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An 87-year-old woman presented 11 months after routine phacoemulsification cataract extraction and posterior chamber intraocular lens implantation in her left eye complaining of the abrupt onset of redness and decreased vision in that eye. Examination revealed a mild anterior chamber reaction and significant corneal edema. The eye was minimally responsive to topical steroid therapy, and initial serial slitlamp examinations with gonioscopy were unrevealing. After multiple head-positioning maneuvers were performed, a retained nuclear fragment was uncovered. The nuclear fragment was aspirated and liquefied by the phacoemulsification device in the anterior chamber. A retained nuclear fragment with an intact posterior capsule is a recognized cause of inflammation in the immediate postoperative presentation. Delayed presentation of symptoms is rare and presumably secondary to sequestration of the fragment behind the iris. We present a case and a review of the literature regarding sequestered retained nuclear fragments following what is initially thought to be uneventful cataract extraction. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

The article presents a study which showed that combined deficiency of dystrophin and integrins in murine cardiac myocytes leads to more severe cardiomyopathic changes in the stressed myocardium. Mdx mice were crossed to those with cardiac myocyte-specific deletion of Β (ΒKO) integrin to produce Β1KOmdx. It was found that matrix y-carboxyglutamic acid protein, decorin, periostin, and the osteoblast transcription factor Runx2/Cbfal increased in cardiac muscle of Β1KO.

: PurposeTo evaluate the incidence of epithelial defects that occur with laser in situ keratomileusis (LASIK) using nonpreserved carboxymethylcellulose sodium 0.5% solution (Refresh Plus®) intraoperatively.: SettingCommunity-based refractive center.: MethodsThis retrospective study comprised 105 patients (210 eyes) who had primary bilateral LASIK by 1 of 2 surgeons between October 1 and December 1, 2000. The 114 eyes treated subsequent to November 1, 2000, received Refresh Plus intraoperatively, and the 96 eyes treated before this date did not. The incidence of epithelial defects and diffuse lamellar keratitis (DLK) in both groups was recorded. The preoperative keratometry measurements of all cases were also recorded.: ResultsThere was a statistically significant decrease in the incidence of epithelial defects in the group that received Refresh Plus intraoperatively (P = .02). No statistically significant between-group difference in the incidence of DLK was detected. Analysis of the keratometry measurements revealed no statistically significant association between the amount or axis of astigmatism and the incidence of epithelial defects or DLK.: ConclusionThe intraoperative use of nonpreserved Refresh Plus significantly decreased the rate of epithelial defects that occurred during LASIK. [Copyright &y& Elsevier]

: PurposeTo investigate the association between the use of carboxymethylcellulose sodium 1% (Celluvisc®) (Allergan, Inc.) during laser in situ keratomileusis (LASIK) and the development of diffuse lamellar keratitis (DLK).: SettingOutpatient surgery center, Detroit, Michigan, USA.: MethodsIn this retrospective case series, the postoperative clinical course and surgical outcomes in 30 eyes of 15 consecutive patients who had LASIK with the use of Celluvisc were reviewed. All patients had primary LASIK, and the incidence and severity of DLK were analyzed.: ResultsDiffuse lamellar keratitis developed in 24 of the 30 eyes (80.0%) in which Celluvisc was used before the keratectomy (P = < .0001, Fischer exact test). Sixteen eyes (66.7%) had stage 1, and 8 (33.3%) had stage 2. Diffuse lamellar keratitis was diagnosed in most cases (91.6%) on postoperative day 1. All inflammation resolved after treatment with intense topical corticosteroids.: ConclusionsCelluvisc used immediately before the keratectomy in LASIK was highly associated with the development of DLK. [Copyright &y& Elsevier]

Purpose: The aim of this study was to describe a simple technique to insert a venous catheter as a stent for the treatment of acquired punctal and canalicular stenosis., Methods: We performed this technique using a central venous catheter as a stent for the treatment of acquired punctal and canalicular stenosis., Results: The results show the easy availability of the material used for the intervention, its easy execution, and the low costs of materials. The goal of this technique is to have a lacrimal dot dilated and canalicular duct easy to irrigate., Conclusion: The use of a venous catheter as a stent for treatment of acquired punctal and canalicular stenosis seems to be simple, safe, repeatable, and noninvasive.

The dystrophin-glycoprotein complex is a large complex of membrane-associated proteins linking the cytoskeleton to the extracellular matrix in muscle. Transmembrane heterodimeric (alphabeta) integrins serve also as cellular adhesion molecules and mechanotransducers. In the animal model for Duchenne muscular dystrophy, the mdx mouse, loss of dystrophin causes more severe abnormalities in skeletal than in cardiac muscle. We hypothesized that ablation of cardiac myocyte integrins in the mdx background would lead to a severe cardiomyopathic phenotype. Mdx mice were crossed to ones with cardiac myocyte-specific deletion of beta1 integrin (beta1KO) to generate beta1KOmdx. Unstressed beta1KOmdx mice were viable and had normal cardiac function; however, high mortality was seen in peri- and postpartum females by 6 months of age, when severe myocardial necrosis and fibrosis and extensive dystrophic calcification was seen. Decreased ventricular function and blunted adrenergic responsiveness was found in the beta1KOmdx mice compared with control (Lox/Lox, no Cre), beta1KO, and mdx. Similarly, adult beta1KOmdx males were more prone to isoproterenol-induced heart failure and death compared with control groups. Given the extensive calcification, we analyzed transcript levels of genes linked to fibrosis and calcification and found matrix gamma-carboxyglutamic acid protein, decorin, periostin, and the osteoblast transcription factor Runx2/Cbfa1 significantly increased in beta1KOmdx cardiac muscle. Our data show that combined deficiency of dystrophin and integrins in murine cardiac myocytes results in more severe cardiomyopathic changes in the stressed myocardium than reduction of either dystrophin or integrins alone and predisposes to myocardial calcification.

