Scheduled Postoperative Ripcord Removal in Baerveldt 350 Implants: A Prospective, Randomized Trial.

PURPOSE: Many surgeons remove the ripcord in the Baerveldt glaucoma drainage device to better control tube opening and intraocular pressure (IOP) lowering postoperatively. However, complications following Baerveldt implant surgery with or without ripcord removal are not well-characterized. We performed a prospective, randomized trial to test the hypothesis that scheduled ripcord removal decreases complications and final IOP. METHODS: Eighty-one patients were enrolled and randomized to scheduled ripcord removal at postoperative week 3 or to observation. They were followed for 6 months, and outcomes were compared between the 2 groups. RESULTS: Forty-four patients were randomized to scheduled ripcord removal and 37 to observation. The intervention group had a similar rate of total complications after ripcord removal (36% vs. 24%, P=0.24), a lower rate of tube fibrin obstruction (2.3% vs. 13.5%, P=0.05), and a larger decrease in the number of medications (1.3 vs. 0.49 fewer medications, P=0.01). The removal group's mean IOP decrease was 8.6 mm Hg and success rate was 59%, defined as 5 mm Hg

Health coaching for glaucoma care: a pilot study using mixed methods.

INTRODUCTION: Adherence to glaucoma medications is essential for successful treatment of the disease but is complex and difficult for many of our patients. Health coaching has been used successfully in the treatment of other chronic diseases. This pilot study explores the use of health coaching for glaucoma care. METHODS: A mixed methods study design was used to assess the health coaching intervention for glaucoma patients. The health coaching intervention consisted of four to six health coaching sessions with a certified health coach via telephone. Quantitative measures included demographic and health information, adherence to glaucoma medications (using the visual analog adherence scale and medication event monitoring system), and an exit survey rating the experience. Qualitative measures included a precoaching health questionnaire, notes made by the coach during the intervention, and an exit interview with the subjects at the end of the study. RESULTS: Four glaucoma patients participated in the study; all derived benefits from the health coaching. Study subjects demonstrated increased glaucoma drop adherence in response to the coaching intervention, in both visual analog scale and medication event monitoring system. Study subjects' qualitative feedback reflected a perceived improvement in both eye and general health self-care. The subjects stated that they would recommend health coaching to friends or family members. CONCLUSION: Health coaching was helpful to the glaucoma patients in this study; it has the potential to improve glaucoma care and overall health.

Effects of activated omental cells on rat limbal corneal alkali injury.

Omental cells (OCs) are shown to help wound healing. The purpose of this study is to investigate if OCs improve cornea repair after alkali injury by subconjunctival injection of activated OCs in rats. Forty eight hours after limbal corneal alkali injury, fresh isolated OCs were injected subconjunctivally into the recipient rat's eye. Prior to the injury and at 0, 4 and 8 days after injury, the eyes were examined using slit lamp biomicroscopy. Corneal opacification and corneal neovascularization were graded in a masked fashion. The inflammatory response to the injury was evaluated by counting neutrophil cell numbers in the cornea under microscope. There was no significant difference in corneal opacification between the control and OCs treatment groups; however, the corneal neovascularization was significantly less in the eyes treated with OCs as compared to the controls. Also OCs treatment markedly decreased neutrophil infiltration after corneal-limbal alkali injury. Our results suggest that OCs may have a beneficial role in corneal healing after limbal corneal alkali injury by suppressing inflammatory cell infiltrates and corneal neovascularization.

Neuroprotective effect of resveratrol prophylaxis on experimental retinal ischemic injury.

The purpose of the present study was to investigate whether systemically administered resveratrol can protect against acute retinal ischemic reperfusion injury. Two groups of adult male Sprague Dawley rats (n = 6 per group) were used for this study. Resveratrol (30 mg/kg) or an equal volume of vehicle (30% Solutol HS 15 in 0.9% saline) was administered daily for 5 days via intraperitoneal injection. On the third day of treatment, retinal ischemic injury was induced by elevation of intraocular pressure for 45 min. Prior to resveratrol administration and one-week following ischemic insult, retinal function was measured by scotopic electroretinography (ERG). Retinas were harvested and morphologically analyzed one week after ischemic insult. ERG a- and b-wave amplitudes were significantly reduced following ischemic reperfusion injury. Resveratrol treatment attenuated ischemic-induced loss of retinal function. In control vehicle-treated rats, ischemic reperfusion injury elicited marked thinning of inner retinal layers. Resveratrol prophylactic treatment reduced ischemia-mediated thinning of the whole retina and in particular the inner retinal layers. Therefore, resveratrol may have therapeutic value for the management of retinal ischemic disorders.

Use of a combined MR imaging and interventional radiology suite for intraprocedural monitoring of uterine artery embolization.

PURPOSE: The optimal embolic endpoint for uterine artery embolization (UAE) is unknown. It is difficult to quantify substasis endpoints with the use of conventional x-ray interventional radiology (IR) guidance. Although magnetic resonance (MR) imaging can detect perfusion changes, intraprocedural perfusion changes within targeted uterine leiomyomas and the remaining uterine wall remain unknown. A hybrid MR/IR unit was used to test the hypothesis that MR imaging can detect changes in uterine perfusion-dependent signal enhancement immediately after UAE. MATERIALS AND METHODS: In this prospective study, UAE was performed in a hybrid MR/IR unit in women with symptomatic uterine leiomyomas. This MR/IR unit contains a wide-bore 1.5-T MR scanner connected by a sliding table to an adjacent x-ray digital subtraction angiography unit. Gadolinium-enhanced MR imaging was performed before and after UAE. Relative signal-to-noise ratio (SNR) was measured within each tumor and the adjacent uterine wall, and mean relative SNR changes were compared before and after UAE with the paired t test (alpha=0.05). RESULTS: UAE was technically successful in all six women, in whom 10 tumors were assessed (seven intramural, two submucosal, one subserosal). Mean relative SNR of the tumors before UAE was 62.2+/-25.0 and was reduced to 41.1+/-17.7 after UAE (P<.01). Mean relative SNR of the adjacent uterine wall was 64.2+/-14.3 before UAE and decreased to 28.8+/-14.9 after UAE (P<.01). CONCLUSIONS: Immediate reductions in perfusion-dependent enhancement in targeted uterine leiomyomas and the adjacent uterine wall can be detected during UAE with the use of a hybrid MR/IR unit. Further studies are now warranted to compare long-term clinical outcomes versus immediate changes in perfusion at the time of UAE.