Liquid crystal display microperimetry in idiopathic subretinal fibrosis.

A 46-year-old woman presented with a history of decreased vision. On examination, best-corrected visual acuity was 20/30 in both eyes. Fundus evaluation of the right eye revealed subretinal fibrosis of the macula involving the fovea. The fundus of the left eye was normal. Fluorescein angiography confirmed the diagnosis. At 10 months of follow-up, the patient was asymptomatic and the visual acuity was stable at 20/25 in both eyes. Liquid crystal display microperimetry showed comparable retinal sensitivity in both eyes (P> .05). However, the right eye revealed unstable fixation compared to the left eye. Idiopathic subretinal fibrosis should be considered in the differential diagnosis of patients with subretinal fibrosis. Liquid crystal display microperimetry is a useful tool in evaluating these patients.     

Illuminated curved vitrectomy probe for vitreoretinal surgery.

A new self-illuminated and curved vitrectomy probe was designed for better accessibility of the peripheral retina, particularly in phakic patients. This probe has a 20-gauge pneumatic cutter. The curvature at the shaft has a 19.4-mm radius and is 25 mm long. A 2.5-cm piece of polyethylene terephthalate tubing (heat-shrink tubing) is threaded over both the probe and the 0.5-mm diameter fiberoptic light source to assemble the illuminated probe. Use of this instrument avoids inadvertent trauma to the clear lens in phakic eyes and allows the surgeon to illuminate the anterior vitreous with one hand while the other hand can be used to depress the sclera. This instrument complements wide-angle viewing for safe and quick surgical treatment of peripheral retinal pathology in phakic patients.     

Pars plana modified Baerveldt implant versus neodymium:YAG cyclophotocoagulation in the management of neovascular glaucoma

OBJECTIVE: To determine the relative effectiveness of neodymium:YAG cyclophotocoagulation (NCYC) and pars plana modified Baerveldt implant (PPBI) surgery on intraocular pressure (IOP) control in eyes with neovascular glaucoma (NVG). PARTICIPANTS: In this retrospective comparative group study, 30 patients with NVG treated with contact NCYC were compared with 18 patients who underwent PPBI. Patients groups were not statistically dissimilar with respect to the underlying disorder-causing angle and iris neovascularization, intraocular pressure, and patient's age. RESULTS: During a follow up of 6 months, an IOP control of > or = 6 and < or = 21 mm Hg was achieved in 23 eyes (76.6%) treated with NCYC compared with 17 eyes (94.4%) receiving PPBI (P = 0.13). Among eyes that had unsuccessful outcome in both groups, the proportions with persistently high IOP or hypotony were greater in the NCYC group than in the PPBI group. Based on our criteria, the cumulative proportion of failure in the NCYC group was 23.3% at 6 months as compared to 5.6% in the PPBI group. Seven eyes (23.3%) in the NCYC group lost light perception versus 1 eye (5.6%) in the PPBI group. The incidence of postoperative choroidal effusion (36%) was higher in the PPBI group. CONCLUSIONS: This study suggests that in the management of NVG, PPBI surgery more frequently controls IOP in a medically acceptable range with less hypotony and greater preservation of visual acuity than NCYC.     

Transepithelial paracellular leakiness induced by chronic phorbol ester exposure correlates with polyp-like foci and redistribution of protein kinase C-alpha

Although exposure of LLC-PK1 epithelial cell sheets to phorbol esters (TPA) causes a near immediate and total decrease of transepithelial electrical resistance (TER), continuation of exposure for 3 to 4 days results in a tachyphylactic response as TER begins to return to control levels. Recovery of TER is maximal by 5 to 6 days, but reaches only 70 to 80% of control level. A reciprocal change in the transepithelial flux of D-mannitol indicates that the TER decrease is indicative of an increase in tight junction permeability. Exposure of cell sheets to TPA for several days also results in the appearance of multilayered polyp- like foci (PLFs) across the otherwise one cell layer thick cell sheets. The pattern of penetration of the electron dense dye, ruthenium red, from the apical surface, across the tight junction and into the lateral intercellular space indicates that the tight junctions of the cell sheet become uniformly leaky after acute exposure to TPA. However, when exposure is continued for several days, only the junctions of cells in the PLFs manifest leakiness. The decrease in TER following acute TPA exposure correlates with the translocation of protein kinase C-alpha (PKC alpha) into a membrane-associated compartment. With exposure of several days, only a trace of PKC alpha is visible by Western immunoblot, and this is in the membrane-associated compartment. Immunofluorescent microscopy indicates that the trace of PKC alpha seen in the Western immunoblots is ascribable distinctly to cells of the PLFs. Monolayer areas between PLFs show no discernible immunofluorescent signal. The data therefore indicate that tight junction barrier function may be restored in certain areas by the down regulation of PKC alpha from the membrane-associated compartment. Failure to down regulate may result in the paracellular leakiness and abnormal cell architecture of the PLFs. Possible implications of this model for in vivo epithelial tumor promotion are discussed.      

The pelvic digit ��eleventh finger��

Described as asymptomatic and an incidental finding on a plain x-ray film, the “pelvic digit” is a rare congenital anomaly. A 35-year-old man is of a rare symptomatic pelvic digit that warranted surgical excision. Its importance lies in its differentiation from acquired abnormalities due to trauma such as myositis ossificans and avulsion injuries of pelvis. If this entity is kept in mind, unnecessary investigations or interventions can be avoided.