bluuebunny/crossref_metadata_2025 huggingface dataset:
Disappearance of human chorionic gonadotropin after cesarean section with regard to fetal sex
Authors: Steier Johan A. , Bergsjø Per B. , Myking Ole L.
Published: March 2003

Background.  To evaluate the influence of gender on the disappearance of human chorionic gonadotropin by cesarean section after fullterm pregnancies.

Materials and methods.  Forty‐nine uncomplicated pregnancies: 26 had male (male group) and 23 had female (female group) fetuses.

Results.  Before the cesarean section the serum human chorionic gonadotropin levels were higher in the female than in the male bearing pregnancies. After cesarean section the human chorionic gonadotropin levels fell rapidly. The decrease in the human chorionic gonadotropin values was significantly faster in the male than in the female group during the first hours after delivery (2P < 0.02), while no significant difference was seen after 24 and 72 h.

Conclusion.  This study shows a significantly faster human chorionic gonadotropin disappearance rate in pregnancies with male compared with female fetuses during the first hours after a cesarean section. This indicates a gender difference, which could be related to different human chorionic gonadotropin molecular structures or to more specific metabolic events.
Individual risk assessment of thrombosis in pregnancy
Authors: Lindqvist Pelle G. , Kublikas Marius , Dahlbäck Björn
Published: March 2003

Background. Thromboembolic complications during pregnancy are major contributors to maternal death, but there is no reliable way to estimate the absolute risk of thrombosis before the occurrence of a thromboembolic complication.

Objective. To create a model for individual estimation of thrombosis risk during pregnancy and to determine the distribution of risk estimates in a series of gravidae.

Method and patients. Estimates of absolute risk of pregnancy‐related thromboembolism were calculated by multiplying reported figures of thrombosis incidence by prevalence‐adjusted odds ratios of the following variables: smoking, parity, preeclampsia, mode of delivery, age, overweight, activated protein C resistance (FV Leiden or FV:Q506), thrombosis heredity, and previous thrombosis. We present the risk distribution among a unselected prospectively gathered cohort of 2384 unselected gravidae who were interviewed and tested for activated protein C resistance in early pregnancy.

Results and conclusions. A model for individual estimation of the absolute risk of thrombosis is presented, which is provided to the readers as a free automatic Internet‐based service (http://www.riskpreg.com). As compared with antepartum, more women at high risk can be identified in the postpartum period and we suggest that this might be of use in planning the prevention of thrombosis.
Para‐aortic lymph node metastasis in relation to serum CA 125 levels and nuclear grade in endometrial carcinoma
Authors: Ebina Yasuhiko , Sakuragi Noriaki , Hareyama Hitoshi , Todo Yukiharu , Nomura Eij , Takeda Mahito , Okamoto Kazuhira , Yamada Hideto , Yamamoto Ritsu , Fujimoto Seiichiro
Published: March 2003

Background. To investigate the relationship between preoperative serum CA 125 levels and para‐aortic lymph node (PAN) metastasis as determined by systematic pelvic and para‐aortic lymph node dissection in endometrial carcinoma.

Methods. This study included 180 patients (n= 55, premenopausal; n= 125, postmenopausal) with endometrial carcinoma treated by complete surgical staging. Cut‐off values of preoperative serum CA 125 levels for PAN metastasis were determined by receiver characteristic curve (ROC) analysis. Logistic regression analysis was used to determine independent predictors for PAN metastasis.

Results. The median serum CA 125 levels of patients with PAN metastasis were significantly higher than the levels of those with no metastasis in both premenopausal and postmenopausal groups. Based on ROC analysis, we could determine four cut‐off values (70 and 210 U/mL for premenopausal patients, 20 and 60 U/mL for postmenopausal patients) and categorize the serum CA 125 levels into low, moderate and high groups. By logistic regression analysis, the CA 125 level and nuclear grade were found to be significant predictors of PAN metastasis, respectively. Using this model, the patients were stratified into three risk groups. The probabilities of PAN metastasis for patients in the low‐risk, intermediate‐risk and high‐risk groups were less than 2%, 2–25% and more than 50%, respectively.

Conclusions. Serum CA 125 levels and nuclear grade are important risk factors for PAN metastasis in endometrial carcinoma.
Menstrual diary data and menopausal transition: methodologic issues
Authors: Taffe John , Dennerstein Lorraine
Published: March 2003

Objectives. To identify problems arising in the analysis of menstrual diary data in a longitudinal study of the menopausal transition, and to propose solutions.

Subjects and methods. Menstrual diary information provided by 372 women over a period 7 years is the basis of the study. This paper considers the processes and decisions associated with transforming this information into a form suitable for answering research questions.

Results. We decided to use ‘cycle’ as the unit of analysis and to regard spotting‐only episodes as nonmenstrual bleeding. Difficulties in distinguishing between long cycles and gaps because of recording lapses are shown to be related to both the design of the menstrual diary cards and the procedures used by fieldworkers. A new design that should minimize such difficulties is presented. Procedural changes are also proposed.

Conclusions. It is important to minimize uncertainty about the meaning of gaps in menstrual diary data, especially in studies of the menopausal transition. Methodologic improvements that can help to achieve this aim include design of diary cards and fieldwork procedures to reduce uncertainty. The design of data entry interfaces to facilitate the checking of raw data and the use of graphs as a diagnostic tool are other important steps.
Hormone replacement therapy with tibolone: effects on sexual functioning in postmenopausal women
Authors: Egarter Christian , Topcuoglu Ata M. , Vogl Sonja , Sator Michael
Published: March 2003

Objective.  Because hormonal changes in postmenopausal women may be accompanied by sexual problems and a worsening of various aspects of libido, the aim of this study was to assess the effect of tibolone (Liviel®) on sexual life.

