Correlation of the severity of diabetic retinopathy and the heart muscle perfusion in patients with type 2 diabetes.

OBJECTIVE: The objective was to investigate whether microvascular disturbances in patients with type 2 diabetes (DM) as defined by retinal examination predict the existence of macrovascular disturbances found on radioisotopic perfusion examinations of the heart muscle. MATERIALS AND METHODS: A total of 100 patients with type 2 DM and an additional cardiovascular risk factor were enrolled in the study. All patients underwent comprehensive ophthalmologic examination, including fundus color photography and fluorescein angiography, and were divided into three groups: group 1 (NoDR): met the inclusion criteria but had no diabetic retinopathy; group 2 (NPDR): had signs of nonproliferative diabetic retinopathy; group 3 (PDR): had signs of preproliferative or proliferative diabetic retinopathy. After collecting general medical history and clinical data, patients underwent heart muscle perfusion studies. All patients followed a 48-h protocol heart muscle perfusion examination in the rest state as well as after the standardized exercise test. Single photon emission computed tomography examination was performed. RESULTS: In the PDR group, the impairment of the heart muscle perfusion at stress and rest was more frequent than in the NPDR and NoDR groups. Analysis of the heart muscle perfusion results for the three groups showed a significant relationship with the severity of microvascular complications observed in eye fundus examinations. CONCLUSIONS: Comprehensive ophthalmologic assessment of the progression of diabetic retinopathy in patients with type 2 DM may be an indicator of heart muscle perfusion disturbance.

Lesões coriorretinianas em mães de crianças com toxoplasmose congênita no national collaborative Chicago-based, toxoplasmosis study / Chorioretinal lesions in mothers of children with congenital toxoplasmosis in the national collaborative Chicago-based, congenital toxoplasmosis study

Aims: To determine whether mothers of children with congenital toxoplasmosis have chorioretinal lesions consistent with toxoplasmosis. Methods: Prospective cohort study. Ophthalmologists in our study have examined 173 children with congenital toxoplasmosis in a hospital outpatient setting. These children were referred to us by their primary care physicians. One hundred and thirty mothers of these children had retina examinations of both eyes at least once. Main outcome measure was lesion(s) consistent with ocular toxoplasmosis. Results: Of 130 mothers examined between 1991-2005, 10 (7.7%, 95% Confidence Interval 3.8%, 13.7%) had chorioretinal lesions which likely represent resolved toxoplasmic chorioretinitis. Most of these were small peripheral chorioretinal lesions. None reactivated between 1991-2005. Conclusions: Chorioretinal lesions consistent with quiescent ocular toxoplasmosis occur in mothers of children with congenital toxoplasmosis in the United States.

Progression of diabetic retinopathy correlated with muscle perfusion disturbances of the lower limbs, with clinically important diagnostic recommendations.

INTRODUCTION: The objective of this study was to investigate the relationship between microvascular and macrovascular disturbances in patients with type 2 diabetes, as shown by results of ophthalmological examination and by vascular and perfusion examinations of the lower limbs. MATERIAL AND METHODS: A total of 85 patients with type 2 diabetes and an additional cardiovascular risk factor were enrolled in the study. All patients underwent complex ophthalmological examination, including fundus colour photography and fluorescein angiography, and were divided into two groups: group I with signs of diabetic non-proliferative retinopathy (NPDR), and group II with signs of diabetic proliferative retinopathy (P/PDR). After collection of the general medical history and analysis of medical data, patients underwent vascular and muscle perfusion examination of the lower limbs. RESULTS: In the P/PDR group, disturbances of lower-limb perfusion were more frequent than in the NPDR group. Analysis of the blood flow and results of lower-limb muscle perfusion for the two groups showed a significant relationship with the severity of microvascular complications observed in examination of the fundus. CONCLUSIONS: Ophthalmological assessment of the progression of diabetic retinopathy in patients with type 2 diabetes is a reliable indicator of the changes in peripheral vessel systems and perfusion defects in the lower limbs.

