Intravitreal Triamcinolone Acetonide Injection in a Rodent Model of Anterior Ischemic Optic Neuropathy.

INTRODUCTION: The management of nonarteritic anterior ischemic optic neuropathy centers around prevention of second eye involvement, without a uniformly accepted therapy for the involved eye. Several researchers have assessed the benefit of steroids with conflicting results. This experimental study was designed to evaluate the efficacy of a single intravitreal triamcinolone acetonide injection (IVTA) in preserving retinal ganglion cells (RGCs) in a rodent model of anterior ischemic optic neuropathy (rAION). METHODS: The rAION was induced in female Wistar rats. Animals were randomized into 3 groups: 1) untreated, 2) treated with 56 µg IVTA, and 3) intravitreal saline (placebo). Procedures were performed in the left eye, with the right eye serving as control. After 30 days, animals were sacrificed and eyes were assessed histologically for RGC number. RESULTS: The average number of RGC was significantly lower in rAION subgroups when compared with the control group (P < 0.001). No significant difference was seen between rAION eyes treated with IVTA, placebo, and untreated eyes (P > 0.05%). CONCLUSIONS: In this rodent model for AION, no therapeutic benefit of intravitreal steroid injection was identified.

Marsupialization of orbital conjunctival inclusion cysts related to strabismus surgery.

A 52-year-old woman presented with a giant conjunctival cyst related to strabismus surgery that was adjacent to the medial rectus muscle. Management consisted of excision of the anterior cyst wall with suturing of the remaining cyst lining to overlying conjunctiva. Following marsupialization, the cyst did not recur with persistence of the conjunctival drainage site.

Levator superioris muscle function in involutional blepharoptosis.

PURPOSE: To assess the role of muscular degeneration, we evaluated the correlation between ptosis severity and levator muscle function. DESIGN: Retrospective cohort study. METHODS: The medical records of 136 patients (53 men and 83 women; mean age, 67 years) with acquired blepharoptosis were reviewed for levator function (LF), margin reflex distance (MRD), age, and gender. Multivariate linear regression was performed for statistical analysis. RESULTS: A significant correlation (P < .001) was seen between MRD (mean, 1.0 + 1.0 mm; range, -3.0 to 3.0 mm) and LF (mean, 15.0 + 1.0 mm; range, 11.0 to 20.0 mm). On average, a 0.5-mm reduction in LF was observed for each 1.0-mm decrease in MRD. This was independent to other variables assessed. CONCLUSIONS: In patients with involutional blepharoptosis, a directly proportional decrease in levator function and eyelid height was observed. This may implicate an abnormality of the levator muscle itself as a contributing factor in the development of involutional blepharoptosis.

Giant cell arteritis in Asians: a comparative study.

BACKGROUND: Giant cell arteritis (GCA) is a common systemic vasculitis, with a presumed Caucasian predominance. The occurrence of GCA in Asians has rarely been addressed. This study aims to assess the incidence of giant cell arteritis in Asians. METHODS: In this retrospective review, the self-reported ethnicities of patients with biopsy-proven GCA at the University of California-San Francisco (UCSF) were recorded. Ethnic distribution of the patient population served by UCSF was estimated from an age- and sex-matched control group. The odds ratio for each ethnicity (Asian and Caucasian) was determined and compared using Fisher's exact test and logistic regression analysis. RESULTS: The ethnic distribution of the 38 patients with positive temporal artery biopsies were as follows: Caucasian n=31 (81.6%), Asian n=1 (2.6%) and other n=6 (15.8%). The ethnic distribution of the patient population served by UCSF was as follows: Caucasian 42%, Asian 28% and other 30%. The difference in the proportion of GCA in Asians and Caucasians was statistically significant (OR 0.049 (95% CI 0.0065 to 0.374), p=0.0036). CONCLUSIONS: In our patient population, GCA was seen 20 times less frequently in Asian than Caucasian patients. Although this difference is significantly different (p=0.036), given the small sample size and wide CI this should be viewed as a rough estimate.

Pars plana vitrectomy from a temporal approach for a patient with a deep orbit.

PURPOSE: To present an alternate technique for safely performing pars plana vitrectomy (PPV) for patients with extremely deep-set eyes or prominent brow ridges. PATIENT AND METHODS: A single patient with a very deep orbit and severe glaucoma that limited the surgeon's ability to operate on the superior conjunctiva underwent 25-gauge PPV with the surgeon seated temporally. RESULTS: Twenty-five-gauge PPV with epiretinal membrane peeling and intraocular lens suturing was performed safely. CONCLUSION: PPV can be performed from a temporal approach if the access to the superior conjunctiva is limited.