Methods.  Postmenopausal first‐time users of hormone replacement therapy (HRT) were included in this open, multicenter study. Patients were treated with tibolone 2.5 mg daily for at least 4 months. Both at baseline and after 4 months of treatment, patients were asked to complete two different questionnaires rating the women's subjective assessment of their sexual problems or desires.

Results.  One hundred and eighty‐four women were enrolled to receive HRT with tibolone. Overall, a significant increase in women's satisfaction with their sexual lives and a significant improvement in different aspects of libido was found.

Conclusion.  Tibolone has beneficial effects on several aspects of sexual life in postmenopausal women. These effects may be due to both an increase in genital blood flow and the central estrogenic/androgenic activity.
Audit of neonatal deaths of nonmalformed infants of 34 or more weeks' gestation: unavoidable catastrophic events or suboptimal care?
Authors: Holt Jan , Fagerli Ingebjørg , Holdø Bjørn , Vold Ingar Nikolai
Published: March 2003

Background.  The neonatal death rate (death ≤ 28 days/1000 live births) has decreased and the level is now so low that it has been questioned whether further improvement is possible. The aim of this study was to categorize nonmalformed infants of 34 weeks' or more gestational age dying in the neonatal period to analyze if these deaths might have been prevented.

Material and methods.  We used the audit method to study neonatal deaths during 1986–98 in a county population of approximately 240 000 inhabitants.

Results.  Twenty‐six neonatal deaths from a population of 41 901 live births were analyzed. The neonatal deaths were found to be associated with antepartum hypoxia (six cases); intrapartum catastrophes (seven cases); intrapartum monitoring deficiencies (five cases); resuscitation and stabilization after birth (two cases); infection (one case); sudden infant death syndrome (four cases); and peritonitis (died at home, one case). Suboptimal care was recorded in 16 cases. Neonatal death was unlikely to be associated with suboptimal care in six cases, but in 10 cases suboptimal care might or was likely to have brought about the fatal outcome.

Conclusion.  Avoiding suboptimal care might or is likely to prevent neonatal death in 10/26 (38.5%) of nonmalformed infants of 34 weeks' or more gestational age. Such improvements may, however, only slightly influence the neonatal death rate, with a reduction from 4.4 to 4.2/1000 live births.
Acupuncture in the management of pain in labor
Authors: Skilnand Else , Fossen Ditlev , Heiberg Eli
Published: March 2003

Background.  To assess if acupuncture could be a reasonable option for pain relief in labor and to look at possible effects of acupuncture on the progress of labor.

Methods.  In a controlled, single blind study, 210 healthy parturients in spontaneous, active labor at term were randomly assigned to receive either real acupuncture or false acupuncture. Visual analog scale assessments were used to evaluate subjective effect on pain. The objective parameter of outcome was the need for analgesic medication in each group.

Results.  There were significantly lower mean pain scores and significantly less need for pharmacological analgesia in the study group compared with the control group. The women given real acupuncture spent less time in active labor and needed less augmentation than the control group.

Conclusion.  The results indicate that acupuncture reduces the experience of pain in labor. A secondary outcome of acupuncture was a shorter delivery time, which mainly, if not exclusively, can be explained by the reduced need for epidural analgesia. Acupuncture may be useful for parturients who wish a nonpharmacological analgesia without side‐effects. For others it could be the analgesic method of choice, with pharmacological analgesics as supplements.
Effect of pregnancy on trunk range of motion when sitting and standing
Authors: Gilleard Wendy , Crosbie Jack , Smith Richard
Published: March 2003

Background.  During pregnancy, apposition of body segments and changes in trunk mobility and motion control due to increased mass and dimensions may reduce the functional range of motion of the trunk segments. Although static postures have been investigated, dynamic trunk motion during pregnancy in sitting and standing has had very limited investigation.

Methods.  Included in the study was a volunteer sample of convenience of nine primiparous and multiparous women. Twelve nulliparous females formed a control group. The subjects were filmed while performing maximum seated and standing trunk forward flexion, side‐to‐side flexion and seated axial rotation. A repeated measures anova was used to investigate systematic changes in the motion of the pelvic and thoracic segments and the thoracolumbar spines during pregnancy.

Results.  As pregnancy progressed, there was no significant decrease in the range of side‐to‐side flexion. For forward flexion and axial rotation, motion of the thoracic segment and the thoracolumbar spine was significantly reduced. Movement of the pelvis was less affected. Base of support width was increased for forward flexion and side‐to‐side flexion.

Conclusions.  In late pregnancy, strategies such as increasing the width of the base of support and reducing obstruction from other body parts were used to minimize the effects of increased trunk mass and girths. Not all trunk segment motion was affected equally. The differing effect on individual trunk segment motion may lead to altered movement patterns during functional tasks.
Joel‐Cohen or Pfannenstiel incision at cesarean delivery: does it make a difference?
Authors: Franchi Massimo , Ghezzi Fabio , Raio Luigi , Di Naro Edoardo , Miglierina Massimiliano , Agosti Massimo , Bolis Pierfrancesco
Published: March 2003

Objective.  To evaluate whether the technique to open the abdomen might influence the operative time and the maternal and neonatal outcome.

