Isolated bilateral trigeminal neuropathy in sarcoidosis presenting with neurotrophic corneal ulcers.

Sarcoidosis is a multisystem granulomatous disease that may affect various organs. Nevertheless, involvement of the trigeminal nerve is exceedingly uncommon. This report presents a rare case of isolated bilateral trigeminal neuropathy presenting with neurotrophic corneal ulcers. The patient was treated with topical chloramphenicol and lubricants, as well as botulinum toxin injection to the upper eyelid to induce ptosis. Our case illustrates the importance of recognizing that bilateral corneal ulceration might be a manifestation of sarcoidosis. Physicians should be aware of this rare association, when treating sarcoidosis patients with eye related symptoms.

Detection of integrins in human cataract lens epithelial cells and two mammalian lens epithelial cell lines.

AIM: To compare the incidence of various integrin subunits in human cataract anterior lens epithelial cells (A-LEC) and in two mammalian LEC lines. METHODS: Circular sections of anterior capsules with attached LEC were obtained during cataract surgery. Integrin subunits were immunolocalised in these anterior LEC and in a human and rabbit LEC line, using four monoclonal antibodies specific for subunits alpha2, alpha3, and alpha5, and beta subunit 2. RESULTS: All of these subunits were found in at least a proportion A-LEC samples as follows: alpha2 71%, alpha3 92%, alpha5 62%, and beta2 24%. The human LEC line was immunoreactive for alpha2 and alpha3 only. The rabbit lens epithelial cell line was immunoreactive for alpha5 but there was no staining for alpha2, alpha3, or beta2. CONCLUSION: The A-LEC and mammalian LEC lines showed a similarity in their pattern of integrin expression. As these integrins are receptors for extracellular matrix (ECM) components, they are likely to be associated with the attachment and migration of LECs that precedes capsular opacification. Therefore these cell lines may be useful in the elucidation of mechanisms involved the pathogenesis of capsule opacification.

Patient satisfaction in our initial experience with endonasal endoscopic non-laser dacryocystorhinostomy.

BACKGROUND/AIMS: Endonasal endoscopic dacryocystorhinostomy (EN-DCR) is now a well-established procedure to relieve nasolacrimal duct obstruction. In the past, attempts have been made to comment on the anatomical success of the procedure. However, no studies have been conducted to evaluate patient satisfaction with the EN non-laser DCR procedure in comparison with the surgeon's experience. METHODS: Records of patients undergoing EN-DCR and external DCR (ET-DCR) surgery were reviewed. A telephone questionnaire was used to assess patient satisfaction with both procedures. Data were analyzed with Fisher's exact test and the chi-square test. RESULTS: Twenty primary EN-DCR's and 16 revision EN-DCR's were performed by the same surgeon (RM) over a three-year period. At last review, 89% of ET-DCR and 75% of EN-DCR procedures were noted to have a patent sac washout performed in the eye clinic. A telephonic interview revealed no significant difference between the surgical outcome [15/20 (75%)] and patient satisfaction [14/20 (70%)] with the primary EN-DCR procedure. Patient satisfaction with revision EN-DCR [10/16 (63%)] was slightly poorer than the surgical outcome recorded for revision EN-DCR [12/16 (75%)] but this was also not statistically significant. Telephonic interview was possible for 42/64 (66%) patients undergoing primary external ET-DCR's and a total of 36/42 (86%) patients were satisfied with the procedure. Patient age, laterality, duration of symptoms, previous ocular procedures or preexisting ocular disease and associated ENT procedures did not alter the surgical result or patient satisfaction in either group. CONCLUSIONS: This study suggests that patient satisfaction with endoscopic endonasal non-laser DCR for primary or revision DCR surgery is comparable to that with the external-DCR technique since there was no significant difference in patient satisfaction between the two groups of patients. Patient perception of their symptomatic improvement was lower (though not statistically significant) in relation to the final clinical assessment of the outcome of both primary and revision EN-DCR.

Expression of CD18, CD49b, CD49c and CD49e on lens anterior capsules in human cataracts.

