Drug delivery applications with ethosomes.

Ethosomes are specially tailored vesicular carriers able to efficiently deliver various molecules with different physicochemical properties into deep skin layers and across the skin. This paper reviews the unique characteristics of the ethosomal carriers, focusing on work carried out with drug containing ethosomal systems in animal models and in clinical studies. The paper concludes with a discussion on the safety of the ethosomal system applications.

Chorioretinitis sclopetaria from BB ex memoria.

Chorioretinitis sclopetaria presents a characteristic pattern of choroidal and retinal changes caused by a high velocity projectile passing into the orbit, in close proximity to the globe. While it is unlikely that a patient should completely forget the trauma causing such damage, preserved or compensated visual function may blur the patient's memory of these events over time. Characteristic physical findings help to clarify the antecedent history. Despite the lack of an acknowledged history of ocular trauma or surgery, in our case, the characteristic ocular findings discovered at presentation allowed for recognition of the underlying etiology. Because of good visual function, the patient had completely forgotten about the trauma that occurred 12 years earlier. Strabismus surgery was performed for treatment of the presenting symptomatic diplopia. The pathognomonic findings in chorioretinitis sclopetaria are invaluable in correctly diagnosing this condition, especially when a history of ocular trauma is unavailable.

The diagnosis and management of orbital blowout fractures: update 2001.

A cogent update of orbital blowout history, anatomy, and management are included with a retrospective study of 59 pure orbital blowout fractures which occurred between 1994 and 1998. Our goal is to provide a better understanding of this frequently encountered entity and to help augment the confidence of nonophthalmologists who will often evaluate patients with suspected orbital blowout fractures.

Monocanalicular intubation for dacryostenosis in oculo-auriculo-vertebral dysplasia (hemifacial microsomia) with congenital corneal anesthesia.

PURPOSE: To present a case of oculo-auriculo-vertebral dysplasia associated with corneal anesthesia and ipsilateral dacryostenosis that was successfully treated with monocanalicular lacrimal intubation. METHODS: Case report. RESULTS: Previous neurotrophic corneal ulcers in a child with hemifacial microsomia had become secondarily infected from a stagnant tear lake, resulting in significant corneal scarring and visual loss. A single monocanalicular stent maintained nasolacrimal patency without causing further corneal trauma, despite constant medial gaze because of wide lateral tarsorrhaphy and contralateral occlusion therapy for amblyopia. CONCLUSIONS: Monocanalicular stents may aid the treatment of dacryostenosis in the face of compromised corneal sensation.

Infectious crystalline keratopathy caused by Candida guilliermondii.

PURPOSE: To describe the manifestations of infectious crystalline keratopathy caused by Candida guilliermondii in a corneal transplant performed for pseudophakic bullous keratopathy. METHOD: Case report. RESULTS: Candida guilliermondii was identified as the causative organism of an indolent infectious crystalline keratopathy. Incisional lamellar biopsy provided diagnostic culture and histopathologic results. Histopathology showed aggregates of yeast elements between corneal stromal lamellae, without inflammation. The infection progressed despite a 6-week course of topical amphotericin B and an additional 6-week course of topical and oral fluconazole. Repeat penetrating keratoplasty resulted in clear graft, with no recurrent infection. CONCLUSIONS: Fungal keratopathy should be included in the differential diagnosis of infectious crystalline keratopathy. Numerous Candida species have been isolated in addition to the most common causative bacterial organism, Streptococcus viridans. Candida guilliermondii is yet one more causative agent of infectious crystalline keratopathy. Candida guilliermondii, a rare human pathogen, was resistant to medical therapy in this case.

Anophthalmic socket and orbital implants. Role of CT and MR imaging.

The role of CT and MR imaging examination of orbital implants and the anophthalmic socket is expanding constantly. As the imaging techniques gain refinement and resolution, the list of potential clinical application grows. Frequent clinical-radiologic queries regarding the anophthalmic socket include neuro-radiologic findings with congenital anophthalmia or bilateral microphthalmia, the vascularization or position of an orbital implant following enucleation, or orbital recurrence of tumor following enucleation. Common clinical-radiologic questions regarding orbital implants relate to the associated findings of trauma, infection, bleeding, or recurrence of tumor in relationship to the existing orbital implant.

