Effects of dabigatran versus warfarin on 2-year cognitive outcomes in old patients with atrial fibrillation: results from the GIRAF randomized clinical trial.

BACKGROUND: Observational studies support a role for oral anticoagulation to reduce the risk of dementia in atrial fibrillation patients, but conclusive data are lacking. Since dabigatran offers a more stable anticoagulation, we hypothesized it would reduce cognitive decline when compared to warfarin in old patients with atrial fibrillation. METHODS: The GIRAF trial was a 24-month, randomized, parallel-group, controlled, open-label, hypothesis generating trial. The trial was done in six centers including a geriatric care unit, secondary and tertiary care cardiology hospitals in São Paulo, Brazil. We included patients aged ≥ 70 years and CHA2DS2-VASc score > 1. The primary endpoint was the absolute difference in cognitive performance at 2 years. Patients were assigned 1:1 to take dabigatran (110 or 150 mg twice daily) or warfarin, controlled by INR and followed for 24 months. Patients were evaluated at baseline and at 2 years with a comprehensive and thorough cognitive evaluation protocol of tests for different cognitive domains including the Montreal Cognitive Assessment (MoCA), Mini-Mental State Exam (MMSE), a composite neuropsychological test battery (NTB), and computer-generated tests (CGNT). RESULTS: Between 2014 and 2019, 5523 participants were screened and 200 were assigned to dabigatran (N = 99) or warfarin (N = 101) treatment. After adjustment for age, log of years of education, and raw baseline score, the difference between the mean change from baseline in the dabigatran group minus warfarin group was - 0.12 for MMSE (95% confidence interval [CI] - 0.88 to 0.63; P = 0.75), 0.05 (95% CI - 0.07 to 0.18; P = 0.40) for NTB, - 0.15 (95% CI - 0.30 to 0.01; P = 0.06) for CGNT, and - 0.96 (95% CI - 1.80 to 0.13; P = 0.02) for MoCA, with higher values suggesting less cognitive decline in the warfarin group. CONCLUSIONS: For elderly patients with atrial fibrillation, and without cognitive compromise at baseline that did not have stroke and were adequately treated with warfarin (TTR of 70%) or dabigatran for 2 years, there was no statistical difference at 5% significance level in any of the cognitive outcomes after adjusting for multiple comparisons. TRIAL REGISTRATION: Cognitive Impairment Related to Atrial Fibrillation Prevention Trial (GIRAF), NCT01994265 .

Massive Cavitation by Pneumocystis jirovecii in an Immunocompromised Patient.

Since the development of antiretroviral therapy (ART) and antibiotic prophylaxis, the incidence of opportunistic infections in human immunodeficiency virus-acquired immunodeficiency syndrome (HIV-AIDS) has been drastically reduced. However, third-world countries remain a fertile ground for medication nonadherence and inappropriate patient follow-up. Here, we present the case of a 42-year-old male with a history of HIV who presented with worsening shortness of breath and atypical chest pain. A chest X-ray and chest computed tomography scan revealed a left parahilar cavitation measuring 86 mm in diameter. A percutaneous lung biopsy revealed Pneumocystis jirovecii. Appropriate antibiotics were started, and the patient's clinical status significantly improved. This case illustrates the devastating consequences of uncontrolled HIV-AIDS. ART and prophylactic antibiotics remain the cornerstone of treatment to ameliorate progressive lung damage in patients.

The "false-positive" conundrum: IgA reference level overestimates the seroprevalence of antibodies to SARS-CoV-2.

