Patulous nasolacrimal duct with air reflux: a complication of submucosal diathermy of the inferior turbinate.

BACKGROUND: Submucosal diathermy to the inferior turbinate is a widely practised procedure to improve the nasal airway when nasal obstruction is due to hypertrophy of the inferior turbinate. This paper reports a case of an unusual nasolacrimal complication following submucosal diathermy to the inferior turbinate, and reviews the relevant literature.Case reportA 33-year-old male patient developed a patulous nasolacrimal duct opening following submucosal diathermy of the inferior turbinate. This resulted in spontaneous reflux of air and nasal mucus on to the ocular surface. CONCLUSION: This newly recognised complication of submucosal diathermy to the inferior turbinate indicates the need to be aware of the potential risk to the nasolacrimal system with this technique.

Ocular air gun injuries: a one-year surveillance study in the UK and Eire (BOSU). 2001-2002.

AIMS: The vulnerability of the eye means that ocular air gun injuries figure prominently in the medical literature. This Study reports the results of the first ocular air gun injury surveillance study. METHODS: Ocular air gun injuries were reported to the British Ophthalmic Surveillance Unit (BOSU; United Kingdom and Eire) for the period November 2001-December 2002 (13 months). Two questionnaires were used to collect demographic details, circumstances of injury, details of injuries, medical management and outcome. RESULTS: A total of 105 initial and 99 follow-up questionnaires were returned. Eighty-six ocular air gun injuries occurred during the last 12 months of surveillance yielding a corrected, estimated incidence of 91-115 injuries/year. Injuries were most frequent in August/September, and 90% (95/105) of victims were men with mean age of 17.5 years (74% under 18 years). In all, 40% (32/81) of injuries occurred at home and 53% (43/81) in a public place. 23% (19/84) of injuries were deliberate, 66% (69/104) of injuries were severe and 20% (21/105) resulted in ruptured globes. In all, 54% (48/89) required hospital admission and 41 required surgery. A total of 11% (12/105) of eyes were either enucleated or eviscerated. Final visual acuity was 6/12 (Snellen) in 65% (59/91). Moderate/significant cosmetic deformities were recorded in 10% (8/77) and restricted ocular movements in 5% (4/72). CONCLUSIONS: Ocular air gun injuries damage sight and leave lasting morbidity. The demographics and circumstances of injury are well documented with access to, and unsupervised use of, air guns, appearing the principal risks for injury.

Late reactivation of thyroid associated ophthalmopathy causing optic neuropathy.

We describe a case of thyroid associated ophthalmopathy complicated by optic neuropathy presenting 18 years after the diagnosis of dysthyroidism, due to late reactivation of a previously stable ophthalmopathy.

Oral and intraperitoneal immunization with rotavirus 2/6 virus-like particles stimulates a systemic and mucosal immune response in mice.

We examined the use of a virus-like particle (VLP) as an immunogen by analysing the IgA and IgG response generated in serum, intestinal (fecal), pulmonary and uterine samples. The particle comprised two rotavirus capsid proteins (simian VP2 and murine VP6) generated using recombinant baculovirus expression of the two capsid proteins, which self-assembled into particulate VLP2/6. Mice were immunized orally or intraperitoneally (i.p.) with 0 or 100 microg VLP2/6 with or without 5 microg cholera toxin adjuvant. The results showed a systemic and mucosal immune response to VLP2/6 when administered i.p. and, to a lesser extent, when delivered orally which was not dependent on adjuvant use and further proves the concept of VLP2/6 as an effective immunogen.

Uracil recognition by archaeal family B DNA polymerases.

Archaeal family-B DNA polymerases possess a novel uracil-sensing mechanism. A specialized pocket scans the template, ahead of the replication fork, for the presence of uracil; on encountering this base, DNA synthesis is stalled. The structural basis for uracil recognition by polymerases is described and compared with other uracil-recognizing enzymes (uridine-triphosphate pyrophophatases and uracil-DNA glycosylases). Remarkably, protein-protein interactions between all three archaeal uracil sensors are observed; possibly the enzymes co-operate to efficiently eliminate uracil from archaeal genomes.

