Assessment of anterior chamber flare and cells after laser in situ keratomileusis.

PURPOSE: To determine the presence of anterior chamber flare and cells after laser in situ keratomileusis (LASIK) for the correction of myopia. SETTING: Hermann Eye Center and the University of Texas Medical School, Department of Ophthalmology and Visual Science, Houston, Texas, USA. METHODS: Forty-three eyes of 23 consecutive patients ranging in age from 24 to 62 years had LASIK for myopia. All surgeries were performed by a single surgeon using a VISX Star laser and the same technique. Patients received no preoperative antiinflammatory medications. Postoperatively, all patients were instructed to use 1 drop of ofloxacin (Ocuflox) and 1 drop of fluorometholone 0.1% (FML) in the operated eye 4 times daily while awake for 7 days. At baseline and postoperative days 1, 7, and 28, anterior chamber flare was measured and cells were counted using a Kowa laser flare meter (FM-500) and laser cell counter (LC-500), respectively. RESULTS: Flare and cells increased significantly on day 1 (P <.0001 for both flare and cells) and returned to preoperative levels by day 7. No statistically significant correlation was detected between the amount of inflammation and the number of laser pulses (P =.2922) or the ablation time (P =.8383). CONCLUSIONS: A significant increase in anterior chamber inflammation occurred during the first 24 hours after LASIK. Inflammation levels then subsided to preoperative levels by day 7 with steroid use. Anterior chamber inflammation did not appear to correlate with the duration of the ablation or the number of laser pulses.

Bleb window cryopexy for the management of oversized, misplaced blebs.

PURPOSE: To describe a new technique for revising oversized blebs after trabeculectomy. METHODS: A chart review of consecutive patients undergoing bleb window cryopexy was conducted. Patients with symptomatic oversized blebs were candidates for the technique, regardless of the intraocular pressure. Under topical anesthesia, the bleb was incised and a 3 mm x 3 mm conjunctival window was removed using 0.12 forceps and Vannas scissors. Light cryotherapy was applied to the sclera through the window. A soft bandage contact lens was then placed for compression, and a patch was applied. All patients were given antibiotic drops the first day after surgery. Topical corticosteroid drops were used to minimize postoperative inflammation. Outcome measures included relief of symptoms, adequate control of intraocular pressure, and restoration of filtering bleb function without further antiglaucoma medication or surgical bleb revision. RESULTS: Nine patients met the inclusion criteria. All patients had flattening of the bleb with symptomatic relief within 2 weeks. No loss of bleb function occurred. One patient developed aqueous misdirection after the procedure. CONCLUSION: Early results showed that bleb window cryopexy is safe and effective. This minimally invasive technique can be useful for selected patients with large. symptomatic, overhanging blebs.

Efficacy of preoperative versus postoperative ketorolac tromethamine 0.5% in reducing inflammation after cataract surgery.

PURPOSE: To compare the efficacy of 30 minute preoperative versus 1 day postoperative administration of ketorolac tromethamine 0.5% ophthalmic solution (Acular) in reducing anterior chamber inflammation after cataract surgery. SETTING: The Hermann Eye Center, The University of Texas Health Science Center-Houston, Texas, USA. METHODS: Fifty eyes of 48 consecutive patients scheduled for phacoemulsification with intraocular lens implantation were included. Before surgery, patients were randomly assigned to start the study drug 30 minutes preoperatively or 1 day postoperatively. No other antiinflammatory agents were used intraoperatively or postoperatively. Main outcome measures were flare and cell counts. RESULTS: Preoperative and postoperative flare and cell counts did not differ significantly between the 2 treatment groups at any time. Both groups showed significant increases in flare (P =.0001) and cells (P =.0001) 1 day postoperatively. Flare and cells returned to baseline levels by day 28 in both groups. There was no significant difference at any time between the 2 groups in the change from the preoperative level of inflammation. CONCLUSIONS: There was no difference between administering ketorolac 30 minutes preoperatively versus 1 day postoperatively in reducing inflammation.

Autologous conjunctival resurfacing of leaking filtering blebs.