BACKGROUND: On 12 June 2020, Brazil reached the second position worldwide in the number of COVID-19 cases. Authorities increased the number of tests performed, including the identification of antibodies to SARS-CoV-2 (IgG, IgA, and IgM). There was an overflooding of the market with several tests, and the presence of possible false-positive results became a challenge. The purpose of this study was to describe the seroprevalence and immunoglobulin blood levels in a group of asymptomatic individuals using the reference levels provided by the manufacturer. METHODS: Levels of IgG and IgA antibodies to SARS-CoV-2 were determined in blood serum by the same ELISA (enzyme-linked immunoassay) test. Patients must be free of symptoms. RESULTS: From 20 to 22 May 2020, 938 individuals were tested. There were 441 (47%) men, age 53 years (interquartile range (IQR) = 39-63.2). The sample included 335 (35.7%) subjects aged ≥60 years old. Subjects with a positive test were 54 (5.8%) for IgG and 96 (10.2%) for IgA and 42 (4.5%) for both IgG and IgA. The prevalence of IgG and IgA positive test was not different in men and women and not different in individuals under 60 and over 60 years of age. Conversely, analysing only individuals with positive tests, the levels of IgG in positive subjects were significantly higher than those with an IgA positive test, 3.00 (IQR = 1.68-5.65), and 1.95 (IQR = 1.40-3.38), respectively; P = 0.017. Additionally, individuals with isolated IgA positive tests had significantly lower levels of IgA than those with both IgA and IgG positive tests: 1.95 (IQR = 1.60-2.40) and 3.15 (IQR = 2.20-3.90), respectively, P = 0.005. These latter data suggest that IgA shows a deviation of the distribution to the left in comparison to IgG distribution data. Indeed, many subjects reported as IgA positive had immunoglobulin levels slightly elevated. CONCLUSIONS: In conclusion, we strongly suggest caution in the interpretation of IgA test results. This recommendation is more important for those with positive IgA just above the reference level.

Integrated use of biomarkers to evaluate the reproductive physiology of Astyanax fasciatus and Hoplias malabaricus males (Teleostei: Characiformes) in polluted reservoirs.

The reproductive physiology of fish can be changed by the presence of pollutants in the water, which act as endocrine disrupting compounds (EDC). We evaluated the impacts of water contaminants in polluted reservoirs acting as possible EDC on the reproductive physiology of Astyanax fasciatus and Hoplias malabaricus males. We used biomarkers with different levels of biological organization. Hoplias malabaricus adult males were collected in the summer and winter at five different sites in the Tietê River Basin: the Ponte Nova reservoir (PN), considered a reference site due to the low anthropogenic influence; the Billings reservoir (BIL) at two different branches; and the Guarapiranga reservoir (GUA) at two different branches. Astyanax fasciatus adult males were collected at PN and BIL. BIL and GUA are subjected to great anthropogenic action. We analyzed gonadal histomorphology, testosterone (T), 11-ketotestosterone (11-KT), estradiol (E2) plasma levels, and gene expression of hepatic vitellogenin (vtgA) and pituitary follicle stimulating hormone (fshß). In the PN reservoir (reference), the biomarkers analyzed in both species did not differ between the periods analyzed. This is an evidence that the animals keep the same reproductive activity during both seasons. The changes in the plasma concentration of gonadal steroids in both species in polluted reservoirs suggest the presence of EDC compounds in the water and/or adjusts of the physiological setpoint to allow the reproduction in such adverse conditions. The use of vtgA as biomarker suggests the presence of estrogenic compounds, mainly in BIL, but with a more evident response of H. malabaricus. However, even considering physiological changes, both species present testes during the maturation phase that allow the reproduction in an environment with a high degree of pollution.

Eye-related neoplasms in dogs: A retrospective study / Neoplasias relacionadas con los ojos en perros: Estudio retrospectivo / Neoplasias relacionadas aos olhos em cães: Estudo retrospectivo

Abstract Background: Eye-related neoplasms in dogs have a significant impact on visual ability, comfort, and longevity. Therapeutic alternatives and prognosis vary according to type of neoplasm and its anatomical location. Objective: To describe the frequency and distribution of eye-related neoplasms affecting dogs in the Aburrá valley (Antioquia province, Colombia). Methods: A retrospective collection of eye-related neoplasms in dogs, diagnosed at the Animal Pathology Laboratory of Universidad de Antioquia (Colombia), was conducted. Data spanning from years 2005 to 2017 were used. Records included age, sex, breed, neoplasm type and location, and cellular origin of neoplasm. A total of 250 eye-related-neoplasm reports affecting 246 dogs were analyzed -one report per animal, with the exception of four animals with both eyes simultaneously affected by the same type of neoplasm. Results: Animals between 8 and 11 years of age were more frequently affected by eye-related neoplasms (43.9%). Labrador retriever (19.1%), mixed-breed dogs (13.4%), and Poodle (12.2%) were the most frequently affected breeds. Neoplasms affected the eyelid in 76.8% of cases. Meibomian gland adenoma was the most frequent neoplasm (22.8%), followed by Meibomian gland epithelioma (20.0%), squamous cell carcinoma (8.8%), and melanocytoma (7.2%). The cellular origin of neoplasms was epithelial in 73.6% of the cases. Conclusion: Meibomian gland adenoma was the most common eye-related neoplasm. To our knowledge, this is the first retrospective report aimed to eye-related neoplasms in dogs published in Colombia.

