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PubMed2006

The importance of base curve in the design of minus iseikonic lenses.

PURPOSE: A widely advocated approach to increasing spectacle magnification in minus lenses is to increase center thickness and reduce vertex distance. Conventionally, a steeper base curve is to be avoided because of the accompanying increased vertex distance in a minus lens and the reduction of spectacle magnification that results. This approach works when small amounts of spectacle magnification are needed. However, when large amounts are needed for high minus lenses with flat base curves, the conventional approach does not provide sufficient magnification. Facial features such as eyelash length limit the contribution of reducing vertex distance, and the flat base curves limit the efficacy of increasing center thickness. Steeper base curves are required to increase the optical "leverage" of increasing center thickness. METHODS: Through use of an example, a steeper base curve is shown to increase the spectacle magnification of a high minus lens. The gain in spectacle magnification is preserved by maintaining a nearly constant vertex distance through bevel location. RESULTS: In the example, changing the base curve of a -6.50-D lens by +4.50 D while increasing the center thickness by 4.1 mm resulted in a +4.4% increase in spectacle magnification. The lens bevel was kept as close as possible to the front surface, allowing the increased center thickness to keep the back vertex at essentially a constant vertex distance in the presence of the steeper base curve. Without the steeper base curve, it was not possible to attain the needed spectacle magnification. CONCLUSIONS: When large amounts of spectacle magnification are needed for high minus lenses, both steeper base curves and increased center thicknesses are necessary. The reduction in spectacle magnification from increased vertex distance that is expected with steeper base curves can be neutralized by keeping the bevel close to the front surface on the thicker lens.

Adult↗

PubMed2003

The use of micrografts and minigrafts in the aesthetic reconstruction of the face and scalp.

Hair transplantation by use of micrografts (one- to two-hair follicular unit grafts) and minigrafts (three- to four-hair follicular unit grafts) used in large numbers (>1000 grafts) in a single session was initially described for the treatment of male pattern baldness. More recently, the author has found many other applications, particularly in facial and scalp reconstruction. The most common causes for aesthetic hair restoration of those areas in the author's experience include hair loss resulting from aesthetic facial rejuvenation surgery, revision of unsatisfactory results from previous hair transplantation, burn alopecia, congenital reasons, and hair loss after oncologic resections. The basic technique is described in detail, with variations given for each of the challenging anatomic areas, including the sideburns and temporal hairline, eyebrows, eyelashes, mustache, beard, and remaining scalp. Special attention is given to the direction of hair growth, hair texture, aesthetic planning, and absence of detectable scars, in order to mimic nature and to result in a minimal number of procedures. The use of micrografts and minigrafts in the aesthetic reconstruction of the face and scalp has been found to be safe and predictable, and has provided a high level of patient satisfaction.

Face↗

PubMed2004

Surgery without skin resection for eyelid entropion.

The previously reported surgical methods for eyelid entropion are basically manipulations of the skin or the conjunctival surface. When entropion is marked, manipulations also involve the tarsus. In the most widely used method, the eyelashes are directed outward by horizontal wedge resection of an appropriate amount of the excessive skin in the ciliary vestibule. This method is simple and effective but sometimes causes recurrences, conspicuous scars due to tension of the resection site, or lagophthalmos due to excessive resection. We speculated that partial swelling of the orbicularis muscle at the front of the tarsus is one of the main causes of pediatric eyelid entropion and found that correction of entropion is possible by partial resection of this muscle without skin resection. Eight patients with congenital entropion were treated by this method, and good results were obtained.

Child, Preschool↗

PubMed2006

Correction of involutional entropion by horizontal tangential wedge excision of the tarsus.

Involutional entropion, a condition in which the lower eyelid margin is rotated inward, occurs often in elderly people. It can result in corneal and conjunctival irritation by the inverted eyelashes. The pathophysiology has been attributed to multiple factors, including attenuation of the tarsal plate with age, enophthalmus occurring with aging, decreased action of the inferior palpebral muscle, and the overridge of the preseptal orbicularis oculi. Many surgical options have been described for the treatment of involutional entropion. We present an innovative surgical procedure for correction of involutional entropion by a horizontal tangential wedge excision of the tarsal plate.

Aged↗

PubMed2006

Periciliary Y-V epicanthoplasty.

