Effect of Er:YAG laser cavity preparation on the bond strength of 2-hydroxyethyl methacrylate-free and 2-hydroxyethyl methacrylate-rich self-etch adhesive systems: An in vitro study.

BACKGROUND: Despite many advantages of lasers and reduction of the risk of surface bonding errors with newer self-etch systems, they have not been thoroughly researched. This study was done to evaluate the effect of Er:YAG laser cavity preparation on the microtensile bond strength of 2-hydroxyethyl methacrylate (HEMA)-rich and HEMA-free one-step self-etch adhesive systems. MATERIALS AND METHODS: In this in vitro study, eighty freshly extracted human premolars were collected. Cavities were prepared in 40 teeth with carbide bur (Group 1) and in other 40 teeth with Er:YAG LASER (490 mJ and 15 Hz) (Group 2). Subgroups of twenty teeth each were made according to the adhesive systems used. After placement of restoration, the mean values of the bond strength were calculated using universal testing machine. Data were then tabulated and analyzed using descriptive statistics (Significant at P < 0.05). RESULTS: The overall microtensile bonding strength was higher when the cavities were prepared with bur compared to those with Er:YAG laser. Mean bond strengths of single-bottle self-etching seventh-generation dentin bonding agents to bur-prepared cavities were higher than those to laser-prepared cavities irrespective of the adhesive system (P = 0.01). No statistically significant difference was observed between HEMA-free and HEMA-rich self-etch adhesive systems. CONCLUSION: The effect of Er:YAG laser for cavity preparation did not show improved performance when evaluated using microtensile bond strength with seventh-generation bonding agents, Adper Easy One and G-Bond. More studies are required to assess the effect of lasers.

Children with Down syndrome benefit from bifocals as evidenced by increased compliance with spectacle wear.

BACKGROUND: In our experience, children with Down syndrome were noncompliant with spectacle wear, often attributed to their inability to appreciate benefit from the glasses. Studies show that up to 80% of children with Down syndrome have reduced accommodation. The purpose of this study was to evaluate whether the use of bifocals increased compliance with spectacle wear. METHODS: A retrospective review of medical records from 1983 to 2007 identified 86 children with Down syndrome who were prescribed either bifocal or single vision spectacles. Compliance with spectacle wear was assessed by telephone and was available for 57 children: 27 with bifocals and 30 with single-vision spectacles. Accommodative ability had been assessed by dynamic retinoscopy in 39 of these children. RESULTS: In the 27 bifocal children, all had poor accommodation on dynamic retinoscopy. Of these 27 children, 24 were compliant with spectacle wear (89%), whereas only 15 of the 30 single-vision spectacle children were compliant (50%). Of the 30 single-vision spectacle children, 18 had not had dynamic retinoscopy, and accommodative ability was thus unknown. Of the 12 who had undergone dynamic retinoscopy, 5 showed poor accommodation. The remaining 7 had good accommodation but showed compliance of only 43% in wearing single-vision glasses. The association between type of spectacle prescribed and compliance with wear was statistically significant by χ(2) testing (P = 0.002). CONCLUSIONS: In our study cohort, the addition of bifocal segments improved compliance with spectacle wear in children with Down syndrome.

Vertical vergence adaptation produces an objective vertical deviation that changes with head tilt.

PURPOSE: To document the cyclovertical ocular motor mechanism used for vertical fusion in healthy subjects, and to explore whether vertical vergence training in healthy individuals can produce objectively confirmed vertical deviations that change with head tilt, revealing a basic mechanism that can produce a pattern of misalignment in an otherwise normal ocular motor system that is similar to superior oblique muscle paresis (SOP). METHODS: Seven subjects with normal orthoptic examinations were adapted to vertical image disparities using our tilting haploscopic eye-tracking apparatus presenting concentric circle targets without torsional cues. Static eye positions were recorded with head straight and when tilted 45 degrees to the left and right, during both binocular and monocular viewing. RESULTS: Vertical fusional vergence was accompanied by a cycloversion, with the downward-moving eye intorting and the upward-moving eye extorting, implicating primary involvement of the oblique extraocular muscles. After adaptation to the slowly increasing vertical target separation, all subjects developed a temporary vertical deviation in the straight ahead position that increased with head tilt to one side and decreased with head tilt to the other side. CONCLUSIONS: These results not only show that head-tilt-dependent changes in vertical deviation are not necessarily pathognomonic for SOP, but also, and more importantly, suggest mechanisms that can mimic SOP and suggest a possible role for vertical vergence training in reducing deviations and thus the amount of head tilt required for fusion. Ultimately, vertical vergence training may provide an adjunct or alternative to extraocular muscle surgery in selected cases.

Infectious crystalline keratopathy associated with Klebsiella oxytoca.

