McCannel Suture Technique Resolves Persistent Dysphotopsia Following Laser Peripheral Iridotomy in Phakic Eyes.

A 57-year-old woman presented with photophobia and complaint of a persistent white light in the inferior field of her left eye for 18 months following laser peripheral iridotomy both eyes. In primary gaze, the upper lid margin was noted to bisect the iridotomy at 2 o'clock left eye (OS). She relates that the light moves with her eyelid OS only and resolves by lifting the lid. A 54-year-old male presented with complaint of seeing 2 horizontal lines in his field of vision immediately following laser iridotomy OS that have persisted for a duration of 7 years. He notes they are constant and resolve by lifting up the eyelid. In primary position, the left upper lid margin was noted to bisect the iridotomy at 12 o'clock OS. Given the presence of nonresolving symptomatic dysphotopsia, each patient underwent surgical repair of the iridotomy using a McCannel suture technique with complete resolution of their symptoms. Dysphotopsias are an uncommon complication that can occur following laser peripheral iridotomy. If they persist and conservative measures are ineffective, iris suture repair can provide a definitive intervention in resolving them. Laser iridotomies located in the far periphery pose a surgical challenge with respect to accessibility. A McCannel suture technique provides a feasible approach in suturing them with minimal iris manipulation. Furthermore, it is prudent to assess the upper lid position in primary gaze before creating an iridotomy in order to avoid interference with the lid margin tear film meniscus that can lead to the formation of symptomatic dysphotopsia.

Cancer Treatment-Induced Bone Loss in Women With Breast Cancer and Men With Prostate Cancer.

Cancer and cancer therapies can have a negative impact on bone health. Because cancer is a common diagnosis, survivorship concerns for osteoporosis and fragility fractures are an important component of care. This review addresses management of bone health in nonmetastatic cancer survivorship with a focus on breast cancer and prostate cancer.

Unusual cause of severe diabetic ketoacidosis precipitated by Streptococcus bovis/equinus (SBSEC) bacteremia: Case report and review of literature.

Diabetic ketoacidosis is a feared complication in patients with diabetes mellitus and poses high risk of mortality and morbidity unless treated in timely manner. Infection is one of the most common precipitating factors for the development of diabetic ketoacidosis. Bacteremia with Group A and Group B beta hemolytic streptococcal strains are well known, however nonenterococcal Group D strains such as the Streptococcus bovis/Streptococcus equinus complex (SBSEC) still remains an understudied entity. Here we present a case of a 35-year-old Type I diabetic female presenting with severe diabetic ketoacidosis with overlapping features of hyperosmolar hyperglycemia, precipitated by Streptococcus alactolyticus bacteremia, successfully treated with four-week course of parenteral ceftriaxone. This case report emphasizes the potential importance of SBSEC as an emerging pathologic strain and culprit for triggering diabetic ketoacidosis which requires prompt diagnosis and targeted therapy.

Biomechanical Responses of Lamina Cribrosa to Intraocular Pressure Change Assessed by Optical Coherence Tomography in Glaucoma Eyes.

Purpose: The purpose of this study was to measure change in anterior lamina cribrosa depth (ALD) globally and regionally in glaucoma eyes at different intraocular pressures (IOP). Methods: Twenty-seven glaucoma patients were imaged before and after IOP-lowering procedures using optical coherence tomography. The anterior lamina was marked in approximately 25 locations in each of six radial scans to obtain global and regional estimates of ALD. ALD and its change with IOP were compared with optic disc damage, nerve fiber layer thickness, and visual field loss. Results: Variables associated with deeper baseline ALD included larger cup/disc ratio, thinner rim area, larger cup volume, thinner central corneal thickness, and male sex (all P ≤ 0.02). When IOP was lowered, ALD position became more anterior, more posterior, or was unchanged. The mean ALD change after lowering was 27 ± 142 µm (P = 0.3). The mean absolute value of ALD change was 112 ± 90 µm (P = 0.002). Change in ALD was greater in eyes with lower IOP in paired comparisons (P = 0.006) but was not associated with the magnitude of IOP lowering between imaging sessions (P = 0.94). Eyes with no significant change in ALD tended to have more visual field loss than those with significant anterior ALD displacement (P = 0.07). Areas within each optic nerve head that corresponded to zones with thicker nerve fiber layer had greater ALD positional change (P = 0.0007). Conclusions: The lamina can move either anteriorly or posteriorly with IOP decrease, with greater displacement at lower IOP. Glaucoma eyes and regions within glaucoma eyes associated with greater glaucoma damage exhibited smaller responses.

Measured Changes in Limbal Strain During Simulated Sleep in Face Down Position Using an Instrumented Contact Lens in Healthy Adults and Adults With Glaucoma.

