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Purpose: We investigated whether glucosamine sulfate modulates the production of ICAM-1 induced by proinflammatory cytokines and whether glucosamine sulfate inhibits leukocyte adhesion to a monolayer of human conjunctival epithelial cells stimulated with proinflammatory cytokines., Methods: We used flow cytometry and either primary cultured human conjunctival cells or the Chang conjunctival cell model to determine the effects of glucosamine sulfate on the production of ICAM-1 in response to tumor necrosis factor (TNF)-alpha, interferon (IFN)-gamma, interleukin (IL)-1beta, IL-6, TNF-alpha plus IFN-gamma, or TNF-alpha plus IL-1beta. The effects of glucosamine sulfate on the expression of the ICAM-1 gene, upregulated by various cytokines, were determined by semiquantitative reverse transcription-polymerase chain reaction. The activation and nuclear translocation of the nuclear factors NF-kappaB and STAT1 were evaluated by the transient transfection of reporter gene systems and immunocytochemistry. The influence of glucosamine-sulfate-modulated ICAM-1 on neutrophil adhesion was demonstrated in a model that measures the adherence of conjunctival cells and neutrophils., Results: TNF-alpha, IFN-gamma, and IL-1beta significantly increased the production of ICAM-1 by both primary cultured human conjunctival cells and Chang conjunctival cells. Glucosamine sulfate effectively downregulated the production of ICAM-1 induced by TNF-alpha, IFN-gamma, IL-1beta, TNF-alpha plus IFN-gamma, or TNF-alpha plus IL-1beta. This downregulation occurred through the interferon-stimulated response element, IFN-gamma activation sequence, and binding sequence of NF-kappaB at the mRNA and protein levels. Glucosamine sulfate further inhibited the nuclear translocation of p65 protein in TNF-alpha- and IL-1beta-stimulated Chang conjunctival cells and phosphorylated STAT1 in IFN-gamma-stimulated Chang conjunctival cells. Glucosamine sulfate also significantly reduced the number of neutrophils adhering to a conjunctival monolayer in response to TNF-alpha, IFN-gamma, or IL-1beta., Conclusions: Our results suggest that glucosamine sulfate inhibits ICAM-1 production in conjunctival epithelial cells in vitro. Therefore, glucosamine sulfate might be valuable in the treatment of inflammatory ocular-surface conditions.

Purpose: The aim of this study was to compare the efficacy of 0.5% apraclonidine with that of 4% cocaine and to evaluate its safety in the diagnosis of Horner syndrome in pediatric patients., Methods: This was a randomized, crossover study, wherein 10 patients with a probable diagnosis of Horner syndrome were assigned to undergo pharmacological testing with 4% cocaine and 0.5% apaconidine. The difference in the pupil diameters of each eye was recorded under dim light before and 1 h after 0.5% apraclonidine or 4% cocaine was instilled. Any adverse effects were noted during examination or reported by the patients' parents were recorded., Results: The mean differences in pupil diameter before and after 4% cocaine testing were -2.08 and -2.97 mm, respectively (P = 0.0047). All patients had an anisocoria greater than 1 mm after 4% cocaine testing. The mean difference in pupil diameter before and after 0.5% apraclonidine was instilled were -2.04 and +1.08 mm, respectively (P = 0.005). All patients showed a reversal of anisocoria after 0.5% apraclonidine testing. Conjunctival hyperemia was noted in 2 patients, but systemic adverse effects were not noted during examination nor reported by the patients' parents., Conclusions: The application of 0.5% apraclonidine in pediatric patients is safe and effective in the diagnosis of Horner syndrome.

Aims: The aim of this study was to evaluate the efficacy of mitomycin C in reducing postoperative adhesions following strabismus surgery., Methods: This study was a prospective, single-center, interventional case series. We randomized 14 patients with restrictive strabismus to the mitomycin C group (7 patients) or to the control group (7 patients). We used mitomycin C intraoperatively for 5 min at a concentration of 0.2 mg/mL in the mitomycin group after adhesion release. We compared postoperative results using the forced duction test., Results: Compared to the control group, the mitomycin C group exhibited a better range of passive duction at all postoperative follow-up times; however, mitomycin C did not completely eliminate the problem of postoperative adhesions. Patients receiving mitomycin C did not report any complications during this study., Conclusions: The intraoperative application of mitomycin C is a safe and effective adjunct to surgery in the treatment of restrictive strabismus.

Purpose: To investigate the clinical efficacy of a new patient-operated intraocular pressure tool, the Proview eye pressure monitor (PEPM; Bausch & Lomb, Inc., Rochester, NY), for monitoring intraocular pressure (IOP) in patients with glaucoma or ocular hypertension., Patients and Methods: One hundred and forty eyes of 70 Taiwanese patients from the Tri-Service General Hospital (Taiwan, Republic of China) who had been diagnosed with ocular hypertension or glaucoma were studied. After being fully trained during an initial clinic visit, patients measured their own IOP with the PEPM at home. The IOPs were measured again using a Haag-StreitBern Goldmann tonometer (GT; Haag-Streit, Köniz, Switzerland) during subsequent outpatient visits. The training time, assessment of the patients' ease of PEPM use, and accuracy of measured PEPM IOPs in relation to GT IOPs were recorded and analyzed., Results: Relative to GT readings, PEPM readings tended to be overestimated at lower pressure (<10 mmHg) and underestimated at higher pressure (>20 mmHg). Between 10 to 20 mmHg, PEPM measurements did not significantly differ from GT measurements. Up to 80% of the PEPM measurements fell within +/- 3 mmHg of the corresponding GT readings. When consideration was limited to GT readings of > or =21 mmHg, PEPM measured IOPs of > or =21 mmHg with a sensitivity of 80% and a specificity of 90%. The mean satisfaction rating of PEPM use was 88.3 +/- 2.0 (maximum, 100). The mean training time for appropriate use of PEPM was 17.9 +/- 4.0 minutes. The older the patients, the longer the training time that was required., Conclusion: Our data suggest that after appropriate training: (1) PEPM and GT measurements correspond well between 10 mmHg and 20 mmHg and (2) PEPM could offer patients with glaucoma or ocular hypertension an easy-to-use, substantially reliable means of selfmonitoring IOP.