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The adjunct consumer group.

Little by little, the community is becoming aware of the Weber Mental Health Center and PAAG. A recent study shows that the community approach leads to high visibility; PAAG activities were known by 37% of 1,000 people recently interviewed. This compares to 5%, 7%, and 15% having knowledge of other more traditional medical centers in Utah. It is felt that this approach is an important part in putting the community mental health center in proper perspective in the community. It is felt that the adjunct consumer group provides almost infinite flexibility to meet human needs. As a result, the Northern Utah Unit of the State Hospital will remain closed, largely because PAAG is serving the community.

Adult↗

Impact of family history of colon cancer on development of multiple primaries after diagnosis of colon cancer.

PURPOSE: The purpose of this study was to assess risk of developing multiple primaries after a diagnosis of colon cancer and to determine the impact that having a family history of cancer has on cancer risk. METHODS: Data from the Utah Cancer Registry and the Utah Population Database were used. A cohort of 2,236 first primary colon cancers were observed for the subsequent development of additional primary cancers. RESULTS: We observed a greater than expected incidence of colon, rectal, and pancreatic cancers among the cohort. The standardized incidence ratios were 2.77 (95 percent confidence interval (CI), 2.07-3.70), 2.26 (95 percent CI, 1.34-3.81), and 2.38 (95 percent CI, 1.32-4.30), respectively. Having a family history of colon or rectal cancer did not greatly influence risk of having a multiple primary. However, there was a trend toward increased risk of pancreatic cancer (hazard rate ratios, 1.99; 95 percent CI, 0.67-5.90) and bladder cancer (hazard rate ratios, 2.35; 95 percent CI, 0.77-7.18) among patients with a family history of rectal cancer. We also observed that risk of uterine cancer in the cohort was positively associated with family history of uterine cancer, risk of breast cancer was positively associated with family history of breast cancer, and risk of prostate cancer was positively associated with family history of prostate cancer. CONCLUSIONS: People with colon cancer are at a greater risk of developing colon, rectal, and possibly pancreatic cancer. Although a family history of colon or rectal cancer did not have a large impact on developing other cancers, a family history of other primary cancers did influence risk of other cancers.

Aged↗

Designing fault-tolerant distributed archives for picture archiving and communication systems.

PURPOSE: Distributed archives in a picture archiving and communication system (PACS) environment can provide added fault tolerance and fail-over capability, as well as increased load capacity at a more economical price than traditional 'high-availability" systems. Systems can be configured with varying levels of fault tolerance, depending on the amount of redundancy desired. There is, however, a direct correlation between the level of hardware redundancy and cost to implement. This presentation details the system design for fault-tolerant distributed archives as well as several options for redundancy, referencing implementation of a fault-tolerant archive system at the University of Utah. METHODS: The distributed archive system described here is based on Image Devices' image archive software, which can be implemented on multiple individual archive servers in order to distribute archive functionality and operational load. The configuration and implementation of the individual servers together make up the distributed archive system and does not impact the ability of the system to be scaled to meet future requirements. Several implementation and configuration options exist, including the ability for servers to maintain replicated databases containing patient and image information. Thus, each archive can be aware of all information and the location of this information within the distributed archive system. RESULTS: The goal is to produce systems that will still be operational in the event of any single point of failure, ie, a network connection failure between facilities or the failure of a single archive server within the distributed system. During normal operation, workload for image acquisition, image routing and image query requests will be distributed between the archive servers. If the system is deployed in a multifacility environment, each archive server can be configured to be responsible for the acquisition and image distribution management within that server's local facility. If the system is deployed in a single facility environment, load can be distributed evenly between the archive servers based on an understanding of the workload requirements generated be each acquisition and display device in the system. In the event that an archive server fails, other archive servers within the system will have the ability to provide some or all of the failed server's functionality. The degree of fail-over capability is dependent on the archive server's configuration as well as hardware redundancy employed. Three levels of fault-tolerant design can be achieved with this system architecture: (1) duplicate work capability only; (2) duplicate work capability and short-term image cache; (3) duplicate work capability, short-term image cache, and longterm image archival. Using the basic fault-tolerant design above, we have implemented a multifacility distributed archive system at the University of Utah. This system was implemented at a fraction of the cost of true "high-availability" archive architectures yet provides constant up time for the PACS system. If the network connection between the two locations goes down, each site is still fully functional for soft-copy read, as well as image acquisition and distribution. If either of the archive servers goes down, the image sources are redirected to the other archive server. The operational server then handles image distribution for both locations. Access to images in the short-term image cache is available to both archive servers and is not affected by loss of the network connection or remote server. Because there is ony one long-term archive device, the ability to retrieve images from long-term storage is the only function compromised by a network or server failure. CONCLUSION: By implementing distributed archives in a PACS environment, it is possible to achieve a highly fault-tolerant system without the expense of high-availability hardware and software. The design concepts outlined here can be applied to any PACS system that supports distributed archive functionality.

