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At least 631 records · Page 35Linked to original sources
PubMed1995

Management of congenital leg length inequality: value of early axis correction.

The principles of treatment of congenital leg length inequality include three strategies: joint stabilization, axis correction, and limb length equalization. We believe that early axis correction is important for normal musculoskeletal development and that residual deformity may be self-perpetuating. Of 97 lower limbs assessed, 14 had PFFD alone, 6 fibula hemimelia alone, and 49 a combination of the two. Seventy-four limb segments were operated on, including 29 joint stabilizations, 65 axis corrections, and 62 lengthenings. Axis correction was the commonest procedure in the under-five age group and may be performed alone or in combination with another treatment strategy. The average lengthening achieved was 4 cm representing a 15.75% length increase. The mean bone healing index was 54.25 days/cm, slightly more in the tibia than in the femur. We recommend early axis correction and joint stabilization prior to lengthening. The choice of lengthening technique depends on the preexisting risk factors and lengthenings should be short and frequent.

Ankle Joint↗
PubMed2006

Neuroregulation of the hypothalamus-pituitary-adrenal (HPA) axis in humans: effects of GABA-, mineralocorticoid-, and GH-Secretagogue-receptor modulation.

The hypothalamus-pituitary-adrenal (HPA) axis exerts a variety of effects at both the central and peripheral level. Its activity is mainly regulated by CRH, AVP, and the glucocorticoid-mediated feedback action. Moreover, many neurotransmitters and neuropeptides influence HPA axis activity by acting at the hypothalamic and/or suprahypothalamic level. Among them, GABA and Growth Hormone Secretagogues (GHS)/GHS-receptor systems have been shown to exert a clear inhibitory and stimulatory effect, respectively, on corticotroph secretion. Alprazolam (ALP), a GABA-A receptor agonist, shows the most marked inhibitory effect on both spontaneous and stimulated HPA axis activity, in agreement with its peculiar efficacy in panic disorders and depression where an HPA axis hyperactivation is generally present. Ghrelin and synthetic GHS possess a marked ACTH/cortisol-releasing effect in humans and the ghrelin/GHS-R system is probably involved in the modulation of the HPA response to stress and nutritional/metabolic variations. The glucocorticoid-mediated negative feedback action is mediated by both glucocorticoid (GR) and mineralocorticoid (MR) receptors activation at the central level, mainly in the hippocampus. In agreement with animal studies, MRs seem to play a crucial role in the maintenance of the circadian ACTH and cortisol rhythm, through the modulation of CRH and AVP release. GABA agonists (mainly ALP), ghrelin, as well as MR agonists/antagonists, may represent good tools to explore the activity of the HPA axis in both physiological conditions and pathological states characterized by an impaired control of the corticotroph function.

Feedback↗
PubMed1966

Germination of phaseolus vulgaris I. Resumption of axis growth.

Growth of the excised axis of Phaseolus vulgaris L. (var. White Marrowfat) begins after a 7-hour incubation in buffer or water at 26 degrees . Growth, as measured by axis elongation or fresh weight increase, is linear for at least 8 hours with a resultant fresh weight increase of approximately 65%. Cell elongation begins 4 or 5 hours prior to cell division and 5 or 6 hours prior to radicle protrusion in the intact seed.The initiation of axis elongation is apparently dependent on synthesis of RNA and protein. Both actinomycin D and puromycin inhibit the initiation of elongation. Actinomycin I) inhibits the incorporation of ATP-8-C(14) into axis RNA and C(14)-leucine into protein, while puromycin inhibits the incorporation of C(14)-leucine into axis protein.The respiratory rate of the axes increases sharply at about the time of initiation of cell elongation. Dinitrophenol initially increases O(2) uptake by the axes, but at the end of 15 hours the rates of O(2) uptake by control or dinitrophenol-treated axes are approximately the same.

Journal Article↗
PubMed2004

A formal classification of 3D medial axis points and their local geometry.