IMPORTANCE: Eyes of patients with glaucoma may be damaged during sleep. OBJECTIVE: To measure strains in glaucoma eyes and control eyes produced by mechanical force or deformation of the eye from contact when one side of the face rests against a pillow. DESIGN, SETTING, AND PARTICIPANTS: This study took place in a clinic-based setting among 22 patients with glaucoma and 11 age-matched controls. The research was conducted at Wilmer Eye Institute between February 4, 2014, and December 2, 2014. Data analysis was done from June 3, 2014, to June 30, 2015. MAIN OUTCOMES AND MEASURES: We used a contact lens sensor (CLS) to measure change in limbal strain associated with placing one side of the face down (FD) on a pillow in simulated sleep. Baseline intraocular pressure (IOP) was measured with a tonometer. The CLS data were collected every 5 minutes during intervals of up to 60 minutes in various positions, including sitting, lateral decubitus, FD (with the CLS-instrumented eye toward the pillow), and supine. Measured changes in limbal strain were related to estimated changes in IOP and to modeled strain produced by changes in IOP. RESULTS: Among 22 patients with glaucoma and 11 controls, 17 were female. The mean age for the glaucoma group was 62.6 years, while the mean age for the control group was 61.4 years (P = .68). Baseline IOP was also similar for the 2 groups. The mean IOP sitting at the start was 13.7 mm Hg for the glaucoma group and 13.8 mm Hg for the control group (P = .73), and the mean IOP lying at the start was 17.5 mm Hg for the glaucoma group and 16.0 mm Hg for the control group (P = .88). By multivariable linear regression, FD position was associated with an increase in limbal strain in glaucoma eyes (mean [SE], 44.1 [20.4] mV Eq; P = .03) but not in control eyes (mean [SE], 13.6 [13.9] mV Eq, P = .33). While FD, the increased CLS values in patients with glaucoma did not decrease over time (slope, 0.275 mV Eq/min; P = .53 by univariable linear regression). Magnitudes of measured changes in limbal strain were greater in glaucoma eyes with past visual field worsening (P = .006 by multivariable linear modeling). The mean limbal strain increase among patients with glaucoma in FD position was equivalent to strain expected for a mean (SE) IOP increase of 2.5 (1.1) mm Hg from a baseline IOP of 14.2 mm Hg. CONCLUSIONS AND RELEVANCE: Contact with a pillow in FD position during simulated sleep produced a sustained strain increase in glaucoma eyes, particularly those eyes with past progressive visual field loss. The mean FD change in glaucoma eyes was equivalent to strain increase associated with a mean (SE) sustained IOP elevation of 2.5 (1.1) mm Hg. Further experiments are planned to determine if facial features or a protective eye shield prevents sleep position-induced limbal strains during a mean 8-hour sleep period.

Downregulation of beta-microglobulin to diminish T-lymphocyte lysis of non-syngeneic cell sources of engineered heart tissue constructs.

The presence of non-autologous major histocompatibility complex class I (MHC-I) molecules on the surface of the grafted cells is one of the main reasons for their rejection in non-syngeneic hosts. We present a straightforward strategy to decrease the presence of MHC-I by shRNA inhibition of beta-2-microglobulin (B2M), a conservative light chain of MHC-I, on the surface of two main cell types that are used to engineer heart tissue constructs. Engineered heart tissue constructs can be generated by combining mouse WT19 fibroblasts and mouse embryonic stem cell-derived cardiac myocytes (mESC-CM). WT19 fibroblasts were stably transduced with an anti-B2M shRNA, which yielded a cell line with dramatically reduced B2M expression levels (16 ± 11% of mock treated control cell line). Interferon gamma treatment increased the levels of B2M expression by >3-fold in both control and transduced fibroblasts; yet, B2M expression levels still remained very low in the transduced cells. When compared with their unmodified counterparts, transduced fibroblasts caused 5.7-fold lesser activation of cognate T-cells. B2M depletion in mESC-CM was achieved by 72 h transduction with anti-B2M shRNA lentiviral particles. Transduced mESC-CM exhibited regular beating and expressed classical cardiac markers. When compared with their unmodified counterparts, transduced mESC-CM caused 2.5-fold lesser activation of cognate T-cells. In vivo assessment of B2M downregulation was performed by analyzing the preferential survival of B2M-downregulated cells in the intraperitoneal cavity of allogeneic mice. Both B2M-downregulated fibroblasts and B2M-downregulated myocytes survived significantly better when compared to their unmodified counterparts (2.01 ± 0.4 and 5.07 ± 1.6 fold increase in survival, respectively). In contrast, when modified WT19 fibroblasts were injected into the intraperitoneal cavity of syngeneic C57Bl/6 mice, no significant survival advantage was observed. Notably, the preferential survival of B2M-downregulated cells persisted in allogeneic hosts with normal levels of natural killer cells, although the effect was lesser in magnitude. Use of shRNA against beta-2-microglobulin offers a simple and effective approach to minimize immunogenicity of the main cellular components of cardiac tissue constructs in non-syngeneic recipients.

In vivo function of the ER-Golgi transport protein LMAN1 in photoreceptor homeostasis.

LMAN1 is a type I transmembrane protein that selectively transports its cargo proteins from ER to ER-Golgi intermediate compartment (ERGIC) and Golgi. Lman1 is a direct target of the transcription factor NRL in mouse retina. Therefore, we examined the in vivo function of LMAN1 in retina. Although Lman1 (- / -) mouse eyes did not show abnormality in histology and electroretinogram analysis at 3 months, Lman1 (- / -) retina at 6 months showed a decrease in cis-Golgi markers GM130 and GRASP65. We also observed abnormal level and location of Rhodopsin in these mice. Taken together, LMAN1 may play a role in photoreceptor gene transport and homeostasis.