Computer Systems↗

Chronic toxicity of un-ionized ammonia to early life-stages of endangered Colorado pikeminnow (Ptychocheilus lucius) and razorback sucker (Xyrauchen texanus) compared to the surrogate fathead minnow (Pimephales promelas).

Ammonia-contaminated groundwater enters the Upper Colorado River from beneath the abandoned Moab Uranium Mill Tailings Pile near Moab, Utah. This reach of the Upper Colorado River was designated as critical habitat for four endangered fish species because it is one of the few existing areas with known spawning and rearing habitats. Un-ionized ammonia (NH3) concentrations frequently exceed 1.00 mg/L in backwaters adjacent to the tailings pile, which exceeds the Utah 30-d average chronic water quality criterion for un-ionized ammonia (0.07 mg/L NH3; temperature 20 degrees C; pH 8.2) by a factor of more than 10. However, there is little published information regarding the sensitivity of endangered fishes to ammonia. We conducted 28-d static renewal studies with post-swim-up larvae to determine the relative sensitivity of Colorado pikeminnow (Ptychocheilus lucius), razorback sucker (Xyrauchen texanus), and the standard surrogate fathead minnow (Pimephales promelas) to NH3. Chronic values (ChVs) for mortality and growth were determined as the geometric mean of the no observed effect concentration and the lowest observed effect concentration based on analysis of variance. The ChVs for growth of fathead minnow, Colorado pikeminnow, and razorback sucker were 0.43, 0.40, and 0.67 mg/L NH3, respectively. The ChVs for mortality of fathead minnow, Colorado pikeminnow, and razorback sucker were 0.43, 0.70, and 0.67 mg/L NH3, respectively. Therefore, the ChVs for mortality and growth were similar for fathead minnow and razorback sucker; however, the ChV for growth was lower than the ChV for mortality for Colorado pikeminnow. Maximum likelihood regression was used to calculate 28-d lethal concentrations (LCx) for each species. The 28-d LC50, LC20, and LC1 values for fathead minnow were 0.69, 0.42, and 0.13 mg/L NH3, respectively. The 28-d LC50, LC20, and LC1 values for Colorado pikeminnow were 0.76, 0.61, and 0.38 mg/L NH3, respectively. The 28-d LC50, LC20, and LC1 values for razorback sucker were 0.54, 0.38, and 0.25 mg/L NH3, respectively. The fathead minnow, Colorado pikeminnow, and razorback sucker are relatively similar in sensitivity and rank at the 35th, 49th, and 31st percentiles, respectively, of the theoretical chronic fish sensitivity distributions for NH3. The existing water quality criteria for NH3, if met by remediation activities at the Moab site, would be protective of these endangered fishes even if fish sensitivity is based on the conservative LC1 value.

Ammonia↗

Should scatter be corrected in both transmission and emission data for accurate quantitation in cardiac SPET?

