Wegener's granulomatosis mimicking a parotid abscess.

We present the case of a previously healthy 59-year-old man who was under treatment for scleritis and episcleritis when he developed a parotid-gland swelling and pus-producing sinus. On surgical exploration, the features were those of a parotid abscess, but the lesion not only failed to heal post-operatively but increased in size very significantly. There was also severe necrotizing keratitis of the eyes. Due to clinical suspicion and a positive antineutrophil cytoplasmic antibodies test, Wegener's granulomatosis was diagnosed and the patient successfully treated with cyclophosphamide and steroids. Previously, a number of cases of Wegener's granulomatosis causing salivary-gland swelling have been reported in the literature; this is the first case in which the disease has masqueraded as a parotid abscess.

Visual recovery in unilateral traumatic pediatric cataracts treated with posterior chamber intraocular lens and anterior vitrectomy in Pakistan.

PURPOSE: To evaluate visual recovery in unilateral traumatic cataracts in children treated with posterior chamber intraocular lens implantation and anterior vitrectomy. METHODS: Sixteen children with unilateral traumatic cataract between ages 3-10 years (mean, 5 years 8 months) were treated with posterior chamber intraocular lens implantation and anterior vitrectomy. Surgery was performed between 2 weeks and 7 months (mean, 7.75 weeks) after injury. Follow up was between 9 and 29 months (mean, 17.9 months). RESULTS: The most common postoperative complication was fibrinous uveitis, which developed in 4 children (25%). All eyes had a clear visual axis postoperatively; none required capsulotomy. The mean postoperative refraction was +0.9 diopters (range, +3.50 to -2.75 diopters). Three eyes (18.75%) had visual acuity of 6/9, 8 eyes (50%) had visual acuity of 6/12 or better, and 11 eyes (68.75%) had visual acuity of 6/18 or better. The cause of poor visual acuity was cystoid macular edema in one eye, macular scars in two eyes, and amblyopia in one eye. CONCLUSIONS: Unilateral traumatic cataracts in children in whom aphakia is corrected with posterior chamber lens implantation combined with anterior vitrectomy result in good visual outcome, and we recommend this treatment modality in traumatic cataract in children.

A comparison of the effectiveness of dorzolamide and acetazolamide in preventing post-operative intraocular pressure rise following phacoemulsification surgery.

The aim of this study was to evaluate the effectiveness of topical dorzolamide versus systemic acetazolamide in preventing the intraocular pressure (IOP) spike, following routine phacoemulsification surgery. In this prospective study, 59 eyes (59 patients), undergoing routine phacoemulsification surgery with posterior intraocular implant, were divided into three groups. Group 1 received acetazolamide 250 mg SR orally, immediately post-operatively. Group 2 received one drop of dorzolamide immediately after surgery. Group 3 or control, received neither. The IOP, was checked 4 h, 24 h and 2 weeks post-operatively. When compared with mean baseline pre-operative IOP, the 4 h mean post-operative IOP was slightly higher in the dorzolamide group by a mean of +2.49 mmHg (P = 0.2502). It was significantly higher in the acetazolamide group by a mean of +6.13 mmHg (P = 0.0034) and in the control group by a mean of +11.81 mmHg (P = 0.000). At 24 h the mean IOP in the control group remained significantly elevated by a mean of +5.87 mmHg (P = 0.003). Topical dorzolamide is effective in reducing the early IOP rise during the first 24 h following routine uncomplicated phacoemulsification surgery.

Early results of punch trabeculectomy.

PURPOSE: To evaluate the effectiveness of punch trabeculectomy in controlling intraocular pressure (IOP) in patients with uncontrolled chronic open-angle glaucoma (COAG) undergoing medical treatment. METHODS: This prospective study included 22 patients (27 eyes) with uncontrolled COAC on medical treatment undergoing punch trabeculectomy through a scleral tunnel. The tunnel was created with a 3.5 mm keratome, the tunnel mouth was not sutured but the conjunctival flap was sutured by 8/0 vicryl. The mean surgical time from opening the conjunctiva to closing the conjunctiva was 8 m 59 s. IOP and other parameters were checked on day 1 and subsequently at intervals appropriate to the individual. RESULTS: After a mean period of 22.2 months follow-up the mean IOP was 13.3 mmHg (SD 5.2). There were few transient early post-operative complications; two eyes had a shallow anterior chamber (AC) due to excess drainage, five had IOP above 21 mmHg, which responded to ocular massage, ten eyes had hyphaema less than 1.5 mm and two eyes had no filtration bleb. CONCLUSIONS: Punch trabeculectomy is a rapid and effective method of controlling IOP. The complication rate is moderate and mainly transient.

Hyperconvolution of the inner limiting membrane in vitreomaculopathies.

BACKGROUND: This study investigates the similarities and differences between epiretinal membranes in four clinically distinct types of vitreomaculopathy. We propose a hypothesis on the origin of the predominant cell type and its potential role in causing these conditions. METHODS: Epiretinal membranes (ERMs) surgically removed from a prospective, consecutive series of vitrectomies for macular pucker associated with an untreated peripheral horseshoe tear (MP), cellophane maculopathy (CM), stage 4 macular hole (MH) and vitreomacular traction syndrome (VMT) were examined by light microscopy and by immunocytochemistry (ICC) using antibodies marking type IV collagen, type II collagen, glial fibrillary acidic protein (GFAP), and low- and high-molecular-weight cytokeratin (MNF116). These specimens were compared with post-mortem control eyes with and without physiological posterior vitreous detachment (PVD). Light microscopy was carried out on 5-microm-thick sections cut from formalin-fixed, paraffin-embedded tissue blocks. Appropriate autoclave or enzyme pre-digestion steps were deployed to retrieve antigens for ICC. No patient had undergone previous vitreoretinal surgery or peripheral retinopexy. RESULTS: From a series of 38 patients, (13 CM, 8 MP, 16 MH and 1 VMT) a total of 20 specimens contained sufficient tissue for histology and immunocytochemistry. All specimens contained portions of inner limiting membrane (ILM) coated by GFAP-positive cells. Specimens from patients with MP and CM exhibited hyperconvolution of the ILM, which was not found in the specimens from patients with MH or VMT or in the control eyes. Hyperconvolution was associated with increased glial cell density, GFAP staining intensity and duplication of ILM basement membrane. Three cases of ERMs from the MP group contained, in addition, cytokeratin-positive cells. In the control group; post-mortem eyes with PVDs showed patchy staining of the posterior hyaloid membrane for GFAP and type 4 collagen. Post-mortem eyes with attached gel showed weak positivity of the ILM for type 4 collagen, and a monolayer of GFAP-positive cells lined the vitreous aspect of the ILM. CONCLUSIONS: These results indicate that glial cells are fundamentally important in the formation of ERMs found in this group of vitreomaculopathies. The hyperconvolution and duplication of the ILM in CM and MP were striking and distinctive features and suggest a mechanism by which these membranes exert tractional forces on the retina. Post-mortem control eyes contained a similar (but more dispersed) population of GFAP-positive cells in the region of the ILM, suggesting the primary aetiology for CM and MP may originate within the ILM. ERMs from MP cases may, in addition, contain cytokeratin-positive cells, of probable RPE origin.