Evaluation of polymerization in fluoride-containing composite resins

Fluoride-containing restorative materials are frequently utilized to delay or inhibit caries. The quality of the fluoride-containing composite resins was evaluated by testing their microhardness, polymerization shrinkage, thermal expansion coefficient, and surface morphology. Some of them were evaluated in conjunction with the thermocycling process. The microhardness values of the thermocycled specimens were similar to those of the specimens immersed only in distilled water. Among the specimens, Surefil showed the highest (68.6 +/- 1.2 Hv) value. A linear correlation was found between microhardness and the filler content (vol%) of the specimens regardless of their states. Polymerization shrinkage rapidly increased during the light curing, and then it reached a plateau. The shrinkage values increased as the specimens became thicker. In a temperature range of 30 approximately 80 degrees C, the coefficients of thermal expansion of the control specimens ranged between 43 x 10(-6)/ degrees C and 77 x 10(-6)/ degrees C. An inverse correlations were observed between the filler content (vol%) and the coefficient of thermal expansion and between microhardness and the coefficient of thermal expansion of the control specimens. Tetric Ceram showed a perforated or "Swiss-cheese" morphology after thermocycling. It was unique and occurred only in this product.

Photodetection of basal cell carcinoma using methyl 5-aminolaevulinate-induced protoporphyrin IX based on fluorescence image analysis

BACKGROUND

The preferential accumulation of 5-aminolaevulinic acid (ALA)-induced protoporphyrin IX (PpIX) in neoplastic cells supports its potential use in the photodetection of porphyrin fluorescence in tumour cells. Hence, epithelial tumours, including basal cell carcinoma (BCC), might be visualized using the fluorescence of selectively accumulated ALA-induced PpIX.

AIM

In this study, we evaluated the clinical efficacy of PpIX fluorescence images using fluorescence image analysis (FIA) to define the lateral border between the tumour and tumour-free areas of facial BCC.

METHODS

FIA was used to define the lateral border between the tumour and tumour-free areas on red fluorescence images induced by the topical application of methyl 5-aminolaevulinate (MAL) ointment. According to the FIA results, 50 tissue samples, obtained from 10 patients with BCC, were divided into three categories: tumour area (n = 10), suspected tumour area (n = 20) and suspected tumour-free area (n = 20). These tissue samples were evaluated by histopathological examination. The FIA tool marked out the PpIX fluorescence image for defining the lateral border between the BCC tumour and tumour-free areas.

RESULTS

The rate of tumour detection from BCC lesions using PpIX fluorescence with the FIA tool showed a sensitivity of 94.1% and specificity of 82.6%.

CONCLUSION

These results suggest that MAL-induced PpIX fluorescence imaging using FIA is quite sensitive and specific for detecting tumour and occult tumour in facial BCC lesions. This method of presurgical in vivo imaging is therefore proposed as a useful tool for defining the lateral border between BCC tumour and tumour-free areas.

Effect of low-level laser treatment after installation of dental titanium implant-immunohistochemical study of RANKL, RANK, OPG: An experimental study in rats

BACKGROUND AND OBJECTIVES

This experiment using an animal experimental model was conducted in order to investigate the effect of low-level laser therapy (LLLT) on the healing of the dental titanium implant.

STUDY DESIGN/MATERIALS AND METHODS

The experimental group received LLLT for a week and the control group did not. Each group consisted of 10 rats. Two rats from the groups were euthenized on the days 1, 3, 7, 14, and 21 of the experiment. The expression of receptor activator of nuclear factor kB ligand (RANKL), osteoprotegerin (OPG), and receptor activator of nuclear factor kB (RANK) were investigated.

RESULTS

The expression of RANKL was observed from the initial stage of the installation of the implant for both the experimental and control groups. However, the degree of expression was higher in the experimental group. The degree of expression of OPG increased remarkably in the experimental group, while in the control group the degree of expression increased only slightly. In the experimental group, the expression of RANK was observed from the first day, but in the control group, it was weakly observed after day 3. The overall expression within the bone was slight on day 7 in the control group, while an active expression was observed in the experimental group. Bone density after installation of dental titanium implant during osseointegration in the experimental group was higher than the control group. The surface and structure of the titanium implant was not damaged by low-level laser (LLL).

