To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears.
Zika virus (ZIKV) is an emerging flavivirus that causes congenital abnormalities and Guillain-Barré syndrome. ZIKV infection also results in severe eye disease characterized by optic neuritis, chorioretinal atrophy, and blindness in newborns and conjunctivitis and uveitis in adults. We evaluated ZIKV infection of the eye by using recently developed mouse models of pathogenesis. ZIKV-inoculated mice developed conjunctivitis, panuveitis, and infection of the cornea, iris, optic nerve, and ganglion and bipolar cells in the retina. This phenotype was independent of the entry receptors Axl or Mertk, given that Axl(-/-), Mertk(-/-), and Axl(-/-)Mertk(-/-) double knockout mice sustained levels of infection similar to those of control animals. We also detected abundant viral RNA in tears, suggesting that virus might be secreted from lacrimal glands or shed from the cornea. This model provides a foundation for studying ZIKV-induced ocular disease, defining mechanisms of viral persistence, and developing therapeutic approaches for viral infections of the eye.
- Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery
- Published over 5 years ago
Upper eyelid paralysis leads to lagophthalmos with the risk of exposure keratitis, corneal ulceration and blindness.
Skin tears experienced by older adults require special skills to promote healing. Home healthcare providers are in key positions to manage skin tears and prevent further skin trauma. Several guidelines, risk assessments, classifications, and products exist to manage high-risk patients. Frequent evaluation of the effectiveness of the treatment and prevention strategies in an overall skin care protocol for home care patients is critical to reduce skin tear incidence and promote prompt healing when skin tears are present.
BACKGROUNDS: We report successful outcomes of monocanalicularnasal intubation with Monoka tubes and endoscopic findings for Hasner valve area. This method is presented as a primary treatment modality in congenital nasolacrimal duct obstruction (CNLDO) with an enlarged lacrimal sac and chronic dacryocystitis. METHODS: In a prospective noncomparative consecutive case series, 23 eyes of 18 patients with CNLDO with an enlarged lacrimal sac and chronic dacryocystitis underwent endoscopic probing and monocanalicularnasal intubation under general anesthesia. Demographic information, including age, sex, duration of preoperative symptoms, operative endoscopic findings, timing of silicone tube removal, follow-up periods, complications, and outcomes, was analyzed. RESULTS: The study included 23 eyes of 18 patients. Mean (SD) age was 19.7 (12.2) months (range, 9-48 mo). Under nasal endoscopic view, the probe tip protruded through a balloon-like nasal mucosa around the Hasner valve. In all cases, tubes were removed in an office setting under topical anesthesia. Mean follow-up period was 24.6 (5.4) weeks. Complications, such as punctal slitting and corneal abrasion, were not observed. All patients showed successful results until the final follow-up. CONCLUSIONS: In cases of CNLDO with an enlarged lacrimal sac and chronic dacryocystitis, monocanalicular intubation is recommended rather than simple probing. Monoka tube intubation has the advantages of technical ease of insertion and tube removal. Moreover, the tubing does not threaten the unprobed part of the lacrimal drainage system. Endoscopic findings revealed that the probe tip protruded through a balloon-like nasal mucosa with pus around the Hasner valve.
Abstract Purpose: To evaluate the efficacy and safety of adjunctive mitomycin-c (MMC) during probing in adults with primary nasolacrimal duct (NLD) obstruction. Methods: This is a prospective, comparative, randomized interventional study. A total of 40 adult patients with unilateral epiphora caused by primary NLD obstruction were treated and evaluated. Lacrimal probing and irrigation with adjunctive MMC (1 mL of 0.2 mg/mL, once) in cases and only probing in controls were done. At the end of 3 months, subjective improvement in epiphora and patency on syringing were evaluated. Results: Complete subjective improvement in epiphora was found in 15% of cases as opposed to 0% in controls, at 3 months of follow-up. Moderate improvement was seen in 25% of cases as opposed to 5% of controls. Mild improvement was seen in 25% of cases as opposed to 35% in controls. The overall subjective improvement was seen in 65% of cases as opposed to 40% in controls. On syringing, NLD was patent in 30% of cases as opposed to 10% in controls at 3 months of follow-up, which was not significant. Conclusions: Use of intraoperative MMC improves the success of probing to some extent. Being a minimally invasive procedure, it can be tried in patients who refuse or are not systemically fit for undergoing dacryocystorhinostomy.
