Burden and Depression in Caregivers of Blind Patients in New York State.

PURPOSE: To describe the degree of burden of care and the proportion at risk of depression among individuals caring for legally blind patients. METHODS: We performed a cross-sectional study of 486 individuals providing care to their family members who were legally blind. Best-corrected visual acuity of the better-seeing eye in patients determined group placement: Group 1, 20/200-10/200; group 2, 10/200 to light perception (LP); group 3, no light perception (NLP); group VF, visual field loss to <20 central degrees. Burden was evaluated using the Burden Index of Caregivers (BIC-11) and the prevalence at risk of depression was determined by the Center for Epidemiologic Studies Depression (CES-D) scale. RESULTS: Total mean BIC-11 scores ranged from 8.78 ± 4.82 (group 1) to 12.03 ± 5.22 (group 3; p = 0.04). Daily hours spent on close supervision, intensity of caregiving and presence of multiple chronic illnesses in caregivers were the significant covariates affecting BIC-11 scores (p < 0.05). The prevalence of caregivers at risk of depression increased with vision loss from 6.9% (group 1) to 17.9% (group 3; p < 0.05). Female caregivers had an odds ratio (OR) of 2.89 for depression (95% confidence interval, CI, 1.07-3.97; p = 0.04). Caregivers with ≥2 comorbidities had OR 4.24 (95% CI 2.41-6.11) for risk of depression (p < 0.01). CONCLUSION: Burden of care was highest among caregivers who provided greater hours of supervision. Patients with more limitations in their activities of daily living had caregivers who reported higher burden. Female caregivers and caregivers with multiple chronic illnesses were at higher risk of depression.

Optic nerve morphology in normal children.

PURPOSE: To expand the normative database of pediatric eyes analyzed with the Optovue optical coherence tomography (OCT). METHODS: In a community-based, cross-sectional analysis, 77 healthy 5-year-old children were recruited from pediatric practices. No subject had any known ocular disorder. Their optic nerves were assessed using Optovue optical coherence tomography (OCT). Data were compared to the normative database obtained by Optovue for adults, ages 18-25, 40-45, and 55-60. Comparisons included thickness of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), and optic nerve head disk area, vertical (VCD) and horizontal (HCD) cup:disk ratios, and cup area. RESULTS: In comparison to all adult age groups, the children's optic nerve heads were statistically less cupped (cup area, VCD, HCD), all with P values of <0.0003. No statistical difference was identified between the children and adults aged 18-25 and 40-45 with respect to RNFL or GCC. Both RNFL and GCC were thicker in the children compared to adults aged 55-60 (P < 0.003). Children's disk area's were marginally smaller than those of adults, the difference not reaching statistical significance. CONCLUSIONS: Our OCT results demonstrate that young children's optic nerves are statistically less cupped than those of all normal adults. The children's RNFL and GCC are statistically thicker than those of adults aged 55-60.

Thioaptamers targeting dengue virus type-2 envelope protein domain III.

Thioaptamers targeting the dengue-2 virus (DENV-2) envelope protein domain III (EDIII) were developed. EDIII, which contains epitopes for binding neutralizing antibodies, is the putative host-receptor binding domain and is thus an attractive target for development of vaccines, anti-viral therapeutic and diagnostic agents. Thioaptamer DENTA-1 bound to DENV-2 EDIII adjacent to a known neutralizing antibody binding site with a dissociation constant of 154nM.

Soni-removal of nucleic acids from inclusion bodies.

Inclusion bodies (IBs) are commonly formed in Escherichia coli due to over expression of recombinant proteins in non-native state. Isolation, denaturation and refolding of these IBs is generally performed to obtain functional protein. However, during this process IBs tend to form non-specific interactions with sheared nucleic acids from the genome, thus getting carried over into downstream processes. This may hinder the refolding of IBs into their native state. To circumvent this, we demonstrate a methodology termed soni-removal which involves disruption of nucleic acid-inclusion body interaction using sonication; followed by solvent based separation. As opposed to conventional techniques that use enzymes and column-based separations, soni-removal is a cost effective alternative for complete elimination of buried and/or strongly bound short nucleic acid contaminants from IBs.