Novel corneal features in two males with incontinentia pigmenti.

Incontinentia pigmenti (IP) is a rare X linked genetic disorder, which predominantly affects females. The mutations are usually lethal in males. Two male cases are presented; a genetic mosaic for the common IP deletion and another in whom the genetic abnormality has not yet been characterised. Emphasis is placed on the ocular features present in this disorder and in particular a novel corneal feature and its possible aetiology.

In vitro development of pig preantral follicles cultured in a serum-free medium and the effect of angiotensin II.

A novel culture system is reported in which pig preantral follicles (< 300 microm in diameter) with an intact thecal cell layer were isolated and cultured in a serum-free medium for up to 30 days. The medium supported follicle culture after isolation, while maintaining both somatic cell and oocyte viability. Follicles were cultured in groups (n = 3 per group) on collagen-coated wells for 16 days, during which they retained a three-dimensional structure, maintained oocyte viability and increased in diameter and number of somatic cells. Follicle culture for 30 days resulted in a further increase in number of cells, oocyte viability was maintained, and a significant increase in follicle diameter was observed (P < 0.001), with 29% of follicles forming an antrum. Follicles synthesized measurable quantities of progesterone (168 pg per 100 microl per 48 h; no significant increase with time) and increasing quantities of oestradiol (136 pg per 100 microl per 48 h; P < 0.001 with time). Further supplementation of the medium with 100 micromol testosterone l(-1) at day 28 resulted in a significant increase in oestradiol secretion by both antral (P < 0.01) and preantral follicles (P < 0.05). Culture over 30 days in medium with 10(-10) mol angiotensin II l(-1) and further supplementation at day 28 with 100 micromol testosterone l-1 also increased oestradiol synthesis (P < 0.001). These results show that viable preantral follicles may be cultured for extended periods, and indicate that the possible role of angiotensin II in folliculogenesis and steroidogenesis in early development of pig follicles requires further investigation.

Autoradiographic determination of angiotensin II receptors in prepubertal and postpubertal pig ovarian tissue.

The aim of this study was to determine whether specific receptors for angiotensin II are present in prepubertal and postpubertal pig ovaries using an autoradiographic technique and computerized densitometry. Frozen sections were cut from prepared samples, and (125)I-labelled angiotensin II and the angiotensin II receptor subtype-specific nonpeptide antagonists for receptor subtype 1, AT(1) (GR117289) and subtype 2, AT(2) (PD123319) were used. In both pre- and postpubertal pig ovarian tissue, specific receptors for angiotensin II were demonstrated. These receptors had a density of 2487.6 (range: 267.5-5177.6, n = 4) and 3703.8 (range: 1819.9-5207.8, n = 4) fmol per mm(2), respectively, and dissociation constants of 130.0 and 26.3 nmol l(-1), respectively (prepubertal ovarian range: 106.0-165.4 nmol l(-1); postpubertal ovarian range: 26.1-100.3 nmol l(-1); P < 0.05, Mann-Whitney U test). AT(1) receptors with a K(i) for (125)I-labelled angiotensin II of 346.9 nmol l(-1) in the prepubertal and 268.1 nmol l(-1) in the postpubertal ovary were located predominantly in follicle wall tissue. Competitive inhibition studies using both angiotensin II antagonists resulted in a decrease in K(i) with prepubertal tissue (283.7 nmol l(-1)) and an increase in postpubertal tissue (293.9 nmol l(-1)). Immunocytochemistry using sections from paraffin wax-embedded prepubertal (n = 4) and postpubertal (n = 4) pig ovaries confirmed the presence of AT(1) receptors on the granulosa cell layer, but not the thecal cell layer, of antral follicles in both pre- and postpubertal pig ovarian tissue, and AT(2) receptors within the granulosa cell layer of prepubertal pig ovarian antral follicles. In summary, these results indicate that angiotensin II receptors are of higher affinity in postpubertal tissue than they are in prepubertal tissue, and indicate an active renin-angiotensin system within the pig ovary.

