Transepithelial corneal crosslinking for keratoconus.

PURPOSE: To evaluate outcomes of corneal crosslinking (CXL) using a transepithelial technique for the treatment of keratoconus. SETTING: Cornea and refractive surgery subspecialty practice. DESIGN: Prospective case series. METHODS: Transepithelial CXL was performed in keratoconic eyes using riboflavin 0.1% and topical anesthetic containing benzalkonium chloride to facilitate riboflavin diffusion through the epithelium. Eyes were randomized to receive riboflavin administration either every 1 minute or every 2 minutes during ultraviolet-A exposure at 3mW/cm2. The principal outcome was change in maximum keratometry (K) and secondary outcomes included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, mean K, and comparison of randomized groups. RESULTS: Eighty-two eyes of 56 patients were treated. At 1 year, maximum K decreased significantly by 0.45 diopters (D) ± 1.94 (SD); it improved by 2.0 D or more in 11 eyes (13%) and worsened by 2.0 D or more in 4 eyes (5%). The mean UDVA significantly improved by 0.7 lines, whereas the CDVA improved by 0.2 lines. Two eyes showed both continued progression with loss of CDVA. Only the 1-minute subgroup showed significant improvements in maximum K (-0.73 D) and UDVA. Transient corneal erosion and epitheliopathy were reported in 21% of eyes. CONCLUSIONS: Transepithelial CXL resulted in significant improvements in maximum K and UDVA over 1 year. There was a suggestion that increased riboflavin dosing might improve procedure outcomes. Further study is required to determine the relative advantages and disadvantages of different transepithelial approaches to the standard CXL protocol with epithelial removal.

Transepithelial corneal collagen crosslinking for keratoconus: six-month results.

PURPOSE: To evaluate the safety and efficacy of corneal collagen crosslinking (CXL) using a transepithelial technique to treat keratoconus. SETTING: Cornea and refractive surgery subspecialty practice. DESIGN: Prospective clinical trial. METHODS: Transepithelial CXL was performed in eyes with keratoconus using proparacaine with benzalkonium chloride (BAK) 0.01% to facilitate riboflavin absorption and riboflavin 0.10% without dextran. Eyes were randomized to receive ultraviolet-A treatment (365 nm, 3 mW/cm(2)) with concurrent administration of riboflavin randomized to every 1 minute or every 2 minutes for 30 minutes. The principal outcomes included uncorrected (UDVA) and corrected (CDVA) distance visual acuities and topography-derived maximum keratometry (K) values. Patients were followed for 6 months. RESULTS: Thirty eyes of 25 patients were treated. The mean maximum K value flattened by 0.9 diopter (D) (baseline 58.7 D; 6 months 57.8 D) (P=.01). The maximum K worsened by 2.0 D or more in 1 patient. The mean CDVA improved by 0.83 Snellen lines (P=.03). One patient lost 2 lines of CDVA. There were no differences in the UDVA, CDVA, or keratometry outcomes between the 1-minute instillation subgroup and the 2-minute instillation subgroup. CONCLUSIONS: Transepithelial CXL resulted in a statistically significant improvement in maximum K values and CDVA at the 6-month follow-up. Further follow-up is necessary to ascertain the ability of transepithelial CXL to achieve long-term stabilization of the cornea in eyes with keratoconus.

Diagnosing thyroid lymphoma: steroid administration may result in rapid improvement of dyspnea : a report of two cases.

INTRODUCTION: Thyroid nodules, whether benign or malignant, are slow growing masses. There are certain clinical situations where sudden rapid growth may occur and cause acute respiratory compromise secondary to tracheal compression. CASE PRESENTATION: Here we describe two patients with suddenly enlarging thyroid nodules, who developed acute respiratory compromise in the absence of tracheal compression. Their symptoms rapidly improved with administration of corticosteroids, and in subsequent workup, both were diagnosed as thyroid lymphoma. CONCLUSIONS: The potent effect of corticosteroids in the rapid improvement of respiratory compromise associated with thyroid lymphoma represents an important clinical finding. This opens the possibility for the favorable response to corticosteroid therapy to be regarded as a possible preliminary diagnostic tool for thyroid lymphoma in acute respiratory distress patients in the absence of tracheal compression. Subsequent retrospective studies are necessary to verify this hypothesis.

Twelve-year review of pediatric traumatic open globe injuries in an urban U.S. population.

