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PubMed2005

Dynamics of pneumococcal carriage among healthy Icelandic children attending day-care centres.

Invasive pneumococcal disease and antimicrobial (AM) resistance in pneumococci are important public health concerns. With the advent of new pneumococcal vaccines, information on serotype prevalence and their temporal fluctuations is important. Information on AM use and consent for participation was obtained by a questionnaire to parents of children at 5 day-care centres in Reykjavik from 1992 to 1999, and nasopharyngeal swabs were cultured selectively for pneumococci. The pneumococci were serotyped and pulsed field gel electrophoresis used to determine clonality. Of 1228 nasopharyngeal swabs, 640 (52.1%) yielded pneumococci of which 89 (13.9%) had decreased susceptibility to penicillin and 1 was resistant. Children receiving AMs during the month preceding nasopharyngeal sampling and children attending a day-care centre where AM use was high were significantly more likely to carry penicillin non-susceptible isolates. Serotypes 6A, 6B and 23F were most common (48%), and 74% of serotyped isolates belonged to 1 of the 7 most common serotypes. Almost all penicillin non-susceptible isolates were of serotype 6B or 19A. Serotype prevalence fluctuated markedly between y. In conclusion, there was significant variation in serotype prevalence between y, and only 51% of the pneumococci belonged to serotypes covered by the current 7-valent conjugated vaccine.

Anti-Bacterial Agents↗
PubMed1990

Skin conductance response after 6-hydroxydopamine lesion of central noradrenaline system in cats.

Absence of skin conductance response (SCR) is a psychophysiological sign frequently observed among schizophrenic patients. This alteration of electrodermal activity can be reproduced in cats and rats by intraventricular administration of 6-hydroxydopamine (6-OHDA), a neurotoxin selectively destroying catecholamine neurons. The finding appears to be quite consistent with the catecholamine hypothesis of schizophrenia. To determine which catecholamine system--the dopamine (DA) or the noradrenaline (NA)--is responsible for the induction of this abnormality, the same dose of 6-OHDA was microinjected to either the ventral tegmental area (VTA, n = 3), through which most DA fibers ascend, or to the ascending noradrenergic bundle (ANB, n = 3), through which most NA fibers ascend. Four cats remained intact as a control for later brain catecholamine estimation. The skin conductance of all pretreatment intact cats (n = 10) showed not only spontaneous fluctuations but also SCRs to auditory stimuli (5 kHz, 100 dB, 1 sec) which habituated with repetition. In contrast, ANB-lesioned cats showed a complete abolition of auditory SCRs, few spontaneous fluctuations, and a low basal skin conductance level. These abnormalities were statistically significant. On the other hand, no change was found in the skin conductance activity of the VTA-lesioned cats. Catecholamine estimation after the experiment confirmed selective destruction of the appropriate system corresponding to each type of lesion. These findings are discussed in the context of the DA or NA theory of schizophrenia, and involvement of the NA system in the pathogenesis of this illness is suggested.

Animals↗
PubMed1989

Critical density fluctuations in lipid bilayers detected by fluorescence lifetime heterogeneity.

The heterogeneity of the decay of the fluorescence of transparinaric acid in single-component lipid bilayers at temperatures above their gel/liquid crystalline phase transition is shown to be due to the presence of regions of higher local density and higher acyl chain order than the predominant fluid regions. This conclusion is based on selective excitation behavior and the observation of time-resolved fluorescence anisotropies that increase at long times. The fractional amplitude of the long lifetime component of the fluorescence shows a temperature variation that conforms to conventional descriptions of critical behavior. The critical exponent extracted from this variation is 1.1, close to the value of 1.0 that describes ultrasonic data. We therefore conclude that liquid crystalline lipid bilayers exhibit critical behavior with significant density and order fluctuations. This behavior must be taken into account in the interpretation of fluorescence and other spectroscopic measurements of the properties of bilayers.

Kinetics↗
PubMed1995

Intermittency and transient chaos from simple frequency-dependent selection.

Frequency-dependent selection is an important determinant of the evolution of gametophytic self-incompatibility systems in plants, aposematic (warning) and cryptic coloration, systems of mimicry, competitive interactions among members of a population, mating preferences, predator-prey and host-parasite interactions, aggression and other behavioural traits. Past theoretical studies of frequency-dependent selection have shown it to be a plausible mechanism for the maintenance of genetic variability in natural populations. Here, through an analysis of a simple deterministic model for frequency-dependent selection, we demonstrate that complex dynamic behaviour is possible under a broad range of parameter values. In particular we show that the model exhibits not only cycles and chaos but also, for a more restricted set of parameters, transient chaos and intermittency: alterations between an apparently deterministic behaviour and apparently chaotic fluctuations. This behaviour, which has not been stressed within the population genetics literature, provides an explanation for erratic dynamics of gene frequencies.