Ideally, reliable quantitation in single-photon emission tomography (SPET) requires both emission and transmission data to be scatter free. Although scatter in emission data has been extensively studied, it is not well known how scatter in transmission data affects relative and absolute quantitation in reconstructed images. We studied SPET quantitative accuracy for different amounts of scatter in emission and transmission data using a Utah phantom and a cardiac Data Spectrum phantom including different attenuating media. Acquisitions over 180 degrees were considered and three projection sets were derived: 20% images and Jaszczak and triple-energy-window scatter-corrected projections. Transmission data were acquired using gadolinium-153 line sources in a 90-110 keV window using a narrow or wide scanning window. The transmission scans were performed either simultaneously with the emission acquisition or 24 h later. Transmission maps were reconstructed using filtered backprojection and mu values were linearly scaled from 100 to 140 keV. Attenuation-corrected images were reconstructed using a conjugate gradient minimal residual algorithm. The mu value underestimation varied between 4% with a narrow transmission window in soft tissue and 22% with a wide window in a material simulating bone. Scatter in the emission and transmission data had little effect on the uniformity of activity distribution in the left ventricle wall and in a uniformly hot compartment of the Utah phantom. Correcting the transmission data for scatter had no impact on contrast between a hot and a cold region or on signal-to-noise ratio (SNR) in regions with uniform activity distribution, while correcting the emission data for scatter improved contrast and reduced SNR. For absolute quantitation, the most accurate results (bias <4% in both phantoms) were obtained when reducing scatter in both emission and transmission data. In conclusion, trying to obtain the same amount of scatter in emission and transmission data, in addition to being impractical because of the difficulty in knowing the precise scatter components, did not yield such accurate absolute activity quantitation as when emission and transmission scatter were reduced.

Heart↗

Prevalence of attention deficit-/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates.

OBJECTIVE: This study was performed to evaluate the prevalence of ADHD as well as comorbid conditions among young male prison inmates. METHOD: We investigated 129 prison inmates (mean age+/-SE: 19.2+/-2.0 years) and 54 healthy male control subjects (mean age+/-SE: 22.2+/-3.12 years) for the presence of adult ADHD using the Wender Utah Rating Scale (WURS), the Eysenck Impulsivity Questionnaire (EIQ), the diagnostic criteria for ADHD according to DSM-IV and ICD-10-research criteria and the Utah criteria for adult ADHD. In order to determine comorbid personality disorders we applied the International Personality Disorder Examination (IPDE). Externalization (ED) and Internalization Disorders (ID) were evaluated by means of the Achenbach Scales. Alcoholism (ALC) was examined via the Alcohol Use Disorder Test (AUDIT) and substance use disorder (SUD) has been investigated with the Structured Clinical Interview for DSM-IV (SCID). RESULTS: The overall prevalence of ADHD according to DSM-IV was 45%. The prevalence of disturbance of activity and attention (DAA) and hyperkinetic conduct disorder (HCD) via the ICD-10 research criteria was 21.7%. Sole DAA without any comorbid condition could be detected in one case. The most common diagnostic combinations were DAA/HCD and SUD/ALC (89% of all DAA/HCD cases). CONCLUSION: The prevalence of DAA/HCD or ADHD in young adult prison inmates is significantly elevated when compared to nondelinquent controls. Generally the population of young adult male prison inmates exhibits a considerable psychiatric morbidity. Of the total sample, 64% suffered from at least 2 disorders. Only 8.5% had no psychiatric diagnoses. This indicates the urgent need for more psychiatric expertise in young offender facilities.

Adolescent↗

Use of bioclimatic indexes to characterize phenological phases of apple varieties in Northern Italy.

The research was designed to characterize the phenological behaviour of different apple varieties and to compare different bioclimatic indexes in order to evaluate their adaptability in describing the phenological phases of fruit species. A field study on the requirement for chilling units (winter chilling requirement) and the accumulation of growing degree hours of 15 native apple cultivars was carried out in a fruit-growing area in North West Italy (Cuneo Province, Piedmont). From 1991 to 1993, climatic data were collected at meteorological stations installed in an experimental orchard (Verzuolo, Cuneo). Four methods were compared to determine the winter chilling requirement: Hutchins, Weinberger-Eggert, Utah and North Carolina. The Utah method was applied to determine the time when the chilling units accumulated become effective in meeting the rest requirements. A comparison of the different methods indicated that the Weinberger-Eggert method is the best: as it showed the lowest statistical variability during the 3 years of observations. The growing degree hour requirement (GDH) was estimated by the North Carolina method with two different base temperatures: 4.4 degrees C and 6.1 degrees C. More difficulties were met when the date of rest completion and the beginning of GDH accumulation was determined. The best base temperature for the estimation of GDH is 4.4 degrees C. Phenological and climatic characterizations are two basic tools for giving farmers and agricultural advisors important information about which varieties to choose and which are the best and the most correct cultivation practices to follow.