PURPOSE: To present a case series of a new technique to repair late bleb leaks. DESIGN: Retrospective, noncomparative, consecutive case series. PARTICIPANTS: Forty-seven autologous conjunctival resurfacings of late bleb leaks were performed by four surgeons at two institutions. METHODS: Autologous conjunctival grafts were placed over existing de-epithelialized leaking blebs. MAIN OUTCOME MEASURES: Leak-free, Seidel-negative blebs and controlled glaucoma. RESULTS: After a mean follow-up of 14 +/- 12 months, one patient continued to have bleb leak at the last follow-up, and one frank leak resolved with aqueous suppression. Intraocular pressure increased from 6.6 +/- 4.4 mmHg (0.13 glaucoma medications) to 11.9 +/- 4.1 mmHg (0.41 glaucoma medications). CONCLUSIONS: Conjunctival resurfacing with autologous tissue is an effective technique to repair late bleb leaks.

Comparison of antibiotic drops placed in the conjunctival cul-de-sac to antibiotic ointment applied to the lid margin in reduction of bacterial colonization on the lid margin.

PURPOSE: To compare the efficacy of antibiotic drops placed in the conjunctival cul-de-sac to antibiotic ointment applied to the lid margin in reduction of bacterial colonization on the lid margin. METHODS: A randomized, prospective, single-masked study was conducted on 19 patients with culture-proven colonization of bacteria on the lid margins. Ophthalmic eligibility criteria included the presence of > or =50 colony-forming units/mL (CFU/mL) of bacteria on both right and left lids. Each patient received one drop of ofloxacin in one eye every night for one week, followed by one drop once a week for one month. In the same manner, each patient received bacitracin ointment (erythromycin or gentamicin ointment if lid margin bacteria were resistant to bacitracin) to the lid margin of the fellow eye. Quantitative lid cultures were taken at initial visit, one week, one month, and two months. Fifteen volunteers (30 lids) served as controls. Lid cultures were taken at initial visit, one week, and one month. RESULTS: Both antibiotic drop and ointment reduced average bacterial CFU/mL at one week and one month. Average bacterial CFU/mL reestablished to baseline values at two months. There was no statistically significant difference between antibiotic drop and ointment in reducing bacterial colonization on the lid margin. CONCLUSION: Antibiotic drops placed in the conjunctival cul-de-sac appear to be as effective as ointment applied to the lid margins in reducing bacterial colonization in patients with > or =50 CFU/mL of bacteria on the lid margins.

The Houston Vision Assessment Test (HVAT): an assessment of validity. The Cataract Outcome Study Group.

PURPOSE: Cataract surgery is one of the most successful procedures in medicine, and outcome is typically measured by a single factor - improvement in visual acuity. Health-related functional outcome testing, which quantifies the patient's self-reported perception of impairment, can be integrated with objective clinical findings. Based on the patient's self-assessed lifestyle impairment, the physician and patient together can make an informed decision on the treatment that is most likely to benefit the patient. METHOD: A functional outcome test (the Houston Vision Assessment Test - HVAT, copyrighted 1990, 1992) was evaluated in a cataract population of 149 patients from seven study centers. Test results were correlated with objective ophthalmic endpoints. The HVAT divides an estimated total impairment into subcomponents of Visual Impairment (correctable by cataract surgery) and non-visual Physical Impairments (co-morbidities not affected by cataract surgery). RESULTS: In this prospective study, the average Visual Impairment score improved by 19 points (65%) following cataract extraction (the mean HVAT Visual Impairment score was 29 points before surgery and 10 points at 5 months post-surgery, a change of 65%). Physical Impairment remained unchanged by surgery. Visual acuity was a poor predictor of Visual Impairment. CONCLUSIONS: The HVAT has 11 simple questions. It may be self-administered and is available on the Internet: http://www.DHAC.com. The physician may err if his decision in favor of cataract surgery is based only on visual acuity. The HVAT has the potential to guide the decision-making process between patient and physician.

Effects of atropine on anterior chamber depth and anterior chamber inflammation after primary trabeculectomy.

