Promoter polymorphism of the erythropoietin gene in severe diabetic eye and kidney complications.

Significant morbidity and mortality among patients with diabetes mellitus result largely from a greatly increased incidence of microvascular complications. Proliferative diabetic retinopathy (PDR) and end stage renal disease (ESRD) are two of the most common and severe microvascular complications of diabetes. A high concordance exists in the development of PDR and ESRD in diabetic patients, as well as strong familial aggregation of these complications, suggesting a common underlying genetic mechanism. However, the precise gene(s) and genetic variant(s) involved remain largely unknown. Erythropoietin (EPO) is a potent angiogenic factor observed in the diabetic human and mouse eye. By a combination of case-control association and functional studies, we demonstrate that the T allele of SNP rs1617640 in the promoter of the EPO gene is significantly associated with PDR and ESRD in three European-American cohorts [Utah: P = 1.91 x 10(-3); Genetics of Kidneys in Diabetes (GoKinD) Study: P = 2.66 x 10(-8); and Boston: P = 2.1 x 10(-2)]. The EPO concentration in human vitreous body was 7.5-fold higher in normal subjects with the TT risk genotype than in those with the GG genotype. Computational analysis suggests that the risk allele (T) of rs1617640 creates a matrix match with the EVI1/MEL1 or AP1 binding site, accounting for an observed 25-fold enhancement of luciferase reporter expression as compared with the G allele. These results suggest that rs1617640 in the EPO promoter is significantly associated with PDR and ESRD. This study identifies a disease risk-associated gene and potential pathway mediating severe diabetic microvascular complications.

Conjunctival flaps for pterygium surgery.

The literature reveals that pterygium surgery focuses on adjunctive therapy such as mitomycin C and 5-fluorouracil, and beta irradiation with bare sclera technique to decrease recurrence. The following description of the basic surgical technique of conjunctival flaps shows that it is simple, easier to perform, has faster healing time, and is more effective in preventing recurrence than any of the others.

Pterygium monograph [abstract]

The paper outlines and discusses in details all the various aspects of pterygium management. Pterygium is a tropical lesion and should be presented by experts in the region. Features, epidemiology, pathogeneses, pathology, prevention, medical and surgical management, mechanism(s) of recurrences and current treatment, including case histories and outcomes are discussed. Contribution comes from the experiences of OSWI members. Financing and publication of this endeavour are presented. (AU)

Aquasense IOLs: a new concept [abstract]

UV-absorbing posterior chamber hydrophilic acrylic IOLs are designed for implantation in the capsular bag. The optic is biconvex and the haptics are joined in a one-piece configuration. The lens is supplied in its own sterile vial and hydrated in balance salt solution. The mechanics of insertion advantages and disadvantages and result are discussed. (AU)

Health maintenance [abstract]

TEENAGE: Devil-may-care. TWENTIES: Peak performance fare. THIRTIES-FORTIES: Prepare. FIFTIES-SIXTIES: Take good care. SEVENTIES-EIGHTIES: All hell beware. With increasing age, comes an increased need for fibre, fruits and vegetables and the decreased need for cholesterol and salt. There is need to moderate the use of carbohydrates, maintain exercise and work through injuries. THREE TENETS: Diet, Exercise and Positive Thinking. (AU)

Update on phakic intraocular lenses: two-year results

Since July 21, 1998, twenty-seven eyes have been implanted with angle-supported OII phakic intraocular lenses (IOL) in the Eastern Caribbean. Present visual acuity ranges from 20/20 (78 percent), 20/25 (14 percent), 20/30 (4 percent), 20/40 (4 percent); intraocular pressures range from 14 to 21 mmHg. There have been no inflammatory complications or cataract formation to date. All information is included in an FDA study on phakic - IOLs.(AU)

Surgical reversal of presbyopia

The opposing theories of Helmholtz and Schachar on the mechanism of diminished accommodation in presbyopia are presented. Clinical experience with five (5) patients is discussed.(Au)

Recurrent pterygium

Recurrence after surgery for pterygium remains an important concern. The pathogenesis and management of recurrence is discussed with reference to the utilization of surgical preventive measures and adjunctive therapy. The results of Mitomycin C (14 cases) and AL-3789 (10 cases) are presented. (Au)

Phakic intraocular lens in pigmented eyes

39 eyes in 20 patients with high hyperopia ranging from +3.00 to +7.00, high myopia ranging from -6.00 to -20.00 with accompanying astigmatism from -1.00 to -5.00, were implanted with the anterior chamber phakic intraocular lens from Ophthalmic Innovations International, Inc. Resulting visual acuities, avoidance of complications, special considerations for heavy iris pigmentation and general outcomes are discussed.(AU)

Pterygium surgery and mitomycin C: ten year results

Over 1,0000 primary and recurrent surgical procedures were performed in a 10 year period with the adjunctive application of 4mg/dl mitomycin C (0.05 ml) intraoperatively, with only two recurrence. The technique and the pre-and post-operative care of the first 100 cases with 10 year follow-up are discussed(AU)

Viscocanalostomy: A glaucoma surgical technique - Videotape presentation

A surgical technique for decreasing intraocular pressure comprising a two-tiered approach to Schlemm's canal and the trabecular meshwork, was done in 660 heavily pigmented eyes in South Africans of colour and followed for ten years. The canal is opened and maintained with the instillation of viscoelastic, and a "clear window" is created over Descemet's membrane to facilitate continuous leakage of aqueous from the anterior chamber. The second tier is excised and the first tier is sutured tightly to the adjacent sclera, taking great care not to cauterise or injure the "collecting channels" on the surface. This technique was done on both primary and secondary glaucomatous eyes and offers excellent results and minimal complications (AU)