Temporal dynamics of the early immune response following Mycobacterium bovis infection of cattle

Bovine tuberculosis is an infectious disease of global significance that remains endemic in many countries. Mycobacterium bovis infection in cattle is characterized by a cell-mediated immune response (CMI) that precedes humoral responses, however the timing and trajectories of CMI and antibody responses determined by newer generation assays remain undefined. Here we used defined-antigen interferon-gamma release assays (IGRA) and an eleven-antigen multiplex ELISA (Enferplex TB test) alongside traditional tuberculin-based IGRA and IDEXX M. bovis antibody tests to assess immune trajectories following experimental M. bovis infection of cattle. The results show CMI responses developed as early as two-weeks post-infection, with all infected cattle testing positive three weeks post-infection. Interestingly, 6 of 8 infected animals were serologically positive with the Enferplex TB assay as early as 4 weeks post-infection. As expected, application of the tuberculin skin test enhanced subsequent serological reactivity. Infrequent M. bovis faecal shedding was observed but was uncorrelated with observed immune trajectories. Together, the results show that early antibody responses to M. bovis infection are detectable in some individuals and highlight an urgent need to identify biomarkers that better predict infection outcomes, particularly for application in low-and-middle income countries where test-and-slaughter based control methods are largely unfeasible.

The safety of BCG vaccination in cattle: results from good laboratory practice safety studies in calves and lactating cows

Bovine tuberculosis (bTB) is a global disease of livestock that has damaging economic, animal health and public health consequences. Conventional bTB disease control strategies, based around the testing and slaughter of cattle infected with bTB, are typically used to help limit or reduce the transmission of this disease but in many low- and middle-income countries such strategies may often be economically unviable, culturally unacceptable or logistically impracticable. The use of vaccination to protect cattle against bTB could provide a potentially more affordable, ethically acceptable and practical additional disease control measure. The protective efficacy of the commercially produced and readily available human vaccine against tuberculosis (Mycobacterium bovis Bacille Calmette-Guérin; BCG) in cattle has been demonstrated in many experimental laboratory and field studies. However, Good Laboratory Practice (GLP) studies assessing the safety of BCG vaccination in cattle have not previously been reported. We describe here the results of two GLP safety studies in which calves and lactating cows were vaccinated with BCG (Danish 1331 strain). From an animal health and welfare perspective, the results of these studies indicate that BCG vaccine is well tolerated in these categories of cattle with only transient and minor local or systemic reactions. Furthermore, there was no evidence that BCG was shed in raw milk, saliva or faeces collected from vaccinates and vaccination did not have a detrimental effect on milk yields in lactating cattle. These data, underpinned by GLP principles, further support the existing data on the safety of BCG vaccine in cattle and complement the abundant available cattle efficacy data for this potential cattle bTB vaccine.

Assessment of the frequency of Mycobacterium bovis shedding in the faeces of naturally and experimentally TB infected cattle

Aims

To assess the prevalence of Mycobacterium bovis bacilli in faecal samples of tuberculous cattle, and to better understand the risk of environmental dissemination of bovine tuberculosis (TB) through the spreading of manure or slurry.

Methods and Results

Faecal samples were collected from 72 naturally infected cattle with visible lesions of TB that had reacted to the tuberculin skin test and 12 cattle experimentally infected with M. bovis. These were examined by microbial culture and PCR to assess the presence of M. bovis bacilli. There were no positive cultures from any naturally infected test reactor animal. A single M. bovis colony was cultured from a faecal sample from one of the experimentally infected animals. A single PCR positive result was obtained from the faecal sample of one naturally infected test reactor.

Conclusions

The prevalence of M. bovis in the faecal samples of TB‐infected cattle was extremely low.

Significance and Impact of the Study

The results suggest that the risk of spreading TB through the use of slurry or manure as an agricultural fertilizer is lower than that suggested in some historical literature. The results could inform a reconsideration of current risk assessments and guidelines on the disposal of manure and slurry from TB‐infected herds.

Practical application of international recommendations and safety standards in the systematic planning and implementation of remediation of sites or areas with residual radioactive material

The IAEA fundamental safety objective is'to protect people and the environment from harmful effects of ionizing radiation'and this must be done 'without unduly limiting the operation of facilities or the conduct of activities that give rise to radiation risks', while ensuring that people and the environment, present and future are protected against radiation risks (IAEA 2006Fundamental Safety Principles, Safety FundamentalsNo. SF-1). In addition,'protective actions to reduce existing or unregulated radiation risks must be justified and optimized'(IAEA 2006Fundamental Safety Principles, Safety FundamentalsNo. SF-1). An international system of radiological protection can be applied such that processes, such as remediation, can be systematically undertaken to address the wide range of'existing exposure situations'present globally. In doing so, decisions made regarding actions undertaken can be demonstrated to be'justified'and'optimized'(i.e. balanced), such that the amount of effort should be commensurate with the risk (applying a'graded approach'). In addition, protection of people and the environment can be demonstrated by comparing the actual exposure to appropriate criteria over the lifetime of remediation. This paper provides an overview of the current IAEA safety standards on remediation of sites or areas contaminated with residual radioactive material within the international system of radiological protection and provides practical examples of their application through case studies considered in IAEA international model validation programs.

Why are "suboptimal" temperatures preferred in a tropical intertidal ectotherm?

In thermally extreme environments it is challenging for organisms to maximize performance due to risks associated with stochastic variation in temperature and, subsequently, over evolutionary time minimizing the exposure to risk can serve as one of the mechanisms that result in organisms preferring suboptimal temperatures. We tested this hypothesis in a slow-moving intertidal snail on tropical rocky shores, where temperature variability increases with time from 30 min to 20 h when recorded at 30 min intervals (due to short-term environmental autocorrelation where temperatures closer in time are more similar as compared to temperatures over a long period of time). Failure to accommodate temporal variation in thermal stress by selecting cool habitats can result in mortality. Thermal performance curves for different traits (heart rate and locomotion) were measured and compared to the snail's thermal preferences in both the field and laboratory. Predicted performances of the snails were simulated based on thermal performance curves for different traits over multiple time scales and simulated carryover effects. A strong mismatch was found between physiological and behavioural thermal maxima of the snails (physiological thermal maximum being higher by ~ 7 °C), but the snails avoided these maxima and sought temperatures 7 - 14 °C cooler. Such a risk-averse strategy can be explained by their predicted performances where the snails should make decisions about preferred temperatures based on time periods ≥ 5 h to avoid underestimating the temporal variation in body temperature. In extreme and stochastic environments, where the temporal variation in environmental conditions can lead to substantial divergence between instantaneous and time-averaged thermal performances, "cooler is better" and "suboptimal" body temperatures are preferred as they provide sufficient buffer to reduce mortality risk from heat stress.

