Experimental studies of the dilution of vehicle exhaust pollutants by environment-protecting pervious pavement.

This study determines whether environment-protecting pervious pavement can dilute pollutants immediately after emissions from vehicle. The turbulence-driven dry-deposition process is too slow to be considered in this aspect. The pavement used is the JW pavement (according to its inventors name), a high-load-bearing water-permeable pavement with patents in over 100 countries, which has already been used for more than 8 years in Taiwan and is well suited to replacing conventional road pavement, making the potential implementation of the study results feasible. The design of this study included two sets of experiments. Variation of the air pollutant concentrations within a fenced area over the JW pavement with one vehicle discharging emissions into was monitored and compared with results over a non-JW pavement. The ambient wind speed was low during the first experiment, and the results obtained were highly credible. It was found that the JW pavement diluted vehicle pollutant emissions near the ground surface by 40%-87% within 5 min of emission; whereas the data at 2 m height suggested that about 58%-97% of pollutants were trapped underneath the pavement 20 min after emission. Those quantitative estimations may be off by +/- 10%, if errors in emissions and measurements were considered. SO2 and CO2 underwent the most significant reduction. Very likely, pollutants were forced to move underneath due to the special design of the pavement. During the second experiment, ambient wind speeds were high and the results obtained had less credibility, but they did not disprove the pollutant dilution capacity of the JW pavement. In order to track the fate of pollutants, parts of the pavement were removed to reveal a micro version of wetland underneath, which could possibly hold the responsibility of absorbing and decomposing pollutants to forms harmless to the environment and human health.

Orbicularis myectomy with levator advancement in Schwartz-Jampel syndrome.

PURPOSE: Schwartz-Jampel syndrome is a disorder of continuous myotonia causing blepharospasm, acquired ptosis, and blepharophimosis. We report the management of the associated eyelid anomalies with orbicularis oculi myectomy, levator aponeurosis resection, and lateral canthopexy. METHODS: Interventional case reports. Two patients with Schwartz-Jampel syndrome presented with blepharospasm, acquired ptosis, and blepharophimosis. Orbicularis myectomy, levator aponeurosis resection, and lateral canthopexy were performed to relieve the blepharospasm and to correct the ptosis and blepharophimosis. RESULTS: Significant functional and cosmetic improvements were achieved by increasing the palpebral fissure height and length while greatly decreasing the blepharospasm of the patients. No recurrence of the blepharospasm or eyelid anomalies has been noted after 1 and 15 years of follow-up, respectively. CONCLUSION: The blepharospasm and eyelid alterations caused by Schwartz-Jampel syndrome should be treated to provide functional and cosmetic improvements. Our technique of myectomy, levator resection, and lateral canthopexy provides an excellent, long-lasting result.

A new groove director for simplified nasolacrimal intubation.

Silicone intubation is commonly performed to maintain patency of the lacrimal drainage system. We describe a new lacrimal groove director, designed to simplify retrieval of the metal Crawford probe with minimal trauma to the nasal mucosa. This instrument can also be used to infracture or medialize the inferior turbinate in both pediatric and adult populations during nasolacrimal duct intubation or external or endoscopic dacryocystorhinostomy.

Management of eyelid anomalies associated with Blepharo-cheilo-dontic syndrome.

PURPOSE: To describe the previously unreported management of the eyelid anomalies associated with blepharocheilo-dontic syndrome. Blepharo-cheilo-dontic syndrome is a syndrome of congenital cleft lip/palate, oligodontia, euryblepharon, eyelid ectropion, and lagophthalmos. METHODS: Case report. A 3-month-old male presented with bilateral upper and lower eyelid ectropion with eyelid retraction, marked euryblepharon, severe lagophthalmos, and a right side cleft lip/palate. Lateral tarsal strips, lower eyelid retractor disinsertion, myocutaneous advancement of the cheek and eyelids, and lateral tarsorrhaphy were performed. RESULTS: Correction of the ectropion, eyelid retraction, euryblepharon, and marked improvement in his lagophthalmos were achieved postoperatively. No recurrence of the ectropion or euryblepharon has been noted after 6 months of follow-up. CONCLUSION: Appropriate reconstructive surgery of the eyelids reduces the morbidity associated with the eyelid anomalies and provides an excellent cosmetic result for patients with blepharo-cheilo-dontic syndrome.

