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Plasticity of neuropeptide Y in the rat superior cervical ganglion in response to nerve lesion.

Axotomy of the rat superior cervical ganglion results in a two-fold increase of neuropeptide tyrosine as determined by radioimmunoassay. On the other hand, treatment of sympathetic neuron cultures with leukemia inhibitory factor, a cytokine that is known to be involved in the up-regulation of galanin after axotomy in vivo, decreases neuropeptide tyrosine messenger RNA. These, apparently contradictory findings, prompted us to investigate the regulation of neuropeptide tyrosine in the axotomized superior cervical ganglion in vivo. For comparison, the regulation of galanin was examined under the same conditions. Compared to control ganglia, the number of neuropeptide tyrosine-positive cell bodies decreased while the density of immunoreactive neuronal processes increased one week after transection of the major postganglionic nerves. The nerve fibres were identified as axons by the absence of MAP2, a somatodendritic marker protein. They extended into both carotid nerves and ramified at the lesion site. In situ hybridization revealed that, although the number of neuropeptide tyrosine messenger RNA-positive neurons was not different from controls, the average grain density/neuron decreased by 40%. When axotomized ganglia were decentralized simultaneously, a three-fold elevation of neuropeptide tyrosine immunoreactivity was detectable by radioimmunoassay and an additional increase in numerical density of neuropeptide tyrosine-immunoreactive nerve fibres was observed. Levels of neuropeptide tyrosine messenger RNA were significantly reduced within postganglionic neurons. This synergistic effect of combined axotomy and decentralization on peptide content was also detected for the neuropeptide galanin that, in contrast to neuropeptide tyrosine, is induced by axotomy or decentralization on protein and messenger RNA level. Therefore, while neuropeptide tyrosine messenger RNA is reduced in axotomized ganglia (most likely in response to leukemia inhibitory factor), the peptide accumulates in axonal processes resulting in increased peptide levels as determined by radioimmunoassay.

Animals↗

Fourier analysis of irregular astigmatism after implantation of 3 types of intraocular lenses.

PURPOSE: To evaluate irregular astigmatism after silicone, acrylic, and poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation using Fourier analysis of videokeratography data. METHODS: Two hundred forty eyes having phacoemulsification and IOL implantation were randomly assigned to 1 of 3 groups: 3.5 mm incision and silicone IOL, 4.1 mm incision and acrylic IOL, or 6.5 mm incision and PMMA IOL. All eyes had videokeratographic examinations preoperatively and 2, 4, and 10 days and 1 and 3 months postoperatively. The dioptric data of the central cornea were decomposed into spherical equivalent, regular astigmatism, and irregular astigmatism (decentration and higher-order irregularity) components using Fourier analysis. RESULTS: Regular astigmatism in the PMMA group was greater than in the silicone and acrylic groups. Decentration in all 3 groups increased significantly postoperatively but virtually returned to preoperative levels by 10 days. No significant difference was observed among the 3 groups. Higher-order irregularity significantly increased after surgery in all 3 groups. The higher-order irregularity in the PMMA group persisted for up to 1 month, while that in the silicone and acrylic groups returned to preoperative levels by 4 days, resulting in significant differences between these groups 10 days and 1 month after IOL implantation. CONCLUSION: Irregular astigmatism, both the decentration and higher-order irregularity components, increased significantly after 3 types of scleral tunnel incisions for silicone, acrylic, or PMMA IOL implantation but returned to preoperative levels soon after surgery except for the higher order irregularity after PMMA IOL implantation.

Acrylic Resins↗

Biometry of 3 types of intraocular lenses using Scheimpflug photography.