Heterochromia iridis and pertinent clinical findings in patients with glaucoma associated with Sturge-Weber syndrome.

PURPOSE: To examine the clinical and gonioscopic findings in patients with glaucoma associated with Sturge-Weber syndrome. METHODS: Retrospective review of clinical findings of all patients with Sturge-Weber syndrome who presented between January 1978 and December 2003. Koeppe gonioscopy was performed under general anesthesia and findings were photographed when feasible. Iris color was documented by color sketch or photograph at initial presentation. Fisher exact test was used to determine whether the presence of heterochromia was statistically higher in the glaucomatous group. RESULTS: Fifty-five patients who met inclusion criteria were identified, of whom 44 (80%) had glaucoma. Unilateral glaucoma was diagnosed in 30 eyes and bilateral glaucoma in 14 eyes, yielding 58 eyes with glaucoma and 52 eyes without. Gonioscopic examination revealed distinct anatomic abnormalities in the anterior chamber angle in 32 (55%) of the glaucomatous eyes in contrast to the normal fellow eyes in patients with unilateral glaucoma and to the patients without glaucoma. Heterochromia iridis with darker iris on the glaucomatous side was present in 11 of the 30 patients with unilateral glaucoma (37%, P < .001) but in none of the patients without glaucoma. CONCLUSION: The characteristics observed in the anterior chamber angle in this large, uniquely examined series are the first reported to the authors' knowledge and may support a role for neural crest derived anomalies in the pathogenesis of glaucoma in these infant eyes. Careful examination for heterochromia iridis may be judicious in these patients.

Structure of yellow fever virus envelope protein domain III.

The structure of recombinant domain III of the envelope protein (rED3) of yellow fever virus (YFV), containing the major neutralization site, was determined using NMR spectroscopy. The amino acid sequence and structure of the YFV-rED3 shows differences from ED3s of other mosquito-borne flaviviruses; in particular, the partially surface-exposed BC loop where methionine-304 and valine-324 were identified as being critical for the structure of the loop. Variations in the structure and surface chemistry of ED3 between flaviviruses affect neutralization sites and may affect host cell receptor interactions and play a role in the observed variations in viral pathogenesis and tissue tropism.

NMR assignments of the sylvatic dengue 1 virus envelope protein domain III.

Nearly complete backbone and side chain resonance assignments have been obtained for the third domain, residues M289-K400, of the envelope protein from the sylvatic strain (P72-1244) of the dengue 1 virus, containing mutations N336S and E370K, using double- and triple-resonance spectroscopy.

NMR assignments of the yellow fever virus envelope protein domain III.

Nearly complete backbone and sidechain resonance assignments have been obtained for the third domain, residues S288-K398, of the envelope protein from the Asibi strain of yellow fever virus using double- and triple-resonance spectroscopy.

Central corneal thickness and glaucoma in aphakic and pseudophakic children.

BACKGROUND: The risk of glaucoma among aphakic children is as high as 32%, based primarily on intraocular pressure (IOP) measurements. Although IOP may be falsely elevated by increased central corneal thickness, central corneal thickness (CCT) values have not been reported in this population. METHODS: Patients from the practices of 2 pediatric ophthalmologists and 2 glaucoma specialists had measurements of CCT, IOP, and optic nerve cupping, with visual field analysis when possible. Normal fellow eyes of unilateral aphakes and pseudophakes were included as controls. RESULTS: In 36 aphakic and 6 pseudophakic eyes CCT averaged 660 microns compared with 576 microns for phakic fellow eyes (P < 0.0001). Glaucoma, defined by IOP at least 35 mm Hg or by IOP at least 22 mm Hg associated with optic nerve changes, occurred in 21% of 28 aphakic patients but in no pseudophakic patient. CONCLUSIONS: CCT in aphakic/pseudophakic children is substantially increased compared with control patients. These values may be important in interpreting IOP measurements in these children.

Pars plana modified Baerveldt implant versus neodymium:YAG cyclophotocoagulation in the management of neovascular glaucoma.

