Cirugía combinada de trabeculostomía láser excímer y facoelmusificación: datos a un año en el mundo real de una MIGS de tipo láser / Combined excimer laser trabeculostomy and phacoemulsification: one year follow-up real world data of a laser-based MIGS

Objetivos Evaluar la eficacia y posibles complicaciones de la trabeculostomía láser excímer (excimer laser trabeculostomy, ELT) una técnica de cirugía de glaucoma mínimamente invasiva (minimally invasive glaucoma surgery, MIGS) emergente de tipo láser, realizada en combinación con la cirugía de la catarata durante la práctica clínica habitual. Pacientes y métodos Estudio intervencionista, retrospectivo, en un único centro. Se recopilaron los datos clínicos preoperatorios y postoperatorios de pacientes con catarata y glaucoma de ángulo abierto (GAA) que fueron sometidos a cirugía combinada de ELT y facoemulsificación, en el día preoperatorio, a una semana, y uno, dos, tres, seis, nueve y 12 meses después de la cirugía. La variable principal del estudio fue la presión intraocular (PIO). El éxito cualificado y completo se definió como una PIO menor de 21 mmHg con una reducción del 20% o más de la PIO preoperatoria, con o sin tratamiento médico adyuvante, respectivamente. Resultados Se incluyeron 34 ojos de 29 pacientes; 29 ojos completaron el seguimiento a un año. La PIO preoperatoria media bajo medicación hipotensora fue de 20,9 ± 2,6 mmHg (± desviación estándar, DE) y disminuyó significativamente al año (16,3 ± 1,9; p < 0,0001). El número medio de medicamentos reductores de la PIO disminuyó de 1,7 ± 0,7 a 0,3 ± 0,8 (p < 0,0001) en el seguimiento de 12 meses. Al año, el 81% de los ojos estaban libres de medicación. Se obtuvo un éxito cualificado y completo en el 62% y el 58% de los ojos, respectivamente. Dos ojos presentaron hipema postoperatorio, tres ojos sufrieron un aumento transitorio de PIO y un paciente requirió de cirugía filtrante en los tres meses sucesivos (AU)

Purpose To evaluate the efficacy and complication profile of excimer laser trabeculostomy (ELT), an emerging laser-based trabecular minimally invasive glaucoma surgery (MIGS), combined with cataract surgery in routine clinical practice. Patients and methods Single-site, retrospective, interventional study. Preoperative and postoperative clinical data of patients with cataract and open-angle glaucoma (OAG) who underwent combined phacoemulsification and ELT were collected and analyzed at preoperative day, one week postoperatively, and after one, two, three, six, nine and 12 months. Main outcome measure was intraocular pressure (IOP). Qualified and complete success were defined as an IOP less than 21 mmHg and an IOP reduction ≥ 20% from preoperative medicated IOP with or without adjuvant medical treatment, respectively. Results Thirty-four eyes of 29 patients were included; 29 eyes completed 1-year follow-up. The mean preoperative IOP under medications was 20.9 ± 2.6 mmHg (± standard deviation, SD) and decreased significantly at one year (16.3 ± 1.9; p < 0.0001). The mean number of IOP-lowering medications decreased from 1.7 ± 0.7 to 0.3 ± 0.8 (p < 0.0001) at the 12-month follow-up. At one year, 81% of eyes were medication free. Qualified and complete success was obtained in 62% and 58% of eyes, respectively. Two eyes had postoperative hyphema, three eyes had transient IOP spikes and one patient underwent a subsequent filtering surgery at three months. Conclusion Combining ELT with phacoemulsification in eyes with cataract and mild to moderate OAG significantly reduced IOP and medication use without meaningful complications after one-year follow-up in a real world clinical practice setting (AU)

Combined excimer laser trabeculostomy and phacoemulsification: One year follow-up real world data of a laser-based MIGS.

