Search PubMed⌕ Search

Biomedical subjects

S Rauz

Publications and source records attributed to S Rauz.

15 recordsLinked to original sources
PubMed2001

Expression and putative role of 11 beta-hydroxysteroid dehydrogenase isozymes within the human eye.

PURPOSE: The human eye is an important target tissue for steroid hormones, and glucocorticoids have been implicated in the pathogenesis of ocular disease, including glaucoma. In peripheral tissues, corticosteroid hormone action is regulated at a prereceptor level through the activity of the 11 beta-hydroxysteroid dehydrogenase (11 beta-HSD) isozymes: an oxo-reductase (11 beta-HSD1) that activates cortisol (F) from cortisone (E) and a dehydrogenase (11 beta-HSD2) that inactivates F to E. The purpose of this study was to analyze the expression and putative role of 11 beta-HSD within the human eye. METHODS: Immunohistochemical and reverse transcription-polymerase chain reaction (RT-PCR) studies were performed on sections of human ocular tissues, surgical trabecular meshwork (TM) specimens and a ciliary nonpigmented epithelial (NPE) cell-line. Free F and E concentrations in aqueous humor were determined by gas chromatography-mass spectrometry (GC/MS). IOP was measured in eight male volunteers before and after oral ingestion of carbenoxolone (CBX), a known inhibitor of 11 beta-HSD. RESULTS: 11 beta-HSD1 was expressed in the basal cells of the corneal epithelium and the NPE. 11 beta-HSD2 was restricted to the corneal endothelium. RT-PCR revealed mRNA for only the glucocorticoid receptor (GR) in the TM specimens, whereas GR, mineralocorticoid receptor and 11 beta-HSD1 mRNAs were all present in the NPE cell line. The demonstration of free F in excess of E (F/E 14:1) in the aqueous humor suggested predominant 11 beta-HSD1 activity. Compared with baseline (14.7 +/- 1.06 mm Hg, mean +/- SD), the IOP decreased significantly on both the third and seventh days of CBX ingestion (12.48 +/- 1.11 mm Hg, P < 0.0001 and 11.78 +/- 1.50 mm Hg, P < 0.0001, respectively). CONCLUSIONS: These results suggest that the 11 beta-HSD1 isozyme may modulate steroid-regulated sodium transport across the NPE, thereby influencing IOP.

11-beta-Hydroxysteroid Dehydrogenase Type 2↗
PubMed2000

Evaluation of foldable intraocular lenses in patients with uveitis.

OBJECTIVE: To evaluate various foldable posterior chamber intraocular lenses (IOLs) after phacoemulsification in patients with uveitis. DESIGN: A prospective, noncomparative, interventional case series. PARTICIPANTS: Forty-nine consecutive patients (60 eyes) with various types of uveitis (anterior, n = 20; posterior, n = 1; panuveitis, n = 37, intermediate, n = 2). INTERVENTION: All patients underwent phacoemulsification with foldable posterior chamber IOL implantation. All eyes were free of active inflammation at the time of surgery. A variety of IOL biomaterials were implanted: acrylic (n = 30), silicone (n = 17), and hydrogel (n = 13). MAIN OUTCOME MEASURES: Detailed examination was performed by one masked observer. Several parameters were compared for each implant biomaterial, including level of best corrected Snellen visual acuity at final follow-up, presence of posterior synechiae, anterior capsular phimosis, posterior capsule opacification, and the degree of cellular deposits on the IOL optic. RESULTS: There were 26 males and 23 females, aged 9 to 83 years (mean, 48 years). Follow-up ranged from 1 to 33 months (mean, 17.03 months). At final follow-up, 56 eyes (93.3%) had an improvement in visual acuity compared with preoperative levels as follows: 34 eyes (56.6%) achieved an improvement of four or more Snellen lines, and 44 eyes (73.3%) achieved 20/30 or better. Giant cells, observed on the IOL optic in 19 eyes (31.7%), were most often seen on the acrylic biomaterial at the 1-month follow-up, although this was not found to be statistically significant. Scratch marks produced by the lens-introducing forceps were seen in 24 eyes (40.0%), mainly on the acrylic and hydrogel optics. Posterior capsule opacification (PCO) occurred in 49 eyes (81.7%), with only 5 eyes requiring laser capsulotomy. There was no association between PCO and the various lens biomaterials. Other causes for reduced visual acuity included glaucomatous optic neuropathy (n = 5) and cystoid macular edema (n = 8). CONCLUSIONS: The use of foldable IOLs in eyes with uveitis is safe, but the optimal biomaterial has yet to be found.