Optimisation of Mycobacterium bovis BCG Fermentation and Storage Survival

Mycobacterium bovis Bacillus Calmette–Guérin (M. bovis BCG) was generated over a century ago for protection against Mycobacterium tuberculosis (Mtb) and is one the oldest vaccines still in use. The BCG vaccine is currently produced using a pellicle growth method, which is a complex and lengthy process that has been challenging to standardise. Fermentation for BCG vaccine production would reduce the complexity associated with pellicle growth and increase batch to batch reproducibility. This more standardised growth lends itself to quantification of the total number of bacilli in the BCG vaccine by alternative approaches, such as flow cytometry, which can also provide information about the metabolic status of the bacterial population. The aim of the work reported here was to determine which batch fermentation conditions and storage conditions give the most favourable outcomes in terms of the yield and stability of live M. bovis BCG Danish bacilli. We compared different media and assessed growth over time in culture, using total viable counts, total bacterial counts, and turbidity throughout culture. We applied fluorescent viability dyes and flow cytometry to measure real-time within-culture viability. Culture samples were stored in different cryoprotectants at different temperatures to assess the effect of these combined conditions on bacterial titres. Roisin’s minimal medium and Middlebrook 7H9 medium gave comparable, high titres in fermenters. Flow cytometry proved to be a useful tool for enumeration of total bacterial counts and in the assessment of within-culture cell viability and cell death. Of the cryoprotectants evaluated, 5% (v/v) DMSO showed the most significant positive effect on survival and reduced the negative effects of low temperature storage on M. bovis BCG Danish viability. In conclusion, we have shown a reproducible, more standardised approach for the production, evaluation, and storage of high titre, viable, BCG vaccine.

Bioreactor-Grown Bacillus of Calmette and Guérin (BCG) Vaccine Protects Badgers against Virulent Mycobacterium bovis When Administered Orally: Identifying Limitations in Baited Vaccine Delivery

Bovine tuberculosis (TB) in Great Britain adversely affects animal health and welfare and is a cause of considerable economic loss. The situation is exacerbated by European badgers (Meles meles) acting as a wildlife source of recurrent Mycobacterium bovis infection to cattle. Vaccination of badgers against TB is a possible means to reduce and control bovine TB. The delivery of vaccine in oral bait holds the best prospect for vaccinating badgers over a wide geographical area. There are practical limitations over the volume and concentration of Bacillus of Calmette and Guérin (BCG) that can be prepared for inclusion in bait. The production of BCG in a bioreactor may overcome these issues. We evaluated the efficacy of oral, bioreactor-grown BCG against experimental TB in badgers. We demonstrated repeatable protection through the direct administration of at least 2.0 × 10⁸ colony forming units of BCG to the oral cavity, whereas vaccination via voluntary consumption of bait containing the same preparation of BCG did not result in demonstrable protection at the group-level, although a minority of badgers consuming bait showed immunological responses and protection after challenge equivalent to badgers receiving oral vaccine by direct administration. The need to deliver oral BCG in the context of a palatable and environmentally robust bait appears to introduce such variation in BCG delivery to sites of immune induction in the badger as to render experimental studies variable and inconsistent.

Effects of dietary supplementation with vitamin E, selenium yeast or both on egg incubation response, embryonic development, keet quality, and posthatch growth of helmeted guinea fowl breeders

This study investigated the effects of dietary supplementation with vitamin E (vit. E), selenium yeast (Se yeast), or both on egg incubation response, embryonic development, keet quality, and posthatch growth of helmeted guinea fowls. Two hundred and forty 24-week old helmeted guinea fowl hens (average weight 1.75 + 0.22 kg) and cocks (average weight 2.15 + 0.20 kg) were assigned into 24 pens; each pen housed 10 hens and 2 cocks. There were four dietary treatments consisting of a basal diet (control), basal diet supplemented with vit. E (30 IU/kg), Se yeast (0.3 mg/kg Se), or both. Six pens were assigned to each treatment. Egg incubation response were estimated using 504 settable eggs sampled from each treatment collected during 15 to 17 weeks in lay. A total of 72 fertile eggs sampled from each treatment were used for the estimation of embryonic development. Quality of day-old keets hatched was scored based on physical conditions, while posthatch growth was measured for 21 days. Guinea fowl breeders fed diet supplemented with both vit. E and Se yeast produced the highest (P < 0.05) number of fertile eggs, percentage fertility, number of hatchlings, hatchability of total eggs, and hatchability of fertile eggs. Supplementation with vit. E + Se yeast resulted in the heaviest (P < 0.05) embryo weight, relative embryo weight, least (P < 0.05) yolk sac weight, and relative yolk sac weight on 25 days of incubation. Hatchlings from breeders fed diet supplemented with Se yeast and vit. E + Se yeast showed normal swallowed yolk. Supplementation of maternal diet with vit. E, Se yeast, and vit. E + Se yeast resulted in improved (P < 0.05) feed conversion ratio of subsequent hatchlings during 1 to 7-day posthatch growth. It can be concluded that dietary supplementation of vit. E + Se yeast in guinea fowl breeders resulted in improved egg fertility, hatchability, heavier embryo weights, hatchlings of good quality, and improved posthatch growth during the first 7 days.

Detection of live M. bovis BCG in tissues and IFN-γ responses in European badgers (Meles meles) vaccinated by oropharyngeal instillation or directly in the ileum

Background

Oral vaccination with Mycobacterium bovis Bacille of Calmette and Guerin (BCG) has provided protection against M. bovis to badgers both experimentally and in the field. There is also evidence suggesting that the persistence of live BCG within the host is important for maintaining protection against TB. Here we investigated the capacity of badger inductive mucosal sites to absorb and maintain live BCG. The targeted mucosae were the oropharyngeal cavity (tonsils and sublingual area) and the small intestine (ileum).

Results

We showed that significant quantities of live BCG persisted within badger in tissues of vaccinated badgers for at least 8 weeks following oral vaccination with only very mild pathological features and induced the circulation of IFNγ-producing mononuclear cells. The uptake of live BCG by tonsils and drainage to retro-pharyngeal lymph nodes was repeatable in the animal group vaccinated by oropharyngeal instillation whereas those vaccinated directly in the ileum displayed a lower frequency of BCG detection in the enteric wall or draining mesenteric lymph nodes. No faecal excretion of live BCG was observed, including when BCG was delivered directly in the ileum.

Conclusions

The apparent local loss of BCG viability suggests an unfavorable gastro-enteric environment for BCG in badgers, which should be taken in consideration when developing an oral vaccine for use in this species.

Preferred temperature of intertidal ectotherms: Broad patterns and methodological approaches

Preferred temperature (Tpref) has been measured in over 100 species of aquatic and 300 species of terrestrial ectotherms as a metric for assessing behavioural thermoregulation in variable environments and, as such, has been linked to ecological processes ranging from individual behaviour to population and community dynamics. Due to the asymmetric shape of performance curves, Tpref is typically lower than the optimal temperature (Topt, where physiological performance is at its peak), and the degree of this mismatch increases with variability in Tb. Intertidal ectotherms experience huge variability in Tb on a daily basis and therefore provide a good system to test whether the relationship between Tpref and variation in Tb holds in more extreme environments. A review of the literature, however, only revealed comparisons between Tpref and Topt for five intertidal species and measurements of Tpref for 23 species. An analysis of this limited literature for intertidal ectotherms showed a positive relationship between acclimation temperature and Tpref. There was, however, great variation in the methodologies employed to make these assessments. Factors contributing to behavioural thermoregulation in intertidal ectotherms including small body size; low mobility; interactions among individuals; endogenous clocks; metabolic effects; thermal sensitivity; sampling of the thermal environment and recent acclimation history were considered to varying degrees when measuring Tpref, confounding comparisons between species. The methodologies used to measure Tpref in intertidal ectotherms were reviewed in light of each of these factors, and methodologies proposed to standardize approaches. Given the theoretical predictions about the relationships between Tpref and variability in Tb, the spatial and temporal thermal variability experienced by intertidal ectotherms provides numerous opportunities to test these expectations if assessed in a standardized manner, and can potentially provide insights into the value of behavioural thermoregulation in the more thermally variable environments predicted to occur in the near future.

