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Clinically normal buttock skin of 20 diabetic and eight control subjects, aged 16-30 years, was examined using electron microscopy. The number of layers of cellular material in vessel walls, external to the endothelial cell was increased in patients with a long duration of diabetes, but was never more than two layers in control subjects. Prominent collagen deposition in the wall of dermal blood vessels was observed only in diabetic skin. No ultrastructural features were significantly related to recent glycaemic control, or with the presence of identified microvascular complications of diabetes. The difficulties involved in the interpretation of electron microscopy of diabetic skin are discussed. Routine electron microscopical examination of clinically normal diabetic skin provides little information of clinical value on an individual basis. [ABSTRACT FROM AUTHOR]

Biopsies of clinically normal skin of 22 young patients with insulin-dependent diabetes of varying duration ( > 10 years, n= 12; <5 years, n= 10) were examined using a panel of histological stains, and compared with those of 10 non-diabetic control subjects of similar age. Abnormalities under light microscopy were scored for severity. Scores for both groups of diabetics were significantly greater than scores for controls (P<0.001). Increased upper dermal vasculature and PAS positivity of blood vessel walls were more frequent in diabetic skin than in controls, and increased with duration of disease. PAS positivity was caused in part by deposition of glycogen in endothelial cells. Clumping of elastic fibres in the upper dermis was observed in seven of the 22 skin biopsies from diabetic patients, but not in control biopsies. An inflammatory infiltrate was more frequent in diabetic skin. No association was demonstrated between the histological scores and the presence of diabetic retinopathy, or the concentration of glycosylated haemoglobin in the diabetic subjects. None of the histological features was specific to diabetic skin. [ABSTRACT FROM AUTHOR]

Objective: To establish the practice patterns of the members of the Canadian Ophthalmological Society (COS) in cataract surgery., Design: Web-based questionnaire., Participants: Members of the COS indicating practice focus to be cataract surgery., Methods: In January 2011 an e-mail with a link to Fluid Surveys was sent from the COS office to the 292 members who had indicated their practices' focus to be cataract surgery. A reminder e-mail was sent 3 weeks later. Approval for the survey was obtained from the Regina Qu'Appelle Health Region Research Ethics Board. All responses were collected anonymously., Results: There were 92 responses (31.5%). In 2009, the response rate was 20.7%, and in 2010 it was 32.5%. The results of the 3 surveys were compared. There was a gradual increase in the use of topical-only anaesthesia, in the number of days during which the nonsteroidal anti-inflammatory drug (NSAID) eye drops were used preoperatively, and in the use of multifocal and toric intraocular lenses. Postoperatively, the use of an NSAID eye drop alone remained unchanged, but there was a decrease in the use of steroid eye drops alone and a corresponding increase in the use of a combination steroid and NSAID eye drop., Conclusions: Over the past 3 years the majority of the practice patterns in cataract surgery by the members of the Canadian Ophthalmological Society have remained unchanged. However, there were certain areas where definite trends were noted., (Copyright © 2012 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Objective: To establish the cataract surgery practice patterns of the members of the Canadian Ophthalmological Society (COS)., Study Design: Web-based questionnaire., Methods: In January 2010, an email with a link to SurveyMonkey was sent from the COS office to its 305 members who had indicated their practice focus is cataract surgery. A reminder email was sent 2 weeks later. All responses were collected anonymously., Results: There was a 32.5% response rate (99 responses), compared with 20.7% in 2009. Two respondents volunteered that they no longer performed cataract surgery and 1 response was incomplete; therefore, 96 responses were analyzed. The results of the 2010 survey were compared to those of the 2009 survey., Conclusions: While the majority of the practice patterns analyzed were unchanged between the 2009 and 2010 surveys, there appears to be a trend to start nonsteroidal anti-inflammatory drug eye drops earlier preoperatively and an increase in the use of one-piece hydrophobic acrylic, aspheric, and blue-blocking intraocular lenses. The use of the fourth generation fluoroquinolone antibiotic gatifloxacin has increased at the expense of older antibiotics.

Objective: To establish the practice patterns of the members of the Canadian Ophthalmological Society (COS) in cataract surgery., Design: A questionnaire consisting of multiple choice questions on cataract surgery practices was sent as an attachment by email to the members of the COS., Participants: Seven-hundred and seventy-seven COS members with a valid email address in the Society's database., Methods: A 29-item questionnaire pertaining to cataract surgery practices was sent by email. A reminder email with the attached questionnaire was sent 3 weeks later. The survey data were descriptively analyzed with the Statistical Package for the Social Sciences (SPSS) v 16.0 software and the results compared with those from surveys by the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons., Results: There were 161 responses. Of these, 30 members did not do any cataract surgery, and a further 8 responses were incomplete, therefore, 123 responses were analyzed. The majority of the respondents (69.1%) were between 40-59 years old. Phacoemulsification was the procedure of choice of all the respondents. Topical anaesthesia with clear corneal incisions was the most popular technique. Only 59.8% of respondents used a NSAID drop while 90.1% used a steroid drop postoperatively., Conclusions: The practice patterns of the members of the COS for cataract surgery have not been reported before. This survey will serve as a baseline for future ones.