CONCLUSIONS

From the above results, the expression of OPG, RANKL, and RANK during the osseointegration of the dental titanium implant was observed within bone tissue. The application of the LLL influenced the expression of OPG, RANKL, and RANK, and resulted in the expansion of metabolic bone activity and increased the activity of bone tissue cells.

Mineral loss from bovine enamel by a 30% hydrogen peroxide solution

This study investigated the effect of a 30% hydrogen peroxide bleaching agent on bovine enamel in terms of mineral loss. Contents of mineral elements both in the teeth and bleaching agent were evaluated to estimate the effect of hydrogen peroxide on teeth. Finely polished non-carious bovine incisors (n = 5) were immersed in a 30% hydrogen peroxide solution for 120 h. The amounts of concentrated elements in the bleaching agent (5 mL) were measured using inductively coupled plasma-atomic emission spectrometer and ion chromatograph. The contents of mineral elements in the teeth were measured using an electron probe microanalyzer. The Ca/P ratio in the bleaching agent was approximately 1.99. The amount of Zn in the bleaching agent was below the detection limit. The total content of mineral elements of the unbleached enamel (90.75 +/- 1.58) was slightly greater than that of the bleached enamel (87.44 +/- 0.77). The Ca/P ratio of the bleached enamel was 2.06. The amount of Ca loss from the bleached enamels after 120 h was similar to the amount of Ca loss from teeth exposed to a soft drink or juice for a few minutes. Therefore, mineral loss caused by the bleaching process may not be a threatening factor to teeth.

Intraocular pressure measurement in mice: a comparison between Goldmann and rebound tonometry

PURPOSE

The development of mouse models of glaucoma requires methods to accurately measure the intraocular pressure (IOP) in this species. The aim of this study was to compare the accuracy of IOP measurements in mice between modified Goldmann and rebound tonometers.

METHODS

IOP was measured either with a modified Goldmann or a rebound tonometer while simultaneously measuring the IOP using invasive manometry in enucleated eyes and in vivo. The level of IOP was controlled hydrostatically. The agreement and correlation between the IOP determined by invasive manometry and by either noninvasive method was evaluated. In addition, the IOP was determined by both noninvasive methods in a cohort of mice with laser-induced ocular hypertension (OHT), and the agreement and correlation between the two tonometry methods were evaluated.

RESULTS

Measured IOP by either noninvasive tonometer correlated well with those recorded simultaneously by invasive manometry (r=0.98 for rebound and r=0.94 for Goldmann). In mice with OHT, the IOP correlation between rebound and modified Goldmann was moderate (r=0.71); the IOP measured by modified Goldmann tonometry was consistently higher than that by rebound by approximately 5 mmHg. However, the relative per cent increases in IOP were similar between the two methods.

CONCLUSION

Both noninvasive methods of IOP measurements in mice are suitable to detect changes in IOP although rebound tonometry correlated better with the invasive manometry readings. The results suggest that the relative, rather than absolute, IOP offers a more reliable means of correlating findings from studies using different tonometers.

Longitudinal fMRI study for locomotor recovery in patients with stroke

The authors investigated bihemispheric motor network reorganization supporting locomotor recovery after stroke over time. They determined longitudinal changes in locomotor function and fMRI in 10 stroke patients at the subacute stage and the chronic stage. The results suggest that the bihemispheric reorganization mechanism underlying locomotor recovery evolved from the ipsilateral (contralesional) primary sensorimotor cortex (SM1) activation at the subacute stage to the contralateral (ipsilesional) SM1 activation at the chronic stage.

