Traumatic wound dehiscence after deep anterior lamellar keratoplasty.

We report the case of a 12-year-old boy with severe keratoconus who had uneventful deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in the left eye for severe loss of best spectacle-corrected visual acuity and contact lens intolerance. Two weeks after surgery, the patient experienced accidental blunt trauma to the operative eye and developed a traumatic 180-degree superior wound dehiscence of the lamellar graft without perforation into the anterior chamber. The DALK technique provided adequate tectonic support to prevent a ruptured globe throughout the traumatic event in contrast to penetrating keratoplasty, which can lead to devastating vision damage after blunt trauma. The traumatic wound dehiscence was repaired without entry into the anterior chamber, and the patient had a successful, quick recovery in visual acuity with no permanent damage to the eye.

Identification of unknown intraocular material after cataract surgery: evaluation of a potential cause of toxic anterior segment syndrome.

PURPOSE: To describe and identify unknown opaque material between the optic of an AR40 intraocular lens (IOL) injected with the Emerald Series implantation system (both AMO, Inc.) and the posterior capsule at the conclusion of routine phacoemulsification to prevent an outbreak of toxic anterior segment syndrome (TASS). SETTING: Ambulatory care center operating room, University of North Carolina Hospitals and Department of Ophthalmology, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina, USA. METHODS: After coaxial phacoemulsification in multiple patients, opaque material was present between the optic of a posterior chamber IOL and the posterior capsule. Although there was no TASS, the material was removed from 2 eyes and analyzed with scanning electron microscopy (SEM) and x-ray microanalysis (XRM). Similarly, crystalline lens, Klenzyme (Steris Corp.), Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%), and Provisc (sodium hyaluronate 1.0%) were analyzed. RESULTS: On SEM, the material had an irregular undulating surface similar to that of Provisc. Viscoat and the crystalline lens had smoother surfaces. On XRM, the material contained sodium, chlorine, and calcium, like Viscoat and Provisc, and phosphorous and sulfur, like Viscoat. The material also contained silicone, magnesium, aluminum, titanium, iron, and zinc. Klenzyme had smaller peaks of sodium, chlorine, and calcium and a higher carbon background than the unknown material. CONCLUSIONS: The material was likely ophthalmic viscosurgical device that was chemically and structurally altered by the cleaning and sterilization process. The silicone and metallic elements were probably from the Emerald Series implantation system as the disposable cartridge is coated with silicone and the reusable injector is metal.

Determining factors for corneal endothelial cell loss by using bimanual microincision phacoemulsification and power modulation.

PURPOSE: To determine risk factors for central corneal endothelial cell loss in bimanual microincision cataract surgery by using power modulation. METHODS: Prospective study: 79 eyes (70 subjects) with uncomplicated bimanual cataract surgery by using power modulation. Cataracts were graded with the LOCS III system. Specular microscopy was performed preoperatively and postoperatively (5 weeks). Endothelial cell density was calculated (CD; cells/square millimeter). Endothelial cell loss (ECL = preoperative CD - postoperative CD; cells/square millimeter) and proportional loss of cells [PLC = (ECL/preoperative CD) x 100; %)] were calculated. Phacoemulsification time (seconds) and average phacoemulsification power in foot position 3 (%) were recorded. RESULTS: Cataracts were moderate to high density, nuclear color = 3.96, and nuclear opalescence = 3.91. Endothelial cell loss = 196 cells/square millimeter (P < 0.0001). Proportional loss of cells = 8.12% (P < 0.0001). Average phacoemulsification power in foot position 3 was low (8.17%). Increased nuclear color and opalescence were correlated with more phacoemulsification time and higher average phacoemulsification power in foot position 3 (P < 0.0001). Endothelial cell loss and proportional loss of cells, respectively, were affected by increased nuclear color (P < 0.004, P < 0.003) and opalescence (P < 0.006, P < 0.004) but were not affected by phacoemulsification time. Average phacoemulsification power in foot position 3 had a mild effect on endothelial cell loss and proportional loss of cells (P = 0.02, P = 0.02). CONCLUSIONS: Despite the need for longer phacoemulsification time and increased power to emulsify denser cataracts, the amount of endothelial cell loss was only mildly affected by the average phacoemulsification power in foot position 3 and unaffected by total phacoemulsification time, showing that bimanual phacoemulsification with power modulation is an efficient and effective technique for performing cataract surgery.

Alterations in central neuropeptide expression, release, and receptor binding in rats bred for high anxiety: critical role of vasopressin.

To model aspects of trait anxiety/depression, Wistar rats were bred for extremes in either hyper (HAB)- or hypo(LAB)-anxiety as measured on the elevated plus-maze and in a variety of additional behavioral tests. Similar to psychiatric patients, HAB rats prefer passive stress-coping strategies, indicative of depression-like behavior, show hyper-reactivity of the hypothalamo-pituitary-adrenal axis, and a pathological response to the dexamethasone/corticotropin-releasing hormone (CRH) challenge test. Here we tested central mRNA expression, release patterns, and receptor binding of neuropeptides critically involved in the regulation of both anxiety-related behavior and the HPA axis. Thus, CRH, arginine-8-vasopressin (AVP), and oxytocin (OXT) were studied in brains of HAB and LAB males both under basal conditions and after exposure to a mild emotional stressor. In HAB rats, CRH mRNA was decreased in the bed nucleus of the stria terminalis only. While no significant difference in CRH1-receptor binding was found in any brain area, CRH2-receptor binding was elevated in the hypothalamic paraventricular nucleus (PVN), the ventromedial hypothalamus, and the central amygdala of HABs compared to LABs. AVP, but not OXT, mRNA expression as well as release of the neuropeptide, were higher in the PVN of HABs, whereas AVP V1a-receptor binding failed to show significant differences in any brain region studied. Remarkably, intra-PVN treatment of HABs with the AVP V1-receptor antagonist d (CH(2))(5) Tyr (Me) AVP resulted in a decrease in anxiety/depression-related behavior. The elevated expression and release of AVP within the PVN of HAB rats together with the behavioral effects of the AVP V1-receptor antagonist suggest a critical involvement of this neuropeptide in neuroendocrine and behavioral phenomena associated with trait anxiety/depression.

Semicarbazide-sensitive amine oxidase in aortic smooth muscle cells mediates synthesis of a methylglyoxal-AGE: implications for vascular complications in diabetes.

Semicarbazide-sensitive amine oxidase (SSAO) catalyzes formation of methylglyoxal (MG) from aminoacetone; MG then reacts with proteins to form advanced glycation end products or AGEs. Because of its potential to generate MG, SSAO may contribute to AGE-associated vascular complications of aging and diabetes. We developed a method to measure SSAO activity in bovine aortic smooth muscle cells (BASMC) based on the oxidation of 2',7'-dichlorofluorescin by hydrogen peroxide and horseradish peroxidase. The SSAO activity was completely inhibited by 10 mM semicarbazide. Argpyrimidine is a readily detectable fluorescent product of the reaction between MG and arginine. Cell lysates incubated with aminoacetone formed argpyrimidine in a reaction that was inhibited by 20 mM semicarbazide. Immunostaining of tissue sections showed that aminoacetone-treated rats (normal as well as diabetic) formed more argpyrimidine in aortic smooth muscle than untreated controls. We believe that SSAO can enhance AGE synthesis in the macrovasculature of diabetic individuals by production of MG.