Anterior tucking of the iris caused by posterior chamber lenses with polypropylene loops

One hundred ten eyes that had extracapsular cataract extraction with posterior chamber lens implantation were examined gonioscopically to ascertain the frequency of anteriorly displaced polypropylene loops "tucking" into the posterior iris surface. The association with iris transillumination defects and the development of postoperative uveitis, hyphema, and raised intraocular pressure were also recorded. Sixty-six eyes (60%) had one or two anteriorly tucked loops; 28 of them (25%) had some associated iris transillumination defect related to the implant. Twenty eyes (18%) developed persistent postoperative uveitis; 15 of them had anteriorly tucked loops. Two eyes had postoperative hyphema and in both these eyes the loops were anteriorly tucked. The means of recognizing and preventing potential complications are discussed.     

Evidence for persistence of adenovirus in the tear film a decade following conjunctivitis

Chronic papillary conjunctivitis has been described following adenoviral conjunctivitis. It is unknown however, how long adenovirus is able to persist in the tear film and conjunctiva. To determine if adenovirus persists in the ocular surface following adenoviral conjunctivitis, 304 patients with a history of adenovirus conjunctivitis from whom an adenovirus had been isolated 10 years previously were sent a questionnaire regarding persistent or recurrent symptoms and were invited to attend. Patients were examined and samples of tears and conjunctival cells were collected from both eyes using tear film washes, filter paper, and swabs, the latter for virus isolation. Extracted DNA from the ocular samples was amplified using primers for herpes simplex virus (thymidine kinase) and adenovirus (hexon) genes. Adenovirus amplicons were sequenced and compared to original serotype. Thirty patients attended, 19 of whom had persistent papillary conjunctivitis. Evidence of adenovirus DNA was detected in 17 of 30 patients, 15 of whom also had evidence of a chronic papillary conjunctivitis. Adenovirus DNA was significantly associated with papillary conjunctivitis (P = 0.03). Adenovirus amplicons were successfully sequenced from six patients. Four patients harbored type 3 adenovirus, the same serotype with which they were infected originally 10 years previously. Two patients were infected originally with adenovirus serotype 3 but the current serotype was type 4. Infection of the ocular surface with adenovirus may predispose to the development of a persistent or recurrent conjunctivitis, the presence of which, appears to be associated with evidence of long term persistence of adenovirus DNA.     

Modulation of retinal pigment epithelial cell behavior by Agaricus bisporus lectin.

PURPOSE: To determine whether Agaricus bisporus lectin (ABL) binds retinal pigment epithelial cells (RPEs), to conduct a preliminary viability study of RPEs exposed to ABL, and to evaluate the effects of ABL on RPE proliferation and RPE-mediated matrix contraction in vitro. METHODS: Using cultured bovine RPEs, immunohistochemistry was used to study ABL binding. Morphologic and trypan blue exclusion techniques were used for toxicity studies. The effect of ABL on RPE proliferation was investigated by [methyl-3H]-thymidine incorporation. The effect of ABL on RPE-mediated matrix contraction was evaluated with RPE-populated three-dimensional collagen matrices. RESULTS: ABL bound to RPE cells. This binding was inhibited by asialomucin. No change in RPE morphology or trypan blue exclusion compared with controls was observed in RPEs incubated with 5 to 60 microg/ml ABL for 3 days. Twenty-four-hour incubations of RPEs with ABL significantly inhibited RPE proliferation in a dose-dependent way, 40 microg/ml ABL inhibited proliferation by 83% (SE 14, P<0.05). ABL showed a dose-dependent significant inhibition of RPE-mediated collagen matrix contraction over 3 days, with 93% inhibition compared with controls by 40 microg/ml lectin (P<0.05). The inhibitory effect of ABL on proliferation and gel contraction was partly reversible after eliminating ABL from the culture medium. CONCLUSIONS: Bovine RPE cells bind ABL, and preliminary evaluations suggest that levels of ABL that are nontoxic to the cells potently inhibit RPE proliferation and RPE-mediated matrix contraction. ABL deserves further investigation as a potential inhibitor of RPE proliferation and cell-mediated matrix contraction in anomalous reparative processes such as proliferative vitreoretinopathy and as a laboratory tool for RPE behavioral studies.     

Deep sclerectomy and trabeculectomy augmented with Mitomycin C: 2-year post-operative outcomes

Graefe's Archive for Clinical and Experimental Ophthalmology - Two-year post-operative outcomes of both deep sclerectomy (DS) and trabeculectomy surgery (Trab) augmented with Mitomycin C (MMC)...     

Simplifying collection of corneal specimens in cases of suspected bacterial keratitis

Identification of the causative organisms in suspected bacterial keratitis traditionally involves collecting multiple corneal scrapes, which are plated directly onto different solid agar culture media. Difficulties have been reported with this practice, so the development of a simpler diagnostic method in suspected bacterial keratitis would be useful. It is unclear whether a single corneal scrape sent to the microbiology laboratory in a liquid transport culture medium (indirect method) is as reliable for the diagnosis of bacterial keratitis as inoculation of multiple scrapes directly onto agar plates (direct method). To investigate this, bacterial recovery was assessed following transfer and transport of different concentrations and types of bacteria from an artificially contaminated surgical blade into brain heart infusion (BHI). Bacterial recovery rates between the proposed (indirect) and standard (direct) method were then compared after the in vitro inoculation of pig corneas and following specimen collection in patients with presumed bacterial ulcerative keratitis. Recovery of bacteria from contaminated surgical blades was found to be the same from both solid and liquid culture media. There was no significant difference in the numbers of positive cultures from solid (direct) and liquid (indirect) culture media, both in the experimental pig cornea inoculation study (P = 0.34) and in experiments with patients with clinical infections (P = 0.4), with an 85.2% agreement between methods (kappa = 0.61, P < 0.0001). In conclusion, therefore, the collection of two corneal scrapes, one used for Gram staining and the other transported in BHI followed by plating and subculturing in an enrichment medium, provides a simple method for the investigation of presumed bacterial keratitis.     

