Ketorolac tromethamine 0.5% ophthalmic solution in the treatment of moderate to severe ocular inflammation after cataract surgery: a randomized, vehicle-controlled clinical trial

PURPOSE

To investigate the efficacy and safety of ketorolac tromethamine 0.5% ophthalmic solution (Acular; Allergan, Inc, Irvine, California) in the treatment of moderate to severe anterior segment inflammation developing after unilateral cataract surgery with intraocular lens implantation.

METHODS

Only patients who exhibited moderate or greater levels of cells and flare 1 day after surgery were included in this multicenter, double-masked, randomly assigned, parallel-group study. Topical ketorolac or vehicle solution (Allergan, Inc) was administered to the treated eye four times daily, starting the day after surgery and continuing for 14 days.

RESULTS

Ketorolac was significantly more effective than the vehicle solution in reducing anterior chamber cells (P < or = .030) and flare (P < or = .025), conjunctival erythema (P < or = .046), ciliary flush (P < or = .006), tearing (P < or = .012), photophobia (P < or = .014), and pain (P < or = .049). Half as many patients from the ketorolac group (14/51) were discontinued from the study for lack of efficacy, compared with the vehicle group (28/51; P = .005). There was no significant difference between ketorolac and the vehicle solution in changes in visual acuity, intraocular pressure, biomicroscopic or ophthalmoscopic variables, or adverse events.

CONCLUSIONS

Ketorolac tromethamine 0.5% ophthalmic solution is safe and provides substantial anti-inflammatory activity in the treatment of moderate to severe anterior segment inflammation developing after cataract surgery and intraocular lens implantation.

Ocular and ocular adnexal injuries treated by United States military ophthalmologists during Operations Desert Shield and Desert Storm

BACKGROUND

Ocular and ocular adnexal injuries, both combat-related and accidental, are common during wartime. In a combat setting, the eye is particularly vulnerable to serious injury from tiny flying particles that might minimally affect other parts of the body. The purpose of this study is to examine the incidence of serious ocular and ocular adnexal injuries that occurred during Operations Desert Shield and Desert Storm.

METHODS

The authors retrospectively reviewed serious ocular and ocular adnexal injuries treated by United States Army and Navy ophthalmologists that occurred during Operations Desert Shield and Desert Storm. Only those injuries that resulted in, or would have resulted in, hospital admission because of the ocular or ocular adnexal injury alone are presented.

RESULTS

During Desert Shield, 20 patients (23 eyes) suffered serious ocular or ocular adnexal injuries compared with 160 patients (198 eyes) in Desert Storm. During Desert Storm, 78% of all serious injuries were caused by blast fragmentation from munitions. More than one third of the 98 globe lacerations reported in this article were 10 mm or less in size. Of 35 enucleations performed during Desert Storm, 94% were the result of munitions fragments.

CONCLUSIONS

During Operation Desert Storm, fragmentation wounds from munitions were the most common cause of ocular and ocular adnexal morbidity. The authors' findings indicate that polycarbonate ballistic protective eyewear could have prevented many of the ocular injuries that they report.

Long-term follow-up of iatrogenic phototoxicity

OBJECTIVE

To evaluate the outcomes of a group of patients who suffered iatrogenic phototoxic injury.

METHODS

The medical records of 24 patients (24 eyes) with iatrogenic phototoxicity from 3 medical centers were reviewed. We report the findings from long-term follow-up of these patients with particular attention to visual outcome, type and duration of procedure, and location of the phototoxic lesion.

RESULTS

Phototoxic injury occurred after anterior segment surgery in 20 eyes and after vitrectomy in 4 eyes. The mean duration of surgery was 109 minutes; there was no statistically significant difference in duration between the anterior segment procedures and the vitrectomies. Mean final visual acuity was 20/40 for all cases (range, 20/15 to counting fingers) and 20/25 for all anterior segment cases. In vitrectomized eyes, the mean final visual acuity was 20/900. Phototoxic lesions tended to spare the fovea after anterior segment surgery and involve the foveal center after vitrectomy.