PURPOSE: To compare differences in intraocular lens (IOL) decentration and tilt and anterior chamber depth (ACD) using Scheimpflug photography as well as best corrected visual acuity (BCVA) in eyes having phacoemulsification with implantation of 1 of 3 types of IOLs. SETTING: Chung-Ang University Hospital, Seoul, Korea. METHODS: This study comprised 137 cataractous eyes of 108 patients having phacoemulsification and IOL implantation. Eyes were randomized into 3 groups based on IOL type: poly(methyl methacrylate) (PMMA) (n = 65); silicone (n = 47); soft acrylic (n = 25). Biometric analysis was performed with an EAS-1000 Scheimpflug camera 1, 3, and 6 months after surgery. Best corrected visual acuity was also measured at these visits. RESULTS: The anterior chamber was deeper 1 month after surgery, with no statistical difference among groups. There were no significant differences among groups in IOL decentration and tilt or final BCVA during the follow-up. CONCLUSIONS: In this study in which a properly constructed continuous curvilinear capsulorhexis was created and IOLs were accurately placed in normal capsular bags, changes in ACD, IOL decentration and tilt, and BCVA were similar in eyes with a PMMA, silicone, or soft acrylic IOL.

Acrylic Resins↗

Modified capsular tension ring for patients with congenital loss of zonular support.

PURPOSE: To evaluate the results of implantation of a modified capsular tension ring (MCTR) and a posterior chamber intraocular lens (PC IOL) in patients with congenitally subluxated crystalline lenses. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Ninety eyes of 57 patients with congenital loss of zonular support (Weill-Marchesani syndrome, idiopathic ectopia lentis, and Marfan's syndrome) had phacoemulsification with PC IOL and MCTR implantation. The preoperative examination included best corrected visual acuity (BCVA) and the presence or absence of phacodonesis, lens decentration, and vitreous prolapse. The postoperative evaluation included BCVA and the presence or absence of pseudophacodonesis, PC IOL centration, and posterior capsule opacification (PCO). RESULTS: At the last postoperative examination, the BCVA was 20/40 or better in 80 eyes (88.9%); 1 eye (1.1%) lost 1 line of acuity. Preoperatively, 18 eyes (20%) had phacodonesis; 1 eye had postoperative pseudophacodonesis. Decentration before surgery was present in 86 eyes (95.6%); 6 eyes (6.7%) developed late symptomatic PC IOL decentration a median of 17.84 months +/- 10.73 (SD) after surgery. Other complications were increased intraocular pressure (2.2%), persistent iritis (3.3%), broken suture (10.0%), retinal detachment (1.1%), and PCO (20.0%). CONCLUSIONS: Use of the MCTR resulted in centration of the capsular bag and PC IOL in 90 eyes with congenitally subluxated crystalline lenses. Fixation of a 9-0 polypropylene suture is recommended to decrease the risk for late suture breakage.

Adult↗

Evaluation of a one-piece poly(methyl methacrylate) intraocular lens with a 7 mm biconvex optic and a total diameter of 10 mm.

To find out how large the total diameter of an open-loop intraocular lens (IOL) should be, we studied 90 consecutive implantations of a one-piece poly(methyl methacrylate) IOL with a 7 mm biconvex optic and a total diameter of 10 mm (Adatomed 75 ST). The lens design made implantation simple, even through a small capsulorhexis. In 85% of the cases, the IOL remained well centered. One case with asymmetric placement of the IOL showed a decentration of more than 1 mm. In 14% of the eyes slight decentrations occurred because the capsular bag was too large. Contact between the iris and IOL was found in 15%. In 4% there were folds in the posterior capsule, and in 35% there was a small space between the IOL and the posterior capsule because the capsular bag was too large. Although the ST lens has a small total diameter, it remained at a distance from the iris in most cases. In-the-bag implantation through a continuous central capsulorhexis is mandatory to avoid secondary displacement; nevertheless, slight decentrations cannot be excluded. For a large capsular bag, the total diameter of an IOL should exceed 10 mm. Clinical results, cellular reaction on the lens surface (26.6%), biocompatibility, and visual performance are comparable to those of other well-approved poly(methyl methacrylate) IOLs.

Adult↗

Corneal topography following excimer photorefractive keratectomy for myopia.

