Topical steroid use in the treatment of ocular alkali burns

BACKGROUND—Ocular alkali burns can be associated with a poor visual outcome. The release of collagenases and proteases after the injury leads to corneoscleral melting. The role of topical steroids in such patients is controversial as they have been postulated to exacerbate corneoscleral melting.
METHODS—30 patients were reviewed retrospectively after admission to King's College Hospital with alkali burns between 1990 and 1993. All patients were treated with an intense and prolonged regimen of topical steroids and topical and systemic vitamin C.
RESULTS—22 patients had mild injuries and eight had severe injuries as estimated by the Roper-Hall grading system. 23 patients were treated with topical steroids for > 10 days and 22 patients were treated with topical vitamin C for more than 10 days. One patient with a severe injury developed corneoscleral melting.
CONCLUSION—Prolonged treatment with topical steroids when used in conjunction with topical vitamin C is not associated with corneoscleral melting.

     

Visual-evoked potential evidence of chiasmal hypoplasia

PURPOSE: To show that chiasmal hypoplasia or aplasia need not be an isolated developmental anomaly and to examine the spectrum of associated clinical findings to explore the possibility that these patients may represent a phenotypic manifestation of a developmental gene anomaly. DESIGN: An observational case series. PARTICIPANTS: Five infants, between several weeks and 7 months of age, in whom the electrophysiologic characteristic of chiasmal hypoplasia had been noted were included. METHODS: Flash electroretinography and flash and pattern visual-evoked potentials (VEPs) were elicited from all patients. Clinical ophthalmologic examinations, including funduscopy, were performed, and all patients had magnetic resonance imaging (MRI) brain scans. MAIN OUTCOME MEASURES: The occipital distribution of monocular VEP response peaks was studied. The symmetry of lateral channel responses was compared for monocular stimulation. RESULTS: All five patients had a crossed asymmetry in the monocular VEP occipital distribution, which is consistent with a paucity of fibers crossing at the chiasm. The MRI findings supported this electrophysiologic observation, illustrating degrees of chiasmal hypoplasia and variable coincidence of other midline abnormalities of the brain. Optic disc appearances varied from normal to hypoplastic and colobomatous. CONCLUSIONS: The ophthalmologic and MRI findings of five patients who showed a crossed asymmetry in monocular flash VEPs are consistent with a paucity of axons crossing at the chiasm. The similarities between achiasmia in humans and mice due to a Pax2 gene anomaly are discussed.     

Efficacy of multi-wave locked system laser therapy on nerve regeneration after crushing in Wister rats

[Purpose] To investigate the efficacy of the multi-wave locked system laser therapy on the regeneration of peripheral nerve injuries by evaluating the functional, electrophysiological, and morphological changes of the crushed sciatic nerve in Wistar rats. [Materials and Methods] Sixty male Wistar rats (200–250 g) were randomly assigned to control negative, control positive, or laser groups and subjected to no laser therapy or crushing, to crushing without laser therapy, or crushing followed by multi-wave locked system laser therapy five times/week for four weeks (power=1 W, energy density=10 J/cm², total energy=100 J), respectively. Functional, electrophysiological, and morphometric analyses were performed before and 7, 15, 21, and 28 days after crushing. The sciatic functional index, compound motor action potential amplitude, motor nerve conduction velocity, and nerve and myelin sheath diameters were measured. [Results] The sciatic functional index value decreased significantly, while the compound motor action potential amplitude, motor nerve conduction velocity, nerve diameter, and myelin sheath diameter increased significantly in the laser group post-treatment compared to the values in the control groups. [Conclusion] Multi-wave locked system laser therapy was effective in accelerating the regeneration of crushed sciatic nerves in Wistar rats.     

Radiation therapy as definitive treatment for localized carcinoma of prostate

A progress report on the treatment of 116 patients with adenocarcinoma of the prostate treated by external irradiation is presented. Fifteen, 60, and 41 patients presented initially with Stages A, B, and C, respectively. The majority of the patients received 7,000–7,500 rads during a period of seven to eight weeks, locally to the prostate gland. The five-year actuarial survival were 90, 70, and 40 per cent for Stages A, B, and C, respectively. The five-year survival rates for patients with well and moderately differentiated tumors were significantly better (45 per cent) than for those with poorly differentiated tumors (24 per cent). The five-year survival rate in the patients who received prior or concomitant hormone manipulation was lower (33 per cent) as compared with those receiving radiation therapy alone (43 per cent). All of the above differences were statistically significant (0.01 level). Of the patients failing, distant metastases have developed in 88 per cent suggesting that subclinical distant metastases might have been present prior to initiation of radiotherapy. The local control rate was 82 per cent. The morbidity of this mode of therapy was found to be acceptable. Radical radiation therapy is an effective method for control of carcinoma of the prostate and is potentially curative.