Understanding the structural changes following photodynamic and transpupillary thermotherapy for choroidal hemangioma using optical coherence tomography and optical coherence tomography angiography

Purpose: To study optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A) features of circumscribed choroidal hemangioma (CCH) following treatment with photodynamic therapy (PDT) and transpupillary thermotherapy (TTT). Methods: A retrospective chart review of consecutive patients treated for CCH over 2 years (May 2016�April 2018). The investigations, in addition to comprehensive eye examination, included color fundus photography, B-scan ultrasonography, OCT, and OCT-A. Results: The study included 16 eyes of 16 patients (9 males and 7 females). The mean age at presentation was 43.5 � 9 years (range 33�62 years). Macula (n = 6) and superior arcade (n = 5) were the common tumor locations. Twelve eyes received multiple treatment sessions: TTT (seven eyes; mean 2.4 sessions) and PDT (five eyes; mean 2 sessions). Four eyes were observed because vision was not threatened. Pretreatment OCT features were Bruch's membrane atrophy (15 eyes), retinal pigment epithelial atrophy (13 eyes), outer retinal abnormalities (12 eyes), and macular subretinal fluid (12 eyes). Pretreatment OCT-A features were complete loss of choriocapillaris (16 eyes), irregularly arranged fine arborizing vessels (11 eyes), and more than 50% signal void hyporeflective areas (12 eyes). Posttreatment OCT-A showed persistence of choriocapillaris loss, flat scar with fibrosis and thinning of choroid in all eyes treated with TTT, and persistence of deeper choroidal vessels and no loss of choriocapillaris in eyes treated with PDT. Conclusion: OCT and OCT-A help understand the structural outcome following PDT and TTT in circumscribed choroidal hemangioma.

Glue-assisted retinopexy for rhegmatogenous retinal detachments (GuARD): A novel surgical technique for closing retinal breaks

Purpose: This study describes a novel surgical technique of fibrin glue-assisted retinopexy for rhegmatogenous retinal detachment (GuARD) without oil or gas tamponade after pars plana vitrectomy (PPV). Methods: This pilot clinical trial included five eyes of five patients with rhegmatogenous retinal detachments (RD). A complete PPV was done in all cases followed by fluid–air exchange, laser photocoagulation around the break/s, and application of 0.1–0.2 mL of fibrin glue. No air, long-acting gas or silicone oil was used subsequently. No specific postoperative positioning was prescribed. The primary outcome measure was efficacy of the procedure defined as successful anatomical retinal reattachment. Secondary outcome measures were postoperative improvement in best corrected visual acuity (BCVA) and complications. Results: The median age of patients was 55 (range: 36–61 years) years and median duration of symptoms was 15 (range: 7–60) days. All eyes were pseudophakic, four eyes had inferior and one eye had total RD. Successful retinal reattachment was achieved in all (100%) cases and was maintained at the end of 3–8 months of follow-up. The median BCVA improved from 20/100 preoperatively to 20/80 at 1-week and 20/50 at 1-month postoperatively. None of the eyes had any postoperative complications such as elevated intraocular pressures or unexpected inflammation. Conclusion: The findings of this study suggest that GuARD is a promising technique for treatment of rhegmatogenous RD that may allow early visual recovery while avoiding the problems of gas or oil tamponade and obviating the need of postoperative positioning.

Keratomycosis due to Purpureocillium lilacinum: A case report from Sub-Himalayan region of Uttarakhand

The fungus Purpureocillium lilacinum previously known as Paceliomyces lilacinus is an emerging pathogen that can cause severe human infections including devastating oculomycosis. Treatment with traditional antifungals often fails, and the organism shows variable susceptibility to novel triazoles. We hereby report a case of keratomycosis caused by Pur. lilacinum in an immunocompetent male patient following trauma. The patient was successfully treated with voriconazole. The drug shows good activity against Pur. lilacinum and could be a promising therapeutic alternative to treat infections caused by this fungus, which generally shows resistance to conventional antifungal agents including novel triazoles.

Management of Candida glabrata infectious crystalline keratopathy with endophthalmitis following penetrating keratoplasty

A 33-year-old male underwent an optical keratoplasty elsewhere in the right eye following which he developed endophthalmitis and subsequently underwent a pars plana vitrectomy and lensectomy. At presentation, he had a deep stromal crystalline infiltration along the graft–host junction. A large therapeutic keratoplasty was performed, and the excised corneal button was evaluated. Histopathology revealed gram-positive round-to-oval budding structures and microbiology identified the organism as Candida glabrata. He was treated with antifungals in the postoperative period. At 4 months after therapeutic keratoplasty, the patient developed recurrent endophthalmitis, following stoppage of antifungals. The treatment was reinstituted for another year, and the patient did well with a clear graft at 18-month-follow-up period after the recurrence episode. Management of infectious crystalline keratopathy with endophthalmitis is a challenging situation and requires long-term treatment.

