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Elimination kinetics following a single dose of teicoplanin in rats pre-treated with morphine sulphate (MS), phenobarbital sodium (Pb), and normal saline (NS) were determined. A microbioassay was used to measure teicoplanin levels. A significant increase in the total clearance of teicoplanin was found in rats pre-treated with MS as compared to controls ( < 0·048). Wide variability was observed in the renal and non-renal clearances of teicoplanin. The mean renal clearance for rats pre-treated with MS, Pb and NS was 0·61±0·07 mL/min/kg, 0·60±013 mL/min/kg, and 0·46±0·02 mL/min/kg, respectively; the mean non-renal clearance was 0·33±0·18 mL/min/kg, 0·17±0·15 mL/min/kg, and 0·08±0·03 mL/min/kg, respectively. The differences among the groups for renal and non-renal clearance were not statistically significant. The mean apparent volume of distribution of teicoplanin at steady state was significantly lower in the Pb-pre-treated rats as compared to controls (P < 0·043). The mean half-life for MS-, Pb-, and NS pre-treated groups was 81±3·1 h, 5·9±3·3 h, and 34·6±20·7 h, respectively. The differences in mean half-life among the groups achieved statistical significance ( < 0.016). The increase in the total clearance of teicoplanin can best be explained by an increase in both renal elimination and hepatic metabolic pathways. [ABSTRACT FROM PUBLISHER]

Purpose: To evaluate the posterior segment visualization in patients with small-aperture intraocular lens (IOL) implantation., Methods: In this prospective, comparative case series, 15 patients who had unilateral implantation of the small-aperture IOL in their non-dominant eyes were recruited. Their fellow eyes were pseudophakic with a monofocal IOL in 14 patients and phakic in 1 patient. All underwent bilateral posterior segment clinical investigations including fundus photography, threshold perimetry, and optical coherence tomography of the posterior pole including optic nerve head. The results from these investigations were graded by a clinician masked to the laterality and type of IOL. Patient 11 developed postoperative endophthalmitis 4 weeks following cataract surgery with implantation of a small-aperture IOL and underwent pars plana vitrectomy. The intraoperative view of the posterior segment was subjectively evaluated by the retinal surgeon., Results: All 15 patients had successful image captures with all clinical investigative tools with no differences in image quality detected between the images obtained from the monofocal pseudophakic and small-aperture IOL eyes. The small-aperture IOL did not subjectively obstruct the intraoperative view for the retinal surgeon during pars plana vitrectomy., Conclusions: Standard posterior segment investigations including non-mydriatic fundus photography, optical coherence tomography, and automated perimetry can be safely and effectively performed in eyes with small-aperture IOLs. There is no difference in the image quality. [J Refract Surg. 2019;35(8):538-542.]., (© 2019 Srinivasan, Khoo, & Koshy.)

Purpose: Submacular haemorrhage (SMH) is a cause of severe visual loss in neovascular age-related macular degeneration (nAMD). The incidence is uncertain and furthermore there is no widely used classification system nor agreed best practice. The aim of this national surveillance study was to identify the incidence, presenting features and clinical course of new fovea-involving submacular haemorrhage associated with nAMD., Methods: A questionnaire was sent monthly to every ophthalmic specialist in Scotland over a 12-month period asking them to report all newly presenting patients with acute SMH secondary to nAMD of at least two disc diameters (DDs) in greatest linear diameter. A follow-up questionnaire was sent 6 months after initial presentation. Cases related to other causes were excluded., Results: Twenty-nine cases were reported giving an incidence of 5.4 per million per annum (range 2-15). The mean age was 83 years (range 66-96) and females accounted for 17/29 (59%). Fifteen of the 29 cases (52%) had a past history of AMD, of which 7 had nAMD. Nineteen of the 29 cases (66%) presented within 7 days of onset and the majority had SMH of < 11 DD (20/29, 69%). Treatment options comprised the following: observation (n = 6, 21%), anti-VEGF alone (n = 6, 21%) or vitrectomy with co-application of tissue plasminogen activator (TPA), anti-VEGF and gas (n = 17, 58%). The vitrectomy group experienced the greatest change in vision from logMAR 1.89-1.50 (p = 0.374). Four of 20 (20%) cases with 6 months follow-up suffered a re-bleed at a mean time of 96 days., Conclusions: The incidence, clinical features and course of a consecutive national cohort of patients with SMH secondary to nAMD are presented.

Context: - The Department of Anatomic Pathology is a division of the Pathology & Laboratory Medicine Institute at Cleveland Clinic Abu Dhabi. The hospital offers the same model of care as its US-based counterpart the Cleveland Clinic, established in 1921 in Cleveland, Ohio. Pathology services at Cleveland Clinic are internationally acclaimed: the endeavor for Cleveland Clinic Abu Dhabi was to create a parallel facility, with the same standards in a greenfield start-up environment., Objective: - To narrate how we addressed challenges customary in any laboratory start-up and issues distinctive to our setting with the aim to provide a model for others involved in a similar undertaking., Data Sources: - All information in this article is based on published literature obtained by search on internet-based search engines, Clinical and Laboratory Standards Institute, and the authors' firsthand experience., Conclusions: - Key considerations in establishing an anatomic pathology laboratory are careful planning and design, adherence to local and international regulatory standards, selection of equipment and supplies, appropriate staffing, development of a laboratory information system, and sound test validation. In addition to meeting our clinical needs, alliance with the US Cleveland Clinic had an integral role in establishing our laboratory and regional reputation.

