[Boston keratoprosthesis type 1]. / La kératoprothèse de Boston type 1.

Penetrating keratoplasty is the most commonly performed tissue transplant in the world. However, its success depends on the health of the ocular surface and the intact immune privilege of the eye. In the absence of these two conditions, corneal transplants have an increased failure rate and result in corneal blindness. For more than two hundred years, researchers have been trying to find the best design of the artificial cornea in order to address these cases of severe corneal blindness. Despite previous difficulties, interest in the field has recently been revived, and considerable progress has been made over the last 20 years, to the point where the keratoprosthesis is now considered a primary procedure for some indications and is no longer always a surgery of last resort. In this review, we describe the global and personal experience with Boston keratoprosthesis type 1. It is a relatively new treatment for severe corneal blindness in the context of multiple failed corneal transplants and high-risk conditions. In the last decade, changes in the design, surgical technique, and postoperative management have increased the success rate and popularity of the Boston keratoprosthesis and decreased its complications substantially, making it a safe and effective alternative for certain corneal pathologies. However, some complications persist and require management to improve the visual prognosis of patients with corneal blindness.

Secondary intraocular lens implantation with absence of capsular support: Scleral versus iris fixation.

PURPOSE: To assess the outcomes of iris fixated (IF) posterior chamber (PC) intraocular lens (IOL) versus scleral-fixated (SF) PC IOL implantation, and compare them with the results reviewed from the literature. SETTING: The study took place in the ophthalmology department of the Eye and Ear Hospital (Lebanon). DESIGN: This is a retrospective institutional study that collected the records of patients admitted for secondary IOL implantation between January 2007 and December 2016. METHODS: A total of 28 eyes that underwent PC IOL fixation were included, 13 of which underwent trans-scleral PC IOL fixation and 15 of which underwent iris PC IOL fixation. Data were analyzed over a period of 3 years. RESULTS: Of the 28 patients, 18 (64.3%) were male and 10 (35.7%) were female (mean age at intervention 36.78±23.47 [standard deviation, SD] years). There were no significant intergroup differences with regard to baseline values and demographic characteristics. Trauma was the most common etiology for posterior capsule insufficiency (82.1%). The mean preoperative baseline BCVA was 0.58±0.27 logMAR for SF and 0.27±0.20 logMAR for IF (P=0.07). Both groups had significant improvement in vision during the follow up period. No significant differences were noted regarding early or late postoperative complications between the two groups. CONCLUSION: SF and IF techniques for PC IOL have similar outcomes and result in a significant improvement in BCVA. When compared to AC (anterior chamber) IOL, both techniques seem to yield fewer complications.

Thick keratoconic cornea associated with posterior polymorphous corneal dystrophy.

INTRODUCTION: We herein report a case of bilateral unusually thick non-edematous keratoconic corneas with associated endothelial features of posterior polymorphous corneal dystrophy (PPCD). CASE REPORT: We report the case of a 27-year-old myopic woman who presented for refractive surgery. Slit lamp exam showed bilateral corneal protrusion with diffuse deep stromal and endothelial vesicular opacities and small paracentral bands. Topography showed generalized advanced corneal steepening in both eyes with increased anterior and posterior central corneal elevations in comparison to the best fit sphere. Ultrasound pachymetry showed central corneal thickness of 605µm (RE) and 612µm (LE). On specular biomicroscopy, cell density of 2503 cells/mm2 RE and 1526 cells/mm2 LE with significant cellular pleomorphism and polymegathism were noted. DISCUSSION: Clinical and paraclinical findings together suggest the presence of simultaneous keratoconus and PPCD. The literature has suggested an association between PPCD and steep cornea. Moreover, many reports have also described cases of associated PPCD and keratoconus with characteristic thinning and ectasia, in comparison to the unusual thick corneas noted in our patient, despite the absence of edema. Identification of genetics factors is further needed to clarify this association. CONCLUSION: This case describes a patient whose corneas present features of both keratoconus and PPCD and is unique due to the presence of increased corneal thickness despite the absence of edema.

Heart conduction problems in a tetraplegic patient caused by a single therapeutic dosage of Baclofen.