Corneal topographic analysis was performed on 97 consecutive eyes with at least one month follow-up after excimer laser photorefractive keratectomy for myopia. Centration of the ablated zone was documented in all eyes at the one month postoperative examination with the Topographic Modeling System (Computed Anatomy Inc., NY). Thirty-seven percent of eyes were within 0.25 mm of the pupillary center (PC); 48% of eyes were between 0.25 and 0.50 mm, 13% were between 0.50 and 1.00 mm, and 2% were more than 1.00 mm from the PC. The greatest amount of decentration was 1.50 mm. The mean decentration was 0.36 mm. The surface regularity index (SRI), which is a measure of the optical performance of the cornea, was significantly less at the sixth postoperative month than at the first postoperative month (P = .013). No correlation between the SRI and the amount of decentration was found. Four main patterns of ablation were noted by differential topographic analysis at the one month interval. A central uniform ablation was present in 45% of eyes; "semicircular ablations" were present in 33% of eyes, a "keyhole" ablation pattern in 12%, and a curious "central bump" ablation pattern in 10%. Corneal topographic analysis was a useful tool for documenting and quantitating results following excimer photorefractive surgery.

Cornea↗

Functional results of posterior chamber lens implantation with scleral fixation.

Recently, scleral fixation has been used in posterior chamber intraocular lens implantation in the absence of the posterior capsule. Fixation is achieved with a suture through the ciliary sulcus and sclera at a horizontal or vertical position. To achieve good functional results, the optical portion of the lens must lie on the optical axis. Unilateral lens implantation in the absence of the posterior capsule was performed with scleral fixation in 48 patients. Follow-up ranged from 14 months to 2.6 years. The position of the posterior chamber lens was defined in relation to the limbus and the pupillary margin. There was no evidence of lens decentration in miosis. Under conditions of extreme mydriasis, decentration of less than 1.0 mm was found in four patients; four others had approximately 1.5 mm of decentration. Magnetic resonance imaging was used to determine lens position in some cases. Scleral fixation is a viable alternative for implantation of posterior chamber lenses in the absence of the posterior capsule.

Adult↗

Computer modeling of visual impairment caused by intraocular lens misalignment.

PURPOSE: To evaluate a computer program to modulate the visual impairment caused by intraocular lens (IOL) misalignment and visualize results obtained by numerical calculations. SETTING: Department of Ophthalmology, Medical Faculty of Charles University, Prague, Czech Republic. METHODS: The optic imagery of a Landolt circle was calculated using a ray-tracing computer program. Visual aberrations resulting from a decentered and/or tilted IOL were studied using this program and compared with theoretical calculations. RESULTS: The IOL decentration and/or tilt shifted the postoperative refractive errors toward myopia and astigmatism (oblique). The combination of IOL decentration and tilt produced a refractive error that depended on the relationship between the geometrical axes of the decentration and tilt. The refractive error can be enhanced or diminished depending on the relationship of these axes. CONCLUSIONS: These findings verify the results calculated by paraxial vergence equations. A ray-tracing program simulated the optic imagery for various kinds of IOL misalignment and IOL optic properties.

Astigmatism↗

Health technology assessment in Sweden.

Sweden has a welfare system that is based on the fundamental principle that all citizens are entitled to good health and medical care, regardless of where they live or what their economic circumstances are. Health and medical care are considered to be public sector responsibilities. However, there is growing interest in establishing more private alternatives to public care. An important characteristic of the Swedish healthcare system is its decentralization, with a major role for county councils. County councils are now merging into larger administrative units (region). The whole Swedish system is in the process of reform, mainly because of perceptions that it was too rigid and had insufficient patient orientation. An important factor in the reforms is that power in the system will be even more decentralized and will have greater public input. This change is seen as calling for increased central follow-up and evaluation of matters such as social, ethical, and economic aspects. Although the state has decentralized control, it still attempts to control the general direction of the system through regulation, subsidy, recommendations, and guidelines. An important actor in the system is the Swedish Council on Technology Assessment in Health Care (SBU). SBU began in 1987 with assessments of health technologies, but its success has recently led policy makers to extend its coverage to dental care. Health technology assessment is increasingly visible to policy makers, who find it useful in decision making.

Delivery of Health Care↗

Synaptic vesicle proteins and neuronal plasticity in adrenergic neurons.