Resumen Antecedentes: Las neoplasias relacionadas con los ojos en perros tienen un impacto significativo en la capacidad visual, la comodidad y la longevidad del animal. Las opciones terapéuticas y el pronóstico para el perro y para el tejido afectado varían según el tipo de neoplasia y su ubicación anatómica. Objetivo: Describir la frecuencia y distribución de neoplasias relacionadas con los ojos en perros del Valle de Aburrá (Departamento de Antioquia, Colombia). Métodos: Se realizó una evaluación retrospectiva de neoplasias relacionadas con los ojos en perros, diagnosticadas en el laboratorio de patología animal de la Universidad de Antioquia (Colombia). Los registros incluyeron información de 13 años (2005-2017). Los datos recolectados incluyeron edad, sexo, raza, tipo de tumor y ubicación, y origen celular de la neoplasia. Resultados: Se analizó un total de 250 reportes de neoplasias relacionadas con los ojos, afectando 246 perros (un reporte por animal, excepto cuatro animales en los que ambos ojos fueron afectados simultáneamente por el mismo tipo de neoplasia. Los animales entre 8 y 11 años de edad fueron los más frecuentemente afectados por neoplasias relacionadas con los ojos (43,9%). Las razas Labrador retriever (19,1%), perros mestizos (13,4%) y Poodle (12,2%) fueron las más frecuentemente afectadas. Las neoplasias afectaron el párpado en el 76,8% de los casos. El adenoma de la glándula de Meibomio fue la neoplasia más frecuente (22,8%), seguida por el epitelioma de la glándula de Meibomio (20,0%), el carcinoma de células escamosas (8,8%) y el melanocitoma (7,2%). El origen celular de las neoplasias fue epitelial en el 73,6% de los casos. Conclusión: Se encontró que el adenoma de la glándula de Meibomio es la neoplasia ocular más común. Hasta donde sabemos, este es el primer reporte retrospectivo dirigido específicamente a neoplasias relacionadas con ojos en perros publicado en Colombia.

Resumo Antecedentes: As neoplasias relacionadas aos olhos em cães são importantes porque têm um impacto significativo na capacidade visual, conforto e longevidade do animal. As opções terapêuticas e o prognóstico para o cão e para o tecido afetado variam de acordo com o tipo de neoplasia e sua localização anatômica. Objetivo: Descrever a frequência e distribuição das neoplasias relacionadas aos olhos em cães do Valle de Aburrá (Estado de Antioquia, Colômbia). Métodos: Foi realizada uma coleta retrospectiva de neoplasias relacionadas aos olhos em cães diagnosticados no laboratório de patologia animal da Universidade de Antioquia (Colômbia). Os registros coletaram informações de 13 anos (2005-2017). Os dados coletados incluíram idade, sexo, raça, tipo de tumor e localização e origem celular da neoplasia. Resultados: Um total de 250 relatos de neoplasias relacionadas aos olhos foram analisados, afetando 246 cães (um relatório por animal, com exceção de quatro animais, em que ambos os olhos foram afetados simultaneamente para o mesmo tipo de neoplasia relacionada aos olhos). Animais entre 8 e 11 anos foram mais acometidos por neoplasias relacionadas aos olhos (43,9%). As raças Labrador retriever (19,1%), mestiças (13,4%) e Poodle (12,2%) foram as raças mais afetadas. Neoplasias afetaram a pálpebra em 76,8% dos casos. Adenoma da glândula Meibomiana foi a neoplasia mais frequente (22,8%), seguido por epitelioma glândula Meibomiana (20,0%), carcinoma de células escamosas (8,8%) e melanocitoma (7,2%). A origem celular das neoplasias foi epitelial em 73,6% dos casos. Conclusão: Este estudo constatou que o adenoma da glândula Meibomiana é a neoplasia ocular mais comum. Para nosso conhecimento, este é o primeiro relato retrospectivo especificamente voltado para as neoplasias relacionadas aos olhos em cães publicados até o momento na Colômbia.