This paper proposes a novel hypergraph skeletal representation for 3D shape based on a formal derivation of the generic structure of its medial axis. By classifying each skeletal point by its order of contact, we show that, generically, the medial axis consists of five types of points, which are then organized into sheets, curves, and points: 1) sheets (manifolds with boundary) which are the locus of bitangent spheres with regular tangency A1(2) (Ak(n) notation means n distinct k-fold tangencies of the sphere of contact, as explained in the text); two types of curves, 2) the intersection curve of three sheets and the locus of centers of tritangent spheres, A1(3), and 3) the boundary of sheets, which are the locus of centers of spheres whose radius equals the larger principal curvature, i.e., higher order contact A3 points; and two types of points, 4) centers of quad-tangent spheres, A1(4), and 5) centers of spheres with one regular tangency and one higher order tangency, A1A3. The geometry of the 3D medial axis thus consists of sheets (A1(2)) bounded by one type of curve (A3) on their free end, which corresponds to ridges on the surface, and attached to two other sheets at another type of curve (A1(3)), which support a generalized cylinder description. The A3 curves can only end in A1A3 points where they must meet an A1(3) curve. The A1(3) curves meet together in fours at an A1(4) point. This formal result leads to a compact representation for 3D shape, referred to as the medial axis hypergraph representation consisting of nodes (A1(4) and A1A3 points), links between pairs of nodes (A1(3) and A3 curves) and hyperlinks between groups of links (A1(2) sheets). The description of the local geometry at nodes by itself is sufficient to capture qualitative aspects of shapes, in analogy to 2D. We derive a pointwise reconstruction formula to reconstruct a surface from this medial axis hypergraph together with the radius function. Thus, this information completely characterizes 3D shape and lays the theoretical foundation for its use in recognition, morphing, design, and manipulation of shapes.

Algorithms↗
PubMed1994

The overnight single-dose metyrapone test is a simple and reliable index of the hypothalamic-pituitary-adrenal axis.

OBJECTIVE: The ACTH stimulation test examines adrenal responsiveness but may not examine the entire hypothalamic-pituitary-adrenal (HPA) axis and requires parenteral administration. The cortisol response to hypoglycaemia provides an index of activity of the entire HPA axis but is demanding for patients and medical staff. The aim of the present study was to examine the performance of the overnight single-dose metyrapone test as it provides a simple alternative test for HPA axis function. DESIGN: Audit of the overnight metyrapone test performed in one centre between 1979 and 1991. PATIENTS: Three hundred and ninety-eight patients underwent 576 tests. Comparisons between the responses to metyrapone and the ACTH stimulation test and of the responses to metyrapone and insulin induced hypoglycaemia test were possible in 87 and 17 patients respectively. MEASUREMENTS: Following the midnight administration of metyrapone tablets, 30 mg/kg orally, blood samples were obtained between 0800 and 0930 h for radioimmunoassay of both 11-deoxycortisol and cortisol. RESULTS: Five hundred and seventy-six metyrapone tests were performed on 398 patients with no serious side-effects encountered. Adrenal insufficiency was diagnosed in 105 patients. Of these, 18 had a primary adrenal disorder and 87 had a disorder of the hypothalamic-pituitary unit. One hundred per cent concordance between the metyrapone, the ACTH and the hypoglycaemia test was seen in patients with primary adrenal insufficiency. In 19 patients with secondary adrenal insufficiency, who underwent both the metyrapone and the ACTH tests, discord between these two tests was observed in 10 patients (53%). Nine of these patients demonstrated a normal response to ACTH and a subnormal response to metyrapone. In only one patient was an abnormal cortisol response to ACTH associated with a normal response to metyrapone. In contrast, in 17 patients discord between the metyrapone and the hypoglycaemia test was seen in only 1 patient who demonstrated a normal response to the metyrapone test and a subnormal response to hypoglycaemia. CONCLUSION: Since the metyrapone test gives similar information about hypothalamic-pituitary axis function as does the hypoglycaemia test, we recommend the use of the overnight metyrapone test as a safe, simple and reliable index of the hypothalamic-pituitary axis integrity. The ACTH stimulation test should not be used for patients suspected of having secondary adrenal insufficiency.

Adrenal Insufficiency↗
PubMed1995

Neuropeptide Y (NPY) may integrate responses of hypothalamic feeding systems and the hypothalamo-pituitary-adrenal axis.

Neuropeptide Y (NPY) is a powerful stimulus to food intake in the rat. Exogenous NPY given into the third ventricle or into the paraventricular nucleus (PVN) of the hypothalamus stimulates both food consumption as well as the hypothalamus-pituitary-adrenal (HPA) axis. Presumably NPY activates the adrenocortical system through direct stimulation of CRF containing cells in the PVN. Food intake is also a major regulator of adrenocortical activation. Rhythms in HPA axis activity follow rhythms in food consumption, and rats that have been food deprived overnight have inhibited HPA axis responses to restraint stress and corticosteroid feedback the following morning. To investigate the interaction of NPY with both feeding and HPA axis activation three sets of experiments were performed: Animals fed ad lib were injected icv with NPY (2.5 micrograms) and allowed access to food or not post injection; animals were fasted overnight prior to NPY injection; finally, dose response experiments were performed to examine the relative sensitivities of feeding and HPA axis activation to exogenous NPY. Ad lib fed animals allowed access to food after NPY injection had slightly greater ACTH responses to NPY while glucocorticoid and insulin responses were not significantly different from ad lib fed animals not allowed access to food post injection. Animals allowed to eat post injection had significantly decreased food consumption the night following injection, however, total 24 h food consumption was not different between these animals and those given food 8 h post NPY injection. In overnight fasted animals NPY injections produced ACTH responses of equal magnitude to those in ad lib fed animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2004

