corneal incisions could be created in vivo for corneal pockets. No further optimization was required when creating deeper corneal flaps for the hydrogel inlay. It is important to emphasize that settings obtained and reported here are not applicable to other femtosecond lasers.

Efficacy and perioperative timing of bromfenac in the management of ocular discomfort after femtosecond laser-assisted laser in situ keratomileusis.

PURPOSE: To evaluate the safety, efficacy, and appropriate perioperative timing of the use of topical bromfenac ophthalmic solution 0.07% after femtosecond laser-assisted laser in situ keratomileusis (LASIK). SETTING: Keil LASIK Vision Center, Grand Rapids, Michigan, USA. DESIGN: Prospective case series. METHODS: Ocular discomfort was assessed 1, 2, and 5 hours postoperatively and the following morning using the Ocular Comfort Grading Assessment in patients treated with topical bromfenac 0.07% or artificial tears just before, just after, or before and after femtosecond laser-assisted LASIK. Visual outcomes and complications were noted up to 24 hours. RESULTS: The study enrolled 64 patients (120 eyes). Patients who were treated with bromfenac 0.07% just before or before and after femtosecond laser-assisted LASIK showed the greatest statistically significant decrease in several discomfort scores within the first few hours in comparison with the control group. Two hours after surgery, the majority of patients who were treated before and after LASIK were sleeping comfortably. There were no significant differences in visual acuity; 1 day postoperatively, the uncorrected distance visual acuity was 20/20 in 106 eyes (89%) and 20/25 or better in 116 eyes (97%). At 3 months, all patients had binocular distance visual acuity of 20/20 or better and 86% of patients had 20/15 or better. CONCLUSION: Ocular discomfort after femtosecond laser-assisted LASIK was reduced with a single dose of topical bromfenac 0.07% given immediately before surgery or given just before and after surgery and was typically minimal in all groups the morning after surgery.

Brief depressive symptoms in patients with bipolar disorder: analysis of long-term self-reported data.

OBJECTIVE: Most patients with bipolar disorder experience depressive symptoms outside of an episode of depression as defined by DSM-IV criteria. This study explores the frequency of brief depressive episodes, lasting 1 to 4 days, using daily self-reported mood ratings. METHOD: Mood ratings were obtained from 448 patients (281 bipolar I, 167 bipolar II) using ChronoRecord software (91,786 total days). Episodes of depression and days of depression outside of episodes were determined. The intensity of depressive symptoms (mild versus moderate to severe) was compared. RESULTS: Using the DSM-IV length criteria, 61% of all depressive days occurred outside of a depressed episode. Decreasing the minimum length criterion to 2 days, both the number of patients experiencing a depressed episode (128 to 317) and the mean percent of days spent in a depressed episode by each patient (7.9% to 17.8.%) increased by about 2½ times, and 34.3% of depressed days remained outside of an episode. Depending on the episode length, the proportion of days within an episode with severe symptoms varied from 1/3 to 1/4 for episodes lasting from 14 to 2 days, and 1/4 for single-day episodes. There was no significant difference in the frequency of brief depressive episodes between bipolar I and II disorders. For all episode lengths, patients taking antidepressants spent 4% more days within an episode and 6% more days with depressive symptoms outside of an episode than those not taking antidepressants. CONCLUSION: Brief depressive episodes lasting 1 to 4 days occur frequently in bipolar disorder and do not distinguish between bipolar I and II disorders. Symptoms of moderate to severe intensity occur on 1/4 to 1/3 of the days in brief depressive episodes. This study did not address brief depression in those without bipolar disorder. Patients taking antidepressants experienced more brief depressive episodes. Controlled trials are needed to assess the impact of antidepressants on subsyndromal depressive symptoms.

Lindane stimulates neutrophils by selectively activating phospholipase C and phosphoinositide-kinase activity.

The organochlorine insecticide lindane is a known activator of neutrophil responses. In this work we delineated the biochemical pathways by which lindane stimulates neutrophil oxidant production. Plasma membrane GTPase activity was not stimulated by lindane, ruling out a role for lindane-induced activation of G-proteins or G-protein coupled receptors, whereas inhibition of phospholipase C inhibited lindane-induced oxidant production. Together these data pointed to phospholipase C as the direct target of lindane activation. Type I phosphoinositide 3-kinase was not significantly activated by lindane and an inhibitor of phosphoinositide 3-kinases inhibited oxidant production by only 40%. Thus, Type I phosphoinositide 3-kinase played a minor role, if any, in lindane-induced oxidant production. Lindane stimulated an increase in phosphatidylinositol phosphate suggesting a Type II or III phosphotidylinositol 3-kinase or phosphatidylinositol 4-kinase activity was also stimulated.

Phenylalanine-independent biosynthesis of 1,3,5,8-tetrahydroxyxanthone. A retrobiosynthetic NMR study with root cultures of Swertia chirata.

Root cultures of Swertia chirata (Gentianaceae) were grown with supplements of [1-13C]glucose, [U-13C6]glucose or [carboxy-13C]shikimic acid. 1,3,5,8-Tetrahydroxyxanthone was isolated and analysed by quantitative NMR analysis. The observed isotopomer distribution shows that 1,3,5,8-tetrahydroxyxanthone is biosynthesized via a polyketide-type pathway. The starter unit, 3-hydroxybenzoyl-CoA, is obtained from an early shikimate pathway intermediate. Phenylalanine, cinnamic acid and benzoic acid were ruled out as intermediates.

Priming-induced localization of G(ialpha2) in high density membrane microdomains.

Subcellular fractionation of human neutrophils on linear sucrose density gradients was utilized to test the hypothesis that priming regulates the subcellular and sub-plasma membrane distribution of neutrophil G-protein subunits, G(ialpha2) and G(ialpha3), N-formyl peptide receptor, Lyn kinase and phospholipase C(beta2). G(ialpha2), but not G(ialpha3), moved from a lighter to a higher density plasma membrane fraction. Unoccupied N-formyl peptide receptors were found throughout the plasma membrane fractions and this distribution did not change with priming. In unprimed cells G(ialpha2) and its effector, phospholipase C(beta2), were segregated in different membrane compartments; priming caused G(ialpha2) to move to the compartment in which phospholipase C(beta2) resided. Thus, an important component of the mechanism of priming may involve regulation of the location of G-proteins and effector molecules in plasma membrane compartments where their abilities to couple may be enhanced.