Methods.  All consecutive women who underwent a cesarean section at a gestational age greater than or equal to 32 weeks were randomly allocated to have either the Joel‐Cohen or the Pfannenstiel incision.

Exclusion criteria were two or more previous cesarean sections and previous longitudinal abdominal incision. During the study period 366 patients underwent a cesarean delivery. Of these patients, 56 did not meet the inclusion criteria. The remaining patients were allocated to the Joel‐Cohen (n= 152) group and to the Pfannenstiel (n= 158) group. Extraction time was defined as the time interval from skin incision to the clamping of the umbilical cord.

Results.  The total operative time was similar in both groups [Joel‐Cohen 32 min (12–60) vs. Pfannenstiel 33 min (18–70)]. The extraction time was shorter in the Joel‐Cohen group than in the Pfannenstiel group [190 s (60–600) vs. 240 s (50–600), p= 0.05]. This remained statistically significant after adjustment for confounding variables (Hazard = 1.26, p= 0.05). No difference was found between groups in terms of intraoperative and postoperative complications. No difference was found in the neonatal neurodevelopmental assessment at 6 months of age in relation to the abdominal incision performed.

Conclusion.  The Joel‐Cohen method of opening the abdomen at cesarean delivery is faster then the Pfannenstiel technique at delivering the fetus. However, considering the absence of benefits to the mother and the fetus there is no clear indication for performing a Joel‐Cohen incision.
Trends in teenage fertility, abortion, and pregnancy rates in Iceland compared with other Nordic countries, 1976–99
Authors: Bender Sóley S. , Geirsson Reynir T. , Kosunen Elise
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 38–47. © Acta Obstet Gynecol Scand 2003

Background.  Iceland is often considered very similar to the other Nordic countries. The purpose of this study was to explore trends in teenage fertility, abortion, and pregnancy rates in Iceland, compare these trends with corresponding rates in Denmark, Finland, Norway, and Sweden during the period 1976–99, and to evaluate similarities and dissimilarities.

Methods.  The study is based on data about fertility, abortion, and pregnancy rates obtained from the Icelandic and Nordic national population and abortion registers for the age group 15–19 years years.

Results.  Teenage fertility and pregnancy rates in the five Nordic countries declined over the study period by 57–67% and 31–50%, respectively, and in Iceland they remained significantly higher than in the Nordic countries. In 1999 almost every other teenage pregnancy in Iceland (45.9/1000) resulted in a childbirth (24.4/1000). Regional fertility rates were highest in the countryside. While the abortion rate has been declining in the four Nordic countries by 20–41%, they have concurrently been rising in Iceland by 133% (9.4/1000 in 1976–80, 21.9/1000 in 1996–99) and are presently higher than in the other Nordic countries. Regionally, abortion rates in Iceland were highest in the Capital area.

Conclusions.  The teenage pregnancy rate is higher in Iceland than in the other Nordic countries. This may be explained by cultural norms in Iceland's society regarding childbearing, early initiation of sexual intercourse, more limited sex education, and less effective delivery and use of contraceptive methods. There is a need to promote sexual and reproductive health to young people in Iceland by combining diverse preventive approaches.
Lipogranuloma peritonealis caused by spontaneous rupture of a benign cystic ovarian teratoma
Authors: Wiberg Nana , Kiss Katalin , Dalsgaard Lone
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 91–94. © Acta Obstet Gynecol Scand 2003
The influence of near‐work on development of myopia among university students. A three‐year longitudinal study among engineering students in Norway
Authors: Kinge Bettina , Midelfart Anna , Jacobsen Geir , Rystad Jarand
Published: March 2003

Purpose: The aim of this study was to investigate the effect of near‐work on development and progression of myopia among adults exposed to high educational demands.

Methods: A three‐year longitudinal refraction study was performed among 224 Norwegian engineering students (mean age 20.6 years, 117 females and 107 males) measuring their refraction at the beginning and the end of the period. The examinations included automated and clinical refraction in cycloplegia and a questionnaire regarding time spent on different kinds of near‐work was filled in by the participants. A total of 192 students (100 females and 92 males) completed the study.

Results: The mean refractive change of −0.51±0.49 D (n=192) during the three‐year period was statistically significant (p=0.0001). A significant relationship between refractive change towards myopia and time spent on reading scientific literature (p≤0.001) and on practical near‐work (p≤0.05), respectively, was found. Also, a significant relationship between refractive change towards myopia and time spent at lectures was revealed (p≤0.001). No relationship was found between refractive change and time spent at working with video display terminals (VDT) or watching television, respectively.

Conclusions: The results indicate that intensive near‐work could initiate myopia or lead to its progression in young adults. The time spent on near‐work seems to play a significant role in that process.
Ophthalmic artery blood flow velocity changes in diabetic patients as a manifestation of macroangiopathy
Authors: Ino‐ue Masanori , Azumi Atsushi , Yamamoto Misao
Published: March 2003

Purpose: The hemodynamic characteristics of ophthalmic artery (OA) blood flow velocity in diabetic patients with ocular involvement were evaluated.

Methods: Changes in OA blood flow of eyes with background diabetic retinopathy (BDR), proliferative retinopathy (PDR) and ocular ischemic syndrome (OIS) were ananalyzed by Color Doppler imaging.