The neurons in the superior cervical ganglion are active in plasticity and re-modelling in order to adapt to requirements. However, so far, only a few studies dealing with synaptic vesicle related proteins during adaptive processes have been published. In the present paper, changes in content and expression of the synaptic vesicle related proteins in the neurons after decentralization (cutting the cervical sympathetic trunk) or axotomy (cutting the internal and external carotid nerves) were studied. Immunofluorescence studies were carried out using antibodies and antisera against integral membrane proteins, vesicle associated proteins, NPY, and the enzymes TH and PNMT. For colocalization studies, the sections were simultaneously double labelled. Confocal laser scanning microscopy was used for colocalization studies as well as for semi-quantification analysis, using the computer software. Westen blot analysis, in situ 3'-end DNA labelling, and in situ hybridization were also employed. After decentralization of the ganglia several of the synaptic vesicle proteins (synaptotagmin I, synaptophysin, SNAP-25, CLC and GAP-43) were increased in the iris nerve terminal network, but with different time patterns, while TH-immunoreactivity had clearly decreased. In the ganglia, these proteins had decreased at 1 day after decentralization, probably due to degeneration of the pre-ganglionic nerve fibres and terminals. At later intervals, these proteins, except SNAP-25, had increased in the nerve fibre bundles and re-appeared in nerve fibres outlining the principal neurons.

Animals↗

Comparative evaluation of plate haptic lenses with smaller and larger positioning holes.

PURPOSE: To evaluate the visual outcome, intraoperative problems and postoperative complications of plate haptic intraocular lenses with smaller foot plate positioning holes and larger holes. METHODS: Fifty eyes of 50 patients underwent clear corneal phacoemulsification with implantation of either small hole plate haptics (25 eyes) or large hole plate haptic lenses (25 eyes). The intraoperative complications were noted and the postoperative parameters were evaluated on the first day, 1 week, 1 month, 3 months, 6 months and 12 months. These included the best corrected visual acuities, intraocular lens (IOL) decentring, diameter of anterior capsulorhexis and posterior capsule opacification. RESULTS: The mean duration of follow-up was 14.8+/-2.1 months in the group with the small foot plate positioning holes (Chiron C10UB) lens and 15.6+/-3.2 months in the group with the large feet plate positioning holes (Chiron C11UB) lens. The was no significant difference in the visual acuities of the two groups. The mean IOL decentring was 0.42+/-0.28 mm in the C10UB lenses and 0.24+/-0.10 mm in the C11UB lenses (P = 0.05). The mean diameter of the anterior capsulorhexis was 4.68+/-0.23 mm in the former, while it was 4.21+/-0.68 mm in the latter (P = 0.0027). The posterior capsule opacification was significantly increased in the C11UB group (P = 0.0298). Neodymium : yttrium aluminium garnet (Nd: YAG) laser capsulotomy was required in 8% of the C10UB group, compared to 28% in the C11UB group. CONCLUSION: Results are similar with the two types of plate haptic lenses. The lenses with larger holes have a significantly higher posterior capsule opacification and more anterior capsulorhexis contracture, although the IOL decentring is less with these lenses.

Aged↗

Diplopia as a complication of laser in situ keratomileusis surgery.

A case is presented of a patient with high myopia who developed vertical binocular diplopia after decentred laser in situ keratomileusis (LASIK) surgery with associated decompensation of pre-existing exophoria into an exotropia. A 40-year-old man underwent LASIK surgery for high myopia in his right eye. Preoperatively, he was approximately -26.00/-2.00 x 35 degrees with visual acuity of 6/12(-2) in that eye. He also had an asymptomatic exophoria. After LASIK surgery, he achieved a refraction of -3.25/-0.50 x 80 degrees with 6/21 best-corrected visual acuity. He also developed binocular diplopia. The ablation zone had been decentred upwards and there was also an exo- and hypo-deviation of his right eye. He was able to superimpose the two images in free space with vertical and horizontal prisms.A hard contact lens also resulted in superimposition of the two images. Vertical decentration of the ablation zone can induce a vertical prism effect after LASIK surgery and result in vertical diplopia. This together with abnormal optics also caused loss of best-corrected vision and decompensation of his pre-existing exophoria into an exotropia.