The epicanthal fold is a semilunar flap of eyelid skin on the medial aspect of the eye. Many surgical techniques have been described to eliminate the epicanthal fold, which is a feature uniquely predominant among the Asian population. However, many surgeons avoid epicanthoplasty because of the fear of visible scar formation. From January of 2002 to April of 2004, 118 patients with medial epicanthal folds underwent epicanthoplasty using a periciliary Y-V advancement procedure for the prevention of visible scar formation. The mean age of the patients was 25.2 years (range, 16 years to 56 years). The median follow-up period was 6 months (range, 2 weeks to 2 years). We performed periciliary Y-V epicanthoplasty only when a patient had wide interepicanthal distance (over 32 mm) or a completely eclipsed lacrimal caruncle. Most of the patients attained satisfactory results, and there were few complications in our cases. Scarring of the medial canthal area has not been a problem with this technique because we designed incisions along the eyelashes and skin-mucosal junctions. We have found that our periciliary Y-V epicanthoplasty is a very reliable and effective method for eliminating the epicanthal fold with minimal scar formation.

Adolescent↗

PubMed2002

Automatic estimation of the corneal limbus in videokeratoscopy.

An algorithm for estimating the corneal limbus from videokeratoscopic images is proposed. After the image is transformed to a polar grid, a novel edge-detection procedure, suitable for the detection of the soft edge produced by the limbus, is used to locate the limbus. Outliers due to the eyelids, eyelashes, and videokeratoscopic rings are removed by taking advantage of the approximate circularity of the cornea. An ellipse which minimizes the sum of the squared algebraic errors is fitted to the remaining edge points. Comparisons between the proposed algorithm, a manual computer-based technique and an algorithm which uses conventional edge-detection techniques demonstrate the accuracy of the proposed algorithm.

Algorithms↗

PubMed1992

Mechanism of androgen action in cultured dermal papilla cells derived from human hair follicles with varying responses to androgens in vivo.

Androgens are major regulators of human hair growth, but their effects vary: many follicles are stimulated by androgens, e.g., beard; some remain unaffected, e.g., eyelashes; whereas scalp follicles undergo regression and balding in genetically disposed individuals. Because the dermal papilla controls many aspects of the hair follicle, androgens may act via the dermal papilla, affecting the other follicular components indirectly. In this hypothesis androgens would alter dermal papilla cell production of regulatory substances, e.g., growth factors and/or extracellular matrix components. To test this theory the mechanism of androgen action has been compared in primary lines of dermal papilla cells cultured from androgen-dependent follicles and relatively androgen-independent non-balding scalp. Androgen receptor levels were assayed by saturation analysis (9-10 points; 0.05-10 nmol/l) using the synthetic androgen [3H]-mibolerone and specificity was confirmed by competition studies. Androgen metabolism was investigated both intracellularly and in the media after a 2-h incubation with 5 nM [3H]-testosterone. Carrier and [14C] steroids were added to the extracts before separation by thin-layer chromatography; steroid identity was confirmed by recrystallization. Dermal papilla cells from androgen-dependent follicles contained higher levels of specific, high-affinity, low-capacity androgen receptors than non-balding scalp cells. Testosterone metabolism also varied with beard, public and scalp cells containing testosterone and androstenedione intracellularly, but only beard cells producing 5 alpha-dihydrotestosterone, in line with the scanty beard growth found in 5 alpha-reductase deficiency. Elsewhere we have shown that cultured dermal papilla cells produce extracellular matrix components and mitogenic factors. These results all concur with our original hypothesis and suggest that further studies of such cells may elucidate the paradoxical effects of androgens on human hair follicles.

Androgens↗

PubMed2005

A novel locus of ectodermal dysplasia maps to chromosome 10q24.32-q25.1.

Ectodermal dysplasia (ED) represents a heterogeneous group of genetic disorders characterized by the absence or deformity in two or more of the ectodermal appendages. We have studied an autosomal recessive form of ED in 13 individuals over six generations from an inbred Pakistani family. The clinical features of the affected individuals include highly dystrophic nails and thin hair on scalp, fine eyebrows and eyelashes, and thin body hair. Genome-wide linkage analysis of 390 microsatellite markers mapped the ED gene to the 3.92 cM interval flanked by markers D10S1710 and D10S1741 on chromosome 10q24.32-q25.1. Multipoint linkage analysis generated a maximum logarithm of odds ratio score of 4.79 in the interval D10S1239-D10S1264, which corresponds to 6.35 Mb.

Chromosomes, Human, Pair 10↗

PubMed2005

Influence of prostaglandin F2alpha and its analogues on hair regrowth and follicular melanogenesis in a murine model.