PURPOSE: To investigate the effects of postoperative atropine on central and peripheral anterior chamber depth and anterior chamber inflammation in patients undergoing primary trabeculectomy. METHODS: Two separate groups of patients who were phakic without previous intraocular surgery undergoing primary trabeculectomy were prospectively randomized to atropine or no atropine. In the first group of patients, 24 eyes of 21 patients undergoing primary trabeculectomy were prospectively randomized to atropine or no atropine, and their anterior chamber depth was measured. Central and peripheral chamber depths were measured using the EAS-1000 anterior segment analysis system (Nidek, Tokyo, Japan) before surgery and on postoperative days 1, 3, 7, 14, and 30. In the second group, 34 patients undergoing primary trabeculectomy were prospectively randomized to atropine or no atropine, and their anterior chamber reaction was documented. The amount of cells and flare was measured using the Kowa laser flare meter (FM-500) and cell counter (LC-500) (Kowa Electronics and Optics, Tokyo, Japan) preoperatively and on postoperative day 1, 7, and 30. RESULTS: Compared with preoperative measurements, a small (approximately 0.1 mm) but statistically significant deepening of the central and peripheral anterior chamber depth on days 1, 7, 14, and 30 was found in patients who used atropine. In the nonatropine group, no statistically significant change was found in central or peripheral anterior chamber depths at any time as compared with preoperative values. There was no statistically significant difference in the cell or flare counts between the atropine and nonatropine groups at any time. CONCLUSIONS: This study showed a small but statistically significant deepening of the anterior chamber with atropine. No statistically significant differences were observed in the cell or flare counts between atropine and nonatropine groups. Routine atropine use after trabeculectomy may not be necessary to reduce postoperative complications, such as shallowing of the anterior chamber or anterior chamber inflammation. In patients with a shallow anterior chamber, however, atropine would be expected to deepen the chamber.

Epithelial healing rates with topical ciprofloxacin, ofloxacin, and ofloxacin with artificial tears after photorefractive keratectomy.

PURPOSE: To determine whether corneal epithelial healing differs after the use of topical ciprofloxacin alone, topical ofloxacin alone, or topical ofloxacin with artificial tears in patients having photorefractive keratectomy (PRK). SETTING: Department of Ophthalmology and Visual Science, The University of Texas Health Science Center at Houston, Houston, Texas, USA. METHODS: Eighteen patients (6 women, 12 men) with moderate myopia (-1.50 to -6.00 diopters [D]) had standardized PRK. Patient age ranged from 25 to 62 years. The 28 eyes (16 right, 12 left) were randomized into 3 treatment groups: ofloxacin alone, n = 9 eyes; ciprofloxacin, n = 9 eyes; and ofloxacin with Refresh Plus, n = 10 eyes. The drugs were administered immediately after surgery and then every 6 hours. Video recordings of the corneal wounds stained with fluorescein were performed at 8:00 AM and 4:00 PM using a video slitlamp camera with a cobalt-blue light until the wound completely healed. The videotaped images were recorded and analyzed by a computer planimetry program. Wound areas were recorded and compared among the 3 drugs. The square-root transformation was applied to the wound area to obtain a constant healing rate. Statistical comparisons were analyzed using an analysis of variance test. RESULTS: Mean recovery time was 82.67 hours +/- 14.42 (SD) in the ofloxacin eyes, 120.89 +/- 34.05 hours in the ciprofloxacin eyes, and 76.80 +/- 19.30 hours in the ofloxacin with Refresh Plus eyes. Mean healing rate was 0.66 +/- 0.17 hours, 0.54 +/- 0.16 hours, and 0.67 +/- 0.15 hours, respectively. The healing rate was significantly higher in the ofloxacin with Refresh Plus eyes than in the ciprofloxacin eyes (P < .0001). There was no significant difference between the ofloxacin eyes and the ofloxacin with Refresh Plus eyes (P = .42). CONCLUSION: Ofloxacin with Refresh Plus and ofloxacin alone had a more positive effect on epithelial healing than ciprofloxacin. The ciprofloxacin eyes were significantly more prone to impaired or delayed wound healing and to the development of corneal haze.

Low-dose postoperative transconjunctival application of mitomycin C in rabbit trabeculectomy.

