[Surgery of intravitreous nuclear luxations post-phacoemulsification]. / Chirurgie des luxations nucléaires intravitréennes post-phacoémulsification.

PURPOSE: To evaluate anatomical and functional results after surgery of retained nucleus or nuclear lens fragments into the vitreous cavity after phacoemulsification. METHODS: Files of 46 patients that underwent vitrectomy for posterior retained nuclear fragments between July 92 and June 96 were studied retrospectively. Minimum follow-up was 6 months. Patients having only cortical material were excluded. In 34 cases the nucleus or nuclear fragments were removed posteriorly during a pars plana vitrectomy using either fragmentation with fragmatome (13 cases) or cutting with the vitreotome tip (21 cases). Anterior removal after pars plana vitrectomy was performed in 12 cases. 20 patients were operated on the first week, 12 during the second week and 14 after the second week following phacoemulsification. RESULTS: Forty-one per cent of the patients reached 20/40 or better. 28% had less than 20/200. 8 (17%) patients presented a retinal detachment, 6 a cystoid macular edema, 6 a bullous dystrophy, and 9 an elevated intraocular pressure. At the end of follow-up 89% have been implanted (50% had been implanted at the end of the cataract surgery). We found no correlation between visual acuity and timing of surgery, anterior or posterior site removal of nuclear fragments or lens implantation during phacoemulsification. CONCLUSION: Dislocation of the nucleus into the vitreous cavity is a serious event during phacoemulsification because of its inflammatory and retinal complications. Vitreoretinal surgery allows good visual recovery in about half of the patients. Technical handling depends primarily on the nucleus density. An IOL may be placed at the end of phacoemulsification if the nucleus is not too hard and if the anterior segment has been cleaned carefully.

Sex education and family planning services for young adults: alternative urban strategies in Mexico.

In Mexico, youth face difficulties in obtaining reliable information on sex education and family planning through existing community programs. Two alternative strategies to provide these services are being tested in poor urban areas of Monterrey. In one experimental area, Integrated Youth Centers were established, which provide sex education and family planning services as well as counseling, academic tutoring, and recreational activities. In another area, trained young adults and community counselors work through informal networks to provide sex education and family planning information. Both utilization and the cost of these services are examined in the context of plans for expanding coverage in Mexico-U.S. border areas.

PIP: In Mexico, youth face difficulties in obtaining reliable information on sex education and family planning through existing community programs. 2 alternative strategies to provide these services are being tested in poor urban areas of Monterrey. In 1 experimental area, Integrated Youth Centers (IYC) were established which provide sex education and family planning services as well as counseling, academic tutoring, and recreational activities. In another area, trained young adults and community counselors work through informal networks to privide sex education and family planning information. Both utilization and the cost of these services are examined in the context of plans for expanding coverage in Mexico-US border areas. This project has demonstrated that it is feasible to provide sex education and family planning services to young adults in a variety of formats. In terms of cost-effectiveness, these results suggest that the development of an IYC is neither the most effective nor least expensive alternative available for providing these services. The Community Youth Program has been much more effective in reaching young adults, particularly single males, at less than 1/3 of the cost of operating an IYC. Another important finding is that both youth programs seem to reach a youger, unmarried group not previously served by other programs.