CONCLUSIONS

In general, patients who suffer phototoxicity do well, and the prognosis is good for extrafoveal lesions. Foveal injury, which often occurs with vitrectomy, usually leads to a worse visual outcome. The development of choroidal neovascularization may have an effect on the ultimate visual outcome as well.

[Surgical indications in intraosseous lipoma of the calcaneus. Case report and critical review of the literature]

Intraosseous lipomas represent a small number of benign bone tumors with incidence rates of approximately 0.1%. In about 15% these neoplasias are localized within the calcaneus, mostly at Ward's triangle. The tumors usually remain clinically inapparent and diagnosis is often obtained incidentally. Although CT scan and MRI provide specific and sensitive diagnostic tools that can distinguish morphology and dignity, surgical treatment is not standardized yet. In conjunction with a case report, we summarize and critically compare current treatment strategies.

Combining parallel pattern generation of electrohydrodynamic lithography with serial addressing

Electrohydrodynamic lithography (EHDL) is a parallel patterning process which typically makes use of topographically structured electrodes to guide pattern formation along areas of higher electrical field strength. The main driving force for pattern formation is an electrostatic pressure acting on a thin film polymer surface caused by a voltage applied between a top and bottom electrode. We here demonstrate that the principle can be applied using an addressable electrode composed of interdigitated fingers. Depending on the applied voltages, line patterns with different periodicities were fabricated. Our proof-of-concept experiments pave the way for a parallel pattern replication process where a serially addressed master is used. We complement the experiments by modelling the potentials across the electrodes and electrostatic forces acting on the polymer surface using different addressing schemes. Numerical simulations of the experimental setup pointed to some critical issues we experienced during the design of the experiments.

Via different electrode addressing schemes in electrohydrodynamic lithography, different patterns were generated.

Multimodal general anesthesia approach for Ex Utero Intrapartum Therapy (EXIT) procedures: two case reports

High-dose volatile anesthesia is the most common method of achieving uterine relaxation for Ex Utero Intrapartum Therapy (EXIT) procedures. Other methods employ nitroglycerin for additional uterine relaxation with or without remifentanil for additional fetal analgesia. We report a combination approach including one minimum alveolar concentration of volatile anesthetic plus nitroglycerin and remifentanil infusions, to provide timely uterine relaxation under general anesthesia for both mother and fetus, during two EXIT procedures.

Dynamics of Sliding Friction between Laser-Induced Periodic Surface Structures (LIPSS) on Stainless Steel and PMMA Microspheres

In this work, we investigated the sliding friction measured between poly(methyl methacrylate) (PMMA) colloidal probes with two different diameters D (1.5 and 15 μm) and laser-induced periodic surface structures (LIPSS) on stainless steel with periodicities Λ of 0.42 and 0.9 μm, when the probes are elastically driven along two directions, perpendicular and parallel to the LIPSS. The time evolution of the friction shows the characteristic features of a reverse stick-slip mechanism recently reported on periodic gratings. The morphologies of colloidal probes and modified steel surfaces are geometrically convoluted in the atomic force microscopy (AFM) topographies simultaneously recorded with the friction measurements. The LIPSS periodicity is only revealed with smaller probes (D = 1.5 μm) and when Λ takes the largest value of 0.9 μm. The average value of the friction force is found to be proportional to the normal load, with a coefficient of friction μ varying between 0.23 and 0.54. The values of μ are rather independent of the direction of motion, and they reach their maximum when the small probe is scanned on the LIPSS with the larger periodicity. The friction is also found to decrease with increasing velocity in all cases, which is attributed to the corresponding decrease of the viscoelastic contact time. These results can be used to model the sliding contacts formed by a set of spherical asperities of different sizes driven on a rough solid surface.