Posterior chamber collamer phakic intraocular lens for myopia and hyperopia.

PURPOSE: To assess the feasibility of correcting refractive errors using a foldable posterior chamber phakic intraocular lens. METHODS: Thirty-four foldable posterior chamber phakic intraocular lenses (STAAR Collamer intraocular lens) were consecutively implanted by the same surgeon (PMP) in 19 myopic eyes and 15 hyperopic eyes. In myopic eyes, mean preoperative spherical equivalent refraction was -16.65 +/-3.37 D (range, -8.12 to -21.25 D). In hyperopic eyes, mean preoperative spherical equivalent refraction was +7.77+/-2.08 D (range, +4.75 to +11.75 D). Mean follow-up was 12 months (range, 6 to 18 mo). Two hyperopic eyes were not included in the data analysis because of removal of the intraocular lens due to pupillary block. RESULTS: Myopic eyes (n=19)-Mean spherical equivalent postoperative refraction was -1.51+/-1.37 D (range, -5.50 to+0.38 D). Postoperative refraction was within +/-0.50 D in 4 eyes (21.05%) and within +/-1.00 D in 8 eyes (42.10%). Uncorrected visual acuity was 20/40 or better in 12 eyes (63.15%) and 20/25 or better in 3 eyes (15.78%). No eye had an uncorrected visual acuity of 20/20 or better. Spectacle-corrected visual acuity was 20/40 or better in all eyes, 20/25 or better in 12 eyes (63.15%), and 20/20 or better in 1 eye (5.26%). Spectacle-corrected visual acuity was unchanged in 10 eyes (52.63%) and improved in 9 eyes (47.36%). A retinal detachment developed in 1 eye (5.26%). Hyperopic eyes (n=15)-Mean spherical equivalent postoperative refraction was +0.02+/-0.64 D (range, -1.00 to +1.50 D). Postoperative refraction was within +/-0.50 D in 9 eyes (69.25%) and +/-1.00 D in 12 eyes (92.30%). Uncorrected visual acuity was 20/40 or better in 6 eyes (46.15%) and 20/25 or better in 3 eyes (20.25%). No eye had an uncorrected visual acuity of 20/20 or better. Spectacle-corrected visual acuity was 20/40 or better in 7 eyes (53.84%), 20/25 or better in 6 eyes (46.15%), and 20/20 or better in 2 eyes (15.38%). Spectacle-corrected visual acuity was unchanged in 10 eyes (76.92%), significantly improved in 2 eyes (15.38%), and worse in 1 eye (7.69%). Two of 15 eyes (13.33%) developed a severe pupillary block necessitating removal of the implants. One eye (7.69%) developed an anterior subcapsular cataract. CONCLUSIONS: Refractive predictability appears better for hyeropia than for myopia using the STAAR Collamer foldable posterior chamber phakic intraocular lens. In hyperopic eyes, development of pupillary block may occur.

Excimer laser in situ keratomileusis for myopia.

PURPOSE: To evaluate the efficacy, safety, and predictability of excimer laser in situ keratomileusis (LASIK) for the correction of myopia. METHODS: Forty-six consecutive eyes that had LASIK with the VISX 20/20B laser and Chiron corneal shaper were evaluated. Mean spherical equivalent of the preoperative manifest refraction was -9.40 +/- 3.78 diopters (D) (range, -3.50 to -19.75 D). The refractive effect (postoperative refraction minus baseline refraction), residual refractive error (refractive effect minus planned correction) and uncorrected and spectacle-corrected visual acuity were examined. RESULTS: Mean follow-up was 6.1 months (range, 3 to 9 mo). Spectacle-corrected visual acuity was unchanged in 39 eyes (84.78%), significantly improved in five eyes (10.86%), and worse in two eyes (4.34%). Uncorrected visual acuity was 20/20 or better in 15 eyes (32.6%) and 20/40 or better in 39 eyes (84.78%). Thirteen eyes (28.26%) had a postoperative spherical equivalent refraction within +/- 0.50 D and 36 eyes (78.26%) within +/- 1.00 D of attempted correction. No intraoperative complication occurred. Postoperative complications were few and not severe: three eyes (6.52%) developed regular astigmatism, two eyes (4.34%) had interface deposits, and three eyes (6.52%) had small epithelial cysts in the interface. CONCLUSION: LASIK with the VISX 20/20B laser is safe, moderately effective, and relatively predictable for correcting myopia from -3.50 to -19.50 D. Predictability decreases with increasing myopia.

Collamer intraocular contact lens to correct high myopia.

