The effect of bacteriochlorophyll derivative WST-D and near infrared light on the molecular and fibrillar architecture of the corneal stroma.

A cross-linking technique involving application of Bacteriochlorophyll Derivative WST-11 mixed with dextran (WST-D) to the epithelium-debrided cornea and illumination with Near Infrared (NIR), has been identified as a promising therapy for stiffening pathologically weakened corneas. To investigate its effect on corneal collagen architecture, x-ray scattering and electron microscopy data were collected from paired WST-D/NIR treated and untreated rabbit corneas. The treated eye received 2.5 mg/mL WST-D and was illuminated by a NIR diode laser (755 nm, 10 mW/cm2). An increase in corneal thickness (caused by corneal oedema) occurred at 1-day post-treatment but resolved in the majority of cases within 4 days. The epithelium was fully healed after 6-8 days. X-ray scattering revealed no difference in average collagen interfibrillar spacing, fibril diameter, D-periodicity or intermolecular spacing between treated and untreated specimens. Similarly, electron microscopy images of the anterior and posterior stroma in healed WST-D/NIR corneas and untreated controls revealed no obvious differences in collagen organisation or fibril diameter. As the size and organisation of stromal collagen is closely associated with the optical properties of the cornea, the absence of any large-scale changes following treatment confirms the potential of WST-D/NIR therapy as a means of safely stiffening the cornea.

Rhinocerebral mucormycosis in patients without predisposing medical conditions: a review of the literature.

Rhinocerebral mucormycosis is a rare disease, affecting almost exclusively patients with known predisposing conditions such as diabetes mellitus, immunocompromised status, haemochromatosis or major trauma. Subsequent to a case of rhinocerebral mucormycosis in a 78-year-old woman without any known risk factor, we reviewed the published English-language literature and found an additional 72 cases. Reviewing all the published case series of mucormycosis involving any site, the proportion of apparently normal hosts among cases of rhinocerebral mucormycosis was found to be 9.06% (95% confidence interval 6.7-11.8). These findings suggest that rhinocerebral mucormycosis in patients without known predisposing factors is more prevalent than was previously believed.

The course of surface deposits on a hydrophilic acrylic intraocular lens after implantation through a hexagonal cartridge.

AIM: To evaluate the outcome of surface deposits that occurred during implantation of hydrophylic acrylic intraocular lenses (IOLs) through a hexagonal cartridge. METHODS: Surface deposits were observed on the posterior surface of the ACR6D SE IOLs that were injected through a hexagonal cartridge filled with sodium hyaluronate 1%. All the patients were examined 1 day, 1 week, 1 month, 6 months and 1 year postoperatively. The location of the deposits was recorded and photographed. The patients were questioned about blurred vision, glare or halos. RESULTS: Linear or curly deposits were detected on the posterior surface of the IOL in six patients. In four patients, the deposits were peripheral and were observed 1 week postoperatively. In two patients, the deposits were noticed immediately after implantation. In one eye, they were misinterpreted as a crack in the IOL's optic and were left in the eye. In the second patient the deposits were removed immediately after implantation with forceps. The deposits that were left after implantation (five eyes) did not resolve during 1 year of follow-up. None of the eyes developed abnormal inflammatory reaction. In three eyes the best-corrected visual acuity (BCVA) was 6/6. In the other three eyes the BCVA was 6/12. None of the patients experienced any visual disturbance. CONCLUSIONS: Implantation of the ACR6D SE IOL through a hexagonal cartridge can lead to the formation of deposits on the posterior surface of the lens. The deposits do not resolve and may resemble a crack in the IOL. The deposits left on the IOL had no clinical relevance in our patients.

Linear deposits on the surfaces of intraocular lenses implanted through a hexagonal cartridge which mimic scratches/cracks on the lenses.

