What is on the horizon for cycloablation?

The concept of cycloablation has been present for several decades, but the inability to titrate a predictable and reproducible response has been its drawback. However, cycloablation still plays an important role in our paradigm of glaucoma therapy, since it can be the treatment of last resort for a small group of patients who have exhausted all other treatment modalities. Experience with argon or diode endolaser cyclophotocoagulation holds promise for these and other patients because it appears to demonstrate a safer side-effect profile, while providing good results. Better results may be partially due to visualization of the ciliary processes before applying laser energy, which allows for targeted destruction of tissue and limits the amount of inflammation. Additional experience will better define the indications and scope of these newer modalities.

Site of service, anesthesia, and postoperative practice patterns for oculoplastic and orbital surgeries.

PURPOSE: Variations in physician practice patterns, particularly with reference to cost-intensive resource utilization, are increasingly being scrutinized. However, little information is currently available regarding physician practice patterns for oculoplastic surgery. METHODS: The authors surveyed members of the American Society of Ophthalmic Plastic and Reconstructive Surgery regarding their most common site of service, type of anesthesia, and first postoperative week of follow-up for 15 selected eyelid, lacrimal, and orbital procedures. RESULTS: The majority of eyelid and lacrimal surgeries are currently performed on an out-patient basis (hospital out-patient, ambulatory surgery center, or office), typically using local anesthesia, with or without sedation. Regional differences were noted. Physicians in western states showed a greater tendency toward office-based surgery for procedures such as blepharoplasty and ptosis repair. Orbital procedures were performed more frequently as a hospital inpatient surgery, under general anesthesia. Patterns of follow-up within the first postoperative week varied considerably for most procedures. Compared with admitting practices in 1987, an obvious trend toward out-patient surgery was noted. CONCLUSION: Variations in practice patterns will assume greater importance as the pressure for cost-containment increases. Total costs are affected by physician choices for site of service and type of anesthesia. This study allows surgeons who perform oculoplastic procedures to compare their practices with a national group specializing in such surgery. Further outcome-oriented studies are needed to develop practice guidelines for "preferred patterns" of care.

A mutation that uncouples flagellum assembly from transcription alters the temporal pattern of flagellar gene expression in Caulobacter crescentus.

The transcription of flagellar genes in Caulobacter crescentus is regulated by cell cycle events that culminate in the synthesis of a new flagellum once every cell division. Early flagellar gene products regulate the expression of late flagellar genes at two distinct stages of the flagellar trans-acting hierarchy. Here we investigate the coupling of early flagellar biogenesis with middle and late flagellar gene expression. We have isolated mutants (bfa) that do not require early class II flagellar gene products for the transcription of middle or late flagellar genes. bfa mutant strains are apparently defective in a negative regulatory pathway that couples early flagellar biogenesis to late flagellar gene expression. The bfa regulatory pathway functions solely at the level of transcription. Although flagellin promoters are transcribed in class II/bfa double mutants, there is no detectable flagellin protein on immunoblots prepared from mutant cell extracts. This finding suggests that early flagellar biogenesis is coupled to gene expression by two distinct mechanisms: one that negatively regulates transcription, mediated by bfa, and another that functions posttranscriptionally. To determine whether bfa affects the temporal pattern of late flagellar gene expression, cell cycle experiments were performed in bfa mutant strains. In a bfa mutant strain, flagellin expression fails to shut off at its normal time in the cell division cycle. This experimental result indicates that bfa may function as a regulator of flagellar gene transcription late in the cell cycle, after early flagellar structures have been assembled.