Iodine and other factors associated with fertility outcome following oil-soluble contrast medium hysterosalpingography: a prospective cohort study.

Objective: To examine factors associated with fertility following hysterosalpingography (HSG) using an oil-soluble contrast medium (OSCM). Design: In a prospective cohort study on 196 women undergoing OSCM HSG, we showed that iodine excess was almost universal (98%) and mild subclinical hypothyroidism was frequent (38%). Here, we report the analyses of secondary outcomes examining factors associated with the likelihood of pregnancy following the HSG. Setting: Auckland, New Zealand (2019-2021). Sample: 196 women with primary or secondary infertility who underwent OSCM HSG. Methods: Baseline and serial urine iodine concentrations (UIC) and thyroid function tests were measured over six months following the HSG. Pregnancy and treatment with levothyroxine during the study period were documented. Results: Following OSCM HSG, pregnancy rates were 49% in women aged <40 years (77/158) but considerably lower (16%) among those ≥40 years (6/38). Similarly, live birth rates were markedly lower in women ≥40 years (17%; 1/6) versus <40 years (73%; 56/77). 29% of participants were iodine deficient at baseline despite advice recommending iodine fortification. Following HSG, the likelihood of pregnancy in women with moderate iodine deficiency was 64% higher than in women with normal iodine levels (p=0.048). Among women aged <40 years who had subclinical hypothyroidism (n=75), levothyroxine treatment was associated with higher pregnancy rates compared to untreated women [63% (26/48) vs 37% (10/27), respectively; p=0.047]. Conclusion: OSCM HSG was associated with higher pregnancy rates in women ≤40 than in those aged >40 years. Iodine deficiency was relatively common in this cohort, and increased iodine levels from OSCM exposure may contribute to the improved fertility observed with this procedure. Trial registration: This study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR: 12620000738921) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000738921.

The impact of prolonged, maternal iodine exposure in early gestation on neonatal thyroid function.

Context: Hysterosalpingography (HSG) using oil-soluble contrast medium (OSCM) improves pregnancy rates but results in severe and persistent iodine excess, potentially impacting the fetus and neonate. Objective: To determine the incidence of thyroid dysfunction in newborns conceived within six months of OSCM HSG. Design: Offspring study of a prospective cohort of women who underwent OSCM HSG. Setting: Auckland region, New Zealand (2020-2022). Participants: Offspring from the SELFI (Safety and Efficacy of Lipiodol in Fertility Investigations) study cohort (n=57). Measurements: All newborns had a dried blood spot card for TSH measurement 48 hours after birth as part of New Zealand's Newborn Metabolic Screening Programme. Forty-one neonates also had a heel prick serum sample at one week to measure thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3). Maternal urine iodine concentration (UIC) and TSH in the six months after OSCM HSG were retrieved from the SELFI study for analyses. Primary outcome: Incidence of hypothyroidism in the neonatal period. Results: There was no evidence of primary hypothyroidism on newborn screening (TSH 2-10 mIU/L). All neonates tested at one week had normal serum TSH, FT4, and FT3 levels. However, increasing maternal peak UIC levels during pregnancy were associated with lower TSH levels (p= 0.006), although also associated with lower FT4 levels (p=0.032). Conclusions: While pre-conceptional OSCM HSG in women did not result in neonatal hypothyroidism, gestational iodine excess was associated with a paradoxical lowering of neonatal TSH levels despite lower FT4 levels. These changes likely reflect alterations in deiodinase activity in the fetal hypothalamic-pituitary axis from iodine excess. Trial registration: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000738921, identifier 12620000738921.

The SELFI Study: Iodine Excess and Thyroid Dysfunction in Women Undergoing Oil-Soluble Contrast Hysterosalpingography.

