bluuebunny/crossref_metadata_2025 huggingface dataset:
Operative Management of Distal Tibialis Anterior Tendinopathy
Authors: Grundy Julian R. B. , O'Sullivan Richard M. , Beischer Andrew D.
Published: March 2010

Background: The results of operative management for distal tibialis anterior tendinopathy (DTAT) without rupture have not previously been described in the literature. We present the results of 12 operative procedures. Materials and Methods: Of 40 patients diagnosed clinically and radiographically with DTAT, we reviewed 11 patients who underwent surgery for failure of nonoperative management. Assessment included pre and postoperative AOFAS midfoot scores, clinical examination and postoperative VAS pain scoring, at a mean followup of 29 months. Results: Ten women (ten feet) and one man (2 feet) underwent surgery. The mean age at surgery was 59 years. The mean duration of symptoms prior to surgery was 1 year. The mean preoperative AOFAS score was 52. Preoperative MRI showed tendinosis in two tendons and tendinosis with longitudinal split tears in ten tendons. Six of the twelve cases showed some associated degenerative changes of the midfoot. Six tendons were simply debrided and the insertion reinforced with a suture anchor. Six tendons were augmented with an extensor hallucis longus (EHL) transfer into the medial cuneiform. All patients improved postoperatively, with a mean improvement in AOFAS score of 33 and the mean postoperative pain VAS of 0.9 out of 10. Two patients underwent concomitant procedures on the same foot. Three of the six treated with EHL transfer have some symptomatic hallux interphalangeal joint extensor lag. In six cases the patient was completely satisfied. Three were satisfied with minor reservations. Of the three that were dissatisfied, two underwent subsequent surgery improving their symptoms. The third, though pain-free, was troubled by her toe-catching when walking barefoot. No patient regretted having had the surgery. Conclusion: Debridement and repair of DTAT, with EHL augmentation for greater than 50% tendon involvement, provided a high level of patient satisfaction after nonoperative management failed in this series.

Level of Evidence: IV, Retrospective Case Series
Rotational Scarf and Akin Osteotomy for Correction of Hallux Valgus Associated with Metatarsus Adductus
Authors: Larholt Jonathan , Kilmartin Timothy E.
Published: March 2010

Background: The presence of metatarsus adductus can complicate hallux valgus surgery. It reduces the gap between the first and second metatarsal and can restrict the transposition of the first metatarsal head. It also confounds the measurement of the first second intermetatarsal angle. Materials and Methods: Twenty-seven patients, (24 female, 38 feet), of average age 59 (SD 23) with symptomatic hallux valgus associated with metatarsus adductus underwent a rotation scarf with Akin osteotomy and were reviewed at an average of 59 (SD 23) months postop. Standard radiographic assessment of the hallux valgus was undertaken as well as measurement of the metatarsus adductus using the Kilmartin angle and the intermetatarsal angle of Engel. Results: The mean preoperative intermetatarsal and hallux valgus angles were 14 degrees (SD 4) and 35 degrees (SD 7.4) respectively. The mean postoperative intermetatarsal and hallux valgus angles were 3.9 degrees (S.D. 3.3) and 13.2 degrees (SD 9.4) ( p < 0.0001). The confounding effect of metatarsus adductus was evaluated using the Kilmartin angle and the intermetatarsal angle of Engel which significantly improved with surgery ( p < 0.0001). Conclusion: The rotation scarf & Akin osteotomy was an effective procedure for correcting hallux valgus associated with metatarsus adductus. It allowed good realignment of the first MTP joint without the need for lesser metatarsal surgery to reduce the metatarsus adductus.

Level of Evidence: IV, Retrospective Case Series
Displaced Isolated Cuboid Fractures: Results of Four Cases With Operative Treatment
Authors: Raaij Tom M. van , Duffy Paul J. , Buckley Richard E.
Published: March 2010

Level of Evidence: V, Expert Opinion
Magnetic Resonance Imaging Findings of Microgeodic Disease of the Toe: A Case Report
Authors: Onishi Yasuo , Hitora Toshiaki , Kawaguchi Yoji , Yamada Eiji , Akisue Toshihiro , Yamamoto Tetsuji
Published: March 2010

Level of Evidence: V, Expert Opinion
Dislocation of the Tibialis Posterior Tendon treated with Autogenous Bone Block: A Case Report
Authors: Lee Kang , Byun Woo Jin , Ha Jeong Ku , Lee Woo-Chun
Published: March 2010

Level of Evidence: V, Expert Opinion
The Last East German and the Memory of the German Democratic Republic
Authors: McAdams A. James
Published: March 2010

The author ponders over the identity of the last self-identifying East German and wonders what he or she will say before leaving memories of the region behind. He distinguishes among three possible candidates for this honor: the ordinary citizen with little aspiration to political or social notoriety; the enthusiast with an interest in perpetuating the old regime's values; and the dissident activist dedicated to transforming that order. After identifying the likely last East German, the author speculates about the message our protagonist will have to share with the leaders of unified Germany. Finally, he provides reasons for why the Federal Republic can benefit from this advice.
Obamamania and Anti-Americanism as Complementary Concepts in Contemporary German Discourse
Authors: Hatlapa Ruth , Markovits Andrei S.
Published: March 2010