Results: Patients with BDR and PDR had significantly lower diastolic and mean blood flow velocities and higher pulsatility indices compared to controls. Diabetic patients with OIS had significantly lower systolic, diastolic and mean anterograde OA blood flow velocities than the controls. Pulsatility indices were higher in anterograde OA blood flow measurements compared to controls. Systolic blood flow velocities in rubeotic eyes with OIS were significantly lower than in rubeotic eyes with PDR.

Conclusion: OA blood flow measurements by color doppler imaging may detect macroangiopathies in diabetic patients as manifested by carotid atheromas and arterio‐ and arterosclerosis of the OA and its branches.
Risk factors for the development of pterygium in Singapore: A hospital‐based case‐control study
Authors: Saw Seang‐Mei , Banerjee Karabee , Tan Donald
Published: March 2003

Purpose: A hospital‐based case‐control study, designed to evaluate the risk factors for the development of pterygium in Singapore.

Methods: Sixty‐one cases and 125 controls were interviewed at the Singapore National Eye Centre. Information on present and past (5 and 10 years ago) exposure to sunlight on weekdays and weekends, sociodemographic data, behavior lifestyle and family history of eye disease was collected.

Results: Patients with pterygia were mostly males, smoked and drank alcohol more often, had lower combined family incomes and were more likely to have a family history of eye disease. The adjusted odds ratios for the development of pterygia were 1.27 (95 percent confidence interval 1.06 to 1.54) and 1.31 (95 percent confidence interval 1.09 to 1.57) for participants who had spent more time in the sun five and ten years ago respectively.

Conclusions: Pterygium is an important public health problem in Singapore and its development is related to the amount of sunlight exposure.
Bilateral diffuse uveal melanocytic proliferation and uterine cancer. A case report
Authors: Ritland J. S. , Eide N. , Tausjø J.
Published: March 2003

Purpose: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP), a rare paraneoplastic syndrome causing visual loss in patients with systemic carcinoma.

Results: A 70‐year‐old woman developed visual symptoms 13 months after surgery and local irradiation therapy for uterine cancer. Following bilateral external beam irradiation supplemented with subsequent drainage of subretinal fluid in the left eye, the visual acuity improved from 0.01 to 0.15 in this eye only. The visual acuity remained at this level until she died 4 1/4 years after the onset of eye symptoms.

Conclusion: This is the fourth case that survived longer than 24 months after the onset of visual symptoms of the 22 previously reported cases with BDUMP. It demonstrates that radiotherapy may have a vision‐preserving effect in this group of patients. The patient also developed two different paraneoplastic phenomena – a nephrotic syndrome before and BDUMP after treatment for uterine cancer.
Ganciclovir delivery through an intravitreal microdialysis probe in rabbit
Authors: Waga Janina
Published: March 2003

ABSTRACT. The treatment of cytomegalovirus retinitis has during the last years been done mainly with sustained release ganciclovir devices implanted in the vitreous. In the present study it is shown that ganciclovir can be administered into the rabbit vitreous by microdialysis. A concentration of about 10−6M, which is considered within the therapeutic range, is achieved in the vitreous after a microdialysis perfusion. The method offers possibility of variation in the drug delivery that is not possible with the ganciclovir implants.
Sequential development of bilateral primary choroidal melanoma
Authors: Kiratli Hayyam , Bilgiç Sevg♀l
Published: March 2003

Purpose: A case of a woman who had bilateral choroidal melanoma diagnosed sequentially 20 months apart and managed conservatively is described.

Methods: The first eye having a juxtapapillary melanoma was treated with a notched episcleral radioactive plaque. The second eye, initially containing a small nevus with unequivocal rapid growth, was managed with diode laser transpupillary thermotherapy.

Results: Both tumors regressed considerably following treatment and the patient retained good visual acuity in both eyes. No other malignancies or metastasis were detected during the follow‐up period.

Conclusions: A small choroidal nevus rapidly grew after treating a choroidal melanoma in the fellow eye. Close follow‐up of such patients is mandatory. Also, conservative treatment should be opted whenever possible given the unpredictable course of the opposite melanocytic lesion.
Grafting of the posterior cornea. Description of a new technique with 12‐month clinical results
Authors: Ehlers Niels , Ehlers Hanne , Hjortdal Jesper , Møller‐Pedersen Torben
Published: March 2003

Purpose: To describe the technique of grafting only the posterior cornea and to report 12‐month clinical results.

Method: A two‐layer technique with an anterior recipient flap created by a microkeratome and a posterior penetrating donor graft allows for a watertight wound closure and at the same time a peroperative correction of astigmatism. Four eyes (3 patients) were followed for 12 months.

Results: The surgical technique could be completed in all cases without complications. The postoperative course was uneventful. The intrastromal absorbable sutures disappeared spontaneously and completely. Graft thickness showed the expected 6‐month minimum while recipient flap thickness remained constant. After 1 year endothelial cell densities were 1200–2300 cells/mm2. Confocal microscopy showed activated keratocytes in the flap and quiescent keratocytes in the donor tissue by one year. The anterior chamber depth was normal in all cases. The optical quality of the cornea was studied by automatic keratometry and keratoscopy (TMS). The obtained optical properties were not optimal.