Agriculture↗

How representative are the surveillance, epidemiology, and end results (SEER) program cancer data of the United States?

OBJECTIVE: Data from the 11 Surveillance, Epidemiology, and End Results tumor registries cover 14% of the U.S. population and are often used to provide national estimates of cancer incidence and survival. Cancer mortality data for the U.S. and for SEER are compared to assess the representation of SEER to the U.S. METHODS: Comparisons between US and SEER cancer mortality were made for 16 of the leading causes of cancer death. Cancer site-specific comparisons were also made by race and sex. In addition, tobacco-related cancers were considered. Analyses were performed for the years when all 11 SEER registries were included in the SEER program. Poisson regression was used to estimate site-specific cancer mortality rate ratios between the U.S. and SEER. RESULTS: Cancer site-specific mortality rates derived from SEER data tend to under-represent the U.S. cancer mortality experience for white males and females and black males. Under-representation is observed across the majority of SEER registries, with the highest amount of under representation in Utah and New Mexico. Under-representation of SEER data compared with US data is noticeably greater among tobacco-related cancers, particularly in Utah and New Mexico. CONCLUSION: For certain cancer sites, particularly tobacco-related cancers, the SEER coverage population is not representative of the U.S. population.

Demography↗

Cardiac retransplantation: a viable option? The Registry of the International Society for Heart and Lung Transplantation.

To evaluate cardiac retransplantation as an appropriate utilization of scarce donor organs we analyzed data from the registry of the International Society for Heart and Lung Transplantation (ISHLT) (n = 449) and the Utah Cardiac Transplant Program (n = 20). Actuarial survival among retransplants was lower than in patients who received only one transplant in both the ISHLT registry patients (1 year survival, 48% versus 78%; p = 0.001) and the Utah series (1 year survival, 74% versus 88%; p = 0.06). Uncontrolled rejection, short interval (< 6 months) between transplantations, and the need for mechanical circulatory support were identified as risk factors for retransplantation. The incidence of rejection and infection was similar in first and second transplant recipients. Second transplant recipients had a higher level of sensitization, a greater incidence of donor-specific positive crossmatches, and an increased early mortality. Repetition in the second donor of mismatched HLA antigens present in the first donor did not adversely affect survival. If patients who underwent retransplantation within 6 months of their initial transplantation, those receiving transplants for uncontrolled rejection, and those requiring mechanical assistance were eliminated from the study, the short-term and long-term survival after cardiac retransplantation does not differ from that in patients having a single transplant.

Actuarial Analysis↗

Tricuspid valve replacement after cardiac transplantation.

BACKGROUND: Tricuspid valve insufficiency (TI) is common after orthotopic heart transplantation. However, tricuspid valve replacement or repair (TVR) is rare. The aim of this study is to evaluate our experience with TVR in cardiac transplant recipients. METHODS: The Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program database was queried for TVR in all adult and pediatric heart transplant recipients. Pre-operative parameters and cardiac hemodynamics were compared with post-operative findings. RESULTS: Since 1985, we identified in our database 17 patients who had 16 TVR, and 2 tricuspid valve repair procedures. Thirty-four heart transplant recipients from the same period were used as controls. The indication for TVR was symptomatic right heart failure (RHF) in 89% of cases, and there was no significant difference between the control group and the surgery group in the average number of biopsies. A flail leaflet was found in 16 cases (89%). One patient died post-operatively due to cardiogenic shock, and 1 patient died 8 months after TVR due to progressive RHF. Improvement in heart failure symptoms was seen in 12 cases. The central venous pressure (CVP) decreased from 17.8 +/- 4.1 mm Hg to 11.0 +/- 7.3 mm Hg (p = 0.013). There was no significant change in cardiac output or renal function. However, the furosemide dose decreased significantly from 47.69 +/- 56.44 mg/day to 26.54 +/- 46.43 mg/day (p = 0.009). CONCLUSIONS: After orthotopic heart transplantation, TVR is a safe and effective procedure to alleviate RHF symptoms. Flail leaflets are the most common operative finding, suggesting that biopsy-induced trauma is the likely cause of severe TI in these patients.

