bluuebunny/crossref_metadata_2025 huggingface dataset:
New method of abdominoplasty for morbidly obese patients
Authors: Ollapallil Jacob , Koong David , Panchacharavel Gowrinanthanan , Butcher Charles , Yapo Benjamin
Published: December 2004

Introduction:  We report two cases of morbidly obese patients with huge infected abdominal aprons who underwent apronectomies at Alice Springs Hospital, Northern Territory, Australia. We describe a novel technique which to date has not been described in the available literature. Patients afflicted by morbid obesity with large aprons can be incapacitated by immobility as well as suffer from recurrent infections. Apronectomy in this situation can be difficult because of the heavy weight of the apron.

Method:  This technique involves the use of a small crane and large orthopaedic K‐nails. Two K‐nails were inserted into the apron and attached to a small crane. This facilitated the elevation and manipulation of the apron during surgical dissection. The abdominal tissue removed from the female and male weighed 30 kg and 64 kg, respectively. The wounds were closed primarily and drained by three large bore suction drains.

Results:  The female patient had a largely uneventful postoperative course with a minor wound infection that resolved with conservative treatment. The other patient required a more protracted course of antibiotics for his more severe infection. Mobility was markedly improved in both individuals.

Conclusion:  This novel technique can be used successfully for severely morbidly obese individuals and can significantly reduce the surgeon's and assistants’ difficulty in manipulating and handling a heavy apron during dissection.
A Comparative Evaluation and Prognosis of Asia Pacific Bilateral and Regional Trade Arrangements
Authors: Low Linda
Published: December 2004

This paper provides an evaluation of the growing regional and bilateral trade arrangements in Asia and discusses some plausible scenarios for Asian regionalism. Changes in international relations, information communications technology, the knowledge‐based economy and deregulation have altered trade modalities in the international political economy. The ‘new regionalism’ activities in Asia appear to be a response to these international developments and to be complementary to WTO‐managed trade liberalisation.
Microfinance in the Asia Pacific
Authors: Donaghue Kieran
Published: December 2004

The use of financial services as a development tool has taken a variety of forms over the past 25 years—rural credit schemes offering heavily subsidised loans to poor farmers, microfinance organisations providing working capital loans to predominately female micro‐entrepreneurs, and a variety of organisations offering a range of financial services (credit, savings and insurance) to help poor households increase incomes and reduce their vulnerability to income fluctuations. Microfinance providers in Asia and Latin America have been world leaders, and the demonstration effect of their successes has helped to build substantial microfinance industries in countries such as Indonesia, Bangladesh and Bolivia. Africa has fewer well‐known programs but some notable performers and growing microfinance sectors nonetheless; while regions such as the South Pacific have few if any microfinance successes. This paper highlights some key themes in the development of microfinance, with particular reference to the Asia Pacific region.
Legal Infrastructure and Governance Reform in Post‐Crisis Asia: The case of Indonesia
Authors: Lindsey Tim
Published: December 2004

This article reflects on problems encountered in implementing legal infrastructure reform in the light of current theory and recent, post‐crisis experience in East Asia. Indonesia's experience of radical legal infrastructure reform in the six years since the crisis began has been both extensive and troubled. It is therefore a compelling case study of whether the new paradigm of Post‐Washington Consensus Governance reform has delivered the kind of legal institutional changes that its proponents believe might have prevented the crisis. The article begins with an examination of the Governance paradigm rationale for legal infrastructure reform before surveying the Indonesian experience. It concludes with a critique of Governance reform practices and suggest some ‘lessons learned’ for future legal infrastructure reform, drawn from the Indonesia case study. It argues that the Governance paradigm promotes overly simplistic approaches to the complex and political project of legal infrastructure reform in developing states.
PEG‐Hemoglobin as a Resuscitation Solution in the Treatment of Hypovolemic Shock in the Anesthetized Rat
Authors: Conover Charles D. , Linberg Rita , Lejeune Laura , Nagy Melissa , Shum Kwok L.
Published: December 2004

Abstract: This study was designed to determine the advantages of using the hemoglobin‐based oxygen carrier, polyethylene glycol conjugated bovine hemoglobin (PEG‐Hb), as an additive to Ringer's lactate solution (RLS) for the treatment of acute hemorrhage in anesthetized female rats. Different compositions of PEG‐Hb and RLS were administered intravenously in a paradigm that provided 30 ml/kg of resuscitation fluid following an episode of 15 min of hypotension. Hypotension was achieved by the removal of blood (1 ml/min) from the femoral vein until the mean arterial pressure was lowered to or below 50 mmHg and subsequently maintained until resuscitation. Short‐term cardiovascular assessment showed that resuscitation fluids containing PEG‐Hb resulted in higher mean arterial pressure, aortic blood flow, renal blood flow, and less dramatic shifts in arterial base excess and respiratory blood gases than plain RLS. The long‐term survival experiment showed lower lactate dehydrogenase, alkaline phosphatase, and serum glutamic pyruvic transaminase levels in most groups resuscitated with solutions containing PEG‐Hb, but no differences in survival (100%) were observed. The data suggest that the addition of PEG‐Hb to RLS improves its resuscitative effects. Specifically, a solution of 50% RLS:50% PEG‐Hb appeared to have the most favorable cardiovascular and metabolic effects in this anesthetized rat hypovolemic shock resuscitation model. Presumably, the improved effects seen with the addition of PEG‐Hb were due to its innate plasma expansion and oxygen‐delivery capabilities.
Initial Experience with a New Right Ventricular Support Device for Beating Heart Surgery
Authors: Kuhn‐Régnier Ferdinand , Geissler Hans Joachim , Lercher Aurelia , Mehlhorn Uwe , Mehler Oliver , Fischer Jürgen Harmut , De Vivie Ernst Rainer
Published: December 2004