Conclusions: The developed novel technique gives a better wound closure and a complication free postoperative course. It may allow for better control of postoperative astigmatism. In order to disseminate the use of the technique, eyebanks should supply posterior corneas to the surgeon.
Prevalence of myopia in a sample of Greek students
Authors: Mavracanas Thomas A. , Mandalos Achilleas , Peios Dimitrios , Golias Vasilios , Megalou Katherine , Gregoriadou Anthoula , Delidou Kyriaki , Katsougiannopoulos Basil
Published: March 2003

Purpose: An epidemiological study, concerning the prevalence of myopia among the student population (15–18 years old) of Northern Greece, was carried out.

Methods: Specific questionnaires were used in order to collect data on the refractive condition of students.

Results: Myopia prevalence was 36.8% and was found to be more common in females (46.0%) than in males (29.7%). The prevalence increased in students with myopic parents and myopic siblings. It was also found that myopia correlates strongly with nearwork and school performance.

Conclusion: The study results suggest that myopia is a rather common refractive error in Greek students. Findings also indicate that myopia is probably hereditary and correlates with educational level, intelligence and excessive nearwork.
Clinical comparison of the measurement of the IOP with the ocular blood flow tonometer, the Tonopen XL and the Goldmann applanation tonometer
Authors: Bafa M. , Lambrinakis I. , Dayan M. , Birch M.
Published: March 2003

ABSTRACT. Purpose: In addition to measuring ocular blood flow, the ocular blood flow tonometer (OBF) can also be set to solely record intraocular pressure (IOP). In this mode it provides a quick means of tonometry which may allow nursing staff to be more easily trained in its use than conventional Goldmann tonometry. With a view to its eventual use in nurse‐led clinics we undertook a study to compare both the OBF tonometer and our currently favoured nurse practitioners tonometer the tonopen XL with Goldmann tonometry.

Method: IOP was measured in 99 eyes with all three tonometers in a random order.

Results: There was not any statistically significant difference between the measurements of all three tonometers.

Conclusions: It is concluded that OBF tonometer can provide clinically useful measurements of intraocular pressure which may in fact be more accurate than the tonopen, however, our opinion is that it possibly is not suitable for a universal glaucoma clinics application.
Defective visual field tests in chronic heavy smokers
Authors: Hepsen Ibrahim F. , Evereklioglu Cem
Published: March 2003

ABSTRACT. Purpose: To evaluate the visual field changes in smokers.

Methods: In 24 healthy, chronic, heavy cigarette smokers and 16 age and sex‐matched healthy non‐smokers, central 30–2 threshold tests were evaluated. The quantitative perimetric indices as objective retinal sensitivity measures were recorded in both eyes, but only those from the second eye were chosen for analysis. The visual field defects were also assessed.

Results: All subjects had normal visual acuity. The central visual fields in smokers showed relative to absolute scotomas in 20 ° to 30 °. Quantitative perimetric indices including total threshold dB with red and white target, MD, PSD, and CPSD values were significantly different (p<0.05) between the groups. Smokers showed both diffuse and localised retinal sensitivity decrease. SF showed no significant difference (p>0.05) between the groups.

Conclusion: In healthy, chronic, heavy cigarette smokers, retinal sensitivity was found to be decreased although central vision was not affected. This is possibly due to a cumulative effect of chronic smoking onto the retinal and/or optic nerve functions without clinically evident optic neuropathy.
Ocular perfusion and age‐related macular degeneration
Authors: Ciulla Thomas A. , Harris Alon , Martin Bruce J.
Published: March 2003

ABSTRACT. Purpose: To review the role of ocular perfusion in the pathophysiology of age‐related macular degeneration (AMD), the leading cause of irreversible blindness in the industrialized world.

Methods: Medline search of the literature published in English or with English abstracts from 1966 to 2000 was performed using various combinations of relevant key words.

Results: Vascular defects have been identified in both nonexudative and exudative AMD patients using fluorescein angiographic methods, laser Doppler flowmetry, indocyanine green angiography, and color Doppler imaging.

Conclusion: Although these studies lend some support to the vascular pathogenesis of AMD, it is not possible to determine if the choroidal perfusion abnormalities play a causative role in nonexudative AMD, if they are simply an association with another primary alteration, such as a primary RPE defect or a genetic defect at the photoreceptor level, or if they are more strongly associated with one particular form of this heterogeneous disease. Further study is warranted.
The effect on diurnal intraocular pressure of the fixed combination of latanoprost 0.005% and timolol 0.5% in patients with ocular hypertension
Authors: Larsson Lill‐Inger
Published: March 2003

ABSTRACT. Purpose: To measure the effect on intraocular pressure (IOP) after single‐dose administration of the fixed combination of latanoprost 0.005% and timolol 0.5%.

Methods: A randomized, double‐masked placebo‐controlled parallel‐group study was carried out. Twenty patients with ocular hypertension received the fixed combination of latanoprost+timolol, while 10 received placebo eyedrops. On baseline day no eyedrops were given, but IOP was measured repeatedly between 8.00 a.m. and 8.00 p.m. On Day 7 the eyedrops were given at 8.00 a.m., and IOP measured as on baseline day. On Day 8 and Day 9, IOP was again measured at 8.00 a.m.

Results: There was no difference in IOP in the placebo group. In the latanoprost+timolol group maximal IOP reduction (12.4±2.8 mmHg; mean±standard deviation) occurred 6.4 hours after drug administration (5.2–7.7 hours; 95% confidence interval [CI]). The mean IOP reduction after 24 hours was 9.8 mmHg (7.4–12.2 mmHg; 95% CI; p<0.001), and after 48 hours 5.7 mmHg (3.4–8.1 mmHg; 95% CI; p<0.001).

