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Tran L, Hayes R, Apel A, Moloney TP. Correction: Recurrent post-operative endophthalmitis caused by Sphingomonas paucimobilis despite vitrectomy - a case and review of the literature. J Ophthalmic Inflamm Infect 2023; 13:22. [PMID: 37126159 PMCID: PMC10151264 DOI: 10.1186/s12348-023-00346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Affiliation(s)
- Luke Tran
- Department of Ophthalmology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Rylan Hayes
- Department of Ophthalmology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Andrew Apel
- Department of Ophthalmology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- The Eye Health Centre, Wickham Terrace, Brisbane, QLD, Australia
| | - Thomas P Moloney
- School of Medicine, University of Queensland, Brisbane, QLD, Australia.
- The Eye Health Centre, Wickham Terrace, Brisbane, QLD, Australia.
- Vitreoretinal Unit, Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
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2
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Green M, Zhang S, Nadivulath T, Apel A, Stapleton F. Clinical factors associated with positive corneal culture in suspected microbial keratitis. Cont Lens Anterior Eye 2021; 45:101543. [PMID: 34949563 DOI: 10.1016/j.clae.2021.101543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/03/2022]
Abstract
AIMS Determine demographic and clinical characteristics associated with positive culture in suspected microbial keratitis. METHODS Retrospective audit of patients that had corneal scrapings between October 1999-September 2004 at Princess Alexandra Hospital. Clinical information was gathered from medical records, smear and culture results from the local microbiology database. Univariate and multivariate analyses of variables associated with positive cultures and calculation of population attributable risk percentage (PAR). RESULTS Univariate analysis showed that positive cultures were associated with patients over 60 years (81% vs 55%; p < 0.001), presenting visual acuity (VA) of 6/24 or worse (74% vs 57%; p = 0.012) or contact lens-related keratitis (CLK 77% vs 62%; p = 0.08). Analysis of patients' clinical presentation showed that positive culture was associated with a central epithelial defect (74% vs 57%; p = 0.012), anterior chamber reaction of 2 + cells or worse (73% vs 56%; p = 0.03), an epithelial defect of 2 mm or more in diameter (71% vs 50%; p = 0.006) or no prior treatment with antibiotics (68% vs 56%; p = 0.053). Multivariate analysis showed the independent variables associated with positive cultures were VA of 6/24 or worse on presentation, contact lens-related keratitis, age greater than 60 years, an anterior chamber reaction of 2 + cells or worse and no prior treatment with antibiotics. The factor with the highest attributable risk (PAR%) for a positive corneal scraping was VA of 6/24 or worse on presentation (21%). CONCLUSIONS In this series positive cultures were associated with poor presenting VA contact lens keratitis (CLK), older age, anterior chamber reaction and no prior treatment with antibiotics.
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Affiliation(s)
- Matthew Green
- Ophthalmology Department, Gold Coast University Hospital, Gold Coast, Australia
| | - Susan Zhang
- Ophthalmology Department, Sunshine Coast Hospital and Health Service, Sunshine Coast, Australia.
| | - Thomas Nadivulath
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Andrew Apel
- Princess Alexandra Hospital, Brisbane, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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3
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Kandel H, Nguyen V, Ferdi AC, Gupta A, Abbondanza M, Sullivan L, Apel A, Watson SL. Comparative Efficacy and Safety of Standard Versus Accelerated Corneal Crosslinking for Keratoconus: 1-Year Outcomes From the Save Sight Keratoconus Registry Study. Cornea 2021; 40:1581-1589. [PMID: 33935236 DOI: 10.1097/ico.0000000000002747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/04/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to compare the efficacy and safety of standard [Ultraviolet (UV) light power: 3 mW/cm2, duration: 30 minutes] versus accelerated (UV power: 9 mW/cm2, duration: 10 minutes) corneal crosslinking (CXL) for stabilizing keratoconus. METHODS A total of 684 eyes (555 patients; mean age ± SD, 25.0 ± 7.9 years; women, 30.6%) from 24 international sites with epithelium-off CXL for keratoconus had follow-up data at 1-year and met the inclusion criteria. Two hundred sixty-six eyes (228 patients) had undergone standard CXL, and 418 eyes (327 patients) had undergone accelerated CXL. The outcome measures included changes in visual acuity, keratometry, minimum corneal thickness, and frequency of adverse events. The outcomes were compared using mixed-effects regression models adjusted for age, sex, visual acuity, keratometry, pachymetry, doctor, practice, and eye laterality. RESULTS The adjusted mean changes (95% confidence interval) in outcomes were similar in standard and accelerated CXL in visual acuity [6.5 (2.0, 11.1) versus 5.5 (0.4, 10.6) logMAR letters, respectively], Kmax [-0.9 (-1.4, -0.3) D versus -1.2 (-1.9, -0.4) D, respectively], K2 [-0.4 (-0.9, 0.2) D versus -0.4 (-1.1, 0.3), D respectively], or minimum corneal thickness [-13.3 (-20.3, -6.3) μm versus -16.6 (-24.5, -8.6) μm, respectively] (all P > 0.05). The frequency of adverse events at the 12-month visit was also similar between the CXL groups (standard, 8.3% vs. accelerated, 5.5%; P = 0.21). CONCLUSIONS This real-world observational study found that both standard and accelerated CXL were similarly safe and effective in stabilizing keratoconus at 1-year postsurgery in the real-world setting. The findings support the adoption of accelerated CXL for time and convenience.