PURPOSE: To examine the lens epithelial cells obtained from the anterior lens capsules removed during cataract surgery and detect various subclasses of the cell surface adhesion molecules known as integrins. METHODS: The circular sections of anterior capsules with attached lens epithelial cells (LECs) were obtained during cataract surgery from 28 patients. The lens capsules were immunohistochemically stained. RESULTS: CD49b CD49c, CD49e, and CD18 were detected in varying degrees in specimens obtained from human cataractous lenses. The positive percentages were 33, 75, 33, and 20%, respectively. The most striking feature was the increasing staining profiles towards the edges of the capsules (away from the central part of the lens capsules) for CD49c, suggesting that the LECs showed higher immunoreactivity for this antibody. The immunoreactivity for CD49b and CD49e was weaker. This was absent for CD18 in the central part of the lens capsules. CONCLUSION: The positive expression of antibodies suggests that specific integrin subunits were expressed in LECs of human cataracts. These results suggest that lens epithelial cells expressing CD49b, CD49c, CD49e, and CD18 might be precursors in the process of anterior lens epithelial cell (A cell) adhesion, and hence play a role in anterior capsule opacification or in subsequent migration and a possible role in posterior capsule opacification.

Sub-Tenon's versus peribulbar anaesthesia for cataract surgery.

We present a comparison of one quadrant sub-Tenon's anaesthesia and peribulbar anaesthesia. Patient discomfort during injection of anaesthetic and during cataract surgery was assessed using a 10-point visual analogue scale ranging from no pain to the worst pain imaginable. Data are available for 74 patients undergoing cataract surgery under peribulbar anaesthesia and for 55 patients in whom sub-Tenon's anaesthesia was used. Pain scores for administration of anaesthetic were significantly lower (Kruskal-Wallis H-test, p < 0.01) for sub-Tenon's anaesthesia (mean 1.4) compared with the peribulbar technique (mean 2.4). However, a similar number of patients experienced pain of greater than 3 for the two techniques (10 (18.5%) for sub-Tenon's and 14 (18.9%) for peribulbar). Per-operative pain scores for sub-Tenon's anaesthesia (mean 0.5) were lower than those for peribulbar anaesthesia (mean 1.2) but not significantly so (Kruskal-Wallis H-test, p = 0.073). Significantly fewer patients, however, experienced pain of greater than 3 (Fisher exact test, p < 0.05) in the sub-Tenon's group. In addition less anaesthetic solution and a shorter interval from administration to surgery was required in the sub-Tenon's group. Sub-Tenon's anaesthesia appears to be a more effective method of anaesthesia than the peribulbar method.

Linkage of a medium sized Scottish autosomal dominant retinitis pigmentosa family to chromosome 7q.

Retinitis pigmentosa is a group of hereditary retinopathies which is both clinically and genetically heterogeneous. Autosomal dominant (ADRP), autosomal recessive (ARRP), and X linked recessive (XLRP), as well as digenic forms of inheritance have been reported. ADRP has been linked to 3q, 6p, 7p, 7q, 8cen, 17p, 17q, and 19q. Three unrelated ADRP families have been reported to show linkage to 7q. We tested a Scottish ADRP family with microsatellite markers mapping within the 7q31-q35 region, and found three markers (D7S487, D7S514, D7S530) showing statistically significant evidence of linkage. A maximum two point lod score of 3.311 at 0% recombination was obtained for D7S514.

A comparison of flash electroretinograms recorded from Burian Allen, JET, C-glide, gold foil, DTL and skin electrodes.

Single flash scotopic and photopic electroretinograms (ERGs) were recorded from the same subjects using six types of corneal electrode, in order to assess their relative effectiveness. In addition, the ERG from a lower eyelid skin electrode was recorded to give an indication of the degree of attenuation to be expected from a skin electrode. On average, the scotopic ERG recorded from the Burian Allen electrode measured 471 microV (100%), and relative to this the b-waves recorded using other electrodes were as follows: JET (89%), C-glide (77%), gold foil (56%), DTL (46%) and skin (12%). Under photopic conditions the order was the same and the interelectrode proportions similar. The b-wave amplitude recorded using the Burian Allen electrode was 125 microV (100%), and with other electrodes was as follows: JET (93%), C-glide (78%), gold foil (60%), DTL (60%) and skin (14%).