Abstract:  Objective: Device supported beating heart surgery has been advocated to extend patient selection criteria for off‐pump surgery. This article reports the initial experimental and clinical results with a novel paracardial right ventricular support device. Methods: Preclinical experiments were performed in two pigs. Ten elective patients with triple vessel disease were subjected to beating heart coronary artery bypass grafting surgery during right ventricular support by the paracardial device. Measurements included intraoperative hemodynamics during cardiac tilting, perioperative left ventricular ejection fraction (LVEF), hemolysis parameters, mortality and major morbidity events. Results: A mean of 3.2 ± 0.2 distal anastomoses per patient were performed. Mean arterial pressure and central venous oxygen saturation remained stable during cardiac tilting. Perioperative LVEF did not vary significantly. Sixty‐day mortality and postoperative infarction rate were 0%. Functional Canadian Cardiovascular Society class at 6 days after surgery was 1.2 ± 0.1 vs. 3.3 ± 0.2 pre‐operatively. Conclusion: In this initial clinical experience, application of the novel paracardial right ventricular support device proved  to be safe and efficient.
Articular Cartilage Repair Using Tissue Engineering Technique—Novel Approach with Minimally Invasive Procedure
Authors: Ochi Mitsuo , Adachi Nobuo , Nobuto Hiroo , Yanada Shinobu , Ito Yohei , Agung Muhammad
Published: December 2004

Abstract:  Articular cartilage has very limited potential to spontaneously heal, because it lacks vessels and is isolated from systemic regulation. Although there have been many attempts to treat articular cartilage defects, such as drilling, microfracture techniques, soft tissue grafts or osteochondral grafts, no treatment has managed to repair the defects with long‐lasting hyaline cartilage. Recently, a regenerative medicine using a tissue engineering technique for cartilage repair has been given much attention in the orthopedic field. In 1994, Brittberg et al. introduced a new cell technology in which chondrocytes expanded in monolayer culture were transplanted into the cartilage defect of the knee. As a second generation of chondrocyte transplantation, since 1996 we have been performing transplantation of tissue‐engineered cartilage made ex vivo for the treatment of osteochondral defects of the joints. This signifies a concept shift from cell transplantation to tissue transplantation made ex vivo using tissue engineering techniques. We have reported good clinical results with this surgical treatment. However, extensive basic research is vital to achieve better clinical results with this tissue engineering technique. This article describes our recent research using a minimally invasive tissue engineering technique to promote cartilage regeneration.
Establishment of Banking System for Allogeneic Cultured Dermal Substitute
Authors: Kuroyanagi Yoshimitsu , Kubo Kentaro , Matsui Hiromich , Kim Hyun Jung , Numari Shinichiro , Mabuchi Yho , Kagawa Shizuko
Published: December 2004

Abstract:   Allogeneic cultured dermal substitute (CDS) was prepared by culturing fibroblasts on a two‐layered spongy matrix of hyaluronic acid (HA) and atelo‐collagen (Col). Allogeneic CDS can be cryopreserved and transported to other hospitals in a frozen state. Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), hepatocyte growth factor (HGF), platelet derived growth factor (PDGF)‐AA, transforming growth factor (TGF)‐β1, keratinocytes growth factor (KGF), interleukin (IL)‐6 and IL‐8 were contained in the culture medium which was used in preparing CDS over a cultivation period of one week (fresh CDS culture medium sample). After thawing a cryopreserved CDS, the CDS was recultured in a culture medium for one week. VEGF, bFGF, HGF, TGF‐β1 and IL‐8 were contained in the culture medium which was used in reculturing CDS for one week (cryopreserved CDS culture medium sample), although some cytokines were detected at a lower level than those before freezing. This finding suggests that the cryopreserved CDS retains its ability to release these cytokines.

Clinical research on allogeneic CDS, which was newly developed at the R & D Center for Artificial Skin of Kitasato University, has been carried out in medical centers across Japan with the support of the Millennium Project of the Ministry of Health, Labor and Welfare. It was demonstrated that the allogeneic CDS functions as an excellent cell therapy for intractable skin ulcers as well as burn injuries. The spongy matrix itself, as well as the cytokines released from the allogeneic CDS, seemed to be beneficial for the treatment of intractable skin defect.
Cultured Autologous Human Cells for Hard Tissue Regeneration: Preparation and Characterization of Mesenchymal Stem Cells from Bone Marrow
Authors: Kotobuki Noriko , Hirose Motohiro , Takakura Yoshinori , Ohgushi Hajime
Published: December 2004