STUDY DESIGN: Case report. OBJECTIVE: To examine the unusual and unknown, severe side effect of a therapeutic dose of oral Baclofen on cardiac function. SETTING: Spinal Cord Unit, Rehabilitation Centre Amsterdam, Amsterdam, The Netherlands. METHODS: Review of relevant literature. RESULTS: A 53-year-old patient with an incomplete C2 tetrapareses (ASIA B) developed severe and painful muscle spasms together with respiratory failure and autonomic dysreflexia. Spasmolytic treatment was started. After the first admission of 5 mg of oral Baclofen, he collapsed in bed with extreme bradycardia, hypotension, hyperventilation and decreased oxygen saturation. A second dosage of 5 mg Baclofen resulted in the same complications. After implantation of a pacemaker, restarting oral Baclofen induced a pacemaker rhythm with episode of hypotension and respiratory failure and also a delirium. Intrathecal Baclofen also resulted in a pacemaker rhythm with hypotension and a decreased cardiac output. To our knowledge, this is the first time a severe heart conduction problem was induced in a spinal cord injury patient after a single therapeutic dose of Baclofen. CONCLUSION: In this case therapeutic oral Baclofen has caused serious cardiac conduction problems.

Is chronic HIV infection associated with venous thrombotic disease? A systematic review.

Infection with the human immunodeficiency virus (HIV) is still a major health problem world-wide. HIV infection has changed into a chronic infection with the chance of developing long-term complications. Vascular complications are frequently reported in the current literature. HIV and treatment by highly active antiretroviral therapy (HAART) are associated with many cardiovascular risk factors. An increased risk of arterial cardiovascular complications was found in a number of studies. However, data about the risk of venous thrombotic disease (VTE), including potentially fatal conditions as pulmonary embolism, were limited. In a systematic review of the literature, ten relevant epidemiological studies were identified that investigated the risk of venous thrombotic disease in HIV-infected patients. The incidence was increased two- to tenfold in comparison with a healthy population of the same age. However, these studies were mainly retrospective cohort studies that were prone to selection bias, confounding factors were not always mentioned and in all but three control populations were missing. An increased risk of venous thrombotic disease in HIV-infected patients could be explained by the presence of a hypercoagulable state, characterised by an increase in procoagulant factors, such as endothelial TF expression and thrombogenic properties of microparticles, and a decrease in anticoagulant factors, including AT III, HC II and the protein C pathway. Furthermore, the risk of VTE was associated with an increased risk of infections and autoimmune haemolytic anaemia, and was weakly associated with HAART. All together, quite some evidence pointed towards a relationship between HIV infection and venous thrombotic disease, but the association still needs to be established in properly designed epidemiological studies.

MRI in clinically asymptomatic neuropathic leprosy feet: a baseline study.

This study was undertaken to analyze the magnetic resonance imaging (MRI) findings in the clinically asymptomatic neuropathic feet of leprosy patients. Since in the literature no MRI data are available concerning the asymptomatic neuropathic foot in leprosy, the interpretation of MRI examinations in clinically suspected neuropathic feet in leprosy is difficult. We examined 10 adult leprosy patients with clinically asymptomatic neuropathic feet. Inclusion criteria were a normal or near normal neuropathic foot, without signs of inflammation. All patients underwent an MRI protocol with the inclusion of two-point Dixon chemical shift imaging as fat suppression sequence. We found MRI changes in almost all patients. The most striking were the changes located in the region of the first metacarpophalangeal (MTP) joint. These changes ranged from degradation and interruption of the subcutaneous fat to effusion/synovitis in the first MTP joint. This study reveals significant MRI changes in clinically asymptomatic neuropathic feet in patients with leprosy. These changes may relate to the development of ulcerations. MRI may play an important role in detecting feet at risk and may influence clinical decision making.

Anorexia nervosa: long-term outcome in 50 female patients.

Fifty consecutively referred female patients with anorexia nervosa were followed-up to identify those completely healthy at a minimum of four years (mean eight years) since onset. As well as using Morgan's Outcome Measures, an independent psychiatrist elicited details of food/weight pre-occupation and psychiatric state. The outcome results, based on weight and menstruation, (36% 'good', 36% 'intermediate', and 26% 'poor' including 2% dead, and 2% not assessed) did not differ significantly from those of the three similar published studies on similar patients; 62% of patients continued to have some food/weight pre-occupation. DSM III criteria for a psychiatric disorder other than eating disorder were fulfilled by 50%; dysthymic disorder was common (34%), occurring exclusively in patients with continuing eating disorder symptoms, while only 20% of the sample were free of any physical or mental abnormality. Of 52 prognostic factors studied, only four were significantly related to the outcome measures. Length of illness at presentation was the only prognostic factor common to all four similarly conducted studies.