We describe a surgical technique of pars plana posterior capsulectomy using a transconjunctival sutureless 2-port 27-gauge microincision vitrectomy system to deal with dense posterior capsule opacification (PCO). The technique was used successfully in 5 eyes of 5 patients with dense PCO that had been unsuccessfully treated by neodymium:YAG laser photodisruption., (Copyright © 2017 ASCRS and ESCRS. All rights reserved.)

Purpose: To develop and validate a classification system for focal vitreomacular traction (VMT) with and without macular hole based on spectral domain optical coherence tomography (SD-OCT), intended to aid in decision-making and prognostication., Methods: A panel of retinal specialists convened to develop this system. A literature review followed by discussion on a wide range of cases formed the basis for the proposed classification. Key features on OCT were identified and analysed for their utility in clinical practice. A final classification was devised based on two sequential, independent validation exercises to improve interobserver variability., Results: This classification tool pertains to idiopathic focal VMT assessed by a horizontal line scan using SD-OCT. The system uses width (W), interface features (I), foveal shape (S), retinal pigment epithelial changes (P), elevation of vitreous attachment (E), and inner and outer retinal changes (R) to give the acronym WISPERR. Each category is scored hierarchically. Results from the second independent validation exercise indicated a high level of agreement between graders: intraclass correlation ranged from 0.84 to 0.99 for continuous variables and Fleiss' kappa values ranged from 0.76 to 0.95 for categorical variables., Conclusions: We present an OCT-based classification system for focal VMT that allows anatomical detail to be scrutinised and scored qualitatively and quantitatively using a simple, pragmatic algorithm, which may be of value in clinical practice as well as in future research studies.

We describe a case of von Hippel-Lindau disease (VHL) through three generations of the same family. First presentation was a young female with a 6-week history of headaches behind the eyes. On examination she was found to have bilateral retinal capillary haemangiomas (RCH). Preliminary diagnosis of VHL was suspected and further investigations confirmed the initial diagnosis. The patient was found to have pancreatic and kidney lesions and her mother had a cerebellar haemangioblastoma. Following genetic testing, the VHL gene appeared in the 9-year-old boy. On recent presymptomatic ophthalmic screening, the child was found to have RCH. Both patient and child's RCHs were successfully managed with a variety of treatments.

This report describes the case of a 59-year-old woman diagnosed with cytomegalovirus (CMV) retinitis. The diagnosis was suggested by a typical fundus appearance, and confirmed by a positive PCR for CMV of both serum and vitreous biopsy. HIV status was negative. The patient's medical history included thymoma followed by a thymectomy, recent multiple oral thrush infections, lower respiratory tract infections, urinary tract infections and severe weight loss. She had previously been treated for toxoplasma chorioretinitis and had vitrectomies for retinal detachment in the right eye. Immunological investigations revealed low T cells, almost absent B cells with reduced immunoglobulins consistent with the diagnosis of Good syndrome. The patient received treatment with intravenous ganciclovir, followed by maintenance valganciclovir, resulting in resolution of the ocular pathology. Immunoglobulin replacement therapy to boost the humoral immunity has been commenced.

Aims: To assess the utility of optical coherence tomography (OCT) in a nurse-led, fast-track clinic for new age-related macular degeneration (AMD) referrals, and to see how often indocyanine green angiography (ICGA) led to an additional diagnosis to that provided by fundus fluorescein angiography (FFA)., Method: Retrospective audit of a consecutive series of 134 new patients referred with suspected wet AMD. When visual acuity was >or=6/60 an OCT was performed. If the OCT was consistent with "wet" AMD, the patient underwent simultaneous FFA/ICGA. The sensitivity and specificity of this clinic was calculated. The number of additional diagnoses made using ICGA was recorded., Results: 23/134 (17.16%) patients had OCT only and were not subsequently found to have wet AMD. FFA/ICGA was performed in 111 patients, showing wet AMD in 90 (81%) patients. OCT as used in our clinic had a sensitivity of 1 and a specificity of 0.65 for detecting wet AMD. ICGA provided additional diagnoses in 19 (14.17%) patients. ICGA detected a specific vascular abnormality in 58% of the occult lesions., Conclusions: OCT proved to be an effective screening tool for wet AMD in this clinic, with excellent sensitivity and reasonable specificity. ICGA provided an additional diagnosis in a significant number of cases, but did not define a vascular abnormality in all occult cases.

Purpose: To assess the effect of sub-Tenon's anaesthesia on intraocular pressure (IOP) prior to cataract surgery., Methods: Fifty consecutive patients undergoing phacoemulsification of cataract were recruited. Routine sub-Tenon's anaesthesia was administered with 5 ml unpreserved 2% lignocaine. IOPs were measured immediately prior to and at 1, 3, 5 and 10 min after injection. Efficacy was assessed subjectively by the operating surgeon. No ocular compression was used. Pre- and post-injection IOPs were compared using the Wilcoxon signed rank test, whereas all other results were compared with baseline using Student's two-tailed paired t-tests., Results: All patients achieved good analgesia and akinesis. There was no significant difference between the IOP prior to and 1 min after injection. At all time intervals after 3 min there was a significant reduction in IOP compared with the pre-injection measurement. At 5 min, the mean IOP reduction was 2.72 mmHg and at 10 min IOP was lowered by 2.92 mmHg. Both reductions were statistically significant compared with baseline., Conclusions: Sub-Tenon's anaesthesia does not cause any significant rise in IOP, thereby possibly making it the anaesthetic technique of choice when an increase in IOP is undesirable. There is no indication for the use of an ocular pressure-reducing device when sub-Tenon's anaesthesia is employed.