Insertion of a foldable hydrophobic IOL through the trabeculectomy fistula in cases with Microincision cataract surgery combined with trabeculectomy

BACKGROUND: The use of conventional foldable hydrophobic intraocular lenses (IOLs) in microincision cataract surgery (MICS) currently requires wound enlargement. We describe a combined surgical technique of MICS and trabeculectomy with insertion of a foldable IOL through the trabeculectomy fistula. METHODS: After completion of MICS through two side port incisions, a 3.2 mm keratome is used to enter the anterior chamber under the previously outlined scleral flap. An Acrysof multi piece IOL (Alcon labs, Fort Worth, Tx) is inserted into the capsular bag through this incision. The scleral flap is then elevated and a 2 × 2 mm fistula made with a Kelly's punch. The scleral flap and conjunctival closure is performed as usual. RESULTS: Five patients with primary open angle glaucoma with a visually significant cataract underwent the above mentioned procedure. An IOL was implated in the capsular bag in all cases with no intraperative complications. After surgery, all patients obtained a best corrected visual acuity of 20/20, IOL was well centered at 4 weeks follow up. The mean IOP (without any antiglaucoma medication) was 13.2 + 2.4 mm Hg at 12 weeks with a well formed diffuse filtering bleb in all the cases. CONCLUSION: The technique of combining MICS with trabeculectomy and insertion of a foldable IOL through the trabeculectomy fistula is a feasible and valuable technique for cases which require combined cataract and glaucoma surgery

Risk Factors for Tube Shunt Exposure: A Matched Case-Control Study

Purpose. To evaluate potential risk factors for developing tube shunt exposure in glaucoma patients. Patients and Methods. Forty-one cases from 41 patients that had tube shunt exposure from 1996 to 2005 were identified from the Robert Cizik Eye Clinic and Bascom Palmer Eye Institute. Each case was matched with 2 controls of the same gender and with tube shunts implanted within 6 months of the index case. Conditional logistic regression was used to determine risk factors. Results. The study cohort includes a total of 121 eyes from 121 patients. The mean age was 63.6 ± 19.7 years, ranging from 1 to 96 years. The average time to exposure was 19.29 ± 23.75 months (range 0.36–85.74 months). Risk factors associated with tube exposure were Hispanic ethnicity (; OR = 3.6; 95% CI, 1.3–9.7), neovascular glaucoma (; OR = 28.5; 95% CI, 2.6–316.9), previous trabeculectomy (; OR = 5.3; 95% CI, 1.6–17.7), and combined surgery (; OR = 3.7; 95% CI, 1.1–12.7). Conclusions. Hispanic ethnicity, neovascular glaucoma, previous trabeculectomy, and combined surgery were identified as potential risk factors for tube shunt exposure. These potential risk factors should be considered when determining the indication for performing tube shunt implantation and the frequency of long-term followup

Improving the biopharmaceutical attributes of mangiferin using vitamin E-TPGS co-loaded self-assembled phosholipidic nano-mixed micellar systems

The current research work encompasses the development, characterization, and evaluation of self-assembled phospholipidic nano-mixed miceller system (SPNMS) of a poorly soluble BCS Class IV xanthone bioactive, mangiferin (Mgf) functionalized with co-delivery of vitamin E TPGS. Systematic optimization using I-optimal design yielded self-assembled phospholipidic nano-micelles with a particle size of  80% of drug release in 15 min. The cytotoxicity and cellular uptake studies performed using MCF-7 and MDA-MB-231 cell lines demonstrated greater kill and faster cellular uptake. The ex vivo intestinal permeability revealed higher lymphatic uptake, while in situ perfusion and in vivo pharmacokinetic studies indicated nearly 6.6- and 3.0-folds augmentation in permeability and bioavailability of Mgf. In a nutshell, vitamin E functionalized SPNMS of Mgf improved the biopharmaceutical performance of Mgf in rats for enhanced anticancer potency

Biochemical and Ultrastructural Changes in Lens during Aging of Wistar Albino Rats

Aims: To correlate the age-related structural changes in lens with its contents of amino acids and minerals involved in its functional activity (sodium, calcium, magnesium and copper). Study Design: Experimental study. Place and Duration of Study: Department of Zoology, Faculty of Science, Mansoura University, Egypt, between June 2009 and July 2011. Methodology: One hundred male and female albino rats of the Wistar strain (Rattus norvegicus) aging 1, 6, 18, 30 & 42 months were used during experimentation. At the mentioned ages, the animals were sacrificed by diethyl ether and ocular regions were dissected and lens separated. Amino acids content were determined in both lenses of five individuals. In the other five individuals, unilateral ectomized lenses were subjected for chemical determination of calcium, sodium, cupper and magnesium. The rest lenses on the other side were fixed in 10% phosphate buffered formalin followed by 2.5% glutaraldhyde for scanning electron microscopic investigation. Statistically analysis was carried out by the help of SPSS software. Results: The estimated amino acids were altered in both sexes with advancement of aging. The lens amino acids; taurine, prolline, serine, threonine, methionine, lysine and arginine were markedly increased during aging comparing with apparent depletion of asparate, valine and methionine. The alterations in amino acid contents were parallel with increased accumulation of calcium, sodium and cupper and a depletion of magnesium content. Scanning Electron Microscopic (SEM) observations exhibited sequences of changes of the structures of lens fibers and their pattern of attachments during the advancement of aging. In the advanced aged group, the lens fibers become fragile and widely separated as a result of loosely attached of the interfibrillar junctions of the ball and socket especially at 30 & 42 month old rats. Conclusion: Aging led to alterations of lens fibers at ultrastructural levels associated with diversity of changes in their amino acids contents parallel with increase accumulation of sodium, calcium and cupper and a decrease of magnesium content. The observed findings may be attributed to the increase of advanced glycation end products initiated oxidative stress, impairing lens structure and function

IMMEDIATE AND LATE EFFECT OF CRYOTHERAPY ON BALANCE IN HEALTHY SUBJECTS

Background: cryotherapy application is commonly used as a physical therapy tools with many advantages, however numerous researchers have stated decrease in subject balance which affects quality of movement following cryotherapy application, thus the purpose of study was to investigate the immediate and late effect of cryotherapy on ankle dominant joint on static balance and test the difference in static balance change between both sexes. Methods: Thirty healthy subjects, Subjects had their static balance tested during two conditions: (1) an experimental condition where the subject received the cryotherapy application by using cooled gel pack to the dominant ankle joint for 15 minutes immediately before static balance testing and (2) a control condition finished at room temperature. Using coin flip for randomization the order of examining condition. Biodex balance system was used to measure static balance. Results: analysis of data using ANOVA and unpaired test, show insignificantly statistically effect in all aspect of static balance within female group and within male group with p-value of overall stability index for female=0.669, for male =0.382, Anterior/posterior stability index for female =0.196, for male=0.552 and medial/lateral stability index for female =0.989, for male=0.46 and insignificant statistically difference between male and female in all aspect of static balance. Conclusion: the result of the study suggest that using cold gel pack for fifteen minutes of cold gel pack on dominant ankle extremity have no effect on static balance on both sexes

Novel anterior-chamber angle measurements by high-definition optical coherence tomography using the Schwalbe line as the landmark

10.1136/bjo.2010.189217British Journal of Ophthalmology957955-959BJOP