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A Sugar

Publications and source records attributed to A Sugar.

At least 55 records · Page 3Linked to original sources
PubMed1992

A randomized, prospective, double-masked clinical trial of Optisol vs DexSol corneal storage media.

We compared Optisol and DexSol, two chondroitin-sulfate-based media for corneal storage at 4 degrees C, by transplanting 31 donor cornea pairs (one cornea stored in Optisol and its mate in DexSol for 20 to 134 hours) into 31 pairs of recipients (62 patients). All grafts were clear 1 year after transplantation except for one primary donor failure (Optisol group). Optisol-stored corneas were significantly thinner than DexSol-stored corneas after cardinal suture placement (0.64 mm vs 0.76 mm) and at the end of surgery (0.69 mm vs 0.78 mm); at all points afterward through 1 year the two groups did not differ. The activity of two lysosomal enzymes released into the media during storage, alpha-mannosidase and alpha-glucosidase, was lower in the Optisol group. Epithelial status and all endothelial morphometric parameters, except the figure coefficient at 1 year, did not differ between the two groups before surgery and 3, 6, and 12 months after surgery. Mean endothelial cell loss at 1 year was 15% for the Optisol group and 21% for the DexSol group (P = .22). Thus, Optisol-stored corneas were thinner during surgery than DexSol-stored corneas and there was less lysosomal enzyme activity in the Optisol medium after tissue storage. There were no significant differences in postoperative clinical or endothelial morphometric parameters, however.

Adult↗
PubMed1992

Lag screws in sagittal split osteotomies: should they be removed?

The use of stainless steel lag screws to provide rigid internal fixation for sagittal split osteotomies was first described more than 17 years ago. It was shown that the need for intermaxillary fixation could be eliminated and that lower relapse rates could be produced. However a decade later, removal of the screws was still being advocated. In this study, 48 patients had a total of 259 screws inserted over a 5 year period. Twenty six screws were removed 10 months following insertion. Most of these were removed in the absence of any symptoms although a few were palpable or tender to touch. None of the screws removed were loose nor was there any evidence of infection or corrosion associated with them. The long term consequences of screw retention are discussed and it is suggested that they do not need to be removed routinely.

Adolescent↗
PubMed1992

Intercellular adhesion molecule-1 (ICAM-1) and HLA-DR antigens in herpes keratitis.

PURPOSE: Intercellular adhesion molecule-1 (ICAM-1) is a cell surface glycoprotein that binds leukocyte function antigen-1 receptor on leukocytes, thereby regulating leukocyte trafficking and function at sites of inflammation. Recently, the authors demonstrated ICAM-1 in human corneas exposed to proinflammatory cytokines, but ICAM-1 has not been reported in corneal disease. In this study, the presence of ICAM-1 in human disciform herpes simplex virus (HSV) keratitis is investigated. METHODS: Immunohistochemistry was performed for ICAM-1 on 4 keratoplasty specimens from patients with corneal scarring due to disciform HSV keratitis and 1 corneoscleral biopsy of a patient with active HSV keratoscleritis using specific, characterized monoclonal antibody to ICAM-1. Negative immunohistochemical controls included monoclonal antibodies to other vascular endothelial adhesion molecules or mouse serum. RESULTS: All 5 specimens demonstrated intense ICAM-1 immunoreactivity of keratinocytes, stromal keratocytes, and endothelial cells, predominantly in regions of leukocytic infiltration. Diffuse, intense HLA-DR positivity was detected throughout the corneas. The specimens failed to react with control antibodies. CONCLUSION: These results are the first to demonstrate ICAM-1 in human corneal disease and suggest important roles for ICAM-1 and HLA-DR co-expression in generating immune responses in HSV keratitis. Increased ICAM-1 expression in regions of leukocytic infiltration may regulate leukocyte-corneal cell binding, thereby promoting immune responses and damage by activated leukocytes.

Adult↗
PubMed1992

Secondary localized amyloidosis in interstitial keratitis. Clinicopathologic findings.