CONTEXT: Hysterosalpingography (HSG) with oil-soluble contrast medium (OSCM) improves pregnancy rates. However, OSCM has high iodine content and long half-life, leading to potential iodine excess. OBJECTIVE: This work aimed to determine the pattern of iodine excess after OSCM HSG and the effect on thyroid function. METHODS: A prospective cohort study was conducted of 196 consecutive consenting eligible women without overt hypothyroidism or hyperthyroidism. All completed the study with compliance greater than 95%. Participants underwent OSCM HSG (Auckland, 2019-2021) with serial monitoring of thyrotropin (TSH), free thyroxine (FT4), and urine iodine concentration (UIC) for 24 weeks. The main outcome measure was the development of subclinical hypothyroidism (SCH), defined as a nonpregnant TSH greater than 4 mIU/L with normal FT4 (11-22 pmol/L) in those with normal baseline thyroid function. RESULTS: Iodine excess (UIC ≥ 300 µg/L) was almost universal (98%) with UIC peaking usually by 4 weeks. There was marked iodine excess, with 90% and 17% of participants having UIC greater than or equal to 1000 µg/L and greater than 10 000 µg/L, respectively. Iodine excess was prolonged with 67% having a UIC greater than or equal to 1000 µg/L for at least 3 months. SCH developed in 38%; the majority (96%) were mild (TSH 4-10 mIU/L) and most developed SCH by week 4 (75%). Three participants met the current treatment guidelines (TSH > 10 mIU/L). Thyroxine treatment of mild SCH tended to improve pregnancy success (P = .063). Hyperthyroidism (TSH < 0.3 mIU/L) occurred in 9 participants (5%). CONCLUSION: OSCM HSG resulted in marked and prolonged iodine excess. SCH occurred frequently with late-onset hyperthyroidism occasionally. Regular thyroid function tests are required for 6 months following this procedure.

Hysterosalpingography with Oil-Soluble Contrast Medium Does Not Increase Newborn Hypothyroidism.

OBJECTIVE: Hysterosalpingography (HSG) with oil-soluble contrast medium (OSCM) improves pregnancy rates in women with idiopathic infertility. However, OSCM has high iodine content and slow clearance resulting in potential iodine excess. If pregnancy occurs, this could impact fetal thyroid gland development and function. We aim to determine the effect of a preconceptional OSCM HSG on the thyroid function of the neonate. Design and Patients. This was a retrospective analysis of newborn TSH data for a cohort of neonates conceived within six months of an OSCM HSG in the Auckland region, New Zealand, from the years 2000 to 2019. Thyroid-stimulating hormone (TSH) levels of these newborns were obtained from newborn screening, which is routinely performed for all children at 48-72 hours of life. The primary outcome was the incidence of permanent or transient congenital hypothyroidism in this cohort. RESULTS: Of 146 babies included, all had normal TSH levels with values ranging from 1 to 7 mIU/L on the whole blood analysis of a capillary heel sample using the Perkin-Elmer AutoDelfia assay. Conception during the first 3 cycles following an OSCM HSG was 76%; however, TSH levels in this group were not higher than those conceived in later cycles. CONCLUSION: Preconceptional OSCM HSG did not increase the risk of congenital hypothyroidism in the New Zealand scenario.

Long-term Results of Nd:YAG Goniopuncture on Viscocanalostomy and Phacoviscocanalostomy.

PRCIS: Laser goniopuncture (LGP) is an effective outpatient procedure which has been shown to maintain reduced intraocular pressure (IOP) 5 years following initial laser treatment in patients who have had viscocanalostomy (VC) (with or without phacoemulsification). PURPOSE: The purpose of this study was to establish the long term (5 y) efficacy of neodymium-doped:yttrium aluminum-garnet LGP to lower IOP following VC or phacoviscocanalostomy (PVC) in patients with glaucoma. PATIENTS AND METHODS: This retrospective study analyzed patients who underwent LGP following VC±phacoemulsification between 2009 and 2012 at the Stanley Eye Unit in Abergele. Reason for further intervention included either increasing IOP outside target range or worsening visual fields. Statistical analyses were performed comparing pregoniopucture values to those taken up to 5 years later. RESULTS: Of the 620 VC and PVC procedures performed between 2009 and 2012, 218 eyes underwent LGP after a mean of 25 months [95% confidence interval (CI): 22.58 to 27.41] following surgery. Patients having a PVC had a longer mean time to goniopuncture compared with those who were phakic and had VC only (P<0.001). Immediately following goniopuncture IOP dropped, and a statistically significant reduction persisted at 5 year follow-up (P<0.001). Goniopuncture reduced IOP significantly from a pretreatment value of 21 to 15 mm Hg over 5 years (95% CI) (χ2F(4)=119.1, P<0.001). In total, 154 eyes (71%) were commenced on IOP-lowering medication at a mean of 14 months (95% CI: 12 to 17). At 5 years, successful IOP control was achieved in 73% (49 of 67) of eyes. There was no difference found between type of surgery and successful pressure control at 5 years (χ2(1)=2.00, P=0.16). CONCLUSION: LGP is an effective procedure which maintains a statistically significant reduction in IOP in the long term.