Abstract:  Mesenchymal stem cells (MSCs) are multipotent cells and can be induced in vitro and in vivo to differentiate not only into the variety of mesodermal cells, but into either ectodermal or endodermal cells. This capability indicates the usefulness of MSCs for tissue engineering. Cell surface antigen analyses using various types of CD antibodies demonstrated that adherent fibroblastic cells derived from fresh human bone marrow are mesenchymal types and the cells showed extensive capability for proliferation and/or differentiation. We labeled the adherent cultured marrow cells as MSCs and, significantly, found the MSCs could even proliferate from aged marrow cells. After about sixteen days of culturing, we were able to harvest 100 million MSCs from only 3 ml of fresh human marrow. Moreover, the MSCs could be cryopreserved at −80°C without noticeable loss of viability and capability of osteoblastic differentiation. These results indicate that MSCs hold promise for utilization in hard tissue regeneration.
Osteogenic Differentiation of Human Bone Marrow‐derived Mesenchymal Cells Cultured on Alumina Ceramics
Authors: Kitamura Shigeyuki , Ohgushi Hajime , Hirose Motohiro , Funaoka Hiroyuki , Takakura Yoshinori , Ito Hiromoto
Published: December 2004

Abstract:   Alumina ceramics have excellent mechanical and biocompatible properties, but are bioinert and hence have no bone‐bonding properties. We took a tissue‐engineering approach in an attempt to modify the ceramic surface and so provide an osteogenic/osteoconductive milieu. We obtained human bone marrow mesenchymal cells from four donors and then cultured the cells for two weeks on alumina ceramic in the presence of β‐glycerophosphate, ascorbic acid and dexamethasone. The cells showed extensive alkaline phosphatase staining and mineralization, as evidenced by Alizarin Red S staining and calcein uptake. Biochemical analyses revealed high levels of alkaline phosphatase activity, osteocalcin expression and calcium content. This data indicates the appearance of active osteoblasts that are concomitant with bone matrix formation, i.e., in vitro cultured bone. The cultured bone/alumina composites should prevent the aseptic loosening of all‐alumina ceramic joints or the detachment of implanted alumina ceramics, and thus could have clinical significance in orthopedic reconstructive surgery.
Liver Regeneration Using a Hybrid Artificial Liver Support System
Authors: Mizumoto H. , Funatsu K.
Published: December 2004

Abstract:   We have developed two types of hybrid artificial liver support system (HALSS) that use hepatocyte organoid culture: (1) a PUF‐HALSS comprising an artificial liver module using polyurethane foam (PUF), in which hepatocytes form spheroids in its pores, and maintained liver‐specific functions for at least ten days in vitro; (2) an LLS‐HALSS that uses a liver lobule‐like structure (LLS) module containing hollow fibers with a microregular arrangement in which hepatocytes in the extra‐fiber space of the module form the organoids by centrifugation that maintain liver‐specific functions for at least two months in vitro. In preclinical experiments, a PUF‐HALSS was applied to a pig having liver failure. To evaluate the effect of liver regeneration, a PUF‐ and an LLS‐HALSS were applied to a rat having reversible hepatic failure. Each HALSS was effective in supporting liver function, stabilization of general conditions and recovery from liver failure state. These results indicate that these HALSS may be useful to treat liver failure patients until liver transplantation or until regeneration of the native liver.
Long‐term Transcutaneous Neuromuscular Electrical Stimulation in Patients with Bipolar Sensing Implantable Cardioverter Defibrillators: A Pilot Safety Study
Authors: Crevenna Richard , Wolzt Michael , Fialka‐Moser Veronika , Keilani Mohammad , Nuhr Martin , Paternostro‐Sluga Tatjana , Pacher Richard , Mayr Winfried , Quittan Michael
Published: December 2004

Abstract:  Neuromuscular electrical stimulation (NMES) is an option for increasing thigh muscle strength and endurance capacity in patients with chronic heart failure. Electromagnetic interference (EMI) by the signals with sensing of implantable cardioverter defibrillators (ICDs) is possible. The aim of the present pilot safety study was to test the safety of a long‐term NMES in patients with ICDs. Six patients with subpectoral ICDs were subjected to long‐term NMES of thigh muscles. Four inpatients received NMES to increase muscle strength, and two outpatients performed NMES as a home treatment to increase endurance capacity. During long‐term NMES, all patients together received 14 139 799 biphasic electrical pulses and 412 425 on‐phases without adverse events. ICD function after the stimulation period revealed no abnormalities in any patient. These results indicate that long‐term NMES of thigh muscles seems to be safe in patients with ICDs, providing that an individual risk is excluded before.
The safety and efficacy of unoprostone 0.15% versus brimonidine 0.2%
Authors: Stewart William C. , Stewart Jeanette A. , Day Douglas G. , Jenkins Jessica
Published: December 2004

Purpose:  To compare the efficacy and safety of unoprostone versus brimonidine both given twice daily in ocular hypertensive or primary open‐angle glaucoma subjects.

Methods:  After a 1‐month washout period a baseline diurnal curve was measured every 2 hours from 08 : 00 hours (trough) to 20 : 00 hours in subjects with a trough intraocular pressure (IOP) and the pressure 24 mmHg. Qualified subjects were randomized to either brimonidine or unoprostone. After 6 weeks of treatment the period 1 diurnal curve was performed. Subjects were then switched to the opposite treatment for 6 weeks and the period 2 diurnal curve was performed.

Results:  A total of 33 subjects were included in this study. In the brimonidine‐treated group the trough IOP 20.1 ± 2.8 mmHg was reduced from baseline up to 8 hours after dosing. In the unoprostone‐treated group the trough IOP was 19.5 ± 3.0 mmHg, which was statistically equal to that of brimonidine (p = 0.21), was reduced from baseline for 12 hours after dosing. Brimonidine decreased the IOP statistically more than unoprostone at 10 : 00 and 12 : 00 hours (p < 0.0001 and p = 0.02, respectively), while unoprostone reduced the IOP more than brimonidine at 18 : 00 and 20 : 00 hours (p = 0.002 and p = 0.05, respectively). Safety levels were similar between groups, but unoprostone caused more ocular stinging than brimonidine (p = 0.008).

