Towards improved outcome in children treated surgically for spontaneous intracranial suppuration in South Wales

INTRODUCTION

Spontaneous central nervous system (CNS) infections in children are rare. Treatment involves surgical intervention and antibiotic therapy. We describe a single centre experience of managing this condition in South Wales.

METHODS

We performed a retrospective review of surgically managed cases in our unit for patients under 18 years of age between 2008 and 2018. Data were collected regarding aetiology, location, microbiology examination, treatment and outcomes.

RESULTS

Twenty-six patients were identified of which 25 case notes were available. Fifteen were male and 10 were female. Median age was 12 years (age range 0.3-17 years). Seven patients (28%) had a burr-hole aspiration and 18 (72%) underwent craniotomy. A second procedure was performed in 10 (40%) and a third procedure in two (8%). Fourteen (56%) had a brain abscess, 10 (40%) had subdural empyema (one was bilateral) and one (4%) had an extradural empyema. Fifteen (60%) had a raised WCC (>11.5 × 10⁹/L) and 22 (88%) had a CRP of >10 mg/L at presentation. Three (12%) patients had a normal WCC and CRP at presentation. Overall, 12 (48%) were secondary to sinus infection, with the most common organism being Streptococcus. Seven (28%) were due to otitis media or mastoiditis, six (24%) had no cause identified. The mean number of CT/MRI scans was 6.7 (range 3-13). The mean follow-up period was 16.7 months (range 1-117 months). At last follow up, 19 (76%) had a GOS of 5, five (20%) had a GOS of 4 and one (12%) had GOS of 3. There were no deaths.

CONCLUSIONS

In Wales, outcomes have improved over time in keeping with other paediatric neurosurgical units in England. Increased availability of imaging resources in our hospital and use of neuro-navigation for all cases in our unit as well as earlier identification of sepsis, communication with microbiologists with dedicated ward rounds and, enhanced identification of causative organisms and contemporary anti-microbials have also contributed towards the improved management of this condition.

Variability of retinopathy consequent upon novel mutations in LAMA1

PURPOSE

Bi-allelic mutations in LAMA1 (laminin 1) (OMIM # 150320) cause Poretti-Boltshauser Syndrome (PTBHS), a rare non-progressive cerebellar dysplasia disorder with ophthalmic manifestations including oculomotor apraxia, high myopia, and retinal dystrophy. Only 38 variants, nearly all loss of function have been reported. Here, we describe novel LAMA1 variants and detailed retinal manifestations in two unrelated families.

METHODS

Whole-genome sequencing was conducted on three siblings of a consanguineous family with myopia and retinal dystrophy and on a child from an unrelated non-consanguineous couple. Clinical evaluation included full ophthalmic examination, detailed colour, autofluorescence retinal imaging, retinal optical coherence tomography (OCT), fluorescein angiography under anesthesia, and pattern and full-field electroretinography.

RESULTS

Genetic analysis revealed a novel homozygous LAMA1 frameshift variant, c.1492del p.(Arg498Glyfs *25), in the affected siblings in family 1 and a novel frameshift c.3065del p.(Gly1022Valfs *2) and a deletion spanning exons 17-23 in an unrelated individual in family 2. Two of the three siblings and the unrelated child had oculomotor apraxia in childhood; none of the siblings had symptoms of other neurological dysfunction as adults. All four had myopia. The affected siblings had a qualitatively similar retinopathy of wide-ranging severity. The unrelated patient had a severe abnormality of retinal vascular development, which resulted in vitreous haemorrhage and neovascular glaucoma in the left eye and a rhegmatogenous retinal detachment in the right eye.

CONCLUSIONS

This report describes the detailed retinal structural and functional consequences of LAMA1 deficiency in four patients from two families, and these exhibit significant variability with evidence of both retinal dystrophy and abnormal and incomplete retinal vascularisation.

Accuracy of scleral transillumination techniques to identify infant ciliary body for sclerostomy and intravitreal injections

IMPORTANCE

There is variation in the literature for sclerotomy and intravitreal injection placement in young children, ranging from 0.5 to 3.0 mm from the limbus. We assess the accuracy of scleral transillumination to identify the ciliary body in infants for safe sclerotomy and intravitreal injections in young children.

BACKGROUND

The study compares the perilimbal "dark band" seen on scleral transillumination (STI) with the ultrasound biomicroscopy (UBM), and compares these measurements with the current guidelines for sclerotomy in infants.