Viscocanalostomy and combined phacoemulsification with viscocanalostomy: A five-year follow-up.

PURPOSE: To assess the effectiveness and safety of viscocanalostomy (VC) and phaco-viscocanalostomy (PV) surgeries in eyes with a five-year follow-up. METHODS: Retrospective review of patients who underwent VC and PV between January 2010 and December 2012 in the Stanley Eye Unit Abergele, UK. Patients were included for the analysis if they had a full 5-year follow-up or required redo surgery in the 5-year period. Success was defined as an intraocular pressure (IOP) of <21 mmHg. The subanalysis included IOP <16 mmHg, IOP reduction >20%, and IOP reduction >30%, the complication rate, and the drop in the use of glaucoma medications post-surgery. RESULTS: A total of 370 eyes from 303 patients were included for the analysis. The mean preoperative IOP was 23 mmHg ± 5.3 mmHg with an average of 3.0 ± 0.1 medications. By year 5, this was reduced to 14.3 mmHg ± 6.5 mmHg with a mean of 1.0+/- 0.9 medications; 47.8% of the eyes had an IOP of <21 mmHg by year 5 without medication with a total of 92.6% of the eyes reaching this target with medication. The main complication in this group was the perforation of the Trabeculo Descemet's Window (TDW) but this was not associated with a poorer outcome. CONCLUSION: This large data set of eyes undergoing VC surgery demonstrates the effectiveness and safety of this technique over 5 years.

Screening of natural compounds from Cyperus rotundus Linn against SARS-CoV-2 main protease (Mpro): An integrated computational approach.

Coronavirus disease 2019 (COVID-19) is a viral respiratory disease that has been spreading across the globe. The World Health Organization (WHO) declared it as a public health emergency. The treatment of COVID-19 has been hampered due to the lack of effective therapeutic efforts. Main Protease (Mpro) is a key enzyme in the viral replication cycle and its non-specificity to human protease makes it a potential drug target. Cyperus rotundus Linn, which belongs to the Cyperaceae family, is a traditional herbal medicine that has been widely studied for its antiviral properties. In this study, a computational approach was used to screen natural compounds from C. rotundus Linn using BIOVIA Discovery Suite and novel potential molecules against Mpro of SARS-CoV-2 were predicted. Molecular docking was performed using LibDock protocol and selected ligands were further subjected to docking analysis by CDOCKER. The docking scores of the selected ligands were compared with standard antiretroviral drugs such as lopinavir and ritonavir to assess their binding potentials. Interaction pharmacophore analysis was then performed for the compounds exhibiting good binding scores to evaluate their protein-ligand interactions. The selected protein-ligand complexes were subjected to molecular dynamics simulation for 50 ns. Results of binding free energy analysis revealed that two compounds-ß-amyrin and stigmasta-5,22-dien-3-ol-exhibited the best binding interactions and stability. Finally, absorption, distribution, metabolism, excretion, and toxicity (ADMET) studies were performed to understand the pharmacokinetic properties and safety profile of the compounds. The overall results indicate that the phytochemicals from Cyperus rotundus Linn, namely ß-amyrin and stigmasta-5,22-dien-3-ol, can be screened as potential inhibitors of SARS-CoV-2 Mpro.