OBJECTIVE: To determine the relative effectiveness of neodymium:YAG cyclophotocoagulation (NCYC) and pars plana modified Baerveldt implant (PPBI) surgery on intraocular pressure (IOP) control in eyes with neovascular glaucoma (NVG). PARTICIPANTS: In this retrospective comparative group study, 30 patients with NVG treated with contact NCYC were compared with 18 patients who underwent PPBI. Patients groups were not statistically dissimilar with respect to the underlying disorder-causing angle and iris neovascularization, intraocular pressure, and patient's age. RESULTS: During a follow up of 6 months, an IOP control of > or = 6 and < or = 21 mm Hg was achieved in 23 eyes (76.6%) treated with NCYC compared with 17 eyes (94.4%) receiving PPBI (P = 0.13). Among eyes that had unsuccessful outcome in both groups, the proportions with persistently high IOP or hypotony were greater in the NCYC group than in the PPBI group. Based on our criteria, the cumulative proportion of failure in the NCYC group was 23.3% at 6 months as compared to 5.6% in the PPBI group. Seven eyes (23.3%) in the NCYC group lost light perception versus 1 eye (5.6%) in the PPBI group. The incidence of postoperative choroidal effusion (36%) was higher in the PPBI group. CONCLUSIONS: This study suggests that in the management of NVG, PPBI surgery more frequently controls IOP in a medically acceptable range with less hypotony and greater preservation of visual acuity than NCYC.

O uso intraoperatório de mitomicina C em glaucomas refratários / Topical intraoperative mitomycin C in refractory glaucomas

Foram revistos os prontuários de 42 pacientes portadores de glaucoma refratário submetidos a trabeculectomia associada ao uso intra-operatório de mitomicina C (0.4 mg/ml) entre outubro de 1991 e maio de 1992 no Serviço de Glaucoma do Wills Eye Hospital (Philadelphia, EUA). Dos 42 olhos, 34 puderam ser seguidos por pelo menos 6 meses. Dentre estes 34, 29 (83,5 por cento) apresentaram controle pressórico adequado ao final de um período de seguimento médio de 7,2 +ou- 1,4 meses. As principais complicaçöes pós-operatórias, entre as quais, descolamento da coróide (16,6 por cento), câmara anterior rasa (9,5 por cento) e maculopatia por hipotonia (4,8 por cento) estäo relacionadas ao excesso de filtraçäo observado no pós-operatório. Este estudo sugere que a mitomicina C é um potente inibidor do processo de cicatrizaçäo, altamente eficaz em prevenir a falência da cirurgia filtrante em olhos com glaucomas refratários. A reduçäo da dosagem e do tempo de exposiçäo à mitomicina C podem resultar em um menor número de complicaçöes secundárias ao excesso de filtraçäo. Estudos prospectivos e randomizados estäo sendo realizados para investigar esta possibilidade

O efeito da iridectomia periférica em pacientes com glaucoma pigmentar / The effects of peripheral iridectomy on pigmentary glaucoma

Os autores analisaram o efeito da iridectomia periférica em olhos com glaucoma pigmentar. Realizaram-se dois estudos com este objetivo: o primeiro, retrospectivo, comparava olhos de pacientes com glaucoma pigmentar bilateral que haviam sido submetidos à iridectomia periférica em apenas um dos olhos. O segundo, prospectivo e randomizado, comparava olhos submetidos ou näo à iridectomia periférica. O estudo retrospectivo mostrou que os olhos submetidos à iridectomia apresentaram uma mudança significativa da configuraçäo da íris periférica, além de reduçäo da pigmentaçäo da malha trabecular e do fuso de Krukenberg. O estudo prospectivo demonstrou um estreitamento do ângulo dos olhos submetidos à iridectomia, o que foi constatado através de uso de instrumento de análise computadorizada do segmento anterior. Demonstramos pela primeira vez que a iridectomia periférica em pacientes com glaucoma pigmentar pode promover uma alteraçäo da configuraçäo angular e pode reduzir a dispersäo pigmentar. Um maior período de seguimento será necessário para avaliar os efeitos sobre a pressäo intra-ocular e a progressäo do dano glaucomatoso ao nervo ótico.