Mini-incision cataract surgery and toric lens implantation for the reduction of high myopic astigmatism in patients with pellucid marginal degeneration.

PURPOSE: To evaluate the clinical outcomes, safety, and efficacy of cataract surgery with the implantation of a toric intraocular lens (IOL) in eyes with stable pellucid marginal degeneration (PMD). METHODS: Eleven eyes (eight patients) diagnosed as stable PMD and cataract underwent mini-incision 2.2 mm cataract surgery followed by the implantation of hydrophobic toric aspheric IOL (AcrySof IQ Toric IOL, Alcon, Fort Worth, TX, USA). Perioperative variables of interest included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, and corneal topography. Paired samples t-tests were used to analyze preoperative and postoperative visual acuity, astigmatism, and spherical equivalent (SE) parameters. Follow-up was 6 months. RESULTS: The mean CDVA was 0.62±0.26 logMAR preoperatively and 0.07±0.07 logMAR postoperatively. The mean preoperative sphere and cylinder was -3.14±3.58D and -4.84±2.02D, respectively. The mean postoperative manifest refractive sphere and cylinder was -0.30±0.51D and -0.81±1.51D, respectively. There was a significant reduction in refractive astigmatism after toric IOL implantation (P<0.002). The toric IOL axis rotation was <5° in all cases at the final follow-up. CONCLUSIONS: Implantation of hydrophobic toric IOL was a safe and effective surgical procedure to correct mild to moderate stable PMD.

In vivo confocal microscopy in bilateral herpetic keratitis: a case report.

PURPOSE: Bilateral herpetic keratitis is a rare infection of the cornea. Ocular herpes in atopic patients is more often bilateral, with more frequent recurrences. The authors report a case of bilateral herpes simplex virus (HSV) keratitis during the active phase studied by in vivo confocal microscopy. METHODS: A 28-year-old man with 5 years history of unilateral HSV keratitis and atopic dermatitis was referred to the authors for a clinical and diagnostic evaluation.RESULTS. The corneas showed the typical features of dendritic HSV keratitis in both eyes. Examination by in vivo confocal microscopy demonstrated similar lesions in both eyes: a distortion of the superficial and basal epithelium and the presence of irregular hyperreflective structures and dendritic particles near the epithelial cells. The subbasal nerve plexus presented a tortuous appearance with hyperreflective areas and beadlike formations along the fibers. After a week of antiviral treatment, in vivo confocal microscopy examination demonstrated an irregular epithelium with highly reflective deposits and reflective areas. A reduction of nerve fiber bundles with a large number of beadlike formations and abnormal tortuosity was also noted. CONCLUSIONS: In vivo confocal microscopy enables a noninvasive evaluation of the ocular surface at a high magnification level. It could be useful for the early and differential diagnosis of corneal infections and when HSV keratitis recurrence is suspected.

Air-guided manual deep anterior lamellar keratoplasty: long-term results and confocal microscopic findings.

PURPOSE: To evaluate the long-term results of air-guided manual deep anterior lamellar keratoplasty (DALK) and to perform confocal microscopy on postoperative DALK corneas. METHODS: Seven postoperative consecutive DALK corneas were evaluated 1 year after suture removal. All patients underwent a complete ophthalmologic examination evaluating visual acuity, astigmatism, corneal thickness, and endothelial cell count. Confocal microscopy was performed to examine the corneas of the seven eyes and to obtain the measured interface depth. RESULTS: Eighteen months after surgery, the mean postoperative uncorrected visual acuity was 20/38 and the mean best-corrected visual acuity was 20/23. Postoperative mean value of residual recipient stroma thickness was 65.57 microm +/- 28.74. CONCLUSIONS: Maximum depth DALK can lead to significant advantages for quality of vision when compared to other types of anterior lamellar keratoplasty. Still, it remains a challenging procedure. These results show that a deep dissection without baring Descemet membrane makes good visual results possible, preventing corneal perforation and conversion to penetrating graft.

Unilateral corneal endothelial dystrophy and anterior keratoconus.

PURPOSE: To describe a case of keratoconus and Fuchs' corneal endothelial dystrophy in the left eye with no corneal disease in the right eye. METHODS: A 64-year-old woman presented with visual impairment in her left eye; computer-assisted topographic analysis and specular microscopy were performed in both eyes and left cornea was histopathologically examined. RESULTS: Keratoconus was diagnosed by slit-lamp examination, keratometry, and computer-assisted topographic analysis. Corneal endothelial dystrophy was diagnosed on the basis of clinical examination and specular microscopy. Histopathologic examination revealed a stromal degeneration typical of keratoconus and a non-guttae form of endothelial dystrophy. CONCLUSIONS: This is a rare case of unilateral corneal endothelial dystrophy and keratoconus.