Conclusion:  This study suggests that twice daily brimonidine demonstrates a statistically greater peak reduction in IOP than unoprostone. However, unoprostone, but not brimonidine, decreased IOP over the complete 12‐hour daytime dosing cycle.
Phototherapeutic keratectomy in Salzmann's nodular degeneration
Authors: Germundsson Johan , Fagerholm Per
Published: December 2004

Purpose:  To describe the outcome in vision and refraction of phototherapeutic keratectomy (PTK) in Salzmann's nodular degeneration (SND).

Methods:  Five eyes of four patients underwent PTK with the objective of restoring an acceptable refractive status and improving visual acuity. This surgical technique aims to make the nodules level with the corneal surface using an excimer laser.

Results:  Best corrected visual acuity (BCVA) improved in all five eyes. Astigmatism was reduced in four eyes and increased somewhat in one. During the observation period one eye suffered a late recurrence that required a penetrating graft.

Conclusion:  Salzmann's nodular degeneration is a rare disease that is sometimes difficult to diagnose as it has some resemblance to other diseases. The aetiology of the disease is unknown. Phototherapeutic keratectomy is a safe and effective mode of treatment. Recurrences occur with time.
Ocular anisometropia and laterality
Authors: Goldschmidt Ernst , Lyhne Niels , Lam Carly S. Y.
Published: December 2004

Purpose:  To study the difference in refraction between right and left eyes (anisometropia) in different age groups, look for evidence of eye laterality (more refractive error in one eye) and compare the size of anisometropia in the myopic and emmetropic ranges.

Methods:  The study was based on children in Hong Kong (examined at the age of 6 years and again at the age of 8.5 years) and their parents (aged 26–60 years).

Results:  In all age groups the difference between right and left eyes in sphere and cylinder was modest, in most cases ≤ 0.25 D. In both children and their parents a tendency towards spherical right eye laterality was found in the myopic individuals (p < 0.05). This was not the case with the cylinder. In the 8.5‐year‐old children and in their parents, the numerical size of spherical anisometropia increased with myopia (p < 0.05 and p < 0.01, respectively). Cylindrical anisometropia did not exhibit such an increase.

Conclusion:  In Hong Kong children and their parents we found a tendency towards more spherical myopia in right eyes (laterality) in myopic cases. The numerical size of spherical anisometropia also increased in myopia in these groups. Cylindrical anisometropia appeared to be independent of spherical ametropia. In most cases right/left differences in both sphere and cylinder were small and our findings justify the use of data from one eye only in publications on refraction.
Fungal endophthalmitis caused by Paecilomyces variotii following cataract surgery: a presumed operating room air‐conditioning system contamination
Authors: Tarkkanen Ahti , Raivio Virpi , Anttila Veli‐Jukka , Tommila Petri , Ralli Reijo , Merenmies Lauri , Immonen Ilkka
Published: December 2004

Purpose:  To report a case of delayed fungal endophthalmitis by Paecilomyces variotii following uncomplicated cataract surgery. To our knowledge this is the first reported case of postoperative endophthalmitis by this species.

Methods:  We report the longterm clinical follow‐up of an 83‐year‐old female who underwent uncomplicated sutureless, small‐incision cataract surgery. She developed recurring uveitis 4 months after surgery. Vitreous tap and finally complete vitrectomy with removal of the capsular bag including the intraocular lens were performed. Fungi were studied by histopathology and culture.

Results:  At histopathological examination, the fungi were found to be closely related with the capsular bag. A few mononuclear inflammatory cells were encountered. At culture, Paecilomyces variotii, a common ubiquitous non‐pathogenic saprophyte, was identified. Despite systemic, intravitreal and topical antifungal therapy after vitrectomy the uveitis recurred several times, but no fungal organisms were isolated from the repeat intraocular specimen. At 18 months postoperatively the subject's visual acuity was finger counting at 2 metres. At the time of surgery the operating room air‐conditioning system was undergoing repairs. Cases of fungal endophthalmitis after contamination from air‐conditioning ventilation systems have been reported before, but none of the cases reported have been caused by P. variotii.

Conclusion:  P. variotii, a non‐pathogenic environmental saprophyte, may be disastrous if introduced into the eye. International recommendations on the environmental control of the operating room air‐conditioning ventilation system should be strictly followed. No intraoperative surgery should be undertaken while the air‐conditioning system is undergoing repairs or service.
Bilateral endogenous bacterial endophthalmitis: a report of four cases
Authors: Christensen Steen Rugaard , Hansen Ann‐Brit Eg , La Cour Morten , Fledelius Hans Callø
Published: December 2004

Purpose:  To present and discuss four cases of bilateral endogenous endophthalmitis.

Methods:  An observational study of four patients aged 55–80 years, seen within a 2‐year period. All had diagnostic and therapeutic vitrectomy. The antibiotic therapy was guided by analyses of cultures of blood and vitreous.

Results:  Blood cultures demonstrated Streptococcus pneumoniae in two patients and Staphylococcus aureus and Morganella morganii, each in one patient. The findings corresponded with culture findings from vitreous material in two patients. The primary foci for the metastatic spread of infection were endocarditis, discitis and a subdural abscess of the lumbar spine, urinary tract infection, and infection of a recent hip alloplasty, respectively, in the four patients. Five eyes became blind, whereas three eyes recovered to visual acuity of 0.25–0.67.