The dynamics of the hypothalamic-pituitary-adrenal axis during maternal deprivation.

A close contact between the dam and the litter is essential for the normal development of the hypothalamic-pituitary-adrenal (HPA) axis in rats and mice. Maternal signals, as licking and feeding, have been shown to sustain the HPA axis of the pups in a hypo-responsive state. Disruption of this mother-pup interaction by 24 h of maternal deprivation activates the otherwise quiescent stress system of the neonates, resulting in an enhanced adrenal sensitivity to adrenocorticotropic hormone (ACTH) and a decreased expression of central HPA markers, such as corticotropin-releasing hormone (CRH). However, the dynamics of these central and peripheral changes over the 24h period are largely unknown. In this study, we examined the time course of some of the central and peripheral indices of HPA activity during 24 h of maternal deprivation. We measured corticosterone and ACTH in the blood as well as CRH, mineralocorticoid and glucocorticoid receptor expression in the brain. Our results demonstrate that each of the components of the HPA axis responds to maternal deprivation at different time points following removal of the mother and with a very specific time course. The main activation of the HPA axis occurred between 4 h and 8 h of maternal absence. By contrast, during the second half of the deprivation period, negativefeedback mechanisms restrained the further increase in ACTH and corticosterone release. We conclude that maternal deprivation triggers a cascade of sequential changes at the various levels of the stress system, and that measuring only one aspect of the system at one time point does not accurately reflect the dynamic alterations of the HPA axis.

Adrenocorticotropic Hormone↗
PubMed2005

Genetic differences in hypothalamic-pituitary-adrenal axis activity and food restriction-induced hyperactivity in three inbred strains of rats.

We used three inbred rat strains known for significant differences in the activity and reactivity of their hypothalamic-pituitary-adrenal (HPA) axis to stress [Fischer 344 (F344), Brown Norway (BN) and Lewis (Lew) rats] to search for a strain difference in the paradoxical increase in running activity induced by food restriction and to explore the role of the HPA axis in this behaviour. Rats were randomly assigned to either an ad lib sedentary group (AL), a control wheel activity group (ACT), a food restriction-induced hyperactivity group (FR-ACT) group (1.5 h/day ad lib food, 22.5 h/day ad lib wheel access) or a pair-fed group (FR). The BN and Lew rats reached the 25% body weight-loss criterion of FR-ACT (strain effect: F(2,132) = 45.58, P < 10-6) faster than the F344 strain due to higher food restriction-induced running activity (strain effect: F(2,65) = 17.43, P = 0.00001). FR and FR-ACT decreased thymus weight (marker of integrated HPA axis activation) in all strains. In Lew and BN strains, FR-ACT induced a further decrement on thymus weight compared to their FR group. Prefeeding corticosterone levels (15.00 h) increased during the study in BN and Lew FR-ACT rats, but not in F344. Total wheel turns were correlated to both final adipose weight (r = -0.49, P = 0.002) and thymus weight decrement (r = 0.59, P = 0.0001), emphasizing the relationship between fat mass and HPA axis activation in excessive running activity. Increased running in conditions of food restriction and HPA axis activation may be linked at the level of the central nervous system. However, the involvement of corticotrophin-releasing hormone, agouti-related peptide or cocaine- and amphetamine-regulated transcript in behavioural disturbances of FR-ACT rats was excluded (in situ hybridization). We propose that corticosterone may be the link between initial low levels of fat mass and/or rate of fat mass loss (peripheral energy stores) and increased wheel activity, favouring fueling through lipolysis and proteolysis and reinforcing the self starvation via reward mechanisms, thus establishing a deleterious vicious cycle.

Adrenal Glands↗
PubMed2006

Pituitary mRNA expression of the growth hormone axis in the 1-year-old intrauterine growth restricted rat.