There is no question that with Barack Obama the United States has a rock star as president who—behooving rock stars—is adored and admired the world over. His being awarded the Nobel Peace Prize nary a year after being elected president and barely ten months into his holding the office, testified to his global popularity rather than his actual accomplishments, which may well turn out to be unique and formidable. And it is equally evident that few—if any—American presidents were more reviled, disdained and distrusted all across the globe than George W. Bush, Obama's immediate predecessor. Indeed, the contrast between the hatred for the former and the admiration for the latter might lead to the impression that the negative attitudes towards America and Americans that was so prevalent during the Bush years have miraculously morphed into a lovefest towards the United States on the part of the global public. This paper—concentrating solely on the German case but representing a larger research project encompassing much of Western Europe—argues that love for Obama and disdain for America are not only perfectly compatible but that, in fact, the two are merely different empirical manifestations of a conceptually singular view of America. Far from being mutually exclusive, these two strains are highly congruent, indeed complementary and symbiotic with each other.
Post coitum triste est…? Sexual Politics and Cultures in Postunification Germany
Authors: Herzog Dagmar
Published: March 2010

This article analyzes the evolution of sexual politics and cultures in post-unification Germany, tracing these through three stages. First is the more immediate aftermath, in the early to mid 1990s, of ostalgische consternation over the loss of what Easterners understood to be the special qualities of GDR sexual culture, analyzing this consternation in the context of the—mutually conflicting—fantasies that Easterners and Westerners had about each other, replete with Easterners' ideas about how capitalism deforms interhuman interactions and Westerners' ideas about the deformations caused by totalitarian surveillance. A second stage runs from the mid 1990s through to the early twenty-first century, and includes both the convergence between East and West on the governmental policy level and the growing similarities identified in Easterners' and Westerners' sexual habits and mores. The third stage concerns the more recent past of the last five years and emphasizes the paradoxical coexistence of, on the one hand, strong commitment (on both the governmental and popular levels) to liberal values of individual sexual self-determination and toleration of diversity and a general sex-positive climate with, on the other, tremendous anxiety about the rise of European Islam (with its purportedly intrinsic hostility to both homosexuality and female sexual independence) and about the precipitous decline of the German birthrate. Attention is also paid to the newest policy directions with regard to adolescent sexuality and age of consent laws, abortion access, and disability rights.
The Social Integration of Germany since Unification
Authors: Silver Hilary
Published: March 2010

Germans are inordinately preoccupied with the question of national integration. From the Kulturkampf to the Weimar Republic to the separation of East and West, social fractiousness is deeply ingrained in German history, giving rise to a desire to unify the "incomplete nation." Yet, the impulse to integrate German society has long been ambivalent. Between Bismarck and the Nazi interregnum, top-down efforts to force Germans to integrate threatened to erase valued differences. The twentieth anniversary of German reunification is the occasion to assess the reality of and ambivalence towards social integration in contemporary Germany. A review of economic and social measures of East-West, immigrant, and Muslim integration provides many indications of progress. Nevertheless, social cleavages persist despite political integration. Indeed, in some aspects, including in the party system, fragmentation is greater now than it was two decades ago. Yet successful social integration is a two-way street, requiring newcomers and oldtimers to interact. Integration of the European Union to some extent has followed this German path, with subsidiarity ensuring a decentralized social model and limited cohesion. German ambivalence about social integration is a major reason for the continuing social fragmentation of the society.
Thioredoxin and Cancer: A Role for Thioredoxin in all States of Tumor Oxygenation
Authors: Karlenius Therese Christina , Tonissen Kathryn Fay
Published: March 2010

Thioredoxin is a small redox-regulating protein, which plays crucial roles in maintaining cellular redox homeostasis and cell survival and is highly expressed in many cancers. The tumor environment is usually under either oxidative or hypoxic stress and both stresses are known up-regulators of thioredoxin expression. These environments exist in tumors because their abnormal vascular networks result in an unstable oxygen delivery. Therefore, the oxygenation patterns in human tumors are complex, leading to hypoxia/re-oxygenation cycling. During carcinogenesis, tumor cells often become more resistant to hypoxia or oxidative stress-induced cell death and most studies on tumor oxygenation have focused on these two tumor environments. However, recent investigations suggest that the hypoxic cycling occurring within tumors plays a larger role in the contribution to tumor cell survival than either oxidative stress or hypoxia alone. Thioredoxin is known to have important roles in both these cellular responses and several studies implicate thioredoxin as a contributor to cancer progression. However, only a few studies exist that investigate the regulation of thioredoxin in the hypoxic and cycling hypoxic response in cancers. This review focuses on the role of thioredoxin in the various states of tumor oxygenation.
Alcohol and Acetaldehyde in Public Health: From Marvel to Menace
Authors: Guo Rui , Ren Jun
Published: March 2010

Alcohol abuse is a serious medical and social problem. Although light to moderate alcohol consumption is beneficial to cardiovascular health, heavy drinking often results in organ damage and social problems. In addition, genetic susceptibility to the effect of alcohol on cancer and coronary heart disease differs across the population. A number of mechanisms including direct the toxicity of ethanol, its metabolites [e.g., acetaldehyde and fatty acid ethyl esters (FAEEs)] and oxidative stress may mediate alcoholic complications. Acetaldehyde, the primary metabolic product of ethanol, is an important candidate toxin in developing alcoholic diseases. Meanwhile, free radicals produced during ethanol metabolism and FAEEs are also important triggers for alcoholic damages.
Selective Heck Arylation of Cyclohexene with Homogeneous and Heterogeneous Palladium Catalysts
Authors: Mieczyńska Ewa , Trzeciak Anna M.
Published: March 2010