Neural Progenitor Cell Transplants into the Developing and Mature Central Nervous System

When developing cell transplant strategies to repair the diseased or injured central nervous system (CNS), it is essential to consider host-graft interactions and how they may influence the outcome of the transplants. Recent studies have demonstrated that transplanted neural progenitor cells (NPCs) can differentiate and integrate morphologically into developing mammalian retinas. Is the ability to differentiate and to undergo structural integration into the CNS unique to specific progenitor cells, or is this plasticity a function of host environment, or both? To address these issues we have used the developing retina of the Brazilian opossum and have compared the structural integration of brain and retinal progenitor cells transplanted into the eyes at different developmental stages. The Brazilian opossum, Monodelphis domestica, is a small pouchless marsupial native to South America. This animal's lack of a pouch and fetal-like nature at birth circumvents the need for in utero surgical procedures, and thus provides an ideal environment in which to study the interactions between developing host tissues and transplanted NPCs. To test whether NPCs affect visual function we transplanted adult hippocampal progenitor cells (AHPCs) into normal, healthy adult rat eyes and performed noninvasive functional recordings. Monitoring of the retina and optic nerve over time by electroretinography and pupillometry revealed no severe perturbation in visual function in the transplant recipient eyes. Taken together, our findings suggest that the age of the host environment can strongly influence NPC differentiation and that transplantation of neural progenitor cells may be a useful strategy aimed at treating neurodegeneration and pathology of the CNS.

Vitreous and retinal amino acid concentrations in experimental central retinal artery occlusion in the primate

PURPOSE

Vitreous and retinal amino-acid concentrations were evaluated in a primate model of central retinal artery occlusion (CRAO) to study the role of glutamate excitotoxicity in acute retinal ischaemia.

METHODS

Unilateral, acute CRAO was produced by temporary clamping of the central retinal artery for 190 min in four elderly rhesus monkeys. Fundus photography, fluorescein angiography, and electroretinogram were performed before and during CRAO, and after unclamping the artery. Vitreous samples were obtained before and after CRAO in both eyes, and analysed for 13 amino-acid concentrations using high-pressure liquid chromatography. The animals were killed 350 min after retinal reperfusion, and the retinal tissue was submitted for amino-acid analysis.

RESULTS

In all four eyes, the macula showed the 'cherry red spot'. The CRAO was confirmed by fluorescein angiography and decreased b-wave on electroretinogram. Retinal histology confirmed ischaemic changes in the inner retina. Changes in all 13 vitreous amino-acid concentrations after CRAO (including glutamate) were not significantly different between study and control eyes (P = 0.09 to 0.82). All retinal amino-acid concentrations (including glutamate) were not significantly different between two eyes (P = 0.07-0.93).

CONCLUSIONS

In the primate model of acute inner retinal ischaemia induced by transient CRAO, we were unable to detect significantly elevated concentrations of vitreous and retinal glutamate. Our primate model has the advantage of closely modelling the CRAO in humans. Further basic and clinical studies are needed to elucidate the role of glutamate excitotoxicity in retinal ischaemia.

The effect of 30% hydrogen peroxide on the color of compomers

The interaction between bleaching agents and recently introduced compomers has several issues that need to be explored, including morphology and mechanical properties. To investigate the effect of 30% hydrogen peroxide, a bleaching agent, on the color of compomers, three compomers (Compoglass F, Elan, and F2000) were polymerized, bleached up to 120 h, and then measured to determine the reflectance of the specimen during the bleaching process. Color differences were evaluated from the reflectance and color values that were represented by CIE L*a*b* values. Compomers stored in distilled water were used as a source of reference. Teeth were also used for comparison. Color differences for both the tested teeth and compomers and different periods of bleaching and soaking in distilled water showed statistically significant difference (p < 0.0001). Among the tested compomers, Compoglass F demonstrated the highest color difference. In addition, the color differences were maximal during the first 24 h. After 24 h, the color difference increased nearly linearly. Compomers stored in both a bleaching agent and distilled water did not exhibit much color difference between them. However, the color difference between teeth and compomers was considerable.