Intrauterine growth restriction (IUGR) is one of the major causes of short stature in childhood. Abnormalities in the growth hormone (GH) axis have frequently been observed in children who are born intrauterine growth restricted and GH treatment is effective to improve final height. However, the way that the GH axis is involved is not fully understood. Previously, when investigating the effect of IUGR on the central somatotrophic axis, a hypothalamic effect was discovered with elevated somatostatin and decreased neuropeptide Y mRNA expression levels, whereas serum GH and insulin-like growth factor I (IGFI) were unaltered. These findings were thought to indicate a hypothalamic alteration of the GH axis due to IUGR, probably to compensate pituitary output, thereby normalising peripheral values of GH and IGFI. Therefore, the present study aimed to evaluate the effect of IUGR on the pituitary GH axis in this rat model. Pups from rats that underwent bilateral uterine artery ligation at day 17 of pregnancy were studied. Pituitary glands were collected from 1-year-old offspring for quantitative measurements of GH, GH-receptor (GH-R), GH-releasing hormone receptor (GHRH-R), somatostatin receptor subtype 2 and 5, IGFI and IGFI receptor mRNA levels using a real-time reverse transcriptase-polymerase chain reaction. In addition, liver GH-R and IGFI mRNA expression levels were measured and a radioimmunoassay was performed to determine serum IGFI levels. In the IUGR rat, levels of pituitary GH, GH-R and GHRH-R relative gene expression (RGE) were increased. No differences were found in the RGE level of all other pituitary growth factors, liver GH-R and IGFI, and serum IGFI concentration between IUGR and control rats. The present data show that intrauterine growth failure leads to changes in the pituitary that might counterbalance the effects found previously in the hypothalamus.

Adaptation, Physiological↗
PubMed1982

Metameric pattern development in the embryonic axis of the mouse. I. Differentiation of the cranial segments.

The overall pattern of the mesoderm in the embryonic axis of the cranial region of mouse embryos was examined with the scanning electron microscope (SEM). A segmental organization was observed first in the paraxial mesodermal wings and midline axis of embryos at the late primitive streak stage. Each segmental unit consists of a somitomere in the paraxial region on each side of an enclosed stretch of midline notochord. Somitomeres appear initially as circular domains of radially arranged cells that swirl about the core center of the unit and are quite similar morphologically to those described recently in chick embryos [12]. Lying in tandem sequence, the segments comprise the chordamesoderm that underlies the neural plate. As additional pairs of somitomeres are added from the primitive streak at the caudal end of the axis, those established in the cranial region remain contiguous and undergo morphogenesis that is coordinate with neurulation. We divide the development of the cranial axis into five phases and associate somitomeres in the mesoderm with neuromeric segmentation in the neural plate. It was found that the first pair of somitomeres comes to underlie the prosencephalon, the second and third pairs underlie the mesencephalon, while the fifth, sixth, and seventh pairs of somitomeres underlie neuromeres of the metencephalon. The eighth pair of somitomeres are the first to separate themselves from the first seven and from the first pair of somites visible at the light microscope level. This study suggests that the cranial axis of the mouse embryo is initially organized into segments like the rest of the body and that subsequent cranial morphology is a consequence of differential development of these segments.

Animals↗
PubMed2006

Hypo-response of the hypothalamic-pituitary-adrenocortical axis after an ethanol challenge in prenatally stressed adolescent male rats.

The period of adolescence and environmental factors, such as stress, are important in determining ethanol vulnerability in both humans and rats. Ethanol is a powerful activator of the hypothalamic-pituitary-adrenal (HPA) axis but attenuated responses of the HPA axis to ethanol have been described in populations with a high risk of ethanol abuse. In rats, prenatal stress leads to prolonged stress-induced corticosterone secretion and increases the vulnerability to drugs of abuse, such as amphetamine and nicotine in adulthood and 3,4-methylenedioxymethamphetamine in adolescent rats. The aim of the present study was to assess the impact of a prenatal stress on HPA axis responsiveness to a moderate dose of ethanol (1.5 g/kg i.p.) in adolescent male rats (28 days old). The parameters evaluated were plasma adrenocorticotropic hormone, plasma corticosterone and mRNA expression of HPA axis central markers (mineralocorticoid receptor, glucocorticoid receptor, corticotropin-releasing hormone and pro-opiomelanocortin). Contrary to prior expectations, our results demonstrate that prenatal stress blunts the HPA axis responsiveness to a moderate dose of ethanol in adolescent rats in spite of similar blood ethanol levels. These data suggest that prenatal stress may have the opposite effect on the response to stress depending on the attributes of the stressor stimulus. They thus raise questions about the possible impact of prenatal stress on the further development of ethanol vulnerability.