Chorioretinal lesions in mothers of children with congenital toxoplasmosis in the National Collaborative Chicago-based, Congenital Toxoplasmosis Study.

AIMS: To determine whether mothers of children with congenital toxoplasmosis have chorioretinal lesions consistent with toxoplasmosis. METHODS: Prospective cohort study. Ophthalmologists in our study have examined 173 children with congenital toxoplasmosis in a hospital outpatient setting. These children were referred to us by their primary care physicians. One hundred and thirty mothers of these children had retina examinations of both eyes at least once. Main outcome measure was lesion(s) consistent with ocular toxoplasmosis. RESULTS: Of 130 mothers examined between 1991-2005, 10 (7.7%, 95% Confidence Interval 3.8%, 13.7%) had chorioretinal lesions which likely represent resolved toxoplasmic chorioretinitis. Most of these were small peripheral chorioretinal lesions. None reactivated between 1991-2005. CONCLUSIONS: Chorioretinal lesions consistent with quiescent ocular toxoplasmosis occur in mothers of children with congenital toxoplasmosis in the United States.

Quantitative thermographic analysis of viscoelastic substances in an experimental study in rabbits.

PURPOSE: To measure the temperature parameters on the corneal surface during the delivery of standardized ultrasound energy assisted with ophthalmic viscosurgical devices (OVDs) or different temperatures of irrigating solutions in an experimental animal model. SETTING: Department of Ophthalmology and Visual Rehabilitation, Medical University of Lodz, and Central Institute for Labor Protection, National Research Institute, Warsaw, Poland. METHODS: Thirty rabbits (60 eyes) were randomly divided into 6 groups in which different OVD or balanced salt solutions (BSS) were used: group 1: Viscoat (sodium hyaluronate 3%-chondroitin sulfate); group 2: Provisc (sodium hyaluronate 1%); group 3: soft-shell technique; group 4: Celoftal (hydroxypropyl methylcellulose 2%); group 5: BSS 22 degrees C; and group 6: BSS 4 degrees C. After the nucleus and lens cortex were removed, the anterior chamber was filled with OVD or BSS and a phaco tip was introduced into the pupillary plane and switched on. The same phaco tip parameters were used in all groups. For thermographic measurements (ie, maximal temperature [MT], dynamic rise in temperature [DRT], and time when the maximal level of temperature [TMLT] was achieved), a thermocamera was used. RESULTS: Mean preoperative temperature on the rabbit corneal surface was 22.76 degrees C +/- 1.48 degrees C (SD). Working with a phaco tip increased the temperature in each group. A significantly higher MT was observed in group 5 (27.85 degrees C +/- 0.52 degrees C), followed by group 2 (27.75 degrees C +/- 0.54 degrees C), group 3 (27.74 degrees C +/- 0.46 degrees C), and group 4 (27.25 degrees C +/- 0.60 degrees C), than in group 6 (26.81 degrees C +/- 0.34 degrees C) and group 1 (26.52 degrees C +/- 0.48 degrees C) (P<.05). Significantly higher values of DRT and shorter TMLT values were observed in group 5 (1.16 degrees C/s +/- 0.42 degrees C/s, 4 seconds) and group 6 (0.91 degrees C/s +/- 0.13 degrees C/s, 5 seconds) than in groups 2, 3, 1, and 4 (0.09 degrees C/s +/- 0.07 degrees C/s, 30 seconds; 0.08 degrees C/s +/- 0.04 degrees C/s, 40 seconds; 0.07 degrees C/s +/- 0.03 degrees C/s, 45 seconds; 0.06 degrees C/s +/- 0.02 degrees C/s, 50 seconds, respectively) (P<.0001). CONCLUSIONS: Currently used OVDs potentially offer different levels of protection against the increase in temperature that occurs during phacoemulsification. Therefore, the surgeon should consider this aspect when choosing an OVD, particularly in difficult cases (ie, hard nucleus, shallow anterior chamber, endothelial abnormalities).

