Timing of Jones Tube Placement After Excision of Nasal or Lacrimal Drainage System Malignancy: A Survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS).

Purpose: To elicit, from a survey of oculoplastic surgeons, the timing and reason for delaying Jones tube placement after the excision of nasal or lacrimal drainage system malignancy. Methods: The authors reviewed current literature and distributed an anonymous survey to 627 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) to determine the length of time members wait to perform a Jones tube placement after the removal of nasal or lacrimal drainage system malignancy. The survey also included questions about the rationale for this waiting period. Results: Fifty-eight members of ASOPRS (9.3%) responded to our survey, 49 (84.4%) of whom had performed Jones tube placement on patients who had an excision of a nasal or lacrimal drainage system malignancy. Nearly 52% of respondents waited one year for Jones tube placement. However, a sizeable number of respondents opted to wait five years (15.1%). The most common rationale for waiting was a concern for tumor recurrence (42 responses). Conclusion: There is no consensus on when to perform Jones tube placement after the excision of nasal or lacrimal drainage system malignancy. This survey demonstrates a broad array of waiting periods between operations, although most surgeons wait 12 months.

Bilateral Carotid-Cavernous Fistula: A Diagnostic and Therapeutic Challenge.

Carotid-cavernous fistula (CCF) is an aberrant communication between the main trunk or branches of carotid artery and the cavernous sinus. Most of the cases of CCF occur following head trauma, but congenital and spontaneous cases have been reported. We report an interesting case of bilateral CCF with no history of trauma, thus most likely spontaneous form. Since it is rare, it was a diagnostic challenge. The suspicion of this diagnosis was made due to clinical features of headache, signs of increased Intracranial Pressure (ICP) (nausea, vomiting, and worsening headaches during Valsalva), exophthalmos, periorbital edema, periorbital erythema, chemosis, and conjunctival injection in both eyes. It was diagnosed with a 4-vessel angiography (digital subtraction angiography) which is the gold standard and was managed successfully with endovascular coil embolization.

Intraoperative complications and visual outcomes of cataract surgery in patients with retinal vein occlusion: multicenter database study.

PURPOSE: To compare the visual outcomes and the rate of intraoperative complications in eyes with and without retinal vein occlusion (RVO) after phacoemulsification over a period of 15 years in a real-world clinical setting. SETTING: 8 independent U.K. National Health Service ophthalmology departments. DESIGN: Retrospective, multicenter cohort study. METHODS: Eyes were classified based on the presence or absence of RVO. For analyzing visual acuity (VA) and the incidence of postoperative cystoid macular edema, eyes with any copathology, combined ocular surgical procedures, and intraoperative complications, or of diabetic patients were excluded. RESULTS: Of 178 856 eyes, 1796 eyes with RVO preoperatively and 177 060 eyes without RVO were allocated to the RVO group and the reference group, respectively. Cataract surgery in eyes with RVO was associated with an improvement in the mean VA of 0.35 logMAR (3 to 4 Snellen lines), and a substantial gain (≥0.30 logMAR units [3 Snellen lines]) was achieved in 55.10% of eyes at 4 to 12 weeks postoperatively. The mean postoperative VA was worse in eyes with RVO compared with that in eyes without RVO at 4 to 12 weeks (logMAR 0.40 vs 0.12 [20/50 vs 20/25]; P < .0001). The proportion of eyes achieving a visual gain of ≥ 0.3 logMAR (3 Snellen lines) was also lower in eyes with RVO (55.10% vs 64.55%; P = .0076). There was no statistically significant difference in posterior capsule rupture rates between the 2 groups (1.73% vs 1.72%; P = .9741). CONCLUSIONS: Although postoperative vision improved significantly in eyes with RVO after cataract surgery, this improvement was worse than that achieved by eyes without RVO.

Residue Y70 of the Nitrilase Cyanide Dihydratase from Bacillus pumilus Is Critical for Formation and Activity of the Spiral Oligomer.

Nitrilases pose attractive alternatives to the chemical hydrolysis of nitrile compounds. The activity of bacterial nitrilases towards substrate is intimately tied to the formation of large spiral-shaped oligomers. In the nitrilase CynD (cyanide dihydratase) from Bacillus pumilus, mutations in a predicted oligomeric surface region altered its oligomerization and reduced its activity. One mutant, CynD Y70C, retained uniform oligomer formation however it was inactive, unlike all other inactive mutants throughout that region all of which significantly perturbed oligomer formation. It was hypothesized that Y70 is playing an additional role necessary for CynD activity beyond influencing oligomerization. Here, we performed saturation mutagenesis at residue 70 and demonstrated that only tyrosine or phenylalanine is permissible for CynD activity. Furthermore, we show that other residues at this position are not only inactive, but have altered or disrupted oligomer conformations. These results suggest that Y70's essential role in activity is independent of its role in the formation of the spiral oligomer.