Reefscapes of fear: predation risk and reef hetero-geneity interact to shape herbivore foraging behaviour.

Predators can exert strong direct and indirect effects on ecological communities by intimidating their prey. The nature of predation risk effects is often context dependent, but in some ecosystems these contingencies are often overlooked. Risk effects are often not uniform across landscapes or among species. Indeed, they can vary widely across gradients of habitat complexity and with different prey escape tactics. These context dependencies may be especially important for ecosystems such as coral reefs that vary widely in habitat complexity and have species-rich predator and prey communities. With field experiments using predator decoys of the black grouper (Mycteroperca bonaci), we investigated how reef complexity interacts with predation risk to affect the foraging behaviour and herbivory rates of large herbivorous fishes (e.g. parrotfishes and surgeonfishes) across four coral reefs in the Florida Keys (USA). In both high and low complexity areas of the reef, we measured how herbivory changed with increasing distance from the predator decoy to examine how herbivorous fishes reconcile the conflicting demands of avoiding predation vs. foraging within a reefscape context. We show that with increasing risk, herbivorous fishes consumed dramatically less food (ca. 90%) but fed at a faster rate when they did feed (ca. 26%). Furthermore, we show that fishes foraging closest to the predator decoy were 40% smaller than those that foraged at further distances. Thus, smaller individuals showed muted response to predation risk compared to their larger counterparts, potentially due to their decreased risk to predation or lower reproductive value (i.e. the asset protection principle). Habitat heterogeneity mediated risk effects differently for different species of herbivores, with predation risk more strongly suppressing herbivore feeding in more complex areas and for individuals at higher risk of predation. Predators appear to create a reefscape of fear that changes the size structure of herbivores towards smaller individuals, increases individual feeding rates, but suppresses overall amounts of primary producers consumed, potentially altering patterns of herbivory, an ecosystem process critical for healthy coral reefs.

Loss of gibberellin production in Fusarium verticillioides (Gibberella fujikuroi MP-A) is due to a deletion in the gibberellic acid gene cluster.

Fusarium verticillioides (Gibberella fujikuroi mating population A [MP-A]) is a widespread pathogen on maize and is well-known for producing fumonisins, mycotoxins that cause severe disease in animals and humans. The species is a member of the Gibberella fujikuroi species complex, which consists of at least 11 different biological species, termed MP-A to -K. All members of this species complex are known to produce a variety of secondary metabolites. The production of gibberellins (GAs), a group of diterpenoid plant hormones, is mainly restricted to Fusarium fujikuroi (G. fujikuroi MP-C) and Fusarium konzum (MP-I), although most members of the G. fujikuroi species complex contain the GA biosynthesis gene cluster or parts of it. In this work, we show that the inability to produce GAs in F. verticillioides (MP-A) is due to the loss of a majority of the GA gene cluster as found in F. fujikuroi. The remaining part of the cluster consists of the full-length F. verticillioides des gene (Fvdes), encoding the GA(4) desaturase, and the coding region of FvP450-4, encoding the ent-kaurene oxidase. Both genes share a high degree of sequence identity with the corresponding genes of F. fujikuroi. The GA production capacity of F. verticillioides was restored by transforming a cosmid with the entire GA gene cluster from F. fujikuroi, indicating the existence of an active regulation system in F. verticillioides. Furthermore, the GA(4) desaturase gene des from F. verticillioides encodes an active enzyme which was able to restore the GA production in a corresponding des deletion mutant of F. fujikuroi.

