Exposure to topical apraclonidine in children with glaucoma.

PURPOSE: The topical alpha-2 adrenergic agonist, brimonidine, although effective at intraocular pressure (IOP) reduction in adults, is contraindicated in infants/small children due to severe systemic side effects. The topical alpha-2 adrenergic agonist apraclonidine, used for short-term IOP reduction in adults, and described for Horner's syndrome testing, has recently been reported to cause systemic side effects in children. We have used topical apraclonidine 0.5% to treat infants and small children with glaucoma undergoing angle surgery, and selected children needing additional IOP reduction. Here we evaluate the safety of topical apraclonidine 0.5% when used in children with glaucoma. METHODS: Retrospective chart review of sequential children with glaucoma, having angle surgery or examination under anesthesia at Duke Eye Center from 1995 to 2006, who received topical apraclonidine 0.5%. Demographic and glaucoma-related information were noted, including any reported side effects. RESULTS: In all, 115 eyes of 75 pediatric glaucoma patients received apraclonidine 0.5% drops, for a total 179 treatment sessions. Most sessions (91%, 162/179) occurred during and after angle surgery, primarily in children with congenital/infantile glaucoma (53%, 40/75). Median age at apraclonidine exposure was 5.3 months (range, 0.1 mo to 17 y). Median number of apraclonidine dose exposures was 15 (range, 4 to 5745); median number of concurrent glaucoma medications was 3. Nonthreatening side effects were noted in 8% (6/75) total children: topical allergy (2 children), lethargy (3 children), and decreased appetite (1 child). CONCLUSIONS: In contrast to brimonidine, topical apraclonidine 0.5% can safely be administered for short-term treatment of most infants and children undergoing angle surgery for glaucoma, rarely producing systemic side effects.

Microbial keratitis following corneal transplantation.

PURPOSE: To study clinical and microbiologic characteristics of corneal infections following penetrating keratoplasty (PK). DESIGN: Retrospective case series. METHODS: Medical records of patients who presented to Duke University Eye Center from January 1, 1999 to July 1, 2005 with microbial keratitis after PK were reviewed. RESULTS: Forty-four corneal graft infections were reviewed. Mean interval between PK and infection was 26.3 months. Associated conditions included broken or loose sutures (10, 22.7%) and topical corticosteroids (34, 77.3%). Staphylococcal (12, 20.7%) and Pseudomonal (7, 12.1%) species were common pathogens, and fungal species accounted for eight (18.2%) infections. Twelve patients (27.3%) had polymicrobial infections. Thirteen patients (29.5%) underwent repeat PK. Mean postinfection visual acuity at last follow-up was 20/400. CONCLUSIONS: Microbial infections within corneal grafts can occur anytime in the postoperative course and are associated with broken sutures and the use of topical corticosteroids. The diversity of pathogenic organisms, antibiotic resistance, and the potential for poor outcomes supports aggressive management of these infections.

Collagen-rich crystalloids in a scarred vascularized cornea.

Collagen-rich crystalloids, also referred to as collagenous crystalloids, are uncommon findings in benign salivary gland tumors with myoepithelial differentiation and in cutaneous neoplasms. Herein, we report the presence of collagen-rich crystalloids in the scarred, vascularized cornea of a 56-year-old woman. The patient underwent penetrating keratoplasty, and microscopic examination of hematoxylin-eosin-stained sections disclosed large aggregates of refractile material within the corneal stroma. The deposits were partially birefringent when viewed with polarized light and composed of radially arranged columns (long rectangles) with rounded to pointed tips. The deposits had tinctorial properties of collagen using Masson trichrome and the van Gieson method for collagen, and they stained with Alcian blue, pH 2.5, and Verhoeff elastic stain. They did not stain with Gomori methenamine silver, Snook reticulin stain, or tyrosine using the Baker modification of the Millon reaction. This is the first report, to our knowledge, of collagen-rich crystalloids in the cornea. Their presence in the cornea indicates that these structures may occur in the absence of neoplasia.

Polysensory interactions along lateral temporal regions evoked by audiovisual speech.

Many socially significant biological stimuli are polymodal, and information processing is enhanced for polymodal over unimodal stimuli. The human superior temporal sulcus (STS) region has been implicated in processing socially relevant stimuli--particularly those derived from biological motion such as mouth movements. Single unit studies in monkeys have demonstrated that regions of STS are polysensory--responding to visual, auditory and somato-sensory stimuli, and human neuroimaging studies have shown that lip-reading activates auditory regions of the lateral temporal lobe. We evaluated whether concurrent speech sounds and mouth movements were more potent activators of STS than either speech sounds or mouth movements alone. In an event-related fMRI study, subjects observed an animated character that produced audiovisual speech and the audio and visual components of speech alone. Strong activation of the STS region was evoked in all three conditions, with greatest levels of activity elicited by audiovisual speech. Subsets of activated voxels within the STS region demonstrated overadditivity (audiovisual > audio + visual) and underadditivity (audiovisual < audio + visual). These results confirm the polysensory nature of STS region and demonstrate for the first time that polymodal interactions may both potentiate and inhibit activation.

Laparoscopic repair of a Morgagni hernia presenting with syncope in an 85-year-old woman: case report and update of the literature.

An 85-year-old woman was transferred from her local hospital for cardiac evaluation after presenting with repeated episodes of syncope during bowel movements. A thorough evaluation revealed no cardiac abnormalities but did reveal a Morgagni hernia with transverse colon in the mediastinum. She underwent laparoscopic reduction of the colon and repair of the hernia with mesh and had a rapid and uneventful recovery.