Cysteine metabolism in periportal and perivenous hepatocytes: perivenous cells have greater capacity for glutathione production and taurine synthesis but not for cysteine catabolism

Hepatocyte preparations highly enriched in cells from either the periportal or the perivenous zone of the liver acinus were prepared using a digitonin/collagenase perfusion method. Five enzymes of cysteine metabolism were assayed in both periportal and perivenous preparations. The ratios of periportal to perivenous activity were 0.76, 0.60, 0.81, 1.62, and 1.01 for cysteine dioxygenase, cysteinesulfinate decarboxylase, gamma-glutamylcysteine synthetase, cystathionase, and asparate (cysteinesulfinate) aminotransferase, respectively. Only cysteinesulfinate decarboxylase activity was significantly different between periportal and perivenous cells. In incubations with 2 mmol/L [(35)S]cysteine, total cysteine catabolism ([(35)S]taurine plus [(35)S]sulfate) between periportal and perivenous cells was not different, which is consistent with the observation of similar cysteine dioxygenase activity across the hepatic acinus. Consistent with the lower cysteinesulfinate decarboxylase activity in periportal cells, 16% of the total catabolism of [(35)S]cysteine in periportal cells resulted in taurine synthesis compared to 28% in perivenous cells. A lower rate of [(35)S]glutathione synthesis was observed in periportal cells compared to perivenous cells, but gamma-glutamylcysteine synthetase activity was not significantly different between perivenous and periportal cells. Cysteinesulfnate decarboxylase can be added to the list of enzymes whose activities are markedly enriched in perivenous cells.

Effect of bleaching agents on the fluoride release and microhardness of dental materials

The use of bleaching agents has become a popular procedure for whitening teeth. Recently introduced polyacid-modified composite resins (compomers) have several favorable features, such as improved physical properties and fluoride release. Because these two materials have many possibilities to interact in the oral cavity during dental treatment, it is necessary to understand such interaction. To evaluate the effect of a bleaching agent on dental restoratives, three compomers were photopolymerized and then bleached for 1, 2, 3 and 5 days with the use of 30% hydrogen peroxide. Fluoride release, surface microhardness, and surface modifications were evaluated. It was found that the cumulative fluoride release was found to be linearly correlated to the tested periods of bleaching in all compomers. Among the tested compomers, F2000 showed the highest cumulative fluoride release. Bleached compomers became soft because of surface degradation, so the surface microhardness decreased. F2000 showed an apparent crack formation that was not observed in other compomers. The nearly linear correlation between the filler content and microhardness was found in the control samples. However, the same correlation was not observed after the compomers were stored in a bleaching agent or distilled water.

Effects of hydrogen peroxide on the light reflectance and morphology of bovine enamel

The purpose of this study was to examine the effects of a bleaching agent (30% hydrogen peroxide) on the surface of bovine enamel using a scanning electron microscope and a UV-VIS-NIR spectrophotometer. Five non-carious bovine incisors were bleached for 0, 1, 2 and 3 days using 30% hydrogen peroxide. The light reflectance spectrum was measured using a spectrophotometer with diffuse reflectance mode. Colour values and colour differences in the teeth were evaluated from the reflectance measurements with the CIE L*a*b* colour coordinate system. Surface alterations in the bleached and unbleached teeth were studied using a scanning electron microscope. The change of reflectance in the teeth was related to the change of colour. Most reflectance change occurred within a 1-day bleaching, and this result was confirmed by a CIE L*a*b* colour coordinate system. The colour differences in the bleached teeth were significant enough to be perceived by the observer's eye. The comparison of bleached to unbleached bovine enamel revealed that the bleached surface showed non-uniform slight morphological alterations, and it developed varying degrees of surface porosity. This study indicates that the bleached bovine teeth showed apparent colour differences as well as slight morphological alterations after bleaching.

Post-transcriptional regulation of cysteine dioxygenase in rat liver

Changes in hepatic cysteine dioxygenase (CDO) activity in response to diet play a dominant role in regulation of cysteine catabolism and taurine synthesis. We have conducted several studies of the molecular regulation of CDO activity in rat liver and rat hepatocytes. Compared to levels observed in liver of rats fed a basal 10% casein diet, up to 180-fold higher levels of CDO activity and protein were observed in liver of rats fed diets that contained additional protein, complete amino acid mixture, methionine, or cystine. Neither CDO activity nor CDO protein was induced by excess non-sulfur amino acids alone. Excess sulfur amino acids or protein did not significantly increase the concentration of hepatic CDO mRNA. Preliminary studies indicate that the polysome profile for association of CDO mRNA with polysomes is not altered by an increase in dietary protein level, suggesting that regulation may be posttranslational and possibly involve a decrease in the rate of CDO degradation. In primary cultures of rat hepatocytes, CDO mRNA, protein, and activity all virtually disappeared by 12 to 24 h of culture in standard medium whereas CDO protein, but not CDO mRNA, accumulated markedly between 12 and 24 h in hepatocytes cultured in medium with excess methionine or cyst(e)ine. These observations are also consistent with a limited role of transcriptional or translational regulation of CDO in response to diet.