Palladium catalysts containing Pd(II) supported on Al2O3 and alumina-based mixed oxides, Al2O3-ZrO2, Al2O3-CeO2, and Al2O3-Fe2O3, are very effective in the Heck coupling of iodobenzene with cyclohexene in DMF solution. The best results, up to 81% of monoarylated products with a selectivity to 4-phenylcyclohexene (3) close to 90% were obtained with KOH as a base. The catalytic activity of palladium supported on alumina-based oxides was compared with that of homogeneous precursors, such as Pd(OAc)2 and PdCl2(PhCN)2, used in [Bu4N]Br as the reaction medium. Under such conditions homogeneous systems were more selective and produced up to 60% of monoarylated products with a selectivity to 3 close to 60%.
Synthetic Medicinal Chemistry in Chagas’ Disease: Compounds at The Final Stage of “Hit-To-Lead” Phase
Authors: Cerecetto Hugo , González Mercedes
Published: March 2010

Chagas’ disease, or American trypanosomosiasis, has been the most relevant illness produced by protozoa in Latin America. Synthetic medicinal chemistry efforts have provided an extensive number of chemodiverse hits at the “active-to-hit” stage. However, only a more limited number of these have been studied in vivo in models of Chagas’ disease. Herein, we survey some of the cantidates able to surpass the “hit-to-lead” stage discussing their limitations or merit to enter in clinical trials in the short term.
Mitochondrial and Cell Death Mechanisms in Neurodegenerative Diseases
Authors: Martin Lee J.
Published: March 2010

Alzheimer’s disease (AD), Parkinson’s disease (PD) and amyotrophic lateral sclerosis (ALS) are the most common human adult-onset neurodegenerative diseases. They are characterized by prominent age-related neurodegeneration in selectively vulnerable neural systems. Some forms of AD, PD, and ALS are inherited, and genes causing these diseases have been identified. Nevertheless, the mechanisms of the neuronal cell death are unresolved. Morphological, biochemical, genetic, as well as cell and animal model studies reveal that mitochondria could have roles in this neurodegeneration. The functions and properties of mitochondria might render subsets of selectively vulnerable neurons intrinsically susceptible to cellular aging and stress and overlying genetic variations, triggering neurodegeneration according to a cell death matrix theory. In AD, alterations in enzymes involved in oxidative phosphorylation, oxidative damage, and mitochondrial binding of Aβ and amyloid precursor protein have been reported. In PD, mutations in putative mitochondrial proteins have been identified and mitochondrial DNA mutations have been found in neurons in the substantia nigra. In ALS, changes occur in mitochondrial respiratory chain enzymes and mitochondrial cell death proteins. Transgenic mouse models of human neurodegenerative disease are beginning to reveal possible principles governing the biology of selective neuronal vulnerability that implicate mitochondria and the mitochondrial permeability transition pore. This review summarizes how mitochondrial pathobiology might contribute to neuronal death in AD, PD, and ALS and could serve as a target for drug therapy.
Following Enzyme Activity with Infrared Spectroscopy
Authors: Kumar Saroj , Barth Andreas
Published: March 2010

Fourier transform infrared (FTIR) spectroscopy provides a direct, "on-line" monitor of enzymatic reactions. Measurement of enzymatic activity is based on the fact that the infrared spectra of reactants and products of an enzymatic reaction are usually different. Several examples are given using the enzymes pyruvate kinase, fumarase and alcohol dehydrogenase. The main advantage of the infrared method is that it observes the reaction of interest directly, i.e.,no activity assay is required to convert the progress of the reaction into an observable quantity.
Development of X-Y Servo Pneumatic-Piezoelectric Hybrid Actuators for Position Control with High Response, Large Stroke and Nanometer Accuracy
Authors: Chiang Mao-Hsiung
Published: March 2010

This study aims to develop a X-Y dual-axial intelligent servo pneumatic-piezoelectric hybrid actuator for position control with high response, large stroke (250 mm, 200 mm) and nanometer accuracy (20 nm). In each axis, the rodless pneumatic actuator serves to position in coarse stroke and the piezoelectric actuator compensates in fine stroke. Thus, the overall control systems of the single axis become a dual-input single-output (DISO) system. Although the rodless pneumatic actuator has relatively larger friction force, it has the advantage of mechanism for multi-axial development. Thus, the X-Y dual-axial positioning system is developed based on the servo pneumatic-piezoelectric hybrid actuator. In addition, the decoupling self-organizing fuzzy sliding mode control is developed as the intelligent control strategies. Finally, the proposed novel intelligent X-Y dual-axial servo pneumatic-piezoelectric hybrid actuators are implemented and verified experimentally.
Symmetry and Beauty in Plato
Authors: Lloyd David R.
Published: March 2010

Plato writes about Beauty in many of his dialogues, particularly in the Symposium, but he has no word equivalent to our "Symmetry", and this concept was not then formalised. Nevertheless, there are indications that some aspects of the concept were understood, if only intuitively. Plato has a very abstract concept of beauty, and when he uses "beauty" to characterise the so-called "Platonic Solids" in the Timaeus, he seems to be emphasising at least their regularity. It can be argued that the way in which he specifies the detailed construction of the solids is remarkably close to a modern description in terms of (point) symmetry. For Plato, something of our symmetry is included in what he means by beauty, and the long mathematical approach to symmetry starts with the Timaeus.
Fluctuating Asymmetry: Methods, Theory, and Applications
Authors: Graham John H. , Raz Shmuel , Hel-Or Hagit , Nevo Eviatar
Published: March 2010

