The comparative histologic effects of subthreshold 532- and 810-nm diode micropulse laser on the retina.

PURPOSE: Therapeutic retinal laser photocoagulation can damage the neurosensory retina and cause iatrogenic visual impairment. Subthreshold micropulse photocoagulation may decrease this risk by selective tissue treatment. The aim of this study was to compare subthreshold 810-nm diode micropulse laser and subthreshold 532-nm micropulse laser on the retina by histologic examination and differential protein expression. METHODS: Fourteen Dutch-belted rabbits received subthreshold 810-nm diode micropulse laser photocoagulation in their right eye and subthreshold 532-nm micropulse laser photocoagulation in their left eye. Histology and immunohistochemical detection of stromal cell-derived factor-1 (SDF-1), ß-actin, vascular endothelial growth factor (VEGF), glial fibrillary acidic protein (GFAP), and insulin-like growth factor 1 (IGF-1) were analyzed 12 hours, 3 days, 14 days, and 28 days post-laser photocoagulation. RESULTS: Histologically, all time points produced a similar degree of retinal disruption in both wavelengths. Immunohistochemically, SDF-1 expression was greatest at the 12-hour time point and decreased thereafter. SDF-1, VEGF, and ß-actin up-regulation was detected at early time points in both the 810- and 532-nm micropulse laser-treated animals. CONCLUSIONS: Subthreshold micropulse retinal laser photocoagulation caused equivalent histologic changes from both 532- and 810-nm diode lasers. Differential protein expression was not evident between the different laser conditions.

Surgical management of pediatric limbal dermoids with sutureless amniotic membrane transplantation and augmentation.

PURPOSE: To further evaluate the efficacy of a new surgical technique for removal of pediatric corneal-limbal dermoids and ocular surface reconstruction using multilayered amniotic membrane. METHODS: Three pediatric patients with corneal-limbal dermoid (grade I) in one practice were identified in a retrospective fashion. All patients underwent deep lamellar excision followed by sutureless multilayered amniotic membrane transplantation by a single surgeon (AP). Preoperative and postoperative visual acuity, anterior segment examination, anterior segment B-scan, and cycloplegic refraction were performed. RESULTS: Three patients with ages ranging from 6 months to 18 years had a postoperative follow-up of 9 to 12 months from the time of surgery. This surgical technique achieved rapid postoperative corneal re-epithelialization, reduced postoperative pain, and diminished postoperative scarring in all three patients. Existing preoperative astigmatism remained unchanged throughout the follow-up period. No intraoperative or postoperative complications were noted. CONCLUSION: This surgical approach offers an alternative surgical technique to a simple excision with or without deep lamellar keratoplasty for removal of pediatric corneal-limbal dermoids (grade I). In the management of pediatric limbal dermoids (grade I), surgical excision combined with sutureless multilayered amniotic membrane transplantation eliminates painful postoperative recovery and corneal neovascularization, and can achieve an improved long-term ocular surface cosmesis.

Strabismus surgery on the elderly and the effects on disability.

It is widely believed that strabismus surgery in elderly adults has low value and is of limited benefit. In this study, consecutive patients older than 65 years of age who had undergone strabismus surgery were asked to complete a telephone questionnaire rating their before-surgery and after-surgery severity of various problems, including specific health, daily functioning, social interactions, concerns about the future, self-image, and job-related problems. Of the 56 patients identified, 37 completed the survey. Problem ratings improved significantly on all 5 of 6 items after surgery, with specific health and daily tasks yielding the greatest improvement. For all items, the number of patients who indicated an improvement was greater than the number of patients who indicated no change or deterioration with surgery. This study further details the benefits of strabismus surgery in the elderly.

A case of autoimmune-related retinopathy and optic neuropathy syndrome treated by autologous nonmyeloablative hematopoietic stem cell transplantation.

Autoimmune-related retinopathy and optic neuropathy (ARRON) syndrome is characterized by visual loss and often the presence of antibodies against retinal or optic nerve antigens in the absence of cancer. Limited success has been reported in treatment of ARRON syndrome with medications that suppress the immune system. In many patients, current strategies are insufficient to control the disease. A 47-year-old woman with progressive visual and hearing loss attributed to ARRON syndrome that was resistant to conventional therapies underwent autologous hematopoietic stem cell transplantation (HSCT). Clinical manifestations appeared to stabilize. This report suggests that autologous HSCT may have a therapeutic role in ARRON syndrome.

Long-term success in the correction of exposed glaucoma drainage tubes with a tube extender.

PURPOSE: To report long-term success of surgical correction of exposed glaucoma drainage device (GDD) tubes with a commercially available tube extender. DESIGN: Observational case series. METHODS: Chart review of surgical correction for GDD tube exposure by rerouting the tube using the New World Medical Tube Extender (NWMTE; New World Medical, Rancho Cucamonga, California, USA). RESULTS: Surgical revision of GDD tube exposure with the NWMTE controlled intraocular pressure without repeat exposure up to three years after surgery. CONCLUSIONS: A tube extender can provide long-term correction of an exposed GDD tube by bypassing weakened tissue, thus avoiding or delaying a second implant surgery.

Candidate gene screening for posterior polymorphous dystrophy.

PURPOSE: To perform candidate gene screening for posterior polymorphous corneal dystrophy (PPCD). The initial 3 genes chosen, ID1, BCL2L1, and VSX1, lie within the region on chromosome 20 to which the PPCD gene has been linked, and mutations in VSX1 have previously been identified in patients with PPCD. METHODS: DNA extraction, PCR amplification, and direct sequencing of the VSX1, BCL2L1, and ID1 genes were performed in 14 affected patients (12 families) as well as in unaffected family members and healthy control subjects. RESULTS: No coding region mutations in the BCL2L1 or ID1 genes were identified in affected patients. In the VSX1 gene, the previously identified Gly160Asp missense change was not present in any of our 12 probands, and the Asp144Glu mutation was identified in 1 affected patient as well as 1 unaffected control individual. Additionally, 2 synonymous substitutions were identified, Ala182Ala (8 affected patients from 8 families) and Gly239Gly (1 affected patient and 1 unaffected patient from the same family). In the ID1 gene, the synonymous substitution Gly216Gly was observed in 2 affected patients (2 families) who also demonstrated a single nucleotide change in both the 5'UTR (2129T>C) and 3'UTR (3267A>G). Another 5'UTR change, 2177T>C, was identified in 1 affected patient and his unaffected parent, both of whom also demonstrated the 2129T>C and 3267A>G changes. CONCLUSIONS: None of the 12 probands with PPCD demonstrated the previously described Gly160Asp mutation within the VSX1 gene. The Asp144Glu missense change, present in an affected patient as well as an unaffected control individual, appears to be a rare polymorphism, not a disease-causing mutation. No coding region changes were identified in the ID1 or BCL2L1 genes. Therefore, although we report a number of novel polymorphisms in the VSX1 and ID1 genes, the failure to identify any sequence variants that sort with the disease phenotype suggests that other genetic factors are involved in PPCD.