Gadolinium enhancement: improved MRI detection of retinoblastoma extension into the optic nerve.

We performed T1-, T2-, proton density-weighted, and T1-weighted gadolinium-enhanced MRI on 24 patients with retinoblastoma, using a 1.5 T superconducting unit and head and orbital surface coil imaging. All patients underwent a complete ophthalmologic examination, including B-scan ultrasonography. CT was performed on 10 of 24 patients. Pathologic correlation was obtained in 18 patients who required enucleation. Contrast-enhanced T1-weighted MRI with fat suppression was the sequence most sensitive to optic nerve extension and provided the greatest differentiation between tumor and uninvolved extrascleral tissue. Retinoblastoma demonstrated contrast enhancement.

The eye.

In recent years, the growing application of computed tomography (CT) and magnetic resonance (MR) imaging evaluation of the orbit and globe have dramatically increased the role of imaging and, hence, that of the radiologist in assessing ophthalmologic disorders. This article discusses magnetic resonance imaging features of the most common and less common ocular pathologies, with particular emphasis on the potential of magnetic resonance imaging in the field of ophthalmology.

Choroidal-ciliary body melanoma. A multivariate survival analysis of tumor location.

BACKGROUND: Posterior uveal melanomas with ciliary body involvement have greater mortality when compared with choroidal melanomas. This study was conducted to determine if this association is due to an independent effect or to correlations with other parameters. METHODS: From the 4335 cases of uveal melanoma with follow-up data in the Registry of Ophthalmic Pathology, 664 were selected; therefore, approximately two thirds of the patients died of metastatic melanoma. Ciliary body involvement was determined by the location of the anterior tumor margin. Kaplan-Meier survival, Cox regression, and Gamel-Boag log-normal regression analyses were performed. Covariables included ciliary body involvement, largest tumor dimension, mean diameter of the largest ten nucleoli, and modified Callender classification. RESULTS: Kaplan-Meier and univariate Cox analyses indicated a significant association between ciliary body involvement and tumor-related death but when included in a multivariate Cox model, ciliary body involvement was not statistically significant. Similarly, when ciliary body involvement was included in a multivariate Gamel-Boag model, ciliary body involvement was not statistically significant. Melanomas that involve the ciliary body were more likely to be larger (Student's t = 10.5; P = 10(-6)), contain larger nucleoli (Student's t = 2.43; P = 0.015), and be of mixed cell type (chi-square = 17.2; P = 3 x 10(-5)). CONCLUSIONS: Ciliary body involvement is associated with tumor-related mortality but this association is primarily due to ciliary body tumors being larger with more malignant cytology.

Hydroxyapatite orbital implant abscess: histopathologic correlation of an infected implant following evisceration.

A 60-year-old diabetic man with a history of ocular trauma and absolute glaucoma underwent evisceration with placement of an 18 mm hydroxyapatite orbital implant. The host scleral shell was left intact with no posterior opening for vascular ingrowth. One year later the patient presented with implant exposure, limited fibrovascular ingrowth into the implant, and a Staphylococcus aureus orbital abscess. The implant was removed, and pathology demonstrated suppurative inflammation with limited vascular ingrowth. This patient's risk factors for an implant-associated wound infection included diabetes, impaired wound healing, history of trauma, early implant exposure, and delayed fibrovascular ingrowth. Awareness of the infectious complications of any orbital implant including hydroxyapatite allows the surgeon to alter management strategies in an attempt to reduce such risk. Surgeons may consider posterior scleral portals with evisceration surgery to facilitate hydroxyapatite vascularization. Patient selection, implant size, and surgical technique are key factors for a management strategy designed to reduce the risk of implant infection.

Conjunctival mass formation with unexpected foreign body.

Two 4-year-old females with inferior fornix conjunctival lesions are described. Both cases proved to be cotton-material-induced granulomas. These cases are reported to emphasize that recognition of foreign body conjunctival granuloma remains as a challenge to ophthalmologists.