Topical cyclosporine A for the dry eye findings of thyroid orbitopathy patients.

PURPOSE: To determine the beneficial effect of topically administered Cyclosporine A (CsA) for the dry eye findings of thyroid orbitopathy patients. PATIENTS AND METHODS: This prospective pilot study included 73 eyes of 42 patients with thyroid orbitopathy who had documented dry eye findings. Patients were randomly assigned into two groups: in group 1 (48 eyes), patients received topical artificial tear-drop treatment. In group 2 (25 eyes), patients received topical CsA and artificial tear-drop treatment. During a mean follow-up of 6 months, change in Schirmer's test with aneasthesia, tear break-up-time (BUT) and impression cytology results were analyzed and were compared between groups. RESULTS: The two groups were age (P=0.449) and gender (P=0.942) matched. The Schirmer's test (P=0.441), tear BUT (P=0.718) and impression score (P=0.103) were also similar before the treatment in both groups. In group 1, all three parameters improved significantly with treatment (P<0.001 for all). In group 2, Schirmer's test (P=0.001) and tear BUT (P<0.001) improved, but the impression score (P=0.175) did not change significantly after treatment. The percentage of patients with improved tear BUT (P=0.04) and improved impression score (P<0.001) were higher in group 1. At the end of follow-up, group 1 patients had better Schirmer's test (P=0.004), tear BUT (P=0.021) and impression scores (P<0.001), than group 2 patients. CONCLUSIONS: The combined CsA use with artificial tear drops is not more advantageous than the use of artificial tear drops alone, for the dry eye findings of thyroid orbitopathy patients.

Brucella infection in total hip replacement: case report and review of the literature.

A 47-y-old female underwent revision of a left total hip replacement because of loose prosthesis. Routine intraoperative culture of the hip site grew Brucella sp. The patient was treated with a combination of vibramycin and rifampicin for 5 months. At 4-y follow-up, her condition is good. Though prosthetic infection with Brucella spp. is an extremly rare condition (only 1 case each of femur and hip, and 3 cases of knee had been previously reported in the English literature), brucella infection of prosthetic joints should be considered in brucella endemic areas.

The results of trabeculectomy with and without mitomycin C in young patients.

The results of primary trabeculectomy with and without mitomycin C (MMC) were evaluated in young glaucoma patients. The patients, 15-40 years of age, were divided into two main groups and two subgroups. In group IA, primary Cairns type trabeculectomy was performed in 24 eyes of 24 patients with juvenile glaucoma; in group IB, trabeculectomy + MMC 0.4 mg/ml in 3 min was done in 20 eyes of 20 patients with juvenile glaucoma; in group IIA, primary trabeculectomy was performed in 20 eyes of 20 patients with developmental glaucoma, and in group IIB, trabeculectomy + MMC 0.4 mg/ml in 3 min was performed in 16 eyes of 16 patients with developmental glaucoma. The success rate of the surgery was 75% in group IA, 90% in group IB, 50% in group IIA, and 75% in group IIB. There was no statistically significant difference among the groups in terms of success rates of trabeculectomies (p > 0.05).

Comparison of the anti-inflammatory effects of diclofenac and flurbiprofen eye drops after cataract extraction.

PURPOSE: A clinical double-blind study was performed in patients who had undergone extracapsular cataract extraction and intraocular lens implantation (ECCE+IOL) to compare the anti-inflammatory effects of diclofenac sodium 0.1% and flurbiprofen 0.03% eye drops. METHODS: The diclofenac group included 21 eyes of 21 patients and the flurbiprofen group included 22 eyes of 22 patients. The parameters compared were pachymetry of the cornea, corneal surface changes, intraocular pressure (IOP) and the degree of inflammation of the anterior chamber at one, three and six weeks after cataract surgery. RESULTS: There was no statistically significant difference between the two treatment groups in corneal pachymetry, corneal surface changes, IOP and the anterior chamber inflammation (p>0.05). CONCLUSION: Both drugs were well tolerated and may be safely used to reduce inflammation for cataract surgery.

Substance abuse treatment staff: recovery status and approaches to treatment.