Acrylic Resins↗
PubMed2000

Plasma total homocysteine and retinal vascular disease.

PURPOSE: Hyperhomocysteinaemia has been linked to macrovascular disease. Our aim was to investigate whether there is a relationship between fasting plasma total homocysteine levels and retinal vascular disease. METHODS: We measured the homocysteine levels in 70 patients with arterial or venous retinal vessel occlusion and compared them with the levels in 85 controls without evidence of ischaemic heart disease. Homocysteine levels were determined by high-performance liquid chromatography with electrochemical detection and compared after logarithmic transformation. RESULTS: Homocysteine levels were found by univariate analysis (unpaired two-tailed t-test) to be significantly higher in the group with retinal artery occlusion than the group with retinal vein occlusion (p = 0.045) and in both groups compared with controls (18.4 and 13.8 vs 9.5 mumol/l; p = 0.0002 and < 0.0001, respectively). The controls, however, were significantly younger than the subjects (51.5 +/- 15.4 vs 66.2 +/- 11.9 years; p < 0.0001), but analysis of the results by age revealed significant differences between the groups and controls for the seventh decade (vein occlusions, p = 0.05) and for the eighth decade (artery occlusions, p = 0.037). Subgroup analysis of the retinal vessel occlusion group revealed significant differences in mean blood pressure between those with branch retinal vein occlusions (175/100 mmHg) and both those with central retinal vein occlusions (155/88 mmHg) and those with retinal artery occlusions (157/86 mmHg). Both vein occlusion subgroups also differed significantly with regard to homocysteine levels, branch < central (12.2 +/- 1.3 vs 15.0 +/- 1.6 mumol/l, p = 0.03). Multiple linear regression analysis revealed significant relationships between homocysteine levels and the presence of retinal vessel occlusion (p = 0.0002), serum creatinine (p = 0.001) and age (p = 0.003), but not gender. CONCLUSIONS: We conclude that homocysteine may be a risk factor for retinal vascular disease and could be simply and cheaply treated with folate and vitamins B6 and B12.

Adult↗
PubMed2000

The role of preoperative subconjunctival mydricaine and topical diclofenac sodium 0.1% in maintaining mydriasis during vitrectomy.

PURPOSE: To establish the role of preoperative subconjunctival mydricaine and diclofenac 0.1% in maintaining mydriasis during vitrectomy. METHODS: Fifty-seven patients were entered into the study. All were given cyclopentolate 1% and phenylephrine 2.5% preoperatively. Each patient was randomly allocated to one of three groups. In Group 1, patients received mydricaine by subconjunctival injection and diclofenac 0.1% topically preoperatively. In Group 2, patients received only subconjunctival mydricaine. Group 3 patients received only topical diclofenac preoperatively. Pupil diameter was measured with calipers before and at the end of the operation. RESULTS: There was no statistically significant difference in the change in pupil size between Groups 2 and 3. In all patients in Group 1 (who received both subconjunctival mydricaine and diclofenac preoperatively), pupil size was either maintained or increased after vitrectomy. This result was statistically significant when compared with the other groups (for Group 1 versus Group 2, P<0.005; for Group 1 versus Group 3, P<4.7x10(-06)). CONCLUSION: Topical diclofenac is useful for maintaining pupil size during vitrectomy only when used in conjunction with subconjunctival mydricaine, especially in patients in whom prolonged surgery is anticipated.

Adolescent↗
PubMed1999

Changing patterns of HIV related ocular disease.