Conclusions:  Endogenous bacterial endophthalmitis usually leads to total loss of vision. The disease is acute and the time span for intervention limited. We believe that an active therapeutic approach including intravitreal antibiotics and vitreoretinal surgery saved three eyes from blindness.
Are cataract and iris atrophy toxic complications of medical treatment of acanthamoeba keratitis?
Authors: Ehlers Niels , Hjortdal Jesper
Published: December 2004

Purpose:  Two cases of acanthamoeba keratitis with almost identical clinical courses developed mature cataract and iris atrophy after prolonged treatment with chlorhexidine 0.02% and propamidine isethionate 0.1%. It is suggested that these complications were caused by the chemicals, rather than resulting from the amoebae‐induced inflammation.

Methods:  Penetrating keratoplasty was performed in both cases when perforation from peripheral ulceration was threatening.

Results and Conclusions:  The immediate results were good. From these two cases it seems possible that there is a maximum level of intensity of the medical treatment and also that surgery should be considered at an earlier stage, before intraocular complications develop.
Sensitivity and specificity of digital retinal images in grading diabetic retinopathy
Authors: Saari Jukka M. , Summanen Paula , Kivelä Tero , Saari K. Matti
Published: December 2004

Purpose:  To assess three novel digital fundus cameras for diabetic retinopathy (DR) screening.

Methods:  Digital colour and red‐free retinal imaging (Topcon TRC 50 IA, Canon CR6−45NM, and MediTell) was used to capture 427 images of 70 diabetes patients and control subjects. The images were graded for DR by three readers in a randomized and masked manner using a modified Early Treatment Diabetic Retinopathy Study classification. The reference standard was based on mydriatic ophthalmoscopy and colour and red‐free images.

Results:  Digital 50 ° red‐free imaging had sensitivity of 97.7%, two‐field 50 ° colour imaging 94.0%, and two‐field 45 ° colour imaging sensitivity of 88.9%. The specificity of these imaging modalities was 98.9−100%, and ungradeable images represented 1.2−1.6%. The hand‐held digital colour videocamera (MediTell) showed a sensitivity of 6.9% and ungradeable images represented 92.3%

Conclusion:  Digital 50 ° red‐free and two‐field 50 ° or 45 ° colour imaging were suitable for DR screening, whereas the hand‐held digital videocamera did not fulfil the needs of DR screening.
Gonioscopic view of the trabeculo‐Descemet's membrane after deep sclerectomy
Authors: Vuori Marja‐Liisa
Published: December 2004

Purpose:  To study the appearance of the trabeculo‐Descemet's membrane (TDM) after deep sclerectomy with collagen implant (DSCI).

Methods:  All patients who underwent a successful DSCI for open‐angle glaucoma were included in a non‐randomized clinical study. Gonioscopy was performed between 6 and 12 months postoperatively in all patients.

Results:  Gonioscopy was performed in 42 eyes of 38 patients after a mean follow‐up time of 8.3 ± 2.5 months after DSCI. The diagnosis was chronic open‐angle glaucoma in 16 eyes and exfoliative glaucoma in 24 eyes. One patient had pigmentary glaucoma and one had normal tension glaucoma. None of the patients were on glaucoma medication postoperatively. Synechias to the TDM were seen in five eyes. Pigment accumulation to the TDM was seen in nine eyes, four of which had capsular glaucoma, three had primary open‐angle glaucoma, one had pigmentary glaucoma and one had normal tension glaucoma. Puncture holes at the TDM were seen in all eight eyes in which Nd:YAG laser goniopuncture had been performed.

Conclusion:  Postoperative changes, which may go unnoticed without routine gonioscopy, occur at the TDM after deep sclerectomy with collagen implant. Pigment accumulates relatively shortly after surgery. Whether or not these changes are progressive remains unknown. Careful follow‐up after deep sclerectomy is necessary and should include routine gonioscopy.
Time‐lapse recordings of human corneal epithelial healing
Authors: Hardarson Thorir , Hanson Charles , Claesson Margareta , Stenevi Ulf
Published: December 2004

Purpose:  The aim of this study was to design an experimental set‐up for the study of human corneal epithelial wound healing in a controlled in vitro situation.

Methods:  A time‐lapse set‐up was used. This allowed for pictures to be captured with a magnification ranging from × 80 to × 1800. Pictures were captured at 1‐min intervals during the observation period, which lasted up to 4 days. Human corneal tissue was obtained from the Eye Bank or from surgery. A small, rounded lesion was produced in the corneal epithelium with a miniature drill. The specimens were placed in a mini‐incubator; the camera focused on the epithelial lesion and continuously observed using the time‐lapse set‐up.

Results:  The healing process of human corneal epithelium could be followed for several days. The initial healing response could be divided into a slow, a rapid and a consolidating phase. The first two phases lasted about 12 hours, and by then, epithelial cells covered the lesion. Depending on the origin of the tissue and the placement of the lesion, variations in the healing response could be seen.

Conclusion:  The time‐lapse technique makes it possible to study epithelial wound healing over time at the cellular level. Data collected in this way can fill the gap between in vivo studies, where, by nature, human wound healing studies are restricted, and cell culture techniques, where cellular responses in many cases differ from the in vivo situation.
Chemokine receptors and early activation markers in acute anterior uveitis
Authors: Sørensen Klitgaard Torben L. , Øgard Carsten , Krogh Erik
Published: December 2004

Purpose:  To study the peripheral expression of chemokine receptors and early activation markers in acute anterior uveitis (AU).