Adrenocorticotropic Hormone↗
PubMed1997

The hypothalamic-pituitary-adrenal axis and the female reproductive system.

The hypothalamic-pituitary-adrenal (HPA) axis and the female reproductive system are intertwined and exhibit a complex relationship. Thus, the HPA axis exerts profound, mostly inhibitory effects, on the reproductive axis, with corticotropin-releasing hormone (CRH) and CRH-induced propiomelanocortin peptides inhibiting hypothalamic GnRH secretion, and with glucocorticoids inhibiting pituitary LH and ovarian estrogen and progesterone secretion and rendering estrogen-target tissues, such as the endometrium, resistant to the gonadal steroid. These effects of the HPA axis are responsible for the "hypothalamic" amenorrhea of stress, depression and eating disorders, and the hypogonadism of Cushing's syndrome. Conversely, estrogen directly stimulates the CRH gene, which may explain the slight hypercortisolism of females and the preponderance of depressive, anxiety, and eating disorders, as well as Cushing's disease in women. Interestingly, several components of the HPA axis and their receptors are present in reproductive tissues, as autocoid regulators of their various functions. These include ovarian and endometrial CRH, which may participate in the inflammatory processes of the ovary, that is, ovulation and luteolysis, and of the endometrium, that is, implantation and menstruation. Finally, the hypercortisolism of the latter half of pregnancy can be explained by high levels of placenta CRH in plasma. This hypercortisolism causes a transient adrenal suppression in the postpartum period, which may explain the postpartum blues/depression and autoimmune phenomena of this period.

Corticotropin-Releasing Hormone↗
PubMed1998

Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is characterized by profound fatigue and an array of diffuse somatic symptoms. Our group has established that impaired activation of the hypothalamic-pituitary-adrenal (HPA) axis is an essential neuroendocrine feature of this condition. The relevance of this finding to the pathophysiology of CFS is supported by the observation that the onset and course of this illness is excerbated by physical and emotional stressors. It is also notable that this HPA dysregulation differs from that seen in melancholic depression, but shares features with other clinical syndromes (e.g., fibromyalgia). How the HPA axis dysfunction develops is unclear, though recent work suggests disturbances in serotonergic neurotransmission and alterations in the activity of AVP, an important co-secretagogue that, along with CRH, influences HPA axis function. In order to provide a more refined view of the nature of the HPA dusturbance in patients with CFS, we have studied the detailed, pulsatile characteristics of the HPA axis in a group of patients meeting the 1994 CDC case criteria for CFS. Results of that work are consistent with the view that patients with CFS have a reduction of HPA axis activity due, in part, to impaired central nervous system drive. These observations provide an important clue to the development of more effective treatment to this disabling condition.

Fatigue Syndrome, Chronic↗
PubMed1998

Altered reactivity of the hypothalamus-pituitary-adrenal axis in patients with atopic dermatitis: pathologic factor or symptom?

Atopic dermatitis (AD) is a chronic inflammatory skin disease with the principal symptoms of dry skin, lichnification, eczematous inflammation, and an intense pruritus. Despite general acceptance that AD is a multifactorial skin disorder, dysregulation of immune functions (e.g., hypersecretion of immunoglobulin-E, altered cytokine profiles) is considered to be mainly involved in AD pathogenesis. Considerable evidence points to an immunoregulatory function for the hypothalamus-pituitary-adrenal (HPA) axis, suggesting that appropriate reactivity of the HPA axis is necessary to prevent the immune system from reaching a level that may be damaging for the host. It is further hypothesized that dysfunctional reactivity of the HPA axis may increase the vulnerability of the organism to immune-related disorders such as inflammatory diseases. In the present paper the role of the HPA axis for the development and chronification of allergic inflammation will be summarized and the potential pathological significance of a dysfunctional HPA axis in AD pathogenesis will be discussed.

Animals↗
PubMed2000

Molecular genetic control of axis patterning during early embryogenesis of vertebrates.