PURPOSE: Mitomycin C (MMC) is commonly administered during filtering surgery to enhance the success of the procedure. Unfortunately, the increased success rate is associated with complications, including late bleb leaks, endophthalmitis, and ciliary epithelial toxicity. The purpose of this study was to investigate a safe and effective dose regimen for MMC to reduce incidence of those complications. METHODS: Trabeculectomy was performed in 36 rabbits. MMC was applied only during surgery, only one day after surgery, or once daily after surgery for 3 days at lower concentrations. Balanced salt solution (BSS) was administered during surgery to one group as a placebo. The time to bleb failure was determined and the eyes were evaluated histopathologically. Success and toxicity were compared for the different treatment groups. RESULTS: The mean time until trabeculectomy failure was 2.83 days for the placebo group, 6.33 days with administration of MMC 0.5 mg/mL during surgery, 7.83 days with administration of MMC 0.5 mg/mL once after surgery, and 11, 9, and 4.83 days with administration of MMC 0.1 mg/mL, 0.05 mg/mL, or 0.025 mg/mL, respectively, once a day for 3 consecutive days. On electron microscopic examination of the ciliary epithelium, toxic effects were greatest with MMC concentrations of 0.5 mg/mL and were less with lower concentrations. CONCLUSION: The effect of MMC on trabeculectomy survival was dependent on both the concentration and the method of administration. Lower concentrations with multiple postoperative administrations were as effective as but caused less ciliary body toxicity than intraoperative administration of higher concentrations.

Consensual inflammation following ocular surgery.

PURPOSE: To determine whether a consensual inflammatory response occurs following unilateral phacoemulsification or trabeculectomy in humans. METHODS: Sixty patients undergoing phacoemulsification or primary trabeculectomy were included in the study. Some patients were randomly assigned to have a shield placed on the non-operated eye during surgery. The Kowa laser flare meter (FM-500) and laser cell counter (LC-500) (Kowa Electronics and Optics, Tokyo, Japan) were used to assess the inflammatory response in both eyes. Measurements were taken preoperatively and on postoperative days 1, 7 and 28. The regression analysis with random model effect was used to identify factors which may affect the change of flare and cells in the non-operated eye after surgery. Correlation was evaluated between the inflammatory responses of the paired eyes. A P<0.05 was considered statistically significant for all analyses. RESULTS: The flare and cells in the non-operated eye showed a small, but significant, increase on day 1 (mean flare increased 2.68 photons/ms from preoperative level with P<0.001 and mean cells increased 2.49 cells/0.5 mm3 from preoperative level with P<0.0001). At day 7 the amount of inflammation was still elevated (mean flare increased 0.41 photons/ms from preoperative level with P<0.001 and mean cells increased 0.63 cells/0.5 mm3 from preoperative level with P<0.001). By day 28, the amount of inflammation in the nonoperated eyes returned to preoperative levels. CONCLUSIONS: Subclinical inflammation occurs in the non-operated eye following phacoemulsification and trabeculectomy. The etiology of this finding has yet to be elucidated.

Endobronchial intubation causes an immediate increase in peak inflation pressure in pediatric patients.

UNLABELLED: Our purpose was to determine whether endobronchial intubation always causes an immediate increase in peak inflation pressure and, if so, the magnitude of the increase. Fourteen children scheduled for central line placement for prolonged antibiotic administration comprised the study group. After routine premedication and induction of anesthesia (halothane in oxygen), an endotracheal tube was inserted, and its position was verified by auscultation and fluoroscopy. Children were mechanically ventilated using a preset volume pressure-limited ventilator with a 5-L fresh gas flow. All children received a constant tidal volume using a similar circuit, similar tubing, and a similar compression volume. The lowest peak inflation pressure to deliver a tidal volume of 15 mL/kg was used. After adjusting the respiratory rate (end-tidal CO2 30 mm Hg) and anesthetic level (halothane end-tidal 1.2%), the peak inflation pressure at this endotracheal position was recorded. The endotracheal tube was advanced into a bronchus, the position was verified as above, and peak inflation pressure was recorded. The endobronchial tube was then pulled back into the trachea, and placement of the central line proceeded. The peak inflation pressure at the endobronchial position was significantly greater than the peak inflation pressure at the endotracheal position (P < 0.0001). The increase was instantaneous at the endobronchial position. Monitoring peak inflation pressure while inserting an endotracheal tube and during anesthesia can help to diagnose endobronchial intubation. IMPLICATIONS: Monitoring peak inflation pressure while inserting an endotracheal tube and during anesthesia can help to diagnose endobronchial intubation.

