An effective therapeutic modality for the management of hyperaemic conjunctival margins following the Hughes' procedure.
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Conjunctiva↗
Biomedical subjects
P Heyworth
Publications and source records attributed to P Heyworth.
[The NADPH-oxidase complex in chronic granulomatous disease: preliminary description of a cluster in Mérida-Venezuela].
Chronic Granulomatous Disease (CGD) is a primary immunodeficiency characterized by an unusual predisposition to develop bacterial and fungal infections due to a failure of phagocytic leukocytes to generate superoxide, required for the intracellular killing of microorganisms. The lack of superoxide production is secondary to a defect in the NADPH-oxidase enzymatic complex activation, as a result of mutations of any of the components. Both, X-linked and autosomal recessive patterns of inheritance have been demonstrated in this disease, being the X-linked the most frequent and characterized by mutations in gp91phox. Mutations in p47phox, p67phox and p22phox have been shown in the autosomal recessive pattern. The molecular and genetic characteristic of NADPH-oxidase complex and its pathology in CGD are reviewed along with a brief description of the preliminary findings in two families from Mérida, Venezuela.
Adolescent↗
The systemic absorption of adrenaline from posterior segment infusion during vitreoretinal surgery.
BACKGROUND/PURPOSE: Adrenaline infused into the posterior segment of the eye during vitreoretinal surgery may be absorbed and give rise to unwanted cardiovascular effects. We sought to establish whether significant amounts of adrenaline are systematically absorbed. METHODS: This study was prospective and double-masked, with patients randomised into two groups. The first group received a posterior segment infusion containing Hartmann's solution alone (Hs group) and the second group received a posterior segment infusion of Hartmann's solution containing 0.5 ml of 1:1000 (0.5 mg) adrenaline per 500 ml (Hs + Ad group). Pre-medication and anaesthetic techniques were standardised for all patients. Venous blood samples were collected prior to induction, 5 min following intubation and 5, 10, 15 and 30 min following the commencement of the infusion. Samples were analysed for adrenaline levels using high-performance liquid chromatography. RESULTS: Ten patients were studied: 4 in the Hs group and 6 in the Hs + Ad group. The mean dose of adrenaline administered in the Hs + Ad group was 655.08 nmol (0.12 mg). The median serum adrenaline level following infusion for the Hs + Ad group was 0.15 nmol/l (LQ = 0.100, UQ = 0.360) and the median serum adrenaline level for the Hs group was 0.10 nmol/l (LQ = 0.100, UQ = 0.350). There was no overall statistical difference in the levels of serum adrenaline between the two groups, and furthermore adrenaline levels remained within physiological parameters for both groups. CONCLUSION: There does not appear to be significant adrenaline absorption from posterior segment infusion. Continued caution should be exercised, however, as idiosyncratic reactions may still occur.
Absorption↗
Natural history of recurrent erosion syndrome--a 4 year review of 117 patients.
AIMS/BACKGROUND: Recurrent erosion syndrome encompasses a group of mixed aetiologies for which there are a number of methods of management which may influence the course of the disease. METHODS: The outcomes of a cohort of patients initially treated with topical lubricants were studied. 117 consecutive patients presenting over 1 year with a history of recurrent erosions were enrolled, baseline characteristics were documented, and treatment with lubricants was initiated. Patients were surveyed 4 years later inquiring about symptoms and treatments required. RESULTS: A total of 94 (80%) of the initial cohort were contacted. The mean age was 44 years and the sex distribution was 44 males to 50 females. The mean period of follow up was 48 months. 55 (59%) were still symptomatic with attacks occurring at a median frequency of 60 days. 13 patients (24%) complained of an episode at least every week and 28 patients (51%) suffered at least every month. The median pain score (analogue scale of 1-10) was 2.5. Seventy five per cent (n = 21) of patients with epithelial basement membrane dystrophy (EBMD) were symptomatic compared with those with a traumatic aetiology among whom 46% (n = 28) were symptomatic. This difference was significant (p = 0.02). Those with EBMD were more likely to be continuing to use topical lubricants than the trauma group. CONCLUSION: Patients with a traumatic aetiology are less likely to suffer chronic recurrent erosion syndrome than those with EBMD.
Administration, Topical↗
Broad laser indentation surface for retinal laser photocoagulation using indirect ophthalmoscopic delivery.
Laser photocoagulation of the peripheral retina is an important part of the therapeutic options for treating many vitreoretinal disorders, such as diabetic retinopathy, retinopathy of prematurity, and vitreoretinal degeneration. When preequatorial retinal photocoagulation is required, indirect delivery of laser energy is preferable, whether applied in the office setting or as part of a sterile surgical procedure. The anterior retina is usually visualized by scleral indentation employing a conventional scleral indentor or muscle hook. Under these circumstances the retinal surface presented frequently is too small and irregular, making efficient laser delivery unnecessarily laborious, resulting in a variable uptake of laser energy.