Fluctuating asymmetry consists of random deviations from perfect symmetry in populations of organisms. It is a measure of developmental noise, which reflects a population’s average state of adaptation and coadaptation. Moreover, it increases under both environmental and genetic stress, though responses are often inconsistent. Researchers base studies of fluctuating asymmetry upon deviations from bilateral, radial, rotational, dihedral, translational, helical, and fractal symmetries. Here, we review old and new methods of measuring fluctuating asymmetry, including measures of dispersion, landmark methods for shape asymmetry, and continuous symmetry measures. We also review the theory, developmental origins, and applications of fluctuating asymmetry, and attempt to explain conflicting results. In the process, we present examples from the literature, and from our own research at “Evolution Canyon” and elsewhere.
Inhibition of Hemorragic Snake Venom Components: Old and New Approaches
Authors: Panfoli Isabella , Calzia Daniela , Ravera Silvia , Morelli Alessandro
Published: March 2010

Snake venoms are complex toxin mixtures. Viperidae and Crotalidae venoms, which are hemotoxic, are responsible for most of the envenomations around the world. Administration of antivenins aimed at the neutralization of toxins in humans is prone to potential risks. Neutralization of snake venom toxins has been achieved through different approaches: plant extracts have been utilized in etnomedicine. Direct electric current from low voltage showed neutralizing properties against venom phospholipase A2 and metalloproteases. This mini-review summarizes new achievements in venom key component inhibition. A deeper knowledge of alternative ways to inhibit venom toxins may provide supplemental treatments to serum therapy.
Epidemiologic Observations from Passive and Targeted Surveillance during the First Wave of the 2009 H1N1 Influenza Pandemic in Milwaukee, WI
Authors: Kumar Swati , Chusid Michael J. , Willoughby Rodney E. , Havens Peter L. , Kehl Sue C. , Ledeboer Nathan A. , Simpson Pippa , VanDyke Meredith , Davis Elizabeth , Gaffney Kate , Li Shun-Hwa , Bose Michael E. , Henrickson Kelly J.
Published: March 2010

The first wave of the 2009 influenza H1N1 pandemic (H1N1pdm) in Milwaukee, WI has been recognized as the largest reported regional outbreak in the United States. The epidemiologic and clinical characteristics of this large first wave outbreak from April 28th 2009–July 25th 2009, studied using both passive and targeted surveillance methodologies are presented. A total of 2791 individuals with H1N1pdm infection were identified; 60 % were 5–18 years old. The 5–18 year and 0–4 year age groups had high infection (1131 and 1101 per 100,000) and hospitalization (49 and 12 per 100,000) rates respectively. Non-Hispanic blacks and Hispanics had the highest hospitalization and infection rates. In targeted surveillance, infected patients had fever (78%), cough (80%), sore throat (38%), and vomiting or diarrhea (8%). The “influenza like illness” definition captured only 68 % of infected patients. Modeling estimates that 10.3 % of Milwaukee population was infected in the first wave and 59% were asymptomatic. The distinct epidemiologic profile of H1N1pdm infections observed in the study has direct implications for predicting the burden of infection and hospitalization in the next waves of H1N1pdm. Careful consideration of demographic predictors of infection and hospitalization with H1N1pdm will be important for effective preparedness for subsequent influenza seasons.
Combination of Laser Photocoagulation and Intravitreal Bevacizumab in Aggressive Posterior Retinopathy of Prematurity
Authors: Altinsoy Halil Ibrahim , Mutlu Fatih Mehmet , Güngör Rıza , Sarici S. Ümit
Published: March 2010

The response to combined laser photocoagulation and a single intravitreal injection of 0.75 mg bevacizumab to each eye on separate days in two patients with aggressive, posterior retinopathy of prematurity (ROP) is described. Combined treatment resulted in regression of zone-1 disease in Case 1, which had no retinal detachment. However, no significant regression or unfavorable anatomic response was observed in the second case with retinal detachment. Although the combination of laser photocoagulation and intravitreal bevacizumab injection seems to be well tolerated, inducing prompt regression of agressive zone-1 ROP without retinal detachment, further controlled studies with long-term follow-up are necessary for their use in the treatment of ROP with for potentially dangerous growth factor inhibitors in premature babies.
Aureobasidium Pullulans
Keratitis Following Automated Lamellar Therapeutic Keratoplasty
Authors: Chawla Bhavna , Sharma Namrata , Titiyal Jeewan S. , Nayak Niranjan , Satpathy Gita
Published: March 2010

Aureobasidium pullulans
is a rare cause of fungal keratitis. A 73-year-old man underwent Automated Lamellar Therapeutic Keratoplasty (ALTK) for healed trachomatous keratopathy in his left eye. Five days later, he developed a graft infection. Cultures from corneal scraping showed findings consistent with
Aureobasidium pullulans
. The keratitis failed to respond to intensive topical and systemic anti-fungal therapy. Hence, the lamellar graft was removed. Despite this, the clinical condition deteriorated and a therapeutic penetrating keratoplasty had to be carried out to salvage the eye. At 1 year follow-up, there was no recurrence of infection. Graft infection with
Aureobasidium pullulans
may not be amenable to topical and systemic antifungal therapy and a penetrating keratoplasty may be required for control of infection.
Successful Removal of a Ruptured Orbital Cyst Using 2.3% Sodium Hyaluronate and Indocyanine Green
Authors: Hiraoka Takahiro , Kaji Yuichi , Okamoto Fumiki , Oshika Tetsuro
Published: March 2010