Survival of Mycobacterium bovis BCG oral vaccine during transit through a dynamic in vitro model simulating the upper gastrointestinal tract of badgers

In developing an oral bait BCG vaccine against tuberculosis in badgers we wanted to understand the conditions of the gastrointestinal tract and their impact on vaccine viability. Conditions mimicking stomach and small-intestine caused substantial reduction in BCG viability. We performed in vivo experiments using a telemetric pH monitoring system and used the data to parameterise a dynamic in vitro system (TIM-1) of the stomach and small intestine. Some BCG died in the stomach compartment and through the duodenum and jejunum compartments. BCG survival in the stomach was greatest when bait was absent but by the time BCG reached the jejunum, BCG viability was not significantly affected by the presence of bait. Our data suggest that from a starting quantity of 2.85 ± 0.45 x 108 colony-forming units of BCG around 2 log10 may be killed before delivery to the intestinal lymphoid tissue. There are economic arguments for reducing the dose of BCG to vaccinate badgers orally. Our findings imply this could be achieved if we can protect BCG from the harsh environment of the stomach and duodenum. TIM-1 is a valuable, non-animal model with which to evaluate and optimise formulations to maximise BCG survival in the gastrointestinal tract.

Assessment of the safety of Bacillus Calmette-Guérin vaccine administered orally to badgers (Meles meles)

European badgers (Meles meles) are a wildlife reservoir for Mycobacterium bovis (M. bovis) in parts of England, Wales and Ireland, constituting a potential source of tuberculosis (TB) infection for cattle. Vaccination of badgers against TB is one of the tools available for helping reduce the prevalence of bovine TB in badgers, made possible by the licensing in 2010 of Bacillus Calmette-Guérin (BCG) vaccine for intramuscular administration to badgers (BadgerBCG). However, practical limitations associated with administering an injected vaccine to wild animals make an oral, bait-delivered form of the vaccine highly desirable. Evaluation of the safety of oral BCG to badgers and the environment is a mandatory step on the road to licensing an oral vaccine. This study had the following objectives: (a) to determine whether adverse effects followed the oral administration of BCG vaccine to badgers; (b) to measure the quantity and frequency of BCG excreted in the faeces of vaccinated badgers; and (c) to assess whether there was evidence of the vaccine spreading to unvaccinated, 'sentinel' badgers sharing the same environment as vaccinated animals. We report here that the oral administration per badger of ≥6.4 × 10⁹ cfu BCG, followed 14 days later by a single oral dose of ≥6.4 × 10⁷ cfu BCG caused no adverse physical effects and did not affect the social behaviour and feeding habits of the vaccinated animals. BCG was cultured from the faeces of two of nine vaccinated animals (372 cfu/g and 996 cfu/g, respectively) approximately 48 h after the higher dose of BCG was administered and by one of the nine vaccinated animal (80 cfu/g) approximately 24 h after receiving the lower dose of BCG. We found no evidence for the transmission of BCG to unvaccinated, sentinel, badgers housed with the vaccinated animals despite the occasional excretion of BCG in faeces.

ESTIMATES OF RADIATION DOSES TO THE SKIN FOR PEOPLE CAMPED AT WALLATINNA DURING THE UK TOTEM 1 ATOMIC WEAPONS TEST

A group of Aboriginal people was camped at Wallatinna in South Australia, ~170 km downwind from Emu Field, where an atomic test (the Totem 1 test) was carried out at 07.00 on 15 October 1953 local time (21.30 on 14 October 1953 GMT (Greenwich Mean Time)). They left the camp ~24 hours later. These people stated that a phenomenon that has become known as a 'black mist' rolled through their camp site ~5 hours after detonation and that some of them subsequently became sick, displaying skin reddening and nausea. They feared that the sickness was a result of exposure to high levels of radiation. The purpose of this paper is to determine if these people could have received ionising radiation doses high enough to cause the symptoms displayed. The methodology used for the dose estimates is described in the paper. The exposure modes considered were external exposure due to the passage of a contaminated plume over the camp site, inhalation of material from this plume, external exposure from material deposited on the ground as the plume passed, and consumption of contaminated food and water. The contaminants considered in the airborne cloud and the ground plume were fission products and unburnt plutonium from the nuclear detonation, and neutron activation products caused by vaporisation of the tower used to position the weapon. The source was approximated by a line source. An upper estimate of the effective doses received is ~4 mSv, which is well below the level at which acute radiation effects are observed. This estimate is consistent with earlier assessments, which did not consider inhalation of the contribution from neutron activation products.

The Effect of Oral Vaccination with Mycobacterium bovis BCG on the Development of Tuberculosis in Captive European Badgers (Meles meles)

The European badger (Meles meles) is a reservoir host of Mycobacterium bovis and responsible for a proportion of the tuberculosis (TB) cases seen in cattle in the United Kingdom and Republic of Ireland. An injectable preparation of the bacillus Calmette-Guérin (BCG) vaccine is licensed for use in badgers in the UK and its use forms part of the bovine TB eradication plans of England and Wales. However, there are practical limitations to the widespread application of an injectable vaccine for badgers and a research priority is the development of an oral vaccine deliverable to badgers in bait. Previous studies reported the successful vaccination of badgers with oral preparations of 10⁸ colony forming units (CFU) of both Pasteur and Danish strains of BCG contained within a lipid matrix composed of triglycerides of fatty acids. Protection against TB in these studies was expressed as a reduction in the number and apparent progression of visible lesions, and reductions in the bacterial load and dissemination of infection. To reduce the cost of an oral vaccine and reduce the potential for environmental contamination with BCG, it is necessary to define the minimal efficacious dose of oral BCG for badgers. The objectives of the two studies reported here were to compare the efficacy of BCG Danish strain in a lipid matrix with unformulated BCG given orally, and to evaluate the efficacy of BCG Danish in a lipid matrix at a 10-fold lower dose than previously evaluated in badgers. In the first study, both BCG unformulated and in a lipid matrix reduced the number and apparent progression of visible lesions and the dissemination of infection from the lung. In the second study, vaccination with BCG in the lipid matrix at a 10-fold lower dose produced a similar outcome, but with greater intra-group variability than seen with the higher dose in the first study. Further research is needed before we are able to recommend a final dose of BCG for oral vaccination of badgers against TB or to know whether oral vaccination of wild badgers with BCG will significantly reduce transmission of the disease.

Testing of a palatable bait and compatible vaccine carrier for the oral vaccination of European badgers (Meles meles) against tuberculosis

The oral vaccination of wild badgers (Meles meles) with live Bacillus Calmette-Guérin (BCG) is one of the tools being considered for the control of bovine tuberculosis (caused by Mycobacterium bovis) in the UK. The design of a product for oral vaccination requires that numerous, and often competing, conditions are met. These include the need for a highly palatable, but physically stable bait that will meet regulatory requirements, and one which is also compatible with the vaccine formulation; in this case live BCG. In collaboration with two commercial bait companies we have developed a highly attractive and palatable bait recipe designed specifically for European badgers (Meles meles) that meets these requirements. The palatability of different batches of bait was evaluated against a standardised palatable control bait using captive badgers. The physical properties of the bait are described e.g. firmness and colour. The microbial load in the bait was assessed against European and US Pharmacopoeias. The bait was combined with an edible vaccine carrier made of hydrogenated peanut oil in which BCG vaccine was stable during bait manufacture and cold storage, demonstrating <0.5 log₁₀ reduction in titre after 117weeks' storage at -20°C. BCG stability in bait was also evaluated at +4°C and under simulated environmental conditions (20°C, 98% Relative Humidity; RH). Finally, iophenoxic acid biomarkers were utilised as a surrogate for the BCG vaccine, to test variants of the vaccine-bait design for their ability to deliver biomarker to the gastrointestinal tract of individual animals. These data provide the first detailed description of a bait-vaccine delivery system developed specifically for the oral vaccination of badgers against Mycobacterium bovis using live BCG.