PURPOSE: To evaluate the efficacy and complication profile of excimer laser trabeculostomy (ELT), an emerging laser-based trabecular minimally invasive glaucoma surgery (MIGS), combined with cataract surgery in routine clinical practice. PATIENTS AND METHODS: Single-site, retrospective, interventional study. Preoperative and postoperative clinical data of patients with cataract and open-angle glaucoma (OAG) who underwent combined phacoemulsification and ELT were collected and analyzed at preoperative day, one week postoperatively, and after one, two, three, six, nine and 12 months. Main outcome measure was intraocular pressure (IOP). Qualified and complete success were defined as an IOP less than 21mmHg and an IOP reduction ≥20% from preoperative medicated IOP with or without adjuvant medical treatment, respectively. RESULTS: Thirty-four eyes of 29 patients were included; 29 eyes completed 1-year follow-up. The mean preoperative IOP under medications was 20.9±2.6mmHg (±standard deviation, SD) and decreased significantly at one year (16.3±1.9; p<0.0001). The mean number of IOP-lowering medications decreased from 1.7±0.7 to 0.3±0.8 (p<0.0001) at the 12-month follow-up. At one year, 81% of eyes were medication free. Qualified and complete success was obtained in 62% and 58% of eyes, respectively. Two eyes had postoperative hyphema, three eyes had transient IOP spikes and one patient underwent a subsequent filtering surgery at three months. CONCLUSION: Combining ELT with phacoemulsification in eyes with cataract and mild to moderate OAG significantly reduced IOP and medication use without meaningful complications after one-year follow-up in a real world clinical practice setting.

Combined excimer laser trabeculostomy and phacoemulsification: one year follow-up real world data of a laser-based MIGS. / Cirugía combinada de trabeculostomía láser excímer y facoelmusificación: datos a un año en el mundo real de una MIGS de tipo láser.

PURPOSE: To evaluate the efficacy and complication profile of excimer laser trabeculostomy (ELT), an emerging laser-based trabecular minimally invasive glaucoma surgery (MIGS), combined with cataract surgery in routine clinical practice. PATIENTS AND METHODS: Single-site, retrospective, interventional study. Preoperative and postoperative clinical data of patients with cataract and open-angle glaucoma (OAG) who underwent combined phacoemulsification and ELT were collected and analyzed at preoperative day, one week postoperatively, and after one, two, three, six, nine and 12 months. Main outcome measure was intraocular pressure (IOP). Qualified and complete success were defined as an IOP less than 21 mmHg and an IOP reduction ≥ 20% from preoperative medicated IOP with or without adjuvant medical treatment, respectively. RESULTS: Thirty-four eyes of 29 patients were included; 29 eyes completed 1-year follow-up. The mean preoperative IOP under medications was 20.9 ± 2.6 mmHg (± standard deviation, SD) and decreased significantly at one year (16.3 ± 1.9; p < 0.0001). The mean number of IOP-lowering medications decreased from 1.7 ± 0.7 to 0.3 ± 0.8 (p < 0.0001) at the 12-month follow-up. At one year, 81% of eyes were medication free. Qualified and complete success was obtained in 62% and 58% of eyes, respectively. Two eyes had postoperative hyphema, three eyes had transient IOP spikes and one patient underwent a subsequent filtering surgery at three months. CONCLUSION: Combining ELT with phacoemulsification in eyes with cataract and mild to moderate OAG significantly reduced IOP and medication use without meaningful complications after one-year follow-up in a real world clinical practice setting.

Role of the bandage soft contact lens in the postoperative laser in situ keratomileusis patient.