Adult↗

Death rounds: end-of-life discussions among medical residents in the intensive care unit.

PURPOSE: We introduced "Death Rounds," a monthly discussion of the issues and emotions surrounding the care of dying patients, into the intensive care unit (ICU) rotations for medical house staff. We surveyed participating residents to evaluate their satisfaction with these discussions. SUBJECTS AND METHODS: Death Rounds occurred at university-based teaching hospitals in Seattle, Washington and Salt Lake City, Utah, between October 2000 and March 2002. Residents who had attended Death Rounds were surveyed in April 2002. RESULTS: A 10-item survey was distributed by e-mail to 116 residents in Utah and Washington. Of 116 residents, 97 (84%) responded to the survey; 50 of these 97 had attended at least one Death Rounds. Of these 50, the majority reported that Death Rounds were worthwhile (76%) and that sessions should be incorporated into all ICU rotations (76%). CONCLUSIONS: Death Rounds provide a unique opportunity for residents to discuss the issues raised in caring for dying patients. This conference can be easily incorporated into the ICU curriculum. Most residents who participated in the survey indicated that they valued Death Rounds and believed that it should be included in all ICU rotations.

Adult↗

Capsular bag opacification after experimental implantation of a new accommodating intraocular lens in rabbit eyes.

PURPOSE: To evaluate the development of capsular bag opacification in rabbit eyes after implantation of an intraocular lens (IOL) designed to minimize contact between the anterior capsule and the IOL and ensure expansion of the capsular bag. SETTING: David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Ten New Zealand white rabbits had a study IOL (new accommodating silicone IOL [Synchrony, Visiogen, Inc.]) implanted in 1 eye and a control IOL (1-piece plate silicone IOL with large fixation holes) implanted in the other eye. Intraocular lens position, anterior capsule opacification (ACO), and posterior capsule opacification (PCO) were qualitatively assessed using slitlamp retroillumination photographs of the dilated eyes. Anterior capsule opacification and PCO were graded on a 0 to 4 scale after the eyes were enucleated (Miyake-Apple posterior and anterior views after excision of the cornea and iris). The eyes were also evaluated histopathologically. RESULTS: The rate of ACO and PCO was significantly higher in the control group. Fibrosis and ACO were almost absent in the study group; the control group exhibited extensive capsulorhexis contraction, including capsulorhexis occlusion. Postoperative IOL dislocation into the anterior chamber and pupillary block syndrome were observed in some eyes in the study group. CONCLUSIONS: The special design features associated with the study IOL appeared to help prevent PCO. Complications in the study group were probably caused by the increased posterior vitreous pressure in rabbit eyes compared to human eyes and the relatively large size of the study IOL relative to the anterior segment of rabbit eyes.

Animals↗

Correlation between different measurements within the eye relative to phakic intraocular lens implantation.

PURPOSE: To obtain measurements of the white-to-white distance and the anterior chamber and ciliary sulcus diameters in phakic human eyes obtained post-mortem to find a correlation between these measurements. SETTING: David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Twenty-two phakic human eyes obtained from eye banks within 24 hours of death were evaluated. The following measurements were performed: white-to-white distance, anterior chamber diameter with a plastic sizer after a small limbal incision, and anterior chamber and ciliary sulcus diameters after fixation and sagittal section of the eyes. The first 10 eyes were studied at the 6 o'clock to 12 o'clock meridian and the last 12 eyes, at the 3 o'clock to 9 o'clock meridian. RESULTS: A positive correlation was found between the white-to-white measurements and the anterior chamber diameter in the 10 eyes studied at the 6 o'clock to 12 o'clock meridian but not in the 12 eyes studied at the 3 o'clock to 9 o'clock meridian. The latter is the meridian frequently used by surgeons to perform white-to-white measurements and thus choose the overall size of the phakic intraocular lens to be implanted. No correlation was found between the white-to-white measurements and the ciliary sulcus diameter in the 2 meridians. CONCLUSION: Experimental studies using cadaver eyes are helpful in evaluating sizing techniques for phakic IOL implantation as well as in better understanding the anatomical relationships between ocular structures.