AIM: To describe unique linear deposits on the surface of posterior chamber intraocular lenses (IOLs) occurring after implantation through a hexagonal cartridge. METHODS: Five ACR6D SE IOLs (Corneal Laboratories, Pringy, France) were injected/implanted through hexagonal cartridges. Two of these were injected into a petri dish and the remaining three were inserted into the evacuated capsular bag of cadaver eyes. In addition, three other ACR6D SE IOLs were injected into a petri dish through round cartridges. The latter served as controls. RESULTS: All lenses that were injected/implanted through the hexagonal cartridges demonstrated linear deposits on the posterior surface of the IOL optic component. The IOLs that were injected through the round cartridges had no deposits. All the hexagonal cartridges showed signs of internal cracking. None of the round cartridges were cracked. CONCLUSION: Implantation of at least one IOL model, the ACR6D SE IOL, through a hexagonal cartridge can result in linear deposits on the posterior optical surface of the IOL. The shape of the cartridge appears to be a significant factor in causing the depositions.

Topical tetracaine versus topical tetracaine plus intracameral lidocaine for cataract surgery.

PURPOSE: To compare topical tetracaine 0.5% alone and with intracameral lidocaine 1% as a local anesthetic agent in phacoemulsification with intraocular lens (IOL) implantation. SETTING: The Toronto Hospital-Western Division, Toronto, Canada. METHODS: Fifty-nine consecutive patients (60 eyes) having phacoemulsification with implantation of a foldable acrylic IOL (AcrySof) were randomized into 1 of 2 groups: The intracameral balanced salt solution (BSS) group received topical tetracaine 0.5% plus intracameral BSS; the intracameral lidocaine group received topical tetracaine 0.5% with preservative-free intracameral lidocaine 1%. The patients' subjective experience of pain was measured at 4 points during surgery using a 4-point pain scale. Patient and surgeon satisfaction with the anesthesia used was measured using a 5-point satisfaction scale. Central endothelial cell counts were obtained preoperatively and 1 month postoperatively. Best corrected visual acuity (BCVA) was measured preoperatively and 1 hour, 1 day, 1 week, and 1 month postoperatively. RESULTS: The mean pain score after phacoemulsification was significantly higher in the intracameral BSS group than in the intracameral lidocaine group (0.63 +/- 0.7 [SD] and 0.23 +/- 0.4, respectively, P < .019). The mean pain score at the end of surgery was also significantly higher in the intracameral BSS group than in the intracameral lidocaine group (0.60 +/- 0.6 and 0.21 +/- 0.4, respectively; P < .014). The surgeon satisfaction score was significantly lower for the intracameral BSS group than for the intracameral lidocaine group (3.90 +/- 1.2 and 4.73 +/- 0.8, respectively; P < .0007). There was no difference in patient satisfaction between the intracameral BSS and intracameral lidocaine groups (4.60 +/- 0.6 and 4.70 +/- 0.8). Endothelial cell loss 1 month postoperatively was similar between the 2 groups (6.1% +/- 8% and 6.7% +/- 6%). Ninety-seven percent of patients (29/30) in each group noted BCVA improvement from preoperatively. The rate of potential visual acuity recovery was similar in both groups. CONCLUSION: Topical tetracaine 0.5% with intracameral lidocaine was safe and effective in patients having phacoemulsification with IOL implantation. The advantage of using intracameral lidocaine 1% over a placebo was a significant decrease in the patients' subjective experience of pain and in the surgeon's satisfaction with the anesthesia used. None of the other parameters measured in this study differed significantly between the 2 groups.

Utilizing eye bank eyes and keratoplasty techniques to teach phacoemulsification.

Learning microsurgery can be a difficult task. Three techniques for practicing phacoemulsification using eye bank eyes, rigid contact lenses, and lamellar keratoplasty are described. These simple methods provide a realistic environment for learning and developing microsurgical skills.

Development of exudative age-related macular degeneration after cataract surgery.

The macular status of patients with findings consistent with early dry age-related macular degeneration (AMD) who underwent an extracapsular cataract extraction with intraocular lens implantation was evaluated by fundoscopy and fluorescein angiography pre-operatively and during the first post-operative year. Five patients who developed the exudative form of AMD, and who represent the problems arising when treating patients with AMD and cataract, are described. Patients who received laser photocoagulation responded with recurrent choroidal neovascularisation. We suggest that patients with signs of age-related changes scheduled for cataract surgery should undergo a thorough pre- and post-operative assessment of their retinal status.

