Transient monocular abduction on upgaze with impaired downward pursuit in downgaze – a new pattern of misdirection?

A patient with a long history of diplopia on upgaze was examined clinically and electro-oculographically. Upward saccades were normal in the right eye, whilst the left eye made a diagonal saccade up and to the left, coming back to midline with a slow movement. Only minor underaction of her left lateral rectus was observed on examination and both adducting and abducting saccades were of normal velocity. Upward smooth pursuit was largely smooth, albeit with occasional saccadic intrusions; downward pursuit was smooth from upgaze to the horizontal and saccadic from there to downgaze. The saccadic defect could arise from a misdirected axonal projection from the third nerve nucleus to the left lateral rectus; the pursuit deficit could arise from a proposed misrouting of vertical smooth pursuit signals.     

Techniques,indications and complications of corneal debridement

The cornea is the most exposed surface of the eye and, as such, is vulnerable to external trauma and the risk of infection. Many corneal diseases alter shape, surface, and transparency and thus result in reduced vision. The external position of the cornea, however, lends itself to diagnostic and therapeutic maneuvers that are commonly performed and readily done in the clinic. More sophisticated techniques require the use of complex equipment such as excimer and femtosecond laser. Complications that develop from poor healing and/or secondary infection are best avoided with appropriate technique, antisepsis, and modification of wound healing. We review corneal debridement in the management of corneal disease.     

Bleeding during pregnancy is associated with familial preterm birth

Purpose: the purpose of this study is to identify risk factors for familial, likely genetically-determined, preterm birth.

Materials and methods: We performed a case–control study, enrolling 211 patients (103 cases and 108 controls). Cases delivered between 20 and 35 weeks gestation, with a prior preterm birth or first-degree relative born prematurely. Controls delivered between 37–42 weeks. Groups were compared using a comprehensive questionnaire validated by medical record. Multivariate logistic regression assessed risk factor associations.

Results: Of cases, 30% reported bleeding during pregnancy compared with 5% of controls, adjusted odds ratio (adjOR) 9.0, 95%CI 3.31–24.47. Of cases that delivered at 20–28 weeks, 44.8% reported bleeding during pregnancy compared with 24.6% at 29–35 weeks, p?=?.04. Other associations were prior first-trimester miscarriage adjOR 2.55 (CI 1.21–5.35) or second-trimester miscarriage, adjOR 6.3 (CI 1.76–22.56).

Conclusions: Bleeding during pregnancy and prior miscarriage were significantly associated with familial preterm birth. The magnitude of effect for bleeding in pregnancy was higher with earlier preterm births. These associations warrant further investigation.