Pregnancy Outcome in Military and Civilian Women

Low birth weight and prematurity account for much of the morbidity and mortality in the neonatal period as well as for much of the cost in newborn care. The purpose of this investigation was to determine if two groups of pregnant women, military enlisted and civilian dependents, differed in selected risk factors (smoking, alcohol consumption, weight gain, prenatal care, work patterns, life stress, and social support) or in pregnancy outcome (infant birth weight and gestational age). The House (1981) theory of stress, social support, and health served as the framework for this study. Since little has been published on pregnancy outcome in military populations, it was hypothesized that there would be no differences between the military and civilian subjects. This comparative survey design included a sample of 200 low risk primiparas who were interviewed during the third trimester of pregnancy. Outcome data was collected after delivery. Data was analyzed by t-test comparisons of mean values for predictor and outcome variables, chi-square analyses of categorical data, correlation matrices of variables, and multiple regression. Results showed that several prenatal risk factors were statistically different for the two groups of women. Hours worked per week, weeks worked during pregnancy, and number of prenatal clinic visits were greater for the active duty military group. Prenatal weight gain and reported level of social support were greater for the civilian dependents. However, outcome measures of infant birth weight and gestational age were not significantly different for the two groups. Pregnancy outcome was not contingent on maternal military status or employment patterns. Work outside the home during pregnancy did not compromise outcome. Active duty women, who worked longer into pregnancy, demonstrated as favorable results as their civilian counterparts

Use of 25% sulfur hexafluoride gas mixture may minimize short-term postoperative hypotony in sutureless 25-gauge pars plana vitrectomy surgery

Yoreh Barak, James W Heroman, Shlomit SchaalDepartment of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, USABackground: The purpose of this study was to compare postoperative intraocular pressures and percentage of vitreous cavity gas fill one day following 25-gauge pars plana vitrectomy with 20% versus 25% sulfur hexafluoride (SF6) gas fill.Methods: This was a retrospective review of 187 consecutive cases of 25-gauge pars plana vitrectomy with complete fluid/gas exchange. The main outcome measures included percentage of gas fill of the vitreous cavity and intraocular pressure on postoperative day one.Results: Fifty eyes underwent 25-gauge pars plana vitrectomy with 20% SF6 tamponade and 137 with 25% SF6 tamponade. On postoperative day one in the 20% SF6 group, there were five (10%) patients with hypotony (intraocular pressure ≤ 5 mmHg) and none in the 25% SF6 group. Mean intraocular pressure was 9 ± 2.5 mmHg and 16.8 ± 2.4 mmHg for the 20% SF6 and 25% SF6 groups, respectively (P < 0.01). None of the patients had postoperative intraocular pressure > 23 mmHg. Mean vitreous cavity gas fill on postoperative day one was 70.7% ± 10% in the 20% SF6 group and 89.5% ± 2.2% in the 25% SF6 group (P < 0.01). There was no difference in the number of phakic patients needing cataract surgery between the groups.Conclusion: A slightly expansile concentration of 25% SF6 gas can be safely and beneficially used in 25-gauge vitrectomy surgery to increase the amount of gas fill in the vitreous cavity and prevent postoperative hypotony.Keywords: hypotony, 25-gauge pars plana vitrectomy, sulfur hexafluorid

The Past, Present, and Future of Exudative Age-Related Macular Degeneration Treatment

Treatment of exudative age-related macular degeneration has been revolutionized within the last 6 years with the introduction of vascular endothelial growth factor neutralizing agents. Previously popular “destructive treatments,” such as laser photocoagulation and photodynamic treatment have either been abandoned or used as an adjunct to pharmacotherapy. Despite the increase in vision after antivascular endothelial growth factor (VEGF) agents, they require repetitive and costly intravitreal injections that also carry the inherit risks of infection, retinal tears, and detachment. Several new and more potent VEGF inhibitors are at different stages of development. The goal of evolving pharmacotherapy is to preserve the therapeutic effect while reducing or eliminating the discomfort of intravitreal drug delivery, as well as identify new therapeutic targets. Complement inhibitors, immunomodulators, integrin inhibitors are a few of the new class of drugs that are expected to be in our armamentarium soon. Current medications act to decrease leakage through abnormal subretinal choroidal vasculature and promote involution. However, these medications are only effective in treating the active stage of the choroidal neovascular membrane. Restoration of vision of a large number of patients with involuted choroidal neovascular membranes is warranted. For this purpose, tissue engineering techniques have been employed to reconstruct the subretinal anatomy. Discovery of biomarkers, pharmacogenetics, and very specific targeting holds the promise of increased potency and safety in the future