Keratoconus associated with corneal macular dystrophy: in vivo confocal microscopic evaluation.

PURPOSE: The authors present a case, studied through in vivo confocal microscopy, of concomitant keratoconus and macular corneal dystrophy (MCD). METHODS: A 29-year-old man underwent a penetrating keratoplasty in the right eye in May 2005. Confocal microscopy was performed to examine the cornea of the right eye. RESULTS: A diagnosis of concomitant keratoconus and MCD was suspected, due to the simultaneous findings of corneal ectasia and stromal opacities. CONCLUSIONS: In this case, using in vivo confocal microscopy, morphologic changes were detected in many corneal layers and compared with the histopathologic findings. The morphologic alterations were found mainly in the area of the cornea apex.

Retinocytoma associated with calcified vitreous deposits.

PURPOSE: To report a case of bilateral retinocytoma associated with calcified vitreous deposits. METHODS: Case report. RESULTS: On routine examination, a 35-year-old asymptomatic father of a child with bilateral retinoblastoma presented bilateral retinocytoma associated with vitreous calcifications, in the vicinity of the retinocytoma in his left eye. Fundus photographic documentation and fluorescein angiography were performed. The patient has been followed up for 10 years. CONCLUSIONS: The lesions in both eyes have remained stable without signs of growth or malignant transformation. Calcified vitreous deposits are a recently described feature of retinocytoma in addition to the three classic features: translucent retinal mass, retinal pigment epithelial alteration, and calcification.

Public health and complex emergencies: new issues, new conditions.

Public health practice in complex emergencies has become increasingly sophisticated and well informed over the course of the past quarter century. Humanitarian relief organizations have learned many lessons in the areas of food, water and sanitation, shelter, and primary health. However, closer scrutiny from the media and funding agencies, together with changing conditions and an increasingly insecure environment, will require that changes be made. First and foremost, nongovernmental organizations must recognize that an increasing proportion of morbidity and mortality is the consequence of widespread human rights abuses. These organizations should become more familiar with international human rights and humanitarian law, and their personnel should receive clear guidance as to how to recognize and report violations. At the same time, nongovernmental organizations will have to work more closely with military forces that have a very different organizational culture. In addition, as emergencies become more complex, nongovernmental organizations should do more to attract and retain seasoned professionals. Finally, advances in both technical and operational areas will occur only through carefully designed and implemented research.

Antibacterial activity in Actinidia chinensis, Feijoa sellowiana and Aberia caffra.

The antibacterial activity of extracts from various parts of plants (leaves, fruits and stems) was studied in Actinidia chinensis, Feijoa sellowiana and Aberia caffra. These are tropical plants used for food. The fruits (subdivided into skin, pulp and seeds), leaves and stems were separately extracted and tested, in triplicate, against eight Gram positive and Gram negative bacterial strains. All the extracts, except from the leaves of A. caffra, showed activity against all the strains employed. Inhibition of bacterial growth was tested against Na-cefotaxime, benzyl penicillin and tetracycline. The antibiotic activity of fruit resides essentially in the seeds. The antibacterial activity of extracts from vegetative plant parts was generally less active that from fruit extracts. The minimum inhibiting concentration (MIC) and minimum bactericidal concentration (MBC) were determined for all the extracts and showed exclusively bacteriostatic activity.

A quantitative densitometric determination of heroin and cocaine samples by high-performance thin-layer chromatography.

The traditional thin-layer chromatography (TLC) is a sensitive technique frequently used in chemical analysis for semiquantitative determinations. In the last years a high-performance thin-layer chromatography system (HPTLC) has been developed. It assures quantitative determinations with direct densitometric measurements of chromatographic spots in situ on the plate. Here, we wish to report a method for the drug determination in street samples, that employs a CAMAG TLC/HPTLC Scanner Photodensitometer and a CAMAG LINOMAT III for sample application. Samples of illicit drug traffic (50 samples of street heroin and 30 samples of street cocaine) are tested and the gas-liquid chromatography (GLC) and HPTLC determinations are compared. The HPTLC method has proven to be sensitive, precise and accurate for quantitative determinations of drugs in street samples. Furthermore this method may be useful in forensic chemistry to show a "fingerprint" of each sample.