Laboratory model of tissue adhesive (2-octyl cyanoacrylate) in sealing clear corneal cataract wounds.

PURPOSE: To determine the efficacy of a tissue adhesive (2-octyl cyanoacrylate with parabens; Liquid Bandage, Johnson & Johnson, Skillman, New Jersey) in sealing clear corneal cataract wounds. DESIGN: Laboratory investigation. METHODS: Seven human donor globes were prepared for Miyake video microscopy. A 3.0-mm clear corneal incision was created. A transscleral cannula was inserted and connected to a bottle of saline. The bottle height was varied to alter intraocular pressure. Droplets of India ink were placed on the wound. Main outcome measure was any influx of India ink into the anterior chamber as viewed through the Miyake system with intraocular pressure (IOP) fluctuation or with manual pressure. If India ink was present in the eye, it was irrigated out, and the experiment was repeated with IOP fluctuation and manual pressure after the application of 2-octyl cyanoacrylate to the wound. RESULTS: One eye demonstrated the presence of India ink inside the eye on IOP reduction to <5 mm Hg. Three eyes demonstrated the presence of India ink inside the eye with manual pressure. Three eyes did not leak with manual pressure or IOP variation. All seven eyes without glue leaked with exaggerated manual pressure at the wound edge. Of the seven eyes with tissue adhesive, none demonstrated influx of India ink with IOP variation or manual wound manipulation. CONCLUSIONS: Our laboratory model demonstrates that 2-octyl cyanoacrylate prevents the influx of ocular surface fluid independent of IOP and manual wound manipulation. Further investigations in clinical models are necessary to determine the future use of this adhesive barrier substance.

Liquid bandage (2-octyl cyanoacrylate) as a temporary wound barrier in clear corneal cataract surgery.

PURPOSE: To determine the feasibility and side effect profile of 2-octyl cyanoacrylate with parabens (Liquid Bandage) as an adjunct wound sealant and barrier against the inflow of ocular surface fluid after clear corneal cataract surgery. DESIGN: Prospective interventional case series. PARTICIPANTS: Fifty-one eyes of 51 patients undergoing clear corneal cataract surgery. METHODS: Fifty-one eyes of 51 patients who underwent cataract surgery by one surgeon (RSK) were enrolled. A 2.75-mm clear corneal, triplanar, temporal incision was used in each case, followed by routine phacoemulsification. At the conclusion of each case, the wound was dried with a cellulose sponge. A modified microsponge with 1 to 2 drops of 2-octyl cyanoacrylate with parabens was then applied in a smooth layer to the wound. All wounds were rechecked for leakage with a cellulose sponge applied at the wound lip. The following criteria were evaluated on the first 2 postoperative visits: (1) visual acuity; (2) patient complaints; (3) wound integrity; (4) presence of tissue adhesive; and (5) any adverse events, including abnormal increase in local tissue reaction to the adhesive. MAIN OUTCOME MEASURES: Side effect profile and clinical course of 2-octyl cyanoacrylate with parabens applied to clear corneal wounds. RESULTS: All 51 eyes demonstrated intraoperative watertight wound closure after the application of 2-octyl cyanoacrylate with parabens. Forty-five eyes (88%) had tissue adhesive still completely covering the wound on postoperative day 1. Two eyes (4%) had tissue adhesive over portions of their wound, and 4 eyes (8%) had no adhesive noted on their wound. All wounds were watertight on all postoperative visits. Thirty-one of 51 patients (61%) complained of mild transient foreign body sensation on postoperative day 1. Twenty-six patients (51%) had trace diffuse bulbar conjunctival hyperemia. Five patients had trace focal conjunctival hyperemia adjacent to the wound. Nine patients (18%) had remnants of the adhesive remaining on the second postoperative visit. CONCLUSIONS: Our study demonstrates the ease of use and applicability and low side effect profile of 2-octyl cyanoacrylate with parabens as a temporary wound barrier in clear corneal cataract surgery.