Relationship between macular hole size and the potential benefit of internal limiting membrane peeling

Macular hole size is a predictor for anatomical closure. Holes >400 μm in aperture size on an OCT scan are more likely to close when ILM is peeled

Safety profile of the intravitreal streptokinase-plasmin complex as an adjunct to vitrectomy in the rabbit

BACKGROUND

The generation of an atraumatic posterior vitreous detachment (PVD), a common goal in vitreoretinal surgery, is a challenge, particularly in children and young trauma patients. Plasmin has been proposed as an adjunct to vitrectomy to enzymatically generate a PVD. Low doses of streptokinase-activated plasmin were tested in human pilot studies. This dose-escalation study assesses the safety range of intravitreal human streptokinase-plasmin in rabbits.

METHODS

Plasminogen was isolated from human plasma by affinity chromatography, followed by activation with streptokinase (1:1), to generate the streptokinase-plasmin complex. Enzyme doses from 0.1-7 activity units (AU, in 0.1 ml) were injected into the mid-vitreous of 35 eyes; six control eyes were injected with balanced salt solution (BSS, 0.1 ml). Thirty minutes after injection, a two-port vitrectomy was performed. Fundus and slit lamp examinations were performed on days 1 and 7. On days 2 and 7, bright flash electroretinography was performed and compared with preoperative recordings. Some animals receiving higher doses of streptokinase-plasmin (1-7 AU) were followed clinically and with electroretinography for up to 9 months.

RESULTS

A mild-to-moderate inflammatory response was seen in both control and plasmin-treated eyes on day 1, but had disappeared completely by day 7 in most eyes. In the 7 AU group, inflammation was stronger and more protracted. Two of three eyes from this group developed wrinkling of the medullary rays; one of them showed discoloration and traction at the medullary rays in the late follow-up. Electroretinograms (ERGs) of vitrectomized control eyes showed the following changes from preoperative values: 48 h, a-wave -11.10% [no significant (n.s.)], b-wave -14.62% (P=0.046); 7 days, a-wave +9.18% (n.s.), b wave +11.69% (n.s.). For the enzyme-treated eyes: 48 h: a-wave -20.43% (P<0.001), b-wave -9.57% (p<0.001); 7 days: a wave -14.21% (P<0.001), b-wave +2.48% (P<0.001). There was no evidence of dose-dependent ERG changes in enzyme-treated eyes at doses up to 5 AU. Groups of up to 3 AU were investigated by light and transmission electron microscopy, without evidence of toxicity.

CONCLUSION

Streptokinase-plasmin doses up to 3 AU were found to be safe when injected into rabbit eyes followed by vitrectomy.

Indocyanine green mediated photothrombosis for the management of predominantly classic choroidal neovascularisation caused by age related macular degeneration

AIMS

To study the effectiveness of indocyanine green mediated photothrombosis in the management of predominantly classic subfoveal choroidal neovascularisation associated with age related macular degeneration.

METHODS

Prospective, non-comparative, interventional case series of nine patients with predominantly classic subfoveal choroidal neovascularisation secondary to age related macular degeneration who declined photocoagulation or verteporfin photodynamic therapy. Patients were submitted to one or more treatments with an intravenous injection of a small volume of high concentration indocyanine green solution followed by low irradiance, large spot 810 nm continuous laser application via a transpupillary approach. Main outcome measures were change in best corrected visual acuity and macular exudative manifestations.

RESULTS

After 12 months of follow up, the final best corrected visual acuity was the same (plus or minus two ETDRS lines) in five eyes (55%), improved more than two ETDRS lines in three eyes (33%), and worsened by more than two lines in the remaining eye. The improved vision was probably related to partial or complete restoration of the macular architecture as a result of fluid resolution, whereas the worsened vision was primarily the result of treatment failure in achieving substantial choroidal neovascular occlusion. There were no complications related to the procedure.

CONCLUSION

Indocyanine green mediated photothrombosis may be an effective alternative treatment for predominantly classic subfoveal choroidal neovascularisation caused by age related macular degeneration.

Different cardiac response to copper in limpets from metal polluted and clean shores of Hong Kong

The gastropod limpet, Cellana grata, is common on moderately exposed to exposed Hong Kong rocky shores. On the basis of the existing literature on trace metal contamination in Hong Kong, four sites were identified, representative of highly polluted (Aberdeen and Lei Yue Mun) and clean (Cape d'Aguilar and Clear Water Bay) conditions. Limpets from the two polluted sites showed similar, but significantly higher body concentrations of copper than limpets from the two clean sites, which were also similar. Non-invasive measurements of cardiac activity of limpets from the four sites showed between site differences in baseline heart rates under standard seawater, irrespective of pollution level. When acutely exposed to water borne copper (2 h, 0.5+/-0.06 SD ppm), however, limpets from clean sites showed a significantly higher increase in inter-beating time (bradycardia) than those from polluted sites. These results highlight the potential use of cardiac activity to assess the exposure of natural populations of limpets to trace metal pollution.

Visual adaptations in a diurnal rodent, Octodon degus

The degu (Octodon degus) is a diurnal rodent, native to Chile. Basic features of vision and visual organization in this species were examined in a series of anatomical, electrophysiological and behavioral experiments. The lens of the degu eye selectively absorbs short-wavelength light and shows a progressive increase in optical density as a function of age. Electroretinograms recorded using a flicker-photometric procedure reveal three spectral mechanisms: a rod with peak sensitivity of about 500 nm and two types of cone having respective spectral peaks of about 362 nm and 507 nm. Opsin antibody labeling was used to determine the retinal distributions of the three receptor types. A total of about one-third of the approximately 9 million photoreceptors of the degu retina are cones with the two types (507 nm/362 nm) represented in a ratio of about 13:1. The contributions to vision of all three receptor types were examined in a series of behavioral experiments. A consistent feature of both the electrophysiological and behavioral results is that relatively high levels of light adaptation are required to effect the full transition from rod-based to cone-based vision. In behavioral tests degus were shown to be able to make color discriminations between ultraviolet and visible lights.

Constrained global optimization for estimating molecular structure from atomic distances

Finding optimal three-dimensional molecular configurations based on a limited amount of experimental and/or theoretical data requires efficient nonlinear optimization algorithms. Optimization methods must be able to find atomic configurations that are close to the absolute, or global, minimum error and also satisfy known physical constraints such as minimum separation distances between atoms (based on van der Waals interactions). The most difficult obstacles in these types of problems are that 1) using a limited amount of input data leads to many possible local optima and 2) introducing physical constraints, such as minimum separation distances, helps to limit the search space but often makes convergence to a global minimum more difficult. We introduce a constrained global optimization algorithm that is robust and efficient in yielding near-optimal three-dimensional configurations that are guaranteed to satisfy known separation constraints. The algorithm uses an atom-based approach that reduces the dimensionality and allows for tractable enforcement of constraints while maintaining good global convergence properties. We evaluate the new optimization algorithm using synthetic data from the yeast phenylalanine tRNA and several proteins, all with known crystal structure taken from the Protein Data Bank. We compare the results to commonly applied optimization methods, such as distance geometry, simulated annealing, continuation, and smoothing. We show that compared to other optimization approaches, our algorithm is able combine sparse input data with physical constraints in an efficient manner to yield structures with lower root mean squared deviation.

Incidence of retinal detachment and visual outcome in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage

PURPOSE

To determine visual outcomes and the incidence of retinal detachment in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage.