PURPOSE: To determine whether a bandage soft contact lens (BSCL) is routinely needed in the postoperative laser in situ keratomileusis (LASIK) patient and whether topical tetracaine 0.5% or diclofenac sodium 0.1% (Voltaren) is more effective in relieving patient discomfort than a BSCL. SETTING: LCA-Vision Center, Toronto, Ontario, Canada. METHODS: In this prospective randomized comparative study, all patients had bilateral simultaneous LASIK procedures. Post-LASIK patient comfort was evaluated through 3 arms of the study: BSCL versus no BSCL, 40 consecutive patients with 1 eye randomized to receive a BSCL and no BSCL in the fellow eye; BSCL versus tetracaine 0.5%, 26 consecutive patients with 1 eye randomized to receive a BSCL and tetracaine 0.5% in the fellow eye; tetracaine 0.5% versus Voltaren, 54 consecutive patients with 1 eye randomized to receive tetracaine 0.5% and Voltaren in the fellow eye. RESULTS: The patient preferences after LASIK were as follows: BSCL versus no BSCL-12 (30%) versus 23 (58%) (P =.062); BSCL versus tetracaine 0.5%-4 (15%) versus 22 (85%) (P <.001). On average, the eyes with no BSCL had a 2-line improvement in uncorrected visual acuity over the BSCL eyes. Tetracaine 0.5% versus Voltaren-13 (24%) versus 21 (39%) (P =.170). CONCLUSIONS: The routine use of a BSCL in the postoperative LASIK patient is not necessary. Voltaren and tetracaine 0.5% were safe and more effective in relieving postoperative patient discomfort and resulted in improved visual acuity immediately postoperatively.

Ab externo scleral fixation of the Cionni modified capsular tension ring.

The Cionni modified capsular tension ring (CTR) allows for scleral fixation in cases of significant zonular dialysis, providing long-term centration of in-the-bag foldable intraocular lenses. Previous techniques of suture placement require placement of the primary incision along the axis of zonular weakness or enlarging and/or distorting the primary incision to attain proper positioning. They also use blind passes of the needle under the iris to approximate the ciliary sulcus. We describe an external closed-system approach for preplacing 10-0 polypropylene sutures in the ciliary sulcus for a Cionni modified CTR under topical anesthesia. This technique does not use blind passes of the suture needle and results in accurate placement of the sutures in the ciliary sulcus under a closed and stable system.

Remittances and their economic impact in post-war Somaliland.

This paper examines the role of remittances, provided by a large global diaspora of migrant workers and refugees, in post-war Somaliland. Based on field-work conducted in Somaliland under the COPE project in 1998/9, the paper discusses trends in the size, source, means of transfer, distribution and use of remittances, their role in livelihoods and in the country's economic recovery and future prospects. The total value of remittances, originating mainly from migrant labour in the Gulf and more recently an exodus of refugees to the West, and greatly facilitated by the growth of telecommunications in Somaliland and of remittance agencies, is estimated at some US$500 million annually--around four times the value of livestock exports and much more significant than hitherto appreciated. Contrary to the prevailing view that remittances are mainly used for consumption and unproductive investments such as housing and land, this study suggests that in Somaliland they have contributed to the rapid growth of a vibrant private sector. On the other hand, remittance flows have been associated with a number of negative side-effects such as the loss of the country's most educated and skilled labour, increased income inequality and booming sector effects, and their positive impact is limited by the present lack of credit schemes and facilities for saving.

Effects of insulin and 2-deoxy-D-glucose administration on CNS IGF-II content.

In order to determine whether effects of insulin on central nervous system (CNS) insulin-like growth factor II (IGF-II) content are direct or whether they are due to insulin-induced glucoprivation, short-term (2 h) time course studies were conducted utilizing the glucoprivic agent 2-deoxy-D-glucose (2-DG). Insulin (2 U/kg b.wt.), 2-DG (500 mg/kg b.wt.) or vehicle were administered to Sprague-Dawley rats (350-450 kg) and groups of animals were killed at time 0 and 15, 30, 45, 60, and 120 min following injection. Specific hypothalamic and hindbrain regions obtained by microdissection, were analyzed for IGF-II content by RIA. Insulin and 2-DG exerted similar effects on IGF-II content in the dorsomedial hypothalamus and the paraventricular nucleus. These data suggest that IGF-II was primarily regulated by glucoprivation in these regions. Only 2-DG altered ventromedial hypothalamic IGF-II content, and opposite responses to the two agents were observed in the arcuate nucleus. This uncoupling of IGF-II response suggests that differences in peripheral vs. central signals for IGF-II secretion may be involved. The vagal complex was responsive only to insulin injection indicating a specific response that may be tied to sensory vagal function.