Rate of visual field loss and long-term visual outcome in primary open-angle glaucoma

PURPOSE

To evaluate long-term visual field outcome in primary open-angle glaucoma.

METHODS

In this retrospective cohort study, 40 eyes of 40 patients with primary open-angle glaucoma with elevated intraocular pressure and a minimum of 8-year longitudinal series of visual fields were plotted with Goldmann perimeter. Eyes with any other ocular disease except cataract were excluded. Manual grid templates were used to quantify the visual fields. Linear regression was performed to estimate the rate of visual field decline. Pertinent clinical factors were evaluated for statistical association with the rate of decline. Long-term clinical outcome including visual acuity, rate of legal blindness, and rate of medical and surgical interventions was also measured.

RESULTS

In the 40 eyes studied, with a mean follow-up of 14 years, the visual field score decreased at the rate of -1.5% per year. Overall, 68% showed significant decrease, and the rate of decrease among these eyes was -2.1% per year. Five eyes became legally blind from glaucoma; the cumulative rate of blindness from glaucoma was 19% at 22 years. Higher intraocular pressure and greater number of antiglaucoma medications on initial presentation were associated with faster and slower deterioration of visual field (compared with the average), respectively.

CONCLUSIONS

With standard glaucoma therapy, the rate of visual field loss in primary open-angle glaucoma is slow. Lower intraocular pressure and more antiglaucoma medications are associated with slower visual field decline. Legal blindness from glaucoma is 19% over a follow-up of 22 years.

Cysteine regulates expression of cysteine dioxygenase and gamma-glutamylcysteine synthetase in cultured rat hepatocytes

Rat hepatocytes cultured for 3 days in basal medium expressed low levels of cysteine dioxygenase (CDO) and high levels of gamma-glutamylcysteine synthetase (GCS). When the medium was supplemented with 2 mmol/l methionine or cysteine, CDO activity and CDO protein increased by >10-fold and CDO mRNA increased by 1.5- or 3.2-fold. In contrast, GCS activity decreased to 51 or 29% of basal, GCS heavy subunit (GCS-HS) protein decreased to 89 or 58% of basal, and GCS mRNA decreased to 79 or 37% of basal for methionine or cysteine supplementation, respectively. Supplementation with cysteine consistently yielded responses of greater magnitude than did supplementation with an equimolar amount of methionine. Addition of propargylglycine to inhibit cystathionine gamma-lyase activity and, hence, cysteine formation from methionine prevented the effects of methionine, but not those of cysteine, on CDO and GCS expression. Addition of buthionine sulfoximine to inhibit GCS, and thus block glutathione synthesis from cysteine, did not alter the ability of methionine or cysteine to increase CDO. GSH concentration was not correlated with changes in either CDO or GCS-HS expression. The effectiveness of cysteine was equivalent to or greater than that of its precursors (S-adenosylmethionine, cystathionine, homocysteine) or metabolites (taurine, sulfate). Taken together, these results suggest that cysteine itself is an important cellular signal for upregulation of CDO and downregulation of GCS.

Cysteine dioxygenase and gamma-glutamylcysteine synthetase activities in primary cultured hepatocytes respond to sulfur amino acid supplementation in a reciprocal manner