PURPOSE: To evaluate the epidemiology, anatomical characteristics, and clinical outcomes of pediatric traumatic open globe injuries and to compare the observed final visual acuity to the expected visual acuity as predicted by the Ocular Trauma Score (OTS). METHODS: Retrospective chart review of 89 pediatric patients (89 eyes) with open globe injury presenting between 1997 and 2008. RESULTS: Sixty-five patients (73%) were male, average age was 9.7 years, and mean follow-up was 22.6 months. The most common causes of trauma were: accidents (79%), violence (10%), and motor vehicle accidents (9%). Penetrating ocular injury was the most common trauma (54%), followed by blunt rupture (34%). Zone 1 injuries represented 49% of cases, and zones 2 and 3 represented 29% and 21%, respectively. No patient developed endophthalmitis. The average presenting and final visual acuities were logarithm of the minimum angle of resolution 1.927 and 1.401, respectively. Lens trauma was noted in 44 (49%) eyes. Twenty-eight patients (31%) had retinal detachment within 6 months of presentation. Total retinal attachment was achieved in 12 (63%) of 19 eyes undergoing repair. Enucleation was performed in 9 (10%) patients. Final visual acuities were not statistically different from visual acuities predicted by OTS (P > .05). CONCLUSIONS: The visual prognosis in pediatric open globe injury is poor. The zone of injury may correlate with poor final visual acuity, risk of retinal detachment, and subsequent need for an enucleation. The final predicted visual acuity correlated well with the observed final visual acuity in these patients.

Disrupted membrane structure and intracellular Ca²âº signaling in adult skeletal muscle with acute knockdown of Bin1.

Efficient intracellular Ca²âº ([Ca²âº]i) homeostasis in skeletal muscle requires intact triad junctional complexes comprised of t-tubule invaginations of plasma membrane and terminal cisternae of sarcoplasmic reticulum. Bin1 consists of a specialized BAR domain that is associated with t-tubule development in skeletal muscle and involved in tethering the dihydropyridine receptors (DHPR) to the t-tubule. Here, we show that Bin1 is important for Ca²âº homeostasis in adult skeletal muscle. Since systemic ablation of Bin1 in mice results in postnatal lethality, in vivo electroporation mediated transfection method was used to deliver RFP-tagged plasmid that produced short -hairpin (sh)RNA targeting Bin1 (shRNA-Bin1) to study the effect of Bin1 knockdown in adult mouse FDB skeletal muscle. Upon confirming the reduction of endogenous Bin1 expression, we showed that shRNA-Bin1 muscle displayed swollen t-tubule structures, indicating that Bin1 is required for the maintenance of intact membrane structure in adult skeletal muscle. Reduced Bin1 expression led to disruption of t-tubule structure that was linked with alterations to intracellular Ca²âº release. Voltage-induced Ca²âº released in isolated single muscle fibers of shRNA-Bin1 showed that both the mean amplitude of Ca²âº current and SR Ca²âº transient were reduced when compared to the shRNA-control, indicating compromised coupling between DHPR and ryanodine receptor 1. The mean frequency of osmotic stress induced Ca²âº sparks was reduced in shRNA-Bin1, indicating compromised DHPR activation. ShRNA-Bin1 fibers also displayed reduced Ca²âº sparks' amplitude that was attributed to decreased total Ca²âº stores in the shRNA-Bin1 fibers. Human mutation of Bin1 is associated with centronuclear myopathy and SH3 domain of Bin1 is important for sarcomeric protein organization in skeletal muscle. Our study showing the importance of Bin1 in the maintenance of intact t-tubule structure and ([Ca²âº]i) homeostasis in adult skeletal muscle could provide mechanistic insight on the potential role of Bin1 in skeletal muscle contractility and pathology of myopathy.

Long-term follow-up of spontaneous retinal pigment epithelium tears in age-related macular degeneration treated with anti-VEGF therapy.

PURPOSE: To describe the clinical response following anti-vascular endothelial growth factor (VEGF) therapy in patients with spontaneous retinal pigment epithelium (RPE) tears secondary to age-related macular degeneration (AMD). METHODS: Retrospective chart review of patients with AMD who developed a spontaneous RPE tear and were subsequently treated with anti-VEGF therapy at a single institution. RESULTS: In 5 patients included in the study, the median number (range) of injections received was 14.2 (5-18). The median baseline acuity was 20/200, which remained stable at 12 months and improved to 20/60 at 24 months. These changes were not statistically different. CONCLUSIONS: Anti-VEGF therapy appears safe in eyes with spontaneous RPE tear secondary to AMD and may help to stabilize or even improve acuity in some cases.

Unusual presentations of cavernous carotid aneurysms: further evidence for topographic organization of the oculomotor nerve.

Two patients with carotid cavernous aneurysms presented with uncommon patterns of third nerve involvement, one with an isolated elevation deficit without ptosis and the other with a depression deficit with possible pupillary involvement. These patterns are best explained by topographic organization of third nerve fibers within the cavernous sinus (prior to its anatomic bifurcation) that subserve individual extraocular muscles.