DESIGN

Retrospective consecutive noncomparative interventional case series.

PARTICIPANTS

Thirty-six eyes (15 right eyes and 21 left eyes) of 34 patients (18 female and 16 male) ranging in age from 42 to 94 years. Mean follow-up was 14 months.

METHODS

A comparison of the best-corrected initial visual acuities versus final visual acuities after spontaneous resolution of vitreous hemorrhage or surgical intervention. The number of eyes that were found to have retinal tears or that had a rhegmatogenous retinal detachment develop was documented. Logarithm of the minimum angle of resolution-converted visual acuities was used for comparison. Categorical data were analyzed by Fisher's exact test, and population means were compared by Student's t test.

MAIN OUTCOME MEASURES

Final mean visual acuities, number of eyes with at least one retinal tear, location of retinal tears, number of eyes that had retinal detachment develop, and the number of eyes repaired with scleral buckling surgery and/or pars plana vitrectomy.

RESULTS

Twenty-four of 36 eyes (67%) were found to have at least one retinal break (range, 0-4 breaks), with 88% of breaks located in the superior retina. Eleven eyes (31%) had more than one retinal break. Fourteen of 36 eyes (39%) had a rhegmatogenous retinal detachment develop that was repaired with pars plana vitrectomy and scleral buckling. An additional 14 eyes (39%) underwent vitrectomy for nonclearing vitreous hemorrhage. The incidence of retinal detachment in eyes with a history of retinal detachment in the contralateral eye was 75% (P = 0.04). Seven of 14 eyes (50%) with retinal detachment had coexisting proliferative vitreoretinopathy. Most retinal breaks and detachments occurred in emmetropic or myopic eyes. For all 36 eyes the mean preoperative visual acuity was 20/1233, and the mean final visual acuity was 20/62 (P < 0.0001). Eyes that had a macula-off retinal detachment develop had worse final visual outcomes (20/264; P = 0.01), as did eyes that had proliferative vitreoretinopathy develop (20/129; P = 0.04).

CONCLUSIONS

Acute, spontaneous, nontraumatic posterior vitreous separation with dense fundus-obscuring vitreous hemorrhage is associated with a high incidence of retinal tears and detachment. Close follow-up with clinical examination and ultrasonography is necessary, because many of these eyes may eventually require surgical intervention. Aggressive management with early vitrectomy should be considered when there is a history of retinal detachment in the contralateral eye.

Presumed acquired ocular toxoplasmosis in deer hunters

PURPOSE

To describe acquired ocular toxoplasmosis in deer hunters.

METHODS AND RESULTS

The authors describe five young men presenting with flu-like symptoms followed by visual loss due to a unilateral, focal necrotizing retinitis. All five men gave a history of ingesting undercooked or uncooked venison. All five had elevated toxoplasma serology, and all five improved clinically with an antitoxoplasma regimen.

CONCLUSION

In previously healthy young men, flu-like symptoms associated with visual loss and retinitis should prompt questioning about hunting and raw game meat ingestion, especially when toxoplasmosis is suspected.

Autologous plasmin enzyme in the surgical management of diabetic retinopathy

PURPOSE

This is a pilot study to assess the use of autologous plasmin enzyme (APE) as an adjunct to vitreous surgery in eyes with advanced diabetic retinopathy.

DESIGN

Prospective noncomparative interventional case series.

PARTICIPANTS

Seven patients with advanced diabetic retinopathy selected at random from our practice population.

METHODS

Seven eyes were treated with APE as an adjunct to standard vitreous surgery. Six eyes had macular tractional retinal detachments, and one eye had refractory macular edema. Three fellow eyes had standard vitreous surgery performed for macular tractional retinal detachments without APE. All 10 eyes had macular edema and background diabetic retinopathy.

MAIN OUTCOME MEASURES

The main outcome measures included induction of a posterior vitreous detachment, retinal reattachment, improvement in visual acuity, and resolution of macular edema.

RESULTS

All seven APE-treated eyes achieved spontaneous or easy removal of the posterior hyaloid including one eye that had vitreoschisis over areas of detached retina. All eyes treated with APE had resolution of intraretinal edema. Retinas of all eyes treated with APE were reattached. The three fellow eyes were treated by vitreous surgery without APE. Two of the three fellow eyes had reattached retinas, but none had resolution of intraretinal edema without further focal photocoagulation treatment. Mean visual acuity improvement was 0.7 logarithm of the minimum angle of resolution (LogMAR) units in APE-treated eyes and 0.1 LogMAR units in eyes without APE. The average follow-up period was 14 months.

CONCLUSIONS

This pilot study suggests that APE may be beneficial in the surgical management of diabetic retinopathy.

Adult retinopathy of prematurity: outcomes of rhegmatogenous retinal detachments and retinal tears

PURPOSE

To describe the results of retinal tears and rhegmatogenous retinal detachments (RD) in adults with retinopathy of prematurity (ROP).

DESIGN

Noncomparitive interventional case series.

METHODS

Retrospective cohort of 216 eyes of 108 patients, 15 years or older, followed for up to 23 years (median, 6.2 years).

RESULTS

One eye was initially seen with an RD, and during follow-up 30 eyes had an RD develop. An additional surgical procedure was required in 7 of the 31 eyes (23%) with an RD. Four eyes were initially seen with retinal tears, and during follow-up 19 eyes had a retinal tear develop. Seven of the 23 eyes (30%) with a retinal tear had initial repair fail. Eyes with minimal cicatricial changes from ROP were still at high risk for tears and detachments developing. Eighty percent of eyes with retinal tears and 60% of eyes with an RD that started with vision >20/60 maintained that level of vision at the final examination.

CONCLUSION

In patients with a history of premature birth, features of fundus examinations do not correlate with the occurrence of a retinal tear or RD. Repair of a tear or detachment in such a patient is more likely to require multiple procedures but can still be associated with good visual results. Physicians should consider widespread relief of vitreoretinal traction for a tear or detachment in any patient with a history of premature birth.

Sympathetic ophthalmia associated with pars plana vitrectomy without antecedent penetrating trauma

PURPOSE

To evaluate, describe, and categorize the clinical presentation, clinical course, histopathology, and response to therapy in patients without a history of penetrating ocular trauma who developed sympathetic ophthalmia following pars plana vitrectomy.

METHODS

The records of patients without a history of trauma who underwent pars plana vitrectomy and developed sympathetic ophthalmia were retrospectively reviewed. Cases were analyzed with respect to clinical presentation, fluorescein angiographic findings, anatomic and visual outcomes, histopathology, and response to therapy.

RESULTS

Eight eyes were identified. The median age at presentation was 55 years, with a range of 14 to 62 years. The time from vitrectomy to diagnosis of sympathetic ophthalmia ranged from 2 months to greater than 2 years, with a median of 7 months. Six of eight patients (75%) presented with anterior chamber reaction. All eight patients presented with a vitreous inflammatory response. The optic nerve was inflamed clinically or angiographically in four of eight cases (50%). Small yellow-white sub-retinal pigment epithelial deposits were present in four of eight cases (50%). Two eyes had lesions characterized as multifocal choroiditis. One eye had larger yellow placoid-like lesions. One eye presented with vitritis but no retinal lesions. Subretinal choroidal neovascularization was noted in the inciting eye of one patient. Vision improved in the sympathizing eye with immunosuppressive therapy in five of eight cases (62.5%).

CONCLUSIONS

Sympathetic ophthalmia can be seen following pars plana vitrectomy in patients without penetrating injuries or a history of trauma. Indeed, it may be seen after successful vitrectomy for retinal detachment. Diverse clinical presentations are possible, and persistent or atypical uveitis following vitrectomy should alert the surgeon to the development of sympathetic ophthalmia.