Emerging Application of Nanorobotics and Artificial Intelligence To Cross the BBB: Advances in Design, Controlled Maneuvering, and Targeting of the Barriers.

The blood-brain barrier (BBB) is a prime focus for clinicians to maintain the homeostatic function in health and deliver the theranostics in brain cancer and number of neurological diseases. The structural hierarchy and in situ biochemical signaling of BBB neurovascular unit have been primary targets to recapitulate into the in vitro modules. The microengineered perfusion systems and development in 3D cellular and organoid culture have given a major thrust to BBB research for neuropharmacology. In this review, we focus on revisiting the nanoparticles based bimolecular engineering to enable them to maneuver, control, target, and deliver the theranostic payloads across cellular BBB as nanorobots or nanobots. Subsequently we provide a brief outline of specific case studies addressing the payload delivery in brain tumor and neurological disorders (e.g., Alzheimer's disease, Parkinson's disease, multiple sclerosis, etc.). In addition, we also address the opportunities and challenges across the nanorobots' development and design. Finally, we address how computationally powered machine learning (ML) tools and artificial intelligence (AI) can be partnered with robotics to predict and design the next generation nanorobots to interact and deliver across the BBB without causing damage, toxicity, or malfunctions. The content of this review could be references to multidisciplinary science to clinicians, roboticists, chemists, and bioengineers involved in cutting-edge pharmaceutical design and BBB research.

Evaluating the long-term efficacy and effectiveness of Viscocanalostomy and combined phacoemulsification with Viscocanalostomy in the treatment of patients with uveitic glaucoma: 5-year follow up data.

BACKGROUND: Uveitic glaucoma commonly leads to a more intense optic nerve damage than other types of glaucoma, causing glaucomatous optic nerves and visual field defects. Anterior uveitis is the most commonly associated risk factor. Surgical intervention is usually indicated when all medical treatment has failed. We report five-year results for 16 eyes of uveitic glaucoma managed with viscocanalostomy (VC)/Phaco viscocanalostomy (PVC). METHODS: Retrospective analysis on all uveitic glaucoma cases meeting a five-year follow up was completed. All patients were managed surgically with either viscocanalostomy (VC) or phacoviscocanalostomy (PVC). Outcomes evaluated included intraocular pressures measurement pre-listing, on day 1, year 1 to year 5. Complete success rate was defined as achieving an intraocular pressure (IOP) lower than 21 mmHg or reduced by 30% without medications, and qualified success was achieved when IOP was lower than 21 mmHg or a reduction in IOP of 30% with topical medical therapy ± Laser goniopuncture (LGP). If further surgeries were required to reduce IOP due to glaucoma progression then they were classified as a failure. RESULTS: A total of 16 patients with uveitic glaucoma were reviewed. Complete success was seen in 75% of patients at year 1, 50% of patients at year 3 and 19% of patients in year 5. Conversely qualified success was achieved in 94% of patients at year 1, 86% of patients at year 3 and 75% of patients at year 5. In the group of patients requiring further surgery, 50% of patients had previous surgeries, including cataract surgery, trabeculectomy and viscocanalostomy. There was a mean number of 4 pre-operative drops before their primary surgery and a mean drop in eye medications of 1.1 at 5 years follow-up. Success rates were prognostically linked to lower mean number of interventions and lower percentage of previous surgeries. CONCLUSION: There remains a significant paucity of information in the utilization of PVC in uveitic glaucoma. The advantage of nonpenetrating glaucoma surgery (NPGS) includes the lack of entry into the anterior chamber and the avoidance of an iridectomy which may reduce intraocular inflammation and postoperative complications. Our study shows that non-penetrating surgery is successful in treating advanced uveitic glaucoma.

Ophthalmic nurse practitioner assessment of glaucoma: evaluating agreement within an initiative to enhance capacity in glaucoma clinics.