Aged↗

Pathological evaluation of postmortem human eyes implanted with a new single-piece hydrophobic acrylic lens.

PURPOSE: To report the pathological findings in 14 human cadaver eyes implanted with a single-piece AcrySof(Alcon Laboratories) posterior chamber intraocular lens (IOL). SETTING: David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Fourteen human autopsy eyes implanted with a single-piece AcrySof (SA30AL) IOL were evaluated. The eyes were sectioned at the equatorial plane, and the anterior segment containing the IOL in the capsular bag was evaluated from a posterior perspective (Miyake-Apple view) and from an anterior perspective (surgeon's view) after removal of cornea and iris. They were then processed through paraffin, sectioned, and stained with hematoxylin-eosin, periodic acid-Schiff, and Masson's trichrome and examined under light microscopy. RESULTS: All IOLs had symmetric in-the-bag fixation. Slight decentration was measured in 1 eye, which also had an anterior capsule tear. Grade 1 anterior capsule opacification was present in 9 eyes. No central posterior capsule opacification or posterior capsule folds were observed in any eye. Soemmering's ring formation was observed in 5 eyes. Zonular stretch caused by different degrees of capsular bag contraction was present in 4 eyes without decentration of the IOL. CONCLUSIONS: Analyses of pseudophakic cadaver eyes from the posterior (Miyake-Apple) view, complemented by microscopic analyses, proved useful in the evaluation of IOL-capsular bag interaction. These studies are more important in cases of newly introduced lens designs.

Anterior Eye Segment↗

Legacy AdvanTec and Sovereign WhiteStar: a wound temperature study.

PURPOSE: To assess the wound temperature of the Sovereign WhiteStar (S-WS) (AMO) and Legacy AdvanTec (L-ADV) (Alcon) phacoemulsification systems. SETTING: John A. Moran Eye Center, Health Sciences Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Phacoemulsification using 20-gauge, 30-degree straight tips with the L-ADV and S-WS systems was performed in fresh cadaver eyes. The power was set at 50%, and aspiration was 12 mL/min; the L-ADV was run at 15 pulses per second (pps) and the S-WS at WS CF (6 milliseconds on, 12 milliseconds off). Temperature was measured at 5-second intervals for 60 seconds using a microthermistor placed in the wound. The phaco tip was angled 30 degrees to increase wound-tissue contact. At 10 seconds, the flow was clamped to simulate occlusion. Five runs, sleeved and unsleeved, were averaged for the phaco tip. RESULTS: The mean temperature was significantly higher with L-ADV than with S-WS (from 10 seconds on in the sleeved condition and from 5 seconds on in the unsleeved condition after the aspiration line was clamped). In 2 of 5 sleeved runs and 4 of 5 unsleeved runs, the L-ADV handpiece decreased power as the temperature increased. One run with the L-ADV with sleeve showed signs of wound burn. There were no signs of wound burn with the S-WS. The highest temperature recorded was 57.5 degrees C with the L-ADV and 38.6 degrees C with the S-WS. Power tests showed L-ADV protected the stroke length and S-WS had constant power except in air where it increased power. CONCLUSIONS: There was less increase in wound temperature over time with the S-WS than with the L-ADV system in sleeved and unsleeved simulated surgery in human eye-bank eyes. Because the ultrasound handpieces respond differently under different load scenarios, meaningful comparisons of pulsing features are difficult to create.

Anterior Eye Segment↗

Posterior capsule opacification in rabbit eyes implanted with hydrophilic acrylic intraocular lenses with enhanced square edge.