DESIGN

Prospective case series in a tertiary paediatric hospital.

PARTICIPANTS

Children aged ≤36 months undergoing general anaesthesia for eye procedures.

METHODS

Scleral transillumination was performed to measure the perilimbal dark band. UBM of the ciliary body region was then performed, and correlated with transillumination findings.

MAIN OUTCOME MEASURES

The midpoints of STI and UBM were compared to current cadaver-based guidelines to assess the safe point for sclerotomy.

RESULTS

Twenty children were recruited, 36 STI and 35 UBM measurements were obtained. The posterior edge of the dark band had good correlation with the posterior border of the ciliary body. Transillumination and UBM correlated well for midpoint measurements. The midpoint of the dark band on transillumination was confirmed to be in the ciliary body by UBM in all cases.

CONCLUSIONS AND RELEVANCE

The STI technique is a useful and fast technique to demonstrate the ciliary body. The midpoint of the dark band on STI correlates well with the UBM, and has a potential use for confirming safe-entry into the posterior segment if using current guidelines. The current cadaver-based paediatric guidelines safely avoid retinal injury.

Non-contact ultra-widefield retinal imaging of infants with suspected abusive head trauma

PurposeThe purpose of the study was to audit the use of non-contact ultra-widefield retinal imaging in infants with suspected abusive head trauma (AHT) using the Optos P200MA Scanning Laser Ophthalmoscope.Patients and methodsA retrospective, observational case series. Ten eyes of five consecutive infants (aged 1-15 months) with suspected (or in 1 case, known) AHT referred for an ophthalmological opinion were included. Each infant underwent non-contact ultra-widefield retinal imaging using the Optos P200MA scanning laser ophthalmoscope. Optos fundus fluorescein angiography (FFA) was performed in one infant with oral sedation. The other four infants did not require sedation. The main outcome measure was the acquisition of a single, definitive ultra-widefield retinal image in each eye. Safety was audited by determining adverse changes in heart rate and oxygen saturations that required cessation of imaging.ResultsThe Optos P200MA ultra-widefield scanning laser ophthalmoscope acquired good quality retinal images in all infants. Documentation of acute, widespread retinal haemorrhages contributed to a diagnosis of AHT in three infants. Chronic pre-macular haemorrhage and macular schisis were documented by FFA in a fourth infant. The absence of retinal haemorrhages was documented in a fifth infant contributing to the exclusion of a diagnosis of AHT. There were no adverse safety signals in any infant in this series.ConclusionThe Optos P200MA ultra-widefield scanning laser ophthalmoscope appears safe to use in infants with suspected AHT, providing high-quality retinal images in a single frame without ocular contact. Optos P200MA may be used as alternative to RetCam to document retinal haemorrhages in stable infants with suspected AHT.

Risk factors for retinal detachment following cataract surgery: the impact of posterior capsular rupture

AIM

To investigate risk factors for retinal detachment (RD) after cataract surgery, particularly posterior capsular rupture (PCR) with or without vitreous loss.

METHODS

Single centre electronic medical record database study of 18 065 consecutive first eye cataract operations performed between 2005 and 2014. Survival analysis was performed with Kaplan-Meier curves and a Cox proportional hazard regression analysis to calculate HRs with respect to RD.

RESULTS

The RD rate at 3 months and 7 years was 0.067% and 0.30%, respectively, with a median time to RD of 15 months (mean: 18 months, range: 0-84 months). Men had a higher RD risk (HR 2.00; 95% CI 1.03 to 3.88; p=0.03) in the univariate model. Patients <60 years and those >80 years had an HR of 5.12 (95% CI 2.60 to 10.07; p<0.001) and 0.16 (95% CI 0.38 to 0.69; p=0.01), respectively, compared with patients 60-80 years of age. Eyes longer than 25 mm had an HR of 3.98 (95% CI 1.93 to 8.20; p<0.001) compared with eyes 23-25 mm. PCR occurred in 400 (2.2%) eyes. The HR for RD was 12.83 (95% CI 5.62 to 29.30; p<0.001) for PCR with vitreous loss. There were no RD events in eyes with PCR without vitreous loss.

CONCLUSIONS

The risk for RD after cataract surgery is higher in younger patients and eyes with longer axial length or PCR with vitreous loss during surgery.

