Indications for penetrating keratoplasty and associated procedures, 1989-1995.

PURPOSE: To identify changing trends in indications for penetrating keratoplasty and associated surgical procedures. METHODS: Review of charts from all patients who underwent penetrating keratoplasty at Wills Eye Hospital from January 1, 1989 through December 31, 1995. RESULTS: A total of 2,442 corneal transplants were performed in 2,186 patients. The leading indication for penetrating keratoplasty was pseudophakic corneal edema, accounting for 634 cases (26.0%); 54.7% of them were associated with anterior chamber intraocular lenses, 36.4% with posterior chamber intraocular lenses, and 3.1% with iris-fixated intraocular lenses. Regraft (17.8%), Fuchs' dystrophy (15.7%), and keratoconus (13.2%) followed pseudophakic corneal edema in frequency. Cataract extraction, with or without intraocular lens implantation, was combined with penetrating keratoplasty in 439 cases of 1,264 phakic eyes (34.7%). Intraocular lens exchange was performed in 285 of the 634 cases of pseudophakic corneal edema (44.9%). CONCLUSION: Pseudophakic corneal edema was the leading indication for penetrating keratoplasty, with an increasing number of cases associated with posterior chamber intraocular lenses during the study period (p = 0.001). The number of regrafts steadily increased between 1989 and 1995 (p = 0.001), being the second most common indication for corneal transplantation since 1992.

Repair of Descemet's membrane detachment with intracameral injection of 20% sulfur hexafluoride gas.

Detachment of Descemet's membrane is a rare complication of cataract surgery that can cause permanent corneal decompensation. We report five patients with Descemet's membrane detachments who were successfully treated with intracameral injection of 20% sulfur hexafluoride gas with resultant resolution of their corneal edema.

A 20-yr longitudinal study of Olympic oarsmen.

Nine 1972 silver-medalist oarsmen were studied before the Olympic Games and 10 and 20 yr later. Peak power, metabolic responses, and heart rate were recorded during rowing ergometry; blood lactate was measured following exercise. The skinfold equation yielded percent body fat. The average change (multiple analysis of variance) among measurements from 1972 to 1992 was 37.5 +/- 3% (P < 0.01). Average changes between 1972 and 1982 and between 1982 and 1992 were similar, 17 and 18%, respectively (P < 0.01). The most significant change between 1972 and 1992 was decreased peak blood lactate (106%). Decreases in peak power, VE, and VO2 (ml.kg-1.min-1) were all similar, approximately 40%, and were significant. Body fat increased (from 12.3 to 15.6%), and absolute VO2 and relative VO2 (lean body mass) decreased 30% (P < 0.01). Only body weight, heart rate, and O2 pulse showed smaller changes, but these changes were still significant (P < 0.05). Relative peak VO2 decreased from 65.5 to 46.8 ml.kg-1.min-1 from 1972 to 1992 and at a rate of 10%.decade-1. The most significant changes between 1972 and 1982 were increases in percent body fat (from 12.3 to 16.3%) and decreases in VO2 values (P < 0.01). There was less change in body fat between 1982 and 1992, but lactate significantly decreased (P < 0.01), as did peak power and absolute and relative VO2 and VE. Although fitness levels in former elite oarsmen decreased each decade, these declines were somewhat arrested by regular aerobic training. Body fat increased and metabolic capacity decreased rapidly during the first decade, whereas anaerobic capacity decreased more significantly in the second decade. Anaerobic capacity diminished at a significantly greater rate than aerobic capacity, probably as a result of the aging process and emphasis on aerobic training in post-competitive years.

Ocular injuries related to air bag inflation.

BACKGROUND AND OBJECTIVES: The effectiveness of air bags as a safety device in decreasing fatalities and reducing morbidity in frontal impact motor vehicle accidents has been well established. However, case reports have surfaced documenting ocular injuries related to air bag inflation. The purpose of this study was to identify and analyze ocular injuries sustained during air bag inflation. PATIENTS AND METHODS: Hospital emergency room records were reviewed retrospectively for a period of 4 years for patients who had sustained ocular injuries in motor vehicle accidents. Those injuries associated with air bag inflation were analyzed as to the nature of the injury, type of vehicle, speed, and visual morbidity. RESULTS: Fourteen cases of ocular injury related to air bag inflation were identified. Hyphema (nine cases) and cornea abrasion (eight cases) were the most common. Three cases, all patients who had been wearing glasses, sustained serious and permanent ocular damage. CONCLUSION: While air bags are an unequivocal safety feature, ocular injuries do occur that are related to air bag inflation. Eyeglass wear may present an additional risk factor.

Ocular injuries associated with eyeglass wear and airbag inflation.

OBJECTIVE: The purpose of this report is to detail three cases of serious ocular injury associated with eyeglass wear during airbag inflation following motor vehicle crashes. DESIGN: Although there were too few cases to provide valid statistics, an attempt was made to determine if there were characteristics common to the glasses or accidents that would provide preventive information. MATERIALS AND METHODS: The emergency room records were reviewed for a 4-year period and cases were extracted involving ocular injuries related to airbag inflation. Fourteen cases were found, and three patients were wearing glasses. These cases were studied in detail. MEASUREMENTS AND MAIN RESULTS: All three patients sustained serious, vision-compromising ocular damage. CONCLUSIONS: Eyeglass wear presents an additional risk factor for ocular injury during airbag inflation. Frame damage and lens shatter provide potential for both blunt and penetrating types of ocular injury.

Energy expenditure during simulated rowing.

Metabolic function was measured by open-circuit spirometry for 310 competitive oarsmen during and following a 6-min maximal rowing ergometer exercise. Aerobic and anaerobic energy contributions to exercise were estimated by calculating exercise O2 cost and O2 debt.O2 debt was measured for 30 min of recovery using oxygen consumption (Vo2) during light rowing as the base line. Venous blood lactates were analyzed at rest and at 5 and 30 min of recovery. Maximal ventilation volumes ranged from 175 to 22l 1/min while Vo2 max values averaged 5,950 ml/min and 67.6 ml/kg min. Maximal venous blood lactates ranged from 126 to 240 mg/100 ml. Average O2 debt equaled 13.4 liters. The total energy cost for simulated rowing was calculated at 221.5 kcal assuming 5 kcal/l O2 with aerobic metabolism contributing 70% to the total energy released and anaerobiosis providing the remaining 30%. Vo2 values for each minute of exercise reflect a severe steady state since oarsmen work at 96-98% of maximal aerobic capacity. O2 debt and lactate measurements attest to the severity of exercise and dominance of anaerobic metabolism during early stages of work.