Recovery status is an important characteristic of staff members working within substance abuse treatment. Recovering and nonrecovering staff members were contrasted previously, however there is a third group: Individuals who are not recovering themselves but are part of families with recovering or addicted members. The purpose of the present study is to compare background, roles within program and approaches to treatment of these three groups. Six hundred and thirty-four staff members of fifty-one treatment programs completed questionnaires. Five hundred and seventy-five completed an item indicating their recovery status. Forty-four percent identified themselves as nonrecovering, 30 percent as recovering, and 26 percent as nonrecovering but part of families with an addicted or recovering member. Nonrecovering staff with addicted or recovering family members differed from the other two groups on gender, more of them were female, but were similar to nonrecovering staff in their approach to treatment but fell between recovering and nonrecovering staff on measures of roles within programs and background. Recovering counselors reported to pursue a wider range of treatment goals and to use more varied treatment techniques than nonrecovering counselors. The implication of these findings for training and licensure of paraprofessionals in the field of substance abuse treatment is discussed.

The SRKII formula in the calculation of intraocular lens power.

This study compares the predictive accuracy of the SRKII formula for groups with average axial length and long eyes. 344 eyes which underwent cataract extraction with implantation of a posterior-chamber intraocular lens were included in the survey; 246 eyes had an average axial length (22.0-24.49 mm), and 98 eyes had an axial length of more than 24.50 mm. Mean absolute errors were 0.26+/-0.68 dpt in the first group and 1.16+/-1.78 dpt in the second group. 94.3% of the average eyes were within 1.0 dpt of the expected refraction, 98.8% within 2.0 dpt, whereas in the long-eye group 58.2% were within 1.0 dpt and 84.7% within 2.0 dpt. The results show that the SRKII formula performed credibly in average-length eyes; in the long eyes the ratio of large refractive deviations was greater than that of the other group.

Test-retest reliability of psychoactive substance abuse and dependence diagnoses in telephone interviews using a modified Diagnostic Interview Schedule-Substance Abuse Module.

The test-retest reliability of lifetime substance abuse and dependence diagnoses obtained by telephone interviewers was investigated. Trained personnel administered two identical interviews based on a modified Diagnostic Interview Schedule-Substance Abuse Module (DISSAM) approximately a week apart for 100 respondents, of whom 55 were receiving alcohol or other drug treatment and 45 and randomly selected from residential households in one Michigan county. The uncorrected agreement for all lifetime dependence diagnoses exceeded 93% for all six categories assessed and the more conservative chance corrected agreement (Cohen's Kappa coefficient kappa) was .92 (alcohol),.76 (marijuana),.87 (cocaine), and .71 (other opiates). Kappa coefficients for hallucinogens and heroin dependence could not be calculated due to low (i.e., 5% or less) base rates. Likewise, kappa was calculated only for a single abuse diagnosis, alcohol, with kappa = .42 and 95% agreement. In the interpretation of kappa, the standard applied was: kappa ranging from .41 to .60 represented moderate agreement, kappa ranging from .61 to .80 represented substantial agreement, and kappa ranging from .81 to 1.00 represented excellent agreement. Thus, test-retest reliability was excellent for lifetime alcohol and cocaine dependence and was substantial for lifetime marijuana and other opiates dependence. These results indicate that lifetime psychoactive substance abuse diagnoses can be obtained fairly reliably over the telephone using trained lay interviewers.

The results of surgical treatment in Duane's retraction syndrome.

In an attempt to evaluate the response to surgical treatment, the surgical outcome of 16 patients with Duane's retraction syndrome (DRS) was investigated. Single horizontal rectus muscle recession, transposition of vertical recti and recession of both horizontal recti were carried out. In one of the four patients with significant globe retraction, Y splitting of the lateral rectus muscle was added to the procedure to overcome the cosmetically unacceptable upshoot. Single horizontal muscle recession surgery was effective in reducing the abnormal head posture and the deviation in primary position. The results of both horizontal recti recession were not so predictable in reducing globe retraction. Recession of both horizontal recti was ineffective in vertical DRS. It is suggested that the variability of surgical outcome in DRS may be related to the different innervational patterns and mechanical factors.

Surgical results in highly asymmetric dissociated vertical deviations.

The effect of surgery in highly asymmetric dissociated vertical deviations (DVD) was evaluated in 13 patients. All the patients had a moderate or large DVD (more than 15 PD) in one eye with a latent or very small (less than 5 PD) DVD in the fellow eye. As there was no strong fixation preference in either of the two eyes of the patients before surgery, bilateral surgery was performed. Eleven patients underwent surgery which consisted of conventional (3-5 mm) superior rectus (SR) recession combined with posterior fixation sutures placed 13 mm from the original insertion in the eye with moderate or large DVD, with posterior fixation sutures alone in the eye with minimal or latent DVD. In the remaining two patients, bilateral conventional SR recessions were combined with posterior fixation sutures. The mean follow-up was eight months. A cure was defined as latency or elimination of the hyperdeviation and was noted in five patients, two of whom had undergone bilateral SR recessions with posterior fixation sutures. All the remaining eight patients developed a cosmetically unacceptable moderate or large DVD (more than 15 PD) in the eye that had a very small DVD prior to surgery, two of them having a manifest comitant hypertropia postoperatively in addition to the DVD, demonstrating overcorrections with the previously elevated eye now in a hypotropic position. Performing posterior fixation sutures alone to the eye with a very small DVD does not seem to be effective in the surgical treatment of DVD; combining posterior fixation sutures with a recession of the SR muscle seems to be a more reasonable approach.