Purpose of Review: Confocal microscopy's role within ophthalmology has been evolving since the introduction of this technology in 1955. The purpose of this review is to describe the confocal microscope and illustrate its recent ophthalmic applications., Recent Findings: Numerous investigators have used confocal microscopy to research ophthalmic disease and to find new diagnostic applications. This review will describe the development and uses of this technology. The cornea was the first ophthalmic tissue to be imaged due to its transparency, although, tissues, such as conjunctiva, are now being studied. This article will review normal confocal corneal appearance and discuss a wide range of recent applications that include corneal infections, dystrophies and disease. Furthermore, this article will discuss recent developments in refractive surgery, ocular surgery and various miscellaneous discoveries., Summary: Confocal microscopy is developing into a powerful research and diagnostic tool in ophthalmology. The future uses of this novel technology will evolve and is increasingly becoming a vital tool in the ophthalmologist's armamentarium.

Purpose of Review: To summarize the known uses of in-vivo confocal microscopy in refractive surgery, highlighting the current developments in the field., Recent Findings: Examination of the cornea after laser in-situ keratomileusis demonstrated that the keratocyte density within the laser in-situ keratomileusis flap and anterior residual corneal bed continued to decline during the entire 3-year period of the study. The progressive loss of keratocytes in the flap and anterior portion of the residual corneal bed could have long-term implications in terms of corneal stability, refractive stability and cellular integrity after laser in-situ keratomileusis. Additional studies showed that the density of sub-basal nerves decreased by 90% 1 month after laser in-situ keratomileusis. At some point between 3 and 6 months after laser in-situ keratomileusis, the sub-basal nerves began to recover and by 2 years they had reached approximately 50% of their original preoperative density. Analysis of sub-basal nerve density after photorefractive keratectomy reported that the nerve density completely recovered to preoperative levels by 2 years. Other confocal microscopic studies demonstrated that the microscope can detect infectious organisms in vivo, without stains or dyes., Summary: The confocal microscope is a unique diagnostic instrument that can be used to evaluate corneal healing, long-term stability and to assess complications after refractive surgery. The ability of the device to view in-vivo cellular detail, microorganisms, inflammatory cells, epitheliod cells, fibrosis and measure the postoperative thickness of the residual corneal bed after laser in-situ keratomileusis, in a noninvasive manner, highlights the unique capabilities of this instrument.

Objective: To determine whether ketorolac (Acular) treatment and other factors influence regression after LASIK-induced consecutive hyperopia., Methods: Seventy-two eyes of 51 patients who had undergone LASIK for myopia and compound myopic astigmatism and who experienced consecutive hyperopia of at least +0.50 diopters within the first postoperative week were analyzed. The consenting patients were treated with ketorolac (Acular). Data were collected over a period of 2 months. Primary preoperative variables included age, eye, preoperative manifest and cycloplegic refractions, and pachymetry. Postoperative variables included presence of microstriae and treatment with ketorolac. Treatment success was measured as reduction of consecutive hyperopia., Results: Thirty-seven eyes were treated, and 35 eyes were in the control group. Mean start time for treatment with ketorolac was 9 days after surgery (range 3-35 days). Mean treatment time was 24.5 days (range 10-63 days). Both groups were matched for all preoperative variables except for age, including manifest and cycloplegic refraction, eye treated, and pachymetry. Treated patients were on average 9 years older than the control group. There was no significant difference in the overall rate of regression between the 2 groups at the 1-month and 2-month periods. Thicker preoperative corneas in all eyes had a sporadic association with reduction of consecutive hyperopia., Conclusions: Ketorolac does not improve consecutive hyperopia after LASIK for myopia and compound myopic astigmatism when compared with a matched control group. Pachymetry appears to be a determining factor in the degree of regression experienced after consecutive hyperopia. This finding warrants further investigation.

Purpose: To evaluate the use of a human fibrin tissue adhesive in the adherence of corneal lamellar flaps in rabbit eyes., Methods: Corneal flaps were made using a microkeratome in both eyes of six New Zealand white rabbits. In the right eyes, the flaps were glued with fibrin tissue adhesive; in the left eyes, flaps were allowed to heal without adhesive (controls). All eyes were treated with antibiotics and steroids once daily for 10 days. Slit-lamp biomicroscopy was performed 1 and 10 days after surgery. The rabbits with surviving flaps were euthanized and the corneas obtained for histopathologic examination 10 days after surgery., Results: Slit-lamp examinations showed no interface deposits and no other signs of corneal toxicity. Histologically, a few inflammatory cells were seen in both the experimental and control eyes, and microscopic gapping and tissue debris were observed in three of the six control eyes., Conclusions: Human fibrin tissue glue was well tolerated in these eyes, with no or minimal corneal toxicity. Further studies are needed to determine the tensile strength of the adhesive bond in the cornea.