Catalase-like oxygen production by horseradish peroxidase must predominantly be an enzyme-catalyzed reaction

When hydrogen peroxide (H2O2) was provided as the only substrate for horseradish peroxidase C (HRP-C) the catalase-like emission of oxygen gas was observed. The reaction was favored at neutral compared to acidic pH. Addition of the superoxide radical scavengers tetranitromethane (TNM) or superoxide dismutase (SOD) increased activity. TNM's effect was concentration dependent but SOD's was not, indicating that only some of the superoxide generated was released into solution. Manganous ions (Mn2+) react with superoxide radicals to regenerate H2O2 but not oxygen; when added to the reaction medium oxygen production was reduced but not abolished. The effect was essentially concentration independent, suggesting that most oxygen was produced enzymatically and not by chemical disproportionation of superoxide. The catalase-like activities of some site-directed mutants of HRP-C suggest that active site residues histidine 42 and arginine 38 are influential in determining this activity. A clear correlation also existed between catalase activity and the enzymes' resistance to inactivation by H2O2. Computer simulation of a reaction scheme that included catalase-like activity agreed well with experimental data.

Cone-based vision of rats for ultraviolet and visible lights

Rats (Rattus norvegicus) have two classes of cone, one containing an ultraviolet (UV)-sensitive photopigment and the other housing a pigment maximally sensitive in the middle (M) wavelengths of the visible spectrum. The manner in which signals from these two cone types contribute to rat vision was investigated through recordings of a gross electrical potential (the electroretinogram, ERG) and behavioral discrimination tests. Spectral sensitivity functions obtained from both types of measurement indicate clear contributions from each of the cone classes, but there is a marked enhancement of the relative sensitivity to UV light in the behavioral index; for instance, under some photopic test conditions, rats are approximately equally sensitive to middle-wavelength and UV lights. In adaptation tests, thresholds for UV and M lights were found to be differentially elevated in the presence of chromatic adapting backgrounds, thus providing the possibility that signals from the two cones could be used by the rat visual system to support color discriminations. Evidence of dichromatic color vision in the rat was subsequently obtained from tests of wavelength discrimination.

Surgical management of macular holes: a report by the American Academy of Ophthalmology

OBJECTIVE

The document describes macular hole surgery and examines the available evidence to address questions about the efficacy of the procedure for different stages of macular hole, complications during and after surgery, and modifications to the technique.

METHODS

A literature search conducted for the years 1968 to 2000 retrieved over 400 citations that matched the search criteria. This information was reviewed by panel members and a methodologist, and it was evaluated for the quality of the evidence presented.

RESULTS

There are three multicenter, controlled, randomized trials that constitute Level I evidence and compare the value of surgery versus observation for macular hole. There are three multicenter, controlled, randomized trials studying the use of adjuvant therapy in macular hole repair. Postoperative vision of 20/40 or better has been reported in 22% to 49% of patients in randomized trials. The risks of surgical complications include retinal detachment (3%), endophthalmitis (<1%), cataract (>75%), and late reopening the hole (2% to 10%).

CONCLUSIONS

The evidence does not support surgery for patients with stage 1 holes. Level I evidence supports surgery for stage 2 holes to prevent progression to later stages of the disease and further visual loss. Level I evidence shows that surgery improves the vision in a majority of patients with stage 3 and stage 4 holes. There is no strong evidence that adjuvant therapy used at the time of surgery results in improved surgical outcomes. Patient inconvenience, patient preference, and quality of life issues have not been studied.

Using meta computing tools to facilitate large-scale analyses of biological databases

Given the high rate at which biological data are being collected and made public, it is essential that computational tools be developed that are capable of efficiently accessing and analyzing these data. High-performance distributed computing resources can play a key role in enabling large-scale analyses of biological databases. We use a distributed computing environment, Legion, to enable large-scale computations on the Protein Data Bank (PDB). In particular, we employ the Feature program to scan all protein structures in the PDB in search for unrecognized potential cation binding sites. We evaluate the efficiency of Legion's parallel execution capabilities and analyze the initial biological implications that result from having a site annotation scan of the entire PDB. We discuss four interesting proteins with unannotated, high-scoring candidate cation binding sites.

Spectrum of luminescence from laser-created bubbles in water

The spectrum of the luminescence emitted at the collapse of single laser-induced bubbles in water is measured for different maximum bubble radii. Bubbles as large as 2 mm show a molecular OH(*) band at 310 nm in the spectrum, which otherwise can be fitted approximately with a blackbody curve at a temperature of 7800 K. This finding provides a connection between the light emission of single bubbles and multibubble sonoluminescence, since in the latter case the same molecular band is observed. Surface instabilities are observed in the larger bubbles, and may be connected with the OH(*) emission.

Drug approval summaries: arsenic trioxide, tamoxifen citrate, anastrazole, paclitaxel, bexarotene

This report summarizes information on drugs recently approved by the Food and Drug Administration, Office of Drug Evaluation I, Division of Oncology Drug Products. Five applications supporting new claims will be discussed: Trisenox (arsenic trioxide) for induction of remission and consolidation in patients with acute promyelocytic leukemia who are refractory to, or have relapsed from, retinoid and anthracycline chemotherapy, and whose disease is characterized by the presence of the t(15;17) translocation or PML/RAR-alpha gene expression; Nolvadex (tamoxifen citrate) in women with ductal carcinoma in situ, following breast surgery and radiation, to reduce the risk of invasive breast cancer; Arimidex (anastrazole) for first-line treatment of postmenopausal women with hormone receptor positive or hormone receptor unknown locally advanced or metastatic breast cancer; Taxol (paclitaxel), 175 mg/m(2) by 3 h infusion in combination with cisplatin for first-line treatment of advanced ovarian cancer; and Targretin gel (bexarotene) for the topical treatment of cutaneous lesions in patients with stage IA and IB cutaneous T-cell lymphoma who have not tolerated other therapies or who have refractory or persistent disease. Information provided includes rationale for drug development, study design, efficacy and safety results, and pertinent literature references.

Quenched Kosterlitz-Thouless superfluid transitions

Rapidly quenched Kosterlitz-Thouless (KT) superfluid transitions are studied by solving the Fokker-Planck equation for the vortex-pair dynamics in conjunction with the KT recursion relations. Power-law decays of the vortex density at long times are found, and the results are in agreement with a scaling proposal made by Minnhagen and co-workers for the dynamical critical exponent. The superfluid density is strongly depressed after a quench, with the subsequent recovery being logarithmically slow for starting temperatures near T(KT). No evidence is found of vortices being "created" in a rapid quench; there is only decay of the existing thermal vortex pairs.

Soccer ball-related retinal injuries: a report of 13 cases

PURPOSE

To describe the clinical characteristics and management of retinal injuries caused by soccer ball impact as well as the mechanism of injury, prognostic features, risk factors, and possible prevention strategies.

METHODS

Thirteen cases of soccer ball injuries from retina referral practices were retrospectively reviewed, with attention to the mechanism of associated ocular complications and the anatomic and visual outcomes.