Alleles↗
PubMed2004

Recent failures of new potential symptomatic treatments for Parkinson's disease: causes and solutions.

One major goal of current research in Parkinson's disease (PD) is the discovery of novel agents to improve symptomatic management. The object of these new treatments should be to provide effective symptom control throughout the course of the disease without the development of side effects such as motor and psychiatric complications. Results of several clinical trials of new treatment options reported in the past 2 years have shown negative or unsatisfactory results. Most of the drugs and surgical procedures used in these studies had been tested previously in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) monkeys as well as in the classic 6-hydroxydopamine-lesioned rat model. They raise several questions about the true reliability of animal studies, the adequacy of the working hypotheses and design of clinical trials, the validity of tools in current use to evaluate a specific effect, and the selectivity of the drugs used. All these factors may explain failure. This review focuses on pharmacological and surgical treatments tested to improve the management of patients with motor fluctuations and dyskinesias. Some of the recent trials and possible reasons for their lack of success are critically analysed. Finally, some suggestions to avoid further failures and improve results are proposed.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗
PubMed2006

Fiber-optic flow-through sensor for online monitoring of glucose.

A new microdialysis-based glucose-sensing system with an integrated fiber-optic hybrid sensor is presented. Design and dimensions of the cell are adapted for its coupling with commercially available microdialysis techniques, thereby providing a new system for continuous glucose monitoring. The glucose level is detected via oxygen consumption which occurs as a consequence of enzymatic reaction between immobilized glucose oxidase and glucose. The use of gas-permeable Tygon tubing ensures complete and constant air-saturation of the measuring fluid in the cell. Nevertheless, a reference oxygen optode is used to detect and to compensate response changes caused by events like bacterial growth, temperature fluctuations, or failure of the peristaltic pump. In contrast to widely used electrochemical sensors, the response of the microdialysis-based fiber-optic glucose sensor is highly selective, making this sensor approach particularly advantageous for continuous glucose monitoring of patients in intensive care units. The effects of flow rate, pH, temperature, and common interferences on the sensor response are presented and discussed in detail. The sensor is evaluated in vitro using a 3-day continuous test in glucose-spiked plasma. The ability to measure glucose in humans is demonstrated by coupling the flow-through cell and commercially available microdialysis catheter CMA60. A 24-h monitoring test using this setup is successfully applied to a healthy volunteer.

Enzymes, Immobilized↗
PubMed2005

Insulin enhances growth hormone induction of the MEK/ERK signaling pathway.

Growth hormone (GH) plays an important role in growth and metabolism by signaling via at least three major pathways, including STATs, ERK1/2, and phosphatidylinositol 3-kinase/Akt. Physiological concentrations of insulin promote growth probably by modulating liver GH receptor (GHR) levels in vivo, but the possible effects of insulin on GH-induced post-GHR signaling have yet to be studied. We hypothesized that short-term insulin, similar to the fluctuations that occur following feeding, affects GH-induced post-GHR signaling. Our present studies suggest that, in rat H4IIE hepatoma cells, insulin (4 h or less) selectively enhanced GH-induced phosphorylation of MEK1/2 and ERK1/2, but not GH-induced activation of STAT5 and Akt. Although insulin pretreatment altered GH-induced formation of Shc.Grb2.SOS complex, it did not significantly affect GH-induced activation of other signaling intermediates upstream of MEK/ERK, including JAK2, Ras, and Raf-1. Immunofluorescent staining indicated that insulin pretreatment facilitated GH-induced cell membrane translocation of MEK1/2. Insulin pretreatment also increased the amount of MEK association with its scaffolding protein, KSR. In summary, short-term insulin treatment of cultured, liver-derived cells selectively sensitized GH-induced MEK/ERK phosphorylation independent of JAK2, Ras, and Raf-1, but likely resulted from increased cell membrane translocation of MEK1/2. These findings suggest that insulin may be necessary for sensitization of cells to GH-induced ERK1/2 activation and provides a potential cellular mechanism by which insulin promotes growth.

Animals↗
PubMed1996

Epilepsy surgery in infants.