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Affiliation(s)
- Himal Kandel
- The University of Sydney, Faculty of Medicine and Health, Save Sight Institute, Sydney, NSW, Australia
| | - Vuong Nguyen
- The University of Sydney, Faculty of Medicine and Health, Save Sight Institute, Sydney, NSW, Australia
| | - Alex C Ferdi
- The University of Sydney, Faculty of Medicine and Health, Save Sight Institute, Sydney, NSW, Australia
| | - Aanchal Gupta
- Adelaide Eye & Laser Centre, Adelaide, SA, Australia
- South Australian Institute of Ophthalmology, Adelaide, SA, Australia
| | | | | | - Andrew Apel
- The Eye Health Centre, Brisbane, QLD, Australia
| | - Stephanie L Watson
- The University of Sydney, Faculty of Medicine and Health, Save Sight Institute, Sydney, NSW, Australia
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4
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Ison M, Scott J, Apel J, Apel A. Patient Expectation, Satisfaction and Clinical Outcomes with a New Multifocal Intraocular Lens. Clin Ophthalmol 2021; 15:4131-4140. [PMID: 34675480 PMCID: PMC8520966 DOI: 10.2147/opth.s327424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To report patient expectations, visual performance and satisfaction with AcrySof IQ PanOptix multifocal intraocular lens in a heterogeneous patient group. Additionally, determine if identifiable pre-operative characteristics can predict post-operative satisfaction. Methods Data were prospectively collected for 67 consecutive patients (134 eyes) who underwent bilateral Panoptix implantation in a private ophthalmology clinic. A pre-operative questionnaire was completed regarding vision satisfaction, visual phenomena and expectations. Routine clinical parameters were collected 1 month and follow-up questionnaire administered 3 months post-operatively. Results Post-operative unaided distance vision was 20/20 (0.01 ± 0.10) and binocular near vision 20/25-2 (N5; 0.14 ± 0.06). Patients satisfied with vision increased from 6% (n=4) unaided and 48% (n=32) aided pre-operatively to 94% (n=63) unaided post-operatively (p<0.001). There was marked increase in frequency of halo from 14% (n=9) to 69% (n=46; p<0.001) but no corresponding increase in how bothersome this symptom was (p=0.193) nor the frequency of other visual phenomena. Worse post-operative vision and fluctuating vision were associated with lower post-operative satisfaction. There was no difference in satisfaction or residual astigmatism in those implanted with toric lenses. A total of 96% (n=64) of patients were spectacle-free at 3-months and would recommend this procedure to others. Conclusion This study supports the trend towards increased patient expectations of multifocal intraocular lenses, matched by excellent visual outcomes and satisfaction. Visual phenomena may be less troubling with new multifocal lenses than previously reported. A pre-operative questionnaire may be a useful education tool but could not isolate pre-operative characteristics that predict post-operative satisfaction.
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Affiliation(s)
- Matthew Ison
- Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia.,University of Queensland, St Lucia, QLD, 4072, Australia
| | - Jane Scott
- The Eye Health Centre, Brisbane, QLD, 4000, Australia
| | - John Apel
- The Eye Health Centre, Brisbane, QLD, 4000, Australia
| | - Andrew Apel
- Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia.,The Eye Health Centre, Brisbane, QLD, 4000, Australia
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5
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Statham M, Apel A, Stephensen D. Correction of astigmatism after penetrating keratoplasty using the Acri.Comfort toric intraocular lens. Clin Exp Optom 2021; 93:42-4. [DOI: 10.1111/j.1444-0938.2009.00436.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Andrew Apel
- The Eye Health Centre, Brisbane, Australia E‐mail:
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Abstract
Clinical relevance: Keratitis is common and studies of blindness throughout the world have found that corneal disease is the second most common cause of blindness.Background: Microbial keratitis a bacterial, fungal, or protozoan disease of the cornea, characterised by a corneal infiltrate with an overlying epithelial defect and associated anterior chamber reaction.Methods: Patients were identified through the hospital pathology database and a retrospective chart review of all patients with a positive corneal culture between 1999 and 2015 at Princess Alexandra Hospital was carried out.Results: There were 895 records from 779 patients included and additional 107 records excluded. The average age of the included patients was 58.9 years (SD 21.0). Males made up 498 (55.6%) of the included patients. Contact lens microbial keratitis (CLMK) was the most common risk factor for MK and was significantly more common in younger patients. CLMK was significantly associated with cultures positive for Pseudomonas aeruginosa (p < 0.001) while MK secondary to ocular surface disease and prior ocular surgery were more commonly associated with gram-positive organisms (p < 0.001). Monotherapy with a fluoroquinolone was the most common treatment for patients with MK. Good outcomes were seen in 57% of patients.Conclusion: In this patient group, contact lens wear was the most common risk factor for MK. Pseudomonas aeruginosa was the most common isolate.