Incidence and treatment of retinopathy of prematurity in England between 1990 and 2011: database study

AIMS

To study the incidence and treatment of retinopathy of prematurity (ROP) in England, 1990-2011.

METHODS

English national Hospital Episode Statistics were analysed, for babies born in hospital and for inpatient admissions, to obtain annual rates of diagnosis of, and treatment for, babies with ROP. National data on low birthweight (LBW) babies, born <1500 g and therefore eligible for ROP screening, were used as denominators in calculating rates of ROP per 1000 babies at risk.

RESULTS

The recorded incidence of ROP increased tenfold, from 12.8 per 1000 LBW babies in 1990 to 125.5 per 1000 LBW babies in 2011. Tretment rates for ROP by cryotherapy or laser rose from 1.7 to 14.8 per 1000 LBW babies between 1990 and 2011. In 1990, 13.3% of babies with ROP were treated with cryotherapy, which fell to 0.1% in 2011. Rates for laser treatment rose from 1.8% of babies with ROP in 1999 to 11.7% in 2011.

CONCLUSIONS

Increased neonatal survival, improved awareness of ROP and dissemination of guidance on screening and treatment of ROP will all have contributed to the substantial rise in recorded incidence of ROP between 1990 and 2011. Retinal ablation is now almost always performed using laser treatment rather than cryotherapy.

Transient retinal artery occlusion during phacoemulsification cataract surgery

PURPOSE

Transient retinal artery occlusion (TRAO) is a potentially underdiagnosed cause of immediate 'pad off' visual loss following phacoemulsification cataract surgery under sub-Tenon's anaesthesia.

METHODS

We describe a series of three patients presenting with enigmatic 'pad off' visual loss following phacoemulsification surgery, each diagnosed with TRAO. We describe the variable clinical presentation, illustrate the value of optical coherence tomography (OCT) imaging in establishing the diagnosis, and present the final visual outcomes.

RESULTS

Clinical findings alone may be subtle and inadequate in localising the pathology in patients with TRAO. Cross-comparison of superior and inferior macula OCT profiles in branch-pattern arterial occlusion-and between healthy and affected eyes in central-pattern arteriolar occlusion-is critical in clinching the diagnosis. The typical evolution of OCT appearance is acute-phase inner retinal thickening/oedema and hyperreflectivity followed by progressive, late-phase inner retinal atrophy. Visual acuity may recover but central scotomas, and defects in colour perception may persist.

CONCLUSION

The diagnosis of TRAO is challenging; delayed presentation may resolve fundal and retinal angiographic abnormalities. OCT may be the only imaging modality that can provide objective evidence of TRAO. Meticulous comparison/segmentation of OCT images is therefore mandatory in patients presenting with acute post-operative visual loss to exclude TRAO.

Multifocal Necrotizing Chorioretinitis Following Phacoemulsification Surgery

INTRODUCTION

Toxoplasma chorioretinitis is a leading cause of infectious posterior uveitis worldwide.

METHODS

We report an atypical presentation of Toxoplasma chorioretinitis presenting after uneventful cataract surgery in an 81-year-old male, with known hypernephroma and rheumatoid arthritis, treated with prednisolone and methotrexate.

RESULTS

He was treated for acute retinal necrosis and cytomegalovirus retinitis before Toxoplasma chorioretinitis was confirmed by vitreous biopsy 11 months after presentation. He developed a secondary rhegmatogenous retinal detachment, treated successfully with pars plana vitrectomy, silicone oil and endolaser. Visual acuity at discharge was 6/12 following silicone oil removal.

DISCUSSION

Necrotising chorioretinitis in immunosuppressed or elderly patients may present with an atypical phenotype. Clinical diagnosis in this context remains challenging. We discuss the clinical reasoning behind investigation and management of this patient group in whom viral and Toxoplasma retinitis may be clinically indistinguishable. The significance of vitreous PCR results in clinical decision making in the context of infectious posterior uveitis is discussed.

Bimanual anterior segment revision surgery for anterior capsule contraction syndrome associated with anterior flexion of intraocular lens haptics

PURPOSE

To report the incidence of anterior capsule contraction syndrome (ACCS) and to present a novel minimally invasive bimanual technique for anterior segment revision surgery associated with ACCS with anterior flexion of the intraocular lens haptics.