Ondansetron versus placebo for the control of nausea and vomiting during Caesarean section under spinal anaesthesia.

This prospective, randomised, placebo-controlled, double-blind study was performed to evaluate the effects of ondansetron on nausea and vomiting during elective Caesarean section under spinal anaesthesia. Seventy-four full-term parturients were studied. After umbilical-cord clamping, ondansetron 4 mg or 0.9% saline was injected intravenously and the study period continued for 2 h. The severity of nausea was graded from 0 = none to 10 = maximum, while that of vomiting was graded from single = once per min to continuous = multiple per min. The incidence of vomiting was lower following ondansetron (36%) compared with the control group (58%, p < 0.028). Neither the severity of vomiting nor the incidence of nausea was influenced by ondansetron. However, for those who experienced nausea, ondansetron reduced its severity (p = 0.05). We conclude that the intra-operative administration of 4 mg ondansetron intravenously during Caesarean section under spinal anaesthesia significantly reduces the incidence of vomiting and the severity of nausea.

Ondansetron/promethazine combination or promethazine alone reduces nausea and vomiting after middle ear surgery.

STUDY OBJECTIVES: To determine the incidence of postoperative nausea and vomiting when a combination of ondansetron and promethazine is given prophylactically, and to ascertain the effect of postoperative nausea and vomiting on recovery room duration and patient satisfaction. DESIGN: Prospective, randomized, placebo-controlled, double-blind study. SETTING: University-affiliated tertiary-care hospital. PATIENTS: 87 ASA physical status I and II adult patients scheduled for middle ear surgery. INTERVENTIONS: Patients were randomly assigned to receive one of the following interventions intravenously: ondansetron 4 mg (Group 1), promethazine 25 mg (Group 2), ondansetron 2 mg plus promethazine 12.5 mg (Group 3, combination), or placebo (Group 4). MEASUREMENTS AND MAIN RESULTS: Independent, study blinded observers recorded complaints of nausea and number of episodes of vomiting for 24 hours following the patient's first response to commands. All patients were contacted the day after discharge to inquire about nausea and vomiting. The awakening time, postanesthesia care unit and day surgery unit durations, opioid use, and side effects were recorded. At the end of the 24-hour period, the study blinded observers asked patients for an overall assessment of their global anesthesia experience using an 11-point scale. During the 24-hour period, the incidence of postoperative nausea and vomiting was reduced from 74% (placebo) to 39% (promethazine; p = 0.03) and 29% (combination; p = 0.003). Compared with placebo, the severity of vomiting was significantly less in the combination group (p = 0.04). The number of very satisfied patients correlated negatively with the incidence of postoperative nausea and vomiting (p < 0.0001) and with the severity of vomiting (p = 0.003). CONCLUSION: The prophylactic use of an antiemetic with middle ear surgery may reduce postoperative nausea and vomiting over 24 hours, and the ondansetron/promethazine combination or promethazine alone are cost-effective choices. Finally, the combination reduced significantly the severity of vomiting.

Incidence of perihepatic adhesions in ectopic gestation.

OBJECTIVE: To compare the incidence of perihepatic adhesions in patients undergoing surgery for ectopic pregnancy with the incidence in patients undergoing elective laparoscopic sterilization. Fitz-Hugh-Curtis syndrome is a perihepatitis that usually occurs as a complication of pelvic inflammatory disease. Perihepatic adhesions may be an aftereffect of the acute hepatic episode, and because the cause of ectopic gestation is thought to be salpingitis, women with an ectopic gestation may also have a higher prevalence of coexisting perihepatic adhesions. METHODS: We reviewed charts of 97 women who had undergone laparoscopy or laparotomy for ectopic pregnancy (study group) and 116 women who had laparoscopic sterilization (control group). We recorded all perihepatic, pelvic, or abdominal adhesions that were documented at the time of surgery. Medical histories and sites of adhesions in the two groups were compared. RESULTS: The incidence of perihepatic adhesions was 14% in the study group compared with 3% in the control group (P < .01). For the total patient population, a history of pelvic infection correlated positively with the presence of perihepatic adhesions (P < .01), and the study (ectopic) group had a higher incidence of previous pelvic infection. CONCLUSION: Compared with control subjects, significantly more women with ectopic pregnancies had perihepatic adhesions. In women who have history of pelvic infection or ectopic pregnancy, physicians should inquire about long-term right upper quadrant pain. The inclusion of lysis of perihepatic adhesions in the preoperative consent form may be useful.