A comparison of stereoscopic and monoscopic evaluation of optic disc topography using a digital optic disc stereo camera.

AIMS: To compare stereophotographic and monophotographic optic disc assessments made using a digital optic disc stereo camera. METHODS: Stereo digital optic disc photographs of 150 selected patients who had presented to a glaucoma clinic were assessed by two masked observers on separate occasions using (1) the stereophotographs and a stereoviewer, (2) a single image from the same stereopair. Results were analysed for both right and left eyes separately. 95% tolerance limits for change (TC) and intraclass correlation coefficients (ICC) were calculated and a multivariate analysis using a general linear model for repeated measures was performed. RESULTS: A total of 201 optic disc images of 150 patients (84 females, 108 left eyes) were analysed. Mean age of patients was 64 years. The results for right eyes are as follows (similar results were obtained for left eyes). Intraobserver (stereoscopic compared to monoscopic) measurements of: horizontal cup:disc ratios (CDR), ICC = 0.5995 and 0.7269, TC = 34% and 27%; vertical CDR, ICC = 0.8298 and 0.817, TC = 25% and 27%; area CDR, ICC = 0.7757 and 0.8259, TC = 28% and 25%; circumference CDR, ICC = 0.7618 and 0.8103, TC = 28% and 25%. Interobserver measurements of: horizontal CDR, ICC stereoscopic (SS) = 0.7287; monoscopic (MS) = 0.5030; TC SS = 30%; MS = 32%; vertical CDR, ICC SS = 0.8439; MS = 0.7106; TC SS = 25%; MS = 31%; area CDR, ICC SS = 0.8392; MS = 0.6276; TC SS = 26%; MS = 32%; circumference CDR, ICC SS = 0.8433; MS = 0.6438, TC SS = 26%; MS = 31%. Systematic bias between observers and between methods was within acceptable limits. CONCLUSIONS: This study using a digital stereo camera indicates that there may be little benefit of stereoscopic imaging over monoscopic imaging despite demonstrating small but inconsistent differences between both observers and methods.

Ocular air-gun injury: 19 cases.

There have been many calls for preventive action against injuries caused by air-guns. Eye injuries are particularly serious, and we conducted a retrospective study to review their characteristics. Ophthalmic consultants in the south-west region of England and South Wales were asked to recollect any injuries that had resulted from air weapons. Information was recorded on the nature and circumstances of the injury, subsequent management, and long-term effects. 19 cases of ocular injury were identified, sustained at mean age 19.7 years, all in the past decade. 15 of the victims were male. At least 12 shootings were accidental but 2 were deliberate. The injury was self-inflicted in 5 cases, and in 6 the assailant was known to the victim. 9 sustained ruptured globes and 8 had severe contusions. Ultimately 4 individuals required enucleation and 2 evisceration. At last review, visual acuity was no perception of light in 10 (53%) and "counting fingers" or worse in 16. Victims spent an average of nearly 10 days as an inpatient. The characteristics of the incidents that lead to ocular air-weapon injuries are unchanged. Reform of the firearms laws is probably the best way to prevention.

Superior rectus-levator synkinesis: a previously unrecognized cause of failure of ptosis surgery.

