Corneal edema after phacoemulsification surgery in patients with type II diabetes mellitus.

INTRODUCTION: Corneal edema delays early visual recovery after phacoemulsification surgery in diabetes mellitus. OBJECTIVE: To compare corneal edema of eyes in patients with type II diabetes mellitus and in non-diabetics after phacoemusification surgery. MATERIALS AND METHODS: A hospital-based, retrospective study involving 96 eyes that underwent phacoemulsification surgery for immature cataract at the Department of Ophthalmology, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal was carried out. Evaluation was performed of 33 eyes in patients with diabetes mellitus (diabetic group) and of 63 eyes in patients without diabetes mellitus (non-diabetic group). All diabetic patients had controlled blood glucose for at least one week prior to the surgery. The operated eye was examined before surgery and on one day, one week, and one month after surgery. Intraocular pressure was measured on each visit. MAIN OUTCOME MEASURES: The findings of post-operative corneal edema and visual acuity between the diabetic and non-diabetic groups were studied and compared. RESULTS: There was no difference clinically in any pre-operative corneal examination between the diabetic and non-diabetic groups. The corneal edema after surgery was significantly higher in the diabetic group than in the non-diabetic group (p less than 0.001). The number of patients with corneal edema one day and one week after surgery was significantly higher in the diabetic group than in the non-diabetic group (after 1 day, OR = 62.5; 95 % CI = 15.31 - 255.11, p less than 0.000) and after 1 week, OR = 6.77; 95 % CI = 1.28 - 35.76, p less than 0.006). CONCLUSION: Corneal edema following phacoemusification surgery in diabetic eyes is likely to be more frequent than in non-diabetic eyes.

Expression of vascular endothelial growth factor in exuberant tracheal granulation tissue in children.

Prolonged tracheotomy and endotracheal intubation often induce symptoms of airway obstruction and delay decannulation and extubation. Bronchoscopic examination of patients undergoing these treatments usually shows the presence of exuberant (pseudopapillary or nodular) granulation tissue occupying the airway lumen. An immunohistochemical analysis was undertaken of vascular endothelial growth factor (VEGF) expression in exuberant tracheal granulation tissue (n=17) obtained from children treated with prolonged tracheotomy or endotracheal intubation. Increased levels of VEGF protein and mRNA were expressed mainly by tracheal epithelial cells that migrated to cover the granulation tissue and partly by pericapillary macrophages in this tissue, whereas normal tracheal epithelium did not express VEGF. The VEGF expression level correlated significantly with the severity of the exuberant granulation tissue response (p=0.0018). As VEGF induces angiogenesis and vascular permeability, characteristics of granulation tissue, and plays a pivotal role in granulation tissue development, enhanced VEGF expression may be involved in the development of exuberant tracheal granulation tissue.

Neonatal renal artery blood flow velocities using color Doppler ultrasonography.

BACKGROUND: It is essential to evaluate the renal function for the management of high risk neonates. Color Doppler ultrasound technique can provide a useful information to evaluate the neonatal renal artery blood flow velocities. This study was performed to obtain the normative data of renal blood flow velocities in preterm and fullterm neonates and to compare the renal blood flow velocities with the aortic blood flow velocities. The normal volumetric state of fluid balance and renal function are essential in the management of the sick neonates. METHODS: The renal peak systolic blood flow velocity (renal PSFV), the renal mean blood flow velocity (renal MFV), the renal end diastolic blood flow velocity (renal EDFV) and the renal resistance index (renal RI) and also the cardiac output, the aortic peak systolic blood flow velocity (aortic PSFV) and the aortic mean blood flow velocity (aortic MFV) were serially recorded from one to 7 days after birth in 16 preterm and one to 5 days in 23 normal fullterm neonates. RESULTS: The renal PSFV was significantly increased with the postnatal age, and the renal MFV was significantly increased between three and five days of age in the preterm neonates. In the fullterm neonates there was no significant change of the renal PSFV between one and five days of age, but the renal MFV was significantly increased between three and five days of age. There were no statistically significant differences of the renal PSFV, the renal MFV, the renal EDFV and the renal RI between the preterm and the fullterm neonates in the first five days after birth. The cardiac output in the preterm neonates was higher than that in the fullterm neonates: on day 3; 313 +/- 59 vs. 254 +/- 40 ml/kg/min. (p < 0.001) and on day 5; 357 +/- 95 vs. 280 +/- 35 ml/kg/min. (p < 0.01). The renal blood flow velocities were not significantly correlated with the aortic blood flow velocities in the normal fullterm neonates, whereas, in the preterm neonates the renal PSFV correlated with the cardiac output (r = 0.35, p < 0.01), the aortic PSFV (r = 0.45, p < 0.001) and the aortic MFV (r = 0.39, p < 0.01), and the renal MFV also correlated with the aortic PSFV (r = 0.30, p < 0.05) and the aortic MFV (r = 0.32, p < 0.05). CONCLUSIONS: The increased renal flow velocities with the postnatal age in the preterm infants might depend on the increased cardiac output.

Blindness from cataract formation in leprosy.

Of 744 leprous patients, 61 (8.2%) had cataract-induced blindness; 46 patients (6.2%) were unilaterally blind and 15 (2.0%) were bilaterally blind. The mean age of patients with cataracts was 63.4 years in the tuberculoid-type leprosy and 56.4 years in the lepromatous type. The appearance of cataracts in lepromatous patients at an earlier age than in tuberculoid patients is significant (p less than 0.005). Of 41 cataractous eyes with posterior iris synechiae, 42.1% were observed in patients with tuberculoid-type leprosy and 59.1% in patients with the lepromatous type. Histopathological examination of 24 lenses showed that irregularities of the lens epithelium were present in 79.2%. Posterior iris synechiae were seen in 66.7% and fibrous pseudometaplasia in 41.7%. Posterior migration of the lens epithelium in the posterior subcapsular area was observed in 54.2%. In view of these clinical and histopathological findings, we discuss the probability that most cataracts in leprous patients are complicated in nature.

Incidence of cataracts in the mobile eye hospitals of Nepal.

The incidence of cataract in Nepal was determined from data collected in 14 mobile eye hospitals (called 'eye camps'). Of a total of 12,217 patients examined in the out-patient department (OPD), cataract surgery was performed on 2,163. The percentage of cataract patients in the OPD was less in the mountains (13.8%) than in the Tarai plains (19.8%). In the inhabitants of the mountains, the majority of whom belong to the Tibeto-Birman race, cataracts appeared at a significantly later age in both males and females compared to the people of the plains, who are mostly Indo-Aryan. Cataracts were discovered in both groups at a younger age in women than in men.