Role of prophylactic scleral buckling in the management of retained intraocular foreign bodies

Purpose: To evaluate the role of prophylactic scleral buckling procedure with pars plana vitrectomy for the removal of retained intraocular foreign bodies (RIOFB) in the prevention of postoperative retinal detachment. Methods: In a prospective, clinical, controlled study, 28 patients with RIOFB without retinal detachment were randomly divided into two groups of 15 (group I) and 13 (group II) patients. All patients underwent a standard three‐port pars plana vitrectomy with foreign body removal. In addition to this standard procedure, patients assigned to group I had a 360° encircling scleral buckle placed at the time of surgery. Group II patients did not have any scleral buckling. All patients were followed up for an average period of 11.8 months. Both groups were comparable with respect to age, sex, duration of injury, nature of injury, and site, size and type of RIOFB. Results: The retinal detachment rate was found to be 6.6% in group I and 30.8% in group II (P = 0.24). Prophylactic scleral buckling reduced the risk of retinal detachment by 24% but this was not found to be statistically significant. Conclusion: Prophylactic scleral buckle placement with pars plana vitreous surgery for RIOFB may reduce the risk of late onset retinal detachment. A larger study would seem warranted.     

Infectious meningitis: prospective evaluation with magnetization transfer MRI

The study was performed with the aim of prospectively characterizing infectious meningitis of different aetiology using magnetization transfer (MT) MRI. Spin-echo (SE) T(1), T(2) and pre- and post-contrast T(1) weighted MT images in 100 patients with aetiologically proven meningitis were evaluated for the visibility and enhancement of the meninges on pre- and post-contrast T(1) weighted MT images, respectively. The MT ratio (MTR) was calculated from the thickened meninges in tuberculous meningitis. In addition, the percentage difference in the mean signal intensity (SI) of the meninges and adjacent brain parenchyma was calculated and compared between different groups using 2-tailed student's t-test. T(1) weighted MT images were highly sensitive (96%) in the detection of abnormal meningeal enhancement. Meninges were visible on pre-contrast T(1) weighted MT images only in patients with tuberculous meningitis. The MTR from meninges in tuberculous infection was 19.10+/-1.02, and the percentage difference in the mean SI of the meninges and the adjacent T(2) normal brain parenchyma was significantly higher (p<0.05) in the tuberculous group compared with that in the non-tuberculous group. MT MRI is an important technique for the detection and characterization of infectious meningitis of different aetiology. Visibility of the meninges on pre-contrast T(1) weighted MT images may be considered highly suggestive of tuberculous meningitis.     

Changing profile of retinopathy of prematurity

The aim of this study was to determine the evolving trends of retinopathy of prematurity (ROP) at a tertiary neonatal intensive care unit. In an ongoing screening programme for ROP, we estimated the incidence of ROP among at-risk neonates in a tertiary care unit. We compared our data over the last 12 months (1999-2000; period II) to the previously published data (1993-94; period I) to study changes in the spectrum of the disease. The overall incidence of ROP in period II was not significantly different from the incidence in period I (32 vs. 20 per cent, p > 0.05). However, a decreasing trend in the proportion of severe ROP (stage III) from 46 to 21 per cent in the later period was noted. The need for cryotherapy also dropped significantly compared with the earlier period (8 vs. 46 per cent respectively, p < 0.05). On multivariate analysis, apnea (p < 0.001; RR = 12.5; 95 per cent CI, 3.03-50.9; clinical sepsis (p < 0.001; RR = 5.7; 95 per cent CI, 1.6-20.7); and male sex (p < 0.001; RR = 6.3; 95 per cent CI 1.6-25.5) emerged as significant risk factors. Although the incidence of ROP is static, the more severe form of the disease (stage III) is showing a decline. Our data suggests that efficient management of apnea and sepsis may be crucial in further minimizing the risk of ROP.     

The role of estrogen in cardiovascular disease

Cardiovascular disease is the number one cause of death among women, accounting for nearly 50% of female deaths. Statistics show that women on average develop cardiovascular disease 10 to 15 years later in life than men, and that the risk may increase after menopause. This observation has led to much speculation as to what physiological change(s) associated with menopause is responsible for the higher risk of atherosclerosis. Estrogen, with its potential as a cardioprotective agent and as an immunomodulator of the inflammatory response in atherosclerosis, has received the most attention. Understanding the mechanisms that lead to these differences may allow beneficial therapeutic intervention to enhance this effect in females and evoke this protection in males. This review will do the following: (1) characterize mechanisms of atherosclerosis, (2) explore the role of estrogen-replacement therapy, (3) define the effect of gender on inflammation, (4) compare and contrast the effects of estrogen and testosterone on endothelial functional, and (5) suggest mechanistic based therapeutic opportunities.     

Programme planning and screening strategy in retinopathy of prematurity

Retinopathy of Prematurity (ROP) is one of the major emerging causes of childhood blindness. A well organised screening strategy and timely intervention can to a large extent prevent blindness due to ROP. This communication proposes a screening strategy and management plan to develop a model for the care of babies with ROP.     

Intraocular ciprofloxacin levels after oral administration in silicone oil-filled eyes

PURPOSE: To evaluate penetration of oral ciprofloxacin in the retro-silicone oil space fluid (RSOF) in silicone oil (SO)-filled eyes. METHODS: One dose of 750 mg ciprofloxacin was given to two groups of five patients with vitrectomized eyes with SO endotamponade, 4 hours (group I) and 8 hours (group II) before SO removal. In 10 vitrectomized eyes with SO endotamponade (group III) and another 10 patients scheduled for vitrectomy for the first time (group IV), two 750-mg doses every 12 hours, with the last dose 12 hours before surgery, were given. Blood samples were taken at the time of collection of RSOF samples in groups I, II, and III and of the vitreous in group IV. All samples were assayed for ciprofloxacin by high-performance liquid chromatography. RESULTS: The mean drug concentration in the RSOF was 0.34 +/- 0.09, 0.37 +/- 0.04, 0.84 +/- 0.29, and 0.44 +/- 0.11 micro g/mL in groups I, II, III, and IV respectively. The mean serum concentration was 1.29 +/- 0.63, 1.08 +/- 0.14, 1.93 +/- 0.84, and 1.34 +/- 0.55 micro g/mL in groups I, II, III, and IV respectively with no statistically significant difference between groups III and IV (P = 0.081). CONCLUSIONS: Antibiotic levels in the RSOF in SO-filled eyes after oral administration of ciprofloxacin in two 750-mg doses exceeded the minimal inhibitory concentration for 90% of isolates (MIC(90)) for most bacterial species and was higher than levels reached in the vitreous in nonvitrectomized eyes (P = 0.001).