Management of submacular hemorrhage with intravitreous tissue plasminogen activator injection and pneumatic displacement

Objective

To investigate the efficacy and safety of treating thick submacular hemorrhages with intravitreous tissue plasminogen activator (tPA) and pneumatic displacement.

Routine childhood vaccination programme coverage,El Salvador, 2011—In search of timeliness

While assessing immunization programmes, not only vaccination coverage is important, but also timely receipt of vaccines. We estimated both vaccination coverage and timeliness, as well as reasons for non-vaccination, and identified predictors of delayed or missed vaccination, for vaccines of the first two years of age, in El Salvador.     

Trace elements in pacific Dunlin (Calidris alpina pacifica): patterns of accumulation and concentrations in kidneys and feathers

Ecotoxicology - Trace element concentrations were measured in Pacific Dunlin (Calidris alpina pacifica) to identify factors that influence accumulation and to assess toxicity risks. We report...     

RPE CD14 immunohistochemical,genetic, and functional expression

CD14 is the primary receptor for lipopolysaccharide (LPS)that plays important roles in host defense and subserves other host-related biological functions. We previously identified CD14 on cultured human retinal pigment epithelial (HRPE) cells using immunocytochemical techniques. In this study, we investigated immunoreactive HRPE CD14 expression by immunohistochemically staining HRPE cells and HRPE cells in sections of human eyes with anti-CD14 monoclonal antibodies (mAb). Constitutive HRPE gene and protein expression were confirmed by semiquantitative PCR and western blotting. ELISA for cell-associated and secreted (s) HRPE CD14 revealed that specific digestion by phosphoinositol-specific phospholipase C (PI-PLC) significantly reduced (P<0.01) cell-associated HRPE CD14 which was not modulated by LPS or gamma-IFN. ELISA of the conditioned media (CM) of HRPE cells treated with PI-PLC contained significantly more (P<0.001) sCD14, but sCD14 was not modulated by LPS or gamma-IFN. FACS analysis confirmed HRPE cell surface CD14. To show functional CD14, fluorescently-labelled LPS and CD14 were demonstrated to show significant co-localization on live, cultured HRPE cells in close proximity (<7A) as demonstrated by resonance energy transfer of the fluorescent ligands (P<0.0001). Significant inhibition (P<0.001) of LPS-induced IL-8 secretion, as measured by ELISA, occurred in the presence of function blocking anti-CD14 mAb. Significant inhibition of LPS-induced HRPE IL-8 secretion by PKC, PTK, PI3 kinase, and p38 kinase inhibitors indicated cell mediators responsible for LPS-induced HRPE chemokine secretion. This study demonstrates that HRPE cells express functional CD14 in vitro and in situ along at the outer blood-retina barrier.     

Human RPE cell lysis of extracellular matrix: functional urokinase plasminogen activator receptor (uPAR), collagenase and elastase

Age-related macular degeneration (ARMD), proliferative vitreoretinopathy (PVR) and uveitis are characterized by RPE motility through the ECM of retinal lesions. The purpose of this study was to test the hypothesis that multiple proteolytic systems are functionally intact at the HRPE surface and peri-cellular region and that these activities are differentially modulated by IL-1beta. HRPE cells were evaluated: (1). as individual cells or cell extracts, (2). during migration across three-dimensional ECM-like layers and (3). in tissue sections. The urokirase plasminogen activator receptor (uPAR; CD87) was detected on HRPE cells as well as its functional activity. Although uPAR was associated with CD11b (CR3) on live resting cells, polarized migratory HRPE cells were found to dissociate uPAR from CR3; uPAR then translocated to anterior pole of the cell, where it enhanced PAI-1-inhibitable local proteolytic activity. The relative contribution of uPAR and collagenase in HRPE migration was evaluated using three-dimensional gelatin matrices. Interestingly, uPAR/uPA was found to play a key role in migration across these layers. IL-1 upregulated uPAR, collagenase, and elastase activities, suggesting that cytokines may affect the invasive program of HRPE cells in vivo. Immunohistochemistry for uPAR was performed in sections of human retina. Immunoreactive uPAR was present along the HRPE basolateral membrane in retinal sections and in sections of diseased retinal tissue at an enhanced level. Our results suggest that multiple proteolytic systems are present in association with HRPE and that the uPAR/uPA system may be particularly important.     

Atopy: a patient-specific risk factor for diffuse lamellar keratitis

OBJECTIVE: To identify whether atopy is a patient-specific risk factor for the development of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK). DESIGN: Retrospective survey study. PARTICIPANTS: Three hundred sixty consecutive patients who underwent same-day bilateral myopic astigmatic primary LASIK procedures during March 1, 2000, through July 31, 2000. METHODS: We collected data for 360 consecutive patients undergoing LASIK during a 4-month period. On preoperative medical history questionnaires, patients self-identified whether they were atopic. All patients also indicated whether they were taking antiallergy medications or were untreated for allergy. MAIN OUTCOME MEASURES: The incidence of DLK after LASIK surgery. RESULTS: The risk of DLK in untreated atopic patients was much greater than the risk of DLK among nonatopics (odds ratio, 5.85; 95% confidence interval, 2.89-11.85; P = 0.001). However, the risk of DLK among atopic patients taking an oral systemic nonsedating histamine receptor 1 antagonist and among nonatopic patients did not differ significantly (odds ratio, 0.54; 95% confidence interval, 0.12-2.46; P = 0.43). CONCLUSIONS: Atopy is a patient-specific risk factor for the development of DLK after primary bilateral LASIK for either myopia or myopic astigmatism. Atopic individuals benefit from preoperative treatment to minimize the incidence of DLK and the potential for visual loss.     

Transcaruncular approach to medial canthal tendon plication for lower eyelid laxity

PURPOSE: A new operation to correct lower eyelid laxity was evaluated. METHODS: A new transcaruncular, orbital approach to posterior medial canthal tendon plication was performed on eight orbits of four cadavers, which were then analyzed with computed tomography or histologic techniques. The procedure was also performed on 23 eyelids of 15 patients with lower eyelid medial canthal tendon laxity, alone or in conjunction with other procedures. These patients were followed up for a mean of 12 months. RESULTS: Improved postoperative eyelid position, epiphora, and superficial punctate keratopathy were found. Radiographic and histologic analysis demonstrated consistency of suture placement without involvement of contiguous anatomical structures. CONCLUSIONS: This procedure appears to be a safe, reproducible, and effective corrective procedure for medial canthal tendon laxity and lagophthalmos. When combined with lateral lower eyelid tightening, it is also an effective treatment for lower eyelid retraction and superficial punctate keratopathy. Other potential advantages and complications of this procedure are described in comparison to other reported surgical methods used to address medial canthal tendon laxity and malpositions of the medial lower eyelid.     

Pigmented orbital mass due to remote pencil trauma

A 45-year-old woman with a medial canthal mass associated with new-onset epiphora was found to have a darkly pigmented mass arising from the lacrimal sac wall because of intranasal pencil trauma 40 years before. Resection of the graphite-induced granuloma with dacryocystorhinostomy was curative.