METHODS

A consecutive cohort of 268 eyes of 161 patients undergoing phacoemulsification and implantation of the same type of hydrophilic acrylic aspheric intraocular lens cohort were analysed and a novel technique of minimally invasive bimanual technique for anterior segment revision surgery is described.

RESULTS

We identified four eyes (1.5%) of three patients with advanced ACCS. Successful restoration of a clear visual axis with minimal induction of astigmatism and rapid visual rehabilitation was achieved in all four cases.

CONCLUSION

This technique is a safe and minimally invasive alternative to laser or vitrector-cut capsulotomy to restore a clear visual axis. In cases of advanced ACCS, it offers the option for haptic reposition or amputation.

Occlusive IOLs for intractable diplopia demonstrate a novel near-infrared window of transmission for SLO/OCT imaging and clinical assessment

PURPOSE

Occlusive intraocular lens (IOL) implantation is an effective therapeutic option in patients with intractable diplopia, visual confusion, and unsightly leukocoria. However, their use has been restricted by concerns that inability to visualize the retina may prevent the diagnosis of important posterior pole diseases. In this study, transmission spectra of occlusive IOLs were defined as a basis for acquiring scanning laser ophthalmoscopy/optical coherence tomography (SLO/OCT) images.

METHODS

Fifteen IOLs of three designs were examined: black small and large PMMA and black Lotus (Morcher GmbH, Stuttgart, Germany). Each IOL was placed between a broad-spectrum white light source and a spectroradiometer, to generate transmission spectra for each lens and determine the cutoff wavelength. Transmission in the near-infrared (NIR) range was confirmed with an 850-nm LED. A model eye was implanted with occlusive IOLs, and SLO/OCT scans were acquired with seven clinical SLO/OCT imaging systems.

RESULTS

Occlusive IOLs demonstrated high levels of transmission of NIR light. It was determined that most SLO/OCT scanners would achieve 99% to 100% transmission at their operational wavelengths of NIR light. Furthermore, all clinical SLO/OCT imaging systems were capable of imaging fine retinal features without attenuation through occlusive IOLs in a model eye.

CONCLUSIONS

In this study, a novel NIR window of high-level transmission was identified across the occlusive IOLs with applications to SLO/OCT imaging and NIR-based clinical assessment. The ability to acquire high-quality SLO/OCT scans to detect posterior pole disease may fundamentally change the current view on occlusive IOLs and encourage their use in patients with intractable diplopia.

Why is there no bulk specific heat anomaly at the superconducting transition temperature of BaPb(1-x) Bi(x) O(3)?

Caloric measurements have shown that there is no bulk specific heat anomaly at the superconducting transition temperature of BaPb(0.75)Bi(0.25)O(3).

A sticky sight: cyanoacrylate 'superglue' injuries of the eye

A 64-year-old man presented to casualty with blurred vision and pain in his left eye, 2 h after inadvertently instilling clear nail glue into his eye instead of postoperative Timolol eye drops. The glue was removed at the slit lamp revealing a corneal abrasion, which was managed with topical antibiotics. Inadvertent ocular cyanoacrylate, or 'superglue', instillation has been reported frequently since 1982 when superglue was repackaged into ophthalmic style dropper bottles. This case report highlights the continuing problem of cyanoacrylate eye injuries and serves as a reminder to healthcare professionals to report such incidents to manufacturers and regulatory bodies, on behalf of their patients, to promote the introduction of universal safety mechanisms on all household chemical containers. Failure of glue manufacturers to introduce safety cap mechanisms has resulted in significant ocular morbidity over the last 27 years, and such incidents are expected to occur until superglue bottles are redesigned.

Diagnosis and pathogenesis of congenital X-linked retinoschisis with optical coherence tomography

This study shows how optical coherence tomography has been valuable in the diagnosis of congenital X-linked retinoschisis. An infant with convergent strabismus underwent serial optical coherence tomography examinations that helped to make the diagnosis of congenital X-linked retinoschisis. Optical coherence tomography is useful in the diagnosis of congenital X-linked retinoschisis and adds new information about pathogenesis. The authors recommend the use of optical coherence tomography in pediatric retinal disease, even if the macula appears normal on indirect ophthalmoscopy.

Sub-Tenon's local anaesthesia for the treatment of retinopathy of prematurity with diode laser

PURPOSE

To evaluate the safety and efficacy of sub-Tenon's local anaesthesia (LA) for laser treatment of threshold retinopathy of prematurity (ROP).

