Tear protein analysis in patients with primary acquired nasolacrimal duct obstruction treated with lacrimal passage intubation.

PURPOSE: The pathophysiology of nasolacrimal duct obstruction (NLDO) may involve quantitative as well as qualitative changes in tears. We measured tear protein concentrations in patients with primary acquired NLDO and compared them with the tear proteins in healthy individuals and patients with dry eye disease. STUDY DESIGN: Case-control study. METHODS: Twenty-four patients diagnosed with primary acquired NLDO who underwent endoscopic lacrimal passage intubation were included in the study. Tear fluid was collected with Schirmer's test strips three times: before intubation, after intubation while the nasolacrimal tube was in place, and after extubation. At the same time, 24 age-matched normal controls and 24 patients with dry eye were selected from subjects whose tears were collected during the same study period. We measured the following components of tear fluid: total protein, lactoferrin, albumin, and interleukin 6 (IL-6) levels. RESULTS: Total proteins and albumin levels in tears of the NLDO group were significantly lower than those of the control group (P < 0.001 and P = 0.014, respectively, Mann-Whitney U test). Total proteins, albumin, and lactoferrin levels were significantly increased after extubation of nasolacrimal tube (P < 0.001, P = 0.004, and P = 0.029, respectively, Wilcoxon matched-pairs signed-rank test). There were no statistically significant differences in total protein, albumin, lactoferrin and IL-6 levels between patients with NLDO after lacrimal passage extubation and controls. CONCLUSIONS: Our study shows distinct differences in protein composition of tear fluid in NLDO eyes and demonstrates that these can be normalized by nasolacrimal tube placement.

[Recent outcomes of vitreous surgery for diabetic retinopathy].

PURPOSE: To investigate background, surgical method, complications, prognosis, and prognostic factors in patients undergoing vitrectomy for diabetic retinopathy. SUBJECTS AND METHODS: Three hundred and forty eyes of 261 patients undergoing vitrectomy for diabetic retinopathy in five recent years were studied regarding background, surgical method, complications, and visual prognosis. Factors influencing postoperative visual acuity and complications were also examined using univariate and multivariate analyses. RESULTS: Final postoperative visual acuity (FPVA) improved in 226 eyes (66%). FPVA of 0.1 or better and 0.5 or better was achieved in 80% and 45% of all patients, respectively. Postoperative complications occurred in 89 eyes(26%). In the vitreous hemorrhage group, FPVA improved in 86%, and FPVA of 0.5 or better was achieved in 60%. Postoperative complications were most common in the traction detachment group and the percentage was 40%. Factors influencing FPVA were preoperative visual acuity, postoperative complications, indications for surgery, and preoperative severity. Factors influencing postoperative complications were patient background, preoperative visual acuity, preoperative severity, and iatrogenic breaks. CONCLUSIONS: Vitrectomy is a useful method for diabetic retinopathy but postoperative complications must be managed.

Membranous proliferation on the posterior surface of an intraocular lens after Nd:YAG laser capsulotomy.

BACKGROUND: We report on three patients who showed a rare complication, centripetal membranous proliferation from the posterior capsulotomy edge onto the posterior surface of an intraocular lens (IOL), 3 to 6 months after neodymium:YAG (Nd:YAG) capsulotomy. CASES: These three patients had juvenile rheumatoid arthritis, retinitis pigmentosa, and sarcoidosis, respectively, prior to cataract surgery. OBSERVATIONS: Elschnig's pearls developed in the eyes of all three patients after cataract surgery, and were treated by Nd:YAG laser. However, membranous proliferation continued, and Nd:YAG laser treatment was required a second time to disrupt the proliferating fibrous membrane and achieve resolution of the patients' symptoms. CONCLUSIONS: Common factors in our cases and cases in the literature were that the IOLs were biconvex and made of polymethyl methacrylate. Ophthalmologists should be aware that after cataract surgery, lens epithelial cells can proliferate onto any surface that provides adequate protein nourishment.