Methods:  The expression of chemokine receptors CCR1, CCR2, CCR3, CCR5 and CXCR3, and activation markers CD25 (IL2R‐α‐chain), CD122 (IL2R‐β‐chain) and CD69 were studied on peripheral blood mononuclear cells using flow cytometry in 10 patients with acute anterior uveitis and in 10 healthy controls.

Results:  We found a highly significant up‐regulation of CCR5 (p < 0.001) on CD4 + T‐cells in the blood of patients with AU compared to in healthy controls. CD69 was significantly higher on both CD4 + and CD8 + T‐cells (p < 0.05 and p < 0.001, respectively). We also found a significantly higher expression of CD25 expressing CD4 + T‐cells in patients with anterior uveitis (p < 0.05). This expression was directly correlated to the severity of disease (ρ = 0.720, p < 0.05).

Conclusion:  Our data show that patients with acute anterior uveitis have a specific systemic immune activation.
Exfoliation syndrome in Estonian patients scheduled for cataract surgery
Authors: Kaljurand Kuldar , Puska Päivi
Published: December 2004

Purpose:  To examine the frequency of exfoliation syndrome (XFS) in Estonian patients scheduled for cataract surgery.

Methods:  A series of 305 patients (mean age 71.5 ± 8.6 years) scheduled for cataract surgery were examined for the presence of exfoliation syndrome, predominant type of lens opacification and intraocular pressure (IOP).

Results:  Exfoliation material was detected in 108 (35.4%) patients, of whom 51 (47.2%) were bilaterally and 57 (52.8%) were unilaterally affected. In the bilaterally phakic patients exfoliation material was detected in 92 (30.2%) patients, of whom 51 (55.4%) were bilaterally and 41 (44.6%) were unilaterally affected. Intraocular pressure was higher in eyes with exfoliation than in eyes without it (19.2 ± 6.5 mmHg and 17.1 ± 3.8 mmHg, respectively; p = 0.006). Nuclear sclerosis predominated in eyes with XFS compared to those without XFS (57.6% and 36.9%, respectively). Cortical (7.6%) and subcapsular (7.6%) cataracts were less common in eyes with XFS than in eyes without XFS (16.9% and 20.2%, respectively). Mature cataract was found in 41.3% of all mixed types of cataracts.

Conclusion:  Exfoliation syndrome is common in Estonian patients. It was detected in 35.4% of the patients scheduled for cataract surgery.
Computerized calculation scheme for toric intraocular lenses
Authors: Langenbucher Achim , Seitz Berthold
Published: December 2004

Background and Purpose:  While a number of intraocular lens (IOL) power prediction formulae are well established for determination of spherical lenses, no common strategy has been published for the computation of toric IOLs. The purpose of this study is to describe a paraxial computing scheme for tracing an axial pencil of rays through the ‘optical system eye’ containing astigmatic refractive surfaces with their axes at random. The capabilities of this computing scheme are demonstrated with clinical examples.

Methods:  Based on a schematic model eye with spherocylindric surfaces, we use two alternative notations for description of vergences or prescriptions: (1) standard notation (refraction in both cardinal meridians and axis), and (2) component notation (spherical equivalent and cylindric component in 0 ° and 45 °. Refractive surfaces are added to the vergence in component notation, whereas the transformation of the vergence through media is performed in the standard notation for both cardinal meridians. For calculation of the toric lens implant, a pencil of rays is traced through the spectacle and the cornea to the estimated lens position as well as backwards from the retina to the estimated lens position. For calculation of residual spectacle refraction, a pencil of rays is traced backwards from the retina through the toric lens implant and the cornea to the spectacle plane.

Results:  In example 1 we calculate a ‘thin toric lens’ for compensation of a corneal astigmatism to achieve a spherical target refraction. In example 2 we compute a ‘thick toric lens’, which has to compensate for an oblique corneal astigmatism and rotate the spectacle cylinder to the against the rule position to enhance near vision. In example 3 we estimate the residual refraction at the corneal plane after implantation of a thick toric lens, when the cylinder of the lens implant is compensating the corneal cylinder in part and the axis of implantation is not fully aligned with the axis of the corneal astigmatism.

Conclusion:  This novel mathematical concept for computation of toric IOLs or prediction of the refractive outcome with a toric implant in place is a straightforward, computer‐based approach, which may substitute for more or less empirical methods of determining toric IOL implants.
Angiotensin‐converting enzyme inhibitors (ACEIs) and age‐related maculopathy (ARM): cross‐sectional findings from the Blue Mountains Eye Study
Authors: Wu Kathy H. C. , Wang Jie Jin , Rochtchina Elena , Foran Suriya , Ng Martin K. C. , Mitchell Paul
Published: December 2004

Purpose:  To assess the relationship between the use of angiotensin‐converting enzyme inhibitors (ACEIs) and prevalence of age‐related maculopathy (ARM).

Methods:  Eligible residents aged ≥ 49 years were first examined in 1992–94 (Cross‐section 1, n = 3654). Of these, 2335 were re‐examined in 1997–99, together with an additional 1174 who became eligible after 1994 (Cross‐section 2, n = 3509). Information regarding ACEI use was obtained and retinal photographs were graded using the Wisconsin ARM Grading System.