Formation of the axis and its subsequent patterning to establish the tube-within-a-tube body plan characteristic of vertebrates are initiated during gastrulation. In higher vertebrates (i.e., birds and mammals), gastrulation involves six key events: establishment of the rostrocaudal/mediolateral axis; formation and progression of the primitive streak and organizer; epiboly of the epiblast, ingression of prospective mesodermal and endodermal cells through the primitive streak, and migration of cells away from the primitive streak; regression of the primitive streak; establishment of the right-left axis; and formation of the tail bud. Over 50 years of study of these processes have provided a morphological framework for understanding how these events occur, and recent advances in imaging, microsurgical intervention, and cell tracking are beginning to elucidate the underlying cell behaviors that drive morphogenetic movements. Moreover, homotopic transplantation and dye microinjection studies are being used to generate high-resolution fate maps, and heterotopic transplantation studies are revealing the cell-cell interactions that are sufficient as well as required for mesodermal and ectodermal commitment. Additionally, the roles of the organizer and secondary signaling centers in establishing the body plan are being defined. With the advent of the molecular/genetic age, the molecular basis for axis formation is beginning to become understood. Thus, it is becoming clear that secreted growth factors/signaling molecules produced by localized signaling centers induce and pattern the axis, presumably through downstream activation of signal-transduction proteins and cascades of transcription factors.

Animals↗
PubMed1998

A generic off-axis energy correction for linac photon beam dosimetry.

Cooperative clinical trial group protocols frequently require off-axis point dose calculations. The Radiological Physics Center uses the calculative technique developed by Hanson et al. [Med. Phys. 7, 145-146 (1980); 7, 147-150 (1980)] to verify these calculations. In order to correct for off-axis energy changes, this technique requires off-axis half-value layer data, HVL, as a function of off-axis ray angle for the specific beam. This paper presents a formulism based on HVL mesurements on a limited number of therapy beams, which allows the calculation of an off-axis energy-correction factor for any clinical photon beam created by a linear accelerator using conventional flattening filters.

Clinical Protocols↗
PubMed1988

Cell wall is required for fixation of the embryonic axis in Fucus zygotes.

Establishment of a primary developmental axis generally is thought to involve rearrangements in the plasma membrane or cytoplasm of the egg. In this report the additional requirement for cell wall in polarization of Fucus zygotes was investigated. Protoplasts of fertilized eggs were tested for their ability to establish an axis in accordance with an orienting vector of unilateral light. The results demonstrate that cell wall is not required for axis formation. However, the orientation of the axis remains labile until new cell wall is synthesized. The presence of a cell wall is an absolute requirement for axis fixation.

Cell Differentiation↗
PubMed2000

Effect of disagreement between refractive, keratometric, and topographic determination of astigmatic axis on suture removal after penetrating keratoplasty.

BACKGROUND/AIMS: Post-keratoplasty astigmatism can be managed by selective suture removal in the steep axis. Corneal topography, keratometry, and refraction are used to determine the steep axis for suture removal. However, often there is a disagreement between the topographically determined steep axis and sutures to be removed and that determined by keratometry and refraction. The purpose of this study was to evaluate any difference in the effect of suture removal, on visual acuity and astigmatism, in patients where such a disagreement existed. METHODS: 37 cases (from 37 patients) of selective suture removal after penetrating keratoplasty, were included. In the first group "the disagreement group" (n=15) there was disagreement between corneal topography, keratometry, and refraction regarding the axis of astigmatism and sutures to be removed. In the second group "the agreement group" (n=22) there was agreement between corneal topography, keratometry, and refraction in the determination of the astigmatic axis and sutures to be removed. Sutures were removed according to the corneal topography, at least 5 months postoperatively. Vector analysis for change in astigmatism and visual acuity after suture removal was compared between groups. RESULTS: In the disagreement group, the amount of vector corrected change in refractive, keratometric, and topographic astigmatism after suture removal was 3.45 (SD 2.34), 3.57 (1.63), and 2.83 (1. 68) dioptres, respectively. In the agreement group, the amount of vector corrected change in refractive, keratometric, and topographic astigmatism was 5.95 (3.52), 5.37 (3.29), and 4.71 (2.69) dioptres respectively. This difference in the vector corrected change in astigmatism between groups was statistically significant, p values of 0.02, 0.03, and 0.03 respectively. Visual acuity changes were more favourable in the agreement group. Improvement or no change in visual acuity occurred in 90.9% in the agreement group compared with 73.3% of the disagreement group. CONCLUSIONS: Agreement between refraction, keratometry, and topography was associated with greater change in vector corrected astigmatism and was an indicator of good prognosis. Disagreement between refraction, keratometry, and topography was associated with less vector corrected change in astigmatism, a greater probability of decrease in visual acuity, and a relatively poor outcome following suture removal. However, patients in the disagreement group still have a greater chance of improvement than worsening, following suture removal.

Astigmatism↗