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Affiliation(s)
- Matthew Green
- Gold Coast University Hospital, Southport, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Andrew Apel
- Princess Alexandra Hospital, Brisbane, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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7
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Green M, Sara S, Hughes I, Apel A, Stapleton F. Trends in contact lens microbial keratitis 1999 to 2015: a retrospective clinical review. Clin Exp Ophthalmol 2019; 47:726-732. [PMID: 30801907 DOI: 10.1111/ceo.13484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/18/2019] [Accepted: 02/10/2019] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Contact lens microbial keratitis (CLMK) is the most common cause of microbial keratitis in our community. BACKGROUND Define the trend in rate of CLMK and define patient demographics/culture results that may have a predictive value in patients with CLMK. DESIGN Retrospective review of clinical records of patients with MK. PARTICIPANTS All patients with positive corneal scraping between 1999 and 2015 at the Princess Alexandra Hospital, Brisbane, Queensland identified through local microbiology database. METHODS Trend in CLMK tested with chi-squared test of peak 3 years vs other years and Poisson regression of interrupted time series. Patient characteristics predictive of CLMK were defined by creating a polynomial regression model by stepwise variable selection. MAIN OUTCOME MEASURES Yearly rate of CLMK. RESULTS Records of 895 episodes of MK were included. The most common: risk factor was contact lens wear (324, 36.2%), isolated organism was Pseudomonas aeruginosa (P. aeruginosa 181, 55.9%) and treatment was monotherapy with a fluoroquinolone 172, 53%). CLMK was most common between 2009 and 2011 (49.5% vs other years 32%, P < 0.001). Poisson regression of the interrupted time series showed there was a significant decrease in the rate over time after 2010 (P < 0.001). Independent factors predictive of CLMK in multivariate regression were young age (15-49 years) and corneal culture positive for P. aeruginosa CONCLUSIONS AND RELEVANCE: The rate of CLMK in our community ranged between 32% and 50% and the rate of disease appears to have peaked during 2009 to 2011 and subsequently declined.
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Affiliation(s)
- Matthew Green
- Ophthalmology department, Gold Coast University Hospital, Southport, Queensland, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Sergio Sara
- Ophthalmology department, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Ian Hughes
- Ophthalmology department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Andrew Apel
- Ophthalmology department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
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8
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Darcy K, Apel A, Donaldson M, McDonald R, Males J, Coote M, Werner L, Chan E. Calcification of hydrophilic acrylic intraocular lenses following secondary surgical procedures in the anterior and posterior segments. Br J Ophthalmol 2019; 103:1700-1703. [PMID: 30798263 DOI: 10.1136/bjophthalmol-2018-313385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/20/2018] [Accepted: 01/28/2019] [Indexed: 11/03/2022]
Abstract
AIMS To report 15 cases of intraocular lens (IOL) calcification following intraocular surgery and to identify common risk factors. METHODS A retrospective case review of patients with IOL calcification reported from the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, and six surgeons in private practice in the Australian states of Victoria, New South Wales and Queensland. RESULTS 15 cases of IOL calcification were identified. Eight cases were in hydrophilic acrylic IOLs and seven in hydrophilic acrylic IOLs with hydrophobic surface properties. Five cases occurred following intraocular injection of gas during endothelial keratoplasties. Two cases occurred following pars plana vitrectomy where gas was used. The remaining eight cases did not involve the injection of any intraocular gas; six cases were following trabeculectomy surgery, and two cases were after insertion of a 'piggyback' sulcus IOL. In each case, the calcification had a characteristic pattern, being centrally placed in the pupillary zone, mainly affecting the anterior lens surface. CONCLUSION The aetiology of IOL calcification is not fully understood, although there are known risk factors such as using hydrophilic acrylic materials and the use of intraocular gas. Surgical consideration of a patient's ocular comorbidities before IOL implantation is an important tool to mitigate some of this risk.
