ABSTRACT
BACKGROUND: This study aims to describe outcomes of posteriorly-placed glaucoma drainage devices (GDD) with concurrent endoscopic vitrectomy in pediatric patients with glaucoma and corneal opacification. METHODS: This retrospective case series identified patients under 18 years of age who underwent posteriorly-placed GDD implantation with concurrent endoscopic vitrectomy between 2012 and 2021. Data collected included ocular diagnoses, prior intraocular surgeries, type and position of GDD, surgical complications, and additional surgeries. Preoperative and final visual acuity, intraocular pressure (IOP), number of glaucoma medications, and exam findings were also recorded. Surgical data included type and position of GDD, Success was defined as IOP between 5-21 mmHg without visually devastating complication or need for additional glaucoma surgery. RESULTS: Ten patients (14 eyes) with sclerocornea (6), Peters Anomaly (4), corneal decompensation from increased IOP (3), and corneal scar (1) underwent combined endoscopic vitrectomy with posteriorly-placed GDD (Baerveldt (10 eyes), Ahmed (4 eyes)) at 4.6 ± 5.8 years of age. Four eyes of 3 patients remained successful at final follow-up, while 10 eyes of 7 patients required 2.4 ± 1.3 additional surgeries for glaucoma (7) or hypotony (3). Kaplan Meier analysis demonstrated 1- and 2-year survival rates of 36% and 18%, respectively. At final follow-up (3.7 ± 2.4 years), after an average of 4.4 ± 2.4 glaucoma surgeries, 13 of 14 eyes had obtained IOP control on significantly fewer (p<0.0001) IOP-lowering medications. Additional complications included retinal detachment (2), chronic corneal graft failure (2), phthisis (1) and band keratopathy (1). CONCLUSIONS: Management of glaucoma in pediatric eyes with corneal opacification is challenging and often requires multiple surgeries. A combined endoscopic vitrectomy and posteriorly placed GDD is a viable technique to establish aqueous humor outflow. Although the success rate is low, this surgical approach may be useful in ultimately obtaining IOP control and preserving vision in these complex eyes.
Subject(s)
Glaucoma Drainage Implants , Glaucoma , Adolescent , Child , Glaucoma/etiology , Glaucoma Drainage Implants/adverse effects , Humans , Retrospective Studies , Treatment Outcome , Vitrectomy/adverse effectsABSTRACT
PurposeTo evaluate the sensitivity and specificity of a portable non-mydriatic fundus camera to diagnose vision-threatening diabetic retinopathy (VTDR).Patients and methodsA prospective, single-site, comparative instrument validation study was undertaken at the Aravind Eye Care System. Overall, 155 subjects with and without diabetes were recruited. Images from 275 eyes were obtained with the (1) non-mydriatic Smartscope, (2) mydriatic Smartscope, and (3) mydriatic table-top camera of the macular, nasal, and superotemporal fields. A retina specialist performed a dilated fundus examination (DFE), (reference standard). Two masked retina specialists graded the images. Sensitivity and specificity to detect VTDR with the undilated Smartscope was calculated compared to DFE.ResultsGraders 1 and 2 had a sensitivity of 93% (95% confidence interval (CI): 87-97%) and 88% (95% CI: 81-93%) and a specificity of 84% (95% CI: 77-89%) and 90% (95% CI: 84-94%), respectively, in diagnosing VTDR with the undilated Smartscope compared to DFE. Compared with the dilated Topcon images, graders 1 and 2 had sensitivity of 88% (95% CI: 81-93%) and 82% (95% CI: 73-88%) and specificity of 99% (95% CI: 96-100%) and 99% (95% CI: 95-100%).ConclusionsRemote graders had high sensitivity and specificity in diagnosing VTDR with undilated Smartscope images, suggesting utility where portability is a necessity.
Subject(s)
Diabetic Retinopathy/diagnostic imaging , Mass Screening/methods , Ophthalmoscopy/methods , Adult , Aged , Case-Control Studies , Female , Humans , India , Male , Middle Aged , Photography/methods , Prospective Studies , Sensitivity and SpecificityABSTRACT
AIM: To propose a new mechanism for the development of idiopathic macular hole in the setting of pre-existing posterior vitreous detachment (PVD). METHODS: Patients were examined clinically with fundus contact lens biomicroscopy and high-definition optical coherence tomography (OCT) was used to characterize the structural changes in the fovea following PVD. RESULTS: Two patients presented with vitreofoveal separation and were found by high-definition OCT to have subtle foveal disruption and irregularity of the foveal contour with no evidence of a full thickness macular hole. Sequential examination of these patients demonstrated delayed formation of idiopathic macular hole. CONCLUSION: Traction-induced inner foveal damage occurring before or coincident with spontaneous vitreofoveal separation destabilizes the fovea and predisposes some eyes to delayed macular hole formation.