METHODS

A cohort of 18 eyes of 10 neonates with threshold ROP was treated with diode laser peripheral retinal ablation over 14 treatment sessions using oral sedation and sub-Tenon's anaesthesia. Treatment was performed in a neonatal unit. The heart and respiratory rate, trans-cutaneous oxygen saturation, and physical activity were continuously monitored for signs of neonatal distress. Cardio-respiratory stability during and after the procedure was scored for each eye treated using a Cardio-respiratory index described previously.

RESULTS

In all cases, the planned dose of laser was delivered. One out of 18 eyes developed stage 4b tractional retinal detachment over a follow-up of at least 6 months for all babies. Systemic complications during treatment included transient bradycardia and apnoea requiring stimulation in two babies and excessive head mobility in three babies. Treatment duration varied between 20 and 80 min. Ocular complications were conjunctival haemorrhage and chemosis. The mean cardio-respiratory index was 1.13, which compared favourably with the standard published.

CONCLUSIONS

Sub-Tenon's LA with oral sedation appears to be a safe and effective alternative to general anaesthesia for laser treatment of ROP, with the potential for lower morbidity.

Variation in anaesthesia for the laser treatment of retinopathy of prematurity—a survey of ophthalmologists in the UK

PURPOSE

Laser treatment for retinopathy of prematurity (ROP) may be associated with systemic stress for the infant. No national consensus on the optimum method of anaesthesia for the treatment of ROP currently exists. This study ascertains the anaesthetic practices employed for the treatment of ROP by ophthalmologists in the United Kingdom (UK), and also their attitudes towards these practices.

MATERIALS AND METHODS

A postal questionnaire was sent to 46 consultant ophthalmologists identified as performing treatment for ROP in the UK. The consultants were asked to estimate the annual number of babies with ROP that they treated with laser, what methods of anaesthesia they employed, for comments regarding the arrangements for, and types of anaesthesia employed and whether they believed that the neonatal stress response to laser treatment was associated with a significant risk of systemic complications.

RESULTS

In all, 35 (76%) questionnaires were returned. A total of 30 (86%) respondents reported performing laser treatment for ROP. Of these, 15 (50%) used general anaesthesia for all cases and 11 (37%) intravenous sedation combined with topical anaesthesia for all cases. Oral sedation combined with topical anaesthesia, rectal chloral hydrate and paracetamol combined with topical anaesthesia, intravenous ketamine combined with topical anaesthesia, and subtenon's local anesthesia were used by one (3%) respondent each. There were no ophthalmologists using subconjunctival or topical anaesthetic alone or treating without anaesthesia.

CONCLUSION

This survey reveals considerable variation in practice among UK ophthalmologists regarding the anaesthetic methods employed in the treatment of ROP, and their beliefs regarding the systemic stress associated with treatment.

Intravitreal triamcinolone for the treatment of ischemic macular edema associated with branch retinal vein occlusion

PURPOSE

To evaluate the safety and efficacy of intravitreal triamcinolone acetonide (IVTA) for ischemic macular edema associated with branch retinal vein occlusion (BRVO) and foveal ischemia.

DESIGN

Prospective interventional case series.

METHODS

setting: Clinical practice. study population: Eighteen eyes of 18 patients with macular edema associated with BRVO and foveal ischemia. intervention: Four mg IVTA. main outcome measures: Visual acuity (VA), optical coherence tomography, macular thickness measurements, and treatment-related complications.

RESULTS

The mean duration of BRVO before treatment was 14 months. All patients were followed for a minimum of nine months, and 12 patients completed 12 months follow-up. The mean logarithm of the minimum angle of resolution (logMAR) VA improved significantly from 0.81 +/- 0.36 at baseline to 0.65 +/- 0.30 at one month (P = .03) but did not vary significantly from baseline at three, six, nine, and 12 months. Macular thickness improved significantly in all eyes from a mean of 400 +/- 134 mum preinjection, to 228 +/- 58 mum at one month (P < .01) and 256 +/- 121 mum at three months (P < .01) but did not vary significantly from baseline at six, nine, and 12 months. Eight eyes developed posterior subcapsular cataract, intraocular pressure (IOP) exceeded 21 mm Hg in four eyes, and two eyes developed vitreomacular traction during follow-up.