AIMS: A local service evaluation was conducted in order to compare clinical assessment measures and management decisions between an ophthalmic nurse practitioner and a reference standard glaucoma consultant, for patients referred into secondary care with suspected Chronic Open Angle Glaucoma or Ocular Hypertension. METHODS: One hundred patients were selected. A clinical pathway incorporating the assessment methods recommended by National Institute for Health and Care Excellence (NICE) Glaucoma update 2017 (NG81) was delivered by a single ophthalmic nurse practitioner and the reference standard glaucoma consultant. Clinical findings and outcomes were recorded, with both practitioners being masked to each other's findings. Agreement was determined employing Cohen's kappa, measuring inter-rater agreement allowing for chance agreement. RESULTS: Agreement was observed as follows: Visual field assessment (kappa k = 0.806, 95% CI 0.661-0.951); Optical Coherence Tomography evaluation (kappa k = 0.648, 95% CI 0.507-0.798); C:D Ratio assessment (Cronbach's alpha α = 0.96, 95% CI 0.88-0.94); Diagnosis (kappa k = 0.874, 95% CI 0.818-0.914); and Treatment planning (kappa κ = 0.844, 95% CI 0.733-0.955). In three cases the nurse practitioner judged the optic nerve to appear normal, where the reference standard examiner detected glaucoma and commenced treatment. CONCLUSION: This service evaluation demonstrates how an ophthalmic nurse practitioner with appropriate theoretical knowledge and practical training, can develop skills to reach a high level of agreement in patient assessment and management for those patients with suspected glaucoma. Within the limitations of a single centre and single practitioner evaluation, our findings provide evidence that this model of capacity expansion ought to merit wider consideration in secondary care glaucoma services.

Iodine and fertility: do we know enough?

Iodine is a vital micronutrient and its importance in thyroid function is well established. However, abnormalities in iodine intake may also have other effects. In particular, iodine is taken up avidly by the ovary and endometrium. Iodine deficiency is associated with reduced fertility. The use of high iodine concentration contrast media has recently been shown to improve conception rates in couples with unexplained infertility (UI). We hypothesize that this improvement could be related to the iodine excess and mechanisms independent of its action on thyroid. In this article, the metabolism of iodine and its potential role in fertility will be discussed, including the impact of both iodine deficiency and excess states and the importance of iodine in normal fetal development. This will include insights from animal studies on the effect of iodine in the uterine and ovarian structural environment, hormonal milieu and immunological factors affecting implantation. We speculate that iodine may well have a role as a potential therapy for UI.

Bilateral occlusive retinal vasculitis associated with primary sclerosing cholangitis.

We present the case of a 46-year-old man who presented with bilateral panuveitis and occlusive retinal vasculitis 6 months after being acutely admitted with abnormal liver function and diagnosed with primary sclerosing cholangitis (PSC). Initial investigations by the medical and ophthalmic departments including all autoimmune investigations were within normal parameters. Of particular interest was the high likelihood of inadvertent androgenic-anabolic steroid self-suppression of disease. As a lifelong bodybuilder, the patient had been taking oral and intramuscular steroids for years. He became symptomatic upon cessation of these recreational medications. There remains a significant paucity of information describing the relationship between uveitis and PSC. Given the poorly understood aetiology of this rare cholestatic disease, we review the current literature and highlight the diagnostic and therapeutic challenges for such a patient. PSC may predispose patients to an occlusive panuveitis with androgenic-anabolic steroids suppressing ocular autoimmune disease.

XEN® stent complications: a case series.

BACKGROUND: XEN® gel stent (Allergan, Dublin/Republic of Ireland) is a relatively new microinvasive glaucoma device providing an ab-interno approach to the subconjunctival space for aqueous drainage and reduction of intraocular pressure. It is thought to be less invasive, reduce surgical time and post-operative infection rates compared with traditional glaucoma procedures. Little information however, has been published regarding complications and subsequent management. CASE PRESENTATION: The authors highlight five complicated cases of XEN® stent insertion, how they were managed and key learning points. Cases include: entire stent found at the bottom of the anterior chamber several months after uncomplicated insertion, stent broke into multiple pieces during manipulation within subconjunctiva, XEN45 stent migrated into the anterior chamber 7 months post-operatively and a case of limbal-based conjunctival dissection during open revision which lead to additional scarring around the stent and subsequent raised intraocular pressure. CONCLUSIONS: We present some new and interesting complications of XEN implant as well as potential management options. This can assist clinical decision-making and enable better pre-operative discussions with patients regarding risks of surgery.