Endonasal laser dacryocystorhinostomy and external dacryocystorhinostomy outcome profile in a general ophthalmic service unit: a comparative retrospective study

PURPOSE: To evaluate the outcome profile of endonasal laser dacryocystorhinostomy (ENL-DCR) in comparison with external dacryocystorhinostomy (ENL-DCR) carried out as part of general ophthalmic service within the same center. METHODS: Patients who have undergone external or endonasal laser DCR in the authors institute with a minimum follow-up of 9 months and at least 3 months after removal of the tubes were invited to participate in this research. We used a questionnaire and a systematic clinical examination for detecting lacrimal passage patency and function. Patients were classified into categories: complete anatomical and physiological success; anatomical success with partial relief of symptoms; anatomical success with no relief of symptoms; anatomical failure.The endoscopic view of the ostium vertical location has been classified into four levels. RESULTS: One hundred and ten external-DCR and 53 Endonasal-DCR procedures were evaluated. Free communication (anatomical success) was achieved in 82% undergoing Ext-DCR and in 58% undergoing ENL-DCR. A significant number of patients continued to have symptoms in spite of a patent fistula (54% for Ext-DCR and 39% for ENL-DCR). The site of the opening of the internal ostium was significantly related to the persistence of symptoms in spite of free communication (P < 0.001, chi-square test). CONCLUSION: In this series of patients undergoing DCR in a general ophthalmic unit, the standard Ext-DCR technique has a higher anatomical success rate than the endoscopic laser DCR but not necessarily with equivalent rate of relief of symptoms. An inferiorly placed ostium is more likely to result in complete relief of symptoms.     

Intraocular pressure and pulse rate measurements by the OBF tonograph--comparison to reference instruments.

The purpose of this study was to evaluate the accuracy of intraocular pressure (IOP) and ocular pulse rate (OPR) measurements obtained by the Ocular Blood Flow (OBF) tonograph (OBF Labs, Wiltshire, UK). Measurements of IOP and OPR by the OBF tonograph were compared to those of reference instruments. For IOP evaluation, measurements were obtained on patients with normal and abnormal pressures using the OBF tonograph and the Goldmann applannation tonometer in random alternate order. For the OPR evaluation, measurements were obtained using the OBF tonograph with simultaneous heart rate monitoring by ECG on patients with normal IOP. The validity of the OBF tonograph measurements was quantified in terms of 95% limits of agreement and their relationships to measurements by reference instruments was determined by linear regression analyses. 102 patients were recruited for IOP measurements. Mean IOP obtained by the Goldmann tonometer was 20.7 mmHg (7-42 mmHg, SD 6.98) whilst mean IOP obtained by the OBF tonograph was 20.1 mmHg (8.1-40.2, SD 6.1). Goldmann IOP and OBF tonograph IOP readings were well correlated (r = 0.945). Analysis of the difference in IOP measurements between two instruments (tonograph minus Goldmann tonometer) showed the mean bias to be 0.26 mmHg (-7.8 to +6.1 mmHg) and the 95% limits of agreement to be -4.35 to +4.87 mmHg. Agreement between two instruments appeared to be dependent on the IOP; at IOP lower than 20.6 mmHg there was an overall tendency for the tonograph IOP to be higher than Goldmann IOP and vice versa when IOP was above 20.6 mmHg. 47 patients were recruited for OPR and ECG measurements. Mean pulse rates were 74.8 beats per min (mean 43-110) by ECG and 73.9 beats per min (43-110) by tonography. Analysis of the difference in pulse rate between instruments (tonograph OPR minus ECG pulse rate) against the average pulse rate showed the mean bias to be -0.8 beats and the 95% limits of agreement to be between -7 to +5 beats. Ocular pulse rate values obtained by the OBF tonograph were very accurate when compared to ECG pulse rate. This indicates that there is unlikely to be a systematic lag in continuous ocular pulse waveform recording. Intraocular pressure measurements by the OBF tonograph correlated very well with Goldmann readings over a wide range of pressures and should be valid in the clinical setting.     

Endoscopic-guided trephination dacryocystorhinostomy (hesham DCR) : Technique and pilot trial

OBJECTIVES: (1) Test the feasibility and the safety of guided transnasal trephination in creating a nasolacrimal fistula. (2) Develop an appropriate lacrimal maintainer and test its value in modulating healing at the fistula site. DESIGN: Prospective, noncomparative interventional case series. PARTICIPANTS: Five cadavers and 19 patients. METHOD: A transcanalicular lacrimal probe penetrated the lacrimal fossa to guide the passage of a flexible trephine up the nose, which created the nasolacrimal communication. A special wide-caliber lacrimal maintainer was inserted along lacrimal tubes within the created passage. OUTCOME MEASURES: For cadaveric study, direct inspection after dissection of the facial flap was performed. For the clinical trial, subjective improvement in watery eye, dye testing, lacrimal probing, lacrimal irrigation, and endoscopic nasal examination. RESULTS: The technique resulted in the creation of a regular fistula of reproducible diameter into which a standard-shaped wide caliber maintainer could be inserted. Three months after removal of the maintainer and 6 months after surgery, a patent ostium was achieved in 17 of 18 (94%) patients who had a completed procedure. Relief of symptoms was achieved in 83%. CONCLUSIONS: Guided endoscopic dacryocystorhinostomy provides a simple and safe option for the treatment of nasolacrimal duct obstruction. The lacrimal maintainer is a useful device to achieve a large patent nasolacrimal communication.