Cytomegalovirus (CMV) retinitis is the commonest ocular complication of AIDS and the prevention of recurrence has been dependent on lifelong maintenance treatment. Recently there has been a dramatic downturn in the number of new cases of CMV retinitis, which has been attributed to the introduction of highly active antiretroviral therapy (HAART) and subsequent improved survival. Whereas paucity of inflammation has been considered to be the hallmark of the ophthalmic manifestations of AIDS, with immune recovery, a new pattern of ophthalmic AIDS has emerged. This is characterised by a heightened inflammatory response and more frequent complications associated with this response--for example, vitritis, cystoid macular oedema. In spite of this, regression of CMV retinitis has been reported, as well as absence of reactivation or progression after withdrawal of anti-CMV maintenance treatment. How long this situation will continue is not known and we remain cautious about the future of CMV retinitis and other opportunistic ocular infections.

AIDS-Related Opportunistic Infections↗
PubMed1999

Using the second instrument peripheral corneal incision in phacoemulsification as a blow-off valve.

PURPOSE: To assess the rise in intraocular pressure following phacoemulsification and whether it can be modified by the architecture of the peripheral corneal incision for the second instrument. SETTING: Frimley Park Hospital, Frimley, United Kingdom. METHOD: Forty-two patients had intraocular pressures measured from both eyes preoperatively, then underwent routine scleral section phacoemulsification. They were randomly assigned to perpendicular (blow-off valve) and oblique (water-tight) peripheral corneal incision groups. Postoperative intraocular pressures were measured at 3, 6, 12 and 18 hours. Pressures from the unoperated eyes were used as controls. Aqueous release from the second instrument peripheral corneal incisions and frown scleral incision were assessed using the Seidel's test. RESULTS: There was a rise in intraocular pressure in both groups compared to the control eyes (mean 10.95+/-2.19 mmHg, P<0.00005) at 6 hours. The difference between the groups was significant at 12 hours (mean difference 3.35 mmHg, P<0.05); 63.6% of the perpendicular incisions and 15% of the oblique incisions were Seidel's positive. The frown incision did not leak. CONCLUSION: This study documents the natural history of the rise in intraocular pressure following phacoemulsification peaking at 6 hours. Pharmacological agents should be administered to cover this period. The perpendicular peripheral corneal incision had a tendency to act as a blow-off valve allowing release of aqueous when intraocular pressures were elevated in the first 18 hours following phacoemulsification. This phenomenon is likely to result in a reduction in rise of intraocular pressure compared to the oblique peripheral corneal incision group which tended to be water-tight.

Aged↗
PubMed1997

Capsulorhexis phymosis following uncomplicated phacoemulsification surgery.

PURPOSE: The aim of the study was to assess and compare the degree of capsulorhexis phymosis following uncomplicated phacoemulsification cataract surgery in polymethylmethacrylate (PMMA) and silicone lens implants. METHOD: Sixty-four patients were evaluated 1 day, 6 weeks and 6 months following phacoemulsification cataract extraction. The anterior capsular diameters were measured with the illuminated beam of the slit lamp at 45 degrees and 135 degrees and the surface area of the opening calculated. We have measured and compared the change in the capsulorhexis size for both lens types and assessed its statistical significance with a paired Student's t-test. RESULTS: A statistically significant contraction of the capsulorhexis was noted in all patients within the first 6 weeks (p < 0.001). Capsular contraction continued between 6 weeks and 6 months post-operatively but to a lesser extent (p < 0.05). The difference in the degree of phymosis between the first period (1 day to 6 weeks) and the second (6 weeks to 6 months) was statistically highly significant for all patients (p < 0.001). The capsular areas for the silicone lens implants were significantly smaller than for the PMMA implants at 6 weeks and 6 months. None of our patients had a clinically significant capsular contracture requiring Nd:YAG laser capsulotomy. CONCLUSION: Anterior capsular contraction is commonly observed following capsulorhexis in phacoemulsification surgery. This study demonstrates that the maximum rate of contraction occurs in the first 6 weeks following surgery and is more pronounced with silicone lens implants.

Aged↗
PubMed1997

Variation in astigmatism following the single-step, self-sealing clear corneal section for phacoemulsification.

