Latanoprost Induced Iris Pigment Epithelial and Ciliary Body Cyst Formation in Hypermetropic Eyes.

PURPOSE: Latanoprost has become one of the most widely prescribed topical antihypertensive medications in recent years. Yet there have been few reports of secondary iris pigment epithelial (IPE) and ciliary body (CB) cyst formation to date and none, to our knowledge, reported in eyes predisposed to primary angle closure. METHODS: We report the first documented case of bilateral IPE and CB cysts in a hypermetropic patient with prior laser peripheral iridotomies (LPIs) as a rare, delayed side effect of topical Latanoprost treatment. The cysts subsided with discontinuation of Latanoprost, thereby demonstrating a causal relationship. We discuss the pathogenesis of such cysts and advocate using of serial ultrasound biomicroscopic (UBM) images to monitor them. RESULTS AND CONCLUSIONS: Latanoprost may cause iris pigment epithelial and ciliary body cysts that remain clinically undetected. In eyes predisposed to angle closure, such cysts may become clinically detectable and masquerade as iris tumours. Prior laser peripheral iridotomies in these eyes may delay or prevent the detection of these cysts. Ultrasound biomicroscopy (UBM) imaging is therefore a valuable tool in diagnosing and monitoring these cysts.

Scleral perforation after trans-scleral cyclodiode laser for intraocular pressure reduction.

Herein a case is reported of a full-thickness scleral burn in the left eye of a 61-year-old man, following contact trans-scleral cyclodiode laser treatment for traumatic aphakic glaucoma, unresponsive to maximal medical treatment. The defect was successfully repaired by scleral suturing under local anaesthetic.

Intraocular lens pupillary capture after neodymium:YAG laser treatment of interlenticular opacification of posterior chamber piggyback intraocular lenses.

A hyperopic 73-year-old woman had bilateral phacoemulsification with primary implantation of piggyback AcrySof intraocular lenses (IOLs) (Alcon) in the capsular bag. Interlenticular opacification (ILO) developed after 6 months in the left eye and after 2 years in the right eye. Treatment of the ILO in the left eye with a neodymium:YAG (Nd:YAG) laser resulted in pupillary capture of the optic of the anterior IOL. This case shows that despite using low energy levels, pupillary capture of the anterior IOL can occur after Nd:YAG laser treatment for ILO in piggyback IOLs.

Imaging of metastatic orbital leiomyosarcoma.

A 74-year-old man with a previous history of lower leg soft tissues leiomyosarcoma and multiple metastasis presented with a progressive painless proptosis of the left eye. Orbital ultrasound, CT, and MRI revealed a large mass in the left medial orbit. The mass was surgically removed and pathologic examination confirmed the diagnosis of a metastatic orbital leiomyosarcoma. The imaging characteristics of this rare tumor are comprehensively detailed, using complementary ultrasound, CT, and MRI, the combination of which allowed planning of total excision of the lesion.

A polymorphism at codon 31 of gene p21 is not associated with primary open angle glaucoma in Caucasians.

BACKGROUND: Primary open angle glaucoma (POAG) is considered to be a neurodegenerative optic neuropathy, in which cell death occurs by apoptosis. p21, is an important protective component of the apoptotic pathway, regulating cellular arrest in the presence of DNA damage. An unstable or altered p21 protein could modify the cellular response to genomic injury and abolish the effect of p21. A previous study on a Chinese cohort suggested that the p21 codon 31 polymorphism may alter the state of apoptosis in glaucomatous optic neuropathy, failing to protect the ganglion cells. The aim of this study was to test the hypothesis that a p21 codon 31 polymorphism is associated with POAG on a Caucasian cohort. METHODS: 140 POAG patients and a control group of 73 healthy individuals were included in the study. All the subjects were of Caucasian origin. Genomic DNA was amplified by polymerase chain reaction, followed by enzymatic restriction fragment length polymorphism technique (PCR-RFLP). Patients and controls were genotyped for a single nucleotide polymorphism (C/A transversion) in the third base of codon 31 of p21, which leads to a serine (Ser)/arginine (Arg) substitution. RESULTS: The distribution of the genotypes in the POAG patients showed 128 (91.4%) Ser homozygotes, 10 (7.1%) Ser/Arg heterozygotes and 2 (1.5%) Arg homozygotes. In the control cohort, there were 61 (83.6%) Ser homozygotes and 12 (16.4%) Ser/Arg heterozygotes. No Arg homozygotes were present amongst the control group. Both the allelic and genotypic frequencies of the Ser or Arg residues at codon 31 were not significantly different between POAG patients and controls (Fisher's exact test, P = 0.20 for alleles and P = 0.0561 for genotypes). CONCLUSION: This study suggests that the p21 codon 31 polymorphism does not contribute to the risk of POAG in the Caucasian population.

Clinical outcome of endonasal KTP laser assisted dacryocystorhinostomy.