PURPOSE: To evaluate the development of posterior capsule opacification (PCO) after implantation of single-piece hydrophilic acrylic intraocular lenses (IOLs) with an enhanced square edge. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: The standard 570H Centerflex (Rayner Ltd.) design was compared to 2 new designs with enhanced square edges: the 570E and the 570C. Ten IOLs of each type were implanted in a randomized manner by the same surgeon in 15 pigmented rabbits. After a follow-up of 3 weeks, the rabbits were killed and the eyes were analyzed from the posterior view. The intensity of central PCO, peripheral PCO, and Soemmering's ring formation was graded from 0 to 4. The area of Soemmering's ring was graded from 0 to 4 based on the number of quadrants involved. Other parameters analyzed were capsulorhexis coverage of the IOL edge and IOL centration and fixation. Results from the posterior view were complemented by histopathological evaluation. RESULTS: Posterior capsule opacification was lowest in the 570C group, highest in the 570H group, and intermediate in the 570E group. There was a statistically significant difference between the 3 groups in peripheral PCO (P = .039). No significant difference was found between the groups in the other parameters analyzed. When cell ingrowth occurred with the 570H, it started at the optic-haptic junctions, as observed during the clinical follow-up and confirmed by gross and histopathological analyses. CONCLUSIONS: The square optic edge is the most important IOL design feature for PCO prevention. However, it should be present for 360 degrees around the IOL optic to provide an effective barrier effect.

Acrylic Resins↗

Analysis of the capsule edge after Fugo plasma blade capsulotomy, continuous curvilinear capsulorhexis, and can-opener capsulotomy.

PURPOSE: To compare the quality of the edges of anterior capsulotomies performed in porcine eyes using 3 different techniques. SETTING: David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. METHODS: Four porcine eyes were submitted to the center in 10% neutral buffered formalin. The cornea of the eyes had been removed, and a continuous capsulotomy had been performed in each eye using the Fugo plasma blade. To provide morphologic correlation, 4 additional porcine eyes were used in the study. In 2, a manual continuous curvilinear capsulorhexis (CCC) was performed after the cornea or cornea/iris was removed and in the other 2, a can-opener capsulotomy (COC) was performed. The eyes were then placed in 10% neutral buffered formalin. Gross (macroscopic) and microscopic analysis of each eye was performed, and photographs were taken. One eye in each group was also prepared and analyzed under scanning electron microscopy (SEM). RESULTS: The capsulotomy margin in the Fugo blade group presented some regularly spaced tags directed centrally with smooth edges at the base. Such a configuration would not interfere with the dynamics of the capsulorhexis sphincter and would generally not lead to radial tears. The smooth and regular nature of the capsulotomy margin in the CCC group was confirmed by gross and microscopic examinations of the eyes. The capsulotomy margin in the COC group presented some sharp notches directed outward, irregularly spaced, and irregular in shape. These are known to have a tendency to extend and form radial tears. CONCLUSION: Although performance of an anterior capsulotomy with the Fugo blade was associated with some margin irregularities, the geometry of the centrally directed tags prevented them from becoming the site of radial tear formation. The base of the capsulotomy performed with the Fugo blade appeared to be almost as smooth and regular as in the CCC under SEM evaluation.

Animals↗

Laser in situ keratomileusis in patients with corneal guttata and family history of Fuchs' endothelial dystrophy.

PURPOSE: To report 1-year results of laser in situ keratomileusis (LASIK) in 7 eyes with corneal endothelial guttata and a family history of Fuchs' endothelial dystrophy. SETTING: John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: A retrospective chart review was performed of 4 patients (7 eyes) who had trace to 1+endothelial guttata and a family history of Fuchs dystrophy and then had uneventful LASIK for the correction of myopia and myopic astigmatism. Preoperative and postoperative measurements included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal pachymetry, endothelial cell density (ECD), manifest refraction, and spherical equivalent. The changes in ECD, pachymetry, and spherical equivalent after LASIK were subjected to statistical analysis using a paired Student t test to determine significance. RESULTS: Transient corneal edema was noted in the early postoperative period in 3 eyes of 2 patients. At 1 year, 6 of the 7 (86%) eyes had lost > or =2 lines of BSCVA. A statistically significant decrease in ECD of 12.4% +/- 2.7% was observed at 1 year compared with baseline (P < .001). An increase in corneal thickness (P = .006) and a statistically significant myopic shift in spherical equivalent (P = .017) was also noted at 1 year compared with 3 months. CONCLUSIONS: Patients with mild corneal guttata and a family history of Fuchs' dystrophy are prone to transient corneal edema, loss of BSCVA, endothelial cell loss, and myopic regression after uneventful LASIK for correction of myopia and myopic astigmatism.

Adult↗