PURPOSE: To determine the feasibility of using posterior chamber intraocular contact lenses to treat myopia. SETTING: Ambulatory surgery centers in Torino, Ancona, and Ivrea, Italy. METHODS: The phakic intraocular contact lens is made of a collagen copolymer. We implanted 15 of these lenses in 14 patients with preoperative spherical equivalents ranging from -10.8 to -24.0 diopters (D); average myopia was -15.3 D +/- 3.1 (SD). Average follow-up was 7.0 +/- 1.95 months. RESULTS: Mean postoperative spherical equivalent was -2.0 +/- 1.6 D. Uncorrected visual acuity improved in 14 eyes. Best spectacle-corrected acuity was maintained or improved in all but one eye. No iritis or cataracts were observed. Six months postoperatively, the mean endothelial cell loss was 4%. A pupillary block requiring a superior peripheral iridectomy occurred in one eye. CONCLUSIONS: Because of the incomplete follow-up, we cannot draw conclusions about the long-term safety of the implantable contact lens. The intimate contact between the contact lens and the natural lens raises the possibility of cataract formation. However, examination by Scheimpflug photography and ultrasound biomicroscopy showed no progressive lens opacities.

Is the HELLP syndrome due to inherited factors? Report of two cases.

The etiology and pathogenesis of the HELLP syndrome, a multisystem disease occurring only in pregnancy, are still unclear. Curiously, very few authors have investigated whether inherited factors may be involved. We report two cases of HELLP syndrome in two unrelated women whose fetuses were relatives (first cousins). The first case concerned a woman aged 32 with a normal course pregnancy who was admitted to the hospital for fever, nausea and vomiting, low platelets, hemolysis and increased liver enzymes. Abruptio placentae with fetal death and severe disseminated intravascular coagulation with hemorrhages ensued within a few hours. Hysterectomy was then performed. After treatment with transfusions and drugs the patient slowly improved; 28 days later she left the hospital in good condition. The second case involved a woman aged 31 with a normal course pregnancy who was admitted to the hospital for epigastric pain, nausea, low platelets, hemolysis and increased liver enzymes. The patient underwent an immediate cesarean section and delivered a live infant; no bleeding occurred during or after delivery. The patient's condition rapidly improved and she left the hospital after 13 days. Until now, no author has proved that inherited fetal factors are at work in the HELLP syndrome. Our observations suggest a role for genetic factors, and this needs to be investigated in prospective studies.

Growth retardation, size at birth and perinatal mortality in twin pregnancy.

The records of 194 consecutive pairs of twins were reviewed. Univariate and multivariate analyses of relative risks (RR) of perinatal death were performed. Perinatal mortality rate was higher in small-for-gestational-age twins and in fetuses with discordancy in size at birth more than 20% and 25%. The RR of perinatal death for small-for-gestational-age twins was 4.8 (2.74-8.42 95% CI). For intertwin birth-weight percent differences of 20% and 25%, the RR was 5.48 (3.2-9.38 95% CI) and 7.2 (3.87-13.42 95% CI). Population mortality attributable risk in the two populations (10.36% and 14.5%, respectively) demonstrates the importance of the prenatal assessment of the respective size of twins in preventing perinatal death.

Assessment of peri-neonatal mortality and morbidity risk in twin pregnancy.

A case control study on peri-neonatal mortality and morbidity rates in 154 twin pregnancies has been performed. The mortality rates along with main neonatal morbidity factors were evaluated in relation to the birth weight and gestational age. The risk of death in peri-neonatal period was 17 times greater (relative risk 17.30) (p less than .00005) in newborns weighing less than 2000 g and about 15 times (r.r. 14.53) (p less than .00005) in twins born before 34th week of gestational age with respect to the controls. The Apgar score of the 2nd twin was lower than that of the 1st, both at 1' (p less than .05) and 5' (p less than .025). The development of HMD was strongly influenced by the gestational age when less than 34th week (r.r. 15.89) (p less than .00005). No difference in incidence was found between the newborns with gestational age between 34-37 weeks and those at term. The potential implications of these findings on obstetric and neonatologic treatment of LBW and VLBW twins was discussed.

The significance of ponderal index as a prognostic factor in a low-birth-weight population.

Neonatal prognostic significance of some biometric parameters in a population study of 331 low-birth-weight newborns was investigated. Multiple logistic regression analysis demonstrates that length, head size and weight are the best predictors of neonatal outcome in small for gestational age (SGA) newborns. In the population of SGA newborns biometric parameters more affected by growth failure were thoracic circumference, weight, head circumference and length, in that order. It seems that the best parameters for the sonographic diagnosis of growth failure are the poorest predictors of neonatal outcome. The possible role of ponderal index as an expression of fetal and neonatal well-being is discussed.

Determination of plasmatic copper and zinc in uncomplicated pregnancies.

The copper and zinc plasmatic concentrations were determined in a group of 50 pregnant women and in a control group. We found higher copper and lower zinc plasmatic levels in pregnancy than in control group. No correlation was found between the copper and zinc plasmatic levels and the weeks of pregnancy.

Microinvasive carcinoma of the vulva.

A case of microcarcinoma of the vulva (depth of invasion less than 5 mm) with an unexpected natural history is reported. The 338 cases, up today, reported in literature are reviewed and therapeutical protocols discussed.