A healthy 64-year-old man presented with a non-tender soft mass in the upper inner quadrant of the anterior left orbit. Magnetic resonance imaging revealed a 14 × 16 × 14–mm homogeneous cystic lesion in the anterior superonasal orbit with a distinct margin. An orbital cyst was suspected, and its surgical removal was planned. During the operation, the cystic mass ruptured unexpectedly and collapsed. Subsequently, a mixture of 0.5 mL of 2.3% sodium hyaluronate and 0.5 mL of 1% indocyanine green (ICG) was injected into the orbital cyst using a 27-gauge needle. Thereafter, the cyst became easily visible and clearly defined, which was successfully removed without difficulty. The usage of 2.3% sodium hyaluronate and ICG facilitated safe and complete excision of an accidentally ruptured orbital cyst.
Midlenticular Optic Opacification af a Hydrophobic Acrylic Intraocular Lens in Association with Retained Perfluorocarbon Liquid Following Vitreoretinal Surgery
Authors: Prasad Pradeep S. , Oliver Scott C. N. , Gonzales Christine R.
Published: March 2010

The postoperative course of a patient who underwent retinal detachment repair using perfluoro-
n
-octane (PFO) and perfluoropropane (C
3
F
8
) gas endotamponade is described in which midlenticular optic opacification of a hydrophobic acrylic intraocular lens was noted. Mechanisms for optic opacification are proposed, which include dystrophic calcification and PFO-induced optic degeneration. The case presents a novel case of midlenticular intraocular lens optic opacification in the setting of retained perfluorocarbon liquid following retinal detachment repair.
Post-pneumatic Retinopexy Endophthalmitis: Management of Infection and Persistent Retinal Detachment
Authors: Sharma Tarun
Published: March 2010

Pneumatic retinopexy is an invasive procedure and requires all asepsis precautions to be followed, possibility of infective endophthalmitis to be kept in mind in clinical settings. This case report illustrates this important complication. A patient underwent pneumatic retinopexy to repair superior half retinal detachment caused by a single horseshoe-shaped tear. Two days later, he developed all signs of infective endophthalmitis. He was managed with intravitreal antibiotics and later vitreous surgery and gas tamponade to repair persistent retinal detachment. At one and half year of follow-up, his vision was 6/9, attached retina and no evidence of recurrence of infection.
Transpupillary Thermotherapy for Juxtafoveal Leak in Central Serous Chorioretinopathy
Authors: Sharma Tarun , Parikh Shaileen D.
Published: March 2010

The authors describe the use of transpupillary thermotherapy (TTT) for juxtafoveal central serous chorioretinopathy (CSC) leak. A 45-year-old man with juxtafoveal leak developed fibrinous exudate in the macular area, demonstrated on optical coherence tomography. After one session of TTT, fibrinous exudate totally disappeared with improvement in vision to 20/40 from counting finger. Subretinal fluid got absorbed with obliteration of leak on fluorescein angiogram. TTT may be useful as a treatment option in juxtafoveal leak of CSC.
Macular Microhole of the Outer Retinal Defect with a Perifoveal Posterior Vitreous Detachment
Authors: Takahashi Atsushi , Ishiko Satoshi , Nagaoka Taiji , Kato Yuji , Kameyama Daiki , Yoshida Akitoshi
Published: March 2010

To report a case of a macular microhole of an outer retinal defect that resolved spontaneously during visualization of the sequential anatomic changes on optical coherence tomography (OCT) before and after detachment of the posterior hyaloid from the fovea. The patient was a 47-year-old woman with a central scotoma and metamorphopsia. OCT 3 detected a small outer retinal defect, a so-called macular microhole. The OCT ophthalmoscope showed an elevated foveal photoreceptor layer with a perifoveal posterior vitreous detachment (PVD) at the initial visit. Six months later, both OCTs showed resolution of the photoreceptor layer abnormality and detachment of the posterior hyaloid from the fovea. The photoreceptor layer abnormality and visual symptoms resolved almost simultaneously. These findings may explain that the elevated foveal photoreceptor layer associated with the perifoveal PVD could be the anatomic mechanism responsible for macular microhole formation.
Bilateral Isolated Orbital Neurofibroma
Authors: Kim Usha , Bansal Svati
Published: March 2010

A rare case of bilateral orbital neurofibroma in a young healthy man is presented. The clinical, pathological and radiological features are described. The mass was excised using lateral orbitotomy approach in both the eyes. A definitive diagnosis was made on histopathological examination. The need for recognition and differentiation from the other causes of lacrimal gland swellings is discussed. A complete systemic evaluation in such cases is essential to rule out any associated disorders; however, such an association may not be universal.
Full Thickness Macular Hole Formation in a Patient with Cystoid Macular Edema Caused by CRVO Treated with Intravitreal Bevacizicumab
Authors: Georgalas Ilias , Rouvas Alexandros , Kotsolis Athanasios , Karagiannis Dimitrios , Ladas Ioannis
Published: March 2010

Recent studies have shown the beneficial effect of intravitreal injections of Bevacizicumab in several ocular neovasular disorders, however, the possible adverse effects of this treatment have not been fully described. The authors report the development of a full thickness macular hole (FTMH) in a 44-year-old patient with cystoid macular edema secondary to central retinal vein occlusion after treatment with intravitreal injection of Bevacizicumab and describe its course after vitrectomy, internal limiting membrane peeling and gas tamponade.
Pupillary Block Glaucoma After Pars Plana Vitrectomy with Air-Fluid Exchange in Pseudophakic Air-Filled Eye
Authors: Hu Allen Y. H. , Tsui Irena , Hubschman Jean-Pierre
Published: March 2010

