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The value of intraoperative digital subtraction angiography in surgery for intracranial aneurysms, the benefits and cost-effectiveness are a matter of discussion. We prospectively studied 126 patients with 144 aneurysms, most on the anterior intracranial circulation, who underwent clipping and intraoperative angiography. Follow-up was 28.4 +/- 13.1 months. We tried to work out the indications for intraoperative angiography of the anterior circulation and its cost-effectiveness. In 10.3 % of patients (9 % per aneurysm) unexpected findings were shown by intraoperative angiography: inadequately clipped aneurysms in 10 (7.9 %), a completely unclipped aneurysm in one (0.8 %) and occluded major arteries in two (1.6 %). A broad neck was a variable of statistical significance for inadequate clipping or stenosis or occlusion of an adjacent vessel. There was a strong trend for aneurysms more than 15 mm in diameter to be "risky". Their site was not a predictive factor. We believe that intraoperative angiography is indicated in surgery not only on large and giant aneurysms, but also broad-based aneurysms of the anterior cerebral circulation regardless of their size. It is cost-effective compared to postoperative angiography. The rate of stroke in our hands was 0.8%.

Objective:To determine stromal thermal changes after erbium (Er):YAG laser corneal trephination with the use of 2 open masks. Methods: Corneal trephination was performed in 89 enucleated pig eyes with an Er:YAG laser (400microsecond pulse duration), 4 open masks (2 metallic and 2 ceramic) for both donors and recipients, and an automated globe rotation device. Different combinations of laser settings were used: pulse energy, 100, 200, and 400 mJ; repetition rate, 2 and 5 Hz; and spot size, 1.3 and 3.2 mm. Thermal effects in corneal stroma and regularity of the cut edges were quantitatively assessed by light microscopy, transmission and scanning electron microscopy.Results: Best regularity and minimal thermal effects of the cut were observed with the use of ceramic masks at 200 mJ, 2 Hz, and 3.2-mm spot size, with middepth ther-mal changes of 18 ± 2 µm. Effects increased with cut depth and were lower in donor corneas and with the use of ceramic masks (PϽ.001). Regularity of the cut was higher in the donors (P = .05) with lower repetition rates (PϽ.001). Conclusions:Even with the "free-running" Er:YAG laser mode, features of the trephination cut resembling those created by the 193-nm excimer laser along metal mask were achieved. Ceramic masks may be more suitable than metal masks. The Er:YAG laser seems to have the potential to be a compact and low-cost alternative in nonmechanical trephination for penetrating keratoplasty.Clinical Relevance: Thermal effects after corneal trephination with the free-running Er:YAG laser (2.94 mm) are limited and predictable.

Our results demonstrate a breakdown of the blood-ocular barriers in eyes with retinal detachment and an elevation of corpuscular elements in aqueous as manifestations of pseudouveitis. In eyes with PVR the alteration of blood-ocular barriers seems to be more extensive than in eyes without PVR indicating a possible role of the LFCM for early detection of PVR.

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