Latanoprost and isopropyl unoprostone, which are analogues of prostaglandin F2alpha (PGF2alpha), are promising drugs for the reduction of intra-ocular pressure. However, they have been reported to have side effects, including hypertrichosis and hyperpigmentation of the eyelashes and periocular skin, and occasionally poliosis. In order to investigate these effects further, PGF2alpha, latanoprost and isopropyl unoprostone were applied to the dorsal skin of 7-week-old C57BL/6 mice, and hair length was measured during the treatment. The three molecules all showed stimulatory effects on the murine hair follicles and the follicular melanocytes in both the telogen and anagen stages, and stimulated conversion from the telogen to the anagen phase. PGE2 is known to act synergistically with PGF2alpha, and hence the influence of PGE2 was also examined. PGE2 did not induce distinct telogen-to-anagen conversion, but showed moderate growth stimulatory effects on early anagen hair follicles. In addition, we observed a case of hypertrichosis and trichomegaly with an excess of melanogenesis, leading to the emergence of white hair, suggesting that poliosis can occur as a side effect of eye treatment with solutions of PGF2alpha analogues. The stimulatory effects of PGF2alpha and PGE2 on hair growth have been discussed with regard to the role of protein kinase C and mast cells.

Animals↗

PubMed2001

Marie Unna hypotrichosis in an Asian family.

We report on two patients from one family with Marie Unna hypotrichosis who showed a diffuse hair defect which typically occurs as an isolated phenomenon. The ultrastructural hair findings consisted of longitudinal grooving of the hair shafts and a flattening in cross-section. Characteristically, scalp hair had been lost from the scalp margins and a high frontal and nuchal hairline had been present at birth. Eyelashes were absent, and eyebrows, axillary, and pubic hair were very sparse. Other affected cases have been reported in Caucasian families; however, this is the first case in the English medical literature of a family from Asia affected by Marie Unna hypotrichosis.

Adult↗

PubMed2005

Cardio-facio-cutaneous syndrome: two cases in the same generation.

A 4-year-old Japanese boy, the youngest of three brothers, presented with ichthyosiform hyperkeratosis over his whole body, eczematous erythema with partial desquamation and erosion on the flexor side of the joints of extremities, the fossa axillaries, and the genital and buttock regions, and total hair loss on the scalp and the absence of eyebrows and eyelashes. In addition to the ichthyotic eruptions and hair abnormalities, he also had a ventricular septal defect, mental retardation, growth retardation, characteristic facial features such as a depressed nasal bridge, low-set ears, and ocular hypertelorism; therefore, he was diagnosed with cardio-facio-cutaneous (CFC) syndrome. The patient's family did not have a history of consanguineous marriage. The parents and the eldest son were healthy. However, the second son, also born with ichthyosiform hyperkeratosis over his whole body, total hair loss on the scalp, myocardial deficiency, mental retardation, growth retardation, and characteristic facial features, had died of pneumonia and sepsis at the age of 1.5 years. Because the middle brother had the same disease, the present case is considered to be a rare case of CFC syndrome with in a single generation.

Alopecia↗

PubMed1977

Etomidate in electroconvulsive therapy. A within-patient comparison with alphaxalone/alphadalone.

In a group of 31 patients undergoing electroconvulsive therapy, there was no significant difference between the times of return of eyelash reflex, swallowing and respiration following a single induction dose of 0.2 mg/kg of etomidate as compared with an induction dose of 0.036 ml/kg of alphaxalone/alphadalone. The incidence of involuntary movements and increased muscle tone was significantly greater after etomidate than following alphaxalone/alphadalone; but the involuntary movements were never marked. The overall incidence of pain on injection was 15% after etomidate. There was a low incidence of venous sequelae following either drug.

Adolescent↗

PubMed1982

The 'induction' dose of thiopentone. A method of study and preliminary illustrative results.

Study of the minimal dose requirements for induction of anaesthesia poses great problems which are solved by the use of a standard administration technique and the abolition of the eyelash reflex as an endpoint. This has been used in 2206 consecutive unselected inductions, in which variables considered to be likely to influence the dosage were recorded. Milligram per kilogram is the most acceptable method of expressing the average dosage of thiopentone. Doses follow a right skew distribution. Women required a significantly lower average dose of thiopentone than men, while obese patients required less than others. Moderate or heavy drinking increased the induction dose but the use of tobacco did not have any influence. The most important factors governing dosage are the physical fitness of the patient and the premedication used. Patients in ASA grades 1 and 2 required significantly more thiopentone than those in grades 3 and 4. This effect is as great as that of premedication in which an opiate with a phenothiazine or hyoscine markedly reduced the induction dose. It was more important than the patient's pre-operative condition with respect to sedation or apprehension. Small doses of opiates or benzodiazepines do not have as much effect on dosage.

Adolescent↗

PubMed1986

Single breath induction of anaesthesia, using a vital capacity breath of halothane, nitrous oxide and oxygen.

