Expression of invasion-related extracellular matrix molecules in human glioblastoma versus intracerebral lung adenocarcinoma metastasis.

Tumor cell invasion into the surrounding brain tissue is mainly responsible for the failure of radical surgical resection, with tumor recurrence in the form of microdisseminated disease. Extracellular matrix (ECM)-related molecules and their receptors predominantly participate in the invasion process, including cell adhesion to the surrounding microenvironment and cell migration. The extent of infiltration of the healthy brain by malignant tumors strongly depends on the tumor cell type. Malignant gliomas show much more intensive peritumoral invasion than do metastatic tumors. In this study, the mRNA expression of 30 invasion-related molecules (twenty-one ECM components, two related receptors, and seven ECM-related enzymes) was investigated by quantitative reverse transcriptase-polymerase chain reaction. Fresh frozen human tissue samples from glioblastoma (GBM), intracerebral lung adenocarcinoma metastasis, and normal brain were evaluated. Significant differences were established for 24 of the 30 molecules. To confirm our results at the protein level, immunohistochemical analysis of seven molecules was performed (agrin, neurocan, syndecan, versican, matrix metalloproteinase 2 [MMP-2], MMP-9, and hyaluronan). Determining the differences in the levels of invasion-related molecules for tumors of different origins can help to identify the exact molecular mechanisms that facilitate peritumoral infiltration by glioblastoma cells. These results should allow the selection of target molecules for potential chemotherapeutic agents directed against highly invasive malignant gliomas.

Suspected ciliary block associated with Viscoat use.

Ciliary block or malignant glaucoma is thought to be caused by the misdirection of aqueous into the vitreous. It is refractory to medical treatment and often requires vitreous aspiration. We present a case of ciliary block glaucoma caused by sodium chondroitin sulfate-sodium hyaluronate (Viscoat) gaining access to the vitreous through an unsuspected, small zonular dialysis. Vitrectomy performed through a peripheral iridectomy resolved this severe condition.

Incomplete posterior U.G.H. syndrome--different iatrogenic entity?

U.G.H. syndrome is a known complication of IOL implantation associated with the use of anterior and rarely, posterior chamber intraocular lenses. It is due to mechanical excoriation of the angle or iris by the haptics or optic of an IOL and consists of uveitis, glaucoma and hyphema (U.G.H.). The advised therapeutic approach is explantation of the IOL. Following implantation of a posterior chamber IOL, three patients presented with bleeding into the posterior chamber, one associated with glaucoma. No patient had signs of uveitis. We decided to address the symptoms and not to explant the IOL. We believe that this constitutes a variant of the 'classical' U.G.H. syndrome, namely an incomplete posterior U.G.H. (I.P.U.G.H.) syndrome, in which explanation of the I.O.L. is not compulsory.

The "anchor" anterior capsulectomy.

In recent years, continuous circular capsulorhexis (CCC) has become the preferred anterior capsulectomy in many ophthalmic centers. Yet, many ocular surgeons are still uncomfortable with it, especially when tearing the capsule on its lower semicircle, since this often results in corneal endothelial injury, and, thus, postoperative lower corneal edema. We present a modified anterior capsulectomy, which consists of a crescent capsulorhexis and a perpendicular discission, followed by circular tearing of the resulting capsular flaps. This "anchor" anterior capsulectomy (AAC) was used in 14 cases of elective extracapsular cataract extraction, followed by intraocular lens (IOL) implantation. The capsulectomy was successful in 12, and IOL implantation was successful in 12. The procedure was relatively easy to perform and resulted in good "in-the-bag" implantation, regardless of the IOL's overall length and the optic's size. AAC can serve as an intermediate step in learning CCC as well as a reliable alternative anterior capsulectomy.

Procedures involving star-shaped capsulectomy for managing congenital cataracts in developing nations.

The management of congenital cataracts is still challenging, especially in developing nations, where surgical facilities are limited. Congenital cataracts were extracted from 22 patients (26 eyes): a procedure consisting of a star-shaped anterior capsulectomy and wash-out of lens material (STARWO) was performed in 16 of them (18 eyes) (group A); a procedure consisting of a star-shaped anterior capsulectomy, wash-out, anterior vitrectomy through the posterior capsulotomy, and repeated tearing of remnants of the anterior capsule (STARWAR) was performed in six patients (eight eyes) (group B). Intraocular lenses were implanted in both groups. In group A, secondary membranes (27.7%) developed in five eyes, postoperative uveitis in four (22.2%), and a late Elschnig pearl in 1 (5.5%). In group B, there was one case of secondary membrane formation (12.5%), and one of postoperative uveitis; neither required subsequent intervention. The inexpensive instrumentation used and the low rate of perioperative complications encountered in these patients make these two techniques attractive alternatives for managing congentital cataracts in developing nations.

[Diffuse corneal pigmentation--a new sign in neurofibromatosis].

Neurofibromatosis is an autosomal dominant disease affecting many organs. It is known for the characteristic pigmented skin spots and various neurofibromas. We present a 79-year old man who underwent elective cataract extraction. The surgery was complicated by the presence of diffuse, deep, intracorneal pigmentation. To our knowledge, this sign has not as yet been described in neurofibromatosis.