Persistent indocyanine green angiographic findings in multiple evanescent white dot syndrome.

This report describes unique findings of persistent peripapillary and posterior pole hypofluorescence on indocyanine green angiography (ICGA) in multiple evanescent white dot syndrome (MEWDS). A 38-year-old woman experienced a sudden decrease of visual acuity in the left eye. Multiple white lesions were seen on fundus examination. Fluorescein angiography, indocyanine green angiography, and automated perimetry were performed. Fundus appearance and fluorescein angiography were consistent with the diagnosis of MEWDS. Automated perimetry revealed an enlarged blind spot. ICGA revealed a zone of hypofluorescence surrounding the optic disc and throughout the posterior pole. The enlarged blind spot resolved after seven weeks along with the signs and symptoms of MEWDS. Nine months after initial presentation, ICGA revealed persistent peripapillary and posterior pole hypofluorescence. Resolution of the enlarged blind spot and return of vision does not completely correlate with the disappearance of hypofluorescent areas on ICGA. These findings suggest that MEWDS may result in persistent abnormalities in choroidal circulation even after clinical symptoms resolve.

The effect of punctal occlusion on tear production, tear clearance, and ocular surface sensation in normal subjects.

PURPOSE: To evaluate the effect of temporary punctal occlusion on tear production, tear clearance, and ocular surface sensation in normal subjects. METHODS: Noncomparative interventional case series. Punctal occlusion with silicone punctal plugs was performed on nine normal subjects without complaints of ocular irritation and no known history of ocular surface disease. The lower punctum of both eyes was occluded in five subjects. The upper and lower puncta of only one eye were occluded in four subjects. Corneal and conjunctival sensations were measured with the Cochet-Bonnet anesthesiometer. Tear fluorescein clearance was evaluated with a CytoFluor II fluorophotometer by measuring the fluorescein concentration in minimally stimulated tear samples collected from the inferior tear meniscus 15 minutes after instillation of fluorescein. Schirmer test was performed without anesthesia. The tests were performed at days 0, 1, 3, 7, and 14 to 17 after punctal occlusion. Relationships were analyzed with linear regressions, and a quadratic term was used to model a return to preocclusion levels. Paired t test was used to study the change in tear fluorescein concentration. RESULTS: In subjects who had the lower puncta of both eyes occluded, conjunctival sensation decreased in both eyes (right eye, P =.008; left eye, P =.003), but there was no change in corneal sensation. Their tear fluorescein clearance did not show a significant change from baseline (P =.90). However, a decrease in Schirmer test scores approached statistical significance (P =.056). In subjects with both puncta of only one eye occluded, we noted a decrease in corneal sensation (occluded eye, P =.042; nonoccluded eye, P =.036), conjunctival sensation (occluded, P =.001; nonoccluded, P =.060), and Schirmer scores (occluded, P =.022; nonoccluded, P =.011). Linear regression did not show a significant change in tear fluorescein clearance for either eye (occluded, P =.28; nonoccluded, P =.44). However, paired t test showed a significant worsening of tear clearance in the occluded eye from day 0 to day 3 (P =.001) followed by a subsequent improvement in tear clearance from day 3 to the end of the study period (P =.045). Paired t test did not reveal any significant changes in tear clearance in the nonoccluded eye. The quadratic term of the linear regression model demonstrated an increase toward preocclusion levels that approached statistical significance for corneal sensation (occluded, P =.053; nonoccluded, P =.099). It was statistically significant for conjunctival sensation (occluded, P =.001; nonoccluded, P =.045) and Schirmer scores (occluded, P =.047; nonoccluded, P =.044). CONCLUSIONS: Temporary punctal occlusion in normal subjects decreases tear production and ocular surface sensation. Our findings suggest that in addition to blocking tear drainage, punctal occlusion may affect the ocular surface/lacrimal gland interaction. These effects were more pronounced in subjects with both upper and lower puncta occluded. In normal subjects, there appears to be an autoregulatory mechanism to return tear production, tear clearance, and ocular surface sensation to preocclusion levels 14 to 17 days after punctal occlusion.

