Uveitis-glaucoma-hyphema syndrome secondary to a Soemmerring ring.

We report the case of a patient who developed the uveitis-glaucoma-hyphema (UGH) syndrome secondary to extensive fibrosis (Soemmerring ring) around the haptics of the single-piece intraocular lens (IOL) in the capsular bag. The development of significant capsule fibrosis caused the IOL to tilt out of the iris plane, leading to haptic-iris and haptic-ciliary body chafing. The mechanisms described should prompt clinicians to consider the UGH syndrome even in the setting of a single-piece IOL properly placed in the capsular bag. Anterior segment imaging with ultrasound biomicroscopy can be used to evaluate the position of the IOL haptics in suspected cases.

Increased Intraocular Pressure and Hyperglycemic Level in Diabetic Patients.

PURPOSE: To determine whether hyperglycemic levels as determined from high hemoglobin A1c (HbA1c) levels influence intraocular pressure (IOP) in patients with non-proliferative diabetic retinopathy (NPDR). METHODS: A retrospective chart review was performed on subjects with a diagnosis of NPDR and a corresponding HbA1c level measured within 90 days before or after an IOP measurement over a two-year period. Exclusion criteria included a diagnosis of glaucoma or treatment with IOP lowering medications or oral or topical steroids. RESULTS: Using 14.5mmHg as a baseline mean value for IOP, 42 subjects had an IOP < 14.5mmHg and mean HbA1c of 8.1±1.1, while 72 subjects had an IOP ≥ 14.5mmHg and a mean HbA1c of 9.0±2.1. Although there was an overlap in the confidence intervals, a significant difference (P = 0.01) in the mean HbA1c level was observed in regression analysis between the two groups. Importantly, diabetic subjects with elevated HbA1c levels rarely (<1%) exhibited reduced IOP levels. CONCLUSIONS: Diabetic subjects with elevated HbA1c levels exhibited significantly higher IOPs compared to those with lower HbA1c levels. Findings from this study indicate an association between hyperglycemia and elevated IOP and that poor glycemic control may contribute to increased IOP levels in long-term diabetic patients.

The Anterior Double-Tilt Precision Attachment Case for Cleft Palate Patients and Accident Victims. Case Reports.

Passively retained precision attachment removable partial dentures have been used successfully since the 1920s. Adult cleft palate patients and accident victims often have endured a lifetime of wearing awkward appliances to replace the missing structures that never formed intraorally or were lost in a traumatic accident. These patients tend to be poor candidates for dental implants, even with repeated grafting surgeries. The anterior double-tilt precision attachment case is a great treatment option for adults to restore the missing dental structures. Anterior precision partial dentures are stable appliances in the mouth that are worn 24 hours a day and only removed for hygiene. They can be custom designed for maximum esthetics. They do not require denture paste, and they extend minimally onto the palate. As a result, they do not interfere with musculature, tongue movements, speech and taste. Cleft palate patients and accident victims with poor or non-existent edentulous ridges will have difficulty retaining a denture, so preservation of the existing dentition is essential for comfort and function. Because these prostheses do not apply destructive forces to the abutment teeth, they can last decades with minimal maintenance.

Vitreous evaluation: a diagnostic challenge.

PURPOSE: To categorize vitrectomy cytologic diagnoses and ancillary tests to address appropriate processing of low-volume vitreous samples. DESIGN: Retrospective case series. PARTICIPANTS: Five thousand seven hundred thirty-six vitreous samples. METHODS: Cytologic diagnoses of therapeutic and diagnostic vitrectomy samples and their processing protocols from 3 teaching institutions were reviewed. MAIN OUTCOME MEASURES: Diagnostic results were categorized as negative for malignancy, suspicious for malignancy, and positive for malignancy. All ancillary studies performed were documented, including special stains, immunohistochemistry analysis, cytokine levels, and polymerase chain reaction (PCR) analysis. RESULTS: Of the 5736 vitreous samples analyzed, 4683 (81.64%) were from Tufts Medical Center (TMC), 955 (16.65%) were from Boston Medical Center (BMC), and 98 (1.70%) were from Massachusetts Eye Research and Surgery Institution (MERSI). Cases from TMC and BMC were therapeutic and diagnostic vitrectomies, and MERSI cases were diagnostic vitrectomies. Most vitrectomies showed negative results for malignancy: 99.47% of TMC cases, 99.89% of BMC cases, and 79.6% of MERSI cases. These included vitreous hemorrhage and inflammatory or infectious findings. Ancillary studies performed in this category included Periodic Acid-Schiff staining for fungi, PCR analysis for toxoplasmosis, cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex virus I and II, and vitreous cultures for infections (coagulase-negative Staphylococcus, Candida, Fusarium, and Propionibacterium species). Interleukin (IL) 10-to-IL-6 ratios were performed on 38.7% of cases from MERSI. Fourteen cases from TMC were suspicious for malignancy based on cytologic evaluation. Eleven cases from TMC, 1 case from BMC, and 20 cases from MERSI showed positive results for malignancy and included B-cell lymphoma, retinoblastoma, melanoma, and metastatic adenocarcinoma. The ancillary testing included PCR for heavy chain immunoglobulin gene rearrangements, immunohistochemistry for EBV, in situ hybridization for κ and λ light chains, and cytogenetics. CONCLUSIONS: This is the largest data pool of reported cytologic diagnoses of diagnostic and therapeutic vitrectomy samples. Cytologic evaluation of therapeutic vitrectomy samples provides a valuable baseline of nonpathologic findings that assist in differentiation between malignancy, infections, and inflammatory conditions. Allocation of small-volume vitreous samples to select ancillary testing from the plethora of available diagnostic tests requires preoperative communication between surgeons and pathologists to ensure appropriate and timely treatment methods.

