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The aim of this randomized single-blinded active-controlled clinical study was to evaluate the early efficacy of low-dose Escherichia coli–derived recombinant human bone morphogenetic protein 2 (rhBMP-2) soaked with hydroxyapatite granules (BMP-2/H) as compared with an inorganic bovine bone xenograft (ABX) in maxillary sinus floor augmentation. In a total of 127 subjects who were enrolled at 6 centers, maxillary sinus floors were augmented with 1 mg/mL of rhBMP-2 (0.5 to 2.0 mg per sinus) and BMP-2/H (0.5 to 2.0 g; n = 65) or with ABX alone (0.5 to 2.0 g; n = 62). Core biopsies were obtained 3 mo after the augmentation surgery and were analyzed histomorphometrically. The mean new bone formation with BMP-2/H and ABX augmentation was 16.10% ± 10.52% and 8.25% ± 9.47%, respectively. The BMP-2/H group was noninferior to the ABX group; the lower limit of the 1-sided 97.5% confidence interval for the difference between the 2 groups was calculated as 4.33%, which was greater than the prespecified noninferiority margin of −3.75%. An additional test with the Wilcoxon rank-sum test with a 2-sided 5% significance level showed that bone formation between the 2 groups was significantly different (P < 0.0001). The soft tissue and residual graft areas showed no significant differences between the groups. With regard to safety, no significant difference between the 2 groups was observed; there was no significant increase in the amount of rhBMP-2 antibody in the serum after BMP-2/H grafting. Our study suggested that low-dose Escherichia coli–derived rhBMP-2 with hydroxyapatite was effective in early stages for enhanced bone formation after maxillary sinus floor augmentation without harmful adverse events (Clinicaltrials.gov NCT01634308). [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the role of the passive layers in galvanic corrosion of Ti-Nb alloys and commercially pure titanium (cp-Ti). Ti-Nb alloys with 5, 10, 15, and 20 wt% niobium (Nb) content were prepared using an arc-melting technique under high purity Ar gas. The cp-Ti was used as a control. The electrochemical corrosion behaviors were investigated by A.C. impedance, potentiodynamic polarization, and galvanic corrosion tests. According to the results of impedance analysis, the passivation layer on Ti-Nb alloys consisted of outer, intermediate, inner, and metal defect layers, while the passivation layer on cp-Ti consisted of outer, intermediate, and inner layers. According to the results of anodic polarization tests, Ti-Nb alloys exhibited better zero potentials and reduced zero current densities. The outer layer and the inner layer of Ti-Nb alloys and cp-Ti had an effect mainly on the values of the initial galvanic current density and the sign of galvanic current density, respectively. Ti-10Nb alloy exhibited a relatively high initial galvanic current density compared to the other Ti-Nb alloys. Unlike Ti-5Nb, Ti-10Nb, and Ti-15Nb, which exhibited galvanic current densities with a minus sign, Ti-20Nb exhibited a galvanic current density with a plus sign due to its weaker inner layer than that of Ti. [ABSTRACT FROM AUTHOR]

Purpose: To assess the reproducibility of measurement of retinal nerve fiber layer (RNFL) thickness among subjects using the GDx Nerve Fiber Analyzer (NFA)., Methods: One eye of each of five young and healthy volunteers was imaged by three newly trained technicians (R.-H.P, K.-R.K., and S.-T.K.). Each volunteer was scanned six consecutive times for five independent times within a 1-month period. One composite image was selected out of three best images per session. Intra- and interoperator reproducibilities were calculated and the influence of placement of measurement ellipse by a single operator on interobserver reproducibility was also investigated., Results: Mean coefficients of variation for total integral value of RNFL were 3.67 +/- 1.47%, 3.86 +/- 2.13%, and 4.16 +/- 1.97%, respectively for the three technicians. Interoperator variability was not statistically significant (P = 0.075), and the difference was even less if a single ellipse drawn by one operator was used in all measurements (P = 0.1528) by repeated-measures analysis of variance (ANOVA)., Conclusions: The results suggest that GDx NFA may provide acceptable intraoperator as well as interoperator reproducibility among Asian eyes.