Characteristics of, prevalence of, and risk factors for corneal pigmentation (pigmentary keratopathy) in Pugs
- Journal of the American Veterinary Medical Association
- Published about 4 years ago
Objective-To determine the characteristics of, prevalence of, and risk factors for corneal pigmentation (CP) in Pugs. Design-Prospective cross-sectional study. Animals-295 Pugs > 16 weeks old. Procedures-Ophthalmic examination of the anterior segment of each eye was performed, including determination of tear film characteristics (Schirmer tear test and tear film breakup time) and corneal sensitivity. Digital photographs of the head and each eye were obtained. Corneal pigmentation of eyes was graded as absent, very mild, mild, moderate, or severe. Signalment and medical history information and American Kennel Club registration status were recorded. Results-CP was detected in at least 1 eye of 243 of the 295 (82.4%) Pugs; CP was typically very mild or mild. Detection of CP was not significantly associated with coat color, age, eyelid conformation, or tear film characteristics but was significantly associated with sex of dogs. The severity of CP was not significantly associated with American Kennel Club registration status or age, but was significantly associated with sex, tear film characteristics, and coat color. Iris hypoplasia was detected in 72.1% of the Pugs. Iris-to-iris persistent pupillary membranes were detected in 85.3% of the Pugs. Conclusions and Clinical Relevance-Prevalence of CP in Pugs in this study was high. Unexpectedly high prevalences of iris hypoplasia and persistent pupillary membranes were also identified. The condition identified in these Pugs was a pigmentary keratopathy, rather than pigmentary keratitis or corneal melanosis. This condition may have a genetic basis, and further studies are warranted to determine etiology.
Abstract Prolapse of the lacrimal gland is an unusual condition. An appearance of bilateral dermatochalasis was observed in the medical examination of a 30-year-old female patient with bilateral upper eyelid edema.The patient underwent bilateral blepharopylasty. During the surgery, it was noticed that in the temporal portions of the eyelids, there was a prolabed tissue-like lacrimal gland. We did incisional biopsy from the prolabed tissue that was thought to be orbital lobe of the lacrimal gland and carried out reposition of the orbital rim with 5-0 polyester suture and closed the orbital septum. Lacrimal gland reposition is a procedure which entails the separation of such anatomic structures as orbital septum, adipose tissue, and levator complex. However, failure to recognize a prolapsed lacrimal gland may mistreat by simple excision, and will lead to important alterations in ocular lubrication. In our case, repositioning of the glands was successfully performed during upper-lid blepharoplasty.
ABSTRACT Aims: Cicatricial upper eyelid retraction with exposure keratopathy and impending corneal perforation requires prompt intervention. Standard procedures such as isolated levator recession, botulinum toxin, and lid weights will only induce a partial ptosis. Conventional tarsorrhaphy, though ideal to achieve complete closure, is likely to result in dehiscence in these cases. We describe a one-stage technique of levator and Muller’s muscle recession combined with a tarsorrhaphy used in four patients with an impending corneal perforation due to cicatricial lagophthalmos. Methods: This is an interventional, non-comparative retrospective case series of four patients who had undergone tarsorrhaphy in combination with levator recession. Results: In all four cases, it was not possible to mechanically close the eyelids preoperatively due to cicatricial lid retraction involving the middle lamella. The aetiology for lagophthalmos was varied: (Case 1) bilateral sclerosing metastatic breast cancer involving the lids; (Case 2) severe anterior and middle lamella shortening due to actinic changes; (Case 3) middle and posterior lamella shortening due to glaucoma treatment and multiple surgery (Case 4) due to traumatic facial scarring and seventh nerve palsy. In all cases, the corneal thinning and epithelial defects resolved completely following surgery. In one case, we were able to partially reopen the tarsorrhaphy for further corneal surgery. Discussion: We describe a safe, effective and reversible surgical procedure for managing cases with cicatricial upper eyelid retraction, which would otherwise lead to serious corneal complications.
- Contact lens & anterior eye : the journal of the British Contact Lens Association
- Published over 4 years ago
PURPOSE: To determine the type and distribution of ocular conditions cared for in a clinic dedicated to scleral devices and to report the clinical outcomes afforded by this approach. METHODS: Fifty-one charts of patients fitted unilaterally or bilaterally with a scleral device (Prosthetic Replacement of the Ocular Surface Ecosystem - PROSE) in a two year period were retrospectively reviewed. Patient demographics, ocular diagnoses, associated systemic conditions, best corrected visual acuity (BCVA) before and after fitting, Visual Function Questionnaire score (VFQ-25), and ocular surface disease index (OSDI) score were collected. RESULTS: All 51 patients were successfully wearing the PROSE device for a period of anywhere from weeks to years. The most common reasons for fitting were to relieve symptoms of moderate to severe dry eye syndrome (“DES”, n=25), management of refractive problems (“refractive”, n=23) with keratoconus being the most common (n=14), and to manage other anomalies (“other”, n=3). Best corrected visual acuity (logMAR) improved with the wearing of the PROSE device for both the DES (17 letters) and the refractive group (10 letters), but not the “other” group. No serious complications were recorded for any of the patients. CONCLUSIONS: The PROSE device is a useful option not only for the management of ocular surface disease and optical imperfections, but also for other ophthalmic conditions. Moderate to severe dry eye was the most common anomaly managed, followed by eyes with irregular corneal astigmatism. DES and refractive patients experienced improvement in visual acuity with wearing of the PROSE device.