Pupillary block is seen after pars plana vitrectomy (PPV) with gas or silicone oil endotamponade in aphakic eyes. A case of a pseudophakic patient with pupillary block glaucoma related to the migration of air into the anterior chamber was reported. A 76-year-old woman underwent combined PPV with air endotamponade and uncomplicated cataract extraction for epiretinal membrane and cataract. On postoperative day 1, she had an 80% air fill of the anterior chamber. She returned 6 days later with pupillary block glaucoma. She was managed with a surgical peripheral iridectomy, posterior synechiolysis, and evacuation of the air from the anterior chamber. The risk of pseudophakic pupillary block glaucoma after PPV with air tamponade may be increased with inflammation due to combined PPV and cataract extraction, zonular weakness, and efflux of air from the vitreous cavity into the anterior chamber. Early detection and treatment is recommended to avoid permanent sequelae.
Regression of Macular Cavernous Hemangioma with Systemic Infliximab
Authors: Japiassú Ricardo M. , Moura Brasil Oswaldo F. , de Souza Eduardo C.
Published: March 2010

Cavernous hemangioma of the retina is an unusual vascular hamartoma that has been reported to occur either sporadically or as a dominantly inherited trait. A case of a large and sporadic macular cavernous hemangioma that was successfully treated with systemic infliximab as a first line of treatment is presented. The patient was referred with decreased vision of the right eye for 6 months. Fundus examination disclosed a reddish elevated lesion in the posterior pole that obscured the macula and encroached on the fovea. It consisted of grapelike aneurysms. The patient underwent treatment with infliximab intravenously. Two weeks after the second infusion of infliximab, visual acuity improved to 20/80 with a marked involution of the tumor in the right eye. Although the data are limited, we think that a new perspective for treatment of retinal vascular tumors may appear in the future considering antibodies antibodies to tumor necrosis factor (TNF)-alpha.
Pars Plana Vitrectomy and Intravitreal Liposomal Amphotericin B in the Treatment of Candida Endophthalmitis
Authors: Koç Aylin , Onal Sumru , Yenice Ozlem , Kazokoglu Haluk
Published: March 2010

Candida endophthalmitis is a common cause of fungal endophthalmitis. A case of bilateral endogenous endophthalmitis caused by
Candida albicans
without candidemia in an otherwise healthy 77-year-old man was reported. The patient underwent bilateral pars plana vitrectomy and intravitreal liposomal amphotericin B injections in addition to systemic fluconazole therapy. Postoperatively, a significant decrease of inflammation and resolution of abscesses were observed in both eyes. Vision improved in the left eye but remained constant in the right eye because of secondary cataract formation. To the best of our knowledge, this is the first report on the use of liposomal amphotericin B intravitreally in a patient with bilateral endogenous candida endophthalmitis. No evidence of clinical ocular toxicity was observed with the liposomal form of amphotericin B injection.
A Perforating Eye Injury Caused by a Staple Gun, Treated Successfully Without Vitrectomy
Authors: Lang Yaron , Bishara Nizar , Barak Yoreh , Fineberg Edward
Published: March 2010

A 30-year-old carpenter accidentally impaled his own left eye with a 5 cm staple ejected from a pneumatic gun. Entering the globe off-axis, the stainless steel staple caused a vitreous hemorrhage. On the day of injury, the staple was removed surgically. The vitreous hemorrhage cleared rapidly enough to permit laser treatment around the equatorial retinal perforation site. Visual acuity improved to 6/9 and remained stable over a one-year period of careful follow-up. No retinal detachment developed. No additional intervention was required. While vitrectomy with or without a circular buckling remains the standard for perforations into the posterior segment, selected cases may be managed conservatively.
Transpositional Autokeratoplasty in a Patient with Unilateral Choroidal Melanoma and Contralateral Exposure Keratopathy
Authors: Mehta Hemal , Hungerford John L. , Gartry David S. , Herbert Helen M. , Mruthyunjaya Prithvi
Published: March 2010

Penetrating keratoplasty was required to improve corneal clarity in the left eye, which had suffered chronic exposure keratopathy following a cerebellopontine angle tumor with facial nerve involvement. The right eye had a large choroidal melanoma, which had failed brachy-therapy, but the cornea was transparent and healthy. The right eye corneal button was sutured to the left eye host and a donor corneal button was sutured to the right eye rim. The right eye was subsequently enucleated. Two years later, the patient had 6/12 visual acuity with a clear graft and no tumor seeding in the host eye. Although limited opportunities arise to employ transpositional autokeratoplasty, where appropriate, it offers an alternative to conventional allokeratoplasty with a lower risk of immune rejection.
Delayed Suprachoroidal Hemorrhage After Reinstitution of Warfarin in Combined Procedure
Authors: Rumelt Shimon , Treviño Aaron
Published: March 2010

