Neodymium:YLF picosecond laser segmentation for retinal traction associated with proliferative diabetic retinopathy.

PURPOSE: To determine the applicability of laser segmentation for severing fibrovascular tissue and hyaloid interfaces in the treatment of tractional complications of proliferative diabetic retinopathy. METHODS: A prototype neodymium:yttrium-lithium-fluoride (Nd:YLF) picosecond pulse photodisruptive laser was used in eight eyes (seven patients) with proliferative diabetic retinopathy as part of a Food and Drug Administration-approved phase 1 protocol. There were three indications for treatment: type I: distortion and shallow elevation of the macular caused by taut, adherent, posterior hyaloid interface (two eyes); type II: traction retinal detachment involving the fovea (two eyes); and type III: fovea-threatened, traction retinal detachment (four eyes). Traction release was accomplished by laser segmentation of the detached hyaloid interfaces and fibrotic, contracted proliferative tissue. The Nd:YLF uses low pulse energy (0.10 mJ, 1,000 pulses per second for 10 consecutive seconds) that allows tissue cutting near the retinal surface. RESULTS: Both type I eyes had relief of traction forces; visual acuity improved from 20/400 to 20/50 in one eye; the other remained stable. Of the two type II eyes, one had anatomic reattachment of the fovea with improvement in visual acuity (hand movements to 20/50); the second required vitrectomy. Of the four type III eyes, all had anatomic improvement; three maintained pretreatment acuity; the fourth eye developed vitreous hemorrhage at 6 months and underwent vitrectomy. Three treatments (two eyes) caused vitreous hemorrhage that resulted in a transient drop in acuity (1 to 2 lines). No patient developed a retinal break or choroidal hemorrhage. CONCLUSION: In a small pilot study, the Nd:YLF laser segmented proliferative tissue near the retinal surface and elevated hyaloid interfaces. In selected cases, this may enable flattening of traction retinal detachment or release of retinal distortion.

Oncologists' attitudes to treatment of cancer patients.

This study, based on questionnaire responses of 46 Israeli oncologists, explores the factors influencing these physicians' beliefs and decisions regarding chemo- and radiation therapy. A simple discriminant analysis identified five physician-related variables with a significant impact on the subjects' attitudes to treatment: age, sex, years of oncology experience, pity for the patient, and whether they believed all cancer patients suffer from pain. In the absence of an unambiguous clinical protocol, the major influences on decisions to treat with chemo- or radiation therapy include, in addition to diagnosis, the patient's overall health, the physician's perception of treatment effectiveness, and the stage to which the illness has progressed. The discussion of the findings centers on their implications for practice.

Long-term effects of adolescent drug use in the Israeli middle class.

This is a self-report study of a purposive sample of 111 middle-class Israelis in their 30s. The sample, designed to overrepresent adolescent drug experience, included 53 subjects (47.7%) reporting having tried illicit drugs during adolescence (epidemiological data indicate approximately 7% percent adolescent drug use in Israel). None of the users was apprehended. Comparing the users with the nonusers on variables indicating adult conformity, adjustment, and subjective well-being revealed no significant difference between the two groups.

Distinctive cataract in the Stickler syndrome.

We determined the clinical characteristics of cataract in 133 patients with the Stickler syndrome. Cataracts of various types or aphakia were found in 115 of 231 eyes (49.8%) studied. The most frequent and distinctive lesions, described as wedge and fleck cataracts, accounted for 40 of the 93 cataracts (43.0%) observed. These distinctive opacities may serve as a clinical marker for the Stickler syndrome and facilitate early diagnosis.