PURPOSE: We report 12 infants who had frontal (n = 3), temporal (n = 2), or temporoparieto-occipital (n = 2) resection or functional hemispherectomies (n = 5) at age 2.5-29 (mean 15.3) months for catastrophic epilepsy due to focal cortical dysplasia (n = 5), Sturge-Weber syndrome (n = 3), ganglioglioma (n = 3), or hemimegalencephaly (n = 1). Seizures began at 1 day to 14 months (mean, 4.0 months) after birth, occurred frequently (often many times per day, and were refractory to antiepileptic drugs. Patients were evaluated for surgery at 2.5-24 (mean 12.4) months of age. Seven patients had hemiparesis and eight had slowed cognitive development. Seizures were characterized by arrest or marked reduction of behavioral motor activity with nuclear level of consciousness (n = 4, with temporal or temporoparietal EEG seizures), focal clonic activity (n = 3, with perirolandic EEG seizures), generalized tonic stiffening (n = 3, with temporoparieto-occipital, parietal, or frontal EEG seizures), or infantile spasms and hypsarrhythmia (n = 2, with a frontal tumor or temporoparieto-occipital cortical dysplasia). METHODS: Magnetic resonance imaging (MRI) revealed the epileptogenic lesion in all but two patients, both with cortical dysplasia localized by interictal positron-emission tomography (PET) and other clinical or EEG features and confirmed on histopathologic examination of resected tissue. RESULTS: At follow-up 4-86 (mean 32) months after surgery, six patients were seizure free (Engel outcome class I), three had rare seizures with none in at least the previous 6 months (Engel class II), and two had worthwhile improvement (Engel class III). Except for the severely developmentally delayed infant with hemimegalencephaly, several patients had marked "catch-up" developmental progress after class I, II, or III outcome. Postoperative complications included subdural hematoma over the contralateral hemisphere (one patient) and entrapment and enlargement of the ipsilateral temporal horn (one patient) after hemispherectomy, both corrected uneventfully with a second surgical procedure. One patient died of unexplained causes several hours after frontal lobectomy. No patients had new neurologic deficits after surgery, and one patient had resolution of progressive fluctuating hemiparesis after resection of temporoparieto-occipital cortical dysplasia. CONCLUSIONS: Our results agree with previous reports that epilepsy surgery can provide relief from catastrophic epilepsy in carefully selected infants.

Age Factors↗
PubMed1985

Horopter deviations and distortions.

Previously gathered data from 3 subjects, judged to show usually very steady binocular fixation, were selected for retrospective analysis. This consisted of determining the means and standard error of the means of as many control runs as were available. The role of the fluctuation of vergence eye movement responses in producing the results is discussed. It is concluded that the longitudinal horopter most likely always conforms to the locus of a circle constructed through the two entrance pupils and the point of fixation.

Aniseikonia↗
PubMed1988

Kinetic analysis of voltage- and ion-dependent conductances in saccular hair cells of the bull-frog, Rana catesbeiana.

1. By the use of whole-cell and excised-patch tight-seal recording techniques, we studied ionic conductances in voltage-clamped solitary hair cells isolated from the bull-frog's sacculus. As a basis for assessing their contributions to hair cell electrical resonance, we developed kinetic models describing voltage-dependent Ca2+ and Ca2+-dependent K+ conductances. 2. A transient K+ current (IA) was activated by steps to potentials positive to -50 mV from holding potentials more negative than -70 mV. In the steady state, the current was fully inactivated at the normal resting potential. Possibly due to the dissipation of a Donnan potential between the pipette's interior and the cell, the voltage dependence of IA inactivation slowly shifted in the negative direction during whole-cell recording. 3. The voltage-gated Ca2+ current (ICa) was isolated by blocking IA with 4-aminopyridine (4-AP) and Ca2+-activated K+ current with tetraethylammonium (TEA). The ICa was activated at potentials more positive than -60 to -50 mV and was maximal at about -10 mV. Its magnitude was highly variable among cells, with an average value of -240 pA at -30 mV. Its activation could be fitted well by a third-order (m3) gating scheme. 4. A Ca2+-activated K+ current (IK(Ca)) was isolated as the component of membrane current blocked by TEA. This current was activated at potentials more positive than -60 to -50 mV and had an average value of 1.5 nA at -30 mV. The Ca2+-activated K+ conductance (gK(Ca)) showed a high apparent voltage dependence, increasing e-fold every 3 mV at potentials between -50 and -40 mV. 5. The Ca2+-activated K+ current displayed rapid activation and deactivation kinetics. The current reached half-maximal activation in 2-4 ms at voltages between -50 and -30 mV, and the tail current decayed exponentially with a time constant of 1.0 ms at -70 mV. The activation rate and magnitude of IK(Ca) were reduced by lowering the extracellular Ca2+ concentration. 6. The open probability of Ca2+-activated K+ channels was estimated by ensemble-fluctuation analysis of whole-cell currents evoked by voltage steps to -30 mV. The average open probability was estimated to be 0.8 at this potential. 7. K+-selective channels with a high conductance (140-200 pS) were examined in excised, inside-out membrane patches. The activity of these channels depended on intracellular Ca2+ and membrane potential. These properties suggest that the channels underlie the whole-cell Ca2+-activated K+ current.(ABSTRACT TRUNCATED AT 400 WORDS)

