Prosthetic options for below knee amputations after osteomyelitis and nonunion of the tibia

Below the knee amputation after trauma is an appropriate option for many patients with recalcitrant infection and nonunion of the tibia. Patients who have had transtibial amputations have lower energy expenditure, heart rate, and oxygen cost when ambulating with their prostheses than when using a three-point gait with crutches without their artificial limb. Innovative prosthetists have improved each of the five essential components of the limb amputated below the knee: socket, insert, shaft and pylon, foot and ankle assembly, and suspension system. Prosthetists are integral members of the patient's healthcare team. Their recommendations and direct patient care are essential to optimizing the functional ability of patients who have had amputations.     

Implantation of verisyse phakic intraocular lens to correct myopic refractive error after penetrating keratoplasty in pseudophakic eyes

PURPOSE: We report 2 cases in which a Verisyse phakic intraocular lens (PIOL) was used to successfully treat high myopia after penetrating keratoplasty (PK) in pseudophakic patients. METHODS: Case 1 involved a 69-year-old pseudophakic man with a manifest refraction (MR) of -6.50 + 1.75 x 048 and a best spectacle corrected visual acuity (BSCVA) of 20/40 approximately 16 months after PK in the right eye. Case 2 was a 78-year-old pseudophakic man who had an MR of -9.00 + 5.75 x 132 with a BSCVA of 20/100 approximately 24 months after PK in the left eye. RESULTS: In case 1, 10 months after Verisyse PIOL implantation, the MR was pl +2.00 x 135 with a BSCVA of 20/30. Endothelial cell density (ECD) in this patient decreased from 1926.1 to 815.3 cells/mm over 17 months. In case 2, 24 months after Verisyse PIOL implantation, the MR was -3.25 + 3.50 x 105 with a BSCVA of 20/60. ECD in this patient decreased from 2108.4 to 753.8 cells/mm in 30 months. CONCLUSION: The Verisyse PIOL may provide an alternative method to correct high myopia for anisometropia in pseudophakic patients after PK. In this report, PIOL implantation was associated with a decrease in ECD. Further studies are required to determine the long-term effects and ultimate safety of PIOL placement on the integrity of the cornea endothelium after corneal transplant in pseudophakic patients.     

The effect of the fourth-generation fluoroquinolones on corneal reepithelialization after penetrating keratoplasty

PURPOSE: To compare the effects of topical moxifloxacin and gatifloxacin on corneal reepithelialization after penetrating keratoplasty. METHODS: In this single-center, open-label, prospective study, 46 consecutive patients requiring penetrating keratoplasty were alternately assigned to receive either postoperative moxifloxacin 0.5% ophthalmic solution (n = 23; Vigamox) or gatifloxacin 0.3% ophthalmic solution (n = 23; Zymar). The primary outcome measure was the area of the epithelial defect measured by slit-lamp evaluation during the postoperative period. RESULTS: The mean area of the epithelial defect was similar in both treatment groups at baseline (P = 0.104), but it was significantly larger in the moxifloxacin group than in the gatifloxacin group at day 4 (23.9 mm2 versus 10.6 mm2, respectively; P < .001) and day 7 (3.8 mm2 versus 0.85 mm2, respectively; P = 0.03). At every follow-up visit after day 4, there were more eyes with complete reepithelialization of the corneal graft in the gatifloxacin group than in the moxifloxacin group (statistically significant at days 7 and 14). CONCLUSIONS: The results of this preliminary study suggest that the postoperative use of gatifloxacin in corneal transplant patients may allow the early stages of corneal graft reepithelialization to proceed more quickly than does treatment with moxifloxacin. These findings suggest that a larger, masked, randomized clinical study in a more homogeneous patient population is warranted to further investigate the relative effects of moxifloxacin and gatifloxacin on postoperative corneal wound healing.