RESULTS

Soccer ball injuries occurred in both male and female patients (9 male, 4 female) with ages ranging from 8 to 21 years (median 14 years). These patients were observed from 0 to 64 months (median follow-up, 8 months). Four patients had traumatic macular holes, two eyes had retinal detachment associated with retinal dialysis, two had retinal tears associated with hemorrhage, one had a choroidal rupture, and one had only vitreous hemorrhage and Berlin's edema. Although six eyes had some degree of traumatic retinal pigment epitheliopathy, it was the primary diagnosis in only three. Visual acuity at presentation ranged from 20/20 to count fingers, with 7/13 (54%) having 20/200 or worse vision. Seven eyes underwent surgical procedures; the remainder were observed. Final visions ranged from 20/20 to count fingers, with 3/13 (23%) having 20/200 or worse vision. Six eyes (46%) improved by two or more lines by the last follow-up.

CONCLUSION

Soccer ball-related ocular injuries disproportionately affect young players, are more frequent in females than previously reported, and have more severe visual consequences than previously recognized. Injury prevention strategies to minimize contact between the eye and the soccer ball may reduce the incidence and severity of eye injuries.

External versus internal approach to the removal of metallic intraocular foreign bodies

OBJECTIVE

To review the management of metallic intraocular foreign bodies (IOFB) at a single institution and to compare the use of internal and external approaches for their removal.

SUBJECTS AND METHODS

A retrospective review was conducted on 70 eyes from 70 patients who underwent surgical removal of a metallic IOFB with either an internal (vitrectomy followed by forceps or internal magnet use) or external approach (large electromagnet) by seven vitreoretinal surgeons at a single institution between 1973 and 1996. Visual acuity and complications occurring with the two approaches were the main outcome measures studied.

RESULTS

Overall, patients showed significant improvement in visual acuity following surgical intervention (P < 0.001) despite widely varying surgical techniques. When the authors compared patients treated with an external versus an internal approach they found no statistically significant difference with regard to visual outcome and a trend toward a higher rate of postoperative endophthalmitis in the external approach group.

CONCLUSION

Surgical removal of metallic IOFB results in significant visual improvement. The external approach to the removal of magnetic metallic IOFB remains a viable treatment option in select cases.

Clinical course and surgical treatment of macular epiretinal membranes in young subjects

OBJECTIVE

To examine the surgical and nonsurgical visual outcomes of young subjects with idiopathic macular epiretinal membranes (ERMs).

DESIGN

Retrospective observational and noncomparative interventional case series.

PARTICIPANTS

Nineteen consecutive subjects (20 eyes) aged 40 years or less with an idiopathic macular ERM.

METHODS

Group 1: 10 consecutive eyes were initially seen with visual acuity of 20/50 or better; 7 eyes were observed, and 3 eyes with progressive visual loss to <20/50 underwent vitrectomy and membrane peeling. Group 2: 10 consecutive eyes with presenting visual acuity of 20/60 or worse underwent vitrectomy and membrane peeling.

MAIN OUTCOME MEASURES

Visual acuity, cataract formation, ERM recurrence, operative complications.

RESULTS

Group 1: With no surgery, visual acuity remained stable or improved in 5 of 10 eyes (50%), with a mean follow-up of 3.7 years. Three of 10 eyes (30%) had visual loss < or =20/60 develop and underwent vitrectomy. Postoperative visual acuity improved an average of 6 lines with a mean follow-up of 17.6 months. Group 2: After vitrectomy, visual acuity improved 2 or more lines in 7 of 10 eyes (70%), with a mean improvement of 4.4 lines and mean follow-up of 29.2 months. Groups 1 and 2: Three of 13 eyes (23%) that underwent vitrectomy had recurrent ERM formation.

CONCLUSIONS

Young subjects with idiopathic macular ERMs and a presenting visual acuity of 20/50 or better had a favorable visual outcome with observation. Subjects with an initial vision of 20/60 or worse, or those who had a visual decrease to < or =20/60 had significantly improved visual acuity after vitrectomy. ERM recurrence is relatively high after surgery.

A comparison of visual results and complications in eyes with posterior chamber intraocular lens dislocation treated with pars plana vitrectomy and lens repositioning or lens exchange

PURPOSE

To compare the visual results and the postoperative complications in eyes with posterior chamber intraocular lens (PCIOL) dislocation that underwent pars plana vitrectomy with lens repositioning with eyes that underwent pars plana vitrectomy with lens exchange.

DESIGN

Nonrandomized consecutive comparative case series.

PARTICIPANTS

Fifty-nine eyes (27 right eyes and 32 left eyes) of 56 subjects (28 women and 28 men) ranging in age from 59 to 90 years. Mean follow-up was 34 months.

METHODS

A comparison of the best-corrected preoperative visual acuities, final visual acuities, and postoperative complications in subjects with dislocated PCIOLs that underwent pars plana vitrectomy. Logarithm of the minimum angle of resolution (LogMAR)-converted visual acuities were used for comparison. Categorical data were analyzed by Fisher's exact test, and population means were compared by a pooled Student's t test.

MAIN OUTCOME MEASURES

Final mean visual acuities, change in mean visual acuities, and postoperative complications.

RESULTS

For all 59 eyes the mean preoperative visual acuity was 20/152, and the mean final visual acuity was 20/48. Final visual results were similar between the eyes that underwent lens repositioning (20/55) and the eyes that underwent lens exchange (20/43; P = 0.19). Final visual results were also similar between the eyes that underwent lens exchange with sutured PCIOL placement (20/51) and the eyes that underwent lens exchange with anterior chamber intraocular lens (ACIOL) placement (20/38; P = 0.26). Final mean visual acuity in eyes that received an ACIOL (20/38) was better than in eyes that underwent repositioning of the dislocated lens into the ciliary sulcus (20/65; P = 0.01). The mean increase in visual acuities was greater for eyes with ACIOL placement compared with eyes with sutured PCIOL placement (P = 0.01). For all eyes, final visual results were unaffected by a concurrent diagnosis of age-related macular degeneration (20/52; P: = 0.71), glaucoma (20/48; P = 0.95), or postoperative cystoid macular edema (20/55; P = 0.45). Final visual acuities were significantly worse in eyes with a detectable preoperative afferent pupillary defect (20/200; P<0.0001). Postoperative retinal detachments developed in 4 of 29 eyes (14%) that underwent lens repositioning and in 2 of 30 eyes (7%) that had lens exchange (P = 0.42). Postoperative lens subluxations occurred in 6 of 29 eyes (21%) that underwent lens repositioning and in 1 of 30 eyes (3%) that underwent lens exchange (P = 0.05).

CONCLUSIONS

The final visual results in eyes with dislocated PCIOLs that underwent pars plana vitrectomy with lens repositioning were similar to the visual results obtained in eyes that underwent pars plana vitrectomy with lens exchange. For eyes that underwent lens exchange, final visual results in eyes that received an ACIOL were similar to the visual results obtained in eyes that received a PCIOL; however, eyes with an ACIOL showed a greater increase in mean visual acuity. Eyes with a preoperative afferent pupillary defect had worse final visual results.

Surgical repair of full-thickness idiopathic macular holes associated with significant macular drusen

OBJECTIVE

To evaluate the visual and anatomic results of surgically repaired macular holes in eyes with intermediate or large-sized macular drusen.

DESIGN

Retrospective noncomparative case series.

PARTICIPANTS

Thirty-four eyes of 32 patients undergoing macular hole surgery with preoperative intermediate or large-sized macular drusen as defined by the Age-Related Eye Disease Study (AREDS).

INTERVENTION

Pars plana vitrectomy for standard macular hole repair performed by multiple surgeons.

MAIN OUTCOME MEASURES

Visual acuity, anatomic hole closure.

RESULTS

Initial hole closure failed in 8 eyes (24%) overall, 5 of 28 eyes (18%) with AREDS category 2 drusen and 3 of 6 eyes (50%) with category 3 drusen (P = 0.1263). Final macular hole closure was seen in 93% of category 2 and 67% of category 3 eyes (P = 0.1347). Mean final visual acuity was 20/60 overall, 20/60 for category 2, and 20/50 for category 3 eyes.