PURPOSE: To describe a previously unreported type of ptosis associated with abnormal synkinesis between the superior rectus muscle and the levator palpebrae superioris. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Seven cases with congenital or longstanding unilateral ptosis presenting to a regional, tertiary referral, oculoplastic service. Six of these cases were seen within a period of 2 years. METHODS: Detailed observations of eyelid, ocular, and pupil movements of both eyes were performed before the planning of ptosis surgery anterior levator resection. MAIN OUTCOME MEASURES: Magnitude of ptosis and its variation with the position of gaze. RESULTS: Ptosis present in the primary position disappeared or markedly reduced with upgaze so that measurements of levator function were apparently normal. Close examination of the relative movement of the eyelids revealed evidence of superior rectus to levator synkinesis occurring during upgaze. In three cases the synkinesis was recognized only after failed ptosis surgery. Once recognized, two of these cases underwent further surgery with an excellent result. Three other patients all had successful surgery. CONCLUSIONS: Superior rectus to levator synkinesis may be easily overlooked if eyelid elevation in upgaze is ascribed to normal levator function rather than a synkinetic movement. We draw attention to the importance of identifying this relatively common condition to plan appropriate ptosis surgery. The lack of levator muscle tone in the primary position of gaze means that an augmented resection of the levator muscle should be performed.

A new digital optic disc stereo camera: intraobserver and interobserver repeatability of optic disc measurements.

AIMS: To investigate the intraobserver and interobserver repeatability of optic disc measurement using a new digital optic disc stereo camera. METHODS: 112 consecutive new patients presenting to a glaucoma service had dilated optic disc photography performed using a new digital stereo camera (Discam, Marcher Enterprises Ltd, Hereford). The images were analysed by two masked observers using a stereo viewer and computer simulated stereopsis. Vertical and horizontal cup:disc ratios (CDR), cup area:disc area, and cup circumference:disc circumference were computed. Intraobserver and interobserver repeatability analyses were performed. Intraclass correlation coefficients (ICC) and 95% tolerance for change (TC) were computed. RESULTS: 220 optic discs were photographed, of which 196 were suitable for analysis (10 were of poor image quality and 14 had anomalous discs). Mean age of patients was 65 years, 60 were male and 48 female. For intraobserver measurements of: horizontal CDR, ICC = 0.94, TC = 0.11 (15% of range); vertical CDR, ICC = 0.92, TC = 0.14 (16% of range); cup area:disc area, ICC = 0.95, TC = 0.10 (13% of range), and cup circumference:disc circumference, ICC = 0.95, TC = 0.09 (14% of range). For interobserver measurements of: horizontal CDR, ICC = 0.89, TC = 0.14 (19% of range); vertical CDR, ICC = 0.90, TC = 0.14 (16% of range); cup area:disc area, ICC = 0.92, TC = 0.13 (16% of range), and cup circumference:disc circumference, ICC = 0.90, TC = 0.12 (17% of range). Systematic bias between observers was within acceptable limits. CONCLUSIONS: Digital stereo disc photography and analysis provide repeatable measures of optic disc variables. The results compare favourably with ophthalmoscopic and stereophotographic methods of assessment of the optic disc.

Material properties of ophthalmic sutures after sterilization and disinfection.

PURPOSE: To assess the effects that sterilization and disinfection have on the tensile properties of commonly used ophthalmic sutures. SETTING: University of Bristol, Bristol, United Kingdom. METHODS: The sutures 10-0 nylon, 10-0 polypropylene (Prolene), 8-0 virgin silk, and 8-0 polyglactin 910 (Vicryl) were subjected to thermal or chemical sterilization/disinfection including autoclaving, boiling, and immersion in alcohol or glutaraldehyde. Measurements of tensile strength, suture extension to the point of failure, and suture stiffness were then performed. RESULTS: Nylon and Prolene were little affected by all sterilization and disinfection methods. Virgin silk and Vicryl were weakened by thermal methods of sterilization and disinfection. Both Vicryl, and to a lesser extent virgin silk, appeared to be strengthened by immersion in alcohol or glutaraldehyde. CONCLUSION: The casual reuse of ophthalmic sutures is not recommended. However, when there is no alternative, nylon and Prolene monofilaments can be autoclaved or immersed in fresh activated glutaraldehyde, and Vicryl and virgin silk can be immersed in fresh activated glutaraldehyde without significant loss of tensile strength.