CONCLUSIONS

IVTA is effective in reducing ischemic macular edema associated with BRVO and foveal capillary nonperfusion. This reduction is often associated with a temporary improvement in VA. Raised IOP and development of posterior subcapsular cataract are disadvantages of this treatment.

Nutrition in burns: A practical solution to a difficult problem

The nutritional aspects of burns is an important but yet not properly looked after problem in the management of burns. We present our experience with dealing with such a problem giving a practical and easy to deliver solution to nutrition. Early enteral nutrition should be started with frequent assessment to the need of the patient and it requires a team approach.

Videoendoscope-Guided Fluorescein-Assisted Vitrectomy for Phakic Malignant Glaucoma

Malignant glaucoma is a rare secondary glaucoma classically occurring after intraocular surgery in eyes with primary angle closure. Pars plana vitrectomy is reserved for the treatment of malignant glaucoma when medical and laser treatment fail. The primary aim of surgery is the removal of the anterior vitreous to reduce resistance to aqueous flow into the anterior chamber. In phakic eyes, conventional pars plana vitrectomy without lens extraction is frequently unsuccessful because of difficulty visualizing the normally transparent anterior vitreous, combined with the technical challenge of removing the anterior vitreous without damaging the crystalline lens. We describe a technique of intraocular, videoendoscope-guided, fluorescein-assisted pars plana vitrectomy that enables direct visualization and thorough removal of the anterior vitreous without the need for lens extraction in prepresbyopic patients without cataract.

Serial autofluorescence imaging over two years following indocyanine green-assisted internal limiting membrane peel for macular hole

A 65-year-old patient with an idiopathic full-thickness macular hole underwent a vitrectomy, inner limiting membrane (ILM) peel and gas tamponade. The ILM was stained using 0.5% indocyanine green (ICG). Postoperative autofluorescence imaging shows a central focal hyperfluorescence surrounded by a perifoveal hypofluoresecnt area corresponding to the dyed and peeled ILM. Serial autofluorescence images showed progressive decrease in staining until 2 years later when no signs of ICG autofluorescence were apparent. The visual acuity for this patient improved two Snellen lines from 6/36 to 6/18 at 2 years. ICG may not be clinically toxic as is currently feared.

Design, synthesis and pharmacological evaluation of some novel 2-(4-nitrophenyl)-3-methylthio-3-(substituted)arylamino acrylamides as potential anti-inflammatory agents

On the basis of structure based drug design we have designed a series of 2-(4-nitrophenyl)-3-methylthio-3-(substituted)arylamino acrylamides as potential antiinflammatory agents. Good 3D similarity was observed between the designed molecule and rofecoxib (r.m.s.d. 0.161). The effect of opening the central ring and introducing a spacer (-NH-) between one of the aryl rings and the central ring of the basic structure of the COX-2 inhibitors was also studied. The designed molecules were synthesised by thiocarbomylation of the 4-nitro-phenylacetamide with aryl isothiocyanates followed by subsequent methylation of the enethiolate salts. All compounds were screened for their antiinflammatory activity by the carrageenan induced rat paw edema method. Compounds 4 and 6 exhibited potent antiinflammatory activity, which was found to be comparable with the standard drug, rofecoxib. Both the potent molecules were also screened for their ulcerogenic potential in Albino rats. A very low ulcer index was observed with both compounds, although higher than rofecoxib.

Optical coherence tomography under general anesthesia in a child with nystagmus

PURPOSE

To describe a method that permits optical coherence tomography scanning to be performed under general anesthesia.

DESIGN

Observational case report.

METHODS

A 7-year-old child underwent optical coherence tomography scanning under general anesthesia. He was positioned prone, with the neck extended to enable vertical facial alignment on the scanner. An anti-Trendelenburg trend on the operating table minimized the degree of neck extension required. Intravenous fluids, modest ventilator airway pressures, and compression stockings were used to minimize perioperative hemodynamic disturbance and the potential for orthostatic hypotension associated with the anti-Trendelenburg trend.

RESULTS

High-quality, diagnostically important optical coherence tomography scans were obtained.

CONCLUSION

With appropriate patient positioning and anesthetic management, optical coherence tomography scanning can be performed on uncooperative adults and children under general anesthesia.