4-Aminopyridine↗
PubMed1992

Mechanism of release of Ca2+ from intracellular stores in response to ionomycin in oocytes of the frog Xenopus laevis.

1. The mechanism of Ca2+ release from intracellular stores was studied in defolliculated Xenopus laevis oocytes by measuring whole-cell currents using the two-electrode voltage-clamp method. 2. The extracellular application of ionomycin, a selective Ca2+ ionophore, evoked an inward current consisting of a spike-like fast component followed by a long-lasting slow component with few superimposed current oscillations (fluctuations). The ionomycin response occurred in a dose-dependent manner and was dependent on Cl-. 3. No apparent refractory period was observed for repetitively evoked small ionomycin responses when the concentration of ionomycin was low (0.1 microM). In contrast, a larger ionomycin response (1 microM), consisting of fast and slow components, was followed by refractory period. Washing for 50-90 min was necessary for full recovery of the ionomycin response. 4. The response to ionomycin was suppressed by the extracellular application of acetoxymethyl ester of bis-(O-aminophenoxy)-ethane-N,N,N',N'-tetraacetic acid (BAPTA AM, 1-10 microM), a membrane-permeable intracellular Ca2+ chelator. 5. The ionomycin response was not affected by pertussis toxin (PTX, 0.3-2.0 microgram/ml), a blocker of guanine nucleotide-binding regulatory proteins (G proteins). In contrast, the response to acetylcholine (ACh), which is known to occur via a G protein, was suppressed by PTX. 6. The fast component was not affected by removing Ca2+ from the bathing medium or by replacing extracellular Ca2+ with Ba2+ or Mn2+ (all of these solutions were supplemented with 2 mM EGTA), whereas the slow component was suppressed. 7. Injection of inositol 1,4,5-trisphosphate (IP3) following a response to extra-cellularly applied ionomycin did not evoke an appreciable membrane current. In contrast, ionomycin evoked a small inward current when it was applied after an inward-current response evoked by IP3 injection, whereas a second injection of IP3 did not evoke any appreciable current. 8. The results indicate that (a) ionomycin releases Ca2+ from its intracellular stores without the involvement of G proteins, resulting in activation of Ca(2+)-activated Cl- channels, (b) ionomycin mainly acts on the same intracellular Ca2+ stores as IP3, and (c) entry of Ca2+ from outside the cell considerably contributes to the slow component of the ionomycin response, whereas its fast component is predominantly dependent on the release of Ca2+ from the intracellular stores.

Acetylcholine↗
PubMed2005

Signal processing strategies that improve performance and understanding of the quantitative ultrasound SPECTRAL FIT algorithm.

Quantifying the size of the tissue microstructure using the backscattered power spectrum has had limited success due to frequency-dependent attenuation along the propagation path, thus masking the frequency dependence of the scatterer size. Previously, the SPECTRAL FIT algorithm was developed to solve for total attenuation and scatterer size simultaneously [Bigelow et al., J. Acoust. Soc. Am. 117, 1431-1439 (2005)]. Herein, the outcomes from signal processing strategies on the SPECTRAL FIT algorithm are investigated. The signal processing methods can be grouped into two categories, viz., methods that improve the performance of the algorithm and methods that provide insight. The methods that improve the performance include compensating for the windowing function used to gate the time-domain signal, averaging the spectra in the normal frequency domain rather than the log domain to improve the precision of the scatterer size and attenuation estimates, improving the selection of the usable frequency range for the SPECTRAL FIT algorithm, and improving the compensation for electronic noise. The methods that provide insight demonstrate that the anomalous rapid fluctuations of the backscattered power spectrum do not affect the SPECTRAL FIT algorithm, and accurate attenuation estimates can be obtained even when the correct scatterer geometry (i.e., form factor) is not known.