Purpose: To determine whether adrenaline in the irrigating solution is necessary when diclofenac eyedrops are used before cataract surgery., Setting: Pasqua Hospital, Regina, Saskatchewan, Canada., Methods: In this prospective randomized masked study, all patients used diclofenac eyedrops 2 days preoperatively. The pupils were dilated with a wick soaked in a dilating solution containing diclofenac. Patients were divided into 2 groups. One group had 0.5 mL of 1:1000 adrenaline in 500.0 mL of fortified balanced salt solution (BSS Plus) (adrenaline group). The other group did not (no-adrenaline group). The horizontal diameter of the pupils was measured with calipers., Results: The study included 207 patients. There were no surgical complications. In the adrenaline group, the mean pupil size was 8.19 mm +/- 0.86 (SD) before the first incision, 8.14 +/- 0.87 mm after phacoemulsification, and 8.14 +/- 0.85 mm after cortical removal. In the no-adrenaline group, the means were 8.19 +/- 0.87 mm, 7.94 +/- 0.99 mm, and 7.87 +/-1.03 mm, respectively. The mean pupil constriction was 0.05 +/- 0.21 mm in the adrenaline group and 0.33 +/- 0.43 mm in the no-adrenaline group. The difference was statistically significant (Mann-Whitney test). Further analysis of preoperative pupil size showed a significant difference for smaller pupils only., Conclusions: When diclofenac eyedrops were used before cataract surgery, the smaller preoperative pupils constricted significantly less when adrenaline was added to the irrigating solution. This was not true for larger pupils. Thus, adrenaline in the irrigating solution does not appear necessary in eyes with large preoperative pupils.

Purpose: To determine whether the penetration into the aqueous humor of gatifloxacin (Zymar) and moxifloxacin (Vigamox) eyedrops was affected by altering their concentrations in the dilating mixture in which the wick used to dilate the pupil before cataract surgery was soaked., Setting: Pasqua Hospital, Regina, Saskatchewan, Canada., Methods: This prospective randomized open-label study comprised 65 women and 35 men who were divided into 2 main groups. One group received 1 mL of the antibiotic in the dilating mixture and the other, 2 mL. Each group was divided into 2 subgroups, 1 for gatifloxacin and 1 for moxifloxacin. At the beginning of surgery, 0.1 mL of aqueous humor was aspirated, frozen, and couriered to the provincial laboratory for analysis by high-performance liquid chromatography., Results: In the first group, the mean concentration of gatifloxacin in the aqueous humor was 0.30 microg/mL +/- 0.21 (SD) and of moxifloxacin, 0.97 +/- 0.63 microg/mL. When the volume of the antibiotic in the dilating mixture was doubled, the mean concentration increased to 0.34 +/- 0.25 microg/mL and 1.37 +/- 0.79 microg/mL, respectively. Only the increased penetration of moxifloxacin was statistically significant., Conclusions: Moxifloxacin penetrated the aqueous humor better than gatifloxacin when given in a wick soaked in the dilating mixture before cataract surgery. Only the penetration of moxifloxacin increased significantly when the volume of the antibiotic in the dilating mixture was doubled. In both groups, only moxifloxacin reached and exceeded the minimum inhibitory concentration levels for the most common ocular pathogens causing endophthalmitis.