Adult↗

Effect of catecholamine depletion and denervation on neuropeptide Y(NPY) and tyrosine-hydroxylase (TH) mRNA levels in rat sympathetic ganglia.

Neuropeptide Y (NPY) and noradrenaline (NA) are synthesized and stored in sympathetic nerves and concomitantly released in response to appropriate stimuli. The two substances have been reported to interact on various levels: postjunctionally, by mutually potentiating their vasoconstrictor effects, prejunctionally, by inhibiting each other's release. The possibility of an interaction on the levels of their synthesis was investigated in this study. Specific cDNA probes were used for the measurement of the steady state levels of the mRNAs encoding prepro-NPY and tyrosine hydroxylase (TH) in the superior sympathetic cervical and stellate ganglia of rats. Reserpine (5 mg/kg) was administered for inducing catecholamine depletion. This caused a large decrease in the NA content of the heart associated with an about 50% reduction in cardiac NPY levels. Ganglionic NPY and TH mRNA levels increased 3-6 fold as compared to vehicle treated animals. To determine whether this effect was due to transynaptic induction, superior cervical ganglia were decentralized in a subgroup of rats. Decentralized ganglia displayed significantly lower NPY and TH mRNA levels than intact ones. The response to reserpine was almost completely prevented by decentralization. These Observations indicate that the activation of gene expression of NPY and TH by reserpine depends on intact ganglionic innervation and is therefore reflexly mediated. Trans-synaptic induction may regulate NPY and TH mRNA levels also under basal conditions.

Animals↗

Alternative models of delivery of anticoagulant services.

The dramatic increase in patients on oral anticoagulants in the last decade has led to the development of alternative models of anticoagulant care delivery. Some degree of decentralization is desirable to maintain the efficiency and quality of the anticoagulant control service. One effective model, which has relatively few resource implications, is the decentralized system whereby patients have blood drawn in the general practice premises but analysis and dosing is still performed by the hematology department, a model that provides increased efficiency while maintaining the standards of clinical care. The use of computerized decision support systems has been central to the decentralization process and has led to improvements in quality of service in hospitals and the primary-care setting. Regardless of the model adopted, it is important to follow clinical guidelines, take part in external quality-control, and perform regular audits to assess the delivery of the service.

Anticoagulants↗

[Calculating the localization and dimension of the real pupil in keratoconus with ray tracing of corneal topography data].

BACKGROUND: It is crucial to center surgical procedures for optical indications on the pupil or the optical axis of the eye. In keratoconus the pupil appears to be dislocated due to optical aberrations of corneal topography. The purpose of this study was to evaluate the real pupil structure from the virtual image using exact raytracing techniques. PATIENTS AND METHODS: Eighty-eight patients with keratoconus (46 with mild and 42 with severe clinical signs) and a control group of 40 normal subjects were included in this study. Topographic height data were calculated from refraction data of a commercially available topographer (TMS-1) using a local approximation algorithm and a convex surface was modelled using a subdivision scheme. For the posterior corneal surface we postulated an aspherical surface with a central radius of curvature of 6.5 mm using Navarro's model eye. At the virtual pupil outline a bundle of parallel rays were intersected with the anterior and posterior corneal surface and refracted into the anterior chamber. The intersections of these rays with the pupil plane was defined as the real pupil outline. We assessed the amount and direction of pupil dislocation, the ratio between the virtual and real pupil size for each group and correlated these parameters with the central corneal power. RESULTS: The size of the virtual pupil exceeded the reference value of the real pupil in the normal group by 11%, in the group with mild keratoconus by 19% and in the group with severe keratoconus by 35%. The center of the virtual pupil was decentered 0.06 mm in the normal group, 0.49 in the group with mild keratoconus and 1.24 mm in the group with severe keratoconus. Whereas the direction of decentration was randomly in the normal group, we measured a preferred decentration to the inferior quadrants in mild keratoconus and a systematic decentration to the temporal inferior quadrant in severe keratoconus. Correlation of the optical dislocation did not correlate with central corneal power in any group. CONCLUSIONS: In keratoconic eyes the pupil outline is distorted and dislocated due to optical aberrations of the cornea. Exact raytracing technique allows the calculation of the real pupil outline from the virtual image and the topographic height of both corneal surfaces. Knowledge about the real pupil position may have an impact on adequate centration of keratorefractive surgery and penetrating keratoplasty.