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Affiliation(s)
| | - Andrew Apel
- Ophthalmology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia.,Ophthalmology, University of Queensland, Brisbane, Queensland, Australia
| | - Mark Donaldson
- Ophthalmology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia.,Ophthalmology, University of Queensland, Brisbane, Queensland, Australia
| | - Robert McDonald
- Sydney Eye Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - John Males
- University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, Sydney, New South Wales, Australia
| | - Michael Coote
- Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Elsie Chan
- Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia .,Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
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Brockmann K, Schulte C, Schneiderhan-Marra N, Apel A, Pont-Sunyer C, Vilas D, Ruiz-Martinez J, Langkamp M, Corvol JC, Cormier F, Knorpp T, Joos TO, Bernard A, Gasser T, Marras C, Schüle B, Aasly JO, Foroud T, Marti-Masso JF, Brice A, Tolosa E, Berg D, Maetzler W. Inflammatory profile discriminates clinical subtypes in LRRK2-associated Parkinson's disease. Eur J Neurol 2018; 24:427-e6. [PMID: 28102045 DOI: 10.1111/ene.13223] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/07/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE The presentation of Parkinson's disease patients with mutations in the LRRK2 gene (PDLRRK2 ) is highly variable, suggesting a strong influence of modifying factors. In this context, inflammation is a potential candidate inducing clinical subtypes. METHODS An extensive battery of peripheral inflammatory markers was measured in human serum in a multicentre cohort of 142 PDLRRK2 patients from the MJFF LRRK2 Consortium, stratified by three different subtypes as recently proposed for idiopathic Parkinson's disease: diffuse/malignant, intermediate and mainly pure motor. RESULTS Patients classified as diffuse/malignant presented with the highest levels of the pro-inflammatory proteins interleukin 8 (IL-8), monocyte chemotactic protein 1 (MCP-1) and macrophage inflammatory protein 1-β (MIP-1-β) paralleled by high levels of the neurotrophic protein brain-derived neurotrophic factor (BDNF). It was also possible to distinguish the clinical subtypes based on their inflammatory profile by using discriminant and area under the receiver operating characteristic curve analysis. CONCLUSIONS Inflammation seems to be associated with the presence of a specific clinical subtype in PDLRRK2 that is characterized by a broad and more severely affected spectrum of motor and non-motor symptoms. The pro-inflammatory metabolites IL-8, MCP-1 and MIP-1-β as well as BDNF are interesting candidates to be included in biomarker panels that aim to differentiate subtypes in PDLRRK2 and predict progression.
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Affiliation(s)
- K Brockmann
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - C Schulte
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - N Schneiderhan-Marra
- Natural and Medical Sciences Institute at the University of Tübingen (NMI), Reutlingen, Germany
| | - A Apel
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - C Pont-Sunyer
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - D Vilas
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - J Ruiz-Martinez
- Hospital Universitario Donostia, Biodonostia Institut, San Sebastián, Guipuzcoa, Spain
| | | | - J-C Corvol
- Département de Génétique et Cytogénétique, Hôpital de la Pitié Salpêtrière, Sorbonne Universités, INSERM, Paris, France
| | - F Cormier
- Département de Génétique et Cytogénétique, Hôpital de la Pitié Salpêtrière, Sorbonne Universités, INSERM, Paris, France
| | - T Knorpp
- Natural and Medical Sciences Institute at the University of Tübingen (NMI), Reutlingen, Germany
| | - T O Joos
- Natural and Medical Sciences Institute at the University of Tübingen (NMI), Reutlingen, Germany
| | - A Bernard
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - T Gasser
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - C Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - B Schüle
- Parkinson Institute and Clinical Center, Sunnyvale, CA, USA
| | - J O Aasly
- Department of Neurology, St Olavs Hospital, Trondheim, Norway
| | - T Foroud
- Department of Medical and Molecular Genetics, Indiana University, Bloomington, IN, USA
| | - J F Marti-Masso
- Hospital Universitario Donostia, Biodonostia Institut, San Sebastián, Guipuzcoa, Spain
| | - A Brice
- Département de Génétique et Cytogénétique, Hôpital de la Pitié Salpêtrière, Sorbonne Universités, INSERM, Paris, France
| | - E Tolosa
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - D Berg
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - W Maetzler
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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MacLean KD, Apel A, Wilson J, Werner L. Calcification of hydrophilic acrylic intraocular lenses associated with intracameral air injection following DMEK. J Cataract Refract Surg 2015; 41:1310-4. [PMID: 26100959 DOI: 10.1016/j.jcrs.2015.05.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED We present 2 cases of localized calcification on the anterior surface/subsurface of hydrophilic acrylic intraocular lenses (IOLs) following procedures involving intracameral injection of air. Although this phenomenon has been reported in hydrophilic acrylic IOLs, to our knowledge it has not been reported in the IOLs described in our cases, one a sulcus-fixated supplementary IOL and the other a hydrophilic acrylic IOL with a hydrophobic surface. Centralized opacity of the IOLs was first noted months after Descemet membrane endothelial keratoplasty had been performed in both cases; explantation was required. Laboratory analysis of the IOLs confirmed calcification of the anterior surfaces in a localized pattern in the area of the capsulorhexis or pupil. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Kyle D MacLean
- From the John A. Moran Eye Center (MacLean, Werner), University of Utah, Salt Lake City, Utah, USA; the Eye Health Centre (Apel, Wilson), Brisbane, Queensland, Australia
| | - Andrew Apel
- From the John A. Moran Eye Center (MacLean, Werner), University of Utah, Salt Lake City, Utah, USA; the Eye Health Centre (Apel, Wilson), Brisbane, Queensland, Australia
| | - Jessica Wilson
- From the John A. Moran Eye Center (MacLean, Werner), University of Utah, Salt Lake City, Utah, USA; the Eye Health Centre (Apel, Wilson), Brisbane, Queensland, Australia
| | - Liliana Werner
- From the John A. Moran Eye Center (MacLean, Werner), University of Utah, Salt Lake City, Utah, USA; the Eye Health Centre (Apel, Wilson), Brisbane, Queensland, Australia.