Insulin therapy and acute kidney injury in critically ill patients a systematic review.

BACKGROUND: Intensive insulin therapy has been found to reduce mortality in some critically ill patients. We performed a systematic review and meta-analysis to ascertain the effect of intensive insulin therapy on the incidence of acute kidney injury (AKI) in adult critically ill patients. METHODS: We searched MEDLINE, SCOPUS and the Cochrane Central Register of Controlled Trials for studies that compared 'conventional' vs 'intensive' insulin therapy in critically ill patients. Studies were combined with random effects model meta-analyses. RESULTS: Five studies, three of which were randomized controlled trials, reported AKI as a secondary outcome. Two of the studies were non-concurrent prospective cohort studies. All were single-centre studies conducted in intensive care unit settings. By meta-analysis across all studies, intensive insulin therapy reduced the incidence of AKI by 38% [risk ratio (RR) 0.62; 95% confidence interval (CI) 0.47, 0.83; P = 0.001]. The findings of the randomized and cohort studies were similar and the studies were not statistically heterogeneous. Three studies reported the effect of insulin therapy on dialysis requirement. Overall, intensive insulin therapy reduced the incidence of dialysis requirement by 35%, however, this was not statistically significant (RR 0.65; 95% CI 0.40, 1.05; P = 0.08). The overall rate of hypoglycaemia in the conventional insulin therapy group was 1.3% (range 0.3-3.4%). Intensive insulin therapy was associated with a >4-fold increase in the risk of hypoglycaemia (RR 4.5; 95% CI 2.4, 8.5; P < 0.00001) CONCLUSION: There is evidence that intensive insulin therapy initiated in critically ill adult patients is associated with a reduction in the incidence of AKI in medical and surgical settings. A large trial primarily designed to examine the effect of insulin on the prevention of AKI is needed to confirm this finding.

Distribution of gibberellin biosynthetic genes and gibberellin production in the Gibberella fujikuroi species complex.

Gibberella fujikuroi is a species-rich monophyletic complex of at least nine sexually fertile biological species (mating populations, MP-A to MP-I) and more than 30 anamorphs in the genus Fusarium. They produce a variety of secondary metabolites, such as fumonisins, fusaproliferin, moniliformin, beauvericin, fusaric acid, and gibberellins (GAs), a group of plant hormones. In this study, we examined for the first time all nine sexually fertile species (MPs) and additional anamorphs within and outside the G. fujikuroi species complex for the presence of GA biosynthetic genes. So far, the ability to produce GAs was described only for Fusarium fujikuroi (G. fujikuroi MP-C), which contains seven clustered genes in the genome all participating in GA biosynthesis. We show that six other MPs (MPs B, D, E, F, G, and I) and most of the anamorphs within the species complex also contain the entire gene cluster, except for F. verticillioides (MP-A), and F. circinatum (MP-H), containing only parts of it. Despite the presence of the entire gene cluster in most of the species within the G. fujikuroi species complex, expression of GA biosynthetic genes and GA production were detected only in F. fujikuroi (MP-C) and one isolate of F. konzum (MP-I). We used two new molecular marker genes, P450-4 from the GA gene cluster, and cpr, encoding the highly conserved NADPH cytochrome P450 reductase to study phylogenetic relationships within the G. fujikuroi species complex. The molecular phylogenetic studies for both genes have revealed good agreement with phylogenetic trees inferred from other genes. Furthermore, we discuss the role and evolutionary origin of the GA biosynthetic gene cluster.

Analysis of the efficacy, predictability, and safety of LASEK for myopia and myopic astigmatism using the Technolas 217 excimer laser.

