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And failure in these inflamed eyes.33, 34 The success rate of corneal transplantation in terms of graft clarity is also poor in patients with immunologic or ocular surface disorders. The use of tissue adhesives in this setting, to delay or avoid penetrating keratoplasty until the eye is less inflamed and the ocular surface is healthier, can be invaluable. Kenyon5 and others32 have emphasized the importance of early application of corneal glue in any noninfected, progressive thinning disorder before perforation. Not only is the procedure much easier to perform on a nonperforated eye, but tissue adhesive has been shown to arrest the process of ulceration. In addition, Eiferman and Snyder35 reported antibacterial activity of butyl-2-cyanoacrylate against Gram-positive organisms. This antibacterial activity may in part contribute to the success of tissue adhesives in some infected ulcers. In these situations, prevention of perforation with early gluing may be a key factor in a favorable visual outcome. Although the goal of tissue adhesive application is to quickly restore the integrity of the globe, with the understanding that subsequent, more definitive therapy may be needed, it is sometimes successful as a single permanent procedure. Of all perforations and descemetoceles treated with tissue adhesives, 33% to 44% required no additional surgical intervention and healed with tissue adhesive alone.3, 36 Penetrating or lamellar keratoplasty, however, was required in 37% to 43% of cases, and 7% to 9% later required enucleation or evisceration.3, 36 The resulting visual outcome can be quite variable and depends on a large number of complicating factors such as the underlying ocular disease, location and size of the perforation, and visual acuity before perforation. In our experience, tissue adhesive is best suited for small, relatively central perforations 1 to 2 less in diameter at the level of Descemet's membrane, although successful treatment of perforations up to 3 has been reported.36 Cyanoacrylate adhesive works best in ulcerations because they provide a concave surface as opposed to bulging descemetoceles, which have a more convex curvature. Depending on the location and configuration of the ulcer, however, exceptions to these rules exist. Others have found tissue adhesives more useful in peripheral lesions.4 In general, when in doubt, one has little to lose by attempting corneal gluing before undertaking an emergent surgical procedure. In peripheral ulcers, the glue is more likely to dislodge than in a comparable central ulcer primarily because the glue also covers an adjacent area of conjunctiva that does not hold glue well. Not infrequently, with both central and peripheral perforations, the glue may become dislodged, causing shallowing of the anterior chamber. Reapplication of glue may be necessary to restore the integrity of the globe. Despite lack of approval by the Food and Drug Administration FDA ; , Histoacryl blau D-3508 Melsungen, West Germany ; , isobutyl-2-cyanoacrylate, has been a commonly used tissue adhesive for the cornea.37, 38 It has been available in Canada, but not in the United States; however, it is difficult to obtain at the present time. Another polymer, n-butyl cyanoacrylate Nexacryl, Tri and flonase and detrol, for example, succinate. GIC860665 Consolidated with GIC861051 County of San Diego v. San Diego NORML Tentative Ruling re Motions for Judgment on the Pleadings First, the Court states what this ruling is not about. This ruling does not decide whether marijuana has medical benefits, or for whom. Those issues are not before this Court in this matter. This matter presents the Court with issues of law only, and those issues of law are addressed below. A. The Nature and Procedural Posture of this Matter. Case GIC860665 is the declaratory relief action filed on 2 1 County of San Diego against San Diego NORML, State of California, and Sandra Shewry Director of the California Department of Health Services ; . Case GIC861051 is the declaratory relief action filed on 2 8 County of Bernardino and Gary Penrod Sheriff of the County of San Bernardino ; against State of California and Sandra Shewry. On 3 30 06, the above two cases were consolidated, with GIC860665 as the lead case. On 6 2 06, the Court granted County of Merced and Merced County Sheriff Mark Pazin's motion to for leave to file their Complaint In Intervention alleging causes of action for declaratory relief and injunctive relief. On 8 4 06, the Court granted the motion by Wendy Christakes, Pamela Sakuda, Norbert Litzinger, William Britt, Yvonne Westbrook, Stephen O'Brien, the Wo Men's Alliance for Medical Marijuana and Americans for Safe Access collectively, "Patient Intervenors" ; for leave to file their proposed complaint in intervention on condition they simultaneously file an amendment to their proposed complaint in intervention that explicitly states that subdivision d ; of Health and Safety Code section 11362.5 is not being placed in issue by their complaint ; . That complaint in intervention and the amendment thereto were filed on 8 10 06. The three counties and two sheriffs allege that Health and Safety Code1 section 11362.5 "Compassionate Use Act" or "CUA" ; , with the exception of subdivision d ; thereof, and sections 11362.7 through 11362.83 "MMP"2 ; are preempted, by the Supremacy Clause of the United States Constitution, by the federal Controlled Substance Act "CSA" ; and or by the Single Convention on Narcotic Drugs "Single Convention.

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