Adult↗

Rapid recovery of function after partial denervation of the rat pineal gland suggests a novel mechanism for neural plasticity.

The activity of serotonin N-acetyltransferase (NATase) in the rat pineal gland exhibits a large (approximately 100-fold) circadian variation, with peak activity occurring in the dark part of the light/dark cycle. Surgical removal of both superior cervical ganglia abolishes this rhythm in enzyme activity. Unilateral ganglionectomy caused a 75% decrease in NATase activity during the dark period immediately following the operation; however, by the subsequent dark period (32 hr after operation) the rhythm in NATase activity had returned to normal. Similar results were found after the internal carotid nerve was cut, and data are presented indicating that this is the postganglionic trunk by which sympathetic neurons reach the pineal gland. Denervation of one superior cervical ganglion (unilateral "decentralization") also produced a 75% decrease in NATase activity during the dark period immediately following the operation; however, after decentralization, enzyme activity did not return to normal in subsequent cycles. It is hypothesized that this recovery is due to loss of norepinephrine uptake sites in the degenerating sympathetic nerve terminals. As a result of decreased norepinephrine uptake, the effectiveness of the norepinephrine released by surviving neurons may be enhanced. This hypothesis is supported by experiments in which pharmacological blockade of norepinephrine uptake in unilaterally decentralized animals increased NATase activity to control levels. We propose that neural systems which use transmitter uptake as the mechanism of transmitter inactivation have a built-in "reserve stimulatory capacity."

Acetyltransferases↗

Work redesign and role restructuring in a pharmacy department with pharmacist assistants.

A new staffing model for decentralized pharmacists and support staff at a university hospital is described. A new technical support position--the pharmacist assistant--was created, and activities were reallocated among the pharmacists, pharmacist assistants, and pharmacy technicians according to the recommendations of two total quality management teams. Pharmacist assistants were to perform many of the drug distribution and record-keeping functions previously performed by pharmacists. The activities marked for reallocation accounted for about 50% of pharmacist time in the existing staffing model; they would not be performed by experienced pharmacy technicians who received brief training to be pharmacist assistants. Nine pharmacists and nine technicians tested the new staffing model on four patient care units over a four-week period. The reassignment of pharmacist tasks to pharmacist assistants theoretically gave pilot-unit pharmacists more time for providing and documenting patient-specific clinical activities and an additional 12 hours a week to participate in such global patient care activities as critical-pathway and quality improvement meetings. By the end of the study, the pharmacist assistants demonstrated that they could perform the reassigned activities; however, the pharmacists were not yet confident in the assistants' ability to do so. A pilot study of a new decentralized pharmacy staffing model demonstrated that technical support personnel can perform many distributive and record-keeping activities traditionally performed by decentralized pharmacists.

Hospital Restructuring↗

Optical performance of decentered bifocal contact lenses.

Contact lenses frequently do not center over the pupil. The potential changes in optical performance introduced by poor centration of bifocal contact lenses have only been described previously from theoretical considerations. The present study measured the modulation transfer function (MTF) of rigid concentric-design refractive and rigid diffractive bifocal contact lenses with varying apertures and amounts of decentration. Decentration was shown to have a greater effect on the MTF of the refractive than on the MTF of the diffractive bifocals. The MTF of the refractive bifocals was related to the proportion of the aperture covered by the central optic zone (COZ). Unexpectedly, the MTF of the distance focus of the diffractive bifocal contact lenses was reduced at moderately high spatial frequencies. The practitioner should be aware of the effects of decentration of bifocal contact lenses.

Contact Lenses↗