PURPOSE: To evaluate the efficacy, predictability, and safety of laser-assisted subepithelial keratectomy (LASEK) for the treatment of myopia and myopic astigmatism. SETTING: Stanford University Eye Laser Center, Stanford, California, USA. METHODS: This retrospective analysis comprised 102 eyes that had LASEK for myopia using the Bausch & Lomb Technolas 217 excimer laser. Primary outcome variables including uncorrected visual acuity (UCVA), best spectacle- corrected visual acuity (BSCVA), manifest refraction, and complications were evaluated at 3, 6, and 12 months. Vector analysis was performed on eyes that received astigmatic correction. RESULTS: The mean spherical equivalent was -7.03 diopters (D) +/- 2.61 (SD) preoperatively, +0.19 +/- 0.64 D at 3 months, +0.23 +/- 0.82 D at 6 months, and +0.03 +/- 0.63 D at 12 months (P<.001). At 3, 6, and 12 months, the UCVA was 20/20 or better in 66%, 67%, and 83% of eyes, respectively, and 20/40 or better in 98%, 99%, and 100%; 74%, 70%, and 83%, respectively, were within +/-0.5 D of emmetropia, and 89%, 86%, and 97%, respectively, were within +/-1.0 D. No eye lost more than 2 lines of BSCVA. At 3, 6, and 12 months, 10.0%, 8.7%, and 0% of eyes, respectively, had trace corneal haze. Vector analysis found a success rate of approximately 78% to 80% in achieving the astigmatic surgical correction at the 3 postoperative visits. CONCLUSIONS: Laser-assisted subepithelial keratectomy was an effective, predictable, and safe procedure for the treatment of myopia and myopic astigmatism. Further studies are needed to determine the role of LASEK in the refractive surgery spectrum.

Treatment of epithelial ingrowth after laser in situ keratomileusis with mechanical debridement and flap suturing.

OBJECTIVE: To evaluate the efficacy and safety of mechanical debridement and suturing of the laser in situ keratomileusis (LASIK) flap in the treatment of clinically significant epithelial ingrowth after LASIK. METHODS: In a retrospective study, 20 eyes (n = 19 patients) in which clinically significant epithelial ingrowth developed after LASIK were treated with lifting of the flap, scraping of the epithelial ingrowth, and flap suturing. Primary outcome measurements including recurrence of ingrowth, uncorrected visual acuity (VA), manifest refraction, best spectacle-corrected VA, and complications were evaluated at the last postoperative examination. RESULTS: At the last postoperative examination (mean +/- SD, 10.5 +/- 14.3 months; range, 1.5-64 months), 100% of eyes had no recurrence of clinically significant epithelial ingrowth. The uncorrected VA changed from 20/20 or better in 7 eyes (35%) and 20/40 or better in 15 eyes (75%) preoperatively to 20/20 or better in 9 eyes (45%) and 20/40 or better in 16 eyes (80%) at the last follow-up examination. There was no significant change in the mean logarithm of the minimum angle of resolution (logMAR) uncorrected VA before (mean +/- SD, 0.3 +/- 0.5; range, -0.1 to 1.7) and after surgery (mean +/- SD, 0.2 +/- 0.4; range, -0.1 to 1.7) (P =.40). Mean +/- SD spherical equivalent changed from -0.21 +/- 0.82 diopters (D) (range, -1.25 to 1.00 D) preoperatively to -0.53 +/- 0.89 D (range, -2.50 to 0.38 D) at last follow-up (P =.30). No eyes lost 2 or more lines of best spectacle-corrected VA, and there were no complications associated with the treatment. CONCLUSIONS: Suturing the LASIK flap in addition to mechanical debridement of epithelial ingrowth is a safe and effective treatment for clinically significant epithelial ingrowth after LASIK.

The NADPH-cytochrome P450 reductase gene from Gibberella fujikuroi is essential for gibberellin biosynthesis.