Evaluation of tolerability and efficacy of glucosamine with chondroitin in the treatment of knee osteoarthritis – a double blind multicentre randomized prospective comparative study.

There are few comparative studies conducted with glucosamine [GlcN1 (glucosamine sulfate with potassium chloride), GlcN2 (glucosamine sulfate plus chondroitin sulfate) along with ChoN3 (chondroitin sulfate alone)] in the treatment of knee osteoarthritis. In this study the treated groups were studied for alleviation of pain and joint stiffness with correlation of measurement of urinary pyridinium cross links such as pyridinoline (Pyr) and deoxypyridinoline (Dpyr). Hence, this study was eventually planned to evaluate the efficacy, safety and tolerability of glucosamine with chondroitin sulfate treated groups. Urinary pyridinium crosslinks such as Pyr and Dpyr measurement are used to monitor the clinical status as well as bone turnover of OA patients. These two collagen crosslinks measured in urine, which provides information both on the pathogenesis of OA as well as the rate of bone turnover. The results of this study suggest that GlcN2 and ChoN3 can relieve pain, improving functional ability and joint mobility so as to enhance the quality of life for osteoarthritis patients.

Anticonvulsant effect of cytoskeletal depolymerizers in combination with potassium channel opener and adenylate cyclase activator; a causative link with nerve growth factor?

Anticonvulsant effect of cytoskeletal depolymerizing drugs in combination with potassium channel (KATP) opener and adenylate cyclase activator was evaluated in animal models of epilepsy. Seizures were induced in the animals by subjecting them to maximal electroshock (MES) or by injecting a chemical convulsant, pentylenetetrazole (PTZ). Moreover a correlation with the nerve growth factor (NGF) was also investigated. The anticonvulsant effect of minoxidil (1200 micrograms/kg i.p.) and Deacetylforskolin (600 micrograms/kg i.p.) was significantly enhanced in the mice pre-treated with cytoskeletal depolymerizing drugs. On the other hand nerve growth factor potentiated the convulsive phenomenon and decreased the seizure threshold in both the electroshock and chemically induced convulsions. Another interesting feature was the interaction of cytochalasin B, a microfilament disrupter in preventing the action of mNGF and PTZ. This study demonstrates the importance of interaction between cytoskeletal structures and signalling molecules in determining the convulsive threshold. This study clearly points to the importance of the nerve growth factor in convulsive phenomenon.

Enigmatic relationship of Pleckstrin homology domain with phospholipid breakdown mediated signal transduction.

Research into phospholipid signaling continues to flourish, as more and more bioactive lipids and proteins are being identified and their actions characterised. The Pleckstrin homology (PH) domain is one such newly recognized protein module thought to play an important role in intracellular signal transduction. The tertiary structures of several PH domains have been determined, some of them complexed with ligands and on the basis of structural similarities between PH domains and lipid binding proteins it has been suggested that PH domains may be binding to lipophilic molecules. In fact many of the proteins that contain this domain can interfere with the membrane association. This review examines the specificity of this binding and illustrates the importance of charge-charge interactions in PIP2-PH domain complex formation. The precise physiological functions of PH domain in vivo remains to be explored therefore this review examines the biochemical aspects of the interaction of PH domains with phospholipid breakdown mediated products and proto-oncogenic serine-threonine kinase (Akt), protein tyrosine kinases, which have been found to be a target of phospholipid second messengers. Thus, number of cellular processes mediated by this way, ranging from insulin signaling and protein synthesis to differentiation and cell survival are regulated by this intracellular signaling protein module.

Reversal of angiotensin converting enzyme (ACE) inhibitor induced vasodilatation by vasopressin in hindquarters of rat.

The effect of exogenously administered vasopressin was observed on captopril induced vasodilatation in hindquarters of anaesthetised rats. Drops of perfusate were counted for 6 min and mean of the outflow was expressed as drops per min (dpm). In the control group (n = 6) the rate of flow was 9.5 +/- 1.04 dpm which increased to 12.33 +/- 1.36 dpm following captopril (200 micrograms/ml) infusion. In test group (n = 6) pretreated with vasopressin (4 I.U./kg 1 hr before) the rate of flow was 9.16 +/- 0.98 dpm which was reduced to 5.5 +/- 1.04 dpm following infusion with captopril. It is concluded that vasopressin reverses the vasodilatory effect of captopril.