[The role of endogenous opioids in modulation of immunosuppression in fish]. / Die Rolle endogener Opioide in der Modulation der Immunsuppression bei Fischen.

We have previously shown that social confrontation between aggressive fish (e.g., Tilapia) produces a suppression of several immunological parameters--nonspecific cytotoxicity and mitogen-stimulated proliferation in pronephric lymphocytes--in the subordinate fish. By using the opioid antagonist, naltrexone, we now demonstrate indirectly that this immunosuppression is in part mediated by the endogenous opioid system. Evidence is presented that naltrexone-mediated reversal of immunosuppression may be limited to the populations of the cytotoxic and T-cell lineages. The proliferative response to lipopolysaccharide is unaffected by naltrexone. Our data also demonstrate that serum from subordinate (immunosuppressed) fish is immunosuppressive in normal fish: an effect that can be reversed by naltrexone. These results support a link between the neuroendocrine and immune systems in these animals.

Prenatal ethanol and the prepubertal sexually dimorphic nucleus of the preoptic area.

The volume of the sexually dimorphic nucleus of the preoptic area of the hypothalamus (SDN-POA) was determined in 14-31-day-old male and female rats whose mothers received a liquid diet containing 5% w/v ethanol from day 8 of gestation to parturition. Pair-fed dams received as a nutritional control an equal volume of an isocaloric liquid diet with maltose-dextrin in place of ethanol. Normal controls had laboratory rat chow and water available ad lib. The SDN-POA volume of ethanol-exposed males was significantly reduced compared to the pair-fed and normal males, and became indistinguishable from the SDN-POA volumes of the pair-fed and normal females. Ethanol-treated females also had a markedly reduced SDN-POA volume compared to the pair-fed and normal females. Our findings indicate that the SDN-POA of prepubertal rats of both sexes is sensitive to the effects of in utero ethanol exposure. While plasma testosterone, progesterone and estradiol titers, which we measured in fetuses on gestation day 22, were differentially affected by maternal ethanol consumption, the alterations by themselves cannot adequately explain the effects of prenatal ethanol exposure on the developing SDN-POA.

Social confrontation "stress" in aggressive fish is associated with an endogenous opioid-mediated suppression of proliferative response to mitogens and nonspecific cytotoxicity.

We have previously shown that social confrontation between aggressive fish (e.g., Tilapia) produces a suppression of several immunological parameters--nonspecific cytotoxicity and mitogen-stimulated proliferation in pronephric leukocytes--in the subordinate fish. By using the opioid antagonist, naltrexone, we now demonstrate indirectly that this immunosuppression is in part mediated by the endogenous opioid system. Evidence is presented that naltrexone-mediated reversal of immunosuppression may be limited to the populations of the cytotoxic and T-cell lineages. The proliferation response to lipopolysaccharide is unaffected by naltrexone. Our data also demonstrate that serum from subordinate (immunosuppressed) fish is immunosuppressive in normal fish--an effect that can be reversed by naltrexone. These results support a link between the neuroendocrine and immune systems in fish, the lowest vertebrate.

Suppression of natural cytotoxic cell activity by social aggressiveness in Tilapia.

Our earlier observations revealed that social stress causes drastic effects on different physiological mechanisms and degenerative changes in leucocytes. In this preliminary work, we analyzed the effect of social aggressiveness on functional activities of leucocytes emphasizing (NCC) activity in Tilapia. At 10 hr post stress induction, fish could be differentiated into three categories: 1) dominants; 2) subordinates; and 3) indeterminants. Results of NCC as indicated by 4 hr. 51Cr-release assay, demonstrated a significant suppression in cytotoxic reactivity in the subordinates and indeterminants compared to dominants. This suppression appears to be due to a decrease in the binding capacity of effector cells to YAC-1 target cells as indicated by the decreased number of conjugate forming cells. This binding process is a key event in activating the fish equivalent of NK cells in mammals. Decreased NCC-activity in stressed fish suggests that aberrations in cell mediated immunity result from social aggressiveness.