A 79-year-old non-compliant male with pseudoexfoliative glaucoma and cataract in the left eye underwent uneventful combined phacoemulsification, posterior chamber intraocular lens insertion and trabeculectomy with mitomycin C through one port a week after replacement of warfarin with subcutaneous injections of enoxaparin (Clexane; Sanofi-Aventis, Netaniya, Israel). The intraocular pressure (IOP) following surgery was zero. Four days later, warfarin was restarted because of short ventricular tachycardia when the patient developed suprachoroidal hemorrhage and later hyphema and vitreous hemorrhages. The patient underwent drainage of the suprachoroidal hemorrhage. His IOP increased to 10 to 12 mm Hg while the bleb was functioning, but visual acuity remained poor because of chorioretinal retinal scarring from age-related macular degeneration. Premature reinstitution of warfarin may cause delayed hemorrhages if the postoperative IOP is low. Preoperative approval from the internist for a prolonged replacement of warfarin with lesser potent agents, or tightening of the scleral flap and releasing the sutures later in trabeculectomy in combined procedures may be warranted.
Loss of Foveal Cone Photoreceptor Outer Segments in Occult Macular Dystrophy
Authors: Sisk Robert A. , Berrocal Audina M. , Lam Byron L.
Published: March 2010

To describe a previously unreported finding on optical coherence tomography (OCT) in a patient with occult macular dystrophy (OMD) and correlate it with retinal dysfunction. Retrospective observational case report. A 72-year-old woman presented with sequential progressive central scotomata with reduced visual acuities and color vision in both eyes. Fundoscopic appearance, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography were normal. Full-field ERG was normal, but multifocal ERG demonstrated reduced amplitudes, confirming the diagnosis of OMD. OCT demonstrated loss of cone outer segments with preservation of the inner segment-outer segment junction and photoreceptor cell bodies in both eyes. Loss of cone photoreceptor outer segments may be responsible for decreased visual acuity and foveal thinning in OMD.
Unilateral Acute Retinal Necrosis 2 Months After Herpes Simplex Encephalitis
Authors: Sugitani Kazuhiko , Hirano Yoshio , Yasukawa Tsutomu , Yoshida Munenori , Ogura Yuichiro
Published: March 2010

A case with unilateral acute retinal necrosis (ARN) following herpes simplex virus (HSV) encephalitis was reported. A 40-year-old man presented with unilateral visual loss. He had a history of HSV encephalitis 2 months previously, and had been successfully treated with intravenously acyclovir. The ophthalmologic examination in his left eye suggested ARN syndrome. The best-corrected visual acuity was 20/222. Magnetic resonance imaging (MRI) showed high density signals from the optic chiasm to optic disc. The patient underwent encircling scleral buckling, lensectomy, and vitrectomy with endolaser photocoagulation and silicone oil tamponade. Postoperatively, the high density signals on MRI decreased, the retina maintained attached, and the visual acuity at the final visit improved to 20/20. Unilateral ARN can develop after HSV encephalitis. Acyclovir should be administered over the long term to control the virus.
Purtscher-Like Retinopathy: Optical Coherence Tomography and Visual Field Findings
Authors: Alasil Tarek , Tokuhara Keith , Bowes Larry D. , Fan Joseph
Published: March 2010

A 30-year-old male presented with decreased vision in the right eye after a recent hospitalization for acute pancreatitis. On presentation, his visual acuity was 20/100 right eye (OD) and 20/20 left eye (OS). The funduscopic examination findings were consistent with Purtscher-like retinopathy (PLR). Cirrus HD-OCT (Spectral Domain Technology, Zeiss) of the right eye showed retinal nerve fiber layer swelling and significant subretinal fluid. Humphrey visual field (Central 24-2) revealed generalized defect on the right and inferior nasal step on the left. During the next 6 months, the patient had improvement in visual acuity (20/30 OD and 20/20 OS) and normalization of optical coherence tomography (OCT) findings. However, the visual field (VF) worsened bilaterally suggesting that the injuries induced by micro-infarctions at the level of the retinal nerve fiber layer (RNFL) were not reversible. To our knowledge, there have been no reports in the literature that compare high-resolution OCT and VF findings in patients with PLR.
Autofluorescence and High-Resolution OCT Findings Revealed Ciliopathy in Senior-Loken Syndrome
Authors: Cella Wener , Lima Luiz H. , Wang Nan-Kai , Tosi Joaquin , Yannuzzi Lawrence A. , Tsang Stephen H.
Published: March 2010

To describe novel findings on fundus autofluorescence (FAF) and high-resolution optical coherence tomography (OCT) in a 27-year-old woman with the Senior-Loken syndrome (SLSN) emphasizing the photoreceptors' cilia appearance in the macula. The patient had renal transplantation early in life and poor visual acuity due to advanced autosomal recessive retinitis pigmentosa. FAF showed diffuse spots of decreased autofluorescence in the mid-periphery and a perifoveal ring of increased autofluorescence suggesting a bull's eye maculopathy. High-resolution OCT revealed a barely detectable inner–outer photo-receptor segment junction in the central macula corresponding to the area inside of the ring of increased autofluorescence, suggesting initial ciliary junction disorganization before photoreceptors death. Non-invasive technologies can monitor central photoreceptors cilliary anatomy enabling early detection of cell disorganization in diseases involving ciliopathy such as the Senior-Loken syndrome are concluded.
Resolution of Pigmented Keratic Precipitates Following Treatment of Pseudophakic Endophthalmitis Caused by
Propionibacterium acnes
Authors: Javey Golnaz , Albini Thomas A. , Flynn Harry W.
Published: March 2010