Algorithms↗
PubMed2002

Allelic variation of a Beauveria bassiana (Ascomycota: Hypocreales) minisatellite is independent of host range and geographic origin.

The minisatellite locus, BbMin1, was isolated from a partial Beauveria bassiana genomic library that consisted of poly(GA) flanked inserts. Polymerase chain reaction (PCR) of the BbMin1 repeat demonstrated allele size variation among 95 B. bassiana isolates. Amplification was also observed from single isolates of Beauveria amorpha, Beauveria brongniartii, and Beauveria caledonica. Eight alleles were identified at the haploid locus, where repeat number fluctuated between one and fourteen. AMOVA and theta (Fst) indicated that fixation of repeat number has not occurred within pathogenic ecotypes or geographically isolated samples of B. bassiana. Selective neutrality of allele size, the rate of BbMin1 mutation, and the age of the species may contribute to host and geographic independence of the marker. Presence of alleles with a large number of repeat units may be attributed to the rare occurrence of somatic recombination or DNA replication error. The molecular genetic marker was useful for the identification of genetic types of B. bassiana and related species.

Analysis of Variance↗
PubMed1992

The onset of postischemic hypoperfusion in rats is precipitous and may be controlled by local neurons.

BACKGROUND AND PURPOSE: Reperfusion following transient global cerebral ischemia is characterized by an initial hyperemic phase, which precedes hypoperfusion. The pathogenesis of these flow derangements remains obscure. Our study investigates the dynamics of postischemic cerebral blood flow changes, with particular attention to the role of local neurons. METHODS: We assessed local cortical blood flow continuously by laser Doppler flowmetry to permit observation of any rapid flow changes after forebrain ischemia induced by four-vessel occlusion for 20 minutes in rats. To investigate the role of local cortical neurons in the regulation of any blood flow fluctuations, five rats received intracortical microinjections of a neurotoxin (10 micrograms ibotenic acid in 1 microliter; 1.5-mm-depth parietal cortex) 24 hours before ischemia to induce selective and localized neuronal depletion in an area corresponding to the sample volume of the laser Doppler probe (1 mm3). Local cerebral blood flow was measured within the injection site and at an adjacent control site. RESULTS: Ischemia was followed by marked hyperemia (235 +/- 23% of control, n = 7), followed by secondary hypoperfusion (45 +/- 3% of control, n = 7). The transition from hyperemia to hypoperfusion occurred not gradually but precipitously (maximal slope of flow decay: 66 +/- 6%/min; n = 7). In ibotenic acid-injected rats, hyperemia was preserved at the injection site, but the sudden decline of blood flow was abolished (maximal slope of flow decay: 5 +/- 3%/min compared with 53 +/- 8%/min at the control site; n = 5, p less than 0.001) and no significant hypoperfusion developed (103 +/- 20% of control at 60 minutes). CONCLUSIONS: These data suggest that the rapid transition to cortical hypoperfusion after forebrain ischemia may be triggered locally by a neuronal mechanism but that this mechanism does not underlie the initial hyperemia.

Animals↗
PubMed1998

Early onset parkinsonism with diurnal fluctuation maps to a locus for juvenile parkinsonism.

Early onset parkinsonism with diurnal fluctuation (EPDF) is a dopa-responsive parkinsonism characterized by early onset and improvement of parkinsonian symptoms after sleep. A pathologic study of one case of EPDF showed selective neuronal degeneration in the zona compacta of the substantia nigra without Lewy body formation. To determine the disease locus for EPDF, the authors examined 53 members of 17 EPDF families and analyzed 151 meioses. Multipoint linkage analysis gave a peak lod score of 14.2 at 1.0 cM telomeric to D6S305 and placed the disease locus in the 17-cM interval between D6S437 and D6S253, which is exactly the same position mapped for autosomal recessive juvenile parkinsonism (ARJP; Mendelian inheritance in man 600116). The highest two-point lod score was obtained at D6S305 (10.13 at theta = 0). Haplotype analysis agreed with the result of multipoint analysis. A high proportion of nonconsanguinity (8/17 families), the absence of commonly shared haplotypes, and the widespread geographic distribution of the families' origins suggest that EPDF has multiple founder mutations. The authors concluded that EPDF and ARJP are allelic disorders and should be included in the spectrum of a single-clinicogenetic entity of chromosome 6q-linked parkinsonism. This disease could be characterized by a benign clinical course and relatively selective degeneration of nigral dopaminergic neurons with no Lewy body formation. To determine whether ARJP/EPDF constitutes a significant proportion of familial or sporadic forms of benign early onset parkinsonism will require further study.