Cases of secondary localized corneal amyloidosis have been described in various corneal and ocular inflammations but are believed to occur uncommonly. The authors examined histopathologic specimens from 33 consecutive patients with interstitial keratitis who underwent penetrating keratoplasty for visual rehabilitation. In 11 cases (33%), multiple fusiform deposits of amyloid were identified and confirmed in middle and deep corneal stroma using histochemical staining. Characteristic electron microscopic findings were present in two cases. These results indicate that secondary localized corneal amyloidosis occurs frequently in interstitial keratitis and displays a distinct pattern of deposition.

Aged↗
PubMed1992

Toxoplasma encephalitis in patients with the acquired immunodeficiency syndrome.

Among 504 cases of AIDS diagnosed between 1983 and 1990, there were 86 patients (17%) with toxoplasma encephalitis (TE). All were symptomatic at the time of diagnosis. General signs such as fever, neck stiffness, or headache were present in 87.2%, and 75.6% had focal signs. The primary means of diagnosis was computerized tomographic scanning, revealing 169 lesions of which 80% were immediately contrast-enhancing. All patients had IgG antibodies against Toxoplasma gondii either before (74 of 75 evaluable patients) or at the time of diagnosis of TE (73 of 75). Elevated antibody titers were present in 44% of evaluable patients, compared to 11% of patients with AIDS and other opportunistic infections. Initial treatment was pyrimethamine plus sulfonamides in 65 patients, and pyrimethamine plus clindamycin in 12 patients, with other combinations or no treatment accounting for the remainder. Life-table analysis of the time to discontinuation of treatment because of suspected side effects suggested that sulfadiazine was significantly more toxic, with 48% of patients experiencing an interruption in treatment after 30 days, than pyrimethamine (12%) or clindamycin (24%). The 30-day mortality rate was 12%, and median survival was 310 days after diagnosis, 530 in patients treated with zidovudine and 190 days in those not so treated. Of 82 evaluable patients, 16 relapsed once and 4 of these more than once. The risk of relapse was 27% 1 year after diagnosis of a first episode of TE.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Treatment for cerebral toxoplasmosis protects against Pneumocystis carinii pneumonia in patients with AIDS. The Swiss HIV Cohort Study.

OBJECTIVE: To determine whether long-term maintenance treatment for toxoplasmosis protects against Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: Cohort study. SETTING: Switzerland. PATIENTS: A total of 453 patients with human immunodeficiency virus (HIV) entered the Swiss HIV Cohort Study. Ninety-nine patients with cerebral toxoplasmosis but no previous or simultaneous P. carinii pneumonia were compared with 240 patients with AIDS and other severe opportunistic infections (Centers for Disease Control [CDC] stage IVC1 infection other than toxoplasmosis and P. carinii pneumonia) as well as with 114 patients receiving inhaled pentamidine in a study of primary pneumocystis prophylaxis in patients infected with HIV. MEASUREMENTS: Life-table analysis for P. carinii-free survival. MAIN RESULTS: Six of 99 (6%) patients with toxoplasmosis, 50 of 240 (21%) patients with other severe opportunistic infections, and 8 of 114 (6%) patients receiving inhaled pentamidine developed P. carinii pneumonia. Life-table analysis showed that the incidence of pneumonia was substantially lower in patients with toxoplasmosis compared with that in patients with other severe opportunistic infections and was similar to the incidence in patients receiving pentamidine as prophylaxis. Analysis of the medication records from patients with toxoplasmosis showed that pyrimethamine and sulfonamides were administered 50% of the time; pyrimethamine and clindamycin, 25% of the time; and pyrimethamine alone, 9.9% of the time but that only one of the six patients with toxoplasmosis who developed P. carinii pneumonia received pyrimethamine and sulfonamides in the month before diagnosis. CONCLUSION: Patients with cerebral toxoplasmosis have a low risk for subsequently developing P. carinii pneumonia. This decreased risk is probably the result of chronic suppressive treatment with pyrimethamine and sulfonamides.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The effect of allograft rejection after penetrating keratoplasty on central endothelial cell density.