Conclusions: The fixed combination of latanoprost+timolol statistically significantly reduced IOP after single‐dose administration. The maximal effect was noted after about 6 hours, and the IOP reduction was still pronounced after 48 hours.
Association between visual impairment and functional and morphological cerebral abnormalities in full‐term children
Authors: Grönqvist Sonia , Flodmark Olof , Tornqvist Kristina , Edlund Göran , Hellström Ann
Published: March 2003

ABSTRACT.Purpose:To characterise the nature and degree of ocular disorders and cerebral morphological and functional abnormalities in a population‐based group of visually impaired full‐term pre‐school children.

Methods:Forty‐five children who were born at full‐term between 1989 and 1995 in Värmland, Sweden, were reported as being visually impaired. An ophthalmological examination was performed and clinical data regarding mental development and neurological disease were obtained for all children. Cerebral imaging was performed in 35 children.

Results:Twenty‐six per cent of the children were found to have ocular disorders only. Forty‐two per cent had cerebral morphological abnormalities, verified by cerebral imaging, and 65% had signs of cerebral functional abnormalities. In total, 74% were found to have cerebral morphological and/or cerebral functional abnormalities.

Conclusion:The majority of children with visual impairment, including children with ocular disorders, were found to have cerebral morphological and/or cerebral functional abnormalities. We suggest that any child with visual impairment should therefore undergo cerebral imaging and be examined by a paediatrician in order to establish the correct diagnosis.
Refraction in juvenile chronic arthritis: a long‐term follow‐up study, with emphasis on myopia
Authors: Fledelius Hans , Zak Marek , Pedersen Freddy Karup
Published: March 2003

ABSTRACT. Objective: Assessment of refraction anomalies in juvenile chronic arthritis (JCA) on a long‐term follow‐up basis.

Material and Methods: Sixty‐five adults, 52 females and 13 males, with a history of active JCA had a complete ophthalmic evaluation including subjective refractioning on average 26.4 years after JCA onset. The age range was 22–49 years.

Results: The refraction ranged from −8.12 D to +6.5 D with a mean (SD) of −0.64 (2.16) D. The mean refraction in the JCA group was significantly more towards myopia than that of a coeval adult hospital‐based sample used as controls (p=0.008). Twenty‐eight out of the 65 (43%) had a negative refractive value of at least 0.37 D. Myopia onset age ranged from 8 to 31 years. In those able to specify their myopia onset by first purchase of spectacles (n=25) the JCA onset had preceded the myopia, with a mean (SD) interval of 10.1 (5.4) years.

Conclusion: The elevated myopia figure of 43% among JCA patients suggests an association between myopia and JCA. In lack of more precise indicators and in accordance with older literature, an explanation might be a weakening effect of chronic inflammation on scleral connective tissue.
“Scleral tunnel incision”‐trabeculectomy with one releasable suture
Authors: Vuori Marja‐Liisa , Viitanen Tommi
Published: March 2003

ABSTRACT. Purpose: To describe a modified surgical technique, a scleral tunnel incision‐ trabeculectomy (STIT) and evaluate its safety and efficacy in lowering IOP in glaucoma patients.

Methods: One hundred and three patients were included in a retrospective, nonrandomized clinical study. Fifty‐three patients were operated conventionally and 40 patients underwent STIT. In the modified technique the sides of the scleral flap are opened only half‐way to the limbus and the flap is closed with a single releasable “slipknot”‐suture.

Results: The mean IOP on the first postoperative day was 4.5±6.8 mmHg in the conventional group and 7.4±7.1 mmHg in the tunnel incision group (p=0.012). On the second postoperative day the mean IOP was 4.5±7.3 mmHg and 6.3±6.5 mmHg in the conventional group and tunnel incision group, respectively (p=0.065). There was no statistically significant difference in the mean postoperative IOP between the groups at one month and at 6–12 months. Shallow anterior chamber and iridocorneal touch occurred statistically significantly less in the tunnel incision group than in the conventional group.

Conclusion: STIT appears to be equivalent to conventional trabeculectomy (CT) in lowering IOP during the first 6–12 months postoperatively. It is also relatively safe and has fewer early complications related to excessive aqueous outflow than CT.
Long‐term visual results following primary trabeculectomy for infantile glaucoma
Authors: O'Reilly James , Lanigan Bernadette , O'Keefe Michael
Published: March 2003

Purpose: To report the long‐term visual outcome of eyes that underwent primary trabeculectomy for infantile glaucoma and to evaluate factors that affect visual prognosis.

Methods: Thirty‐five eyes of 22 consecutive patients presenting between 1980 and 1995 were included. Visual acuity, visual fields and refractive status were assessed and patient records reviewed.

Results: Nineteen of 22 patients (86.3%) achieved 6/12 or better, (21 of 35 eyes; 60%). Reasons for decreased vision included amblyopia (5 eyes), field loss (4 eyes), corneal opacification (2 eyes), and uncontrolled IOP (1 eye). Primary glaucoma had a better outcome than secondary glaucoma. Vision was frequently unequal despite controlled pressure, clear media and full fields in both eyes. This was associated with myopic anisometropia and apparent amblyopia. Ten patients responded to patching. Eyes with field defects were unresponsive to patching.