Hepatocytes were cultured for 3 days as spheroids (aggregates) or as monolayers in basal medium and in sulfur amino acid-supplemented media. Cultured hepatocytes had low levels of cysteine dioxygenase (CDO) activity and normal levels of gamma-glutamylcysteine synthetase (GCS) and cysteine-sulfinate decarboxylase (CSDC) activities compared to freshly isolated cells. CDO activity increased and GCS activity decreased in a dose-response manner in cells cultured in either methionine- or cysteine-supplemented media. CSDC activity was not significantly affected by methionine supplementation. Changes in CDO and GCS were associated with changes in cysteine catabolism to taurine plus sulfate and in synthesis of glutathione, respectively. These responses are similar to those observed in liver of intact rats fed diets supplemented with sulfur amino acids. A near-maximal response of CDO or GCS activity was observed when the medium contained 1.O mmol/L of methionine plus cyst(e)ine. Changes in CDO and GCS activities did not appear to be mediated by changes in the intracellular glutathione concentration. Cultured hepatocytes offer a useful model for further studies of cysteine metabolism and its regulation in response to sulfur amino acid availability.

Long-term results of eyes with penetrating keratoplasty and glaucoma drainage tube implant

PURPOSE

To present long-term results of eyes with penetrating keratoplasty (PK) and glaucoma tube implant.

DESIGN

Retrospective, noncomparative, interventional case series.

PARTICIPANTS

We retrospectively reviewed medical records of all patients who underwent both PK and glaucoma tube implant (Baerveldt or Ahmed) at the University of Iowa between July of 1988 and December of 1997 (55 eyes).

METHODS

Success of the tube implant or PK was evaluated using Kaplan-Meier survival analysis. Association of relevant clinical factors with glaucoma or corneal graft outcome was evaluated using log-rank test or Cox proportional hazard regression analysis. The factors evaluated were glaucoma and cornea diagnoses; prior, simultaneous, and subsequent surgeries; type of tube implant; relative timing of surgeries; and postsurgical complications.

MAIN OUTCOME MEASURES

Glaucoma outcome was assessed by postoperative intraocular pressure (IOP), number of medications, and need for further glaucoma surgery. Corneal outcome was assessed by graft rejection, failure, and Snellen visual acuity. Surgical procedures before and during the study period, and their complications were evaluated.

RESULTS

The mean preoperative intraocular pressure was 29.8 mmHg with an average of 2.9 medications. At last postoperative follow-up, the mean IOP decreased to 14.3 mmHg with 0.7 medication. The tube implant successfully controlled glaucoma in 45 eyes (82%) at 3 years. More severe postsurgical complications were associated with greater glaucoma failure. Graft rejection occurred in 17 eyes, and 7 of these progressed to failure. Nonimmunologic graft failure occurred in an additional 17 eyes (31%). The remaining 31 eyes (56%) had a clear graft. The corneal grafts remained clear in 70% and 55% of eyes at 2 and 3 years, respectively. Corneal graft failure was associated with glaucoma and cornea diagnoses groups, type of tube implant, and relative timing of the two surgeries. Complications occurred in 23 eyes (42%), and 10 of these were serious.

CONCLUSIONS

A drainage tube implant can successfully control glaucoma in a majority (82%) of keratoplasty eyes at 3 years. However, the success of corneal grafts is low (55%) at 3 years. Postsurgical complications are not uncommon and are associated with poor glaucoma outcome. Other clinical factors are associated with poor graft outcome.

Non-secretion of mutant proteins of the glaucoma gene myocilin in cultured trabecular meshwork cells and in aqueous humor

Until recently, very little was known about the molecular mechanisms responsible for the development of glaucoma, a leading cause of blindness worldwide. Mutations in the glaucoma gene myocilin (MYOC, GLC1A) are associated with elevated intraocular pressure and the development of autosomal dominant juvenile glaucoma and a subset of adult-onset glaucoma. MYOC is expressed in the trabecular meshwork (TM), a tissue responsible for drainage of aqueous humor from the eye, and the tissue involved in elevated intraocular pressure associated with glaucoma. To better understand the role of MYOC in glaucoma pathogenesis, we examined the expression of normal and mutant myocilin in cultured ocular (TM) and non-ocular cells as well as in the aqueous humor of patients with and without MYOC glaucoma. Normal myocilin was secreted from cultured cells, but very little to no myocilin was secreted from cells expressing five different mutant forms of MYOC. In addition, no mutant myocilin was detected in the aqueous humor of patients harboring a nonsense MYOC mutation (Q368X). Co-transfection of cultured cells with normal and mutant myocilin led to suppression of normal myocilin secretion. These studies suggest that MYOC glaucoma is due either to insufficient levels of secreted myocilin or to compromised TM cell function caused by congestion of the TM secretory pathway.