Background and Objectives: To identify risk factors for intraocular pressure (IOP) increases during hemodialysis (HD) in the early postoperative period following pars plana vitrectomy (PPV)., Patients and Methods: Comparisons of 36 vitrectomized eyes of 22 diabetics undergoing maintenance HD with those of 138 eyes of 69 nonoperated patients. Serial IOPs were measured before PPV, after PPV/before dialysis, and during dialysis. Serum osmolarity and blood pressure were also recorded., Results: In 20 of 36 operated eyes (55.6%) and 18 of 138 nonoperated eyes (13.0%) IOP was increased (> or =4 mm Hg) during HD. In the operated group, marked increases (> or =7 mm Hg) were noted in 9 eyes and ocular pain in 5 eyes. Eyes with pre-existing outflow obstruction and/or acute postoperative outflow compromise carried high risks. No correlation with changes in serum osmolarity or blood pressure was found., Conclusion: Monitoring of IOP during HD seems warranted when diabetics with pre-existing outflow obstruction and/or postoperative outflow compromise, undergo HD following PPV.

Objective: To study the surgical outcome and complications of Ahmed glaucoma valve (AGV) implantation with mitomycin C (MMC) in refractory glaucoma., Patients and Methods: The authors retrospectively reviewed the records of 40 eyes in 37 consecutive patients who underwent combined AGV with MMC (0.4 mg/mL; 5 minutes). All patients had a minimum of 6 months of follow-up. Outcome measures were best corrected visual acuity, intraocular pressure (IOP), the number of medications, success rates, and the incidence of complications., Results: The Kaplan-Meier life table analysis revealed that the probabilities of surgical success based on our success criteria at 1 year and 2 years postoperatively were 80% and 77%, respectively. Postoperative IOP was significantly lower at all follow-up intervals. At the final visit fewer glaucoma medications were used (2.5 vs 0.7, preoperative vs postoperative). The most frequent complication was hypotony (17%)., Conclusion: In this retrospective case series with relatively short follow-ups, AGV implantation with mitomycin C in refractory glaucoma appears to be effective without increased complication rates.

Purpose: To evaluate the effect on primary position horizontal binocular alignment of superior oblique tenotomy for A-pattern exotropia with bilateral superior oblique overaction using new surgical and anesthesia techniques., Subjects and Methods: We performed intraoperatively adjustable horizontal strabismus surgery under topical anesthesia in 6 cases of A-pattern exotropia. After adjusting the horizontal deviation nearly to orthotropia in primary position, we measured the angle of horizontal deviation in up-, primary, and downgaze positions. This was followed by bilateral superior oblique tenotomy and remeasurement of the horizontal deviation in the same 3 positions. Postoperatively we remeasured the deviation at one day, one month and three months., Results: There was no immediate change in the horizontal deviation in primary position in 2 of the 6 patients, and 3-8 delta of immediate esotropic shift in 4 of the 6 patients (average 3.3 delta) after bilateral superior oblique tenotomy. At 3 months postop' the small esotropia noted at the immediate postop' measurement became orthotropic. There was a tendency of increased exotropic shift or becoming exotropic in those patients with slight exotropia or orthotropia at the immediate postop' measurement. But these shifts were minimal., Conclusion: When combined surgery of superior oblique and horizontal muscle is planned for A-pattern exotropia, the effect of bilateral superior oblique tenotomy on the primary position horizontal binocular alignment can be disregarded.

We performed penetrating keratoplasty on 32 eyes that developed pseudophakic bullous keratopathy associated with closed-loop anterior chamber intraocular lenses. All lenses were exchanged at the time of keratoplasty. Seventeen patients received anterior chamber intraocular lenses and 15 patients had a posterior chamber lens sutured to the iris or sclera. Postoperatively, 13 of 32 eyes (41%) achieved a visual acuity of 20/100 or better, and 27 of 32 eyes (84%) had a clear graft. A high incidence of cystoid macular edema (eight cases), and graft rejection (seven cases) resulted in marked visual loss.