RESUMO
Purpose: Pediatric strabismus surgery has low success rates and high reoperation rates because of difficult alignment measurements and the nature of different strabismus types. Furthermore, adjustable sutures are not easily employed in children on an OPD basis. Methods: This was a retrospective comparative case study of children less than 12 years old who underwent strabismus surgery and were followed up at least 6 months postoperatively. We proposed a novel method that combines adjustable sutures and corneal light reflexes in regular strabismus surgery to improve surgical results. Efficacy and safety were evaluated and compared with those in a regular fixed-suture group. Results: In total, 128 children (88: exotropia and 41: esotropia) in the novel method group (Group 1) and 109 (71: exotropia and 38: esotropia) in the regular fixed-suture group (Group 2) were enrolled. The primary outcome was the immediate target angle (for esotropia within 4 PD of orthotropia and exotropia within 8 PD of esotropia within the first week postoperatively); the secondary outcome was success at the 6-month visit (angle of deviation < 10 PD). Consequently, there was a significantly higher proportion of achieving the immediate target range and success rate in both exotropic and esotropic patients in Group 1 than in Group 2. A significantly lower reoperation rate was also demonstrated in Group 1. No complications were noted in either group.Conclusions: The novel method enabled a higher proportion of subjects to achieve an immediate target range and success rate and a lower chance of reoperation among both esotropic and exotropic patients.
RESUMO
PURPOSE: To investigate whether recombinant adeno-associated virus (rAAV) vector--mediated transgene expression is induced by inflammation in corneal endothelial cells in vivo. METHODS: The ocular anterior chamber of New Zealand White rabbits was injected with rAAV-LacZ (10(7) units of infection). Transient ocular anterior segment inflammation was induced by an intravitreal injection of lipopolysaccharide (LPS). The effect of inflammation on LacZ gene expression in corneal endothelial cells was evaluated by histochemical staining and reverse transcription-polymerase chain reaction (RT-PCR). The influence of rAAV on endothelial cell function was monitored by measuring corneal thickness. RESULTS: Inflammatory reaction peaked at 1 day after LPS treatment and, at the same time, most of the endothelial cells (91.3% plus minus 7.2%) showed prominent LacZ gene expression. The transgene expression gradually diminished to basal level (3.4% plus minus 2.1%) when the inflammation subsided at 15 days after LPS treatment. The diminished transgene expression was efficiently reactivated to a high level (86.1% plus minus 8.7%) by a second LPS injection 60 days later. Moreover, the transgene expression remained low for a long period (60 days) in the absence of LPS treatment, but was increased to high levels (87.3% plus minus 8.1%) 1 day after LPS treatment. Throughout the observation period, endothelial cell function remained intact. CONCLUSIONS: The rAAV vector can deliver genes into endothelial cells, and transgene expression is dramatically induced by inflammation. The rAAV-delivered transgene is stable and does not compromise endothelial cell function. Inducible rAAV-mediated transgene expression in corneal endothelial cells is a potential strategy in the treatment and prevention of ocular diseases.