Inhalational induction of anaesthesia, using a single vital capacity breath of 4% halothane in 66% nitrous oxide and 33% oxygen was evaluated in 100 unpremedicated outpatients. The technique was found to be acceptable to most (91%) of the patients studied, with a mean (SD) induction time (measured from beginning of inspiration to loss of 'eyelash reflex') of 83(21) seconds. Relative cardiovascular stability was a notable finding of the technique, with a slight decrease in the mean arterial pressure of only 10%. Anaesthetic induction time was unaffected by age, weight or smoking habits. The technique of single breath induction is therefore proposed as a safe and acceptable alternative to intravenous induction in co-operative adult patients.

Adolescent↗

PubMed1987

Propofol for intravenous sedation.

This study investigated the properties of propofol when given by subanaesthetic infusion to provide sedation as an adjunct to spinal anaesthesia for lower limb surgery in 40 patients. Sedation, defined as sleep with preservation of eyelash reflex and purposeful reaction to verbal or mild physical stimulation, was satisfactorily achieved and maintained with minimal complications. The mean duration of infusion was 98 minutes and a mean infusion rate of 3.0 mg/kg/hour was required in patients over 65. This was significantly less (p less than 0.005) than the 4.1 mg/kg/hour required in younger patients. Recovery was impressively rapid; patients regained full consciousness approximately 4 minutes after the end of infusion, and were free from minor postoperative sequelae. Conversion to general anaesthesia was achieved in three patients where surgery encroached outside the analgesic field of the regional block, simply by increasing the infusion rate to approximately 10 mg/kg/hour.

Adolescent↗

PubMed1987

The control of intra-ocular pressure during the induction of anaesthesia for emergency eye surgery. A high-dose vecuronium technique.

A technique of rapid sequence induction of anaesthesia for use in patients with penetrating eye injuries is described. This utilises a three maximal breaths method of pre-oxygenation, the intravenous injection of thiopentone and high dose vecuronium (0.2 mg/kg). Using the loss of eyelash reflex as the starting point for timing, all patients were intubated after 60 seconds without coughing and bucking. No postintubation increases in intra-ocular pressure were seen in 70% of patients and in no patient did the increase in intra-ocular pressure exceed 5 mmHg. After 3 minutes of apnoea, the minimum haemoglobin oxygen saturation was 94% with a mean value of 97.6%.

Anesthesia, General↗

PubMed1988

Recovery times and side effects after propofol infusion and after isoflurane during ear surgery with additional infiltration anaesthesia.

Two anaesthetic procedures that did not include nitrous oxide were compared in a randomised study of 50 patients for tympanoplasty and tympanoscopy: propofol given for induction and maintenance, and thiopentone-isoflurane given for induction and maintenance, respectively. Induction in the first group was with a bolus injection of propofol and the same agent was given for the duration of anaesthesia by continuous intravenous administration. Thiopentone was given until loss of the eyelash reflex and anaesthesia maintained with isoflurane 0.4-2.0%. Analgesia was achieved in both groups by fentanyl given intravenously and by local injection of mepivacaine with ornipressin. The two patient groups were analysed for age, sex and weight as well as for side effects during the induction, maintenance and recovery periods, such as coughing, vomiting, venous pain, spontaneous movements, singultus, headaches, dysrhythmias and psychic disorders possibly due to anaesthesia. Side effects were moderate in both groups. Recovery time was statistically significantly shorter in the propofol group and the patients in this group appeared to be much more aware after recovery than those in the thiopentone-isoflurane group.

Adolescent↗

PubMed1990

Arterial oxygen saturation during induction of anaesthesia.

Three groups of 10 ASA 1 patients were studied to determine the incidence of hypoxaemia (oxygen saturation less than or equal to 90%) using pulse oximetry during induction of 'mask' anaesthesia, and whether simple oxygenation techniques could prevent its occurrence. We also surveyed all anaesthetists in three major hospitals to ascertain their techniques for this method of anaesthesia. Anaesthesia was induced in all patients with thiopentone and maintained with nitrous oxide and isoflurane. The first group received 33% oxygen in nitrous oxide as carrier gases, a second group a few normal breaths of 100% oxygen during thiopentone administration followed by 33% oxygen in nitrous oxide, while a third group received 100% oxygen after loss of eyelash reflex until spontaneous breathing was established. No patient received positive pressure ventilation before spontaneous breathing was established. Six of the 10 patients in the first group became hypoxaemic compared to none in the second group, and three patients became hypoxaemic in the third group. Thirty-seven percent of anaesthetists who responded to the survey either did not apply positive pressure ventilation before establishment of spontaneous breathing, or only did so if apnoea was prolonged. Only one anaesthetist fully pre-oxygenated patients lungs. We conclude that to avoid the likely occurrence of hypoxaemia during induction of mask anaesthesia, a minimum of a few breaths pre-oxygenation is necessary.

Adolescent↗