Sublingual midazolam premedication in children: a dose response study.

The purpose of this study was to evaluate various doses of sublingual midazolam premedication in children. In our prospective, double-blind, placebo-controlled trial, children (n = 102, age range 12 to 129 months) scheduled for day surgery were randomized to receive either midazolam in one of three doses (0.25, 0.5, or 0.75 mg.kg-1) or placebo. Injectable midazolam was mixed with a thick grape syrup and placed under the tongue; the patient was asked to hold it as long as possible before swallowing. Children readily accepted the mixture. Analysing all patients randomized, none of the children receiving placebo vs 28% receiving 0.25 mg.kg-1 (P = 0.02), 52% receiving 0.5 mg.kg-1 (P < 0.001), and 64% receiving 0.75 mg.kg-1 (P < 0.001) of midazolam showed satisfactory sedation (drowsy) at 15 min after administration. Children receiving the two higher doses of midazolam (0.5 and 0.75 mg.kg-1) accepted mask induction willingly, while the group receiving 0.25 mg.kg-1 resembled the placebo group (P < 0.05).

Alfentanil decreases the excitatory phenomena of sodium methohexital.

STUDY OBJECTIVE: To evaluate the effects of alfentanil or lidocaine on the excitatory phenomena (myoclonus, cough, hiccough) caused by methohexital anesthesia and on the hemodynamic changes induced by retrobulbar block. DESIGN: Prospective, randomized, placebo-controlled, double-blind study. SETTING: University-affiliated, tertiary-care hospital. PATIENTS: 60 ASA physical status II and III patients who were admitted for elective cataract extractions and intraocular lens implantations. INTERVENTIONS: Patients were randomly assigned to one of three groups. After adequate preoxygenation in the holding area, Group 1 received alfentanil 5 micrograms/kg intravenously (i.v.), Group 2 received lidocaine 1 mg/kg i.v. and Group 3 received the placebo (saline) i.v. Immediately after the bolus injection of the study solution, sodium methohexital 1.5 mg/kg was injected i.v. over 30 seconds. As soon as the eyelid reflex was lost, the retrobulbar block was placed over 5 seconds. MEASUREMENTS AND MAIN RESULTS: Occurrences of excitatory phenomena were recorded by an independent observer who was blinded as to treatment allocation. Other side effects such as oculocardiac reflex, nausea, vomiting, itching, or chest wall rigidity were recorded. Vital signs were recorded at baseline and 1, 3, and 5 minutes after placement of the block. In the alfentanil group, the incidence of myoclonus or cough was significantly less than in the lidocaine or placebo groups. Alfentanil also decreased systolic and diastolic blood pressure significantly at 1, 3, and 5 minutes after retrobulbar block. Changes in heart rate were not significantly different from baseline. CONCLUSION: A small dose of alfentanil (5 micrograms/kg i.v.) decreases myoclonus and cough induced by sodium methohexital anesthesia i.v., resulting in improved quality of induction of anesthesia. Alfentanil also attenuates the cardiovascular responses caused by placement of a retrobulbar block.

Absence or presence of a leak around tracheal tube may not affect postoperative croup in children.