PURPOSE: A single-step, self-sealing, 3.2 mm clear corneal section is described and the incidence and variation of surgically induced astigmatism following phacoemulsification over a period of 3 months is determined. METHODS: Twenty-two patients who underwent uncomplicated 3.2 mm clear corneal phacoemulsification with foldable Allergan silicone intraocular lens implantation were autorefracted pre-operatively and on day 1, week 1, week 6 and at 3 months. The variation in induced astigmatism was analysed using the subtraction method and vector analysis. The change in direction of the cylindrical axis was examined. RESULTS: The induced astigmatism represented by the total vector on day 1 was 1.17 D and vector decomposition ratio, ATR:WTR (against-the-rule:with-the-rule), was 21.05:78.95. The total vector increased by 0.5 D in the first week and then stabilised. Vector decomposition showed an against-the-rule astigmatic drift so that by 3 months the ATR:WTR was 40.49:59.91. There was a tendency of the axis of the negative cylinder to swing towards the corneal section meridian on day 1 and to oscillate around that meridian at week 1 and week 6. By 3 months the direction reverted to that pre-operatively, in most cases. CONCLUSIONS: The single-step, self-sealing clear corneal section is mechanically stable and, though there is some variability in the measured astigmatism, there is an acceptable functional result throughout the post-operative period.

Aged↗
PubMed1997

Sub-Tenon's anesthesia and orbicularis oculi function.

BACKGROUND AND OBJECTIVE: To assess the necessary volume of local anesthetic with added hyaluronidase that must be infiltrated to the sub-Tenon's space to achieve complete eyelid akinesia. PATIENTS AND METHODS: Eighty-five consecutive patients were randomly assigned to two groups, receiving either 5 ml or 7 ml of local anesthetic to the sub-Tenon's space. Each patient was assessed clinically at 5 and 10 minutes for orbicularis oculi function. The anesthetic solution consisted of 5 ml of 2% lidocaine, 5 ml of 0.75% bupivacaine hydrochloride, and 1500 IU of hyaluronidase. A top-up of anesthetic infiltration was given in doses of 2 ml if excessive orbicularis muscle function persisted at 10 ml. Routine phacoemulsification surgery was performed, and, if necessary, a top-up of anesthetic was given on the table. RESULTS: Complete eyelid akinesia was achieved in 7.5% (3 of 40) of the patients in the 5-ml group and in 93.3% (42 of 45) of the patients in the 7-ml group (P < .005). There was no effect for 57.5% (23 of 40) of the patients in the 5-ml group and for 2.2% (1 of 45) of the patients in the 7-ml group. A top-up of anesthetic was given in the anesthetic room to 40 patients, 37 of whom were in the 5-ml group, and a Van Lint block of the facial nerves was necessary for 1 patient from the 5-ml group. An on-the-table top-up of anesthesia was necessary for 3 patients (2 from the 5-ml group, 1 from the 7-ml group). CONCLUSIONS: The addition of hyaluronidase promotes diffusion of sub-Tenon's anesthetic, resulting in effective akinesia of the orbicularis oculi. The infiltration of 7 ml of the anesthetic solution significantly improves the rate of eyelid akinesia.

Aged↗
PubMed1996

One stage vertical rectus muscle recession using adjustable sutures under local anaesthesia.

AIMS: To assess the results of visual axis alignment following one stage adjustable suture surgery to correct vertical diplopia. METHOD: Eight patients with a mean age of 44.9 years (range 16-80 years) complaining of vertical diplopia underwent rectus muscle recession under local anaesthesia with intraoperative adjustment of sutures. Diplopia was secondary to superior oblique paresis in four patients, dysthyroid eye disease in two patients, superior rectus paresis in one patient, and one developed a consecutive deviation after previous squint surgery. The surgery consisted of seven single muscle recessions (six inferior recti and one superior rectus) and one two muscle recession (inferior and lateral recti). The surgery was performed under topical anaesthesia supplemented with a subconjunctival injection of local anaesthetic over the muscle insertions. RESULTS: The patients remained comfortable throughout their surgery. All had a reduction in their vertical deviation. Six were asymptomatic and were eventually discharged. One had residual diplopia which was well tolerated without further intervention. One had persistent troublesome diplopia which was corrected by temporary Fresnel prisms. He became asymptomatic after further surgery of a 1 mm inferior rectus advancement. CONCLUSION: One stage adjustable suture surgery is recommended in all cases of strabismus surgery when postoperative results would otherwise be unpredictable.

Adolescent↗