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11
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Moloney TP, Ghaznawi M, Cheng S, Apel A. Rare case of Langerhans cell histiocytosis of the conjunctiva. Clin Exp Ophthalmol 2014; 43:191-2. [DOI: 10.1111/ceo.12385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas P Moloney
- Department of Ophthalmology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Mohammad Ghaznawi
- Department of Ophthalmology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Sean Cheng
- Department of Ophthalmology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Andrew Apel
- Department of Ophthalmology; Princess Alexandra Hospital; Brisbane Queensland Australia
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Lehmann J, Schubert S, Schäfer A, Apel A, Laspe P, Schiller S, Ohlenbusch A, Gratchev A, Emmert S. An unusual mutation in the XPG gene leads to an internal in-frame deletion and a XP/CS complex phenotype. Br J Dermatol 2014; 171:903-5. [PMID: 24702031 DOI: 10.1111/bjd.13035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- J Lehmann
- Department of Dermatology, Venerology and Allergology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
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13
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Apel W, Apel A, Stephensen D, Versace P. Axial myopic progression following phakic intraocular lens implantation. J Cataract Refract Surg 2013; 39:1435-8. [PMID: 23871113 DOI: 10.1016/j.jcrs.2013.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 04/09/2013] [Accepted: 04/09/2013] [Indexed: 11/19/2022]
Abstract
UNLABELLED A 45-year-old woman presented to her ophthalmologist complaining of worsening uncorrected distance visual acuity following placement of an Implantable Collamer Lens phakic intraocular lens (pIOL) approximately 10 years earlier. Prior to the pIOL surgery, contact ultrasound axial length (AL) measurements of 28.28 mm in the right eye and 27.90 mm in the left eye indicated the presence of axial myopia. At review 10 years after the initial pIOL surgery, the AL measured by partial coherence interferometry had increased to 30.25 mm and 29.22 mm, respectively, indicating a progression of the axial myopia. This case suggests that in some patients, age and recent myopic stability are insufficient criteria to conclude that the high myopia is nonprogressive. In our patient, placement of a pIOL and induction of a stable, constant, and focused foveal image were not sufficient to prevent further axial myopic progression. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Warren Apel
- Sydney Eye Hospital, Sydney, New South Wales, Australia.
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Statham M, Apel A, Stephensen D. Intraocular lens outcomes: a concern – response. Clin Exp Ophthalmol 2010. [DOI: 10.1111/j.1442-9071.2010.02248_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Andrew Apel
- The Eye Health Centre, Brisbane, Queensland, Australia
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Statham M, Apel A, Stephensen D. Comparison of the AcrySof SA60 spherical intraocular lens and the AcrySof Toric SN60T3 intraocular lens outcomes in patients with low amounts of corneal astigmatism. Clin Exp Ophthalmol 2009; 37:775-9. [DOI: 10.1111/j.1442-9071.2009.02154.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kallifatidis G, Rausch V, Baumann B, Apel A, Beckermann BM, Groth A, Mattern J, Li Z, Kolb A, Moldenhauer G, Altevogt P, Wirth T, Werner J, Schemmer P, Büchler MW, Salnikov AV, Herr I. Sulforaphane targets pancreatic tumour-initiating cells by NF-kappaB-induced antiapoptotic signalling. Gut 2009; 58:949-63. [PMID: 18829980 DOI: 10.1136/gut.2008.149039] [Citation(s) in RCA: 169] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Emerging evidence suggests that highly treatment-resistant tumour-initiating cells (TICs) play a central role in the pathogenesis of pancreatic cancer. Tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) is considered to be a novel anticancer agent; however, recent studies have shown that many pancreatic cancer cells are resistant to apoptosis induction by TRAIL due to TRAIL-activated nuclear factor-kappaB (NF-kappaB) signalling. Several chemopreventive agents are able to inhibit NF-kappaB, and favourable results have been obtained--for example, for the broccoli compound sulforaphane-in preventing metastasis in clinical studies. The aim of the study was to identify TICs in pancreatic carcinoma for analysis of resistance mechanisms and for definition of sensitising agents. METHODS TICs were defined by expression patterns of a CD44(+)/CD24(-), CD44(+)/CD24(+) or CD44(+)/CD133(+) phenotype and correlation to growth in immunodeficient mice, differentiation grade, clonogenic growth, sphere formation, aldehyde dehydrogenase (ALDH) activity and therapy resistance. RESULTS Mechanistically, specific binding of transcriptionally active cRel-containing NF-kappaB complexes in TICs was observed. Sulforaphane prevented NF-kappaB binding, downregulated apoptosis inhibitors and induced apoptosis, together with prevention of clonogenicity. Gemcitabine, the chemopreventive agents resveratrol and wogonin, and the death ligand TRAIL were less effective. In a xenograft model, sulforaphane strongly blocked tumour growth and angiogenesis, while combination with TRAIL had an additive effect without obvious cytotoxicity in normal cells. Freshly isolated patient tumour cells expressing markers for TICs could be sensitised by sulforaphane for TRAIL-induced cytotoxicity. CONCLUSION The data provide new insights into resistance mechanisms of TICs and suggest the combination of sulforaphane with TRAIL as a promising strategy for targeting of pancreatic TICs.