Conclusions: Field defects, corneal scarring, marked anisometropia and severe astigmatism result in poor vision. Anisometropic amblyopia is frequently present and responds well to patching. Visual outcome is dependent on early and sustained control of intraocular pressure and aggressive treatment of amblyopia.
Experimental transplantation of autologous iris pigment epithelial cells to the subretinal space
Authors: Crafoord Sven , Geng Lijun , Seregard Stefan , Algvere Peep V.
Published: March 2003

Purpose: To investigate the cellular morphology in the subretinal space following transplantation of iris pigment epithelial (IPE) cells from the same eye.

Methods: Following an iridectomy, fresh IPE cells were prepared and no culturing performed. After pars plana vitrectomy, a suspension of autologous IPE cells was injected into the subretinal space in 37 rabbits. The grafts were monitored by ophthalmoscopy and colour fundus photography. Rabbits were sacrificed at 1, 2, 3 and 6 months, respectively, and the eyes examined with light and electron microscopy.

Results: The grafted area retained the same configuration over 6 months but then appeared less pigmented. At 1–3 months, the IPE formed one or more contiguous layers on top of native RPE. At 6 months, cells compatible with grafted IPE were present in the subretinal space, often forming monolayer‐like chains integrating with the native RPE. Depigmented cells of presumed IPE origin were seen and frequently in association with abundant melanin granules located in the apical portion of adjacent RPE cells. In such areas, large macrophage‐like cells were observed.

Conclusion: Transplanted IPE cells survived for up to 6 months in the subretinal space. Our observations suggest a scenario of remodelling of the cellular layers in the subretinal space over time where grafted IPE cells formed a compound layer with the native RPE. Transplantation of autologous IPE cells may have a potential as a treatment modality in selected cases of age‐related macular degeneration.
Planned two‐step vitrectomy for extremely large and thick subretinal hematoma
Authors: Matsuo Toshihiko , Shiraga Fumio , Takasu Ippei
Published: March 2003

Purpose: To describe a new surgical strategy, planned two‐step vitrectomy, for a large and thick subretinal hematoma involving 3 or more quadrants of the fundus.

Surgical Methods: In a first‐step vitrectomy, a retinotomy was made in the posterior pole, after any vitreous hemorrhage had been removed. Following fluid‐gas exchange with no laser photocoagulation around the retinotomy, patients took a face‐down position for a few days to a week to facilitate subretinal hemorrhage movement to the vitreous cavity and anterior chamber. In a second‐step surgery, the hemorrhage in the vitreous cavity and anterior chamber was washed out. The remaining subretinal hemorrhage was aspirated, and the retina was reattached with fluid‐gas exchange and laser photocoagulation around the retinotomy.

Results: The planned two‐step vitrectomy was performed in 4 consecutive patients with large and thick subretinal hematomas involving 3 or more quadrants seen during a 3‐year period. By a face‐down position after the first‐step vitrectomy, subretinal hemorrhage moved to the vitreous cavity and anterior chamber. The remaining subretinal hemorrhage in a smaller quantity could be easily removed, leading to retinal reattachment in the second‐step surgery.

Conclusions: The planned two‐step vitrectomy is a safer and more effective procedure for removing a large quantity of subretinal hemorrhage in a shorter period of surgical time, compared with hemorrhage removal in a single vitrectomy.
Thyroid associated ophthalmopathy: botulinum toxin A in the treatment of upper eyelid retraction – a pilot study
Authors: Träisk Frank , Tallstedt Leif
Published: March 2003

Purpose: Eyelid retraction in patients with thyroid associated ophthalmopathy is a common cause of eye discomfort and a disfigured facial appearance. The aim of this pilot study was to evaluate the effects and safety of inducing a temporary partial ptosis of the eyelid through injection of botulinum toxin A into the levator palpebrae superioris muscle.

Methods: Nine patients were treated. They were followed up with ophthalmologic examinations and self‐assessment questionnaires until the point at which they either required renewed treatment or had no residual effect of the first injection. Maximum follow‐up time was twenty weeks.

Results: In all eyes but one there was a lowering of the eyelid position one week after treatment and all these patients reported an improvement of eye appearance and symptoms. There was variability in the degree of lowering of the eyelid with the same dose of injected botulinum toxin A. It was also difficult to predict the time interval needed for re‐treatment. Ptosis impairing visual acuity was not a consequence of the treatment in any of the patients. One week after treatment two patients experienced increased diplopia but only one showed transient change in Lees screen measurement of eye motility.

Conclusion: Botulinum toxin A injection may be used to lower the upper eyelid position in patients awaiting eyelid surgery. The treatment safely relieved symptoms and improved eye appearance. However, treatment was short term and difficult to predict. There is also an inherent risk of transient diplopia.
Evaluation of the new Ocuton S tonometer
Authors: Marchini Giorgio , Babighian Silvia , Specchia Luca , Perfetti Sergio
Published: March 2003

Purpose:  To evaluate the intra‐ and interobserver variability of the Ocuton S tonometer, its correlation with Goldmann tonometry, the reliability of self‐tonometry and the safety of the instrument.

Methods:  Thirty‐five healthy subjects and 45 patients with primary open‐angle glaucoma (POAG), aged from 38 to 80 years (mean age: 64.6 ± 12.2 years), underwent tonometry with the Ocuton S tonometer in one eye chosen at random. The intra‐ and interobserver variability between two operators (kappa coefficient), the Ocuton S/Goldmann correlation and the reliability of self‐tonometry were evaluated by performing two tonometries on each patient in subgroups. Each tonometry was considered as the mean of three consecutive measurements. Central ultrasonic pachymetry, keratometry and corneal biomicroscopy were also evaluated.