We identified all patients who had undergone penetrating keratoplasty for keratoconus and were being observed longitudinally (N = 174). During the follow-up period, 57 of 174 patients (33%) showed evidence of an allograft rejection episode, which occurred at an average of eight months after the operation. We analyzed specular photographs of the corneal endothelium, taken before and after the first allograft rejection episode. A significant decrease in endothelial cell density was observed (11.8%, P less than .0001). As a control, we analyzed all available specular photographs from patients with keratoconus who showed no evidence of allograft rejection after penetrating keratoplasty. The observed endothelial cell density decrease (11.8%) in patients with keratoconus undergoing allograft rejection exceeded that found in the control subjects (6.8%) during a comparable time period (P = .06). Severe allograft rejection episodes resulted in a decrease in endothelial cell density that exceeded expected loss significantly (14.8% compared with 6.9%, P = .01), whereas mild allograft rejection episodes were not associated with a loss in endothelial cell density exceeding that expected (1.8% compared with 6.5%, P = .34).

Endothelium, Corneal↗
PubMed1991

Implantation of Kelman-style, open-loop anterior chamber lenses during keratoplasty for aphakic and pseudophakic bullous keratopathy. A comparison with iris-sutured posterior chamber lenses.

The clinical and specular microscopic results of 40 cases (39 patients) of penetrating keratoplasty during which a Kelman-style anterior chamber intraocular lens was implanted were reviewed retrospectively. Thirty-one pseudophakic eyes received an intraocular lens exchange and nine aphakic eyes received a secondary intraocular lens. Postoperative follow-up averaged 24.5 months (range, 3 to 51 months). At 1, 2, and 3 years after keratoplasty, 39.3%, 63.2%, and 63.6% of eyes, respectively, had visual acuities of 20/40 or better. Ninety-five percent of the grafts remained clear. Causes of poor postoperative visual acuity included cystoid macular edema (32.5%), new glaucoma (22.5%), and age-related macular degeneration (10.0%). Other causes were endothelial rejection leading to graft failure, corneal ulceration, and retinal detachment. Corneal endothelial cell loss by specular microscopy was 11.5% at 1 years, 21.3% at 2 years, and 25.0% at 3 years. These results were compared with cell loss associated with iris-sutured posterior chamber lenses in penetrating keratoplasty. Visual outcomes and complication rates were similar between these two methods; however, the endothelial attrition at 1 and 2 years for the sutured posterior chamber lens was greater than that of the Kelman anterior chamber lens.

Adult↗
PubMed1990

Radiological assessment of hemifacial microsomia by three-dimensional computed tomography.

Hemifacial microsomia (HFM) is the commonest asymmetrical craniofacial deformity leading to underdevelopment of the craniofacial skeleton and soft tissues on the affected side. Timing of reconstructive surgery is based on a comprehensive analysis and classification of the deformity. Lateral cephalometric radiographs are of limited value because of superimposition of normal and abnormal bony structures. The skeletal and soft-tissue findings of six patients with HFM who underwent three-dimensional (3D) CT are presented. This method allows a comprehensive assessment of the deformity at a low radiation dose, 22% of that of a conventional CT scan, by the use of a low dose technique.

Adolescent↗
PubMed1990

Endothelial rejection following penetrating keratoplasty using Healon or BSS.

In order to evaluate the effect of a commonly used sodium hyaluronate preparation (Healon, Pharmacia AB, Uppsala, Sweden) on the incidence of endothelial rejection, endothelial cell loss, intraocular pressure, and corneal thickness after penetrating keratoplasty, we conducted a randomized clinical trial. Patients were allocated to receive Healon (n = 41) or BSS (Alcon Laboratories, Inc., Fort Worth, TX, U.S.A.; n = 37) during surgery. At 1 year after surgery, the Kaplan-Meier estimate of the proportion remaining free of endothelial rejection was 78.1% (SE 6.5%) in the Healon group, and 70.6% (SE 7.9%) in the BSS group. Survival analysis showed no overall difference in endothelial rejection between groups. The percent loss in endothelial cell density showed substantial variability within each group, but for those followed 2 years after surgery, the amount of loss was significantly less in Healon-treated patients (17.3% versus 30.2%). Four Healon patients required medication for intraocular pressure rises in the early postoperative period, and the average intraocular pressure 1 day after surgery was greater in the Healon group (18.2 versus 13.7 mm Hg). Corneal thickness was slightly greater in patients receiving Healon, but no clinically important differences were noted.