Inhibition of estrone sulfatase (ES) by alkyl and cycloalkyl ester derivatives of 4-[(aminosulfonyl)oxy] benzoic acid

In our search for potent inhibitors of the enzyme estrone sulfatase (ES), we have undertaken the synthesis and biochemical evaluation of a range of esters of 4-[(aminosulfonyl)oxy] benzoic acid. The results of the study show that the synthesised compounds possess potent inhibitory activity, indeed the cyclooctyl derivative was found to be more potent than 667-COUMATE, which is currently undergoing clinical trials.

Outcome of ICG-assisted ILM peel in macular hole surgery

PURPOSE

To investigate whether indocyanine green (ICG) staining of the internal limiting membrane (ILM) improves surgical outcome.

METHODS

A total of 34 patients were identified who underwent macular hole surgery with ILM peeling augmented with ICG. These were matched retrospectively with 34 patients who underwent macular hole surgery without the use of ICG. Closure rates from primary and secondary procedures were compared, as were changes in Snellen and Logmar visual acuity.

RESULTS

There was no significant difference between the two groups with reference to demographic features of age, sex, staging of the macular holes, and the proportion subsequently undergoing cataract surgery. The mean follow-up period was 7.7 months in the ICG group and 6.3 months in the non-ICG group. Closure rates from primary surgery were 91.2% in the ICG group and 73.5% in the non-ICG group (P = 0.056), whereas overall closure rates following further surgery were similar in both groups (94.1 and 91.2%, respectively). Logmar visual improvement above baseline was achieved in 53% of the non-ICG group compared to 82% of the ICG group (P = 0.01). Where primary hole closure occurred, there was no statistically significant difference in visual outcome between the two groups.

CONCLUSION

ICG-assisted ILM peel in macular hole surgery is associated with a higher closure rate following a single surgical procedure. This difference was found to approach statistical significance (P = 0.056). Overall visual improvement was greater in the ICG group (P = 0.01); however, this reflected the higher closure rates. Visual outcomes between the two groups were comparable where primary hole closure occurred.

The design, synthesis, and in vitro biochemical evaluation of a series of esters of 4-[(aminosulfonyl)oxy]benzoate as novel and highly potent inhibitors of estrone sulfatase

We report the initial results of our study into the use of a potential transition-state (TS) of the reaction catalysed by the enzyme estrone sulfatase (ES) in the design of a series of cyclic esters of 4-[(aminosulfonyl)oxy]benzoate as novel inhibitors of ES. The results of the study show that these compounds are some of the most potent inhibitors known todate, possessing greater inhibitory activity than the three standard compounds: 4-methylcoumarin-7-O-sulfamate (COUMATE); the tricyclic derivative of COUMATE, namely 667-COUMATE (which is in Phase I of clinical trials) and; the steroidal inhibitor estrone-3-O-sulfamate (EMATE).

Structure-activity relationship determination within a group of substituted phenyl sulfamate based compounds against the enzyme oestrone sulfatase

The enzyme oestrone sulfatase (ES) is responsible for the conversion of the stored (sulfated) form of oestrogens to the active form, namely oestrone. In our continuing quest to synthesize potent inhibitors of oestrone sulfatase and to determine the structural requirements for such inhibition, we have synthesized and evaluated several derivatives of phenyl sulfamate. We report the results of the synthesis and biochemical evaluation of a series of 3- and 4-aminosulfonated derivatives of phenol in an effort to investigate the role of the acid dissociation constant (pK(a)), and therefore the stability of the phenoxide ion, on the inhibitory activity of compounds against this enzyme. The results showed that there was a strong correlation between the observed pK(a) and inhibitory activity within the aminosulfonated compounds considered. This suggested that in the inhibition of oestrone sulfatase by these compounds, pK(a) was an important physicochemical property, and as such, the stability of the O(-) ion was a crucial factor in the inhibition, and therefore the drug design process.

Design, synthesis and biochemical evaluation of AC ring mimics as novel inhibitors of the enzyme estrone sulfatase (ES)

We report the initial results of our study into a series of simple 4'-O-sulfamoyl-4-biphenyl based compounds as novel inhibitors of the enzyme estrone sulfatase (ES). The results of the study show that these compounds are potent inhibitors, possessing greater inhibitory activity than COUMATE, but weaker inhibitory activity than EMATE or the tricyclic derivative of COUMATE, namely 667-COUMATE. Furthermore, the compounds are observed to be irreversible inhibitors.