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Affiliation(s)
- G Kallifatidis
- Molecular OncoSurgery Group, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany
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Kallifatidis G, Beckermann BM, Groth A, Schubert M, Apel A, Khamidjanov A, Ryschich E, Wenger T, Wagner W, Diehlmann A, Saffrich R, Krause U, Eckstein V, Mattern J, Chai M, Schütz G, Ho AD, Gebhard MM, Büchler MW, Friess H, Büchler P, Herr I. Improved lentiviral transduction of human mesenchymal stem cells for therapeutic intervention in pancreatic cancer. Cancer Gene Ther 2008; 15:231-40. [PMID: 18202717 DOI: 10.1038/sj.cgt.7701097] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Genetic modification of human bone marrow mesenchymal stem cells (MSC) is highly valuable for their exploitation in basic science and therapeutic applications, for example in cancer. We present here a new, fast and easy-to-use method to enrich a functional population of lentiviral (LV)-transduced MSC expressing enhanced green fluorescent protein (eGFP). We replaced the eGFP gene by a fusion gene of puromycin acetyltransferase and eGFP. Upon LV gene transfer and puromycin selection, we quickly obtained a pure transduced MSC population, in which growth, differentiation capacity and migration preferences were not compromised. Furthermore, we are the first to report the migration velocity of MSC among which 30% were moving and velocity of about 15 mum h(-1) was not altered by LV transduction. Manipulated MSC underwent senescence one passage earlier than non-transduced cells, suggesting the use for therapeutic intervention in early passage numbers. Upon tail vein application in nude mice, the majority of LV-transduced MSC could be detected in human orthotopic pancreatic tumor xenografts and to a minor extent in mouse liver, kidney and lung. Together, LV transduction of genes to MSC followed by puromycin selection is a powerful tool for basic research and improves the therapeutic prospects of MSC as vehicles in gene therapy.
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Affiliation(s)
- G Kallifatidis
- Molecular OncoSurgery, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany
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Apel A, Stephensen D. Surgical management of acute angle-closure glaucoma after toric ICL implantation. J Cataract Refract Surg 2007; 33:1672; author reply 1672. [PMID: 17889740 DOI: 10.1016/j.jcrs.2007.05.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Accepted: 05/29/2007] [Indexed: 10/22/2022]
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Abstract
The utilisation of complementary and alternative medicine (CAM) is widespread in neuroimmunological diseases like multiple sclerosis (MS) but has been disregarded in research until lately. After describing the problems of definition in CAM, different categories will be described. Various confounding factors on CAM utilisation exist, though hardly investigated. Besides sociodemographic variables like education, income, gender and age, illness-related factors like severity of disease are discussed. Furthermore, the important role of coping and CAM utilisation has not been investigated in neuroimmunological diseases, yet. Results derived from our investigations on CAM utilisation in MS indicate that users of CAM apply coping strategies, such as "rumination", "search for information" and "search for meaning in religion", more frequently than non-users and that current CAM utilisation is related to depression. Further research is needed in this field, as well as in other neuroimmunological diseases.
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Affiliation(s)
- A Apel
- Dept. of Neurology, University of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany.
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Abstract
PURPOSE To compare the rejection rates, graft failure rates, mean visual, keratometric and refractive outcomes of combined penetrating keratoplasty and cataract extraction with penetrating keratoplasty alone. METHODS A retrospective study of all patients who had combined keratoplasty and cataract extraction/intraocular lens insertion (49 eyes; mean age 65.3 years; mean follow up 17 months) compared with all patients who had keratoplasty only (58 eyes; mean age 64.0 years; mean follow up 14 months). RESULTS One hundred and seven eyes in 99 patients had keratoplasty in the period and were included in the study. The most common indication for keratoplasty in patients who had triple procedures was Fuchs' endothelial dystrophy (24.5%). During the study seven (6.5%) grafts failed and four (3.7%) had allogenic rejection without failure during this period. There was no statistical difference between the graft survival rates of the two study groups. The mean postoperative logMAR visual acuity (VA) was 0.42 and postoperative VA of 6/12 or better was seen in 71% of patients. Mean postoperative corneal curvature was 44.6 dioptres (D), mean corneal astigmatism was -4.0 D and was >or=5 D in 38%. Mean double-angle Cartesian coordinates for corneal astigmatism were x-0.87 D and y-0.29 D. Mean best sphere of postoperative refractions was -0.61 D and mean absolute refractive error was 2.2 D. There was no statistically significant difference in VA, keratometric or refractive outcome measures between the two study groups. CONCLUSION Over a short follow up, keratoplasty combined with cataract extraction/intraocular lens insertion showed a similar risk of graft failure or allogenic graft rejection when compared with keratoplasty alone and we recommend the triple procedure for quicker visual recovery and less operative procedures.
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Affiliation(s)
- Matthew Green
- Gold Coast Hospital, Southport, Queensland, Australia.