Purpose: To determine whether the penetration into the aqueous humor of 2 new fourth-generation fluoroquinolone antibiotics, gatifloxacin (Zymar) and moxifloxacin (Vigamox) eyedrops, was affected by different methods of administration before cataract surgery., Setting: Pasqua Hospital, Regina, Saskatchewan, Canada., Methods: This prospective randomized study comprised 193 patients. The patients were divided into 2 main groups. One group received gatifloxacin eyedrops and the other, moxifloxacin eyedrops. Each group was subdivided into 4 subgroups. All patients received the drops 4 times a day starting 2 days preoperatively. The first subgroup did not receive any more antibiotics. The second subgroup received the antibiotic drops 3 times, starting approximately 2 hours preoperatively. The third subgroup received a wick soaked in a dilating mixture containing the antibiotic. The fourth subgroup received the wick and the antibiotic drops at the time of preparation for surgery. At the beginning of surgery, 0.1 mL of aqueous humor was aspirated, frozen, and sent under ice by courier to the Provincial Laboratory for analysis by high-performance liquid chromatography., Results: The study included 124 women and 69 men. The mean concentrations in the aqueous humor were 0.19, 0.82, 0.22, and 0.30 microg/mL in the 4 gatifloxacin subgroups, respectively, and 0.38, 2.16, 0.88, and 0.97 microg/mL in the 4 moxifloxacin subgroups, respectively. Analysis of variance showed the differences between the 2 antibiotics to be statistically significant., Conclusions: Moxifloxacin penetrated the aqueous humor better than gatifloxacin regardless of the method of administration. Both antibiotics penetrated the aqueous humor well when given in drop form. They reached and exceeded the minimum inhibitory concentration levels for the most common ocular pathogens causing endophthalmitis. Only moxifloxacin reached these levels when the wick was used.

Purpose: To survey the members of the Canadian Society of Cataract and Refractive Surgery (CSCRS) and identify their practices regarding the perioperative use of warfarin and acetylsalicylic acid (aspirin) in cataract surgery., Setting: Private practice, Regina, Saskatchewan, Canada., Methods: Members of the CSCRS were faxed a questionnaire that examined their perioperative management of patients being treated with warfarin and aspirin., Results: Of the 110 eligible participants, 82 returned a completed questionnaire, representing a response rate of 74.5%. Warfarin or aspirin was routinely stopped prior to cataract surgery by 25.6% of the respondents. The majority of surgeons who discontinued these medications reported doing so 3 to 7 days prior to surgery and resumed their use 1 to 2 days postoperatively. Topical anesthesia and clear corneal incisions were preferred by the higher volume surgeons. These surgeons were also less likely to discontinue either warfarin or aspirin preoperatively., Conclusions: The majority of the Canadian Society of Cataract and Refractive Surgery members do not stop either warfarin or aspirin for cataract surgery during the perioperative period.

Before cataract surgery at our institution, we traditionally dilated the pupils with 5 drops: proparacaine 0.5%, cyclopentolate 1%, phenylephrine 2.5%, flurbiprofen sodium 0.03% (Ocufen), and ofloxacin 0.3% (Ocuflox) at 15-minute intervals given 3 times. This was work intensive for the nursing staff. Since September 2000, we have used a wick soaked in a dilating mixture containing cyclopentolate 1%, phenylephrine 2.5%, diclofenac sodium 0.1% (Voltaren), and Ocuflox. Use of the wick has been beneficial and time saving to hospital staff.

Among the recognized complications of retrobulbar anesthesia, postoperative permanent diplopia has rarely been reported. We describe two patients with inferior rectus muscle restriction after retrobulbar anesthesia for cataract extraction and intraocular lens implantation. Both did well after inferior rectus recession with placement of an adjustable suture.

Nine heroin addicts with presumed candidal endophthalmitis were seen in Glasgow between November 1982 and April 1984. Six patients during a two month period in 1983. The physical symptoms and signs observed, results of laboratory investigations and responses to anti-fungal chemotherapy are reported. Epidemiological factors relating to possible sources of infection are explored.

We have compared left ventricular function in 40 insulin-dependent diabetic patients (30 male, 10 female) aged 16-30 years (mean 23 years) with duration of diabetes 3 months to 25 years (mean 10 years) with 19 healthy age and sex-matched controls using radionuclide ventriculography at rest, during cold-pressor stimulation, isometric exercise, and dynamic exercise. There were no differences in exercise or smoking habits in the two groups. All subjects had a normal resting electrocardiogram and a normal electrocardiographic response to dynamic exercise using the Bruce protocol on the Marquette Computer Assisted System of Exercise. Left ventricular ejection fraction was similar at rest and fell in diabetics and controls, respectively, by 2.3 +/- 1.0% and 3.0 +/- 0.08% (NS) and by 2.4 +/- 0.8% and 2.2 +/- 0.8% (NS) during isometric exercise, and cold pressor testing. During supine dynamic exercise on a bicycle ergometer ejection fraction rose in both groups by 13.9 +/- 1.7% and 13.7 +/- 1.6%, respectively (NS). No statistically significant differences were found in peak ventricular filling and emptying rates and abnormalities of regional wall motion did not develop. Two female patients with diabetes for more than 10 years had an abnormal response to dynamic exercise manifested by a fall in ejection fraction. In comparison to the higher frequency of abnormalities reported in diabetics using echocardiography and the measurement of systolic time intervals, abnormal left ventricular function assessed by radionuclide ventriculography is uncommon in young patients.