Correlation of automated visual field parameters and peripapillary nerve fiber layer thickness as measured by scanning laser polarimetry

PURPOSE

To correlate Humphrey visual field mean sensitivity and peripapillary nerve fiber layer thickness as measured by scanning laser polarimetry.

METHODS

The authors studied 54 eyes of 34 patients who visited a university-based glaucoma clinic and had undergone scanning laser polarimetry and Humphrey perimetry within 6 months. The study population included normal patients and those with glaucoma, ocular hypertension, and glaucoma suspect. The authors correlated visual field sensitivity with peripapillary nerve fiber thickness, and visual field mean deviation with the average deviation from the normal nerve fiber layer thickness. They also correlated the visual field mean deviation with all available GDx Nerve Fiber Analyzer parameters.

RESULTS

The visual field mean sensitivity and deviation showed a bilinear correlation to peripapillary nerve fiber layer thickness. The visual field mean sensitivity changed little when the nerve fiber layer thickness was greater than 70 microm. The nerve fiber layer thickness below this level was associated with a rapid decrease in the visual field sensitivity. Similarly, the visual field mean deviation was close to 0 dB when the nerve fiber layer was within -10 microm of the normal value; below this thickness, the mean deviation became substantially more negative. There was a large individual variability around the bilinear fit. Of the scanning laser polarimetry parameters, a calculated index, referred to as the number, had the highest correlation with the Humphrey mean deviation.

CONCLUSION

The bilinear correlation and its variability between the scanning laser polarimetry and visual field parameters make it difficult to predict the result of one from the other. In general, the correlation between the two is better when there is a significant visual field defect than when the visual field is close to normal.

Apparent central nervous system depression in infants after the use of topical brimonidine

PURPOSE

To report two cases in which topical brimonidine resulted in apparent central nervous system depression and unresponsiveness in an infant.

METHODS

Review of two patients. An 11-day-old infant became lethargic and apneic after a single drop of brimonidine. These symptoms were reproduced after a second administration of brimonidine. A 5-month-old infant became lethargic and poorly responsive after receiving 1 drop of brimonidine in each eye.

RESULTS

The first patient required admission to the hospital for medical stabilization. He recovered without sequelae. The second patient recovered spontaneously approximately 2.5 hours after administration of brimonidine.

CONCLUSIONS

Topical brimonidine may be associated with central nervous system depression in infants. The use of brimonidine is not recommended in these patients until further data are available.

Orbital melanoma presenting as orbital cellulitis: a clinicopathologic report

Most choroidal melanomas are diagnosed when the tumor is still relatively small and confined to the globe. Rarely, these tumors can escape detection and extend through the sclera. They can reach a large size and create significant orbital inflammation. The authors describe a 71-year-old man with orbital cellulitis secondary to a necrotic choroidal melanoma that invaded the orbit. This tumor had minimal intraocular involvement with a large extrascleral component. On histopathologic analysis, the lesion was best classified as a spindle B melanoma with epithelioid areas (mixed melanoma). The patient was treated with an enucleation and postoperative radiation. This report demonstrates that malignancies in the orbit can present as acute infections. Early suspicion, diagnosis, and treatment of these lesions offer the best chance for survival.

Test-retest variability of blue-on-yellow perimetry is greater than white-on-white perimetry in normal subjects

PURPOSE

To compare long-term fluctuation of blue-on-yellow automated perimetry with white-on-white automated perimetry in normal subjects.

METHODS

White-on-white and blue-on-yellow automated perimetry were performed on a Humphrey Visual Field Analyzer and an Octopus perimeter, both modified for blue-on-yellow perimetry. The study sample consisted of 31 eyes of 31 normal subjects for the Humphrey perimeter and 33 eyes of 33 normal subjects for the Octopus perimeter. After one practice session, each subject completed four testing sessions over a period of 2 to 8 weeks, each separated by at least 1 day. Each testing session consisted of both white-on-white and blue-on-yellow perimetry performed on one eye; the order of the tests was alternated for successive sessions. Long-term fluctuation (expressed as statistical variance) was calculated for each test location. Intersubject variability (expressed as statistical variance) across all subjects was determined for each test location.