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Faiss JH, Apel A, Baum K, Dähne D, Deppe R, Hoffmann F, Köhler W, Kunkel A, Sailer M, Schilling H, Wachowius U, Zettl UK. Kognitive Defizite im Frühstadium der Multiplen Sklerose. Akt Neurol 2007. [DOI: 10.1055/s-2007-987996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Apel A, Greim B, Klauer T, König N, Zettl UK. Krankheitsbewältigung bei Multipler Sklerose unter dem Gesichtspunkt krankheitsspezifischer Variablen. Akt Neurol 2007. [DOI: 10.1055/s-2007-987982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abu-Mugheisib M, Tumani H, Kamin F, Apel A, Köhler W, Hoffmann F, Benecke R, Zettl UK. Effects on cerebrospinal fluid biomarkers in multiple sclerosis patients after repeated intrathecal triamcinolone acetonid application. Akt Neurol 2007. [DOI: 10.1055/s-2007-988026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The hypothesis that stress might be connected to causation or exacerbation of multiple sclerosis has been under discussion for a long time. The current studies indicate that there is a coincidence between stress and disease progression. Besides the state of art in research different stress models will be introduced in the paper and the relations between disease, resources and coping will be discussed. Besides the influence of distressing life events on disease, the effect of illness-related characteristics on the coping behaviour will be considered in this regard. From the results of the presented studies and the described stress models it was concluded that the possibilities of stress avoiding intervention programs should be taken into account more strongly in the future.
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Affiliation(s)
- A Apel
- Universität Rostock, Klinik und Poliklinik für Neurologie.
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Apel A, Greim B, König N, Zettl U. Mit welchem Ziel wenden Patienten mit Multipler Sklerose alternative und komplementäre Therapien an? Akt Neurol 2006. [DOI: 10.1055/s-2006-953211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Apel A, Greim B, König N, Zettl U. Krankheitsbewältigung bei Multipler Sklerose. Akt Neurol 2005. [DOI: 10.1055/s-2005-919587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Apel A, Engel C, Greim B, König N, Zettl UK. Einfluss psychologischer Variablen auf die Anwendung alternativer und komplementärer Therapien bei Multipler Sklerose. Akt Neurol 2004. [DOI: 10.1055/s-2004-833105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Zettl UK, Engel C, Greim B, Apel A. Subjektive Effekte und Nebenwirkungen alternativer und komplementärer Therapien bei Patienten mit Multipler Sklerose. Akt Neurol 2004. [DOI: 10.1055/s-2004-833104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Orthokeratology is a method of changing refraction in myopic patients by using rigid contact lenses to reduce the curvature of the cornea. This treatment was in use in the two cases of corneal ulcer described in this paper and appears to have contributed to the development of their disease. As with extended wear contact lenses, patients undergoing orthokeratology treatment are frequently advised to wear the orthokeratology lenses overnight increasing the risk of corneal ulceration and infection. Patients should be adequately warned of the associated risks and advised that any envisaged benefits of the procedure are temporary.
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Affiliation(s)
- Kenneth Hutchinson
- Department of Ophthalmology, Royal Brisbane Hospital, Queensland, Australia.
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Abstract
Despite its importance in every-day life and vocational rehabilitation, arithmetic ability has rarely been investigated in schizophrenic patients. Those few studies reporting arithmetic deficits in schizophrenia, however, administered complex calculation tasks which drew not only on arithmetic abilities, but also on working memory resources known to be impaired in schizophrenia. In the present study, arithmetic abilities and working memory functions were investigated in schizophrenic patients (n=24) and healthy control subjects (n=24). Arithmetic fact retrieval was assessed in single-digit multiplication and corresponding division problems using a result verification task which minimized working memory demands. Problem size and the disparity of the proposed result were manipulated. The storage component of working memory was tested with a digit span forward task and the executive control component with a digit span backward as well as with verbal fluency tasks. Schizophrenic patients performed worse than controls only in the executive tasks. Digit span forward was preserved. In the arithmetic tasks, groups did not differ from each other, and a similar pattern of task manipulations was obtained. Hence, despite the executive control deficit retrieval of arithmetic facts is preserved in schizophrenia. Moreover, the same underlying cognitive processes as in control subjects are involved.
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Affiliation(s)
- M Kiefer
- University of Ulm, Department of Psychiatry, Leimgrubenweg 12, 89075, Ulm, Germany.
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Abstract
PURPOSE Two cases of corneal crystal deposition are reported, both caused by a benign monoclonal gammopathy METHODS Similar corneal pathology is identified in these two patients, both of whom presented with visual acuities of 6/6 or better Consideration of possible causes involved biochemical and haematological testing and assessment. RESULTS Potential for malignant transformation of monoclonal gammopathy was recognized, hence the need for ongoing haematological follow-up. CONCLUSION Corneal crystals may be the initial presentation in a patient with monoclonal gammopathy, a rare, but significant, clinical finding.