Phaco-antigenic glaucoma following uncomplicated cataract surgery.

INTRODUCTION: Phaco-antigenic glaucoma occurs in less than 1% of cataract surgeries. Managing this rare complication is challenging, especially when there are few documented cases reported. We describe the challenges of managing a case of bilateral phaco-antigenic glaucoma following uncomplicated cataract surgery requiring viscocanalostomy. CASE DESCRIPTION: An 82-year-old atopic lady presented with a 2-day history of painful injected right eye. She was 4 days post left and 8 days post right uncomplicated cataract surgery. On examination, the anterior chambers were deep with no hypopyon. Intraocular pressure was raised at 38 mmHg in the right eye and 24 mmHg in the left eye initially. However, intraocular pressure remained uncontrolled despite maximum medical treatment; she attended A + E six times within 11 days with intraocular pressures of up to 48 mmHg in the right eye and 46 mmHg in the left eye. A vitreous biopsy was reported negative for infective organisms. Eventually, bilateral viscocanalostomies were performed and vision improved to 0.24 logMAR in both eyes with intraocular pressures of 8 mmHg in the right eye and 10 mmHg in the left eye. CONCLUSION: We present a rare presentation of phaco-antigenic glaucoma following an uncomplicated cataract surgical procedure with good results following timely intervention.

Endophthalmitis Following XEN Stent Exposure.

BACKROUND: XEN45 Gel stents are in their infancy, and clinical expertise with microsurgical glaucoma devices are increasing. The soft flexible nature of the XEN stent together with its malleability under the conjunctival tissue should negate any risk of exposure of the XEN45 stent (XEN). However, we report a case in which sight-threatening endophthalmitis was the presenting feature of this complication. CASE REPORT: We present a case of uncomplicated XEN implantation that developed endophthalmitis 4 months after surgery. She gave an 8-day history of diarrhea before presentation. She was noted to have exposure of the XEN stent at the point of entry of the XEN into the subconjunctival space. The stent was removed, pars plana vitrectomy was carried out, and intravitreal antibiotics were administered. Achieving low intraocular pressures, bearing in mind her preservative allergy, became a challenge, as we struggled to manage her advanced glaucoma medically. A CyPass Micro-Stent was subsequently inserted to control the intraocular pressure. CONCLUSIONS: Episodes of XEN stent exposure may not be so isolated. We postulate that poor handwashing transmitted the causative organism to the exposed stent, which then resulted in endopthalmitis. We would like to highlight a few learning points from this case.

The efficacy of Viscocanalostomies and combined phacoemulsification with Viscocanalostomies in the treatment of patients with glaucoma: a non-randomised observational study.