RESULTS

On the Humphrey perimeter, the long term fluctuation for blue-on-yellow perimetry (4.07 +/- 3.07 dB2) was significantly greater than that for white-on-white perimetry (1.97 +/- 0.99 dB2; P < .001). Long-term fluctuation increased as a function of eccentricity for both blue-on-yellow and white-on-white perimetry. Short-term fluctuation was significantly greater for blue-on-yellow (0.46 +/- 0.25 dB) than that for white-on-white perimetry (0.29 +/- 0.19 dB; P < .02). Finally, the intersubject variability was significantly greater in blue-on-yellow (13.2 +/- 2.8 dB2) than it was in white-on-white perimetry (4.25 +/- 1.13 dB2; P < .001). Similar results were found with the Octopus perimeter.

CONCLUSIONS

Long-term fluctuation and short-term fluctuation of blue-on-yellow perimetry are greater than those of white-on-white perimetry in normal subjects. The increased long-term fluctuation requires appropriate statistical approaches when evaluating serial change of blue-on-yellow perimetry.

Temporal corneal phacoemulsification in patients with filtered glaucoma

OBJECTIVE

To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that underwent prior trabeculectomy.

DESIGN

Retrospective case-control study.

PATIENTS

Forty consecutive patients who underwent temporal clear corneal phacoemulsification subsequent to trabeculectomy (trabeculectomy-phacoemulsification group) were identified, and 40 control patients who underwent trabeculectomy alone (trabeculectomy group) were matched to the case patients for length of follow-up, age, IOP, number of antiglaucoma medications, number of 5-fluorouracil injections, race, sex, and diagnosis.

MAIN OUTCOME MEASURES

Intraocular pressure before vs 1 year after phacoemulsification in the trabeculectomy-phacoemulsification group compared with IOP in the trabeculectomy group and survival analysis of IOP control after trabeculectomy in the 2 groups.

RESULTS

In the trabeculectomy-phacoemulsification group, IOP 1 year after phacoemulsification was not significantly different from the prephacoemulsification IOP value (P = .65). Kaplan-Meier survival analysis showed that the rates of IOP control 3, 6, and 9 years after trabeculectomy in the trabeculectomy-phacoemulsification group were 80%, 66%, and 44%, respectively; in the trabeculectomy group, these were 79%, 69%, and 55%, respectively. These survival curves were not statistically different (P = .55).

CONCLUSION

Cataract surgery by temporal clear corneal phacoemulsification in eyes with filtering blebs after trabeculectomy does not adversely affect long-term IOP control.

Temporal corneal phacoemulsification in filtered glaucoma patients

PURPOSE

To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that had prior trabeculectomy.

DESIGN

Retrospective case-control study.

PATIENTS

Forty consecutive patients (cases; TRAB-PHACO group) who underwent temporal corneal phacoemulsification subsequent to trabeculectomy were identified. Forty patients (controls; TRAB group) who had trabeculectomy alone were matched to the cases for length of follow-up, age, IOP, number of anti-glaucoma medications, number of 5-fluorouracil (5-FU) injections, race, sex and diagnosis.

MAIN OUTCOME MEASURES

Comparison of IOP before and one year after phacoemulsification in the TRAB-PHACO group, and comparison with the TRAB group. Survival analysis of IOP control after trabeculectomy in the TRAB-PHACO and TRAB groups.

RESULTS

In the TRAB-PHACO group, IOP one year after phacoemulsification was not significantly different from the pre-phacoemulsification IOP value (p = 0.65). Kaplan-Meier survival analysis showed that the rates of IOP control at 3, 6 and 9 years after trabeculectomy in the TRAB-PHACO group were 80%, 66% and 44%; in the TRAB group these were 79%, 69% and 55%. These survival curves were not statistically different (p = 0.55).

CONCLUSIONS

Cataract surgery by temporal clear corneal phacoemulsification in eyes with filtering blebs after trabeculectomy does not adversely affect long term IOP control.