Calculation of intraocular lens power with the SRK II formula for axial high myopia.

AIM: The SRK II formula has been widely used for intraocular lens (IOL) power calculations. The predictability of this formula is evaluated in axial myopic patients. METHODS: Planned extracapsular cataract extraction and posterior chamber IOL implantation (PECCE + IOL) were performed on 98 eyes of 98 patients with axial length > 24.5 mm. Cases had no preoperative complications and postoperative visual acuity was at least 0.5 (Snellen). Corneal refractive power and axial length were measured preoperatively and emmetropic IOL power calculations were made using the SRK II formula. Long-term (mean 4.7 months) visual acuities and refractions were noted postoperatively. RESULTS: The absolute refractive error was < 1.00 Diopters (D) in 57 eyes (58.2%) and < 2.00 D in 83 eyes (84.7%). The mean absolute error of the SRK II formula in axial myopia was 1.16 D +/- 0.78 SD. CONCLUSIONS: The SRK II formula is not very accurate in axial myopic patients.

Treatment of glaucoma in young nanophthalmic patients.

PURPOSE: To evaluate the criteria of diagnosis and management of secondary glaucoma in young nanophthalmic patients. METHODS: Considering the anatomic features and clinical characteristics, 22 eyes of 11 patients were identified as bilateral nanophthalmos. Intraocular pressures (IOP) were checked with Goldmann applanation or Keeler pulse-air 2000 tonometer, and Nd-Yag laser was used for iridotomies. Prophylactic V-shaped unsutured sclerectomies over the pars plana were combined with trabeculectomy, and Mitomycin C (MMC) in 0.2 mg/ml concentration was applied. RESULTS: Among 22 eyes of bilateral nanophthalmic patients 8 eyes had secondary angle-closure glaucoma. Laser iridotomies were performed in 6 eyes. Laser iridotomy and supplemental medical therapy were sufficient in 4 out of 6 eyes. Mean IOP dropped from 26.4 to 14.5 mmHg in these patients. Due to continuous increase of IOP in the other patients, they underwent trabeculectomy with V-shaped sclerostomy and intraoperative MMC application. Mean IOP dropped from 39.3 mmHg to 19.3 mmHg. Postoperative uveal effusion on other major complications were not observed. Mean age of these patients was 14.6 years during treatment. CONCLUSION: Management of glaucoma in nanophthalmus is complicated. Initial treatment is medical. If it is insufficient, laser iridotomies and V-shaped sclerostomies with filtration surgery can be performed at any age.

Effects of antiglaucoma drugs on ocular surface.

Topical medications have a very important role in chronic glaucoma treatment. Long-term use of these medications can cause significant changes on ocular surfaces. In this study, the ocular surfaces of 20 control subjects (group I), 20 primary open-angle glaucoma patients (group II) treated (mean 21.20 +/- 1.32 months) with 0.50% timolol maleate, and 20 primary open-angle glaucoma patients (group III) treated (mean 21.70 +/- 1.34 months) with 0.50% timolol maleate + 1% dipivefrin hydrochloride were evaluated. Studied parameters included Schirmer's test, tear break-up time, conjunctiva impression cytology and goblet cell density. These results suggest that long-term applications of topical anti glaucoma medications damage the ocular surface.

The longitudinal stability of the Addiction Severity Index.

The Addiction Severity Index (ASI) is a structured interview widely used by substance abuse clinicians and researchers for client screening, determining treatment needs, and assessing treatment outcomes. Previous researchers have evaluated inter-rater agreement, test-retest reliability, and concurrent validity. The present report describes the stability of ASI scores in longitudinal work. In the context of an ongoing treatment outcome evaluation study involving seven assessors, inter-rater agreement, inter-rater reliability, as well as intra- and inter-rater accuracy were assessed repeatedly during a 2-year period. The results show the scores derived from the ASI to be stable across assessors and over time. The relationship between stable scores and resources required for training are discussed.