BACKGROUND: To evaluate the clinical outcome of primary endonasal laser assisted dacryocystorhinostomy (ENL-DCR) using the potassium-titanyl-phosphate laser. METHODS: We retrospectively reviewed all primary ENL-DCRs performed within a period of twelve months by the same combined Ophthalmology and Otorhinolaringology team in Freeman Hospital, Newcastle upon Tyne, UK. The main outcome measure for success was resolution or significant improvement of epiphora. Details of surgery, intraoperative and postoperative complications, as well as pathology associated with failure were also studied. Patients were followed up for at least 12 months. RESULTS: A total of 41 consecutive ENL-DCRs on 29 patients (22 females, 7 males, mean age 75 years) were analysed. All patients had bicanalicular silicone intubation for at least 4 months. The success rate at 12 months postoperatively was 78.1%. Pathology associated with failure included: intranasal pathology (12.2%), mucocele (7.3%), and systemic sarcoidosis (2.4%). No significant intra-operative complications were recorded. CONCLUSION: The ENL-DCR with potassium-titanyl-phosphate laser can be considered as a safe and efficient primary procedure for the treatment of nasolacrimal duct obstruction.

Apolipoprotein E promoter polymorphisms do not have a major influence on the risk of developing primary open angle glaucoma.

PURPOSE: Primary open angle glaucoma (POAG) is a major cause of late onset visual failure of unknown etiology. Recent genetic association studies have implicated the apolipoprotein E (APOE) gene in the pathophysiology of primary open angle glaucoma, but there have been conflicting findings. METHODS: To resolve this issue we studied 140 cases and 73 controls that were carefully phenotyped, and used a logistic regression model to simultaneously analyze the effect of apolipoprotein E genotype and functional polymorphisms in the apolipoprotein E gene promoter while controlling for potentially confounding variables. RESULTS: We found no evidence of an association between the apolipoprotein E promoter region polymorphisms and primary open angle glaucoma. CONCLUSIONS: Apolipoprotein E promoter polymorphisms are unlikely to have a major impact on the pathophysiology of primary open angle glaucoma.

The role of apolipoprotein E gene polymorphisms in primary open-angle glaucoma.

OBJECTIVE: To test the hypothesis that genetic polymorphisms of the apolipoprotein E (APOE) gene are associated with primary open-angle glaucoma (POAG), based on the association between neurodegenerative diseases and the APOE genotype. METHODS: Genomic DNA was examined from an unrelated cohort of 137 POAG patients and 75 control subjects from the ophthalmology department of the Royal Victoria Infirmary. The APOE allele frequency (epsilon2, epsilon3, and epsilon4 alleles) was studied by polymerase chain reaction amplification of the related locus (19q13.2), enzymatic digestion of the products, gel electrophoresis, and imaging under UV illumination. For statistical analysis, we used a logistic regression model that included intraocular pressure as a continuous variable to study the possible correlation between POAG and APOE allele frequency. RESULTS: Logistic regression analysis showed no statistically significant association between the frequency of the APOE allele and POAG for the population studied, irrespective of the IOP (epsilon2 odds ratio, 0.82; 95% confidence interval, 0.12-5.79 [P =.84]; epsilon3 odds ratio, 0.39; 95% confidence interval, 0.10-1.49 [P =.17]; and epsilon4 odds ratio, 3.84; 95% confidence interval, 0.80-18.49 [P =.09]). CONCLUSION: In our cohort, the APOE genotype does not constitute a risk factor for developing POAG, even in patients with normal-tension glaucoma.Clinical Relevance Apolipoprotein E polymorphisms do not appear to be contributory to POAG.

Improved illumination for the Perkins applanation tonometer.

AIMS: To improve the Perkins tonometer measurements by using an augmented, monochromatic solid-state light source of 470 nm wavelength. METHODS: This prospective study comprised 44 patients of our ophthalmic department who were split into two groups of 21 and 23 patients, and were tested by two independent ophthalmologists. Intraocular pressure (IOP) was measured in both eyes, comparing the instrument with augmented source against the standard Perkins for both observers. A set of three consecutive IOP measurements was recorded on each patient's eye and the time required to make each of them was recorded. The mean of the three IOP values was used in the analyses. RESULTS: For Observer 1, higher values of IOP with our augmented illumination against the standard were recorded, the mean difference of +0.59 mmHg being statistically significant (95% CI, 0.0 to +1.18 mmHg). For Observer 2, the mean difference of -0.22 mmHg was not significant (95% CI, -0.70 to +0.26 mmHg). Measurement times for observers were shorter when using the augmented illumination (Observer 1: mean difference = -2.0 s, S.E. = 1.4 s, CI, +0.8 to -4.9 s; Observer 2: mean difference = -5.0 s, S.E. = 1.3 s, CI, -2.5 to -7.5 s). CONCLUSION: The monochromatic blue light source may improve the performance of IOP measurements with the Perkins instrument under bright room conditions, making them faster and more convenient.