Results:  In Cross‐section 1, prevalence rates of late and early stage ARM were 1.3% and 4.3% among current ACEI users, and 2.0% and 4.8% among non‐current users, respectively. In Cross‐section 2, prevalence rates of late and early stage ARM were 2.3% and 11.3% among current ACEI users, and 1.3% and 9.3% among non‐current users, respectively. After adjusting for age, sex and smoking, neither survey found any significant association between ACEI use and prevalence of either late or early ARM.

Conclusions:  No significant cross‐sectional associations were found between ACEI use and ARM prevalence in this population.
The prevalence of retinopathy in an unselected population of type 2 diabetes patients from Århus County, Denmark
Authors: Hove Marianne N. , Kristensen Jette K. , Lauritzen Torsten , Bek Toke
Published: December 2004

Purpose:  To determine the prevalence of diabetic retinopathy and the causes of visual impairment in an unselected population of type 2 diabetes patients, and to describe the risk factors for developing diabetic retinopathy in this population.

Methods:  A total of 10 851 type 2 diabetes patients were identified in the county of Århus. A representative sample of 378 patients underwent a routine ocular examination, including fundus photography. Blood pressure and serum haemoglobin A1c, total cholesterol, high density lipoprotein cholesterol, triglyceride and apolipoprotein a were measured.

Results:  The prevalence of diabetic retinopathy in the type 2 diabetes population was 31.5%. In all, 2.9% had proliferative diabetic retinopathy and 5.3% had clinically significant macular oedema. Of the latter, 8/20 (40%) were newly identified and had not yet been laser‐treated. There was a positive correlation between severity of retinopathy and duration of diabetes, HbA1c, systolic blood pressure and treatment with insulin. None of the patients had social blindness (visual acuity < 0.1), but 15/378 (4.0%) had developed visual impairment (VA < 0.3).

Conclusion:  The prevalence of diabetic retinopathy and visual impairment in this unselected type 2 diabetes population was lower than anticipated from the existing literature, and causes other than diabetic retinopathy contributed significantly to the occurrence of visual loss. A substantial number of the patients with vision‐threatening diabetic maculopathy had not been referred for timely photocoagulation treatment.
Multifocal electroretinography and optical coherence tomography in two patients with solar retinopathy
Authors: Schatz Patrik , Eriksson Urban , Ponjavic Vesna , Andréasson Sten
Published: December 2004

Purpose:  Clinical investigation of central retinal dysfunction in two cases of solar retinopathy.

Methods:  Two patients were examined for best corrected visual acuity (VA), fundus inspection, visual fields, multifocal electroretinography (mfERG) with a stimulus pattern of 241 hexagons and, at follow‐up, also with optical coherence tomography (OCT).

Results:  At the initial examination, mfERG revealed central retinal dysfunction, which had improved by the time of follow‐up. In Case 1, a foveal oedema regressed over time, although VA remained slightly reduced. In Case 2, OCT showed spots of increased reflectivity corresponding to the patient's symptoms.

Conclusion:  Central retinal dysfunction due to solar retinopathy may improve over time. However, structural and functional changes may persist. This report illustrates that mfERG and OCT are useful tools for objective documentation of the pathology in solar retinopathy.
Longterm results in surgical removal of subfoveal choroidal neovascularization in age‐related macular degeneration
Authors: Guthoff Rainer , Schrader Wolfgang
Published: December 2004

Purpose:  This study aimed to analyse visual outcome, surgical complications and recurrence rates 3 years after removal of subretinal choroidal neovascularization (CNV) in patients with age‐related macular degeneration (AMD).

Methods:  The study involved a retrospective analysis of 50 eyes of 50 patients who underwent surgical removal of CNV in AMD between February 1996 and June 1998. The minimum follow‐up period was 36 months. Improvement or worsening of visual acuity (VA) was defined as a change of more than two lines.

Results:  The mean reduction in VA was 2.2 ± 6.9 lines. Visual acuity improved in 12 eyes, remained stable in 16 eyes and worsened in 22 eyes. Recurrence of CNV occurred in three eyes.

Conclusion:  After surgical excision of age‐related subfoveal CNV, VA improved or stabilized in a large group of patients. Considering the development of VA and the low recurrence rate, surgical treatment seems to be beneficial compared to the natural course of CNV over a longterm follow‐up of more than 3 years.
Longterm follow‐up of patients with multifocal choroiditis and panuveitis
Authors: Vianna Raul N. G. , Özdal Pinar Ç. , Filho João Pessoa Souza , Ventura Marcelo Palis , Saraiva Vinicius S. , Deschênes Jean
Published: December 2004

Purpose:  To report the visual prognosis and longterm complications in patients with multifocal choroiditis and panuveitis (MCP).

Methods:  A retrospective study was performed with patients who met inclusion criteria for MCP at the Uveitis Clinic, Royal Victoria Hospital, McGill University, Montreal, Canada. Information collected included duration of follow‐up, visual acuity (VA) measured at each clinical visit, ocular and systemic treatment and ocular complications observed during follow‐up.

Results:  Nineteen patients (37 eyes) with MCP with a mean follow‐up of 76.9 months were studied. Kaplan−Meier survival analysis showed a decrease in the proportion of patients with a final VA ≥ 20/40 over time. Cystoid macular oedema was seen in 29.7% of the eyes and was the most frequent macular abnormality observed in our group. On the other hand, choroidal neovascularization was detected in only six (16.2%) of the eyes, but was related to VA < 20/200 in four of these eyes. Glaucoma was detected in 10.8% of the eyes. Cataract (posterior subcapsular and/or nuclear) was the most common longterm complication, occurring in 40% of affected eyes. Cataract surgery improved the VA in 83.3% of these eyes.