Equipment Design↗
Conventional routine clinical review may not be necessary after uncomplicated phacoemulsification.
AIM: To determine the clinical intervention rate during routine review after uncomplicated phacoemulsification. METHODS: A review of case notes in 651 consecutive cases of uncomplicated phacoemulsification from 1994 (< or = 5.5 mm self sealing wound) was performed. The intervention rate at scheduled routine review visits and at unscheduled visits to the eye casualty service in the first 120 postoperative days was recorded. Interventions were defined as departures from predetermined postoperative care protocols. RESULTS: Clinical interventions were reported in 2.8% (95% confidence interval 1.5 to 4.1%) of (n = 1652) routine follow up visits. Many of these interventions were avoidable or trivial; 90% of patients had no postoperative intervention at any visit. 7.3% of patients made unscheduled visits to the emergency service. The intervention rate in this group was 50% (35.9 to 64.1%). CONCLUSIONS: The intervention rate in routine clinical review after uncomplicated modern cataract surgery is low. Alternatives to conventional postoperative review, including shared care with non-ophthalmologists and improved perioperative patient education with an open channel for self referral, should be evaluated.
Adult↗
A comparison of slit-lamp supported versus hand-held biometry.
Biometry allows determination of the final refractive outcome following cataract extraction with intraocular lens implantation. We compared the accuracy of axial length measurement performed with the slit-lamp supported biometry probe versus a hand-held technique. The two methods of biometry were performed on 32 patients undergoing endocapsular cataract extraction with lens implantation. One of the methods was selected at random in order to predict implant power for a desired refractive outcome using the SRK-T formula. There was no difference in 'within-subject' variance of axial length measurement between the two methods (t = 1.74, p = 0.091), and there was no difference in refractive outcome when the power calculations for the two techniques were compared (t = 0.12, p = 0.906). The hand-held technique provides a useful alternative method of biometry in 'difficult' patients.
Biometry↗
Extraconal bupivacaine in scleral buckling procedures.
BACKGROUND: Intraoperative retrobulbar bupivacaine injection provides effective analgesia after scleral buckling procedures performed under general anesthesia, but is associated with significant risks. METHODS: The safety and analgesic efficacy of an extraconal technique using a blunt cannula was evaluated. Forty patients undergoing scleral buckling procedures with general anesthesia were randomized to intraoperative extraconal bupivacaine injection (bupivacaine group. n = 21) or to no such treatment (control group, n = 19). General anesthetic and postoperative analgesia regimens were standardized. Analgesia requirements, pain, nausea, and sedation levels were graded at four intervals the first 24 hours after surgery. Chemosis was assessed 1 day after surgery, and ocular motility was assessed at 1 day, 1 week, and subsequent review. RESULTS: Maximum, 0 to 2-hour, and 4 to 6-hour pain levels were lower in the bupivacaine group than the control group (Wilcoxon rank sum, P < 0.005, < 0.005, < 0.01, respectively). Postoperative analgesia was required within the first 24 hours of surgery by all patients in the control group, but by only 12 of 21 patients (57%) in the bupivacaine group (Fisher's exact test, P = 0.001). Ptosis with minimal supraduction defect was noted at first postoperative examination in two patients who had undergone extraconal bupivacaine injection but resolved within 1 week. No other complication was encountered. CONCLUSION: Intraoperative extraconal bupivacaine injection appears to be a safe and effective method for reducing pain and analgesia requirements after scleral buckling procedures performed under general anesthesia.
Adolescent↗
Lens hardness in mature cataracts.
A cataract is said to be mature when all the cortical fibres become opaque. Depending on the pathophysiological processes that cause the cortical fibre opacification this phenomenon may be associated with a varying degree of nuclear sclerosis. A relationship between lens hardness and degree of nuclear sclerosis in non-mature cataracts has been demonstrated previously. This study aimed to investigate the relationship between the hardness of mature cataracts and the transmitted nuclear colour, age and rate of progression of the cataract. Thirty-eight patients with mature cataracts were assessed prior to extracapsular cataract surgery. The nuclear colour that was transmitted through the opaque cortex was graded using reference photographs. Age and duration of visual symptoms were recorded and lens hardness was measured by a specially designed lens guillotine. Multivariate analysis of data indicates a relationship between hardness of a mature cataract and the transmitted nuclear colour and age (adjusted R2 = 0.59). There is also a tendency for hardening of the lens as the duration of visual symptoms increases. By considering these clinical markers, the cataract surgeon can estimate the hardness of the lens and therefore its suitability for phacoemulsification.
Age Factors↗
Water content, lens hardness and cataract appearance.