Age-related macular degeneration after extracapsular cataract extraction with intraocular lens implantation.

PURPOSE: To evaluate the course of age-related maculopathy after cataract surgery. METHODS: Included were 47 patients with bilateral, symmetric, early age-related macular degeneration (AMD), documented by fluorescein angiography, who underwent extracapsular cataract extraction with intraocular lens implantation in one eye. The fellow eye served as the control. The patients were retrospectively reviewed or prospectively followed. RESULTS: Wet AMD developed in nine eyes (19.1%) that were treated with surgery compared with two fellow eyes (4.3%). It was detected within 3 months of surgery in four (44.4%) of the nine affected eyes and within 6 to 12 months of surgery in four other eyes (44.4%). Progression to wet AMD occurred significantly more often in men than in women (P < 0.05). Soft drusen were found as a significant ocular risk factor (P < 0.05). The final visual outcome was poor in all eyes with such progression. CONCLUSIONS: In this study, progression of AMD occurred more often in the surgical eyes compared with the fellow eyes. However, the reasons for the progression of AMD after cataract surgery are still uncertain. Further prospective studies are needed to investigate this observation.

Blood supply and innervation of the supermedial thigh flap employed in one-stage reconstruction of the scrotum and vulva--an anatomical study.

The supermedial thigh flap is an arterial and sensate flap. Anatomical studies reveal both large and small nutrient arteries. Its largest and most consistent artery is the superficial branch of the deep external pudendal artery, which constitutes the main circulation. The secondary blood supply to the base of the flaps is contributed by musculocutaneous perforators of the medial circumflex femoral artery. Subcutaneous branches of the superficial femoral artery, when present, are an additional source of arterial supply. Branches of the ilioinguinal nerve provide sensory innervation to the flaps.

Arterial blood supply to the infrahyoid muscles: an anatomical study.

The arterial supply to the infrahyoid strap muscles originating from the superior thyroid artery (STA), the inferior thyroid artery (ITA), and the internal mammary artery (IMA), also called the internal thoracic artery, were investigated. Intraarterial silicone dye was injected into eight fresh cadavers followed by dissections. The blood supply to the infrahyoid muscles was found to be segmented in nature with the dividing line at the level of the cricoid ring. No axial pattern of vascularization could be demonstrated within the strap muscles. The skin overlying these muscles is supplied by tributaries arising from the above-described arteries. Application of the information gathered is discussed in consideration of local myocutaneous and myoosseous flaps for reconstructive surgery, particularly of the larynx and trachea.

Rotary-door flap in laryngotracheal reconstruction.

A newly described vascularized myocutaneous flap based on the infrahyoid muscles is presented. The blood supply originating at the superior and inferior thyroid arteries is preserved. This flap is rotated axially, 180 degrees, to augment and resurface the lumen of the stenosed airway. Stenting is achieved by means of a silicone T tube topped by a custom-carved laryngeal stent. Hyoid transposition may be included when required. We successfully reconstructed 15 cases of laryngotracheal stenosis by this method. The regional flap provides a dependable, readily applicable technique for reconstruction of difficult laryngotracheal stenoses.

[The medical system and social ideology. Construction of a moral logic and body of thought in the 18th century]. / Système médical et idéologie sociale. La construction d'une logique et d'une pensée morale au XVIIIème siecle.

This article proposes an historical case study of the relationships between a body of medical knowledge and the social and political concerns of the period in which it developed. The analysis of the writings of J.C. Lettsom (1744-1815), a Quaker physician, and famous practitioner of London, demonstrates that very narrow links exist between his medical conceptions on the human body and his conceptions on the organisation and the functioning of the "social body". Such notions as freedom, equilibrium, circulation, interdependence, sensitivity and mutual sympathy are shown to structurate Lettsom's discourse on the human body and the social body. It is suggested that such relationships can be deciphered in other contexts as recent works in social history of medicine and in ethno-medicine tend to make it evident.