Propionibacterium acnes
is a well-recognized cause of chronic postoperative endophthalmitis after cataract surgery. The subtle clinical signs of this infection and its initial favorable response to topical steroids may lead to delayed diagnosis and treatment. Two patients with culture proven
P. acnes
endophthalmitis after cataract surgery that presented with prominent pigmented keratic precipitates (KPs) and low-grade iritis in the involved eye were managed. Both cases had initial treatment with diagnostic pars plana vitrectomy (PPV) with intraocular antibiotic (IOAB) injection. Secondary treatment for recurrence was required in both patients. The KPs and iritis resolved after removal of intraocular lens (IOL) and capsular bag.
Interface Haze Formation After Ultra Thin Flap Laser in Situ Keratomileusis
Authors: Kymionis George D. , Karavitaki Alexandra E. , Portaliou Dimitra M. , Papadiamantis Anastasios G. , Giapitzakis Ioannis , Pallikaris Aristofanis I. , Yoo Sonia H.
Published: March 2010

In this case series, five patients
(
10 eyes) underwent laser in siter keratomileusis (LASIK) for the correction of moderate myopia and astigmatism with the Schwind Carriazo Pendular microkeratome 90 μm head. Flap (superior hinged) thickness measured intraoperatively was assessed less than 70 m in all eyes. On first month's postoperative examination, subepithelial mild corneal haze with consequent myopic regression was found in all patients. A significant improvement of haze formation and residual refractive error were observed during the following postoperative months. In conclusion, post-LASIK subepithelial corneal haze after thin flap creation is a temporarily potential complication that could affect patient's refractive error during the first postoperative month.
Descement's Membrane Detachment Diagnosis Using a Very High Frequency Ultrasound Scanning System
Authors: Kymionis MD George D. , Stratos Aimilianos A. , I.Bouzoukis Dimitrios , Krokidis Miltiadis E. , Tsilimbaris Miltiadis K.
Published: March 2010

A 74-year-old woman was referred to our institute due to persistent corneal edema after cataract surgery. Slit-lamp examination revealed severe total corneal edema (obscuring anterior chamber and iris). Using a very high frequency (VHF) ultrasound scanning system (Artemis 2, Ultralink LLC) descement's membrane detachment (DMD) was diagnosed. VHF ultrasound scanning system could be a useful instrument in detecting post-cataract surgery DMD especially in patients in which diagnosis is difficult due to significant corneal clouding.
Lens Dislocation Following Yag Laser Peripheral Iridotomy
Authors: Moore Sacha P. , Smith Michael , Rattigan Siobhan , Gray Roger
Published: March 2010

A rare case where laser peripheral iridotomy resulted in crystalline lens dislocation into the vitreous cavity. The patient was managed with pars plana vitrectomy, fragmatome lensectomy, anterior chamber intraocular lens and surgical iridotomy with a final best corrected visual acuity of 6/9. Multiple episodes of laser peripheral iridotomy carries a risk of complete lens dislocation.
Vitrectomy, Laser Photocoagulation, and Intravitreal Triamcinolone for Combined Hamartoma of the Retina and Retinal Pigment Epithelium
Authors: Nam Dong Heun , Shin Kwang Hoon , Lee Dae Yeong , Sohn Hee Jin
Published: March 2010

Combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) is a rare, benign tumor, but there are no established managements for CHRRPE. A patient with CHRRPE who is treated successfully by the new combination therapy was described. A 32-year-old man was diagnosed as having CHRRPE after evaluation with ophthalmoscopy, fluorescein angiography (FA), and optical coherence tomography (OCT). First performed intravitreal triamcinolone acetonide (IVTA) (4 mg/0.1 mL) and laser photocoagulation to treat the vascular component. There was a rapid and good response after that therapy, but a recurrence 3 months later. To relieve the glial component, we simultaneously combined vitrectomy with IVTA and laser photocoagulation. After the combination therapy, there were no recurrences or complications. A combination therapy of vitrectomy, laser photocoagulation, and intravitreal triamcinolone could be considered as a possible management for CHRRPE with the vascular and glial components.
Morphological Findings of Intraocular Lens with Haptics Detached from Optics Following Cataract Surgery
Authors: Suzuki Yukihiko , Suzuki Kaori , Metok Tomomi , Nakazawai Mitsuru
Published: March 2010

A 55-year-old woman was treated using phacoemulsification, aspiration, and intraocular lens (IOL) implantation. Three months after surgery, the optical zone of the anterior capsule was completely closed due to strong capsular contractions. As the two haptics were found to be completely detached from the optics, the IOL was subsequently extracted and morphologically examined. Although the optics and haptics of the IOL when viewed with a stereomicroscope appeared to have no marked damage on their surfaces, an ultra-structural examination showed that a portion of the acrylic optics on the detached surface was defective. We considered that the IOL haptics might have become detached from the optics due to continuous force from postoperative capsular contractions.
Three-Dimensional Features of Polypoidal Choroidal Vasculopathy Observed by Spectral-Domain OCT
Authors: Abe Sachi , Yamamoto Teiko , Haneda Shion , Saito Kouko , Miura Hitomi , Kirii Eriko , Yamashita Hidetoshi
Published: March 2010

Five eyes of five patients with polypoidal choroidal vasculopathy (PCV) without acute hemorrhagic changes or subretinal proliferative tissue to observe the three-dimensional structures and to demonstrate the nature of these images and their interpretation. The abnormal networks surrounding polypoidal lesions were considered to be abnormal pathological blood vessels. The segmentation analysis of spectral-domain optical coherence tomography (OCT) has revealed the three-dimensional features of polypoidal lesions and surrounding abnormal blood vessel networks beneath retinal pigment epithelium. The changes of pathological findings of PCV were also detected, including the enlargement of hemorrhagic pigment epithelium detachment (PED). The segmentation analysis is useful to observe PCV lesions from the bird's eye view.