Acetates↗
PubMed1990

Incidence of HIV antibody-positive eye/cornea donors in hospital versus medical examiner cases.

We retrospectively examined Michigan Eye-Bank and Transplantation Center data on all eye/cornea donors in Michigan and Illinois for whom human immunodeficiency virus (HIV) antibody screening results were available. This was done to compare the HIV-antibody positive serology rate in hospital versus medical examiner donors. This population consisted of 3,783 donor records for the period January 1, 1986 through June 30, 1988--a 30-month period. Of these, 2,628 records were from hospital donors, and 1,155 were medical examiner cases. Of the 2,628 hospital donors, 22 (or 0.83%) tested positive for HIV antibody. Ten of the 1,155 medical examiner donors (or 0.87%) tested positive for HIV antibody. We examined donor demographics of gender, race, age, positive hepatitis B surface antigen, and residence for each group. The difference in the HIV antibody-positive rate between the two groups--hospital and medical examiner donors--is 0.04%, with a slightly higher rate in the medical examiner group. The chi-square was 0.0079, and the p-value was 0.928. We conclude that this difference is neither clinically nor statistically significant.

Adolescent↗
PubMed1989

Implantation of posterior chamber intraocular lenses in the absence of lens capsule during penetrating keratoplasty.

We retrospectively studied the clinical records and the corneal endothelial cell counts of 133 consecutive eyes that received sutured posterior chamber intraocular lenses during penetrating keratoplasty in the absence of lens capsular support. Postoperative follow-up time ranged from three to 24 months, with 82 patients having at least one year of follow-up. At one year, 45.1% of these patients had 20/40 or better visual acuity, 30.5% had a visual acuity between 20/50 and 20/100, and 24.4% had a visual acuity of 20/200 or worse. At two years, 63.6% had a visual acuity of 20/40 or better, 18.2% had a visual acuity between 20/50 and 20/100, and 18.2% had a visual acuity of 20/200 or worse. Ninety-seven percent of the grafts remained clear at their latest follow-up examination. Cystoid macular edema (36.4%) and age-related macular degeneration (14.0%) accounted for poor visual acuity in most cases. Less common problems included graft rejection, retinal detachment, glaucoma, and endophthalmitis. At one year, the endothelial cell loss in the grafts averaged 19% with sutured posterior chamber intraocular lenses.

Aged↗
PubMed1989

Corneal astigmatism after penetrating keratoplasty. The role of suture technique.

A randomized clinical trial was conducted to contrast two techniques of suturing in penetrating keratoplasty (PK) surgery: double running 10-0 and 11-0 sutures (DR), and a combination of 12 interrupted 10-0 sutures with a single running 11-0 suture (IR), followed by selective suture removal. The primary outcome evaluated in the 60 patients within each group was keratometric astigmatism. A decreasing trend in astigmatism over postoperative year 1 was observed only in the IR group (from 4.00 diopters [D] at 3 months to 2.50 D at 12 months). The difference in median astigmatism at 1 year (IR, 2.50 D; DR, 4.00 D) approached statistical significance (P = 0.06, Mann-Whitney U test). Both groups showed comparable steepening of almost 1 D during postoperative year 1. Assessment of the rate of visual rehabilitation was limited by a greater proportion of IR patients showing cystoid macular edema (CME) after surgery. These results, while favorable toward the IR/selective suture removal technique, must be substantiated by a final assessment after all sutures have been removed.

Aged↗