Survival of the fittest: phacoemulsification outcomes in four corneal transplants by Dr Ramon Castroviejo.

AIM: To evaluate and report the outcomes following phacoemulsification on four eyes, 45 years or more after corneal transplantation. METHODS: A retrospective case series of four eyes in three patients (P1, P2, P3), undergoing phacoemulsification at least 45 years after corneal transplantation by Dr Ramon Castroviejo. Corneal graft survival outcome measures included central corneal thickness (CCT), best-corrected visual acuity (BCVA), corneal clarity and endothelial cell count (ECC). RESULTS: Phacoemulsification was successfully completed in all four cases with no instances of graft failure during the postoperative follow-up period, which ranged from 17 months to 76 months. At the conclusion of the follow-up period, all four grafts remained clear, and BCVA remained better than or similar to preoperative values. Long-term follow-up revealed no meaningful changes in CCT after phacoemulsification. All but one case experienced a decrease in ECC, with ECC values in the four cases ranging from 538 cells/mm2 to 1436 cells/mm2 at the conclusion of postoperative follow-up. CONCLUSION: Limited data have been published on the long-term survival of corneal grafts after intraocular surgery, especially for extremely 'mature' corneal transplants. This case series demonstrates that with appropriate preoperative, intraoperative and postoperative measures, successful phacoemulsification can be performed in these cases with excellent long-term results.

Relationship Of Lipids, C-Reactive Protein And Sialic Acid In The Healthy Individuals.

BACKGROUND: Raised levels of cholesterol and triglycerides are major risk factors for atherosclerosis, which can lead to coronary heart disease. Both the CRP and Sialic Acid levels are elevated in response to acute as well as chronic inflammatory conditions. This study was conducted to determine the serum lipid profile, CRP and Sialic Acid levels and their relationship with each other in healthy individuals. METHODS: This was a cross-sectional study performed by the Department of Biochemistry, Institute of Basic Medical Sciences (IBMS), Khyber Medical University (KMU) Peshawar. Two hundred healthy subjects in the age group of 18-50 years of either gender was recruited through consecutive sampling. Blood sampling were taken from all the participants and analysed each for serum lipid profile, CRP and Sialic Acid levels through standardized methods. RESULTS: A total of 200 individuals were included, 53.5% being male. Mean age was 33.39±9.76 years. Mean height was 167.86±10.8 cm. Mean weight was 66.87±11.39kg. Mean Hip-Waist ratio was 0.93±0.16 whereas mean BMI was 24.12±3.65. The simultaneous raised levels of serum lipids, CRP and Sialic Acid were observed more commonly in females as compared to males. CRP and Sialic Acid has got statistically significant correlation with HDL. Sialic Acid had statistically significant correlation with triglycerides in the study population with a significant p-value (<0.05), while having a non-significant correlation with total cholesterol and LDL. CRP had got significant correlation with total cholesterol and LDL and non-significant correlation with triglycerides. CONCLUSIONS: The study showed that serum CRP and Sialic Acid had a significant negative correlation with serum HDL. A significant positive correlation was found between serum Sialic Acid and triglycerides. CRP and Sialic Acid though expensive but are useful predictors of atherosclerotic disease.

Serum Apo A-1 and Its Role as a Biomarker of Coronary Artery Disease.

OBJECTIVES: To evaluate the role of apolipoprotein(Apo A-1) as a biomarker of coronary artery disease (CAD) and its comparison with the traditional marker high-density lipoprotein (HDL). METHODOLOGY: One hundred patients proven to have coronary artery disease by angiography were recruited and their serum biomarkers were compared with 100 normal individuals adjusted for age and sex. RESULT: The mean +/-standard deviation (SD) value of plasma Apo A-1 levels in the normal individuals were observed to be 207.42 +/- 41.35 (mg/dL) against 90.69 +/- 20.77 (mg/dL) in the cardiac patients. On the other hand the serum HDL levels were 52.93 +/-33.58 (mg/dL) in the normal individuals and 37.86 +/- 23.19 (mg/dL) in the cardiac patients. Both of these differences were statistically significant (p < 0.001). For Apo A-1, a large proportion of patients (85%) were found to be in the abnormal range when compared to the control group in which only 7% had an abnormal value. For HDL, a majority (70%) of the cardiac patients had abnormal values while 40% of the normal individuals also had abnormal values. The sensitivity of Apo A-1 for detecting CAD was 85%, while for HDL, it was only 69%. Similarly, the specificity of Apo A-1 for detecting CAD was 93%, while for HDL, it was 60%. When plotted on a receiver operating characteristic (ROC) curve, Apo A-1 had a much larger area under the curve when compared to HDL. CONCLUSION: This study suggests that Apo A-1 may, in fact, be more sensitive than HDL as a predictor of CAD. However, to completely elucidate its role as a biomarker, to set target serum levels and to increase its clinical use, further studies are required.