Congenital orbital cyst detected and monitored by prenatal ultrasonography.

PURPOSE: High-resolution prenatal ultrasound can allow for early detection and monitoring of many fetal anomalies, including those involving the globe and orbit. We describe a case of a congenital orbital cyst detected and monitored by prenatal transvaginal ultrasonography. METHODS: After detection of a congenital orbital cyst, serial transvaginal ultrasound examinations were performed through the remainder of the pregnancy to monitor the growth and development of the fetus and the orbital cyst. RESULTS: A large retrobulbar orbital cyst causing extreme proptosis was detected at 23 weeks of gestation and monitored through the remainder of the pregnancy. Lack of growth, benign behavior, and appropriate interval fetal growth without destruction of adjacent structures was noted. After birth, early surgical intervention allowed for complete surgical excision of the cyst without the need for enucleation or exenteration. Fifteen months after excision, the patient wore a scleral shell and had a good cosmetic appearance with good ocular motility. CONCLUSIONS: Prenatal ultrasound may allow for early detection of orbital masses. To our knowledge, this report describes the first case of a congenital orbital cyst detected and monitored by prenatal ultrasonography.

Unilateral glaucoma in Sotos syndrome (cerebral gigantism).

PURPOSE: To report a patient with unilateral glaucoma associated with Sotos syndrome. Sotos syndrome (cerebral gigantism) is a disorder of growth and development with characteristic facial changes and normal endocrine function. Ocular manifestations may also include megalocornea, iris hypoplasia, cataracts, megalophthalmos, strabismus, nystagmus, and retinal dystrophy. METHODS: Case report. A 50 year-old man with the clinical features of Sotos syndrome presented with complaints of decreased vision in the left eye. RESULTS: Ophthalmologic examination revealed bilateral megalocornea, megalophthalmos, iris hypoplasia and transillumination defects, cataracts, and unilateral glaucoma. Intraocular pressure was lowered, and visual field loss was stabilized with topical medications. CONCLUSION: Sotos syndrome patients should be examined routinely to allow for early detection and treatment of potential ocular problems, including glaucoma.

Sebaceous cell carcinoma of the eyelid and the human immunodeficiency virus.

PURPOSE: Patients infected with the human immunodeficiency virus (HIV) are at increased risk for developing malignancies, which are acquired at a younger age and are more aggressive. Sebaceous cell carcinoma is a rare eyelid tumor typically occurring in the seventh decade of life. We report two cases of sebaceous cell carcinoma in young HIV-infected patients. METHODS: Case series and review of the literature. We describe two HIV-infected patients with sebaceous cell carcinoma of the eyelid and caruncle. The first patient was a 36-year-old woman with a 9-month history of an enlarging right lower eyelid mass. The second patient was a 34-year-old man with a 6-month history of an enlarging right caruncular mass. RESULTS: Biopsy showed both masses to be sebaceous cell carcinoma. The first patient underwent Mohs' micrographic excision of the lesion followed by reconstruction of the full-thickness eyelid defect with a combination of tarsoconjunctival and myocutaneous advancement flaps. The second patient underwent exenteration because of orbital involvement. CONCLUSION: Sebaceous cell carcinoma should be considered for any suspicious eyelid lesion in young HIV-infected patients.

Radiation therapy for local control of eyelid sebaceous cell carcinoma: report of two cases and review of the literature.

