Floppy iris behaviour during cataract surgery: associations and variations.

AIM: To assess the association of floppy iris behaviour during cataract surgery with use of alpha-1-antagonists and diabetes mellitus. METHODS: 1842 eyes of 1786 patients undergoing phacohoemulsification surgery were prospectively enrolled. The use of commonly prescribed alpha-1-antagonists and the presence or absence of diabetes mellitus were noted. The occurrence of any of the features of the intraoperative floppy iris syndrome (IFIS) was noted by surgeons blinded to the patient's history. RESULTS: 57% of patients receiving tamsulosin showed features of IFIS compared with 1% of the non-tamsulosin group (p<0.001). Of these, more than half the patients manifested the syndrome in an incomplete form. Only 1 of the 51 patients receiving other alpha-1-antagonists had IFIS. Diabetes was also not associated with IFIS (p = 1). CONCLUSIONS: Tamsulosin is significantly associated with floppy iris behaviour during cataract surgery. But not all of these patients will necessarily show all or any features of IFIS. The floppy iris syndrome is likely to represent a continuum of severity. Various undefined factors, diabetes not being one of them, may have a contributory role. Non-selective alpha-1-antagonists are unlikely to be associated with IFIS.

Acute angle closure glaucoma resulting from myelodysplasia.

Patients with bleeding diatheses can present in a variety of clinical situations. When these patients manifest with ocular complications, their management can be challenging. We describe a case of acute angle closure glaucoma secondary to subretinal haemorrhage, with myelodysplasia as a predisposing factor.

[Icterohemorrhagic leptospirosis with acute renal failure (author's transl)]. / Leptospirosis icterohemorrágica con insuficiencia renal aguda.

Icterohemorrhagic leptospirosis is a zoonosis which is relatively frequent in rural agricultural or cattle areas. In the severe forms of the disease renal affection is frequent, but the incidence of acute renal insufficiency is far lesser. Three cases of acute renal insufficiency in adult male patients secondary to an infection by Leptospira icterohaemorrhagiae are presented. Two of the patients resided in urban areas and only one of which presented professional risk. The clinical polymorphysm of the illness is confirmed, having observed not only the absence of fever but also that of jaundice. The former history of chronic alcoholism, present in two cases, determined diagnostic difficulties with acute alcoholic hepatitis. The serologic diagnosis is often positive only at the end of the second week, and the need to carry out a series of seroaglutinations is to be insisted upon. The types of renal impairment in leptospirosis are reviewed and the presence of acute renal insufficiency is stressed, including those patients with less severe forms of the disease, and especially those without Weil's syndrome. All of the patients had to be treated with dialysis, although two of them had a conserved diuresis after an initial brief period of oliguria.

[Hodgkin's disease complicated with autoimmune thrombocytopenic purpura and a nephrotic syndrome due to deposition of circulating immunocomplexes (author's transl)]. / Enfermedad de Hodgkin complicada con púrpura trombopénica autoimmune y síndrome nefrótico por depósito de immunocomplejos circulantes.

This report deals with a case of Hodgkin's disease presenting during its evolution with autoimmune thrombocytopenic purpura and a nephrotic syndrome with extramembranous glomerulonephritis. The histopathological study of renal tissue demonstrated the presence of IgG and the C3 fraction of complement in the extramembranous deposits. The same type of immunoglobulins and C3 existed in the serum as circulating immunocomplexes, suggesting that the glomerulonephritis was due to the deposition of such immunocomplexes in the glomerular membrane. A review of the literature discloses 32 cases of autoimmune thrombocytopenic purpura associated to Hodgkin's lymphoma, and 47 cases of Hodgkin's lymphoma associated to the nephrotic syndrome. However, the association of both complications in the same patient with lymphoma has been heretofore unreported. The possible etiopathogenic mechanisms of these autoimmune complications and its pathological features are discussed along with the response to treatment. Generally the activity of such disorders parallels that of the lymphoma, thus making them potentially useful parameters to appraise lymphomatous activity.

Post-intravitreal anti-VEGF endophthalmitis in the United Kingdom: incidence, features, risk factors, and outcomes.

PURPOSE: To describe the incidence, features, management, and risk factors of post-intravitreal anti-VEGF endophthalmitis (PIAE) in patients undergoing treatment for exudative age-related macular degeneration in the United Kingdom. METHODS: Prospective observational case control study. Forty-seven cases of PIAE were identified through the British Ophthalmological Surveillance Unit from January 2009 to March 2010. Data collected at diagnosis and at 6 months follow-up included patient demographics, intravitreal injection details, pre- and post-injection management, visual acuity, clinical features and management of PIAE, causative organisms, and clinical outcomes. Details were compared with 200 control cases from 10 control centres to identify potential risk factors. RESULTS: Estimated PIAE was 0.025%. Culture-positive PIAE incidence was 0.015%. Mean age of presentation was 78 years. Mean number of intravitreal injections before PIAE was 5. Mean days to presentation was 5 (range 1-39). Positive microbiology culture was found in 59.6%. The majority of causative organisms were Gram positive (92.8%). Significant risk factors were failure to administer topical antibiotics immediately after the injection (P=0.001), blepharitis (P=0.006), subconjunctival anaesthesia (P=0.021), patient squeezing during the injection (P=0.021), and failure to administer topical antibiotics before anti-VEGF injection (P=0.05). DISCUSSION: The incidence of PIAE in the United Kingdom is comparable to other studies at a rate of 0.025%. The most common causative organisms were Gram positive. Measures to minimise the risk of PIAE include treatment of blepharitis before injection, avoidance of subconjunctival anaesthesia, topical antibiotic administration immediately after injection with consideration to administering topical antibiotics before injection.

Monoclonal antibody analysis of crescentic membranous glomerulonephropathy.

Idiopathic membranous glomerulonephropathy (MG) has a rather benign prognosis. Acute renal failure with cellular crescents superimposed on MG is unusual and its pathogenesis is not fully understood. We report 3 patients with crescentic MG who showed strong glomerular and interstitial infiltration of leukocytes (CD45), T lymphocytes (CD3), helper/inducer T cells (CD4), cytotoxic/suppressor T cells (CD8), and monocyte-macrophages (CD14). A similar number of CD4+ and CD8+ cells contributed to T cellularity within the glomerular tuft, whereas CD4+ cells were predominant over CD8+ cells in the crescents. Intercellular adhesion molecule-1 (ICAM-1) antigens (CD54) were found on renal vascular endothelium, interstitial cellular aggregates and proximal tubular epithelial cells. The case reports illustrate the contribution of macrophages and T cells bearing predominantly CD4+ phenotype to cellular crescents, and the abnormal expression of ICAM-1 antigens on proximal tubular epithelial cells. Both features suggest that cell-mediated immunity may play a role in the transformation of crescentic MG.