Regrowth of upper eyelid eyelashes after making a surgical incision on the upper eyelid in a case of severe alopecia areata.

Alopecia areata can affect only the scalp (alopecia totalis) or whole body (alopecia universalis). The authors report a case of eyelash regrowth induced by a minor surgical procedure in a 44-year-old Caucasian man with alopecia universalis. The mechanism of the regrowth of eyelashes after a surgical procedure remains unanswered and further studies may help elucidate this phenomenon.

A Case of Secondary Pigment Dispersion Following Laser to Cosmetically Lighten the Irises.

Eye color is the latest physical attribute to be subject to alteration for cosmetic reasons. We report a rare case of bilateral secondary pigment dispersion following laser burns to the irises for cosmetic purposes. This case demonstrates a case of secondary pigment dispersion not previously reported in the literature to the best of our knowledge.

A case of malignant glaucoma following insertion of Preserflo™ MicroShunt.

PURPOSE: To describe a case of malignant glaucoma following insertion of a Preserflo™ MicroShunt in a patient with primary open angle glaucoma (POAG). DESIGN: Case report. CASE: A 46-year-old Caucasian man with medically uncontrolled POAG developed malignant glaucoma 1 day after an uncomplicated insertion of a mitomycin C (MMC) augmented Preserflo MicroShunt (PMS). RESULTS: Initial medical treatment with aqueous suppressants and atropine 1% resulted in temporary resolution of the episode, although partial occlusion of the PMS with iris required a Nd:YAG laser iridotomy to open the inlet of the device. However, the malignant glaucoma recurred 6 days later. Temporary resolution was subsequently achieved with an Nd:YAG laser peripheral irido-zonulo-hyaloidotomy in combination with topical atropine, though a subsequent PMS revision was required due to bleb encapsulation. Unfortunately, the revision procedure was followed 2 days later, by a further recurrence of malignant glaucoma which was eventually resolved by left pars plana vitrectomy (PPV) in combination with clear lens extraction (CLE) and surgical irido-zonulo-hyaloidectomy. Subsequently, the eye remained stable, with a deep anterior chamber (AC), a partially functioning bleb, and an intraocular pressure (IOP) of 14 mmHg on one topical IOP-lowering agent, 8 months after the last procedure. CONCLUSIONS: The management of malignant glaucoma after PMS insertion and its subsequent clinical course is described. Apart from the propensity for a small tube such as the PMS to obstruct with iris when the AC is shallow, management is similar to other scenarios in which malignant glaucoma may develop.

Sequential retinal necrosis secondary to varicella zoster in unrecognised long-standing HIV infection: patient safety report.

A retired woman with left ophthalmic shingles of over 2 years' duration attended with bilateral vision loss and systemic upset. Acute retinal necrosis with detachment was detected on right fundus examination. Cataract in left eye precluded funduscopy. Ocular ultrasonography revealed fibrotic retinal detachment in the left eye. MRI brain and orbits also showed signals of retinal detachment. No abnormal MRI signal within the optic nerve or brain was found. Varicella zoster virus was detected in ocular aqueous and blood samples. High-dose intravenous acyclovir was administered. HIV test was positive with a very low CD4 count. Antiretroviral medications were prescribed. There was no recovery of vision. She was certified as blind, and social services were involved in seeking to provide alterations to her home in view of her severe disability. This case highlights the importance of suspecting HIV in patients with severe or chronic ophthalmic shingles. Images and implications for clinical practice are presented.

Avastin and Lucentis: what do patients know? A prospective questionnaire survey.

OBJECTIVES: To assess patients' knowledge of their drug therapy for neovascular macular degeneration and to identify which aspects of the drug they considered most important if given the option of switching to an alternative drug. DESIGN: Prospective questionnaire survey. SETTING: Wolverhampton, England. PARTICIPANTS: A total of 126 patients attending our hospital service for intravitreal ranibizumab therapy for neovascular macular degeneration. MAIN OUTCOME MEASURES: Using a questionnaire, patients were asked questions pertaining to aspects of drug therapy in neovascular macular degeneration. Fields covered included drug names, knowledge of alternative drugs, cost of drugs and their views on switching to another drug. RESULTS: Eighty (63.5%) had heard of Lucentis (ranibizumab) and 31 (24.6%) were aware of Avastin (bevacizumab). Of the latter 31 patients, 20 did not have a preference between Avastin and Lucentis. These patients felt that the factors they would consider important for them to consider switching were effectiveness (10, 50%), specialist recommendation (8, 40%), safety (2, 10%) and cost (0). CONCLUSIONS: Introducing a cheaper, off-label alternative in the therapy of macular degeneration in the presence of a licensed option has been extensively debated. Many patients have no knowledge of this controversial issue but it is likely that efficacy and recommendation by clinicians are more important than cost to patients who may consider switching to the off-label Avastin.