PURPOSE: Because of previous reports of increased rate of recurrence and mortality after radiation therapy, eyelid sebaceous cell carcinoma has been considered radioresistant. Recent reports of success with primary radiation therapy have been attributed to advancements in irradiating technology and technique. Two cases of eyelid sebaceous cell carcinoma successfully treated with radiation therapy are reported. The techniques used are compared with the techniques described in previous reports, and factors favoring successful treatment are reevaluated. METHODS: Case series and review of the literature. Two cases of eyelid sebaceous cell carcinoma that underwent radiation therapy are described. Both patients were offered, but refused, surgical excision. One patient received 69 Gy combined superficial and megavoltage x-ray irradiation to the left lower eyelid. The second patient received 59 Gy megavoltage electron beam irradiation to the right upper eyelid. A review of the literature was performed, and Fisher's exact test analysis was used to compare the results of all reported cases treated with < or =55 Gy with those treated with >55 Gy. RESULTS: In both cases, the tumor responded to radiation therapy. One patient died 39 months after treatment, of myocardial infarction. The second patient is without clinical evidence of tumor recurrence 46 months after treatment. Fisher's exact test showed an advantage to patients treated with >55 Gy radiation (p = 0.05). CONCLUSION: Radiation therapy with an appropriate delivery system is effective as a curative treatment for eyelid sebaceous cell carcinoma when >55 Gy of radiation dose is delivered. It should be considered for patients seeking an alternative to surgical excision.

Oscillopsia and pseudonystagmus in kidney transplant patients.

PURPOSE: Modern immunosuppressants have improved the success of kidney transplantation for renal failure patients. They also may induce neurotoxic effects including tremor. We report two cases of pseudonystagmus and oscillopsia in transplant patients caused by immunosuppressant-induced head tremor and gentamicin-induced vestibulotoxicity. METHODS: Case reports. Head tremor, static visual acuity, and dynamic visual acuity were measured. Vestibular function was evaluated with ice water calorics. RESULTS: Both patients had significant head tremor and pseudonystagmus. Head stabilization improved static visual acuity. Dynamic visual acuity revealed a 4-line and 10-line loss of visual acuity, respectively. CONCLUSIONS: These findings of pseudonystagmus and oscillopsia are likely to become more prevalent as more renal failure patients receive transplants. Improvement may be seen with reduction of immunosuppressant, reduction of stimulant intake, use of medications to reduce head tremor, and vestibular rehabilitation.

Update on hereditary optic neuropathy.

Although no treatment is available for hereditary optic neuropathies, recent localization and identification of some of the genetic loci have helped the evaluation and management of patients with these disorders. This article discusses the clinical features and known genetic information regarding Leber's hereditary optic neuropathy, dominant optic atrophy, recessive optic atrophy, and Wolfram syndrome.

Cytoskeletal antigen expression in ocular mucosa-associated lymphoid tissue.

The human lacrimal gland (LG) and ocular surface contain discrete regions of epithelial cells with specific functions and at different stages of cellular differentiation. Epithelial cells contain cytoskeletal antigens that show a differentiation-dependent pattern of expression. The objective of this study was to characterize the various epithelial cell populations in normal human ocular mucosa-associated lymphoid tissue (MALT; LG, conjunctiva, and cornea) based on their immunohistochemical staining patterns with anticytoskeletal monoclonal antibodies (MoAbs) reactive with cytokeratins (AE-1, AE-2, AE-3, AE-5, AE-14, PKK1, and 34 beta E12), muscle-specific actin (HHF35), and vimentin. AE-1 stained LG (acini, ducts, and myoepithelia) and the full thickness of corneal and conjunctival epithelia. It stained only the superficial and basal limbal epithelium. AE-2 weakly stained all epithelia, except LG acini and proximal intralobular ducts. AE-3 and 34 beta E12 MoAbs had strong immunoreactivity with all MALT epithelia. AE-5 strongly stained the inner cells (suprabasal) of LG central intra- and interlobular ducts and the suprabasal epithelial layers of the cornea. It weakly stained LG myoepithelia and the superficial conjunctival epithelium. AE-14 stained the outer (basal) cells of LG central intra- and interlobular ducts, LG myoepithelia, basal epithelial layers of the limbus and conjunctiva, and all corneal epithelia. PKK1 stained all epithelia, except the basal limbus. HHF35 and the antivimentin MoAbs stained only the LG myoepithelia. The results of these studies indicate that the different epithelia in human ocular MALT may be differentiated by specific patterns of immunoreactivity with anticytoskeletal MoAbs. These MoAbs may be useful molecular markers for identifying ocular MALT epithelia.