Linkage to D3S47 (C17) in one large autosomal dominant retinitis pigmentosa family and exclusion in another: confirmation of genetic heterogeneity.

Recently Dryja and his co-workers observed a mutation in the 23d codon of the rhodopsin gene in a proportion of autosomal dominant retinitis pigmentosa (ADRP) patients. Linkage analysis with a rhodopsin-linked probe C17 (D3S47) was carried out in two large British ADRP families, one with diffuse-type (D-type) RP and the other with regional-type (R-type) RP. Significantly positive lod scores (lod score maximum [Zmax] = +5.58 at recombination fraction [theta] = .0) were obtained between C17 and our D-type ADRP family showing complete penetrance. Sequence and oligonucleotide analysis has, however, shown that no point mutation at the 23d codon exists in affected individuals in our complete-penetrance pedigree, indicating that another rhodopsin mutation is probably responsible for ADRP in this family. Significantly negative lod scores (Z less than -2 at theta = .045) were, however, obtained between C17 and our R-type family which showed incomplete penetrance. Previous results presented by this laboratory also showed no linkage between C17 and another large British R-type ADRP family with incomplete penetrance. This confirms genetic heterogeneity. Some types of ADRP are being caused by different mutations in the rhodopsin locus (3q21-24) or another tightly linked gene in this region, while other types of ADRP are the result of mutations elsewhere in the genome.

A study of the causes of non-compliance by patients prescribed eyedrops.

An investigation into the causes of non-compliance by patients using eyedrops has been undertaken by questionnaire, ability tests, and by tests on eyedrop bottles. The results indicate a high prevalence of non-compliance, compounded by an inability adequately to instill a drop into the eye. About half the patients had difficulty aiming the drop, and other problems including squeezing the bottle, blinking, and seeing the tip of the bottle. Ability tests included a measurement of the grip strength of patients to complement measurement of the force required to expel a drop from a bottle. Some patients, particularly those with arthritis, could not generate enough force to squeeze a bottle. These same patients also had difficulty with the other movements required to administer drops. While some attempts have been made to produce devices to assist with eyedrops which can improve the aim of the patient, none give assistance in expelling a drop. An additional problem found was the reluctance of patients to admit to medical staff that they experienced any difficulty with their drops.

Congenital corneal anaesthesia and the MURCS association: a case report.

Bilateral corneal anaesthesia and reduced sensation in the distribution of the ophthalmic division of the fifth cranial nerve associated with neuroparalytic keratitis and reduced vision is described in a 26-year-old woman with absence of the fallopian tubes, uterus, and upper vagina, a single pelvic kidney, and cervico-thoracic vertebral anomalies (the MURCS association). Other features of the disorder also present were short stature, facial asymmetry, micrognathia, and cleft palate. The neuroparalytic keratitis did not respond to tear substitutes and bilateral lateral tarsorrhaphies were eventually needed. This is the first report of congenital corneal anaesthesia in a case of MURCS.

A genetic linkage study of a family with Norrie's disease.

A family having one member with Norrie's disease, X-linked retinal dysplasia associated with hearing loss and mental retardation, was studied using DNA markers. The DNA markers were used to try and confirm the diagnosis of Norrie's disease by detecting a deletion of the X chromosome. Linkage analysis using the polymorphic DNA markers was performed and this allowed more accurate determination of the carrier status of two sisters of the affected boy than by empiric risk calculation. The advantage of multiple polymorphic DNA markers for linkage analysis is illustrated.

Rhino-orbital-cerebral mucormycosis--a clinico-pathological report of two cases.

Rhino-orbital-cerebral mucormycosis is an acute fungal infection of the oropharynx, paranasal sinuses, orbit and intracranial structures. It is rare, occurring mainly in diabetics in ketoacidosis. The clinical presentation is highly suggestive of the diagnosis. Current treatment has resulted in a greatly improved prognosis for survival and clinical awareness of this disease is important for early initiation of treatment with optimal effect. A clinico-pathological report of two cases is presented.