To prevent postoperative croup in children, many anaesthesiologists use a tracheal tube that allows a leak when tested with 20 to 25 cm of water pressure. We studied the correlation of postoperative croup with leak, duration of anaesthesia, and a recent cold in 159 healthy outpatient children who had strabismus correction by the same surgeon and the same anaesthesiologist. We found no correlation between the presence or absence of a leak and the incidence or severity of postoperative croup. There was a strong trend toward significance when postoperative croup and duration of anaesthesia were compared (P = 0.056) and a significant, positive correlation between severe croup (requiring racemic epinephrine) and duration of anaesthesia (P = 0.005). Patients having a recent cold did not have an increased incidence of postoperative croup. A leak around the tracheal tube at 20 to 25 cm of water pressure may not be required for a healthy child who undergoes surgery lasting less than 2 h if the child has no history of croup.

A randomized double-masked trial comparing ketorolac tromethamine 0.5%, diclofenac sodium 0.1%, and prednisolone acetate 1% in reducing post-phacoemulsification flare and cells.

BACKGROUND AND OBJECTIVE: To compare the efficacy of ketorolac tromethamine 0.5%, diclofenac sodium 0.1%, and prednisolone acetate 1% in reducing flare and cells following cataract surgery. PATIENTS AND METHODS: Fifty-eight patients undergoing phacoemulsification with posterior chamber intraocular lens implantation were randomly selected to receive either ketorolac tromethamine 0.5%, diclofenac sodium 0.1%, or prednisolone acetate 1% following surgery. The treatment regimen was 1 drop 4 times a day for 1 week, then twice a day for the next 3 weeks. Flare, cells, and intraocular pressures (IOPs) were measured preoperatively and on postoperative days 1, 7, and 28. RESULTS: No statistically significant differences in either actual flare or cell counts or in change in flare or cell counts from baseline were detected among the three groups. No statistically significant differences in IOP or in change of IOP from preoperative measurements were detected. No medication-related complications were noted at any time. CONCLUSION: Ketorolac tromethamine 0.5% and diclofenac sodium 0.1% may be as effective and as safe as prednisolone acetate 1% in controlling inflammation following cataract extraction.

Reproducibility of the laser flare meter and laser cell counter in assessing anterior chamber inflammation following cataract surgery.

BACKGROUND AND OBJECTIVES: To determine the interobserver and intraobserver reproducibility of the laser flare meter and laser cell counter in assessing anterior chamber inflammation following cataract surgery. PATIENTS AND METHODS: Thirty-nine eyes with varied degrees of inflammation and 9 normal eyes were included in the study. Anterior chamber flare and cells were evaluated with the slit lamp and graded on a scale of 0 to 4+. The flare and cells were then measured three times each using the flare meter and cell counter by two different, experienced observers. The intraobserver reproducibilities were computed to evaluate repeatability of the instruments operated by the same observer. The first measurement taken by each observer was used to assess reproducibility between the two observers. RESULTS: The intraobserver reproducibility for overall flare was 0.995 for both observers. The intraobserver reproducibility for overall cells was 0.996 for observer 1 and 0.991 for observer 2. The overall interobserver reproducibility was 0.994 for flare and 0.988 for cells. The correlation between measurements and slit-lamp ratings was 0.78 for flare and 0.56 for cells. CONCLUSIONS: The intraobserver and interobserver reproducibilities were excellent, with good correlation to slit-lamp measurements. Reproducible results can be obtained using the laser flare meter and the laser cell counter. It is not known whether these results are applicable to other inflammatory processes with higher grades of flare and cells and with different protein and cell types.

Artificial skin equivalent differentiation depends on fibroblast donor site: use of eyelid fibroblasts.

Our objective was to construct and explore human skin equivalents from several normal and pathologic donor skin sites to determine if the fibroblast origin influences epidermal differentiation. Also, we wanted to find out if fibroblasts from some donor sites produced epidermis of superior quality for plastic surgery repairs. Skin equivalents were constructed from 15 normal skin specimens, 9 normal eyelid specimens, 15 lesional skin specimens taken from patients with psoriasis, and 4 specimens from keloid scars. Results show that the tissue origin of the donor fibroblasts determines epidermal differentiation and the time period for regeneration. Eyelid fibroblasts were very dependable in establishing well-differentiated skin equivalents in all nine specimens. Our findings contribute to the accumulated knowledge of wound healing and should also be of value in skin grafting, especially when large areas are denuded as in burns, severe trauma, or cancer ablation.