CONCLUSIONS

A trend of reduced initial macular hole closure was seen in eyes with significant macular drusen. Reoperation improved closure rates. If closure was accomplished, visual outcomes were excellent.

Evidence for a role of HLA DRB1 alleles in the control of IgE levels, strengthened by interacting TCR A/D marker alleles

BACKGROUND

MHC class II alleles at human chromosome 6p21.1 and alleles in the TCR A/D locus at human chromosome 14q11.2 have been implicated in susceptibility to specific allergies and the modulation of total serum IgE. It has also been hypothesized that HLA and TCR allelic interactions may have a strong influence on predisposition to allergic disease.

OBJECTIVE

This study was performed to investigate the influence of HLA-DRB and DQB1 alleles and D14S50 alleles (adjacent to TCR A/D locus on 14q11.2), individually and in-combination, on total serum IgE levels, and on the development of specific allergies.

METHODS

We performed an association study between HLA-DRB, HLA-DQB1 polymorphisms, D14S50 alleles, total serum IgE expression and specific allergies to house dust mite, grass pollens and cat fur. A sample of 181 individuals was drawn from a larger set of 2415 adults, sampled at random from a district in Nottingham.

RESULTS

Strong association was observed between HLA-DRB1*0701 allele and high total serum IgE expression (P < 0.001). D14S50 alleles alone showed no evidence for independent association. However, there was a significant interaction between DRB1*0701 and D14S50 allele 170 such that, when both were present, there was a further increase in total serum IgE levels.

CONCLUSION

This study suggests that DRB1*0701 allele is involved in the modulation of total serum IgE, and that there is an interaction between DRB1*0701 and a marker adjacent to TCR A/D in the control of IgE expression.

A new approach to stage 3 macular holes

PURPOSE

The purpose of this article is to demonstrate the feasibility of a surgical approach that might be possible in an office setting for idiopathic stage 3 macular holes. The posterior hyaloid of the vitreous and perihole tissue is enzymatically manipulated to create an atraumatic posterior vitreous separation and may stimulate cell proliferation to close macular holes.

DESIGN

Prospective noncomparative interventional case series.

PARTICIPANTS

Nine eyes of eight patients with idiopathic stage 3 macular holes were treated.

METHODS

The patients were treated with an injection of 0.4 IU of autologous plasmin enzyme into the midvitreous cavity and lavage of the vitreous cavity with an infusion light pipe and vitreous cutter followed by filling 70% to 80% of the vitreous cavity with 14% C3F8 and head-down positioning.

MAIN OUTCOME MEASURES

Posterior vitreous detachment, macular hole closure, and vision improvement.

RESULTS

Eight of nine eyes showed a spontaneous posterior vitreous detachment. One eye required minimal suction of less than 50 mmHg to elevate the posterior hyaloid off the retinal surface. Eyes were followed for a minimum of 6 months. All holes closed, and there was an average visual acuity improvement of four lines. The average surgical time for this procedure was 20 minutes.

CONCLUSIONS

Autologous plasmin enzyme-assisted vitreous surgery techniques can reduce operative time, expense, and patient inconvenience while maintaining excellent surgical results, which may allow office-based vitreous surgery for idiopathic stage 3 macular holes.

Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid

PURPOSE

To evaluate the role of vitrectomy in eyes with diffuse diabetic macular edema associated with a taut posterior hyaloid.

METHODS

Records of 55 eyes of 50 patients with diabetic retinopathy and diffuse clinically significant diabetic macular edema who underwent vitrectomy with stripping of the premacular posterior hyaloid were reviewed. In all 55 eyes, diffuse diabetic macular edema was present on contact lens examination and confirmed with fluorescein angiography. On fundus examination, the premacular posterior hyaloid was attached and appeared taut.

RESULTS

The mean preoperative best-corrected visual acuity was 20/160, and the mean final best-corrected visual acuity was 20/80 (P <.0001, Wilcoxon signed rank test), with 27 (49.1%) of the 55 eyes demonstrating improvement in best-corrected visual acuity of 2 or more lines. Fifty-two (94.5%) of the 55 vitrectomized eyes showed improvement in clinically significant macular edema and in 45 eyes (81.8%) the macular edema resolved completely during a mean period of 4.5 months (range, 1 to 13 months). Eyes with macular ischemia and preoperative best-corrected visual acuity of 20/200 or less tended to respond less favorably to vitrectomy than eyes lacking these characteristics. All eyes had at least 6 months of follow-up after surgery, with a mean follow-up of 23.2 months.

CONCLUSION

In eyes with persistent diffuse diabetic macular edema with a taut premacular posterior hyaloid face unresponsive to laser therapy, vitrectomy with removal of the posterior hyaloid appears to be beneficial in some cases. Careful selection of eyes with favorable preoperative clinical characteristics may improve surgical outcomes.

Nonsurgical management of macular hemorrhage secondary to retinal artery macroaneurysms

OBJECTIVE

To report visual acuity outcomes of nonsurgical management of macular hemorrhage secondary to retinal artery macroaneurysms.

METHODS

Forty-one patients at multiple centers with macular hemorrhage secondary to retinal artery macroaneurysms managed with observation alone were reviewed. Time to clearance of macular hemorrhage, visual acuity at final follow-up, and presence or absence of macular pigmentary changes after absorption of the hemorrhage were recorded for each patient.

RESULTS

On initial examination, visual acuity was 20/200 or worse in all except 4 patients (3 with 20/70, 1 with 20/80). At an average follow-up of 15. 7 months, a final visual acuity of 20/40 or better was achieved in 15 eyes (37%), between 20/50 and 20/100 in 12 (29%), and 20/200 or worse in 14 (34%). Macular pigmentary abnormalities were noted after clearance of the hemorrhage in 23 (56%) of 41 cases, and these eyes generally had worse visual acuity outcomes.

CONCLUSIONS

In eyes with macular hemorrhage secondary to retinal artery macroaneurysms managed with observation alone, good visual acuity outcomes can often be achieved. Poorer visual acuity outcomes are associated with macular pigmentary changes after resorption of blood. Arch Ophthalmol. 2000;118:780-785

Effect of perifoveal tissue dissection in the management of acute idiopathic full-thickness macular holes

OBJECTIVE

To evaluate the efficacy of perifoveal tissue dissection (PTD) on patients undergoing pars plana vitrectomy for idiopathic macular holes of less than 1-year's duration.

METHODS

Pars plana core vitrectomy was performed on 107 eyes of 104 consecutive patients with acute idiopathic macular holes. One cohort had routine PTD. In the other cohort, no attempt was made to strip preretinal tissue. Follow-up was longer than 6 months (follow-up range, 6 to 36 months).

RESULTS

Overall, 95 (89%) of all macular holes were closed. Visual acuity improved 2 lines or more of the Snellen letter chart in 91 eyes (85%). A postoperative visual acuity of 20/50 or better was achieved in 79 eyes (74%). A transient increase in intraocular pressure (230 mm Hg) developed in 25 eyes (23.4%). In 6 eyes (5.6%) a retinal detachment developed. One eye had retinal pigment epithelial changes and 1 patient reported peripheral field loss. No statistically significant differences were noted between eyes having PTD and those without PTD for any outcome measure.

CONCLUSION

In this series, no beneficial or adverse effect could be demonstrated by performing PTD in eyes undergoing pars plana core vitrectomy for acute idiopathic macular holes.