Asymmetric glaucoma in pseudoplateau iris syndrome.

A 39-year-old Caucasian man with bilateral narrow angles, a plateau-like iris configuration on gonioscopy and elevated intraocular pressure (IOP) presented with significant asymmetric glaucoma, left eye affected more than right. Initial management with topical medical therapy, laser iridoplasty and peripheral iridotomy in the left eye was ineffective in lowering the IOP or opening the anterior chamber angle. Ultrasound biomicroscopy demonstrated bilateral ciliary body cysts. The patient ultimately required surgical management, consisting of cataract extraction and endoscopic cyclophotocoagulation of ciliary body cysts in the left eye and trabeculectomy in the right eye, for persistent IOP control to prevent further optic nerve damage and subsequent visual field loss.

Role of GSK-3ß in Regulation of Canonical Wnt/ß-catenin Signaling and PI3-K/Akt Oncogenic Pathway in Colon Cancer.

Non-steroidal anti-inflammatory drugs (NSAIDs) are emerging as novel chemopreventive agents because of their ability in blocking cellular proliferation, and thereby tumor development, and also by promoting apoptosis. GSK-3ß, a serine threonine kinase and a negative regulator of the oncogenic Wnt/ß-catenin signaling pathway, plays a critical role in the regulation of oncogenesis. Celecoxib and etoricoxib, the two cyclooxygenase-2 (COX-2) selective NSAIDs, and Diclofenac, a preferential COX-2 inhibitory NSAID, had shown uniformly the chemopreventive and anti-neoplastic effects in the early stage of colon cancer by promoting apoptosis as well as an over-expression of GSK-3ß while down-regulating the PI3-K/Akt oncogenic pathway.

Chemoprevention of Colon Cancer through Inhibition of Angiogenesis and Induction of Apoptosis by Nonsteroidal Anti-Inflammatory Drugs.

Cancer cells require nourishment for the growth of the primary tumor mass and spread of the metastatic colony. These needs are fulfilled by tumor-associated neovasculature known as angiogenesis, which also favors the transition from hyperplasia to neoplasia, that is, from a state of cellular multiplication to uncontrolled proliferation. Therefore, targeting angiogenesis is profitable as a mechanism to inhibit tumor growth. Furthermore, it is important to understand the cross-communication between vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMPs) in the neoplastic and proinflammatory milieu. We studied the role of two important chemokines (monocyte chemoattractant protein-1 [MCP-1] and macrophage inflammatory protein-1ß [MIP-1ß]) along with VEGF and MMPs in nonsteroidal anti-inflammatory drug (NSAID)-induced chemopreventive effects in experimental colon cancer in rats. 1,2-Dimethylhydrazine dihydrochloride (DMH) was used as cancer-inducing agent and three NSAIDs (celecoxib, etoricoxib, and diclofenac) were given orally as chemopreventive agents. Analysis by immunofluorescence and western blotting shows that the expression of VEGF, MMP-2, and MMP-9 was found to be significantly elevated in the DMH- treated group and notably lowered by NSAID coadministration. The expression of MCP-1 was found to be markedly decreased, whereas that of MIP-1ß increased after NSAID coadministration. NSAID coadministration was also able to induce apoptosis, confirmed using studies by Hoechst/propidium iodide (PI) costaining and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Results from the present study indicate the potential role of these chemokines along with VEGF and MMPs against angiogenesis in DMH-induced cancer. The inhibition of angiogenesis and induction of apoptosis by NSAIDs were found to be possible mechanisms in the chemoprevention of colon cancer.

Breaking bad news: A communication competency for ophthalmology training programs.

As the ophthalmology accreditation system undergoes major changes, training programs must evaluate residents in the 6 core competencies, including appropriately communicating bad news. Although the literature is replete with recommendations for breaking bad news across various non-ophthalmology specialties, no formal training programs exist for ophthalmology. There are many valuable lessons to be learned from our colleagues regarding this important skill. We examine the historic basis for breaking bad news, explore current recommendations among other specialties, and then evaluate a pilot study in breaking bad news for ophthalmology residents. The results of this study are limited by a small number of residents at a single academic center. Future studies from multiple training programs should be conducted to further evaluate the need and efficacy of formal communication skills training in this area, as well as the generalizability of our pilot training program. If validated, this work could serve as a template for future ophthalmology resident training and evaluation in this core competency.

Chemopreventive action of non-steroidal anti-inflammatory drugs on the inflammatory pathways in colon cancer.

Non-steroidal anti-inflammatory drugs (NSAIDs) are emerging as novel chemopreventive agents against a variety of cancers owing to their capability in blocking the tumor development by cellular proliferation and by promoting apoptosis. Inflammation is principal cause of colon carcinogenesis. A missing link between inflammation and cancer could be the activation of NF-κB, which is a hallmark of inflammatory response, and is commonly detected in malignant tumors. Therefore, targeting pro-inflammatory cyclooxygenase enzymes and transcription factors will be profitable as a mechanism to inhibit tumor growth. In the present study, we have studied the role of various pro-inflammatory enzymes and transcription factors in the development of the 1,2-dimethylhydrazine dihydrochloride (DMH)-induced colorectal cancer and also observed the role of three NSAIDs, viz., Celecoxib, Etoricoxib and Diclofenac. Carcinogenic changes were observed in morphological and histopathological studies, whereas protein regulations of various biomolecules were identified by immunofluorescence analysis. Apoptotic studies was done by TUNEL assay and Hoechst/PI co-staining of the isolated colonocytes. It was found that DMH-treated animals were having an over-expression of pro-inflammatory enzymes, aberrant nuclear localization of activated cell survival transcription factor, NF-κB and suppression of anti-inflammatory transcription factor PPAR-γ, thereby suggesting a marked role of inflammation in the tumor progression. However, co-administration of NSAIDs has significantly reduced the inflammatory potential of the growing neoplasm.

Intracameral triamcinolone acetonide in glaucoma surgery: a prospective randomized controlled trial.

PURPOSE: To evaluate the efficacy and safety of intracameral triamcinolone acetonide (TA) in glaucoma surgery. DESIGN: Prospective randomized clinical trial. SETTING: Institutional-Wills Eye Hospital. STUDY POPULATION: Patients undergoing trabeculectomy (with or without cataract surgery) or tube shunt surgery. INTERVENTION: Patients were randomized to receive intracameral TA or balanced salt solution at the end of surgery. Follow-up time was 6 months. MAIN OUTCOME MEASURES: Intraocular pressure, visual acuity, inflammation measured by slit-lamp examination and laser flare meter, cataract grading, bleb appearance, dry eye scores, use of supplemental medical therapy, surgical success, and rate of complications. RESULTS: Seventy-seven patients were enrolled in the study, including 37 in the TA group and 40 in the control group. There were no significant differences in success rates between the 2 groups (P=.60). Intraocular pressure and medication use were similar between the groups for each follow-up visit. Dry eye scores were lower in the TA group at month 1 (P=.042), while flare scores were higher in the TA group on day 1 (P=.015) but lower at month 1 (P=.044). The complication rates were higher in the TA group on day 1 (P=.04). All other outcome measures were similar for both groups. CONCLUSIONS: Intracameral TA did not affect the success rates or change the complication rates of glaucoma surgery.