To determine the incidence of late-onset bleb-related complications following trabeculectomy with mitomycin and to report the management and outcome of bleb leaks following trabeculectomy with mitomycin.Methods: A retrospective medical record review of all patients who underwent trabeculectomy with mitomycin from June 1, 1991, through April 30, 1998, at our institution was performed. The Kaplan-Meier survival method was used to estimate the probability of (1) endophthalmitis, (2) blebitis, (3) a bleb leak, and (4) the combined outcome (the first occurrence of a bleb leak, blebitis, or endophthalmitis). This survival analysis included only the first trabeculectomy in an eye, with at least 3 months of follow-up during the study period. A separate description of bleb leak management and outcome was performed.Results: Two hundred thirty-nine eyes of 198 patients were included in the survival analysis. The average follow-up was 2.7 (range, 0.3-7.3) years. Twenty eyes (8%) from 19 patients experienced a bleb leak; the adjusted incidence was 3.2% per patient-year. Five eyes (2%) had an episode of blebitis. Eight eyes (3%) experienced an episode of endophthalmitis; the follow-up adjusted in-

Cholesterol esterification, catalyzed by acyl-CoA:cholesterol acyltransferase (ACAT), plays a central role in cellular cholesterol homeostasis and in physiologic processes that lead to coronary heart disease. Although ACAT resides in the endoplasmic reticulum (ER), the cholesterol substrate for esterification originates in the plasma membrane and must be transported to the ER for esterification. Progesterone inhibits esterification, possibly by blocking the transport of cholesterol to the ER. Recent studies suggest that progesterone acts by inhibiting the activity of one or more of the multidrugresistant (MDR) P-glycoproteins. In the current manuscript, we demonstrate that progesterone's ability to inhibit esterification is not mediated through the progesterone receptor. We evaluate a series of steroid hormones and find a strong correlation between a steroid hormone's hydrophobicity and its ability to inhibit both cholesterol esterification and MDR-catalyzed drug efflux. We also find that cholesterol esterification is inhibited by nonsteroidal MDR inhibitors, and that this inhibition specifically affects the esterification of cholesterol derived from the plasma membrane. MDR inhibitors also inhibit cholesterol esterification in a wide range of cultured human cell lines. These observations suggest that MDR activity normally functions in a general process of intracellular cholesterol transport. Cells maintain exquisite control over the level of free cholesterol through a complex set of homeostatic mechanisms that control the rates of cholesterol biosynthesis, cholesterol esterification, and receptor mediated endocytosis of cholesterol-rich low density lipoproteins (LDL 1 ; reviewed by Goldstein and Brown (1)). Cholesterol esterification is catalyzed by acyl-CoA: cholesterol acyltransferase (ACAT) in the endoplasmic reticulum (ER) and involves the covalent attachment of fatty acids to the 3-position hydroxyl group of cholesterol to form cholesteryl esters. In a homeostatic process, excess free cholesterol stimulates esterification resulting in the storage of excess cholesterol in the form of cytosolic lipid droplets. While free cholesterol can be toxic to cells, cholesteryl esters can accumulate to relatively high levels. Under most physiologic conditions, the rate of cholesterol esterification is not limited by ACAT levels but rather by the availability of cholesterol substrate in the ER (2, 3). Very little cholesterol is found in the ER; 90% of all cholesterol resides in the plasma membrane (4), and most of the remainder is found in endocytic vesicles derived from the plasma membrane (5). Under conditions of excess cholesterol, cholesterol is transported from the plasma membrane to the ER where it is esterified by ACAT. The mechanism by which this transport occurs is poorly understood.The delivery of plasma membrane cholesterol to the ER is also required for a number of other processes involved in cholesterol homeostasis. HMG-CoA reductase, the rate-limiting enzyme of cholesterol biosynthesis, resides in the ER e...

The phaco-chop technique provided safe, effective cataract extraction with significantly less energy than that required for divide and conquer phacoemulsification.

To give a brief overview of issues pertinent to selecting an ophthalmic electronic medical record (EMR) program and to outline the company demographics and software capabilities of the major vendors in this area. Methods: Software companies shipping an EMR package were contacted to obtain information on their software and company demographics. The focus was on companies selectively marketing to ophthalmology practices, and, therefore, most were selected based on their representation at the 1998 and/or 1999 American Academy of Ophthalmology meeting. Software companies that responded to repeated inquiries in a timely fashion were included.