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Affiliation(s)
- K Hutchinson
- The Eye Unit, Greenslopes Private Hospital, Brisbane, Queensland, Australia
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Hopkins JJ, Apel A, Trope GE, Rootman DS. Early intraocular pressure after phacoemulsification combined with trabeculectomy. Ophthalmic Surg Lasers 1998; 29:273-9. [PMID: 9571658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE To determine the efficacy of combined phacoemulsification--trabeculectomy in preventing early postoperative increases in intraocular pressure (IOP). PATIENTS AND METHODS Eighty patients were enrolled in a prospective cohort study. Thirty-six patients with cataracts and uncontrolled glaucoma underwent combined phacoemulsification--trabeculectomy, and 44 patients with cataracts underwent phacoemulsification alone. The operations were performed in a standardized manner by one surgeon. IOP was measured at 4 hours, 1 day, and 7 days after surgery. The need for intervention (digital massage, medications) and the presence of complications were documented. RESULTS Four hours after surgery, 5.5% of patients undergoing the combined procedure had IOPs greater than 30 mm Hg, compared with 22.7% of phacoemulsification patients (P < .05). No significant difference in IOP was found between the groups at postoperative day 1 or day 7. CONCLUSION These results suggest that combined phacoemulsification-trabeculectomy protects against early postoperative elevations in IOP. This finding may influence the surgical management of cataracts in patients with poorly controlled glaucoma and significant compromise of visual field or optic nerve.
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Affiliation(s)
- J J Hopkins
- Department of Ophthalmology, University of Toronto, Ontario, Canada
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Hopkins JJ, Apel A, Trope GE, Rootman DS. Early Intraocular Pressure After Phacoemulsification Combined With Trabeculectomy. Ophthalmic Surg Lasers Imaging Retina 1998. [DOI: 10.3928/1542-8877-19980401-03] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The effect of local cyclosporine therapy upon corneal transplant survival was investigated. A high risk rabbit model with vascularized corneas was used to assess the efficacy of subconjunctivally implanted degradable devices for cyclosporine therapy. Animals were divided into four groups, receiving either no therapy, a placebo PLGA device, or drug containing devices implanted either at the time of transplantation or two weeks previous. The mean survival times of animals in the control and placebo groups were statistically equivalent (21 +/- 4 days vs 18 +/- 4 days). Devices containing CsA improved the survival time of grafts. Predosing the animals with CsA improved the survival time to 28 +/- 7 days, and CsA devices implanted at the time of transplantation increased the survival time to 35 +/- 7 days. The improvement in survival times was consistent with the in vitro drug release profiles. No systemic CsA was detected, suggesting that the effect may have been local. Histological assessment indicated that devices were well tolerated.
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Affiliation(s)
- A Apel
- Department of Ophthalmology, University of Toronto, Ontario, Canada
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Abstract
A case of infectious crystalline keratopathy in a patient who had undergone trabeculectomy without 5-fluorouracil is described. Chronic low-dose topical steroids were employed. Crystalline keratopathy occurring in this setting has not been previously described. A 73-year-old diabetic women presented with feathery crystal-like corneal infiltrates. These were cultured and treated with antibiotics based on the sensitivities. The cultures showed a nutritional variant of Streptococcus that was difficult to grow on routine culture plates. It was sensitive to vancomycin. Resolution of the infection occurred with topical treatment. Infectious crystalline keratopathy is a rare but classical corneal infection. The microbiological characteristics that give rise to its clinical appearance and laboratory characteristics are discussed. A rationale for diagnosis and treatment is suggested.
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Affiliation(s)
- A Apel
- Department of Ophthalmology, University of Toronto, Ontario, Canada
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Maberley D, Apel A, Rootman DS. Releasable "U" suture for trabeculectomy surgery. Ophthalmic Surg 1994; 25:251-255. [PMID: 8015779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Overfiltration after glaucoma surgery can lead to significant complications. Tight suturing of the trabeculectomy flap reduces this problem but can lead to higher pressure and poor drainage of aqueous. Releasable sutures often leave irritating exposed suture ends. We describe a simple two-arm releasable suture technique that leaves no exposed suture ends until one arm of the suture is removed. Good control of postoperative pressure with few complications was achieved in 28 cases using this technique, which allows manipulation at the slit lamp of the trabeculectomy flap, obviating laser lysis of the sutures.
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Affiliation(s)
- D Maberley
- University of Toronto, Toronto Hospital Western Division, Ontario, Canada
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Abstract
Peribulbar anaesthesia is becoming an increasingly popular alternative to retrobulbar anaesthesia for local anaesthesia in intraocular surgery. The results of 50 consecutive single-injection peribulbar anaesthetics performed by the same surgeon are reported. A description of the procedure is included. The technique produced adequate conditions for surgery in all cases. Only 4% (two cases) were considered to have inadequate akinesia five minutes after the injection and required additional injections. None of the complications described with retrobulbar and other forms of peribulbar anaesthesia were observed. The procedure is relatively easy to master. It can be performed by surgeons or anaesthetists and can be used in the in-patient or day surgery setting. The study shows it to be a safe and reliable alternative to previously described methods of local anaesthesia.
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Affiliation(s)
- A Apel
- Repatriation General Hospital Brisbane, Australia
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