Subject(s)
Fovea Centralis/injuries , Retinal Perforations/etiology , Vitreous Body/pathology , Vitreous Detachment/complications , Aged , Humans , Male , Retinal Perforations/diagnosis , Risk Factors , Tissue Adhesions , Tomography, Optical Coherence , Visual Acuity/physiology , Vitreous Detachment/diagnosisABSTRACT
In accelerated hypertension, vasogenic brain edema associated with PRES may represent either autoregulatory breakthrough leading to vasodilation or excessive autoregulation leading to vasoconstriction. We describe 2 patients with PRES in accelerated hypertension who had serous retinal detachments, a vasoconstrictive phenomenon. The concurrence of serous retinal detachment and PRES offers intriguing support for the idea that vasoconstriction rather than vasodilation is the mechanism of vasogenic edema in PRES.
Subject(s)
Central Serous Chorioretinopathy/diagnosis , Hypertension/diagnosis , Posterior Leukoencephalopathy Syndrome/diagnosis , Retinal Detachment/diagnosis , Adolescent , Adult , Female , Humans , Magnetic Resonance Imaging , MaleABSTRACT
Cytosine arabinoside (ara-C) is a nucleoside analog used in the treatment of hematologic malignancies. One of the major side effects of ara-C chemotherapy is neurotoxicity. In this study, we have further characterized the cell death induced by ara-C in sympathetic neurons. Similar to neurons undergoing trophic factor deprivation-induced apoptosis, ara-C-exposed neurons became hypometabolic before death and upregulated c-myb, c-fos, and Bim. Bax deletion delayed, but did not prevent, ara-C toxicity. Neurons died by apoptosis, indicated by the release of mitochondrial cytochrome-c and caspase-3 activation. p53-deficient neurons demonstrated decreased sensitivity to ara-C, but neither p53 nor multiple p53-regulated genes were induced. Mature neurons showed increased ara-C resistance. These results demonstrate that molecular mechanisms underlying ara-C-induced death are similar to those responsible for trophic factor deprivation-induced apoptosis. However, substantial differences in neuronal death after these two distinct stress stimuli exist since ara-C toxicity, unlike the developmental death, can proceed in the absence of Bax.
Subject(s)
Antimetabolites, Antineoplastic/toxicity , Apoptosis , Cytarabine/toxicity , Neurons/drug effects , Proto-Oncogene Proteins c-bcl-2 , Proto-Oncogene Proteins/physiology , Superior Cervical Ganglion/cytology , Animals , Caspase 3 , Caspases/metabolism , Cell Differentiation , Cell Survival/drug effects , Cells, Cultured , Cytochromes c/metabolism , Dose-Response Relationship, Drug , Female , Gene Deletion , Genes, p53 , Kinetics , Male , Mice , Mitochondria/metabolism , Neurons/cytology , Neurons/metabolism , Rats , Rats, Sprague-Dawley , Signal Transduction , Up-Regulation , bcl-2-Associated X ProteinABSTRACT
Mammalian MACF1 (Macrophin1; previously named ACF7) is a giant cytoskeletal linker protein with three known isoforms that arise by alternative splicing. We isolated a 19.1-kb cDNA encoding a fourth isoform (MACF1-4) with a unique N-terminus. Instead of an N-terminal actin-binding domain found in the other three isoforms, MACF1-4 has eight plectin repeats. The MACF1 gene is located on human Chr 1p32, contains at least 102 exons, spans over 270 kb, and gives rise to four major isoforms with different N-termini. The genomic organization of the actin-binding domain is highly conserved in mammalian genes for both plectin and BPAG1. All eight plectin repeats are encoded by one large exon; this feature is similar to the genomic structure of plectin. The intron positions within spectrin repeats in MACF1 are very similar to those in the dystrophin gene. This demonstrates that MACF1 has characteristic features of genes for two classes of cytoskeletal proteins, i.e., plectin and dystrophin.
Subject(s)
Microfilament Proteins/genetics , Alternative Splicing , Amino Acid Sequence , Animals , Base Sequence , Cloning, Molecular , DNA/chemistry , DNA/genetics , Dystrophin/genetics , Exons , Female , Gene Expression , Genes/genetics , Humans , Intermediate Filament Proteins/genetics , Introns , Male , Mice , Mice, Inbred C57BL , Molecular Sequence Data , Plectin , Protein Isoforms/genetics , RNA/genetics , RNA/metabolism , Sequence Alignment , Sequence Analysis, DNA , Sequence Homology, Amino AcidABSTRACT
We isolated a full-length cDNA encoding a novel 278 amino acid beta subunit of Na,K-ATPase from a mouse retinal cDNA library. The highest sequence identity was to known beta 3 isoforms, identifying the protein as the mouse beta 3 subunit of Na,K-ATPase. Two transcripts, 1.75 kb and 2.1 kb, probably arise from use of alternative poly(A) addition signals.