The fungus Gibberella fujikuroi is used for the commercial production of gibberellins (GAs), which it produces in very large quantities. Four of the seven GA biosynthetic genes in this species encode cytochrome P450 monooxygenases, which function in association with NADPH-cytochrome P450 reductases (CPRs) that mediate the transfer of electrons from NADPH to the P450 monooxygenases. Only one cpr gene (cpr-Gf) was found in G. fujikuroi and cloned by a PCR approach. The encoded protein contains the conserved CPR functional domains, including the FAD, FMN, and NADPH binding motifs. cpr-Gf disruption mutants were viable but showed a reduced growth rate. Furthermore, disruption resulted in total loss of GA(3), GA(4), and GA(7) production, but low levels of non-hydroxylated C(20)-GAs (GA(15) and GA(24)) were still detected. In addition, the knock-out mutants were much more sensitive to benzoate than the wild type due to loss of activity of another P450 monooxygenase, the detoxifying enzyme, benzoate p-hydroxylase. The UV-induced mutant of G. fujikuroi, SG138, which was shown to be blocked at most of the GA biosynthetic steps catalyzed by P450 monooxygenases, displayed the same phenotype. Sequence analysis of the mutant cpr allele in SG138 revealed a nonsense mutation at amino acid position 627. The mutant was complemented with the cpr-Gf and the Aspergillus niger cprA genes, both genes fully restoring the ability to produce GAs. Northern blot analysis revealed co-regulated expression of the cpr-Gf gene and the GA biosynthetic genes P450-1, P450-2, P450-4 under GA production conditions (nitrogen starvation). In addition, expression of cpr-Gf is induced by benzoate. These results indicate that CPR-Gf is the main but not the only electron donor for several P450 monooxygenases from primary and secondary metabolism.

Comparison of videokeratographic functional optical zones in conductive keratoplasty and laser in situ keratomileusis for hyperopia.

PURPOSE: To compare the videokeratographic functional optical zone of eyes treated with conductive keratoplasty to eyes treated with laser in situ keratomileusis (LASIK) for hyperopia. METHODS: Sixteen eyes treated with conductive keratoplasty for hyperopia were retrospectively evaluated to determine the size of the videokeratographic functional optical zone. The functional optical zone of these eyes was compared to the functional optical zone of 16 eyes that underwent LASIK for hyperopia with the VISX S2 excimer laser, for comparable amounts of hyperopia. The functional optical zone was measured at the edge of central corneal steepening and paracentral flattening on videokeratography 3 to 6 months after surgery. RESULTS: The functional optical zone after surgery measured an average of 5.6 mm horizontally and 5.6 mm vertically in the conductive keratoplasty eyes, and 4.7 mm horizontally and 5.1 mm vertically in the hyperopic LASIK eyes (P<.001 and P<.005). The mean functional optical zone area was 31.1 mm2 in the conductive keratoplasty eyes and 24.6 mm2 in the hyperopic LASIK eyes (P<.001). The functional optical zone created by conductive keratoplasty had more uniform central steepening and less peripheral blending than the functional optical zone created by hyperopic LASIK. CONCLUSION: Conductive keratoplasty was effective at creating central steepening in the cornea. The functional optical zone resulting from conductive keratoplasty was significantly larger than that obtained with hyperopic LASIK using the VISX S2 excimer laser.

Phototherapeutic keratectomy for anterior basement membrane dystrophy after laser in situ keratomileusis.

OBJECTIVE: To evaluate the efficacy and safety of phototherapeutic keratectomy (PTK) in the treatment of symptomatic anterior basement membrane dystrophy following laser in situ keratomileusis (LASIK). METHODS: In a retrospective study, 10 eyes of 10 patients that developed symptomatic anterior basement membrane dystrophy following LASIK for myopia were treated with PTK using the VISX S2 (VISX Inc, Santa Clara, Calif) excimer laser. Primary outcome measurements including corneal clarity, resolution of symptoms, uncorrected visual acuity (UCVA), manifest refraction, best spectacle-corrected visual acuity (BSCVA), and complications were evaluated preoperatively, 1 day postoperatively, and at the last postoperative follow-up visit. RESULTS: At the last follow-up visit (mean [SD], 8.8 [5.5] months; range, 4-22 months), 100% of the eyes had clear corneas with no evidence of anterior basement membrane dystrophy, and all eyes were asymptomatic. Mean spherical equivalent changed from -0.75 (0.99) diopters (D) (range, -2.75 to +0.25 D) preoperatively to -0.51 (0.80) D (range, -1.63 to +1.00 D) at the last follow-up visit (P =.64). Uncorrected visual acuity improved from 20/20 or better in 1 eye (10%) and 20/40 or better in 5 eyes (50%) preoperatively to 20/20 or better in 5 eyes (50%) and 20/40 or better in 7 eyes (70%) postoperatively. No eyes lost lines of BSCVA, 2 eyes gained 1 line, 2 eyes gained 2 lines, and 1 eye gained 4 lines. There was a statistically significant improvement in mean logMAR BSCVA postoperatively, improving from 0.06 (0.16) (range, -0.1 to +0.3) to -0.08 (0.07) (range, -0.1 to +0.1) (P =.04). Postoperative complications included diffuse lamellar keratitis that resolved after treatment without sequelae (20%) and induced myopia exceeding -1.50 D (10%). CONCLUSION: Phototherapeutic keratectomy for the treatment of symptomatic anterior basement membrane dystrophy following LASIK treatment is safe and effective.