Adolescent↗
PubMed1998

Persistence of hepatitis B vaccine immune protection and response to hepatitis B booster immunization.

AIM:To identify the persistence of immune protection of China-made, plasma derived hepatitis B vaccine after infancy immunization and the time table of booster immunization.METHODS:A cross-sectional follow-up study and an experimental study on booster were used for the evaluation of the serological effect 7 years after vaccination and the antibody anamnestic response. Radioimmunoassay was used for the detection of hepatitis B virus markers. RESULTS:The protective anti-HBs positive rates of 1018 children, who were vaccinated according to the regimen of three doses of 10 &mgr;g hepatitis B vaccine in their infancy, declined from 75.0% during the first two years to 48.2% in the 7th year after the first dosage, however, the positive rates for HBsAg and anti-HBc always fluctuated at a low frequency. A total of 144 subjects aged 6 or 7 years, who were negative for both HBsAg and anti-HBc before booster, were selected from 1018 children of the follow-up study, and boosted with 1&mgr;g intradermally or 2&mgr;g hypodermically hepatitis B vaccines. Their anti-HBs GMT and anti-HBs positive rates were 190.6mIU/ml and 89.6% in the first month after booster,significantly higher than 14.7mIU/ml and 54.9% before booster (P < 0.01), and declined back to 25.3mIU/ml and 75.5% in the 12th month; among 65 children with the anti-HBs negative before booster, 40 had a level of anti-HBS< = 100mIU/ml one month after booster, suggesting retention of immune memory in most of them.CONCLUSION:No need for revaccination against hepatitis B in the 7th year after the initial immunization due to better persistence of immune protection of the vaccine and retention of immune memory to hepatitis B virus in the vast majority of the vaccinees.

Journal Article↗
PubMed1989

[The effects of longterm selection on the genetic structure of populations--a simulation study. II. The effects of selection on genetic variances].

Monte Carlo simulation has been done to study the effects of longterm artificial selection on genetic variances under additive, dominant, and over-dominant models. The effects of population size, linkage, and heritability have been considered. Just as under the additive model, the additive variance under the dominant and over-dominant models has also been decomposed into three components which represent changes in gene frequencies (VT), departure from Hardy-Weinberg equilibrium (VHW) and from linkage equilibrium (VLD) respectively. These present a resonable approach to study the association among multiple genes. In small populations, genetic variance fluctuates wildly over generations and replicates due to the establishment of linkage disequilibrium. Rapid decrease of VT observed. Intense linkage retained a greater additive variance in the small populations while slowing down responses, which makes it difficult to predict responses during longterm selection.

Animals↗
PubMedDate not supplied

Long-term surgical results of combined trabeculotomy ab externo and cataract extraction.

Trabeculotomy ab externo has been demonstrated to be effective in controlling intraocular pressure (IOP) in adult patients with either primary open-angle glaucoma or pseudoexfoliation syndrome. We evaluated the surgical outcome of 60 eyes with either primary open-angle glaucoma or pseudoexfoliation syndrome that underwent combined trabeculotomy ab externo and cataract extraction. All patients were at least 40 years old, and were followed for at least 1 year. At the final examination, IOP was well controlled (21 mm Hg or less) in 54 (90%) of the 60 eyes, with or without medication. Also, "overall success" (ie, stabilization of IOP, visual field, and optic nerve status) was achieved in 49 (81.7%). Complications included fibrin exudation (22%), transient IOP elevation (17%), early perforation of the probe into the anterior chamber (10%), and detachment of Descemet's membrane (5%). We recommend combined trabeculotomy ab externo and cataract extraction in selected cases of glaucoma with coexisting cataract. For cases in which the target IOP level is in the low teens, or for patients who may not tolerate postoperative fluctuations in IOP, we do not recommend trabeculotomy ab externo. Also, in eyes that have normal-tension glaucoma, or that have already sustained severe damage to the optic nerve, visual dysfunction caused by glaucomatous changes may progress even after successful combined trabeculotomy ab externo and cataract extraction.

Aged↗