Conclusion:  The visual acuity of patients with MCP decreases with time. Visual loss can occur from complications following the inflammation itself and/or iatrogenic induced by the chronic use of corticosteroids.
Vitrectomy in vitreomacular traction syndrome evaluated by ocular coherence tomography (OCT) retinal mapping
Authors: Larsson Jörgen
Published: December 2004

Purpose:  To evaluate vitreomacular traction syndrome with ocular coherence tomography (OCT) retinal mapping before and after vitrectomy.

Methods:  A prospective study of 11 eyes with vitreomacular traction syndrome was carried out. Ocular coherence tomography retinal mapping was performed before vitrectomy and 6 months postoperatively. Visual acuity (VA) was measured with the ETDRS chart.

Results:  All patients showed a reduction in the thickness of the macular area postoperatively. The mean thickness in the central macular area was 609 µm preoperatively and 243 µm 6 months postoperatively (p < 0.001). Ten patients had an increase in VA of at least two lines on the ETDRS chart and in one patient VA was unchanged. The mean improvement in VA was 3.1 lines.

Conclusion:  Retinal mapping with OCT is a good method of evaluating the thickness of the macula before and after surgery in vitreomacular traction syndrome and vitrectomy improves VA in most cases
The effect of the menstrual cycle on optic nerve head analysis in healthy women
Authors: Akar Munire Erman , Taskin Omur , Yucel Iclal , Akar Yusuf
Published: December 2004

Purpose:  To determine the effect of the menstrual cycle on optic nerve head topographic analysis in normally menstruating, healthy women.

Material and Methods:  The study included single eyes selected randomly from each of 52 healthy women with regular menstrual cycles. All subjects underwent a complete ocular examination. Optic nerve head topographic analyses were performed using a confocal scanning laser ophthalmoscope, the Heidelberg Retinal Tomograph II (HRT II, software version 1.6). The analyses were repeated three times during the menstrual cycle: in the follicular phase (days 7−10 of the cycle), at ovulation, and in the late luteal phase (days 1–3 before menstrual bleeding). Serum oestradiol, progesterone and luteinizing hormone levels were measured at each menstrual phase.

Results:  Fourteen subjects were excluded from the study. The mean age of the subjects (n = 38) was 25.6 ± 3.7 years (range 21–34 years). Blood oestradiol levels were significantly lower in the late luteal phase (35.8 pg/ml) (p < 0.0001). The mean disc area of the subjects was 1.94 ± 0.33 mm2. The neuroretinal rim area decreased significantly during the luteal phase (p < 0.001). However, the linear cup : disc ratio, cup : disc area ratio and the cup area were significantly higher during the luteal phase (p < 0.001).

Conclusion:  These observations raise the possibility that sex hormone fluctuations which occur during a normal menstrual cycle in healthy women significantly alter neuroretinal rim area and cup variables of the optic nerve head. These findings should be taken into consideration in the clinical follow‐up of young women with glaucoma.
Co‐existence of intraocular and orbital lymphoma
Authors: Neudorfer Meira , Kessler Ada , Anteby Irene , Goldenberg Dafna , Barak Adiel
Published: December 2004

Background: The concomitant occurrence of both intraocular and periocular lymphomas is extremely rare. Periocular involvement by lymphoproliferative disease ranges from benign lymphoid hyperplasia to malignant lymphoma. Intraocular lymphomas usually appear in conjunction with primary central nervous system lymphoma.

Case Reports: We describe clinical characteristics, standardized A‐ and B‐scan ultrasonography, colour Doppler, computerized tomographic and magnetic resonance imaging, and immunohistological findings in three cases of concurrent choroidal and periocular involvement of lymphoma.

Discussion: The clinical presentation of diffuse choroidal tumours may be variable, making diagnosis of intraocular lymphoma troublesome on clinical grounds alone. The high accuracy of colour Doppler imaging is known to be effective in differentiating the benign from the malignant and adds valuable information in the differential diagnosis of a low reflective lesion. We suggest the use of auxiliary examinations such as ultrasonography and colour Doppler imaging to help in the differential diagnosis of choroidal and orbital tumours.
Low contrast visual acuity in pseudophakic patients implanted with an anterior surface modified prolate intraocular lens
Authors: Ricci Federico , Scuderi Gianluca , Missiroli Filippo , Regine Federico , Cerulli Angelica
Published: December 2004

Purpose:  To determine whether implantation of a new intraocular lens (IOL) with a modified prolate anterior surface, designed to reduce the positive spherical aberration of the pseudophakic eyes, results in improved contrast sensitivity assessed in terms of low contrast visual acuity (VA).

Methods:  We carried out an intraindividual study of 12 patients with bilateral cataracts, randomized to receive a prolate anterior surface IOL (Tecnis Z9000, Pharmacia) in one eye and a biconvex spherical surface IOL (CeeOn 911 A, Pharmacia) in the other. High and low contrast VA was assessed under photopic conditions, before and after pupil dilation.

Results:  After mydriasis, the Technis Z9000 provided significantly better low contrast VA at contrast levels ≤ 25%. No significant difference was found under normal pupil conditions.

Conclusion:  Our results confirm the hypothesis that the spherical aberration of the eye after cataract surgery can be reduced by an anterior prolate surface IOL.