PURPOSE: The purpose of this study is to report a novel case of a Klebsiella oxytoca-associated infectious crystalline keratopathy METHODS: This is a case report study. RESULTS: An 80-year-old woman presented with complaint of noticing a white spot in the left eye for 2 to 3 days, as well as mild soreness and discharge. Past ocular history was notable for a failed left corneal transplant for which she was taking prednisolone acetate 1 % twice per day. On slit-lamp examination, there was an extensive stromal ulcer and infiltrate in the inferior half of the transplant. Extending superiorly in the graft were branching, needle-like deep stromal opacities, characteristic of infectious crystalline keratopathy. Diagnostic scrapings revealed Gram-negative bacilli, subsequently identified on culture as K. oxytoca. There was also light growth of Staphylococcus species. The patient was placed on double topical antibiotic therapy with moxifloxacin and fortified tobramycin. After 2 months of treatment there was gradual resolution of the infection. CONCLUSIONS: K. oxytoca is a microorganism which can be associated with clinical infectious crystalline keratopathy, presenting as a mixed infection along with Staphylococcus species.

Treatment of Sjögren's syndrome-associated dry eye an evidence-based review.

BACKGROUND: Outcomes-based review of reported treatment options for patients with dry eye secondary to Sjögren's syndrome (SS). CLINICAL RELEVANCE: Dry eye affects many individuals worldwide. Significant proportion of patients with dry eye has underlying SS, a progressive autoimmune condition. The few suggested guidelines for the treatment of dry eye are mostly based on severity of symptoms and/or clinical findings rather than on outcomes analysis, and do not differentiate SS from other causes of dry eye. METHODS AND LITERATURE REVIEW: A search strategy was developed to identify prospective, interventional studies of treatments for SS-associated dry eye from electronic databases. Eligible references were restricted to English-language articles published after 1975. These sources were augmented by hand searches of reference lists from accessed articles. Study selection, data extraction, and grading of evidence were completed independently by ≥4 review authors. RESULTS: The searches identified 3559 references as of August 10, 2010. After duplicate review of the titles and abstracts, 245 full-text papers were assessed, 62 of which were relevant for inclusion in the review. CONCLUSIONS: In the current literature on SS-associated dry eye, there is a paucity of rigorous clinical trials to support therapy recommendations. Nonetheless, the recommended treatments include topical lubricants, topical anti-inflammatory therapy, and tear-conserving strategies. The efficacy of oral secretagogues seems greater in the treatment of oral dryness than ocular dryness. Although oral hydroxychloroquine is commonly prescribed to patients with SS to alleviate fatigue and arthralgias, the literature lacks strong evidence for the efficacy of this treatment for dry eye.

Multiple cutaneous metastases from esophageal adenocarcinoma.

INTRODUCTION: Cutaneous metastases from internal malignancies are very uncommon. [corrected] We describe an extremely rare case of multiple cutaneous metastases from esophageal adenocarcinoma. CASE REPORT: A month before the patient came to us, he had presented to the ER for evaluation of skin lesions and was sent home on a 1-week course of oral antibiotics. He later presented with dysphagia and was diagnosed with esophageal adenocarcinoma and biopsy of the skin lesions revealed metastases. DISCUSSION: This report stresses the importance that newly appearing skin lesions may be the first presentation of esophageal carcinoma.

Rheumatoid arthritis is a risk factor for dry eye in the Indian population.

PURPOSE: To compare the prevalence and severity of dry eye in patients with rheumatoid arthritis (RA) with that in age- and sex-matched controls in the Indian population. METHODS: A cross-sectional study was performed on 84 randomly selected eyes of 84 adult patients with well-documented rheumatoid arthritis and 84 eyes of 84 age- and sex-matched controls in the Department of Ophthalmology, Seth G.S. Medical College and K.E.M. Hospital. McMonnie's dry eye questionnaire was used to classify the patients on the basis of their symptoms. Dry eye was diagnosed if the wetting on Schirmer filter paper test was < or =5 mm at 5 minutes and the tear film breakup time was < 10 seconds on slit-lamp examination after fluorescein staining. RESULTS: Twenty three patients (27.3%) with rheumatoid arthritis had dry eyes based on the Schirmer test as compared to 10 (12%) age- and sex-matched controls; 19 (22.62%) patients with RA had a tear film breakup time of < 10 sec. on slit-lamp examination, compared to 8 (9.52%) patients without RA. The difference in the mean wetting (p = 0.003) and mean tear film breakup time (p < 0.001) between RA and non-RA patients was statistically significant. Ocular symptoms had a limited correlation with the results of these tests. CONCLUSIONS: Patients with RA in the Indian population have a significantly higher prevalence and severity of dry eye when compared to age- and sex-matched controls.