Intraocular telescopic lens evaluation in patients with age-related macular degeneration

PURPOSE: To evaluate the improvement of distance and near visual acuity after removal of cataract and implantation of an 3.0x intraocular miniaturized telescope (IMT) in patients with stable atrophic type age-related macular degeneration (ARMD). SETTINGS: Instituto Oftalmológico de Alicante and a multicenter group. METHODS: In this prospective noncomparative multinational consecutive study, 40 eyes of 40 patients with dry-type ARMD were implanted with IMTs at multiple centers. Standard phacoemulsification procedure followed by enlargement of the incision to 10 mm and implantation in the capsular bag of an 3.0x IMT was carried out in all the cases. Patients were followed for 12 months. Evaluation included the differences between preoperative and postoperative uncorrected and best corrected visual acuity for far and near, position of the IMT, intraocular pressure, and occurrence of any postoperative complications. RESULTS: Mean preoperative uncorrected distance visual acuity (UCDVA) in the operated eye was 0.9 logMAR (0.125 +/- 0.01, range 0.1 to 0.3 in decimal values); at 1 year postoperatively, mean UCDVA in the operated eye was 0.6 logMAR (0.25 +/- 0.14, range 0.1 to 0.5 in decimal values). Mean preoperative uncorrected near visual acuity (UCNVA) in the operated eye was 0.8 logMAR (0.16 +/- 0.13, range 0.1 to 0.5 in decimal values); at 1 year postoperatively, mean UCNVA in the operated eye was 0.4 logMAR (0.4 +/- 0.26, range 0.1 to 1.0 in decimal values). The differences between pre- and postoperative distance and near visual acuities were statistically significant. Six cases were explanted, and 14 developed adverse effects, 7 of which were persistent. The corneal endothelium tolerated the procedure well. CONCLUSION: Implantation of IMT is feasible and plays an effective role in improving far and near visual acuity in patients with stable dry-type ARMD.     

Neuro-ophthalmological findings in sarcoidosis

PURPOSE: This review emphasizes the importance of neuro-ophthalmological signs and symptoms in sarcoidosis. The presence of ophthalmological and neuro-ophthalmological findings may lead to diagnosis of the disease and the initiation of adequate treatment. MATERIAL AND METHODS: Patients who had been diagnosed with neurosarcoidosis during the period 1990 - 2001 were identified from the departmental diagnostic index. The history, clinical, laboratory and imaging data of patients were analysed. RESULTS: Fifteen patients were identified, four men and 11 women, with a mean age of 44.1 years (range 26-65 years). In six of the 15 (40%), neurological deficits were the initial symptoms. Nine (60%) had known sarcoidosis at the time of presentation. Ten patients (66%) had ophthalmological/neuro-ophthalmological symptoms and signs. CONCLUSION: Neuro-ophthalmological symptoms may develop early in neurosarcoidosis. If neuro-ophthalmological symptoms arise in patients with established biopsy-proven sarcoidosis, the diagnosis is usually easy to make. However, a number of patients with neurosarcoidosis may present with neuro-ophthalmic symptoms before systemic involvement becomes obvious. In this situation the diagnosis is challenging, and the major goal is to establish the presence of systemic sarcoidosis.     

Direct microvascular repair of an infant's transected coronary artery: case report

The authors report the direct, microvascular repair of a right coronary artery transected during reoperation fOr complications of arterial switch operation (ASO) in a 3 month-old child. This is the first documented use of direct microsurgical anastamosis in the repair of an infant's transected coronary artery. Deviation from standard coronary bypass graft repair was permitted by vessel characteristics, as well as close collaboration between plastic surgery and cardiac surgery services. Patency of repair was confirmed intraoperatively with Doppler ultrasound and through postoperative echocardiograms documenting stable right ventricular function. This case highlights the benefit of a multidisciplinary approach to an emergent clinical problem using microsurgical techniques.     

High rate of recurrence in renal transplant recipients after a first episode of venous thromboembolism

BACKGROUND: No data are available about the optimal duration of oral anticoagulant therapy (OAT) after an episode of venous thromboembolism (VTE) occurring in renal transplant (RT) recipients. Our study was undertaken to evaluate the risk of VTE recurrence in patients developing a first episode of VTE after RT. METHODS: Among 484 RT patients, 34 (7%) developed a first VTE: 28/34 VTE patients (Group 1) were prospectively studied, after stopping OAT. Group 1 was compared with a group of 84 patients without history of renal disease who had suffered from a first episode of VTE matched for age, sex and type of thrombotic event (Group 2) and with a matched group of 84 RT recipients with no history of VTE (Group 3). After OAT withdrawal, blood samples were obtained for thrombophilia and clotting activation markers (prothrombin fragment 1+2 (F1+2) and D-dimer plasma levels). RESULTS: During follow-up, 14/28 patients of Group 1 and 8/84 patients of Group 2 experienced VTE recurrence (P < 0.0005). Homocysteine, F1+2 and D-dimer plasma levels were significantly higher in Group 1 than in Group 2 and 3 (P < 0.0001 and <0.05 respectively) for all the three parameters. CONCLUSIONS: Our data outline the high risk of VTE recurrence in RT recipients. Strategies for VTE recurrence prevention are needed; Prolonged OAT, in spite of the high bleeding risk of RT patients, should be considered in this respect.     

Importance of parenteral nutrition in patients undergoing hemopoietic stem cell transplantation procedures in the autologous system

OBJECTIVE: The aim of this study was to assess the frequency of parenteral nutrition and to compare the impact of parenteral and oral feeding on the nutrition and clinical status of adults undergoing autologous hemopoietic stem cell transplantation. METHODS: The study involved 35 patients with neoplasm of the hemopoietic system who underwent hemopoietic cell autotransplantation at the Hematology Clinic (Jagiellonian University, Krakow, Poland). The patients' nutrition status was assessed using body mass index (BMI) values, body mass components, concentration of albumin, and total protein in blood serum. The clinical status evaluation included duration of hematologic reconstruction, concentration of bilirubin, enzyme activity (alanine aminotransferase and aspartate aminotransferase), severity of infections, and duration of hospitalization. RESULTS: Parenteral nutrition was required in 19 patients. Oral feeding was used in 16 patients. Symptoms of malnutrition on the day preceding the introduction of conditioning treatment were recorded only in patients requiring parenteral nutrition (31.6%). In the posttransplantation period, a statistically significant decrease in body mass was observed in both groups, whereas the share of fatty tissue in total body mass was significantly less in patients (men and women) fed parenterally. CONCLUSION: A supply of 25-30 kcal/kg and 1-1.5 g protein/kg/day as an element of parenteral nutrition (where 20%-30% of the energy requirement was covered by fats, 15%-20% by amino acids, and 50%-55% by glucose) helped prevent the development of malnutrition and restore the functions of the hemopoietic system at a level comparable to that for patients fed naturally.