Ahmed valve, suture-less implantation: A new approach to an easier technique.

PURPOSE: Tissue adhesives have been used in ophthalmology instead of sutures to minimize the operating time. This case series investigated the effectiveness and safety of use of cyanoacrylate in Ahmed valve implantation through pars plana for refractory glaucoma. PATIENTS AND METHODS: Seventeen eyes of 17 patients with refractory glaucoma underwent Ahmed valve scleral suture-less implantation through pars plana with a cyanoacrylate suture of the plate. Refractory glaucoma was defined as intraocular pressure (IOP) ≥ 21 mm Hg with antiglaucoma eye drops, good adherence to treatment, and no previous glaucoma surgery. IOP control and development of complications were evaluated during the follow-up (mean follow-up, 13.23 mo, 6 to 28 mo). RESULTS: IOP control, defined as IOP ≤ 21 mm Hg with or without antiglaucoma eye drops, was achieved in 82.2% of patients, and 58.8% were able to eliminate antiglaucoma eye drops. Mean surgical time was 9.76 ± 2.60 and 6 ± 0.81 minutes in patients with previous vitrectomy (4 cases). Postoperative complications included transiently increased IOP, transient hyphema, early postoperative hypotony (4 cases), and tube block by the vitreous (2 cases): 1 resolved by Nd:YAG and the other by second vitrectomy. No cases of tube or plate extrusion, plate migration, choroidal or retinal detachment, or vitreous hemorrhage were observed. CONCLUSIONS: These results are promising and demonstrate a safe and effective alternative to the traditional scleral suture. Our data suggest that Ahmed valve implantation through pars plana with cyanoacrylate is a safe and effective method for refractory glaucoma. Further studies are needed to confirm our observation.

Treatment of refractory dry eye associated with graft versus host disease with 0.03% tacrolimus eyedrops.

PURPOSE: We investigate the efficacy of 0.03% topical tacrolimus eyedrops for the treatment of dry eye in graft versus host disease (GVHD) patients resistant/intolerant to 0.05% topical cyclosporine. METHODS: Forty-three patients were enrolled in this prospective study. After completing a 1-year run-in period of using artificial tears, 50% autologous serum eyedrops, and punctal plug occlusion, all the symptomatic patients (n=29) were treated with 0.05% topical cyclosporine (Restasis(®); Allergan, Inc.). After 1 month, the patients who presented topical or systemic intolerance to cyclosporine were instructed to instill 0.03% topical tacrolimus once a day for 3 months (n=14). All the patients were allowed to continue with their basal dry eye treatment. Visual acuity, fluorescein staining, Schirmer test, fluorescein tear break-up time, and tear meniscus height measurement were evaluated fortnightly (minimum 3 months). Subjective assessments of symptoms were also reported at the beginning and at the end of the study. RESULTS: Dry eye symptoms and signs improved statistically (P<0.05) and significantly with tacrolimus and cyclosporine topical treatment. No significant differences were observed between both the groups. The mean follow-up time was 12.14±2.69 months (range 10-18 months). CONCLUSION: The findings of this prospective pilot study suggest that cyclosporine-intolerant patients with dry eye associated with GVHD can be effectively treated with topical tacrolimus.

Oral propranolol for circumscribed choroidal hemangioma.

INTRODUCTION: Several therapeutic approaches have been developed to treat choroidal hemangioma. However, all these therapies are associated with a potential risk of damaging the overlying retina. CASE REPORT: We report a case of circumscribed choroidal hemangioma (CCH) in a 59-year-old man refractory to laser treatment. Visual acuity was 20/200 and a serous macular detachment was present. The CCH was treated with oral propanolol, whereupon visual acuity improved to 20/20 and the macular detachment resolved without systemic or local adverse effects. DISCUSSION: Propanolol is a ß-blocker commonly used in cardiology that may induce endothelium vasoconstriction and inhibit endothelial proliferation. It has been shown to be effective in infantile facial hemangiomas, and proved safe and effective for the CCH in our patient. Further studies are needed to confirm our observation.

Fulminant bilateral Haemophilus influenzae keratitis in a patient with hypovitaminosis A treated with contaminated autologous serum.

We report on a patient with hypovitaminosis A treated with autologous serum (AS) who had bilateral infectious ulcers positive for Haemophilus influenzae. The patient suffered a perforation of his right eye and total healing of his left eye with a residual leukoma. In cases of severe malnutrition, serum levels of vitamins and bacteriostatic and growth factors are reduced, so AS would not only be ineffective but also increase the risk of secondary corneal infection. The prophylactic use of a topical antibiotic would be useful in treatment with AS, especially in patients who do not use and adequately store the eye drops, as in our patient.

Bleeding Follicular Conjunctivitis due to Influenza H1N1 Virus.

Influenza H1N1 or A virus is a new virus serotype capable of human-to-human transmission. This infection causes a flu syndrome similar to that of seasonal influenza, with only one case of conjunctivitis described and no clinical details or microbiological confirmation. Its diagnosis is performed by PCR of pharyngeal smear of the patients affected. We report the first well-documented case in the medical literature of conjunctivitis by H1N1 virus.

Aqueous humor neutrophil gelatinase-associated lipocalin levels in patients with idiopathic acute anterior uveitis.

PURPOSE: The purpose of this study was to evaluate the levels of neutrophil gelatinase-associated lipocalin (NGAL) in the aqueous humor in eyes with idiopathic acute anterior uveitis (AAU). METHODS: A comparative control study. Aqueous humor was collected from 20 eyes of 20 patients with idiopathic AAU. The control group included 20 aqueous samples from 20 patients about to undergo cataract surgery and without any other ocular or systemic diseases. The level of NGAL was determined with a commercially available ELISA kit. RESULTS: The concentration of NGAL in aqueous humor was markedly higher in patients with idiopathic AAU than in control subjects (Mann-Whitney U test, p<0.001). The level of NGAL was 139,197.38+/-183,426.36 (mean+/-SD) pg/ml in eyes with AAU and 3,169.96+/-1,595.78 pg/ml in the eyes of the control group. CONCLUSIONS: The aqueous humor NGAL level is increased in eyes with idiopathic AAU. These results imply that NGAL is associated with the regulation of inflammation in patients with AAU and could be used as a biomarker of ocular inflammation and immunomodulatory treatment response.