Hardening of a cataractous lens is associated with the clinical appearance of brunescence and advancing age. Alterations in the nature and concentration of proteins, lens fibre compaction and other biochemical changes may all be contributing factors towards increased hardness. As the nucleus confers most of the rigidity to the lens and water content decreases towards the centre of the nucleus, the hardness might be thought to be related to total water content. To study the relationship between water content, hardness and the clinical appearance of cataract, 135 lenses were obtained from eyes undergoing extracapsular cataract surgery. The cataracts were assessed and classified pre-operatively. Lens hardness was determined by a specially designed guillotine and water content was measured by weighing the lens before and after desiccation. A regression analysis was carried out to look at the variation of lens water content with hardness, degree of nuclear sclerosis, extent of cortical and posterior subcapsular cataract, vacuolation and age. Multivariate analysis of data demonstrated a relationship between lens hardness and lens water content, degree of nuclear sclerosis and age (R2 = 0.59). An association could not be detected between lens water content and age, degree of nuclear sclerosis, extent of cortical and posterior subcapsular cataract and vacuoles. This study suggests that hardening of the lens is reflected by a respective decrease in water content. Increased hardness is associated with coloration and advancing age.
Adult↗
Unsuspected bronchospasm in association with topical timolol--a common problem in elderly people: can we easily identify those affected and do cardioselective agents lead to improvement?
The extent of impairment of respiratory function in a group of 52 elderly, glaucomatous patients receiving topical timolol therapy was investigated. To predict those patients who were likely to benefit from changing therapy, symptoms were elicited by direct questioning, and lung spirometry was measured before and after inhalation of salbutamol. Changing from timolol to either pilocarpine or the cardioselective betaxolol produced improvement in lung function tests. Mean peak flow increased from 278 l/min to 328 l/min (p < 0.001), forced expiratory volume in 1s (FEV1) from 1.66 l to 1.85 l (p < 0.001) and forced vital capacity (FVC) from 2.41 to 2.64 l (p < 0.001). Spirometry in a control group of 20 subjects was unchanged. Nineteen of 47 patients demonstrated a clinically significant (defined as 15% or more) increase in all values of lung function tests. Change to pilocarpine or betaxolol was equally effective in producing improvement but betaxolol had fewer side-effects. The presence of exertional dyspnoea, cough with sputum, raised dyspnoea score and improved lung function tests after salbutamol identified those patients experiencing clinically significant bronchospasm with an 89% specificity and 74% sensitivity.
Aged↗
Improved lung function tests on changing from topical timolol: non-selective beta-blockade impairs lung function tests in elderly patients.
Fifty-two elderly glaucomatous patients, without a history of asthma or obstructive airways disease, who were using topical timolol for control of intraocular pressure were recruited. Their topical therapy was changed to either betaxolol or pilocarpine. The change was associated with improvement in mean peak flow from 278 l/min to 328 l/min (t = 5.73, p < 0.001), mean FEV1 from 1.66 l to 1.85 l (t = 7.09, p < 0.001) and mean FVC from 2.40 l to 2.64 l (t = 5.07, p < 0.001). Change to either betaxolol or pilocarpine was associated with improved lung function tests. Lung function tests in a control group of 20 showed no significant changes. Both drugs maintained control of intraocular pressure but betaxolol had fewer ocular side effects.
Administration, Topical↗
The relationship between clinical classification of cataract and lens hardness.
'Hardness' of the cataractous lens is one of the major factors influencing the suitability of a patient for phacoemulsification. Surgeons should be able to estimate hardness when choosing patients for this method of cataract extraction. The aims of the study were to investigate the relationship between the clinical appearance of cataracts and their hardness. Ninety-one lenses were studied from patients undergoing endocapsular cataract extraction. Lenses were assessed using a classification based on the Lens Opacities Classification System II and hardness was assessed using an automated lens guillotine. The degree of nuclear sclerosis and the age of the patient were found to influence lens hardness. Regression analysis showed that 56% of the variation in hardness could be explained in terms of age and the degree of nuclear sclerosis. The presence of posterior subcapsular and cortical cataract did not influence hardness. These findings confirm our clinical suspicions and enable surgeons to make a more objective analysis of hardness prior to phacoemulsification.
Adult↗
Separation of phosphoproteins by fast protein liquid chromatography.
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Cells, Cultured↗
Subcellular localization of some glycolytic enzymes in parasitic flagellated protozoa.
1. The glycolytic enzymes of Tritrichomonas foetus, unlike those of Trypanosoma brucei, are apparently not located in microbody-like organelles (glycosomes) but appear to occur in the cytosol. 2. The localization of the glycolytic enzymes in Crithidia fasciculata and in the epimastigote and trypomastigote forms of Trypanosoma cruzi is however similar to that in T. brucei. 3. No evidence was obtained for the existence of glycolytic enzyme-containing microbodies in rat liver. 4. The glycosome is probably an organelle unique to members of the Kinetoplastida.
Animals↗
Unsuspected orbitocranial injury following ocular trauma.
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Adult↗