Results:  The intra‐ and interobserver variability ranged from 0.38 to 0.66. The difference between the means of intraocular pressure (IOP) with the Ocuton S (24.4 ± 4.7 mmHg) and the Goldmann tonometer (18.1 ± 4.7 mmHg) was statistically significant (p < 0.0001). Linear regression analysis revealed a good Ocuton S/Goldmann correspondence (r = 0.88, p = 0.0001). However, IOP values detected with the Ocuton were consistently overestimated, compared to those detected with the Goldmann tonometer. The correlation between corneal thickness and IOP was statistically significant both for the Goldmann (r = 0.510, p = 0.021) and for the Ocuton S tonometer (r = 0.520, p = 0.019). No correlation was found between keratometry and IOP. The mean measurement obtained by self‐tonometry (21.9 ± 3.6 mmHg) showed no statistically significant difference when compared to the mean measurement obtained by an expert operator (21.3 ± 3.4 mmHg).

Conclusion:  The Ocuton S tonometer is a safe instrument that can be used easily by the patient. However, in comparison to the Goldmann tonometer , it overestimates IOP and requires further technical and methodological refinements in order to ensure greater reliability.
The Swedish National Cataract Register: A 9‐year review
Authors: Lundström Mats , Stenevi Ulf , Thorburn William
Published: March 2003

The Swedish National Cataract Register (NCR) has been collecting data on cataract extractions in Sweden since 1992. This unique national database now contains data pertaining to more than 400 000 operations, representing 93.4% of all operations performed nationwide during 1992–2000. Clinic participation in the NCR is voluntary. Tests have shown NCR data to be extremely reliable, while the participation of nearly all providers of cataract surgery in Sweden makes the data highly representative of cataract surgery throughout the country.

The NCR collects pre‐ and per‐operative data for every cataract extraction performed at participating clinics. Surgical outcome data and data about patients' self‐assessed visual function is collected in approximately 10% of cases. Since 1998, all cases of suspected postoperative endophthalmitis have also been reported to the NCR.

The rate of surgery has increased from 4.47 to 7.26 per 1000 inhabitants during the period. Female subjects have constituted about 66% of all operated subjects each year and the mean age of patients has slowly increased from 75.2 to 76.1 years. Average pre‐operative visual acuity has improved each year. Second eye surgery has increased from 28.5% to 36.8% of all surgeries. Phacoemulsification has reached 98% as type of surgery (in 2000) and 92.7% of all intraocular lenses are foldable. Surgical outcome has improved by achieving a final refraction closer to the target refraction and less surgically induced astigmatism. The positive impact of cataract surgery in very elderly people has been demonstrated, as has the positive effect of second eye surgery, especially in young subjects.

The NCR has served to enhance knowledge about trends and results of cataract surgery in Sweden. This review article describes some of the activities carried out and their results.
Electroretinographic oscillatory potentials in insulin‐dependent diabetes patients: A long‐term follow‐up
Authors: Vadalà Maria , Anastasi Mario , Lodato Gaetano , Cillino Salvatore
Published: March 2003

Purpose: The aim of this research was to study the relevance of long‐term follow‐up of electroretinographic oscillatory potentials (OPs) in predicting the onset of minimal non‐proliferative diabetic retinopathy in insulin‐dependent diabetes patients.

Methods:  A total of 80 insulin‐dependent diabetics, with normal fundi and normal OPs at first examination, were followed prospectively for 10 years. Oscillatory potentials were measured and fundus examinations performed once or twice per year.

Results:  During follow‐up, 35% of patients developed diabetic retinopathy after a mean disease duration of 12 ± 2 years. A decrease in OP amplitudes was seen in 46% of this group, but reductions were also seen in the 25% of patients whose fundi remained normal. Statistical analysis of best‐fit survival curves shows a significant difference (p < 0.001) in the point of Kaplan‐Meiers' curve maximal linearity (TmaxS).

Conclusions:  It appears that eyes with reduced OP amplitude have a greater probability of developing diabetic retinopathy. Subnormal OP amplitudes are not proof of real concomitant visible vascular damage, but may reflect a predisposition to functional neurosensorial disorder.
Outcome after treatment of congenital unilateral cataract
Authors: Lundvall Anna , Kugelberg Ulla
Published: March 2003

Purpose:  To evaluate long‐term functional outcome after treatment of congenital unilateral cataract.

Methods:  The records of 30 consecutive children operated on before the age of 12 months at St. Erik's Eye Hospital over a 5‐year period (1991–96) were reviewed retrospectively. The patients were followed until 4–9.5 years of age. Linear Snellen visual acuity (VA), occlusion therapy compliance, and the presence of nystagmus, strabismus and other complications are reported.

Results:  Six children achieved VA of 0.1 or better. They were all operated on before 3 months of age. Of the 12 infants operated on before 6 weeks of age, four have VA between 0.3 and 0.4 and eight have VA of finger counting or less. Four developed severe secondary glaucoma within 6 months of cataract extraction. Two of these had persistent fetal vasculature. Three eyes developing glaucoma became amaurotic. Occlusion therapy was abandoned before the age of 2.5 years in 21 children.

Conclusion:  Good levels of VA were achieved only in children who underwent cataract surgery before 3 months of age and who adhered to the occlusion therapy schedule. Severe secondary glaucoma developed in four out of 12 children operated on within 6 weeks. Full compliance with the occlusion therapy programme was uncommon.