BACKGROUND: To evaluate the outcomes of Viscocanalostomy (VC) and Phacoviscocanalostomy (PV) in controlling primary and secondary glaucoma in a large cohort of patients from a single eye unit and performed by a single surgeon. METHODS: This non-randomised, retrospective study was conducted on 620 eyes of 458 patients. All patients who had either viscocanalostomy (VC) or combined phacoemulsification and viscocanalostomy (PV) over a three-year period were included. Intraocular pressures (IOP), number of anti-glaucoma medications used, and any complications were recorded over a 3-year follow up period. Paired T-Test was used to compare preoperative and post-operative IOP at specified time points. Kaplan-Meier survival models were used to determine success rates over the study period. RESULTS: Six hundred twenty procedures were performed during the 3-year study period, of which 427 were PV and 193 VC. The mean follow-up was 31.8 months. Overall complete success (IOP ≤ 21 mmHg, without medication) at 3 years was achieved in 65.7% of patients, with qualified success (IOP ≤21 mmHg with or without medication) achieved in 96.0%. Subgroup analysis showed complete success rate of 76.0% for PV and 63.1% for VC (p = 0.005), with qualified success 95.9% for PV and 94.0% for VC (p = 0.668). Mean pre-operative IOP (mmHg) for all procedures was 23.02 ± 5.6, with PV and VC subgroups at 22.54 ± 5.10 and 24.06 ± 6.45. Post-operatively IOP at month 12 and 36 was 14.74 ± 3.57 and 14.40 ± 3.17 respectively for all procedures, 14.62 ± 3.26 and 14.44 ± 3.10 for PV, and 15.03 ± 4.18 and 14.31 ± 3.33 for VC. Across all procedures, pre-operatively an average of 3.05 ± 0.96 anti-glaucoma medications were used. This reduced to 0.13 ± 0.39 in 12 months and 0.38 + 0.71 by 36 months. Sixty-five cases had complications due to trabeculo-Descemet window perforation during viscocanalostomy with 7 cases developing complications from the cataract element. In the 12.9% of patients who had complications there were no differences of IOP noted at 3 years. CONCLUSION: VC and PV have good IOP lowering capacity and are both effective at sustaining a reduction in IOP at 3 years. PV achieved a higher success rate without medication. The low complication profile with reduced post-operative care means these procedures may be a preferred option for early surgical intervention.

Effect of primary Phacoviscocanalostomy/ Viscocanalostomy on intraocular pressure of normal tension glaucoma patients: 3-year results.

BACKGROUND: The objective of this study was to evaluate the efficacy of Viscocanalostomy/Phacoviscocanalostomy (VC/PVC) in lowering intraocular pressure (IOP) in Normal Tension Glaucoma (NTG) patients. METHODS: Retrospective electronic database review of patients who underwent VC/PVC for NTG between December 2009 and November 2011 at Stanley eye unit in Abergele Hospital. Goldmann applanation tonometry (GAT) was used for all IOP measurements which were taken at the time of listing for surgery and at 1 day, 1 week, 1 month, then 3-monthly up to 1 year, then half-yearly up to 3 years post operatively. Statistical analysis was performed using unpaired t-test. A P value of <0.05 was accepted as the level of significance. RESULTS: Operations were performed on 94 eyes from 67 patients over the study period. The mean age at the time of surgery was 76.4 years. Pre-operative IOP was 17.75 ± 2.19 mmHg (range 12-21 mmHg). 3 year follow-up showed a mean IOP of 13.41 ± 2.22 mmHg (range 8-18 mmHg). By year 3, 17 patients needed laser goniopuncture and 25 patients needed antiglaucoma drops. IOP was reduced by 24.4% at 3 years post-surgery, which was statistically significant (p < 0.0001). CONCLUSIONS: From our results, which show a 24.5% reduction in IOP at 3 years with 12% complication rate, we propose that a logical surgical management for NTG patients would be viscocanalostomy, thereby keeping trabeculectomy as an alternative.

Histoplasma capsulatum Infection with Extensive Lytic Bone Lesions Mimicking LCH.

Multiple lytic bone lesions in a child can be a manifestation of various diseases like Langerhans cell histiocytosis, metastatic neuroblastoma, leukemia, hyperparathyroidism, multifocal osteomyelitis and histoplasmosis. Disseminated histoplasmosis caused by Histoplasma capsulatum var. duboisii is well known to present with multiple osteolytic lesions in immunocompromised adults and is mostly restricted to the African subcontinent. Histoplasmosis seen in American and Asian countries is caused by Histoplasma capsulatum var. capsulatum, which presents with pulmonary and systemic manifestations and rarely bone involvement. We report a case of histoplasmosis, caused by H. capsulatum var. capsulatum with extensive lytic bone lesions in a 13 year old immunocompetent boy who presented with prolonged fever, weight loss and multiple boggy swellings. He responded to amphotericin and is currently on Itraconazole. This case is unique for extensive osteolytic lesions with H. capsulatum var. capsulatum infection in an immunocompetent child.