Precision attachment case restoration with implant abutments: a review with case reports.

Passively retained precision attachment partial dentures have been used successfully on natural tooth abutments since the 1920s. However, the dental profession has not advocated their use with implant abutments. When used in the passive manner that has proven successful on natural tooth abutments, precision attachment cases on implant abutments can be an excellent treatment option. This type of case has been used successfully for more than 17 years and offers tremendous advantages over the conventional overdenture approach to removal restorations on implant abutments.

The role of intravenous immunoglobulin in treatment of acute retinal necrosis.

PURPOSE: To describe a case of successful treatment of acute retinal necrosis with a combination of antivirals and intravenous immunoglobulin. METHODS: This is a case report of a 77-year-old white man diagnosed with unilateral acute retinal necrosis. RESULTS: Combination therapy with systemic antivirals, prophylactic laser retinopexy, and intravenous immunoglobulin halted progression of retinitis and preserved visual acuity. CONCLUSION: Acute retinal necrosis is an aggressive disease with significant risk of vision loss even when treated with appropriate therapy. In this report, the authors describe a case of successful treatment with a combination of systemic antivirals and intravenous immunoglobulin. Intraocular antiviral injection plus systemic treatment remain to be a more cost-effective option.

Technique for making full-coverage provisional restorations on teeth with insufficient clinical crowns.

Provisional restorations fabricated with copper bands are tremendous practice builders, eliminating the sensitivity, recurrent decay and poor retention that are common with conventional temporary restorations. The copper-band provisional restoration is the ideal choice when conventional butt-joint temporary restorations are unsuitable. The technique for making this restoration is demonstrated in this article with a step-by-step "how-to" description. An analysis of the basic principles and theories behind the success of the copper band provisional restoration is also presented, as well as a discussion of the restoration's advantages and disadvantages.

A clinician's perspective on evidence-based dentistry.

Evidence-based dentistry seems to be more popular with researchers and those in policy positions than with clinicians. A private practitioner looks at the difference between the promise of evidence-based dentistry, which urges a blend of science, clinical judgment, and patient preferences, and the actuality of the rhetoric of rigorous and formulaic clinical trials. The same dichotomy exists in medicine, where the concept originated. Without subscribing to the formality of evidence-based dentistry, practitioners can place a valid scientific foundation under their practices by avoiding unproven assumptions, carefully monitoring outcomes, using measures that are clinically relevant, relating both positive and negative outcomes to possible explanations, and cautiously introducing new techniques. The standards for publishing clinical research seem to favor adherence to methodological rules over useful of outcomes.

Bevacizumab vs ranibizumab for age-related macular degeneration: early results of a prospective double-masked, randomized clinical trial.

PURPOSE: To report early outcomes of a prospective, double-masked, controlled trial comparing bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) to ranibizumab (Lucentis; Genentech Inc) for the treatment of age-related macular degeneration. DESIGN: Prospective, double-masked, randomized clinical trial. METHODS: This is a single-center, randomized clinical trial at the Boston Veterans Affairs Healthcare System. Patients who met inclusion criteria were randomized 2:1 to bevacizumab or ranibizumab. Each patient contributed 1 eye to the study. All subjects and investigators (except for the pharmacist responsible for study assignments) were masked to treatment arms. Visual acuity (VA) was checked on Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Patients were given either bevacizumab or ranibizumab every month for the first 3 months, followed by optical coherence tomography-guided, variable-dosing schedule. Main outcomes measured were VA and foveal thickness. RESULTS: Twenty patients completed the 6-month follow up. Thirteen patients received bevacizumab and 7 patients received ranibizumab. No subjects in either group lost more than 15 letters on ETDRS chart. The average preoperative VA was 31.6 letters in the bevacizumab group and 30.4 letters in the ranibizumab group. At 6 months follow-up, mean vision was 46.4 letters in the bevacizumab group and 37.4 letters in the ranibizumab group. Two-tailed ttest failed to show statistical significance between the two groups. Patients in the bevacizumab group underwent an average of 5 injections, while patients in the ranibizumab group underwent a mean of 4 injections. CONCLUSION: Early results of a head-to-head, randomized, double-masked, prospective, single-center controlled trial between bevacizumab and ranibizumab show no difference in efficacy between the two treatments for choroidal neovascularizaton in the treatment of age-related macular degeneration. As this study conveys results of a small number of patients, further studies with larger sample sizes are needed in order to establish statistical significance.

Visual and anatomic outcomes of vitreoretinal surgery: results at the Boston VA and a review of the literature.

INTRODUCTION: The veteran population presents unique challenges in the management of vitreoretinal disorders. We compiled the surgical outcomes for the most common visually significant vitreoretinal diagnoses. Those results were then compared to visual and anatomic outcomes established in the literature. MATERIALS AND METHODS: Medical records over a three-year time period, from January 2005 through December 2007, were reviewed for 208 persons who underwent vitreoretinal surgery for vitreous hemorrhage, retained lens fragment, rhegmatogenous and tractional retinal detachment, macular hole, and macular pucker at the Jamaica Plain Campus of the Veterans Affairs Boston Healthcare System in Boston, MA. A comprehensive search of the literature was conducted on Medline. Data from several large case series and meta-analyses were compared to results obtained at the VA Boston. RESULTS: A total of 208 veterans underwent vitreoretinal surgery from January 2005 to December 2007. After excluding those with rare diagnoses and lack of adequate follow-up data, the outcomes of 181 vitreoretinal procedures were included in this study. DISCUSSION: Overall, veterans at a regional referral center in Boston demonstrate postoperative visual and anatomic outcomes comparable to outcomes reported in the ophthalmic literature.