Goniotomy for glaucoma secondary to chronic childhood uveitis.

PURPOSE: To evaluate the safety and efficacy of standard goniotomy surgery for young patients with refractory glaucoma associated with chronic childhood uveitis. DESIGN: Interventional case series. METHODS: We retrospectively reviewed all goniotomies performed at our institution for patients with a diagnosis of refractory glaucoma associated with chronic childhood uveitis from 1994 to 2000 (this was our first-line surgery for such patients during these years). Uveitis was medically controlled in all cases for at least 6 weeks before surgery. The main outcome measure was time after surgery without failure. Success was defined as final intraocular pressure (IOP) or=6 months or until surgical failure. RESULTS: Nineteen goniotomies were performed on 16 eyes (12 patients). Diagnoses included uveitic glaucoma associated with juvenile rheumatoid arthritis, sarcoidosis, and idiopathic uveitis. The mean patient age at first goniotomy was 15.3 years (range, 6.5-30), with mean follow-up 32.4 months (range, 6-84). Cases included were phakic (10 eyes), aphakic (four eyes), and pseudophakic (two eyes). The mean preoperative IOP was 32.3 +/- 4.6 mm Hg. Surgical success was achieved in 12 of 16 (75%) eyes with a mean postoperative IOP of 12 +/- 2.5 mm Hg for these eyes (mean IOP reduction, 20.0 mm Hg, P <.0001). In 10 of 16 eyes (60%), surgical success was achieved after a single goniotomy. Uveitis was stable in all patients after the early post-operative period. Successful eyes used, on average, 1.4 +/- 1.1 glaucoma medications after goniotomy. Complications were mild and included transient hyphema in nine cases (56%) and worsening of a preexisting cataract in a single case (6%). CONCLUSIONS: Goniotomy represents a safe and effective first-line surgery for young patients with refractory glaucoma associated with chronic uveitis, although the majority of patients require glaucoma medication after the procedure.

Laser in situ keratomileusis enhancement for consecutive hyperopia after myopic overcorrection.

PURPOSE: To assess the efficacy, predictability, and safety of laser in situ keratomileusis (LASIK) for the treatment of consecutive hyperopia after myopic LASIK. SETTING: Stanford University School of Medicine, Stanford, California, USA. METHODS: In a retrospective study, 36 eyes of 30 patients with consecutive hyperopia after myopic LASIK had LASIK retreatment using the VISX S2 excimer laser. Primary outcome variables including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, complications, and vector analysis were evaluated preoperatively and 1 day and 3 months postoperatively. RESULTS: The mean spherical equivalent decreased from +1.52 diopters (D) +/- 0.55 (SD) (range +0.63 to +2.63 D) preoperatively to -0.10 +/- 0.52 D (range -1.25 to +1.50 D) 3 months after retreatment. The UCVA was 20/20 or better in 24 eyes (66.7%) and 20/40 or better in 34 eyes (94.4%). Twenty eyes (55.5%) were within +/-0.5 D of the intended correction and 34 eyes (94.4%), within +/-1.0 D. No eye lost 2 or more lines of BSCVA. One eye (2.8%) developed diffuse lamellar keratitis that resolved without sequelae, and 2 eyes (5.6%) developed nonprogressive epithelial ingrowth that did not require removal. CONCLUSIONS: Laser in situ keratomileusis retreatment for consecutive hyperopia following myopic LASIK was an effective, predictable, and safe procedure. Long-term follow-up is needed to assess stability.